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diff --git a/L1/questions.jsonl b/L1/questions.jsonl
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index 0000000000000000000000000000000000000000..843dbb5bd047970ef16ba30dbad71f3173141dd7
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+{"id":"l1-sample-1c4540f592a065284cecaaa5","question":"根据 CSCO 2025，治疗前常规加做 PET/CT 的“高远处转移风险”人群，哪一项表述最准确？","options":{"A":"仅病理为未分化型，但分期早且 EBV DNA 不高","B":"T1N0M0，且 EBV DNA 低水平或阴性","C":"N0–1 且 EBV DNA >4000 copies/mL，或 N2–3，或 T3–4","D":"原发灶局限鼻咽、无任何高危因素者均应常规 PET/CT"},"answer":"C"}
+{"id":"l1-sample-7662f5f79a5812f9b86a9fc7","question":"根据 CSCO 2025，对极低远处转移风险的确诊鼻咽癌患者，以下哪项最符合“先分层、后升级”的筛查策略？","options":{"A":"直接以全身 PET/CT 作为所有患者的常规首选","B":"以 PET/MRI 替代胸部 CT 与腹部评估","C":"先行脑 MRI 与骨髓穿刺，以排除隐匿远转","D":"先行腹部超声；如结果可疑，再补充上腹部增强 CT 或 MRI"},"answer":"D"}
+{"id":"l1-sample-1f7c06723e7868f5a28d05a1","question":"根据 CSCO 2025，结构化影像报告对鼻咽癌临床管理的直接价值，以下哪项最符合指南表述？","options":{"A":"主要服务科研，临床决策价值有限","B":"有助于减少侵犯范围和淋巴结信息遗漏，并为精准分期与治疗决策提供标准化信息","C":"仅在复发再分期时有价值，初诊意义有限","D":"可替代病理并直接给出组织学分型"},"answer":"B"}
+{"id":"l1-sample-37503f36da80ddffc1fa3cdf","question":"MRI提示蝶骨基底部轻度骨硬化，但病灶与原发灶不连续，且各序列信号不与原发灶一致。对该影像学表现最合理的判断是？","options":{"A":"应直接按N3处理","B":"不能仅凭此表现升为T3","C":"可直接定为T4","D":"可直接定为T3"},"answer":"B"}
+{"id":"l1-sample-3e36776cb7848cf0ce3806f2","question":"关于 PET/MRI 在鼻咽癌治疗前评估中的定位，最符合 CSCO 2025 表述的是：","options":{"A":"已可完全替代标准 PET/CT 与鼻咽+颈部 MRI 路径","B":"仅适用于所有早期患者","C":"仍处探索阶段，尚不能替代标准 PET/CT 与 MRI 路径","D":"只能用于复发后评估"},"answer":"C"}
+{"id":"l1-sample-91bf6c62b123334b7aadfd4b","question":"根据 CSCO 2025，对鼻咽癌颅底骨侵犯的影像学判定，最符合指南的是：","options":{"A":"只要MRI稍异常即可","B":"病灶需与原发灶连续，且MRI信号与原发灶一致","C":"任何翼突基底部改变都算T4","D":"只要CT有骨质硬化即可"},"answer":"B"}
+{"id":"l1-sample-3719fef52e654f77444dbc94","question":"根据 CSCO 2025，对早期颅底骨质受侵的影像诊断，特别强调：","options":{"A":"仅有 MRI/CT 骨质硬化不足以诊断 T3，需在所有 MRI 序列上与原发肿瘤信号一致","B":"CT/MRI 只要出现骨质硬化即可诊断 T3","C":"所有颅底骨质异常都应按 T4 处理","D":"只要蝶骨基底部或翼突异常即直接降为 T2"},"answer":"A"}
+{"id":"l1-sample-6c3db22f88f351344b0774fc","question":"根据 CSCO 2025，关于鼻咽原发灶侵犯范围评估的首选影像学，哪一项最符合指南？","options":{"A":"颈部超声联合骨显像作为局部首选影像","B":"鼻咽平扫+增强MRI","C":"FDG-PET/CT作为原发灶首选并替代MRI","D":"鼻咽平扫+增强CT作为常规首选"},"answer":"B"}
+{"id":"l1-sample-a10005f8559addbd49e60cd8","question":"根据 CSCO 2025，对 MRI 尚未达到转移标准的小颈部淋巴结，若 PET/CT 出现明确异常摄取，最符合指南的处理是：","options":{"A":"按转移淋巴结纳入分期与靶区评估","B":"仍按反应性淋巴结处理，仅建议短期随访","C":"只有同时出现坏死或环形强化时才可视为转移","D":"必须先行开放活检后方可上调分期"},"answer":"A"}
+{"id":"l1-sample-c954e6ced0f1c284a1ff76d4","question":"根据 CSCO 2025，当鼻咽原发灶尚未明确、但出现颈部淋巴结肿大或非常规区域淋巴结可疑转移时，下一步最符合指南的是：","options":{"A":"在影像引导下对可疑淋巴结行穿刺/活检以明确病理与原发线索","B":"经验性按鼻咽癌直接开始放化疗","C":"仅凭 EBV DNA 阳性即可视为鼻咽癌转移","D":"直接做开放性整块淋巴结切除活检作为首选"},"answer":"A"}
+{"id":"l1-sample-73790c9fe25803a58aa10e0f","question":"根据 CSCO 2025，关于鼻咽癌中 PET/CT 与 MRI 的分工，下列哪项最符合指南逻辑？","options":{"A":"两者功能等价，仅根据设备可及性任选其一即可","B":"MRI 仍是原发灶与邻近软组织侵犯评估首选；PET/CT 更有助于小淋巴结和远处转移评估","C":"MRI 主要用于远处转移筛查，PET/CT 主要用于原发灶 T 分期","D":"PET/CT 可替代 MRI 作为原发灶侵犯范围评估首选"},"answer":"B"}
+{"id":"l1-sample-a96260063376cb339975fe61","question":"根据 CSCO 2025，在鼻咽镜可达且可见可疑原发灶的前提下，获取组织学诊断的首选方式通常是？","options":{"A":"鼻咽镜下肿块活检","B":"外周血 ctDNA 检测","C":"PET/CT 代替病理取材","D":"颈部开放性淋巴结活检作为首选"},"answer":"A"}
+{"id":"l1-sample-0441177c2b985bef57a48565","question":"根据 CSCO 2025，若鼻咽原发灶难以取得诊断性组织，下一步最符合指南的补救策略是：","options":{"A":"放弃组织学诊断，按影像直接开始治疗","B":"先完成放疗，待复发后再补病理","C":"对颈部可疑转移淋巴结行穿刺或活检以获得病理","D":"仅凭 EBV 抗体阳性即可确诊鼻咽癌"},"answer":"C"}
+{"id":"l1-sample-95ed214f0d9c5ca2fd9f14f0","question":"根据 CSCO 2025，当常规形态学尚不能明确诊断为鼻咽癌时，最符合指南的补充病理策略是：","options":{"A":"补做pancytokeratin免疫组化和/或EBER原位杂交","B":"补做p16免疫组化和HPV RNA原位杂交作为首选","C":"补做S100与SOX10以首先排查黑色素细胞肿瘤","D":"补做TTF-1与Napsin A以首先排查肺腺癌"},"answer":"A"}
+{"id":"l1-sample-65e3a6b8cf6802c1bd32eedc","question":"根据 CSCO 2025，关于我国流行区鼻咽癌的主要病理谱，哪一项最符合指南表述？","options":{"A":"以角化性鳞癌为主体，非角化性癌相对少见","B":"以非角化性癌最常见，其中又可分为分化型和未分化型","C":"几乎所有病例均应直接归为未分化癌","D":"以基底样鳞癌最常见，且与 EBV 关系最密切"},"answer":"B"}
+{"id":"l1-sample-82e7769d38664f54ed42cc3c","question":"根据 NCCN 2025，当囊性颈部淋巴结作为首发表现时，最符合指南的诊断取材策略是：","options":{"A":"应先做开放性切除活检，再考虑针吸","B":"应先经验性抗感染治疗，待肿块持续存在后再说","C":"单纯触诊下 FNA 已足够，通常优于图像引导穿刺","D":"US 或 CT 引导下的针吸/穿刺可提高诊断收益，优于单纯触诊 FNA"},"answer":"D"}
+{"id":"l1-sample-6513d4f3ab295e0f09230357","question":"根据 NCCN 2025，对不可切除或转移性疾病、且计划接受系统治疗的患者，若需追加组织取材，最符合指南目的导向的是：","options":{"A":"尽量获取 core biopsy，以便后续免疫与基因组辅助检测","B":"细胞学阳性后不再需要更多组织","C":"仅检测外周血 EBV DNA 即可取代组织学扩展检测","D":"先开始治疗，病理类型以后再补"},"answer":"A"}
+{"id":"l1-sample-a7a8dfb30e639fba94e09c16","question":"囊性颈部淋巴结作为初始诊断线索时，哪一种取材策略更能提高诊断收益？","options":{"A":"单纯触诊下 FNA","B":"先经验性抗感染后再决定是否穿刺","C":"直接开放性整块切除活检","D":"图像引导下（超声或 CT）穿刺"},"answer":"D"}
+{"id":"l1-sample-83041f133076fa6b89d29a02","question":"对不可切除或转移性 NPC、且已计划进入全身治疗的患者，额外获取 core biopsy 最重要的价值是：","options":{"A":"满足后续免疫与基因组辅助检测需要","B":"替代 MRI","C":"替代病理诊断本身","D":"只为了 HPV 检测"},"answer":"A"}
+{"id":"l1-sample-e3424d962b6e8167e20342fd","question":"按CSCO，以下哪类患者最需要纳入鼻咽癌MDT常规讨论对象？","options":{"A":"局部晚期、复发/转移，或出现严重放疗并发症，或需要评估局部根治手段利弊的患者","B":"所有T1N0且治疗完全标准化的患者","C":"仅病理未分化型患者","D":"仅儿童患者"},"answer":"A"}
+{"id":"l1-sample-444cead0bc71b1cab860d04c","question":"根据 CSCO 2025，鼻咽癌 MDT 讨论对象中，除局部晚期及复发/转移患者外，还应特别纳入：","options":{"A":"仅儿童患者","B":"仅角化型患者","C":"所有 T1N0 患者","D":"出现严重放疗并发症（如鼻咽坏死、放射性脑病）的患者"},"answer":"D"}
+{"id":"l1-sample-e1e0ef3cdf44602fae0751ea","question":"根据 CSCO 2025，鼻咽癌 MDT 的 I 级推荐学科构成不包括：","options":{"A":"病理科、核医学科、营养科、生物治疗/免疫治疗科","B":"仅病理科和手术科，其他学科可不参加","C":"放疗科、肿瘤内科、放射诊断科、头颈外科/耳鼻喉科","D":"心理科、口腔科"},"answer":"B"}
+{"id":"l1-sample-32ce7f35b40ee66e75435e46","question":"根据 AJCC/UICC 第9版与 CSCO 2025，下列哪项最符合 T1 的定义？","options":{"A":"肿瘤侵犯咽旁间隙和/或邻近软组织","B":"肿瘤局限鼻咽，或侵犯鼻腔/口咽但无咽旁间隙受侵","C":"肿瘤侵犯颅底骨或鼻旁窦","D":"肿瘤侵犯眶下裂/眼眶或明确颅神经"},"answer":"B"}
+{"id":"l1-sample-146e2618210b7a46e9af3c02","question":"根据 AJCC/UICC 第9版与 CSCO 2025，下列哪项最符合 T2 的定义？","options":{"A":"肿瘤局限鼻咽，或仅及鼻腔/口咽","B":"肿瘤侵犯颅底骨、鼻旁窦或颈椎","C":"肿瘤侵犯咽旁间隙和/或邻近软组织（如翼内肌、翼外肌、椎前肌）","D":"肿瘤侵犯眶下裂/眼眶或明确颅神经"},"answer":"C"}
+{"id":"l1-sample-d06615a88c34b6d20769ed2b","question":"根据 AJCC/UICC 第9版与 CSCO 2025，下列哪项最符合 T3 的定义？","options":{"A":"肿瘤侵犯咽旁间隙和邻近软组织，但无骨结构受侵","B":"肿瘤侵犯眶下裂、眼眶或明确颅神经","C":"肿瘤明确侵犯颅底骨、鼻旁窦、颈椎或翼状结构等骨性结构","D":"仅出现双侧咽后淋巴结转移"},"answer":"C"}
+{"id":"l1-sample-67246b8752a66f01a99dbd93","question":"根据 AJCC/UICC 第9版与 CSCO 2025，下列哪项最符合 T4 的定义？","options":{"A":"肿瘤局限鼻咽，或仅及鼻腔/口咽","B":"明确侵犯颅神经、眶下裂/眼眶或颅内","C":"仅见蝶骨基底部骨硬化，但缺乏连续侵犯与典型 MRI 肿瘤信号","D":"仅见鼻旁窦侵犯而无其他高级受侵"},"answer":"B"}
+{"id":"l1-sample-8b048f3a8a93f1937b75d3df","question":"根据 CSCO 2025，关于早期颅底骨质受侵，最符合指南表述的是？","options":{"A":"任何翼突改变均可定为 T3","B":"只要 MRI 可疑即为 T3","C":"只要 CT 有骨硬化即为 T3","D":"需病灶与原发灶连续，且 MRI 各序列信号与原发灶一致"},"answer":"D"}
+{"id":"l1-sample-a8d9bcfc95350db5fcb3d9a7","question":"根据 CSCO 2025，对明确眶下裂受侵的鼻咽癌，分期和高危靶区设计更应按：","options":{"A":"T4","B":"T3","C":"T2","D":"仅N分期改变"},"answer":"A"}
+{"id":"l1-sample-7506d12967e8571f723e776e","question":"根据 AJCC/UICC 第9版与 CSCO 2025，N1 的定义最符合下列哪项表述？","options":{"A":"双侧颈部淋巴结转移，均≤6 cm，位于环状软骨尾侧缘以上，且无严重颈部包膜外侵","B":"单侧颈部淋巴结和/或单、双侧咽后淋巴结转移，均≤6 cm，位于环状软骨尾侧缘以上，且无严重颈部包膜外侵","C":"任一颈部淋巴结 >6 cm，或侵犯环状软骨尾侧缘以下","D":"任何伴严重颈部包膜外侵的颈部淋巴结转移，即使≤6 cm且位于环状软骨以上"},"answer":"B"}
+{"id":"l1-sample-21ee82e529a268415fe6691f","question":"根据 AJCC/UICC 第9版与 CSCO 2025，下列哪项最符合 N2 定义？","options":{"A":"任一颈部淋巴结 >6 cm，或侵犯环状软骨尾侧缘以下","B":"仅出现咽后淋巴结转移即可定义为 N2","C":"双侧颈部淋巴结转移，均 ≤6 cm，位于环状软骨尾侧缘以上，且无严重颈部 ENE","D":"单侧颈部淋巴结转移，≤6 cm，位于环状软骨尾侧缘以上，且无严重颈部 ENE"},"answer":"C"}
+{"id":"l1-sample-41535ba4bc7b5224a6ddfc8b","question":"根据 AJCC/UICC 第9版与 CSCO 2025，N3 的定义最符合下列哪项表述？","options":{"A":"双侧颈部淋巴结转移，均≤6 cm，位于环状软骨尾侧缘以上，无严重颈部包膜外侵","B":"任一 VB 区淋巴结转移，即使≤6 cm且无严重包膜外侵","C":"单侧或双侧颈部淋巴结 >6 cm，或侵犯环状软骨尾侧缘以下，或存在严重颈部包膜外侵","D":"任何坏死性颈部淋巴结转移，即使≤6 cm且位于环状软骨以上"},"answer":"C"}
+{"id":"l1-sample-ea53f9663b84038af3a6a0c8","question":"根据 AJCC/UICC 第9版与 CSCO 2025，严重颈部淋巴结包膜外侵在分期中的意义是？","options":{"A":"一旦出现即按M1处理","B":"主要用于T分期调整而非N分期调整","C":"仅提示预后不良，但不影响N分期","D":"可将原本N1–2级别的颈部结节病变升级至N3"},"answer":"D"}
+{"id":"l1-sample-d3a03d9c5e6540da575a6add","question":"根据 AJCC/UICC 第9版与 CSCO 2025，关于咽后淋巴结严重包膜外侵，以下哪项最符合指南表述？","options":{"A":"应与严重颈部ENE完全等同，一律直接按N3处理","B":"不建议仅凭咽后淋巴结包膜情况直接升级至N3","C":"一旦存在即归入M1a","D":"一旦存在即按T4处理"},"answer":"B"}
+{"id":"l1-sample-4ef94d5d4b04ad25d7e3d0b0","question":"根据 AJCC/UICC 第9版与 CSCO 2025，T0 的定义是？","options":{"A":"原位癌局限于鼻咽黏膜","B":"局限鼻咽的微小灶，影像学难以显示","C":"原发灶无法评价，但已有颈部淋巴结肿大","D":"无原发肿瘤证据，但有EBV阳性的颈部淋巴结累及"},"answer":"D"}
+{"id":"l1-sample-4ed1cd98f95e34f52077aa58","question":"单侧颈II区淋巴结 4.5 cm，MRI示侵犯胸锁乳突肌。分期中，该淋巴结最关键的分期意义是？","options":{"A":"仍属N1，因为未超过6 cm","B":"直接归为M1a","C":"仍属N2，因为没有下颈受累","D":"可按N3，因为存在严重颈部包膜外侵"},"answer":"D"}
+{"id":"l1-sample-817f81d09fa650add2470d81","question":"根据 CSCO 2025，以下哪项属于分期调整中写明的新要点？","options":{"A":"任何咽后淋巴结高级别包膜外侵均直接升级至 N3","B":"严重颈部淋巴结包膜外侵升级至 N3","C":"M1a 与 M1b 以是否肝转移为界","D":"T1N0 改归 IB 期"},"answer":"B"}
+{"id":"l1-sample-795f18d16c54a7a961dc142b","question":"根据 CSCO 2025，对于咽后淋巴结的高级别包膜外侵犯，下列哪项最符合分期与影像解释？","options":{"A":"一律按 M1a 处理","B":"一律直接按 N3 处理","C":"一律按 T4 处理","D":"一般不建议仅凭咽后淋巴结高级别包膜外侵犯升级至 N3"},"answer":"D"}
+{"id":"l1-sample-ca17666d22625293321f962e","question":"根据 AJCC/UICC 第9版与 CSCO 2025，M1a 指？","options":{"A":"≥1个器官/部位存在≤3个转移病灶","B":"单器官转移但病灶数>3个","C":"仅远处淋巴结转移而无实质器官转移","D":"仅单器官单病灶转移"},"answer":"A"}
+{"id":"l1-sample-a426bf344df0e58a02e4320f","question":"根据 AJCC/UICC 第9版与 CSCO 2025，M1b 指？","options":{"A":"仅骨转移且骨灶>3个时才属M1b","B":"仅肺转移","C":"≥1个器官/部位存在>3个转移病灶","D":"任何肝转移均属M1b"},"answer":"C"}
+{"id":"l1-sample-75cebc344564c7fb52ad8a8d","question":"根据 AJCC/UICC 第9版与 CSCO 2025，IA 期最符合分期表述的是：","options":{"A":"T4N0–2M0或任何T、N3M0","B":"T1–2N0M0","C":"T3N0–2M0","D":"T0–2N1M0"},"answer":"B"}
+{"id":"l1-sample-40b33d025527c63becbf74d2","question":"根据 AJCC/UICC 第9版与 CSCO 2025，下列哪一组属于 ⅠB 期？","options":{"A":"T1–2N0M0","B":"T3N0–2M0","C":"T0–2N1M0","D":"T4N0–2M0 或任何 T、N3M0"},"answer":"C"}
+{"id":"l1-sample-2f35aa16c3b165b16ad7e167","question":"根据 AJCC/UICC 第9版与 CSCO 2025，II 期最符合分期表述的是：","options":{"A":"T0–2N2M0或T3N0–2M0","B":"T1–2N0–1M0","C":"任何T、任何N、M1a","D":"T4N0–2M0或任何T、N3M0"},"answer":"A"}
+{"id":"l1-sample-de28257eedb482ffb44d1cca","question":"根据 AJCC/UICC 第9版与 CSCO 2025，下列哪一组属于 Ⅲ期？","options":{"A":"T3N1M0","B":"T1–2N0M0","C":"任何 T、任何 N、M1a","D":"T4N0–2M0，或任何 T、N3M0"},"answer":"D"}
+{"id":"l1-sample-06d91d044e80a719c3e16a5b","question":"根据 AJCC/UICC 第9版与 CSCO 2025，关于鼻咽癌总体分期框架，下列哪项正确？","options":{"A":"Stage IV 仍包括大量非转移性 T4/N3 病例","B":"所有 T4M0 仍自动归入 Stage IV","C":"所有 N3M0 仍自动归入 IVA","D":"Stage IV 仅保留给 M1 疾病，并细分为 IVA（M1a）和 IVB（M1b）"},"answer":"D"}
+{"id":"l1-sample-0c9d35876d6a567eb01c71a6","question":"患者分期为T2N1M0。按总体分期，最符合的是？","options":{"A":"II期","B":"IA期","C":"IB期","D":"III期"},"answer":"C"}
+{"id":"l1-sample-5c40187fd1dfae0e04cda89b","question":"患者cT4N2M1，PET/CT示肝和骨共4个远处病灶。按总体分期，最符合的是？","options":{"A":"不能分期，需先治疗后再定","B":"III期","C":"IVA期","D":"IVB期"},"answer":"D"}
+{"id":"l1-sample-c8a1c14ebfa64227afd33e9e","question":"根据 CSCO 2025，鼻咽癌总体分期中，哪项最符合 2025 的新分期框架？","options":{"A":"Stage IV 仅保留给转移性疾病，并细分 IVA/IVB","B":"Stage IV 仍包含大量非转移性 T4/N3 患者","C":"M1 不再细分","D":"T1N0 与 T2N0 仍分属不同总分期"},"answer":"A"}
+{"id":"l1-sample-4fd242c96e36d2ca25f29456","question":"根据 CSCO 2025，对于鼻咽坏死患者，特别指出哪一因素可纳入临床风险分层模型？","options":{"A":"既往是否扁桃体切除","B":"ABO 血型","C":"颈内动脉暴露情况","D":"是否近视"},"answer":"C"}
+{"id":"l1-sample-2e52e74d44341d386ee62bb9","question":"根据 CSCO 2025，T1N0 的标准初治结论是？","options":{"A":"必须诱导化疗","B":"无须化疗，根治性放疗为主","C":"必须辅助化疗","D":"必须同步化疗"},"answer":"B"}
+{"id":"l1-sample-9d8d869a18f96be5cd6ee230","question":"根据 NCCN 2025，T1N0M0 的标准局部治疗是？","options":{"A":"免疫联合 RT","B":"CCRT→辅助","C":"definitive RT","D":"IC→CCRT"},"answer":"C"}
+{"id":"l1-sample-bd5b265fbf404509ffbe297f","question":"根据 NCCN 2025，T2N0M0 若存在 high-risk features，更符合的是？","options":{"A":"definitive RT ± concurrent systemic therapy","B":"必须手术","C":"仍只能 RT alone","D":"必须后线免疫"},"answer":"A"}
+{"id":"l1-sample-48a9ff5ed5f2b1b5c5130463","question":"根据 CSCO 2025，T1–2N1 一旦合并明显不良因素，更标准的路径是哪一项？","options":{"A":"仍优先单纯放疗，不因危险因素改变","B":"同期放化疗","C":"先完成放疗，再视情况只做辅助治疗","D":"必须一律升级为诱导化疗后同期放化疗"},"answer":"B"}
+{"id":"l1-sample-81eed36698570de1a046ee47","question":"根据 CSCO 2025，T4N0 或 T3N1 的 I 级推荐是？","options":{"A":"仅辅助化疗","B":"单纯放疗","C":"单药免疫","D":"诱导化疗 + 同期放化疗"},"answer":"D"}
+{"id":"l1-sample-cf54cf1c2ee4e3bf5d39ffd0","question":"根据 CSCO 2025，T1–4N2–3 和 T4N1 的高等级推荐包括？","options":{"A":"仅诱导化疗 + 同期放化疗","B":"仅诱导化疗 + 同期放化疗 + 节拍辅助化疗","C":"诱导化疗 + 同期放化疗，以及诱导化疗 + 同期放化疗 + 节拍辅助化疗","D":"单纯放疗"},"answer":"C"}
+{"id":"l1-sample-15b7083085b8ee660e03e802","question":"根据 CSCO 2025，T1–4N2–3 和 T4N1 中，已进入高等级推荐的免疫整合路径更接近？","options":{"A":"先手术后 PD-1","B":"IC + CCRT + PD-1","C":"RT + PD-1 单药","D":"后线进展后才加 PD-1"},"answer":"B"}
+{"id":"l1-sample-44af6bb31c0a5f0a25e736eb","question":"根据 CSCO 2025 表10，对 T3N0 且无高危不良预后因素的患者，最符合表格的分层推荐是：","options":{"A":"单纯放疗可作为 1A类选择；同期放化疗为 2A类","B":"只能辅助化疗","C":"必须同期放化疗 + 特瑞普利单抗","D":"必须诱导化疗 + 同期放化疗（1A类）"},"answer":"A"}
+{"id":"l1-sample-50abd9294da917801d2cf2d7","question":"根据 NCCN 2025，局部晚期鼻咽癌诱导/序贯治疗的 preferred regimens 包括哪一项？","options":{"A":"GP 与 dose-adjusted TPF","B":"PF 与 MTX","C":"cetuximab 单药与 nivolumab 单药","D":"paclitaxel 单药与顺铂单药"},"answer":"A"}
+{"id":"l1-sample-339ee3b6727d5a71b3e97ee1","question":"根据 NCCN 2025，鼻咽癌诱导治疗 other recommended regimens 包括？","options":{"A":"Nivolumab/ipilimumab","B":"Cisplatin/5-FU 与 docetaxel/cisplatin","C":"Methotrexate 单药","D":"Tislelizumab 单药"},"answer":"B"}
+{"id":"l1-sample-bd2cc2ca133547663da668e2","question":"根据 CSCO 2025，关于局部晚期鼻咽癌诱导化疗的推荐等级，以下哪项表述最准确？","options":{"A":"只有GP属于I级推荐，TPF和TP均降为2A类","B":"单药吉西他滨因耐受性好而被列为I级推荐","C":"GP和TPF属于I级推荐，TP为2A类，而单药吉西他滨不属高等级诱导方案","D":"只要含顺铂的两药或三药方案均自动属于I级推荐"},"answer":"C"}
+{"id":"l1-sample-912a1fae2624e18bf8f705a2","question":"根据 CSCO 2025，下列哪项属于诱导化疗 2A类方案？","options":{"A":"cetuximab + RT","B":"单药卡培他滨","C":"单药顺铂","D":"TP"},"answer":"D"}
+{"id":"l1-sample-69c28a1bb9fa9293003e7665","question":"根据 CSCO 2025，同期化疗 1A类方案是？","options":{"A":"派安普利单抗","B":"顺铂","C":"卡瑞利珠单抗","D":"西妥昔单抗"},"answer":"B"}
+{"id":"l1-sample-7bd0ee2115383a7e284f67ff","question":"根据 NCCN 2025，induction 之后，与 RT 同期的药物通常包括？","options":{"A":"MTX 单药","B":"pembrolizumab 单药","C":"weekly 5-FU","D":"weekly cisplatin 或 carboplatin"},"answer":"D"}
+{"id":"l1-sample-5dc3d56314aefba20c52e485","question":"根据 NCCN 2025，CCRT 后辅助治疗的 preferred regimen 是？","options":{"A":"RT 后接 nivolumab","B":"RT 后接 cetuximab","C":"RT 后接 docetaxel","D":"Cisplatin + RT 后接 cisplatin/5-FU"},"answer":"D"}
+{"id":"l1-sample-c2a1fb7957e15eba388451f9","question":"根据 CSCO 2025，局部晚期鼻咽癌辅助治疗 1A类包括？","options":{"A":"单药 docetaxel","B":"单药 cetuximab","C":"单药派安普利单抗","D":"节拍卡培他滨"},"answer":"D"}
+{"id":"l1-sample-cca479f644bef3c252a30c26","question":"58岁患者，cT3N2M0，ECOG 0。按NCCN，最符合指南层级的治疗描述是？","options":{"A":"临床试验或IC→CCRT（preferred，category 1）或CCRT→adjuvant","B":"RT alone","C":"手术优先","D":"单药pembrolizumab"},"answer":"A"}
+{"id":"l1-sample-c77187029adfcd2b2655bb36","question":"同步放化疗阶段患者出现顺铂绝对禁忌，题干要求选择‘CSCO已明确列为可考虑的替代同步药物’。以下哪项最不符合要求？","options":{"A":"Carboplatin AUC 5–6","B":"Pemetrexed 500 mg/m² q3w","C":"Oxaliplatin 70 mg/m² weekly","D":"Nedaplatin 100 mg/m² q3w"},"answer":"B"}
+{"id":"l1-sample-d5c43867eb832ca556e0bdd1","question":"根据 CSCO 2025，对无法使用顺铂的同期放化疗患者，可选的其他同期药物不包括：","options":{"A":"奥沙利铂 70 mg/m² 每周一次","B":"卡铂 AUC 5–6","C":"伊匹木单抗 1 mg/kg 每 6 周一次","D":"奈达铂 100 mg/m² 每 3 周一次"},"answer":"C"}
+{"id":"l1-sample-39a167da1f0936ecf8c01a2e","question":"根据 CSCO 2025，关于局部晚期鼻咽癌同期顺铂给药方式，更强调：","options":{"A":"累积剂量不重要，只要完成 1 个周期即可","B":"3周方案绝对优于每周方案","C":"每周方案绝对优于3周方案","D":"决定疗效更关键的是顺铂累积剂量，而不是给药频次本身"},"answer":"D"}
+{"id":"l1-sample-7a6902544497c8c940e92f80","question":"根据 CSCO 2025，关于同期顺铂累积剂量，更符合指南的说法是：","options":{"A":"不应低于 150 mg/m²","B":"不应低于 200 mg/m²","C":"不应低于 100 mg/m²","D":"不应低于 300 mg/m²"},"answer":"B"}
+{"id":"l1-sample-2676b95fa55891e94043d0bb","question":"根据 CSCO 2025，紫杉醇（或紫杉醇白蛋白）+ 顺铂 + 卡培他滨这一一线 1B类方案，最符合表格的特征是：","options":{"A":"只能用于既往接受过PD-1治疗的患者","B":"固定只做2疗程，不做任何维持","C":"21天为一个疗程，化疗阶段后卡培他滨继续维持至疾病进展或不良反应不可耐受","D":"必须同步放疗后才能用"},"answer":"C"}
+{"id":"l1-sample-7246208d6956bf42c0902ab6","question":"根据 CSCO 2025，顺铂 + 吉西他滨 + 恩度 这一 2B类方案，最符合表格的周期特征是：","options":{"A":"21天一疗程，固定6疗程","B":"14天一疗程，直到进展","C":"21天一疗程，最多4疗程","D":"28天一疗程，最多8疗程"},"answer":"C"}
+{"id":"l1-sample-44909a8c2edc6f2ec7a40fb5","question":"根据 CSCO 2025，关于局部晚期鼻咽癌诱导化疗表格，GP 与 TPF 的典型周期写法最符合的是：","options":{"A":"GP 固定1疗程，TPF 固定6疗程","B":"GP 为每周方案，TPF 为每2周方案","C":"二者通常都按每3周一次，共3疗程书写","D":"二者都按每4周一次，直到进展"},"answer":"C"}
+{"id":"l1-sample-3e859d722c6076e3f6c15745","question":"根据 CSCO 2025 表10，对 T1-4N2-3 和 T4N1，以下哪项属于 1A类推荐？","options":{"A":"仅免疫单药","B":"仅同步顺铂单药","C":"诱导化疗 + 同期放化疗；诱导化疗 + 同期放化疗 + 节拍辅助化疗；诱导化疗 + 同期放化疗 + 信迪利单抗/卡瑞利珠单抗","D":"单纯放疗"},"answer":"C"}
+{"id":"l1-sample-4a4088e3670aa78d2b98ca83","question":"根据 CSCO 2025 表11，局部晚期鼻咽癌的诱导化疗 1A类方案不包括：","options":{"A":"顺铂 + 5-FU","B":"紫杉醇 + 顺铂 + 卡培他滨","C":"TPF","D":"GP"},"answer":"A"}
+{"id":"l1-sample-d10a282c5e323002e54c1fa0","question":"根据 CSCO 2025 表11，下列哪项最符合局部晚期鼻咽癌辅助化疗在表格中的推荐层级？","options":{"A":"只有顺铂+5-FU 为 1A类，节拍卡培他滨为 2A类","B":"节拍卡培他滨与顺铂+5-FU 均为 1A类","C":"卡培他滨单药为 1A类，但节拍卡培他滨不是","D":"所有辅助化疗都只列为 2B类"},"answer":"B"}
+{"id":"l1-sample-b42155d77451872297e59d46","question":"根据 NCCN 2025 NASO-B 脚注，关于“cisplatin + RT 不接辅助化疗”的证据等级，下列哪项最准确？","options":{"A":"对 T3,N1–3,M0 / T4,N0–3,M0 / T0(EBV+)–2,N2–3,M0 为 category 2B；对其他适应分期为 category 2A","B":"对所有需并放的分期均为 category 1","C":"所有分期都只列为 category 2B","D":"NCCN 不区分不同分期的证据等级"},"answer":"A"}
+{"id":"l1-sample-02e087c0de8e4a3805be721f","question":"根据 CSCO 2025，对顺铂绝对禁忌、但仍需完成同期治疗的患者，以下哪组药物全部属于指南已明确列出的替代同步方案？","options":{"A":"卡铂 AUC 5、吉西他滨 1000 mg/m²、依托泊苷 100 mg/m²","B":"奥沙利铂 85 mg/m² q2w、培美曲塞、替吉奥","C":"卡铂 AUC 5–6、奥沙利铂 70 mg/m² weekly、奈达铂 100 mg/m² q3w","D":"卡铂 AUC 2 weekly、培美曲塞 500 mg/m²、奈达铂 80 mg/m²"},"answer":"C"}
+{"id":"l1-sample-2ea018100cb468ab13fbba6a","question":"根据 CSCO 2025，周疗与三周疗顺铂的比较，当前更稳妥的表述是：","options":{"A":"累积剂量更关键，通常不应低于 200 mg/m²","B":"两者都不再推荐","C":"三周疗一定优于周疗","D":"周疗一定优于三周疗"},"answer":"A"}
+{"id":"l1-sample-05e59e7b0819e1c1ea30014d","question":"根据 NCCN 2025，classic concurrent systemic therapy/RT 中，q3w 顺铂一般给？","options":{"A":"25 mg/m² d1–4","B":"100 mg/m²，共 2–3 周期","C":"40 mg/m²，共 2 周期","D":"80 mg 固定剂量每周"},"answer":"B"}
+{"id":"l1-sample-e22d7b5a179330f94162b752","question":"根据 NCCN 2025，对 cisplatin ineligible/intolerant 者，可考虑？","options":{"A":"只能改用 EGFR 单抗","B":"Carboplatin + RT followed by carboplatin/5-FU","C":"直接放弃同期治疗","D":"只能改用 PD-1 单药"},"answer":"B"}
+{"id":"l1-sample-159c09d9f4c42ab9270a799d","question":"根据 CSCO 2025，对可切除的局部复发鼻咽癌，最符合“局部根治优先”理念的治疗是：","options":{"A":"挽救性手术，优先考虑经鼻内镜微创切除","B":"一律先二线免疫","C":"一律先再程放疗","D":"只做支持治疗"},"answer":"A"}
+{"id":"l1-sample-414f8fab9958780316d059cc","question":"根据 CSCO 2025，对单纯颈部淋巴结复发的患者，当前首选局部治疗方式是：","options":{"A":"单纯化疗","B":"一律再程放疗","C":"单纯观察","D":"颈部淋巴结清扫术"},"answer":"D"}
+{"id":"l1-sample-d492a3f6b80ca20b16e4592f","question":"局部鼻咽复发，病灶局限，可完整切除。按CSCO，更符合局部根治优先理念的治疗是？","options":{"A":"单纯支持治疗","B":"一律先再程放疗","C":"挽救性手术，优先考虑微创内镜路径","D":"一律后线免疫"},"answer":"C"}
+{"id":"l1-sample-5e47f6b46ef83eeb65e9f87b","question":"仅颈部淋巴结复发，无明显原发局部复发。按CSCO，当前首选局部治疗方式是？","options":{"A":"PD-1单药","B":"一律再程放疗","C":"单纯化疗","D":"颈淋巴结清扫术"},"answer":"D"}
+{"id":"l1-sample-87c03f69152d821abbf70cb1","question":"根据 CSCO 2025，对不可手术复发鼻咽癌，以下最准确的是：","options":{"A":"一律放弃局部治疗","B":"只能免疫单药","C":"所有患者都应再程放疗","D":"需结合风险分层决定是否再程放疗"},"answer":"D"}
+{"id":"l1-sample-427a6750f40d24aadf7ef074","question":"根据 NCCN 2025，复发/持续病变术后若存在最核心的高危病理特征（如ENE或阳性切缘），推荐：","options":{"A":"只做PET/CT复查","B":"只做口服卡培他滨","C":"systemic therapy/RT","D":"仅观察"},"answer":"C"}
+{"id":"l1-sample-39be6f7308424437af960900","question":"根据 CSCO 2025，关于不可手术局部复发患者的分层与再程放疗，下列哪项最准确？","options":{"A":"不可手术即只做最佳支持治疗","B":"所有不可手术患者都应立即再程放疗","C":"不可手术即直接改用儿童方案","D":"需结合高危/低危分层决定是否再程放疗"},"answer":"D"}
+{"id":"l1-sample-2a26680c31e7dd4f9ab18214","question":"根据 CSCO 2025，对初治转移后获得控制、但局部复发合并远处转移的患者，更强调的治疗主轴是：","options":{"A":"局部手术为唯一核心","B":"统一首选颈清扫","C":"统一首选再程放疗","D":"以全身系统性药物治疗为主"},"answer":"D"}
+{"id":"l1-sample-7b0e771e1839460ad60f1153","question":"根据 NCCN 2025，对 locoregional recurrence/persistent disease 且既往已接受放疗的患者，以下哪项最符合指南？","options":{"A":"再放疗总是优于手术","B":"reirradiation 应用于高度选择的患者，而非所有病例","C":"任何既往放疗患者都只能支持治疗","D":"只要有复发就禁止再放疗"},"answer":"B"}
+{"id":"l1-sample-cf53d0451a09c85a2315f42c","question":"根据 NCCN 2025 ADV-3/ADV-4，对“既往已放疗、locoregional recurrent/persistent、且 unresectable”的患者，最符合指南的是：","options":{"A":"必须直接进入儿童方案","B":"reirradiation ± systemic therapy 仅适用于高度筛选病例，且 clinical trial preferred","C":"所有病例都必须立刻再放疗","D":"只要不可切除就只能观察"},"answer":"B"}
+{"id":"l1-sample-838b7c0582002927164dc375","question":"根据 NCCN 2025，对 M1 oligometastatic disease、PS 0–1 的患者，诱导治疗后可考虑哪一项？","options":{"A":"RT 至原发灶、区域淋巴结及寡转移灶","B":"仅最佳支持治疗","C":"一律继续无限期化疗","D":"一律不做局部治疗"},"answer":"A"}
+{"id":"l1-sample-cd9237acd2b5ca048d0d2751","question":"根据 NCCN 2025，对系统治疗后达到 CR 或 near CR 的 M1 寡转移病例，可考虑：","options":{"A":"仅做骨扫描","B":"立即停治观察","C":"仅行颈清扫","D":"definitive RT to primary and regional nodes（preferred）"},"answer":"D"}
+{"id":"l1-sample-878a7f699523ed0c87efac75","question":"M1寡转移、PS 0–1患者接受诱导治疗后达到near CR。按NCCN，下一步更符合指南的是？","options":{"A":"对原发灶和区域淋巴结行definitive RT，并按需处理寡转移灶","B":"只继续无限期化疗，不再做局部治疗","C":"立即停治观察","D":"仅做颈清扫"},"answer":"A"}
+{"id":"l1-sample-a78431dd3fdad8aafbfb844c","question":"广泛转移鼻咽癌，PS 3–4。按NCCN，更符合的处理是？","options":{"A":"诱导后再并放","B":"最佳支持治疗","C":"一律加toripalimab+GP","D":"三药强化化疗"},"answer":"B"}
+{"id":"l1-sample-e614b7239caf36a87ebb090b","question":"根据 NCCN 2025 NASO-B，对 M1 oligometastatic disease 且 PS 0–1 的患者，诱导化疗后可考虑的“useful in certain circumstances”策略是：","options":{"A":"必须立即手术切除所有病灶","B":"maintenance capecitabine without concurrent RT","C":"固定进入免疫单药二线","D":"只能最佳支持治疗"},"answer":"B"}
+{"id":"l1-sample-109df2ac03913a99c35acc68","question":"根据 NCCN 2025 ADV-3/ADV-4，对“初诊即 M1、widely metastatic、PS 0–2”的患者，下列哪项最符合 very advanced 框架？","options":{"A":"必须直接最佳支持治疗","B":"可考虑 combination systemic therapy 或 single-agent systemic therapy；对有限转移者可选择性整合 surgery/RT/系统治疗；亦可最佳支持治疗","C":"只要是 M1 就必须手术","D":"只能做局部再放疗"},"answer":"B"}
+{"id":"l1-sample-0700af2e1adc88ad9faed685","question":"根据 NCCN 2025 ADV-3/ADV-4，对 widely metastatic 且 poor PS（3–4）的患者，最符合指南的是：","options":{"A":"PS 3–4 与 PS 0–1 完全采用同一策略","B":"优先 combination systemic therapy","C":"必须局部根治性放疗","D":"PS 3 可考虑 single-agent systemic therapy 或 BSC ± palliative RT/surgery；PS 4 以 BSC ± palliative RT 为主"},"answer":"D"}
+{"id":"l1-sample-bd06967e87dd95f8a7a8960d","question":"根据 NCCN 2025，对 recurrent/unresectable/oligometastatic/metastatic NPC（且无局部手术或 RT 机会），preferred first-line regimen 是：","options":{"A":"cisplatin/gemcitabine + toripalimab-tpzi","B":"PF","C":"paclitaxel 单药","D":"cetuximab 单药"},"answer":"A"}
+{"id":"l1-sample-6b5eef68ed781f733269c86a","question":"根据 CSCO 2025，关于RM-NPC一线高等级推荐，以下哪项表述最准确？","options":{"A":"一线1A类只包括GP本身，不包括任何免疫联合","B":"只有toripalimab+GP属于1A类，其他PD-1联合均为2A类","C":"GP+camrelizumab、GP+toripalimab、GP+tislelizumab、GP+tagitanlimab均已进入1A类，而pembrolizumab单药不属于这一层级","D":"所有PD-1单药均属于1A类一线标准"},"answer":"C"}
+{"id":"l1-sample-4b2277551b3df02789c057e4","question":"根据 CSCO 2025，一线 GP 方案中，吉西他滨和顺铂的常用剂量是？","options":{"A":"Gemcitabine 1250 mg/m² d1,15 + cisplatin 100 mg/m² d1","B":"Gemcitabine 1000 mg/m² d1,8 + cisplatin 80 mg/m² d1","C":"Gemcitabine 800 mg/m² d1,8 + cisplatin 75 mg/m² d1","D":"Gemcitabine 1000 mg/m² d1 + carboplatin AUC5"},"answer":"B"}
+{"id":"l1-sample-43822928709a42ac756c8b17","question":"根据 CSCO 2025，一线 GP + toripalimab 中，toripalimab 常用剂量是？","options":{"A":"240 mg q3w","B":"3 mg/kg q2w","C":"1200 mg q3w","D":"200 mg q2w"},"answer":"A"}
+{"id":"l1-sample-b1c81ea0de4fc63799e5b923","question":"根据 CSCO 2025，一线 GP + camrelizumab 中，camrelizumab 常用剂量是？","options":{"A":"240 mg q3w","B":"200 mg q3w","C":"200 mg q2w","D":"3 mg/kg q2w"},"answer":"B"}
+{"id":"l1-sample-f14c468c74200e82db0bc293","question":"根据 CSCO 2025，一线 GP + tislelizumab 方案中，tislelizumab 的常用给药为：","options":{"A":"200 mg q3w","B":"200 mg q2w","C":"240 mg q3w","D":"1200 mg q3w"},"answer":"A"}
+{"id":"l1-sample-965b5efa74546310acdff5e5","question":"根据 CSCO 2025，下列哪项属于一线 2A类方案？","options":{"A":"nivolumab/ipilimumab","B":"pembrolizumab 单药","C":"methotrexate 单药","D":"cisplatin/carboplatin + 5-FU"},"answer":"D"}
+{"id":"l1-sample-fa31fb3d888b521ce0e2caa4","question":"根据 CSCO 2025，下列哪项属于 RM-NPC 一线 2B类方案？","options":{"A":"GP + Endostar","B":"GP + toripalimab","C":"GP + camrelizumab","D":"GP"},"answer":"A"}
+{"id":"l1-sample-87976b33d1065ee12cadf77b","question":"根据 NCCN 2025，下列哪一项属于 preferred first-line regimen？","options":{"A":"cisplatin/gemcitabine","B":"carboplatin/gemcitabine","C":"cisplatin/5-FU","D":"cisplatin/gemcitabine + toripalimab-tpzi"},"answer":"D"}
+{"id":"l1-sample-a77d9e807490d13e7f52303b","question":"关于camrelizumab在RM-NPC中的用法，下列哪项配对正确？","options":{"A":"一线GP联合：200 mg q2w；后线单药：200 mg q3w","B":"一线GP联合：200 mg q3w；后线单药：200 mg q2w","C":"一线和后线均为3 mg/kg q2w","D":"一线和后线均为240 mg q3w"},"answer":"B"}
+{"id":"l1-sample-b40af8e4e1d0c6fbe390b7fc","question":"根据 CSCO 2025，与2024版相比，RM-NPC 一线 1A类方案中新增的免疫联合化疗是：","options":{"A":"GP + 帕博利珠单抗","B":"GP + 塔戈利单抗","C":"GP + 派安普利单抗","D":"GP + 纳武利尤单抗"},"answer":"B"}
+{"id":"l1-sample-28db9919b9b0ec95f4ae613b","question":"根据 CSCO 2025，关于 RM-NPC 一线治疗的表述，最准确的是：","options":{"A":"一线标准仍仅限 GP，不推荐免疫联合","B":"一线首选为 nivolumab + ipilimumab","C":"一线标准治疗为 GP + PD-1/PD-L1 单抗","D":"一线首选为单药特瑞普利单抗"},"answer":"C"}
+{"id":"l1-sample-21eaaed5fd98db69dad2a9ac","question":"根据 CSCO 2025，关于 RM-NPC 的一线标准治疗，哪一项表述最准确？","options":{"A":"GP 单药始终是唯一标准","B":"PD-1 单药已成为一线标准","C":"GP + PD-1/PD-L1 单抗是一线标准治疗","D":"CTLA-4/PD-1 双抗是一线首选"},"answer":"C"}
+{"id":"l1-sample-98e8f235a25b93eaae3b5c22","question":"根据 CSCO 2025，RM-NPC 一线 GP + 卡瑞利珠单抗的表格给法，最符合指南的是：","options":{"A":"卡瑞利珠单抗200 mg q2w；联合GP最多2疗程后停药","B":"卡瑞利珠单抗240 mg q3w；联合GP最多6疗程后停药","C":"卡瑞利珠单抗3 mg/kg q2w；不需要维持","D":"卡瑞利珠单抗200 mg q3w；联合GP 4–6疗程，后单药维持"},"answer":"D"}
+{"id":"l1-sample-9e31fb41be350acf281e84f3","question":"根据 CSCO 2025，RM-NPC 一线 GP + 特瑞普利单抗的表格给法，最符合指南的是：","options":{"A":"特瑞普利单抗240 mg q6w；仅作维持","B":"特瑞普利单抗240 mg q3w；联合GP最多6疗程，后单药维持","C":"特瑞普利单抗200 mg q3w；联合GP最多4疗程","D":"特瑞普利单抗3 mg/kg q2w；联合GP 4–6疗程后停药"},"answer":"B"}
+{"id":"l1-sample-ef626cb7d3c245722c00afde","question":"根据 CSCO 2025，RM-NPC 一线 GP + 替雷利珠单抗的表格给法，最符合指南的是：","options":{"A":"替雷利珠单抗3 mg/kg q2w；联合GP 2疗程","B":"替雷利珠单抗240 mg q3w；联合GP最多6疗程","C":"替雷利珠单抗200 mg q2w；仅单药连续使用","D":"替雷利珠单抗200 mg q3w；联合GP 4–6疗程，后单药维持"},"answer":"D"}
+{"id":"l1-sample-191f7d62af9c3af1421915a5","question":"根据 CSCO 2025，顺铂/卡铂 + 5-FU 在 RM-NPC 一线 2A类方案中的周期，最符合表格的是：","options":{"A":"21天为一个疗程，直至进展不可耐受","B":"21天为一个疗程，4–6疗程","C":"14天为一个疗程，固定2疗程","D":"28天为一个疗程，最多8疗程"},"answer":"B"}
+{"id":"l1-sample-1cb2eff1a97dea2274bc5f0a","question":"根据 CSCO 2025，卡铂 + 紫杉醇 作为 RM-NPC 一线 2A类方案时，表格中的关键周期特征是：","options":{"A":"仅可用于二线以后","B":"卡铂 AUC 5，第1天；紫杉醇 175 mg/m²，第1天；21天一疗程，4–6疗程","C":"卡铂 AUC 2，每周一次；紫杉醇 80 mg/m²，每周一次；固定8疗程","D":"卡铂 AUC 6，每4周一次；紫杉醇单药维持"},"answer":"B"}
+{"id":"l1-sample-7248ef187edbdc80363078e8","question":"根据 CSCO 2025，顺铂 + 多西他赛 作为 RM-NPC 一线 2A类方案时，表格中最常见的周期写法是：","options":{"A":"28天一疗程，最多8疗程","B":"连续口服维持直到进展","C":"14天一疗程，固定2疗程","D":"21天一疗程，4–6疗程"},"answer":"D"}
+{"id":"l1-sample-710dbfea19605e17f3607bf3","question":"根据 CSCO 2025 表12，下列哪项属于 RM-NPC 一线 2A类，而不是 1A/1B/2B类？","options":{"A":"吉西他滨 + 顺铂 + 塔戈利单抗","B":"紫杉醇或白蛋白紫杉醇 + 顺铂 + 卡培他滨","C":"卡培他滨 + 顺铂","D":"吉西他滨 + 顺铂 + 恩度"},"answer":"C"}
+{"id":"l1-sample-a0099e295bbeef3f805b6868","question":"根据 CSCO 2025 表13，下列哪项属于 RM-NPC 一线 2A类方案中的另一典型行？","options":{"A":"紫杉醇或紫杉醇白蛋白 + 顺铂 + 卡培他滨","B":"吉西他滨 + 顺铂 + 卡瑞利珠单抗","C":"吉西他滨 + 顺铂 + 特瑞普利单抗","D":"紫杉醇白蛋白 + 顺铂"},"answer":"D"}
+{"id":"l1-sample-0aa5c1613ff9adfc5a9b3f62","question":"根据 CSCO 2025 表12，下列哪项属于 RM-NPC 一线 2B类方案？","options":{"A":"顺铂/卡铂 + 5-FU","B":"吉西他滨 + 顺铂 + 恩度","C":"卡培他滨 + 顺铂","D":"紫杉醇或白蛋白紫杉醇 + 顺铂 + 卡培他滨"},"answer":"B"}
+{"id":"l1-sample-be75359771a64fa0198c3b21","question":"根据 CSCO 2025，当鼻咽原发灶“复发/残留”与“放疗后纤维化”难以区分时，最符合指南的影像学策略是：","options":{"A":"一次鼻咽镜活检阴性即可基本排除复发","B":"仅重复增强 MRI，PET/CT 无额外价值","C":"仅重复 PET/CT，MRI 不再需要","D":"结合 PET/CT 与 MRI 进行综合判断"},"answer":"D"}
+{"id":"l1-sample-7257f11b7128071f47093bdd","question":"根据 NCCN 2025，对含铂治疗后进展的 NPC，preferred subsequent-line regimen 是：","options":{"A":"toripalimab-tpzi","B":"capecitabine","C":"methotrexate","D":"cetuximab"},"answer":"A"}
+{"id":"l1-sample-0c7243c34facb8286633b348","question":"根据 NCCN 2025，pembrolizumab 作为 useful in certain circumstances 的一个条件是？","options":{"A":"所有 EBV 阳性","B":"所有 RM-NPC","C":"TMB-H（≥10 mut/Mb）","D":"仅局部复发"},"answer":"C"}
+{"id":"l1-sample-6e3cc22f883713614ec2f2af","question":"根据 CSCO 2025，至少二线系统治疗失败后的单药 camrelizumab，常用剂量是？","options":{"A":"3 mg/kg q2w","B":"200 mg q2w","C":"240 mg q3w","D":"200 mg q3w"},"answer":"B"}
+{"id":"l1-sample-168942faddba3241d9dcd117","question":"根据 CSCO 2025，后线单药 toripalimab 常用剂量是？","options":{"A":"3 mg/kg q2w","B":"240 mg q3w","C":"200 mg q3w","D":"200 mg q2w"},"answer":"A"}
+{"id":"l1-sample-6edc01bca33053b2f6c0bef4","question":"根据 CSCO 2025，后线单药 penpulimab 常用剂量是？","options":{"A":"240 mg q3w","B":"3 mg/kg q2w","C":"1200 mg q3w","D":"200 mg q2w"},"answer":"D"}
+{"id":"l1-sample-178a60213a80b58330d43c26","question":"根据 CSCO 2025，camrelizumab + apatinib 的常见后线剂量组合是：","options":{"A":"camrelizumab 240 mg q3w + apatinib 250 mg qd","B":"camrelizumab 200 mg q3w + apatinib 250 mg qd","C":"camrelizumab 200 mg q2w + apatinib 500 mg qd","D":"camrelizumab 200 mg q3w + apatinib 125 mg qd"},"answer":"B"}
+{"id":"l1-sample-d156b84a20d619341f1868ea","question":"关于toripalimab在鼻咽癌中的给药，下列哪项配对正确？","options":{"A":"一线和后线均为200 mg q3w","B":"一线和后线均为200 mg q2w","C":"一线GP联合：3 mg/kg q2w；后线单药：240 mg q3w","D":"一线GP联合：240 mg q3w；后线单药：3 mg/kg q2w"},"answer":"D"}
+{"id":"l1-sample-200463b4033182c23d1917a5","question":"64岁RM-NPC患者，一线未接受toripalimab，现含铂后进展，PD-L1阳性。按NCCN，下列哪项最符合‘preferred subsequent-line’层级？","options":{"A":"Capecitabine","B":"Pembrolizumab","C":"Nivolumab","D":"Toripalimab-tpzi"},"answer":"D"}
+{"id":"l1-sample-2ecc30629f001ebeab616aca","question":"既往治疗过的复发/转移性非角化型NPC，当前病情进展。按NCCN，下列哪项对nivolumab的表述最准确？","options":{"A":"属于可考虑的后线免疫，限定为既往治疗过的复发/转移性非角化型疾病","B":"只能与gemcitabine合用","C":"是preferred subsequent-line，优先于toripalimab","D":"仅限PD-L1阳性患者"},"answer":"A"}
+{"id":"l1-sample-04f1518b6304792cc3aceb25","question":"根据 CSCO 2025，关于 RM-NPC 二线/多线治疗，以下哪项更符合 2025 版趋势？","options":{"A":"二线及以上仍鼓励临床试验，单药化疗仍是重要基石之一","B":"所有既往 PD-1 失败患者都直接进入 CTLA-4 双抗标准方案","C":"二线后不再建议任何系统治疗","D":"PD-1 单药已完全取代单药化疗成为二线Ⅰ级推荐"},"answer":"A"}
+{"id":"l1-sample-b9693e8aa16ae40af764f984","question":"根据 CSCO 2025，下列哪项最符合 2025 版对后线派安普利单抗的定位？","options":{"A":"仅用于儿童局部复发","B":"仅用于局部晚期同步放疗","C":"一线联合 GP 的 1A类方案","D":"至少二线系统治疗失败后的单药选择之一"},"answer":"D"}
+{"id":"l1-sample-8de2569f3d785fdbae5b6bb8","question":"根据 CSCO 2025，关于阿帕替尼相关方案，最需要警惕的临床问题是：","options":{"A":"一定导致听力永久恢复","B":"可替代所有化疗方案成为一线标准","C":"对既往再放疗/鼻咽局部复发患者，鼻咽坏死风险值得特别警惕","D":"显著增加甲状腺功能减退"},"answer":"C"}
+{"id":"l1-sample-8822c0a252347e066d481ab6","question":"根据 CSCO 2025，对接受 GP+PD-1/PD-L1 一线治疗后未进展的 RM-NPC 患者，后续最符合指南的是：","options":{"A":"统一换成卡培他滨维持","B":"继续无限期联合化疗","C":"改为 PD-1/PD-L1 单药维持，直至不可耐受、疾病进展或满2年","D":"立即停药观察"},"answer":"C"}
+{"id":"l1-sample-b497247a89a0160c71d0120e","question":"根据 CSCO 2025，对一线“仅接受化疗”且未进展的 RM-NPC 患者，指南允许考虑的维持策略之一是：","options":{"A":"固定改用伊匹木单抗","B":"口服氟尿嘧啶类维持（如卡培他滨或 S-1）","C":"所有患者都必须局部放疗维持","D":"固定改用纳武利尤单抗"},"answer":"B"}
+{"id":"l1-sample-e55ac59f9fb92bd810b745c6","question":"根据 CSCO 2025，为什么 RM-NPC 在一线含铂治疗失败后，二线仍保留单药化疗的重要地位？","options":{"A":"因为二线时只能重复一线 GP","B":"因为二线后所有患者都不再适合系统治疗","C":"因为目前暂无高级别循证优选二线方案，单药化疗仍是重要基石之一","D":"因为二线免疫已被证实明显优于化疗，所以化疗只是历史遗留"},"answer":"C"}
+{"id":"l1-sample-a139fd4468b6e49b23252afe","question":"根据 CSCO 2025，下列哪组更符合 RM-NPC 二线及以上单药化疗的 2A类推荐？","options":{"A":"特瑞普利单抗 / 卡瑞利珠单抗 / 派安普利单抗 均为二线1A","B":"卡培他滨 / 多西他赛 / 吉西他滨（如一线未接受同一药物之一）","C":"仅限甲氨蝶呤单药","D":"顺铂 / 吉西他滨 / 5-FU 必须原方案重打"},"answer":"B"}
+{"id":"l1-sample-bc2e578b4ba810d1e3a10783","question":"根据 CSCO 2025，下列哪项更符合 RM-NPC 二线及以上联合化疗的 2A类推荐？","options":{"A":"CTLA-4+PD-1 双抗为统一二线标准","B":"所有二线患者必须改用放疗","C":"阿帕替尼+卡培他滨已升为二线1A","D":"吉西他滨+长春瑞滨 或 伊立替康（如一线未接受同一药物）"},"answer":"D"}
+{"id":"l1-sample-37754a54f2c4dcb60c2ad681","question":"根据 CSCO 2025，关于后线免疫药物进入条件，下列哪项最准确？","options":{"A":"特瑞普利单抗可用于至少一线失败或放化疗结束后6个月内进展，而卡瑞利珠单抗/派安普利单抗通常要求至少二线失败","B":"所有后线免疫都只限 PD-L1 TPS≥1%","C":"所有后线免疫都要求至少三线失败","D":"卡瑞利珠单抗、派安普利单抗、特瑞普利单抗的进入条件完全相同"},"answer":"A"}
+{"id":"l1-sample-b2f9486d057c1e771ac7bd47","question":"根据 CSCO 2025，卡瑞利珠单抗 + 阿帕替尼更适合哪类患者？","options":{"A":"至少一线系统治疗失败，或诱导/同期/辅助放化疗结束后6个月内进展，且不适合放疗及手术的复发/转移患者","B":"所有初治转移患者的一线标准","C":"仅儿童复发患者","D":"仅T1N0局部病灶"},"answer":"A"}
+{"id":"l1-sample-b2d2349edab21a111176c937","question":"根据 CSCO 2025，关于三线及以上治疗，最符合序贯逻辑的是：","options":{"A":"三线后统一停治","B":"若既往未接受 PD-1/PD-L1，可优先考虑 PD-1/PD-L1；若既往已接受，则优先考虑前线尚未使用的单药化疗并鼓励临床试验","C":"三线后不再区分既往是否暴露 PD-1/PD-L1","D":"三线必须重复一线含铂方案"},"answer":"B"}
+{"id":"l1-sample-ccc21b2b2782427bc04c4e90","question":"根据 CSCO 2025，下列哪项最符合 2025 版对帕博利珠单抗后线定位的表述？","options":{"A":"帕博利珠单抗只能用于儿童","B":"所有后线患者均 2B类","C":"帕博利珠单抗已成为 RM-NPC 一线 1A 标准","D":"帕博利珠单抗在二线及以上中属于 2A类，但前提是既往一线未接受 PD-1/PD-L1 抑制剂"},"answer":"D"}
+{"id":"l1-sample-ccf1763324d32e4dc6ab0c41","question":"根据 CSCO 2025，关于从一线转向二线的“触发条件”，哪项最符合指南语境？","options":{"A":"只要影像学部分缓解就必须转二线","B":"一线完成4个周期后无论疗效如何都自动进入二线","C":"一线治疗出现疾病进展或无法耐受毒性时进入后续线治疗；若一线免疫联合且未进展，则优先进入维持而非直接二线","D":"只要 EBV DNA 不下降就立刻算二线失败"},"answer":"C"}
+{"id":"l1-sample-e4f0a3123f05766b276ed8a5","question":"根据 CSCO 2025，关于帕博利珠单抗在二线及以上治疗中的表格定位，最准确的是：","options":{"A":"2B类，且只能用于至少二线失败后的儿童患者","B":"1A类，且无任何前提条件","C":"只作为一线维持，不进入二线表格","D":"2A类，但前提是如一线未接受 PD-1/PD-L1 抑制剂"},"answer":"D"}
+{"id":"l1-sample-02a6f3e5d48a95a9fc12ef7e","question":"根据 CSCO 2025 表13，关于 RM-NPC 二线及以上免疫治疗的推荐层级，下列哪项最符合表格？","options":{"A":"四者均列为 1A类","B":"只有帕博利珠单抗被列入表格","C":"四者均列为 2A类且无前提条件","D":"卡瑞利珠单抗、特瑞普利单抗、纳武利尤单抗均列为 2B类；帕博利珠单抗列为 2A类但要求一线未接受 PD-1/PD-L1"},"answer":"D"}
+{"id":"l1-sample-a931dd740dd0447270148c52","question":"根据 NCCN 2025 NASO-B，关于 nivolumab and hyaluronidase-nvhy（皮下制剂）在鼻咽癌后线中的脚注说明，下列哪项最准确？","options":{"A":"只能用于一线联合化疗，不能用于后线","B":"可替代 IV nivolumab，且剂量和给药方式与 IV 完全相同","C":"可替代 IV nivolumab，但其剂量和给药方式与 IV nivolumab 不同","D":"NCCN 未提及该皮下制剂"},"answer":"C"}
+{"id":"l1-sample-d865f1ce45b27f1114bd8a09","question":"根据 CSCO 2025，鼻咽癌放疗体位固定中，指南优先推荐的组合是？","options":{"A":"仅真空垫","B":"仅标准树脂头枕","C":"仅牙托，不需要热塑膜","D":"头颈肩热塑膜 + 个体化发泡胶头颈垫"},"answer":"D"}
+{"id":"l1-sample-1ade86ba3721601302a5f446","question":"根据 CSCO 2025，鼻咽癌 CT-sim/MR-sim 的关键层厚要求更接近？","options":{"A":"CT 和 MRI 都建议约 3 mm 层厚","B":"仅 CT 需要薄层，MRI 无所谓","C":"仅 MRI 需要薄层，CT 无所谓","D":"5 mm 即可"},"answer":"A"}
+{"id":"l1-sample-6a29f9632cca7b3179e10b2b","question":"根据 CSCO 2025，鼻咽癌 IMRT 计划设计的更标准表述是？","options":{"A":"所有计划都不需要剂量验证","B":"固定野 IMRT 不推荐，必须 VMAT","C":"推荐逆向计划；fixed-beam IMRT 常用 7–9 个共面照射野，也可用单/双弧 VMAT","D":"只能 3D-CRT"},"answer":"C"}
+{"id":"l1-sample-d2c91d2fe740b26b445ede0c","question":"根据 CSCO 2025，鼻咽癌fixed-beam IMRT常用的照射野数是：","options":{"A":"12–14野","B":"7–9野","C":"3–4野","D":"5–6野"},"answer":"B"}
+{"id":"l1-sample-cdd4d75d7657907bb1839d87","question":"根据 CSCO 2025，鼻咽癌放疗期间摆位验证的最低要求是：","options":{"A":"每周1次二维验证","B":"完全离线校正即可","C":"每次治疗前至少2D IGRT","D":"仅首次治疗时CBCT"},"answer":"C"}
+{"id":"l1-sample-bace0c654f5e8209e0c017aa","question":"根据 CSCO 2025，关于 MRI 定位（MR-sim）参数，下列哪项最符合指南？","options":{"A":"层厚 3 mm，层间距 0 mm","B":"层厚 5 mm，层间距 2 mm","C":"MRI 定位并非常规推荐","D":"层厚 1 mm，层间距 1 mm"},"answer":"A"}
+{"id":"l1-sample-e815a55d07dc7b9e92f9222e","question":"根据 NCCN 2025 ADV-A/NASO-B，关于 concurrent systemic therapy/RT 的实施要求，哪项最符合指南？","options":{"A":"可由任意团队实施，不强调经验和 supportive care","B":"只要有放疗机即可，不需要系统治疗团队","C":"只需关注化疗剂量，不必关注 supportive care","D":"应由有经验团队实施，并包含充分 supportive care"},"answer":"D"}
+{"id":"l1-sample-be34e371007a87bac6d53c69","question":"根据 NCCN 2025，对T1N0M0鼻咽癌行颈部预防照射时，推荐纳入的层面是：","options":{"A":"II、IV、VB、VI","B":"7A/B、II、III、VA","C":"仅咽后区","D":"I、IV、VI"},"answer":"B"}
+{"id":"l1-sample-5226557a2a81867138797158","question":"根据 NCCN 2025，对需要 concurrent systemic therapy/RT 的鼻咽癌患者，下列哪项最符合放疗剂量分层原则？","options":{"A":"高危区通常约 70 Gy，低至中危亚临床扩散区通常 44–50 Gy 或 54–63 Gy","B":"所有靶区统一 70 Gy","C":"低危区通常也要 70 Gy","D":"NCCN 不区分风险区剂量"},"answer":"A"}
+{"id":"l1-sample-f93474c6b9f5bd3e1be15002","question":"根据 CSCO 2025 §3.3/表8，鼻咽原发灶 GTVp 的 PTVp 边界及典型处方剂量最符合的是：","options":{"A":"GTVp+1 mm；70 Gy/35 F","B":"GTVp+10 mm；5412 cGy/33 F","C":"GTVp+5 mm；6006 cGy/33 F","D":"GTVp+3 mm；6996 cGy/33 F"},"answer":"D"}
+{"id":"l1-sample-a586fd415110debd2aa8e9a8","question":"根据 CSCO 2025 第3.3节/表8，颈部淋巴结 GTVn 的 PTVn 边界及典型处方剂量最符合哪一项？","options":{"A":"GTVn + 5 mm；6600–6996 cGy/33 F","B":"GTVn + 1 mm；6006 cGy/33 F","C":"GTVn + 10 mm；6996 cGy/33 F","D":"GTVn + 3 mm；5412–5610 cGy/33 F"},"answer":"A"}
+{"id":"l1-sample-691f1365c15edd83edef47e6","question":"根据 CSCO 2025 §3.3/表8，原发灶高危亚临床病灶区 CTVp1 的勾画原则，最符合指南的是：","options":{"A":"必须统一扩展 15 mm，不能因 OAR 调整","B":"只对颈部淋巴结定义，不用于原发灶","C":"GTVp+5–10 mm，通常包括全部鼻咽黏膜；邻近重要OAR时距离可缩小至1 mm","D":"仅等于 GTVp 本身，不做扩展"},"answer":"C"}
+{"id":"l1-sample-2c41573415c635b252fc566c","question":"根据 CSCO 2025 §3.3/表8，原发灶常见路径及 CTV2 设置中，哪一项搭配最符合表格？","options":{"A":"鼻腔受侵 → 包括翼腭窝和后组筛窦","B":"翼外肌受侵 → 仅包括眶尖","C":"咽旁间隙受侵 → 仅包括下颌角","D":"斜坡受侵 → 仅包括上颌窦前壁"},"answer":"A"}
+{"id":"l1-sample-bdb4c644d8925f64ab3137a5","question":"根据 CSCO 2025 第3.3节/表8，颈部淋巴结高危亚临床病灶区 CTVn1 的表述，哪一项最符合指南？","options":{"A":"CTVn1 与 PTVn 完全等同","B":"CTVn1 只用于咽后淋巴结，不用于颈部淋巴结","C":"CTVn1 = GTVn + 10 mm；且不参考诱导化疗前范围；PTVn1 5412 cGy/33 F","D":"CTVn1 = GTVn + 3–5 mm；若接受诱导化疗，应包括化疗前侵犯范围/边界；PTVn1 典型剂量 6006 cGy/33 F"},"answer":"D"}
+{"id":"l1-sample-9d865ab8c6ab0b6376ae804e","question":"根据 CSCO 2025 §3.3 正常组织限量，腮腺的表格型限量写法最符合的是：","options":{"A":"V60 Gy MAC ≤10 cm²","B":"Dmean ≤26 Gy，或至少一侧腮腺 V30 Gy ≤50%","C":"D2% ≤70 Gy","D":"D0.03cc ≤6 Gy"},"answer":"B"}
+{"id":"l1-sample-9ed0e831d27934546154e03e","question":"根据 CSCO 2025 §3.3 正常组织限量，关于甲状腺与臂丛的剂量限制，下列哪项最符合表格？","options":{"A":"甲状腺 Dmean ≤26 Gy；臂丛 D0.03cc ≤6 Gy","B":"甲状腺和臂丛均无具体表格限量","C":"甲状腺 D2% ≤70 Gy；臂丛 Dmean ≤35 Gy","D":"甲状腺 V50 Gy ≤60% 或 V60 Gy MAC ≤10 cm²；臂丛 PRV D0.03cc ≤66 Gy，MAC ≤70 Gy"},"answer":"D"}
+{"id":"l1-sample-f455558fab8b3c0d824a8e04","question":"根据 CSCO 2025，调强计划剂量验证的常用 Gamma 通过率容差限值为？","options":{"A":"3%/2 mm、10%阈值、Gamma通过率≥95%","B":"3%/3 mm，Gamma ≥70%","C":"2%/1 mm，Gamma ≥100%","D":"5%/5 mm，Gamma ≥80%"},"answer":"A"}
+{"id":"l1-sample-d94f89a11bf48e14a3e6a2ee","question":"关于NPC IMRT计划剂量验证，下列哪项最符合CSCO常用容差标准？","options":{"A":"Gamma 5%/5 mm，≥80%","B":"Gamma 2%/1 mm，必须100%","C":"只做机器自检，不需患者特异验证","D":"Gamma 3%/2 mm、10%阈值，≥95%"},"answer":"D"}
+{"id":"l1-sample-a018685c45a65443be9a5a4f","question":"根据 CSCO 2025，关于调强计划验证，下列哪项描述最准确？","options":{"A":"鼻咽癌 IMRT 无需做计划验证","B":"应包括点剂量验证和剂量分布验证，并鼓励基于患者解剖结构的三维剂量验证","C":"只需点剂量验证即可","D":"只需剂量分布验证即可"},"answer":"B"}
+{"id":"l1-sample-625b58f56be5085cb60173f5","question":"根据 CSCO 2025，同期周疗顺铂常用剂量是？","options":{"A":"60 mg/m²","B":"80 mg/m²","C":"30–40 mg/m²","D":"20 mg/m²"},"answer":"C"}
+{"id":"l1-sample-26d359131b00e0986df077f5","question":"根据 CSCO 2025 与 NCCN 2025，同期三周顺铂常用剂量是？","options":{"A":"120 mg/m²","B":"80 mg/m²","C":"75 mg/m²","D":"100 mg/m²"},"answer":"D"}
+{"id":"l1-sample-ed354404d6c3a2246c809896","question":"根据 NCCN 2025，关于再放疗，最符合条件的是：","options":{"A":"距初次 RT 约 ≥6 个月，能再给至少 60 Gy，且能耐受同步治疗","B":"只要患者要求即可","C":"所有复发患者都优先再放疗","D":"初次 RT 后 2 个月复发即可再放"},"answer":"A"}
+{"id":"l1-sample-ee1e187255820d8b50c146d4","question":"以下哪组条件最符合NCCN对再放疗候选者的描述？","options":{"A":"距初次RT 2个月、任何体能状态、任意剂量均可","B":"只要有复发就应首选再放疗","C":"距初次RT约≥6个月、能够再给至少60 Gy、且可耐受同步治疗","D":"只看患者意愿，不需考虑既往剂量与器官风险"},"answer":"C"}
+{"id":"l1-sample-6c8b84316a2f3df4acfeca67","question":"根据 NCCN 2025 ADV-A/NASO-A 脚注，当鼻咽癌放疗总剂量 >70 Gy 时，部分专家建议如何微调分割方式以减少毒性？","options":{"A":"一律改为每周一次大分割","B":"总剂量 >70 Gy 时不需要任何分割调整","C":"对至少部分疗程轻度调整为 <2.0 Gy/fraction","D":"统一改为 >2.2 Gy/fraction"},"answer":"C"}
+{"id":"l1-sample-f6f8aee4988b03cabf491aa4","question":"根据 NCCN 2025 ADV-A/NASO-A 脚注，关于 >70 Gy 时的额外加量（boost），哪项最符合指南脚注？","options":{"A":"可根据临床情况再加 2–3 次照射","B":"绝对禁止任何额外加量","C":"额外加量只允许在儿童中进行","D":"必须固定追加 10 次照射"},"answer":"A"}
+{"id":"l1-sample-1222f1d82f1173910c61bcd3","question":"根据 NCCN 2025 ADV-A/NASO-A，在何种情况下可考虑 proton therapy？","options":{"A":"所有鼻咽癌患者一律优先 proton","B":"只用于化疗失败后的姑息放疗","C":"当光子放疗无法满足正常组织限量，或会影响标准肿瘤/术后体积剂量时","D":"仅 T1N0 才可考虑 proton"},"answer":"C"}
+{"id":"l1-sample-430242228049fba7e9b5196e","question":"根据 NCCN 2025 ADV-A，对既往放疗后拟行再放疗的患者，OAR 可接受剂量最应依据下列哪项综合判断？","options":{"A":"原始放疗距今的时间间隔、拟纳入体积、患者预期寿命及DVH分析","B":"只看是否能接受同步化疗","C":"只看患者年龄","D":"只看当前CT上的肿瘤大小"},"answer":"A"}
+{"id":"l1-sample-0f29c460d042f7ca1c4c8a86","question":"根据 CSCO 2025，关于外周血EBV抗体/EBV DNA在鼻咽癌中的应用，以下哪项最符合指南表述？","options":{"A":"阴性结果基本可以排除鼻咽癌","B":"主要只对角化型鼻咽癌具有临床价值","C":"仅在治疗后随访时有意义，初诊价值有限","D":"阳性结果可辅助诊断和风险评估，但阴性不能完全排除疾病"},"answer":"D"}
+{"id":"l1-sample-4f61de7104d5225aa742cc96","question":"根据 NCCN 2025，T2N0/T0(EBV+)–2N1/T3N0 路径中提到的 high-risk features 包括？","options":{"A":"吸烟史","B":"年龄 >60","C":"男性","D":"bulky tumor volume 和高 serum EBV DNA"},"answer":"D"}
+{"id":"l1-sample-c1db498befc328a0c3f3698a","question":"根据 NCCN 2025，对 T0(EBV+)–2N1M0 或 T3N0M0，最符合指南的是：","options":{"A":"RT alone regardless of risk","B":"IC→CCRT 为 preferred category 1","C":"concurrent systemic therapy/RT；若有 high-risk features，再考虑 induction 或 adjuvant","D":"pembrolizumab 单药"},"answer":"C"}
+{"id":"l1-sample-a9d0b4ed9ace8ae981867825","question":"根据 NCCN 2025，对 EBV-associated disease 且 T4,N1–3 或 any T,N2–3，可作为 useful in certain circumstances 的方案是？","options":{"A":"nivolumab 单药维持","B":"cisplatin + RT 后 capecitabine ± prior induction","C":"直接手术","D":"methotrexate 单药"},"answer":"B"}
+{"id":"l1-sample-e6e7c258257025ccffcd9475","question":"52岁男性，初诊鼻咽癌 cT2N0M0，MRI示原发灶体积偏大，血浆EBV DNA 12000 copies/mL。按NCCN，最符合指南的初始治疗是？","options":{"A":"直接进入RM-NPC一线免疫联合","B":"definitive RT，可考虑加 concurrent systemic therapy","C":"单纯definitive RT","D":"IC→CCRT 为唯一首选"},"answer":"B"}
+{"id":"l1-sample-fdd0075cfa0cf875605b7139","question":"50岁患者，T0(EBV+)N1M0，EBV DNA显著升高。按NCCN，最符合指南主路径的表述是？","options":{"A":"IC→CCRT 为preferred category 1","B":"PD-1单药联合RT","C":"concurrent systemic therapy/RT；若有high-risk features，再考虑induction或adjuvant","D":"单纯RT"},"answer":"C"}
+{"id":"l1-sample-926dc3469d5a0a3bdb65bd01","question":"根据 CSCO 2025，下列哪组血清学指标组合已被前瞻性筛查研究用于提高鼻咽癌早诊率？","options":{"A":"TGAb + TPOAb","B":"VCA/IgA + EBNA1/IgA","C":"AFP + PIVKA-II","D":"CEA + CA19-9"},"answer":"B"}
+{"id":"l1-sample-1d530059ecf79c21bee4a7aa","question":"根据 CSCO 2025，血浆EBV DNA用于鼻咽癌筛查时，最准确的表述是：","options":{"A":"灵敏度和特异度可很高，但目前缺乏统一标准化流程","B":"灵敏度和特异度都很低","C":"阴性即可排除鼻咽癌","D":"只能用于治疗后监测"},"answer":"A"}
+{"id":"l1-sample-7be36d076e9260f428a54209","question":"根据 NCCN 2025，血浆/血清EBV DNA最常用的PCR扩增靶点之一是：","options":{"A":"TERT启动子","B":"BamHI-W","C":"KRAS exon 2","D":"BCR-ABL1"},"answer":"B"}
+{"id":"l1-sample-5bff88ac5b674dc2c026a33d","question":"根据 CSCO 2025，关于 EBV 相关标志物筛查，下列最准确的是：","options":{"A":"目前已有大规模头对头研究证明 EBV DNA 绝对优于血清抗体","B":"目前仍缺乏大规模头对头研究明确 EBV DNA 与血清 IgA 抗体谁更优","C":"二者均已被证实完全无效","D":"目前已有大规模头对头研究证明血清抗体绝对优于 EBV DNA"},"answer":"B"}
+{"id":"l1-sample-933f7a86537f42eb7bbdefe6","question":"根据 CSCO 2025，关于鼻咽拭子/唾液甲基化或 miRNA-BARTs 等新型 EBV 相关检测的定位，更符合指南的是：","options":{"A":"已成为所有人群筛查的标准常规","B":"仅用于术后病理会诊","C":"具有潜力，但仍缺乏足够大样本人群研究验证","D":"已完全取代 EBER 和血浆 EBV DNA"},"answer":"C"}
+{"id":"l1-sample-af4bb3441f5704214d6af714","question":"根据 CSCO 2025，关于鼻咽癌筛查中的新型血清学分子标志物，下列哪项更符合指南注释？","options":{"A":"P85-Ab 只用于治疗后疗效监测","B":"抗BNLF2b总抗体（P85-Ab）被提及为筛查表现优异的新型标志物之一","C":"P85-Ab 已被完全取代并不再推荐讨论","D":"P85-Ab 只用于非角化型儿童病例"},"answer":"B"}
+{"id":"l1-sample-266a84792400324f200eeadd","question":"根据 CSCO 2025，关于鼻咽拭子/唾液甲基化、miRNA-BARTs 等新型 EBV 相关检测，最符合指南的是：","options":{"A":"属于有潜力的方向，但仍需更多大样本人群研究验证","B":"已成为所有高发区人群的标准常规筛查手段","C":"只能用于病理切片复核","D":"已经完全取代血浆 EBV DNA"},"answer":"A"}
+{"id":"l1-sample-213b41f339bb7513cfe54539","question":"根据 CSCO 2025，对 T2N0 且无 EBV DNA ≥4000 copies/mL、无 bulky 等不良因素的患者，优先推荐哪一项？","options":{"A":"单纯放疗","B":"同期放化疗","C":"诱导化疗后同期放化疗","D":"放疗后常规辅助化疗"},"answer":"A"}
+{"id":"l1-sample-1d97c2206e933dad43d4dffb","question":"根据 CSCO 2025，对 T1–2N1 且无 ≥3 cm 淋巴结、无 Ⅳ/ⅤB 区转移、无包膜外侵、无高 EBV DNA 的患者，可考虑哪一项？","options":{"A":"一律诱导化疗后同期放化疗","B":"一律 PD-1 联合放疗","C":"单纯放疗","D":"一律同期放化疗后辅助治疗"},"answer":"C"}
+{"id":"l1-sample-7ef9b84f8d310e4d5063a677","question":"根据 CSCO 2025，T3N0 在无 EBV DNA ≥4000 copies/mL、无 bulky 等不良因素时，可考虑：","options":{"A":"必须 CCRT","B":"必须 IC→CCRT","C":"单纯放疗","D":"必须辅助化疗"},"answer":"C"}
+{"id":"l1-sample-eeb675f9f04b1178f18dd0f8","question":"根据 NCCN 2025，对 T3N1–3M0 / T4N0–3M0 / T0(EBV+)–2N2–3M0，主路径是：","options":{"A":"PD-1 单药","B":"surgery first","C":"RT alone","D":"clinical trial 或 IC→CCRT（preferred, category 1）或 CCRT→adjuvant"},"answer":"D"}
+{"id":"l1-sample-101c19841957e2cd84f3f6cb","question":"45岁男性，cT1N1M0，单侧II区淋巴结 1.8 cm，无IV/VB区转移，无包膜外侵，EBV DNA 1800 copies/mL。按CSCO，更符合指南的治疗是？","options":{"A":"同期放化疗+节拍卡培他滨","B":"同期放化疗","C":"诱导化疗+同期放化疗","D":"单纯放疗"},"answer":"D"}
+{"id":"l1-sample-ff946b492579bd19ab26122c","question":"48岁男性，cT2N1M0，单侧VB区淋巴结转移，最大短径2.4 cm，EBV DNA 6200 copies/mL。按CSCO，更符合指南的治疗是？","options":{"A":"同期放化疗","B":"单纯放疗","C":"只需诱导化疗","D":"仅随访观察"},"answer":"A"}
+{"id":"l1-sample-b82c2df424484eb33f38b20a","question":"根据 CSCO 2025，下列哪项更符合鼻咽癌 EBV 风险预测的认识？","options":{"A":"治疗前血浆 EBV DNA 与肿瘤负荷、分期和进展风险呈正相关","B":"EBV DNA 只在儿童患者中有意义","C":"治疗前血浆 EBV DNA 与肿瘤负荷、分期和进展风险呈负相关","D":"EBV DNA 仅用于病理分型，不用于风险评估"},"answer":"A"}
+{"id":"l1-sample-d0742f9a2ccbe1aa883c0366","question":"根据 CSCO 2025，对“不超过一线治疗失败”且 EBV 相关的 RM-NPC，可考虑哪一项联合方案？","options":{"A":"特瑞普利单抗 + 卡培他滨","B":"卡瑞利珠单抗 + 阿帕替尼","C":"纳武利尤单抗 + 伊匹木单抗","D":"帕博利珠单抗 + 西妥昔单抗"},"answer":"C"}
+{"id":"l1-sample-21b5cf47e0ee678362d7a84f","question":"根据 CSCO 2025，关于血浆 EBV DNA 与 TNM 分期的关系，更准确的表述是：","options":{"A":"EBV DNA 只用于儿童病例","B":"TNM 已足够，EBV DNA 无额外价值","C":"治疗前血浆 EBV DNA 联合 TNM 可进一步提高风险/预后分层效能","D":"二者互不相关"},"answer":"C"}
+{"id":"l1-sample-70d3819f705a08a4ccec12af","question":"根据 CSCO 2025 表10，对 T1–2N1 且无淋巴结≥3 cm、无Ⅳ/ⅤB区转移、无包膜外侵、无 EBV DNA≥4000 的患者，最符合表格的是：","options":{"A":"必须节拍辅助卡培他滨","B":"单纯放疗可列为 1A类；同期放化疗为 2A类","C":"必须诱导化疗 + 同期放化疗","D":"只能同步免疫治疗"},"answer":"B"}
+{"id":"l1-sample-bbe6b78bc348bcf514092486","question":"根据 CSCO 2025，在初治完成后，若借助血浆 EBV DNA 辅助判断失败模式，下列哪项最符合现有证据？","options":{"A":"对失败模式判断基本没有临床价值","B":"对远处转移的诊断准确性通常高于对复发的诊断","C":"对区域复发的诊断准确性最高","D":"对局部复发的诊断准确性最高"},"answer":"B"}
+{"id":"l1-sample-3a44e792dbb7a3af6689a3ad","question":"治疗后常规影像未见明确病灶，但血浆EBV DNA持续进行性升高。按CSCO，更合理的下一步是？","options":{"A":"仅观察，等待EBV DNA自然波动","B":"立即开始二线免疫","C":"直接诊断远处转移","D":"进一步结合PET/CT检查"},"answer":"D"}
+{"id":"l1-sample-489b27aef77bf52d3c576397","question":"根据 NCCN 2025，对EBER阳性鼻咽癌，随访中可考虑：","options":{"A":"固定每月脑脊液检测","B":"常规骨髓活检","C":"EBV DNA监测","D":"每周肺功能"},"answer":"C"}
+{"id":"l1-sample-f14303ee1bbd0a76c55acc86","question":"根据 CSCO 2025，关于鼻咽癌EBV相关检测，以下哪项正确？","options":{"A":"只在复发时有用","B":"仅儿童有意义","C":"若EBV抗体和EBV DNA均阴性，就可排除鼻咽癌","D":"阴性结果不能排除鼻咽癌"},"answer":"D"}
+{"id":"l1-sample-009666bccacfbceb4a2d9bcc","question":"根据 CSCO 2025，关于血浆EBV DNA的标准化检测，最符合现状的是：","options":{"A":"仅中国有统一国家标准","B":"目前尚无国际公认统一标准化流程","C":"PCR已完全被NGS淘汰","D":"已存在国际公认统一流程"},"answer":"B"}
+{"id":"l1-sample-26a46059cf04f98d71a932e4","question":"根据 CSCO 2025，关于 EBV DNA 实验室标准化检测，下列哪项最符合现有指南的“深度细节”要求？","options":{"A":"不需要国家药监部门批准的检测试剂","B":"EBV DNA 定量只需唾液样本，不需血浆","C":"样本类型通常为外周血，推荐 EDTA 抗凝，且实验室应分试剂准备区、标本制备区和扩增区","D":"任何样本、任何操作区设置都无差异"},"answer":"C"}
+{"id":"l1-sample-f8fabb29bfde8e7070350371","question":"根据 NCCN 2025 NASO-B，在鼻咽癌系统治疗开始前，指南脚注建议至少补做哪些生物标志物检测？","options":{"A":"仅 BRAF 和 KRAS","B":"仅 MSI","C":"至少 CPS 和 TMB","D":"仅 HER2 和 EGFR"},"answer":"C"}
+{"id":"l1-sample-3547d2f3f7753af578fe38e2","question":"根据 CSCO 2025 儿童章节，关于非转移性儿童鼻咽癌诱导化疗推荐等级，哪一项最符合指南表述？","options":{"A":"GP 与 TPF 同属 2A类，PF 降为 3类","B":"所有成人 1A 级诱导方案在儿童中均自动沿用为 2A类","C":"PF、TPF、TP 均为 2A类，而 GP 不属于 2A类","D":"只有 PF 属于 2A类，TPF 和 TP 均为 3类"},"answer":"C"}
+{"id":"l1-sample-f1080e8ddf6a7b26f417419f","question":"根据 CSCO 2025 儿童章节，在非转移性儿童鼻咽癌中，被列为 3类推荐的诱导方案是：","options":{"A":"GP","B":"PF","C":"TPF","D":"TP"},"answer":"A"}
+{"id":"l1-sample-0a6451951bee0afcf3faf037","question":"根据 CSCO 2025 儿童章节，对儿童鼻咽癌，下列哪项表述更准确？","options":{"A":"治疗策略通常参照成人框架，但需更强调长期毒性与生长发育影响","B":"同期化疗的唯一最佳方案已由高质量随机研究完全确立","C":"IFN-β 已成为所有患儿绝对标准治疗","D":"儿童放疗剂量原则上应尽可能高于成人"},"answer":"A"}
+{"id":"l1-sample-a1f5d250a269eed3524c947b","question":"根据 CSCO 2025 表17，非转移儿童鼻咽癌分层中，ⅣB期的表格推荐最符合的是：","options":{"A":"全身化疗 ± 局部放疗（3类）","B":"单纯放疗（3类）","C":"诱导化疗 + 同期放化疗（2A类）","D":"免疫联合放疗（1A类）"},"answer":"A"}
+{"id":"l1-sample-9ed3fd7d9013449db044e755","question":"根据 CSCO 2025 表18，儿童鼻咽癌诱导化疗推荐中，GP 方案的推荐等级是：","options":{"A":"1A类","B":"1B类","C":"2A类","D":"3类"},"answer":"D"}
+{"id":"l1-sample-2cd317398631c63e91a79883","question":"根据 CSCO 2025 表19，儿童鼻咽癌 TPF 方案的典型周期写法最符合的是：","options":{"A":"每3周一次，共3–4疗程","B":"每4周一次，共2疗程","C":"每2周一次，共6疗程","D":"每周一次，共7疗程"},"answer":"A"}
+{"id":"l1-sample-10a122429460a58c463c61ca","question":"根据 CSCO 2025 表19，儿童鼻咽癌 GP 诱导方案中，吉西他滨与顺铂的给药时间最符合的是：","options":{"A":"吉西他滨 d1；顺铂 d8","B":"二者均 d1–4","C":"二者均每周一次连续7周","D":"吉西他滨 d1、8；顺铂 d1"},"answer":"D"}
+{"id":"l1-sample-01aea8e975211e325cf7d0d6","question":"根据 CSCO 2025 儿童注释，关于儿童鼻咽癌诱导化疗方案中的甲氨蝶呤和博来霉素，最符合表述的是：","options":{"A":"由于不良反应较大，已罕有应用","B":"仅用于 T1N0 患儿","C":"只能与免疫治疗联合使用","D":"由于疗效最好，应成为儿童标准首选"},"answer":"A"}
+{"id":"l1-sample-2a68cd5200ff90b14fa63608","question":"根据 CSCO 2025 儿童章节，关于复发/转移儿童鼻咽癌，下列哪项最准确？","options":{"A":"证据较少，可参考成人已证实有效的治疗原则","B":"原则上完全不考虑局部治疗","C":"免疫治疗已成所有患儿标准一线","D":"证据非常充分，已有大量随机III期标准"},"answer":"A"}
+{"id":"l1-sample-fac80c5d96c28126fbe269cc","question":"根据 CSCO 2025 儿童章节，对初治即存在转移的儿童鼻咽癌，在转移灶控制前提下可考虑：","options":{"A":"只做手术","B":"永远不照射原发灶","C":"只做观察","D":"照射原发灶"},"answer":"D"}
+{"id":"l1-sample-6ea0e7e7f7d1232b5ec3cd46","question":"根据 CSCO 2025 儿童章节，对寡转移儿童鼻咽癌，更强调：","options":{"A":"化疗基础上的局部治疗","B":"只做放疗不做药物","C":"只做免疫单药","D":"单纯支持治疗"},"answer":"A"}
+{"id":"l1-sample-6c4a0a7c84e45844861dbd6a","question":"根据 CSCO 2025 儿童章节，儿童鼻咽癌同期化疗推荐的核心药物是？","options":{"A":"卡铂","B":"顺铂","C":"PD-1抑制剂","D":"5-FU"},"answer":"B"}
+{"id":"l1-sample-2182621ca9ae06ec97af5afb","question":"根据 CSCO 2025 儿童章节，儿童鼻咽癌同步“周疗”顺铂的常用剂量为：","options":{"A":"20 mg/m²，每周 1 次","B":"100 mg/m²，d1，每 3 周 1 次","C":"30–40 mg/m²，每周 1 次","D":"80 mg/m²，d1，每 3 周 1 次"},"answer":"C"}
+{"id":"l1-sample-d018761555b7d9792531907c","question":"根据 CSCO 2025 儿童章节，儿童鼻咽癌同步“三周方案”顺铂的常用剂量为：","options":{"A":"30–40 mg/m²，每周 1 次","B":"80 mg/m²，d1，每 3 周 1 次","C":"100 mg/m²，d1，每 3 周 1 次","D":"120 mg/m²，d1，每 3 周 1 次"},"answer":"C"}
+{"id":"l1-sample-50eb35b884522b916f3f68f0","question":"根据 CSCO 2025 儿童章节，儿童鼻咽癌辅助 IFN-β 的常用方案为：","options":{"A":"250 mg 口服每日，持续半年","B":"3 mg/kg q2w，共 6 个月","C":"100000 IU/kg，每周 3 次，共 6 个月","D":"200 mg q3w，共 1 年"},"answer":"C"}
+{"id":"l1-sample-a2ae8e3120f3ad95c25d04e4","question":"根据 CSCO 2025 儿童章节，关于儿童鼻咽癌放疗，最符合指南表述的是？","options":{"A":"不需考虑改野、缩野","B":"总剂量不能低于70 Gy","C":"一律70–72 Gy","D":"每天分割剂量可降至 1.8 Gy，以减少后遗症"},"answer":"D"}
+{"id":"l1-sample-b73d036443c30e13aeb022a6","question":"儿童非转移鼻咽癌，诱导治疗后达到CR。按CSCO儿童章节，更合理的放疗剂量是？","options":{"A":"60–61.2 Gy","B":"66–68 Gy","C":"固定70 Gy","D":"54 Gy"},"answer":"A"}
+{"id":"l1-sample-66ded656173ccc46c52640cd","question":"关于儿童鼻咽癌的IFN-β辅助治疗，以下最符合指南精神的是？","options":{"A":"已被证实可替代同期顺铂","B":"所有患儿的绝对标准治疗","C":"对局部晚期或诱导反应不良患儿可作为治疗选择，但暂无统一专家共识","D":"仅用于复发/转移患儿"},"answer":"C"}
+{"id":"l1-sample-9cf319877af91ad59db51fcd","question":"根据 CSCO 2025，关于儿童鼻咽癌同期化疗的最佳策略，更准确的表述是：","options":{"A":"随机对照证据充分，结论已完全统一","B":"儿童同期化疗仅能用卡铂","C":"儿童一律不应做同期化疗","D":"关于最佳策略仍存在争议"},"answer":"D"}
+{"id":"l1-sample-1470f6d5b4462567b3c73c88","question":"根据 CSCO 2025，对诱导化疗后达到 CR 或非常好部分缓解（VGPR）的儿童鼻咽癌患者，部分学者提出可考虑：","options":{"A":"单纯放疗/降级放疗策略","B":"完全省略放疗","C":"直接转入免疫维持","D":"必须三药同步化疗"},"answer":"A"}
+{"id":"l1-sample-44b7f7cb27142236d0707baa","question":"根据 CSCO 2025 表19，儿童鼻咽癌同期化疗的 DDP 单周方案与三周方案，最符合表格的是：","options":{"A":"单周 30–40 mg/m²，共3疗程；三周 100 mg/m²，共7疗程","B":"单周与三周方案剂量完全相同","C":"单周 30–40 mg/m²，共7疗程；三周 100 mg/m²，共3疗程","D":"单周 20 mg/m²，共4疗程；三周 80 mg/m²，共6疗程"},"answer":"C"}
+{"id":"l1-sample-60e4145b3c2b5f14f9c75535","question":"根据 CSCO 2025 表20，儿童鼻咽癌诱导化疗后达到 CR 时，PTVp/PTVn 的推荐放疗剂量是：","options":{"A":"68–70 Gy","B":"60–61.2 Gy","C":"54 Gy","D":"60–66 Gy"},"answer":"B"}
+{"id":"l1-sample-16f2a3d0f1e061283e7a4cde","question":"根据 CSCO 2025，放化疗结束后的首次系统随访评估通常建议在？","options":{"A":"4 周","B":"12–16 周","C":"1–2 周","D":"1 年"},"answer":"B"}
+{"id":"l1-sample-eb1364b4a3adcedd94dad55e","question":"根据 CSCO 2025，对 IMRT 结束时 MRI 仍可检出残留病灶者，可考虑？","options":{"A":"一律进入后线免疫","B":"一律停治观察","C":"一律直接手术","D":"追加 2–3 次、每次 4–6 Gy 的 boost"},"answer":"D"}
+{"id":"l1-sample-edbecdb3d31b0fdd56830a9e","question":"根据 NCCN 2025，治疗后 FDG-PET/CT 作为 preferred response assessment 的时点通常应？","options":{"A":"8–12周，与CT/MRI反应评估完全等同","B":"≥12周","C":"仅在出现症状后再做","D":"<4周，以尽早识别治疗失败"},"answer":"B"}
+{"id":"l1-sample-1a1a7bf160a7b195c042f7d8","question":"放化疗结束后6周行FDG-PET/CT显示鼻咽原发区代谢轻中度升高。按NCCN，最准确的判断是？","options":{"A":"这个时点已经是preferred response assessment","B":"时点过早，PET/CT首选评估通常应≥12周","C":"可直接判定进展并进入二线","D":"可直接判定残留并手术"},"answer":"B"}
+{"id":"l1-sample-04e68083241a942b25a5de52","question":"治疗后≥12周PET/CT结果equivocal，无明确进行性症状。按NCCN，最符合指南的是？","options":{"A":"观察或3–6个月后重复PET/CT","B":"立即按复发处理","C":"立即永久停止随访","D":"直接行系统治疗"},"answer":"A"}
+{"id":"l1-sample-b1082e23b99d6f246a03d5f9","question":"IMRT结束时MRI仍见明确残留病灶，且病灶位置允许继续补量。按CSCO，更符合指南的是？","options":{"A":"一律停治观察","B":"必须直接手术","C":"追加2–3次、每次4–6 Gy boost","D":"必须立即转免疫治疗"},"answer":"C"}
+{"id":"l1-sample-066350438d0dc92cd4d5d4f8","question":"根据 CSCO 2025，关于 PET/CT 与 MRI 在复发/残留评估中的定位，最准确的是：","options":{"A":"二者都不推荐用于复发评估","B":"对原发灶复发/残留诊断困难者，推荐 PET/CT 与 MRI 联合应用","C":"MRI 可完全替代 PET/CT","D":"PET/CT 可完全替代 MRI"},"answer":"B"}
+{"id":"l1-sample-bb192a7272cc8191636a3a40","question":"根据 CSCO 2025 表22，关于随访中 PET/CT 的触发条件，最符合表格的是：","options":{"A":"主要用于临床怀疑远处转移，或 EBV DNA 升高的 T4/N3 患者","B":"所有患者每次复查都常规做 PET/CT","C":"5年后才允许做 PET/CT","D":"仅限 T1N0 患者"},"answer":"A"}
+{"id":"l1-sample-865c0bde9671374c9000b846","question":"根据 CSCO 2025，鼻咽癌最常用、应用最广泛的营养风险筛查工具是：","options":{"A":"Child-Pugh","B":"CHA2DS2-VASc","C":"NRS 2002","D":"APACHE II"},"answer":"C"}
+{"id":"l1-sample-a3e915677acfe060e3265afd","question":"根据 CSCO 2025，放疗期间出现高营养风险，通常指 NRS 2002 评分：","options":{"A":">3","B":"=1","C":"<3","D":"≥2"},"answer":"A"}
+{"id":"l1-sample-5a06671fc606d2ad1c9b819c","question":"根据 CSCO 2025，关于营养支持时机，下列最符合证据导向的是：","options":{"A":"等体重下降>10%再干预","B":"鼻咽癌不需要系统营养筛查","C":"放疗开始时尽早营养干预优于晚期被动干预","D":"白蛋白正常就无需营养评估"},"answer":"C"}
+{"id":"l1-sample-52fa27913a9c19667d2bc6a0","question":"根据 CSCO 2025，关于营养不良对鼻咽癌放疗的影响，下列哪项最符合指南表述？","options":{"A":"只影响化疗，不影响放疗","B":"仅影响体重，不影响治疗过程","C":"可导致放疗中断、摆位误差增大和放疗敏感性降低","D":"反而可提高局部控制率"},"answer":"C"}
+{"id":"l1-sample-2e015c2250a8dc755f997fdd","question":"根据 CSCO 2025，下列哪项最符合鼻咽癌围放疗期营养管理原则？","options":{"A":"只有体重下降 >10% 后才需要开始营养干预","B":"放疗完成后再开始营养评估最合理","C":"仅高龄患者需要营养管理","D":"所有鼻咽癌放疗患者都需要全程规范化营养管理"},"answer":"D"}
+{"id":"l1-sample-4c3b430d844e15202d1e3cb7","question":"根据 CSCO 2025 与 NCCN 2025，对鼻咽癌长期生存者的规范管理，更合理的是？","options":{"A":"只要影像学无复发，就无需系统性长期管理","B":"主要围绕EBV DNA和鼻咽镜，其他管理可弱化","C":"同时关注复发监测、吞咽/营养、听力、内分泌及晚期放疗毒性","D":"以复发监测为唯一目标，其余问题按需处理"},"answer":"C"}
+{"id":"l1-sample-43db1d63689c39536601a042","question":"根据 CSCO 2025，下列哪项更属于鼻咽癌放疗晚期不良反应？","options":{"A":"口腔急性黏膜炎","B":"急性放射性皮炎","C":"短暂恶心","D":"张口困难"},"answer":"D"}
+{"id":"l1-sample-a6087cb3f27104a7d6f41b23","question":"根据 NCCN 2025，鼻咽癌长期支持性评估中，应按临床需要考虑：","options":{"A":"仅复查甲状腺彩超","B":"营养、吞咽/言语、听力、眼科/内分泌","C":"仅复查鼻咽镜","D":"仅复查血常规"},"answer":"B"}
+{"id":"l1-sample-1d427f6c293c6c0ffd712a05","question":"根据 NCCN 2025，除肿瘤复查外，长期survivorship管理中还应持续关注：","options":{"A":"仅甲状腺功能","B":"抑郁、吞咽/言语、听力、营养与淋巴水肿","C":"仅血浆EBV DNA","D":"仅影像学变化"},"answer":"B"}
+{"id":"l1-sample-969c211f3b2f9f407f40ca8e","question":"根据 NCCN 2025，对颅底接受高剂量放疗的长期生存者，可考虑的长期内分泌评估是：","options":{"A":"无需任何内分泌随访","B":"定期骨髓活检","C":"定期垂体功能评估","D":"仅AFP检测"},"answer":"C"}
+{"id":"l1-sample-b7204ebf3b7e9c3310d6e889","question":"根据 CSCO 2025，下列哪项更属于鼻咽癌放疗严重晚期并发症，并且在局部复发/坏死分层中具有重要意义？","options":{"A":"一过性轻度恶心","B":"鼻咽坏死","C":"短暂味觉减退","D":"口腔黏膜急性充血"},"answer":"B"}
+{"id":"l1-sample-467bc390cdf6ae6c19b899e1","question":"根据 NCCN 2025，除 TSH 外，对长期存活的鼻咽癌患者，下列哪项也属于随访中应持续关注的 supportive care 重点？","options":{"A":"抑郁、淋巴水肿、吞咽/言语、听力、营养与功能康复","B":"仅肿瘤标志物CEA","C":"仅胸片","D":"仅血脂"},"answer":"A"}
+{"id":"l1-sample-614b023765fc8a6ca7adb51f","question":"根据 CSCO 2025 表22及注释，关于鼻咽癌随访表中的长期功能评估，下列哪项最符合指南原文？","options":{"A":"4–5年及5年以上随访仍建议关注口腔、听力、视力、吞咽、营养和功能康复评估","B":"功能康复只在儿童患者中需要","C":"随访表只强调影像，不涉及功能问题","D":"5年后仅保留鼻咽镜，不再做功能评估"},"answer":"A"}
+{"id":"l1-sample-4fdf6f392d97872ec8afe2a0","question":"根据 CSCO 2025，第 1–3 年的常规随访频率通常为？","options":{"A":"每 6–12 个月一次","B":"每年一次","C":"每 3–6 个月一次","D":"每月一次"},"answer":"C"}
+{"id":"l1-sample-b48f2f10292139e9c3c77901","question":"根据 CSCO 2025，第 4–5 年的常规随访频率通常为？","options":{"A":"每 6–12 个月","B":"每 3–6 个月","C":"每 1–3 个月","D":"每 2 年一次"},"answer":"A"}
+{"id":"l1-sample-3be85edecfd9210fecdec70b","question":"根据 CSCO 2025，关于鼻咽癌随访策略，下列最准确的是：","options":{"A":"5年后不再需要随访","B":"所有患者统一随访频率，无需风险分层","C":"应采用分层管理并强调终身随访","D":"仅复发后才随访"},"answer":"C"}
+{"id":"l1-sample-2dd93fc6498c7cc8e8c299d1","question":"根据 CSCO 2025，哪类患者在治疗后5年内更需要密切随访？","options":{"A":"仅角化型患者","B":"仅T1N0","C":"仅儿童患者","D":"局部晚期（T3–4或N2–3）患者"},"answer":"D"}
+{"id":"l1-sample-ef14abbfbb6791552781a774","question":"根据 CSCO 2025，对局部晚期（T3–4 或 N2–3）患者，随访理念最符合的是：","options":{"A":"采用分层管理并强调治疗后 5 年内对高风险患者更密切随访","B":"随访仅靠血浆 EBV DNA","C":"只要 1 年无病即可停止随访","D":"所有患者同一频率随访即可"},"answer":"A"}
diff --git a/L2/README.md b/L2/README.md
new file mode 100644
index 0000000000000000000000000000000000000000..88756d1c875d3724ad8840337f9ecd4721704779
--- /dev/null
+++ b/L2/README.md
@@ -0,0 +1,5 @@
+# L2: guideline application
+
+185 questions, scored by the macro-average of four capability groups. Three fields define each input: `vignette`, `question` and `options`. The reference `answer` and `explanation` must not be included in the model input.
+
+One question is marked `question_type: multiple_choice`: select every applicable option and return the complete set, for example `\boxed{C,D}`. The answer set must match exactly, independently of order. Other questions require one option.
diff --git a/L2/questions.jsonl b/L2/questions.jsonl
new file mode 100644
index 0000000000000000000000000000000000000000..9ef9e052756c2ddc1a048ce43e75ed26fe4ee249
--- /dev/null
+++ b/L2/questions.jsonl
@@ -0,0 +1,185 @@
+{"id":"l2-sample-75fc717b760b9aee1b352b79","question":"最符合循证医学及精准诊疗原则的推荐是？","options":{"A":"考虑为免疫治疗相关假性进展，建议继续卡瑞利珠单抗单药维持，密切随访，暂不进行干预。","B":"判定为疾病全面进展（PD），立即停用免疫治疗，二线更换为卡培他滨单药或多西他赛单药化疗。","C":"完善肺结节活检或PET-CT以明确性质；若证实为寡转移/寡进展，建议维持原免疫治疗方案，并针对肺结节及颈部淋巴结行立体定向放疗（SBRT）或消融治疗。","D":"判定为对PD-1抑制剂耐药，立即更换为抗EGFR单抗（如西妥昔单抗）联合化疗作为二线挽救治疗。"},"answer":"C","vignette":"患者男，52岁，复发性鼻咽癌（rT4N2M0）。一线接受“吉西他滨+顺铂+卡瑞利珠单抗”治疗6周期后，行卡瑞利珠单抗维持治疗。维持治疗第9个月复查MRI提示：鼻咽部原发灶稳定，但新发一枚右肺下叶结节（直径1.2cm），且颈部II区淋巴结较前增大20%。患者目前无咳嗽、咳痰，无发热。查体：颈部淋巴结质韧，活动度可。实验室检查：血浆EBV DNA由维持期间的0 copies/mL升至500 copies/mL。既往放疗史为2年前根治性放疗（PGTVnx 70Gy）。","capability_group":"metastatic_systemic"}
+{"id":"l2-sample-868d7ca966b726924c91034a","question":"最推荐的治疗模式是？","options":{"A":"诱导化疗（GP方案 2疗程）+ 同期放化疗","B":"单纯调强适形放射治疗（IMRT）","C":"IMRT同期联合顺铂单药化疗（100 mg/m² q3w）","D":"IMRT同期联合卡培他滨节拍化疗"},"answer":"B","vignette":"患者男，45岁，因“右侧耳鸣伴听力下降2个月”就诊。鼻咽镜示右侧咽隐窝结节状新生物。MRI显示：鼻咽右侧壁增厚，肿瘤侵犯翼内肌内侧缘（T2），未累及颅底及其他深部结构；双侧颈部可见数个短径<5mm淋巴结，影像学特征倾向良性（N0）。全身检查未见远处转移。\n\n关键实验室检查：治疗前血浆EBV DNA检测结果为 150 copies/mL（低于切点值）。ECOG 0分。既往体健。","capability_group":"initial_definitive"}
+{"id":"l2-sample-946dc092849baab405329164","question":"以下哪项治疗决策在确保生存获益的同时，最能体现“减毒”原则？","options":{"A":"单纯调强放射治疗（IMRT）","B":"同步放化疗（CCRT，顺铂 100mg/m² q3w）","C":"诱导化疗（GP方案 × 2周期）序贯单纯调强放射治疗（IMRT）","D":"诱导化疗（TPF方案 × 3周期）序贯同步放化疗（CCRT）"},"answer":"C","vignette":"背景：患者男，57岁，PS评分 0分。因“回吸性涕血”就诊。\n\n影像学：MRI示鼻咽顶后壁肿物，向外侧浸润超越咽颅底筋膜，侵犯咽旁间隙；左侧颈部可见一枚肿大淋巴结（II区），最大径2.2cm，包膜完整；全身PET/CT排除远处转移。\n\n实验室：治疗前血浆EBV-DNA 1.8×10^4 copies/mL。\n\n病理：非角化性未分化癌。\n\n分期：T2N1M0（II期，AJCC第8版）。","capability_group":"initial_definitive"}
+{"id":"l2-sample-7efe32aeeffef3fd4899c840","question":"最佳诊疗方案是？","options":{"A":"诱导化疗（吉西他滨+顺铂）序贯单纯调强放疗","B":"同期放化疗（IMRT + 顺铂 100mg/m² q3w）","C":"同期放化疗（IMRT + 顺铂 40mg/m² q1w）","D":"单纯根治性调强放疗（IMRT）"},"answer":"D","vignette":"患者男，74岁，ECOG PS评分0分。主诉“回吸性血涕半年”就诊。既往体健，否认高血压、糖尿病及心脑血管病史。鼻咽镜及活检确诊为非角化性未分化癌。治疗前分期检查（MRI及全身评估）提示鼻咽顶后壁增厚，侵犯咽旁间隙，双侧颈部可见多发淋巴结肿大，最大径约2.5cm，未累及锁骨上窝，无远处转移。TNM分期评估为cT1cN1M0（第8版AJCC分期）。治疗前血浆EBV-DNA检测为0 copies/mL（低于检测下限）。血常规、肝肾功能及心电图均未见明显异常。明确淋巴结特征“双侧颈部II区淋巴结肿大，最大径2.5cm，影像学未见淋巴结包膜外侵犯（ENE-）”。","capability_group":"initial_definitive"}
+{"id":"l2-sample-b38c0ded572618b7655f0309","question":"下一步最合理的治疗策略调整是什么？","options":{"A":"认定为疾病进展（PD），更换二线化疗方案（如紫杉醇+卡铂），暂停局部放疗。","B":"继续原方案全身治疗，但在肝脏病灶处增加局部消融或SBRT治疗，待肝脏病灶控制后，再行鼻咽及颈部根治性放疗。","C":"忽略肝脏病灶的“假性进展”可能，直接开始鼻咽及颈部原发灶的根治性调强放疗（IMRT），同期联合顺铂化疗。","D":"针对肝脏进展病灶行局部治疗（如SBRT或消融），同时对鼻咽及颈部原发灶行根治性放疗（IMRT），放疗后继续免疫维持治疗"},"answer":"D","vignette":"患者男，54岁。确诊“鼻咽非角化性未分化型癌，cT4N2M1（IVB期）”。\n\n初诊情况：鼻咽顶后壁肿块侵犯海绵窦及斜坡，包绕右侧颈内动脉；双颈II区淋巴结转移；PET/CT示T6椎体、右侧髂骨及肝S6段（单发，1.5cm）共3处高代谢转移灶。EBV-DNA 1.2×10^5 copies/mL。\n治疗经过：患者接受了3周期“吉西他滨+顺铂+特瑞普利单抗”诱导治疗。\n复查评估：鼻咽及颈部病灶PR（缩小50%）；T6及髂骨病灶代谢显著降低；但肝S6段病灶由1.5cm增大至2.0cm，且代谢增高。患者目前ECOG PS 1分，肝肾功能正常。","capability_group":"metastatic_systemic"}
+{"id":"l2-sample-96d85b01f9b60669c3472ffd","question":"首选的挽救性治疗策略是？","options":{"A":"诱导化疗（吉西他滨+顺铂）2周期后行挽救性调强放疗（IMRT）","B":"单纯PD-1抑制剂免疫治疗","C":"经鼻内镜下鼻咽病灶切除术","D":"挽救性调强放疗（IMRT）60Gy/30f"},"answer":"C","vignette":"患者男，43岁，ECOG 0分。既往史：3年前确诊鼻咽癌（T3N1M0），行根治性IMRT及同期顺铂化疗，达到完全缓解（CR）。现病史：晨起回吸性涕血1个月。辅助检查：鼻咽增强MRI示鼻咽顶后壁局限性软组织结节，大小1.2cm×1.0cm，局限于鼻咽腔内（rT1），与双侧颈内动脉包膜间距>5mm，颅底骨质完整。颈部超声及PET-CT未见区域淋巴结及远处转移。EBV-DNA 1000 copies/mL。活检病理：非角化性未分化癌。","capability_group":"post_treatment_recurrence"}
+{"id":"l2-sample-edded87d6f1cd1eb801b194c","question":"基于目前的临床证据与最佳实践，下一步对颈部病灶的首选处理策略是？","options":{"A":"针对颈部代谢活跃区域行调强放疗（IMRT）局部推量（Boost）至60Gy","B":"立即行双侧颈淋巴结清扫术（Neck Dissection）","C":"启动二线姑息性化疗（如吉西他滨+顺铂 GP方案）","D":"建议行超声引导下颈部淋巴结细针穿刺活检（FNA），若阴性或无法穿刺则密切随访（1-2个月后复查）"},"answer":"D","vignette":"患者男，49岁，ECOG评分0分。患者因鼻咽癌（cT3N2M0，III期）于3个月前完成根治性同步放化疗（PGTVnx 70Gy/33f，PGTVnd 66Gy/33f）。近期出现少量回吸性涕血。鼻内镜检查见鼻咽顶后壁粘膜充血、少许白色分泌物附着，未见明确新生物及活动性出血点。 复查PET-CT显示：鼻咽部代谢未见明显异常；双侧颈部II区见数个小淋巴结影，最大径约0.8cm，SUVmax值为4.5（较治疗前显著下降，治疗前SUVmax 12.0），呈现代谢轻度活跃；颅底骨质破坏范围较前稳定。血浆EBV-DNA检测结果为0 copies/mL。血常规及生化指标均在正常范围内（WBC 5.5×10^9/L, Hgb 125g/L, PLT 210×10^9/L, Cr 80μmol/L）。体格检查显示颈部未触及明显肿大质硬淋巴结，颈部皮肤软组织质地尚可，无明显纤维化。","capability_group":"post_treatment_recurrence"}
+{"id":"l2-sample-be5d157e9c1bd7a0794ce4c9","question":"下列治疗调整策略中最合理的是？","options":{"A":"立即终止放疗和化疗，给予G-CSF及TPO治疗，直至ANC > 1.5×10^9/L且PLT > 75×10^9/L后重启放疗。","B":"暂停同步化疗，给予升白及升血小板支持治疗；在密切监测血象及患者状态下，尽量维持放射治疗不中断。","C":"继续放疗，同步顺铂剂量下调25%并推迟一周使用，同时预防性使用抗生素。","D":"鉴于骨髓耐受性差，终止后续放化疗，改用卡瑞利珠单抗单药维持治疗。"},"answer":"B","vignette":"患者男，57岁，确诊鼻咽癌（T3N2M0，III期）。诱导化疗后行同期放化疗（CCRT）。放疗第20次/33次，同步顺铂（100mg/m² q3w）已完成第一周期。今日复查：WBC 1.5×10^9/L，ANC 0.7×10^9/L，PLT 35×10^9/L（CTCAE III度），Hgb 78g/L。患者无发热，无出血点，ECOG 1分。EBV DNA转阴。","capability_group":"toxicity_contraindication"}
+{"id":"l2-sample-239798053d7453dc27d22d3a","question":"以下哪种初始治疗策略更符合当前指南推荐？","options":{"A":"单纯根治性调强放疗（IMRT）","B":"诱导化疗（GP方案 x 2-3周期）序贯单纯放疗","C":"同步放化疗（CCRT，顺铂 100mg/m² q3w x 2-3周期）","D":"诱导化疗（GP方案 x 3周期）序贯同步放化疗（CCRT）"},"answer":"C","vignette":"患者男，55岁。主诉“回吸性涕血1月余”。鼻咽镜活检：非角化性癌（未分化型）。查体：ECOG 0分。MRI示：鼻咽顶后壁增厚，侵犯咽旁间隙（T2），左颈II区淋巴结2.5cm（N1），无包膜外侵犯。PET/CT无远处转移。EBV DNA：15,000 copies/mL。诊断：cT2N1M0 (II期，AJCC第8版)。既往体健，无听力障碍，肾功能正常。","capability_group":"initial_definitive"}
+{"id":"l2-sample-914222a9ec9f47ad515cb60a","question":"同期放化疗方案中的化疗药物首选下列哪项？","options":{"A":"顺铂 (Cisplatin) 100 mg/m² Q3W","B":"顺铂 (Cisplatin) 40 mg/m² Weekly","C":"卡铂 (Carboplatin) AUC 5-6 Q3W","D":"氟尿嘧啶 (5-FU) 单药持续灌注"},"answer":"C","vignette":"患者男，66岁，ECOG 0分。确诊“鼻咽非角化性癌（未分化型）”，cT3N2M0（第8版AJCC分期），III期。既往史：双耳重度感音神经性耳聋（气导听阈平均 >70dB），仅凭助听器维持微弱听力。实验室检查：血肌酐 80 μmol/L，CCr 85 ml/min。拟行IMRT根治性放疗+同期化疗。","capability_group":"toxicity_contraindication"}
+{"id":"l2-sample-6877bf76f32ebae87056d1a6","question":"基于指南证据，下列哪种治疗策略作为优先推荐？","options":{"A":"吉西他滨+顺铂（GP方案）诱导化疗（3周期），序贯同期放化疗（顺铂单药增敏）","B":"单纯同期放化疗（顺铂单药增敏，3周期）","C":"多西他赛+顺铂+5-氟尿嘧啶（TPF方案）诱导化疗（3周期），序贯单纯根治性放疗","D":"同期放化疗（顺铂单药增敏），序贯辅助化疗（PF方案 3周期）"},"answer":"A","vignette":"患者男，66岁，1959年1月出生，既往体健，无吸烟史。因“回吸性涕血1月余”就诊。查体：ECOG评分 0分，鼻咽镜检查可见顶后壁及咽隐窝肿物。影像学检查（MRI）显示鼻咽部肿物侵犯颅底骨质，双侧颈部可见数个肿大淋巴结，最大径约4.5cm，位于II区，未包绕颈内动脉，锁骨上窝未见肿大淋巴结。胸腹部CT及骨扫描未见远处转移。实验室检查：WBC 5.5×10^9/L, Hgb 125g/L, PLT 210×10^9/L, ALT 25 U/L, Cr 80 umol/L。血浆EBV-DNA定量检测示 1.0×10^4 copies/mL。病理活检提示非角化性未分化癌。根据AJCC/UICC第8版分期系统，该患者T分期为T3（颅底骨质破坏），N分期为N2（双侧淋巴结转移，<6cm），M0，临床分期为III期。","capability_group":"initial_definitive"}
+{"id":"l2-sample-115f8f2454d709bccea64e99","question":"结合患者重度感音神经性听力损伤，在保留根治性治疗目标的前提下，以下哪项治疗原则最合理？","options":{"A":"因EBV-DNA较低且淋巴结较小，仅行单纯IMRT，无须评估系统治疗。","B":"采用含顺铂的TPF诱导化疗，随后行含顺铂的同期放化疗。","C":"采用含顺铂的GP诱导化疗，随后行含顺铂的同期放化疗。","D":"保留以根治性IMRT为核心的综合治疗；完善听力评估，由MDT选择适用的非顺铂方案，并制定序贯或同步治疗安排。"},"answer":"D","vignette":"患者：男，43岁。\n\n主诉：回吸性涕血1个月。\n\n检查：\n\n病理：鼻咽非角化性未分化癌。\n\nMRI：鼻咽顶后壁增厚，轻微侵犯翼内肌（T2）；双侧颈部II区可见多发淋巴结，最大径1.5cm，均位于环状软骨下缘以上，临床判定为双侧颈部淋巴结转移（N2）。\n\nEBV DNA：治疗前血浆EBV DNA为 300 copies/mL（低负荷）。\n\n既往史：乙肝病毒携带者（正在服用恩替卡韦，DNA不可测），严重听力受损（双耳感音神经性耳聋，需助听器）。\n\n分期：T2N2M0（III期，AJCC第8版）。","capability_group":"initial_definitive"}
+{"id":"l2-sample-1f7bf01bc67fa7c83722816f","question":"基于该患者的复发特征及既往治疗史，后续最佳的挽救性治疗策略是？","options":{"A":"经鼻内镜下鼻咽病灶切除术（Endoscopic Nasopharyngectomy）","B":"调强放射治疗（IMRT）再程放疗（60Gy/30f）","C":"诱导化疗（吉西他滨+顺铂）后行再程放疗","D":"免疫检查点抑制剂（PD-1单抗）单药维持治疗"},"answer":"A","vignette":"患者男，55岁。3年前确诊为鼻咽未分化癌（T2N1M0），接受根治性放化疗（IMRT 70Gy/33f + 同期顺铂），治疗后达到完全缓解。近期无诱因出现回吸性涕血，量少。查体：鼻咽部可见局部黏膜粗糙。MRI增强扫描显示：鼻咽顶后壁局部增厚，病灶局限在鼻咽腔内（rT1），与双侧颈内动脉均有清晰脂肪间隙，未见颅底骨质破坏，颈部淋巴结及全身检查未见转移征象。实验室检查：WBC 5.5×10^9/L, Hgb 125g/L, PLT 210×10^9/L, ALT 25 U/L, Cr 80 umol/L。血浆EBV-DNA定量为1000 copies/mL。ECOG评分 0分。","capability_group":"post_treatment_recurrence"}
+{"id":"l2-sample-5375d9cc89c0da92c4f84144","question":"以下哪项最符合当前指南支持的首选一线系统治疗策略？","options":{"A":"吉西他滨 + 顺铂（GP）联合 PD-1抑制剂（如特瑞普利单抗或卡瑞利珠单抗）","B":"单药 PD-1抑制剂免疫治疗","C":"顺铂 + 氟尿嘧啶（PF）联合 根治性调强放疗（IMRT）","D":"吉西他滨 + 顺铂（GP）单纯化疗"},"answer":"A","vignette":"患者男，63岁。因间断回吸性涕血1个月就诊。鼻咽镜示鼻咽顶后壁/咽隐窝巨大肿物；头颈MRI示鼻咽原发灶局部侵袭并双侧颈部及锁骨上窝多发淋巴结肿大。PET/CT及骨扫描示脊柱、骨盆、肋骨等多发骨转移，无内脏危象。实验室：WBC 5.5×10^9/L，Hgb 125 g/L，PLT 210×10^9/L，ALT 25 U/L，Cr 80 μmol/L。血浆EBV-DNA 2.0×10^5 copies/mL。ECOG PS 0分。","capability_group":"metastatic_systemic"}
+{"id":"l2-sample-e97643f942c332128545f424","question":"基于该患者既往治疗史及当前最新（2025 年）CSCO 指南，以下哪项更符合二线系统治疗的最佳推荐？","options":{"A":"卡培他滨单药治疗","B":"以对症/局部姑息放疗为主（如骨痛或高风险部位），暂不行系统治疗","C":"多西他赛+顺铂+氟尿嘧啶（TPF方案）联合化疗","D":"单药PD-1抑制剂（如特瑞普利单抗或卡瑞利珠单抗）治疗"},"answer":"A","vignette":"患者男，68岁，PS 0分。确诊复发转移性鼻咽癌。4个月前起行吉西他滨+顺铂（GP）一线化疗4周期，未行免疫治疗。末次化疗结束后1.5个月复查：原发灶稳定，但出现多发新发骨转移灶，评估PD。查体无特殊。血常规及肝肾功能未见明显异常。血浆EBV-DNA 5.0×10^4 copies/mL。","capability_group":"metastatic_systemic"}
+{"id":"l2-sample-d6c8ea5af1141e9925773252","question":"针对该患者右侧颈部II区PET轻度摄取的小淋巴结，下一步最合理的处理是？","options":{"A":"判定为颈部淋巴结残留，立即行右侧改良根治性颈淋巴结清扫术","B":"判定为局部区域未控，给予吉西他滨+顺铂（GP方案）辅助化疗2-4个周期","C":"考虑放疗后炎症反应或肉芽肿可能大，建议密切随访，4-6周后复查颈部超声/MRI，必要时行FNA","D":"针对右侧颈部II区代谢活跃淋巴结行立体定向放射治疗（SBRT）或局部推量（Boost）至 80Gy","E":"立即行超声引导下粗针穿刺活检（CNB），若为阴性则行预防性颈清扫"},"answer":"C","vignette":"患者男，67岁。局部晚期鼻咽癌，3个月前完成根治性同步放化疗（鼻咽原发灶及高危区域DT 70 Gy/33 f）。ECOG 0分，双侧颈部未触及明显肿大淋巴结。复查鼻咽及颈部MRI：鼻咽顶后壁软组织稍增厚；双侧颈部见数个小淋巴结（短径<1.0 cm）。PET-CT：鼻咽部代谢未见异常升高；右侧颈部II区一淋巴结轻度代谢活跃，SUVmax 4.5；余无异常代谢。EBV-DNA 0 copies/mL；血常规及肝肾功能正常。","capability_group":"post_treatment_recurrence"}
+{"id":"l2-sample-21afac227dc8f3f37931d45b","question":"对于该患者，下一步首选的挽救性综合治疗策略是？","options":{"A":"诱导化疗（如GP方案：吉西他滨+顺铂）后序贯再程放疗（如IMRT/质子等）","B":"直接行挽救性鼻咽切除术（内镜下或开放手术）","C":"单纯免疫检查点抑制剂（如PD-1单抗）维持治疗","D":"再程同步放化疗（顺铂 100mg/m² q3w + IMRT）"},"answer":"A","vignette":"患者男，75岁，ECOG评分0分。既往体健，无高血压、糖尿病及心脑血管病史。患者 3 年前确诊鼻咽癌后曾接受根治性放化疗综合治疗，3 月前复查提示复发。查体及影像学检查显示复发病灶范围较广，累及颅底骨质及海绵窦，但部淋巴结未见明显肿大，未见远处转移。实验室检查：血常规、肝肾功能均在正常范围。血浆EBV-DNA检测结果为0 copies/mL。患者目前无明显头痛、复视等颅神经受损症状，一般状况良好。","capability_group":"initial_definitive"}
+{"id":"l2-sample-a1021875efcf8fddd6ad6e78","question":"同期放化疗阶段，下列哪项方案最为合理且安全？","options":{"A":"采用标准剂量顺铂（100 mg/m² q3w）进行同期放化疗，同时给予强化水化（>3000ml/d）及甘露醇利尿","B":"放弃同期全身治疗，仅行单纯根治性调强放疗（IMRT）","C":"采用卡铂（按AUC 5-6 每3周一次）替代顺铂进行同期放化疗，或采用EGFR靶向药物（如西妥昔单抗/尼妥珠单抗）联合根治性放疗","D":"采用PD-1抑制剂（如卡瑞利珠单抗或特瑞普利单抗）联合根治性放疗","E":"采用吉西他滨联合奈达铂（GN方案）进行诱导化疗，序贯单纯根治性放疗"},"answer":"C","vignette":"患者，男，60岁，因“回吸性涕血伴头痛2个月”就诊。既往有高血压病史及慢性肾脏病（CKD）病史。查体：ECOG评分 0分。鼻咽镜活检示：非角化性未分化癌。影像学分期检查（MRI及CT）显示：鼻咽顶后壁软组织肿块，侵犯颅底骨质及脑神经，伴双侧颈部II区、III区淋巴结肿大，最大径约4.5cm，无远处转移（临床分期：cT4N2M0，IVA期 AJCC 第 8 版）。实验室检查：WBC 5.5×10^9/L, Hgb 125 g/L, PLT 210×10^9/L。血肌酐（Cr）197 μmol/L。血浆EBV-DNA拷贝数为 5000 copies/mL。拟行根治性放疗联合全身治疗。","capability_group":"toxicity_contraindication"}
+{"id":"l2-sample-ed3e25f2fa2b8223d53af0ce","question":"当前首选的挽救性治疗策略是？","options":{"A":"经鼻内镜下鼻咽病损切除术（Nasopharyngectomy）","B":"卡瑞利珠单抗+吉西他滨+顺铂全身系统性治疗","C":"吉西他滨+顺铂（GP方案）诱导化疗后行再程放疗","D":"调强适形放疗（IMRT）再程放疗（总剂量60Gy/30f）"},"answer":"A","vignette":"患者男，61岁，ECOG PS 0。主诉回吸性涕血1个月。3年前鼻咽癌（T2N1M0）行根治性同期放化疗，随访无异常。现鼻咽部MRI增强：鼻咽顶后壁黏膜局限性增厚并明显强化，病灶局限于鼻咽腔内（rT1），未见颅底骨质破坏或海绵窦侵犯，影像未提示颈内动脉受侵。颈部MRI/超声未见肿大淋巴结。PET/CT未见远处转移。血浆EBV-DNA 1000 copies/mL。无张口困难。","capability_group":"post_treatment_recurrence"}
+{"id":"l2-sample-3bcbae8b370bb58860b7aca7","question":"依据当前高质量循证证据与指南推荐，以下哪项是最佳一线系统治疗策略？","options":{"A":"吉西他滨 + 顺铂（GP方案）联合PD-1抑制剂（如特瑞普利单抗或卡瑞利珠单抗），联合化疗完成后继续PD-1抑制剂治疗至疾病进展或不可耐受","B":"吉西他滨 + 顺铂（GP方案）诱导化疗3周期，序贯同期放化疗（IMRT + 大剂量顺铂）以根治原发灶及颈部淋巴结","C":"单纯吉西他滨 + 顺铂（GP方案）化疗6周期，后续观察等待","D":"TPF方案（多西他赛+顺铂+氟尿嘧啶）诱导化疗3周期，序贯帕博利珠单抗单药维持治疗","E":"吉西他滨 + 顺铂（GP方案）联合PD-1抑制剂（如特瑞普利单抗或卡瑞利珠单抗）3 个疗程，后续PD-1抑制剂维持治疗"},"answer":"A","vignette":"患者男，66岁，回吸性涕血2月余。鼻咽镜活检：非角化性未分化癌。PET/CT示鼻咽原发灶，双侧颈部及锁骨上窝多发淋巴结转移，并见胸椎、腰椎及骨盆多发骨转移灶。血象及肝肾功能基本正常。血浆EBV-DNA 2.0×10^5 copies/mL。ECOG 0分，无活动性自身免疫病史。","capability_group":"metastatic_systemic"}
+{"id":"l2-sample-cf1dc95aa7ef0c31c6100120","question":"最佳的综合治疗策略是？","options":{"A":"立即行鼻咽原发灶及颈部淋巴结的根治性同步放化疗，随后给予吉西他滨+顺铂（GP）辅助化疗，骨转移灶行立体定向放疗（SBRT）","B":"先行吉西他滨+顺铂（GP）联合PD-1抑制剂全身系统性治疗，若治疗反应良好（无进展），随后给予原发灶、颈部淋巴结根治性放疗，并对骨转移灶进行局部放疗","C":"仅给予吉西他滨+顺铂（GP）联合PD-1抑制剂全身治疗及维持治疗，直至疾病进展或出现不可耐受毒性，因已属IVB期，暂不考虑针对原发灶的根治性放疗","D":"首选针对胸椎及髂骨转移灶的姑息性放疗以预防骨相关事件，随后行鼻咽部原发灶及颈部淋巴结的根治性放疗，最后行全身化疗联合免疫治疗","E":"先行诱导化疗（TPF方案），随后行原发灶及颈部淋巴结同步放化疗，骨转移灶密切观察，待出现疼痛症状时再行局部姑息干预"},"answer":"B","vignette":"患者男，55岁，因“回吸性涕血伴头痛1月余”就诊。既往体健。查体：ECOG PS 0分，鼻咽镜见顶后壁肿物。头颈部MRI提示：鼻咽顶后壁肿物侵犯海绵窦，伴双侧颈部II区淋巴结肿大（最大径约3cm）。全身PET-CT提示：鼻咽及双侧颈部淋巴结高代谢；胸椎（T6）及左侧髂骨可见两处高代谢病灶，考虑骨转移，无伴随明显骨痛及病理性骨折风险；其余脏器未见转移。辅助检查：血常规及肝肾功能正常，血浆EBV DNA 5.0×10^4 copies/mL。活检病理证实为非角化性未分化型癌。PD-L1 CPS = 15。经MDT讨论，诊断为：鼻咽非角化性未分化型癌（cT4N1M1，IVB期），初诊寡转移。","capability_group":"metastatic_systemic"}
+{"id":"l2-sample-08632f9c2d0a52ad72ece325","question":"最恰当的治疗策略是？","options":{"A":"直接行内镜下扩大鼻咽切除术 + 颈部淋巴结清扫术","B":"诱导化疗（吉西他滨+顺铂）联合抗血管生成药物（贝伐珠单抗），序贯根治性调强放疗（IMRT）","C":"诱导化疗（吉西他滨+顺铂）后，序贯根治性调强放疗（IMRT），放疗期间密切监测血压","D":"姑息性化疗（吉西他滨+顺铂）联合PD-1抑制剂，放弃局部根治性治疗","E":"单纯再次高剂量调强放疗（IMRT，>60Gy），同步加用铂类化疗"},"answer":"C","vignette":"患者男，45岁，ECOG评分0分。既往有重度高血压病史5年，近期血压波动于160-180/95-110mmHg，服用多种降压药控制不佳。患者2年前因鼻咽癌（T3N1M0）接受了根治性诱导化疗+同期放化疗，达到完全缓解（CR）。近期复查鼻咽镜及MRI提示鼻咽顶后壁及咽旁间隙受侵，并伴有同侧颈部II区单个淋巴结肿大（最大径2cm），全身PET-CT未见远处转移。当前复发分期评估为rT3N1M0。查体：生命体征平稳，鼻咽部可见坏死物与新生物混合。辅助检查：血常规、肝肾功能均正常。血浆EBV-DNA检测为 2500 copies/mL。患者强烈要求根治性治疗，但极度担忧再放疗引起的大出血等致死性并发症。","capability_group":"initial_definitive"}
+{"id":"l2-sample-0a5f22c7f5b32aed6ddc46ba","question":"结合现有指南与临床研究证据，对于该患者以下哪种综合治疗策略最合适？","options":{"A":"立即行鼻咽原发灶及颈部淋巴结的根治性同步放化疗，随后给予吉西他滨+顺铂（GP方案）辅助化疗以控制骨转移灶","B":"先行吉西他滨+顺铂（GP方案）全身化疗，若病灶缓解或稳定，序贯针对鼻咽原发灶及颈部淋巴结的根治性放疗，骨转移灶予以双膦酸盐保守治疗","C":"给予吉西他滨+顺铂联合PD-1抑制剂（如特瑞普利单抗/卡瑞利珠单抗）全身治疗4-6个周期，若疾病未进展，序贯鼻咽原发灶及颈部淋巴结的根治性放疗，并对骨转移灶行局部放疗（如SBRT），随后以PD-1抑制剂维持治疗","D":"仅给予吉西他滨+顺铂联合PD-1抑制剂全身治疗，待症状缓解后以PD-1抑制剂维持治疗，不建议行原发灶及转移灶的局部放疗以避免叠加毒性","E":"首选针对骨转移灶的立体定向放射治疗（SBRT）及原发灶的根治性放疗，随后序贯PD-1抑制剂单药维持治疗"},"answer":"C","vignette":"患者男，67岁，既往体健。因“回吸性涕血伴复视1月余”就诊。查体：ECOG评分0分，双侧颈部可触及数枚质韧淋巴结。鼻咽镜示顶后壁肿物。头颈部MRI显示：鼻咽顶后壁软组织肿块，侵犯海绵窦，伴第V、VI对脑神经受累征象；双侧颈部II区可见多发淋巴结肿大，最大径约4.5cm，无包膜外侵犯。全身PET-CT示：除鼻咽及颈部病灶外，仅见胸椎（T6）及左侧髂骨两处高代谢病灶，考虑骨转移，无内脏转移。血常规及生化指标均在正常范围。血浆EBV-DNA定量为5.0×10^4 copies/mL。肿瘤组织PD-L1 CPS=15。患者及家属治疗意愿强烈，希望获得最大生存获益。","capability_group":"metastatic_systemic"}
+{"id":"l2-sample-59594a281f4c3cd7b099d820","question":"该患者拟行根治性治疗。基于当前高等级证据/指南推荐，以下哪项综合治疗模式是最推荐的？","options":{"A":"吉西他滨+顺铂（GP方案）诱导化疗序贯同期放化疗（顺铂单药周疗或三周疗）","B":"多西他奇+顺铂+氟尿嘧啶（TPF方案）诱导化疗序贯单纯调强放疗（IMRT）","C":"单纯同期放化疗（顺铂单药100mg/m² Q3W）","D":"卡培他滨节拍化疗联合调强放疗（IMRT），后续辅助卡培他滨维持治疗"},"answer":"A","vignette":"患者男性，44岁，1981年1月出生。既往体健。因“回吸性涕血伴头痛1月余”就诊。体格检查示ECOG评分0分，双侧颈部可触及肿大淋巴结，质硬，最大径约3cm。鼻咽镜及活检确诊为非角化性未分化型鼻咽癌。头颈部增强MRI及CT显示鼻咽顶后壁软组织肿块，侵犯斜坡及颅底骨质，双侧咽后淋巴结及颈部II、III区淋巴结肿大，双侧颈部淋巴结最大径均<6cm，且位于环状软骨下缘以上。全身检查未见远处转移。辅助检查示：WBC 5.5×10^9/L, Hgb 125g/L, PLT 210×10^9/L, ALT 25 U/L, Cr 80 μmol/L。治疗前血浆EBV-DNA定量为1.0×10^4 copies/mL。","capability_group":"initial_definitive"}
+{"id":"l2-sample-73e205b8105137792dd44235","question":"以下哪项是最佳的综合治疗策略？","options":{"A":"立即行鼻咽原发灶及颈部淋巴结根治性放疗（IMRT）同期联合顺铂化疗，结束后序贯吉西他滨+顺铂（GP方案）全身化疗","B":"给予吉西他滨+顺铂（GP方案）联合PD-1抑制剂全身治疗，若达到客观缓解（PR/CR），后续采用PD-1抑制剂维持治疗，无需对原发灶及转移灶行局部放疗","C":"给予吉西他滨+顺铂（GP方案）联合PD-1抑制剂全身诱导治疗，若全身病灶控制良好，序贯鼻咽原发灶及颈部淋巴结根治性放疗，并对骨转移灶行立体定向放射治疗（SBRT）","D":"给予吉西他滨+顺铂（GP方案）全身化疗4-6个周期，若未进展，仅对鼻咽原发灶及颈部淋巴结行姑息性减症放疗（剂量<60Gy），骨转移灶继续观察","E":"首选手术切除鼻咽原发灶及颈部淋巴结清扫，术后针对骨转移灶行姑息性放疗及全身化疗联合免疫治疗"},"answer":"C","vignette":"患者男，57岁，既往体健。因“回吸性涕血1月余”就诊。查体：双侧颈部可触及数枚肿大淋巴结，质硬，最大径约2cm。ECOG评分 0分。\n\n辅助检查：鼻咽部MRI提示鼻咽顶后壁软组织肿块，侵犯海绵窦，伴第V、VI对脑神经受累征象；双侧颈部II-III区可见多发淋巴结转移，最大径均<6cm，无包膜外侵犯。全身PET-CT确认胸椎（T8）及左侧髂骨存在两处高代谢病灶，考虑骨转移，肝肺未见异常。\n\n实验室检查：肝肾功能正常。血浆EBV DNA 5.0×10^4 copies/mL。肿瘤组织PD-L1 CPS=2。病理活检证实为非角化性未分化型癌。\n\n诊断：鼻咽癌初诊IVA期（T4N2M1a，AJCC  第 9 版）。","capability_group":"metastatic_systemic"}
+{"id":"l2-sample-6c40a3007c45022659bea3d4","question":"下一步最恰当的标准治疗策略是？","options":{"A":"降阶梯行单纯根治性调强放疗（IMRT），豁免同期化疗","B":"继续给予顺铂单药同期放化疗（CCRT），放疗剂量DT 70Gy/33f，顺铂 100mg/m² q3w × 2-3周期","C":"行根治性调强放疗（IMRT），并联合信迪利单抗（PD-1抑制剂）同期及辅助治疗","D":"继续原GP方案诱导化疗至6周期达到最大肿瘤退缩后，再行单纯根治性调强放疗（IMRT）","E":"给予顺铂同期放化疗（CCRT），并在放疗结束后序贯卡培他滨节拍化疗维持治疗1年"},"answer":"B","vignette":"患者男，54岁，ECOG评分0分。因“回吸性涕血伴右颈部肿块”确诊为鼻咽非角化性癌（未分化型）。初诊MRI显示肿瘤侵犯颅底骨质，右侧颈部可见最大径约4.5cm的融合淋巴结，无远处转移。临床分期为cT3N2M0（III期，AJCC第8版）。治疗前血浆EBV DNA为 25,000 copies/mL。\n\n根据高危局部晚期鼻咽癌的治疗原则，患者接受了“吉西他滨+顺铂（GP方案）”诱导化疗3周期。目前为诱导化疗结束后3周返院评估。\n\n查体：右颈部肿块明显缩小。复查鼻咽及颈部MRI显示原发灶及颈部淋巴结较前显著缩小，达到部分缓解（PR）。实验室检查：血常规、肝肾功能均正常。复查血浆EBV DNA降至 0 copies/mL。","capability_group":"initial_definitive"}
+{"id":"l2-sample-ff0d325b57e535f0b23be456","question":"下一步最恰当的治疗策略是？","options":{"A":"调强放疗（IMRT）同期联合尼妥珠单抗，避免使用细胞毒性药物以保护心脏","B":"调强放疗（IMRT）同期联合单药顺铂（100mg/m² q3w），放疗结束后序贯卡培他滨节拍维持治疗半年","C":"调强放疗（IMRT）同期联合单药顺铂（100mg/m² q3w），放疗期间密切进行心电监护","D":"豁免同期化疗，行单纯调强放疗（IMRT），因诱导化疗后EBV DNA已转阴，降阶梯治疗可减少毒性"},"answer":"C","vignette":"患者男，58岁，PS评分0分。\n\n既往史：20余年前曾有1次晕厥史；2025年初爬山时出现短暂黑蒙、胸闷，休息后缓解。2025年5月动态心电图提示：窦性心律稍缓，偶发室早，大于1.5秒的长RR间期共4266阵（最长2.007秒），下壁及前侧壁导联可见一过性ST段压低，心内科会诊考虑“心律失常，疑似冠脉痉挛/心肌缺血”，建议暂予观察，避免使用诱发冠脉痉挛的药物。既往否认高血压、糖尿病病史。\n\n现病史：确诊鼻咽癌（非角化性癌，未分化型），分期为cT3cN1cM0（第8版AJCC分期，III期）。基线血浆EBV DNA为 15,000 copies/mL。\n\n治疗经过：患者已完成2个疗程GP方案（吉西他滨 1g/m² d1,8 + 顺铂 80mg/m² d1）诱导化疗，过程顺利，未诉胸闷心悸。目前处于诱导化疗后第3周。\n\n复查评估：鼻咽及颈部病灶明显缩小（疗效评价PR），血浆EBV DNA转阴（0 copies/mL）。血常规及肝肾功能均在正常范围。","capability_group":"initial_definitive"}
+{"id":"l2-sample-4f79cba980a890729b5cbe82","question":"该患者目前最标准且获益最明确的一线综合治疗策略是？","options":{"A":"单纯同期放化疗（IMRT + 大剂量顺铂），放疗结束后序贯卡培他滨节拍辅助化疗（1年）","B":"吉西他滨+顺铂（GP）诱导化疗（3周期）序贯同期放化疗（IMRT + 顺铂）","C":"吉西他滨+顺铂（GP）联合PD-1抑制剂诱导化疗，序贯同期放化疗，并在放疗后使用PD-1抑制剂维持治疗","D":"多西他赛+顺铂+氟尿嘧啶（TPF）诱导化疗序贯单纯调强放疗（IMRT），以降低严重毒副反应","E":"顺铂+氟尿嘧啶（PF）诱导化疗序贯同期放化疗（IMRT + 顺铂）"},"answer":"B","vignette":"患者男，46岁，既往体健。因“回吸性涕血伴双侧颈部肿块2个月”就诊。查体：PS评分0分，双侧颈部可触及多个质硬肿大淋巴结，最大直径约4.5cm，活动度尚可。辅助检查：血常规、肝肾功能及电解质均在正常范围（Cr 75 μmol/L，肌酐清除率 110 mL/min），纯音测听示双耳听力正常。血浆EBV-DNA定量检测示 8.5×10^4 copies/mL。\n\n鼻咽+颈部MRI及CT示：鼻咽顶后壁及双侧咽隐窝软组织明显增厚，肿瘤向上侵犯斜坡及蝶窦底壁，向外侧侵犯翼腭窝；双侧颈部II、III区可见多发肿大淋巴结，最大径约4.5cm，包膜完整，未见远处转移征象。病理活检证实为鼻咽非角化性未分化癌。","capability_group":"initial_definitive"}
+{"id":"l2-sample-206b89b11ad74cadc22ea9ee","question":"下一步最恰当的治疗策略是？","options":{"A":"立即启动恩替卡韦抗病毒治疗，并序贯同步放化疗（IMRT + 顺铂 100mg/m² q3w），放化疗期间密切监测 HBV-DNA 及肝功能相关指标","B":"因诱导化疗后EBV-DNA已清零且影像学达PR，提示预后良好，立即启动抗病毒治疗后，行单纯调强放疗（IMRT）以豁免同期化疗毒性","C":"立即启动抗病毒治疗，并序贯同步放化疗（IMRT + 顺铂），同时联合PD-1抑制剂（如信迪利单抗）以进一步提高无病生存率（DFS）","D":"暂停抗肿瘤治疗，立即启动恩替卡韦及保肝治疗，待HBV-DNA转阴且肝功能恢复正常后，继续第3-4周期GP方案诱导化疗","E":"立即启动抗病毒治疗，考虑到HBV再激活及肝功能异常，将同步化疗方案中的顺铂替换为卡铂或西妥昔单抗，联合IMRT"},"answer":"A","vignette":"患者，男性，48岁，因鼻咽部肿块伴颈部淋巴结肿大就诊。MRI显示鼻咽肿瘤侵犯颅底及双侧颈部多组淋巴结，分期为cT4cN3cM0。既往有慢性乙型肝炎史，基线HBV-DNA阳性，未接受抗病毒治疗。完成3周期GP方案诱导化疗后，肿瘤缩小，EBV-DNA降至未检出。近期复查发现HBV-DNA显著升高，ALT 65 U/L，AST 48 U/L，无黄疸，肝功能其余指标正常。肾功能、听力检查均正常。患者拟进入同步放化疗阶段，家属关心后续治疗方案及乙肝处理。","capability_group":"initial_definitive"}
+{"id":"l2-sample-89f6d9c42b40a6b6b8916dae","question":"首选的一线系统治疗策略是？","options":{"A":"顺铂 + 氟尿嘧啶（PF）方案化疗，联合帕博利珠单抗，随后帕博利珠单抗维持治疗","B":"吉西他滨 + 顺铂（GP）联合 PD-1抑制剂（如特瑞普利单抗/卡瑞利珠单抗/替雷利珠单抗）4-6周期，随后PD-1抑制剂维持治疗","C":"吉西他滨 + 顺铂（GP）联合 PD-1抑制剂 4-6周期，随后对鼻咽原发灶、颈部淋巴结及所有骨转移灶行根治性放疗","D":"鉴于PD-L1 CPS<20，免疫治疗获益有限，首选吉西他滨 + 顺铂（GP）双药化疗6周期，随后定期随访","E":"先行鼻咽部及颈部淋巴结姑息性放疗以缓解脑神经受压症状，随后行单药PD-1抑制剂治疗","F":"吉西他滨 + 顺铂（GP）联合 PD-1抑制剂 （如特瑞普利单抗/卡瑞利珠单抗/替雷利珠单抗）4-6周期，随后对鼻咽原发灶行姑息性放疗"},"answer":"B","vignette":"患者男，65岁，既往体健。因“回吸性涕血伴右侧面部麻木1月余”就诊。查体：ECOG评分 0分，双侧颈部及右侧锁骨上窝可触及肿大淋巴结，质硬固定。鼻咽镜活检示：非角化性未分化型癌。免疫组化：EBER(+)，PD-L1 CPS=1。头颈部MRI显示：鼻咽顶后壁肿物侵犯海绵窦，累及第V、VI对脑神经；双侧颈部及右侧锁骨上窝多发淋巴结肿大。全身PET/CT及骨扫描提示：胸椎、腰椎、骨盆及双侧肋骨多发高代谢病灶，提示广泛骨转移。实验室检查：WBC 5.5×10^9/L, Hgb 125g/L, PLT 210×10^9/L, ALT 25 U/L, Cr 80 μmol/L。血浆EBV-DNA定量为 2.0×10^5 copies/mL。患者肝肾功能及心肺储备良好。","capability_group":"metastatic_systemic"}
+{"id":"l2-sample-dcc5da25c149aece8ff83ec6","question":"关于其后续综合治疗策略，以下最恰当的决策是？","options":{"A":"继续原方案（GP+特瑞普利单抗）至满6个周期，若影像学评估达到完全缓解（CR），则可免除局部放疗，直接进入特瑞普利单抗单药维持阶段","B":"立即启动鼻咽及颈部原发灶的根治性放疗（66-70Gy），放疗期间同步给予大剂量顺铂（100mg/m² q3w）以强化局控，放疗结束后行特瑞普利单抗维持治疗","C":"启动鼻咽及颈部原发灶的根治性放疗（66-70Gy），放疗期间不常规推荐同步化疗，放疗结束后继续使用特瑞普利单抗维持治疗；肺部转移灶暂不作局部干预，以全身免疫维持为主","D":"给予鼻咽及颈部姑息剂量放疗（50-54Gy）以减轻局部肿瘤负荷，同时对双肺转移灶行立体定向放疗（SBRT），随后继续GP方案化疗至疾病进展","E":"暂停全身系统治疗，优先对双肺转移灶进行射频消融或手术切除，达到无瘤状态（NED）后再行鼻咽及颈部根治性放疗"},"answer":"C","vignette":"患者男，38岁，既往体健。确诊为非角化性鳞状细胞癌（未分化型），初诊分期为cT3N3M1（IVB期，双肺多发无症状小结节转移）。初诊时血浆EBV-DNA为 4.5×10^5 copies/mL。\n\nMDT团队为其制定了“吉西他滨+顺铂+特瑞普利单抗（GP+PD-1）”的全身系统性治疗方案。患者在接受3个周期治疗后复查：鼻咽原发灶及颈部淋巴结明显缩小，双肺转移灶部分缓解（PR），血浆EBV-DNA转阴（0 copies/mL），ECOG评分0分，且未发生≥3级免疫或化疗相关不良反应。","capability_group":"metastatic_systemic"}
+{"id":"l2-sample-eec909842e36cb19de3f2fb0","question":"下列最符合当前指南规范且能最大化生存获益的临床处理策略是？","options":{"A":"立即暂停放疗与化疗，给予G-CSF、重组人TPO支持，并预防性输注单采血小板1治疗量；待ANC > 1.5且PLT > 100后恢复放疗，第3周期同期化疗顺铂减量25%","B":"暂停同期顺铂化疗，给予G-CSF及TPO受体激动剂（或IL-11）及促红素支持治疗，严密监测下维持放疗不中断；鉴于肾功能受损及听力下降，后续取消第3周期顺铂，可考虑替换为尼妥珠单抗或西妥昔单抗同期靶向治疗","C":"维持放疗不中断，给予G-CSF及TPO支持治疗；鉴于顺铂出现剂量限制性毒性，第3周期同期化疗直接替换为卡铂（AUC=5）以减轻胃肠道和肾毒性","D":"暂停放疗，给予G-CSF及TPO支持治疗，待血象恢复（ANC > 1.0，PLT > 50）后继续放疗；为保证局部控制率，必须在放疗结束前补足第3周期顺铂化疗","E":"维持放疗不中断，给予G-CSF及TPO支持治疗，并预防性使用广谱抗生素；取消后续所有同期全身治疗，放疗结束后直接转为卡培他滨节拍性维持治疗"},"answer":"B","vignette":"患者男，58岁。因“发现右侧颈部包块伴回吸性涕血3个月”就诊。确诊为非角化性鳞状细胞癌，分期为 T4N2M0，IVA期（AJCC 第8版）。ECOG评分 1分。\n\n治疗经过： 患者接受了3个周期的 TPF（多西他赛+顺铂+5-FU）诱导化疗，疗效评估为部分缓解（PR）。随后开始根治性调强放疗（IMRT，计划剂量 PGTVnx 70Gy/33Fx），并计划同期给予顺铂（100mg/m²，q3w）化疗2-3个周期。\n\n当前情况： 患者目前处于放疗第4周（已完成 42Gy/21Fx），刚完成第2周期同期顺铂化疗后第7天。今日复查血常规示：WBC 1.2×10^9/L，ANC（绝对中性粒细胞）0.4×10^9/L，Hgb 75g/L，PLT 35×10^9/L。生化指标：ALT 35 U/L，Cr 110 μmol/L（基线为 70 μmol/L），肌酐清除率（Ccr）45 mL/min。患者诉伴有双耳高频听力下降。查体：体温 37.2℃，皮肤黏膜无瘀点瘀斑，无活动性出血。","capability_group":"toxicity_contraindication"}
+{"id":"l2-sample-a4aaacc0d83da65cc72cec52","question":"以下哪项是首选的根治性挽救治疗策略？","options":{"A":"调强放射治疗（IMRT）再程放疗（60-70Gy）","B":"经鼻内镜下鼻咽病灶切除术（Endoscopic Nasopharyngectomy）","C":"质子重离子放射治疗（PRT）","D":"立体定向放射治疗（SBRT/SRS）","E":"诱导化疗（吉西他滨+顺铂）后行IMRT再程放疗"},"answer":"B","vignette":"患者男，57岁。3年前因鼻咽癌（T2N1M0）行根治性放化疗（PGTVnx 70Gy/33f）后完全缓解。近2周晨起回吸性涕中带血。鼻咽镜：鼻咽顶后壁局限性新生物，表面粗糙。查体：ECOG 0分，伴有既往放疗引起的 III度口干及 I 度颈部软组织纤维化。影像：头颈部增强MRI示鼻咽顶后壁局灶性软组织增厚/肿块，局限于鼻咽腔内，未见颅底骨质破坏；与颈内动脉之间间隙尚存，未见血管包绕；颈部未见肿大淋巴结。PET-CT未见远处转移。肝肾功能正常，血象基本正常。","capability_group":"post_treatment_recurrence"}
+{"id":"l2-sample-946df298634fc17e3f73b528","question":"针对该患者，下一步治疗策略最恰当的是？","options":{"A":"停用化疗，采用特瑞普利单抗单药维持治疗，并继续定期使用骨改良药物（如唑来膦酸）","B":"停用顺铂，采用吉西他滨 + 特瑞普利单抗联合维持治疗，并继续定期使用骨改良药物","C":"采用特瑞普利单抗 + 卡培他滨节拍化疗联合维持，暂缓骨改良药物以减轻肾脏负担","D":"立即对鼻咽原发灶及颈部淋巴结进行根治性放疗，放疗期间暂停特瑞普利单抗，放疗后继续免疫维持","E":"维持原方案（GP + 特瑞普利单抗）继续治疗至9-12个周期以追求完全缓解（CR），随后转为观察"},"answer":"A","vignette":"患者男，60岁。初诊因“回吸性涕血伴右颈部包块”就诊，确诊为非角化性鳞状细胞癌（未分化型），PET-CT提示鼻咽顶后壁占位，双侧颈部淋巴结转移，伴胸椎、腰椎、骨盆多发骨转移（无脊髓压迫及承重骨病理性骨折风险）。临床分期：cT2N2M1（IVB期）。\n\n初始治疗：给予“吉西他滨+顺铂（GP）+ 特瑞普利单抗”方案全身治疗6个周期。同时针对骨转移灶给予了唑来膦酸治疗。\n\n当前评估：6周期后复查，鼻咽原发灶及颈部淋巴结明显缩小，骨转移灶成骨性修复，整体疗效评估为部分缓解（PR）。血浆EBV-DNA由基线的 4.5×10^5 copies/mL 降至 0 copies/mL（转阴）。血常规及肝肾功能正常，无明显免疫相关不良反应（irAEs）。体能状态评分ECOG 0分。","capability_group":"metastatic_systemic"}
+{"id":"l2-sample-6d1b06ca9965ff761b971806","question":"依据现行指南，该患者首选的根治性初始治疗方案是？","options":{"A":"单纯根治性调强放疗（IMRT）","B":"同期放化疗（IMRT + 顺铂 100mg/m² q3w）","C":"单纯根治性调强放疗 + 辅助化疗（卡培他滨节拍化疗）","D":"诱导化疗（吉西他滨+顺铂）后行同期放化疗"},"answer":"A","vignette":"患者男，66岁，既往体健，无吸烟酗酒史。因“反复回吸性涕血1个月”就诊。查体：ECOG PS 0分，双侧颈部未触及肿大淋巴结。鼻咽镜检查可见鼻咽顶后壁粘膜粗糙、微隆起，活检病理证实为非角化性未分化癌。头颈部增强MRI显示：病灶局限于鼻咽顶后壁，未侵犯咽旁间隙，未见颅底骨质破坏，双侧颈部淋巴结短径均<5mm，无坏死或环形强化特征。全身检查（胸腹CT及骨扫描）未见远处转移。辅助检查示：WBC 5.5×10^9/L, Hgb 125g/L, PLT 210×10^9/L, ALT 25 U/L, Cr 80 μmol/L。治疗前血浆EBV DNA检测结果为0 copies/mL。","capability_group":"initial_definitive"}
+{"id":"l2-sample-1b62f6369bbb1979e03fb542","question":"针对该颈部淋巴结的下一步管理策略最合适的是？","options":{"A":"密切随访观察（每1-2个月复查超声或MRI），暂不进行侵入性操作","B":"立即启动吉西他滨+顺铂（GP方案）辅助化疗","C":"立即行双侧颈部淋巴结清扫术","D":"给予颈部淋巴结区域局部推量放疗（Boost RT）"},"answer":"A","vignette":"患者男，61岁。既往确诊为鼻咽癌（T3N2M0），已完成标准的根治性同步放化疗。目前距离放疗结束3个月，体格检查示ECOG评分0分，鼻咽镜检查见鼻咽顶后壁粘膜略显粗糙，但未见明确溃疡或新生物。复查血常规及肝肾功能均正常（WBC 5.5×10^9/L, Hgb 125g/L, PLT 210×10^9/L, ALT 25 U/L, Cr 80 umol/L），血浆EBV DNA为0 copies/mL。全身PET-CT复查显示：鼻咽部代谢轻度增高（考虑放疗后炎症改变），但双侧颈部II区可见数枚小淋巴结，最大径约0.8cm，代谢轻度活跃，SUVmax值为4.5。颅底骨质破坏范围同前片比较无明显变化。","capability_group":"post_treatment_recurrence"}
+{"id":"l2-sample-a0a642e66433a187ea3555e5","question":"根据目前的循证医学证据，最合理的治疗模式是？","options":{"A":"同期放化疗（CCRT，顺铂周疗或三周疗）","B":"单纯根治性调强放疗（IMRT）","C":"诱导化疗（GP方案 x 3周期）序贯同期放化疗（CCRT）","D":"诱导化疗（TP方案 x 4周期）序贯同期放化疗（CCRT）"},"answer":"A","vignette":"患者男，40岁，既往体健。因“回吸性涕血1月余”就诊。查体：ECOG评分0分，鼻咽镜见鼻咽顶后壁新生物。头颈部增强MRI显示：鼻咽顶后壁增厚，侵犯咽旁间隙，可见单侧II区淋巴结肿大，短径约2cm（<6cm），无锁骨上淋巴结转移及远处转移征象。血常规及生化指标：WBC 5.5×10^9/L, Hgb 125g/L, PLT 210×10^9/L, ALT 25 U/L, Cr 80 umol/L。血浆EBV-DNA定量检测结果为15,000 copies/mL。临床分期评估为T2N1M0（AJCC第8版，II期）。","capability_group":"initial_definitive"}
+{"id":"l2-sample-650f5fcad48189c9ab04763a","question":"结合患者既存重度感音神经性听力损伤，根据CSCO–ASCO鼻咽癌联合指南，以下哪些药物及剂量可作为顺铂不适用时的同期化疗替代选择？（多选，选择所有符合项）","options":{"A":"顺铂 (Cisplatin) 100 mg/m² d1, q3w","B":"顺铂 (Cisplatin) 40 mg/m² d1, q1w","C":"奈达铂 (Nedaplatin) 100 mg/m² d1, q3w","D":"卡铂 (Carboplatin) AUC=5 d1, q3w","E":"西妥昔单抗 (Cetuximab) 400 mg/m² 负荷剂量，随后 250 mg/m² q1w"},"answer":"C+D","vignette":"患者，男，45岁。主诉回吸性涕血伴右侧颈部包块2个月。\n\n既往史：双耳重度感音神经性耳聋5年（纯音测听提示双耳平均听阈>75 dB HL，日常依赖助听器）。无高血压、糖尿病史。\n\n体格检查：ECOG PS 0分。右侧颈部II区可及一大小约 4×3 cm 质硬淋巴结，固定无压痛。\n\n辅助检查：鼻咽镜及活检确诊为鼻咽非角化性癌（未分化型）。头颈部MRI提示：鼻咽顶后壁肿物侵犯斜坡及蝶窦（T3），双侧咽后淋巴结及右侧颈部II区淋巴结转移，最大径4.5cm，均位于环状软骨下缘以上，无包膜外侵犯（N1）。全身PET-CT未见远处转移（M0）。临床分期：T3N1M0，III期（AJCC 第8版）。\n\n实验室检查：WBC 5.5×10^9/L, Hgb 125g/L, PLT 210×10^9/L。血清肌酐 95 μmol/L，肌酐清除率（Ccr）估算为 75 mL/min。血浆EBV-DNA：1.5×10^4 copies/mL。\n\n治疗计划：MDT讨论决定行根治性调强放疗（IMRT），并计划联合同期系统治疗。","capability_group":"toxicity_contraindication","question_type":"multiple_choice"}
+{"id":"l2-sample-b7cc0a429bdfd9d8d1947fe9","question":"以下哪项更符合当前循证证据与指南推荐的二线系统治疗策略？","options":{"A":"帕博利珠单抗（Pembrolizumab）单药治疗","B":"特瑞普利单抗（Toripalimab）或 卡瑞利珠单抗（Camrelizumab）单药治疗","C":"替雷利珠单抗（Tislelizumab）联合 吉西他滨+顺铂","D":"多西他赛联合阿帕替尼（Apatinib）","E":"针对进展骨转移灶行姑息放疗，全身治疗更换为多西他赛+顺铂+氟尿嘧啶（TPF方案）"},"answer":"B","vignette":"患者男，48岁。1年前确诊为复发/转移性鼻咽癌（初诊即伴有多发骨转移），接受吉西他滨联合顺铂（GP方案）一线姑息化疗6周期，最佳疗效评价为部分缓解（PR）。末次化疗结束1.5个月后，患者再次出现回吸性涕血，复查PET-CT提示：鼻咽原发灶较前增大，全身多发骨转移灶较前增多、增大（无脊髓压迫及承重骨病理性骨折风险）。查体及辅助检查：ECOG评分 0分。EBV DNA 5.0×10⁴ copies/mL。血常规及肝肾功能正常。肿瘤组织PD-L1表达检测示：CPS=1。既往无自身免疫性疾病史。","capability_group":"metastatic_systemic"}
+{"id":"l2-sample-e8dc9d1f89cc5e3bea3cda57","question":"针对该患者的最佳一线综合治疗策略是？","options":{"A":"多西他赛+顺铂+氟尿嘧啶 (TPF) 诱导化疗 序贯 同期放化疗 (顺铂)","B":"吉西他滨+顺铂 (GP) 诱导化疗 序贯 同期放化疗 (顺铂)","C":"信迪利单抗 + 吉西他滨+顺铂 (GP) 诱导化疗 序贯 同期放化疗联合信迪利单抗，后接信迪利单抗维持治疗","D":"同期放化疗 (顺铂) 序贯 顺铂+氟尿嘧啶 (PF) 辅助化疗","E":"吉西他滨+顺铂 (GP) 诱导化疗 序贯 单纯调强放疗 (IMRT) （去同期化疗策略）"},"answer":"B","vignette":"患者男，67岁，因“右侧头痛伴复视、回吸性涕血2个月”就诊。查体：PS评分 1分，右侧外展神经麻痹。鼻咽镜示鼻咽顶后壁及右侧壁结节样肿物。影像学检查（MRI/CT）：鼻咽右侧壁肿物，向上侵犯斜坡、蝶窦及右侧海绵窦；双侧颈部II区、III区多发肿大淋巴结，最大径4.5cm，MRI提示部分淋巴结存在包膜外侵犯（ENE+），未见锁骨上淋巴结肿大；PET-CT未见远处转移征象。\n实验室检查：WBC 4.2×10^9/L, Hgb 115g/L, PLT 150×10^9/L。肝功能正常；血清肌酐 85 μmol/L（估算肌酐清除率 CrCl 约 62 mL/min）。血浆EBV-DNA定量检测结果：5.5×10^5 copies/mL。病理活检：非角化性未分化癌（WHO III型）。","capability_group":"initial_definitive"}
+{"id":"l2-sample-d65bc9cdb1777e2e46fda53a","question":"下列哪项综合治疗策略符合最新循证医学证据？","options":{"A":"单纯根治性调强放疗（IMRT）","B":"诱导化疗（吉西他滨+顺铂，GP方案）序贯单纯根治性调强放疗（IMRT）","C":"同期放化疗（CCRT，单药大剂量顺铂 100mg/m² q3w）","D":"同期放化疗（CCRT，单药卡铂 AUC=5 q3w）","E":"诱导化疗（多西他赛+顺铂+5-FU，TPF方案）序贯同期放化疗"},"answer":"D","vignette":"患者男，69岁，既往有高血压病史10年，血压控制良好。因“间断回吸性涕血伴右侧颈部包块1个月”就诊，结合影像学和病理诊断为鼻咽癌 T2N1M0。查体：PS评分1分，右颈部可及一质硬肿物。纯音测听提示双耳高频轻度感音神经性耳聋。鼻咽镜示鼻咽顶后壁肿物。头颈部MRI显示：鼻咽顶后壁及侧壁增厚，侵犯咽旁间隙；右侧颈部II区可见一枚肿大淋巴结，最大径2.5cm，包膜完整，未见结外侵犯（ENE阴性）；胸腹盆CT未见远处转移。\n\n实验室检查：WBC 5.5×10^9/L, Hgb 125g/L, PLT 210×10^9/L, ALT 25 U/L, 血清肌酐（Cr） 95 umol/L（估算肌酐清除率 eCrCl 约 55 mL/min）。治疗前血浆EBV DNA定量检测为 15,000 copies/mL。","capability_group":"initial_definitive"}
+{"id":"l2-sample-1ac5a14bf2a17a948ab5747a","question":"下列哪项二线/后线治疗策略最为合理？","options":{"A":"跨线保留特瑞普利单抗，并联合紫杉醇或多西他赛化疗","B":"停用特瑞普利单抗，换用单药化疗（如卡培他滨或紫杉类）或抗血管生成靶向药物（如阿帕替尼）","C":"停用特瑞普利单抗，换用“紫杉醇+卡铂”方案联合抗EGFR单抗（如西妥昔单抗）","D":"换用另一种PD-1抑制剂（如卡瑞利珠单抗或替雷利珠单抗）联合抗血管生成药物","E":"针对肝脏及骨转移病灶进行SBRT（立体定向体部放疗），继续原方案维持"},"answer":"B","vignette":"患者男性，58岁，既往确诊为局部晚期鼻咽癌（非角化性未分化型），曾接受根治性放化疗。1年前出现双肺及肝脏多发转移，一线接受了“吉西他滨+顺铂+特瑞普利单抗”方案治疗6个周期，疗效评估为部分缓解（PR），随后进入“特瑞普利单抗”单药维持治疗。\n\n维持治疗第5个月时，患者出现右上腹隐痛。复查PET-CT提示：双肺结节较前相仿，但肝脏多发转移灶明显增大增多，最大者约4.5cm，SUVmax 12.5；新增多发胸椎及肋骨转移。实验室检查：WBC 5.5×10^9/L，Hgb 110 g/L，PLT 180×10^9/L，ALT 65 U/L，AST 72 U/L，总胆红素正常。血浆EBV-DNA定量检测由1.0×10^3 copies/mL升至 8.5×10^5 copies/mL。患者目前体能状态良好（ECOG PS 1分），无内脏危象。","capability_group":"metastatic_systemic"}
+{"id":"l2-sample-0128a4bd5d76a03d5ec3220f","question":"结合该患者既往史，以下哪种同期用药更合适？","options":{"A":"卡铂 (Carboplatin) AUC 5-6，每3周一次","B":"顺铂 (Cisplatin) 100 mg/m²，每3周一次","C":"尼妥珠单抗 (Nimotuzumab) 联合多西他赛 (Docetaxel)","D":"顺铂 (Cisplatin) 40 mg/m²，每周一次"},"answer":"A","vignette":"患者男，60岁。因持续性回吸性涕血1个月就诊。既往史显著：患者自述双耳重度感音神经性耳聋多年，日常交流需依赖助听器及唇语，听力图证实双耳高频听力损失严重。体格检查：ECOG PS评分 0分。鼻咽镜及活检确诊为鼻咽非角化性癌（未分化型）。影像学分期检查（MRI及CT）显示：鼻咽顶后壁肿物侵犯颅底骨质，双侧颈部可见多发肿大淋巴结，最大径约为4cm，主要位于II区，无远处转移征象。实验室检查：血常规 WBC 5.5×10^9/L, Hgb 125g/L, PLT 210×10^9/L；肝肾功能正常（Cr 80 μmol/L，Ccr估算约为85 ml/min）；血浆EBV-DNA拷贝数为 5.0×10^3 copies/mL。经多学科讨论，计划行根治性放疗联合同期化疗。","capability_group":"toxicity_contraindication"}
+{"id":"l2-sample-2efbce1e272bc427d0dcdf38","question":"以下哪项是当前最推荐的一线综合治疗模式？","options":{"A":"诱导化疗（吉西他滨+顺铂）序贯单纯根治性调强放疗（IC + IMRT）","B":"单纯同期放化疗（顺铂）联合大分子抗EGFR单抗（CCRT + 尼妥珠单抗）","C":"诱导化疗（吉西他滨+顺铂）序贯同期放化疗（顺铂）（IC + CCRT）","D":"诱导化疗（吉西他滨+顺铂）联合PD-1抑制剂，序贯同期放化疗，随后PD-1抑制剂维持治疗","E":"诱导化疗（多西他赛+顺铂+氟尿嘧啶，TPF方案）序贯同期放化疗（顺铂）"},"answer":"D","vignette":"患者男，66岁，既往体健，无慢性病史。因“回吸性涕血伴右侧颈部肿块2个月”就诊。查体：ECOG PS 0分，右侧颈部可触及一质硬肿块，固定无压痛。鼻咽镜示鼻咽顶后壁及右侧咽隐窝不规则肿物。\n\n影像学检查：头颈部MRI显示鼻咽右侧壁及顶后壁软组织明显增厚，侵犯斜坡、翼突根部及卵圆孔，右侧颈部II区、III区可见多发淋巴结肿大并融合，最大径约6.5cm，且MRI提示明显的淋巴结包膜外侵犯（ENE），病变位于环状软骨下缘以上。全身PET/CT未见远处转移。\n\n辅助检查： 肝肾功能、血常规及心电图均正常。血浆EBV-DNA定量为 5.5×10^5 copies/mL。\n\n病理活检： （鼻咽）非角化性未分化癌。","capability_group":"initial_definitive"}
+{"id":"l2-sample-710fc2890f27249c1aa695fb","question":"根据最新临床研究结果及指南共识，推荐的治疗策略是？","options":{"A":"诱导化疗（吉西他滨+顺铂）序贯单纯根治性调强放疗（IMRT）","B":"单纯根治性调强放疗（IMRT）","C":"同期放化疗（IMRT + 顺铂 100mg/m² q3w）","D":"同期放化疗（IMRT + 顺铂 40mg/m² qw）","E":"单纯根治性调强放疗（IMRT）联合尼妥珠单抗"},"answer":"B","vignette":"患者男，51岁，因“发现右侧颈部肿物伴回吸性涕血2个月”就诊。查体：鼻咽顶后壁见结节样肿物，右侧颈部II区可触及一约1.5cm×1.5cm质硬淋巴结，活动度可。ECOG PS评分0分。\n\n辅助检查：\n鼻咽+颈部MRI：鼻咽顶后壁软组织增厚，侵犯咽旁间隙；右侧咽后及颈部IIa区未见肿大淋巴结，未见包膜外侵犯（ENE阴性）。\n全身PET-CT：未见远处转移征象。\n病理：鼻咽非角化性癌，未分化型。\n实验室检查：血常规、肝肾功能均正常。治疗前血浆EBV DNA检测结果为 150 copies/mL。","capability_group":"initial_definitive"}
+{"id":"l2-sample-6fc1bdcbcdfc0489fd4f9e47","question":"首选的挽救性治疗策略是？","options":{"A":"调强适形放射治疗（IMRT）再程放疗（60Gy/30f）","B":"鼻咽内镜下挽救性鼻咽切除术（带或不带带蒂皮瓣修复）","C":"碳离子或质子重离子放射治疗（PT）","D":"立体定向放射治疗（SBRT/CyberKnife）局部加量","E":"卡瑞利珠单抗 + 吉西他滨 + 顺铂 全身系统性治疗","F":"组织间插植近距离放射治疗（Brachytherapy）"},"answer":"B","vignette":"患者男，61岁。3年前因鼻咽非角化性癌（cT3N1M0，VIII版）接受根治性诱导化疗（TPF方案）+ 同期放化疗（顺铂），原发灶处方剂量为70Gy/35f，治疗后达到完全缓解。近期常规随访发现血浆EBV-DNA由阴性转为 1500 copies/mL。患者偶有回吸性涕血，伴轻度口干（既往放疗所致），无头痛、复视。查体：颈部未及肿大淋巴结，颅神经（-）。ECOG PS 0分。\n\n影像学检查：鼻咽高分辨率MRI及PET-CT显示，鼻咽顶后壁及右侧咽隐窝可见一局限性结节样强化灶，大小约 1.2cm×1.0cm，病灶局限于鼻咽腔内（rT1N0M0）。病灶外侧缘距离右侧颈内动脉破裂孔段最近距离为 6mm。无颅底骨质破坏及海绵窦受累。\n\n全身检查：未见远处转移征象。心肺肝肾功能良好。","capability_group":"post_treatment_recurrence"}
+{"id":"l2-sample-61204e2dd99c95abb15f9a2f","question":"下一步最合理的措施是？","options":{"A":"立即在超声引导下行左侧颈部淋巴结细针穿刺活检（FNA），若为阴性则行颈清扫术","B":"考虑放疗后炎症反应可能性大，暂不干预，建议4-6周后复查颈部超声或MRI","C":"给予左侧颈部II区局部放射治疗推量（Boost）10-14Gy，以消除微小残留病灶","D":"完善血浆EBV-DNA甲基化检测或靶向NGS，若提示肿瘤信号阳性则行挽救性颈清扫","E":"立即行左侧改良根治性颈淋巴结清扫术，避免穿刺导致的肿瘤针道播散","F":"在鼻咽镜下对顶后壁坏死物进行深部活检，同时行颈部淋巴结FNA"},"answer":"B","vignette":"患者男，70岁，ECOG评分0分。既往确诊为非角化性鼻咽癌（T3N2M0，），已完成根治性同步放化疗（顺铂同期），治疗结束至今12周。患者近日诉偶有少量回吸性涕血，无头痛及颈部胀痛。\n\n复查结果：\n\n鼻咽镜：鼻咽顶后壁可见少许白膜及坏死物附着，黏膜充血，未见明显新生物。\n\n全身PET-CT：鼻咽部原发灶区域代谢未见异常增高；左侧颈部II区可见一孤立性淋巴结影，长径约1.2cm（放疗前为3.5cm伴坏死），代谢轻度活跃，SUVmax值为3.8（肝血池SUVmean为2.5）；其余部位未见远处转移征象。\n\n颈部高分辨率MRI：左侧II区淋巴结短径0.8cm，形态尚规则，T2WI呈稍高信号，DWI（b=1000）呈轻度高信号，ADC图未见明显低信号（ADC值约1.4×10⁻³ mm²/s），增强后呈轻度均匀强化。\n\n实验室检查：血浆游离EBV-DNA 0 copies/mL（放疗前为4.5×10⁴ copies/mL）。\n\n体格检查颈部触诊因放疗后组织变硬，未触及明确孤立肿块。","capability_group":"post_treatment_recurrence"}
+{"id":"l2-sample-bd20cfd6cc2e623ef7f8a395","question":"下列最恰当的临床处理策略是？","options":{"A":"立即暂停放疗与化疗；紧急输注单采血小板1治疗量，皮下注射G-CSF，经验性静脉使用头孢吡肟或亚胺培南；待ANC > 1.5×10^9/L且PLT > 50×10^9/L且退热48小时后恢复放疗；取消第3周期同期化疗。","B":"维持原计划放疗以防肿瘤加速再增殖，永久终止同期化疗；皮下注射G-CSF及TPO，口服阿莫西林/克拉维酸钾抗感染；因无活动性出血，暂不输注血小板，严密监测血象。","C":"立即暂停放疗与化疗；紧急输注单采血小板1治疗量，静脉使用亚胺培南+万古霉素，皮下注射G-CSF；待ANC > 1.0×10^9/L且PLT > 20×10^9/L后即刻恢复放疗；后续放疗需重新计算BED并给予加速超分割或增加总剂量补偿；取消第3周期同期化疗。","D":"暂停放疗，将第3周期顺铂减量至75mg/m²；紧急输注红细胞及血小板，静脉使用头孢哌酮舒巴坦；待血象完全恢复正常后，放化疗同步重启，以保证放化疗协同增敏效应。","E":"维持原计划放疗，暂停化疗；紧急输注单采血小板1治疗量，静脉使用头孢他啶，皮下注射G-CSF；若放疗期间PLT持续<20×10^9/L则必须中断放疗；取消第3周期同期化疗。"},"answer":"A","vignette":"患者男，42岁。因“反复回吸性涕血伴头痛2月”就诊。活检确诊为鼻咽非角化性癌（未分化型）。基线MRI提示肿瘤侵犯斜坡及双侧海绵窦，双侧颈部多发淋巴结转移（最大径4.5cm，包膜外侵犯），分期为T4N2M0。基线EBV-DNA 4.5×10^4 copies/mL。\n\n患者接受了3个周期GP方案（吉西他滨+顺铂）诱导化疗，复查EBV-DNA降至0，影像学评估PR。随后开始根治性调强放疗（IMRT，PGTVnx 70Gy/33F）联合同期顺铂单药化疗（100mg/m²，q3w）。\n\n当前情况：\n\n目前处于放疗第24次（放疗第5周初，已完成剂量约50.9Gy），患者刚完成第2周期同期顺铂化疗后第8天。今日患者突发寒战，体温38.9℃。\n\n急查血常规：WBC 0.8×10^9/L，ANC（绝对中性粒细胞计数）0.3×10^9/L，Hgb 75g/L，PLT 18×10^9/L。\n\n生化及凝血：ALT 35 U/L, Cr 85 μmol/L，凝血功能正常。\n\n查体：双下肢可见散在出血点，无鼻出血及消化道出血征象。口腔黏膜II度放射性炎症。血培养已抽。","capability_group":"toxicity_contraindication"}
+{"id":"l2-sample-b0b6b394f28e2df081554cdd","question":"下列哪一项是最优化且符合当前指南推荐的标准方案？","options":{"A":"因诱导化疗达到PR且EBV-DNA清零，提示肿瘤对治疗高度敏感，为降低晚期毒性，可豁免同期化疗，仅行单纯IMRT","B":"给予同期顺铂单药化疗（100 mg/m² q3w × 2-3周期），期间严密检测 EBV，放疗结束后根据放疗期间 EBV 变化趋势决定是否行辅助化疗或维持治疗","C":"给予同期顺铂单药化疗（100 mg/m² q3w），并在放疗结束后给予卡培他滨节拍化疗（持续1年）以进一步降低远处转移风险","D":"给予同期顺铂单药化疗联合PD-1抑制剂，并在放疗结束后继续使用PD-1抑制剂维持治疗半年至一年","E":"给予同期靶向治疗（尼妥珠单抗）替代顺铂，以规避顺铂累积剂量带来的不可逆耳毒性和肾毒性，放疗后定期随访"},"answer":"B","vignette":"患者男，62岁，既往体健，2024年6月确诊乙肝，规律口服恩替卡韦治疗，HBV-DNA < 100 IU/mL，肝功能正常。确诊鼻咽非角化性癌（未分化型）cT3N2M0（II期，AJCC第 9版）。初诊血浆EBV-DNA为 1.5×10^4 copies/mL。\n\n经MDT讨论，患者接受了3个周期GP方案（吉西他滨+顺铂）诱导化疗。复查鼻咽MRI显示原发灶及颈部淋巴结较前明显缩小，疗效评价为PR；复查血浆EBV-DNA降至 0 copies/mL。\n\n目前患者即将开始根治性放疗（IMRT）。","capability_group":"initial_definitive"}
+{"id":"l2-sample-173183dc300f555847f42b00","question":"最佳综合治疗模式是？","options":{"A":"单纯根治性调强放疗（IMRT）","B":"诱导化疗（吉西他滨+顺铂，GP方案 x 3周期）+ 同期放化疗（CCRT）","C":"同期放化疗（CCRT，顺铂 100mg/m² q3w 或 40mg/m² qw）","D":"诱导化疗（多西他赛+顺铂，TP方案 x 2-3周期）+ 单纯根治性调强放疗（IMRT）","E":"同期放化疗（CCRT）+ 辅助化疗（卡培他滨节拍维持治疗 1年）","F":"诱导化疗（吉西他滨+顺铂+特瑞普利单抗）+ 同期放化疗"},"answer":"C","vignette":"患者男，50岁，既往体健。因“间断回吸性涕中带血2月余”就诊。查体：ECOG PS评分 0分。鼻咽镜见鼻咽顶后壁及侧壁结节样肿物。\n\n影像学检查：头颈部高分辨率MRI显示鼻咽顶后壁软组织增厚，向外侵犯咽旁间隙，未达颅底骨质，未侵犯翼突内侧板；左侧颈部IIa区可见单发肿大淋巴结，最大径约2.5cm，MRI显示包膜完整，无包膜外侵犯（ENE阴性）。胸腹部CT及全身骨扫描未见远处转移征象。\n\n实验室检查：WBC 5.5×10^9/L, Hgb 125 g/L, PLT 210×10^9/L, ALT 25 U/L, 肌酐 80 μmol/L，肌酐清除率(Ccr) 95 mL/min。纯音测听双耳听力正常。\n\n分子病理：治疗前血浆游离EBV-DNA定量检测结果为 1.5×10^4 copies/mL（本实验室参考值 < 400 copies/mL）。","capability_group":"initial_definitive"}
+{"id":"l2-sample-c218e8bf35c8dd0e39cf9572","question":"最佳的一线综合治疗策略是？","options":{"A":"吉西他滨+顺铂（GP方案）诱导化疗，序贯同期放化疗（顺铂单药+IMRT）","B":"同期放化疗（顺铂单药+IMRT），无需诱导化疗","C":"单纯调强适形放射治疗（IMRT）","D":"吉西他滨+顺铂（GP方案）诱导化疗，序贯单纯调强适形放射治疗（IMRT）"},"answer":"A","vignette":"患者男，58岁，既往体健。因“回吸性涕血1个月”就诊。查体：ECOG评分0分，双侧颈部可触及数个肿大淋巴结，质韧，最大径约3cm，活动度尚可。鼻咽镜及活检病理示：非角化性未分化型癌。头颈部增强MRI及CT显示：鼻咽顶后壁软组织肿块，侵犯斜坡及颅底骨质，双侧咽后淋巴结及双侧颈部II、III区淋巴结肿大，最大径均小于6cm，未见锁骨上淋巴结转移及远处转移征象。辅助检查：EBV-DNA 1.0×10^4 copies/mL；血常规、肝肾功能均在正常范围（Cr 80 umol/L）。","capability_group":"initial_definitive"}
+{"id":"l2-sample-3aa2b7cc75d49a2fb1d7bf74","question":"该患者最标准的推荐治疗模式是？","options":{"A":"单纯根治性调强放疗（IMRT）","B":"同期放化疗（CCRT，顺铂单药）","C":"诱导化疗（GP方案或TP方案）序贯单纯IMRT","D":"诱导化疗（GP方案）序贯同期放化疗（CCRT）","E":"同期放化疗（CCRT）联合PD-1单抗，序贯PD-1单抗维持治疗"},"answer":"B","vignette":"患者男，51岁，既往体健。因“间断回吸性涕血1个月”就诊。查体：ECOG评分 0分。鼻咽镜活检病理示：（鼻咽顶后壁）非角化性癌，未分化型。头颈部MRI显示：鼻咽顶后壁肿物，侵犯咽旁间隙，未累及颅底骨质及脑神经；左侧颈部IIa区可见单发肿大淋巴结，最大径约为2.5cm，界清，无包膜外侵犯（ENE）征象。全身PET-CT未见远处转移。实验室检查：肝肾功能、血常规均正常。放疗前血浆游离EBV-DNA定量检测为 15,000 copies/mL。","capability_group":"initial_definitive"}
+{"id":"l2-sample-e2e0cc999c3f5bc4aa21f0fd","question":"结合患者目前的临床特征及诱导化疗后的反应，下一步最恰当的治疗策略是？","options":{"A":"单纯调强放疗（IMRT），基于EBV-DNA转阴行降阶梯治疗，豁免同期化疗","B":"同步放化疗（IMRT + 顺铂 100 mg/m² q3w × 2-3周期）","C":"同步放化疗（IMRT + 顺铂 40 mg/m² qw × 6-7周期）","D":"同步放化疗（IMRT + 顺铂 100 mg/m² q3w）联合 PD-1抑制剂，随后PD-1抑制剂维持治疗","E":"继续追加1-2个周期GP方案诱导化疗以追求完全缓解（CR），随后行单纯IMRT"},"answer":"B","vignette":"患者男，57岁，ECOG评分0分。因回吸性涕血伴头痛就诊，确诊为非角化性鳞状细胞癌（鼻咽癌，cT4cN1cM0，IVA期，AJCC第8版）。基线血浆EBV-DNA为 45,000 copies/mL。患者接受了3个周期的GP方案（吉西他滨+顺铂）诱导化疗。\n\n现返院复查，查体未见明显异常。复查鼻咽+颈部MRI显示原发灶及颈部淋巴结较前明显缩小，达到部分缓解（PR）。实验室检查示：血常规正常，肝肾功能（CrCl 95 mL/min）正常，无听力下降及外周神经毒性。血浆EBV-DNA检测结果为 0 copies/mL（转阴）。","capability_group":"initial_definitive"}
+{"id":"l2-sample-2dab052102793af6496d639d","question":"最佳的综合治疗策略是？","options":{"A":"同期放化疗（顺铂单药+IMRT），随后给予氟尿嘧啶+顺铂 (PF方案) 辅助化疗","B":"多西他赛+顺铂+氟尿嘧啶 (TPF方案) 诱导化疗，序贯单纯调强放疗 (IMRT)","C":"吉西他滨+顺铂 (GP方案) 诱导化疗，序贯同期放化疗（顺铂单药+IMRT）","D":"吉西他滨+顺铂 (GP方案) 联合信迪利单抗诱导化疗，序贯同期放化疗，随后信迪利单抗维持治疗","E":"单纯同期放化疗（顺铂单药+IMRT），不进行诱导或辅助化疗"},"answer":"C","vignette":"患者男，53岁，既往体健，无吸烟史。因“回吸性涕血伴右侧颈部包块1个月”就诊。查体：ECOG评分 0分，双侧颈部触及数枚肿大淋巴结，质韧，最大径约4cm，主要位于II、III区，未融合，位置均位于环状软骨水平以上。鼻咽镜活检示：非角化性未分化癌。头颈部MRI及CT显示：鼻咽顶后壁软组织肿块，侵犯斜坡及左侧翼突，伴有明显的颅底骨质破坏；双侧咽后淋巴结及颈部淋巴结肿大，最大径4.5cm，无锁骨上淋巴结转移。胸腹部CT及全身骨扫描未见远处转移。实验室检查：WBC 5.5×10^9/L, Hgb 125g/L, PLT 210×10^9/L, 肝肾功能正常。血浆EBV-DNA定量检测为 4.5×10^4 copies/mL。结合影像学及临床特征，该患者分期被判定为III期（T3N2M0）。","capability_group":"initial_definitive"}
+{"id":"l2-sample-a70ceb394c77e0f3620a8012","question":"目前符合指南推荐的最佳一线标准治疗策略是？","options":{"A":"鉴于PD-L1 CPS=1，首选吉西他滨 + 顺铂（GP）单纯化疗","B":"吉西他滨 + 顺铂（GP） + 特瑞普利单抗（或卡瑞利珠单抗/替雷利珠单抗）联合治疗，随后采用PD-1单抗维持治疗","C":"吉西他滨 + 顺铂（GP） + 西妥昔单抗联合治疗，随后采用西妥昔单抗维持治疗","D":"诱导化疗（GP方案）2-3个周期后，立即序贯鼻咽原发灶及颈部淋巴结的姑息性放疗","E":"帕博利珠单抗单药一线治疗，因其在头颈部鳞癌中具有全人群获益的证据"},"answer":"B","vignette":"患者男，59岁，既往体健。因“回吸性涕血伴头痛1月余”就诊。查体：左侧锁骨上窝触及数枚肿大淋巴结，质硬固定。鼻咽部MRI：鼻咽顶后壁软组织肿块，侵犯海绵窦，伴第V、VI对脑神经受累。全身PET-CT：双肺多发高代谢结节（最大径2.5cm），胸椎及骨盆多处骨质破坏伴代谢增高。实验室检查：血常规及肝肾功能正常；血浆EBV-DNA定量为 2.0×10^5 copies/mL。ECOG PS评分 0分。病理活检：非角化性未分化型癌。**免疫组化：PD-L1 CPS = 1。","capability_group":"metastatic_systemic"}
+{"id":"l2-sample-ee5b7a62029097420ce058c6","question":"基于患者目前的临床表现及辅助检查结果，下一步最恰当的处理策略是？","options":{"A":"立即行右侧颈部淋巴结清扫术，鼻咽部病灶密切观察","B":"立即鼻咽镜下对顶后壁黏膜行活检，同时在超声引导下行右颈部淋巴结细针穿刺活检（FNA）","C":"针对右颈部淋巴结区域给予局部推量放疗（Boost RT），并启动PD-1抑制剂辅助治疗半年","D":"给予鼻腔冲洗及局部对症处理，密切随访观察，1-2个月后复查头颈部MRI及血浆EBV-DNA，若持续可疑再考虑活检","E":"考虑肿瘤局部残留，启动以吉西他滨+顺铂（GP方案）为主的全身化疗","F":"立即行挽救性鼻咽部内镜下切除术及右侧颈部淋巴结清扫术"},"answer":"D","vignette":"患者男，66岁，ECOG评分0分。既往因“鼻咽未分化型非角化性癌（cT3N2M0, III期，第八版AJCC）”接受根治性同步放化疗（IMRT + 顺铂同期化疗2周期），治疗过程顺利。目前距离放疗结束已3个月。患者近日诉偶有回吸性涕血，量少，伴轻度鼻干。\n\n查体：电子鼻咽镜示鼻咽顶后壁黏膜充血、粗糙，附着少许白膜及血痂，未见明显新生物；双侧颈部未触及肿大淋巴结。\n\n实验室检查：血常规及肝肾功能正常；血浆游离EBV-DNA为 0 copies/mL（治疗前为 4.5×10^4 copies/mL）。\n\n影像学评估：\n\n头颈部MRI：鼻咽顶后壁软组织较前明显变薄，T1增强可见轻度均匀强化，DWI（b=1000）未见明显高信号；双侧颈部淋巴结明显缩小，右侧颈部II区可见一枚淋巴结，短径约1.1cm（治疗前短径2.5cm），包膜完整，未见坏死区。\nPET-CT： 鼻咽部原发灶未见异常高代谢；右侧颈部II区该枚淋巴结代谢轻度活跃，SUVmax值为4.5（治疗前SUVmax为12.0），其余部位未见异常。","capability_group":"post_treatment_recurrence"}
+{"id":"l2-sample-1fa6ea637ea07fd4ec7ba84b","question":"下列哪项后续处理策略最为恰当？","options":{"A":"立即在超声引导下行右颈部淋巴结细针穿刺活检（FNA），并对鼻咽部粗糙黏膜行多点深部活检，以排除微小残留病灶","B":"考虑为放疗后早期肿瘤残留，立即启动GP方案（吉西他滨+顺铂）全身化疗2-3周期，随后评估是否需要挽救性颈清扫","C":"考虑为放射性鼻咽炎及反应性淋巴结增生，给予鼻腔冲洗、止血等对症处理，嘱患者6-8周后复查头颈部MRI及鼻咽镜","D":"针对右侧颈部II区代谢活跃淋巴结行调强放疗（IMRT）局部推量（Boost），总剂量60Gy，以根除潜在残留","E":"安排右侧颈部II-V区挽救性淋巴结清扫术，因PET-CT提示代谢活跃，高度怀疑淋巴结残留"},"answer":"C","vignette":"患者男，64岁，因“局部晚期鼻咽癌（T3N2M0，III期）根治性放化疗结束后12周，突发回吸性涕血3天”复诊。既往史无特殊。\n\n查体：ECOG PS 0分，颅神经检查阴性。鼻咽镜检查见顶后壁黏膜稍粗糙、充血，表面附着少许白色伪膜及血丝，未见明显外突肿物。双侧颈部触诊未及明显肿大淋巴结。\n\n辅助检查：血常规及肝肾功能正常。血浆EBV-DNA（放疗前为 4.5×10^5 copies/mL，放疗结束时及本次复查）：均为 0 copies/mL。\n\n影像学复查：\n\nPET-CT：鼻咽部未见明显异常高代谢；右侧颈部II区见一枚淋巴结，短径约0.8cm，代谢轻度活跃（SUVmax 4.5）；颅底骨质可见放疗后硬化改变，无新发破坏。\n头颈部MRI：鼻咽顶后壁黏膜弥漫性增厚，T2WI呈高信号，增强扫描呈轻-中度均匀强化，DWI（b=1000）未见明显高信号受限区，ADC值增高。右侧颈部II区淋巴结短径0.8cm，形态规则，淋巴结门结构可见。","capability_group":"post_treatment_recurrence"}
+{"id":"l2-sample-bc45d49eb1c605d53ea384fd","question":"下一步最符合当前循证医学证据和指南推荐的标准治疗策略是？","options":{"A":"鉴于EBV-DNA已清零且肿瘤退缩良好，为避免进一步加重听力和肾脏毒性，直接行单纯根治性调强放疗（IMRT）","B":"开始同期放化疗，采用 IMRT + 顺铂 40 mg/m² 每周一次（qw）方案，以降低单次大剂量顺铂带来的肾脏和听力损伤风险","C":"开始同期放化疗，采用 IMRT + 顺铂 100 mg/m² 每三周一次（q3w）方案，放疗期间加强水化，密切监测听力、肾功能及血糖","D":"开始同期放化疗，考虑到患者的1级听力下降、一过性肾损伤及糖尿病基础，将同期化疗药物替换为卡铂（AUC=5）q3w","E":"开始同期放化疗，采用 IMRT + 尼妥珠单抗（EGFR单抗）每周一次，以在保证局部控制率的同时完全规避铂类叠加毒性"},"answer":"C","vignette":"患者男性，48岁，ECOG PS评分1分。既往有高血压、2型糖尿病史5年，长期服药，近期空腹血糖波动在8-10 mmol/L。确诊为鼻咽非角化性癌（未分化型）cT4N2M0（III 期，AJCC分期第 8 版）。基线血浆EBV-DNA为4.5×10^5 copies/mL。\n\n患者已完成3个周期“吉西他滨+顺铂（GP方案）”诱导化疗。复查鼻咽部MRI显示：鼻咽原发灶及双侧颈部淋巴结均达到部分缓解（PR）。复查血浆EBV-DNA为0 copies/mL。\n\n毒性评估：诱导化疗期间，患者出现过1级血肌酐升高（最高115 μmol/L，现已恢复至85 μmol/L，估算肌酐清除率 75 mL/min），并诉有轻微耳鸣，纯音测听提示双耳高频听力轻度下降（1级听力毒性）。\n\n目前准备进入放疗阶段。","capability_group":"initial_definitive"}
+{"id":"l2-sample-a02adc901c755d703d9228a3","question":"下一步最合理且符合循证医学证据的临床决策是？","options":{"A":"立即行超声引导下右颈II区淋巴结细针穿刺活检（US-FNA）以明确病理","B":"启动PD-1抑制剂（如特瑞普利单抗）单药辅助维持治疗，并密切随访","C":"密切随访观察，建议4-6周后复查颈部MRI及血浆EBV-DNA，暂不干预","D":"针对右颈II区残留淋巴结行挽救性颈部淋巴结清扫术","E":"针对右颈II区淋巴结行立体定向放射治疗（SBRT）局部推量","F":"启动以吉西他滨+顺铂（GP方案）为主的辅助化疗2-4个周期"},"answer":"C","vignette":"患者男，67岁，ECOG评分0分。既往因“鼻咽非角化性癌 T4N3M0（VIII版AJCC）”接受根治性放化疗（IMRT + 顺铂同期化疗3周期），基线血浆EBV-DNA高达 1.5×10^5 copies/mL。治疗于3个月前结束。近期患者诉晨起偶有回吸性血涕，伴轻度口干。体格检查：右侧颈部II区可触及一质韧结节，活动度差，无明显触痛。\n\n复查实验室检查：血常规及肝肾功能正常。血浆EBV-DNA检测为 0 copies/mL。\n\n鼻咽+颈部高分辨率MRI提示：鼻咽顶后壁软组织较前明显变薄，颅底骨质破坏区边缘硬化；右颈II区可见一大小约 1.3cm × 1.0cm 的淋巴结，T2WI呈不均匀稍高信号，增强扫描边缘轻度强化，中心未见强化。\n\n全身PET-CT检查显示：鼻咽部未见异常高代谢；右颈II区该淋巴结FDG代谢轻度异常增高，SUVmax值为 3.8（肝脏血池本底SUVmean 2.1），余全身未见异常高代谢灶。","capability_group":"post_treatment_recurrence"}
+{"id":"l2-sample-b8238a59b23d95b0ad574d20","question":"下列哪项是最符合当前循证医学证据且最恰当的临床决策？","options":{"A":"给予吉西他滨+顺铂（GP方案）诱导化疗2-3个周期，随后行单纯调强放疗（IMRT）","B":"采用单纯调强放疗（IMRT）","C":"给予顺铂单药（100mg/m² q3w）同期放化疗，以确保局部控制率","D":"采用调强放疗（IMRT）联合EGFR单抗（如尼妥珠单抗或西妥昔单抗）同期治疗，作为老年患者的低毒替代方案","E":"采用调强放疗（IMRT）联合PD-1抑制剂同期治疗，以利用免疫协同放疗的“远隔效应”"},"answer":"B","vignette":"患者男，71岁。因“回吸性涕血伴右侧颈部包块1个月”就诊。既往史：2018年因“腹股沟疝”行无张力修补术；否认高血压、糖尿病及冠心病史。ECOG评分 1分。\n\n辅助检查：\n\n鼻咽镜及活检：鼻咽顶后壁非角化性鳞状细胞癌（未分化型）。\n颈部及鼻咽MRI：肿瘤局限于鼻咽腔，未侵犯咽旁间隙及颅底骨质；右侧咽后淋巴结肿大（最大径1.2cm），右侧颈部IIb区可见一肿大淋巴结（最大径2.1cm），未见包膜外侵犯（ENE阴性）。\n全身PET-CT：未见远处转移征象。\n实验室检查：血常规、肝肾功能均正常；治疗前血浆EBV DNA检测为 0 copies/mL。\n临床诊断：鼻咽癌 cT1N1M0，II期（AJCC 第8版）。\n\n患者及家属对治疗的毒副反应较为担忧，强烈要求在保证根治率的前提下尽量保留生活质量。","capability_group":"initial_definitive"}
+{"id":"l2-sample-17d93f41389ee1201e71d184","question":"依据2025版CSCO鼻咽癌诊疗指南及相关研究，针对该患者拟采用的诱导化疗序贯根治性放疗路径，以下哪项综合治疗安排最合理？（单选）","options":{"A":"GP方案（吉西他滨+顺铂）诱导化疗序贯顺铂同期IMRT。结合获益、毒性和患者意愿，可考虑加用信迪利单抗，按相应研究安排覆盖诱导、同期及辅助阶段","B":"仅依据治疗前EBV-DNA为0，决定省略同期化疗，采用TPF方案（多西他赛+顺铂+氟尿嘧啶）诱导化疗序贯单纯IMRT","C":"单纯同期放化疗（顺铂 100mg/m² q3w）","D":"同期放化疗（顺铂）序贯辅助化疗（顺铂+氟尿嘧啶，PF方案）","E":"GP方案联合特瑞普利单抗诱导治疗，序贯顺铂同期IMRT并联合特瑞普利单抗。免疫治疗预定仅覆盖诱导及同期阶段，放疗结束后即按计划停用","F":"诱导化疗（吉西他滨+顺铂）序贯同期放疗联合西妥昔单抗"},"answer":"A","vignette":"患者男，43岁。因“回吸性涕血伴右侧鼻塞2个月”就诊。既往体健，PS评分 0分。\n\n专科查体：右侧咽隐窝可见菜花状新生物，表面覆有坏死物。双侧颈部可触及多枚肿大淋巴结，质硬，固定。\n\n病理活检：（鼻咽）非角化性未分化型癌。\n\n影像学检查：鼻咽部MRI示肿瘤侵犯翼突基底部及斜坡骨质；双侧颈部II区、III区多发转移性淋巴结，最大者位于右侧II区，短径 3.5 cm，伴包膜外侵犯（ENE+）。所有转移性淋巴结最大径均≤6 cm，均位于环状软骨下缘以上，未见锁骨上淋巴结转移。全身PET-CT未见远处转移征象。临床分期为T3N2M0，III期（AJCC第8版）。\n\n实验室检查：WBC 5.6×10^9/L，Hb 145 g/L，PLT 210×10^9/L；ALT 25 U/L，AST 20 U/L，TBIL 12.4 μmol/L；Cr 79.8 μmol/L。血浆EBV-DNA：0 copies/mL。","capability_group":"initial_definitive"}
+{"id":"l2-sample-4e6510b5de22d33eda125d88","question":"关于下一步治疗策略，最恰当的建议是？","options":{"A":"立即加用PD-1抑制剂联合原方案化疗至6周期，随后转入PD-1抑制剂维持，暂无需特殊处理乙肝，密切监测肝功能即可","B":"鉴于EBV-DNA已转阴且疗效达PR，停用全身化疗，改行肝脏病灶射频消融及骨转移灶立体定向放疗（SBRT），并启动拉米夫定抗病毒治疗","C":"继续原方案化疗至6周期，结束后转入卡培他滨维持治疗，并立即启动恩替卡韦或替诺福韦抗病毒治疗","D":"暂停化疗，行PET-CT评估全身情况，若无其他代谢活跃病灶，直接转为卡培他滨单药节拍维持治疗，并启动恩替卡韦抗病毒治疗","E":"继续原方案化疗至6周期同时加用PD-1抑制剂，结束后转入免疫维持治疗，并立即启动恩替卡韦或替诺福韦抗病毒治疗","F":"鉴于已达PR，立即转为卡培他滨单药维持治疗，并密切监测HBV-DNA滴度，若滴度升高则立即启动抗病毒治疗"},"answer":"C","vignette":"患者男，42岁。既往有乙型病毒性肝炎病史（HBsAg+，HBeAg+，抗-HBc+），未接受抗病毒治疗。2018年初诊为鼻咽非角化性癌（未分化型），行根治性放疗。2019年局部复发，同期因甲状腺肿物行甲状腺右叶及峡部切除+左叶部分切除+右Ⅵ区淋巴结清扫术，病理提示甲状腺乳头状癌。2024年6月复查发现肝左叶多发结节及胸椎右侧椎弓根异常信号。随后接受“吉西他滨+顺铂”方案化疗，目前已完成4个周期，末次化疗结束2周余。现查体ECOG评分0分。最新辅助检查：WBC 5.18×10^9/L，Hgb 135g/L，PLT 108×10^9/L，Cr 96.8 μmol/L，ALT 45 U/L，AST 40 U/L。血浆EBV-DNA 0 copies/mL。复查影像学评估疗效为部分缓解（PR），肝脏病灶明显缩小，骨转移灶稳定。","capability_group":"post_treatment_recurrence"}
+{"id":"l2-sample-96de8a005f137bcb52c32e3b","question":"基于该患者当前的疾病状态及前期治疗反应，关于下一步的综合治疗决策及放疗靶区勾画原则，下列哪项是最恰当的？","options":{"A":"行第3周期GP方案诱导化疗以促使EBV DNA完全转阴，随后行单纯调强放疗（IMRT），GTVnx需按诱导化疗前范围勾画","B":"行第3周期GP方案诱导化疗后立即开始同期放化疗（IMRT + 顺铂单药），原发灶GTVnx和转移淋巴结GTVnd均严格按诱导化疗后残留肿瘤范围勾画","C":"行第3周期GP方案诱导化疗后立即开始同期放化疗（IMRT + 顺铂单药），原发灶GTVnx按诱导化疗前残留肿瘤范围勾画，转移淋巴结GTVnd按诱导化疗后残留肿瘤范围勾画","D":"立即开始同期放化疗（IMRT + 顺铂+氟尿嘧啶双药），原发灶GTVnx按诱导化疗后范围勾画，GTVnd按化疗前范围勾画","E":"立即开始单纯调强放疗（IMRT），因肿瘤已达客观缓解且EBV DNA显著下降，免除同期化疗以保护听力及肾功能","F":"更换为TPF方案（多西他赛+顺铂+氟尿嘧啶）继续诱导化疗1周期强化局部控制，随后行同期放化疗"},"answer":"B","vignette":"患者男，45岁。因“回吸性涕血伴右侧耳鸣2个月”就诊。\n\n初诊影像学（头颈部MRI）：鼻咽顶后壁及右侧咽隐窝软组织肿块，侵犯斜坡及右侧破裂孔。双侧咽后淋巴结肿大；双侧颈II、III区多发肿大淋巴结，最大短径3.5cm，未见坏死及包膜外侵犯。胸腹部CT及全身骨扫描未见异常。\n\n初诊实验室检查：WBC 5.5×10^9/L, Hgb 125g/L, PLT 210×10^9/L, ALT 25 U/L, Cr 80 μmol/L。血浆EBV DNA 1.5×10^4 copies/mL。\n\n前期治疗：给予吉西他滨+顺铂（GP方案）诱导化疗2周期。\n\n复查评估：复查MRI示鼻咽原发灶及颈部淋巴结较前缩小约35%。复查实验室检查：WBC 4.2×10^9/L, Hgb 115g/L, PLT 180×10^9/L, Cr 85 μmol/L。血浆EBV DNA 500 copies/mL。","capability_group":"initial_definitive"}
+{"id":"l2-sample-1fd4f76e516e9739ff50a18b","question":"基于患者当前情况及高级别循证医学证据，首选的一线系统治疗方案是？","options":{"A":"吉西他滨 + 顺铂 + 特瑞普利单抗","B":"吉西他滨 + 卡铂 + 特瑞普利单抗","C":"吉西他滨 + 顺铂","D":"吉西他滨 + 卡铂","E":"多西他赛 + 顺铂 + 氟尿嘧啶（TPF）","F":"鼻咽及颈部根治性同步放化疗（IMRT + 顺铂），序贯全身化疗"},"answer":"D","vignette":"患者男，63岁。因“间断回吸性涕血伴左颈部肿块2月”就诊。\n\n既往史：类风湿关节炎病史10年，长期口服泼尼松 15 mg/d 及甲氨蝶呤 10 mg/w，近1个月因晨僵及关节疼痛加重，自行将泼尼松加量至 25 mg/d。\n\n查体：左侧锁骨上窝触及 3cm×4cm 肿大淋巴结，质硬固定。双腕关节轻度肿胀压痛。\n\n病理：鼻咽镜活检提示未分化型非角化性癌。\n\n影像学：头颈部MRI示鼻咽顶后壁肿物侵犯海绵窦，伴第V、VI对脑神经受累；左侧锁骨上窝多发淋巴结肿大。全身骨扫描及骨盆MRI示多发胸腰椎体及骨盆成骨性破坏。\n\n实验室检查：WBC 5.5×10^9/L，Hgb 110g/L，PLT 210×10^9/L，ALT 25 U/L，AST 30 U/L，总胆红素 15 μmol/L，血清肌酐 145 μmol/L，血清白蛋白 35 g/L。血浆EBV-DNA定量为 2.0×10^5 copies/mL。身高 170 cm，体重 65 kg。","capability_group":"metastatic_systemic"}
+{"id":"l2-sample-4c775d634fca2040b6e73c13","question":"根据该患者的临床分期及风险特征，目前首选的根治性治疗方案是？","options":{"A":"根治性调强放疗（IMRT）同期联合顺铂单药化疗","B":"诱导化疗（吉西他滨+顺铂）后行同期放化疗","C":"根治性调强放疗（IMRT）序贯辅助化疗（氟尿嘧啶+顺铂）","D":"单纯根治性调强放疗（IMRT）"},"answer":"D","vignette":"患者男，66岁，因“间断回吸性涕中带血1个月”就诊。既往体健，无慢性病史。查体：ECOG评分 0分，双侧颈部未触及肿大淋巴结，其余系统查体无殊。鼻咽镜及病理活检提示：非角化性癌（未分化型）。辅助检查：鼻咽部MRI显示顶后壁软组织增厚，病变局限于鼻咽腔内，未侵犯咽旁间隙，未见颅底骨质破坏；双侧颈部淋巴结短径均<5mm，无坏死或包膜外侵犯征象。全身PET/CT未见远处转移。实验室检查：血常规 WBC 5.5×10^9/L, Hgb 125g/L, PLT 210×10^9/L；生化 ALT 25 U/L, Cr 80 μmol/L；血浆EBV-DNA检测为 0 copies/mL。","capability_group":"initial_definitive"}
+{"id":"l2-sample-4aaa7e1e6faee4b17abe85d6","question":"为尽量降低毒副反应，经随机非劣效试验证实适用于该患者的推荐治疗策略是？","options":{"A":"诱导化疗（吉西他滨+顺铂）序贯调强放射治疗（IMRT）","B":"调强放射治疗（IMRT）+ 同期化疗（顺铂 100mg/m² q3w）","C":"调强放射治疗（IMRT）+ 同期化疗（顺铂 40mg/m² qw）","D":"单纯调强放射治疗（IMRT）","E":"调强放射治疗（IMRT）+ 尼妥珠单抗靶向治疗","F":"诱导化疗（多西他赛+顺铂+氟尿嘧啶）序贯同期放化疗","G":"调强放射治疗（IMRT）+ 免疫治疗（PD-1抑制剂）"},"answer":"D","vignette":"患者男，40岁。因“间断回吸性涕血1个月”就诊。鼻咽镜检查提示右侧咽隐窝软组织饱满。头颈部MRI显示右侧鼻咽顶后壁及侧壁增厚，侵犯咽旁间隙，未见颅底骨质破坏及脑神经受累，双侧颈部及咽后淋巴结短径均<5mm且形态正常。全身PET-CT未见异常高代谢灶。鼻咽活检病理：非角化性未分化癌。\n\n治疗前血浆EBV DNA检测：0 copies/mL。\n\n实验室检查：WBC 5.5×10^9/L，Hgb 125 g/L，PLT 210×10^9/L，ALT 25 U/L，Cr 80 μmol/L。患者发病以来体力活动完全正常，能进行发病前的所有日常活动。","capability_group":"initial_definitive"}
+{"id":"l2-sample-6b5d2425b647bbdf5e02b616","question":"基于该患者的临床特征，在追求长期生存甚至临床治愈的前提下，目前最佳的综合治疗策略是？","options":{"A":"立即行鼻咽原发灶及颈部淋巴结的根治性同期放化疗（CCRT），同期联合PD-1抑制剂，骨病灶暂不处理，待局部控制后再行全身化疗","B":"给予吉西他滨+顺铂联合PD-1抑制剂全身治疗，若达到客观缓解（PR）或疾病稳定（SD），后续对鼻咽原发灶、颈部淋巴结及两处骨病灶均行局部放疗，随后继续PD-1抑制剂维持","C":"给予吉西他滨+顺铂联合PD-1抑制剂全身治疗，若达到客观缓解（PR）或疾病稳定（SD），后续仅对鼻咽原发灶及颈部淋巴结行根治性放疗，骨病灶继续依靠药物控制","D":"首选针对T8胸椎及左侧髂骨病灶行立体定向体部放疗（SBRT），随后行鼻咽原发灶及颈部淋巴结的根治性同期放化疗（CCRT）","E":"仅给予吉西他滨+顺铂联合PD-1抑制剂全身治疗直至疾病进展或出现不可耐受毒性，不建议对原发灶进行高剂量放疗以避免严重毒副反应","F":"立即行鼻咽原发灶及颈部淋巴结的根治性放疗，随后给予吉西他滨+顺铂辅助化疗，并根据EBV-DNA下降情况决定是否联合免疫治疗"},"answer":"B","vignette":"患者男性，66岁。因“回吸性涕血1个月”就诊。查体：ECOG 0分，双侧颈部触及数枚质硬淋巴结，最大径约2cm，未融合，活动度尚可。鼻咽镜活检病理：非角化性未分化癌。头颈部MRI：鼻咽顶后壁软组织肿块，侵犯双侧海绵窦，并伴有第V、VI对脑神经受累征象；双侧颈部可见多个肿大淋巴结，最大短径4cm，包膜外侵犯不明显。全身PET-CT：胸椎（T8）及左侧髂骨可见两处高代谢病灶（SUVmax分别为8.5和7.2），伴局部骨质破坏，未见内脏高代谢灶。实验室检查：WBC 5.5×10^9/L, Hgb 125g/L, PLT 210×10^9/L, ALT 25 U/L, Cr 80 umol/L。血浆EBV-DNA定量为5.0×10^4 copies/mL。","capability_group":"metastatic_systemic"}
+{"id":"l2-sample-550a4c8c8f49d1399c3aa9a2","question":"目前最佳的综合治疗策略是？","options":{"A":"立即行鼻咽原发灶及颈部淋巴结的根治性同期放化疗（CCRT），同期联合PD-1抑制剂，骨病灶暂不处理，待局部控制后再行全身化疗","B":"给予吉西他滨+顺铂联合PD-1抑制剂全身治疗，若达到客观缓解（PR）或疾病稳定（SD），后续对鼻咽原发灶、颈部淋巴结及两处骨病灶均行局部放疗，随后继续PD-1抑制剂维持","C":"给予吉西他滨+顺铂联合PD-1抑制剂全身治疗，若达到客观缓解（PR）或疾病稳定（SD），后续仅对鼻咽原发灶及颈部淋巴结行根治性放疗，骨病灶继续依靠药物控制","D":"首选针对T8胸椎及左侧髂骨病灶行立体定向体部放疗（SBRT），随后行鼻咽原发灶及颈部淋巴结的根治性同期放化疗（CCRT）","E":"仅给予吉西他滨+顺铂联合PD-1抑制剂全身治疗直至疾病进展或出现不可耐受毒性，不建议对原发灶进行高剂量放疗以避免严重毒副反应","F":"立即行鼻咽原发灶及颈部淋巴结的根治性放疗，随后给予吉西他滨+顺铂辅助化疗，并根据EBV-DNA下降情况决定是否联合免疫治疗"},"answer":"B","vignette":"患者男性，66岁。因“回吸性涕血1个月”就诊。查体：ECOG 0分，双侧颈部触及数枚质硬淋巴结，最大径约2cm，未融合，活动度尚可。鼻咽镜活检病理：非角化性未分化癌。头颈部MRI：鼻咽顶后壁软组织肿块，侵犯双侧海绵窦，并伴有第V、VI对脑神经受累征象；双侧颈部可见多个肿大淋巴结，最大短径4cm，包膜外侵犯不明显。全身PET-CT：胸椎（T8）及左侧髂骨可见两处高代谢病灶（SUVmax分别为8.5和7.2），伴局部骨质破坏，未见内脏高代谢灶。实验室检查：WBC 5.5×10^9/L, Hgb 125g/L, PLT 210×10^9/L, ALT 25 U/L, Cr 80 umol/L。血浆EBV-DNA定量为5.0×10^4 copies/mL。","capability_group":"initial_definitive"}
+{"id":"l2-sample-4ab7cfec52ad4324a92a56af","question":"最佳的初始标准综合治疗策略是？","options":{"A":"顺铂+氟尿嘧啶（PF方案）同期放化疗，序贯PF方案辅助化疗","B":"多西他赛+顺铂+氟尿嘧啶（TPF方案）诱导化疗，序贯单纯调强放射治疗（IMRT）","C":"吉西他滨+顺铂（GP方案）诱导化疗，序贯顺铂同期放化疗（CCRT）","D":"顺铂同期放化疗（CCRT），联合尼妥珠单抗靶向治疗","E":"特瑞普利单抗联合GP方案诱导化疗，序贯顺铂同期放化疗及特瑞普利单抗维持治疗","F":"单纯调强放射治疗（IMRT），局部推量"},"answer":"C","vignette":"患者男，50岁。因“回吸性涕血1个月”就诊。查体：ECOG 0分，双侧颈部可触及多发肿大淋巴结，质硬，活动度差，最大径约4.5cm，未融合，双侧锁骨上窝未及肿大淋巴结。鼻咽镜活检示：非角化性未分化癌。MRI及CT检查显示：鼻咽顶后壁软组织肿块，侵犯斜坡及颅底骨质，未侵犯脑神经、下咽及眼眶；双侧咽后及双侧颈部II-III区可见多发肿大淋巴结，最大径4.5cm，包膜外侵犯（-），无远处转移征象。实验室检查：WBC 5.5×10^9/L, Hgb 125g/L, PLT 210×10^9/L, ALT 25 U/L, Cr 80 umol/L。治疗前血浆EBV-DNA定量为1.0×10^4 copies/mL。","capability_group":"initial_definitive"}
+{"id":"l2-sample-c9ac07492f4b39de96c804a5","question":"基于当前循证医学证据及国内外权威指南，针对该患者的最佳综合治疗策略是？","options":{"A":"诱导化疗（吉西他滨+顺铂）3周期 序贯 同期放化疗（顺铂单药）","B":"诱导化疗（多西他赛+顺铂+5-氟尿嘧啶）3周期 序贯 同期放化疗（顺铂单药）","C":"诱导化疗（吉西他滨+奈达铂）3周期 序贯 同期放化疗（奈达铂单药）","D":"同期放化疗（顺铂单药） 序贯 辅助化疗（吉西他滨+顺铂）","E":"诱导化疗（吉西他滨+卡铂+特瑞普利单抗）3周期 序贯 同期放化疗（卡铂单药）","F":"单纯调强放射治疗（IMRT）联合西妥昔单抗靶向治疗"},"answer":"C","vignette":"患者男，52岁，因“右耳闷堵伴回吸性涕血3个月”就诊。既往有高血压病史5年，血压控制良好；否认糖尿病史。ECOG PS评分 1分。\n\n专科查体及影像学：鼻咽内镜示右侧咽隐窝结节样肿物。鼻咽及颈部MRI示：肿瘤侵犯右侧翼突内侧板及破裂孔，向上与海绵窦下壁分界不清，未见明显脑膜强化；右侧咽后淋巴结肿大（最大径1.4cm），右侧颈部IIb区见融合淋巴结，最大径3.8cm，影像学提示包膜外侵犯（ENE）阳性；左侧颈部未见异常。胸部CT、腹部增强CT及全身骨扫描未见远处转移征象。\n\n实验室检查：WBC 5.8×10^9/L, Hgb 135g/L, PLT 160×10^9/L。ALT 35 U/L, AST 40 U/L。血清肌酐（Cr） 115 μmol/L，计算肌酐清除率（CrCl）约为 58 mL/min。纯音测听提示双耳4000-8000Hz存在中度感音神经性听力损失。血浆EBV DNA定量检测为 35,000 copies/mL。","capability_group":"initial_definitive"}
+{"id":"l2-sample-492a4a66beaf4659c84f1781","question":"首选的挽救性治疗策略是？","options":{"A":"调强适形放射治疗（IMRT）再程放疗，处方剂量60Gy/30f","B":"质子重离子放射治疗（PT/CIRT），处方剂量60GyE/30f","C":"鼻内镜下鼻咽病损切除术（Endoscopic Nasopharyngectomy）","D":"开放性上颌骨外旋入路鼻咽切除术","E":"吉西他滨+顺铂（GP方案）诱导化疗2-3周期后，行IMRT再程放疗","F":"局部放射性粒子（如125I）植入近距离放射治疗"},"answer":"C","vignette":"患者男，65岁。3年前因鼻咽非角化性癌（T2N1M0，VIII版）接受根治性诱导化疗+同期放化疗，放疗剂量为PGTVnx 70Gy/33f，双侧颈部预防剂量54Gy/33f。治疗后达临床完全缓解（cCR）。近1个月患者出现间断性回吸性涕血。查体：双侧颈部皮肤轻度色素沉着及皮下组织硬化，未触及肿大淋巴结；张口度正常。鼻咽镜示鼻咽顶后壁黏膜隆起，表面粗糙伴少许渗血。活检病理证实为鼻咽非角化性癌。\n\n鼻咽高分辨率MRI增强扫描及血管成像（MRA）提示：鼻咽顶后壁见一1.2cm×1.0cm结节状异常强化影，病灶局限于鼻咽黏膜及黏膜下层，未侵犯咽旁间隙及颅底骨质；病灶外侧缘距离双侧颈内动脉破裂孔段（C3段）最近距离为4mm，其间可见完整的高信号脂肪间隙。全身PET-CT未见远处转移征象。\n\n实验室检查：WBC 4.2×10^9/L，Hgb 115g/L，PLT 150×10^9/L，ALT 25 U/L，Cr 95 μmol/L，Ccr 65 mL/min。血浆EBV DNA 1500 copies/mL。","capability_group":"post_treatment_recurrence"}
+{"id":"l2-sample-5039abae7cd79fad6abdcc07","question":"基于该患者的临床分期及风险特征，目前首选的根治性治疗方案是？","options":{"A":"单纯根治性调强放疗（IMRT）","B":"单纯根治性调强放疗 + 辅助化疗（氟尿嘧啶+顺铂）","C":"同期放化疗（IMRT + 顺铂 100mg/m2 q3w）","D":"诱导化疗（吉西他滨+顺铂）后行同期放化疗"},"answer":"A","vignette":"患者男，54岁，既往体健。因“回吸性涕血2周”就诊。查体：鼻咽镜检查可见顶后壁黏膜粗糙、轻度增厚，表面少许血迹。头颈部MRI显示：鼻咽顶后壁局限性增厚，病变局限于鼻咽腔内，未侵犯咽旁间隙，未见颅底骨质破坏；双侧颈部未见肿大淋巴结。全身PET-CT未见远处转移。病理活检证实为非角化性未分化癌。实验室检查：WBC 5.5×10^9/L, Hgb 125g/L, PLT 210×10^9/L, ALT 25 U/L, Cr 80 μmol/L。血浆EBV-DNA检测为0 copies/mL。ECOG评分0分。","capability_group":"initial_definitive"}
+{"id":"l2-sample-6aaa0d852513f8b65fde8d5e","question":"基于该患者既往放疗史及目前复发病灶的解剖学特征，综合考虑疗效与远期生存质量，最佳的挽救性治疗策略是？","options":{"A":"调强适形放疗（IMRT）再程放疗，总剂量60Gy","B":"诱导化疗（吉西他滨+顺铂）后行再程放疗","C":"经鼻内镜下鼻咽切除术（Endoscopic Nasopharyngectomy）","D":"免疫检查点抑制剂（PD-1单抗）联合吉西他滨+顺铂化疗"},"answer":"C","vignette":"患者男，69岁，3年前因鼻咽癌（T2N1M0）接受过根治性放化疗，治疗后定期随访无异常。近期患者出现回吸性涕血，行鼻咽镜检查提示鼻咽顶后壁粘膜粗糙、糜烂。鼻咽部MRI增强扫描显示：鼻咽顶后壁局限性软组织增厚，病灶局限于鼻咽腔内（rT1），未侵犯颅底骨质，与双侧颈内动脉之间存在明确的安全间隙，颈部淋巴结未见肿大。全身PET/CT未见远处转移。血浆EBV-DNA定量为1000 copies/mL。查体：ECOG评分0分，张口度正常，颅神经检查阴性。血常规及肝肾功能均在正常范围（Cr 80 umol/L）。","capability_group":"post_treatment_recurrence"}
+{"id":"l2-sample-ac3ab0a8c5aa8acdbdfb096a","question":"当前最恰当的治疗策略是？","options":{"A":"立即更换二线化疗方案（如紫杉醇+卡铂），并停用PD-1抑制剂","B":"暂停全身治疗，仅给予双膦酸盐或地舒单抗治疗骨转移","C":"维持原PD-1抑制剂治疗，针对新发骨转移灶行局部放疗（SBRT或常规放疗）","D":"停用PD-1抑制剂，加用靶向药物（如尼妥珠单抗）联合卡培他滨维持治疗"},"answer":"C","vignette":"患者男，61岁，既往体健，无吸烟史，无慢性病及传染病史。患者确诊为鼻咽癌（cT1cN1cM1，多发骨转移及肺转移)。一线接受GP（吉西他滨+顺铂）方案化疗6周期联合PD-1抑制剂免疫治疗，疗效评价为部分缓解（PR）。随后进入维持治疗阶段，方案为PD-1抑制剂单药维持。维持治疗期间定期复查，EBV-DNA持续低于检测下限（0 copies/mL）。近期复查影像学显示：原发灶及颈部淋巴结控制良好，肺部病灶稳定，但胸椎T7及T9椎体新发高代谢灶，提示骨转移进展，伴有轻度背痛（NRS 2分），未压迫脊髓。血常规及肝肾功能均正常。ECOG PS评分0分。","capability_group":"metastatic_systemic"}
+{"id":"l2-sample-c0c05c06776ea378cedc0b31","question":"基于当前循证医学证据及患者现状，下一步最恰当的治疗策略是？","options":{"A":"调强放疗（IMRT）同期联合顺铂 100mg/m² q3w × 2-3周期，放疗后序贯卡瑞利珠单抗维持治疗1年","B":"调强放疗（IMRT）同期联合顺铂 100mg/m² q3w × 2-3周期，根据患者治疗过程中肿瘤消退情况及 EBV 变化趋势决定是否追加辅助治疗","C":"单纯调强放疗（IMRT）","D":"调强放疗（IMRT）同期联合顺铂 100mg/m² q3w × 2-3周期，放疗后序贯卡培他滨节拍化疗维持1年","E":"调强放疗（IMRT）同期联合尼妥珠单抗 200mg qw × 7-8周期，放疗后不常规追加辅助治疗"},"answer":"B","vignette":"患者男，65岁。因“发现右侧颈部肿物2个月，伴回吸性血涕”就诊。鼻咽镜活检病理：非角化性癌，未分化型。MRI提示：肿瘤侵犯翼突根部及颅底骨质，未侵犯脑神经；双侧颈部多发淋巴结肿大，右侧颈IV区可见一融合淋巴结，最大径6.2cm，包膜外侵犯（ENE）阳性。PET-CT未见远处转移。基线血浆EBV-DNA：4.5×10^5 copies/mL。肌酐清除率（Ccr） 65 mL/min，听力测试提示轻度高频听力下降。\n\n目前已接受“吉西他滨 1g/m² d1,8 + 顺铂 80mg/m² d1，q3w”方案诱导化疗3个周期。复查MRI提示鼻咽原发灶缩小40%，右颈IV区淋巴结缩小至2.5cm。复查血浆EBV-DNA：0 copies/mL。血常规：WBC 3.2×10^9/L，ANC 1.8×10^9/L，PLT 95×10^9/L。ALT 35 U/L，AST 40 U/L，Ccr 58 mL/min。","capability_group":"initial_definitive"}
+{"id":"l2-sample-46fe0ad5b6e11f80051625af","question":"基于该患者的分期及危险度分层，首选的根治性治疗方案是？","options":{"A":"同期放化疗（IMRT + 顺铂 100mg/m² q3w）","B":"单纯调强适形放射治疗（IMRT）","C":"单纯调强适形放射治疗（IMRT）+ 辅助化疗（氟尿嘧啶+顺铂）","D":"诱导化疗（吉西他滨+顺铂）后行同期放化疗"},"answer":"B","vignette":"患者男，57岁（1968年1月出生），既往体健。因“间断回吸性涕中带血1个月”就诊。体格检查未触及颈部淋巴结肿大。鼻咽镜活检示：非角化性癌（未分化型）。治疗前MRI提示：鼻咽顶后壁软组织增厚，病变局限于鼻咽腔内，未侵犯咽旁间隙，颅底骨质结构完整，双侧颈部未见肿大淋巴结。实验室检查：血常规 WBC 5.5×10^9/L, Hgb 125g/L, PLT 210×10^9/L；肝肾功能正常（ALT 25 U/L, Cr 80 μmol/L）。治疗前血浆EBV-DNA检测结果为0 copies/mL。ECOG评分0分。","capability_group":"initial_definitive"}
+{"id":"l2-sample-01cae19e31025bf5fa574ebe","question":"综合考虑疗效与远期生存质量，首选的挽救性治疗策略是？","options":{"A":"鼻内镜下鼻咽切除术（Endoscopic Nasopharyngectomy）","B":"免疫检查点抑制剂（PD-1单抗）联合单药化疗维持治疗","C":"吉西他滨+顺铂（GP方案）诱导化疗后行挽救性放疗","D":"挽救性调强放疗（Re-IMRT），总剂量60Gy"},"answer":"A","vignette":"患者男，55岁，3年前确诊为鼻咽癌（T2N1M0），接受了根治性调强放疗（IMRT）联合同期化疗，治疗后定期随访无异常。近期患者出现晨起回吸性涕中带血，持续约2周。查体见鼻咽部粘膜稍充血，未见明显溃疡或大块新生物。鼻内镜提示鼻咽顶后壁局部隆起。头颈部增强MRI显示：鼻咽顶后壁局限性增厚，病灶局限于鼻咽腔内（rT1），与双侧颈内动脉均有清晰脂肪间隙（>5mm），颅底骨质未见破坏，双侧颈部淋巴结阴性。血常规、肝肾功能均正常（WBC 5.5, Hgb 125, PLT 210, Cr 80 umol/L）。血浆EBV-DNA定量为 1000 copies/mL。ECOG评分为0分。既往放疗总剂量为 PGTVnx 70Gy/33f。","capability_group":"post_treatment_recurrence"}
+{"id":"l2-sample-4ff0ba14e272dc951a3adb13","question":"目前最恰当的一线治疗策略是？","options":{"A":"吉西他滨 + 顺铂（GP方案）联合PD-1抑制剂","B":"紫杉醇 + 卡铂（TC方案）同步局部姑息性放疗","C":"单药PD-1抑制剂维持治疗","D":"卡培他滨单药节拍化疗"},"answer":"A","vignette":"患者男，56岁，因“确诊鼻咽癌21月余，右颈部肿块进行性增大9月余”入院。既往高血压病史7年，药物控制良好，无其他重大合并症。ECOG PS评分0分。患者21个月前确诊为鼻咽癌，接受过根治性放化疗（具体方案不详），近期复查发现右颈部淋巴结显著增大，伴肺部多发结节。影像学分期评估提示：鼻咽部病灶稳定，右颈部巨大淋巴结融合包块，双肺多发转移瘤，临床分期为rT3cN3cM1b（IVB期，AJCC 第 9 版）。实验室检查示血常规、肝肾功能均在正常范围内，血浆EBV-DNA检测为0 copies/mL（低于检测下限）。患者目前无明显疼痛，进食正常，体力状况良好。","capability_group":"metastatic_systemic"}
+{"id":"l2-sample-52b485076dea4370db71f3c7","question":"最恰当的后续治疗策略是？","options":{"A":"同期放化疗（IMRT + 顺铂 100mg/m² q3w × 2-3周期），放疗结束后不再行辅助化疗","B":"单纯根治性调强放疗（IMRT），因诱导化疗效果极佳且EBV-DNA已清零","C":"同期放化疗（IMRT + 顺铂 100mg/m² q3w）后，继续给予GP方案辅助化疗3个周期","D":"同期放化疗（IMRT + 顺铂 40mg/m² qw），并联合卡培他滨节拍维持治疗1年"},"answer":"A","vignette":"患者男，48岁，既往体健，1月前诊断为肺结核，经抗结核治疗后痰涂片转阴，目前处于恢复期。否认高血压、糖尿病、冠心病及其他慢性病史。本次因确诊鼻咽癌入院。查体ECOG评分0分。鼻咽镜及活检病理证实为非角化性癌（未分化型）。治疗前MRI及PET-CT分期提示鼻咽顶后壁肿物侵犯颅底骨质及海绵窦，双侧颈部可见多个肿大淋巴结，最大径约4cm，下颈部未及明确肿大淋巴结，无远处转移征象。临床分期为cT4N2M0（IVA期）。基线血浆EBV-DNA为2.5×10^4 copies/mL。血常规及生化检查：WBC、Hgb、PLT、ALT、Cr均在正常范围。患者现已完成吉西他滨+顺铂（GP方案）诱导化疗3个周期，过程顺利，复查MRI显示原发灶及颈部淋巴结显著缩小（PR），复查EBV-DNA已降至0 copies/mL。目前需制定下一步治疗方案。","capability_group":"initial_definitive"}
+{"id":"l2-sample-8f884261c18f7a04cb77237f","question":"下一步最恰当的治疗策略是？","options":{"A":"鉴于患者曾出现ALT > 200 U/L的严重肝损伤，应立即中断放疗，仅给予最佳支持治疗及恩替卡韦抗病毒治疗，避免肝衰竭风险。","B":"立即停止局部放疗，改回全身化疗，追加2-4个疗程的GP（吉西他滨+顺铂）方案以巩固疗效。","C":"暂停放疗，行高强度清髓性化疗联合自体干细胞移植，以期获得长期无病生存。","D":"继续完成原发灶及颈部淋巴结的根治性剂量放疗（总剂量约66-70Gy），同时密切监测肝功能与乙肝病毒载量，放疗结束后根据耐受情况考虑维持治疗。"},"answer":"D","vignette":"患者男，64岁，ECOG评分0分。既往体健，初诊时确诊为鼻咽癌cT3cN2cM1a期，筛查发现乙肝小三阳，HBV-DNA升高，但基线肝功能正常，已开始口服恩替卡韦抗病毒治疗。患者接受了以铂类为基础的全身化疗作为诱导治疗，共完成4个疗程。在第2疗程后曾出现药物性肝损伤（ALT升高至220.9 U/L），经保肝治疗后好转并顺利完成后续化疗。目前为诱导化疗结束后27天，原发灶及颈部淋巴结区域已开始姑息性放疗，目前已完成8次放疗。最新复查显示：血常规及肾功能未见明显异常，ALT正常；血浆EBV-DNA已降至0 copies/mL。复查影像学评估显示原发灶及转移灶均较治疗前明显缩小，达到部分缓解（PR）。","capability_group":"metastatic_systemic"}
+{"id":"l2-sample-8b313aa16f686e461f4366ac","question":"基于目前最高级别的循证医学证据，针对该患者的首选一线系统治疗方案是？","options":{"A":"吉西他滨 + 顺铂（GP） + PD-1抑制剂（如特瑞普利单抗或卡瑞利珠单抗）","B":"TPF诱导化疗（多西他赛+顺铂+氟尿嘧啶）序贯根治性放疗","C":"吉西他滨 + 顺铂（GP）单纯化疗","D":"根治性放疗（鼻咽+颈部淋巴结） + 同期顺铂化疗"},"answer":"A","vignette":"患者男，63岁（1962年1月出生），既往体健。因“回吸性涕血伴头痛2个月”就诊。体格检查示左侧锁骨上窝可触及一直径约2cm肿大淋巴结，质硬，活动度差；余浅表淋巴结未触及肿大。鼻咽镜活检示：非角化性癌（未分化型）。\n\n辅助检查：\n- 头颈部MRI：鼻咽顶后壁软组织肿块，侵犯海绵窦及脑神经，双侧颈部及左侧锁骨上窝多发肿大淋巴结。\n- 全身骨扫描及PET-CT：显示多发骨转移（包括胸椎、骨盆及股骨近端），无内脏危象。\n- 实验室检查：WBC 5.5×10⁹/L, Hgb 125 g/L, PLT 210×10⁹/L, ALT 25 U/L, Cr 80 μmol/L。\n- 血浆EBV DNA：2.0×10⁵ copies/mL。\n- ECOG PS评分：0分。\n\n患者目前无明显骨痛，无脊髓压迫症状，肝肾功能及骨髓储备良好。","capability_group":"metastatic_systemic"}
+{"id":"l2-sample-0eb73c7166b9c784d0380142","question":"下一步最恰当的治疗决策是？","options":{"A":"立即开始同期放化疗（IMRT + 顺铂单药增敏）","B":"继续GP方案诱导化疗至第3周期，待肿瘤进一步缩小后再行放疗","C":"更换为TP方案（多西他赛+顺铂）追加2周期化疗以清除残留微小病灶","D":"结束化疗，仅行单纯调强放疗（IMRT）以降低毒性"},"answer":"A","vignette":"患者男，51岁，既往体健。因“回吸性涕血伴头痛2月”就诊。初诊影像学及病理确诊为鼻咽非角化性癌（未分化型）。分期检查示：鼻咽顶后壁肿物侵犯颅底骨质，双侧颈部可见多发淋巴结转移，最大径约3cm，包膜完整，无远处转移证据。基线EBV DNA为2.5×10^4 copies/mL。ECOG评分0分。患者接受了吉西他滨+顺铂（GP方案）诱导化疗2周期。目前刚完成第2周期化疗后复查：鼻咽及颈部MRI显示原发灶及颈部淋巴结较前明显退缩，体积缩小约35%（评估为PR），颅底骨质破坏范围未进一步扩大。复查EBV DNA降至500 copies/mL。血常规及生化指标：WBC 5.5×10^9/L, Hgb 125g/L, PLT 210×10^9/L, ALT 25 U/L, Cr 80 umol/L。患者目前无明显化疗相关毒性反应，一般情况良好。","capability_group":"initial_definitive"}
+{"id":"l2-sample-6613d750b1fb16b0e3baa758","question":"下列哪项治疗策略最为恰当？","options":{"A":"顺铂 + 氟尿嘧啶（PF方案）联合帕博利珠单抗，6个周期后采用帕博利珠单抗单药维持治疗","B":"吉西他滨 + 顺铂（GP方案）联合特瑞普利单抗，4-6个周期评估若达到PR/SD，序贯对鼻咽原发灶及颈部淋巴结行根治性剂量放疗，并继续免疫维持","C":"诱导化疗（TPF方案）3个周期后，行鼻咽及颈部同期放化疗，随后针对肝脏及骨转移灶行SBRT（立体定向体部放疗）","D":"卡培他滨单药维持治疗","E":"吉西他滨 + 顺铂（GP方案）联合卡瑞利珠单抗，6个周期后采用卡瑞利珠单抗联合卡培他滨维持治疗","F":"依托泊苷 + 铂类（EP方案）全身化疗，联合双膦酸盐治疗，若病情控制则行单纯免疫维持治疗"},"answer":"B","vignette":"患者男，61岁。6年前曾因“右侧颈部无痛性包块”于外院行局部切除术，术后病理提示“转移性低分化癌”，患者拒绝进一步检查与治疗。1个月前无明显诱因出现回吸性涕血，伴右侧持续性头痛。\n\n查体：ECOG状态：患者每日可坚持轻体力家务，但需卧床休息约2小时。右颈部可见陈旧性手术瘢痕，双侧颈部可触及多个肿大淋巴结，最大者位于右侧IIb区，约3.5cm×2.5cm，质硬，固定。\n\n辅助检查：\n\n鼻咽+颈部MRI：鼻咽顶后壁及右侧壁不规则增厚，病变侵犯右侧头长肌、翼内肌及斜坡骨质，向上突入右侧海绵窦，包绕颈内动脉；双侧颈部（II、III、IV区）多发肿大淋巴结，部分融合伴坏死。\n胸腹盆CT及全身骨扫描：肝右叶可见两处类圆形低密度影（最大径2.1cm），增强扫描呈环形强化；T8、L3椎体及右侧髂骨可见多发成骨性破坏灶。\n实验室检查： WBC 5.6×10^9/L，Hgb 115 g/L，PLT 180×10^9/L；ALT 35 U/L，AST 42 U/L，Cr 88 μmol/L，TBIL 15 μmol/L。血浆EBV-DNA：4.5×10^5 copies/mL。\n鼻咽镜活检病理：（鼻咽）非角化性癌，未分化型。免疫组化：EBER(+)，PD-L1 CPS=2。","capability_group":"metastatic_systemic"}
+{"id":"l2-sample-fa6de23fdb91df83017ddc78","question":"基于最新（2025 年）CSCO 指南，该患者下一步最恰当的局部区域治疗及全身治疗衔接方案是？","options":{"A":"调强放疗（IMRT） + 顺铂 100 mg/m² q3w 同期化疗，放疗后序贯特瑞普利单抗维持","B":"调强放疗（IMRT） + 顺铂 40 mg/m² qw 同期化疗，放疗后序贯特瑞普利单抗维持","C":"调强放疗（IMRT） + 奈达铂 80-100 mg/m² q3w 同期化疗，放疗后序贯特瑞普利单抗维持","D":"调强放疗（IMRT） + 卡铂 AUC=5 q3w 同期化疗，放疗后序贯特瑞普利单抗维持","E":"调强放疗（IMRT） + 尼妥珠单抗 200mg qw 同期靶向治疗，放疗后序贯特瑞普利单抗维持","F":"单纯调强放疗（IMRT），放疗后序贯特瑞普利单抗维持"},"answer":"F","vignette":"患者男，58岁，体重 65 kg。确诊为鼻咽非角化性鳞癌，初始分期为 cT4N3M0，III期（第9版AJCC分期）。既往有慢性中耳炎病史。患者入组接受了 3 周期“吉西他滨+顺铂+特瑞普利单抗”诱导治疗。复查头颈部MRI示鼻咽原发灶及双侧颈部淋巴结较前缩小，疗效评价为部分缓解（PR）。\n\n当前体格检查：ECOG PS评分 1分。纯音测听提示双耳高频听力较治疗前下降，评估为 CTCAE 2级听力受损。\n\n实验室检查：WBC 3.2×10^9/L，ANC 1.8×10^9/L，Hgb 105 g/L，PLT 95×10^9/L；血清肌酐（Scr）135 μmol/L（基线为 85 μmol/L）；血浆EBV-DNA由治疗前的 5.5×10^5 copies/mL 降至 1.2×10^3 copies/mL。","capability_group":"initial_definitive"}
+{"id":"l2-sample-7ef9b2d72d4d8c5b9dc911d5","question":"目前最佳的挽救性治疗策略是？","options":{"A":"鼻咽切除术（内镜下或开放手术）","B":"调强适形放疗（IMRT）再程放疗（总剂量60Gy/30f）","C":"单纯免疫检查点抑制剂（PD-1单抗）维持治疗","D":"诱导化疗（吉西他滨+顺铂）后行根治性放疗"},"answer":"A","vignette":"患者男，44岁（1981年1月出生）。3年前因鼻咽癌接受过根治性放疗（具体剂量不详，过程顺利）。近期出现回吸性涕血，量少。既往史无特殊，ECOG评分0分。查体：鼻咽部未见明显外生性肿物，颈部未触及肿大淋巴结。辅助检查：血常规 WBC 5.5×10^9/L, Hgb 125g/L, PLT 210×10^9/L；生化指标 ALT 25 U/L, Cr 80 μmol/L。血浆EBV DNA 1000 copies/mL。鼻咽+颈部增强MRI示：鼻咽顶后壁软组织局限性增厚，病灶局限于鼻咽腔内（rT1），与双侧颈内动脉均存在清晰脂肪间隙，未见颅底骨质破坏，双侧颈部淋巴结阴性。纤维鼻咽镜活检证实为非角化性癌（未分化型）。","capability_group":"post_treatment_recurrence"}
+{"id":"l2-sample-6ae2796a1932c7887e6803c9","question":"首选的根治性治疗方案是？","options":{"A":"诱导化疗（吉西他滨+顺铂）后行单纯调强放射治疗","B":"单纯调强适形放射治疗（IMRT）","C":"调强放射治疗同期联合顺铂单药化疗（100mg/m² q3w）","D":"单纯调强放射治疗后行辅助化疗（氟尿嘧啶+顺铂）"},"answer":"B","vignette":"患者男，61岁（1964年1月出生），既往体健，无吸烟酗酒史。主诉“晨起回吸性涕中带血1月余”就诊。查体：ECOG评分 0分，双侧颈部未触及肿大淋巴结，颅神经检查阴性。鼻咽镜检查见顶后壁黏膜粗糙、轻度隆起。头颈部增强MRI显示：鼻咽顶后壁局限性增厚，病变局限于鼻咽腔内，未侵犯咽旁间隙、颅底骨质及周围软组织；双侧颈部及咽后淋巴结未见肿大（短径均<5mm，且无坏死征象）。血浆EBV-DNA检测结果为 0 copies/mL。血常规及生化检查：WBC 5.5×10^9/L, Hgb 125g/L, PLT 210×10^9/L, ALT 25 U/L, Cr 80 μmol/L。胸腹部CT及全身骨扫描未见远处转移征象。活检病理证实为非角化性未分化癌。","capability_group":"initial_definitive"}
+{"id":"l2-sample-ef5ec2d389b086e3f6745d0d","question":"目前最推荐的治疗策略是？","options":{"A":"诱导化疗（吉西他滨+顺铂）序贯单纯调强放疗（IMRT）","B":"同期放化疗（IMRT + 顺铂 100mg/m² q3w）","C":"单纯根治性调强放疗（IMRT）","D":"同期放化疗（IMRT + 顺铂 40mg/m² weekly）联合尼妥珠单抗"},"answer":"C","vignette":"患者男，42岁，既往体健。因“回吸性涕血1月余”就诊。查体：鼻咽部见菜花样肿物，双侧颈部未触及肿大淋巴结。ECOG评分 0分。辅助检查：血常规、肝肾功能均未见异常。血浆EBV-DNA检测示：0 copies/mL。鼻咽+颈部MRI示：鼻咽顶后壁软组织增厚，侵犯咽旁间隙，未侵犯翼突内侧板及颅底，双侧颈部及咽后淋巴结短径均<5mm。病理活检确诊为非角化性未分化癌。PET-CT未见远处转移征象。","capability_group":"initial_definitive"}
+{"id":"l2-sample-33c6dcbba152fe3105da2007","question":"最合适的首选治疗策略是？","options":{"A":"单纯根治性调强放疗（IMRT）","B":"诱导化疗（吉西他滨+顺铂）后行同期放化疗","C":"单纯根治性调强放疗 + 辅助化疗（氟尿嘧啶+顺铂）","D":"同期放化疗（顺铂 100mg/m² q3w × 2-3周期）"},"answer":"A","vignette":"患者男，51岁，因“回吸性涕血1个月”就诊。既往体健，无吸烟史。体格检查未触及颈部肿大淋巴结。鼻咽镜检查提示鼻咽顶后壁新生物。头颈部MRI显示鼻咽顶后壁软组织增厚，侵犯咽旁间隙（T2），未见颈部淋巴结肿大（N0）。胸腹CT及骨扫描未见远处转移。实验室检查：血常规 WBC 5.5×10^9/L, Hgb 125g/L, PLT 210×10^9/L；肝肾功能正常，Cr 80 umol/L；治疗前血浆EBV DNA为0 copies/mL。ECOG评分为0分。病理活检证实为非角化性癌（未分化型）。","capability_group":"initial_definitive"}
+{"id":"l2-sample-414cb9850992025dd34e5dab","question":"首选的根治性治疗方案是？","options":{"A":"单纯根治性调强放疗（IMRT）","B":"同期放化疗（IMRT + 顺铂 100mg/m² q3w）","C":"诱导化疗（吉西他滨+顺铂）后行同期放化疗","D":"单纯根治性调强放疗（IMRT）序贯辅助化疗（氟尿嘧啶+顺铂）"},"answer":"A","vignette":"患者男，45岁，既往体健。因“晨起回吸性涕中带血2周”就诊。体格检查：ECOG PS评分 0分，鼻咽镜检查可见鼻咽顶后壁一局限性隆起，表面粘膜略粗糙，触之易出血。颈部触诊未及肿大淋巴结。辅助检查：头颈部增强MRI显示鼻咽顶后壁局限性增厚，病变局限于鼻咽腔内，未侵犯咽旁间隙，颅底骨质未见破坏，双侧颈部淋巴结未见异常肿大及强化（T1N0M0）。血常规：WBC 5.5×10^9/L, Hgb 125g/L, PLT 210×10^9/L。生化检查：ALT 25 U/L, Cr 80 μmol/L。血浆EBV-DNA定量检测：0 copies/mL。","capability_group":"initial_definitive"}
+{"id":"l2-sample-02fa8f130f34e3a31bc03188","question":"针对该患者最佳的一线综合治疗策略是？","options":{"A":"单纯同期放化疗（顺铂单药，100mg/m² q3w）","B":"吉西他滨+顺铂（GP方案）诱导化疗，序贯同期放化疗（顺铂单药）","C":"多西他赛+顺铂+氟尿嘧啶（TPF方案）诱导化疗，序贯单纯根治性放疗","D":"卡瑞利珠单抗联合吉西他滨+顺铂诱导治疗，序贯放疗"},"answer":"B","vignette":"患者男，45岁（1980年1月出生），既往体健。因“回吸性涕血1月余”就诊。查体：ECOG评分0分，鼻咽镜检查可见鼻咽顶后壁肿物。头颈部MRI及CT显示：鼻咽部肿物侵犯颅底骨质，双侧颈部可见多发淋巴结肿大，最大径约4.5cm，均位于锁骨上窝以上，包膜完整。全身PET-CT未见远处转移。实验室检查：WBC 5.5×10^9/L, Hgb 125g/L, PLT 210×10^9/L, ALT 25 U/L, Cr 80 umol/L。血浆EBV-DNA定量为 1.0×10^4 copies/mL。病理活检提示：非角化性未分化癌。根据AJCC/UICC第8版分期系统，该患者临床分期为T3N2M0（III期）。","capability_group":"initial_definitive"}
+{"id":"l2-sample-069988f95c9caef0cda92d7b","question":"最合适的治疗策略是？","options":{"A":"同期放化疗（IMRT + 顺铂 100mg/m² q3w × 2-3周期）","B":"单纯调强放射治疗（IMRT）","C":"诱导化疗（吉西他滨+顺铂）后行同期放化疗","D":"单纯调强放射治疗 + 辅助化疗（氟尿嘧啶+顺铂）"},"answer":"B","vignette":"患者男，45岁，既往体健。因“回吸性涕血1个月”就诊。鼻咽镜活检病理示：非角化性未分化癌。体格检查未触及颈部肿大淋巴结。头颈部MRI提示：鼻咽顶后壁增厚，向两侧咽隐窝侵犯，并累及咽旁间隙（T2），未见颈部淋巴结肿大（N0），无远处转移征象。实验室检查：血常规 WBC 5.5×10^9/L, Hgb 125g/L, PLT 210×10^9/L；肝肾功能 ALT 25 U/L, Cr 80 μmol/L。治疗前血浆EBV-DNA检测为0 copies/mL。ECOG PS评分为0分。","capability_group":"initial_definitive"}
+{"id":"l2-sample-14321b4f62dbda510569a1ad","question":"基于该患者的临床分期及风险特征，首选的根治性治疗方案是？","options":{"A":"同期放化疗（IMRT + 顺铂 100mg/m² q3w）","B":"单纯根治性调强放疗 + 辅助化疗（氟尿嘧啶+顺铂）","C":"诱导化疗（吉西他滨+顺铂）后行同期放化疗","D":"单纯根治性调强放疗（IMRT）"},"answer":"D","vignette":"患者男，47岁，既往体健。因“间断回吸性涕血1个月”就诊。体格检查：一般情况良好，ECOG评分0分，浅表淋巴结未触及肿大，鼻咽镜检见顶后壁黏膜粗糙。头颈部MRI增强扫描显示：鼻咽顶后壁局限性增厚，病变局限于鼻咽腔内，未侵犯咽旁间隙，未见颅底骨质破坏；双侧颈部未见肿大淋巴结。全身检查（胸腹部CT及骨扫描）未见远处转移征象。实验室检查：WBC 5.5×10^9/L, Hgb 125g/L, PLT 210×10^9/L, ALT 25 U/L, Cr 80 μmol/L。血浆EBV DNA检测结果为0 copies/mL。病理活检证实为非角化性未分化癌。","capability_group":"initial_definitive"}
+{"id":"l2-sample-b434bdf52da97e3815b3ce00","question":"针对该患者最适宜的初始标准治疗策略是？","options":{"A":"根治性调强放疗（IMRT）","B":"同步放化疗（顺铂单周或三周方案）","C":"诱导化疗（吉西他滨+顺铂）序贯同步放化疗","D":"诱导化疗（多西他赛+顺铂+氟尿嘧啶）序贯根治性调强放疗","E":"同步放化疗联合EGFR单抗（如尼妥珠单抗）","F":"诱导化疗（吉西他滨+顺铂）联合PD-1单抗序贯同步放化疗"},"answer":"B","vignette":"患者男性，63岁。因“回吸性涕血2个月”就诊。查体：ECOG评分0分。鼻咽部MRI显示：鼻咽顶后壁软组织不规则增厚，向右侧侵犯咽旁间隙，翼突内侧板及颅底骨质未见异常信号，未见颅神经受累征象；右侧咽后可见一肿大淋巴结，最大径1.2cm；右侧颈部II区可见一枚肿大淋巴结，短径1.5cm，最大径2.8cm，增强扫描包膜完整，周围脂肪间隙清晰；左侧颈部未见异常淋巴结。全身PET/CT未见远处转移。实验室检查：WBC 5.5×10^9/L, Hgb 125g/L, PLT 210×10^9/L, ALT 25 U/L, Cr 80 μmol/L。血浆EBV DNA定量检测：15,000 copies/mL。","capability_group":"initial_definitive"}
+{"id":"l2-sample-841521b3ffa90a42b892d8c1","question":"基于该患者既往治疗史及当前病情，以下哪项最适合作为下一步系统治疗策略？","options":{"A":"特瑞普利单抗（Toripalimab）或卡瑞利珠单抗（Camrelizumab）单药治疗","B":"多西他赛+顺铂+氟尿嘧啶（TPF方案）联合化疗","C":"针对多发骨转移病灶行姑息性放疗，暂缓全身治疗","D":"再次使用吉西他滨+卡铂（GC方案）联合化疗"},"answer":"A","vignette":"患者男，52岁，出生日期[出生信息已隐去]月。既往确诊为鼻咽癌（cT3N2M0，III期），接受过吉西他滨联合顺铂（GP方案）诱导化疗序贯同期放化疗。治疗结束仅1.5个月后，患者再次出现回吸性涕血。复查PET-CT提示鼻咽部病灶代谢增高，伴全身多发骨转移（椎体、肋骨）。查体ECOG评分0分。实验室检查示：WBC 5.5×10^9/L，Hgb 125 g/L，PLT 210×10^9/L，ALT 25 U/L，Cr 80 μmol/L。血浆EBV-DNA定量为5.0×10^4 copies/mL。既往无免疫相关不良反应史，无自身免疫性疾病史。","capability_group":"metastatic_systemic"}
+{"id":"l2-sample-d8e0e2a0b5828210438cc746","question":"下述治疗处理最合适的是？","options":{"A":"立即暂停放疗与化疗，紧急输注单采血小板，并给予G-CSF及促红细胞生成素（EPO）。待ANC≥1.5×10^9/L且PLT≥75×10^9/L后恢复放疗，第3周期同期化疗改用卡铂（AUC=5）","B":"在严密支持下尽量维持放疗计划不中断，永久停用同期顺铂。紧急输注单采血小板，并给予G-CSF及TPO支持治疗。因重度毒副反应，后续放疗期间不再联合同期化疗或靶向药物","C":"维持放疗计划不中断，暂停同期化疗。给予G-CSF及TPO支持治疗，暂不输注血小板。待血象恢复后，因患者出现肾功能受损及耳鸣，第3周期同期治疗转换为尼妥珠单抗（Nimotuzumab）","D":"暂停放疗3-5天以等待骨髓功能恢复，期间给予强效升白及升血小板治疗。待PLT≥50×10^9/L后恢复放疗，并取消后续所有同期化疗，放疗结束后直接进入随访","E":"维持放疗计划不中断，将第3周期顺铂剂量减量至60mg/m²，并分三天给药。同时预防性使用抗生素，输注红细胞悬液及血小板，确保放化疗强度的完整性"},"answer":"B","vignette":"患者男，68岁，ECOG评分1分。确诊为非角化性鳞状细胞癌（鼻咽），分期为T3N2M0（II期）。治疗前EBV-DNA为 4.5×10^4 copies/mL。患者接受了3个周期的GP方案（吉西他滨+顺铂）诱导化疗后，EBV-DNA降至 0 copies/mL，影像学评估为PR。随后开始根治性调强放疗（IMRT，处方剂量PGTVnx 70Gy/33F）联合同期顺铂化疗（100mg/m² q3w）。现放疗进行至第22次（累积剂量约46.6Gy），患者刚完成第2周期同期顺铂化疗后第8天。复查血常规：WBC 1.2×10^9/L，ANC 0.4×10^9/L，Hgb 75g/L，PLT 18×10^9/L。生化：ALT 35 U/L，Cr 115 μmol/L（基线为70 μmol/L），Ccr 45 mL/min。患者诉双耳持续性高频耳鸣，无发热，双下肢可见散在出血点。查体：生命体征平稳。","capability_group":"toxicity_contraindication"}
+{"id":"l2-sample-7e73e4ea1f8b5273f952468f","question":"最合理的下一步处理策略是？","options":{"A":"密切随访观察，1-3个月后复查影像学检查或超声引导下细针穿刺活检（FNA）","B":"立即行右侧颈部淋巴结清扫术","C":"针对右侧颈部II区淋巴结行立体定向放射治疗（SBRT）推量","D":"给予吉西他滨+顺铂（GP方案）诱导化疗2个周期"},"answer":"A","vignette":"患者男，47岁。因鼻咽癌（T3N2M0）接受根治性同步放化疗，治疗于3个月前结束。患者现因晨起回吸性涕血2周复诊。体格检查示鼻咽部黏膜稍充血，颈部未触及明显肿大淋巴结。ECOG评分0分。复查鼻咽+颈部增强CT显示：鼻咽部软组织稍增厚，颅底骨质破坏较前无明显变化；双侧颈部见数枚小淋巴结，短径均<1.0cm。PET-CT复查提示：鼻咽部未见明显异常代谢增高，右侧颈部II区见一枚淋巴结代谢轻度活跃，SUVmax值为4.5。血常规及生化检查均在正常范围。血浆EBV-DNA检测结果为0 copies/mL。","capability_group":"post_treatment_recurrence"}
+{"id":"l2-sample-bf9ce3e544604dba606d93a2","question":"下一步首选的处理策略是？","options":{"A":"立即行鼻咽顶后壁及右颈部II区淋巴结活检以明确病理","B":"启动吉西他滨+顺铂（GP方案）辅助化疗2-4个周期","C":"密切观察，嘱局部鼻腔冲洗，1-3个月后复查MRI及EBV-DNA","D":"行右侧功能性颈部淋巴结清扫术（挽救性手术）","E":"给予鼻咽部及右颈部残留病灶局部推量放疗（Boost RT）","F":"安排内镜下鼻咽部坏死组织清理术并联合高压氧治疗"},"answer":"C","vignette":"患者男，45岁。因局部晚期鼻咽癌（T3N2M0，非角化性癌，未分化型）完成根治性同步放化疗（顺铂同期）后3个月。近期诉间断回吸性涕血，伴轻度鼻塞。查体：双侧颈部未触及肿大淋巴结。实验室检查：WBC 4.2×10^9/L, Hgb 115 g/L, PLT 180×10^9/L；血浆EBV-DNA为 0 copies/mL（治疗前为 4.5×10^5 copies/mL）。\n\n鼻咽镜检查：鼻咽顶后壁黏膜充血水肿，表面附着少许白膜及暗红色血痂，未见明显外突性肿物。\n\n头颈部MRI：鼻咽顶后壁软组织稍增厚，T1WI呈等信号，T2WI呈高信号，增强扫描呈轻度延迟强化；双侧颈部II区可见数枚淋巴结，最大短径约0.8cm。\n\nPET-CT：鼻咽顶后壁FDG代谢轻度增高（SUVmax 3.2）；右侧颈部II区一枚淋巴结FDG代谢活跃（SUVmax 4.5），余未见异常。","capability_group":"post_treatment_recurrence"}
+{"id":"l2-sample-30c565af9e60180960ac13f3","question":"对于该患者首选的一线系统治疗方案是？","options":{"A":"吉西他滨 + 顺铂（GP方案）联合 PD-1抑制剂（如特瑞普利单抗或卡瑞利珠单抗）","B":"吉西他滨 + 顺铂（GP方案）单纯化疗","C":"多西他赛 + 顺铂 + 氟尿嘧啶（TPF方案）诱导化疗，序贯局部放疗","D":"根治性同步放化疗（IMRT + 大剂量顺铂），随后给予PD-1抑制剂维持治疗"},"answer":"A","vignette":"患者男，55岁，既往体健。因“间断回吸性涕血3个月”就诊。查体：ECOG评分0分，双侧颈部及锁骨上窝可触及多发肿大淋巴结，质硬固定。鼻咽镜检查提示鼻咽顶后壁及侧壁可见结节状新生物。头颈部MRI显示：鼻咽顶后壁肿物侵犯海绵窦，伴第V、VI对脑神经受累征象；双侧咽后、颈部及锁骨上窝多发淋巴结肿大。全身骨扫描及后续CT证实多发骨转移（脊柱、骨盆、肋骨）。实验室检查：WBC 5.5×10^9/L, Hgb 125g/L, PLT 210×10^9/L, ALT 25 U/L, Cr 80 μmol/L。血浆EBV-DNA定量为2.0×10^5 copies/mL。患者无免疫治疗禁忌证。","capability_group":"metastatic_systemic"}
+{"id":"l2-sample-6ef9511eaff89491ade69977","question":"结合患者既往史、肿瘤负荷及EBV状态，目前最恰当的治疗策略是？","options":{"A":"TPF方案（多西他赛+顺铂+氟尿嘧啶）诱导化疗3周期，序贯同步放化疗","B":"吉西他滨 + 顺铂（GP方案）全身化疗，联合PD-1抑制剂","C":"根治性同步放化疗（IMRT + 大剂量顺铂），随后辅助化疗","D":"单纯姑息性放疗针对原发灶及骨转移灶，暂缓全身治疗"},"answer":"B","vignette":"患者男，63岁，ECOG PS 0分。既往有冠心病、高血压（间断服药）、糖尿病史，曾行心脏起搏器植入术。自诉有乙肝病史已治愈。患者4个月前突发间断晕厥，2个月前出现声音嘶哑，1个月前出现复视及面部麻木。查体提示颅神经受损体征明显。影像学检查提示鼻咽部巨大肿物侵犯颅底骨质及海绵窦，伴双侧颈部多发淋巴结肿大，且发现多发肺转移及骨转移。临床分期为cT4cN3cM1（IVB期）。实验室检查：血常规、肝肾功能基本正常，EBV DNA为0 copies/mL。病理活检证实为非角化性未分化癌。","capability_group":"metastatic_systemic"}
+{"id":"l2-sample-d63258014cc9d0829950d294","question":"针对该患者的首选一线治疗策略是？","options":{"A":"吉西他滨 + 顺铂（GP方案）联合 PD-1单抗治疗","B":"多西他赛 + 顺铂 + 氟尿嘧啶（TPF方案）诱导化疗序贯同期放化疗","C":"根治性调强放疗（IMRT）同期顺铂化疗，随后辅助化疗","D":"吉西他滨 + 顺铂（GP方案）单纯化疗"},"answer":"A","vignette":"患者男，58岁，因“间断回吸性涕血3个月”就诊。既往体健。查体：双侧颈部及左侧锁骨上窝触及多枚肿大淋巴结，质硬固定。鼻咽镜示鼻咽顶后壁及双侧侧壁菜花样肿物。头颈部MRI提示鼻咽顶后壁软组织肿块，侵犯海绵窦，伴双侧咽后及颈部、左侧锁骨上区多发淋巴结肿大。PET/CT显示全身多发骨高代谢病灶（包括椎体及骨盆），无内脏转移。实验室检查：血常规WBC 5.5×10⁹/L，Hgb 125g/L，PLT 210×10⁹/L；肝肾功能正常（ALT 25 U/L, Cr 80 μmol/L）；血浆EBV DNA定量为2.0×10⁵ copies/mL。ECOG评分0分。病理活检证实为非角化性癌（未分化型）。","capability_group":"metastatic_systemic"}
+{"id":"l2-sample-0918886f46cb441912b63e29","question":"下列哪项策略最符合循证医学原则且能平衡疗效与安全性？","options":{"A":"采用卡铂（Carboplatin）替代顺铂进行同期放化疗，并密切监测肾功能。","B":"放弃同期化疗，仅行单纯根治性调强放疗（IMRT），以避免加重肾损伤。","C":"坚持使用标准剂量顺铂（100mg/m² q3w）同期化疗，但需实施超强水化利尿方案（每日液体量>4000ml）。","D":"先给予3个疗程多西他赛+氟尿嘧啶 诱导化疗，随后行单纯放疗，不再进行同期化疗"},"answer":"A","vignette":"患者男，51岁，因“回吸性涕血1月余”就诊。鼻咽镜活检示非角化性未分化癌。既往有慢性肾脏病史5年，长期随访。体格检查：ECOG评分 0分，双侧颈部触及数枚肿大淋巴结，最大径均小于6cm，质硬，活动度差。辅助检查：头颈部增强CT及MRI显示鼻咽顶后壁增厚，侵犯斜坡及颅底骨质，双侧颈部II区及III区可见多发肿大淋巴结，无远处转移征象。实验室检查：WBC 5.5×10^9/L，Hgb 125 g/L，PLT 210×10^9/L，ALT 25 U/L，血肌酐（Cr）170 μmol/L（估算肾小球滤过率eGFR约为35-40 ml/min/1.73m²），血浆EBV-DNA 5000 copies/mL。临床分期评估为局部晚期（T3-4N1-2M0）。拟行根治性放化疗。","capability_group":"toxicity_contraindication"}
+{"id":"l2-sample-c32487d2f8db4d72f7369728","question":"当前最恰当的治疗策略是？","options":{"A":"PD-1抑制剂单药维持治疗","B":"首选局部消融治疗（如SBRT或手术切除），密切随访，暂不进行全身化疗","C":"特瑞普利单抗 + 吉西他滨 + 顺铂联合治疗","D":"吉西他滨 + 顺铂（GP方案）全身化疗6周期"},"answer":"B","vignette":"患者男，64岁，既往体健，无心脑血管疾病及糖尿病史。4年前确诊鼻咽癌，接受根治性同步放化疗，治疗结束后定期复查无复发。近期例行复查胸部CT发现右肺下叶一实性结节，直径约1.5cm，边缘稍显毛糙，余肺野清晰，未见其他部位转移征象。行经皮肺穿刺活检，病理证实为非角化性癌，结合免疫组化（EBER+），符合鼻咽癌肺转移。目前患者无咳嗽、咳痰、咯血及胸痛等症状，ECOG评分0分。查体未触及浅表淋巴结肿大。辅助检查示：血常规、肝肾功能均正常，EBV-DNA定量检测为0 copies/mL（低于检测下限）。既往放疗区域未见复发迹象。患者及家属对于再次高强度化疗存在顾虑，希望尽可能保持生活质量。","capability_group":"metastatic_systemic"}
+{"id":"l2-sample-76e2e1f3c22a823ce89d1937","question":"下一步最合理的处理策略是？","options":{"A":"立即行鼻咽部增厚区钳取活检及左侧II区淋巴结FNA，以明确是否为肿瘤残留","B":"安排左侧颈部II-V区择期淋巴结清扫术作为挽救性治疗","C":"给予卡培他滨单药口服节拍性维持治疗，并定期随访","D":"暂不进行有创干预，嘱患者每日鼻腔冲洗，4-6周后复查MRI及EBV-DNA","E":"针对左侧II区淋巴结及鼻咽原发灶行局部推量放疗（Boost RT）至 10-15Gy","F":"启动GP方案（吉西他滨+顺铂）辅助化疗2周期以消除微小残留病灶"},"answer":"D","vignette":"患者男，69岁，ECOG 1分。确诊为鼻咽非角化性癌（cT3N2M0，II期，AJCC 第 9 版），接受根治性IMRT（PGTVnx 70Gy/33f，PGTVnd 66Gy/33f）联合同步顺铂（100mg/m² q3w × 2周期）化疗。现为放疗结束第12周门诊复查。\n\n主诉： 间断回吸性涕血伴轻度鼻塞1周。\n\n查体： 颈部皮肤轻度色素沉着，触诊因放疗后组织纤维化质韧，未及明确孤立包块。\n\n辅助检查：\n\n鼻咽镜：鼻咽顶后壁黏膜充血肿胀，表面附着少许白膜及暗红色血痂，未见明显外生性肿物。\n\n颈部+鼻咽MRI：鼻咽顶后壁软组织较治疗前明显退缩，局部仍有厚度约 0.6 cm 的不规则增厚，增强后呈不均匀轻度强化。双侧颈部多发小淋巴结，左侧II区见一大小约 1.1 cm × 0.8 cm 淋巴结，短径<1cm，包膜完整，未见坏死区。\n\nPET-CT：鼻咽顶后壁增厚区 SUVmax 3.2；左侧II区上述淋巴结 SUVmax 4.1。其余部位未见异常高代谢灶。\n\n实验室检查： WBC 3.2×10⁹/L, ANC 1.5×10⁹/L, Hgb 110g/L, PLT 95×10⁹/L, Cr 95μmol/L。血浆EBV-DNA：450 copies/mL。","capability_group":"post_treatment_recurrence"}
+{"id":"l2-sample-b81aebac2503b7b8cc1bb827","question":"针对该患者目前的复发状态，综合考虑疗效与远期生存质量，首选的挽救性治疗策略是？","options":{"A":"鼻内镜下鼻咽病灶切除术","B":"调强放疗（IMRT）再程放疗（60Gy/30f）","C":"吉西他滨+顺铂（GP方案）诱导化疗序贯再程放疗","D":"卡瑞利珠单抗+吉西他滨+顺铂全身系统治疗"},"answer":"A","vignette":"患者男，59岁，ECOG评分0分。既往史：3年前确诊为鼻咽癌（T2N1M0），接受根治性放化疗后达完全缓解。近期因出现间断性回吸性涕血复诊。查体：鼻内镜见鼻咽顶后壁粘膜粗糙，活检证实为非角化性癌。辅助检查：头颈部增强MRI显示鼻咽顶后壁局部软组织增厚，病灶局限于鼻咽腔内（rT1），与双侧颈内动脉均有清晰间隙，未见颅底骨质破坏，颈部淋巴结未见肿大。血浆EBV-DNA定量为1000 copies/mL。血常规及肝肾功能均正常（WBC 5.5, Hgb 125, PLT 210, Cr 80 umol/L）。全身PET-CT未见远处转移。","capability_group":"post_treatment_recurrence"}
+{"id":"l2-sample-2e325bee84147399f639eea5","question":"基于当前临床及辅助检查资料，下一步最合理的处理策略是？","options":{"A":"考虑鼻咽原发灶残留伴斜坡骨质侵犯，立即行内镜下鼻咽及颅底病灶扩大微创切除术","B":"考虑肿瘤局部复发，鉴于放疗刚结束4个月，首选启动吉西他滨+顺铂（GP方案）姑息性化疗","C":"考虑放射性颅底骨坏死合并放射性中耳炎，行鼓膜穿刺抽液，给予高压氧及保守治疗，1个月后复查EBV DNA及MRI","D":"诊断不明确，立即在内镜下对右侧咽隐窝黏膜及斜坡骨质行深部咬取活检以明确病理","E":"考虑颈部淋巴结转移复发，行超声引导下右颈IIb区淋巴结细针穿刺活检（FNA），若阳性则行颈清扫","F":"考虑放疗后炎症改变，EBV DNA假阳性，仅需针对中耳炎对症处理，3个月后常规复查","G":"考虑微小残留病灶（MRD），立即给予PD-1抑制剂单药维持治疗以清除外周血EBV DNA"},"answer":"C","vignette":"患者男，45岁，确诊为鼻咽非角化性癌（T3N2M0，III期），完成根治性同步放化疗（顺铂同期）后4个月。放疗结束时复查EBV DNA为0 copies/mL。\n\n近2周患者诉右侧持续性深部头痛，伴右耳闷胀感及听力下降。无复视、面部麻木。\n\n查体：右侧鼓膜内陷，鼓室可见液平。鼻咽镜示：右侧咽隐窝变浅，黏膜粗糙、覆少许白膜，未见明显外生性肿物。\n\n实验室检查：血常规及肝肾功能无明显异常。EBV DNA定量检测为 4.5×10² copies/mL（参考值 <100 copies/mL）。\n\n头颈部MRI：右侧咽隐窝黏膜稍增厚，T2WI呈均匀稍高信号，增强后呈中度均匀强化；右侧乳突及中耳腔可见长T1长T2积液信号；斜坡偏右侧骨质可见局限性异常信号，T1WI呈低信号，T2WI呈高信号，增强扫描示病变边缘强化，中央无强化；右侧颈部IIb区可见一短径0.8cm淋巴结，T2WI呈均匀稍高信号，包膜完整。\n\nPET-CT：右侧咽隐窝SUVmax 3.2；斜坡异常信号区边缘SUVmax 4.5；右侧颈部IIb区淋巴结SUVmax 2.2。","capability_group":"post_treatment_recurrence"}
+{"id":"l2-sample-a17b51c68c2d22f24dbc95d6","question":"最佳的下一步处理策略是？","options":{"A":"密切随访观察，建议1-3个月后再次复查影像学及EBV-DNA","B":"立即行右颈部淋巴结清扫术（Neck Dissection）","C":"开始吉西他滨+顺铂（GP方案）诱导化疗以清除残留病灶","D":"针对右颈部淋巴结行局部调强放疗推量（IMRT Boost）"},"answer":"A","vignette":"患者男，51岁，既往确诊为鼻咽癌（cT3N2M0），于3个月前完成根治性同步放化疗。治疗过程顺利，无严重并发症。近日患者诉偶有回吸性涕血，无头痛、复视。复查鼻咽镜见咽隐窝黏膜充血，未见明显新生物。头颈部增强CT显示颅底骨质破坏较前无明显变化，但提示双侧颈部淋巴结较前缩小，最大径均<1.0cm。PET-CT复查显示：鼻咽部代谢未见明显异常，但右颈II区可见一淋巴结代谢轻度活跃，SUVmax值为4.5，其余部位未见异常高代谢。查体：双侧颈部未触及明显肿大淋巴结。实验室检查：WBC 5.5×10^9/L, Hgb 125g/L, PLT 210×10^9/L, ALT 25 U/L, Cr 80 μmol/L。血浆EBV-DNA检测为0 copies/mL。ECOG评分0分。","capability_group":"post_treatment_recurrence"}
+{"id":"l2-sample-fdf1ee0bc55014ab090d2d1b","question":"该患者最适宜的初始根治性治疗策略是？","options":{"A":"诱导化疗（吉西他滨+顺铂）序贯单纯根治性调强放疗 (IMRT)","B":"同期放化疗 (IMRT + 顺铂 100 mg/m² q3w)","C":"同期放化疗 (IMRT + 顺铂 40 mg/m² qw)","D":"单纯根治性调强放疗 (IMRT)","E":"单纯根治性调强放疗 (IMRT) 联合 尼妥珠单抗","F":"诱导化疗（吉西他滨+卡铂）序贯同期放化疗（IMRT + 卡铂）"},"answer":"D","vignette":"患者男，52岁。因“右耳闷堵感伴间断回吸性涕血2个月”就诊。查体：右侧咽隐窝见结节样隆起，表面覆少许坏死物。双颈部触诊未及明显肿大淋巴结。纯音测听提示右耳轻度传导性耳聋。\n\n鼻咽及颈部MRI平扫+增强提示：右侧咽隐窝软组织肿块，向外侧侵犯咽旁间隙并累及右侧翼内肌，向上未见颅底骨质破坏，卵圆孔及破裂孔未见扩大，双侧海绵窦及脑神经未见异常强化影。双侧咽后及颈部可见多发小淋巴结，最大者位于右侧IIa区，短径约 8 mm，皮髓质分界清，未见坏死及环形强化。胸腹部CT及全身骨扫描未见异常。\n\n实验室检查：WBC 5.5×10^9/L, Hgb 125 g/L, PLT 210×10^9/L；ALT 25 U/L, AST 30 U/L, Cr 108 μmol/L；血浆 EBV DNA 滴度：0 copies/mL。\n\n病理活检：（右侧鼻咽）非角化性未分化癌。ECOG评分 0分。","capability_group":"initial_definitive"}
+{"id":"l2-sample-ea5986c18aa99119a818b673","question":"在制定同期放化疗方案时，最合适的化疗药物选择是什么？","options":{"A":"紫杉醇 (Paclitaxel) 单药每3周一次","B":"卡铂 (Carboplatin) AUC 5-6，每3周一次","C":"顺铂 (Cisplatin) 100 mg/m²，每3周一次","D":"顺铂 (Cisplatin) 40 mg/m²，每周一次"},"answer":"B","vignette":"患者男，53岁（1972年1月出生），既往史显著，确诊为重度感音神经性耳聋多年，需依赖助听器辅助交流，日常听力功能严重受损。因“回吸性涕血1月余”就诊。查体：ECOG评分0分。鼻咽镜及活检确诊为鼻咽非角化性癌（未分化型）。影像学分期检查（MRI及CT）显示：鼻咽顶后壁肿物侵犯颅底骨质，双侧颈部见多发肿大淋巴结，最大径均<6cm，且位于锁骨上窝以上，无远处转移证据。实验室检查：WBC 5.5×10^9/L, Hgb 125 g/L, PLT 210×10^9/L, ALT 25 U/L, 血肌酐(Cr) 80 umol/L。血浆EBV DNA定量为5000 copies/mL。患者拟行根治性放疗，并在治疗计划中考虑联合同期化疗。","capability_group":"toxicity_contraindication"}
+{"id":"l2-sample-dee046af7dec8657ac0f7ade","question":"以下哪项策略最为恰当？","options":{"A":"立即启动传统辅助化疗（顺铂+5-氟尿嘧啶，PF方案）3个周期，以清除微小残留病灶","B":"采用卡培他滨单药节拍维持治疗（Metronomic maintenance therapy）持续1年，和/或PD-1抑制剂（如特瑞普利单抗/卡瑞利珠单抗）持续1年","C":"推荐入组临床试验","D":"密切随访观察，暂不进行全身干预，待出现明确影像学复发或转移后再行姑息性系统治疗","E":"补做1-2周期GP方案化疗，因为诱导阶段对GP方案敏感，可进一步降低EBV-DNA"},"answer":"C","vignette":"患者男，35岁，ECOG评分0分。因“发现右侧颈部肿物1个月”就诊，确诊为非角化性鳞状细胞癌（未分化型）。分期评估为cT1cN3M0（第9版AJCC分期，III期）。基线血浆EBV-DNA为 4.5×10^5 copies/mL。\n\n治疗经过：患者接受了3周期吉西他滨+顺铂（GP方案）诱导化疗。复查MRI示颈部淋巴结部分缓解（PR），但复查血浆EBV-DNA仍为 1.2×10^3 copies/mL（未转阴）。随后患者进入根治性调强放疗（IMRT）+ 同期顺铂（100mg/m²，q3w）化疗阶段。在完成放疗及2周期同期化疗后，患者出现3级放射性口腔黏膜炎及2级听力下降，拒绝接受第3周期同期顺铂。放疗结束后4周复查，颈部淋巴结及鼻咽病灶均达到完全缓解（CR），但血浆EBV-DNA仍为 500 copies/mL。","capability_group":"initial_definitive"}
+{"id":"l2-sample-e21853522589c4773b1de138","question":"鉴于该患者的基线肾功能状态及肿瘤分期，在制定同期放化疗（CCRT）的系统治疗方案时，下列哪项决策最为合理且安全？","options":{"A":"采用卡铂（Carboplatin）替代顺铂进行同期化疗，并密切监测肾功能与骨髓抑制情况。","B":"采用标准剂量顺铂（Cisplatin 100mg/m^2 q3w）进行同期化疗，但在给药前给予加强水化利尿（每日液体量>3000ml）。","C":"放弃同期化疗，仅行单纯根治性调强放疗（IMRT），以避免任何加重肾损伤的风险。","D":"采用奈达铂（Nedaplatin）替代顺铂，因其无肾毒性，且无需调整剂量。"},"answer":"A","vignette":"患者男，43岁，因“回吸性涕血1月余”就诊。既往有慢性肾脏病（CKD）3期病史，平时未规律随访。体格检查：ECOG评分 0分，鼻咽镜见顶后壁肿物，双侧颈部触及数个质硬淋巴结，最大径均小于6cm，位于锁骨上窝以上。影像学检查（增强CT及MRI）提示鼻咽顶后壁软组织肿块，伴颅底骨质破坏；双侧颈部II-III区多发淋巴结肿大，无远处转移征象。实验室检查：白细胞 5.5×10^9/L，血红蛋白 125g/L，血小板 210×10^9/L，丙氨酸氨基转移酶 25 U/L，血清肌酐 182 μmol/L（eGFR约为 35-40 ml/min/1.73m^2）。血浆EBV-DNA定量为 5000 copies/mL。病理活检证实为非角化性未分化癌。目前考虑为局部晚期鼻咽癌，拟行根治性放化疗。","capability_group":"toxicity_contraindication"}
+{"id":"l2-sample-b7a431ada434f82a91757b88","question":"接下来的治疗策略中最恰当的是？","options":{"A":"同步放化疗（CCRT），方案为顺铂单药（100mg/m² q3w 或 40mg/m² qw）同步放射治疗","B":"单纯根治性放射治疗（RT alone），因EBV DNA已转阴且T分期较早","C":"继续诱导化疗至4-6个疗程，待肿瘤进一步退缩后再行单纯放疗","D":"同步放化疗，但考虑到诱导化疗已应用铂类，改用西妥昔单抗或尼妥珠单抗联合放疗以降低毒性"},"answer":"A","vignette":"患者男，43岁，既往体健，无慢性病及传染病史。患者确诊鼻咽癌，分期为cT1cN2M0（II期），PS评分0分。初始治疗方案为诱导化疗，已完成2个疗程的吉西他滨+顺铂（GP方案）化疗。现为化疗后2周返院复查。查体无特殊不适。实验室检查显示：WBC 3.72×10^9/L，Hgb 133g/L，PLT 294×10^9/L，肝肾功能正常（Cr 54.2 μmol/L）。复查EBV DNA为0 copies/mL（低于检测下限）。患者目前状态良好，无明显化疗毒性残留。","capability_group":"initial_definitive"}
+{"id":"l2-sample-c7b2a9eb09c21633910e7870","question":"下列哪项治疗策略在平衡疗效与安全性后最为合理？","options":{"A":"采用根治性调强放疗（IMRT），同步化疗方案调整为卡铂（AUC=5-6，q3w）","B":"采用根治性调强放疗（IMRT），同步给予标准剂量顺铂（100mg/m²，q3w），并加强水化利尿","C":"先进行TP方案（多西他赛+顺铂）诱导化疗2周期，根据肾功能恢复情况再决定后续放疗方案","D":"仅行单纯根治性调强放疗（IMRT），不进行任何形式的同步化疗"},"answer":"A","vignette":"患者男，62岁，因“间断回吸性涕血2个月”就诊。既往有慢性肾脏病（CKD）3期病史多年，长期随访中。体格检查示ECOG PS评分0分，鼻咽镜检查可见顶后壁肿物。头颈部增强CT及MRI显示鼻咽顶后壁软组织肿块，伴颅底骨质破坏（海绵窦未受累），双侧颈部见多发肿大淋巴结，最大径约3.5cm，包膜完整，位于锁骨上窝以上。全身检查未见远处转移。实验室检查：WBC 5.5×10^9/L, Hgb 125g/L, PLT 210×10^9/L, ALT 25 U/L，血清肌酐（Cr）189 μmol/L（计算eGFR约为30-35 ml/min/1.73m²）。血浆EBV-DNA定量为5000 copies/mL。病理活检证实为非角化性癌（未分化型）。","capability_group":"toxicity_contraindication"}
+{"id":"l2-sample-531219f44bbd0490d6640c7a","question":"下一步最恰当的治疗策略是？","options":{"A":"行同期放化疗（IMRT + 顺铂 100mg/m² q3w × 2-3周期）","B":"行同期放化疗（IMRT + 奈达铂 80mg/m² q3w），并联合尼妥珠单抗靶向治疗","C":"单纯调强放疗（IMRT），不再联合同期化疗","D":"继续诱导化疗（GP方案）至4-6个周期，随后行单纯放疗"},"answer":"A","vignette":"患者男，70岁。既往体健，否认高血压、糖尿病及心脑血管病史。患者因“回吸性涕血伴鼻塞2月”就诊，经鼻咽镜活检及影像学检查确诊为鼻咽非角化性癌，分期为cT4N1M0（IVa期，AJCC第8版）。EBV DNA治疗前为4.5×10^4 copies/mL。患者初始接受了诱导化疗（吉西他滨+顺铂，GP方案）2个周期。目前为第2周期化疗结束后3周返院复查。查体：ECOG评分0分，双侧颈部未触及肿大淋巴结。复查鼻咽MRI显示原发灶较前明显缩小，颅底骨质破坏范围稳定，颈部淋巴结消退。复查血常规及生化指标：WBC 4.2×10^9/L，Hgb 115g/L，PLT 180×10^9/L，ALT 25 U/L，Cr 78 μmol/L。复查血浆EBV DNA为0 copies/mL。患者目前无明显听力下降或周围神经毒性症状。","capability_group":"initial_definitive"}
+{"id":"l2-sample-4e7340ea1ea0bf7810152eae","question":"下一步最恰当的治疗策略是？","options":{"A":"暂停放疗，额外增加1个周期的辅助化疗以巩固疗效，随后恢复放疗","B":"将第2程同期化疗方案更改为奈达铂或卡铂，以预防顺铂累积性肾毒性","C":"继续按原计划进行根治性放疗，并按期给予第2程同期顺铂（100mg/m²）化疗","D":"鉴于EBV DNA已清零且诱导化疗有效，为降低毒性，取消后续同期化疗，仅行单纯放疗"},"answer":"C","vignette":"患者男，46 岁，ECOG PS 0 分。确诊鼻咽癌（非角化性未分化癌），cT3N1M0。诱导化疗（GP 方案）2 周期后评估 PR，血浆 EBV DNA 从 4.2×10^3 降至 0 copies/mL。现进入同期放化疗阶段，放疗已完成 18Gy/9f。今日完成第 1 程同期顺铂（100 mg/m²，d1）化疗后 3 周复查。\n\n新增关键数据：\n\n听力检测：纯音测听显示高频区（4000-8000Hz）平均听阈较基线升高 12dB，患者主观无耳鸣或听力下降主诉（CTCAE 1 级耳毒性）。\n\n肾功能：Scr 78 μmol/L（基线 72 μmol/L），eGFR 95 mL/min/1.73m²。\n\nEBV DNA：持续 0 copies/mL。\n\n营养状况： 体重较诱导前下降 4%，白蛋白 38g/L。","capability_group":"initial_definitive"}
+{"id":"l2-sample-1d654a188d788456b1ae4751","question":"基于目前的循证医学证据，最优的治疗策略是？","options":{"A":"单纯根治性调强放疗（IMRT），因EBV-DNA阴性提示肿瘤负荷低及预后较好","B":"多西他赛+顺铂+氟尿嘧啶（TPF方案）诱导化疗序贯同期放化疗","C":"吉西他滨+顺铂（GP方案）诱导化疗（2-3周期）序贯同期放化疗（顺铂单药）","D":"同期放化疗（CCRT）+ 辅助化疗（AC），以强化全身控制"},"answer":"C","vignette":"患者男，63岁，ECOG PS 0分。主诉“回吸性涕血伴左颈部包块2月余”入院。既往体健，否认高血压、糖尿病及肝炎病史。查体：左侧颈部可触及多个融合肿大淋巴结，最大径约5cm，质硬，固定，下颈部亦可触及肿大淋巴结（锁骨上窝未触及明显肿大）。鼻咽镜及活检示：鼻咽非角化性癌（未分化型）。MRI分期提示：鼻咽顶后壁及左侧咽隐窝增厚，颅底骨质未见明显破坏；左侧颈部II-IV区多发淋巴结肿大伴融合，最大短径>3cm，包膜外侵犯明显，右侧颈部淋巴结阴性。全身检查未见远处转移。TNM分期评估为cT1N3M0（第9版AJCC），III期。治疗前EBV-DNA为0 copy/mL（检测下限500 copies/mL）。血常规及肝肾功能均正常。患者目前尚未开始治疗，正处于治疗方案制定阶段。","capability_group":"initial_definitive"}
+{"id":"l2-sample-73da9c03cfec254f8521b7e2","question":"关于该患者下一步的治疗决策，下列说法最准确的是？","options":{"A":"因诱导化疗后EBV DNA已清零且达到PR，符合降阶梯治疗标准，可豁免同期顺铂化疗，直接行单纯调强放疗（IMRT）","B":"应行IMRT联合同期顺铂化疗，且为了保证生存获益，同期顺铂的累积剂量应尽量达到或超过200 mg/m²，放疗结束后定期随访","C":"应行IMRT联合同期顺铂化疗，考虑到患者为T4N3极高危，放疗结束后应常规给予卡培他滨节拍维持治疗1年","D":"应行IMRT联合同期顺铂化疗，放疗结束后继续给予GP方案辅助化疗2周期（即“全明治”模式），以彻底清除微小残留病灶","E":"鉴于患者极高危的复发转移风险，应在同期放化疗阶段及放疗后，常规加入信迪利单抗（PD-1抑制剂）维持治疗1年"},"answer":"B","vignette":"患者男，51岁，既往体健。因确诊鼻咽癌（非角化性癌，未分化型）入院。初诊分期评估为cT4N3M0（III期，AJCC第9版），伴有广泛颅底骨质破坏及双侧颈部淋巴结融合包块（最大径6cm），下颈部受累。基线血浆EBV DNA为4.5×10^4 copies/mL。纯音测听示双耳听力正常。患者已完成“吉西他滨+顺铂（GP方案）”诱导化疗3周期，过程顺利。复查评估显示：鼻咽部原发灶及颈部淋巴结均较前明显缩小（PR），颅底骨质破坏范围稳定。最新实验室检查：WBC 4.2×10^9/L，Cr 80 μmol/L，肌酐清除率(Ccr) 95 mL/min。复查血浆EBV DNA已转阴（0 copies/mL）。目前ECOG评分0分。","capability_group":"initial_definitive"}
+{"id":"l2-sample-f4e13449e8a52066c8b8a367","question":"结合患者目前的治疗阶段及耐受情况，下一步最恰当的治疗策略是？","options":{"A":"继续完成剩余放疗，并给予第2疗程同期顺铂化疗（推荐减量至80mg/m²或改为单周方案），以确保累计顺铂剂量达标。","B":"立即停止放疗，因WBC及PLT处于临界值，先给予G-CSF升白治疗，待血象完全恢复正常后再恢复放疗及化疗。","C":"继续完成剩余放疗，取消第2疗程同期化疗，放疗结束后直接进入辅助化疗（Adjuvant Chemotherapy）阶段。","D":"继续完成剩余放疗，但取消第2疗程同期顺铂化疗，改用尼妥珠单抗或西妥昔单抗靶向治疗替代，以降低毒性。"},"answer":"A","vignette":"患者男，45岁（1980年出生）。既往体健，否认肝炎、结核、高血压及心脏病史，无吸烟酗酒史。2个月前确诊2型糖尿病，服用二甲双胍及阿卡波糖治疗，自述近期空腹血糖控制在6-7mmol/L。患者因“回吸性涕血伴左颈部包块”就诊，确诊为鼻咽未分化型非角化性癌。初诊分期为cT3cN2cM0（第9版AJCC分期），属于局部晚期。基线EBV-DNA为2.4×10^4 copies/mL。根据CSCO指南及真实世界证据策略，患者接受了“诱导化疗+同期放化疗”模式。目前患者已完成GP方案（吉西他滨+顺铂）诱导化疗2周期，随后进入同期放化疗（IMRT），计划放疗总剂量70Gy/33F。目前放疗进行至第29次（29F），同期顺铂（100mg/m² q3w）已完成第1疗程（于放疗开始第1天给予）。今日复查：体能状态ECOG 0分，体重较前下降3kg。查体：鼻咽部肿瘤明显退缩，双颈部淋巴结未触及。血常规：WBC 3.2×10^9/L，NEUT 1.6×10^9/L，Hgb 105g/L，PLT 110×10^9/L。生化：ALT 35 U/L，Cr 88 μmol/L（eGFR >60 ml/min）。EBV-DNA转阴（0 copies/mL）。患者诉轻度口干及咽痛（RTOG 2级），无明显恶心呕吐。","capability_group":"initial_definitive"}
+{"id":"l2-sample-56939ded516a4af2531a4e46","question":"针对该患者目前残留的肝S6段寡转移病灶，最恰当的后续治疗策略是？","options":{"A":"立即更换为二线化疗方案（如紫杉醇+卡铂），以求进一步清除残留病灶","B":"在维持免疫治疗的基础上，对肝S6段病灶行立体定向放疗（SBRT）或消融治疗","C":"行肝S6段病灶手术切除，术后继续辅助化疗","D":"继续维持原免疫治疗方案，暂缓针对肝脏病灶的局部治疗，密切观察"},"answer":"B","vignette":"患者男，74岁，ECOG PS 1分。既往史：2019年确诊鼻咽癌（TxN1M0），接受过根治性放化疗联合靶向治疗。既往身体一般，左眼因视网膜脱落术后失明，右眼高度近视并于2023年失明。无高血压、糖尿病、肝炎等病史。2023年8月复查发现双上肺结节增大、肝S6段新增小结节及右侧颈部多发非均质性淋巴结，临床诊断为鼻咽癌复发伴肺、肝及颈部淋巴结转移（rcTxN1M1 IV期）。随后患者接受了多程化疗（吉西他滨+顺铂）联合PD-1抑制剂免疫治疗。目前复查评估：鼻咽部及颈部病灶较前缩小并稳定，肺部病灶稳定，但肝S6段病灶虽略有缩小但仍持续存在活性（寡转移状态）。目前EBV-DNA拷贝数为0。血常规及肝肾功能基本正常。患者及其家属咨询下一步治疗方案，特别是针对肝脏残留病灶的处理。","capability_group":"post_treatment_recurrence"}
+{"id":"l2-sample-3aec77b82b25f1bb3d40023f","question":"诊断该患者推荐的最佳综合治疗模式是？","options":{"A":"诱导化疗（TP方案 x 3周期）序贯单纯放疗","B":"同期放化疗（CCRT，顺铂周疗或三周疗）","C":"诱导化疗（TP方案 x 3周期）序贯同期放化疗（CCRT）","D":"单纯根治性调强放疗（IMRT）"},"answer":"B","vignette":"患者男，43岁，既往体健。因“回吸性涕血1月余”就诊。鼻咽镜及活检确诊为鼻咽非角化性未分化癌。头颈部MRI显示：鼻咽顶后壁增厚，侵犯咽旁间隙，未累及颅底骨质；左侧颈部II区可见肿大淋巴结，最大径约为2.5cm，未发生融合，未见包膜外侵犯，下颈部及锁骨上窝未见异常淋巴结。全身检查未见远处转移。基线实验室检查：WBC 5.5×10^9/L, Hgb 125g/L, PLT 210×10^9/L, ALT 25 U/L, Cr 80 umol/L。血浆EBV-DNA定量检测结果为15,000 copies/mL。体能状态评分（ECOG PS）为0分。","capability_group":"initial_definitive"}
+{"id":"l2-sample-3940687b4550e6f7bb96d2e8","question":"以下哪项是最推荐的首选治疗策略？","options":{"A":"诱导化疗（吉西他滨+顺铂）序贯同期放化疗","B":"同期放化疗（IMRT + 顺铂 100mg/m² q3w）","C":"单纯根治性调强放疗（IMRT）","D":"根治性调强放疗（IMRT）+ 同期尼妥珠单抗（EGFR单抗）"},"answer":"C","vignette":"患者男性，66岁，既往体健。因“间断回吸性涕血2个月”就诊。体格检查示ECOG PS评分为0。鼻咽镜活检病理证实为非角化性未分化癌。头颈部增强MRI显示鼻咽顶后壁软组织增厚，并侵犯咽旁间隙，颅底骨质未见侵犯；双侧颈部未见异常肿大淋巴结。全身PET-CT未见远处转移。实验室检查：EBV DNA（血浆）为0 copies/mL；血常规及生化指标均在正常范围内。","capability_group":"initial_definitive"}
+{"id":"l2-sample-1e4be323d7d9825707447690","question":"下列综合处理策略中最符合现行指南与临床最佳实践的是？","options":{"A":"立即暂停放疗与同期化疗；停用利伐沙班；暂不输注血小板；给予广谱抗生素经验性抗感染；皮下注射重组人白介素-11（rhIL-11）及G-CSF；待ANC≥1.5×10^9/L且PLT≥75×10^9/L后恢复放疗","B":"暂停放疗与同期化疗；停用利伐沙班；紧急输注1个单位单采血小板；给予G-CSF及重组人血小板生成素（rhTPO）；因符合粒缺伴发热（FN），立即住院静脉使用抗假单胞菌β-内酰胺类抗生素；待血象恢复至安全范围后尽快恢复放疗","C":"暂停同期化疗，放疗中断休息1周；继续口服利伐沙班以防房颤卒中；给予G-CSF及海曲泊帕口服升血小板；口服左氧氟沙星预防感染；1周后若血象恢复，放疗计划需重新计算生物等效剂量（BED）并增加总剂量","D":"暂停同期化疗，维持放疗；停用利伐沙班；紧急输注单采血小板；给予G-CSF及rhIL-11；因仅为低热，暂不使用抗生素，行血培养后密切观察；待血象恢复后，第2周期顺铂减量至 80mg/m² 继续同期化疗","E":"终止后续所有化疗，转为单纯放疗；停用利伐沙班；给予G-CSF及rhTPO皮下注射；因存在粒缺伴发热（FN），立即住院静脉使用抗假单胞菌β-内酰胺类抗生素；若放疗因血象持续不升被迫中断超过5天，后续需采用加速超分割或增加单次剂量进行补偿"},"answer":"B","vignette":"患者男，71岁，PS评分1分。既往有高血压及阵发性心房颤动病史5年，长期口服利伐沙班，目前心室率控制良好。因“右侧颈部包块伴回吸性涕血2个月”就诊，确诊为非角化性鳞状细胞癌（鼻咽），分期为 cT3N2M0（III期），EBV-DNA 4500 copies/mL。\n\n患者接受根治性调强放疗（IMRT，计划剂量 69.96Gy/33F）联合同期顺铂（100mg/m²，q3w）化疗。目前处于放疗第22次（第4周周末），已完成第1周期顺铂化疗。\n\n今日常规复查血常规：WBC 1.2×10^9/L，ANC 0.45×10^9/L（IV度），Hgb 85g/L，PLT 25×10^9/L（IV度）。\n\n生化指标：ALT 35 U/L，Cr 95 μmol/L。\n\n查体：体温 38.5℃，双下肢可见散在少量出血点，无肉眼血尿及黑便。\n\n心电图：心房颤动，心室率 88次/分。","capability_group":"toxicity_contraindication"}
+{"id":"l2-sample-3f48b1956054406dcd3f3dd0","question":"对该患者最推荐的综合治疗模式是？","options":{"A":"同期放化疗（CCRT，顺铂周疗或三周疗）","B":"诱导化疗（GP方案 x 2-3周期）序贯同期放化疗（CCRT）","C":"单纯调强放射治疗（IMRT）","D":"诱导化疗（TP方案 x 3周期）序贯单纯放射治疗"},"answer":"A","vignette":"患者男，63岁（1962年1月出生），既往体健。因“回吸性涕血1月余”就诊。查体PS评分0分。病理活检证实为非角化性未分化癌。鼻咽部MRI显示鼻咽顶后壁软组织增厚，侵犯咽旁间隙，单侧颈部可见一枚最大径约2.5cm的淋巴结（II区），未见远处转移征象。实验室检查：WBC 5.5×10^9/L, Hgb 125g/L, PLT 210×10^9/L, ALT 25 U/L, Cr 80 umol/L。治疗前血浆EBV DNA定量检测结果为15,000 copies/mL。","capability_group":"initial_definitive"}
+{"id":"l2-sample-8961545c66aca0e9a2717a52","question":"下列哪项综合治疗策略是该患者的标准首选？","options":{"A":"单纯根治性调强放疗（IMRT）","B":"诱导化疗（GP方案：吉西他滨+顺铂，2-3周期）序贯单纯根治性IMRT","C":"同步放化疗（CCRT，顺铂 100mg/m² q3w 或 40mg/m² qw）","D":"诱导化疗（GP方案，3周期）序贯同步放化疗（CCRT）","E":"单纯根治性IMRT 联合 EGFR单抗（如尼妥珠单抗或西妥昔单抗）","F":"同步放化疗（CCRT）序贯 PD-1抑制剂辅助治疗半年"},"answer":"C","vignette":"患者男，49岁，既往体健。因“回吸性涕血1月余”就诊。查体：PS评分0分。鼻咽镜活检病理示：（鼻咽顶后壁）非角化性癌，未分化型。头颈部MRI显示：鼻咽顶后壁肿物侵犯咽旁间隙，单侧咽后及IIb区可见肿大淋巴结，最大短径约2.2cm，无包膜外侵犯（ENE阴性），无远处转移征象。血常规及肝肾功能正常。治疗前血浆游离EBV-DNA定量检测结果为 1.5×10^4 copies/mL。","capability_group":"initial_definitive"}
+{"id":"l2-sample-c231b97f0945fdfa7f8029a6","question":"以下临床决策中最优的是？","options":{"A":"立即在内镜下对鼻咽顶后壁白色坏死物及增厚区进行多点深部活检，以排除原发灶残留","B":"立即行左侧颈部II区淋巴结切除活检术，以获取充足组织进行病理及基因检测","C":"针对左颈部II区淋巴结在超声引导下行细针穿刺活检（FNA），或选择密切随访（1-2个月后复查超声/MRI）","D":"考虑微小残留病灶可能，给予卡瑞利珠单抗（PD-1抑制剂）单药维持治疗半年","E":"针对左颈部II区代谢活跃淋巴结，行立体定向放射治疗（SBRT）局部推量，以防复发","F":"启动GP方案（吉西他滨+顺铂）全身化疗2个周期，随后再次评估颈部淋巴结退缩情况"},"answer":"C","vignette":"患者男，65岁，因局部晚期鼻咽癌（cT3N2M0，非角化性癌，未分化型）接受了根治性同步放化疗（顺铂同期），治疗结束至今已3个月。患者近期出现晨起回吸性涕血，伴轻度鼻塞，无头痛、复视及面部麻木。\n\n体格检查：ECOG PS 0分。鼻咽内镜检查：鼻咽顶后壁及双侧咽隐窝黏膜充血，表面可见少许白色坏死物及结痂附着，未见明确菜花状或结节状新生物。双侧颈部触诊未及明显肿大淋巴结。\n\n实验室检查：血浆EBV-DNA为 0 copy/mL（放疗前为 4.5×10^5 copy/mL）。\n\n影像学检查：\n头颈部MRI：鼻咽顶后壁软组织较放疗前明显退缩，局部仍略厚，呈T1WI等信号、T2WI稍高信号，增强扫描呈轻度均匀强化；DWI（b=1000）未见明显高信号，ADC值未见减低。颅底骨质破坏区边缘硬化。\n\nPET-CT：鼻咽原发灶未见异常高代谢；左侧颈部II区可见一淋巴结，大小约1.2cm x 0.8cm，形态尚规则，淋巴门结构模糊，代谢轻度活跃，SUVmax值为4.5（肝脏血池本底SUVmean 2.2）。其余全身部位未见异常。","capability_group":"post_treatment_recurrence"}
+{"id":"l2-sample-8bb2015190123a53bca86f0b","question":"当前最符合国内外权威指南推荐的首选挽救性治疗策略是？","options":{"A":"调强放射治疗（IMRT）再次放疗（60-66Gy），同步顺铂化疗","B":"鼻内镜下鼻咽病损切除术（带血管蒂鼻中隔黏膜瓣修复）","C":"质子重离子放射治疗（PT/CIRT）","D":"立体定向放射治疗（SBRT/CyberKnife），分次剂量5-8Gy","E":"组织间插植近距离放射治疗（Brachytherapy）","F":"卡瑞利珠单抗联合吉西他滨+顺铂（GP方案）诱导治疗后评估局部处理","G":"开放性手术（如上颌骨外旋入路鼻咽切除术）"},"answer":"B","vignette":"患者男，69岁，ECOG评分1分。3.5年前因“局部晚期鼻咽癌（cT3N1M0）”行诱导化疗+根治性同步放化疗，既往放疗剂量为PGTVnx 70Gy/33f，治疗后达完全缓解。既往遗留2级口干及轻度颈部软组织纤维化，张口度正常，无明显耳鸣及听力下降。\n\n近期常规随访发现血浆EBV-DNA定量由阴性转为 1500 copies/mL。鼻咽镜及增强MRI/PET-CT显示：鼻咽顶后壁偏右侧可见一局限性结节，直径约1.2cm，FDG代谢异常增高（SUVmax 8.5）；病灶局限于鼻咽腔内（rT1），向外侧距右侧咽鼓管圆枕约2mm，与右侧颈内动脉破裂孔段最近距离约 6mm，且脂肪间隙清晰；颅底骨质未见破坏，未见区域淋巴结肿大及远处转移。\n\n患者心肺功能良好，凝血功能正常。","capability_group":"post_treatment_recurrence"}
+{"id":"l2-sample-a1d4f9e14f35db3b273a3c62","question":"基于目前的循证医学证据及主流诊疗规范，针对该患者，最佳的综合治疗策略是？","options":{"A":"单纯根治性调强放疗（IMRT）","B":"吉西他滨+顺铂诱导化疗（3周期）序贯同期放化疗（顺铂单药）","C":"同期放化疗（顺铂单药）","D":"吉西他滨+顺铂诱导化疗（3周期）序贯单纯调强放疗"},"answer":"B","vignette":"患者男，69岁，出生于[出生信息已隐去]月。既往体健，无吸烟史。因“回吸性涕血1个月”就诊。查体：ECOG评分 0分。鼻咽镜检查可见鼻咽顶后壁肿物。头颈部MRI显示：鼻咽顶后壁软组织肿块，侵犯斜坡及翼突，伴颅底骨质破坏；双侧颈部可见多发肿大淋巴结，最大径约4.5cm，位于II区，包膜完整，未累及下颈部。全身PET/CT未见远处转移。血常规及生化检查：WBC 5.5×10^9/L, Hgb 125g/L, PLT 210×10^9/L, ALT 25 U/L, Cr 80 umol/L。血浆EBV-DNA定量：1.0×10^4 copies/mL。病理活检提示：非角化性未分化癌。临床分期评估为 T3N2M0 (第8版AJCC分期，III期)。","capability_group":"initial_definitive"}
+{"id":"l2-sample-a80cbd7e261ab3d7e0edc467","question":"下列哪项二线治疗方案最为合适？","options":{"A":"PD-1抑制剂（如卡瑞利珠单抗或特瑞普利单抗）单药治疗","B":"针对多发骨转移灶进行广泛姑息性放疗，暂缓全身治疗","C":"多西他赛+顺铂+5-氟尿嘧啶（TPF方案）联合化疗","D":"吉西他滨+卡铂联合化疗","E":"卡培他滨单药口服化疗","F":"PD-1抑制剂联合多西他赛化疗"},"answer":"A","vignette":"患者男，64岁，既往确诊为非角化性鼻咽癌（未分化型），初诊分期cT3N2M0。患者在一线接受吉西他滨+顺铂（GP方案）联合诱导化疗及同期放化疗后，病情曾获得部分缓解。然而，在末次含铂化疗结束不到2个月，患者主诉回吸性涕血。PET-CT示鼻咽部病灶较前稍增大，且出现全身多发骨转移（脊柱、骨盆），伴高代谢。查体：ECOG PS 0分。实验室检查：血浆EBV-DNA 5.0×10^4 copies/mL；血常规WBC 5.5×10^9/L，Hgb 125 g/L，PLT 210×10^9/L；肝肾功能正常（ALT 25 U/L, Cr 80 μmol/L）。既往无自身免疫性疾病史。","capability_group":"metastatic_systemic"}
+{"id":"l2-sample-3b9d5e2106c97acae2a6bffd","question":"下列哪项治疗策略最为推荐？","options":{"A":"单纯调强放射治疗（IMRT）","B":"诱导化疗（吉西他滨+顺铂）序贯同期放化疗","C":"同期放化疗（IMRT + 顺铂 40mg/m² q1w）联合辅助化疗","D":"同期放化疗（IMRT + 顺铂 100mg/m² q3w）"},"answer":"A","vignette":"患者男，49岁，既往体健，无吸烟史。因“回吸性涕血1月余”就诊。鼻咽镜活检示：非角化性未分化癌。头颈部增强MRI显示：鼻咽顶后壁及侧壁增厚，肿瘤侵犯咽旁间隙，未见颅底骨质破坏，双侧颈部未见肿大淋巴结。胸腹部CT及全身骨扫描未见远处转移。实验室检查：WBC 5.5×10^9/L, Hgb 125 g/L, PLT 210×10^9/L, ALT 25 U/L, Cr 80 μmol/L。治疗前血浆EBV DNA检测结果为0 copies/mL（低于检测下限）。ECOG PS评分为0分。","capability_group":"initial_definitive"}
+{"id":"l2-sample-3db6257aa37499a45a181e08","question":"基于当前循证医学证据及患者的器官功能状态，关于后续同期放化疗（CCRT）的系统治疗方案，下列哪项决策最为恰当？","options":{"A":"采用调强放疗（IMRT），同期给予顺铂小剂量周疗（Cisplatin 40mg/m² qw），共6-7周，以降低单次肾脏负荷","B":"采用调强放疗（IMRT），同期给予卡铂（Carboplatin，基于AUC给药）","C":"采用调强放疗（IMRT），同期给予奈达铂（Nedaplatin） 80-100mg/m² q3w，共2-3周期，替代顺铂以维持疗效并降低肾毒性","D":"采用调强放疗（IMRT），同期联合西妥昔单抗（Cetuximab）靶向治疗，完全避免铂类药物的进一步肾脏及听力损害","E":"采用调强放疗（IMRT），同期联合卡培他滨（Capecitabine）节拍化疗，并在放疗后给予卡培他滨维持治疗","F":"采用单纯调强放疗（IMRT），因诱导化疗后EBV-DNA已转阴且淋巴结PR，降级治疗以保护器官功能"},"answer":"B","vignette":"患者男，62岁，身高170cm，体重65kg。半年前确诊为鼻咽非角化性癌（未分化型），分期为cT1cN3M0（III期，AJCC第9版）。初诊时血浆EBV-DNA为 4.5×10⁴ copies/mL。既往有左肾多发结石伴左肾萎缩病史10年。患者已接受诱导化疗（吉西他滨 1g/m² d1,8 + 顺铂 80mg/m² d1，q3w）2周期。诱导化疗期间，患者在第2周期出现2级血清肌酐升高，经水化后恢复。当前复查评估：颈部淋巴结较前缩小（PR），复查EBV-DNA降至 0 copies/mL。ECOG PS 1分。实验室检查：血常规正常；肝功能正常；血清肌酐（SCr） 125 μmol/L（1.41 mg/dL）。根据Cockcroft-Gault公式计算，当前肌酐清除率（CrCl）约为 48 mL/min。听力测试提示双侧高频听力轻度下降（1级），无临床耳鸣症状。","capability_group":"toxicity_contraindication"}
+{"id":"l2-sample-6fd68342a7b21d14d5f978e8","question":"最佳的初始治疗策略是？","options":{"A":"立即行原发灶及颈部淋巴结根治性调强放疗（IMRT），同期联合顺铂化疗，骨转移灶暂不处理","B":"仅给予姑息性全身化疗，直至疾病进展，不考虑局部放疗","C":"首选针对T10胸椎及右侧髂骨转移灶行立体定向放疗（SBRT），随后给予免疫单药维持治疗","D":"全身系统性化疗（联合或不联合免疫治疗），若治疗后病灶控制良好，后续跟进原发灶及转移灶的根治性放疗"},"answer":"D","vignette":"患者男性，48岁，既往体健。因“回吸性涕血伴头痛1个月”就诊。查体：ECOG评分0分，双侧颈部可触及数枚质硬淋巴结，最大径均小于6cm，颅神经查体提示第V、VI对脑神经受累。辅助检查：血常规及肝肾功能均正常（WBC 5.5×10^9/L, Hgb 125g/L, PLT 210×10^9/L, Cr 80 μmol/L）。血浆EBV DNA定量为5.0×10^4 copies/mL。鼻咽部MRI显示鼻咽顶后壁软组织肿块，侵犯海绵窦及颅底骨质。全身PET/CT及骨扫描提示：除鼻咽部及双侧颈部淋巴结高代谢外，仅见胸椎T10及右侧髂骨两处高代谢病灶，考虑为骨转移，未见内脏转移。","capability_group":"metastatic_systemic"}
+{"id":"l2-sample-e3aed3722ed468d0a2b8e167","question":"最佳的一线综合治疗模式是？","options":{"A":"诱导化疗（吉西他滨+顺铂）后序贯同期放化疗（顺铂+调强放疗）","B":"单纯同期放化疗（顺铂+调强放疗）","C":"单纯调强放疗后序贯辅助化疗（顺铂+氟尿嘧啶）","D":"诱导化疗（多西他赛+顺铂+氟尿嘧啶）后序贯单纯调强放疗"},"answer":"A","vignette":"患者男性，40岁，既往体健。因“回吸性涕血1月余”就诊。鼻咽镜活检示：非角化性癌（未分化型）。体格检查：ECOG评分0分，双侧颈部可触及数枚质硬淋巴结，最大径约3cm，活动度差。辅助检查：鼻咽及颈部MRI显示鼻咽顶后壁肿物侵犯斜坡及颅底骨质，双侧颈部II-III区可见多发肿大淋巴结，最大径<6cm，包膜外侵犯不明显，无远处转移征象。实验室检查：WBC 5.5×10^9/L, Hgb 125g/L, PLT 210×10^9/L, ALT 25 U/L, Cr 80 umol/L。血浆EBV-DNA定量为1.0×10^4 copies/mL。根据AJCC/UICC第8版分期系统，患者临床分期为T3N2M0（III期）。","capability_group":"initial_definitive"}
+{"id":"l2-sample-47264765c37a393dbb74b849","question":"最符合当前循证医学证据的治疗策略是？","options":{"A":"诱导化疗（吉西他滨+顺铂）序贯同期放化疗（IMRT + 顺铂）","B":"同期放化疗（IMRT + 三周一次顺铂 100mg/m²）","C":"单纯根治性调强放疗（IMRT）","D":"同期放化疗（IMRT + 每周一次顺铂 40mg/m²）","E":"单纯根治性调强放疗（IMRT）+ 尼妥珠单抗靶向治疗"},"answer":"C","vignette":"患者男，69岁，既往体健。因“回吸性涕血1个月”就诊。鼻咽镜活检病理：非角化性未分化癌。头颈部MRI：鼻咽顶后壁及侧壁增厚，肿瘤侵犯咽旁间隙，未累及颅底骨质，双侧颈部淋巴结短径均<5mm。全身PET-CT未见远处转移。辅助检查：血常规、肝肾功能正常；治疗前血浆EBV DNA为0 copies/mL。ECOG PS评分0分。患者表示希望尽量减少治疗毒副作用，","capability_group":"initial_definitive"}
+{"id":"l2-sample-dc805f23fbd137c1ebd00d74","question":"以下哪项符合最佳诊疗策略？","options":{"A":"立即行全身系统性化疗（吉西他滨+顺铂）联合PD-1抑制剂，直至疾病进展或出现不可耐受毒性，局部病灶及骨转移灶仅在出现压迫或疼痛症状时行姑息性放疗","B":"给予诱导化疗（吉西他滨+顺铂）联合PD-1抑制剂治疗4-6个周期，若全身病灶控制良好（CR/PR/SD），后续对鼻咽原发灶、颈部淋巴结及两处骨转移灶均行根治性剂量的放疗，并继续以PD-1抑制剂维持治疗","C":"给予诱导化疗（TPF方案：多西他赛+顺铂+氟尿嘧啶）3个周期后，行同步放化疗（顺铂）处理鼻咽及颈部病灶，骨转移灶行大分割立体定向放疗（SBRT），后续不进行免疫维持","D":"立即行同步放化疗（CCRT）处理鼻咽及颈部病灶，同步联合PD-1抑制剂，放疗结束后针对骨转移灶行SBRT，并以吉西他滨+卡培他滨进行节拍化疗维持","E":"给予诱导化疗（吉西他滨+顺铂）3个周期，评估后对鼻咽及颈部病灶行根治性放疗，因右侧颈内动脉受包绕，放疗剂量需严格限制在姑息剂量以内以防大出血，骨转移灶行双膦酸盐治疗"},"answer":"B","vignette":"患者男，43岁，因“回吸性涕血伴右侧持续性头痛1月余”就诊。既往体健。鼻咽镜活检示：非角化性未分化癌。头颈部MRI提示：鼻咽顶后壁软组织肿块，侵犯双侧海绵窦，包绕右侧颈内动脉（>180度），伴双侧第V、VI脑神经受累征象；双侧颈部可见多个肿大淋巴结，最大径4.5cm，MRI提示明显包膜外侵犯（ENE+）。全身PET/CT提示：除鼻咽及颈部病灶外，仅见胸椎（T6）及左侧髂骨各一处高代谢病灶，未见内脏转移。\n\n实验室检查：血浆EBV-DNA定量：5.0×10^5 copies/mL。肿瘤组织PD-L1 CPS=15。血常规及肝肾功能基本正常。ECOG评分0分。","capability_group":"metastatic_systemic"}
+{"id":"l2-sample-ec6245afdc48f7f2289e857e","question":"在常规临床实践中，下一步最恰当的治疗策略是？","options":{"A":"同期放化疗（IMRT + 顺铂单药增敏），化疗期间继续联合PD-1抑制剂维持治疗","B":"单纯调强放疗（IMRT），放疗结束后继续使用PD-1抑制剂辅助治疗","C":"继续原方案（GP+PD-1抑制剂）化疗2周期以达到完全缓解（CR）后再行放疗","D":"同期放化疗（IMRT + 顺铂单药增敏），放化疗期间暂不联合PD-1抑制剂，待放疗结束后再评估是否加用辅助免疫治疗"},"answer":"D","vignette":"患者男，58岁，既往体健，无吸烟史，无基础疾病。因“回吸性涕血伴颈部包块”就诊。初诊影像学及病理确诊为鼻咽癌（非角化性癌，未分化型）。分期检查提示：鼻咽顶后壁肿物侵犯颅底骨质及海绵窦，双侧颈部见多个肿大淋巴结，最大径>6cm，锁骨上窝未见肿大淋巴结，未见远处转移。TNM分期为cT4N3M0（III期）。基线EBV-DNA为4.5×10^5 copies/mL。患者接受了诱导治疗：吉西他滨+顺铂（GP方案）联合PD-1抑制剂治疗4个周期。目前为第4程化疗联合免疫治疗后3周。复查评估：鼻咽部病灶较前明显缩小，颈部淋巴结大部分消退，疗效评价为部分缓解（PR）。现查体：ECOG PS 0分。实验室检查：血常规、肝肾功能均未见明显异常。复查EBV-DNA：0 copies/mL。","capability_group":"initial_definitive"}
+{"id":"l2-sample-ade20162220f0c55b95a92ef","question":"目前最推荐的一线系统治疗方案是？","options":{"A":"吉西他滨 + 顺铂（GP）联合 PD-1抑制剂（如特瑞普利单抗或卡瑞利珠单抗）","B":"吉西他滨 + 顺铂（GP）单纯化疗","C":"诱导化疗（TPF方案：多西他赛+顺铂+氟尿嘧啶）序贯根治性放疗","D":"根治性放疗（鼻咽原发灶+颈部淋巴结）同期联合顺铂化疗"},"answer":"A","vignette":"患者男，50岁（1975年1月出生），既往体健。因“回吸性涕血伴头痛2月余”就诊。体格检查示右侧锁骨上窝触及数枚肿大淋巴结，质硬固定，余无特殊。ECOG评分0分。头颈部MRI提示：鼻咽顶后壁软组织肿块，侵犯海绵窦，伴双侧咽后淋巴结及右侧锁骨上淋巴结肿大。全身骨扫描及后续MRI证实胸椎、腰椎及骨盆多发骨质破坏，提示多发骨转移。实验室检查：WBC 5.5×10^9/L, Hgb 125g/L, PLT 210×10^9/L, ALT 25 U/L, Cr 80 μmol/L。血浆EBV-DNA定量检测为2.0×10^5 copies/mL。病理活检证实为非角化性未分化型鼻咽癌。","capability_group":"metastatic_systemic"}
+{"id":"l2-sample-b0cb819f636a2253ee5b8df6","question":"首选的一线系统治疗方案是？","options":{"A":"根治性放疗 + 同期顺铂化疗","B":"帕博利珠单抗单药治疗","C":"吉西他滨 + 顺铂（GP方案）联合 PD-1抑制剂","D":"吉西他滨 + 顺铂（GP方案）单纯化疗"},"answer":"C","vignette":"患者，男，45岁，既往体健。因“回吸性涕血2月余，伴持续性头痛”就诊。查体：ECOG评分0分，双侧颈部及锁骨上窝触及多枚肿大淋巴结，质硬固定，余无特殊。辅助检查：鼻咽部MRI显示鼻咽顶后壁肿物侵犯海绵窦，伴第V、VI对脑神经受累征象；双侧颈部及锁骨上窝多发淋巴结肿大。全身骨扫描及后续MRI证实脊柱及骨盆多发骨转移。实验室检查：血常规WBC 5.5×10^9/L, Hgb 125g/L, PLT 210×10^9/L；肝肾功能正常（ALT 25 U/L, Cr 80 μmol/L）。血浆EBV-DNA定量检测结果为2.0×10^5 copies/mL。病理活检证实为非角化性未分化型鼻咽癌。","capability_group":"metastatic_systemic"}
+{"id":"l2-sample-c196bfeb28bc124ebd646ceb","question":"下列最恰当的临床处理策略是？","options":{"A":"暂停第2周期顺铂化疗；给予短效G-CSF及重组人血小板生成素（rhTPO）支持治疗，严密监测血象下继续IMRT；若后续血象恢复，可考虑将剩余顺铂改为单药周疗（40mg/m²）或取消后续化疗","B":"暂停第2周期顺铂化疗；给予长效PEG-G-CSF及白介素-11（IL-11）支持治疗；暂停IMRT 3-5天，待ANC≥1.5×10⁹/L且PLT≥75×10⁹/L后，同步重启放疗与减量25%的顺铂化疗","C":"按计划进行第2周期顺铂化疗，但将剂量减低25%并分3天给药以降低峰值毒性；同步给予短效G-CSF及输注单采血小板；继续IMRT以保证总治疗时间（OTT）不延长","D":"终止同期顺铂化疗，直接替换为西妥昔单抗（靶向EGFR）以避免进一步骨髓抑制和耳毒性；给予短效G-CSF及rhTPO支持治疗，继续IMRT","E":"暂停所有放化疗；给予短效G-CSF及rhTPO支持治疗；待血象完全恢复后继续IMRT，并在放疗结束后补做2周期顺铂辅助化疗，以弥补同期化疗剂量的不足"},"answer":"A","vignette":"患者男，47岁，确诊非角化性鼻咽癌（T3N1M0，III期），ECOG评分0分。既往体健。患者接受了2周期TP方案（多西他赛+顺铂）诱导化疗，随后开始根治性同期放化疗（CCRT），方案为顺铂单药（100mg/m²，q3w）联合调强放疗（IMRT，计划总剂量70Gy/33F）。\n\n目前放疗进行至第4周（已完成19次，累积剂量40.3Gy），患者出现II度放射性口腔黏膜炎，回吸性涕血消失。复查血常规提示：WBC 1.6×10⁹/L，ANC 0.7×10⁹/L，Hgb 85g/L，PLT 42×10⁹/L。生化指标：ALT 25 U/L，Cr 85 μmol/L（基线70 μmol/L）。患者诉伴有轻度双侧高频听力下降，无发热，无明显出血倾向。原计划明日进行第2周期同期顺铂化疗。","capability_group":"toxicity_contraindication"}
+{"id":"l2-sample-86eaed42c6d5ca4c159297ff","question":"最佳的初始治疗策略是？","options":{"A":"立即行鼻咽原发灶及颈部淋巴结的根治性同步放化疗，随后给予辅助化疗以控制远处转移。","B":"给予全身系统性化疗（联合PD-1抑制剂），若化疗后全身病灶控制良好，后续序贯鼻咽原发灶及颈部淋巴结的根治性放疗，并考虑对骨转移灶行局部治疗。","C":"首选对骨转移灶进行立体定向放疗（SBRT）以缓解疼痛风险，随即行原发灶根治性放疗，最后根据耐受情况决定是否行辅助化疗。","D":"仅给予以铂类为基础的姑息性全身化疗（联合或不联合免疫治疗），直至疾病进展，暂不考虑局部放疗介入。"},"answer":"B","vignette":"患者男，43岁，既往体健。因“回吸性涕血1月余”就诊。体格检查示ECOG PS评分0分，鼻咽镜见顶后壁肿物。头颈部MRI显示鼻咽顶后壁软组织肿块侵犯海绵窦，伴有第V、VI对脑神经受累征象；双侧颈部见多发肿大淋巴结，最大径均<6cm，且位于锁骨上窝以上。PET-CT及骨扫描提示胸椎（T6）及右侧髂骨可见两处高代谢病灶，余处未见明显异常。实验室检查：WBC 5.5×10⁹/L, Hgb 125g/L, PLT 210×10⁹/L, ALT 25 U/L, Cr 80 μmol/L。血浆EBV-DNA定量为5.0×10⁴ copies/mL。","capability_group":"metastatic_systemic"}
+{"id":"l2-sample-8550289c011f4727846dd0a3","question":"最推荐的一线治疗策略是？","options":{"A":"吉西他滨+顺铂（GP方案）诱导化疗，序贯同期顺铂放化疗","B":"同期顺铂放化疗（CCRT）后，序贯辅助化疗（PF方案）","C":"多西他赛+顺铂+氟尿嘧啶（TPF方案）诱导化疗，序贯单纯调强放疗","D":"单纯调强放射治疗（IMRT）"},"answer":"A","vignette":"患者男，40岁，因“回吸性涕血1个月”就诊。既往体健。查体：ECOG PS评分 0分，鼻咽镜示鼻咽顶后壁肿物，病理证实为非角化性癌（未分化型）。头颈部MRI及CT显示：鼻咽顶后壁软组织肿块，伴颅底骨质破坏（累及斜坡），双侧颈部可见多个肿大淋巴结，最大径约为3.5cm，位于下颈部（IV区），未包绕颈内动脉。全身检查（PET-CT）未见远处转移。血浆EBV DNA拷贝数为 1.0×10^4 copies/mL。血常规及生化检查：WBC 5.5×10^9/L, Hgb 125g/L, PLT 210×10^9/L, ALT 25 U/L, Cr 80 μmol/L。根据AJCC/UICC第8版分期，该患者被确诊为鼻咽癌 T3N2M0 (III期)。","capability_group":"initial_definitive"}
+{"id":"l2-sample-e00985ad2fa7d2d126e315fc","question":"下列哪项综合治疗策略最为合理？","options":{"A":"立即行鼻咽原发灶及颈部淋巴结根治性同步放化疗（65-70Gy），随后给予吉西他滨+顺铂（GP）联合PD-1抑制剂辅助治疗4-6周期，骨转移灶行姑息性放疗（30Gy/10f）","B":"给予吉西他滨+顺铂（GP）联合PD-1抑制剂全身治疗4-6周期；若复查EBV DNA显著下降且影像学评估≥SD（疾病稳定），对鼻咽原发灶及颈部淋巴结行根治性放疗（65-70Gy），对骨转移灶行SBRT（立体定向放疗），随后以PD-1抑制剂维持治疗","C":"给予吉西他滨+顺铂（GP）全身化疗4-6周期；若评估≥SD，对鼻咽原发灶及颈部淋巴结行根治性放疗（65-70Gy），骨转移灶暂不处理，密切观察，直至出现疼痛症状时再行姑息放疗","D":"给予紫杉醇+顺铂+5-FU（TPF）诱导化疗3周期，序贯原发灶及转移灶同步放化疗，随后以卡培他滨节拍化疗维持1年","E":"给予吉西他滨+顺铂（GP）联合PD-1抑制剂全身治疗，直至疾病进展或出现不可耐受毒性；不推荐对无症状的原发灶和骨转移灶进行早期局部放疗，以免中断全身免疫治疗"},"answer":"B","vignette":"患者男，45岁，既往体健。因“回吸性涕血伴右侧面部麻木2月”就诊。ECOG PS评分0分。鼻咽镜见顶后壁肿物。头颈部MRI：鼻咽顶后壁及右侧壁增厚，侵犯海绵窦，右侧第V、VI对脑神经受累；双侧颈部见多枚肿大淋巴结（最大短径2.5cm）。全身PET-CT：胸椎（T8）及左侧髂骨见两处高代谢病灶，最大径均<2cm，无软组织肿块形成；肝脏S4段见一0.5cm低密度结节，代谢未见异常。实验室检查：肝肾功能正常。血浆EBV DNA定量为 5.0×10^4 copies/mL。病理确诊为非角化性未分化型鼻咽癌。经多学科会诊（MDT），肝脏结节考虑为良性囊肿，明确诊断为：初诊寡转移鼻咽癌（T4N2M1a，IVA期，AJCC 第 9 版）","capability_group":"metastatic_systemic"}
+{"id":"l2-sample-a8913fccee0d75f4dd768ea8","question":"下列哪项是最具共识且最恰当的治疗策略？","options":{"A":"经鼻内镜扩大颅底肿瘤切除术，术后辅以PD-1单抗维持治疗","B":"诱导化疗（如吉西他滨+顺铂）2-3个周期后，行再程放疗，放疗技术优先选择IMRT调强放疗，剂量建议60-66Gy，采用超分割技术","C":"诱导化疗（如吉西他滨+顺铂）2-3个周期后，行再程放疗，放疗技术优先选择质子或碳离子放射治疗（PT/CIRT），次选调强放疗","D":"同步放化疗（IMRT 60Gy + 顺铂 40mg/m² 每周方案），放疗后序贯免疫治疗","E":"姑息性一线化疗（吉西他滨+顺铂）联合PD-1单抗，视肿瘤退缩情况决定是否局部干预","F":"放射性粒子植入（如125I）联合靶向治疗（如西妥昔单抗）"},"answer":"C","vignette":"2023年10月常规复查，MRI显示：鼻咽部术后改变，左侧壁及顶后壁结节状增厚；病变向上侵犯蝶骨基底部、斜坡及左侧翼突基底部，骨质信号异常伴强化；病变外缘距离左侧颈内动脉破裂孔段约2mm。PET-CT未见远处转移。临床分期评估为rT3N0M0 rII期。\n\n实验室及病理检查： 鼻咽活检证实为非角化性癌。EBV-DNA < 100 copies/mL（阴性）。PD-L1 CPS=5。WBC 6.6×10^9/L，Hgb 133g/L，PLT 230×10^9/L，Cr 85 μmol/L。\n\n临床症状：患者目前偶有左侧面部麻木感，无复视、无张口困难、无头痛，一般情况良好。","capability_group":"post_treatment_recurrence"}
+{"id":"l2-sample-e6d1195dabef4d44ad76d163","question":"最恰当的处理措施是？","options":{"A":"继续原计划放疗，将第2周期同期顺铂剂量减半（50mg/m²）使用，并加强升白、升血小板治疗","B":"立即停止放疗和化疗，直至血象完全恢复正常（WBC > 4.0×10⁹/L, PLT > 100×10⁹/L）后再重启治疗","C":"停止所有放化疗，改为单药免疫检查点抑制剂维持治疗，待骨髓功能恢复后重新评估","D":"暂停同期化疗，给予G-CSF及rhTPO等支持治疗，待血小板纠正至≥50×10⁹/L后，在密切监测下继续原计划放疗"},"answer":"D","vignette":"患者男，55岁，既往体健。因“回吸性涕血伴头痛2月”就诊。初诊影像学提示鼻咽顶后壁肿物伴颅底骨质破坏，双侧颈部可见数枚肿大淋巴结，最大径约3.5cm。病理确诊为非角化性未分化癌。临床分期为T4N2M0（III期）。患者开始接受根治性调强放疗（IMRT）联合同期顺铂化疗（100mg/m²，q3w）。目前处于放疗第4周（已完成第1周期化疗）。今日复查血常规：WBC 1.8×10⁹/L，ANC 0.8×10⁹/L，Hgb 80g/L，PLT 45×10⁹/L（CTCAE III度血小板减少）。生化指标正常。患者目前无发热，无明显出血倾向。","capability_group":"toxicity_contraindication"}
+{"id":"l2-sample-57d5ab2e16890eec669800b1","question":"下一步最优的处理策略是？","options":{"A":"立即行右侧II-V区功能性颈淋巴结清扫术，以防肿瘤局部复发转移","B":"针对右侧IIb区淋巴结行超声引导下细针穿刺活检（FNA），若病理阴性则继续密切随访","C":"考虑到SUVmax>4.0提示肿瘤残留风险极高，应立即给予立体定向放射治疗（SBRT）局部推量","D":"暂不进行有创检查，建议密切随访，1个月后复查血浆EBV-DNA，并在6-12周后复查颈部超声或MRI评估淋巴结变化","E":"启动卡瑞利珠单抗或特瑞普利单抗维持治疗，持续1年，同时动态监测EBV-DNA","F":"在鼻咽镜下对顶后壁坏死物及黏膜下组织进行深部活检，同时行颈部淋巴结切除活检"},"answer":"D","vignette":"患者男，66岁，ECOG评分0分。既往确诊为非角化性鼻咽癌（T3N2M0，III期，AJCC 第 8 版），接受了诱导化疗（GP方案2周期）+根治性同步放化疗（顺铂单药），治疗过程顺利。目前距离放疗结束已满12周。患者因偶有回吸性涕血复诊，无头痛、复视。\n\n查体：鼻咽部黏膜稍充血，表面覆少许白膜，颈部触诊未及明显肿大淋巴结。\n\n实验室检查：血常规及肝肾功能正常；血浆EBV-DNA放疗前为 4.5×10^4 copies/mL，放疗结束时及本次复查均为 0 copies/mL。\n\n影像学及内镜检查：\n\n鼻咽镜：鼻咽顶后壁见少许坏死物附着，黏膜下未见明显隆起。\n\n头颈部MRI：鼻咽部原发灶明显缩小，呈长T1长T2信号，增强后呈轻度均匀强化；双侧颈部见数枚小淋巴结，其中右侧IIb区见一枚大小约 1.1cm×0.8cm 淋巴结，包膜完整，DWI呈等/稍高信号，ADC值较放疗前显著升高。\n\nPET-CT：鼻咽部未见异常高代谢；右侧IIb区该枚淋巴结代谢轻度活跃，SUVmax 4.2（肝脏血池本底 SUVmean 2.5）；余全身未见异常。","capability_group":"post_treatment_recurrence"}
+{"id":"l2-sample-370649625123119975a5e6b7","question":"目前最推荐的根治性治疗策略是？","options":{"A":"单纯调强放射治疗（IMRT）","B":"同期放化疗（IMRT + 顺铂 100mg/m² q3w）","C":"诱导化疗（吉西他滨+顺铂）序贯单纯IMRT","D":"调强放射治疗（IMRT）+ 同期尼妥珠单抗"},"answer":"A","vignette":"患者男，49岁。因“回吸性涕血1个月”就诊。MRI显示：鼻咽顶后壁软组织增厚，侵犯咽旁间隙，未见颅底骨质破坏；双侧颈部淋巴结未见肿大（符合影像学淋巴结阴性标准）。病理为非角化性未分化癌。治疗前血浆EBV DNA定量为 0 copies/mL。ECOG评分0分。临床分期为cT2N0M0（第八版AJCC）。","capability_group":"initial_definitive"}
+{"id":"l2-sample-b36588996102ceafc2c4c0b3","question":"鉴于该患者的基线肾功能状态及肿瘤分期，在制定同期放化疗（CCRT）方案时，下列哪项治疗策略在平衡疗效与安全性上最为合理？","options":{"A":"放弃同期化疗，仅行单纯根治性调强放疗（IMRT）","B":"采用卡铂（Carboplatin）替代顺铂进行同期化疗，剂量根据Calvert公式计算，联合IMRT","C":"给予标准剂量顺铂（100 mg/m² q3w）同期化疗，但在给药前后给予超大剂量水化利尿（>4000ml/日）","D":"采用EGFR单抗（如西妥昔单抗或尼妥珠单抗）替代铂类进行同期靶向联合放疗"},"answer":"B","vignette":"患者男，42岁，因“回吸性涕血伴头痛2月余”就诊。鼻咽镜活检病理确诊为鼻咽非角化性癌（未分化型）。影像学分期：鼻咽顶后壁肿物侵犯颅底骨质，双侧颈部可见多发淋巴结肿大，最大径约4cm，位于II区，无远处转移征象（T3N2M0）。既往史：慢性肾脏病（CKD）3b期病史5年。入院查体：ECOG评分 0分。实验室检查：血常规正常；肝功能正常；肾功能示血肌酐（Cr）200 μmol/L，计算eGFR约为32 ml/min/1.73m²。血浆EBV-DNA定量为 5000 copies/mL。拟行根治性放疗为主的综合治疗。","capability_group":"toxicity_contraindication"}
+{"id":"l2-sample-c34117aff74acf80cb4227e5","question":"最佳的综合治疗策略是？","options":{"A":"全身系统性化疗（联合PD-1抑制剂）作为诱导，若疾病控制良好，随后给予鼻咽及颈部淋巴结根治性放疗，并考虑对骨转移灶进行局部治疗。","B":"先行胸椎及髂骨转移灶的姑息性放疗以控制疼痛，随后给予吉西他滨+顺铂（GP方案）化疗，原发灶待出现梗阻症状后再行放疗。","C":"仅给予以铂类为基础的全身姑息性化疗（联合或不联合免疫治疗），直至疾病进展，暂不考虑原发灶放疗。","D":"立即行鼻咽部及颈部淋巴结根治性放疗，同期联合以铂类为基础的化疗，放疗结束后再行辅助化疗。"},"answer":"A","vignette":"患者男，55岁，既往体健。因“回吸性涕血1个月”就诊。查体：ECOG评分 0分。鼻咽镜示鼻咽顶后壁及双侧侧壁新生物。头颈部MRI显示：鼻咽部肿物侵犯海绵窦，并伴有颅神经受累征象；双侧颈部见多发淋巴结肿大，最大径均 < 6cm，包膜完整。全身PET-CT及骨扫描提示：胸椎（T6、T7）及右侧髂骨可见共计3个独立高代谢病灶，确诊为多发骨转移，未见内脏转移。实验室检查：EBV-DNA 5.0×10^4 copies/mL，WBC 5.5×10^9/L, Hgb 125g/L, PLT 210×10^9/L, ALT 25 U/L, Cr 80 umol/L。","capability_group":"metastatic_systemic"}
+{"id":"l2-sample-6da452b401cbb782f869a77d","question":"下列哪项方案最为恰当？","options":{"A":"暂停免疫治疗，纠正电解质紊乱，心内科会诊完善全面心脏评估；待心脏毒性排除或恢复后，优选单药PD-1抑制剂维持治疗，暂不联合卡培他滨维持","B":"立即给予大剂量补液及升压治疗，继续原定PD-1抑制剂+卡培他滨维持治疗，因为患者属于IV期高危复发风险，需强化维持治疗以延长PFS。","C":"考虑为吉西他滨迟发性心脏毒性，永久停用所有抗肿瘤治疗，仅给予最佳支持治疗（BSC），因为患者已获PR且EBV转阴，过度治疗风险大于获益。","D":"立即行原发灶及转移灶的姑息性放疗，同步联合PD-1抑制剂维持，以巩固化疗疗效，忽略心脏症状，因为QTc 480ms尚未达到停药标准（>500ms）。"},"answer":"A","vignette":"患者男，56岁，ECOG评分0分。既往有高血压病史15年，服用缬沙坦及非洛地平控制良好；乙肝病史，长期服用恩替卡韦，病毒载量控制稳定。既往史包括10年前胃溃疡切除术，5年前脊髓神经纤维瘤手术，以及2023年2月左肾结石碎石术。患者初诊确诊为鼻咽癌（cT4cN2cM1b，IVB期），伴多发骨转移及少量肺转移。经吉西他滨+顺铂（GP方案）联合PD-1抑制剂一线治疗6个周期后，复查影像学评估为部分缓解（PR），原发灶及转移灶均显著缩小，且血浆EBV-DNA降至0 copies/mL。今日患者突发头晕、乏力，继而晕厥1小时入院，急查心电图提示窦性心动过缓，QTc间期延长（480ms），电解质示轻度低钾，血压105/65mmHg。排除急性脑血管意外及心肌梗死。","capability_group":"metastatic_systemic"}
+{"id":"l2-sample-38b2be57ed0f1614c10bd29d","question":"下列干预策略中最恰当的是？","options":{"A":"'立即暂停放疗与同步顺铂，紧急输注单采血小板1个治疗量，并给予G-CSF及TPO受体激动剂；待血象恢复后重启放疗，并考虑增加总剂量以补偿中断时间","B":"暂停同步顺铂，在严密监测下继续原计划IMRT；立即给予治疗性G-CSF及重组人血小板生成素（rhTPO）皮下注射，并考虑输注红细胞悬液纠正贫血；若后续放疗期间PLT降至 < 20×10^9/L或出现活动性大出血，则暂停放疗","C":"暂停同步顺铂，将同步方案替换为尼妥珠单抗（EGFR单抗）以维持增敏效应，继续原计划IMRT；同时给予G-CSF及rhTPO支持治疗","D":"暂停放疗与同步顺铂，给予G-CSF及rhTPO支持治疗；鉴于患者EBV DNA持续阴性提示预后不良且对化疗可能不敏感，待血象恢复后，应放弃原放疗计划，改用PD-1单抗联合化疗的全身系统性治疗","E":"继续原计划IMRT及同步顺铂（顺铂减量至 20mg/m²），预防性输注红细胞悬液及单采血小板，并联合长效PEG-rhG-CSF支持"},"answer":"B","vignette":"患者男，53岁，因“回吸性涕血伴右侧耳部闷塞感2月”就诊。ECOG PS 0分。病理确诊为鼻咽非角化性癌（未分化型）。分期为 cT3N2M0（第9版 II期）。治疗前血浆 EBV DNA 为 0 copies/mL（多次复查均阴性）。患者接受了3个周期的 GP方案（吉西他滨+顺铂）诱导化疗，肿瘤退缩明显（PR）。随后进入根治性同步放化疗阶段（IMRT，PGTVnx 70Gy/33F，同步每周顺铂 40mg/m²）。现处于放疗第22次（第4周半），患者出现重度乏力。今日复查血常规：WBC 1.1×10^9/L，ANC 0.4×10^9/L（4级），Hgb 78g/L，PLT 35×10^9/L（3级）。查体：口腔黏膜散在充血，无溃疡；双下肢可见散在针尖样出血点，无发热（T 36.8℃），无头痛及呕吐。肝肾功能正常。已知该患者对重组人白介素-11（rhIL-11）有过敏史。","capability_group":"toxicity_contraindication"}
+{"id":"l2-sample-730e6fa448444418d5f1e248","question":"根据目前权威临床指南及循证医学证据，针对该患者病情的最佳初始治疗策略是？","options":{"A":"单纯调强放射治疗 (IMRT)","B":"吉西他滨+顺铂 (GP方案) 诱导化疗，序贯同期放化疗 (顺铂+IMRT)","C":"多西他赛+顺铂+氟尿嘧啶 (TPF方案) 诱导化疗，序贯单纯调强放射治疗 (IMRT)","D":"同期放化疗 (顺铂+IMRT)，随后行辅助化疗 (PF方案)"},"answer":"B","vignette":"患者男，59岁，既往体健，无吸烟史。因“回吸性涕血2个月”就诊。查体：ECOG评分 0分，鼻咽镜见顶后壁肿物，病理示非角化性未分化癌。头颈部MRI显示：鼻咽顶后壁及侧壁增厚，侵犯斜坡及翼突，可见颅底骨质破坏；双侧颈部II区可见数个肿大淋巴结，最大径约3.5cm，包膜完整，未融合，位于环状软骨下缘以上。全身PET/CT未见远处转移。辅助检查：血常规 WBC 5.5×10^9/L, Hgb 125g/L, PLT 210×10^9/L；肝肾功能正常 (ALT 25 U/L, Cr 80 μmol/L)；治疗前血浆EBV DNA定量为 1.0×10^4 copies/mL。","capability_group":"initial_definitive"}
+{"id":"l2-sample-a87a3ffd2ee9f19059d18eb0","question":"针对该患者的最佳综合治疗策略及依据是？","options":{"A":"单纯根治性调强放疗（IMRT），因最新多中心非劣效RCT证实II期鼻咽癌单纯放疗的生存获益与同期放化疗相当，且毒性显著降低","B":"诱导化疗（吉西他滨+顺铂）序贯单纯IMRT，以期通过诱导化疗消灭微转移灶，同时豁免同期化疗以保护听力及肾功能","C":"同期放化疗（CCRT，顺铂 100mg/m² q3w）","D":"诱导化疗（TPF方案）序贯同期放化疗","E":"同期放化疗（CCRT）联合PD-1抑制剂（如特瑞普利单抗），因高EBV病毒载量提示肿瘤微环境呈免疫炎症表型，联合免疫治疗可显著提升pCR率"},"answer":"C","vignette":"患者于×月因鼻咽部不适就诊。查体：ECOG评分0分，鼻咽镜检查发现顶后壁肿物，病理提示非角化性未分化癌。头颈部MRI显示鼻咽顶后壁及侧壁增厚，侵犯斜坡及翼突，颅底骨质破坏；双侧颈部II区可见多个肿大淋巴结，最大径约3.5cm，包膜完整，未融合，位于环状软骨下缘以上。全身PET/CT未见远处转移。辅助检查：血常规WBC 5.5×10^9/L，Hgb 125g/L，PLT 210×10^9/L；肝肾功能正常（ALT 25 U/L，Cr 80 μmol/L）；治疗前血浆EBV DNA定量为1.0×10^4 copies/mL。","capability_group":"initial_definitive"}
+{"id":"l2-sample-0824820cff5456a2463423bf","question":"最合理的化疗药物选择是？","options":{"A":"卡铂 (Carboplatin) AUC 5-6，每3周一次","B":"顺铂 (Cisplatin) 40 mg/m²，每周一次","C":"西妥昔单抗 (Cetuximab) 400 mg/m² 负荷，后250 mg/m² 每周维持","D":"顺铂 (Cisplatin) 100 mg/m²，每3周一次"},"answer":"A","vignette":"患者男，52岁（1973年1月出生）。因“回吸性涕血伴鼻塞2个月”就诊。既往史显著：双耳重度感音神经性耳聋多年，依靠助听器维持基本交流，无其他慢性病史。查体：ECOG PS 0分。鼻咽镜活检示：非角化性未分化型癌。影像学分期检查（MRI及CT）显示：鼻咽顶后壁肿物侵犯斜坡及破裂孔，颅底骨质有明显破坏；双侧颈部可见多发肿大淋巴结，最大径均 < 6cm，主要位于II区，包膜外侵犯不明显，无远处转移征象。实验室检查：WBC 5.5×10^9/L, Hgb 125g/L, PLT 210×10^9/L, ALT 25 U/L, Cr 80 μmol/L。治疗前血浆EBV DNA定量为5000 copies/mL。经多学科讨论，计划行根治性放疗联合同期化疗。","capability_group":"toxicity_contraindication"}
+{"id":"l2-sample-5e13b026cd89f6a6c4f975bc","question":"基于该患者的临床分期及风险分层，首选的根治性治疗方案是？","options":{"A":"单纯调强放射治疗（IMRT）","B":"单纯调强放射治疗 + 辅助化疗（氟尿嘧啶+顺铂）","C":"诱导化疗（吉西他滨+顺铂）后行同期放化疗","D":"同期放化疗（IMRT + 顺铂 100mg/m² q3w）"},"answer":"A","vignette":"患者男，59岁，既往体健。因“间断回吸性涕血1个月”就诊。体格检查及鼻咽镜检提示鼻咽顶后壁粘膜粗糙、增厚。头颈部MRI显示：病变局限于鼻咽腔内，顶后壁软组织轻度增厚，未侵犯咽旁间隙，未见颅底骨质破坏；双侧颈部淋巴结未见肿大（短径均<5mm，且形态正常）。全身检查未见远处转移征象。实验室检查：血常规 WBC 5.5×10^9/L, Hgb 125g/L, PLT 210×10^9/L；肝肾功能正常（ALT 25 U/L, Cr 80 μmol/L）。血浆EBV-DNA检测结果为0 copies/mL。病理活检证实为非角化性未分化癌。患者ECOG评分为0分。","capability_group":"initial_definitive"}
+{"id":"l2-sample-69cb459b20fbc4f0e85b93f5","question":"基于该患者的临床特征及风险分层，首选的根治性治疗方案是？","options":{"A":"单纯调强适形放射治疗（IMRT）","B":"同期放化疗（IMRT + 顺铂 100mg/m2 q3w）","C":"诱导化疗（吉西他滨+顺铂）后行同期放化疗","D":"单纯调强适形放射治疗（IMRT）+ 辅助化疗（氟尿嘧啶+顺铂）"},"answer":"A","vignette":"患者男，60岁，既往体健。因“回吸性涕血1个月”就诊。查体：鼻咽镜检查见顶后壁黏膜粗糙、微隆起，活检病理证实为非角化性癌（未分化型）。头颈部MRI显示：肿瘤局限于鼻咽顶后壁，未侵犯咽旁间隙，未见颅底骨质破坏，双侧颈部未见肿大淋巴结。全身检查（胸腹部CT及骨扫描）未见远处转移。实验室检查：WBC 5.5×10^9/L, Hgb 125 g/L, PLT 210×10^9/L, ALT 25 U/L, Cr 80 umol/L。血浆EBV-DNA检测结果为0 copies/mL。ECOG评分为0分。根据第8版AJCC分期，该患者被诊断为cT1N0M0期鼻咽癌。","capability_group":"initial_definitive"}
+{"id":"l2-sample-e796331f0a3eedd8b954ad7f","question":"最推荐的根治性治疗策略是？","options":{"A":"吉西他滨+顺铂（GP方案）诱导化疗（2-3周期）序贯同期放化疗（顺铂单药）","B":"单纯根治性调强放疗（IMRT）","C":"同期放化疗（顺铂单药）","D":"同期放化疗（顺铂单药）后序贯吉西他滨+顺铂辅助化疗"},"answer":"A","vignette":"患者男，67岁，既往体健。因“回吸性涕血1个月”就诊。鼻咽镜活检示非角化性未分化癌。体格检查示双侧颈部可触及数枚肿大淋巴结，质硬，活动度差，最大径约4cm，位于下颈部，未累及锁骨上窝。头颈部MRI及CT显示：鼻咽顶后壁及侧壁增厚，伴颅底骨质破坏（翼突内板及斜坡受侵），未见颅内受侵；双侧II-III区多发肿大淋巴结，最大径<6cm，包膜外侵犯不明显。全身PET/CT未见远处转移。辅助检查：WBC 5.5×10^9/L, Hgb 125g/L, PLT 210×10^9/L, ALT 25 U/L, Cr 80 umol/L。血浆EBV-DNA定量为1.0×10^4 copies/mL。ECOG PS评分0分。临床分期评估为T3N2M0（AJCC第8版，III期）。","capability_group":"initial_definitive"}
+{"id":"l2-sample-3df9171e443c9f03986bee02","question":"该患者首选的最佳综合治疗策略是？","options":{"A":"先行全身系统性化疗（如吉西他滨+顺铂），若化疗后病灶缓解或稳定，后续跟进鼻咽及颈部原发灶的高剂量根治性放疗，并考虑对骨转移灶进行局部治疗。","B":"首选针对椎体骨转移灶行姑息性放疗以预防骨折和疼痛，随后行原发灶根治性手术切除，术后辅助放化疗。","C":"鉴于患者已出现多发骨转移，属于晚期IVB期（AJCC 8th），治疗目标主要为姑息减症，首选PD-1抑制剂联合GP方案化疗，原发灶放疗仅在出现严重局部压迫症状时介入。","D":"立即行鼻咽原发灶及颈部淋巴结根治性放疗（IMRT），同步使用顺铂增敏，放疗结束后再给予辅助化疗以控制全身微小转移。"},"answer":"A","vignette":"患者男，48岁，既往体健。因“间断回吸性涕血1个月”就诊。体格检查示PS评分0分，双侧颈部可触及数个肿大淋巴结，最大径均<6cm，质硬，活动度差。鼻咽镜活检示非角化性未分化癌。头颈部MRI显示鼻咽顶后壁软组织肿块，侵犯海绵窦及双侧翼腭窝，伴第V、VI对脑神经受累征象；双侧颈部II-III区可见多发肿大淋巴结。全身PET-CT及骨扫描提示：胸腰椎可见3处高代谢病灶，考虑骨转移，余未见远处转移征象。基线实验室检查：EBV DNA 5.0×10^4 copies/mL，WBC 5.5×10^9/L，Hgb 125g/L，PLT 210×10^9/L，肝肾功能正常。患者目前无骨痛症状，无脊髓压迫风险。","capability_group":"metastatic_systemic"}
+{"id":"l2-sample-8f7eb5e37f75169611ce8358","question":"关于该患者下一步的治疗策略及放疗靶区勾画原则，下列哪项是最符合当前循证医学证据及指南推荐的？","options":{"A":"鉴于诱导化疗后EBV DNA已转阴且达到PR，根据最新III期临床研究证据，可豁免同期化疗，直接行单纯根治性调强放疗（IMRT），以降低晚期毒性并保持非劣效的生存获益","B":"给予IMRT同期联合顺铂（100mg/m² q3w）化疗。为缩小照射体积并保护正常组织，原发灶大体肿瘤靶区（GTVnx）应严格按照诱导化疗后的肿瘤残留范围进行勾画","C":"给予IMRT同期联合顺铂（100mg/m² q3w）化疗。原发灶大体肿瘤靶区（GTVnx）原则上应参考诱导化疗前的肿瘤范围，但当肿瘤退缩远离脑干、视交叉等危及器官（OAR）时，靠近OAR侧的边界可按化疗后的范围进行勾画","D":"给予IMRT同期联合顺铂化疗，并序贯PD-1抑制剂维持治疗1年。因CONTINUUM等研究已证实，对于所有局部晚期鼻咽癌，在标准放化疗基础上加入免疫治疗可显著提高总生存期（OS）","E":"给予IMRT同期联合卡铂或奈达铂化疗。因患者已接受3周期含铂诱导化疗，继续使用大剂量顺铂将导致极高危的不可逆感音神经性耳聋，且卡铂同期化疗的局控率已证实优于顺铂"},"answer":"C","vignette":"患者男，47岁，既往体健。因“发现左颈部包块1个月”就诊，鼻咽镜及病理确诊为鼻咽非角化性癌（未分化型）。初诊影像学评估为cT3cN2cM0（第8版AJCC分期）。基线血浆EBV DNA为 4.5×10^4 copies/mL。患者接受了3周期吉西他滨+顺铂（GP方案）诱导化疗，过程顺利。目前为诱导化疗结束后3周，复查鼻咽及颈部MRI显示原发灶及淋巴结明显缩小，达到部分缓解（PR）。最新实验室检查：肝肾功能正常，听力测试正常。复查血浆EBV DNA为 0 copies/mL。","capability_group":"initial_definitive"}
+{"id":"l2-sample-312841256eb36681c5a67c27","question":"最恰当的后续管理策略是？","options":{"A":"考虑到孤立肾且出现疑似早期免疫相关性肾炎（肌酐轻度升高伴尿蛋白+-），应立即暂停特瑞普利单抗，给予小剂量糖皮质激素（如泼尼松 0.5mg/kg/d）干预，待肾功能恢复基线后再降级重启","B":"鉴于患者已达临床完全缓解（cCR）且免疫维持已超过1年，继续用药的边际获益递减而孤立肾不可逆损伤风险增加，应停用免疫治疗，针对原肝骨转移灶行SBRT巩固以追求潜在治愈","C":"继续按标准剂量和周期维持特瑞普利单抗治疗，密切监测肾功能及尿常规；TRUST滴度波动属正常范围，暂不干预梅毒","D":"将特瑞普利单抗的给药间隔延长至每6周一次，以减轻孤立肾的药物排泄负担，同时因TRUST滴度升高（1:1升至1:2），需加用苄星青霉素驱梅治疗以防免疫过度激活导致梅毒复发","E":"停用特瑞普利单抗，序贯卡培他滨节拍化疗维持，因卡培他滨主要经肝脏代谢，对孤立肾的安全性优于潜在的免疫性肾炎风险","F":"继续特瑞普利单抗维持治疗，但需预防性加用保肾药物（如百令胶囊/金水宝），并针对骨转移原发部位加用双膦酸盐预防骨相关事件（SREs）"},"answer":"C","vignette":"患者男，44岁，先天性左侧孤立肾。2年前确诊为鼻咽非角化性癌（初诊分期cT4cN3cM1，伴肝、骨多发转移），既往有隐性梅毒病史（规范治疗后TRUST滴度长期维持1:1）。\n\n患者接受了一线吉西他滨+顺铂联合特瑞普利单抗治疗6周期，原发灶及转移灶均达部分缓解（PR），随后对原发灶及颈部淋巴结行根治性放疗，肝骨病灶逐渐退缩至影像学无活性。此后患者接受特瑞普利单抗单药维持治疗，至今已维持14个月。\n\n近期复查：患者无不适，ECOG PS 0分。鼻咽镜及全身PET-CT未见肿瘤活性（评估为cCR），血浆EBV-DNA连续3次为0 copies/mL。\n\n实验室检查： 肝功能正常；血肌酐 118 μmol/L（基线为105 μmol/L），eGFR 62 ml/min/1.73m²；尿常规示：尿蛋白（+-），红细胞 1-2/HPF；梅毒TRUST滴度复查为 1:2。","capability_group":"metastatic_systemic"}
+{"id":"l2-sample-b464e1f1b3aebb8a1caf95e8","question":"基于该患者的临床分期及高危因素特征，最佳的一线综合治疗策略是？","options":{"A":"吉西他滨+顺铂诱导化疗（3周期），序贯同期放化疗（顺铂单药增敏）","B":"多西他赛+顺铂+氟尿嘧啶（TPF）诱导化疗，序贯单纯根治性放疗","C":"帕博利珠单抗联合吉西他滨+顺铂诱导治疗，序贯同期放化疗","D":"单纯同期放化疗（顺铂100mg/m² q3w × 3周期）"},"answer":"A","vignette":"患者男，53岁，既往体健。因“回吸性涕血1月余”就诊。查体：ECOG评分0分，双侧颈部触及数枚质硬淋巴结，最大径约4cm，活动度差，无压痛。鼻咽镜活检提示非角化性未分化癌。头颈部MRI及增强CT显示：鼻咽顶后壁软组织肿块，侵犯斜坡及颅底骨质，双侧咽后及颈部II-III区可见多发肿大淋巴结，最大径<6cm，包膜外侵犯不明显，双侧锁骨上窝未见肿大淋巴结。全身检查未见远处转移。辅助检查：WBC 5.5×10^9/L, Hgb 125g/L, PLT 210×10^9/L, ALT 25 U/L, Cr 80 μmol/L。血浆EBV-DNA定量为1.0×10^4 copies/mL。临床分期评估为T3N2M0（II期，AJCC第9版）。","capability_group":"initial_definitive"}
+{"id":"l2-sample-24be33c9cf770eae89b0efa3","question":"下列哪种综合治疗模式为当前指南的首选推荐？","options":{"A":"单纯调强放射治疗（IMRT）","B":"诱导化疗（GP方案 x 3周期）序贯同期放化疗（CCRT）","C":"诱导化疗（TPF方案 x 3周期）序贯单纯IMRT","D":"同期放化疗（CCRT，顺铂单药周方案或三周方案）"},"answer":"D","vignette":"患者男，63岁。因“间断回吸性涕血2个月”就诊。查体：鼻咽部见新生物。鼻咽MRI：鼻咽顶后壁软组织增厚，侵犯咽旁间隙，单侧咽后及颈部II区淋巴结肿大，最大径 2.5cm，未及包膜外侵犯（ENE阴性）。全身PET-CT未见远处转移。血浆EBV DNA：15,000 copies/mL。病理：非角化性未分化癌。定为II期（T2N1M0）。ECOG 0分，肝肾功能及听力正常。","capability_group":"initial_definitive"}
+{"id":"l2-sample-7530b04e85c359ea97affeee","question":"首选的一线系统治疗策略是？","options":{"A":"卡培他滨单药节拍化疗联合 EGFR单抗（如西妥昔单抗）","B":"吉西他滨 + 顺铂（GP方案）联合 PD-1单抗治疗，后续视情况考虑姑息性放疗","C":"根治性同步放化疗（IMRT + 大剂量顺铂），随后序贯吉西他滨 + 顺铂维持化疗","D":"单纯吉西他滨 + 顺铂（GP方案）化疗 6 周期"},"answer":"B","vignette":"患者男，42岁，既往体健。因“回吸性涕血伴头痛2月”就诊。查体示ECOG PS评分0分，双侧颈部及左侧锁骨上窝可触及多枚肿大淋巴结，质硬固定。鼻咽镜活检病理提示：非角化性未分化型癌。头颈部MRI显示：鼻咽顶后壁软组织肿块，侵犯双侧海绵窦，伴第V、VI对脑神经受累征象；双侧颈部及锁骨上窝多发淋巴结肿大。PET/CT及骨扫描显示：全身多发骨转移（包括椎体、骨盆及肋骨），无内脏转移。实验室检查：EBV-DNA 2.0×10^5 copies/mL，WBC 5.5×10^9/L，Hgb 125g/L，PLT 210×10^9/L，ALT 25 U/L，Cr 80 μmol/L。患者目前无显著骨痛，未发生病理性骨折。","capability_group":"metastatic_systemic"}
+{"id":"l2-sample-319157280e0a2c1978c00b5c","question":"最符合权威指南推荐且最恰当的是？","options":{"A":"停用GP方案，继续使用特瑞普利单抗单药维持治疗，并密切监测甲状腺功能","B":"停用顺铂，继续使用吉西他滨联合特瑞普利单抗维持治疗，直至EBV-DNA完全清零","C":"停用GP方案，鉴于EBV-DNA未清零且存在肝脏寡残留，采用特瑞普利单抗联合卡培他滨进行双药维持治疗","D":"停用GP方案，针对肝脏残留病灶立即行立体定向放疗（SBRT），随后使用特瑞普利单抗维持治疗","E":"停用特瑞普利单抗（因已发生irAE），改用卡培他滨单药维持治疗","F":"停用GP方案，采用特瑞普利单抗联合小分子VEGFR-TKI（如阿帕替尼）维持治疗以强化对残留病灶的控制"},"answer":"A","vignette":"患者男，61岁，ECOG PS 1分。2020年确诊为局部晚期鼻咽癌，行根治性放化疗。2022年10月复查发现肝脏多发转移（最大径3.2cm）及双肺多发小结节，经穿刺证实为鼻咽癌转移。基线血浆EBV-DNA为 4.5×10^5 copies/mL。\n\n患者随后入组接受了一线“吉西他滨+顺铂（GP）联合特瑞普利单抗”治疗。在完成第6周期治疗后进行疗效评估：双肺结节完全消失，肝脏病灶明显缩小，仅残留一处1.2cm的结节，总体评价为部分缓解（PR）。复查血浆EBV-DNA降至 8.0×10^2 copies/mL（未完全清零）。\n\n当前安全性评估：患者在第5、6周期出现2级周围神经病变（手足麻木，影响工具性日常生活），以及1级甲状腺功能减退（目前口服左甲状腺素钠片，TSH控制在正常范围）。血常规示2级白细胞减少。","capability_group":"post_treatment_recurrence"}
+{"id":"l2-sample-0b851eeb7344f4764a08810c","question":"当前首选的挽救性治疗策略是？","options":{"A":"经鼻内镜鼻咽病灶切除术（Endoscopic Nasopharyngectomy）","B":"吉西他滨 + 顺铂（GP方案）诱导化疗，随后观察","C":"调强适形放疗（IMRT）再次放疗，总剂量60Gy/30f","D":"光动力疗法（PDT）局部处理"},"answer":"A","vignette":"患者男，62岁，ECOG PS 0分。主诉“回吸性涕血2周”。既往史：3年前确诊为鼻咽癌（T3N1M0），接受过根治性放化疗，治疗结束时评估为完全缓解。近期随访MRI提示：鼻咽顶后壁可见一局限性软组织增厚结节，增强扫描可见轻度强化，病灶局限于鼻咽腔内（rT1），与双侧颈内动脉均有清晰脂肪间隙，未见颅底骨质破坏。颈部淋巴结超声及MRI未见肿大淋巴结。全身PET/CT未见远处转移。查体：鼻内镜见鼻咽顶后壁菜花状新生物，活检证实为非角化性癌。实验室检查：血常规、肝肾功能正常；血浆EBV DNA 1000 copies/mL。","capability_group":"post_treatment_recurrence"}
+{"id":"l2-sample-d9d72e571ddacd613f8f570c","question":"以下哪种治疗策略最能平衡疗效与毒性，并符合目前的优选循证医学证据？","options":{"A":"多西他赛+顺铂+氟尿嘧啶（TPF方案）诱导化疗（3周期），诱导化疗后行同期放化疗。","B":"单纯同期顺铂化疗联合调强放疗（CCRT），不进行诱导化疗。","C":"吉西他滨+顺铂（GP方案）诱导化疗（2-3周期），诱导化疗后行同期顺铂单药化疗联合调强放疗（IMRT）。","D":"单纯调强放疗（IMRT），因EBV DNA阴性预示预后良好，可豁免化疗。"},"answer":"C","vignette":"患者男，66岁，ECOG评分0分。既往体健，否认高血压、糖尿病及肝炎病史，无外伤及输血史。因确诊鼻咽癌伴颈部淋巴结转移就诊。初诊分期检查显示鼻咽部局限性病灶（cT1），伴双侧颈部多发淋巴结转移，最大径大于6cm，且下颈部受累（cN3）。既往未接受过抗肿瘤治疗。实验室检查示血常规及肝肾功能均正常，EBV DNA拷贝数为0 copies/mL（低于检测下限）。患者目前为初治局部晚期鼻咽癌，未发现远处转移。临床诊断为局限期鼻咽癌（T1N3M0，IV A期）。","capability_group":"initial_definitive"}
+{"id":"l2-sample-32fc315cd2de9da26454da94","question":"关于后续治疗策略的最优选择及临床考量，以下哪项最为恰当？","options":{"A":"鉴于患者为极低危人群（T1N1且EBV DNA阴性），同期化疗的绝对获益有限且增加毒性，建议取消后续的同期顺铂化疗，改为单纯根治性调强放疗（IMRT）","B":"继续按原计划完成剩余的同期放化疗，放疗结束后无需常规增加辅助化疗，进入定期随访观察","C":"考虑到患者年轻且耐受性极佳，为进一步降低远处转移风险，建议在完成同期放化疗后，序贯卡培他滨单药节拍性辅助化疗维持1年","D":"鉴于咽后淋巴结转移（N1），存在潜在的微转移风险，建议在放疗结束后补充2个周期的GP方案（吉西他滨+顺铂）辅助化疗"},"answer":"B","vignette":"患者男，38岁，既往体健，ECOG 0分。确诊为非角化性癌（未分化型），基线分期为cT1cN1cM0（AJCC第8版，单侧咽后淋巴结转移，最大径1.2cm），基线EBV DNA为0 copies/mL。经MDT讨论后，患者已接受1个周期以顺铂为基础（100mg/m²，d1）的同期放化疗（CCRT）。目前放疗进行至第4周，复查血常规及肝肾功基本正常，复查EBV DNA仍为0 copies/mL。患者出现1级口干及1级放射性皮炎，耐受性良好。","capability_group":"initial_definitive"}
+{"id":"l2-sample-7ae12cc9ec0c37f5058638ec","question":"最佳的一线综合治疗策略是？","options":{"A":"吉西他滨+顺铂 (GP) 诱导化疗（3周期）序贯 同期放化疗（顺铂 100mg/m² q3w）","B":"同期放化疗（IMRT + 顺铂 40mg/m² q1w）序贯 辅助化疗（PF方案 3周期）","C":"单纯同期放化疗（IMRT + 顺铂 100mg/m² q3w）","D":"多西他赛+顺铂+氟尿嘧啶 (TPF) 诱导化疗（3周期）序贯 单纯调强放疗（IMRT）"},"answer":"A","vignette":"患者男，43岁，既往体健。因“回吸性涕血1月余”就诊。查体：ECOG评分 0分。鼻咽镜示鼻咽顶后壁肿物。头颈部MRI及CT显示：鼻咽顶后壁软组织肿块，伴颅底骨质破坏（累及翼突及破裂孔），双侧颈部II区可见多发肿大淋巴结，最大径约3.5cm，包膜完整，未融合，双侧淋巴结均位于环状软骨下缘以上。胸腹盆CT及全身骨扫描未见远处转移。血常规及生化检查：WBC 5.5×10^9/L, Hgb 125g/L, PLT 210×10^9/L, ALT 25 U/L, Cr 80 umol/L。血浆EBV-DNA定量为 10,000 copies/mL。病理活检提示：非角化性未分化癌。","capability_group":"initial_definitive"}
+{"id":"l2-sample-b4ca1dd498d565198bbea2ea","question":"考虑到患者既往病史，同期化疗方案首选以下哪项？","options":{"A":"卡铂 (Carboplatin) 单药，AUC 5-6，每3周一次","B":"顺铂 (Cisplatin) 单药，100 mg/m²，每3周一次","C":"顺铂 (Cisplatin) 单药，40 mg/m²，每周一次","D":"尼妥珠单抗 (Nimotuzumab) 联合多西他赛 (Docetaxel)"},"answer":"A","vignette":"患者男，54岁（1971年1月出生），因回吸性涕血1个月就诊。既往史显著：双耳重度感音神经性耳聋多年，需佩戴大功率助听器方可维持日常交流。体能状态评分（ECOG PS）为0分。鼻咽镜及活检确诊为鼻咽非角化性癌（未分化型）。增强CT及MRI显示：鼻咽顶后壁肿物侵犯颅底骨质，伴有骨质破坏；双侧颈部可见数枚肿大淋巴结，最大径均小于6cm，位于锁骨上窝以上区域。全身检查未见远处转移。辅助检查示：WBC 5.5×10^9/L, Hgb 125g/L, PLT 210×10^9/L, ALT 25 U/L, Cr 80 μmol/L。血浆EBV-DNA定量为5000 copies/mL。经多学科讨论（MDT），计划行根治性放疗联合同期化疗。","capability_group":"toxicity_contraindication"}
+{"id":"l2-sample-92f5b1d3c1cdfc92eca37c7c","question":"首选的一线系统治疗方案是？","options":{"A":"吉西他滨 + 顺铂 (GP方案) + PD-1抑制剂","B":"吉西他滨 + 顺铂 (GP方案) 单纯化疗","C":"TPF诱导化疗（多西他赛+顺铂+氟尿嘧啶）序贯根治性放疗","D":"根治性放疗（针对鼻咽及颈部病灶）+ 同期顺铂化疗"},"answer":"A","vignette":"患者男，70岁（1955年1月出生），既往体健。因“回吸性涕血伴右侧头痛2月余”就诊。查体：ECOG评分0分，右侧锁骨上窝触及数枚质硬、融合肿大淋巴结，右侧外展神经麻痹。鼻咽部MRI提示：鼻咽顶后壁软组织肿块，侵犯海绵窦及斜坡，伴双侧颈部及右侧锁骨上窝多发淋巴结肿大。全身骨扫描及后续CT证实胸腰椎及骨盆多发骨转移。实验室检查：WBC 5.5×10^9/L, Hgb 125g/L, PLT 210×10^9/L, ALT 25 U/L, Cr 80 μmol/L。血浆EBV-DNA定量为2.0×10^5 copies/mL。患者无免疫治疗禁忌证。","capability_group":"metastatic_systemic"}
+{"id":"l2-sample-25ffd1fe92bdb14fd32682d3","question":"下一步最恰当的治疗策略是？","options":{"A":"继续给予辅助化疗（Adjuvant Chemotherapy）2-3周期（如PF方案）","B":"追加PD-1抑制剂免疫维持治疗1年","C":"给予卡培他滨节拍维持化疗1年","D":"结束抗肿瘤治疗，进入定期随访观察"},"answer":"D","vignette":"患者男，68岁，PS评分0分。既往体健，无高血压、糖尿病及心肾疾病史，15年前行阑尾切除术。患者确诊鼻咽癌（非角化性癌，未分化型），初诊分期为cT3cN2M0（II期，AJCC第9版）。既往治疗经过：已完成诱导化疗（Gemcitabine + Cisplatin）2周期，复查血浆EBV-DNA降为0 copies/mL（治疗前为1.5×10^4 copies/mL），随后进行了同期放化疗（IMRT + Cisplatin 100 mg/m² q3w × 2），目前为同期放化疗结束后12周。复查鼻咽及颈部MRI显示原发灶及颈部淋巴结均较前明显缩小，达到临床完全缓解（cCR）。最新实验室检查：血常规及肝肾功能均未见明显异常，血浆EBV-DNA持续为0 copies/mL。患者目前一般情况良好，无严重放化疗毒性反应残留。","capability_group":"initial_definitive"}
+{"id":"l2-sample-13056a45d6fa34e56721e6e5","question":"首选的一线系统治疗方案是？","options":{"A":"TPF方案（多西他赛+顺铂+氟尿嘧啶）诱导化疗，序贯姑息性放疗","B":"吉西他滨 + 顺铂（GP） + 特瑞普利单抗（或卡瑞利珠单抗）","C":"吉西他滨 + 顺铂（GP）单纯化疗","D":"根治性调强放疗（IMRT）同期顺铂化疗，随后行辅助化疗"},"answer":"B","vignette":"患者男，68岁，既往体健。因“回吸性涕血伴右侧面部麻木2月余”就诊。查体：ECOG评分0分，双侧颈部未触及明显肿大淋巴结，左侧锁骨上窝触及数枚质硬、融合淋巴结。鼻咽镜活检病理提示：非角化性未分化癌。头颈部MRI显示：鼻咽顶后壁软组织肿块，侵犯海绵窦，伴右侧第V、VI对脑神经受累征象；双侧颈部及左侧锁骨上窝多发淋巴结肿大。全身PET-CT及骨扫描提示：胸椎、腰椎及骨盆多发骨质破坏，代谢活跃，提示广泛骨转移。实验室检查：EBV-DNA 2.0×10^5 copies/mL；血常规：WBC 5.5×10^9/L, Hgb 125g/L, PLT 210×10^9/L；生化：ALT 25 U/L, Cr 80 μmol/L。患者目前无显著骨痛，重要脏器功能储备良好。","capability_group":"metastatic_systemic"}
+{"id":"l2-sample-1646b48370e50b03361286a3","question":"基于患者目前的治疗反应（姑息化疗6周期后SD，EBV-DNA清零）及身体状况，下一步最合理的治疗策略是？","options":{"A":"恢复特瑞普利单抗单药维持治疗，并联合地舒单抗皮下注射","B":"采用卡培他滨单药口服维持治疗，并联合唑来膦酸静脉滴注","C":"采用吉西他滨单药静脉维持治疗，并针对多发骨转移灶行姑息性放疗（30Gy/10f）","D":"停用所有抗肿瘤药物，进入观察随访期，仅给予双膦酸盐预防骨相关事件","E":"采用特瑞普利单抗联合卡培他滨维持治疗，并联合地舒单抗皮下注射"},"answer":"B","vignette":"患者男，70岁。既往体健。2022年3月确诊为鼻咽未分化型非角化性癌（cT3N3M0 IVA期），接受诱导化疗（GP方案）序贯同期放化疗（IMRT+顺铂）后达到完全缓解（CR）。\n\n2023年12月常规随访发现多发椎体及肋骨转移（无承重骨破坏，无骨痛），确诊为IVB期。血浆EBV-DNA为 4.5×10^4 copies/mL。\n\n姑息治疗经过：2024年1月起，患者接受“吉西他滨+顺铂+特瑞普利单抗”一线姑息治疗。在第3周期治疗后，患者出现活动后气促，胸部CT提示双肺多发磨玻璃影，诊断为3级免疫相关性肺炎（irAE）。经静脉大剂量甲泼尼龙（2mg/kg/d）治疗2周后症状缓解，影像学吸收，激素逐渐减量至停药。\n\n后续治疗：因irAE，永久停用特瑞普利单抗。患者随后仅接受了第4至第6周期的“吉西他滨+顺铂”双药化疗，末次化疗结束于3周前。\n\n当前状态：患者一般情况良好，ECOG PS 0分，无骨痛，无呼吸道症状。复查影像学示：骨转移灶成骨性改变，无新发病灶，疗效评价为病情稳定（SD）。血浆EBV-DNA定量为 0 copies/mL。血常规及肝肾功能正常。","capability_group":"metastatic_systemic"}
+{"id":"l2-sample-eeda5f2ca819946d9105ed1d","question":"基于该患者的临床分期及风险分层，首选的根治性治疗方案是？","options":{"A":"同期放化疗（IMRT + 单药顺铂周疗）","B":"诱导化疗（吉西他滨+顺铂）后行单纯IMRT","C":"单纯IMRT + 辅助化疗（氟尿嘧啶+顺铂）","D":"单纯调强适形放射治疗（IMRT）"},"answer":"D","vignette":"患者男，65岁，既往体健。因“回吸性涕血1个月”就诊。查体：鼻咽顶后壁可见粗糙黏膜隆起，颈部未触及肿大淋巴结。鼻咽镜活检病理示：非角化性未分化癌。辅助检查如下：\n1. 鼻咽+颈部MRI：鼻咽顶后壁软组织增厚，局限于鼻咽腔内，未侵犯咽旁间隙、颅底骨质或鼻腔，双侧颈部未见肿大淋巴结。\n2. 实验室检查：WBC 5.5×10^9/L，Hgb 125g/L，PLT 210×10^9/L，ALT 25 U/L，Cr 80 μmol/L。\n3. 血浆EBV-DNA：0 copies/mL。\n4. 全身评估（胸腹CT及骨扫描）未见远处转移。\n患者ECOG评分为0分。","capability_group":"initial_definitive"}
+{"id":"l2-sample-ba5cb5caeb6205effc7983a1","question":"针对该患者最恰当的后续维持及局部干预策略是？","options":{"A":"停用GP化疗，采用特瑞普利单抗单药维持；同时对原发灶及颈部淋巴结行根治性放疗（66-70 Gy），骨转移灶行立体定向放射治疗（SBRT）","B":"停用GP化疗，采用特瑞普利单抗单药维持；同时对原发灶及颈部淋巴结行根治性放疗（66-70 Gy），骨转移灶暂不作局部放疗，继续系统维持","C":"停用GP化疗，采用特瑞普利单抗联合卡培他滨维持；同时对原发灶及颈部淋巴结行姑息性放疗（50-54 Gy），骨转移灶暂不处理","D":"停用GP化疗，采用特瑞普利单抗单药维持；鉴于广泛多发转移，暂不进行任何局部放疗，待系统治疗进展后再行局部干预","E":"减量GP方案（降低25%剂量）继续联合特瑞普利单抗治疗至9个周期以巩固疗效，随后对原发灶及颈部淋巴结行根治性放疗","F":"停用GP化疗，采用特瑞普利单抗单药维持；同时对原发灶、颈部淋巴结及主要骨转移灶均行姑息性减症放疗（30 Gy/10f）"},"answer":"B","vignette":"患者男，45岁，ECOG评分0分。确诊为初诊转移性鼻咽癌（cT4N3M1，IVB期），PET-CT提示鼻咽顶后壁及双侧颈部多发淋巴结转移，伴全身多发骨转移（中轴骨及附肢骨广泛转移，>10处，无承重骨病理性骨折风险及脊髓压迫症状）。既往接受了吉西他滨+顺铂（GP方案）联合特瑞普利单抗（PD-1抑制剂）的一线系统治疗。\n\n共完成6个周期后复查：鼻咽部原发灶及颈部淋巴结明显缩小（达到PR），多发骨转移灶成骨性改变，较前稳定（SD）。血浆EBV-DNA由初诊时的 5.4×10^5 copies/mL 降至 0 copies/mL。\n\n安全性方面：患者在第6周期化疗后第5天出现高热（39.5℃），血常规提示IV度骨髓抑制伴发热性中性粒细胞减少（FN），经G-CSF及广谱抗生素治疗后恢复。目前患者一般情况良好，无明显骨痛。","capability_group":"metastatic_systemic"}
+{"id":"l2-sample-7ce2f2e0a46518075d2dc9c2","question":"结合现有循证证据与指南推荐，以下哪项更合理作为二线系统治疗？","options":{"A":"针对多发骨转移灶行大范围姑息性放疗，暂不进行系统治疗","B":"多西他赛+顺铂+氟尿嘧啶（TPF方案）诱导化疗","C":"再次使用吉西他滨+卡铂双药联合化疗","D":"单药PD-1抑制剂（如卡瑞利珠单抗或特瑞普利单抗）治疗"},"answer":"D","vignette":"患者男，68岁，出生日期[出生信息已隐去]月。因“回吸性涕血伴腰痛2周”就诊。既往史：确诊为鼻咽癌（T3N2M0），接受吉西他滨+顺铂（GP方案）诱导化疗3周期及同期放化疗，治疗过程顺利。末次化疗结束距今仅1.5个月。现查体：ECOG评分 0分，鼻咽镜检查示鼻咽顶后壁新生物。全身骨显像提示多发骨代谢活跃灶（椎体、肋骨）。辅助检查：血常规 WBC 5.5×10^9/L, Hgb 125g/L, PLT 210×10^9/L；生化指标 ALT 25 U/L, Cr 80 umol/L。血浆EBV-DNA定量为 5.0×10^4 copies/mL。患者目前无内脏危象，无免疫治疗禁忌证。","capability_group":"metastatic_systemic"}
+{"id":"l2-sample-b232df2d6c5bb88e206c9c82","question":"以下哪项同期化疗方案选择更合理且更安全？","options":{"A":"采用标准剂量顺铂（Cisplatin 100 mg/m² q3w）进行同期放化疗，并在化疗前后给予加强水化利尿及肾脏保护治疗。","B":"放弃同期化疗，仅行单纯根治性调强放疗（IMRT），并在放疗结束后给予吉西他滨+顺铂辅助化疗。","C":"采用卡铂（Carboplatin）替代顺铂进行同期放化疗，剂量按AUC 5-6每3周一次或AUC 2每周一次给药。","D":"采用奈达铂（Nedaplatin）80 mg/m² q3w替代顺铂，因其肾毒性相对较低，但仍需适当水化。"},"answer":"C","vignette":"患者男，51岁，因“回吸性涕血1月余”就诊。鼻咽镜活检病理示非角化性未分化癌。既往有慢性肾脏病（CKD）3期病史，未行透析治疗。体能状态评分（ECOG PS）为0分。分期检查资料如下：鼻咽部MRI及CT显示鼻咽顶后壁软组织增厚，伴颅底骨质破坏；双侧颈部可见多发淋巴结肿大，最大径均小于6cm，主要位于II区，无包膜外侵犯征象；全身PET-CT未见远处转移。实验室检查：白细胞 5.5×10^9/L，血红蛋白 125 g/L，血小板 210×10^9/L，ALT 25 U/L，血清肌酐 201 μmol/L（计算肌酐清除率约为 30-35 ml/min）。血浆EBV-DNA定量为 5000 copies/mL。目前拟行根治性放化疗。","capability_group":"toxicity_contraindication"}
+{"id":"l2-sample-2f4a4cf31eec2d081a378f1c","question":"基于该患者的既往史，同期化疗方案首选下列哪项？","options":{"A":"顺铂 (Cisplatin) 40 mg/m²，每周一次","B":"顺铂 (Cisplatin) 100 mg/m²，每3周一次","C":"卡铂 (Carboplatin) AUC 5-6，每3周一次","D":"西妥昔单抗 (Cetuximab) 400 mg/m² 负荷剂量，随后 250 mg/m² 每周一次"},"answer":"C","vignette":"患者男性，60岁，因“回吸性涕血1月余”就诊。既往史显著：双耳重度感音神经性耳聋（佩戴助听器效果欠佳）。体格检查：ECOG评分0分，鼻咽镜见顶后壁肿物，双侧颈部触及肿大淋巴结，最大径均小于6cm。辅助检查：头颈部CT及MRI显示鼻咽顶后壁软组织增厚，伴颅底骨质破坏，双侧颈部II区多发淋巴结肿大，包膜完整，无远处转移征象。实验室检查：EBV-DNA 5000 copies/mL，WBC 5.5×10^9/L，Hgb 125g/L，PLT 210×10^9/L，ALT 25 U/L，血肌酐 80 μmol/L。病理活检证实为非角化性未分化型鼻咽癌。患者拟行根治性放疗（IMRT），计划联合同期化疗。","capability_group":"toxicity_contraindication"}
+{"id":"l2-sample-b07a2c66dc90c0d07463f93f","question":"此时最恰当的处理策略是？","options":{"A":"暂停放疗，继续给予全量同期化疗，并加强输血及细胞因子支持治疗。","B":"暂停同期化疗，给予G-CSF及TPO/白介素-11支持治疗，严密监测下坚持继续放疗。","C":"将同期顺铂剂量减半继续化疗，同时给予升白及升血小板治疗，并继续放疗。","D":"立即停止所有治疗（包括放疗和化疗），直至血象完全恢复正常后再重新开始放疗。"},"answer":"B","vignette":"患者男，68岁，出生日期[出生信息已隐去]月。既往体健，ECOG评分0分。患者因“回吸性涕血”就诊，确诊为鼻咽癌（cT3N2M0，III期）。基线EBV DNA为0 copies/mL。影像学CT显示颅底骨质破坏，双侧颈部淋巴结肿大，但最大径均<6cm。患者接受根治性放疗联合同期化疗（顺铂单药）。目前放疗进行至第4周，患者自觉乏力。血常规示：WBC 1.8×10^9/L，Hgb 80g/L，PLT 45×10^9/L（重度骨髓抑制）。生化检查：ALT 25 U/L，Cr 80 umol/L。患者无发热，无活动性出血倾向。","capability_group":"toxicity_contraindication"}
+{"id":"l2-sample-f0d008f5f2da5c9f8afaeacf","question":"根据CSCO及国际主流诊疗原则，针对该患者目前的临床分期及风险特征，治疗策略最优选择是？","options":{"A":"单纯根治性调强放疗（IMRT）联合辅助化疗（氟尿嘧啶+顺铂）","B":"诱导化疗（吉西他滨+顺铂）后行同期放化疗","C":"同期放化疗（IMRT + 顺铂 100mg/m² q3w × 2周期）","D":"单纯根治性调强放疗（IMRT）"},"answer":"D","vignette":"患者男，55岁，既往体健。因“间断回吸性涕血1个月”就诊。鼻咽镜活检：非角化性未分化癌。头颈部MRI：鼻咽顶后壁软组织增厚，侵犯咽旁间隙；双侧颈部未见肿大淋巴结。全身评估无远处转移。治疗前血浆EBV-DNA：0 copies/mL。血常规及生化：WBC 5.5×10^9/L，Hgb 125 g/L，PLT 210×10^9/L，ALT 25 U/L，Cr 80 μmol/L。ECOG 0分。患者关注治疗相关远期毒性。","capability_group":"initial_definitive"}
+{"id":"l2-sample-0731a53f55a0139868c99889","question":"结合患者的分期及目前治疗状态，下一步最合适的治疗策略是？","options":{"A":"继续按计划完成根治性放疗，并按原计划给予第2、3周期顺铂同步化疗（100mg/m²）。","B":"继续按计划完成根治性放疗，但取消后续的同步化疗，改为单纯放疗。","C":"继续同步放化疗，但在放疗结束后必须加用辅助化疗（如PF方案）3周期。","D":"中断放疗，改为吉西他滨+顺铂（GP方案）诱导化疗2周期后再恢复放疗。"},"answer":"B","vignette":"患者男，69岁，ECOG PS 0分。既往体健，无高血压、糖尿病、心脏病史。患者因确诊鼻咽癌（非角化性癌，未分化型），于3周前开始接受根治性放疗，计划同步进行顺铂化疗（100mg/m² q3w）。目前处于放疗中期，已完成第1周期同步化疗及约15次放疗。入院复查评估。初诊分期为cT1cN1cM0（第8版AJCC分期），即T1期（局限于鼻咽），N1期（单侧颈部淋巴结转移，<6cm，锁骨上窝以上），M0。治疗前血浆EBV-DNA为0 copies/mL（低于检测下限）。目前血常规及生化指标：WBC 4.2×10^9/L, Hgb 125g/L, PLT 180×10^9/L, ALT 25 U/L, Cr 78 μmol/L。患者自述放疗反应轻微，仅有轻度口干，进食正常。","capability_group":"initial_definitive"}
+{"id":"l2-sample-3a3e8d4cbbe7b9ef45044bfd","question":"下一步最恰当的治疗调整策略是？","options":{"A":"立即停止放疗和化疗；入院行成分输血及升血小板/升白支持治疗，待血象恢复至可安全继续治疗水平后，再评估恢复放疗及化疗","B":"停止放疗及化疗，改用免疫检查点抑制剂（PD-1单抗）单药治疗以替代后续治疗","C":"暂停同期化疗；在强力升白及升血小板支持治疗下，密切监测血象，若无活动性出血及感染迹象，尽量维持放疗不中断。","D":"继续原计划放疗，将同期顺铂剂量减半（50%剂量）继续给药，同时给予重组人粒细胞集落刺激因子（G-CSF）和重组人血小板生成素（TPO）支持。"},"answer":"C","vignette":"患者男，68岁，PS评分0分。既往体健。因“回吸性涕血伴头痛2月”就诊。确诊为鼻咽癌，TNM分期评估显示颅底骨质破坏（T3），双侧颈部可见数个肿大淋巴结，最大径均<6cm，且位于锁骨上窝以上（N2），无远处转移（M0）。治疗方案制定为根治性放疗联合同期化疗（顺铂单药）。\n\n目前患者处于放疗第4周（累积剂量约40Gy），今日复查血常规提示：白细胞计数（WBC）1.8×10^9/L，绝对中性粒细胞计数（ANC）0.8×10^9/L，血红蛋白（Hgb）80g/L，血小板（PLT）45×10^9/L。肝肾功能基本正常（ALT 25 U/L, Cr 80 umol/L）。EBV-DNA拷贝数为0。患者目前无发热，无明显出血倾向，但感到中度乏力。","capability_group":"toxicity_contraindication"}
+{"id":"l2-sample-d135e24aac544dc035755add","question":"结合患者目前的分期、诱导化疗反应及EBV-DNA状态，下一步最恰当的治疗策略是？","options":{"A":"继续追加2-3个周期的GP方案诱导化疗，待肿瘤进一步缩小后再行放疗","B":"同步放化疗（IMRT + 顺铂单药周疗或三周疗）","C":"单纯调强放疗（IMRT），不再加用同期化疗","D":"同步放化疗 + 辅助化疗（AC）3个周期"},"answer":"B","vignette":"患者男，51岁，既往有乙肝、丙肝病史，目前规律服用恩替卡韦抗病毒治疗，病毒载量控制良好。否认高血压、糖尿病及心脏病史。患者确诊为鼻咽非角化性癌，初诊分期为 cT1cN3M0（IVa期，AJCC 8th）。患者此前已完成3个周期的GP方案（吉西他滨+顺铂）诱导化疗，过程顺利，耐受性良好。目前复查评估：鼻咽部及颈部病灶较前明显缩小，达到部分缓解（PR），血浆EBV-DNA转阴（0 copies/mL）。查体：ECOG评分 0分，浅表淋巴结未触及肿大。实验室检查：血常规、肝肾功能均在正常范围内（WBC、Hgb、PLT、ALT、Cr均正常）。","capability_group":"initial_definitive"}
+{"id":"l2-sample-3b528ab65f988c8d5012008e","question":"结合患者分期及指南，最合理的治疗策略是？","options":{"A":"同步放化疗（CCRT），同步顺铂 40mg/m² q1w × 6-7周期","B":"诱导化疗3周期，随后行单纯调强放疗","C":"单纯根治性调强放疗（IMRT），不再同步化疗","D":"同步放化疗（CCRT），同步顺铂 100mg/m² q3w × 2-3周期"},"answer":"C","vignette":"患者男，58岁。确诊鼻咽非角化性癌，cT1N1M0（AJCC 8版），基线EBV-DNA 1.2×10^3 copies/mL。EBV-DNA 0 copies/mL；血常规及肝肾功能无异常，ECOG PS 0。","capability_group":"initial_definitive"}
+{"id":"l2-sample-3af8ab2bcb7747472f1e1f1a","question":"基于该患者的临床分期及肾功能情况，关于同期放化疗方案，下列哪项调整策略最为合理？","options":{"A":"采用调强放疗（IMRT）同期联合顺铂100 mg/m² q3w，并行标准补液与肾功能监测","B":"采用调强放疗（IMRT）同期联合顺铂40 mg/m² q1w","C":"仅行单纯调强放疗（IMRT），不进行同期化疗，以避免肾毒性加重","D":"采用调强放疗（IMRT）同期联合卡铂（Carboplatin）单药（按AUC/Calvert公式剂量计算）"},"answer":"D","vignette":"患者男，40岁，因“回吸性涕血1月余”就诊。既往史明确记载患有慢性肾病3期，平时未规律随访。体格检查示PS评分0分。鼻咽镜检查可见鼻咽顶后壁肿物。增强CT及MRI显示鼻咽部肿物侵犯颅底骨质，双侧颈部可见多发淋巴结肿大，最大径均小于6cm，主要位于II区，无包膜外侵犯征象。未发现远处转移。实验室检查：白细胞 5.5×10^9/L，血红蛋白 125 g/L，血小板 210×10^9/L，谷丙转氨酶 25 U/L，血清肌酐 206 μmol/L。血浆EBV DNA定量为 5000 copies/mL。病理活检确诊为非角化性癌（未分化型）。","capability_group":"toxicity_contraindication"}
+{"id":"l2-sample-99151b55d2f0ec0667c212ca","question":"该患者一线含铂化疗结束后短期内进展，以下哪项二线系统治疗最合理？","options":{"A":"卡培他滨单药维持治疗","B":"针对所有骨转移病灶及鼻咽部复发灶立即进行根治性剂量的姑息放疗，暂不考虑系统治疗","C":"TPF方案（多西他赛+顺铂+氟尿嘧啶）再次含铂联合化疗","D":"单药免疫检查点抑制剂治疗（如特瑞普利单抗或卡瑞利珠单抗）"},"answer":"D","vignette":"患者男，59岁（1966年1月出生）。既往确诊为鼻咽癌（cT3N2M0），接受根治性放化疗后1年复发。随后接受一线GP方案（吉西他滨+顺铂）化疗6周期，治疗结束时疗效评估为部分缓解（PR）。然而，在化疗结束仅1.5个月后，患者再次出现回吸性涕血。复查全身PET-CT提示：鼻咽部病灶较前稍增大，且出现多发胸椎及肋骨高代谢病灶，考虑多发骨转移进展。查体：ECOG PS 0分，心肺听诊无殊。实验室检查：WBC 5.5×10^9/L, Hgb 125 g/L, PLT 210×10^9/L, ALT 25 U/L, Cr 80 umol/L。血浆EBV-DNA定量为 5.0×10^4 copies/mL。既往无自身免疫性疾病史。","capability_group":"metastatic_systemic"}
+{"id":"l2-sample-8944b991d39aa62afdd23a42","question":"基于该患者的特殊既往史及临床分期，最合适的同步用药选择是？","options":{"A":"西妥昔单抗 (Cetuximab) 负荷剂量后每周维持","B":"卡铂 (Carboplatin) AUC 5-6，每3周一次","C":"顺铂 (Cisplatin) 40 mg/m²，每周一次","D":"顺铂 (Cisplatin) 100 mg/m²，每3周一次"},"answer":"B","vignette":"患者男，42岁，因“回吸性涕血2月余”就诊。既往史显著：幼年因病致双耳重度感音神经性耳聋，目前依靠助听器维持微弱听力。体格检查：ECOG PS 0分。鼻咽镜活检示：非角化性未分化癌。影像学检查（CT及MRI）显示：鼻咽顶后壁软组织肿块，伴颅底骨质破坏（卵圆孔受侵），双侧颈部II区可见数枚肿大淋巴结，最大径约3.5cm，未见远处转移。实验室检查：WBC 5.5×10^9/L, Hgb 125g/L, PLT 210×10^9/L, ALT 25 U/L, Cr 80 μmol/L。血浆EBV-DNA定量为5000 copies/mL。经多学科讨论，拟行根治性放疗联合同期化疗。","capability_group":"toxicity_contraindication"}
+{"id":"l2-sample-e203ff0ae1558cc17d2f956d","question":"考虑到患者特殊既往史和听力保护需求，同期化疗药物更合适的首选是？","options":{"A":"顺铂 (Cisplatin) 100 mg/m²，每3周一次","B":"顺铂 (Cisplatin) 40 mg/m²，每周一次","C":"奈达铂 (Nedaplatin) 80-100 mg/m²，每3周一次","D":"卡铂 (Carboplatin) AUC 5-6，每3周一次"},"answer":"D","vignette":"患者男，64岁（1961年1月出生），因“回吸性涕血2月余”就诊。既往史显著：双耳重度感音神经性耳聋多年，需佩戴大功率助听器维持基本交流。查体：ECOG评分0分，鼻咽镜见顶后壁肿物。影像学检查（MRI及CT）提示鼻咽顶后壁增厚，伴颅底骨质破坏，双侧颈部可见多个肿大淋巴结，最大径均<6cm，包膜完整，无远处转移征象。实验室检查：WBC 5.5×10^9/L，Hgb 125g/L，PLT 210×10^9/L，ALT 25 U/L，血肌酐 80 μmol/L。血浆EBV-DNA定量为 5.0×10^3 copies/mL。临床分期评估为 T3N2M0 (III期)。现拟行根治性放疗联合同期化疗。","capability_group":"toxicity_contraindication"}
diff --git a/L3/N400.jsonl b/L3/N400.jsonl
new file mode 100644
index 0000000000000000000000000000000000000000..9d5fb751cb5ffdd56ce7ccc2be8cf60696285c57
--- /dev/null
+++ b/L3/N400.jsonl
@@ -0,0 +1,400 @@
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+{"id": "L3-N400:mri-0b9e6c5f475f4363", "n_stage": "N3", "input_format": "plane_groups"}
+{"id": "L3-N400:mri-64db89bf3cbe4fb6", "n_stage": "N3", "input_format": "plane_groups"}
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diff --git a/L3/Path.jsonl b/L3/Path.jsonl
new file mode 100644
index 0000000000000000000000000000000000000000..2e0ea25cf6033b136bb0264fa0be0bff78800dcb
--- /dev/null
+++ b/L3/Path.jsonl
@@ -0,0 +1,69 @@
+{"id": "Path-13eeaad7588e7d78cb5bbcd3", "gold": "1"}
+{"id": "Path-1e87026f70fe05477166a4b5", "gold": "1"}
+{"id": "Path-8d99b454807ba57bc86a4504", "gold": "1"}
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diff --git a/L3/README.md b/L3/README.md
new file mode 100644
index 0000000000000000000000000000000000000000..cedd6f132f5c97df97144ca168dae5b8b4dd467e
--- /dev/null
+++ b/L3/README.md
@@ -0,0 +1,9 @@
+# L3 · Multimodal grounding
+
+L3 contains 69 pathology cases, 200 sequence questions, 2,700 structure cards from 100 patients, 400 T-stage cases and 400 N-stage cases.
+
+`T400.jsonl` and `N400.jsonl` are the primary stage labels. `requests/T400.jsonl` and `requests/N400.jsonl` contain prompts and image paths relative to this L3 directory. Extract `images_and_inputs.tar.gz` here and the seven MRI shards inside `extensions/`.
+
+T400 comprises 100 structure-card patients and 300 sequence-group patients; N400 is a disjoint cohort using sequence groups. `Path.jsonl`, `Seq.jsonl`, `Struct.jsonl` and `secondary_labels/` contain the other task references.
+
+See [the MRI group guide](extensions/README.md) for sequences, anatomical coverage and model-specific sampling.
diff --git a/L3/Seq.jsonl b/L3/Seq.jsonl
new file mode 100644
index 0000000000000000000000000000000000000000..29dfe072efa1791bbec2cfa803df3460479e3c21
--- /dev/null
+++ b/L3/Seq.jsonl
@@ -0,0 +1,200 @@
+{"id": "Seq-8774e28a1aca45adea8d47b5", "gold": "E", "options": [{"option_id": "A", "sequence_label": "T1_Ax", "sequence_cn": "轴位 T1"}, {"option_id": "B", "sequence_label": "T2_Ax", "sequence_cn": "轴位 T2"}, {"option_id": "C", "sequence_label": "T1+C_Ax", "sequence_cn": "轴位增强 T1"}, {"option_id": "D", "sequence_label": "T1_COR", "sequence_cn": "冠状位 T1"}, {"option_id": "E", "sequence_label": "T1_SAG", "sequence_cn": "矢状位 T1"}, {"option_id": "F", "sequence_label": "T1+C_SAG", "sequence_cn": "矢状位增强 T1"}, {"option_id": "G", "sequence_label": "T1+C_COR_FS", "sequence_cn": "冠状位增强压脂 T1"}]}
+{"id": "Seq-b30ebe5dd4fee01809057bd0", "gold": "C", "options": [{"option_id": "A", "sequence_label": "T1_Ax", "sequence_cn": "轴位 T1"}, {"option_id": "B", "sequence_label": "T2_Ax", "sequence_cn": "轴位 T2"}, {"option_id": "C", "sequence_label": "T1+C_Ax", "sequence_cn": "轴位增强 T1"}, {"option_id": "D", "sequence_label": "T1_COR", "sequence_cn": "冠状位 T1"}, {"option_id": "E", "sequence_label": "T1_SAG", "sequence_cn": "矢状位 T1"}, {"option_id": "F", "sequence_label": "T1+C_SAG", "sequence_cn": "矢状位增强 T1"}, {"option_id": "G", "sequence_label": "T1+C_COR_FS", "sequence_cn": "冠状位增强压脂 T1"}]}
+{"id": "Seq-5a867646f5f64e7938db1dfa", "gold": "G", "options": [{"option_id": "A", "sequence_label": "T1_Ax", "sequence_cn": "轴位 T1"}, {"option_id": "B", "sequence_label": "T2_Ax", "sequence_cn": "轴位 T2"}, {"option_id": "C", "sequence_label": "T1+C_Ax", "sequence_cn": "轴位增强 T1"}, {"option_id": "D", "sequence_label": "T1_COR", "sequence_cn": "冠状位 T1"}, {"option_id": "E", "sequence_label": "T1_SAG", "sequence_cn": "矢状位 T1"}, {"option_id": "F", "sequence_label": "T1+C_SAG", "sequence_cn": "矢状位增强 T1"}, {"option_id": "G", "sequence_label": "T1+C_COR_FS", "sequence_cn": "冠状位增强压脂 T1"}]}
+{"id": "Seq-24866715418b4c6bfdc095f9", "gold": "D", "options": [{"option_id": "A", "sequence_label": "T1_Ax", "sequence_cn": "轴位 T1"}, {"option_id": "B", "sequence_label": "T2_Ax", "sequence_cn": "轴位 T2"}, {"option_id": "C", "sequence_label": "T1+C_Ax", "sequence_cn": "轴位增强 T1"}, {"option_id": "D", "sequence_label": "T1_COR", "sequence_cn": "冠状位 T1"}, {"option_id": "E", "sequence_label": "T1_SAG", "sequence_cn": "矢状位 T1"}, {"option_id": "F", "sequence_label": "T1+C_SAG", "sequence_cn": "矢状位增强 T1"}, {"option_id": "G", "sequence_label": "T1+C_COR_FS", "sequence_cn": "冠状位增强压脂 T1"}]}
+{"id": "Seq-bd818e43c8628d1f51c22ec2", "gold": "E", "options": [{"option_id": "A", "sequence_label": "T1_Ax", "sequence_cn": "轴位 T1"}, {"option_id": "B", "sequence_label": "T2_Ax", "sequence_cn": "轴位 T2"}, {"option_id": "C", "sequence_label": "T1+C_Ax", "sequence_cn": "轴位增强 T1"}, {"option_id": "D", "sequence_label": "T1_COR", "sequence_cn": "冠状位 T1"}, {"option_id": "E", "sequence_label": "T1_SAG", "sequence_cn": "矢状位 T1"}, {"option_id": "F", "sequence_label": "T1+C_SAG", "sequence_cn": "矢状位增强 T1"}, {"option_id": "G", "sequence_label": "T1+C_COR_FS", "sequence_cn": "冠状位增强压脂 T1"}]}
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+{"id": "Seq-4309e66a393937baacacd612", "gold": "B", "options": [{"option_id": "A", "sequence_label": "T1_Ax", "sequence_cn": "轴位 T1"}, {"option_id": "B", "sequence_label": "T2_Ax", "sequence_cn": "轴位 T2"}, {"option_id": "C", "sequence_label": "T1+C_Ax", "sequence_cn": "轴位增强 T1"}, {"option_id": "D", "sequence_label": "T1_COR", "sequence_cn": "冠状位 T1"}, {"option_id": "E", "sequence_label": "T1_SAG", "sequence_cn": "矢状位 T1"}, {"option_id": "F", "sequence_label": "T1+C_SAG", "sequence_cn": "矢状位增强 T1"}, {"option_id": "G", "sequence_label": "T1+C_COR_FS", "sequence_cn": "冠状位增强压脂 T1"}]}
+{"id": "Seq-f7286915dc2a00074e402bb4", "gold": "G", "options": [{"option_id": "A", "sequence_label": "T1_Ax", "sequence_cn": "轴位 T1"}, {"option_id": "B", "sequence_label": "T2_Ax", "sequence_cn": "轴位 T2"}, {"option_id": "C", "sequence_label": "T1+C_Ax", "sequence_cn": "轴位增强 T1"}, {"option_id": "D", "sequence_label": "T1_COR", "sequence_cn": "冠状位 T1"}, {"option_id": "E", "sequence_label": "T1_SAG", "sequence_cn": "矢状位 T1"}, {"option_id": "F", "sequence_label": "T1+C_SAG", "sequence_cn": "矢状位增强 T1"}, {"option_id": "G", "sequence_label": "T1+C_COR_FS", "sequence_cn": "冠状位增强压脂 T1"}]}
+{"id": "Seq-1a4148cbde6d7e9470931feb", "gold": "G", "options": [{"option_id": "A", "sequence_label": "T1_Ax", "sequence_cn": "轴位 T1"}, {"option_id": "B", "sequence_label": "T2_Ax", "sequence_cn": "轴位 T2"}, {"option_id": "C", "sequence_label": "T1+C_Ax", "sequence_cn": "轴位增强 T1"}, {"option_id": "D", "sequence_label": "T1_COR", "sequence_cn": "冠状位 T1"}, {"option_id": "E", "sequence_label": "T1_SAG", "sequence_cn": "矢状位 T1"}, {"option_id": "F", "sequence_label": "T1+C_SAG", "sequence_cn": "矢状位增强 T1"}, {"option_id": "G", "sequence_label": "T1+C_COR_FS", "sequence_cn": "冠状位增强压脂 T1"}]}
+{"id": "Seq-c380ceb73cb9c47f22a6d22f", "gold": "D", "options": [{"option_id": "A", "sequence_label": "T1_Ax", "sequence_cn": "轴位 T1"}, {"option_id": "B", "sequence_label": "T2_Ax", "sequence_cn": "轴位 T2"}, {"option_id": "C", "sequence_label": "T1+C_Ax", "sequence_cn": "轴位增强 T1"}, {"option_id": "D", "sequence_label": "T1_COR", "sequence_cn": "冠状位 T1"}, {"option_id": "E", "sequence_label": "T1_SAG", "sequence_cn": "矢状位 T1"}, {"option_id": "F", "sequence_label": "T1+C_SAG", "sequence_cn": "矢状位增强 T1"}, {"option_id": "G", "sequence_label": "T1+C_COR_FS", "sequence_cn": "冠状位增强压脂 T1"}]}
+{"id": "Seq-1531489934aadf43f7436033", "gold": "C", "options": [{"option_id": "A", "sequence_label": "T1_Ax", "sequence_cn": "轴位 T1"}, {"option_id": "B", "sequence_label": "T2_Ax", "sequence_cn": "轴位 T2"}, {"option_id": "C", "sequence_label": "T1+C_Ax", "sequence_cn": "轴位增强 T1"}, {"option_id": "D", "sequence_label": "T1_COR", "sequence_cn": "冠状位 T1"}, {"option_id": "E", "sequence_label": "T1_SAG", "sequence_cn": "矢状位 T1"}, {"option_id": "F", "sequence_label": "T1+C_SAG", "sequence_cn": "矢状位增强 T1"}, {"option_id": "G", "sequence_label": "T1+C_COR_FS", "sequence_cn": "冠状位增强压脂 T1"}]}
+{"id": "Seq-aa2bb95fbda6a56f5f50f65c", "gold": "C", "options": [{"option_id": "A", "sequence_label": "T1_Ax", "sequence_cn": "轴位 T1"}, {"option_id": "B", "sequence_label": "T2_Ax", "sequence_cn": "轴位 T2"}, {"option_id": "C", "sequence_label": "T1+C_Ax", "sequence_cn": "轴位增强 T1"}, {"option_id": "D", "sequence_label": "T1_COR", "sequence_cn": "冠状位 T1"}, {"option_id": "E", "sequence_label": "T1_SAG", "sequence_cn": "矢状位 T1"}, {"option_id": "F", "sequence_label": "T1+C_SAG", "sequence_cn": "矢状位增强 T1"}, {"option_id": "G", "sequence_label": "T1+C_COR_FS", "sequence_cn": "冠状位增强压脂 T1"}]}
+{"id": "Seq-742e381158d4463f4078e763", "gold": "B", "options": [{"option_id": "A", "sequence_label": "T1_Ax", "sequence_cn": "轴位 T1"}, {"option_id": "B", "sequence_label": "T2_Ax", "sequence_cn": "轴位 T2"}, {"option_id": "C", "sequence_label": "T1+C_Ax", "sequence_cn": "轴位增强 T1"}, {"option_id": "D", "sequence_label": "T1_COR", "sequence_cn": "冠状位 T1"}, {"option_id": "E", "sequence_label": "T1_SAG", "sequence_cn": "矢状位 T1"}, {"option_id": "F", "sequence_label": "T1+C_SAG", "sequence_cn": "矢状位增强 T1"}, {"option_id": "G", "sequence_label": "T1+C_COR_FS", "sequence_cn": "冠状位增强压脂 T1"}]}
+{"id": "Seq-ec778bc04405c6460bda5cbe", "gold": "F", "options": [{"option_id": "A", "sequence_label": "T1_Ax", "sequence_cn": "轴位 T1"}, {"option_id": "B", "sequence_label": "T2_Ax", "sequence_cn": "轴位 T2"}, {"option_id": "C", "sequence_label": "T1+C_Ax", "sequence_cn": "轴位增强 T1"}, {"option_id": "D", "sequence_label": "T1_COR", "sequence_cn": "冠状位 T1"}, {"option_id": "E", "sequence_label": "T1_SAG", "sequence_cn": "矢状位 T1"}, {"option_id": "F", "sequence_label": "T1+C_SAG", "sequence_cn": "矢状位增强 T1"}, {"option_id": "G", "sequence_label": "T1+C_COR_FS", "sequence_cn": "冠状位增强压脂 T1"}]}
+{"id": "Seq-eb820b78aadcb1efad5b807a", "gold": "A", "options": [{"option_id": "A", "sequence_label": "T1_Ax", "sequence_cn": "轴位 T1"}, {"option_id": "B", "sequence_label": "T2_Ax", "sequence_cn": "轴位 T2"}, {"option_id": "C", "sequence_label": "T1+C_Ax", "sequence_cn": "轴位增强 T1"}, {"option_id": "D", "sequence_label": "T1_COR", "sequence_cn": "冠状位 T1"}, {"option_id": "E", "sequence_label": "T1_SAG", "sequence_cn": "矢状位 T1"}, {"option_id": "F", "sequence_label": "T1+C_SAG", "sequence_cn": "矢状位增强 T1"}, {"option_id": "G", "sequence_label": "T1+C_COR_FS", "sequence_cn": "冠状位增强压脂 T1"}]}
diff --git a/L3/Struct.jsonl b/L3/Struct.jsonl
new file mode 100644
index 0000000000000000000000000000000000000000..a97508d69580b00023d578cbdb5e47f0769bf812
--- /dev/null
+++ b/L3/Struct.jsonl
@@ -0,0 +1,2700 @@
+{"id": "Struct-de1b797d714e85b6bf3c57f5", "gold": "nasal_passage", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-3703948681b97c9ec03e4401", "gold": "oropharynx", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-db159312358be129cdb6fb5c", "gold": "levator_veli_palatini", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-265ef66827f45f0590f07e7f", "gold": "levator_veli_palatini", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-d0f3aec89617b82473fbed00", "gold": "parapharyngeal_space", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-4ef56740cce32814e6fbe979", "gold": "parapharyngeal_space", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-0289c768b011528617b6733c", "gold": "carotid_sheath", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-f3c5ce1dc3e08cf21a69f238", "gold": "carotid_sheath", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-ead3d6ae216d718e4c011d0a", "gold": "longus_capitis", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-3cfc02f65457cb112ca59a13", "gold": "longus_capitis", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-1e762f6ec75edf2f2e99c332", "gold": "medial_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-125b90e143b71706b7565b40", "gold": "medial_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-9c5cbb7090592fc33925dc6e", "gold": "lateral_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-128bf6b836d63733b3723f3e", "gold": "lateral_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-5b0a773548b770eadc36b520", "gold": "pterygoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-ea61aa80ef7b8d3bbda167ea", "gold": "pterygoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-3c1750fb9b09276ba0f325aa", "gold": "sphenoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-62fb9cc6396667ea2d8d5c69", "gold": "clivus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-9886f988c23eab8ff5543ea0", "gold": "petrous_apex", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-e1b2fc5fa228f9af30bce89a", "gold": "petrous_apex", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-8d2c10a0b8d305077c6f7fa4", "gold": "atlas", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-68eb631f3d6682dd33c4e2d1", "gold": "axis", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-281fad55e8077e766a081250", "gold": "sphenoid_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-4f76e570b4fe5b89e95236c3", "gold": "ethmoid_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-5d5342538af894524dd0acbc", "gold": "maxillary_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-913c000756c46ebba0eca8c0", "gold": "maxillary_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-e58f4feb4a36b716c6c598f3", "gold": "cavernous_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-e43bfaca1987c776d1d65543", "gold": "oropharynx", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-25410c8c6d8c25a223532c49", "gold": "maxillary_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-35d92964a211973d7889d5c6", "gold": "cavernous_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-1910675e80ffeebb87abb683", "gold": "nasal_passage", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-b0c2ff3a09939cff62f6c7c9", "gold": "levator_veli_palatini", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-c60e0f5f51e4acc975baa8b6", "gold": "levator_veli_palatini", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-d09b41568a10229b4056fb38", "gold": "parapharyngeal_space", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-68b634ee3eaca45c184408d8", "gold": "parapharyngeal_space", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-19f0d545713b210ca6ddce7a", "gold": "carotid_sheath", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-ad8fd49b4af03f40177e51d1", "gold": "carotid_sheath", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-b0a7917020cadbcef28f2bc1", "gold": "longus_capitis", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-cff5eecf6d9f26ce6179d244", "gold": "longus_capitis", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-7ea6573a9488e1749b28788f", "gold": "medial_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-0785a3509dd408c9173ea9ab", "gold": "longus_capitis", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-19a4d752d543b23f342ddba3", "gold": "pterygoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-60e94e92f1838987f7df3eaf", "gold": "clivus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-31b1ad8b24894368cfbb7fcc", "gold": "petrous_apex", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-274e3317487b4def7746b396", "gold": "sphenoid_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-cb023e84fe29dcc0c6f517b2", "gold": "maxillary_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-4732cdcf068b35dae3ce05a2", "gold": "maxillary_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-93142d7b01a113bb87f93b9a", "gold": "cavernous_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-2b6da710e89c8760a6405562", "gold": "nasal_passage", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-8d2614eeb8c9b0ff3fc5d270", "gold": "oropharynx", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-b61003bdd137068ee9055bc7", "gold": "levator_veli_palatini", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-146329e7b84aebfc223b8c68", "gold": "parapharyngeal_space", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-c3db1c5ee1c0ef9b61655a06", "gold": "carotid_sheath", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-19f1b19214d3ccbf364a22f2", "gold": "carotid_sheath", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-09c13501b949a6ad57f46013", "gold": "longus_capitis", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-ec1fbb7bf683d9858cc494ab", "gold": "pterygoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-36a362c1ae62021addfa534b", "gold": "pterygoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-067b4367da91d449f51ab2c6", "gold": "sphenoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-712a109067b8964b064b08ba", "gold": "clivus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-e928f36a6a95eeffe6384845", "gold": "petrous_apex", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-cc98e687693e3cfacd436b07", "gold": "atlas", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-21d9852487a42e5a12f9e663", "gold": "axis", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-ba264d34aa3c04947c9d27a8", "gold": "clivus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-1388084f4585f5425602164b", "gold": "sphenoid_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-36d020d0411de420eb0bc1fd", "gold": "maxillary_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-5643df56b2e53223105d5bdb", "gold": "nasal_passage", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-733e08fdc7bb3ea876c10890", "gold": "parapharyngeal_space", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-2d92807be41f571154a5628b", "gold": "parapharyngeal_space", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-fa2f1b8c4913d2e4ddc3374a", "gold": "cavernous_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-fac9418cd592fa4dbcdc792b", "gold": "nasal_passage", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-6226f05983d69bc8c8455d9a", "gold": "levator_veli_palatini", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-1f19bed9c558629aa35b7f0a", "gold": "parapharyngeal_space", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-db4959aa7737ce49865b8255", "gold": "carotid_sheath", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-32a6d4ca59d7f565d67fbb43", "gold": "carotid_sheath", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-a7c6a1112f38c223001a6d9d", "gold": "longus_capitis", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-8c48dbef2596179a2c948bc0", "gold": "longus_capitis", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-6e09a2fd79804b48f715ce66", "gold": "medial_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-ca7f9bd13d96cdb49080be9b", "gold": "medial_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-91318df4c80d9fc392dc6e96", "gold": "lateral_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-44d7bbec31e29a99f2d43b99", "gold": "lateral_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-6c33d336a29511364a181656", "gold": "pterygoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-87dbca874cae2584c5460746", "gold": "pterygoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-343fbc152cbef6e9c9e4df51", "gold": "sphenoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-d101a34806632003b09d587f", "gold": "clivus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-9c0a92d7d1c5c47daee2a744", "gold": "petrous_apex", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-a0f674f3bea8f102ce48063f", "gold": "petrous_apex", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-1ff24cc756c63f2eecf8212c", "gold": "atlas", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-7cc4d2ecec369425886dd42b", "gold": "axis", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-a329a11753377b8d40cb4ddc", "gold": "sphenoid_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-0b2f87e9c97208c29492981c", "gold": "ethmoid_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-8ddf819aebbe8462d60f18cd", "gold": "maxillary_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-144d52f9b757aba7fc61d542", "gold": "cavernous_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-cbd2989023dd51845e387bcb", "gold": "sphenoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-59d412f336e0147196884e03", "gold": "clivus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-7f3ebfd38fe8e5404d7e1ce9", "gold": "petrous_apex", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-db611651eb8e53285c2cb44b", "gold": "petrous_apex", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-fd4de96065ae7506c1d02aeb", "gold": "axis", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-cbeb2dca3378afc7fbdd0d4a", "gold": "sphenoid_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-bb2929a149382844d7b65211", "gold": "maxillary_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-d6c659487af96f9d3e09cfbc", "gold": "maxillary_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-bc203f34e44ebac430c6380a", "gold": "cavernous_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-a9cd8c54ef937142a215a687", "gold": "nasal_passage", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-6857314991a43030d43ce866", "gold": "oropharynx", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-4f4dc1834008af45f1fbfb9d", "gold": "levator_veli_palatini", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-10124e1fbd154c19d2e89068", "gold": "levator_veli_palatini", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-5931d1d568f2e5c34fca8067", "gold": "parapharyngeal_space", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-4f1026f5477583e2da89cf18", "gold": "parapharyngeal_space", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-0f4db76ad95d45de0b7e2ac7", "gold": "carotid_sheath", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-53ca1e40eadd81bab2883bdb", "gold": "carotid_sheath", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-4d195a43514d6ef4c9dfe7a8", "gold": "longus_capitis", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-5ea71a6910052a2c4a5007c7", "gold": "longus_capitis", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-865b596ae029b8481d7ac900", "gold": "medial_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-6c7b5f67638e75c4ee6e4d6d", "gold": "medial_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-bd0439fee79b3636de37c550", "gold": "lateral_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-505c3ba7bb1712fb03a97022", "gold": "lateral_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-2eaa5d16a2c485206d33a7b5", "gold": "pterygoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-74e3b1425d368320c016e7c3", "gold": "pterygoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-0cd2a9ff61bed00389d42ab9", "gold": "sphenoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-1a49bba92f18822c6f130a75", "gold": "petrous_apex", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-21f431e11a54e64782ee8f8d", "gold": "medial_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-9322a14171ecba156f19740e", "gold": "pterygoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-91c855b6020d7d48c2084b85", "gold": "cavernous_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-2299f609598782a694c86916", "gold": "levator_veli_palatini", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-c1ec1514787fc9d996227b69", "gold": "levator_veli_palatini", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-521a994fd8672f61b4ca1a33", "gold": "parapharyngeal_space", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-8f30a7b87a4c4c77cbd4e990", "gold": "parapharyngeal_space", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-353a03711bbf9cf0f06038f4", "gold": "carotid_sheath", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-ebe9a5c694d678e7e3843e14", "gold": "longus_capitis", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-b0dc5c1016f4bb4cb1864d83", "gold": "parapharyngeal_space", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-cb5622011d62714181e421a4", "gold": "carotid_sheath", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-0ac5486779d2cfaf065fb38d", "gold": "pterygoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-c68894700cd3a47606513980", "gold": "pterygoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-6854daf7c88f324e8e135625", "gold": "clivus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-a7c5972f91d517f29fc90ac0", "gold": "petrous_apex", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-4489bce2401a6ab83b6e7454", "gold": "petrous_apex", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-72a3566efe9ec9be4445c3ab", "gold": "lateral_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-902c2a7b3bdc2a1cb81a06be", "gold": "pterygoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-65c4812f536f5c8519b9e397", "gold": "petrous_apex", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-9f9fadbaeb1356a819709c6e", "gold": "sphenoid_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-b43ea908ec0ea6244eeecc71", "gold": "cavernous_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-3bf87c02cd6ce978a6a3b37e", "gold": "nasal_passage", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-9d6cb5f762053e6743acffdb", "gold": "levator_veli_palatini", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-7acf2b0d287663996de35306", "gold": "maxillary_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-cfb6edf5f4b8b518e2524ff2", "gold": "cavernous_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-32e453aa868ab9a35a6355fb", "gold": "nasal_passage", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-55fe0fad1439f6c402d4fbb5", "gold": "levator_veli_palatini", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-ffa7f5ac3df574f48520fe46", "gold": "parapharyngeal_space", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-7698470b408a6c29169141ba", "gold": "carotid_sheath", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-d0833e6ef95f5d45c4191d67", "gold": "medial_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-f1ff0cc586464e2eceac8f12", "gold": "medial_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-7d60b494f181bcb739651071", "gold": "lateral_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-4b5a6f5557102360f805eebc", "gold": "lateral_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-665c3e33c1f0883a002f9d7f", "gold": "pterygoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-c3fde6218055e4db2de82dfd", "gold": "pterygoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-d46cef1079ee96d9f6307045", "gold": "sphenoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-4a68be93880ce94edc4402a9", "gold": "clivus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-dee7a536a3e005d7af8dbbf8", "gold": "petrous_apex", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-4d0d3952a7b00bb7d0e19abc", "gold": "petrous_apex", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-121351dfdb13021815a7440b", "gold": "atlas", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-350fa0f00b67d2c9bdaf6d73", "gold": "axis", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-dcbde9ac0b06389bba31ec20", "gold": "sphenoid_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-3a775a4f3017486a0eb0880b", "gold": "pterygoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-403193a155239582ad5d25af", "gold": "clivus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-9d16cb4180a7c15356a8d1f5", "gold": "petrous_apex", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-64e8d6939f0bca8907a885dc", "gold": "ethmoid_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-ea19b16682d3d43f5da820d8", "gold": "maxillary_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-67d09b995500a81beb049283", "gold": "maxillary_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-66a1f4e40542e851717e127c", "gold": "cavernous_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-de80db8b7a35262fd82be6fc", "gold": "nasal_passage", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-d502d71e287a82b86605c37b", "gold": "levator_veli_palatini", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-8421cb2e61e620b9a095b306", "gold": "parapharyngeal_space", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-9845c53ea15a0b803915676d", "gold": "parapharyngeal_space", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-7d179ba38269d3049122cb87", "gold": "carotid_sheath", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-b227ac4676a8c95858981e34", "gold": "maxillary_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-fe4ad1e1cdbf141088d4ef0a", "gold": "cavernous_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-04d59d8690c6f670d7c258fb", "gold": "nasal_passage", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-6339de32540584ea49826461", "gold": "oropharynx", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-4a8af8d810a90ad5865fbd02", "gold": "levator_veli_palatini", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-32116323ec6e459a61774fe1", "gold": "levator_veli_palatini", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-0eedad13f28c0be22ec11fbf", "gold": "carotid_sheath", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-dcd0e119742c7f5ce020a9e5", "gold": "longus_capitis", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-24d97912d0dc4d58b853103b", "gold": "longus_capitis", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-d15d1fe93e8b1a840d260c97", "gold": "medial_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-499a6e59e17c5cedb33c406f", "gold": "lateral_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-b3b9c912214b26e30e61bfb9", "gold": "pterygoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-dc88f4afc7337d1db54e7964", "gold": "sphenoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-1d81a7f09da67a664ffc7596", "gold": "clivus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-5ba8ecbab1bde54e53487a28", "gold": "axis", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-64782be995ac695b7f88d260", "gold": "sphenoid_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-2081e4ce57886ed0beec824c", "gold": "ethmoid_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-c93f6781f90914818bf33a01", "gold": "maxillary_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-4524ab0034b9e1075cf9ca85", "gold": "maxillary_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-101c056a695880e55be089c9", "gold": "petrous_apex", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-bd53d9d5abde23a251a1733c", "gold": "atlas", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-dc3caae8b51d300df2a8028d", "gold": "maxillary_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-14b5419a22071e68c8f3104d", "gold": "cavernous_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-f3ba6671b3b7bf3ad59341bc", "gold": "oropharynx", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-188c8f8f0ffc62d1f9d31f0a", "gold": "levator_veli_palatini", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-bf51daad80e5ca6f42c6160c", "gold": "parapharyngeal_space", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-635f3387a146babf7e8aaf4c", "gold": "parapharyngeal_space", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-653e8db3d85abf4caf29c864", "gold": "carotid_sheath", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-0f355696f3f587f6b6281c09", "gold": "carotid_sheath", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-12cfc702f0f4f35b9f067505", "gold": "longus_capitis", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-280f3fcd04b60bd12e6f1fd5", "gold": "longus_capitis", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-d555b534da344f231da9c446", "gold": "medial_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-52b647d863260ed76b6ded14", "gold": "medial_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-4d8b526803b6f5bed4279f62", "gold": "lateral_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-9f3d4f4725919c63fc24b56f", "gold": "pterygoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-d3cec1e882d609fa9b163aed", "gold": "pterygoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-dcb694ef46a58a39180f6642", "gold": "sphenoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-d8269dc1fd3db08fb6890fa5", "gold": "clivus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-1cdb451489fa55b23ecd1b9e", "gold": "pterygoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-c4fc16ddd56fdfdcbdbccdbb", "gold": "sphenoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-de255aa6f1c88725bdf0d34c", "gold": "clivus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-471d01053acd131482fab3bf", "gold": "petrous_apex", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-84c0b78a4a34c01e6de9a41e", "gold": "petrous_apex", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-96bd295ffbe8f98fe95dbea8", "gold": "atlas", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-192ff49888c49d52e1ad4e8a", "gold": "cavernous_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-c8e76c7930080494a764ef75", "gold": "nasal_passage", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-3e0a86301d24b8ad099b1bcf", "gold": "oropharynx", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-709baf3afb2c87b02998852b", "gold": "levator_veli_palatini", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-20ca2b833bda7edce03e4e94", "gold": "levator_veli_palatini", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-d8ff2d300a88a84160a4cd38", "gold": "parapharyngeal_space", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-692622948e003d7320c9a29a", "gold": "parapharyngeal_space", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-84090fd72238cece73164714", "gold": "carotid_sheath", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-373649fa86d0652942b53cb5", "gold": "carotid_sheath", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-509cf0a149178028fe3a2958", "gold": "longus_capitis", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-f04d79b830dbd5722df6016e", "gold": "longus_capitis", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-7bddad5c2b50a7263403644e", "gold": "petrous_apex", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-84dce84cc99aec9d1ca0b9a6", "gold": "nasal_passage", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-c8c6a907a78044e88be83f82", "gold": "longus_capitis", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-57b25a4ae86f3aa4009131fe", "gold": "medial_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-a45dde19f52b71ae57a573aa", "gold": "lateral_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-ead450a87fcc04604671300b", "gold": "lateral_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-6f5005a13523b85cfb3af9af", "gold": "pterygoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-9c6a476e85c27e56b123cad8", "gold": "pterygoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-d249eafb577c0212ad4caf1d", "gold": "sphenoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-ae5a36c6d7109eab03f669fa", "gold": "clivus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-e89d86f929207fcc3d9938b1", "gold": "petrous_apex", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-74fc62b4a837fbfa5eb85274", "gold": "maxillary_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-ca0d9fff9bd21aa87233d4e1", "gold": "cavernous_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-cf217f49a5a2452f74a25b49", "gold": "nasal_passage", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-2fd3f7b8718edf13afb8a1c9", "gold": "oropharynx", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-2b9d208036f911adea159579", "gold": "levator_veli_palatini", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-de0f97bad7f5ac344c24db6c", "gold": "levator_veli_palatini", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-f04e1f2e82326960081c8efb", "gold": "parapharyngeal_space", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-8021774027cc7355fd7adef2", "gold": "carotid_sheath", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-6ca734c0725e66890db094cb", "gold": "petrous_apex", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-301c8a03689d591205c5ad1e", "gold": "levator_veli_palatini", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-77935bcbb5484fd2ac5eb408", "gold": "lateral_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-3768acae7ea6014f2782c03e", "gold": "pterygoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-694525c88bd61c86c1274c68", "gold": "sphenoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-08f7c9d9735d59984d21742a", "gold": "clivus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-03c22415afd35c121a0638b2", "gold": "petrous_apex", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-c6598f2f91a4f21bccaf0f22", "gold": "petrous_apex", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-5f5a56946c83df0ebe537b4c", "gold": "atlas", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-e8467314e8fd287b6fc2fca2", "gold": "sphenoid_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-d59fe2b4f7b202be9acb4b47", "gold": "ethmoid_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-031e03d72884311cc3c40301", "gold": "maxillary_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-f12a682046f048a3f88f59bf", "gold": "maxillary_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-0a70974956fb2e34ac9b8492", "gold": "cavernous_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-46304541ad766cceab889d28", "gold": "nasal_passage", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-9add9788ba3eeedab9f97131", "gold": "oropharynx", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-7f0fadcb71c930b8ab963b56", "gold": "levator_veli_palatini", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-b7dd4501442f43025471d041", "gold": "levator_veli_palatini", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-16b7fd10f34ca75d63f6d715", "gold": "parapharyngeal_space", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-8226fafb4aa0b74e2d3b3c55", "gold": "parapharyngeal_space", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-655d49f974913a1a3f732764", "gold": "carotid_sheath", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-087ce05bc2d74fbe53b56a65", "gold": "carotid_sheath", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-2296b3966846b6c36ad8c053", "gold": "longus_capitis", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-563f160f8a7953956ae5e308", "gold": "longus_capitis", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-89e8c11e0c55fdf35fbca1b8", "gold": "medial_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-81acb6f8ddfc6b873f96f4e0", "gold": "medial_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-c5bdf7dd1ec63cafcc3e6a16", "gold": "lateral_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-ef77842081fd96ad34ee25b0", "gold": "lateral_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-6a5ecf19cc44b73c1e3b4fe8", "gold": "pterygoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-600509af71d462e8739f353b", "gold": "pterygoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-33eda39a86d6f435dcd61e5d", "gold": "pterygoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-4be5124e9cddda534f0d4648", "gold": "clivus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-0d23cf5888b028a8ae5c2a4f", "gold": "petrous_apex", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-33953b6ded8222cb66a087f6", "gold": "petrous_apex", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-5ba54d32cc38851b35631236", "gold": "maxillary_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-fc1b2214b5a4e0455531719d", "gold": "maxillary_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-aa68c3d8a8cdafd459ff6877", "gold": "cavernous_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-28f17033338dc7b0c59599d4", "gold": "nasal_passage", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-308bf624a2b7a4867ba752b7", "gold": "oropharynx", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-5263912df49b24aac443bdf7", "gold": "levator_veli_palatini", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-cc4ccc27b6640b603102d12e", "gold": "parapharyngeal_space", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-931c456164040576c0c2d2fc", "gold": "carotid_sheath", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-862775da04e27064f3a10959", "gold": "carotid_sheath", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-61d6f635917f3aaf59badedd", "gold": "sphenoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-693f5637c64ac16875889186", "gold": "levator_veli_palatini", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-b36be44af1e113d8946a585d", "gold": "parapharyngeal_space", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-9ac20dcfbc24dec49636aede", "gold": "carotid_sheath", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-ec208a8e652d70fd627d6dd1", "gold": "carotid_sheath", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-53b5cd20a97af01c786abf64", "gold": "medial_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-5b99cce4f0e5c12cc84ad20a", "gold": "medial_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-646e10b14b27dabb0bd42484", "gold": "lateral_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-a3064e4d4fecacd0ad120530", "gold": "pterygoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-fc71890fe827e6dda22004c3", "gold": "pterygoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-394f054a97a9a4d531845f91", "gold": "sphenoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-79006fe041739f5156d4fede", "gold": "clivus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-b1811ad007573573ef9e6143", "gold": "petrous_apex", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-02275ace4281ce8c675bc32e", "gold": "medial_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-4b0518fdef2e697844354ef8", "gold": "medial_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-824163a328459830354bce0c", "gold": "lateral_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-11502dffeb77c19d030565c9", "gold": "pterygoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-f73e9aa6ccd1e62256e7e8be", "gold": "sphenoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-bab2cb87ca2cea79bf388c89", "gold": "clivus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-be3e121f58a3252d51da41c7", "gold": "petrous_apex", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-48ef34b7f6a46320857bc626", "gold": "nasal_passage", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-3b2e75d470e2c59849de0829", "gold": "oropharynx", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-449c93d5fa120db15ecf9c31", "gold": "levator_veli_palatini", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-9b713ca1bee43a6ebf8f8bc2", "gold": "levator_veli_palatini", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-7202845fdbf21e7e3d4d91b1", "gold": "parapharyngeal_space", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-9dc65af9809f2d17f3fc3db4", "gold": "parapharyngeal_space", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-d7484db477c574460427127f", "gold": "carotid_sheath", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-9bd4237c1467cfd3ab43f158", "gold": "carotid_sheath", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-08c04f785977d6f8e94767af", "gold": "longus_capitis", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-804677bf3f3143bbd3ccc33c", "gold": "longus_capitis", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-c6d16dbd47032eb4c565b598", "gold": "medial_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-4eb3cf2302d2bedd32711bd9", "gold": "petrous_apex", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-a7bb157660d60dd72d5c8907", "gold": "cavernous_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-c21b9bcde5cef47dc333bb5a", "gold": "levator_veli_palatini", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-0b8b4515d6a5263248fcbc1b", "gold": "parapharyngeal_space", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-0a735bbafe4562cb549bf147", "gold": "parapharyngeal_space", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-1b2e1e042fd217895a9bd723", "gold": "carotid_sheath", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-4508b110406857030f854a70", "gold": "medial_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-747339ac4dda936e4231b360", "gold": "medial_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-326c17d88b0771628fcd105a", "gold": "lateral_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-0e063116a48c443604dbe86b", "gold": "lateral_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-acf0acf379a861c14ae3c796", "gold": "pterygoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-2b9fdb72bcac73684141e7ec", "gold": "pterygoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-39a1bffa0d01ea54fc4eb312", "gold": "sphenoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-ff151bd1ab38b9dab732e25a", "gold": "clivus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-f070c2609eb783aaa2871025", "gold": "petrous_apex", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-5bb24bd18b1a3b9caca1a8d0", "gold": "petrous_apex", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-6b4d252e833cc2da365b45a7", "gold": "atlas", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-ce587b964b63426171f46781", "gold": "longus_capitis", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-b28282bc6e42b69ee54a816f", "gold": "sphenoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-e25a8ed8f1b44fac4b779da3", "gold": "nasal_passage", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-f11a9a57789cab9954a67900", "gold": "levator_veli_palatini", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-94bfe368fb091aad7b6527df", "gold": "parapharyngeal_space", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-8508813fb0781098683cf653", "gold": "parapharyngeal_space", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-b54df803d1684f732fa44572", "gold": "carotid_sheath", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-5bc5ab0eff6dd034b0235501", "gold": "longus_capitis", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-6cc8d5b419733d6a43df481d", "gold": "pterygoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-561bfb3d2336aa219af1cab0", "gold": "sphenoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-b30b55f92038e88624217e6c", "gold": "clivus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-19121f8f2df3d3aeee8ebe06", "gold": "petrous_apex", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-4d4a9057bb1a5b9eacceb654", "gold": "atlas", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-80e88a71375de0bd37b4280b", "gold": "axis", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-2010086737413b80af046332", "gold": "sphenoid_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-f0da5b398216ec30151956d8", "gold": "ethmoid_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-94d302b8c768a1bc53122cbb", "gold": "maxillary_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-9632027c70dfb67aa5a820f8", "gold": "medial_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-33350049adf4f68387aa6915", "gold": "lateral_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-64ba39abae4badb08cbf416e", "gold": "sphenoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-063f91325ac977681e03ab07", "gold": "maxillary_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-eb6b4534e6231170acbc72ae", "gold": "oropharynx", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-bf904e8c92ef4d8b3562f4d1", "gold": "levator_veli_palatini", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-93de4bcd9a76585ffbf0c057", "gold": "parapharyngeal_space", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-a74a0cef9ec9ad144382cecb", "gold": "parapharyngeal_space", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-49f2695da72781b15c8a612b", "gold": "carotid_sheath", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-6740c2b54be1598af7cefc91", "gold": "longus_capitis", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-5d16b0b70606a3065f9c284d", "gold": "medial_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-17f8b23da1fdadde699f3c40", "gold": "sphenoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-7ec5685f832a92da62f69b80", "gold": "cavernous_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-99988f0a0fa6baeadab025e1", "gold": "nasal_passage", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-769a5fd487e560da291e0b5b", "gold": "parapharyngeal_space", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-8c9141d5eaa5177ca43a1b03", "gold": "carotid_sheath", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-08b0228ab452dcc90ec78f6a", "gold": "medial_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-72c428f7862cf214c9ebc0ca", "gold": "pterygoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-ac21873a3d70f931db0482fb", "gold": "petrous_apex", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-abf60ced6e746e717235c2ef", "gold": "petrous_apex", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-329b21dd9a09038228775aff", "gold": "longus_capitis", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-9c6e8cd6d953e88600440db0", "gold": "maxillary_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-acfc18990df346e3dc3b9620", "gold": "cavernous_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-0598d0f29ad73974a421e60a", "gold": "oropharynx", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-aff5a6cd6f7e442832e66045", "gold": "levator_veli_palatini", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-50260fcc61f164eff98d70a8", "gold": "levator_veli_palatini", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-8b8290ac24e38ae58a8f7450", "gold": "parapharyngeal_space", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-20f2c0737a844cd69bf22949", "gold": "cavernous_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-30c2d81da1dfbdc849050c40", "gold": "parapharyngeal_space", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-773f5bf3d4747dc8f69af496", "gold": "parapharyngeal_space", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-74a0defc493cb6c8cf14c866", "gold": "carotid_sheath", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-027b09202b5abef769be7146", "gold": "carotid_sheath", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-5521a922c6c20e0436d9c7d6", "gold": "longus_capitis", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-4bdcd5050a898c1a1ae7e022", "gold": "longus_capitis", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-0232de104825418bea15a7e0", "gold": "medial_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-d60b5708fa5a590e3a18e665", "gold": "medial_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-cdf4d6f1b44c0f1cbede27aa", "gold": "lateral_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-31ba7cbadb46549796b78589", "gold": "lateral_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-fd418f9796b791f357c1b5fb", "gold": "pterygoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-a7a7f0a79f35277b5e8b1849", "gold": "pterygoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-d724e166551fe897cbd3144e", "gold": "sphenoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-0550a6cfa8148ab2234f0e4b", "gold": "clivus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-e2ed11bf684b2a6a9d54183f", "gold": "petrous_apex", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-c4e7fa8eda7a1c0aaff9d70e", "gold": "petrous_apex", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-0c6e6e9804fd7d779ff32bf0", "gold": "atlas", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-f50d6dc1040b081dda21ea0a", "gold": "axis", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-2498f977b914be63f0239b4a", "gold": "sphenoid_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-ec4276241e17ddbd0d43efc3", "gold": "axis", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-b6d5e513a489a51ce9e508bf", "gold": "parapharyngeal_space", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-19e2676ec3aca8da08a77bde", "gold": "parapharyngeal_space", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-017a074dfc384409ed2d8d28", "gold": "carotid_sheath", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-77c2fb8ef7678788d6f97447", "gold": "carotid_sheath", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-54c7c32fc637e99dff7ee17c", "gold": "longus_capitis", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-8653e4fc371f46edc38d2ff4", "gold": "longus_capitis", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-e882aa764adb971d46e58222", "gold": "medial_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-c5064b1716692691004f327c", "gold": "medial_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-ab189dc18e8b2721e82d622e", "gold": "lateral_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-ec07b51d8e4307c48f13bccf", "gold": "pterygoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-3d7a64d25a55b5a30defd23d", "gold": "clivus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-c653d3211f666447b64d03cf", "gold": "ethmoid_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-80b13c7fccb72d8504893012", "gold": "maxillary_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-4c82c96ee34caff2b27c002b", "gold": "maxillary_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-1bb2b6a8257c580401f926ab", "gold": "petrous_apex", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-3b48c101c4d3b2f3c60d488e", "gold": "petrous_apex", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-2b0cc8b003d884fb04fb43f4", "gold": "atlas", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-6ddf8ef204af8dd3812a9ba1", "gold": "axis", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-46a7231d39482548ac601399", "gold": "maxillary_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-365d5a02760bff7fd64e3b82", "gold": "maxillary_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-1b50395dc9b0859db2b2b8a3", "gold": "cavernous_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-2c2937681d983e19b83d5259", "gold": "oropharynx", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-c34850c92435e674777ac2d4", "gold": "levator_veli_palatini", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-9939bc67ee50f926752f4862", "gold": "levator_veli_palatini", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-ef14b04253d18e3fe036dd79", "gold": "parapharyngeal_space", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-231bdca1cf266cd1fd7d17e8", "gold": "parapharyngeal_space", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-3c448335081af645a8a15823", "gold": "carotid_sheath", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-942f6bdd74c06cd848ce69dd", "gold": "carotid_sheath", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-9c4bc10e19c67fd851750e53", "gold": "longus_capitis", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-ca11b75958d63028464b90a1", "gold": "longus_capitis", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-946f92a146466c40a49201a7", "gold": "medial_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-f8bdc26fce14b6164d654f44", "gold": "medial_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-8918a2e92999a8722fc81bcb", "gold": "lateral_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-debc709a750acc0c6738032b", "gold": "lateral_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-65d1a65491f767b259228fa8", "gold": "pterygoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-776ce0c1ce1b1b40187a9399", "gold": "pterygoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-7b49daa89cde7bb3257cc0d6", "gold": "sphenoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-3c83539280b14eaf065c4d63", "gold": "clivus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-02466ab272c96ecc46ce76cb", "gold": "parapharyngeal_space", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-6bb8cffcc821bde7f7dbaa13", "gold": "medial_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-5d7a6d6f77dbe9166829c1d9", "gold": "medial_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-327117548b41e23c8d066967", "gold": "sphenoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-b1aac601c8969a332d08a55b", "gold": "clivus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-13645066025bff5800fee482", "gold": "petrous_apex", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-cc2f44b81c75cca744b1a478", "gold": "levator_veli_palatini", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-de894ea7c9748ac804bf9f85", "gold": "parapharyngeal_space", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-c3fba535466cf654255a8ba5", "gold": "parapharyngeal_space", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-73d4c55c66551080f3d3acef", "gold": "carotid_sheath", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-36b9a889634b5395a499e17d", "gold": "carotid_sheath", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-aab5b76b3f7d251265e0a96d", "gold": "longus_capitis", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-5be8aa5a320e737226017956", "gold": "medial_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-7a4bfb06ad6688e2486ecdd8", "gold": "medial_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-424452180a4fe4a1a6c90077", "gold": "lateral_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-0dd8d3905a9f80f0b9de1363", "gold": "sphenoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-94dc30ef1498ebafcfba4efd", "gold": "levator_veli_palatini", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-febbfd03cea12e5e266a2805", "gold": "parapharyngeal_space", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-dc051c0340e7ca294d9d99a8", "gold": "petrous_apex", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-53fc866fbd5cf85c371e8112", "gold": "maxillary_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-dc54b26e64e1d0442e03e044", "gold": "nasal_passage", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-233d99cafe2ee54ef8768aec", "gold": "levator_veli_palatini", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-02d4070225ade8ec983fd83e", "gold": "parapharyngeal_space", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-97e8c12d3d96beecbbb90bf9", "gold": "parapharyngeal_space", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-1721ca60ef19b40677a3b1b2", "gold": "carotid_sheath", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-0e34e617c4233566577054f4", "gold": "carotid_sheath", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-9938aec675ba1b9ce329a9b7", "gold": "longus_capitis", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-753a55b12599425c6979f4d4", "gold": "longus_capitis", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-efaa93d8e3524b9b58ac09f0", "gold": "medial_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-9c4a74f3a9e92b19e23e0543", "gold": "medial_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-bfd79b89e413326501b8aa83", "gold": "lateral_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-62b2888714608b8a6661c01a", "gold": "pterygoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-8e272e42777384a11c82726b", "gold": "pterygoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-662502283668ac0ad7626394", "gold": "sphenoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-93a7300aadebd29d76d72f30", "gold": "axis", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-513feeddeb846259029ed322", "gold": "sphenoid_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-8c43db1711b1176f46cc08b4", "gold": "ethmoid_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-ff325ce8d14c8a36938d1be8", "gold": "longus_capitis", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-8c9ced63d6c69356db22bdce", "gold": "pterygoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-51c267574e331bdf912d7530", "gold": "pterygoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-09eaac13e0f94c24ba53be99", "gold": "sphenoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-cb7c9f2dd65c696d90889163", "gold": "clivus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-9a437cb77162091d6bae0ab7", "gold": "petrous_apex", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-daeaaae90536b2bd7508dc68", "gold": "petrous_apex", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-68d74cbecc5ac42996f20b2c", "gold": "atlas", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-454dd5bd98906a8532c4f1ab", "gold": "axis", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-b3f882153dc9d34f224daaed", "gold": "ethmoid_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-aa5c2069fdcc239e751004ea", "gold": "maxillary_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-e1fce2a374792110ae5a2f1b", "gold": "cavernous_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-02a7ea4650d2b9ed30e743fa", "gold": "nasal_passage", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-90037c676da69f659e50d666", "gold": "oropharynx", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-38df37dd4a1e335e56d9f333", "gold": "levator_veli_palatini", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-f335ca69479c8d3c7d4698fd", "gold": "levator_veli_palatini", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-4ae2ea12c600b3fd7fc49d51", "gold": "parapharyngeal_space", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-63de694ae471396070e564f8", "gold": "parapharyngeal_space", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-d43a77b485911ccb0a4e3b5f", "gold": "carotid_sheath", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-0ec4db94b621578d4e524961", "gold": "carotid_sheath", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-67744426a3794149a3e54f03", "gold": "longus_capitis", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-2d4fb3323c5dd1b04f6705ff", "gold": "longus_capitis", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-2e36aa16702aa4392a1bca19", "gold": "medial_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-a7d0a8ade528727887074b3b", "gold": "medial_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-770ea660c1d0112b2cd2d38d", "gold": "lateral_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-5eaefd0f268a7a96482a97ef", "gold": "lateral_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-101c11cbb67fc24973788f90", "gold": "pterygoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-dc4b697688bde3d50f327e4b", "gold": "pterygoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-f5a5aaffff494bd398c90f4d", "gold": "cavernous_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-49d85b44497c7683f43ecc87", "gold": "nasal_passage", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-249fe1f83df1970cb52587b0", "gold": "oropharynx", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-d970b575dae2bb4ccc3e54fb", "gold": "medial_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-2e50ed65b2f4ba6a94edd0b9", "gold": "lateral_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-bf0dd9f37e5f4b84a13d340f", "gold": "pterygoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-d60a1256e4d1128e8dbb9f4b", "gold": "pterygoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-31e88273b93759d7e2a1104a", "gold": "sphenoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-41223d4ff3b6f70bd03a937e", "gold": "clivus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-182898bc14a91757c464cc8a", "gold": "petrous_apex", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-2c5f3b135ae6284e084ca279", "gold": "cavernous_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-0986490c3c5bcf474728a40c", "gold": "levator_veli_palatini", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-0d41e8c86dd6f88bf57dffaf", "gold": "levator_veli_palatini", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-b16924b3fde750653af62ac7", "gold": "parapharyngeal_space", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-dac5b4db34c957777f664629", "gold": "carotid_sheath", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-d4e88cd0b30d594c5665ec73", "gold": "carotid_sheath", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-c74c08b40b4cf8d37dd2882a", "gold": "longus_capitis", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-484b5a6aff117f2a67d8351f", "gold": "medial_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-9c415a30443a19b917d850f9", "gold": "oropharynx", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-39c6b73ac8c500e63b18a511", "gold": "cavernous_sinus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-8605c3dd52a6a8ade0dbde85", "gold": "levator_veli_palatini", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-0430d5b013981af2923c8fca", "gold": "parapharyngeal_space", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-4add60cd132c131b284131be", "gold": "parapharyngeal_space", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-635ac2c4edfef89c41374325", "gold": "carotid_sheath", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-3b0cfa04ff08424e996bdcba", "gold": "carotid_sheath", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-5bd958601e2153a17460f917", "gold": "longus_capitis", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-40ff19a4cac29ae023f16dd3", "gold": "medial_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-148e43553d42207913b4b1a2", "gold": "medial_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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+{"id": "Struct-197e3209b87933cc263592a8", "gold": "lateral_pterygoid", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-b7875435fc935557d854e86c", "gold": "pterygoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-170cc6f654a1f01097250771", "gold": "pterygoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-d5a18ec309a92875f6c93981", "gold": "sphenoid_base", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-8f75f12e1412caf2f9245dc3", "gold": "clivus", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-44347aa3ade5a1d9e73042eb", "gold": "petrous_apex", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-f33183224e3160c78f12ea84", "gold": "petrous_apex", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-07169c518ad218fb77e0800c", "gold": "atlas", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
+{"id": "Struct-757c0aa7ffdd06094b78f2a0", "gold": "axis", "structure_choices": ["atlas", "axis", "carotid_sheath", "cavernous_sinus", "clivus", "ethmoid_sinus", "lateral_pterygoid", "levator_veli_palatini", "longus_capitis", "maxillary_sinus", "medial_pterygoid", "nasal_passage", "oropharynx", "parapharyngeal_space", "petrous_apex", "pterygoid_base", "sphenoid_base", "sphenoid_sinus"]}
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diff --git a/L3/T400.jsonl b/L3/T400.jsonl
new file mode 100644
index 0000000000000000000000000000000000000000..f4f4fb03586caec518a59a933934d699a55ac869
--- /dev/null
+++ b/L3/T400.jsonl
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diff --git a/L3/extensions/N400/labels.jsonl b/L3/extensions/N400/labels.jsonl
new file mode 100644
index 0000000000000000000000000000000000000000..207082ca90ff632738da00e9b4587731142651b7
--- /dev/null
+++ b/L3/extensions/N400/labels.jsonl
@@ -0,0 +1,400 @@
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+{"id": "L3-N400:mri-48630004d8dd4f52", "n_stage": "N3"}
+{"id": "L3-N400:mri-315bc8f8912b4f66", "n_stage": "N3"}
+{"id": "L3-N400:mri-7ddc879e7cdf4ad4", "n_stage": "N3"}
+{"id": "L3-N400:mri-0f81d3b1e90c4fa9", "n_stage": "N3"}
+{"id": "L3-N400:mri-820d6370fe604b87", "n_stage": "N3"}
+{"id": "L3-N400:mri-97796b3c7edd420c", "n_stage": "N3"}
+{"id": "L3-N400:mri-2be0a9325162419a", "n_stage": "N3"}
+{"id": "L3-N400:mri-f55583b958f042d1", "n_stage": "N3"}
+{"id": "L3-N400:mri-96568525a2b14fe6", "n_stage": "N3"}
+{"id": "L3-N400:mri-54d674a472bc433c", "n_stage": "N3"}
+{"id": "L3-N400:mri-9468961926634fdd", "n_stage": "N3"}
+{"id": "L3-N400:mri-58cf64ac1d2440de", "n_stage": "N3"}
+{"id": "L3-N400:mri-ee8be7ba49ae4b0e", "n_stage": "N3"}
+{"id": "L3-N400:mri-eb6e8835c88f4bd7", "n_stage": "N3"}
+{"id": "L3-N400:mri-737cb6258c5046ed", "n_stage": "N3"}
+{"id": "L3-N400:mri-33030b0efc2f46c1", "n_stage": "N3"}
+{"id": "L3-N400:mri-a185a2e383804c0e", "n_stage": "N3"}
+{"id": "L3-N400:mri-cb9b5f7a135f4bd2", "n_stage": "N3"}
+{"id": "L3-N400:mri-cf85e43636134247", "n_stage": "N3"}
+{"id": "L3-N400:mri-fce3d9661b564100", "n_stage": "N3"}
+{"id": "L3-N400:mri-979b8558f54a454a", "n_stage": "N3"}
+{"id": "L3-N400:mri-b75a98b53b78430b", "n_stage": "N3"}
+{"id": "L3-N400:mri-2851eee410e141de", "n_stage": "N3"}
+{"id": "L3-N400:mri-90703c29e9484056", "n_stage": "N3"}
+{"id": "L3-N400:mri-56491de3aa6d4b24", "n_stage": "N3"}
+{"id": "L3-N400:mri-58f0bb032a164706", "n_stage": "N3"}
+{"id": "L3-N400:mri-8839afbd6e0d4aab", "n_stage": "N3"}
+{"id": "L3-N400:mri-aac5d0ef07ee44e1", "n_stage": "N3"}
+{"id": "L3-N400:mri-a742ee67f3b2440c", "n_stage": "N3"}
+{"id": "L3-N400:mri-b193700652bb4abf", "n_stage": "N3"}
+{"id": "L3-N400:mri-16cb459d984242b3", "n_stage": "N3"}
+{"id": "L3-N400:mri-fb8f9aac4af7446f", "n_stage": "N3"}
+{"id": "L3-N400:mri-0b9e6c5f475f4363", "n_stage": "N3"}
+{"id": "L3-N400:mri-64db89bf3cbe4fb6", "n_stage": "N3"}
+{"id": "L3-N400:mri-36dfc5d473c34e37", "n_stage": "N3"}
+{"id": "L3-N400:mri-a523ca589f684931", "n_stage": "N3"}
+{"id": "L3-N400:mri-93377512d50c4ef4", "n_stage": "N3"}
diff --git a/L3/extensions/README.md b/L3/extensions/README.md
new file mode 100644
index 0000000000000000000000000000000000000000..81b9ce13cc810591066735b5f20e17261caa670c
--- /dev/null
+++ b/L3/extensions/README.md
@@ -0,0 +1,23 @@
+# MRI sequence-group data
+
+This directory contains the group-format inputs for 300 T-stage and 400 N-stage patients. Together with the 100-patient structure-card panel in `L3/primary_l3_inputs/`, these form T400 and N400. Both tasks use AJCC/UICC edition 8; the T and N cohorts are patient-disjoint.
+
+## Files
+
+- `images-01.tar` through `images-07.tar`: seven 100-case image shards, containing 45,829 lossless PNG groups.
+- `requests.jsonl`: prompts and ordered image paths for all 700 patients.
+- `requests_gpt41.jsonl`: at most 50 groups per case, sampled within the axial/coronal groups with both endpoints retained.
+- `requests_internvl.jsonl`: the groups selected for the model's 40,960-token context.
+- `T300/labels.jsonl`, `N400/labels.jsonl`: report-derived reference stages.
+
+Extract every shard into this directory. Image paths in these request files are relative to this directory. The complete T400 and N400 labels are one level above, in `L3/T400.jsonl` and `L3/N400.jsonl`.
+
+## Layout and coverage
+
+Axial groups stack T1, T2 and enhanced T1 from the same physical plane. Coronal groups stack enhanced fat-suppressed T1 and precontrast non-fat-suppressed T1. Each clinical display tile is 512×512 pixels. Group dimensions are 512×1644 and 512×1096 pixels, including sequence labels.
+
+T coverage runs from the suprasellar cistern to inferior C3; N coverage extends from the skull base to the inferior sternoclavicular joint. The study team reviewed the anatomical bounds. All selected images for a patient enter one model request. Model-specific sampling, tiling and spatial merging are documented in the [evaluation code](https://github.com/pidneuralode/NPCBench/blob/main/docs/mri_extension.md).
+
+The 300 group-format T cases and all 400 N cases have explicit clinical M0 status. The combined T400 set includes 374 M0, 14 M1 and 12 cases with unspecified M status. T and N labels are reference labels for their own tasks; the T300 set does not provide independent structure-invasion annotations.
+
+Images are rendered derivatives without DICOM headers or patient-identity maps. The files contain anonymous case IDs and sequence labels. Clinical pixels are retained.
diff --git a/L3/extensions/T300/labels.jsonl b/L3/extensions/T300/labels.jsonl
new file mode 100644
index 0000000000000000000000000000000000000000..16c5aeee195bf2fbd786613487d2f5e86e95b9b4
--- /dev/null
+++ b/L3/extensions/T300/labels.jsonl
@@ -0,0 +1,300 @@
+{"id": "L3-T300:mri-d4c892f0b7e3423f", "t_stage": "T1"}
+{"id": "L3-T300:mri-1a77d0c1afdc43b7", "t_stage": "T1"}
+{"id": "L3-T300:mri-e75b60d1d083428e", "t_stage": "T1"}
+{"id": "L3-T300:mri-e3d8eb4d531d4fcf", "t_stage": "T1"}
+{"id": "L3-T300:mri-76a6988d1e084bab", "t_stage": "T1"}
+{"id": "L3-T300:mri-492555690ebc4338", "t_stage": "T1"}
+{"id": "L3-T300:mri-6075270c70db4d72", "t_stage": "T1"}
+{"id": "L3-T300:mri-a822794800b24433", "t_stage": "T1"}
+{"id": "L3-T300:mri-524c6754989f4a43", "t_stage": "T1"}
+{"id": "L3-T300:mri-43a46f6923804318", "t_stage": "T1"}
+{"id": "L3-T300:mri-0f97d76a51a040a4", "t_stage": "T1"}
+{"id": "L3-T300:mri-4eff6559f14148d5", "t_stage": "T1"}
+{"id": "L3-T300:mri-7cb304a3ddd04efa", "t_stage": "T1"}
+{"id": "L3-T300:mri-d2d9da67055048e2", "t_stage": "T1"}
+{"id": "L3-T300:mri-c4103868bea44f56", "t_stage": "T1"}
+{"id": "L3-T300:mri-a3351c647eb34a73", "t_stage": "T1"}
+{"id": "L3-T300:mri-91686de02cb64fc2", "t_stage": "T1"}
+{"id": "L3-T300:mri-93a27965e6ad4525", "t_stage": "T1"}
+{"id": "L3-T300:mri-02211a5df28b41c8", "t_stage": "T1"}
+{"id": "L3-T300:mri-aafde48fd76947e0", "t_stage": "T1"}
+{"id": "L3-T300:mri-e62cf64b75ea4c8c", "t_stage": "T1"}
+{"id": "L3-T300:mri-327d5554ba1d4a18", "t_stage": "T1"}
+{"id": "L3-T300:mri-976a2674bc694056", "t_stage": "T1"}
+{"id": "L3-T300:mri-451326ee669447a4", "t_stage": "T1"}
+{"id": "L3-T300:mri-86711ff1ba3b4fe1", "t_stage": "T1"}
+{"id": "L3-T300:mri-ea272624a53e4790", "t_stage": "T1"}
+{"id": "L3-T300:mri-52410c4d23b24b8a", "t_stage": "T1"}
+{"id": "L3-T300:mri-fcc9b515f8994f0e", "t_stage": "T1"}
+{"id": "L3-T300:mri-7a7ad2d70dc5430a", "t_stage": "T1"}
+{"id": "L3-T300:mri-3ea899b4a60449de", "t_stage": "T1"}
+{"id": "L3-T300:mri-f5e94b609a994f45", "t_stage": "T1"}
+{"id": "L3-T300:mri-9ec9fbbfc5a4455a", "t_stage": "T1"}
+{"id": "L3-T300:mri-5d8f67cc09114eee", "t_stage": "T1"}
+{"id": "L3-T300:mri-812aaa7d98de44b8", "t_stage": "T1"}
+{"id": "L3-T300:mri-d711445434a34edd", "t_stage": "T1"}
+{"id": "L3-T300:mri-13f68ff6760b49da", "t_stage": "T2"}
+{"id": "L3-T300:mri-48efb702a3a14741", "t_stage": "T2"}
+{"id": "L3-T300:mri-2036815a13894335", "t_stage": "T2"}
+{"id": "L3-T300:mri-b6a2446b183c424d", "t_stage": "T2"}
+{"id": "L3-T300:mri-38731096d9a3413d", "t_stage": "T2"}
+{"id": "L3-T300:mri-21c6274f45f64906", "t_stage": "T2"}
+{"id": "L3-T300:mri-60382ae47d2949ad", "t_stage": "T2"}
+{"id": "L3-T300:mri-076b103275994f82", "t_stage": "T2"}
+{"id": "L3-T300:mri-bc9d4d6445624b29", "t_stage": "T2"}
+{"id": "L3-T300:mri-b0afe5791e844b85", "t_stage": "T2"}
+{"id": "L3-T300:mri-b437689d0567403e", "t_stage": "T2"}
+{"id": "L3-T300:mri-de245813d9f84619", "t_stage": "T2"}
+{"id": "L3-T300:mri-112255f79d7b4cec", "t_stage": "T2"}
+{"id": "L3-T300:mri-e9d0d067dff1443e", "t_stage": "T2"}
+{"id": "L3-T300:mri-92996c65c0034e2b", "t_stage": "T2"}
+{"id": "L3-T300:mri-cd8283ba429a4f34", "t_stage": "T2"}
+{"id": "L3-T300:mri-0ca285ccae614db6", "t_stage": "T2"}
+{"id": "L3-T300:mri-8e2393c214054928", "t_stage": "T2"}
+{"id": "L3-T300:mri-964cc314fdba4813", "t_stage": "T2"}
+{"id": "L3-T300:mri-89ad7e4f032e4280", "t_stage": "T2"}
+{"id": "L3-T300:mri-17791822e81042f8", "t_stage": "T2"}
+{"id": "L3-T300:mri-e4e91086f13f4cfd", "t_stage": "T2"}
+{"id": "L3-T300:mri-641082354d954f14", "t_stage": "T2"}
+{"id": "L3-T300:mri-b8195ac61cf24d8e", "t_stage": "T2"}
+{"id": "L3-T300:mri-a8825a33e2e244c7", "t_stage": "T2"}
+{"id": "L3-T300:mri-a66aedc73c134dce", "t_stage": "T2"}
+{"id": "L3-T300:mri-4fc9388c39ea4bec", "t_stage": "T2"}
+{"id": "L3-T300:mri-1710b5fe45bb4c9b", "t_stage": "T2"}
+{"id": "L3-T300:mri-40ab680e8ff847d6", "t_stage": "T2"}
+{"id": "L3-T300:mri-396b4602039e46f3", "t_stage": "T2"}
+{"id": "L3-T300:mri-0588f21611574c53", "t_stage": "T2"}
+{"id": "L3-T300:mri-f4e104d4b1914b92", "t_stage": "T2"}
+{"id": "L3-T300:mri-d55be5ee6a164720", "t_stage": "T2"}
+{"id": "L3-T300:mri-819452b5910247dc", "t_stage": "T2"}
+{"id": "L3-T300:mri-d49832b605474bfa", "t_stage": "T2"}
+{"id": "L3-T300:mri-2bedb86c0d404023", "t_stage": "T3"}
+{"id": "L3-T300:mri-0f94f5ebff6c4b23", "t_stage": "T3"}
+{"id": "L3-T300:mri-2248452041c244a6", "t_stage": "T3"}
+{"id": "L3-T300:mri-a75f78b1241a410a", "t_stage": "T3"}
+{"id": "L3-T300:mri-ca4047d888404407", "t_stage": "T3"}
+{"id": "L3-T300:mri-5bef6cc79ec84d5f", "t_stage": "T3"}
+{"id": "L3-T300:mri-66a44b250d614109", "t_stage": "T3"}
+{"id": "L3-T300:mri-fc63c9cacf214122", "t_stage": "T3"}
+{"id": "L3-T300:mri-37345bffc7aa45be", "t_stage": "T3"}
+{"id": "L3-T300:mri-0394f36828774a62", "t_stage": "T3"}
+{"id": "L3-T300:mri-1cbc32dff74a4430", "t_stage": "T3"}
+{"id": "L3-T300:mri-62733f1276564ed5", "t_stage": "T3"}
+{"id": "L3-T300:mri-5f4e71f281864ee8", "t_stage": "T3"}
+{"id": "L3-T300:mri-d6bbc416db544bc3", "t_stage": "T3"}
+{"id": "L3-T300:mri-2d9c445715964c25", "t_stage": "T3"}
+{"id": "L3-T300:mri-aa61cf9331744ddd", "t_stage": "T3"}
+{"id": "L3-T300:mri-85bf21a1e54d4f86", "t_stage": "T3"}
+{"id": "L3-T300:mri-cd1d5e72481942cd", "t_stage": "T3"}
+{"id": "L3-T300:mri-07a00ae75e7b4977", "t_stage": "T3"}
+{"id": "L3-T300:mri-3640dbda84064e7c", "t_stage": "T3"}
+{"id": "L3-T300:mri-3fb297150b194344", "t_stage": "T3"}
+{"id": "L3-T300:mri-e5bad77de70140d2", "t_stage": "T3"}
+{"id": "L3-T300:mri-8a2e314a61574ad4", "t_stage": "T3"}
+{"id": "L3-T300:mri-89e6a98ecc3a4c9f", "t_stage": "T3"}
+{"id": "L3-T300:mri-f38067ba8f3f41c6", "t_stage": "T3"}
+{"id": "L3-T300:mri-591cf62b9f5c4f41", "t_stage": "T3"}
+{"id": "L3-T300:mri-a1c6c7fdf7e94572", "t_stage": "T3"}
+{"id": "L3-T300:mri-ac7e267005f6465a", "t_stage": "T3"}
+{"id": "L3-T300:mri-df899a3786cb48e5", "t_stage": "T3"}
+{"id": "L3-T300:mri-8a31792e1b9548c6", "t_stage": "T3"}
+{"id": "L3-T300:mri-92679901993c443c", "t_stage": "T3"}
+{"id": "L3-T300:mri-47a7dce19f27448f", "t_stage": "T3"}
+{"id": "L3-T300:mri-a099dc17835b4447", "t_stage": "T3"}
+{"id": "L3-T300:mri-46d4180f5c9b4ea7", "t_stage": "T3"}
+{"id": "L3-T300:mri-433ebef7edd64a24", "t_stage": "T3"}
+{"id": "L3-T300:mri-a593896fc6c34499", "t_stage": "T3"}
+{"id": "L3-T300:mri-19b78e282ae648fc", "t_stage": "T3"}
+{"id": "L3-T300:mri-77d61075f19a4a7e", "t_stage": "T3"}
+{"id": "L3-T300:mri-531b90fa4b7b430c", "t_stage": "T3"}
+{"id": "L3-T300:mri-3fef1b1edce94fa6", "t_stage": "T3"}
+{"id": "L3-T300:mri-960fac01b62540bb", "t_stage": "T3"}
+{"id": "L3-T300:mri-f3c7c9ffe2254cce", "t_stage": "T3"}
+{"id": "L3-T300:mri-9be1862b768f4779", "t_stage": "T3"}
+{"id": "L3-T300:mri-27888c92886445dd", "t_stage": "T3"}
+{"id": "L3-T300:mri-52bc4d5404e34274", "t_stage": "T3"}
+{"id": "L3-T300:mri-5893d155cf924e90", "t_stage": "T3"}
+{"id": "L3-T300:mri-55ee2875d8c74396", "t_stage": "T3"}
+{"id": "L3-T300:mri-009d069830a941cc", "t_stage": "T3"}
+{"id": "L3-T300:mri-5927ca297b614ffd", "t_stage": "T3"}
+{"id": "L3-T300:mri-a5b56fee006e4280", "t_stage": "T3"}
+{"id": "L3-T300:mri-db4b9a10a3444950", "t_stage": "T3"}
+{"id": "L3-T300:mri-ec4156cac1c84d7f", "t_stage": "T3"}
+{"id": "L3-T300:mri-b9040a34fa5e4315", "t_stage": "T3"}
+{"id": "L3-T300:mri-7c103c2defd14c13", "t_stage": "T3"}
+{"id": "L3-T300:mri-dce34f88ac514aa2", "t_stage": "T3"}
+{"id": "L3-T300:mri-dcdf6ec887f345f5", "t_stage": "T3"}
+{"id": "L3-T300:mri-dba945687774414a", "t_stage": "T3"}
+{"id": "L3-T300:mri-c676d561104541b6", "t_stage": "T3"}
+{"id": "L3-T300:mri-10d48e8b495348d4", "t_stage": "T3"}
+{"id": "L3-T300:mri-911862d19e9e456f", "t_stage": "T3"}
+{"id": "L3-T300:mri-52ab912be8f94df4", "t_stage": "T3"}
+{"id": "L3-T300:mri-ccaecc2dd6674b4c", "t_stage": "T3"}
+{"id": "L3-T300:mri-20452f5fb9304914", "t_stage": "T3"}
+{"id": "L3-T300:mri-9bc82b4fc3564f98", "t_stage": "T3"}
+{"id": "L3-T300:mri-e7ca4067ba764e60", "t_stage": "T3"}
+{"id": "L3-T300:mri-ca6c28608dc74151", "t_stage": "T3"}
+{"id": "L3-T300:mri-2cda076179fb48e3", "t_stage": "T3"}
+{"id": "L3-T300:mri-bbcf4ba5ac804eee", "t_stage": "T3"}
+{"id": "L3-T300:mri-b0306ff4925b498a", "t_stage": "T3"}
+{"id": "L3-T300:mri-8369bc80cc524c36", "t_stage": "T3"}
+{"id": "L3-T300:mri-7850ff7cafae4340", "t_stage": "T3"}
+{"id": "L3-T300:mri-ab79773a626e48a4", "t_stage": "T3"}
+{"id": "L3-T300:mri-412e83e3a9394b43", "t_stage": "T3"}
+{"id": "L3-T300:mri-16c2f9f2b11e43e7", "t_stage": "T3"}
+{"id": "L3-T300:mri-3f31af08249d42ef", "t_stage": "T3"}
+{"id": "L3-T300:mri-25fd5f6282bd417a", "t_stage": "T3"}
+{"id": "L3-T300:mri-acc2b4aa749d4481", "t_stage": "T3"}
+{"id": "L3-T300:mri-4c6b71e4929542b4", "t_stage": "T3"}
+{"id": "L3-T300:mri-70a24066e1394843", "t_stage": "T3"}
+{"id": "L3-T300:mri-3931b6ac51dd4dc5", "t_stage": "T3"}
+{"id": "L3-T300:mri-94619c73cc6e4b8d", "t_stage": "T3"}
+{"id": "L3-T300:mri-d7919e72b6ea42d5", "t_stage": "T3"}
+{"id": "L3-T300:mri-35e2272d24e44428", "t_stage": "T3"}
+{"id": "L3-T300:mri-f18cbd80507c4825", "t_stage": "T3"}
+{"id": "L3-T300:mri-b03c65e16e9040f7", "t_stage": "T3"}
+{"id": "L3-T300:mri-46fd12fc3c8e4db4", "t_stage": "T3"}
+{"id": "L3-T300:mri-f1332bb1d0564e4d", "t_stage": "T3"}
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+{"id":"L3-T300:mri-d4c892f0b7e3423f","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-d4c892f0b7e3423f/axial_001.png","assets/T/mri-d4c892f0b7e3423f/axial_002.png","assets/T/mri-d4c892f0b7e3423f/axial_003.png","assets/T/mri-d4c892f0b7e3423f/axial_004.png","assets/T/mri-d4c892f0b7e3423f/axial_005.png","assets/T/mri-d4c892f0b7e3423f/axial_006.png","assets/T/mri-d4c892f0b7e3423f/axial_007.png","assets/T/mri-d4c892f0b7e3423f/axial_008.png","assets/T/mri-d4c892f0b7e3423f/axial_009.png","assets/T/mri-d4c892f0b7e3423f/axial_010.png","assets/T/mri-d4c892f0b7e3423f/axial_011.png","assets/T/mri-d4c892f0b7e3423f/axial_012.png","assets/T/mri-d4c892f0b7e3423f/axial_013.png","assets/T/mri-d4c892f0b7e3423f/axial_014.png","assets/T/mri-d4c892f0b7e3423f/axial_015.png","assets/T/mri-d4c892f0b7e3423f/axial_016.png","assets/T/mri-d4c892f0b7e3423f/axial_017.png","assets/T/mri-d4c892f0b7e3423f/axial_018.png","assets/T/mri-d4c892f0b7e3423f/axial_019.png","assets/T/mri-d4c892f0b7e3423f/axial_020.png","assets/T/mri-d4c892f0b7e3423f/axial_021.png","assets/T/mri-d4c892f0b7e3423f/axial_022.png","assets/T/mri-d4c892f0b7e3423f/axial_023.png","assets/T/mri-d4c892f0b7e3423f/axial_024.png","assets/T/mri-d4c892f0b7e3423f/axial_025.png","assets/T/mri-d4c892f0b7e3423f/axial_026.png","assets/T/mri-d4c892f0b7e3423f/axial_027.png","assets/T/mri-d4c892f0b7e3423f/axial_028.png","assets/T/mri-d4c892f0b7e3423f/axial_029.png","assets/T/mri-d4c892f0b7e3423f/axial_030.png","assets/T/mri-d4c892f0b7e3423f/axial_031.png","assets/T/mri-d4c892f0b7e3423f/axial_032.png","assets/T/mri-d4c892f0b7e3423f/axial_033.png","assets/T/mri-d4c892f0b7e3423f/axial_034.png","assets/T/mri-d4c892f0b7e3423f/axial_035.png","assets/T/mri-d4c892f0b7e3423f/axial_036.png","assets/T/mri-d4c892f0b7e3423f/axial_037.png","assets/T/mri-d4c892f0b7e3423f/axial_038.png","assets/T/mri-d4c892f0b7e3423f/axial_039.png","assets/T/mri-d4c892f0b7e3423f/axial_040.png","assets/T/mri-d4c892f0b7e3423f/axial_041.png","assets/T/mri-d4c892f0b7e3423f/axial_042.png","assets/T/mri-d4c892f0b7e3423f/coronal_001.png","assets/T/mri-d4c892f0b7e3423f/coronal_002.png","assets/T/mri-d4c892f0b7e3423f/coronal_003.png","assets/T/mri-d4c892f0b7e3423f/coronal_004.png","assets/T/mri-d4c892f0b7e3423f/coronal_005.png","assets/T/mri-d4c892f0b7e3423f/coronal_006.png","assets/T/mri-d4c892f0b7e3423f/coronal_007.png","assets/T/mri-d4c892f0b7e3423f/coronal_008.png","assets/T/mri-d4c892f0b7e3423f/coronal_009.png","assets/T/mri-d4c892f0b7e3423f/coronal_010.png","assets/T/mri-d4c892f0b7e3423f/coronal_011.png","assets/T/mri-d4c892f0b7e3423f/coronal_012.png","assets/T/mri-d4c892f0b7e3423f/coronal_013.png","assets/T/mri-d4c892f0b7e3423f/coronal_014.png","assets/T/mri-d4c892f0b7e3423f/coronal_015.png","assets/T/mri-d4c892f0b7e3423f/coronal_016.png","assets/T/mri-d4c892f0b7e3423f/coronal_017.png","assets/T/mri-d4c892f0b7e3423f/coronal_018.png","assets/T/mri-d4c892f0b7e3423f/coronal_019.png","assets/T/mri-d4c892f0b7e3423f/coronal_020.png","assets/T/mri-d4c892f0b7e3423f/coronal_021.png","assets/T/mri-d4c892f0b7e3423f/coronal_022.png","assets/T/mri-d4c892f0b7e3423f/coronal_023.png","assets/T/mri-d4c892f0b7e3423f/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-1a77d0c1afdc43b7","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-1a77d0c1afdc43b7/axial_001.png","assets/T/mri-1a77d0c1afdc43b7/axial_002.png","assets/T/mri-1a77d0c1afdc43b7/axial_003.png","assets/T/mri-1a77d0c1afdc43b7/axial_004.png","assets/T/mri-1a77d0c1afdc43b7/axial_005.png","assets/T/mri-1a77d0c1afdc43b7/axial_006.png","assets/T/mri-1a77d0c1afdc43b7/axial_007.png","assets/T/mri-1a77d0c1afdc43b7/axial_008.png","assets/T/mri-1a77d0c1afdc43b7/axial_009.png","assets/T/mri-1a77d0c1afdc43b7/axial_010.png","assets/T/mri-1a77d0c1afdc43b7/axial_011.png","assets/T/mri-1a77d0c1afdc43b7/axial_012.png","assets/T/mri-1a77d0c1afdc43b7/axial_013.png","assets/T/mri-1a77d0c1afdc43b7/axial_014.png","assets/T/mri-1a77d0c1afdc43b7/axial_015.png","assets/T/mri-1a77d0c1afdc43b7/axial_016.png","assets/T/mri-1a77d0c1afdc43b7/axial_017.png","assets/T/mri-1a77d0c1afdc43b7/axial_018.png","assets/T/mri-1a77d0c1afdc43b7/axial_019.png","assets/T/mri-1a77d0c1afdc43b7/axial_020.png","assets/T/mri-1a77d0c1afdc43b7/axial_021.png","assets/T/mri-1a77d0c1afdc43b7/axial_022.png","assets/T/mri-1a77d0c1afdc43b7/axial_023.png","assets/T/mri-1a77d0c1afdc43b7/axial_024.png","assets/T/mri-1a77d0c1afdc43b7/axial_025.png","assets/T/mri-1a77d0c1afdc43b7/axial_026.png","assets/T/mri-1a77d0c1afdc43b7/axial_027.png","assets/T/mri-1a77d0c1afdc43b7/axial_028.png","assets/T/mri-1a77d0c1afdc43b7/axial_029.png","assets/T/mri-1a77d0c1afdc43b7/axial_030.png","assets/T/mri-1a77d0c1afdc43b7/axial_031.png","assets/T/mri-1a77d0c1afdc43b7/axial_032.png","assets/T/mri-1a77d0c1afdc43b7/axial_033.png","assets/T/mri-1a77d0c1afdc43b7/axial_034.png","assets/T/mri-1a77d0c1afdc43b7/axial_035.png","assets/T/mri-1a77d0c1afdc43b7/axial_036.png","assets/T/mri-1a77d0c1afdc43b7/axial_037.png","assets/T/mri-1a77d0c1afdc43b7/axial_038.png","assets/T/mri-1a77d0c1afdc43b7/axial_039.png","assets/T/mri-1a77d0c1afdc43b7/axial_040.png","assets/T/mri-1a77d0c1afdc43b7/axial_041.png","assets/T/mri-1a77d0c1afdc43b7/axial_042.png","assets/T/mri-1a77d0c1afdc43b7/coronal_001.png","assets/T/mri-1a77d0c1afdc43b7/coronal_002.png","assets/T/mri-1a77d0c1afdc43b7/coronal_003.png","assets/T/mri-1a77d0c1afdc43b7/coronal_004.png","assets/T/mri-1a77d0c1afdc43b7/coronal_005.png","assets/T/mri-1a77d0c1afdc43b7/coronal_006.png","assets/T/mri-1a77d0c1afdc43b7/coronal_007.png","assets/T/mri-1a77d0c1afdc43b7/coronal_008.png","assets/T/mri-1a77d0c1afdc43b7/coronal_009.png","assets/T/mri-1a77d0c1afdc43b7/coronal_010.png","assets/T/mri-1a77d0c1afdc43b7/coronal_011.png","assets/T/mri-1a77d0c1afdc43b7/coronal_012.png","assets/T/mri-1a77d0c1afdc43b7/coronal_013.png","assets/T/mri-1a77d0c1afdc43b7/coronal_014.png","assets/T/mri-1a77d0c1afdc43b7/coronal_015.png","assets/T/mri-1a77d0c1afdc43b7/coronal_016.png","assets/T/mri-1a77d0c1afdc43b7/coronal_017.png","assets/T/mri-1a77d0c1afdc43b7/coronal_018.png","assets/T/mri-1a77d0c1afdc43b7/coronal_019.png","assets/T/mri-1a77d0c1afdc43b7/coronal_020.png","assets/T/mri-1a77d0c1afdc43b7/coronal_021.png","assets/T/mri-1a77d0c1afdc43b7/coronal_022.png","assets/T/mri-1a77d0c1afdc43b7/coronal_023.png","assets/T/mri-1a77d0c1afdc43b7/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-e75b60d1d083428e","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-e75b60d1d083428e/axial_001.png","assets/T/mri-e75b60d1d083428e/axial_002.png","assets/T/mri-e75b60d1d083428e/axial_003.png","assets/T/mri-e75b60d1d083428e/axial_004.png","assets/T/mri-e75b60d1d083428e/axial_005.png","assets/T/mri-e75b60d1d083428e/axial_006.png","assets/T/mri-e75b60d1d083428e/axial_007.png","assets/T/mri-e75b60d1d083428e/axial_008.png","assets/T/mri-e75b60d1d083428e/axial_009.png","assets/T/mri-e75b60d1d083428e/axial_010.png","assets/T/mri-e75b60d1d083428e/axial_011.png","assets/T/mri-e75b60d1d083428e/axial_012.png","assets/T/mri-e75b60d1d083428e/axial_013.png","assets/T/mri-e75b60d1d083428e/axial_014.png","assets/T/mri-e75b60d1d083428e/axial_015.png","assets/T/mri-e75b60d1d083428e/axial_016.png","assets/T/mri-e75b60d1d083428e/axial_017.png","assets/T/mri-e75b60d1d083428e/axial_018.png","assets/T/mri-e75b60d1d083428e/axial_019.png","assets/T/mri-e75b60d1d083428e/axial_020.png","assets/T/mri-e75b60d1d083428e/axial_021.png","assets/T/mri-e75b60d1d083428e/axial_022.png","assets/T/mri-e75b60d1d083428e/axial_023.png","assets/T/mri-e75b60d1d083428e/axial_024.png","assets/T/mri-e75b60d1d083428e/axial_025.png","assets/T/mri-e75b60d1d083428e/axial_026.png","assets/T/mri-e75b60d1d083428e/axial_027.png","assets/T/mri-e75b60d1d083428e/axial_028.png","assets/T/mri-e75b60d1d083428e/axial_029.png","assets/T/mri-e75b60d1d083428e/axial_030.png","assets/T/mri-e75b60d1d083428e/axial_031.png","assets/T/mri-e75b60d1d083428e/axial_032.png","assets/T/mri-e75b60d1d083428e/axial_033.png","assets/T/mri-e75b60d1d083428e/axial_034.png","assets/T/mri-e75b60d1d083428e/axial_035.png","assets/T/mri-e75b60d1d083428e/axial_036.png","assets/T/mri-e75b60d1d083428e/axial_037.png","assets/T/mri-e75b60d1d083428e/axial_038.png","assets/T/mri-e75b60d1d083428e/axial_039.png","assets/T/mri-e75b60d1d083428e/axial_040.png","assets/T/mri-e75b60d1d083428e/coronal_001.png","assets/T/mri-e75b60d1d083428e/coronal_002.png","assets/T/mri-e75b60d1d083428e/coronal_003.png","assets/T/mri-e75b60d1d083428e/coronal_004.png","assets/T/mri-e75b60d1d083428e/coronal_005.png","assets/T/mri-e75b60d1d083428e/coronal_006.png","assets/T/mri-e75b60d1d083428e/coronal_007.png","assets/T/mri-e75b60d1d083428e/coronal_008.png","assets/T/mri-e75b60d1d083428e/coronal_009.png","assets/T/mri-e75b60d1d083428e/coronal_010.png","assets/T/mri-e75b60d1d083428e/coronal_011.png","assets/T/mri-e75b60d1d083428e/coronal_012.png","assets/T/mri-e75b60d1d083428e/coronal_013.png","assets/T/mri-e75b60d1d083428e/coronal_014.png","assets/T/mri-e75b60d1d083428e/coronal_015.png","assets/T/mri-e75b60d1d083428e/coronal_016.png","assets/T/mri-e75b60d1d083428e/coronal_017.png","assets/T/mri-e75b60d1d083428e/coronal_018.png","assets/T/mri-e75b60d1d083428e/coronal_019.png","assets/T/mri-e75b60d1d083428e/coronal_020.png","assets/T/mri-e75b60d1d083428e/coronal_021.png","assets/T/mri-e75b60d1d083428e/coronal_022.png","assets/T/mri-e75b60d1d083428e/coronal_023.png","assets/T/mri-e75b60d1d083428e/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-e3d8eb4d531d4fcf","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-e3d8eb4d531d4fcf/axial_001.png","assets/T/mri-e3d8eb4d531d4fcf/axial_002.png","assets/T/mri-e3d8eb4d531d4fcf/axial_003.png","assets/T/mri-e3d8eb4d531d4fcf/axial_004.png","assets/T/mri-e3d8eb4d531d4fcf/axial_005.png","assets/T/mri-e3d8eb4d531d4fcf/axial_006.png","assets/T/mri-e3d8eb4d531d4fcf/axial_007.png","assets/T/mri-e3d8eb4d531d4fcf/axial_008.png","assets/T/mri-e3d8eb4d531d4fcf/axial_009.png","assets/T/mri-e3d8eb4d531d4fcf/axial_010.png","assets/T/mri-e3d8eb4d531d4fcf/axial_011.png","assets/T/mri-e3d8eb4d531d4fcf/axial_012.png","assets/T/mri-e3d8eb4d531d4fcf/axial_013.png","assets/T/mri-e3d8eb4d531d4fcf/axial_014.png","assets/T/mri-e3d8eb4d531d4fcf/axial_015.png","assets/T/mri-e3d8eb4d531d4fcf/axial_016.png","assets/T/mri-e3d8eb4d531d4fcf/axial_017.png","assets/T/mri-e3d8eb4d531d4fcf/axial_018.png","assets/T/mri-e3d8eb4d531d4fcf/axial_019.png","assets/T/mri-e3d8eb4d531d4fcf/axial_020.png","assets/T/mri-e3d8eb4d531d4fcf/axial_021.png","assets/T/mri-e3d8eb4d531d4fcf/axial_022.png","assets/T/mri-e3d8eb4d531d4fcf/axial_023.png","assets/T/mri-e3d8eb4d531d4fcf/axial_024.png","assets/T/mri-e3d8eb4d531d4fcf/axial_025.png","assets/T/mri-e3d8eb4d531d4fcf/axial_026.png","assets/T/mri-e3d8eb4d531d4fcf/axial_027.png","assets/T/mri-e3d8eb4d531d4fcf/axial_028.png","assets/T/mri-e3d8eb4d531d4fcf/axial_029.png","assets/T/mri-e3d8eb4d531d4fcf/axial_030.png","assets/T/mri-e3d8eb4d531d4fcf/axial_031.png","assets/T/mri-e3d8eb4d531d4fcf/axial_032.png","assets/T/mri-e3d8eb4d531d4fcf/axial_033.png","assets/T/mri-e3d8eb4d531d4fcf/axial_034.png","assets/T/mri-e3d8eb4d531d4fcf/axial_035.png","assets/T/mri-e3d8eb4d531d4fcf/axial_036.png","assets/T/mri-e3d8eb4d531d4fcf/axial_037.png","assets/T/mri-e3d8eb4d531d4fcf/axial_038.png","assets/T/mri-e3d8eb4d531d4fcf/axial_039.png","assets/T/mri-e3d8eb4d531d4fcf/axial_040.png","assets/T/mri-e3d8eb4d531d4fcf/axial_041.png","assets/T/mri-e3d8eb4d531d4fcf/axial_042.png","assets/T/mri-e3d8eb4d531d4fcf/coronal_001.png","assets/T/mri-e3d8eb4d531d4fcf/coronal_002.png","assets/T/mri-e3d8eb4d531d4fcf/coronal_003.png","assets/T/mri-e3d8eb4d531d4fcf/coronal_004.png","assets/T/mri-e3d8eb4d531d4fcf/coronal_005.png","assets/T/mri-e3d8eb4d531d4fcf/coronal_006.png","assets/T/mri-e3d8eb4d531d4fcf/coronal_007.png","assets/T/mri-e3d8eb4d531d4fcf/coronal_008.png","assets/T/mri-e3d8eb4d531d4fcf/coronal_009.png","assets/T/mri-e3d8eb4d531d4fcf/coronal_010.png","assets/T/mri-e3d8eb4d531d4fcf/coronal_011.png","assets/T/mri-e3d8eb4d531d4fcf/coronal_012.png","assets/T/mri-e3d8eb4d531d4fcf/coronal_013.png","assets/T/mri-e3d8eb4d531d4fcf/coronal_014.png","assets/T/mri-e3d8eb4d531d4fcf/coronal_015.png","assets/T/mri-e3d8eb4d531d4fcf/coronal_016.png","assets/T/mri-e3d8eb4d531d4fcf/coronal_017.png","assets/T/mri-e3d8eb4d531d4fcf/coronal_018.png","assets/T/mri-e3d8eb4d531d4fcf/coronal_019.png","assets/T/mri-e3d8eb4d531d4fcf/coronal_020.png","assets/T/mri-e3d8eb4d531d4fcf/coronal_021.png","assets/T/mri-e3d8eb4d531d4fcf/coronal_022.png","assets/T/mri-e3d8eb4d531d4fcf/coronal_023.png","assets/T/mri-e3d8eb4d531d4fcf/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-76a6988d1e084bab","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 60 张图，均来自同一次检查。\n\n- 前 36 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-76a6988d1e084bab/axial_001.png","assets/T/mri-76a6988d1e084bab/axial_002.png","assets/T/mri-76a6988d1e084bab/axial_003.png","assets/T/mri-76a6988d1e084bab/axial_004.png","assets/T/mri-76a6988d1e084bab/axial_005.png","assets/T/mri-76a6988d1e084bab/axial_006.png","assets/T/mri-76a6988d1e084bab/axial_007.png","assets/T/mri-76a6988d1e084bab/axial_008.png","assets/T/mri-76a6988d1e084bab/axial_009.png","assets/T/mri-76a6988d1e084bab/axial_010.png","assets/T/mri-76a6988d1e084bab/axial_011.png","assets/T/mri-76a6988d1e084bab/axial_012.png","assets/T/mri-76a6988d1e084bab/axial_013.png","assets/T/mri-76a6988d1e084bab/axial_014.png","assets/T/mri-76a6988d1e084bab/axial_015.png","assets/T/mri-76a6988d1e084bab/axial_016.png","assets/T/mri-76a6988d1e084bab/axial_017.png","assets/T/mri-76a6988d1e084bab/axial_018.png","assets/T/mri-76a6988d1e084bab/axial_019.png","assets/T/mri-76a6988d1e084bab/axial_020.png","assets/T/mri-76a6988d1e084bab/axial_021.png","assets/T/mri-76a6988d1e084bab/axial_022.png","assets/T/mri-76a6988d1e084bab/axial_023.png","assets/T/mri-76a6988d1e084bab/axial_024.png","assets/T/mri-76a6988d1e084bab/axial_025.png","assets/T/mri-76a6988d1e084bab/axial_026.png","assets/T/mri-76a6988d1e084bab/axial_027.png","assets/T/mri-76a6988d1e084bab/axial_028.png","assets/T/mri-76a6988d1e084bab/axial_029.png","assets/T/mri-76a6988d1e084bab/axial_030.png","assets/T/mri-76a6988d1e084bab/axial_031.png","assets/T/mri-76a6988d1e084bab/axial_032.png","assets/T/mri-76a6988d1e084bab/axial_033.png","assets/T/mri-76a6988d1e084bab/axial_034.png","assets/T/mri-76a6988d1e084bab/axial_035.png","assets/T/mri-76a6988d1e084bab/axial_036.png","assets/T/mri-76a6988d1e084bab/coronal_001.png","assets/T/mri-76a6988d1e084bab/coronal_002.png","assets/T/mri-76a6988d1e084bab/coronal_003.png","assets/T/mri-76a6988d1e084bab/coronal_004.png","assets/T/mri-76a6988d1e084bab/coronal_005.png","assets/T/mri-76a6988d1e084bab/coronal_006.png","assets/T/mri-76a6988d1e084bab/coronal_007.png","assets/T/mri-76a6988d1e084bab/coronal_008.png","assets/T/mri-76a6988d1e084bab/coronal_009.png","assets/T/mri-76a6988d1e084bab/coronal_010.png","assets/T/mri-76a6988d1e084bab/coronal_011.png","assets/T/mri-76a6988d1e084bab/coronal_012.png","assets/T/mri-76a6988d1e084bab/coronal_013.png","assets/T/mri-76a6988d1e084bab/coronal_014.png","assets/T/mri-76a6988d1e084bab/coronal_015.png","assets/T/mri-76a6988d1e084bab/coronal_016.png","assets/T/mri-76a6988d1e084bab/coronal_017.png","assets/T/mri-76a6988d1e084bab/coronal_018.png","assets/T/mri-76a6988d1e084bab/coronal_019.png","assets/T/mri-76a6988d1e084bab/coronal_020.png","assets/T/mri-76a6988d1e084bab/coronal_021.png","assets/T/mri-76a6988d1e084bab/coronal_022.png","assets/T/mri-76a6988d1e084bab/coronal_023.png","assets/T/mri-76a6988d1e084bab/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-492555690ebc4338","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-492555690ebc4338/axial_001.png","assets/T/mri-492555690ebc4338/axial_002.png","assets/T/mri-492555690ebc4338/axial_003.png","assets/T/mri-492555690ebc4338/axial_004.png","assets/T/mri-492555690ebc4338/axial_005.png","assets/T/mri-492555690ebc4338/axial_006.png","assets/T/mri-492555690ebc4338/axial_007.png","assets/T/mri-492555690ebc4338/axial_008.png","assets/T/mri-492555690ebc4338/axial_009.png","assets/T/mri-492555690ebc4338/axial_010.png","assets/T/mri-492555690ebc4338/axial_011.png","assets/T/mri-492555690ebc4338/axial_012.png","assets/T/mri-492555690ebc4338/axial_013.png","assets/T/mri-492555690ebc4338/axial_014.png","assets/T/mri-492555690ebc4338/axial_015.png","assets/T/mri-492555690ebc4338/axial_016.png","assets/T/mri-492555690ebc4338/axial_017.png","assets/T/mri-492555690ebc4338/axial_018.png","assets/T/mri-492555690ebc4338/axial_019.png","assets/T/mri-492555690ebc4338/axial_020.png","assets/T/mri-492555690ebc4338/axial_021.png","assets/T/mri-492555690ebc4338/axial_022.png","assets/T/mri-492555690ebc4338/axial_023.png","assets/T/mri-492555690ebc4338/axial_024.png","assets/T/mri-492555690ebc4338/axial_025.png","assets/T/mri-492555690ebc4338/axial_026.png","assets/T/mri-492555690ebc4338/axial_027.png","assets/T/mri-492555690ebc4338/axial_028.png","assets/T/mri-492555690ebc4338/axial_029.png","assets/T/mri-492555690ebc4338/axial_030.png","assets/T/mri-492555690ebc4338/axial_031.png","assets/T/mri-492555690ebc4338/axial_032.png","assets/T/mri-492555690ebc4338/axial_033.png","assets/T/mri-492555690ebc4338/axial_034.png","assets/T/mri-492555690ebc4338/axial_035.png","assets/T/mri-492555690ebc4338/axial_036.png","assets/T/mri-492555690ebc4338/axial_037.png","assets/T/mri-492555690ebc4338/axial_038.png","assets/T/mri-492555690ebc4338/axial_039.png","assets/T/mri-492555690ebc4338/axial_040.png","assets/T/mri-492555690ebc4338/axial_041.png","assets/T/mri-492555690ebc4338/axial_042.png","assets/T/mri-492555690ebc4338/coronal_001.png","assets/T/mri-492555690ebc4338/coronal_002.png","assets/T/mri-492555690ebc4338/coronal_003.png","assets/T/mri-492555690ebc4338/coronal_004.png","assets/T/mri-492555690ebc4338/coronal_005.png","assets/T/mri-492555690ebc4338/coronal_006.png","assets/T/mri-492555690ebc4338/coronal_007.png","assets/T/mri-492555690ebc4338/coronal_008.png","assets/T/mri-492555690ebc4338/coronal_009.png","assets/T/mri-492555690ebc4338/coronal_010.png","assets/T/mri-492555690ebc4338/coronal_011.png","assets/T/mri-492555690ebc4338/coronal_012.png","assets/T/mri-492555690ebc4338/coronal_013.png","assets/T/mri-492555690ebc4338/coronal_014.png","assets/T/mri-492555690ebc4338/coronal_015.png","assets/T/mri-492555690ebc4338/coronal_016.png","assets/T/mri-492555690ebc4338/coronal_017.png","assets/T/mri-492555690ebc4338/coronal_018.png","assets/T/mri-492555690ebc4338/coronal_019.png","assets/T/mri-492555690ebc4338/coronal_020.png","assets/T/mri-492555690ebc4338/coronal_021.png","assets/T/mri-492555690ebc4338/coronal_022.png","assets/T/mri-492555690ebc4338/coronal_023.png","assets/T/mri-492555690ebc4338/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-6075270c70db4d72","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-6075270c70db4d72/axial_001.png","assets/T/mri-6075270c70db4d72/axial_002.png","assets/T/mri-6075270c70db4d72/axial_003.png","assets/T/mri-6075270c70db4d72/axial_004.png","assets/T/mri-6075270c70db4d72/axial_005.png","assets/T/mri-6075270c70db4d72/axial_006.png","assets/T/mri-6075270c70db4d72/axial_007.png","assets/T/mri-6075270c70db4d72/axial_008.png","assets/T/mri-6075270c70db4d72/axial_009.png","assets/T/mri-6075270c70db4d72/axial_010.png","assets/T/mri-6075270c70db4d72/axial_011.png","assets/T/mri-6075270c70db4d72/axial_012.png","assets/T/mri-6075270c70db4d72/axial_013.png","assets/T/mri-6075270c70db4d72/axial_014.png","assets/T/mri-6075270c70db4d72/axial_015.png","assets/T/mri-6075270c70db4d72/axial_016.png","assets/T/mri-6075270c70db4d72/axial_017.png","assets/T/mri-6075270c70db4d72/axial_018.png","assets/T/mri-6075270c70db4d72/axial_019.png","assets/T/mri-6075270c70db4d72/axial_020.png","assets/T/mri-6075270c70db4d72/axial_021.png","assets/T/mri-6075270c70db4d72/axial_022.png","assets/T/mri-6075270c70db4d72/axial_023.png","assets/T/mri-6075270c70db4d72/axial_024.png","assets/T/mri-6075270c70db4d72/axial_025.png","assets/T/mri-6075270c70db4d72/axial_026.png","assets/T/mri-6075270c70db4d72/axial_027.png","assets/T/mri-6075270c70db4d72/axial_028.png","assets/T/mri-6075270c70db4d72/axial_029.png","assets/T/mri-6075270c70db4d72/axial_030.png","assets/T/mri-6075270c70db4d72/axial_031.png","assets/T/mri-6075270c70db4d72/axial_032.png","assets/T/mri-6075270c70db4d72/axial_033.png","assets/T/mri-6075270c70db4d72/axial_034.png","assets/T/mri-6075270c70db4d72/axial_035.png","assets/T/mri-6075270c70db4d72/axial_036.png","assets/T/mri-6075270c70db4d72/axial_037.png","assets/T/mri-6075270c70db4d72/axial_038.png","assets/T/mri-6075270c70db4d72/axial_039.png","assets/T/mri-6075270c70db4d72/axial_040.png","assets/T/mri-6075270c70db4d72/axial_041.png","assets/T/mri-6075270c70db4d72/axial_042.png","assets/T/mri-6075270c70db4d72/coronal_001.png","assets/T/mri-6075270c70db4d72/coronal_002.png","assets/T/mri-6075270c70db4d72/coronal_003.png","assets/T/mri-6075270c70db4d72/coronal_004.png","assets/T/mri-6075270c70db4d72/coronal_005.png","assets/T/mri-6075270c70db4d72/coronal_006.png","assets/T/mri-6075270c70db4d72/coronal_007.png","assets/T/mri-6075270c70db4d72/coronal_008.png","assets/T/mri-6075270c70db4d72/coronal_009.png","assets/T/mri-6075270c70db4d72/coronal_010.png","assets/T/mri-6075270c70db4d72/coronal_011.png","assets/T/mri-6075270c70db4d72/coronal_012.png","assets/T/mri-6075270c70db4d72/coronal_013.png","assets/T/mri-6075270c70db4d72/coronal_014.png","assets/T/mri-6075270c70db4d72/coronal_015.png","assets/T/mri-6075270c70db4d72/coronal_016.png","assets/T/mri-6075270c70db4d72/coronal_017.png","assets/T/mri-6075270c70db4d72/coronal_018.png","assets/T/mri-6075270c70db4d72/coronal_019.png","assets/T/mri-6075270c70db4d72/coronal_020.png","assets/T/mri-6075270c70db4d72/coronal_021.png","assets/T/mri-6075270c70db4d72/coronal_022.png","assets/T/mri-6075270c70db4d72/coronal_023.png","assets/T/mri-6075270c70db4d72/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-a822794800b24433","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-a822794800b24433/axial_001.png","assets/T/mri-a822794800b24433/axial_002.png","assets/T/mri-a822794800b24433/axial_003.png","assets/T/mri-a822794800b24433/axial_004.png","assets/T/mri-a822794800b24433/axial_005.png","assets/T/mri-a822794800b24433/axial_006.png","assets/T/mri-a822794800b24433/axial_007.png","assets/T/mri-a822794800b24433/axial_008.png","assets/T/mri-a822794800b24433/axial_009.png","assets/T/mri-a822794800b24433/axial_010.png","assets/T/mri-a822794800b24433/axial_011.png","assets/T/mri-a822794800b24433/axial_012.png","assets/T/mri-a822794800b24433/axial_013.png","assets/T/mri-a822794800b24433/axial_014.png","assets/T/mri-a822794800b24433/axial_015.png","assets/T/mri-a822794800b24433/axial_016.png","assets/T/mri-a822794800b24433/axial_017.png","assets/T/mri-a822794800b24433/axial_018.png","assets/T/mri-a822794800b24433/axial_019.png","assets/T/mri-a822794800b24433/axial_020.png","assets/T/mri-a822794800b24433/axial_021.png","assets/T/mri-a822794800b24433/axial_022.png","assets/T/mri-a822794800b24433/axial_023.png","assets/T/mri-a822794800b24433/axial_024.png","assets/T/mri-a822794800b24433/axial_025.png","assets/T/mri-a822794800b24433/axial_026.png","assets/T/mri-a822794800b24433/axial_027.png","assets/T/mri-a822794800b24433/axial_028.png","assets/T/mri-a822794800b24433/axial_029.png","assets/T/mri-a822794800b24433/axial_030.png","assets/T/mri-a822794800b24433/axial_031.png","assets/T/mri-a822794800b24433/axial_032.png","assets/T/mri-a822794800b24433/axial_033.png","assets/T/mri-a822794800b24433/axial_034.png","assets/T/mri-a822794800b24433/axial_035.png","assets/T/mri-a822794800b24433/axial_036.png","assets/T/mri-a822794800b24433/axial_037.png","assets/T/mri-a822794800b24433/axial_038.png","assets/T/mri-a822794800b24433/axial_039.png","assets/T/mri-a822794800b24433/axial_040.png","assets/T/mri-a822794800b24433/coronal_001.png","assets/T/mri-a822794800b24433/coronal_002.png","assets/T/mri-a822794800b24433/coronal_003.png","assets/T/mri-a822794800b24433/coronal_004.png","assets/T/mri-a822794800b24433/coronal_005.png","assets/T/mri-a822794800b24433/coronal_006.png","assets/T/mri-a822794800b24433/coronal_007.png","assets/T/mri-a822794800b24433/coronal_008.png","assets/T/mri-a822794800b24433/coronal_009.png","assets/T/mri-a822794800b24433/coronal_010.png","assets/T/mri-a822794800b24433/coronal_011.png","assets/T/mri-a822794800b24433/coronal_012.png","assets/T/mri-a822794800b24433/coronal_013.png","assets/T/mri-a822794800b24433/coronal_014.png","assets/T/mri-a822794800b24433/coronal_015.png","assets/T/mri-a822794800b24433/coronal_016.png","assets/T/mri-a822794800b24433/coronal_017.png","assets/T/mri-a822794800b24433/coronal_018.png","assets/T/mri-a822794800b24433/coronal_019.png","assets/T/mri-a822794800b24433/coronal_020.png","assets/T/mri-a822794800b24433/coronal_021.png","assets/T/mri-a822794800b24433/coronal_022.png","assets/T/mri-a822794800b24433/coronal_023.png","assets/T/mri-a822794800b24433/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-524c6754989f4a43","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-524c6754989f4a43/axial_001.png","assets/T/mri-524c6754989f4a43/axial_002.png","assets/T/mri-524c6754989f4a43/axial_003.png","assets/T/mri-524c6754989f4a43/axial_004.png","assets/T/mri-524c6754989f4a43/axial_005.png","assets/T/mri-524c6754989f4a43/axial_006.png","assets/T/mri-524c6754989f4a43/axial_007.png","assets/T/mri-524c6754989f4a43/axial_008.png","assets/T/mri-524c6754989f4a43/axial_009.png","assets/T/mri-524c6754989f4a43/axial_010.png","assets/T/mri-524c6754989f4a43/axial_011.png","assets/T/mri-524c6754989f4a43/axial_012.png","assets/T/mri-524c6754989f4a43/axial_013.png","assets/T/mri-524c6754989f4a43/axial_014.png","assets/T/mri-524c6754989f4a43/axial_015.png","assets/T/mri-524c6754989f4a43/axial_016.png","assets/T/mri-524c6754989f4a43/axial_017.png","assets/T/mri-524c6754989f4a43/axial_018.png","assets/T/mri-524c6754989f4a43/axial_019.png","assets/T/mri-524c6754989f4a43/axial_020.png","assets/T/mri-524c6754989f4a43/axial_021.png","assets/T/mri-524c6754989f4a43/axial_022.png","assets/T/mri-524c6754989f4a43/axial_023.png","assets/T/mri-524c6754989f4a43/axial_024.png","assets/T/mri-524c6754989f4a43/axial_025.png","assets/T/mri-524c6754989f4a43/axial_026.png","assets/T/mri-524c6754989f4a43/axial_027.png","assets/T/mri-524c6754989f4a43/axial_028.png","assets/T/mri-524c6754989f4a43/axial_029.png","assets/T/mri-524c6754989f4a43/axial_030.png","assets/T/mri-524c6754989f4a43/axial_031.png","assets/T/mri-524c6754989f4a43/axial_032.png","assets/T/mri-524c6754989f4a43/axial_033.png","assets/T/mri-524c6754989f4a43/axial_034.png","assets/T/mri-524c6754989f4a43/axial_035.png","assets/T/mri-524c6754989f4a43/axial_036.png","assets/T/mri-524c6754989f4a43/axial_037.png","assets/T/mri-524c6754989f4a43/axial_038.png","assets/T/mri-524c6754989f4a43/axial_039.png","assets/T/mri-524c6754989f4a43/axial_040.png","assets/T/mri-524c6754989f4a43/axial_041.png","assets/T/mri-524c6754989f4a43/axial_042.png","assets/T/mri-524c6754989f4a43/coronal_001.png","assets/T/mri-524c6754989f4a43/coronal_002.png","assets/T/mri-524c6754989f4a43/coronal_003.png","assets/T/mri-524c6754989f4a43/coronal_004.png","assets/T/mri-524c6754989f4a43/coronal_005.png","assets/T/mri-524c6754989f4a43/coronal_006.png","assets/T/mri-524c6754989f4a43/coronal_007.png","assets/T/mri-524c6754989f4a43/coronal_008.png","assets/T/mri-524c6754989f4a43/coronal_009.png","assets/T/mri-524c6754989f4a43/coronal_010.png","assets/T/mri-524c6754989f4a43/coronal_011.png","assets/T/mri-524c6754989f4a43/coronal_012.png","assets/T/mri-524c6754989f4a43/coronal_013.png","assets/T/mri-524c6754989f4a43/coronal_014.png","assets/T/mri-524c6754989f4a43/coronal_015.png","assets/T/mri-524c6754989f4a43/coronal_016.png","assets/T/mri-524c6754989f4a43/coronal_017.png","assets/T/mri-524c6754989f4a43/coronal_018.png","assets/T/mri-524c6754989f4a43/coronal_019.png","assets/T/mri-524c6754989f4a43/coronal_020.png","assets/T/mri-524c6754989f4a43/coronal_021.png","assets/T/mri-524c6754989f4a43/coronal_022.png","assets/T/mri-524c6754989f4a43/coronal_023.png","assets/T/mri-524c6754989f4a43/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-43a46f6923804318","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 68 张图，均来自同一次检查。\n\n- 前 44 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-43a46f6923804318/axial_001.png","assets/T/mri-43a46f6923804318/axial_002.png","assets/T/mri-43a46f6923804318/axial_003.png","assets/T/mri-43a46f6923804318/axial_004.png","assets/T/mri-43a46f6923804318/axial_005.png","assets/T/mri-43a46f6923804318/axial_006.png","assets/T/mri-43a46f6923804318/axial_007.png","assets/T/mri-43a46f6923804318/axial_008.png","assets/T/mri-43a46f6923804318/axial_009.png","assets/T/mri-43a46f6923804318/axial_010.png","assets/T/mri-43a46f6923804318/axial_011.png","assets/T/mri-43a46f6923804318/axial_012.png","assets/T/mri-43a46f6923804318/axial_013.png","assets/T/mri-43a46f6923804318/axial_014.png","assets/T/mri-43a46f6923804318/axial_015.png","assets/T/mri-43a46f6923804318/axial_016.png","assets/T/mri-43a46f6923804318/axial_017.png","assets/T/mri-43a46f6923804318/axial_018.png","assets/T/mri-43a46f6923804318/axial_019.png","assets/T/mri-43a46f6923804318/axial_020.png","assets/T/mri-43a46f6923804318/axial_021.png","assets/T/mri-43a46f6923804318/axial_022.png","assets/T/mri-43a46f6923804318/axial_023.png","assets/T/mri-43a46f6923804318/axial_024.png","assets/T/mri-43a46f6923804318/axial_025.png","assets/T/mri-43a46f6923804318/axial_026.png","assets/T/mri-43a46f6923804318/axial_027.png","assets/T/mri-43a46f6923804318/axial_028.png","assets/T/mri-43a46f6923804318/axial_029.png","assets/T/mri-43a46f6923804318/axial_030.png","assets/T/mri-43a46f6923804318/axial_031.png","assets/T/mri-43a46f6923804318/axial_032.png","assets/T/mri-43a46f6923804318/axial_033.png","assets/T/mri-43a46f6923804318/axial_034.png","assets/T/mri-43a46f6923804318/axial_035.png","assets/T/mri-43a46f6923804318/axial_036.png","assets/T/mri-43a46f6923804318/axial_037.png","assets/T/mri-43a46f6923804318/axial_038.png","assets/T/mri-43a46f6923804318/axial_039.png","assets/T/mri-43a46f6923804318/axial_040.png","assets/T/mri-43a46f6923804318/axial_041.png","assets/T/mri-43a46f6923804318/axial_042.png","assets/T/mri-43a46f6923804318/axial_043.png","assets/T/mri-43a46f6923804318/axial_044.png","assets/T/mri-43a46f6923804318/coronal_001.png","assets/T/mri-43a46f6923804318/coronal_002.png","assets/T/mri-43a46f6923804318/coronal_003.png","assets/T/mri-43a46f6923804318/coronal_004.png","assets/T/mri-43a46f6923804318/coronal_005.png","assets/T/mri-43a46f6923804318/coronal_006.png","assets/T/mri-43a46f6923804318/coronal_007.png","assets/T/mri-43a46f6923804318/coronal_008.png","assets/T/mri-43a46f6923804318/coronal_009.png","assets/T/mri-43a46f6923804318/coronal_010.png","assets/T/mri-43a46f6923804318/coronal_011.png","assets/T/mri-43a46f6923804318/coronal_012.png","assets/T/mri-43a46f6923804318/coronal_013.png","assets/T/mri-43a46f6923804318/coronal_014.png","assets/T/mri-43a46f6923804318/coronal_015.png","assets/T/mri-43a46f6923804318/coronal_016.png","assets/T/mri-43a46f6923804318/coronal_017.png","assets/T/mri-43a46f6923804318/coronal_018.png","assets/T/mri-43a46f6923804318/coronal_019.png","assets/T/mri-43a46f6923804318/coronal_020.png","assets/T/mri-43a46f6923804318/coronal_021.png","assets/T/mri-43a46f6923804318/coronal_022.png","assets/T/mri-43a46f6923804318/coronal_023.png","assets/T/mri-43a46f6923804318/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-0f97d76a51a040a4","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 26 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-0f97d76a51a040a4/axial_001.png","assets/T/mri-0f97d76a51a040a4/axial_002.png","assets/T/mri-0f97d76a51a040a4/axial_003.png","assets/T/mri-0f97d76a51a040a4/axial_004.png","assets/T/mri-0f97d76a51a040a4/axial_005.png","assets/T/mri-0f97d76a51a040a4/axial_006.png","assets/T/mri-0f97d76a51a040a4/axial_007.png","assets/T/mri-0f97d76a51a040a4/axial_008.png","assets/T/mri-0f97d76a51a040a4/axial_009.png","assets/T/mri-0f97d76a51a040a4/axial_010.png","assets/T/mri-0f97d76a51a040a4/axial_011.png","assets/T/mri-0f97d76a51a040a4/axial_012.png","assets/T/mri-0f97d76a51a040a4/axial_013.png","assets/T/mri-0f97d76a51a040a4/axial_014.png","assets/T/mri-0f97d76a51a040a4/axial_015.png","assets/T/mri-0f97d76a51a040a4/axial_016.png","assets/T/mri-0f97d76a51a040a4/axial_017.png","assets/T/mri-0f97d76a51a040a4/axial_018.png","assets/T/mri-0f97d76a51a040a4/axial_019.png","assets/T/mri-0f97d76a51a040a4/axial_020.png","assets/T/mri-0f97d76a51a040a4/axial_021.png","assets/T/mri-0f97d76a51a040a4/axial_022.png","assets/T/mri-0f97d76a51a040a4/axial_023.png","assets/T/mri-0f97d76a51a040a4/axial_024.png","assets/T/mri-0f97d76a51a040a4/axial_025.png","assets/T/mri-0f97d76a51a040a4/axial_026.png","assets/T/mri-0f97d76a51a040a4/axial_027.png","assets/T/mri-0f97d76a51a040a4/axial_028.png","assets/T/mri-0f97d76a51a040a4/axial_029.png","assets/T/mri-0f97d76a51a040a4/axial_030.png","assets/T/mri-0f97d76a51a040a4/axial_031.png","assets/T/mri-0f97d76a51a040a4/axial_032.png","assets/T/mri-0f97d76a51a040a4/axial_033.png","assets/T/mri-0f97d76a51a040a4/axial_034.png","assets/T/mri-0f97d76a51a040a4/axial_035.png","assets/T/mri-0f97d76a51a040a4/axial_036.png","assets/T/mri-0f97d76a51a040a4/axial_037.png","assets/T/mri-0f97d76a51a040a4/axial_038.png","assets/T/mri-0f97d76a51a040a4/axial_039.png","assets/T/mri-0f97d76a51a040a4/axial_040.png","assets/T/mri-0f97d76a51a040a4/coronal_001.png","assets/T/mri-0f97d76a51a040a4/coronal_002.png","assets/T/mri-0f97d76a51a040a4/coronal_003.png","assets/T/mri-0f97d76a51a040a4/coronal_004.png","assets/T/mri-0f97d76a51a040a4/coronal_005.png","assets/T/mri-0f97d76a51a040a4/coronal_006.png","assets/T/mri-0f97d76a51a040a4/coronal_007.png","assets/T/mri-0f97d76a51a040a4/coronal_008.png","assets/T/mri-0f97d76a51a040a4/coronal_009.png","assets/T/mri-0f97d76a51a040a4/coronal_010.png","assets/T/mri-0f97d76a51a040a4/coronal_011.png","assets/T/mri-0f97d76a51a040a4/coronal_012.png","assets/T/mri-0f97d76a51a040a4/coronal_013.png","assets/T/mri-0f97d76a51a040a4/coronal_014.png","assets/T/mri-0f97d76a51a040a4/coronal_015.png","assets/T/mri-0f97d76a51a040a4/coronal_016.png","assets/T/mri-0f97d76a51a040a4/coronal_017.png","assets/T/mri-0f97d76a51a040a4/coronal_018.png","assets/T/mri-0f97d76a51a040a4/coronal_019.png","assets/T/mri-0f97d76a51a040a4/coronal_020.png","assets/T/mri-0f97d76a51a040a4/coronal_021.png","assets/T/mri-0f97d76a51a040a4/coronal_022.png","assets/T/mri-0f97d76a51a040a4/coronal_023.png","assets/T/mri-0f97d76a51a040a4/coronal_024.png","assets/T/mri-0f97d76a51a040a4/coronal_025.png","assets/T/mri-0f97d76a51a040a4/coronal_026.png"],"stage_edition":8}
+{"id":"L3-T300:mri-4eff6559f14148d5","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 62 张图，均来自同一次检查。\n\n- 前 38 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-4eff6559f14148d5/axial_001.png","assets/T/mri-4eff6559f14148d5/axial_002.png","assets/T/mri-4eff6559f14148d5/axial_003.png","assets/T/mri-4eff6559f14148d5/axial_004.png","assets/T/mri-4eff6559f14148d5/axial_005.png","assets/T/mri-4eff6559f14148d5/axial_006.png","assets/T/mri-4eff6559f14148d5/axial_007.png","assets/T/mri-4eff6559f14148d5/axial_008.png","assets/T/mri-4eff6559f14148d5/axial_009.png","assets/T/mri-4eff6559f14148d5/axial_010.png","assets/T/mri-4eff6559f14148d5/axial_011.png","assets/T/mri-4eff6559f14148d5/axial_012.png","assets/T/mri-4eff6559f14148d5/axial_013.png","assets/T/mri-4eff6559f14148d5/axial_014.png","assets/T/mri-4eff6559f14148d5/axial_015.png","assets/T/mri-4eff6559f14148d5/axial_016.png","assets/T/mri-4eff6559f14148d5/axial_017.png","assets/T/mri-4eff6559f14148d5/axial_018.png","assets/T/mri-4eff6559f14148d5/axial_019.png","assets/T/mri-4eff6559f14148d5/axial_020.png","assets/T/mri-4eff6559f14148d5/axial_021.png","assets/T/mri-4eff6559f14148d5/axial_022.png","assets/T/mri-4eff6559f14148d5/axial_023.png","assets/T/mri-4eff6559f14148d5/axial_024.png","assets/T/mri-4eff6559f14148d5/axial_025.png","assets/T/mri-4eff6559f14148d5/axial_026.png","assets/T/mri-4eff6559f14148d5/axial_027.png","assets/T/mri-4eff6559f14148d5/axial_028.png","assets/T/mri-4eff6559f14148d5/axial_029.png","assets/T/mri-4eff6559f14148d5/axial_030.png","assets/T/mri-4eff6559f14148d5/axial_031.png","assets/T/mri-4eff6559f14148d5/axial_032.png","assets/T/mri-4eff6559f14148d5/axial_033.png","assets/T/mri-4eff6559f14148d5/axial_034.png","assets/T/mri-4eff6559f14148d5/axial_035.png","assets/T/mri-4eff6559f14148d5/axial_036.png","assets/T/mri-4eff6559f14148d5/axial_037.png","assets/T/mri-4eff6559f14148d5/axial_038.png","assets/T/mri-4eff6559f14148d5/coronal_001.png","assets/T/mri-4eff6559f14148d5/coronal_002.png","assets/T/mri-4eff6559f14148d5/coronal_003.png","assets/T/mri-4eff6559f14148d5/coronal_004.png","assets/T/mri-4eff6559f14148d5/coronal_005.png","assets/T/mri-4eff6559f14148d5/coronal_006.png","assets/T/mri-4eff6559f14148d5/coronal_007.png","assets/T/mri-4eff6559f14148d5/coronal_008.png","assets/T/mri-4eff6559f14148d5/coronal_009.png","assets/T/mri-4eff6559f14148d5/coronal_010.png","assets/T/mri-4eff6559f14148d5/coronal_011.png","assets/T/mri-4eff6559f14148d5/coronal_012.png","assets/T/mri-4eff6559f14148d5/coronal_013.png","assets/T/mri-4eff6559f14148d5/coronal_014.png","assets/T/mri-4eff6559f14148d5/coronal_015.png","assets/T/mri-4eff6559f14148d5/coronal_016.png","assets/T/mri-4eff6559f14148d5/coronal_017.png","assets/T/mri-4eff6559f14148d5/coronal_018.png","assets/T/mri-4eff6559f14148d5/coronal_019.png","assets/T/mri-4eff6559f14148d5/coronal_020.png","assets/T/mri-4eff6559f14148d5/coronal_021.png","assets/T/mri-4eff6559f14148d5/coronal_022.png","assets/T/mri-4eff6559f14148d5/coronal_023.png","assets/T/mri-4eff6559f14148d5/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-7cb304a3ddd04efa","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 70 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 28 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-7cb304a3ddd04efa/axial_001.png","assets/T/mri-7cb304a3ddd04efa/axial_002.png","assets/T/mri-7cb304a3ddd04efa/axial_003.png","assets/T/mri-7cb304a3ddd04efa/axial_004.png","assets/T/mri-7cb304a3ddd04efa/axial_005.png","assets/T/mri-7cb304a3ddd04efa/axial_006.png","assets/T/mri-7cb304a3ddd04efa/axial_007.png","assets/T/mri-7cb304a3ddd04efa/axial_008.png","assets/T/mri-7cb304a3ddd04efa/axial_009.png","assets/T/mri-7cb304a3ddd04efa/axial_010.png","assets/T/mri-7cb304a3ddd04efa/axial_011.png","assets/T/mri-7cb304a3ddd04efa/axial_012.png","assets/T/mri-7cb304a3ddd04efa/axial_013.png","assets/T/mri-7cb304a3ddd04efa/axial_014.png","assets/T/mri-7cb304a3ddd04efa/axial_015.png","assets/T/mri-7cb304a3ddd04efa/axial_016.png","assets/T/mri-7cb304a3ddd04efa/axial_017.png","assets/T/mri-7cb304a3ddd04efa/axial_018.png","assets/T/mri-7cb304a3ddd04efa/axial_019.png","assets/T/mri-7cb304a3ddd04efa/axial_020.png","assets/T/mri-7cb304a3ddd04efa/axial_021.png","assets/T/mri-7cb304a3ddd04efa/axial_022.png","assets/T/mri-7cb304a3ddd04efa/axial_023.png","assets/T/mri-7cb304a3ddd04efa/axial_024.png","assets/T/mri-7cb304a3ddd04efa/axial_025.png","assets/T/mri-7cb304a3ddd04efa/axial_026.png","assets/T/mri-7cb304a3ddd04efa/axial_027.png","assets/T/mri-7cb304a3ddd04efa/axial_028.png","assets/T/mri-7cb304a3ddd04efa/axial_029.png","assets/T/mri-7cb304a3ddd04efa/axial_030.png","assets/T/mri-7cb304a3ddd04efa/axial_031.png","assets/T/mri-7cb304a3ddd04efa/axial_032.png","assets/T/mri-7cb304a3ddd04efa/axial_033.png","assets/T/mri-7cb304a3ddd04efa/axial_034.png","assets/T/mri-7cb304a3ddd04efa/axial_035.png","assets/T/mri-7cb304a3ddd04efa/axial_036.png","assets/T/mri-7cb304a3ddd04efa/axial_037.png","assets/T/mri-7cb304a3ddd04efa/axial_038.png","assets/T/mri-7cb304a3ddd04efa/axial_039.png","assets/T/mri-7cb304a3ddd04efa/axial_040.png","assets/T/mri-7cb304a3ddd04efa/axial_041.png","assets/T/mri-7cb304a3ddd04efa/axial_042.png","assets/T/mri-7cb304a3ddd04efa/coronal_001.png","assets/T/mri-7cb304a3ddd04efa/coronal_002.png","assets/T/mri-7cb304a3ddd04efa/coronal_003.png","assets/T/mri-7cb304a3ddd04efa/coronal_004.png","assets/T/mri-7cb304a3ddd04efa/coronal_005.png","assets/T/mri-7cb304a3ddd04efa/coronal_006.png","assets/T/mri-7cb304a3ddd04efa/coronal_007.png","assets/T/mri-7cb304a3ddd04efa/coronal_008.png","assets/T/mri-7cb304a3ddd04efa/coronal_009.png","assets/T/mri-7cb304a3ddd04efa/coronal_010.png","assets/T/mri-7cb304a3ddd04efa/coronal_011.png","assets/T/mri-7cb304a3ddd04efa/coronal_012.png","assets/T/mri-7cb304a3ddd04efa/coronal_013.png","assets/T/mri-7cb304a3ddd04efa/coronal_014.png","assets/T/mri-7cb304a3ddd04efa/coronal_015.png","assets/T/mri-7cb304a3ddd04efa/coronal_016.png","assets/T/mri-7cb304a3ddd04efa/coronal_017.png","assets/T/mri-7cb304a3ddd04efa/coronal_018.png","assets/T/mri-7cb304a3ddd04efa/coronal_019.png","assets/T/mri-7cb304a3ddd04efa/coronal_020.png","assets/T/mri-7cb304a3ddd04efa/coronal_021.png","assets/T/mri-7cb304a3ddd04efa/coronal_022.png","assets/T/mri-7cb304a3ddd04efa/coronal_023.png","assets/T/mri-7cb304a3ddd04efa/coronal_024.png","assets/T/mri-7cb304a3ddd04efa/coronal_025.png","assets/T/mri-7cb304a3ddd04efa/coronal_026.png","assets/T/mri-7cb304a3ddd04efa/coronal_027.png","assets/T/mri-7cb304a3ddd04efa/coronal_028.png"],"stage_edition":8}
+{"id":"L3-T300:mri-d2d9da67055048e2","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-d2d9da67055048e2/axial_001.png","assets/T/mri-d2d9da67055048e2/axial_002.png","assets/T/mri-d2d9da67055048e2/axial_003.png","assets/T/mri-d2d9da67055048e2/axial_004.png","assets/T/mri-d2d9da67055048e2/axial_005.png","assets/T/mri-d2d9da67055048e2/axial_006.png","assets/T/mri-d2d9da67055048e2/axial_007.png","assets/T/mri-d2d9da67055048e2/axial_008.png","assets/T/mri-d2d9da67055048e2/axial_009.png","assets/T/mri-d2d9da67055048e2/axial_010.png","assets/T/mri-d2d9da67055048e2/axial_011.png","assets/T/mri-d2d9da67055048e2/axial_012.png","assets/T/mri-d2d9da67055048e2/axial_013.png","assets/T/mri-d2d9da67055048e2/axial_014.png","assets/T/mri-d2d9da67055048e2/axial_015.png","assets/T/mri-d2d9da67055048e2/axial_016.png","assets/T/mri-d2d9da67055048e2/axial_017.png","assets/T/mri-d2d9da67055048e2/axial_018.png","assets/T/mri-d2d9da67055048e2/axial_019.png","assets/T/mri-d2d9da67055048e2/axial_020.png","assets/T/mri-d2d9da67055048e2/axial_021.png","assets/T/mri-d2d9da67055048e2/axial_022.png","assets/T/mri-d2d9da67055048e2/axial_023.png","assets/T/mri-d2d9da67055048e2/axial_024.png","assets/T/mri-d2d9da67055048e2/axial_025.png","assets/T/mri-d2d9da67055048e2/axial_026.png","assets/T/mri-d2d9da67055048e2/axial_027.png","assets/T/mri-d2d9da67055048e2/axial_028.png","assets/T/mri-d2d9da67055048e2/axial_029.png","assets/T/mri-d2d9da67055048e2/axial_030.png","assets/T/mri-d2d9da67055048e2/axial_031.png","assets/T/mri-d2d9da67055048e2/axial_032.png","assets/T/mri-d2d9da67055048e2/axial_033.png","assets/T/mri-d2d9da67055048e2/axial_034.png","assets/T/mri-d2d9da67055048e2/axial_035.png","assets/T/mri-d2d9da67055048e2/axial_036.png","assets/T/mri-d2d9da67055048e2/axial_037.png","assets/T/mri-d2d9da67055048e2/axial_038.png","assets/T/mri-d2d9da67055048e2/axial_039.png","assets/T/mri-d2d9da67055048e2/axial_040.png","assets/T/mri-d2d9da67055048e2/coronal_001.png","assets/T/mri-d2d9da67055048e2/coronal_002.png","assets/T/mri-d2d9da67055048e2/coronal_003.png","assets/T/mri-d2d9da67055048e2/coronal_004.png","assets/T/mri-d2d9da67055048e2/coronal_005.png","assets/T/mri-d2d9da67055048e2/coronal_006.png","assets/T/mri-d2d9da67055048e2/coronal_007.png","assets/T/mri-d2d9da67055048e2/coronal_008.png","assets/T/mri-d2d9da67055048e2/coronal_009.png","assets/T/mri-d2d9da67055048e2/coronal_010.png","assets/T/mri-d2d9da67055048e2/coronal_011.png","assets/T/mri-d2d9da67055048e2/coronal_012.png","assets/T/mri-d2d9da67055048e2/coronal_013.png","assets/T/mri-d2d9da67055048e2/coronal_014.png","assets/T/mri-d2d9da67055048e2/coronal_015.png","assets/T/mri-d2d9da67055048e2/coronal_016.png","assets/T/mri-d2d9da67055048e2/coronal_017.png","assets/T/mri-d2d9da67055048e2/coronal_018.png","assets/T/mri-d2d9da67055048e2/coronal_019.png","assets/T/mri-d2d9da67055048e2/coronal_020.png","assets/T/mri-d2d9da67055048e2/coronal_021.png","assets/T/mri-d2d9da67055048e2/coronal_022.png","assets/T/mri-d2d9da67055048e2/coronal_023.png","assets/T/mri-d2d9da67055048e2/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-c4103868bea44f56","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 62 张图，均来自同一次检查。\n\n- 前 38 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-c4103868bea44f56/axial_001.png","assets/T/mri-c4103868bea44f56/axial_002.png","assets/T/mri-c4103868bea44f56/axial_003.png","assets/T/mri-c4103868bea44f56/axial_004.png","assets/T/mri-c4103868bea44f56/axial_005.png","assets/T/mri-c4103868bea44f56/axial_006.png","assets/T/mri-c4103868bea44f56/axial_007.png","assets/T/mri-c4103868bea44f56/axial_008.png","assets/T/mri-c4103868bea44f56/axial_009.png","assets/T/mri-c4103868bea44f56/axial_010.png","assets/T/mri-c4103868bea44f56/axial_011.png","assets/T/mri-c4103868bea44f56/axial_012.png","assets/T/mri-c4103868bea44f56/axial_013.png","assets/T/mri-c4103868bea44f56/axial_014.png","assets/T/mri-c4103868bea44f56/axial_015.png","assets/T/mri-c4103868bea44f56/axial_016.png","assets/T/mri-c4103868bea44f56/axial_017.png","assets/T/mri-c4103868bea44f56/axial_018.png","assets/T/mri-c4103868bea44f56/axial_019.png","assets/T/mri-c4103868bea44f56/axial_020.png","assets/T/mri-c4103868bea44f56/axial_021.png","assets/T/mri-c4103868bea44f56/axial_022.png","assets/T/mri-c4103868bea44f56/axial_023.png","assets/T/mri-c4103868bea44f56/axial_024.png","assets/T/mri-c4103868bea44f56/axial_025.png","assets/T/mri-c4103868bea44f56/axial_026.png","assets/T/mri-c4103868bea44f56/axial_027.png","assets/T/mri-c4103868bea44f56/axial_028.png","assets/T/mri-c4103868bea44f56/axial_029.png","assets/T/mri-c4103868bea44f56/axial_030.png","assets/T/mri-c4103868bea44f56/axial_031.png","assets/T/mri-c4103868bea44f56/axial_032.png","assets/T/mri-c4103868bea44f56/axial_033.png","assets/T/mri-c4103868bea44f56/axial_034.png","assets/T/mri-c4103868bea44f56/axial_035.png","assets/T/mri-c4103868bea44f56/axial_036.png","assets/T/mri-c4103868bea44f56/axial_037.png","assets/T/mri-c4103868bea44f56/axial_038.png","assets/T/mri-c4103868bea44f56/coronal_001.png","assets/T/mri-c4103868bea44f56/coronal_002.png","assets/T/mri-c4103868bea44f56/coronal_003.png","assets/T/mri-c4103868bea44f56/coronal_004.png","assets/T/mri-c4103868bea44f56/coronal_005.png","assets/T/mri-c4103868bea44f56/coronal_006.png","assets/T/mri-c4103868bea44f56/coronal_007.png","assets/T/mri-c4103868bea44f56/coronal_008.png","assets/T/mri-c4103868bea44f56/coronal_009.png","assets/T/mri-c4103868bea44f56/coronal_010.png","assets/T/mri-c4103868bea44f56/coronal_011.png","assets/T/mri-c4103868bea44f56/coronal_012.png","assets/T/mri-c4103868bea44f56/coronal_013.png","assets/T/mri-c4103868bea44f56/coronal_014.png","assets/T/mri-c4103868bea44f56/coronal_015.png","assets/T/mri-c4103868bea44f56/coronal_016.png","assets/T/mri-c4103868bea44f56/coronal_017.png","assets/T/mri-c4103868bea44f56/coronal_018.png","assets/T/mri-c4103868bea44f56/coronal_019.png","assets/T/mri-c4103868bea44f56/coronal_020.png","assets/T/mri-c4103868bea44f56/coronal_021.png","assets/T/mri-c4103868bea44f56/coronal_022.png","assets/T/mri-c4103868bea44f56/coronal_023.png","assets/T/mri-c4103868bea44f56/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-a3351c647eb34a73","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-a3351c647eb34a73/axial_001.png","assets/T/mri-a3351c647eb34a73/axial_002.png","assets/T/mri-a3351c647eb34a73/axial_003.png","assets/T/mri-a3351c647eb34a73/axial_004.png","assets/T/mri-a3351c647eb34a73/axial_005.png","assets/T/mri-a3351c647eb34a73/axial_006.png","assets/T/mri-a3351c647eb34a73/axial_007.png","assets/T/mri-a3351c647eb34a73/axial_008.png","assets/T/mri-a3351c647eb34a73/axial_009.png","assets/T/mri-a3351c647eb34a73/axial_010.png","assets/T/mri-a3351c647eb34a73/axial_011.png","assets/T/mri-a3351c647eb34a73/axial_012.png","assets/T/mri-a3351c647eb34a73/axial_013.png","assets/T/mri-a3351c647eb34a73/axial_014.png","assets/T/mri-a3351c647eb34a73/axial_015.png","assets/T/mri-a3351c647eb34a73/axial_016.png","assets/T/mri-a3351c647eb34a73/axial_017.png","assets/T/mri-a3351c647eb34a73/axial_018.png","assets/T/mri-a3351c647eb34a73/axial_019.png","assets/T/mri-a3351c647eb34a73/axial_020.png","assets/T/mri-a3351c647eb34a73/axial_021.png","assets/T/mri-a3351c647eb34a73/axial_022.png","assets/T/mri-a3351c647eb34a73/axial_023.png","assets/T/mri-a3351c647eb34a73/axial_024.png","assets/T/mri-a3351c647eb34a73/axial_025.png","assets/T/mri-a3351c647eb34a73/axial_026.png","assets/T/mri-a3351c647eb34a73/axial_027.png","assets/T/mri-a3351c647eb34a73/axial_028.png","assets/T/mri-a3351c647eb34a73/axial_029.png","assets/T/mri-a3351c647eb34a73/axial_030.png","assets/T/mri-a3351c647eb34a73/axial_031.png","assets/T/mri-a3351c647eb34a73/axial_032.png","assets/T/mri-a3351c647eb34a73/axial_033.png","assets/T/mri-a3351c647eb34a73/axial_034.png","assets/T/mri-a3351c647eb34a73/axial_035.png","assets/T/mri-a3351c647eb34a73/axial_036.png","assets/T/mri-a3351c647eb34a73/axial_037.png","assets/T/mri-a3351c647eb34a73/axial_038.png","assets/T/mri-a3351c647eb34a73/axial_039.png","assets/T/mri-a3351c647eb34a73/axial_040.png","assets/T/mri-a3351c647eb34a73/coronal_001.png","assets/T/mri-a3351c647eb34a73/coronal_002.png","assets/T/mri-a3351c647eb34a73/coronal_003.png","assets/T/mri-a3351c647eb34a73/coronal_004.png","assets/T/mri-a3351c647eb34a73/coronal_005.png","assets/T/mri-a3351c647eb34a73/coronal_006.png","assets/T/mri-a3351c647eb34a73/coronal_007.png","assets/T/mri-a3351c647eb34a73/coronal_008.png","assets/T/mri-a3351c647eb34a73/coronal_009.png","assets/T/mri-a3351c647eb34a73/coronal_010.png","assets/T/mri-a3351c647eb34a73/coronal_011.png","assets/T/mri-a3351c647eb34a73/coronal_012.png","assets/T/mri-a3351c647eb34a73/coronal_013.png","assets/T/mri-a3351c647eb34a73/coronal_014.png","assets/T/mri-a3351c647eb34a73/coronal_015.png","assets/T/mri-a3351c647eb34a73/coronal_016.png","assets/T/mri-a3351c647eb34a73/coronal_017.png","assets/T/mri-a3351c647eb34a73/coronal_018.png","assets/T/mri-a3351c647eb34a73/coronal_019.png","assets/T/mri-a3351c647eb34a73/coronal_020.png","assets/T/mri-a3351c647eb34a73/coronal_021.png","assets/T/mri-a3351c647eb34a73/coronal_022.png","assets/T/mri-a3351c647eb34a73/coronal_023.png","assets/T/mri-a3351c647eb34a73/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-91686de02cb64fc2","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-91686de02cb64fc2/axial_001.png","assets/T/mri-91686de02cb64fc2/axial_002.png","assets/T/mri-91686de02cb64fc2/axial_003.png","assets/T/mri-91686de02cb64fc2/axial_004.png","assets/T/mri-91686de02cb64fc2/axial_005.png","assets/T/mri-91686de02cb64fc2/axial_006.png","assets/T/mri-91686de02cb64fc2/axial_007.png","assets/T/mri-91686de02cb64fc2/axial_008.png","assets/T/mri-91686de02cb64fc2/axial_009.png","assets/T/mri-91686de02cb64fc2/axial_010.png","assets/T/mri-91686de02cb64fc2/axial_011.png","assets/T/mri-91686de02cb64fc2/axial_012.png","assets/T/mri-91686de02cb64fc2/axial_013.png","assets/T/mri-91686de02cb64fc2/axial_014.png","assets/T/mri-91686de02cb64fc2/axial_015.png","assets/T/mri-91686de02cb64fc2/axial_016.png","assets/T/mri-91686de02cb64fc2/axial_017.png","assets/T/mri-91686de02cb64fc2/axial_018.png","assets/T/mri-91686de02cb64fc2/axial_019.png","assets/T/mri-91686de02cb64fc2/axial_020.png","assets/T/mri-91686de02cb64fc2/axial_021.png","assets/T/mri-91686de02cb64fc2/axial_022.png","assets/T/mri-91686de02cb64fc2/axial_023.png","assets/T/mri-91686de02cb64fc2/axial_024.png","assets/T/mri-91686de02cb64fc2/axial_025.png","assets/T/mri-91686de02cb64fc2/axial_026.png","assets/T/mri-91686de02cb64fc2/axial_027.png","assets/T/mri-91686de02cb64fc2/axial_028.png","assets/T/mri-91686de02cb64fc2/axial_029.png","assets/T/mri-91686de02cb64fc2/axial_030.png","assets/T/mri-91686de02cb64fc2/axial_031.png","assets/T/mri-91686de02cb64fc2/axial_032.png","assets/T/mri-91686de02cb64fc2/axial_033.png","assets/T/mri-91686de02cb64fc2/axial_034.png","assets/T/mri-91686de02cb64fc2/axial_035.png","assets/T/mri-91686de02cb64fc2/axial_036.png","assets/T/mri-91686de02cb64fc2/axial_037.png","assets/T/mri-91686de02cb64fc2/axial_038.png","assets/T/mri-91686de02cb64fc2/axial_039.png","assets/T/mri-91686de02cb64fc2/axial_040.png","assets/T/mri-91686de02cb64fc2/coronal_001.png","assets/T/mri-91686de02cb64fc2/coronal_002.png","assets/T/mri-91686de02cb64fc2/coronal_003.png","assets/T/mri-91686de02cb64fc2/coronal_004.png","assets/T/mri-91686de02cb64fc2/coronal_005.png","assets/T/mri-91686de02cb64fc2/coronal_006.png","assets/T/mri-91686de02cb64fc2/coronal_007.png","assets/T/mri-91686de02cb64fc2/coronal_008.png","assets/T/mri-91686de02cb64fc2/coronal_009.png","assets/T/mri-91686de02cb64fc2/coronal_010.png","assets/T/mri-91686de02cb64fc2/coronal_011.png","assets/T/mri-91686de02cb64fc2/coronal_012.png","assets/T/mri-91686de02cb64fc2/coronal_013.png","assets/T/mri-91686de02cb64fc2/coronal_014.png","assets/T/mri-91686de02cb64fc2/coronal_015.png","assets/T/mri-91686de02cb64fc2/coronal_016.png","assets/T/mri-91686de02cb64fc2/coronal_017.png","assets/T/mri-91686de02cb64fc2/coronal_018.png","assets/T/mri-91686de02cb64fc2/coronal_019.png","assets/T/mri-91686de02cb64fc2/coronal_020.png","assets/T/mri-91686de02cb64fc2/coronal_021.png","assets/T/mri-91686de02cb64fc2/coronal_022.png","assets/T/mri-91686de02cb64fc2/coronal_023.png","assets/T/mri-91686de02cb64fc2/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-93a27965e6ad4525","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 70 张图，均来自同一次检查。\n\n- 前 44 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 26 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-93a27965e6ad4525/axial_001.png","assets/T/mri-93a27965e6ad4525/axial_002.png","assets/T/mri-93a27965e6ad4525/axial_003.png","assets/T/mri-93a27965e6ad4525/axial_004.png","assets/T/mri-93a27965e6ad4525/axial_005.png","assets/T/mri-93a27965e6ad4525/axial_006.png","assets/T/mri-93a27965e6ad4525/axial_007.png","assets/T/mri-93a27965e6ad4525/axial_008.png","assets/T/mri-93a27965e6ad4525/axial_009.png","assets/T/mri-93a27965e6ad4525/axial_010.png","assets/T/mri-93a27965e6ad4525/axial_011.png","assets/T/mri-93a27965e6ad4525/axial_012.png","assets/T/mri-93a27965e6ad4525/axial_013.png","assets/T/mri-93a27965e6ad4525/axial_014.png","assets/T/mri-93a27965e6ad4525/axial_015.png","assets/T/mri-93a27965e6ad4525/axial_016.png","assets/T/mri-93a27965e6ad4525/axial_017.png","assets/T/mri-93a27965e6ad4525/axial_018.png","assets/T/mri-93a27965e6ad4525/axial_019.png","assets/T/mri-93a27965e6ad4525/axial_020.png","assets/T/mri-93a27965e6ad4525/axial_021.png","assets/T/mri-93a27965e6ad4525/axial_022.png","assets/T/mri-93a27965e6ad4525/axial_023.png","assets/T/mri-93a27965e6ad4525/axial_024.png","assets/T/mri-93a27965e6ad4525/axial_025.png","assets/T/mri-93a27965e6ad4525/axial_026.png","assets/T/mri-93a27965e6ad4525/axial_027.png","assets/T/mri-93a27965e6ad4525/axial_028.png","assets/T/mri-93a27965e6ad4525/axial_029.png","assets/T/mri-93a27965e6ad4525/axial_030.png","assets/T/mri-93a27965e6ad4525/axial_031.png","assets/T/mri-93a27965e6ad4525/axial_032.png","assets/T/mri-93a27965e6ad4525/axial_033.png","assets/T/mri-93a27965e6ad4525/axial_034.png","assets/T/mri-93a27965e6ad4525/axial_035.png","assets/T/mri-93a27965e6ad4525/axial_036.png","assets/T/mri-93a27965e6ad4525/axial_037.png","assets/T/mri-93a27965e6ad4525/axial_038.png","assets/T/mri-93a27965e6ad4525/axial_039.png","assets/T/mri-93a27965e6ad4525/axial_040.png","assets/T/mri-93a27965e6ad4525/axial_041.png","assets/T/mri-93a27965e6ad4525/axial_042.png","assets/T/mri-93a27965e6ad4525/axial_043.png","assets/T/mri-93a27965e6ad4525/axial_044.png","assets/T/mri-93a27965e6ad4525/coronal_001.png","assets/T/mri-93a27965e6ad4525/coronal_002.png","assets/T/mri-93a27965e6ad4525/coronal_003.png","assets/T/mri-93a27965e6ad4525/coronal_004.png","assets/T/mri-93a27965e6ad4525/coronal_005.png","assets/T/mri-93a27965e6ad4525/coronal_006.png","assets/T/mri-93a27965e6ad4525/coronal_007.png","assets/T/mri-93a27965e6ad4525/coronal_008.png","assets/T/mri-93a27965e6ad4525/coronal_009.png","assets/T/mri-93a27965e6ad4525/coronal_010.png","assets/T/mri-93a27965e6ad4525/coronal_011.png","assets/T/mri-93a27965e6ad4525/coronal_012.png","assets/T/mri-93a27965e6ad4525/coronal_013.png","assets/T/mri-93a27965e6ad4525/coronal_014.png","assets/T/mri-93a27965e6ad4525/coronal_015.png","assets/T/mri-93a27965e6ad4525/coronal_016.png","assets/T/mri-93a27965e6ad4525/coronal_017.png","assets/T/mri-93a27965e6ad4525/coronal_018.png","assets/T/mri-93a27965e6ad4525/coronal_019.png","assets/T/mri-93a27965e6ad4525/coronal_020.png","assets/T/mri-93a27965e6ad4525/coronal_021.png","assets/T/mri-93a27965e6ad4525/coronal_022.png","assets/T/mri-93a27965e6ad4525/coronal_023.png","assets/T/mri-93a27965e6ad4525/coronal_024.png","assets/T/mri-93a27965e6ad4525/coronal_025.png","assets/T/mri-93a27965e6ad4525/coronal_026.png"],"stage_edition":8}
+{"id":"L3-T300:mri-02211a5df28b41c8","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 68 张图，均来自同一次检查。\n\n- 前 44 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-02211a5df28b41c8/axial_001.png","assets/T/mri-02211a5df28b41c8/axial_002.png","assets/T/mri-02211a5df28b41c8/axial_003.png","assets/T/mri-02211a5df28b41c8/axial_004.png","assets/T/mri-02211a5df28b41c8/axial_005.png","assets/T/mri-02211a5df28b41c8/axial_006.png","assets/T/mri-02211a5df28b41c8/axial_007.png","assets/T/mri-02211a5df28b41c8/axial_008.png","assets/T/mri-02211a5df28b41c8/axial_009.png","assets/T/mri-02211a5df28b41c8/axial_010.png","assets/T/mri-02211a5df28b41c8/axial_011.png","assets/T/mri-02211a5df28b41c8/axial_012.png","assets/T/mri-02211a5df28b41c8/axial_013.png","assets/T/mri-02211a5df28b41c8/axial_014.png","assets/T/mri-02211a5df28b41c8/axial_015.png","assets/T/mri-02211a5df28b41c8/axial_016.png","assets/T/mri-02211a5df28b41c8/axial_017.png","assets/T/mri-02211a5df28b41c8/axial_018.png","assets/T/mri-02211a5df28b41c8/axial_019.png","assets/T/mri-02211a5df28b41c8/axial_020.png","assets/T/mri-02211a5df28b41c8/axial_021.png","assets/T/mri-02211a5df28b41c8/axial_022.png","assets/T/mri-02211a5df28b41c8/axial_023.png","assets/T/mri-02211a5df28b41c8/axial_024.png","assets/T/mri-02211a5df28b41c8/axial_025.png","assets/T/mri-02211a5df28b41c8/axial_026.png","assets/T/mri-02211a5df28b41c8/axial_027.png","assets/T/mri-02211a5df28b41c8/axial_028.png","assets/T/mri-02211a5df28b41c8/axial_029.png","assets/T/mri-02211a5df28b41c8/axial_030.png","assets/T/mri-02211a5df28b41c8/axial_031.png","assets/T/mri-02211a5df28b41c8/axial_032.png","assets/T/mri-02211a5df28b41c8/axial_033.png","assets/T/mri-02211a5df28b41c8/axial_034.png","assets/T/mri-02211a5df28b41c8/axial_035.png","assets/T/mri-02211a5df28b41c8/axial_036.png","assets/T/mri-02211a5df28b41c8/axial_037.png","assets/T/mri-02211a5df28b41c8/axial_038.png","assets/T/mri-02211a5df28b41c8/axial_039.png","assets/T/mri-02211a5df28b41c8/axial_040.png","assets/T/mri-02211a5df28b41c8/axial_041.png","assets/T/mri-02211a5df28b41c8/axial_042.png","assets/T/mri-02211a5df28b41c8/axial_043.png","assets/T/mri-02211a5df28b41c8/axial_044.png","assets/T/mri-02211a5df28b41c8/coronal_001.png","assets/T/mri-02211a5df28b41c8/coronal_002.png","assets/T/mri-02211a5df28b41c8/coronal_003.png","assets/T/mri-02211a5df28b41c8/coronal_004.png","assets/T/mri-02211a5df28b41c8/coronal_005.png","assets/T/mri-02211a5df28b41c8/coronal_006.png","assets/T/mri-02211a5df28b41c8/coronal_007.png","assets/T/mri-02211a5df28b41c8/coronal_008.png","assets/T/mri-02211a5df28b41c8/coronal_009.png","assets/T/mri-02211a5df28b41c8/coronal_010.png","assets/T/mri-02211a5df28b41c8/coronal_011.png","assets/T/mri-02211a5df28b41c8/coronal_012.png","assets/T/mri-02211a5df28b41c8/coronal_013.png","assets/T/mri-02211a5df28b41c8/coronal_014.png","assets/T/mri-02211a5df28b41c8/coronal_015.png","assets/T/mri-02211a5df28b41c8/coronal_016.png","assets/T/mri-02211a5df28b41c8/coronal_017.png","assets/T/mri-02211a5df28b41c8/coronal_018.png","assets/T/mri-02211a5df28b41c8/coronal_019.png","assets/T/mri-02211a5df28b41c8/coronal_020.png","assets/T/mri-02211a5df28b41c8/coronal_021.png","assets/T/mri-02211a5df28b41c8/coronal_022.png","assets/T/mri-02211a5df28b41c8/coronal_023.png","assets/T/mri-02211a5df28b41c8/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-aafde48fd76947e0","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-aafde48fd76947e0/axial_001.png","assets/T/mri-aafde48fd76947e0/axial_002.png","assets/T/mri-aafde48fd76947e0/axial_003.png","assets/T/mri-aafde48fd76947e0/axial_004.png","assets/T/mri-aafde48fd76947e0/axial_005.png","assets/T/mri-aafde48fd76947e0/axial_006.png","assets/T/mri-aafde48fd76947e0/axial_007.png","assets/T/mri-aafde48fd76947e0/axial_008.png","assets/T/mri-aafde48fd76947e0/axial_009.png","assets/T/mri-aafde48fd76947e0/axial_010.png","assets/T/mri-aafde48fd76947e0/axial_011.png","assets/T/mri-aafde48fd76947e0/axial_012.png","assets/T/mri-aafde48fd76947e0/axial_013.png","assets/T/mri-aafde48fd76947e0/axial_014.png","assets/T/mri-aafde48fd76947e0/axial_015.png","assets/T/mri-aafde48fd76947e0/axial_016.png","assets/T/mri-aafde48fd76947e0/axial_017.png","assets/T/mri-aafde48fd76947e0/axial_018.png","assets/T/mri-aafde48fd76947e0/axial_019.png","assets/T/mri-aafde48fd76947e0/axial_020.png","assets/T/mri-aafde48fd76947e0/axial_021.png","assets/T/mri-aafde48fd76947e0/axial_022.png","assets/T/mri-aafde48fd76947e0/axial_023.png","assets/T/mri-aafde48fd76947e0/axial_024.png","assets/T/mri-aafde48fd76947e0/axial_025.png","assets/T/mri-aafde48fd76947e0/axial_026.png","assets/T/mri-aafde48fd76947e0/axial_027.png","assets/T/mri-aafde48fd76947e0/axial_028.png","assets/T/mri-aafde48fd76947e0/axial_029.png","assets/T/mri-aafde48fd76947e0/axial_030.png","assets/T/mri-aafde48fd76947e0/axial_031.png","assets/T/mri-aafde48fd76947e0/axial_032.png","assets/T/mri-aafde48fd76947e0/axial_033.png","assets/T/mri-aafde48fd76947e0/axial_034.png","assets/T/mri-aafde48fd76947e0/axial_035.png","assets/T/mri-aafde48fd76947e0/axial_036.png","assets/T/mri-aafde48fd76947e0/axial_037.png","assets/T/mri-aafde48fd76947e0/axial_038.png","assets/T/mri-aafde48fd76947e0/axial_039.png","assets/T/mri-aafde48fd76947e0/axial_040.png","assets/T/mri-aafde48fd76947e0/axial_041.png","assets/T/mri-aafde48fd76947e0/axial_042.png","assets/T/mri-aafde48fd76947e0/coronal_001.png","assets/T/mri-aafde48fd76947e0/coronal_002.png","assets/T/mri-aafde48fd76947e0/coronal_003.png","assets/T/mri-aafde48fd76947e0/coronal_004.png","assets/T/mri-aafde48fd76947e0/coronal_005.png","assets/T/mri-aafde48fd76947e0/coronal_006.png","assets/T/mri-aafde48fd76947e0/coronal_007.png","assets/T/mri-aafde48fd76947e0/coronal_008.png","assets/T/mri-aafde48fd76947e0/coronal_009.png","assets/T/mri-aafde48fd76947e0/coronal_010.png","assets/T/mri-aafde48fd76947e0/coronal_011.png","assets/T/mri-aafde48fd76947e0/coronal_012.png","assets/T/mri-aafde48fd76947e0/coronal_013.png","assets/T/mri-aafde48fd76947e0/coronal_014.png","assets/T/mri-aafde48fd76947e0/coronal_015.png","assets/T/mri-aafde48fd76947e0/coronal_016.png","assets/T/mri-aafde48fd76947e0/coronal_017.png","assets/T/mri-aafde48fd76947e0/coronal_018.png","assets/T/mri-aafde48fd76947e0/coronal_019.png","assets/T/mri-aafde48fd76947e0/coronal_020.png","assets/T/mri-aafde48fd76947e0/coronal_021.png","assets/T/mri-aafde48fd76947e0/coronal_022.png","assets/T/mri-aafde48fd76947e0/coronal_023.png","assets/T/mri-aafde48fd76947e0/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-e62cf64b75ea4c8c","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-e62cf64b75ea4c8c/axial_001.png","assets/T/mri-e62cf64b75ea4c8c/axial_002.png","assets/T/mri-e62cf64b75ea4c8c/axial_003.png","assets/T/mri-e62cf64b75ea4c8c/axial_004.png","assets/T/mri-e62cf64b75ea4c8c/axial_005.png","assets/T/mri-e62cf64b75ea4c8c/axial_006.png","assets/T/mri-e62cf64b75ea4c8c/axial_007.png","assets/T/mri-e62cf64b75ea4c8c/axial_008.png","assets/T/mri-e62cf64b75ea4c8c/axial_009.png","assets/T/mri-e62cf64b75ea4c8c/axial_010.png","assets/T/mri-e62cf64b75ea4c8c/axial_011.png","assets/T/mri-e62cf64b75ea4c8c/axial_012.png","assets/T/mri-e62cf64b75ea4c8c/axial_013.png","assets/T/mri-e62cf64b75ea4c8c/axial_014.png","assets/T/mri-e62cf64b75ea4c8c/axial_015.png","assets/T/mri-e62cf64b75ea4c8c/axial_016.png","assets/T/mri-e62cf64b75ea4c8c/axial_017.png","assets/T/mri-e62cf64b75ea4c8c/axial_018.png","assets/T/mri-e62cf64b75ea4c8c/axial_019.png","assets/T/mri-e62cf64b75ea4c8c/axial_020.png","assets/T/mri-e62cf64b75ea4c8c/axial_021.png","assets/T/mri-e62cf64b75ea4c8c/axial_022.png","assets/T/mri-e62cf64b75ea4c8c/axial_023.png","assets/T/mri-e62cf64b75ea4c8c/axial_024.png","assets/T/mri-e62cf64b75ea4c8c/axial_025.png","assets/T/mri-e62cf64b75ea4c8c/axial_026.png","assets/T/mri-e62cf64b75ea4c8c/axial_027.png","assets/T/mri-e62cf64b75ea4c8c/axial_028.png","assets/T/mri-e62cf64b75ea4c8c/axial_029.png","assets/T/mri-e62cf64b75ea4c8c/axial_030.png","assets/T/mri-e62cf64b75ea4c8c/axial_031.png","assets/T/mri-e62cf64b75ea4c8c/axial_032.png","assets/T/mri-e62cf64b75ea4c8c/axial_033.png","assets/T/mri-e62cf64b75ea4c8c/axial_034.png","assets/T/mri-e62cf64b75ea4c8c/axial_035.png","assets/T/mri-e62cf64b75ea4c8c/axial_036.png","assets/T/mri-e62cf64b75ea4c8c/axial_037.png","assets/T/mri-e62cf64b75ea4c8c/axial_038.png","assets/T/mri-e62cf64b75ea4c8c/axial_039.png","assets/T/mri-e62cf64b75ea4c8c/axial_040.png","assets/T/mri-e62cf64b75ea4c8c/axial_041.png","assets/T/mri-e62cf64b75ea4c8c/axial_042.png","assets/T/mri-e62cf64b75ea4c8c/coronal_001.png","assets/T/mri-e62cf64b75ea4c8c/coronal_002.png","assets/T/mri-e62cf64b75ea4c8c/coronal_003.png","assets/T/mri-e62cf64b75ea4c8c/coronal_004.png","assets/T/mri-e62cf64b75ea4c8c/coronal_005.png","assets/T/mri-e62cf64b75ea4c8c/coronal_006.png","assets/T/mri-e62cf64b75ea4c8c/coronal_007.png","assets/T/mri-e62cf64b75ea4c8c/coronal_008.png","assets/T/mri-e62cf64b75ea4c8c/coronal_009.png","assets/T/mri-e62cf64b75ea4c8c/coronal_010.png","assets/T/mri-e62cf64b75ea4c8c/coronal_011.png","assets/T/mri-e62cf64b75ea4c8c/coronal_012.png","assets/T/mri-e62cf64b75ea4c8c/coronal_013.png","assets/T/mri-e62cf64b75ea4c8c/coronal_014.png","assets/T/mri-e62cf64b75ea4c8c/coronal_015.png","assets/T/mri-e62cf64b75ea4c8c/coronal_016.png","assets/T/mri-e62cf64b75ea4c8c/coronal_017.png","assets/T/mri-e62cf64b75ea4c8c/coronal_018.png","assets/T/mri-e62cf64b75ea4c8c/coronal_019.png","assets/T/mri-e62cf64b75ea4c8c/coronal_020.png","assets/T/mri-e62cf64b75ea4c8c/coronal_021.png","assets/T/mri-e62cf64b75ea4c8c/coronal_022.png","assets/T/mri-e62cf64b75ea4c8c/coronal_023.png","assets/T/mri-e62cf64b75ea4c8c/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-327d5554ba1d4a18","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-327d5554ba1d4a18/axial_001.png","assets/T/mri-327d5554ba1d4a18/axial_002.png","assets/T/mri-327d5554ba1d4a18/axial_003.png","assets/T/mri-327d5554ba1d4a18/axial_004.png","assets/T/mri-327d5554ba1d4a18/axial_005.png","assets/T/mri-327d5554ba1d4a18/axial_006.png","assets/T/mri-327d5554ba1d4a18/axial_007.png","assets/T/mri-327d5554ba1d4a18/axial_008.png","assets/T/mri-327d5554ba1d4a18/axial_009.png","assets/T/mri-327d5554ba1d4a18/axial_010.png","assets/T/mri-327d5554ba1d4a18/axial_011.png","assets/T/mri-327d5554ba1d4a18/axial_012.png","assets/T/mri-327d5554ba1d4a18/axial_013.png","assets/T/mri-327d5554ba1d4a18/axial_014.png","assets/T/mri-327d5554ba1d4a18/axial_015.png","assets/T/mri-327d5554ba1d4a18/axial_016.png","assets/T/mri-327d5554ba1d4a18/axial_017.png","assets/T/mri-327d5554ba1d4a18/axial_018.png","assets/T/mri-327d5554ba1d4a18/axial_019.png","assets/T/mri-327d5554ba1d4a18/axial_020.png","assets/T/mri-327d5554ba1d4a18/axial_021.png","assets/T/mri-327d5554ba1d4a18/axial_022.png","assets/T/mri-327d5554ba1d4a18/axial_023.png","assets/T/mri-327d5554ba1d4a18/axial_024.png","assets/T/mri-327d5554ba1d4a18/axial_025.png","assets/T/mri-327d5554ba1d4a18/axial_026.png","assets/T/mri-327d5554ba1d4a18/axial_027.png","assets/T/mri-327d5554ba1d4a18/axial_028.png","assets/T/mri-327d5554ba1d4a18/axial_029.png","assets/T/mri-327d5554ba1d4a18/axial_030.png","assets/T/mri-327d5554ba1d4a18/axial_031.png","assets/T/mri-327d5554ba1d4a18/axial_032.png","assets/T/mri-327d5554ba1d4a18/axial_033.png","assets/T/mri-327d5554ba1d4a18/axial_034.png","assets/T/mri-327d5554ba1d4a18/axial_035.png","assets/T/mri-327d5554ba1d4a18/axial_036.png","assets/T/mri-327d5554ba1d4a18/axial_037.png","assets/T/mri-327d5554ba1d4a18/axial_038.png","assets/T/mri-327d5554ba1d4a18/axial_039.png","assets/T/mri-327d5554ba1d4a18/axial_040.png","assets/T/mri-327d5554ba1d4a18/coronal_001.png","assets/T/mri-327d5554ba1d4a18/coronal_002.png","assets/T/mri-327d5554ba1d4a18/coronal_003.png","assets/T/mri-327d5554ba1d4a18/coronal_004.png","assets/T/mri-327d5554ba1d4a18/coronal_005.png","assets/T/mri-327d5554ba1d4a18/coronal_006.png","assets/T/mri-327d5554ba1d4a18/coronal_007.png","assets/T/mri-327d5554ba1d4a18/coronal_008.png","assets/T/mri-327d5554ba1d4a18/coronal_009.png","assets/T/mri-327d5554ba1d4a18/coronal_010.png","assets/T/mri-327d5554ba1d4a18/coronal_011.png","assets/T/mri-327d5554ba1d4a18/coronal_012.png","assets/T/mri-327d5554ba1d4a18/coronal_013.png","assets/T/mri-327d5554ba1d4a18/coronal_014.png","assets/T/mri-327d5554ba1d4a18/coronal_015.png","assets/T/mri-327d5554ba1d4a18/coronal_016.png","assets/T/mri-327d5554ba1d4a18/coronal_017.png","assets/T/mri-327d5554ba1d4a18/coronal_018.png","assets/T/mri-327d5554ba1d4a18/coronal_019.png","assets/T/mri-327d5554ba1d4a18/coronal_020.png","assets/T/mri-327d5554ba1d4a18/coronal_021.png","assets/T/mri-327d5554ba1d4a18/coronal_022.png","assets/T/mri-327d5554ba1d4a18/coronal_023.png","assets/T/mri-327d5554ba1d4a18/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-976a2674bc694056","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-976a2674bc694056/axial_001.png","assets/T/mri-976a2674bc694056/axial_002.png","assets/T/mri-976a2674bc694056/axial_003.png","assets/T/mri-976a2674bc694056/axial_004.png","assets/T/mri-976a2674bc694056/axial_005.png","assets/T/mri-976a2674bc694056/axial_006.png","assets/T/mri-976a2674bc694056/axial_007.png","assets/T/mri-976a2674bc694056/axial_008.png","assets/T/mri-976a2674bc694056/axial_009.png","assets/T/mri-976a2674bc694056/axial_010.png","assets/T/mri-976a2674bc694056/axial_011.png","assets/T/mri-976a2674bc694056/axial_012.png","assets/T/mri-976a2674bc694056/axial_013.png","assets/T/mri-976a2674bc694056/axial_014.png","assets/T/mri-976a2674bc694056/axial_015.png","assets/T/mri-976a2674bc694056/axial_016.png","assets/T/mri-976a2674bc694056/axial_017.png","assets/T/mri-976a2674bc694056/axial_018.png","assets/T/mri-976a2674bc694056/axial_019.png","assets/T/mri-976a2674bc694056/axial_020.png","assets/T/mri-976a2674bc694056/axial_021.png","assets/T/mri-976a2674bc694056/axial_022.png","assets/T/mri-976a2674bc694056/axial_023.png","assets/T/mri-976a2674bc694056/axial_024.png","assets/T/mri-976a2674bc694056/axial_025.png","assets/T/mri-976a2674bc694056/axial_026.png","assets/T/mri-976a2674bc694056/axial_027.png","assets/T/mri-976a2674bc694056/axial_028.png","assets/T/mri-976a2674bc694056/axial_029.png","assets/T/mri-976a2674bc694056/axial_030.png","assets/T/mri-976a2674bc694056/axial_031.png","assets/T/mri-976a2674bc694056/axial_032.png","assets/T/mri-976a2674bc694056/axial_033.png","assets/T/mri-976a2674bc694056/axial_034.png","assets/T/mri-976a2674bc694056/axial_035.png","assets/T/mri-976a2674bc694056/axial_036.png","assets/T/mri-976a2674bc694056/axial_037.png","assets/T/mri-976a2674bc694056/axial_038.png","assets/T/mri-976a2674bc694056/axial_039.png","assets/T/mri-976a2674bc694056/axial_040.png","assets/T/mri-976a2674bc694056/coronal_001.png","assets/T/mri-976a2674bc694056/coronal_002.png","assets/T/mri-976a2674bc694056/coronal_003.png","assets/T/mri-976a2674bc694056/coronal_004.png","assets/T/mri-976a2674bc694056/coronal_005.png","assets/T/mri-976a2674bc694056/coronal_006.png","assets/T/mri-976a2674bc694056/coronal_007.png","assets/T/mri-976a2674bc694056/coronal_008.png","assets/T/mri-976a2674bc694056/coronal_009.png","assets/T/mri-976a2674bc694056/coronal_010.png","assets/T/mri-976a2674bc694056/coronal_011.png","assets/T/mri-976a2674bc694056/coronal_012.png","assets/T/mri-976a2674bc694056/coronal_013.png","assets/T/mri-976a2674bc694056/coronal_014.png","assets/T/mri-976a2674bc694056/coronal_015.png","assets/T/mri-976a2674bc694056/coronal_016.png","assets/T/mri-976a2674bc694056/coronal_017.png","assets/T/mri-976a2674bc694056/coronal_018.png","assets/T/mri-976a2674bc694056/coronal_019.png","assets/T/mri-976a2674bc694056/coronal_020.png","assets/T/mri-976a2674bc694056/coronal_021.png","assets/T/mri-976a2674bc694056/coronal_022.png","assets/T/mri-976a2674bc694056/coronal_023.png","assets/T/mri-976a2674bc694056/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-451326ee669447a4","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-451326ee669447a4/axial_001.png","assets/T/mri-451326ee669447a4/axial_002.png","assets/T/mri-451326ee669447a4/axial_003.png","assets/T/mri-451326ee669447a4/axial_004.png","assets/T/mri-451326ee669447a4/axial_005.png","assets/T/mri-451326ee669447a4/axial_006.png","assets/T/mri-451326ee669447a4/axial_007.png","assets/T/mri-451326ee669447a4/axial_008.png","assets/T/mri-451326ee669447a4/axial_009.png","assets/T/mri-451326ee669447a4/axial_010.png","assets/T/mri-451326ee669447a4/axial_011.png","assets/T/mri-451326ee669447a4/axial_012.png","assets/T/mri-451326ee669447a4/axial_013.png","assets/T/mri-451326ee669447a4/axial_014.png","assets/T/mri-451326ee669447a4/axial_015.png","assets/T/mri-451326ee669447a4/axial_016.png","assets/T/mri-451326ee669447a4/axial_017.png","assets/T/mri-451326ee669447a4/axial_018.png","assets/T/mri-451326ee669447a4/axial_019.png","assets/T/mri-451326ee669447a4/axial_020.png","assets/T/mri-451326ee669447a4/axial_021.png","assets/T/mri-451326ee669447a4/axial_022.png","assets/T/mri-451326ee669447a4/axial_023.png","assets/T/mri-451326ee669447a4/axial_024.png","assets/T/mri-451326ee669447a4/axial_025.png","assets/T/mri-451326ee669447a4/axial_026.png","assets/T/mri-451326ee669447a4/axial_027.png","assets/T/mri-451326ee669447a4/axial_028.png","assets/T/mri-451326ee669447a4/axial_029.png","assets/T/mri-451326ee669447a4/axial_030.png","assets/T/mri-451326ee669447a4/axial_031.png","assets/T/mri-451326ee669447a4/axial_032.png","assets/T/mri-451326ee669447a4/axial_033.png","assets/T/mri-451326ee669447a4/axial_034.png","assets/T/mri-451326ee669447a4/axial_035.png","assets/T/mri-451326ee669447a4/axial_036.png","assets/T/mri-451326ee669447a4/axial_037.png","assets/T/mri-451326ee669447a4/axial_038.png","assets/T/mri-451326ee669447a4/axial_039.png","assets/T/mri-451326ee669447a4/axial_040.png","assets/T/mri-451326ee669447a4/axial_041.png","assets/T/mri-451326ee669447a4/axial_042.png","assets/T/mri-451326ee669447a4/coronal_001.png","assets/T/mri-451326ee669447a4/coronal_002.png","assets/T/mri-451326ee669447a4/coronal_003.png","assets/T/mri-451326ee669447a4/coronal_004.png","assets/T/mri-451326ee669447a4/coronal_005.png","assets/T/mri-451326ee669447a4/coronal_006.png","assets/T/mri-451326ee669447a4/coronal_007.png","assets/T/mri-451326ee669447a4/coronal_008.png","assets/T/mri-451326ee669447a4/coronal_009.png","assets/T/mri-451326ee669447a4/coronal_010.png","assets/T/mri-451326ee669447a4/coronal_011.png","assets/T/mri-451326ee669447a4/coronal_012.png","assets/T/mri-451326ee669447a4/coronal_013.png","assets/T/mri-451326ee669447a4/coronal_014.png","assets/T/mri-451326ee669447a4/coronal_015.png","assets/T/mri-451326ee669447a4/coronal_016.png","assets/T/mri-451326ee669447a4/coronal_017.png","assets/T/mri-451326ee669447a4/coronal_018.png","assets/T/mri-451326ee669447a4/coronal_019.png","assets/T/mri-451326ee669447a4/coronal_020.png","assets/T/mri-451326ee669447a4/coronal_021.png","assets/T/mri-451326ee669447a4/coronal_022.png","assets/T/mri-451326ee669447a4/coronal_023.png","assets/T/mri-451326ee669447a4/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-86711ff1ba3b4fe1","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 62 张图，均来自同一次检查。\n\n- 前 38 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-86711ff1ba3b4fe1/axial_001.png","assets/T/mri-86711ff1ba3b4fe1/axial_002.png","assets/T/mri-86711ff1ba3b4fe1/axial_003.png","assets/T/mri-86711ff1ba3b4fe1/axial_004.png","assets/T/mri-86711ff1ba3b4fe1/axial_005.png","assets/T/mri-86711ff1ba3b4fe1/axial_006.png","assets/T/mri-86711ff1ba3b4fe1/axial_007.png","assets/T/mri-86711ff1ba3b4fe1/axial_008.png","assets/T/mri-86711ff1ba3b4fe1/axial_009.png","assets/T/mri-86711ff1ba3b4fe1/axial_010.png","assets/T/mri-86711ff1ba3b4fe1/axial_011.png","assets/T/mri-86711ff1ba3b4fe1/axial_012.png","assets/T/mri-86711ff1ba3b4fe1/axial_013.png","assets/T/mri-86711ff1ba3b4fe1/axial_014.png","assets/T/mri-86711ff1ba3b4fe1/axial_015.png","assets/T/mri-86711ff1ba3b4fe1/axial_016.png","assets/T/mri-86711ff1ba3b4fe1/axial_017.png","assets/T/mri-86711ff1ba3b4fe1/axial_018.png","assets/T/mri-86711ff1ba3b4fe1/axial_019.png","assets/T/mri-86711ff1ba3b4fe1/axial_020.png","assets/T/mri-86711ff1ba3b4fe1/axial_021.png","assets/T/mri-86711ff1ba3b4fe1/axial_022.png","assets/T/mri-86711ff1ba3b4fe1/axial_023.png","assets/T/mri-86711ff1ba3b4fe1/axial_024.png","assets/T/mri-86711ff1ba3b4fe1/axial_025.png","assets/T/mri-86711ff1ba3b4fe1/axial_026.png","assets/T/mri-86711ff1ba3b4fe1/axial_027.png","assets/T/mri-86711ff1ba3b4fe1/axial_028.png","assets/T/mri-86711ff1ba3b4fe1/axial_029.png","assets/T/mri-86711ff1ba3b4fe1/axial_030.png","assets/T/mri-86711ff1ba3b4fe1/axial_031.png","assets/T/mri-86711ff1ba3b4fe1/axial_032.png","assets/T/mri-86711ff1ba3b4fe1/axial_033.png","assets/T/mri-86711ff1ba3b4fe1/axial_034.png","assets/T/mri-86711ff1ba3b4fe1/axial_035.png","assets/T/mri-86711ff1ba3b4fe1/axial_036.png","assets/T/mri-86711ff1ba3b4fe1/axial_037.png","assets/T/mri-86711ff1ba3b4fe1/axial_038.png","assets/T/mri-86711ff1ba3b4fe1/coronal_001.png","assets/T/mri-86711ff1ba3b4fe1/coronal_002.png","assets/T/mri-86711ff1ba3b4fe1/coronal_003.png","assets/T/mri-86711ff1ba3b4fe1/coronal_004.png","assets/T/mri-86711ff1ba3b4fe1/coronal_005.png","assets/T/mri-86711ff1ba3b4fe1/coronal_006.png","assets/T/mri-86711ff1ba3b4fe1/coronal_007.png","assets/T/mri-86711ff1ba3b4fe1/coronal_008.png","assets/T/mri-86711ff1ba3b4fe1/coronal_009.png","assets/T/mri-86711ff1ba3b4fe1/coronal_010.png","assets/T/mri-86711ff1ba3b4fe1/coronal_011.png","assets/T/mri-86711ff1ba3b4fe1/coronal_012.png","assets/T/mri-86711ff1ba3b4fe1/coronal_013.png","assets/T/mri-86711ff1ba3b4fe1/coronal_014.png","assets/T/mri-86711ff1ba3b4fe1/coronal_015.png","assets/T/mri-86711ff1ba3b4fe1/coronal_016.png","assets/T/mri-86711ff1ba3b4fe1/coronal_017.png","assets/T/mri-86711ff1ba3b4fe1/coronal_018.png","assets/T/mri-86711ff1ba3b4fe1/coronal_019.png","assets/T/mri-86711ff1ba3b4fe1/coronal_020.png","assets/T/mri-86711ff1ba3b4fe1/coronal_021.png","assets/T/mri-86711ff1ba3b4fe1/coronal_022.png","assets/T/mri-86711ff1ba3b4fe1/coronal_023.png","assets/T/mri-86711ff1ba3b4fe1/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-ea272624a53e4790","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-ea272624a53e4790/axial_001.png","assets/T/mri-ea272624a53e4790/axial_002.png","assets/T/mri-ea272624a53e4790/axial_003.png","assets/T/mri-ea272624a53e4790/axial_004.png","assets/T/mri-ea272624a53e4790/axial_005.png","assets/T/mri-ea272624a53e4790/axial_006.png","assets/T/mri-ea272624a53e4790/axial_007.png","assets/T/mri-ea272624a53e4790/axial_008.png","assets/T/mri-ea272624a53e4790/axial_009.png","assets/T/mri-ea272624a53e4790/axial_010.png","assets/T/mri-ea272624a53e4790/axial_011.png","assets/T/mri-ea272624a53e4790/axial_012.png","assets/T/mri-ea272624a53e4790/axial_013.png","assets/T/mri-ea272624a53e4790/axial_014.png","assets/T/mri-ea272624a53e4790/axial_015.png","assets/T/mri-ea272624a53e4790/axial_016.png","assets/T/mri-ea272624a53e4790/axial_017.png","assets/T/mri-ea272624a53e4790/axial_018.png","assets/T/mri-ea272624a53e4790/axial_019.png","assets/T/mri-ea272624a53e4790/axial_020.png","assets/T/mri-ea272624a53e4790/axial_021.png","assets/T/mri-ea272624a53e4790/axial_022.png","assets/T/mri-ea272624a53e4790/axial_023.png","assets/T/mri-ea272624a53e4790/axial_024.png","assets/T/mri-ea272624a53e4790/axial_025.png","assets/T/mri-ea272624a53e4790/axial_026.png","assets/T/mri-ea272624a53e4790/axial_027.png","assets/T/mri-ea272624a53e4790/axial_028.png","assets/T/mri-ea272624a53e4790/axial_029.png","assets/T/mri-ea272624a53e4790/axial_030.png","assets/T/mri-ea272624a53e4790/axial_031.png","assets/T/mri-ea272624a53e4790/axial_032.png","assets/T/mri-ea272624a53e4790/axial_033.png","assets/T/mri-ea272624a53e4790/axial_034.png","assets/T/mri-ea272624a53e4790/axial_035.png","assets/T/mri-ea272624a53e4790/axial_036.png","assets/T/mri-ea272624a53e4790/axial_037.png","assets/T/mri-ea272624a53e4790/axial_038.png","assets/T/mri-ea272624a53e4790/axial_039.png","assets/T/mri-ea272624a53e4790/axial_040.png","assets/T/mri-ea272624a53e4790/axial_041.png","assets/T/mri-ea272624a53e4790/axial_042.png","assets/T/mri-ea272624a53e4790/coronal_001.png","assets/T/mri-ea272624a53e4790/coronal_002.png","assets/T/mri-ea272624a53e4790/coronal_003.png","assets/T/mri-ea272624a53e4790/coronal_004.png","assets/T/mri-ea272624a53e4790/coronal_005.png","assets/T/mri-ea272624a53e4790/coronal_006.png","assets/T/mri-ea272624a53e4790/coronal_007.png","assets/T/mri-ea272624a53e4790/coronal_008.png","assets/T/mri-ea272624a53e4790/coronal_009.png","assets/T/mri-ea272624a53e4790/coronal_010.png","assets/T/mri-ea272624a53e4790/coronal_011.png","assets/T/mri-ea272624a53e4790/coronal_012.png","assets/T/mri-ea272624a53e4790/coronal_013.png","assets/T/mri-ea272624a53e4790/coronal_014.png","assets/T/mri-ea272624a53e4790/coronal_015.png","assets/T/mri-ea272624a53e4790/coronal_016.png","assets/T/mri-ea272624a53e4790/coronal_017.png","assets/T/mri-ea272624a53e4790/coronal_018.png","assets/T/mri-ea272624a53e4790/coronal_019.png","assets/T/mri-ea272624a53e4790/coronal_020.png","assets/T/mri-ea272624a53e4790/coronal_021.png","assets/T/mri-ea272624a53e4790/coronal_022.png","assets/T/mri-ea272624a53e4790/coronal_023.png","assets/T/mri-ea272624a53e4790/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-52410c4d23b24b8a","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 71 张图，均来自同一次检查。\n\n- 前 45 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 26 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-52410c4d23b24b8a/axial_001.png","assets/T/mri-52410c4d23b24b8a/axial_002.png","assets/T/mri-52410c4d23b24b8a/axial_003.png","assets/T/mri-52410c4d23b24b8a/axial_004.png","assets/T/mri-52410c4d23b24b8a/axial_005.png","assets/T/mri-52410c4d23b24b8a/axial_006.png","assets/T/mri-52410c4d23b24b8a/axial_007.png","assets/T/mri-52410c4d23b24b8a/axial_008.png","assets/T/mri-52410c4d23b24b8a/axial_009.png","assets/T/mri-52410c4d23b24b8a/axial_010.png","assets/T/mri-52410c4d23b24b8a/axial_011.png","assets/T/mri-52410c4d23b24b8a/axial_012.png","assets/T/mri-52410c4d23b24b8a/axial_013.png","assets/T/mri-52410c4d23b24b8a/axial_014.png","assets/T/mri-52410c4d23b24b8a/axial_015.png","assets/T/mri-52410c4d23b24b8a/axial_016.png","assets/T/mri-52410c4d23b24b8a/axial_017.png","assets/T/mri-52410c4d23b24b8a/axial_018.png","assets/T/mri-52410c4d23b24b8a/axial_019.png","assets/T/mri-52410c4d23b24b8a/axial_020.png","assets/T/mri-52410c4d23b24b8a/axial_021.png","assets/T/mri-52410c4d23b24b8a/axial_022.png","assets/T/mri-52410c4d23b24b8a/axial_023.png","assets/T/mri-52410c4d23b24b8a/axial_024.png","assets/T/mri-52410c4d23b24b8a/axial_025.png","assets/T/mri-52410c4d23b24b8a/axial_026.png","assets/T/mri-52410c4d23b24b8a/axial_027.png","assets/T/mri-52410c4d23b24b8a/axial_028.png","assets/T/mri-52410c4d23b24b8a/axial_029.png","assets/T/mri-52410c4d23b24b8a/axial_030.png","assets/T/mri-52410c4d23b24b8a/axial_031.png","assets/T/mri-52410c4d23b24b8a/axial_032.png","assets/T/mri-52410c4d23b24b8a/axial_033.png","assets/T/mri-52410c4d23b24b8a/axial_034.png","assets/T/mri-52410c4d23b24b8a/axial_035.png","assets/T/mri-52410c4d23b24b8a/axial_036.png","assets/T/mri-52410c4d23b24b8a/axial_037.png","assets/T/mri-52410c4d23b24b8a/axial_038.png","assets/T/mri-52410c4d23b24b8a/axial_039.png","assets/T/mri-52410c4d23b24b8a/axial_040.png","assets/T/mri-52410c4d23b24b8a/axial_041.png","assets/T/mri-52410c4d23b24b8a/axial_042.png","assets/T/mri-52410c4d23b24b8a/axial_043.png","assets/T/mri-52410c4d23b24b8a/axial_044.png","assets/T/mri-52410c4d23b24b8a/axial_045.png","assets/T/mri-52410c4d23b24b8a/coronal_001.png","assets/T/mri-52410c4d23b24b8a/coronal_002.png","assets/T/mri-52410c4d23b24b8a/coronal_003.png","assets/T/mri-52410c4d23b24b8a/coronal_004.png","assets/T/mri-52410c4d23b24b8a/coronal_005.png","assets/T/mri-52410c4d23b24b8a/coronal_006.png","assets/T/mri-52410c4d23b24b8a/coronal_007.png","assets/T/mri-52410c4d23b24b8a/coronal_008.png","assets/T/mri-52410c4d23b24b8a/coronal_009.png","assets/T/mri-52410c4d23b24b8a/coronal_010.png","assets/T/mri-52410c4d23b24b8a/coronal_011.png","assets/T/mri-52410c4d23b24b8a/coronal_012.png","assets/T/mri-52410c4d23b24b8a/coronal_013.png","assets/T/mri-52410c4d23b24b8a/coronal_014.png","assets/T/mri-52410c4d23b24b8a/coronal_015.png","assets/T/mri-52410c4d23b24b8a/coronal_016.png","assets/T/mri-52410c4d23b24b8a/coronal_017.png","assets/T/mri-52410c4d23b24b8a/coronal_018.png","assets/T/mri-52410c4d23b24b8a/coronal_019.png","assets/T/mri-52410c4d23b24b8a/coronal_020.png","assets/T/mri-52410c4d23b24b8a/coronal_021.png","assets/T/mri-52410c4d23b24b8a/coronal_022.png","assets/T/mri-52410c4d23b24b8a/coronal_023.png","assets/T/mri-52410c4d23b24b8a/coronal_024.png","assets/T/mri-52410c4d23b24b8a/coronal_025.png","assets/T/mri-52410c4d23b24b8a/coronal_026.png"],"stage_edition":8}
+{"id":"L3-T300:mri-fcc9b515f8994f0e","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-fcc9b515f8994f0e/axial_001.png","assets/T/mri-fcc9b515f8994f0e/axial_002.png","assets/T/mri-fcc9b515f8994f0e/axial_003.png","assets/T/mri-fcc9b515f8994f0e/axial_004.png","assets/T/mri-fcc9b515f8994f0e/axial_005.png","assets/T/mri-fcc9b515f8994f0e/axial_006.png","assets/T/mri-fcc9b515f8994f0e/axial_007.png","assets/T/mri-fcc9b515f8994f0e/axial_008.png","assets/T/mri-fcc9b515f8994f0e/axial_009.png","assets/T/mri-fcc9b515f8994f0e/axial_010.png","assets/T/mri-fcc9b515f8994f0e/axial_011.png","assets/T/mri-fcc9b515f8994f0e/axial_012.png","assets/T/mri-fcc9b515f8994f0e/axial_013.png","assets/T/mri-fcc9b515f8994f0e/axial_014.png","assets/T/mri-fcc9b515f8994f0e/axial_015.png","assets/T/mri-fcc9b515f8994f0e/axial_016.png","assets/T/mri-fcc9b515f8994f0e/axial_017.png","assets/T/mri-fcc9b515f8994f0e/axial_018.png","assets/T/mri-fcc9b515f8994f0e/axial_019.png","assets/T/mri-fcc9b515f8994f0e/axial_020.png","assets/T/mri-fcc9b515f8994f0e/axial_021.png","assets/T/mri-fcc9b515f8994f0e/axial_022.png","assets/T/mri-fcc9b515f8994f0e/axial_023.png","assets/T/mri-fcc9b515f8994f0e/axial_024.png","assets/T/mri-fcc9b515f8994f0e/axial_025.png","assets/T/mri-fcc9b515f8994f0e/axial_026.png","assets/T/mri-fcc9b515f8994f0e/axial_027.png","assets/T/mri-fcc9b515f8994f0e/axial_028.png","assets/T/mri-fcc9b515f8994f0e/axial_029.png","assets/T/mri-fcc9b515f8994f0e/axial_030.png","assets/T/mri-fcc9b515f8994f0e/axial_031.png","assets/T/mri-fcc9b515f8994f0e/axial_032.png","assets/T/mri-fcc9b515f8994f0e/axial_033.png","assets/T/mri-fcc9b515f8994f0e/axial_034.png","assets/T/mri-fcc9b515f8994f0e/axial_035.png","assets/T/mri-fcc9b515f8994f0e/axial_036.png","assets/T/mri-fcc9b515f8994f0e/axial_037.png","assets/T/mri-fcc9b515f8994f0e/axial_038.png","assets/T/mri-fcc9b515f8994f0e/axial_039.png","assets/T/mri-fcc9b515f8994f0e/axial_040.png","assets/T/mri-fcc9b515f8994f0e/coronal_001.png","assets/T/mri-fcc9b515f8994f0e/coronal_002.png","assets/T/mri-fcc9b515f8994f0e/coronal_003.png","assets/T/mri-fcc9b515f8994f0e/coronal_004.png","assets/T/mri-fcc9b515f8994f0e/coronal_005.png","assets/T/mri-fcc9b515f8994f0e/coronal_006.png","assets/T/mri-fcc9b515f8994f0e/coronal_007.png","assets/T/mri-fcc9b515f8994f0e/coronal_008.png","assets/T/mri-fcc9b515f8994f0e/coronal_009.png","assets/T/mri-fcc9b515f8994f0e/coronal_010.png","assets/T/mri-fcc9b515f8994f0e/coronal_011.png","assets/T/mri-fcc9b515f8994f0e/coronal_012.png","assets/T/mri-fcc9b515f8994f0e/coronal_013.png","assets/T/mri-fcc9b515f8994f0e/coronal_014.png","assets/T/mri-fcc9b515f8994f0e/coronal_015.png","assets/T/mri-fcc9b515f8994f0e/coronal_016.png","assets/T/mri-fcc9b515f8994f0e/coronal_017.png","assets/T/mri-fcc9b515f8994f0e/coronal_018.png","assets/T/mri-fcc9b515f8994f0e/coronal_019.png","assets/T/mri-fcc9b515f8994f0e/coronal_020.png","assets/T/mri-fcc9b515f8994f0e/coronal_021.png","assets/T/mri-fcc9b515f8994f0e/coronal_022.png","assets/T/mri-fcc9b515f8994f0e/coronal_023.png","assets/T/mri-fcc9b515f8994f0e/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-7a7ad2d70dc5430a","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 60 张图，均来自同一次检查。\n\n- 前 36 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-7a7ad2d70dc5430a/axial_001.png","assets/T/mri-7a7ad2d70dc5430a/axial_002.png","assets/T/mri-7a7ad2d70dc5430a/axial_003.png","assets/T/mri-7a7ad2d70dc5430a/axial_004.png","assets/T/mri-7a7ad2d70dc5430a/axial_005.png","assets/T/mri-7a7ad2d70dc5430a/axial_006.png","assets/T/mri-7a7ad2d70dc5430a/axial_007.png","assets/T/mri-7a7ad2d70dc5430a/axial_008.png","assets/T/mri-7a7ad2d70dc5430a/axial_009.png","assets/T/mri-7a7ad2d70dc5430a/axial_010.png","assets/T/mri-7a7ad2d70dc5430a/axial_011.png","assets/T/mri-7a7ad2d70dc5430a/axial_012.png","assets/T/mri-7a7ad2d70dc5430a/axial_013.png","assets/T/mri-7a7ad2d70dc5430a/axial_014.png","assets/T/mri-7a7ad2d70dc5430a/axial_015.png","assets/T/mri-7a7ad2d70dc5430a/axial_016.png","assets/T/mri-7a7ad2d70dc5430a/axial_017.png","assets/T/mri-7a7ad2d70dc5430a/axial_018.png","assets/T/mri-7a7ad2d70dc5430a/axial_019.png","assets/T/mri-7a7ad2d70dc5430a/axial_020.png","assets/T/mri-7a7ad2d70dc5430a/axial_021.png","assets/T/mri-7a7ad2d70dc5430a/axial_022.png","assets/T/mri-7a7ad2d70dc5430a/axial_023.png","assets/T/mri-7a7ad2d70dc5430a/axial_024.png","assets/T/mri-7a7ad2d70dc5430a/axial_025.png","assets/T/mri-7a7ad2d70dc5430a/axial_026.png","assets/T/mri-7a7ad2d70dc5430a/axial_027.png","assets/T/mri-7a7ad2d70dc5430a/axial_028.png","assets/T/mri-7a7ad2d70dc5430a/axial_029.png","assets/T/mri-7a7ad2d70dc5430a/axial_030.png","assets/T/mri-7a7ad2d70dc5430a/axial_031.png","assets/T/mri-7a7ad2d70dc5430a/axial_032.png","assets/T/mri-7a7ad2d70dc5430a/axial_033.png","assets/T/mri-7a7ad2d70dc5430a/axial_034.png","assets/T/mri-7a7ad2d70dc5430a/axial_035.png","assets/T/mri-7a7ad2d70dc5430a/axial_036.png","assets/T/mri-7a7ad2d70dc5430a/coronal_001.png","assets/T/mri-7a7ad2d70dc5430a/coronal_002.png","assets/T/mri-7a7ad2d70dc5430a/coronal_003.png","assets/T/mri-7a7ad2d70dc5430a/coronal_004.png","assets/T/mri-7a7ad2d70dc5430a/coronal_005.png","assets/T/mri-7a7ad2d70dc5430a/coronal_006.png","assets/T/mri-7a7ad2d70dc5430a/coronal_007.png","assets/T/mri-7a7ad2d70dc5430a/coronal_008.png","assets/T/mri-7a7ad2d70dc5430a/coronal_009.png","assets/T/mri-7a7ad2d70dc5430a/coronal_010.png","assets/T/mri-7a7ad2d70dc5430a/coronal_011.png","assets/T/mri-7a7ad2d70dc5430a/coronal_012.png","assets/T/mri-7a7ad2d70dc5430a/coronal_013.png","assets/T/mri-7a7ad2d70dc5430a/coronal_014.png","assets/T/mri-7a7ad2d70dc5430a/coronal_015.png","assets/T/mri-7a7ad2d70dc5430a/coronal_016.png","assets/T/mri-7a7ad2d70dc5430a/coronal_017.png","assets/T/mri-7a7ad2d70dc5430a/coronal_018.png","assets/T/mri-7a7ad2d70dc5430a/coronal_019.png","assets/T/mri-7a7ad2d70dc5430a/coronal_020.png","assets/T/mri-7a7ad2d70dc5430a/coronal_021.png","assets/T/mri-7a7ad2d70dc5430a/coronal_022.png","assets/T/mri-7a7ad2d70dc5430a/coronal_023.png","assets/T/mri-7a7ad2d70dc5430a/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-3ea899b4a60449de","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 72 张图，均来自同一次检查。\n\n- 前 44 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 28 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-3ea899b4a60449de/axial_001.png","assets/T/mri-3ea899b4a60449de/axial_002.png","assets/T/mri-3ea899b4a60449de/axial_003.png","assets/T/mri-3ea899b4a60449de/axial_004.png","assets/T/mri-3ea899b4a60449de/axial_005.png","assets/T/mri-3ea899b4a60449de/axial_006.png","assets/T/mri-3ea899b4a60449de/axial_007.png","assets/T/mri-3ea899b4a60449de/axial_008.png","assets/T/mri-3ea899b4a60449de/axial_009.png","assets/T/mri-3ea899b4a60449de/axial_010.png","assets/T/mri-3ea899b4a60449de/axial_011.png","assets/T/mri-3ea899b4a60449de/axial_012.png","assets/T/mri-3ea899b4a60449de/axial_013.png","assets/T/mri-3ea899b4a60449de/axial_014.png","assets/T/mri-3ea899b4a60449de/axial_015.png","assets/T/mri-3ea899b4a60449de/axial_016.png","assets/T/mri-3ea899b4a60449de/axial_017.png","assets/T/mri-3ea899b4a60449de/axial_018.png","assets/T/mri-3ea899b4a60449de/axial_019.png","assets/T/mri-3ea899b4a60449de/axial_020.png","assets/T/mri-3ea899b4a60449de/axial_021.png","assets/T/mri-3ea899b4a60449de/axial_022.png","assets/T/mri-3ea899b4a60449de/axial_023.png","assets/T/mri-3ea899b4a60449de/axial_024.png","assets/T/mri-3ea899b4a60449de/axial_025.png","assets/T/mri-3ea899b4a60449de/axial_026.png","assets/T/mri-3ea899b4a60449de/axial_027.png","assets/T/mri-3ea899b4a60449de/axial_028.png","assets/T/mri-3ea899b4a60449de/axial_029.png","assets/T/mri-3ea899b4a60449de/axial_030.png","assets/T/mri-3ea899b4a60449de/axial_031.png","assets/T/mri-3ea899b4a60449de/axial_032.png","assets/T/mri-3ea899b4a60449de/axial_033.png","assets/T/mri-3ea899b4a60449de/axial_034.png","assets/T/mri-3ea899b4a60449de/axial_035.png","assets/T/mri-3ea899b4a60449de/axial_036.png","assets/T/mri-3ea899b4a60449de/axial_037.png","assets/T/mri-3ea899b4a60449de/axial_038.png","assets/T/mri-3ea899b4a60449de/axial_039.png","assets/T/mri-3ea899b4a60449de/axial_040.png","assets/T/mri-3ea899b4a60449de/axial_041.png","assets/T/mri-3ea899b4a60449de/axial_042.png","assets/T/mri-3ea899b4a60449de/axial_043.png","assets/T/mri-3ea899b4a60449de/axial_044.png","assets/T/mri-3ea899b4a60449de/coronal_001.png","assets/T/mri-3ea899b4a60449de/coronal_002.png","assets/T/mri-3ea899b4a60449de/coronal_003.png","assets/T/mri-3ea899b4a60449de/coronal_004.png","assets/T/mri-3ea899b4a60449de/coronal_005.png","assets/T/mri-3ea899b4a60449de/coronal_006.png","assets/T/mri-3ea899b4a60449de/coronal_007.png","assets/T/mri-3ea899b4a60449de/coronal_008.png","assets/T/mri-3ea899b4a60449de/coronal_009.png","assets/T/mri-3ea899b4a60449de/coronal_010.png","assets/T/mri-3ea899b4a60449de/coronal_011.png","assets/T/mri-3ea899b4a60449de/coronal_012.png","assets/T/mri-3ea899b4a60449de/coronal_013.png","assets/T/mri-3ea899b4a60449de/coronal_014.png","assets/T/mri-3ea899b4a60449de/coronal_015.png","assets/T/mri-3ea899b4a60449de/coronal_016.png","assets/T/mri-3ea899b4a60449de/coronal_017.png","assets/T/mri-3ea899b4a60449de/coronal_018.png","assets/T/mri-3ea899b4a60449de/coronal_019.png","assets/T/mri-3ea899b4a60449de/coronal_020.png","assets/T/mri-3ea899b4a60449de/coronal_021.png","assets/T/mri-3ea899b4a60449de/coronal_022.png","assets/T/mri-3ea899b4a60449de/coronal_023.png","assets/T/mri-3ea899b4a60449de/coronal_024.png","assets/T/mri-3ea899b4a60449de/coronal_025.png","assets/T/mri-3ea899b4a60449de/coronal_026.png","assets/T/mri-3ea899b4a60449de/coronal_027.png","assets/T/mri-3ea899b4a60449de/coronal_028.png"],"stage_edition":8}
+{"id":"L3-T300:mri-f5e94b609a994f45","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 70 张图，均来自同一次检查。\n\n- 前 44 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 26 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-f5e94b609a994f45/axial_001.png","assets/T/mri-f5e94b609a994f45/axial_002.png","assets/T/mri-f5e94b609a994f45/axial_003.png","assets/T/mri-f5e94b609a994f45/axial_004.png","assets/T/mri-f5e94b609a994f45/axial_005.png","assets/T/mri-f5e94b609a994f45/axial_006.png","assets/T/mri-f5e94b609a994f45/axial_007.png","assets/T/mri-f5e94b609a994f45/axial_008.png","assets/T/mri-f5e94b609a994f45/axial_009.png","assets/T/mri-f5e94b609a994f45/axial_010.png","assets/T/mri-f5e94b609a994f45/axial_011.png","assets/T/mri-f5e94b609a994f45/axial_012.png","assets/T/mri-f5e94b609a994f45/axial_013.png","assets/T/mri-f5e94b609a994f45/axial_014.png","assets/T/mri-f5e94b609a994f45/axial_015.png","assets/T/mri-f5e94b609a994f45/axial_016.png","assets/T/mri-f5e94b609a994f45/axial_017.png","assets/T/mri-f5e94b609a994f45/axial_018.png","assets/T/mri-f5e94b609a994f45/axial_019.png","assets/T/mri-f5e94b609a994f45/axial_020.png","assets/T/mri-f5e94b609a994f45/axial_021.png","assets/T/mri-f5e94b609a994f45/axial_022.png","assets/T/mri-f5e94b609a994f45/axial_023.png","assets/T/mri-f5e94b609a994f45/axial_024.png","assets/T/mri-f5e94b609a994f45/axial_025.png","assets/T/mri-f5e94b609a994f45/axial_026.png","assets/T/mri-f5e94b609a994f45/axial_027.png","assets/T/mri-f5e94b609a994f45/axial_028.png","assets/T/mri-f5e94b609a994f45/axial_029.png","assets/T/mri-f5e94b609a994f45/axial_030.png","assets/T/mri-f5e94b609a994f45/axial_031.png","assets/T/mri-f5e94b609a994f45/axial_032.png","assets/T/mri-f5e94b609a994f45/axial_033.png","assets/T/mri-f5e94b609a994f45/axial_034.png","assets/T/mri-f5e94b609a994f45/axial_035.png","assets/T/mri-f5e94b609a994f45/axial_036.png","assets/T/mri-f5e94b609a994f45/axial_037.png","assets/T/mri-f5e94b609a994f45/axial_038.png","assets/T/mri-f5e94b609a994f45/axial_039.png","assets/T/mri-f5e94b609a994f45/axial_040.png","assets/T/mri-f5e94b609a994f45/axial_041.png","assets/T/mri-f5e94b609a994f45/axial_042.png","assets/T/mri-f5e94b609a994f45/axial_043.png","assets/T/mri-f5e94b609a994f45/axial_044.png","assets/T/mri-f5e94b609a994f45/coronal_001.png","assets/T/mri-f5e94b609a994f45/coronal_002.png","assets/T/mri-f5e94b609a994f45/coronal_003.png","assets/T/mri-f5e94b609a994f45/coronal_004.png","assets/T/mri-f5e94b609a994f45/coronal_005.png","assets/T/mri-f5e94b609a994f45/coronal_006.png","assets/T/mri-f5e94b609a994f45/coronal_007.png","assets/T/mri-f5e94b609a994f45/coronal_008.png","assets/T/mri-f5e94b609a994f45/coronal_009.png","assets/T/mri-f5e94b609a994f45/coronal_010.png","assets/T/mri-f5e94b609a994f45/coronal_011.png","assets/T/mri-f5e94b609a994f45/coronal_012.png","assets/T/mri-f5e94b609a994f45/coronal_013.png","assets/T/mri-f5e94b609a994f45/coronal_014.png","assets/T/mri-f5e94b609a994f45/coronal_015.png","assets/T/mri-f5e94b609a994f45/coronal_016.png","assets/T/mri-f5e94b609a994f45/coronal_017.png","assets/T/mri-f5e94b609a994f45/coronal_018.png","assets/T/mri-f5e94b609a994f45/coronal_019.png","assets/T/mri-f5e94b609a994f45/coronal_020.png","assets/T/mri-f5e94b609a994f45/coronal_021.png","assets/T/mri-f5e94b609a994f45/coronal_022.png","assets/T/mri-f5e94b609a994f45/coronal_023.png","assets/T/mri-f5e94b609a994f45/coronal_024.png","assets/T/mri-f5e94b609a994f45/coronal_025.png","assets/T/mri-f5e94b609a994f45/coronal_026.png"],"stage_edition":8}
+{"id":"L3-T300:mri-9ec9fbbfc5a4455a","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-9ec9fbbfc5a4455a/axial_001.png","assets/T/mri-9ec9fbbfc5a4455a/axial_002.png","assets/T/mri-9ec9fbbfc5a4455a/axial_003.png","assets/T/mri-9ec9fbbfc5a4455a/axial_004.png","assets/T/mri-9ec9fbbfc5a4455a/axial_005.png","assets/T/mri-9ec9fbbfc5a4455a/axial_006.png","assets/T/mri-9ec9fbbfc5a4455a/axial_007.png","assets/T/mri-9ec9fbbfc5a4455a/axial_008.png","assets/T/mri-9ec9fbbfc5a4455a/axial_009.png","assets/T/mri-9ec9fbbfc5a4455a/axial_010.png","assets/T/mri-9ec9fbbfc5a4455a/axial_011.png","assets/T/mri-9ec9fbbfc5a4455a/axial_012.png","assets/T/mri-9ec9fbbfc5a4455a/axial_013.png","assets/T/mri-9ec9fbbfc5a4455a/axial_014.png","assets/T/mri-9ec9fbbfc5a4455a/axial_015.png","assets/T/mri-9ec9fbbfc5a4455a/axial_016.png","assets/T/mri-9ec9fbbfc5a4455a/axial_017.png","assets/T/mri-9ec9fbbfc5a4455a/axial_018.png","assets/T/mri-9ec9fbbfc5a4455a/axial_019.png","assets/T/mri-9ec9fbbfc5a4455a/axial_020.png","assets/T/mri-9ec9fbbfc5a4455a/axial_021.png","assets/T/mri-9ec9fbbfc5a4455a/axial_022.png","assets/T/mri-9ec9fbbfc5a4455a/axial_023.png","assets/T/mri-9ec9fbbfc5a4455a/axial_024.png","assets/T/mri-9ec9fbbfc5a4455a/axial_025.png","assets/T/mri-9ec9fbbfc5a4455a/axial_026.png","assets/T/mri-9ec9fbbfc5a4455a/axial_027.png","assets/T/mri-9ec9fbbfc5a4455a/axial_028.png","assets/T/mri-9ec9fbbfc5a4455a/axial_029.png","assets/T/mri-9ec9fbbfc5a4455a/axial_030.png","assets/T/mri-9ec9fbbfc5a4455a/axial_031.png","assets/T/mri-9ec9fbbfc5a4455a/axial_032.png","assets/T/mri-9ec9fbbfc5a4455a/axial_033.png","assets/T/mri-9ec9fbbfc5a4455a/axial_034.png","assets/T/mri-9ec9fbbfc5a4455a/axial_035.png","assets/T/mri-9ec9fbbfc5a4455a/axial_036.png","assets/T/mri-9ec9fbbfc5a4455a/axial_037.png","assets/T/mri-9ec9fbbfc5a4455a/axial_038.png","assets/T/mri-9ec9fbbfc5a4455a/axial_039.png","assets/T/mri-9ec9fbbfc5a4455a/axial_040.png","assets/T/mri-9ec9fbbfc5a4455a/coronal_001.png","assets/T/mri-9ec9fbbfc5a4455a/coronal_002.png","assets/T/mri-9ec9fbbfc5a4455a/coronal_003.png","assets/T/mri-9ec9fbbfc5a4455a/coronal_004.png","assets/T/mri-9ec9fbbfc5a4455a/coronal_005.png","assets/T/mri-9ec9fbbfc5a4455a/coronal_006.png","assets/T/mri-9ec9fbbfc5a4455a/coronal_007.png","assets/T/mri-9ec9fbbfc5a4455a/coronal_008.png","assets/T/mri-9ec9fbbfc5a4455a/coronal_009.png","assets/T/mri-9ec9fbbfc5a4455a/coronal_010.png","assets/T/mri-9ec9fbbfc5a4455a/coronal_011.png","assets/T/mri-9ec9fbbfc5a4455a/coronal_012.png","assets/T/mri-9ec9fbbfc5a4455a/coronal_013.png","assets/T/mri-9ec9fbbfc5a4455a/coronal_014.png","assets/T/mri-9ec9fbbfc5a4455a/coronal_015.png","assets/T/mri-9ec9fbbfc5a4455a/coronal_016.png","assets/T/mri-9ec9fbbfc5a4455a/coronal_017.png","assets/T/mri-9ec9fbbfc5a4455a/coronal_018.png","assets/T/mri-9ec9fbbfc5a4455a/coronal_019.png","assets/T/mri-9ec9fbbfc5a4455a/coronal_020.png","assets/T/mri-9ec9fbbfc5a4455a/coronal_021.png","assets/T/mri-9ec9fbbfc5a4455a/coronal_022.png","assets/T/mri-9ec9fbbfc5a4455a/coronal_023.png","assets/T/mri-9ec9fbbfc5a4455a/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-5d8f67cc09114eee","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-5d8f67cc09114eee/axial_001.png","assets/T/mri-5d8f67cc09114eee/axial_002.png","assets/T/mri-5d8f67cc09114eee/axial_003.png","assets/T/mri-5d8f67cc09114eee/axial_004.png","assets/T/mri-5d8f67cc09114eee/axial_005.png","assets/T/mri-5d8f67cc09114eee/axial_006.png","assets/T/mri-5d8f67cc09114eee/axial_007.png","assets/T/mri-5d8f67cc09114eee/axial_008.png","assets/T/mri-5d8f67cc09114eee/axial_009.png","assets/T/mri-5d8f67cc09114eee/axial_010.png","assets/T/mri-5d8f67cc09114eee/axial_011.png","assets/T/mri-5d8f67cc09114eee/axial_012.png","assets/T/mri-5d8f67cc09114eee/axial_013.png","assets/T/mri-5d8f67cc09114eee/axial_014.png","assets/T/mri-5d8f67cc09114eee/axial_015.png","assets/T/mri-5d8f67cc09114eee/axial_016.png","assets/T/mri-5d8f67cc09114eee/axial_017.png","assets/T/mri-5d8f67cc09114eee/axial_018.png","assets/T/mri-5d8f67cc09114eee/axial_019.png","assets/T/mri-5d8f67cc09114eee/axial_020.png","assets/T/mri-5d8f67cc09114eee/axial_021.png","assets/T/mri-5d8f67cc09114eee/axial_022.png","assets/T/mri-5d8f67cc09114eee/axial_023.png","assets/T/mri-5d8f67cc09114eee/axial_024.png","assets/T/mri-5d8f67cc09114eee/axial_025.png","assets/T/mri-5d8f67cc09114eee/axial_026.png","assets/T/mri-5d8f67cc09114eee/axial_027.png","assets/T/mri-5d8f67cc09114eee/axial_028.png","assets/T/mri-5d8f67cc09114eee/axial_029.png","assets/T/mri-5d8f67cc09114eee/axial_030.png","assets/T/mri-5d8f67cc09114eee/axial_031.png","assets/T/mri-5d8f67cc09114eee/axial_032.png","assets/T/mri-5d8f67cc09114eee/axial_033.png","assets/T/mri-5d8f67cc09114eee/axial_034.png","assets/T/mri-5d8f67cc09114eee/axial_035.png","assets/T/mri-5d8f67cc09114eee/axial_036.png","assets/T/mri-5d8f67cc09114eee/axial_037.png","assets/T/mri-5d8f67cc09114eee/axial_038.png","assets/T/mri-5d8f67cc09114eee/axial_039.png","assets/T/mri-5d8f67cc09114eee/axial_040.png","assets/T/mri-5d8f67cc09114eee/axial_041.png","assets/T/mri-5d8f67cc09114eee/axial_042.png","assets/T/mri-5d8f67cc09114eee/coronal_001.png","assets/T/mri-5d8f67cc09114eee/coronal_002.png","assets/T/mri-5d8f67cc09114eee/coronal_003.png","assets/T/mri-5d8f67cc09114eee/coronal_004.png","assets/T/mri-5d8f67cc09114eee/coronal_005.png","assets/T/mri-5d8f67cc09114eee/coronal_006.png","assets/T/mri-5d8f67cc09114eee/coronal_007.png","assets/T/mri-5d8f67cc09114eee/coronal_008.png","assets/T/mri-5d8f67cc09114eee/coronal_009.png","assets/T/mri-5d8f67cc09114eee/coronal_010.png","assets/T/mri-5d8f67cc09114eee/coronal_011.png","assets/T/mri-5d8f67cc09114eee/coronal_012.png","assets/T/mri-5d8f67cc09114eee/coronal_013.png","assets/T/mri-5d8f67cc09114eee/coronal_014.png","assets/T/mri-5d8f67cc09114eee/coronal_015.png","assets/T/mri-5d8f67cc09114eee/coronal_016.png","assets/T/mri-5d8f67cc09114eee/coronal_017.png","assets/T/mri-5d8f67cc09114eee/coronal_018.png","assets/T/mri-5d8f67cc09114eee/coronal_019.png","assets/T/mri-5d8f67cc09114eee/coronal_020.png","assets/T/mri-5d8f67cc09114eee/coronal_021.png","assets/T/mri-5d8f67cc09114eee/coronal_022.png","assets/T/mri-5d8f67cc09114eee/coronal_023.png","assets/T/mri-5d8f67cc09114eee/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-812aaa7d98de44b8","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-812aaa7d98de44b8/axial_001.png","assets/T/mri-812aaa7d98de44b8/axial_002.png","assets/T/mri-812aaa7d98de44b8/axial_003.png","assets/T/mri-812aaa7d98de44b8/axial_004.png","assets/T/mri-812aaa7d98de44b8/axial_005.png","assets/T/mri-812aaa7d98de44b8/axial_006.png","assets/T/mri-812aaa7d98de44b8/axial_007.png","assets/T/mri-812aaa7d98de44b8/axial_008.png","assets/T/mri-812aaa7d98de44b8/axial_009.png","assets/T/mri-812aaa7d98de44b8/axial_010.png","assets/T/mri-812aaa7d98de44b8/axial_011.png","assets/T/mri-812aaa7d98de44b8/axial_012.png","assets/T/mri-812aaa7d98de44b8/axial_013.png","assets/T/mri-812aaa7d98de44b8/axial_014.png","assets/T/mri-812aaa7d98de44b8/axial_015.png","assets/T/mri-812aaa7d98de44b8/axial_016.png","assets/T/mri-812aaa7d98de44b8/axial_017.png","assets/T/mri-812aaa7d98de44b8/axial_018.png","assets/T/mri-812aaa7d98de44b8/axial_019.png","assets/T/mri-812aaa7d98de44b8/axial_020.png","assets/T/mri-812aaa7d98de44b8/axial_021.png","assets/T/mri-812aaa7d98de44b8/axial_022.png","assets/T/mri-812aaa7d98de44b8/axial_023.png","assets/T/mri-812aaa7d98de44b8/axial_024.png","assets/T/mri-812aaa7d98de44b8/axial_025.png","assets/T/mri-812aaa7d98de44b8/axial_026.png","assets/T/mri-812aaa7d98de44b8/axial_027.png","assets/T/mri-812aaa7d98de44b8/axial_028.png","assets/T/mri-812aaa7d98de44b8/axial_029.png","assets/T/mri-812aaa7d98de44b8/axial_030.png","assets/T/mri-812aaa7d98de44b8/axial_031.png","assets/T/mri-812aaa7d98de44b8/axial_032.png","assets/T/mri-812aaa7d98de44b8/axial_033.png","assets/T/mri-812aaa7d98de44b8/axial_034.png","assets/T/mri-812aaa7d98de44b8/axial_035.png","assets/T/mri-812aaa7d98de44b8/axial_036.png","assets/T/mri-812aaa7d98de44b8/axial_037.png","assets/T/mri-812aaa7d98de44b8/axial_038.png","assets/T/mri-812aaa7d98de44b8/axial_039.png","assets/T/mri-812aaa7d98de44b8/axial_040.png","assets/T/mri-812aaa7d98de44b8/coronal_001.png","assets/T/mri-812aaa7d98de44b8/coronal_002.png","assets/T/mri-812aaa7d98de44b8/coronal_003.png","assets/T/mri-812aaa7d98de44b8/coronal_004.png","assets/T/mri-812aaa7d98de44b8/coronal_005.png","assets/T/mri-812aaa7d98de44b8/coronal_006.png","assets/T/mri-812aaa7d98de44b8/coronal_007.png","assets/T/mri-812aaa7d98de44b8/coronal_008.png","assets/T/mri-812aaa7d98de44b8/coronal_009.png","assets/T/mri-812aaa7d98de44b8/coronal_010.png","assets/T/mri-812aaa7d98de44b8/coronal_011.png","assets/T/mri-812aaa7d98de44b8/coronal_012.png","assets/T/mri-812aaa7d98de44b8/coronal_013.png","assets/T/mri-812aaa7d98de44b8/coronal_014.png","assets/T/mri-812aaa7d98de44b8/coronal_015.png","assets/T/mri-812aaa7d98de44b8/coronal_016.png","assets/T/mri-812aaa7d98de44b8/coronal_017.png","assets/T/mri-812aaa7d98de44b8/coronal_018.png","assets/T/mri-812aaa7d98de44b8/coronal_019.png","assets/T/mri-812aaa7d98de44b8/coronal_020.png","assets/T/mri-812aaa7d98de44b8/coronal_021.png","assets/T/mri-812aaa7d98de44b8/coronal_022.png","assets/T/mri-812aaa7d98de44b8/coronal_023.png","assets/T/mri-812aaa7d98de44b8/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-d711445434a34edd","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 68 张图，均来自同一次检查。\n\n- 前 44 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-d711445434a34edd/axial_001.png","assets/T/mri-d711445434a34edd/axial_002.png","assets/T/mri-d711445434a34edd/axial_003.png","assets/T/mri-d711445434a34edd/axial_004.png","assets/T/mri-d711445434a34edd/axial_005.png","assets/T/mri-d711445434a34edd/axial_006.png","assets/T/mri-d711445434a34edd/axial_007.png","assets/T/mri-d711445434a34edd/axial_008.png","assets/T/mri-d711445434a34edd/axial_009.png","assets/T/mri-d711445434a34edd/axial_010.png","assets/T/mri-d711445434a34edd/axial_011.png","assets/T/mri-d711445434a34edd/axial_012.png","assets/T/mri-d711445434a34edd/axial_013.png","assets/T/mri-d711445434a34edd/axial_014.png","assets/T/mri-d711445434a34edd/axial_015.png","assets/T/mri-d711445434a34edd/axial_016.png","assets/T/mri-d711445434a34edd/axial_017.png","assets/T/mri-d711445434a34edd/axial_018.png","assets/T/mri-d711445434a34edd/axial_019.png","assets/T/mri-d711445434a34edd/axial_020.png","assets/T/mri-d711445434a34edd/axial_021.png","assets/T/mri-d711445434a34edd/axial_022.png","assets/T/mri-d711445434a34edd/axial_023.png","assets/T/mri-d711445434a34edd/axial_024.png","assets/T/mri-d711445434a34edd/axial_025.png","assets/T/mri-d711445434a34edd/axial_026.png","assets/T/mri-d711445434a34edd/axial_027.png","assets/T/mri-d711445434a34edd/axial_028.png","assets/T/mri-d711445434a34edd/axial_029.png","assets/T/mri-d711445434a34edd/axial_030.png","assets/T/mri-d711445434a34edd/axial_031.png","assets/T/mri-d711445434a34edd/axial_032.png","assets/T/mri-d711445434a34edd/axial_033.png","assets/T/mri-d711445434a34edd/axial_034.png","assets/T/mri-d711445434a34edd/axial_035.png","assets/T/mri-d711445434a34edd/axial_036.png","assets/T/mri-d711445434a34edd/axial_037.png","assets/T/mri-d711445434a34edd/axial_038.png","assets/T/mri-d711445434a34edd/axial_039.png","assets/T/mri-d711445434a34edd/axial_040.png","assets/T/mri-d711445434a34edd/axial_041.png","assets/T/mri-d711445434a34edd/axial_042.png","assets/T/mri-d711445434a34edd/axial_043.png","assets/T/mri-d711445434a34edd/axial_044.png","assets/T/mri-d711445434a34edd/coronal_001.png","assets/T/mri-d711445434a34edd/coronal_002.png","assets/T/mri-d711445434a34edd/coronal_003.png","assets/T/mri-d711445434a34edd/coronal_004.png","assets/T/mri-d711445434a34edd/coronal_005.png","assets/T/mri-d711445434a34edd/coronal_006.png","assets/T/mri-d711445434a34edd/coronal_007.png","assets/T/mri-d711445434a34edd/coronal_008.png","assets/T/mri-d711445434a34edd/coronal_009.png","assets/T/mri-d711445434a34edd/coronal_010.png","assets/T/mri-d711445434a34edd/coronal_011.png","assets/T/mri-d711445434a34edd/coronal_012.png","assets/T/mri-d711445434a34edd/coronal_013.png","assets/T/mri-d711445434a34edd/coronal_014.png","assets/T/mri-d711445434a34edd/coronal_015.png","assets/T/mri-d711445434a34edd/coronal_016.png","assets/T/mri-d711445434a34edd/coronal_017.png","assets/T/mri-d711445434a34edd/coronal_018.png","assets/T/mri-d711445434a34edd/coronal_019.png","assets/T/mri-d711445434a34edd/coronal_020.png","assets/T/mri-d711445434a34edd/coronal_021.png","assets/T/mri-d711445434a34edd/coronal_022.png","assets/T/mri-d711445434a34edd/coronal_023.png","assets/T/mri-d711445434a34edd/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-13f68ff6760b49da","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-13f68ff6760b49da/axial_001.png","assets/T/mri-13f68ff6760b49da/axial_002.png","assets/T/mri-13f68ff6760b49da/axial_003.png","assets/T/mri-13f68ff6760b49da/axial_004.png","assets/T/mri-13f68ff6760b49da/axial_005.png","assets/T/mri-13f68ff6760b49da/axial_006.png","assets/T/mri-13f68ff6760b49da/axial_007.png","assets/T/mri-13f68ff6760b49da/axial_008.png","assets/T/mri-13f68ff6760b49da/axial_009.png","assets/T/mri-13f68ff6760b49da/axial_010.png","assets/T/mri-13f68ff6760b49da/axial_011.png","assets/T/mri-13f68ff6760b49da/axial_012.png","assets/T/mri-13f68ff6760b49da/axial_013.png","assets/T/mri-13f68ff6760b49da/axial_014.png","assets/T/mri-13f68ff6760b49da/axial_015.png","assets/T/mri-13f68ff6760b49da/axial_016.png","assets/T/mri-13f68ff6760b49da/axial_017.png","assets/T/mri-13f68ff6760b49da/axial_018.png","assets/T/mri-13f68ff6760b49da/axial_019.png","assets/T/mri-13f68ff6760b49da/axial_020.png","assets/T/mri-13f68ff6760b49da/axial_021.png","assets/T/mri-13f68ff6760b49da/axial_022.png","assets/T/mri-13f68ff6760b49da/axial_023.png","assets/T/mri-13f68ff6760b49da/axial_024.png","assets/T/mri-13f68ff6760b49da/axial_025.png","assets/T/mri-13f68ff6760b49da/axial_026.png","assets/T/mri-13f68ff6760b49da/axial_027.png","assets/T/mri-13f68ff6760b49da/axial_028.png","assets/T/mri-13f68ff6760b49da/axial_029.png","assets/T/mri-13f68ff6760b49da/axial_030.png","assets/T/mri-13f68ff6760b49da/axial_031.png","assets/T/mri-13f68ff6760b49da/axial_032.png","assets/T/mri-13f68ff6760b49da/axial_033.png","assets/T/mri-13f68ff6760b49da/axial_034.png","assets/T/mri-13f68ff6760b49da/axial_035.png","assets/T/mri-13f68ff6760b49da/axial_036.png","assets/T/mri-13f68ff6760b49da/axial_037.png","assets/T/mri-13f68ff6760b49da/axial_038.png","assets/T/mri-13f68ff6760b49da/axial_039.png","assets/T/mri-13f68ff6760b49da/axial_040.png","assets/T/mri-13f68ff6760b49da/axial_041.png","assets/T/mri-13f68ff6760b49da/axial_042.png","assets/T/mri-13f68ff6760b49da/coronal_001.png","assets/T/mri-13f68ff6760b49da/coronal_002.png","assets/T/mri-13f68ff6760b49da/coronal_003.png","assets/T/mri-13f68ff6760b49da/coronal_004.png","assets/T/mri-13f68ff6760b49da/coronal_005.png","assets/T/mri-13f68ff6760b49da/coronal_006.png","assets/T/mri-13f68ff6760b49da/coronal_007.png","assets/T/mri-13f68ff6760b49da/coronal_008.png","assets/T/mri-13f68ff6760b49da/coronal_009.png","assets/T/mri-13f68ff6760b49da/coronal_010.png","assets/T/mri-13f68ff6760b49da/coronal_011.png","assets/T/mri-13f68ff6760b49da/coronal_012.png","assets/T/mri-13f68ff6760b49da/coronal_013.png","assets/T/mri-13f68ff6760b49da/coronal_014.png","assets/T/mri-13f68ff6760b49da/coronal_015.png","assets/T/mri-13f68ff6760b49da/coronal_016.png","assets/T/mri-13f68ff6760b49da/coronal_017.png","assets/T/mri-13f68ff6760b49da/coronal_018.png","assets/T/mri-13f68ff6760b49da/coronal_019.png","assets/T/mri-13f68ff6760b49da/coronal_020.png","assets/T/mri-13f68ff6760b49da/coronal_021.png","assets/T/mri-13f68ff6760b49da/coronal_022.png","assets/T/mri-13f68ff6760b49da/coronal_023.png","assets/T/mri-13f68ff6760b49da/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-48efb702a3a14741","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-48efb702a3a14741/axial_001.png","assets/T/mri-48efb702a3a14741/axial_002.png","assets/T/mri-48efb702a3a14741/axial_003.png","assets/T/mri-48efb702a3a14741/axial_004.png","assets/T/mri-48efb702a3a14741/axial_005.png","assets/T/mri-48efb702a3a14741/axial_006.png","assets/T/mri-48efb702a3a14741/axial_007.png","assets/T/mri-48efb702a3a14741/axial_008.png","assets/T/mri-48efb702a3a14741/axial_009.png","assets/T/mri-48efb702a3a14741/axial_010.png","assets/T/mri-48efb702a3a14741/axial_011.png","assets/T/mri-48efb702a3a14741/axial_012.png","assets/T/mri-48efb702a3a14741/axial_013.png","assets/T/mri-48efb702a3a14741/axial_014.png","assets/T/mri-48efb702a3a14741/axial_015.png","assets/T/mri-48efb702a3a14741/axial_016.png","assets/T/mri-48efb702a3a14741/axial_017.png","assets/T/mri-48efb702a3a14741/axial_018.png","assets/T/mri-48efb702a3a14741/axial_019.png","assets/T/mri-48efb702a3a14741/axial_020.png","assets/T/mri-48efb702a3a14741/axial_021.png","assets/T/mri-48efb702a3a14741/axial_022.png","assets/T/mri-48efb702a3a14741/axial_023.png","assets/T/mri-48efb702a3a14741/axial_024.png","assets/T/mri-48efb702a3a14741/axial_025.png","assets/T/mri-48efb702a3a14741/axial_026.png","assets/T/mri-48efb702a3a14741/axial_027.png","assets/T/mri-48efb702a3a14741/axial_028.png","assets/T/mri-48efb702a3a14741/axial_029.png","assets/T/mri-48efb702a3a14741/axial_030.png","assets/T/mri-48efb702a3a14741/axial_031.png","assets/T/mri-48efb702a3a14741/axial_032.png","assets/T/mri-48efb702a3a14741/axial_033.png","assets/T/mri-48efb702a3a14741/axial_034.png","assets/T/mri-48efb702a3a14741/axial_035.png","assets/T/mri-48efb702a3a14741/axial_036.png","assets/T/mri-48efb702a3a14741/axial_037.png","assets/T/mri-48efb702a3a14741/axial_038.png","assets/T/mri-48efb702a3a14741/axial_039.png","assets/T/mri-48efb702a3a14741/axial_040.png","assets/T/mri-48efb702a3a14741/coronal_001.png","assets/T/mri-48efb702a3a14741/coronal_002.png","assets/T/mri-48efb702a3a14741/coronal_003.png","assets/T/mri-48efb702a3a14741/coronal_004.png","assets/T/mri-48efb702a3a14741/coronal_005.png","assets/T/mri-48efb702a3a14741/coronal_006.png","assets/T/mri-48efb702a3a14741/coronal_007.png","assets/T/mri-48efb702a3a14741/coronal_008.png","assets/T/mri-48efb702a3a14741/coronal_009.png","assets/T/mri-48efb702a3a14741/coronal_010.png","assets/T/mri-48efb702a3a14741/coronal_011.png","assets/T/mri-48efb702a3a14741/coronal_012.png","assets/T/mri-48efb702a3a14741/coronal_013.png","assets/T/mri-48efb702a3a14741/coronal_014.png","assets/T/mri-48efb702a3a14741/coronal_015.png","assets/T/mri-48efb702a3a14741/coronal_016.png","assets/T/mri-48efb702a3a14741/coronal_017.png","assets/T/mri-48efb702a3a14741/coronal_018.png","assets/T/mri-48efb702a3a14741/coronal_019.png","assets/T/mri-48efb702a3a14741/coronal_020.png","assets/T/mri-48efb702a3a14741/coronal_021.png","assets/T/mri-48efb702a3a14741/coronal_022.png","assets/T/mri-48efb702a3a14741/coronal_023.png","assets/T/mri-48efb702a3a14741/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-2036815a13894335","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 67 张图，均来自同一次检查。\n\n- 前 43 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-2036815a13894335/axial_001.png","assets/T/mri-2036815a13894335/axial_002.png","assets/T/mri-2036815a13894335/axial_003.png","assets/T/mri-2036815a13894335/axial_004.png","assets/T/mri-2036815a13894335/axial_005.png","assets/T/mri-2036815a13894335/axial_006.png","assets/T/mri-2036815a13894335/axial_007.png","assets/T/mri-2036815a13894335/axial_008.png","assets/T/mri-2036815a13894335/axial_009.png","assets/T/mri-2036815a13894335/axial_010.png","assets/T/mri-2036815a13894335/axial_011.png","assets/T/mri-2036815a13894335/axial_012.png","assets/T/mri-2036815a13894335/axial_013.png","assets/T/mri-2036815a13894335/axial_014.png","assets/T/mri-2036815a13894335/axial_015.png","assets/T/mri-2036815a13894335/axial_016.png","assets/T/mri-2036815a13894335/axial_017.png","assets/T/mri-2036815a13894335/axial_018.png","assets/T/mri-2036815a13894335/axial_019.png","assets/T/mri-2036815a13894335/axial_020.png","assets/T/mri-2036815a13894335/axial_021.png","assets/T/mri-2036815a13894335/axial_022.png","assets/T/mri-2036815a13894335/axial_023.png","assets/T/mri-2036815a13894335/axial_024.png","assets/T/mri-2036815a13894335/axial_025.png","assets/T/mri-2036815a13894335/axial_026.png","assets/T/mri-2036815a13894335/axial_027.png","assets/T/mri-2036815a13894335/axial_028.png","assets/T/mri-2036815a13894335/axial_029.png","assets/T/mri-2036815a13894335/axial_030.png","assets/T/mri-2036815a13894335/axial_031.png","assets/T/mri-2036815a13894335/axial_032.png","assets/T/mri-2036815a13894335/axial_033.png","assets/T/mri-2036815a13894335/axial_034.png","assets/T/mri-2036815a13894335/axial_035.png","assets/T/mri-2036815a13894335/axial_036.png","assets/T/mri-2036815a13894335/axial_037.png","assets/T/mri-2036815a13894335/axial_038.png","assets/T/mri-2036815a13894335/axial_039.png","assets/T/mri-2036815a13894335/axial_040.png","assets/T/mri-2036815a13894335/axial_041.png","assets/T/mri-2036815a13894335/axial_042.png","assets/T/mri-2036815a13894335/axial_043.png","assets/T/mri-2036815a13894335/coronal_001.png","assets/T/mri-2036815a13894335/coronal_002.png","assets/T/mri-2036815a13894335/coronal_003.png","assets/T/mri-2036815a13894335/coronal_004.png","assets/T/mri-2036815a13894335/coronal_005.png","assets/T/mri-2036815a13894335/coronal_006.png","assets/T/mri-2036815a13894335/coronal_007.png","assets/T/mri-2036815a13894335/coronal_008.png","assets/T/mri-2036815a13894335/coronal_009.png","assets/T/mri-2036815a13894335/coronal_010.png","assets/T/mri-2036815a13894335/coronal_011.png","assets/T/mri-2036815a13894335/coronal_012.png","assets/T/mri-2036815a13894335/coronal_013.png","assets/T/mri-2036815a13894335/coronal_014.png","assets/T/mri-2036815a13894335/coronal_015.png","assets/T/mri-2036815a13894335/coronal_016.png","assets/T/mri-2036815a13894335/coronal_017.png","assets/T/mri-2036815a13894335/coronal_018.png","assets/T/mri-2036815a13894335/coronal_019.png","assets/T/mri-2036815a13894335/coronal_020.png","assets/T/mri-2036815a13894335/coronal_021.png","assets/T/mri-2036815a13894335/coronal_022.png","assets/T/mri-2036815a13894335/coronal_023.png","assets/T/mri-2036815a13894335/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-b6a2446b183c424d","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 60 张图，均来自同一次检查。\n\n- 前 36 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-b6a2446b183c424d/axial_001.png","assets/T/mri-b6a2446b183c424d/axial_002.png","assets/T/mri-b6a2446b183c424d/axial_003.png","assets/T/mri-b6a2446b183c424d/axial_004.png","assets/T/mri-b6a2446b183c424d/axial_005.png","assets/T/mri-b6a2446b183c424d/axial_006.png","assets/T/mri-b6a2446b183c424d/axial_007.png","assets/T/mri-b6a2446b183c424d/axial_008.png","assets/T/mri-b6a2446b183c424d/axial_009.png","assets/T/mri-b6a2446b183c424d/axial_010.png","assets/T/mri-b6a2446b183c424d/axial_011.png","assets/T/mri-b6a2446b183c424d/axial_012.png","assets/T/mri-b6a2446b183c424d/axial_013.png","assets/T/mri-b6a2446b183c424d/axial_014.png","assets/T/mri-b6a2446b183c424d/axial_015.png","assets/T/mri-b6a2446b183c424d/axial_016.png","assets/T/mri-b6a2446b183c424d/axial_017.png","assets/T/mri-b6a2446b183c424d/axial_018.png","assets/T/mri-b6a2446b183c424d/axial_019.png","assets/T/mri-b6a2446b183c424d/axial_020.png","assets/T/mri-b6a2446b183c424d/axial_021.png","assets/T/mri-b6a2446b183c424d/axial_022.png","assets/T/mri-b6a2446b183c424d/axial_023.png","assets/T/mri-b6a2446b183c424d/axial_024.png","assets/T/mri-b6a2446b183c424d/axial_025.png","assets/T/mri-b6a2446b183c424d/axial_026.png","assets/T/mri-b6a2446b183c424d/axial_027.png","assets/T/mri-b6a2446b183c424d/axial_028.png","assets/T/mri-b6a2446b183c424d/axial_029.png","assets/T/mri-b6a2446b183c424d/axial_030.png","assets/T/mri-b6a2446b183c424d/axial_031.png","assets/T/mri-b6a2446b183c424d/axial_032.png","assets/T/mri-b6a2446b183c424d/axial_033.png","assets/T/mri-b6a2446b183c424d/axial_034.png","assets/T/mri-b6a2446b183c424d/axial_035.png","assets/T/mri-b6a2446b183c424d/axial_036.png","assets/T/mri-b6a2446b183c424d/coronal_001.png","assets/T/mri-b6a2446b183c424d/coronal_002.png","assets/T/mri-b6a2446b183c424d/coronal_003.png","assets/T/mri-b6a2446b183c424d/coronal_004.png","assets/T/mri-b6a2446b183c424d/coronal_005.png","assets/T/mri-b6a2446b183c424d/coronal_006.png","assets/T/mri-b6a2446b183c424d/coronal_007.png","assets/T/mri-b6a2446b183c424d/coronal_008.png","assets/T/mri-b6a2446b183c424d/coronal_009.png","assets/T/mri-b6a2446b183c424d/coronal_010.png","assets/T/mri-b6a2446b183c424d/coronal_011.png","assets/T/mri-b6a2446b183c424d/coronal_012.png","assets/T/mri-b6a2446b183c424d/coronal_013.png","assets/T/mri-b6a2446b183c424d/coronal_014.png","assets/T/mri-b6a2446b183c424d/coronal_015.png","assets/T/mri-b6a2446b183c424d/coronal_016.png","assets/T/mri-b6a2446b183c424d/coronal_017.png","assets/T/mri-b6a2446b183c424d/coronal_018.png","assets/T/mri-b6a2446b183c424d/coronal_019.png","assets/T/mri-b6a2446b183c424d/coronal_020.png","assets/T/mri-b6a2446b183c424d/coronal_021.png","assets/T/mri-b6a2446b183c424d/coronal_022.png","assets/T/mri-b6a2446b183c424d/coronal_023.png","assets/T/mri-b6a2446b183c424d/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-38731096d9a3413d","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 70 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 28 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-38731096d9a3413d/axial_001.png","assets/T/mri-38731096d9a3413d/axial_002.png","assets/T/mri-38731096d9a3413d/axial_003.png","assets/T/mri-38731096d9a3413d/axial_004.png","assets/T/mri-38731096d9a3413d/axial_005.png","assets/T/mri-38731096d9a3413d/axial_006.png","assets/T/mri-38731096d9a3413d/axial_007.png","assets/T/mri-38731096d9a3413d/axial_008.png","assets/T/mri-38731096d9a3413d/axial_009.png","assets/T/mri-38731096d9a3413d/axial_010.png","assets/T/mri-38731096d9a3413d/axial_011.png","assets/T/mri-38731096d9a3413d/axial_012.png","assets/T/mri-38731096d9a3413d/axial_013.png","assets/T/mri-38731096d9a3413d/axial_014.png","assets/T/mri-38731096d9a3413d/axial_015.png","assets/T/mri-38731096d9a3413d/axial_016.png","assets/T/mri-38731096d9a3413d/axial_017.png","assets/T/mri-38731096d9a3413d/axial_018.png","assets/T/mri-38731096d9a3413d/axial_019.png","assets/T/mri-38731096d9a3413d/axial_020.png","assets/T/mri-38731096d9a3413d/axial_021.png","assets/T/mri-38731096d9a3413d/axial_022.png","assets/T/mri-38731096d9a3413d/axial_023.png","assets/T/mri-38731096d9a3413d/axial_024.png","assets/T/mri-38731096d9a3413d/axial_025.png","assets/T/mri-38731096d9a3413d/axial_026.png","assets/T/mri-38731096d9a3413d/axial_027.png","assets/T/mri-38731096d9a3413d/axial_028.png","assets/T/mri-38731096d9a3413d/axial_029.png","assets/T/mri-38731096d9a3413d/axial_030.png","assets/T/mri-38731096d9a3413d/axial_031.png","assets/T/mri-38731096d9a3413d/axial_032.png","assets/T/mri-38731096d9a3413d/axial_033.png","assets/T/mri-38731096d9a3413d/axial_034.png","assets/T/mri-38731096d9a3413d/axial_035.png","assets/T/mri-38731096d9a3413d/axial_036.png","assets/T/mri-38731096d9a3413d/axial_037.png","assets/T/mri-38731096d9a3413d/axial_038.png","assets/T/mri-38731096d9a3413d/axial_039.png","assets/T/mri-38731096d9a3413d/axial_040.png","assets/T/mri-38731096d9a3413d/axial_041.png","assets/T/mri-38731096d9a3413d/axial_042.png","assets/T/mri-38731096d9a3413d/coronal_001.png","assets/T/mri-38731096d9a3413d/coronal_002.png","assets/T/mri-38731096d9a3413d/coronal_003.png","assets/T/mri-38731096d9a3413d/coronal_004.png","assets/T/mri-38731096d9a3413d/coronal_005.png","assets/T/mri-38731096d9a3413d/coronal_006.png","assets/T/mri-38731096d9a3413d/coronal_007.png","assets/T/mri-38731096d9a3413d/coronal_008.png","assets/T/mri-38731096d9a3413d/coronal_009.png","assets/T/mri-38731096d9a3413d/coronal_010.png","assets/T/mri-38731096d9a3413d/coronal_011.png","assets/T/mri-38731096d9a3413d/coronal_012.png","assets/T/mri-38731096d9a3413d/coronal_013.png","assets/T/mri-38731096d9a3413d/coronal_014.png","assets/T/mri-38731096d9a3413d/coronal_015.png","assets/T/mri-38731096d9a3413d/coronal_016.png","assets/T/mri-38731096d9a3413d/coronal_017.png","assets/T/mri-38731096d9a3413d/coronal_018.png","assets/T/mri-38731096d9a3413d/coronal_019.png","assets/T/mri-38731096d9a3413d/coronal_020.png","assets/T/mri-38731096d9a3413d/coronal_021.png","assets/T/mri-38731096d9a3413d/coronal_022.png","assets/T/mri-38731096d9a3413d/coronal_023.png","assets/T/mri-38731096d9a3413d/coronal_024.png","assets/T/mri-38731096d9a3413d/coronal_025.png","assets/T/mri-38731096d9a3413d/coronal_026.png","assets/T/mri-38731096d9a3413d/coronal_027.png","assets/T/mri-38731096d9a3413d/coronal_028.png"],"stage_edition":8}
+{"id":"L3-T300:mri-21c6274f45f64906","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-21c6274f45f64906/axial_001.png","assets/T/mri-21c6274f45f64906/axial_002.png","assets/T/mri-21c6274f45f64906/axial_003.png","assets/T/mri-21c6274f45f64906/axial_004.png","assets/T/mri-21c6274f45f64906/axial_005.png","assets/T/mri-21c6274f45f64906/axial_006.png","assets/T/mri-21c6274f45f64906/axial_007.png","assets/T/mri-21c6274f45f64906/axial_008.png","assets/T/mri-21c6274f45f64906/axial_009.png","assets/T/mri-21c6274f45f64906/axial_010.png","assets/T/mri-21c6274f45f64906/axial_011.png","assets/T/mri-21c6274f45f64906/axial_012.png","assets/T/mri-21c6274f45f64906/axial_013.png","assets/T/mri-21c6274f45f64906/axial_014.png","assets/T/mri-21c6274f45f64906/axial_015.png","assets/T/mri-21c6274f45f64906/axial_016.png","assets/T/mri-21c6274f45f64906/axial_017.png","assets/T/mri-21c6274f45f64906/axial_018.png","assets/T/mri-21c6274f45f64906/axial_019.png","assets/T/mri-21c6274f45f64906/axial_020.png","assets/T/mri-21c6274f45f64906/axial_021.png","assets/T/mri-21c6274f45f64906/axial_022.png","assets/T/mri-21c6274f45f64906/axial_023.png","assets/T/mri-21c6274f45f64906/axial_024.png","assets/T/mri-21c6274f45f64906/axial_025.png","assets/T/mri-21c6274f45f64906/axial_026.png","assets/T/mri-21c6274f45f64906/axial_027.png","assets/T/mri-21c6274f45f64906/axial_028.png","assets/T/mri-21c6274f45f64906/axial_029.png","assets/T/mri-21c6274f45f64906/axial_030.png","assets/T/mri-21c6274f45f64906/axial_031.png","assets/T/mri-21c6274f45f64906/axial_032.png","assets/T/mri-21c6274f45f64906/axial_033.png","assets/T/mri-21c6274f45f64906/axial_034.png","assets/T/mri-21c6274f45f64906/axial_035.png","assets/T/mri-21c6274f45f64906/axial_036.png","assets/T/mri-21c6274f45f64906/axial_037.png","assets/T/mri-21c6274f45f64906/axial_038.png","assets/T/mri-21c6274f45f64906/axial_039.png","assets/T/mri-21c6274f45f64906/axial_040.png","assets/T/mri-21c6274f45f64906/axial_041.png","assets/T/mri-21c6274f45f64906/axial_042.png","assets/T/mri-21c6274f45f64906/coronal_001.png","assets/T/mri-21c6274f45f64906/coronal_002.png","assets/T/mri-21c6274f45f64906/coronal_003.png","assets/T/mri-21c6274f45f64906/coronal_004.png","assets/T/mri-21c6274f45f64906/coronal_005.png","assets/T/mri-21c6274f45f64906/coronal_006.png","assets/T/mri-21c6274f45f64906/coronal_007.png","assets/T/mri-21c6274f45f64906/coronal_008.png","assets/T/mri-21c6274f45f64906/coronal_009.png","assets/T/mri-21c6274f45f64906/coronal_010.png","assets/T/mri-21c6274f45f64906/coronal_011.png","assets/T/mri-21c6274f45f64906/coronal_012.png","assets/T/mri-21c6274f45f64906/coronal_013.png","assets/T/mri-21c6274f45f64906/coronal_014.png","assets/T/mri-21c6274f45f64906/coronal_015.png","assets/T/mri-21c6274f45f64906/coronal_016.png","assets/T/mri-21c6274f45f64906/coronal_017.png","assets/T/mri-21c6274f45f64906/coronal_018.png","assets/T/mri-21c6274f45f64906/coronal_019.png","assets/T/mri-21c6274f45f64906/coronal_020.png","assets/T/mri-21c6274f45f64906/coronal_021.png","assets/T/mri-21c6274f45f64906/coronal_022.png","assets/T/mri-21c6274f45f64906/coronal_023.png","assets/T/mri-21c6274f45f64906/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-60382ae47d2949ad","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-60382ae47d2949ad/axial_001.png","assets/T/mri-60382ae47d2949ad/axial_002.png","assets/T/mri-60382ae47d2949ad/axial_003.png","assets/T/mri-60382ae47d2949ad/axial_004.png","assets/T/mri-60382ae47d2949ad/axial_005.png","assets/T/mri-60382ae47d2949ad/axial_006.png","assets/T/mri-60382ae47d2949ad/axial_007.png","assets/T/mri-60382ae47d2949ad/axial_008.png","assets/T/mri-60382ae47d2949ad/axial_009.png","assets/T/mri-60382ae47d2949ad/axial_010.png","assets/T/mri-60382ae47d2949ad/axial_011.png","assets/T/mri-60382ae47d2949ad/axial_012.png","assets/T/mri-60382ae47d2949ad/axial_013.png","assets/T/mri-60382ae47d2949ad/axial_014.png","assets/T/mri-60382ae47d2949ad/axial_015.png","assets/T/mri-60382ae47d2949ad/axial_016.png","assets/T/mri-60382ae47d2949ad/axial_017.png","assets/T/mri-60382ae47d2949ad/axial_018.png","assets/T/mri-60382ae47d2949ad/axial_019.png","assets/T/mri-60382ae47d2949ad/axial_020.png","assets/T/mri-60382ae47d2949ad/axial_021.png","assets/T/mri-60382ae47d2949ad/axial_022.png","assets/T/mri-60382ae47d2949ad/axial_023.png","assets/T/mri-60382ae47d2949ad/axial_024.png","assets/T/mri-60382ae47d2949ad/axial_025.png","assets/T/mri-60382ae47d2949ad/axial_026.png","assets/T/mri-60382ae47d2949ad/axial_027.png","assets/T/mri-60382ae47d2949ad/axial_028.png","assets/T/mri-60382ae47d2949ad/axial_029.png","assets/T/mri-60382ae47d2949ad/axial_030.png","assets/T/mri-60382ae47d2949ad/axial_031.png","assets/T/mri-60382ae47d2949ad/axial_032.png","assets/T/mri-60382ae47d2949ad/axial_033.png","assets/T/mri-60382ae47d2949ad/axial_034.png","assets/T/mri-60382ae47d2949ad/axial_035.png","assets/T/mri-60382ae47d2949ad/axial_036.png","assets/T/mri-60382ae47d2949ad/axial_037.png","assets/T/mri-60382ae47d2949ad/axial_038.png","assets/T/mri-60382ae47d2949ad/axial_039.png","assets/T/mri-60382ae47d2949ad/axial_040.png","assets/T/mri-60382ae47d2949ad/coronal_001.png","assets/T/mri-60382ae47d2949ad/coronal_002.png","assets/T/mri-60382ae47d2949ad/coronal_003.png","assets/T/mri-60382ae47d2949ad/coronal_004.png","assets/T/mri-60382ae47d2949ad/coronal_005.png","assets/T/mri-60382ae47d2949ad/coronal_006.png","assets/T/mri-60382ae47d2949ad/coronal_007.png","assets/T/mri-60382ae47d2949ad/coronal_008.png","assets/T/mri-60382ae47d2949ad/coronal_009.png","assets/T/mri-60382ae47d2949ad/coronal_010.png","assets/T/mri-60382ae47d2949ad/coronal_011.png","assets/T/mri-60382ae47d2949ad/coronal_012.png","assets/T/mri-60382ae47d2949ad/coronal_013.png","assets/T/mri-60382ae47d2949ad/coronal_014.png","assets/T/mri-60382ae47d2949ad/coronal_015.png","assets/T/mri-60382ae47d2949ad/coronal_016.png","assets/T/mri-60382ae47d2949ad/coronal_017.png","assets/T/mri-60382ae47d2949ad/coronal_018.png","assets/T/mri-60382ae47d2949ad/coronal_019.png","assets/T/mri-60382ae47d2949ad/coronal_020.png","assets/T/mri-60382ae47d2949ad/coronal_021.png","assets/T/mri-60382ae47d2949ad/coronal_022.png","assets/T/mri-60382ae47d2949ad/coronal_023.png","assets/T/mri-60382ae47d2949ad/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-076b103275994f82","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-076b103275994f82/axial_001.png","assets/T/mri-076b103275994f82/axial_002.png","assets/T/mri-076b103275994f82/axial_003.png","assets/T/mri-076b103275994f82/axial_004.png","assets/T/mri-076b103275994f82/axial_005.png","assets/T/mri-076b103275994f82/axial_006.png","assets/T/mri-076b103275994f82/axial_007.png","assets/T/mri-076b103275994f82/axial_008.png","assets/T/mri-076b103275994f82/axial_009.png","assets/T/mri-076b103275994f82/axial_010.png","assets/T/mri-076b103275994f82/axial_011.png","assets/T/mri-076b103275994f82/axial_012.png","assets/T/mri-076b103275994f82/axial_013.png","assets/T/mri-076b103275994f82/axial_014.png","assets/T/mri-076b103275994f82/axial_015.png","assets/T/mri-076b103275994f82/axial_016.png","assets/T/mri-076b103275994f82/axial_017.png","assets/T/mri-076b103275994f82/axial_018.png","assets/T/mri-076b103275994f82/axial_019.png","assets/T/mri-076b103275994f82/axial_020.png","assets/T/mri-076b103275994f82/axial_021.png","assets/T/mri-076b103275994f82/axial_022.png","assets/T/mri-076b103275994f82/axial_023.png","assets/T/mri-076b103275994f82/axial_024.png","assets/T/mri-076b103275994f82/axial_025.png","assets/T/mri-076b103275994f82/axial_026.png","assets/T/mri-076b103275994f82/axial_027.png","assets/T/mri-076b103275994f82/axial_028.png","assets/T/mri-076b103275994f82/axial_029.png","assets/T/mri-076b103275994f82/axial_030.png","assets/T/mri-076b103275994f82/axial_031.png","assets/T/mri-076b103275994f82/axial_032.png","assets/T/mri-076b103275994f82/axial_033.png","assets/T/mri-076b103275994f82/axial_034.png","assets/T/mri-076b103275994f82/axial_035.png","assets/T/mri-076b103275994f82/axial_036.png","assets/T/mri-076b103275994f82/axial_037.png","assets/T/mri-076b103275994f82/axial_038.png","assets/T/mri-076b103275994f82/axial_039.png","assets/T/mri-076b103275994f82/axial_040.png","assets/T/mri-076b103275994f82/coronal_001.png","assets/T/mri-076b103275994f82/coronal_002.png","assets/T/mri-076b103275994f82/coronal_003.png","assets/T/mri-076b103275994f82/coronal_004.png","assets/T/mri-076b103275994f82/coronal_005.png","assets/T/mri-076b103275994f82/coronal_006.png","assets/T/mri-076b103275994f82/coronal_007.png","assets/T/mri-076b103275994f82/coronal_008.png","assets/T/mri-076b103275994f82/coronal_009.png","assets/T/mri-076b103275994f82/coronal_010.png","assets/T/mri-076b103275994f82/coronal_011.png","assets/T/mri-076b103275994f82/coronal_012.png","assets/T/mri-076b103275994f82/coronal_013.png","assets/T/mri-076b103275994f82/coronal_014.png","assets/T/mri-076b103275994f82/coronal_015.png","assets/T/mri-076b103275994f82/coronal_016.png","assets/T/mri-076b103275994f82/coronal_017.png","assets/T/mri-076b103275994f82/coronal_018.png","assets/T/mri-076b103275994f82/coronal_019.png","assets/T/mri-076b103275994f82/coronal_020.png","assets/T/mri-076b103275994f82/coronal_021.png","assets/T/mri-076b103275994f82/coronal_022.png","assets/T/mri-076b103275994f82/coronal_023.png","assets/T/mri-076b103275994f82/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-bc9d4d6445624b29","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 60 张图，均来自同一次检查。\n\n- 前 36 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-bc9d4d6445624b29/axial_001.png","assets/T/mri-bc9d4d6445624b29/axial_002.png","assets/T/mri-bc9d4d6445624b29/axial_003.png","assets/T/mri-bc9d4d6445624b29/axial_004.png","assets/T/mri-bc9d4d6445624b29/axial_005.png","assets/T/mri-bc9d4d6445624b29/axial_006.png","assets/T/mri-bc9d4d6445624b29/axial_007.png","assets/T/mri-bc9d4d6445624b29/axial_008.png","assets/T/mri-bc9d4d6445624b29/axial_009.png","assets/T/mri-bc9d4d6445624b29/axial_010.png","assets/T/mri-bc9d4d6445624b29/axial_011.png","assets/T/mri-bc9d4d6445624b29/axial_012.png","assets/T/mri-bc9d4d6445624b29/axial_013.png","assets/T/mri-bc9d4d6445624b29/axial_014.png","assets/T/mri-bc9d4d6445624b29/axial_015.png","assets/T/mri-bc9d4d6445624b29/axial_016.png","assets/T/mri-bc9d4d6445624b29/axial_017.png","assets/T/mri-bc9d4d6445624b29/axial_018.png","assets/T/mri-bc9d4d6445624b29/axial_019.png","assets/T/mri-bc9d4d6445624b29/axial_020.png","assets/T/mri-bc9d4d6445624b29/axial_021.png","assets/T/mri-bc9d4d6445624b29/axial_022.png","assets/T/mri-bc9d4d6445624b29/axial_023.png","assets/T/mri-bc9d4d6445624b29/axial_024.png","assets/T/mri-bc9d4d6445624b29/axial_025.png","assets/T/mri-bc9d4d6445624b29/axial_026.png","assets/T/mri-bc9d4d6445624b29/axial_027.png","assets/T/mri-bc9d4d6445624b29/axial_028.png","assets/T/mri-bc9d4d6445624b29/axial_029.png","assets/T/mri-bc9d4d6445624b29/axial_030.png","assets/T/mri-bc9d4d6445624b29/axial_031.png","assets/T/mri-bc9d4d6445624b29/axial_032.png","assets/T/mri-bc9d4d6445624b29/axial_033.png","assets/T/mri-bc9d4d6445624b29/axial_034.png","assets/T/mri-bc9d4d6445624b29/axial_035.png","assets/T/mri-bc9d4d6445624b29/axial_036.png","assets/T/mri-bc9d4d6445624b29/coronal_001.png","assets/T/mri-bc9d4d6445624b29/coronal_002.png","assets/T/mri-bc9d4d6445624b29/coronal_003.png","assets/T/mri-bc9d4d6445624b29/coronal_004.png","assets/T/mri-bc9d4d6445624b29/coronal_005.png","assets/T/mri-bc9d4d6445624b29/coronal_006.png","assets/T/mri-bc9d4d6445624b29/coronal_007.png","assets/T/mri-bc9d4d6445624b29/coronal_008.png","assets/T/mri-bc9d4d6445624b29/coronal_009.png","assets/T/mri-bc9d4d6445624b29/coronal_010.png","assets/T/mri-bc9d4d6445624b29/coronal_011.png","assets/T/mri-bc9d4d6445624b29/coronal_012.png","assets/T/mri-bc9d4d6445624b29/coronal_013.png","assets/T/mri-bc9d4d6445624b29/coronal_014.png","assets/T/mri-bc9d4d6445624b29/coronal_015.png","assets/T/mri-bc9d4d6445624b29/coronal_016.png","assets/T/mri-bc9d4d6445624b29/coronal_017.png","assets/T/mri-bc9d4d6445624b29/coronal_018.png","assets/T/mri-bc9d4d6445624b29/coronal_019.png","assets/T/mri-bc9d4d6445624b29/coronal_020.png","assets/T/mri-bc9d4d6445624b29/coronal_021.png","assets/T/mri-bc9d4d6445624b29/coronal_022.png","assets/T/mri-bc9d4d6445624b29/coronal_023.png","assets/T/mri-bc9d4d6445624b29/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-b0afe5791e844b85","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-b0afe5791e844b85/axial_001.png","assets/T/mri-b0afe5791e844b85/axial_002.png","assets/T/mri-b0afe5791e844b85/axial_003.png","assets/T/mri-b0afe5791e844b85/axial_004.png","assets/T/mri-b0afe5791e844b85/axial_005.png","assets/T/mri-b0afe5791e844b85/axial_006.png","assets/T/mri-b0afe5791e844b85/axial_007.png","assets/T/mri-b0afe5791e844b85/axial_008.png","assets/T/mri-b0afe5791e844b85/axial_009.png","assets/T/mri-b0afe5791e844b85/axial_010.png","assets/T/mri-b0afe5791e844b85/axial_011.png","assets/T/mri-b0afe5791e844b85/axial_012.png","assets/T/mri-b0afe5791e844b85/axial_013.png","assets/T/mri-b0afe5791e844b85/axial_014.png","assets/T/mri-b0afe5791e844b85/axial_015.png","assets/T/mri-b0afe5791e844b85/axial_016.png","assets/T/mri-b0afe5791e844b85/axial_017.png","assets/T/mri-b0afe5791e844b85/axial_018.png","assets/T/mri-b0afe5791e844b85/axial_019.png","assets/T/mri-b0afe5791e844b85/axial_020.png","assets/T/mri-b0afe5791e844b85/axial_021.png","assets/T/mri-b0afe5791e844b85/axial_022.png","assets/T/mri-b0afe5791e844b85/axial_023.png","assets/T/mri-b0afe5791e844b85/axial_024.png","assets/T/mri-b0afe5791e844b85/axial_025.png","assets/T/mri-b0afe5791e844b85/axial_026.png","assets/T/mri-b0afe5791e844b85/axial_027.png","assets/T/mri-b0afe5791e844b85/axial_028.png","assets/T/mri-b0afe5791e844b85/axial_029.png","assets/T/mri-b0afe5791e844b85/axial_030.png","assets/T/mri-b0afe5791e844b85/axial_031.png","assets/T/mri-b0afe5791e844b85/axial_032.png","assets/T/mri-b0afe5791e844b85/axial_033.png","assets/T/mri-b0afe5791e844b85/axial_034.png","assets/T/mri-b0afe5791e844b85/axial_035.png","assets/T/mri-b0afe5791e844b85/axial_036.png","assets/T/mri-b0afe5791e844b85/axial_037.png","assets/T/mri-b0afe5791e844b85/axial_038.png","assets/T/mri-b0afe5791e844b85/axial_039.png","assets/T/mri-b0afe5791e844b85/axial_040.png","assets/T/mri-b0afe5791e844b85/axial_041.png","assets/T/mri-b0afe5791e844b85/axial_042.png","assets/T/mri-b0afe5791e844b85/coronal_001.png","assets/T/mri-b0afe5791e844b85/coronal_002.png","assets/T/mri-b0afe5791e844b85/coronal_003.png","assets/T/mri-b0afe5791e844b85/coronal_004.png","assets/T/mri-b0afe5791e844b85/coronal_005.png","assets/T/mri-b0afe5791e844b85/coronal_006.png","assets/T/mri-b0afe5791e844b85/coronal_007.png","assets/T/mri-b0afe5791e844b85/coronal_008.png","assets/T/mri-b0afe5791e844b85/coronal_009.png","assets/T/mri-b0afe5791e844b85/coronal_010.png","assets/T/mri-b0afe5791e844b85/coronal_011.png","assets/T/mri-b0afe5791e844b85/coronal_012.png","assets/T/mri-b0afe5791e844b85/coronal_013.png","assets/T/mri-b0afe5791e844b85/coronal_014.png","assets/T/mri-b0afe5791e844b85/coronal_015.png","assets/T/mri-b0afe5791e844b85/coronal_016.png","assets/T/mri-b0afe5791e844b85/coronal_017.png","assets/T/mri-b0afe5791e844b85/coronal_018.png","assets/T/mri-b0afe5791e844b85/coronal_019.png","assets/T/mri-b0afe5791e844b85/coronal_020.png","assets/T/mri-b0afe5791e844b85/coronal_021.png","assets/T/mri-b0afe5791e844b85/coronal_022.png","assets/T/mri-b0afe5791e844b85/coronal_023.png","assets/T/mri-b0afe5791e844b85/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-b437689d0567403e","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-b437689d0567403e/axial_001.png","assets/T/mri-b437689d0567403e/axial_002.png","assets/T/mri-b437689d0567403e/axial_003.png","assets/T/mri-b437689d0567403e/axial_004.png","assets/T/mri-b437689d0567403e/axial_005.png","assets/T/mri-b437689d0567403e/axial_006.png","assets/T/mri-b437689d0567403e/axial_007.png","assets/T/mri-b437689d0567403e/axial_008.png","assets/T/mri-b437689d0567403e/axial_009.png","assets/T/mri-b437689d0567403e/axial_010.png","assets/T/mri-b437689d0567403e/axial_011.png","assets/T/mri-b437689d0567403e/axial_012.png","assets/T/mri-b437689d0567403e/axial_013.png","assets/T/mri-b437689d0567403e/axial_014.png","assets/T/mri-b437689d0567403e/axial_015.png","assets/T/mri-b437689d0567403e/axial_016.png","assets/T/mri-b437689d0567403e/axial_017.png","assets/T/mri-b437689d0567403e/axial_018.png","assets/T/mri-b437689d0567403e/axial_019.png","assets/T/mri-b437689d0567403e/axial_020.png","assets/T/mri-b437689d0567403e/axial_021.png","assets/T/mri-b437689d0567403e/axial_022.png","assets/T/mri-b437689d0567403e/axial_023.png","assets/T/mri-b437689d0567403e/axial_024.png","assets/T/mri-b437689d0567403e/axial_025.png","assets/T/mri-b437689d0567403e/axial_026.png","assets/T/mri-b437689d0567403e/axial_027.png","assets/T/mri-b437689d0567403e/axial_028.png","assets/T/mri-b437689d0567403e/axial_029.png","assets/T/mri-b437689d0567403e/axial_030.png","assets/T/mri-b437689d0567403e/axial_031.png","assets/T/mri-b437689d0567403e/axial_032.png","assets/T/mri-b437689d0567403e/axial_033.png","assets/T/mri-b437689d0567403e/axial_034.png","assets/T/mri-b437689d0567403e/axial_035.png","assets/T/mri-b437689d0567403e/axial_036.png","assets/T/mri-b437689d0567403e/axial_037.png","assets/T/mri-b437689d0567403e/axial_038.png","assets/T/mri-b437689d0567403e/axial_039.png","assets/T/mri-b437689d0567403e/axial_040.png","assets/T/mri-b437689d0567403e/axial_041.png","assets/T/mri-b437689d0567403e/axial_042.png","assets/T/mri-b437689d0567403e/coronal_001.png","assets/T/mri-b437689d0567403e/coronal_002.png","assets/T/mri-b437689d0567403e/coronal_003.png","assets/T/mri-b437689d0567403e/coronal_004.png","assets/T/mri-b437689d0567403e/coronal_005.png","assets/T/mri-b437689d0567403e/coronal_006.png","assets/T/mri-b437689d0567403e/coronal_007.png","assets/T/mri-b437689d0567403e/coronal_008.png","assets/T/mri-b437689d0567403e/coronal_009.png","assets/T/mri-b437689d0567403e/coronal_010.png","assets/T/mri-b437689d0567403e/coronal_011.png","assets/T/mri-b437689d0567403e/coronal_012.png","assets/T/mri-b437689d0567403e/coronal_013.png","assets/T/mri-b437689d0567403e/coronal_014.png","assets/T/mri-b437689d0567403e/coronal_015.png","assets/T/mri-b437689d0567403e/coronal_016.png","assets/T/mri-b437689d0567403e/coronal_017.png","assets/T/mri-b437689d0567403e/coronal_018.png","assets/T/mri-b437689d0567403e/coronal_019.png","assets/T/mri-b437689d0567403e/coronal_020.png","assets/T/mri-b437689d0567403e/coronal_021.png","assets/T/mri-b437689d0567403e/coronal_022.png","assets/T/mri-b437689d0567403e/coronal_023.png","assets/T/mri-b437689d0567403e/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-de245813d9f84619","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-de245813d9f84619/axial_001.png","assets/T/mri-de245813d9f84619/axial_002.png","assets/T/mri-de245813d9f84619/axial_003.png","assets/T/mri-de245813d9f84619/axial_004.png","assets/T/mri-de245813d9f84619/axial_005.png","assets/T/mri-de245813d9f84619/axial_006.png","assets/T/mri-de245813d9f84619/axial_007.png","assets/T/mri-de245813d9f84619/axial_008.png","assets/T/mri-de245813d9f84619/axial_009.png","assets/T/mri-de245813d9f84619/axial_010.png","assets/T/mri-de245813d9f84619/axial_011.png","assets/T/mri-de245813d9f84619/axial_012.png","assets/T/mri-de245813d9f84619/axial_013.png","assets/T/mri-de245813d9f84619/axial_014.png","assets/T/mri-de245813d9f84619/axial_015.png","assets/T/mri-de245813d9f84619/axial_016.png","assets/T/mri-de245813d9f84619/axial_017.png","assets/T/mri-de245813d9f84619/axial_018.png","assets/T/mri-de245813d9f84619/axial_019.png","assets/T/mri-de245813d9f84619/axial_020.png","assets/T/mri-de245813d9f84619/axial_021.png","assets/T/mri-de245813d9f84619/axial_022.png","assets/T/mri-de245813d9f84619/axial_023.png","assets/T/mri-de245813d9f84619/axial_024.png","assets/T/mri-de245813d9f84619/axial_025.png","assets/T/mri-de245813d9f84619/axial_026.png","assets/T/mri-de245813d9f84619/axial_027.png","assets/T/mri-de245813d9f84619/axial_028.png","assets/T/mri-de245813d9f84619/axial_029.png","assets/T/mri-de245813d9f84619/axial_030.png","assets/T/mri-de245813d9f84619/axial_031.png","assets/T/mri-de245813d9f84619/axial_032.png","assets/T/mri-de245813d9f84619/axial_033.png","assets/T/mri-de245813d9f84619/axial_034.png","assets/T/mri-de245813d9f84619/axial_035.png","assets/T/mri-de245813d9f84619/axial_036.png","assets/T/mri-de245813d9f84619/axial_037.png","assets/T/mri-de245813d9f84619/axial_038.png","assets/T/mri-de245813d9f84619/axial_039.png","assets/T/mri-de245813d9f84619/axial_040.png","assets/T/mri-de245813d9f84619/coronal_001.png","assets/T/mri-de245813d9f84619/coronal_002.png","assets/T/mri-de245813d9f84619/coronal_003.png","assets/T/mri-de245813d9f84619/coronal_004.png","assets/T/mri-de245813d9f84619/coronal_005.png","assets/T/mri-de245813d9f84619/coronal_006.png","assets/T/mri-de245813d9f84619/coronal_007.png","assets/T/mri-de245813d9f84619/coronal_008.png","assets/T/mri-de245813d9f84619/coronal_009.png","assets/T/mri-de245813d9f84619/coronal_010.png","assets/T/mri-de245813d9f84619/coronal_011.png","assets/T/mri-de245813d9f84619/coronal_012.png","assets/T/mri-de245813d9f84619/coronal_013.png","assets/T/mri-de245813d9f84619/coronal_014.png","assets/T/mri-de245813d9f84619/coronal_015.png","assets/T/mri-de245813d9f84619/coronal_016.png","assets/T/mri-de245813d9f84619/coronal_017.png","assets/T/mri-de245813d9f84619/coronal_018.png","assets/T/mri-de245813d9f84619/coronal_019.png","assets/T/mri-de245813d9f84619/coronal_020.png","assets/T/mri-de245813d9f84619/coronal_021.png","assets/T/mri-de245813d9f84619/coronal_022.png","assets/T/mri-de245813d9f84619/coronal_023.png","assets/T/mri-de245813d9f84619/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-112255f79d7b4cec","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-112255f79d7b4cec/axial_001.png","assets/T/mri-112255f79d7b4cec/axial_002.png","assets/T/mri-112255f79d7b4cec/axial_003.png","assets/T/mri-112255f79d7b4cec/axial_004.png","assets/T/mri-112255f79d7b4cec/axial_005.png","assets/T/mri-112255f79d7b4cec/axial_006.png","assets/T/mri-112255f79d7b4cec/axial_007.png","assets/T/mri-112255f79d7b4cec/axial_008.png","assets/T/mri-112255f79d7b4cec/axial_009.png","assets/T/mri-112255f79d7b4cec/axial_010.png","assets/T/mri-112255f79d7b4cec/axial_011.png","assets/T/mri-112255f79d7b4cec/axial_012.png","assets/T/mri-112255f79d7b4cec/axial_013.png","assets/T/mri-112255f79d7b4cec/axial_014.png","assets/T/mri-112255f79d7b4cec/axial_015.png","assets/T/mri-112255f79d7b4cec/axial_016.png","assets/T/mri-112255f79d7b4cec/axial_017.png","assets/T/mri-112255f79d7b4cec/axial_018.png","assets/T/mri-112255f79d7b4cec/axial_019.png","assets/T/mri-112255f79d7b4cec/axial_020.png","assets/T/mri-112255f79d7b4cec/axial_021.png","assets/T/mri-112255f79d7b4cec/axial_022.png","assets/T/mri-112255f79d7b4cec/axial_023.png","assets/T/mri-112255f79d7b4cec/axial_024.png","assets/T/mri-112255f79d7b4cec/axial_025.png","assets/T/mri-112255f79d7b4cec/axial_026.png","assets/T/mri-112255f79d7b4cec/axial_027.png","assets/T/mri-112255f79d7b4cec/axial_028.png","assets/T/mri-112255f79d7b4cec/axial_029.png","assets/T/mri-112255f79d7b4cec/axial_030.png","assets/T/mri-112255f79d7b4cec/axial_031.png","assets/T/mri-112255f79d7b4cec/axial_032.png","assets/T/mri-112255f79d7b4cec/axial_033.png","assets/T/mri-112255f79d7b4cec/axial_034.png","assets/T/mri-112255f79d7b4cec/axial_035.png","assets/T/mri-112255f79d7b4cec/axial_036.png","assets/T/mri-112255f79d7b4cec/axial_037.png","assets/T/mri-112255f79d7b4cec/axial_038.png","assets/T/mri-112255f79d7b4cec/axial_039.png","assets/T/mri-112255f79d7b4cec/axial_040.png","assets/T/mri-112255f79d7b4cec/coronal_001.png","assets/T/mri-112255f79d7b4cec/coronal_002.png","assets/T/mri-112255f79d7b4cec/coronal_003.png","assets/T/mri-112255f79d7b4cec/coronal_004.png","assets/T/mri-112255f79d7b4cec/coronal_005.png","assets/T/mri-112255f79d7b4cec/coronal_006.png","assets/T/mri-112255f79d7b4cec/coronal_007.png","assets/T/mri-112255f79d7b4cec/coronal_008.png","assets/T/mri-112255f79d7b4cec/coronal_009.png","assets/T/mri-112255f79d7b4cec/coronal_010.png","assets/T/mri-112255f79d7b4cec/coronal_011.png","assets/T/mri-112255f79d7b4cec/coronal_012.png","assets/T/mri-112255f79d7b4cec/coronal_013.png","assets/T/mri-112255f79d7b4cec/coronal_014.png","assets/T/mri-112255f79d7b4cec/coronal_015.png","assets/T/mri-112255f79d7b4cec/coronal_016.png","assets/T/mri-112255f79d7b4cec/coronal_017.png","assets/T/mri-112255f79d7b4cec/coronal_018.png","assets/T/mri-112255f79d7b4cec/coronal_019.png","assets/T/mri-112255f79d7b4cec/coronal_020.png","assets/T/mri-112255f79d7b4cec/coronal_021.png","assets/T/mri-112255f79d7b4cec/coronal_022.png","assets/T/mri-112255f79d7b4cec/coronal_023.png","assets/T/mri-112255f79d7b4cec/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-e9d0d067dff1443e","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-e9d0d067dff1443e/axial_001.png","assets/T/mri-e9d0d067dff1443e/axial_002.png","assets/T/mri-e9d0d067dff1443e/axial_003.png","assets/T/mri-e9d0d067dff1443e/axial_004.png","assets/T/mri-e9d0d067dff1443e/axial_005.png","assets/T/mri-e9d0d067dff1443e/axial_006.png","assets/T/mri-e9d0d067dff1443e/axial_007.png","assets/T/mri-e9d0d067dff1443e/axial_008.png","assets/T/mri-e9d0d067dff1443e/axial_009.png","assets/T/mri-e9d0d067dff1443e/axial_010.png","assets/T/mri-e9d0d067dff1443e/axial_011.png","assets/T/mri-e9d0d067dff1443e/axial_012.png","assets/T/mri-e9d0d067dff1443e/axial_013.png","assets/T/mri-e9d0d067dff1443e/axial_014.png","assets/T/mri-e9d0d067dff1443e/axial_015.png","assets/T/mri-e9d0d067dff1443e/axial_016.png","assets/T/mri-e9d0d067dff1443e/axial_017.png","assets/T/mri-e9d0d067dff1443e/axial_018.png","assets/T/mri-e9d0d067dff1443e/axial_019.png","assets/T/mri-e9d0d067dff1443e/axial_020.png","assets/T/mri-e9d0d067dff1443e/axial_021.png","assets/T/mri-e9d0d067dff1443e/axial_022.png","assets/T/mri-e9d0d067dff1443e/axial_023.png","assets/T/mri-e9d0d067dff1443e/axial_024.png","assets/T/mri-e9d0d067dff1443e/axial_025.png","assets/T/mri-e9d0d067dff1443e/axial_026.png","assets/T/mri-e9d0d067dff1443e/axial_027.png","assets/T/mri-e9d0d067dff1443e/axial_028.png","assets/T/mri-e9d0d067dff1443e/axial_029.png","assets/T/mri-e9d0d067dff1443e/axial_030.png","assets/T/mri-e9d0d067dff1443e/axial_031.png","assets/T/mri-e9d0d067dff1443e/axial_032.png","assets/T/mri-e9d0d067dff1443e/axial_033.png","assets/T/mri-e9d0d067dff1443e/axial_034.png","assets/T/mri-e9d0d067dff1443e/axial_035.png","assets/T/mri-e9d0d067dff1443e/axial_036.png","assets/T/mri-e9d0d067dff1443e/axial_037.png","assets/T/mri-e9d0d067dff1443e/axial_038.png","assets/T/mri-e9d0d067dff1443e/axial_039.png","assets/T/mri-e9d0d067dff1443e/axial_040.png","assets/T/mri-e9d0d067dff1443e/axial_041.png","assets/T/mri-e9d0d067dff1443e/axial_042.png","assets/T/mri-e9d0d067dff1443e/coronal_001.png","assets/T/mri-e9d0d067dff1443e/coronal_002.png","assets/T/mri-e9d0d067dff1443e/coronal_003.png","assets/T/mri-e9d0d067dff1443e/coronal_004.png","assets/T/mri-e9d0d067dff1443e/coronal_005.png","assets/T/mri-e9d0d067dff1443e/coronal_006.png","assets/T/mri-e9d0d067dff1443e/coronal_007.png","assets/T/mri-e9d0d067dff1443e/coronal_008.png","assets/T/mri-e9d0d067dff1443e/coronal_009.png","assets/T/mri-e9d0d067dff1443e/coronal_010.png","assets/T/mri-e9d0d067dff1443e/coronal_011.png","assets/T/mri-e9d0d067dff1443e/coronal_012.png","assets/T/mri-e9d0d067dff1443e/coronal_013.png","assets/T/mri-e9d0d067dff1443e/coronal_014.png","assets/T/mri-e9d0d067dff1443e/coronal_015.png","assets/T/mri-e9d0d067dff1443e/coronal_016.png","assets/T/mri-e9d0d067dff1443e/coronal_017.png","assets/T/mri-e9d0d067dff1443e/coronal_018.png","assets/T/mri-e9d0d067dff1443e/coronal_019.png","assets/T/mri-e9d0d067dff1443e/coronal_020.png","assets/T/mri-e9d0d067dff1443e/coronal_021.png","assets/T/mri-e9d0d067dff1443e/coronal_022.png","assets/T/mri-e9d0d067dff1443e/coronal_023.png","assets/T/mri-e9d0d067dff1443e/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-92996c65c0034e2b","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-92996c65c0034e2b/axial_001.png","assets/T/mri-92996c65c0034e2b/axial_002.png","assets/T/mri-92996c65c0034e2b/axial_003.png","assets/T/mri-92996c65c0034e2b/axial_004.png","assets/T/mri-92996c65c0034e2b/axial_005.png","assets/T/mri-92996c65c0034e2b/axial_006.png","assets/T/mri-92996c65c0034e2b/axial_007.png","assets/T/mri-92996c65c0034e2b/axial_008.png","assets/T/mri-92996c65c0034e2b/axial_009.png","assets/T/mri-92996c65c0034e2b/axial_010.png","assets/T/mri-92996c65c0034e2b/axial_011.png","assets/T/mri-92996c65c0034e2b/axial_012.png","assets/T/mri-92996c65c0034e2b/axial_013.png","assets/T/mri-92996c65c0034e2b/axial_014.png","assets/T/mri-92996c65c0034e2b/axial_015.png","assets/T/mri-92996c65c0034e2b/axial_016.png","assets/T/mri-92996c65c0034e2b/axial_017.png","assets/T/mri-92996c65c0034e2b/axial_018.png","assets/T/mri-92996c65c0034e2b/axial_019.png","assets/T/mri-92996c65c0034e2b/axial_020.png","assets/T/mri-92996c65c0034e2b/axial_021.png","assets/T/mri-92996c65c0034e2b/axial_022.png","assets/T/mri-92996c65c0034e2b/axial_023.png","assets/T/mri-92996c65c0034e2b/axial_024.png","assets/T/mri-92996c65c0034e2b/axial_025.png","assets/T/mri-92996c65c0034e2b/axial_026.png","assets/T/mri-92996c65c0034e2b/axial_027.png","assets/T/mri-92996c65c0034e2b/axial_028.png","assets/T/mri-92996c65c0034e2b/axial_029.png","assets/T/mri-92996c65c0034e2b/axial_030.png","assets/T/mri-92996c65c0034e2b/axial_031.png","assets/T/mri-92996c65c0034e2b/axial_032.png","assets/T/mri-92996c65c0034e2b/axial_033.png","assets/T/mri-92996c65c0034e2b/axial_034.png","assets/T/mri-92996c65c0034e2b/axial_035.png","assets/T/mri-92996c65c0034e2b/axial_036.png","assets/T/mri-92996c65c0034e2b/axial_037.png","assets/T/mri-92996c65c0034e2b/axial_038.png","assets/T/mri-92996c65c0034e2b/axial_039.png","assets/T/mri-92996c65c0034e2b/axial_040.png","assets/T/mri-92996c65c0034e2b/axial_041.png","assets/T/mri-92996c65c0034e2b/axial_042.png","assets/T/mri-92996c65c0034e2b/coronal_001.png","assets/T/mri-92996c65c0034e2b/coronal_002.png","assets/T/mri-92996c65c0034e2b/coronal_003.png","assets/T/mri-92996c65c0034e2b/coronal_004.png","assets/T/mri-92996c65c0034e2b/coronal_005.png","assets/T/mri-92996c65c0034e2b/coronal_006.png","assets/T/mri-92996c65c0034e2b/coronal_007.png","assets/T/mri-92996c65c0034e2b/coronal_008.png","assets/T/mri-92996c65c0034e2b/coronal_009.png","assets/T/mri-92996c65c0034e2b/coronal_010.png","assets/T/mri-92996c65c0034e2b/coronal_011.png","assets/T/mri-92996c65c0034e2b/coronal_012.png","assets/T/mri-92996c65c0034e2b/coronal_013.png","assets/T/mri-92996c65c0034e2b/coronal_014.png","assets/T/mri-92996c65c0034e2b/coronal_015.png","assets/T/mri-92996c65c0034e2b/coronal_016.png","assets/T/mri-92996c65c0034e2b/coronal_017.png","assets/T/mri-92996c65c0034e2b/coronal_018.png","assets/T/mri-92996c65c0034e2b/coronal_019.png","assets/T/mri-92996c65c0034e2b/coronal_020.png","assets/T/mri-92996c65c0034e2b/coronal_021.png","assets/T/mri-92996c65c0034e2b/coronal_022.png","assets/T/mri-92996c65c0034e2b/coronal_023.png","assets/T/mri-92996c65c0034e2b/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-cd8283ba429a4f34","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-cd8283ba429a4f34/axial_001.png","assets/T/mri-cd8283ba429a4f34/axial_002.png","assets/T/mri-cd8283ba429a4f34/axial_003.png","assets/T/mri-cd8283ba429a4f34/axial_004.png","assets/T/mri-cd8283ba429a4f34/axial_005.png","assets/T/mri-cd8283ba429a4f34/axial_006.png","assets/T/mri-cd8283ba429a4f34/axial_007.png","assets/T/mri-cd8283ba429a4f34/axial_008.png","assets/T/mri-cd8283ba429a4f34/axial_009.png","assets/T/mri-cd8283ba429a4f34/axial_010.png","assets/T/mri-cd8283ba429a4f34/axial_011.png","assets/T/mri-cd8283ba429a4f34/axial_012.png","assets/T/mri-cd8283ba429a4f34/axial_013.png","assets/T/mri-cd8283ba429a4f34/axial_014.png","assets/T/mri-cd8283ba429a4f34/axial_015.png","assets/T/mri-cd8283ba429a4f34/axial_016.png","assets/T/mri-cd8283ba429a4f34/axial_017.png","assets/T/mri-cd8283ba429a4f34/axial_018.png","assets/T/mri-cd8283ba429a4f34/axial_019.png","assets/T/mri-cd8283ba429a4f34/axial_020.png","assets/T/mri-cd8283ba429a4f34/axial_021.png","assets/T/mri-cd8283ba429a4f34/axial_022.png","assets/T/mri-cd8283ba429a4f34/axial_023.png","assets/T/mri-cd8283ba429a4f34/axial_024.png","assets/T/mri-cd8283ba429a4f34/axial_025.png","assets/T/mri-cd8283ba429a4f34/axial_026.png","assets/T/mri-cd8283ba429a4f34/axial_027.png","assets/T/mri-cd8283ba429a4f34/axial_028.png","assets/T/mri-cd8283ba429a4f34/axial_029.png","assets/T/mri-cd8283ba429a4f34/axial_030.png","assets/T/mri-cd8283ba429a4f34/axial_031.png","assets/T/mri-cd8283ba429a4f34/axial_032.png","assets/T/mri-cd8283ba429a4f34/axial_033.png","assets/T/mri-cd8283ba429a4f34/axial_034.png","assets/T/mri-cd8283ba429a4f34/axial_035.png","assets/T/mri-cd8283ba429a4f34/axial_036.png","assets/T/mri-cd8283ba429a4f34/axial_037.png","assets/T/mri-cd8283ba429a4f34/axial_038.png","assets/T/mri-cd8283ba429a4f34/axial_039.png","assets/T/mri-cd8283ba429a4f34/axial_040.png","assets/T/mri-cd8283ba429a4f34/axial_041.png","assets/T/mri-cd8283ba429a4f34/axial_042.png","assets/T/mri-cd8283ba429a4f34/coronal_001.png","assets/T/mri-cd8283ba429a4f34/coronal_002.png","assets/T/mri-cd8283ba429a4f34/coronal_003.png","assets/T/mri-cd8283ba429a4f34/coronal_004.png","assets/T/mri-cd8283ba429a4f34/coronal_005.png","assets/T/mri-cd8283ba429a4f34/coronal_006.png","assets/T/mri-cd8283ba429a4f34/coronal_007.png","assets/T/mri-cd8283ba429a4f34/coronal_008.png","assets/T/mri-cd8283ba429a4f34/coronal_009.png","assets/T/mri-cd8283ba429a4f34/coronal_010.png","assets/T/mri-cd8283ba429a4f34/coronal_011.png","assets/T/mri-cd8283ba429a4f34/coronal_012.png","assets/T/mri-cd8283ba429a4f34/coronal_013.png","assets/T/mri-cd8283ba429a4f34/coronal_014.png","assets/T/mri-cd8283ba429a4f34/coronal_015.png","assets/T/mri-cd8283ba429a4f34/coronal_016.png","assets/T/mri-cd8283ba429a4f34/coronal_017.png","assets/T/mri-cd8283ba429a4f34/coronal_018.png","assets/T/mri-cd8283ba429a4f34/coronal_019.png","assets/T/mri-cd8283ba429a4f34/coronal_020.png","assets/T/mri-cd8283ba429a4f34/coronal_021.png","assets/T/mri-cd8283ba429a4f34/coronal_022.png","assets/T/mri-cd8283ba429a4f34/coronal_023.png","assets/T/mri-cd8283ba429a4f34/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-0ca285ccae614db6","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-0ca285ccae614db6/axial_001.png","assets/T/mri-0ca285ccae614db6/axial_002.png","assets/T/mri-0ca285ccae614db6/axial_003.png","assets/T/mri-0ca285ccae614db6/axial_004.png","assets/T/mri-0ca285ccae614db6/axial_005.png","assets/T/mri-0ca285ccae614db6/axial_006.png","assets/T/mri-0ca285ccae614db6/axial_007.png","assets/T/mri-0ca285ccae614db6/axial_008.png","assets/T/mri-0ca285ccae614db6/axial_009.png","assets/T/mri-0ca285ccae614db6/axial_010.png","assets/T/mri-0ca285ccae614db6/axial_011.png","assets/T/mri-0ca285ccae614db6/axial_012.png","assets/T/mri-0ca285ccae614db6/axial_013.png","assets/T/mri-0ca285ccae614db6/axial_014.png","assets/T/mri-0ca285ccae614db6/axial_015.png","assets/T/mri-0ca285ccae614db6/axial_016.png","assets/T/mri-0ca285ccae614db6/axial_017.png","assets/T/mri-0ca285ccae614db6/axial_018.png","assets/T/mri-0ca285ccae614db6/axial_019.png","assets/T/mri-0ca285ccae614db6/axial_020.png","assets/T/mri-0ca285ccae614db6/axial_021.png","assets/T/mri-0ca285ccae614db6/axial_022.png","assets/T/mri-0ca285ccae614db6/axial_023.png","assets/T/mri-0ca285ccae614db6/axial_024.png","assets/T/mri-0ca285ccae614db6/axial_025.png","assets/T/mri-0ca285ccae614db6/axial_026.png","assets/T/mri-0ca285ccae614db6/axial_027.png","assets/T/mri-0ca285ccae614db6/axial_028.png","assets/T/mri-0ca285ccae614db6/axial_029.png","assets/T/mri-0ca285ccae614db6/axial_030.png","assets/T/mri-0ca285ccae614db6/axial_031.png","assets/T/mri-0ca285ccae614db6/axial_032.png","assets/T/mri-0ca285ccae614db6/axial_033.png","assets/T/mri-0ca285ccae614db6/axial_034.png","assets/T/mri-0ca285ccae614db6/axial_035.png","assets/T/mri-0ca285ccae614db6/axial_036.png","assets/T/mri-0ca285ccae614db6/axial_037.png","assets/T/mri-0ca285ccae614db6/axial_038.png","assets/T/mri-0ca285ccae614db6/axial_039.png","assets/T/mri-0ca285ccae614db6/axial_040.png","assets/T/mri-0ca285ccae614db6/axial_041.png","assets/T/mri-0ca285ccae614db6/axial_042.png","assets/T/mri-0ca285ccae614db6/coronal_001.png","assets/T/mri-0ca285ccae614db6/coronal_002.png","assets/T/mri-0ca285ccae614db6/coronal_003.png","assets/T/mri-0ca285ccae614db6/coronal_004.png","assets/T/mri-0ca285ccae614db6/coronal_005.png","assets/T/mri-0ca285ccae614db6/coronal_006.png","assets/T/mri-0ca285ccae614db6/coronal_007.png","assets/T/mri-0ca285ccae614db6/coronal_008.png","assets/T/mri-0ca285ccae614db6/coronal_009.png","assets/T/mri-0ca285ccae614db6/coronal_010.png","assets/T/mri-0ca285ccae614db6/coronal_011.png","assets/T/mri-0ca285ccae614db6/coronal_012.png","assets/T/mri-0ca285ccae614db6/coronal_013.png","assets/T/mri-0ca285ccae614db6/coronal_014.png","assets/T/mri-0ca285ccae614db6/coronal_015.png","assets/T/mri-0ca285ccae614db6/coronal_016.png","assets/T/mri-0ca285ccae614db6/coronal_017.png","assets/T/mri-0ca285ccae614db6/coronal_018.png","assets/T/mri-0ca285ccae614db6/coronal_019.png","assets/T/mri-0ca285ccae614db6/coronal_020.png","assets/T/mri-0ca285ccae614db6/coronal_021.png","assets/T/mri-0ca285ccae614db6/coronal_022.png","assets/T/mri-0ca285ccae614db6/coronal_023.png","assets/T/mri-0ca285ccae614db6/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-8e2393c214054928","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 68 张图，均来自同一次检查。\n\n- 前 44 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-8e2393c214054928/axial_001.png","assets/T/mri-8e2393c214054928/axial_002.png","assets/T/mri-8e2393c214054928/axial_003.png","assets/T/mri-8e2393c214054928/axial_004.png","assets/T/mri-8e2393c214054928/axial_005.png","assets/T/mri-8e2393c214054928/axial_006.png","assets/T/mri-8e2393c214054928/axial_007.png","assets/T/mri-8e2393c214054928/axial_008.png","assets/T/mri-8e2393c214054928/axial_009.png","assets/T/mri-8e2393c214054928/axial_010.png","assets/T/mri-8e2393c214054928/axial_011.png","assets/T/mri-8e2393c214054928/axial_012.png","assets/T/mri-8e2393c214054928/axial_013.png","assets/T/mri-8e2393c214054928/axial_014.png","assets/T/mri-8e2393c214054928/axial_015.png","assets/T/mri-8e2393c214054928/axial_016.png","assets/T/mri-8e2393c214054928/axial_017.png","assets/T/mri-8e2393c214054928/axial_018.png","assets/T/mri-8e2393c214054928/axial_019.png","assets/T/mri-8e2393c214054928/axial_020.png","assets/T/mri-8e2393c214054928/axial_021.png","assets/T/mri-8e2393c214054928/axial_022.png","assets/T/mri-8e2393c214054928/axial_023.png","assets/T/mri-8e2393c214054928/axial_024.png","assets/T/mri-8e2393c214054928/axial_025.png","assets/T/mri-8e2393c214054928/axial_026.png","assets/T/mri-8e2393c214054928/axial_027.png","assets/T/mri-8e2393c214054928/axial_028.png","assets/T/mri-8e2393c214054928/axial_029.png","assets/T/mri-8e2393c214054928/axial_030.png","assets/T/mri-8e2393c214054928/axial_031.png","assets/T/mri-8e2393c214054928/axial_032.png","assets/T/mri-8e2393c214054928/axial_033.png","assets/T/mri-8e2393c214054928/axial_034.png","assets/T/mri-8e2393c214054928/axial_035.png","assets/T/mri-8e2393c214054928/axial_036.png","assets/T/mri-8e2393c214054928/axial_037.png","assets/T/mri-8e2393c214054928/axial_038.png","assets/T/mri-8e2393c214054928/axial_039.png","assets/T/mri-8e2393c214054928/axial_040.png","assets/T/mri-8e2393c214054928/axial_041.png","assets/T/mri-8e2393c214054928/axial_042.png","assets/T/mri-8e2393c214054928/axial_043.png","assets/T/mri-8e2393c214054928/axial_044.png","assets/T/mri-8e2393c214054928/coronal_001.png","assets/T/mri-8e2393c214054928/coronal_002.png","assets/T/mri-8e2393c214054928/coronal_003.png","assets/T/mri-8e2393c214054928/coronal_004.png","assets/T/mri-8e2393c214054928/coronal_005.png","assets/T/mri-8e2393c214054928/coronal_006.png","assets/T/mri-8e2393c214054928/coronal_007.png","assets/T/mri-8e2393c214054928/coronal_008.png","assets/T/mri-8e2393c214054928/coronal_009.png","assets/T/mri-8e2393c214054928/coronal_010.png","assets/T/mri-8e2393c214054928/coronal_011.png","assets/T/mri-8e2393c214054928/coronal_012.png","assets/T/mri-8e2393c214054928/coronal_013.png","assets/T/mri-8e2393c214054928/coronal_014.png","assets/T/mri-8e2393c214054928/coronal_015.png","assets/T/mri-8e2393c214054928/coronal_016.png","assets/T/mri-8e2393c214054928/coronal_017.png","assets/T/mri-8e2393c214054928/coronal_018.png","assets/T/mri-8e2393c214054928/coronal_019.png","assets/T/mri-8e2393c214054928/coronal_020.png","assets/T/mri-8e2393c214054928/coronal_021.png","assets/T/mri-8e2393c214054928/coronal_022.png","assets/T/mri-8e2393c214054928/coronal_023.png","assets/T/mri-8e2393c214054928/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-964cc314fdba4813","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-964cc314fdba4813/axial_001.png","assets/T/mri-964cc314fdba4813/axial_002.png","assets/T/mri-964cc314fdba4813/axial_003.png","assets/T/mri-964cc314fdba4813/axial_004.png","assets/T/mri-964cc314fdba4813/axial_005.png","assets/T/mri-964cc314fdba4813/axial_006.png","assets/T/mri-964cc314fdba4813/axial_007.png","assets/T/mri-964cc314fdba4813/axial_008.png","assets/T/mri-964cc314fdba4813/axial_009.png","assets/T/mri-964cc314fdba4813/axial_010.png","assets/T/mri-964cc314fdba4813/axial_011.png","assets/T/mri-964cc314fdba4813/axial_012.png","assets/T/mri-964cc314fdba4813/axial_013.png","assets/T/mri-964cc314fdba4813/axial_014.png","assets/T/mri-964cc314fdba4813/axial_015.png","assets/T/mri-964cc314fdba4813/axial_016.png","assets/T/mri-964cc314fdba4813/axial_017.png","assets/T/mri-964cc314fdba4813/axial_018.png","assets/T/mri-964cc314fdba4813/axial_019.png","assets/T/mri-964cc314fdba4813/axial_020.png","assets/T/mri-964cc314fdba4813/axial_021.png","assets/T/mri-964cc314fdba4813/axial_022.png","assets/T/mri-964cc314fdba4813/axial_023.png","assets/T/mri-964cc314fdba4813/axial_024.png","assets/T/mri-964cc314fdba4813/axial_025.png","assets/T/mri-964cc314fdba4813/axial_026.png","assets/T/mri-964cc314fdba4813/axial_027.png","assets/T/mri-964cc314fdba4813/axial_028.png","assets/T/mri-964cc314fdba4813/axial_029.png","assets/T/mri-964cc314fdba4813/axial_030.png","assets/T/mri-964cc314fdba4813/axial_031.png","assets/T/mri-964cc314fdba4813/axial_032.png","assets/T/mri-964cc314fdba4813/axial_033.png","assets/T/mri-964cc314fdba4813/axial_034.png","assets/T/mri-964cc314fdba4813/axial_035.png","assets/T/mri-964cc314fdba4813/axial_036.png","assets/T/mri-964cc314fdba4813/axial_037.png","assets/T/mri-964cc314fdba4813/axial_038.png","assets/T/mri-964cc314fdba4813/axial_039.png","assets/T/mri-964cc314fdba4813/axial_040.png","assets/T/mri-964cc314fdba4813/coronal_001.png","assets/T/mri-964cc314fdba4813/coronal_002.png","assets/T/mri-964cc314fdba4813/coronal_003.png","assets/T/mri-964cc314fdba4813/coronal_004.png","assets/T/mri-964cc314fdba4813/coronal_005.png","assets/T/mri-964cc314fdba4813/coronal_006.png","assets/T/mri-964cc314fdba4813/coronal_007.png","assets/T/mri-964cc314fdba4813/coronal_008.png","assets/T/mri-964cc314fdba4813/coronal_009.png","assets/T/mri-964cc314fdba4813/coronal_010.png","assets/T/mri-964cc314fdba4813/coronal_011.png","assets/T/mri-964cc314fdba4813/coronal_012.png","assets/T/mri-964cc314fdba4813/coronal_013.png","assets/T/mri-964cc314fdba4813/coronal_014.png","assets/T/mri-964cc314fdba4813/coronal_015.png","assets/T/mri-964cc314fdba4813/coronal_016.png","assets/T/mri-964cc314fdba4813/coronal_017.png","assets/T/mri-964cc314fdba4813/coronal_018.png","assets/T/mri-964cc314fdba4813/coronal_019.png","assets/T/mri-964cc314fdba4813/coronal_020.png","assets/T/mri-964cc314fdba4813/coronal_021.png","assets/T/mri-964cc314fdba4813/coronal_022.png","assets/T/mri-964cc314fdba4813/coronal_023.png","assets/T/mri-964cc314fdba4813/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-89ad7e4f032e4280","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 67 张图，均来自同一次检查。\n\n- 前 43 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-89ad7e4f032e4280/axial_001.png","assets/T/mri-89ad7e4f032e4280/axial_002.png","assets/T/mri-89ad7e4f032e4280/axial_003.png","assets/T/mri-89ad7e4f032e4280/axial_004.png","assets/T/mri-89ad7e4f032e4280/axial_005.png","assets/T/mri-89ad7e4f032e4280/axial_006.png","assets/T/mri-89ad7e4f032e4280/axial_007.png","assets/T/mri-89ad7e4f032e4280/axial_008.png","assets/T/mri-89ad7e4f032e4280/axial_009.png","assets/T/mri-89ad7e4f032e4280/axial_010.png","assets/T/mri-89ad7e4f032e4280/axial_011.png","assets/T/mri-89ad7e4f032e4280/axial_012.png","assets/T/mri-89ad7e4f032e4280/axial_013.png","assets/T/mri-89ad7e4f032e4280/axial_014.png","assets/T/mri-89ad7e4f032e4280/axial_015.png","assets/T/mri-89ad7e4f032e4280/axial_016.png","assets/T/mri-89ad7e4f032e4280/axial_017.png","assets/T/mri-89ad7e4f032e4280/axial_018.png","assets/T/mri-89ad7e4f032e4280/axial_019.png","assets/T/mri-89ad7e4f032e4280/axial_020.png","assets/T/mri-89ad7e4f032e4280/axial_021.png","assets/T/mri-89ad7e4f032e4280/axial_022.png","assets/T/mri-89ad7e4f032e4280/axial_023.png","assets/T/mri-89ad7e4f032e4280/axial_024.png","assets/T/mri-89ad7e4f032e4280/axial_025.png","assets/T/mri-89ad7e4f032e4280/axial_026.png","assets/T/mri-89ad7e4f032e4280/axial_027.png","assets/T/mri-89ad7e4f032e4280/axial_028.png","assets/T/mri-89ad7e4f032e4280/axial_029.png","assets/T/mri-89ad7e4f032e4280/axial_030.png","assets/T/mri-89ad7e4f032e4280/axial_031.png","assets/T/mri-89ad7e4f032e4280/axial_032.png","assets/T/mri-89ad7e4f032e4280/axial_033.png","assets/T/mri-89ad7e4f032e4280/axial_034.png","assets/T/mri-89ad7e4f032e4280/axial_035.png","assets/T/mri-89ad7e4f032e4280/axial_036.png","assets/T/mri-89ad7e4f032e4280/axial_037.png","assets/T/mri-89ad7e4f032e4280/axial_038.png","assets/T/mri-89ad7e4f032e4280/axial_039.png","assets/T/mri-89ad7e4f032e4280/axial_040.png","assets/T/mri-89ad7e4f032e4280/axial_041.png","assets/T/mri-89ad7e4f032e4280/axial_042.png","assets/T/mri-89ad7e4f032e4280/axial_043.png","assets/T/mri-89ad7e4f032e4280/coronal_001.png","assets/T/mri-89ad7e4f032e4280/coronal_002.png","assets/T/mri-89ad7e4f032e4280/coronal_003.png","assets/T/mri-89ad7e4f032e4280/coronal_004.png","assets/T/mri-89ad7e4f032e4280/coronal_005.png","assets/T/mri-89ad7e4f032e4280/coronal_006.png","assets/T/mri-89ad7e4f032e4280/coronal_007.png","assets/T/mri-89ad7e4f032e4280/coronal_008.png","assets/T/mri-89ad7e4f032e4280/coronal_009.png","assets/T/mri-89ad7e4f032e4280/coronal_010.png","assets/T/mri-89ad7e4f032e4280/coronal_011.png","assets/T/mri-89ad7e4f032e4280/coronal_012.png","assets/T/mri-89ad7e4f032e4280/coronal_013.png","assets/T/mri-89ad7e4f032e4280/coronal_014.png","assets/T/mri-89ad7e4f032e4280/coronal_015.png","assets/T/mri-89ad7e4f032e4280/coronal_016.png","assets/T/mri-89ad7e4f032e4280/coronal_017.png","assets/T/mri-89ad7e4f032e4280/coronal_018.png","assets/T/mri-89ad7e4f032e4280/coronal_019.png","assets/T/mri-89ad7e4f032e4280/coronal_020.png","assets/T/mri-89ad7e4f032e4280/coronal_021.png","assets/T/mri-89ad7e4f032e4280/coronal_022.png","assets/T/mri-89ad7e4f032e4280/coronal_023.png","assets/T/mri-89ad7e4f032e4280/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-17791822e81042f8","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-17791822e81042f8/axial_001.png","assets/T/mri-17791822e81042f8/axial_002.png","assets/T/mri-17791822e81042f8/axial_003.png","assets/T/mri-17791822e81042f8/axial_004.png","assets/T/mri-17791822e81042f8/axial_005.png","assets/T/mri-17791822e81042f8/axial_006.png","assets/T/mri-17791822e81042f8/axial_007.png","assets/T/mri-17791822e81042f8/axial_008.png","assets/T/mri-17791822e81042f8/axial_009.png","assets/T/mri-17791822e81042f8/axial_010.png","assets/T/mri-17791822e81042f8/axial_011.png","assets/T/mri-17791822e81042f8/axial_012.png","assets/T/mri-17791822e81042f8/axial_013.png","assets/T/mri-17791822e81042f8/axial_014.png","assets/T/mri-17791822e81042f8/axial_015.png","assets/T/mri-17791822e81042f8/axial_016.png","assets/T/mri-17791822e81042f8/axial_017.png","assets/T/mri-17791822e81042f8/axial_018.png","assets/T/mri-17791822e81042f8/axial_019.png","assets/T/mri-17791822e81042f8/axial_020.png","assets/T/mri-17791822e81042f8/axial_021.png","assets/T/mri-17791822e81042f8/axial_022.png","assets/T/mri-17791822e81042f8/axial_023.png","assets/T/mri-17791822e81042f8/axial_024.png","assets/T/mri-17791822e81042f8/axial_025.png","assets/T/mri-17791822e81042f8/axial_026.png","assets/T/mri-17791822e81042f8/axial_027.png","assets/T/mri-17791822e81042f8/axial_028.png","assets/T/mri-17791822e81042f8/axial_029.png","assets/T/mri-17791822e81042f8/axial_030.png","assets/T/mri-17791822e81042f8/axial_031.png","assets/T/mri-17791822e81042f8/axial_032.png","assets/T/mri-17791822e81042f8/axial_033.png","assets/T/mri-17791822e81042f8/axial_034.png","assets/T/mri-17791822e81042f8/axial_035.png","assets/T/mri-17791822e81042f8/axial_036.png","assets/T/mri-17791822e81042f8/axial_037.png","assets/T/mri-17791822e81042f8/axial_038.png","assets/T/mri-17791822e81042f8/axial_039.png","assets/T/mri-17791822e81042f8/axial_040.png","assets/T/mri-17791822e81042f8/axial_041.png","assets/T/mri-17791822e81042f8/axial_042.png","assets/T/mri-17791822e81042f8/coronal_001.png","assets/T/mri-17791822e81042f8/coronal_002.png","assets/T/mri-17791822e81042f8/coronal_003.png","assets/T/mri-17791822e81042f8/coronal_004.png","assets/T/mri-17791822e81042f8/coronal_005.png","assets/T/mri-17791822e81042f8/coronal_006.png","assets/T/mri-17791822e81042f8/coronal_007.png","assets/T/mri-17791822e81042f8/coronal_008.png","assets/T/mri-17791822e81042f8/coronal_009.png","assets/T/mri-17791822e81042f8/coronal_010.png","assets/T/mri-17791822e81042f8/coronal_011.png","assets/T/mri-17791822e81042f8/coronal_012.png","assets/T/mri-17791822e81042f8/coronal_013.png","assets/T/mri-17791822e81042f8/coronal_014.png","assets/T/mri-17791822e81042f8/coronal_015.png","assets/T/mri-17791822e81042f8/coronal_016.png","assets/T/mri-17791822e81042f8/coronal_017.png","assets/T/mri-17791822e81042f8/coronal_018.png","assets/T/mri-17791822e81042f8/coronal_019.png","assets/T/mri-17791822e81042f8/coronal_020.png","assets/T/mri-17791822e81042f8/coronal_021.png","assets/T/mri-17791822e81042f8/coronal_022.png","assets/T/mri-17791822e81042f8/coronal_023.png","assets/T/mri-17791822e81042f8/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-e4e91086f13f4cfd","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-e4e91086f13f4cfd/axial_001.png","assets/T/mri-e4e91086f13f4cfd/axial_002.png","assets/T/mri-e4e91086f13f4cfd/axial_003.png","assets/T/mri-e4e91086f13f4cfd/axial_004.png","assets/T/mri-e4e91086f13f4cfd/axial_005.png","assets/T/mri-e4e91086f13f4cfd/axial_006.png","assets/T/mri-e4e91086f13f4cfd/axial_007.png","assets/T/mri-e4e91086f13f4cfd/axial_008.png","assets/T/mri-e4e91086f13f4cfd/axial_009.png","assets/T/mri-e4e91086f13f4cfd/axial_010.png","assets/T/mri-e4e91086f13f4cfd/axial_011.png","assets/T/mri-e4e91086f13f4cfd/axial_012.png","assets/T/mri-e4e91086f13f4cfd/axial_013.png","assets/T/mri-e4e91086f13f4cfd/axial_014.png","assets/T/mri-e4e91086f13f4cfd/axial_015.png","assets/T/mri-e4e91086f13f4cfd/axial_016.png","assets/T/mri-e4e91086f13f4cfd/axial_017.png","assets/T/mri-e4e91086f13f4cfd/axial_018.png","assets/T/mri-e4e91086f13f4cfd/axial_019.png","assets/T/mri-e4e91086f13f4cfd/axial_020.png","assets/T/mri-e4e91086f13f4cfd/axial_021.png","assets/T/mri-e4e91086f13f4cfd/axial_022.png","assets/T/mri-e4e91086f13f4cfd/axial_023.png","assets/T/mri-e4e91086f13f4cfd/axial_024.png","assets/T/mri-e4e91086f13f4cfd/axial_025.png","assets/T/mri-e4e91086f13f4cfd/axial_026.png","assets/T/mri-e4e91086f13f4cfd/axial_027.png","assets/T/mri-e4e91086f13f4cfd/axial_028.png","assets/T/mri-e4e91086f13f4cfd/axial_029.png","assets/T/mri-e4e91086f13f4cfd/axial_030.png","assets/T/mri-e4e91086f13f4cfd/axial_031.png","assets/T/mri-e4e91086f13f4cfd/axial_032.png","assets/T/mri-e4e91086f13f4cfd/axial_033.png","assets/T/mri-e4e91086f13f4cfd/axial_034.png","assets/T/mri-e4e91086f13f4cfd/axial_035.png","assets/T/mri-e4e91086f13f4cfd/axial_036.png","assets/T/mri-e4e91086f13f4cfd/axial_037.png","assets/T/mri-e4e91086f13f4cfd/axial_038.png","assets/T/mri-e4e91086f13f4cfd/axial_039.png","assets/T/mri-e4e91086f13f4cfd/axial_040.png","assets/T/mri-e4e91086f13f4cfd/axial_041.png","assets/T/mri-e4e91086f13f4cfd/axial_042.png","assets/T/mri-e4e91086f13f4cfd/coronal_001.png","assets/T/mri-e4e91086f13f4cfd/coronal_002.png","assets/T/mri-e4e91086f13f4cfd/coronal_003.png","assets/T/mri-e4e91086f13f4cfd/coronal_004.png","assets/T/mri-e4e91086f13f4cfd/coronal_005.png","assets/T/mri-e4e91086f13f4cfd/coronal_006.png","assets/T/mri-e4e91086f13f4cfd/coronal_007.png","assets/T/mri-e4e91086f13f4cfd/coronal_008.png","assets/T/mri-e4e91086f13f4cfd/coronal_009.png","assets/T/mri-e4e91086f13f4cfd/coronal_010.png","assets/T/mri-e4e91086f13f4cfd/coronal_011.png","assets/T/mri-e4e91086f13f4cfd/coronal_012.png","assets/T/mri-e4e91086f13f4cfd/coronal_013.png","assets/T/mri-e4e91086f13f4cfd/coronal_014.png","assets/T/mri-e4e91086f13f4cfd/coronal_015.png","assets/T/mri-e4e91086f13f4cfd/coronal_016.png","assets/T/mri-e4e91086f13f4cfd/coronal_017.png","assets/T/mri-e4e91086f13f4cfd/coronal_018.png","assets/T/mri-e4e91086f13f4cfd/coronal_019.png","assets/T/mri-e4e91086f13f4cfd/coronal_020.png","assets/T/mri-e4e91086f13f4cfd/coronal_021.png","assets/T/mri-e4e91086f13f4cfd/coronal_022.png","assets/T/mri-e4e91086f13f4cfd/coronal_023.png","assets/T/mri-e4e91086f13f4cfd/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-641082354d954f14","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-641082354d954f14/axial_001.png","assets/T/mri-641082354d954f14/axial_002.png","assets/T/mri-641082354d954f14/axial_003.png","assets/T/mri-641082354d954f14/axial_004.png","assets/T/mri-641082354d954f14/axial_005.png","assets/T/mri-641082354d954f14/axial_006.png","assets/T/mri-641082354d954f14/axial_007.png","assets/T/mri-641082354d954f14/axial_008.png","assets/T/mri-641082354d954f14/axial_009.png","assets/T/mri-641082354d954f14/axial_010.png","assets/T/mri-641082354d954f14/axial_011.png","assets/T/mri-641082354d954f14/axial_012.png","assets/T/mri-641082354d954f14/axial_013.png","assets/T/mri-641082354d954f14/axial_014.png","assets/T/mri-641082354d954f14/axial_015.png","assets/T/mri-641082354d954f14/axial_016.png","assets/T/mri-641082354d954f14/axial_017.png","assets/T/mri-641082354d954f14/axial_018.png","assets/T/mri-641082354d954f14/axial_019.png","assets/T/mri-641082354d954f14/axial_020.png","assets/T/mri-641082354d954f14/axial_021.png","assets/T/mri-641082354d954f14/axial_022.png","assets/T/mri-641082354d954f14/axial_023.png","assets/T/mri-641082354d954f14/axial_024.png","assets/T/mri-641082354d954f14/axial_025.png","assets/T/mri-641082354d954f14/axial_026.png","assets/T/mri-641082354d954f14/axial_027.png","assets/T/mri-641082354d954f14/axial_028.png","assets/T/mri-641082354d954f14/axial_029.png","assets/T/mri-641082354d954f14/axial_030.png","assets/T/mri-641082354d954f14/axial_031.png","assets/T/mri-641082354d954f14/axial_032.png","assets/T/mri-641082354d954f14/axial_033.png","assets/T/mri-641082354d954f14/axial_034.png","assets/T/mri-641082354d954f14/axial_035.png","assets/T/mri-641082354d954f14/axial_036.png","assets/T/mri-641082354d954f14/axial_037.png","assets/T/mri-641082354d954f14/axial_038.png","assets/T/mri-641082354d954f14/axial_039.png","assets/T/mri-641082354d954f14/axial_040.png","assets/T/mri-641082354d954f14/axial_041.png","assets/T/mri-641082354d954f14/axial_042.png","assets/T/mri-641082354d954f14/coronal_001.png","assets/T/mri-641082354d954f14/coronal_002.png","assets/T/mri-641082354d954f14/coronal_003.png","assets/T/mri-641082354d954f14/coronal_004.png","assets/T/mri-641082354d954f14/coronal_005.png","assets/T/mri-641082354d954f14/coronal_006.png","assets/T/mri-641082354d954f14/coronal_007.png","assets/T/mri-641082354d954f14/coronal_008.png","assets/T/mri-641082354d954f14/coronal_009.png","assets/T/mri-641082354d954f14/coronal_010.png","assets/T/mri-641082354d954f14/coronal_011.png","assets/T/mri-641082354d954f14/coronal_012.png","assets/T/mri-641082354d954f14/coronal_013.png","assets/T/mri-641082354d954f14/coronal_014.png","assets/T/mri-641082354d954f14/coronal_015.png","assets/T/mri-641082354d954f14/coronal_016.png","assets/T/mri-641082354d954f14/coronal_017.png","assets/T/mri-641082354d954f14/coronal_018.png","assets/T/mri-641082354d954f14/coronal_019.png","assets/T/mri-641082354d954f14/coronal_020.png","assets/T/mri-641082354d954f14/coronal_021.png","assets/T/mri-641082354d954f14/coronal_022.png","assets/T/mri-641082354d954f14/coronal_023.png","assets/T/mri-641082354d954f14/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-b8195ac61cf24d8e","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-b8195ac61cf24d8e/axial_001.png","assets/T/mri-b8195ac61cf24d8e/axial_002.png","assets/T/mri-b8195ac61cf24d8e/axial_003.png","assets/T/mri-b8195ac61cf24d8e/axial_004.png","assets/T/mri-b8195ac61cf24d8e/axial_005.png","assets/T/mri-b8195ac61cf24d8e/axial_006.png","assets/T/mri-b8195ac61cf24d8e/axial_007.png","assets/T/mri-b8195ac61cf24d8e/axial_008.png","assets/T/mri-b8195ac61cf24d8e/axial_009.png","assets/T/mri-b8195ac61cf24d8e/axial_010.png","assets/T/mri-b8195ac61cf24d8e/axial_011.png","assets/T/mri-b8195ac61cf24d8e/axial_012.png","assets/T/mri-b8195ac61cf24d8e/axial_013.png","assets/T/mri-b8195ac61cf24d8e/axial_014.png","assets/T/mri-b8195ac61cf24d8e/axial_015.png","assets/T/mri-b8195ac61cf24d8e/axial_016.png","assets/T/mri-b8195ac61cf24d8e/axial_017.png","assets/T/mri-b8195ac61cf24d8e/axial_018.png","assets/T/mri-b8195ac61cf24d8e/axial_019.png","assets/T/mri-b8195ac61cf24d8e/axial_020.png","assets/T/mri-b8195ac61cf24d8e/axial_021.png","assets/T/mri-b8195ac61cf24d8e/axial_022.png","assets/T/mri-b8195ac61cf24d8e/axial_023.png","assets/T/mri-b8195ac61cf24d8e/axial_024.png","assets/T/mri-b8195ac61cf24d8e/axial_025.png","assets/T/mri-b8195ac61cf24d8e/axial_026.png","assets/T/mri-b8195ac61cf24d8e/axial_027.png","assets/T/mri-b8195ac61cf24d8e/axial_028.png","assets/T/mri-b8195ac61cf24d8e/axial_029.png","assets/T/mri-b8195ac61cf24d8e/axial_030.png","assets/T/mri-b8195ac61cf24d8e/axial_031.png","assets/T/mri-b8195ac61cf24d8e/axial_032.png","assets/T/mri-b8195ac61cf24d8e/axial_033.png","assets/T/mri-b8195ac61cf24d8e/axial_034.png","assets/T/mri-b8195ac61cf24d8e/axial_035.png","assets/T/mri-b8195ac61cf24d8e/axial_036.png","assets/T/mri-b8195ac61cf24d8e/axial_037.png","assets/T/mri-b8195ac61cf24d8e/axial_038.png","assets/T/mri-b8195ac61cf24d8e/axial_039.png","assets/T/mri-b8195ac61cf24d8e/axial_040.png","assets/T/mri-b8195ac61cf24d8e/coronal_001.png","assets/T/mri-b8195ac61cf24d8e/coronal_002.png","assets/T/mri-b8195ac61cf24d8e/coronal_003.png","assets/T/mri-b8195ac61cf24d8e/coronal_004.png","assets/T/mri-b8195ac61cf24d8e/coronal_005.png","assets/T/mri-b8195ac61cf24d8e/coronal_006.png","assets/T/mri-b8195ac61cf24d8e/coronal_007.png","assets/T/mri-b8195ac61cf24d8e/coronal_008.png","assets/T/mri-b8195ac61cf24d8e/coronal_009.png","assets/T/mri-b8195ac61cf24d8e/coronal_010.png","assets/T/mri-b8195ac61cf24d8e/coronal_011.png","assets/T/mri-b8195ac61cf24d8e/coronal_012.png","assets/T/mri-b8195ac61cf24d8e/coronal_013.png","assets/T/mri-b8195ac61cf24d8e/coronal_014.png","assets/T/mri-b8195ac61cf24d8e/coronal_015.png","assets/T/mri-b8195ac61cf24d8e/coronal_016.png","assets/T/mri-b8195ac61cf24d8e/coronal_017.png","assets/T/mri-b8195ac61cf24d8e/coronal_018.png","assets/T/mri-b8195ac61cf24d8e/coronal_019.png","assets/T/mri-b8195ac61cf24d8e/coronal_020.png","assets/T/mri-b8195ac61cf24d8e/coronal_021.png","assets/T/mri-b8195ac61cf24d8e/coronal_022.png","assets/T/mri-b8195ac61cf24d8e/coronal_023.png","assets/T/mri-b8195ac61cf24d8e/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-a8825a33e2e244c7","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 44 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-a8825a33e2e244c7/axial_001.png","assets/T/mri-a8825a33e2e244c7/axial_002.png","assets/T/mri-a8825a33e2e244c7/axial_003.png","assets/T/mri-a8825a33e2e244c7/axial_004.png","assets/T/mri-a8825a33e2e244c7/axial_005.png","assets/T/mri-a8825a33e2e244c7/axial_006.png","assets/T/mri-a8825a33e2e244c7/axial_007.png","assets/T/mri-a8825a33e2e244c7/axial_008.png","assets/T/mri-a8825a33e2e244c7/axial_009.png","assets/T/mri-a8825a33e2e244c7/axial_010.png","assets/T/mri-a8825a33e2e244c7/axial_011.png","assets/T/mri-a8825a33e2e244c7/axial_012.png","assets/T/mri-a8825a33e2e244c7/axial_013.png","assets/T/mri-a8825a33e2e244c7/axial_014.png","assets/T/mri-a8825a33e2e244c7/axial_015.png","assets/T/mri-a8825a33e2e244c7/axial_016.png","assets/T/mri-a8825a33e2e244c7/axial_017.png","assets/T/mri-a8825a33e2e244c7/axial_018.png","assets/T/mri-a8825a33e2e244c7/axial_019.png","assets/T/mri-a8825a33e2e244c7/axial_020.png","assets/T/mri-a8825a33e2e244c7/coronal_001.png","assets/T/mri-a8825a33e2e244c7/coronal_002.png","assets/T/mri-a8825a33e2e244c7/coronal_003.png","assets/T/mri-a8825a33e2e244c7/coronal_004.png","assets/T/mri-a8825a33e2e244c7/coronal_005.png","assets/T/mri-a8825a33e2e244c7/coronal_006.png","assets/T/mri-a8825a33e2e244c7/coronal_007.png","assets/T/mri-a8825a33e2e244c7/coronal_008.png","assets/T/mri-a8825a33e2e244c7/coronal_009.png","assets/T/mri-a8825a33e2e244c7/coronal_010.png","assets/T/mri-a8825a33e2e244c7/coronal_011.png","assets/T/mri-a8825a33e2e244c7/coronal_012.png","assets/T/mri-a8825a33e2e244c7/coronal_013.png","assets/T/mri-a8825a33e2e244c7/coronal_014.png","assets/T/mri-a8825a33e2e244c7/coronal_015.png","assets/T/mri-a8825a33e2e244c7/coronal_016.png","assets/T/mri-a8825a33e2e244c7/coronal_017.png","assets/T/mri-a8825a33e2e244c7/coronal_018.png","assets/T/mri-a8825a33e2e244c7/coronal_019.png","assets/T/mri-a8825a33e2e244c7/coronal_020.png","assets/T/mri-a8825a33e2e244c7/coronal_021.png","assets/T/mri-a8825a33e2e244c7/coronal_022.png","assets/T/mri-a8825a33e2e244c7/coronal_023.png","assets/T/mri-a8825a33e2e244c7/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-a66aedc73c134dce","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 62 张图，均来自同一次检查。\n\n- 前 38 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-a66aedc73c134dce/axial_001.png","assets/T/mri-a66aedc73c134dce/axial_002.png","assets/T/mri-a66aedc73c134dce/axial_003.png","assets/T/mri-a66aedc73c134dce/axial_004.png","assets/T/mri-a66aedc73c134dce/axial_005.png","assets/T/mri-a66aedc73c134dce/axial_006.png","assets/T/mri-a66aedc73c134dce/axial_007.png","assets/T/mri-a66aedc73c134dce/axial_008.png","assets/T/mri-a66aedc73c134dce/axial_009.png","assets/T/mri-a66aedc73c134dce/axial_010.png","assets/T/mri-a66aedc73c134dce/axial_011.png","assets/T/mri-a66aedc73c134dce/axial_012.png","assets/T/mri-a66aedc73c134dce/axial_013.png","assets/T/mri-a66aedc73c134dce/axial_014.png","assets/T/mri-a66aedc73c134dce/axial_015.png","assets/T/mri-a66aedc73c134dce/axial_016.png","assets/T/mri-a66aedc73c134dce/axial_017.png","assets/T/mri-a66aedc73c134dce/axial_018.png","assets/T/mri-a66aedc73c134dce/axial_019.png","assets/T/mri-a66aedc73c134dce/axial_020.png","assets/T/mri-a66aedc73c134dce/axial_021.png","assets/T/mri-a66aedc73c134dce/axial_022.png","assets/T/mri-a66aedc73c134dce/axial_023.png","assets/T/mri-a66aedc73c134dce/axial_024.png","assets/T/mri-a66aedc73c134dce/axial_025.png","assets/T/mri-a66aedc73c134dce/axial_026.png","assets/T/mri-a66aedc73c134dce/axial_027.png","assets/T/mri-a66aedc73c134dce/axial_028.png","assets/T/mri-a66aedc73c134dce/axial_029.png","assets/T/mri-a66aedc73c134dce/axial_030.png","assets/T/mri-a66aedc73c134dce/axial_031.png","assets/T/mri-a66aedc73c134dce/axial_032.png","assets/T/mri-a66aedc73c134dce/axial_033.png","assets/T/mri-a66aedc73c134dce/axial_034.png","assets/T/mri-a66aedc73c134dce/axial_035.png","assets/T/mri-a66aedc73c134dce/axial_036.png","assets/T/mri-a66aedc73c134dce/axial_037.png","assets/T/mri-a66aedc73c134dce/axial_038.png","assets/T/mri-a66aedc73c134dce/coronal_001.png","assets/T/mri-a66aedc73c134dce/coronal_002.png","assets/T/mri-a66aedc73c134dce/coronal_003.png","assets/T/mri-a66aedc73c134dce/coronal_004.png","assets/T/mri-a66aedc73c134dce/coronal_005.png","assets/T/mri-a66aedc73c134dce/coronal_006.png","assets/T/mri-a66aedc73c134dce/coronal_007.png","assets/T/mri-a66aedc73c134dce/coronal_008.png","assets/T/mri-a66aedc73c134dce/coronal_009.png","assets/T/mri-a66aedc73c134dce/coronal_010.png","assets/T/mri-a66aedc73c134dce/coronal_011.png","assets/T/mri-a66aedc73c134dce/coronal_012.png","assets/T/mri-a66aedc73c134dce/coronal_013.png","assets/T/mri-a66aedc73c134dce/coronal_014.png","assets/T/mri-a66aedc73c134dce/coronal_015.png","assets/T/mri-a66aedc73c134dce/coronal_016.png","assets/T/mri-a66aedc73c134dce/coronal_017.png","assets/T/mri-a66aedc73c134dce/coronal_018.png","assets/T/mri-a66aedc73c134dce/coronal_019.png","assets/T/mri-a66aedc73c134dce/coronal_020.png","assets/T/mri-a66aedc73c134dce/coronal_021.png","assets/T/mri-a66aedc73c134dce/coronal_022.png","assets/T/mri-a66aedc73c134dce/coronal_023.png","assets/T/mri-a66aedc73c134dce/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-4fc9388c39ea4bec","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-4fc9388c39ea4bec/axial_001.png","assets/T/mri-4fc9388c39ea4bec/axial_002.png","assets/T/mri-4fc9388c39ea4bec/axial_003.png","assets/T/mri-4fc9388c39ea4bec/axial_004.png","assets/T/mri-4fc9388c39ea4bec/axial_005.png","assets/T/mri-4fc9388c39ea4bec/axial_006.png","assets/T/mri-4fc9388c39ea4bec/axial_007.png","assets/T/mri-4fc9388c39ea4bec/axial_008.png","assets/T/mri-4fc9388c39ea4bec/axial_009.png","assets/T/mri-4fc9388c39ea4bec/axial_010.png","assets/T/mri-4fc9388c39ea4bec/axial_011.png","assets/T/mri-4fc9388c39ea4bec/axial_012.png","assets/T/mri-4fc9388c39ea4bec/axial_013.png","assets/T/mri-4fc9388c39ea4bec/axial_014.png","assets/T/mri-4fc9388c39ea4bec/axial_015.png","assets/T/mri-4fc9388c39ea4bec/axial_016.png","assets/T/mri-4fc9388c39ea4bec/axial_017.png","assets/T/mri-4fc9388c39ea4bec/axial_018.png","assets/T/mri-4fc9388c39ea4bec/axial_019.png","assets/T/mri-4fc9388c39ea4bec/axial_020.png","assets/T/mri-4fc9388c39ea4bec/axial_021.png","assets/T/mri-4fc9388c39ea4bec/axial_022.png","assets/T/mri-4fc9388c39ea4bec/axial_023.png","assets/T/mri-4fc9388c39ea4bec/axial_024.png","assets/T/mri-4fc9388c39ea4bec/axial_025.png","assets/T/mri-4fc9388c39ea4bec/axial_026.png","assets/T/mri-4fc9388c39ea4bec/axial_027.png","assets/T/mri-4fc9388c39ea4bec/axial_028.png","assets/T/mri-4fc9388c39ea4bec/axial_029.png","assets/T/mri-4fc9388c39ea4bec/axial_030.png","assets/T/mri-4fc9388c39ea4bec/axial_031.png","assets/T/mri-4fc9388c39ea4bec/axial_032.png","assets/T/mri-4fc9388c39ea4bec/axial_033.png","assets/T/mri-4fc9388c39ea4bec/axial_034.png","assets/T/mri-4fc9388c39ea4bec/axial_035.png","assets/T/mri-4fc9388c39ea4bec/axial_036.png","assets/T/mri-4fc9388c39ea4bec/axial_037.png","assets/T/mri-4fc9388c39ea4bec/axial_038.png","assets/T/mri-4fc9388c39ea4bec/axial_039.png","assets/T/mri-4fc9388c39ea4bec/axial_040.png","assets/T/mri-4fc9388c39ea4bec/coronal_001.png","assets/T/mri-4fc9388c39ea4bec/coronal_002.png","assets/T/mri-4fc9388c39ea4bec/coronal_003.png","assets/T/mri-4fc9388c39ea4bec/coronal_004.png","assets/T/mri-4fc9388c39ea4bec/coronal_005.png","assets/T/mri-4fc9388c39ea4bec/coronal_006.png","assets/T/mri-4fc9388c39ea4bec/coronal_007.png","assets/T/mri-4fc9388c39ea4bec/coronal_008.png","assets/T/mri-4fc9388c39ea4bec/coronal_009.png","assets/T/mri-4fc9388c39ea4bec/coronal_010.png","assets/T/mri-4fc9388c39ea4bec/coronal_011.png","assets/T/mri-4fc9388c39ea4bec/coronal_012.png","assets/T/mri-4fc9388c39ea4bec/coronal_013.png","assets/T/mri-4fc9388c39ea4bec/coronal_014.png","assets/T/mri-4fc9388c39ea4bec/coronal_015.png","assets/T/mri-4fc9388c39ea4bec/coronal_016.png","assets/T/mri-4fc9388c39ea4bec/coronal_017.png","assets/T/mri-4fc9388c39ea4bec/coronal_018.png","assets/T/mri-4fc9388c39ea4bec/coronal_019.png","assets/T/mri-4fc9388c39ea4bec/coronal_020.png","assets/T/mri-4fc9388c39ea4bec/coronal_021.png","assets/T/mri-4fc9388c39ea4bec/coronal_022.png","assets/T/mri-4fc9388c39ea4bec/coronal_023.png","assets/T/mri-4fc9388c39ea4bec/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-1710b5fe45bb4c9b","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-1710b5fe45bb4c9b/axial_001.png","assets/T/mri-1710b5fe45bb4c9b/axial_002.png","assets/T/mri-1710b5fe45bb4c9b/axial_003.png","assets/T/mri-1710b5fe45bb4c9b/axial_004.png","assets/T/mri-1710b5fe45bb4c9b/axial_005.png","assets/T/mri-1710b5fe45bb4c9b/axial_006.png","assets/T/mri-1710b5fe45bb4c9b/axial_007.png","assets/T/mri-1710b5fe45bb4c9b/axial_008.png","assets/T/mri-1710b5fe45bb4c9b/axial_009.png","assets/T/mri-1710b5fe45bb4c9b/axial_010.png","assets/T/mri-1710b5fe45bb4c9b/axial_011.png","assets/T/mri-1710b5fe45bb4c9b/axial_012.png","assets/T/mri-1710b5fe45bb4c9b/axial_013.png","assets/T/mri-1710b5fe45bb4c9b/axial_014.png","assets/T/mri-1710b5fe45bb4c9b/axial_015.png","assets/T/mri-1710b5fe45bb4c9b/axial_016.png","assets/T/mri-1710b5fe45bb4c9b/axial_017.png","assets/T/mri-1710b5fe45bb4c9b/axial_018.png","assets/T/mri-1710b5fe45bb4c9b/axial_019.png","assets/T/mri-1710b5fe45bb4c9b/axial_020.png","assets/T/mri-1710b5fe45bb4c9b/axial_021.png","assets/T/mri-1710b5fe45bb4c9b/axial_022.png","assets/T/mri-1710b5fe45bb4c9b/axial_023.png","assets/T/mri-1710b5fe45bb4c9b/axial_024.png","assets/T/mri-1710b5fe45bb4c9b/axial_025.png","assets/T/mri-1710b5fe45bb4c9b/axial_026.png","assets/T/mri-1710b5fe45bb4c9b/axial_027.png","assets/T/mri-1710b5fe45bb4c9b/axial_028.png","assets/T/mri-1710b5fe45bb4c9b/axial_029.png","assets/T/mri-1710b5fe45bb4c9b/axial_030.png","assets/T/mri-1710b5fe45bb4c9b/axial_031.png","assets/T/mri-1710b5fe45bb4c9b/axial_032.png","assets/T/mri-1710b5fe45bb4c9b/axial_033.png","assets/T/mri-1710b5fe45bb4c9b/axial_034.png","assets/T/mri-1710b5fe45bb4c9b/axial_035.png","assets/T/mri-1710b5fe45bb4c9b/axial_036.png","assets/T/mri-1710b5fe45bb4c9b/axial_037.png","assets/T/mri-1710b5fe45bb4c9b/axial_038.png","assets/T/mri-1710b5fe45bb4c9b/axial_039.png","assets/T/mri-1710b5fe45bb4c9b/axial_040.png","assets/T/mri-1710b5fe45bb4c9b/axial_041.png","assets/T/mri-1710b5fe45bb4c9b/axial_042.png","assets/T/mri-1710b5fe45bb4c9b/coronal_001.png","assets/T/mri-1710b5fe45bb4c9b/coronal_002.png","assets/T/mri-1710b5fe45bb4c9b/coronal_003.png","assets/T/mri-1710b5fe45bb4c9b/coronal_004.png","assets/T/mri-1710b5fe45bb4c9b/coronal_005.png","assets/T/mri-1710b5fe45bb4c9b/coronal_006.png","assets/T/mri-1710b5fe45bb4c9b/coronal_007.png","assets/T/mri-1710b5fe45bb4c9b/coronal_008.png","assets/T/mri-1710b5fe45bb4c9b/coronal_009.png","assets/T/mri-1710b5fe45bb4c9b/coronal_010.png","assets/T/mri-1710b5fe45bb4c9b/coronal_011.png","assets/T/mri-1710b5fe45bb4c9b/coronal_012.png","assets/T/mri-1710b5fe45bb4c9b/coronal_013.png","assets/T/mri-1710b5fe45bb4c9b/coronal_014.png","assets/T/mri-1710b5fe45bb4c9b/coronal_015.png","assets/T/mri-1710b5fe45bb4c9b/coronal_016.png","assets/T/mri-1710b5fe45bb4c9b/coronal_017.png","assets/T/mri-1710b5fe45bb4c9b/coronal_018.png","assets/T/mri-1710b5fe45bb4c9b/coronal_019.png","assets/T/mri-1710b5fe45bb4c9b/coronal_020.png","assets/T/mri-1710b5fe45bb4c9b/coronal_021.png","assets/T/mri-1710b5fe45bb4c9b/coronal_022.png","assets/T/mri-1710b5fe45bb4c9b/coronal_023.png","assets/T/mri-1710b5fe45bb4c9b/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-40ab680e8ff847d6","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-40ab680e8ff847d6/axial_001.png","assets/T/mri-40ab680e8ff847d6/axial_002.png","assets/T/mri-40ab680e8ff847d6/axial_003.png","assets/T/mri-40ab680e8ff847d6/axial_004.png","assets/T/mri-40ab680e8ff847d6/axial_005.png","assets/T/mri-40ab680e8ff847d6/axial_006.png","assets/T/mri-40ab680e8ff847d6/axial_007.png","assets/T/mri-40ab680e8ff847d6/axial_008.png","assets/T/mri-40ab680e8ff847d6/axial_009.png","assets/T/mri-40ab680e8ff847d6/axial_010.png","assets/T/mri-40ab680e8ff847d6/axial_011.png","assets/T/mri-40ab680e8ff847d6/axial_012.png","assets/T/mri-40ab680e8ff847d6/axial_013.png","assets/T/mri-40ab680e8ff847d6/axial_014.png","assets/T/mri-40ab680e8ff847d6/axial_015.png","assets/T/mri-40ab680e8ff847d6/axial_016.png","assets/T/mri-40ab680e8ff847d6/axial_017.png","assets/T/mri-40ab680e8ff847d6/axial_018.png","assets/T/mri-40ab680e8ff847d6/axial_019.png","assets/T/mri-40ab680e8ff847d6/axial_020.png","assets/T/mri-40ab680e8ff847d6/axial_021.png","assets/T/mri-40ab680e8ff847d6/axial_022.png","assets/T/mri-40ab680e8ff847d6/axial_023.png","assets/T/mri-40ab680e8ff847d6/axial_024.png","assets/T/mri-40ab680e8ff847d6/axial_025.png","assets/T/mri-40ab680e8ff847d6/axial_026.png","assets/T/mri-40ab680e8ff847d6/axial_027.png","assets/T/mri-40ab680e8ff847d6/axial_028.png","assets/T/mri-40ab680e8ff847d6/axial_029.png","assets/T/mri-40ab680e8ff847d6/axial_030.png","assets/T/mri-40ab680e8ff847d6/axial_031.png","assets/T/mri-40ab680e8ff847d6/axial_032.png","assets/T/mri-40ab680e8ff847d6/axial_033.png","assets/T/mri-40ab680e8ff847d6/axial_034.png","assets/T/mri-40ab680e8ff847d6/axial_035.png","assets/T/mri-40ab680e8ff847d6/axial_036.png","assets/T/mri-40ab680e8ff847d6/axial_037.png","assets/T/mri-40ab680e8ff847d6/axial_038.png","assets/T/mri-40ab680e8ff847d6/axial_039.png","assets/T/mri-40ab680e8ff847d6/axial_040.png","assets/T/mri-40ab680e8ff847d6/axial_041.png","assets/T/mri-40ab680e8ff847d6/axial_042.png","assets/T/mri-40ab680e8ff847d6/coronal_001.png","assets/T/mri-40ab680e8ff847d6/coronal_002.png","assets/T/mri-40ab680e8ff847d6/coronal_003.png","assets/T/mri-40ab680e8ff847d6/coronal_004.png","assets/T/mri-40ab680e8ff847d6/coronal_005.png","assets/T/mri-40ab680e8ff847d6/coronal_006.png","assets/T/mri-40ab680e8ff847d6/coronal_007.png","assets/T/mri-40ab680e8ff847d6/coronal_008.png","assets/T/mri-40ab680e8ff847d6/coronal_009.png","assets/T/mri-40ab680e8ff847d6/coronal_010.png","assets/T/mri-40ab680e8ff847d6/coronal_011.png","assets/T/mri-40ab680e8ff847d6/coronal_012.png","assets/T/mri-40ab680e8ff847d6/coronal_013.png","assets/T/mri-40ab680e8ff847d6/coronal_014.png","assets/T/mri-40ab680e8ff847d6/coronal_015.png","assets/T/mri-40ab680e8ff847d6/coronal_016.png","assets/T/mri-40ab680e8ff847d6/coronal_017.png","assets/T/mri-40ab680e8ff847d6/coronal_018.png","assets/T/mri-40ab680e8ff847d6/coronal_019.png","assets/T/mri-40ab680e8ff847d6/coronal_020.png","assets/T/mri-40ab680e8ff847d6/coronal_021.png","assets/T/mri-40ab680e8ff847d6/coronal_022.png","assets/T/mri-40ab680e8ff847d6/coronal_023.png","assets/T/mri-40ab680e8ff847d6/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-396b4602039e46f3","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 60 张图，均来自同一次检查。\n\n- 前 36 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-396b4602039e46f3/axial_001.png","assets/T/mri-396b4602039e46f3/axial_002.png","assets/T/mri-396b4602039e46f3/axial_003.png","assets/T/mri-396b4602039e46f3/axial_004.png","assets/T/mri-396b4602039e46f3/axial_005.png","assets/T/mri-396b4602039e46f3/axial_006.png","assets/T/mri-396b4602039e46f3/axial_007.png","assets/T/mri-396b4602039e46f3/axial_008.png","assets/T/mri-396b4602039e46f3/axial_009.png","assets/T/mri-396b4602039e46f3/axial_010.png","assets/T/mri-396b4602039e46f3/axial_011.png","assets/T/mri-396b4602039e46f3/axial_012.png","assets/T/mri-396b4602039e46f3/axial_013.png","assets/T/mri-396b4602039e46f3/axial_014.png","assets/T/mri-396b4602039e46f3/axial_015.png","assets/T/mri-396b4602039e46f3/axial_016.png","assets/T/mri-396b4602039e46f3/axial_017.png","assets/T/mri-396b4602039e46f3/axial_018.png","assets/T/mri-396b4602039e46f3/axial_019.png","assets/T/mri-396b4602039e46f3/axial_020.png","assets/T/mri-396b4602039e46f3/axial_021.png","assets/T/mri-396b4602039e46f3/axial_022.png","assets/T/mri-396b4602039e46f3/axial_023.png","assets/T/mri-396b4602039e46f3/axial_024.png","assets/T/mri-396b4602039e46f3/axial_025.png","assets/T/mri-396b4602039e46f3/axial_026.png","assets/T/mri-396b4602039e46f3/axial_027.png","assets/T/mri-396b4602039e46f3/axial_028.png","assets/T/mri-396b4602039e46f3/axial_029.png","assets/T/mri-396b4602039e46f3/axial_030.png","assets/T/mri-396b4602039e46f3/axial_031.png","assets/T/mri-396b4602039e46f3/axial_032.png","assets/T/mri-396b4602039e46f3/axial_033.png","assets/T/mri-396b4602039e46f3/axial_034.png","assets/T/mri-396b4602039e46f3/axial_035.png","assets/T/mri-396b4602039e46f3/axial_036.png","assets/T/mri-396b4602039e46f3/coronal_001.png","assets/T/mri-396b4602039e46f3/coronal_002.png","assets/T/mri-396b4602039e46f3/coronal_003.png","assets/T/mri-396b4602039e46f3/coronal_004.png","assets/T/mri-396b4602039e46f3/coronal_005.png","assets/T/mri-396b4602039e46f3/coronal_006.png","assets/T/mri-396b4602039e46f3/coronal_007.png","assets/T/mri-396b4602039e46f3/coronal_008.png","assets/T/mri-396b4602039e46f3/coronal_009.png","assets/T/mri-396b4602039e46f3/coronal_010.png","assets/T/mri-396b4602039e46f3/coronal_011.png","assets/T/mri-396b4602039e46f3/coronal_012.png","assets/T/mri-396b4602039e46f3/coronal_013.png","assets/T/mri-396b4602039e46f3/coronal_014.png","assets/T/mri-396b4602039e46f3/coronal_015.png","assets/T/mri-396b4602039e46f3/coronal_016.png","assets/T/mri-396b4602039e46f3/coronal_017.png","assets/T/mri-396b4602039e46f3/coronal_018.png","assets/T/mri-396b4602039e46f3/coronal_019.png","assets/T/mri-396b4602039e46f3/coronal_020.png","assets/T/mri-396b4602039e46f3/coronal_021.png","assets/T/mri-396b4602039e46f3/coronal_022.png","assets/T/mri-396b4602039e46f3/coronal_023.png","assets/T/mri-396b4602039e46f3/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-0588f21611574c53","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-0588f21611574c53/axial_001.png","assets/T/mri-0588f21611574c53/axial_002.png","assets/T/mri-0588f21611574c53/axial_003.png","assets/T/mri-0588f21611574c53/axial_004.png","assets/T/mri-0588f21611574c53/axial_005.png","assets/T/mri-0588f21611574c53/axial_006.png","assets/T/mri-0588f21611574c53/axial_007.png","assets/T/mri-0588f21611574c53/axial_008.png","assets/T/mri-0588f21611574c53/axial_009.png","assets/T/mri-0588f21611574c53/axial_010.png","assets/T/mri-0588f21611574c53/axial_011.png","assets/T/mri-0588f21611574c53/axial_012.png","assets/T/mri-0588f21611574c53/axial_013.png","assets/T/mri-0588f21611574c53/axial_014.png","assets/T/mri-0588f21611574c53/axial_015.png","assets/T/mri-0588f21611574c53/axial_016.png","assets/T/mri-0588f21611574c53/axial_017.png","assets/T/mri-0588f21611574c53/axial_018.png","assets/T/mri-0588f21611574c53/axial_019.png","assets/T/mri-0588f21611574c53/axial_020.png","assets/T/mri-0588f21611574c53/axial_021.png","assets/T/mri-0588f21611574c53/axial_022.png","assets/T/mri-0588f21611574c53/axial_023.png","assets/T/mri-0588f21611574c53/axial_024.png","assets/T/mri-0588f21611574c53/axial_025.png","assets/T/mri-0588f21611574c53/axial_026.png","assets/T/mri-0588f21611574c53/axial_027.png","assets/T/mri-0588f21611574c53/axial_028.png","assets/T/mri-0588f21611574c53/axial_029.png","assets/T/mri-0588f21611574c53/axial_030.png","assets/T/mri-0588f21611574c53/axial_031.png","assets/T/mri-0588f21611574c53/axial_032.png","assets/T/mri-0588f21611574c53/axial_033.png","assets/T/mri-0588f21611574c53/axial_034.png","assets/T/mri-0588f21611574c53/axial_035.png","assets/T/mri-0588f21611574c53/axial_036.png","assets/T/mri-0588f21611574c53/axial_037.png","assets/T/mri-0588f21611574c53/axial_038.png","assets/T/mri-0588f21611574c53/axial_039.png","assets/T/mri-0588f21611574c53/axial_040.png","assets/T/mri-0588f21611574c53/coronal_001.png","assets/T/mri-0588f21611574c53/coronal_002.png","assets/T/mri-0588f21611574c53/coronal_003.png","assets/T/mri-0588f21611574c53/coronal_004.png","assets/T/mri-0588f21611574c53/coronal_005.png","assets/T/mri-0588f21611574c53/coronal_006.png","assets/T/mri-0588f21611574c53/coronal_007.png","assets/T/mri-0588f21611574c53/coronal_008.png","assets/T/mri-0588f21611574c53/coronal_009.png","assets/T/mri-0588f21611574c53/coronal_010.png","assets/T/mri-0588f21611574c53/coronal_011.png","assets/T/mri-0588f21611574c53/coronal_012.png","assets/T/mri-0588f21611574c53/coronal_013.png","assets/T/mri-0588f21611574c53/coronal_014.png","assets/T/mri-0588f21611574c53/coronal_015.png","assets/T/mri-0588f21611574c53/coronal_016.png","assets/T/mri-0588f21611574c53/coronal_017.png","assets/T/mri-0588f21611574c53/coronal_018.png","assets/T/mri-0588f21611574c53/coronal_019.png","assets/T/mri-0588f21611574c53/coronal_020.png","assets/T/mri-0588f21611574c53/coronal_021.png","assets/T/mri-0588f21611574c53/coronal_022.png","assets/T/mri-0588f21611574c53/coronal_023.png","assets/T/mri-0588f21611574c53/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-f4e104d4b1914b92","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-f4e104d4b1914b92/axial_001.png","assets/T/mri-f4e104d4b1914b92/axial_002.png","assets/T/mri-f4e104d4b1914b92/axial_003.png","assets/T/mri-f4e104d4b1914b92/axial_004.png","assets/T/mri-f4e104d4b1914b92/axial_005.png","assets/T/mri-f4e104d4b1914b92/axial_006.png","assets/T/mri-f4e104d4b1914b92/axial_007.png","assets/T/mri-f4e104d4b1914b92/axial_008.png","assets/T/mri-f4e104d4b1914b92/axial_009.png","assets/T/mri-f4e104d4b1914b92/axial_010.png","assets/T/mri-f4e104d4b1914b92/axial_011.png","assets/T/mri-f4e104d4b1914b92/axial_012.png","assets/T/mri-f4e104d4b1914b92/axial_013.png","assets/T/mri-f4e104d4b1914b92/axial_014.png","assets/T/mri-f4e104d4b1914b92/axial_015.png","assets/T/mri-f4e104d4b1914b92/axial_016.png","assets/T/mri-f4e104d4b1914b92/axial_017.png","assets/T/mri-f4e104d4b1914b92/axial_018.png","assets/T/mri-f4e104d4b1914b92/axial_019.png","assets/T/mri-f4e104d4b1914b92/axial_020.png","assets/T/mri-f4e104d4b1914b92/axial_021.png","assets/T/mri-f4e104d4b1914b92/axial_022.png","assets/T/mri-f4e104d4b1914b92/axial_023.png","assets/T/mri-f4e104d4b1914b92/axial_024.png","assets/T/mri-f4e104d4b1914b92/axial_025.png","assets/T/mri-f4e104d4b1914b92/axial_026.png","assets/T/mri-f4e104d4b1914b92/axial_027.png","assets/T/mri-f4e104d4b1914b92/axial_028.png","assets/T/mri-f4e104d4b1914b92/axial_029.png","assets/T/mri-f4e104d4b1914b92/axial_030.png","assets/T/mri-f4e104d4b1914b92/axial_031.png","assets/T/mri-f4e104d4b1914b92/axial_032.png","assets/T/mri-f4e104d4b1914b92/axial_033.png","assets/T/mri-f4e104d4b1914b92/axial_034.png","assets/T/mri-f4e104d4b1914b92/axial_035.png","assets/T/mri-f4e104d4b1914b92/axial_036.png","assets/T/mri-f4e104d4b1914b92/axial_037.png","assets/T/mri-f4e104d4b1914b92/axial_038.png","assets/T/mri-f4e104d4b1914b92/axial_039.png","assets/T/mri-f4e104d4b1914b92/axial_040.png","assets/T/mri-f4e104d4b1914b92/axial_041.png","assets/T/mri-f4e104d4b1914b92/axial_042.png","assets/T/mri-f4e104d4b1914b92/coronal_001.png","assets/T/mri-f4e104d4b1914b92/coronal_002.png","assets/T/mri-f4e104d4b1914b92/coronal_003.png","assets/T/mri-f4e104d4b1914b92/coronal_004.png","assets/T/mri-f4e104d4b1914b92/coronal_005.png","assets/T/mri-f4e104d4b1914b92/coronal_006.png","assets/T/mri-f4e104d4b1914b92/coronal_007.png","assets/T/mri-f4e104d4b1914b92/coronal_008.png","assets/T/mri-f4e104d4b1914b92/coronal_009.png","assets/T/mri-f4e104d4b1914b92/coronal_010.png","assets/T/mri-f4e104d4b1914b92/coronal_011.png","assets/T/mri-f4e104d4b1914b92/coronal_012.png","assets/T/mri-f4e104d4b1914b92/coronal_013.png","assets/T/mri-f4e104d4b1914b92/coronal_014.png","assets/T/mri-f4e104d4b1914b92/coronal_015.png","assets/T/mri-f4e104d4b1914b92/coronal_016.png","assets/T/mri-f4e104d4b1914b92/coronal_017.png","assets/T/mri-f4e104d4b1914b92/coronal_018.png","assets/T/mri-f4e104d4b1914b92/coronal_019.png","assets/T/mri-f4e104d4b1914b92/coronal_020.png","assets/T/mri-f4e104d4b1914b92/coronal_021.png","assets/T/mri-f4e104d4b1914b92/coronal_022.png","assets/T/mri-f4e104d4b1914b92/coronal_023.png","assets/T/mri-f4e104d4b1914b92/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-d55be5ee6a164720","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-d55be5ee6a164720/axial_001.png","assets/T/mri-d55be5ee6a164720/axial_002.png","assets/T/mri-d55be5ee6a164720/axial_003.png","assets/T/mri-d55be5ee6a164720/axial_004.png","assets/T/mri-d55be5ee6a164720/axial_005.png","assets/T/mri-d55be5ee6a164720/axial_006.png","assets/T/mri-d55be5ee6a164720/axial_007.png","assets/T/mri-d55be5ee6a164720/axial_008.png","assets/T/mri-d55be5ee6a164720/axial_009.png","assets/T/mri-d55be5ee6a164720/axial_010.png","assets/T/mri-d55be5ee6a164720/axial_011.png","assets/T/mri-d55be5ee6a164720/axial_012.png","assets/T/mri-d55be5ee6a164720/axial_013.png","assets/T/mri-d55be5ee6a164720/axial_014.png","assets/T/mri-d55be5ee6a164720/axial_015.png","assets/T/mri-d55be5ee6a164720/axial_016.png","assets/T/mri-d55be5ee6a164720/axial_017.png","assets/T/mri-d55be5ee6a164720/axial_018.png","assets/T/mri-d55be5ee6a164720/axial_019.png","assets/T/mri-d55be5ee6a164720/axial_020.png","assets/T/mri-d55be5ee6a164720/axial_021.png","assets/T/mri-d55be5ee6a164720/axial_022.png","assets/T/mri-d55be5ee6a164720/axial_023.png","assets/T/mri-d55be5ee6a164720/axial_024.png","assets/T/mri-d55be5ee6a164720/axial_025.png","assets/T/mri-d55be5ee6a164720/axial_026.png","assets/T/mri-d55be5ee6a164720/axial_027.png","assets/T/mri-d55be5ee6a164720/axial_028.png","assets/T/mri-d55be5ee6a164720/axial_029.png","assets/T/mri-d55be5ee6a164720/axial_030.png","assets/T/mri-d55be5ee6a164720/axial_031.png","assets/T/mri-d55be5ee6a164720/axial_032.png","assets/T/mri-d55be5ee6a164720/axial_033.png","assets/T/mri-d55be5ee6a164720/axial_034.png","assets/T/mri-d55be5ee6a164720/axial_035.png","assets/T/mri-d55be5ee6a164720/axial_036.png","assets/T/mri-d55be5ee6a164720/axial_037.png","assets/T/mri-d55be5ee6a164720/axial_038.png","assets/T/mri-d55be5ee6a164720/axial_039.png","assets/T/mri-d55be5ee6a164720/axial_040.png","assets/T/mri-d55be5ee6a164720/axial_041.png","assets/T/mri-d55be5ee6a164720/axial_042.png","assets/T/mri-d55be5ee6a164720/coronal_001.png","assets/T/mri-d55be5ee6a164720/coronal_002.png","assets/T/mri-d55be5ee6a164720/coronal_003.png","assets/T/mri-d55be5ee6a164720/coronal_004.png","assets/T/mri-d55be5ee6a164720/coronal_005.png","assets/T/mri-d55be5ee6a164720/coronal_006.png","assets/T/mri-d55be5ee6a164720/coronal_007.png","assets/T/mri-d55be5ee6a164720/coronal_008.png","assets/T/mri-d55be5ee6a164720/coronal_009.png","assets/T/mri-d55be5ee6a164720/coronal_010.png","assets/T/mri-d55be5ee6a164720/coronal_011.png","assets/T/mri-d55be5ee6a164720/coronal_012.png","assets/T/mri-d55be5ee6a164720/coronal_013.png","assets/T/mri-d55be5ee6a164720/coronal_014.png","assets/T/mri-d55be5ee6a164720/coronal_015.png","assets/T/mri-d55be5ee6a164720/coronal_016.png","assets/T/mri-d55be5ee6a164720/coronal_017.png","assets/T/mri-d55be5ee6a164720/coronal_018.png","assets/T/mri-d55be5ee6a164720/coronal_019.png","assets/T/mri-d55be5ee6a164720/coronal_020.png","assets/T/mri-d55be5ee6a164720/coronal_021.png","assets/T/mri-d55be5ee6a164720/coronal_022.png","assets/T/mri-d55be5ee6a164720/coronal_023.png","assets/T/mri-d55be5ee6a164720/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-819452b5910247dc","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 68 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 26 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-819452b5910247dc/axial_001.png","assets/T/mri-819452b5910247dc/axial_002.png","assets/T/mri-819452b5910247dc/axial_003.png","assets/T/mri-819452b5910247dc/axial_004.png","assets/T/mri-819452b5910247dc/axial_005.png","assets/T/mri-819452b5910247dc/axial_006.png","assets/T/mri-819452b5910247dc/axial_007.png","assets/T/mri-819452b5910247dc/axial_008.png","assets/T/mri-819452b5910247dc/axial_009.png","assets/T/mri-819452b5910247dc/axial_010.png","assets/T/mri-819452b5910247dc/axial_011.png","assets/T/mri-819452b5910247dc/axial_012.png","assets/T/mri-819452b5910247dc/axial_013.png","assets/T/mri-819452b5910247dc/axial_014.png","assets/T/mri-819452b5910247dc/axial_015.png","assets/T/mri-819452b5910247dc/axial_016.png","assets/T/mri-819452b5910247dc/axial_017.png","assets/T/mri-819452b5910247dc/axial_018.png","assets/T/mri-819452b5910247dc/axial_019.png","assets/T/mri-819452b5910247dc/axial_020.png","assets/T/mri-819452b5910247dc/axial_021.png","assets/T/mri-819452b5910247dc/axial_022.png","assets/T/mri-819452b5910247dc/axial_023.png","assets/T/mri-819452b5910247dc/axial_024.png","assets/T/mri-819452b5910247dc/axial_025.png","assets/T/mri-819452b5910247dc/axial_026.png","assets/T/mri-819452b5910247dc/axial_027.png","assets/T/mri-819452b5910247dc/axial_028.png","assets/T/mri-819452b5910247dc/axial_029.png","assets/T/mri-819452b5910247dc/axial_030.png","assets/T/mri-819452b5910247dc/axial_031.png","assets/T/mri-819452b5910247dc/axial_032.png","assets/T/mri-819452b5910247dc/axial_033.png","assets/T/mri-819452b5910247dc/axial_034.png","assets/T/mri-819452b5910247dc/axial_035.png","assets/T/mri-819452b5910247dc/axial_036.png","assets/T/mri-819452b5910247dc/axial_037.png","assets/T/mri-819452b5910247dc/axial_038.png","assets/T/mri-819452b5910247dc/axial_039.png","assets/T/mri-819452b5910247dc/axial_040.png","assets/T/mri-819452b5910247dc/axial_041.png","assets/T/mri-819452b5910247dc/axial_042.png","assets/T/mri-819452b5910247dc/coronal_001.png","assets/T/mri-819452b5910247dc/coronal_002.png","assets/T/mri-819452b5910247dc/coronal_003.png","assets/T/mri-819452b5910247dc/coronal_004.png","assets/T/mri-819452b5910247dc/coronal_005.png","assets/T/mri-819452b5910247dc/coronal_006.png","assets/T/mri-819452b5910247dc/coronal_007.png","assets/T/mri-819452b5910247dc/coronal_008.png","assets/T/mri-819452b5910247dc/coronal_009.png","assets/T/mri-819452b5910247dc/coronal_010.png","assets/T/mri-819452b5910247dc/coronal_011.png","assets/T/mri-819452b5910247dc/coronal_012.png","assets/T/mri-819452b5910247dc/coronal_013.png","assets/T/mri-819452b5910247dc/coronal_014.png","assets/T/mri-819452b5910247dc/coronal_015.png","assets/T/mri-819452b5910247dc/coronal_016.png","assets/T/mri-819452b5910247dc/coronal_017.png","assets/T/mri-819452b5910247dc/coronal_018.png","assets/T/mri-819452b5910247dc/coronal_019.png","assets/T/mri-819452b5910247dc/coronal_020.png","assets/T/mri-819452b5910247dc/coronal_021.png","assets/T/mri-819452b5910247dc/coronal_022.png","assets/T/mri-819452b5910247dc/coronal_023.png","assets/T/mri-819452b5910247dc/coronal_024.png","assets/T/mri-819452b5910247dc/coronal_025.png","assets/T/mri-819452b5910247dc/coronal_026.png"],"stage_edition":8}
+{"id":"L3-T300:mri-d49832b605474bfa","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-d49832b605474bfa/axial_001.png","assets/T/mri-d49832b605474bfa/axial_002.png","assets/T/mri-d49832b605474bfa/axial_003.png","assets/T/mri-d49832b605474bfa/axial_004.png","assets/T/mri-d49832b605474bfa/axial_005.png","assets/T/mri-d49832b605474bfa/axial_006.png","assets/T/mri-d49832b605474bfa/axial_007.png","assets/T/mri-d49832b605474bfa/axial_008.png","assets/T/mri-d49832b605474bfa/axial_009.png","assets/T/mri-d49832b605474bfa/axial_010.png","assets/T/mri-d49832b605474bfa/axial_011.png","assets/T/mri-d49832b605474bfa/axial_012.png","assets/T/mri-d49832b605474bfa/axial_013.png","assets/T/mri-d49832b605474bfa/axial_014.png","assets/T/mri-d49832b605474bfa/axial_015.png","assets/T/mri-d49832b605474bfa/axial_016.png","assets/T/mri-d49832b605474bfa/axial_017.png","assets/T/mri-d49832b605474bfa/axial_018.png","assets/T/mri-d49832b605474bfa/axial_019.png","assets/T/mri-d49832b605474bfa/axial_020.png","assets/T/mri-d49832b605474bfa/axial_021.png","assets/T/mri-d49832b605474bfa/axial_022.png","assets/T/mri-d49832b605474bfa/axial_023.png","assets/T/mri-d49832b605474bfa/axial_024.png","assets/T/mri-d49832b605474bfa/axial_025.png","assets/T/mri-d49832b605474bfa/axial_026.png","assets/T/mri-d49832b605474bfa/axial_027.png","assets/T/mri-d49832b605474bfa/axial_028.png","assets/T/mri-d49832b605474bfa/axial_029.png","assets/T/mri-d49832b605474bfa/axial_030.png","assets/T/mri-d49832b605474bfa/axial_031.png","assets/T/mri-d49832b605474bfa/axial_032.png","assets/T/mri-d49832b605474bfa/axial_033.png","assets/T/mri-d49832b605474bfa/axial_034.png","assets/T/mri-d49832b605474bfa/axial_035.png","assets/T/mri-d49832b605474bfa/axial_036.png","assets/T/mri-d49832b605474bfa/axial_037.png","assets/T/mri-d49832b605474bfa/axial_038.png","assets/T/mri-d49832b605474bfa/axial_039.png","assets/T/mri-d49832b605474bfa/axial_040.png","assets/T/mri-d49832b605474bfa/coronal_001.png","assets/T/mri-d49832b605474bfa/coronal_002.png","assets/T/mri-d49832b605474bfa/coronal_003.png","assets/T/mri-d49832b605474bfa/coronal_004.png","assets/T/mri-d49832b605474bfa/coronal_005.png","assets/T/mri-d49832b605474bfa/coronal_006.png","assets/T/mri-d49832b605474bfa/coronal_007.png","assets/T/mri-d49832b605474bfa/coronal_008.png","assets/T/mri-d49832b605474bfa/coronal_009.png","assets/T/mri-d49832b605474bfa/coronal_010.png","assets/T/mri-d49832b605474bfa/coronal_011.png","assets/T/mri-d49832b605474bfa/coronal_012.png","assets/T/mri-d49832b605474bfa/coronal_013.png","assets/T/mri-d49832b605474bfa/coronal_014.png","assets/T/mri-d49832b605474bfa/coronal_015.png","assets/T/mri-d49832b605474bfa/coronal_016.png","assets/T/mri-d49832b605474bfa/coronal_017.png","assets/T/mri-d49832b605474bfa/coronal_018.png","assets/T/mri-d49832b605474bfa/coronal_019.png","assets/T/mri-d49832b605474bfa/coronal_020.png","assets/T/mri-d49832b605474bfa/coronal_021.png","assets/T/mri-d49832b605474bfa/coronal_022.png","assets/T/mri-d49832b605474bfa/coronal_023.png","assets/T/mri-d49832b605474bfa/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-2bedb86c0d404023","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-2bedb86c0d404023/axial_001.png","assets/T/mri-2bedb86c0d404023/axial_002.png","assets/T/mri-2bedb86c0d404023/axial_003.png","assets/T/mri-2bedb86c0d404023/axial_004.png","assets/T/mri-2bedb86c0d404023/axial_005.png","assets/T/mri-2bedb86c0d404023/axial_006.png","assets/T/mri-2bedb86c0d404023/axial_007.png","assets/T/mri-2bedb86c0d404023/axial_008.png","assets/T/mri-2bedb86c0d404023/axial_009.png","assets/T/mri-2bedb86c0d404023/axial_010.png","assets/T/mri-2bedb86c0d404023/axial_011.png","assets/T/mri-2bedb86c0d404023/axial_012.png","assets/T/mri-2bedb86c0d404023/axial_013.png","assets/T/mri-2bedb86c0d404023/axial_014.png","assets/T/mri-2bedb86c0d404023/axial_015.png","assets/T/mri-2bedb86c0d404023/axial_016.png","assets/T/mri-2bedb86c0d404023/axial_017.png","assets/T/mri-2bedb86c0d404023/axial_018.png","assets/T/mri-2bedb86c0d404023/axial_019.png","assets/T/mri-2bedb86c0d404023/axial_020.png","assets/T/mri-2bedb86c0d404023/axial_021.png","assets/T/mri-2bedb86c0d404023/axial_022.png","assets/T/mri-2bedb86c0d404023/axial_023.png","assets/T/mri-2bedb86c0d404023/axial_024.png","assets/T/mri-2bedb86c0d404023/axial_025.png","assets/T/mri-2bedb86c0d404023/axial_026.png","assets/T/mri-2bedb86c0d404023/axial_027.png","assets/T/mri-2bedb86c0d404023/axial_028.png","assets/T/mri-2bedb86c0d404023/axial_029.png","assets/T/mri-2bedb86c0d404023/axial_030.png","assets/T/mri-2bedb86c0d404023/axial_031.png","assets/T/mri-2bedb86c0d404023/axial_032.png","assets/T/mri-2bedb86c0d404023/axial_033.png","assets/T/mri-2bedb86c0d404023/axial_034.png","assets/T/mri-2bedb86c0d404023/axial_035.png","assets/T/mri-2bedb86c0d404023/axial_036.png","assets/T/mri-2bedb86c0d404023/axial_037.png","assets/T/mri-2bedb86c0d404023/axial_038.png","assets/T/mri-2bedb86c0d404023/axial_039.png","assets/T/mri-2bedb86c0d404023/axial_040.png","assets/T/mri-2bedb86c0d404023/axial_041.png","assets/T/mri-2bedb86c0d404023/axial_042.png","assets/T/mri-2bedb86c0d404023/coronal_001.png","assets/T/mri-2bedb86c0d404023/coronal_002.png","assets/T/mri-2bedb86c0d404023/coronal_003.png","assets/T/mri-2bedb86c0d404023/coronal_004.png","assets/T/mri-2bedb86c0d404023/coronal_005.png","assets/T/mri-2bedb86c0d404023/coronal_006.png","assets/T/mri-2bedb86c0d404023/coronal_007.png","assets/T/mri-2bedb86c0d404023/coronal_008.png","assets/T/mri-2bedb86c0d404023/coronal_009.png","assets/T/mri-2bedb86c0d404023/coronal_010.png","assets/T/mri-2bedb86c0d404023/coronal_011.png","assets/T/mri-2bedb86c0d404023/coronal_012.png","assets/T/mri-2bedb86c0d404023/coronal_013.png","assets/T/mri-2bedb86c0d404023/coronal_014.png","assets/T/mri-2bedb86c0d404023/coronal_015.png","assets/T/mri-2bedb86c0d404023/coronal_016.png","assets/T/mri-2bedb86c0d404023/coronal_017.png","assets/T/mri-2bedb86c0d404023/coronal_018.png","assets/T/mri-2bedb86c0d404023/coronal_019.png","assets/T/mri-2bedb86c0d404023/coronal_020.png","assets/T/mri-2bedb86c0d404023/coronal_021.png","assets/T/mri-2bedb86c0d404023/coronal_022.png","assets/T/mri-2bedb86c0d404023/coronal_023.png","assets/T/mri-2bedb86c0d404023/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-0f94f5ebff6c4b23","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-0f94f5ebff6c4b23/axial_001.png","assets/T/mri-0f94f5ebff6c4b23/axial_002.png","assets/T/mri-0f94f5ebff6c4b23/axial_003.png","assets/T/mri-0f94f5ebff6c4b23/axial_004.png","assets/T/mri-0f94f5ebff6c4b23/axial_005.png","assets/T/mri-0f94f5ebff6c4b23/axial_006.png","assets/T/mri-0f94f5ebff6c4b23/axial_007.png","assets/T/mri-0f94f5ebff6c4b23/axial_008.png","assets/T/mri-0f94f5ebff6c4b23/axial_009.png","assets/T/mri-0f94f5ebff6c4b23/axial_010.png","assets/T/mri-0f94f5ebff6c4b23/axial_011.png","assets/T/mri-0f94f5ebff6c4b23/axial_012.png","assets/T/mri-0f94f5ebff6c4b23/axial_013.png","assets/T/mri-0f94f5ebff6c4b23/axial_014.png","assets/T/mri-0f94f5ebff6c4b23/axial_015.png","assets/T/mri-0f94f5ebff6c4b23/axial_016.png","assets/T/mri-0f94f5ebff6c4b23/axial_017.png","assets/T/mri-0f94f5ebff6c4b23/axial_018.png","assets/T/mri-0f94f5ebff6c4b23/axial_019.png","assets/T/mri-0f94f5ebff6c4b23/axial_020.png","assets/T/mri-0f94f5ebff6c4b23/axial_021.png","assets/T/mri-0f94f5ebff6c4b23/axial_022.png","assets/T/mri-0f94f5ebff6c4b23/axial_023.png","assets/T/mri-0f94f5ebff6c4b23/axial_024.png","assets/T/mri-0f94f5ebff6c4b23/axial_025.png","assets/T/mri-0f94f5ebff6c4b23/axial_026.png","assets/T/mri-0f94f5ebff6c4b23/axial_027.png","assets/T/mri-0f94f5ebff6c4b23/axial_028.png","assets/T/mri-0f94f5ebff6c4b23/axial_029.png","assets/T/mri-0f94f5ebff6c4b23/axial_030.png","assets/T/mri-0f94f5ebff6c4b23/axial_031.png","assets/T/mri-0f94f5ebff6c4b23/axial_032.png","assets/T/mri-0f94f5ebff6c4b23/axial_033.png","assets/T/mri-0f94f5ebff6c4b23/axial_034.png","assets/T/mri-0f94f5ebff6c4b23/axial_035.png","assets/T/mri-0f94f5ebff6c4b23/axial_036.png","assets/T/mri-0f94f5ebff6c4b23/axial_037.png","assets/T/mri-0f94f5ebff6c4b23/axial_038.png","assets/T/mri-0f94f5ebff6c4b23/axial_039.png","assets/T/mri-0f94f5ebff6c4b23/axial_040.png","assets/T/mri-0f94f5ebff6c4b23/coronal_001.png","assets/T/mri-0f94f5ebff6c4b23/coronal_002.png","assets/T/mri-0f94f5ebff6c4b23/coronal_003.png","assets/T/mri-0f94f5ebff6c4b23/coronal_004.png","assets/T/mri-0f94f5ebff6c4b23/coronal_005.png","assets/T/mri-0f94f5ebff6c4b23/coronal_006.png","assets/T/mri-0f94f5ebff6c4b23/coronal_007.png","assets/T/mri-0f94f5ebff6c4b23/coronal_008.png","assets/T/mri-0f94f5ebff6c4b23/coronal_009.png","assets/T/mri-0f94f5ebff6c4b23/coronal_010.png","assets/T/mri-0f94f5ebff6c4b23/coronal_011.png","assets/T/mri-0f94f5ebff6c4b23/coronal_012.png","assets/T/mri-0f94f5ebff6c4b23/coronal_013.png","assets/T/mri-0f94f5ebff6c4b23/coronal_014.png","assets/T/mri-0f94f5ebff6c4b23/coronal_015.png","assets/T/mri-0f94f5ebff6c4b23/coronal_016.png","assets/T/mri-0f94f5ebff6c4b23/coronal_017.png","assets/T/mri-0f94f5ebff6c4b23/coronal_018.png","assets/T/mri-0f94f5ebff6c4b23/coronal_019.png","assets/T/mri-0f94f5ebff6c4b23/coronal_020.png","assets/T/mri-0f94f5ebff6c4b23/coronal_021.png","assets/T/mri-0f94f5ebff6c4b23/coronal_022.png","assets/T/mri-0f94f5ebff6c4b23/coronal_023.png","assets/T/mri-0f94f5ebff6c4b23/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-2248452041c244a6","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-2248452041c244a6/axial_001.png","assets/T/mri-2248452041c244a6/axial_002.png","assets/T/mri-2248452041c244a6/axial_003.png","assets/T/mri-2248452041c244a6/axial_004.png","assets/T/mri-2248452041c244a6/axial_005.png","assets/T/mri-2248452041c244a6/axial_006.png","assets/T/mri-2248452041c244a6/axial_007.png","assets/T/mri-2248452041c244a6/axial_008.png","assets/T/mri-2248452041c244a6/axial_009.png","assets/T/mri-2248452041c244a6/axial_010.png","assets/T/mri-2248452041c244a6/axial_011.png","assets/T/mri-2248452041c244a6/axial_012.png","assets/T/mri-2248452041c244a6/axial_013.png","assets/T/mri-2248452041c244a6/axial_014.png","assets/T/mri-2248452041c244a6/axial_015.png","assets/T/mri-2248452041c244a6/axial_016.png","assets/T/mri-2248452041c244a6/axial_017.png","assets/T/mri-2248452041c244a6/axial_018.png","assets/T/mri-2248452041c244a6/axial_019.png","assets/T/mri-2248452041c244a6/axial_020.png","assets/T/mri-2248452041c244a6/axial_021.png","assets/T/mri-2248452041c244a6/axial_022.png","assets/T/mri-2248452041c244a6/axial_023.png","assets/T/mri-2248452041c244a6/axial_024.png","assets/T/mri-2248452041c244a6/axial_025.png","assets/T/mri-2248452041c244a6/axial_026.png","assets/T/mri-2248452041c244a6/axial_027.png","assets/T/mri-2248452041c244a6/axial_028.png","assets/T/mri-2248452041c244a6/axial_029.png","assets/T/mri-2248452041c244a6/axial_030.png","assets/T/mri-2248452041c244a6/axial_031.png","assets/T/mri-2248452041c244a6/axial_032.png","assets/T/mri-2248452041c244a6/axial_033.png","assets/T/mri-2248452041c244a6/axial_034.png","assets/T/mri-2248452041c244a6/axial_035.png","assets/T/mri-2248452041c244a6/axial_036.png","assets/T/mri-2248452041c244a6/axial_037.png","assets/T/mri-2248452041c244a6/axial_038.png","assets/T/mri-2248452041c244a6/axial_039.png","assets/T/mri-2248452041c244a6/axial_040.png","assets/T/mri-2248452041c244a6/axial_041.png","assets/T/mri-2248452041c244a6/axial_042.png","assets/T/mri-2248452041c244a6/coronal_001.png","assets/T/mri-2248452041c244a6/coronal_002.png","assets/T/mri-2248452041c244a6/coronal_003.png","assets/T/mri-2248452041c244a6/coronal_004.png","assets/T/mri-2248452041c244a6/coronal_005.png","assets/T/mri-2248452041c244a6/coronal_006.png","assets/T/mri-2248452041c244a6/coronal_007.png","assets/T/mri-2248452041c244a6/coronal_008.png","assets/T/mri-2248452041c244a6/coronal_009.png","assets/T/mri-2248452041c244a6/coronal_010.png","assets/T/mri-2248452041c244a6/coronal_011.png","assets/T/mri-2248452041c244a6/coronal_012.png","assets/T/mri-2248452041c244a6/coronal_013.png","assets/T/mri-2248452041c244a6/coronal_014.png","assets/T/mri-2248452041c244a6/coronal_015.png","assets/T/mri-2248452041c244a6/coronal_016.png","assets/T/mri-2248452041c244a6/coronal_017.png","assets/T/mri-2248452041c244a6/coronal_018.png","assets/T/mri-2248452041c244a6/coronal_019.png","assets/T/mri-2248452041c244a6/coronal_020.png","assets/T/mri-2248452041c244a6/coronal_021.png","assets/T/mri-2248452041c244a6/coronal_022.png","assets/T/mri-2248452041c244a6/coronal_023.png","assets/T/mri-2248452041c244a6/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-a75f78b1241a410a","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 26 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-a75f78b1241a410a/axial_001.png","assets/T/mri-a75f78b1241a410a/axial_002.png","assets/T/mri-a75f78b1241a410a/axial_003.png","assets/T/mri-a75f78b1241a410a/axial_004.png","assets/T/mri-a75f78b1241a410a/axial_005.png","assets/T/mri-a75f78b1241a410a/axial_006.png","assets/T/mri-a75f78b1241a410a/axial_007.png","assets/T/mri-a75f78b1241a410a/axial_008.png","assets/T/mri-a75f78b1241a410a/axial_009.png","assets/T/mri-a75f78b1241a410a/axial_010.png","assets/T/mri-a75f78b1241a410a/axial_011.png","assets/T/mri-a75f78b1241a410a/axial_012.png","assets/T/mri-a75f78b1241a410a/axial_013.png","assets/T/mri-a75f78b1241a410a/axial_014.png","assets/T/mri-a75f78b1241a410a/axial_015.png","assets/T/mri-a75f78b1241a410a/axial_016.png","assets/T/mri-a75f78b1241a410a/axial_017.png","assets/T/mri-a75f78b1241a410a/axial_018.png","assets/T/mri-a75f78b1241a410a/axial_019.png","assets/T/mri-a75f78b1241a410a/axial_020.png","assets/T/mri-a75f78b1241a410a/axial_021.png","assets/T/mri-a75f78b1241a410a/axial_022.png","assets/T/mri-a75f78b1241a410a/axial_023.png","assets/T/mri-a75f78b1241a410a/axial_024.png","assets/T/mri-a75f78b1241a410a/axial_025.png","assets/T/mri-a75f78b1241a410a/axial_026.png","assets/T/mri-a75f78b1241a410a/axial_027.png","assets/T/mri-a75f78b1241a410a/axial_028.png","assets/T/mri-a75f78b1241a410a/axial_029.png","assets/T/mri-a75f78b1241a410a/axial_030.png","assets/T/mri-a75f78b1241a410a/axial_031.png","assets/T/mri-a75f78b1241a410a/axial_032.png","assets/T/mri-a75f78b1241a410a/axial_033.png","assets/T/mri-a75f78b1241a410a/axial_034.png","assets/T/mri-a75f78b1241a410a/axial_035.png","assets/T/mri-a75f78b1241a410a/axial_036.png","assets/T/mri-a75f78b1241a410a/axial_037.png","assets/T/mri-a75f78b1241a410a/axial_038.png","assets/T/mri-a75f78b1241a410a/axial_039.png","assets/T/mri-a75f78b1241a410a/axial_040.png","assets/T/mri-a75f78b1241a410a/coronal_001.png","assets/T/mri-a75f78b1241a410a/coronal_002.png","assets/T/mri-a75f78b1241a410a/coronal_003.png","assets/T/mri-a75f78b1241a410a/coronal_004.png","assets/T/mri-a75f78b1241a410a/coronal_005.png","assets/T/mri-a75f78b1241a410a/coronal_006.png","assets/T/mri-a75f78b1241a410a/coronal_007.png","assets/T/mri-a75f78b1241a410a/coronal_008.png","assets/T/mri-a75f78b1241a410a/coronal_009.png","assets/T/mri-a75f78b1241a410a/coronal_010.png","assets/T/mri-a75f78b1241a410a/coronal_011.png","assets/T/mri-a75f78b1241a410a/coronal_012.png","assets/T/mri-a75f78b1241a410a/coronal_013.png","assets/T/mri-a75f78b1241a410a/coronal_014.png","assets/T/mri-a75f78b1241a410a/coronal_015.png","assets/T/mri-a75f78b1241a410a/coronal_016.png","assets/T/mri-a75f78b1241a410a/coronal_017.png","assets/T/mri-a75f78b1241a410a/coronal_018.png","assets/T/mri-a75f78b1241a410a/coronal_019.png","assets/T/mri-a75f78b1241a410a/coronal_020.png","assets/T/mri-a75f78b1241a410a/coronal_021.png","assets/T/mri-a75f78b1241a410a/coronal_022.png","assets/T/mri-a75f78b1241a410a/coronal_023.png","assets/T/mri-a75f78b1241a410a/coronal_024.png","assets/T/mri-a75f78b1241a410a/coronal_025.png","assets/T/mri-a75f78b1241a410a/coronal_026.png"],"stage_edition":8}
+{"id":"L3-T300:mri-ca4047d888404407","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 62 张图，均来自同一次检查。\n\n- 前 38 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-ca4047d888404407/axial_001.png","assets/T/mri-ca4047d888404407/axial_002.png","assets/T/mri-ca4047d888404407/axial_003.png","assets/T/mri-ca4047d888404407/axial_004.png","assets/T/mri-ca4047d888404407/axial_005.png","assets/T/mri-ca4047d888404407/axial_006.png","assets/T/mri-ca4047d888404407/axial_007.png","assets/T/mri-ca4047d888404407/axial_008.png","assets/T/mri-ca4047d888404407/axial_009.png","assets/T/mri-ca4047d888404407/axial_010.png","assets/T/mri-ca4047d888404407/axial_011.png","assets/T/mri-ca4047d888404407/axial_012.png","assets/T/mri-ca4047d888404407/axial_013.png","assets/T/mri-ca4047d888404407/axial_014.png","assets/T/mri-ca4047d888404407/axial_015.png","assets/T/mri-ca4047d888404407/axial_016.png","assets/T/mri-ca4047d888404407/axial_017.png","assets/T/mri-ca4047d888404407/axial_018.png","assets/T/mri-ca4047d888404407/axial_019.png","assets/T/mri-ca4047d888404407/axial_020.png","assets/T/mri-ca4047d888404407/axial_021.png","assets/T/mri-ca4047d888404407/axial_022.png","assets/T/mri-ca4047d888404407/axial_023.png","assets/T/mri-ca4047d888404407/axial_024.png","assets/T/mri-ca4047d888404407/axial_025.png","assets/T/mri-ca4047d888404407/axial_026.png","assets/T/mri-ca4047d888404407/axial_027.png","assets/T/mri-ca4047d888404407/axial_028.png","assets/T/mri-ca4047d888404407/axial_029.png","assets/T/mri-ca4047d888404407/axial_030.png","assets/T/mri-ca4047d888404407/axial_031.png","assets/T/mri-ca4047d888404407/axial_032.png","assets/T/mri-ca4047d888404407/axial_033.png","assets/T/mri-ca4047d888404407/axial_034.png","assets/T/mri-ca4047d888404407/axial_035.png","assets/T/mri-ca4047d888404407/axial_036.png","assets/T/mri-ca4047d888404407/axial_037.png","assets/T/mri-ca4047d888404407/axial_038.png","assets/T/mri-ca4047d888404407/coronal_001.png","assets/T/mri-ca4047d888404407/coronal_002.png","assets/T/mri-ca4047d888404407/coronal_003.png","assets/T/mri-ca4047d888404407/coronal_004.png","assets/T/mri-ca4047d888404407/coronal_005.png","assets/T/mri-ca4047d888404407/coronal_006.png","assets/T/mri-ca4047d888404407/coronal_007.png","assets/T/mri-ca4047d888404407/coronal_008.png","assets/T/mri-ca4047d888404407/coronal_009.png","assets/T/mri-ca4047d888404407/coronal_010.png","assets/T/mri-ca4047d888404407/coronal_011.png","assets/T/mri-ca4047d888404407/coronal_012.png","assets/T/mri-ca4047d888404407/coronal_013.png","assets/T/mri-ca4047d888404407/coronal_014.png","assets/T/mri-ca4047d888404407/coronal_015.png","assets/T/mri-ca4047d888404407/coronal_016.png","assets/T/mri-ca4047d888404407/coronal_017.png","assets/T/mri-ca4047d888404407/coronal_018.png","assets/T/mri-ca4047d888404407/coronal_019.png","assets/T/mri-ca4047d888404407/coronal_020.png","assets/T/mri-ca4047d888404407/coronal_021.png","assets/T/mri-ca4047d888404407/coronal_022.png","assets/T/mri-ca4047d888404407/coronal_023.png","assets/T/mri-ca4047d888404407/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-5bef6cc79ec84d5f","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-5bef6cc79ec84d5f/axial_001.png","assets/T/mri-5bef6cc79ec84d5f/axial_002.png","assets/T/mri-5bef6cc79ec84d5f/axial_003.png","assets/T/mri-5bef6cc79ec84d5f/axial_004.png","assets/T/mri-5bef6cc79ec84d5f/axial_005.png","assets/T/mri-5bef6cc79ec84d5f/axial_006.png","assets/T/mri-5bef6cc79ec84d5f/axial_007.png","assets/T/mri-5bef6cc79ec84d5f/axial_008.png","assets/T/mri-5bef6cc79ec84d5f/axial_009.png","assets/T/mri-5bef6cc79ec84d5f/axial_010.png","assets/T/mri-5bef6cc79ec84d5f/axial_011.png","assets/T/mri-5bef6cc79ec84d5f/axial_012.png","assets/T/mri-5bef6cc79ec84d5f/axial_013.png","assets/T/mri-5bef6cc79ec84d5f/axial_014.png","assets/T/mri-5bef6cc79ec84d5f/axial_015.png","assets/T/mri-5bef6cc79ec84d5f/axial_016.png","assets/T/mri-5bef6cc79ec84d5f/axial_017.png","assets/T/mri-5bef6cc79ec84d5f/axial_018.png","assets/T/mri-5bef6cc79ec84d5f/axial_019.png","assets/T/mri-5bef6cc79ec84d5f/axial_020.png","assets/T/mri-5bef6cc79ec84d5f/axial_021.png","assets/T/mri-5bef6cc79ec84d5f/axial_022.png","assets/T/mri-5bef6cc79ec84d5f/axial_023.png","assets/T/mri-5bef6cc79ec84d5f/axial_024.png","assets/T/mri-5bef6cc79ec84d5f/axial_025.png","assets/T/mri-5bef6cc79ec84d5f/axial_026.png","assets/T/mri-5bef6cc79ec84d5f/axial_027.png","assets/T/mri-5bef6cc79ec84d5f/axial_028.png","assets/T/mri-5bef6cc79ec84d5f/axial_029.png","assets/T/mri-5bef6cc79ec84d5f/axial_030.png","assets/T/mri-5bef6cc79ec84d5f/axial_031.png","assets/T/mri-5bef6cc79ec84d5f/axial_032.png","assets/T/mri-5bef6cc79ec84d5f/axial_033.png","assets/T/mri-5bef6cc79ec84d5f/axial_034.png","assets/T/mri-5bef6cc79ec84d5f/axial_035.png","assets/T/mri-5bef6cc79ec84d5f/axial_036.png","assets/T/mri-5bef6cc79ec84d5f/axial_037.png","assets/T/mri-5bef6cc79ec84d5f/axial_038.png","assets/T/mri-5bef6cc79ec84d5f/axial_039.png","assets/T/mri-5bef6cc79ec84d5f/axial_040.png","assets/T/mri-5bef6cc79ec84d5f/coronal_001.png","assets/T/mri-5bef6cc79ec84d5f/coronal_002.png","assets/T/mri-5bef6cc79ec84d5f/coronal_003.png","assets/T/mri-5bef6cc79ec84d5f/coronal_004.png","assets/T/mri-5bef6cc79ec84d5f/coronal_005.png","assets/T/mri-5bef6cc79ec84d5f/coronal_006.png","assets/T/mri-5bef6cc79ec84d5f/coronal_007.png","assets/T/mri-5bef6cc79ec84d5f/coronal_008.png","assets/T/mri-5bef6cc79ec84d5f/coronal_009.png","assets/T/mri-5bef6cc79ec84d5f/coronal_010.png","assets/T/mri-5bef6cc79ec84d5f/coronal_011.png","assets/T/mri-5bef6cc79ec84d5f/coronal_012.png","assets/T/mri-5bef6cc79ec84d5f/coronal_013.png","assets/T/mri-5bef6cc79ec84d5f/coronal_014.png","assets/T/mri-5bef6cc79ec84d5f/coronal_015.png","assets/T/mri-5bef6cc79ec84d5f/coronal_016.png","assets/T/mri-5bef6cc79ec84d5f/coronal_017.png","assets/T/mri-5bef6cc79ec84d5f/coronal_018.png","assets/T/mri-5bef6cc79ec84d5f/coronal_019.png","assets/T/mri-5bef6cc79ec84d5f/coronal_020.png","assets/T/mri-5bef6cc79ec84d5f/coronal_021.png","assets/T/mri-5bef6cc79ec84d5f/coronal_022.png","assets/T/mri-5bef6cc79ec84d5f/coronal_023.png","assets/T/mri-5bef6cc79ec84d5f/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-66a44b250d614109","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-66a44b250d614109/axial_001.png","assets/T/mri-66a44b250d614109/axial_002.png","assets/T/mri-66a44b250d614109/axial_003.png","assets/T/mri-66a44b250d614109/axial_004.png","assets/T/mri-66a44b250d614109/axial_005.png","assets/T/mri-66a44b250d614109/axial_006.png","assets/T/mri-66a44b250d614109/axial_007.png","assets/T/mri-66a44b250d614109/axial_008.png","assets/T/mri-66a44b250d614109/axial_009.png","assets/T/mri-66a44b250d614109/axial_010.png","assets/T/mri-66a44b250d614109/axial_011.png","assets/T/mri-66a44b250d614109/axial_012.png","assets/T/mri-66a44b250d614109/axial_013.png","assets/T/mri-66a44b250d614109/axial_014.png","assets/T/mri-66a44b250d614109/axial_015.png","assets/T/mri-66a44b250d614109/axial_016.png","assets/T/mri-66a44b250d614109/axial_017.png","assets/T/mri-66a44b250d614109/axial_018.png","assets/T/mri-66a44b250d614109/axial_019.png","assets/T/mri-66a44b250d614109/axial_020.png","assets/T/mri-66a44b250d614109/axial_021.png","assets/T/mri-66a44b250d614109/axial_022.png","assets/T/mri-66a44b250d614109/axial_023.png","assets/T/mri-66a44b250d614109/axial_024.png","assets/T/mri-66a44b250d614109/axial_025.png","assets/T/mri-66a44b250d614109/axial_026.png","assets/T/mri-66a44b250d614109/axial_027.png","assets/T/mri-66a44b250d614109/axial_028.png","assets/T/mri-66a44b250d614109/axial_029.png","assets/T/mri-66a44b250d614109/axial_030.png","assets/T/mri-66a44b250d614109/axial_031.png","assets/T/mri-66a44b250d614109/axial_032.png","assets/T/mri-66a44b250d614109/axial_033.png","assets/T/mri-66a44b250d614109/axial_034.png","assets/T/mri-66a44b250d614109/axial_035.png","assets/T/mri-66a44b250d614109/axial_036.png","assets/T/mri-66a44b250d614109/axial_037.png","assets/T/mri-66a44b250d614109/axial_038.png","assets/T/mri-66a44b250d614109/axial_039.png","assets/T/mri-66a44b250d614109/axial_040.png","assets/T/mri-66a44b250d614109/axial_041.png","assets/T/mri-66a44b250d614109/axial_042.png","assets/T/mri-66a44b250d614109/coronal_001.png","assets/T/mri-66a44b250d614109/coronal_002.png","assets/T/mri-66a44b250d614109/coronal_003.png","assets/T/mri-66a44b250d614109/coronal_004.png","assets/T/mri-66a44b250d614109/coronal_005.png","assets/T/mri-66a44b250d614109/coronal_006.png","assets/T/mri-66a44b250d614109/coronal_007.png","assets/T/mri-66a44b250d614109/coronal_008.png","assets/T/mri-66a44b250d614109/coronal_009.png","assets/T/mri-66a44b250d614109/coronal_010.png","assets/T/mri-66a44b250d614109/coronal_011.png","assets/T/mri-66a44b250d614109/coronal_012.png","assets/T/mri-66a44b250d614109/coronal_013.png","assets/T/mri-66a44b250d614109/coronal_014.png","assets/T/mri-66a44b250d614109/coronal_015.png","assets/T/mri-66a44b250d614109/coronal_016.png","assets/T/mri-66a44b250d614109/coronal_017.png","assets/T/mri-66a44b250d614109/coronal_018.png","assets/T/mri-66a44b250d614109/coronal_019.png","assets/T/mri-66a44b250d614109/coronal_020.png","assets/T/mri-66a44b250d614109/coronal_021.png","assets/T/mri-66a44b250d614109/coronal_022.png","assets/T/mri-66a44b250d614109/coronal_023.png","assets/T/mri-66a44b250d614109/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-fc63c9cacf214122","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-fc63c9cacf214122/axial_001.png","assets/T/mri-fc63c9cacf214122/axial_002.png","assets/T/mri-fc63c9cacf214122/axial_003.png","assets/T/mri-fc63c9cacf214122/axial_004.png","assets/T/mri-fc63c9cacf214122/axial_005.png","assets/T/mri-fc63c9cacf214122/axial_006.png","assets/T/mri-fc63c9cacf214122/axial_007.png","assets/T/mri-fc63c9cacf214122/axial_008.png","assets/T/mri-fc63c9cacf214122/axial_009.png","assets/T/mri-fc63c9cacf214122/axial_010.png","assets/T/mri-fc63c9cacf214122/axial_011.png","assets/T/mri-fc63c9cacf214122/axial_012.png","assets/T/mri-fc63c9cacf214122/axial_013.png","assets/T/mri-fc63c9cacf214122/axial_014.png","assets/T/mri-fc63c9cacf214122/axial_015.png","assets/T/mri-fc63c9cacf214122/axial_016.png","assets/T/mri-fc63c9cacf214122/axial_017.png","assets/T/mri-fc63c9cacf214122/axial_018.png","assets/T/mri-fc63c9cacf214122/axial_019.png","assets/T/mri-fc63c9cacf214122/axial_020.png","assets/T/mri-fc63c9cacf214122/axial_021.png","assets/T/mri-fc63c9cacf214122/axial_022.png","assets/T/mri-fc63c9cacf214122/axial_023.png","assets/T/mri-fc63c9cacf214122/axial_024.png","assets/T/mri-fc63c9cacf214122/axial_025.png","assets/T/mri-fc63c9cacf214122/axial_026.png","assets/T/mri-fc63c9cacf214122/axial_027.png","assets/T/mri-fc63c9cacf214122/axial_028.png","assets/T/mri-fc63c9cacf214122/axial_029.png","assets/T/mri-fc63c9cacf214122/axial_030.png","assets/T/mri-fc63c9cacf214122/axial_031.png","assets/T/mri-fc63c9cacf214122/axial_032.png","assets/T/mri-fc63c9cacf214122/axial_033.png","assets/T/mri-fc63c9cacf214122/axial_034.png","assets/T/mri-fc63c9cacf214122/axial_035.png","assets/T/mri-fc63c9cacf214122/axial_036.png","assets/T/mri-fc63c9cacf214122/axial_037.png","assets/T/mri-fc63c9cacf214122/axial_038.png","assets/T/mri-fc63c9cacf214122/axial_039.png","assets/T/mri-fc63c9cacf214122/axial_040.png","assets/T/mri-fc63c9cacf214122/axial_041.png","assets/T/mri-fc63c9cacf214122/axial_042.png","assets/T/mri-fc63c9cacf214122/coronal_001.png","assets/T/mri-fc63c9cacf214122/coronal_002.png","assets/T/mri-fc63c9cacf214122/coronal_003.png","assets/T/mri-fc63c9cacf214122/coronal_004.png","assets/T/mri-fc63c9cacf214122/coronal_005.png","assets/T/mri-fc63c9cacf214122/coronal_006.png","assets/T/mri-fc63c9cacf214122/coronal_007.png","assets/T/mri-fc63c9cacf214122/coronal_008.png","assets/T/mri-fc63c9cacf214122/coronal_009.png","assets/T/mri-fc63c9cacf214122/coronal_010.png","assets/T/mri-fc63c9cacf214122/coronal_011.png","assets/T/mri-fc63c9cacf214122/coronal_012.png","assets/T/mri-fc63c9cacf214122/coronal_013.png","assets/T/mri-fc63c9cacf214122/coronal_014.png","assets/T/mri-fc63c9cacf214122/coronal_015.png","assets/T/mri-fc63c9cacf214122/coronal_016.png","assets/T/mri-fc63c9cacf214122/coronal_017.png","assets/T/mri-fc63c9cacf214122/coronal_018.png","assets/T/mri-fc63c9cacf214122/coronal_019.png","assets/T/mri-fc63c9cacf214122/coronal_020.png","assets/T/mri-fc63c9cacf214122/coronal_021.png","assets/T/mri-fc63c9cacf214122/coronal_022.png","assets/T/mri-fc63c9cacf214122/coronal_023.png","assets/T/mri-fc63c9cacf214122/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-37345bffc7aa45be","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-37345bffc7aa45be/axial_001.png","assets/T/mri-37345bffc7aa45be/axial_002.png","assets/T/mri-37345bffc7aa45be/axial_003.png","assets/T/mri-37345bffc7aa45be/axial_004.png","assets/T/mri-37345bffc7aa45be/axial_005.png","assets/T/mri-37345bffc7aa45be/axial_006.png","assets/T/mri-37345bffc7aa45be/axial_007.png","assets/T/mri-37345bffc7aa45be/axial_008.png","assets/T/mri-37345bffc7aa45be/axial_009.png","assets/T/mri-37345bffc7aa45be/axial_010.png","assets/T/mri-37345bffc7aa45be/axial_011.png","assets/T/mri-37345bffc7aa45be/axial_012.png","assets/T/mri-37345bffc7aa45be/axial_013.png","assets/T/mri-37345bffc7aa45be/axial_014.png","assets/T/mri-37345bffc7aa45be/axial_015.png","assets/T/mri-37345bffc7aa45be/axial_016.png","assets/T/mri-37345bffc7aa45be/axial_017.png","assets/T/mri-37345bffc7aa45be/axial_018.png","assets/T/mri-37345bffc7aa45be/axial_019.png","assets/T/mri-37345bffc7aa45be/axial_020.png","assets/T/mri-37345bffc7aa45be/axial_021.png","assets/T/mri-37345bffc7aa45be/axial_022.png","assets/T/mri-37345bffc7aa45be/axial_023.png","assets/T/mri-37345bffc7aa45be/axial_024.png","assets/T/mri-37345bffc7aa45be/axial_025.png","assets/T/mri-37345bffc7aa45be/axial_026.png","assets/T/mri-37345bffc7aa45be/axial_027.png","assets/T/mri-37345bffc7aa45be/axial_028.png","assets/T/mri-37345bffc7aa45be/axial_029.png","assets/T/mri-37345bffc7aa45be/axial_030.png","assets/T/mri-37345bffc7aa45be/axial_031.png","assets/T/mri-37345bffc7aa45be/axial_032.png","assets/T/mri-37345bffc7aa45be/axial_033.png","assets/T/mri-37345bffc7aa45be/axial_034.png","assets/T/mri-37345bffc7aa45be/axial_035.png","assets/T/mri-37345bffc7aa45be/axial_036.png","assets/T/mri-37345bffc7aa45be/axial_037.png","assets/T/mri-37345bffc7aa45be/axial_038.png","assets/T/mri-37345bffc7aa45be/axial_039.png","assets/T/mri-37345bffc7aa45be/axial_040.png","assets/T/mri-37345bffc7aa45be/axial_041.png","assets/T/mri-37345bffc7aa45be/axial_042.png","assets/T/mri-37345bffc7aa45be/coronal_001.png","assets/T/mri-37345bffc7aa45be/coronal_002.png","assets/T/mri-37345bffc7aa45be/coronal_003.png","assets/T/mri-37345bffc7aa45be/coronal_004.png","assets/T/mri-37345bffc7aa45be/coronal_005.png","assets/T/mri-37345bffc7aa45be/coronal_006.png","assets/T/mri-37345bffc7aa45be/coronal_007.png","assets/T/mri-37345bffc7aa45be/coronal_008.png","assets/T/mri-37345bffc7aa45be/coronal_009.png","assets/T/mri-37345bffc7aa45be/coronal_010.png","assets/T/mri-37345bffc7aa45be/coronal_011.png","assets/T/mri-37345bffc7aa45be/coronal_012.png","assets/T/mri-37345bffc7aa45be/coronal_013.png","assets/T/mri-37345bffc7aa45be/coronal_014.png","assets/T/mri-37345bffc7aa45be/coronal_015.png","assets/T/mri-37345bffc7aa45be/coronal_016.png","assets/T/mri-37345bffc7aa45be/coronal_017.png","assets/T/mri-37345bffc7aa45be/coronal_018.png","assets/T/mri-37345bffc7aa45be/coronal_019.png","assets/T/mri-37345bffc7aa45be/coronal_020.png","assets/T/mri-37345bffc7aa45be/coronal_021.png","assets/T/mri-37345bffc7aa45be/coronal_022.png","assets/T/mri-37345bffc7aa45be/coronal_023.png","assets/T/mri-37345bffc7aa45be/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-0394f36828774a62","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 72 张图，均来自同一次检查。\n\n- 前 44 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 28 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-0394f36828774a62/axial_001.png","assets/T/mri-0394f36828774a62/axial_002.png","assets/T/mri-0394f36828774a62/axial_003.png","assets/T/mri-0394f36828774a62/axial_004.png","assets/T/mri-0394f36828774a62/axial_005.png","assets/T/mri-0394f36828774a62/axial_006.png","assets/T/mri-0394f36828774a62/axial_007.png","assets/T/mri-0394f36828774a62/axial_008.png","assets/T/mri-0394f36828774a62/axial_009.png","assets/T/mri-0394f36828774a62/axial_010.png","assets/T/mri-0394f36828774a62/axial_011.png","assets/T/mri-0394f36828774a62/axial_012.png","assets/T/mri-0394f36828774a62/axial_013.png","assets/T/mri-0394f36828774a62/axial_014.png","assets/T/mri-0394f36828774a62/axial_015.png","assets/T/mri-0394f36828774a62/axial_016.png","assets/T/mri-0394f36828774a62/axial_017.png","assets/T/mri-0394f36828774a62/axial_018.png","assets/T/mri-0394f36828774a62/axial_019.png","assets/T/mri-0394f36828774a62/axial_020.png","assets/T/mri-0394f36828774a62/axial_021.png","assets/T/mri-0394f36828774a62/axial_022.png","assets/T/mri-0394f36828774a62/axial_023.png","assets/T/mri-0394f36828774a62/axial_024.png","assets/T/mri-0394f36828774a62/axial_025.png","assets/T/mri-0394f36828774a62/axial_026.png","assets/T/mri-0394f36828774a62/axial_027.png","assets/T/mri-0394f36828774a62/axial_028.png","assets/T/mri-0394f36828774a62/axial_029.png","assets/T/mri-0394f36828774a62/axial_030.png","assets/T/mri-0394f36828774a62/axial_031.png","assets/T/mri-0394f36828774a62/axial_032.png","assets/T/mri-0394f36828774a62/axial_033.png","assets/T/mri-0394f36828774a62/axial_034.png","assets/T/mri-0394f36828774a62/axial_035.png","assets/T/mri-0394f36828774a62/axial_036.png","assets/T/mri-0394f36828774a62/axial_037.png","assets/T/mri-0394f36828774a62/axial_038.png","assets/T/mri-0394f36828774a62/axial_039.png","assets/T/mri-0394f36828774a62/axial_040.png","assets/T/mri-0394f36828774a62/axial_041.png","assets/T/mri-0394f36828774a62/axial_042.png","assets/T/mri-0394f36828774a62/axial_043.png","assets/T/mri-0394f36828774a62/axial_044.png","assets/T/mri-0394f36828774a62/coronal_001.png","assets/T/mri-0394f36828774a62/coronal_002.png","assets/T/mri-0394f36828774a62/coronal_003.png","assets/T/mri-0394f36828774a62/coronal_004.png","assets/T/mri-0394f36828774a62/coronal_005.png","assets/T/mri-0394f36828774a62/coronal_006.png","assets/T/mri-0394f36828774a62/coronal_007.png","assets/T/mri-0394f36828774a62/coronal_008.png","assets/T/mri-0394f36828774a62/coronal_009.png","assets/T/mri-0394f36828774a62/coronal_010.png","assets/T/mri-0394f36828774a62/coronal_011.png","assets/T/mri-0394f36828774a62/coronal_012.png","assets/T/mri-0394f36828774a62/coronal_013.png","assets/T/mri-0394f36828774a62/coronal_014.png","assets/T/mri-0394f36828774a62/coronal_015.png","assets/T/mri-0394f36828774a62/coronal_016.png","assets/T/mri-0394f36828774a62/coronal_017.png","assets/T/mri-0394f36828774a62/coronal_018.png","assets/T/mri-0394f36828774a62/coronal_019.png","assets/T/mri-0394f36828774a62/coronal_020.png","assets/T/mri-0394f36828774a62/coronal_021.png","assets/T/mri-0394f36828774a62/coronal_022.png","assets/T/mri-0394f36828774a62/coronal_023.png","assets/T/mri-0394f36828774a62/coronal_024.png","assets/T/mri-0394f36828774a62/coronal_025.png","assets/T/mri-0394f36828774a62/coronal_026.png","assets/T/mri-0394f36828774a62/coronal_027.png","assets/T/mri-0394f36828774a62/coronal_028.png"],"stage_edition":8}
+{"id":"L3-T300:mri-1cbc32dff74a4430","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 76 张图，均来自同一次检查。\n\n- 前 48 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 28 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-1cbc32dff74a4430/axial_001.png","assets/T/mri-1cbc32dff74a4430/axial_002.png","assets/T/mri-1cbc32dff74a4430/axial_003.png","assets/T/mri-1cbc32dff74a4430/axial_004.png","assets/T/mri-1cbc32dff74a4430/axial_005.png","assets/T/mri-1cbc32dff74a4430/axial_006.png","assets/T/mri-1cbc32dff74a4430/axial_007.png","assets/T/mri-1cbc32dff74a4430/axial_008.png","assets/T/mri-1cbc32dff74a4430/axial_009.png","assets/T/mri-1cbc32dff74a4430/axial_010.png","assets/T/mri-1cbc32dff74a4430/axial_011.png","assets/T/mri-1cbc32dff74a4430/axial_012.png","assets/T/mri-1cbc32dff74a4430/axial_013.png","assets/T/mri-1cbc32dff74a4430/axial_014.png","assets/T/mri-1cbc32dff74a4430/axial_015.png","assets/T/mri-1cbc32dff74a4430/axial_016.png","assets/T/mri-1cbc32dff74a4430/axial_017.png","assets/T/mri-1cbc32dff74a4430/axial_018.png","assets/T/mri-1cbc32dff74a4430/axial_019.png","assets/T/mri-1cbc32dff74a4430/axial_020.png","assets/T/mri-1cbc32dff74a4430/axial_021.png","assets/T/mri-1cbc32dff74a4430/axial_022.png","assets/T/mri-1cbc32dff74a4430/axial_023.png","assets/T/mri-1cbc32dff74a4430/axial_024.png","assets/T/mri-1cbc32dff74a4430/axial_025.png","assets/T/mri-1cbc32dff74a4430/axial_026.png","assets/T/mri-1cbc32dff74a4430/axial_027.png","assets/T/mri-1cbc32dff74a4430/axial_028.png","assets/T/mri-1cbc32dff74a4430/axial_029.png","assets/T/mri-1cbc32dff74a4430/axial_030.png","assets/T/mri-1cbc32dff74a4430/axial_031.png","assets/T/mri-1cbc32dff74a4430/axial_032.png","assets/T/mri-1cbc32dff74a4430/axial_033.png","assets/T/mri-1cbc32dff74a4430/axial_034.png","assets/T/mri-1cbc32dff74a4430/axial_035.png","assets/T/mri-1cbc32dff74a4430/axial_036.png","assets/T/mri-1cbc32dff74a4430/axial_037.png","assets/T/mri-1cbc32dff74a4430/axial_038.png","assets/T/mri-1cbc32dff74a4430/axial_039.png","assets/T/mri-1cbc32dff74a4430/axial_040.png","assets/T/mri-1cbc32dff74a4430/axial_041.png","assets/T/mri-1cbc32dff74a4430/axial_042.png","assets/T/mri-1cbc32dff74a4430/axial_043.png","assets/T/mri-1cbc32dff74a4430/axial_044.png","assets/T/mri-1cbc32dff74a4430/axial_045.png","assets/T/mri-1cbc32dff74a4430/axial_046.png","assets/T/mri-1cbc32dff74a4430/axial_047.png","assets/T/mri-1cbc32dff74a4430/axial_048.png","assets/T/mri-1cbc32dff74a4430/coronal_001.png","assets/T/mri-1cbc32dff74a4430/coronal_002.png","assets/T/mri-1cbc32dff74a4430/coronal_003.png","assets/T/mri-1cbc32dff74a4430/coronal_004.png","assets/T/mri-1cbc32dff74a4430/coronal_005.png","assets/T/mri-1cbc32dff74a4430/coronal_006.png","assets/T/mri-1cbc32dff74a4430/coronal_007.png","assets/T/mri-1cbc32dff74a4430/coronal_008.png","assets/T/mri-1cbc32dff74a4430/coronal_009.png","assets/T/mri-1cbc32dff74a4430/coronal_010.png","assets/T/mri-1cbc32dff74a4430/coronal_011.png","assets/T/mri-1cbc32dff74a4430/coronal_012.png","assets/T/mri-1cbc32dff74a4430/coronal_013.png","assets/T/mri-1cbc32dff74a4430/coronal_014.png","assets/T/mri-1cbc32dff74a4430/coronal_015.png","assets/T/mri-1cbc32dff74a4430/coronal_016.png","assets/T/mri-1cbc32dff74a4430/coronal_017.png","assets/T/mri-1cbc32dff74a4430/coronal_018.png","assets/T/mri-1cbc32dff74a4430/coronal_019.png","assets/T/mri-1cbc32dff74a4430/coronal_020.png","assets/T/mri-1cbc32dff74a4430/coronal_021.png","assets/T/mri-1cbc32dff74a4430/coronal_022.png","assets/T/mri-1cbc32dff74a4430/coronal_023.png","assets/T/mri-1cbc32dff74a4430/coronal_024.png","assets/T/mri-1cbc32dff74a4430/coronal_025.png","assets/T/mri-1cbc32dff74a4430/coronal_026.png","assets/T/mri-1cbc32dff74a4430/coronal_027.png","assets/T/mri-1cbc32dff74a4430/coronal_028.png"],"stage_edition":8}
+{"id":"L3-T300:mri-62733f1276564ed5","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-62733f1276564ed5/axial_001.png","assets/T/mri-62733f1276564ed5/axial_002.png","assets/T/mri-62733f1276564ed5/axial_003.png","assets/T/mri-62733f1276564ed5/axial_004.png","assets/T/mri-62733f1276564ed5/axial_005.png","assets/T/mri-62733f1276564ed5/axial_006.png","assets/T/mri-62733f1276564ed5/axial_007.png","assets/T/mri-62733f1276564ed5/axial_008.png","assets/T/mri-62733f1276564ed5/axial_009.png","assets/T/mri-62733f1276564ed5/axial_010.png","assets/T/mri-62733f1276564ed5/axial_011.png","assets/T/mri-62733f1276564ed5/axial_012.png","assets/T/mri-62733f1276564ed5/axial_013.png","assets/T/mri-62733f1276564ed5/axial_014.png","assets/T/mri-62733f1276564ed5/axial_015.png","assets/T/mri-62733f1276564ed5/axial_016.png","assets/T/mri-62733f1276564ed5/axial_017.png","assets/T/mri-62733f1276564ed5/axial_018.png","assets/T/mri-62733f1276564ed5/axial_019.png","assets/T/mri-62733f1276564ed5/axial_020.png","assets/T/mri-62733f1276564ed5/axial_021.png","assets/T/mri-62733f1276564ed5/axial_022.png","assets/T/mri-62733f1276564ed5/axial_023.png","assets/T/mri-62733f1276564ed5/axial_024.png","assets/T/mri-62733f1276564ed5/axial_025.png","assets/T/mri-62733f1276564ed5/axial_026.png","assets/T/mri-62733f1276564ed5/axial_027.png","assets/T/mri-62733f1276564ed5/axial_028.png","assets/T/mri-62733f1276564ed5/axial_029.png","assets/T/mri-62733f1276564ed5/axial_030.png","assets/T/mri-62733f1276564ed5/axial_031.png","assets/T/mri-62733f1276564ed5/axial_032.png","assets/T/mri-62733f1276564ed5/axial_033.png","assets/T/mri-62733f1276564ed5/axial_034.png","assets/T/mri-62733f1276564ed5/axial_035.png","assets/T/mri-62733f1276564ed5/axial_036.png","assets/T/mri-62733f1276564ed5/axial_037.png","assets/T/mri-62733f1276564ed5/axial_038.png","assets/T/mri-62733f1276564ed5/axial_039.png","assets/T/mri-62733f1276564ed5/axial_040.png","assets/T/mri-62733f1276564ed5/axial_041.png","assets/T/mri-62733f1276564ed5/axial_042.png","assets/T/mri-62733f1276564ed5/coronal_001.png","assets/T/mri-62733f1276564ed5/coronal_002.png","assets/T/mri-62733f1276564ed5/coronal_003.png","assets/T/mri-62733f1276564ed5/coronal_004.png","assets/T/mri-62733f1276564ed5/coronal_005.png","assets/T/mri-62733f1276564ed5/coronal_006.png","assets/T/mri-62733f1276564ed5/coronal_007.png","assets/T/mri-62733f1276564ed5/coronal_008.png","assets/T/mri-62733f1276564ed5/coronal_009.png","assets/T/mri-62733f1276564ed5/coronal_010.png","assets/T/mri-62733f1276564ed5/coronal_011.png","assets/T/mri-62733f1276564ed5/coronal_012.png","assets/T/mri-62733f1276564ed5/coronal_013.png","assets/T/mri-62733f1276564ed5/coronal_014.png","assets/T/mri-62733f1276564ed5/coronal_015.png","assets/T/mri-62733f1276564ed5/coronal_016.png","assets/T/mri-62733f1276564ed5/coronal_017.png","assets/T/mri-62733f1276564ed5/coronal_018.png","assets/T/mri-62733f1276564ed5/coronal_019.png","assets/T/mri-62733f1276564ed5/coronal_020.png","assets/T/mri-62733f1276564ed5/coronal_021.png","assets/T/mri-62733f1276564ed5/coronal_022.png","assets/T/mri-62733f1276564ed5/coronal_023.png","assets/T/mri-62733f1276564ed5/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-5f4e71f281864ee8","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-5f4e71f281864ee8/axial_001.png","assets/T/mri-5f4e71f281864ee8/axial_002.png","assets/T/mri-5f4e71f281864ee8/axial_003.png","assets/T/mri-5f4e71f281864ee8/axial_004.png","assets/T/mri-5f4e71f281864ee8/axial_005.png","assets/T/mri-5f4e71f281864ee8/axial_006.png","assets/T/mri-5f4e71f281864ee8/axial_007.png","assets/T/mri-5f4e71f281864ee8/axial_008.png","assets/T/mri-5f4e71f281864ee8/axial_009.png","assets/T/mri-5f4e71f281864ee8/axial_010.png","assets/T/mri-5f4e71f281864ee8/axial_011.png","assets/T/mri-5f4e71f281864ee8/axial_012.png","assets/T/mri-5f4e71f281864ee8/axial_013.png","assets/T/mri-5f4e71f281864ee8/axial_014.png","assets/T/mri-5f4e71f281864ee8/axial_015.png","assets/T/mri-5f4e71f281864ee8/axial_016.png","assets/T/mri-5f4e71f281864ee8/axial_017.png","assets/T/mri-5f4e71f281864ee8/axial_018.png","assets/T/mri-5f4e71f281864ee8/axial_019.png","assets/T/mri-5f4e71f281864ee8/axial_020.png","assets/T/mri-5f4e71f281864ee8/axial_021.png","assets/T/mri-5f4e71f281864ee8/axial_022.png","assets/T/mri-5f4e71f281864ee8/axial_023.png","assets/T/mri-5f4e71f281864ee8/axial_024.png","assets/T/mri-5f4e71f281864ee8/axial_025.png","assets/T/mri-5f4e71f281864ee8/axial_026.png","assets/T/mri-5f4e71f281864ee8/axial_027.png","assets/T/mri-5f4e71f281864ee8/axial_028.png","assets/T/mri-5f4e71f281864ee8/axial_029.png","assets/T/mri-5f4e71f281864ee8/axial_030.png","assets/T/mri-5f4e71f281864ee8/axial_031.png","assets/T/mri-5f4e71f281864ee8/axial_032.png","assets/T/mri-5f4e71f281864ee8/axial_033.png","assets/T/mri-5f4e71f281864ee8/axial_034.png","assets/T/mri-5f4e71f281864ee8/axial_035.png","assets/T/mri-5f4e71f281864ee8/axial_036.png","assets/T/mri-5f4e71f281864ee8/axial_037.png","assets/T/mri-5f4e71f281864ee8/axial_038.png","assets/T/mri-5f4e71f281864ee8/axial_039.png","assets/T/mri-5f4e71f281864ee8/axial_040.png","assets/T/mri-5f4e71f281864ee8/coronal_001.png","assets/T/mri-5f4e71f281864ee8/coronal_002.png","assets/T/mri-5f4e71f281864ee8/coronal_003.png","assets/T/mri-5f4e71f281864ee8/coronal_004.png","assets/T/mri-5f4e71f281864ee8/coronal_005.png","assets/T/mri-5f4e71f281864ee8/coronal_006.png","assets/T/mri-5f4e71f281864ee8/coronal_007.png","assets/T/mri-5f4e71f281864ee8/coronal_008.png","assets/T/mri-5f4e71f281864ee8/coronal_009.png","assets/T/mri-5f4e71f281864ee8/coronal_010.png","assets/T/mri-5f4e71f281864ee8/coronal_011.png","assets/T/mri-5f4e71f281864ee8/coronal_012.png","assets/T/mri-5f4e71f281864ee8/coronal_013.png","assets/T/mri-5f4e71f281864ee8/coronal_014.png","assets/T/mri-5f4e71f281864ee8/coronal_015.png","assets/T/mri-5f4e71f281864ee8/coronal_016.png","assets/T/mri-5f4e71f281864ee8/coronal_017.png","assets/T/mri-5f4e71f281864ee8/coronal_018.png","assets/T/mri-5f4e71f281864ee8/coronal_019.png","assets/T/mri-5f4e71f281864ee8/coronal_020.png","assets/T/mri-5f4e71f281864ee8/coronal_021.png","assets/T/mri-5f4e71f281864ee8/coronal_022.png","assets/T/mri-5f4e71f281864ee8/coronal_023.png","assets/T/mri-5f4e71f281864ee8/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-d6bbc416db544bc3","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 68 张图，均来自同一次检查。\n\n- 前 44 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-d6bbc416db544bc3/axial_001.png","assets/T/mri-d6bbc416db544bc3/axial_002.png","assets/T/mri-d6bbc416db544bc3/axial_003.png","assets/T/mri-d6bbc416db544bc3/axial_004.png","assets/T/mri-d6bbc416db544bc3/axial_005.png","assets/T/mri-d6bbc416db544bc3/axial_006.png","assets/T/mri-d6bbc416db544bc3/axial_007.png","assets/T/mri-d6bbc416db544bc3/axial_008.png","assets/T/mri-d6bbc416db544bc3/axial_009.png","assets/T/mri-d6bbc416db544bc3/axial_010.png","assets/T/mri-d6bbc416db544bc3/axial_011.png","assets/T/mri-d6bbc416db544bc3/axial_012.png","assets/T/mri-d6bbc416db544bc3/axial_013.png","assets/T/mri-d6bbc416db544bc3/axial_014.png","assets/T/mri-d6bbc416db544bc3/axial_015.png","assets/T/mri-d6bbc416db544bc3/axial_016.png","assets/T/mri-d6bbc416db544bc3/axial_017.png","assets/T/mri-d6bbc416db544bc3/axial_018.png","assets/T/mri-d6bbc416db544bc3/axial_019.png","assets/T/mri-d6bbc416db544bc3/axial_020.png","assets/T/mri-d6bbc416db544bc3/axial_021.png","assets/T/mri-d6bbc416db544bc3/axial_022.png","assets/T/mri-d6bbc416db544bc3/axial_023.png","assets/T/mri-d6bbc416db544bc3/axial_024.png","assets/T/mri-d6bbc416db544bc3/axial_025.png","assets/T/mri-d6bbc416db544bc3/axial_026.png","assets/T/mri-d6bbc416db544bc3/axial_027.png","assets/T/mri-d6bbc416db544bc3/axial_028.png","assets/T/mri-d6bbc416db544bc3/axial_029.png","assets/T/mri-d6bbc416db544bc3/axial_030.png","assets/T/mri-d6bbc416db544bc3/axial_031.png","assets/T/mri-d6bbc416db544bc3/axial_032.png","assets/T/mri-d6bbc416db544bc3/axial_033.png","assets/T/mri-d6bbc416db544bc3/axial_034.png","assets/T/mri-d6bbc416db544bc3/axial_035.png","assets/T/mri-d6bbc416db544bc3/axial_036.png","assets/T/mri-d6bbc416db544bc3/axial_037.png","assets/T/mri-d6bbc416db544bc3/axial_038.png","assets/T/mri-d6bbc416db544bc3/axial_039.png","assets/T/mri-d6bbc416db544bc3/axial_040.png","assets/T/mri-d6bbc416db544bc3/axial_041.png","assets/T/mri-d6bbc416db544bc3/axial_042.png","assets/T/mri-d6bbc416db544bc3/axial_043.png","assets/T/mri-d6bbc416db544bc3/axial_044.png","assets/T/mri-d6bbc416db544bc3/coronal_001.png","assets/T/mri-d6bbc416db544bc3/coronal_002.png","assets/T/mri-d6bbc416db544bc3/coronal_003.png","assets/T/mri-d6bbc416db544bc3/coronal_004.png","assets/T/mri-d6bbc416db544bc3/coronal_005.png","assets/T/mri-d6bbc416db544bc3/coronal_006.png","assets/T/mri-d6bbc416db544bc3/coronal_007.png","assets/T/mri-d6bbc416db544bc3/coronal_008.png","assets/T/mri-d6bbc416db544bc3/coronal_009.png","assets/T/mri-d6bbc416db544bc3/coronal_010.png","assets/T/mri-d6bbc416db544bc3/coronal_011.png","assets/T/mri-d6bbc416db544bc3/coronal_012.png","assets/T/mri-d6bbc416db544bc3/coronal_013.png","assets/T/mri-d6bbc416db544bc3/coronal_014.png","assets/T/mri-d6bbc416db544bc3/coronal_015.png","assets/T/mri-d6bbc416db544bc3/coronal_016.png","assets/T/mri-d6bbc416db544bc3/coronal_017.png","assets/T/mri-d6bbc416db544bc3/coronal_018.png","assets/T/mri-d6bbc416db544bc3/coronal_019.png","assets/T/mri-d6bbc416db544bc3/coronal_020.png","assets/T/mri-d6bbc416db544bc3/coronal_021.png","assets/T/mri-d6bbc416db544bc3/coronal_022.png","assets/T/mri-d6bbc416db544bc3/coronal_023.png","assets/T/mri-d6bbc416db544bc3/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-2d9c445715964c25","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 70 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 28 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-2d9c445715964c25/axial_001.png","assets/T/mri-2d9c445715964c25/axial_002.png","assets/T/mri-2d9c445715964c25/axial_003.png","assets/T/mri-2d9c445715964c25/axial_004.png","assets/T/mri-2d9c445715964c25/axial_005.png","assets/T/mri-2d9c445715964c25/axial_006.png","assets/T/mri-2d9c445715964c25/axial_007.png","assets/T/mri-2d9c445715964c25/axial_008.png","assets/T/mri-2d9c445715964c25/axial_009.png","assets/T/mri-2d9c445715964c25/axial_010.png","assets/T/mri-2d9c445715964c25/axial_011.png","assets/T/mri-2d9c445715964c25/axial_012.png","assets/T/mri-2d9c445715964c25/axial_013.png","assets/T/mri-2d9c445715964c25/axial_014.png","assets/T/mri-2d9c445715964c25/axial_015.png","assets/T/mri-2d9c445715964c25/axial_016.png","assets/T/mri-2d9c445715964c25/axial_017.png","assets/T/mri-2d9c445715964c25/axial_018.png","assets/T/mri-2d9c445715964c25/axial_019.png","assets/T/mri-2d9c445715964c25/axial_020.png","assets/T/mri-2d9c445715964c25/axial_021.png","assets/T/mri-2d9c445715964c25/axial_022.png","assets/T/mri-2d9c445715964c25/axial_023.png","assets/T/mri-2d9c445715964c25/axial_024.png","assets/T/mri-2d9c445715964c25/axial_025.png","assets/T/mri-2d9c445715964c25/axial_026.png","assets/T/mri-2d9c445715964c25/axial_027.png","assets/T/mri-2d9c445715964c25/axial_028.png","assets/T/mri-2d9c445715964c25/axial_029.png","assets/T/mri-2d9c445715964c25/axial_030.png","assets/T/mri-2d9c445715964c25/axial_031.png","assets/T/mri-2d9c445715964c25/axial_032.png","assets/T/mri-2d9c445715964c25/axial_033.png","assets/T/mri-2d9c445715964c25/axial_034.png","assets/T/mri-2d9c445715964c25/axial_035.png","assets/T/mri-2d9c445715964c25/axial_036.png","assets/T/mri-2d9c445715964c25/axial_037.png","assets/T/mri-2d9c445715964c25/axial_038.png","assets/T/mri-2d9c445715964c25/axial_039.png","assets/T/mri-2d9c445715964c25/axial_040.png","assets/T/mri-2d9c445715964c25/axial_041.png","assets/T/mri-2d9c445715964c25/axial_042.png","assets/T/mri-2d9c445715964c25/coronal_001.png","assets/T/mri-2d9c445715964c25/coronal_002.png","assets/T/mri-2d9c445715964c25/coronal_003.png","assets/T/mri-2d9c445715964c25/coronal_004.png","assets/T/mri-2d9c445715964c25/coronal_005.png","assets/T/mri-2d9c445715964c25/coronal_006.png","assets/T/mri-2d9c445715964c25/coronal_007.png","assets/T/mri-2d9c445715964c25/coronal_008.png","assets/T/mri-2d9c445715964c25/coronal_009.png","assets/T/mri-2d9c445715964c25/coronal_010.png","assets/T/mri-2d9c445715964c25/coronal_011.png","assets/T/mri-2d9c445715964c25/coronal_012.png","assets/T/mri-2d9c445715964c25/coronal_013.png","assets/T/mri-2d9c445715964c25/coronal_014.png","assets/T/mri-2d9c445715964c25/coronal_015.png","assets/T/mri-2d9c445715964c25/coronal_016.png","assets/T/mri-2d9c445715964c25/coronal_017.png","assets/T/mri-2d9c445715964c25/coronal_018.png","assets/T/mri-2d9c445715964c25/coronal_019.png","assets/T/mri-2d9c445715964c25/coronal_020.png","assets/T/mri-2d9c445715964c25/coronal_021.png","assets/T/mri-2d9c445715964c25/coronal_022.png","assets/T/mri-2d9c445715964c25/coronal_023.png","assets/T/mri-2d9c445715964c25/coronal_024.png","assets/T/mri-2d9c445715964c25/coronal_025.png","assets/T/mri-2d9c445715964c25/coronal_026.png","assets/T/mri-2d9c445715964c25/coronal_027.png","assets/T/mri-2d9c445715964c25/coronal_028.png"],"stage_edition":8}
+{"id":"L3-T300:mri-aa61cf9331744ddd","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 62 张图，均来自同一次检查。\n\n- 前 38 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-aa61cf9331744ddd/axial_001.png","assets/T/mri-aa61cf9331744ddd/axial_002.png","assets/T/mri-aa61cf9331744ddd/axial_003.png","assets/T/mri-aa61cf9331744ddd/axial_004.png","assets/T/mri-aa61cf9331744ddd/axial_005.png","assets/T/mri-aa61cf9331744ddd/axial_006.png","assets/T/mri-aa61cf9331744ddd/axial_007.png","assets/T/mri-aa61cf9331744ddd/axial_008.png","assets/T/mri-aa61cf9331744ddd/axial_009.png","assets/T/mri-aa61cf9331744ddd/axial_010.png","assets/T/mri-aa61cf9331744ddd/axial_011.png","assets/T/mri-aa61cf9331744ddd/axial_012.png","assets/T/mri-aa61cf9331744ddd/axial_013.png","assets/T/mri-aa61cf9331744ddd/axial_014.png","assets/T/mri-aa61cf9331744ddd/axial_015.png","assets/T/mri-aa61cf9331744ddd/axial_016.png","assets/T/mri-aa61cf9331744ddd/axial_017.png","assets/T/mri-aa61cf9331744ddd/axial_018.png","assets/T/mri-aa61cf9331744ddd/axial_019.png","assets/T/mri-aa61cf9331744ddd/axial_020.png","assets/T/mri-aa61cf9331744ddd/axial_021.png","assets/T/mri-aa61cf9331744ddd/axial_022.png","assets/T/mri-aa61cf9331744ddd/axial_023.png","assets/T/mri-aa61cf9331744ddd/axial_024.png","assets/T/mri-aa61cf9331744ddd/axial_025.png","assets/T/mri-aa61cf9331744ddd/axial_026.png","assets/T/mri-aa61cf9331744ddd/axial_027.png","assets/T/mri-aa61cf9331744ddd/axial_028.png","assets/T/mri-aa61cf9331744ddd/axial_029.png","assets/T/mri-aa61cf9331744ddd/axial_030.png","assets/T/mri-aa61cf9331744ddd/axial_031.png","assets/T/mri-aa61cf9331744ddd/axial_032.png","assets/T/mri-aa61cf9331744ddd/axial_033.png","assets/T/mri-aa61cf9331744ddd/axial_034.png","assets/T/mri-aa61cf9331744ddd/axial_035.png","assets/T/mri-aa61cf9331744ddd/axial_036.png","assets/T/mri-aa61cf9331744ddd/axial_037.png","assets/T/mri-aa61cf9331744ddd/axial_038.png","assets/T/mri-aa61cf9331744ddd/coronal_001.png","assets/T/mri-aa61cf9331744ddd/coronal_002.png","assets/T/mri-aa61cf9331744ddd/coronal_003.png","assets/T/mri-aa61cf9331744ddd/coronal_004.png","assets/T/mri-aa61cf9331744ddd/coronal_005.png","assets/T/mri-aa61cf9331744ddd/coronal_006.png","assets/T/mri-aa61cf9331744ddd/coronal_007.png","assets/T/mri-aa61cf9331744ddd/coronal_008.png","assets/T/mri-aa61cf9331744ddd/coronal_009.png","assets/T/mri-aa61cf9331744ddd/coronal_010.png","assets/T/mri-aa61cf9331744ddd/coronal_011.png","assets/T/mri-aa61cf9331744ddd/coronal_012.png","assets/T/mri-aa61cf9331744ddd/coronal_013.png","assets/T/mri-aa61cf9331744ddd/coronal_014.png","assets/T/mri-aa61cf9331744ddd/coronal_015.png","assets/T/mri-aa61cf9331744ddd/coronal_016.png","assets/T/mri-aa61cf9331744ddd/coronal_017.png","assets/T/mri-aa61cf9331744ddd/coronal_018.png","assets/T/mri-aa61cf9331744ddd/coronal_019.png","assets/T/mri-aa61cf9331744ddd/coronal_020.png","assets/T/mri-aa61cf9331744ddd/coronal_021.png","assets/T/mri-aa61cf9331744ddd/coronal_022.png","assets/T/mri-aa61cf9331744ddd/coronal_023.png","assets/T/mri-aa61cf9331744ddd/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-85bf21a1e54d4f86","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 62 张图，均来自同一次检查。\n\n- 前 38 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-85bf21a1e54d4f86/axial_001.png","assets/T/mri-85bf21a1e54d4f86/axial_002.png","assets/T/mri-85bf21a1e54d4f86/axial_003.png","assets/T/mri-85bf21a1e54d4f86/axial_004.png","assets/T/mri-85bf21a1e54d4f86/axial_005.png","assets/T/mri-85bf21a1e54d4f86/axial_006.png","assets/T/mri-85bf21a1e54d4f86/axial_007.png","assets/T/mri-85bf21a1e54d4f86/axial_008.png","assets/T/mri-85bf21a1e54d4f86/axial_009.png","assets/T/mri-85bf21a1e54d4f86/axial_010.png","assets/T/mri-85bf21a1e54d4f86/axial_011.png","assets/T/mri-85bf21a1e54d4f86/axial_012.png","assets/T/mri-85bf21a1e54d4f86/axial_013.png","assets/T/mri-85bf21a1e54d4f86/axial_014.png","assets/T/mri-85bf21a1e54d4f86/axial_015.png","assets/T/mri-85bf21a1e54d4f86/axial_016.png","assets/T/mri-85bf21a1e54d4f86/axial_017.png","assets/T/mri-85bf21a1e54d4f86/axial_018.png","assets/T/mri-85bf21a1e54d4f86/axial_019.png","assets/T/mri-85bf21a1e54d4f86/axial_020.png","assets/T/mri-85bf21a1e54d4f86/axial_021.png","assets/T/mri-85bf21a1e54d4f86/axial_022.png","assets/T/mri-85bf21a1e54d4f86/axial_023.png","assets/T/mri-85bf21a1e54d4f86/axial_024.png","assets/T/mri-85bf21a1e54d4f86/axial_025.png","assets/T/mri-85bf21a1e54d4f86/axial_026.png","assets/T/mri-85bf21a1e54d4f86/axial_027.png","assets/T/mri-85bf21a1e54d4f86/axial_028.png","assets/T/mri-85bf21a1e54d4f86/axial_029.png","assets/T/mri-85bf21a1e54d4f86/axial_030.png","assets/T/mri-85bf21a1e54d4f86/axial_031.png","assets/T/mri-85bf21a1e54d4f86/axial_032.png","assets/T/mri-85bf21a1e54d4f86/axial_033.png","assets/T/mri-85bf21a1e54d4f86/axial_034.png","assets/T/mri-85bf21a1e54d4f86/axial_035.png","assets/T/mri-85bf21a1e54d4f86/axial_036.png","assets/T/mri-85bf21a1e54d4f86/axial_037.png","assets/T/mri-85bf21a1e54d4f86/axial_038.png","assets/T/mri-85bf21a1e54d4f86/coronal_001.png","assets/T/mri-85bf21a1e54d4f86/coronal_002.png","assets/T/mri-85bf21a1e54d4f86/coronal_003.png","assets/T/mri-85bf21a1e54d4f86/coronal_004.png","assets/T/mri-85bf21a1e54d4f86/coronal_005.png","assets/T/mri-85bf21a1e54d4f86/coronal_006.png","assets/T/mri-85bf21a1e54d4f86/coronal_007.png","assets/T/mri-85bf21a1e54d4f86/coronal_008.png","assets/T/mri-85bf21a1e54d4f86/coronal_009.png","assets/T/mri-85bf21a1e54d4f86/coronal_010.png","assets/T/mri-85bf21a1e54d4f86/coronal_011.png","assets/T/mri-85bf21a1e54d4f86/coronal_012.png","assets/T/mri-85bf21a1e54d4f86/coronal_013.png","assets/T/mri-85bf21a1e54d4f86/coronal_014.png","assets/T/mri-85bf21a1e54d4f86/coronal_015.png","assets/T/mri-85bf21a1e54d4f86/coronal_016.png","assets/T/mri-85bf21a1e54d4f86/coronal_017.png","assets/T/mri-85bf21a1e54d4f86/coronal_018.png","assets/T/mri-85bf21a1e54d4f86/coronal_019.png","assets/T/mri-85bf21a1e54d4f86/coronal_020.png","assets/T/mri-85bf21a1e54d4f86/coronal_021.png","assets/T/mri-85bf21a1e54d4f86/coronal_022.png","assets/T/mri-85bf21a1e54d4f86/coronal_023.png","assets/T/mri-85bf21a1e54d4f86/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-cd1d5e72481942cd","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-cd1d5e72481942cd/axial_001.png","assets/T/mri-cd1d5e72481942cd/axial_002.png","assets/T/mri-cd1d5e72481942cd/axial_003.png","assets/T/mri-cd1d5e72481942cd/axial_004.png","assets/T/mri-cd1d5e72481942cd/axial_005.png","assets/T/mri-cd1d5e72481942cd/axial_006.png","assets/T/mri-cd1d5e72481942cd/axial_007.png","assets/T/mri-cd1d5e72481942cd/axial_008.png","assets/T/mri-cd1d5e72481942cd/axial_009.png","assets/T/mri-cd1d5e72481942cd/axial_010.png","assets/T/mri-cd1d5e72481942cd/axial_011.png","assets/T/mri-cd1d5e72481942cd/axial_012.png","assets/T/mri-cd1d5e72481942cd/axial_013.png","assets/T/mri-cd1d5e72481942cd/axial_014.png","assets/T/mri-cd1d5e72481942cd/axial_015.png","assets/T/mri-cd1d5e72481942cd/axial_016.png","assets/T/mri-cd1d5e72481942cd/axial_017.png","assets/T/mri-cd1d5e72481942cd/axial_018.png","assets/T/mri-cd1d5e72481942cd/axial_019.png","assets/T/mri-cd1d5e72481942cd/axial_020.png","assets/T/mri-cd1d5e72481942cd/axial_021.png","assets/T/mri-cd1d5e72481942cd/axial_022.png","assets/T/mri-cd1d5e72481942cd/axial_023.png","assets/T/mri-cd1d5e72481942cd/axial_024.png","assets/T/mri-cd1d5e72481942cd/axial_025.png","assets/T/mri-cd1d5e72481942cd/axial_026.png","assets/T/mri-cd1d5e72481942cd/axial_027.png","assets/T/mri-cd1d5e72481942cd/axial_028.png","assets/T/mri-cd1d5e72481942cd/axial_029.png","assets/T/mri-cd1d5e72481942cd/axial_030.png","assets/T/mri-cd1d5e72481942cd/axial_031.png","assets/T/mri-cd1d5e72481942cd/axial_032.png","assets/T/mri-cd1d5e72481942cd/axial_033.png","assets/T/mri-cd1d5e72481942cd/axial_034.png","assets/T/mri-cd1d5e72481942cd/axial_035.png","assets/T/mri-cd1d5e72481942cd/axial_036.png","assets/T/mri-cd1d5e72481942cd/axial_037.png","assets/T/mri-cd1d5e72481942cd/axial_038.png","assets/T/mri-cd1d5e72481942cd/axial_039.png","assets/T/mri-cd1d5e72481942cd/axial_040.png","assets/T/mri-cd1d5e72481942cd/axial_041.png","assets/T/mri-cd1d5e72481942cd/axial_042.png","assets/T/mri-cd1d5e72481942cd/coronal_001.png","assets/T/mri-cd1d5e72481942cd/coronal_002.png","assets/T/mri-cd1d5e72481942cd/coronal_003.png","assets/T/mri-cd1d5e72481942cd/coronal_004.png","assets/T/mri-cd1d5e72481942cd/coronal_005.png","assets/T/mri-cd1d5e72481942cd/coronal_006.png","assets/T/mri-cd1d5e72481942cd/coronal_007.png","assets/T/mri-cd1d5e72481942cd/coronal_008.png","assets/T/mri-cd1d5e72481942cd/coronal_009.png","assets/T/mri-cd1d5e72481942cd/coronal_010.png","assets/T/mri-cd1d5e72481942cd/coronal_011.png","assets/T/mri-cd1d5e72481942cd/coronal_012.png","assets/T/mri-cd1d5e72481942cd/coronal_013.png","assets/T/mri-cd1d5e72481942cd/coronal_014.png","assets/T/mri-cd1d5e72481942cd/coronal_015.png","assets/T/mri-cd1d5e72481942cd/coronal_016.png","assets/T/mri-cd1d5e72481942cd/coronal_017.png","assets/T/mri-cd1d5e72481942cd/coronal_018.png","assets/T/mri-cd1d5e72481942cd/coronal_019.png","assets/T/mri-cd1d5e72481942cd/coronal_020.png","assets/T/mri-cd1d5e72481942cd/coronal_021.png","assets/T/mri-cd1d5e72481942cd/coronal_022.png","assets/T/mri-cd1d5e72481942cd/coronal_023.png","assets/T/mri-cd1d5e72481942cd/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-07a00ae75e7b4977","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 68 张图，均来自同一次检查。\n\n- 前 44 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-07a00ae75e7b4977/axial_001.png","assets/T/mri-07a00ae75e7b4977/axial_002.png","assets/T/mri-07a00ae75e7b4977/axial_003.png","assets/T/mri-07a00ae75e7b4977/axial_004.png","assets/T/mri-07a00ae75e7b4977/axial_005.png","assets/T/mri-07a00ae75e7b4977/axial_006.png","assets/T/mri-07a00ae75e7b4977/axial_007.png","assets/T/mri-07a00ae75e7b4977/axial_008.png","assets/T/mri-07a00ae75e7b4977/axial_009.png","assets/T/mri-07a00ae75e7b4977/axial_010.png","assets/T/mri-07a00ae75e7b4977/axial_011.png","assets/T/mri-07a00ae75e7b4977/axial_012.png","assets/T/mri-07a00ae75e7b4977/axial_013.png","assets/T/mri-07a00ae75e7b4977/axial_014.png","assets/T/mri-07a00ae75e7b4977/axial_015.png","assets/T/mri-07a00ae75e7b4977/axial_016.png","assets/T/mri-07a00ae75e7b4977/axial_017.png","assets/T/mri-07a00ae75e7b4977/axial_018.png","assets/T/mri-07a00ae75e7b4977/axial_019.png","assets/T/mri-07a00ae75e7b4977/axial_020.png","assets/T/mri-07a00ae75e7b4977/axial_021.png","assets/T/mri-07a00ae75e7b4977/axial_022.png","assets/T/mri-07a00ae75e7b4977/axial_023.png","assets/T/mri-07a00ae75e7b4977/axial_024.png","assets/T/mri-07a00ae75e7b4977/axial_025.png","assets/T/mri-07a00ae75e7b4977/axial_026.png","assets/T/mri-07a00ae75e7b4977/axial_027.png","assets/T/mri-07a00ae75e7b4977/axial_028.png","assets/T/mri-07a00ae75e7b4977/axial_029.png","assets/T/mri-07a00ae75e7b4977/axial_030.png","assets/T/mri-07a00ae75e7b4977/axial_031.png","assets/T/mri-07a00ae75e7b4977/axial_032.png","assets/T/mri-07a00ae75e7b4977/axial_033.png","assets/T/mri-07a00ae75e7b4977/axial_034.png","assets/T/mri-07a00ae75e7b4977/axial_035.png","assets/T/mri-07a00ae75e7b4977/axial_036.png","assets/T/mri-07a00ae75e7b4977/axial_037.png","assets/T/mri-07a00ae75e7b4977/axial_038.png","assets/T/mri-07a00ae75e7b4977/axial_039.png","assets/T/mri-07a00ae75e7b4977/axial_040.png","assets/T/mri-07a00ae75e7b4977/axial_041.png","assets/T/mri-07a00ae75e7b4977/axial_042.png","assets/T/mri-07a00ae75e7b4977/axial_043.png","assets/T/mri-07a00ae75e7b4977/axial_044.png","assets/T/mri-07a00ae75e7b4977/coronal_001.png","assets/T/mri-07a00ae75e7b4977/coronal_002.png","assets/T/mri-07a00ae75e7b4977/coronal_003.png","assets/T/mri-07a00ae75e7b4977/coronal_004.png","assets/T/mri-07a00ae75e7b4977/coronal_005.png","assets/T/mri-07a00ae75e7b4977/coronal_006.png","assets/T/mri-07a00ae75e7b4977/coronal_007.png","assets/T/mri-07a00ae75e7b4977/coronal_008.png","assets/T/mri-07a00ae75e7b4977/coronal_009.png","assets/T/mri-07a00ae75e7b4977/coronal_010.png","assets/T/mri-07a00ae75e7b4977/coronal_011.png","assets/T/mri-07a00ae75e7b4977/coronal_012.png","assets/T/mri-07a00ae75e7b4977/coronal_013.png","assets/T/mri-07a00ae75e7b4977/coronal_014.png","assets/T/mri-07a00ae75e7b4977/coronal_015.png","assets/T/mri-07a00ae75e7b4977/coronal_016.png","assets/T/mri-07a00ae75e7b4977/coronal_017.png","assets/T/mri-07a00ae75e7b4977/coronal_018.png","assets/T/mri-07a00ae75e7b4977/coronal_019.png","assets/T/mri-07a00ae75e7b4977/coronal_020.png","assets/T/mri-07a00ae75e7b4977/coronal_021.png","assets/T/mri-07a00ae75e7b4977/coronal_022.png","assets/T/mri-07a00ae75e7b4977/coronal_023.png","assets/T/mri-07a00ae75e7b4977/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-3640dbda84064e7c","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-3640dbda84064e7c/axial_001.png","assets/T/mri-3640dbda84064e7c/axial_002.png","assets/T/mri-3640dbda84064e7c/axial_003.png","assets/T/mri-3640dbda84064e7c/axial_004.png","assets/T/mri-3640dbda84064e7c/axial_005.png","assets/T/mri-3640dbda84064e7c/axial_006.png","assets/T/mri-3640dbda84064e7c/axial_007.png","assets/T/mri-3640dbda84064e7c/axial_008.png","assets/T/mri-3640dbda84064e7c/axial_009.png","assets/T/mri-3640dbda84064e7c/axial_010.png","assets/T/mri-3640dbda84064e7c/axial_011.png","assets/T/mri-3640dbda84064e7c/axial_012.png","assets/T/mri-3640dbda84064e7c/axial_013.png","assets/T/mri-3640dbda84064e7c/axial_014.png","assets/T/mri-3640dbda84064e7c/axial_015.png","assets/T/mri-3640dbda84064e7c/axial_016.png","assets/T/mri-3640dbda84064e7c/axial_017.png","assets/T/mri-3640dbda84064e7c/axial_018.png","assets/T/mri-3640dbda84064e7c/axial_019.png","assets/T/mri-3640dbda84064e7c/axial_020.png","assets/T/mri-3640dbda84064e7c/axial_021.png","assets/T/mri-3640dbda84064e7c/axial_022.png","assets/T/mri-3640dbda84064e7c/axial_023.png","assets/T/mri-3640dbda84064e7c/axial_024.png","assets/T/mri-3640dbda84064e7c/axial_025.png","assets/T/mri-3640dbda84064e7c/axial_026.png","assets/T/mri-3640dbda84064e7c/axial_027.png","assets/T/mri-3640dbda84064e7c/axial_028.png","assets/T/mri-3640dbda84064e7c/axial_029.png","assets/T/mri-3640dbda84064e7c/axial_030.png","assets/T/mri-3640dbda84064e7c/axial_031.png","assets/T/mri-3640dbda84064e7c/axial_032.png","assets/T/mri-3640dbda84064e7c/axial_033.png","assets/T/mri-3640dbda84064e7c/axial_034.png","assets/T/mri-3640dbda84064e7c/axial_035.png","assets/T/mri-3640dbda84064e7c/axial_036.png","assets/T/mri-3640dbda84064e7c/axial_037.png","assets/T/mri-3640dbda84064e7c/axial_038.png","assets/T/mri-3640dbda84064e7c/axial_039.png","assets/T/mri-3640dbda84064e7c/axial_040.png","assets/T/mri-3640dbda84064e7c/axial_041.png","assets/T/mri-3640dbda84064e7c/axial_042.png","assets/T/mri-3640dbda84064e7c/coronal_001.png","assets/T/mri-3640dbda84064e7c/coronal_002.png","assets/T/mri-3640dbda84064e7c/coronal_003.png","assets/T/mri-3640dbda84064e7c/coronal_004.png","assets/T/mri-3640dbda84064e7c/coronal_005.png","assets/T/mri-3640dbda84064e7c/coronal_006.png","assets/T/mri-3640dbda84064e7c/coronal_007.png","assets/T/mri-3640dbda84064e7c/coronal_008.png","assets/T/mri-3640dbda84064e7c/coronal_009.png","assets/T/mri-3640dbda84064e7c/coronal_010.png","assets/T/mri-3640dbda84064e7c/coronal_011.png","assets/T/mri-3640dbda84064e7c/coronal_012.png","assets/T/mri-3640dbda84064e7c/coronal_013.png","assets/T/mri-3640dbda84064e7c/coronal_014.png","assets/T/mri-3640dbda84064e7c/coronal_015.png","assets/T/mri-3640dbda84064e7c/coronal_016.png","assets/T/mri-3640dbda84064e7c/coronal_017.png","assets/T/mri-3640dbda84064e7c/coronal_018.png","assets/T/mri-3640dbda84064e7c/coronal_019.png","assets/T/mri-3640dbda84064e7c/coronal_020.png","assets/T/mri-3640dbda84064e7c/coronal_021.png","assets/T/mri-3640dbda84064e7c/coronal_022.png","assets/T/mri-3640dbda84064e7c/coronal_023.png","assets/T/mri-3640dbda84064e7c/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-3fb297150b194344","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 67 张图，均来自同一次检查。\n\n- 前 43 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-3fb297150b194344/axial_001.png","assets/T/mri-3fb297150b194344/axial_002.png","assets/T/mri-3fb297150b194344/axial_003.png","assets/T/mri-3fb297150b194344/axial_004.png","assets/T/mri-3fb297150b194344/axial_005.png","assets/T/mri-3fb297150b194344/axial_006.png","assets/T/mri-3fb297150b194344/axial_007.png","assets/T/mri-3fb297150b194344/axial_008.png","assets/T/mri-3fb297150b194344/axial_009.png","assets/T/mri-3fb297150b194344/axial_010.png","assets/T/mri-3fb297150b194344/axial_011.png","assets/T/mri-3fb297150b194344/axial_012.png","assets/T/mri-3fb297150b194344/axial_013.png","assets/T/mri-3fb297150b194344/axial_014.png","assets/T/mri-3fb297150b194344/axial_015.png","assets/T/mri-3fb297150b194344/axial_016.png","assets/T/mri-3fb297150b194344/axial_017.png","assets/T/mri-3fb297150b194344/axial_018.png","assets/T/mri-3fb297150b194344/axial_019.png","assets/T/mri-3fb297150b194344/axial_020.png","assets/T/mri-3fb297150b194344/axial_021.png","assets/T/mri-3fb297150b194344/axial_022.png","assets/T/mri-3fb297150b194344/axial_023.png","assets/T/mri-3fb297150b194344/axial_024.png","assets/T/mri-3fb297150b194344/axial_025.png","assets/T/mri-3fb297150b194344/axial_026.png","assets/T/mri-3fb297150b194344/axial_027.png","assets/T/mri-3fb297150b194344/axial_028.png","assets/T/mri-3fb297150b194344/axial_029.png","assets/T/mri-3fb297150b194344/axial_030.png","assets/T/mri-3fb297150b194344/axial_031.png","assets/T/mri-3fb297150b194344/axial_032.png","assets/T/mri-3fb297150b194344/axial_033.png","assets/T/mri-3fb297150b194344/axial_034.png","assets/T/mri-3fb297150b194344/axial_035.png","assets/T/mri-3fb297150b194344/axial_036.png","assets/T/mri-3fb297150b194344/axial_037.png","assets/T/mri-3fb297150b194344/axial_038.png","assets/T/mri-3fb297150b194344/axial_039.png","assets/T/mri-3fb297150b194344/axial_040.png","assets/T/mri-3fb297150b194344/axial_041.png","assets/T/mri-3fb297150b194344/axial_042.png","assets/T/mri-3fb297150b194344/axial_043.png","assets/T/mri-3fb297150b194344/coronal_001.png","assets/T/mri-3fb297150b194344/coronal_002.png","assets/T/mri-3fb297150b194344/coronal_003.png","assets/T/mri-3fb297150b194344/coronal_004.png","assets/T/mri-3fb297150b194344/coronal_005.png","assets/T/mri-3fb297150b194344/coronal_006.png","assets/T/mri-3fb297150b194344/coronal_007.png","assets/T/mri-3fb297150b194344/coronal_008.png","assets/T/mri-3fb297150b194344/coronal_009.png","assets/T/mri-3fb297150b194344/coronal_010.png","assets/T/mri-3fb297150b194344/coronal_011.png","assets/T/mri-3fb297150b194344/coronal_012.png","assets/T/mri-3fb297150b194344/coronal_013.png","assets/T/mri-3fb297150b194344/coronal_014.png","assets/T/mri-3fb297150b194344/coronal_015.png","assets/T/mri-3fb297150b194344/coronal_016.png","assets/T/mri-3fb297150b194344/coronal_017.png","assets/T/mri-3fb297150b194344/coronal_018.png","assets/T/mri-3fb297150b194344/coronal_019.png","assets/T/mri-3fb297150b194344/coronal_020.png","assets/T/mri-3fb297150b194344/coronal_021.png","assets/T/mri-3fb297150b194344/coronal_022.png","assets/T/mri-3fb297150b194344/coronal_023.png","assets/T/mri-3fb297150b194344/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-e5bad77de70140d2","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-e5bad77de70140d2/axial_001.png","assets/T/mri-e5bad77de70140d2/axial_002.png","assets/T/mri-e5bad77de70140d2/axial_003.png","assets/T/mri-e5bad77de70140d2/axial_004.png","assets/T/mri-e5bad77de70140d2/axial_005.png","assets/T/mri-e5bad77de70140d2/axial_006.png","assets/T/mri-e5bad77de70140d2/axial_007.png","assets/T/mri-e5bad77de70140d2/axial_008.png","assets/T/mri-e5bad77de70140d2/axial_009.png","assets/T/mri-e5bad77de70140d2/axial_010.png","assets/T/mri-e5bad77de70140d2/axial_011.png","assets/T/mri-e5bad77de70140d2/axial_012.png","assets/T/mri-e5bad77de70140d2/axial_013.png","assets/T/mri-e5bad77de70140d2/axial_014.png","assets/T/mri-e5bad77de70140d2/axial_015.png","assets/T/mri-e5bad77de70140d2/axial_016.png","assets/T/mri-e5bad77de70140d2/axial_017.png","assets/T/mri-e5bad77de70140d2/axial_018.png","assets/T/mri-e5bad77de70140d2/axial_019.png","assets/T/mri-e5bad77de70140d2/axial_020.png","assets/T/mri-e5bad77de70140d2/axial_021.png","assets/T/mri-e5bad77de70140d2/axial_022.png","assets/T/mri-e5bad77de70140d2/axial_023.png","assets/T/mri-e5bad77de70140d2/axial_024.png","assets/T/mri-e5bad77de70140d2/axial_025.png","assets/T/mri-e5bad77de70140d2/axial_026.png","assets/T/mri-e5bad77de70140d2/axial_027.png","assets/T/mri-e5bad77de70140d2/axial_028.png","assets/T/mri-e5bad77de70140d2/axial_029.png","assets/T/mri-e5bad77de70140d2/axial_030.png","assets/T/mri-e5bad77de70140d2/axial_031.png","assets/T/mri-e5bad77de70140d2/axial_032.png","assets/T/mri-e5bad77de70140d2/axial_033.png","assets/T/mri-e5bad77de70140d2/axial_034.png","assets/T/mri-e5bad77de70140d2/axial_035.png","assets/T/mri-e5bad77de70140d2/axial_036.png","assets/T/mri-e5bad77de70140d2/axial_037.png","assets/T/mri-e5bad77de70140d2/axial_038.png","assets/T/mri-e5bad77de70140d2/axial_039.png","assets/T/mri-e5bad77de70140d2/axial_040.png","assets/T/mri-e5bad77de70140d2/coronal_001.png","assets/T/mri-e5bad77de70140d2/coronal_002.png","assets/T/mri-e5bad77de70140d2/coronal_003.png","assets/T/mri-e5bad77de70140d2/coronal_004.png","assets/T/mri-e5bad77de70140d2/coronal_005.png","assets/T/mri-e5bad77de70140d2/coronal_006.png","assets/T/mri-e5bad77de70140d2/coronal_007.png","assets/T/mri-e5bad77de70140d2/coronal_008.png","assets/T/mri-e5bad77de70140d2/coronal_009.png","assets/T/mri-e5bad77de70140d2/coronal_010.png","assets/T/mri-e5bad77de70140d2/coronal_011.png","assets/T/mri-e5bad77de70140d2/coronal_012.png","assets/T/mri-e5bad77de70140d2/coronal_013.png","assets/T/mri-e5bad77de70140d2/coronal_014.png","assets/T/mri-e5bad77de70140d2/coronal_015.png","assets/T/mri-e5bad77de70140d2/coronal_016.png","assets/T/mri-e5bad77de70140d2/coronal_017.png","assets/T/mri-e5bad77de70140d2/coronal_018.png","assets/T/mri-e5bad77de70140d2/coronal_019.png","assets/T/mri-e5bad77de70140d2/coronal_020.png","assets/T/mri-e5bad77de70140d2/coronal_021.png","assets/T/mri-e5bad77de70140d2/coronal_022.png","assets/T/mri-e5bad77de70140d2/coronal_023.png","assets/T/mri-e5bad77de70140d2/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-8a2e314a61574ad4","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-8a2e314a61574ad4/axial_001.png","assets/T/mri-8a2e314a61574ad4/axial_002.png","assets/T/mri-8a2e314a61574ad4/axial_003.png","assets/T/mri-8a2e314a61574ad4/axial_004.png","assets/T/mri-8a2e314a61574ad4/axial_005.png","assets/T/mri-8a2e314a61574ad4/axial_006.png","assets/T/mri-8a2e314a61574ad4/axial_007.png","assets/T/mri-8a2e314a61574ad4/axial_008.png","assets/T/mri-8a2e314a61574ad4/axial_009.png","assets/T/mri-8a2e314a61574ad4/axial_010.png","assets/T/mri-8a2e314a61574ad4/axial_011.png","assets/T/mri-8a2e314a61574ad4/axial_012.png","assets/T/mri-8a2e314a61574ad4/axial_013.png","assets/T/mri-8a2e314a61574ad4/axial_014.png","assets/T/mri-8a2e314a61574ad4/axial_015.png","assets/T/mri-8a2e314a61574ad4/axial_016.png","assets/T/mri-8a2e314a61574ad4/axial_017.png","assets/T/mri-8a2e314a61574ad4/axial_018.png","assets/T/mri-8a2e314a61574ad4/axial_019.png","assets/T/mri-8a2e314a61574ad4/axial_020.png","assets/T/mri-8a2e314a61574ad4/axial_021.png","assets/T/mri-8a2e314a61574ad4/axial_022.png","assets/T/mri-8a2e314a61574ad4/axial_023.png","assets/T/mri-8a2e314a61574ad4/axial_024.png","assets/T/mri-8a2e314a61574ad4/axial_025.png","assets/T/mri-8a2e314a61574ad4/axial_026.png","assets/T/mri-8a2e314a61574ad4/axial_027.png","assets/T/mri-8a2e314a61574ad4/axial_028.png","assets/T/mri-8a2e314a61574ad4/axial_029.png","assets/T/mri-8a2e314a61574ad4/axial_030.png","assets/T/mri-8a2e314a61574ad4/axial_031.png","assets/T/mri-8a2e314a61574ad4/axial_032.png","assets/T/mri-8a2e314a61574ad4/axial_033.png","assets/T/mri-8a2e314a61574ad4/axial_034.png","assets/T/mri-8a2e314a61574ad4/axial_035.png","assets/T/mri-8a2e314a61574ad4/axial_036.png","assets/T/mri-8a2e314a61574ad4/axial_037.png","assets/T/mri-8a2e314a61574ad4/axial_038.png","assets/T/mri-8a2e314a61574ad4/axial_039.png","assets/T/mri-8a2e314a61574ad4/axial_040.png","assets/T/mri-8a2e314a61574ad4/coronal_001.png","assets/T/mri-8a2e314a61574ad4/coronal_002.png","assets/T/mri-8a2e314a61574ad4/coronal_003.png","assets/T/mri-8a2e314a61574ad4/coronal_004.png","assets/T/mri-8a2e314a61574ad4/coronal_005.png","assets/T/mri-8a2e314a61574ad4/coronal_006.png","assets/T/mri-8a2e314a61574ad4/coronal_007.png","assets/T/mri-8a2e314a61574ad4/coronal_008.png","assets/T/mri-8a2e314a61574ad4/coronal_009.png","assets/T/mri-8a2e314a61574ad4/coronal_010.png","assets/T/mri-8a2e314a61574ad4/coronal_011.png","assets/T/mri-8a2e314a61574ad4/coronal_012.png","assets/T/mri-8a2e314a61574ad4/coronal_013.png","assets/T/mri-8a2e314a61574ad4/coronal_014.png","assets/T/mri-8a2e314a61574ad4/coronal_015.png","assets/T/mri-8a2e314a61574ad4/coronal_016.png","assets/T/mri-8a2e314a61574ad4/coronal_017.png","assets/T/mri-8a2e314a61574ad4/coronal_018.png","assets/T/mri-8a2e314a61574ad4/coronal_019.png","assets/T/mri-8a2e314a61574ad4/coronal_020.png","assets/T/mri-8a2e314a61574ad4/coronal_021.png","assets/T/mri-8a2e314a61574ad4/coronal_022.png","assets/T/mri-8a2e314a61574ad4/coronal_023.png","assets/T/mri-8a2e314a61574ad4/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-89e6a98ecc3a4c9f","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-89e6a98ecc3a4c9f/axial_001.png","assets/T/mri-89e6a98ecc3a4c9f/axial_002.png","assets/T/mri-89e6a98ecc3a4c9f/axial_003.png","assets/T/mri-89e6a98ecc3a4c9f/axial_004.png","assets/T/mri-89e6a98ecc3a4c9f/axial_005.png","assets/T/mri-89e6a98ecc3a4c9f/axial_006.png","assets/T/mri-89e6a98ecc3a4c9f/axial_007.png","assets/T/mri-89e6a98ecc3a4c9f/axial_008.png","assets/T/mri-89e6a98ecc3a4c9f/axial_009.png","assets/T/mri-89e6a98ecc3a4c9f/axial_010.png","assets/T/mri-89e6a98ecc3a4c9f/axial_011.png","assets/T/mri-89e6a98ecc3a4c9f/axial_012.png","assets/T/mri-89e6a98ecc3a4c9f/axial_013.png","assets/T/mri-89e6a98ecc3a4c9f/axial_014.png","assets/T/mri-89e6a98ecc3a4c9f/axial_015.png","assets/T/mri-89e6a98ecc3a4c9f/axial_016.png","assets/T/mri-89e6a98ecc3a4c9f/axial_017.png","assets/T/mri-89e6a98ecc3a4c9f/axial_018.png","assets/T/mri-89e6a98ecc3a4c9f/axial_019.png","assets/T/mri-89e6a98ecc3a4c9f/axial_020.png","assets/T/mri-89e6a98ecc3a4c9f/axial_021.png","assets/T/mri-89e6a98ecc3a4c9f/axial_022.png","assets/T/mri-89e6a98ecc3a4c9f/axial_023.png","assets/T/mri-89e6a98ecc3a4c9f/axial_024.png","assets/T/mri-89e6a98ecc3a4c9f/axial_025.png","assets/T/mri-89e6a98ecc3a4c9f/axial_026.png","assets/T/mri-89e6a98ecc3a4c9f/axial_027.png","assets/T/mri-89e6a98ecc3a4c9f/axial_028.png","assets/T/mri-89e6a98ecc3a4c9f/axial_029.png","assets/T/mri-89e6a98ecc3a4c9f/axial_030.png","assets/T/mri-89e6a98ecc3a4c9f/axial_031.png","assets/T/mri-89e6a98ecc3a4c9f/axial_032.png","assets/T/mri-89e6a98ecc3a4c9f/axial_033.png","assets/T/mri-89e6a98ecc3a4c9f/axial_034.png","assets/T/mri-89e6a98ecc3a4c9f/axial_035.png","assets/T/mri-89e6a98ecc3a4c9f/axial_036.png","assets/T/mri-89e6a98ecc3a4c9f/axial_037.png","assets/T/mri-89e6a98ecc3a4c9f/axial_038.png","assets/T/mri-89e6a98ecc3a4c9f/axial_039.png","assets/T/mri-89e6a98ecc3a4c9f/axial_040.png","assets/T/mri-89e6a98ecc3a4c9f/axial_041.png","assets/T/mri-89e6a98ecc3a4c9f/axial_042.png","assets/T/mri-89e6a98ecc3a4c9f/coronal_001.png","assets/T/mri-89e6a98ecc3a4c9f/coronal_002.png","assets/T/mri-89e6a98ecc3a4c9f/coronal_003.png","assets/T/mri-89e6a98ecc3a4c9f/coronal_004.png","assets/T/mri-89e6a98ecc3a4c9f/coronal_005.png","assets/T/mri-89e6a98ecc3a4c9f/coronal_006.png","assets/T/mri-89e6a98ecc3a4c9f/coronal_007.png","assets/T/mri-89e6a98ecc3a4c9f/coronal_008.png","assets/T/mri-89e6a98ecc3a4c9f/coronal_009.png","assets/T/mri-89e6a98ecc3a4c9f/coronal_010.png","assets/T/mri-89e6a98ecc3a4c9f/coronal_011.png","assets/T/mri-89e6a98ecc3a4c9f/coronal_012.png","assets/T/mri-89e6a98ecc3a4c9f/coronal_013.png","assets/T/mri-89e6a98ecc3a4c9f/coronal_014.png","assets/T/mri-89e6a98ecc3a4c9f/coronal_015.png","assets/T/mri-89e6a98ecc3a4c9f/coronal_016.png","assets/T/mri-89e6a98ecc3a4c9f/coronal_017.png","assets/T/mri-89e6a98ecc3a4c9f/coronal_018.png","assets/T/mri-89e6a98ecc3a4c9f/coronal_019.png","assets/T/mri-89e6a98ecc3a4c9f/coronal_020.png","assets/T/mri-89e6a98ecc3a4c9f/coronal_021.png","assets/T/mri-89e6a98ecc3a4c9f/coronal_022.png","assets/T/mri-89e6a98ecc3a4c9f/coronal_023.png","assets/T/mri-89e6a98ecc3a4c9f/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-f38067ba8f3f41c6","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 26 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-f38067ba8f3f41c6/axial_001.png","assets/T/mri-f38067ba8f3f41c6/axial_002.png","assets/T/mri-f38067ba8f3f41c6/axial_003.png","assets/T/mri-f38067ba8f3f41c6/axial_004.png","assets/T/mri-f38067ba8f3f41c6/axial_005.png","assets/T/mri-f38067ba8f3f41c6/axial_006.png","assets/T/mri-f38067ba8f3f41c6/axial_007.png","assets/T/mri-f38067ba8f3f41c6/axial_008.png","assets/T/mri-f38067ba8f3f41c6/axial_009.png","assets/T/mri-f38067ba8f3f41c6/axial_010.png","assets/T/mri-f38067ba8f3f41c6/axial_011.png","assets/T/mri-f38067ba8f3f41c6/axial_012.png","assets/T/mri-f38067ba8f3f41c6/axial_013.png","assets/T/mri-f38067ba8f3f41c6/axial_014.png","assets/T/mri-f38067ba8f3f41c6/axial_015.png","assets/T/mri-f38067ba8f3f41c6/axial_016.png","assets/T/mri-f38067ba8f3f41c6/axial_017.png","assets/T/mri-f38067ba8f3f41c6/axial_018.png","assets/T/mri-f38067ba8f3f41c6/axial_019.png","assets/T/mri-f38067ba8f3f41c6/axial_020.png","assets/T/mri-f38067ba8f3f41c6/axial_021.png","assets/T/mri-f38067ba8f3f41c6/axial_022.png","assets/T/mri-f38067ba8f3f41c6/axial_023.png","assets/T/mri-f38067ba8f3f41c6/axial_024.png","assets/T/mri-f38067ba8f3f41c6/axial_025.png","assets/T/mri-f38067ba8f3f41c6/axial_026.png","assets/T/mri-f38067ba8f3f41c6/axial_027.png","assets/T/mri-f38067ba8f3f41c6/axial_028.png","assets/T/mri-f38067ba8f3f41c6/axial_029.png","assets/T/mri-f38067ba8f3f41c6/axial_030.png","assets/T/mri-f38067ba8f3f41c6/axial_031.png","assets/T/mri-f38067ba8f3f41c6/axial_032.png","assets/T/mri-f38067ba8f3f41c6/axial_033.png","assets/T/mri-f38067ba8f3f41c6/axial_034.png","assets/T/mri-f38067ba8f3f41c6/axial_035.png","assets/T/mri-f38067ba8f3f41c6/axial_036.png","assets/T/mri-f38067ba8f3f41c6/axial_037.png","assets/T/mri-f38067ba8f3f41c6/axial_038.png","assets/T/mri-f38067ba8f3f41c6/axial_039.png","assets/T/mri-f38067ba8f3f41c6/axial_040.png","assets/T/mri-f38067ba8f3f41c6/coronal_001.png","assets/T/mri-f38067ba8f3f41c6/coronal_002.png","assets/T/mri-f38067ba8f3f41c6/coronal_003.png","assets/T/mri-f38067ba8f3f41c6/coronal_004.png","assets/T/mri-f38067ba8f3f41c6/coronal_005.png","assets/T/mri-f38067ba8f3f41c6/coronal_006.png","assets/T/mri-f38067ba8f3f41c6/coronal_007.png","assets/T/mri-f38067ba8f3f41c6/coronal_008.png","assets/T/mri-f38067ba8f3f41c6/coronal_009.png","assets/T/mri-f38067ba8f3f41c6/coronal_010.png","assets/T/mri-f38067ba8f3f41c6/coronal_011.png","assets/T/mri-f38067ba8f3f41c6/coronal_012.png","assets/T/mri-f38067ba8f3f41c6/coronal_013.png","assets/T/mri-f38067ba8f3f41c6/coronal_014.png","assets/T/mri-f38067ba8f3f41c6/coronal_015.png","assets/T/mri-f38067ba8f3f41c6/coronal_016.png","assets/T/mri-f38067ba8f3f41c6/coronal_017.png","assets/T/mri-f38067ba8f3f41c6/coronal_018.png","assets/T/mri-f38067ba8f3f41c6/coronal_019.png","assets/T/mri-f38067ba8f3f41c6/coronal_020.png","assets/T/mri-f38067ba8f3f41c6/coronal_021.png","assets/T/mri-f38067ba8f3f41c6/coronal_022.png","assets/T/mri-f38067ba8f3f41c6/coronal_023.png","assets/T/mri-f38067ba8f3f41c6/coronal_024.png","assets/T/mri-f38067ba8f3f41c6/coronal_025.png","assets/T/mri-f38067ba8f3f41c6/coronal_026.png"],"stage_edition":8}
+{"id":"L3-T300:mri-591cf62b9f5c4f41","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 68 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 28 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-591cf62b9f5c4f41/axial_001.png","assets/T/mri-591cf62b9f5c4f41/axial_002.png","assets/T/mri-591cf62b9f5c4f41/axial_003.png","assets/T/mri-591cf62b9f5c4f41/axial_004.png","assets/T/mri-591cf62b9f5c4f41/axial_005.png","assets/T/mri-591cf62b9f5c4f41/axial_006.png","assets/T/mri-591cf62b9f5c4f41/axial_007.png","assets/T/mri-591cf62b9f5c4f41/axial_008.png","assets/T/mri-591cf62b9f5c4f41/axial_009.png","assets/T/mri-591cf62b9f5c4f41/axial_010.png","assets/T/mri-591cf62b9f5c4f41/axial_011.png","assets/T/mri-591cf62b9f5c4f41/axial_012.png","assets/T/mri-591cf62b9f5c4f41/axial_013.png","assets/T/mri-591cf62b9f5c4f41/axial_014.png","assets/T/mri-591cf62b9f5c4f41/axial_015.png","assets/T/mri-591cf62b9f5c4f41/axial_016.png","assets/T/mri-591cf62b9f5c4f41/axial_017.png","assets/T/mri-591cf62b9f5c4f41/axial_018.png","assets/T/mri-591cf62b9f5c4f41/axial_019.png","assets/T/mri-591cf62b9f5c4f41/axial_020.png","assets/T/mri-591cf62b9f5c4f41/axial_021.png","assets/T/mri-591cf62b9f5c4f41/axial_022.png","assets/T/mri-591cf62b9f5c4f41/axial_023.png","assets/T/mri-591cf62b9f5c4f41/axial_024.png","assets/T/mri-591cf62b9f5c4f41/axial_025.png","assets/T/mri-591cf62b9f5c4f41/axial_026.png","assets/T/mri-591cf62b9f5c4f41/axial_027.png","assets/T/mri-591cf62b9f5c4f41/axial_028.png","assets/T/mri-591cf62b9f5c4f41/axial_029.png","assets/T/mri-591cf62b9f5c4f41/axial_030.png","assets/T/mri-591cf62b9f5c4f41/axial_031.png","assets/T/mri-591cf62b9f5c4f41/axial_032.png","assets/T/mri-591cf62b9f5c4f41/axial_033.png","assets/T/mri-591cf62b9f5c4f41/axial_034.png","assets/T/mri-591cf62b9f5c4f41/axial_035.png","assets/T/mri-591cf62b9f5c4f41/axial_036.png","assets/T/mri-591cf62b9f5c4f41/axial_037.png","assets/T/mri-591cf62b9f5c4f41/axial_038.png","assets/T/mri-591cf62b9f5c4f41/axial_039.png","assets/T/mri-591cf62b9f5c4f41/axial_040.png","assets/T/mri-591cf62b9f5c4f41/coronal_001.png","assets/T/mri-591cf62b9f5c4f41/coronal_002.png","assets/T/mri-591cf62b9f5c4f41/coronal_003.png","assets/T/mri-591cf62b9f5c4f41/coronal_004.png","assets/T/mri-591cf62b9f5c4f41/coronal_005.png","assets/T/mri-591cf62b9f5c4f41/coronal_006.png","assets/T/mri-591cf62b9f5c4f41/coronal_007.png","assets/T/mri-591cf62b9f5c4f41/coronal_008.png","assets/T/mri-591cf62b9f5c4f41/coronal_009.png","assets/T/mri-591cf62b9f5c4f41/coronal_010.png","assets/T/mri-591cf62b9f5c4f41/coronal_011.png","assets/T/mri-591cf62b9f5c4f41/coronal_012.png","assets/T/mri-591cf62b9f5c4f41/coronal_013.png","assets/T/mri-591cf62b9f5c4f41/coronal_014.png","assets/T/mri-591cf62b9f5c4f41/coronal_015.png","assets/T/mri-591cf62b9f5c4f41/coronal_016.png","assets/T/mri-591cf62b9f5c4f41/coronal_017.png","assets/T/mri-591cf62b9f5c4f41/coronal_018.png","assets/T/mri-591cf62b9f5c4f41/coronal_019.png","assets/T/mri-591cf62b9f5c4f41/coronal_020.png","assets/T/mri-591cf62b9f5c4f41/coronal_021.png","assets/T/mri-591cf62b9f5c4f41/coronal_022.png","assets/T/mri-591cf62b9f5c4f41/coronal_023.png","assets/T/mri-591cf62b9f5c4f41/coronal_024.png","assets/T/mri-591cf62b9f5c4f41/coronal_025.png","assets/T/mri-591cf62b9f5c4f41/coronal_026.png","assets/T/mri-591cf62b9f5c4f41/coronal_027.png","assets/T/mri-591cf62b9f5c4f41/coronal_028.png"],"stage_edition":8}
+{"id":"L3-T300:mri-a1c6c7fdf7e94572","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 68 张图，均来自同一次检查。\n\n- 前 44 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-a1c6c7fdf7e94572/axial_001.png","assets/T/mri-a1c6c7fdf7e94572/axial_002.png","assets/T/mri-a1c6c7fdf7e94572/axial_003.png","assets/T/mri-a1c6c7fdf7e94572/axial_004.png","assets/T/mri-a1c6c7fdf7e94572/axial_005.png","assets/T/mri-a1c6c7fdf7e94572/axial_006.png","assets/T/mri-a1c6c7fdf7e94572/axial_007.png","assets/T/mri-a1c6c7fdf7e94572/axial_008.png","assets/T/mri-a1c6c7fdf7e94572/axial_009.png","assets/T/mri-a1c6c7fdf7e94572/axial_010.png","assets/T/mri-a1c6c7fdf7e94572/axial_011.png","assets/T/mri-a1c6c7fdf7e94572/axial_012.png","assets/T/mri-a1c6c7fdf7e94572/axial_013.png","assets/T/mri-a1c6c7fdf7e94572/axial_014.png","assets/T/mri-a1c6c7fdf7e94572/axial_015.png","assets/T/mri-a1c6c7fdf7e94572/axial_016.png","assets/T/mri-a1c6c7fdf7e94572/axial_017.png","assets/T/mri-a1c6c7fdf7e94572/axial_018.png","assets/T/mri-a1c6c7fdf7e94572/axial_019.png","assets/T/mri-a1c6c7fdf7e94572/axial_020.png","assets/T/mri-a1c6c7fdf7e94572/axial_021.png","assets/T/mri-a1c6c7fdf7e94572/axial_022.png","assets/T/mri-a1c6c7fdf7e94572/axial_023.png","assets/T/mri-a1c6c7fdf7e94572/axial_024.png","assets/T/mri-a1c6c7fdf7e94572/axial_025.png","assets/T/mri-a1c6c7fdf7e94572/axial_026.png","assets/T/mri-a1c6c7fdf7e94572/axial_027.png","assets/T/mri-a1c6c7fdf7e94572/axial_028.png","assets/T/mri-a1c6c7fdf7e94572/axial_029.png","assets/T/mri-a1c6c7fdf7e94572/axial_030.png","assets/T/mri-a1c6c7fdf7e94572/axial_031.png","assets/T/mri-a1c6c7fdf7e94572/axial_032.png","assets/T/mri-a1c6c7fdf7e94572/axial_033.png","assets/T/mri-a1c6c7fdf7e94572/axial_034.png","assets/T/mri-a1c6c7fdf7e94572/axial_035.png","assets/T/mri-a1c6c7fdf7e94572/axial_036.png","assets/T/mri-a1c6c7fdf7e94572/axial_037.png","assets/T/mri-a1c6c7fdf7e94572/axial_038.png","assets/T/mri-a1c6c7fdf7e94572/axial_039.png","assets/T/mri-a1c6c7fdf7e94572/axial_040.png","assets/T/mri-a1c6c7fdf7e94572/axial_041.png","assets/T/mri-a1c6c7fdf7e94572/axial_042.png","assets/T/mri-a1c6c7fdf7e94572/axial_043.png","assets/T/mri-a1c6c7fdf7e94572/axial_044.png","assets/T/mri-a1c6c7fdf7e94572/coronal_001.png","assets/T/mri-a1c6c7fdf7e94572/coronal_002.png","assets/T/mri-a1c6c7fdf7e94572/coronal_003.png","assets/T/mri-a1c6c7fdf7e94572/coronal_004.png","assets/T/mri-a1c6c7fdf7e94572/coronal_005.png","assets/T/mri-a1c6c7fdf7e94572/coronal_006.png","assets/T/mri-a1c6c7fdf7e94572/coronal_007.png","assets/T/mri-a1c6c7fdf7e94572/coronal_008.png","assets/T/mri-a1c6c7fdf7e94572/coronal_009.png","assets/T/mri-a1c6c7fdf7e94572/coronal_010.png","assets/T/mri-a1c6c7fdf7e94572/coronal_011.png","assets/T/mri-a1c6c7fdf7e94572/coronal_012.png","assets/T/mri-a1c6c7fdf7e94572/coronal_013.png","assets/T/mri-a1c6c7fdf7e94572/coronal_014.png","assets/T/mri-a1c6c7fdf7e94572/coronal_015.png","assets/T/mri-a1c6c7fdf7e94572/coronal_016.png","assets/T/mri-a1c6c7fdf7e94572/coronal_017.png","assets/T/mri-a1c6c7fdf7e94572/coronal_018.png","assets/T/mri-a1c6c7fdf7e94572/coronal_019.png","assets/T/mri-a1c6c7fdf7e94572/coronal_020.png","assets/T/mri-a1c6c7fdf7e94572/coronal_021.png","assets/T/mri-a1c6c7fdf7e94572/coronal_022.png","assets/T/mri-a1c6c7fdf7e94572/coronal_023.png","assets/T/mri-a1c6c7fdf7e94572/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-ac7e267005f6465a","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-ac7e267005f6465a/axial_001.png","assets/T/mri-ac7e267005f6465a/axial_002.png","assets/T/mri-ac7e267005f6465a/axial_003.png","assets/T/mri-ac7e267005f6465a/axial_004.png","assets/T/mri-ac7e267005f6465a/axial_005.png","assets/T/mri-ac7e267005f6465a/axial_006.png","assets/T/mri-ac7e267005f6465a/axial_007.png","assets/T/mri-ac7e267005f6465a/axial_008.png","assets/T/mri-ac7e267005f6465a/axial_009.png","assets/T/mri-ac7e267005f6465a/axial_010.png","assets/T/mri-ac7e267005f6465a/axial_011.png","assets/T/mri-ac7e267005f6465a/axial_012.png","assets/T/mri-ac7e267005f6465a/axial_013.png","assets/T/mri-ac7e267005f6465a/axial_014.png","assets/T/mri-ac7e267005f6465a/axial_015.png","assets/T/mri-ac7e267005f6465a/axial_016.png","assets/T/mri-ac7e267005f6465a/axial_017.png","assets/T/mri-ac7e267005f6465a/axial_018.png","assets/T/mri-ac7e267005f6465a/axial_019.png","assets/T/mri-ac7e267005f6465a/axial_020.png","assets/T/mri-ac7e267005f6465a/axial_021.png","assets/T/mri-ac7e267005f6465a/axial_022.png","assets/T/mri-ac7e267005f6465a/axial_023.png","assets/T/mri-ac7e267005f6465a/axial_024.png","assets/T/mri-ac7e267005f6465a/axial_025.png","assets/T/mri-ac7e267005f6465a/axial_026.png","assets/T/mri-ac7e267005f6465a/axial_027.png","assets/T/mri-ac7e267005f6465a/axial_028.png","assets/T/mri-ac7e267005f6465a/axial_029.png","assets/T/mri-ac7e267005f6465a/axial_030.png","assets/T/mri-ac7e267005f6465a/axial_031.png","assets/T/mri-ac7e267005f6465a/axial_032.png","assets/T/mri-ac7e267005f6465a/axial_033.png","assets/T/mri-ac7e267005f6465a/axial_034.png","assets/T/mri-ac7e267005f6465a/axial_035.png","assets/T/mri-ac7e267005f6465a/axial_036.png","assets/T/mri-ac7e267005f6465a/axial_037.png","assets/T/mri-ac7e267005f6465a/axial_038.png","assets/T/mri-ac7e267005f6465a/axial_039.png","assets/T/mri-ac7e267005f6465a/axial_040.png","assets/T/mri-ac7e267005f6465a/coronal_001.png","assets/T/mri-ac7e267005f6465a/coronal_002.png","assets/T/mri-ac7e267005f6465a/coronal_003.png","assets/T/mri-ac7e267005f6465a/coronal_004.png","assets/T/mri-ac7e267005f6465a/coronal_005.png","assets/T/mri-ac7e267005f6465a/coronal_006.png","assets/T/mri-ac7e267005f6465a/coronal_007.png","assets/T/mri-ac7e267005f6465a/coronal_008.png","assets/T/mri-ac7e267005f6465a/coronal_009.png","assets/T/mri-ac7e267005f6465a/coronal_010.png","assets/T/mri-ac7e267005f6465a/coronal_011.png","assets/T/mri-ac7e267005f6465a/coronal_012.png","assets/T/mri-ac7e267005f6465a/coronal_013.png","assets/T/mri-ac7e267005f6465a/coronal_014.png","assets/T/mri-ac7e267005f6465a/coronal_015.png","assets/T/mri-ac7e267005f6465a/coronal_016.png","assets/T/mri-ac7e267005f6465a/coronal_017.png","assets/T/mri-ac7e267005f6465a/coronal_018.png","assets/T/mri-ac7e267005f6465a/coronal_019.png","assets/T/mri-ac7e267005f6465a/coronal_020.png","assets/T/mri-ac7e267005f6465a/coronal_021.png","assets/T/mri-ac7e267005f6465a/coronal_022.png","assets/T/mri-ac7e267005f6465a/coronal_023.png","assets/T/mri-ac7e267005f6465a/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-df899a3786cb48e5","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-df899a3786cb48e5/axial_001.png","assets/T/mri-df899a3786cb48e5/axial_002.png","assets/T/mri-df899a3786cb48e5/axial_003.png","assets/T/mri-df899a3786cb48e5/axial_004.png","assets/T/mri-df899a3786cb48e5/axial_005.png","assets/T/mri-df899a3786cb48e5/axial_006.png","assets/T/mri-df899a3786cb48e5/axial_007.png","assets/T/mri-df899a3786cb48e5/axial_008.png","assets/T/mri-df899a3786cb48e5/axial_009.png","assets/T/mri-df899a3786cb48e5/axial_010.png","assets/T/mri-df899a3786cb48e5/axial_011.png","assets/T/mri-df899a3786cb48e5/axial_012.png","assets/T/mri-df899a3786cb48e5/axial_013.png","assets/T/mri-df899a3786cb48e5/axial_014.png","assets/T/mri-df899a3786cb48e5/axial_015.png","assets/T/mri-df899a3786cb48e5/axial_016.png","assets/T/mri-df899a3786cb48e5/axial_017.png","assets/T/mri-df899a3786cb48e5/axial_018.png","assets/T/mri-df899a3786cb48e5/axial_019.png","assets/T/mri-df899a3786cb48e5/axial_020.png","assets/T/mri-df899a3786cb48e5/axial_021.png","assets/T/mri-df899a3786cb48e5/axial_022.png","assets/T/mri-df899a3786cb48e5/axial_023.png","assets/T/mri-df899a3786cb48e5/axial_024.png","assets/T/mri-df899a3786cb48e5/axial_025.png","assets/T/mri-df899a3786cb48e5/axial_026.png","assets/T/mri-df899a3786cb48e5/axial_027.png","assets/T/mri-df899a3786cb48e5/axial_028.png","assets/T/mri-df899a3786cb48e5/axial_029.png","assets/T/mri-df899a3786cb48e5/axial_030.png","assets/T/mri-df899a3786cb48e5/axial_031.png","assets/T/mri-df899a3786cb48e5/axial_032.png","assets/T/mri-df899a3786cb48e5/axial_033.png","assets/T/mri-df899a3786cb48e5/axial_034.png","assets/T/mri-df899a3786cb48e5/axial_035.png","assets/T/mri-df899a3786cb48e5/axial_036.png","assets/T/mri-df899a3786cb48e5/axial_037.png","assets/T/mri-df899a3786cb48e5/axial_038.png","assets/T/mri-df899a3786cb48e5/axial_039.png","assets/T/mri-df899a3786cb48e5/axial_040.png","assets/T/mri-df899a3786cb48e5/coronal_001.png","assets/T/mri-df899a3786cb48e5/coronal_002.png","assets/T/mri-df899a3786cb48e5/coronal_003.png","assets/T/mri-df899a3786cb48e5/coronal_004.png","assets/T/mri-df899a3786cb48e5/coronal_005.png","assets/T/mri-df899a3786cb48e5/coronal_006.png","assets/T/mri-df899a3786cb48e5/coronal_007.png","assets/T/mri-df899a3786cb48e5/coronal_008.png","assets/T/mri-df899a3786cb48e5/coronal_009.png","assets/T/mri-df899a3786cb48e5/coronal_010.png","assets/T/mri-df899a3786cb48e5/coronal_011.png","assets/T/mri-df899a3786cb48e5/coronal_012.png","assets/T/mri-df899a3786cb48e5/coronal_013.png","assets/T/mri-df899a3786cb48e5/coronal_014.png","assets/T/mri-df899a3786cb48e5/coronal_015.png","assets/T/mri-df899a3786cb48e5/coronal_016.png","assets/T/mri-df899a3786cb48e5/coronal_017.png","assets/T/mri-df899a3786cb48e5/coronal_018.png","assets/T/mri-df899a3786cb48e5/coronal_019.png","assets/T/mri-df899a3786cb48e5/coronal_020.png","assets/T/mri-df899a3786cb48e5/coronal_021.png","assets/T/mri-df899a3786cb48e5/coronal_022.png","assets/T/mri-df899a3786cb48e5/coronal_023.png","assets/T/mri-df899a3786cb48e5/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-8a31792e1b9548c6","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-8a31792e1b9548c6/axial_001.png","assets/T/mri-8a31792e1b9548c6/axial_002.png","assets/T/mri-8a31792e1b9548c6/axial_003.png","assets/T/mri-8a31792e1b9548c6/axial_004.png","assets/T/mri-8a31792e1b9548c6/axial_005.png","assets/T/mri-8a31792e1b9548c6/axial_006.png","assets/T/mri-8a31792e1b9548c6/axial_007.png","assets/T/mri-8a31792e1b9548c6/axial_008.png","assets/T/mri-8a31792e1b9548c6/axial_009.png","assets/T/mri-8a31792e1b9548c6/axial_010.png","assets/T/mri-8a31792e1b9548c6/axial_011.png","assets/T/mri-8a31792e1b9548c6/axial_012.png","assets/T/mri-8a31792e1b9548c6/axial_013.png","assets/T/mri-8a31792e1b9548c6/axial_014.png","assets/T/mri-8a31792e1b9548c6/axial_015.png","assets/T/mri-8a31792e1b9548c6/axial_016.png","assets/T/mri-8a31792e1b9548c6/axial_017.png","assets/T/mri-8a31792e1b9548c6/axial_018.png","assets/T/mri-8a31792e1b9548c6/axial_019.png","assets/T/mri-8a31792e1b9548c6/axial_020.png","assets/T/mri-8a31792e1b9548c6/axial_021.png","assets/T/mri-8a31792e1b9548c6/axial_022.png","assets/T/mri-8a31792e1b9548c6/axial_023.png","assets/T/mri-8a31792e1b9548c6/axial_024.png","assets/T/mri-8a31792e1b9548c6/axial_025.png","assets/T/mri-8a31792e1b9548c6/axial_026.png","assets/T/mri-8a31792e1b9548c6/axial_027.png","assets/T/mri-8a31792e1b9548c6/axial_028.png","assets/T/mri-8a31792e1b9548c6/axial_029.png","assets/T/mri-8a31792e1b9548c6/axial_030.png","assets/T/mri-8a31792e1b9548c6/axial_031.png","assets/T/mri-8a31792e1b9548c6/axial_032.png","assets/T/mri-8a31792e1b9548c6/axial_033.png","assets/T/mri-8a31792e1b9548c6/axial_034.png","assets/T/mri-8a31792e1b9548c6/axial_035.png","assets/T/mri-8a31792e1b9548c6/axial_036.png","assets/T/mri-8a31792e1b9548c6/axial_037.png","assets/T/mri-8a31792e1b9548c6/axial_038.png","assets/T/mri-8a31792e1b9548c6/axial_039.png","assets/T/mri-8a31792e1b9548c6/axial_040.png","assets/T/mri-8a31792e1b9548c6/axial_041.png","assets/T/mri-8a31792e1b9548c6/axial_042.png","assets/T/mri-8a31792e1b9548c6/coronal_001.png","assets/T/mri-8a31792e1b9548c6/coronal_002.png","assets/T/mri-8a31792e1b9548c6/coronal_003.png","assets/T/mri-8a31792e1b9548c6/coronal_004.png","assets/T/mri-8a31792e1b9548c6/coronal_005.png","assets/T/mri-8a31792e1b9548c6/coronal_006.png","assets/T/mri-8a31792e1b9548c6/coronal_007.png","assets/T/mri-8a31792e1b9548c6/coronal_008.png","assets/T/mri-8a31792e1b9548c6/coronal_009.png","assets/T/mri-8a31792e1b9548c6/coronal_010.png","assets/T/mri-8a31792e1b9548c6/coronal_011.png","assets/T/mri-8a31792e1b9548c6/coronal_012.png","assets/T/mri-8a31792e1b9548c6/coronal_013.png","assets/T/mri-8a31792e1b9548c6/coronal_014.png","assets/T/mri-8a31792e1b9548c6/coronal_015.png","assets/T/mri-8a31792e1b9548c6/coronal_016.png","assets/T/mri-8a31792e1b9548c6/coronal_017.png","assets/T/mri-8a31792e1b9548c6/coronal_018.png","assets/T/mri-8a31792e1b9548c6/coronal_019.png","assets/T/mri-8a31792e1b9548c6/coronal_020.png","assets/T/mri-8a31792e1b9548c6/coronal_021.png","assets/T/mri-8a31792e1b9548c6/coronal_022.png","assets/T/mri-8a31792e1b9548c6/coronal_023.png","assets/T/mri-8a31792e1b9548c6/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-92679901993c443c","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-92679901993c443c/axial_001.png","assets/T/mri-92679901993c443c/axial_002.png","assets/T/mri-92679901993c443c/axial_003.png","assets/T/mri-92679901993c443c/axial_004.png","assets/T/mri-92679901993c443c/axial_005.png","assets/T/mri-92679901993c443c/axial_006.png","assets/T/mri-92679901993c443c/axial_007.png","assets/T/mri-92679901993c443c/axial_008.png","assets/T/mri-92679901993c443c/axial_009.png","assets/T/mri-92679901993c443c/axial_010.png","assets/T/mri-92679901993c443c/axial_011.png","assets/T/mri-92679901993c443c/axial_012.png","assets/T/mri-92679901993c443c/axial_013.png","assets/T/mri-92679901993c443c/axial_014.png","assets/T/mri-92679901993c443c/axial_015.png","assets/T/mri-92679901993c443c/axial_016.png","assets/T/mri-92679901993c443c/axial_017.png","assets/T/mri-92679901993c443c/axial_018.png","assets/T/mri-92679901993c443c/axial_019.png","assets/T/mri-92679901993c443c/axial_020.png","assets/T/mri-92679901993c443c/axial_021.png","assets/T/mri-92679901993c443c/axial_022.png","assets/T/mri-92679901993c443c/axial_023.png","assets/T/mri-92679901993c443c/axial_024.png","assets/T/mri-92679901993c443c/axial_025.png","assets/T/mri-92679901993c443c/axial_026.png","assets/T/mri-92679901993c443c/axial_027.png","assets/T/mri-92679901993c443c/axial_028.png","assets/T/mri-92679901993c443c/axial_029.png","assets/T/mri-92679901993c443c/axial_030.png","assets/T/mri-92679901993c443c/axial_031.png","assets/T/mri-92679901993c443c/axial_032.png","assets/T/mri-92679901993c443c/axial_033.png","assets/T/mri-92679901993c443c/axial_034.png","assets/T/mri-92679901993c443c/axial_035.png","assets/T/mri-92679901993c443c/axial_036.png","assets/T/mri-92679901993c443c/axial_037.png","assets/T/mri-92679901993c443c/axial_038.png","assets/T/mri-92679901993c443c/axial_039.png","assets/T/mri-92679901993c443c/axial_040.png","assets/T/mri-92679901993c443c/axial_041.png","assets/T/mri-92679901993c443c/axial_042.png","assets/T/mri-92679901993c443c/coronal_001.png","assets/T/mri-92679901993c443c/coronal_002.png","assets/T/mri-92679901993c443c/coronal_003.png","assets/T/mri-92679901993c443c/coronal_004.png","assets/T/mri-92679901993c443c/coronal_005.png","assets/T/mri-92679901993c443c/coronal_006.png","assets/T/mri-92679901993c443c/coronal_007.png","assets/T/mri-92679901993c443c/coronal_008.png","assets/T/mri-92679901993c443c/coronal_009.png","assets/T/mri-92679901993c443c/coronal_010.png","assets/T/mri-92679901993c443c/coronal_011.png","assets/T/mri-92679901993c443c/coronal_012.png","assets/T/mri-92679901993c443c/coronal_013.png","assets/T/mri-92679901993c443c/coronal_014.png","assets/T/mri-92679901993c443c/coronal_015.png","assets/T/mri-92679901993c443c/coronal_016.png","assets/T/mri-92679901993c443c/coronal_017.png","assets/T/mri-92679901993c443c/coronal_018.png","assets/T/mri-92679901993c443c/coronal_019.png","assets/T/mri-92679901993c443c/coronal_020.png","assets/T/mri-92679901993c443c/coronal_021.png","assets/T/mri-92679901993c443c/coronal_022.png","assets/T/mri-92679901993c443c/coronal_023.png","assets/T/mri-92679901993c443c/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-47a7dce19f27448f","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 70 张图，均来自同一次检查。\n\n- 前 46 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-47a7dce19f27448f/axial_001.png","assets/T/mri-47a7dce19f27448f/axial_002.png","assets/T/mri-47a7dce19f27448f/axial_003.png","assets/T/mri-47a7dce19f27448f/axial_004.png","assets/T/mri-47a7dce19f27448f/axial_005.png","assets/T/mri-47a7dce19f27448f/axial_006.png","assets/T/mri-47a7dce19f27448f/axial_007.png","assets/T/mri-47a7dce19f27448f/axial_008.png","assets/T/mri-47a7dce19f27448f/axial_009.png","assets/T/mri-47a7dce19f27448f/axial_010.png","assets/T/mri-47a7dce19f27448f/axial_011.png","assets/T/mri-47a7dce19f27448f/axial_012.png","assets/T/mri-47a7dce19f27448f/axial_013.png","assets/T/mri-47a7dce19f27448f/axial_014.png","assets/T/mri-47a7dce19f27448f/axial_015.png","assets/T/mri-47a7dce19f27448f/axial_016.png","assets/T/mri-47a7dce19f27448f/axial_017.png","assets/T/mri-47a7dce19f27448f/axial_018.png","assets/T/mri-47a7dce19f27448f/axial_019.png","assets/T/mri-47a7dce19f27448f/axial_020.png","assets/T/mri-47a7dce19f27448f/axial_021.png","assets/T/mri-47a7dce19f27448f/axial_022.png","assets/T/mri-47a7dce19f27448f/axial_023.png","assets/T/mri-47a7dce19f27448f/axial_024.png","assets/T/mri-47a7dce19f27448f/axial_025.png","assets/T/mri-47a7dce19f27448f/axial_026.png","assets/T/mri-47a7dce19f27448f/axial_027.png","assets/T/mri-47a7dce19f27448f/axial_028.png","assets/T/mri-47a7dce19f27448f/axial_029.png","assets/T/mri-47a7dce19f27448f/axial_030.png","assets/T/mri-47a7dce19f27448f/axial_031.png","assets/T/mri-47a7dce19f27448f/axial_032.png","assets/T/mri-47a7dce19f27448f/axial_033.png","assets/T/mri-47a7dce19f27448f/axial_034.png","assets/T/mri-47a7dce19f27448f/axial_035.png","assets/T/mri-47a7dce19f27448f/axial_036.png","assets/T/mri-47a7dce19f27448f/axial_037.png","assets/T/mri-47a7dce19f27448f/axial_038.png","assets/T/mri-47a7dce19f27448f/axial_039.png","assets/T/mri-47a7dce19f27448f/axial_040.png","assets/T/mri-47a7dce19f27448f/axial_041.png","assets/T/mri-47a7dce19f27448f/axial_042.png","assets/T/mri-47a7dce19f27448f/axial_043.png","assets/T/mri-47a7dce19f27448f/axial_044.png","assets/T/mri-47a7dce19f27448f/axial_045.png","assets/T/mri-47a7dce19f27448f/axial_046.png","assets/T/mri-47a7dce19f27448f/coronal_001.png","assets/T/mri-47a7dce19f27448f/coronal_002.png","assets/T/mri-47a7dce19f27448f/coronal_003.png","assets/T/mri-47a7dce19f27448f/coronal_004.png","assets/T/mri-47a7dce19f27448f/coronal_005.png","assets/T/mri-47a7dce19f27448f/coronal_006.png","assets/T/mri-47a7dce19f27448f/coronal_007.png","assets/T/mri-47a7dce19f27448f/coronal_008.png","assets/T/mri-47a7dce19f27448f/coronal_009.png","assets/T/mri-47a7dce19f27448f/coronal_010.png","assets/T/mri-47a7dce19f27448f/coronal_011.png","assets/T/mri-47a7dce19f27448f/coronal_012.png","assets/T/mri-47a7dce19f27448f/coronal_013.png","assets/T/mri-47a7dce19f27448f/coronal_014.png","assets/T/mri-47a7dce19f27448f/coronal_015.png","assets/T/mri-47a7dce19f27448f/coronal_016.png","assets/T/mri-47a7dce19f27448f/coronal_017.png","assets/T/mri-47a7dce19f27448f/coronal_018.png","assets/T/mri-47a7dce19f27448f/coronal_019.png","assets/T/mri-47a7dce19f27448f/coronal_020.png","assets/T/mri-47a7dce19f27448f/coronal_021.png","assets/T/mri-47a7dce19f27448f/coronal_022.png","assets/T/mri-47a7dce19f27448f/coronal_023.png","assets/T/mri-47a7dce19f27448f/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-a099dc17835b4447","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 69 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 27 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-a099dc17835b4447/axial_001.png","assets/T/mri-a099dc17835b4447/axial_002.png","assets/T/mri-a099dc17835b4447/axial_003.png","assets/T/mri-a099dc17835b4447/axial_004.png","assets/T/mri-a099dc17835b4447/axial_005.png","assets/T/mri-a099dc17835b4447/axial_006.png","assets/T/mri-a099dc17835b4447/axial_007.png","assets/T/mri-a099dc17835b4447/axial_008.png","assets/T/mri-a099dc17835b4447/axial_009.png","assets/T/mri-a099dc17835b4447/axial_010.png","assets/T/mri-a099dc17835b4447/axial_011.png","assets/T/mri-a099dc17835b4447/axial_012.png","assets/T/mri-a099dc17835b4447/axial_013.png","assets/T/mri-a099dc17835b4447/axial_014.png","assets/T/mri-a099dc17835b4447/axial_015.png","assets/T/mri-a099dc17835b4447/axial_016.png","assets/T/mri-a099dc17835b4447/axial_017.png","assets/T/mri-a099dc17835b4447/axial_018.png","assets/T/mri-a099dc17835b4447/axial_019.png","assets/T/mri-a099dc17835b4447/axial_020.png","assets/T/mri-a099dc17835b4447/axial_021.png","assets/T/mri-a099dc17835b4447/axial_022.png","assets/T/mri-a099dc17835b4447/axial_023.png","assets/T/mri-a099dc17835b4447/axial_024.png","assets/T/mri-a099dc17835b4447/axial_025.png","assets/T/mri-a099dc17835b4447/axial_026.png","assets/T/mri-a099dc17835b4447/axial_027.png","assets/T/mri-a099dc17835b4447/axial_028.png","assets/T/mri-a099dc17835b4447/axial_029.png","assets/T/mri-a099dc17835b4447/axial_030.png","assets/T/mri-a099dc17835b4447/axial_031.png","assets/T/mri-a099dc17835b4447/axial_032.png","assets/T/mri-a099dc17835b4447/axial_033.png","assets/T/mri-a099dc17835b4447/axial_034.png","assets/T/mri-a099dc17835b4447/axial_035.png","assets/T/mri-a099dc17835b4447/axial_036.png","assets/T/mri-a099dc17835b4447/axial_037.png","assets/T/mri-a099dc17835b4447/axial_038.png","assets/T/mri-a099dc17835b4447/axial_039.png","assets/T/mri-a099dc17835b4447/axial_040.png","assets/T/mri-a099dc17835b4447/axial_041.png","assets/T/mri-a099dc17835b4447/axial_042.png","assets/T/mri-a099dc17835b4447/coronal_001.png","assets/T/mri-a099dc17835b4447/coronal_002.png","assets/T/mri-a099dc17835b4447/coronal_003.png","assets/T/mri-a099dc17835b4447/coronal_004.png","assets/T/mri-a099dc17835b4447/coronal_005.png","assets/T/mri-a099dc17835b4447/coronal_006.png","assets/T/mri-a099dc17835b4447/coronal_007.png","assets/T/mri-a099dc17835b4447/coronal_008.png","assets/T/mri-a099dc17835b4447/coronal_009.png","assets/T/mri-a099dc17835b4447/coronal_010.png","assets/T/mri-a099dc17835b4447/coronal_011.png","assets/T/mri-a099dc17835b4447/coronal_012.png","assets/T/mri-a099dc17835b4447/coronal_013.png","assets/T/mri-a099dc17835b4447/coronal_014.png","assets/T/mri-a099dc17835b4447/coronal_015.png","assets/T/mri-a099dc17835b4447/coronal_016.png","assets/T/mri-a099dc17835b4447/coronal_017.png","assets/T/mri-a099dc17835b4447/coronal_018.png","assets/T/mri-a099dc17835b4447/coronal_019.png","assets/T/mri-a099dc17835b4447/coronal_020.png","assets/T/mri-a099dc17835b4447/coronal_021.png","assets/T/mri-a099dc17835b4447/coronal_022.png","assets/T/mri-a099dc17835b4447/coronal_023.png","assets/T/mri-a099dc17835b4447/coronal_024.png","assets/T/mri-a099dc17835b4447/coronal_025.png","assets/T/mri-a099dc17835b4447/coronal_026.png","assets/T/mri-a099dc17835b4447/coronal_027.png"],"stage_edition":8}
+{"id":"L3-T300:mri-46d4180f5c9b4ea7","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 72 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 30 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-46d4180f5c9b4ea7/axial_001.png","assets/T/mri-46d4180f5c9b4ea7/axial_002.png","assets/T/mri-46d4180f5c9b4ea7/axial_003.png","assets/T/mri-46d4180f5c9b4ea7/axial_004.png","assets/T/mri-46d4180f5c9b4ea7/axial_005.png","assets/T/mri-46d4180f5c9b4ea7/axial_006.png","assets/T/mri-46d4180f5c9b4ea7/axial_007.png","assets/T/mri-46d4180f5c9b4ea7/axial_008.png","assets/T/mri-46d4180f5c9b4ea7/axial_009.png","assets/T/mri-46d4180f5c9b4ea7/axial_010.png","assets/T/mri-46d4180f5c9b4ea7/axial_011.png","assets/T/mri-46d4180f5c9b4ea7/axial_012.png","assets/T/mri-46d4180f5c9b4ea7/axial_013.png","assets/T/mri-46d4180f5c9b4ea7/axial_014.png","assets/T/mri-46d4180f5c9b4ea7/axial_015.png","assets/T/mri-46d4180f5c9b4ea7/axial_016.png","assets/T/mri-46d4180f5c9b4ea7/axial_017.png","assets/T/mri-46d4180f5c9b4ea7/axial_018.png","assets/T/mri-46d4180f5c9b4ea7/axial_019.png","assets/T/mri-46d4180f5c9b4ea7/axial_020.png","assets/T/mri-46d4180f5c9b4ea7/axial_021.png","assets/T/mri-46d4180f5c9b4ea7/axial_022.png","assets/T/mri-46d4180f5c9b4ea7/axial_023.png","assets/T/mri-46d4180f5c9b4ea7/axial_024.png","assets/T/mri-46d4180f5c9b4ea7/axial_025.png","assets/T/mri-46d4180f5c9b4ea7/axial_026.png","assets/T/mri-46d4180f5c9b4ea7/axial_027.png","assets/T/mri-46d4180f5c9b4ea7/axial_028.png","assets/T/mri-46d4180f5c9b4ea7/axial_029.png","assets/T/mri-46d4180f5c9b4ea7/axial_030.png","assets/T/mri-46d4180f5c9b4ea7/axial_031.png","assets/T/mri-46d4180f5c9b4ea7/axial_032.png","assets/T/mri-46d4180f5c9b4ea7/axial_033.png","assets/T/mri-46d4180f5c9b4ea7/axial_034.png","assets/T/mri-46d4180f5c9b4ea7/axial_035.png","assets/T/mri-46d4180f5c9b4ea7/axial_036.png","assets/T/mri-46d4180f5c9b4ea7/axial_037.png","assets/T/mri-46d4180f5c9b4ea7/axial_038.png","assets/T/mri-46d4180f5c9b4ea7/axial_039.png","assets/T/mri-46d4180f5c9b4ea7/axial_040.png","assets/T/mri-46d4180f5c9b4ea7/axial_041.png","assets/T/mri-46d4180f5c9b4ea7/axial_042.png","assets/T/mri-46d4180f5c9b4ea7/coronal_001.png","assets/T/mri-46d4180f5c9b4ea7/coronal_002.png","assets/T/mri-46d4180f5c9b4ea7/coronal_003.png","assets/T/mri-46d4180f5c9b4ea7/coronal_004.png","assets/T/mri-46d4180f5c9b4ea7/coronal_005.png","assets/T/mri-46d4180f5c9b4ea7/coronal_006.png","assets/T/mri-46d4180f5c9b4ea7/coronal_007.png","assets/T/mri-46d4180f5c9b4ea7/coronal_008.png","assets/T/mri-46d4180f5c9b4ea7/coronal_009.png","assets/T/mri-46d4180f5c9b4ea7/coronal_010.png","assets/T/mri-46d4180f5c9b4ea7/coronal_011.png","assets/T/mri-46d4180f5c9b4ea7/coronal_012.png","assets/T/mri-46d4180f5c9b4ea7/coronal_013.png","assets/T/mri-46d4180f5c9b4ea7/coronal_014.png","assets/T/mri-46d4180f5c9b4ea7/coronal_015.png","assets/T/mri-46d4180f5c9b4ea7/coronal_016.png","assets/T/mri-46d4180f5c9b4ea7/coronal_017.png","assets/T/mri-46d4180f5c9b4ea7/coronal_018.png","assets/T/mri-46d4180f5c9b4ea7/coronal_019.png","assets/T/mri-46d4180f5c9b4ea7/coronal_020.png","assets/T/mri-46d4180f5c9b4ea7/coronal_021.png","assets/T/mri-46d4180f5c9b4ea7/coronal_022.png","assets/T/mri-46d4180f5c9b4ea7/coronal_023.png","assets/T/mri-46d4180f5c9b4ea7/coronal_024.png","assets/T/mri-46d4180f5c9b4ea7/coronal_025.png","assets/T/mri-46d4180f5c9b4ea7/coronal_026.png","assets/T/mri-46d4180f5c9b4ea7/coronal_027.png","assets/T/mri-46d4180f5c9b4ea7/coronal_028.png","assets/T/mri-46d4180f5c9b4ea7/coronal_029.png","assets/T/mri-46d4180f5c9b4ea7/coronal_030.png"],"stage_edition":8}
+{"id":"L3-T300:mri-433ebef7edd64a24","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 70 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 28 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-433ebef7edd64a24/axial_001.png","assets/T/mri-433ebef7edd64a24/axial_002.png","assets/T/mri-433ebef7edd64a24/axial_003.png","assets/T/mri-433ebef7edd64a24/axial_004.png","assets/T/mri-433ebef7edd64a24/axial_005.png","assets/T/mri-433ebef7edd64a24/axial_006.png","assets/T/mri-433ebef7edd64a24/axial_007.png","assets/T/mri-433ebef7edd64a24/axial_008.png","assets/T/mri-433ebef7edd64a24/axial_009.png","assets/T/mri-433ebef7edd64a24/axial_010.png","assets/T/mri-433ebef7edd64a24/axial_011.png","assets/T/mri-433ebef7edd64a24/axial_012.png","assets/T/mri-433ebef7edd64a24/axial_013.png","assets/T/mri-433ebef7edd64a24/axial_014.png","assets/T/mri-433ebef7edd64a24/axial_015.png","assets/T/mri-433ebef7edd64a24/axial_016.png","assets/T/mri-433ebef7edd64a24/axial_017.png","assets/T/mri-433ebef7edd64a24/axial_018.png","assets/T/mri-433ebef7edd64a24/axial_019.png","assets/T/mri-433ebef7edd64a24/axial_020.png","assets/T/mri-433ebef7edd64a24/axial_021.png","assets/T/mri-433ebef7edd64a24/axial_022.png","assets/T/mri-433ebef7edd64a24/axial_023.png","assets/T/mri-433ebef7edd64a24/axial_024.png","assets/T/mri-433ebef7edd64a24/axial_025.png","assets/T/mri-433ebef7edd64a24/axial_026.png","assets/T/mri-433ebef7edd64a24/axial_027.png","assets/T/mri-433ebef7edd64a24/axial_028.png","assets/T/mri-433ebef7edd64a24/axial_029.png","assets/T/mri-433ebef7edd64a24/axial_030.png","assets/T/mri-433ebef7edd64a24/axial_031.png","assets/T/mri-433ebef7edd64a24/axial_032.png","assets/T/mri-433ebef7edd64a24/axial_033.png","assets/T/mri-433ebef7edd64a24/axial_034.png","assets/T/mri-433ebef7edd64a24/axial_035.png","assets/T/mri-433ebef7edd64a24/axial_036.png","assets/T/mri-433ebef7edd64a24/axial_037.png","assets/T/mri-433ebef7edd64a24/axial_038.png","assets/T/mri-433ebef7edd64a24/axial_039.png","assets/T/mri-433ebef7edd64a24/axial_040.png","assets/T/mri-433ebef7edd64a24/axial_041.png","assets/T/mri-433ebef7edd64a24/axial_042.png","assets/T/mri-433ebef7edd64a24/coronal_001.png","assets/T/mri-433ebef7edd64a24/coronal_002.png","assets/T/mri-433ebef7edd64a24/coronal_003.png","assets/T/mri-433ebef7edd64a24/coronal_004.png","assets/T/mri-433ebef7edd64a24/coronal_005.png","assets/T/mri-433ebef7edd64a24/coronal_006.png","assets/T/mri-433ebef7edd64a24/coronal_007.png","assets/T/mri-433ebef7edd64a24/coronal_008.png","assets/T/mri-433ebef7edd64a24/coronal_009.png","assets/T/mri-433ebef7edd64a24/coronal_010.png","assets/T/mri-433ebef7edd64a24/coronal_011.png","assets/T/mri-433ebef7edd64a24/coronal_012.png","assets/T/mri-433ebef7edd64a24/coronal_013.png","assets/T/mri-433ebef7edd64a24/coronal_014.png","assets/T/mri-433ebef7edd64a24/coronal_015.png","assets/T/mri-433ebef7edd64a24/coronal_016.png","assets/T/mri-433ebef7edd64a24/coronal_017.png","assets/T/mri-433ebef7edd64a24/coronal_018.png","assets/T/mri-433ebef7edd64a24/coronal_019.png","assets/T/mri-433ebef7edd64a24/coronal_020.png","assets/T/mri-433ebef7edd64a24/coronal_021.png","assets/T/mri-433ebef7edd64a24/coronal_022.png","assets/T/mri-433ebef7edd64a24/coronal_023.png","assets/T/mri-433ebef7edd64a24/coronal_024.png","assets/T/mri-433ebef7edd64a24/coronal_025.png","assets/T/mri-433ebef7edd64a24/coronal_026.png","assets/T/mri-433ebef7edd64a24/coronal_027.png","assets/T/mri-433ebef7edd64a24/coronal_028.png"],"stage_edition":8}
+{"id":"L3-T300:mri-a593896fc6c34499","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 68 张图，均来自同一次检查。\n\n- 前 44 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-a593896fc6c34499/axial_001.png","assets/T/mri-a593896fc6c34499/axial_002.png","assets/T/mri-a593896fc6c34499/axial_003.png","assets/T/mri-a593896fc6c34499/axial_004.png","assets/T/mri-a593896fc6c34499/axial_005.png","assets/T/mri-a593896fc6c34499/axial_006.png","assets/T/mri-a593896fc6c34499/axial_007.png","assets/T/mri-a593896fc6c34499/axial_008.png","assets/T/mri-a593896fc6c34499/axial_009.png","assets/T/mri-a593896fc6c34499/axial_010.png","assets/T/mri-a593896fc6c34499/axial_011.png","assets/T/mri-a593896fc6c34499/axial_012.png","assets/T/mri-a593896fc6c34499/axial_013.png","assets/T/mri-a593896fc6c34499/axial_014.png","assets/T/mri-a593896fc6c34499/axial_015.png","assets/T/mri-a593896fc6c34499/axial_016.png","assets/T/mri-a593896fc6c34499/axial_017.png","assets/T/mri-a593896fc6c34499/axial_018.png","assets/T/mri-a593896fc6c34499/axial_019.png","assets/T/mri-a593896fc6c34499/axial_020.png","assets/T/mri-a593896fc6c34499/axial_021.png","assets/T/mri-a593896fc6c34499/axial_022.png","assets/T/mri-a593896fc6c34499/axial_023.png","assets/T/mri-a593896fc6c34499/axial_024.png","assets/T/mri-a593896fc6c34499/axial_025.png","assets/T/mri-a593896fc6c34499/axial_026.png","assets/T/mri-a593896fc6c34499/axial_027.png","assets/T/mri-a593896fc6c34499/axial_028.png","assets/T/mri-a593896fc6c34499/axial_029.png","assets/T/mri-a593896fc6c34499/axial_030.png","assets/T/mri-a593896fc6c34499/axial_031.png","assets/T/mri-a593896fc6c34499/axial_032.png","assets/T/mri-a593896fc6c34499/axial_033.png","assets/T/mri-a593896fc6c34499/axial_034.png","assets/T/mri-a593896fc6c34499/axial_035.png","assets/T/mri-a593896fc6c34499/axial_036.png","assets/T/mri-a593896fc6c34499/axial_037.png","assets/T/mri-a593896fc6c34499/axial_038.png","assets/T/mri-a593896fc6c34499/axial_039.png","assets/T/mri-a593896fc6c34499/axial_040.png","assets/T/mri-a593896fc6c34499/axial_041.png","assets/T/mri-a593896fc6c34499/axial_042.png","assets/T/mri-a593896fc6c34499/axial_043.png","assets/T/mri-a593896fc6c34499/axial_044.png","assets/T/mri-a593896fc6c34499/coronal_001.png","assets/T/mri-a593896fc6c34499/coronal_002.png","assets/T/mri-a593896fc6c34499/coronal_003.png","assets/T/mri-a593896fc6c34499/coronal_004.png","assets/T/mri-a593896fc6c34499/coronal_005.png","assets/T/mri-a593896fc6c34499/coronal_006.png","assets/T/mri-a593896fc6c34499/coronal_007.png","assets/T/mri-a593896fc6c34499/coronal_008.png","assets/T/mri-a593896fc6c34499/coronal_009.png","assets/T/mri-a593896fc6c34499/coronal_010.png","assets/T/mri-a593896fc6c34499/coronal_011.png","assets/T/mri-a593896fc6c34499/coronal_012.png","assets/T/mri-a593896fc6c34499/coronal_013.png","assets/T/mri-a593896fc6c34499/coronal_014.png","assets/T/mri-a593896fc6c34499/coronal_015.png","assets/T/mri-a593896fc6c34499/coronal_016.png","assets/T/mri-a593896fc6c34499/coronal_017.png","assets/T/mri-a593896fc6c34499/coronal_018.png","assets/T/mri-a593896fc6c34499/coronal_019.png","assets/T/mri-a593896fc6c34499/coronal_020.png","assets/T/mri-a593896fc6c34499/coronal_021.png","assets/T/mri-a593896fc6c34499/coronal_022.png","assets/T/mri-a593896fc6c34499/coronal_023.png","assets/T/mri-a593896fc6c34499/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-19b78e282ae648fc","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 62 张图，均来自同一次检查。\n\n- 前 38 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-19b78e282ae648fc/axial_001.png","assets/T/mri-19b78e282ae648fc/axial_002.png","assets/T/mri-19b78e282ae648fc/axial_003.png","assets/T/mri-19b78e282ae648fc/axial_004.png","assets/T/mri-19b78e282ae648fc/axial_005.png","assets/T/mri-19b78e282ae648fc/axial_006.png","assets/T/mri-19b78e282ae648fc/axial_007.png","assets/T/mri-19b78e282ae648fc/axial_008.png","assets/T/mri-19b78e282ae648fc/axial_009.png","assets/T/mri-19b78e282ae648fc/axial_010.png","assets/T/mri-19b78e282ae648fc/axial_011.png","assets/T/mri-19b78e282ae648fc/axial_012.png","assets/T/mri-19b78e282ae648fc/axial_013.png","assets/T/mri-19b78e282ae648fc/axial_014.png","assets/T/mri-19b78e282ae648fc/axial_015.png","assets/T/mri-19b78e282ae648fc/axial_016.png","assets/T/mri-19b78e282ae648fc/axial_017.png","assets/T/mri-19b78e282ae648fc/axial_018.png","assets/T/mri-19b78e282ae648fc/axial_019.png","assets/T/mri-19b78e282ae648fc/axial_020.png","assets/T/mri-19b78e282ae648fc/axial_021.png","assets/T/mri-19b78e282ae648fc/axial_022.png","assets/T/mri-19b78e282ae648fc/axial_023.png","assets/T/mri-19b78e282ae648fc/axial_024.png","assets/T/mri-19b78e282ae648fc/axial_025.png","assets/T/mri-19b78e282ae648fc/axial_026.png","assets/T/mri-19b78e282ae648fc/axial_027.png","assets/T/mri-19b78e282ae648fc/axial_028.png","assets/T/mri-19b78e282ae648fc/axial_029.png","assets/T/mri-19b78e282ae648fc/axial_030.png","assets/T/mri-19b78e282ae648fc/axial_031.png","assets/T/mri-19b78e282ae648fc/axial_032.png","assets/T/mri-19b78e282ae648fc/axial_033.png","assets/T/mri-19b78e282ae648fc/axial_034.png","assets/T/mri-19b78e282ae648fc/axial_035.png","assets/T/mri-19b78e282ae648fc/axial_036.png","assets/T/mri-19b78e282ae648fc/axial_037.png","assets/T/mri-19b78e282ae648fc/axial_038.png","assets/T/mri-19b78e282ae648fc/coronal_001.png","assets/T/mri-19b78e282ae648fc/coronal_002.png","assets/T/mri-19b78e282ae648fc/coronal_003.png","assets/T/mri-19b78e282ae648fc/coronal_004.png","assets/T/mri-19b78e282ae648fc/coronal_005.png","assets/T/mri-19b78e282ae648fc/coronal_006.png","assets/T/mri-19b78e282ae648fc/coronal_007.png","assets/T/mri-19b78e282ae648fc/coronal_008.png","assets/T/mri-19b78e282ae648fc/coronal_009.png","assets/T/mri-19b78e282ae648fc/coronal_010.png","assets/T/mri-19b78e282ae648fc/coronal_011.png","assets/T/mri-19b78e282ae648fc/coronal_012.png","assets/T/mri-19b78e282ae648fc/coronal_013.png","assets/T/mri-19b78e282ae648fc/coronal_014.png","assets/T/mri-19b78e282ae648fc/coronal_015.png","assets/T/mri-19b78e282ae648fc/coronal_016.png","assets/T/mri-19b78e282ae648fc/coronal_017.png","assets/T/mri-19b78e282ae648fc/coronal_018.png","assets/T/mri-19b78e282ae648fc/coronal_019.png","assets/T/mri-19b78e282ae648fc/coronal_020.png","assets/T/mri-19b78e282ae648fc/coronal_021.png","assets/T/mri-19b78e282ae648fc/coronal_022.png","assets/T/mri-19b78e282ae648fc/coronal_023.png","assets/T/mri-19b78e282ae648fc/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-77d61075f19a4a7e","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 62 张图，均来自同一次检查。\n\n- 前 38 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-77d61075f19a4a7e/axial_001.png","assets/T/mri-77d61075f19a4a7e/axial_002.png","assets/T/mri-77d61075f19a4a7e/axial_003.png","assets/T/mri-77d61075f19a4a7e/axial_004.png","assets/T/mri-77d61075f19a4a7e/axial_005.png","assets/T/mri-77d61075f19a4a7e/axial_006.png","assets/T/mri-77d61075f19a4a7e/axial_007.png","assets/T/mri-77d61075f19a4a7e/axial_008.png","assets/T/mri-77d61075f19a4a7e/axial_009.png","assets/T/mri-77d61075f19a4a7e/axial_010.png","assets/T/mri-77d61075f19a4a7e/axial_011.png","assets/T/mri-77d61075f19a4a7e/axial_012.png","assets/T/mri-77d61075f19a4a7e/axial_013.png","assets/T/mri-77d61075f19a4a7e/axial_014.png","assets/T/mri-77d61075f19a4a7e/axial_015.png","assets/T/mri-77d61075f19a4a7e/axial_016.png","assets/T/mri-77d61075f19a4a7e/axial_017.png","assets/T/mri-77d61075f19a4a7e/axial_018.png","assets/T/mri-77d61075f19a4a7e/axial_019.png","assets/T/mri-77d61075f19a4a7e/axial_020.png","assets/T/mri-77d61075f19a4a7e/axial_021.png","assets/T/mri-77d61075f19a4a7e/axial_022.png","assets/T/mri-77d61075f19a4a7e/axial_023.png","assets/T/mri-77d61075f19a4a7e/axial_024.png","assets/T/mri-77d61075f19a4a7e/axial_025.png","assets/T/mri-77d61075f19a4a7e/axial_026.png","assets/T/mri-77d61075f19a4a7e/axial_027.png","assets/T/mri-77d61075f19a4a7e/axial_028.png","assets/T/mri-77d61075f19a4a7e/axial_029.png","assets/T/mri-77d61075f19a4a7e/axial_030.png","assets/T/mri-77d61075f19a4a7e/axial_031.png","assets/T/mri-77d61075f19a4a7e/axial_032.png","assets/T/mri-77d61075f19a4a7e/axial_033.png","assets/T/mri-77d61075f19a4a7e/axial_034.png","assets/T/mri-77d61075f19a4a7e/axial_035.png","assets/T/mri-77d61075f19a4a7e/axial_036.png","assets/T/mri-77d61075f19a4a7e/axial_037.png","assets/T/mri-77d61075f19a4a7e/axial_038.png","assets/T/mri-77d61075f19a4a7e/coronal_001.png","assets/T/mri-77d61075f19a4a7e/coronal_002.png","assets/T/mri-77d61075f19a4a7e/coronal_003.png","assets/T/mri-77d61075f19a4a7e/coronal_004.png","assets/T/mri-77d61075f19a4a7e/coronal_005.png","assets/T/mri-77d61075f19a4a7e/coronal_006.png","assets/T/mri-77d61075f19a4a7e/coronal_007.png","assets/T/mri-77d61075f19a4a7e/coronal_008.png","assets/T/mri-77d61075f19a4a7e/coronal_009.png","assets/T/mri-77d61075f19a4a7e/coronal_010.png","assets/T/mri-77d61075f19a4a7e/coronal_011.png","assets/T/mri-77d61075f19a4a7e/coronal_012.png","assets/T/mri-77d61075f19a4a7e/coronal_013.png","assets/T/mri-77d61075f19a4a7e/coronal_014.png","assets/T/mri-77d61075f19a4a7e/coronal_015.png","assets/T/mri-77d61075f19a4a7e/coronal_016.png","assets/T/mri-77d61075f19a4a7e/coronal_017.png","assets/T/mri-77d61075f19a4a7e/coronal_018.png","assets/T/mri-77d61075f19a4a7e/coronal_019.png","assets/T/mri-77d61075f19a4a7e/coronal_020.png","assets/T/mri-77d61075f19a4a7e/coronal_021.png","assets/T/mri-77d61075f19a4a7e/coronal_022.png","assets/T/mri-77d61075f19a4a7e/coronal_023.png","assets/T/mri-77d61075f19a4a7e/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-531b90fa4b7b430c","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-531b90fa4b7b430c/axial_001.png","assets/T/mri-531b90fa4b7b430c/axial_002.png","assets/T/mri-531b90fa4b7b430c/axial_003.png","assets/T/mri-531b90fa4b7b430c/axial_004.png","assets/T/mri-531b90fa4b7b430c/axial_005.png","assets/T/mri-531b90fa4b7b430c/axial_006.png","assets/T/mri-531b90fa4b7b430c/axial_007.png","assets/T/mri-531b90fa4b7b430c/axial_008.png","assets/T/mri-531b90fa4b7b430c/axial_009.png","assets/T/mri-531b90fa4b7b430c/axial_010.png","assets/T/mri-531b90fa4b7b430c/axial_011.png","assets/T/mri-531b90fa4b7b430c/axial_012.png","assets/T/mri-531b90fa4b7b430c/axial_013.png","assets/T/mri-531b90fa4b7b430c/axial_014.png","assets/T/mri-531b90fa4b7b430c/axial_015.png","assets/T/mri-531b90fa4b7b430c/axial_016.png","assets/T/mri-531b90fa4b7b430c/axial_017.png","assets/T/mri-531b90fa4b7b430c/axial_018.png","assets/T/mri-531b90fa4b7b430c/axial_019.png","assets/T/mri-531b90fa4b7b430c/axial_020.png","assets/T/mri-531b90fa4b7b430c/axial_021.png","assets/T/mri-531b90fa4b7b430c/axial_022.png","assets/T/mri-531b90fa4b7b430c/axial_023.png","assets/T/mri-531b90fa4b7b430c/axial_024.png","assets/T/mri-531b90fa4b7b430c/axial_025.png","assets/T/mri-531b90fa4b7b430c/axial_026.png","assets/T/mri-531b90fa4b7b430c/axial_027.png","assets/T/mri-531b90fa4b7b430c/axial_028.png","assets/T/mri-531b90fa4b7b430c/axial_029.png","assets/T/mri-531b90fa4b7b430c/axial_030.png","assets/T/mri-531b90fa4b7b430c/axial_031.png","assets/T/mri-531b90fa4b7b430c/axial_032.png","assets/T/mri-531b90fa4b7b430c/axial_033.png","assets/T/mri-531b90fa4b7b430c/axial_034.png","assets/T/mri-531b90fa4b7b430c/axial_035.png","assets/T/mri-531b90fa4b7b430c/axial_036.png","assets/T/mri-531b90fa4b7b430c/axial_037.png","assets/T/mri-531b90fa4b7b430c/axial_038.png","assets/T/mri-531b90fa4b7b430c/axial_039.png","assets/T/mri-531b90fa4b7b430c/axial_040.png","assets/T/mri-531b90fa4b7b430c/axial_041.png","assets/T/mri-531b90fa4b7b430c/axial_042.png","assets/T/mri-531b90fa4b7b430c/coronal_001.png","assets/T/mri-531b90fa4b7b430c/coronal_002.png","assets/T/mri-531b90fa4b7b430c/coronal_003.png","assets/T/mri-531b90fa4b7b430c/coronal_004.png","assets/T/mri-531b90fa4b7b430c/coronal_005.png","assets/T/mri-531b90fa4b7b430c/coronal_006.png","assets/T/mri-531b90fa4b7b430c/coronal_007.png","assets/T/mri-531b90fa4b7b430c/coronal_008.png","assets/T/mri-531b90fa4b7b430c/coronal_009.png","assets/T/mri-531b90fa4b7b430c/coronal_010.png","assets/T/mri-531b90fa4b7b430c/coronal_011.png","assets/T/mri-531b90fa4b7b430c/coronal_012.png","assets/T/mri-531b90fa4b7b430c/coronal_013.png","assets/T/mri-531b90fa4b7b430c/coronal_014.png","assets/T/mri-531b90fa4b7b430c/coronal_015.png","assets/T/mri-531b90fa4b7b430c/coronal_016.png","assets/T/mri-531b90fa4b7b430c/coronal_017.png","assets/T/mri-531b90fa4b7b430c/coronal_018.png","assets/T/mri-531b90fa4b7b430c/coronal_019.png","assets/T/mri-531b90fa4b7b430c/coronal_020.png","assets/T/mri-531b90fa4b7b430c/coronal_021.png","assets/T/mri-531b90fa4b7b430c/coronal_022.png","assets/T/mri-531b90fa4b7b430c/coronal_023.png","assets/T/mri-531b90fa4b7b430c/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-3fef1b1edce94fa6","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-3fef1b1edce94fa6/axial_001.png","assets/T/mri-3fef1b1edce94fa6/axial_002.png","assets/T/mri-3fef1b1edce94fa6/axial_003.png","assets/T/mri-3fef1b1edce94fa6/axial_004.png","assets/T/mri-3fef1b1edce94fa6/axial_005.png","assets/T/mri-3fef1b1edce94fa6/axial_006.png","assets/T/mri-3fef1b1edce94fa6/axial_007.png","assets/T/mri-3fef1b1edce94fa6/axial_008.png","assets/T/mri-3fef1b1edce94fa6/axial_009.png","assets/T/mri-3fef1b1edce94fa6/axial_010.png","assets/T/mri-3fef1b1edce94fa6/axial_011.png","assets/T/mri-3fef1b1edce94fa6/axial_012.png","assets/T/mri-3fef1b1edce94fa6/axial_013.png","assets/T/mri-3fef1b1edce94fa6/axial_014.png","assets/T/mri-3fef1b1edce94fa6/axial_015.png","assets/T/mri-3fef1b1edce94fa6/axial_016.png","assets/T/mri-3fef1b1edce94fa6/axial_017.png","assets/T/mri-3fef1b1edce94fa6/axial_018.png","assets/T/mri-3fef1b1edce94fa6/axial_019.png","assets/T/mri-3fef1b1edce94fa6/axial_020.png","assets/T/mri-3fef1b1edce94fa6/axial_021.png","assets/T/mri-3fef1b1edce94fa6/axial_022.png","assets/T/mri-3fef1b1edce94fa6/axial_023.png","assets/T/mri-3fef1b1edce94fa6/axial_024.png","assets/T/mri-3fef1b1edce94fa6/axial_025.png","assets/T/mri-3fef1b1edce94fa6/axial_026.png","assets/T/mri-3fef1b1edce94fa6/axial_027.png","assets/T/mri-3fef1b1edce94fa6/axial_028.png","assets/T/mri-3fef1b1edce94fa6/axial_029.png","assets/T/mri-3fef1b1edce94fa6/axial_030.png","assets/T/mri-3fef1b1edce94fa6/axial_031.png","assets/T/mri-3fef1b1edce94fa6/axial_032.png","assets/T/mri-3fef1b1edce94fa6/axial_033.png","assets/T/mri-3fef1b1edce94fa6/axial_034.png","assets/T/mri-3fef1b1edce94fa6/axial_035.png","assets/T/mri-3fef1b1edce94fa6/axial_036.png","assets/T/mri-3fef1b1edce94fa6/axial_037.png","assets/T/mri-3fef1b1edce94fa6/axial_038.png","assets/T/mri-3fef1b1edce94fa6/axial_039.png","assets/T/mri-3fef1b1edce94fa6/axial_040.png","assets/T/mri-3fef1b1edce94fa6/coronal_001.png","assets/T/mri-3fef1b1edce94fa6/coronal_002.png","assets/T/mri-3fef1b1edce94fa6/coronal_003.png","assets/T/mri-3fef1b1edce94fa6/coronal_004.png","assets/T/mri-3fef1b1edce94fa6/coronal_005.png","assets/T/mri-3fef1b1edce94fa6/coronal_006.png","assets/T/mri-3fef1b1edce94fa6/coronal_007.png","assets/T/mri-3fef1b1edce94fa6/coronal_008.png","assets/T/mri-3fef1b1edce94fa6/coronal_009.png","assets/T/mri-3fef1b1edce94fa6/coronal_010.png","assets/T/mri-3fef1b1edce94fa6/coronal_011.png","assets/T/mri-3fef1b1edce94fa6/coronal_012.png","assets/T/mri-3fef1b1edce94fa6/coronal_013.png","assets/T/mri-3fef1b1edce94fa6/coronal_014.png","assets/T/mri-3fef1b1edce94fa6/coronal_015.png","assets/T/mri-3fef1b1edce94fa6/coronal_016.png","assets/T/mri-3fef1b1edce94fa6/coronal_017.png","assets/T/mri-3fef1b1edce94fa6/coronal_018.png","assets/T/mri-3fef1b1edce94fa6/coronal_019.png","assets/T/mri-3fef1b1edce94fa6/coronal_020.png","assets/T/mri-3fef1b1edce94fa6/coronal_021.png","assets/T/mri-3fef1b1edce94fa6/coronal_022.png","assets/T/mri-3fef1b1edce94fa6/coronal_023.png","assets/T/mri-3fef1b1edce94fa6/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-960fac01b62540bb","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 38 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 26 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-960fac01b62540bb/axial_001.png","assets/T/mri-960fac01b62540bb/axial_002.png","assets/T/mri-960fac01b62540bb/axial_003.png","assets/T/mri-960fac01b62540bb/axial_004.png","assets/T/mri-960fac01b62540bb/axial_005.png","assets/T/mri-960fac01b62540bb/axial_006.png","assets/T/mri-960fac01b62540bb/axial_007.png","assets/T/mri-960fac01b62540bb/axial_008.png","assets/T/mri-960fac01b62540bb/axial_009.png","assets/T/mri-960fac01b62540bb/axial_010.png","assets/T/mri-960fac01b62540bb/axial_011.png","assets/T/mri-960fac01b62540bb/axial_012.png","assets/T/mri-960fac01b62540bb/axial_013.png","assets/T/mri-960fac01b62540bb/axial_014.png","assets/T/mri-960fac01b62540bb/axial_015.png","assets/T/mri-960fac01b62540bb/axial_016.png","assets/T/mri-960fac01b62540bb/axial_017.png","assets/T/mri-960fac01b62540bb/axial_018.png","assets/T/mri-960fac01b62540bb/axial_019.png","assets/T/mri-960fac01b62540bb/axial_020.png","assets/T/mri-960fac01b62540bb/axial_021.png","assets/T/mri-960fac01b62540bb/axial_022.png","assets/T/mri-960fac01b62540bb/axial_023.png","assets/T/mri-960fac01b62540bb/axial_024.png","assets/T/mri-960fac01b62540bb/axial_025.png","assets/T/mri-960fac01b62540bb/axial_026.png","assets/T/mri-960fac01b62540bb/axial_027.png","assets/T/mri-960fac01b62540bb/axial_028.png","assets/T/mri-960fac01b62540bb/axial_029.png","assets/T/mri-960fac01b62540bb/axial_030.png","assets/T/mri-960fac01b62540bb/axial_031.png","assets/T/mri-960fac01b62540bb/axial_032.png","assets/T/mri-960fac01b62540bb/axial_033.png","assets/T/mri-960fac01b62540bb/axial_034.png","assets/T/mri-960fac01b62540bb/axial_035.png","assets/T/mri-960fac01b62540bb/axial_036.png","assets/T/mri-960fac01b62540bb/axial_037.png","assets/T/mri-960fac01b62540bb/axial_038.png","assets/T/mri-960fac01b62540bb/coronal_001.png","assets/T/mri-960fac01b62540bb/coronal_002.png","assets/T/mri-960fac01b62540bb/coronal_003.png","assets/T/mri-960fac01b62540bb/coronal_004.png","assets/T/mri-960fac01b62540bb/coronal_005.png","assets/T/mri-960fac01b62540bb/coronal_006.png","assets/T/mri-960fac01b62540bb/coronal_007.png","assets/T/mri-960fac01b62540bb/coronal_008.png","assets/T/mri-960fac01b62540bb/coronal_009.png","assets/T/mri-960fac01b62540bb/coronal_010.png","assets/T/mri-960fac01b62540bb/coronal_011.png","assets/T/mri-960fac01b62540bb/coronal_012.png","assets/T/mri-960fac01b62540bb/coronal_013.png","assets/T/mri-960fac01b62540bb/coronal_014.png","assets/T/mri-960fac01b62540bb/coronal_015.png","assets/T/mri-960fac01b62540bb/coronal_016.png","assets/T/mri-960fac01b62540bb/coronal_017.png","assets/T/mri-960fac01b62540bb/coronal_018.png","assets/T/mri-960fac01b62540bb/coronal_019.png","assets/T/mri-960fac01b62540bb/coronal_020.png","assets/T/mri-960fac01b62540bb/coronal_021.png","assets/T/mri-960fac01b62540bb/coronal_022.png","assets/T/mri-960fac01b62540bb/coronal_023.png","assets/T/mri-960fac01b62540bb/coronal_024.png","assets/T/mri-960fac01b62540bb/coronal_025.png","assets/T/mri-960fac01b62540bb/coronal_026.png"],"stage_edition":8}
+{"id":"L3-T300:mri-f3c7c9ffe2254cce","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 70 张图，均来自同一次检查。\n\n- 前 44 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 26 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-f3c7c9ffe2254cce/axial_001.png","assets/T/mri-f3c7c9ffe2254cce/axial_002.png","assets/T/mri-f3c7c9ffe2254cce/axial_003.png","assets/T/mri-f3c7c9ffe2254cce/axial_004.png","assets/T/mri-f3c7c9ffe2254cce/axial_005.png","assets/T/mri-f3c7c9ffe2254cce/axial_006.png","assets/T/mri-f3c7c9ffe2254cce/axial_007.png","assets/T/mri-f3c7c9ffe2254cce/axial_008.png","assets/T/mri-f3c7c9ffe2254cce/axial_009.png","assets/T/mri-f3c7c9ffe2254cce/axial_010.png","assets/T/mri-f3c7c9ffe2254cce/axial_011.png","assets/T/mri-f3c7c9ffe2254cce/axial_012.png","assets/T/mri-f3c7c9ffe2254cce/axial_013.png","assets/T/mri-f3c7c9ffe2254cce/axial_014.png","assets/T/mri-f3c7c9ffe2254cce/axial_015.png","assets/T/mri-f3c7c9ffe2254cce/axial_016.png","assets/T/mri-f3c7c9ffe2254cce/axial_017.png","assets/T/mri-f3c7c9ffe2254cce/axial_018.png","assets/T/mri-f3c7c9ffe2254cce/axial_019.png","assets/T/mri-f3c7c9ffe2254cce/axial_020.png","assets/T/mri-f3c7c9ffe2254cce/axial_021.png","assets/T/mri-f3c7c9ffe2254cce/axial_022.png","assets/T/mri-f3c7c9ffe2254cce/axial_023.png","assets/T/mri-f3c7c9ffe2254cce/axial_024.png","assets/T/mri-f3c7c9ffe2254cce/axial_025.png","assets/T/mri-f3c7c9ffe2254cce/axial_026.png","assets/T/mri-f3c7c9ffe2254cce/axial_027.png","assets/T/mri-f3c7c9ffe2254cce/axial_028.png","assets/T/mri-f3c7c9ffe2254cce/axial_029.png","assets/T/mri-f3c7c9ffe2254cce/axial_030.png","assets/T/mri-f3c7c9ffe2254cce/axial_031.png","assets/T/mri-f3c7c9ffe2254cce/axial_032.png","assets/T/mri-f3c7c9ffe2254cce/axial_033.png","assets/T/mri-f3c7c9ffe2254cce/axial_034.png","assets/T/mri-f3c7c9ffe2254cce/axial_035.png","assets/T/mri-f3c7c9ffe2254cce/axial_036.png","assets/T/mri-f3c7c9ffe2254cce/axial_037.png","assets/T/mri-f3c7c9ffe2254cce/axial_038.png","assets/T/mri-f3c7c9ffe2254cce/axial_039.png","assets/T/mri-f3c7c9ffe2254cce/axial_040.png","assets/T/mri-f3c7c9ffe2254cce/axial_041.png","assets/T/mri-f3c7c9ffe2254cce/axial_042.png","assets/T/mri-f3c7c9ffe2254cce/axial_043.png","assets/T/mri-f3c7c9ffe2254cce/axial_044.png","assets/T/mri-f3c7c9ffe2254cce/coronal_001.png","assets/T/mri-f3c7c9ffe2254cce/coronal_002.png","assets/T/mri-f3c7c9ffe2254cce/coronal_003.png","assets/T/mri-f3c7c9ffe2254cce/coronal_004.png","assets/T/mri-f3c7c9ffe2254cce/coronal_005.png","assets/T/mri-f3c7c9ffe2254cce/coronal_006.png","assets/T/mri-f3c7c9ffe2254cce/coronal_007.png","assets/T/mri-f3c7c9ffe2254cce/coronal_008.png","assets/T/mri-f3c7c9ffe2254cce/coronal_009.png","assets/T/mri-f3c7c9ffe2254cce/coronal_010.png","assets/T/mri-f3c7c9ffe2254cce/coronal_011.png","assets/T/mri-f3c7c9ffe2254cce/coronal_012.png","assets/T/mri-f3c7c9ffe2254cce/coronal_013.png","assets/T/mri-f3c7c9ffe2254cce/coronal_014.png","assets/T/mri-f3c7c9ffe2254cce/coronal_015.png","assets/T/mri-f3c7c9ffe2254cce/coronal_016.png","assets/T/mri-f3c7c9ffe2254cce/coronal_017.png","assets/T/mri-f3c7c9ffe2254cce/coronal_018.png","assets/T/mri-f3c7c9ffe2254cce/coronal_019.png","assets/T/mri-f3c7c9ffe2254cce/coronal_020.png","assets/T/mri-f3c7c9ffe2254cce/coronal_021.png","assets/T/mri-f3c7c9ffe2254cce/coronal_022.png","assets/T/mri-f3c7c9ffe2254cce/coronal_023.png","assets/T/mri-f3c7c9ffe2254cce/coronal_024.png","assets/T/mri-f3c7c9ffe2254cce/coronal_025.png","assets/T/mri-f3c7c9ffe2254cce/coronal_026.png"],"stage_edition":8}
+{"id":"L3-T300:mri-9be1862b768f4779","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-9be1862b768f4779/axial_001.png","assets/T/mri-9be1862b768f4779/axial_002.png","assets/T/mri-9be1862b768f4779/axial_003.png","assets/T/mri-9be1862b768f4779/axial_004.png","assets/T/mri-9be1862b768f4779/axial_005.png","assets/T/mri-9be1862b768f4779/axial_006.png","assets/T/mri-9be1862b768f4779/axial_007.png","assets/T/mri-9be1862b768f4779/axial_008.png","assets/T/mri-9be1862b768f4779/axial_009.png","assets/T/mri-9be1862b768f4779/axial_010.png","assets/T/mri-9be1862b768f4779/axial_011.png","assets/T/mri-9be1862b768f4779/axial_012.png","assets/T/mri-9be1862b768f4779/axial_013.png","assets/T/mri-9be1862b768f4779/axial_014.png","assets/T/mri-9be1862b768f4779/axial_015.png","assets/T/mri-9be1862b768f4779/axial_016.png","assets/T/mri-9be1862b768f4779/axial_017.png","assets/T/mri-9be1862b768f4779/axial_018.png","assets/T/mri-9be1862b768f4779/axial_019.png","assets/T/mri-9be1862b768f4779/axial_020.png","assets/T/mri-9be1862b768f4779/axial_021.png","assets/T/mri-9be1862b768f4779/axial_022.png","assets/T/mri-9be1862b768f4779/axial_023.png","assets/T/mri-9be1862b768f4779/axial_024.png","assets/T/mri-9be1862b768f4779/axial_025.png","assets/T/mri-9be1862b768f4779/axial_026.png","assets/T/mri-9be1862b768f4779/axial_027.png","assets/T/mri-9be1862b768f4779/axial_028.png","assets/T/mri-9be1862b768f4779/axial_029.png","assets/T/mri-9be1862b768f4779/axial_030.png","assets/T/mri-9be1862b768f4779/axial_031.png","assets/T/mri-9be1862b768f4779/axial_032.png","assets/T/mri-9be1862b768f4779/axial_033.png","assets/T/mri-9be1862b768f4779/axial_034.png","assets/T/mri-9be1862b768f4779/axial_035.png","assets/T/mri-9be1862b768f4779/axial_036.png","assets/T/mri-9be1862b768f4779/axial_037.png","assets/T/mri-9be1862b768f4779/axial_038.png","assets/T/mri-9be1862b768f4779/axial_039.png","assets/T/mri-9be1862b768f4779/axial_040.png","assets/T/mri-9be1862b768f4779/axial_041.png","assets/T/mri-9be1862b768f4779/axial_042.png","assets/T/mri-9be1862b768f4779/coronal_001.png","assets/T/mri-9be1862b768f4779/coronal_002.png","assets/T/mri-9be1862b768f4779/coronal_003.png","assets/T/mri-9be1862b768f4779/coronal_004.png","assets/T/mri-9be1862b768f4779/coronal_005.png","assets/T/mri-9be1862b768f4779/coronal_006.png","assets/T/mri-9be1862b768f4779/coronal_007.png","assets/T/mri-9be1862b768f4779/coronal_008.png","assets/T/mri-9be1862b768f4779/coronal_009.png","assets/T/mri-9be1862b768f4779/coronal_010.png","assets/T/mri-9be1862b768f4779/coronal_011.png","assets/T/mri-9be1862b768f4779/coronal_012.png","assets/T/mri-9be1862b768f4779/coronal_013.png","assets/T/mri-9be1862b768f4779/coronal_014.png","assets/T/mri-9be1862b768f4779/coronal_015.png","assets/T/mri-9be1862b768f4779/coronal_016.png","assets/T/mri-9be1862b768f4779/coronal_017.png","assets/T/mri-9be1862b768f4779/coronal_018.png","assets/T/mri-9be1862b768f4779/coronal_019.png","assets/T/mri-9be1862b768f4779/coronal_020.png","assets/T/mri-9be1862b768f4779/coronal_021.png","assets/T/mri-9be1862b768f4779/coronal_022.png","assets/T/mri-9be1862b768f4779/coronal_023.png","assets/T/mri-9be1862b768f4779/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-27888c92886445dd","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-27888c92886445dd/axial_001.png","assets/T/mri-27888c92886445dd/axial_002.png","assets/T/mri-27888c92886445dd/axial_003.png","assets/T/mri-27888c92886445dd/axial_004.png","assets/T/mri-27888c92886445dd/axial_005.png","assets/T/mri-27888c92886445dd/axial_006.png","assets/T/mri-27888c92886445dd/axial_007.png","assets/T/mri-27888c92886445dd/axial_008.png","assets/T/mri-27888c92886445dd/axial_009.png","assets/T/mri-27888c92886445dd/axial_010.png","assets/T/mri-27888c92886445dd/axial_011.png","assets/T/mri-27888c92886445dd/axial_012.png","assets/T/mri-27888c92886445dd/axial_013.png","assets/T/mri-27888c92886445dd/axial_014.png","assets/T/mri-27888c92886445dd/axial_015.png","assets/T/mri-27888c92886445dd/axial_016.png","assets/T/mri-27888c92886445dd/axial_017.png","assets/T/mri-27888c92886445dd/axial_018.png","assets/T/mri-27888c92886445dd/axial_019.png","assets/T/mri-27888c92886445dd/axial_020.png","assets/T/mri-27888c92886445dd/axial_021.png","assets/T/mri-27888c92886445dd/axial_022.png","assets/T/mri-27888c92886445dd/axial_023.png","assets/T/mri-27888c92886445dd/axial_024.png","assets/T/mri-27888c92886445dd/axial_025.png","assets/T/mri-27888c92886445dd/axial_026.png","assets/T/mri-27888c92886445dd/axial_027.png","assets/T/mri-27888c92886445dd/axial_028.png","assets/T/mri-27888c92886445dd/axial_029.png","assets/T/mri-27888c92886445dd/axial_030.png","assets/T/mri-27888c92886445dd/axial_031.png","assets/T/mri-27888c92886445dd/axial_032.png","assets/T/mri-27888c92886445dd/axial_033.png","assets/T/mri-27888c92886445dd/axial_034.png","assets/T/mri-27888c92886445dd/axial_035.png","assets/T/mri-27888c92886445dd/axial_036.png","assets/T/mri-27888c92886445dd/axial_037.png","assets/T/mri-27888c92886445dd/axial_038.png","assets/T/mri-27888c92886445dd/axial_039.png","assets/T/mri-27888c92886445dd/axial_040.png","assets/T/mri-27888c92886445dd/coronal_001.png","assets/T/mri-27888c92886445dd/coronal_002.png","assets/T/mri-27888c92886445dd/coronal_003.png","assets/T/mri-27888c92886445dd/coronal_004.png","assets/T/mri-27888c92886445dd/coronal_005.png","assets/T/mri-27888c92886445dd/coronal_006.png","assets/T/mri-27888c92886445dd/coronal_007.png","assets/T/mri-27888c92886445dd/coronal_008.png","assets/T/mri-27888c92886445dd/coronal_009.png","assets/T/mri-27888c92886445dd/coronal_010.png","assets/T/mri-27888c92886445dd/coronal_011.png","assets/T/mri-27888c92886445dd/coronal_012.png","assets/T/mri-27888c92886445dd/coronal_013.png","assets/T/mri-27888c92886445dd/coronal_014.png","assets/T/mri-27888c92886445dd/coronal_015.png","assets/T/mri-27888c92886445dd/coronal_016.png","assets/T/mri-27888c92886445dd/coronal_017.png","assets/T/mri-27888c92886445dd/coronal_018.png","assets/T/mri-27888c92886445dd/coronal_019.png","assets/T/mri-27888c92886445dd/coronal_020.png","assets/T/mri-27888c92886445dd/coronal_021.png","assets/T/mri-27888c92886445dd/coronal_022.png","assets/T/mri-27888c92886445dd/coronal_023.png","assets/T/mri-27888c92886445dd/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-52bc4d5404e34274","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-52bc4d5404e34274/axial_001.png","assets/T/mri-52bc4d5404e34274/axial_002.png","assets/T/mri-52bc4d5404e34274/axial_003.png","assets/T/mri-52bc4d5404e34274/axial_004.png","assets/T/mri-52bc4d5404e34274/axial_005.png","assets/T/mri-52bc4d5404e34274/axial_006.png","assets/T/mri-52bc4d5404e34274/axial_007.png","assets/T/mri-52bc4d5404e34274/axial_008.png","assets/T/mri-52bc4d5404e34274/axial_009.png","assets/T/mri-52bc4d5404e34274/axial_010.png","assets/T/mri-52bc4d5404e34274/axial_011.png","assets/T/mri-52bc4d5404e34274/axial_012.png","assets/T/mri-52bc4d5404e34274/axial_013.png","assets/T/mri-52bc4d5404e34274/axial_014.png","assets/T/mri-52bc4d5404e34274/axial_015.png","assets/T/mri-52bc4d5404e34274/axial_016.png","assets/T/mri-52bc4d5404e34274/axial_017.png","assets/T/mri-52bc4d5404e34274/axial_018.png","assets/T/mri-52bc4d5404e34274/axial_019.png","assets/T/mri-52bc4d5404e34274/axial_020.png","assets/T/mri-52bc4d5404e34274/axial_021.png","assets/T/mri-52bc4d5404e34274/axial_022.png","assets/T/mri-52bc4d5404e34274/axial_023.png","assets/T/mri-52bc4d5404e34274/axial_024.png","assets/T/mri-52bc4d5404e34274/axial_025.png","assets/T/mri-52bc4d5404e34274/axial_026.png","assets/T/mri-52bc4d5404e34274/axial_027.png","assets/T/mri-52bc4d5404e34274/axial_028.png","assets/T/mri-52bc4d5404e34274/axial_029.png","assets/T/mri-52bc4d5404e34274/axial_030.png","assets/T/mri-52bc4d5404e34274/axial_031.png","assets/T/mri-52bc4d5404e34274/axial_032.png","assets/T/mri-52bc4d5404e34274/axial_033.png","assets/T/mri-52bc4d5404e34274/axial_034.png","assets/T/mri-52bc4d5404e34274/axial_035.png","assets/T/mri-52bc4d5404e34274/axial_036.png","assets/T/mri-52bc4d5404e34274/axial_037.png","assets/T/mri-52bc4d5404e34274/axial_038.png","assets/T/mri-52bc4d5404e34274/axial_039.png","assets/T/mri-52bc4d5404e34274/axial_040.png","assets/T/mri-52bc4d5404e34274/axial_041.png","assets/T/mri-52bc4d5404e34274/axial_042.png","assets/T/mri-52bc4d5404e34274/coronal_001.png","assets/T/mri-52bc4d5404e34274/coronal_002.png","assets/T/mri-52bc4d5404e34274/coronal_003.png","assets/T/mri-52bc4d5404e34274/coronal_004.png","assets/T/mri-52bc4d5404e34274/coronal_005.png","assets/T/mri-52bc4d5404e34274/coronal_006.png","assets/T/mri-52bc4d5404e34274/coronal_007.png","assets/T/mri-52bc4d5404e34274/coronal_008.png","assets/T/mri-52bc4d5404e34274/coronal_009.png","assets/T/mri-52bc4d5404e34274/coronal_010.png","assets/T/mri-52bc4d5404e34274/coronal_011.png","assets/T/mri-52bc4d5404e34274/coronal_012.png","assets/T/mri-52bc4d5404e34274/coronal_013.png","assets/T/mri-52bc4d5404e34274/coronal_014.png","assets/T/mri-52bc4d5404e34274/coronal_015.png","assets/T/mri-52bc4d5404e34274/coronal_016.png","assets/T/mri-52bc4d5404e34274/coronal_017.png","assets/T/mri-52bc4d5404e34274/coronal_018.png","assets/T/mri-52bc4d5404e34274/coronal_019.png","assets/T/mri-52bc4d5404e34274/coronal_020.png","assets/T/mri-52bc4d5404e34274/coronal_021.png","assets/T/mri-52bc4d5404e34274/coronal_022.png","assets/T/mri-52bc4d5404e34274/coronal_023.png","assets/T/mri-52bc4d5404e34274/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-5893d155cf924e90","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 68 张图，均来自同一次检查。\n\n- 前 44 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-5893d155cf924e90/axial_001.png","assets/T/mri-5893d155cf924e90/axial_002.png","assets/T/mri-5893d155cf924e90/axial_003.png","assets/T/mri-5893d155cf924e90/axial_004.png","assets/T/mri-5893d155cf924e90/axial_005.png","assets/T/mri-5893d155cf924e90/axial_006.png","assets/T/mri-5893d155cf924e90/axial_007.png","assets/T/mri-5893d155cf924e90/axial_008.png","assets/T/mri-5893d155cf924e90/axial_009.png","assets/T/mri-5893d155cf924e90/axial_010.png","assets/T/mri-5893d155cf924e90/axial_011.png","assets/T/mri-5893d155cf924e90/axial_012.png","assets/T/mri-5893d155cf924e90/axial_013.png","assets/T/mri-5893d155cf924e90/axial_014.png","assets/T/mri-5893d155cf924e90/axial_015.png","assets/T/mri-5893d155cf924e90/axial_016.png","assets/T/mri-5893d155cf924e90/axial_017.png","assets/T/mri-5893d155cf924e90/axial_018.png","assets/T/mri-5893d155cf924e90/axial_019.png","assets/T/mri-5893d155cf924e90/axial_020.png","assets/T/mri-5893d155cf924e90/axial_021.png","assets/T/mri-5893d155cf924e90/axial_022.png","assets/T/mri-5893d155cf924e90/axial_023.png","assets/T/mri-5893d155cf924e90/axial_024.png","assets/T/mri-5893d155cf924e90/axial_025.png","assets/T/mri-5893d155cf924e90/axial_026.png","assets/T/mri-5893d155cf924e90/axial_027.png","assets/T/mri-5893d155cf924e90/axial_028.png","assets/T/mri-5893d155cf924e90/axial_029.png","assets/T/mri-5893d155cf924e90/axial_030.png","assets/T/mri-5893d155cf924e90/axial_031.png","assets/T/mri-5893d155cf924e90/axial_032.png","assets/T/mri-5893d155cf924e90/axial_033.png","assets/T/mri-5893d155cf924e90/axial_034.png","assets/T/mri-5893d155cf924e90/axial_035.png","assets/T/mri-5893d155cf924e90/axial_036.png","assets/T/mri-5893d155cf924e90/axial_037.png","assets/T/mri-5893d155cf924e90/axial_038.png","assets/T/mri-5893d155cf924e90/axial_039.png","assets/T/mri-5893d155cf924e90/axial_040.png","assets/T/mri-5893d155cf924e90/axial_041.png","assets/T/mri-5893d155cf924e90/axial_042.png","assets/T/mri-5893d155cf924e90/axial_043.png","assets/T/mri-5893d155cf924e90/axial_044.png","assets/T/mri-5893d155cf924e90/coronal_001.png","assets/T/mri-5893d155cf924e90/coronal_002.png","assets/T/mri-5893d155cf924e90/coronal_003.png","assets/T/mri-5893d155cf924e90/coronal_004.png","assets/T/mri-5893d155cf924e90/coronal_005.png","assets/T/mri-5893d155cf924e90/coronal_006.png","assets/T/mri-5893d155cf924e90/coronal_007.png","assets/T/mri-5893d155cf924e90/coronal_008.png","assets/T/mri-5893d155cf924e90/coronal_009.png","assets/T/mri-5893d155cf924e90/coronal_010.png","assets/T/mri-5893d155cf924e90/coronal_011.png","assets/T/mri-5893d155cf924e90/coronal_012.png","assets/T/mri-5893d155cf924e90/coronal_013.png","assets/T/mri-5893d155cf924e90/coronal_014.png","assets/T/mri-5893d155cf924e90/coronal_015.png","assets/T/mri-5893d155cf924e90/coronal_016.png","assets/T/mri-5893d155cf924e90/coronal_017.png","assets/T/mri-5893d155cf924e90/coronal_018.png","assets/T/mri-5893d155cf924e90/coronal_019.png","assets/T/mri-5893d155cf924e90/coronal_020.png","assets/T/mri-5893d155cf924e90/coronal_021.png","assets/T/mri-5893d155cf924e90/coronal_022.png","assets/T/mri-5893d155cf924e90/coronal_023.png","assets/T/mri-5893d155cf924e90/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-55ee2875d8c74396","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-55ee2875d8c74396/axial_001.png","assets/T/mri-55ee2875d8c74396/axial_002.png","assets/T/mri-55ee2875d8c74396/axial_003.png","assets/T/mri-55ee2875d8c74396/axial_004.png","assets/T/mri-55ee2875d8c74396/axial_005.png","assets/T/mri-55ee2875d8c74396/axial_006.png","assets/T/mri-55ee2875d8c74396/axial_007.png","assets/T/mri-55ee2875d8c74396/axial_008.png","assets/T/mri-55ee2875d8c74396/axial_009.png","assets/T/mri-55ee2875d8c74396/axial_010.png","assets/T/mri-55ee2875d8c74396/axial_011.png","assets/T/mri-55ee2875d8c74396/axial_012.png","assets/T/mri-55ee2875d8c74396/axial_013.png","assets/T/mri-55ee2875d8c74396/axial_014.png","assets/T/mri-55ee2875d8c74396/axial_015.png","assets/T/mri-55ee2875d8c74396/axial_016.png","assets/T/mri-55ee2875d8c74396/axial_017.png","assets/T/mri-55ee2875d8c74396/axial_018.png","assets/T/mri-55ee2875d8c74396/axial_019.png","assets/T/mri-55ee2875d8c74396/axial_020.png","assets/T/mri-55ee2875d8c74396/axial_021.png","assets/T/mri-55ee2875d8c74396/axial_022.png","assets/T/mri-55ee2875d8c74396/axial_023.png","assets/T/mri-55ee2875d8c74396/axial_024.png","assets/T/mri-55ee2875d8c74396/axial_025.png","assets/T/mri-55ee2875d8c74396/axial_026.png","assets/T/mri-55ee2875d8c74396/axial_027.png","assets/T/mri-55ee2875d8c74396/axial_028.png","assets/T/mri-55ee2875d8c74396/axial_029.png","assets/T/mri-55ee2875d8c74396/axial_030.png","assets/T/mri-55ee2875d8c74396/axial_031.png","assets/T/mri-55ee2875d8c74396/axial_032.png","assets/T/mri-55ee2875d8c74396/axial_033.png","assets/T/mri-55ee2875d8c74396/axial_034.png","assets/T/mri-55ee2875d8c74396/axial_035.png","assets/T/mri-55ee2875d8c74396/axial_036.png","assets/T/mri-55ee2875d8c74396/axial_037.png","assets/T/mri-55ee2875d8c74396/axial_038.png","assets/T/mri-55ee2875d8c74396/axial_039.png","assets/T/mri-55ee2875d8c74396/axial_040.png","assets/T/mri-55ee2875d8c74396/axial_041.png","assets/T/mri-55ee2875d8c74396/axial_042.png","assets/T/mri-55ee2875d8c74396/coronal_001.png","assets/T/mri-55ee2875d8c74396/coronal_002.png","assets/T/mri-55ee2875d8c74396/coronal_003.png","assets/T/mri-55ee2875d8c74396/coronal_004.png","assets/T/mri-55ee2875d8c74396/coronal_005.png","assets/T/mri-55ee2875d8c74396/coronal_006.png","assets/T/mri-55ee2875d8c74396/coronal_007.png","assets/T/mri-55ee2875d8c74396/coronal_008.png","assets/T/mri-55ee2875d8c74396/coronal_009.png","assets/T/mri-55ee2875d8c74396/coronal_010.png","assets/T/mri-55ee2875d8c74396/coronal_011.png","assets/T/mri-55ee2875d8c74396/coronal_012.png","assets/T/mri-55ee2875d8c74396/coronal_013.png","assets/T/mri-55ee2875d8c74396/coronal_014.png","assets/T/mri-55ee2875d8c74396/coronal_015.png","assets/T/mri-55ee2875d8c74396/coronal_016.png","assets/T/mri-55ee2875d8c74396/coronal_017.png","assets/T/mri-55ee2875d8c74396/coronal_018.png","assets/T/mri-55ee2875d8c74396/coronal_019.png","assets/T/mri-55ee2875d8c74396/coronal_020.png","assets/T/mri-55ee2875d8c74396/coronal_021.png","assets/T/mri-55ee2875d8c74396/coronal_022.png","assets/T/mri-55ee2875d8c74396/coronal_023.png","assets/T/mri-55ee2875d8c74396/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-009d069830a941cc","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 62 张图，均来自同一次检查。\n\n- 前 38 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-009d069830a941cc/axial_001.png","assets/T/mri-009d069830a941cc/axial_002.png","assets/T/mri-009d069830a941cc/axial_003.png","assets/T/mri-009d069830a941cc/axial_004.png","assets/T/mri-009d069830a941cc/axial_005.png","assets/T/mri-009d069830a941cc/axial_006.png","assets/T/mri-009d069830a941cc/axial_007.png","assets/T/mri-009d069830a941cc/axial_008.png","assets/T/mri-009d069830a941cc/axial_009.png","assets/T/mri-009d069830a941cc/axial_010.png","assets/T/mri-009d069830a941cc/axial_011.png","assets/T/mri-009d069830a941cc/axial_012.png","assets/T/mri-009d069830a941cc/axial_013.png","assets/T/mri-009d069830a941cc/axial_014.png","assets/T/mri-009d069830a941cc/axial_015.png","assets/T/mri-009d069830a941cc/axial_016.png","assets/T/mri-009d069830a941cc/axial_017.png","assets/T/mri-009d069830a941cc/axial_018.png","assets/T/mri-009d069830a941cc/axial_019.png","assets/T/mri-009d069830a941cc/axial_020.png","assets/T/mri-009d069830a941cc/axial_021.png","assets/T/mri-009d069830a941cc/axial_022.png","assets/T/mri-009d069830a941cc/axial_023.png","assets/T/mri-009d069830a941cc/axial_024.png","assets/T/mri-009d069830a941cc/axial_025.png","assets/T/mri-009d069830a941cc/axial_026.png","assets/T/mri-009d069830a941cc/axial_027.png","assets/T/mri-009d069830a941cc/axial_028.png","assets/T/mri-009d069830a941cc/axial_029.png","assets/T/mri-009d069830a941cc/axial_030.png","assets/T/mri-009d069830a941cc/axial_031.png","assets/T/mri-009d069830a941cc/axial_032.png","assets/T/mri-009d069830a941cc/axial_033.png","assets/T/mri-009d069830a941cc/axial_034.png","assets/T/mri-009d069830a941cc/axial_035.png","assets/T/mri-009d069830a941cc/axial_036.png","assets/T/mri-009d069830a941cc/axial_037.png","assets/T/mri-009d069830a941cc/axial_038.png","assets/T/mri-009d069830a941cc/coronal_001.png","assets/T/mri-009d069830a941cc/coronal_002.png","assets/T/mri-009d069830a941cc/coronal_003.png","assets/T/mri-009d069830a941cc/coronal_004.png","assets/T/mri-009d069830a941cc/coronal_005.png","assets/T/mri-009d069830a941cc/coronal_006.png","assets/T/mri-009d069830a941cc/coronal_007.png","assets/T/mri-009d069830a941cc/coronal_008.png","assets/T/mri-009d069830a941cc/coronal_009.png","assets/T/mri-009d069830a941cc/coronal_010.png","assets/T/mri-009d069830a941cc/coronal_011.png","assets/T/mri-009d069830a941cc/coronal_012.png","assets/T/mri-009d069830a941cc/coronal_013.png","assets/T/mri-009d069830a941cc/coronal_014.png","assets/T/mri-009d069830a941cc/coronal_015.png","assets/T/mri-009d069830a941cc/coronal_016.png","assets/T/mri-009d069830a941cc/coronal_017.png","assets/T/mri-009d069830a941cc/coronal_018.png","assets/T/mri-009d069830a941cc/coronal_019.png","assets/T/mri-009d069830a941cc/coronal_020.png","assets/T/mri-009d069830a941cc/coronal_021.png","assets/T/mri-009d069830a941cc/coronal_022.png","assets/T/mri-009d069830a941cc/coronal_023.png","assets/T/mri-009d069830a941cc/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-5927ca297b614ffd","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-5927ca297b614ffd/axial_001.png","assets/T/mri-5927ca297b614ffd/axial_002.png","assets/T/mri-5927ca297b614ffd/axial_003.png","assets/T/mri-5927ca297b614ffd/axial_004.png","assets/T/mri-5927ca297b614ffd/axial_005.png","assets/T/mri-5927ca297b614ffd/axial_006.png","assets/T/mri-5927ca297b614ffd/axial_007.png","assets/T/mri-5927ca297b614ffd/axial_008.png","assets/T/mri-5927ca297b614ffd/axial_009.png","assets/T/mri-5927ca297b614ffd/axial_010.png","assets/T/mri-5927ca297b614ffd/axial_011.png","assets/T/mri-5927ca297b614ffd/axial_012.png","assets/T/mri-5927ca297b614ffd/axial_013.png","assets/T/mri-5927ca297b614ffd/axial_014.png","assets/T/mri-5927ca297b614ffd/axial_015.png","assets/T/mri-5927ca297b614ffd/axial_016.png","assets/T/mri-5927ca297b614ffd/axial_017.png","assets/T/mri-5927ca297b614ffd/axial_018.png","assets/T/mri-5927ca297b614ffd/axial_019.png","assets/T/mri-5927ca297b614ffd/axial_020.png","assets/T/mri-5927ca297b614ffd/axial_021.png","assets/T/mri-5927ca297b614ffd/axial_022.png","assets/T/mri-5927ca297b614ffd/axial_023.png","assets/T/mri-5927ca297b614ffd/axial_024.png","assets/T/mri-5927ca297b614ffd/axial_025.png","assets/T/mri-5927ca297b614ffd/axial_026.png","assets/T/mri-5927ca297b614ffd/axial_027.png","assets/T/mri-5927ca297b614ffd/axial_028.png","assets/T/mri-5927ca297b614ffd/axial_029.png","assets/T/mri-5927ca297b614ffd/axial_030.png","assets/T/mri-5927ca297b614ffd/axial_031.png","assets/T/mri-5927ca297b614ffd/axial_032.png","assets/T/mri-5927ca297b614ffd/axial_033.png","assets/T/mri-5927ca297b614ffd/axial_034.png","assets/T/mri-5927ca297b614ffd/axial_035.png","assets/T/mri-5927ca297b614ffd/axial_036.png","assets/T/mri-5927ca297b614ffd/axial_037.png","assets/T/mri-5927ca297b614ffd/axial_038.png","assets/T/mri-5927ca297b614ffd/axial_039.png","assets/T/mri-5927ca297b614ffd/axial_040.png","assets/T/mri-5927ca297b614ffd/coronal_001.png","assets/T/mri-5927ca297b614ffd/coronal_002.png","assets/T/mri-5927ca297b614ffd/coronal_003.png","assets/T/mri-5927ca297b614ffd/coronal_004.png","assets/T/mri-5927ca297b614ffd/coronal_005.png","assets/T/mri-5927ca297b614ffd/coronal_006.png","assets/T/mri-5927ca297b614ffd/coronal_007.png","assets/T/mri-5927ca297b614ffd/coronal_008.png","assets/T/mri-5927ca297b614ffd/coronal_009.png","assets/T/mri-5927ca297b614ffd/coronal_010.png","assets/T/mri-5927ca297b614ffd/coronal_011.png","assets/T/mri-5927ca297b614ffd/coronal_012.png","assets/T/mri-5927ca297b614ffd/coronal_013.png","assets/T/mri-5927ca297b614ffd/coronal_014.png","assets/T/mri-5927ca297b614ffd/coronal_015.png","assets/T/mri-5927ca297b614ffd/coronal_016.png","assets/T/mri-5927ca297b614ffd/coronal_017.png","assets/T/mri-5927ca297b614ffd/coronal_018.png","assets/T/mri-5927ca297b614ffd/coronal_019.png","assets/T/mri-5927ca297b614ffd/coronal_020.png","assets/T/mri-5927ca297b614ffd/coronal_021.png","assets/T/mri-5927ca297b614ffd/coronal_022.png","assets/T/mri-5927ca297b614ffd/coronal_023.png","assets/T/mri-5927ca297b614ffd/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-a5b56fee006e4280","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-a5b56fee006e4280/axial_001.png","assets/T/mri-a5b56fee006e4280/axial_002.png","assets/T/mri-a5b56fee006e4280/axial_003.png","assets/T/mri-a5b56fee006e4280/axial_004.png","assets/T/mri-a5b56fee006e4280/axial_005.png","assets/T/mri-a5b56fee006e4280/axial_006.png","assets/T/mri-a5b56fee006e4280/axial_007.png","assets/T/mri-a5b56fee006e4280/axial_008.png","assets/T/mri-a5b56fee006e4280/axial_009.png","assets/T/mri-a5b56fee006e4280/axial_010.png","assets/T/mri-a5b56fee006e4280/axial_011.png","assets/T/mri-a5b56fee006e4280/axial_012.png","assets/T/mri-a5b56fee006e4280/axial_013.png","assets/T/mri-a5b56fee006e4280/axial_014.png","assets/T/mri-a5b56fee006e4280/axial_015.png","assets/T/mri-a5b56fee006e4280/axial_016.png","assets/T/mri-a5b56fee006e4280/axial_017.png","assets/T/mri-a5b56fee006e4280/axial_018.png","assets/T/mri-a5b56fee006e4280/axial_019.png","assets/T/mri-a5b56fee006e4280/axial_020.png","assets/T/mri-a5b56fee006e4280/axial_021.png","assets/T/mri-a5b56fee006e4280/axial_022.png","assets/T/mri-a5b56fee006e4280/axial_023.png","assets/T/mri-a5b56fee006e4280/axial_024.png","assets/T/mri-a5b56fee006e4280/axial_025.png","assets/T/mri-a5b56fee006e4280/axial_026.png","assets/T/mri-a5b56fee006e4280/axial_027.png","assets/T/mri-a5b56fee006e4280/axial_028.png","assets/T/mri-a5b56fee006e4280/axial_029.png","assets/T/mri-a5b56fee006e4280/axial_030.png","assets/T/mri-a5b56fee006e4280/axial_031.png","assets/T/mri-a5b56fee006e4280/axial_032.png","assets/T/mri-a5b56fee006e4280/axial_033.png","assets/T/mri-a5b56fee006e4280/axial_034.png","assets/T/mri-a5b56fee006e4280/axial_035.png","assets/T/mri-a5b56fee006e4280/axial_036.png","assets/T/mri-a5b56fee006e4280/axial_037.png","assets/T/mri-a5b56fee006e4280/axial_038.png","assets/T/mri-a5b56fee006e4280/axial_039.png","assets/T/mri-a5b56fee006e4280/axial_040.png","assets/T/mri-a5b56fee006e4280/coronal_001.png","assets/T/mri-a5b56fee006e4280/coronal_002.png","assets/T/mri-a5b56fee006e4280/coronal_003.png","assets/T/mri-a5b56fee006e4280/coronal_004.png","assets/T/mri-a5b56fee006e4280/coronal_005.png","assets/T/mri-a5b56fee006e4280/coronal_006.png","assets/T/mri-a5b56fee006e4280/coronal_007.png","assets/T/mri-a5b56fee006e4280/coronal_008.png","assets/T/mri-a5b56fee006e4280/coronal_009.png","assets/T/mri-a5b56fee006e4280/coronal_010.png","assets/T/mri-a5b56fee006e4280/coronal_011.png","assets/T/mri-a5b56fee006e4280/coronal_012.png","assets/T/mri-a5b56fee006e4280/coronal_013.png","assets/T/mri-a5b56fee006e4280/coronal_014.png","assets/T/mri-a5b56fee006e4280/coronal_015.png","assets/T/mri-a5b56fee006e4280/coronal_016.png","assets/T/mri-a5b56fee006e4280/coronal_017.png","assets/T/mri-a5b56fee006e4280/coronal_018.png","assets/T/mri-a5b56fee006e4280/coronal_019.png","assets/T/mri-a5b56fee006e4280/coronal_020.png","assets/T/mri-a5b56fee006e4280/coronal_021.png","assets/T/mri-a5b56fee006e4280/coronal_022.png","assets/T/mri-a5b56fee006e4280/coronal_023.png","assets/T/mri-a5b56fee006e4280/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-db4b9a10a3444950","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-db4b9a10a3444950/axial_001.png","assets/T/mri-db4b9a10a3444950/axial_002.png","assets/T/mri-db4b9a10a3444950/axial_003.png","assets/T/mri-db4b9a10a3444950/axial_004.png","assets/T/mri-db4b9a10a3444950/axial_005.png","assets/T/mri-db4b9a10a3444950/axial_006.png","assets/T/mri-db4b9a10a3444950/axial_007.png","assets/T/mri-db4b9a10a3444950/axial_008.png","assets/T/mri-db4b9a10a3444950/axial_009.png","assets/T/mri-db4b9a10a3444950/axial_010.png","assets/T/mri-db4b9a10a3444950/axial_011.png","assets/T/mri-db4b9a10a3444950/axial_012.png","assets/T/mri-db4b9a10a3444950/axial_013.png","assets/T/mri-db4b9a10a3444950/axial_014.png","assets/T/mri-db4b9a10a3444950/axial_015.png","assets/T/mri-db4b9a10a3444950/axial_016.png","assets/T/mri-db4b9a10a3444950/axial_017.png","assets/T/mri-db4b9a10a3444950/axial_018.png","assets/T/mri-db4b9a10a3444950/axial_019.png","assets/T/mri-db4b9a10a3444950/axial_020.png","assets/T/mri-db4b9a10a3444950/axial_021.png","assets/T/mri-db4b9a10a3444950/axial_022.png","assets/T/mri-db4b9a10a3444950/axial_023.png","assets/T/mri-db4b9a10a3444950/axial_024.png","assets/T/mri-db4b9a10a3444950/axial_025.png","assets/T/mri-db4b9a10a3444950/axial_026.png","assets/T/mri-db4b9a10a3444950/axial_027.png","assets/T/mri-db4b9a10a3444950/axial_028.png","assets/T/mri-db4b9a10a3444950/axial_029.png","assets/T/mri-db4b9a10a3444950/axial_030.png","assets/T/mri-db4b9a10a3444950/axial_031.png","assets/T/mri-db4b9a10a3444950/axial_032.png","assets/T/mri-db4b9a10a3444950/axial_033.png","assets/T/mri-db4b9a10a3444950/axial_034.png","assets/T/mri-db4b9a10a3444950/axial_035.png","assets/T/mri-db4b9a10a3444950/axial_036.png","assets/T/mri-db4b9a10a3444950/axial_037.png","assets/T/mri-db4b9a10a3444950/axial_038.png","assets/T/mri-db4b9a10a3444950/axial_039.png","assets/T/mri-db4b9a10a3444950/axial_040.png","assets/T/mri-db4b9a10a3444950/coronal_001.png","assets/T/mri-db4b9a10a3444950/coronal_002.png","assets/T/mri-db4b9a10a3444950/coronal_003.png","assets/T/mri-db4b9a10a3444950/coronal_004.png","assets/T/mri-db4b9a10a3444950/coronal_005.png","assets/T/mri-db4b9a10a3444950/coronal_006.png","assets/T/mri-db4b9a10a3444950/coronal_007.png","assets/T/mri-db4b9a10a3444950/coronal_008.png","assets/T/mri-db4b9a10a3444950/coronal_009.png","assets/T/mri-db4b9a10a3444950/coronal_010.png","assets/T/mri-db4b9a10a3444950/coronal_011.png","assets/T/mri-db4b9a10a3444950/coronal_012.png","assets/T/mri-db4b9a10a3444950/coronal_013.png","assets/T/mri-db4b9a10a3444950/coronal_014.png","assets/T/mri-db4b9a10a3444950/coronal_015.png","assets/T/mri-db4b9a10a3444950/coronal_016.png","assets/T/mri-db4b9a10a3444950/coronal_017.png","assets/T/mri-db4b9a10a3444950/coronal_018.png","assets/T/mri-db4b9a10a3444950/coronal_019.png","assets/T/mri-db4b9a10a3444950/coronal_020.png","assets/T/mri-db4b9a10a3444950/coronal_021.png","assets/T/mri-db4b9a10a3444950/coronal_022.png","assets/T/mri-db4b9a10a3444950/coronal_023.png","assets/T/mri-db4b9a10a3444950/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-ec4156cac1c84d7f","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-ec4156cac1c84d7f/axial_001.png","assets/T/mri-ec4156cac1c84d7f/axial_002.png","assets/T/mri-ec4156cac1c84d7f/axial_003.png","assets/T/mri-ec4156cac1c84d7f/axial_004.png","assets/T/mri-ec4156cac1c84d7f/axial_005.png","assets/T/mri-ec4156cac1c84d7f/axial_006.png","assets/T/mri-ec4156cac1c84d7f/axial_007.png","assets/T/mri-ec4156cac1c84d7f/axial_008.png","assets/T/mri-ec4156cac1c84d7f/axial_009.png","assets/T/mri-ec4156cac1c84d7f/axial_010.png","assets/T/mri-ec4156cac1c84d7f/axial_011.png","assets/T/mri-ec4156cac1c84d7f/axial_012.png","assets/T/mri-ec4156cac1c84d7f/axial_013.png","assets/T/mri-ec4156cac1c84d7f/axial_014.png","assets/T/mri-ec4156cac1c84d7f/axial_015.png","assets/T/mri-ec4156cac1c84d7f/axial_016.png","assets/T/mri-ec4156cac1c84d7f/axial_017.png","assets/T/mri-ec4156cac1c84d7f/axial_018.png","assets/T/mri-ec4156cac1c84d7f/axial_019.png","assets/T/mri-ec4156cac1c84d7f/axial_020.png","assets/T/mri-ec4156cac1c84d7f/axial_021.png","assets/T/mri-ec4156cac1c84d7f/axial_022.png","assets/T/mri-ec4156cac1c84d7f/axial_023.png","assets/T/mri-ec4156cac1c84d7f/axial_024.png","assets/T/mri-ec4156cac1c84d7f/axial_025.png","assets/T/mri-ec4156cac1c84d7f/axial_026.png","assets/T/mri-ec4156cac1c84d7f/axial_027.png","assets/T/mri-ec4156cac1c84d7f/axial_028.png","assets/T/mri-ec4156cac1c84d7f/axial_029.png","assets/T/mri-ec4156cac1c84d7f/axial_030.png","assets/T/mri-ec4156cac1c84d7f/axial_031.png","assets/T/mri-ec4156cac1c84d7f/axial_032.png","assets/T/mri-ec4156cac1c84d7f/axial_033.png","assets/T/mri-ec4156cac1c84d7f/axial_034.png","assets/T/mri-ec4156cac1c84d7f/axial_035.png","assets/T/mri-ec4156cac1c84d7f/axial_036.png","assets/T/mri-ec4156cac1c84d7f/axial_037.png","assets/T/mri-ec4156cac1c84d7f/axial_038.png","assets/T/mri-ec4156cac1c84d7f/axial_039.png","assets/T/mri-ec4156cac1c84d7f/axial_040.png","assets/T/mri-ec4156cac1c84d7f/axial_041.png","assets/T/mri-ec4156cac1c84d7f/axial_042.png","assets/T/mri-ec4156cac1c84d7f/coronal_001.png","assets/T/mri-ec4156cac1c84d7f/coronal_002.png","assets/T/mri-ec4156cac1c84d7f/coronal_003.png","assets/T/mri-ec4156cac1c84d7f/coronal_004.png","assets/T/mri-ec4156cac1c84d7f/coronal_005.png","assets/T/mri-ec4156cac1c84d7f/coronal_006.png","assets/T/mri-ec4156cac1c84d7f/coronal_007.png","assets/T/mri-ec4156cac1c84d7f/coronal_008.png","assets/T/mri-ec4156cac1c84d7f/coronal_009.png","assets/T/mri-ec4156cac1c84d7f/coronal_010.png","assets/T/mri-ec4156cac1c84d7f/coronal_011.png","assets/T/mri-ec4156cac1c84d7f/coronal_012.png","assets/T/mri-ec4156cac1c84d7f/coronal_013.png","assets/T/mri-ec4156cac1c84d7f/coronal_014.png","assets/T/mri-ec4156cac1c84d7f/coronal_015.png","assets/T/mri-ec4156cac1c84d7f/coronal_016.png","assets/T/mri-ec4156cac1c84d7f/coronal_017.png","assets/T/mri-ec4156cac1c84d7f/coronal_018.png","assets/T/mri-ec4156cac1c84d7f/coronal_019.png","assets/T/mri-ec4156cac1c84d7f/coronal_020.png","assets/T/mri-ec4156cac1c84d7f/coronal_021.png","assets/T/mri-ec4156cac1c84d7f/coronal_022.png","assets/T/mri-ec4156cac1c84d7f/coronal_023.png","assets/T/mri-ec4156cac1c84d7f/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-b9040a34fa5e4315","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-b9040a34fa5e4315/axial_001.png","assets/T/mri-b9040a34fa5e4315/axial_002.png","assets/T/mri-b9040a34fa5e4315/axial_003.png","assets/T/mri-b9040a34fa5e4315/axial_004.png","assets/T/mri-b9040a34fa5e4315/axial_005.png","assets/T/mri-b9040a34fa5e4315/axial_006.png","assets/T/mri-b9040a34fa5e4315/axial_007.png","assets/T/mri-b9040a34fa5e4315/axial_008.png","assets/T/mri-b9040a34fa5e4315/axial_009.png","assets/T/mri-b9040a34fa5e4315/axial_010.png","assets/T/mri-b9040a34fa5e4315/axial_011.png","assets/T/mri-b9040a34fa5e4315/axial_012.png","assets/T/mri-b9040a34fa5e4315/axial_013.png","assets/T/mri-b9040a34fa5e4315/axial_014.png","assets/T/mri-b9040a34fa5e4315/axial_015.png","assets/T/mri-b9040a34fa5e4315/axial_016.png","assets/T/mri-b9040a34fa5e4315/axial_017.png","assets/T/mri-b9040a34fa5e4315/axial_018.png","assets/T/mri-b9040a34fa5e4315/axial_019.png","assets/T/mri-b9040a34fa5e4315/axial_020.png","assets/T/mri-b9040a34fa5e4315/axial_021.png","assets/T/mri-b9040a34fa5e4315/axial_022.png","assets/T/mri-b9040a34fa5e4315/axial_023.png","assets/T/mri-b9040a34fa5e4315/axial_024.png","assets/T/mri-b9040a34fa5e4315/axial_025.png","assets/T/mri-b9040a34fa5e4315/axial_026.png","assets/T/mri-b9040a34fa5e4315/axial_027.png","assets/T/mri-b9040a34fa5e4315/axial_028.png","assets/T/mri-b9040a34fa5e4315/axial_029.png","assets/T/mri-b9040a34fa5e4315/axial_030.png","assets/T/mri-b9040a34fa5e4315/axial_031.png","assets/T/mri-b9040a34fa5e4315/axial_032.png","assets/T/mri-b9040a34fa5e4315/axial_033.png","assets/T/mri-b9040a34fa5e4315/axial_034.png","assets/T/mri-b9040a34fa5e4315/axial_035.png","assets/T/mri-b9040a34fa5e4315/axial_036.png","assets/T/mri-b9040a34fa5e4315/axial_037.png","assets/T/mri-b9040a34fa5e4315/axial_038.png","assets/T/mri-b9040a34fa5e4315/axial_039.png","assets/T/mri-b9040a34fa5e4315/axial_040.png","assets/T/mri-b9040a34fa5e4315/coronal_001.png","assets/T/mri-b9040a34fa5e4315/coronal_002.png","assets/T/mri-b9040a34fa5e4315/coronal_003.png","assets/T/mri-b9040a34fa5e4315/coronal_004.png","assets/T/mri-b9040a34fa5e4315/coronal_005.png","assets/T/mri-b9040a34fa5e4315/coronal_006.png","assets/T/mri-b9040a34fa5e4315/coronal_007.png","assets/T/mri-b9040a34fa5e4315/coronal_008.png","assets/T/mri-b9040a34fa5e4315/coronal_009.png","assets/T/mri-b9040a34fa5e4315/coronal_010.png","assets/T/mri-b9040a34fa5e4315/coronal_011.png","assets/T/mri-b9040a34fa5e4315/coronal_012.png","assets/T/mri-b9040a34fa5e4315/coronal_013.png","assets/T/mri-b9040a34fa5e4315/coronal_014.png","assets/T/mri-b9040a34fa5e4315/coronal_015.png","assets/T/mri-b9040a34fa5e4315/coronal_016.png","assets/T/mri-b9040a34fa5e4315/coronal_017.png","assets/T/mri-b9040a34fa5e4315/coronal_018.png","assets/T/mri-b9040a34fa5e4315/coronal_019.png","assets/T/mri-b9040a34fa5e4315/coronal_020.png","assets/T/mri-b9040a34fa5e4315/coronal_021.png","assets/T/mri-b9040a34fa5e4315/coronal_022.png","assets/T/mri-b9040a34fa5e4315/coronal_023.png","assets/T/mri-b9040a34fa5e4315/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-7c103c2defd14c13","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-7c103c2defd14c13/axial_001.png","assets/T/mri-7c103c2defd14c13/axial_002.png","assets/T/mri-7c103c2defd14c13/axial_003.png","assets/T/mri-7c103c2defd14c13/axial_004.png","assets/T/mri-7c103c2defd14c13/axial_005.png","assets/T/mri-7c103c2defd14c13/axial_006.png","assets/T/mri-7c103c2defd14c13/axial_007.png","assets/T/mri-7c103c2defd14c13/axial_008.png","assets/T/mri-7c103c2defd14c13/axial_009.png","assets/T/mri-7c103c2defd14c13/axial_010.png","assets/T/mri-7c103c2defd14c13/axial_011.png","assets/T/mri-7c103c2defd14c13/axial_012.png","assets/T/mri-7c103c2defd14c13/axial_013.png","assets/T/mri-7c103c2defd14c13/axial_014.png","assets/T/mri-7c103c2defd14c13/axial_015.png","assets/T/mri-7c103c2defd14c13/axial_016.png","assets/T/mri-7c103c2defd14c13/axial_017.png","assets/T/mri-7c103c2defd14c13/axial_018.png","assets/T/mri-7c103c2defd14c13/axial_019.png","assets/T/mri-7c103c2defd14c13/axial_020.png","assets/T/mri-7c103c2defd14c13/axial_021.png","assets/T/mri-7c103c2defd14c13/axial_022.png","assets/T/mri-7c103c2defd14c13/axial_023.png","assets/T/mri-7c103c2defd14c13/axial_024.png","assets/T/mri-7c103c2defd14c13/axial_025.png","assets/T/mri-7c103c2defd14c13/axial_026.png","assets/T/mri-7c103c2defd14c13/axial_027.png","assets/T/mri-7c103c2defd14c13/axial_028.png","assets/T/mri-7c103c2defd14c13/axial_029.png","assets/T/mri-7c103c2defd14c13/axial_030.png","assets/T/mri-7c103c2defd14c13/axial_031.png","assets/T/mri-7c103c2defd14c13/axial_032.png","assets/T/mri-7c103c2defd14c13/axial_033.png","assets/T/mri-7c103c2defd14c13/axial_034.png","assets/T/mri-7c103c2defd14c13/axial_035.png","assets/T/mri-7c103c2defd14c13/axial_036.png","assets/T/mri-7c103c2defd14c13/axial_037.png","assets/T/mri-7c103c2defd14c13/axial_038.png","assets/T/mri-7c103c2defd14c13/axial_039.png","assets/T/mri-7c103c2defd14c13/axial_040.png","assets/T/mri-7c103c2defd14c13/coronal_001.png","assets/T/mri-7c103c2defd14c13/coronal_002.png","assets/T/mri-7c103c2defd14c13/coronal_003.png","assets/T/mri-7c103c2defd14c13/coronal_004.png","assets/T/mri-7c103c2defd14c13/coronal_005.png","assets/T/mri-7c103c2defd14c13/coronal_006.png","assets/T/mri-7c103c2defd14c13/coronal_007.png","assets/T/mri-7c103c2defd14c13/coronal_008.png","assets/T/mri-7c103c2defd14c13/coronal_009.png","assets/T/mri-7c103c2defd14c13/coronal_010.png","assets/T/mri-7c103c2defd14c13/coronal_011.png","assets/T/mri-7c103c2defd14c13/coronal_012.png","assets/T/mri-7c103c2defd14c13/coronal_013.png","assets/T/mri-7c103c2defd14c13/coronal_014.png","assets/T/mri-7c103c2defd14c13/coronal_015.png","assets/T/mri-7c103c2defd14c13/coronal_016.png","assets/T/mri-7c103c2defd14c13/coronal_017.png","assets/T/mri-7c103c2defd14c13/coronal_018.png","assets/T/mri-7c103c2defd14c13/coronal_019.png","assets/T/mri-7c103c2defd14c13/coronal_020.png","assets/T/mri-7c103c2defd14c13/coronal_021.png","assets/T/mri-7c103c2defd14c13/coronal_022.png","assets/T/mri-7c103c2defd14c13/coronal_023.png","assets/T/mri-7c103c2defd14c13/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-dce34f88ac514aa2","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-dce34f88ac514aa2/axial_001.png","assets/T/mri-dce34f88ac514aa2/axial_002.png","assets/T/mri-dce34f88ac514aa2/axial_003.png","assets/T/mri-dce34f88ac514aa2/axial_004.png","assets/T/mri-dce34f88ac514aa2/axial_005.png","assets/T/mri-dce34f88ac514aa2/axial_006.png","assets/T/mri-dce34f88ac514aa2/axial_007.png","assets/T/mri-dce34f88ac514aa2/axial_008.png","assets/T/mri-dce34f88ac514aa2/axial_009.png","assets/T/mri-dce34f88ac514aa2/axial_010.png","assets/T/mri-dce34f88ac514aa2/axial_011.png","assets/T/mri-dce34f88ac514aa2/axial_012.png","assets/T/mri-dce34f88ac514aa2/axial_013.png","assets/T/mri-dce34f88ac514aa2/axial_014.png","assets/T/mri-dce34f88ac514aa2/axial_015.png","assets/T/mri-dce34f88ac514aa2/axial_016.png","assets/T/mri-dce34f88ac514aa2/axial_017.png","assets/T/mri-dce34f88ac514aa2/axial_018.png","assets/T/mri-dce34f88ac514aa2/axial_019.png","assets/T/mri-dce34f88ac514aa2/axial_020.png","assets/T/mri-dce34f88ac514aa2/axial_021.png","assets/T/mri-dce34f88ac514aa2/axial_022.png","assets/T/mri-dce34f88ac514aa2/axial_023.png","assets/T/mri-dce34f88ac514aa2/axial_024.png","assets/T/mri-dce34f88ac514aa2/axial_025.png","assets/T/mri-dce34f88ac514aa2/axial_026.png","assets/T/mri-dce34f88ac514aa2/axial_027.png","assets/T/mri-dce34f88ac514aa2/axial_028.png","assets/T/mri-dce34f88ac514aa2/axial_029.png","assets/T/mri-dce34f88ac514aa2/axial_030.png","assets/T/mri-dce34f88ac514aa2/axial_031.png","assets/T/mri-dce34f88ac514aa2/axial_032.png","assets/T/mri-dce34f88ac514aa2/axial_033.png","assets/T/mri-dce34f88ac514aa2/axial_034.png","assets/T/mri-dce34f88ac514aa2/axial_035.png","assets/T/mri-dce34f88ac514aa2/axial_036.png","assets/T/mri-dce34f88ac514aa2/axial_037.png","assets/T/mri-dce34f88ac514aa2/axial_038.png","assets/T/mri-dce34f88ac514aa2/axial_039.png","assets/T/mri-dce34f88ac514aa2/axial_040.png","assets/T/mri-dce34f88ac514aa2/coronal_001.png","assets/T/mri-dce34f88ac514aa2/coronal_002.png","assets/T/mri-dce34f88ac514aa2/coronal_003.png","assets/T/mri-dce34f88ac514aa2/coronal_004.png","assets/T/mri-dce34f88ac514aa2/coronal_005.png","assets/T/mri-dce34f88ac514aa2/coronal_006.png","assets/T/mri-dce34f88ac514aa2/coronal_007.png","assets/T/mri-dce34f88ac514aa2/coronal_008.png","assets/T/mri-dce34f88ac514aa2/coronal_009.png","assets/T/mri-dce34f88ac514aa2/coronal_010.png","assets/T/mri-dce34f88ac514aa2/coronal_011.png","assets/T/mri-dce34f88ac514aa2/coronal_012.png","assets/T/mri-dce34f88ac514aa2/coronal_013.png","assets/T/mri-dce34f88ac514aa2/coronal_014.png","assets/T/mri-dce34f88ac514aa2/coronal_015.png","assets/T/mri-dce34f88ac514aa2/coronal_016.png","assets/T/mri-dce34f88ac514aa2/coronal_017.png","assets/T/mri-dce34f88ac514aa2/coronal_018.png","assets/T/mri-dce34f88ac514aa2/coronal_019.png","assets/T/mri-dce34f88ac514aa2/coronal_020.png","assets/T/mri-dce34f88ac514aa2/coronal_021.png","assets/T/mri-dce34f88ac514aa2/coronal_022.png","assets/T/mri-dce34f88ac514aa2/coronal_023.png","assets/T/mri-dce34f88ac514aa2/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-dcdf6ec887f345f5","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-dcdf6ec887f345f5/axial_001.png","assets/T/mri-dcdf6ec887f345f5/axial_002.png","assets/T/mri-dcdf6ec887f345f5/axial_003.png","assets/T/mri-dcdf6ec887f345f5/axial_004.png","assets/T/mri-dcdf6ec887f345f5/axial_005.png","assets/T/mri-dcdf6ec887f345f5/axial_006.png","assets/T/mri-dcdf6ec887f345f5/axial_007.png","assets/T/mri-dcdf6ec887f345f5/axial_008.png","assets/T/mri-dcdf6ec887f345f5/axial_009.png","assets/T/mri-dcdf6ec887f345f5/axial_010.png","assets/T/mri-dcdf6ec887f345f5/axial_011.png","assets/T/mri-dcdf6ec887f345f5/axial_012.png","assets/T/mri-dcdf6ec887f345f5/axial_013.png","assets/T/mri-dcdf6ec887f345f5/axial_014.png","assets/T/mri-dcdf6ec887f345f5/axial_015.png","assets/T/mri-dcdf6ec887f345f5/axial_016.png","assets/T/mri-dcdf6ec887f345f5/axial_017.png","assets/T/mri-dcdf6ec887f345f5/axial_018.png","assets/T/mri-dcdf6ec887f345f5/axial_019.png","assets/T/mri-dcdf6ec887f345f5/axial_020.png","assets/T/mri-dcdf6ec887f345f5/axial_021.png","assets/T/mri-dcdf6ec887f345f5/axial_022.png","assets/T/mri-dcdf6ec887f345f5/axial_023.png","assets/T/mri-dcdf6ec887f345f5/axial_024.png","assets/T/mri-dcdf6ec887f345f5/axial_025.png","assets/T/mri-dcdf6ec887f345f5/axial_026.png","assets/T/mri-dcdf6ec887f345f5/axial_027.png","assets/T/mri-dcdf6ec887f345f5/axial_028.png","assets/T/mri-dcdf6ec887f345f5/axial_029.png","assets/T/mri-dcdf6ec887f345f5/axial_030.png","assets/T/mri-dcdf6ec887f345f5/axial_031.png","assets/T/mri-dcdf6ec887f345f5/axial_032.png","assets/T/mri-dcdf6ec887f345f5/axial_033.png","assets/T/mri-dcdf6ec887f345f5/axial_034.png","assets/T/mri-dcdf6ec887f345f5/axial_035.png","assets/T/mri-dcdf6ec887f345f5/axial_036.png","assets/T/mri-dcdf6ec887f345f5/axial_037.png","assets/T/mri-dcdf6ec887f345f5/axial_038.png","assets/T/mri-dcdf6ec887f345f5/axial_039.png","assets/T/mri-dcdf6ec887f345f5/axial_040.png","assets/T/mri-dcdf6ec887f345f5/axial_041.png","assets/T/mri-dcdf6ec887f345f5/axial_042.png","assets/T/mri-dcdf6ec887f345f5/coronal_001.png","assets/T/mri-dcdf6ec887f345f5/coronal_002.png","assets/T/mri-dcdf6ec887f345f5/coronal_003.png","assets/T/mri-dcdf6ec887f345f5/coronal_004.png","assets/T/mri-dcdf6ec887f345f5/coronal_005.png","assets/T/mri-dcdf6ec887f345f5/coronal_006.png","assets/T/mri-dcdf6ec887f345f5/coronal_007.png","assets/T/mri-dcdf6ec887f345f5/coronal_008.png","assets/T/mri-dcdf6ec887f345f5/coronal_009.png","assets/T/mri-dcdf6ec887f345f5/coronal_010.png","assets/T/mri-dcdf6ec887f345f5/coronal_011.png","assets/T/mri-dcdf6ec887f345f5/coronal_012.png","assets/T/mri-dcdf6ec887f345f5/coronal_013.png","assets/T/mri-dcdf6ec887f345f5/coronal_014.png","assets/T/mri-dcdf6ec887f345f5/coronal_015.png","assets/T/mri-dcdf6ec887f345f5/coronal_016.png","assets/T/mri-dcdf6ec887f345f5/coronal_017.png","assets/T/mri-dcdf6ec887f345f5/coronal_018.png","assets/T/mri-dcdf6ec887f345f5/coronal_019.png","assets/T/mri-dcdf6ec887f345f5/coronal_020.png","assets/T/mri-dcdf6ec887f345f5/coronal_021.png","assets/T/mri-dcdf6ec887f345f5/coronal_022.png","assets/T/mri-dcdf6ec887f345f5/coronal_023.png","assets/T/mri-dcdf6ec887f345f5/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-dba945687774414a","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-dba945687774414a/axial_001.png","assets/T/mri-dba945687774414a/axial_002.png","assets/T/mri-dba945687774414a/axial_003.png","assets/T/mri-dba945687774414a/axial_004.png","assets/T/mri-dba945687774414a/axial_005.png","assets/T/mri-dba945687774414a/axial_006.png","assets/T/mri-dba945687774414a/axial_007.png","assets/T/mri-dba945687774414a/axial_008.png","assets/T/mri-dba945687774414a/axial_009.png","assets/T/mri-dba945687774414a/axial_010.png","assets/T/mri-dba945687774414a/axial_011.png","assets/T/mri-dba945687774414a/axial_012.png","assets/T/mri-dba945687774414a/axial_013.png","assets/T/mri-dba945687774414a/axial_014.png","assets/T/mri-dba945687774414a/axial_015.png","assets/T/mri-dba945687774414a/axial_016.png","assets/T/mri-dba945687774414a/axial_017.png","assets/T/mri-dba945687774414a/axial_018.png","assets/T/mri-dba945687774414a/axial_019.png","assets/T/mri-dba945687774414a/axial_020.png","assets/T/mri-dba945687774414a/axial_021.png","assets/T/mri-dba945687774414a/axial_022.png","assets/T/mri-dba945687774414a/axial_023.png","assets/T/mri-dba945687774414a/axial_024.png","assets/T/mri-dba945687774414a/axial_025.png","assets/T/mri-dba945687774414a/axial_026.png","assets/T/mri-dba945687774414a/axial_027.png","assets/T/mri-dba945687774414a/axial_028.png","assets/T/mri-dba945687774414a/axial_029.png","assets/T/mri-dba945687774414a/axial_030.png","assets/T/mri-dba945687774414a/axial_031.png","assets/T/mri-dba945687774414a/axial_032.png","assets/T/mri-dba945687774414a/axial_033.png","assets/T/mri-dba945687774414a/axial_034.png","assets/T/mri-dba945687774414a/axial_035.png","assets/T/mri-dba945687774414a/axial_036.png","assets/T/mri-dba945687774414a/axial_037.png","assets/T/mri-dba945687774414a/axial_038.png","assets/T/mri-dba945687774414a/axial_039.png","assets/T/mri-dba945687774414a/axial_040.png","assets/T/mri-dba945687774414a/coronal_001.png","assets/T/mri-dba945687774414a/coronal_002.png","assets/T/mri-dba945687774414a/coronal_003.png","assets/T/mri-dba945687774414a/coronal_004.png","assets/T/mri-dba945687774414a/coronal_005.png","assets/T/mri-dba945687774414a/coronal_006.png","assets/T/mri-dba945687774414a/coronal_007.png","assets/T/mri-dba945687774414a/coronal_008.png","assets/T/mri-dba945687774414a/coronal_009.png","assets/T/mri-dba945687774414a/coronal_010.png","assets/T/mri-dba945687774414a/coronal_011.png","assets/T/mri-dba945687774414a/coronal_012.png","assets/T/mri-dba945687774414a/coronal_013.png","assets/T/mri-dba945687774414a/coronal_014.png","assets/T/mri-dba945687774414a/coronal_015.png","assets/T/mri-dba945687774414a/coronal_016.png","assets/T/mri-dba945687774414a/coronal_017.png","assets/T/mri-dba945687774414a/coronal_018.png","assets/T/mri-dba945687774414a/coronal_019.png","assets/T/mri-dba945687774414a/coronal_020.png","assets/T/mri-dba945687774414a/coronal_021.png","assets/T/mri-dba945687774414a/coronal_022.png","assets/T/mri-dba945687774414a/coronal_023.png","assets/T/mri-dba945687774414a/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-c676d561104541b6","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 60 张图，均来自同一次检查。\n\n- 前 36 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-c676d561104541b6/axial_001.png","assets/T/mri-c676d561104541b6/axial_002.png","assets/T/mri-c676d561104541b6/axial_003.png","assets/T/mri-c676d561104541b6/axial_004.png","assets/T/mri-c676d561104541b6/axial_005.png","assets/T/mri-c676d561104541b6/axial_006.png","assets/T/mri-c676d561104541b6/axial_007.png","assets/T/mri-c676d561104541b6/axial_008.png","assets/T/mri-c676d561104541b6/axial_009.png","assets/T/mri-c676d561104541b6/axial_010.png","assets/T/mri-c676d561104541b6/axial_011.png","assets/T/mri-c676d561104541b6/axial_012.png","assets/T/mri-c676d561104541b6/axial_013.png","assets/T/mri-c676d561104541b6/axial_014.png","assets/T/mri-c676d561104541b6/axial_015.png","assets/T/mri-c676d561104541b6/axial_016.png","assets/T/mri-c676d561104541b6/axial_017.png","assets/T/mri-c676d561104541b6/axial_018.png","assets/T/mri-c676d561104541b6/axial_019.png","assets/T/mri-c676d561104541b6/axial_020.png","assets/T/mri-c676d561104541b6/axial_021.png","assets/T/mri-c676d561104541b6/axial_022.png","assets/T/mri-c676d561104541b6/axial_023.png","assets/T/mri-c676d561104541b6/axial_024.png","assets/T/mri-c676d561104541b6/axial_025.png","assets/T/mri-c676d561104541b6/axial_026.png","assets/T/mri-c676d561104541b6/axial_027.png","assets/T/mri-c676d561104541b6/axial_028.png","assets/T/mri-c676d561104541b6/axial_029.png","assets/T/mri-c676d561104541b6/axial_030.png","assets/T/mri-c676d561104541b6/axial_031.png","assets/T/mri-c676d561104541b6/axial_032.png","assets/T/mri-c676d561104541b6/axial_033.png","assets/T/mri-c676d561104541b6/axial_034.png","assets/T/mri-c676d561104541b6/axial_035.png","assets/T/mri-c676d561104541b6/axial_036.png","assets/T/mri-c676d561104541b6/coronal_001.png","assets/T/mri-c676d561104541b6/coronal_002.png","assets/T/mri-c676d561104541b6/coronal_003.png","assets/T/mri-c676d561104541b6/coronal_004.png","assets/T/mri-c676d561104541b6/coronal_005.png","assets/T/mri-c676d561104541b6/coronal_006.png","assets/T/mri-c676d561104541b6/coronal_007.png","assets/T/mri-c676d561104541b6/coronal_008.png","assets/T/mri-c676d561104541b6/coronal_009.png","assets/T/mri-c676d561104541b6/coronal_010.png","assets/T/mri-c676d561104541b6/coronal_011.png","assets/T/mri-c676d561104541b6/coronal_012.png","assets/T/mri-c676d561104541b6/coronal_013.png","assets/T/mri-c676d561104541b6/coronal_014.png","assets/T/mri-c676d561104541b6/coronal_015.png","assets/T/mri-c676d561104541b6/coronal_016.png","assets/T/mri-c676d561104541b6/coronal_017.png","assets/T/mri-c676d561104541b6/coronal_018.png","assets/T/mri-c676d561104541b6/coronal_019.png","assets/T/mri-c676d561104541b6/coronal_020.png","assets/T/mri-c676d561104541b6/coronal_021.png","assets/T/mri-c676d561104541b6/coronal_022.png","assets/T/mri-c676d561104541b6/coronal_023.png","assets/T/mri-c676d561104541b6/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-10d48e8b495348d4","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-10d48e8b495348d4/axial_001.png","assets/T/mri-10d48e8b495348d4/axial_002.png","assets/T/mri-10d48e8b495348d4/axial_003.png","assets/T/mri-10d48e8b495348d4/axial_004.png","assets/T/mri-10d48e8b495348d4/axial_005.png","assets/T/mri-10d48e8b495348d4/axial_006.png","assets/T/mri-10d48e8b495348d4/axial_007.png","assets/T/mri-10d48e8b495348d4/axial_008.png","assets/T/mri-10d48e8b495348d4/axial_009.png","assets/T/mri-10d48e8b495348d4/axial_010.png","assets/T/mri-10d48e8b495348d4/axial_011.png","assets/T/mri-10d48e8b495348d4/axial_012.png","assets/T/mri-10d48e8b495348d4/axial_013.png","assets/T/mri-10d48e8b495348d4/axial_014.png","assets/T/mri-10d48e8b495348d4/axial_015.png","assets/T/mri-10d48e8b495348d4/axial_016.png","assets/T/mri-10d48e8b495348d4/axial_017.png","assets/T/mri-10d48e8b495348d4/axial_018.png","assets/T/mri-10d48e8b495348d4/axial_019.png","assets/T/mri-10d48e8b495348d4/axial_020.png","assets/T/mri-10d48e8b495348d4/axial_021.png","assets/T/mri-10d48e8b495348d4/axial_022.png","assets/T/mri-10d48e8b495348d4/axial_023.png","assets/T/mri-10d48e8b495348d4/axial_024.png","assets/T/mri-10d48e8b495348d4/axial_025.png","assets/T/mri-10d48e8b495348d4/axial_026.png","assets/T/mri-10d48e8b495348d4/axial_027.png","assets/T/mri-10d48e8b495348d4/axial_028.png","assets/T/mri-10d48e8b495348d4/axial_029.png","assets/T/mri-10d48e8b495348d4/axial_030.png","assets/T/mri-10d48e8b495348d4/axial_031.png","assets/T/mri-10d48e8b495348d4/axial_032.png","assets/T/mri-10d48e8b495348d4/axial_033.png","assets/T/mri-10d48e8b495348d4/axial_034.png","assets/T/mri-10d48e8b495348d4/axial_035.png","assets/T/mri-10d48e8b495348d4/axial_036.png","assets/T/mri-10d48e8b495348d4/axial_037.png","assets/T/mri-10d48e8b495348d4/axial_038.png","assets/T/mri-10d48e8b495348d4/axial_039.png","assets/T/mri-10d48e8b495348d4/axial_040.png","assets/T/mri-10d48e8b495348d4/axial_041.png","assets/T/mri-10d48e8b495348d4/axial_042.png","assets/T/mri-10d48e8b495348d4/coronal_001.png","assets/T/mri-10d48e8b495348d4/coronal_002.png","assets/T/mri-10d48e8b495348d4/coronal_003.png","assets/T/mri-10d48e8b495348d4/coronal_004.png","assets/T/mri-10d48e8b495348d4/coronal_005.png","assets/T/mri-10d48e8b495348d4/coronal_006.png","assets/T/mri-10d48e8b495348d4/coronal_007.png","assets/T/mri-10d48e8b495348d4/coronal_008.png","assets/T/mri-10d48e8b495348d4/coronal_009.png","assets/T/mri-10d48e8b495348d4/coronal_010.png","assets/T/mri-10d48e8b495348d4/coronal_011.png","assets/T/mri-10d48e8b495348d4/coronal_012.png","assets/T/mri-10d48e8b495348d4/coronal_013.png","assets/T/mri-10d48e8b495348d4/coronal_014.png","assets/T/mri-10d48e8b495348d4/coronal_015.png","assets/T/mri-10d48e8b495348d4/coronal_016.png","assets/T/mri-10d48e8b495348d4/coronal_017.png","assets/T/mri-10d48e8b495348d4/coronal_018.png","assets/T/mri-10d48e8b495348d4/coronal_019.png","assets/T/mri-10d48e8b495348d4/coronal_020.png","assets/T/mri-10d48e8b495348d4/coronal_021.png","assets/T/mri-10d48e8b495348d4/coronal_022.png","assets/T/mri-10d48e8b495348d4/coronal_023.png","assets/T/mri-10d48e8b495348d4/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-911862d19e9e456f","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-911862d19e9e456f/axial_001.png","assets/T/mri-911862d19e9e456f/axial_002.png","assets/T/mri-911862d19e9e456f/axial_003.png","assets/T/mri-911862d19e9e456f/axial_004.png","assets/T/mri-911862d19e9e456f/axial_005.png","assets/T/mri-911862d19e9e456f/axial_006.png","assets/T/mri-911862d19e9e456f/axial_007.png","assets/T/mri-911862d19e9e456f/axial_008.png","assets/T/mri-911862d19e9e456f/axial_009.png","assets/T/mri-911862d19e9e456f/axial_010.png","assets/T/mri-911862d19e9e456f/axial_011.png","assets/T/mri-911862d19e9e456f/axial_012.png","assets/T/mri-911862d19e9e456f/axial_013.png","assets/T/mri-911862d19e9e456f/axial_014.png","assets/T/mri-911862d19e9e456f/axial_015.png","assets/T/mri-911862d19e9e456f/axial_016.png","assets/T/mri-911862d19e9e456f/axial_017.png","assets/T/mri-911862d19e9e456f/axial_018.png","assets/T/mri-911862d19e9e456f/axial_019.png","assets/T/mri-911862d19e9e456f/axial_020.png","assets/T/mri-911862d19e9e456f/axial_021.png","assets/T/mri-911862d19e9e456f/axial_022.png","assets/T/mri-911862d19e9e456f/axial_023.png","assets/T/mri-911862d19e9e456f/axial_024.png","assets/T/mri-911862d19e9e456f/axial_025.png","assets/T/mri-911862d19e9e456f/axial_026.png","assets/T/mri-911862d19e9e456f/axial_027.png","assets/T/mri-911862d19e9e456f/axial_028.png","assets/T/mri-911862d19e9e456f/axial_029.png","assets/T/mri-911862d19e9e456f/axial_030.png","assets/T/mri-911862d19e9e456f/axial_031.png","assets/T/mri-911862d19e9e456f/axial_032.png","assets/T/mri-911862d19e9e456f/axial_033.png","assets/T/mri-911862d19e9e456f/axial_034.png","assets/T/mri-911862d19e9e456f/axial_035.png","assets/T/mri-911862d19e9e456f/axial_036.png","assets/T/mri-911862d19e9e456f/axial_037.png","assets/T/mri-911862d19e9e456f/axial_038.png","assets/T/mri-911862d19e9e456f/axial_039.png","assets/T/mri-911862d19e9e456f/axial_040.png","assets/T/mri-911862d19e9e456f/axial_041.png","assets/T/mri-911862d19e9e456f/axial_042.png","assets/T/mri-911862d19e9e456f/coronal_001.png","assets/T/mri-911862d19e9e456f/coronal_002.png","assets/T/mri-911862d19e9e456f/coronal_003.png","assets/T/mri-911862d19e9e456f/coronal_004.png","assets/T/mri-911862d19e9e456f/coronal_005.png","assets/T/mri-911862d19e9e456f/coronal_006.png","assets/T/mri-911862d19e9e456f/coronal_007.png","assets/T/mri-911862d19e9e456f/coronal_008.png","assets/T/mri-911862d19e9e456f/coronal_009.png","assets/T/mri-911862d19e9e456f/coronal_010.png","assets/T/mri-911862d19e9e456f/coronal_011.png","assets/T/mri-911862d19e9e456f/coronal_012.png","assets/T/mri-911862d19e9e456f/coronal_013.png","assets/T/mri-911862d19e9e456f/coronal_014.png","assets/T/mri-911862d19e9e456f/coronal_015.png","assets/T/mri-911862d19e9e456f/coronal_016.png","assets/T/mri-911862d19e9e456f/coronal_017.png","assets/T/mri-911862d19e9e456f/coronal_018.png","assets/T/mri-911862d19e9e456f/coronal_019.png","assets/T/mri-911862d19e9e456f/coronal_020.png","assets/T/mri-911862d19e9e456f/coronal_021.png","assets/T/mri-911862d19e9e456f/coronal_022.png","assets/T/mri-911862d19e9e456f/coronal_023.png","assets/T/mri-911862d19e9e456f/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-52ab912be8f94df4","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-52ab912be8f94df4/axial_001.png","assets/T/mri-52ab912be8f94df4/axial_002.png","assets/T/mri-52ab912be8f94df4/axial_003.png","assets/T/mri-52ab912be8f94df4/axial_004.png","assets/T/mri-52ab912be8f94df4/axial_005.png","assets/T/mri-52ab912be8f94df4/axial_006.png","assets/T/mri-52ab912be8f94df4/axial_007.png","assets/T/mri-52ab912be8f94df4/axial_008.png","assets/T/mri-52ab912be8f94df4/axial_009.png","assets/T/mri-52ab912be8f94df4/axial_010.png","assets/T/mri-52ab912be8f94df4/axial_011.png","assets/T/mri-52ab912be8f94df4/axial_012.png","assets/T/mri-52ab912be8f94df4/axial_013.png","assets/T/mri-52ab912be8f94df4/axial_014.png","assets/T/mri-52ab912be8f94df4/axial_015.png","assets/T/mri-52ab912be8f94df4/axial_016.png","assets/T/mri-52ab912be8f94df4/axial_017.png","assets/T/mri-52ab912be8f94df4/axial_018.png","assets/T/mri-52ab912be8f94df4/axial_019.png","assets/T/mri-52ab912be8f94df4/axial_020.png","assets/T/mri-52ab912be8f94df4/axial_021.png","assets/T/mri-52ab912be8f94df4/axial_022.png","assets/T/mri-52ab912be8f94df4/axial_023.png","assets/T/mri-52ab912be8f94df4/axial_024.png","assets/T/mri-52ab912be8f94df4/axial_025.png","assets/T/mri-52ab912be8f94df4/axial_026.png","assets/T/mri-52ab912be8f94df4/axial_027.png","assets/T/mri-52ab912be8f94df4/axial_028.png","assets/T/mri-52ab912be8f94df4/axial_029.png","assets/T/mri-52ab912be8f94df4/axial_030.png","assets/T/mri-52ab912be8f94df4/axial_031.png","assets/T/mri-52ab912be8f94df4/axial_032.png","assets/T/mri-52ab912be8f94df4/axial_033.png","assets/T/mri-52ab912be8f94df4/axial_034.png","assets/T/mri-52ab912be8f94df4/axial_035.png","assets/T/mri-52ab912be8f94df4/axial_036.png","assets/T/mri-52ab912be8f94df4/axial_037.png","assets/T/mri-52ab912be8f94df4/axial_038.png","assets/T/mri-52ab912be8f94df4/axial_039.png","assets/T/mri-52ab912be8f94df4/axial_040.png","assets/T/mri-52ab912be8f94df4/axial_041.png","assets/T/mri-52ab912be8f94df4/axial_042.png","assets/T/mri-52ab912be8f94df4/coronal_001.png","assets/T/mri-52ab912be8f94df4/coronal_002.png","assets/T/mri-52ab912be8f94df4/coronal_003.png","assets/T/mri-52ab912be8f94df4/coronal_004.png","assets/T/mri-52ab912be8f94df4/coronal_005.png","assets/T/mri-52ab912be8f94df4/coronal_006.png","assets/T/mri-52ab912be8f94df4/coronal_007.png","assets/T/mri-52ab912be8f94df4/coronal_008.png","assets/T/mri-52ab912be8f94df4/coronal_009.png","assets/T/mri-52ab912be8f94df4/coronal_010.png","assets/T/mri-52ab912be8f94df4/coronal_011.png","assets/T/mri-52ab912be8f94df4/coronal_012.png","assets/T/mri-52ab912be8f94df4/coronal_013.png","assets/T/mri-52ab912be8f94df4/coronal_014.png","assets/T/mri-52ab912be8f94df4/coronal_015.png","assets/T/mri-52ab912be8f94df4/coronal_016.png","assets/T/mri-52ab912be8f94df4/coronal_017.png","assets/T/mri-52ab912be8f94df4/coronal_018.png","assets/T/mri-52ab912be8f94df4/coronal_019.png","assets/T/mri-52ab912be8f94df4/coronal_020.png","assets/T/mri-52ab912be8f94df4/coronal_021.png","assets/T/mri-52ab912be8f94df4/coronal_022.png","assets/T/mri-52ab912be8f94df4/coronal_023.png","assets/T/mri-52ab912be8f94df4/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-ccaecc2dd6674b4c","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 60 张图，均来自同一次检查。\n\n- 前 36 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-ccaecc2dd6674b4c/axial_001.png","assets/T/mri-ccaecc2dd6674b4c/axial_002.png","assets/T/mri-ccaecc2dd6674b4c/axial_003.png","assets/T/mri-ccaecc2dd6674b4c/axial_004.png","assets/T/mri-ccaecc2dd6674b4c/axial_005.png","assets/T/mri-ccaecc2dd6674b4c/axial_006.png","assets/T/mri-ccaecc2dd6674b4c/axial_007.png","assets/T/mri-ccaecc2dd6674b4c/axial_008.png","assets/T/mri-ccaecc2dd6674b4c/axial_009.png","assets/T/mri-ccaecc2dd6674b4c/axial_010.png","assets/T/mri-ccaecc2dd6674b4c/axial_011.png","assets/T/mri-ccaecc2dd6674b4c/axial_012.png","assets/T/mri-ccaecc2dd6674b4c/axial_013.png","assets/T/mri-ccaecc2dd6674b4c/axial_014.png","assets/T/mri-ccaecc2dd6674b4c/axial_015.png","assets/T/mri-ccaecc2dd6674b4c/axial_016.png","assets/T/mri-ccaecc2dd6674b4c/axial_017.png","assets/T/mri-ccaecc2dd6674b4c/axial_018.png","assets/T/mri-ccaecc2dd6674b4c/axial_019.png","assets/T/mri-ccaecc2dd6674b4c/axial_020.png","assets/T/mri-ccaecc2dd6674b4c/axial_021.png","assets/T/mri-ccaecc2dd6674b4c/axial_022.png","assets/T/mri-ccaecc2dd6674b4c/axial_023.png","assets/T/mri-ccaecc2dd6674b4c/axial_024.png","assets/T/mri-ccaecc2dd6674b4c/axial_025.png","assets/T/mri-ccaecc2dd6674b4c/axial_026.png","assets/T/mri-ccaecc2dd6674b4c/axial_027.png","assets/T/mri-ccaecc2dd6674b4c/axial_028.png","assets/T/mri-ccaecc2dd6674b4c/axial_029.png","assets/T/mri-ccaecc2dd6674b4c/axial_030.png","assets/T/mri-ccaecc2dd6674b4c/axial_031.png","assets/T/mri-ccaecc2dd6674b4c/axial_032.png","assets/T/mri-ccaecc2dd6674b4c/axial_033.png","assets/T/mri-ccaecc2dd6674b4c/axial_034.png","assets/T/mri-ccaecc2dd6674b4c/axial_035.png","assets/T/mri-ccaecc2dd6674b4c/axial_036.png","assets/T/mri-ccaecc2dd6674b4c/coronal_001.png","assets/T/mri-ccaecc2dd6674b4c/coronal_002.png","assets/T/mri-ccaecc2dd6674b4c/coronal_003.png","assets/T/mri-ccaecc2dd6674b4c/coronal_004.png","assets/T/mri-ccaecc2dd6674b4c/coronal_005.png","assets/T/mri-ccaecc2dd6674b4c/coronal_006.png","assets/T/mri-ccaecc2dd6674b4c/coronal_007.png","assets/T/mri-ccaecc2dd6674b4c/coronal_008.png","assets/T/mri-ccaecc2dd6674b4c/coronal_009.png","assets/T/mri-ccaecc2dd6674b4c/coronal_010.png","assets/T/mri-ccaecc2dd6674b4c/coronal_011.png","assets/T/mri-ccaecc2dd6674b4c/coronal_012.png","assets/T/mri-ccaecc2dd6674b4c/coronal_013.png","assets/T/mri-ccaecc2dd6674b4c/coronal_014.png","assets/T/mri-ccaecc2dd6674b4c/coronal_015.png","assets/T/mri-ccaecc2dd6674b4c/coronal_016.png","assets/T/mri-ccaecc2dd6674b4c/coronal_017.png","assets/T/mri-ccaecc2dd6674b4c/coronal_018.png","assets/T/mri-ccaecc2dd6674b4c/coronal_019.png","assets/T/mri-ccaecc2dd6674b4c/coronal_020.png","assets/T/mri-ccaecc2dd6674b4c/coronal_021.png","assets/T/mri-ccaecc2dd6674b4c/coronal_022.png","assets/T/mri-ccaecc2dd6674b4c/coronal_023.png","assets/T/mri-ccaecc2dd6674b4c/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-20452f5fb9304914","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-20452f5fb9304914/axial_001.png","assets/T/mri-20452f5fb9304914/axial_002.png","assets/T/mri-20452f5fb9304914/axial_003.png","assets/T/mri-20452f5fb9304914/axial_004.png","assets/T/mri-20452f5fb9304914/axial_005.png","assets/T/mri-20452f5fb9304914/axial_006.png","assets/T/mri-20452f5fb9304914/axial_007.png","assets/T/mri-20452f5fb9304914/axial_008.png","assets/T/mri-20452f5fb9304914/axial_009.png","assets/T/mri-20452f5fb9304914/axial_010.png","assets/T/mri-20452f5fb9304914/axial_011.png","assets/T/mri-20452f5fb9304914/axial_012.png","assets/T/mri-20452f5fb9304914/axial_013.png","assets/T/mri-20452f5fb9304914/axial_014.png","assets/T/mri-20452f5fb9304914/axial_015.png","assets/T/mri-20452f5fb9304914/axial_016.png","assets/T/mri-20452f5fb9304914/axial_017.png","assets/T/mri-20452f5fb9304914/axial_018.png","assets/T/mri-20452f5fb9304914/axial_019.png","assets/T/mri-20452f5fb9304914/axial_020.png","assets/T/mri-20452f5fb9304914/axial_021.png","assets/T/mri-20452f5fb9304914/axial_022.png","assets/T/mri-20452f5fb9304914/axial_023.png","assets/T/mri-20452f5fb9304914/axial_024.png","assets/T/mri-20452f5fb9304914/axial_025.png","assets/T/mri-20452f5fb9304914/axial_026.png","assets/T/mri-20452f5fb9304914/axial_027.png","assets/T/mri-20452f5fb9304914/axial_028.png","assets/T/mri-20452f5fb9304914/axial_029.png","assets/T/mri-20452f5fb9304914/axial_030.png","assets/T/mri-20452f5fb9304914/axial_031.png","assets/T/mri-20452f5fb9304914/axial_032.png","assets/T/mri-20452f5fb9304914/axial_033.png","assets/T/mri-20452f5fb9304914/axial_034.png","assets/T/mri-20452f5fb9304914/axial_035.png","assets/T/mri-20452f5fb9304914/axial_036.png","assets/T/mri-20452f5fb9304914/axial_037.png","assets/T/mri-20452f5fb9304914/axial_038.png","assets/T/mri-20452f5fb9304914/axial_039.png","assets/T/mri-20452f5fb9304914/axial_040.png","assets/T/mri-20452f5fb9304914/axial_041.png","assets/T/mri-20452f5fb9304914/axial_042.png","assets/T/mri-20452f5fb9304914/coronal_001.png","assets/T/mri-20452f5fb9304914/coronal_002.png","assets/T/mri-20452f5fb9304914/coronal_003.png","assets/T/mri-20452f5fb9304914/coronal_004.png","assets/T/mri-20452f5fb9304914/coronal_005.png","assets/T/mri-20452f5fb9304914/coronal_006.png","assets/T/mri-20452f5fb9304914/coronal_007.png","assets/T/mri-20452f5fb9304914/coronal_008.png","assets/T/mri-20452f5fb9304914/coronal_009.png","assets/T/mri-20452f5fb9304914/coronal_010.png","assets/T/mri-20452f5fb9304914/coronal_011.png","assets/T/mri-20452f5fb9304914/coronal_012.png","assets/T/mri-20452f5fb9304914/coronal_013.png","assets/T/mri-20452f5fb9304914/coronal_014.png","assets/T/mri-20452f5fb9304914/coronal_015.png","assets/T/mri-20452f5fb9304914/coronal_016.png","assets/T/mri-20452f5fb9304914/coronal_017.png","assets/T/mri-20452f5fb9304914/coronal_018.png","assets/T/mri-20452f5fb9304914/coronal_019.png","assets/T/mri-20452f5fb9304914/coronal_020.png","assets/T/mri-20452f5fb9304914/coronal_021.png","assets/T/mri-20452f5fb9304914/coronal_022.png","assets/T/mri-20452f5fb9304914/coronal_023.png","assets/T/mri-20452f5fb9304914/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-9bc82b4fc3564f98","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-9bc82b4fc3564f98/axial_001.png","assets/T/mri-9bc82b4fc3564f98/axial_002.png","assets/T/mri-9bc82b4fc3564f98/axial_003.png","assets/T/mri-9bc82b4fc3564f98/axial_004.png","assets/T/mri-9bc82b4fc3564f98/axial_005.png","assets/T/mri-9bc82b4fc3564f98/axial_006.png","assets/T/mri-9bc82b4fc3564f98/axial_007.png","assets/T/mri-9bc82b4fc3564f98/axial_008.png","assets/T/mri-9bc82b4fc3564f98/axial_009.png","assets/T/mri-9bc82b4fc3564f98/axial_010.png","assets/T/mri-9bc82b4fc3564f98/axial_011.png","assets/T/mri-9bc82b4fc3564f98/axial_012.png","assets/T/mri-9bc82b4fc3564f98/axial_013.png","assets/T/mri-9bc82b4fc3564f98/axial_014.png","assets/T/mri-9bc82b4fc3564f98/axial_015.png","assets/T/mri-9bc82b4fc3564f98/axial_016.png","assets/T/mri-9bc82b4fc3564f98/axial_017.png","assets/T/mri-9bc82b4fc3564f98/axial_018.png","assets/T/mri-9bc82b4fc3564f98/axial_019.png","assets/T/mri-9bc82b4fc3564f98/axial_020.png","assets/T/mri-9bc82b4fc3564f98/axial_021.png","assets/T/mri-9bc82b4fc3564f98/axial_022.png","assets/T/mri-9bc82b4fc3564f98/axial_023.png","assets/T/mri-9bc82b4fc3564f98/axial_024.png","assets/T/mri-9bc82b4fc3564f98/axial_025.png","assets/T/mri-9bc82b4fc3564f98/axial_026.png","assets/T/mri-9bc82b4fc3564f98/axial_027.png","assets/T/mri-9bc82b4fc3564f98/axial_028.png","assets/T/mri-9bc82b4fc3564f98/axial_029.png","assets/T/mri-9bc82b4fc3564f98/axial_030.png","assets/T/mri-9bc82b4fc3564f98/axial_031.png","assets/T/mri-9bc82b4fc3564f98/axial_032.png","assets/T/mri-9bc82b4fc3564f98/axial_033.png","assets/T/mri-9bc82b4fc3564f98/axial_034.png","assets/T/mri-9bc82b4fc3564f98/axial_035.png","assets/T/mri-9bc82b4fc3564f98/axial_036.png","assets/T/mri-9bc82b4fc3564f98/axial_037.png","assets/T/mri-9bc82b4fc3564f98/axial_038.png","assets/T/mri-9bc82b4fc3564f98/axial_039.png","assets/T/mri-9bc82b4fc3564f98/axial_040.png","assets/T/mri-9bc82b4fc3564f98/axial_041.png","assets/T/mri-9bc82b4fc3564f98/axial_042.png","assets/T/mri-9bc82b4fc3564f98/coronal_001.png","assets/T/mri-9bc82b4fc3564f98/coronal_002.png","assets/T/mri-9bc82b4fc3564f98/coronal_003.png","assets/T/mri-9bc82b4fc3564f98/coronal_004.png","assets/T/mri-9bc82b4fc3564f98/coronal_005.png","assets/T/mri-9bc82b4fc3564f98/coronal_006.png","assets/T/mri-9bc82b4fc3564f98/coronal_007.png","assets/T/mri-9bc82b4fc3564f98/coronal_008.png","assets/T/mri-9bc82b4fc3564f98/coronal_009.png","assets/T/mri-9bc82b4fc3564f98/coronal_010.png","assets/T/mri-9bc82b4fc3564f98/coronal_011.png","assets/T/mri-9bc82b4fc3564f98/coronal_012.png","assets/T/mri-9bc82b4fc3564f98/coronal_013.png","assets/T/mri-9bc82b4fc3564f98/coronal_014.png","assets/T/mri-9bc82b4fc3564f98/coronal_015.png","assets/T/mri-9bc82b4fc3564f98/coronal_016.png","assets/T/mri-9bc82b4fc3564f98/coronal_017.png","assets/T/mri-9bc82b4fc3564f98/coronal_018.png","assets/T/mri-9bc82b4fc3564f98/coronal_019.png","assets/T/mri-9bc82b4fc3564f98/coronal_020.png","assets/T/mri-9bc82b4fc3564f98/coronal_021.png","assets/T/mri-9bc82b4fc3564f98/coronal_022.png","assets/T/mri-9bc82b4fc3564f98/coronal_023.png","assets/T/mri-9bc82b4fc3564f98/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-e7ca4067ba764e60","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-e7ca4067ba764e60/axial_001.png","assets/T/mri-e7ca4067ba764e60/axial_002.png","assets/T/mri-e7ca4067ba764e60/axial_003.png","assets/T/mri-e7ca4067ba764e60/axial_004.png","assets/T/mri-e7ca4067ba764e60/axial_005.png","assets/T/mri-e7ca4067ba764e60/axial_006.png","assets/T/mri-e7ca4067ba764e60/axial_007.png","assets/T/mri-e7ca4067ba764e60/axial_008.png","assets/T/mri-e7ca4067ba764e60/axial_009.png","assets/T/mri-e7ca4067ba764e60/axial_010.png","assets/T/mri-e7ca4067ba764e60/axial_011.png","assets/T/mri-e7ca4067ba764e60/axial_012.png","assets/T/mri-e7ca4067ba764e60/axial_013.png","assets/T/mri-e7ca4067ba764e60/axial_014.png","assets/T/mri-e7ca4067ba764e60/axial_015.png","assets/T/mri-e7ca4067ba764e60/axial_016.png","assets/T/mri-e7ca4067ba764e60/axial_017.png","assets/T/mri-e7ca4067ba764e60/axial_018.png","assets/T/mri-e7ca4067ba764e60/axial_019.png","assets/T/mri-e7ca4067ba764e60/axial_020.png","assets/T/mri-e7ca4067ba764e60/axial_021.png","assets/T/mri-e7ca4067ba764e60/axial_022.png","assets/T/mri-e7ca4067ba764e60/axial_023.png","assets/T/mri-e7ca4067ba764e60/axial_024.png","assets/T/mri-e7ca4067ba764e60/axial_025.png","assets/T/mri-e7ca4067ba764e60/axial_026.png","assets/T/mri-e7ca4067ba764e60/axial_027.png","assets/T/mri-e7ca4067ba764e60/axial_028.png","assets/T/mri-e7ca4067ba764e60/axial_029.png","assets/T/mri-e7ca4067ba764e60/axial_030.png","assets/T/mri-e7ca4067ba764e60/axial_031.png","assets/T/mri-e7ca4067ba764e60/axial_032.png","assets/T/mri-e7ca4067ba764e60/axial_033.png","assets/T/mri-e7ca4067ba764e60/axial_034.png","assets/T/mri-e7ca4067ba764e60/axial_035.png","assets/T/mri-e7ca4067ba764e60/axial_036.png","assets/T/mri-e7ca4067ba764e60/axial_037.png","assets/T/mri-e7ca4067ba764e60/axial_038.png","assets/T/mri-e7ca4067ba764e60/axial_039.png","assets/T/mri-e7ca4067ba764e60/axial_040.png","assets/T/mri-e7ca4067ba764e60/coronal_001.png","assets/T/mri-e7ca4067ba764e60/coronal_002.png","assets/T/mri-e7ca4067ba764e60/coronal_003.png","assets/T/mri-e7ca4067ba764e60/coronal_004.png","assets/T/mri-e7ca4067ba764e60/coronal_005.png","assets/T/mri-e7ca4067ba764e60/coronal_006.png","assets/T/mri-e7ca4067ba764e60/coronal_007.png","assets/T/mri-e7ca4067ba764e60/coronal_008.png","assets/T/mri-e7ca4067ba764e60/coronal_009.png","assets/T/mri-e7ca4067ba764e60/coronal_010.png","assets/T/mri-e7ca4067ba764e60/coronal_011.png","assets/T/mri-e7ca4067ba764e60/coronal_012.png","assets/T/mri-e7ca4067ba764e60/coronal_013.png","assets/T/mri-e7ca4067ba764e60/coronal_014.png","assets/T/mri-e7ca4067ba764e60/coronal_015.png","assets/T/mri-e7ca4067ba764e60/coronal_016.png","assets/T/mri-e7ca4067ba764e60/coronal_017.png","assets/T/mri-e7ca4067ba764e60/coronal_018.png","assets/T/mri-e7ca4067ba764e60/coronal_019.png","assets/T/mri-e7ca4067ba764e60/coronal_020.png","assets/T/mri-e7ca4067ba764e60/coronal_021.png","assets/T/mri-e7ca4067ba764e60/coronal_022.png","assets/T/mri-e7ca4067ba764e60/coronal_023.png","assets/T/mri-e7ca4067ba764e60/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-ca6c28608dc74151","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-ca6c28608dc74151/axial_001.png","assets/T/mri-ca6c28608dc74151/axial_002.png","assets/T/mri-ca6c28608dc74151/axial_003.png","assets/T/mri-ca6c28608dc74151/axial_004.png","assets/T/mri-ca6c28608dc74151/axial_005.png","assets/T/mri-ca6c28608dc74151/axial_006.png","assets/T/mri-ca6c28608dc74151/axial_007.png","assets/T/mri-ca6c28608dc74151/axial_008.png","assets/T/mri-ca6c28608dc74151/axial_009.png","assets/T/mri-ca6c28608dc74151/axial_010.png","assets/T/mri-ca6c28608dc74151/axial_011.png","assets/T/mri-ca6c28608dc74151/axial_012.png","assets/T/mri-ca6c28608dc74151/axial_013.png","assets/T/mri-ca6c28608dc74151/axial_014.png","assets/T/mri-ca6c28608dc74151/axial_015.png","assets/T/mri-ca6c28608dc74151/axial_016.png","assets/T/mri-ca6c28608dc74151/axial_017.png","assets/T/mri-ca6c28608dc74151/axial_018.png","assets/T/mri-ca6c28608dc74151/axial_019.png","assets/T/mri-ca6c28608dc74151/axial_020.png","assets/T/mri-ca6c28608dc74151/axial_021.png","assets/T/mri-ca6c28608dc74151/axial_022.png","assets/T/mri-ca6c28608dc74151/axial_023.png","assets/T/mri-ca6c28608dc74151/axial_024.png","assets/T/mri-ca6c28608dc74151/axial_025.png","assets/T/mri-ca6c28608dc74151/axial_026.png","assets/T/mri-ca6c28608dc74151/axial_027.png","assets/T/mri-ca6c28608dc74151/axial_028.png","assets/T/mri-ca6c28608dc74151/axial_029.png","assets/T/mri-ca6c28608dc74151/axial_030.png","assets/T/mri-ca6c28608dc74151/axial_031.png","assets/T/mri-ca6c28608dc74151/axial_032.png","assets/T/mri-ca6c28608dc74151/axial_033.png","assets/T/mri-ca6c28608dc74151/axial_034.png","assets/T/mri-ca6c28608dc74151/axial_035.png","assets/T/mri-ca6c28608dc74151/axial_036.png","assets/T/mri-ca6c28608dc74151/axial_037.png","assets/T/mri-ca6c28608dc74151/axial_038.png","assets/T/mri-ca6c28608dc74151/axial_039.png","assets/T/mri-ca6c28608dc74151/axial_040.png","assets/T/mri-ca6c28608dc74151/axial_041.png","assets/T/mri-ca6c28608dc74151/axial_042.png","assets/T/mri-ca6c28608dc74151/coronal_001.png","assets/T/mri-ca6c28608dc74151/coronal_002.png","assets/T/mri-ca6c28608dc74151/coronal_003.png","assets/T/mri-ca6c28608dc74151/coronal_004.png","assets/T/mri-ca6c28608dc74151/coronal_005.png","assets/T/mri-ca6c28608dc74151/coronal_006.png","assets/T/mri-ca6c28608dc74151/coronal_007.png","assets/T/mri-ca6c28608dc74151/coronal_008.png","assets/T/mri-ca6c28608dc74151/coronal_009.png","assets/T/mri-ca6c28608dc74151/coronal_010.png","assets/T/mri-ca6c28608dc74151/coronal_011.png","assets/T/mri-ca6c28608dc74151/coronal_012.png","assets/T/mri-ca6c28608dc74151/coronal_013.png","assets/T/mri-ca6c28608dc74151/coronal_014.png","assets/T/mri-ca6c28608dc74151/coronal_015.png","assets/T/mri-ca6c28608dc74151/coronal_016.png","assets/T/mri-ca6c28608dc74151/coronal_017.png","assets/T/mri-ca6c28608dc74151/coronal_018.png","assets/T/mri-ca6c28608dc74151/coronal_019.png","assets/T/mri-ca6c28608dc74151/coronal_020.png","assets/T/mri-ca6c28608dc74151/coronal_021.png","assets/T/mri-ca6c28608dc74151/coronal_022.png","assets/T/mri-ca6c28608dc74151/coronal_023.png","assets/T/mri-ca6c28608dc74151/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-2cda076179fb48e3","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-2cda076179fb48e3/axial_001.png","assets/T/mri-2cda076179fb48e3/axial_002.png","assets/T/mri-2cda076179fb48e3/axial_003.png","assets/T/mri-2cda076179fb48e3/axial_004.png","assets/T/mri-2cda076179fb48e3/axial_005.png","assets/T/mri-2cda076179fb48e3/axial_006.png","assets/T/mri-2cda076179fb48e3/axial_007.png","assets/T/mri-2cda076179fb48e3/axial_008.png","assets/T/mri-2cda076179fb48e3/axial_009.png","assets/T/mri-2cda076179fb48e3/axial_010.png","assets/T/mri-2cda076179fb48e3/axial_011.png","assets/T/mri-2cda076179fb48e3/axial_012.png","assets/T/mri-2cda076179fb48e3/axial_013.png","assets/T/mri-2cda076179fb48e3/axial_014.png","assets/T/mri-2cda076179fb48e3/axial_015.png","assets/T/mri-2cda076179fb48e3/axial_016.png","assets/T/mri-2cda076179fb48e3/axial_017.png","assets/T/mri-2cda076179fb48e3/axial_018.png","assets/T/mri-2cda076179fb48e3/axial_019.png","assets/T/mri-2cda076179fb48e3/axial_020.png","assets/T/mri-2cda076179fb48e3/axial_021.png","assets/T/mri-2cda076179fb48e3/axial_022.png","assets/T/mri-2cda076179fb48e3/axial_023.png","assets/T/mri-2cda076179fb48e3/axial_024.png","assets/T/mri-2cda076179fb48e3/axial_025.png","assets/T/mri-2cda076179fb48e3/axial_026.png","assets/T/mri-2cda076179fb48e3/axial_027.png","assets/T/mri-2cda076179fb48e3/axial_028.png","assets/T/mri-2cda076179fb48e3/axial_029.png","assets/T/mri-2cda076179fb48e3/axial_030.png","assets/T/mri-2cda076179fb48e3/axial_031.png","assets/T/mri-2cda076179fb48e3/axial_032.png","assets/T/mri-2cda076179fb48e3/axial_033.png","assets/T/mri-2cda076179fb48e3/axial_034.png","assets/T/mri-2cda076179fb48e3/axial_035.png","assets/T/mri-2cda076179fb48e3/axial_036.png","assets/T/mri-2cda076179fb48e3/axial_037.png","assets/T/mri-2cda076179fb48e3/axial_038.png","assets/T/mri-2cda076179fb48e3/axial_039.png","assets/T/mri-2cda076179fb48e3/axial_040.png","assets/T/mri-2cda076179fb48e3/axial_041.png","assets/T/mri-2cda076179fb48e3/axial_042.png","assets/T/mri-2cda076179fb48e3/coronal_001.png","assets/T/mri-2cda076179fb48e3/coronal_002.png","assets/T/mri-2cda076179fb48e3/coronal_003.png","assets/T/mri-2cda076179fb48e3/coronal_004.png","assets/T/mri-2cda076179fb48e3/coronal_005.png","assets/T/mri-2cda076179fb48e3/coronal_006.png","assets/T/mri-2cda076179fb48e3/coronal_007.png","assets/T/mri-2cda076179fb48e3/coronal_008.png","assets/T/mri-2cda076179fb48e3/coronal_009.png","assets/T/mri-2cda076179fb48e3/coronal_010.png","assets/T/mri-2cda076179fb48e3/coronal_011.png","assets/T/mri-2cda076179fb48e3/coronal_012.png","assets/T/mri-2cda076179fb48e3/coronal_013.png","assets/T/mri-2cda076179fb48e3/coronal_014.png","assets/T/mri-2cda076179fb48e3/coronal_015.png","assets/T/mri-2cda076179fb48e3/coronal_016.png","assets/T/mri-2cda076179fb48e3/coronal_017.png","assets/T/mri-2cda076179fb48e3/coronal_018.png","assets/T/mri-2cda076179fb48e3/coronal_019.png","assets/T/mri-2cda076179fb48e3/coronal_020.png","assets/T/mri-2cda076179fb48e3/coronal_021.png","assets/T/mri-2cda076179fb48e3/coronal_022.png","assets/T/mri-2cda076179fb48e3/coronal_023.png","assets/T/mri-2cda076179fb48e3/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-bbcf4ba5ac804eee","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 68 张图，均来自同一次检查。\n\n- 前 44 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-bbcf4ba5ac804eee/axial_001.png","assets/T/mri-bbcf4ba5ac804eee/axial_002.png","assets/T/mri-bbcf4ba5ac804eee/axial_003.png","assets/T/mri-bbcf4ba5ac804eee/axial_004.png","assets/T/mri-bbcf4ba5ac804eee/axial_005.png","assets/T/mri-bbcf4ba5ac804eee/axial_006.png","assets/T/mri-bbcf4ba5ac804eee/axial_007.png","assets/T/mri-bbcf4ba5ac804eee/axial_008.png","assets/T/mri-bbcf4ba5ac804eee/axial_009.png","assets/T/mri-bbcf4ba5ac804eee/axial_010.png","assets/T/mri-bbcf4ba5ac804eee/axial_011.png","assets/T/mri-bbcf4ba5ac804eee/axial_012.png","assets/T/mri-bbcf4ba5ac804eee/axial_013.png","assets/T/mri-bbcf4ba5ac804eee/axial_014.png","assets/T/mri-bbcf4ba5ac804eee/axial_015.png","assets/T/mri-bbcf4ba5ac804eee/axial_016.png","assets/T/mri-bbcf4ba5ac804eee/axial_017.png","assets/T/mri-bbcf4ba5ac804eee/axial_018.png","assets/T/mri-bbcf4ba5ac804eee/axial_019.png","assets/T/mri-bbcf4ba5ac804eee/axial_020.png","assets/T/mri-bbcf4ba5ac804eee/axial_021.png","assets/T/mri-bbcf4ba5ac804eee/axial_022.png","assets/T/mri-bbcf4ba5ac804eee/axial_023.png","assets/T/mri-bbcf4ba5ac804eee/axial_024.png","assets/T/mri-bbcf4ba5ac804eee/axial_025.png","assets/T/mri-bbcf4ba5ac804eee/axial_026.png","assets/T/mri-bbcf4ba5ac804eee/axial_027.png","assets/T/mri-bbcf4ba5ac804eee/axial_028.png","assets/T/mri-bbcf4ba5ac804eee/axial_029.png","assets/T/mri-bbcf4ba5ac804eee/axial_030.png","assets/T/mri-bbcf4ba5ac804eee/axial_031.png","assets/T/mri-bbcf4ba5ac804eee/axial_032.png","assets/T/mri-bbcf4ba5ac804eee/axial_033.png","assets/T/mri-bbcf4ba5ac804eee/axial_034.png","assets/T/mri-bbcf4ba5ac804eee/axial_035.png","assets/T/mri-bbcf4ba5ac804eee/axial_036.png","assets/T/mri-bbcf4ba5ac804eee/axial_037.png","assets/T/mri-bbcf4ba5ac804eee/axial_038.png","assets/T/mri-bbcf4ba5ac804eee/axial_039.png","assets/T/mri-bbcf4ba5ac804eee/axial_040.png","assets/T/mri-bbcf4ba5ac804eee/axial_041.png","assets/T/mri-bbcf4ba5ac804eee/axial_042.png","assets/T/mri-bbcf4ba5ac804eee/axial_043.png","assets/T/mri-bbcf4ba5ac804eee/axial_044.png","assets/T/mri-bbcf4ba5ac804eee/coronal_001.png","assets/T/mri-bbcf4ba5ac804eee/coronal_002.png","assets/T/mri-bbcf4ba5ac804eee/coronal_003.png","assets/T/mri-bbcf4ba5ac804eee/coronal_004.png","assets/T/mri-bbcf4ba5ac804eee/coronal_005.png","assets/T/mri-bbcf4ba5ac804eee/coronal_006.png","assets/T/mri-bbcf4ba5ac804eee/coronal_007.png","assets/T/mri-bbcf4ba5ac804eee/coronal_008.png","assets/T/mri-bbcf4ba5ac804eee/coronal_009.png","assets/T/mri-bbcf4ba5ac804eee/coronal_010.png","assets/T/mri-bbcf4ba5ac804eee/coronal_011.png","assets/T/mri-bbcf4ba5ac804eee/coronal_012.png","assets/T/mri-bbcf4ba5ac804eee/coronal_013.png","assets/T/mri-bbcf4ba5ac804eee/coronal_014.png","assets/T/mri-bbcf4ba5ac804eee/coronal_015.png","assets/T/mri-bbcf4ba5ac804eee/coronal_016.png","assets/T/mri-bbcf4ba5ac804eee/coronal_017.png","assets/T/mri-bbcf4ba5ac804eee/coronal_018.png","assets/T/mri-bbcf4ba5ac804eee/coronal_019.png","assets/T/mri-bbcf4ba5ac804eee/coronal_020.png","assets/T/mri-bbcf4ba5ac804eee/coronal_021.png","assets/T/mri-bbcf4ba5ac804eee/coronal_022.png","assets/T/mri-bbcf4ba5ac804eee/coronal_023.png","assets/T/mri-bbcf4ba5ac804eee/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-b0306ff4925b498a","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 68 张图，均来自同一次检查。\n\n- 前 44 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-b0306ff4925b498a/axial_001.png","assets/T/mri-b0306ff4925b498a/axial_002.png","assets/T/mri-b0306ff4925b498a/axial_003.png","assets/T/mri-b0306ff4925b498a/axial_004.png","assets/T/mri-b0306ff4925b498a/axial_005.png","assets/T/mri-b0306ff4925b498a/axial_006.png","assets/T/mri-b0306ff4925b498a/axial_007.png","assets/T/mri-b0306ff4925b498a/axial_008.png","assets/T/mri-b0306ff4925b498a/axial_009.png","assets/T/mri-b0306ff4925b498a/axial_010.png","assets/T/mri-b0306ff4925b498a/axial_011.png","assets/T/mri-b0306ff4925b498a/axial_012.png","assets/T/mri-b0306ff4925b498a/axial_013.png","assets/T/mri-b0306ff4925b498a/axial_014.png","assets/T/mri-b0306ff4925b498a/axial_015.png","assets/T/mri-b0306ff4925b498a/axial_016.png","assets/T/mri-b0306ff4925b498a/axial_017.png","assets/T/mri-b0306ff4925b498a/axial_018.png","assets/T/mri-b0306ff4925b498a/axial_019.png","assets/T/mri-b0306ff4925b498a/axial_020.png","assets/T/mri-b0306ff4925b498a/axial_021.png","assets/T/mri-b0306ff4925b498a/axial_022.png","assets/T/mri-b0306ff4925b498a/axial_023.png","assets/T/mri-b0306ff4925b498a/axial_024.png","assets/T/mri-b0306ff4925b498a/axial_025.png","assets/T/mri-b0306ff4925b498a/axial_026.png","assets/T/mri-b0306ff4925b498a/axial_027.png","assets/T/mri-b0306ff4925b498a/axial_028.png","assets/T/mri-b0306ff4925b498a/axial_029.png","assets/T/mri-b0306ff4925b498a/axial_030.png","assets/T/mri-b0306ff4925b498a/axial_031.png","assets/T/mri-b0306ff4925b498a/axial_032.png","assets/T/mri-b0306ff4925b498a/axial_033.png","assets/T/mri-b0306ff4925b498a/axial_034.png","assets/T/mri-b0306ff4925b498a/axial_035.png","assets/T/mri-b0306ff4925b498a/axial_036.png","assets/T/mri-b0306ff4925b498a/axial_037.png","assets/T/mri-b0306ff4925b498a/axial_038.png","assets/T/mri-b0306ff4925b498a/axial_039.png","assets/T/mri-b0306ff4925b498a/axial_040.png","assets/T/mri-b0306ff4925b498a/axial_041.png","assets/T/mri-b0306ff4925b498a/axial_042.png","assets/T/mri-b0306ff4925b498a/axial_043.png","assets/T/mri-b0306ff4925b498a/axial_044.png","assets/T/mri-b0306ff4925b498a/coronal_001.png","assets/T/mri-b0306ff4925b498a/coronal_002.png","assets/T/mri-b0306ff4925b498a/coronal_003.png","assets/T/mri-b0306ff4925b498a/coronal_004.png","assets/T/mri-b0306ff4925b498a/coronal_005.png","assets/T/mri-b0306ff4925b498a/coronal_006.png","assets/T/mri-b0306ff4925b498a/coronal_007.png","assets/T/mri-b0306ff4925b498a/coronal_008.png","assets/T/mri-b0306ff4925b498a/coronal_009.png","assets/T/mri-b0306ff4925b498a/coronal_010.png","assets/T/mri-b0306ff4925b498a/coronal_011.png","assets/T/mri-b0306ff4925b498a/coronal_012.png","assets/T/mri-b0306ff4925b498a/coronal_013.png","assets/T/mri-b0306ff4925b498a/coronal_014.png","assets/T/mri-b0306ff4925b498a/coronal_015.png","assets/T/mri-b0306ff4925b498a/coronal_016.png","assets/T/mri-b0306ff4925b498a/coronal_017.png","assets/T/mri-b0306ff4925b498a/coronal_018.png","assets/T/mri-b0306ff4925b498a/coronal_019.png","assets/T/mri-b0306ff4925b498a/coronal_020.png","assets/T/mri-b0306ff4925b498a/coronal_021.png","assets/T/mri-b0306ff4925b498a/coronal_022.png","assets/T/mri-b0306ff4925b498a/coronal_023.png","assets/T/mri-b0306ff4925b498a/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-8369bc80cc524c36","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 60 张图，均来自同一次检查。\n\n- 前 36 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-8369bc80cc524c36/axial_001.png","assets/T/mri-8369bc80cc524c36/axial_002.png","assets/T/mri-8369bc80cc524c36/axial_003.png","assets/T/mri-8369bc80cc524c36/axial_004.png","assets/T/mri-8369bc80cc524c36/axial_005.png","assets/T/mri-8369bc80cc524c36/axial_006.png","assets/T/mri-8369bc80cc524c36/axial_007.png","assets/T/mri-8369bc80cc524c36/axial_008.png","assets/T/mri-8369bc80cc524c36/axial_009.png","assets/T/mri-8369bc80cc524c36/axial_010.png","assets/T/mri-8369bc80cc524c36/axial_011.png","assets/T/mri-8369bc80cc524c36/axial_012.png","assets/T/mri-8369bc80cc524c36/axial_013.png","assets/T/mri-8369bc80cc524c36/axial_014.png","assets/T/mri-8369bc80cc524c36/axial_015.png","assets/T/mri-8369bc80cc524c36/axial_016.png","assets/T/mri-8369bc80cc524c36/axial_017.png","assets/T/mri-8369bc80cc524c36/axial_018.png","assets/T/mri-8369bc80cc524c36/axial_019.png","assets/T/mri-8369bc80cc524c36/axial_020.png","assets/T/mri-8369bc80cc524c36/axial_021.png","assets/T/mri-8369bc80cc524c36/axial_022.png","assets/T/mri-8369bc80cc524c36/axial_023.png","assets/T/mri-8369bc80cc524c36/axial_024.png","assets/T/mri-8369bc80cc524c36/axial_025.png","assets/T/mri-8369bc80cc524c36/axial_026.png","assets/T/mri-8369bc80cc524c36/axial_027.png","assets/T/mri-8369bc80cc524c36/axial_028.png","assets/T/mri-8369bc80cc524c36/axial_029.png","assets/T/mri-8369bc80cc524c36/axial_030.png","assets/T/mri-8369bc80cc524c36/axial_031.png","assets/T/mri-8369bc80cc524c36/axial_032.png","assets/T/mri-8369bc80cc524c36/axial_033.png","assets/T/mri-8369bc80cc524c36/axial_034.png","assets/T/mri-8369bc80cc524c36/axial_035.png","assets/T/mri-8369bc80cc524c36/axial_036.png","assets/T/mri-8369bc80cc524c36/coronal_001.png","assets/T/mri-8369bc80cc524c36/coronal_002.png","assets/T/mri-8369bc80cc524c36/coronal_003.png","assets/T/mri-8369bc80cc524c36/coronal_004.png","assets/T/mri-8369bc80cc524c36/coronal_005.png","assets/T/mri-8369bc80cc524c36/coronal_006.png","assets/T/mri-8369bc80cc524c36/coronal_007.png","assets/T/mri-8369bc80cc524c36/coronal_008.png","assets/T/mri-8369bc80cc524c36/coronal_009.png","assets/T/mri-8369bc80cc524c36/coronal_010.png","assets/T/mri-8369bc80cc524c36/coronal_011.png","assets/T/mri-8369bc80cc524c36/coronal_012.png","assets/T/mri-8369bc80cc524c36/coronal_013.png","assets/T/mri-8369bc80cc524c36/coronal_014.png","assets/T/mri-8369bc80cc524c36/coronal_015.png","assets/T/mri-8369bc80cc524c36/coronal_016.png","assets/T/mri-8369bc80cc524c36/coronal_017.png","assets/T/mri-8369bc80cc524c36/coronal_018.png","assets/T/mri-8369bc80cc524c36/coronal_019.png","assets/T/mri-8369bc80cc524c36/coronal_020.png","assets/T/mri-8369bc80cc524c36/coronal_021.png","assets/T/mri-8369bc80cc524c36/coronal_022.png","assets/T/mri-8369bc80cc524c36/coronal_023.png","assets/T/mri-8369bc80cc524c36/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-7850ff7cafae4340","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 63 张图，均来自同一次检查。\n\n- 前 39 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-7850ff7cafae4340/axial_001.png","assets/T/mri-7850ff7cafae4340/axial_002.png","assets/T/mri-7850ff7cafae4340/axial_003.png","assets/T/mri-7850ff7cafae4340/axial_004.png","assets/T/mri-7850ff7cafae4340/axial_005.png","assets/T/mri-7850ff7cafae4340/axial_006.png","assets/T/mri-7850ff7cafae4340/axial_007.png","assets/T/mri-7850ff7cafae4340/axial_008.png","assets/T/mri-7850ff7cafae4340/axial_009.png","assets/T/mri-7850ff7cafae4340/axial_010.png","assets/T/mri-7850ff7cafae4340/axial_011.png","assets/T/mri-7850ff7cafae4340/axial_012.png","assets/T/mri-7850ff7cafae4340/axial_013.png","assets/T/mri-7850ff7cafae4340/axial_014.png","assets/T/mri-7850ff7cafae4340/axial_015.png","assets/T/mri-7850ff7cafae4340/axial_016.png","assets/T/mri-7850ff7cafae4340/axial_017.png","assets/T/mri-7850ff7cafae4340/axial_018.png","assets/T/mri-7850ff7cafae4340/axial_019.png","assets/T/mri-7850ff7cafae4340/axial_020.png","assets/T/mri-7850ff7cafae4340/axial_021.png","assets/T/mri-7850ff7cafae4340/axial_022.png","assets/T/mri-7850ff7cafae4340/axial_023.png","assets/T/mri-7850ff7cafae4340/axial_024.png","assets/T/mri-7850ff7cafae4340/axial_025.png","assets/T/mri-7850ff7cafae4340/axial_026.png","assets/T/mri-7850ff7cafae4340/axial_027.png","assets/T/mri-7850ff7cafae4340/axial_028.png","assets/T/mri-7850ff7cafae4340/axial_029.png","assets/T/mri-7850ff7cafae4340/axial_030.png","assets/T/mri-7850ff7cafae4340/axial_031.png","assets/T/mri-7850ff7cafae4340/axial_032.png","assets/T/mri-7850ff7cafae4340/axial_033.png","assets/T/mri-7850ff7cafae4340/axial_034.png","assets/T/mri-7850ff7cafae4340/axial_035.png","assets/T/mri-7850ff7cafae4340/axial_036.png","assets/T/mri-7850ff7cafae4340/axial_037.png","assets/T/mri-7850ff7cafae4340/axial_038.png","assets/T/mri-7850ff7cafae4340/axial_039.png","assets/T/mri-7850ff7cafae4340/coronal_001.png","assets/T/mri-7850ff7cafae4340/coronal_002.png","assets/T/mri-7850ff7cafae4340/coronal_003.png","assets/T/mri-7850ff7cafae4340/coronal_004.png","assets/T/mri-7850ff7cafae4340/coronal_005.png","assets/T/mri-7850ff7cafae4340/coronal_006.png","assets/T/mri-7850ff7cafae4340/coronal_007.png","assets/T/mri-7850ff7cafae4340/coronal_008.png","assets/T/mri-7850ff7cafae4340/coronal_009.png","assets/T/mri-7850ff7cafae4340/coronal_010.png","assets/T/mri-7850ff7cafae4340/coronal_011.png","assets/T/mri-7850ff7cafae4340/coronal_012.png","assets/T/mri-7850ff7cafae4340/coronal_013.png","assets/T/mri-7850ff7cafae4340/coronal_014.png","assets/T/mri-7850ff7cafae4340/coronal_015.png","assets/T/mri-7850ff7cafae4340/coronal_016.png","assets/T/mri-7850ff7cafae4340/coronal_017.png","assets/T/mri-7850ff7cafae4340/coronal_018.png","assets/T/mri-7850ff7cafae4340/coronal_019.png","assets/T/mri-7850ff7cafae4340/coronal_020.png","assets/T/mri-7850ff7cafae4340/coronal_021.png","assets/T/mri-7850ff7cafae4340/coronal_022.png","assets/T/mri-7850ff7cafae4340/coronal_023.png","assets/T/mri-7850ff7cafae4340/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-ab79773a626e48a4","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 68 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 26 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-ab79773a626e48a4/axial_001.png","assets/T/mri-ab79773a626e48a4/axial_002.png","assets/T/mri-ab79773a626e48a4/axial_003.png","assets/T/mri-ab79773a626e48a4/axial_004.png","assets/T/mri-ab79773a626e48a4/axial_005.png","assets/T/mri-ab79773a626e48a4/axial_006.png","assets/T/mri-ab79773a626e48a4/axial_007.png","assets/T/mri-ab79773a626e48a4/axial_008.png","assets/T/mri-ab79773a626e48a4/axial_009.png","assets/T/mri-ab79773a626e48a4/axial_010.png","assets/T/mri-ab79773a626e48a4/axial_011.png","assets/T/mri-ab79773a626e48a4/axial_012.png","assets/T/mri-ab79773a626e48a4/axial_013.png","assets/T/mri-ab79773a626e48a4/axial_014.png","assets/T/mri-ab79773a626e48a4/axial_015.png","assets/T/mri-ab79773a626e48a4/axial_016.png","assets/T/mri-ab79773a626e48a4/axial_017.png","assets/T/mri-ab79773a626e48a4/axial_018.png","assets/T/mri-ab79773a626e48a4/axial_019.png","assets/T/mri-ab79773a626e48a4/axial_020.png","assets/T/mri-ab79773a626e48a4/axial_021.png","assets/T/mri-ab79773a626e48a4/axial_022.png","assets/T/mri-ab79773a626e48a4/axial_023.png","assets/T/mri-ab79773a626e48a4/axial_024.png","assets/T/mri-ab79773a626e48a4/axial_025.png","assets/T/mri-ab79773a626e48a4/axial_026.png","assets/T/mri-ab79773a626e48a4/axial_027.png","assets/T/mri-ab79773a626e48a4/axial_028.png","assets/T/mri-ab79773a626e48a4/axial_029.png","assets/T/mri-ab79773a626e48a4/axial_030.png","assets/T/mri-ab79773a626e48a4/axial_031.png","assets/T/mri-ab79773a626e48a4/axial_032.png","assets/T/mri-ab79773a626e48a4/axial_033.png","assets/T/mri-ab79773a626e48a4/axial_034.png","assets/T/mri-ab79773a626e48a4/axial_035.png","assets/T/mri-ab79773a626e48a4/axial_036.png","assets/T/mri-ab79773a626e48a4/axial_037.png","assets/T/mri-ab79773a626e48a4/axial_038.png","assets/T/mri-ab79773a626e48a4/axial_039.png","assets/T/mri-ab79773a626e48a4/axial_040.png","assets/T/mri-ab79773a626e48a4/axial_041.png","assets/T/mri-ab79773a626e48a4/axial_042.png","assets/T/mri-ab79773a626e48a4/coronal_001.png","assets/T/mri-ab79773a626e48a4/coronal_002.png","assets/T/mri-ab79773a626e48a4/coronal_003.png","assets/T/mri-ab79773a626e48a4/coronal_004.png","assets/T/mri-ab79773a626e48a4/coronal_005.png","assets/T/mri-ab79773a626e48a4/coronal_006.png","assets/T/mri-ab79773a626e48a4/coronal_007.png","assets/T/mri-ab79773a626e48a4/coronal_008.png","assets/T/mri-ab79773a626e48a4/coronal_009.png","assets/T/mri-ab79773a626e48a4/coronal_010.png","assets/T/mri-ab79773a626e48a4/coronal_011.png","assets/T/mri-ab79773a626e48a4/coronal_012.png","assets/T/mri-ab79773a626e48a4/coronal_013.png","assets/T/mri-ab79773a626e48a4/coronal_014.png","assets/T/mri-ab79773a626e48a4/coronal_015.png","assets/T/mri-ab79773a626e48a4/coronal_016.png","assets/T/mri-ab79773a626e48a4/coronal_017.png","assets/T/mri-ab79773a626e48a4/coronal_018.png","assets/T/mri-ab79773a626e48a4/coronal_019.png","assets/T/mri-ab79773a626e48a4/coronal_020.png","assets/T/mri-ab79773a626e48a4/coronal_021.png","assets/T/mri-ab79773a626e48a4/coronal_022.png","assets/T/mri-ab79773a626e48a4/coronal_023.png","assets/T/mri-ab79773a626e48a4/coronal_024.png","assets/T/mri-ab79773a626e48a4/coronal_025.png","assets/T/mri-ab79773a626e48a4/coronal_026.png"],"stage_edition":8}
+{"id":"L3-T300:mri-412e83e3a9394b43","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-412e83e3a9394b43/axial_001.png","assets/T/mri-412e83e3a9394b43/axial_002.png","assets/T/mri-412e83e3a9394b43/axial_003.png","assets/T/mri-412e83e3a9394b43/axial_004.png","assets/T/mri-412e83e3a9394b43/axial_005.png","assets/T/mri-412e83e3a9394b43/axial_006.png","assets/T/mri-412e83e3a9394b43/axial_007.png","assets/T/mri-412e83e3a9394b43/axial_008.png","assets/T/mri-412e83e3a9394b43/axial_009.png","assets/T/mri-412e83e3a9394b43/axial_010.png","assets/T/mri-412e83e3a9394b43/axial_011.png","assets/T/mri-412e83e3a9394b43/axial_012.png","assets/T/mri-412e83e3a9394b43/axial_013.png","assets/T/mri-412e83e3a9394b43/axial_014.png","assets/T/mri-412e83e3a9394b43/axial_015.png","assets/T/mri-412e83e3a9394b43/axial_016.png","assets/T/mri-412e83e3a9394b43/axial_017.png","assets/T/mri-412e83e3a9394b43/axial_018.png","assets/T/mri-412e83e3a9394b43/axial_019.png","assets/T/mri-412e83e3a9394b43/axial_020.png","assets/T/mri-412e83e3a9394b43/axial_021.png","assets/T/mri-412e83e3a9394b43/axial_022.png","assets/T/mri-412e83e3a9394b43/axial_023.png","assets/T/mri-412e83e3a9394b43/axial_024.png","assets/T/mri-412e83e3a9394b43/axial_025.png","assets/T/mri-412e83e3a9394b43/axial_026.png","assets/T/mri-412e83e3a9394b43/axial_027.png","assets/T/mri-412e83e3a9394b43/axial_028.png","assets/T/mri-412e83e3a9394b43/axial_029.png","assets/T/mri-412e83e3a9394b43/axial_030.png","assets/T/mri-412e83e3a9394b43/axial_031.png","assets/T/mri-412e83e3a9394b43/axial_032.png","assets/T/mri-412e83e3a9394b43/axial_033.png","assets/T/mri-412e83e3a9394b43/axial_034.png","assets/T/mri-412e83e3a9394b43/axial_035.png","assets/T/mri-412e83e3a9394b43/axial_036.png","assets/T/mri-412e83e3a9394b43/axial_037.png","assets/T/mri-412e83e3a9394b43/axial_038.png","assets/T/mri-412e83e3a9394b43/axial_039.png","assets/T/mri-412e83e3a9394b43/axial_040.png","assets/T/mri-412e83e3a9394b43/coronal_001.png","assets/T/mri-412e83e3a9394b43/coronal_002.png","assets/T/mri-412e83e3a9394b43/coronal_003.png","assets/T/mri-412e83e3a9394b43/coronal_004.png","assets/T/mri-412e83e3a9394b43/coronal_005.png","assets/T/mri-412e83e3a9394b43/coronal_006.png","assets/T/mri-412e83e3a9394b43/coronal_007.png","assets/T/mri-412e83e3a9394b43/coronal_008.png","assets/T/mri-412e83e3a9394b43/coronal_009.png","assets/T/mri-412e83e3a9394b43/coronal_010.png","assets/T/mri-412e83e3a9394b43/coronal_011.png","assets/T/mri-412e83e3a9394b43/coronal_012.png","assets/T/mri-412e83e3a9394b43/coronal_013.png","assets/T/mri-412e83e3a9394b43/coronal_014.png","assets/T/mri-412e83e3a9394b43/coronal_015.png","assets/T/mri-412e83e3a9394b43/coronal_016.png","assets/T/mri-412e83e3a9394b43/coronal_017.png","assets/T/mri-412e83e3a9394b43/coronal_018.png","assets/T/mri-412e83e3a9394b43/coronal_019.png","assets/T/mri-412e83e3a9394b43/coronal_020.png","assets/T/mri-412e83e3a9394b43/coronal_021.png","assets/T/mri-412e83e3a9394b43/coronal_022.png","assets/T/mri-412e83e3a9394b43/coronal_023.png","assets/T/mri-412e83e3a9394b43/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-16c2f9f2b11e43e7","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-16c2f9f2b11e43e7/axial_001.png","assets/T/mri-16c2f9f2b11e43e7/axial_002.png","assets/T/mri-16c2f9f2b11e43e7/axial_003.png","assets/T/mri-16c2f9f2b11e43e7/axial_004.png","assets/T/mri-16c2f9f2b11e43e7/axial_005.png","assets/T/mri-16c2f9f2b11e43e7/axial_006.png","assets/T/mri-16c2f9f2b11e43e7/axial_007.png","assets/T/mri-16c2f9f2b11e43e7/axial_008.png","assets/T/mri-16c2f9f2b11e43e7/axial_009.png","assets/T/mri-16c2f9f2b11e43e7/axial_010.png","assets/T/mri-16c2f9f2b11e43e7/axial_011.png","assets/T/mri-16c2f9f2b11e43e7/axial_012.png","assets/T/mri-16c2f9f2b11e43e7/axial_013.png","assets/T/mri-16c2f9f2b11e43e7/axial_014.png","assets/T/mri-16c2f9f2b11e43e7/axial_015.png","assets/T/mri-16c2f9f2b11e43e7/axial_016.png","assets/T/mri-16c2f9f2b11e43e7/axial_017.png","assets/T/mri-16c2f9f2b11e43e7/axial_018.png","assets/T/mri-16c2f9f2b11e43e7/axial_019.png","assets/T/mri-16c2f9f2b11e43e7/axial_020.png","assets/T/mri-16c2f9f2b11e43e7/axial_021.png","assets/T/mri-16c2f9f2b11e43e7/axial_022.png","assets/T/mri-16c2f9f2b11e43e7/axial_023.png","assets/T/mri-16c2f9f2b11e43e7/axial_024.png","assets/T/mri-16c2f9f2b11e43e7/axial_025.png","assets/T/mri-16c2f9f2b11e43e7/axial_026.png","assets/T/mri-16c2f9f2b11e43e7/axial_027.png","assets/T/mri-16c2f9f2b11e43e7/axial_028.png","assets/T/mri-16c2f9f2b11e43e7/axial_029.png","assets/T/mri-16c2f9f2b11e43e7/axial_030.png","assets/T/mri-16c2f9f2b11e43e7/axial_031.png","assets/T/mri-16c2f9f2b11e43e7/axial_032.png","assets/T/mri-16c2f9f2b11e43e7/axial_033.png","assets/T/mri-16c2f9f2b11e43e7/axial_034.png","assets/T/mri-16c2f9f2b11e43e7/axial_035.png","assets/T/mri-16c2f9f2b11e43e7/axial_036.png","assets/T/mri-16c2f9f2b11e43e7/axial_037.png","assets/T/mri-16c2f9f2b11e43e7/axial_038.png","assets/T/mri-16c2f9f2b11e43e7/axial_039.png","assets/T/mri-16c2f9f2b11e43e7/axial_040.png","assets/T/mri-16c2f9f2b11e43e7/coronal_001.png","assets/T/mri-16c2f9f2b11e43e7/coronal_002.png","assets/T/mri-16c2f9f2b11e43e7/coronal_003.png","assets/T/mri-16c2f9f2b11e43e7/coronal_004.png","assets/T/mri-16c2f9f2b11e43e7/coronal_005.png","assets/T/mri-16c2f9f2b11e43e7/coronal_006.png","assets/T/mri-16c2f9f2b11e43e7/coronal_007.png","assets/T/mri-16c2f9f2b11e43e7/coronal_008.png","assets/T/mri-16c2f9f2b11e43e7/coronal_009.png","assets/T/mri-16c2f9f2b11e43e7/coronal_010.png","assets/T/mri-16c2f9f2b11e43e7/coronal_011.png","assets/T/mri-16c2f9f2b11e43e7/coronal_012.png","assets/T/mri-16c2f9f2b11e43e7/coronal_013.png","assets/T/mri-16c2f9f2b11e43e7/coronal_014.png","assets/T/mri-16c2f9f2b11e43e7/coronal_015.png","assets/T/mri-16c2f9f2b11e43e7/coronal_016.png","assets/T/mri-16c2f9f2b11e43e7/coronal_017.png","assets/T/mri-16c2f9f2b11e43e7/coronal_018.png","assets/T/mri-16c2f9f2b11e43e7/coronal_019.png","assets/T/mri-16c2f9f2b11e43e7/coronal_020.png","assets/T/mri-16c2f9f2b11e43e7/coronal_021.png","assets/T/mri-16c2f9f2b11e43e7/coronal_022.png","assets/T/mri-16c2f9f2b11e43e7/coronal_023.png","assets/T/mri-16c2f9f2b11e43e7/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-3f31af08249d42ef","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-3f31af08249d42ef/axial_001.png","assets/T/mri-3f31af08249d42ef/axial_002.png","assets/T/mri-3f31af08249d42ef/axial_003.png","assets/T/mri-3f31af08249d42ef/axial_004.png","assets/T/mri-3f31af08249d42ef/axial_005.png","assets/T/mri-3f31af08249d42ef/axial_006.png","assets/T/mri-3f31af08249d42ef/axial_007.png","assets/T/mri-3f31af08249d42ef/axial_008.png","assets/T/mri-3f31af08249d42ef/axial_009.png","assets/T/mri-3f31af08249d42ef/axial_010.png","assets/T/mri-3f31af08249d42ef/axial_011.png","assets/T/mri-3f31af08249d42ef/axial_012.png","assets/T/mri-3f31af08249d42ef/axial_013.png","assets/T/mri-3f31af08249d42ef/axial_014.png","assets/T/mri-3f31af08249d42ef/axial_015.png","assets/T/mri-3f31af08249d42ef/axial_016.png","assets/T/mri-3f31af08249d42ef/axial_017.png","assets/T/mri-3f31af08249d42ef/axial_018.png","assets/T/mri-3f31af08249d42ef/axial_019.png","assets/T/mri-3f31af08249d42ef/axial_020.png","assets/T/mri-3f31af08249d42ef/axial_021.png","assets/T/mri-3f31af08249d42ef/axial_022.png","assets/T/mri-3f31af08249d42ef/axial_023.png","assets/T/mri-3f31af08249d42ef/axial_024.png","assets/T/mri-3f31af08249d42ef/axial_025.png","assets/T/mri-3f31af08249d42ef/axial_026.png","assets/T/mri-3f31af08249d42ef/axial_027.png","assets/T/mri-3f31af08249d42ef/axial_028.png","assets/T/mri-3f31af08249d42ef/axial_029.png","assets/T/mri-3f31af08249d42ef/axial_030.png","assets/T/mri-3f31af08249d42ef/axial_031.png","assets/T/mri-3f31af08249d42ef/axial_032.png","assets/T/mri-3f31af08249d42ef/axial_033.png","assets/T/mri-3f31af08249d42ef/axial_034.png","assets/T/mri-3f31af08249d42ef/axial_035.png","assets/T/mri-3f31af08249d42ef/axial_036.png","assets/T/mri-3f31af08249d42ef/axial_037.png","assets/T/mri-3f31af08249d42ef/axial_038.png","assets/T/mri-3f31af08249d42ef/axial_039.png","assets/T/mri-3f31af08249d42ef/axial_040.png","assets/T/mri-3f31af08249d42ef/axial_041.png","assets/T/mri-3f31af08249d42ef/axial_042.png","assets/T/mri-3f31af08249d42ef/coronal_001.png","assets/T/mri-3f31af08249d42ef/coronal_002.png","assets/T/mri-3f31af08249d42ef/coronal_003.png","assets/T/mri-3f31af08249d42ef/coronal_004.png","assets/T/mri-3f31af08249d42ef/coronal_005.png","assets/T/mri-3f31af08249d42ef/coronal_006.png","assets/T/mri-3f31af08249d42ef/coronal_007.png","assets/T/mri-3f31af08249d42ef/coronal_008.png","assets/T/mri-3f31af08249d42ef/coronal_009.png","assets/T/mri-3f31af08249d42ef/coronal_010.png","assets/T/mri-3f31af08249d42ef/coronal_011.png","assets/T/mri-3f31af08249d42ef/coronal_012.png","assets/T/mri-3f31af08249d42ef/coronal_013.png","assets/T/mri-3f31af08249d42ef/coronal_014.png","assets/T/mri-3f31af08249d42ef/coronal_015.png","assets/T/mri-3f31af08249d42ef/coronal_016.png","assets/T/mri-3f31af08249d42ef/coronal_017.png","assets/T/mri-3f31af08249d42ef/coronal_018.png","assets/T/mri-3f31af08249d42ef/coronal_019.png","assets/T/mri-3f31af08249d42ef/coronal_020.png","assets/T/mri-3f31af08249d42ef/coronal_021.png","assets/T/mri-3f31af08249d42ef/coronal_022.png","assets/T/mri-3f31af08249d42ef/coronal_023.png","assets/T/mri-3f31af08249d42ef/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-25fd5f6282bd417a","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 70 张图，均来自同一次检查。\n\n- 前 46 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-25fd5f6282bd417a/axial_001.png","assets/T/mri-25fd5f6282bd417a/axial_002.png","assets/T/mri-25fd5f6282bd417a/axial_003.png","assets/T/mri-25fd5f6282bd417a/axial_004.png","assets/T/mri-25fd5f6282bd417a/axial_005.png","assets/T/mri-25fd5f6282bd417a/axial_006.png","assets/T/mri-25fd5f6282bd417a/axial_007.png","assets/T/mri-25fd5f6282bd417a/axial_008.png","assets/T/mri-25fd5f6282bd417a/axial_009.png","assets/T/mri-25fd5f6282bd417a/axial_010.png","assets/T/mri-25fd5f6282bd417a/axial_011.png","assets/T/mri-25fd5f6282bd417a/axial_012.png","assets/T/mri-25fd5f6282bd417a/axial_013.png","assets/T/mri-25fd5f6282bd417a/axial_014.png","assets/T/mri-25fd5f6282bd417a/axial_015.png","assets/T/mri-25fd5f6282bd417a/axial_016.png","assets/T/mri-25fd5f6282bd417a/axial_017.png","assets/T/mri-25fd5f6282bd417a/axial_018.png","assets/T/mri-25fd5f6282bd417a/axial_019.png","assets/T/mri-25fd5f6282bd417a/axial_020.png","assets/T/mri-25fd5f6282bd417a/axial_021.png","assets/T/mri-25fd5f6282bd417a/axial_022.png","assets/T/mri-25fd5f6282bd417a/axial_023.png","assets/T/mri-25fd5f6282bd417a/axial_024.png","assets/T/mri-25fd5f6282bd417a/axial_025.png","assets/T/mri-25fd5f6282bd417a/axial_026.png","assets/T/mri-25fd5f6282bd417a/axial_027.png","assets/T/mri-25fd5f6282bd417a/axial_028.png","assets/T/mri-25fd5f6282bd417a/axial_029.png","assets/T/mri-25fd5f6282bd417a/axial_030.png","assets/T/mri-25fd5f6282bd417a/axial_031.png","assets/T/mri-25fd5f6282bd417a/axial_032.png","assets/T/mri-25fd5f6282bd417a/axial_033.png","assets/T/mri-25fd5f6282bd417a/axial_034.png","assets/T/mri-25fd5f6282bd417a/axial_035.png","assets/T/mri-25fd5f6282bd417a/axial_036.png","assets/T/mri-25fd5f6282bd417a/axial_037.png","assets/T/mri-25fd5f6282bd417a/axial_038.png","assets/T/mri-25fd5f6282bd417a/axial_039.png","assets/T/mri-25fd5f6282bd417a/axial_040.png","assets/T/mri-25fd5f6282bd417a/axial_041.png","assets/T/mri-25fd5f6282bd417a/axial_042.png","assets/T/mri-25fd5f6282bd417a/axial_043.png","assets/T/mri-25fd5f6282bd417a/axial_044.png","assets/T/mri-25fd5f6282bd417a/axial_045.png","assets/T/mri-25fd5f6282bd417a/axial_046.png","assets/T/mri-25fd5f6282bd417a/coronal_001.png","assets/T/mri-25fd5f6282bd417a/coronal_002.png","assets/T/mri-25fd5f6282bd417a/coronal_003.png","assets/T/mri-25fd5f6282bd417a/coronal_004.png","assets/T/mri-25fd5f6282bd417a/coronal_005.png","assets/T/mri-25fd5f6282bd417a/coronal_006.png","assets/T/mri-25fd5f6282bd417a/coronal_007.png","assets/T/mri-25fd5f6282bd417a/coronal_008.png","assets/T/mri-25fd5f6282bd417a/coronal_009.png","assets/T/mri-25fd5f6282bd417a/coronal_010.png","assets/T/mri-25fd5f6282bd417a/coronal_011.png","assets/T/mri-25fd5f6282bd417a/coronal_012.png","assets/T/mri-25fd5f6282bd417a/coronal_013.png","assets/T/mri-25fd5f6282bd417a/coronal_014.png","assets/T/mri-25fd5f6282bd417a/coronal_015.png","assets/T/mri-25fd5f6282bd417a/coronal_016.png","assets/T/mri-25fd5f6282bd417a/coronal_017.png","assets/T/mri-25fd5f6282bd417a/coronal_018.png","assets/T/mri-25fd5f6282bd417a/coronal_019.png","assets/T/mri-25fd5f6282bd417a/coronal_020.png","assets/T/mri-25fd5f6282bd417a/coronal_021.png","assets/T/mri-25fd5f6282bd417a/coronal_022.png","assets/T/mri-25fd5f6282bd417a/coronal_023.png","assets/T/mri-25fd5f6282bd417a/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-acc2b4aa749d4481","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-acc2b4aa749d4481/axial_001.png","assets/T/mri-acc2b4aa749d4481/axial_002.png","assets/T/mri-acc2b4aa749d4481/axial_003.png","assets/T/mri-acc2b4aa749d4481/axial_004.png","assets/T/mri-acc2b4aa749d4481/axial_005.png","assets/T/mri-acc2b4aa749d4481/axial_006.png","assets/T/mri-acc2b4aa749d4481/axial_007.png","assets/T/mri-acc2b4aa749d4481/axial_008.png","assets/T/mri-acc2b4aa749d4481/axial_009.png","assets/T/mri-acc2b4aa749d4481/axial_010.png","assets/T/mri-acc2b4aa749d4481/axial_011.png","assets/T/mri-acc2b4aa749d4481/axial_012.png","assets/T/mri-acc2b4aa749d4481/axial_013.png","assets/T/mri-acc2b4aa749d4481/axial_014.png","assets/T/mri-acc2b4aa749d4481/axial_015.png","assets/T/mri-acc2b4aa749d4481/axial_016.png","assets/T/mri-acc2b4aa749d4481/axial_017.png","assets/T/mri-acc2b4aa749d4481/axial_018.png","assets/T/mri-acc2b4aa749d4481/axial_019.png","assets/T/mri-acc2b4aa749d4481/axial_020.png","assets/T/mri-acc2b4aa749d4481/axial_021.png","assets/T/mri-acc2b4aa749d4481/axial_022.png","assets/T/mri-acc2b4aa749d4481/axial_023.png","assets/T/mri-acc2b4aa749d4481/axial_024.png","assets/T/mri-acc2b4aa749d4481/axial_025.png","assets/T/mri-acc2b4aa749d4481/axial_026.png","assets/T/mri-acc2b4aa749d4481/axial_027.png","assets/T/mri-acc2b4aa749d4481/axial_028.png","assets/T/mri-acc2b4aa749d4481/axial_029.png","assets/T/mri-acc2b4aa749d4481/axial_030.png","assets/T/mri-acc2b4aa749d4481/axial_031.png","assets/T/mri-acc2b4aa749d4481/axial_032.png","assets/T/mri-acc2b4aa749d4481/axial_033.png","assets/T/mri-acc2b4aa749d4481/axial_034.png","assets/T/mri-acc2b4aa749d4481/axial_035.png","assets/T/mri-acc2b4aa749d4481/axial_036.png","assets/T/mri-acc2b4aa749d4481/axial_037.png","assets/T/mri-acc2b4aa749d4481/axial_038.png","assets/T/mri-acc2b4aa749d4481/axial_039.png","assets/T/mri-acc2b4aa749d4481/axial_040.png","assets/T/mri-acc2b4aa749d4481/coronal_001.png","assets/T/mri-acc2b4aa749d4481/coronal_002.png","assets/T/mri-acc2b4aa749d4481/coronal_003.png","assets/T/mri-acc2b4aa749d4481/coronal_004.png","assets/T/mri-acc2b4aa749d4481/coronal_005.png","assets/T/mri-acc2b4aa749d4481/coronal_006.png","assets/T/mri-acc2b4aa749d4481/coronal_007.png","assets/T/mri-acc2b4aa749d4481/coronal_008.png","assets/T/mri-acc2b4aa749d4481/coronal_009.png","assets/T/mri-acc2b4aa749d4481/coronal_010.png","assets/T/mri-acc2b4aa749d4481/coronal_011.png","assets/T/mri-acc2b4aa749d4481/coronal_012.png","assets/T/mri-acc2b4aa749d4481/coronal_013.png","assets/T/mri-acc2b4aa749d4481/coronal_014.png","assets/T/mri-acc2b4aa749d4481/coronal_015.png","assets/T/mri-acc2b4aa749d4481/coronal_016.png","assets/T/mri-acc2b4aa749d4481/coronal_017.png","assets/T/mri-acc2b4aa749d4481/coronal_018.png","assets/T/mri-acc2b4aa749d4481/coronal_019.png","assets/T/mri-acc2b4aa749d4481/coronal_020.png","assets/T/mri-acc2b4aa749d4481/coronal_021.png","assets/T/mri-acc2b4aa749d4481/coronal_022.png","assets/T/mri-acc2b4aa749d4481/coronal_023.png","assets/T/mri-acc2b4aa749d4481/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-4c6b71e4929542b4","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-4c6b71e4929542b4/axial_001.png","assets/T/mri-4c6b71e4929542b4/axial_002.png","assets/T/mri-4c6b71e4929542b4/axial_003.png","assets/T/mri-4c6b71e4929542b4/axial_004.png","assets/T/mri-4c6b71e4929542b4/axial_005.png","assets/T/mri-4c6b71e4929542b4/axial_006.png","assets/T/mri-4c6b71e4929542b4/axial_007.png","assets/T/mri-4c6b71e4929542b4/axial_008.png","assets/T/mri-4c6b71e4929542b4/axial_009.png","assets/T/mri-4c6b71e4929542b4/axial_010.png","assets/T/mri-4c6b71e4929542b4/axial_011.png","assets/T/mri-4c6b71e4929542b4/axial_012.png","assets/T/mri-4c6b71e4929542b4/axial_013.png","assets/T/mri-4c6b71e4929542b4/axial_014.png","assets/T/mri-4c6b71e4929542b4/axial_015.png","assets/T/mri-4c6b71e4929542b4/axial_016.png","assets/T/mri-4c6b71e4929542b4/axial_017.png","assets/T/mri-4c6b71e4929542b4/axial_018.png","assets/T/mri-4c6b71e4929542b4/axial_019.png","assets/T/mri-4c6b71e4929542b4/axial_020.png","assets/T/mri-4c6b71e4929542b4/axial_021.png","assets/T/mri-4c6b71e4929542b4/axial_022.png","assets/T/mri-4c6b71e4929542b4/axial_023.png","assets/T/mri-4c6b71e4929542b4/axial_024.png","assets/T/mri-4c6b71e4929542b4/axial_025.png","assets/T/mri-4c6b71e4929542b4/axial_026.png","assets/T/mri-4c6b71e4929542b4/axial_027.png","assets/T/mri-4c6b71e4929542b4/axial_028.png","assets/T/mri-4c6b71e4929542b4/axial_029.png","assets/T/mri-4c6b71e4929542b4/axial_030.png","assets/T/mri-4c6b71e4929542b4/axial_031.png","assets/T/mri-4c6b71e4929542b4/axial_032.png","assets/T/mri-4c6b71e4929542b4/axial_033.png","assets/T/mri-4c6b71e4929542b4/axial_034.png","assets/T/mri-4c6b71e4929542b4/axial_035.png","assets/T/mri-4c6b71e4929542b4/axial_036.png","assets/T/mri-4c6b71e4929542b4/axial_037.png","assets/T/mri-4c6b71e4929542b4/axial_038.png","assets/T/mri-4c6b71e4929542b4/axial_039.png","assets/T/mri-4c6b71e4929542b4/axial_040.png","assets/T/mri-4c6b71e4929542b4/axial_041.png","assets/T/mri-4c6b71e4929542b4/axial_042.png","assets/T/mri-4c6b71e4929542b4/coronal_001.png","assets/T/mri-4c6b71e4929542b4/coronal_002.png","assets/T/mri-4c6b71e4929542b4/coronal_003.png","assets/T/mri-4c6b71e4929542b4/coronal_004.png","assets/T/mri-4c6b71e4929542b4/coronal_005.png","assets/T/mri-4c6b71e4929542b4/coronal_006.png","assets/T/mri-4c6b71e4929542b4/coronal_007.png","assets/T/mri-4c6b71e4929542b4/coronal_008.png","assets/T/mri-4c6b71e4929542b4/coronal_009.png","assets/T/mri-4c6b71e4929542b4/coronal_010.png","assets/T/mri-4c6b71e4929542b4/coronal_011.png","assets/T/mri-4c6b71e4929542b4/coronal_012.png","assets/T/mri-4c6b71e4929542b4/coronal_013.png","assets/T/mri-4c6b71e4929542b4/coronal_014.png","assets/T/mri-4c6b71e4929542b4/coronal_015.png","assets/T/mri-4c6b71e4929542b4/coronal_016.png","assets/T/mri-4c6b71e4929542b4/coronal_017.png","assets/T/mri-4c6b71e4929542b4/coronal_018.png","assets/T/mri-4c6b71e4929542b4/coronal_019.png","assets/T/mri-4c6b71e4929542b4/coronal_020.png","assets/T/mri-4c6b71e4929542b4/coronal_021.png","assets/T/mri-4c6b71e4929542b4/coronal_022.png","assets/T/mri-4c6b71e4929542b4/coronal_023.png","assets/T/mri-4c6b71e4929542b4/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-70a24066e1394843","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 68 张图，均来自同一次检查。\n\n- 前 44 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-70a24066e1394843/axial_001.png","assets/T/mri-70a24066e1394843/axial_002.png","assets/T/mri-70a24066e1394843/axial_003.png","assets/T/mri-70a24066e1394843/axial_004.png","assets/T/mri-70a24066e1394843/axial_005.png","assets/T/mri-70a24066e1394843/axial_006.png","assets/T/mri-70a24066e1394843/axial_007.png","assets/T/mri-70a24066e1394843/axial_008.png","assets/T/mri-70a24066e1394843/axial_009.png","assets/T/mri-70a24066e1394843/axial_010.png","assets/T/mri-70a24066e1394843/axial_011.png","assets/T/mri-70a24066e1394843/axial_012.png","assets/T/mri-70a24066e1394843/axial_013.png","assets/T/mri-70a24066e1394843/axial_014.png","assets/T/mri-70a24066e1394843/axial_015.png","assets/T/mri-70a24066e1394843/axial_016.png","assets/T/mri-70a24066e1394843/axial_017.png","assets/T/mri-70a24066e1394843/axial_018.png","assets/T/mri-70a24066e1394843/axial_019.png","assets/T/mri-70a24066e1394843/axial_020.png","assets/T/mri-70a24066e1394843/axial_021.png","assets/T/mri-70a24066e1394843/axial_022.png","assets/T/mri-70a24066e1394843/axial_023.png","assets/T/mri-70a24066e1394843/axial_024.png","assets/T/mri-70a24066e1394843/axial_025.png","assets/T/mri-70a24066e1394843/axial_026.png","assets/T/mri-70a24066e1394843/axial_027.png","assets/T/mri-70a24066e1394843/axial_028.png","assets/T/mri-70a24066e1394843/axial_029.png","assets/T/mri-70a24066e1394843/axial_030.png","assets/T/mri-70a24066e1394843/axial_031.png","assets/T/mri-70a24066e1394843/axial_032.png","assets/T/mri-70a24066e1394843/axial_033.png","assets/T/mri-70a24066e1394843/axial_034.png","assets/T/mri-70a24066e1394843/axial_035.png","assets/T/mri-70a24066e1394843/axial_036.png","assets/T/mri-70a24066e1394843/axial_037.png","assets/T/mri-70a24066e1394843/axial_038.png","assets/T/mri-70a24066e1394843/axial_039.png","assets/T/mri-70a24066e1394843/axial_040.png","assets/T/mri-70a24066e1394843/axial_041.png","assets/T/mri-70a24066e1394843/axial_042.png","assets/T/mri-70a24066e1394843/axial_043.png","assets/T/mri-70a24066e1394843/axial_044.png","assets/T/mri-70a24066e1394843/coronal_001.png","assets/T/mri-70a24066e1394843/coronal_002.png","assets/T/mri-70a24066e1394843/coronal_003.png","assets/T/mri-70a24066e1394843/coronal_004.png","assets/T/mri-70a24066e1394843/coronal_005.png","assets/T/mri-70a24066e1394843/coronal_006.png","assets/T/mri-70a24066e1394843/coronal_007.png","assets/T/mri-70a24066e1394843/coronal_008.png","assets/T/mri-70a24066e1394843/coronal_009.png","assets/T/mri-70a24066e1394843/coronal_010.png","assets/T/mri-70a24066e1394843/coronal_011.png","assets/T/mri-70a24066e1394843/coronal_012.png","assets/T/mri-70a24066e1394843/coronal_013.png","assets/T/mri-70a24066e1394843/coronal_014.png","assets/T/mri-70a24066e1394843/coronal_015.png","assets/T/mri-70a24066e1394843/coronal_016.png","assets/T/mri-70a24066e1394843/coronal_017.png","assets/T/mri-70a24066e1394843/coronal_018.png","assets/T/mri-70a24066e1394843/coronal_019.png","assets/T/mri-70a24066e1394843/coronal_020.png","assets/T/mri-70a24066e1394843/coronal_021.png","assets/T/mri-70a24066e1394843/coronal_022.png","assets/T/mri-70a24066e1394843/coronal_023.png","assets/T/mri-70a24066e1394843/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-3931b6ac51dd4dc5","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 62 张图，均来自同一次检查。\n\n- 前 38 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-3931b6ac51dd4dc5/axial_001.png","assets/T/mri-3931b6ac51dd4dc5/axial_002.png","assets/T/mri-3931b6ac51dd4dc5/axial_003.png","assets/T/mri-3931b6ac51dd4dc5/axial_004.png","assets/T/mri-3931b6ac51dd4dc5/axial_005.png","assets/T/mri-3931b6ac51dd4dc5/axial_006.png","assets/T/mri-3931b6ac51dd4dc5/axial_007.png","assets/T/mri-3931b6ac51dd4dc5/axial_008.png","assets/T/mri-3931b6ac51dd4dc5/axial_009.png","assets/T/mri-3931b6ac51dd4dc5/axial_010.png","assets/T/mri-3931b6ac51dd4dc5/axial_011.png","assets/T/mri-3931b6ac51dd4dc5/axial_012.png","assets/T/mri-3931b6ac51dd4dc5/axial_013.png","assets/T/mri-3931b6ac51dd4dc5/axial_014.png","assets/T/mri-3931b6ac51dd4dc5/axial_015.png","assets/T/mri-3931b6ac51dd4dc5/axial_016.png","assets/T/mri-3931b6ac51dd4dc5/axial_017.png","assets/T/mri-3931b6ac51dd4dc5/axial_018.png","assets/T/mri-3931b6ac51dd4dc5/axial_019.png","assets/T/mri-3931b6ac51dd4dc5/axial_020.png","assets/T/mri-3931b6ac51dd4dc5/axial_021.png","assets/T/mri-3931b6ac51dd4dc5/axial_022.png","assets/T/mri-3931b6ac51dd4dc5/axial_023.png","assets/T/mri-3931b6ac51dd4dc5/axial_024.png","assets/T/mri-3931b6ac51dd4dc5/axial_025.png","assets/T/mri-3931b6ac51dd4dc5/axial_026.png","assets/T/mri-3931b6ac51dd4dc5/axial_027.png","assets/T/mri-3931b6ac51dd4dc5/axial_028.png","assets/T/mri-3931b6ac51dd4dc5/axial_029.png","assets/T/mri-3931b6ac51dd4dc5/axial_030.png","assets/T/mri-3931b6ac51dd4dc5/axial_031.png","assets/T/mri-3931b6ac51dd4dc5/axial_032.png","assets/T/mri-3931b6ac51dd4dc5/axial_033.png","assets/T/mri-3931b6ac51dd4dc5/axial_034.png","assets/T/mri-3931b6ac51dd4dc5/axial_035.png","assets/T/mri-3931b6ac51dd4dc5/axial_036.png","assets/T/mri-3931b6ac51dd4dc5/axial_037.png","assets/T/mri-3931b6ac51dd4dc5/axial_038.png","assets/T/mri-3931b6ac51dd4dc5/coronal_001.png","assets/T/mri-3931b6ac51dd4dc5/coronal_002.png","assets/T/mri-3931b6ac51dd4dc5/coronal_003.png","assets/T/mri-3931b6ac51dd4dc5/coronal_004.png","assets/T/mri-3931b6ac51dd4dc5/coronal_005.png","assets/T/mri-3931b6ac51dd4dc5/coronal_006.png","assets/T/mri-3931b6ac51dd4dc5/coronal_007.png","assets/T/mri-3931b6ac51dd4dc5/coronal_008.png","assets/T/mri-3931b6ac51dd4dc5/coronal_009.png","assets/T/mri-3931b6ac51dd4dc5/coronal_010.png","assets/T/mri-3931b6ac51dd4dc5/coronal_011.png","assets/T/mri-3931b6ac51dd4dc5/coronal_012.png","assets/T/mri-3931b6ac51dd4dc5/coronal_013.png","assets/T/mri-3931b6ac51dd4dc5/coronal_014.png","assets/T/mri-3931b6ac51dd4dc5/coronal_015.png","assets/T/mri-3931b6ac51dd4dc5/coronal_016.png","assets/T/mri-3931b6ac51dd4dc5/coronal_017.png","assets/T/mri-3931b6ac51dd4dc5/coronal_018.png","assets/T/mri-3931b6ac51dd4dc5/coronal_019.png","assets/T/mri-3931b6ac51dd4dc5/coronal_020.png","assets/T/mri-3931b6ac51dd4dc5/coronal_021.png","assets/T/mri-3931b6ac51dd4dc5/coronal_022.png","assets/T/mri-3931b6ac51dd4dc5/coronal_023.png","assets/T/mri-3931b6ac51dd4dc5/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-94619c73cc6e4b8d","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 26 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-94619c73cc6e4b8d/axial_001.png","assets/T/mri-94619c73cc6e4b8d/axial_002.png","assets/T/mri-94619c73cc6e4b8d/axial_003.png","assets/T/mri-94619c73cc6e4b8d/axial_004.png","assets/T/mri-94619c73cc6e4b8d/axial_005.png","assets/T/mri-94619c73cc6e4b8d/axial_006.png","assets/T/mri-94619c73cc6e4b8d/axial_007.png","assets/T/mri-94619c73cc6e4b8d/axial_008.png","assets/T/mri-94619c73cc6e4b8d/axial_009.png","assets/T/mri-94619c73cc6e4b8d/axial_010.png","assets/T/mri-94619c73cc6e4b8d/axial_011.png","assets/T/mri-94619c73cc6e4b8d/axial_012.png","assets/T/mri-94619c73cc6e4b8d/axial_013.png","assets/T/mri-94619c73cc6e4b8d/axial_014.png","assets/T/mri-94619c73cc6e4b8d/axial_015.png","assets/T/mri-94619c73cc6e4b8d/axial_016.png","assets/T/mri-94619c73cc6e4b8d/axial_017.png","assets/T/mri-94619c73cc6e4b8d/axial_018.png","assets/T/mri-94619c73cc6e4b8d/axial_019.png","assets/T/mri-94619c73cc6e4b8d/axial_020.png","assets/T/mri-94619c73cc6e4b8d/axial_021.png","assets/T/mri-94619c73cc6e4b8d/axial_022.png","assets/T/mri-94619c73cc6e4b8d/axial_023.png","assets/T/mri-94619c73cc6e4b8d/axial_024.png","assets/T/mri-94619c73cc6e4b8d/axial_025.png","assets/T/mri-94619c73cc6e4b8d/axial_026.png","assets/T/mri-94619c73cc6e4b8d/axial_027.png","assets/T/mri-94619c73cc6e4b8d/axial_028.png","assets/T/mri-94619c73cc6e4b8d/axial_029.png","assets/T/mri-94619c73cc6e4b8d/axial_030.png","assets/T/mri-94619c73cc6e4b8d/axial_031.png","assets/T/mri-94619c73cc6e4b8d/axial_032.png","assets/T/mri-94619c73cc6e4b8d/axial_033.png","assets/T/mri-94619c73cc6e4b8d/axial_034.png","assets/T/mri-94619c73cc6e4b8d/axial_035.png","assets/T/mri-94619c73cc6e4b8d/axial_036.png","assets/T/mri-94619c73cc6e4b8d/axial_037.png","assets/T/mri-94619c73cc6e4b8d/axial_038.png","assets/T/mri-94619c73cc6e4b8d/axial_039.png","assets/T/mri-94619c73cc6e4b8d/axial_040.png","assets/T/mri-94619c73cc6e4b8d/coronal_001.png","assets/T/mri-94619c73cc6e4b8d/coronal_002.png","assets/T/mri-94619c73cc6e4b8d/coronal_003.png","assets/T/mri-94619c73cc6e4b8d/coronal_004.png","assets/T/mri-94619c73cc6e4b8d/coronal_005.png","assets/T/mri-94619c73cc6e4b8d/coronal_006.png","assets/T/mri-94619c73cc6e4b8d/coronal_007.png","assets/T/mri-94619c73cc6e4b8d/coronal_008.png","assets/T/mri-94619c73cc6e4b8d/coronal_009.png","assets/T/mri-94619c73cc6e4b8d/coronal_010.png","assets/T/mri-94619c73cc6e4b8d/coronal_011.png","assets/T/mri-94619c73cc6e4b8d/coronal_012.png","assets/T/mri-94619c73cc6e4b8d/coronal_013.png","assets/T/mri-94619c73cc6e4b8d/coronal_014.png","assets/T/mri-94619c73cc6e4b8d/coronal_015.png","assets/T/mri-94619c73cc6e4b8d/coronal_016.png","assets/T/mri-94619c73cc6e4b8d/coronal_017.png","assets/T/mri-94619c73cc6e4b8d/coronal_018.png","assets/T/mri-94619c73cc6e4b8d/coronal_019.png","assets/T/mri-94619c73cc6e4b8d/coronal_020.png","assets/T/mri-94619c73cc6e4b8d/coronal_021.png","assets/T/mri-94619c73cc6e4b8d/coronal_022.png","assets/T/mri-94619c73cc6e4b8d/coronal_023.png","assets/T/mri-94619c73cc6e4b8d/coronal_024.png","assets/T/mri-94619c73cc6e4b8d/coronal_025.png","assets/T/mri-94619c73cc6e4b8d/coronal_026.png"],"stage_edition":8}
+{"id":"L3-T300:mri-d7919e72b6ea42d5","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-d7919e72b6ea42d5/axial_001.png","assets/T/mri-d7919e72b6ea42d5/axial_002.png","assets/T/mri-d7919e72b6ea42d5/axial_003.png","assets/T/mri-d7919e72b6ea42d5/axial_004.png","assets/T/mri-d7919e72b6ea42d5/axial_005.png","assets/T/mri-d7919e72b6ea42d5/axial_006.png","assets/T/mri-d7919e72b6ea42d5/axial_007.png","assets/T/mri-d7919e72b6ea42d5/axial_008.png","assets/T/mri-d7919e72b6ea42d5/axial_009.png","assets/T/mri-d7919e72b6ea42d5/axial_010.png","assets/T/mri-d7919e72b6ea42d5/axial_011.png","assets/T/mri-d7919e72b6ea42d5/axial_012.png","assets/T/mri-d7919e72b6ea42d5/axial_013.png","assets/T/mri-d7919e72b6ea42d5/axial_014.png","assets/T/mri-d7919e72b6ea42d5/axial_015.png","assets/T/mri-d7919e72b6ea42d5/axial_016.png","assets/T/mri-d7919e72b6ea42d5/axial_017.png","assets/T/mri-d7919e72b6ea42d5/axial_018.png","assets/T/mri-d7919e72b6ea42d5/axial_019.png","assets/T/mri-d7919e72b6ea42d5/axial_020.png","assets/T/mri-d7919e72b6ea42d5/axial_021.png","assets/T/mri-d7919e72b6ea42d5/axial_022.png","assets/T/mri-d7919e72b6ea42d5/axial_023.png","assets/T/mri-d7919e72b6ea42d5/axial_024.png","assets/T/mri-d7919e72b6ea42d5/axial_025.png","assets/T/mri-d7919e72b6ea42d5/axial_026.png","assets/T/mri-d7919e72b6ea42d5/axial_027.png","assets/T/mri-d7919e72b6ea42d5/axial_028.png","assets/T/mri-d7919e72b6ea42d5/axial_029.png","assets/T/mri-d7919e72b6ea42d5/axial_030.png","assets/T/mri-d7919e72b6ea42d5/axial_031.png","assets/T/mri-d7919e72b6ea42d5/axial_032.png","assets/T/mri-d7919e72b6ea42d5/axial_033.png","assets/T/mri-d7919e72b6ea42d5/axial_034.png","assets/T/mri-d7919e72b6ea42d5/axial_035.png","assets/T/mri-d7919e72b6ea42d5/axial_036.png","assets/T/mri-d7919e72b6ea42d5/axial_037.png","assets/T/mri-d7919e72b6ea42d5/axial_038.png","assets/T/mri-d7919e72b6ea42d5/axial_039.png","assets/T/mri-d7919e72b6ea42d5/axial_040.png","assets/T/mri-d7919e72b6ea42d5/axial_041.png","assets/T/mri-d7919e72b6ea42d5/axial_042.png","assets/T/mri-d7919e72b6ea42d5/coronal_001.png","assets/T/mri-d7919e72b6ea42d5/coronal_002.png","assets/T/mri-d7919e72b6ea42d5/coronal_003.png","assets/T/mri-d7919e72b6ea42d5/coronal_004.png","assets/T/mri-d7919e72b6ea42d5/coronal_005.png","assets/T/mri-d7919e72b6ea42d5/coronal_006.png","assets/T/mri-d7919e72b6ea42d5/coronal_007.png","assets/T/mri-d7919e72b6ea42d5/coronal_008.png","assets/T/mri-d7919e72b6ea42d5/coronal_009.png","assets/T/mri-d7919e72b6ea42d5/coronal_010.png","assets/T/mri-d7919e72b6ea42d5/coronal_011.png","assets/T/mri-d7919e72b6ea42d5/coronal_012.png","assets/T/mri-d7919e72b6ea42d5/coronal_013.png","assets/T/mri-d7919e72b6ea42d5/coronal_014.png","assets/T/mri-d7919e72b6ea42d5/coronal_015.png","assets/T/mri-d7919e72b6ea42d5/coronal_016.png","assets/T/mri-d7919e72b6ea42d5/coronal_017.png","assets/T/mri-d7919e72b6ea42d5/coronal_018.png","assets/T/mri-d7919e72b6ea42d5/coronal_019.png","assets/T/mri-d7919e72b6ea42d5/coronal_020.png","assets/T/mri-d7919e72b6ea42d5/coronal_021.png","assets/T/mri-d7919e72b6ea42d5/coronal_022.png","assets/T/mri-d7919e72b6ea42d5/coronal_023.png","assets/T/mri-d7919e72b6ea42d5/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-35e2272d24e44428","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 68 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 26 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-35e2272d24e44428/axial_001.png","assets/T/mri-35e2272d24e44428/axial_002.png","assets/T/mri-35e2272d24e44428/axial_003.png","assets/T/mri-35e2272d24e44428/axial_004.png","assets/T/mri-35e2272d24e44428/axial_005.png","assets/T/mri-35e2272d24e44428/axial_006.png","assets/T/mri-35e2272d24e44428/axial_007.png","assets/T/mri-35e2272d24e44428/axial_008.png","assets/T/mri-35e2272d24e44428/axial_009.png","assets/T/mri-35e2272d24e44428/axial_010.png","assets/T/mri-35e2272d24e44428/axial_011.png","assets/T/mri-35e2272d24e44428/axial_012.png","assets/T/mri-35e2272d24e44428/axial_013.png","assets/T/mri-35e2272d24e44428/axial_014.png","assets/T/mri-35e2272d24e44428/axial_015.png","assets/T/mri-35e2272d24e44428/axial_016.png","assets/T/mri-35e2272d24e44428/axial_017.png","assets/T/mri-35e2272d24e44428/axial_018.png","assets/T/mri-35e2272d24e44428/axial_019.png","assets/T/mri-35e2272d24e44428/axial_020.png","assets/T/mri-35e2272d24e44428/axial_021.png","assets/T/mri-35e2272d24e44428/axial_022.png","assets/T/mri-35e2272d24e44428/axial_023.png","assets/T/mri-35e2272d24e44428/axial_024.png","assets/T/mri-35e2272d24e44428/axial_025.png","assets/T/mri-35e2272d24e44428/axial_026.png","assets/T/mri-35e2272d24e44428/axial_027.png","assets/T/mri-35e2272d24e44428/axial_028.png","assets/T/mri-35e2272d24e44428/axial_029.png","assets/T/mri-35e2272d24e44428/axial_030.png","assets/T/mri-35e2272d24e44428/axial_031.png","assets/T/mri-35e2272d24e44428/axial_032.png","assets/T/mri-35e2272d24e44428/axial_033.png","assets/T/mri-35e2272d24e44428/axial_034.png","assets/T/mri-35e2272d24e44428/axial_035.png","assets/T/mri-35e2272d24e44428/axial_036.png","assets/T/mri-35e2272d24e44428/axial_037.png","assets/T/mri-35e2272d24e44428/axial_038.png","assets/T/mri-35e2272d24e44428/axial_039.png","assets/T/mri-35e2272d24e44428/axial_040.png","assets/T/mri-35e2272d24e44428/axial_041.png","assets/T/mri-35e2272d24e44428/axial_042.png","assets/T/mri-35e2272d24e44428/coronal_001.png","assets/T/mri-35e2272d24e44428/coronal_002.png","assets/T/mri-35e2272d24e44428/coronal_003.png","assets/T/mri-35e2272d24e44428/coronal_004.png","assets/T/mri-35e2272d24e44428/coronal_005.png","assets/T/mri-35e2272d24e44428/coronal_006.png","assets/T/mri-35e2272d24e44428/coronal_007.png","assets/T/mri-35e2272d24e44428/coronal_008.png","assets/T/mri-35e2272d24e44428/coronal_009.png","assets/T/mri-35e2272d24e44428/coronal_010.png","assets/T/mri-35e2272d24e44428/coronal_011.png","assets/T/mri-35e2272d24e44428/coronal_012.png","assets/T/mri-35e2272d24e44428/coronal_013.png","assets/T/mri-35e2272d24e44428/coronal_014.png","assets/T/mri-35e2272d24e44428/coronal_015.png","assets/T/mri-35e2272d24e44428/coronal_016.png","assets/T/mri-35e2272d24e44428/coronal_017.png","assets/T/mri-35e2272d24e44428/coronal_018.png","assets/T/mri-35e2272d24e44428/coronal_019.png","assets/T/mri-35e2272d24e44428/coronal_020.png","assets/T/mri-35e2272d24e44428/coronal_021.png","assets/T/mri-35e2272d24e44428/coronal_022.png","assets/T/mri-35e2272d24e44428/coronal_023.png","assets/T/mri-35e2272d24e44428/coronal_024.png","assets/T/mri-35e2272d24e44428/coronal_025.png","assets/T/mri-35e2272d24e44428/coronal_026.png"],"stage_edition":8}
+{"id":"L3-T300:mri-f18cbd80507c4825","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 68 张图，均来自同一次检查。\n\n- 前 44 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-f18cbd80507c4825/axial_001.png","assets/T/mri-f18cbd80507c4825/axial_002.png","assets/T/mri-f18cbd80507c4825/axial_003.png","assets/T/mri-f18cbd80507c4825/axial_004.png","assets/T/mri-f18cbd80507c4825/axial_005.png","assets/T/mri-f18cbd80507c4825/axial_006.png","assets/T/mri-f18cbd80507c4825/axial_007.png","assets/T/mri-f18cbd80507c4825/axial_008.png","assets/T/mri-f18cbd80507c4825/axial_009.png","assets/T/mri-f18cbd80507c4825/axial_010.png","assets/T/mri-f18cbd80507c4825/axial_011.png","assets/T/mri-f18cbd80507c4825/axial_012.png","assets/T/mri-f18cbd80507c4825/axial_013.png","assets/T/mri-f18cbd80507c4825/axial_014.png","assets/T/mri-f18cbd80507c4825/axial_015.png","assets/T/mri-f18cbd80507c4825/axial_016.png","assets/T/mri-f18cbd80507c4825/axial_017.png","assets/T/mri-f18cbd80507c4825/axial_018.png","assets/T/mri-f18cbd80507c4825/axial_019.png","assets/T/mri-f18cbd80507c4825/axial_020.png","assets/T/mri-f18cbd80507c4825/axial_021.png","assets/T/mri-f18cbd80507c4825/axial_022.png","assets/T/mri-f18cbd80507c4825/axial_023.png","assets/T/mri-f18cbd80507c4825/axial_024.png","assets/T/mri-f18cbd80507c4825/axial_025.png","assets/T/mri-f18cbd80507c4825/axial_026.png","assets/T/mri-f18cbd80507c4825/axial_027.png","assets/T/mri-f18cbd80507c4825/axial_028.png","assets/T/mri-f18cbd80507c4825/axial_029.png","assets/T/mri-f18cbd80507c4825/axial_030.png","assets/T/mri-f18cbd80507c4825/axial_031.png","assets/T/mri-f18cbd80507c4825/axial_032.png","assets/T/mri-f18cbd80507c4825/axial_033.png","assets/T/mri-f18cbd80507c4825/axial_034.png","assets/T/mri-f18cbd80507c4825/axial_035.png","assets/T/mri-f18cbd80507c4825/axial_036.png","assets/T/mri-f18cbd80507c4825/axial_037.png","assets/T/mri-f18cbd80507c4825/axial_038.png","assets/T/mri-f18cbd80507c4825/axial_039.png","assets/T/mri-f18cbd80507c4825/axial_040.png","assets/T/mri-f18cbd80507c4825/axial_041.png","assets/T/mri-f18cbd80507c4825/axial_042.png","assets/T/mri-f18cbd80507c4825/axial_043.png","assets/T/mri-f18cbd80507c4825/axial_044.png","assets/T/mri-f18cbd80507c4825/coronal_001.png","assets/T/mri-f18cbd80507c4825/coronal_002.png","assets/T/mri-f18cbd80507c4825/coronal_003.png","assets/T/mri-f18cbd80507c4825/coronal_004.png","assets/T/mri-f18cbd80507c4825/coronal_005.png","assets/T/mri-f18cbd80507c4825/coronal_006.png","assets/T/mri-f18cbd80507c4825/coronal_007.png","assets/T/mri-f18cbd80507c4825/coronal_008.png","assets/T/mri-f18cbd80507c4825/coronal_009.png","assets/T/mri-f18cbd80507c4825/coronal_010.png","assets/T/mri-f18cbd80507c4825/coronal_011.png","assets/T/mri-f18cbd80507c4825/coronal_012.png","assets/T/mri-f18cbd80507c4825/coronal_013.png","assets/T/mri-f18cbd80507c4825/coronal_014.png","assets/T/mri-f18cbd80507c4825/coronal_015.png","assets/T/mri-f18cbd80507c4825/coronal_016.png","assets/T/mri-f18cbd80507c4825/coronal_017.png","assets/T/mri-f18cbd80507c4825/coronal_018.png","assets/T/mri-f18cbd80507c4825/coronal_019.png","assets/T/mri-f18cbd80507c4825/coronal_020.png","assets/T/mri-f18cbd80507c4825/coronal_021.png","assets/T/mri-f18cbd80507c4825/coronal_022.png","assets/T/mri-f18cbd80507c4825/coronal_023.png","assets/T/mri-f18cbd80507c4825/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-b03c65e16e9040f7","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 68 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 26 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-b03c65e16e9040f7/axial_001.png","assets/T/mri-b03c65e16e9040f7/axial_002.png","assets/T/mri-b03c65e16e9040f7/axial_003.png","assets/T/mri-b03c65e16e9040f7/axial_004.png","assets/T/mri-b03c65e16e9040f7/axial_005.png","assets/T/mri-b03c65e16e9040f7/axial_006.png","assets/T/mri-b03c65e16e9040f7/axial_007.png","assets/T/mri-b03c65e16e9040f7/axial_008.png","assets/T/mri-b03c65e16e9040f7/axial_009.png","assets/T/mri-b03c65e16e9040f7/axial_010.png","assets/T/mri-b03c65e16e9040f7/axial_011.png","assets/T/mri-b03c65e16e9040f7/axial_012.png","assets/T/mri-b03c65e16e9040f7/axial_013.png","assets/T/mri-b03c65e16e9040f7/axial_014.png","assets/T/mri-b03c65e16e9040f7/axial_015.png","assets/T/mri-b03c65e16e9040f7/axial_016.png","assets/T/mri-b03c65e16e9040f7/axial_017.png","assets/T/mri-b03c65e16e9040f7/axial_018.png","assets/T/mri-b03c65e16e9040f7/axial_019.png","assets/T/mri-b03c65e16e9040f7/axial_020.png","assets/T/mri-b03c65e16e9040f7/axial_021.png","assets/T/mri-b03c65e16e9040f7/axial_022.png","assets/T/mri-b03c65e16e9040f7/axial_023.png","assets/T/mri-b03c65e16e9040f7/axial_024.png","assets/T/mri-b03c65e16e9040f7/axial_025.png","assets/T/mri-b03c65e16e9040f7/axial_026.png","assets/T/mri-b03c65e16e9040f7/axial_027.png","assets/T/mri-b03c65e16e9040f7/axial_028.png","assets/T/mri-b03c65e16e9040f7/axial_029.png","assets/T/mri-b03c65e16e9040f7/axial_030.png","assets/T/mri-b03c65e16e9040f7/axial_031.png","assets/T/mri-b03c65e16e9040f7/axial_032.png","assets/T/mri-b03c65e16e9040f7/axial_033.png","assets/T/mri-b03c65e16e9040f7/axial_034.png","assets/T/mri-b03c65e16e9040f7/axial_035.png","assets/T/mri-b03c65e16e9040f7/axial_036.png","assets/T/mri-b03c65e16e9040f7/axial_037.png","assets/T/mri-b03c65e16e9040f7/axial_038.png","assets/T/mri-b03c65e16e9040f7/axial_039.png","assets/T/mri-b03c65e16e9040f7/axial_040.png","assets/T/mri-b03c65e16e9040f7/axial_041.png","assets/T/mri-b03c65e16e9040f7/axial_042.png","assets/T/mri-b03c65e16e9040f7/coronal_001.png","assets/T/mri-b03c65e16e9040f7/coronal_002.png","assets/T/mri-b03c65e16e9040f7/coronal_003.png","assets/T/mri-b03c65e16e9040f7/coronal_004.png","assets/T/mri-b03c65e16e9040f7/coronal_005.png","assets/T/mri-b03c65e16e9040f7/coronal_006.png","assets/T/mri-b03c65e16e9040f7/coronal_007.png","assets/T/mri-b03c65e16e9040f7/coronal_008.png","assets/T/mri-b03c65e16e9040f7/coronal_009.png","assets/T/mri-b03c65e16e9040f7/coronal_010.png","assets/T/mri-b03c65e16e9040f7/coronal_011.png","assets/T/mri-b03c65e16e9040f7/coronal_012.png","assets/T/mri-b03c65e16e9040f7/coronal_013.png","assets/T/mri-b03c65e16e9040f7/coronal_014.png","assets/T/mri-b03c65e16e9040f7/coronal_015.png","assets/T/mri-b03c65e16e9040f7/coronal_016.png","assets/T/mri-b03c65e16e9040f7/coronal_017.png","assets/T/mri-b03c65e16e9040f7/coronal_018.png","assets/T/mri-b03c65e16e9040f7/coronal_019.png","assets/T/mri-b03c65e16e9040f7/coronal_020.png","assets/T/mri-b03c65e16e9040f7/coronal_021.png","assets/T/mri-b03c65e16e9040f7/coronal_022.png","assets/T/mri-b03c65e16e9040f7/coronal_023.png","assets/T/mri-b03c65e16e9040f7/coronal_024.png","assets/T/mri-b03c65e16e9040f7/coronal_025.png","assets/T/mri-b03c65e16e9040f7/coronal_026.png"],"stage_edition":8}
+{"id":"L3-T300:mri-46fd12fc3c8e4db4","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-46fd12fc3c8e4db4/axial_001.png","assets/T/mri-46fd12fc3c8e4db4/axial_002.png","assets/T/mri-46fd12fc3c8e4db4/axial_003.png","assets/T/mri-46fd12fc3c8e4db4/axial_004.png","assets/T/mri-46fd12fc3c8e4db4/axial_005.png","assets/T/mri-46fd12fc3c8e4db4/axial_006.png","assets/T/mri-46fd12fc3c8e4db4/axial_007.png","assets/T/mri-46fd12fc3c8e4db4/axial_008.png","assets/T/mri-46fd12fc3c8e4db4/axial_009.png","assets/T/mri-46fd12fc3c8e4db4/axial_010.png","assets/T/mri-46fd12fc3c8e4db4/axial_011.png","assets/T/mri-46fd12fc3c8e4db4/axial_012.png","assets/T/mri-46fd12fc3c8e4db4/axial_013.png","assets/T/mri-46fd12fc3c8e4db4/axial_014.png","assets/T/mri-46fd12fc3c8e4db4/axial_015.png","assets/T/mri-46fd12fc3c8e4db4/axial_016.png","assets/T/mri-46fd12fc3c8e4db4/axial_017.png","assets/T/mri-46fd12fc3c8e4db4/axial_018.png","assets/T/mri-46fd12fc3c8e4db4/axial_019.png","assets/T/mri-46fd12fc3c8e4db4/axial_020.png","assets/T/mri-46fd12fc3c8e4db4/axial_021.png","assets/T/mri-46fd12fc3c8e4db4/axial_022.png","assets/T/mri-46fd12fc3c8e4db4/axial_023.png","assets/T/mri-46fd12fc3c8e4db4/axial_024.png","assets/T/mri-46fd12fc3c8e4db4/axial_025.png","assets/T/mri-46fd12fc3c8e4db4/axial_026.png","assets/T/mri-46fd12fc3c8e4db4/axial_027.png","assets/T/mri-46fd12fc3c8e4db4/axial_028.png","assets/T/mri-46fd12fc3c8e4db4/axial_029.png","assets/T/mri-46fd12fc3c8e4db4/axial_030.png","assets/T/mri-46fd12fc3c8e4db4/axial_031.png","assets/T/mri-46fd12fc3c8e4db4/axial_032.png","assets/T/mri-46fd12fc3c8e4db4/axial_033.png","assets/T/mri-46fd12fc3c8e4db4/axial_034.png","assets/T/mri-46fd12fc3c8e4db4/axial_035.png","assets/T/mri-46fd12fc3c8e4db4/axial_036.png","assets/T/mri-46fd12fc3c8e4db4/axial_037.png","assets/T/mri-46fd12fc3c8e4db4/axial_038.png","assets/T/mri-46fd12fc3c8e4db4/axial_039.png","assets/T/mri-46fd12fc3c8e4db4/axial_040.png","assets/T/mri-46fd12fc3c8e4db4/coronal_001.png","assets/T/mri-46fd12fc3c8e4db4/coronal_002.png","assets/T/mri-46fd12fc3c8e4db4/coronal_003.png","assets/T/mri-46fd12fc3c8e4db4/coronal_004.png","assets/T/mri-46fd12fc3c8e4db4/coronal_005.png","assets/T/mri-46fd12fc3c8e4db4/coronal_006.png","assets/T/mri-46fd12fc3c8e4db4/coronal_007.png","assets/T/mri-46fd12fc3c8e4db4/coronal_008.png","assets/T/mri-46fd12fc3c8e4db4/coronal_009.png","assets/T/mri-46fd12fc3c8e4db4/coronal_010.png","assets/T/mri-46fd12fc3c8e4db4/coronal_011.png","assets/T/mri-46fd12fc3c8e4db4/coronal_012.png","assets/T/mri-46fd12fc3c8e4db4/coronal_013.png","assets/T/mri-46fd12fc3c8e4db4/coronal_014.png","assets/T/mri-46fd12fc3c8e4db4/coronal_015.png","assets/T/mri-46fd12fc3c8e4db4/coronal_016.png","assets/T/mri-46fd12fc3c8e4db4/coronal_017.png","assets/T/mri-46fd12fc3c8e4db4/coronal_018.png","assets/T/mri-46fd12fc3c8e4db4/coronal_019.png","assets/T/mri-46fd12fc3c8e4db4/coronal_020.png","assets/T/mri-46fd12fc3c8e4db4/coronal_021.png","assets/T/mri-46fd12fc3c8e4db4/coronal_022.png","assets/T/mri-46fd12fc3c8e4db4/coronal_023.png","assets/T/mri-46fd12fc3c8e4db4/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-f1332bb1d0564e4d","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 62 张图，均来自同一次检查。\n\n- 前 38 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-f1332bb1d0564e4d/axial_001.png","assets/T/mri-f1332bb1d0564e4d/axial_002.png","assets/T/mri-f1332bb1d0564e4d/axial_003.png","assets/T/mri-f1332bb1d0564e4d/axial_004.png","assets/T/mri-f1332bb1d0564e4d/axial_005.png","assets/T/mri-f1332bb1d0564e4d/axial_006.png","assets/T/mri-f1332bb1d0564e4d/axial_007.png","assets/T/mri-f1332bb1d0564e4d/axial_008.png","assets/T/mri-f1332bb1d0564e4d/axial_009.png","assets/T/mri-f1332bb1d0564e4d/axial_010.png","assets/T/mri-f1332bb1d0564e4d/axial_011.png","assets/T/mri-f1332bb1d0564e4d/axial_012.png","assets/T/mri-f1332bb1d0564e4d/axial_013.png","assets/T/mri-f1332bb1d0564e4d/axial_014.png","assets/T/mri-f1332bb1d0564e4d/axial_015.png","assets/T/mri-f1332bb1d0564e4d/axial_016.png","assets/T/mri-f1332bb1d0564e4d/axial_017.png","assets/T/mri-f1332bb1d0564e4d/axial_018.png","assets/T/mri-f1332bb1d0564e4d/axial_019.png","assets/T/mri-f1332bb1d0564e4d/axial_020.png","assets/T/mri-f1332bb1d0564e4d/axial_021.png","assets/T/mri-f1332bb1d0564e4d/axial_022.png","assets/T/mri-f1332bb1d0564e4d/axial_023.png","assets/T/mri-f1332bb1d0564e4d/axial_024.png","assets/T/mri-f1332bb1d0564e4d/axial_025.png","assets/T/mri-f1332bb1d0564e4d/axial_026.png","assets/T/mri-f1332bb1d0564e4d/axial_027.png","assets/T/mri-f1332bb1d0564e4d/axial_028.png","assets/T/mri-f1332bb1d0564e4d/axial_029.png","assets/T/mri-f1332bb1d0564e4d/axial_030.png","assets/T/mri-f1332bb1d0564e4d/axial_031.png","assets/T/mri-f1332bb1d0564e4d/axial_032.png","assets/T/mri-f1332bb1d0564e4d/axial_033.png","assets/T/mri-f1332bb1d0564e4d/axial_034.png","assets/T/mri-f1332bb1d0564e4d/axial_035.png","assets/T/mri-f1332bb1d0564e4d/axial_036.png","assets/T/mri-f1332bb1d0564e4d/axial_037.png","assets/T/mri-f1332bb1d0564e4d/axial_038.png","assets/T/mri-f1332bb1d0564e4d/coronal_001.png","assets/T/mri-f1332bb1d0564e4d/coronal_002.png","assets/T/mri-f1332bb1d0564e4d/coronal_003.png","assets/T/mri-f1332bb1d0564e4d/coronal_004.png","assets/T/mri-f1332bb1d0564e4d/coronal_005.png","assets/T/mri-f1332bb1d0564e4d/coronal_006.png","assets/T/mri-f1332bb1d0564e4d/coronal_007.png","assets/T/mri-f1332bb1d0564e4d/coronal_008.png","assets/T/mri-f1332bb1d0564e4d/coronal_009.png","assets/T/mri-f1332bb1d0564e4d/coronal_010.png","assets/T/mri-f1332bb1d0564e4d/coronal_011.png","assets/T/mri-f1332bb1d0564e4d/coronal_012.png","assets/T/mri-f1332bb1d0564e4d/coronal_013.png","assets/T/mri-f1332bb1d0564e4d/coronal_014.png","assets/T/mri-f1332bb1d0564e4d/coronal_015.png","assets/T/mri-f1332bb1d0564e4d/coronal_016.png","assets/T/mri-f1332bb1d0564e4d/coronal_017.png","assets/T/mri-f1332bb1d0564e4d/coronal_018.png","assets/T/mri-f1332bb1d0564e4d/coronal_019.png","assets/T/mri-f1332bb1d0564e4d/coronal_020.png","assets/T/mri-f1332bb1d0564e4d/coronal_021.png","assets/T/mri-f1332bb1d0564e4d/coronal_022.png","assets/T/mri-f1332bb1d0564e4d/coronal_023.png","assets/T/mri-f1332bb1d0564e4d/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-eb71471006a94a6e","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-eb71471006a94a6e/axial_001.png","assets/T/mri-eb71471006a94a6e/axial_002.png","assets/T/mri-eb71471006a94a6e/axial_003.png","assets/T/mri-eb71471006a94a6e/axial_004.png","assets/T/mri-eb71471006a94a6e/axial_005.png","assets/T/mri-eb71471006a94a6e/axial_006.png","assets/T/mri-eb71471006a94a6e/axial_007.png","assets/T/mri-eb71471006a94a6e/axial_008.png","assets/T/mri-eb71471006a94a6e/axial_009.png","assets/T/mri-eb71471006a94a6e/axial_010.png","assets/T/mri-eb71471006a94a6e/axial_011.png","assets/T/mri-eb71471006a94a6e/axial_012.png","assets/T/mri-eb71471006a94a6e/axial_013.png","assets/T/mri-eb71471006a94a6e/axial_014.png","assets/T/mri-eb71471006a94a6e/axial_015.png","assets/T/mri-eb71471006a94a6e/axial_016.png","assets/T/mri-eb71471006a94a6e/axial_017.png","assets/T/mri-eb71471006a94a6e/axial_018.png","assets/T/mri-eb71471006a94a6e/axial_019.png","assets/T/mri-eb71471006a94a6e/axial_020.png","assets/T/mri-eb71471006a94a6e/axial_021.png","assets/T/mri-eb71471006a94a6e/axial_022.png","assets/T/mri-eb71471006a94a6e/axial_023.png","assets/T/mri-eb71471006a94a6e/axial_024.png","assets/T/mri-eb71471006a94a6e/axial_025.png","assets/T/mri-eb71471006a94a6e/axial_026.png","assets/T/mri-eb71471006a94a6e/axial_027.png","assets/T/mri-eb71471006a94a6e/axial_028.png","assets/T/mri-eb71471006a94a6e/axial_029.png","assets/T/mri-eb71471006a94a6e/axial_030.png","assets/T/mri-eb71471006a94a6e/axial_031.png","assets/T/mri-eb71471006a94a6e/axial_032.png","assets/T/mri-eb71471006a94a6e/axial_033.png","assets/T/mri-eb71471006a94a6e/axial_034.png","assets/T/mri-eb71471006a94a6e/axial_035.png","assets/T/mri-eb71471006a94a6e/axial_036.png","assets/T/mri-eb71471006a94a6e/axial_037.png","assets/T/mri-eb71471006a94a6e/axial_038.png","assets/T/mri-eb71471006a94a6e/axial_039.png","assets/T/mri-eb71471006a94a6e/axial_040.png","assets/T/mri-eb71471006a94a6e/coronal_001.png","assets/T/mri-eb71471006a94a6e/coronal_002.png","assets/T/mri-eb71471006a94a6e/coronal_003.png","assets/T/mri-eb71471006a94a6e/coronal_004.png","assets/T/mri-eb71471006a94a6e/coronal_005.png","assets/T/mri-eb71471006a94a6e/coronal_006.png","assets/T/mri-eb71471006a94a6e/coronal_007.png","assets/T/mri-eb71471006a94a6e/coronal_008.png","assets/T/mri-eb71471006a94a6e/coronal_009.png","assets/T/mri-eb71471006a94a6e/coronal_010.png","assets/T/mri-eb71471006a94a6e/coronal_011.png","assets/T/mri-eb71471006a94a6e/coronal_012.png","assets/T/mri-eb71471006a94a6e/coronal_013.png","assets/T/mri-eb71471006a94a6e/coronal_014.png","assets/T/mri-eb71471006a94a6e/coronal_015.png","assets/T/mri-eb71471006a94a6e/coronal_016.png","assets/T/mri-eb71471006a94a6e/coronal_017.png","assets/T/mri-eb71471006a94a6e/coronal_018.png","assets/T/mri-eb71471006a94a6e/coronal_019.png","assets/T/mri-eb71471006a94a6e/coronal_020.png","assets/T/mri-eb71471006a94a6e/coronal_021.png","assets/T/mri-eb71471006a94a6e/coronal_022.png","assets/T/mri-eb71471006a94a6e/coronal_023.png","assets/T/mri-eb71471006a94a6e/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-3e9b74c4b7e84825","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 70 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 28 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-3e9b74c4b7e84825/axial_001.png","assets/T/mri-3e9b74c4b7e84825/axial_002.png","assets/T/mri-3e9b74c4b7e84825/axial_003.png","assets/T/mri-3e9b74c4b7e84825/axial_004.png","assets/T/mri-3e9b74c4b7e84825/axial_005.png","assets/T/mri-3e9b74c4b7e84825/axial_006.png","assets/T/mri-3e9b74c4b7e84825/axial_007.png","assets/T/mri-3e9b74c4b7e84825/axial_008.png","assets/T/mri-3e9b74c4b7e84825/axial_009.png","assets/T/mri-3e9b74c4b7e84825/axial_010.png","assets/T/mri-3e9b74c4b7e84825/axial_011.png","assets/T/mri-3e9b74c4b7e84825/axial_012.png","assets/T/mri-3e9b74c4b7e84825/axial_013.png","assets/T/mri-3e9b74c4b7e84825/axial_014.png","assets/T/mri-3e9b74c4b7e84825/axial_015.png","assets/T/mri-3e9b74c4b7e84825/axial_016.png","assets/T/mri-3e9b74c4b7e84825/axial_017.png","assets/T/mri-3e9b74c4b7e84825/axial_018.png","assets/T/mri-3e9b74c4b7e84825/axial_019.png","assets/T/mri-3e9b74c4b7e84825/axial_020.png","assets/T/mri-3e9b74c4b7e84825/axial_021.png","assets/T/mri-3e9b74c4b7e84825/axial_022.png","assets/T/mri-3e9b74c4b7e84825/axial_023.png","assets/T/mri-3e9b74c4b7e84825/axial_024.png","assets/T/mri-3e9b74c4b7e84825/axial_025.png","assets/T/mri-3e9b74c4b7e84825/axial_026.png","assets/T/mri-3e9b74c4b7e84825/axial_027.png","assets/T/mri-3e9b74c4b7e84825/axial_028.png","assets/T/mri-3e9b74c4b7e84825/axial_029.png","assets/T/mri-3e9b74c4b7e84825/axial_030.png","assets/T/mri-3e9b74c4b7e84825/axial_031.png","assets/T/mri-3e9b74c4b7e84825/axial_032.png","assets/T/mri-3e9b74c4b7e84825/axial_033.png","assets/T/mri-3e9b74c4b7e84825/axial_034.png","assets/T/mri-3e9b74c4b7e84825/axial_035.png","assets/T/mri-3e9b74c4b7e84825/axial_036.png","assets/T/mri-3e9b74c4b7e84825/axial_037.png","assets/T/mri-3e9b74c4b7e84825/axial_038.png","assets/T/mri-3e9b74c4b7e84825/axial_039.png","assets/T/mri-3e9b74c4b7e84825/axial_040.png","assets/T/mri-3e9b74c4b7e84825/axial_041.png","assets/T/mri-3e9b74c4b7e84825/axial_042.png","assets/T/mri-3e9b74c4b7e84825/coronal_001.png","assets/T/mri-3e9b74c4b7e84825/coronal_002.png","assets/T/mri-3e9b74c4b7e84825/coronal_003.png","assets/T/mri-3e9b74c4b7e84825/coronal_004.png","assets/T/mri-3e9b74c4b7e84825/coronal_005.png","assets/T/mri-3e9b74c4b7e84825/coronal_006.png","assets/T/mri-3e9b74c4b7e84825/coronal_007.png","assets/T/mri-3e9b74c4b7e84825/coronal_008.png","assets/T/mri-3e9b74c4b7e84825/coronal_009.png","assets/T/mri-3e9b74c4b7e84825/coronal_010.png","assets/T/mri-3e9b74c4b7e84825/coronal_011.png","assets/T/mri-3e9b74c4b7e84825/coronal_012.png","assets/T/mri-3e9b74c4b7e84825/coronal_013.png","assets/T/mri-3e9b74c4b7e84825/coronal_014.png","assets/T/mri-3e9b74c4b7e84825/coronal_015.png","assets/T/mri-3e9b74c4b7e84825/coronal_016.png","assets/T/mri-3e9b74c4b7e84825/coronal_017.png","assets/T/mri-3e9b74c4b7e84825/coronal_018.png","assets/T/mri-3e9b74c4b7e84825/coronal_019.png","assets/T/mri-3e9b74c4b7e84825/coronal_020.png","assets/T/mri-3e9b74c4b7e84825/coronal_021.png","assets/T/mri-3e9b74c4b7e84825/coronal_022.png","assets/T/mri-3e9b74c4b7e84825/coronal_023.png","assets/T/mri-3e9b74c4b7e84825/coronal_024.png","assets/T/mri-3e9b74c4b7e84825/coronal_025.png","assets/T/mri-3e9b74c4b7e84825/coronal_026.png","assets/T/mri-3e9b74c4b7e84825/coronal_027.png","assets/T/mri-3e9b74c4b7e84825/coronal_028.png"],"stage_edition":8}
+{"id":"L3-T300:mri-de9e22a5b5b946f0","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-de9e22a5b5b946f0/axial_001.png","assets/T/mri-de9e22a5b5b946f0/axial_002.png","assets/T/mri-de9e22a5b5b946f0/axial_003.png","assets/T/mri-de9e22a5b5b946f0/axial_004.png","assets/T/mri-de9e22a5b5b946f0/axial_005.png","assets/T/mri-de9e22a5b5b946f0/axial_006.png","assets/T/mri-de9e22a5b5b946f0/axial_007.png","assets/T/mri-de9e22a5b5b946f0/axial_008.png","assets/T/mri-de9e22a5b5b946f0/axial_009.png","assets/T/mri-de9e22a5b5b946f0/axial_010.png","assets/T/mri-de9e22a5b5b946f0/axial_011.png","assets/T/mri-de9e22a5b5b946f0/axial_012.png","assets/T/mri-de9e22a5b5b946f0/axial_013.png","assets/T/mri-de9e22a5b5b946f0/axial_014.png","assets/T/mri-de9e22a5b5b946f0/axial_015.png","assets/T/mri-de9e22a5b5b946f0/axial_016.png","assets/T/mri-de9e22a5b5b946f0/axial_017.png","assets/T/mri-de9e22a5b5b946f0/axial_018.png","assets/T/mri-de9e22a5b5b946f0/axial_019.png","assets/T/mri-de9e22a5b5b946f0/axial_020.png","assets/T/mri-de9e22a5b5b946f0/axial_021.png","assets/T/mri-de9e22a5b5b946f0/axial_022.png","assets/T/mri-de9e22a5b5b946f0/axial_023.png","assets/T/mri-de9e22a5b5b946f0/axial_024.png","assets/T/mri-de9e22a5b5b946f0/axial_025.png","assets/T/mri-de9e22a5b5b946f0/axial_026.png","assets/T/mri-de9e22a5b5b946f0/axial_027.png","assets/T/mri-de9e22a5b5b946f0/axial_028.png","assets/T/mri-de9e22a5b5b946f0/axial_029.png","assets/T/mri-de9e22a5b5b946f0/axial_030.png","assets/T/mri-de9e22a5b5b946f0/axial_031.png","assets/T/mri-de9e22a5b5b946f0/axial_032.png","assets/T/mri-de9e22a5b5b946f0/axial_033.png","assets/T/mri-de9e22a5b5b946f0/axial_034.png","assets/T/mri-de9e22a5b5b946f0/axial_035.png","assets/T/mri-de9e22a5b5b946f0/axial_036.png","assets/T/mri-de9e22a5b5b946f0/axial_037.png","assets/T/mri-de9e22a5b5b946f0/axial_038.png","assets/T/mri-de9e22a5b5b946f0/axial_039.png","assets/T/mri-de9e22a5b5b946f0/axial_040.png","assets/T/mri-de9e22a5b5b946f0/axial_041.png","assets/T/mri-de9e22a5b5b946f0/axial_042.png","assets/T/mri-de9e22a5b5b946f0/coronal_001.png","assets/T/mri-de9e22a5b5b946f0/coronal_002.png","assets/T/mri-de9e22a5b5b946f0/coronal_003.png","assets/T/mri-de9e22a5b5b946f0/coronal_004.png","assets/T/mri-de9e22a5b5b946f0/coronal_005.png","assets/T/mri-de9e22a5b5b946f0/coronal_006.png","assets/T/mri-de9e22a5b5b946f0/coronal_007.png","assets/T/mri-de9e22a5b5b946f0/coronal_008.png","assets/T/mri-de9e22a5b5b946f0/coronal_009.png","assets/T/mri-de9e22a5b5b946f0/coronal_010.png","assets/T/mri-de9e22a5b5b946f0/coronal_011.png","assets/T/mri-de9e22a5b5b946f0/coronal_012.png","assets/T/mri-de9e22a5b5b946f0/coronal_013.png","assets/T/mri-de9e22a5b5b946f0/coronal_014.png","assets/T/mri-de9e22a5b5b946f0/coronal_015.png","assets/T/mri-de9e22a5b5b946f0/coronal_016.png","assets/T/mri-de9e22a5b5b946f0/coronal_017.png","assets/T/mri-de9e22a5b5b946f0/coronal_018.png","assets/T/mri-de9e22a5b5b946f0/coronal_019.png","assets/T/mri-de9e22a5b5b946f0/coronal_020.png","assets/T/mri-de9e22a5b5b946f0/coronal_021.png","assets/T/mri-de9e22a5b5b946f0/coronal_022.png","assets/T/mri-de9e22a5b5b946f0/coronal_023.png","assets/T/mri-de9e22a5b5b946f0/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-973c4546eae9419a","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 62 张图，均来自同一次检查。\n\n- 前 38 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-973c4546eae9419a/axial_001.png","assets/T/mri-973c4546eae9419a/axial_002.png","assets/T/mri-973c4546eae9419a/axial_003.png","assets/T/mri-973c4546eae9419a/axial_004.png","assets/T/mri-973c4546eae9419a/axial_005.png","assets/T/mri-973c4546eae9419a/axial_006.png","assets/T/mri-973c4546eae9419a/axial_007.png","assets/T/mri-973c4546eae9419a/axial_008.png","assets/T/mri-973c4546eae9419a/axial_009.png","assets/T/mri-973c4546eae9419a/axial_010.png","assets/T/mri-973c4546eae9419a/axial_011.png","assets/T/mri-973c4546eae9419a/axial_012.png","assets/T/mri-973c4546eae9419a/axial_013.png","assets/T/mri-973c4546eae9419a/axial_014.png","assets/T/mri-973c4546eae9419a/axial_015.png","assets/T/mri-973c4546eae9419a/axial_016.png","assets/T/mri-973c4546eae9419a/axial_017.png","assets/T/mri-973c4546eae9419a/axial_018.png","assets/T/mri-973c4546eae9419a/axial_019.png","assets/T/mri-973c4546eae9419a/axial_020.png","assets/T/mri-973c4546eae9419a/axial_021.png","assets/T/mri-973c4546eae9419a/axial_022.png","assets/T/mri-973c4546eae9419a/axial_023.png","assets/T/mri-973c4546eae9419a/axial_024.png","assets/T/mri-973c4546eae9419a/axial_025.png","assets/T/mri-973c4546eae9419a/axial_026.png","assets/T/mri-973c4546eae9419a/axial_027.png","assets/T/mri-973c4546eae9419a/axial_028.png","assets/T/mri-973c4546eae9419a/axial_029.png","assets/T/mri-973c4546eae9419a/axial_030.png","assets/T/mri-973c4546eae9419a/axial_031.png","assets/T/mri-973c4546eae9419a/axial_032.png","assets/T/mri-973c4546eae9419a/axial_033.png","assets/T/mri-973c4546eae9419a/axial_034.png","assets/T/mri-973c4546eae9419a/axial_035.png","assets/T/mri-973c4546eae9419a/axial_036.png","assets/T/mri-973c4546eae9419a/axial_037.png","assets/T/mri-973c4546eae9419a/axial_038.png","assets/T/mri-973c4546eae9419a/coronal_001.png","assets/T/mri-973c4546eae9419a/coronal_002.png","assets/T/mri-973c4546eae9419a/coronal_003.png","assets/T/mri-973c4546eae9419a/coronal_004.png","assets/T/mri-973c4546eae9419a/coronal_005.png","assets/T/mri-973c4546eae9419a/coronal_006.png","assets/T/mri-973c4546eae9419a/coronal_007.png","assets/T/mri-973c4546eae9419a/coronal_008.png","assets/T/mri-973c4546eae9419a/coronal_009.png","assets/T/mri-973c4546eae9419a/coronal_010.png","assets/T/mri-973c4546eae9419a/coronal_011.png","assets/T/mri-973c4546eae9419a/coronal_012.png","assets/T/mri-973c4546eae9419a/coronal_013.png","assets/T/mri-973c4546eae9419a/coronal_014.png","assets/T/mri-973c4546eae9419a/coronal_015.png","assets/T/mri-973c4546eae9419a/coronal_016.png","assets/T/mri-973c4546eae9419a/coronal_017.png","assets/T/mri-973c4546eae9419a/coronal_018.png","assets/T/mri-973c4546eae9419a/coronal_019.png","assets/T/mri-973c4546eae9419a/coronal_020.png","assets/T/mri-973c4546eae9419a/coronal_021.png","assets/T/mri-973c4546eae9419a/coronal_022.png","assets/T/mri-973c4546eae9419a/coronal_023.png","assets/T/mri-973c4546eae9419a/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-8fbe2995ecbf4644","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-8fbe2995ecbf4644/axial_001.png","assets/T/mri-8fbe2995ecbf4644/axial_002.png","assets/T/mri-8fbe2995ecbf4644/axial_003.png","assets/T/mri-8fbe2995ecbf4644/axial_004.png","assets/T/mri-8fbe2995ecbf4644/axial_005.png","assets/T/mri-8fbe2995ecbf4644/axial_006.png","assets/T/mri-8fbe2995ecbf4644/axial_007.png","assets/T/mri-8fbe2995ecbf4644/axial_008.png","assets/T/mri-8fbe2995ecbf4644/axial_009.png","assets/T/mri-8fbe2995ecbf4644/axial_010.png","assets/T/mri-8fbe2995ecbf4644/axial_011.png","assets/T/mri-8fbe2995ecbf4644/axial_012.png","assets/T/mri-8fbe2995ecbf4644/axial_013.png","assets/T/mri-8fbe2995ecbf4644/axial_014.png","assets/T/mri-8fbe2995ecbf4644/axial_015.png","assets/T/mri-8fbe2995ecbf4644/axial_016.png","assets/T/mri-8fbe2995ecbf4644/axial_017.png","assets/T/mri-8fbe2995ecbf4644/axial_018.png","assets/T/mri-8fbe2995ecbf4644/axial_019.png","assets/T/mri-8fbe2995ecbf4644/axial_020.png","assets/T/mri-8fbe2995ecbf4644/axial_021.png","assets/T/mri-8fbe2995ecbf4644/axial_022.png","assets/T/mri-8fbe2995ecbf4644/axial_023.png","assets/T/mri-8fbe2995ecbf4644/axial_024.png","assets/T/mri-8fbe2995ecbf4644/axial_025.png","assets/T/mri-8fbe2995ecbf4644/axial_026.png","assets/T/mri-8fbe2995ecbf4644/axial_027.png","assets/T/mri-8fbe2995ecbf4644/axial_028.png","assets/T/mri-8fbe2995ecbf4644/axial_029.png","assets/T/mri-8fbe2995ecbf4644/axial_030.png","assets/T/mri-8fbe2995ecbf4644/axial_031.png","assets/T/mri-8fbe2995ecbf4644/axial_032.png","assets/T/mri-8fbe2995ecbf4644/axial_033.png","assets/T/mri-8fbe2995ecbf4644/axial_034.png","assets/T/mri-8fbe2995ecbf4644/axial_035.png","assets/T/mri-8fbe2995ecbf4644/axial_036.png","assets/T/mri-8fbe2995ecbf4644/axial_037.png","assets/T/mri-8fbe2995ecbf4644/axial_038.png","assets/T/mri-8fbe2995ecbf4644/axial_039.png","assets/T/mri-8fbe2995ecbf4644/axial_040.png","assets/T/mri-8fbe2995ecbf4644/axial_041.png","assets/T/mri-8fbe2995ecbf4644/axial_042.png","assets/T/mri-8fbe2995ecbf4644/coronal_001.png","assets/T/mri-8fbe2995ecbf4644/coronal_002.png","assets/T/mri-8fbe2995ecbf4644/coronal_003.png","assets/T/mri-8fbe2995ecbf4644/coronal_004.png","assets/T/mri-8fbe2995ecbf4644/coronal_005.png","assets/T/mri-8fbe2995ecbf4644/coronal_006.png","assets/T/mri-8fbe2995ecbf4644/coronal_007.png","assets/T/mri-8fbe2995ecbf4644/coronal_008.png","assets/T/mri-8fbe2995ecbf4644/coronal_009.png","assets/T/mri-8fbe2995ecbf4644/coronal_010.png","assets/T/mri-8fbe2995ecbf4644/coronal_011.png","assets/T/mri-8fbe2995ecbf4644/coronal_012.png","assets/T/mri-8fbe2995ecbf4644/coronal_013.png","assets/T/mri-8fbe2995ecbf4644/coronal_014.png","assets/T/mri-8fbe2995ecbf4644/coronal_015.png","assets/T/mri-8fbe2995ecbf4644/coronal_016.png","assets/T/mri-8fbe2995ecbf4644/coronal_017.png","assets/T/mri-8fbe2995ecbf4644/coronal_018.png","assets/T/mri-8fbe2995ecbf4644/coronal_019.png","assets/T/mri-8fbe2995ecbf4644/coronal_020.png","assets/T/mri-8fbe2995ecbf4644/coronal_021.png","assets/T/mri-8fbe2995ecbf4644/coronal_022.png","assets/T/mri-8fbe2995ecbf4644/coronal_023.png","assets/T/mri-8fbe2995ecbf4644/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-c543bdb39c8642be","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-c543bdb39c8642be/axial_001.png","assets/T/mri-c543bdb39c8642be/axial_002.png","assets/T/mri-c543bdb39c8642be/axial_003.png","assets/T/mri-c543bdb39c8642be/axial_004.png","assets/T/mri-c543bdb39c8642be/axial_005.png","assets/T/mri-c543bdb39c8642be/axial_006.png","assets/T/mri-c543bdb39c8642be/axial_007.png","assets/T/mri-c543bdb39c8642be/axial_008.png","assets/T/mri-c543bdb39c8642be/axial_009.png","assets/T/mri-c543bdb39c8642be/axial_010.png","assets/T/mri-c543bdb39c8642be/axial_011.png","assets/T/mri-c543bdb39c8642be/axial_012.png","assets/T/mri-c543bdb39c8642be/axial_013.png","assets/T/mri-c543bdb39c8642be/axial_014.png","assets/T/mri-c543bdb39c8642be/axial_015.png","assets/T/mri-c543bdb39c8642be/axial_016.png","assets/T/mri-c543bdb39c8642be/axial_017.png","assets/T/mri-c543bdb39c8642be/axial_018.png","assets/T/mri-c543bdb39c8642be/axial_019.png","assets/T/mri-c543bdb39c8642be/axial_020.png","assets/T/mri-c543bdb39c8642be/axial_021.png","assets/T/mri-c543bdb39c8642be/axial_022.png","assets/T/mri-c543bdb39c8642be/axial_023.png","assets/T/mri-c543bdb39c8642be/axial_024.png","assets/T/mri-c543bdb39c8642be/axial_025.png","assets/T/mri-c543bdb39c8642be/axial_026.png","assets/T/mri-c543bdb39c8642be/axial_027.png","assets/T/mri-c543bdb39c8642be/axial_028.png","assets/T/mri-c543bdb39c8642be/axial_029.png","assets/T/mri-c543bdb39c8642be/axial_030.png","assets/T/mri-c543bdb39c8642be/axial_031.png","assets/T/mri-c543bdb39c8642be/axial_032.png","assets/T/mri-c543bdb39c8642be/axial_033.png","assets/T/mri-c543bdb39c8642be/axial_034.png","assets/T/mri-c543bdb39c8642be/axial_035.png","assets/T/mri-c543bdb39c8642be/axial_036.png","assets/T/mri-c543bdb39c8642be/axial_037.png","assets/T/mri-c543bdb39c8642be/axial_038.png","assets/T/mri-c543bdb39c8642be/axial_039.png","assets/T/mri-c543bdb39c8642be/axial_040.png","assets/T/mri-c543bdb39c8642be/axial_041.png","assets/T/mri-c543bdb39c8642be/axial_042.png","assets/T/mri-c543bdb39c8642be/coronal_001.png","assets/T/mri-c543bdb39c8642be/coronal_002.png","assets/T/mri-c543bdb39c8642be/coronal_003.png","assets/T/mri-c543bdb39c8642be/coronal_004.png","assets/T/mri-c543bdb39c8642be/coronal_005.png","assets/T/mri-c543bdb39c8642be/coronal_006.png","assets/T/mri-c543bdb39c8642be/coronal_007.png","assets/T/mri-c543bdb39c8642be/coronal_008.png","assets/T/mri-c543bdb39c8642be/coronal_009.png","assets/T/mri-c543bdb39c8642be/coronal_010.png","assets/T/mri-c543bdb39c8642be/coronal_011.png","assets/T/mri-c543bdb39c8642be/coronal_012.png","assets/T/mri-c543bdb39c8642be/coronal_013.png","assets/T/mri-c543bdb39c8642be/coronal_014.png","assets/T/mri-c543bdb39c8642be/coronal_015.png","assets/T/mri-c543bdb39c8642be/coronal_016.png","assets/T/mri-c543bdb39c8642be/coronal_017.png","assets/T/mri-c543bdb39c8642be/coronal_018.png","assets/T/mri-c543bdb39c8642be/coronal_019.png","assets/T/mri-c543bdb39c8642be/coronal_020.png","assets/T/mri-c543bdb39c8642be/coronal_021.png","assets/T/mri-c543bdb39c8642be/coronal_022.png","assets/T/mri-c543bdb39c8642be/coronal_023.png","assets/T/mri-c543bdb39c8642be/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-ff0c8aa579c84949","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-ff0c8aa579c84949/axial_001.png","assets/T/mri-ff0c8aa579c84949/axial_002.png","assets/T/mri-ff0c8aa579c84949/axial_003.png","assets/T/mri-ff0c8aa579c84949/axial_004.png","assets/T/mri-ff0c8aa579c84949/axial_005.png","assets/T/mri-ff0c8aa579c84949/axial_006.png","assets/T/mri-ff0c8aa579c84949/axial_007.png","assets/T/mri-ff0c8aa579c84949/axial_008.png","assets/T/mri-ff0c8aa579c84949/axial_009.png","assets/T/mri-ff0c8aa579c84949/axial_010.png","assets/T/mri-ff0c8aa579c84949/axial_011.png","assets/T/mri-ff0c8aa579c84949/axial_012.png","assets/T/mri-ff0c8aa579c84949/axial_013.png","assets/T/mri-ff0c8aa579c84949/axial_014.png","assets/T/mri-ff0c8aa579c84949/axial_015.png","assets/T/mri-ff0c8aa579c84949/axial_016.png","assets/T/mri-ff0c8aa579c84949/axial_017.png","assets/T/mri-ff0c8aa579c84949/axial_018.png","assets/T/mri-ff0c8aa579c84949/axial_019.png","assets/T/mri-ff0c8aa579c84949/axial_020.png","assets/T/mri-ff0c8aa579c84949/axial_021.png","assets/T/mri-ff0c8aa579c84949/axial_022.png","assets/T/mri-ff0c8aa579c84949/axial_023.png","assets/T/mri-ff0c8aa579c84949/axial_024.png","assets/T/mri-ff0c8aa579c84949/axial_025.png","assets/T/mri-ff0c8aa579c84949/axial_026.png","assets/T/mri-ff0c8aa579c84949/axial_027.png","assets/T/mri-ff0c8aa579c84949/axial_028.png","assets/T/mri-ff0c8aa579c84949/axial_029.png","assets/T/mri-ff0c8aa579c84949/axial_030.png","assets/T/mri-ff0c8aa579c84949/axial_031.png","assets/T/mri-ff0c8aa579c84949/axial_032.png","assets/T/mri-ff0c8aa579c84949/axial_033.png","assets/T/mri-ff0c8aa579c84949/axial_034.png","assets/T/mri-ff0c8aa579c84949/axial_035.png","assets/T/mri-ff0c8aa579c84949/axial_036.png","assets/T/mri-ff0c8aa579c84949/axial_037.png","assets/T/mri-ff0c8aa579c84949/axial_038.png","assets/T/mri-ff0c8aa579c84949/axial_039.png","assets/T/mri-ff0c8aa579c84949/axial_040.png","assets/T/mri-ff0c8aa579c84949/axial_041.png","assets/T/mri-ff0c8aa579c84949/axial_042.png","assets/T/mri-ff0c8aa579c84949/coronal_001.png","assets/T/mri-ff0c8aa579c84949/coronal_002.png","assets/T/mri-ff0c8aa579c84949/coronal_003.png","assets/T/mri-ff0c8aa579c84949/coronal_004.png","assets/T/mri-ff0c8aa579c84949/coronal_005.png","assets/T/mri-ff0c8aa579c84949/coronal_006.png","assets/T/mri-ff0c8aa579c84949/coronal_007.png","assets/T/mri-ff0c8aa579c84949/coronal_008.png","assets/T/mri-ff0c8aa579c84949/coronal_009.png","assets/T/mri-ff0c8aa579c84949/coronal_010.png","assets/T/mri-ff0c8aa579c84949/coronal_011.png","assets/T/mri-ff0c8aa579c84949/coronal_012.png","assets/T/mri-ff0c8aa579c84949/coronal_013.png","assets/T/mri-ff0c8aa579c84949/coronal_014.png","assets/T/mri-ff0c8aa579c84949/coronal_015.png","assets/T/mri-ff0c8aa579c84949/coronal_016.png","assets/T/mri-ff0c8aa579c84949/coronal_017.png","assets/T/mri-ff0c8aa579c84949/coronal_018.png","assets/T/mri-ff0c8aa579c84949/coronal_019.png","assets/T/mri-ff0c8aa579c84949/coronal_020.png","assets/T/mri-ff0c8aa579c84949/coronal_021.png","assets/T/mri-ff0c8aa579c84949/coronal_022.png","assets/T/mri-ff0c8aa579c84949/coronal_023.png","assets/T/mri-ff0c8aa579c84949/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-e3e37a23a6af4277","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-e3e37a23a6af4277/axial_001.png","assets/T/mri-e3e37a23a6af4277/axial_002.png","assets/T/mri-e3e37a23a6af4277/axial_003.png","assets/T/mri-e3e37a23a6af4277/axial_004.png","assets/T/mri-e3e37a23a6af4277/axial_005.png","assets/T/mri-e3e37a23a6af4277/axial_006.png","assets/T/mri-e3e37a23a6af4277/axial_007.png","assets/T/mri-e3e37a23a6af4277/axial_008.png","assets/T/mri-e3e37a23a6af4277/axial_009.png","assets/T/mri-e3e37a23a6af4277/axial_010.png","assets/T/mri-e3e37a23a6af4277/axial_011.png","assets/T/mri-e3e37a23a6af4277/axial_012.png","assets/T/mri-e3e37a23a6af4277/axial_013.png","assets/T/mri-e3e37a23a6af4277/axial_014.png","assets/T/mri-e3e37a23a6af4277/axial_015.png","assets/T/mri-e3e37a23a6af4277/axial_016.png","assets/T/mri-e3e37a23a6af4277/axial_017.png","assets/T/mri-e3e37a23a6af4277/axial_018.png","assets/T/mri-e3e37a23a6af4277/axial_019.png","assets/T/mri-e3e37a23a6af4277/axial_020.png","assets/T/mri-e3e37a23a6af4277/axial_021.png","assets/T/mri-e3e37a23a6af4277/axial_022.png","assets/T/mri-e3e37a23a6af4277/axial_023.png","assets/T/mri-e3e37a23a6af4277/axial_024.png","assets/T/mri-e3e37a23a6af4277/axial_025.png","assets/T/mri-e3e37a23a6af4277/axial_026.png","assets/T/mri-e3e37a23a6af4277/axial_027.png","assets/T/mri-e3e37a23a6af4277/axial_028.png","assets/T/mri-e3e37a23a6af4277/axial_029.png","assets/T/mri-e3e37a23a6af4277/axial_030.png","assets/T/mri-e3e37a23a6af4277/axial_031.png","assets/T/mri-e3e37a23a6af4277/axial_032.png","assets/T/mri-e3e37a23a6af4277/axial_033.png","assets/T/mri-e3e37a23a6af4277/axial_034.png","assets/T/mri-e3e37a23a6af4277/axial_035.png","assets/T/mri-e3e37a23a6af4277/axial_036.png","assets/T/mri-e3e37a23a6af4277/axial_037.png","assets/T/mri-e3e37a23a6af4277/axial_038.png","assets/T/mri-e3e37a23a6af4277/axial_039.png","assets/T/mri-e3e37a23a6af4277/axial_040.png","assets/T/mri-e3e37a23a6af4277/coronal_001.png","assets/T/mri-e3e37a23a6af4277/coronal_002.png","assets/T/mri-e3e37a23a6af4277/coronal_003.png","assets/T/mri-e3e37a23a6af4277/coronal_004.png","assets/T/mri-e3e37a23a6af4277/coronal_005.png","assets/T/mri-e3e37a23a6af4277/coronal_006.png","assets/T/mri-e3e37a23a6af4277/coronal_007.png","assets/T/mri-e3e37a23a6af4277/coronal_008.png","assets/T/mri-e3e37a23a6af4277/coronal_009.png","assets/T/mri-e3e37a23a6af4277/coronal_010.png","assets/T/mri-e3e37a23a6af4277/coronal_011.png","assets/T/mri-e3e37a23a6af4277/coronal_012.png","assets/T/mri-e3e37a23a6af4277/coronal_013.png","assets/T/mri-e3e37a23a6af4277/coronal_014.png","assets/T/mri-e3e37a23a6af4277/coronal_015.png","assets/T/mri-e3e37a23a6af4277/coronal_016.png","assets/T/mri-e3e37a23a6af4277/coronal_017.png","assets/T/mri-e3e37a23a6af4277/coronal_018.png","assets/T/mri-e3e37a23a6af4277/coronal_019.png","assets/T/mri-e3e37a23a6af4277/coronal_020.png","assets/T/mri-e3e37a23a6af4277/coronal_021.png","assets/T/mri-e3e37a23a6af4277/coronal_022.png","assets/T/mri-e3e37a23a6af4277/coronal_023.png","assets/T/mri-e3e37a23a6af4277/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-c32d5d583da8477e","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-c32d5d583da8477e/axial_001.png","assets/T/mri-c32d5d583da8477e/axial_002.png","assets/T/mri-c32d5d583da8477e/axial_003.png","assets/T/mri-c32d5d583da8477e/axial_004.png","assets/T/mri-c32d5d583da8477e/axial_005.png","assets/T/mri-c32d5d583da8477e/axial_006.png","assets/T/mri-c32d5d583da8477e/axial_007.png","assets/T/mri-c32d5d583da8477e/axial_008.png","assets/T/mri-c32d5d583da8477e/axial_009.png","assets/T/mri-c32d5d583da8477e/axial_010.png","assets/T/mri-c32d5d583da8477e/axial_011.png","assets/T/mri-c32d5d583da8477e/axial_012.png","assets/T/mri-c32d5d583da8477e/axial_013.png","assets/T/mri-c32d5d583da8477e/axial_014.png","assets/T/mri-c32d5d583da8477e/axial_015.png","assets/T/mri-c32d5d583da8477e/axial_016.png","assets/T/mri-c32d5d583da8477e/axial_017.png","assets/T/mri-c32d5d583da8477e/axial_018.png","assets/T/mri-c32d5d583da8477e/axial_019.png","assets/T/mri-c32d5d583da8477e/axial_020.png","assets/T/mri-c32d5d583da8477e/axial_021.png","assets/T/mri-c32d5d583da8477e/axial_022.png","assets/T/mri-c32d5d583da8477e/axial_023.png","assets/T/mri-c32d5d583da8477e/axial_024.png","assets/T/mri-c32d5d583da8477e/axial_025.png","assets/T/mri-c32d5d583da8477e/axial_026.png","assets/T/mri-c32d5d583da8477e/axial_027.png","assets/T/mri-c32d5d583da8477e/axial_028.png","assets/T/mri-c32d5d583da8477e/axial_029.png","assets/T/mri-c32d5d583da8477e/axial_030.png","assets/T/mri-c32d5d583da8477e/axial_031.png","assets/T/mri-c32d5d583da8477e/axial_032.png","assets/T/mri-c32d5d583da8477e/axial_033.png","assets/T/mri-c32d5d583da8477e/axial_034.png","assets/T/mri-c32d5d583da8477e/axial_035.png","assets/T/mri-c32d5d583da8477e/axial_036.png","assets/T/mri-c32d5d583da8477e/axial_037.png","assets/T/mri-c32d5d583da8477e/axial_038.png","assets/T/mri-c32d5d583da8477e/axial_039.png","assets/T/mri-c32d5d583da8477e/axial_040.png","assets/T/mri-c32d5d583da8477e/coronal_001.png","assets/T/mri-c32d5d583da8477e/coronal_002.png","assets/T/mri-c32d5d583da8477e/coronal_003.png","assets/T/mri-c32d5d583da8477e/coronal_004.png","assets/T/mri-c32d5d583da8477e/coronal_005.png","assets/T/mri-c32d5d583da8477e/coronal_006.png","assets/T/mri-c32d5d583da8477e/coronal_007.png","assets/T/mri-c32d5d583da8477e/coronal_008.png","assets/T/mri-c32d5d583da8477e/coronal_009.png","assets/T/mri-c32d5d583da8477e/coronal_010.png","assets/T/mri-c32d5d583da8477e/coronal_011.png","assets/T/mri-c32d5d583da8477e/coronal_012.png","assets/T/mri-c32d5d583da8477e/coronal_013.png","assets/T/mri-c32d5d583da8477e/coronal_014.png","assets/T/mri-c32d5d583da8477e/coronal_015.png","assets/T/mri-c32d5d583da8477e/coronal_016.png","assets/T/mri-c32d5d583da8477e/coronal_017.png","assets/T/mri-c32d5d583da8477e/coronal_018.png","assets/T/mri-c32d5d583da8477e/coronal_019.png","assets/T/mri-c32d5d583da8477e/coronal_020.png","assets/T/mri-c32d5d583da8477e/coronal_021.png","assets/T/mri-c32d5d583da8477e/coronal_022.png","assets/T/mri-c32d5d583da8477e/coronal_023.png","assets/T/mri-c32d5d583da8477e/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-4f33ce82b81a40bc","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-4f33ce82b81a40bc/axial_001.png","assets/T/mri-4f33ce82b81a40bc/axial_002.png","assets/T/mri-4f33ce82b81a40bc/axial_003.png","assets/T/mri-4f33ce82b81a40bc/axial_004.png","assets/T/mri-4f33ce82b81a40bc/axial_005.png","assets/T/mri-4f33ce82b81a40bc/axial_006.png","assets/T/mri-4f33ce82b81a40bc/axial_007.png","assets/T/mri-4f33ce82b81a40bc/axial_008.png","assets/T/mri-4f33ce82b81a40bc/axial_009.png","assets/T/mri-4f33ce82b81a40bc/axial_010.png","assets/T/mri-4f33ce82b81a40bc/axial_011.png","assets/T/mri-4f33ce82b81a40bc/axial_012.png","assets/T/mri-4f33ce82b81a40bc/axial_013.png","assets/T/mri-4f33ce82b81a40bc/axial_014.png","assets/T/mri-4f33ce82b81a40bc/axial_015.png","assets/T/mri-4f33ce82b81a40bc/axial_016.png","assets/T/mri-4f33ce82b81a40bc/axial_017.png","assets/T/mri-4f33ce82b81a40bc/axial_018.png","assets/T/mri-4f33ce82b81a40bc/axial_019.png","assets/T/mri-4f33ce82b81a40bc/axial_020.png","assets/T/mri-4f33ce82b81a40bc/axial_021.png","assets/T/mri-4f33ce82b81a40bc/axial_022.png","assets/T/mri-4f33ce82b81a40bc/axial_023.png","assets/T/mri-4f33ce82b81a40bc/axial_024.png","assets/T/mri-4f33ce82b81a40bc/axial_025.png","assets/T/mri-4f33ce82b81a40bc/axial_026.png","assets/T/mri-4f33ce82b81a40bc/axial_027.png","assets/T/mri-4f33ce82b81a40bc/axial_028.png","assets/T/mri-4f33ce82b81a40bc/axial_029.png","assets/T/mri-4f33ce82b81a40bc/axial_030.png","assets/T/mri-4f33ce82b81a40bc/axial_031.png","assets/T/mri-4f33ce82b81a40bc/axial_032.png","assets/T/mri-4f33ce82b81a40bc/axial_033.png","assets/T/mri-4f33ce82b81a40bc/axial_034.png","assets/T/mri-4f33ce82b81a40bc/axial_035.png","assets/T/mri-4f33ce82b81a40bc/axial_036.png","assets/T/mri-4f33ce82b81a40bc/axial_037.png","assets/T/mri-4f33ce82b81a40bc/axial_038.png","assets/T/mri-4f33ce82b81a40bc/axial_039.png","assets/T/mri-4f33ce82b81a40bc/axial_040.png","assets/T/mri-4f33ce82b81a40bc/axial_041.png","assets/T/mri-4f33ce82b81a40bc/axial_042.png","assets/T/mri-4f33ce82b81a40bc/coronal_001.png","assets/T/mri-4f33ce82b81a40bc/coronal_002.png","assets/T/mri-4f33ce82b81a40bc/coronal_003.png","assets/T/mri-4f33ce82b81a40bc/coronal_004.png","assets/T/mri-4f33ce82b81a40bc/coronal_005.png","assets/T/mri-4f33ce82b81a40bc/coronal_006.png","assets/T/mri-4f33ce82b81a40bc/coronal_007.png","assets/T/mri-4f33ce82b81a40bc/coronal_008.png","assets/T/mri-4f33ce82b81a40bc/coronal_009.png","assets/T/mri-4f33ce82b81a40bc/coronal_010.png","assets/T/mri-4f33ce82b81a40bc/coronal_011.png","assets/T/mri-4f33ce82b81a40bc/coronal_012.png","assets/T/mri-4f33ce82b81a40bc/coronal_013.png","assets/T/mri-4f33ce82b81a40bc/coronal_014.png","assets/T/mri-4f33ce82b81a40bc/coronal_015.png","assets/T/mri-4f33ce82b81a40bc/coronal_016.png","assets/T/mri-4f33ce82b81a40bc/coronal_017.png","assets/T/mri-4f33ce82b81a40bc/coronal_018.png","assets/T/mri-4f33ce82b81a40bc/coronal_019.png","assets/T/mri-4f33ce82b81a40bc/coronal_020.png","assets/T/mri-4f33ce82b81a40bc/coronal_021.png","assets/T/mri-4f33ce82b81a40bc/coronal_022.png","assets/T/mri-4f33ce82b81a40bc/coronal_023.png","assets/T/mri-4f33ce82b81a40bc/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-842294051b2440d7","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 38 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 28 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-842294051b2440d7/axial_001.png","assets/T/mri-842294051b2440d7/axial_002.png","assets/T/mri-842294051b2440d7/axial_003.png","assets/T/mri-842294051b2440d7/axial_004.png","assets/T/mri-842294051b2440d7/axial_005.png","assets/T/mri-842294051b2440d7/axial_006.png","assets/T/mri-842294051b2440d7/axial_007.png","assets/T/mri-842294051b2440d7/axial_008.png","assets/T/mri-842294051b2440d7/axial_009.png","assets/T/mri-842294051b2440d7/axial_010.png","assets/T/mri-842294051b2440d7/axial_011.png","assets/T/mri-842294051b2440d7/axial_012.png","assets/T/mri-842294051b2440d7/axial_013.png","assets/T/mri-842294051b2440d7/axial_014.png","assets/T/mri-842294051b2440d7/axial_015.png","assets/T/mri-842294051b2440d7/axial_016.png","assets/T/mri-842294051b2440d7/axial_017.png","assets/T/mri-842294051b2440d7/axial_018.png","assets/T/mri-842294051b2440d7/axial_019.png","assets/T/mri-842294051b2440d7/axial_020.png","assets/T/mri-842294051b2440d7/axial_021.png","assets/T/mri-842294051b2440d7/axial_022.png","assets/T/mri-842294051b2440d7/axial_023.png","assets/T/mri-842294051b2440d7/axial_024.png","assets/T/mri-842294051b2440d7/axial_025.png","assets/T/mri-842294051b2440d7/axial_026.png","assets/T/mri-842294051b2440d7/axial_027.png","assets/T/mri-842294051b2440d7/axial_028.png","assets/T/mri-842294051b2440d7/axial_029.png","assets/T/mri-842294051b2440d7/axial_030.png","assets/T/mri-842294051b2440d7/axial_031.png","assets/T/mri-842294051b2440d7/axial_032.png","assets/T/mri-842294051b2440d7/axial_033.png","assets/T/mri-842294051b2440d7/axial_034.png","assets/T/mri-842294051b2440d7/axial_035.png","assets/T/mri-842294051b2440d7/axial_036.png","assets/T/mri-842294051b2440d7/axial_037.png","assets/T/mri-842294051b2440d7/axial_038.png","assets/T/mri-842294051b2440d7/coronal_001.png","assets/T/mri-842294051b2440d7/coronal_002.png","assets/T/mri-842294051b2440d7/coronal_003.png","assets/T/mri-842294051b2440d7/coronal_004.png","assets/T/mri-842294051b2440d7/coronal_005.png","assets/T/mri-842294051b2440d7/coronal_006.png","assets/T/mri-842294051b2440d7/coronal_007.png","assets/T/mri-842294051b2440d7/coronal_008.png","assets/T/mri-842294051b2440d7/coronal_009.png","assets/T/mri-842294051b2440d7/coronal_010.png","assets/T/mri-842294051b2440d7/coronal_011.png","assets/T/mri-842294051b2440d7/coronal_012.png","assets/T/mri-842294051b2440d7/coronal_013.png","assets/T/mri-842294051b2440d7/coronal_014.png","assets/T/mri-842294051b2440d7/coronal_015.png","assets/T/mri-842294051b2440d7/coronal_016.png","assets/T/mri-842294051b2440d7/coronal_017.png","assets/T/mri-842294051b2440d7/coronal_018.png","assets/T/mri-842294051b2440d7/coronal_019.png","assets/T/mri-842294051b2440d7/coronal_020.png","assets/T/mri-842294051b2440d7/coronal_021.png","assets/T/mri-842294051b2440d7/coronal_022.png","assets/T/mri-842294051b2440d7/coronal_023.png","assets/T/mri-842294051b2440d7/coronal_024.png","assets/T/mri-842294051b2440d7/coronal_025.png","assets/T/mri-842294051b2440d7/coronal_026.png","assets/T/mri-842294051b2440d7/coronal_027.png","assets/T/mri-842294051b2440d7/coronal_028.png"],"stage_edition":8}
+{"id":"L3-T300:mri-02abb54e29f14bca","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-02abb54e29f14bca/axial_001.png","assets/T/mri-02abb54e29f14bca/axial_002.png","assets/T/mri-02abb54e29f14bca/axial_003.png","assets/T/mri-02abb54e29f14bca/axial_004.png","assets/T/mri-02abb54e29f14bca/axial_005.png","assets/T/mri-02abb54e29f14bca/axial_006.png","assets/T/mri-02abb54e29f14bca/axial_007.png","assets/T/mri-02abb54e29f14bca/axial_008.png","assets/T/mri-02abb54e29f14bca/axial_009.png","assets/T/mri-02abb54e29f14bca/axial_010.png","assets/T/mri-02abb54e29f14bca/axial_011.png","assets/T/mri-02abb54e29f14bca/axial_012.png","assets/T/mri-02abb54e29f14bca/axial_013.png","assets/T/mri-02abb54e29f14bca/axial_014.png","assets/T/mri-02abb54e29f14bca/axial_015.png","assets/T/mri-02abb54e29f14bca/axial_016.png","assets/T/mri-02abb54e29f14bca/axial_017.png","assets/T/mri-02abb54e29f14bca/axial_018.png","assets/T/mri-02abb54e29f14bca/axial_019.png","assets/T/mri-02abb54e29f14bca/axial_020.png","assets/T/mri-02abb54e29f14bca/axial_021.png","assets/T/mri-02abb54e29f14bca/axial_022.png","assets/T/mri-02abb54e29f14bca/axial_023.png","assets/T/mri-02abb54e29f14bca/axial_024.png","assets/T/mri-02abb54e29f14bca/axial_025.png","assets/T/mri-02abb54e29f14bca/axial_026.png","assets/T/mri-02abb54e29f14bca/axial_027.png","assets/T/mri-02abb54e29f14bca/axial_028.png","assets/T/mri-02abb54e29f14bca/axial_029.png","assets/T/mri-02abb54e29f14bca/axial_030.png","assets/T/mri-02abb54e29f14bca/axial_031.png","assets/T/mri-02abb54e29f14bca/axial_032.png","assets/T/mri-02abb54e29f14bca/axial_033.png","assets/T/mri-02abb54e29f14bca/axial_034.png","assets/T/mri-02abb54e29f14bca/axial_035.png","assets/T/mri-02abb54e29f14bca/axial_036.png","assets/T/mri-02abb54e29f14bca/axial_037.png","assets/T/mri-02abb54e29f14bca/axial_038.png","assets/T/mri-02abb54e29f14bca/axial_039.png","assets/T/mri-02abb54e29f14bca/axial_040.png","assets/T/mri-02abb54e29f14bca/coronal_001.png","assets/T/mri-02abb54e29f14bca/coronal_002.png","assets/T/mri-02abb54e29f14bca/coronal_003.png","assets/T/mri-02abb54e29f14bca/coronal_004.png","assets/T/mri-02abb54e29f14bca/coronal_005.png","assets/T/mri-02abb54e29f14bca/coronal_006.png","assets/T/mri-02abb54e29f14bca/coronal_007.png","assets/T/mri-02abb54e29f14bca/coronal_008.png","assets/T/mri-02abb54e29f14bca/coronal_009.png","assets/T/mri-02abb54e29f14bca/coronal_010.png","assets/T/mri-02abb54e29f14bca/coronal_011.png","assets/T/mri-02abb54e29f14bca/coronal_012.png","assets/T/mri-02abb54e29f14bca/coronal_013.png","assets/T/mri-02abb54e29f14bca/coronal_014.png","assets/T/mri-02abb54e29f14bca/coronal_015.png","assets/T/mri-02abb54e29f14bca/coronal_016.png","assets/T/mri-02abb54e29f14bca/coronal_017.png","assets/T/mri-02abb54e29f14bca/coronal_018.png","assets/T/mri-02abb54e29f14bca/coronal_019.png","assets/T/mri-02abb54e29f14bca/coronal_020.png","assets/T/mri-02abb54e29f14bca/coronal_021.png","assets/T/mri-02abb54e29f14bca/coronal_022.png","assets/T/mri-02abb54e29f14bca/coronal_023.png","assets/T/mri-02abb54e29f14bca/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-735dee52e15e4269","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 68 张图，均来自同一次检查。\n\n- 前 44 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-735dee52e15e4269/axial_001.png","assets/T/mri-735dee52e15e4269/axial_002.png","assets/T/mri-735dee52e15e4269/axial_003.png","assets/T/mri-735dee52e15e4269/axial_004.png","assets/T/mri-735dee52e15e4269/axial_005.png","assets/T/mri-735dee52e15e4269/axial_006.png","assets/T/mri-735dee52e15e4269/axial_007.png","assets/T/mri-735dee52e15e4269/axial_008.png","assets/T/mri-735dee52e15e4269/axial_009.png","assets/T/mri-735dee52e15e4269/axial_010.png","assets/T/mri-735dee52e15e4269/axial_011.png","assets/T/mri-735dee52e15e4269/axial_012.png","assets/T/mri-735dee52e15e4269/axial_013.png","assets/T/mri-735dee52e15e4269/axial_014.png","assets/T/mri-735dee52e15e4269/axial_015.png","assets/T/mri-735dee52e15e4269/axial_016.png","assets/T/mri-735dee52e15e4269/axial_017.png","assets/T/mri-735dee52e15e4269/axial_018.png","assets/T/mri-735dee52e15e4269/axial_019.png","assets/T/mri-735dee52e15e4269/axial_020.png","assets/T/mri-735dee52e15e4269/axial_021.png","assets/T/mri-735dee52e15e4269/axial_022.png","assets/T/mri-735dee52e15e4269/axial_023.png","assets/T/mri-735dee52e15e4269/axial_024.png","assets/T/mri-735dee52e15e4269/axial_025.png","assets/T/mri-735dee52e15e4269/axial_026.png","assets/T/mri-735dee52e15e4269/axial_027.png","assets/T/mri-735dee52e15e4269/axial_028.png","assets/T/mri-735dee52e15e4269/axial_029.png","assets/T/mri-735dee52e15e4269/axial_030.png","assets/T/mri-735dee52e15e4269/axial_031.png","assets/T/mri-735dee52e15e4269/axial_032.png","assets/T/mri-735dee52e15e4269/axial_033.png","assets/T/mri-735dee52e15e4269/axial_034.png","assets/T/mri-735dee52e15e4269/axial_035.png","assets/T/mri-735dee52e15e4269/axial_036.png","assets/T/mri-735dee52e15e4269/axial_037.png","assets/T/mri-735dee52e15e4269/axial_038.png","assets/T/mri-735dee52e15e4269/axial_039.png","assets/T/mri-735dee52e15e4269/axial_040.png","assets/T/mri-735dee52e15e4269/axial_041.png","assets/T/mri-735dee52e15e4269/axial_042.png","assets/T/mri-735dee52e15e4269/axial_043.png","assets/T/mri-735dee52e15e4269/axial_044.png","assets/T/mri-735dee52e15e4269/coronal_001.png","assets/T/mri-735dee52e15e4269/coronal_002.png","assets/T/mri-735dee52e15e4269/coronal_003.png","assets/T/mri-735dee52e15e4269/coronal_004.png","assets/T/mri-735dee52e15e4269/coronal_005.png","assets/T/mri-735dee52e15e4269/coronal_006.png","assets/T/mri-735dee52e15e4269/coronal_007.png","assets/T/mri-735dee52e15e4269/coronal_008.png","assets/T/mri-735dee52e15e4269/coronal_009.png","assets/T/mri-735dee52e15e4269/coronal_010.png","assets/T/mri-735dee52e15e4269/coronal_011.png","assets/T/mri-735dee52e15e4269/coronal_012.png","assets/T/mri-735dee52e15e4269/coronal_013.png","assets/T/mri-735dee52e15e4269/coronal_014.png","assets/T/mri-735dee52e15e4269/coronal_015.png","assets/T/mri-735dee52e15e4269/coronal_016.png","assets/T/mri-735dee52e15e4269/coronal_017.png","assets/T/mri-735dee52e15e4269/coronal_018.png","assets/T/mri-735dee52e15e4269/coronal_019.png","assets/T/mri-735dee52e15e4269/coronal_020.png","assets/T/mri-735dee52e15e4269/coronal_021.png","assets/T/mri-735dee52e15e4269/coronal_022.png","assets/T/mri-735dee52e15e4269/coronal_023.png","assets/T/mri-735dee52e15e4269/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-49da801e248b4e3b","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-49da801e248b4e3b/axial_001.png","assets/T/mri-49da801e248b4e3b/axial_002.png","assets/T/mri-49da801e248b4e3b/axial_003.png","assets/T/mri-49da801e248b4e3b/axial_004.png","assets/T/mri-49da801e248b4e3b/axial_005.png","assets/T/mri-49da801e248b4e3b/axial_006.png","assets/T/mri-49da801e248b4e3b/axial_007.png","assets/T/mri-49da801e248b4e3b/axial_008.png","assets/T/mri-49da801e248b4e3b/axial_009.png","assets/T/mri-49da801e248b4e3b/axial_010.png","assets/T/mri-49da801e248b4e3b/axial_011.png","assets/T/mri-49da801e248b4e3b/axial_012.png","assets/T/mri-49da801e248b4e3b/axial_013.png","assets/T/mri-49da801e248b4e3b/axial_014.png","assets/T/mri-49da801e248b4e3b/axial_015.png","assets/T/mri-49da801e248b4e3b/axial_016.png","assets/T/mri-49da801e248b4e3b/axial_017.png","assets/T/mri-49da801e248b4e3b/axial_018.png","assets/T/mri-49da801e248b4e3b/axial_019.png","assets/T/mri-49da801e248b4e3b/axial_020.png","assets/T/mri-49da801e248b4e3b/axial_021.png","assets/T/mri-49da801e248b4e3b/axial_022.png","assets/T/mri-49da801e248b4e3b/axial_023.png","assets/T/mri-49da801e248b4e3b/axial_024.png","assets/T/mri-49da801e248b4e3b/axial_025.png","assets/T/mri-49da801e248b4e3b/axial_026.png","assets/T/mri-49da801e248b4e3b/axial_027.png","assets/T/mri-49da801e248b4e3b/axial_028.png","assets/T/mri-49da801e248b4e3b/axial_029.png","assets/T/mri-49da801e248b4e3b/axial_030.png","assets/T/mri-49da801e248b4e3b/axial_031.png","assets/T/mri-49da801e248b4e3b/axial_032.png","assets/T/mri-49da801e248b4e3b/axial_033.png","assets/T/mri-49da801e248b4e3b/axial_034.png","assets/T/mri-49da801e248b4e3b/axial_035.png","assets/T/mri-49da801e248b4e3b/axial_036.png","assets/T/mri-49da801e248b4e3b/axial_037.png","assets/T/mri-49da801e248b4e3b/axial_038.png","assets/T/mri-49da801e248b4e3b/axial_039.png","assets/T/mri-49da801e248b4e3b/axial_040.png","assets/T/mri-49da801e248b4e3b/axial_041.png","assets/T/mri-49da801e248b4e3b/axial_042.png","assets/T/mri-49da801e248b4e3b/coronal_001.png","assets/T/mri-49da801e248b4e3b/coronal_002.png","assets/T/mri-49da801e248b4e3b/coronal_003.png","assets/T/mri-49da801e248b4e3b/coronal_004.png","assets/T/mri-49da801e248b4e3b/coronal_005.png","assets/T/mri-49da801e248b4e3b/coronal_006.png","assets/T/mri-49da801e248b4e3b/coronal_007.png","assets/T/mri-49da801e248b4e3b/coronal_008.png","assets/T/mri-49da801e248b4e3b/coronal_009.png","assets/T/mri-49da801e248b4e3b/coronal_010.png","assets/T/mri-49da801e248b4e3b/coronal_011.png","assets/T/mri-49da801e248b4e3b/coronal_012.png","assets/T/mri-49da801e248b4e3b/coronal_013.png","assets/T/mri-49da801e248b4e3b/coronal_014.png","assets/T/mri-49da801e248b4e3b/coronal_015.png","assets/T/mri-49da801e248b4e3b/coronal_016.png","assets/T/mri-49da801e248b4e3b/coronal_017.png","assets/T/mri-49da801e248b4e3b/coronal_018.png","assets/T/mri-49da801e248b4e3b/coronal_019.png","assets/T/mri-49da801e248b4e3b/coronal_020.png","assets/T/mri-49da801e248b4e3b/coronal_021.png","assets/T/mri-49da801e248b4e3b/coronal_022.png","assets/T/mri-49da801e248b4e3b/coronal_023.png","assets/T/mri-49da801e248b4e3b/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-b0849ba65caa4723","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-b0849ba65caa4723/axial_001.png","assets/T/mri-b0849ba65caa4723/axial_002.png","assets/T/mri-b0849ba65caa4723/axial_003.png","assets/T/mri-b0849ba65caa4723/axial_004.png","assets/T/mri-b0849ba65caa4723/axial_005.png","assets/T/mri-b0849ba65caa4723/axial_006.png","assets/T/mri-b0849ba65caa4723/axial_007.png","assets/T/mri-b0849ba65caa4723/axial_008.png","assets/T/mri-b0849ba65caa4723/axial_009.png","assets/T/mri-b0849ba65caa4723/axial_010.png","assets/T/mri-b0849ba65caa4723/axial_011.png","assets/T/mri-b0849ba65caa4723/axial_012.png","assets/T/mri-b0849ba65caa4723/axial_013.png","assets/T/mri-b0849ba65caa4723/axial_014.png","assets/T/mri-b0849ba65caa4723/axial_015.png","assets/T/mri-b0849ba65caa4723/axial_016.png","assets/T/mri-b0849ba65caa4723/axial_017.png","assets/T/mri-b0849ba65caa4723/axial_018.png","assets/T/mri-b0849ba65caa4723/axial_019.png","assets/T/mri-b0849ba65caa4723/axial_020.png","assets/T/mri-b0849ba65caa4723/axial_021.png","assets/T/mri-b0849ba65caa4723/axial_022.png","assets/T/mri-b0849ba65caa4723/axial_023.png","assets/T/mri-b0849ba65caa4723/axial_024.png","assets/T/mri-b0849ba65caa4723/axial_025.png","assets/T/mri-b0849ba65caa4723/axial_026.png","assets/T/mri-b0849ba65caa4723/axial_027.png","assets/T/mri-b0849ba65caa4723/axial_028.png","assets/T/mri-b0849ba65caa4723/axial_029.png","assets/T/mri-b0849ba65caa4723/axial_030.png","assets/T/mri-b0849ba65caa4723/axial_031.png","assets/T/mri-b0849ba65caa4723/axial_032.png","assets/T/mri-b0849ba65caa4723/axial_033.png","assets/T/mri-b0849ba65caa4723/axial_034.png","assets/T/mri-b0849ba65caa4723/axial_035.png","assets/T/mri-b0849ba65caa4723/axial_036.png","assets/T/mri-b0849ba65caa4723/axial_037.png","assets/T/mri-b0849ba65caa4723/axial_038.png","assets/T/mri-b0849ba65caa4723/axial_039.png","assets/T/mri-b0849ba65caa4723/axial_040.png","assets/T/mri-b0849ba65caa4723/axial_041.png","assets/T/mri-b0849ba65caa4723/axial_042.png","assets/T/mri-b0849ba65caa4723/coronal_001.png","assets/T/mri-b0849ba65caa4723/coronal_002.png","assets/T/mri-b0849ba65caa4723/coronal_003.png","assets/T/mri-b0849ba65caa4723/coronal_004.png","assets/T/mri-b0849ba65caa4723/coronal_005.png","assets/T/mri-b0849ba65caa4723/coronal_006.png","assets/T/mri-b0849ba65caa4723/coronal_007.png","assets/T/mri-b0849ba65caa4723/coronal_008.png","assets/T/mri-b0849ba65caa4723/coronal_009.png","assets/T/mri-b0849ba65caa4723/coronal_010.png","assets/T/mri-b0849ba65caa4723/coronal_011.png","assets/T/mri-b0849ba65caa4723/coronal_012.png","assets/T/mri-b0849ba65caa4723/coronal_013.png","assets/T/mri-b0849ba65caa4723/coronal_014.png","assets/T/mri-b0849ba65caa4723/coronal_015.png","assets/T/mri-b0849ba65caa4723/coronal_016.png","assets/T/mri-b0849ba65caa4723/coronal_017.png","assets/T/mri-b0849ba65caa4723/coronal_018.png","assets/T/mri-b0849ba65caa4723/coronal_019.png","assets/T/mri-b0849ba65caa4723/coronal_020.png","assets/T/mri-b0849ba65caa4723/coronal_021.png","assets/T/mri-b0849ba65caa4723/coronal_022.png","assets/T/mri-b0849ba65caa4723/coronal_023.png","assets/T/mri-b0849ba65caa4723/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-b976847fc598493f","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-b976847fc598493f/axial_001.png","assets/T/mri-b976847fc598493f/axial_002.png","assets/T/mri-b976847fc598493f/axial_003.png","assets/T/mri-b976847fc598493f/axial_004.png","assets/T/mri-b976847fc598493f/axial_005.png","assets/T/mri-b976847fc598493f/axial_006.png","assets/T/mri-b976847fc598493f/axial_007.png","assets/T/mri-b976847fc598493f/axial_008.png","assets/T/mri-b976847fc598493f/axial_009.png","assets/T/mri-b976847fc598493f/axial_010.png","assets/T/mri-b976847fc598493f/axial_011.png","assets/T/mri-b976847fc598493f/axial_012.png","assets/T/mri-b976847fc598493f/axial_013.png","assets/T/mri-b976847fc598493f/axial_014.png","assets/T/mri-b976847fc598493f/axial_015.png","assets/T/mri-b976847fc598493f/axial_016.png","assets/T/mri-b976847fc598493f/axial_017.png","assets/T/mri-b976847fc598493f/axial_018.png","assets/T/mri-b976847fc598493f/axial_019.png","assets/T/mri-b976847fc598493f/axial_020.png","assets/T/mri-b976847fc598493f/axial_021.png","assets/T/mri-b976847fc598493f/axial_022.png","assets/T/mri-b976847fc598493f/axial_023.png","assets/T/mri-b976847fc598493f/axial_024.png","assets/T/mri-b976847fc598493f/axial_025.png","assets/T/mri-b976847fc598493f/axial_026.png","assets/T/mri-b976847fc598493f/axial_027.png","assets/T/mri-b976847fc598493f/axial_028.png","assets/T/mri-b976847fc598493f/axial_029.png","assets/T/mri-b976847fc598493f/axial_030.png","assets/T/mri-b976847fc598493f/axial_031.png","assets/T/mri-b976847fc598493f/axial_032.png","assets/T/mri-b976847fc598493f/axial_033.png","assets/T/mri-b976847fc598493f/axial_034.png","assets/T/mri-b976847fc598493f/axial_035.png","assets/T/mri-b976847fc598493f/axial_036.png","assets/T/mri-b976847fc598493f/axial_037.png","assets/T/mri-b976847fc598493f/axial_038.png","assets/T/mri-b976847fc598493f/axial_039.png","assets/T/mri-b976847fc598493f/axial_040.png","assets/T/mri-b976847fc598493f/coronal_001.png","assets/T/mri-b976847fc598493f/coronal_002.png","assets/T/mri-b976847fc598493f/coronal_003.png","assets/T/mri-b976847fc598493f/coronal_004.png","assets/T/mri-b976847fc598493f/coronal_005.png","assets/T/mri-b976847fc598493f/coronal_006.png","assets/T/mri-b976847fc598493f/coronal_007.png","assets/T/mri-b976847fc598493f/coronal_008.png","assets/T/mri-b976847fc598493f/coronal_009.png","assets/T/mri-b976847fc598493f/coronal_010.png","assets/T/mri-b976847fc598493f/coronal_011.png","assets/T/mri-b976847fc598493f/coronal_012.png","assets/T/mri-b976847fc598493f/coronal_013.png","assets/T/mri-b976847fc598493f/coronal_014.png","assets/T/mri-b976847fc598493f/coronal_015.png","assets/T/mri-b976847fc598493f/coronal_016.png","assets/T/mri-b976847fc598493f/coronal_017.png","assets/T/mri-b976847fc598493f/coronal_018.png","assets/T/mri-b976847fc598493f/coronal_019.png","assets/T/mri-b976847fc598493f/coronal_020.png","assets/T/mri-b976847fc598493f/coronal_021.png","assets/T/mri-b976847fc598493f/coronal_022.png","assets/T/mri-b976847fc598493f/coronal_023.png","assets/T/mri-b976847fc598493f/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-7ea32cf357cc42b5","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-7ea32cf357cc42b5/axial_001.png","assets/T/mri-7ea32cf357cc42b5/axial_002.png","assets/T/mri-7ea32cf357cc42b5/axial_003.png","assets/T/mri-7ea32cf357cc42b5/axial_004.png","assets/T/mri-7ea32cf357cc42b5/axial_005.png","assets/T/mri-7ea32cf357cc42b5/axial_006.png","assets/T/mri-7ea32cf357cc42b5/axial_007.png","assets/T/mri-7ea32cf357cc42b5/axial_008.png","assets/T/mri-7ea32cf357cc42b5/axial_009.png","assets/T/mri-7ea32cf357cc42b5/axial_010.png","assets/T/mri-7ea32cf357cc42b5/axial_011.png","assets/T/mri-7ea32cf357cc42b5/axial_012.png","assets/T/mri-7ea32cf357cc42b5/axial_013.png","assets/T/mri-7ea32cf357cc42b5/axial_014.png","assets/T/mri-7ea32cf357cc42b5/axial_015.png","assets/T/mri-7ea32cf357cc42b5/axial_016.png","assets/T/mri-7ea32cf357cc42b5/axial_017.png","assets/T/mri-7ea32cf357cc42b5/axial_018.png","assets/T/mri-7ea32cf357cc42b5/axial_019.png","assets/T/mri-7ea32cf357cc42b5/axial_020.png","assets/T/mri-7ea32cf357cc42b5/axial_021.png","assets/T/mri-7ea32cf357cc42b5/axial_022.png","assets/T/mri-7ea32cf357cc42b5/axial_023.png","assets/T/mri-7ea32cf357cc42b5/axial_024.png","assets/T/mri-7ea32cf357cc42b5/axial_025.png","assets/T/mri-7ea32cf357cc42b5/axial_026.png","assets/T/mri-7ea32cf357cc42b5/axial_027.png","assets/T/mri-7ea32cf357cc42b5/axial_028.png","assets/T/mri-7ea32cf357cc42b5/axial_029.png","assets/T/mri-7ea32cf357cc42b5/axial_030.png","assets/T/mri-7ea32cf357cc42b5/axial_031.png","assets/T/mri-7ea32cf357cc42b5/axial_032.png","assets/T/mri-7ea32cf357cc42b5/axial_033.png","assets/T/mri-7ea32cf357cc42b5/axial_034.png","assets/T/mri-7ea32cf357cc42b5/axial_035.png","assets/T/mri-7ea32cf357cc42b5/axial_036.png","assets/T/mri-7ea32cf357cc42b5/axial_037.png","assets/T/mri-7ea32cf357cc42b5/axial_038.png","assets/T/mri-7ea32cf357cc42b5/axial_039.png","assets/T/mri-7ea32cf357cc42b5/axial_040.png","assets/T/mri-7ea32cf357cc42b5/coronal_001.png","assets/T/mri-7ea32cf357cc42b5/coronal_002.png","assets/T/mri-7ea32cf357cc42b5/coronal_003.png","assets/T/mri-7ea32cf357cc42b5/coronal_004.png","assets/T/mri-7ea32cf357cc42b5/coronal_005.png","assets/T/mri-7ea32cf357cc42b5/coronal_006.png","assets/T/mri-7ea32cf357cc42b5/coronal_007.png","assets/T/mri-7ea32cf357cc42b5/coronal_008.png","assets/T/mri-7ea32cf357cc42b5/coronal_009.png","assets/T/mri-7ea32cf357cc42b5/coronal_010.png","assets/T/mri-7ea32cf357cc42b5/coronal_011.png","assets/T/mri-7ea32cf357cc42b5/coronal_012.png","assets/T/mri-7ea32cf357cc42b5/coronal_013.png","assets/T/mri-7ea32cf357cc42b5/coronal_014.png","assets/T/mri-7ea32cf357cc42b5/coronal_015.png","assets/T/mri-7ea32cf357cc42b5/coronal_016.png","assets/T/mri-7ea32cf357cc42b5/coronal_017.png","assets/T/mri-7ea32cf357cc42b5/coronal_018.png","assets/T/mri-7ea32cf357cc42b5/coronal_019.png","assets/T/mri-7ea32cf357cc42b5/coronal_020.png","assets/T/mri-7ea32cf357cc42b5/coronal_021.png","assets/T/mri-7ea32cf357cc42b5/coronal_022.png","assets/T/mri-7ea32cf357cc42b5/coronal_023.png","assets/T/mri-7ea32cf357cc42b5/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-0dc57ca1c41d4864","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-0dc57ca1c41d4864/axial_001.png","assets/T/mri-0dc57ca1c41d4864/axial_002.png","assets/T/mri-0dc57ca1c41d4864/axial_003.png","assets/T/mri-0dc57ca1c41d4864/axial_004.png","assets/T/mri-0dc57ca1c41d4864/axial_005.png","assets/T/mri-0dc57ca1c41d4864/axial_006.png","assets/T/mri-0dc57ca1c41d4864/axial_007.png","assets/T/mri-0dc57ca1c41d4864/axial_008.png","assets/T/mri-0dc57ca1c41d4864/axial_009.png","assets/T/mri-0dc57ca1c41d4864/axial_010.png","assets/T/mri-0dc57ca1c41d4864/axial_011.png","assets/T/mri-0dc57ca1c41d4864/axial_012.png","assets/T/mri-0dc57ca1c41d4864/axial_013.png","assets/T/mri-0dc57ca1c41d4864/axial_014.png","assets/T/mri-0dc57ca1c41d4864/axial_015.png","assets/T/mri-0dc57ca1c41d4864/axial_016.png","assets/T/mri-0dc57ca1c41d4864/axial_017.png","assets/T/mri-0dc57ca1c41d4864/axial_018.png","assets/T/mri-0dc57ca1c41d4864/axial_019.png","assets/T/mri-0dc57ca1c41d4864/axial_020.png","assets/T/mri-0dc57ca1c41d4864/axial_021.png","assets/T/mri-0dc57ca1c41d4864/axial_022.png","assets/T/mri-0dc57ca1c41d4864/axial_023.png","assets/T/mri-0dc57ca1c41d4864/axial_024.png","assets/T/mri-0dc57ca1c41d4864/axial_025.png","assets/T/mri-0dc57ca1c41d4864/axial_026.png","assets/T/mri-0dc57ca1c41d4864/axial_027.png","assets/T/mri-0dc57ca1c41d4864/axial_028.png","assets/T/mri-0dc57ca1c41d4864/axial_029.png","assets/T/mri-0dc57ca1c41d4864/axial_030.png","assets/T/mri-0dc57ca1c41d4864/axial_031.png","assets/T/mri-0dc57ca1c41d4864/axial_032.png","assets/T/mri-0dc57ca1c41d4864/axial_033.png","assets/T/mri-0dc57ca1c41d4864/axial_034.png","assets/T/mri-0dc57ca1c41d4864/axial_035.png","assets/T/mri-0dc57ca1c41d4864/axial_036.png","assets/T/mri-0dc57ca1c41d4864/axial_037.png","assets/T/mri-0dc57ca1c41d4864/axial_038.png","assets/T/mri-0dc57ca1c41d4864/axial_039.png","assets/T/mri-0dc57ca1c41d4864/axial_040.png","assets/T/mri-0dc57ca1c41d4864/axial_041.png","assets/T/mri-0dc57ca1c41d4864/axial_042.png","assets/T/mri-0dc57ca1c41d4864/coronal_001.png","assets/T/mri-0dc57ca1c41d4864/coronal_002.png","assets/T/mri-0dc57ca1c41d4864/coronal_003.png","assets/T/mri-0dc57ca1c41d4864/coronal_004.png","assets/T/mri-0dc57ca1c41d4864/coronal_005.png","assets/T/mri-0dc57ca1c41d4864/coronal_006.png","assets/T/mri-0dc57ca1c41d4864/coronal_007.png","assets/T/mri-0dc57ca1c41d4864/coronal_008.png","assets/T/mri-0dc57ca1c41d4864/coronal_009.png","assets/T/mri-0dc57ca1c41d4864/coronal_010.png","assets/T/mri-0dc57ca1c41d4864/coronal_011.png","assets/T/mri-0dc57ca1c41d4864/coronal_012.png","assets/T/mri-0dc57ca1c41d4864/coronal_013.png","assets/T/mri-0dc57ca1c41d4864/coronal_014.png","assets/T/mri-0dc57ca1c41d4864/coronal_015.png","assets/T/mri-0dc57ca1c41d4864/coronal_016.png","assets/T/mri-0dc57ca1c41d4864/coronal_017.png","assets/T/mri-0dc57ca1c41d4864/coronal_018.png","assets/T/mri-0dc57ca1c41d4864/coronal_019.png","assets/T/mri-0dc57ca1c41d4864/coronal_020.png","assets/T/mri-0dc57ca1c41d4864/coronal_021.png","assets/T/mri-0dc57ca1c41d4864/coronal_022.png","assets/T/mri-0dc57ca1c41d4864/coronal_023.png","assets/T/mri-0dc57ca1c41d4864/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-c3cc2672fd8e420a","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 62 张图，均来自同一次检查。\n\n- 前 38 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-c3cc2672fd8e420a/axial_001.png","assets/T/mri-c3cc2672fd8e420a/axial_002.png","assets/T/mri-c3cc2672fd8e420a/axial_003.png","assets/T/mri-c3cc2672fd8e420a/axial_004.png","assets/T/mri-c3cc2672fd8e420a/axial_005.png","assets/T/mri-c3cc2672fd8e420a/axial_006.png","assets/T/mri-c3cc2672fd8e420a/axial_007.png","assets/T/mri-c3cc2672fd8e420a/axial_008.png","assets/T/mri-c3cc2672fd8e420a/axial_009.png","assets/T/mri-c3cc2672fd8e420a/axial_010.png","assets/T/mri-c3cc2672fd8e420a/axial_011.png","assets/T/mri-c3cc2672fd8e420a/axial_012.png","assets/T/mri-c3cc2672fd8e420a/axial_013.png","assets/T/mri-c3cc2672fd8e420a/axial_014.png","assets/T/mri-c3cc2672fd8e420a/axial_015.png","assets/T/mri-c3cc2672fd8e420a/axial_016.png","assets/T/mri-c3cc2672fd8e420a/axial_017.png","assets/T/mri-c3cc2672fd8e420a/axial_018.png","assets/T/mri-c3cc2672fd8e420a/axial_019.png","assets/T/mri-c3cc2672fd8e420a/axial_020.png","assets/T/mri-c3cc2672fd8e420a/axial_021.png","assets/T/mri-c3cc2672fd8e420a/axial_022.png","assets/T/mri-c3cc2672fd8e420a/axial_023.png","assets/T/mri-c3cc2672fd8e420a/axial_024.png","assets/T/mri-c3cc2672fd8e420a/axial_025.png","assets/T/mri-c3cc2672fd8e420a/axial_026.png","assets/T/mri-c3cc2672fd8e420a/axial_027.png","assets/T/mri-c3cc2672fd8e420a/axial_028.png","assets/T/mri-c3cc2672fd8e420a/axial_029.png","assets/T/mri-c3cc2672fd8e420a/axial_030.png","assets/T/mri-c3cc2672fd8e420a/axial_031.png","assets/T/mri-c3cc2672fd8e420a/axial_032.png","assets/T/mri-c3cc2672fd8e420a/axial_033.png","assets/T/mri-c3cc2672fd8e420a/axial_034.png","assets/T/mri-c3cc2672fd8e420a/axial_035.png","assets/T/mri-c3cc2672fd8e420a/axial_036.png","assets/T/mri-c3cc2672fd8e420a/axial_037.png","assets/T/mri-c3cc2672fd8e420a/axial_038.png","assets/T/mri-c3cc2672fd8e420a/coronal_001.png","assets/T/mri-c3cc2672fd8e420a/coronal_002.png","assets/T/mri-c3cc2672fd8e420a/coronal_003.png","assets/T/mri-c3cc2672fd8e420a/coronal_004.png","assets/T/mri-c3cc2672fd8e420a/coronal_005.png","assets/T/mri-c3cc2672fd8e420a/coronal_006.png","assets/T/mri-c3cc2672fd8e420a/coronal_007.png","assets/T/mri-c3cc2672fd8e420a/coronal_008.png","assets/T/mri-c3cc2672fd8e420a/coronal_009.png","assets/T/mri-c3cc2672fd8e420a/coronal_010.png","assets/T/mri-c3cc2672fd8e420a/coronal_011.png","assets/T/mri-c3cc2672fd8e420a/coronal_012.png","assets/T/mri-c3cc2672fd8e420a/coronal_013.png","assets/T/mri-c3cc2672fd8e420a/coronal_014.png","assets/T/mri-c3cc2672fd8e420a/coronal_015.png","assets/T/mri-c3cc2672fd8e420a/coronal_016.png","assets/T/mri-c3cc2672fd8e420a/coronal_017.png","assets/T/mri-c3cc2672fd8e420a/coronal_018.png","assets/T/mri-c3cc2672fd8e420a/coronal_019.png","assets/T/mri-c3cc2672fd8e420a/coronal_020.png","assets/T/mri-c3cc2672fd8e420a/coronal_021.png","assets/T/mri-c3cc2672fd8e420a/coronal_022.png","assets/T/mri-c3cc2672fd8e420a/coronal_023.png","assets/T/mri-c3cc2672fd8e420a/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-17373bfa653f4f94","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-17373bfa653f4f94/axial_001.png","assets/T/mri-17373bfa653f4f94/axial_002.png","assets/T/mri-17373bfa653f4f94/axial_003.png","assets/T/mri-17373bfa653f4f94/axial_004.png","assets/T/mri-17373bfa653f4f94/axial_005.png","assets/T/mri-17373bfa653f4f94/axial_006.png","assets/T/mri-17373bfa653f4f94/axial_007.png","assets/T/mri-17373bfa653f4f94/axial_008.png","assets/T/mri-17373bfa653f4f94/axial_009.png","assets/T/mri-17373bfa653f4f94/axial_010.png","assets/T/mri-17373bfa653f4f94/axial_011.png","assets/T/mri-17373bfa653f4f94/axial_012.png","assets/T/mri-17373bfa653f4f94/axial_013.png","assets/T/mri-17373bfa653f4f94/axial_014.png","assets/T/mri-17373bfa653f4f94/axial_015.png","assets/T/mri-17373bfa653f4f94/axial_016.png","assets/T/mri-17373bfa653f4f94/axial_017.png","assets/T/mri-17373bfa653f4f94/axial_018.png","assets/T/mri-17373bfa653f4f94/axial_019.png","assets/T/mri-17373bfa653f4f94/axial_020.png","assets/T/mri-17373bfa653f4f94/axial_021.png","assets/T/mri-17373bfa653f4f94/axial_022.png","assets/T/mri-17373bfa653f4f94/axial_023.png","assets/T/mri-17373bfa653f4f94/axial_024.png","assets/T/mri-17373bfa653f4f94/axial_025.png","assets/T/mri-17373bfa653f4f94/axial_026.png","assets/T/mri-17373bfa653f4f94/axial_027.png","assets/T/mri-17373bfa653f4f94/axial_028.png","assets/T/mri-17373bfa653f4f94/axial_029.png","assets/T/mri-17373bfa653f4f94/axial_030.png","assets/T/mri-17373bfa653f4f94/axial_031.png","assets/T/mri-17373bfa653f4f94/axial_032.png","assets/T/mri-17373bfa653f4f94/axial_033.png","assets/T/mri-17373bfa653f4f94/axial_034.png","assets/T/mri-17373bfa653f4f94/axial_035.png","assets/T/mri-17373bfa653f4f94/axial_036.png","assets/T/mri-17373bfa653f4f94/axial_037.png","assets/T/mri-17373bfa653f4f94/axial_038.png","assets/T/mri-17373bfa653f4f94/axial_039.png","assets/T/mri-17373bfa653f4f94/axial_040.png","assets/T/mri-17373bfa653f4f94/axial_041.png","assets/T/mri-17373bfa653f4f94/axial_042.png","assets/T/mri-17373bfa653f4f94/coronal_001.png","assets/T/mri-17373bfa653f4f94/coronal_002.png","assets/T/mri-17373bfa653f4f94/coronal_003.png","assets/T/mri-17373bfa653f4f94/coronal_004.png","assets/T/mri-17373bfa653f4f94/coronal_005.png","assets/T/mri-17373bfa653f4f94/coronal_006.png","assets/T/mri-17373bfa653f4f94/coronal_007.png","assets/T/mri-17373bfa653f4f94/coronal_008.png","assets/T/mri-17373bfa653f4f94/coronal_009.png","assets/T/mri-17373bfa653f4f94/coronal_010.png","assets/T/mri-17373bfa653f4f94/coronal_011.png","assets/T/mri-17373bfa653f4f94/coronal_012.png","assets/T/mri-17373bfa653f4f94/coronal_013.png","assets/T/mri-17373bfa653f4f94/coronal_014.png","assets/T/mri-17373bfa653f4f94/coronal_015.png","assets/T/mri-17373bfa653f4f94/coronal_016.png","assets/T/mri-17373bfa653f4f94/coronal_017.png","assets/T/mri-17373bfa653f4f94/coronal_018.png","assets/T/mri-17373bfa653f4f94/coronal_019.png","assets/T/mri-17373bfa653f4f94/coronal_020.png","assets/T/mri-17373bfa653f4f94/coronal_021.png","assets/T/mri-17373bfa653f4f94/coronal_022.png","assets/T/mri-17373bfa653f4f94/coronal_023.png","assets/T/mri-17373bfa653f4f94/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-763095d057044bf9","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 60 张图，均来自同一次检查。\n\n- 前 36 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-763095d057044bf9/axial_001.png","assets/T/mri-763095d057044bf9/axial_002.png","assets/T/mri-763095d057044bf9/axial_003.png","assets/T/mri-763095d057044bf9/axial_004.png","assets/T/mri-763095d057044bf9/axial_005.png","assets/T/mri-763095d057044bf9/axial_006.png","assets/T/mri-763095d057044bf9/axial_007.png","assets/T/mri-763095d057044bf9/axial_008.png","assets/T/mri-763095d057044bf9/axial_009.png","assets/T/mri-763095d057044bf9/axial_010.png","assets/T/mri-763095d057044bf9/axial_011.png","assets/T/mri-763095d057044bf9/axial_012.png","assets/T/mri-763095d057044bf9/axial_013.png","assets/T/mri-763095d057044bf9/axial_014.png","assets/T/mri-763095d057044bf9/axial_015.png","assets/T/mri-763095d057044bf9/axial_016.png","assets/T/mri-763095d057044bf9/axial_017.png","assets/T/mri-763095d057044bf9/axial_018.png","assets/T/mri-763095d057044bf9/axial_019.png","assets/T/mri-763095d057044bf9/axial_020.png","assets/T/mri-763095d057044bf9/axial_021.png","assets/T/mri-763095d057044bf9/axial_022.png","assets/T/mri-763095d057044bf9/axial_023.png","assets/T/mri-763095d057044bf9/axial_024.png","assets/T/mri-763095d057044bf9/axial_025.png","assets/T/mri-763095d057044bf9/axial_026.png","assets/T/mri-763095d057044bf9/axial_027.png","assets/T/mri-763095d057044bf9/axial_028.png","assets/T/mri-763095d057044bf9/axial_029.png","assets/T/mri-763095d057044bf9/axial_030.png","assets/T/mri-763095d057044bf9/axial_031.png","assets/T/mri-763095d057044bf9/axial_032.png","assets/T/mri-763095d057044bf9/axial_033.png","assets/T/mri-763095d057044bf9/axial_034.png","assets/T/mri-763095d057044bf9/axial_035.png","assets/T/mri-763095d057044bf9/axial_036.png","assets/T/mri-763095d057044bf9/coronal_001.png","assets/T/mri-763095d057044bf9/coronal_002.png","assets/T/mri-763095d057044bf9/coronal_003.png","assets/T/mri-763095d057044bf9/coronal_004.png","assets/T/mri-763095d057044bf9/coronal_005.png","assets/T/mri-763095d057044bf9/coronal_006.png","assets/T/mri-763095d057044bf9/coronal_007.png","assets/T/mri-763095d057044bf9/coronal_008.png","assets/T/mri-763095d057044bf9/coronal_009.png","assets/T/mri-763095d057044bf9/coronal_010.png","assets/T/mri-763095d057044bf9/coronal_011.png","assets/T/mri-763095d057044bf9/coronal_012.png","assets/T/mri-763095d057044bf9/coronal_013.png","assets/T/mri-763095d057044bf9/coronal_014.png","assets/T/mri-763095d057044bf9/coronal_015.png","assets/T/mri-763095d057044bf9/coronal_016.png","assets/T/mri-763095d057044bf9/coronal_017.png","assets/T/mri-763095d057044bf9/coronal_018.png","assets/T/mri-763095d057044bf9/coronal_019.png","assets/T/mri-763095d057044bf9/coronal_020.png","assets/T/mri-763095d057044bf9/coronal_021.png","assets/T/mri-763095d057044bf9/coronal_022.png","assets/T/mri-763095d057044bf9/coronal_023.png","assets/T/mri-763095d057044bf9/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-70df53cf06454db7","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 70 张图，均来自同一次检查。\n\n- 前 46 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-70df53cf06454db7/axial_001.png","assets/T/mri-70df53cf06454db7/axial_002.png","assets/T/mri-70df53cf06454db7/axial_003.png","assets/T/mri-70df53cf06454db7/axial_004.png","assets/T/mri-70df53cf06454db7/axial_005.png","assets/T/mri-70df53cf06454db7/axial_006.png","assets/T/mri-70df53cf06454db7/axial_007.png","assets/T/mri-70df53cf06454db7/axial_008.png","assets/T/mri-70df53cf06454db7/axial_009.png","assets/T/mri-70df53cf06454db7/axial_010.png","assets/T/mri-70df53cf06454db7/axial_011.png","assets/T/mri-70df53cf06454db7/axial_012.png","assets/T/mri-70df53cf06454db7/axial_013.png","assets/T/mri-70df53cf06454db7/axial_014.png","assets/T/mri-70df53cf06454db7/axial_015.png","assets/T/mri-70df53cf06454db7/axial_016.png","assets/T/mri-70df53cf06454db7/axial_017.png","assets/T/mri-70df53cf06454db7/axial_018.png","assets/T/mri-70df53cf06454db7/axial_019.png","assets/T/mri-70df53cf06454db7/axial_020.png","assets/T/mri-70df53cf06454db7/axial_021.png","assets/T/mri-70df53cf06454db7/axial_022.png","assets/T/mri-70df53cf06454db7/axial_023.png","assets/T/mri-70df53cf06454db7/axial_024.png","assets/T/mri-70df53cf06454db7/axial_025.png","assets/T/mri-70df53cf06454db7/axial_026.png","assets/T/mri-70df53cf06454db7/axial_027.png","assets/T/mri-70df53cf06454db7/axial_028.png","assets/T/mri-70df53cf06454db7/axial_029.png","assets/T/mri-70df53cf06454db7/axial_030.png","assets/T/mri-70df53cf06454db7/axial_031.png","assets/T/mri-70df53cf06454db7/axial_032.png","assets/T/mri-70df53cf06454db7/axial_033.png","assets/T/mri-70df53cf06454db7/axial_034.png","assets/T/mri-70df53cf06454db7/axial_035.png","assets/T/mri-70df53cf06454db7/axial_036.png","assets/T/mri-70df53cf06454db7/axial_037.png","assets/T/mri-70df53cf06454db7/axial_038.png","assets/T/mri-70df53cf06454db7/axial_039.png","assets/T/mri-70df53cf06454db7/axial_040.png","assets/T/mri-70df53cf06454db7/axial_041.png","assets/T/mri-70df53cf06454db7/axial_042.png","assets/T/mri-70df53cf06454db7/axial_043.png","assets/T/mri-70df53cf06454db7/axial_044.png","assets/T/mri-70df53cf06454db7/axial_045.png","assets/T/mri-70df53cf06454db7/axial_046.png","assets/T/mri-70df53cf06454db7/coronal_001.png","assets/T/mri-70df53cf06454db7/coronal_002.png","assets/T/mri-70df53cf06454db7/coronal_003.png","assets/T/mri-70df53cf06454db7/coronal_004.png","assets/T/mri-70df53cf06454db7/coronal_005.png","assets/T/mri-70df53cf06454db7/coronal_006.png","assets/T/mri-70df53cf06454db7/coronal_007.png","assets/T/mri-70df53cf06454db7/coronal_008.png","assets/T/mri-70df53cf06454db7/coronal_009.png","assets/T/mri-70df53cf06454db7/coronal_010.png","assets/T/mri-70df53cf06454db7/coronal_011.png","assets/T/mri-70df53cf06454db7/coronal_012.png","assets/T/mri-70df53cf06454db7/coronal_013.png","assets/T/mri-70df53cf06454db7/coronal_014.png","assets/T/mri-70df53cf06454db7/coronal_015.png","assets/T/mri-70df53cf06454db7/coronal_016.png","assets/T/mri-70df53cf06454db7/coronal_017.png","assets/T/mri-70df53cf06454db7/coronal_018.png","assets/T/mri-70df53cf06454db7/coronal_019.png","assets/T/mri-70df53cf06454db7/coronal_020.png","assets/T/mri-70df53cf06454db7/coronal_021.png","assets/T/mri-70df53cf06454db7/coronal_022.png","assets/T/mri-70df53cf06454db7/coronal_023.png","assets/T/mri-70df53cf06454db7/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-59438dc37157453f","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-59438dc37157453f/axial_001.png","assets/T/mri-59438dc37157453f/axial_002.png","assets/T/mri-59438dc37157453f/axial_003.png","assets/T/mri-59438dc37157453f/axial_004.png","assets/T/mri-59438dc37157453f/axial_005.png","assets/T/mri-59438dc37157453f/axial_006.png","assets/T/mri-59438dc37157453f/axial_007.png","assets/T/mri-59438dc37157453f/axial_008.png","assets/T/mri-59438dc37157453f/axial_009.png","assets/T/mri-59438dc37157453f/axial_010.png","assets/T/mri-59438dc37157453f/axial_011.png","assets/T/mri-59438dc37157453f/axial_012.png","assets/T/mri-59438dc37157453f/axial_013.png","assets/T/mri-59438dc37157453f/axial_014.png","assets/T/mri-59438dc37157453f/axial_015.png","assets/T/mri-59438dc37157453f/axial_016.png","assets/T/mri-59438dc37157453f/axial_017.png","assets/T/mri-59438dc37157453f/axial_018.png","assets/T/mri-59438dc37157453f/axial_019.png","assets/T/mri-59438dc37157453f/axial_020.png","assets/T/mri-59438dc37157453f/axial_021.png","assets/T/mri-59438dc37157453f/axial_022.png","assets/T/mri-59438dc37157453f/axial_023.png","assets/T/mri-59438dc37157453f/axial_024.png","assets/T/mri-59438dc37157453f/axial_025.png","assets/T/mri-59438dc37157453f/axial_026.png","assets/T/mri-59438dc37157453f/axial_027.png","assets/T/mri-59438dc37157453f/axial_028.png","assets/T/mri-59438dc37157453f/axial_029.png","assets/T/mri-59438dc37157453f/axial_030.png","assets/T/mri-59438dc37157453f/axial_031.png","assets/T/mri-59438dc37157453f/axial_032.png","assets/T/mri-59438dc37157453f/axial_033.png","assets/T/mri-59438dc37157453f/axial_034.png","assets/T/mri-59438dc37157453f/axial_035.png","assets/T/mri-59438dc37157453f/axial_036.png","assets/T/mri-59438dc37157453f/axial_037.png","assets/T/mri-59438dc37157453f/axial_038.png","assets/T/mri-59438dc37157453f/axial_039.png","assets/T/mri-59438dc37157453f/axial_040.png","assets/T/mri-59438dc37157453f/axial_041.png","assets/T/mri-59438dc37157453f/axial_042.png","assets/T/mri-59438dc37157453f/coronal_001.png","assets/T/mri-59438dc37157453f/coronal_002.png","assets/T/mri-59438dc37157453f/coronal_003.png","assets/T/mri-59438dc37157453f/coronal_004.png","assets/T/mri-59438dc37157453f/coronal_005.png","assets/T/mri-59438dc37157453f/coronal_006.png","assets/T/mri-59438dc37157453f/coronal_007.png","assets/T/mri-59438dc37157453f/coronal_008.png","assets/T/mri-59438dc37157453f/coronal_009.png","assets/T/mri-59438dc37157453f/coronal_010.png","assets/T/mri-59438dc37157453f/coronal_011.png","assets/T/mri-59438dc37157453f/coronal_012.png","assets/T/mri-59438dc37157453f/coronal_013.png","assets/T/mri-59438dc37157453f/coronal_014.png","assets/T/mri-59438dc37157453f/coronal_015.png","assets/T/mri-59438dc37157453f/coronal_016.png","assets/T/mri-59438dc37157453f/coronal_017.png","assets/T/mri-59438dc37157453f/coronal_018.png","assets/T/mri-59438dc37157453f/coronal_019.png","assets/T/mri-59438dc37157453f/coronal_020.png","assets/T/mri-59438dc37157453f/coronal_021.png","assets/T/mri-59438dc37157453f/coronal_022.png","assets/T/mri-59438dc37157453f/coronal_023.png","assets/T/mri-59438dc37157453f/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-458582a19ad64257","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-458582a19ad64257/axial_001.png","assets/T/mri-458582a19ad64257/axial_002.png","assets/T/mri-458582a19ad64257/axial_003.png","assets/T/mri-458582a19ad64257/axial_004.png","assets/T/mri-458582a19ad64257/axial_005.png","assets/T/mri-458582a19ad64257/axial_006.png","assets/T/mri-458582a19ad64257/axial_007.png","assets/T/mri-458582a19ad64257/axial_008.png","assets/T/mri-458582a19ad64257/axial_009.png","assets/T/mri-458582a19ad64257/axial_010.png","assets/T/mri-458582a19ad64257/axial_011.png","assets/T/mri-458582a19ad64257/axial_012.png","assets/T/mri-458582a19ad64257/axial_013.png","assets/T/mri-458582a19ad64257/axial_014.png","assets/T/mri-458582a19ad64257/axial_015.png","assets/T/mri-458582a19ad64257/axial_016.png","assets/T/mri-458582a19ad64257/axial_017.png","assets/T/mri-458582a19ad64257/axial_018.png","assets/T/mri-458582a19ad64257/axial_019.png","assets/T/mri-458582a19ad64257/axial_020.png","assets/T/mri-458582a19ad64257/axial_021.png","assets/T/mri-458582a19ad64257/axial_022.png","assets/T/mri-458582a19ad64257/axial_023.png","assets/T/mri-458582a19ad64257/axial_024.png","assets/T/mri-458582a19ad64257/axial_025.png","assets/T/mri-458582a19ad64257/axial_026.png","assets/T/mri-458582a19ad64257/axial_027.png","assets/T/mri-458582a19ad64257/axial_028.png","assets/T/mri-458582a19ad64257/axial_029.png","assets/T/mri-458582a19ad64257/axial_030.png","assets/T/mri-458582a19ad64257/axial_031.png","assets/T/mri-458582a19ad64257/axial_032.png","assets/T/mri-458582a19ad64257/axial_033.png","assets/T/mri-458582a19ad64257/axial_034.png","assets/T/mri-458582a19ad64257/axial_035.png","assets/T/mri-458582a19ad64257/axial_036.png","assets/T/mri-458582a19ad64257/axial_037.png","assets/T/mri-458582a19ad64257/axial_038.png","assets/T/mri-458582a19ad64257/axial_039.png","assets/T/mri-458582a19ad64257/axial_040.png","assets/T/mri-458582a19ad64257/coronal_001.png","assets/T/mri-458582a19ad64257/coronal_002.png","assets/T/mri-458582a19ad64257/coronal_003.png","assets/T/mri-458582a19ad64257/coronal_004.png","assets/T/mri-458582a19ad64257/coronal_005.png","assets/T/mri-458582a19ad64257/coronal_006.png","assets/T/mri-458582a19ad64257/coronal_007.png","assets/T/mri-458582a19ad64257/coronal_008.png","assets/T/mri-458582a19ad64257/coronal_009.png","assets/T/mri-458582a19ad64257/coronal_010.png","assets/T/mri-458582a19ad64257/coronal_011.png","assets/T/mri-458582a19ad64257/coronal_012.png","assets/T/mri-458582a19ad64257/coronal_013.png","assets/T/mri-458582a19ad64257/coronal_014.png","assets/T/mri-458582a19ad64257/coronal_015.png","assets/T/mri-458582a19ad64257/coronal_016.png","assets/T/mri-458582a19ad64257/coronal_017.png","assets/T/mri-458582a19ad64257/coronal_018.png","assets/T/mri-458582a19ad64257/coronal_019.png","assets/T/mri-458582a19ad64257/coronal_020.png","assets/T/mri-458582a19ad64257/coronal_021.png","assets/T/mri-458582a19ad64257/coronal_022.png","assets/T/mri-458582a19ad64257/coronal_023.png","assets/T/mri-458582a19ad64257/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-bdfb1b2968c54938","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-bdfb1b2968c54938/axial_001.png","assets/T/mri-bdfb1b2968c54938/axial_002.png","assets/T/mri-bdfb1b2968c54938/axial_003.png","assets/T/mri-bdfb1b2968c54938/axial_004.png","assets/T/mri-bdfb1b2968c54938/axial_005.png","assets/T/mri-bdfb1b2968c54938/axial_006.png","assets/T/mri-bdfb1b2968c54938/axial_007.png","assets/T/mri-bdfb1b2968c54938/axial_008.png","assets/T/mri-bdfb1b2968c54938/axial_009.png","assets/T/mri-bdfb1b2968c54938/axial_010.png","assets/T/mri-bdfb1b2968c54938/axial_011.png","assets/T/mri-bdfb1b2968c54938/axial_012.png","assets/T/mri-bdfb1b2968c54938/axial_013.png","assets/T/mri-bdfb1b2968c54938/axial_014.png","assets/T/mri-bdfb1b2968c54938/axial_015.png","assets/T/mri-bdfb1b2968c54938/axial_016.png","assets/T/mri-bdfb1b2968c54938/axial_017.png","assets/T/mri-bdfb1b2968c54938/axial_018.png","assets/T/mri-bdfb1b2968c54938/axial_019.png","assets/T/mri-bdfb1b2968c54938/axial_020.png","assets/T/mri-bdfb1b2968c54938/axial_021.png","assets/T/mri-bdfb1b2968c54938/axial_022.png","assets/T/mri-bdfb1b2968c54938/axial_023.png","assets/T/mri-bdfb1b2968c54938/axial_024.png","assets/T/mri-bdfb1b2968c54938/axial_025.png","assets/T/mri-bdfb1b2968c54938/axial_026.png","assets/T/mri-bdfb1b2968c54938/axial_027.png","assets/T/mri-bdfb1b2968c54938/axial_028.png","assets/T/mri-bdfb1b2968c54938/axial_029.png","assets/T/mri-bdfb1b2968c54938/axial_030.png","assets/T/mri-bdfb1b2968c54938/axial_031.png","assets/T/mri-bdfb1b2968c54938/axial_032.png","assets/T/mri-bdfb1b2968c54938/axial_033.png","assets/T/mri-bdfb1b2968c54938/axial_034.png","assets/T/mri-bdfb1b2968c54938/axial_035.png","assets/T/mri-bdfb1b2968c54938/axial_036.png","assets/T/mri-bdfb1b2968c54938/axial_037.png","assets/T/mri-bdfb1b2968c54938/axial_038.png","assets/T/mri-bdfb1b2968c54938/axial_039.png","assets/T/mri-bdfb1b2968c54938/axial_040.png","assets/T/mri-bdfb1b2968c54938/axial_041.png","assets/T/mri-bdfb1b2968c54938/axial_042.png","assets/T/mri-bdfb1b2968c54938/coronal_001.png","assets/T/mri-bdfb1b2968c54938/coronal_002.png","assets/T/mri-bdfb1b2968c54938/coronal_003.png","assets/T/mri-bdfb1b2968c54938/coronal_004.png","assets/T/mri-bdfb1b2968c54938/coronal_005.png","assets/T/mri-bdfb1b2968c54938/coronal_006.png","assets/T/mri-bdfb1b2968c54938/coronal_007.png","assets/T/mri-bdfb1b2968c54938/coronal_008.png","assets/T/mri-bdfb1b2968c54938/coronal_009.png","assets/T/mri-bdfb1b2968c54938/coronal_010.png","assets/T/mri-bdfb1b2968c54938/coronal_011.png","assets/T/mri-bdfb1b2968c54938/coronal_012.png","assets/T/mri-bdfb1b2968c54938/coronal_013.png","assets/T/mri-bdfb1b2968c54938/coronal_014.png","assets/T/mri-bdfb1b2968c54938/coronal_015.png","assets/T/mri-bdfb1b2968c54938/coronal_016.png","assets/T/mri-bdfb1b2968c54938/coronal_017.png","assets/T/mri-bdfb1b2968c54938/coronal_018.png","assets/T/mri-bdfb1b2968c54938/coronal_019.png","assets/T/mri-bdfb1b2968c54938/coronal_020.png","assets/T/mri-bdfb1b2968c54938/coronal_021.png","assets/T/mri-bdfb1b2968c54938/coronal_022.png","assets/T/mri-bdfb1b2968c54938/coronal_023.png","assets/T/mri-bdfb1b2968c54938/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-38792095f50d47c9","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-38792095f50d47c9/axial_001.png","assets/T/mri-38792095f50d47c9/axial_002.png","assets/T/mri-38792095f50d47c9/axial_003.png","assets/T/mri-38792095f50d47c9/axial_004.png","assets/T/mri-38792095f50d47c9/axial_005.png","assets/T/mri-38792095f50d47c9/axial_006.png","assets/T/mri-38792095f50d47c9/axial_007.png","assets/T/mri-38792095f50d47c9/axial_008.png","assets/T/mri-38792095f50d47c9/axial_009.png","assets/T/mri-38792095f50d47c9/axial_010.png","assets/T/mri-38792095f50d47c9/axial_011.png","assets/T/mri-38792095f50d47c9/axial_012.png","assets/T/mri-38792095f50d47c9/axial_013.png","assets/T/mri-38792095f50d47c9/axial_014.png","assets/T/mri-38792095f50d47c9/axial_015.png","assets/T/mri-38792095f50d47c9/axial_016.png","assets/T/mri-38792095f50d47c9/axial_017.png","assets/T/mri-38792095f50d47c9/axial_018.png","assets/T/mri-38792095f50d47c9/axial_019.png","assets/T/mri-38792095f50d47c9/axial_020.png","assets/T/mri-38792095f50d47c9/axial_021.png","assets/T/mri-38792095f50d47c9/axial_022.png","assets/T/mri-38792095f50d47c9/axial_023.png","assets/T/mri-38792095f50d47c9/axial_024.png","assets/T/mri-38792095f50d47c9/axial_025.png","assets/T/mri-38792095f50d47c9/axial_026.png","assets/T/mri-38792095f50d47c9/axial_027.png","assets/T/mri-38792095f50d47c9/axial_028.png","assets/T/mri-38792095f50d47c9/axial_029.png","assets/T/mri-38792095f50d47c9/axial_030.png","assets/T/mri-38792095f50d47c9/axial_031.png","assets/T/mri-38792095f50d47c9/axial_032.png","assets/T/mri-38792095f50d47c9/axial_033.png","assets/T/mri-38792095f50d47c9/axial_034.png","assets/T/mri-38792095f50d47c9/axial_035.png","assets/T/mri-38792095f50d47c9/axial_036.png","assets/T/mri-38792095f50d47c9/axial_037.png","assets/T/mri-38792095f50d47c9/axial_038.png","assets/T/mri-38792095f50d47c9/axial_039.png","assets/T/mri-38792095f50d47c9/axial_040.png","assets/T/mri-38792095f50d47c9/coronal_001.png","assets/T/mri-38792095f50d47c9/coronal_002.png","assets/T/mri-38792095f50d47c9/coronal_003.png","assets/T/mri-38792095f50d47c9/coronal_004.png","assets/T/mri-38792095f50d47c9/coronal_005.png","assets/T/mri-38792095f50d47c9/coronal_006.png","assets/T/mri-38792095f50d47c9/coronal_007.png","assets/T/mri-38792095f50d47c9/coronal_008.png","assets/T/mri-38792095f50d47c9/coronal_009.png","assets/T/mri-38792095f50d47c9/coronal_010.png","assets/T/mri-38792095f50d47c9/coronal_011.png","assets/T/mri-38792095f50d47c9/coronal_012.png","assets/T/mri-38792095f50d47c9/coronal_013.png","assets/T/mri-38792095f50d47c9/coronal_014.png","assets/T/mri-38792095f50d47c9/coronal_015.png","assets/T/mri-38792095f50d47c9/coronal_016.png","assets/T/mri-38792095f50d47c9/coronal_017.png","assets/T/mri-38792095f50d47c9/coronal_018.png","assets/T/mri-38792095f50d47c9/coronal_019.png","assets/T/mri-38792095f50d47c9/coronal_020.png","assets/T/mri-38792095f50d47c9/coronal_021.png","assets/T/mri-38792095f50d47c9/coronal_022.png","assets/T/mri-38792095f50d47c9/coronal_023.png","assets/T/mri-38792095f50d47c9/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-548ab2f74ff34cd7","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 62 张图，均来自同一次检查。\n\n- 前 38 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-548ab2f74ff34cd7/axial_001.png","assets/T/mri-548ab2f74ff34cd7/axial_002.png","assets/T/mri-548ab2f74ff34cd7/axial_003.png","assets/T/mri-548ab2f74ff34cd7/axial_004.png","assets/T/mri-548ab2f74ff34cd7/axial_005.png","assets/T/mri-548ab2f74ff34cd7/axial_006.png","assets/T/mri-548ab2f74ff34cd7/axial_007.png","assets/T/mri-548ab2f74ff34cd7/axial_008.png","assets/T/mri-548ab2f74ff34cd7/axial_009.png","assets/T/mri-548ab2f74ff34cd7/axial_010.png","assets/T/mri-548ab2f74ff34cd7/axial_011.png","assets/T/mri-548ab2f74ff34cd7/axial_012.png","assets/T/mri-548ab2f74ff34cd7/axial_013.png","assets/T/mri-548ab2f74ff34cd7/axial_014.png","assets/T/mri-548ab2f74ff34cd7/axial_015.png","assets/T/mri-548ab2f74ff34cd7/axial_016.png","assets/T/mri-548ab2f74ff34cd7/axial_017.png","assets/T/mri-548ab2f74ff34cd7/axial_018.png","assets/T/mri-548ab2f74ff34cd7/axial_019.png","assets/T/mri-548ab2f74ff34cd7/axial_020.png","assets/T/mri-548ab2f74ff34cd7/axial_021.png","assets/T/mri-548ab2f74ff34cd7/axial_022.png","assets/T/mri-548ab2f74ff34cd7/axial_023.png","assets/T/mri-548ab2f74ff34cd7/axial_024.png","assets/T/mri-548ab2f74ff34cd7/axial_025.png","assets/T/mri-548ab2f74ff34cd7/axial_026.png","assets/T/mri-548ab2f74ff34cd7/axial_027.png","assets/T/mri-548ab2f74ff34cd7/axial_028.png","assets/T/mri-548ab2f74ff34cd7/axial_029.png","assets/T/mri-548ab2f74ff34cd7/axial_030.png","assets/T/mri-548ab2f74ff34cd7/axial_031.png","assets/T/mri-548ab2f74ff34cd7/axial_032.png","assets/T/mri-548ab2f74ff34cd7/axial_033.png","assets/T/mri-548ab2f74ff34cd7/axial_034.png","assets/T/mri-548ab2f74ff34cd7/axial_035.png","assets/T/mri-548ab2f74ff34cd7/axial_036.png","assets/T/mri-548ab2f74ff34cd7/axial_037.png","assets/T/mri-548ab2f74ff34cd7/axial_038.png","assets/T/mri-548ab2f74ff34cd7/coronal_001.png","assets/T/mri-548ab2f74ff34cd7/coronal_002.png","assets/T/mri-548ab2f74ff34cd7/coronal_003.png","assets/T/mri-548ab2f74ff34cd7/coronal_004.png","assets/T/mri-548ab2f74ff34cd7/coronal_005.png","assets/T/mri-548ab2f74ff34cd7/coronal_006.png","assets/T/mri-548ab2f74ff34cd7/coronal_007.png","assets/T/mri-548ab2f74ff34cd7/coronal_008.png","assets/T/mri-548ab2f74ff34cd7/coronal_009.png","assets/T/mri-548ab2f74ff34cd7/coronal_010.png","assets/T/mri-548ab2f74ff34cd7/coronal_011.png","assets/T/mri-548ab2f74ff34cd7/coronal_012.png","assets/T/mri-548ab2f74ff34cd7/coronal_013.png","assets/T/mri-548ab2f74ff34cd7/coronal_014.png","assets/T/mri-548ab2f74ff34cd7/coronal_015.png","assets/T/mri-548ab2f74ff34cd7/coronal_016.png","assets/T/mri-548ab2f74ff34cd7/coronal_017.png","assets/T/mri-548ab2f74ff34cd7/coronal_018.png","assets/T/mri-548ab2f74ff34cd7/coronal_019.png","assets/T/mri-548ab2f74ff34cd7/coronal_020.png","assets/T/mri-548ab2f74ff34cd7/coronal_021.png","assets/T/mri-548ab2f74ff34cd7/coronal_022.png","assets/T/mri-548ab2f74ff34cd7/coronal_023.png","assets/T/mri-548ab2f74ff34cd7/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-8f7fa7b69467480e","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 62 张图，均来自同一次检查。\n\n- 前 38 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-8f7fa7b69467480e/axial_001.png","assets/T/mri-8f7fa7b69467480e/axial_002.png","assets/T/mri-8f7fa7b69467480e/axial_003.png","assets/T/mri-8f7fa7b69467480e/axial_004.png","assets/T/mri-8f7fa7b69467480e/axial_005.png","assets/T/mri-8f7fa7b69467480e/axial_006.png","assets/T/mri-8f7fa7b69467480e/axial_007.png","assets/T/mri-8f7fa7b69467480e/axial_008.png","assets/T/mri-8f7fa7b69467480e/axial_009.png","assets/T/mri-8f7fa7b69467480e/axial_010.png","assets/T/mri-8f7fa7b69467480e/axial_011.png","assets/T/mri-8f7fa7b69467480e/axial_012.png","assets/T/mri-8f7fa7b69467480e/axial_013.png","assets/T/mri-8f7fa7b69467480e/axial_014.png","assets/T/mri-8f7fa7b69467480e/axial_015.png","assets/T/mri-8f7fa7b69467480e/axial_016.png","assets/T/mri-8f7fa7b69467480e/axial_017.png","assets/T/mri-8f7fa7b69467480e/axial_018.png","assets/T/mri-8f7fa7b69467480e/axial_019.png","assets/T/mri-8f7fa7b69467480e/axial_020.png","assets/T/mri-8f7fa7b69467480e/axial_021.png","assets/T/mri-8f7fa7b69467480e/axial_022.png","assets/T/mri-8f7fa7b69467480e/axial_023.png","assets/T/mri-8f7fa7b69467480e/axial_024.png","assets/T/mri-8f7fa7b69467480e/axial_025.png","assets/T/mri-8f7fa7b69467480e/axial_026.png","assets/T/mri-8f7fa7b69467480e/axial_027.png","assets/T/mri-8f7fa7b69467480e/axial_028.png","assets/T/mri-8f7fa7b69467480e/axial_029.png","assets/T/mri-8f7fa7b69467480e/axial_030.png","assets/T/mri-8f7fa7b69467480e/axial_031.png","assets/T/mri-8f7fa7b69467480e/axial_032.png","assets/T/mri-8f7fa7b69467480e/axial_033.png","assets/T/mri-8f7fa7b69467480e/axial_034.png","assets/T/mri-8f7fa7b69467480e/axial_035.png","assets/T/mri-8f7fa7b69467480e/axial_036.png","assets/T/mri-8f7fa7b69467480e/axial_037.png","assets/T/mri-8f7fa7b69467480e/axial_038.png","assets/T/mri-8f7fa7b69467480e/coronal_001.png","assets/T/mri-8f7fa7b69467480e/coronal_002.png","assets/T/mri-8f7fa7b69467480e/coronal_003.png","assets/T/mri-8f7fa7b69467480e/coronal_004.png","assets/T/mri-8f7fa7b69467480e/coronal_005.png","assets/T/mri-8f7fa7b69467480e/coronal_006.png","assets/T/mri-8f7fa7b69467480e/coronal_007.png","assets/T/mri-8f7fa7b69467480e/coronal_008.png","assets/T/mri-8f7fa7b69467480e/coronal_009.png","assets/T/mri-8f7fa7b69467480e/coronal_010.png","assets/T/mri-8f7fa7b69467480e/coronal_011.png","assets/T/mri-8f7fa7b69467480e/coronal_012.png","assets/T/mri-8f7fa7b69467480e/coronal_013.png","assets/T/mri-8f7fa7b69467480e/coronal_014.png","assets/T/mri-8f7fa7b69467480e/coronal_015.png","assets/T/mri-8f7fa7b69467480e/coronal_016.png","assets/T/mri-8f7fa7b69467480e/coronal_017.png","assets/T/mri-8f7fa7b69467480e/coronal_018.png","assets/T/mri-8f7fa7b69467480e/coronal_019.png","assets/T/mri-8f7fa7b69467480e/coronal_020.png","assets/T/mri-8f7fa7b69467480e/coronal_021.png","assets/T/mri-8f7fa7b69467480e/coronal_022.png","assets/T/mri-8f7fa7b69467480e/coronal_023.png","assets/T/mri-8f7fa7b69467480e/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-70b5e28526f74079","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-70b5e28526f74079/axial_001.png","assets/T/mri-70b5e28526f74079/axial_002.png","assets/T/mri-70b5e28526f74079/axial_003.png","assets/T/mri-70b5e28526f74079/axial_004.png","assets/T/mri-70b5e28526f74079/axial_005.png","assets/T/mri-70b5e28526f74079/axial_006.png","assets/T/mri-70b5e28526f74079/axial_007.png","assets/T/mri-70b5e28526f74079/axial_008.png","assets/T/mri-70b5e28526f74079/axial_009.png","assets/T/mri-70b5e28526f74079/axial_010.png","assets/T/mri-70b5e28526f74079/axial_011.png","assets/T/mri-70b5e28526f74079/axial_012.png","assets/T/mri-70b5e28526f74079/axial_013.png","assets/T/mri-70b5e28526f74079/axial_014.png","assets/T/mri-70b5e28526f74079/axial_015.png","assets/T/mri-70b5e28526f74079/axial_016.png","assets/T/mri-70b5e28526f74079/axial_017.png","assets/T/mri-70b5e28526f74079/axial_018.png","assets/T/mri-70b5e28526f74079/axial_019.png","assets/T/mri-70b5e28526f74079/axial_020.png","assets/T/mri-70b5e28526f74079/axial_021.png","assets/T/mri-70b5e28526f74079/axial_022.png","assets/T/mri-70b5e28526f74079/axial_023.png","assets/T/mri-70b5e28526f74079/axial_024.png","assets/T/mri-70b5e28526f74079/axial_025.png","assets/T/mri-70b5e28526f74079/axial_026.png","assets/T/mri-70b5e28526f74079/axial_027.png","assets/T/mri-70b5e28526f74079/axial_028.png","assets/T/mri-70b5e28526f74079/axial_029.png","assets/T/mri-70b5e28526f74079/axial_030.png","assets/T/mri-70b5e28526f74079/axial_031.png","assets/T/mri-70b5e28526f74079/axial_032.png","assets/T/mri-70b5e28526f74079/axial_033.png","assets/T/mri-70b5e28526f74079/axial_034.png","assets/T/mri-70b5e28526f74079/axial_035.png","assets/T/mri-70b5e28526f74079/axial_036.png","assets/T/mri-70b5e28526f74079/axial_037.png","assets/T/mri-70b5e28526f74079/axial_038.png","assets/T/mri-70b5e28526f74079/axial_039.png","assets/T/mri-70b5e28526f74079/axial_040.png","assets/T/mri-70b5e28526f74079/axial_041.png","assets/T/mri-70b5e28526f74079/axial_042.png","assets/T/mri-70b5e28526f74079/coronal_001.png","assets/T/mri-70b5e28526f74079/coronal_002.png","assets/T/mri-70b5e28526f74079/coronal_003.png","assets/T/mri-70b5e28526f74079/coronal_004.png","assets/T/mri-70b5e28526f74079/coronal_005.png","assets/T/mri-70b5e28526f74079/coronal_006.png","assets/T/mri-70b5e28526f74079/coronal_007.png","assets/T/mri-70b5e28526f74079/coronal_008.png","assets/T/mri-70b5e28526f74079/coronal_009.png","assets/T/mri-70b5e28526f74079/coronal_010.png","assets/T/mri-70b5e28526f74079/coronal_011.png","assets/T/mri-70b5e28526f74079/coronal_012.png","assets/T/mri-70b5e28526f74079/coronal_013.png","assets/T/mri-70b5e28526f74079/coronal_014.png","assets/T/mri-70b5e28526f74079/coronal_015.png","assets/T/mri-70b5e28526f74079/coronal_016.png","assets/T/mri-70b5e28526f74079/coronal_017.png","assets/T/mri-70b5e28526f74079/coronal_018.png","assets/T/mri-70b5e28526f74079/coronal_019.png","assets/T/mri-70b5e28526f74079/coronal_020.png","assets/T/mri-70b5e28526f74079/coronal_021.png","assets/T/mri-70b5e28526f74079/coronal_022.png","assets/T/mri-70b5e28526f74079/coronal_023.png","assets/T/mri-70b5e28526f74079/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-59351260374f4914","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 72 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 30 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-59351260374f4914/axial_001.png","assets/T/mri-59351260374f4914/axial_002.png","assets/T/mri-59351260374f4914/axial_003.png","assets/T/mri-59351260374f4914/axial_004.png","assets/T/mri-59351260374f4914/axial_005.png","assets/T/mri-59351260374f4914/axial_006.png","assets/T/mri-59351260374f4914/axial_007.png","assets/T/mri-59351260374f4914/axial_008.png","assets/T/mri-59351260374f4914/axial_009.png","assets/T/mri-59351260374f4914/axial_010.png","assets/T/mri-59351260374f4914/axial_011.png","assets/T/mri-59351260374f4914/axial_012.png","assets/T/mri-59351260374f4914/axial_013.png","assets/T/mri-59351260374f4914/axial_014.png","assets/T/mri-59351260374f4914/axial_015.png","assets/T/mri-59351260374f4914/axial_016.png","assets/T/mri-59351260374f4914/axial_017.png","assets/T/mri-59351260374f4914/axial_018.png","assets/T/mri-59351260374f4914/axial_019.png","assets/T/mri-59351260374f4914/axial_020.png","assets/T/mri-59351260374f4914/axial_021.png","assets/T/mri-59351260374f4914/axial_022.png","assets/T/mri-59351260374f4914/axial_023.png","assets/T/mri-59351260374f4914/axial_024.png","assets/T/mri-59351260374f4914/axial_025.png","assets/T/mri-59351260374f4914/axial_026.png","assets/T/mri-59351260374f4914/axial_027.png","assets/T/mri-59351260374f4914/axial_028.png","assets/T/mri-59351260374f4914/axial_029.png","assets/T/mri-59351260374f4914/axial_030.png","assets/T/mri-59351260374f4914/axial_031.png","assets/T/mri-59351260374f4914/axial_032.png","assets/T/mri-59351260374f4914/axial_033.png","assets/T/mri-59351260374f4914/axial_034.png","assets/T/mri-59351260374f4914/axial_035.png","assets/T/mri-59351260374f4914/axial_036.png","assets/T/mri-59351260374f4914/axial_037.png","assets/T/mri-59351260374f4914/axial_038.png","assets/T/mri-59351260374f4914/axial_039.png","assets/T/mri-59351260374f4914/axial_040.png","assets/T/mri-59351260374f4914/axial_041.png","assets/T/mri-59351260374f4914/axial_042.png","assets/T/mri-59351260374f4914/coronal_001.png","assets/T/mri-59351260374f4914/coronal_002.png","assets/T/mri-59351260374f4914/coronal_003.png","assets/T/mri-59351260374f4914/coronal_004.png","assets/T/mri-59351260374f4914/coronal_005.png","assets/T/mri-59351260374f4914/coronal_006.png","assets/T/mri-59351260374f4914/coronal_007.png","assets/T/mri-59351260374f4914/coronal_008.png","assets/T/mri-59351260374f4914/coronal_009.png","assets/T/mri-59351260374f4914/coronal_010.png","assets/T/mri-59351260374f4914/coronal_011.png","assets/T/mri-59351260374f4914/coronal_012.png","assets/T/mri-59351260374f4914/coronal_013.png","assets/T/mri-59351260374f4914/coronal_014.png","assets/T/mri-59351260374f4914/coronal_015.png","assets/T/mri-59351260374f4914/coronal_016.png","assets/T/mri-59351260374f4914/coronal_017.png","assets/T/mri-59351260374f4914/coronal_018.png","assets/T/mri-59351260374f4914/coronal_019.png","assets/T/mri-59351260374f4914/coronal_020.png","assets/T/mri-59351260374f4914/coronal_021.png","assets/T/mri-59351260374f4914/coronal_022.png","assets/T/mri-59351260374f4914/coronal_023.png","assets/T/mri-59351260374f4914/coronal_024.png","assets/T/mri-59351260374f4914/coronal_025.png","assets/T/mri-59351260374f4914/coronal_026.png","assets/T/mri-59351260374f4914/coronal_027.png","assets/T/mri-59351260374f4914/coronal_028.png","assets/T/mri-59351260374f4914/coronal_029.png","assets/T/mri-59351260374f4914/coronal_030.png"],"stage_edition":8}
+{"id":"L3-T300:mri-38c0615f5e7b48d4","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-38c0615f5e7b48d4/axial_001.png","assets/T/mri-38c0615f5e7b48d4/axial_002.png","assets/T/mri-38c0615f5e7b48d4/axial_003.png","assets/T/mri-38c0615f5e7b48d4/axial_004.png","assets/T/mri-38c0615f5e7b48d4/axial_005.png","assets/T/mri-38c0615f5e7b48d4/axial_006.png","assets/T/mri-38c0615f5e7b48d4/axial_007.png","assets/T/mri-38c0615f5e7b48d4/axial_008.png","assets/T/mri-38c0615f5e7b48d4/axial_009.png","assets/T/mri-38c0615f5e7b48d4/axial_010.png","assets/T/mri-38c0615f5e7b48d4/axial_011.png","assets/T/mri-38c0615f5e7b48d4/axial_012.png","assets/T/mri-38c0615f5e7b48d4/axial_013.png","assets/T/mri-38c0615f5e7b48d4/axial_014.png","assets/T/mri-38c0615f5e7b48d4/axial_015.png","assets/T/mri-38c0615f5e7b48d4/axial_016.png","assets/T/mri-38c0615f5e7b48d4/axial_017.png","assets/T/mri-38c0615f5e7b48d4/axial_018.png","assets/T/mri-38c0615f5e7b48d4/axial_019.png","assets/T/mri-38c0615f5e7b48d4/axial_020.png","assets/T/mri-38c0615f5e7b48d4/axial_021.png","assets/T/mri-38c0615f5e7b48d4/axial_022.png","assets/T/mri-38c0615f5e7b48d4/axial_023.png","assets/T/mri-38c0615f5e7b48d4/axial_024.png","assets/T/mri-38c0615f5e7b48d4/axial_025.png","assets/T/mri-38c0615f5e7b48d4/axial_026.png","assets/T/mri-38c0615f5e7b48d4/axial_027.png","assets/T/mri-38c0615f5e7b48d4/axial_028.png","assets/T/mri-38c0615f5e7b48d4/axial_029.png","assets/T/mri-38c0615f5e7b48d4/axial_030.png","assets/T/mri-38c0615f5e7b48d4/axial_031.png","assets/T/mri-38c0615f5e7b48d4/axial_032.png","assets/T/mri-38c0615f5e7b48d4/axial_033.png","assets/T/mri-38c0615f5e7b48d4/axial_034.png","assets/T/mri-38c0615f5e7b48d4/axial_035.png","assets/T/mri-38c0615f5e7b48d4/axial_036.png","assets/T/mri-38c0615f5e7b48d4/axial_037.png","assets/T/mri-38c0615f5e7b48d4/axial_038.png","assets/T/mri-38c0615f5e7b48d4/axial_039.png","assets/T/mri-38c0615f5e7b48d4/axial_040.png","assets/T/mri-38c0615f5e7b48d4/coronal_001.png","assets/T/mri-38c0615f5e7b48d4/coronal_002.png","assets/T/mri-38c0615f5e7b48d4/coronal_003.png","assets/T/mri-38c0615f5e7b48d4/coronal_004.png","assets/T/mri-38c0615f5e7b48d4/coronal_005.png","assets/T/mri-38c0615f5e7b48d4/coronal_006.png","assets/T/mri-38c0615f5e7b48d4/coronal_007.png","assets/T/mri-38c0615f5e7b48d4/coronal_008.png","assets/T/mri-38c0615f5e7b48d4/coronal_009.png","assets/T/mri-38c0615f5e7b48d4/coronal_010.png","assets/T/mri-38c0615f5e7b48d4/coronal_011.png","assets/T/mri-38c0615f5e7b48d4/coronal_012.png","assets/T/mri-38c0615f5e7b48d4/coronal_013.png","assets/T/mri-38c0615f5e7b48d4/coronal_014.png","assets/T/mri-38c0615f5e7b48d4/coronal_015.png","assets/T/mri-38c0615f5e7b48d4/coronal_016.png","assets/T/mri-38c0615f5e7b48d4/coronal_017.png","assets/T/mri-38c0615f5e7b48d4/coronal_018.png","assets/T/mri-38c0615f5e7b48d4/coronal_019.png","assets/T/mri-38c0615f5e7b48d4/coronal_020.png","assets/T/mri-38c0615f5e7b48d4/coronal_021.png","assets/T/mri-38c0615f5e7b48d4/coronal_022.png","assets/T/mri-38c0615f5e7b48d4/coronal_023.png","assets/T/mri-38c0615f5e7b48d4/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-d05109903e3240f3","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-d05109903e3240f3/axial_001.png","assets/T/mri-d05109903e3240f3/axial_002.png","assets/T/mri-d05109903e3240f3/axial_003.png","assets/T/mri-d05109903e3240f3/axial_004.png","assets/T/mri-d05109903e3240f3/axial_005.png","assets/T/mri-d05109903e3240f3/axial_006.png","assets/T/mri-d05109903e3240f3/axial_007.png","assets/T/mri-d05109903e3240f3/axial_008.png","assets/T/mri-d05109903e3240f3/axial_009.png","assets/T/mri-d05109903e3240f3/axial_010.png","assets/T/mri-d05109903e3240f3/axial_011.png","assets/T/mri-d05109903e3240f3/axial_012.png","assets/T/mri-d05109903e3240f3/axial_013.png","assets/T/mri-d05109903e3240f3/axial_014.png","assets/T/mri-d05109903e3240f3/axial_015.png","assets/T/mri-d05109903e3240f3/axial_016.png","assets/T/mri-d05109903e3240f3/axial_017.png","assets/T/mri-d05109903e3240f3/axial_018.png","assets/T/mri-d05109903e3240f3/axial_019.png","assets/T/mri-d05109903e3240f3/axial_020.png","assets/T/mri-d05109903e3240f3/axial_021.png","assets/T/mri-d05109903e3240f3/axial_022.png","assets/T/mri-d05109903e3240f3/axial_023.png","assets/T/mri-d05109903e3240f3/axial_024.png","assets/T/mri-d05109903e3240f3/axial_025.png","assets/T/mri-d05109903e3240f3/axial_026.png","assets/T/mri-d05109903e3240f3/axial_027.png","assets/T/mri-d05109903e3240f3/axial_028.png","assets/T/mri-d05109903e3240f3/axial_029.png","assets/T/mri-d05109903e3240f3/axial_030.png","assets/T/mri-d05109903e3240f3/axial_031.png","assets/T/mri-d05109903e3240f3/axial_032.png","assets/T/mri-d05109903e3240f3/axial_033.png","assets/T/mri-d05109903e3240f3/axial_034.png","assets/T/mri-d05109903e3240f3/axial_035.png","assets/T/mri-d05109903e3240f3/axial_036.png","assets/T/mri-d05109903e3240f3/axial_037.png","assets/T/mri-d05109903e3240f3/axial_038.png","assets/T/mri-d05109903e3240f3/axial_039.png","assets/T/mri-d05109903e3240f3/axial_040.png","assets/T/mri-d05109903e3240f3/coronal_001.png","assets/T/mri-d05109903e3240f3/coronal_002.png","assets/T/mri-d05109903e3240f3/coronal_003.png","assets/T/mri-d05109903e3240f3/coronal_004.png","assets/T/mri-d05109903e3240f3/coronal_005.png","assets/T/mri-d05109903e3240f3/coronal_006.png","assets/T/mri-d05109903e3240f3/coronal_007.png","assets/T/mri-d05109903e3240f3/coronal_008.png","assets/T/mri-d05109903e3240f3/coronal_009.png","assets/T/mri-d05109903e3240f3/coronal_010.png","assets/T/mri-d05109903e3240f3/coronal_011.png","assets/T/mri-d05109903e3240f3/coronal_012.png","assets/T/mri-d05109903e3240f3/coronal_013.png","assets/T/mri-d05109903e3240f3/coronal_014.png","assets/T/mri-d05109903e3240f3/coronal_015.png","assets/T/mri-d05109903e3240f3/coronal_016.png","assets/T/mri-d05109903e3240f3/coronal_017.png","assets/T/mri-d05109903e3240f3/coronal_018.png","assets/T/mri-d05109903e3240f3/coronal_019.png","assets/T/mri-d05109903e3240f3/coronal_020.png","assets/T/mri-d05109903e3240f3/coronal_021.png","assets/T/mri-d05109903e3240f3/coronal_022.png","assets/T/mri-d05109903e3240f3/coronal_023.png","assets/T/mri-d05109903e3240f3/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-3589d3f1b2ff4daa","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 71 张图，均来自同一次检查。\n\n- 前 45 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 26 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-3589d3f1b2ff4daa/axial_001.png","assets/T/mri-3589d3f1b2ff4daa/axial_002.png","assets/T/mri-3589d3f1b2ff4daa/axial_003.png","assets/T/mri-3589d3f1b2ff4daa/axial_004.png","assets/T/mri-3589d3f1b2ff4daa/axial_005.png","assets/T/mri-3589d3f1b2ff4daa/axial_006.png","assets/T/mri-3589d3f1b2ff4daa/axial_007.png","assets/T/mri-3589d3f1b2ff4daa/axial_008.png","assets/T/mri-3589d3f1b2ff4daa/axial_009.png","assets/T/mri-3589d3f1b2ff4daa/axial_010.png","assets/T/mri-3589d3f1b2ff4daa/axial_011.png","assets/T/mri-3589d3f1b2ff4daa/axial_012.png","assets/T/mri-3589d3f1b2ff4daa/axial_013.png","assets/T/mri-3589d3f1b2ff4daa/axial_014.png","assets/T/mri-3589d3f1b2ff4daa/axial_015.png","assets/T/mri-3589d3f1b2ff4daa/axial_016.png","assets/T/mri-3589d3f1b2ff4daa/axial_017.png","assets/T/mri-3589d3f1b2ff4daa/axial_018.png","assets/T/mri-3589d3f1b2ff4daa/axial_019.png","assets/T/mri-3589d3f1b2ff4daa/axial_020.png","assets/T/mri-3589d3f1b2ff4daa/axial_021.png","assets/T/mri-3589d3f1b2ff4daa/axial_022.png","assets/T/mri-3589d3f1b2ff4daa/axial_023.png","assets/T/mri-3589d3f1b2ff4daa/axial_024.png","assets/T/mri-3589d3f1b2ff4daa/axial_025.png","assets/T/mri-3589d3f1b2ff4daa/axial_026.png","assets/T/mri-3589d3f1b2ff4daa/axial_027.png","assets/T/mri-3589d3f1b2ff4daa/axial_028.png","assets/T/mri-3589d3f1b2ff4daa/axial_029.png","assets/T/mri-3589d3f1b2ff4daa/axial_030.png","assets/T/mri-3589d3f1b2ff4daa/axial_031.png","assets/T/mri-3589d3f1b2ff4daa/axial_032.png","assets/T/mri-3589d3f1b2ff4daa/axial_033.png","assets/T/mri-3589d3f1b2ff4daa/axial_034.png","assets/T/mri-3589d3f1b2ff4daa/axial_035.png","assets/T/mri-3589d3f1b2ff4daa/axial_036.png","assets/T/mri-3589d3f1b2ff4daa/axial_037.png","assets/T/mri-3589d3f1b2ff4daa/axial_038.png","assets/T/mri-3589d3f1b2ff4daa/axial_039.png","assets/T/mri-3589d3f1b2ff4daa/axial_040.png","assets/T/mri-3589d3f1b2ff4daa/axial_041.png","assets/T/mri-3589d3f1b2ff4daa/axial_042.png","assets/T/mri-3589d3f1b2ff4daa/axial_043.png","assets/T/mri-3589d3f1b2ff4daa/axial_044.png","assets/T/mri-3589d3f1b2ff4daa/axial_045.png","assets/T/mri-3589d3f1b2ff4daa/coronal_001.png","assets/T/mri-3589d3f1b2ff4daa/coronal_002.png","assets/T/mri-3589d3f1b2ff4daa/coronal_003.png","assets/T/mri-3589d3f1b2ff4daa/coronal_004.png","assets/T/mri-3589d3f1b2ff4daa/coronal_005.png","assets/T/mri-3589d3f1b2ff4daa/coronal_006.png","assets/T/mri-3589d3f1b2ff4daa/coronal_007.png","assets/T/mri-3589d3f1b2ff4daa/coronal_008.png","assets/T/mri-3589d3f1b2ff4daa/coronal_009.png","assets/T/mri-3589d3f1b2ff4daa/coronal_010.png","assets/T/mri-3589d3f1b2ff4daa/coronal_011.png","assets/T/mri-3589d3f1b2ff4daa/coronal_012.png","assets/T/mri-3589d3f1b2ff4daa/coronal_013.png","assets/T/mri-3589d3f1b2ff4daa/coronal_014.png","assets/T/mri-3589d3f1b2ff4daa/coronal_015.png","assets/T/mri-3589d3f1b2ff4daa/coronal_016.png","assets/T/mri-3589d3f1b2ff4daa/coronal_017.png","assets/T/mri-3589d3f1b2ff4daa/coronal_018.png","assets/T/mri-3589d3f1b2ff4daa/coronal_019.png","assets/T/mri-3589d3f1b2ff4daa/coronal_020.png","assets/T/mri-3589d3f1b2ff4daa/coronal_021.png","assets/T/mri-3589d3f1b2ff4daa/coronal_022.png","assets/T/mri-3589d3f1b2ff4daa/coronal_023.png","assets/T/mri-3589d3f1b2ff4daa/coronal_024.png","assets/T/mri-3589d3f1b2ff4daa/coronal_025.png","assets/T/mri-3589d3f1b2ff4daa/coronal_026.png"],"stage_edition":8}
+{"id":"L3-T300:mri-07e7c88bd85942d7","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-07e7c88bd85942d7/axial_001.png","assets/T/mri-07e7c88bd85942d7/axial_002.png","assets/T/mri-07e7c88bd85942d7/axial_003.png","assets/T/mri-07e7c88bd85942d7/axial_004.png","assets/T/mri-07e7c88bd85942d7/axial_005.png","assets/T/mri-07e7c88bd85942d7/axial_006.png","assets/T/mri-07e7c88bd85942d7/axial_007.png","assets/T/mri-07e7c88bd85942d7/axial_008.png","assets/T/mri-07e7c88bd85942d7/axial_009.png","assets/T/mri-07e7c88bd85942d7/axial_010.png","assets/T/mri-07e7c88bd85942d7/axial_011.png","assets/T/mri-07e7c88bd85942d7/axial_012.png","assets/T/mri-07e7c88bd85942d7/axial_013.png","assets/T/mri-07e7c88bd85942d7/axial_014.png","assets/T/mri-07e7c88bd85942d7/axial_015.png","assets/T/mri-07e7c88bd85942d7/axial_016.png","assets/T/mri-07e7c88bd85942d7/axial_017.png","assets/T/mri-07e7c88bd85942d7/axial_018.png","assets/T/mri-07e7c88bd85942d7/axial_019.png","assets/T/mri-07e7c88bd85942d7/axial_020.png","assets/T/mri-07e7c88bd85942d7/axial_021.png","assets/T/mri-07e7c88bd85942d7/axial_022.png","assets/T/mri-07e7c88bd85942d7/axial_023.png","assets/T/mri-07e7c88bd85942d7/axial_024.png","assets/T/mri-07e7c88bd85942d7/axial_025.png","assets/T/mri-07e7c88bd85942d7/axial_026.png","assets/T/mri-07e7c88bd85942d7/axial_027.png","assets/T/mri-07e7c88bd85942d7/axial_028.png","assets/T/mri-07e7c88bd85942d7/axial_029.png","assets/T/mri-07e7c88bd85942d7/axial_030.png","assets/T/mri-07e7c88bd85942d7/axial_031.png","assets/T/mri-07e7c88bd85942d7/axial_032.png","assets/T/mri-07e7c88bd85942d7/axial_033.png","assets/T/mri-07e7c88bd85942d7/axial_034.png","assets/T/mri-07e7c88bd85942d7/axial_035.png","assets/T/mri-07e7c88bd85942d7/axial_036.png","assets/T/mri-07e7c88bd85942d7/axial_037.png","assets/T/mri-07e7c88bd85942d7/axial_038.png","assets/T/mri-07e7c88bd85942d7/axial_039.png","assets/T/mri-07e7c88bd85942d7/axial_040.png","assets/T/mri-07e7c88bd85942d7/axial_041.png","assets/T/mri-07e7c88bd85942d7/axial_042.png","assets/T/mri-07e7c88bd85942d7/coronal_001.png","assets/T/mri-07e7c88bd85942d7/coronal_002.png","assets/T/mri-07e7c88bd85942d7/coronal_003.png","assets/T/mri-07e7c88bd85942d7/coronal_004.png","assets/T/mri-07e7c88bd85942d7/coronal_005.png","assets/T/mri-07e7c88bd85942d7/coronal_006.png","assets/T/mri-07e7c88bd85942d7/coronal_007.png","assets/T/mri-07e7c88bd85942d7/coronal_008.png","assets/T/mri-07e7c88bd85942d7/coronal_009.png","assets/T/mri-07e7c88bd85942d7/coronal_010.png","assets/T/mri-07e7c88bd85942d7/coronal_011.png","assets/T/mri-07e7c88bd85942d7/coronal_012.png","assets/T/mri-07e7c88bd85942d7/coronal_013.png","assets/T/mri-07e7c88bd85942d7/coronal_014.png","assets/T/mri-07e7c88bd85942d7/coronal_015.png","assets/T/mri-07e7c88bd85942d7/coronal_016.png","assets/T/mri-07e7c88bd85942d7/coronal_017.png","assets/T/mri-07e7c88bd85942d7/coronal_018.png","assets/T/mri-07e7c88bd85942d7/coronal_019.png","assets/T/mri-07e7c88bd85942d7/coronal_020.png","assets/T/mri-07e7c88bd85942d7/coronal_021.png","assets/T/mri-07e7c88bd85942d7/coronal_022.png","assets/T/mri-07e7c88bd85942d7/coronal_023.png","assets/T/mri-07e7c88bd85942d7/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-01305085ab2542e9","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 68 张图，均来自同一次检查。\n\n- 前 44 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-01305085ab2542e9/axial_001.png","assets/T/mri-01305085ab2542e9/axial_002.png","assets/T/mri-01305085ab2542e9/axial_003.png","assets/T/mri-01305085ab2542e9/axial_004.png","assets/T/mri-01305085ab2542e9/axial_005.png","assets/T/mri-01305085ab2542e9/axial_006.png","assets/T/mri-01305085ab2542e9/axial_007.png","assets/T/mri-01305085ab2542e9/axial_008.png","assets/T/mri-01305085ab2542e9/axial_009.png","assets/T/mri-01305085ab2542e9/axial_010.png","assets/T/mri-01305085ab2542e9/axial_011.png","assets/T/mri-01305085ab2542e9/axial_012.png","assets/T/mri-01305085ab2542e9/axial_013.png","assets/T/mri-01305085ab2542e9/axial_014.png","assets/T/mri-01305085ab2542e9/axial_015.png","assets/T/mri-01305085ab2542e9/axial_016.png","assets/T/mri-01305085ab2542e9/axial_017.png","assets/T/mri-01305085ab2542e9/axial_018.png","assets/T/mri-01305085ab2542e9/axial_019.png","assets/T/mri-01305085ab2542e9/axial_020.png","assets/T/mri-01305085ab2542e9/axial_021.png","assets/T/mri-01305085ab2542e9/axial_022.png","assets/T/mri-01305085ab2542e9/axial_023.png","assets/T/mri-01305085ab2542e9/axial_024.png","assets/T/mri-01305085ab2542e9/axial_025.png","assets/T/mri-01305085ab2542e9/axial_026.png","assets/T/mri-01305085ab2542e9/axial_027.png","assets/T/mri-01305085ab2542e9/axial_028.png","assets/T/mri-01305085ab2542e9/axial_029.png","assets/T/mri-01305085ab2542e9/axial_030.png","assets/T/mri-01305085ab2542e9/axial_031.png","assets/T/mri-01305085ab2542e9/axial_032.png","assets/T/mri-01305085ab2542e9/axial_033.png","assets/T/mri-01305085ab2542e9/axial_034.png","assets/T/mri-01305085ab2542e9/axial_035.png","assets/T/mri-01305085ab2542e9/axial_036.png","assets/T/mri-01305085ab2542e9/axial_037.png","assets/T/mri-01305085ab2542e9/axial_038.png","assets/T/mri-01305085ab2542e9/axial_039.png","assets/T/mri-01305085ab2542e9/axial_040.png","assets/T/mri-01305085ab2542e9/axial_041.png","assets/T/mri-01305085ab2542e9/axial_042.png","assets/T/mri-01305085ab2542e9/axial_043.png","assets/T/mri-01305085ab2542e9/axial_044.png","assets/T/mri-01305085ab2542e9/coronal_001.png","assets/T/mri-01305085ab2542e9/coronal_002.png","assets/T/mri-01305085ab2542e9/coronal_003.png","assets/T/mri-01305085ab2542e9/coronal_004.png","assets/T/mri-01305085ab2542e9/coronal_005.png","assets/T/mri-01305085ab2542e9/coronal_006.png","assets/T/mri-01305085ab2542e9/coronal_007.png","assets/T/mri-01305085ab2542e9/coronal_008.png","assets/T/mri-01305085ab2542e9/coronal_009.png","assets/T/mri-01305085ab2542e9/coronal_010.png","assets/T/mri-01305085ab2542e9/coronal_011.png","assets/T/mri-01305085ab2542e9/coronal_012.png","assets/T/mri-01305085ab2542e9/coronal_013.png","assets/T/mri-01305085ab2542e9/coronal_014.png","assets/T/mri-01305085ab2542e9/coronal_015.png","assets/T/mri-01305085ab2542e9/coronal_016.png","assets/T/mri-01305085ab2542e9/coronal_017.png","assets/T/mri-01305085ab2542e9/coronal_018.png","assets/T/mri-01305085ab2542e9/coronal_019.png","assets/T/mri-01305085ab2542e9/coronal_020.png","assets/T/mri-01305085ab2542e9/coronal_021.png","assets/T/mri-01305085ab2542e9/coronal_022.png","assets/T/mri-01305085ab2542e9/coronal_023.png","assets/T/mri-01305085ab2542e9/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-b4f8ba5eda964d53","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-b4f8ba5eda964d53/axial_001.png","assets/T/mri-b4f8ba5eda964d53/axial_002.png","assets/T/mri-b4f8ba5eda964d53/axial_003.png","assets/T/mri-b4f8ba5eda964d53/axial_004.png","assets/T/mri-b4f8ba5eda964d53/axial_005.png","assets/T/mri-b4f8ba5eda964d53/axial_006.png","assets/T/mri-b4f8ba5eda964d53/axial_007.png","assets/T/mri-b4f8ba5eda964d53/axial_008.png","assets/T/mri-b4f8ba5eda964d53/axial_009.png","assets/T/mri-b4f8ba5eda964d53/axial_010.png","assets/T/mri-b4f8ba5eda964d53/axial_011.png","assets/T/mri-b4f8ba5eda964d53/axial_012.png","assets/T/mri-b4f8ba5eda964d53/axial_013.png","assets/T/mri-b4f8ba5eda964d53/axial_014.png","assets/T/mri-b4f8ba5eda964d53/axial_015.png","assets/T/mri-b4f8ba5eda964d53/axial_016.png","assets/T/mri-b4f8ba5eda964d53/axial_017.png","assets/T/mri-b4f8ba5eda964d53/axial_018.png","assets/T/mri-b4f8ba5eda964d53/axial_019.png","assets/T/mri-b4f8ba5eda964d53/axial_020.png","assets/T/mri-b4f8ba5eda964d53/axial_021.png","assets/T/mri-b4f8ba5eda964d53/axial_022.png","assets/T/mri-b4f8ba5eda964d53/axial_023.png","assets/T/mri-b4f8ba5eda964d53/axial_024.png","assets/T/mri-b4f8ba5eda964d53/axial_025.png","assets/T/mri-b4f8ba5eda964d53/axial_026.png","assets/T/mri-b4f8ba5eda964d53/axial_027.png","assets/T/mri-b4f8ba5eda964d53/axial_028.png","assets/T/mri-b4f8ba5eda964d53/axial_029.png","assets/T/mri-b4f8ba5eda964d53/axial_030.png","assets/T/mri-b4f8ba5eda964d53/axial_031.png","assets/T/mri-b4f8ba5eda964d53/axial_032.png","assets/T/mri-b4f8ba5eda964d53/axial_033.png","assets/T/mri-b4f8ba5eda964d53/axial_034.png","assets/T/mri-b4f8ba5eda964d53/axial_035.png","assets/T/mri-b4f8ba5eda964d53/axial_036.png","assets/T/mri-b4f8ba5eda964d53/axial_037.png","assets/T/mri-b4f8ba5eda964d53/axial_038.png","assets/T/mri-b4f8ba5eda964d53/axial_039.png","assets/T/mri-b4f8ba5eda964d53/axial_040.png","assets/T/mri-b4f8ba5eda964d53/axial_041.png","assets/T/mri-b4f8ba5eda964d53/axial_042.png","assets/T/mri-b4f8ba5eda964d53/coronal_001.png","assets/T/mri-b4f8ba5eda964d53/coronal_002.png","assets/T/mri-b4f8ba5eda964d53/coronal_003.png","assets/T/mri-b4f8ba5eda964d53/coronal_004.png","assets/T/mri-b4f8ba5eda964d53/coronal_005.png","assets/T/mri-b4f8ba5eda964d53/coronal_006.png","assets/T/mri-b4f8ba5eda964d53/coronal_007.png","assets/T/mri-b4f8ba5eda964d53/coronal_008.png","assets/T/mri-b4f8ba5eda964d53/coronal_009.png","assets/T/mri-b4f8ba5eda964d53/coronal_010.png","assets/T/mri-b4f8ba5eda964d53/coronal_011.png","assets/T/mri-b4f8ba5eda964d53/coronal_012.png","assets/T/mri-b4f8ba5eda964d53/coronal_013.png","assets/T/mri-b4f8ba5eda964d53/coronal_014.png","assets/T/mri-b4f8ba5eda964d53/coronal_015.png","assets/T/mri-b4f8ba5eda964d53/coronal_016.png","assets/T/mri-b4f8ba5eda964d53/coronal_017.png","assets/T/mri-b4f8ba5eda964d53/coronal_018.png","assets/T/mri-b4f8ba5eda964d53/coronal_019.png","assets/T/mri-b4f8ba5eda964d53/coronal_020.png","assets/T/mri-b4f8ba5eda964d53/coronal_021.png","assets/T/mri-b4f8ba5eda964d53/coronal_022.png","assets/T/mri-b4f8ba5eda964d53/coronal_023.png","assets/T/mri-b4f8ba5eda964d53/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-845f9f6401284877","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-845f9f6401284877/axial_001.png","assets/T/mri-845f9f6401284877/axial_002.png","assets/T/mri-845f9f6401284877/axial_003.png","assets/T/mri-845f9f6401284877/axial_004.png","assets/T/mri-845f9f6401284877/axial_005.png","assets/T/mri-845f9f6401284877/axial_006.png","assets/T/mri-845f9f6401284877/axial_007.png","assets/T/mri-845f9f6401284877/axial_008.png","assets/T/mri-845f9f6401284877/axial_009.png","assets/T/mri-845f9f6401284877/axial_010.png","assets/T/mri-845f9f6401284877/axial_011.png","assets/T/mri-845f9f6401284877/axial_012.png","assets/T/mri-845f9f6401284877/axial_013.png","assets/T/mri-845f9f6401284877/axial_014.png","assets/T/mri-845f9f6401284877/axial_015.png","assets/T/mri-845f9f6401284877/axial_016.png","assets/T/mri-845f9f6401284877/axial_017.png","assets/T/mri-845f9f6401284877/axial_018.png","assets/T/mri-845f9f6401284877/axial_019.png","assets/T/mri-845f9f6401284877/axial_020.png","assets/T/mri-845f9f6401284877/axial_021.png","assets/T/mri-845f9f6401284877/axial_022.png","assets/T/mri-845f9f6401284877/axial_023.png","assets/T/mri-845f9f6401284877/axial_024.png","assets/T/mri-845f9f6401284877/axial_025.png","assets/T/mri-845f9f6401284877/axial_026.png","assets/T/mri-845f9f6401284877/axial_027.png","assets/T/mri-845f9f6401284877/axial_028.png","assets/T/mri-845f9f6401284877/axial_029.png","assets/T/mri-845f9f6401284877/axial_030.png","assets/T/mri-845f9f6401284877/axial_031.png","assets/T/mri-845f9f6401284877/axial_032.png","assets/T/mri-845f9f6401284877/axial_033.png","assets/T/mri-845f9f6401284877/axial_034.png","assets/T/mri-845f9f6401284877/axial_035.png","assets/T/mri-845f9f6401284877/axial_036.png","assets/T/mri-845f9f6401284877/axial_037.png","assets/T/mri-845f9f6401284877/axial_038.png","assets/T/mri-845f9f6401284877/axial_039.png","assets/T/mri-845f9f6401284877/axial_040.png","assets/T/mri-845f9f6401284877/coronal_001.png","assets/T/mri-845f9f6401284877/coronal_002.png","assets/T/mri-845f9f6401284877/coronal_003.png","assets/T/mri-845f9f6401284877/coronal_004.png","assets/T/mri-845f9f6401284877/coronal_005.png","assets/T/mri-845f9f6401284877/coronal_006.png","assets/T/mri-845f9f6401284877/coronal_007.png","assets/T/mri-845f9f6401284877/coronal_008.png","assets/T/mri-845f9f6401284877/coronal_009.png","assets/T/mri-845f9f6401284877/coronal_010.png","assets/T/mri-845f9f6401284877/coronal_011.png","assets/T/mri-845f9f6401284877/coronal_012.png","assets/T/mri-845f9f6401284877/coronal_013.png","assets/T/mri-845f9f6401284877/coronal_014.png","assets/T/mri-845f9f6401284877/coronal_015.png","assets/T/mri-845f9f6401284877/coronal_016.png","assets/T/mri-845f9f6401284877/coronal_017.png","assets/T/mri-845f9f6401284877/coronal_018.png","assets/T/mri-845f9f6401284877/coronal_019.png","assets/T/mri-845f9f6401284877/coronal_020.png","assets/T/mri-845f9f6401284877/coronal_021.png","assets/T/mri-845f9f6401284877/coronal_022.png","assets/T/mri-845f9f6401284877/coronal_023.png","assets/T/mri-845f9f6401284877/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-4d9005f5f44f4b7b","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-4d9005f5f44f4b7b/axial_001.png","assets/T/mri-4d9005f5f44f4b7b/axial_002.png","assets/T/mri-4d9005f5f44f4b7b/axial_003.png","assets/T/mri-4d9005f5f44f4b7b/axial_004.png","assets/T/mri-4d9005f5f44f4b7b/axial_005.png","assets/T/mri-4d9005f5f44f4b7b/axial_006.png","assets/T/mri-4d9005f5f44f4b7b/axial_007.png","assets/T/mri-4d9005f5f44f4b7b/axial_008.png","assets/T/mri-4d9005f5f44f4b7b/axial_009.png","assets/T/mri-4d9005f5f44f4b7b/axial_010.png","assets/T/mri-4d9005f5f44f4b7b/axial_011.png","assets/T/mri-4d9005f5f44f4b7b/axial_012.png","assets/T/mri-4d9005f5f44f4b7b/axial_013.png","assets/T/mri-4d9005f5f44f4b7b/axial_014.png","assets/T/mri-4d9005f5f44f4b7b/axial_015.png","assets/T/mri-4d9005f5f44f4b7b/axial_016.png","assets/T/mri-4d9005f5f44f4b7b/axial_017.png","assets/T/mri-4d9005f5f44f4b7b/axial_018.png","assets/T/mri-4d9005f5f44f4b7b/axial_019.png","assets/T/mri-4d9005f5f44f4b7b/axial_020.png","assets/T/mri-4d9005f5f44f4b7b/axial_021.png","assets/T/mri-4d9005f5f44f4b7b/axial_022.png","assets/T/mri-4d9005f5f44f4b7b/axial_023.png","assets/T/mri-4d9005f5f44f4b7b/axial_024.png","assets/T/mri-4d9005f5f44f4b7b/axial_025.png","assets/T/mri-4d9005f5f44f4b7b/axial_026.png","assets/T/mri-4d9005f5f44f4b7b/axial_027.png","assets/T/mri-4d9005f5f44f4b7b/axial_028.png","assets/T/mri-4d9005f5f44f4b7b/axial_029.png","assets/T/mri-4d9005f5f44f4b7b/axial_030.png","assets/T/mri-4d9005f5f44f4b7b/axial_031.png","assets/T/mri-4d9005f5f44f4b7b/axial_032.png","assets/T/mri-4d9005f5f44f4b7b/axial_033.png","assets/T/mri-4d9005f5f44f4b7b/axial_034.png","assets/T/mri-4d9005f5f44f4b7b/axial_035.png","assets/T/mri-4d9005f5f44f4b7b/axial_036.png","assets/T/mri-4d9005f5f44f4b7b/axial_037.png","assets/T/mri-4d9005f5f44f4b7b/axial_038.png","assets/T/mri-4d9005f5f44f4b7b/axial_039.png","assets/T/mri-4d9005f5f44f4b7b/axial_040.png","assets/T/mri-4d9005f5f44f4b7b/coronal_001.png","assets/T/mri-4d9005f5f44f4b7b/coronal_002.png","assets/T/mri-4d9005f5f44f4b7b/coronal_003.png","assets/T/mri-4d9005f5f44f4b7b/coronal_004.png","assets/T/mri-4d9005f5f44f4b7b/coronal_005.png","assets/T/mri-4d9005f5f44f4b7b/coronal_006.png","assets/T/mri-4d9005f5f44f4b7b/coronal_007.png","assets/T/mri-4d9005f5f44f4b7b/coronal_008.png","assets/T/mri-4d9005f5f44f4b7b/coronal_009.png","assets/T/mri-4d9005f5f44f4b7b/coronal_010.png","assets/T/mri-4d9005f5f44f4b7b/coronal_011.png","assets/T/mri-4d9005f5f44f4b7b/coronal_012.png","assets/T/mri-4d9005f5f44f4b7b/coronal_013.png","assets/T/mri-4d9005f5f44f4b7b/coronal_014.png","assets/T/mri-4d9005f5f44f4b7b/coronal_015.png","assets/T/mri-4d9005f5f44f4b7b/coronal_016.png","assets/T/mri-4d9005f5f44f4b7b/coronal_017.png","assets/T/mri-4d9005f5f44f4b7b/coronal_018.png","assets/T/mri-4d9005f5f44f4b7b/coronal_019.png","assets/T/mri-4d9005f5f44f4b7b/coronal_020.png","assets/T/mri-4d9005f5f44f4b7b/coronal_021.png","assets/T/mri-4d9005f5f44f4b7b/coronal_022.png","assets/T/mri-4d9005f5f44f4b7b/coronal_023.png","assets/T/mri-4d9005f5f44f4b7b/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-d703abecf2bf417e","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-d703abecf2bf417e/axial_001.png","assets/T/mri-d703abecf2bf417e/axial_002.png","assets/T/mri-d703abecf2bf417e/axial_003.png","assets/T/mri-d703abecf2bf417e/axial_004.png","assets/T/mri-d703abecf2bf417e/axial_005.png","assets/T/mri-d703abecf2bf417e/axial_006.png","assets/T/mri-d703abecf2bf417e/axial_007.png","assets/T/mri-d703abecf2bf417e/axial_008.png","assets/T/mri-d703abecf2bf417e/axial_009.png","assets/T/mri-d703abecf2bf417e/axial_010.png","assets/T/mri-d703abecf2bf417e/axial_011.png","assets/T/mri-d703abecf2bf417e/axial_012.png","assets/T/mri-d703abecf2bf417e/axial_013.png","assets/T/mri-d703abecf2bf417e/axial_014.png","assets/T/mri-d703abecf2bf417e/axial_015.png","assets/T/mri-d703abecf2bf417e/axial_016.png","assets/T/mri-d703abecf2bf417e/axial_017.png","assets/T/mri-d703abecf2bf417e/axial_018.png","assets/T/mri-d703abecf2bf417e/axial_019.png","assets/T/mri-d703abecf2bf417e/axial_020.png","assets/T/mri-d703abecf2bf417e/axial_021.png","assets/T/mri-d703abecf2bf417e/axial_022.png","assets/T/mri-d703abecf2bf417e/axial_023.png","assets/T/mri-d703abecf2bf417e/axial_024.png","assets/T/mri-d703abecf2bf417e/axial_025.png","assets/T/mri-d703abecf2bf417e/axial_026.png","assets/T/mri-d703abecf2bf417e/axial_027.png","assets/T/mri-d703abecf2bf417e/axial_028.png","assets/T/mri-d703abecf2bf417e/axial_029.png","assets/T/mri-d703abecf2bf417e/axial_030.png","assets/T/mri-d703abecf2bf417e/axial_031.png","assets/T/mri-d703abecf2bf417e/axial_032.png","assets/T/mri-d703abecf2bf417e/axial_033.png","assets/T/mri-d703abecf2bf417e/axial_034.png","assets/T/mri-d703abecf2bf417e/axial_035.png","assets/T/mri-d703abecf2bf417e/axial_036.png","assets/T/mri-d703abecf2bf417e/axial_037.png","assets/T/mri-d703abecf2bf417e/axial_038.png","assets/T/mri-d703abecf2bf417e/axial_039.png","assets/T/mri-d703abecf2bf417e/axial_040.png","assets/T/mri-d703abecf2bf417e/coronal_001.png","assets/T/mri-d703abecf2bf417e/coronal_002.png","assets/T/mri-d703abecf2bf417e/coronal_003.png","assets/T/mri-d703abecf2bf417e/coronal_004.png","assets/T/mri-d703abecf2bf417e/coronal_005.png","assets/T/mri-d703abecf2bf417e/coronal_006.png","assets/T/mri-d703abecf2bf417e/coronal_007.png","assets/T/mri-d703abecf2bf417e/coronal_008.png","assets/T/mri-d703abecf2bf417e/coronal_009.png","assets/T/mri-d703abecf2bf417e/coronal_010.png","assets/T/mri-d703abecf2bf417e/coronal_011.png","assets/T/mri-d703abecf2bf417e/coronal_012.png","assets/T/mri-d703abecf2bf417e/coronal_013.png","assets/T/mri-d703abecf2bf417e/coronal_014.png","assets/T/mri-d703abecf2bf417e/coronal_015.png","assets/T/mri-d703abecf2bf417e/coronal_016.png","assets/T/mri-d703abecf2bf417e/coronal_017.png","assets/T/mri-d703abecf2bf417e/coronal_018.png","assets/T/mri-d703abecf2bf417e/coronal_019.png","assets/T/mri-d703abecf2bf417e/coronal_020.png","assets/T/mri-d703abecf2bf417e/coronal_021.png","assets/T/mri-d703abecf2bf417e/coronal_022.png","assets/T/mri-d703abecf2bf417e/coronal_023.png","assets/T/mri-d703abecf2bf417e/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-822812f3ff034bba","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 60 张图，均来自同一次检查。\n\n- 前 36 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-822812f3ff034bba/axial_001.png","assets/T/mri-822812f3ff034bba/axial_002.png","assets/T/mri-822812f3ff034bba/axial_003.png","assets/T/mri-822812f3ff034bba/axial_004.png","assets/T/mri-822812f3ff034bba/axial_005.png","assets/T/mri-822812f3ff034bba/axial_006.png","assets/T/mri-822812f3ff034bba/axial_007.png","assets/T/mri-822812f3ff034bba/axial_008.png","assets/T/mri-822812f3ff034bba/axial_009.png","assets/T/mri-822812f3ff034bba/axial_010.png","assets/T/mri-822812f3ff034bba/axial_011.png","assets/T/mri-822812f3ff034bba/axial_012.png","assets/T/mri-822812f3ff034bba/axial_013.png","assets/T/mri-822812f3ff034bba/axial_014.png","assets/T/mri-822812f3ff034bba/axial_015.png","assets/T/mri-822812f3ff034bba/axial_016.png","assets/T/mri-822812f3ff034bba/axial_017.png","assets/T/mri-822812f3ff034bba/axial_018.png","assets/T/mri-822812f3ff034bba/axial_019.png","assets/T/mri-822812f3ff034bba/axial_020.png","assets/T/mri-822812f3ff034bba/axial_021.png","assets/T/mri-822812f3ff034bba/axial_022.png","assets/T/mri-822812f3ff034bba/axial_023.png","assets/T/mri-822812f3ff034bba/axial_024.png","assets/T/mri-822812f3ff034bba/axial_025.png","assets/T/mri-822812f3ff034bba/axial_026.png","assets/T/mri-822812f3ff034bba/axial_027.png","assets/T/mri-822812f3ff034bba/axial_028.png","assets/T/mri-822812f3ff034bba/axial_029.png","assets/T/mri-822812f3ff034bba/axial_030.png","assets/T/mri-822812f3ff034bba/axial_031.png","assets/T/mri-822812f3ff034bba/axial_032.png","assets/T/mri-822812f3ff034bba/axial_033.png","assets/T/mri-822812f3ff034bba/axial_034.png","assets/T/mri-822812f3ff034bba/axial_035.png","assets/T/mri-822812f3ff034bba/axial_036.png","assets/T/mri-822812f3ff034bba/coronal_001.png","assets/T/mri-822812f3ff034bba/coronal_002.png","assets/T/mri-822812f3ff034bba/coronal_003.png","assets/T/mri-822812f3ff034bba/coronal_004.png","assets/T/mri-822812f3ff034bba/coronal_005.png","assets/T/mri-822812f3ff034bba/coronal_006.png","assets/T/mri-822812f3ff034bba/coronal_007.png","assets/T/mri-822812f3ff034bba/coronal_008.png","assets/T/mri-822812f3ff034bba/coronal_009.png","assets/T/mri-822812f3ff034bba/coronal_010.png","assets/T/mri-822812f3ff034bba/coronal_011.png","assets/T/mri-822812f3ff034bba/coronal_012.png","assets/T/mri-822812f3ff034bba/coronal_013.png","assets/T/mri-822812f3ff034bba/coronal_014.png","assets/T/mri-822812f3ff034bba/coronal_015.png","assets/T/mri-822812f3ff034bba/coronal_016.png","assets/T/mri-822812f3ff034bba/coronal_017.png","assets/T/mri-822812f3ff034bba/coronal_018.png","assets/T/mri-822812f3ff034bba/coronal_019.png","assets/T/mri-822812f3ff034bba/coronal_020.png","assets/T/mri-822812f3ff034bba/coronal_021.png","assets/T/mri-822812f3ff034bba/coronal_022.png","assets/T/mri-822812f3ff034bba/coronal_023.png","assets/T/mri-822812f3ff034bba/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-20e02e9841324cfc","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-20e02e9841324cfc/axial_001.png","assets/T/mri-20e02e9841324cfc/axial_002.png","assets/T/mri-20e02e9841324cfc/axial_003.png","assets/T/mri-20e02e9841324cfc/axial_004.png","assets/T/mri-20e02e9841324cfc/axial_005.png","assets/T/mri-20e02e9841324cfc/axial_006.png","assets/T/mri-20e02e9841324cfc/axial_007.png","assets/T/mri-20e02e9841324cfc/axial_008.png","assets/T/mri-20e02e9841324cfc/axial_009.png","assets/T/mri-20e02e9841324cfc/axial_010.png","assets/T/mri-20e02e9841324cfc/axial_011.png","assets/T/mri-20e02e9841324cfc/axial_012.png","assets/T/mri-20e02e9841324cfc/axial_013.png","assets/T/mri-20e02e9841324cfc/axial_014.png","assets/T/mri-20e02e9841324cfc/axial_015.png","assets/T/mri-20e02e9841324cfc/axial_016.png","assets/T/mri-20e02e9841324cfc/axial_017.png","assets/T/mri-20e02e9841324cfc/axial_018.png","assets/T/mri-20e02e9841324cfc/axial_019.png","assets/T/mri-20e02e9841324cfc/axial_020.png","assets/T/mri-20e02e9841324cfc/axial_021.png","assets/T/mri-20e02e9841324cfc/axial_022.png","assets/T/mri-20e02e9841324cfc/axial_023.png","assets/T/mri-20e02e9841324cfc/axial_024.png","assets/T/mri-20e02e9841324cfc/axial_025.png","assets/T/mri-20e02e9841324cfc/axial_026.png","assets/T/mri-20e02e9841324cfc/axial_027.png","assets/T/mri-20e02e9841324cfc/axial_028.png","assets/T/mri-20e02e9841324cfc/axial_029.png","assets/T/mri-20e02e9841324cfc/axial_030.png","assets/T/mri-20e02e9841324cfc/axial_031.png","assets/T/mri-20e02e9841324cfc/axial_032.png","assets/T/mri-20e02e9841324cfc/axial_033.png","assets/T/mri-20e02e9841324cfc/axial_034.png","assets/T/mri-20e02e9841324cfc/axial_035.png","assets/T/mri-20e02e9841324cfc/axial_036.png","assets/T/mri-20e02e9841324cfc/axial_037.png","assets/T/mri-20e02e9841324cfc/axial_038.png","assets/T/mri-20e02e9841324cfc/axial_039.png","assets/T/mri-20e02e9841324cfc/axial_040.png","assets/T/mri-20e02e9841324cfc/axial_041.png","assets/T/mri-20e02e9841324cfc/axial_042.png","assets/T/mri-20e02e9841324cfc/coronal_001.png","assets/T/mri-20e02e9841324cfc/coronal_002.png","assets/T/mri-20e02e9841324cfc/coronal_003.png","assets/T/mri-20e02e9841324cfc/coronal_004.png","assets/T/mri-20e02e9841324cfc/coronal_005.png","assets/T/mri-20e02e9841324cfc/coronal_006.png","assets/T/mri-20e02e9841324cfc/coronal_007.png","assets/T/mri-20e02e9841324cfc/coronal_008.png","assets/T/mri-20e02e9841324cfc/coronal_009.png","assets/T/mri-20e02e9841324cfc/coronal_010.png","assets/T/mri-20e02e9841324cfc/coronal_011.png","assets/T/mri-20e02e9841324cfc/coronal_012.png","assets/T/mri-20e02e9841324cfc/coronal_013.png","assets/T/mri-20e02e9841324cfc/coronal_014.png","assets/T/mri-20e02e9841324cfc/coronal_015.png","assets/T/mri-20e02e9841324cfc/coronal_016.png","assets/T/mri-20e02e9841324cfc/coronal_017.png","assets/T/mri-20e02e9841324cfc/coronal_018.png","assets/T/mri-20e02e9841324cfc/coronal_019.png","assets/T/mri-20e02e9841324cfc/coronal_020.png","assets/T/mri-20e02e9841324cfc/coronal_021.png","assets/T/mri-20e02e9841324cfc/coronal_022.png","assets/T/mri-20e02e9841324cfc/coronal_023.png","assets/T/mri-20e02e9841324cfc/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-4fca7bc4c97948bb","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-4fca7bc4c97948bb/axial_001.png","assets/T/mri-4fca7bc4c97948bb/axial_002.png","assets/T/mri-4fca7bc4c97948bb/axial_003.png","assets/T/mri-4fca7bc4c97948bb/axial_004.png","assets/T/mri-4fca7bc4c97948bb/axial_005.png","assets/T/mri-4fca7bc4c97948bb/axial_006.png","assets/T/mri-4fca7bc4c97948bb/axial_007.png","assets/T/mri-4fca7bc4c97948bb/axial_008.png","assets/T/mri-4fca7bc4c97948bb/axial_009.png","assets/T/mri-4fca7bc4c97948bb/axial_010.png","assets/T/mri-4fca7bc4c97948bb/axial_011.png","assets/T/mri-4fca7bc4c97948bb/axial_012.png","assets/T/mri-4fca7bc4c97948bb/axial_013.png","assets/T/mri-4fca7bc4c97948bb/axial_014.png","assets/T/mri-4fca7bc4c97948bb/axial_015.png","assets/T/mri-4fca7bc4c97948bb/axial_016.png","assets/T/mri-4fca7bc4c97948bb/axial_017.png","assets/T/mri-4fca7bc4c97948bb/axial_018.png","assets/T/mri-4fca7bc4c97948bb/axial_019.png","assets/T/mri-4fca7bc4c97948bb/axial_020.png","assets/T/mri-4fca7bc4c97948bb/axial_021.png","assets/T/mri-4fca7bc4c97948bb/axial_022.png","assets/T/mri-4fca7bc4c97948bb/axial_023.png","assets/T/mri-4fca7bc4c97948bb/axial_024.png","assets/T/mri-4fca7bc4c97948bb/axial_025.png","assets/T/mri-4fca7bc4c97948bb/axial_026.png","assets/T/mri-4fca7bc4c97948bb/axial_027.png","assets/T/mri-4fca7bc4c97948bb/axial_028.png","assets/T/mri-4fca7bc4c97948bb/axial_029.png","assets/T/mri-4fca7bc4c97948bb/axial_030.png","assets/T/mri-4fca7bc4c97948bb/axial_031.png","assets/T/mri-4fca7bc4c97948bb/axial_032.png","assets/T/mri-4fca7bc4c97948bb/axial_033.png","assets/T/mri-4fca7bc4c97948bb/axial_034.png","assets/T/mri-4fca7bc4c97948bb/axial_035.png","assets/T/mri-4fca7bc4c97948bb/axial_036.png","assets/T/mri-4fca7bc4c97948bb/axial_037.png","assets/T/mri-4fca7bc4c97948bb/axial_038.png","assets/T/mri-4fca7bc4c97948bb/axial_039.png","assets/T/mri-4fca7bc4c97948bb/axial_040.png","assets/T/mri-4fca7bc4c97948bb/axial_041.png","assets/T/mri-4fca7bc4c97948bb/axial_042.png","assets/T/mri-4fca7bc4c97948bb/coronal_001.png","assets/T/mri-4fca7bc4c97948bb/coronal_002.png","assets/T/mri-4fca7bc4c97948bb/coronal_003.png","assets/T/mri-4fca7bc4c97948bb/coronal_004.png","assets/T/mri-4fca7bc4c97948bb/coronal_005.png","assets/T/mri-4fca7bc4c97948bb/coronal_006.png","assets/T/mri-4fca7bc4c97948bb/coronal_007.png","assets/T/mri-4fca7bc4c97948bb/coronal_008.png","assets/T/mri-4fca7bc4c97948bb/coronal_009.png","assets/T/mri-4fca7bc4c97948bb/coronal_010.png","assets/T/mri-4fca7bc4c97948bb/coronal_011.png","assets/T/mri-4fca7bc4c97948bb/coronal_012.png","assets/T/mri-4fca7bc4c97948bb/coronal_013.png","assets/T/mri-4fca7bc4c97948bb/coronal_014.png","assets/T/mri-4fca7bc4c97948bb/coronal_015.png","assets/T/mri-4fca7bc4c97948bb/coronal_016.png","assets/T/mri-4fca7bc4c97948bb/coronal_017.png","assets/T/mri-4fca7bc4c97948bb/coronal_018.png","assets/T/mri-4fca7bc4c97948bb/coronal_019.png","assets/T/mri-4fca7bc4c97948bb/coronal_020.png","assets/T/mri-4fca7bc4c97948bb/coronal_021.png","assets/T/mri-4fca7bc4c97948bb/coronal_022.png","assets/T/mri-4fca7bc4c97948bb/coronal_023.png","assets/T/mri-4fca7bc4c97948bb/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-0a0ac98f64f647a1","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 70 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 28 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-0a0ac98f64f647a1/axial_001.png","assets/T/mri-0a0ac98f64f647a1/axial_002.png","assets/T/mri-0a0ac98f64f647a1/axial_003.png","assets/T/mri-0a0ac98f64f647a1/axial_004.png","assets/T/mri-0a0ac98f64f647a1/axial_005.png","assets/T/mri-0a0ac98f64f647a1/axial_006.png","assets/T/mri-0a0ac98f64f647a1/axial_007.png","assets/T/mri-0a0ac98f64f647a1/axial_008.png","assets/T/mri-0a0ac98f64f647a1/axial_009.png","assets/T/mri-0a0ac98f64f647a1/axial_010.png","assets/T/mri-0a0ac98f64f647a1/axial_011.png","assets/T/mri-0a0ac98f64f647a1/axial_012.png","assets/T/mri-0a0ac98f64f647a1/axial_013.png","assets/T/mri-0a0ac98f64f647a1/axial_014.png","assets/T/mri-0a0ac98f64f647a1/axial_015.png","assets/T/mri-0a0ac98f64f647a1/axial_016.png","assets/T/mri-0a0ac98f64f647a1/axial_017.png","assets/T/mri-0a0ac98f64f647a1/axial_018.png","assets/T/mri-0a0ac98f64f647a1/axial_019.png","assets/T/mri-0a0ac98f64f647a1/axial_020.png","assets/T/mri-0a0ac98f64f647a1/axial_021.png","assets/T/mri-0a0ac98f64f647a1/axial_022.png","assets/T/mri-0a0ac98f64f647a1/axial_023.png","assets/T/mri-0a0ac98f64f647a1/axial_024.png","assets/T/mri-0a0ac98f64f647a1/axial_025.png","assets/T/mri-0a0ac98f64f647a1/axial_026.png","assets/T/mri-0a0ac98f64f647a1/axial_027.png","assets/T/mri-0a0ac98f64f647a1/axial_028.png","assets/T/mri-0a0ac98f64f647a1/axial_029.png","assets/T/mri-0a0ac98f64f647a1/axial_030.png","assets/T/mri-0a0ac98f64f647a1/axial_031.png","assets/T/mri-0a0ac98f64f647a1/axial_032.png","assets/T/mri-0a0ac98f64f647a1/axial_033.png","assets/T/mri-0a0ac98f64f647a1/axial_034.png","assets/T/mri-0a0ac98f64f647a1/axial_035.png","assets/T/mri-0a0ac98f64f647a1/axial_036.png","assets/T/mri-0a0ac98f64f647a1/axial_037.png","assets/T/mri-0a0ac98f64f647a1/axial_038.png","assets/T/mri-0a0ac98f64f647a1/axial_039.png","assets/T/mri-0a0ac98f64f647a1/axial_040.png","assets/T/mri-0a0ac98f64f647a1/axial_041.png","assets/T/mri-0a0ac98f64f647a1/axial_042.png","assets/T/mri-0a0ac98f64f647a1/coronal_001.png","assets/T/mri-0a0ac98f64f647a1/coronal_002.png","assets/T/mri-0a0ac98f64f647a1/coronal_003.png","assets/T/mri-0a0ac98f64f647a1/coronal_004.png","assets/T/mri-0a0ac98f64f647a1/coronal_005.png","assets/T/mri-0a0ac98f64f647a1/coronal_006.png","assets/T/mri-0a0ac98f64f647a1/coronal_007.png","assets/T/mri-0a0ac98f64f647a1/coronal_008.png","assets/T/mri-0a0ac98f64f647a1/coronal_009.png","assets/T/mri-0a0ac98f64f647a1/coronal_010.png","assets/T/mri-0a0ac98f64f647a1/coronal_011.png","assets/T/mri-0a0ac98f64f647a1/coronal_012.png","assets/T/mri-0a0ac98f64f647a1/coronal_013.png","assets/T/mri-0a0ac98f64f647a1/coronal_014.png","assets/T/mri-0a0ac98f64f647a1/coronal_015.png","assets/T/mri-0a0ac98f64f647a1/coronal_016.png","assets/T/mri-0a0ac98f64f647a1/coronal_017.png","assets/T/mri-0a0ac98f64f647a1/coronal_018.png","assets/T/mri-0a0ac98f64f647a1/coronal_019.png","assets/T/mri-0a0ac98f64f647a1/coronal_020.png","assets/T/mri-0a0ac98f64f647a1/coronal_021.png","assets/T/mri-0a0ac98f64f647a1/coronal_022.png","assets/T/mri-0a0ac98f64f647a1/coronal_023.png","assets/T/mri-0a0ac98f64f647a1/coronal_024.png","assets/T/mri-0a0ac98f64f647a1/coronal_025.png","assets/T/mri-0a0ac98f64f647a1/coronal_026.png","assets/T/mri-0a0ac98f64f647a1/coronal_027.png","assets/T/mri-0a0ac98f64f647a1/coronal_028.png"],"stage_edition":8}
+{"id":"L3-T300:mri-cabf153e164d4bbc","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-cabf153e164d4bbc/axial_001.png","assets/T/mri-cabf153e164d4bbc/axial_002.png","assets/T/mri-cabf153e164d4bbc/axial_003.png","assets/T/mri-cabf153e164d4bbc/axial_004.png","assets/T/mri-cabf153e164d4bbc/axial_005.png","assets/T/mri-cabf153e164d4bbc/axial_006.png","assets/T/mri-cabf153e164d4bbc/axial_007.png","assets/T/mri-cabf153e164d4bbc/axial_008.png","assets/T/mri-cabf153e164d4bbc/axial_009.png","assets/T/mri-cabf153e164d4bbc/axial_010.png","assets/T/mri-cabf153e164d4bbc/axial_011.png","assets/T/mri-cabf153e164d4bbc/axial_012.png","assets/T/mri-cabf153e164d4bbc/axial_013.png","assets/T/mri-cabf153e164d4bbc/axial_014.png","assets/T/mri-cabf153e164d4bbc/axial_015.png","assets/T/mri-cabf153e164d4bbc/axial_016.png","assets/T/mri-cabf153e164d4bbc/axial_017.png","assets/T/mri-cabf153e164d4bbc/axial_018.png","assets/T/mri-cabf153e164d4bbc/axial_019.png","assets/T/mri-cabf153e164d4bbc/axial_020.png","assets/T/mri-cabf153e164d4bbc/axial_021.png","assets/T/mri-cabf153e164d4bbc/axial_022.png","assets/T/mri-cabf153e164d4bbc/axial_023.png","assets/T/mri-cabf153e164d4bbc/axial_024.png","assets/T/mri-cabf153e164d4bbc/axial_025.png","assets/T/mri-cabf153e164d4bbc/axial_026.png","assets/T/mri-cabf153e164d4bbc/axial_027.png","assets/T/mri-cabf153e164d4bbc/axial_028.png","assets/T/mri-cabf153e164d4bbc/axial_029.png","assets/T/mri-cabf153e164d4bbc/axial_030.png","assets/T/mri-cabf153e164d4bbc/axial_031.png","assets/T/mri-cabf153e164d4bbc/axial_032.png","assets/T/mri-cabf153e164d4bbc/axial_033.png","assets/T/mri-cabf153e164d4bbc/axial_034.png","assets/T/mri-cabf153e164d4bbc/axial_035.png","assets/T/mri-cabf153e164d4bbc/axial_036.png","assets/T/mri-cabf153e164d4bbc/axial_037.png","assets/T/mri-cabf153e164d4bbc/axial_038.png","assets/T/mri-cabf153e164d4bbc/axial_039.png","assets/T/mri-cabf153e164d4bbc/axial_040.png","assets/T/mri-cabf153e164d4bbc/axial_041.png","assets/T/mri-cabf153e164d4bbc/axial_042.png","assets/T/mri-cabf153e164d4bbc/coronal_001.png","assets/T/mri-cabf153e164d4bbc/coronal_002.png","assets/T/mri-cabf153e164d4bbc/coronal_003.png","assets/T/mri-cabf153e164d4bbc/coronal_004.png","assets/T/mri-cabf153e164d4bbc/coronal_005.png","assets/T/mri-cabf153e164d4bbc/coronal_006.png","assets/T/mri-cabf153e164d4bbc/coronal_007.png","assets/T/mri-cabf153e164d4bbc/coronal_008.png","assets/T/mri-cabf153e164d4bbc/coronal_009.png","assets/T/mri-cabf153e164d4bbc/coronal_010.png","assets/T/mri-cabf153e164d4bbc/coronal_011.png","assets/T/mri-cabf153e164d4bbc/coronal_012.png","assets/T/mri-cabf153e164d4bbc/coronal_013.png","assets/T/mri-cabf153e164d4bbc/coronal_014.png","assets/T/mri-cabf153e164d4bbc/coronal_015.png","assets/T/mri-cabf153e164d4bbc/coronal_016.png","assets/T/mri-cabf153e164d4bbc/coronal_017.png","assets/T/mri-cabf153e164d4bbc/coronal_018.png","assets/T/mri-cabf153e164d4bbc/coronal_019.png","assets/T/mri-cabf153e164d4bbc/coronal_020.png","assets/T/mri-cabf153e164d4bbc/coronal_021.png","assets/T/mri-cabf153e164d4bbc/coronal_022.png","assets/T/mri-cabf153e164d4bbc/coronal_023.png","assets/T/mri-cabf153e164d4bbc/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-be161e475b244f3d","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-be161e475b244f3d/axial_001.png","assets/T/mri-be161e475b244f3d/axial_002.png","assets/T/mri-be161e475b244f3d/axial_003.png","assets/T/mri-be161e475b244f3d/axial_004.png","assets/T/mri-be161e475b244f3d/axial_005.png","assets/T/mri-be161e475b244f3d/axial_006.png","assets/T/mri-be161e475b244f3d/axial_007.png","assets/T/mri-be161e475b244f3d/axial_008.png","assets/T/mri-be161e475b244f3d/axial_009.png","assets/T/mri-be161e475b244f3d/axial_010.png","assets/T/mri-be161e475b244f3d/axial_011.png","assets/T/mri-be161e475b244f3d/axial_012.png","assets/T/mri-be161e475b244f3d/axial_013.png","assets/T/mri-be161e475b244f3d/axial_014.png","assets/T/mri-be161e475b244f3d/axial_015.png","assets/T/mri-be161e475b244f3d/axial_016.png","assets/T/mri-be161e475b244f3d/axial_017.png","assets/T/mri-be161e475b244f3d/axial_018.png","assets/T/mri-be161e475b244f3d/axial_019.png","assets/T/mri-be161e475b244f3d/axial_020.png","assets/T/mri-be161e475b244f3d/axial_021.png","assets/T/mri-be161e475b244f3d/axial_022.png","assets/T/mri-be161e475b244f3d/axial_023.png","assets/T/mri-be161e475b244f3d/axial_024.png","assets/T/mri-be161e475b244f3d/axial_025.png","assets/T/mri-be161e475b244f3d/axial_026.png","assets/T/mri-be161e475b244f3d/axial_027.png","assets/T/mri-be161e475b244f3d/axial_028.png","assets/T/mri-be161e475b244f3d/axial_029.png","assets/T/mri-be161e475b244f3d/axial_030.png","assets/T/mri-be161e475b244f3d/axial_031.png","assets/T/mri-be161e475b244f3d/axial_032.png","assets/T/mri-be161e475b244f3d/axial_033.png","assets/T/mri-be161e475b244f3d/axial_034.png","assets/T/mri-be161e475b244f3d/axial_035.png","assets/T/mri-be161e475b244f3d/axial_036.png","assets/T/mri-be161e475b244f3d/axial_037.png","assets/T/mri-be161e475b244f3d/axial_038.png","assets/T/mri-be161e475b244f3d/axial_039.png","assets/T/mri-be161e475b244f3d/axial_040.png","assets/T/mri-be161e475b244f3d/coronal_001.png","assets/T/mri-be161e475b244f3d/coronal_002.png","assets/T/mri-be161e475b244f3d/coronal_003.png","assets/T/mri-be161e475b244f3d/coronal_004.png","assets/T/mri-be161e475b244f3d/coronal_005.png","assets/T/mri-be161e475b244f3d/coronal_006.png","assets/T/mri-be161e475b244f3d/coronal_007.png","assets/T/mri-be161e475b244f3d/coronal_008.png","assets/T/mri-be161e475b244f3d/coronal_009.png","assets/T/mri-be161e475b244f3d/coronal_010.png","assets/T/mri-be161e475b244f3d/coronal_011.png","assets/T/mri-be161e475b244f3d/coronal_012.png","assets/T/mri-be161e475b244f3d/coronal_013.png","assets/T/mri-be161e475b244f3d/coronal_014.png","assets/T/mri-be161e475b244f3d/coronal_015.png","assets/T/mri-be161e475b244f3d/coronal_016.png","assets/T/mri-be161e475b244f3d/coronal_017.png","assets/T/mri-be161e475b244f3d/coronal_018.png","assets/T/mri-be161e475b244f3d/coronal_019.png","assets/T/mri-be161e475b244f3d/coronal_020.png","assets/T/mri-be161e475b244f3d/coronal_021.png","assets/T/mri-be161e475b244f3d/coronal_022.png","assets/T/mri-be161e475b244f3d/coronal_023.png","assets/T/mri-be161e475b244f3d/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-6b684b9630fa40eb","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-6b684b9630fa40eb/axial_001.png","assets/T/mri-6b684b9630fa40eb/axial_002.png","assets/T/mri-6b684b9630fa40eb/axial_003.png","assets/T/mri-6b684b9630fa40eb/axial_004.png","assets/T/mri-6b684b9630fa40eb/axial_005.png","assets/T/mri-6b684b9630fa40eb/axial_006.png","assets/T/mri-6b684b9630fa40eb/axial_007.png","assets/T/mri-6b684b9630fa40eb/axial_008.png","assets/T/mri-6b684b9630fa40eb/axial_009.png","assets/T/mri-6b684b9630fa40eb/axial_010.png","assets/T/mri-6b684b9630fa40eb/axial_011.png","assets/T/mri-6b684b9630fa40eb/axial_012.png","assets/T/mri-6b684b9630fa40eb/axial_013.png","assets/T/mri-6b684b9630fa40eb/axial_014.png","assets/T/mri-6b684b9630fa40eb/axial_015.png","assets/T/mri-6b684b9630fa40eb/axial_016.png","assets/T/mri-6b684b9630fa40eb/axial_017.png","assets/T/mri-6b684b9630fa40eb/axial_018.png","assets/T/mri-6b684b9630fa40eb/axial_019.png","assets/T/mri-6b684b9630fa40eb/axial_020.png","assets/T/mri-6b684b9630fa40eb/axial_021.png","assets/T/mri-6b684b9630fa40eb/axial_022.png","assets/T/mri-6b684b9630fa40eb/axial_023.png","assets/T/mri-6b684b9630fa40eb/axial_024.png","assets/T/mri-6b684b9630fa40eb/axial_025.png","assets/T/mri-6b684b9630fa40eb/axial_026.png","assets/T/mri-6b684b9630fa40eb/axial_027.png","assets/T/mri-6b684b9630fa40eb/axial_028.png","assets/T/mri-6b684b9630fa40eb/axial_029.png","assets/T/mri-6b684b9630fa40eb/axial_030.png","assets/T/mri-6b684b9630fa40eb/axial_031.png","assets/T/mri-6b684b9630fa40eb/axial_032.png","assets/T/mri-6b684b9630fa40eb/axial_033.png","assets/T/mri-6b684b9630fa40eb/axial_034.png","assets/T/mri-6b684b9630fa40eb/axial_035.png","assets/T/mri-6b684b9630fa40eb/axial_036.png","assets/T/mri-6b684b9630fa40eb/axial_037.png","assets/T/mri-6b684b9630fa40eb/axial_038.png","assets/T/mri-6b684b9630fa40eb/axial_039.png","assets/T/mri-6b684b9630fa40eb/axial_040.png","assets/T/mri-6b684b9630fa40eb/axial_041.png","assets/T/mri-6b684b9630fa40eb/axial_042.png","assets/T/mri-6b684b9630fa40eb/coronal_001.png","assets/T/mri-6b684b9630fa40eb/coronal_002.png","assets/T/mri-6b684b9630fa40eb/coronal_003.png","assets/T/mri-6b684b9630fa40eb/coronal_004.png","assets/T/mri-6b684b9630fa40eb/coronal_005.png","assets/T/mri-6b684b9630fa40eb/coronal_006.png","assets/T/mri-6b684b9630fa40eb/coronal_007.png","assets/T/mri-6b684b9630fa40eb/coronal_008.png","assets/T/mri-6b684b9630fa40eb/coronal_009.png","assets/T/mri-6b684b9630fa40eb/coronal_010.png","assets/T/mri-6b684b9630fa40eb/coronal_011.png","assets/T/mri-6b684b9630fa40eb/coronal_012.png","assets/T/mri-6b684b9630fa40eb/coronal_013.png","assets/T/mri-6b684b9630fa40eb/coronal_014.png","assets/T/mri-6b684b9630fa40eb/coronal_015.png","assets/T/mri-6b684b9630fa40eb/coronal_016.png","assets/T/mri-6b684b9630fa40eb/coronal_017.png","assets/T/mri-6b684b9630fa40eb/coronal_018.png","assets/T/mri-6b684b9630fa40eb/coronal_019.png","assets/T/mri-6b684b9630fa40eb/coronal_020.png","assets/T/mri-6b684b9630fa40eb/coronal_021.png","assets/T/mri-6b684b9630fa40eb/coronal_022.png","assets/T/mri-6b684b9630fa40eb/coronal_023.png","assets/T/mri-6b684b9630fa40eb/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-38142f670d79447e","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-38142f670d79447e/axial_001.png","assets/T/mri-38142f670d79447e/axial_002.png","assets/T/mri-38142f670d79447e/axial_003.png","assets/T/mri-38142f670d79447e/axial_004.png","assets/T/mri-38142f670d79447e/axial_005.png","assets/T/mri-38142f670d79447e/axial_006.png","assets/T/mri-38142f670d79447e/axial_007.png","assets/T/mri-38142f670d79447e/axial_008.png","assets/T/mri-38142f670d79447e/axial_009.png","assets/T/mri-38142f670d79447e/axial_010.png","assets/T/mri-38142f670d79447e/axial_011.png","assets/T/mri-38142f670d79447e/axial_012.png","assets/T/mri-38142f670d79447e/axial_013.png","assets/T/mri-38142f670d79447e/axial_014.png","assets/T/mri-38142f670d79447e/axial_015.png","assets/T/mri-38142f670d79447e/axial_016.png","assets/T/mri-38142f670d79447e/axial_017.png","assets/T/mri-38142f670d79447e/axial_018.png","assets/T/mri-38142f670d79447e/axial_019.png","assets/T/mri-38142f670d79447e/axial_020.png","assets/T/mri-38142f670d79447e/axial_021.png","assets/T/mri-38142f670d79447e/axial_022.png","assets/T/mri-38142f670d79447e/axial_023.png","assets/T/mri-38142f670d79447e/axial_024.png","assets/T/mri-38142f670d79447e/axial_025.png","assets/T/mri-38142f670d79447e/axial_026.png","assets/T/mri-38142f670d79447e/axial_027.png","assets/T/mri-38142f670d79447e/axial_028.png","assets/T/mri-38142f670d79447e/axial_029.png","assets/T/mri-38142f670d79447e/axial_030.png","assets/T/mri-38142f670d79447e/axial_031.png","assets/T/mri-38142f670d79447e/axial_032.png","assets/T/mri-38142f670d79447e/axial_033.png","assets/T/mri-38142f670d79447e/axial_034.png","assets/T/mri-38142f670d79447e/axial_035.png","assets/T/mri-38142f670d79447e/axial_036.png","assets/T/mri-38142f670d79447e/axial_037.png","assets/T/mri-38142f670d79447e/axial_038.png","assets/T/mri-38142f670d79447e/axial_039.png","assets/T/mri-38142f670d79447e/axial_040.png","assets/T/mri-38142f670d79447e/axial_041.png","assets/T/mri-38142f670d79447e/axial_042.png","assets/T/mri-38142f670d79447e/coronal_001.png","assets/T/mri-38142f670d79447e/coronal_002.png","assets/T/mri-38142f670d79447e/coronal_003.png","assets/T/mri-38142f670d79447e/coronal_004.png","assets/T/mri-38142f670d79447e/coronal_005.png","assets/T/mri-38142f670d79447e/coronal_006.png","assets/T/mri-38142f670d79447e/coronal_007.png","assets/T/mri-38142f670d79447e/coronal_008.png","assets/T/mri-38142f670d79447e/coronal_009.png","assets/T/mri-38142f670d79447e/coronal_010.png","assets/T/mri-38142f670d79447e/coronal_011.png","assets/T/mri-38142f670d79447e/coronal_012.png","assets/T/mri-38142f670d79447e/coronal_013.png","assets/T/mri-38142f670d79447e/coronal_014.png","assets/T/mri-38142f670d79447e/coronal_015.png","assets/T/mri-38142f670d79447e/coronal_016.png","assets/T/mri-38142f670d79447e/coronal_017.png","assets/T/mri-38142f670d79447e/coronal_018.png","assets/T/mri-38142f670d79447e/coronal_019.png","assets/T/mri-38142f670d79447e/coronal_020.png","assets/T/mri-38142f670d79447e/coronal_021.png","assets/T/mri-38142f670d79447e/coronal_022.png","assets/T/mri-38142f670d79447e/coronal_023.png","assets/T/mri-38142f670d79447e/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-3d5d3d0b166a4855","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-3d5d3d0b166a4855/axial_001.png","assets/T/mri-3d5d3d0b166a4855/axial_002.png","assets/T/mri-3d5d3d0b166a4855/axial_003.png","assets/T/mri-3d5d3d0b166a4855/axial_004.png","assets/T/mri-3d5d3d0b166a4855/axial_005.png","assets/T/mri-3d5d3d0b166a4855/axial_006.png","assets/T/mri-3d5d3d0b166a4855/axial_007.png","assets/T/mri-3d5d3d0b166a4855/axial_008.png","assets/T/mri-3d5d3d0b166a4855/axial_009.png","assets/T/mri-3d5d3d0b166a4855/axial_010.png","assets/T/mri-3d5d3d0b166a4855/axial_011.png","assets/T/mri-3d5d3d0b166a4855/axial_012.png","assets/T/mri-3d5d3d0b166a4855/axial_013.png","assets/T/mri-3d5d3d0b166a4855/axial_014.png","assets/T/mri-3d5d3d0b166a4855/axial_015.png","assets/T/mri-3d5d3d0b166a4855/axial_016.png","assets/T/mri-3d5d3d0b166a4855/axial_017.png","assets/T/mri-3d5d3d0b166a4855/axial_018.png","assets/T/mri-3d5d3d0b166a4855/axial_019.png","assets/T/mri-3d5d3d0b166a4855/axial_020.png","assets/T/mri-3d5d3d0b166a4855/axial_021.png","assets/T/mri-3d5d3d0b166a4855/axial_022.png","assets/T/mri-3d5d3d0b166a4855/axial_023.png","assets/T/mri-3d5d3d0b166a4855/axial_024.png","assets/T/mri-3d5d3d0b166a4855/axial_025.png","assets/T/mri-3d5d3d0b166a4855/axial_026.png","assets/T/mri-3d5d3d0b166a4855/axial_027.png","assets/T/mri-3d5d3d0b166a4855/axial_028.png","assets/T/mri-3d5d3d0b166a4855/axial_029.png","assets/T/mri-3d5d3d0b166a4855/axial_030.png","assets/T/mri-3d5d3d0b166a4855/axial_031.png","assets/T/mri-3d5d3d0b166a4855/axial_032.png","assets/T/mri-3d5d3d0b166a4855/axial_033.png","assets/T/mri-3d5d3d0b166a4855/axial_034.png","assets/T/mri-3d5d3d0b166a4855/axial_035.png","assets/T/mri-3d5d3d0b166a4855/axial_036.png","assets/T/mri-3d5d3d0b166a4855/axial_037.png","assets/T/mri-3d5d3d0b166a4855/axial_038.png","assets/T/mri-3d5d3d0b166a4855/axial_039.png","assets/T/mri-3d5d3d0b166a4855/axial_040.png","assets/T/mri-3d5d3d0b166a4855/axial_041.png","assets/T/mri-3d5d3d0b166a4855/axial_042.png","assets/T/mri-3d5d3d0b166a4855/coronal_001.png","assets/T/mri-3d5d3d0b166a4855/coronal_002.png","assets/T/mri-3d5d3d0b166a4855/coronal_003.png","assets/T/mri-3d5d3d0b166a4855/coronal_004.png","assets/T/mri-3d5d3d0b166a4855/coronal_005.png","assets/T/mri-3d5d3d0b166a4855/coronal_006.png","assets/T/mri-3d5d3d0b166a4855/coronal_007.png","assets/T/mri-3d5d3d0b166a4855/coronal_008.png","assets/T/mri-3d5d3d0b166a4855/coronal_009.png","assets/T/mri-3d5d3d0b166a4855/coronal_010.png","assets/T/mri-3d5d3d0b166a4855/coronal_011.png","assets/T/mri-3d5d3d0b166a4855/coronal_012.png","assets/T/mri-3d5d3d0b166a4855/coronal_013.png","assets/T/mri-3d5d3d0b166a4855/coronal_014.png","assets/T/mri-3d5d3d0b166a4855/coronal_015.png","assets/T/mri-3d5d3d0b166a4855/coronal_016.png","assets/T/mri-3d5d3d0b166a4855/coronal_017.png","assets/T/mri-3d5d3d0b166a4855/coronal_018.png","assets/T/mri-3d5d3d0b166a4855/coronal_019.png","assets/T/mri-3d5d3d0b166a4855/coronal_020.png","assets/T/mri-3d5d3d0b166a4855/coronal_021.png","assets/T/mri-3d5d3d0b166a4855/coronal_022.png","assets/T/mri-3d5d3d0b166a4855/coronal_023.png","assets/T/mri-3d5d3d0b166a4855/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-433b0da09eee4d64","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 62 张图，均来自同一次检查。\n\n- 前 38 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-433b0da09eee4d64/axial_001.png","assets/T/mri-433b0da09eee4d64/axial_002.png","assets/T/mri-433b0da09eee4d64/axial_003.png","assets/T/mri-433b0da09eee4d64/axial_004.png","assets/T/mri-433b0da09eee4d64/axial_005.png","assets/T/mri-433b0da09eee4d64/axial_006.png","assets/T/mri-433b0da09eee4d64/axial_007.png","assets/T/mri-433b0da09eee4d64/axial_008.png","assets/T/mri-433b0da09eee4d64/axial_009.png","assets/T/mri-433b0da09eee4d64/axial_010.png","assets/T/mri-433b0da09eee4d64/axial_011.png","assets/T/mri-433b0da09eee4d64/axial_012.png","assets/T/mri-433b0da09eee4d64/axial_013.png","assets/T/mri-433b0da09eee4d64/axial_014.png","assets/T/mri-433b0da09eee4d64/axial_015.png","assets/T/mri-433b0da09eee4d64/axial_016.png","assets/T/mri-433b0da09eee4d64/axial_017.png","assets/T/mri-433b0da09eee4d64/axial_018.png","assets/T/mri-433b0da09eee4d64/axial_019.png","assets/T/mri-433b0da09eee4d64/axial_020.png","assets/T/mri-433b0da09eee4d64/axial_021.png","assets/T/mri-433b0da09eee4d64/axial_022.png","assets/T/mri-433b0da09eee4d64/axial_023.png","assets/T/mri-433b0da09eee4d64/axial_024.png","assets/T/mri-433b0da09eee4d64/axial_025.png","assets/T/mri-433b0da09eee4d64/axial_026.png","assets/T/mri-433b0da09eee4d64/axial_027.png","assets/T/mri-433b0da09eee4d64/axial_028.png","assets/T/mri-433b0da09eee4d64/axial_029.png","assets/T/mri-433b0da09eee4d64/axial_030.png","assets/T/mri-433b0da09eee4d64/axial_031.png","assets/T/mri-433b0da09eee4d64/axial_032.png","assets/T/mri-433b0da09eee4d64/axial_033.png","assets/T/mri-433b0da09eee4d64/axial_034.png","assets/T/mri-433b0da09eee4d64/axial_035.png","assets/T/mri-433b0da09eee4d64/axial_036.png","assets/T/mri-433b0da09eee4d64/axial_037.png","assets/T/mri-433b0da09eee4d64/axial_038.png","assets/T/mri-433b0da09eee4d64/coronal_001.png","assets/T/mri-433b0da09eee4d64/coronal_002.png","assets/T/mri-433b0da09eee4d64/coronal_003.png","assets/T/mri-433b0da09eee4d64/coronal_004.png","assets/T/mri-433b0da09eee4d64/coronal_005.png","assets/T/mri-433b0da09eee4d64/coronal_006.png","assets/T/mri-433b0da09eee4d64/coronal_007.png","assets/T/mri-433b0da09eee4d64/coronal_008.png","assets/T/mri-433b0da09eee4d64/coronal_009.png","assets/T/mri-433b0da09eee4d64/coronal_010.png","assets/T/mri-433b0da09eee4d64/coronal_011.png","assets/T/mri-433b0da09eee4d64/coronal_012.png","assets/T/mri-433b0da09eee4d64/coronal_013.png","assets/T/mri-433b0da09eee4d64/coronal_014.png","assets/T/mri-433b0da09eee4d64/coronal_015.png","assets/T/mri-433b0da09eee4d64/coronal_016.png","assets/T/mri-433b0da09eee4d64/coronal_017.png","assets/T/mri-433b0da09eee4d64/coronal_018.png","assets/T/mri-433b0da09eee4d64/coronal_019.png","assets/T/mri-433b0da09eee4d64/coronal_020.png","assets/T/mri-433b0da09eee4d64/coronal_021.png","assets/T/mri-433b0da09eee4d64/coronal_022.png","assets/T/mri-433b0da09eee4d64/coronal_023.png","assets/T/mri-433b0da09eee4d64/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-a79d6c4b9bc54d1e","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 26 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-a79d6c4b9bc54d1e/axial_001.png","assets/T/mri-a79d6c4b9bc54d1e/axial_002.png","assets/T/mri-a79d6c4b9bc54d1e/axial_003.png","assets/T/mri-a79d6c4b9bc54d1e/axial_004.png","assets/T/mri-a79d6c4b9bc54d1e/axial_005.png","assets/T/mri-a79d6c4b9bc54d1e/axial_006.png","assets/T/mri-a79d6c4b9bc54d1e/axial_007.png","assets/T/mri-a79d6c4b9bc54d1e/axial_008.png","assets/T/mri-a79d6c4b9bc54d1e/axial_009.png","assets/T/mri-a79d6c4b9bc54d1e/axial_010.png","assets/T/mri-a79d6c4b9bc54d1e/axial_011.png","assets/T/mri-a79d6c4b9bc54d1e/axial_012.png","assets/T/mri-a79d6c4b9bc54d1e/axial_013.png","assets/T/mri-a79d6c4b9bc54d1e/axial_014.png","assets/T/mri-a79d6c4b9bc54d1e/axial_015.png","assets/T/mri-a79d6c4b9bc54d1e/axial_016.png","assets/T/mri-a79d6c4b9bc54d1e/axial_017.png","assets/T/mri-a79d6c4b9bc54d1e/axial_018.png","assets/T/mri-a79d6c4b9bc54d1e/axial_019.png","assets/T/mri-a79d6c4b9bc54d1e/axial_020.png","assets/T/mri-a79d6c4b9bc54d1e/axial_021.png","assets/T/mri-a79d6c4b9bc54d1e/axial_022.png","assets/T/mri-a79d6c4b9bc54d1e/axial_023.png","assets/T/mri-a79d6c4b9bc54d1e/axial_024.png","assets/T/mri-a79d6c4b9bc54d1e/axial_025.png","assets/T/mri-a79d6c4b9bc54d1e/axial_026.png","assets/T/mri-a79d6c4b9bc54d1e/axial_027.png","assets/T/mri-a79d6c4b9bc54d1e/axial_028.png","assets/T/mri-a79d6c4b9bc54d1e/axial_029.png","assets/T/mri-a79d6c4b9bc54d1e/axial_030.png","assets/T/mri-a79d6c4b9bc54d1e/axial_031.png","assets/T/mri-a79d6c4b9bc54d1e/axial_032.png","assets/T/mri-a79d6c4b9bc54d1e/axial_033.png","assets/T/mri-a79d6c4b9bc54d1e/axial_034.png","assets/T/mri-a79d6c4b9bc54d1e/axial_035.png","assets/T/mri-a79d6c4b9bc54d1e/axial_036.png","assets/T/mri-a79d6c4b9bc54d1e/axial_037.png","assets/T/mri-a79d6c4b9bc54d1e/axial_038.png","assets/T/mri-a79d6c4b9bc54d1e/axial_039.png","assets/T/mri-a79d6c4b9bc54d1e/axial_040.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_001.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_002.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_003.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_004.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_005.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_006.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_007.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_008.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_009.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_010.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_011.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_012.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_013.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_014.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_015.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_016.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_017.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_018.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_019.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_020.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_021.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_022.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_023.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_024.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_025.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_026.png"],"stage_edition":8}
+{"id":"L3-T300:mri-58068eea382343a8","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 26 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-58068eea382343a8/axial_001.png","assets/T/mri-58068eea382343a8/axial_002.png","assets/T/mri-58068eea382343a8/axial_003.png","assets/T/mri-58068eea382343a8/axial_004.png","assets/T/mri-58068eea382343a8/axial_005.png","assets/T/mri-58068eea382343a8/axial_006.png","assets/T/mri-58068eea382343a8/axial_007.png","assets/T/mri-58068eea382343a8/axial_008.png","assets/T/mri-58068eea382343a8/axial_009.png","assets/T/mri-58068eea382343a8/axial_010.png","assets/T/mri-58068eea382343a8/axial_011.png","assets/T/mri-58068eea382343a8/axial_012.png","assets/T/mri-58068eea382343a8/axial_013.png","assets/T/mri-58068eea382343a8/axial_014.png","assets/T/mri-58068eea382343a8/axial_015.png","assets/T/mri-58068eea382343a8/axial_016.png","assets/T/mri-58068eea382343a8/axial_017.png","assets/T/mri-58068eea382343a8/axial_018.png","assets/T/mri-58068eea382343a8/axial_019.png","assets/T/mri-58068eea382343a8/axial_020.png","assets/T/mri-58068eea382343a8/axial_021.png","assets/T/mri-58068eea382343a8/axial_022.png","assets/T/mri-58068eea382343a8/axial_023.png","assets/T/mri-58068eea382343a8/axial_024.png","assets/T/mri-58068eea382343a8/axial_025.png","assets/T/mri-58068eea382343a8/axial_026.png","assets/T/mri-58068eea382343a8/axial_027.png","assets/T/mri-58068eea382343a8/axial_028.png","assets/T/mri-58068eea382343a8/axial_029.png","assets/T/mri-58068eea382343a8/axial_030.png","assets/T/mri-58068eea382343a8/axial_031.png","assets/T/mri-58068eea382343a8/axial_032.png","assets/T/mri-58068eea382343a8/axial_033.png","assets/T/mri-58068eea382343a8/axial_034.png","assets/T/mri-58068eea382343a8/axial_035.png","assets/T/mri-58068eea382343a8/axial_036.png","assets/T/mri-58068eea382343a8/axial_037.png","assets/T/mri-58068eea382343a8/axial_038.png","assets/T/mri-58068eea382343a8/axial_039.png","assets/T/mri-58068eea382343a8/axial_040.png","assets/T/mri-58068eea382343a8/coronal_001.png","assets/T/mri-58068eea382343a8/coronal_002.png","assets/T/mri-58068eea382343a8/coronal_003.png","assets/T/mri-58068eea382343a8/coronal_004.png","assets/T/mri-58068eea382343a8/coronal_005.png","assets/T/mri-58068eea382343a8/coronal_006.png","assets/T/mri-58068eea382343a8/coronal_007.png","assets/T/mri-58068eea382343a8/coronal_008.png","assets/T/mri-58068eea382343a8/coronal_009.png","assets/T/mri-58068eea382343a8/coronal_010.png","assets/T/mri-58068eea382343a8/coronal_011.png","assets/T/mri-58068eea382343a8/coronal_012.png","assets/T/mri-58068eea382343a8/coronal_013.png","assets/T/mri-58068eea382343a8/coronal_014.png","assets/T/mri-58068eea382343a8/coronal_015.png","assets/T/mri-58068eea382343a8/coronal_016.png","assets/T/mri-58068eea382343a8/coronal_017.png","assets/T/mri-58068eea382343a8/coronal_018.png","assets/T/mri-58068eea382343a8/coronal_019.png","assets/T/mri-58068eea382343a8/coronal_020.png","assets/T/mri-58068eea382343a8/coronal_021.png","assets/T/mri-58068eea382343a8/coronal_022.png","assets/T/mri-58068eea382343a8/coronal_023.png","assets/T/mri-58068eea382343a8/coronal_024.png","assets/T/mri-58068eea382343a8/coronal_025.png","assets/T/mri-58068eea382343a8/coronal_026.png"],"stage_edition":8}
+{"id":"L3-T300:mri-753dcbe2c0cc4d80","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 70 张图，均来自同一次检查。\n\n- 前 46 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-753dcbe2c0cc4d80/axial_001.png","assets/T/mri-753dcbe2c0cc4d80/axial_002.png","assets/T/mri-753dcbe2c0cc4d80/axial_003.png","assets/T/mri-753dcbe2c0cc4d80/axial_004.png","assets/T/mri-753dcbe2c0cc4d80/axial_005.png","assets/T/mri-753dcbe2c0cc4d80/axial_006.png","assets/T/mri-753dcbe2c0cc4d80/axial_007.png","assets/T/mri-753dcbe2c0cc4d80/axial_008.png","assets/T/mri-753dcbe2c0cc4d80/axial_009.png","assets/T/mri-753dcbe2c0cc4d80/axial_010.png","assets/T/mri-753dcbe2c0cc4d80/axial_011.png","assets/T/mri-753dcbe2c0cc4d80/axial_012.png","assets/T/mri-753dcbe2c0cc4d80/axial_013.png","assets/T/mri-753dcbe2c0cc4d80/axial_014.png","assets/T/mri-753dcbe2c0cc4d80/axial_015.png","assets/T/mri-753dcbe2c0cc4d80/axial_016.png","assets/T/mri-753dcbe2c0cc4d80/axial_017.png","assets/T/mri-753dcbe2c0cc4d80/axial_018.png","assets/T/mri-753dcbe2c0cc4d80/axial_019.png","assets/T/mri-753dcbe2c0cc4d80/axial_020.png","assets/T/mri-753dcbe2c0cc4d80/axial_021.png","assets/T/mri-753dcbe2c0cc4d80/axial_022.png","assets/T/mri-753dcbe2c0cc4d80/axial_023.png","assets/T/mri-753dcbe2c0cc4d80/axial_024.png","assets/T/mri-753dcbe2c0cc4d80/axial_025.png","assets/T/mri-753dcbe2c0cc4d80/axial_026.png","assets/T/mri-753dcbe2c0cc4d80/axial_027.png","assets/T/mri-753dcbe2c0cc4d80/axial_028.png","assets/T/mri-753dcbe2c0cc4d80/axial_029.png","assets/T/mri-753dcbe2c0cc4d80/axial_030.png","assets/T/mri-753dcbe2c0cc4d80/axial_031.png","assets/T/mri-753dcbe2c0cc4d80/axial_032.png","assets/T/mri-753dcbe2c0cc4d80/axial_033.png","assets/T/mri-753dcbe2c0cc4d80/axial_034.png","assets/T/mri-753dcbe2c0cc4d80/axial_035.png","assets/T/mri-753dcbe2c0cc4d80/axial_036.png","assets/T/mri-753dcbe2c0cc4d80/axial_037.png","assets/T/mri-753dcbe2c0cc4d80/axial_038.png","assets/T/mri-753dcbe2c0cc4d80/axial_039.png","assets/T/mri-753dcbe2c0cc4d80/axial_040.png","assets/T/mri-753dcbe2c0cc4d80/axial_041.png","assets/T/mri-753dcbe2c0cc4d80/axial_042.png","assets/T/mri-753dcbe2c0cc4d80/axial_043.png","assets/T/mri-753dcbe2c0cc4d80/axial_044.png","assets/T/mri-753dcbe2c0cc4d80/axial_045.png","assets/T/mri-753dcbe2c0cc4d80/axial_046.png","assets/T/mri-753dcbe2c0cc4d80/coronal_001.png","assets/T/mri-753dcbe2c0cc4d80/coronal_002.png","assets/T/mri-753dcbe2c0cc4d80/coronal_003.png","assets/T/mri-753dcbe2c0cc4d80/coronal_004.png","assets/T/mri-753dcbe2c0cc4d80/coronal_005.png","assets/T/mri-753dcbe2c0cc4d80/coronal_006.png","assets/T/mri-753dcbe2c0cc4d80/coronal_007.png","assets/T/mri-753dcbe2c0cc4d80/coronal_008.png","assets/T/mri-753dcbe2c0cc4d80/coronal_009.png","assets/T/mri-753dcbe2c0cc4d80/coronal_010.png","assets/T/mri-753dcbe2c0cc4d80/coronal_011.png","assets/T/mri-753dcbe2c0cc4d80/coronal_012.png","assets/T/mri-753dcbe2c0cc4d80/coronal_013.png","assets/T/mri-753dcbe2c0cc4d80/coronal_014.png","assets/T/mri-753dcbe2c0cc4d80/coronal_015.png","assets/T/mri-753dcbe2c0cc4d80/coronal_016.png","assets/T/mri-753dcbe2c0cc4d80/coronal_017.png","assets/T/mri-753dcbe2c0cc4d80/coronal_018.png","assets/T/mri-753dcbe2c0cc4d80/coronal_019.png","assets/T/mri-753dcbe2c0cc4d80/coronal_020.png","assets/T/mri-753dcbe2c0cc4d80/coronal_021.png","assets/T/mri-753dcbe2c0cc4d80/coronal_022.png","assets/T/mri-753dcbe2c0cc4d80/coronal_023.png","assets/T/mri-753dcbe2c0cc4d80/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-f298574041324fad","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 63 张图，均来自同一次检查。\n\n- 前 39 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-f298574041324fad/axial_001.png","assets/T/mri-f298574041324fad/axial_002.png","assets/T/mri-f298574041324fad/axial_003.png","assets/T/mri-f298574041324fad/axial_004.png","assets/T/mri-f298574041324fad/axial_005.png","assets/T/mri-f298574041324fad/axial_006.png","assets/T/mri-f298574041324fad/axial_007.png","assets/T/mri-f298574041324fad/axial_008.png","assets/T/mri-f298574041324fad/axial_009.png","assets/T/mri-f298574041324fad/axial_010.png","assets/T/mri-f298574041324fad/axial_011.png","assets/T/mri-f298574041324fad/axial_012.png","assets/T/mri-f298574041324fad/axial_013.png","assets/T/mri-f298574041324fad/axial_014.png","assets/T/mri-f298574041324fad/axial_015.png","assets/T/mri-f298574041324fad/axial_016.png","assets/T/mri-f298574041324fad/axial_017.png","assets/T/mri-f298574041324fad/axial_018.png","assets/T/mri-f298574041324fad/axial_019.png","assets/T/mri-f298574041324fad/axial_020.png","assets/T/mri-f298574041324fad/axial_021.png","assets/T/mri-f298574041324fad/axial_022.png","assets/T/mri-f298574041324fad/axial_023.png","assets/T/mri-f298574041324fad/axial_024.png","assets/T/mri-f298574041324fad/axial_025.png","assets/T/mri-f298574041324fad/axial_026.png","assets/T/mri-f298574041324fad/axial_027.png","assets/T/mri-f298574041324fad/axial_028.png","assets/T/mri-f298574041324fad/axial_029.png","assets/T/mri-f298574041324fad/axial_030.png","assets/T/mri-f298574041324fad/axial_031.png","assets/T/mri-f298574041324fad/axial_032.png","assets/T/mri-f298574041324fad/axial_033.png","assets/T/mri-f298574041324fad/axial_034.png","assets/T/mri-f298574041324fad/axial_035.png","assets/T/mri-f298574041324fad/axial_036.png","assets/T/mri-f298574041324fad/axial_037.png","assets/T/mri-f298574041324fad/axial_038.png","assets/T/mri-f298574041324fad/axial_039.png","assets/T/mri-f298574041324fad/coronal_001.png","assets/T/mri-f298574041324fad/coronal_002.png","assets/T/mri-f298574041324fad/coronal_003.png","assets/T/mri-f298574041324fad/coronal_004.png","assets/T/mri-f298574041324fad/coronal_005.png","assets/T/mri-f298574041324fad/coronal_006.png","assets/T/mri-f298574041324fad/coronal_007.png","assets/T/mri-f298574041324fad/coronal_008.png","assets/T/mri-f298574041324fad/coronal_009.png","assets/T/mri-f298574041324fad/coronal_010.png","assets/T/mri-f298574041324fad/coronal_011.png","assets/T/mri-f298574041324fad/coronal_012.png","assets/T/mri-f298574041324fad/coronal_013.png","assets/T/mri-f298574041324fad/coronal_014.png","assets/T/mri-f298574041324fad/coronal_015.png","assets/T/mri-f298574041324fad/coronal_016.png","assets/T/mri-f298574041324fad/coronal_017.png","assets/T/mri-f298574041324fad/coronal_018.png","assets/T/mri-f298574041324fad/coronal_019.png","assets/T/mri-f298574041324fad/coronal_020.png","assets/T/mri-f298574041324fad/coronal_021.png","assets/T/mri-f298574041324fad/coronal_022.png","assets/T/mri-f298574041324fad/coronal_023.png","assets/T/mri-f298574041324fad/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-2f3a9a16a54948d4","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 69 张图，均来自同一次检查。\n\n- 前 45 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-2f3a9a16a54948d4/axial_001.png","assets/T/mri-2f3a9a16a54948d4/axial_002.png","assets/T/mri-2f3a9a16a54948d4/axial_003.png","assets/T/mri-2f3a9a16a54948d4/axial_004.png","assets/T/mri-2f3a9a16a54948d4/axial_005.png","assets/T/mri-2f3a9a16a54948d4/axial_006.png","assets/T/mri-2f3a9a16a54948d4/axial_007.png","assets/T/mri-2f3a9a16a54948d4/axial_008.png","assets/T/mri-2f3a9a16a54948d4/axial_009.png","assets/T/mri-2f3a9a16a54948d4/axial_010.png","assets/T/mri-2f3a9a16a54948d4/axial_011.png","assets/T/mri-2f3a9a16a54948d4/axial_012.png","assets/T/mri-2f3a9a16a54948d4/axial_013.png","assets/T/mri-2f3a9a16a54948d4/axial_014.png","assets/T/mri-2f3a9a16a54948d4/axial_015.png","assets/T/mri-2f3a9a16a54948d4/axial_016.png","assets/T/mri-2f3a9a16a54948d4/axial_017.png","assets/T/mri-2f3a9a16a54948d4/axial_018.png","assets/T/mri-2f3a9a16a54948d4/axial_019.png","assets/T/mri-2f3a9a16a54948d4/axial_020.png","assets/T/mri-2f3a9a16a54948d4/axial_021.png","assets/T/mri-2f3a9a16a54948d4/axial_022.png","assets/T/mri-2f3a9a16a54948d4/axial_023.png","assets/T/mri-2f3a9a16a54948d4/axial_024.png","assets/T/mri-2f3a9a16a54948d4/axial_025.png","assets/T/mri-2f3a9a16a54948d4/axial_026.png","assets/T/mri-2f3a9a16a54948d4/axial_027.png","assets/T/mri-2f3a9a16a54948d4/axial_028.png","assets/T/mri-2f3a9a16a54948d4/axial_029.png","assets/T/mri-2f3a9a16a54948d4/axial_030.png","assets/T/mri-2f3a9a16a54948d4/axial_031.png","assets/T/mri-2f3a9a16a54948d4/axial_032.png","assets/T/mri-2f3a9a16a54948d4/axial_033.png","assets/T/mri-2f3a9a16a54948d4/axial_034.png","assets/T/mri-2f3a9a16a54948d4/axial_035.png","assets/T/mri-2f3a9a16a54948d4/axial_036.png","assets/T/mri-2f3a9a16a54948d4/axial_037.png","assets/T/mri-2f3a9a16a54948d4/axial_038.png","assets/T/mri-2f3a9a16a54948d4/axial_039.png","assets/T/mri-2f3a9a16a54948d4/axial_040.png","assets/T/mri-2f3a9a16a54948d4/axial_041.png","assets/T/mri-2f3a9a16a54948d4/axial_042.png","assets/T/mri-2f3a9a16a54948d4/axial_043.png","assets/T/mri-2f3a9a16a54948d4/axial_044.png","assets/T/mri-2f3a9a16a54948d4/axial_045.png","assets/T/mri-2f3a9a16a54948d4/coronal_001.png","assets/T/mri-2f3a9a16a54948d4/coronal_002.png","assets/T/mri-2f3a9a16a54948d4/coronal_003.png","assets/T/mri-2f3a9a16a54948d4/coronal_004.png","assets/T/mri-2f3a9a16a54948d4/coronal_005.png","assets/T/mri-2f3a9a16a54948d4/coronal_006.png","assets/T/mri-2f3a9a16a54948d4/coronal_007.png","assets/T/mri-2f3a9a16a54948d4/coronal_008.png","assets/T/mri-2f3a9a16a54948d4/coronal_009.png","assets/T/mri-2f3a9a16a54948d4/coronal_010.png","assets/T/mri-2f3a9a16a54948d4/coronal_011.png","assets/T/mri-2f3a9a16a54948d4/coronal_012.png","assets/T/mri-2f3a9a16a54948d4/coronal_013.png","assets/T/mri-2f3a9a16a54948d4/coronal_014.png","assets/T/mri-2f3a9a16a54948d4/coronal_015.png","assets/T/mri-2f3a9a16a54948d4/coronal_016.png","assets/T/mri-2f3a9a16a54948d4/coronal_017.png","assets/T/mri-2f3a9a16a54948d4/coronal_018.png","assets/T/mri-2f3a9a16a54948d4/coronal_019.png","assets/T/mri-2f3a9a16a54948d4/coronal_020.png","assets/T/mri-2f3a9a16a54948d4/coronal_021.png","assets/T/mri-2f3a9a16a54948d4/coronal_022.png","assets/T/mri-2f3a9a16a54948d4/coronal_023.png","assets/T/mri-2f3a9a16a54948d4/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-a1e9759b1342485d","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 60 张图，均来自同一次检查。\n\n- 前 36 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-a1e9759b1342485d/axial_001.png","assets/T/mri-a1e9759b1342485d/axial_002.png","assets/T/mri-a1e9759b1342485d/axial_003.png","assets/T/mri-a1e9759b1342485d/axial_004.png","assets/T/mri-a1e9759b1342485d/axial_005.png","assets/T/mri-a1e9759b1342485d/axial_006.png","assets/T/mri-a1e9759b1342485d/axial_007.png","assets/T/mri-a1e9759b1342485d/axial_008.png","assets/T/mri-a1e9759b1342485d/axial_009.png","assets/T/mri-a1e9759b1342485d/axial_010.png","assets/T/mri-a1e9759b1342485d/axial_011.png","assets/T/mri-a1e9759b1342485d/axial_012.png","assets/T/mri-a1e9759b1342485d/axial_013.png","assets/T/mri-a1e9759b1342485d/axial_014.png","assets/T/mri-a1e9759b1342485d/axial_015.png","assets/T/mri-a1e9759b1342485d/axial_016.png","assets/T/mri-a1e9759b1342485d/axial_017.png","assets/T/mri-a1e9759b1342485d/axial_018.png","assets/T/mri-a1e9759b1342485d/axial_019.png","assets/T/mri-a1e9759b1342485d/axial_020.png","assets/T/mri-a1e9759b1342485d/axial_021.png","assets/T/mri-a1e9759b1342485d/axial_022.png","assets/T/mri-a1e9759b1342485d/axial_023.png","assets/T/mri-a1e9759b1342485d/axial_024.png","assets/T/mri-a1e9759b1342485d/axial_025.png","assets/T/mri-a1e9759b1342485d/axial_026.png","assets/T/mri-a1e9759b1342485d/axial_027.png","assets/T/mri-a1e9759b1342485d/axial_028.png","assets/T/mri-a1e9759b1342485d/axial_029.png","assets/T/mri-a1e9759b1342485d/axial_030.png","assets/T/mri-a1e9759b1342485d/axial_031.png","assets/T/mri-a1e9759b1342485d/axial_032.png","assets/T/mri-a1e9759b1342485d/axial_033.png","assets/T/mri-a1e9759b1342485d/axial_034.png","assets/T/mri-a1e9759b1342485d/axial_035.png","assets/T/mri-a1e9759b1342485d/axial_036.png","assets/T/mri-a1e9759b1342485d/coronal_001.png","assets/T/mri-a1e9759b1342485d/coronal_002.png","assets/T/mri-a1e9759b1342485d/coronal_003.png","assets/T/mri-a1e9759b1342485d/coronal_004.png","assets/T/mri-a1e9759b1342485d/coronal_005.png","assets/T/mri-a1e9759b1342485d/coronal_006.png","assets/T/mri-a1e9759b1342485d/coronal_007.png","assets/T/mri-a1e9759b1342485d/coronal_008.png","assets/T/mri-a1e9759b1342485d/coronal_009.png","assets/T/mri-a1e9759b1342485d/coronal_010.png","assets/T/mri-a1e9759b1342485d/coronal_011.png","assets/T/mri-a1e9759b1342485d/coronal_012.png","assets/T/mri-a1e9759b1342485d/coronal_013.png","assets/T/mri-a1e9759b1342485d/coronal_014.png","assets/T/mri-a1e9759b1342485d/coronal_015.png","assets/T/mri-a1e9759b1342485d/coronal_016.png","assets/T/mri-a1e9759b1342485d/coronal_017.png","assets/T/mri-a1e9759b1342485d/coronal_018.png","assets/T/mri-a1e9759b1342485d/coronal_019.png","assets/T/mri-a1e9759b1342485d/coronal_020.png","assets/T/mri-a1e9759b1342485d/coronal_021.png","assets/T/mri-a1e9759b1342485d/coronal_022.png","assets/T/mri-a1e9759b1342485d/coronal_023.png","assets/T/mri-a1e9759b1342485d/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-7d52e0807d5e4ece","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 62 张图，均来自同一次检查。\n\n- 前 38 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-7d52e0807d5e4ece/axial_001.png","assets/T/mri-7d52e0807d5e4ece/axial_002.png","assets/T/mri-7d52e0807d5e4ece/axial_003.png","assets/T/mri-7d52e0807d5e4ece/axial_004.png","assets/T/mri-7d52e0807d5e4ece/axial_005.png","assets/T/mri-7d52e0807d5e4ece/axial_006.png","assets/T/mri-7d52e0807d5e4ece/axial_007.png","assets/T/mri-7d52e0807d5e4ece/axial_008.png","assets/T/mri-7d52e0807d5e4ece/axial_009.png","assets/T/mri-7d52e0807d5e4ece/axial_010.png","assets/T/mri-7d52e0807d5e4ece/axial_011.png","assets/T/mri-7d52e0807d5e4ece/axial_012.png","assets/T/mri-7d52e0807d5e4ece/axial_013.png","assets/T/mri-7d52e0807d5e4ece/axial_014.png","assets/T/mri-7d52e0807d5e4ece/axial_015.png","assets/T/mri-7d52e0807d5e4ece/axial_016.png","assets/T/mri-7d52e0807d5e4ece/axial_017.png","assets/T/mri-7d52e0807d5e4ece/axial_018.png","assets/T/mri-7d52e0807d5e4ece/axial_019.png","assets/T/mri-7d52e0807d5e4ece/axial_020.png","assets/T/mri-7d52e0807d5e4ece/axial_021.png","assets/T/mri-7d52e0807d5e4ece/axial_022.png","assets/T/mri-7d52e0807d5e4ece/axial_023.png","assets/T/mri-7d52e0807d5e4ece/axial_024.png","assets/T/mri-7d52e0807d5e4ece/axial_025.png","assets/T/mri-7d52e0807d5e4ece/axial_026.png","assets/T/mri-7d52e0807d5e4ece/axial_027.png","assets/T/mri-7d52e0807d5e4ece/axial_028.png","assets/T/mri-7d52e0807d5e4ece/axial_029.png","assets/T/mri-7d52e0807d5e4ece/axial_030.png","assets/T/mri-7d52e0807d5e4ece/axial_031.png","assets/T/mri-7d52e0807d5e4ece/axial_032.png","assets/T/mri-7d52e0807d5e4ece/axial_033.png","assets/T/mri-7d52e0807d5e4ece/axial_034.png","assets/T/mri-7d52e0807d5e4ece/axial_035.png","assets/T/mri-7d52e0807d5e4ece/axial_036.png","assets/T/mri-7d52e0807d5e4ece/axial_037.png","assets/T/mri-7d52e0807d5e4ece/axial_038.png","assets/T/mri-7d52e0807d5e4ece/coronal_001.png","assets/T/mri-7d52e0807d5e4ece/coronal_002.png","assets/T/mri-7d52e0807d5e4ece/coronal_003.png","assets/T/mri-7d52e0807d5e4ece/coronal_004.png","assets/T/mri-7d52e0807d5e4ece/coronal_005.png","assets/T/mri-7d52e0807d5e4ece/coronal_006.png","assets/T/mri-7d52e0807d5e4ece/coronal_007.png","assets/T/mri-7d52e0807d5e4ece/coronal_008.png","assets/T/mri-7d52e0807d5e4ece/coronal_009.png","assets/T/mri-7d52e0807d5e4ece/coronal_010.png","assets/T/mri-7d52e0807d5e4ece/coronal_011.png","assets/T/mri-7d52e0807d5e4ece/coronal_012.png","assets/T/mri-7d52e0807d5e4ece/coronal_013.png","assets/T/mri-7d52e0807d5e4ece/coronal_014.png","assets/T/mri-7d52e0807d5e4ece/coronal_015.png","assets/T/mri-7d52e0807d5e4ece/coronal_016.png","assets/T/mri-7d52e0807d5e4ece/coronal_017.png","assets/T/mri-7d52e0807d5e4ece/coronal_018.png","assets/T/mri-7d52e0807d5e4ece/coronal_019.png","assets/T/mri-7d52e0807d5e4ece/coronal_020.png","assets/T/mri-7d52e0807d5e4ece/coronal_021.png","assets/T/mri-7d52e0807d5e4ece/coronal_022.png","assets/T/mri-7d52e0807d5e4ece/coronal_023.png","assets/T/mri-7d52e0807d5e4ece/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-9871a28e414f4455","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-9871a28e414f4455/axial_001.png","assets/T/mri-9871a28e414f4455/axial_002.png","assets/T/mri-9871a28e414f4455/axial_003.png","assets/T/mri-9871a28e414f4455/axial_004.png","assets/T/mri-9871a28e414f4455/axial_005.png","assets/T/mri-9871a28e414f4455/axial_006.png","assets/T/mri-9871a28e414f4455/axial_007.png","assets/T/mri-9871a28e414f4455/axial_008.png","assets/T/mri-9871a28e414f4455/axial_009.png","assets/T/mri-9871a28e414f4455/axial_010.png","assets/T/mri-9871a28e414f4455/axial_011.png","assets/T/mri-9871a28e414f4455/axial_012.png","assets/T/mri-9871a28e414f4455/axial_013.png","assets/T/mri-9871a28e414f4455/axial_014.png","assets/T/mri-9871a28e414f4455/axial_015.png","assets/T/mri-9871a28e414f4455/axial_016.png","assets/T/mri-9871a28e414f4455/axial_017.png","assets/T/mri-9871a28e414f4455/axial_018.png","assets/T/mri-9871a28e414f4455/axial_019.png","assets/T/mri-9871a28e414f4455/axial_020.png","assets/T/mri-9871a28e414f4455/axial_021.png","assets/T/mri-9871a28e414f4455/axial_022.png","assets/T/mri-9871a28e414f4455/axial_023.png","assets/T/mri-9871a28e414f4455/axial_024.png","assets/T/mri-9871a28e414f4455/axial_025.png","assets/T/mri-9871a28e414f4455/axial_026.png","assets/T/mri-9871a28e414f4455/axial_027.png","assets/T/mri-9871a28e414f4455/axial_028.png","assets/T/mri-9871a28e414f4455/axial_029.png","assets/T/mri-9871a28e414f4455/axial_030.png","assets/T/mri-9871a28e414f4455/axial_031.png","assets/T/mri-9871a28e414f4455/axial_032.png","assets/T/mri-9871a28e414f4455/axial_033.png","assets/T/mri-9871a28e414f4455/axial_034.png","assets/T/mri-9871a28e414f4455/axial_035.png","assets/T/mri-9871a28e414f4455/axial_036.png","assets/T/mri-9871a28e414f4455/axial_037.png","assets/T/mri-9871a28e414f4455/axial_038.png","assets/T/mri-9871a28e414f4455/axial_039.png","assets/T/mri-9871a28e414f4455/axial_040.png","assets/T/mri-9871a28e414f4455/coronal_001.png","assets/T/mri-9871a28e414f4455/coronal_002.png","assets/T/mri-9871a28e414f4455/coronal_003.png","assets/T/mri-9871a28e414f4455/coronal_004.png","assets/T/mri-9871a28e414f4455/coronal_005.png","assets/T/mri-9871a28e414f4455/coronal_006.png","assets/T/mri-9871a28e414f4455/coronal_007.png","assets/T/mri-9871a28e414f4455/coronal_008.png","assets/T/mri-9871a28e414f4455/coronal_009.png","assets/T/mri-9871a28e414f4455/coronal_010.png","assets/T/mri-9871a28e414f4455/coronal_011.png","assets/T/mri-9871a28e414f4455/coronal_012.png","assets/T/mri-9871a28e414f4455/coronal_013.png","assets/T/mri-9871a28e414f4455/coronal_014.png","assets/T/mri-9871a28e414f4455/coronal_015.png","assets/T/mri-9871a28e414f4455/coronal_016.png","assets/T/mri-9871a28e414f4455/coronal_017.png","assets/T/mri-9871a28e414f4455/coronal_018.png","assets/T/mri-9871a28e414f4455/coronal_019.png","assets/T/mri-9871a28e414f4455/coronal_020.png","assets/T/mri-9871a28e414f4455/coronal_021.png","assets/T/mri-9871a28e414f4455/coronal_022.png","assets/T/mri-9871a28e414f4455/coronal_023.png","assets/T/mri-9871a28e414f4455/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-7ea324ec1d394d0a","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 72 张图，均来自同一次检查。\n\n- 前 48 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-7ea324ec1d394d0a/axial_001.png","assets/T/mri-7ea324ec1d394d0a/axial_002.png","assets/T/mri-7ea324ec1d394d0a/axial_003.png","assets/T/mri-7ea324ec1d394d0a/axial_004.png","assets/T/mri-7ea324ec1d394d0a/axial_005.png","assets/T/mri-7ea324ec1d394d0a/axial_006.png","assets/T/mri-7ea324ec1d394d0a/axial_007.png","assets/T/mri-7ea324ec1d394d0a/axial_008.png","assets/T/mri-7ea324ec1d394d0a/axial_009.png","assets/T/mri-7ea324ec1d394d0a/axial_010.png","assets/T/mri-7ea324ec1d394d0a/axial_011.png","assets/T/mri-7ea324ec1d394d0a/axial_012.png","assets/T/mri-7ea324ec1d394d0a/axial_013.png","assets/T/mri-7ea324ec1d394d0a/axial_014.png","assets/T/mri-7ea324ec1d394d0a/axial_015.png","assets/T/mri-7ea324ec1d394d0a/axial_016.png","assets/T/mri-7ea324ec1d394d0a/axial_017.png","assets/T/mri-7ea324ec1d394d0a/axial_018.png","assets/T/mri-7ea324ec1d394d0a/axial_019.png","assets/T/mri-7ea324ec1d394d0a/axial_020.png","assets/T/mri-7ea324ec1d394d0a/axial_021.png","assets/T/mri-7ea324ec1d394d0a/axial_022.png","assets/T/mri-7ea324ec1d394d0a/axial_023.png","assets/T/mri-7ea324ec1d394d0a/axial_024.png","assets/T/mri-7ea324ec1d394d0a/axial_025.png","assets/T/mri-7ea324ec1d394d0a/axial_026.png","assets/T/mri-7ea324ec1d394d0a/axial_027.png","assets/T/mri-7ea324ec1d394d0a/axial_028.png","assets/T/mri-7ea324ec1d394d0a/axial_029.png","assets/T/mri-7ea324ec1d394d0a/axial_030.png","assets/T/mri-7ea324ec1d394d0a/axial_031.png","assets/T/mri-7ea324ec1d394d0a/axial_032.png","assets/T/mri-7ea324ec1d394d0a/axial_033.png","assets/T/mri-7ea324ec1d394d0a/axial_034.png","assets/T/mri-7ea324ec1d394d0a/axial_035.png","assets/T/mri-7ea324ec1d394d0a/axial_036.png","assets/T/mri-7ea324ec1d394d0a/axial_037.png","assets/T/mri-7ea324ec1d394d0a/axial_038.png","assets/T/mri-7ea324ec1d394d0a/axial_039.png","assets/T/mri-7ea324ec1d394d0a/axial_040.png","assets/T/mri-7ea324ec1d394d0a/axial_041.png","assets/T/mri-7ea324ec1d394d0a/axial_042.png","assets/T/mri-7ea324ec1d394d0a/axial_043.png","assets/T/mri-7ea324ec1d394d0a/axial_044.png","assets/T/mri-7ea324ec1d394d0a/axial_045.png","assets/T/mri-7ea324ec1d394d0a/axial_046.png","assets/T/mri-7ea324ec1d394d0a/axial_047.png","assets/T/mri-7ea324ec1d394d0a/axial_048.png","assets/T/mri-7ea324ec1d394d0a/coronal_001.png","assets/T/mri-7ea324ec1d394d0a/coronal_002.png","assets/T/mri-7ea324ec1d394d0a/coronal_003.png","assets/T/mri-7ea324ec1d394d0a/coronal_004.png","assets/T/mri-7ea324ec1d394d0a/coronal_005.png","assets/T/mri-7ea324ec1d394d0a/coronal_006.png","assets/T/mri-7ea324ec1d394d0a/coronal_007.png","assets/T/mri-7ea324ec1d394d0a/coronal_008.png","assets/T/mri-7ea324ec1d394d0a/coronal_009.png","assets/T/mri-7ea324ec1d394d0a/coronal_010.png","assets/T/mri-7ea324ec1d394d0a/coronal_011.png","assets/T/mri-7ea324ec1d394d0a/coronal_012.png","assets/T/mri-7ea324ec1d394d0a/coronal_013.png","assets/T/mri-7ea324ec1d394d0a/coronal_014.png","assets/T/mri-7ea324ec1d394d0a/coronal_015.png","assets/T/mri-7ea324ec1d394d0a/coronal_016.png","assets/T/mri-7ea324ec1d394d0a/coronal_017.png","assets/T/mri-7ea324ec1d394d0a/coronal_018.png","assets/T/mri-7ea324ec1d394d0a/coronal_019.png","assets/T/mri-7ea324ec1d394d0a/coronal_020.png","assets/T/mri-7ea324ec1d394d0a/coronal_021.png","assets/T/mri-7ea324ec1d394d0a/coronal_022.png","assets/T/mri-7ea324ec1d394d0a/coronal_023.png","assets/T/mri-7ea324ec1d394d0a/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-f31b184843914d18","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-f31b184843914d18/axial_001.png","assets/T/mri-f31b184843914d18/axial_002.png","assets/T/mri-f31b184843914d18/axial_003.png","assets/T/mri-f31b184843914d18/axial_004.png","assets/T/mri-f31b184843914d18/axial_005.png","assets/T/mri-f31b184843914d18/axial_006.png","assets/T/mri-f31b184843914d18/axial_007.png","assets/T/mri-f31b184843914d18/axial_008.png","assets/T/mri-f31b184843914d18/axial_009.png","assets/T/mri-f31b184843914d18/axial_010.png","assets/T/mri-f31b184843914d18/axial_011.png","assets/T/mri-f31b184843914d18/axial_012.png","assets/T/mri-f31b184843914d18/axial_013.png","assets/T/mri-f31b184843914d18/axial_014.png","assets/T/mri-f31b184843914d18/axial_015.png","assets/T/mri-f31b184843914d18/axial_016.png","assets/T/mri-f31b184843914d18/axial_017.png","assets/T/mri-f31b184843914d18/axial_018.png","assets/T/mri-f31b184843914d18/axial_019.png","assets/T/mri-f31b184843914d18/axial_020.png","assets/T/mri-f31b184843914d18/axial_021.png","assets/T/mri-f31b184843914d18/axial_022.png","assets/T/mri-f31b184843914d18/axial_023.png","assets/T/mri-f31b184843914d18/axial_024.png","assets/T/mri-f31b184843914d18/axial_025.png","assets/T/mri-f31b184843914d18/axial_026.png","assets/T/mri-f31b184843914d18/axial_027.png","assets/T/mri-f31b184843914d18/axial_028.png","assets/T/mri-f31b184843914d18/axial_029.png","assets/T/mri-f31b184843914d18/axial_030.png","assets/T/mri-f31b184843914d18/axial_031.png","assets/T/mri-f31b184843914d18/axial_032.png","assets/T/mri-f31b184843914d18/axial_033.png","assets/T/mri-f31b184843914d18/axial_034.png","assets/T/mri-f31b184843914d18/axial_035.png","assets/T/mri-f31b184843914d18/axial_036.png","assets/T/mri-f31b184843914d18/axial_037.png","assets/T/mri-f31b184843914d18/axial_038.png","assets/T/mri-f31b184843914d18/axial_039.png","assets/T/mri-f31b184843914d18/axial_040.png","assets/T/mri-f31b184843914d18/coronal_001.png","assets/T/mri-f31b184843914d18/coronal_002.png","assets/T/mri-f31b184843914d18/coronal_003.png","assets/T/mri-f31b184843914d18/coronal_004.png","assets/T/mri-f31b184843914d18/coronal_005.png","assets/T/mri-f31b184843914d18/coronal_006.png","assets/T/mri-f31b184843914d18/coronal_007.png","assets/T/mri-f31b184843914d18/coronal_008.png","assets/T/mri-f31b184843914d18/coronal_009.png","assets/T/mri-f31b184843914d18/coronal_010.png","assets/T/mri-f31b184843914d18/coronal_011.png","assets/T/mri-f31b184843914d18/coronal_012.png","assets/T/mri-f31b184843914d18/coronal_013.png","assets/T/mri-f31b184843914d18/coronal_014.png","assets/T/mri-f31b184843914d18/coronal_015.png","assets/T/mri-f31b184843914d18/coronal_016.png","assets/T/mri-f31b184843914d18/coronal_017.png","assets/T/mri-f31b184843914d18/coronal_018.png","assets/T/mri-f31b184843914d18/coronal_019.png","assets/T/mri-f31b184843914d18/coronal_020.png","assets/T/mri-f31b184843914d18/coronal_021.png","assets/T/mri-f31b184843914d18/coronal_022.png","assets/T/mri-f31b184843914d18/coronal_023.png","assets/T/mri-f31b184843914d18/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-fa2f991b797a46e9","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 68 张图，均来自同一次检查。\n\n- 前 44 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-fa2f991b797a46e9/axial_001.png","assets/T/mri-fa2f991b797a46e9/axial_002.png","assets/T/mri-fa2f991b797a46e9/axial_003.png","assets/T/mri-fa2f991b797a46e9/axial_004.png","assets/T/mri-fa2f991b797a46e9/axial_005.png","assets/T/mri-fa2f991b797a46e9/axial_006.png","assets/T/mri-fa2f991b797a46e9/axial_007.png","assets/T/mri-fa2f991b797a46e9/axial_008.png","assets/T/mri-fa2f991b797a46e9/axial_009.png","assets/T/mri-fa2f991b797a46e9/axial_010.png","assets/T/mri-fa2f991b797a46e9/axial_011.png","assets/T/mri-fa2f991b797a46e9/axial_012.png","assets/T/mri-fa2f991b797a46e9/axial_013.png","assets/T/mri-fa2f991b797a46e9/axial_014.png","assets/T/mri-fa2f991b797a46e9/axial_015.png","assets/T/mri-fa2f991b797a46e9/axial_016.png","assets/T/mri-fa2f991b797a46e9/axial_017.png","assets/T/mri-fa2f991b797a46e9/axial_018.png","assets/T/mri-fa2f991b797a46e9/axial_019.png","assets/T/mri-fa2f991b797a46e9/axial_020.png","assets/T/mri-fa2f991b797a46e9/axial_021.png","assets/T/mri-fa2f991b797a46e9/axial_022.png","assets/T/mri-fa2f991b797a46e9/axial_023.png","assets/T/mri-fa2f991b797a46e9/axial_024.png","assets/T/mri-fa2f991b797a46e9/axial_025.png","assets/T/mri-fa2f991b797a46e9/axial_026.png","assets/T/mri-fa2f991b797a46e9/axial_027.png","assets/T/mri-fa2f991b797a46e9/axial_028.png","assets/T/mri-fa2f991b797a46e9/axial_029.png","assets/T/mri-fa2f991b797a46e9/axial_030.png","assets/T/mri-fa2f991b797a46e9/axial_031.png","assets/T/mri-fa2f991b797a46e9/axial_032.png","assets/T/mri-fa2f991b797a46e9/axial_033.png","assets/T/mri-fa2f991b797a46e9/axial_034.png","assets/T/mri-fa2f991b797a46e9/axial_035.png","assets/T/mri-fa2f991b797a46e9/axial_036.png","assets/T/mri-fa2f991b797a46e9/axial_037.png","assets/T/mri-fa2f991b797a46e9/axial_038.png","assets/T/mri-fa2f991b797a46e9/axial_039.png","assets/T/mri-fa2f991b797a46e9/axial_040.png","assets/T/mri-fa2f991b797a46e9/axial_041.png","assets/T/mri-fa2f991b797a46e9/axial_042.png","assets/T/mri-fa2f991b797a46e9/axial_043.png","assets/T/mri-fa2f991b797a46e9/axial_044.png","assets/T/mri-fa2f991b797a46e9/coronal_001.png","assets/T/mri-fa2f991b797a46e9/coronal_002.png","assets/T/mri-fa2f991b797a46e9/coronal_003.png","assets/T/mri-fa2f991b797a46e9/coronal_004.png","assets/T/mri-fa2f991b797a46e9/coronal_005.png","assets/T/mri-fa2f991b797a46e9/coronal_006.png","assets/T/mri-fa2f991b797a46e9/coronal_007.png","assets/T/mri-fa2f991b797a46e9/coronal_008.png","assets/T/mri-fa2f991b797a46e9/coronal_009.png","assets/T/mri-fa2f991b797a46e9/coronal_010.png","assets/T/mri-fa2f991b797a46e9/coronal_011.png","assets/T/mri-fa2f991b797a46e9/coronal_012.png","assets/T/mri-fa2f991b797a46e9/coronal_013.png","assets/T/mri-fa2f991b797a46e9/coronal_014.png","assets/T/mri-fa2f991b797a46e9/coronal_015.png","assets/T/mri-fa2f991b797a46e9/coronal_016.png","assets/T/mri-fa2f991b797a46e9/coronal_017.png","assets/T/mri-fa2f991b797a46e9/coronal_018.png","assets/T/mri-fa2f991b797a46e9/coronal_019.png","assets/T/mri-fa2f991b797a46e9/coronal_020.png","assets/T/mri-fa2f991b797a46e9/coronal_021.png","assets/T/mri-fa2f991b797a46e9/coronal_022.png","assets/T/mri-fa2f991b797a46e9/coronal_023.png","assets/T/mri-fa2f991b797a46e9/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-1f3aecd6708d424a","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 70 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 28 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-1f3aecd6708d424a/axial_001.png","assets/T/mri-1f3aecd6708d424a/axial_002.png","assets/T/mri-1f3aecd6708d424a/axial_003.png","assets/T/mri-1f3aecd6708d424a/axial_004.png","assets/T/mri-1f3aecd6708d424a/axial_005.png","assets/T/mri-1f3aecd6708d424a/axial_006.png","assets/T/mri-1f3aecd6708d424a/axial_007.png","assets/T/mri-1f3aecd6708d424a/axial_008.png","assets/T/mri-1f3aecd6708d424a/axial_009.png","assets/T/mri-1f3aecd6708d424a/axial_010.png","assets/T/mri-1f3aecd6708d424a/axial_011.png","assets/T/mri-1f3aecd6708d424a/axial_012.png","assets/T/mri-1f3aecd6708d424a/axial_013.png","assets/T/mri-1f3aecd6708d424a/axial_014.png","assets/T/mri-1f3aecd6708d424a/axial_015.png","assets/T/mri-1f3aecd6708d424a/axial_016.png","assets/T/mri-1f3aecd6708d424a/axial_017.png","assets/T/mri-1f3aecd6708d424a/axial_018.png","assets/T/mri-1f3aecd6708d424a/axial_019.png","assets/T/mri-1f3aecd6708d424a/axial_020.png","assets/T/mri-1f3aecd6708d424a/axial_021.png","assets/T/mri-1f3aecd6708d424a/axial_022.png","assets/T/mri-1f3aecd6708d424a/axial_023.png","assets/T/mri-1f3aecd6708d424a/axial_024.png","assets/T/mri-1f3aecd6708d424a/axial_025.png","assets/T/mri-1f3aecd6708d424a/axial_026.png","assets/T/mri-1f3aecd6708d424a/axial_027.png","assets/T/mri-1f3aecd6708d424a/axial_028.png","assets/T/mri-1f3aecd6708d424a/axial_029.png","assets/T/mri-1f3aecd6708d424a/axial_030.png","assets/T/mri-1f3aecd6708d424a/axial_031.png","assets/T/mri-1f3aecd6708d424a/axial_032.png","assets/T/mri-1f3aecd6708d424a/axial_033.png","assets/T/mri-1f3aecd6708d424a/axial_034.png","assets/T/mri-1f3aecd6708d424a/axial_035.png","assets/T/mri-1f3aecd6708d424a/axial_036.png","assets/T/mri-1f3aecd6708d424a/axial_037.png","assets/T/mri-1f3aecd6708d424a/axial_038.png","assets/T/mri-1f3aecd6708d424a/axial_039.png","assets/T/mri-1f3aecd6708d424a/axial_040.png","assets/T/mri-1f3aecd6708d424a/axial_041.png","assets/T/mri-1f3aecd6708d424a/axial_042.png","assets/T/mri-1f3aecd6708d424a/coronal_001.png","assets/T/mri-1f3aecd6708d424a/coronal_002.png","assets/T/mri-1f3aecd6708d424a/coronal_003.png","assets/T/mri-1f3aecd6708d424a/coronal_004.png","assets/T/mri-1f3aecd6708d424a/coronal_005.png","assets/T/mri-1f3aecd6708d424a/coronal_006.png","assets/T/mri-1f3aecd6708d424a/coronal_007.png","assets/T/mri-1f3aecd6708d424a/coronal_008.png","assets/T/mri-1f3aecd6708d424a/coronal_009.png","assets/T/mri-1f3aecd6708d424a/coronal_010.png","assets/T/mri-1f3aecd6708d424a/coronal_011.png","assets/T/mri-1f3aecd6708d424a/coronal_012.png","assets/T/mri-1f3aecd6708d424a/coronal_013.png","assets/T/mri-1f3aecd6708d424a/coronal_014.png","assets/T/mri-1f3aecd6708d424a/coronal_015.png","assets/T/mri-1f3aecd6708d424a/coronal_016.png","assets/T/mri-1f3aecd6708d424a/coronal_017.png","assets/T/mri-1f3aecd6708d424a/coronal_018.png","assets/T/mri-1f3aecd6708d424a/coronal_019.png","assets/T/mri-1f3aecd6708d424a/coronal_020.png","assets/T/mri-1f3aecd6708d424a/coronal_021.png","assets/T/mri-1f3aecd6708d424a/coronal_022.png","assets/T/mri-1f3aecd6708d424a/coronal_023.png","assets/T/mri-1f3aecd6708d424a/coronal_024.png","assets/T/mri-1f3aecd6708d424a/coronal_025.png","assets/T/mri-1f3aecd6708d424a/coronal_026.png","assets/T/mri-1f3aecd6708d424a/coronal_027.png","assets/T/mri-1f3aecd6708d424a/coronal_028.png"],"stage_edition":8}
+{"id":"L3-T300:mri-b17592ae382c4024","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 62 张图，均来自同一次检查。\n\n- 前 38 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-b17592ae382c4024/axial_001.png","assets/T/mri-b17592ae382c4024/axial_002.png","assets/T/mri-b17592ae382c4024/axial_003.png","assets/T/mri-b17592ae382c4024/axial_004.png","assets/T/mri-b17592ae382c4024/axial_005.png","assets/T/mri-b17592ae382c4024/axial_006.png","assets/T/mri-b17592ae382c4024/axial_007.png","assets/T/mri-b17592ae382c4024/axial_008.png","assets/T/mri-b17592ae382c4024/axial_009.png","assets/T/mri-b17592ae382c4024/axial_010.png","assets/T/mri-b17592ae382c4024/axial_011.png","assets/T/mri-b17592ae382c4024/axial_012.png","assets/T/mri-b17592ae382c4024/axial_013.png","assets/T/mri-b17592ae382c4024/axial_014.png","assets/T/mri-b17592ae382c4024/axial_015.png","assets/T/mri-b17592ae382c4024/axial_016.png","assets/T/mri-b17592ae382c4024/axial_017.png","assets/T/mri-b17592ae382c4024/axial_018.png","assets/T/mri-b17592ae382c4024/axial_019.png","assets/T/mri-b17592ae382c4024/axial_020.png","assets/T/mri-b17592ae382c4024/axial_021.png","assets/T/mri-b17592ae382c4024/axial_022.png","assets/T/mri-b17592ae382c4024/axial_023.png","assets/T/mri-b17592ae382c4024/axial_024.png","assets/T/mri-b17592ae382c4024/axial_025.png","assets/T/mri-b17592ae382c4024/axial_026.png","assets/T/mri-b17592ae382c4024/axial_027.png","assets/T/mri-b17592ae382c4024/axial_028.png","assets/T/mri-b17592ae382c4024/axial_029.png","assets/T/mri-b17592ae382c4024/axial_030.png","assets/T/mri-b17592ae382c4024/axial_031.png","assets/T/mri-b17592ae382c4024/axial_032.png","assets/T/mri-b17592ae382c4024/axial_033.png","assets/T/mri-b17592ae382c4024/axial_034.png","assets/T/mri-b17592ae382c4024/axial_035.png","assets/T/mri-b17592ae382c4024/axial_036.png","assets/T/mri-b17592ae382c4024/axial_037.png","assets/T/mri-b17592ae382c4024/axial_038.png","assets/T/mri-b17592ae382c4024/coronal_001.png","assets/T/mri-b17592ae382c4024/coronal_002.png","assets/T/mri-b17592ae382c4024/coronal_003.png","assets/T/mri-b17592ae382c4024/coronal_004.png","assets/T/mri-b17592ae382c4024/coronal_005.png","assets/T/mri-b17592ae382c4024/coronal_006.png","assets/T/mri-b17592ae382c4024/coronal_007.png","assets/T/mri-b17592ae382c4024/coronal_008.png","assets/T/mri-b17592ae382c4024/coronal_009.png","assets/T/mri-b17592ae382c4024/coronal_010.png","assets/T/mri-b17592ae382c4024/coronal_011.png","assets/T/mri-b17592ae382c4024/coronal_012.png","assets/T/mri-b17592ae382c4024/coronal_013.png","assets/T/mri-b17592ae382c4024/coronal_014.png","assets/T/mri-b17592ae382c4024/coronal_015.png","assets/T/mri-b17592ae382c4024/coronal_016.png","assets/T/mri-b17592ae382c4024/coronal_017.png","assets/T/mri-b17592ae382c4024/coronal_018.png","assets/T/mri-b17592ae382c4024/coronal_019.png","assets/T/mri-b17592ae382c4024/coronal_020.png","assets/T/mri-b17592ae382c4024/coronal_021.png","assets/T/mri-b17592ae382c4024/coronal_022.png","assets/T/mri-b17592ae382c4024/coronal_023.png","assets/T/mri-b17592ae382c4024/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-0bbaeb3ce596430a","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-0bbaeb3ce596430a/axial_001.png","assets/T/mri-0bbaeb3ce596430a/axial_002.png","assets/T/mri-0bbaeb3ce596430a/axial_003.png","assets/T/mri-0bbaeb3ce596430a/axial_004.png","assets/T/mri-0bbaeb3ce596430a/axial_005.png","assets/T/mri-0bbaeb3ce596430a/axial_006.png","assets/T/mri-0bbaeb3ce596430a/axial_007.png","assets/T/mri-0bbaeb3ce596430a/axial_008.png","assets/T/mri-0bbaeb3ce596430a/axial_009.png","assets/T/mri-0bbaeb3ce596430a/axial_010.png","assets/T/mri-0bbaeb3ce596430a/axial_011.png","assets/T/mri-0bbaeb3ce596430a/axial_012.png","assets/T/mri-0bbaeb3ce596430a/axial_013.png","assets/T/mri-0bbaeb3ce596430a/axial_014.png","assets/T/mri-0bbaeb3ce596430a/axial_015.png","assets/T/mri-0bbaeb3ce596430a/axial_016.png","assets/T/mri-0bbaeb3ce596430a/axial_017.png","assets/T/mri-0bbaeb3ce596430a/axial_018.png","assets/T/mri-0bbaeb3ce596430a/axial_019.png","assets/T/mri-0bbaeb3ce596430a/axial_020.png","assets/T/mri-0bbaeb3ce596430a/axial_021.png","assets/T/mri-0bbaeb3ce596430a/axial_022.png","assets/T/mri-0bbaeb3ce596430a/axial_023.png","assets/T/mri-0bbaeb3ce596430a/axial_024.png","assets/T/mri-0bbaeb3ce596430a/axial_025.png","assets/T/mri-0bbaeb3ce596430a/axial_026.png","assets/T/mri-0bbaeb3ce596430a/axial_027.png","assets/T/mri-0bbaeb3ce596430a/axial_028.png","assets/T/mri-0bbaeb3ce596430a/axial_029.png","assets/T/mri-0bbaeb3ce596430a/axial_030.png","assets/T/mri-0bbaeb3ce596430a/axial_031.png","assets/T/mri-0bbaeb3ce596430a/axial_032.png","assets/T/mri-0bbaeb3ce596430a/axial_033.png","assets/T/mri-0bbaeb3ce596430a/axial_034.png","assets/T/mri-0bbaeb3ce596430a/axial_035.png","assets/T/mri-0bbaeb3ce596430a/axial_036.png","assets/T/mri-0bbaeb3ce596430a/axial_037.png","assets/T/mri-0bbaeb3ce596430a/axial_038.png","assets/T/mri-0bbaeb3ce596430a/axial_039.png","assets/T/mri-0bbaeb3ce596430a/axial_040.png","assets/T/mri-0bbaeb3ce596430a/axial_041.png","assets/T/mri-0bbaeb3ce596430a/axial_042.png","assets/T/mri-0bbaeb3ce596430a/coronal_001.png","assets/T/mri-0bbaeb3ce596430a/coronal_002.png","assets/T/mri-0bbaeb3ce596430a/coronal_003.png","assets/T/mri-0bbaeb3ce596430a/coronal_004.png","assets/T/mri-0bbaeb3ce596430a/coronal_005.png","assets/T/mri-0bbaeb3ce596430a/coronal_006.png","assets/T/mri-0bbaeb3ce596430a/coronal_007.png","assets/T/mri-0bbaeb3ce596430a/coronal_008.png","assets/T/mri-0bbaeb3ce596430a/coronal_009.png","assets/T/mri-0bbaeb3ce596430a/coronal_010.png","assets/T/mri-0bbaeb3ce596430a/coronal_011.png","assets/T/mri-0bbaeb3ce596430a/coronal_012.png","assets/T/mri-0bbaeb3ce596430a/coronal_013.png","assets/T/mri-0bbaeb3ce596430a/coronal_014.png","assets/T/mri-0bbaeb3ce596430a/coronal_015.png","assets/T/mri-0bbaeb3ce596430a/coronal_016.png","assets/T/mri-0bbaeb3ce596430a/coronal_017.png","assets/T/mri-0bbaeb3ce596430a/coronal_018.png","assets/T/mri-0bbaeb3ce596430a/coronal_019.png","assets/T/mri-0bbaeb3ce596430a/coronal_020.png","assets/T/mri-0bbaeb3ce596430a/coronal_021.png","assets/T/mri-0bbaeb3ce596430a/coronal_022.png","assets/T/mri-0bbaeb3ce596430a/coronal_023.png","assets/T/mri-0bbaeb3ce596430a/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-7f087e4b9fbd4930","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-7f087e4b9fbd4930/axial_001.png","assets/T/mri-7f087e4b9fbd4930/axial_002.png","assets/T/mri-7f087e4b9fbd4930/axial_003.png","assets/T/mri-7f087e4b9fbd4930/axial_004.png","assets/T/mri-7f087e4b9fbd4930/axial_005.png","assets/T/mri-7f087e4b9fbd4930/axial_006.png","assets/T/mri-7f087e4b9fbd4930/axial_007.png","assets/T/mri-7f087e4b9fbd4930/axial_008.png","assets/T/mri-7f087e4b9fbd4930/axial_009.png","assets/T/mri-7f087e4b9fbd4930/axial_010.png","assets/T/mri-7f087e4b9fbd4930/axial_011.png","assets/T/mri-7f087e4b9fbd4930/axial_012.png","assets/T/mri-7f087e4b9fbd4930/axial_013.png","assets/T/mri-7f087e4b9fbd4930/axial_014.png","assets/T/mri-7f087e4b9fbd4930/axial_015.png","assets/T/mri-7f087e4b9fbd4930/axial_016.png","assets/T/mri-7f087e4b9fbd4930/axial_017.png","assets/T/mri-7f087e4b9fbd4930/axial_018.png","assets/T/mri-7f087e4b9fbd4930/axial_019.png","assets/T/mri-7f087e4b9fbd4930/axial_020.png","assets/T/mri-7f087e4b9fbd4930/axial_021.png","assets/T/mri-7f087e4b9fbd4930/axial_022.png","assets/T/mri-7f087e4b9fbd4930/axial_023.png","assets/T/mri-7f087e4b9fbd4930/axial_024.png","assets/T/mri-7f087e4b9fbd4930/axial_025.png","assets/T/mri-7f087e4b9fbd4930/axial_026.png","assets/T/mri-7f087e4b9fbd4930/axial_027.png","assets/T/mri-7f087e4b9fbd4930/axial_028.png","assets/T/mri-7f087e4b9fbd4930/axial_029.png","assets/T/mri-7f087e4b9fbd4930/axial_030.png","assets/T/mri-7f087e4b9fbd4930/axial_031.png","assets/T/mri-7f087e4b9fbd4930/axial_032.png","assets/T/mri-7f087e4b9fbd4930/axial_033.png","assets/T/mri-7f087e4b9fbd4930/axial_034.png","assets/T/mri-7f087e4b9fbd4930/axial_035.png","assets/T/mri-7f087e4b9fbd4930/axial_036.png","assets/T/mri-7f087e4b9fbd4930/axial_037.png","assets/T/mri-7f087e4b9fbd4930/axial_038.png","assets/T/mri-7f087e4b9fbd4930/axial_039.png","assets/T/mri-7f087e4b9fbd4930/axial_040.png","assets/T/mri-7f087e4b9fbd4930/coronal_001.png","assets/T/mri-7f087e4b9fbd4930/coronal_002.png","assets/T/mri-7f087e4b9fbd4930/coronal_003.png","assets/T/mri-7f087e4b9fbd4930/coronal_004.png","assets/T/mri-7f087e4b9fbd4930/coronal_005.png","assets/T/mri-7f087e4b9fbd4930/coronal_006.png","assets/T/mri-7f087e4b9fbd4930/coronal_007.png","assets/T/mri-7f087e4b9fbd4930/coronal_008.png","assets/T/mri-7f087e4b9fbd4930/coronal_009.png","assets/T/mri-7f087e4b9fbd4930/coronal_010.png","assets/T/mri-7f087e4b9fbd4930/coronal_011.png","assets/T/mri-7f087e4b9fbd4930/coronal_012.png","assets/T/mri-7f087e4b9fbd4930/coronal_013.png","assets/T/mri-7f087e4b9fbd4930/coronal_014.png","assets/T/mri-7f087e4b9fbd4930/coronal_015.png","assets/T/mri-7f087e4b9fbd4930/coronal_016.png","assets/T/mri-7f087e4b9fbd4930/coronal_017.png","assets/T/mri-7f087e4b9fbd4930/coronal_018.png","assets/T/mri-7f087e4b9fbd4930/coronal_019.png","assets/T/mri-7f087e4b9fbd4930/coronal_020.png","assets/T/mri-7f087e4b9fbd4930/coronal_021.png","assets/T/mri-7f087e4b9fbd4930/coronal_022.png","assets/T/mri-7f087e4b9fbd4930/coronal_023.png","assets/T/mri-7f087e4b9fbd4930/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-2495921ad88b46a3","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-2495921ad88b46a3/axial_001.png","assets/T/mri-2495921ad88b46a3/axial_002.png","assets/T/mri-2495921ad88b46a3/axial_003.png","assets/T/mri-2495921ad88b46a3/axial_004.png","assets/T/mri-2495921ad88b46a3/axial_005.png","assets/T/mri-2495921ad88b46a3/axial_006.png","assets/T/mri-2495921ad88b46a3/axial_007.png","assets/T/mri-2495921ad88b46a3/axial_008.png","assets/T/mri-2495921ad88b46a3/axial_009.png","assets/T/mri-2495921ad88b46a3/axial_010.png","assets/T/mri-2495921ad88b46a3/axial_011.png","assets/T/mri-2495921ad88b46a3/axial_012.png","assets/T/mri-2495921ad88b46a3/axial_013.png","assets/T/mri-2495921ad88b46a3/axial_014.png","assets/T/mri-2495921ad88b46a3/axial_015.png","assets/T/mri-2495921ad88b46a3/axial_016.png","assets/T/mri-2495921ad88b46a3/axial_017.png","assets/T/mri-2495921ad88b46a3/axial_018.png","assets/T/mri-2495921ad88b46a3/axial_019.png","assets/T/mri-2495921ad88b46a3/axial_020.png","assets/T/mri-2495921ad88b46a3/axial_021.png","assets/T/mri-2495921ad88b46a3/axial_022.png","assets/T/mri-2495921ad88b46a3/axial_023.png","assets/T/mri-2495921ad88b46a3/axial_024.png","assets/T/mri-2495921ad88b46a3/axial_025.png","assets/T/mri-2495921ad88b46a3/axial_026.png","assets/T/mri-2495921ad88b46a3/axial_027.png","assets/T/mri-2495921ad88b46a3/axial_028.png","assets/T/mri-2495921ad88b46a3/axial_029.png","assets/T/mri-2495921ad88b46a3/axial_030.png","assets/T/mri-2495921ad88b46a3/axial_031.png","assets/T/mri-2495921ad88b46a3/axial_032.png","assets/T/mri-2495921ad88b46a3/axial_033.png","assets/T/mri-2495921ad88b46a3/axial_034.png","assets/T/mri-2495921ad88b46a3/axial_035.png","assets/T/mri-2495921ad88b46a3/axial_036.png","assets/T/mri-2495921ad88b46a3/axial_037.png","assets/T/mri-2495921ad88b46a3/axial_038.png","assets/T/mri-2495921ad88b46a3/axial_039.png","assets/T/mri-2495921ad88b46a3/axial_040.png","assets/T/mri-2495921ad88b46a3/coronal_001.png","assets/T/mri-2495921ad88b46a3/coronal_002.png","assets/T/mri-2495921ad88b46a3/coronal_003.png","assets/T/mri-2495921ad88b46a3/coronal_004.png","assets/T/mri-2495921ad88b46a3/coronal_005.png","assets/T/mri-2495921ad88b46a3/coronal_006.png","assets/T/mri-2495921ad88b46a3/coronal_007.png","assets/T/mri-2495921ad88b46a3/coronal_008.png","assets/T/mri-2495921ad88b46a3/coronal_009.png","assets/T/mri-2495921ad88b46a3/coronal_010.png","assets/T/mri-2495921ad88b46a3/coronal_011.png","assets/T/mri-2495921ad88b46a3/coronal_012.png","assets/T/mri-2495921ad88b46a3/coronal_013.png","assets/T/mri-2495921ad88b46a3/coronal_014.png","assets/T/mri-2495921ad88b46a3/coronal_015.png","assets/T/mri-2495921ad88b46a3/coronal_016.png","assets/T/mri-2495921ad88b46a3/coronal_017.png","assets/T/mri-2495921ad88b46a3/coronal_018.png","assets/T/mri-2495921ad88b46a3/coronal_019.png","assets/T/mri-2495921ad88b46a3/coronal_020.png","assets/T/mri-2495921ad88b46a3/coronal_021.png","assets/T/mri-2495921ad88b46a3/coronal_022.png","assets/T/mri-2495921ad88b46a3/coronal_023.png","assets/T/mri-2495921ad88b46a3/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-6093448809034145","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 26 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-6093448809034145/axial_001.png","assets/T/mri-6093448809034145/axial_002.png","assets/T/mri-6093448809034145/axial_003.png","assets/T/mri-6093448809034145/axial_004.png","assets/T/mri-6093448809034145/axial_005.png","assets/T/mri-6093448809034145/axial_006.png","assets/T/mri-6093448809034145/axial_007.png","assets/T/mri-6093448809034145/axial_008.png","assets/T/mri-6093448809034145/axial_009.png","assets/T/mri-6093448809034145/axial_010.png","assets/T/mri-6093448809034145/axial_011.png","assets/T/mri-6093448809034145/axial_012.png","assets/T/mri-6093448809034145/axial_013.png","assets/T/mri-6093448809034145/axial_014.png","assets/T/mri-6093448809034145/axial_015.png","assets/T/mri-6093448809034145/axial_016.png","assets/T/mri-6093448809034145/axial_017.png","assets/T/mri-6093448809034145/axial_018.png","assets/T/mri-6093448809034145/axial_019.png","assets/T/mri-6093448809034145/axial_020.png","assets/T/mri-6093448809034145/axial_021.png","assets/T/mri-6093448809034145/axial_022.png","assets/T/mri-6093448809034145/axial_023.png","assets/T/mri-6093448809034145/axial_024.png","assets/T/mri-6093448809034145/axial_025.png","assets/T/mri-6093448809034145/axial_026.png","assets/T/mri-6093448809034145/axial_027.png","assets/T/mri-6093448809034145/axial_028.png","assets/T/mri-6093448809034145/axial_029.png","assets/T/mri-6093448809034145/axial_030.png","assets/T/mri-6093448809034145/axial_031.png","assets/T/mri-6093448809034145/axial_032.png","assets/T/mri-6093448809034145/axial_033.png","assets/T/mri-6093448809034145/axial_034.png","assets/T/mri-6093448809034145/axial_035.png","assets/T/mri-6093448809034145/axial_036.png","assets/T/mri-6093448809034145/axial_037.png","assets/T/mri-6093448809034145/axial_038.png","assets/T/mri-6093448809034145/axial_039.png","assets/T/mri-6093448809034145/axial_040.png","assets/T/mri-6093448809034145/coronal_001.png","assets/T/mri-6093448809034145/coronal_002.png","assets/T/mri-6093448809034145/coronal_003.png","assets/T/mri-6093448809034145/coronal_004.png","assets/T/mri-6093448809034145/coronal_005.png","assets/T/mri-6093448809034145/coronal_006.png","assets/T/mri-6093448809034145/coronal_007.png","assets/T/mri-6093448809034145/coronal_008.png","assets/T/mri-6093448809034145/coronal_009.png","assets/T/mri-6093448809034145/coronal_010.png","assets/T/mri-6093448809034145/coronal_011.png","assets/T/mri-6093448809034145/coronal_012.png","assets/T/mri-6093448809034145/coronal_013.png","assets/T/mri-6093448809034145/coronal_014.png","assets/T/mri-6093448809034145/coronal_015.png","assets/T/mri-6093448809034145/coronal_016.png","assets/T/mri-6093448809034145/coronal_017.png","assets/T/mri-6093448809034145/coronal_018.png","assets/T/mri-6093448809034145/coronal_019.png","assets/T/mri-6093448809034145/coronal_020.png","assets/T/mri-6093448809034145/coronal_021.png","assets/T/mri-6093448809034145/coronal_022.png","assets/T/mri-6093448809034145/coronal_023.png","assets/T/mri-6093448809034145/coronal_024.png","assets/T/mri-6093448809034145/coronal_025.png","assets/T/mri-6093448809034145/coronal_026.png"],"stage_edition":8}
+{"id":"L3-T300:mri-cda1302e1734496e","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-cda1302e1734496e/axial_001.png","assets/T/mri-cda1302e1734496e/axial_002.png","assets/T/mri-cda1302e1734496e/axial_003.png","assets/T/mri-cda1302e1734496e/axial_004.png","assets/T/mri-cda1302e1734496e/axial_005.png","assets/T/mri-cda1302e1734496e/axial_006.png","assets/T/mri-cda1302e1734496e/axial_007.png","assets/T/mri-cda1302e1734496e/axial_008.png","assets/T/mri-cda1302e1734496e/axial_009.png","assets/T/mri-cda1302e1734496e/axial_010.png","assets/T/mri-cda1302e1734496e/axial_011.png","assets/T/mri-cda1302e1734496e/axial_012.png","assets/T/mri-cda1302e1734496e/axial_013.png","assets/T/mri-cda1302e1734496e/axial_014.png","assets/T/mri-cda1302e1734496e/axial_015.png","assets/T/mri-cda1302e1734496e/axial_016.png","assets/T/mri-cda1302e1734496e/axial_017.png","assets/T/mri-cda1302e1734496e/axial_018.png","assets/T/mri-cda1302e1734496e/axial_019.png","assets/T/mri-cda1302e1734496e/axial_020.png","assets/T/mri-cda1302e1734496e/axial_021.png","assets/T/mri-cda1302e1734496e/axial_022.png","assets/T/mri-cda1302e1734496e/axial_023.png","assets/T/mri-cda1302e1734496e/axial_024.png","assets/T/mri-cda1302e1734496e/axial_025.png","assets/T/mri-cda1302e1734496e/axial_026.png","assets/T/mri-cda1302e1734496e/axial_027.png","assets/T/mri-cda1302e1734496e/axial_028.png","assets/T/mri-cda1302e1734496e/axial_029.png","assets/T/mri-cda1302e1734496e/axial_030.png","assets/T/mri-cda1302e1734496e/axial_031.png","assets/T/mri-cda1302e1734496e/axial_032.png","assets/T/mri-cda1302e1734496e/axial_033.png","assets/T/mri-cda1302e1734496e/axial_034.png","assets/T/mri-cda1302e1734496e/axial_035.png","assets/T/mri-cda1302e1734496e/axial_036.png","assets/T/mri-cda1302e1734496e/axial_037.png","assets/T/mri-cda1302e1734496e/axial_038.png","assets/T/mri-cda1302e1734496e/axial_039.png","assets/T/mri-cda1302e1734496e/axial_040.png","assets/T/mri-cda1302e1734496e/coronal_001.png","assets/T/mri-cda1302e1734496e/coronal_002.png","assets/T/mri-cda1302e1734496e/coronal_003.png","assets/T/mri-cda1302e1734496e/coronal_004.png","assets/T/mri-cda1302e1734496e/coronal_005.png","assets/T/mri-cda1302e1734496e/coronal_006.png","assets/T/mri-cda1302e1734496e/coronal_007.png","assets/T/mri-cda1302e1734496e/coronal_008.png","assets/T/mri-cda1302e1734496e/coronal_009.png","assets/T/mri-cda1302e1734496e/coronal_010.png","assets/T/mri-cda1302e1734496e/coronal_011.png","assets/T/mri-cda1302e1734496e/coronal_012.png","assets/T/mri-cda1302e1734496e/coronal_013.png","assets/T/mri-cda1302e1734496e/coronal_014.png","assets/T/mri-cda1302e1734496e/coronal_015.png","assets/T/mri-cda1302e1734496e/coronal_016.png","assets/T/mri-cda1302e1734496e/coronal_017.png","assets/T/mri-cda1302e1734496e/coronal_018.png","assets/T/mri-cda1302e1734496e/coronal_019.png","assets/T/mri-cda1302e1734496e/coronal_020.png","assets/T/mri-cda1302e1734496e/coronal_021.png","assets/T/mri-cda1302e1734496e/coronal_022.png","assets/T/mri-cda1302e1734496e/coronal_023.png","assets/T/mri-cda1302e1734496e/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-d514f55b3f3443d5","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 68 张图，均来自同一次检查。\n\n- 前 44 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-d514f55b3f3443d5/axial_001.png","assets/T/mri-d514f55b3f3443d5/axial_002.png","assets/T/mri-d514f55b3f3443d5/axial_003.png","assets/T/mri-d514f55b3f3443d5/axial_004.png","assets/T/mri-d514f55b3f3443d5/axial_005.png","assets/T/mri-d514f55b3f3443d5/axial_006.png","assets/T/mri-d514f55b3f3443d5/axial_007.png","assets/T/mri-d514f55b3f3443d5/axial_008.png","assets/T/mri-d514f55b3f3443d5/axial_009.png","assets/T/mri-d514f55b3f3443d5/axial_010.png","assets/T/mri-d514f55b3f3443d5/axial_011.png","assets/T/mri-d514f55b3f3443d5/axial_012.png","assets/T/mri-d514f55b3f3443d5/axial_013.png","assets/T/mri-d514f55b3f3443d5/axial_014.png","assets/T/mri-d514f55b3f3443d5/axial_015.png","assets/T/mri-d514f55b3f3443d5/axial_016.png","assets/T/mri-d514f55b3f3443d5/axial_017.png","assets/T/mri-d514f55b3f3443d5/axial_018.png","assets/T/mri-d514f55b3f3443d5/axial_019.png","assets/T/mri-d514f55b3f3443d5/axial_020.png","assets/T/mri-d514f55b3f3443d5/axial_021.png","assets/T/mri-d514f55b3f3443d5/axial_022.png","assets/T/mri-d514f55b3f3443d5/axial_023.png","assets/T/mri-d514f55b3f3443d5/axial_024.png","assets/T/mri-d514f55b3f3443d5/axial_025.png","assets/T/mri-d514f55b3f3443d5/axial_026.png","assets/T/mri-d514f55b3f3443d5/axial_027.png","assets/T/mri-d514f55b3f3443d5/axial_028.png","assets/T/mri-d514f55b3f3443d5/axial_029.png","assets/T/mri-d514f55b3f3443d5/axial_030.png","assets/T/mri-d514f55b3f3443d5/axial_031.png","assets/T/mri-d514f55b3f3443d5/axial_032.png","assets/T/mri-d514f55b3f3443d5/axial_033.png","assets/T/mri-d514f55b3f3443d5/axial_034.png","assets/T/mri-d514f55b3f3443d5/axial_035.png","assets/T/mri-d514f55b3f3443d5/axial_036.png","assets/T/mri-d514f55b3f3443d5/axial_037.png","assets/T/mri-d514f55b3f3443d5/axial_038.png","assets/T/mri-d514f55b3f3443d5/axial_039.png","assets/T/mri-d514f55b3f3443d5/axial_040.png","assets/T/mri-d514f55b3f3443d5/axial_041.png","assets/T/mri-d514f55b3f3443d5/axial_042.png","assets/T/mri-d514f55b3f3443d5/axial_043.png","assets/T/mri-d514f55b3f3443d5/axial_044.png","assets/T/mri-d514f55b3f3443d5/coronal_001.png","assets/T/mri-d514f55b3f3443d5/coronal_002.png","assets/T/mri-d514f55b3f3443d5/coronal_003.png","assets/T/mri-d514f55b3f3443d5/coronal_004.png","assets/T/mri-d514f55b3f3443d5/coronal_005.png","assets/T/mri-d514f55b3f3443d5/coronal_006.png","assets/T/mri-d514f55b3f3443d5/coronal_007.png","assets/T/mri-d514f55b3f3443d5/coronal_008.png","assets/T/mri-d514f55b3f3443d5/coronal_009.png","assets/T/mri-d514f55b3f3443d5/coronal_010.png","assets/T/mri-d514f55b3f3443d5/coronal_011.png","assets/T/mri-d514f55b3f3443d5/coronal_012.png","assets/T/mri-d514f55b3f3443d5/coronal_013.png","assets/T/mri-d514f55b3f3443d5/coronal_014.png","assets/T/mri-d514f55b3f3443d5/coronal_015.png","assets/T/mri-d514f55b3f3443d5/coronal_016.png","assets/T/mri-d514f55b3f3443d5/coronal_017.png","assets/T/mri-d514f55b3f3443d5/coronal_018.png","assets/T/mri-d514f55b3f3443d5/coronal_019.png","assets/T/mri-d514f55b3f3443d5/coronal_020.png","assets/T/mri-d514f55b3f3443d5/coronal_021.png","assets/T/mri-d514f55b3f3443d5/coronal_022.png","assets/T/mri-d514f55b3f3443d5/coronal_023.png","assets/T/mri-d514f55b3f3443d5/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-0308881784db400a","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 69 张图，均来自同一次检查。\n\n- 前 45 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-0308881784db400a/axial_001.png","assets/T/mri-0308881784db400a/axial_002.png","assets/T/mri-0308881784db400a/axial_003.png","assets/T/mri-0308881784db400a/axial_004.png","assets/T/mri-0308881784db400a/axial_005.png","assets/T/mri-0308881784db400a/axial_006.png","assets/T/mri-0308881784db400a/axial_007.png","assets/T/mri-0308881784db400a/axial_008.png","assets/T/mri-0308881784db400a/axial_009.png","assets/T/mri-0308881784db400a/axial_010.png","assets/T/mri-0308881784db400a/axial_011.png","assets/T/mri-0308881784db400a/axial_012.png","assets/T/mri-0308881784db400a/axial_013.png","assets/T/mri-0308881784db400a/axial_014.png","assets/T/mri-0308881784db400a/axial_015.png","assets/T/mri-0308881784db400a/axial_016.png","assets/T/mri-0308881784db400a/axial_017.png","assets/T/mri-0308881784db400a/axial_018.png","assets/T/mri-0308881784db400a/axial_019.png","assets/T/mri-0308881784db400a/axial_020.png","assets/T/mri-0308881784db400a/axial_021.png","assets/T/mri-0308881784db400a/axial_022.png","assets/T/mri-0308881784db400a/axial_023.png","assets/T/mri-0308881784db400a/axial_024.png","assets/T/mri-0308881784db400a/axial_025.png","assets/T/mri-0308881784db400a/axial_026.png","assets/T/mri-0308881784db400a/axial_027.png","assets/T/mri-0308881784db400a/axial_028.png","assets/T/mri-0308881784db400a/axial_029.png","assets/T/mri-0308881784db400a/axial_030.png","assets/T/mri-0308881784db400a/axial_031.png","assets/T/mri-0308881784db400a/axial_032.png","assets/T/mri-0308881784db400a/axial_033.png","assets/T/mri-0308881784db400a/axial_034.png","assets/T/mri-0308881784db400a/axial_035.png","assets/T/mri-0308881784db400a/axial_036.png","assets/T/mri-0308881784db400a/axial_037.png","assets/T/mri-0308881784db400a/axial_038.png","assets/T/mri-0308881784db400a/axial_039.png","assets/T/mri-0308881784db400a/axial_040.png","assets/T/mri-0308881784db400a/axial_041.png","assets/T/mri-0308881784db400a/axial_042.png","assets/T/mri-0308881784db400a/axial_043.png","assets/T/mri-0308881784db400a/axial_044.png","assets/T/mri-0308881784db400a/axial_045.png","assets/T/mri-0308881784db400a/coronal_001.png","assets/T/mri-0308881784db400a/coronal_002.png","assets/T/mri-0308881784db400a/coronal_003.png","assets/T/mri-0308881784db400a/coronal_004.png","assets/T/mri-0308881784db400a/coronal_005.png","assets/T/mri-0308881784db400a/coronal_006.png","assets/T/mri-0308881784db400a/coronal_007.png","assets/T/mri-0308881784db400a/coronal_008.png","assets/T/mri-0308881784db400a/coronal_009.png","assets/T/mri-0308881784db400a/coronal_010.png","assets/T/mri-0308881784db400a/coronal_011.png","assets/T/mri-0308881784db400a/coronal_012.png","assets/T/mri-0308881784db400a/coronal_013.png","assets/T/mri-0308881784db400a/coronal_014.png","assets/T/mri-0308881784db400a/coronal_015.png","assets/T/mri-0308881784db400a/coronal_016.png","assets/T/mri-0308881784db400a/coronal_017.png","assets/T/mri-0308881784db400a/coronal_018.png","assets/T/mri-0308881784db400a/coronal_019.png","assets/T/mri-0308881784db400a/coronal_020.png","assets/T/mri-0308881784db400a/coronal_021.png","assets/T/mri-0308881784db400a/coronal_022.png","assets/T/mri-0308881784db400a/coronal_023.png","assets/T/mri-0308881784db400a/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-4cb8cb63e2d748bd","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 68 张图，均来自同一次检查。\n\n- 前 44 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-4cb8cb63e2d748bd/axial_001.png","assets/T/mri-4cb8cb63e2d748bd/axial_002.png","assets/T/mri-4cb8cb63e2d748bd/axial_003.png","assets/T/mri-4cb8cb63e2d748bd/axial_004.png","assets/T/mri-4cb8cb63e2d748bd/axial_005.png","assets/T/mri-4cb8cb63e2d748bd/axial_006.png","assets/T/mri-4cb8cb63e2d748bd/axial_007.png","assets/T/mri-4cb8cb63e2d748bd/axial_008.png","assets/T/mri-4cb8cb63e2d748bd/axial_009.png","assets/T/mri-4cb8cb63e2d748bd/axial_010.png","assets/T/mri-4cb8cb63e2d748bd/axial_011.png","assets/T/mri-4cb8cb63e2d748bd/axial_012.png","assets/T/mri-4cb8cb63e2d748bd/axial_013.png","assets/T/mri-4cb8cb63e2d748bd/axial_014.png","assets/T/mri-4cb8cb63e2d748bd/axial_015.png","assets/T/mri-4cb8cb63e2d748bd/axial_016.png","assets/T/mri-4cb8cb63e2d748bd/axial_017.png","assets/T/mri-4cb8cb63e2d748bd/axial_018.png","assets/T/mri-4cb8cb63e2d748bd/axial_019.png","assets/T/mri-4cb8cb63e2d748bd/axial_020.png","assets/T/mri-4cb8cb63e2d748bd/axial_021.png","assets/T/mri-4cb8cb63e2d748bd/axial_022.png","assets/T/mri-4cb8cb63e2d748bd/axial_023.png","assets/T/mri-4cb8cb63e2d748bd/axial_024.png","assets/T/mri-4cb8cb63e2d748bd/axial_025.png","assets/T/mri-4cb8cb63e2d748bd/axial_026.png","assets/T/mri-4cb8cb63e2d748bd/axial_027.png","assets/T/mri-4cb8cb63e2d748bd/axial_028.png","assets/T/mri-4cb8cb63e2d748bd/axial_029.png","assets/T/mri-4cb8cb63e2d748bd/axial_030.png","assets/T/mri-4cb8cb63e2d748bd/axial_031.png","assets/T/mri-4cb8cb63e2d748bd/axial_032.png","assets/T/mri-4cb8cb63e2d748bd/axial_033.png","assets/T/mri-4cb8cb63e2d748bd/axial_034.png","assets/T/mri-4cb8cb63e2d748bd/axial_035.png","assets/T/mri-4cb8cb63e2d748bd/axial_036.png","assets/T/mri-4cb8cb63e2d748bd/axial_037.png","assets/T/mri-4cb8cb63e2d748bd/axial_038.png","assets/T/mri-4cb8cb63e2d748bd/axial_039.png","assets/T/mri-4cb8cb63e2d748bd/axial_040.png","assets/T/mri-4cb8cb63e2d748bd/axial_041.png","assets/T/mri-4cb8cb63e2d748bd/axial_042.png","assets/T/mri-4cb8cb63e2d748bd/axial_043.png","assets/T/mri-4cb8cb63e2d748bd/axial_044.png","assets/T/mri-4cb8cb63e2d748bd/coronal_001.png","assets/T/mri-4cb8cb63e2d748bd/coronal_002.png","assets/T/mri-4cb8cb63e2d748bd/coronal_003.png","assets/T/mri-4cb8cb63e2d748bd/coronal_004.png","assets/T/mri-4cb8cb63e2d748bd/coronal_005.png","assets/T/mri-4cb8cb63e2d748bd/coronal_006.png","assets/T/mri-4cb8cb63e2d748bd/coronal_007.png","assets/T/mri-4cb8cb63e2d748bd/coronal_008.png","assets/T/mri-4cb8cb63e2d748bd/coronal_009.png","assets/T/mri-4cb8cb63e2d748bd/coronal_010.png","assets/T/mri-4cb8cb63e2d748bd/coronal_011.png","assets/T/mri-4cb8cb63e2d748bd/coronal_012.png","assets/T/mri-4cb8cb63e2d748bd/coronal_013.png","assets/T/mri-4cb8cb63e2d748bd/coronal_014.png","assets/T/mri-4cb8cb63e2d748bd/coronal_015.png","assets/T/mri-4cb8cb63e2d748bd/coronal_016.png","assets/T/mri-4cb8cb63e2d748bd/coronal_017.png","assets/T/mri-4cb8cb63e2d748bd/coronal_018.png","assets/T/mri-4cb8cb63e2d748bd/coronal_019.png","assets/T/mri-4cb8cb63e2d748bd/coronal_020.png","assets/T/mri-4cb8cb63e2d748bd/coronal_021.png","assets/T/mri-4cb8cb63e2d748bd/coronal_022.png","assets/T/mri-4cb8cb63e2d748bd/coronal_023.png","assets/T/mri-4cb8cb63e2d748bd/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-b95098426a0148f8","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-b95098426a0148f8/axial_001.png","assets/T/mri-b95098426a0148f8/axial_002.png","assets/T/mri-b95098426a0148f8/axial_003.png","assets/T/mri-b95098426a0148f8/axial_004.png","assets/T/mri-b95098426a0148f8/axial_005.png","assets/T/mri-b95098426a0148f8/axial_006.png","assets/T/mri-b95098426a0148f8/axial_007.png","assets/T/mri-b95098426a0148f8/axial_008.png","assets/T/mri-b95098426a0148f8/axial_009.png","assets/T/mri-b95098426a0148f8/axial_010.png","assets/T/mri-b95098426a0148f8/axial_011.png","assets/T/mri-b95098426a0148f8/axial_012.png","assets/T/mri-b95098426a0148f8/axial_013.png","assets/T/mri-b95098426a0148f8/axial_014.png","assets/T/mri-b95098426a0148f8/axial_015.png","assets/T/mri-b95098426a0148f8/axial_016.png","assets/T/mri-b95098426a0148f8/axial_017.png","assets/T/mri-b95098426a0148f8/axial_018.png","assets/T/mri-b95098426a0148f8/axial_019.png","assets/T/mri-b95098426a0148f8/axial_020.png","assets/T/mri-b95098426a0148f8/axial_021.png","assets/T/mri-b95098426a0148f8/axial_022.png","assets/T/mri-b95098426a0148f8/axial_023.png","assets/T/mri-b95098426a0148f8/axial_024.png","assets/T/mri-b95098426a0148f8/axial_025.png","assets/T/mri-b95098426a0148f8/axial_026.png","assets/T/mri-b95098426a0148f8/axial_027.png","assets/T/mri-b95098426a0148f8/axial_028.png","assets/T/mri-b95098426a0148f8/axial_029.png","assets/T/mri-b95098426a0148f8/axial_030.png","assets/T/mri-b95098426a0148f8/axial_031.png","assets/T/mri-b95098426a0148f8/axial_032.png","assets/T/mri-b95098426a0148f8/axial_033.png","assets/T/mri-b95098426a0148f8/axial_034.png","assets/T/mri-b95098426a0148f8/axial_035.png","assets/T/mri-b95098426a0148f8/axial_036.png","assets/T/mri-b95098426a0148f8/axial_037.png","assets/T/mri-b95098426a0148f8/axial_038.png","assets/T/mri-b95098426a0148f8/axial_039.png","assets/T/mri-b95098426a0148f8/axial_040.png","assets/T/mri-b95098426a0148f8/axial_041.png","assets/T/mri-b95098426a0148f8/axial_042.png","assets/T/mri-b95098426a0148f8/coronal_001.png","assets/T/mri-b95098426a0148f8/coronal_002.png","assets/T/mri-b95098426a0148f8/coronal_003.png","assets/T/mri-b95098426a0148f8/coronal_004.png","assets/T/mri-b95098426a0148f8/coronal_005.png","assets/T/mri-b95098426a0148f8/coronal_006.png","assets/T/mri-b95098426a0148f8/coronal_007.png","assets/T/mri-b95098426a0148f8/coronal_008.png","assets/T/mri-b95098426a0148f8/coronal_009.png","assets/T/mri-b95098426a0148f8/coronal_010.png","assets/T/mri-b95098426a0148f8/coronal_011.png","assets/T/mri-b95098426a0148f8/coronal_012.png","assets/T/mri-b95098426a0148f8/coronal_013.png","assets/T/mri-b95098426a0148f8/coronal_014.png","assets/T/mri-b95098426a0148f8/coronal_015.png","assets/T/mri-b95098426a0148f8/coronal_016.png","assets/T/mri-b95098426a0148f8/coronal_017.png","assets/T/mri-b95098426a0148f8/coronal_018.png","assets/T/mri-b95098426a0148f8/coronal_019.png","assets/T/mri-b95098426a0148f8/coronal_020.png","assets/T/mri-b95098426a0148f8/coronal_021.png","assets/T/mri-b95098426a0148f8/coronal_022.png","assets/T/mri-b95098426a0148f8/coronal_023.png","assets/T/mri-b95098426a0148f8/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-8cded41e93b4457b","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-8cded41e93b4457b/axial_001.png","assets/T/mri-8cded41e93b4457b/axial_002.png","assets/T/mri-8cded41e93b4457b/axial_003.png","assets/T/mri-8cded41e93b4457b/axial_004.png","assets/T/mri-8cded41e93b4457b/axial_005.png","assets/T/mri-8cded41e93b4457b/axial_006.png","assets/T/mri-8cded41e93b4457b/axial_007.png","assets/T/mri-8cded41e93b4457b/axial_008.png","assets/T/mri-8cded41e93b4457b/axial_009.png","assets/T/mri-8cded41e93b4457b/axial_010.png","assets/T/mri-8cded41e93b4457b/axial_011.png","assets/T/mri-8cded41e93b4457b/axial_012.png","assets/T/mri-8cded41e93b4457b/axial_013.png","assets/T/mri-8cded41e93b4457b/axial_014.png","assets/T/mri-8cded41e93b4457b/axial_015.png","assets/T/mri-8cded41e93b4457b/axial_016.png","assets/T/mri-8cded41e93b4457b/axial_017.png","assets/T/mri-8cded41e93b4457b/axial_018.png","assets/T/mri-8cded41e93b4457b/axial_019.png","assets/T/mri-8cded41e93b4457b/axial_020.png","assets/T/mri-8cded41e93b4457b/axial_021.png","assets/T/mri-8cded41e93b4457b/axial_022.png","assets/T/mri-8cded41e93b4457b/axial_023.png","assets/T/mri-8cded41e93b4457b/axial_024.png","assets/T/mri-8cded41e93b4457b/axial_025.png","assets/T/mri-8cded41e93b4457b/axial_026.png","assets/T/mri-8cded41e93b4457b/axial_027.png","assets/T/mri-8cded41e93b4457b/axial_028.png","assets/T/mri-8cded41e93b4457b/axial_029.png","assets/T/mri-8cded41e93b4457b/axial_030.png","assets/T/mri-8cded41e93b4457b/axial_031.png","assets/T/mri-8cded41e93b4457b/axial_032.png","assets/T/mri-8cded41e93b4457b/axial_033.png","assets/T/mri-8cded41e93b4457b/axial_034.png","assets/T/mri-8cded41e93b4457b/axial_035.png","assets/T/mri-8cded41e93b4457b/axial_036.png","assets/T/mri-8cded41e93b4457b/axial_037.png","assets/T/mri-8cded41e93b4457b/axial_038.png","assets/T/mri-8cded41e93b4457b/axial_039.png","assets/T/mri-8cded41e93b4457b/axial_040.png","assets/T/mri-8cded41e93b4457b/axial_041.png","assets/T/mri-8cded41e93b4457b/axial_042.png","assets/T/mri-8cded41e93b4457b/coronal_001.png","assets/T/mri-8cded41e93b4457b/coronal_002.png","assets/T/mri-8cded41e93b4457b/coronal_003.png","assets/T/mri-8cded41e93b4457b/coronal_004.png","assets/T/mri-8cded41e93b4457b/coronal_005.png","assets/T/mri-8cded41e93b4457b/coronal_006.png","assets/T/mri-8cded41e93b4457b/coronal_007.png","assets/T/mri-8cded41e93b4457b/coronal_008.png","assets/T/mri-8cded41e93b4457b/coronal_009.png","assets/T/mri-8cded41e93b4457b/coronal_010.png","assets/T/mri-8cded41e93b4457b/coronal_011.png","assets/T/mri-8cded41e93b4457b/coronal_012.png","assets/T/mri-8cded41e93b4457b/coronal_013.png","assets/T/mri-8cded41e93b4457b/coronal_014.png","assets/T/mri-8cded41e93b4457b/coronal_015.png","assets/T/mri-8cded41e93b4457b/coronal_016.png","assets/T/mri-8cded41e93b4457b/coronal_017.png","assets/T/mri-8cded41e93b4457b/coronal_018.png","assets/T/mri-8cded41e93b4457b/coronal_019.png","assets/T/mri-8cded41e93b4457b/coronal_020.png","assets/T/mri-8cded41e93b4457b/coronal_021.png","assets/T/mri-8cded41e93b4457b/coronal_022.png","assets/T/mri-8cded41e93b4457b/coronal_023.png","assets/T/mri-8cded41e93b4457b/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-25f828c643384082","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-25f828c643384082/axial_001.png","assets/T/mri-25f828c643384082/axial_002.png","assets/T/mri-25f828c643384082/axial_003.png","assets/T/mri-25f828c643384082/axial_004.png","assets/T/mri-25f828c643384082/axial_005.png","assets/T/mri-25f828c643384082/axial_006.png","assets/T/mri-25f828c643384082/axial_007.png","assets/T/mri-25f828c643384082/axial_008.png","assets/T/mri-25f828c643384082/axial_009.png","assets/T/mri-25f828c643384082/axial_010.png","assets/T/mri-25f828c643384082/axial_011.png","assets/T/mri-25f828c643384082/axial_012.png","assets/T/mri-25f828c643384082/axial_013.png","assets/T/mri-25f828c643384082/axial_014.png","assets/T/mri-25f828c643384082/axial_015.png","assets/T/mri-25f828c643384082/axial_016.png","assets/T/mri-25f828c643384082/axial_017.png","assets/T/mri-25f828c643384082/axial_018.png","assets/T/mri-25f828c643384082/axial_019.png","assets/T/mri-25f828c643384082/axial_020.png","assets/T/mri-25f828c643384082/axial_021.png","assets/T/mri-25f828c643384082/axial_022.png","assets/T/mri-25f828c643384082/axial_023.png","assets/T/mri-25f828c643384082/axial_024.png","assets/T/mri-25f828c643384082/axial_025.png","assets/T/mri-25f828c643384082/axial_026.png","assets/T/mri-25f828c643384082/axial_027.png","assets/T/mri-25f828c643384082/axial_028.png","assets/T/mri-25f828c643384082/axial_029.png","assets/T/mri-25f828c643384082/axial_030.png","assets/T/mri-25f828c643384082/axial_031.png","assets/T/mri-25f828c643384082/axial_032.png","assets/T/mri-25f828c643384082/axial_033.png","assets/T/mri-25f828c643384082/axial_034.png","assets/T/mri-25f828c643384082/axial_035.png","assets/T/mri-25f828c643384082/axial_036.png","assets/T/mri-25f828c643384082/axial_037.png","assets/T/mri-25f828c643384082/axial_038.png","assets/T/mri-25f828c643384082/axial_039.png","assets/T/mri-25f828c643384082/axial_040.png","assets/T/mri-25f828c643384082/coronal_001.png","assets/T/mri-25f828c643384082/coronal_002.png","assets/T/mri-25f828c643384082/coronal_003.png","assets/T/mri-25f828c643384082/coronal_004.png","assets/T/mri-25f828c643384082/coronal_005.png","assets/T/mri-25f828c643384082/coronal_006.png","assets/T/mri-25f828c643384082/coronal_007.png","assets/T/mri-25f828c643384082/coronal_008.png","assets/T/mri-25f828c643384082/coronal_009.png","assets/T/mri-25f828c643384082/coronal_010.png","assets/T/mri-25f828c643384082/coronal_011.png","assets/T/mri-25f828c643384082/coronal_012.png","assets/T/mri-25f828c643384082/coronal_013.png","assets/T/mri-25f828c643384082/coronal_014.png","assets/T/mri-25f828c643384082/coronal_015.png","assets/T/mri-25f828c643384082/coronal_016.png","assets/T/mri-25f828c643384082/coronal_017.png","assets/T/mri-25f828c643384082/coronal_018.png","assets/T/mri-25f828c643384082/coronal_019.png","assets/T/mri-25f828c643384082/coronal_020.png","assets/T/mri-25f828c643384082/coronal_021.png","assets/T/mri-25f828c643384082/coronal_022.png","assets/T/mri-25f828c643384082/coronal_023.png","assets/T/mri-25f828c643384082/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-a4f422bdc4084984","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 68 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 26 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-a4f422bdc4084984/axial_001.png","assets/T/mri-a4f422bdc4084984/axial_002.png","assets/T/mri-a4f422bdc4084984/axial_003.png","assets/T/mri-a4f422bdc4084984/axial_004.png","assets/T/mri-a4f422bdc4084984/axial_005.png","assets/T/mri-a4f422bdc4084984/axial_006.png","assets/T/mri-a4f422bdc4084984/axial_007.png","assets/T/mri-a4f422bdc4084984/axial_008.png","assets/T/mri-a4f422bdc4084984/axial_009.png","assets/T/mri-a4f422bdc4084984/axial_010.png","assets/T/mri-a4f422bdc4084984/axial_011.png","assets/T/mri-a4f422bdc4084984/axial_012.png","assets/T/mri-a4f422bdc4084984/axial_013.png","assets/T/mri-a4f422bdc4084984/axial_014.png","assets/T/mri-a4f422bdc4084984/axial_015.png","assets/T/mri-a4f422bdc4084984/axial_016.png","assets/T/mri-a4f422bdc4084984/axial_017.png","assets/T/mri-a4f422bdc4084984/axial_018.png","assets/T/mri-a4f422bdc4084984/axial_019.png","assets/T/mri-a4f422bdc4084984/axial_020.png","assets/T/mri-a4f422bdc4084984/axial_021.png","assets/T/mri-a4f422bdc4084984/axial_022.png","assets/T/mri-a4f422bdc4084984/axial_023.png","assets/T/mri-a4f422bdc4084984/axial_024.png","assets/T/mri-a4f422bdc4084984/axial_025.png","assets/T/mri-a4f422bdc4084984/axial_026.png","assets/T/mri-a4f422bdc4084984/axial_027.png","assets/T/mri-a4f422bdc4084984/axial_028.png","assets/T/mri-a4f422bdc4084984/axial_029.png","assets/T/mri-a4f422bdc4084984/axial_030.png","assets/T/mri-a4f422bdc4084984/axial_031.png","assets/T/mri-a4f422bdc4084984/axial_032.png","assets/T/mri-a4f422bdc4084984/axial_033.png","assets/T/mri-a4f422bdc4084984/axial_034.png","assets/T/mri-a4f422bdc4084984/axial_035.png","assets/T/mri-a4f422bdc4084984/axial_036.png","assets/T/mri-a4f422bdc4084984/axial_037.png","assets/T/mri-a4f422bdc4084984/axial_038.png","assets/T/mri-a4f422bdc4084984/axial_039.png","assets/T/mri-a4f422bdc4084984/axial_040.png","assets/T/mri-a4f422bdc4084984/axial_041.png","assets/T/mri-a4f422bdc4084984/axial_042.png","assets/T/mri-a4f422bdc4084984/coronal_001.png","assets/T/mri-a4f422bdc4084984/coronal_002.png","assets/T/mri-a4f422bdc4084984/coronal_003.png","assets/T/mri-a4f422bdc4084984/coronal_004.png","assets/T/mri-a4f422bdc4084984/coronal_005.png","assets/T/mri-a4f422bdc4084984/coronal_006.png","assets/T/mri-a4f422bdc4084984/coronal_007.png","assets/T/mri-a4f422bdc4084984/coronal_008.png","assets/T/mri-a4f422bdc4084984/coronal_009.png","assets/T/mri-a4f422bdc4084984/coronal_010.png","assets/T/mri-a4f422bdc4084984/coronal_011.png","assets/T/mri-a4f422bdc4084984/coronal_012.png","assets/T/mri-a4f422bdc4084984/coronal_013.png","assets/T/mri-a4f422bdc4084984/coronal_014.png","assets/T/mri-a4f422bdc4084984/coronal_015.png","assets/T/mri-a4f422bdc4084984/coronal_016.png","assets/T/mri-a4f422bdc4084984/coronal_017.png","assets/T/mri-a4f422bdc4084984/coronal_018.png","assets/T/mri-a4f422bdc4084984/coronal_019.png","assets/T/mri-a4f422bdc4084984/coronal_020.png","assets/T/mri-a4f422bdc4084984/coronal_021.png","assets/T/mri-a4f422bdc4084984/coronal_022.png","assets/T/mri-a4f422bdc4084984/coronal_023.png","assets/T/mri-a4f422bdc4084984/coronal_024.png","assets/T/mri-a4f422bdc4084984/coronal_025.png","assets/T/mri-a4f422bdc4084984/coronal_026.png"],"stage_edition":8}
+{"id":"L3-T300:mri-6e692a723bbd4c7c","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-6e692a723bbd4c7c/axial_001.png","assets/T/mri-6e692a723bbd4c7c/axial_002.png","assets/T/mri-6e692a723bbd4c7c/axial_003.png","assets/T/mri-6e692a723bbd4c7c/axial_004.png","assets/T/mri-6e692a723bbd4c7c/axial_005.png","assets/T/mri-6e692a723bbd4c7c/axial_006.png","assets/T/mri-6e692a723bbd4c7c/axial_007.png","assets/T/mri-6e692a723bbd4c7c/axial_008.png","assets/T/mri-6e692a723bbd4c7c/axial_009.png","assets/T/mri-6e692a723bbd4c7c/axial_010.png","assets/T/mri-6e692a723bbd4c7c/axial_011.png","assets/T/mri-6e692a723bbd4c7c/axial_012.png","assets/T/mri-6e692a723bbd4c7c/axial_013.png","assets/T/mri-6e692a723bbd4c7c/axial_014.png","assets/T/mri-6e692a723bbd4c7c/axial_015.png","assets/T/mri-6e692a723bbd4c7c/axial_016.png","assets/T/mri-6e692a723bbd4c7c/axial_017.png","assets/T/mri-6e692a723bbd4c7c/axial_018.png","assets/T/mri-6e692a723bbd4c7c/axial_019.png","assets/T/mri-6e692a723bbd4c7c/axial_020.png","assets/T/mri-6e692a723bbd4c7c/axial_021.png","assets/T/mri-6e692a723bbd4c7c/axial_022.png","assets/T/mri-6e692a723bbd4c7c/axial_023.png","assets/T/mri-6e692a723bbd4c7c/axial_024.png","assets/T/mri-6e692a723bbd4c7c/axial_025.png","assets/T/mri-6e692a723bbd4c7c/axial_026.png","assets/T/mri-6e692a723bbd4c7c/axial_027.png","assets/T/mri-6e692a723bbd4c7c/axial_028.png","assets/T/mri-6e692a723bbd4c7c/axial_029.png","assets/T/mri-6e692a723bbd4c7c/axial_030.png","assets/T/mri-6e692a723bbd4c7c/axial_031.png","assets/T/mri-6e692a723bbd4c7c/axial_032.png","assets/T/mri-6e692a723bbd4c7c/axial_033.png","assets/T/mri-6e692a723bbd4c7c/axial_034.png","assets/T/mri-6e692a723bbd4c7c/axial_035.png","assets/T/mri-6e692a723bbd4c7c/axial_036.png","assets/T/mri-6e692a723bbd4c7c/axial_037.png","assets/T/mri-6e692a723bbd4c7c/axial_038.png","assets/T/mri-6e692a723bbd4c7c/axial_039.png","assets/T/mri-6e692a723bbd4c7c/axial_040.png","assets/T/mri-6e692a723bbd4c7c/axial_041.png","assets/T/mri-6e692a723bbd4c7c/axial_042.png","assets/T/mri-6e692a723bbd4c7c/coronal_001.png","assets/T/mri-6e692a723bbd4c7c/coronal_002.png","assets/T/mri-6e692a723bbd4c7c/coronal_003.png","assets/T/mri-6e692a723bbd4c7c/coronal_004.png","assets/T/mri-6e692a723bbd4c7c/coronal_005.png","assets/T/mri-6e692a723bbd4c7c/coronal_006.png","assets/T/mri-6e692a723bbd4c7c/coronal_007.png","assets/T/mri-6e692a723bbd4c7c/coronal_008.png","assets/T/mri-6e692a723bbd4c7c/coronal_009.png","assets/T/mri-6e692a723bbd4c7c/coronal_010.png","assets/T/mri-6e692a723bbd4c7c/coronal_011.png","assets/T/mri-6e692a723bbd4c7c/coronal_012.png","assets/T/mri-6e692a723bbd4c7c/coronal_013.png","assets/T/mri-6e692a723bbd4c7c/coronal_014.png","assets/T/mri-6e692a723bbd4c7c/coronal_015.png","assets/T/mri-6e692a723bbd4c7c/coronal_016.png","assets/T/mri-6e692a723bbd4c7c/coronal_017.png","assets/T/mri-6e692a723bbd4c7c/coronal_018.png","assets/T/mri-6e692a723bbd4c7c/coronal_019.png","assets/T/mri-6e692a723bbd4c7c/coronal_020.png","assets/T/mri-6e692a723bbd4c7c/coronal_021.png","assets/T/mri-6e692a723bbd4c7c/coronal_022.png","assets/T/mri-6e692a723bbd4c7c/coronal_023.png","assets/T/mri-6e692a723bbd4c7c/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-59fcd8564a7d4a06","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 68 张图，均来自同一次检查。\n\n- 前 44 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-59fcd8564a7d4a06/axial_001.png","assets/T/mri-59fcd8564a7d4a06/axial_002.png","assets/T/mri-59fcd8564a7d4a06/axial_003.png","assets/T/mri-59fcd8564a7d4a06/axial_004.png","assets/T/mri-59fcd8564a7d4a06/axial_005.png","assets/T/mri-59fcd8564a7d4a06/axial_006.png","assets/T/mri-59fcd8564a7d4a06/axial_007.png","assets/T/mri-59fcd8564a7d4a06/axial_008.png","assets/T/mri-59fcd8564a7d4a06/axial_009.png","assets/T/mri-59fcd8564a7d4a06/axial_010.png","assets/T/mri-59fcd8564a7d4a06/axial_011.png","assets/T/mri-59fcd8564a7d4a06/axial_012.png","assets/T/mri-59fcd8564a7d4a06/axial_013.png","assets/T/mri-59fcd8564a7d4a06/axial_014.png","assets/T/mri-59fcd8564a7d4a06/axial_015.png","assets/T/mri-59fcd8564a7d4a06/axial_016.png","assets/T/mri-59fcd8564a7d4a06/axial_017.png","assets/T/mri-59fcd8564a7d4a06/axial_018.png","assets/T/mri-59fcd8564a7d4a06/axial_019.png","assets/T/mri-59fcd8564a7d4a06/axial_020.png","assets/T/mri-59fcd8564a7d4a06/axial_021.png","assets/T/mri-59fcd8564a7d4a06/axial_022.png","assets/T/mri-59fcd8564a7d4a06/axial_023.png","assets/T/mri-59fcd8564a7d4a06/axial_024.png","assets/T/mri-59fcd8564a7d4a06/axial_025.png","assets/T/mri-59fcd8564a7d4a06/axial_026.png","assets/T/mri-59fcd8564a7d4a06/axial_027.png","assets/T/mri-59fcd8564a7d4a06/axial_028.png","assets/T/mri-59fcd8564a7d4a06/axial_029.png","assets/T/mri-59fcd8564a7d4a06/axial_030.png","assets/T/mri-59fcd8564a7d4a06/axial_031.png","assets/T/mri-59fcd8564a7d4a06/axial_032.png","assets/T/mri-59fcd8564a7d4a06/axial_033.png","assets/T/mri-59fcd8564a7d4a06/axial_034.png","assets/T/mri-59fcd8564a7d4a06/axial_035.png","assets/T/mri-59fcd8564a7d4a06/axial_036.png","assets/T/mri-59fcd8564a7d4a06/axial_037.png","assets/T/mri-59fcd8564a7d4a06/axial_038.png","assets/T/mri-59fcd8564a7d4a06/axial_039.png","assets/T/mri-59fcd8564a7d4a06/axial_040.png","assets/T/mri-59fcd8564a7d4a06/axial_041.png","assets/T/mri-59fcd8564a7d4a06/axial_042.png","assets/T/mri-59fcd8564a7d4a06/axial_043.png","assets/T/mri-59fcd8564a7d4a06/axial_044.png","assets/T/mri-59fcd8564a7d4a06/coronal_001.png","assets/T/mri-59fcd8564a7d4a06/coronal_002.png","assets/T/mri-59fcd8564a7d4a06/coronal_003.png","assets/T/mri-59fcd8564a7d4a06/coronal_004.png","assets/T/mri-59fcd8564a7d4a06/coronal_005.png","assets/T/mri-59fcd8564a7d4a06/coronal_006.png","assets/T/mri-59fcd8564a7d4a06/coronal_007.png","assets/T/mri-59fcd8564a7d4a06/coronal_008.png","assets/T/mri-59fcd8564a7d4a06/coronal_009.png","assets/T/mri-59fcd8564a7d4a06/coronal_010.png","assets/T/mri-59fcd8564a7d4a06/coronal_011.png","assets/T/mri-59fcd8564a7d4a06/coronal_012.png","assets/T/mri-59fcd8564a7d4a06/coronal_013.png","assets/T/mri-59fcd8564a7d4a06/coronal_014.png","assets/T/mri-59fcd8564a7d4a06/coronal_015.png","assets/T/mri-59fcd8564a7d4a06/coronal_016.png","assets/T/mri-59fcd8564a7d4a06/coronal_017.png","assets/T/mri-59fcd8564a7d4a06/coronal_018.png","assets/T/mri-59fcd8564a7d4a06/coronal_019.png","assets/T/mri-59fcd8564a7d4a06/coronal_020.png","assets/T/mri-59fcd8564a7d4a06/coronal_021.png","assets/T/mri-59fcd8564a7d4a06/coronal_022.png","assets/T/mri-59fcd8564a7d4a06/coronal_023.png","assets/T/mri-59fcd8564a7d4a06/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-0aa35f3168d04d3c","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-0aa35f3168d04d3c/axial_001.png","assets/T/mri-0aa35f3168d04d3c/axial_002.png","assets/T/mri-0aa35f3168d04d3c/axial_003.png","assets/T/mri-0aa35f3168d04d3c/axial_004.png","assets/T/mri-0aa35f3168d04d3c/axial_005.png","assets/T/mri-0aa35f3168d04d3c/axial_006.png","assets/T/mri-0aa35f3168d04d3c/axial_007.png","assets/T/mri-0aa35f3168d04d3c/axial_008.png","assets/T/mri-0aa35f3168d04d3c/axial_009.png","assets/T/mri-0aa35f3168d04d3c/axial_010.png","assets/T/mri-0aa35f3168d04d3c/axial_011.png","assets/T/mri-0aa35f3168d04d3c/axial_012.png","assets/T/mri-0aa35f3168d04d3c/axial_013.png","assets/T/mri-0aa35f3168d04d3c/axial_014.png","assets/T/mri-0aa35f3168d04d3c/axial_015.png","assets/T/mri-0aa35f3168d04d3c/axial_016.png","assets/T/mri-0aa35f3168d04d3c/axial_017.png","assets/T/mri-0aa35f3168d04d3c/axial_018.png","assets/T/mri-0aa35f3168d04d3c/axial_019.png","assets/T/mri-0aa35f3168d04d3c/axial_020.png","assets/T/mri-0aa35f3168d04d3c/axial_021.png","assets/T/mri-0aa35f3168d04d3c/axial_022.png","assets/T/mri-0aa35f3168d04d3c/axial_023.png","assets/T/mri-0aa35f3168d04d3c/axial_024.png","assets/T/mri-0aa35f3168d04d3c/axial_025.png","assets/T/mri-0aa35f3168d04d3c/axial_026.png","assets/T/mri-0aa35f3168d04d3c/axial_027.png","assets/T/mri-0aa35f3168d04d3c/axial_028.png","assets/T/mri-0aa35f3168d04d3c/axial_029.png","assets/T/mri-0aa35f3168d04d3c/axial_030.png","assets/T/mri-0aa35f3168d04d3c/axial_031.png","assets/T/mri-0aa35f3168d04d3c/axial_032.png","assets/T/mri-0aa35f3168d04d3c/axial_033.png","assets/T/mri-0aa35f3168d04d3c/axial_034.png","assets/T/mri-0aa35f3168d04d3c/axial_035.png","assets/T/mri-0aa35f3168d04d3c/axial_036.png","assets/T/mri-0aa35f3168d04d3c/axial_037.png","assets/T/mri-0aa35f3168d04d3c/axial_038.png","assets/T/mri-0aa35f3168d04d3c/axial_039.png","assets/T/mri-0aa35f3168d04d3c/axial_040.png","assets/T/mri-0aa35f3168d04d3c/coronal_001.png","assets/T/mri-0aa35f3168d04d3c/coronal_002.png","assets/T/mri-0aa35f3168d04d3c/coronal_003.png","assets/T/mri-0aa35f3168d04d3c/coronal_004.png","assets/T/mri-0aa35f3168d04d3c/coronal_005.png","assets/T/mri-0aa35f3168d04d3c/coronal_006.png","assets/T/mri-0aa35f3168d04d3c/coronal_007.png","assets/T/mri-0aa35f3168d04d3c/coronal_008.png","assets/T/mri-0aa35f3168d04d3c/coronal_009.png","assets/T/mri-0aa35f3168d04d3c/coronal_010.png","assets/T/mri-0aa35f3168d04d3c/coronal_011.png","assets/T/mri-0aa35f3168d04d3c/coronal_012.png","assets/T/mri-0aa35f3168d04d3c/coronal_013.png","assets/T/mri-0aa35f3168d04d3c/coronal_014.png","assets/T/mri-0aa35f3168d04d3c/coronal_015.png","assets/T/mri-0aa35f3168d04d3c/coronal_016.png","assets/T/mri-0aa35f3168d04d3c/coronal_017.png","assets/T/mri-0aa35f3168d04d3c/coronal_018.png","assets/T/mri-0aa35f3168d04d3c/coronal_019.png","assets/T/mri-0aa35f3168d04d3c/coronal_020.png","assets/T/mri-0aa35f3168d04d3c/coronal_021.png","assets/T/mri-0aa35f3168d04d3c/coronal_022.png","assets/T/mri-0aa35f3168d04d3c/coronal_023.png","assets/T/mri-0aa35f3168d04d3c/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-2bcd51a219d545cc","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-2bcd51a219d545cc/axial_001.png","assets/T/mri-2bcd51a219d545cc/axial_002.png","assets/T/mri-2bcd51a219d545cc/axial_003.png","assets/T/mri-2bcd51a219d545cc/axial_004.png","assets/T/mri-2bcd51a219d545cc/axial_005.png","assets/T/mri-2bcd51a219d545cc/axial_006.png","assets/T/mri-2bcd51a219d545cc/axial_007.png","assets/T/mri-2bcd51a219d545cc/axial_008.png","assets/T/mri-2bcd51a219d545cc/axial_009.png","assets/T/mri-2bcd51a219d545cc/axial_010.png","assets/T/mri-2bcd51a219d545cc/axial_011.png","assets/T/mri-2bcd51a219d545cc/axial_012.png","assets/T/mri-2bcd51a219d545cc/axial_013.png","assets/T/mri-2bcd51a219d545cc/axial_014.png","assets/T/mri-2bcd51a219d545cc/axial_015.png","assets/T/mri-2bcd51a219d545cc/axial_016.png","assets/T/mri-2bcd51a219d545cc/axial_017.png","assets/T/mri-2bcd51a219d545cc/axial_018.png","assets/T/mri-2bcd51a219d545cc/axial_019.png","assets/T/mri-2bcd51a219d545cc/axial_020.png","assets/T/mri-2bcd51a219d545cc/axial_021.png","assets/T/mri-2bcd51a219d545cc/axial_022.png","assets/T/mri-2bcd51a219d545cc/axial_023.png","assets/T/mri-2bcd51a219d545cc/axial_024.png","assets/T/mri-2bcd51a219d545cc/axial_025.png","assets/T/mri-2bcd51a219d545cc/axial_026.png","assets/T/mri-2bcd51a219d545cc/axial_027.png","assets/T/mri-2bcd51a219d545cc/axial_028.png","assets/T/mri-2bcd51a219d545cc/axial_029.png","assets/T/mri-2bcd51a219d545cc/axial_030.png","assets/T/mri-2bcd51a219d545cc/axial_031.png","assets/T/mri-2bcd51a219d545cc/axial_032.png","assets/T/mri-2bcd51a219d545cc/axial_033.png","assets/T/mri-2bcd51a219d545cc/axial_034.png","assets/T/mri-2bcd51a219d545cc/axial_035.png","assets/T/mri-2bcd51a219d545cc/axial_036.png","assets/T/mri-2bcd51a219d545cc/axial_037.png","assets/T/mri-2bcd51a219d545cc/axial_038.png","assets/T/mri-2bcd51a219d545cc/axial_039.png","assets/T/mri-2bcd51a219d545cc/axial_040.png","assets/T/mri-2bcd51a219d545cc/axial_041.png","assets/T/mri-2bcd51a219d545cc/axial_042.png","assets/T/mri-2bcd51a219d545cc/coronal_001.png","assets/T/mri-2bcd51a219d545cc/coronal_002.png","assets/T/mri-2bcd51a219d545cc/coronal_003.png","assets/T/mri-2bcd51a219d545cc/coronal_004.png","assets/T/mri-2bcd51a219d545cc/coronal_005.png","assets/T/mri-2bcd51a219d545cc/coronal_006.png","assets/T/mri-2bcd51a219d545cc/coronal_007.png","assets/T/mri-2bcd51a219d545cc/coronal_008.png","assets/T/mri-2bcd51a219d545cc/coronal_009.png","assets/T/mri-2bcd51a219d545cc/coronal_010.png","assets/T/mri-2bcd51a219d545cc/coronal_011.png","assets/T/mri-2bcd51a219d545cc/coronal_012.png","assets/T/mri-2bcd51a219d545cc/coronal_013.png","assets/T/mri-2bcd51a219d545cc/coronal_014.png","assets/T/mri-2bcd51a219d545cc/coronal_015.png","assets/T/mri-2bcd51a219d545cc/coronal_016.png","assets/T/mri-2bcd51a219d545cc/coronal_017.png","assets/T/mri-2bcd51a219d545cc/coronal_018.png","assets/T/mri-2bcd51a219d545cc/coronal_019.png","assets/T/mri-2bcd51a219d545cc/coronal_020.png","assets/T/mri-2bcd51a219d545cc/coronal_021.png","assets/T/mri-2bcd51a219d545cc/coronal_022.png","assets/T/mri-2bcd51a219d545cc/coronal_023.png","assets/T/mri-2bcd51a219d545cc/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-c4fac316d4d04389","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-c4fac316d4d04389/axial_001.png","assets/T/mri-c4fac316d4d04389/axial_002.png","assets/T/mri-c4fac316d4d04389/axial_003.png","assets/T/mri-c4fac316d4d04389/axial_004.png","assets/T/mri-c4fac316d4d04389/axial_005.png","assets/T/mri-c4fac316d4d04389/axial_006.png","assets/T/mri-c4fac316d4d04389/axial_007.png","assets/T/mri-c4fac316d4d04389/axial_008.png","assets/T/mri-c4fac316d4d04389/axial_009.png","assets/T/mri-c4fac316d4d04389/axial_010.png","assets/T/mri-c4fac316d4d04389/axial_011.png","assets/T/mri-c4fac316d4d04389/axial_012.png","assets/T/mri-c4fac316d4d04389/axial_013.png","assets/T/mri-c4fac316d4d04389/axial_014.png","assets/T/mri-c4fac316d4d04389/axial_015.png","assets/T/mri-c4fac316d4d04389/axial_016.png","assets/T/mri-c4fac316d4d04389/axial_017.png","assets/T/mri-c4fac316d4d04389/axial_018.png","assets/T/mri-c4fac316d4d04389/axial_019.png","assets/T/mri-c4fac316d4d04389/axial_020.png","assets/T/mri-c4fac316d4d04389/axial_021.png","assets/T/mri-c4fac316d4d04389/axial_022.png","assets/T/mri-c4fac316d4d04389/axial_023.png","assets/T/mri-c4fac316d4d04389/axial_024.png","assets/T/mri-c4fac316d4d04389/axial_025.png","assets/T/mri-c4fac316d4d04389/axial_026.png","assets/T/mri-c4fac316d4d04389/axial_027.png","assets/T/mri-c4fac316d4d04389/axial_028.png","assets/T/mri-c4fac316d4d04389/axial_029.png","assets/T/mri-c4fac316d4d04389/axial_030.png","assets/T/mri-c4fac316d4d04389/axial_031.png","assets/T/mri-c4fac316d4d04389/axial_032.png","assets/T/mri-c4fac316d4d04389/axial_033.png","assets/T/mri-c4fac316d4d04389/axial_034.png","assets/T/mri-c4fac316d4d04389/axial_035.png","assets/T/mri-c4fac316d4d04389/axial_036.png","assets/T/mri-c4fac316d4d04389/axial_037.png","assets/T/mri-c4fac316d4d04389/axial_038.png","assets/T/mri-c4fac316d4d04389/axial_039.png","assets/T/mri-c4fac316d4d04389/axial_040.png","assets/T/mri-c4fac316d4d04389/coronal_001.png","assets/T/mri-c4fac316d4d04389/coronal_002.png","assets/T/mri-c4fac316d4d04389/coronal_003.png","assets/T/mri-c4fac316d4d04389/coronal_004.png","assets/T/mri-c4fac316d4d04389/coronal_005.png","assets/T/mri-c4fac316d4d04389/coronal_006.png","assets/T/mri-c4fac316d4d04389/coronal_007.png","assets/T/mri-c4fac316d4d04389/coronal_008.png","assets/T/mri-c4fac316d4d04389/coronal_009.png","assets/T/mri-c4fac316d4d04389/coronal_010.png","assets/T/mri-c4fac316d4d04389/coronal_011.png","assets/T/mri-c4fac316d4d04389/coronal_012.png","assets/T/mri-c4fac316d4d04389/coronal_013.png","assets/T/mri-c4fac316d4d04389/coronal_014.png","assets/T/mri-c4fac316d4d04389/coronal_015.png","assets/T/mri-c4fac316d4d04389/coronal_016.png","assets/T/mri-c4fac316d4d04389/coronal_017.png","assets/T/mri-c4fac316d4d04389/coronal_018.png","assets/T/mri-c4fac316d4d04389/coronal_019.png","assets/T/mri-c4fac316d4d04389/coronal_020.png","assets/T/mri-c4fac316d4d04389/coronal_021.png","assets/T/mri-c4fac316d4d04389/coronal_022.png","assets/T/mri-c4fac316d4d04389/coronal_023.png","assets/T/mri-c4fac316d4d04389/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-b6b87fa111a640ca","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 60 张图，均来自同一次检查。\n\n- 前 36 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-b6b87fa111a640ca/axial_001.png","assets/T/mri-b6b87fa111a640ca/axial_002.png","assets/T/mri-b6b87fa111a640ca/axial_003.png","assets/T/mri-b6b87fa111a640ca/axial_004.png","assets/T/mri-b6b87fa111a640ca/axial_005.png","assets/T/mri-b6b87fa111a640ca/axial_006.png","assets/T/mri-b6b87fa111a640ca/axial_007.png","assets/T/mri-b6b87fa111a640ca/axial_008.png","assets/T/mri-b6b87fa111a640ca/axial_009.png","assets/T/mri-b6b87fa111a640ca/axial_010.png","assets/T/mri-b6b87fa111a640ca/axial_011.png","assets/T/mri-b6b87fa111a640ca/axial_012.png","assets/T/mri-b6b87fa111a640ca/axial_013.png","assets/T/mri-b6b87fa111a640ca/axial_014.png","assets/T/mri-b6b87fa111a640ca/axial_015.png","assets/T/mri-b6b87fa111a640ca/axial_016.png","assets/T/mri-b6b87fa111a640ca/axial_017.png","assets/T/mri-b6b87fa111a640ca/axial_018.png","assets/T/mri-b6b87fa111a640ca/axial_019.png","assets/T/mri-b6b87fa111a640ca/axial_020.png","assets/T/mri-b6b87fa111a640ca/axial_021.png","assets/T/mri-b6b87fa111a640ca/axial_022.png","assets/T/mri-b6b87fa111a640ca/axial_023.png","assets/T/mri-b6b87fa111a640ca/axial_024.png","assets/T/mri-b6b87fa111a640ca/axial_025.png","assets/T/mri-b6b87fa111a640ca/axial_026.png","assets/T/mri-b6b87fa111a640ca/axial_027.png","assets/T/mri-b6b87fa111a640ca/axial_028.png","assets/T/mri-b6b87fa111a640ca/axial_029.png","assets/T/mri-b6b87fa111a640ca/axial_030.png","assets/T/mri-b6b87fa111a640ca/axial_031.png","assets/T/mri-b6b87fa111a640ca/axial_032.png","assets/T/mri-b6b87fa111a640ca/axial_033.png","assets/T/mri-b6b87fa111a640ca/axial_034.png","assets/T/mri-b6b87fa111a640ca/axial_035.png","assets/T/mri-b6b87fa111a640ca/axial_036.png","assets/T/mri-b6b87fa111a640ca/coronal_001.png","assets/T/mri-b6b87fa111a640ca/coronal_002.png","assets/T/mri-b6b87fa111a640ca/coronal_003.png","assets/T/mri-b6b87fa111a640ca/coronal_004.png","assets/T/mri-b6b87fa111a640ca/coronal_005.png","assets/T/mri-b6b87fa111a640ca/coronal_006.png","assets/T/mri-b6b87fa111a640ca/coronal_007.png","assets/T/mri-b6b87fa111a640ca/coronal_008.png","assets/T/mri-b6b87fa111a640ca/coronal_009.png","assets/T/mri-b6b87fa111a640ca/coronal_010.png","assets/T/mri-b6b87fa111a640ca/coronal_011.png","assets/T/mri-b6b87fa111a640ca/coronal_012.png","assets/T/mri-b6b87fa111a640ca/coronal_013.png","assets/T/mri-b6b87fa111a640ca/coronal_014.png","assets/T/mri-b6b87fa111a640ca/coronal_015.png","assets/T/mri-b6b87fa111a640ca/coronal_016.png","assets/T/mri-b6b87fa111a640ca/coronal_017.png","assets/T/mri-b6b87fa111a640ca/coronal_018.png","assets/T/mri-b6b87fa111a640ca/coronal_019.png","assets/T/mri-b6b87fa111a640ca/coronal_020.png","assets/T/mri-b6b87fa111a640ca/coronal_021.png","assets/T/mri-b6b87fa111a640ca/coronal_022.png","assets/T/mri-b6b87fa111a640ca/coronal_023.png","assets/T/mri-b6b87fa111a640ca/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-8e0bb3a4b8ba4d5d","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 26 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-8e0bb3a4b8ba4d5d/axial_001.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_002.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_003.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_004.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_005.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_006.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_007.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_008.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_009.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_010.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_011.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_012.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_013.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_014.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_015.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_016.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_017.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_018.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_019.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_020.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_021.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_022.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_023.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_024.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_025.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_026.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_027.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_028.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_029.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_030.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_031.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_032.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_033.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_034.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_035.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_036.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_037.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_038.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_039.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_040.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_001.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_002.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_003.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_004.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_005.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_006.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_007.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_008.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_009.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_010.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_011.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_012.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_013.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_014.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_015.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_016.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_017.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_018.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_019.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_020.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_021.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_022.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_023.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_024.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_025.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_026.png"],"stage_edition":8}
+{"id":"L3-T300:mri-011d16dc8caa467f","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-011d16dc8caa467f/axial_001.png","assets/T/mri-011d16dc8caa467f/axial_002.png","assets/T/mri-011d16dc8caa467f/axial_003.png","assets/T/mri-011d16dc8caa467f/axial_004.png","assets/T/mri-011d16dc8caa467f/axial_005.png","assets/T/mri-011d16dc8caa467f/axial_006.png","assets/T/mri-011d16dc8caa467f/axial_007.png","assets/T/mri-011d16dc8caa467f/axial_008.png","assets/T/mri-011d16dc8caa467f/axial_009.png","assets/T/mri-011d16dc8caa467f/axial_010.png","assets/T/mri-011d16dc8caa467f/axial_011.png","assets/T/mri-011d16dc8caa467f/axial_012.png","assets/T/mri-011d16dc8caa467f/axial_013.png","assets/T/mri-011d16dc8caa467f/axial_014.png","assets/T/mri-011d16dc8caa467f/axial_015.png","assets/T/mri-011d16dc8caa467f/axial_016.png","assets/T/mri-011d16dc8caa467f/axial_017.png","assets/T/mri-011d16dc8caa467f/axial_018.png","assets/T/mri-011d16dc8caa467f/axial_019.png","assets/T/mri-011d16dc8caa467f/axial_020.png","assets/T/mri-011d16dc8caa467f/axial_021.png","assets/T/mri-011d16dc8caa467f/axial_022.png","assets/T/mri-011d16dc8caa467f/axial_023.png","assets/T/mri-011d16dc8caa467f/axial_024.png","assets/T/mri-011d16dc8caa467f/axial_025.png","assets/T/mri-011d16dc8caa467f/axial_026.png","assets/T/mri-011d16dc8caa467f/axial_027.png","assets/T/mri-011d16dc8caa467f/axial_028.png","assets/T/mri-011d16dc8caa467f/axial_029.png","assets/T/mri-011d16dc8caa467f/axial_030.png","assets/T/mri-011d16dc8caa467f/axial_031.png","assets/T/mri-011d16dc8caa467f/axial_032.png","assets/T/mri-011d16dc8caa467f/axial_033.png","assets/T/mri-011d16dc8caa467f/axial_034.png","assets/T/mri-011d16dc8caa467f/axial_035.png","assets/T/mri-011d16dc8caa467f/axial_036.png","assets/T/mri-011d16dc8caa467f/axial_037.png","assets/T/mri-011d16dc8caa467f/axial_038.png","assets/T/mri-011d16dc8caa467f/axial_039.png","assets/T/mri-011d16dc8caa467f/axial_040.png","assets/T/mri-011d16dc8caa467f/axial_041.png","assets/T/mri-011d16dc8caa467f/axial_042.png","assets/T/mri-011d16dc8caa467f/coronal_001.png","assets/T/mri-011d16dc8caa467f/coronal_002.png","assets/T/mri-011d16dc8caa467f/coronal_003.png","assets/T/mri-011d16dc8caa467f/coronal_004.png","assets/T/mri-011d16dc8caa467f/coronal_005.png","assets/T/mri-011d16dc8caa467f/coronal_006.png","assets/T/mri-011d16dc8caa467f/coronal_007.png","assets/T/mri-011d16dc8caa467f/coronal_008.png","assets/T/mri-011d16dc8caa467f/coronal_009.png","assets/T/mri-011d16dc8caa467f/coronal_010.png","assets/T/mri-011d16dc8caa467f/coronal_011.png","assets/T/mri-011d16dc8caa467f/coronal_012.png","assets/T/mri-011d16dc8caa467f/coronal_013.png","assets/T/mri-011d16dc8caa467f/coronal_014.png","assets/T/mri-011d16dc8caa467f/coronal_015.png","assets/T/mri-011d16dc8caa467f/coronal_016.png","assets/T/mri-011d16dc8caa467f/coronal_017.png","assets/T/mri-011d16dc8caa467f/coronal_018.png","assets/T/mri-011d16dc8caa467f/coronal_019.png","assets/T/mri-011d16dc8caa467f/coronal_020.png","assets/T/mri-011d16dc8caa467f/coronal_021.png","assets/T/mri-011d16dc8caa467f/coronal_022.png","assets/T/mri-011d16dc8caa467f/coronal_023.png","assets/T/mri-011d16dc8caa467f/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-610603bf61ce46e3","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-610603bf61ce46e3/axial_001.png","assets/T/mri-610603bf61ce46e3/axial_002.png","assets/T/mri-610603bf61ce46e3/axial_003.png","assets/T/mri-610603bf61ce46e3/axial_004.png","assets/T/mri-610603bf61ce46e3/axial_005.png","assets/T/mri-610603bf61ce46e3/axial_006.png","assets/T/mri-610603bf61ce46e3/axial_007.png","assets/T/mri-610603bf61ce46e3/axial_008.png","assets/T/mri-610603bf61ce46e3/axial_009.png","assets/T/mri-610603bf61ce46e3/axial_010.png","assets/T/mri-610603bf61ce46e3/axial_011.png","assets/T/mri-610603bf61ce46e3/axial_012.png","assets/T/mri-610603bf61ce46e3/axial_013.png","assets/T/mri-610603bf61ce46e3/axial_014.png","assets/T/mri-610603bf61ce46e3/axial_015.png","assets/T/mri-610603bf61ce46e3/axial_016.png","assets/T/mri-610603bf61ce46e3/axial_017.png","assets/T/mri-610603bf61ce46e3/axial_018.png","assets/T/mri-610603bf61ce46e3/axial_019.png","assets/T/mri-610603bf61ce46e3/axial_020.png","assets/T/mri-610603bf61ce46e3/axial_021.png","assets/T/mri-610603bf61ce46e3/axial_022.png","assets/T/mri-610603bf61ce46e3/axial_023.png","assets/T/mri-610603bf61ce46e3/axial_024.png","assets/T/mri-610603bf61ce46e3/axial_025.png","assets/T/mri-610603bf61ce46e3/axial_026.png","assets/T/mri-610603bf61ce46e3/axial_027.png","assets/T/mri-610603bf61ce46e3/axial_028.png","assets/T/mri-610603bf61ce46e3/axial_029.png","assets/T/mri-610603bf61ce46e3/axial_030.png","assets/T/mri-610603bf61ce46e3/axial_031.png","assets/T/mri-610603bf61ce46e3/axial_032.png","assets/T/mri-610603bf61ce46e3/axial_033.png","assets/T/mri-610603bf61ce46e3/axial_034.png","assets/T/mri-610603bf61ce46e3/axial_035.png","assets/T/mri-610603bf61ce46e3/axial_036.png","assets/T/mri-610603bf61ce46e3/axial_037.png","assets/T/mri-610603bf61ce46e3/axial_038.png","assets/T/mri-610603bf61ce46e3/axial_039.png","assets/T/mri-610603bf61ce46e3/axial_040.png","assets/T/mri-610603bf61ce46e3/coronal_001.png","assets/T/mri-610603bf61ce46e3/coronal_002.png","assets/T/mri-610603bf61ce46e3/coronal_003.png","assets/T/mri-610603bf61ce46e3/coronal_004.png","assets/T/mri-610603bf61ce46e3/coronal_005.png","assets/T/mri-610603bf61ce46e3/coronal_006.png","assets/T/mri-610603bf61ce46e3/coronal_007.png","assets/T/mri-610603bf61ce46e3/coronal_008.png","assets/T/mri-610603bf61ce46e3/coronal_009.png","assets/T/mri-610603bf61ce46e3/coronal_010.png","assets/T/mri-610603bf61ce46e3/coronal_011.png","assets/T/mri-610603bf61ce46e3/coronal_012.png","assets/T/mri-610603bf61ce46e3/coronal_013.png","assets/T/mri-610603bf61ce46e3/coronal_014.png","assets/T/mri-610603bf61ce46e3/coronal_015.png","assets/T/mri-610603bf61ce46e3/coronal_016.png","assets/T/mri-610603bf61ce46e3/coronal_017.png","assets/T/mri-610603bf61ce46e3/coronal_018.png","assets/T/mri-610603bf61ce46e3/coronal_019.png","assets/T/mri-610603bf61ce46e3/coronal_020.png","assets/T/mri-610603bf61ce46e3/coronal_021.png","assets/T/mri-610603bf61ce46e3/coronal_022.png","assets/T/mri-610603bf61ce46e3/coronal_023.png","assets/T/mri-610603bf61ce46e3/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-217e2ff416f54d21","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-217e2ff416f54d21/axial_001.png","assets/T/mri-217e2ff416f54d21/axial_002.png","assets/T/mri-217e2ff416f54d21/axial_003.png","assets/T/mri-217e2ff416f54d21/axial_004.png","assets/T/mri-217e2ff416f54d21/axial_005.png","assets/T/mri-217e2ff416f54d21/axial_006.png","assets/T/mri-217e2ff416f54d21/axial_007.png","assets/T/mri-217e2ff416f54d21/axial_008.png","assets/T/mri-217e2ff416f54d21/axial_009.png","assets/T/mri-217e2ff416f54d21/axial_010.png","assets/T/mri-217e2ff416f54d21/axial_011.png","assets/T/mri-217e2ff416f54d21/axial_012.png","assets/T/mri-217e2ff416f54d21/axial_013.png","assets/T/mri-217e2ff416f54d21/axial_014.png","assets/T/mri-217e2ff416f54d21/axial_015.png","assets/T/mri-217e2ff416f54d21/axial_016.png","assets/T/mri-217e2ff416f54d21/axial_017.png","assets/T/mri-217e2ff416f54d21/axial_018.png","assets/T/mri-217e2ff416f54d21/axial_019.png","assets/T/mri-217e2ff416f54d21/axial_020.png","assets/T/mri-217e2ff416f54d21/axial_021.png","assets/T/mri-217e2ff416f54d21/axial_022.png","assets/T/mri-217e2ff416f54d21/axial_023.png","assets/T/mri-217e2ff416f54d21/axial_024.png","assets/T/mri-217e2ff416f54d21/axial_025.png","assets/T/mri-217e2ff416f54d21/axial_026.png","assets/T/mri-217e2ff416f54d21/axial_027.png","assets/T/mri-217e2ff416f54d21/axial_028.png","assets/T/mri-217e2ff416f54d21/axial_029.png","assets/T/mri-217e2ff416f54d21/axial_030.png","assets/T/mri-217e2ff416f54d21/axial_031.png","assets/T/mri-217e2ff416f54d21/axial_032.png","assets/T/mri-217e2ff416f54d21/axial_033.png","assets/T/mri-217e2ff416f54d21/axial_034.png","assets/T/mri-217e2ff416f54d21/axial_035.png","assets/T/mri-217e2ff416f54d21/axial_036.png","assets/T/mri-217e2ff416f54d21/axial_037.png","assets/T/mri-217e2ff416f54d21/axial_038.png","assets/T/mri-217e2ff416f54d21/axial_039.png","assets/T/mri-217e2ff416f54d21/axial_040.png","assets/T/mri-217e2ff416f54d21/coronal_001.png","assets/T/mri-217e2ff416f54d21/coronal_002.png","assets/T/mri-217e2ff416f54d21/coronal_003.png","assets/T/mri-217e2ff416f54d21/coronal_004.png","assets/T/mri-217e2ff416f54d21/coronal_005.png","assets/T/mri-217e2ff416f54d21/coronal_006.png","assets/T/mri-217e2ff416f54d21/coronal_007.png","assets/T/mri-217e2ff416f54d21/coronal_008.png","assets/T/mri-217e2ff416f54d21/coronal_009.png","assets/T/mri-217e2ff416f54d21/coronal_010.png","assets/T/mri-217e2ff416f54d21/coronal_011.png","assets/T/mri-217e2ff416f54d21/coronal_012.png","assets/T/mri-217e2ff416f54d21/coronal_013.png","assets/T/mri-217e2ff416f54d21/coronal_014.png","assets/T/mri-217e2ff416f54d21/coronal_015.png","assets/T/mri-217e2ff416f54d21/coronal_016.png","assets/T/mri-217e2ff416f54d21/coronal_017.png","assets/T/mri-217e2ff416f54d21/coronal_018.png","assets/T/mri-217e2ff416f54d21/coronal_019.png","assets/T/mri-217e2ff416f54d21/coronal_020.png","assets/T/mri-217e2ff416f54d21/coronal_021.png","assets/T/mri-217e2ff416f54d21/coronal_022.png","assets/T/mri-217e2ff416f54d21/coronal_023.png","assets/T/mri-217e2ff416f54d21/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-22348de6a516489b","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-22348de6a516489b/axial_001.png","assets/T/mri-22348de6a516489b/axial_002.png","assets/T/mri-22348de6a516489b/axial_003.png","assets/T/mri-22348de6a516489b/axial_004.png","assets/T/mri-22348de6a516489b/axial_005.png","assets/T/mri-22348de6a516489b/axial_006.png","assets/T/mri-22348de6a516489b/axial_007.png","assets/T/mri-22348de6a516489b/axial_008.png","assets/T/mri-22348de6a516489b/axial_009.png","assets/T/mri-22348de6a516489b/axial_010.png","assets/T/mri-22348de6a516489b/axial_011.png","assets/T/mri-22348de6a516489b/axial_012.png","assets/T/mri-22348de6a516489b/axial_013.png","assets/T/mri-22348de6a516489b/axial_014.png","assets/T/mri-22348de6a516489b/axial_015.png","assets/T/mri-22348de6a516489b/axial_016.png","assets/T/mri-22348de6a516489b/axial_017.png","assets/T/mri-22348de6a516489b/axial_018.png","assets/T/mri-22348de6a516489b/axial_019.png","assets/T/mri-22348de6a516489b/axial_020.png","assets/T/mri-22348de6a516489b/axial_021.png","assets/T/mri-22348de6a516489b/axial_022.png","assets/T/mri-22348de6a516489b/axial_023.png","assets/T/mri-22348de6a516489b/axial_024.png","assets/T/mri-22348de6a516489b/axial_025.png","assets/T/mri-22348de6a516489b/axial_026.png","assets/T/mri-22348de6a516489b/axial_027.png","assets/T/mri-22348de6a516489b/axial_028.png","assets/T/mri-22348de6a516489b/axial_029.png","assets/T/mri-22348de6a516489b/axial_030.png","assets/T/mri-22348de6a516489b/axial_031.png","assets/T/mri-22348de6a516489b/axial_032.png","assets/T/mri-22348de6a516489b/axial_033.png","assets/T/mri-22348de6a516489b/axial_034.png","assets/T/mri-22348de6a516489b/axial_035.png","assets/T/mri-22348de6a516489b/axial_036.png","assets/T/mri-22348de6a516489b/axial_037.png","assets/T/mri-22348de6a516489b/axial_038.png","assets/T/mri-22348de6a516489b/axial_039.png","assets/T/mri-22348de6a516489b/axial_040.png","assets/T/mri-22348de6a516489b/coronal_001.png","assets/T/mri-22348de6a516489b/coronal_002.png","assets/T/mri-22348de6a516489b/coronal_003.png","assets/T/mri-22348de6a516489b/coronal_004.png","assets/T/mri-22348de6a516489b/coronal_005.png","assets/T/mri-22348de6a516489b/coronal_006.png","assets/T/mri-22348de6a516489b/coronal_007.png","assets/T/mri-22348de6a516489b/coronal_008.png","assets/T/mri-22348de6a516489b/coronal_009.png","assets/T/mri-22348de6a516489b/coronal_010.png","assets/T/mri-22348de6a516489b/coronal_011.png","assets/T/mri-22348de6a516489b/coronal_012.png","assets/T/mri-22348de6a516489b/coronal_013.png","assets/T/mri-22348de6a516489b/coronal_014.png","assets/T/mri-22348de6a516489b/coronal_015.png","assets/T/mri-22348de6a516489b/coronal_016.png","assets/T/mri-22348de6a516489b/coronal_017.png","assets/T/mri-22348de6a516489b/coronal_018.png","assets/T/mri-22348de6a516489b/coronal_019.png","assets/T/mri-22348de6a516489b/coronal_020.png","assets/T/mri-22348de6a516489b/coronal_021.png","assets/T/mri-22348de6a516489b/coronal_022.png","assets/T/mri-22348de6a516489b/coronal_023.png","assets/T/mri-22348de6a516489b/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-3eb8d731a99e4f47","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-3eb8d731a99e4f47/axial_001.png","assets/T/mri-3eb8d731a99e4f47/axial_002.png","assets/T/mri-3eb8d731a99e4f47/axial_003.png","assets/T/mri-3eb8d731a99e4f47/axial_004.png","assets/T/mri-3eb8d731a99e4f47/axial_005.png","assets/T/mri-3eb8d731a99e4f47/axial_006.png","assets/T/mri-3eb8d731a99e4f47/axial_007.png","assets/T/mri-3eb8d731a99e4f47/axial_008.png","assets/T/mri-3eb8d731a99e4f47/axial_009.png","assets/T/mri-3eb8d731a99e4f47/axial_010.png","assets/T/mri-3eb8d731a99e4f47/axial_011.png","assets/T/mri-3eb8d731a99e4f47/axial_012.png","assets/T/mri-3eb8d731a99e4f47/axial_013.png","assets/T/mri-3eb8d731a99e4f47/axial_014.png","assets/T/mri-3eb8d731a99e4f47/axial_015.png","assets/T/mri-3eb8d731a99e4f47/axial_016.png","assets/T/mri-3eb8d731a99e4f47/axial_017.png","assets/T/mri-3eb8d731a99e4f47/axial_018.png","assets/T/mri-3eb8d731a99e4f47/axial_019.png","assets/T/mri-3eb8d731a99e4f47/axial_020.png","assets/T/mri-3eb8d731a99e4f47/axial_021.png","assets/T/mri-3eb8d731a99e4f47/axial_022.png","assets/T/mri-3eb8d731a99e4f47/axial_023.png","assets/T/mri-3eb8d731a99e4f47/axial_024.png","assets/T/mri-3eb8d731a99e4f47/axial_025.png","assets/T/mri-3eb8d731a99e4f47/axial_026.png","assets/T/mri-3eb8d731a99e4f47/axial_027.png","assets/T/mri-3eb8d731a99e4f47/axial_028.png","assets/T/mri-3eb8d731a99e4f47/axial_029.png","assets/T/mri-3eb8d731a99e4f47/axial_030.png","assets/T/mri-3eb8d731a99e4f47/axial_031.png","assets/T/mri-3eb8d731a99e4f47/axial_032.png","assets/T/mri-3eb8d731a99e4f47/axial_033.png","assets/T/mri-3eb8d731a99e4f47/axial_034.png","assets/T/mri-3eb8d731a99e4f47/axial_035.png","assets/T/mri-3eb8d731a99e4f47/axial_036.png","assets/T/mri-3eb8d731a99e4f47/axial_037.png","assets/T/mri-3eb8d731a99e4f47/axial_038.png","assets/T/mri-3eb8d731a99e4f47/axial_039.png","assets/T/mri-3eb8d731a99e4f47/axial_040.png","assets/T/mri-3eb8d731a99e4f47/coronal_001.png","assets/T/mri-3eb8d731a99e4f47/coronal_002.png","assets/T/mri-3eb8d731a99e4f47/coronal_003.png","assets/T/mri-3eb8d731a99e4f47/coronal_004.png","assets/T/mri-3eb8d731a99e4f47/coronal_005.png","assets/T/mri-3eb8d731a99e4f47/coronal_006.png","assets/T/mri-3eb8d731a99e4f47/coronal_007.png","assets/T/mri-3eb8d731a99e4f47/coronal_008.png","assets/T/mri-3eb8d731a99e4f47/coronal_009.png","assets/T/mri-3eb8d731a99e4f47/coronal_010.png","assets/T/mri-3eb8d731a99e4f47/coronal_011.png","assets/T/mri-3eb8d731a99e4f47/coronal_012.png","assets/T/mri-3eb8d731a99e4f47/coronal_013.png","assets/T/mri-3eb8d731a99e4f47/coronal_014.png","assets/T/mri-3eb8d731a99e4f47/coronal_015.png","assets/T/mri-3eb8d731a99e4f47/coronal_016.png","assets/T/mri-3eb8d731a99e4f47/coronal_017.png","assets/T/mri-3eb8d731a99e4f47/coronal_018.png","assets/T/mri-3eb8d731a99e4f47/coronal_019.png","assets/T/mri-3eb8d731a99e4f47/coronal_020.png","assets/T/mri-3eb8d731a99e4f47/coronal_021.png","assets/T/mri-3eb8d731a99e4f47/coronal_022.png","assets/T/mri-3eb8d731a99e4f47/coronal_023.png","assets/T/mri-3eb8d731a99e4f47/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-f84a1e34850340b0","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 70 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 28 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-f84a1e34850340b0/axial_001.png","assets/T/mri-f84a1e34850340b0/axial_002.png","assets/T/mri-f84a1e34850340b0/axial_003.png","assets/T/mri-f84a1e34850340b0/axial_004.png","assets/T/mri-f84a1e34850340b0/axial_005.png","assets/T/mri-f84a1e34850340b0/axial_006.png","assets/T/mri-f84a1e34850340b0/axial_007.png","assets/T/mri-f84a1e34850340b0/axial_008.png","assets/T/mri-f84a1e34850340b0/axial_009.png","assets/T/mri-f84a1e34850340b0/axial_010.png","assets/T/mri-f84a1e34850340b0/axial_011.png","assets/T/mri-f84a1e34850340b0/axial_012.png","assets/T/mri-f84a1e34850340b0/axial_013.png","assets/T/mri-f84a1e34850340b0/axial_014.png","assets/T/mri-f84a1e34850340b0/axial_015.png","assets/T/mri-f84a1e34850340b0/axial_016.png","assets/T/mri-f84a1e34850340b0/axial_017.png","assets/T/mri-f84a1e34850340b0/axial_018.png","assets/T/mri-f84a1e34850340b0/axial_019.png","assets/T/mri-f84a1e34850340b0/axial_020.png","assets/T/mri-f84a1e34850340b0/axial_021.png","assets/T/mri-f84a1e34850340b0/axial_022.png","assets/T/mri-f84a1e34850340b0/axial_023.png","assets/T/mri-f84a1e34850340b0/axial_024.png","assets/T/mri-f84a1e34850340b0/axial_025.png","assets/T/mri-f84a1e34850340b0/axial_026.png","assets/T/mri-f84a1e34850340b0/axial_027.png","assets/T/mri-f84a1e34850340b0/axial_028.png","assets/T/mri-f84a1e34850340b0/axial_029.png","assets/T/mri-f84a1e34850340b0/axial_030.png","assets/T/mri-f84a1e34850340b0/axial_031.png","assets/T/mri-f84a1e34850340b0/axial_032.png","assets/T/mri-f84a1e34850340b0/axial_033.png","assets/T/mri-f84a1e34850340b0/axial_034.png","assets/T/mri-f84a1e34850340b0/axial_035.png","assets/T/mri-f84a1e34850340b0/axial_036.png","assets/T/mri-f84a1e34850340b0/axial_037.png","assets/T/mri-f84a1e34850340b0/axial_038.png","assets/T/mri-f84a1e34850340b0/axial_039.png","assets/T/mri-f84a1e34850340b0/axial_040.png","assets/T/mri-f84a1e34850340b0/axial_041.png","assets/T/mri-f84a1e34850340b0/axial_042.png","assets/T/mri-f84a1e34850340b0/coronal_001.png","assets/T/mri-f84a1e34850340b0/coronal_002.png","assets/T/mri-f84a1e34850340b0/coronal_003.png","assets/T/mri-f84a1e34850340b0/coronal_004.png","assets/T/mri-f84a1e34850340b0/coronal_005.png","assets/T/mri-f84a1e34850340b0/coronal_006.png","assets/T/mri-f84a1e34850340b0/coronal_007.png","assets/T/mri-f84a1e34850340b0/coronal_008.png","assets/T/mri-f84a1e34850340b0/coronal_009.png","assets/T/mri-f84a1e34850340b0/coronal_010.png","assets/T/mri-f84a1e34850340b0/coronal_011.png","assets/T/mri-f84a1e34850340b0/coronal_012.png","assets/T/mri-f84a1e34850340b0/coronal_013.png","assets/T/mri-f84a1e34850340b0/coronal_014.png","assets/T/mri-f84a1e34850340b0/coronal_015.png","assets/T/mri-f84a1e34850340b0/coronal_016.png","assets/T/mri-f84a1e34850340b0/coronal_017.png","assets/T/mri-f84a1e34850340b0/coronal_018.png","assets/T/mri-f84a1e34850340b0/coronal_019.png","assets/T/mri-f84a1e34850340b0/coronal_020.png","assets/T/mri-f84a1e34850340b0/coronal_021.png","assets/T/mri-f84a1e34850340b0/coronal_022.png","assets/T/mri-f84a1e34850340b0/coronal_023.png","assets/T/mri-f84a1e34850340b0/coronal_024.png","assets/T/mri-f84a1e34850340b0/coronal_025.png","assets/T/mri-f84a1e34850340b0/coronal_026.png","assets/T/mri-f84a1e34850340b0/coronal_027.png","assets/T/mri-f84a1e34850340b0/coronal_028.png"],"stage_edition":8}
+{"id":"L3-T300:mri-65339b3e03744861","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-65339b3e03744861/axial_001.png","assets/T/mri-65339b3e03744861/axial_002.png","assets/T/mri-65339b3e03744861/axial_003.png","assets/T/mri-65339b3e03744861/axial_004.png","assets/T/mri-65339b3e03744861/axial_005.png","assets/T/mri-65339b3e03744861/axial_006.png","assets/T/mri-65339b3e03744861/axial_007.png","assets/T/mri-65339b3e03744861/axial_008.png","assets/T/mri-65339b3e03744861/axial_009.png","assets/T/mri-65339b3e03744861/axial_010.png","assets/T/mri-65339b3e03744861/axial_011.png","assets/T/mri-65339b3e03744861/axial_012.png","assets/T/mri-65339b3e03744861/axial_013.png","assets/T/mri-65339b3e03744861/axial_014.png","assets/T/mri-65339b3e03744861/axial_015.png","assets/T/mri-65339b3e03744861/axial_016.png","assets/T/mri-65339b3e03744861/axial_017.png","assets/T/mri-65339b3e03744861/axial_018.png","assets/T/mri-65339b3e03744861/axial_019.png","assets/T/mri-65339b3e03744861/axial_020.png","assets/T/mri-65339b3e03744861/axial_021.png","assets/T/mri-65339b3e03744861/axial_022.png","assets/T/mri-65339b3e03744861/axial_023.png","assets/T/mri-65339b3e03744861/axial_024.png","assets/T/mri-65339b3e03744861/axial_025.png","assets/T/mri-65339b3e03744861/axial_026.png","assets/T/mri-65339b3e03744861/axial_027.png","assets/T/mri-65339b3e03744861/axial_028.png","assets/T/mri-65339b3e03744861/axial_029.png","assets/T/mri-65339b3e03744861/axial_030.png","assets/T/mri-65339b3e03744861/axial_031.png","assets/T/mri-65339b3e03744861/axial_032.png","assets/T/mri-65339b3e03744861/axial_033.png","assets/T/mri-65339b3e03744861/axial_034.png","assets/T/mri-65339b3e03744861/axial_035.png","assets/T/mri-65339b3e03744861/axial_036.png","assets/T/mri-65339b3e03744861/axial_037.png","assets/T/mri-65339b3e03744861/axial_038.png","assets/T/mri-65339b3e03744861/axial_039.png","assets/T/mri-65339b3e03744861/axial_040.png","assets/T/mri-65339b3e03744861/axial_041.png","assets/T/mri-65339b3e03744861/axial_042.png","assets/T/mri-65339b3e03744861/coronal_001.png","assets/T/mri-65339b3e03744861/coronal_002.png","assets/T/mri-65339b3e03744861/coronal_003.png","assets/T/mri-65339b3e03744861/coronal_004.png","assets/T/mri-65339b3e03744861/coronal_005.png","assets/T/mri-65339b3e03744861/coronal_006.png","assets/T/mri-65339b3e03744861/coronal_007.png","assets/T/mri-65339b3e03744861/coronal_008.png","assets/T/mri-65339b3e03744861/coronal_009.png","assets/T/mri-65339b3e03744861/coronal_010.png","assets/T/mri-65339b3e03744861/coronal_011.png","assets/T/mri-65339b3e03744861/coronal_012.png","assets/T/mri-65339b3e03744861/coronal_013.png","assets/T/mri-65339b3e03744861/coronal_014.png","assets/T/mri-65339b3e03744861/coronal_015.png","assets/T/mri-65339b3e03744861/coronal_016.png","assets/T/mri-65339b3e03744861/coronal_017.png","assets/T/mri-65339b3e03744861/coronal_018.png","assets/T/mri-65339b3e03744861/coronal_019.png","assets/T/mri-65339b3e03744861/coronal_020.png","assets/T/mri-65339b3e03744861/coronal_021.png","assets/T/mri-65339b3e03744861/coronal_022.png","assets/T/mri-65339b3e03744861/coronal_023.png","assets/T/mri-65339b3e03744861/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-b1b1cc7813aa4e54","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 60 张图，均来自同一次检查。\n\n- 前 36 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-b1b1cc7813aa4e54/axial_001.png","assets/T/mri-b1b1cc7813aa4e54/axial_002.png","assets/T/mri-b1b1cc7813aa4e54/axial_003.png","assets/T/mri-b1b1cc7813aa4e54/axial_004.png","assets/T/mri-b1b1cc7813aa4e54/axial_005.png","assets/T/mri-b1b1cc7813aa4e54/axial_006.png","assets/T/mri-b1b1cc7813aa4e54/axial_007.png","assets/T/mri-b1b1cc7813aa4e54/axial_008.png","assets/T/mri-b1b1cc7813aa4e54/axial_009.png","assets/T/mri-b1b1cc7813aa4e54/axial_010.png","assets/T/mri-b1b1cc7813aa4e54/axial_011.png","assets/T/mri-b1b1cc7813aa4e54/axial_012.png","assets/T/mri-b1b1cc7813aa4e54/axial_013.png","assets/T/mri-b1b1cc7813aa4e54/axial_014.png","assets/T/mri-b1b1cc7813aa4e54/axial_015.png","assets/T/mri-b1b1cc7813aa4e54/axial_016.png","assets/T/mri-b1b1cc7813aa4e54/axial_017.png","assets/T/mri-b1b1cc7813aa4e54/axial_018.png","assets/T/mri-b1b1cc7813aa4e54/axial_019.png","assets/T/mri-b1b1cc7813aa4e54/axial_020.png","assets/T/mri-b1b1cc7813aa4e54/axial_021.png","assets/T/mri-b1b1cc7813aa4e54/axial_022.png","assets/T/mri-b1b1cc7813aa4e54/axial_023.png","assets/T/mri-b1b1cc7813aa4e54/axial_024.png","assets/T/mri-b1b1cc7813aa4e54/axial_025.png","assets/T/mri-b1b1cc7813aa4e54/axial_026.png","assets/T/mri-b1b1cc7813aa4e54/axial_027.png","assets/T/mri-b1b1cc7813aa4e54/axial_028.png","assets/T/mri-b1b1cc7813aa4e54/axial_029.png","assets/T/mri-b1b1cc7813aa4e54/axial_030.png","assets/T/mri-b1b1cc7813aa4e54/axial_031.png","assets/T/mri-b1b1cc7813aa4e54/axial_032.png","assets/T/mri-b1b1cc7813aa4e54/axial_033.png","assets/T/mri-b1b1cc7813aa4e54/axial_034.png","assets/T/mri-b1b1cc7813aa4e54/axial_035.png","assets/T/mri-b1b1cc7813aa4e54/axial_036.png","assets/T/mri-b1b1cc7813aa4e54/coronal_001.png","assets/T/mri-b1b1cc7813aa4e54/coronal_002.png","assets/T/mri-b1b1cc7813aa4e54/coronal_003.png","assets/T/mri-b1b1cc7813aa4e54/coronal_004.png","assets/T/mri-b1b1cc7813aa4e54/coronal_005.png","assets/T/mri-b1b1cc7813aa4e54/coronal_006.png","assets/T/mri-b1b1cc7813aa4e54/coronal_007.png","assets/T/mri-b1b1cc7813aa4e54/coronal_008.png","assets/T/mri-b1b1cc7813aa4e54/coronal_009.png","assets/T/mri-b1b1cc7813aa4e54/coronal_010.png","assets/T/mri-b1b1cc7813aa4e54/coronal_011.png","assets/T/mri-b1b1cc7813aa4e54/coronal_012.png","assets/T/mri-b1b1cc7813aa4e54/coronal_013.png","assets/T/mri-b1b1cc7813aa4e54/coronal_014.png","assets/T/mri-b1b1cc7813aa4e54/coronal_015.png","assets/T/mri-b1b1cc7813aa4e54/coronal_016.png","assets/T/mri-b1b1cc7813aa4e54/coronal_017.png","assets/T/mri-b1b1cc7813aa4e54/coronal_018.png","assets/T/mri-b1b1cc7813aa4e54/coronal_019.png","assets/T/mri-b1b1cc7813aa4e54/coronal_020.png","assets/T/mri-b1b1cc7813aa4e54/coronal_021.png","assets/T/mri-b1b1cc7813aa4e54/coronal_022.png","assets/T/mri-b1b1cc7813aa4e54/coronal_023.png","assets/T/mri-b1b1cc7813aa4e54/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-78c66b5d279f4442","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 68 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 26 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-78c66b5d279f4442/axial_001.png","assets/T/mri-78c66b5d279f4442/axial_002.png","assets/T/mri-78c66b5d279f4442/axial_003.png","assets/T/mri-78c66b5d279f4442/axial_004.png","assets/T/mri-78c66b5d279f4442/axial_005.png","assets/T/mri-78c66b5d279f4442/axial_006.png","assets/T/mri-78c66b5d279f4442/axial_007.png","assets/T/mri-78c66b5d279f4442/axial_008.png","assets/T/mri-78c66b5d279f4442/axial_009.png","assets/T/mri-78c66b5d279f4442/axial_010.png","assets/T/mri-78c66b5d279f4442/axial_011.png","assets/T/mri-78c66b5d279f4442/axial_012.png","assets/T/mri-78c66b5d279f4442/axial_013.png","assets/T/mri-78c66b5d279f4442/axial_014.png","assets/T/mri-78c66b5d279f4442/axial_015.png","assets/T/mri-78c66b5d279f4442/axial_016.png","assets/T/mri-78c66b5d279f4442/axial_017.png","assets/T/mri-78c66b5d279f4442/axial_018.png","assets/T/mri-78c66b5d279f4442/axial_019.png","assets/T/mri-78c66b5d279f4442/axial_020.png","assets/T/mri-78c66b5d279f4442/axial_021.png","assets/T/mri-78c66b5d279f4442/axial_022.png","assets/T/mri-78c66b5d279f4442/axial_023.png","assets/T/mri-78c66b5d279f4442/axial_024.png","assets/T/mri-78c66b5d279f4442/axial_025.png","assets/T/mri-78c66b5d279f4442/axial_026.png","assets/T/mri-78c66b5d279f4442/axial_027.png","assets/T/mri-78c66b5d279f4442/axial_028.png","assets/T/mri-78c66b5d279f4442/axial_029.png","assets/T/mri-78c66b5d279f4442/axial_030.png","assets/T/mri-78c66b5d279f4442/axial_031.png","assets/T/mri-78c66b5d279f4442/axial_032.png","assets/T/mri-78c66b5d279f4442/axial_033.png","assets/T/mri-78c66b5d279f4442/axial_034.png","assets/T/mri-78c66b5d279f4442/axial_035.png","assets/T/mri-78c66b5d279f4442/axial_036.png","assets/T/mri-78c66b5d279f4442/axial_037.png","assets/T/mri-78c66b5d279f4442/axial_038.png","assets/T/mri-78c66b5d279f4442/axial_039.png","assets/T/mri-78c66b5d279f4442/axial_040.png","assets/T/mri-78c66b5d279f4442/axial_041.png","assets/T/mri-78c66b5d279f4442/axial_042.png","assets/T/mri-78c66b5d279f4442/coronal_001.png","assets/T/mri-78c66b5d279f4442/coronal_002.png","assets/T/mri-78c66b5d279f4442/coronal_003.png","assets/T/mri-78c66b5d279f4442/coronal_004.png","assets/T/mri-78c66b5d279f4442/coronal_005.png","assets/T/mri-78c66b5d279f4442/coronal_006.png","assets/T/mri-78c66b5d279f4442/coronal_007.png","assets/T/mri-78c66b5d279f4442/coronal_008.png","assets/T/mri-78c66b5d279f4442/coronal_009.png","assets/T/mri-78c66b5d279f4442/coronal_010.png","assets/T/mri-78c66b5d279f4442/coronal_011.png","assets/T/mri-78c66b5d279f4442/coronal_012.png","assets/T/mri-78c66b5d279f4442/coronal_013.png","assets/T/mri-78c66b5d279f4442/coronal_014.png","assets/T/mri-78c66b5d279f4442/coronal_015.png","assets/T/mri-78c66b5d279f4442/coronal_016.png","assets/T/mri-78c66b5d279f4442/coronal_017.png","assets/T/mri-78c66b5d279f4442/coronal_018.png","assets/T/mri-78c66b5d279f4442/coronal_019.png","assets/T/mri-78c66b5d279f4442/coronal_020.png","assets/T/mri-78c66b5d279f4442/coronal_021.png","assets/T/mri-78c66b5d279f4442/coronal_022.png","assets/T/mri-78c66b5d279f4442/coronal_023.png","assets/T/mri-78c66b5d279f4442/coronal_024.png","assets/T/mri-78c66b5d279f4442/coronal_025.png","assets/T/mri-78c66b5d279f4442/coronal_026.png"],"stage_edition":8}
+{"id":"L3-T300:mri-6727868cac9449ce","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 68 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 28 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-6727868cac9449ce/axial_001.png","assets/T/mri-6727868cac9449ce/axial_002.png","assets/T/mri-6727868cac9449ce/axial_003.png","assets/T/mri-6727868cac9449ce/axial_004.png","assets/T/mri-6727868cac9449ce/axial_005.png","assets/T/mri-6727868cac9449ce/axial_006.png","assets/T/mri-6727868cac9449ce/axial_007.png","assets/T/mri-6727868cac9449ce/axial_008.png","assets/T/mri-6727868cac9449ce/axial_009.png","assets/T/mri-6727868cac9449ce/axial_010.png","assets/T/mri-6727868cac9449ce/axial_011.png","assets/T/mri-6727868cac9449ce/axial_012.png","assets/T/mri-6727868cac9449ce/axial_013.png","assets/T/mri-6727868cac9449ce/axial_014.png","assets/T/mri-6727868cac9449ce/axial_015.png","assets/T/mri-6727868cac9449ce/axial_016.png","assets/T/mri-6727868cac9449ce/axial_017.png","assets/T/mri-6727868cac9449ce/axial_018.png","assets/T/mri-6727868cac9449ce/axial_019.png","assets/T/mri-6727868cac9449ce/axial_020.png","assets/T/mri-6727868cac9449ce/axial_021.png","assets/T/mri-6727868cac9449ce/axial_022.png","assets/T/mri-6727868cac9449ce/axial_023.png","assets/T/mri-6727868cac9449ce/axial_024.png","assets/T/mri-6727868cac9449ce/axial_025.png","assets/T/mri-6727868cac9449ce/axial_026.png","assets/T/mri-6727868cac9449ce/axial_027.png","assets/T/mri-6727868cac9449ce/axial_028.png","assets/T/mri-6727868cac9449ce/axial_029.png","assets/T/mri-6727868cac9449ce/axial_030.png","assets/T/mri-6727868cac9449ce/axial_031.png","assets/T/mri-6727868cac9449ce/axial_032.png","assets/T/mri-6727868cac9449ce/axial_033.png","assets/T/mri-6727868cac9449ce/axial_034.png","assets/T/mri-6727868cac9449ce/axial_035.png","assets/T/mri-6727868cac9449ce/axial_036.png","assets/T/mri-6727868cac9449ce/axial_037.png","assets/T/mri-6727868cac9449ce/axial_038.png","assets/T/mri-6727868cac9449ce/axial_039.png","assets/T/mri-6727868cac9449ce/axial_040.png","assets/T/mri-6727868cac9449ce/coronal_001.png","assets/T/mri-6727868cac9449ce/coronal_002.png","assets/T/mri-6727868cac9449ce/coronal_003.png","assets/T/mri-6727868cac9449ce/coronal_004.png","assets/T/mri-6727868cac9449ce/coronal_005.png","assets/T/mri-6727868cac9449ce/coronal_006.png","assets/T/mri-6727868cac9449ce/coronal_007.png","assets/T/mri-6727868cac9449ce/coronal_008.png","assets/T/mri-6727868cac9449ce/coronal_009.png","assets/T/mri-6727868cac9449ce/coronal_010.png","assets/T/mri-6727868cac9449ce/coronal_011.png","assets/T/mri-6727868cac9449ce/coronal_012.png","assets/T/mri-6727868cac9449ce/coronal_013.png","assets/T/mri-6727868cac9449ce/coronal_014.png","assets/T/mri-6727868cac9449ce/coronal_015.png","assets/T/mri-6727868cac9449ce/coronal_016.png","assets/T/mri-6727868cac9449ce/coronal_017.png","assets/T/mri-6727868cac9449ce/coronal_018.png","assets/T/mri-6727868cac9449ce/coronal_019.png","assets/T/mri-6727868cac9449ce/coronal_020.png","assets/T/mri-6727868cac9449ce/coronal_021.png","assets/T/mri-6727868cac9449ce/coronal_022.png","assets/T/mri-6727868cac9449ce/coronal_023.png","assets/T/mri-6727868cac9449ce/coronal_024.png","assets/T/mri-6727868cac9449ce/coronal_025.png","assets/T/mri-6727868cac9449ce/coronal_026.png","assets/T/mri-6727868cac9449ce/coronal_027.png","assets/T/mri-6727868cac9449ce/coronal_028.png"],"stage_edition":8}
+{"id":"L3-T300:mri-4ba3b56eb4514153","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 69 张图，均来自同一次检查。\n\n- 前 45 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-4ba3b56eb4514153/axial_001.png","assets/T/mri-4ba3b56eb4514153/axial_002.png","assets/T/mri-4ba3b56eb4514153/axial_003.png","assets/T/mri-4ba3b56eb4514153/axial_004.png","assets/T/mri-4ba3b56eb4514153/axial_005.png","assets/T/mri-4ba3b56eb4514153/axial_006.png","assets/T/mri-4ba3b56eb4514153/axial_007.png","assets/T/mri-4ba3b56eb4514153/axial_008.png","assets/T/mri-4ba3b56eb4514153/axial_009.png","assets/T/mri-4ba3b56eb4514153/axial_010.png","assets/T/mri-4ba3b56eb4514153/axial_011.png","assets/T/mri-4ba3b56eb4514153/axial_012.png","assets/T/mri-4ba3b56eb4514153/axial_013.png","assets/T/mri-4ba3b56eb4514153/axial_014.png","assets/T/mri-4ba3b56eb4514153/axial_015.png","assets/T/mri-4ba3b56eb4514153/axial_016.png","assets/T/mri-4ba3b56eb4514153/axial_017.png","assets/T/mri-4ba3b56eb4514153/axial_018.png","assets/T/mri-4ba3b56eb4514153/axial_019.png","assets/T/mri-4ba3b56eb4514153/axial_020.png","assets/T/mri-4ba3b56eb4514153/axial_021.png","assets/T/mri-4ba3b56eb4514153/axial_022.png","assets/T/mri-4ba3b56eb4514153/axial_023.png","assets/T/mri-4ba3b56eb4514153/axial_024.png","assets/T/mri-4ba3b56eb4514153/axial_025.png","assets/T/mri-4ba3b56eb4514153/axial_026.png","assets/T/mri-4ba3b56eb4514153/axial_027.png","assets/T/mri-4ba3b56eb4514153/axial_028.png","assets/T/mri-4ba3b56eb4514153/axial_029.png","assets/T/mri-4ba3b56eb4514153/axial_030.png","assets/T/mri-4ba3b56eb4514153/axial_031.png","assets/T/mri-4ba3b56eb4514153/axial_032.png","assets/T/mri-4ba3b56eb4514153/axial_033.png","assets/T/mri-4ba3b56eb4514153/axial_034.png","assets/T/mri-4ba3b56eb4514153/axial_035.png","assets/T/mri-4ba3b56eb4514153/axial_036.png","assets/T/mri-4ba3b56eb4514153/axial_037.png","assets/T/mri-4ba3b56eb4514153/axial_038.png","assets/T/mri-4ba3b56eb4514153/axial_039.png","assets/T/mri-4ba3b56eb4514153/axial_040.png","assets/T/mri-4ba3b56eb4514153/axial_041.png","assets/T/mri-4ba3b56eb4514153/axial_042.png","assets/T/mri-4ba3b56eb4514153/axial_043.png","assets/T/mri-4ba3b56eb4514153/axial_044.png","assets/T/mri-4ba3b56eb4514153/axial_045.png","assets/T/mri-4ba3b56eb4514153/coronal_001.png","assets/T/mri-4ba3b56eb4514153/coronal_002.png","assets/T/mri-4ba3b56eb4514153/coronal_003.png","assets/T/mri-4ba3b56eb4514153/coronal_004.png","assets/T/mri-4ba3b56eb4514153/coronal_005.png","assets/T/mri-4ba3b56eb4514153/coronal_006.png","assets/T/mri-4ba3b56eb4514153/coronal_007.png","assets/T/mri-4ba3b56eb4514153/coronal_008.png","assets/T/mri-4ba3b56eb4514153/coronal_009.png","assets/T/mri-4ba3b56eb4514153/coronal_010.png","assets/T/mri-4ba3b56eb4514153/coronal_011.png","assets/T/mri-4ba3b56eb4514153/coronal_012.png","assets/T/mri-4ba3b56eb4514153/coronal_013.png","assets/T/mri-4ba3b56eb4514153/coronal_014.png","assets/T/mri-4ba3b56eb4514153/coronal_015.png","assets/T/mri-4ba3b56eb4514153/coronal_016.png","assets/T/mri-4ba3b56eb4514153/coronal_017.png","assets/T/mri-4ba3b56eb4514153/coronal_018.png","assets/T/mri-4ba3b56eb4514153/coronal_019.png","assets/T/mri-4ba3b56eb4514153/coronal_020.png","assets/T/mri-4ba3b56eb4514153/coronal_021.png","assets/T/mri-4ba3b56eb4514153/coronal_022.png","assets/T/mri-4ba3b56eb4514153/coronal_023.png","assets/T/mri-4ba3b56eb4514153/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-f29135603c0e4f4a","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 67 张图，均来自同一次检查。\n\n- 前 43 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-f29135603c0e4f4a/axial_001.png","assets/T/mri-f29135603c0e4f4a/axial_002.png","assets/T/mri-f29135603c0e4f4a/axial_003.png","assets/T/mri-f29135603c0e4f4a/axial_004.png","assets/T/mri-f29135603c0e4f4a/axial_005.png","assets/T/mri-f29135603c0e4f4a/axial_006.png","assets/T/mri-f29135603c0e4f4a/axial_007.png","assets/T/mri-f29135603c0e4f4a/axial_008.png","assets/T/mri-f29135603c0e4f4a/axial_009.png","assets/T/mri-f29135603c0e4f4a/axial_010.png","assets/T/mri-f29135603c0e4f4a/axial_011.png","assets/T/mri-f29135603c0e4f4a/axial_012.png","assets/T/mri-f29135603c0e4f4a/axial_013.png","assets/T/mri-f29135603c0e4f4a/axial_014.png","assets/T/mri-f29135603c0e4f4a/axial_015.png","assets/T/mri-f29135603c0e4f4a/axial_016.png","assets/T/mri-f29135603c0e4f4a/axial_017.png","assets/T/mri-f29135603c0e4f4a/axial_018.png","assets/T/mri-f29135603c0e4f4a/axial_019.png","assets/T/mri-f29135603c0e4f4a/axial_020.png","assets/T/mri-f29135603c0e4f4a/axial_021.png","assets/T/mri-f29135603c0e4f4a/axial_022.png","assets/T/mri-f29135603c0e4f4a/axial_023.png","assets/T/mri-f29135603c0e4f4a/axial_024.png","assets/T/mri-f29135603c0e4f4a/axial_025.png","assets/T/mri-f29135603c0e4f4a/axial_026.png","assets/T/mri-f29135603c0e4f4a/axial_027.png","assets/T/mri-f29135603c0e4f4a/axial_028.png","assets/T/mri-f29135603c0e4f4a/axial_029.png","assets/T/mri-f29135603c0e4f4a/axial_030.png","assets/T/mri-f29135603c0e4f4a/axial_031.png","assets/T/mri-f29135603c0e4f4a/axial_032.png","assets/T/mri-f29135603c0e4f4a/axial_033.png","assets/T/mri-f29135603c0e4f4a/axial_034.png","assets/T/mri-f29135603c0e4f4a/axial_035.png","assets/T/mri-f29135603c0e4f4a/axial_036.png","assets/T/mri-f29135603c0e4f4a/axial_037.png","assets/T/mri-f29135603c0e4f4a/axial_038.png","assets/T/mri-f29135603c0e4f4a/axial_039.png","assets/T/mri-f29135603c0e4f4a/axial_040.png","assets/T/mri-f29135603c0e4f4a/axial_041.png","assets/T/mri-f29135603c0e4f4a/axial_042.png","assets/T/mri-f29135603c0e4f4a/axial_043.png","assets/T/mri-f29135603c0e4f4a/coronal_001.png","assets/T/mri-f29135603c0e4f4a/coronal_002.png","assets/T/mri-f29135603c0e4f4a/coronal_003.png","assets/T/mri-f29135603c0e4f4a/coronal_004.png","assets/T/mri-f29135603c0e4f4a/coronal_005.png","assets/T/mri-f29135603c0e4f4a/coronal_006.png","assets/T/mri-f29135603c0e4f4a/coronal_007.png","assets/T/mri-f29135603c0e4f4a/coronal_008.png","assets/T/mri-f29135603c0e4f4a/coronal_009.png","assets/T/mri-f29135603c0e4f4a/coronal_010.png","assets/T/mri-f29135603c0e4f4a/coronal_011.png","assets/T/mri-f29135603c0e4f4a/coronal_012.png","assets/T/mri-f29135603c0e4f4a/coronal_013.png","assets/T/mri-f29135603c0e4f4a/coronal_014.png","assets/T/mri-f29135603c0e4f4a/coronal_015.png","assets/T/mri-f29135603c0e4f4a/coronal_016.png","assets/T/mri-f29135603c0e4f4a/coronal_017.png","assets/T/mri-f29135603c0e4f4a/coronal_018.png","assets/T/mri-f29135603c0e4f4a/coronal_019.png","assets/T/mri-f29135603c0e4f4a/coronal_020.png","assets/T/mri-f29135603c0e4f4a/coronal_021.png","assets/T/mri-f29135603c0e4f4a/coronal_022.png","assets/T/mri-f29135603c0e4f4a/coronal_023.png","assets/T/mri-f29135603c0e4f4a/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-a201d3a61de2439a","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 70 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 28 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-a201d3a61de2439a/axial_001.png","assets/T/mri-a201d3a61de2439a/axial_002.png","assets/T/mri-a201d3a61de2439a/axial_003.png","assets/T/mri-a201d3a61de2439a/axial_004.png","assets/T/mri-a201d3a61de2439a/axial_005.png","assets/T/mri-a201d3a61de2439a/axial_006.png","assets/T/mri-a201d3a61de2439a/axial_007.png","assets/T/mri-a201d3a61de2439a/axial_008.png","assets/T/mri-a201d3a61de2439a/axial_009.png","assets/T/mri-a201d3a61de2439a/axial_010.png","assets/T/mri-a201d3a61de2439a/axial_011.png","assets/T/mri-a201d3a61de2439a/axial_012.png","assets/T/mri-a201d3a61de2439a/axial_013.png","assets/T/mri-a201d3a61de2439a/axial_014.png","assets/T/mri-a201d3a61de2439a/axial_015.png","assets/T/mri-a201d3a61de2439a/axial_016.png","assets/T/mri-a201d3a61de2439a/axial_017.png","assets/T/mri-a201d3a61de2439a/axial_018.png","assets/T/mri-a201d3a61de2439a/axial_019.png","assets/T/mri-a201d3a61de2439a/axial_020.png","assets/T/mri-a201d3a61de2439a/axial_021.png","assets/T/mri-a201d3a61de2439a/axial_022.png","assets/T/mri-a201d3a61de2439a/axial_023.png","assets/T/mri-a201d3a61de2439a/axial_024.png","assets/T/mri-a201d3a61de2439a/axial_025.png","assets/T/mri-a201d3a61de2439a/axial_026.png","assets/T/mri-a201d3a61de2439a/axial_027.png","assets/T/mri-a201d3a61de2439a/axial_028.png","assets/T/mri-a201d3a61de2439a/axial_029.png","assets/T/mri-a201d3a61de2439a/axial_030.png","assets/T/mri-a201d3a61de2439a/axial_031.png","assets/T/mri-a201d3a61de2439a/axial_032.png","assets/T/mri-a201d3a61de2439a/axial_033.png","assets/T/mri-a201d3a61de2439a/axial_034.png","assets/T/mri-a201d3a61de2439a/axial_035.png","assets/T/mri-a201d3a61de2439a/axial_036.png","assets/T/mri-a201d3a61de2439a/axial_037.png","assets/T/mri-a201d3a61de2439a/axial_038.png","assets/T/mri-a201d3a61de2439a/axial_039.png","assets/T/mri-a201d3a61de2439a/axial_040.png","assets/T/mri-a201d3a61de2439a/axial_041.png","assets/T/mri-a201d3a61de2439a/axial_042.png","assets/T/mri-a201d3a61de2439a/coronal_001.png","assets/T/mri-a201d3a61de2439a/coronal_002.png","assets/T/mri-a201d3a61de2439a/coronal_003.png","assets/T/mri-a201d3a61de2439a/coronal_004.png","assets/T/mri-a201d3a61de2439a/coronal_005.png","assets/T/mri-a201d3a61de2439a/coronal_006.png","assets/T/mri-a201d3a61de2439a/coronal_007.png","assets/T/mri-a201d3a61de2439a/coronal_008.png","assets/T/mri-a201d3a61de2439a/coronal_009.png","assets/T/mri-a201d3a61de2439a/coronal_010.png","assets/T/mri-a201d3a61de2439a/coronal_011.png","assets/T/mri-a201d3a61de2439a/coronal_012.png","assets/T/mri-a201d3a61de2439a/coronal_013.png","assets/T/mri-a201d3a61de2439a/coronal_014.png","assets/T/mri-a201d3a61de2439a/coronal_015.png","assets/T/mri-a201d3a61de2439a/coronal_016.png","assets/T/mri-a201d3a61de2439a/coronal_017.png","assets/T/mri-a201d3a61de2439a/coronal_018.png","assets/T/mri-a201d3a61de2439a/coronal_019.png","assets/T/mri-a201d3a61de2439a/coronal_020.png","assets/T/mri-a201d3a61de2439a/coronal_021.png","assets/T/mri-a201d3a61de2439a/coronal_022.png","assets/T/mri-a201d3a61de2439a/coronal_023.png","assets/T/mri-a201d3a61de2439a/coronal_024.png","assets/T/mri-a201d3a61de2439a/coronal_025.png","assets/T/mri-a201d3a61de2439a/coronal_026.png","assets/T/mri-a201d3a61de2439a/coronal_027.png","assets/T/mri-a201d3a61de2439a/coronal_028.png"],"stage_edition":8}
+{"id":"L3-T300:mri-da21bfabb3a34410","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 60 张图，均来自同一次检查。\n\n- 前 36 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-da21bfabb3a34410/axial_001.png","assets/T/mri-da21bfabb3a34410/axial_002.png","assets/T/mri-da21bfabb3a34410/axial_003.png","assets/T/mri-da21bfabb3a34410/axial_004.png","assets/T/mri-da21bfabb3a34410/axial_005.png","assets/T/mri-da21bfabb3a34410/axial_006.png","assets/T/mri-da21bfabb3a34410/axial_007.png","assets/T/mri-da21bfabb3a34410/axial_008.png","assets/T/mri-da21bfabb3a34410/axial_009.png","assets/T/mri-da21bfabb3a34410/axial_010.png","assets/T/mri-da21bfabb3a34410/axial_011.png","assets/T/mri-da21bfabb3a34410/axial_012.png","assets/T/mri-da21bfabb3a34410/axial_013.png","assets/T/mri-da21bfabb3a34410/axial_014.png","assets/T/mri-da21bfabb3a34410/axial_015.png","assets/T/mri-da21bfabb3a34410/axial_016.png","assets/T/mri-da21bfabb3a34410/axial_017.png","assets/T/mri-da21bfabb3a34410/axial_018.png","assets/T/mri-da21bfabb3a34410/axial_019.png","assets/T/mri-da21bfabb3a34410/axial_020.png","assets/T/mri-da21bfabb3a34410/axial_021.png","assets/T/mri-da21bfabb3a34410/axial_022.png","assets/T/mri-da21bfabb3a34410/axial_023.png","assets/T/mri-da21bfabb3a34410/axial_024.png","assets/T/mri-da21bfabb3a34410/axial_025.png","assets/T/mri-da21bfabb3a34410/axial_026.png","assets/T/mri-da21bfabb3a34410/axial_027.png","assets/T/mri-da21bfabb3a34410/axial_028.png","assets/T/mri-da21bfabb3a34410/axial_029.png","assets/T/mri-da21bfabb3a34410/axial_030.png","assets/T/mri-da21bfabb3a34410/axial_031.png","assets/T/mri-da21bfabb3a34410/axial_032.png","assets/T/mri-da21bfabb3a34410/axial_033.png","assets/T/mri-da21bfabb3a34410/axial_034.png","assets/T/mri-da21bfabb3a34410/axial_035.png","assets/T/mri-da21bfabb3a34410/axial_036.png","assets/T/mri-da21bfabb3a34410/coronal_001.png","assets/T/mri-da21bfabb3a34410/coronal_002.png","assets/T/mri-da21bfabb3a34410/coronal_003.png","assets/T/mri-da21bfabb3a34410/coronal_004.png","assets/T/mri-da21bfabb3a34410/coronal_005.png","assets/T/mri-da21bfabb3a34410/coronal_006.png","assets/T/mri-da21bfabb3a34410/coronal_007.png","assets/T/mri-da21bfabb3a34410/coronal_008.png","assets/T/mri-da21bfabb3a34410/coronal_009.png","assets/T/mri-da21bfabb3a34410/coronal_010.png","assets/T/mri-da21bfabb3a34410/coronal_011.png","assets/T/mri-da21bfabb3a34410/coronal_012.png","assets/T/mri-da21bfabb3a34410/coronal_013.png","assets/T/mri-da21bfabb3a34410/coronal_014.png","assets/T/mri-da21bfabb3a34410/coronal_015.png","assets/T/mri-da21bfabb3a34410/coronal_016.png","assets/T/mri-da21bfabb3a34410/coronal_017.png","assets/T/mri-da21bfabb3a34410/coronal_018.png","assets/T/mri-da21bfabb3a34410/coronal_019.png","assets/T/mri-da21bfabb3a34410/coronal_020.png","assets/T/mri-da21bfabb3a34410/coronal_021.png","assets/T/mri-da21bfabb3a34410/coronal_022.png","assets/T/mri-da21bfabb3a34410/coronal_023.png","assets/T/mri-da21bfabb3a34410/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-c148e76e611e4ad8","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 72 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 30 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-c148e76e611e4ad8/axial_001.png","assets/T/mri-c148e76e611e4ad8/axial_002.png","assets/T/mri-c148e76e611e4ad8/axial_003.png","assets/T/mri-c148e76e611e4ad8/axial_004.png","assets/T/mri-c148e76e611e4ad8/axial_005.png","assets/T/mri-c148e76e611e4ad8/axial_006.png","assets/T/mri-c148e76e611e4ad8/axial_007.png","assets/T/mri-c148e76e611e4ad8/axial_008.png","assets/T/mri-c148e76e611e4ad8/axial_009.png","assets/T/mri-c148e76e611e4ad8/axial_010.png","assets/T/mri-c148e76e611e4ad8/axial_011.png","assets/T/mri-c148e76e611e4ad8/axial_012.png","assets/T/mri-c148e76e611e4ad8/axial_013.png","assets/T/mri-c148e76e611e4ad8/axial_014.png","assets/T/mri-c148e76e611e4ad8/axial_015.png","assets/T/mri-c148e76e611e4ad8/axial_016.png","assets/T/mri-c148e76e611e4ad8/axial_017.png","assets/T/mri-c148e76e611e4ad8/axial_018.png","assets/T/mri-c148e76e611e4ad8/axial_019.png","assets/T/mri-c148e76e611e4ad8/axial_020.png","assets/T/mri-c148e76e611e4ad8/axial_021.png","assets/T/mri-c148e76e611e4ad8/axial_022.png","assets/T/mri-c148e76e611e4ad8/axial_023.png","assets/T/mri-c148e76e611e4ad8/axial_024.png","assets/T/mri-c148e76e611e4ad8/axial_025.png","assets/T/mri-c148e76e611e4ad8/axial_026.png","assets/T/mri-c148e76e611e4ad8/axial_027.png","assets/T/mri-c148e76e611e4ad8/axial_028.png","assets/T/mri-c148e76e611e4ad8/axial_029.png","assets/T/mri-c148e76e611e4ad8/axial_030.png","assets/T/mri-c148e76e611e4ad8/axial_031.png","assets/T/mri-c148e76e611e4ad8/axial_032.png","assets/T/mri-c148e76e611e4ad8/axial_033.png","assets/T/mri-c148e76e611e4ad8/axial_034.png","assets/T/mri-c148e76e611e4ad8/axial_035.png","assets/T/mri-c148e76e611e4ad8/axial_036.png","assets/T/mri-c148e76e611e4ad8/axial_037.png","assets/T/mri-c148e76e611e4ad8/axial_038.png","assets/T/mri-c148e76e611e4ad8/axial_039.png","assets/T/mri-c148e76e611e4ad8/axial_040.png","assets/T/mri-c148e76e611e4ad8/axial_041.png","assets/T/mri-c148e76e611e4ad8/axial_042.png","assets/T/mri-c148e76e611e4ad8/coronal_001.png","assets/T/mri-c148e76e611e4ad8/coronal_002.png","assets/T/mri-c148e76e611e4ad8/coronal_003.png","assets/T/mri-c148e76e611e4ad8/coronal_004.png","assets/T/mri-c148e76e611e4ad8/coronal_005.png","assets/T/mri-c148e76e611e4ad8/coronal_006.png","assets/T/mri-c148e76e611e4ad8/coronal_007.png","assets/T/mri-c148e76e611e4ad8/coronal_008.png","assets/T/mri-c148e76e611e4ad8/coronal_009.png","assets/T/mri-c148e76e611e4ad8/coronal_010.png","assets/T/mri-c148e76e611e4ad8/coronal_011.png","assets/T/mri-c148e76e611e4ad8/coronal_012.png","assets/T/mri-c148e76e611e4ad8/coronal_013.png","assets/T/mri-c148e76e611e4ad8/coronal_014.png","assets/T/mri-c148e76e611e4ad8/coronal_015.png","assets/T/mri-c148e76e611e4ad8/coronal_016.png","assets/T/mri-c148e76e611e4ad8/coronal_017.png","assets/T/mri-c148e76e611e4ad8/coronal_018.png","assets/T/mri-c148e76e611e4ad8/coronal_019.png","assets/T/mri-c148e76e611e4ad8/coronal_020.png","assets/T/mri-c148e76e611e4ad8/coronal_021.png","assets/T/mri-c148e76e611e4ad8/coronal_022.png","assets/T/mri-c148e76e611e4ad8/coronal_023.png","assets/T/mri-c148e76e611e4ad8/coronal_024.png","assets/T/mri-c148e76e611e4ad8/coronal_025.png","assets/T/mri-c148e76e611e4ad8/coronal_026.png","assets/T/mri-c148e76e611e4ad8/coronal_027.png","assets/T/mri-c148e76e611e4ad8/coronal_028.png","assets/T/mri-c148e76e611e4ad8/coronal_029.png","assets/T/mri-c148e76e611e4ad8/coronal_030.png"],"stage_edition":8}
+{"id":"L3-T300:mri-b723d84d978e4a08","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-b723d84d978e4a08/axial_001.png","assets/T/mri-b723d84d978e4a08/axial_002.png","assets/T/mri-b723d84d978e4a08/axial_003.png","assets/T/mri-b723d84d978e4a08/axial_004.png","assets/T/mri-b723d84d978e4a08/axial_005.png","assets/T/mri-b723d84d978e4a08/axial_006.png","assets/T/mri-b723d84d978e4a08/axial_007.png","assets/T/mri-b723d84d978e4a08/axial_008.png","assets/T/mri-b723d84d978e4a08/axial_009.png","assets/T/mri-b723d84d978e4a08/axial_010.png","assets/T/mri-b723d84d978e4a08/axial_011.png","assets/T/mri-b723d84d978e4a08/axial_012.png","assets/T/mri-b723d84d978e4a08/axial_013.png","assets/T/mri-b723d84d978e4a08/axial_014.png","assets/T/mri-b723d84d978e4a08/axial_015.png","assets/T/mri-b723d84d978e4a08/axial_016.png","assets/T/mri-b723d84d978e4a08/axial_017.png","assets/T/mri-b723d84d978e4a08/axial_018.png","assets/T/mri-b723d84d978e4a08/axial_019.png","assets/T/mri-b723d84d978e4a08/axial_020.png","assets/T/mri-b723d84d978e4a08/axial_021.png","assets/T/mri-b723d84d978e4a08/axial_022.png","assets/T/mri-b723d84d978e4a08/axial_023.png","assets/T/mri-b723d84d978e4a08/axial_024.png","assets/T/mri-b723d84d978e4a08/axial_025.png","assets/T/mri-b723d84d978e4a08/axial_026.png","assets/T/mri-b723d84d978e4a08/axial_027.png","assets/T/mri-b723d84d978e4a08/axial_028.png","assets/T/mri-b723d84d978e4a08/axial_029.png","assets/T/mri-b723d84d978e4a08/axial_030.png","assets/T/mri-b723d84d978e4a08/axial_031.png","assets/T/mri-b723d84d978e4a08/axial_032.png","assets/T/mri-b723d84d978e4a08/axial_033.png","assets/T/mri-b723d84d978e4a08/axial_034.png","assets/T/mri-b723d84d978e4a08/axial_035.png","assets/T/mri-b723d84d978e4a08/axial_036.png","assets/T/mri-b723d84d978e4a08/axial_037.png","assets/T/mri-b723d84d978e4a08/axial_038.png","assets/T/mri-b723d84d978e4a08/axial_039.png","assets/T/mri-b723d84d978e4a08/axial_040.png","assets/T/mri-b723d84d978e4a08/axial_041.png","assets/T/mri-b723d84d978e4a08/axial_042.png","assets/T/mri-b723d84d978e4a08/coronal_001.png","assets/T/mri-b723d84d978e4a08/coronal_002.png","assets/T/mri-b723d84d978e4a08/coronal_003.png","assets/T/mri-b723d84d978e4a08/coronal_004.png","assets/T/mri-b723d84d978e4a08/coronal_005.png","assets/T/mri-b723d84d978e4a08/coronal_006.png","assets/T/mri-b723d84d978e4a08/coronal_007.png","assets/T/mri-b723d84d978e4a08/coronal_008.png","assets/T/mri-b723d84d978e4a08/coronal_009.png","assets/T/mri-b723d84d978e4a08/coronal_010.png","assets/T/mri-b723d84d978e4a08/coronal_011.png","assets/T/mri-b723d84d978e4a08/coronal_012.png","assets/T/mri-b723d84d978e4a08/coronal_013.png","assets/T/mri-b723d84d978e4a08/coronal_014.png","assets/T/mri-b723d84d978e4a08/coronal_015.png","assets/T/mri-b723d84d978e4a08/coronal_016.png","assets/T/mri-b723d84d978e4a08/coronal_017.png","assets/T/mri-b723d84d978e4a08/coronal_018.png","assets/T/mri-b723d84d978e4a08/coronal_019.png","assets/T/mri-b723d84d978e4a08/coronal_020.png","assets/T/mri-b723d84d978e4a08/coronal_021.png","assets/T/mri-b723d84d978e4a08/coronal_022.png","assets/T/mri-b723d84d978e4a08/coronal_023.png","assets/T/mri-b723d84d978e4a08/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-9febd5bfd7e4411a","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-9febd5bfd7e4411a/axial_001.png","assets/T/mri-9febd5bfd7e4411a/axial_002.png","assets/T/mri-9febd5bfd7e4411a/axial_003.png","assets/T/mri-9febd5bfd7e4411a/axial_004.png","assets/T/mri-9febd5bfd7e4411a/axial_005.png","assets/T/mri-9febd5bfd7e4411a/axial_006.png","assets/T/mri-9febd5bfd7e4411a/axial_007.png","assets/T/mri-9febd5bfd7e4411a/axial_008.png","assets/T/mri-9febd5bfd7e4411a/axial_009.png","assets/T/mri-9febd5bfd7e4411a/axial_010.png","assets/T/mri-9febd5bfd7e4411a/axial_011.png","assets/T/mri-9febd5bfd7e4411a/axial_012.png","assets/T/mri-9febd5bfd7e4411a/axial_013.png","assets/T/mri-9febd5bfd7e4411a/axial_014.png","assets/T/mri-9febd5bfd7e4411a/axial_015.png","assets/T/mri-9febd5bfd7e4411a/axial_016.png","assets/T/mri-9febd5bfd7e4411a/axial_017.png","assets/T/mri-9febd5bfd7e4411a/axial_018.png","assets/T/mri-9febd5bfd7e4411a/axial_019.png","assets/T/mri-9febd5bfd7e4411a/axial_020.png","assets/T/mri-9febd5bfd7e4411a/axial_021.png","assets/T/mri-9febd5bfd7e4411a/axial_022.png","assets/T/mri-9febd5bfd7e4411a/axial_023.png","assets/T/mri-9febd5bfd7e4411a/axial_024.png","assets/T/mri-9febd5bfd7e4411a/axial_025.png","assets/T/mri-9febd5bfd7e4411a/axial_026.png","assets/T/mri-9febd5bfd7e4411a/axial_027.png","assets/T/mri-9febd5bfd7e4411a/axial_028.png","assets/T/mri-9febd5bfd7e4411a/axial_029.png","assets/T/mri-9febd5bfd7e4411a/axial_030.png","assets/T/mri-9febd5bfd7e4411a/axial_031.png","assets/T/mri-9febd5bfd7e4411a/axial_032.png","assets/T/mri-9febd5bfd7e4411a/axial_033.png","assets/T/mri-9febd5bfd7e4411a/axial_034.png","assets/T/mri-9febd5bfd7e4411a/axial_035.png","assets/T/mri-9febd5bfd7e4411a/axial_036.png","assets/T/mri-9febd5bfd7e4411a/axial_037.png","assets/T/mri-9febd5bfd7e4411a/axial_038.png","assets/T/mri-9febd5bfd7e4411a/axial_039.png","assets/T/mri-9febd5bfd7e4411a/axial_040.png","assets/T/mri-9febd5bfd7e4411a/axial_041.png","assets/T/mri-9febd5bfd7e4411a/axial_042.png","assets/T/mri-9febd5bfd7e4411a/coronal_001.png","assets/T/mri-9febd5bfd7e4411a/coronal_002.png","assets/T/mri-9febd5bfd7e4411a/coronal_003.png","assets/T/mri-9febd5bfd7e4411a/coronal_004.png","assets/T/mri-9febd5bfd7e4411a/coronal_005.png","assets/T/mri-9febd5bfd7e4411a/coronal_006.png","assets/T/mri-9febd5bfd7e4411a/coronal_007.png","assets/T/mri-9febd5bfd7e4411a/coronal_008.png","assets/T/mri-9febd5bfd7e4411a/coronal_009.png","assets/T/mri-9febd5bfd7e4411a/coronal_010.png","assets/T/mri-9febd5bfd7e4411a/coronal_011.png","assets/T/mri-9febd5bfd7e4411a/coronal_012.png","assets/T/mri-9febd5bfd7e4411a/coronal_013.png","assets/T/mri-9febd5bfd7e4411a/coronal_014.png","assets/T/mri-9febd5bfd7e4411a/coronal_015.png","assets/T/mri-9febd5bfd7e4411a/coronal_016.png","assets/T/mri-9febd5bfd7e4411a/coronal_017.png","assets/T/mri-9febd5bfd7e4411a/coronal_018.png","assets/T/mri-9febd5bfd7e4411a/coronal_019.png","assets/T/mri-9febd5bfd7e4411a/coronal_020.png","assets/T/mri-9febd5bfd7e4411a/coronal_021.png","assets/T/mri-9febd5bfd7e4411a/coronal_022.png","assets/T/mri-9febd5bfd7e4411a/coronal_023.png","assets/T/mri-9febd5bfd7e4411a/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-9bf4932ed3d546a2","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-9bf4932ed3d546a2/axial_001.png","assets/T/mri-9bf4932ed3d546a2/axial_002.png","assets/T/mri-9bf4932ed3d546a2/axial_003.png","assets/T/mri-9bf4932ed3d546a2/axial_004.png","assets/T/mri-9bf4932ed3d546a2/axial_005.png","assets/T/mri-9bf4932ed3d546a2/axial_006.png","assets/T/mri-9bf4932ed3d546a2/axial_007.png","assets/T/mri-9bf4932ed3d546a2/axial_008.png","assets/T/mri-9bf4932ed3d546a2/axial_009.png","assets/T/mri-9bf4932ed3d546a2/axial_010.png","assets/T/mri-9bf4932ed3d546a2/axial_011.png","assets/T/mri-9bf4932ed3d546a2/axial_012.png","assets/T/mri-9bf4932ed3d546a2/axial_013.png","assets/T/mri-9bf4932ed3d546a2/axial_014.png","assets/T/mri-9bf4932ed3d546a2/axial_015.png","assets/T/mri-9bf4932ed3d546a2/axial_016.png","assets/T/mri-9bf4932ed3d546a2/axial_017.png","assets/T/mri-9bf4932ed3d546a2/axial_018.png","assets/T/mri-9bf4932ed3d546a2/axial_019.png","assets/T/mri-9bf4932ed3d546a2/axial_020.png","assets/T/mri-9bf4932ed3d546a2/axial_021.png","assets/T/mri-9bf4932ed3d546a2/axial_022.png","assets/T/mri-9bf4932ed3d546a2/axial_023.png","assets/T/mri-9bf4932ed3d546a2/axial_024.png","assets/T/mri-9bf4932ed3d546a2/axial_025.png","assets/T/mri-9bf4932ed3d546a2/axial_026.png","assets/T/mri-9bf4932ed3d546a2/axial_027.png","assets/T/mri-9bf4932ed3d546a2/axial_028.png","assets/T/mri-9bf4932ed3d546a2/axial_029.png","assets/T/mri-9bf4932ed3d546a2/axial_030.png","assets/T/mri-9bf4932ed3d546a2/axial_031.png","assets/T/mri-9bf4932ed3d546a2/axial_032.png","assets/T/mri-9bf4932ed3d546a2/axial_033.png","assets/T/mri-9bf4932ed3d546a2/axial_034.png","assets/T/mri-9bf4932ed3d546a2/axial_035.png","assets/T/mri-9bf4932ed3d546a2/axial_036.png","assets/T/mri-9bf4932ed3d546a2/axial_037.png","assets/T/mri-9bf4932ed3d546a2/axial_038.png","assets/T/mri-9bf4932ed3d546a2/axial_039.png","assets/T/mri-9bf4932ed3d546a2/axial_040.png","assets/T/mri-9bf4932ed3d546a2/axial_041.png","assets/T/mri-9bf4932ed3d546a2/axial_042.png","assets/T/mri-9bf4932ed3d546a2/coronal_001.png","assets/T/mri-9bf4932ed3d546a2/coronal_002.png","assets/T/mri-9bf4932ed3d546a2/coronal_003.png","assets/T/mri-9bf4932ed3d546a2/coronal_004.png","assets/T/mri-9bf4932ed3d546a2/coronal_005.png","assets/T/mri-9bf4932ed3d546a2/coronal_006.png","assets/T/mri-9bf4932ed3d546a2/coronal_007.png","assets/T/mri-9bf4932ed3d546a2/coronal_008.png","assets/T/mri-9bf4932ed3d546a2/coronal_009.png","assets/T/mri-9bf4932ed3d546a2/coronal_010.png","assets/T/mri-9bf4932ed3d546a2/coronal_011.png","assets/T/mri-9bf4932ed3d546a2/coronal_012.png","assets/T/mri-9bf4932ed3d546a2/coronal_013.png","assets/T/mri-9bf4932ed3d546a2/coronal_014.png","assets/T/mri-9bf4932ed3d546a2/coronal_015.png","assets/T/mri-9bf4932ed3d546a2/coronal_016.png","assets/T/mri-9bf4932ed3d546a2/coronal_017.png","assets/T/mri-9bf4932ed3d546a2/coronal_018.png","assets/T/mri-9bf4932ed3d546a2/coronal_019.png","assets/T/mri-9bf4932ed3d546a2/coronal_020.png","assets/T/mri-9bf4932ed3d546a2/coronal_021.png","assets/T/mri-9bf4932ed3d546a2/coronal_022.png","assets/T/mri-9bf4932ed3d546a2/coronal_023.png","assets/T/mri-9bf4932ed3d546a2/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-2d3b01244e0d4ee4","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 67 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 25 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-2d3b01244e0d4ee4/axial_001.png","assets/T/mri-2d3b01244e0d4ee4/axial_002.png","assets/T/mri-2d3b01244e0d4ee4/axial_003.png","assets/T/mri-2d3b01244e0d4ee4/axial_004.png","assets/T/mri-2d3b01244e0d4ee4/axial_005.png","assets/T/mri-2d3b01244e0d4ee4/axial_006.png","assets/T/mri-2d3b01244e0d4ee4/axial_007.png","assets/T/mri-2d3b01244e0d4ee4/axial_008.png","assets/T/mri-2d3b01244e0d4ee4/axial_009.png","assets/T/mri-2d3b01244e0d4ee4/axial_010.png","assets/T/mri-2d3b01244e0d4ee4/axial_011.png","assets/T/mri-2d3b01244e0d4ee4/axial_012.png","assets/T/mri-2d3b01244e0d4ee4/axial_013.png","assets/T/mri-2d3b01244e0d4ee4/axial_014.png","assets/T/mri-2d3b01244e0d4ee4/axial_015.png","assets/T/mri-2d3b01244e0d4ee4/axial_016.png","assets/T/mri-2d3b01244e0d4ee4/axial_017.png","assets/T/mri-2d3b01244e0d4ee4/axial_018.png","assets/T/mri-2d3b01244e0d4ee4/axial_019.png","assets/T/mri-2d3b01244e0d4ee4/axial_020.png","assets/T/mri-2d3b01244e0d4ee4/axial_021.png","assets/T/mri-2d3b01244e0d4ee4/axial_022.png","assets/T/mri-2d3b01244e0d4ee4/axial_023.png","assets/T/mri-2d3b01244e0d4ee4/axial_024.png","assets/T/mri-2d3b01244e0d4ee4/axial_025.png","assets/T/mri-2d3b01244e0d4ee4/axial_026.png","assets/T/mri-2d3b01244e0d4ee4/axial_027.png","assets/T/mri-2d3b01244e0d4ee4/axial_028.png","assets/T/mri-2d3b01244e0d4ee4/axial_029.png","assets/T/mri-2d3b01244e0d4ee4/axial_030.png","assets/T/mri-2d3b01244e0d4ee4/axial_031.png","assets/T/mri-2d3b01244e0d4ee4/axial_032.png","assets/T/mri-2d3b01244e0d4ee4/axial_033.png","assets/T/mri-2d3b01244e0d4ee4/axial_034.png","assets/T/mri-2d3b01244e0d4ee4/axial_035.png","assets/T/mri-2d3b01244e0d4ee4/axial_036.png","assets/T/mri-2d3b01244e0d4ee4/axial_037.png","assets/T/mri-2d3b01244e0d4ee4/axial_038.png","assets/T/mri-2d3b01244e0d4ee4/axial_039.png","assets/T/mri-2d3b01244e0d4ee4/axial_040.png","assets/T/mri-2d3b01244e0d4ee4/axial_041.png","assets/T/mri-2d3b01244e0d4ee4/axial_042.png","assets/T/mri-2d3b01244e0d4ee4/coronal_001.png","assets/T/mri-2d3b01244e0d4ee4/coronal_002.png","assets/T/mri-2d3b01244e0d4ee4/coronal_003.png","assets/T/mri-2d3b01244e0d4ee4/coronal_004.png","assets/T/mri-2d3b01244e0d4ee4/coronal_005.png","assets/T/mri-2d3b01244e0d4ee4/coronal_006.png","assets/T/mri-2d3b01244e0d4ee4/coronal_007.png","assets/T/mri-2d3b01244e0d4ee4/coronal_008.png","assets/T/mri-2d3b01244e0d4ee4/coronal_009.png","assets/T/mri-2d3b01244e0d4ee4/coronal_010.png","assets/T/mri-2d3b01244e0d4ee4/coronal_011.png","assets/T/mri-2d3b01244e0d4ee4/coronal_012.png","assets/T/mri-2d3b01244e0d4ee4/coronal_013.png","assets/T/mri-2d3b01244e0d4ee4/coronal_014.png","assets/T/mri-2d3b01244e0d4ee4/coronal_015.png","assets/T/mri-2d3b01244e0d4ee4/coronal_016.png","assets/T/mri-2d3b01244e0d4ee4/coronal_017.png","assets/T/mri-2d3b01244e0d4ee4/coronal_018.png","assets/T/mri-2d3b01244e0d4ee4/coronal_019.png","assets/T/mri-2d3b01244e0d4ee4/coronal_020.png","assets/T/mri-2d3b01244e0d4ee4/coronal_021.png","assets/T/mri-2d3b01244e0d4ee4/coronal_022.png","assets/T/mri-2d3b01244e0d4ee4/coronal_023.png","assets/T/mri-2d3b01244e0d4ee4/coronal_024.png","assets/T/mri-2d3b01244e0d4ee4/coronal_025.png"],"stage_edition":8}
+{"id":"L3-T300:mri-3a3a1e2f74f04b22","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 67 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 25 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-3a3a1e2f74f04b22/axial_001.png","assets/T/mri-3a3a1e2f74f04b22/axial_002.png","assets/T/mri-3a3a1e2f74f04b22/axial_003.png","assets/T/mri-3a3a1e2f74f04b22/axial_004.png","assets/T/mri-3a3a1e2f74f04b22/axial_005.png","assets/T/mri-3a3a1e2f74f04b22/axial_006.png","assets/T/mri-3a3a1e2f74f04b22/axial_007.png","assets/T/mri-3a3a1e2f74f04b22/axial_008.png","assets/T/mri-3a3a1e2f74f04b22/axial_009.png","assets/T/mri-3a3a1e2f74f04b22/axial_010.png","assets/T/mri-3a3a1e2f74f04b22/axial_011.png","assets/T/mri-3a3a1e2f74f04b22/axial_012.png","assets/T/mri-3a3a1e2f74f04b22/axial_013.png","assets/T/mri-3a3a1e2f74f04b22/axial_014.png","assets/T/mri-3a3a1e2f74f04b22/axial_015.png","assets/T/mri-3a3a1e2f74f04b22/axial_016.png","assets/T/mri-3a3a1e2f74f04b22/axial_017.png","assets/T/mri-3a3a1e2f74f04b22/axial_018.png","assets/T/mri-3a3a1e2f74f04b22/axial_019.png","assets/T/mri-3a3a1e2f74f04b22/axial_020.png","assets/T/mri-3a3a1e2f74f04b22/axial_021.png","assets/T/mri-3a3a1e2f74f04b22/axial_022.png","assets/T/mri-3a3a1e2f74f04b22/axial_023.png","assets/T/mri-3a3a1e2f74f04b22/axial_024.png","assets/T/mri-3a3a1e2f74f04b22/axial_025.png","assets/T/mri-3a3a1e2f74f04b22/axial_026.png","assets/T/mri-3a3a1e2f74f04b22/axial_027.png","assets/T/mri-3a3a1e2f74f04b22/axial_028.png","assets/T/mri-3a3a1e2f74f04b22/axial_029.png","assets/T/mri-3a3a1e2f74f04b22/axial_030.png","assets/T/mri-3a3a1e2f74f04b22/axial_031.png","assets/T/mri-3a3a1e2f74f04b22/axial_032.png","assets/T/mri-3a3a1e2f74f04b22/axial_033.png","assets/T/mri-3a3a1e2f74f04b22/axial_034.png","assets/T/mri-3a3a1e2f74f04b22/axial_035.png","assets/T/mri-3a3a1e2f74f04b22/axial_036.png","assets/T/mri-3a3a1e2f74f04b22/axial_037.png","assets/T/mri-3a3a1e2f74f04b22/axial_038.png","assets/T/mri-3a3a1e2f74f04b22/axial_039.png","assets/T/mri-3a3a1e2f74f04b22/axial_040.png","assets/T/mri-3a3a1e2f74f04b22/axial_041.png","assets/T/mri-3a3a1e2f74f04b22/axial_042.png","assets/T/mri-3a3a1e2f74f04b22/coronal_001.png","assets/T/mri-3a3a1e2f74f04b22/coronal_002.png","assets/T/mri-3a3a1e2f74f04b22/coronal_003.png","assets/T/mri-3a3a1e2f74f04b22/coronal_004.png","assets/T/mri-3a3a1e2f74f04b22/coronal_005.png","assets/T/mri-3a3a1e2f74f04b22/coronal_006.png","assets/T/mri-3a3a1e2f74f04b22/coronal_007.png","assets/T/mri-3a3a1e2f74f04b22/coronal_008.png","assets/T/mri-3a3a1e2f74f04b22/coronal_009.png","assets/T/mri-3a3a1e2f74f04b22/coronal_010.png","assets/T/mri-3a3a1e2f74f04b22/coronal_011.png","assets/T/mri-3a3a1e2f74f04b22/coronal_012.png","assets/T/mri-3a3a1e2f74f04b22/coronal_013.png","assets/T/mri-3a3a1e2f74f04b22/coronal_014.png","assets/T/mri-3a3a1e2f74f04b22/coronal_015.png","assets/T/mri-3a3a1e2f74f04b22/coronal_016.png","assets/T/mri-3a3a1e2f74f04b22/coronal_017.png","assets/T/mri-3a3a1e2f74f04b22/coronal_018.png","assets/T/mri-3a3a1e2f74f04b22/coronal_019.png","assets/T/mri-3a3a1e2f74f04b22/coronal_020.png","assets/T/mri-3a3a1e2f74f04b22/coronal_021.png","assets/T/mri-3a3a1e2f74f04b22/coronal_022.png","assets/T/mri-3a3a1e2f74f04b22/coronal_023.png","assets/T/mri-3a3a1e2f74f04b22/coronal_024.png","assets/T/mri-3a3a1e2f74f04b22/coronal_025.png"],"stage_edition":8}
+{"id":"L3-T300:mri-34db59d07ef34640","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-34db59d07ef34640/axial_001.png","assets/T/mri-34db59d07ef34640/axial_002.png","assets/T/mri-34db59d07ef34640/axial_003.png","assets/T/mri-34db59d07ef34640/axial_004.png","assets/T/mri-34db59d07ef34640/axial_005.png","assets/T/mri-34db59d07ef34640/axial_006.png","assets/T/mri-34db59d07ef34640/axial_007.png","assets/T/mri-34db59d07ef34640/axial_008.png","assets/T/mri-34db59d07ef34640/axial_009.png","assets/T/mri-34db59d07ef34640/axial_010.png","assets/T/mri-34db59d07ef34640/axial_011.png","assets/T/mri-34db59d07ef34640/axial_012.png","assets/T/mri-34db59d07ef34640/axial_013.png","assets/T/mri-34db59d07ef34640/axial_014.png","assets/T/mri-34db59d07ef34640/axial_015.png","assets/T/mri-34db59d07ef34640/axial_016.png","assets/T/mri-34db59d07ef34640/axial_017.png","assets/T/mri-34db59d07ef34640/axial_018.png","assets/T/mri-34db59d07ef34640/axial_019.png","assets/T/mri-34db59d07ef34640/axial_020.png","assets/T/mri-34db59d07ef34640/axial_021.png","assets/T/mri-34db59d07ef34640/axial_022.png","assets/T/mri-34db59d07ef34640/axial_023.png","assets/T/mri-34db59d07ef34640/axial_024.png","assets/T/mri-34db59d07ef34640/axial_025.png","assets/T/mri-34db59d07ef34640/axial_026.png","assets/T/mri-34db59d07ef34640/axial_027.png","assets/T/mri-34db59d07ef34640/axial_028.png","assets/T/mri-34db59d07ef34640/axial_029.png","assets/T/mri-34db59d07ef34640/axial_030.png","assets/T/mri-34db59d07ef34640/axial_031.png","assets/T/mri-34db59d07ef34640/axial_032.png","assets/T/mri-34db59d07ef34640/axial_033.png","assets/T/mri-34db59d07ef34640/axial_034.png","assets/T/mri-34db59d07ef34640/axial_035.png","assets/T/mri-34db59d07ef34640/axial_036.png","assets/T/mri-34db59d07ef34640/axial_037.png","assets/T/mri-34db59d07ef34640/axial_038.png","assets/T/mri-34db59d07ef34640/axial_039.png","assets/T/mri-34db59d07ef34640/axial_040.png","assets/T/mri-34db59d07ef34640/axial_041.png","assets/T/mri-34db59d07ef34640/axial_042.png","assets/T/mri-34db59d07ef34640/coronal_001.png","assets/T/mri-34db59d07ef34640/coronal_002.png","assets/T/mri-34db59d07ef34640/coronal_003.png","assets/T/mri-34db59d07ef34640/coronal_004.png","assets/T/mri-34db59d07ef34640/coronal_005.png","assets/T/mri-34db59d07ef34640/coronal_006.png","assets/T/mri-34db59d07ef34640/coronal_007.png","assets/T/mri-34db59d07ef34640/coronal_008.png","assets/T/mri-34db59d07ef34640/coronal_009.png","assets/T/mri-34db59d07ef34640/coronal_010.png","assets/T/mri-34db59d07ef34640/coronal_011.png","assets/T/mri-34db59d07ef34640/coronal_012.png","assets/T/mri-34db59d07ef34640/coronal_013.png","assets/T/mri-34db59d07ef34640/coronal_014.png","assets/T/mri-34db59d07ef34640/coronal_015.png","assets/T/mri-34db59d07ef34640/coronal_016.png","assets/T/mri-34db59d07ef34640/coronal_017.png","assets/T/mri-34db59d07ef34640/coronal_018.png","assets/T/mri-34db59d07ef34640/coronal_019.png","assets/T/mri-34db59d07ef34640/coronal_020.png","assets/T/mri-34db59d07ef34640/coronal_021.png","assets/T/mri-34db59d07ef34640/coronal_022.png","assets/T/mri-34db59d07ef34640/coronal_023.png","assets/T/mri-34db59d07ef34640/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-d9cf4f2c60544daa","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-d9cf4f2c60544daa/axial_001.png","assets/T/mri-d9cf4f2c60544daa/axial_002.png","assets/T/mri-d9cf4f2c60544daa/axial_003.png","assets/T/mri-d9cf4f2c60544daa/axial_004.png","assets/T/mri-d9cf4f2c60544daa/axial_005.png","assets/T/mri-d9cf4f2c60544daa/axial_006.png","assets/T/mri-d9cf4f2c60544daa/axial_007.png","assets/T/mri-d9cf4f2c60544daa/axial_008.png","assets/T/mri-d9cf4f2c60544daa/axial_009.png","assets/T/mri-d9cf4f2c60544daa/axial_010.png","assets/T/mri-d9cf4f2c60544daa/axial_011.png","assets/T/mri-d9cf4f2c60544daa/axial_012.png","assets/T/mri-d9cf4f2c60544daa/axial_013.png","assets/T/mri-d9cf4f2c60544daa/axial_014.png","assets/T/mri-d9cf4f2c60544daa/axial_015.png","assets/T/mri-d9cf4f2c60544daa/axial_016.png","assets/T/mri-d9cf4f2c60544daa/axial_017.png","assets/T/mri-d9cf4f2c60544daa/axial_018.png","assets/T/mri-d9cf4f2c60544daa/axial_019.png","assets/T/mri-d9cf4f2c60544daa/axial_020.png","assets/T/mri-d9cf4f2c60544daa/axial_021.png","assets/T/mri-d9cf4f2c60544daa/axial_022.png","assets/T/mri-d9cf4f2c60544daa/axial_023.png","assets/T/mri-d9cf4f2c60544daa/axial_024.png","assets/T/mri-d9cf4f2c60544daa/axial_025.png","assets/T/mri-d9cf4f2c60544daa/axial_026.png","assets/T/mri-d9cf4f2c60544daa/axial_027.png","assets/T/mri-d9cf4f2c60544daa/axial_028.png","assets/T/mri-d9cf4f2c60544daa/axial_029.png","assets/T/mri-d9cf4f2c60544daa/axial_030.png","assets/T/mri-d9cf4f2c60544daa/axial_031.png","assets/T/mri-d9cf4f2c60544daa/axial_032.png","assets/T/mri-d9cf4f2c60544daa/axial_033.png","assets/T/mri-d9cf4f2c60544daa/axial_034.png","assets/T/mri-d9cf4f2c60544daa/axial_035.png","assets/T/mri-d9cf4f2c60544daa/axial_036.png","assets/T/mri-d9cf4f2c60544daa/axial_037.png","assets/T/mri-d9cf4f2c60544daa/axial_038.png","assets/T/mri-d9cf4f2c60544daa/axial_039.png","assets/T/mri-d9cf4f2c60544daa/axial_040.png","assets/T/mri-d9cf4f2c60544daa/coronal_001.png","assets/T/mri-d9cf4f2c60544daa/coronal_002.png","assets/T/mri-d9cf4f2c60544daa/coronal_003.png","assets/T/mri-d9cf4f2c60544daa/coronal_004.png","assets/T/mri-d9cf4f2c60544daa/coronal_005.png","assets/T/mri-d9cf4f2c60544daa/coronal_006.png","assets/T/mri-d9cf4f2c60544daa/coronal_007.png","assets/T/mri-d9cf4f2c60544daa/coronal_008.png","assets/T/mri-d9cf4f2c60544daa/coronal_009.png","assets/T/mri-d9cf4f2c60544daa/coronal_010.png","assets/T/mri-d9cf4f2c60544daa/coronal_011.png","assets/T/mri-d9cf4f2c60544daa/coronal_012.png","assets/T/mri-d9cf4f2c60544daa/coronal_013.png","assets/T/mri-d9cf4f2c60544daa/coronal_014.png","assets/T/mri-d9cf4f2c60544daa/coronal_015.png","assets/T/mri-d9cf4f2c60544daa/coronal_016.png","assets/T/mri-d9cf4f2c60544daa/coronal_017.png","assets/T/mri-d9cf4f2c60544daa/coronal_018.png","assets/T/mri-d9cf4f2c60544daa/coronal_019.png","assets/T/mri-d9cf4f2c60544daa/coronal_020.png","assets/T/mri-d9cf4f2c60544daa/coronal_021.png","assets/T/mri-d9cf4f2c60544daa/coronal_022.png","assets/T/mri-d9cf4f2c60544daa/coronal_023.png","assets/T/mri-d9cf4f2c60544daa/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-26f2f06937804ccf","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-26f2f06937804ccf/axial_001.png","assets/T/mri-26f2f06937804ccf/axial_002.png","assets/T/mri-26f2f06937804ccf/axial_003.png","assets/T/mri-26f2f06937804ccf/axial_004.png","assets/T/mri-26f2f06937804ccf/axial_005.png","assets/T/mri-26f2f06937804ccf/axial_006.png","assets/T/mri-26f2f06937804ccf/axial_007.png","assets/T/mri-26f2f06937804ccf/axial_008.png","assets/T/mri-26f2f06937804ccf/axial_009.png","assets/T/mri-26f2f06937804ccf/axial_010.png","assets/T/mri-26f2f06937804ccf/axial_011.png","assets/T/mri-26f2f06937804ccf/axial_012.png","assets/T/mri-26f2f06937804ccf/axial_013.png","assets/T/mri-26f2f06937804ccf/axial_014.png","assets/T/mri-26f2f06937804ccf/axial_015.png","assets/T/mri-26f2f06937804ccf/axial_016.png","assets/T/mri-26f2f06937804ccf/axial_017.png","assets/T/mri-26f2f06937804ccf/axial_018.png","assets/T/mri-26f2f06937804ccf/axial_019.png","assets/T/mri-26f2f06937804ccf/axial_020.png","assets/T/mri-26f2f06937804ccf/axial_021.png","assets/T/mri-26f2f06937804ccf/axial_022.png","assets/T/mri-26f2f06937804ccf/axial_023.png","assets/T/mri-26f2f06937804ccf/axial_024.png","assets/T/mri-26f2f06937804ccf/axial_025.png","assets/T/mri-26f2f06937804ccf/axial_026.png","assets/T/mri-26f2f06937804ccf/axial_027.png","assets/T/mri-26f2f06937804ccf/axial_028.png","assets/T/mri-26f2f06937804ccf/axial_029.png","assets/T/mri-26f2f06937804ccf/axial_030.png","assets/T/mri-26f2f06937804ccf/axial_031.png","assets/T/mri-26f2f06937804ccf/axial_032.png","assets/T/mri-26f2f06937804ccf/axial_033.png","assets/T/mri-26f2f06937804ccf/axial_034.png","assets/T/mri-26f2f06937804ccf/axial_035.png","assets/T/mri-26f2f06937804ccf/axial_036.png","assets/T/mri-26f2f06937804ccf/axial_037.png","assets/T/mri-26f2f06937804ccf/axial_038.png","assets/T/mri-26f2f06937804ccf/axial_039.png","assets/T/mri-26f2f06937804ccf/axial_040.png","assets/T/mri-26f2f06937804ccf/coronal_001.png","assets/T/mri-26f2f06937804ccf/coronal_002.png","assets/T/mri-26f2f06937804ccf/coronal_003.png","assets/T/mri-26f2f06937804ccf/coronal_004.png","assets/T/mri-26f2f06937804ccf/coronal_005.png","assets/T/mri-26f2f06937804ccf/coronal_006.png","assets/T/mri-26f2f06937804ccf/coronal_007.png","assets/T/mri-26f2f06937804ccf/coronal_008.png","assets/T/mri-26f2f06937804ccf/coronal_009.png","assets/T/mri-26f2f06937804ccf/coronal_010.png","assets/T/mri-26f2f06937804ccf/coronal_011.png","assets/T/mri-26f2f06937804ccf/coronal_012.png","assets/T/mri-26f2f06937804ccf/coronal_013.png","assets/T/mri-26f2f06937804ccf/coronal_014.png","assets/T/mri-26f2f06937804ccf/coronal_015.png","assets/T/mri-26f2f06937804ccf/coronal_016.png","assets/T/mri-26f2f06937804ccf/coronal_017.png","assets/T/mri-26f2f06937804ccf/coronal_018.png","assets/T/mri-26f2f06937804ccf/coronal_019.png","assets/T/mri-26f2f06937804ccf/coronal_020.png","assets/T/mri-26f2f06937804ccf/coronal_021.png","assets/T/mri-26f2f06937804ccf/coronal_022.png","assets/T/mri-26f2f06937804ccf/coronal_023.png","assets/T/mri-26f2f06937804ccf/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-629c4e4164da4fae","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 72 张图，均来自同一次检查。\n\n- 前 44 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 28 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-629c4e4164da4fae/axial_001.png","assets/T/mri-629c4e4164da4fae/axial_002.png","assets/T/mri-629c4e4164da4fae/axial_003.png","assets/T/mri-629c4e4164da4fae/axial_004.png","assets/T/mri-629c4e4164da4fae/axial_005.png","assets/T/mri-629c4e4164da4fae/axial_006.png","assets/T/mri-629c4e4164da4fae/axial_007.png","assets/T/mri-629c4e4164da4fae/axial_008.png","assets/T/mri-629c4e4164da4fae/axial_009.png","assets/T/mri-629c4e4164da4fae/axial_010.png","assets/T/mri-629c4e4164da4fae/axial_011.png","assets/T/mri-629c4e4164da4fae/axial_012.png","assets/T/mri-629c4e4164da4fae/axial_013.png","assets/T/mri-629c4e4164da4fae/axial_014.png","assets/T/mri-629c4e4164da4fae/axial_015.png","assets/T/mri-629c4e4164da4fae/axial_016.png","assets/T/mri-629c4e4164da4fae/axial_017.png","assets/T/mri-629c4e4164da4fae/axial_018.png","assets/T/mri-629c4e4164da4fae/axial_019.png","assets/T/mri-629c4e4164da4fae/axial_020.png","assets/T/mri-629c4e4164da4fae/axial_021.png","assets/T/mri-629c4e4164da4fae/axial_022.png","assets/T/mri-629c4e4164da4fae/axial_023.png","assets/T/mri-629c4e4164da4fae/axial_024.png","assets/T/mri-629c4e4164da4fae/axial_025.png","assets/T/mri-629c4e4164da4fae/axial_026.png","assets/T/mri-629c4e4164da4fae/axial_027.png","assets/T/mri-629c4e4164da4fae/axial_028.png","assets/T/mri-629c4e4164da4fae/axial_029.png","assets/T/mri-629c4e4164da4fae/axial_030.png","assets/T/mri-629c4e4164da4fae/axial_031.png","assets/T/mri-629c4e4164da4fae/axial_032.png","assets/T/mri-629c4e4164da4fae/axial_033.png","assets/T/mri-629c4e4164da4fae/axial_034.png","assets/T/mri-629c4e4164da4fae/axial_035.png","assets/T/mri-629c4e4164da4fae/axial_036.png","assets/T/mri-629c4e4164da4fae/axial_037.png","assets/T/mri-629c4e4164da4fae/axial_038.png","assets/T/mri-629c4e4164da4fae/axial_039.png","assets/T/mri-629c4e4164da4fae/axial_040.png","assets/T/mri-629c4e4164da4fae/axial_041.png","assets/T/mri-629c4e4164da4fae/axial_042.png","assets/T/mri-629c4e4164da4fae/axial_043.png","assets/T/mri-629c4e4164da4fae/axial_044.png","assets/T/mri-629c4e4164da4fae/coronal_001.png","assets/T/mri-629c4e4164da4fae/coronal_002.png","assets/T/mri-629c4e4164da4fae/coronal_003.png","assets/T/mri-629c4e4164da4fae/coronal_004.png","assets/T/mri-629c4e4164da4fae/coronal_005.png","assets/T/mri-629c4e4164da4fae/coronal_006.png","assets/T/mri-629c4e4164da4fae/coronal_007.png","assets/T/mri-629c4e4164da4fae/coronal_008.png","assets/T/mri-629c4e4164da4fae/coronal_009.png","assets/T/mri-629c4e4164da4fae/coronal_010.png","assets/T/mri-629c4e4164da4fae/coronal_011.png","assets/T/mri-629c4e4164da4fae/coronal_012.png","assets/T/mri-629c4e4164da4fae/coronal_013.png","assets/T/mri-629c4e4164da4fae/coronal_014.png","assets/T/mri-629c4e4164da4fae/coronal_015.png","assets/T/mri-629c4e4164da4fae/coronal_016.png","assets/T/mri-629c4e4164da4fae/coronal_017.png","assets/T/mri-629c4e4164da4fae/coronal_018.png","assets/T/mri-629c4e4164da4fae/coronal_019.png","assets/T/mri-629c4e4164da4fae/coronal_020.png","assets/T/mri-629c4e4164da4fae/coronal_021.png","assets/T/mri-629c4e4164da4fae/coronal_022.png","assets/T/mri-629c4e4164da4fae/coronal_023.png","assets/T/mri-629c4e4164da4fae/coronal_024.png","assets/T/mri-629c4e4164da4fae/coronal_025.png","assets/T/mri-629c4e4164da4fae/coronal_026.png","assets/T/mri-629c4e4164da4fae/coronal_027.png","assets/T/mri-629c4e4164da4fae/coronal_028.png"],"stage_edition":8}
+{"id":"L3-T300:mri-29505b0ebf294dfd","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-29505b0ebf294dfd/axial_001.png","assets/T/mri-29505b0ebf294dfd/axial_002.png","assets/T/mri-29505b0ebf294dfd/axial_003.png","assets/T/mri-29505b0ebf294dfd/axial_004.png","assets/T/mri-29505b0ebf294dfd/axial_005.png","assets/T/mri-29505b0ebf294dfd/axial_006.png","assets/T/mri-29505b0ebf294dfd/axial_007.png","assets/T/mri-29505b0ebf294dfd/axial_008.png","assets/T/mri-29505b0ebf294dfd/axial_009.png","assets/T/mri-29505b0ebf294dfd/axial_010.png","assets/T/mri-29505b0ebf294dfd/axial_011.png","assets/T/mri-29505b0ebf294dfd/axial_012.png","assets/T/mri-29505b0ebf294dfd/axial_013.png","assets/T/mri-29505b0ebf294dfd/axial_014.png","assets/T/mri-29505b0ebf294dfd/axial_015.png","assets/T/mri-29505b0ebf294dfd/axial_016.png","assets/T/mri-29505b0ebf294dfd/axial_017.png","assets/T/mri-29505b0ebf294dfd/axial_018.png","assets/T/mri-29505b0ebf294dfd/axial_019.png","assets/T/mri-29505b0ebf294dfd/axial_020.png","assets/T/mri-29505b0ebf294dfd/axial_021.png","assets/T/mri-29505b0ebf294dfd/axial_022.png","assets/T/mri-29505b0ebf294dfd/axial_023.png","assets/T/mri-29505b0ebf294dfd/axial_024.png","assets/T/mri-29505b0ebf294dfd/axial_025.png","assets/T/mri-29505b0ebf294dfd/axial_026.png","assets/T/mri-29505b0ebf294dfd/axial_027.png","assets/T/mri-29505b0ebf294dfd/axial_028.png","assets/T/mri-29505b0ebf294dfd/axial_029.png","assets/T/mri-29505b0ebf294dfd/axial_030.png","assets/T/mri-29505b0ebf294dfd/axial_031.png","assets/T/mri-29505b0ebf294dfd/axial_032.png","assets/T/mri-29505b0ebf294dfd/axial_033.png","assets/T/mri-29505b0ebf294dfd/axial_034.png","assets/T/mri-29505b0ebf294dfd/axial_035.png","assets/T/mri-29505b0ebf294dfd/axial_036.png","assets/T/mri-29505b0ebf294dfd/axial_037.png","assets/T/mri-29505b0ebf294dfd/axial_038.png","assets/T/mri-29505b0ebf294dfd/axial_039.png","assets/T/mri-29505b0ebf294dfd/axial_040.png","assets/T/mri-29505b0ebf294dfd/axial_041.png","assets/T/mri-29505b0ebf294dfd/axial_042.png","assets/T/mri-29505b0ebf294dfd/coronal_001.png","assets/T/mri-29505b0ebf294dfd/coronal_002.png","assets/T/mri-29505b0ebf294dfd/coronal_003.png","assets/T/mri-29505b0ebf294dfd/coronal_004.png","assets/T/mri-29505b0ebf294dfd/coronal_005.png","assets/T/mri-29505b0ebf294dfd/coronal_006.png","assets/T/mri-29505b0ebf294dfd/coronal_007.png","assets/T/mri-29505b0ebf294dfd/coronal_008.png","assets/T/mri-29505b0ebf294dfd/coronal_009.png","assets/T/mri-29505b0ebf294dfd/coronal_010.png","assets/T/mri-29505b0ebf294dfd/coronal_011.png","assets/T/mri-29505b0ebf294dfd/coronal_012.png","assets/T/mri-29505b0ebf294dfd/coronal_013.png","assets/T/mri-29505b0ebf294dfd/coronal_014.png","assets/T/mri-29505b0ebf294dfd/coronal_015.png","assets/T/mri-29505b0ebf294dfd/coronal_016.png","assets/T/mri-29505b0ebf294dfd/coronal_017.png","assets/T/mri-29505b0ebf294dfd/coronal_018.png","assets/T/mri-29505b0ebf294dfd/coronal_019.png","assets/T/mri-29505b0ebf294dfd/coronal_020.png","assets/T/mri-29505b0ebf294dfd/coronal_021.png","assets/T/mri-29505b0ebf294dfd/coronal_022.png","assets/T/mri-29505b0ebf294dfd/coronal_023.png","assets/T/mri-29505b0ebf294dfd/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-e2fd54c6f0cc4d8b","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 62 张图，均来自同一次检查。\n\n- 前 38 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-e2fd54c6f0cc4d8b/axial_001.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_002.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_003.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_004.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_005.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_006.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_007.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_008.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_009.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_010.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_011.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_012.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_013.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_014.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_015.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_016.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_017.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_018.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_019.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_020.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_021.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_022.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_023.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_024.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_025.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_026.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_027.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_028.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_029.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_030.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_031.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_032.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_033.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_034.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_035.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_036.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_037.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_038.png","assets/T/mri-e2fd54c6f0cc4d8b/coronal_001.png","assets/T/mri-e2fd54c6f0cc4d8b/coronal_002.png","assets/T/mri-e2fd54c6f0cc4d8b/coronal_003.png","assets/T/mri-e2fd54c6f0cc4d8b/coronal_004.png","assets/T/mri-e2fd54c6f0cc4d8b/coronal_005.png","assets/T/mri-e2fd54c6f0cc4d8b/coronal_006.png","assets/T/mri-e2fd54c6f0cc4d8b/coronal_007.png","assets/T/mri-e2fd54c6f0cc4d8b/coronal_008.png","assets/T/mri-e2fd54c6f0cc4d8b/coronal_009.png","assets/T/mri-e2fd54c6f0cc4d8b/coronal_010.png","assets/T/mri-e2fd54c6f0cc4d8b/coronal_011.png","assets/T/mri-e2fd54c6f0cc4d8b/coronal_012.png","assets/T/mri-e2fd54c6f0cc4d8b/coronal_013.png","assets/T/mri-e2fd54c6f0cc4d8b/coronal_014.png","assets/T/mri-e2fd54c6f0cc4d8b/coronal_015.png","assets/T/mri-e2fd54c6f0cc4d8b/coronal_016.png","assets/T/mri-e2fd54c6f0cc4d8b/coronal_017.png","assets/T/mri-e2fd54c6f0cc4d8b/coronal_018.png","assets/T/mri-e2fd54c6f0cc4d8b/coronal_019.png","assets/T/mri-e2fd54c6f0cc4d8b/coronal_020.png","assets/T/mri-e2fd54c6f0cc4d8b/coronal_021.png","assets/T/mri-e2fd54c6f0cc4d8b/coronal_022.png","assets/T/mri-e2fd54c6f0cc4d8b/coronal_023.png","assets/T/mri-e2fd54c6f0cc4d8b/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-e409f2ae4d1b4e1f","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 68 张图，均来自同一次检查。\n\n- 前 44 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-e409f2ae4d1b4e1f/axial_001.png","assets/T/mri-e409f2ae4d1b4e1f/axial_002.png","assets/T/mri-e409f2ae4d1b4e1f/axial_003.png","assets/T/mri-e409f2ae4d1b4e1f/axial_004.png","assets/T/mri-e409f2ae4d1b4e1f/axial_005.png","assets/T/mri-e409f2ae4d1b4e1f/axial_006.png","assets/T/mri-e409f2ae4d1b4e1f/axial_007.png","assets/T/mri-e409f2ae4d1b4e1f/axial_008.png","assets/T/mri-e409f2ae4d1b4e1f/axial_009.png","assets/T/mri-e409f2ae4d1b4e1f/axial_010.png","assets/T/mri-e409f2ae4d1b4e1f/axial_011.png","assets/T/mri-e409f2ae4d1b4e1f/axial_012.png","assets/T/mri-e409f2ae4d1b4e1f/axial_013.png","assets/T/mri-e409f2ae4d1b4e1f/axial_014.png","assets/T/mri-e409f2ae4d1b4e1f/axial_015.png","assets/T/mri-e409f2ae4d1b4e1f/axial_016.png","assets/T/mri-e409f2ae4d1b4e1f/axial_017.png","assets/T/mri-e409f2ae4d1b4e1f/axial_018.png","assets/T/mri-e409f2ae4d1b4e1f/axial_019.png","assets/T/mri-e409f2ae4d1b4e1f/axial_020.png","assets/T/mri-e409f2ae4d1b4e1f/axial_021.png","assets/T/mri-e409f2ae4d1b4e1f/axial_022.png","assets/T/mri-e409f2ae4d1b4e1f/axial_023.png","assets/T/mri-e409f2ae4d1b4e1f/axial_024.png","assets/T/mri-e409f2ae4d1b4e1f/axial_025.png","assets/T/mri-e409f2ae4d1b4e1f/axial_026.png","assets/T/mri-e409f2ae4d1b4e1f/axial_027.png","assets/T/mri-e409f2ae4d1b4e1f/axial_028.png","assets/T/mri-e409f2ae4d1b4e1f/axial_029.png","assets/T/mri-e409f2ae4d1b4e1f/axial_030.png","assets/T/mri-e409f2ae4d1b4e1f/axial_031.png","assets/T/mri-e409f2ae4d1b4e1f/axial_032.png","assets/T/mri-e409f2ae4d1b4e1f/axial_033.png","assets/T/mri-e409f2ae4d1b4e1f/axial_034.png","assets/T/mri-e409f2ae4d1b4e1f/axial_035.png","assets/T/mri-e409f2ae4d1b4e1f/axial_036.png","assets/T/mri-e409f2ae4d1b4e1f/axial_037.png","assets/T/mri-e409f2ae4d1b4e1f/axial_038.png","assets/T/mri-e409f2ae4d1b4e1f/axial_039.png","assets/T/mri-e409f2ae4d1b4e1f/axial_040.png","assets/T/mri-e409f2ae4d1b4e1f/axial_041.png","assets/T/mri-e409f2ae4d1b4e1f/axial_042.png","assets/T/mri-e409f2ae4d1b4e1f/axial_043.png","assets/T/mri-e409f2ae4d1b4e1f/axial_044.png","assets/T/mri-e409f2ae4d1b4e1f/coronal_001.png","assets/T/mri-e409f2ae4d1b4e1f/coronal_002.png","assets/T/mri-e409f2ae4d1b4e1f/coronal_003.png","assets/T/mri-e409f2ae4d1b4e1f/coronal_004.png","assets/T/mri-e409f2ae4d1b4e1f/coronal_005.png","assets/T/mri-e409f2ae4d1b4e1f/coronal_006.png","assets/T/mri-e409f2ae4d1b4e1f/coronal_007.png","assets/T/mri-e409f2ae4d1b4e1f/coronal_008.png","assets/T/mri-e409f2ae4d1b4e1f/coronal_009.png","assets/T/mri-e409f2ae4d1b4e1f/coronal_010.png","assets/T/mri-e409f2ae4d1b4e1f/coronal_011.png","assets/T/mri-e409f2ae4d1b4e1f/coronal_012.png","assets/T/mri-e409f2ae4d1b4e1f/coronal_013.png","assets/T/mri-e409f2ae4d1b4e1f/coronal_014.png","assets/T/mri-e409f2ae4d1b4e1f/coronal_015.png","assets/T/mri-e409f2ae4d1b4e1f/coronal_016.png","assets/T/mri-e409f2ae4d1b4e1f/coronal_017.png","assets/T/mri-e409f2ae4d1b4e1f/coronal_018.png","assets/T/mri-e409f2ae4d1b4e1f/coronal_019.png","assets/T/mri-e409f2ae4d1b4e1f/coronal_020.png","assets/T/mri-e409f2ae4d1b4e1f/coronal_021.png","assets/T/mri-e409f2ae4d1b4e1f/coronal_022.png","assets/T/mri-e409f2ae4d1b4e1f/coronal_023.png","assets/T/mri-e409f2ae4d1b4e1f/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-9e12e91c8dc74f98","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-9e12e91c8dc74f98/axial_001.png","assets/T/mri-9e12e91c8dc74f98/axial_002.png","assets/T/mri-9e12e91c8dc74f98/axial_003.png","assets/T/mri-9e12e91c8dc74f98/axial_004.png","assets/T/mri-9e12e91c8dc74f98/axial_005.png","assets/T/mri-9e12e91c8dc74f98/axial_006.png","assets/T/mri-9e12e91c8dc74f98/axial_007.png","assets/T/mri-9e12e91c8dc74f98/axial_008.png","assets/T/mri-9e12e91c8dc74f98/axial_009.png","assets/T/mri-9e12e91c8dc74f98/axial_010.png","assets/T/mri-9e12e91c8dc74f98/axial_011.png","assets/T/mri-9e12e91c8dc74f98/axial_012.png","assets/T/mri-9e12e91c8dc74f98/axial_013.png","assets/T/mri-9e12e91c8dc74f98/axial_014.png","assets/T/mri-9e12e91c8dc74f98/axial_015.png","assets/T/mri-9e12e91c8dc74f98/axial_016.png","assets/T/mri-9e12e91c8dc74f98/axial_017.png","assets/T/mri-9e12e91c8dc74f98/axial_018.png","assets/T/mri-9e12e91c8dc74f98/axial_019.png","assets/T/mri-9e12e91c8dc74f98/axial_020.png","assets/T/mri-9e12e91c8dc74f98/axial_021.png","assets/T/mri-9e12e91c8dc74f98/axial_022.png","assets/T/mri-9e12e91c8dc74f98/axial_023.png","assets/T/mri-9e12e91c8dc74f98/axial_024.png","assets/T/mri-9e12e91c8dc74f98/axial_025.png","assets/T/mri-9e12e91c8dc74f98/axial_026.png","assets/T/mri-9e12e91c8dc74f98/axial_027.png","assets/T/mri-9e12e91c8dc74f98/axial_028.png","assets/T/mri-9e12e91c8dc74f98/axial_029.png","assets/T/mri-9e12e91c8dc74f98/axial_030.png","assets/T/mri-9e12e91c8dc74f98/axial_031.png","assets/T/mri-9e12e91c8dc74f98/axial_032.png","assets/T/mri-9e12e91c8dc74f98/axial_033.png","assets/T/mri-9e12e91c8dc74f98/axial_034.png","assets/T/mri-9e12e91c8dc74f98/axial_035.png","assets/T/mri-9e12e91c8dc74f98/axial_036.png","assets/T/mri-9e12e91c8dc74f98/axial_037.png","assets/T/mri-9e12e91c8dc74f98/axial_038.png","assets/T/mri-9e12e91c8dc74f98/axial_039.png","assets/T/mri-9e12e91c8dc74f98/axial_040.png","assets/T/mri-9e12e91c8dc74f98/coronal_001.png","assets/T/mri-9e12e91c8dc74f98/coronal_002.png","assets/T/mri-9e12e91c8dc74f98/coronal_003.png","assets/T/mri-9e12e91c8dc74f98/coronal_004.png","assets/T/mri-9e12e91c8dc74f98/coronal_005.png","assets/T/mri-9e12e91c8dc74f98/coronal_006.png","assets/T/mri-9e12e91c8dc74f98/coronal_007.png","assets/T/mri-9e12e91c8dc74f98/coronal_008.png","assets/T/mri-9e12e91c8dc74f98/coronal_009.png","assets/T/mri-9e12e91c8dc74f98/coronal_010.png","assets/T/mri-9e12e91c8dc74f98/coronal_011.png","assets/T/mri-9e12e91c8dc74f98/coronal_012.png","assets/T/mri-9e12e91c8dc74f98/coronal_013.png","assets/T/mri-9e12e91c8dc74f98/coronal_014.png","assets/T/mri-9e12e91c8dc74f98/coronal_015.png","assets/T/mri-9e12e91c8dc74f98/coronal_016.png","assets/T/mri-9e12e91c8dc74f98/coronal_017.png","assets/T/mri-9e12e91c8dc74f98/coronal_018.png","assets/T/mri-9e12e91c8dc74f98/coronal_019.png","assets/T/mri-9e12e91c8dc74f98/coronal_020.png","assets/T/mri-9e12e91c8dc74f98/coronal_021.png","assets/T/mri-9e12e91c8dc74f98/coronal_022.png","assets/T/mri-9e12e91c8dc74f98/coronal_023.png","assets/T/mri-9e12e91c8dc74f98/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-ae6a7613901c4b94","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-ae6a7613901c4b94/axial_001.png","assets/T/mri-ae6a7613901c4b94/axial_002.png","assets/T/mri-ae6a7613901c4b94/axial_003.png","assets/T/mri-ae6a7613901c4b94/axial_004.png","assets/T/mri-ae6a7613901c4b94/axial_005.png","assets/T/mri-ae6a7613901c4b94/axial_006.png","assets/T/mri-ae6a7613901c4b94/axial_007.png","assets/T/mri-ae6a7613901c4b94/axial_008.png","assets/T/mri-ae6a7613901c4b94/axial_009.png","assets/T/mri-ae6a7613901c4b94/axial_010.png","assets/T/mri-ae6a7613901c4b94/axial_011.png","assets/T/mri-ae6a7613901c4b94/axial_012.png","assets/T/mri-ae6a7613901c4b94/axial_013.png","assets/T/mri-ae6a7613901c4b94/axial_014.png","assets/T/mri-ae6a7613901c4b94/axial_015.png","assets/T/mri-ae6a7613901c4b94/axial_016.png","assets/T/mri-ae6a7613901c4b94/axial_017.png","assets/T/mri-ae6a7613901c4b94/axial_018.png","assets/T/mri-ae6a7613901c4b94/axial_019.png","assets/T/mri-ae6a7613901c4b94/axial_020.png","assets/T/mri-ae6a7613901c4b94/axial_021.png","assets/T/mri-ae6a7613901c4b94/axial_022.png","assets/T/mri-ae6a7613901c4b94/axial_023.png","assets/T/mri-ae6a7613901c4b94/axial_024.png","assets/T/mri-ae6a7613901c4b94/axial_025.png","assets/T/mri-ae6a7613901c4b94/axial_026.png","assets/T/mri-ae6a7613901c4b94/axial_027.png","assets/T/mri-ae6a7613901c4b94/axial_028.png","assets/T/mri-ae6a7613901c4b94/axial_029.png","assets/T/mri-ae6a7613901c4b94/axial_030.png","assets/T/mri-ae6a7613901c4b94/axial_031.png","assets/T/mri-ae6a7613901c4b94/axial_032.png","assets/T/mri-ae6a7613901c4b94/axial_033.png","assets/T/mri-ae6a7613901c4b94/axial_034.png","assets/T/mri-ae6a7613901c4b94/axial_035.png","assets/T/mri-ae6a7613901c4b94/axial_036.png","assets/T/mri-ae6a7613901c4b94/axial_037.png","assets/T/mri-ae6a7613901c4b94/axial_038.png","assets/T/mri-ae6a7613901c4b94/axial_039.png","assets/T/mri-ae6a7613901c4b94/axial_040.png","assets/T/mri-ae6a7613901c4b94/coronal_001.png","assets/T/mri-ae6a7613901c4b94/coronal_002.png","assets/T/mri-ae6a7613901c4b94/coronal_003.png","assets/T/mri-ae6a7613901c4b94/coronal_004.png","assets/T/mri-ae6a7613901c4b94/coronal_005.png","assets/T/mri-ae6a7613901c4b94/coronal_006.png","assets/T/mri-ae6a7613901c4b94/coronal_007.png","assets/T/mri-ae6a7613901c4b94/coronal_008.png","assets/T/mri-ae6a7613901c4b94/coronal_009.png","assets/T/mri-ae6a7613901c4b94/coronal_010.png","assets/T/mri-ae6a7613901c4b94/coronal_011.png","assets/T/mri-ae6a7613901c4b94/coronal_012.png","assets/T/mri-ae6a7613901c4b94/coronal_013.png","assets/T/mri-ae6a7613901c4b94/coronal_014.png","assets/T/mri-ae6a7613901c4b94/coronal_015.png","assets/T/mri-ae6a7613901c4b94/coronal_016.png","assets/T/mri-ae6a7613901c4b94/coronal_017.png","assets/T/mri-ae6a7613901c4b94/coronal_018.png","assets/T/mri-ae6a7613901c4b94/coronal_019.png","assets/T/mri-ae6a7613901c4b94/coronal_020.png","assets/T/mri-ae6a7613901c4b94/coronal_021.png","assets/T/mri-ae6a7613901c4b94/coronal_022.png","assets/T/mri-ae6a7613901c4b94/coronal_023.png","assets/T/mri-ae6a7613901c4b94/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-fd066ee0a9c14d5b","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 68 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 26 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-fd066ee0a9c14d5b/axial_001.png","assets/T/mri-fd066ee0a9c14d5b/axial_002.png","assets/T/mri-fd066ee0a9c14d5b/axial_003.png","assets/T/mri-fd066ee0a9c14d5b/axial_004.png","assets/T/mri-fd066ee0a9c14d5b/axial_005.png","assets/T/mri-fd066ee0a9c14d5b/axial_006.png","assets/T/mri-fd066ee0a9c14d5b/axial_007.png","assets/T/mri-fd066ee0a9c14d5b/axial_008.png","assets/T/mri-fd066ee0a9c14d5b/axial_009.png","assets/T/mri-fd066ee0a9c14d5b/axial_010.png","assets/T/mri-fd066ee0a9c14d5b/axial_011.png","assets/T/mri-fd066ee0a9c14d5b/axial_012.png","assets/T/mri-fd066ee0a9c14d5b/axial_013.png","assets/T/mri-fd066ee0a9c14d5b/axial_014.png","assets/T/mri-fd066ee0a9c14d5b/axial_015.png","assets/T/mri-fd066ee0a9c14d5b/axial_016.png","assets/T/mri-fd066ee0a9c14d5b/axial_017.png","assets/T/mri-fd066ee0a9c14d5b/axial_018.png","assets/T/mri-fd066ee0a9c14d5b/axial_019.png","assets/T/mri-fd066ee0a9c14d5b/axial_020.png","assets/T/mri-fd066ee0a9c14d5b/axial_021.png","assets/T/mri-fd066ee0a9c14d5b/axial_022.png","assets/T/mri-fd066ee0a9c14d5b/axial_023.png","assets/T/mri-fd066ee0a9c14d5b/axial_024.png","assets/T/mri-fd066ee0a9c14d5b/axial_025.png","assets/T/mri-fd066ee0a9c14d5b/axial_026.png","assets/T/mri-fd066ee0a9c14d5b/axial_027.png","assets/T/mri-fd066ee0a9c14d5b/axial_028.png","assets/T/mri-fd066ee0a9c14d5b/axial_029.png","assets/T/mri-fd066ee0a9c14d5b/axial_030.png","assets/T/mri-fd066ee0a9c14d5b/axial_031.png","assets/T/mri-fd066ee0a9c14d5b/axial_032.png","assets/T/mri-fd066ee0a9c14d5b/axial_033.png","assets/T/mri-fd066ee0a9c14d5b/axial_034.png","assets/T/mri-fd066ee0a9c14d5b/axial_035.png","assets/T/mri-fd066ee0a9c14d5b/axial_036.png","assets/T/mri-fd066ee0a9c14d5b/axial_037.png","assets/T/mri-fd066ee0a9c14d5b/axial_038.png","assets/T/mri-fd066ee0a9c14d5b/axial_039.png","assets/T/mri-fd066ee0a9c14d5b/axial_040.png","assets/T/mri-fd066ee0a9c14d5b/axial_041.png","assets/T/mri-fd066ee0a9c14d5b/axial_042.png","assets/T/mri-fd066ee0a9c14d5b/coronal_001.png","assets/T/mri-fd066ee0a9c14d5b/coronal_002.png","assets/T/mri-fd066ee0a9c14d5b/coronal_003.png","assets/T/mri-fd066ee0a9c14d5b/coronal_004.png","assets/T/mri-fd066ee0a9c14d5b/coronal_005.png","assets/T/mri-fd066ee0a9c14d5b/coronal_006.png","assets/T/mri-fd066ee0a9c14d5b/coronal_007.png","assets/T/mri-fd066ee0a9c14d5b/coronal_008.png","assets/T/mri-fd066ee0a9c14d5b/coronal_009.png","assets/T/mri-fd066ee0a9c14d5b/coronal_010.png","assets/T/mri-fd066ee0a9c14d5b/coronal_011.png","assets/T/mri-fd066ee0a9c14d5b/coronal_012.png","assets/T/mri-fd066ee0a9c14d5b/coronal_013.png","assets/T/mri-fd066ee0a9c14d5b/coronal_014.png","assets/T/mri-fd066ee0a9c14d5b/coronal_015.png","assets/T/mri-fd066ee0a9c14d5b/coronal_016.png","assets/T/mri-fd066ee0a9c14d5b/coronal_017.png","assets/T/mri-fd066ee0a9c14d5b/coronal_018.png","assets/T/mri-fd066ee0a9c14d5b/coronal_019.png","assets/T/mri-fd066ee0a9c14d5b/coronal_020.png","assets/T/mri-fd066ee0a9c14d5b/coronal_021.png","assets/T/mri-fd066ee0a9c14d5b/coronal_022.png","assets/T/mri-fd066ee0a9c14d5b/coronal_023.png","assets/T/mri-fd066ee0a9c14d5b/coronal_024.png","assets/T/mri-fd066ee0a9c14d5b/coronal_025.png","assets/T/mri-fd066ee0a9c14d5b/coronal_026.png"],"stage_edition":8}
+{"id":"L3-T300:mri-19abf1bad6184b68","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 60 张图，均来自同一次检查。\n\n- 前 36 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-19abf1bad6184b68/axial_001.png","assets/T/mri-19abf1bad6184b68/axial_002.png","assets/T/mri-19abf1bad6184b68/axial_003.png","assets/T/mri-19abf1bad6184b68/axial_004.png","assets/T/mri-19abf1bad6184b68/axial_005.png","assets/T/mri-19abf1bad6184b68/axial_006.png","assets/T/mri-19abf1bad6184b68/axial_007.png","assets/T/mri-19abf1bad6184b68/axial_008.png","assets/T/mri-19abf1bad6184b68/axial_009.png","assets/T/mri-19abf1bad6184b68/axial_010.png","assets/T/mri-19abf1bad6184b68/axial_011.png","assets/T/mri-19abf1bad6184b68/axial_012.png","assets/T/mri-19abf1bad6184b68/axial_013.png","assets/T/mri-19abf1bad6184b68/axial_014.png","assets/T/mri-19abf1bad6184b68/axial_015.png","assets/T/mri-19abf1bad6184b68/axial_016.png","assets/T/mri-19abf1bad6184b68/axial_017.png","assets/T/mri-19abf1bad6184b68/axial_018.png","assets/T/mri-19abf1bad6184b68/axial_019.png","assets/T/mri-19abf1bad6184b68/axial_020.png","assets/T/mri-19abf1bad6184b68/axial_021.png","assets/T/mri-19abf1bad6184b68/axial_022.png","assets/T/mri-19abf1bad6184b68/axial_023.png","assets/T/mri-19abf1bad6184b68/axial_024.png","assets/T/mri-19abf1bad6184b68/axial_025.png","assets/T/mri-19abf1bad6184b68/axial_026.png","assets/T/mri-19abf1bad6184b68/axial_027.png","assets/T/mri-19abf1bad6184b68/axial_028.png","assets/T/mri-19abf1bad6184b68/axial_029.png","assets/T/mri-19abf1bad6184b68/axial_030.png","assets/T/mri-19abf1bad6184b68/axial_031.png","assets/T/mri-19abf1bad6184b68/axial_032.png","assets/T/mri-19abf1bad6184b68/axial_033.png","assets/T/mri-19abf1bad6184b68/axial_034.png","assets/T/mri-19abf1bad6184b68/axial_035.png","assets/T/mri-19abf1bad6184b68/axial_036.png","assets/T/mri-19abf1bad6184b68/coronal_001.png","assets/T/mri-19abf1bad6184b68/coronal_002.png","assets/T/mri-19abf1bad6184b68/coronal_003.png","assets/T/mri-19abf1bad6184b68/coronal_004.png","assets/T/mri-19abf1bad6184b68/coronal_005.png","assets/T/mri-19abf1bad6184b68/coronal_006.png","assets/T/mri-19abf1bad6184b68/coronal_007.png","assets/T/mri-19abf1bad6184b68/coronal_008.png","assets/T/mri-19abf1bad6184b68/coronal_009.png","assets/T/mri-19abf1bad6184b68/coronal_010.png","assets/T/mri-19abf1bad6184b68/coronal_011.png","assets/T/mri-19abf1bad6184b68/coronal_012.png","assets/T/mri-19abf1bad6184b68/coronal_013.png","assets/T/mri-19abf1bad6184b68/coronal_014.png","assets/T/mri-19abf1bad6184b68/coronal_015.png","assets/T/mri-19abf1bad6184b68/coronal_016.png","assets/T/mri-19abf1bad6184b68/coronal_017.png","assets/T/mri-19abf1bad6184b68/coronal_018.png","assets/T/mri-19abf1bad6184b68/coronal_019.png","assets/T/mri-19abf1bad6184b68/coronal_020.png","assets/T/mri-19abf1bad6184b68/coronal_021.png","assets/T/mri-19abf1bad6184b68/coronal_022.png","assets/T/mri-19abf1bad6184b68/coronal_023.png","assets/T/mri-19abf1bad6184b68/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-c5d6081e8d9f448c","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-c5d6081e8d9f448c/axial_001.png","assets/T/mri-c5d6081e8d9f448c/axial_002.png","assets/T/mri-c5d6081e8d9f448c/axial_003.png","assets/T/mri-c5d6081e8d9f448c/axial_004.png","assets/T/mri-c5d6081e8d9f448c/axial_005.png","assets/T/mri-c5d6081e8d9f448c/axial_006.png","assets/T/mri-c5d6081e8d9f448c/axial_007.png","assets/T/mri-c5d6081e8d9f448c/axial_008.png","assets/T/mri-c5d6081e8d9f448c/axial_009.png","assets/T/mri-c5d6081e8d9f448c/axial_010.png","assets/T/mri-c5d6081e8d9f448c/axial_011.png","assets/T/mri-c5d6081e8d9f448c/axial_012.png","assets/T/mri-c5d6081e8d9f448c/axial_013.png","assets/T/mri-c5d6081e8d9f448c/axial_014.png","assets/T/mri-c5d6081e8d9f448c/axial_015.png","assets/T/mri-c5d6081e8d9f448c/axial_016.png","assets/T/mri-c5d6081e8d9f448c/axial_017.png","assets/T/mri-c5d6081e8d9f448c/axial_018.png","assets/T/mri-c5d6081e8d9f448c/axial_019.png","assets/T/mri-c5d6081e8d9f448c/axial_020.png","assets/T/mri-c5d6081e8d9f448c/axial_021.png","assets/T/mri-c5d6081e8d9f448c/axial_022.png","assets/T/mri-c5d6081e8d9f448c/axial_023.png","assets/T/mri-c5d6081e8d9f448c/axial_024.png","assets/T/mri-c5d6081e8d9f448c/axial_025.png","assets/T/mri-c5d6081e8d9f448c/axial_026.png","assets/T/mri-c5d6081e8d9f448c/axial_027.png","assets/T/mri-c5d6081e8d9f448c/axial_028.png","assets/T/mri-c5d6081e8d9f448c/axial_029.png","assets/T/mri-c5d6081e8d9f448c/axial_030.png","assets/T/mri-c5d6081e8d9f448c/axial_031.png","assets/T/mri-c5d6081e8d9f448c/axial_032.png","assets/T/mri-c5d6081e8d9f448c/axial_033.png","assets/T/mri-c5d6081e8d9f448c/axial_034.png","assets/T/mri-c5d6081e8d9f448c/axial_035.png","assets/T/mri-c5d6081e8d9f448c/axial_036.png","assets/T/mri-c5d6081e8d9f448c/axial_037.png","assets/T/mri-c5d6081e8d9f448c/axial_038.png","assets/T/mri-c5d6081e8d9f448c/axial_039.png","assets/T/mri-c5d6081e8d9f448c/axial_040.png","assets/T/mri-c5d6081e8d9f448c/coronal_001.png","assets/T/mri-c5d6081e8d9f448c/coronal_002.png","assets/T/mri-c5d6081e8d9f448c/coronal_003.png","assets/T/mri-c5d6081e8d9f448c/coronal_004.png","assets/T/mri-c5d6081e8d9f448c/coronal_005.png","assets/T/mri-c5d6081e8d9f448c/coronal_006.png","assets/T/mri-c5d6081e8d9f448c/coronal_007.png","assets/T/mri-c5d6081e8d9f448c/coronal_008.png","assets/T/mri-c5d6081e8d9f448c/coronal_009.png","assets/T/mri-c5d6081e8d9f448c/coronal_010.png","assets/T/mri-c5d6081e8d9f448c/coronal_011.png","assets/T/mri-c5d6081e8d9f448c/coronal_012.png","assets/T/mri-c5d6081e8d9f448c/coronal_013.png","assets/T/mri-c5d6081e8d9f448c/coronal_014.png","assets/T/mri-c5d6081e8d9f448c/coronal_015.png","assets/T/mri-c5d6081e8d9f448c/coronal_016.png","assets/T/mri-c5d6081e8d9f448c/coronal_017.png","assets/T/mri-c5d6081e8d9f448c/coronal_018.png","assets/T/mri-c5d6081e8d9f448c/coronal_019.png","assets/T/mri-c5d6081e8d9f448c/coronal_020.png","assets/T/mri-c5d6081e8d9f448c/coronal_021.png","assets/T/mri-c5d6081e8d9f448c/coronal_022.png","assets/T/mri-c5d6081e8d9f448c/coronal_023.png","assets/T/mri-c5d6081e8d9f448c/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-a2c56cae231d4f86","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-a2c56cae231d4f86/axial_001.png","assets/T/mri-a2c56cae231d4f86/axial_002.png","assets/T/mri-a2c56cae231d4f86/axial_003.png","assets/T/mri-a2c56cae231d4f86/axial_004.png","assets/T/mri-a2c56cae231d4f86/axial_005.png","assets/T/mri-a2c56cae231d4f86/axial_006.png","assets/T/mri-a2c56cae231d4f86/axial_007.png","assets/T/mri-a2c56cae231d4f86/axial_008.png","assets/T/mri-a2c56cae231d4f86/axial_009.png","assets/T/mri-a2c56cae231d4f86/axial_010.png","assets/T/mri-a2c56cae231d4f86/axial_011.png","assets/T/mri-a2c56cae231d4f86/axial_012.png","assets/T/mri-a2c56cae231d4f86/axial_013.png","assets/T/mri-a2c56cae231d4f86/axial_014.png","assets/T/mri-a2c56cae231d4f86/axial_015.png","assets/T/mri-a2c56cae231d4f86/axial_016.png","assets/T/mri-a2c56cae231d4f86/axial_017.png","assets/T/mri-a2c56cae231d4f86/axial_018.png","assets/T/mri-a2c56cae231d4f86/axial_019.png","assets/T/mri-a2c56cae231d4f86/axial_020.png","assets/T/mri-a2c56cae231d4f86/axial_021.png","assets/T/mri-a2c56cae231d4f86/axial_022.png","assets/T/mri-a2c56cae231d4f86/axial_023.png","assets/T/mri-a2c56cae231d4f86/axial_024.png","assets/T/mri-a2c56cae231d4f86/axial_025.png","assets/T/mri-a2c56cae231d4f86/axial_026.png","assets/T/mri-a2c56cae231d4f86/axial_027.png","assets/T/mri-a2c56cae231d4f86/axial_028.png","assets/T/mri-a2c56cae231d4f86/axial_029.png","assets/T/mri-a2c56cae231d4f86/axial_030.png","assets/T/mri-a2c56cae231d4f86/axial_031.png","assets/T/mri-a2c56cae231d4f86/axial_032.png","assets/T/mri-a2c56cae231d4f86/axial_033.png","assets/T/mri-a2c56cae231d4f86/axial_034.png","assets/T/mri-a2c56cae231d4f86/axial_035.png","assets/T/mri-a2c56cae231d4f86/axial_036.png","assets/T/mri-a2c56cae231d4f86/axial_037.png","assets/T/mri-a2c56cae231d4f86/axial_038.png","assets/T/mri-a2c56cae231d4f86/axial_039.png","assets/T/mri-a2c56cae231d4f86/axial_040.png","assets/T/mri-a2c56cae231d4f86/coronal_001.png","assets/T/mri-a2c56cae231d4f86/coronal_002.png","assets/T/mri-a2c56cae231d4f86/coronal_003.png","assets/T/mri-a2c56cae231d4f86/coronal_004.png","assets/T/mri-a2c56cae231d4f86/coronal_005.png","assets/T/mri-a2c56cae231d4f86/coronal_006.png","assets/T/mri-a2c56cae231d4f86/coronal_007.png","assets/T/mri-a2c56cae231d4f86/coronal_008.png","assets/T/mri-a2c56cae231d4f86/coronal_009.png","assets/T/mri-a2c56cae231d4f86/coronal_010.png","assets/T/mri-a2c56cae231d4f86/coronal_011.png","assets/T/mri-a2c56cae231d4f86/coronal_012.png","assets/T/mri-a2c56cae231d4f86/coronal_013.png","assets/T/mri-a2c56cae231d4f86/coronal_014.png","assets/T/mri-a2c56cae231d4f86/coronal_015.png","assets/T/mri-a2c56cae231d4f86/coronal_016.png","assets/T/mri-a2c56cae231d4f86/coronal_017.png","assets/T/mri-a2c56cae231d4f86/coronal_018.png","assets/T/mri-a2c56cae231d4f86/coronal_019.png","assets/T/mri-a2c56cae231d4f86/coronal_020.png","assets/T/mri-a2c56cae231d4f86/coronal_021.png","assets/T/mri-a2c56cae231d4f86/coronal_022.png","assets/T/mri-a2c56cae231d4f86/coronal_023.png","assets/T/mri-a2c56cae231d4f86/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-30dff32cc2994f01","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 68 张图，均来自同一次检查。\n\n- 前 44 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-30dff32cc2994f01/axial_001.png","assets/T/mri-30dff32cc2994f01/axial_002.png","assets/T/mri-30dff32cc2994f01/axial_003.png","assets/T/mri-30dff32cc2994f01/axial_004.png","assets/T/mri-30dff32cc2994f01/axial_005.png","assets/T/mri-30dff32cc2994f01/axial_006.png","assets/T/mri-30dff32cc2994f01/axial_007.png","assets/T/mri-30dff32cc2994f01/axial_008.png","assets/T/mri-30dff32cc2994f01/axial_009.png","assets/T/mri-30dff32cc2994f01/axial_010.png","assets/T/mri-30dff32cc2994f01/axial_011.png","assets/T/mri-30dff32cc2994f01/axial_012.png","assets/T/mri-30dff32cc2994f01/axial_013.png","assets/T/mri-30dff32cc2994f01/axial_014.png","assets/T/mri-30dff32cc2994f01/axial_015.png","assets/T/mri-30dff32cc2994f01/axial_016.png","assets/T/mri-30dff32cc2994f01/axial_017.png","assets/T/mri-30dff32cc2994f01/axial_018.png","assets/T/mri-30dff32cc2994f01/axial_019.png","assets/T/mri-30dff32cc2994f01/axial_020.png","assets/T/mri-30dff32cc2994f01/axial_021.png","assets/T/mri-30dff32cc2994f01/axial_022.png","assets/T/mri-30dff32cc2994f01/axial_023.png","assets/T/mri-30dff32cc2994f01/axial_024.png","assets/T/mri-30dff32cc2994f01/axial_025.png","assets/T/mri-30dff32cc2994f01/axial_026.png","assets/T/mri-30dff32cc2994f01/axial_027.png","assets/T/mri-30dff32cc2994f01/axial_028.png","assets/T/mri-30dff32cc2994f01/axial_029.png","assets/T/mri-30dff32cc2994f01/axial_030.png","assets/T/mri-30dff32cc2994f01/axial_031.png","assets/T/mri-30dff32cc2994f01/axial_032.png","assets/T/mri-30dff32cc2994f01/axial_033.png","assets/T/mri-30dff32cc2994f01/axial_034.png","assets/T/mri-30dff32cc2994f01/axial_035.png","assets/T/mri-30dff32cc2994f01/axial_036.png","assets/T/mri-30dff32cc2994f01/axial_037.png","assets/T/mri-30dff32cc2994f01/axial_038.png","assets/T/mri-30dff32cc2994f01/axial_039.png","assets/T/mri-30dff32cc2994f01/axial_040.png","assets/T/mri-30dff32cc2994f01/axial_041.png","assets/T/mri-30dff32cc2994f01/axial_042.png","assets/T/mri-30dff32cc2994f01/axial_043.png","assets/T/mri-30dff32cc2994f01/axial_044.png","assets/T/mri-30dff32cc2994f01/coronal_001.png","assets/T/mri-30dff32cc2994f01/coronal_002.png","assets/T/mri-30dff32cc2994f01/coronal_003.png","assets/T/mri-30dff32cc2994f01/coronal_004.png","assets/T/mri-30dff32cc2994f01/coronal_005.png","assets/T/mri-30dff32cc2994f01/coronal_006.png","assets/T/mri-30dff32cc2994f01/coronal_007.png","assets/T/mri-30dff32cc2994f01/coronal_008.png","assets/T/mri-30dff32cc2994f01/coronal_009.png","assets/T/mri-30dff32cc2994f01/coronal_010.png","assets/T/mri-30dff32cc2994f01/coronal_011.png","assets/T/mri-30dff32cc2994f01/coronal_012.png","assets/T/mri-30dff32cc2994f01/coronal_013.png","assets/T/mri-30dff32cc2994f01/coronal_014.png","assets/T/mri-30dff32cc2994f01/coronal_015.png","assets/T/mri-30dff32cc2994f01/coronal_016.png","assets/T/mri-30dff32cc2994f01/coronal_017.png","assets/T/mri-30dff32cc2994f01/coronal_018.png","assets/T/mri-30dff32cc2994f01/coronal_019.png","assets/T/mri-30dff32cc2994f01/coronal_020.png","assets/T/mri-30dff32cc2994f01/coronal_021.png","assets/T/mri-30dff32cc2994f01/coronal_022.png","assets/T/mri-30dff32cc2994f01/coronal_023.png","assets/T/mri-30dff32cc2994f01/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-89ab62d7f29d44ef","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-89ab62d7f29d44ef/axial_001.png","assets/T/mri-89ab62d7f29d44ef/axial_002.png","assets/T/mri-89ab62d7f29d44ef/axial_003.png","assets/T/mri-89ab62d7f29d44ef/axial_004.png","assets/T/mri-89ab62d7f29d44ef/axial_005.png","assets/T/mri-89ab62d7f29d44ef/axial_006.png","assets/T/mri-89ab62d7f29d44ef/axial_007.png","assets/T/mri-89ab62d7f29d44ef/axial_008.png","assets/T/mri-89ab62d7f29d44ef/axial_009.png","assets/T/mri-89ab62d7f29d44ef/axial_010.png","assets/T/mri-89ab62d7f29d44ef/axial_011.png","assets/T/mri-89ab62d7f29d44ef/axial_012.png","assets/T/mri-89ab62d7f29d44ef/axial_013.png","assets/T/mri-89ab62d7f29d44ef/axial_014.png","assets/T/mri-89ab62d7f29d44ef/axial_015.png","assets/T/mri-89ab62d7f29d44ef/axial_016.png","assets/T/mri-89ab62d7f29d44ef/axial_017.png","assets/T/mri-89ab62d7f29d44ef/axial_018.png","assets/T/mri-89ab62d7f29d44ef/axial_019.png","assets/T/mri-89ab62d7f29d44ef/axial_020.png","assets/T/mri-89ab62d7f29d44ef/axial_021.png","assets/T/mri-89ab62d7f29d44ef/axial_022.png","assets/T/mri-89ab62d7f29d44ef/axial_023.png","assets/T/mri-89ab62d7f29d44ef/axial_024.png","assets/T/mri-89ab62d7f29d44ef/axial_025.png","assets/T/mri-89ab62d7f29d44ef/axial_026.png","assets/T/mri-89ab62d7f29d44ef/axial_027.png","assets/T/mri-89ab62d7f29d44ef/axial_028.png","assets/T/mri-89ab62d7f29d44ef/axial_029.png","assets/T/mri-89ab62d7f29d44ef/axial_030.png","assets/T/mri-89ab62d7f29d44ef/axial_031.png","assets/T/mri-89ab62d7f29d44ef/axial_032.png","assets/T/mri-89ab62d7f29d44ef/axial_033.png","assets/T/mri-89ab62d7f29d44ef/axial_034.png","assets/T/mri-89ab62d7f29d44ef/axial_035.png","assets/T/mri-89ab62d7f29d44ef/axial_036.png","assets/T/mri-89ab62d7f29d44ef/axial_037.png","assets/T/mri-89ab62d7f29d44ef/axial_038.png","assets/T/mri-89ab62d7f29d44ef/axial_039.png","assets/T/mri-89ab62d7f29d44ef/axial_040.png","assets/T/mri-89ab62d7f29d44ef/axial_041.png","assets/T/mri-89ab62d7f29d44ef/axial_042.png","assets/T/mri-89ab62d7f29d44ef/coronal_001.png","assets/T/mri-89ab62d7f29d44ef/coronal_002.png","assets/T/mri-89ab62d7f29d44ef/coronal_003.png","assets/T/mri-89ab62d7f29d44ef/coronal_004.png","assets/T/mri-89ab62d7f29d44ef/coronal_005.png","assets/T/mri-89ab62d7f29d44ef/coronal_006.png","assets/T/mri-89ab62d7f29d44ef/coronal_007.png","assets/T/mri-89ab62d7f29d44ef/coronal_008.png","assets/T/mri-89ab62d7f29d44ef/coronal_009.png","assets/T/mri-89ab62d7f29d44ef/coronal_010.png","assets/T/mri-89ab62d7f29d44ef/coronal_011.png","assets/T/mri-89ab62d7f29d44ef/coronal_012.png","assets/T/mri-89ab62d7f29d44ef/coronal_013.png","assets/T/mri-89ab62d7f29d44ef/coronal_014.png","assets/T/mri-89ab62d7f29d44ef/coronal_015.png","assets/T/mri-89ab62d7f29d44ef/coronal_016.png","assets/T/mri-89ab62d7f29d44ef/coronal_017.png","assets/T/mri-89ab62d7f29d44ef/coronal_018.png","assets/T/mri-89ab62d7f29d44ef/coronal_019.png","assets/T/mri-89ab62d7f29d44ef/coronal_020.png","assets/T/mri-89ab62d7f29d44ef/coronal_021.png","assets/T/mri-89ab62d7f29d44ef/coronal_022.png","assets/T/mri-89ab62d7f29d44ef/coronal_023.png","assets/T/mri-89ab62d7f29d44ef/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-7fa3212a93944079","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-7fa3212a93944079/axial_001.png","assets/T/mri-7fa3212a93944079/axial_002.png","assets/T/mri-7fa3212a93944079/axial_003.png","assets/T/mri-7fa3212a93944079/axial_004.png","assets/T/mri-7fa3212a93944079/axial_005.png","assets/T/mri-7fa3212a93944079/axial_006.png","assets/T/mri-7fa3212a93944079/axial_007.png","assets/T/mri-7fa3212a93944079/axial_008.png","assets/T/mri-7fa3212a93944079/axial_009.png","assets/T/mri-7fa3212a93944079/axial_010.png","assets/T/mri-7fa3212a93944079/axial_011.png","assets/T/mri-7fa3212a93944079/axial_012.png","assets/T/mri-7fa3212a93944079/axial_013.png","assets/T/mri-7fa3212a93944079/axial_014.png","assets/T/mri-7fa3212a93944079/axial_015.png","assets/T/mri-7fa3212a93944079/axial_016.png","assets/T/mri-7fa3212a93944079/axial_017.png","assets/T/mri-7fa3212a93944079/axial_018.png","assets/T/mri-7fa3212a93944079/axial_019.png","assets/T/mri-7fa3212a93944079/axial_020.png","assets/T/mri-7fa3212a93944079/axial_021.png","assets/T/mri-7fa3212a93944079/axial_022.png","assets/T/mri-7fa3212a93944079/axial_023.png","assets/T/mri-7fa3212a93944079/axial_024.png","assets/T/mri-7fa3212a93944079/axial_025.png","assets/T/mri-7fa3212a93944079/axial_026.png","assets/T/mri-7fa3212a93944079/axial_027.png","assets/T/mri-7fa3212a93944079/axial_028.png","assets/T/mri-7fa3212a93944079/axial_029.png","assets/T/mri-7fa3212a93944079/axial_030.png","assets/T/mri-7fa3212a93944079/axial_031.png","assets/T/mri-7fa3212a93944079/axial_032.png","assets/T/mri-7fa3212a93944079/axial_033.png","assets/T/mri-7fa3212a93944079/axial_034.png","assets/T/mri-7fa3212a93944079/axial_035.png","assets/T/mri-7fa3212a93944079/axial_036.png","assets/T/mri-7fa3212a93944079/axial_037.png","assets/T/mri-7fa3212a93944079/axial_038.png","assets/T/mri-7fa3212a93944079/axial_039.png","assets/T/mri-7fa3212a93944079/axial_040.png","assets/T/mri-7fa3212a93944079/coronal_001.png","assets/T/mri-7fa3212a93944079/coronal_002.png","assets/T/mri-7fa3212a93944079/coronal_003.png","assets/T/mri-7fa3212a93944079/coronal_004.png","assets/T/mri-7fa3212a93944079/coronal_005.png","assets/T/mri-7fa3212a93944079/coronal_006.png","assets/T/mri-7fa3212a93944079/coronal_007.png","assets/T/mri-7fa3212a93944079/coronal_008.png","assets/T/mri-7fa3212a93944079/coronal_009.png","assets/T/mri-7fa3212a93944079/coronal_010.png","assets/T/mri-7fa3212a93944079/coronal_011.png","assets/T/mri-7fa3212a93944079/coronal_012.png","assets/T/mri-7fa3212a93944079/coronal_013.png","assets/T/mri-7fa3212a93944079/coronal_014.png","assets/T/mri-7fa3212a93944079/coronal_015.png","assets/T/mri-7fa3212a93944079/coronal_016.png","assets/T/mri-7fa3212a93944079/coronal_017.png","assets/T/mri-7fa3212a93944079/coronal_018.png","assets/T/mri-7fa3212a93944079/coronal_019.png","assets/T/mri-7fa3212a93944079/coronal_020.png","assets/T/mri-7fa3212a93944079/coronal_021.png","assets/T/mri-7fa3212a93944079/coronal_022.png","assets/T/mri-7fa3212a93944079/coronal_023.png","assets/T/mri-7fa3212a93944079/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-f3694da4bfe340dd","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-f3694da4bfe340dd/axial_001.png","assets/T/mri-f3694da4bfe340dd/axial_002.png","assets/T/mri-f3694da4bfe340dd/axial_003.png","assets/T/mri-f3694da4bfe340dd/axial_004.png","assets/T/mri-f3694da4bfe340dd/axial_005.png","assets/T/mri-f3694da4bfe340dd/axial_006.png","assets/T/mri-f3694da4bfe340dd/axial_007.png","assets/T/mri-f3694da4bfe340dd/axial_008.png","assets/T/mri-f3694da4bfe340dd/axial_009.png","assets/T/mri-f3694da4bfe340dd/axial_010.png","assets/T/mri-f3694da4bfe340dd/axial_011.png","assets/T/mri-f3694da4bfe340dd/axial_012.png","assets/T/mri-f3694da4bfe340dd/axial_013.png","assets/T/mri-f3694da4bfe340dd/axial_014.png","assets/T/mri-f3694da4bfe340dd/axial_015.png","assets/T/mri-f3694da4bfe340dd/axial_016.png","assets/T/mri-f3694da4bfe340dd/axial_017.png","assets/T/mri-f3694da4bfe340dd/axial_018.png","assets/T/mri-f3694da4bfe340dd/axial_019.png","assets/T/mri-f3694da4bfe340dd/axial_020.png","assets/T/mri-f3694da4bfe340dd/axial_021.png","assets/T/mri-f3694da4bfe340dd/axial_022.png","assets/T/mri-f3694da4bfe340dd/axial_023.png","assets/T/mri-f3694da4bfe340dd/axial_024.png","assets/T/mri-f3694da4bfe340dd/axial_025.png","assets/T/mri-f3694da4bfe340dd/axial_026.png","assets/T/mri-f3694da4bfe340dd/axial_027.png","assets/T/mri-f3694da4bfe340dd/axial_028.png","assets/T/mri-f3694da4bfe340dd/axial_029.png","assets/T/mri-f3694da4bfe340dd/axial_030.png","assets/T/mri-f3694da4bfe340dd/axial_031.png","assets/T/mri-f3694da4bfe340dd/axial_032.png","assets/T/mri-f3694da4bfe340dd/axial_033.png","assets/T/mri-f3694da4bfe340dd/axial_034.png","assets/T/mri-f3694da4bfe340dd/axial_035.png","assets/T/mri-f3694da4bfe340dd/axial_036.png","assets/T/mri-f3694da4bfe340dd/axial_037.png","assets/T/mri-f3694da4bfe340dd/axial_038.png","assets/T/mri-f3694da4bfe340dd/axial_039.png","assets/T/mri-f3694da4bfe340dd/axial_040.png","assets/T/mri-f3694da4bfe340dd/coronal_001.png","assets/T/mri-f3694da4bfe340dd/coronal_002.png","assets/T/mri-f3694da4bfe340dd/coronal_003.png","assets/T/mri-f3694da4bfe340dd/coronal_004.png","assets/T/mri-f3694da4bfe340dd/coronal_005.png","assets/T/mri-f3694da4bfe340dd/coronal_006.png","assets/T/mri-f3694da4bfe340dd/coronal_007.png","assets/T/mri-f3694da4bfe340dd/coronal_008.png","assets/T/mri-f3694da4bfe340dd/coronal_009.png","assets/T/mri-f3694da4bfe340dd/coronal_010.png","assets/T/mri-f3694da4bfe340dd/coronal_011.png","assets/T/mri-f3694da4bfe340dd/coronal_012.png","assets/T/mri-f3694da4bfe340dd/coronal_013.png","assets/T/mri-f3694da4bfe340dd/coronal_014.png","assets/T/mri-f3694da4bfe340dd/coronal_015.png","assets/T/mri-f3694da4bfe340dd/coronal_016.png","assets/T/mri-f3694da4bfe340dd/coronal_017.png","assets/T/mri-f3694da4bfe340dd/coronal_018.png","assets/T/mri-f3694da4bfe340dd/coronal_019.png","assets/T/mri-f3694da4bfe340dd/coronal_020.png","assets/T/mri-f3694da4bfe340dd/coronal_021.png","assets/T/mri-f3694da4bfe340dd/coronal_022.png","assets/T/mri-f3694da4bfe340dd/coronal_023.png","assets/T/mri-f3694da4bfe340dd/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-d642a887db8749e7","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 26 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-d642a887db8749e7/axial_001.png","assets/T/mri-d642a887db8749e7/axial_002.png","assets/T/mri-d642a887db8749e7/axial_003.png","assets/T/mri-d642a887db8749e7/axial_004.png","assets/T/mri-d642a887db8749e7/axial_005.png","assets/T/mri-d642a887db8749e7/axial_006.png","assets/T/mri-d642a887db8749e7/axial_007.png","assets/T/mri-d642a887db8749e7/axial_008.png","assets/T/mri-d642a887db8749e7/axial_009.png","assets/T/mri-d642a887db8749e7/axial_010.png","assets/T/mri-d642a887db8749e7/axial_011.png","assets/T/mri-d642a887db8749e7/axial_012.png","assets/T/mri-d642a887db8749e7/axial_013.png","assets/T/mri-d642a887db8749e7/axial_014.png","assets/T/mri-d642a887db8749e7/axial_015.png","assets/T/mri-d642a887db8749e7/axial_016.png","assets/T/mri-d642a887db8749e7/axial_017.png","assets/T/mri-d642a887db8749e7/axial_018.png","assets/T/mri-d642a887db8749e7/axial_019.png","assets/T/mri-d642a887db8749e7/axial_020.png","assets/T/mri-d642a887db8749e7/axial_021.png","assets/T/mri-d642a887db8749e7/axial_022.png","assets/T/mri-d642a887db8749e7/axial_023.png","assets/T/mri-d642a887db8749e7/axial_024.png","assets/T/mri-d642a887db8749e7/axial_025.png","assets/T/mri-d642a887db8749e7/axial_026.png","assets/T/mri-d642a887db8749e7/axial_027.png","assets/T/mri-d642a887db8749e7/axial_028.png","assets/T/mri-d642a887db8749e7/axial_029.png","assets/T/mri-d642a887db8749e7/axial_030.png","assets/T/mri-d642a887db8749e7/axial_031.png","assets/T/mri-d642a887db8749e7/axial_032.png","assets/T/mri-d642a887db8749e7/axial_033.png","assets/T/mri-d642a887db8749e7/axial_034.png","assets/T/mri-d642a887db8749e7/axial_035.png","assets/T/mri-d642a887db8749e7/axial_036.png","assets/T/mri-d642a887db8749e7/axial_037.png","assets/T/mri-d642a887db8749e7/axial_038.png","assets/T/mri-d642a887db8749e7/axial_039.png","assets/T/mri-d642a887db8749e7/axial_040.png","assets/T/mri-d642a887db8749e7/coronal_001.png","assets/T/mri-d642a887db8749e7/coronal_002.png","assets/T/mri-d642a887db8749e7/coronal_003.png","assets/T/mri-d642a887db8749e7/coronal_004.png","assets/T/mri-d642a887db8749e7/coronal_005.png","assets/T/mri-d642a887db8749e7/coronal_006.png","assets/T/mri-d642a887db8749e7/coronal_007.png","assets/T/mri-d642a887db8749e7/coronal_008.png","assets/T/mri-d642a887db8749e7/coronal_009.png","assets/T/mri-d642a887db8749e7/coronal_010.png","assets/T/mri-d642a887db8749e7/coronal_011.png","assets/T/mri-d642a887db8749e7/coronal_012.png","assets/T/mri-d642a887db8749e7/coronal_013.png","assets/T/mri-d642a887db8749e7/coronal_014.png","assets/T/mri-d642a887db8749e7/coronal_015.png","assets/T/mri-d642a887db8749e7/coronal_016.png","assets/T/mri-d642a887db8749e7/coronal_017.png","assets/T/mri-d642a887db8749e7/coronal_018.png","assets/T/mri-d642a887db8749e7/coronal_019.png","assets/T/mri-d642a887db8749e7/coronal_020.png","assets/T/mri-d642a887db8749e7/coronal_021.png","assets/T/mri-d642a887db8749e7/coronal_022.png","assets/T/mri-d642a887db8749e7/coronal_023.png","assets/T/mri-d642a887db8749e7/coronal_024.png","assets/T/mri-d642a887db8749e7/coronal_025.png","assets/T/mri-d642a887db8749e7/coronal_026.png"],"stage_edition":8}
+{"id":"L3-T300:mri-7cb6b3bc5a694c2f","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-7cb6b3bc5a694c2f/axial_001.png","assets/T/mri-7cb6b3bc5a694c2f/axial_002.png","assets/T/mri-7cb6b3bc5a694c2f/axial_003.png","assets/T/mri-7cb6b3bc5a694c2f/axial_004.png","assets/T/mri-7cb6b3bc5a694c2f/axial_005.png","assets/T/mri-7cb6b3bc5a694c2f/axial_006.png","assets/T/mri-7cb6b3bc5a694c2f/axial_007.png","assets/T/mri-7cb6b3bc5a694c2f/axial_008.png","assets/T/mri-7cb6b3bc5a694c2f/axial_009.png","assets/T/mri-7cb6b3bc5a694c2f/axial_010.png","assets/T/mri-7cb6b3bc5a694c2f/axial_011.png","assets/T/mri-7cb6b3bc5a694c2f/axial_012.png","assets/T/mri-7cb6b3bc5a694c2f/axial_013.png","assets/T/mri-7cb6b3bc5a694c2f/axial_014.png","assets/T/mri-7cb6b3bc5a694c2f/axial_015.png","assets/T/mri-7cb6b3bc5a694c2f/axial_016.png","assets/T/mri-7cb6b3bc5a694c2f/axial_017.png","assets/T/mri-7cb6b3bc5a694c2f/axial_018.png","assets/T/mri-7cb6b3bc5a694c2f/axial_019.png","assets/T/mri-7cb6b3bc5a694c2f/axial_020.png","assets/T/mri-7cb6b3bc5a694c2f/axial_021.png","assets/T/mri-7cb6b3bc5a694c2f/axial_022.png","assets/T/mri-7cb6b3bc5a694c2f/axial_023.png","assets/T/mri-7cb6b3bc5a694c2f/axial_024.png","assets/T/mri-7cb6b3bc5a694c2f/axial_025.png","assets/T/mri-7cb6b3bc5a694c2f/axial_026.png","assets/T/mri-7cb6b3bc5a694c2f/axial_027.png","assets/T/mri-7cb6b3bc5a694c2f/axial_028.png","assets/T/mri-7cb6b3bc5a694c2f/axial_029.png","assets/T/mri-7cb6b3bc5a694c2f/axial_030.png","assets/T/mri-7cb6b3bc5a694c2f/axial_031.png","assets/T/mri-7cb6b3bc5a694c2f/axial_032.png","assets/T/mri-7cb6b3bc5a694c2f/axial_033.png","assets/T/mri-7cb6b3bc5a694c2f/axial_034.png","assets/T/mri-7cb6b3bc5a694c2f/axial_035.png","assets/T/mri-7cb6b3bc5a694c2f/axial_036.png","assets/T/mri-7cb6b3bc5a694c2f/axial_037.png","assets/T/mri-7cb6b3bc5a694c2f/axial_038.png","assets/T/mri-7cb6b3bc5a694c2f/axial_039.png","assets/T/mri-7cb6b3bc5a694c2f/axial_040.png","assets/T/mri-7cb6b3bc5a694c2f/coronal_001.png","assets/T/mri-7cb6b3bc5a694c2f/coronal_002.png","assets/T/mri-7cb6b3bc5a694c2f/coronal_003.png","assets/T/mri-7cb6b3bc5a694c2f/coronal_004.png","assets/T/mri-7cb6b3bc5a694c2f/coronal_005.png","assets/T/mri-7cb6b3bc5a694c2f/coronal_006.png","assets/T/mri-7cb6b3bc5a694c2f/coronal_007.png","assets/T/mri-7cb6b3bc5a694c2f/coronal_008.png","assets/T/mri-7cb6b3bc5a694c2f/coronal_009.png","assets/T/mri-7cb6b3bc5a694c2f/coronal_010.png","assets/T/mri-7cb6b3bc5a694c2f/coronal_011.png","assets/T/mri-7cb6b3bc5a694c2f/coronal_012.png","assets/T/mri-7cb6b3bc5a694c2f/coronal_013.png","assets/T/mri-7cb6b3bc5a694c2f/coronal_014.png","assets/T/mri-7cb6b3bc5a694c2f/coronal_015.png","assets/T/mri-7cb6b3bc5a694c2f/coronal_016.png","assets/T/mri-7cb6b3bc5a694c2f/coronal_017.png","assets/T/mri-7cb6b3bc5a694c2f/coronal_018.png","assets/T/mri-7cb6b3bc5a694c2f/coronal_019.png","assets/T/mri-7cb6b3bc5a694c2f/coronal_020.png","assets/T/mri-7cb6b3bc5a694c2f/coronal_021.png","assets/T/mri-7cb6b3bc5a694c2f/coronal_022.png","assets/T/mri-7cb6b3bc5a694c2f/coronal_023.png","assets/T/mri-7cb6b3bc5a694c2f/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-1174f5a99f0e400b","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-1174f5a99f0e400b/axial_001.png","assets/T/mri-1174f5a99f0e400b/axial_002.png","assets/T/mri-1174f5a99f0e400b/axial_003.png","assets/T/mri-1174f5a99f0e400b/axial_004.png","assets/T/mri-1174f5a99f0e400b/axial_005.png","assets/T/mri-1174f5a99f0e400b/axial_006.png","assets/T/mri-1174f5a99f0e400b/axial_007.png","assets/T/mri-1174f5a99f0e400b/axial_008.png","assets/T/mri-1174f5a99f0e400b/axial_009.png","assets/T/mri-1174f5a99f0e400b/axial_010.png","assets/T/mri-1174f5a99f0e400b/axial_011.png","assets/T/mri-1174f5a99f0e400b/axial_012.png","assets/T/mri-1174f5a99f0e400b/axial_013.png","assets/T/mri-1174f5a99f0e400b/axial_014.png","assets/T/mri-1174f5a99f0e400b/axial_015.png","assets/T/mri-1174f5a99f0e400b/axial_016.png","assets/T/mri-1174f5a99f0e400b/axial_017.png","assets/T/mri-1174f5a99f0e400b/axial_018.png","assets/T/mri-1174f5a99f0e400b/axial_019.png","assets/T/mri-1174f5a99f0e400b/axial_020.png","assets/T/mri-1174f5a99f0e400b/axial_021.png","assets/T/mri-1174f5a99f0e400b/axial_022.png","assets/T/mri-1174f5a99f0e400b/axial_023.png","assets/T/mri-1174f5a99f0e400b/axial_024.png","assets/T/mri-1174f5a99f0e400b/axial_025.png","assets/T/mri-1174f5a99f0e400b/axial_026.png","assets/T/mri-1174f5a99f0e400b/axial_027.png","assets/T/mri-1174f5a99f0e400b/axial_028.png","assets/T/mri-1174f5a99f0e400b/axial_029.png","assets/T/mri-1174f5a99f0e400b/axial_030.png","assets/T/mri-1174f5a99f0e400b/axial_031.png","assets/T/mri-1174f5a99f0e400b/axial_032.png","assets/T/mri-1174f5a99f0e400b/axial_033.png","assets/T/mri-1174f5a99f0e400b/axial_034.png","assets/T/mri-1174f5a99f0e400b/axial_035.png","assets/T/mri-1174f5a99f0e400b/axial_036.png","assets/T/mri-1174f5a99f0e400b/axial_037.png","assets/T/mri-1174f5a99f0e400b/axial_038.png","assets/T/mri-1174f5a99f0e400b/axial_039.png","assets/T/mri-1174f5a99f0e400b/axial_040.png","assets/T/mri-1174f5a99f0e400b/axial_041.png","assets/T/mri-1174f5a99f0e400b/axial_042.png","assets/T/mri-1174f5a99f0e400b/coronal_001.png","assets/T/mri-1174f5a99f0e400b/coronal_002.png","assets/T/mri-1174f5a99f0e400b/coronal_003.png","assets/T/mri-1174f5a99f0e400b/coronal_004.png","assets/T/mri-1174f5a99f0e400b/coronal_005.png","assets/T/mri-1174f5a99f0e400b/coronal_006.png","assets/T/mri-1174f5a99f0e400b/coronal_007.png","assets/T/mri-1174f5a99f0e400b/coronal_008.png","assets/T/mri-1174f5a99f0e400b/coronal_009.png","assets/T/mri-1174f5a99f0e400b/coronal_010.png","assets/T/mri-1174f5a99f0e400b/coronal_011.png","assets/T/mri-1174f5a99f0e400b/coronal_012.png","assets/T/mri-1174f5a99f0e400b/coronal_013.png","assets/T/mri-1174f5a99f0e400b/coronal_014.png","assets/T/mri-1174f5a99f0e400b/coronal_015.png","assets/T/mri-1174f5a99f0e400b/coronal_016.png","assets/T/mri-1174f5a99f0e400b/coronal_017.png","assets/T/mri-1174f5a99f0e400b/coronal_018.png","assets/T/mri-1174f5a99f0e400b/coronal_019.png","assets/T/mri-1174f5a99f0e400b/coronal_020.png","assets/T/mri-1174f5a99f0e400b/coronal_021.png","assets/T/mri-1174f5a99f0e400b/coronal_022.png","assets/T/mri-1174f5a99f0e400b/coronal_023.png","assets/T/mri-1174f5a99f0e400b/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-1c71d049f590457f","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 72 张图，均来自同一次检查。\n\n- 前 44 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 28 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-1c71d049f590457f/axial_001.png","assets/T/mri-1c71d049f590457f/axial_002.png","assets/T/mri-1c71d049f590457f/axial_003.png","assets/T/mri-1c71d049f590457f/axial_004.png","assets/T/mri-1c71d049f590457f/axial_005.png","assets/T/mri-1c71d049f590457f/axial_006.png","assets/T/mri-1c71d049f590457f/axial_007.png","assets/T/mri-1c71d049f590457f/axial_008.png","assets/T/mri-1c71d049f590457f/axial_009.png","assets/T/mri-1c71d049f590457f/axial_010.png","assets/T/mri-1c71d049f590457f/axial_011.png","assets/T/mri-1c71d049f590457f/axial_012.png","assets/T/mri-1c71d049f590457f/axial_013.png","assets/T/mri-1c71d049f590457f/axial_014.png","assets/T/mri-1c71d049f590457f/axial_015.png","assets/T/mri-1c71d049f590457f/axial_016.png","assets/T/mri-1c71d049f590457f/axial_017.png","assets/T/mri-1c71d049f590457f/axial_018.png","assets/T/mri-1c71d049f590457f/axial_019.png","assets/T/mri-1c71d049f590457f/axial_020.png","assets/T/mri-1c71d049f590457f/axial_021.png","assets/T/mri-1c71d049f590457f/axial_022.png","assets/T/mri-1c71d049f590457f/axial_023.png","assets/T/mri-1c71d049f590457f/axial_024.png","assets/T/mri-1c71d049f590457f/axial_025.png","assets/T/mri-1c71d049f590457f/axial_026.png","assets/T/mri-1c71d049f590457f/axial_027.png","assets/T/mri-1c71d049f590457f/axial_028.png","assets/T/mri-1c71d049f590457f/axial_029.png","assets/T/mri-1c71d049f590457f/axial_030.png","assets/T/mri-1c71d049f590457f/axial_031.png","assets/T/mri-1c71d049f590457f/axial_032.png","assets/T/mri-1c71d049f590457f/axial_033.png","assets/T/mri-1c71d049f590457f/axial_034.png","assets/T/mri-1c71d049f590457f/axial_035.png","assets/T/mri-1c71d049f590457f/axial_036.png","assets/T/mri-1c71d049f590457f/axial_037.png","assets/T/mri-1c71d049f590457f/axial_038.png","assets/T/mri-1c71d049f590457f/axial_039.png","assets/T/mri-1c71d049f590457f/axial_040.png","assets/T/mri-1c71d049f590457f/axial_041.png","assets/T/mri-1c71d049f590457f/axial_042.png","assets/T/mri-1c71d049f590457f/axial_043.png","assets/T/mri-1c71d049f590457f/axial_044.png","assets/T/mri-1c71d049f590457f/coronal_001.png","assets/T/mri-1c71d049f590457f/coronal_002.png","assets/T/mri-1c71d049f590457f/coronal_003.png","assets/T/mri-1c71d049f590457f/coronal_004.png","assets/T/mri-1c71d049f590457f/coronal_005.png","assets/T/mri-1c71d049f590457f/coronal_006.png","assets/T/mri-1c71d049f590457f/coronal_007.png","assets/T/mri-1c71d049f590457f/coronal_008.png","assets/T/mri-1c71d049f590457f/coronal_009.png","assets/T/mri-1c71d049f590457f/coronal_010.png","assets/T/mri-1c71d049f590457f/coronal_011.png","assets/T/mri-1c71d049f590457f/coronal_012.png","assets/T/mri-1c71d049f590457f/coronal_013.png","assets/T/mri-1c71d049f590457f/coronal_014.png","assets/T/mri-1c71d049f590457f/coronal_015.png","assets/T/mri-1c71d049f590457f/coronal_016.png","assets/T/mri-1c71d049f590457f/coronal_017.png","assets/T/mri-1c71d049f590457f/coronal_018.png","assets/T/mri-1c71d049f590457f/coronal_019.png","assets/T/mri-1c71d049f590457f/coronal_020.png","assets/T/mri-1c71d049f590457f/coronal_021.png","assets/T/mri-1c71d049f590457f/coronal_022.png","assets/T/mri-1c71d049f590457f/coronal_023.png","assets/T/mri-1c71d049f590457f/coronal_024.png","assets/T/mri-1c71d049f590457f/coronal_025.png","assets/T/mri-1c71d049f590457f/coronal_026.png","assets/T/mri-1c71d049f590457f/coronal_027.png","assets/T/mri-1c71d049f590457f/coronal_028.png"],"stage_edition":8}
+{"id":"L3-T300:mri-dc051be38c594e64","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-dc051be38c594e64/axial_001.png","assets/T/mri-dc051be38c594e64/axial_002.png","assets/T/mri-dc051be38c594e64/axial_003.png","assets/T/mri-dc051be38c594e64/axial_004.png","assets/T/mri-dc051be38c594e64/axial_005.png","assets/T/mri-dc051be38c594e64/axial_006.png","assets/T/mri-dc051be38c594e64/axial_007.png","assets/T/mri-dc051be38c594e64/axial_008.png","assets/T/mri-dc051be38c594e64/axial_009.png","assets/T/mri-dc051be38c594e64/axial_010.png","assets/T/mri-dc051be38c594e64/axial_011.png","assets/T/mri-dc051be38c594e64/axial_012.png","assets/T/mri-dc051be38c594e64/axial_013.png","assets/T/mri-dc051be38c594e64/axial_014.png","assets/T/mri-dc051be38c594e64/axial_015.png","assets/T/mri-dc051be38c594e64/axial_016.png","assets/T/mri-dc051be38c594e64/axial_017.png","assets/T/mri-dc051be38c594e64/axial_018.png","assets/T/mri-dc051be38c594e64/axial_019.png","assets/T/mri-dc051be38c594e64/axial_020.png","assets/T/mri-dc051be38c594e64/axial_021.png","assets/T/mri-dc051be38c594e64/axial_022.png","assets/T/mri-dc051be38c594e64/axial_023.png","assets/T/mri-dc051be38c594e64/axial_024.png","assets/T/mri-dc051be38c594e64/axial_025.png","assets/T/mri-dc051be38c594e64/axial_026.png","assets/T/mri-dc051be38c594e64/axial_027.png","assets/T/mri-dc051be38c594e64/axial_028.png","assets/T/mri-dc051be38c594e64/axial_029.png","assets/T/mri-dc051be38c594e64/axial_030.png","assets/T/mri-dc051be38c594e64/axial_031.png","assets/T/mri-dc051be38c594e64/axial_032.png","assets/T/mri-dc051be38c594e64/axial_033.png","assets/T/mri-dc051be38c594e64/axial_034.png","assets/T/mri-dc051be38c594e64/axial_035.png","assets/T/mri-dc051be38c594e64/axial_036.png","assets/T/mri-dc051be38c594e64/axial_037.png","assets/T/mri-dc051be38c594e64/axial_038.png","assets/T/mri-dc051be38c594e64/axial_039.png","assets/T/mri-dc051be38c594e64/axial_040.png","assets/T/mri-dc051be38c594e64/coronal_001.png","assets/T/mri-dc051be38c594e64/coronal_002.png","assets/T/mri-dc051be38c594e64/coronal_003.png","assets/T/mri-dc051be38c594e64/coronal_004.png","assets/T/mri-dc051be38c594e64/coronal_005.png","assets/T/mri-dc051be38c594e64/coronal_006.png","assets/T/mri-dc051be38c594e64/coronal_007.png","assets/T/mri-dc051be38c594e64/coronal_008.png","assets/T/mri-dc051be38c594e64/coronal_009.png","assets/T/mri-dc051be38c594e64/coronal_010.png","assets/T/mri-dc051be38c594e64/coronal_011.png","assets/T/mri-dc051be38c594e64/coronal_012.png","assets/T/mri-dc051be38c594e64/coronal_013.png","assets/T/mri-dc051be38c594e64/coronal_014.png","assets/T/mri-dc051be38c594e64/coronal_015.png","assets/T/mri-dc051be38c594e64/coronal_016.png","assets/T/mri-dc051be38c594e64/coronal_017.png","assets/T/mri-dc051be38c594e64/coronal_018.png","assets/T/mri-dc051be38c594e64/coronal_019.png","assets/T/mri-dc051be38c594e64/coronal_020.png","assets/T/mri-dc051be38c594e64/coronal_021.png","assets/T/mri-dc051be38c594e64/coronal_022.png","assets/T/mri-dc051be38c594e64/coronal_023.png","assets/T/mri-dc051be38c594e64/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-7b8493c771024704","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 68 张图，均来自同一次检查。\n\n- 前 44 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-7b8493c771024704/axial_001.png","assets/T/mri-7b8493c771024704/axial_002.png","assets/T/mri-7b8493c771024704/axial_003.png","assets/T/mri-7b8493c771024704/axial_004.png","assets/T/mri-7b8493c771024704/axial_005.png","assets/T/mri-7b8493c771024704/axial_006.png","assets/T/mri-7b8493c771024704/axial_007.png","assets/T/mri-7b8493c771024704/axial_008.png","assets/T/mri-7b8493c771024704/axial_009.png","assets/T/mri-7b8493c771024704/axial_010.png","assets/T/mri-7b8493c771024704/axial_011.png","assets/T/mri-7b8493c771024704/axial_012.png","assets/T/mri-7b8493c771024704/axial_013.png","assets/T/mri-7b8493c771024704/axial_014.png","assets/T/mri-7b8493c771024704/axial_015.png","assets/T/mri-7b8493c771024704/axial_016.png","assets/T/mri-7b8493c771024704/axial_017.png","assets/T/mri-7b8493c771024704/axial_018.png","assets/T/mri-7b8493c771024704/axial_019.png","assets/T/mri-7b8493c771024704/axial_020.png","assets/T/mri-7b8493c771024704/axial_021.png","assets/T/mri-7b8493c771024704/axial_022.png","assets/T/mri-7b8493c771024704/axial_023.png","assets/T/mri-7b8493c771024704/axial_024.png","assets/T/mri-7b8493c771024704/axial_025.png","assets/T/mri-7b8493c771024704/axial_026.png","assets/T/mri-7b8493c771024704/axial_027.png","assets/T/mri-7b8493c771024704/axial_028.png","assets/T/mri-7b8493c771024704/axial_029.png","assets/T/mri-7b8493c771024704/axial_030.png","assets/T/mri-7b8493c771024704/axial_031.png","assets/T/mri-7b8493c771024704/axial_032.png","assets/T/mri-7b8493c771024704/axial_033.png","assets/T/mri-7b8493c771024704/axial_034.png","assets/T/mri-7b8493c771024704/axial_035.png","assets/T/mri-7b8493c771024704/axial_036.png","assets/T/mri-7b8493c771024704/axial_037.png","assets/T/mri-7b8493c771024704/axial_038.png","assets/T/mri-7b8493c771024704/axial_039.png","assets/T/mri-7b8493c771024704/axial_040.png","assets/T/mri-7b8493c771024704/axial_041.png","assets/T/mri-7b8493c771024704/axial_042.png","assets/T/mri-7b8493c771024704/axial_043.png","assets/T/mri-7b8493c771024704/axial_044.png","assets/T/mri-7b8493c771024704/coronal_001.png","assets/T/mri-7b8493c771024704/coronal_002.png","assets/T/mri-7b8493c771024704/coronal_003.png","assets/T/mri-7b8493c771024704/coronal_004.png","assets/T/mri-7b8493c771024704/coronal_005.png","assets/T/mri-7b8493c771024704/coronal_006.png","assets/T/mri-7b8493c771024704/coronal_007.png","assets/T/mri-7b8493c771024704/coronal_008.png","assets/T/mri-7b8493c771024704/coronal_009.png","assets/T/mri-7b8493c771024704/coronal_010.png","assets/T/mri-7b8493c771024704/coronal_011.png","assets/T/mri-7b8493c771024704/coronal_012.png","assets/T/mri-7b8493c771024704/coronal_013.png","assets/T/mri-7b8493c771024704/coronal_014.png","assets/T/mri-7b8493c771024704/coronal_015.png","assets/T/mri-7b8493c771024704/coronal_016.png","assets/T/mri-7b8493c771024704/coronal_017.png","assets/T/mri-7b8493c771024704/coronal_018.png","assets/T/mri-7b8493c771024704/coronal_019.png","assets/T/mri-7b8493c771024704/coronal_020.png","assets/T/mri-7b8493c771024704/coronal_021.png","assets/T/mri-7b8493c771024704/coronal_022.png","assets/T/mri-7b8493c771024704/coronal_023.png","assets/T/mri-7b8493c771024704/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-5ce68cec7138451f","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-5ce68cec7138451f/axial_001.png","assets/T/mri-5ce68cec7138451f/axial_002.png","assets/T/mri-5ce68cec7138451f/axial_003.png","assets/T/mri-5ce68cec7138451f/axial_004.png","assets/T/mri-5ce68cec7138451f/axial_005.png","assets/T/mri-5ce68cec7138451f/axial_006.png","assets/T/mri-5ce68cec7138451f/axial_007.png","assets/T/mri-5ce68cec7138451f/axial_008.png","assets/T/mri-5ce68cec7138451f/axial_009.png","assets/T/mri-5ce68cec7138451f/axial_010.png","assets/T/mri-5ce68cec7138451f/axial_011.png","assets/T/mri-5ce68cec7138451f/axial_012.png","assets/T/mri-5ce68cec7138451f/axial_013.png","assets/T/mri-5ce68cec7138451f/axial_014.png","assets/T/mri-5ce68cec7138451f/axial_015.png","assets/T/mri-5ce68cec7138451f/axial_016.png","assets/T/mri-5ce68cec7138451f/axial_017.png","assets/T/mri-5ce68cec7138451f/axial_018.png","assets/T/mri-5ce68cec7138451f/axial_019.png","assets/T/mri-5ce68cec7138451f/axial_020.png","assets/T/mri-5ce68cec7138451f/axial_021.png","assets/T/mri-5ce68cec7138451f/axial_022.png","assets/T/mri-5ce68cec7138451f/axial_023.png","assets/T/mri-5ce68cec7138451f/axial_024.png","assets/T/mri-5ce68cec7138451f/axial_025.png","assets/T/mri-5ce68cec7138451f/axial_026.png","assets/T/mri-5ce68cec7138451f/axial_027.png","assets/T/mri-5ce68cec7138451f/axial_028.png","assets/T/mri-5ce68cec7138451f/axial_029.png","assets/T/mri-5ce68cec7138451f/axial_030.png","assets/T/mri-5ce68cec7138451f/axial_031.png","assets/T/mri-5ce68cec7138451f/axial_032.png","assets/T/mri-5ce68cec7138451f/axial_033.png","assets/T/mri-5ce68cec7138451f/axial_034.png","assets/T/mri-5ce68cec7138451f/axial_035.png","assets/T/mri-5ce68cec7138451f/axial_036.png","assets/T/mri-5ce68cec7138451f/axial_037.png","assets/T/mri-5ce68cec7138451f/axial_038.png","assets/T/mri-5ce68cec7138451f/axial_039.png","assets/T/mri-5ce68cec7138451f/axial_040.png","assets/T/mri-5ce68cec7138451f/axial_041.png","assets/T/mri-5ce68cec7138451f/axial_042.png","assets/T/mri-5ce68cec7138451f/coronal_001.png","assets/T/mri-5ce68cec7138451f/coronal_002.png","assets/T/mri-5ce68cec7138451f/coronal_003.png","assets/T/mri-5ce68cec7138451f/coronal_004.png","assets/T/mri-5ce68cec7138451f/coronal_005.png","assets/T/mri-5ce68cec7138451f/coronal_006.png","assets/T/mri-5ce68cec7138451f/coronal_007.png","assets/T/mri-5ce68cec7138451f/coronal_008.png","assets/T/mri-5ce68cec7138451f/coronal_009.png","assets/T/mri-5ce68cec7138451f/coronal_010.png","assets/T/mri-5ce68cec7138451f/coronal_011.png","assets/T/mri-5ce68cec7138451f/coronal_012.png","assets/T/mri-5ce68cec7138451f/coronal_013.png","assets/T/mri-5ce68cec7138451f/coronal_014.png","assets/T/mri-5ce68cec7138451f/coronal_015.png","assets/T/mri-5ce68cec7138451f/coronal_016.png","assets/T/mri-5ce68cec7138451f/coronal_017.png","assets/T/mri-5ce68cec7138451f/coronal_018.png","assets/T/mri-5ce68cec7138451f/coronal_019.png","assets/T/mri-5ce68cec7138451f/coronal_020.png","assets/T/mri-5ce68cec7138451f/coronal_021.png","assets/T/mri-5ce68cec7138451f/coronal_022.png","assets/T/mri-5ce68cec7138451f/coronal_023.png","assets/T/mri-5ce68cec7138451f/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-64b88c007f454cd4","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 67 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 25 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-64b88c007f454cd4/axial_001.png","assets/T/mri-64b88c007f454cd4/axial_002.png","assets/T/mri-64b88c007f454cd4/axial_003.png","assets/T/mri-64b88c007f454cd4/axial_004.png","assets/T/mri-64b88c007f454cd4/axial_005.png","assets/T/mri-64b88c007f454cd4/axial_006.png","assets/T/mri-64b88c007f454cd4/axial_007.png","assets/T/mri-64b88c007f454cd4/axial_008.png","assets/T/mri-64b88c007f454cd4/axial_009.png","assets/T/mri-64b88c007f454cd4/axial_010.png","assets/T/mri-64b88c007f454cd4/axial_011.png","assets/T/mri-64b88c007f454cd4/axial_012.png","assets/T/mri-64b88c007f454cd4/axial_013.png","assets/T/mri-64b88c007f454cd4/axial_014.png","assets/T/mri-64b88c007f454cd4/axial_015.png","assets/T/mri-64b88c007f454cd4/axial_016.png","assets/T/mri-64b88c007f454cd4/axial_017.png","assets/T/mri-64b88c007f454cd4/axial_018.png","assets/T/mri-64b88c007f454cd4/axial_019.png","assets/T/mri-64b88c007f454cd4/axial_020.png","assets/T/mri-64b88c007f454cd4/axial_021.png","assets/T/mri-64b88c007f454cd4/axial_022.png","assets/T/mri-64b88c007f454cd4/axial_023.png","assets/T/mri-64b88c007f454cd4/axial_024.png","assets/T/mri-64b88c007f454cd4/axial_025.png","assets/T/mri-64b88c007f454cd4/axial_026.png","assets/T/mri-64b88c007f454cd4/axial_027.png","assets/T/mri-64b88c007f454cd4/axial_028.png","assets/T/mri-64b88c007f454cd4/axial_029.png","assets/T/mri-64b88c007f454cd4/axial_030.png","assets/T/mri-64b88c007f454cd4/axial_031.png","assets/T/mri-64b88c007f454cd4/axial_032.png","assets/T/mri-64b88c007f454cd4/axial_033.png","assets/T/mri-64b88c007f454cd4/axial_034.png","assets/T/mri-64b88c007f454cd4/axial_035.png","assets/T/mri-64b88c007f454cd4/axial_036.png","assets/T/mri-64b88c007f454cd4/axial_037.png","assets/T/mri-64b88c007f454cd4/axial_038.png","assets/T/mri-64b88c007f454cd4/axial_039.png","assets/T/mri-64b88c007f454cd4/axial_040.png","assets/T/mri-64b88c007f454cd4/axial_041.png","assets/T/mri-64b88c007f454cd4/axial_042.png","assets/T/mri-64b88c007f454cd4/coronal_001.png","assets/T/mri-64b88c007f454cd4/coronal_002.png","assets/T/mri-64b88c007f454cd4/coronal_003.png","assets/T/mri-64b88c007f454cd4/coronal_004.png","assets/T/mri-64b88c007f454cd4/coronal_005.png","assets/T/mri-64b88c007f454cd4/coronal_006.png","assets/T/mri-64b88c007f454cd4/coronal_007.png","assets/T/mri-64b88c007f454cd4/coronal_008.png","assets/T/mri-64b88c007f454cd4/coronal_009.png","assets/T/mri-64b88c007f454cd4/coronal_010.png","assets/T/mri-64b88c007f454cd4/coronal_011.png","assets/T/mri-64b88c007f454cd4/coronal_012.png","assets/T/mri-64b88c007f454cd4/coronal_013.png","assets/T/mri-64b88c007f454cd4/coronal_014.png","assets/T/mri-64b88c007f454cd4/coronal_015.png","assets/T/mri-64b88c007f454cd4/coronal_016.png","assets/T/mri-64b88c007f454cd4/coronal_017.png","assets/T/mri-64b88c007f454cd4/coronal_018.png","assets/T/mri-64b88c007f454cd4/coronal_019.png","assets/T/mri-64b88c007f454cd4/coronal_020.png","assets/T/mri-64b88c007f454cd4/coronal_021.png","assets/T/mri-64b88c007f454cd4/coronal_022.png","assets/T/mri-64b88c007f454cd4/coronal_023.png","assets/T/mri-64b88c007f454cd4/coronal_024.png","assets/T/mri-64b88c007f454cd4/coronal_025.png"],"stage_edition":8}
+{"id":"L3-T300:mri-94083fb208a0400d","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-94083fb208a0400d/axial_001.png","assets/T/mri-94083fb208a0400d/axial_002.png","assets/T/mri-94083fb208a0400d/axial_003.png","assets/T/mri-94083fb208a0400d/axial_004.png","assets/T/mri-94083fb208a0400d/axial_005.png","assets/T/mri-94083fb208a0400d/axial_006.png","assets/T/mri-94083fb208a0400d/axial_007.png","assets/T/mri-94083fb208a0400d/axial_008.png","assets/T/mri-94083fb208a0400d/axial_009.png","assets/T/mri-94083fb208a0400d/axial_010.png","assets/T/mri-94083fb208a0400d/axial_011.png","assets/T/mri-94083fb208a0400d/axial_012.png","assets/T/mri-94083fb208a0400d/axial_013.png","assets/T/mri-94083fb208a0400d/axial_014.png","assets/T/mri-94083fb208a0400d/axial_015.png","assets/T/mri-94083fb208a0400d/axial_016.png","assets/T/mri-94083fb208a0400d/axial_017.png","assets/T/mri-94083fb208a0400d/axial_018.png","assets/T/mri-94083fb208a0400d/axial_019.png","assets/T/mri-94083fb208a0400d/axial_020.png","assets/T/mri-94083fb208a0400d/axial_021.png","assets/T/mri-94083fb208a0400d/axial_022.png","assets/T/mri-94083fb208a0400d/axial_023.png","assets/T/mri-94083fb208a0400d/axial_024.png","assets/T/mri-94083fb208a0400d/axial_025.png","assets/T/mri-94083fb208a0400d/axial_026.png","assets/T/mri-94083fb208a0400d/axial_027.png","assets/T/mri-94083fb208a0400d/axial_028.png","assets/T/mri-94083fb208a0400d/axial_029.png","assets/T/mri-94083fb208a0400d/axial_030.png","assets/T/mri-94083fb208a0400d/axial_031.png","assets/T/mri-94083fb208a0400d/axial_032.png","assets/T/mri-94083fb208a0400d/axial_033.png","assets/T/mri-94083fb208a0400d/axial_034.png","assets/T/mri-94083fb208a0400d/axial_035.png","assets/T/mri-94083fb208a0400d/axial_036.png","assets/T/mri-94083fb208a0400d/axial_037.png","assets/T/mri-94083fb208a0400d/axial_038.png","assets/T/mri-94083fb208a0400d/axial_039.png","assets/T/mri-94083fb208a0400d/axial_040.png","assets/T/mri-94083fb208a0400d/coronal_001.png","assets/T/mri-94083fb208a0400d/coronal_002.png","assets/T/mri-94083fb208a0400d/coronal_003.png","assets/T/mri-94083fb208a0400d/coronal_004.png","assets/T/mri-94083fb208a0400d/coronal_005.png","assets/T/mri-94083fb208a0400d/coronal_006.png","assets/T/mri-94083fb208a0400d/coronal_007.png","assets/T/mri-94083fb208a0400d/coronal_008.png","assets/T/mri-94083fb208a0400d/coronal_009.png","assets/T/mri-94083fb208a0400d/coronal_010.png","assets/T/mri-94083fb208a0400d/coronal_011.png","assets/T/mri-94083fb208a0400d/coronal_012.png","assets/T/mri-94083fb208a0400d/coronal_013.png","assets/T/mri-94083fb208a0400d/coronal_014.png","assets/T/mri-94083fb208a0400d/coronal_015.png","assets/T/mri-94083fb208a0400d/coronal_016.png","assets/T/mri-94083fb208a0400d/coronal_017.png","assets/T/mri-94083fb208a0400d/coronal_018.png","assets/T/mri-94083fb208a0400d/coronal_019.png","assets/T/mri-94083fb208a0400d/coronal_020.png","assets/T/mri-94083fb208a0400d/coronal_021.png","assets/T/mri-94083fb208a0400d/coronal_022.png","assets/T/mri-94083fb208a0400d/coronal_023.png","assets/T/mri-94083fb208a0400d/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-0671b570b9dd4f82","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 62 张图，均来自同一次检查。\n\n- 前 38 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-0671b570b9dd4f82/axial_001.png","assets/T/mri-0671b570b9dd4f82/axial_002.png","assets/T/mri-0671b570b9dd4f82/axial_003.png","assets/T/mri-0671b570b9dd4f82/axial_004.png","assets/T/mri-0671b570b9dd4f82/axial_005.png","assets/T/mri-0671b570b9dd4f82/axial_006.png","assets/T/mri-0671b570b9dd4f82/axial_007.png","assets/T/mri-0671b570b9dd4f82/axial_008.png","assets/T/mri-0671b570b9dd4f82/axial_009.png","assets/T/mri-0671b570b9dd4f82/axial_010.png","assets/T/mri-0671b570b9dd4f82/axial_011.png","assets/T/mri-0671b570b9dd4f82/axial_012.png","assets/T/mri-0671b570b9dd4f82/axial_013.png","assets/T/mri-0671b570b9dd4f82/axial_014.png","assets/T/mri-0671b570b9dd4f82/axial_015.png","assets/T/mri-0671b570b9dd4f82/axial_016.png","assets/T/mri-0671b570b9dd4f82/axial_017.png","assets/T/mri-0671b570b9dd4f82/axial_018.png","assets/T/mri-0671b570b9dd4f82/axial_019.png","assets/T/mri-0671b570b9dd4f82/axial_020.png","assets/T/mri-0671b570b9dd4f82/axial_021.png","assets/T/mri-0671b570b9dd4f82/axial_022.png","assets/T/mri-0671b570b9dd4f82/axial_023.png","assets/T/mri-0671b570b9dd4f82/axial_024.png","assets/T/mri-0671b570b9dd4f82/axial_025.png","assets/T/mri-0671b570b9dd4f82/axial_026.png","assets/T/mri-0671b570b9dd4f82/axial_027.png","assets/T/mri-0671b570b9dd4f82/axial_028.png","assets/T/mri-0671b570b9dd4f82/axial_029.png","assets/T/mri-0671b570b9dd4f82/axial_030.png","assets/T/mri-0671b570b9dd4f82/axial_031.png","assets/T/mri-0671b570b9dd4f82/axial_032.png","assets/T/mri-0671b570b9dd4f82/axial_033.png","assets/T/mri-0671b570b9dd4f82/axial_034.png","assets/T/mri-0671b570b9dd4f82/axial_035.png","assets/T/mri-0671b570b9dd4f82/axial_036.png","assets/T/mri-0671b570b9dd4f82/axial_037.png","assets/T/mri-0671b570b9dd4f82/axial_038.png","assets/T/mri-0671b570b9dd4f82/coronal_001.png","assets/T/mri-0671b570b9dd4f82/coronal_002.png","assets/T/mri-0671b570b9dd4f82/coronal_003.png","assets/T/mri-0671b570b9dd4f82/coronal_004.png","assets/T/mri-0671b570b9dd4f82/coronal_005.png","assets/T/mri-0671b570b9dd4f82/coronal_006.png","assets/T/mri-0671b570b9dd4f82/coronal_007.png","assets/T/mri-0671b570b9dd4f82/coronal_008.png","assets/T/mri-0671b570b9dd4f82/coronal_009.png","assets/T/mri-0671b570b9dd4f82/coronal_010.png","assets/T/mri-0671b570b9dd4f82/coronal_011.png","assets/T/mri-0671b570b9dd4f82/coronal_012.png","assets/T/mri-0671b570b9dd4f82/coronal_013.png","assets/T/mri-0671b570b9dd4f82/coronal_014.png","assets/T/mri-0671b570b9dd4f82/coronal_015.png","assets/T/mri-0671b570b9dd4f82/coronal_016.png","assets/T/mri-0671b570b9dd4f82/coronal_017.png","assets/T/mri-0671b570b9dd4f82/coronal_018.png","assets/T/mri-0671b570b9dd4f82/coronal_019.png","assets/T/mri-0671b570b9dd4f82/coronal_020.png","assets/T/mri-0671b570b9dd4f82/coronal_021.png","assets/T/mri-0671b570b9dd4f82/coronal_022.png","assets/T/mri-0671b570b9dd4f82/coronal_023.png","assets/T/mri-0671b570b9dd4f82/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-2571bcb8b69c4c36","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 72 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 30 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-2571bcb8b69c4c36/axial_001.png","assets/T/mri-2571bcb8b69c4c36/axial_002.png","assets/T/mri-2571bcb8b69c4c36/axial_003.png","assets/T/mri-2571bcb8b69c4c36/axial_004.png","assets/T/mri-2571bcb8b69c4c36/axial_005.png","assets/T/mri-2571bcb8b69c4c36/axial_006.png","assets/T/mri-2571bcb8b69c4c36/axial_007.png","assets/T/mri-2571bcb8b69c4c36/axial_008.png","assets/T/mri-2571bcb8b69c4c36/axial_009.png","assets/T/mri-2571bcb8b69c4c36/axial_010.png","assets/T/mri-2571bcb8b69c4c36/axial_011.png","assets/T/mri-2571bcb8b69c4c36/axial_012.png","assets/T/mri-2571bcb8b69c4c36/axial_013.png","assets/T/mri-2571bcb8b69c4c36/axial_014.png","assets/T/mri-2571bcb8b69c4c36/axial_015.png","assets/T/mri-2571bcb8b69c4c36/axial_016.png","assets/T/mri-2571bcb8b69c4c36/axial_017.png","assets/T/mri-2571bcb8b69c4c36/axial_018.png","assets/T/mri-2571bcb8b69c4c36/axial_019.png","assets/T/mri-2571bcb8b69c4c36/axial_020.png","assets/T/mri-2571bcb8b69c4c36/axial_021.png","assets/T/mri-2571bcb8b69c4c36/axial_022.png","assets/T/mri-2571bcb8b69c4c36/axial_023.png","assets/T/mri-2571bcb8b69c4c36/axial_024.png","assets/T/mri-2571bcb8b69c4c36/axial_025.png","assets/T/mri-2571bcb8b69c4c36/axial_026.png","assets/T/mri-2571bcb8b69c4c36/axial_027.png","assets/T/mri-2571bcb8b69c4c36/axial_028.png","assets/T/mri-2571bcb8b69c4c36/axial_029.png","assets/T/mri-2571bcb8b69c4c36/axial_030.png","assets/T/mri-2571bcb8b69c4c36/axial_031.png","assets/T/mri-2571bcb8b69c4c36/axial_032.png","assets/T/mri-2571bcb8b69c4c36/axial_033.png","assets/T/mri-2571bcb8b69c4c36/axial_034.png","assets/T/mri-2571bcb8b69c4c36/axial_035.png","assets/T/mri-2571bcb8b69c4c36/axial_036.png","assets/T/mri-2571bcb8b69c4c36/axial_037.png","assets/T/mri-2571bcb8b69c4c36/axial_038.png","assets/T/mri-2571bcb8b69c4c36/axial_039.png","assets/T/mri-2571bcb8b69c4c36/axial_040.png","assets/T/mri-2571bcb8b69c4c36/axial_041.png","assets/T/mri-2571bcb8b69c4c36/axial_042.png","assets/T/mri-2571bcb8b69c4c36/coronal_001.png","assets/T/mri-2571bcb8b69c4c36/coronal_002.png","assets/T/mri-2571bcb8b69c4c36/coronal_003.png","assets/T/mri-2571bcb8b69c4c36/coronal_004.png","assets/T/mri-2571bcb8b69c4c36/coronal_005.png","assets/T/mri-2571bcb8b69c4c36/coronal_006.png","assets/T/mri-2571bcb8b69c4c36/coronal_007.png","assets/T/mri-2571bcb8b69c4c36/coronal_008.png","assets/T/mri-2571bcb8b69c4c36/coronal_009.png","assets/T/mri-2571bcb8b69c4c36/coronal_010.png","assets/T/mri-2571bcb8b69c4c36/coronal_011.png","assets/T/mri-2571bcb8b69c4c36/coronal_012.png","assets/T/mri-2571bcb8b69c4c36/coronal_013.png","assets/T/mri-2571bcb8b69c4c36/coronal_014.png","assets/T/mri-2571bcb8b69c4c36/coronal_015.png","assets/T/mri-2571bcb8b69c4c36/coronal_016.png","assets/T/mri-2571bcb8b69c4c36/coronal_017.png","assets/T/mri-2571bcb8b69c4c36/coronal_018.png","assets/T/mri-2571bcb8b69c4c36/coronal_019.png","assets/T/mri-2571bcb8b69c4c36/coronal_020.png","assets/T/mri-2571bcb8b69c4c36/coronal_021.png","assets/T/mri-2571bcb8b69c4c36/coronal_022.png","assets/T/mri-2571bcb8b69c4c36/coronal_023.png","assets/T/mri-2571bcb8b69c4c36/coronal_024.png","assets/T/mri-2571bcb8b69c4c36/coronal_025.png","assets/T/mri-2571bcb8b69c4c36/coronal_026.png","assets/T/mri-2571bcb8b69c4c36/coronal_027.png","assets/T/mri-2571bcb8b69c4c36/coronal_028.png","assets/T/mri-2571bcb8b69c4c36/coronal_029.png","assets/T/mri-2571bcb8b69c4c36/coronal_030.png"],"stage_edition":8}
+{"id":"L3-T300:mri-5fc5c21fa8b64c4f","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 68 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 26 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-5fc5c21fa8b64c4f/axial_001.png","assets/T/mri-5fc5c21fa8b64c4f/axial_002.png","assets/T/mri-5fc5c21fa8b64c4f/axial_003.png","assets/T/mri-5fc5c21fa8b64c4f/axial_004.png","assets/T/mri-5fc5c21fa8b64c4f/axial_005.png","assets/T/mri-5fc5c21fa8b64c4f/axial_006.png","assets/T/mri-5fc5c21fa8b64c4f/axial_007.png","assets/T/mri-5fc5c21fa8b64c4f/axial_008.png","assets/T/mri-5fc5c21fa8b64c4f/axial_009.png","assets/T/mri-5fc5c21fa8b64c4f/axial_010.png","assets/T/mri-5fc5c21fa8b64c4f/axial_011.png","assets/T/mri-5fc5c21fa8b64c4f/axial_012.png","assets/T/mri-5fc5c21fa8b64c4f/axial_013.png","assets/T/mri-5fc5c21fa8b64c4f/axial_014.png","assets/T/mri-5fc5c21fa8b64c4f/axial_015.png","assets/T/mri-5fc5c21fa8b64c4f/axial_016.png","assets/T/mri-5fc5c21fa8b64c4f/axial_017.png","assets/T/mri-5fc5c21fa8b64c4f/axial_018.png","assets/T/mri-5fc5c21fa8b64c4f/axial_019.png","assets/T/mri-5fc5c21fa8b64c4f/axial_020.png","assets/T/mri-5fc5c21fa8b64c4f/axial_021.png","assets/T/mri-5fc5c21fa8b64c4f/axial_022.png","assets/T/mri-5fc5c21fa8b64c4f/axial_023.png","assets/T/mri-5fc5c21fa8b64c4f/axial_024.png","assets/T/mri-5fc5c21fa8b64c4f/axial_025.png","assets/T/mri-5fc5c21fa8b64c4f/axial_026.png","assets/T/mri-5fc5c21fa8b64c4f/axial_027.png","assets/T/mri-5fc5c21fa8b64c4f/axial_028.png","assets/T/mri-5fc5c21fa8b64c4f/axial_029.png","assets/T/mri-5fc5c21fa8b64c4f/axial_030.png","assets/T/mri-5fc5c21fa8b64c4f/axial_031.png","assets/T/mri-5fc5c21fa8b64c4f/axial_032.png","assets/T/mri-5fc5c21fa8b64c4f/axial_033.png","assets/T/mri-5fc5c21fa8b64c4f/axial_034.png","assets/T/mri-5fc5c21fa8b64c4f/axial_035.png","assets/T/mri-5fc5c21fa8b64c4f/axial_036.png","assets/T/mri-5fc5c21fa8b64c4f/axial_037.png","assets/T/mri-5fc5c21fa8b64c4f/axial_038.png","assets/T/mri-5fc5c21fa8b64c4f/axial_039.png","assets/T/mri-5fc5c21fa8b64c4f/axial_040.png","assets/T/mri-5fc5c21fa8b64c4f/axial_041.png","assets/T/mri-5fc5c21fa8b64c4f/axial_042.png","assets/T/mri-5fc5c21fa8b64c4f/coronal_001.png","assets/T/mri-5fc5c21fa8b64c4f/coronal_002.png","assets/T/mri-5fc5c21fa8b64c4f/coronal_003.png","assets/T/mri-5fc5c21fa8b64c4f/coronal_004.png","assets/T/mri-5fc5c21fa8b64c4f/coronal_005.png","assets/T/mri-5fc5c21fa8b64c4f/coronal_006.png","assets/T/mri-5fc5c21fa8b64c4f/coronal_007.png","assets/T/mri-5fc5c21fa8b64c4f/coronal_008.png","assets/T/mri-5fc5c21fa8b64c4f/coronal_009.png","assets/T/mri-5fc5c21fa8b64c4f/coronal_010.png","assets/T/mri-5fc5c21fa8b64c4f/coronal_011.png","assets/T/mri-5fc5c21fa8b64c4f/coronal_012.png","assets/T/mri-5fc5c21fa8b64c4f/coronal_013.png","assets/T/mri-5fc5c21fa8b64c4f/coronal_014.png","assets/T/mri-5fc5c21fa8b64c4f/coronal_015.png","assets/T/mri-5fc5c21fa8b64c4f/coronal_016.png","assets/T/mri-5fc5c21fa8b64c4f/coronal_017.png","assets/T/mri-5fc5c21fa8b64c4f/coronal_018.png","assets/T/mri-5fc5c21fa8b64c4f/coronal_019.png","assets/T/mri-5fc5c21fa8b64c4f/coronal_020.png","assets/T/mri-5fc5c21fa8b64c4f/coronal_021.png","assets/T/mri-5fc5c21fa8b64c4f/coronal_022.png","assets/T/mri-5fc5c21fa8b64c4f/coronal_023.png","assets/T/mri-5fc5c21fa8b64c4f/coronal_024.png","assets/T/mri-5fc5c21fa8b64c4f/coronal_025.png","assets/T/mri-5fc5c21fa8b64c4f/coronal_026.png"],"stage_edition":8}
+{"id":"L3-T300:mri-cc1823e862844adb","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-cc1823e862844adb/axial_001.png","assets/T/mri-cc1823e862844adb/axial_002.png","assets/T/mri-cc1823e862844adb/axial_003.png","assets/T/mri-cc1823e862844adb/axial_004.png","assets/T/mri-cc1823e862844adb/axial_005.png","assets/T/mri-cc1823e862844adb/axial_006.png","assets/T/mri-cc1823e862844adb/axial_007.png","assets/T/mri-cc1823e862844adb/axial_008.png","assets/T/mri-cc1823e862844adb/axial_009.png","assets/T/mri-cc1823e862844adb/axial_010.png","assets/T/mri-cc1823e862844adb/axial_011.png","assets/T/mri-cc1823e862844adb/axial_012.png","assets/T/mri-cc1823e862844adb/axial_013.png","assets/T/mri-cc1823e862844adb/axial_014.png","assets/T/mri-cc1823e862844adb/axial_015.png","assets/T/mri-cc1823e862844adb/axial_016.png","assets/T/mri-cc1823e862844adb/axial_017.png","assets/T/mri-cc1823e862844adb/axial_018.png","assets/T/mri-cc1823e862844adb/axial_019.png","assets/T/mri-cc1823e862844adb/axial_020.png","assets/T/mri-cc1823e862844adb/axial_021.png","assets/T/mri-cc1823e862844adb/axial_022.png","assets/T/mri-cc1823e862844adb/axial_023.png","assets/T/mri-cc1823e862844adb/axial_024.png","assets/T/mri-cc1823e862844adb/axial_025.png","assets/T/mri-cc1823e862844adb/axial_026.png","assets/T/mri-cc1823e862844adb/axial_027.png","assets/T/mri-cc1823e862844adb/axial_028.png","assets/T/mri-cc1823e862844adb/axial_029.png","assets/T/mri-cc1823e862844adb/axial_030.png","assets/T/mri-cc1823e862844adb/axial_031.png","assets/T/mri-cc1823e862844adb/axial_032.png","assets/T/mri-cc1823e862844adb/axial_033.png","assets/T/mri-cc1823e862844adb/axial_034.png","assets/T/mri-cc1823e862844adb/axial_035.png","assets/T/mri-cc1823e862844adb/axial_036.png","assets/T/mri-cc1823e862844adb/axial_037.png","assets/T/mri-cc1823e862844adb/axial_038.png","assets/T/mri-cc1823e862844adb/axial_039.png","assets/T/mri-cc1823e862844adb/axial_040.png","assets/T/mri-cc1823e862844adb/axial_041.png","assets/T/mri-cc1823e862844adb/axial_042.png","assets/T/mri-cc1823e862844adb/coronal_001.png","assets/T/mri-cc1823e862844adb/coronal_002.png","assets/T/mri-cc1823e862844adb/coronal_003.png","assets/T/mri-cc1823e862844adb/coronal_004.png","assets/T/mri-cc1823e862844adb/coronal_005.png","assets/T/mri-cc1823e862844adb/coronal_006.png","assets/T/mri-cc1823e862844adb/coronal_007.png","assets/T/mri-cc1823e862844adb/coronal_008.png","assets/T/mri-cc1823e862844adb/coronal_009.png","assets/T/mri-cc1823e862844adb/coronal_010.png","assets/T/mri-cc1823e862844adb/coronal_011.png","assets/T/mri-cc1823e862844adb/coronal_012.png","assets/T/mri-cc1823e862844adb/coronal_013.png","assets/T/mri-cc1823e862844adb/coronal_014.png","assets/T/mri-cc1823e862844adb/coronal_015.png","assets/T/mri-cc1823e862844adb/coronal_016.png","assets/T/mri-cc1823e862844adb/coronal_017.png","assets/T/mri-cc1823e862844adb/coronal_018.png","assets/T/mri-cc1823e862844adb/coronal_019.png","assets/T/mri-cc1823e862844adb/coronal_020.png","assets/T/mri-cc1823e862844adb/coronal_021.png","assets/T/mri-cc1823e862844adb/coronal_022.png","assets/T/mri-cc1823e862844adb/coronal_023.png","assets/T/mri-cc1823e862844adb/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-2827a4219010408d","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 60 张图，均来自同一次检查。\n\n- 前 36 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-2827a4219010408d/axial_001.png","assets/T/mri-2827a4219010408d/axial_002.png","assets/T/mri-2827a4219010408d/axial_003.png","assets/T/mri-2827a4219010408d/axial_004.png","assets/T/mri-2827a4219010408d/axial_005.png","assets/T/mri-2827a4219010408d/axial_006.png","assets/T/mri-2827a4219010408d/axial_007.png","assets/T/mri-2827a4219010408d/axial_008.png","assets/T/mri-2827a4219010408d/axial_009.png","assets/T/mri-2827a4219010408d/axial_010.png","assets/T/mri-2827a4219010408d/axial_011.png","assets/T/mri-2827a4219010408d/axial_012.png","assets/T/mri-2827a4219010408d/axial_013.png","assets/T/mri-2827a4219010408d/axial_014.png","assets/T/mri-2827a4219010408d/axial_015.png","assets/T/mri-2827a4219010408d/axial_016.png","assets/T/mri-2827a4219010408d/axial_017.png","assets/T/mri-2827a4219010408d/axial_018.png","assets/T/mri-2827a4219010408d/axial_019.png","assets/T/mri-2827a4219010408d/axial_020.png","assets/T/mri-2827a4219010408d/axial_021.png","assets/T/mri-2827a4219010408d/axial_022.png","assets/T/mri-2827a4219010408d/axial_023.png","assets/T/mri-2827a4219010408d/axial_024.png","assets/T/mri-2827a4219010408d/axial_025.png","assets/T/mri-2827a4219010408d/axial_026.png","assets/T/mri-2827a4219010408d/axial_027.png","assets/T/mri-2827a4219010408d/axial_028.png","assets/T/mri-2827a4219010408d/axial_029.png","assets/T/mri-2827a4219010408d/axial_030.png","assets/T/mri-2827a4219010408d/axial_031.png","assets/T/mri-2827a4219010408d/axial_032.png","assets/T/mri-2827a4219010408d/axial_033.png","assets/T/mri-2827a4219010408d/axial_034.png","assets/T/mri-2827a4219010408d/axial_035.png","assets/T/mri-2827a4219010408d/axial_036.png","assets/T/mri-2827a4219010408d/coronal_001.png","assets/T/mri-2827a4219010408d/coronal_002.png","assets/T/mri-2827a4219010408d/coronal_003.png","assets/T/mri-2827a4219010408d/coronal_004.png","assets/T/mri-2827a4219010408d/coronal_005.png","assets/T/mri-2827a4219010408d/coronal_006.png","assets/T/mri-2827a4219010408d/coronal_007.png","assets/T/mri-2827a4219010408d/coronal_008.png","assets/T/mri-2827a4219010408d/coronal_009.png","assets/T/mri-2827a4219010408d/coronal_010.png","assets/T/mri-2827a4219010408d/coronal_011.png","assets/T/mri-2827a4219010408d/coronal_012.png","assets/T/mri-2827a4219010408d/coronal_013.png","assets/T/mri-2827a4219010408d/coronal_014.png","assets/T/mri-2827a4219010408d/coronal_015.png","assets/T/mri-2827a4219010408d/coronal_016.png","assets/T/mri-2827a4219010408d/coronal_017.png","assets/T/mri-2827a4219010408d/coronal_018.png","assets/T/mri-2827a4219010408d/coronal_019.png","assets/T/mri-2827a4219010408d/coronal_020.png","assets/T/mri-2827a4219010408d/coronal_021.png","assets/T/mri-2827a4219010408d/coronal_022.png","assets/T/mri-2827a4219010408d/coronal_023.png","assets/T/mri-2827a4219010408d/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-814687fc8a704a75","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 68 张图，均来自同一次检查。\n\n- 前 44 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-814687fc8a704a75/axial_001.png","assets/T/mri-814687fc8a704a75/axial_002.png","assets/T/mri-814687fc8a704a75/axial_003.png","assets/T/mri-814687fc8a704a75/axial_004.png","assets/T/mri-814687fc8a704a75/axial_005.png","assets/T/mri-814687fc8a704a75/axial_006.png","assets/T/mri-814687fc8a704a75/axial_007.png","assets/T/mri-814687fc8a704a75/axial_008.png","assets/T/mri-814687fc8a704a75/axial_009.png","assets/T/mri-814687fc8a704a75/axial_010.png","assets/T/mri-814687fc8a704a75/axial_011.png","assets/T/mri-814687fc8a704a75/axial_012.png","assets/T/mri-814687fc8a704a75/axial_013.png","assets/T/mri-814687fc8a704a75/axial_014.png","assets/T/mri-814687fc8a704a75/axial_015.png","assets/T/mri-814687fc8a704a75/axial_016.png","assets/T/mri-814687fc8a704a75/axial_017.png","assets/T/mri-814687fc8a704a75/axial_018.png","assets/T/mri-814687fc8a704a75/axial_019.png","assets/T/mri-814687fc8a704a75/axial_020.png","assets/T/mri-814687fc8a704a75/axial_021.png","assets/T/mri-814687fc8a704a75/axial_022.png","assets/T/mri-814687fc8a704a75/axial_023.png","assets/T/mri-814687fc8a704a75/axial_024.png","assets/T/mri-814687fc8a704a75/axial_025.png","assets/T/mri-814687fc8a704a75/axial_026.png","assets/T/mri-814687fc8a704a75/axial_027.png","assets/T/mri-814687fc8a704a75/axial_028.png","assets/T/mri-814687fc8a704a75/axial_029.png","assets/T/mri-814687fc8a704a75/axial_030.png","assets/T/mri-814687fc8a704a75/axial_031.png","assets/T/mri-814687fc8a704a75/axial_032.png","assets/T/mri-814687fc8a704a75/axial_033.png","assets/T/mri-814687fc8a704a75/axial_034.png","assets/T/mri-814687fc8a704a75/axial_035.png","assets/T/mri-814687fc8a704a75/axial_036.png","assets/T/mri-814687fc8a704a75/axial_037.png","assets/T/mri-814687fc8a704a75/axial_038.png","assets/T/mri-814687fc8a704a75/axial_039.png","assets/T/mri-814687fc8a704a75/axial_040.png","assets/T/mri-814687fc8a704a75/axial_041.png","assets/T/mri-814687fc8a704a75/axial_042.png","assets/T/mri-814687fc8a704a75/axial_043.png","assets/T/mri-814687fc8a704a75/axial_044.png","assets/T/mri-814687fc8a704a75/coronal_001.png","assets/T/mri-814687fc8a704a75/coronal_002.png","assets/T/mri-814687fc8a704a75/coronal_003.png","assets/T/mri-814687fc8a704a75/coronal_004.png","assets/T/mri-814687fc8a704a75/coronal_005.png","assets/T/mri-814687fc8a704a75/coronal_006.png","assets/T/mri-814687fc8a704a75/coronal_007.png","assets/T/mri-814687fc8a704a75/coronal_008.png","assets/T/mri-814687fc8a704a75/coronal_009.png","assets/T/mri-814687fc8a704a75/coronal_010.png","assets/T/mri-814687fc8a704a75/coronal_011.png","assets/T/mri-814687fc8a704a75/coronal_012.png","assets/T/mri-814687fc8a704a75/coronal_013.png","assets/T/mri-814687fc8a704a75/coronal_014.png","assets/T/mri-814687fc8a704a75/coronal_015.png","assets/T/mri-814687fc8a704a75/coronal_016.png","assets/T/mri-814687fc8a704a75/coronal_017.png","assets/T/mri-814687fc8a704a75/coronal_018.png","assets/T/mri-814687fc8a704a75/coronal_019.png","assets/T/mri-814687fc8a704a75/coronal_020.png","assets/T/mri-814687fc8a704a75/coronal_021.png","assets/T/mri-814687fc8a704a75/coronal_022.png","assets/T/mri-814687fc8a704a75/coronal_023.png","assets/T/mri-814687fc8a704a75/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-2cce79e2ec6f4326","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 65 张图，均来自同一次检查。\n\n- 前 41 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-2cce79e2ec6f4326/axial_001.png","assets/T/mri-2cce79e2ec6f4326/axial_002.png","assets/T/mri-2cce79e2ec6f4326/axial_003.png","assets/T/mri-2cce79e2ec6f4326/axial_004.png","assets/T/mri-2cce79e2ec6f4326/axial_005.png","assets/T/mri-2cce79e2ec6f4326/axial_006.png","assets/T/mri-2cce79e2ec6f4326/axial_007.png","assets/T/mri-2cce79e2ec6f4326/axial_008.png","assets/T/mri-2cce79e2ec6f4326/axial_009.png","assets/T/mri-2cce79e2ec6f4326/axial_010.png","assets/T/mri-2cce79e2ec6f4326/axial_011.png","assets/T/mri-2cce79e2ec6f4326/axial_012.png","assets/T/mri-2cce79e2ec6f4326/axial_013.png","assets/T/mri-2cce79e2ec6f4326/axial_014.png","assets/T/mri-2cce79e2ec6f4326/axial_015.png","assets/T/mri-2cce79e2ec6f4326/axial_016.png","assets/T/mri-2cce79e2ec6f4326/axial_017.png","assets/T/mri-2cce79e2ec6f4326/axial_018.png","assets/T/mri-2cce79e2ec6f4326/axial_019.png","assets/T/mri-2cce79e2ec6f4326/axial_020.png","assets/T/mri-2cce79e2ec6f4326/axial_021.png","assets/T/mri-2cce79e2ec6f4326/axial_022.png","assets/T/mri-2cce79e2ec6f4326/axial_023.png","assets/T/mri-2cce79e2ec6f4326/axial_024.png","assets/T/mri-2cce79e2ec6f4326/axial_025.png","assets/T/mri-2cce79e2ec6f4326/axial_026.png","assets/T/mri-2cce79e2ec6f4326/axial_027.png","assets/T/mri-2cce79e2ec6f4326/axial_028.png","assets/T/mri-2cce79e2ec6f4326/axial_029.png","assets/T/mri-2cce79e2ec6f4326/axial_030.png","assets/T/mri-2cce79e2ec6f4326/axial_031.png","assets/T/mri-2cce79e2ec6f4326/axial_032.png","assets/T/mri-2cce79e2ec6f4326/axial_033.png","assets/T/mri-2cce79e2ec6f4326/axial_034.png","assets/T/mri-2cce79e2ec6f4326/axial_035.png","assets/T/mri-2cce79e2ec6f4326/axial_036.png","assets/T/mri-2cce79e2ec6f4326/axial_037.png","assets/T/mri-2cce79e2ec6f4326/axial_038.png","assets/T/mri-2cce79e2ec6f4326/axial_039.png","assets/T/mri-2cce79e2ec6f4326/axial_040.png","assets/T/mri-2cce79e2ec6f4326/axial_041.png","assets/T/mri-2cce79e2ec6f4326/coronal_001.png","assets/T/mri-2cce79e2ec6f4326/coronal_002.png","assets/T/mri-2cce79e2ec6f4326/coronal_003.png","assets/T/mri-2cce79e2ec6f4326/coronal_004.png","assets/T/mri-2cce79e2ec6f4326/coronal_005.png","assets/T/mri-2cce79e2ec6f4326/coronal_006.png","assets/T/mri-2cce79e2ec6f4326/coronal_007.png","assets/T/mri-2cce79e2ec6f4326/coronal_008.png","assets/T/mri-2cce79e2ec6f4326/coronal_009.png","assets/T/mri-2cce79e2ec6f4326/coronal_010.png","assets/T/mri-2cce79e2ec6f4326/coronal_011.png","assets/T/mri-2cce79e2ec6f4326/coronal_012.png","assets/T/mri-2cce79e2ec6f4326/coronal_013.png","assets/T/mri-2cce79e2ec6f4326/coronal_014.png","assets/T/mri-2cce79e2ec6f4326/coronal_015.png","assets/T/mri-2cce79e2ec6f4326/coronal_016.png","assets/T/mri-2cce79e2ec6f4326/coronal_017.png","assets/T/mri-2cce79e2ec6f4326/coronal_018.png","assets/T/mri-2cce79e2ec6f4326/coronal_019.png","assets/T/mri-2cce79e2ec6f4326/coronal_020.png","assets/T/mri-2cce79e2ec6f4326/coronal_021.png","assets/T/mri-2cce79e2ec6f4326/coronal_022.png","assets/T/mri-2cce79e2ec6f4326/coronal_023.png","assets/T/mri-2cce79e2ec6f4326/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-babf41133d3f434f","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-babf41133d3f434f/axial_001.png","assets/T/mri-babf41133d3f434f/axial_002.png","assets/T/mri-babf41133d3f434f/axial_003.png","assets/T/mri-babf41133d3f434f/axial_004.png","assets/T/mri-babf41133d3f434f/axial_005.png","assets/T/mri-babf41133d3f434f/axial_006.png","assets/T/mri-babf41133d3f434f/axial_007.png","assets/T/mri-babf41133d3f434f/axial_008.png","assets/T/mri-babf41133d3f434f/axial_009.png","assets/T/mri-babf41133d3f434f/axial_010.png","assets/T/mri-babf41133d3f434f/axial_011.png","assets/T/mri-babf41133d3f434f/axial_012.png","assets/T/mri-babf41133d3f434f/axial_013.png","assets/T/mri-babf41133d3f434f/axial_014.png","assets/T/mri-babf41133d3f434f/axial_015.png","assets/T/mri-babf41133d3f434f/axial_016.png","assets/T/mri-babf41133d3f434f/axial_017.png","assets/T/mri-babf41133d3f434f/axial_018.png","assets/T/mri-babf41133d3f434f/axial_019.png","assets/T/mri-babf41133d3f434f/axial_020.png","assets/T/mri-babf41133d3f434f/axial_021.png","assets/T/mri-babf41133d3f434f/axial_022.png","assets/T/mri-babf41133d3f434f/axial_023.png","assets/T/mri-babf41133d3f434f/axial_024.png","assets/T/mri-babf41133d3f434f/axial_025.png","assets/T/mri-babf41133d3f434f/axial_026.png","assets/T/mri-babf41133d3f434f/axial_027.png","assets/T/mri-babf41133d3f434f/axial_028.png","assets/T/mri-babf41133d3f434f/axial_029.png","assets/T/mri-babf41133d3f434f/axial_030.png","assets/T/mri-babf41133d3f434f/axial_031.png","assets/T/mri-babf41133d3f434f/axial_032.png","assets/T/mri-babf41133d3f434f/axial_033.png","assets/T/mri-babf41133d3f434f/axial_034.png","assets/T/mri-babf41133d3f434f/axial_035.png","assets/T/mri-babf41133d3f434f/axial_036.png","assets/T/mri-babf41133d3f434f/axial_037.png","assets/T/mri-babf41133d3f434f/axial_038.png","assets/T/mri-babf41133d3f434f/axial_039.png","assets/T/mri-babf41133d3f434f/axial_040.png","assets/T/mri-babf41133d3f434f/axial_041.png","assets/T/mri-babf41133d3f434f/axial_042.png","assets/T/mri-babf41133d3f434f/coronal_001.png","assets/T/mri-babf41133d3f434f/coronal_002.png","assets/T/mri-babf41133d3f434f/coronal_003.png","assets/T/mri-babf41133d3f434f/coronal_004.png","assets/T/mri-babf41133d3f434f/coronal_005.png","assets/T/mri-babf41133d3f434f/coronal_006.png","assets/T/mri-babf41133d3f434f/coronal_007.png","assets/T/mri-babf41133d3f434f/coronal_008.png","assets/T/mri-babf41133d3f434f/coronal_009.png","assets/T/mri-babf41133d3f434f/coronal_010.png","assets/T/mri-babf41133d3f434f/coronal_011.png","assets/T/mri-babf41133d3f434f/coronal_012.png","assets/T/mri-babf41133d3f434f/coronal_013.png","assets/T/mri-babf41133d3f434f/coronal_014.png","assets/T/mri-babf41133d3f434f/coronal_015.png","assets/T/mri-babf41133d3f434f/coronal_016.png","assets/T/mri-babf41133d3f434f/coronal_017.png","assets/T/mri-babf41133d3f434f/coronal_018.png","assets/T/mri-babf41133d3f434f/coronal_019.png","assets/T/mri-babf41133d3f434f/coronal_020.png","assets/T/mri-babf41133d3f434f/coronal_021.png","assets/T/mri-babf41133d3f434f/coronal_022.png","assets/T/mri-babf41133d3f434f/coronal_023.png","assets/T/mri-babf41133d3f434f/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-839bb04435614c8f","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 62 张图，均来自同一次检查。\n\n- 前 38 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-839bb04435614c8f/axial_001.png","assets/T/mri-839bb04435614c8f/axial_002.png","assets/T/mri-839bb04435614c8f/axial_003.png","assets/T/mri-839bb04435614c8f/axial_004.png","assets/T/mri-839bb04435614c8f/axial_005.png","assets/T/mri-839bb04435614c8f/axial_006.png","assets/T/mri-839bb04435614c8f/axial_007.png","assets/T/mri-839bb04435614c8f/axial_008.png","assets/T/mri-839bb04435614c8f/axial_009.png","assets/T/mri-839bb04435614c8f/axial_010.png","assets/T/mri-839bb04435614c8f/axial_011.png","assets/T/mri-839bb04435614c8f/axial_012.png","assets/T/mri-839bb04435614c8f/axial_013.png","assets/T/mri-839bb04435614c8f/axial_014.png","assets/T/mri-839bb04435614c8f/axial_015.png","assets/T/mri-839bb04435614c8f/axial_016.png","assets/T/mri-839bb04435614c8f/axial_017.png","assets/T/mri-839bb04435614c8f/axial_018.png","assets/T/mri-839bb04435614c8f/axial_019.png","assets/T/mri-839bb04435614c8f/axial_020.png","assets/T/mri-839bb04435614c8f/axial_021.png","assets/T/mri-839bb04435614c8f/axial_022.png","assets/T/mri-839bb04435614c8f/axial_023.png","assets/T/mri-839bb04435614c8f/axial_024.png","assets/T/mri-839bb04435614c8f/axial_025.png","assets/T/mri-839bb04435614c8f/axial_026.png","assets/T/mri-839bb04435614c8f/axial_027.png","assets/T/mri-839bb04435614c8f/axial_028.png","assets/T/mri-839bb04435614c8f/axial_029.png","assets/T/mri-839bb04435614c8f/axial_030.png","assets/T/mri-839bb04435614c8f/axial_031.png","assets/T/mri-839bb04435614c8f/axial_032.png","assets/T/mri-839bb04435614c8f/axial_033.png","assets/T/mri-839bb04435614c8f/axial_034.png","assets/T/mri-839bb04435614c8f/axial_035.png","assets/T/mri-839bb04435614c8f/axial_036.png","assets/T/mri-839bb04435614c8f/axial_037.png","assets/T/mri-839bb04435614c8f/axial_038.png","assets/T/mri-839bb04435614c8f/coronal_001.png","assets/T/mri-839bb04435614c8f/coronal_002.png","assets/T/mri-839bb04435614c8f/coronal_003.png","assets/T/mri-839bb04435614c8f/coronal_004.png","assets/T/mri-839bb04435614c8f/coronal_005.png","assets/T/mri-839bb04435614c8f/coronal_006.png","assets/T/mri-839bb04435614c8f/coronal_007.png","assets/T/mri-839bb04435614c8f/coronal_008.png","assets/T/mri-839bb04435614c8f/coronal_009.png","assets/T/mri-839bb04435614c8f/coronal_010.png","assets/T/mri-839bb04435614c8f/coronal_011.png","assets/T/mri-839bb04435614c8f/coronal_012.png","assets/T/mri-839bb04435614c8f/coronal_013.png","assets/T/mri-839bb04435614c8f/coronal_014.png","assets/T/mri-839bb04435614c8f/coronal_015.png","assets/T/mri-839bb04435614c8f/coronal_016.png","assets/T/mri-839bb04435614c8f/coronal_017.png","assets/T/mri-839bb04435614c8f/coronal_018.png","assets/T/mri-839bb04435614c8f/coronal_019.png","assets/T/mri-839bb04435614c8f/coronal_020.png","assets/T/mri-839bb04435614c8f/coronal_021.png","assets/T/mri-839bb04435614c8f/coronal_022.png","assets/T/mri-839bb04435614c8f/coronal_023.png","assets/T/mri-839bb04435614c8f/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-40c6389b9ccc4000","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-40c6389b9ccc4000/axial_001.png","assets/T/mri-40c6389b9ccc4000/axial_002.png","assets/T/mri-40c6389b9ccc4000/axial_003.png","assets/T/mri-40c6389b9ccc4000/axial_004.png","assets/T/mri-40c6389b9ccc4000/axial_005.png","assets/T/mri-40c6389b9ccc4000/axial_006.png","assets/T/mri-40c6389b9ccc4000/axial_007.png","assets/T/mri-40c6389b9ccc4000/axial_008.png","assets/T/mri-40c6389b9ccc4000/axial_009.png","assets/T/mri-40c6389b9ccc4000/axial_010.png","assets/T/mri-40c6389b9ccc4000/axial_011.png","assets/T/mri-40c6389b9ccc4000/axial_012.png","assets/T/mri-40c6389b9ccc4000/axial_013.png","assets/T/mri-40c6389b9ccc4000/axial_014.png","assets/T/mri-40c6389b9ccc4000/axial_015.png","assets/T/mri-40c6389b9ccc4000/axial_016.png","assets/T/mri-40c6389b9ccc4000/axial_017.png","assets/T/mri-40c6389b9ccc4000/axial_018.png","assets/T/mri-40c6389b9ccc4000/axial_019.png","assets/T/mri-40c6389b9ccc4000/axial_020.png","assets/T/mri-40c6389b9ccc4000/axial_021.png","assets/T/mri-40c6389b9ccc4000/axial_022.png","assets/T/mri-40c6389b9ccc4000/axial_023.png","assets/T/mri-40c6389b9ccc4000/axial_024.png","assets/T/mri-40c6389b9ccc4000/axial_025.png","assets/T/mri-40c6389b9ccc4000/axial_026.png","assets/T/mri-40c6389b9ccc4000/axial_027.png","assets/T/mri-40c6389b9ccc4000/axial_028.png","assets/T/mri-40c6389b9ccc4000/axial_029.png","assets/T/mri-40c6389b9ccc4000/axial_030.png","assets/T/mri-40c6389b9ccc4000/axial_031.png","assets/T/mri-40c6389b9ccc4000/axial_032.png","assets/T/mri-40c6389b9ccc4000/axial_033.png","assets/T/mri-40c6389b9ccc4000/axial_034.png","assets/T/mri-40c6389b9ccc4000/axial_035.png","assets/T/mri-40c6389b9ccc4000/axial_036.png","assets/T/mri-40c6389b9ccc4000/axial_037.png","assets/T/mri-40c6389b9ccc4000/axial_038.png","assets/T/mri-40c6389b9ccc4000/axial_039.png","assets/T/mri-40c6389b9ccc4000/axial_040.png","assets/T/mri-40c6389b9ccc4000/coronal_001.png","assets/T/mri-40c6389b9ccc4000/coronal_002.png","assets/T/mri-40c6389b9ccc4000/coronal_003.png","assets/T/mri-40c6389b9ccc4000/coronal_004.png","assets/T/mri-40c6389b9ccc4000/coronal_005.png","assets/T/mri-40c6389b9ccc4000/coronal_006.png","assets/T/mri-40c6389b9ccc4000/coronal_007.png","assets/T/mri-40c6389b9ccc4000/coronal_008.png","assets/T/mri-40c6389b9ccc4000/coronal_009.png","assets/T/mri-40c6389b9ccc4000/coronal_010.png","assets/T/mri-40c6389b9ccc4000/coronal_011.png","assets/T/mri-40c6389b9ccc4000/coronal_012.png","assets/T/mri-40c6389b9ccc4000/coronal_013.png","assets/T/mri-40c6389b9ccc4000/coronal_014.png","assets/T/mri-40c6389b9ccc4000/coronal_015.png","assets/T/mri-40c6389b9ccc4000/coronal_016.png","assets/T/mri-40c6389b9ccc4000/coronal_017.png","assets/T/mri-40c6389b9ccc4000/coronal_018.png","assets/T/mri-40c6389b9ccc4000/coronal_019.png","assets/T/mri-40c6389b9ccc4000/coronal_020.png","assets/T/mri-40c6389b9ccc4000/coronal_021.png","assets/T/mri-40c6389b9ccc4000/coronal_022.png","assets/T/mri-40c6389b9ccc4000/coronal_023.png","assets/T/mri-40c6389b9ccc4000/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-d50e7ed4292a41b6","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-d50e7ed4292a41b6/axial_001.png","assets/T/mri-d50e7ed4292a41b6/axial_002.png","assets/T/mri-d50e7ed4292a41b6/axial_003.png","assets/T/mri-d50e7ed4292a41b6/axial_004.png","assets/T/mri-d50e7ed4292a41b6/axial_005.png","assets/T/mri-d50e7ed4292a41b6/axial_006.png","assets/T/mri-d50e7ed4292a41b6/axial_007.png","assets/T/mri-d50e7ed4292a41b6/axial_008.png","assets/T/mri-d50e7ed4292a41b6/axial_009.png","assets/T/mri-d50e7ed4292a41b6/axial_010.png","assets/T/mri-d50e7ed4292a41b6/axial_011.png","assets/T/mri-d50e7ed4292a41b6/axial_012.png","assets/T/mri-d50e7ed4292a41b6/axial_013.png","assets/T/mri-d50e7ed4292a41b6/axial_014.png","assets/T/mri-d50e7ed4292a41b6/axial_015.png","assets/T/mri-d50e7ed4292a41b6/axial_016.png","assets/T/mri-d50e7ed4292a41b6/axial_017.png","assets/T/mri-d50e7ed4292a41b6/axial_018.png","assets/T/mri-d50e7ed4292a41b6/axial_019.png","assets/T/mri-d50e7ed4292a41b6/axial_020.png","assets/T/mri-d50e7ed4292a41b6/axial_021.png","assets/T/mri-d50e7ed4292a41b6/axial_022.png","assets/T/mri-d50e7ed4292a41b6/axial_023.png","assets/T/mri-d50e7ed4292a41b6/axial_024.png","assets/T/mri-d50e7ed4292a41b6/axial_025.png","assets/T/mri-d50e7ed4292a41b6/axial_026.png","assets/T/mri-d50e7ed4292a41b6/axial_027.png","assets/T/mri-d50e7ed4292a41b6/axial_028.png","assets/T/mri-d50e7ed4292a41b6/axial_029.png","assets/T/mri-d50e7ed4292a41b6/axial_030.png","assets/T/mri-d50e7ed4292a41b6/axial_031.png","assets/T/mri-d50e7ed4292a41b6/axial_032.png","assets/T/mri-d50e7ed4292a41b6/axial_033.png","assets/T/mri-d50e7ed4292a41b6/axial_034.png","assets/T/mri-d50e7ed4292a41b6/axial_035.png","assets/T/mri-d50e7ed4292a41b6/axial_036.png","assets/T/mri-d50e7ed4292a41b6/axial_037.png","assets/T/mri-d50e7ed4292a41b6/axial_038.png","assets/T/mri-d50e7ed4292a41b6/axial_039.png","assets/T/mri-d50e7ed4292a41b6/axial_040.png","assets/T/mri-d50e7ed4292a41b6/axial_041.png","assets/T/mri-d50e7ed4292a41b6/axial_042.png","assets/T/mri-d50e7ed4292a41b6/coronal_001.png","assets/T/mri-d50e7ed4292a41b6/coronal_002.png","assets/T/mri-d50e7ed4292a41b6/coronal_003.png","assets/T/mri-d50e7ed4292a41b6/coronal_004.png","assets/T/mri-d50e7ed4292a41b6/coronal_005.png","assets/T/mri-d50e7ed4292a41b6/coronal_006.png","assets/T/mri-d50e7ed4292a41b6/coronal_007.png","assets/T/mri-d50e7ed4292a41b6/coronal_008.png","assets/T/mri-d50e7ed4292a41b6/coronal_009.png","assets/T/mri-d50e7ed4292a41b6/coronal_010.png","assets/T/mri-d50e7ed4292a41b6/coronal_011.png","assets/T/mri-d50e7ed4292a41b6/coronal_012.png","assets/T/mri-d50e7ed4292a41b6/coronal_013.png","assets/T/mri-d50e7ed4292a41b6/coronal_014.png","assets/T/mri-d50e7ed4292a41b6/coronal_015.png","assets/T/mri-d50e7ed4292a41b6/coronal_016.png","assets/T/mri-d50e7ed4292a41b6/coronal_017.png","assets/T/mri-d50e7ed4292a41b6/coronal_018.png","assets/T/mri-d50e7ed4292a41b6/coronal_019.png","assets/T/mri-d50e7ed4292a41b6/coronal_020.png","assets/T/mri-d50e7ed4292a41b6/coronal_021.png","assets/T/mri-d50e7ed4292a41b6/coronal_022.png","assets/T/mri-d50e7ed4292a41b6/coronal_023.png","assets/T/mri-d50e7ed4292a41b6/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-c3378b4651c34176","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-c3378b4651c34176/axial_001.png","assets/T/mri-c3378b4651c34176/axial_002.png","assets/T/mri-c3378b4651c34176/axial_003.png","assets/T/mri-c3378b4651c34176/axial_004.png","assets/T/mri-c3378b4651c34176/axial_005.png","assets/T/mri-c3378b4651c34176/axial_006.png","assets/T/mri-c3378b4651c34176/axial_007.png","assets/T/mri-c3378b4651c34176/axial_008.png","assets/T/mri-c3378b4651c34176/axial_009.png","assets/T/mri-c3378b4651c34176/axial_010.png","assets/T/mri-c3378b4651c34176/axial_011.png","assets/T/mri-c3378b4651c34176/axial_012.png","assets/T/mri-c3378b4651c34176/axial_013.png","assets/T/mri-c3378b4651c34176/axial_014.png","assets/T/mri-c3378b4651c34176/axial_015.png","assets/T/mri-c3378b4651c34176/axial_016.png","assets/T/mri-c3378b4651c34176/axial_017.png","assets/T/mri-c3378b4651c34176/axial_018.png","assets/T/mri-c3378b4651c34176/axial_019.png","assets/T/mri-c3378b4651c34176/axial_020.png","assets/T/mri-c3378b4651c34176/axial_021.png","assets/T/mri-c3378b4651c34176/axial_022.png","assets/T/mri-c3378b4651c34176/axial_023.png","assets/T/mri-c3378b4651c34176/axial_024.png","assets/T/mri-c3378b4651c34176/axial_025.png","assets/T/mri-c3378b4651c34176/axial_026.png","assets/T/mri-c3378b4651c34176/axial_027.png","assets/T/mri-c3378b4651c34176/axial_028.png","assets/T/mri-c3378b4651c34176/axial_029.png","assets/T/mri-c3378b4651c34176/axial_030.png","assets/T/mri-c3378b4651c34176/axial_031.png","assets/T/mri-c3378b4651c34176/axial_032.png","assets/T/mri-c3378b4651c34176/axial_033.png","assets/T/mri-c3378b4651c34176/axial_034.png","assets/T/mri-c3378b4651c34176/axial_035.png","assets/T/mri-c3378b4651c34176/axial_036.png","assets/T/mri-c3378b4651c34176/axial_037.png","assets/T/mri-c3378b4651c34176/axial_038.png","assets/T/mri-c3378b4651c34176/axial_039.png","assets/T/mri-c3378b4651c34176/axial_040.png","assets/T/mri-c3378b4651c34176/axial_041.png","assets/T/mri-c3378b4651c34176/axial_042.png","assets/T/mri-c3378b4651c34176/coronal_001.png","assets/T/mri-c3378b4651c34176/coronal_002.png","assets/T/mri-c3378b4651c34176/coronal_003.png","assets/T/mri-c3378b4651c34176/coronal_004.png","assets/T/mri-c3378b4651c34176/coronal_005.png","assets/T/mri-c3378b4651c34176/coronal_006.png","assets/T/mri-c3378b4651c34176/coronal_007.png","assets/T/mri-c3378b4651c34176/coronal_008.png","assets/T/mri-c3378b4651c34176/coronal_009.png","assets/T/mri-c3378b4651c34176/coronal_010.png","assets/T/mri-c3378b4651c34176/coronal_011.png","assets/T/mri-c3378b4651c34176/coronal_012.png","assets/T/mri-c3378b4651c34176/coronal_013.png","assets/T/mri-c3378b4651c34176/coronal_014.png","assets/T/mri-c3378b4651c34176/coronal_015.png","assets/T/mri-c3378b4651c34176/coronal_016.png","assets/T/mri-c3378b4651c34176/coronal_017.png","assets/T/mri-c3378b4651c34176/coronal_018.png","assets/T/mri-c3378b4651c34176/coronal_019.png","assets/T/mri-c3378b4651c34176/coronal_020.png","assets/T/mri-c3378b4651c34176/coronal_021.png","assets/T/mri-c3378b4651c34176/coronal_022.png","assets/T/mri-c3378b4651c34176/coronal_023.png","assets/T/mri-c3378b4651c34176/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-a10d3a7baeb04f59","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-a10d3a7baeb04f59/axial_001.png","assets/T/mri-a10d3a7baeb04f59/axial_002.png","assets/T/mri-a10d3a7baeb04f59/axial_003.png","assets/T/mri-a10d3a7baeb04f59/axial_004.png","assets/T/mri-a10d3a7baeb04f59/axial_005.png","assets/T/mri-a10d3a7baeb04f59/axial_006.png","assets/T/mri-a10d3a7baeb04f59/axial_007.png","assets/T/mri-a10d3a7baeb04f59/axial_008.png","assets/T/mri-a10d3a7baeb04f59/axial_009.png","assets/T/mri-a10d3a7baeb04f59/axial_010.png","assets/T/mri-a10d3a7baeb04f59/axial_011.png","assets/T/mri-a10d3a7baeb04f59/axial_012.png","assets/T/mri-a10d3a7baeb04f59/axial_013.png","assets/T/mri-a10d3a7baeb04f59/axial_014.png","assets/T/mri-a10d3a7baeb04f59/axial_015.png","assets/T/mri-a10d3a7baeb04f59/axial_016.png","assets/T/mri-a10d3a7baeb04f59/axial_017.png","assets/T/mri-a10d3a7baeb04f59/axial_018.png","assets/T/mri-a10d3a7baeb04f59/axial_019.png","assets/T/mri-a10d3a7baeb04f59/axial_020.png","assets/T/mri-a10d3a7baeb04f59/axial_021.png","assets/T/mri-a10d3a7baeb04f59/axial_022.png","assets/T/mri-a10d3a7baeb04f59/axial_023.png","assets/T/mri-a10d3a7baeb04f59/axial_024.png","assets/T/mri-a10d3a7baeb04f59/axial_025.png","assets/T/mri-a10d3a7baeb04f59/axial_026.png","assets/T/mri-a10d3a7baeb04f59/axial_027.png","assets/T/mri-a10d3a7baeb04f59/axial_028.png","assets/T/mri-a10d3a7baeb04f59/axial_029.png","assets/T/mri-a10d3a7baeb04f59/axial_030.png","assets/T/mri-a10d3a7baeb04f59/axial_031.png","assets/T/mri-a10d3a7baeb04f59/axial_032.png","assets/T/mri-a10d3a7baeb04f59/axial_033.png","assets/T/mri-a10d3a7baeb04f59/axial_034.png","assets/T/mri-a10d3a7baeb04f59/axial_035.png","assets/T/mri-a10d3a7baeb04f59/axial_036.png","assets/T/mri-a10d3a7baeb04f59/axial_037.png","assets/T/mri-a10d3a7baeb04f59/axial_038.png","assets/T/mri-a10d3a7baeb04f59/axial_039.png","assets/T/mri-a10d3a7baeb04f59/axial_040.png","assets/T/mri-a10d3a7baeb04f59/axial_041.png","assets/T/mri-a10d3a7baeb04f59/axial_042.png","assets/T/mri-a10d3a7baeb04f59/coronal_001.png","assets/T/mri-a10d3a7baeb04f59/coronal_002.png","assets/T/mri-a10d3a7baeb04f59/coronal_003.png","assets/T/mri-a10d3a7baeb04f59/coronal_004.png","assets/T/mri-a10d3a7baeb04f59/coronal_005.png","assets/T/mri-a10d3a7baeb04f59/coronal_006.png","assets/T/mri-a10d3a7baeb04f59/coronal_007.png","assets/T/mri-a10d3a7baeb04f59/coronal_008.png","assets/T/mri-a10d3a7baeb04f59/coronal_009.png","assets/T/mri-a10d3a7baeb04f59/coronal_010.png","assets/T/mri-a10d3a7baeb04f59/coronal_011.png","assets/T/mri-a10d3a7baeb04f59/coronal_012.png","assets/T/mri-a10d3a7baeb04f59/coronal_013.png","assets/T/mri-a10d3a7baeb04f59/coronal_014.png","assets/T/mri-a10d3a7baeb04f59/coronal_015.png","assets/T/mri-a10d3a7baeb04f59/coronal_016.png","assets/T/mri-a10d3a7baeb04f59/coronal_017.png","assets/T/mri-a10d3a7baeb04f59/coronal_018.png","assets/T/mri-a10d3a7baeb04f59/coronal_019.png","assets/T/mri-a10d3a7baeb04f59/coronal_020.png","assets/T/mri-a10d3a7baeb04f59/coronal_021.png","assets/T/mri-a10d3a7baeb04f59/coronal_022.png","assets/T/mri-a10d3a7baeb04f59/coronal_023.png","assets/T/mri-a10d3a7baeb04f59/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-802ae4b0d5084e52","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-802ae4b0d5084e52/axial_001.png","assets/T/mri-802ae4b0d5084e52/axial_002.png","assets/T/mri-802ae4b0d5084e52/axial_003.png","assets/T/mri-802ae4b0d5084e52/axial_004.png","assets/T/mri-802ae4b0d5084e52/axial_005.png","assets/T/mri-802ae4b0d5084e52/axial_006.png","assets/T/mri-802ae4b0d5084e52/axial_007.png","assets/T/mri-802ae4b0d5084e52/axial_008.png","assets/T/mri-802ae4b0d5084e52/axial_009.png","assets/T/mri-802ae4b0d5084e52/axial_010.png","assets/T/mri-802ae4b0d5084e52/axial_011.png","assets/T/mri-802ae4b0d5084e52/axial_012.png","assets/T/mri-802ae4b0d5084e52/axial_013.png","assets/T/mri-802ae4b0d5084e52/axial_014.png","assets/T/mri-802ae4b0d5084e52/axial_015.png","assets/T/mri-802ae4b0d5084e52/axial_016.png","assets/T/mri-802ae4b0d5084e52/axial_017.png","assets/T/mri-802ae4b0d5084e52/axial_018.png","assets/T/mri-802ae4b0d5084e52/axial_019.png","assets/T/mri-802ae4b0d5084e52/axial_020.png","assets/T/mri-802ae4b0d5084e52/axial_021.png","assets/T/mri-802ae4b0d5084e52/axial_022.png","assets/T/mri-802ae4b0d5084e52/axial_023.png","assets/T/mri-802ae4b0d5084e52/axial_024.png","assets/T/mri-802ae4b0d5084e52/axial_025.png","assets/T/mri-802ae4b0d5084e52/axial_026.png","assets/T/mri-802ae4b0d5084e52/axial_027.png","assets/T/mri-802ae4b0d5084e52/axial_028.png","assets/T/mri-802ae4b0d5084e52/axial_029.png","assets/T/mri-802ae4b0d5084e52/axial_030.png","assets/T/mri-802ae4b0d5084e52/axial_031.png","assets/T/mri-802ae4b0d5084e52/axial_032.png","assets/T/mri-802ae4b0d5084e52/axial_033.png","assets/T/mri-802ae4b0d5084e52/axial_034.png","assets/T/mri-802ae4b0d5084e52/axial_035.png","assets/T/mri-802ae4b0d5084e52/axial_036.png","assets/T/mri-802ae4b0d5084e52/axial_037.png","assets/T/mri-802ae4b0d5084e52/axial_038.png","assets/T/mri-802ae4b0d5084e52/axial_039.png","assets/T/mri-802ae4b0d5084e52/axial_040.png","assets/T/mri-802ae4b0d5084e52/axial_041.png","assets/T/mri-802ae4b0d5084e52/axial_042.png","assets/T/mri-802ae4b0d5084e52/coronal_001.png","assets/T/mri-802ae4b0d5084e52/coronal_002.png","assets/T/mri-802ae4b0d5084e52/coronal_003.png","assets/T/mri-802ae4b0d5084e52/coronal_004.png","assets/T/mri-802ae4b0d5084e52/coronal_005.png","assets/T/mri-802ae4b0d5084e52/coronal_006.png","assets/T/mri-802ae4b0d5084e52/coronal_007.png","assets/T/mri-802ae4b0d5084e52/coronal_008.png","assets/T/mri-802ae4b0d5084e52/coronal_009.png","assets/T/mri-802ae4b0d5084e52/coronal_010.png","assets/T/mri-802ae4b0d5084e52/coronal_011.png","assets/T/mri-802ae4b0d5084e52/coronal_012.png","assets/T/mri-802ae4b0d5084e52/coronal_013.png","assets/T/mri-802ae4b0d5084e52/coronal_014.png","assets/T/mri-802ae4b0d5084e52/coronal_015.png","assets/T/mri-802ae4b0d5084e52/coronal_016.png","assets/T/mri-802ae4b0d5084e52/coronal_017.png","assets/T/mri-802ae4b0d5084e52/coronal_018.png","assets/T/mri-802ae4b0d5084e52/coronal_019.png","assets/T/mri-802ae4b0d5084e52/coronal_020.png","assets/T/mri-802ae4b0d5084e52/coronal_021.png","assets/T/mri-802ae4b0d5084e52/coronal_022.png","assets/T/mri-802ae4b0d5084e52/coronal_023.png","assets/T/mri-802ae4b0d5084e52/coronal_024.png"],"stage_edition":8}
+{"id":"L3-T300:mri-fc649370f6644c8c","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 26 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-fc649370f6644c8c/axial_001.png","assets/T/mri-fc649370f6644c8c/axial_002.png","assets/T/mri-fc649370f6644c8c/axial_003.png","assets/T/mri-fc649370f6644c8c/axial_004.png","assets/T/mri-fc649370f6644c8c/axial_005.png","assets/T/mri-fc649370f6644c8c/axial_006.png","assets/T/mri-fc649370f6644c8c/axial_007.png","assets/T/mri-fc649370f6644c8c/axial_008.png","assets/T/mri-fc649370f6644c8c/axial_009.png","assets/T/mri-fc649370f6644c8c/axial_010.png","assets/T/mri-fc649370f6644c8c/axial_011.png","assets/T/mri-fc649370f6644c8c/axial_012.png","assets/T/mri-fc649370f6644c8c/axial_013.png","assets/T/mri-fc649370f6644c8c/axial_014.png","assets/T/mri-fc649370f6644c8c/axial_015.png","assets/T/mri-fc649370f6644c8c/axial_016.png","assets/T/mri-fc649370f6644c8c/axial_017.png","assets/T/mri-fc649370f6644c8c/axial_018.png","assets/T/mri-fc649370f6644c8c/axial_019.png","assets/T/mri-fc649370f6644c8c/axial_020.png","assets/T/mri-fc649370f6644c8c/axial_021.png","assets/T/mri-fc649370f6644c8c/axial_022.png","assets/T/mri-fc649370f6644c8c/axial_023.png","assets/T/mri-fc649370f6644c8c/axial_024.png","assets/T/mri-fc649370f6644c8c/axial_025.png","assets/T/mri-fc649370f6644c8c/axial_026.png","assets/T/mri-fc649370f6644c8c/axial_027.png","assets/T/mri-fc649370f6644c8c/axial_028.png","assets/T/mri-fc649370f6644c8c/axial_029.png","assets/T/mri-fc649370f6644c8c/axial_030.png","assets/T/mri-fc649370f6644c8c/axial_031.png","assets/T/mri-fc649370f6644c8c/axial_032.png","assets/T/mri-fc649370f6644c8c/axial_033.png","assets/T/mri-fc649370f6644c8c/axial_034.png","assets/T/mri-fc649370f6644c8c/axial_035.png","assets/T/mri-fc649370f6644c8c/axial_036.png","assets/T/mri-fc649370f6644c8c/axial_037.png","assets/T/mri-fc649370f6644c8c/axial_038.png","assets/T/mri-fc649370f6644c8c/axial_039.png","assets/T/mri-fc649370f6644c8c/axial_040.png","assets/T/mri-fc649370f6644c8c/coronal_001.png","assets/T/mri-fc649370f6644c8c/coronal_002.png","assets/T/mri-fc649370f6644c8c/coronal_003.png","assets/T/mri-fc649370f6644c8c/coronal_004.png","assets/T/mri-fc649370f6644c8c/coronal_005.png","assets/T/mri-fc649370f6644c8c/coronal_006.png","assets/T/mri-fc649370f6644c8c/coronal_007.png","assets/T/mri-fc649370f6644c8c/coronal_008.png","assets/T/mri-fc649370f6644c8c/coronal_009.png","assets/T/mri-fc649370f6644c8c/coronal_010.png","assets/T/mri-fc649370f6644c8c/coronal_011.png","assets/T/mri-fc649370f6644c8c/coronal_012.png","assets/T/mri-fc649370f6644c8c/coronal_013.png","assets/T/mri-fc649370f6644c8c/coronal_014.png","assets/T/mri-fc649370f6644c8c/coronal_015.png","assets/T/mri-fc649370f6644c8c/coronal_016.png","assets/T/mri-fc649370f6644c8c/coronal_017.png","assets/T/mri-fc649370f6644c8c/coronal_018.png","assets/T/mri-fc649370f6644c8c/coronal_019.png","assets/T/mri-fc649370f6644c8c/coronal_020.png","assets/T/mri-fc649370f6644c8c/coronal_021.png","assets/T/mri-fc649370f6644c8c/coronal_022.png","assets/T/mri-fc649370f6644c8c/coronal_023.png","assets/T/mri-fc649370f6644c8c/coronal_024.png","assets/T/mri-fc649370f6644c8c/coronal_025.png","assets/T/mri-fc649370f6644c8c/coronal_026.png"],"stage_edition":8}
+{"id":"L3-T300:mri-d1e14b3341084373","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-d1e14b3341084373/axial_001.png","assets/T/mri-d1e14b3341084373/axial_002.png","assets/T/mri-d1e14b3341084373/axial_003.png","assets/T/mri-d1e14b3341084373/axial_004.png","assets/T/mri-d1e14b3341084373/axial_005.png","assets/T/mri-d1e14b3341084373/axial_006.png","assets/T/mri-d1e14b3341084373/axial_007.png","assets/T/mri-d1e14b3341084373/axial_008.png","assets/T/mri-d1e14b3341084373/axial_009.png","assets/T/mri-d1e14b3341084373/axial_010.png","assets/T/mri-d1e14b3341084373/axial_011.png","assets/T/mri-d1e14b3341084373/axial_012.png","assets/T/mri-d1e14b3341084373/axial_013.png","assets/T/mri-d1e14b3341084373/axial_014.png","assets/T/mri-d1e14b3341084373/axial_015.png","assets/T/mri-d1e14b3341084373/axial_016.png","assets/T/mri-d1e14b3341084373/axial_017.png","assets/T/mri-d1e14b3341084373/axial_018.png","assets/T/mri-d1e14b3341084373/axial_019.png","assets/T/mri-d1e14b3341084373/axial_020.png","assets/T/mri-d1e14b3341084373/axial_021.png","assets/T/mri-d1e14b3341084373/axial_022.png","assets/T/mri-d1e14b3341084373/axial_023.png","assets/T/mri-d1e14b3341084373/axial_024.png","assets/T/mri-d1e14b3341084373/axial_025.png","assets/T/mri-d1e14b3341084373/axial_026.png","assets/T/mri-d1e14b3341084373/axial_027.png","assets/T/mri-d1e14b3341084373/axial_028.png","assets/T/mri-d1e14b3341084373/axial_029.png","assets/T/mri-d1e14b3341084373/axial_030.png","assets/T/mri-d1e14b3341084373/axial_031.png","assets/T/mri-d1e14b3341084373/axial_032.png","assets/T/mri-d1e14b3341084373/axial_033.png","assets/T/mri-d1e14b3341084373/axial_034.png","assets/T/mri-d1e14b3341084373/axial_035.png","assets/T/mri-d1e14b3341084373/axial_036.png","assets/T/mri-d1e14b3341084373/axial_037.png","assets/T/mri-d1e14b3341084373/axial_038.png","assets/T/mri-d1e14b3341084373/axial_039.png","assets/T/mri-d1e14b3341084373/axial_040.png","assets/T/mri-d1e14b3341084373/axial_041.png","assets/T/mri-d1e14b3341084373/axial_042.png","assets/T/mri-d1e14b3341084373/coronal_001.png","assets/T/mri-d1e14b3341084373/coronal_002.png","assets/T/mri-d1e14b3341084373/coronal_003.png","assets/T/mri-d1e14b3341084373/coronal_004.png","assets/T/mri-d1e14b3341084373/coronal_005.png","assets/T/mri-d1e14b3341084373/coronal_006.png","assets/T/mri-d1e14b3341084373/coronal_007.png","assets/T/mri-d1e14b3341084373/coronal_008.png","assets/T/mri-d1e14b3341084373/coronal_009.png","assets/T/mri-d1e14b3341084373/coronal_010.png","assets/T/mri-d1e14b3341084373/coronal_011.png","assets/T/mri-d1e14b3341084373/coronal_012.png","assets/T/mri-d1e14b3341084373/coronal_013.png","assets/T/mri-d1e14b3341084373/coronal_014.png","assets/T/mri-d1e14b3341084373/coronal_015.png","assets/T/mri-d1e14b3341084373/coronal_016.png","assets/T/mri-d1e14b3341084373/coronal_017.png","assets/T/mri-d1e14b3341084373/coronal_018.png","assets/T/mri-d1e14b3341084373/coronal_019.png","assets/T/mri-d1e14b3341084373/coronal_020.png","assets/T/mri-d1e14b3341084373/coronal_021.png","assets/T/mri-d1e14b3341084373/coronal_022.png","assets/T/mri-d1e14b3341084373/coronal_023.png","assets/T/mri-d1e14b3341084373/coronal_024.png"],"stage_edition":8}
+{"id":"L3-N400:mri-5d64214c74e34879","task":"L3-N400","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 63 张图，均来自同一次检查。\n\n- 前 37 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 26 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先综合全部图像中的区域淋巴结影像证据，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，判断该患者的 N 分期，并给出简要影像依据。不要判断 T、M 或总体分期。\n\n`n_stage` 只能输出 N0、N1、N2、N3 之一。\n只输出一个 JSON 对象，不要输出 JSON 以外的解释、markdown 或代码块。\n输出格式：\n{\n  \"n_stage\": \"N0\",\n  \"evidence\": \"简要影像依据\"\n}","images":["assets/N/mri-5d64214c74e34879/axial_001.png","assets/N/mri-5d64214c74e34879/axial_002.png","assets/N/mri-5d64214c74e34879/axial_003.png","assets/N/mri-5d64214c74e34879/axial_004.png","assets/N/mri-5d64214c74e34879/axial_005.png","assets/N/mri-5d64214c74e34879/axial_006.png","assets/N/mri-5d64214c74e34879/axial_007.png","assets/N/mri-5d64214c74e34879/axial_008.png","assets/N/mri-5d64214c74e34879/axial_009.png","assets/N/mri-5d64214c74e34879/axial_010.png","assets/N/mri-5d64214c74e34879/axial_011.png","assets/N/mri-5d64214c74e34879/axial_012.png","assets/N/mri-5d64214c74e34879/axial_013.png","assets/N/mri-5d64214c74e34879/axial_014.png","assets/N/mri-5d64214c74e34879/axial_015.png","assets/N/mri-5d64214c74e34879/axial_016.png","assets/N/mri-5d64214c74e34879/axial_017.png","assets/N/mri-5d64214c74e34879/axial_018.png","assets/N/mri-5d64214c74e34879/axial_019.png","assets/N/mri-5d64214c74e34879/axial_020.png","assets/N/mri-5d64214c74e34879/axial_021.png","assets/N/mri-5d64214c74e34879/axial_022.png","assets/N/mri-5d64214c74e34879/axial_023.png","assets/N/mri-5d64214c74e34879/axial_024.png","assets/N/mri-5d64214c74e34879/axial_025.png","assets/N/mri-5d64214c74e34879/axial_026.png","assets/N/mri-5d64214c74e34879/axial_027.png","assets/N/mri-5d64214c74e34879/axial_028.png","assets/N/mri-5d64214c74e34879/axial_029.png","assets/N/mri-5d64214c74e34879/axial_030.png","assets/N/mri-5d64214c74e34879/axial_031.png","assets/N/mri-5d64214c74e34879/axial_032.png","assets/N/mri-5d64214c74e34879/axial_033.png","assets/N/mri-5d64214c74e34879/axial_034.png","assets/N/mri-5d64214c74e34879/axial_035.png","assets/N/mri-5d64214c74e34879/axial_036.png","assets/N/mri-5d64214c74e34879/axial_037.png","assets/N/mri-5d64214c74e34879/coronal_001.png","assets/N/mri-5d64214c74e34879/coronal_002.png","assets/N/mri-5d64214c74e34879/coronal_003.png","assets/N/mri-5d64214c74e34879/coronal_004.png","assets/N/mri-5d64214c74e34879/coronal_005.png","assets/N/mri-5d64214c74e34879/coronal_006.png","assets/N/mri-5d64214c74e34879/coronal_007.png","assets/N/mri-5d64214c74e34879/coronal_008.png","assets/N/mri-5d64214c74e34879/coronal_009.png","assets/N/mri-5d64214c74e34879/coronal_010.png","assets/N/mri-5d64214c74e34879/coronal_011.png","assets/N/mri-5d64214c74e34879/coronal_012.png","assets/N/mri-5d64214c74e34879/coronal_013.png","assets/N/mri-5d64214c74e34879/coronal_014.png","assets/N/mri-5d64214c74e34879/coronal_015.png","assets/N/mri-5d64214c74e34879/coronal_016.png","assets/N/mri-5d64214c74e34879/coronal_017.png","assets/N/mri-5d64214c74e34879/coronal_018.png","assets/N/mri-5d64214c74e34879/coronal_019.png","assets/N/mri-5d64214c74e34879/coronal_020.png","assets/N/mri-5d64214c74e34879/coronal_021.png","assets/N/mri-5d64214c74e34879/coronal_022.png","assets/N/mri-5d64214c74e34879/coronal_023.png","assets/N/mri-5d64214c74e34879/coronal_024.png","assets/N/mri-5d64214c74e34879/coronal_025.png","assets/N/mri-5d64214c74e34879/coronal_026.png"],"stage_edition":8}
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diff --git a/L3/extensions/requests_gpt41.jsonl b/L3/extensions/requests_gpt41.jsonl
new file mode 100644
index 0000000000000000000000000000000000000000..8f14d4d1c27dcd373db58303b48dfc553786a683
--- /dev/null
+++ b/L3/extensions/requests_gpt41.jsonl
@@ -0,0 +1,700 @@
+{"id":"mri-d4c892f0b7e3423f","request_id":"L3-T300:mri-d4c892f0b7e3423f","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-d4c892f0b7e3423f/axial_001.png","assets/T/mri-d4c892f0b7e3423f/axial_002.png","assets/T/mri-d4c892f0b7e3423f/axial_004.png","assets/T/mri-d4c892f0b7e3423f/axial_005.png","assets/T/mri-d4c892f0b7e3423f/axial_006.png","assets/T/mri-d4c892f0b7e3423f/axial_008.png","assets/T/mri-d4c892f0b7e3423f/axial_009.png","assets/T/mri-d4c892f0b7e3423f/axial_010.png","assets/T/mri-d4c892f0b7e3423f/axial_012.png","assets/T/mri-d4c892f0b7e3423f/axial_013.png","assets/T/mri-d4c892f0b7e3423f/axial_014.png","assets/T/mri-d4c892f0b7e3423f/axial_016.png","assets/T/mri-d4c892f0b7e3423f/axial_017.png","assets/T/mri-d4c892f0b7e3423f/axial_018.png","assets/T/mri-d4c892f0b7e3423f/axial_020.png","assets/T/mri-d4c892f0b7e3423f/axial_021.png","assets/T/mri-d4c892f0b7e3423f/axial_022.png","assets/T/mri-d4c892f0b7e3423f/axial_023.png","assets/T/mri-d4c892f0b7e3423f/axial_025.png","assets/T/mri-d4c892f0b7e3423f/axial_026.png","assets/T/mri-d4c892f0b7e3423f/axial_027.png","assets/T/mri-d4c892f0b7e3423f/axial_029.png","assets/T/mri-d4c892f0b7e3423f/axial_030.png","assets/T/mri-d4c892f0b7e3423f/axial_031.png","assets/T/mri-d4c892f0b7e3423f/axial_033.png","assets/T/mri-d4c892f0b7e3423f/axial_034.png","assets/T/mri-d4c892f0b7e3423f/axial_035.png","assets/T/mri-d4c892f0b7e3423f/axial_037.png","assets/T/mri-d4c892f0b7e3423f/axial_038.png","assets/T/mri-d4c892f0b7e3423f/axial_039.png","assets/T/mri-d4c892f0b7e3423f/axial_041.png","assets/T/mri-d4c892f0b7e3423f/axial_042.png","assets/T/mri-d4c892f0b7e3423f/coronal_001.png","assets/T/mri-d4c892f0b7e3423f/coronal_002.png","assets/T/mri-d4c892f0b7e3423f/coronal_004.png","assets/T/mri-d4c892f0b7e3423f/coronal_005.png","assets/T/mri-d4c892f0b7e3423f/coronal_006.png","assets/T/mri-d4c892f0b7e3423f/coronal_008.png","assets/T/mri-d4c892f0b7e3423f/coronal_009.png","assets/T/mri-d4c892f0b7e3423f/coronal_010.png","assets/T/mri-d4c892f0b7e3423f/coronal_012.png","assets/T/mri-d4c892f0b7e3423f/coronal_013.png","assets/T/mri-d4c892f0b7e3423f/coronal_015.png","assets/T/mri-d4c892f0b7e3423f/coronal_016.png","assets/T/mri-d4c892f0b7e3423f/coronal_017.png","assets/T/mri-d4c892f0b7e3423f/coronal_019.png","assets/T/mri-d4c892f0b7e3423f/coronal_020.png","assets/T/mri-d4c892f0b7e3423f/coronal_021.png","assets/T/mri-d4c892f0b7e3423f/coronal_023.png","assets/T/mri-d4c892f0b7e3423f/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":66,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,12,13,14,16,17,18,20,21,22,23,25,26,27,29,30,31,33,34,35,37,38,39,41,42,43,44,46,47,48,50,51,52,54,55,57,58,59,61,62,63,65,66]}}
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+{"id":"mri-91686de02cb64fc2","request_id":"L3-T300:mri-91686de02cb64fc2","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-91686de02cb64fc2/axial_001.png","assets/T/mri-91686de02cb64fc2/axial_002.png","assets/T/mri-91686de02cb64fc2/axial_004.png","assets/T/mri-91686de02cb64fc2/axial_005.png","assets/T/mri-91686de02cb64fc2/axial_006.png","assets/T/mri-91686de02cb64fc2/axial_008.png","assets/T/mri-91686de02cb64fc2/axial_009.png","assets/T/mri-91686de02cb64fc2/axial_010.png","assets/T/mri-91686de02cb64fc2/axial_011.png","assets/T/mri-91686de02cb64fc2/axial_013.png","assets/T/mri-91686de02cb64fc2/axial_014.png","assets/T/mri-91686de02cb64fc2/axial_015.png","assets/T/mri-91686de02cb64fc2/axial_017.png","assets/T/mri-91686de02cb64fc2/axial_018.png","assets/T/mri-91686de02cb64fc2/axial_019.png","assets/T/mri-91686de02cb64fc2/axial_021.png","assets/T/mri-91686de02cb64fc2/axial_022.png","assets/T/mri-91686de02cb64fc2/axial_023.png","assets/T/mri-91686de02cb64fc2/axial_024.png","assets/T/mri-91686de02cb64fc2/axial_026.png","assets/T/mri-91686de02cb64fc2/axial_027.png","assets/T/mri-91686de02cb64fc2/axial_028.png","assets/T/mri-91686de02cb64fc2/axial_030.png","assets/T/mri-91686de02cb64fc2/axial_031.png","assets/T/mri-91686de02cb64fc2/axial_032.png","assets/T/mri-91686de02cb64fc2/axial_034.png","assets/T/mri-91686de02cb64fc2/axial_035.png","assets/T/mri-91686de02cb64fc2/axial_036.png","assets/T/mri-91686de02cb64fc2/axial_037.png","assets/T/mri-91686de02cb64fc2/axial_039.png","assets/T/mri-91686de02cb64fc2/axial_040.png","assets/T/mri-91686de02cb64fc2/coronal_001.png","assets/T/mri-91686de02cb64fc2/coronal_002.png","assets/T/mri-91686de02cb64fc2/coronal_004.png","assets/T/mri-91686de02cb64fc2/coronal_005.png","assets/T/mri-91686de02cb64fc2/coronal_006.png","assets/T/mri-91686de02cb64fc2/coronal_007.png","assets/T/mri-91686de02cb64fc2/coronal_009.png","assets/T/mri-91686de02cb64fc2/coronal_010.png","assets/T/mri-91686de02cb64fc2/coronal_011.png","assets/T/mri-91686de02cb64fc2/coronal_013.png","assets/T/mri-91686de02cb64fc2/coronal_014.png","assets/T/mri-91686de02cb64fc2/coronal_015.png","assets/T/mri-91686de02cb64fc2/coronal_016.png","assets/T/mri-91686de02cb64fc2/coronal_018.png","assets/T/mri-91686de02cb64fc2/coronal_019.png","assets/T/mri-91686de02cb64fc2/coronal_020.png","assets/T/mri-91686de02cb64fc2/coronal_021.png","assets/T/mri-91686de02cb64fc2/coronal_023.png","assets/T/mri-91686de02cb64fc2/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":64,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,11,13,14,15,17,18,19,21,22,23,24,26,27,28,30,31,32,34,35,36,37,39,40,41,42,44,45,46,47,49,50,51,53,54,55,56,58,59,60,61,63,64]}}
+{"id":"mri-93a27965e6ad4525","request_id":"L3-T300:mri-93a27965e6ad4525","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-93a27965e6ad4525/axial_001.png","assets/T/mri-93a27965e6ad4525/axial_002.png","assets/T/mri-93a27965e6ad4525/axial_004.png","assets/T/mri-93a27965e6ad4525/axial_005.png","assets/T/mri-93a27965e6ad4525/axial_007.png","assets/T/mri-93a27965e6ad4525/axial_008.png","assets/T/mri-93a27965e6ad4525/axial_010.png","assets/T/mri-93a27965e6ad4525/axial_011.png","assets/T/mri-93a27965e6ad4525/axial_012.png","assets/T/mri-93a27965e6ad4525/axial_014.png","assets/T/mri-93a27965e6ad4525/axial_015.png","assets/T/mri-93a27965e6ad4525/axial_017.png","assets/T/mri-93a27965e6ad4525/axial_018.png","assets/T/mri-93a27965e6ad4525/axial_020.png","assets/T/mri-93a27965e6ad4525/axial_021.png","assets/T/mri-93a27965e6ad4525/axial_023.png","assets/T/mri-93a27965e6ad4525/axial_024.png","assets/T/mri-93a27965e6ad4525/axial_025.png","assets/T/mri-93a27965e6ad4525/axial_027.png","assets/T/mri-93a27965e6ad4525/axial_028.png","assets/T/mri-93a27965e6ad4525/axial_030.png","assets/T/mri-93a27965e6ad4525/axial_031.png","assets/T/mri-93a27965e6ad4525/axial_033.png","assets/T/mri-93a27965e6ad4525/axial_034.png","assets/T/mri-93a27965e6ad4525/axial_035.png","assets/T/mri-93a27965e6ad4525/axial_037.png","assets/T/mri-93a27965e6ad4525/axial_038.png","assets/T/mri-93a27965e6ad4525/axial_040.png","assets/T/mri-93a27965e6ad4525/axial_041.png","assets/T/mri-93a27965e6ad4525/axial_043.png","assets/T/mri-93a27965e6ad4525/axial_044.png","assets/T/mri-93a27965e6ad4525/coronal_001.png","assets/T/mri-93a27965e6ad4525/coronal_002.png","assets/T/mri-93a27965e6ad4525/coronal_004.png","assets/T/mri-93a27965e6ad4525/coronal_005.png","assets/T/mri-93a27965e6ad4525/coronal_007.png","assets/T/mri-93a27965e6ad4525/coronal_008.png","assets/T/mri-93a27965e6ad4525/coronal_009.png","assets/T/mri-93a27965e6ad4525/coronal_011.png","assets/T/mri-93a27965e6ad4525/coronal_012.png","assets/T/mri-93a27965e6ad4525/coronal_014.png","assets/T/mri-93a27965e6ad4525/coronal_015.png","assets/T/mri-93a27965e6ad4525/coronal_016.png","assets/T/mri-93a27965e6ad4525/coronal_018.png","assets/T/mri-93a27965e6ad4525/coronal_019.png","assets/T/mri-93a27965e6ad4525/coronal_020.png","assets/T/mri-93a27965e6ad4525/coronal_022.png","assets/T/mri-93a27965e6ad4525/coronal_023.png","assets/T/mri-93a27965e6ad4525/coronal_025.png","assets/T/mri-93a27965e6ad4525/coronal_026.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":70,"selected_count":50,"source_indices_1based":[1,2,4,5,7,8,10,11,12,14,15,17,18,20,21,23,24,25,27,28,30,31,33,34,35,37,38,40,41,43,44,45,46,48,49,51,52,53,55,56,58,59,60,62,63,64,66,67,69,70]}}
+{"id":"mri-02211a5df28b41c8","request_id":"L3-T300:mri-02211a5df28b41c8","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-02211a5df28b41c8/axial_001.png","assets/T/mri-02211a5df28b41c8/axial_002.png","assets/T/mri-02211a5df28b41c8/axial_004.png","assets/T/mri-02211a5df28b41c8/axial_005.png","assets/T/mri-02211a5df28b41c8/axial_007.png","assets/T/mri-02211a5df28b41c8/axial_008.png","assets/T/mri-02211a5df28b41c8/axial_009.png","assets/T/mri-02211a5df28b41c8/axial_011.png","assets/T/mri-02211a5df28b41c8/axial_012.png","assets/T/mri-02211a5df28b41c8/axial_013.png","assets/T/mri-02211a5df28b41c8/axial_015.png","assets/T/mri-02211a5df28b41c8/axial_016.png","assets/T/mri-02211a5df28b41c8/axial_018.png","assets/T/mri-02211a5df28b41c8/axial_019.png","assets/T/mri-02211a5df28b41c8/axial_020.png","assets/T/mri-02211a5df28b41c8/axial_022.png","assets/T/mri-02211a5df28b41c8/axial_023.png","assets/T/mri-02211a5df28b41c8/axial_025.png","assets/T/mri-02211a5df28b41c8/axial_026.png","assets/T/mri-02211a5df28b41c8/axial_027.png","assets/T/mri-02211a5df28b41c8/axial_029.png","assets/T/mri-02211a5df28b41c8/axial_030.png","assets/T/mri-02211a5df28b41c8/axial_032.png","assets/T/mri-02211a5df28b41c8/axial_033.png","assets/T/mri-02211a5df28b41c8/axial_034.png","assets/T/mri-02211a5df28b41c8/axial_036.png","assets/T/mri-02211a5df28b41c8/axial_037.png","assets/T/mri-02211a5df28b41c8/axial_038.png","assets/T/mri-02211a5df28b41c8/axial_040.png","assets/T/mri-02211a5df28b41c8/axial_041.png","assets/T/mri-02211a5df28b41c8/axial_043.png","assets/T/mri-02211a5df28b41c8/axial_044.png","assets/T/mri-02211a5df28b41c8/coronal_001.png","assets/T/mri-02211a5df28b41c8/coronal_002.png","assets/T/mri-02211a5df28b41c8/coronal_004.png","assets/T/mri-02211a5df28b41c8/coronal_005.png","assets/T/mri-02211a5df28b41c8/coronal_006.png","assets/T/mri-02211a5df28b41c8/coronal_008.png","assets/T/mri-02211a5df28b41c8/coronal_009.png","assets/T/mri-02211a5df28b41c8/coronal_010.png","assets/T/mri-02211a5df28b41c8/coronal_012.png","assets/T/mri-02211a5df28b41c8/coronal_013.png","assets/T/mri-02211a5df28b41c8/coronal_015.png","assets/T/mri-02211a5df28b41c8/coronal_016.png","assets/T/mri-02211a5df28b41c8/coronal_017.png","assets/T/mri-02211a5df28b41c8/coronal_019.png","assets/T/mri-02211a5df28b41c8/coronal_020.png","assets/T/mri-02211a5df28b41c8/coronal_021.png","assets/T/mri-02211a5df28b41c8/coronal_023.png","assets/T/mri-02211a5df28b41c8/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":68,"selected_count":50,"source_indices_1based":[1,2,4,5,7,8,9,11,12,13,15,16,18,19,20,22,23,25,26,27,29,30,32,33,34,36,37,38,40,41,43,44,45,46,48,49,50,52,53,54,56,57,59,60,61,63,64,65,67,68]}}
+{"id":"mri-aafde48fd76947e0","request_id":"L3-T300:mri-aafde48fd76947e0","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-aafde48fd76947e0/axial_001.png","assets/T/mri-aafde48fd76947e0/axial_002.png","assets/T/mri-aafde48fd76947e0/axial_004.png","assets/T/mri-aafde48fd76947e0/axial_005.png","assets/T/mri-aafde48fd76947e0/axial_006.png","assets/T/mri-aafde48fd76947e0/axial_008.png","assets/T/mri-aafde48fd76947e0/axial_009.png","assets/T/mri-aafde48fd76947e0/axial_010.png","assets/T/mri-aafde48fd76947e0/axial_012.png","assets/T/mri-aafde48fd76947e0/axial_013.png","assets/T/mri-aafde48fd76947e0/axial_014.png","assets/T/mri-aafde48fd76947e0/axial_016.png","assets/T/mri-aafde48fd76947e0/axial_017.png","assets/T/mri-aafde48fd76947e0/axial_018.png","assets/T/mri-aafde48fd76947e0/axial_020.png","assets/T/mri-aafde48fd76947e0/axial_021.png","assets/T/mri-aafde48fd76947e0/axial_022.png","assets/T/mri-aafde48fd76947e0/axial_023.png","assets/T/mri-aafde48fd76947e0/axial_025.png","assets/T/mri-aafde48fd76947e0/axial_026.png","assets/T/mri-aafde48fd76947e0/axial_027.png","assets/T/mri-aafde48fd76947e0/axial_029.png","assets/T/mri-aafde48fd76947e0/axial_030.png","assets/T/mri-aafde48fd76947e0/axial_031.png","assets/T/mri-aafde48fd76947e0/axial_033.png","assets/T/mri-aafde48fd76947e0/axial_034.png","assets/T/mri-aafde48fd76947e0/axial_035.png","assets/T/mri-aafde48fd76947e0/axial_037.png","assets/T/mri-aafde48fd76947e0/axial_038.png","assets/T/mri-aafde48fd76947e0/axial_039.png","assets/T/mri-aafde48fd76947e0/axial_041.png","assets/T/mri-aafde48fd76947e0/axial_042.png","assets/T/mri-aafde48fd76947e0/coronal_001.png","assets/T/mri-aafde48fd76947e0/coronal_002.png","assets/T/mri-aafde48fd76947e0/coronal_004.png","assets/T/mri-aafde48fd76947e0/coronal_005.png","assets/T/mri-aafde48fd76947e0/coronal_006.png","assets/T/mri-aafde48fd76947e0/coronal_008.png","assets/T/mri-aafde48fd76947e0/coronal_009.png","assets/T/mri-aafde48fd76947e0/coronal_010.png","assets/T/mri-aafde48fd76947e0/coronal_012.png","assets/T/mri-aafde48fd76947e0/coronal_013.png","assets/T/mri-aafde48fd76947e0/coronal_015.png","assets/T/mri-aafde48fd76947e0/coronal_016.png","assets/T/mri-aafde48fd76947e0/coronal_017.png","assets/T/mri-aafde48fd76947e0/coronal_019.png","assets/T/mri-aafde48fd76947e0/coronal_020.png","assets/T/mri-aafde48fd76947e0/coronal_021.png","assets/T/mri-aafde48fd76947e0/coronal_023.png","assets/T/mri-aafde48fd76947e0/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":66,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,12,13,14,16,17,18,20,21,22,23,25,26,27,29,30,31,33,34,35,37,38,39,41,42,43,44,46,47,48,50,51,52,54,55,57,58,59,61,62,63,65,66]}}
+{"id":"mri-e62cf64b75ea4c8c","request_id":"L3-T300:mri-e62cf64b75ea4c8c","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-e62cf64b75ea4c8c/axial_001.png","assets/T/mri-e62cf64b75ea4c8c/axial_002.png","assets/T/mri-e62cf64b75ea4c8c/axial_004.png","assets/T/mri-e62cf64b75ea4c8c/axial_005.png","assets/T/mri-e62cf64b75ea4c8c/axial_006.png","assets/T/mri-e62cf64b75ea4c8c/axial_008.png","assets/T/mri-e62cf64b75ea4c8c/axial_009.png","assets/T/mri-e62cf64b75ea4c8c/axial_010.png","assets/T/mri-e62cf64b75ea4c8c/axial_012.png","assets/T/mri-e62cf64b75ea4c8c/axial_013.png","assets/T/mri-e62cf64b75ea4c8c/axial_014.png","assets/T/mri-e62cf64b75ea4c8c/axial_016.png","assets/T/mri-e62cf64b75ea4c8c/axial_017.png","assets/T/mri-e62cf64b75ea4c8c/axial_018.png","assets/T/mri-e62cf64b75ea4c8c/axial_020.png","assets/T/mri-e62cf64b75ea4c8c/axial_021.png","assets/T/mri-e62cf64b75ea4c8c/axial_022.png","assets/T/mri-e62cf64b75ea4c8c/axial_023.png","assets/T/mri-e62cf64b75ea4c8c/axial_025.png","assets/T/mri-e62cf64b75ea4c8c/axial_026.png","assets/T/mri-e62cf64b75ea4c8c/axial_027.png","assets/T/mri-e62cf64b75ea4c8c/axial_029.png","assets/T/mri-e62cf64b75ea4c8c/axial_030.png","assets/T/mri-e62cf64b75ea4c8c/axial_031.png","assets/T/mri-e62cf64b75ea4c8c/axial_033.png","assets/T/mri-e62cf64b75ea4c8c/axial_034.png","assets/T/mri-e62cf64b75ea4c8c/axial_035.png","assets/T/mri-e62cf64b75ea4c8c/axial_037.png","assets/T/mri-e62cf64b75ea4c8c/axial_038.png","assets/T/mri-e62cf64b75ea4c8c/axial_039.png","assets/T/mri-e62cf64b75ea4c8c/axial_041.png","assets/T/mri-e62cf64b75ea4c8c/axial_042.png","assets/T/mri-e62cf64b75ea4c8c/coronal_001.png","assets/T/mri-e62cf64b75ea4c8c/coronal_002.png","assets/T/mri-e62cf64b75ea4c8c/coronal_004.png","assets/T/mri-e62cf64b75ea4c8c/coronal_005.png","assets/T/mri-e62cf64b75ea4c8c/coronal_006.png","assets/T/mri-e62cf64b75ea4c8c/coronal_008.png","assets/T/mri-e62cf64b75ea4c8c/coronal_009.png","assets/T/mri-e62cf64b75ea4c8c/coronal_010.png","assets/T/mri-e62cf64b75ea4c8c/coronal_012.png","assets/T/mri-e62cf64b75ea4c8c/coronal_013.png","assets/T/mri-e62cf64b75ea4c8c/coronal_015.png","assets/T/mri-e62cf64b75ea4c8c/coronal_016.png","assets/T/mri-e62cf64b75ea4c8c/coronal_017.png","assets/T/mri-e62cf64b75ea4c8c/coronal_019.png","assets/T/mri-e62cf64b75ea4c8c/coronal_020.png","assets/T/mri-e62cf64b75ea4c8c/coronal_021.png","assets/T/mri-e62cf64b75ea4c8c/coronal_023.png","assets/T/mri-e62cf64b75ea4c8c/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":66,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,12,13,14,16,17,18,20,21,22,23,25,26,27,29,30,31,33,34,35,37,38,39,41,42,43,44,46,47,48,50,51,52,54,55,57,58,59,61,62,63,65,66]}}
+{"id":"mri-327d5554ba1d4a18","request_id":"L3-T300:mri-327d5554ba1d4a18","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-327d5554ba1d4a18/axial_001.png","assets/T/mri-327d5554ba1d4a18/axial_002.png","assets/T/mri-327d5554ba1d4a18/axial_004.png","assets/T/mri-327d5554ba1d4a18/axial_005.png","assets/T/mri-327d5554ba1d4a18/axial_006.png","assets/T/mri-327d5554ba1d4a18/axial_008.png","assets/T/mri-327d5554ba1d4a18/axial_009.png","assets/T/mri-327d5554ba1d4a18/axial_010.png","assets/T/mri-327d5554ba1d4a18/axial_011.png","assets/T/mri-327d5554ba1d4a18/axial_013.png","assets/T/mri-327d5554ba1d4a18/axial_014.png","assets/T/mri-327d5554ba1d4a18/axial_015.png","assets/T/mri-327d5554ba1d4a18/axial_017.png","assets/T/mri-327d5554ba1d4a18/axial_018.png","assets/T/mri-327d5554ba1d4a18/axial_019.png","assets/T/mri-327d5554ba1d4a18/axial_021.png","assets/T/mri-327d5554ba1d4a18/axial_022.png","assets/T/mri-327d5554ba1d4a18/axial_023.png","assets/T/mri-327d5554ba1d4a18/axial_024.png","assets/T/mri-327d5554ba1d4a18/axial_026.png","assets/T/mri-327d5554ba1d4a18/axial_027.png","assets/T/mri-327d5554ba1d4a18/axial_028.png","assets/T/mri-327d5554ba1d4a18/axial_030.png","assets/T/mri-327d5554ba1d4a18/axial_031.png","assets/T/mri-327d5554ba1d4a18/axial_032.png","assets/T/mri-327d5554ba1d4a18/axial_034.png","assets/T/mri-327d5554ba1d4a18/axial_035.png","assets/T/mri-327d5554ba1d4a18/axial_036.png","assets/T/mri-327d5554ba1d4a18/axial_037.png","assets/T/mri-327d5554ba1d4a18/axial_039.png","assets/T/mri-327d5554ba1d4a18/axial_040.png","assets/T/mri-327d5554ba1d4a18/coronal_001.png","assets/T/mri-327d5554ba1d4a18/coronal_002.png","assets/T/mri-327d5554ba1d4a18/coronal_004.png","assets/T/mri-327d5554ba1d4a18/coronal_005.png","assets/T/mri-327d5554ba1d4a18/coronal_006.png","assets/T/mri-327d5554ba1d4a18/coronal_007.png","assets/T/mri-327d5554ba1d4a18/coronal_009.png","assets/T/mri-327d5554ba1d4a18/coronal_010.png","assets/T/mri-327d5554ba1d4a18/coronal_011.png","assets/T/mri-327d5554ba1d4a18/coronal_013.png","assets/T/mri-327d5554ba1d4a18/coronal_014.png","assets/T/mri-327d5554ba1d4a18/coronal_015.png","assets/T/mri-327d5554ba1d4a18/coronal_016.png","assets/T/mri-327d5554ba1d4a18/coronal_018.png","assets/T/mri-327d5554ba1d4a18/coronal_019.png","assets/T/mri-327d5554ba1d4a18/coronal_020.png","assets/T/mri-327d5554ba1d4a18/coronal_021.png","assets/T/mri-327d5554ba1d4a18/coronal_023.png","assets/T/mri-327d5554ba1d4a18/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":64,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,11,13,14,15,17,18,19,21,22,23,24,26,27,28,30,31,32,34,35,36,37,39,40,41,42,44,45,46,47,49,50,51,53,54,55,56,58,59,60,61,63,64]}}
+{"id":"mri-976a2674bc694056","request_id":"L3-T300:mri-976a2674bc694056","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-976a2674bc694056/axial_001.png","assets/T/mri-976a2674bc694056/axial_002.png","assets/T/mri-976a2674bc694056/axial_004.png","assets/T/mri-976a2674bc694056/axial_005.png","assets/T/mri-976a2674bc694056/axial_006.png","assets/T/mri-976a2674bc694056/axial_008.png","assets/T/mri-976a2674bc694056/axial_009.png","assets/T/mri-976a2674bc694056/axial_010.png","assets/T/mri-976a2674bc694056/axial_011.png","assets/T/mri-976a2674bc694056/axial_013.png","assets/T/mri-976a2674bc694056/axial_014.png","assets/T/mri-976a2674bc694056/axial_015.png","assets/T/mri-976a2674bc694056/axial_017.png","assets/T/mri-976a2674bc694056/axial_018.png","assets/T/mri-976a2674bc694056/axial_019.png","assets/T/mri-976a2674bc694056/axial_021.png","assets/T/mri-976a2674bc694056/axial_022.png","assets/T/mri-976a2674bc694056/axial_023.png","assets/T/mri-976a2674bc694056/axial_024.png","assets/T/mri-976a2674bc694056/axial_026.png","assets/T/mri-976a2674bc694056/axial_027.png","assets/T/mri-976a2674bc694056/axial_028.png","assets/T/mri-976a2674bc694056/axial_030.png","assets/T/mri-976a2674bc694056/axial_031.png","assets/T/mri-976a2674bc694056/axial_032.png","assets/T/mri-976a2674bc694056/axial_034.png","assets/T/mri-976a2674bc694056/axial_035.png","assets/T/mri-976a2674bc694056/axial_036.png","assets/T/mri-976a2674bc694056/axial_037.png","assets/T/mri-976a2674bc694056/axial_039.png","assets/T/mri-976a2674bc694056/axial_040.png","assets/T/mri-976a2674bc694056/coronal_001.png","assets/T/mri-976a2674bc694056/coronal_002.png","assets/T/mri-976a2674bc694056/coronal_004.png","assets/T/mri-976a2674bc694056/coronal_005.png","assets/T/mri-976a2674bc694056/coronal_006.png","assets/T/mri-976a2674bc694056/coronal_007.png","assets/T/mri-976a2674bc694056/coronal_009.png","assets/T/mri-976a2674bc694056/coronal_010.png","assets/T/mri-976a2674bc694056/coronal_011.png","assets/T/mri-976a2674bc694056/coronal_013.png","assets/T/mri-976a2674bc694056/coronal_014.png","assets/T/mri-976a2674bc694056/coronal_015.png","assets/T/mri-976a2674bc694056/coronal_016.png","assets/T/mri-976a2674bc694056/coronal_018.png","assets/T/mri-976a2674bc694056/coronal_019.png","assets/T/mri-976a2674bc694056/coronal_020.png","assets/T/mri-976a2674bc694056/coronal_021.png","assets/T/mri-976a2674bc694056/coronal_023.png","assets/T/mri-976a2674bc694056/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":64,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,11,13,14,15,17,18,19,21,22,23,24,26,27,28,30,31,32,34,35,36,37,39,40,41,42,44,45,46,47,49,50,51,53,54,55,56,58,59,60,61,63,64]}}
+{"id":"mri-451326ee669447a4","request_id":"L3-T300:mri-451326ee669447a4","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-451326ee669447a4/axial_001.png","assets/T/mri-451326ee669447a4/axial_002.png","assets/T/mri-451326ee669447a4/axial_004.png","assets/T/mri-451326ee669447a4/axial_005.png","assets/T/mri-451326ee669447a4/axial_006.png","assets/T/mri-451326ee669447a4/axial_008.png","assets/T/mri-451326ee669447a4/axial_009.png","assets/T/mri-451326ee669447a4/axial_010.png","assets/T/mri-451326ee669447a4/axial_012.png","assets/T/mri-451326ee669447a4/axial_013.png","assets/T/mri-451326ee669447a4/axial_014.png","assets/T/mri-451326ee669447a4/axial_016.png","assets/T/mri-451326ee669447a4/axial_017.png","assets/T/mri-451326ee669447a4/axial_018.png","assets/T/mri-451326ee669447a4/axial_020.png","assets/T/mri-451326ee669447a4/axial_021.png","assets/T/mri-451326ee669447a4/axial_022.png","assets/T/mri-451326ee669447a4/axial_023.png","assets/T/mri-451326ee669447a4/axial_025.png","assets/T/mri-451326ee669447a4/axial_026.png","assets/T/mri-451326ee669447a4/axial_027.png","assets/T/mri-451326ee669447a4/axial_029.png","assets/T/mri-451326ee669447a4/axial_030.png","assets/T/mri-451326ee669447a4/axial_031.png","assets/T/mri-451326ee669447a4/axial_033.png","assets/T/mri-451326ee669447a4/axial_034.png","assets/T/mri-451326ee669447a4/axial_035.png","assets/T/mri-451326ee669447a4/axial_037.png","assets/T/mri-451326ee669447a4/axial_038.png","assets/T/mri-451326ee669447a4/axial_039.png","assets/T/mri-451326ee669447a4/axial_041.png","assets/T/mri-451326ee669447a4/axial_042.png","assets/T/mri-451326ee669447a4/coronal_001.png","assets/T/mri-451326ee669447a4/coronal_002.png","assets/T/mri-451326ee669447a4/coronal_004.png","assets/T/mri-451326ee669447a4/coronal_005.png","assets/T/mri-451326ee669447a4/coronal_006.png","assets/T/mri-451326ee669447a4/coronal_008.png","assets/T/mri-451326ee669447a4/coronal_009.png","assets/T/mri-451326ee669447a4/coronal_010.png","assets/T/mri-451326ee669447a4/coronal_012.png","assets/T/mri-451326ee669447a4/coronal_013.png","assets/T/mri-451326ee669447a4/coronal_015.png","assets/T/mri-451326ee669447a4/coronal_016.png","assets/T/mri-451326ee669447a4/coronal_017.png","assets/T/mri-451326ee669447a4/coronal_019.png","assets/T/mri-451326ee669447a4/coronal_020.png","assets/T/mri-451326ee669447a4/coronal_021.png","assets/T/mri-451326ee669447a4/coronal_023.png","assets/T/mri-451326ee669447a4/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":66,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,12,13,14,16,17,18,20,21,22,23,25,26,27,29,30,31,33,34,35,37,38,39,41,42,43,44,46,47,48,50,51,52,54,55,57,58,59,61,62,63,65,66]}}
+{"id":"mri-86711ff1ba3b4fe1","request_id":"L3-T300:mri-86711ff1ba3b4fe1","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-86711ff1ba3b4fe1/axial_001.png","assets/T/mri-86711ff1ba3b4fe1/axial_002.png","assets/T/mri-86711ff1ba3b4fe1/axial_003.png","assets/T/mri-86711ff1ba3b4fe1/axial_005.png","assets/T/mri-86711ff1ba3b4fe1/axial_006.png","assets/T/mri-86711ff1ba3b4fe1/axial_007.png","assets/T/mri-86711ff1ba3b4fe1/axial_008.png","assets/T/mri-86711ff1ba3b4fe1/axial_010.png","assets/T/mri-86711ff1ba3b4fe1/axial_011.png","assets/T/mri-86711ff1ba3b4fe1/axial_012.png","assets/T/mri-86711ff1ba3b4fe1/axial_013.png","assets/T/mri-86711ff1ba3b4fe1/axial_015.png","assets/T/mri-86711ff1ba3b4fe1/axial_016.png","assets/T/mri-86711ff1ba3b4fe1/axial_017.png","assets/T/mri-86711ff1ba3b4fe1/axial_018.png","assets/T/mri-86711ff1ba3b4fe1/axial_020.png","assets/T/mri-86711ff1ba3b4fe1/axial_021.png","assets/T/mri-86711ff1ba3b4fe1/axial_022.png","assets/T/mri-86711ff1ba3b4fe1/axial_023.png","assets/T/mri-86711ff1ba3b4fe1/axial_024.png","assets/T/mri-86711ff1ba3b4fe1/axial_026.png","assets/T/mri-86711ff1ba3b4fe1/axial_027.png","assets/T/mri-86711ff1ba3b4fe1/axial_028.png","assets/T/mri-86711ff1ba3b4fe1/axial_029.png","assets/T/mri-86711ff1ba3b4fe1/axial_031.png","assets/T/mri-86711ff1ba3b4fe1/axial_032.png","assets/T/mri-86711ff1ba3b4fe1/axial_033.png","assets/T/mri-86711ff1ba3b4fe1/axial_034.png","assets/T/mri-86711ff1ba3b4fe1/axial_036.png","assets/T/mri-86711ff1ba3b4fe1/axial_037.png","assets/T/mri-86711ff1ba3b4fe1/axial_038.png","assets/T/mri-86711ff1ba3b4fe1/coronal_001.png","assets/T/mri-86711ff1ba3b4fe1/coronal_002.png","assets/T/mri-86711ff1ba3b4fe1/coronal_004.png","assets/T/mri-86711ff1ba3b4fe1/coronal_005.png","assets/T/mri-86711ff1ba3b4fe1/coronal_006.png","assets/T/mri-86711ff1ba3b4fe1/coronal_007.png","assets/T/mri-86711ff1ba3b4fe1/coronal_009.png","assets/T/mri-86711ff1ba3b4fe1/coronal_010.png","assets/T/mri-86711ff1ba3b4fe1/coronal_011.png","assets/T/mri-86711ff1ba3b4fe1/coronal_013.png","assets/T/mri-86711ff1ba3b4fe1/coronal_014.png","assets/T/mri-86711ff1ba3b4fe1/coronal_015.png","assets/T/mri-86711ff1ba3b4fe1/coronal_016.png","assets/T/mri-86711ff1ba3b4fe1/coronal_018.png","assets/T/mri-86711ff1ba3b4fe1/coronal_019.png","assets/T/mri-86711ff1ba3b4fe1/coronal_020.png","assets/T/mri-86711ff1ba3b4fe1/coronal_021.png","assets/T/mri-86711ff1ba3b4fe1/coronal_023.png","assets/T/mri-86711ff1ba3b4fe1/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":62,"selected_count":50,"source_indices_1based":[1,2,3,5,6,7,8,10,11,12,13,15,16,17,18,20,21,22,23,24,26,27,28,29,31,32,33,34,36,37,38,39,40,42,43,44,45,47,48,49,51,52,53,54,56,57,58,59,61,62]}}
+{"id":"mri-ea272624a53e4790","request_id":"L3-T300:mri-ea272624a53e4790","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-ea272624a53e4790/axial_001.png","assets/T/mri-ea272624a53e4790/axial_002.png","assets/T/mri-ea272624a53e4790/axial_004.png","assets/T/mri-ea272624a53e4790/axial_005.png","assets/T/mri-ea272624a53e4790/axial_006.png","assets/T/mri-ea272624a53e4790/axial_008.png","assets/T/mri-ea272624a53e4790/axial_009.png","assets/T/mri-ea272624a53e4790/axial_010.png","assets/T/mri-ea272624a53e4790/axial_012.png","assets/T/mri-ea272624a53e4790/axial_013.png","assets/T/mri-ea272624a53e4790/axial_014.png","assets/T/mri-ea272624a53e4790/axial_016.png","assets/T/mri-ea272624a53e4790/axial_017.png","assets/T/mri-ea272624a53e4790/axial_018.png","assets/T/mri-ea272624a53e4790/axial_020.png","assets/T/mri-ea272624a53e4790/axial_021.png","assets/T/mri-ea272624a53e4790/axial_022.png","assets/T/mri-ea272624a53e4790/axial_023.png","assets/T/mri-ea272624a53e4790/axial_025.png","assets/T/mri-ea272624a53e4790/axial_026.png","assets/T/mri-ea272624a53e4790/axial_027.png","assets/T/mri-ea272624a53e4790/axial_029.png","assets/T/mri-ea272624a53e4790/axial_030.png","assets/T/mri-ea272624a53e4790/axial_031.png","assets/T/mri-ea272624a53e4790/axial_033.png","assets/T/mri-ea272624a53e4790/axial_034.png","assets/T/mri-ea272624a53e4790/axial_035.png","assets/T/mri-ea272624a53e4790/axial_037.png","assets/T/mri-ea272624a53e4790/axial_038.png","assets/T/mri-ea272624a53e4790/axial_039.png","assets/T/mri-ea272624a53e4790/axial_041.png","assets/T/mri-ea272624a53e4790/axial_042.png","assets/T/mri-ea272624a53e4790/coronal_001.png","assets/T/mri-ea272624a53e4790/coronal_002.png","assets/T/mri-ea272624a53e4790/coronal_004.png","assets/T/mri-ea272624a53e4790/coronal_005.png","assets/T/mri-ea272624a53e4790/coronal_006.png","assets/T/mri-ea272624a53e4790/coronal_008.png","assets/T/mri-ea272624a53e4790/coronal_009.png","assets/T/mri-ea272624a53e4790/coronal_010.png","assets/T/mri-ea272624a53e4790/coronal_012.png","assets/T/mri-ea272624a53e4790/coronal_013.png","assets/T/mri-ea272624a53e4790/coronal_015.png","assets/T/mri-ea272624a53e4790/coronal_016.png","assets/T/mri-ea272624a53e4790/coronal_017.png","assets/T/mri-ea272624a53e4790/coronal_019.png","assets/T/mri-ea272624a53e4790/coronal_020.png","assets/T/mri-ea272624a53e4790/coronal_021.png","assets/T/mri-ea272624a53e4790/coronal_023.png","assets/T/mri-ea272624a53e4790/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":66,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,12,13,14,16,17,18,20,21,22,23,25,26,27,29,30,31,33,34,35,37,38,39,41,42,43,44,46,47,48,50,51,52,54,55,57,58,59,61,62,63,65,66]}}
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+{"id":"mri-9ec9fbbfc5a4455a","request_id":"L3-T300:mri-9ec9fbbfc5a4455a","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-9ec9fbbfc5a4455a/axial_001.png","assets/T/mri-9ec9fbbfc5a4455a/axial_002.png","assets/T/mri-9ec9fbbfc5a4455a/axial_004.png","assets/T/mri-9ec9fbbfc5a4455a/axial_005.png","assets/T/mri-9ec9fbbfc5a4455a/axial_006.png","assets/T/mri-9ec9fbbfc5a4455a/axial_008.png","assets/T/mri-9ec9fbbfc5a4455a/axial_009.png","assets/T/mri-9ec9fbbfc5a4455a/axial_010.png","assets/T/mri-9ec9fbbfc5a4455a/axial_011.png","assets/T/mri-9ec9fbbfc5a4455a/axial_013.png","assets/T/mri-9ec9fbbfc5a4455a/axial_014.png","assets/T/mri-9ec9fbbfc5a4455a/axial_015.png","assets/T/mri-9ec9fbbfc5a4455a/axial_017.png","assets/T/mri-9ec9fbbfc5a4455a/axial_018.png","assets/T/mri-9ec9fbbfc5a4455a/axial_019.png","assets/T/mri-9ec9fbbfc5a4455a/axial_021.png","assets/T/mri-9ec9fbbfc5a4455a/axial_022.png","assets/T/mri-9ec9fbbfc5a4455a/axial_023.png","assets/T/mri-9ec9fbbfc5a4455a/axial_024.png","assets/T/mri-9ec9fbbfc5a4455a/axial_026.png","assets/T/mri-9ec9fbbfc5a4455a/axial_027.png","assets/T/mri-9ec9fbbfc5a4455a/axial_028.png","assets/T/mri-9ec9fbbfc5a4455a/axial_030.png","assets/T/mri-9ec9fbbfc5a4455a/axial_031.png","assets/T/mri-9ec9fbbfc5a4455a/axial_032.png","assets/T/mri-9ec9fbbfc5a4455a/axial_034.png","assets/T/mri-9ec9fbbfc5a4455a/axial_035.png","assets/T/mri-9ec9fbbfc5a4455a/axial_036.png","assets/T/mri-9ec9fbbfc5a4455a/axial_037.png","assets/T/mri-9ec9fbbfc5a4455a/axial_039.png","assets/T/mri-9ec9fbbfc5a4455a/axial_040.png","assets/T/mri-9ec9fbbfc5a4455a/coronal_001.png","assets/T/mri-9ec9fbbfc5a4455a/coronal_002.png","assets/T/mri-9ec9fbbfc5a4455a/coronal_004.png","assets/T/mri-9ec9fbbfc5a4455a/coronal_005.png","assets/T/mri-9ec9fbbfc5a4455a/coronal_006.png","assets/T/mri-9ec9fbbfc5a4455a/coronal_007.png","assets/T/mri-9ec9fbbfc5a4455a/coronal_009.png","assets/T/mri-9ec9fbbfc5a4455a/coronal_010.png","assets/T/mri-9ec9fbbfc5a4455a/coronal_011.png","assets/T/mri-9ec9fbbfc5a4455a/coronal_013.png","assets/T/mri-9ec9fbbfc5a4455a/coronal_014.png","assets/T/mri-9ec9fbbfc5a4455a/coronal_015.png","assets/T/mri-9ec9fbbfc5a4455a/coronal_016.png","assets/T/mri-9ec9fbbfc5a4455a/coronal_018.png","assets/T/mri-9ec9fbbfc5a4455a/coronal_019.png","assets/T/mri-9ec9fbbfc5a4455a/coronal_020.png","assets/T/mri-9ec9fbbfc5a4455a/coronal_021.png","assets/T/mri-9ec9fbbfc5a4455a/coronal_023.png","assets/T/mri-9ec9fbbfc5a4455a/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":64,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,11,13,14,15,17,18,19,21,22,23,24,26,27,28,30,31,32,34,35,36,37,39,40,41,42,44,45,46,47,49,50,51,53,54,55,56,58,59,60,61,63,64]}}
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+{"id":"mri-48efb702a3a14741","request_id":"L3-T300:mri-48efb702a3a14741","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-48efb702a3a14741/axial_001.png","assets/T/mri-48efb702a3a14741/axial_002.png","assets/T/mri-48efb702a3a14741/axial_004.png","assets/T/mri-48efb702a3a14741/axial_005.png","assets/T/mri-48efb702a3a14741/axial_006.png","assets/T/mri-48efb702a3a14741/axial_008.png","assets/T/mri-48efb702a3a14741/axial_009.png","assets/T/mri-48efb702a3a14741/axial_010.png","assets/T/mri-48efb702a3a14741/axial_011.png","assets/T/mri-48efb702a3a14741/axial_013.png","assets/T/mri-48efb702a3a14741/axial_014.png","assets/T/mri-48efb702a3a14741/axial_015.png","assets/T/mri-48efb702a3a14741/axial_017.png","assets/T/mri-48efb702a3a14741/axial_018.png","assets/T/mri-48efb702a3a14741/axial_019.png","assets/T/mri-48efb702a3a14741/axial_021.png","assets/T/mri-48efb702a3a14741/axial_022.png","assets/T/mri-48efb702a3a14741/axial_023.png","assets/T/mri-48efb702a3a14741/axial_024.png","assets/T/mri-48efb702a3a14741/axial_026.png","assets/T/mri-48efb702a3a14741/axial_027.png","assets/T/mri-48efb702a3a14741/axial_028.png","assets/T/mri-48efb702a3a14741/axial_030.png","assets/T/mri-48efb702a3a14741/axial_031.png","assets/T/mri-48efb702a3a14741/axial_032.png","assets/T/mri-48efb702a3a14741/axial_034.png","assets/T/mri-48efb702a3a14741/axial_035.png","assets/T/mri-48efb702a3a14741/axial_036.png","assets/T/mri-48efb702a3a14741/axial_037.png","assets/T/mri-48efb702a3a14741/axial_039.png","assets/T/mri-48efb702a3a14741/axial_040.png","assets/T/mri-48efb702a3a14741/coronal_001.png","assets/T/mri-48efb702a3a14741/coronal_002.png","assets/T/mri-48efb702a3a14741/coronal_004.png","assets/T/mri-48efb702a3a14741/coronal_005.png","assets/T/mri-48efb702a3a14741/coronal_006.png","assets/T/mri-48efb702a3a14741/coronal_007.png","assets/T/mri-48efb702a3a14741/coronal_009.png","assets/T/mri-48efb702a3a14741/coronal_010.png","assets/T/mri-48efb702a3a14741/coronal_011.png","assets/T/mri-48efb702a3a14741/coronal_013.png","assets/T/mri-48efb702a3a14741/coronal_014.png","assets/T/mri-48efb702a3a14741/coronal_015.png","assets/T/mri-48efb702a3a14741/coronal_016.png","assets/T/mri-48efb702a3a14741/coronal_018.png","assets/T/mri-48efb702a3a14741/coronal_019.png","assets/T/mri-48efb702a3a14741/coronal_020.png","assets/T/mri-48efb702a3a14741/coronal_021.png","assets/T/mri-48efb702a3a14741/coronal_023.png","assets/T/mri-48efb702a3a14741/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":64,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,11,13,14,15,17,18,19,21,22,23,24,26,27,28,30,31,32,34,35,36,37,39,40,41,42,44,45,46,47,49,50,51,53,54,55,56,58,59,60,61,63,64]}}
+{"id":"mri-2036815a13894335","request_id":"L3-T300:mri-2036815a13894335","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-2036815a13894335/axial_001.png","assets/T/mri-2036815a13894335/axial_002.png","assets/T/mri-2036815a13894335/axial_004.png","assets/T/mri-2036815a13894335/axial_005.png","assets/T/mri-2036815a13894335/axial_006.png","assets/T/mri-2036815a13894335/axial_008.png","assets/T/mri-2036815a13894335/axial_009.png","assets/T/mri-2036815a13894335/axial_010.png","assets/T/mri-2036815a13894335/axial_012.png","assets/T/mri-2036815a13894335/axial_013.png","assets/T/mri-2036815a13894335/axial_015.png","assets/T/mri-2036815a13894335/axial_016.png","assets/T/mri-2036815a13894335/axial_017.png","assets/T/mri-2036815a13894335/axial_019.png","assets/T/mri-2036815a13894335/axial_020.png","assets/T/mri-2036815a13894335/axial_021.png","assets/T/mri-2036815a13894335/axial_023.png","assets/T/mri-2036815a13894335/axial_024.png","assets/T/mri-2036815a13894335/axial_025.png","assets/T/mri-2036815a13894335/axial_027.png","assets/T/mri-2036815a13894335/axial_028.png","assets/T/mri-2036815a13894335/axial_029.png","assets/T/mri-2036815a13894335/axial_031.png","assets/T/mri-2036815a13894335/axial_032.png","assets/T/mri-2036815a13894335/axial_034.png","assets/T/mri-2036815a13894335/axial_035.png","assets/T/mri-2036815a13894335/axial_036.png","assets/T/mri-2036815a13894335/axial_038.png","assets/T/mri-2036815a13894335/axial_039.png","assets/T/mri-2036815a13894335/axial_040.png","assets/T/mri-2036815a13894335/axial_042.png","assets/T/mri-2036815a13894335/axial_043.png","assets/T/mri-2036815a13894335/coronal_001.png","assets/T/mri-2036815a13894335/coronal_002.png","assets/T/mri-2036815a13894335/coronal_004.png","assets/T/mri-2036815a13894335/coronal_005.png","assets/T/mri-2036815a13894335/coronal_006.png","assets/T/mri-2036815a13894335/coronal_008.png","assets/T/mri-2036815a13894335/coronal_009.png","assets/T/mri-2036815a13894335/coronal_010.png","assets/T/mri-2036815a13894335/coronal_012.png","assets/T/mri-2036815a13894335/coronal_013.png","assets/T/mri-2036815a13894335/coronal_015.png","assets/T/mri-2036815a13894335/coronal_016.png","assets/T/mri-2036815a13894335/coronal_017.png","assets/T/mri-2036815a13894335/coronal_019.png","assets/T/mri-2036815a13894335/coronal_020.png","assets/T/mri-2036815a13894335/coronal_021.png","assets/T/mri-2036815a13894335/coronal_023.png","assets/T/mri-2036815a13894335/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":67,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,12,13,15,16,17,19,20,21,23,24,25,27,28,29,31,32,34,35,36,38,39,40,42,43,44,45,47,48,49,51,52,53,55,56,58,59,60,62,63,64,66,67]}}
+{"id":"mri-b6a2446b183c424d","request_id":"L3-T300:mri-b6a2446b183c424d","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 30 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 20 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-b6a2446b183c424d/axial_001.png","assets/T/mri-b6a2446b183c424d/axial_002.png","assets/T/mri-b6a2446b183c424d/axial_003.png","assets/T/mri-b6a2446b183c424d/axial_005.png","assets/T/mri-b6a2446b183c424d/axial_006.png","assets/T/mri-b6a2446b183c424d/axial_007.png","assets/T/mri-b6a2446b183c424d/axial_008.png","assets/T/mri-b6a2446b183c424d/axial_009.png","assets/T/mri-b6a2446b183c424d/axial_011.png","assets/T/mri-b6a2446b183c424d/axial_012.png","assets/T/mri-b6a2446b183c424d/axial_013.png","assets/T/mri-b6a2446b183c424d/axial_014.png","assets/T/mri-b6a2446b183c424d/axial_015.png","assets/T/mri-b6a2446b183c424d/axial_017.png","assets/T/mri-b6a2446b183c424d/axial_018.png","assets/T/mri-b6a2446b183c424d/axial_019.png","assets/T/mri-b6a2446b183c424d/axial_020.png","assets/T/mri-b6a2446b183c424d/axial_022.png","assets/T/mri-b6a2446b183c424d/axial_023.png","assets/T/mri-b6a2446b183c424d/axial_024.png","assets/T/mri-b6a2446b183c424d/axial_025.png","assets/T/mri-b6a2446b183c424d/axial_026.png","assets/T/mri-b6a2446b183c424d/axial_028.png","assets/T/mri-b6a2446b183c424d/axial_029.png","assets/T/mri-b6a2446b183c424d/axial_030.png","assets/T/mri-b6a2446b183c424d/axial_031.png","assets/T/mri-b6a2446b183c424d/axial_032.png","assets/T/mri-b6a2446b183c424d/axial_034.png","assets/T/mri-b6a2446b183c424d/axial_035.png","assets/T/mri-b6a2446b183c424d/axial_036.png","assets/T/mri-b6a2446b183c424d/coronal_001.png","assets/T/mri-b6a2446b183c424d/coronal_002.png","assets/T/mri-b6a2446b183c424d/coronal_003.png","assets/T/mri-b6a2446b183c424d/coronal_005.png","assets/T/mri-b6a2446b183c424d/coronal_006.png","assets/T/mri-b6a2446b183c424d/coronal_007.png","assets/T/mri-b6a2446b183c424d/coronal_008.png","assets/T/mri-b6a2446b183c424d/coronal_009.png","assets/T/mri-b6a2446b183c424d/coronal_011.png","assets/T/mri-b6a2446b183c424d/coronal_012.png","assets/T/mri-b6a2446b183c424d/coronal_013.png","assets/T/mri-b6a2446b183c424d/coronal_014.png","assets/T/mri-b6a2446b183c424d/coronal_016.png","assets/T/mri-b6a2446b183c424d/coronal_017.png","assets/T/mri-b6a2446b183c424d/coronal_018.png","assets/T/mri-b6a2446b183c424d/coronal_019.png","assets/T/mri-b6a2446b183c424d/coronal_020.png","assets/T/mri-b6a2446b183c424d/coronal_022.png","assets/T/mri-b6a2446b183c424d/coronal_023.png","assets/T/mri-b6a2446b183c424d/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":60,"selected_count":50,"source_indices_1based":[1,2,3,5,6,7,8,9,11,12,13,14,15,17,18,19,20,22,23,24,25,26,28,29,30,31,32,34,35,36,37,38,39,41,42,43,44,45,47,48,49,50,52,53,54,55,56,58,59,60]}}
+{"id":"mri-38731096d9a3413d","request_id":"L3-T300:mri-38731096d9a3413d","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 30 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 20 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-38731096d9a3413d/axial_001.png","assets/T/mri-38731096d9a3413d/axial_002.png","assets/T/mri-38731096d9a3413d/axial_004.png","assets/T/mri-38731096d9a3413d/axial_005.png","assets/T/mri-38731096d9a3413d/axial_007.png","assets/T/mri-38731096d9a3413d/axial_008.png","assets/T/mri-38731096d9a3413d/axial_009.png","assets/T/mri-38731096d9a3413d/axial_011.png","assets/T/mri-38731096d9a3413d/axial_012.png","assets/T/mri-38731096d9a3413d/axial_014.png","assets/T/mri-38731096d9a3413d/axial_015.png","assets/T/mri-38731096d9a3413d/axial_017.png","assets/T/mri-38731096d9a3413d/axial_018.png","assets/T/mri-38731096d9a3413d/axial_019.png","assets/T/mri-38731096d9a3413d/axial_021.png","assets/T/mri-38731096d9a3413d/axial_022.png","assets/T/mri-38731096d9a3413d/axial_024.png","assets/T/mri-38731096d9a3413d/axial_025.png","assets/T/mri-38731096d9a3413d/axial_026.png","assets/T/mri-38731096d9a3413d/axial_028.png","assets/T/mri-38731096d9a3413d/axial_029.png","assets/T/mri-38731096d9a3413d/axial_031.png","assets/T/mri-38731096d9a3413d/axial_032.png","assets/T/mri-38731096d9a3413d/axial_034.png","assets/T/mri-38731096d9a3413d/axial_035.png","assets/T/mri-38731096d9a3413d/axial_036.png","assets/T/mri-38731096d9a3413d/axial_038.png","assets/T/mri-38731096d9a3413d/axial_039.png","assets/T/mri-38731096d9a3413d/axial_041.png","assets/T/mri-38731096d9a3413d/axial_042.png","assets/T/mri-38731096d9a3413d/coronal_001.png","assets/T/mri-38731096d9a3413d/coronal_002.png","assets/T/mri-38731096d9a3413d/coronal_004.png","assets/T/mri-38731096d9a3413d/coronal_005.png","assets/T/mri-38731096d9a3413d/coronal_007.png","assets/T/mri-38731096d9a3413d/coronal_008.png","assets/T/mri-38731096d9a3413d/coronal_010.png","assets/T/mri-38731096d9a3413d/coronal_011.png","assets/T/mri-38731096d9a3413d/coronal_012.png","assets/T/mri-38731096d9a3413d/coronal_014.png","assets/T/mri-38731096d9a3413d/coronal_015.png","assets/T/mri-38731096d9a3413d/coronal_017.png","assets/T/mri-38731096d9a3413d/coronal_018.png","assets/T/mri-38731096d9a3413d/coronal_019.png","assets/T/mri-38731096d9a3413d/coronal_021.png","assets/T/mri-38731096d9a3413d/coronal_022.png","assets/T/mri-38731096d9a3413d/coronal_024.png","assets/T/mri-38731096d9a3413d/coronal_025.png","assets/T/mri-38731096d9a3413d/coronal_027.png","assets/T/mri-38731096d9a3413d/coronal_028.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":70,"selected_count":50,"source_indices_1based":[1,2,4,5,7,8,9,11,12,14,15,17,18,19,21,22,24,25,26,28,29,31,32,34,35,36,38,39,41,42,43,44,46,47,49,50,52,53,54,56,57,59,60,61,63,64,66,67,69,70]}}
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+{"id":"mri-60382ae47d2949ad","request_id":"L3-T300:mri-60382ae47d2949ad","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-60382ae47d2949ad/axial_001.png","assets/T/mri-60382ae47d2949ad/axial_002.png","assets/T/mri-60382ae47d2949ad/axial_004.png","assets/T/mri-60382ae47d2949ad/axial_005.png","assets/T/mri-60382ae47d2949ad/axial_006.png","assets/T/mri-60382ae47d2949ad/axial_008.png","assets/T/mri-60382ae47d2949ad/axial_009.png","assets/T/mri-60382ae47d2949ad/axial_010.png","assets/T/mri-60382ae47d2949ad/axial_011.png","assets/T/mri-60382ae47d2949ad/axial_013.png","assets/T/mri-60382ae47d2949ad/axial_014.png","assets/T/mri-60382ae47d2949ad/axial_015.png","assets/T/mri-60382ae47d2949ad/axial_017.png","assets/T/mri-60382ae47d2949ad/axial_018.png","assets/T/mri-60382ae47d2949ad/axial_019.png","assets/T/mri-60382ae47d2949ad/axial_021.png","assets/T/mri-60382ae47d2949ad/axial_022.png","assets/T/mri-60382ae47d2949ad/axial_023.png","assets/T/mri-60382ae47d2949ad/axial_024.png","assets/T/mri-60382ae47d2949ad/axial_026.png","assets/T/mri-60382ae47d2949ad/axial_027.png","assets/T/mri-60382ae47d2949ad/axial_028.png","assets/T/mri-60382ae47d2949ad/axial_030.png","assets/T/mri-60382ae47d2949ad/axial_031.png","assets/T/mri-60382ae47d2949ad/axial_032.png","assets/T/mri-60382ae47d2949ad/axial_034.png","assets/T/mri-60382ae47d2949ad/axial_035.png","assets/T/mri-60382ae47d2949ad/axial_036.png","assets/T/mri-60382ae47d2949ad/axial_037.png","assets/T/mri-60382ae47d2949ad/axial_039.png","assets/T/mri-60382ae47d2949ad/axial_040.png","assets/T/mri-60382ae47d2949ad/coronal_001.png","assets/T/mri-60382ae47d2949ad/coronal_002.png","assets/T/mri-60382ae47d2949ad/coronal_004.png","assets/T/mri-60382ae47d2949ad/coronal_005.png","assets/T/mri-60382ae47d2949ad/coronal_006.png","assets/T/mri-60382ae47d2949ad/coronal_007.png","assets/T/mri-60382ae47d2949ad/coronal_009.png","assets/T/mri-60382ae47d2949ad/coronal_010.png","assets/T/mri-60382ae47d2949ad/coronal_011.png","assets/T/mri-60382ae47d2949ad/coronal_013.png","assets/T/mri-60382ae47d2949ad/coronal_014.png","assets/T/mri-60382ae47d2949ad/coronal_015.png","assets/T/mri-60382ae47d2949ad/coronal_016.png","assets/T/mri-60382ae47d2949ad/coronal_018.png","assets/T/mri-60382ae47d2949ad/coronal_019.png","assets/T/mri-60382ae47d2949ad/coronal_020.png","assets/T/mri-60382ae47d2949ad/coronal_021.png","assets/T/mri-60382ae47d2949ad/coronal_023.png","assets/T/mri-60382ae47d2949ad/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":64,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,11,13,14,15,17,18,19,21,22,23,24,26,27,28,30,31,32,34,35,36,37,39,40,41,42,44,45,46,47,49,50,51,53,54,55,56,58,59,60,61,63,64]}}
+{"id":"mri-076b103275994f82","request_id":"L3-T300:mri-076b103275994f82","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-076b103275994f82/axial_001.png","assets/T/mri-076b103275994f82/axial_002.png","assets/T/mri-076b103275994f82/axial_004.png","assets/T/mri-076b103275994f82/axial_005.png","assets/T/mri-076b103275994f82/axial_006.png","assets/T/mri-076b103275994f82/axial_008.png","assets/T/mri-076b103275994f82/axial_009.png","assets/T/mri-076b103275994f82/axial_010.png","assets/T/mri-076b103275994f82/axial_011.png","assets/T/mri-076b103275994f82/axial_013.png","assets/T/mri-076b103275994f82/axial_014.png","assets/T/mri-076b103275994f82/axial_015.png","assets/T/mri-076b103275994f82/axial_017.png","assets/T/mri-076b103275994f82/axial_018.png","assets/T/mri-076b103275994f82/axial_019.png","assets/T/mri-076b103275994f82/axial_021.png","assets/T/mri-076b103275994f82/axial_022.png","assets/T/mri-076b103275994f82/axial_023.png","assets/T/mri-076b103275994f82/axial_024.png","assets/T/mri-076b103275994f82/axial_026.png","assets/T/mri-076b103275994f82/axial_027.png","assets/T/mri-076b103275994f82/axial_028.png","assets/T/mri-076b103275994f82/axial_030.png","assets/T/mri-076b103275994f82/axial_031.png","assets/T/mri-076b103275994f82/axial_032.png","assets/T/mri-076b103275994f82/axial_034.png","assets/T/mri-076b103275994f82/axial_035.png","assets/T/mri-076b103275994f82/axial_036.png","assets/T/mri-076b103275994f82/axial_037.png","assets/T/mri-076b103275994f82/axial_039.png","assets/T/mri-076b103275994f82/axial_040.png","assets/T/mri-076b103275994f82/coronal_001.png","assets/T/mri-076b103275994f82/coronal_002.png","assets/T/mri-076b103275994f82/coronal_004.png","assets/T/mri-076b103275994f82/coronal_005.png","assets/T/mri-076b103275994f82/coronal_006.png","assets/T/mri-076b103275994f82/coronal_007.png","assets/T/mri-076b103275994f82/coronal_009.png","assets/T/mri-076b103275994f82/coronal_010.png","assets/T/mri-076b103275994f82/coronal_011.png","assets/T/mri-076b103275994f82/coronal_013.png","assets/T/mri-076b103275994f82/coronal_014.png","assets/T/mri-076b103275994f82/coronal_015.png","assets/T/mri-076b103275994f82/coronal_016.png","assets/T/mri-076b103275994f82/coronal_018.png","assets/T/mri-076b103275994f82/coronal_019.png","assets/T/mri-076b103275994f82/coronal_020.png","assets/T/mri-076b103275994f82/coronal_021.png","assets/T/mri-076b103275994f82/coronal_023.png","assets/T/mri-076b103275994f82/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":64,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,11,13,14,15,17,18,19,21,22,23,24,26,27,28,30,31,32,34,35,36,37,39,40,41,42,44,45,46,47,49,50,51,53,54,55,56,58,59,60,61,63,64]}}
+{"id":"mri-bc9d4d6445624b29","request_id":"L3-T300:mri-bc9d4d6445624b29","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 30 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 20 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-bc9d4d6445624b29/axial_001.png","assets/T/mri-bc9d4d6445624b29/axial_002.png","assets/T/mri-bc9d4d6445624b29/axial_003.png","assets/T/mri-bc9d4d6445624b29/axial_005.png","assets/T/mri-bc9d4d6445624b29/axial_006.png","assets/T/mri-bc9d4d6445624b29/axial_007.png","assets/T/mri-bc9d4d6445624b29/axial_008.png","assets/T/mri-bc9d4d6445624b29/axial_009.png","assets/T/mri-bc9d4d6445624b29/axial_011.png","assets/T/mri-bc9d4d6445624b29/axial_012.png","assets/T/mri-bc9d4d6445624b29/axial_013.png","assets/T/mri-bc9d4d6445624b29/axial_014.png","assets/T/mri-bc9d4d6445624b29/axial_015.png","assets/T/mri-bc9d4d6445624b29/axial_017.png","assets/T/mri-bc9d4d6445624b29/axial_018.png","assets/T/mri-bc9d4d6445624b29/axial_019.png","assets/T/mri-bc9d4d6445624b29/axial_020.png","assets/T/mri-bc9d4d6445624b29/axial_022.png","assets/T/mri-bc9d4d6445624b29/axial_023.png","assets/T/mri-bc9d4d6445624b29/axial_024.png","assets/T/mri-bc9d4d6445624b29/axial_025.png","assets/T/mri-bc9d4d6445624b29/axial_026.png","assets/T/mri-bc9d4d6445624b29/axial_028.png","assets/T/mri-bc9d4d6445624b29/axial_029.png","assets/T/mri-bc9d4d6445624b29/axial_030.png","assets/T/mri-bc9d4d6445624b29/axial_031.png","assets/T/mri-bc9d4d6445624b29/axial_032.png","assets/T/mri-bc9d4d6445624b29/axial_034.png","assets/T/mri-bc9d4d6445624b29/axial_035.png","assets/T/mri-bc9d4d6445624b29/axial_036.png","assets/T/mri-bc9d4d6445624b29/coronal_001.png","assets/T/mri-bc9d4d6445624b29/coronal_002.png","assets/T/mri-bc9d4d6445624b29/coronal_003.png","assets/T/mri-bc9d4d6445624b29/coronal_005.png","assets/T/mri-bc9d4d6445624b29/coronal_006.png","assets/T/mri-bc9d4d6445624b29/coronal_007.png","assets/T/mri-bc9d4d6445624b29/coronal_008.png","assets/T/mri-bc9d4d6445624b29/coronal_009.png","assets/T/mri-bc9d4d6445624b29/coronal_011.png","assets/T/mri-bc9d4d6445624b29/coronal_012.png","assets/T/mri-bc9d4d6445624b29/coronal_013.png","assets/T/mri-bc9d4d6445624b29/coronal_014.png","assets/T/mri-bc9d4d6445624b29/coronal_016.png","assets/T/mri-bc9d4d6445624b29/coronal_017.png","assets/T/mri-bc9d4d6445624b29/coronal_018.png","assets/T/mri-bc9d4d6445624b29/coronal_019.png","assets/T/mri-bc9d4d6445624b29/coronal_020.png","assets/T/mri-bc9d4d6445624b29/coronal_022.png","assets/T/mri-bc9d4d6445624b29/coronal_023.png","assets/T/mri-bc9d4d6445624b29/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":60,"selected_count":50,"source_indices_1based":[1,2,3,5,6,7,8,9,11,12,13,14,15,17,18,19,20,22,23,24,25,26,28,29,30,31,32,34,35,36,37,38,39,41,42,43,44,45,47,48,49,50,52,53,54,55,56,58,59,60]}}
+{"id":"mri-b0afe5791e844b85","request_id":"L3-T300:mri-b0afe5791e844b85","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-b0afe5791e844b85/axial_001.png","assets/T/mri-b0afe5791e844b85/axial_002.png","assets/T/mri-b0afe5791e844b85/axial_004.png","assets/T/mri-b0afe5791e844b85/axial_005.png","assets/T/mri-b0afe5791e844b85/axial_006.png","assets/T/mri-b0afe5791e844b85/axial_008.png","assets/T/mri-b0afe5791e844b85/axial_009.png","assets/T/mri-b0afe5791e844b85/axial_010.png","assets/T/mri-b0afe5791e844b85/axial_012.png","assets/T/mri-b0afe5791e844b85/axial_013.png","assets/T/mri-b0afe5791e844b85/axial_014.png","assets/T/mri-b0afe5791e844b85/axial_016.png","assets/T/mri-b0afe5791e844b85/axial_017.png","assets/T/mri-b0afe5791e844b85/axial_018.png","assets/T/mri-b0afe5791e844b85/axial_020.png","assets/T/mri-b0afe5791e844b85/axial_021.png","assets/T/mri-b0afe5791e844b85/axial_022.png","assets/T/mri-b0afe5791e844b85/axial_023.png","assets/T/mri-b0afe5791e844b85/axial_025.png","assets/T/mri-b0afe5791e844b85/axial_026.png","assets/T/mri-b0afe5791e844b85/axial_027.png","assets/T/mri-b0afe5791e844b85/axial_029.png","assets/T/mri-b0afe5791e844b85/axial_030.png","assets/T/mri-b0afe5791e844b85/axial_031.png","assets/T/mri-b0afe5791e844b85/axial_033.png","assets/T/mri-b0afe5791e844b85/axial_034.png","assets/T/mri-b0afe5791e844b85/axial_035.png","assets/T/mri-b0afe5791e844b85/axial_037.png","assets/T/mri-b0afe5791e844b85/axial_038.png","assets/T/mri-b0afe5791e844b85/axial_039.png","assets/T/mri-b0afe5791e844b85/axial_041.png","assets/T/mri-b0afe5791e844b85/axial_042.png","assets/T/mri-b0afe5791e844b85/coronal_001.png","assets/T/mri-b0afe5791e844b85/coronal_002.png","assets/T/mri-b0afe5791e844b85/coronal_004.png","assets/T/mri-b0afe5791e844b85/coronal_005.png","assets/T/mri-b0afe5791e844b85/coronal_006.png","assets/T/mri-b0afe5791e844b85/coronal_008.png","assets/T/mri-b0afe5791e844b85/coronal_009.png","assets/T/mri-b0afe5791e844b85/coronal_010.png","assets/T/mri-b0afe5791e844b85/coronal_012.png","assets/T/mri-b0afe5791e844b85/coronal_013.png","assets/T/mri-b0afe5791e844b85/coronal_015.png","assets/T/mri-b0afe5791e844b85/coronal_016.png","assets/T/mri-b0afe5791e844b85/coronal_017.png","assets/T/mri-b0afe5791e844b85/coronal_019.png","assets/T/mri-b0afe5791e844b85/coronal_020.png","assets/T/mri-b0afe5791e844b85/coronal_021.png","assets/T/mri-b0afe5791e844b85/coronal_023.png","assets/T/mri-b0afe5791e844b85/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":66,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,12,13,14,16,17,18,20,21,22,23,25,26,27,29,30,31,33,34,35,37,38,39,41,42,43,44,46,47,48,50,51,52,54,55,57,58,59,61,62,63,65,66]}}
+{"id":"mri-b437689d0567403e","request_id":"L3-T300:mri-b437689d0567403e","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-b437689d0567403e/axial_001.png","assets/T/mri-b437689d0567403e/axial_002.png","assets/T/mri-b437689d0567403e/axial_004.png","assets/T/mri-b437689d0567403e/axial_005.png","assets/T/mri-b437689d0567403e/axial_006.png","assets/T/mri-b437689d0567403e/axial_008.png","assets/T/mri-b437689d0567403e/axial_009.png","assets/T/mri-b437689d0567403e/axial_010.png","assets/T/mri-b437689d0567403e/axial_012.png","assets/T/mri-b437689d0567403e/axial_013.png","assets/T/mri-b437689d0567403e/axial_014.png","assets/T/mri-b437689d0567403e/axial_016.png","assets/T/mri-b437689d0567403e/axial_017.png","assets/T/mri-b437689d0567403e/axial_018.png","assets/T/mri-b437689d0567403e/axial_020.png","assets/T/mri-b437689d0567403e/axial_021.png","assets/T/mri-b437689d0567403e/axial_022.png","assets/T/mri-b437689d0567403e/axial_023.png","assets/T/mri-b437689d0567403e/axial_025.png","assets/T/mri-b437689d0567403e/axial_026.png","assets/T/mri-b437689d0567403e/axial_027.png","assets/T/mri-b437689d0567403e/axial_029.png","assets/T/mri-b437689d0567403e/axial_030.png","assets/T/mri-b437689d0567403e/axial_031.png","assets/T/mri-b437689d0567403e/axial_033.png","assets/T/mri-b437689d0567403e/axial_034.png","assets/T/mri-b437689d0567403e/axial_035.png","assets/T/mri-b437689d0567403e/axial_037.png","assets/T/mri-b437689d0567403e/axial_038.png","assets/T/mri-b437689d0567403e/axial_039.png","assets/T/mri-b437689d0567403e/axial_041.png","assets/T/mri-b437689d0567403e/axial_042.png","assets/T/mri-b437689d0567403e/coronal_001.png","assets/T/mri-b437689d0567403e/coronal_002.png","assets/T/mri-b437689d0567403e/coronal_004.png","assets/T/mri-b437689d0567403e/coronal_005.png","assets/T/mri-b437689d0567403e/coronal_006.png","assets/T/mri-b437689d0567403e/coronal_008.png","assets/T/mri-b437689d0567403e/coronal_009.png","assets/T/mri-b437689d0567403e/coronal_010.png","assets/T/mri-b437689d0567403e/coronal_012.png","assets/T/mri-b437689d0567403e/coronal_013.png","assets/T/mri-b437689d0567403e/coronal_015.png","assets/T/mri-b437689d0567403e/coronal_016.png","assets/T/mri-b437689d0567403e/coronal_017.png","assets/T/mri-b437689d0567403e/coronal_019.png","assets/T/mri-b437689d0567403e/coronal_020.png","assets/T/mri-b437689d0567403e/coronal_021.png","assets/T/mri-b437689d0567403e/coronal_023.png","assets/T/mri-b437689d0567403e/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":66,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,12,13,14,16,17,18,20,21,22,23,25,26,27,29,30,31,33,34,35,37,38,39,41,42,43,44,46,47,48,50,51,52,54,55,57,58,59,61,62,63,65,66]}}
+{"id":"mri-de245813d9f84619","request_id":"L3-T300:mri-de245813d9f84619","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-de245813d9f84619/axial_001.png","assets/T/mri-de245813d9f84619/axial_002.png","assets/T/mri-de245813d9f84619/axial_004.png","assets/T/mri-de245813d9f84619/axial_005.png","assets/T/mri-de245813d9f84619/axial_006.png","assets/T/mri-de245813d9f84619/axial_008.png","assets/T/mri-de245813d9f84619/axial_009.png","assets/T/mri-de245813d9f84619/axial_010.png","assets/T/mri-de245813d9f84619/axial_011.png","assets/T/mri-de245813d9f84619/axial_013.png","assets/T/mri-de245813d9f84619/axial_014.png","assets/T/mri-de245813d9f84619/axial_015.png","assets/T/mri-de245813d9f84619/axial_017.png","assets/T/mri-de245813d9f84619/axial_018.png","assets/T/mri-de245813d9f84619/axial_019.png","assets/T/mri-de245813d9f84619/axial_021.png","assets/T/mri-de245813d9f84619/axial_022.png","assets/T/mri-de245813d9f84619/axial_023.png","assets/T/mri-de245813d9f84619/axial_024.png","assets/T/mri-de245813d9f84619/axial_026.png","assets/T/mri-de245813d9f84619/axial_027.png","assets/T/mri-de245813d9f84619/axial_028.png","assets/T/mri-de245813d9f84619/axial_030.png","assets/T/mri-de245813d9f84619/axial_031.png","assets/T/mri-de245813d9f84619/axial_032.png","assets/T/mri-de245813d9f84619/axial_034.png","assets/T/mri-de245813d9f84619/axial_035.png","assets/T/mri-de245813d9f84619/axial_036.png","assets/T/mri-de245813d9f84619/axial_037.png","assets/T/mri-de245813d9f84619/axial_039.png","assets/T/mri-de245813d9f84619/axial_040.png","assets/T/mri-de245813d9f84619/coronal_001.png","assets/T/mri-de245813d9f84619/coronal_002.png","assets/T/mri-de245813d9f84619/coronal_004.png","assets/T/mri-de245813d9f84619/coronal_005.png","assets/T/mri-de245813d9f84619/coronal_006.png","assets/T/mri-de245813d9f84619/coronal_007.png","assets/T/mri-de245813d9f84619/coronal_009.png","assets/T/mri-de245813d9f84619/coronal_010.png","assets/T/mri-de245813d9f84619/coronal_011.png","assets/T/mri-de245813d9f84619/coronal_013.png","assets/T/mri-de245813d9f84619/coronal_014.png","assets/T/mri-de245813d9f84619/coronal_015.png","assets/T/mri-de245813d9f84619/coronal_016.png","assets/T/mri-de245813d9f84619/coronal_018.png","assets/T/mri-de245813d9f84619/coronal_019.png","assets/T/mri-de245813d9f84619/coronal_020.png","assets/T/mri-de245813d9f84619/coronal_021.png","assets/T/mri-de245813d9f84619/coronal_023.png","assets/T/mri-de245813d9f84619/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":64,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,11,13,14,15,17,18,19,21,22,23,24,26,27,28,30,31,32,34,35,36,37,39,40,41,42,44,45,46,47,49,50,51,53,54,55,56,58,59,60,61,63,64]}}
+{"id":"mri-112255f79d7b4cec","request_id":"L3-T300:mri-112255f79d7b4cec","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-112255f79d7b4cec/axial_001.png","assets/T/mri-112255f79d7b4cec/axial_002.png","assets/T/mri-112255f79d7b4cec/axial_004.png","assets/T/mri-112255f79d7b4cec/axial_005.png","assets/T/mri-112255f79d7b4cec/axial_006.png","assets/T/mri-112255f79d7b4cec/axial_008.png","assets/T/mri-112255f79d7b4cec/axial_009.png","assets/T/mri-112255f79d7b4cec/axial_010.png","assets/T/mri-112255f79d7b4cec/axial_011.png","assets/T/mri-112255f79d7b4cec/axial_013.png","assets/T/mri-112255f79d7b4cec/axial_014.png","assets/T/mri-112255f79d7b4cec/axial_015.png","assets/T/mri-112255f79d7b4cec/axial_017.png","assets/T/mri-112255f79d7b4cec/axial_018.png","assets/T/mri-112255f79d7b4cec/axial_019.png","assets/T/mri-112255f79d7b4cec/axial_021.png","assets/T/mri-112255f79d7b4cec/axial_022.png","assets/T/mri-112255f79d7b4cec/axial_023.png","assets/T/mri-112255f79d7b4cec/axial_024.png","assets/T/mri-112255f79d7b4cec/axial_026.png","assets/T/mri-112255f79d7b4cec/axial_027.png","assets/T/mri-112255f79d7b4cec/axial_028.png","assets/T/mri-112255f79d7b4cec/axial_030.png","assets/T/mri-112255f79d7b4cec/axial_031.png","assets/T/mri-112255f79d7b4cec/axial_032.png","assets/T/mri-112255f79d7b4cec/axial_034.png","assets/T/mri-112255f79d7b4cec/axial_035.png","assets/T/mri-112255f79d7b4cec/axial_036.png","assets/T/mri-112255f79d7b4cec/axial_037.png","assets/T/mri-112255f79d7b4cec/axial_039.png","assets/T/mri-112255f79d7b4cec/axial_040.png","assets/T/mri-112255f79d7b4cec/coronal_001.png","assets/T/mri-112255f79d7b4cec/coronal_002.png","assets/T/mri-112255f79d7b4cec/coronal_004.png","assets/T/mri-112255f79d7b4cec/coronal_005.png","assets/T/mri-112255f79d7b4cec/coronal_006.png","assets/T/mri-112255f79d7b4cec/coronal_007.png","assets/T/mri-112255f79d7b4cec/coronal_009.png","assets/T/mri-112255f79d7b4cec/coronal_010.png","assets/T/mri-112255f79d7b4cec/coronal_011.png","assets/T/mri-112255f79d7b4cec/coronal_013.png","assets/T/mri-112255f79d7b4cec/coronal_014.png","assets/T/mri-112255f79d7b4cec/coronal_015.png","assets/T/mri-112255f79d7b4cec/coronal_016.png","assets/T/mri-112255f79d7b4cec/coronal_018.png","assets/T/mri-112255f79d7b4cec/coronal_019.png","assets/T/mri-112255f79d7b4cec/coronal_020.png","assets/T/mri-112255f79d7b4cec/coronal_021.png","assets/T/mri-112255f79d7b4cec/coronal_023.png","assets/T/mri-112255f79d7b4cec/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":64,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,11,13,14,15,17,18,19,21,22,23,24,26,27,28,30,31,32,34,35,36,37,39,40,41,42,44,45,46,47,49,50,51,53,54,55,56,58,59,60,61,63,64]}}
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+{"id":"mri-cd8283ba429a4f34","request_id":"L3-T300:mri-cd8283ba429a4f34","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-cd8283ba429a4f34/axial_001.png","assets/T/mri-cd8283ba429a4f34/axial_002.png","assets/T/mri-cd8283ba429a4f34/axial_004.png","assets/T/mri-cd8283ba429a4f34/axial_005.png","assets/T/mri-cd8283ba429a4f34/axial_006.png","assets/T/mri-cd8283ba429a4f34/axial_008.png","assets/T/mri-cd8283ba429a4f34/axial_009.png","assets/T/mri-cd8283ba429a4f34/axial_010.png","assets/T/mri-cd8283ba429a4f34/axial_012.png","assets/T/mri-cd8283ba429a4f34/axial_013.png","assets/T/mri-cd8283ba429a4f34/axial_014.png","assets/T/mri-cd8283ba429a4f34/axial_016.png","assets/T/mri-cd8283ba429a4f34/axial_017.png","assets/T/mri-cd8283ba429a4f34/axial_018.png","assets/T/mri-cd8283ba429a4f34/axial_020.png","assets/T/mri-cd8283ba429a4f34/axial_021.png","assets/T/mri-cd8283ba429a4f34/axial_022.png","assets/T/mri-cd8283ba429a4f34/axial_023.png","assets/T/mri-cd8283ba429a4f34/axial_025.png","assets/T/mri-cd8283ba429a4f34/axial_026.png","assets/T/mri-cd8283ba429a4f34/axial_027.png","assets/T/mri-cd8283ba429a4f34/axial_029.png","assets/T/mri-cd8283ba429a4f34/axial_030.png","assets/T/mri-cd8283ba429a4f34/axial_031.png","assets/T/mri-cd8283ba429a4f34/axial_033.png","assets/T/mri-cd8283ba429a4f34/axial_034.png","assets/T/mri-cd8283ba429a4f34/axial_035.png","assets/T/mri-cd8283ba429a4f34/axial_037.png","assets/T/mri-cd8283ba429a4f34/axial_038.png","assets/T/mri-cd8283ba429a4f34/axial_039.png","assets/T/mri-cd8283ba429a4f34/axial_041.png","assets/T/mri-cd8283ba429a4f34/axial_042.png","assets/T/mri-cd8283ba429a4f34/coronal_001.png","assets/T/mri-cd8283ba429a4f34/coronal_002.png","assets/T/mri-cd8283ba429a4f34/coronal_004.png","assets/T/mri-cd8283ba429a4f34/coronal_005.png","assets/T/mri-cd8283ba429a4f34/coronal_006.png","assets/T/mri-cd8283ba429a4f34/coronal_008.png","assets/T/mri-cd8283ba429a4f34/coronal_009.png","assets/T/mri-cd8283ba429a4f34/coronal_010.png","assets/T/mri-cd8283ba429a4f34/coronal_012.png","assets/T/mri-cd8283ba429a4f34/coronal_013.png","assets/T/mri-cd8283ba429a4f34/coronal_015.png","assets/T/mri-cd8283ba429a4f34/coronal_016.png","assets/T/mri-cd8283ba429a4f34/coronal_017.png","assets/T/mri-cd8283ba429a4f34/coronal_019.png","assets/T/mri-cd8283ba429a4f34/coronal_020.png","assets/T/mri-cd8283ba429a4f34/coronal_021.png","assets/T/mri-cd8283ba429a4f34/coronal_023.png","assets/T/mri-cd8283ba429a4f34/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":66,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,12,13,14,16,17,18,20,21,22,23,25,26,27,29,30,31,33,34,35,37,38,39,41,42,43,44,46,47,48,50,51,52,54,55,57,58,59,61,62,63,65,66]}}
+{"id":"mri-0ca285ccae614db6","request_id":"L3-T300:mri-0ca285ccae614db6","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-0ca285ccae614db6/axial_001.png","assets/T/mri-0ca285ccae614db6/axial_002.png","assets/T/mri-0ca285ccae614db6/axial_004.png","assets/T/mri-0ca285ccae614db6/axial_005.png","assets/T/mri-0ca285ccae614db6/axial_006.png","assets/T/mri-0ca285ccae614db6/axial_008.png","assets/T/mri-0ca285ccae614db6/axial_009.png","assets/T/mri-0ca285ccae614db6/axial_010.png","assets/T/mri-0ca285ccae614db6/axial_012.png","assets/T/mri-0ca285ccae614db6/axial_013.png","assets/T/mri-0ca285ccae614db6/axial_014.png","assets/T/mri-0ca285ccae614db6/axial_016.png","assets/T/mri-0ca285ccae614db6/axial_017.png","assets/T/mri-0ca285ccae614db6/axial_018.png","assets/T/mri-0ca285ccae614db6/axial_020.png","assets/T/mri-0ca285ccae614db6/axial_021.png","assets/T/mri-0ca285ccae614db6/axial_022.png","assets/T/mri-0ca285ccae614db6/axial_023.png","assets/T/mri-0ca285ccae614db6/axial_025.png","assets/T/mri-0ca285ccae614db6/axial_026.png","assets/T/mri-0ca285ccae614db6/axial_027.png","assets/T/mri-0ca285ccae614db6/axial_029.png","assets/T/mri-0ca285ccae614db6/axial_030.png","assets/T/mri-0ca285ccae614db6/axial_031.png","assets/T/mri-0ca285ccae614db6/axial_033.png","assets/T/mri-0ca285ccae614db6/axial_034.png","assets/T/mri-0ca285ccae614db6/axial_035.png","assets/T/mri-0ca285ccae614db6/axial_037.png","assets/T/mri-0ca285ccae614db6/axial_038.png","assets/T/mri-0ca285ccae614db6/axial_039.png","assets/T/mri-0ca285ccae614db6/axial_041.png","assets/T/mri-0ca285ccae614db6/axial_042.png","assets/T/mri-0ca285ccae614db6/coronal_001.png","assets/T/mri-0ca285ccae614db6/coronal_002.png","assets/T/mri-0ca285ccae614db6/coronal_004.png","assets/T/mri-0ca285ccae614db6/coronal_005.png","assets/T/mri-0ca285ccae614db6/coronal_006.png","assets/T/mri-0ca285ccae614db6/coronal_008.png","assets/T/mri-0ca285ccae614db6/coronal_009.png","assets/T/mri-0ca285ccae614db6/coronal_010.png","assets/T/mri-0ca285ccae614db6/coronal_012.png","assets/T/mri-0ca285ccae614db6/coronal_013.png","assets/T/mri-0ca285ccae614db6/coronal_015.png","assets/T/mri-0ca285ccae614db6/coronal_016.png","assets/T/mri-0ca285ccae614db6/coronal_017.png","assets/T/mri-0ca285ccae614db6/coronal_019.png","assets/T/mri-0ca285ccae614db6/coronal_020.png","assets/T/mri-0ca285ccae614db6/coronal_021.png","assets/T/mri-0ca285ccae614db6/coronal_023.png","assets/T/mri-0ca285ccae614db6/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":66,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,12,13,14,16,17,18,20,21,22,23,25,26,27,29,30,31,33,34,35,37,38,39,41,42,43,44,46,47,48,50,51,52,54,55,57,58,59,61,62,63,65,66]}}
+{"id":"mri-8e2393c214054928","request_id":"L3-T300:mri-8e2393c214054928","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-8e2393c214054928/axial_001.png","assets/T/mri-8e2393c214054928/axial_002.png","assets/T/mri-8e2393c214054928/axial_004.png","assets/T/mri-8e2393c214054928/axial_005.png","assets/T/mri-8e2393c214054928/axial_007.png","assets/T/mri-8e2393c214054928/axial_008.png","assets/T/mri-8e2393c214054928/axial_009.png","assets/T/mri-8e2393c214054928/axial_011.png","assets/T/mri-8e2393c214054928/axial_012.png","assets/T/mri-8e2393c214054928/axial_013.png","assets/T/mri-8e2393c214054928/axial_015.png","assets/T/mri-8e2393c214054928/axial_016.png","assets/T/mri-8e2393c214054928/axial_018.png","assets/T/mri-8e2393c214054928/axial_019.png","assets/T/mri-8e2393c214054928/axial_020.png","assets/T/mri-8e2393c214054928/axial_022.png","assets/T/mri-8e2393c214054928/axial_023.png","assets/T/mri-8e2393c214054928/axial_025.png","assets/T/mri-8e2393c214054928/axial_026.png","assets/T/mri-8e2393c214054928/axial_027.png","assets/T/mri-8e2393c214054928/axial_029.png","assets/T/mri-8e2393c214054928/axial_030.png","assets/T/mri-8e2393c214054928/axial_032.png","assets/T/mri-8e2393c214054928/axial_033.png","assets/T/mri-8e2393c214054928/axial_034.png","assets/T/mri-8e2393c214054928/axial_036.png","assets/T/mri-8e2393c214054928/axial_037.png","assets/T/mri-8e2393c214054928/axial_038.png","assets/T/mri-8e2393c214054928/axial_040.png","assets/T/mri-8e2393c214054928/axial_041.png","assets/T/mri-8e2393c214054928/axial_043.png","assets/T/mri-8e2393c214054928/axial_044.png","assets/T/mri-8e2393c214054928/coronal_001.png","assets/T/mri-8e2393c214054928/coronal_002.png","assets/T/mri-8e2393c214054928/coronal_004.png","assets/T/mri-8e2393c214054928/coronal_005.png","assets/T/mri-8e2393c214054928/coronal_006.png","assets/T/mri-8e2393c214054928/coronal_008.png","assets/T/mri-8e2393c214054928/coronal_009.png","assets/T/mri-8e2393c214054928/coronal_010.png","assets/T/mri-8e2393c214054928/coronal_012.png","assets/T/mri-8e2393c214054928/coronal_013.png","assets/T/mri-8e2393c214054928/coronal_015.png","assets/T/mri-8e2393c214054928/coronal_016.png","assets/T/mri-8e2393c214054928/coronal_017.png","assets/T/mri-8e2393c214054928/coronal_019.png","assets/T/mri-8e2393c214054928/coronal_020.png","assets/T/mri-8e2393c214054928/coronal_021.png","assets/T/mri-8e2393c214054928/coronal_023.png","assets/T/mri-8e2393c214054928/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":68,"selected_count":50,"source_indices_1based":[1,2,4,5,7,8,9,11,12,13,15,16,18,19,20,22,23,25,26,27,29,30,32,33,34,36,37,38,40,41,43,44,45,46,48,49,50,52,53,54,56,57,59,60,61,63,64,65,67,68]}}
+{"id":"mri-964cc314fdba4813","request_id":"L3-T300:mri-964cc314fdba4813","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-964cc314fdba4813/axial_001.png","assets/T/mri-964cc314fdba4813/axial_002.png","assets/T/mri-964cc314fdba4813/axial_004.png","assets/T/mri-964cc314fdba4813/axial_005.png","assets/T/mri-964cc314fdba4813/axial_006.png","assets/T/mri-964cc314fdba4813/axial_008.png","assets/T/mri-964cc314fdba4813/axial_009.png","assets/T/mri-964cc314fdba4813/axial_010.png","assets/T/mri-964cc314fdba4813/axial_011.png","assets/T/mri-964cc314fdba4813/axial_013.png","assets/T/mri-964cc314fdba4813/axial_014.png","assets/T/mri-964cc314fdba4813/axial_015.png","assets/T/mri-964cc314fdba4813/axial_017.png","assets/T/mri-964cc314fdba4813/axial_018.png","assets/T/mri-964cc314fdba4813/axial_019.png","assets/T/mri-964cc314fdba4813/axial_021.png","assets/T/mri-964cc314fdba4813/axial_022.png","assets/T/mri-964cc314fdba4813/axial_023.png","assets/T/mri-964cc314fdba4813/axial_024.png","assets/T/mri-964cc314fdba4813/axial_026.png","assets/T/mri-964cc314fdba4813/axial_027.png","assets/T/mri-964cc314fdba4813/axial_028.png","assets/T/mri-964cc314fdba4813/axial_030.png","assets/T/mri-964cc314fdba4813/axial_031.png","assets/T/mri-964cc314fdba4813/axial_032.png","assets/T/mri-964cc314fdba4813/axial_034.png","assets/T/mri-964cc314fdba4813/axial_035.png","assets/T/mri-964cc314fdba4813/axial_036.png","assets/T/mri-964cc314fdba4813/axial_037.png","assets/T/mri-964cc314fdba4813/axial_039.png","assets/T/mri-964cc314fdba4813/axial_040.png","assets/T/mri-964cc314fdba4813/coronal_001.png","assets/T/mri-964cc314fdba4813/coronal_002.png","assets/T/mri-964cc314fdba4813/coronal_004.png","assets/T/mri-964cc314fdba4813/coronal_005.png","assets/T/mri-964cc314fdba4813/coronal_006.png","assets/T/mri-964cc314fdba4813/coronal_007.png","assets/T/mri-964cc314fdba4813/coronal_009.png","assets/T/mri-964cc314fdba4813/coronal_010.png","assets/T/mri-964cc314fdba4813/coronal_011.png","assets/T/mri-964cc314fdba4813/coronal_013.png","assets/T/mri-964cc314fdba4813/coronal_014.png","assets/T/mri-964cc314fdba4813/coronal_015.png","assets/T/mri-964cc314fdba4813/coronal_016.png","assets/T/mri-964cc314fdba4813/coronal_018.png","assets/T/mri-964cc314fdba4813/coronal_019.png","assets/T/mri-964cc314fdba4813/coronal_020.png","assets/T/mri-964cc314fdba4813/coronal_021.png","assets/T/mri-964cc314fdba4813/coronal_023.png","assets/T/mri-964cc314fdba4813/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":64,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,11,13,14,15,17,18,19,21,22,23,24,26,27,28,30,31,32,34,35,36,37,39,40,41,42,44,45,46,47,49,50,51,53,54,55,56,58,59,60,61,63,64]}}
+{"id":"mri-89ad7e4f032e4280","request_id":"L3-T300:mri-89ad7e4f032e4280","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-89ad7e4f032e4280/axial_001.png","assets/T/mri-89ad7e4f032e4280/axial_002.png","assets/T/mri-89ad7e4f032e4280/axial_004.png","assets/T/mri-89ad7e4f032e4280/axial_005.png","assets/T/mri-89ad7e4f032e4280/axial_006.png","assets/T/mri-89ad7e4f032e4280/axial_008.png","assets/T/mri-89ad7e4f032e4280/axial_009.png","assets/T/mri-89ad7e4f032e4280/axial_010.png","assets/T/mri-89ad7e4f032e4280/axial_012.png","assets/T/mri-89ad7e4f032e4280/axial_013.png","assets/T/mri-89ad7e4f032e4280/axial_015.png","assets/T/mri-89ad7e4f032e4280/axial_016.png","assets/T/mri-89ad7e4f032e4280/axial_017.png","assets/T/mri-89ad7e4f032e4280/axial_019.png","assets/T/mri-89ad7e4f032e4280/axial_020.png","assets/T/mri-89ad7e4f032e4280/axial_021.png","assets/T/mri-89ad7e4f032e4280/axial_023.png","assets/T/mri-89ad7e4f032e4280/axial_024.png","assets/T/mri-89ad7e4f032e4280/axial_025.png","assets/T/mri-89ad7e4f032e4280/axial_027.png","assets/T/mri-89ad7e4f032e4280/axial_028.png","assets/T/mri-89ad7e4f032e4280/axial_029.png","assets/T/mri-89ad7e4f032e4280/axial_031.png","assets/T/mri-89ad7e4f032e4280/axial_032.png","assets/T/mri-89ad7e4f032e4280/axial_034.png","assets/T/mri-89ad7e4f032e4280/axial_035.png","assets/T/mri-89ad7e4f032e4280/axial_036.png","assets/T/mri-89ad7e4f032e4280/axial_038.png","assets/T/mri-89ad7e4f032e4280/axial_039.png","assets/T/mri-89ad7e4f032e4280/axial_040.png","assets/T/mri-89ad7e4f032e4280/axial_042.png","assets/T/mri-89ad7e4f032e4280/axial_043.png","assets/T/mri-89ad7e4f032e4280/coronal_001.png","assets/T/mri-89ad7e4f032e4280/coronal_002.png","assets/T/mri-89ad7e4f032e4280/coronal_004.png","assets/T/mri-89ad7e4f032e4280/coronal_005.png","assets/T/mri-89ad7e4f032e4280/coronal_006.png","assets/T/mri-89ad7e4f032e4280/coronal_008.png","assets/T/mri-89ad7e4f032e4280/coronal_009.png","assets/T/mri-89ad7e4f032e4280/coronal_010.png","assets/T/mri-89ad7e4f032e4280/coronal_012.png","assets/T/mri-89ad7e4f032e4280/coronal_013.png","assets/T/mri-89ad7e4f032e4280/coronal_015.png","assets/T/mri-89ad7e4f032e4280/coronal_016.png","assets/T/mri-89ad7e4f032e4280/coronal_017.png","assets/T/mri-89ad7e4f032e4280/coronal_019.png","assets/T/mri-89ad7e4f032e4280/coronal_020.png","assets/T/mri-89ad7e4f032e4280/coronal_021.png","assets/T/mri-89ad7e4f032e4280/coronal_023.png","assets/T/mri-89ad7e4f032e4280/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":67,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,12,13,15,16,17,19,20,21,23,24,25,27,28,29,31,32,34,35,36,38,39,40,42,43,44,45,47,48,49,51,52,53,55,56,58,59,60,62,63,64,66,67]}}
+{"id":"mri-17791822e81042f8","request_id":"L3-T300:mri-17791822e81042f8","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-17791822e81042f8/axial_001.png","assets/T/mri-17791822e81042f8/axial_002.png","assets/T/mri-17791822e81042f8/axial_004.png","assets/T/mri-17791822e81042f8/axial_005.png","assets/T/mri-17791822e81042f8/axial_006.png","assets/T/mri-17791822e81042f8/axial_008.png","assets/T/mri-17791822e81042f8/axial_009.png","assets/T/mri-17791822e81042f8/axial_010.png","assets/T/mri-17791822e81042f8/axial_012.png","assets/T/mri-17791822e81042f8/axial_013.png","assets/T/mri-17791822e81042f8/axial_014.png","assets/T/mri-17791822e81042f8/axial_016.png","assets/T/mri-17791822e81042f8/axial_017.png","assets/T/mri-17791822e81042f8/axial_018.png","assets/T/mri-17791822e81042f8/axial_020.png","assets/T/mri-17791822e81042f8/axial_021.png","assets/T/mri-17791822e81042f8/axial_022.png","assets/T/mri-17791822e81042f8/axial_023.png","assets/T/mri-17791822e81042f8/axial_025.png","assets/T/mri-17791822e81042f8/axial_026.png","assets/T/mri-17791822e81042f8/axial_027.png","assets/T/mri-17791822e81042f8/axial_029.png","assets/T/mri-17791822e81042f8/axial_030.png","assets/T/mri-17791822e81042f8/axial_031.png","assets/T/mri-17791822e81042f8/axial_033.png","assets/T/mri-17791822e81042f8/axial_034.png","assets/T/mri-17791822e81042f8/axial_035.png","assets/T/mri-17791822e81042f8/axial_037.png","assets/T/mri-17791822e81042f8/axial_038.png","assets/T/mri-17791822e81042f8/axial_039.png","assets/T/mri-17791822e81042f8/axial_041.png","assets/T/mri-17791822e81042f8/axial_042.png","assets/T/mri-17791822e81042f8/coronal_001.png","assets/T/mri-17791822e81042f8/coronal_002.png","assets/T/mri-17791822e81042f8/coronal_004.png","assets/T/mri-17791822e81042f8/coronal_005.png","assets/T/mri-17791822e81042f8/coronal_006.png","assets/T/mri-17791822e81042f8/coronal_008.png","assets/T/mri-17791822e81042f8/coronal_009.png","assets/T/mri-17791822e81042f8/coronal_010.png","assets/T/mri-17791822e81042f8/coronal_012.png","assets/T/mri-17791822e81042f8/coronal_013.png","assets/T/mri-17791822e81042f8/coronal_015.png","assets/T/mri-17791822e81042f8/coronal_016.png","assets/T/mri-17791822e81042f8/coronal_017.png","assets/T/mri-17791822e81042f8/coronal_019.png","assets/T/mri-17791822e81042f8/coronal_020.png","assets/T/mri-17791822e81042f8/coronal_021.png","assets/T/mri-17791822e81042f8/coronal_023.png","assets/T/mri-17791822e81042f8/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":66,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,12,13,14,16,17,18,20,21,22,23,25,26,27,29,30,31,33,34,35,37,38,39,41,42,43,44,46,47,48,50,51,52,54,55,57,58,59,61,62,63,65,66]}}
+{"id":"mri-e4e91086f13f4cfd","request_id":"L3-T300:mri-e4e91086f13f4cfd","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-e4e91086f13f4cfd/axial_001.png","assets/T/mri-e4e91086f13f4cfd/axial_002.png","assets/T/mri-e4e91086f13f4cfd/axial_004.png","assets/T/mri-e4e91086f13f4cfd/axial_005.png","assets/T/mri-e4e91086f13f4cfd/axial_006.png","assets/T/mri-e4e91086f13f4cfd/axial_008.png","assets/T/mri-e4e91086f13f4cfd/axial_009.png","assets/T/mri-e4e91086f13f4cfd/axial_010.png","assets/T/mri-e4e91086f13f4cfd/axial_012.png","assets/T/mri-e4e91086f13f4cfd/axial_013.png","assets/T/mri-e4e91086f13f4cfd/axial_014.png","assets/T/mri-e4e91086f13f4cfd/axial_016.png","assets/T/mri-e4e91086f13f4cfd/axial_017.png","assets/T/mri-e4e91086f13f4cfd/axial_018.png","assets/T/mri-e4e91086f13f4cfd/axial_020.png","assets/T/mri-e4e91086f13f4cfd/axial_021.png","assets/T/mri-e4e91086f13f4cfd/axial_022.png","assets/T/mri-e4e91086f13f4cfd/axial_023.png","assets/T/mri-e4e91086f13f4cfd/axial_025.png","assets/T/mri-e4e91086f13f4cfd/axial_026.png","assets/T/mri-e4e91086f13f4cfd/axial_027.png","assets/T/mri-e4e91086f13f4cfd/axial_029.png","assets/T/mri-e4e91086f13f4cfd/axial_030.png","assets/T/mri-e4e91086f13f4cfd/axial_031.png","assets/T/mri-e4e91086f13f4cfd/axial_033.png","assets/T/mri-e4e91086f13f4cfd/axial_034.png","assets/T/mri-e4e91086f13f4cfd/axial_035.png","assets/T/mri-e4e91086f13f4cfd/axial_037.png","assets/T/mri-e4e91086f13f4cfd/axial_038.png","assets/T/mri-e4e91086f13f4cfd/axial_039.png","assets/T/mri-e4e91086f13f4cfd/axial_041.png","assets/T/mri-e4e91086f13f4cfd/axial_042.png","assets/T/mri-e4e91086f13f4cfd/coronal_001.png","assets/T/mri-e4e91086f13f4cfd/coronal_002.png","assets/T/mri-e4e91086f13f4cfd/coronal_004.png","assets/T/mri-e4e91086f13f4cfd/coronal_005.png","assets/T/mri-e4e91086f13f4cfd/coronal_006.png","assets/T/mri-e4e91086f13f4cfd/coronal_008.png","assets/T/mri-e4e91086f13f4cfd/coronal_009.png","assets/T/mri-e4e91086f13f4cfd/coronal_010.png","assets/T/mri-e4e91086f13f4cfd/coronal_012.png","assets/T/mri-e4e91086f13f4cfd/coronal_013.png","assets/T/mri-e4e91086f13f4cfd/coronal_015.png","assets/T/mri-e4e91086f13f4cfd/coronal_016.png","assets/T/mri-e4e91086f13f4cfd/coronal_017.png","assets/T/mri-e4e91086f13f4cfd/coronal_019.png","assets/T/mri-e4e91086f13f4cfd/coronal_020.png","assets/T/mri-e4e91086f13f4cfd/coronal_021.png","assets/T/mri-e4e91086f13f4cfd/coronal_023.png","assets/T/mri-e4e91086f13f4cfd/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":66,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,12,13,14,16,17,18,20,21,22,23,25,26,27,29,30,31,33,34,35,37,38,39,41,42,43,44,46,47,48,50,51,52,54,55,57,58,59,61,62,63,65,66]}}
+{"id":"mri-641082354d954f14","request_id":"L3-T300:mri-641082354d954f14","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-641082354d954f14/axial_001.png","assets/T/mri-641082354d954f14/axial_002.png","assets/T/mri-641082354d954f14/axial_004.png","assets/T/mri-641082354d954f14/axial_005.png","assets/T/mri-641082354d954f14/axial_006.png","assets/T/mri-641082354d954f14/axial_008.png","assets/T/mri-641082354d954f14/axial_009.png","assets/T/mri-641082354d954f14/axial_010.png","assets/T/mri-641082354d954f14/axial_012.png","assets/T/mri-641082354d954f14/axial_013.png","assets/T/mri-641082354d954f14/axial_014.png","assets/T/mri-641082354d954f14/axial_016.png","assets/T/mri-641082354d954f14/axial_017.png","assets/T/mri-641082354d954f14/axial_018.png","assets/T/mri-641082354d954f14/axial_020.png","assets/T/mri-641082354d954f14/axial_021.png","assets/T/mri-641082354d954f14/axial_022.png","assets/T/mri-641082354d954f14/axial_023.png","assets/T/mri-641082354d954f14/axial_025.png","assets/T/mri-641082354d954f14/axial_026.png","assets/T/mri-641082354d954f14/axial_027.png","assets/T/mri-641082354d954f14/axial_029.png","assets/T/mri-641082354d954f14/axial_030.png","assets/T/mri-641082354d954f14/axial_031.png","assets/T/mri-641082354d954f14/axial_033.png","assets/T/mri-641082354d954f14/axial_034.png","assets/T/mri-641082354d954f14/axial_035.png","assets/T/mri-641082354d954f14/axial_037.png","assets/T/mri-641082354d954f14/axial_038.png","assets/T/mri-641082354d954f14/axial_039.png","assets/T/mri-641082354d954f14/axial_041.png","assets/T/mri-641082354d954f14/axial_042.png","assets/T/mri-641082354d954f14/coronal_001.png","assets/T/mri-641082354d954f14/coronal_002.png","assets/T/mri-641082354d954f14/coronal_004.png","assets/T/mri-641082354d954f14/coronal_005.png","assets/T/mri-641082354d954f14/coronal_006.png","assets/T/mri-641082354d954f14/coronal_008.png","assets/T/mri-641082354d954f14/coronal_009.png","assets/T/mri-641082354d954f14/coronal_010.png","assets/T/mri-641082354d954f14/coronal_012.png","assets/T/mri-641082354d954f14/coronal_013.png","assets/T/mri-641082354d954f14/coronal_015.png","assets/T/mri-641082354d954f14/coronal_016.png","assets/T/mri-641082354d954f14/coronal_017.png","assets/T/mri-641082354d954f14/coronal_019.png","assets/T/mri-641082354d954f14/coronal_020.png","assets/T/mri-641082354d954f14/coronal_021.png","assets/T/mri-641082354d954f14/coronal_023.png","assets/T/mri-641082354d954f14/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":66,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,12,13,14,16,17,18,20,21,22,23,25,26,27,29,30,31,33,34,35,37,38,39,41,42,43,44,46,47,48,50,51,52,54,55,57,58,59,61,62,63,65,66]}}
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+{"id":"mri-40ab680e8ff847d6","request_id":"L3-T300:mri-40ab680e8ff847d6","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-40ab680e8ff847d6/axial_001.png","assets/T/mri-40ab680e8ff847d6/axial_002.png","assets/T/mri-40ab680e8ff847d6/axial_004.png","assets/T/mri-40ab680e8ff847d6/axial_005.png","assets/T/mri-40ab680e8ff847d6/axial_006.png","assets/T/mri-40ab680e8ff847d6/axial_008.png","assets/T/mri-40ab680e8ff847d6/axial_009.png","assets/T/mri-40ab680e8ff847d6/axial_010.png","assets/T/mri-40ab680e8ff847d6/axial_012.png","assets/T/mri-40ab680e8ff847d6/axial_013.png","assets/T/mri-40ab680e8ff847d6/axial_014.png","assets/T/mri-40ab680e8ff847d6/axial_016.png","assets/T/mri-40ab680e8ff847d6/axial_017.png","assets/T/mri-40ab680e8ff847d6/axial_018.png","assets/T/mri-40ab680e8ff847d6/axial_020.png","assets/T/mri-40ab680e8ff847d6/axial_021.png","assets/T/mri-40ab680e8ff847d6/axial_022.png","assets/T/mri-40ab680e8ff847d6/axial_023.png","assets/T/mri-40ab680e8ff847d6/axial_025.png","assets/T/mri-40ab680e8ff847d6/axial_026.png","assets/T/mri-40ab680e8ff847d6/axial_027.png","assets/T/mri-40ab680e8ff847d6/axial_029.png","assets/T/mri-40ab680e8ff847d6/axial_030.png","assets/T/mri-40ab680e8ff847d6/axial_031.png","assets/T/mri-40ab680e8ff847d6/axial_033.png","assets/T/mri-40ab680e8ff847d6/axial_034.png","assets/T/mri-40ab680e8ff847d6/axial_035.png","assets/T/mri-40ab680e8ff847d6/axial_037.png","assets/T/mri-40ab680e8ff847d6/axial_038.png","assets/T/mri-40ab680e8ff847d6/axial_039.png","assets/T/mri-40ab680e8ff847d6/axial_041.png","assets/T/mri-40ab680e8ff847d6/axial_042.png","assets/T/mri-40ab680e8ff847d6/coronal_001.png","assets/T/mri-40ab680e8ff847d6/coronal_002.png","assets/T/mri-40ab680e8ff847d6/coronal_004.png","assets/T/mri-40ab680e8ff847d6/coronal_005.png","assets/T/mri-40ab680e8ff847d6/coronal_006.png","assets/T/mri-40ab680e8ff847d6/coronal_008.png","assets/T/mri-40ab680e8ff847d6/coronal_009.png","assets/T/mri-40ab680e8ff847d6/coronal_010.png","assets/T/mri-40ab680e8ff847d6/coronal_012.png","assets/T/mri-40ab680e8ff847d6/coronal_013.png","assets/T/mri-40ab680e8ff847d6/coronal_015.png","assets/T/mri-40ab680e8ff847d6/coronal_016.png","assets/T/mri-40ab680e8ff847d6/coronal_017.png","assets/T/mri-40ab680e8ff847d6/coronal_019.png","assets/T/mri-40ab680e8ff847d6/coronal_020.png","assets/T/mri-40ab680e8ff847d6/coronal_021.png","assets/T/mri-40ab680e8ff847d6/coronal_023.png","assets/T/mri-40ab680e8ff847d6/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":66,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,12,13,14,16,17,18,20,21,22,23,25,26,27,29,30,31,33,34,35,37,38,39,41,42,43,44,46,47,48,50,51,52,54,55,57,58,59,61,62,63,65,66]}}
+{"id":"mri-396b4602039e46f3","request_id":"L3-T300:mri-396b4602039e46f3","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 30 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 20 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-396b4602039e46f3/axial_001.png","assets/T/mri-396b4602039e46f3/axial_002.png","assets/T/mri-396b4602039e46f3/axial_003.png","assets/T/mri-396b4602039e46f3/axial_005.png","assets/T/mri-396b4602039e46f3/axial_006.png","assets/T/mri-396b4602039e46f3/axial_007.png","assets/T/mri-396b4602039e46f3/axial_008.png","assets/T/mri-396b4602039e46f3/axial_009.png","assets/T/mri-396b4602039e46f3/axial_011.png","assets/T/mri-396b4602039e46f3/axial_012.png","assets/T/mri-396b4602039e46f3/axial_013.png","assets/T/mri-396b4602039e46f3/axial_014.png","assets/T/mri-396b4602039e46f3/axial_015.png","assets/T/mri-396b4602039e46f3/axial_017.png","assets/T/mri-396b4602039e46f3/axial_018.png","assets/T/mri-396b4602039e46f3/axial_019.png","assets/T/mri-396b4602039e46f3/axial_020.png","assets/T/mri-396b4602039e46f3/axial_022.png","assets/T/mri-396b4602039e46f3/axial_023.png","assets/T/mri-396b4602039e46f3/axial_024.png","assets/T/mri-396b4602039e46f3/axial_025.png","assets/T/mri-396b4602039e46f3/axial_026.png","assets/T/mri-396b4602039e46f3/axial_028.png","assets/T/mri-396b4602039e46f3/axial_029.png","assets/T/mri-396b4602039e46f3/axial_030.png","assets/T/mri-396b4602039e46f3/axial_031.png","assets/T/mri-396b4602039e46f3/axial_032.png","assets/T/mri-396b4602039e46f3/axial_034.png","assets/T/mri-396b4602039e46f3/axial_035.png","assets/T/mri-396b4602039e46f3/axial_036.png","assets/T/mri-396b4602039e46f3/coronal_001.png","assets/T/mri-396b4602039e46f3/coronal_002.png","assets/T/mri-396b4602039e46f3/coronal_003.png","assets/T/mri-396b4602039e46f3/coronal_005.png","assets/T/mri-396b4602039e46f3/coronal_006.png","assets/T/mri-396b4602039e46f3/coronal_007.png","assets/T/mri-396b4602039e46f3/coronal_008.png","assets/T/mri-396b4602039e46f3/coronal_009.png","assets/T/mri-396b4602039e46f3/coronal_011.png","assets/T/mri-396b4602039e46f3/coronal_012.png","assets/T/mri-396b4602039e46f3/coronal_013.png","assets/T/mri-396b4602039e46f3/coronal_014.png","assets/T/mri-396b4602039e46f3/coronal_016.png","assets/T/mri-396b4602039e46f3/coronal_017.png","assets/T/mri-396b4602039e46f3/coronal_018.png","assets/T/mri-396b4602039e46f3/coronal_019.png","assets/T/mri-396b4602039e46f3/coronal_020.png","assets/T/mri-396b4602039e46f3/coronal_022.png","assets/T/mri-396b4602039e46f3/coronal_023.png","assets/T/mri-396b4602039e46f3/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":60,"selected_count":50,"source_indices_1based":[1,2,3,5,6,7,8,9,11,12,13,14,15,17,18,19,20,22,23,24,25,26,28,29,30,31,32,34,35,36,37,38,39,41,42,43,44,45,47,48,49,50,52,53,54,55,56,58,59,60]}}
+{"id":"mri-0588f21611574c53","request_id":"L3-T300:mri-0588f21611574c53","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-0588f21611574c53/axial_001.png","assets/T/mri-0588f21611574c53/axial_002.png","assets/T/mri-0588f21611574c53/axial_004.png","assets/T/mri-0588f21611574c53/axial_005.png","assets/T/mri-0588f21611574c53/axial_006.png","assets/T/mri-0588f21611574c53/axial_008.png","assets/T/mri-0588f21611574c53/axial_009.png","assets/T/mri-0588f21611574c53/axial_010.png","assets/T/mri-0588f21611574c53/axial_011.png","assets/T/mri-0588f21611574c53/axial_013.png","assets/T/mri-0588f21611574c53/axial_014.png","assets/T/mri-0588f21611574c53/axial_015.png","assets/T/mri-0588f21611574c53/axial_017.png","assets/T/mri-0588f21611574c53/axial_018.png","assets/T/mri-0588f21611574c53/axial_019.png","assets/T/mri-0588f21611574c53/axial_021.png","assets/T/mri-0588f21611574c53/axial_022.png","assets/T/mri-0588f21611574c53/axial_023.png","assets/T/mri-0588f21611574c53/axial_024.png","assets/T/mri-0588f21611574c53/axial_026.png","assets/T/mri-0588f21611574c53/axial_027.png","assets/T/mri-0588f21611574c53/axial_028.png","assets/T/mri-0588f21611574c53/axial_030.png","assets/T/mri-0588f21611574c53/axial_031.png","assets/T/mri-0588f21611574c53/axial_032.png","assets/T/mri-0588f21611574c53/axial_034.png","assets/T/mri-0588f21611574c53/axial_035.png","assets/T/mri-0588f21611574c53/axial_036.png","assets/T/mri-0588f21611574c53/axial_037.png","assets/T/mri-0588f21611574c53/axial_039.png","assets/T/mri-0588f21611574c53/axial_040.png","assets/T/mri-0588f21611574c53/coronal_001.png","assets/T/mri-0588f21611574c53/coronal_002.png","assets/T/mri-0588f21611574c53/coronal_004.png","assets/T/mri-0588f21611574c53/coronal_005.png","assets/T/mri-0588f21611574c53/coronal_006.png","assets/T/mri-0588f21611574c53/coronal_007.png","assets/T/mri-0588f21611574c53/coronal_009.png","assets/T/mri-0588f21611574c53/coronal_010.png","assets/T/mri-0588f21611574c53/coronal_011.png","assets/T/mri-0588f21611574c53/coronal_013.png","assets/T/mri-0588f21611574c53/coronal_014.png","assets/T/mri-0588f21611574c53/coronal_015.png","assets/T/mri-0588f21611574c53/coronal_016.png","assets/T/mri-0588f21611574c53/coronal_018.png","assets/T/mri-0588f21611574c53/coronal_019.png","assets/T/mri-0588f21611574c53/coronal_020.png","assets/T/mri-0588f21611574c53/coronal_021.png","assets/T/mri-0588f21611574c53/coronal_023.png","assets/T/mri-0588f21611574c53/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":64,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,11,13,14,15,17,18,19,21,22,23,24,26,27,28,30,31,32,34,35,36,37,39,40,41,42,44,45,46,47,49,50,51,53,54,55,56,58,59,60,61,63,64]}}
+{"id":"mri-f4e104d4b1914b92","request_id":"L3-T300:mri-f4e104d4b1914b92","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-f4e104d4b1914b92/axial_001.png","assets/T/mri-f4e104d4b1914b92/axial_002.png","assets/T/mri-f4e104d4b1914b92/axial_004.png","assets/T/mri-f4e104d4b1914b92/axial_005.png","assets/T/mri-f4e104d4b1914b92/axial_006.png","assets/T/mri-f4e104d4b1914b92/axial_008.png","assets/T/mri-f4e104d4b1914b92/axial_009.png","assets/T/mri-f4e104d4b1914b92/axial_010.png","assets/T/mri-f4e104d4b1914b92/axial_012.png","assets/T/mri-f4e104d4b1914b92/axial_013.png","assets/T/mri-f4e104d4b1914b92/axial_014.png","assets/T/mri-f4e104d4b1914b92/axial_016.png","assets/T/mri-f4e104d4b1914b92/axial_017.png","assets/T/mri-f4e104d4b1914b92/axial_018.png","assets/T/mri-f4e104d4b1914b92/axial_020.png","assets/T/mri-f4e104d4b1914b92/axial_021.png","assets/T/mri-f4e104d4b1914b92/axial_022.png","assets/T/mri-f4e104d4b1914b92/axial_023.png","assets/T/mri-f4e104d4b1914b92/axial_025.png","assets/T/mri-f4e104d4b1914b92/axial_026.png","assets/T/mri-f4e104d4b1914b92/axial_027.png","assets/T/mri-f4e104d4b1914b92/axial_029.png","assets/T/mri-f4e104d4b1914b92/axial_030.png","assets/T/mri-f4e104d4b1914b92/axial_031.png","assets/T/mri-f4e104d4b1914b92/axial_033.png","assets/T/mri-f4e104d4b1914b92/axial_034.png","assets/T/mri-f4e104d4b1914b92/axial_035.png","assets/T/mri-f4e104d4b1914b92/axial_037.png","assets/T/mri-f4e104d4b1914b92/axial_038.png","assets/T/mri-f4e104d4b1914b92/axial_039.png","assets/T/mri-f4e104d4b1914b92/axial_041.png","assets/T/mri-f4e104d4b1914b92/axial_042.png","assets/T/mri-f4e104d4b1914b92/coronal_001.png","assets/T/mri-f4e104d4b1914b92/coronal_002.png","assets/T/mri-f4e104d4b1914b92/coronal_004.png","assets/T/mri-f4e104d4b1914b92/coronal_005.png","assets/T/mri-f4e104d4b1914b92/coronal_006.png","assets/T/mri-f4e104d4b1914b92/coronal_008.png","assets/T/mri-f4e104d4b1914b92/coronal_009.png","assets/T/mri-f4e104d4b1914b92/coronal_010.png","assets/T/mri-f4e104d4b1914b92/coronal_012.png","assets/T/mri-f4e104d4b1914b92/coronal_013.png","assets/T/mri-f4e104d4b1914b92/coronal_015.png","assets/T/mri-f4e104d4b1914b92/coronal_016.png","assets/T/mri-f4e104d4b1914b92/coronal_017.png","assets/T/mri-f4e104d4b1914b92/coronal_019.png","assets/T/mri-f4e104d4b1914b92/coronal_020.png","assets/T/mri-f4e104d4b1914b92/coronal_021.png","assets/T/mri-f4e104d4b1914b92/coronal_023.png","assets/T/mri-f4e104d4b1914b92/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":66,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,12,13,14,16,17,18,20,21,22,23,25,26,27,29,30,31,33,34,35,37,38,39,41,42,43,44,46,47,48,50,51,52,54,55,57,58,59,61,62,63,65,66]}}
+{"id":"mri-d55be5ee6a164720","request_id":"L3-T300:mri-d55be5ee6a164720","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-d55be5ee6a164720/axial_001.png","assets/T/mri-d55be5ee6a164720/axial_002.png","assets/T/mri-d55be5ee6a164720/axial_004.png","assets/T/mri-d55be5ee6a164720/axial_005.png","assets/T/mri-d55be5ee6a164720/axial_006.png","assets/T/mri-d55be5ee6a164720/axial_008.png","assets/T/mri-d55be5ee6a164720/axial_009.png","assets/T/mri-d55be5ee6a164720/axial_010.png","assets/T/mri-d55be5ee6a164720/axial_012.png","assets/T/mri-d55be5ee6a164720/axial_013.png","assets/T/mri-d55be5ee6a164720/axial_014.png","assets/T/mri-d55be5ee6a164720/axial_016.png","assets/T/mri-d55be5ee6a164720/axial_017.png","assets/T/mri-d55be5ee6a164720/axial_018.png","assets/T/mri-d55be5ee6a164720/axial_020.png","assets/T/mri-d55be5ee6a164720/axial_021.png","assets/T/mri-d55be5ee6a164720/axial_022.png","assets/T/mri-d55be5ee6a164720/axial_023.png","assets/T/mri-d55be5ee6a164720/axial_025.png","assets/T/mri-d55be5ee6a164720/axial_026.png","assets/T/mri-d55be5ee6a164720/axial_027.png","assets/T/mri-d55be5ee6a164720/axial_029.png","assets/T/mri-d55be5ee6a164720/axial_030.png","assets/T/mri-d55be5ee6a164720/axial_031.png","assets/T/mri-d55be5ee6a164720/axial_033.png","assets/T/mri-d55be5ee6a164720/axial_034.png","assets/T/mri-d55be5ee6a164720/axial_035.png","assets/T/mri-d55be5ee6a164720/axial_037.png","assets/T/mri-d55be5ee6a164720/axial_038.png","assets/T/mri-d55be5ee6a164720/axial_039.png","assets/T/mri-d55be5ee6a164720/axial_041.png","assets/T/mri-d55be5ee6a164720/axial_042.png","assets/T/mri-d55be5ee6a164720/coronal_001.png","assets/T/mri-d55be5ee6a164720/coronal_002.png","assets/T/mri-d55be5ee6a164720/coronal_004.png","assets/T/mri-d55be5ee6a164720/coronal_005.png","assets/T/mri-d55be5ee6a164720/coronal_006.png","assets/T/mri-d55be5ee6a164720/coronal_008.png","assets/T/mri-d55be5ee6a164720/coronal_009.png","assets/T/mri-d55be5ee6a164720/coronal_010.png","assets/T/mri-d55be5ee6a164720/coronal_012.png","assets/T/mri-d55be5ee6a164720/coronal_013.png","assets/T/mri-d55be5ee6a164720/coronal_015.png","assets/T/mri-d55be5ee6a164720/coronal_016.png","assets/T/mri-d55be5ee6a164720/coronal_017.png","assets/T/mri-d55be5ee6a164720/coronal_019.png","assets/T/mri-d55be5ee6a164720/coronal_020.png","assets/T/mri-d55be5ee6a164720/coronal_021.png","assets/T/mri-d55be5ee6a164720/coronal_023.png","assets/T/mri-d55be5ee6a164720/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":66,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,12,13,14,16,17,18,20,21,22,23,25,26,27,29,30,31,33,34,35,37,38,39,41,42,43,44,46,47,48,50,51,52,54,55,57,58,59,61,62,63,65,66]}}
+{"id":"mri-819452b5910247dc","request_id":"L3-T300:mri-819452b5910247dc","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-819452b5910247dc/axial_001.png","assets/T/mri-819452b5910247dc/axial_002.png","assets/T/mri-819452b5910247dc/axial_004.png","assets/T/mri-819452b5910247dc/axial_005.png","assets/T/mri-819452b5910247dc/axial_006.png","assets/T/mri-819452b5910247dc/axial_008.png","assets/T/mri-819452b5910247dc/axial_009.png","assets/T/mri-819452b5910247dc/axial_011.png","assets/T/mri-819452b5910247dc/axial_012.png","assets/T/mri-819452b5910247dc/axial_013.png","assets/T/mri-819452b5910247dc/axial_015.png","assets/T/mri-819452b5910247dc/axial_016.png","assets/T/mri-819452b5910247dc/axial_017.png","assets/T/mri-819452b5910247dc/axial_019.png","assets/T/mri-819452b5910247dc/axial_020.png","assets/T/mri-819452b5910247dc/axial_022.png","assets/T/mri-819452b5910247dc/axial_023.png","assets/T/mri-819452b5910247dc/axial_024.png","assets/T/mri-819452b5910247dc/axial_026.png","assets/T/mri-819452b5910247dc/axial_027.png","assets/T/mri-819452b5910247dc/axial_028.png","assets/T/mri-819452b5910247dc/axial_030.png","assets/T/mri-819452b5910247dc/axial_031.png","assets/T/mri-819452b5910247dc/axial_032.png","assets/T/mri-819452b5910247dc/axial_034.png","assets/T/mri-819452b5910247dc/axial_035.png","assets/T/mri-819452b5910247dc/axial_037.png","assets/T/mri-819452b5910247dc/axial_038.png","assets/T/mri-819452b5910247dc/axial_039.png","assets/T/mri-819452b5910247dc/axial_041.png","assets/T/mri-819452b5910247dc/axial_042.png","assets/T/mri-819452b5910247dc/coronal_001.png","assets/T/mri-819452b5910247dc/coronal_002.png","assets/T/mri-819452b5910247dc/coronal_004.png","assets/T/mri-819452b5910247dc/coronal_005.png","assets/T/mri-819452b5910247dc/coronal_007.png","assets/T/mri-819452b5910247dc/coronal_008.png","assets/T/mri-819452b5910247dc/coronal_009.png","assets/T/mri-819452b5910247dc/coronal_011.png","assets/T/mri-819452b5910247dc/coronal_012.png","assets/T/mri-819452b5910247dc/coronal_014.png","assets/T/mri-819452b5910247dc/coronal_015.png","assets/T/mri-819452b5910247dc/coronal_016.png","assets/T/mri-819452b5910247dc/coronal_018.png","assets/T/mri-819452b5910247dc/coronal_019.png","assets/T/mri-819452b5910247dc/coronal_020.png","assets/T/mri-819452b5910247dc/coronal_022.png","assets/T/mri-819452b5910247dc/coronal_023.png","assets/T/mri-819452b5910247dc/coronal_025.png","assets/T/mri-819452b5910247dc/coronal_026.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":68,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,11,12,13,15,16,17,19,20,22,23,24,26,27,28,30,31,32,34,35,37,38,39,41,42,43,44,46,47,49,50,51,53,54,56,57,58,60,61,62,64,65,67,68]}}
+{"id":"mri-d49832b605474bfa","request_id":"L3-T300:mri-d49832b605474bfa","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-d49832b605474bfa/axial_001.png","assets/T/mri-d49832b605474bfa/axial_002.png","assets/T/mri-d49832b605474bfa/axial_004.png","assets/T/mri-d49832b605474bfa/axial_005.png","assets/T/mri-d49832b605474bfa/axial_006.png","assets/T/mri-d49832b605474bfa/axial_008.png","assets/T/mri-d49832b605474bfa/axial_009.png","assets/T/mri-d49832b605474bfa/axial_010.png","assets/T/mri-d49832b605474bfa/axial_011.png","assets/T/mri-d49832b605474bfa/axial_013.png","assets/T/mri-d49832b605474bfa/axial_014.png","assets/T/mri-d49832b605474bfa/axial_015.png","assets/T/mri-d49832b605474bfa/axial_017.png","assets/T/mri-d49832b605474bfa/axial_018.png","assets/T/mri-d49832b605474bfa/axial_019.png","assets/T/mri-d49832b605474bfa/axial_021.png","assets/T/mri-d49832b605474bfa/axial_022.png","assets/T/mri-d49832b605474bfa/axial_023.png","assets/T/mri-d49832b605474bfa/axial_024.png","assets/T/mri-d49832b605474bfa/axial_026.png","assets/T/mri-d49832b605474bfa/axial_027.png","assets/T/mri-d49832b605474bfa/axial_028.png","assets/T/mri-d49832b605474bfa/axial_030.png","assets/T/mri-d49832b605474bfa/axial_031.png","assets/T/mri-d49832b605474bfa/axial_032.png","assets/T/mri-d49832b605474bfa/axial_034.png","assets/T/mri-d49832b605474bfa/axial_035.png","assets/T/mri-d49832b605474bfa/axial_036.png","assets/T/mri-d49832b605474bfa/axial_037.png","assets/T/mri-d49832b605474bfa/axial_039.png","assets/T/mri-d49832b605474bfa/axial_040.png","assets/T/mri-d49832b605474bfa/coronal_001.png","assets/T/mri-d49832b605474bfa/coronal_002.png","assets/T/mri-d49832b605474bfa/coronal_004.png","assets/T/mri-d49832b605474bfa/coronal_005.png","assets/T/mri-d49832b605474bfa/coronal_006.png","assets/T/mri-d49832b605474bfa/coronal_007.png","assets/T/mri-d49832b605474bfa/coronal_009.png","assets/T/mri-d49832b605474bfa/coronal_010.png","assets/T/mri-d49832b605474bfa/coronal_011.png","assets/T/mri-d49832b605474bfa/coronal_013.png","assets/T/mri-d49832b605474bfa/coronal_014.png","assets/T/mri-d49832b605474bfa/coronal_015.png","assets/T/mri-d49832b605474bfa/coronal_016.png","assets/T/mri-d49832b605474bfa/coronal_018.png","assets/T/mri-d49832b605474bfa/coronal_019.png","assets/T/mri-d49832b605474bfa/coronal_020.png","assets/T/mri-d49832b605474bfa/coronal_021.png","assets/T/mri-d49832b605474bfa/coronal_023.png","assets/T/mri-d49832b605474bfa/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":64,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,11,13,14,15,17,18,19,21,22,23,24,26,27,28,30,31,32,34,35,36,37,39,40,41,42,44,45,46,47,49,50,51,53,54,55,56,58,59,60,61,63,64]}}
+{"id":"mri-2bedb86c0d404023","request_id":"L3-T300:mri-2bedb86c0d404023","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-2bedb86c0d404023/axial_001.png","assets/T/mri-2bedb86c0d404023/axial_002.png","assets/T/mri-2bedb86c0d404023/axial_004.png","assets/T/mri-2bedb86c0d404023/axial_005.png","assets/T/mri-2bedb86c0d404023/axial_006.png","assets/T/mri-2bedb86c0d404023/axial_008.png","assets/T/mri-2bedb86c0d404023/axial_009.png","assets/T/mri-2bedb86c0d404023/axial_010.png","assets/T/mri-2bedb86c0d404023/axial_012.png","assets/T/mri-2bedb86c0d404023/axial_013.png","assets/T/mri-2bedb86c0d404023/axial_014.png","assets/T/mri-2bedb86c0d404023/axial_016.png","assets/T/mri-2bedb86c0d404023/axial_017.png","assets/T/mri-2bedb86c0d404023/axial_018.png","assets/T/mri-2bedb86c0d404023/axial_020.png","assets/T/mri-2bedb86c0d404023/axial_021.png","assets/T/mri-2bedb86c0d404023/axial_022.png","assets/T/mri-2bedb86c0d404023/axial_023.png","assets/T/mri-2bedb86c0d404023/axial_025.png","assets/T/mri-2bedb86c0d404023/axial_026.png","assets/T/mri-2bedb86c0d404023/axial_027.png","assets/T/mri-2bedb86c0d404023/axial_029.png","assets/T/mri-2bedb86c0d404023/axial_030.png","assets/T/mri-2bedb86c0d404023/axial_031.png","assets/T/mri-2bedb86c0d404023/axial_033.png","assets/T/mri-2bedb86c0d404023/axial_034.png","assets/T/mri-2bedb86c0d404023/axial_035.png","assets/T/mri-2bedb86c0d404023/axial_037.png","assets/T/mri-2bedb86c0d404023/axial_038.png","assets/T/mri-2bedb86c0d404023/axial_039.png","assets/T/mri-2bedb86c0d404023/axial_041.png","assets/T/mri-2bedb86c0d404023/axial_042.png","assets/T/mri-2bedb86c0d404023/coronal_001.png","assets/T/mri-2bedb86c0d404023/coronal_002.png","assets/T/mri-2bedb86c0d404023/coronal_004.png","assets/T/mri-2bedb86c0d404023/coronal_005.png","assets/T/mri-2bedb86c0d404023/coronal_006.png","assets/T/mri-2bedb86c0d404023/coronal_008.png","assets/T/mri-2bedb86c0d404023/coronal_009.png","assets/T/mri-2bedb86c0d404023/coronal_010.png","assets/T/mri-2bedb86c0d404023/coronal_012.png","assets/T/mri-2bedb86c0d404023/coronal_013.png","assets/T/mri-2bedb86c0d404023/coronal_015.png","assets/T/mri-2bedb86c0d404023/coronal_016.png","assets/T/mri-2bedb86c0d404023/coronal_017.png","assets/T/mri-2bedb86c0d404023/coronal_019.png","assets/T/mri-2bedb86c0d404023/coronal_020.png","assets/T/mri-2bedb86c0d404023/coronal_021.png","assets/T/mri-2bedb86c0d404023/coronal_023.png","assets/T/mri-2bedb86c0d404023/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":66,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,12,13,14,16,17,18,20,21,22,23,25,26,27,29,30,31,33,34,35,37,38,39,41,42,43,44,46,47,48,50,51,52,54,55,57,58,59,61,62,63,65,66]}}
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+{"id":"mri-37345bffc7aa45be","request_id":"L3-T300:mri-37345bffc7aa45be","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-37345bffc7aa45be/axial_001.png","assets/T/mri-37345bffc7aa45be/axial_002.png","assets/T/mri-37345bffc7aa45be/axial_004.png","assets/T/mri-37345bffc7aa45be/axial_005.png","assets/T/mri-37345bffc7aa45be/axial_006.png","assets/T/mri-37345bffc7aa45be/axial_008.png","assets/T/mri-37345bffc7aa45be/axial_009.png","assets/T/mri-37345bffc7aa45be/axial_010.png","assets/T/mri-37345bffc7aa45be/axial_012.png","assets/T/mri-37345bffc7aa45be/axial_013.png","assets/T/mri-37345bffc7aa45be/axial_014.png","assets/T/mri-37345bffc7aa45be/axial_016.png","assets/T/mri-37345bffc7aa45be/axial_017.png","assets/T/mri-37345bffc7aa45be/axial_018.png","assets/T/mri-37345bffc7aa45be/axial_020.png","assets/T/mri-37345bffc7aa45be/axial_021.png","assets/T/mri-37345bffc7aa45be/axial_022.png","assets/T/mri-37345bffc7aa45be/axial_023.png","assets/T/mri-37345bffc7aa45be/axial_025.png","assets/T/mri-37345bffc7aa45be/axial_026.png","assets/T/mri-37345bffc7aa45be/axial_027.png","assets/T/mri-37345bffc7aa45be/axial_029.png","assets/T/mri-37345bffc7aa45be/axial_030.png","assets/T/mri-37345bffc7aa45be/axial_031.png","assets/T/mri-37345bffc7aa45be/axial_033.png","assets/T/mri-37345bffc7aa45be/axial_034.png","assets/T/mri-37345bffc7aa45be/axial_035.png","assets/T/mri-37345bffc7aa45be/axial_037.png","assets/T/mri-37345bffc7aa45be/axial_038.png","assets/T/mri-37345bffc7aa45be/axial_039.png","assets/T/mri-37345bffc7aa45be/axial_041.png","assets/T/mri-37345bffc7aa45be/axial_042.png","assets/T/mri-37345bffc7aa45be/coronal_001.png","assets/T/mri-37345bffc7aa45be/coronal_002.png","assets/T/mri-37345bffc7aa45be/coronal_004.png","assets/T/mri-37345bffc7aa45be/coronal_005.png","assets/T/mri-37345bffc7aa45be/coronal_006.png","assets/T/mri-37345bffc7aa45be/coronal_008.png","assets/T/mri-37345bffc7aa45be/coronal_009.png","assets/T/mri-37345bffc7aa45be/coronal_010.png","assets/T/mri-37345bffc7aa45be/coronal_012.png","assets/T/mri-37345bffc7aa45be/coronal_013.png","assets/T/mri-37345bffc7aa45be/coronal_015.png","assets/T/mri-37345bffc7aa45be/coronal_016.png","assets/T/mri-37345bffc7aa45be/coronal_017.png","assets/T/mri-37345bffc7aa45be/coronal_019.png","assets/T/mri-37345bffc7aa45be/coronal_020.png","assets/T/mri-37345bffc7aa45be/coronal_021.png","assets/T/mri-37345bffc7aa45be/coronal_023.png","assets/T/mri-37345bffc7aa45be/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":66,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,12,13,14,16,17,18,20,21,22,23,25,26,27,29,30,31,33,34,35,37,38,39,41,42,43,44,46,47,48,50,51,52,54,55,57,58,59,61,62,63,65,66]}}
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+{"id":"mri-5f4e71f281864ee8","request_id":"L3-T300:mri-5f4e71f281864ee8","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-5f4e71f281864ee8/axial_001.png","assets/T/mri-5f4e71f281864ee8/axial_002.png","assets/T/mri-5f4e71f281864ee8/axial_004.png","assets/T/mri-5f4e71f281864ee8/axial_005.png","assets/T/mri-5f4e71f281864ee8/axial_006.png","assets/T/mri-5f4e71f281864ee8/axial_008.png","assets/T/mri-5f4e71f281864ee8/axial_009.png","assets/T/mri-5f4e71f281864ee8/axial_010.png","assets/T/mri-5f4e71f281864ee8/axial_011.png","assets/T/mri-5f4e71f281864ee8/axial_013.png","assets/T/mri-5f4e71f281864ee8/axial_014.png","assets/T/mri-5f4e71f281864ee8/axial_015.png","assets/T/mri-5f4e71f281864ee8/axial_017.png","assets/T/mri-5f4e71f281864ee8/axial_018.png","assets/T/mri-5f4e71f281864ee8/axial_019.png","assets/T/mri-5f4e71f281864ee8/axial_021.png","assets/T/mri-5f4e71f281864ee8/axial_022.png","assets/T/mri-5f4e71f281864ee8/axial_023.png","assets/T/mri-5f4e71f281864ee8/axial_024.png","assets/T/mri-5f4e71f281864ee8/axial_026.png","assets/T/mri-5f4e71f281864ee8/axial_027.png","assets/T/mri-5f4e71f281864ee8/axial_028.png","assets/T/mri-5f4e71f281864ee8/axial_030.png","assets/T/mri-5f4e71f281864ee8/axial_031.png","assets/T/mri-5f4e71f281864ee8/axial_032.png","assets/T/mri-5f4e71f281864ee8/axial_034.png","assets/T/mri-5f4e71f281864ee8/axial_035.png","assets/T/mri-5f4e71f281864ee8/axial_036.png","assets/T/mri-5f4e71f281864ee8/axial_037.png","assets/T/mri-5f4e71f281864ee8/axial_039.png","assets/T/mri-5f4e71f281864ee8/axial_040.png","assets/T/mri-5f4e71f281864ee8/coronal_001.png","assets/T/mri-5f4e71f281864ee8/coronal_002.png","assets/T/mri-5f4e71f281864ee8/coronal_004.png","assets/T/mri-5f4e71f281864ee8/coronal_005.png","assets/T/mri-5f4e71f281864ee8/coronal_006.png","assets/T/mri-5f4e71f281864ee8/coronal_007.png","assets/T/mri-5f4e71f281864ee8/coronal_009.png","assets/T/mri-5f4e71f281864ee8/coronal_010.png","assets/T/mri-5f4e71f281864ee8/coronal_011.png","assets/T/mri-5f4e71f281864ee8/coronal_013.png","assets/T/mri-5f4e71f281864ee8/coronal_014.png","assets/T/mri-5f4e71f281864ee8/coronal_015.png","assets/T/mri-5f4e71f281864ee8/coronal_016.png","assets/T/mri-5f4e71f281864ee8/coronal_018.png","assets/T/mri-5f4e71f281864ee8/coronal_019.png","assets/T/mri-5f4e71f281864ee8/coronal_020.png","assets/T/mri-5f4e71f281864ee8/coronal_021.png","assets/T/mri-5f4e71f281864ee8/coronal_023.png","assets/T/mri-5f4e71f281864ee8/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":64,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,11,13,14,15,17,18,19,21,22,23,24,26,27,28,30,31,32,34,35,36,37,39,40,41,42,44,45,46,47,49,50,51,53,54,55,56,58,59,60,61,63,64]}}
+{"id":"mri-d6bbc416db544bc3","request_id":"L3-T300:mri-d6bbc416db544bc3","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-d6bbc416db544bc3/axial_001.png","assets/T/mri-d6bbc416db544bc3/axial_002.png","assets/T/mri-d6bbc416db544bc3/axial_004.png","assets/T/mri-d6bbc416db544bc3/axial_005.png","assets/T/mri-d6bbc416db544bc3/axial_007.png","assets/T/mri-d6bbc416db544bc3/axial_008.png","assets/T/mri-d6bbc416db544bc3/axial_009.png","assets/T/mri-d6bbc416db544bc3/axial_011.png","assets/T/mri-d6bbc416db544bc3/axial_012.png","assets/T/mri-d6bbc416db544bc3/axial_013.png","assets/T/mri-d6bbc416db544bc3/axial_015.png","assets/T/mri-d6bbc416db544bc3/axial_016.png","assets/T/mri-d6bbc416db544bc3/axial_018.png","assets/T/mri-d6bbc416db544bc3/axial_019.png","assets/T/mri-d6bbc416db544bc3/axial_020.png","assets/T/mri-d6bbc416db544bc3/axial_022.png","assets/T/mri-d6bbc416db544bc3/axial_023.png","assets/T/mri-d6bbc416db544bc3/axial_025.png","assets/T/mri-d6bbc416db544bc3/axial_026.png","assets/T/mri-d6bbc416db544bc3/axial_027.png","assets/T/mri-d6bbc416db544bc3/axial_029.png","assets/T/mri-d6bbc416db544bc3/axial_030.png","assets/T/mri-d6bbc416db544bc3/axial_032.png","assets/T/mri-d6bbc416db544bc3/axial_033.png","assets/T/mri-d6bbc416db544bc3/axial_034.png","assets/T/mri-d6bbc416db544bc3/axial_036.png","assets/T/mri-d6bbc416db544bc3/axial_037.png","assets/T/mri-d6bbc416db544bc3/axial_038.png","assets/T/mri-d6bbc416db544bc3/axial_040.png","assets/T/mri-d6bbc416db544bc3/axial_041.png","assets/T/mri-d6bbc416db544bc3/axial_043.png","assets/T/mri-d6bbc416db544bc3/axial_044.png","assets/T/mri-d6bbc416db544bc3/coronal_001.png","assets/T/mri-d6bbc416db544bc3/coronal_002.png","assets/T/mri-d6bbc416db544bc3/coronal_004.png","assets/T/mri-d6bbc416db544bc3/coronal_005.png","assets/T/mri-d6bbc416db544bc3/coronal_006.png","assets/T/mri-d6bbc416db544bc3/coronal_008.png","assets/T/mri-d6bbc416db544bc3/coronal_009.png","assets/T/mri-d6bbc416db544bc3/coronal_010.png","assets/T/mri-d6bbc416db544bc3/coronal_012.png","assets/T/mri-d6bbc416db544bc3/coronal_013.png","assets/T/mri-d6bbc416db544bc3/coronal_015.png","assets/T/mri-d6bbc416db544bc3/coronal_016.png","assets/T/mri-d6bbc416db544bc3/coronal_017.png","assets/T/mri-d6bbc416db544bc3/coronal_019.png","assets/T/mri-d6bbc416db544bc3/coronal_020.png","assets/T/mri-d6bbc416db544bc3/coronal_021.png","assets/T/mri-d6bbc416db544bc3/coronal_023.png","assets/T/mri-d6bbc416db544bc3/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":68,"selected_count":50,"source_indices_1based":[1,2,4,5,7,8,9,11,12,13,15,16,18,19,20,22,23,25,26,27,29,30,32,33,34,36,37,38,40,41,43,44,45,46,48,49,50,52,53,54,56,57,59,60,61,63,64,65,67,68]}}
+{"id":"mri-2d9c445715964c25","request_id":"L3-T300:mri-2d9c445715964c25","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 30 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 20 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-2d9c445715964c25/axial_001.png","assets/T/mri-2d9c445715964c25/axial_002.png","assets/T/mri-2d9c445715964c25/axial_004.png","assets/T/mri-2d9c445715964c25/axial_005.png","assets/T/mri-2d9c445715964c25/axial_007.png","assets/T/mri-2d9c445715964c25/axial_008.png","assets/T/mri-2d9c445715964c25/axial_009.png","assets/T/mri-2d9c445715964c25/axial_011.png","assets/T/mri-2d9c445715964c25/axial_012.png","assets/T/mri-2d9c445715964c25/axial_014.png","assets/T/mri-2d9c445715964c25/axial_015.png","assets/T/mri-2d9c445715964c25/axial_017.png","assets/T/mri-2d9c445715964c25/axial_018.png","assets/T/mri-2d9c445715964c25/axial_019.png","assets/T/mri-2d9c445715964c25/axial_021.png","assets/T/mri-2d9c445715964c25/axial_022.png","assets/T/mri-2d9c445715964c25/axial_024.png","assets/T/mri-2d9c445715964c25/axial_025.png","assets/T/mri-2d9c445715964c25/axial_026.png","assets/T/mri-2d9c445715964c25/axial_028.png","assets/T/mri-2d9c445715964c25/axial_029.png","assets/T/mri-2d9c445715964c25/axial_031.png","assets/T/mri-2d9c445715964c25/axial_032.png","assets/T/mri-2d9c445715964c25/axial_034.png","assets/T/mri-2d9c445715964c25/axial_035.png","assets/T/mri-2d9c445715964c25/axial_036.png","assets/T/mri-2d9c445715964c25/axial_038.png","assets/T/mri-2d9c445715964c25/axial_039.png","assets/T/mri-2d9c445715964c25/axial_041.png","assets/T/mri-2d9c445715964c25/axial_042.png","assets/T/mri-2d9c445715964c25/coronal_001.png","assets/T/mri-2d9c445715964c25/coronal_002.png","assets/T/mri-2d9c445715964c25/coronal_004.png","assets/T/mri-2d9c445715964c25/coronal_005.png","assets/T/mri-2d9c445715964c25/coronal_007.png","assets/T/mri-2d9c445715964c25/coronal_008.png","assets/T/mri-2d9c445715964c25/coronal_010.png","assets/T/mri-2d9c445715964c25/coronal_011.png","assets/T/mri-2d9c445715964c25/coronal_012.png","assets/T/mri-2d9c445715964c25/coronal_014.png","assets/T/mri-2d9c445715964c25/coronal_015.png","assets/T/mri-2d9c445715964c25/coronal_017.png","assets/T/mri-2d9c445715964c25/coronal_018.png","assets/T/mri-2d9c445715964c25/coronal_019.png","assets/T/mri-2d9c445715964c25/coronal_021.png","assets/T/mri-2d9c445715964c25/coronal_022.png","assets/T/mri-2d9c445715964c25/coronal_024.png","assets/T/mri-2d9c445715964c25/coronal_025.png","assets/T/mri-2d9c445715964c25/coronal_027.png","assets/T/mri-2d9c445715964c25/coronal_028.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":70,"selected_count":50,"source_indices_1based":[1,2,4,5,7,8,9,11,12,14,15,17,18,19,21,22,24,25,26,28,29,31,32,34,35,36,38,39,41,42,43,44,46,47,49,50,52,53,54,56,57,59,60,61,63,64,66,67,69,70]}}
+{"id":"mri-aa61cf9331744ddd","request_id":"L3-T300:mri-aa61cf9331744ddd","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-aa61cf9331744ddd/axial_001.png","assets/T/mri-aa61cf9331744ddd/axial_002.png","assets/T/mri-aa61cf9331744ddd/axial_003.png","assets/T/mri-aa61cf9331744ddd/axial_005.png","assets/T/mri-aa61cf9331744ddd/axial_006.png","assets/T/mri-aa61cf9331744ddd/axial_007.png","assets/T/mri-aa61cf9331744ddd/axial_008.png","assets/T/mri-aa61cf9331744ddd/axial_010.png","assets/T/mri-aa61cf9331744ddd/axial_011.png","assets/T/mri-aa61cf9331744ddd/axial_012.png","assets/T/mri-aa61cf9331744ddd/axial_013.png","assets/T/mri-aa61cf9331744ddd/axial_015.png","assets/T/mri-aa61cf9331744ddd/axial_016.png","assets/T/mri-aa61cf9331744ddd/axial_017.png","assets/T/mri-aa61cf9331744ddd/axial_018.png","assets/T/mri-aa61cf9331744ddd/axial_020.png","assets/T/mri-aa61cf9331744ddd/axial_021.png","assets/T/mri-aa61cf9331744ddd/axial_022.png","assets/T/mri-aa61cf9331744ddd/axial_023.png","assets/T/mri-aa61cf9331744ddd/axial_024.png","assets/T/mri-aa61cf9331744ddd/axial_026.png","assets/T/mri-aa61cf9331744ddd/axial_027.png","assets/T/mri-aa61cf9331744ddd/axial_028.png","assets/T/mri-aa61cf9331744ddd/axial_029.png","assets/T/mri-aa61cf9331744ddd/axial_031.png","assets/T/mri-aa61cf9331744ddd/axial_032.png","assets/T/mri-aa61cf9331744ddd/axial_033.png","assets/T/mri-aa61cf9331744ddd/axial_034.png","assets/T/mri-aa61cf9331744ddd/axial_036.png","assets/T/mri-aa61cf9331744ddd/axial_037.png","assets/T/mri-aa61cf9331744ddd/axial_038.png","assets/T/mri-aa61cf9331744ddd/coronal_001.png","assets/T/mri-aa61cf9331744ddd/coronal_002.png","assets/T/mri-aa61cf9331744ddd/coronal_004.png","assets/T/mri-aa61cf9331744ddd/coronal_005.png","assets/T/mri-aa61cf9331744ddd/coronal_006.png","assets/T/mri-aa61cf9331744ddd/coronal_007.png","assets/T/mri-aa61cf9331744ddd/coronal_009.png","assets/T/mri-aa61cf9331744ddd/coronal_010.png","assets/T/mri-aa61cf9331744ddd/coronal_011.png","assets/T/mri-aa61cf9331744ddd/coronal_013.png","assets/T/mri-aa61cf9331744ddd/coronal_014.png","assets/T/mri-aa61cf9331744ddd/coronal_015.png","assets/T/mri-aa61cf9331744ddd/coronal_016.png","assets/T/mri-aa61cf9331744ddd/coronal_018.png","assets/T/mri-aa61cf9331744ddd/coronal_019.png","assets/T/mri-aa61cf9331744ddd/coronal_020.png","assets/T/mri-aa61cf9331744ddd/coronal_021.png","assets/T/mri-aa61cf9331744ddd/coronal_023.png","assets/T/mri-aa61cf9331744ddd/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":62,"selected_count":50,"source_indices_1based":[1,2,3,5,6,7,8,10,11,12,13,15,16,17,18,20,21,22,23,24,26,27,28,29,31,32,33,34,36,37,38,39,40,42,43,44,45,47,48,49,51,52,53,54,56,57,58,59,61,62]}}
+{"id":"mri-85bf21a1e54d4f86","request_id":"L3-T300:mri-85bf21a1e54d4f86","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-85bf21a1e54d4f86/axial_001.png","assets/T/mri-85bf21a1e54d4f86/axial_002.png","assets/T/mri-85bf21a1e54d4f86/axial_003.png","assets/T/mri-85bf21a1e54d4f86/axial_005.png","assets/T/mri-85bf21a1e54d4f86/axial_006.png","assets/T/mri-85bf21a1e54d4f86/axial_007.png","assets/T/mri-85bf21a1e54d4f86/axial_008.png","assets/T/mri-85bf21a1e54d4f86/axial_010.png","assets/T/mri-85bf21a1e54d4f86/axial_011.png","assets/T/mri-85bf21a1e54d4f86/axial_012.png","assets/T/mri-85bf21a1e54d4f86/axial_013.png","assets/T/mri-85bf21a1e54d4f86/axial_015.png","assets/T/mri-85bf21a1e54d4f86/axial_016.png","assets/T/mri-85bf21a1e54d4f86/axial_017.png","assets/T/mri-85bf21a1e54d4f86/axial_018.png","assets/T/mri-85bf21a1e54d4f86/axial_020.png","assets/T/mri-85bf21a1e54d4f86/axial_021.png","assets/T/mri-85bf21a1e54d4f86/axial_022.png","assets/T/mri-85bf21a1e54d4f86/axial_023.png","assets/T/mri-85bf21a1e54d4f86/axial_024.png","assets/T/mri-85bf21a1e54d4f86/axial_026.png","assets/T/mri-85bf21a1e54d4f86/axial_027.png","assets/T/mri-85bf21a1e54d4f86/axial_028.png","assets/T/mri-85bf21a1e54d4f86/axial_029.png","assets/T/mri-85bf21a1e54d4f86/axial_031.png","assets/T/mri-85bf21a1e54d4f86/axial_032.png","assets/T/mri-85bf21a1e54d4f86/axial_033.png","assets/T/mri-85bf21a1e54d4f86/axial_034.png","assets/T/mri-85bf21a1e54d4f86/axial_036.png","assets/T/mri-85bf21a1e54d4f86/axial_037.png","assets/T/mri-85bf21a1e54d4f86/axial_038.png","assets/T/mri-85bf21a1e54d4f86/coronal_001.png","assets/T/mri-85bf21a1e54d4f86/coronal_002.png","assets/T/mri-85bf21a1e54d4f86/coronal_004.png","assets/T/mri-85bf21a1e54d4f86/coronal_005.png","assets/T/mri-85bf21a1e54d4f86/coronal_006.png","assets/T/mri-85bf21a1e54d4f86/coronal_007.png","assets/T/mri-85bf21a1e54d4f86/coronal_009.png","assets/T/mri-85bf21a1e54d4f86/coronal_010.png","assets/T/mri-85bf21a1e54d4f86/coronal_011.png","assets/T/mri-85bf21a1e54d4f86/coronal_013.png","assets/T/mri-85bf21a1e54d4f86/coronal_014.png","assets/T/mri-85bf21a1e54d4f86/coronal_015.png","assets/T/mri-85bf21a1e54d4f86/coronal_016.png","assets/T/mri-85bf21a1e54d4f86/coronal_018.png","assets/T/mri-85bf21a1e54d4f86/coronal_019.png","assets/T/mri-85bf21a1e54d4f86/coronal_020.png","assets/T/mri-85bf21a1e54d4f86/coronal_021.png","assets/T/mri-85bf21a1e54d4f86/coronal_023.png","assets/T/mri-85bf21a1e54d4f86/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":62,"selected_count":50,"source_indices_1based":[1,2,3,5,6,7,8,10,11,12,13,15,16,17,18,20,21,22,23,24,26,27,28,29,31,32,33,34,36,37,38,39,40,42,43,44,45,47,48,49,51,52,53,54,56,57,58,59,61,62]}}
+{"id":"mri-cd1d5e72481942cd","request_id":"L3-T300:mri-cd1d5e72481942cd","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-cd1d5e72481942cd/axial_001.png","assets/T/mri-cd1d5e72481942cd/axial_002.png","assets/T/mri-cd1d5e72481942cd/axial_004.png","assets/T/mri-cd1d5e72481942cd/axial_005.png","assets/T/mri-cd1d5e72481942cd/axial_006.png","assets/T/mri-cd1d5e72481942cd/axial_008.png","assets/T/mri-cd1d5e72481942cd/axial_009.png","assets/T/mri-cd1d5e72481942cd/axial_010.png","assets/T/mri-cd1d5e72481942cd/axial_012.png","assets/T/mri-cd1d5e72481942cd/axial_013.png","assets/T/mri-cd1d5e72481942cd/axial_014.png","assets/T/mri-cd1d5e72481942cd/axial_016.png","assets/T/mri-cd1d5e72481942cd/axial_017.png","assets/T/mri-cd1d5e72481942cd/axial_018.png","assets/T/mri-cd1d5e72481942cd/axial_020.png","assets/T/mri-cd1d5e72481942cd/axial_021.png","assets/T/mri-cd1d5e72481942cd/axial_022.png","assets/T/mri-cd1d5e72481942cd/axial_023.png","assets/T/mri-cd1d5e72481942cd/axial_025.png","assets/T/mri-cd1d5e72481942cd/axial_026.png","assets/T/mri-cd1d5e72481942cd/axial_027.png","assets/T/mri-cd1d5e72481942cd/axial_029.png","assets/T/mri-cd1d5e72481942cd/axial_030.png","assets/T/mri-cd1d5e72481942cd/axial_031.png","assets/T/mri-cd1d5e72481942cd/axial_033.png","assets/T/mri-cd1d5e72481942cd/axial_034.png","assets/T/mri-cd1d5e72481942cd/axial_035.png","assets/T/mri-cd1d5e72481942cd/axial_037.png","assets/T/mri-cd1d5e72481942cd/axial_038.png","assets/T/mri-cd1d5e72481942cd/axial_039.png","assets/T/mri-cd1d5e72481942cd/axial_041.png","assets/T/mri-cd1d5e72481942cd/axial_042.png","assets/T/mri-cd1d5e72481942cd/coronal_001.png","assets/T/mri-cd1d5e72481942cd/coronal_002.png","assets/T/mri-cd1d5e72481942cd/coronal_004.png","assets/T/mri-cd1d5e72481942cd/coronal_005.png","assets/T/mri-cd1d5e72481942cd/coronal_006.png","assets/T/mri-cd1d5e72481942cd/coronal_008.png","assets/T/mri-cd1d5e72481942cd/coronal_009.png","assets/T/mri-cd1d5e72481942cd/coronal_010.png","assets/T/mri-cd1d5e72481942cd/coronal_012.png","assets/T/mri-cd1d5e72481942cd/coronal_013.png","assets/T/mri-cd1d5e72481942cd/coronal_015.png","assets/T/mri-cd1d5e72481942cd/coronal_016.png","assets/T/mri-cd1d5e72481942cd/coronal_017.png","assets/T/mri-cd1d5e72481942cd/coronal_019.png","assets/T/mri-cd1d5e72481942cd/coronal_020.png","assets/T/mri-cd1d5e72481942cd/coronal_021.png","assets/T/mri-cd1d5e72481942cd/coronal_023.png","assets/T/mri-cd1d5e72481942cd/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":66,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,12,13,14,16,17,18,20,21,22,23,25,26,27,29,30,31,33,34,35,37,38,39,41,42,43,44,46,47,48,50,51,52,54,55,57,58,59,61,62,63,65,66]}}
+{"id":"mri-07a00ae75e7b4977","request_id":"L3-T300:mri-07a00ae75e7b4977","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-07a00ae75e7b4977/axial_001.png","assets/T/mri-07a00ae75e7b4977/axial_002.png","assets/T/mri-07a00ae75e7b4977/axial_004.png","assets/T/mri-07a00ae75e7b4977/axial_005.png","assets/T/mri-07a00ae75e7b4977/axial_007.png","assets/T/mri-07a00ae75e7b4977/axial_008.png","assets/T/mri-07a00ae75e7b4977/axial_009.png","assets/T/mri-07a00ae75e7b4977/axial_011.png","assets/T/mri-07a00ae75e7b4977/axial_012.png","assets/T/mri-07a00ae75e7b4977/axial_013.png","assets/T/mri-07a00ae75e7b4977/axial_015.png","assets/T/mri-07a00ae75e7b4977/axial_016.png","assets/T/mri-07a00ae75e7b4977/axial_018.png","assets/T/mri-07a00ae75e7b4977/axial_019.png","assets/T/mri-07a00ae75e7b4977/axial_020.png","assets/T/mri-07a00ae75e7b4977/axial_022.png","assets/T/mri-07a00ae75e7b4977/axial_023.png","assets/T/mri-07a00ae75e7b4977/axial_025.png","assets/T/mri-07a00ae75e7b4977/axial_026.png","assets/T/mri-07a00ae75e7b4977/axial_027.png","assets/T/mri-07a00ae75e7b4977/axial_029.png","assets/T/mri-07a00ae75e7b4977/axial_030.png","assets/T/mri-07a00ae75e7b4977/axial_032.png","assets/T/mri-07a00ae75e7b4977/axial_033.png","assets/T/mri-07a00ae75e7b4977/axial_034.png","assets/T/mri-07a00ae75e7b4977/axial_036.png","assets/T/mri-07a00ae75e7b4977/axial_037.png","assets/T/mri-07a00ae75e7b4977/axial_038.png","assets/T/mri-07a00ae75e7b4977/axial_040.png","assets/T/mri-07a00ae75e7b4977/axial_041.png","assets/T/mri-07a00ae75e7b4977/axial_043.png","assets/T/mri-07a00ae75e7b4977/axial_044.png","assets/T/mri-07a00ae75e7b4977/coronal_001.png","assets/T/mri-07a00ae75e7b4977/coronal_002.png","assets/T/mri-07a00ae75e7b4977/coronal_004.png","assets/T/mri-07a00ae75e7b4977/coronal_005.png","assets/T/mri-07a00ae75e7b4977/coronal_006.png","assets/T/mri-07a00ae75e7b4977/coronal_008.png","assets/T/mri-07a00ae75e7b4977/coronal_009.png","assets/T/mri-07a00ae75e7b4977/coronal_010.png","assets/T/mri-07a00ae75e7b4977/coronal_012.png","assets/T/mri-07a00ae75e7b4977/coronal_013.png","assets/T/mri-07a00ae75e7b4977/coronal_015.png","assets/T/mri-07a00ae75e7b4977/coronal_016.png","assets/T/mri-07a00ae75e7b4977/coronal_017.png","assets/T/mri-07a00ae75e7b4977/coronal_019.png","assets/T/mri-07a00ae75e7b4977/coronal_020.png","assets/T/mri-07a00ae75e7b4977/coronal_021.png","assets/T/mri-07a00ae75e7b4977/coronal_023.png","assets/T/mri-07a00ae75e7b4977/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":68,"selected_count":50,"source_indices_1based":[1,2,4,5,7,8,9,11,12,13,15,16,18,19,20,22,23,25,26,27,29,30,32,33,34,36,37,38,40,41,43,44,45,46,48,49,50,52,53,54,56,57,59,60,61,63,64,65,67,68]}}
+{"id":"mri-3640dbda84064e7c","request_id":"L3-T300:mri-3640dbda84064e7c","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-3640dbda84064e7c/axial_001.png","assets/T/mri-3640dbda84064e7c/axial_002.png","assets/T/mri-3640dbda84064e7c/axial_004.png","assets/T/mri-3640dbda84064e7c/axial_005.png","assets/T/mri-3640dbda84064e7c/axial_006.png","assets/T/mri-3640dbda84064e7c/axial_008.png","assets/T/mri-3640dbda84064e7c/axial_009.png","assets/T/mri-3640dbda84064e7c/axial_010.png","assets/T/mri-3640dbda84064e7c/axial_012.png","assets/T/mri-3640dbda84064e7c/axial_013.png","assets/T/mri-3640dbda84064e7c/axial_014.png","assets/T/mri-3640dbda84064e7c/axial_016.png","assets/T/mri-3640dbda84064e7c/axial_017.png","assets/T/mri-3640dbda84064e7c/axial_018.png","assets/T/mri-3640dbda84064e7c/axial_020.png","assets/T/mri-3640dbda84064e7c/axial_021.png","assets/T/mri-3640dbda84064e7c/axial_022.png","assets/T/mri-3640dbda84064e7c/axial_023.png","assets/T/mri-3640dbda84064e7c/axial_025.png","assets/T/mri-3640dbda84064e7c/axial_026.png","assets/T/mri-3640dbda84064e7c/axial_027.png","assets/T/mri-3640dbda84064e7c/axial_029.png","assets/T/mri-3640dbda84064e7c/axial_030.png","assets/T/mri-3640dbda84064e7c/axial_031.png","assets/T/mri-3640dbda84064e7c/axial_033.png","assets/T/mri-3640dbda84064e7c/axial_034.png","assets/T/mri-3640dbda84064e7c/axial_035.png","assets/T/mri-3640dbda84064e7c/axial_037.png","assets/T/mri-3640dbda84064e7c/axial_038.png","assets/T/mri-3640dbda84064e7c/axial_039.png","assets/T/mri-3640dbda84064e7c/axial_041.png","assets/T/mri-3640dbda84064e7c/axial_042.png","assets/T/mri-3640dbda84064e7c/coronal_001.png","assets/T/mri-3640dbda84064e7c/coronal_002.png","assets/T/mri-3640dbda84064e7c/coronal_004.png","assets/T/mri-3640dbda84064e7c/coronal_005.png","assets/T/mri-3640dbda84064e7c/coronal_006.png","assets/T/mri-3640dbda84064e7c/coronal_008.png","assets/T/mri-3640dbda84064e7c/coronal_009.png","assets/T/mri-3640dbda84064e7c/coronal_010.png","assets/T/mri-3640dbda84064e7c/coronal_012.png","assets/T/mri-3640dbda84064e7c/coronal_013.png","assets/T/mri-3640dbda84064e7c/coronal_015.png","assets/T/mri-3640dbda84064e7c/coronal_016.png","assets/T/mri-3640dbda84064e7c/coronal_017.png","assets/T/mri-3640dbda84064e7c/coronal_019.png","assets/T/mri-3640dbda84064e7c/coronal_020.png","assets/T/mri-3640dbda84064e7c/coronal_021.png","assets/T/mri-3640dbda84064e7c/coronal_023.png","assets/T/mri-3640dbda84064e7c/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":66,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,12,13,14,16,17,18,20,21,22,23,25,26,27,29,30,31,33,34,35,37,38,39,41,42,43,44,46,47,48,50,51,52,54,55,57,58,59,61,62,63,65,66]}}
+{"id":"mri-3fb297150b194344","request_id":"L3-T300:mri-3fb297150b194344","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-3fb297150b194344/axial_001.png","assets/T/mri-3fb297150b194344/axial_002.png","assets/T/mri-3fb297150b194344/axial_004.png","assets/T/mri-3fb297150b194344/axial_005.png","assets/T/mri-3fb297150b194344/axial_006.png","assets/T/mri-3fb297150b194344/axial_008.png","assets/T/mri-3fb297150b194344/axial_009.png","assets/T/mri-3fb297150b194344/axial_010.png","assets/T/mri-3fb297150b194344/axial_012.png","assets/T/mri-3fb297150b194344/axial_013.png","assets/T/mri-3fb297150b194344/axial_015.png","assets/T/mri-3fb297150b194344/axial_016.png","assets/T/mri-3fb297150b194344/axial_017.png","assets/T/mri-3fb297150b194344/axial_019.png","assets/T/mri-3fb297150b194344/axial_020.png","assets/T/mri-3fb297150b194344/axial_021.png","assets/T/mri-3fb297150b194344/axial_023.png","assets/T/mri-3fb297150b194344/axial_024.png","assets/T/mri-3fb297150b194344/axial_025.png","assets/T/mri-3fb297150b194344/axial_027.png","assets/T/mri-3fb297150b194344/axial_028.png","assets/T/mri-3fb297150b194344/axial_029.png","assets/T/mri-3fb297150b194344/axial_031.png","assets/T/mri-3fb297150b194344/axial_032.png","assets/T/mri-3fb297150b194344/axial_034.png","assets/T/mri-3fb297150b194344/axial_035.png","assets/T/mri-3fb297150b194344/axial_036.png","assets/T/mri-3fb297150b194344/axial_038.png","assets/T/mri-3fb297150b194344/axial_039.png","assets/T/mri-3fb297150b194344/axial_040.png","assets/T/mri-3fb297150b194344/axial_042.png","assets/T/mri-3fb297150b194344/axial_043.png","assets/T/mri-3fb297150b194344/coronal_001.png","assets/T/mri-3fb297150b194344/coronal_002.png","assets/T/mri-3fb297150b194344/coronal_004.png","assets/T/mri-3fb297150b194344/coronal_005.png","assets/T/mri-3fb297150b194344/coronal_006.png","assets/T/mri-3fb297150b194344/coronal_008.png","assets/T/mri-3fb297150b194344/coronal_009.png","assets/T/mri-3fb297150b194344/coronal_010.png","assets/T/mri-3fb297150b194344/coronal_012.png","assets/T/mri-3fb297150b194344/coronal_013.png","assets/T/mri-3fb297150b194344/coronal_015.png","assets/T/mri-3fb297150b194344/coronal_016.png","assets/T/mri-3fb297150b194344/coronal_017.png","assets/T/mri-3fb297150b194344/coronal_019.png","assets/T/mri-3fb297150b194344/coronal_020.png","assets/T/mri-3fb297150b194344/coronal_021.png","assets/T/mri-3fb297150b194344/coronal_023.png","assets/T/mri-3fb297150b194344/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":67,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,12,13,15,16,17,19,20,21,23,24,25,27,28,29,31,32,34,35,36,38,39,40,42,43,44,45,47,48,49,51,52,53,55,56,58,59,60,62,63,64,66,67]}}
+{"id":"mri-e5bad77de70140d2","request_id":"L3-T300:mri-e5bad77de70140d2","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-e5bad77de70140d2/axial_001.png","assets/T/mri-e5bad77de70140d2/axial_002.png","assets/T/mri-e5bad77de70140d2/axial_004.png","assets/T/mri-e5bad77de70140d2/axial_005.png","assets/T/mri-e5bad77de70140d2/axial_006.png","assets/T/mri-e5bad77de70140d2/axial_008.png","assets/T/mri-e5bad77de70140d2/axial_009.png","assets/T/mri-e5bad77de70140d2/axial_010.png","assets/T/mri-e5bad77de70140d2/axial_011.png","assets/T/mri-e5bad77de70140d2/axial_013.png","assets/T/mri-e5bad77de70140d2/axial_014.png","assets/T/mri-e5bad77de70140d2/axial_015.png","assets/T/mri-e5bad77de70140d2/axial_017.png","assets/T/mri-e5bad77de70140d2/axial_018.png","assets/T/mri-e5bad77de70140d2/axial_019.png","assets/T/mri-e5bad77de70140d2/axial_021.png","assets/T/mri-e5bad77de70140d2/axial_022.png","assets/T/mri-e5bad77de70140d2/axial_023.png","assets/T/mri-e5bad77de70140d2/axial_024.png","assets/T/mri-e5bad77de70140d2/axial_026.png","assets/T/mri-e5bad77de70140d2/axial_027.png","assets/T/mri-e5bad77de70140d2/axial_028.png","assets/T/mri-e5bad77de70140d2/axial_030.png","assets/T/mri-e5bad77de70140d2/axial_031.png","assets/T/mri-e5bad77de70140d2/axial_032.png","assets/T/mri-e5bad77de70140d2/axial_034.png","assets/T/mri-e5bad77de70140d2/axial_035.png","assets/T/mri-e5bad77de70140d2/axial_036.png","assets/T/mri-e5bad77de70140d2/axial_037.png","assets/T/mri-e5bad77de70140d2/axial_039.png","assets/T/mri-e5bad77de70140d2/axial_040.png","assets/T/mri-e5bad77de70140d2/coronal_001.png","assets/T/mri-e5bad77de70140d2/coronal_002.png","assets/T/mri-e5bad77de70140d2/coronal_004.png","assets/T/mri-e5bad77de70140d2/coronal_005.png","assets/T/mri-e5bad77de70140d2/coronal_006.png","assets/T/mri-e5bad77de70140d2/coronal_007.png","assets/T/mri-e5bad77de70140d2/coronal_009.png","assets/T/mri-e5bad77de70140d2/coronal_010.png","assets/T/mri-e5bad77de70140d2/coronal_011.png","assets/T/mri-e5bad77de70140d2/coronal_013.png","assets/T/mri-e5bad77de70140d2/coronal_014.png","assets/T/mri-e5bad77de70140d2/coronal_015.png","assets/T/mri-e5bad77de70140d2/coronal_016.png","assets/T/mri-e5bad77de70140d2/coronal_018.png","assets/T/mri-e5bad77de70140d2/coronal_019.png","assets/T/mri-e5bad77de70140d2/coronal_020.png","assets/T/mri-e5bad77de70140d2/coronal_021.png","assets/T/mri-e5bad77de70140d2/coronal_023.png","assets/T/mri-e5bad77de70140d2/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":64,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,11,13,14,15,17,18,19,21,22,23,24,26,27,28,30,31,32,34,35,36,37,39,40,41,42,44,45,46,47,49,50,51,53,54,55,56,58,59,60,61,63,64]}}
+{"id":"mri-8a2e314a61574ad4","request_id":"L3-T300:mri-8a2e314a61574ad4","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-8a2e314a61574ad4/axial_001.png","assets/T/mri-8a2e314a61574ad4/axial_002.png","assets/T/mri-8a2e314a61574ad4/axial_004.png","assets/T/mri-8a2e314a61574ad4/axial_005.png","assets/T/mri-8a2e314a61574ad4/axial_006.png","assets/T/mri-8a2e314a61574ad4/axial_008.png","assets/T/mri-8a2e314a61574ad4/axial_009.png","assets/T/mri-8a2e314a61574ad4/axial_010.png","assets/T/mri-8a2e314a61574ad4/axial_011.png","assets/T/mri-8a2e314a61574ad4/axial_013.png","assets/T/mri-8a2e314a61574ad4/axial_014.png","assets/T/mri-8a2e314a61574ad4/axial_015.png","assets/T/mri-8a2e314a61574ad4/axial_017.png","assets/T/mri-8a2e314a61574ad4/axial_018.png","assets/T/mri-8a2e314a61574ad4/axial_019.png","assets/T/mri-8a2e314a61574ad4/axial_021.png","assets/T/mri-8a2e314a61574ad4/axial_022.png","assets/T/mri-8a2e314a61574ad4/axial_023.png","assets/T/mri-8a2e314a61574ad4/axial_024.png","assets/T/mri-8a2e314a61574ad4/axial_026.png","assets/T/mri-8a2e314a61574ad4/axial_027.png","assets/T/mri-8a2e314a61574ad4/axial_028.png","assets/T/mri-8a2e314a61574ad4/axial_030.png","assets/T/mri-8a2e314a61574ad4/axial_031.png","assets/T/mri-8a2e314a61574ad4/axial_032.png","assets/T/mri-8a2e314a61574ad4/axial_034.png","assets/T/mri-8a2e314a61574ad4/axial_035.png","assets/T/mri-8a2e314a61574ad4/axial_036.png","assets/T/mri-8a2e314a61574ad4/axial_037.png","assets/T/mri-8a2e314a61574ad4/axial_039.png","assets/T/mri-8a2e314a61574ad4/axial_040.png","assets/T/mri-8a2e314a61574ad4/coronal_001.png","assets/T/mri-8a2e314a61574ad4/coronal_002.png","assets/T/mri-8a2e314a61574ad4/coronal_004.png","assets/T/mri-8a2e314a61574ad4/coronal_005.png","assets/T/mri-8a2e314a61574ad4/coronal_006.png","assets/T/mri-8a2e314a61574ad4/coronal_007.png","assets/T/mri-8a2e314a61574ad4/coronal_009.png","assets/T/mri-8a2e314a61574ad4/coronal_010.png","assets/T/mri-8a2e314a61574ad4/coronal_011.png","assets/T/mri-8a2e314a61574ad4/coronal_013.png","assets/T/mri-8a2e314a61574ad4/coronal_014.png","assets/T/mri-8a2e314a61574ad4/coronal_015.png","assets/T/mri-8a2e314a61574ad4/coronal_016.png","assets/T/mri-8a2e314a61574ad4/coronal_018.png","assets/T/mri-8a2e314a61574ad4/coronal_019.png","assets/T/mri-8a2e314a61574ad4/coronal_020.png","assets/T/mri-8a2e314a61574ad4/coronal_021.png","assets/T/mri-8a2e314a61574ad4/coronal_023.png","assets/T/mri-8a2e314a61574ad4/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":64,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,11,13,14,15,17,18,19,21,22,23,24,26,27,28,30,31,32,34,35,36,37,39,40,41,42,44,45,46,47,49,50,51,53,54,55,56,58,59,60,61,63,64]}}
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+{"id":"mri-a593896fc6c34499","request_id":"L3-T300:mri-a593896fc6c34499","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-a593896fc6c34499/axial_001.png","assets/T/mri-a593896fc6c34499/axial_002.png","assets/T/mri-a593896fc6c34499/axial_004.png","assets/T/mri-a593896fc6c34499/axial_005.png","assets/T/mri-a593896fc6c34499/axial_007.png","assets/T/mri-a593896fc6c34499/axial_008.png","assets/T/mri-a593896fc6c34499/axial_009.png","assets/T/mri-a593896fc6c34499/axial_011.png","assets/T/mri-a593896fc6c34499/axial_012.png","assets/T/mri-a593896fc6c34499/axial_013.png","assets/T/mri-a593896fc6c34499/axial_015.png","assets/T/mri-a593896fc6c34499/axial_016.png","assets/T/mri-a593896fc6c34499/axial_018.png","assets/T/mri-a593896fc6c34499/axial_019.png","assets/T/mri-a593896fc6c34499/axial_020.png","assets/T/mri-a593896fc6c34499/axial_022.png","assets/T/mri-a593896fc6c34499/axial_023.png","assets/T/mri-a593896fc6c34499/axial_025.png","assets/T/mri-a593896fc6c34499/axial_026.png","assets/T/mri-a593896fc6c34499/axial_027.png","assets/T/mri-a593896fc6c34499/axial_029.png","assets/T/mri-a593896fc6c34499/axial_030.png","assets/T/mri-a593896fc6c34499/axial_032.png","assets/T/mri-a593896fc6c34499/axial_033.png","assets/T/mri-a593896fc6c34499/axial_034.png","assets/T/mri-a593896fc6c34499/axial_036.png","assets/T/mri-a593896fc6c34499/axial_037.png","assets/T/mri-a593896fc6c34499/axial_038.png","assets/T/mri-a593896fc6c34499/axial_040.png","assets/T/mri-a593896fc6c34499/axial_041.png","assets/T/mri-a593896fc6c34499/axial_043.png","assets/T/mri-a593896fc6c34499/axial_044.png","assets/T/mri-a593896fc6c34499/coronal_001.png","assets/T/mri-a593896fc6c34499/coronal_002.png","assets/T/mri-a593896fc6c34499/coronal_004.png","assets/T/mri-a593896fc6c34499/coronal_005.png","assets/T/mri-a593896fc6c34499/coronal_006.png","assets/T/mri-a593896fc6c34499/coronal_008.png","assets/T/mri-a593896fc6c34499/coronal_009.png","assets/T/mri-a593896fc6c34499/coronal_010.png","assets/T/mri-a593896fc6c34499/coronal_012.png","assets/T/mri-a593896fc6c34499/coronal_013.png","assets/T/mri-a593896fc6c34499/coronal_015.png","assets/T/mri-a593896fc6c34499/coronal_016.png","assets/T/mri-a593896fc6c34499/coronal_017.png","assets/T/mri-a593896fc6c34499/coronal_019.png","assets/T/mri-a593896fc6c34499/coronal_020.png","assets/T/mri-a593896fc6c34499/coronal_021.png","assets/T/mri-a593896fc6c34499/coronal_023.png","assets/T/mri-a593896fc6c34499/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":68,"selected_count":50,"source_indices_1based":[1,2,4,5,7,8,9,11,12,13,15,16,18,19,20,22,23,25,26,27,29,30,32,33,34,36,37,38,40,41,43,44,45,46,48,49,50,52,53,54,56,57,59,60,61,63,64,65,67,68]}}
+{"id":"mri-19b78e282ae648fc","request_id":"L3-T300:mri-19b78e282ae648fc","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-19b78e282ae648fc/axial_001.png","assets/T/mri-19b78e282ae648fc/axial_002.png","assets/T/mri-19b78e282ae648fc/axial_003.png","assets/T/mri-19b78e282ae648fc/axial_005.png","assets/T/mri-19b78e282ae648fc/axial_006.png","assets/T/mri-19b78e282ae648fc/axial_007.png","assets/T/mri-19b78e282ae648fc/axial_008.png","assets/T/mri-19b78e282ae648fc/axial_010.png","assets/T/mri-19b78e282ae648fc/axial_011.png","assets/T/mri-19b78e282ae648fc/axial_012.png","assets/T/mri-19b78e282ae648fc/axial_013.png","assets/T/mri-19b78e282ae648fc/axial_015.png","assets/T/mri-19b78e282ae648fc/axial_016.png","assets/T/mri-19b78e282ae648fc/axial_017.png","assets/T/mri-19b78e282ae648fc/axial_018.png","assets/T/mri-19b78e282ae648fc/axial_020.png","assets/T/mri-19b78e282ae648fc/axial_021.png","assets/T/mri-19b78e282ae648fc/axial_022.png","assets/T/mri-19b78e282ae648fc/axial_023.png","assets/T/mri-19b78e282ae648fc/axial_024.png","assets/T/mri-19b78e282ae648fc/axial_026.png","assets/T/mri-19b78e282ae648fc/axial_027.png","assets/T/mri-19b78e282ae648fc/axial_028.png","assets/T/mri-19b78e282ae648fc/axial_029.png","assets/T/mri-19b78e282ae648fc/axial_031.png","assets/T/mri-19b78e282ae648fc/axial_032.png","assets/T/mri-19b78e282ae648fc/axial_033.png","assets/T/mri-19b78e282ae648fc/axial_034.png","assets/T/mri-19b78e282ae648fc/axial_036.png","assets/T/mri-19b78e282ae648fc/axial_037.png","assets/T/mri-19b78e282ae648fc/axial_038.png","assets/T/mri-19b78e282ae648fc/coronal_001.png","assets/T/mri-19b78e282ae648fc/coronal_002.png","assets/T/mri-19b78e282ae648fc/coronal_004.png","assets/T/mri-19b78e282ae648fc/coronal_005.png","assets/T/mri-19b78e282ae648fc/coronal_006.png","assets/T/mri-19b78e282ae648fc/coronal_007.png","assets/T/mri-19b78e282ae648fc/coronal_009.png","assets/T/mri-19b78e282ae648fc/coronal_010.png","assets/T/mri-19b78e282ae648fc/coronal_011.png","assets/T/mri-19b78e282ae648fc/coronal_013.png","assets/T/mri-19b78e282ae648fc/coronal_014.png","assets/T/mri-19b78e282ae648fc/coronal_015.png","assets/T/mri-19b78e282ae648fc/coronal_016.png","assets/T/mri-19b78e282ae648fc/coronal_018.png","assets/T/mri-19b78e282ae648fc/coronal_019.png","assets/T/mri-19b78e282ae648fc/coronal_020.png","assets/T/mri-19b78e282ae648fc/coronal_021.png","assets/T/mri-19b78e282ae648fc/coronal_023.png","assets/T/mri-19b78e282ae648fc/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":62,"selected_count":50,"source_indices_1based":[1,2,3,5,6,7,8,10,11,12,13,15,16,17,18,20,21,22,23,24,26,27,28,29,31,32,33,34,36,37,38,39,40,42,43,44,45,47,48,49,51,52,53,54,56,57,58,59,61,62]}}
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+{"id":"mri-52bc4d5404e34274","request_id":"L3-T300:mri-52bc4d5404e34274","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-52bc4d5404e34274/axial_001.png","assets/T/mri-52bc4d5404e34274/axial_002.png","assets/T/mri-52bc4d5404e34274/axial_004.png","assets/T/mri-52bc4d5404e34274/axial_005.png","assets/T/mri-52bc4d5404e34274/axial_006.png","assets/T/mri-52bc4d5404e34274/axial_008.png","assets/T/mri-52bc4d5404e34274/axial_009.png","assets/T/mri-52bc4d5404e34274/axial_010.png","assets/T/mri-52bc4d5404e34274/axial_012.png","assets/T/mri-52bc4d5404e34274/axial_013.png","assets/T/mri-52bc4d5404e34274/axial_014.png","assets/T/mri-52bc4d5404e34274/axial_016.png","assets/T/mri-52bc4d5404e34274/axial_017.png","assets/T/mri-52bc4d5404e34274/axial_018.png","assets/T/mri-52bc4d5404e34274/axial_020.png","assets/T/mri-52bc4d5404e34274/axial_021.png","assets/T/mri-52bc4d5404e34274/axial_022.png","assets/T/mri-52bc4d5404e34274/axial_023.png","assets/T/mri-52bc4d5404e34274/axial_025.png","assets/T/mri-52bc4d5404e34274/axial_026.png","assets/T/mri-52bc4d5404e34274/axial_027.png","assets/T/mri-52bc4d5404e34274/axial_029.png","assets/T/mri-52bc4d5404e34274/axial_030.png","assets/T/mri-52bc4d5404e34274/axial_031.png","assets/T/mri-52bc4d5404e34274/axial_033.png","assets/T/mri-52bc4d5404e34274/axial_034.png","assets/T/mri-52bc4d5404e34274/axial_035.png","assets/T/mri-52bc4d5404e34274/axial_037.png","assets/T/mri-52bc4d5404e34274/axial_038.png","assets/T/mri-52bc4d5404e34274/axial_039.png","assets/T/mri-52bc4d5404e34274/axial_041.png","assets/T/mri-52bc4d5404e34274/axial_042.png","assets/T/mri-52bc4d5404e34274/coronal_001.png","assets/T/mri-52bc4d5404e34274/coronal_002.png","assets/T/mri-52bc4d5404e34274/coronal_004.png","assets/T/mri-52bc4d5404e34274/coronal_005.png","assets/T/mri-52bc4d5404e34274/coronal_006.png","assets/T/mri-52bc4d5404e34274/coronal_008.png","assets/T/mri-52bc4d5404e34274/coronal_009.png","assets/T/mri-52bc4d5404e34274/coronal_010.png","assets/T/mri-52bc4d5404e34274/coronal_012.png","assets/T/mri-52bc4d5404e34274/coronal_013.png","assets/T/mri-52bc4d5404e34274/coronal_015.png","assets/T/mri-52bc4d5404e34274/coronal_016.png","assets/T/mri-52bc4d5404e34274/coronal_017.png","assets/T/mri-52bc4d5404e34274/coronal_019.png","assets/T/mri-52bc4d5404e34274/coronal_020.png","assets/T/mri-52bc4d5404e34274/coronal_021.png","assets/T/mri-52bc4d5404e34274/coronal_023.png","assets/T/mri-52bc4d5404e34274/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":66,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,12,13,14,16,17,18,20,21,22,23,25,26,27,29,30,31,33,34,35,37,38,39,41,42,43,44,46,47,48,50,51,52,54,55,57,58,59,61,62,63,65,66]}}
+{"id":"mri-5893d155cf924e90","request_id":"L3-T300:mri-5893d155cf924e90","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-5893d155cf924e90/axial_001.png","assets/T/mri-5893d155cf924e90/axial_002.png","assets/T/mri-5893d155cf924e90/axial_004.png","assets/T/mri-5893d155cf924e90/axial_005.png","assets/T/mri-5893d155cf924e90/axial_007.png","assets/T/mri-5893d155cf924e90/axial_008.png","assets/T/mri-5893d155cf924e90/axial_009.png","assets/T/mri-5893d155cf924e90/axial_011.png","assets/T/mri-5893d155cf924e90/axial_012.png","assets/T/mri-5893d155cf924e90/axial_013.png","assets/T/mri-5893d155cf924e90/axial_015.png","assets/T/mri-5893d155cf924e90/axial_016.png","assets/T/mri-5893d155cf924e90/axial_018.png","assets/T/mri-5893d155cf924e90/axial_019.png","assets/T/mri-5893d155cf924e90/axial_020.png","assets/T/mri-5893d155cf924e90/axial_022.png","assets/T/mri-5893d155cf924e90/axial_023.png","assets/T/mri-5893d155cf924e90/axial_025.png","assets/T/mri-5893d155cf924e90/axial_026.png","assets/T/mri-5893d155cf924e90/axial_027.png","assets/T/mri-5893d155cf924e90/axial_029.png","assets/T/mri-5893d155cf924e90/axial_030.png","assets/T/mri-5893d155cf924e90/axial_032.png","assets/T/mri-5893d155cf924e90/axial_033.png","assets/T/mri-5893d155cf924e90/axial_034.png","assets/T/mri-5893d155cf924e90/axial_036.png","assets/T/mri-5893d155cf924e90/axial_037.png","assets/T/mri-5893d155cf924e90/axial_038.png","assets/T/mri-5893d155cf924e90/axial_040.png","assets/T/mri-5893d155cf924e90/axial_041.png","assets/T/mri-5893d155cf924e90/axial_043.png","assets/T/mri-5893d155cf924e90/axial_044.png","assets/T/mri-5893d155cf924e90/coronal_001.png","assets/T/mri-5893d155cf924e90/coronal_002.png","assets/T/mri-5893d155cf924e90/coronal_004.png","assets/T/mri-5893d155cf924e90/coronal_005.png","assets/T/mri-5893d155cf924e90/coronal_006.png","assets/T/mri-5893d155cf924e90/coronal_008.png","assets/T/mri-5893d155cf924e90/coronal_009.png","assets/T/mri-5893d155cf924e90/coronal_010.png","assets/T/mri-5893d155cf924e90/coronal_012.png","assets/T/mri-5893d155cf924e90/coronal_013.png","assets/T/mri-5893d155cf924e90/coronal_015.png","assets/T/mri-5893d155cf924e90/coronal_016.png","assets/T/mri-5893d155cf924e90/coronal_017.png","assets/T/mri-5893d155cf924e90/coronal_019.png","assets/T/mri-5893d155cf924e90/coronal_020.png","assets/T/mri-5893d155cf924e90/coronal_021.png","assets/T/mri-5893d155cf924e90/coronal_023.png","assets/T/mri-5893d155cf924e90/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":68,"selected_count":50,"source_indices_1based":[1,2,4,5,7,8,9,11,12,13,15,16,18,19,20,22,23,25,26,27,29,30,32,33,34,36,37,38,40,41,43,44,45,46,48,49,50,52,53,54,56,57,59,60,61,63,64,65,67,68]}}
+{"id":"mri-55ee2875d8c74396","request_id":"L3-T300:mri-55ee2875d8c74396","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-55ee2875d8c74396/axial_001.png","assets/T/mri-55ee2875d8c74396/axial_002.png","assets/T/mri-55ee2875d8c74396/axial_004.png","assets/T/mri-55ee2875d8c74396/axial_005.png","assets/T/mri-55ee2875d8c74396/axial_006.png","assets/T/mri-55ee2875d8c74396/axial_008.png","assets/T/mri-55ee2875d8c74396/axial_009.png","assets/T/mri-55ee2875d8c74396/axial_010.png","assets/T/mri-55ee2875d8c74396/axial_012.png","assets/T/mri-55ee2875d8c74396/axial_013.png","assets/T/mri-55ee2875d8c74396/axial_014.png","assets/T/mri-55ee2875d8c74396/axial_016.png","assets/T/mri-55ee2875d8c74396/axial_017.png","assets/T/mri-55ee2875d8c74396/axial_018.png","assets/T/mri-55ee2875d8c74396/axial_020.png","assets/T/mri-55ee2875d8c74396/axial_021.png","assets/T/mri-55ee2875d8c74396/axial_022.png","assets/T/mri-55ee2875d8c74396/axial_023.png","assets/T/mri-55ee2875d8c74396/axial_025.png","assets/T/mri-55ee2875d8c74396/axial_026.png","assets/T/mri-55ee2875d8c74396/axial_027.png","assets/T/mri-55ee2875d8c74396/axial_029.png","assets/T/mri-55ee2875d8c74396/axial_030.png","assets/T/mri-55ee2875d8c74396/axial_031.png","assets/T/mri-55ee2875d8c74396/axial_033.png","assets/T/mri-55ee2875d8c74396/axial_034.png","assets/T/mri-55ee2875d8c74396/axial_035.png","assets/T/mri-55ee2875d8c74396/axial_037.png","assets/T/mri-55ee2875d8c74396/axial_038.png","assets/T/mri-55ee2875d8c74396/axial_039.png","assets/T/mri-55ee2875d8c74396/axial_041.png","assets/T/mri-55ee2875d8c74396/axial_042.png","assets/T/mri-55ee2875d8c74396/coronal_001.png","assets/T/mri-55ee2875d8c74396/coronal_002.png","assets/T/mri-55ee2875d8c74396/coronal_004.png","assets/T/mri-55ee2875d8c74396/coronal_005.png","assets/T/mri-55ee2875d8c74396/coronal_006.png","assets/T/mri-55ee2875d8c74396/coronal_008.png","assets/T/mri-55ee2875d8c74396/coronal_009.png","assets/T/mri-55ee2875d8c74396/coronal_010.png","assets/T/mri-55ee2875d8c74396/coronal_012.png","assets/T/mri-55ee2875d8c74396/coronal_013.png","assets/T/mri-55ee2875d8c74396/coronal_015.png","assets/T/mri-55ee2875d8c74396/coronal_016.png","assets/T/mri-55ee2875d8c74396/coronal_017.png","assets/T/mri-55ee2875d8c74396/coronal_019.png","assets/T/mri-55ee2875d8c74396/coronal_020.png","assets/T/mri-55ee2875d8c74396/coronal_021.png","assets/T/mri-55ee2875d8c74396/coronal_023.png","assets/T/mri-55ee2875d8c74396/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":66,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,12,13,14,16,17,18,20,21,22,23,25,26,27,29,30,31,33,34,35,37,38,39,41,42,43,44,46,47,48,50,51,52,54,55,57,58,59,61,62,63,65,66]}}
+{"id":"mri-009d069830a941cc","request_id":"L3-T300:mri-009d069830a941cc","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-009d069830a941cc/axial_001.png","assets/T/mri-009d069830a941cc/axial_002.png","assets/T/mri-009d069830a941cc/axial_003.png","assets/T/mri-009d069830a941cc/axial_005.png","assets/T/mri-009d069830a941cc/axial_006.png","assets/T/mri-009d069830a941cc/axial_007.png","assets/T/mri-009d069830a941cc/axial_008.png","assets/T/mri-009d069830a941cc/axial_010.png","assets/T/mri-009d069830a941cc/axial_011.png","assets/T/mri-009d069830a941cc/axial_012.png","assets/T/mri-009d069830a941cc/axial_013.png","assets/T/mri-009d069830a941cc/axial_015.png","assets/T/mri-009d069830a941cc/axial_016.png","assets/T/mri-009d069830a941cc/axial_017.png","assets/T/mri-009d069830a941cc/axial_018.png","assets/T/mri-009d069830a941cc/axial_020.png","assets/T/mri-009d069830a941cc/axial_021.png","assets/T/mri-009d069830a941cc/axial_022.png","assets/T/mri-009d069830a941cc/axial_023.png","assets/T/mri-009d069830a941cc/axial_024.png","assets/T/mri-009d069830a941cc/axial_026.png","assets/T/mri-009d069830a941cc/axial_027.png","assets/T/mri-009d069830a941cc/axial_028.png","assets/T/mri-009d069830a941cc/axial_029.png","assets/T/mri-009d069830a941cc/axial_031.png","assets/T/mri-009d069830a941cc/axial_032.png","assets/T/mri-009d069830a941cc/axial_033.png","assets/T/mri-009d069830a941cc/axial_034.png","assets/T/mri-009d069830a941cc/axial_036.png","assets/T/mri-009d069830a941cc/axial_037.png","assets/T/mri-009d069830a941cc/axial_038.png","assets/T/mri-009d069830a941cc/coronal_001.png","assets/T/mri-009d069830a941cc/coronal_002.png","assets/T/mri-009d069830a941cc/coronal_004.png","assets/T/mri-009d069830a941cc/coronal_005.png","assets/T/mri-009d069830a941cc/coronal_006.png","assets/T/mri-009d069830a941cc/coronal_007.png","assets/T/mri-009d069830a941cc/coronal_009.png","assets/T/mri-009d069830a941cc/coronal_010.png","assets/T/mri-009d069830a941cc/coronal_011.png","assets/T/mri-009d069830a941cc/coronal_013.png","assets/T/mri-009d069830a941cc/coronal_014.png","assets/T/mri-009d069830a941cc/coronal_015.png","assets/T/mri-009d069830a941cc/coronal_016.png","assets/T/mri-009d069830a941cc/coronal_018.png","assets/T/mri-009d069830a941cc/coronal_019.png","assets/T/mri-009d069830a941cc/coronal_020.png","assets/T/mri-009d069830a941cc/coronal_021.png","assets/T/mri-009d069830a941cc/coronal_023.png","assets/T/mri-009d069830a941cc/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":62,"selected_count":50,"source_indices_1based":[1,2,3,5,6,7,8,10,11,12,13,15,16,17,18,20,21,22,23,24,26,27,28,29,31,32,33,34,36,37,38,39,40,42,43,44,45,47,48,49,51,52,53,54,56,57,58,59,61,62]}}
+{"id":"mri-5927ca297b614ffd","request_id":"L3-T300:mri-5927ca297b614ffd","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-5927ca297b614ffd/axial_001.png","assets/T/mri-5927ca297b614ffd/axial_002.png","assets/T/mri-5927ca297b614ffd/axial_004.png","assets/T/mri-5927ca297b614ffd/axial_005.png","assets/T/mri-5927ca297b614ffd/axial_006.png","assets/T/mri-5927ca297b614ffd/axial_008.png","assets/T/mri-5927ca297b614ffd/axial_009.png","assets/T/mri-5927ca297b614ffd/axial_010.png","assets/T/mri-5927ca297b614ffd/axial_011.png","assets/T/mri-5927ca297b614ffd/axial_013.png","assets/T/mri-5927ca297b614ffd/axial_014.png","assets/T/mri-5927ca297b614ffd/axial_015.png","assets/T/mri-5927ca297b614ffd/axial_017.png","assets/T/mri-5927ca297b614ffd/axial_018.png","assets/T/mri-5927ca297b614ffd/axial_019.png","assets/T/mri-5927ca297b614ffd/axial_021.png","assets/T/mri-5927ca297b614ffd/axial_022.png","assets/T/mri-5927ca297b614ffd/axial_023.png","assets/T/mri-5927ca297b614ffd/axial_024.png","assets/T/mri-5927ca297b614ffd/axial_026.png","assets/T/mri-5927ca297b614ffd/axial_027.png","assets/T/mri-5927ca297b614ffd/axial_028.png","assets/T/mri-5927ca297b614ffd/axial_030.png","assets/T/mri-5927ca297b614ffd/axial_031.png","assets/T/mri-5927ca297b614ffd/axial_032.png","assets/T/mri-5927ca297b614ffd/axial_034.png","assets/T/mri-5927ca297b614ffd/axial_035.png","assets/T/mri-5927ca297b614ffd/axial_036.png","assets/T/mri-5927ca297b614ffd/axial_037.png","assets/T/mri-5927ca297b614ffd/axial_039.png","assets/T/mri-5927ca297b614ffd/axial_040.png","assets/T/mri-5927ca297b614ffd/coronal_001.png","assets/T/mri-5927ca297b614ffd/coronal_002.png","assets/T/mri-5927ca297b614ffd/coronal_004.png","assets/T/mri-5927ca297b614ffd/coronal_005.png","assets/T/mri-5927ca297b614ffd/coronal_006.png","assets/T/mri-5927ca297b614ffd/coronal_007.png","assets/T/mri-5927ca297b614ffd/coronal_009.png","assets/T/mri-5927ca297b614ffd/coronal_010.png","assets/T/mri-5927ca297b614ffd/coronal_011.png","assets/T/mri-5927ca297b614ffd/coronal_013.png","assets/T/mri-5927ca297b614ffd/coronal_014.png","assets/T/mri-5927ca297b614ffd/coronal_015.png","assets/T/mri-5927ca297b614ffd/coronal_016.png","assets/T/mri-5927ca297b614ffd/coronal_018.png","assets/T/mri-5927ca297b614ffd/coronal_019.png","assets/T/mri-5927ca297b614ffd/coronal_020.png","assets/T/mri-5927ca297b614ffd/coronal_021.png","assets/T/mri-5927ca297b614ffd/coronal_023.png","assets/T/mri-5927ca297b614ffd/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":64,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,11,13,14,15,17,18,19,21,22,23,24,26,27,28,30,31,32,34,35,36,37,39,40,41,42,44,45,46,47,49,50,51,53,54,55,56,58,59,60,61,63,64]}}
+{"id":"mri-a5b56fee006e4280","request_id":"L3-T300:mri-a5b56fee006e4280","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-a5b56fee006e4280/axial_001.png","assets/T/mri-a5b56fee006e4280/axial_002.png","assets/T/mri-a5b56fee006e4280/axial_004.png","assets/T/mri-a5b56fee006e4280/axial_005.png","assets/T/mri-a5b56fee006e4280/axial_006.png","assets/T/mri-a5b56fee006e4280/axial_008.png","assets/T/mri-a5b56fee006e4280/axial_009.png","assets/T/mri-a5b56fee006e4280/axial_010.png","assets/T/mri-a5b56fee006e4280/axial_011.png","assets/T/mri-a5b56fee006e4280/axial_013.png","assets/T/mri-a5b56fee006e4280/axial_014.png","assets/T/mri-a5b56fee006e4280/axial_015.png","assets/T/mri-a5b56fee006e4280/axial_017.png","assets/T/mri-a5b56fee006e4280/axial_018.png","assets/T/mri-a5b56fee006e4280/axial_019.png","assets/T/mri-a5b56fee006e4280/axial_021.png","assets/T/mri-a5b56fee006e4280/axial_022.png","assets/T/mri-a5b56fee006e4280/axial_023.png","assets/T/mri-a5b56fee006e4280/axial_024.png","assets/T/mri-a5b56fee006e4280/axial_026.png","assets/T/mri-a5b56fee006e4280/axial_027.png","assets/T/mri-a5b56fee006e4280/axial_028.png","assets/T/mri-a5b56fee006e4280/axial_030.png","assets/T/mri-a5b56fee006e4280/axial_031.png","assets/T/mri-a5b56fee006e4280/axial_032.png","assets/T/mri-a5b56fee006e4280/axial_034.png","assets/T/mri-a5b56fee006e4280/axial_035.png","assets/T/mri-a5b56fee006e4280/axial_036.png","assets/T/mri-a5b56fee006e4280/axial_037.png","assets/T/mri-a5b56fee006e4280/axial_039.png","assets/T/mri-a5b56fee006e4280/axial_040.png","assets/T/mri-a5b56fee006e4280/coronal_001.png","assets/T/mri-a5b56fee006e4280/coronal_002.png","assets/T/mri-a5b56fee006e4280/coronal_004.png","assets/T/mri-a5b56fee006e4280/coronal_005.png","assets/T/mri-a5b56fee006e4280/coronal_006.png","assets/T/mri-a5b56fee006e4280/coronal_007.png","assets/T/mri-a5b56fee006e4280/coronal_009.png","assets/T/mri-a5b56fee006e4280/coronal_010.png","assets/T/mri-a5b56fee006e4280/coronal_011.png","assets/T/mri-a5b56fee006e4280/coronal_013.png","assets/T/mri-a5b56fee006e4280/coronal_014.png","assets/T/mri-a5b56fee006e4280/coronal_015.png","assets/T/mri-a5b56fee006e4280/coronal_016.png","assets/T/mri-a5b56fee006e4280/coronal_018.png","assets/T/mri-a5b56fee006e4280/coronal_019.png","assets/T/mri-a5b56fee006e4280/coronal_020.png","assets/T/mri-a5b56fee006e4280/coronal_021.png","assets/T/mri-a5b56fee006e4280/coronal_023.png","assets/T/mri-a5b56fee006e4280/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":64,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,11,13,14,15,17,18,19,21,22,23,24,26,27,28,30,31,32,34,35,36,37,39,40,41,42,44,45,46,47,49,50,51,53,54,55,56,58,59,60,61,63,64]}}
+{"id":"mri-db4b9a10a3444950","request_id":"L3-T300:mri-db4b9a10a3444950","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-db4b9a10a3444950/axial_001.png","assets/T/mri-db4b9a10a3444950/axial_002.png","assets/T/mri-db4b9a10a3444950/axial_004.png","assets/T/mri-db4b9a10a3444950/axial_005.png","assets/T/mri-db4b9a10a3444950/axial_006.png","assets/T/mri-db4b9a10a3444950/axial_008.png","assets/T/mri-db4b9a10a3444950/axial_009.png","assets/T/mri-db4b9a10a3444950/axial_010.png","assets/T/mri-db4b9a10a3444950/axial_011.png","assets/T/mri-db4b9a10a3444950/axial_013.png","assets/T/mri-db4b9a10a3444950/axial_014.png","assets/T/mri-db4b9a10a3444950/axial_015.png","assets/T/mri-db4b9a10a3444950/axial_017.png","assets/T/mri-db4b9a10a3444950/axial_018.png","assets/T/mri-db4b9a10a3444950/axial_019.png","assets/T/mri-db4b9a10a3444950/axial_021.png","assets/T/mri-db4b9a10a3444950/axial_022.png","assets/T/mri-db4b9a10a3444950/axial_023.png","assets/T/mri-db4b9a10a3444950/axial_024.png","assets/T/mri-db4b9a10a3444950/axial_026.png","assets/T/mri-db4b9a10a3444950/axial_027.png","assets/T/mri-db4b9a10a3444950/axial_028.png","assets/T/mri-db4b9a10a3444950/axial_030.png","assets/T/mri-db4b9a10a3444950/axial_031.png","assets/T/mri-db4b9a10a3444950/axial_032.png","assets/T/mri-db4b9a10a3444950/axial_034.png","assets/T/mri-db4b9a10a3444950/axial_035.png","assets/T/mri-db4b9a10a3444950/axial_036.png","assets/T/mri-db4b9a10a3444950/axial_037.png","assets/T/mri-db4b9a10a3444950/axial_039.png","assets/T/mri-db4b9a10a3444950/axial_040.png","assets/T/mri-db4b9a10a3444950/coronal_001.png","assets/T/mri-db4b9a10a3444950/coronal_002.png","assets/T/mri-db4b9a10a3444950/coronal_004.png","assets/T/mri-db4b9a10a3444950/coronal_005.png","assets/T/mri-db4b9a10a3444950/coronal_006.png","assets/T/mri-db4b9a10a3444950/coronal_007.png","assets/T/mri-db4b9a10a3444950/coronal_009.png","assets/T/mri-db4b9a10a3444950/coronal_010.png","assets/T/mri-db4b9a10a3444950/coronal_011.png","assets/T/mri-db4b9a10a3444950/coronal_013.png","assets/T/mri-db4b9a10a3444950/coronal_014.png","assets/T/mri-db4b9a10a3444950/coronal_015.png","assets/T/mri-db4b9a10a3444950/coronal_016.png","assets/T/mri-db4b9a10a3444950/coronal_018.png","assets/T/mri-db4b9a10a3444950/coronal_019.png","assets/T/mri-db4b9a10a3444950/coronal_020.png","assets/T/mri-db4b9a10a3444950/coronal_021.png","assets/T/mri-db4b9a10a3444950/coronal_023.png","assets/T/mri-db4b9a10a3444950/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":64,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,11,13,14,15,17,18,19,21,22,23,24,26,27,28,30,31,32,34,35,36,37,39,40,41,42,44,45,46,47,49,50,51,53,54,55,56,58,59,60,61,63,64]}}
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+{"id":"mri-b9040a34fa5e4315","request_id":"L3-T300:mri-b9040a34fa5e4315","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-b9040a34fa5e4315/axial_001.png","assets/T/mri-b9040a34fa5e4315/axial_002.png","assets/T/mri-b9040a34fa5e4315/axial_004.png","assets/T/mri-b9040a34fa5e4315/axial_005.png","assets/T/mri-b9040a34fa5e4315/axial_006.png","assets/T/mri-b9040a34fa5e4315/axial_008.png","assets/T/mri-b9040a34fa5e4315/axial_009.png","assets/T/mri-b9040a34fa5e4315/axial_010.png","assets/T/mri-b9040a34fa5e4315/axial_011.png","assets/T/mri-b9040a34fa5e4315/axial_013.png","assets/T/mri-b9040a34fa5e4315/axial_014.png","assets/T/mri-b9040a34fa5e4315/axial_015.png","assets/T/mri-b9040a34fa5e4315/axial_017.png","assets/T/mri-b9040a34fa5e4315/axial_018.png","assets/T/mri-b9040a34fa5e4315/axial_019.png","assets/T/mri-b9040a34fa5e4315/axial_021.png","assets/T/mri-b9040a34fa5e4315/axial_022.png","assets/T/mri-b9040a34fa5e4315/axial_023.png","assets/T/mri-b9040a34fa5e4315/axial_024.png","assets/T/mri-b9040a34fa5e4315/axial_026.png","assets/T/mri-b9040a34fa5e4315/axial_027.png","assets/T/mri-b9040a34fa5e4315/axial_028.png","assets/T/mri-b9040a34fa5e4315/axial_030.png","assets/T/mri-b9040a34fa5e4315/axial_031.png","assets/T/mri-b9040a34fa5e4315/axial_032.png","assets/T/mri-b9040a34fa5e4315/axial_034.png","assets/T/mri-b9040a34fa5e4315/axial_035.png","assets/T/mri-b9040a34fa5e4315/axial_036.png","assets/T/mri-b9040a34fa5e4315/axial_037.png","assets/T/mri-b9040a34fa5e4315/axial_039.png","assets/T/mri-b9040a34fa5e4315/axial_040.png","assets/T/mri-b9040a34fa5e4315/coronal_001.png","assets/T/mri-b9040a34fa5e4315/coronal_002.png","assets/T/mri-b9040a34fa5e4315/coronal_004.png","assets/T/mri-b9040a34fa5e4315/coronal_005.png","assets/T/mri-b9040a34fa5e4315/coronal_006.png","assets/T/mri-b9040a34fa5e4315/coronal_007.png","assets/T/mri-b9040a34fa5e4315/coronal_009.png","assets/T/mri-b9040a34fa5e4315/coronal_010.png","assets/T/mri-b9040a34fa5e4315/coronal_011.png","assets/T/mri-b9040a34fa5e4315/coronal_013.png","assets/T/mri-b9040a34fa5e4315/coronal_014.png","assets/T/mri-b9040a34fa5e4315/coronal_015.png","assets/T/mri-b9040a34fa5e4315/coronal_016.png","assets/T/mri-b9040a34fa5e4315/coronal_018.png","assets/T/mri-b9040a34fa5e4315/coronal_019.png","assets/T/mri-b9040a34fa5e4315/coronal_020.png","assets/T/mri-b9040a34fa5e4315/coronal_021.png","assets/T/mri-b9040a34fa5e4315/coronal_023.png","assets/T/mri-b9040a34fa5e4315/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":64,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,11,13,14,15,17,18,19,21,22,23,24,26,27,28,30,31,32,34,35,36,37,39,40,41,42,44,45,46,47,49,50,51,53,54,55,56,58,59,60,61,63,64]}}
+{"id":"mri-7c103c2defd14c13","request_id":"L3-T300:mri-7c103c2defd14c13","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-7c103c2defd14c13/axial_001.png","assets/T/mri-7c103c2defd14c13/axial_002.png","assets/T/mri-7c103c2defd14c13/axial_004.png","assets/T/mri-7c103c2defd14c13/axial_005.png","assets/T/mri-7c103c2defd14c13/axial_006.png","assets/T/mri-7c103c2defd14c13/axial_008.png","assets/T/mri-7c103c2defd14c13/axial_009.png","assets/T/mri-7c103c2defd14c13/axial_010.png","assets/T/mri-7c103c2defd14c13/axial_011.png","assets/T/mri-7c103c2defd14c13/axial_013.png","assets/T/mri-7c103c2defd14c13/axial_014.png","assets/T/mri-7c103c2defd14c13/axial_015.png","assets/T/mri-7c103c2defd14c13/axial_017.png","assets/T/mri-7c103c2defd14c13/axial_018.png","assets/T/mri-7c103c2defd14c13/axial_019.png","assets/T/mri-7c103c2defd14c13/axial_021.png","assets/T/mri-7c103c2defd14c13/axial_022.png","assets/T/mri-7c103c2defd14c13/axial_023.png","assets/T/mri-7c103c2defd14c13/axial_024.png","assets/T/mri-7c103c2defd14c13/axial_026.png","assets/T/mri-7c103c2defd14c13/axial_027.png","assets/T/mri-7c103c2defd14c13/axial_028.png","assets/T/mri-7c103c2defd14c13/axial_030.png","assets/T/mri-7c103c2defd14c13/axial_031.png","assets/T/mri-7c103c2defd14c13/axial_032.png","assets/T/mri-7c103c2defd14c13/axial_034.png","assets/T/mri-7c103c2defd14c13/axial_035.png","assets/T/mri-7c103c2defd14c13/axial_036.png","assets/T/mri-7c103c2defd14c13/axial_037.png","assets/T/mri-7c103c2defd14c13/axial_039.png","assets/T/mri-7c103c2defd14c13/axial_040.png","assets/T/mri-7c103c2defd14c13/coronal_001.png","assets/T/mri-7c103c2defd14c13/coronal_002.png","assets/T/mri-7c103c2defd14c13/coronal_004.png","assets/T/mri-7c103c2defd14c13/coronal_005.png","assets/T/mri-7c103c2defd14c13/coronal_006.png","assets/T/mri-7c103c2defd14c13/coronal_007.png","assets/T/mri-7c103c2defd14c13/coronal_009.png","assets/T/mri-7c103c2defd14c13/coronal_010.png","assets/T/mri-7c103c2defd14c13/coronal_011.png","assets/T/mri-7c103c2defd14c13/coronal_013.png","assets/T/mri-7c103c2defd14c13/coronal_014.png","assets/T/mri-7c103c2defd14c13/coronal_015.png","assets/T/mri-7c103c2defd14c13/coronal_016.png","assets/T/mri-7c103c2defd14c13/coronal_018.png","assets/T/mri-7c103c2defd14c13/coronal_019.png","assets/T/mri-7c103c2defd14c13/coronal_020.png","assets/T/mri-7c103c2defd14c13/coronal_021.png","assets/T/mri-7c103c2defd14c13/coronal_023.png","assets/T/mri-7c103c2defd14c13/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":64,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,11,13,14,15,17,18,19,21,22,23,24,26,27,28,30,31,32,34,35,36,37,39,40,41,42,44,45,46,47,49,50,51,53,54,55,56,58,59,60,61,63,64]}}
+{"id":"mri-dce34f88ac514aa2","request_id":"L3-T300:mri-dce34f88ac514aa2","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-dce34f88ac514aa2/axial_001.png","assets/T/mri-dce34f88ac514aa2/axial_002.png","assets/T/mri-dce34f88ac514aa2/axial_004.png","assets/T/mri-dce34f88ac514aa2/axial_005.png","assets/T/mri-dce34f88ac514aa2/axial_006.png","assets/T/mri-dce34f88ac514aa2/axial_008.png","assets/T/mri-dce34f88ac514aa2/axial_009.png","assets/T/mri-dce34f88ac514aa2/axial_010.png","assets/T/mri-dce34f88ac514aa2/axial_011.png","assets/T/mri-dce34f88ac514aa2/axial_013.png","assets/T/mri-dce34f88ac514aa2/axial_014.png","assets/T/mri-dce34f88ac514aa2/axial_015.png","assets/T/mri-dce34f88ac514aa2/axial_017.png","assets/T/mri-dce34f88ac514aa2/axial_018.png","assets/T/mri-dce34f88ac514aa2/axial_019.png","assets/T/mri-dce34f88ac514aa2/axial_021.png","assets/T/mri-dce34f88ac514aa2/axial_022.png","assets/T/mri-dce34f88ac514aa2/axial_023.png","assets/T/mri-dce34f88ac514aa2/axial_024.png","assets/T/mri-dce34f88ac514aa2/axial_026.png","assets/T/mri-dce34f88ac514aa2/axial_027.png","assets/T/mri-dce34f88ac514aa2/axial_028.png","assets/T/mri-dce34f88ac514aa2/axial_030.png","assets/T/mri-dce34f88ac514aa2/axial_031.png","assets/T/mri-dce34f88ac514aa2/axial_032.png","assets/T/mri-dce34f88ac514aa2/axial_034.png","assets/T/mri-dce34f88ac514aa2/axial_035.png","assets/T/mri-dce34f88ac514aa2/axial_036.png","assets/T/mri-dce34f88ac514aa2/axial_037.png","assets/T/mri-dce34f88ac514aa2/axial_039.png","assets/T/mri-dce34f88ac514aa2/axial_040.png","assets/T/mri-dce34f88ac514aa2/coronal_001.png","assets/T/mri-dce34f88ac514aa2/coronal_002.png","assets/T/mri-dce34f88ac514aa2/coronal_004.png","assets/T/mri-dce34f88ac514aa2/coronal_005.png","assets/T/mri-dce34f88ac514aa2/coronal_006.png","assets/T/mri-dce34f88ac514aa2/coronal_007.png","assets/T/mri-dce34f88ac514aa2/coronal_009.png","assets/T/mri-dce34f88ac514aa2/coronal_010.png","assets/T/mri-dce34f88ac514aa2/coronal_011.png","assets/T/mri-dce34f88ac514aa2/coronal_013.png","assets/T/mri-dce34f88ac514aa2/coronal_014.png","assets/T/mri-dce34f88ac514aa2/coronal_015.png","assets/T/mri-dce34f88ac514aa2/coronal_016.png","assets/T/mri-dce34f88ac514aa2/coronal_018.png","assets/T/mri-dce34f88ac514aa2/coronal_019.png","assets/T/mri-dce34f88ac514aa2/coronal_020.png","assets/T/mri-dce34f88ac514aa2/coronal_021.png","assets/T/mri-dce34f88ac514aa2/coronal_023.png","assets/T/mri-dce34f88ac514aa2/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":64,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,11,13,14,15,17,18,19,21,22,23,24,26,27,28,30,31,32,34,35,36,37,39,40,41,42,44,45,46,47,49,50,51,53,54,55,56,58,59,60,61,63,64]}}
+{"id":"mri-dcdf6ec887f345f5","request_id":"L3-T300:mri-dcdf6ec887f345f5","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-dcdf6ec887f345f5/axial_001.png","assets/T/mri-dcdf6ec887f345f5/axial_002.png","assets/T/mri-dcdf6ec887f345f5/axial_004.png","assets/T/mri-dcdf6ec887f345f5/axial_005.png","assets/T/mri-dcdf6ec887f345f5/axial_006.png","assets/T/mri-dcdf6ec887f345f5/axial_008.png","assets/T/mri-dcdf6ec887f345f5/axial_009.png","assets/T/mri-dcdf6ec887f345f5/axial_010.png","assets/T/mri-dcdf6ec887f345f5/axial_012.png","assets/T/mri-dcdf6ec887f345f5/axial_013.png","assets/T/mri-dcdf6ec887f345f5/axial_014.png","assets/T/mri-dcdf6ec887f345f5/axial_016.png","assets/T/mri-dcdf6ec887f345f5/axial_017.png","assets/T/mri-dcdf6ec887f345f5/axial_018.png","assets/T/mri-dcdf6ec887f345f5/axial_020.png","assets/T/mri-dcdf6ec887f345f5/axial_021.png","assets/T/mri-dcdf6ec887f345f5/axial_022.png","assets/T/mri-dcdf6ec887f345f5/axial_023.png","assets/T/mri-dcdf6ec887f345f5/axial_025.png","assets/T/mri-dcdf6ec887f345f5/axial_026.png","assets/T/mri-dcdf6ec887f345f5/axial_027.png","assets/T/mri-dcdf6ec887f345f5/axial_029.png","assets/T/mri-dcdf6ec887f345f5/axial_030.png","assets/T/mri-dcdf6ec887f345f5/axial_031.png","assets/T/mri-dcdf6ec887f345f5/axial_033.png","assets/T/mri-dcdf6ec887f345f5/axial_034.png","assets/T/mri-dcdf6ec887f345f5/axial_035.png","assets/T/mri-dcdf6ec887f345f5/axial_037.png","assets/T/mri-dcdf6ec887f345f5/axial_038.png","assets/T/mri-dcdf6ec887f345f5/axial_039.png","assets/T/mri-dcdf6ec887f345f5/axial_041.png","assets/T/mri-dcdf6ec887f345f5/axial_042.png","assets/T/mri-dcdf6ec887f345f5/coronal_001.png","assets/T/mri-dcdf6ec887f345f5/coronal_002.png","assets/T/mri-dcdf6ec887f345f5/coronal_004.png","assets/T/mri-dcdf6ec887f345f5/coronal_005.png","assets/T/mri-dcdf6ec887f345f5/coronal_006.png","assets/T/mri-dcdf6ec887f345f5/coronal_008.png","assets/T/mri-dcdf6ec887f345f5/coronal_009.png","assets/T/mri-dcdf6ec887f345f5/coronal_010.png","assets/T/mri-dcdf6ec887f345f5/coronal_012.png","assets/T/mri-dcdf6ec887f345f5/coronal_013.png","assets/T/mri-dcdf6ec887f345f5/coronal_015.png","assets/T/mri-dcdf6ec887f345f5/coronal_016.png","assets/T/mri-dcdf6ec887f345f5/coronal_017.png","assets/T/mri-dcdf6ec887f345f5/coronal_019.png","assets/T/mri-dcdf6ec887f345f5/coronal_020.png","assets/T/mri-dcdf6ec887f345f5/coronal_021.png","assets/T/mri-dcdf6ec887f345f5/coronal_023.png","assets/T/mri-dcdf6ec887f345f5/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":66,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,12,13,14,16,17,18,20,21,22,23,25,26,27,29,30,31,33,34,35,37,38,39,41,42,43,44,46,47,48,50,51,52,54,55,57,58,59,61,62,63,65,66]}}
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+{"id":"mri-911862d19e9e456f","request_id":"L3-T300:mri-911862d19e9e456f","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-911862d19e9e456f/axial_001.png","assets/T/mri-911862d19e9e456f/axial_002.png","assets/T/mri-911862d19e9e456f/axial_004.png","assets/T/mri-911862d19e9e456f/axial_005.png","assets/T/mri-911862d19e9e456f/axial_006.png","assets/T/mri-911862d19e9e456f/axial_008.png","assets/T/mri-911862d19e9e456f/axial_009.png","assets/T/mri-911862d19e9e456f/axial_010.png","assets/T/mri-911862d19e9e456f/axial_012.png","assets/T/mri-911862d19e9e456f/axial_013.png","assets/T/mri-911862d19e9e456f/axial_014.png","assets/T/mri-911862d19e9e456f/axial_016.png","assets/T/mri-911862d19e9e456f/axial_017.png","assets/T/mri-911862d19e9e456f/axial_018.png","assets/T/mri-911862d19e9e456f/axial_020.png","assets/T/mri-911862d19e9e456f/axial_021.png","assets/T/mri-911862d19e9e456f/axial_022.png","assets/T/mri-911862d19e9e456f/axial_023.png","assets/T/mri-911862d19e9e456f/axial_025.png","assets/T/mri-911862d19e9e456f/axial_026.png","assets/T/mri-911862d19e9e456f/axial_027.png","assets/T/mri-911862d19e9e456f/axial_029.png","assets/T/mri-911862d19e9e456f/axial_030.png","assets/T/mri-911862d19e9e456f/axial_031.png","assets/T/mri-911862d19e9e456f/axial_033.png","assets/T/mri-911862d19e9e456f/axial_034.png","assets/T/mri-911862d19e9e456f/axial_035.png","assets/T/mri-911862d19e9e456f/axial_037.png","assets/T/mri-911862d19e9e456f/axial_038.png","assets/T/mri-911862d19e9e456f/axial_039.png","assets/T/mri-911862d19e9e456f/axial_041.png","assets/T/mri-911862d19e9e456f/axial_042.png","assets/T/mri-911862d19e9e456f/coronal_001.png","assets/T/mri-911862d19e9e456f/coronal_002.png","assets/T/mri-911862d19e9e456f/coronal_004.png","assets/T/mri-911862d19e9e456f/coronal_005.png","assets/T/mri-911862d19e9e456f/coronal_006.png","assets/T/mri-911862d19e9e456f/coronal_008.png","assets/T/mri-911862d19e9e456f/coronal_009.png","assets/T/mri-911862d19e9e456f/coronal_010.png","assets/T/mri-911862d19e9e456f/coronal_012.png","assets/T/mri-911862d19e9e456f/coronal_013.png","assets/T/mri-911862d19e9e456f/coronal_015.png","assets/T/mri-911862d19e9e456f/coronal_016.png","assets/T/mri-911862d19e9e456f/coronal_017.png","assets/T/mri-911862d19e9e456f/coronal_019.png","assets/T/mri-911862d19e9e456f/coronal_020.png","assets/T/mri-911862d19e9e456f/coronal_021.png","assets/T/mri-911862d19e9e456f/coronal_023.png","assets/T/mri-911862d19e9e456f/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":66,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,12,13,14,16,17,18,20,21,22,23,25,26,27,29,30,31,33,34,35,37,38,39,41,42,43,44,46,47,48,50,51,52,54,55,57,58,59,61,62,63,65,66]}}
+{"id":"mri-52ab912be8f94df4","request_id":"L3-T300:mri-52ab912be8f94df4","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-52ab912be8f94df4/axial_001.png","assets/T/mri-52ab912be8f94df4/axial_002.png","assets/T/mri-52ab912be8f94df4/axial_004.png","assets/T/mri-52ab912be8f94df4/axial_005.png","assets/T/mri-52ab912be8f94df4/axial_006.png","assets/T/mri-52ab912be8f94df4/axial_008.png","assets/T/mri-52ab912be8f94df4/axial_009.png","assets/T/mri-52ab912be8f94df4/axial_010.png","assets/T/mri-52ab912be8f94df4/axial_012.png","assets/T/mri-52ab912be8f94df4/axial_013.png","assets/T/mri-52ab912be8f94df4/axial_014.png","assets/T/mri-52ab912be8f94df4/axial_016.png","assets/T/mri-52ab912be8f94df4/axial_017.png","assets/T/mri-52ab912be8f94df4/axial_018.png","assets/T/mri-52ab912be8f94df4/axial_020.png","assets/T/mri-52ab912be8f94df4/axial_021.png","assets/T/mri-52ab912be8f94df4/axial_022.png","assets/T/mri-52ab912be8f94df4/axial_023.png","assets/T/mri-52ab912be8f94df4/axial_025.png","assets/T/mri-52ab912be8f94df4/axial_026.png","assets/T/mri-52ab912be8f94df4/axial_027.png","assets/T/mri-52ab912be8f94df4/axial_029.png","assets/T/mri-52ab912be8f94df4/axial_030.png","assets/T/mri-52ab912be8f94df4/axial_031.png","assets/T/mri-52ab912be8f94df4/axial_033.png","assets/T/mri-52ab912be8f94df4/axial_034.png","assets/T/mri-52ab912be8f94df4/axial_035.png","assets/T/mri-52ab912be8f94df4/axial_037.png","assets/T/mri-52ab912be8f94df4/axial_038.png","assets/T/mri-52ab912be8f94df4/axial_039.png","assets/T/mri-52ab912be8f94df4/axial_041.png","assets/T/mri-52ab912be8f94df4/axial_042.png","assets/T/mri-52ab912be8f94df4/coronal_001.png","assets/T/mri-52ab912be8f94df4/coronal_002.png","assets/T/mri-52ab912be8f94df4/coronal_004.png","assets/T/mri-52ab912be8f94df4/coronal_005.png","assets/T/mri-52ab912be8f94df4/coronal_006.png","assets/T/mri-52ab912be8f94df4/coronal_008.png","assets/T/mri-52ab912be8f94df4/coronal_009.png","assets/T/mri-52ab912be8f94df4/coronal_010.png","assets/T/mri-52ab912be8f94df4/coronal_012.png","assets/T/mri-52ab912be8f94df4/coronal_013.png","assets/T/mri-52ab912be8f94df4/coronal_015.png","assets/T/mri-52ab912be8f94df4/coronal_016.png","assets/T/mri-52ab912be8f94df4/coronal_017.png","assets/T/mri-52ab912be8f94df4/coronal_019.png","assets/T/mri-52ab912be8f94df4/coronal_020.png","assets/T/mri-52ab912be8f94df4/coronal_021.png","assets/T/mri-52ab912be8f94df4/coronal_023.png","assets/T/mri-52ab912be8f94df4/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":66,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,12,13,14,16,17,18,20,21,22,23,25,26,27,29,30,31,33,34,35,37,38,39,41,42,43,44,46,47,48,50,51,52,54,55,57,58,59,61,62,63,65,66]}}
+{"id":"mri-ccaecc2dd6674b4c","request_id":"L3-T300:mri-ccaecc2dd6674b4c","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 30 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 20 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-ccaecc2dd6674b4c/axial_001.png","assets/T/mri-ccaecc2dd6674b4c/axial_002.png","assets/T/mri-ccaecc2dd6674b4c/axial_003.png","assets/T/mri-ccaecc2dd6674b4c/axial_005.png","assets/T/mri-ccaecc2dd6674b4c/axial_006.png","assets/T/mri-ccaecc2dd6674b4c/axial_007.png","assets/T/mri-ccaecc2dd6674b4c/axial_008.png","assets/T/mri-ccaecc2dd6674b4c/axial_009.png","assets/T/mri-ccaecc2dd6674b4c/axial_011.png","assets/T/mri-ccaecc2dd6674b4c/axial_012.png","assets/T/mri-ccaecc2dd6674b4c/axial_013.png","assets/T/mri-ccaecc2dd6674b4c/axial_014.png","assets/T/mri-ccaecc2dd6674b4c/axial_015.png","assets/T/mri-ccaecc2dd6674b4c/axial_017.png","assets/T/mri-ccaecc2dd6674b4c/axial_018.png","assets/T/mri-ccaecc2dd6674b4c/axial_019.png","assets/T/mri-ccaecc2dd6674b4c/axial_020.png","assets/T/mri-ccaecc2dd6674b4c/axial_022.png","assets/T/mri-ccaecc2dd6674b4c/axial_023.png","assets/T/mri-ccaecc2dd6674b4c/axial_024.png","assets/T/mri-ccaecc2dd6674b4c/axial_025.png","assets/T/mri-ccaecc2dd6674b4c/axial_026.png","assets/T/mri-ccaecc2dd6674b4c/axial_028.png","assets/T/mri-ccaecc2dd6674b4c/axial_029.png","assets/T/mri-ccaecc2dd6674b4c/axial_030.png","assets/T/mri-ccaecc2dd6674b4c/axial_031.png","assets/T/mri-ccaecc2dd6674b4c/axial_032.png","assets/T/mri-ccaecc2dd6674b4c/axial_034.png","assets/T/mri-ccaecc2dd6674b4c/axial_035.png","assets/T/mri-ccaecc2dd6674b4c/axial_036.png","assets/T/mri-ccaecc2dd6674b4c/coronal_001.png","assets/T/mri-ccaecc2dd6674b4c/coronal_002.png","assets/T/mri-ccaecc2dd6674b4c/coronal_003.png","assets/T/mri-ccaecc2dd6674b4c/coronal_005.png","assets/T/mri-ccaecc2dd6674b4c/coronal_006.png","assets/T/mri-ccaecc2dd6674b4c/coronal_007.png","assets/T/mri-ccaecc2dd6674b4c/coronal_008.png","assets/T/mri-ccaecc2dd6674b4c/coronal_009.png","assets/T/mri-ccaecc2dd6674b4c/coronal_011.png","assets/T/mri-ccaecc2dd6674b4c/coronal_012.png","assets/T/mri-ccaecc2dd6674b4c/coronal_013.png","assets/T/mri-ccaecc2dd6674b4c/coronal_014.png","assets/T/mri-ccaecc2dd6674b4c/coronal_016.png","assets/T/mri-ccaecc2dd6674b4c/coronal_017.png","assets/T/mri-ccaecc2dd6674b4c/coronal_018.png","assets/T/mri-ccaecc2dd6674b4c/coronal_019.png","assets/T/mri-ccaecc2dd6674b4c/coronal_020.png","assets/T/mri-ccaecc2dd6674b4c/coronal_022.png","assets/T/mri-ccaecc2dd6674b4c/coronal_023.png","assets/T/mri-ccaecc2dd6674b4c/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":60,"selected_count":50,"source_indices_1based":[1,2,3,5,6,7,8,9,11,12,13,14,15,17,18,19,20,22,23,24,25,26,28,29,30,31,32,34,35,36,37,38,39,41,42,43,44,45,47,48,49,50,52,53,54,55,56,58,59,60]}}
+{"id":"mri-20452f5fb9304914","request_id":"L3-T300:mri-20452f5fb9304914","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-20452f5fb9304914/axial_001.png","assets/T/mri-20452f5fb9304914/axial_002.png","assets/T/mri-20452f5fb9304914/axial_004.png","assets/T/mri-20452f5fb9304914/axial_005.png","assets/T/mri-20452f5fb9304914/axial_006.png","assets/T/mri-20452f5fb9304914/axial_008.png","assets/T/mri-20452f5fb9304914/axial_009.png","assets/T/mri-20452f5fb9304914/axial_010.png","assets/T/mri-20452f5fb9304914/axial_012.png","assets/T/mri-20452f5fb9304914/axial_013.png","assets/T/mri-20452f5fb9304914/axial_014.png","assets/T/mri-20452f5fb9304914/axial_016.png","assets/T/mri-20452f5fb9304914/axial_017.png","assets/T/mri-20452f5fb9304914/axial_018.png","assets/T/mri-20452f5fb9304914/axial_020.png","assets/T/mri-20452f5fb9304914/axial_021.png","assets/T/mri-20452f5fb9304914/axial_022.png","assets/T/mri-20452f5fb9304914/axial_023.png","assets/T/mri-20452f5fb9304914/axial_025.png","assets/T/mri-20452f5fb9304914/axial_026.png","assets/T/mri-20452f5fb9304914/axial_027.png","assets/T/mri-20452f5fb9304914/axial_029.png","assets/T/mri-20452f5fb9304914/axial_030.png","assets/T/mri-20452f5fb9304914/axial_031.png","assets/T/mri-20452f5fb9304914/axial_033.png","assets/T/mri-20452f5fb9304914/axial_034.png","assets/T/mri-20452f5fb9304914/axial_035.png","assets/T/mri-20452f5fb9304914/axial_037.png","assets/T/mri-20452f5fb9304914/axial_038.png","assets/T/mri-20452f5fb9304914/axial_039.png","assets/T/mri-20452f5fb9304914/axial_041.png","assets/T/mri-20452f5fb9304914/axial_042.png","assets/T/mri-20452f5fb9304914/coronal_001.png","assets/T/mri-20452f5fb9304914/coronal_002.png","assets/T/mri-20452f5fb9304914/coronal_004.png","assets/T/mri-20452f5fb9304914/coronal_005.png","assets/T/mri-20452f5fb9304914/coronal_006.png","assets/T/mri-20452f5fb9304914/coronal_008.png","assets/T/mri-20452f5fb9304914/coronal_009.png","assets/T/mri-20452f5fb9304914/coronal_010.png","assets/T/mri-20452f5fb9304914/coronal_012.png","assets/T/mri-20452f5fb9304914/coronal_013.png","assets/T/mri-20452f5fb9304914/coronal_015.png","assets/T/mri-20452f5fb9304914/coronal_016.png","assets/T/mri-20452f5fb9304914/coronal_017.png","assets/T/mri-20452f5fb9304914/coronal_019.png","assets/T/mri-20452f5fb9304914/coronal_020.png","assets/T/mri-20452f5fb9304914/coronal_021.png","assets/T/mri-20452f5fb9304914/coronal_023.png","assets/T/mri-20452f5fb9304914/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":66,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,12,13,14,16,17,18,20,21,22,23,25,26,27,29,30,31,33,34,35,37,38,39,41,42,43,44,46,47,48,50,51,52,54,55,57,58,59,61,62,63,65,66]}}
+{"id":"mri-9bc82b4fc3564f98","request_id":"L3-T300:mri-9bc82b4fc3564f98","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-9bc82b4fc3564f98/axial_001.png","assets/T/mri-9bc82b4fc3564f98/axial_002.png","assets/T/mri-9bc82b4fc3564f98/axial_004.png","assets/T/mri-9bc82b4fc3564f98/axial_005.png","assets/T/mri-9bc82b4fc3564f98/axial_006.png","assets/T/mri-9bc82b4fc3564f98/axial_008.png","assets/T/mri-9bc82b4fc3564f98/axial_009.png","assets/T/mri-9bc82b4fc3564f98/axial_010.png","assets/T/mri-9bc82b4fc3564f98/axial_012.png","assets/T/mri-9bc82b4fc3564f98/axial_013.png","assets/T/mri-9bc82b4fc3564f98/axial_014.png","assets/T/mri-9bc82b4fc3564f98/axial_016.png","assets/T/mri-9bc82b4fc3564f98/axial_017.png","assets/T/mri-9bc82b4fc3564f98/axial_018.png","assets/T/mri-9bc82b4fc3564f98/axial_020.png","assets/T/mri-9bc82b4fc3564f98/axial_021.png","assets/T/mri-9bc82b4fc3564f98/axial_022.png","assets/T/mri-9bc82b4fc3564f98/axial_023.png","assets/T/mri-9bc82b4fc3564f98/axial_025.png","assets/T/mri-9bc82b4fc3564f98/axial_026.png","assets/T/mri-9bc82b4fc3564f98/axial_027.png","assets/T/mri-9bc82b4fc3564f98/axial_029.png","assets/T/mri-9bc82b4fc3564f98/axial_030.png","assets/T/mri-9bc82b4fc3564f98/axial_031.png","assets/T/mri-9bc82b4fc3564f98/axial_033.png","assets/T/mri-9bc82b4fc3564f98/axial_034.png","assets/T/mri-9bc82b4fc3564f98/axial_035.png","assets/T/mri-9bc82b4fc3564f98/axial_037.png","assets/T/mri-9bc82b4fc3564f98/axial_038.png","assets/T/mri-9bc82b4fc3564f98/axial_039.png","assets/T/mri-9bc82b4fc3564f98/axial_041.png","assets/T/mri-9bc82b4fc3564f98/axial_042.png","assets/T/mri-9bc82b4fc3564f98/coronal_001.png","assets/T/mri-9bc82b4fc3564f98/coronal_002.png","assets/T/mri-9bc82b4fc3564f98/coronal_004.png","assets/T/mri-9bc82b4fc3564f98/coronal_005.png","assets/T/mri-9bc82b4fc3564f98/coronal_006.png","assets/T/mri-9bc82b4fc3564f98/coronal_008.png","assets/T/mri-9bc82b4fc3564f98/coronal_009.png","assets/T/mri-9bc82b4fc3564f98/coronal_010.png","assets/T/mri-9bc82b4fc3564f98/coronal_012.png","assets/T/mri-9bc82b4fc3564f98/coronal_013.png","assets/T/mri-9bc82b4fc3564f98/coronal_015.png","assets/T/mri-9bc82b4fc3564f98/coronal_016.png","assets/T/mri-9bc82b4fc3564f98/coronal_017.png","assets/T/mri-9bc82b4fc3564f98/coronal_019.png","assets/T/mri-9bc82b4fc3564f98/coronal_020.png","assets/T/mri-9bc82b4fc3564f98/coronal_021.png","assets/T/mri-9bc82b4fc3564f98/coronal_023.png","assets/T/mri-9bc82b4fc3564f98/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":66,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,12,13,14,16,17,18,20,21,22,23,25,26,27,29,30,31,33,34,35,37,38,39,41,42,43,44,46,47,48,50,51,52,54,55,57,58,59,61,62,63,65,66]}}
+{"id":"mri-e7ca4067ba764e60","request_id":"L3-T300:mri-e7ca4067ba764e60","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-e7ca4067ba764e60/axial_001.png","assets/T/mri-e7ca4067ba764e60/axial_002.png","assets/T/mri-e7ca4067ba764e60/axial_004.png","assets/T/mri-e7ca4067ba764e60/axial_005.png","assets/T/mri-e7ca4067ba764e60/axial_006.png","assets/T/mri-e7ca4067ba764e60/axial_008.png","assets/T/mri-e7ca4067ba764e60/axial_009.png","assets/T/mri-e7ca4067ba764e60/axial_010.png","assets/T/mri-e7ca4067ba764e60/axial_011.png","assets/T/mri-e7ca4067ba764e60/axial_013.png","assets/T/mri-e7ca4067ba764e60/axial_014.png","assets/T/mri-e7ca4067ba764e60/axial_015.png","assets/T/mri-e7ca4067ba764e60/axial_017.png","assets/T/mri-e7ca4067ba764e60/axial_018.png","assets/T/mri-e7ca4067ba764e60/axial_019.png","assets/T/mri-e7ca4067ba764e60/axial_021.png","assets/T/mri-e7ca4067ba764e60/axial_022.png","assets/T/mri-e7ca4067ba764e60/axial_023.png","assets/T/mri-e7ca4067ba764e60/axial_024.png","assets/T/mri-e7ca4067ba764e60/axial_026.png","assets/T/mri-e7ca4067ba764e60/axial_027.png","assets/T/mri-e7ca4067ba764e60/axial_028.png","assets/T/mri-e7ca4067ba764e60/axial_030.png","assets/T/mri-e7ca4067ba764e60/axial_031.png","assets/T/mri-e7ca4067ba764e60/axial_032.png","assets/T/mri-e7ca4067ba764e60/axial_034.png","assets/T/mri-e7ca4067ba764e60/axial_035.png","assets/T/mri-e7ca4067ba764e60/axial_036.png","assets/T/mri-e7ca4067ba764e60/axial_037.png","assets/T/mri-e7ca4067ba764e60/axial_039.png","assets/T/mri-e7ca4067ba764e60/axial_040.png","assets/T/mri-e7ca4067ba764e60/coronal_001.png","assets/T/mri-e7ca4067ba764e60/coronal_002.png","assets/T/mri-e7ca4067ba764e60/coronal_004.png","assets/T/mri-e7ca4067ba764e60/coronal_005.png","assets/T/mri-e7ca4067ba764e60/coronal_006.png","assets/T/mri-e7ca4067ba764e60/coronal_007.png","assets/T/mri-e7ca4067ba764e60/coronal_009.png","assets/T/mri-e7ca4067ba764e60/coronal_010.png","assets/T/mri-e7ca4067ba764e60/coronal_011.png","assets/T/mri-e7ca4067ba764e60/coronal_013.png","assets/T/mri-e7ca4067ba764e60/coronal_014.png","assets/T/mri-e7ca4067ba764e60/coronal_015.png","assets/T/mri-e7ca4067ba764e60/coronal_016.png","assets/T/mri-e7ca4067ba764e60/coronal_018.png","assets/T/mri-e7ca4067ba764e60/coronal_019.png","assets/T/mri-e7ca4067ba764e60/coronal_020.png","assets/T/mri-e7ca4067ba764e60/coronal_021.png","assets/T/mri-e7ca4067ba764e60/coronal_023.png","assets/T/mri-e7ca4067ba764e60/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":64,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,11,13,14,15,17,18,19,21,22,23,24,26,27,28,30,31,32,34,35,36,37,39,40,41,42,44,45,46,47,49,50,51,53,54,55,56,58,59,60,61,63,64]}}
+{"id":"mri-ca6c28608dc74151","request_id":"L3-T300:mri-ca6c28608dc74151","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-ca6c28608dc74151/axial_001.png","assets/T/mri-ca6c28608dc74151/axial_002.png","assets/T/mri-ca6c28608dc74151/axial_004.png","assets/T/mri-ca6c28608dc74151/axial_005.png","assets/T/mri-ca6c28608dc74151/axial_006.png","assets/T/mri-ca6c28608dc74151/axial_008.png","assets/T/mri-ca6c28608dc74151/axial_009.png","assets/T/mri-ca6c28608dc74151/axial_010.png","assets/T/mri-ca6c28608dc74151/axial_012.png","assets/T/mri-ca6c28608dc74151/axial_013.png","assets/T/mri-ca6c28608dc74151/axial_014.png","assets/T/mri-ca6c28608dc74151/axial_016.png","assets/T/mri-ca6c28608dc74151/axial_017.png","assets/T/mri-ca6c28608dc74151/axial_018.png","assets/T/mri-ca6c28608dc74151/axial_020.png","assets/T/mri-ca6c28608dc74151/axial_021.png","assets/T/mri-ca6c28608dc74151/axial_022.png","assets/T/mri-ca6c28608dc74151/axial_023.png","assets/T/mri-ca6c28608dc74151/axial_025.png","assets/T/mri-ca6c28608dc74151/axial_026.png","assets/T/mri-ca6c28608dc74151/axial_027.png","assets/T/mri-ca6c28608dc74151/axial_029.png","assets/T/mri-ca6c28608dc74151/axial_030.png","assets/T/mri-ca6c28608dc74151/axial_031.png","assets/T/mri-ca6c28608dc74151/axial_033.png","assets/T/mri-ca6c28608dc74151/axial_034.png","assets/T/mri-ca6c28608dc74151/axial_035.png","assets/T/mri-ca6c28608dc74151/axial_037.png","assets/T/mri-ca6c28608dc74151/axial_038.png","assets/T/mri-ca6c28608dc74151/axial_039.png","assets/T/mri-ca6c28608dc74151/axial_041.png","assets/T/mri-ca6c28608dc74151/axial_042.png","assets/T/mri-ca6c28608dc74151/coronal_001.png","assets/T/mri-ca6c28608dc74151/coronal_002.png","assets/T/mri-ca6c28608dc74151/coronal_004.png","assets/T/mri-ca6c28608dc74151/coronal_005.png","assets/T/mri-ca6c28608dc74151/coronal_006.png","assets/T/mri-ca6c28608dc74151/coronal_008.png","assets/T/mri-ca6c28608dc74151/coronal_009.png","assets/T/mri-ca6c28608dc74151/coronal_010.png","assets/T/mri-ca6c28608dc74151/coronal_012.png","assets/T/mri-ca6c28608dc74151/coronal_013.png","assets/T/mri-ca6c28608dc74151/coronal_015.png","assets/T/mri-ca6c28608dc74151/coronal_016.png","assets/T/mri-ca6c28608dc74151/coronal_017.png","assets/T/mri-ca6c28608dc74151/coronal_019.png","assets/T/mri-ca6c28608dc74151/coronal_020.png","assets/T/mri-ca6c28608dc74151/coronal_021.png","assets/T/mri-ca6c28608dc74151/coronal_023.png","assets/T/mri-ca6c28608dc74151/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":66,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,12,13,14,16,17,18,20,21,22,23,25,26,27,29,30,31,33,34,35,37,38,39,41,42,43,44,46,47,48,50,51,52,54,55,57,58,59,61,62,63,65,66]}}
+{"id":"mri-2cda076179fb48e3","request_id":"L3-T300:mri-2cda076179fb48e3","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-2cda076179fb48e3/axial_001.png","assets/T/mri-2cda076179fb48e3/axial_002.png","assets/T/mri-2cda076179fb48e3/axial_004.png","assets/T/mri-2cda076179fb48e3/axial_005.png","assets/T/mri-2cda076179fb48e3/axial_006.png","assets/T/mri-2cda076179fb48e3/axial_008.png","assets/T/mri-2cda076179fb48e3/axial_009.png","assets/T/mri-2cda076179fb48e3/axial_010.png","assets/T/mri-2cda076179fb48e3/axial_012.png","assets/T/mri-2cda076179fb48e3/axial_013.png","assets/T/mri-2cda076179fb48e3/axial_014.png","assets/T/mri-2cda076179fb48e3/axial_016.png","assets/T/mri-2cda076179fb48e3/axial_017.png","assets/T/mri-2cda076179fb48e3/axial_018.png","assets/T/mri-2cda076179fb48e3/axial_020.png","assets/T/mri-2cda076179fb48e3/axial_021.png","assets/T/mri-2cda076179fb48e3/axial_022.png","assets/T/mri-2cda076179fb48e3/axial_023.png","assets/T/mri-2cda076179fb48e3/axial_025.png","assets/T/mri-2cda076179fb48e3/axial_026.png","assets/T/mri-2cda076179fb48e3/axial_027.png","assets/T/mri-2cda076179fb48e3/axial_029.png","assets/T/mri-2cda076179fb48e3/axial_030.png","assets/T/mri-2cda076179fb48e3/axial_031.png","assets/T/mri-2cda076179fb48e3/axial_033.png","assets/T/mri-2cda076179fb48e3/axial_034.png","assets/T/mri-2cda076179fb48e3/axial_035.png","assets/T/mri-2cda076179fb48e3/axial_037.png","assets/T/mri-2cda076179fb48e3/axial_038.png","assets/T/mri-2cda076179fb48e3/axial_039.png","assets/T/mri-2cda076179fb48e3/axial_041.png","assets/T/mri-2cda076179fb48e3/axial_042.png","assets/T/mri-2cda076179fb48e3/coronal_001.png","assets/T/mri-2cda076179fb48e3/coronal_002.png","assets/T/mri-2cda076179fb48e3/coronal_004.png","assets/T/mri-2cda076179fb48e3/coronal_005.png","assets/T/mri-2cda076179fb48e3/coronal_006.png","assets/T/mri-2cda076179fb48e3/coronal_008.png","assets/T/mri-2cda076179fb48e3/coronal_009.png","assets/T/mri-2cda076179fb48e3/coronal_010.png","assets/T/mri-2cda076179fb48e3/coronal_012.png","assets/T/mri-2cda076179fb48e3/coronal_013.png","assets/T/mri-2cda076179fb48e3/coronal_015.png","assets/T/mri-2cda076179fb48e3/coronal_016.png","assets/T/mri-2cda076179fb48e3/coronal_017.png","assets/T/mri-2cda076179fb48e3/coronal_019.png","assets/T/mri-2cda076179fb48e3/coronal_020.png","assets/T/mri-2cda076179fb48e3/coronal_021.png","assets/T/mri-2cda076179fb48e3/coronal_023.png","assets/T/mri-2cda076179fb48e3/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":66,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,12,13,14,16,17,18,20,21,22,23,25,26,27,29,30,31,33,34,35,37,38,39,41,42,43,44,46,47,48,50,51,52,54,55,57,58,59,61,62,63,65,66]}}
+{"id":"mri-bbcf4ba5ac804eee","request_id":"L3-T300:mri-bbcf4ba5ac804eee","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-bbcf4ba5ac804eee/axial_001.png","assets/T/mri-bbcf4ba5ac804eee/axial_002.png","assets/T/mri-bbcf4ba5ac804eee/axial_004.png","assets/T/mri-bbcf4ba5ac804eee/axial_005.png","assets/T/mri-bbcf4ba5ac804eee/axial_007.png","assets/T/mri-bbcf4ba5ac804eee/axial_008.png","assets/T/mri-bbcf4ba5ac804eee/axial_009.png","assets/T/mri-bbcf4ba5ac804eee/axial_011.png","assets/T/mri-bbcf4ba5ac804eee/axial_012.png","assets/T/mri-bbcf4ba5ac804eee/axial_013.png","assets/T/mri-bbcf4ba5ac804eee/axial_015.png","assets/T/mri-bbcf4ba5ac804eee/axial_016.png","assets/T/mri-bbcf4ba5ac804eee/axial_018.png","assets/T/mri-bbcf4ba5ac804eee/axial_019.png","assets/T/mri-bbcf4ba5ac804eee/axial_020.png","assets/T/mri-bbcf4ba5ac804eee/axial_022.png","assets/T/mri-bbcf4ba5ac804eee/axial_023.png","assets/T/mri-bbcf4ba5ac804eee/axial_025.png","assets/T/mri-bbcf4ba5ac804eee/axial_026.png","assets/T/mri-bbcf4ba5ac804eee/axial_027.png","assets/T/mri-bbcf4ba5ac804eee/axial_029.png","assets/T/mri-bbcf4ba5ac804eee/axial_030.png","assets/T/mri-bbcf4ba5ac804eee/axial_032.png","assets/T/mri-bbcf4ba5ac804eee/axial_033.png","assets/T/mri-bbcf4ba5ac804eee/axial_034.png","assets/T/mri-bbcf4ba5ac804eee/axial_036.png","assets/T/mri-bbcf4ba5ac804eee/axial_037.png","assets/T/mri-bbcf4ba5ac804eee/axial_038.png","assets/T/mri-bbcf4ba5ac804eee/axial_040.png","assets/T/mri-bbcf4ba5ac804eee/axial_041.png","assets/T/mri-bbcf4ba5ac804eee/axial_043.png","assets/T/mri-bbcf4ba5ac804eee/axial_044.png","assets/T/mri-bbcf4ba5ac804eee/coronal_001.png","assets/T/mri-bbcf4ba5ac804eee/coronal_002.png","assets/T/mri-bbcf4ba5ac804eee/coronal_004.png","assets/T/mri-bbcf4ba5ac804eee/coronal_005.png","assets/T/mri-bbcf4ba5ac804eee/coronal_006.png","assets/T/mri-bbcf4ba5ac804eee/coronal_008.png","assets/T/mri-bbcf4ba5ac804eee/coronal_009.png","assets/T/mri-bbcf4ba5ac804eee/coronal_010.png","assets/T/mri-bbcf4ba5ac804eee/coronal_012.png","assets/T/mri-bbcf4ba5ac804eee/coronal_013.png","assets/T/mri-bbcf4ba5ac804eee/coronal_015.png","assets/T/mri-bbcf4ba5ac804eee/coronal_016.png","assets/T/mri-bbcf4ba5ac804eee/coronal_017.png","assets/T/mri-bbcf4ba5ac804eee/coronal_019.png","assets/T/mri-bbcf4ba5ac804eee/coronal_020.png","assets/T/mri-bbcf4ba5ac804eee/coronal_021.png","assets/T/mri-bbcf4ba5ac804eee/coronal_023.png","assets/T/mri-bbcf4ba5ac804eee/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":68,"selected_count":50,"source_indices_1based":[1,2,4,5,7,8,9,11,12,13,15,16,18,19,20,22,23,25,26,27,29,30,32,33,34,36,37,38,40,41,43,44,45,46,48,49,50,52,53,54,56,57,59,60,61,63,64,65,67,68]}}
+{"id":"mri-b0306ff4925b498a","request_id":"L3-T300:mri-b0306ff4925b498a","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-b0306ff4925b498a/axial_001.png","assets/T/mri-b0306ff4925b498a/axial_002.png","assets/T/mri-b0306ff4925b498a/axial_004.png","assets/T/mri-b0306ff4925b498a/axial_005.png","assets/T/mri-b0306ff4925b498a/axial_007.png","assets/T/mri-b0306ff4925b498a/axial_008.png","assets/T/mri-b0306ff4925b498a/axial_009.png","assets/T/mri-b0306ff4925b498a/axial_011.png","assets/T/mri-b0306ff4925b498a/axial_012.png","assets/T/mri-b0306ff4925b498a/axial_013.png","assets/T/mri-b0306ff4925b498a/axial_015.png","assets/T/mri-b0306ff4925b498a/axial_016.png","assets/T/mri-b0306ff4925b498a/axial_018.png","assets/T/mri-b0306ff4925b498a/axial_019.png","assets/T/mri-b0306ff4925b498a/axial_020.png","assets/T/mri-b0306ff4925b498a/axial_022.png","assets/T/mri-b0306ff4925b498a/axial_023.png","assets/T/mri-b0306ff4925b498a/axial_025.png","assets/T/mri-b0306ff4925b498a/axial_026.png","assets/T/mri-b0306ff4925b498a/axial_027.png","assets/T/mri-b0306ff4925b498a/axial_029.png","assets/T/mri-b0306ff4925b498a/axial_030.png","assets/T/mri-b0306ff4925b498a/axial_032.png","assets/T/mri-b0306ff4925b498a/axial_033.png","assets/T/mri-b0306ff4925b498a/axial_034.png","assets/T/mri-b0306ff4925b498a/axial_036.png","assets/T/mri-b0306ff4925b498a/axial_037.png","assets/T/mri-b0306ff4925b498a/axial_038.png","assets/T/mri-b0306ff4925b498a/axial_040.png","assets/T/mri-b0306ff4925b498a/axial_041.png","assets/T/mri-b0306ff4925b498a/axial_043.png","assets/T/mri-b0306ff4925b498a/axial_044.png","assets/T/mri-b0306ff4925b498a/coronal_001.png","assets/T/mri-b0306ff4925b498a/coronal_002.png","assets/T/mri-b0306ff4925b498a/coronal_004.png","assets/T/mri-b0306ff4925b498a/coronal_005.png","assets/T/mri-b0306ff4925b498a/coronal_006.png","assets/T/mri-b0306ff4925b498a/coronal_008.png","assets/T/mri-b0306ff4925b498a/coronal_009.png","assets/T/mri-b0306ff4925b498a/coronal_010.png","assets/T/mri-b0306ff4925b498a/coronal_012.png","assets/T/mri-b0306ff4925b498a/coronal_013.png","assets/T/mri-b0306ff4925b498a/coronal_015.png","assets/T/mri-b0306ff4925b498a/coronal_016.png","assets/T/mri-b0306ff4925b498a/coronal_017.png","assets/T/mri-b0306ff4925b498a/coronal_019.png","assets/T/mri-b0306ff4925b498a/coronal_020.png","assets/T/mri-b0306ff4925b498a/coronal_021.png","assets/T/mri-b0306ff4925b498a/coronal_023.png","assets/T/mri-b0306ff4925b498a/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":68,"selected_count":50,"source_indices_1based":[1,2,4,5,7,8,9,11,12,13,15,16,18,19,20,22,23,25,26,27,29,30,32,33,34,36,37,38,40,41,43,44,45,46,48,49,50,52,53,54,56,57,59,60,61,63,64,65,67,68]}}
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+{"id":"mri-ab79773a626e48a4","request_id":"L3-T300:mri-ab79773a626e48a4","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-ab79773a626e48a4/axial_001.png","assets/T/mri-ab79773a626e48a4/axial_002.png","assets/T/mri-ab79773a626e48a4/axial_004.png","assets/T/mri-ab79773a626e48a4/axial_005.png","assets/T/mri-ab79773a626e48a4/axial_006.png","assets/T/mri-ab79773a626e48a4/axial_008.png","assets/T/mri-ab79773a626e48a4/axial_009.png","assets/T/mri-ab79773a626e48a4/axial_011.png","assets/T/mri-ab79773a626e48a4/axial_012.png","assets/T/mri-ab79773a626e48a4/axial_013.png","assets/T/mri-ab79773a626e48a4/axial_015.png","assets/T/mri-ab79773a626e48a4/axial_016.png","assets/T/mri-ab79773a626e48a4/axial_017.png","assets/T/mri-ab79773a626e48a4/axial_019.png","assets/T/mri-ab79773a626e48a4/axial_020.png","assets/T/mri-ab79773a626e48a4/axial_022.png","assets/T/mri-ab79773a626e48a4/axial_023.png","assets/T/mri-ab79773a626e48a4/axial_024.png","assets/T/mri-ab79773a626e48a4/axial_026.png","assets/T/mri-ab79773a626e48a4/axial_027.png","assets/T/mri-ab79773a626e48a4/axial_028.png","assets/T/mri-ab79773a626e48a4/axial_030.png","assets/T/mri-ab79773a626e48a4/axial_031.png","assets/T/mri-ab79773a626e48a4/axial_032.png","assets/T/mri-ab79773a626e48a4/axial_034.png","assets/T/mri-ab79773a626e48a4/axial_035.png","assets/T/mri-ab79773a626e48a4/axial_037.png","assets/T/mri-ab79773a626e48a4/axial_038.png","assets/T/mri-ab79773a626e48a4/axial_039.png","assets/T/mri-ab79773a626e48a4/axial_041.png","assets/T/mri-ab79773a626e48a4/axial_042.png","assets/T/mri-ab79773a626e48a4/coronal_001.png","assets/T/mri-ab79773a626e48a4/coronal_002.png","assets/T/mri-ab79773a626e48a4/coronal_004.png","assets/T/mri-ab79773a626e48a4/coronal_005.png","assets/T/mri-ab79773a626e48a4/coronal_007.png","assets/T/mri-ab79773a626e48a4/coronal_008.png","assets/T/mri-ab79773a626e48a4/coronal_009.png","assets/T/mri-ab79773a626e48a4/coronal_011.png","assets/T/mri-ab79773a626e48a4/coronal_012.png","assets/T/mri-ab79773a626e48a4/coronal_014.png","assets/T/mri-ab79773a626e48a4/coronal_015.png","assets/T/mri-ab79773a626e48a4/coronal_016.png","assets/T/mri-ab79773a626e48a4/coronal_018.png","assets/T/mri-ab79773a626e48a4/coronal_019.png","assets/T/mri-ab79773a626e48a4/coronal_020.png","assets/T/mri-ab79773a626e48a4/coronal_022.png","assets/T/mri-ab79773a626e48a4/coronal_023.png","assets/T/mri-ab79773a626e48a4/coronal_025.png","assets/T/mri-ab79773a626e48a4/coronal_026.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":68,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,11,12,13,15,16,17,19,20,22,23,24,26,27,28,30,31,32,34,35,37,38,39,41,42,43,44,46,47,49,50,51,53,54,56,57,58,60,61,62,64,65,67,68]}}
+{"id":"mri-412e83e3a9394b43","request_id":"L3-T300:mri-412e83e3a9394b43","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-412e83e3a9394b43/axial_001.png","assets/T/mri-412e83e3a9394b43/axial_002.png","assets/T/mri-412e83e3a9394b43/axial_004.png","assets/T/mri-412e83e3a9394b43/axial_005.png","assets/T/mri-412e83e3a9394b43/axial_006.png","assets/T/mri-412e83e3a9394b43/axial_008.png","assets/T/mri-412e83e3a9394b43/axial_009.png","assets/T/mri-412e83e3a9394b43/axial_010.png","assets/T/mri-412e83e3a9394b43/axial_011.png","assets/T/mri-412e83e3a9394b43/axial_013.png","assets/T/mri-412e83e3a9394b43/axial_014.png","assets/T/mri-412e83e3a9394b43/axial_015.png","assets/T/mri-412e83e3a9394b43/axial_017.png","assets/T/mri-412e83e3a9394b43/axial_018.png","assets/T/mri-412e83e3a9394b43/axial_019.png","assets/T/mri-412e83e3a9394b43/axial_021.png","assets/T/mri-412e83e3a9394b43/axial_022.png","assets/T/mri-412e83e3a9394b43/axial_023.png","assets/T/mri-412e83e3a9394b43/axial_024.png","assets/T/mri-412e83e3a9394b43/axial_026.png","assets/T/mri-412e83e3a9394b43/axial_027.png","assets/T/mri-412e83e3a9394b43/axial_028.png","assets/T/mri-412e83e3a9394b43/axial_030.png","assets/T/mri-412e83e3a9394b43/axial_031.png","assets/T/mri-412e83e3a9394b43/axial_032.png","assets/T/mri-412e83e3a9394b43/axial_034.png","assets/T/mri-412e83e3a9394b43/axial_035.png","assets/T/mri-412e83e3a9394b43/axial_036.png","assets/T/mri-412e83e3a9394b43/axial_037.png","assets/T/mri-412e83e3a9394b43/axial_039.png","assets/T/mri-412e83e3a9394b43/axial_040.png","assets/T/mri-412e83e3a9394b43/coronal_001.png","assets/T/mri-412e83e3a9394b43/coronal_002.png","assets/T/mri-412e83e3a9394b43/coronal_004.png","assets/T/mri-412e83e3a9394b43/coronal_005.png","assets/T/mri-412e83e3a9394b43/coronal_006.png","assets/T/mri-412e83e3a9394b43/coronal_007.png","assets/T/mri-412e83e3a9394b43/coronal_009.png","assets/T/mri-412e83e3a9394b43/coronal_010.png","assets/T/mri-412e83e3a9394b43/coronal_011.png","assets/T/mri-412e83e3a9394b43/coronal_013.png","assets/T/mri-412e83e3a9394b43/coronal_014.png","assets/T/mri-412e83e3a9394b43/coronal_015.png","assets/T/mri-412e83e3a9394b43/coronal_016.png","assets/T/mri-412e83e3a9394b43/coronal_018.png","assets/T/mri-412e83e3a9394b43/coronal_019.png","assets/T/mri-412e83e3a9394b43/coronal_020.png","assets/T/mri-412e83e3a9394b43/coronal_021.png","assets/T/mri-412e83e3a9394b43/coronal_023.png","assets/T/mri-412e83e3a9394b43/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":64,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,11,13,14,15,17,18,19,21,22,23,24,26,27,28,30,31,32,34,35,36,37,39,40,41,42,44,45,46,47,49,50,51,53,54,55,56,58,59,60,61,63,64]}}
+{"id":"mri-16c2f9f2b11e43e7","request_id":"L3-T300:mri-16c2f9f2b11e43e7","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-16c2f9f2b11e43e7/axial_001.png","assets/T/mri-16c2f9f2b11e43e7/axial_002.png","assets/T/mri-16c2f9f2b11e43e7/axial_004.png","assets/T/mri-16c2f9f2b11e43e7/axial_005.png","assets/T/mri-16c2f9f2b11e43e7/axial_006.png","assets/T/mri-16c2f9f2b11e43e7/axial_008.png","assets/T/mri-16c2f9f2b11e43e7/axial_009.png","assets/T/mri-16c2f9f2b11e43e7/axial_010.png","assets/T/mri-16c2f9f2b11e43e7/axial_011.png","assets/T/mri-16c2f9f2b11e43e7/axial_013.png","assets/T/mri-16c2f9f2b11e43e7/axial_014.png","assets/T/mri-16c2f9f2b11e43e7/axial_015.png","assets/T/mri-16c2f9f2b11e43e7/axial_017.png","assets/T/mri-16c2f9f2b11e43e7/axial_018.png","assets/T/mri-16c2f9f2b11e43e7/axial_019.png","assets/T/mri-16c2f9f2b11e43e7/axial_021.png","assets/T/mri-16c2f9f2b11e43e7/axial_022.png","assets/T/mri-16c2f9f2b11e43e7/axial_023.png","assets/T/mri-16c2f9f2b11e43e7/axial_024.png","assets/T/mri-16c2f9f2b11e43e7/axial_026.png","assets/T/mri-16c2f9f2b11e43e7/axial_027.png","assets/T/mri-16c2f9f2b11e43e7/axial_028.png","assets/T/mri-16c2f9f2b11e43e7/axial_030.png","assets/T/mri-16c2f9f2b11e43e7/axial_031.png","assets/T/mri-16c2f9f2b11e43e7/axial_032.png","assets/T/mri-16c2f9f2b11e43e7/axial_034.png","assets/T/mri-16c2f9f2b11e43e7/axial_035.png","assets/T/mri-16c2f9f2b11e43e7/axial_036.png","assets/T/mri-16c2f9f2b11e43e7/axial_037.png","assets/T/mri-16c2f9f2b11e43e7/axial_039.png","assets/T/mri-16c2f9f2b11e43e7/axial_040.png","assets/T/mri-16c2f9f2b11e43e7/coronal_001.png","assets/T/mri-16c2f9f2b11e43e7/coronal_002.png","assets/T/mri-16c2f9f2b11e43e7/coronal_004.png","assets/T/mri-16c2f9f2b11e43e7/coronal_005.png","assets/T/mri-16c2f9f2b11e43e7/coronal_006.png","assets/T/mri-16c2f9f2b11e43e7/coronal_007.png","assets/T/mri-16c2f9f2b11e43e7/coronal_009.png","assets/T/mri-16c2f9f2b11e43e7/coronal_010.png","assets/T/mri-16c2f9f2b11e43e7/coronal_011.png","assets/T/mri-16c2f9f2b11e43e7/coronal_013.png","assets/T/mri-16c2f9f2b11e43e7/coronal_014.png","assets/T/mri-16c2f9f2b11e43e7/coronal_015.png","assets/T/mri-16c2f9f2b11e43e7/coronal_016.png","assets/T/mri-16c2f9f2b11e43e7/coronal_018.png","assets/T/mri-16c2f9f2b11e43e7/coronal_019.png","assets/T/mri-16c2f9f2b11e43e7/coronal_020.png","assets/T/mri-16c2f9f2b11e43e7/coronal_021.png","assets/T/mri-16c2f9f2b11e43e7/coronal_023.png","assets/T/mri-16c2f9f2b11e43e7/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":64,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,11,13,14,15,17,18,19,21,22,23,24,26,27,28,30,31,32,34,35,36,37,39,40,41,42,44,45,46,47,49,50,51,53,54,55,56,58,59,60,61,63,64]}}
+{"id":"mri-3f31af08249d42ef","request_id":"L3-T300:mri-3f31af08249d42ef","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-3f31af08249d42ef/axial_001.png","assets/T/mri-3f31af08249d42ef/axial_002.png","assets/T/mri-3f31af08249d42ef/axial_004.png","assets/T/mri-3f31af08249d42ef/axial_005.png","assets/T/mri-3f31af08249d42ef/axial_006.png","assets/T/mri-3f31af08249d42ef/axial_008.png","assets/T/mri-3f31af08249d42ef/axial_009.png","assets/T/mri-3f31af08249d42ef/axial_010.png","assets/T/mri-3f31af08249d42ef/axial_012.png","assets/T/mri-3f31af08249d42ef/axial_013.png","assets/T/mri-3f31af08249d42ef/axial_014.png","assets/T/mri-3f31af08249d42ef/axial_016.png","assets/T/mri-3f31af08249d42ef/axial_017.png","assets/T/mri-3f31af08249d42ef/axial_018.png","assets/T/mri-3f31af08249d42ef/axial_020.png","assets/T/mri-3f31af08249d42ef/axial_021.png","assets/T/mri-3f31af08249d42ef/axial_022.png","assets/T/mri-3f31af08249d42ef/axial_023.png","assets/T/mri-3f31af08249d42ef/axial_025.png","assets/T/mri-3f31af08249d42ef/axial_026.png","assets/T/mri-3f31af08249d42ef/axial_027.png","assets/T/mri-3f31af08249d42ef/axial_029.png","assets/T/mri-3f31af08249d42ef/axial_030.png","assets/T/mri-3f31af08249d42ef/axial_031.png","assets/T/mri-3f31af08249d42ef/axial_033.png","assets/T/mri-3f31af08249d42ef/axial_034.png","assets/T/mri-3f31af08249d42ef/axial_035.png","assets/T/mri-3f31af08249d42ef/axial_037.png","assets/T/mri-3f31af08249d42ef/axial_038.png","assets/T/mri-3f31af08249d42ef/axial_039.png","assets/T/mri-3f31af08249d42ef/axial_041.png","assets/T/mri-3f31af08249d42ef/axial_042.png","assets/T/mri-3f31af08249d42ef/coronal_001.png","assets/T/mri-3f31af08249d42ef/coronal_002.png","assets/T/mri-3f31af08249d42ef/coronal_004.png","assets/T/mri-3f31af08249d42ef/coronal_005.png","assets/T/mri-3f31af08249d42ef/coronal_006.png","assets/T/mri-3f31af08249d42ef/coronal_008.png","assets/T/mri-3f31af08249d42ef/coronal_009.png","assets/T/mri-3f31af08249d42ef/coronal_010.png","assets/T/mri-3f31af08249d42ef/coronal_012.png","assets/T/mri-3f31af08249d42ef/coronal_013.png","assets/T/mri-3f31af08249d42ef/coronal_015.png","assets/T/mri-3f31af08249d42ef/coronal_016.png","assets/T/mri-3f31af08249d42ef/coronal_017.png","assets/T/mri-3f31af08249d42ef/coronal_019.png","assets/T/mri-3f31af08249d42ef/coronal_020.png","assets/T/mri-3f31af08249d42ef/coronal_021.png","assets/T/mri-3f31af08249d42ef/coronal_023.png","assets/T/mri-3f31af08249d42ef/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":66,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,12,13,14,16,17,18,20,21,22,23,25,26,27,29,30,31,33,34,35,37,38,39,41,42,43,44,46,47,48,50,51,52,54,55,57,58,59,61,62,63,65,66]}}
+{"id":"mri-25fd5f6282bd417a","request_id":"L3-T300:mri-25fd5f6282bd417a","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 33 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 17 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-25fd5f6282bd417a/axial_001.png","assets/T/mri-25fd5f6282bd417a/axial_002.png","assets/T/mri-25fd5f6282bd417a/axial_004.png","assets/T/mri-25fd5f6282bd417a/axial_005.png","assets/T/mri-25fd5f6282bd417a/axial_007.png","assets/T/mri-25fd5f6282bd417a/axial_008.png","assets/T/mri-25fd5f6282bd417a/axial_009.png","assets/T/mri-25fd5f6282bd417a/axial_011.png","assets/T/mri-25fd5f6282bd417a/axial_012.png","assets/T/mri-25fd5f6282bd417a/axial_014.png","assets/T/mri-25fd5f6282bd417a/axial_015.png","assets/T/mri-25fd5f6282bd417a/axial_016.png","assets/T/mri-25fd5f6282bd417a/axial_018.png","assets/T/mri-25fd5f6282bd417a/axial_019.png","assets/T/mri-25fd5f6282bd417a/axial_021.png","assets/T/mri-25fd5f6282bd417a/axial_022.png","assets/T/mri-25fd5f6282bd417a/axial_024.png","assets/T/mri-25fd5f6282bd417a/axial_025.png","assets/T/mri-25fd5f6282bd417a/axial_026.png","assets/T/mri-25fd5f6282bd417a/axial_028.png","assets/T/mri-25fd5f6282bd417a/axial_029.png","assets/T/mri-25fd5f6282bd417a/axial_031.png","assets/T/mri-25fd5f6282bd417a/axial_032.png","assets/T/mri-25fd5f6282bd417a/axial_033.png","assets/T/mri-25fd5f6282bd417a/axial_035.png","assets/T/mri-25fd5f6282bd417a/axial_036.png","assets/T/mri-25fd5f6282bd417a/axial_038.png","assets/T/mri-25fd5f6282bd417a/axial_039.png","assets/T/mri-25fd5f6282bd417a/axial_040.png","assets/T/mri-25fd5f6282bd417a/axial_042.png","assets/T/mri-25fd5f6282bd417a/axial_043.png","assets/T/mri-25fd5f6282bd417a/axial_045.png","assets/T/mri-25fd5f6282bd417a/axial_046.png","assets/T/mri-25fd5f6282bd417a/coronal_001.png","assets/T/mri-25fd5f6282bd417a/coronal_002.png","assets/T/mri-25fd5f6282bd417a/coronal_004.png","assets/T/mri-25fd5f6282bd417a/coronal_005.png","assets/T/mri-25fd5f6282bd417a/coronal_007.png","assets/T/mri-25fd5f6282bd417a/coronal_008.png","assets/T/mri-25fd5f6282bd417a/coronal_010.png","assets/T/mri-25fd5f6282bd417a/coronal_011.png","assets/T/mri-25fd5f6282bd417a/coronal_013.png","assets/T/mri-25fd5f6282bd417a/coronal_014.png","assets/T/mri-25fd5f6282bd417a/coronal_015.png","assets/T/mri-25fd5f6282bd417a/coronal_017.png","assets/T/mri-25fd5f6282bd417a/coronal_018.png","assets/T/mri-25fd5f6282bd417a/coronal_020.png","assets/T/mri-25fd5f6282bd417a/coronal_021.png","assets/T/mri-25fd5f6282bd417a/coronal_023.png","assets/T/mri-25fd5f6282bd417a/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":70,"selected_count":50,"source_indices_1based":[1,2,4,5,7,8,9,11,12,14,15,16,18,19,21,22,24,25,26,28,29,31,32,33,35,36,38,39,40,42,43,45,46,47,48,50,51,53,54,56,57,59,60,61,63,64,66,67,69,70]}}
+{"id":"mri-acc2b4aa749d4481","request_id":"L3-T300:mri-acc2b4aa749d4481","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-acc2b4aa749d4481/axial_001.png","assets/T/mri-acc2b4aa749d4481/axial_002.png","assets/T/mri-acc2b4aa749d4481/axial_004.png","assets/T/mri-acc2b4aa749d4481/axial_005.png","assets/T/mri-acc2b4aa749d4481/axial_006.png","assets/T/mri-acc2b4aa749d4481/axial_008.png","assets/T/mri-acc2b4aa749d4481/axial_009.png","assets/T/mri-acc2b4aa749d4481/axial_010.png","assets/T/mri-acc2b4aa749d4481/axial_011.png","assets/T/mri-acc2b4aa749d4481/axial_013.png","assets/T/mri-acc2b4aa749d4481/axial_014.png","assets/T/mri-acc2b4aa749d4481/axial_015.png","assets/T/mri-acc2b4aa749d4481/axial_017.png","assets/T/mri-acc2b4aa749d4481/axial_018.png","assets/T/mri-acc2b4aa749d4481/axial_019.png","assets/T/mri-acc2b4aa749d4481/axial_021.png","assets/T/mri-acc2b4aa749d4481/axial_022.png","assets/T/mri-acc2b4aa749d4481/axial_023.png","assets/T/mri-acc2b4aa749d4481/axial_024.png","assets/T/mri-acc2b4aa749d4481/axial_026.png","assets/T/mri-acc2b4aa749d4481/axial_027.png","assets/T/mri-acc2b4aa749d4481/axial_028.png","assets/T/mri-acc2b4aa749d4481/axial_030.png","assets/T/mri-acc2b4aa749d4481/axial_031.png","assets/T/mri-acc2b4aa749d4481/axial_032.png","assets/T/mri-acc2b4aa749d4481/axial_034.png","assets/T/mri-acc2b4aa749d4481/axial_035.png","assets/T/mri-acc2b4aa749d4481/axial_036.png","assets/T/mri-acc2b4aa749d4481/axial_037.png","assets/T/mri-acc2b4aa749d4481/axial_039.png","assets/T/mri-acc2b4aa749d4481/axial_040.png","assets/T/mri-acc2b4aa749d4481/coronal_001.png","assets/T/mri-acc2b4aa749d4481/coronal_002.png","assets/T/mri-acc2b4aa749d4481/coronal_004.png","assets/T/mri-acc2b4aa749d4481/coronal_005.png","assets/T/mri-acc2b4aa749d4481/coronal_006.png","assets/T/mri-acc2b4aa749d4481/coronal_007.png","assets/T/mri-acc2b4aa749d4481/coronal_009.png","assets/T/mri-acc2b4aa749d4481/coronal_010.png","assets/T/mri-acc2b4aa749d4481/coronal_011.png","assets/T/mri-acc2b4aa749d4481/coronal_013.png","assets/T/mri-acc2b4aa749d4481/coronal_014.png","assets/T/mri-acc2b4aa749d4481/coronal_015.png","assets/T/mri-acc2b4aa749d4481/coronal_016.png","assets/T/mri-acc2b4aa749d4481/coronal_018.png","assets/T/mri-acc2b4aa749d4481/coronal_019.png","assets/T/mri-acc2b4aa749d4481/coronal_020.png","assets/T/mri-acc2b4aa749d4481/coronal_021.png","assets/T/mri-acc2b4aa749d4481/coronal_023.png","assets/T/mri-acc2b4aa749d4481/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":64,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,11,13,14,15,17,18,19,21,22,23,24,26,27,28,30,31,32,34,35,36,37,39,40,41,42,44,45,46,47,49,50,51,53,54,55,56,58,59,60,61,63,64]}}
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+{"id":"mri-f18cbd80507c4825","request_id":"L3-T300:mri-f18cbd80507c4825","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-f18cbd80507c4825/axial_001.png","assets/T/mri-f18cbd80507c4825/axial_002.png","assets/T/mri-f18cbd80507c4825/axial_004.png","assets/T/mri-f18cbd80507c4825/axial_005.png","assets/T/mri-f18cbd80507c4825/axial_007.png","assets/T/mri-f18cbd80507c4825/axial_008.png","assets/T/mri-f18cbd80507c4825/axial_009.png","assets/T/mri-f18cbd80507c4825/axial_011.png","assets/T/mri-f18cbd80507c4825/axial_012.png","assets/T/mri-f18cbd80507c4825/axial_013.png","assets/T/mri-f18cbd80507c4825/axial_015.png","assets/T/mri-f18cbd80507c4825/axial_016.png","assets/T/mri-f18cbd80507c4825/axial_018.png","assets/T/mri-f18cbd80507c4825/axial_019.png","assets/T/mri-f18cbd80507c4825/axial_020.png","assets/T/mri-f18cbd80507c4825/axial_022.png","assets/T/mri-f18cbd80507c4825/axial_023.png","assets/T/mri-f18cbd80507c4825/axial_025.png","assets/T/mri-f18cbd80507c4825/axial_026.png","assets/T/mri-f18cbd80507c4825/axial_027.png","assets/T/mri-f18cbd80507c4825/axial_029.png","assets/T/mri-f18cbd80507c4825/axial_030.png","assets/T/mri-f18cbd80507c4825/axial_032.png","assets/T/mri-f18cbd80507c4825/axial_033.png","assets/T/mri-f18cbd80507c4825/axial_034.png","assets/T/mri-f18cbd80507c4825/axial_036.png","assets/T/mri-f18cbd80507c4825/axial_037.png","assets/T/mri-f18cbd80507c4825/axial_038.png","assets/T/mri-f18cbd80507c4825/axial_040.png","assets/T/mri-f18cbd80507c4825/axial_041.png","assets/T/mri-f18cbd80507c4825/axial_043.png","assets/T/mri-f18cbd80507c4825/axial_044.png","assets/T/mri-f18cbd80507c4825/coronal_001.png","assets/T/mri-f18cbd80507c4825/coronal_002.png","assets/T/mri-f18cbd80507c4825/coronal_004.png","assets/T/mri-f18cbd80507c4825/coronal_005.png","assets/T/mri-f18cbd80507c4825/coronal_006.png","assets/T/mri-f18cbd80507c4825/coronal_008.png","assets/T/mri-f18cbd80507c4825/coronal_009.png","assets/T/mri-f18cbd80507c4825/coronal_010.png","assets/T/mri-f18cbd80507c4825/coronal_012.png","assets/T/mri-f18cbd80507c4825/coronal_013.png","assets/T/mri-f18cbd80507c4825/coronal_015.png","assets/T/mri-f18cbd80507c4825/coronal_016.png","assets/T/mri-f18cbd80507c4825/coronal_017.png","assets/T/mri-f18cbd80507c4825/coronal_019.png","assets/T/mri-f18cbd80507c4825/coronal_020.png","assets/T/mri-f18cbd80507c4825/coronal_021.png","assets/T/mri-f18cbd80507c4825/coronal_023.png","assets/T/mri-f18cbd80507c4825/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":68,"selected_count":50,"source_indices_1based":[1,2,4,5,7,8,9,11,12,13,15,16,18,19,20,22,23,25,26,27,29,30,32,33,34,36,37,38,40,41,43,44,45,46,48,49,50,52,53,54,56,57,59,60,61,63,64,65,67,68]}}
+{"id":"mri-b03c65e16e9040f7","request_id":"L3-T300:mri-b03c65e16e9040f7","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-b03c65e16e9040f7/axial_001.png","assets/T/mri-b03c65e16e9040f7/axial_002.png","assets/T/mri-b03c65e16e9040f7/axial_004.png","assets/T/mri-b03c65e16e9040f7/axial_005.png","assets/T/mri-b03c65e16e9040f7/axial_006.png","assets/T/mri-b03c65e16e9040f7/axial_008.png","assets/T/mri-b03c65e16e9040f7/axial_009.png","assets/T/mri-b03c65e16e9040f7/axial_011.png","assets/T/mri-b03c65e16e9040f7/axial_012.png","assets/T/mri-b03c65e16e9040f7/axial_013.png","assets/T/mri-b03c65e16e9040f7/axial_015.png","assets/T/mri-b03c65e16e9040f7/axial_016.png","assets/T/mri-b03c65e16e9040f7/axial_017.png","assets/T/mri-b03c65e16e9040f7/axial_019.png","assets/T/mri-b03c65e16e9040f7/axial_020.png","assets/T/mri-b03c65e16e9040f7/axial_022.png","assets/T/mri-b03c65e16e9040f7/axial_023.png","assets/T/mri-b03c65e16e9040f7/axial_024.png","assets/T/mri-b03c65e16e9040f7/axial_026.png","assets/T/mri-b03c65e16e9040f7/axial_027.png","assets/T/mri-b03c65e16e9040f7/axial_028.png","assets/T/mri-b03c65e16e9040f7/axial_030.png","assets/T/mri-b03c65e16e9040f7/axial_031.png","assets/T/mri-b03c65e16e9040f7/axial_032.png","assets/T/mri-b03c65e16e9040f7/axial_034.png","assets/T/mri-b03c65e16e9040f7/axial_035.png","assets/T/mri-b03c65e16e9040f7/axial_037.png","assets/T/mri-b03c65e16e9040f7/axial_038.png","assets/T/mri-b03c65e16e9040f7/axial_039.png","assets/T/mri-b03c65e16e9040f7/axial_041.png","assets/T/mri-b03c65e16e9040f7/axial_042.png","assets/T/mri-b03c65e16e9040f7/coronal_001.png","assets/T/mri-b03c65e16e9040f7/coronal_002.png","assets/T/mri-b03c65e16e9040f7/coronal_004.png","assets/T/mri-b03c65e16e9040f7/coronal_005.png","assets/T/mri-b03c65e16e9040f7/coronal_007.png","assets/T/mri-b03c65e16e9040f7/coronal_008.png","assets/T/mri-b03c65e16e9040f7/coronal_009.png","assets/T/mri-b03c65e16e9040f7/coronal_011.png","assets/T/mri-b03c65e16e9040f7/coronal_012.png","assets/T/mri-b03c65e16e9040f7/coronal_014.png","assets/T/mri-b03c65e16e9040f7/coronal_015.png","assets/T/mri-b03c65e16e9040f7/coronal_016.png","assets/T/mri-b03c65e16e9040f7/coronal_018.png","assets/T/mri-b03c65e16e9040f7/coronal_019.png","assets/T/mri-b03c65e16e9040f7/coronal_020.png","assets/T/mri-b03c65e16e9040f7/coronal_022.png","assets/T/mri-b03c65e16e9040f7/coronal_023.png","assets/T/mri-b03c65e16e9040f7/coronal_025.png","assets/T/mri-b03c65e16e9040f7/coronal_026.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":68,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,11,12,13,15,16,17,19,20,22,23,24,26,27,28,30,31,32,34,35,37,38,39,41,42,43,44,46,47,49,50,51,53,54,56,57,58,60,61,62,64,65,67,68]}}
+{"id":"mri-46fd12fc3c8e4db4","request_id":"L3-T300:mri-46fd12fc3c8e4db4","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-46fd12fc3c8e4db4/axial_001.png","assets/T/mri-46fd12fc3c8e4db4/axial_002.png","assets/T/mri-46fd12fc3c8e4db4/axial_004.png","assets/T/mri-46fd12fc3c8e4db4/axial_005.png","assets/T/mri-46fd12fc3c8e4db4/axial_006.png","assets/T/mri-46fd12fc3c8e4db4/axial_008.png","assets/T/mri-46fd12fc3c8e4db4/axial_009.png","assets/T/mri-46fd12fc3c8e4db4/axial_010.png","assets/T/mri-46fd12fc3c8e4db4/axial_011.png","assets/T/mri-46fd12fc3c8e4db4/axial_013.png","assets/T/mri-46fd12fc3c8e4db4/axial_014.png","assets/T/mri-46fd12fc3c8e4db4/axial_015.png","assets/T/mri-46fd12fc3c8e4db4/axial_017.png","assets/T/mri-46fd12fc3c8e4db4/axial_018.png","assets/T/mri-46fd12fc3c8e4db4/axial_019.png","assets/T/mri-46fd12fc3c8e4db4/axial_021.png","assets/T/mri-46fd12fc3c8e4db4/axial_022.png","assets/T/mri-46fd12fc3c8e4db4/axial_023.png","assets/T/mri-46fd12fc3c8e4db4/axial_024.png","assets/T/mri-46fd12fc3c8e4db4/axial_026.png","assets/T/mri-46fd12fc3c8e4db4/axial_027.png","assets/T/mri-46fd12fc3c8e4db4/axial_028.png","assets/T/mri-46fd12fc3c8e4db4/axial_030.png","assets/T/mri-46fd12fc3c8e4db4/axial_031.png","assets/T/mri-46fd12fc3c8e4db4/axial_032.png","assets/T/mri-46fd12fc3c8e4db4/axial_034.png","assets/T/mri-46fd12fc3c8e4db4/axial_035.png","assets/T/mri-46fd12fc3c8e4db4/axial_036.png","assets/T/mri-46fd12fc3c8e4db4/axial_037.png","assets/T/mri-46fd12fc3c8e4db4/axial_039.png","assets/T/mri-46fd12fc3c8e4db4/axial_040.png","assets/T/mri-46fd12fc3c8e4db4/coronal_001.png","assets/T/mri-46fd12fc3c8e4db4/coronal_002.png","assets/T/mri-46fd12fc3c8e4db4/coronal_004.png","assets/T/mri-46fd12fc3c8e4db4/coronal_005.png","assets/T/mri-46fd12fc3c8e4db4/coronal_006.png","assets/T/mri-46fd12fc3c8e4db4/coronal_007.png","assets/T/mri-46fd12fc3c8e4db4/coronal_009.png","assets/T/mri-46fd12fc3c8e4db4/coronal_010.png","assets/T/mri-46fd12fc3c8e4db4/coronal_011.png","assets/T/mri-46fd12fc3c8e4db4/coronal_013.png","assets/T/mri-46fd12fc3c8e4db4/coronal_014.png","assets/T/mri-46fd12fc3c8e4db4/coronal_015.png","assets/T/mri-46fd12fc3c8e4db4/coronal_016.png","assets/T/mri-46fd12fc3c8e4db4/coronal_018.png","assets/T/mri-46fd12fc3c8e4db4/coronal_019.png","assets/T/mri-46fd12fc3c8e4db4/coronal_020.png","assets/T/mri-46fd12fc3c8e4db4/coronal_021.png","assets/T/mri-46fd12fc3c8e4db4/coronal_023.png","assets/T/mri-46fd12fc3c8e4db4/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":64,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,11,13,14,15,17,18,19,21,22,23,24,26,27,28,30,31,32,34,35,36,37,39,40,41,42,44,45,46,47,49,50,51,53,54,55,56,58,59,60,61,63,64]}}
+{"id":"mri-f1332bb1d0564e4d","request_id":"L3-T300:mri-f1332bb1d0564e4d","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-f1332bb1d0564e4d/axial_001.png","assets/T/mri-f1332bb1d0564e4d/axial_002.png","assets/T/mri-f1332bb1d0564e4d/axial_003.png","assets/T/mri-f1332bb1d0564e4d/axial_005.png","assets/T/mri-f1332bb1d0564e4d/axial_006.png","assets/T/mri-f1332bb1d0564e4d/axial_007.png","assets/T/mri-f1332bb1d0564e4d/axial_008.png","assets/T/mri-f1332bb1d0564e4d/axial_010.png","assets/T/mri-f1332bb1d0564e4d/axial_011.png","assets/T/mri-f1332bb1d0564e4d/axial_012.png","assets/T/mri-f1332bb1d0564e4d/axial_013.png","assets/T/mri-f1332bb1d0564e4d/axial_015.png","assets/T/mri-f1332bb1d0564e4d/axial_016.png","assets/T/mri-f1332bb1d0564e4d/axial_017.png","assets/T/mri-f1332bb1d0564e4d/axial_018.png","assets/T/mri-f1332bb1d0564e4d/axial_020.png","assets/T/mri-f1332bb1d0564e4d/axial_021.png","assets/T/mri-f1332bb1d0564e4d/axial_022.png","assets/T/mri-f1332bb1d0564e4d/axial_023.png","assets/T/mri-f1332bb1d0564e4d/axial_024.png","assets/T/mri-f1332bb1d0564e4d/axial_026.png","assets/T/mri-f1332bb1d0564e4d/axial_027.png","assets/T/mri-f1332bb1d0564e4d/axial_028.png","assets/T/mri-f1332bb1d0564e4d/axial_029.png","assets/T/mri-f1332bb1d0564e4d/axial_031.png","assets/T/mri-f1332bb1d0564e4d/axial_032.png","assets/T/mri-f1332bb1d0564e4d/axial_033.png","assets/T/mri-f1332bb1d0564e4d/axial_034.png","assets/T/mri-f1332bb1d0564e4d/axial_036.png","assets/T/mri-f1332bb1d0564e4d/axial_037.png","assets/T/mri-f1332bb1d0564e4d/axial_038.png","assets/T/mri-f1332bb1d0564e4d/coronal_001.png","assets/T/mri-f1332bb1d0564e4d/coronal_002.png","assets/T/mri-f1332bb1d0564e4d/coronal_004.png","assets/T/mri-f1332bb1d0564e4d/coronal_005.png","assets/T/mri-f1332bb1d0564e4d/coronal_006.png","assets/T/mri-f1332bb1d0564e4d/coronal_007.png","assets/T/mri-f1332bb1d0564e4d/coronal_009.png","assets/T/mri-f1332bb1d0564e4d/coronal_010.png","assets/T/mri-f1332bb1d0564e4d/coronal_011.png","assets/T/mri-f1332bb1d0564e4d/coronal_013.png","assets/T/mri-f1332bb1d0564e4d/coronal_014.png","assets/T/mri-f1332bb1d0564e4d/coronal_015.png","assets/T/mri-f1332bb1d0564e4d/coronal_016.png","assets/T/mri-f1332bb1d0564e4d/coronal_018.png","assets/T/mri-f1332bb1d0564e4d/coronal_019.png","assets/T/mri-f1332bb1d0564e4d/coronal_020.png","assets/T/mri-f1332bb1d0564e4d/coronal_021.png","assets/T/mri-f1332bb1d0564e4d/coronal_023.png","assets/T/mri-f1332bb1d0564e4d/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":62,"selected_count":50,"source_indices_1based":[1,2,3,5,6,7,8,10,11,12,13,15,16,17,18,20,21,22,23,24,26,27,28,29,31,32,33,34,36,37,38,39,40,42,43,44,45,47,48,49,51,52,53,54,56,57,58,59,61,62]}}
+{"id":"mri-eb71471006a94a6e","request_id":"L3-T300:mri-eb71471006a94a6e","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-eb71471006a94a6e/axial_001.png","assets/T/mri-eb71471006a94a6e/axial_002.png","assets/T/mri-eb71471006a94a6e/axial_004.png","assets/T/mri-eb71471006a94a6e/axial_005.png","assets/T/mri-eb71471006a94a6e/axial_006.png","assets/T/mri-eb71471006a94a6e/axial_008.png","assets/T/mri-eb71471006a94a6e/axial_009.png","assets/T/mri-eb71471006a94a6e/axial_010.png","assets/T/mri-eb71471006a94a6e/axial_011.png","assets/T/mri-eb71471006a94a6e/axial_013.png","assets/T/mri-eb71471006a94a6e/axial_014.png","assets/T/mri-eb71471006a94a6e/axial_015.png","assets/T/mri-eb71471006a94a6e/axial_017.png","assets/T/mri-eb71471006a94a6e/axial_018.png","assets/T/mri-eb71471006a94a6e/axial_019.png","assets/T/mri-eb71471006a94a6e/axial_021.png","assets/T/mri-eb71471006a94a6e/axial_022.png","assets/T/mri-eb71471006a94a6e/axial_023.png","assets/T/mri-eb71471006a94a6e/axial_024.png","assets/T/mri-eb71471006a94a6e/axial_026.png","assets/T/mri-eb71471006a94a6e/axial_027.png","assets/T/mri-eb71471006a94a6e/axial_028.png","assets/T/mri-eb71471006a94a6e/axial_030.png","assets/T/mri-eb71471006a94a6e/axial_031.png","assets/T/mri-eb71471006a94a6e/axial_032.png","assets/T/mri-eb71471006a94a6e/axial_034.png","assets/T/mri-eb71471006a94a6e/axial_035.png","assets/T/mri-eb71471006a94a6e/axial_036.png","assets/T/mri-eb71471006a94a6e/axial_037.png","assets/T/mri-eb71471006a94a6e/axial_039.png","assets/T/mri-eb71471006a94a6e/axial_040.png","assets/T/mri-eb71471006a94a6e/coronal_001.png","assets/T/mri-eb71471006a94a6e/coronal_002.png","assets/T/mri-eb71471006a94a6e/coronal_004.png","assets/T/mri-eb71471006a94a6e/coronal_005.png","assets/T/mri-eb71471006a94a6e/coronal_006.png","assets/T/mri-eb71471006a94a6e/coronal_007.png","assets/T/mri-eb71471006a94a6e/coronal_009.png","assets/T/mri-eb71471006a94a6e/coronal_010.png","assets/T/mri-eb71471006a94a6e/coronal_011.png","assets/T/mri-eb71471006a94a6e/coronal_013.png","assets/T/mri-eb71471006a94a6e/coronal_014.png","assets/T/mri-eb71471006a94a6e/coronal_015.png","assets/T/mri-eb71471006a94a6e/coronal_016.png","assets/T/mri-eb71471006a94a6e/coronal_018.png","assets/T/mri-eb71471006a94a6e/coronal_019.png","assets/T/mri-eb71471006a94a6e/coronal_020.png","assets/T/mri-eb71471006a94a6e/coronal_021.png","assets/T/mri-eb71471006a94a6e/coronal_023.png","assets/T/mri-eb71471006a94a6e/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":64,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,11,13,14,15,17,18,19,21,22,23,24,26,27,28,30,31,32,34,35,36,37,39,40,41,42,44,45,46,47,49,50,51,53,54,55,56,58,59,60,61,63,64]}}
+{"id":"mri-3e9b74c4b7e84825","request_id":"L3-T300:mri-3e9b74c4b7e84825","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 30 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 20 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-3e9b74c4b7e84825/axial_001.png","assets/T/mri-3e9b74c4b7e84825/axial_002.png","assets/T/mri-3e9b74c4b7e84825/axial_004.png","assets/T/mri-3e9b74c4b7e84825/axial_005.png","assets/T/mri-3e9b74c4b7e84825/axial_007.png","assets/T/mri-3e9b74c4b7e84825/axial_008.png","assets/T/mri-3e9b74c4b7e84825/axial_009.png","assets/T/mri-3e9b74c4b7e84825/axial_011.png","assets/T/mri-3e9b74c4b7e84825/axial_012.png","assets/T/mri-3e9b74c4b7e84825/axial_014.png","assets/T/mri-3e9b74c4b7e84825/axial_015.png","assets/T/mri-3e9b74c4b7e84825/axial_017.png","assets/T/mri-3e9b74c4b7e84825/axial_018.png","assets/T/mri-3e9b74c4b7e84825/axial_019.png","assets/T/mri-3e9b74c4b7e84825/axial_021.png","assets/T/mri-3e9b74c4b7e84825/axial_022.png","assets/T/mri-3e9b74c4b7e84825/axial_024.png","assets/T/mri-3e9b74c4b7e84825/axial_025.png","assets/T/mri-3e9b74c4b7e84825/axial_026.png","assets/T/mri-3e9b74c4b7e84825/axial_028.png","assets/T/mri-3e9b74c4b7e84825/axial_029.png","assets/T/mri-3e9b74c4b7e84825/axial_031.png","assets/T/mri-3e9b74c4b7e84825/axial_032.png","assets/T/mri-3e9b74c4b7e84825/axial_034.png","assets/T/mri-3e9b74c4b7e84825/axial_035.png","assets/T/mri-3e9b74c4b7e84825/axial_036.png","assets/T/mri-3e9b74c4b7e84825/axial_038.png","assets/T/mri-3e9b74c4b7e84825/axial_039.png","assets/T/mri-3e9b74c4b7e84825/axial_041.png","assets/T/mri-3e9b74c4b7e84825/axial_042.png","assets/T/mri-3e9b74c4b7e84825/coronal_001.png","assets/T/mri-3e9b74c4b7e84825/coronal_002.png","assets/T/mri-3e9b74c4b7e84825/coronal_004.png","assets/T/mri-3e9b74c4b7e84825/coronal_005.png","assets/T/mri-3e9b74c4b7e84825/coronal_007.png","assets/T/mri-3e9b74c4b7e84825/coronal_008.png","assets/T/mri-3e9b74c4b7e84825/coronal_010.png","assets/T/mri-3e9b74c4b7e84825/coronal_011.png","assets/T/mri-3e9b74c4b7e84825/coronal_012.png","assets/T/mri-3e9b74c4b7e84825/coronal_014.png","assets/T/mri-3e9b74c4b7e84825/coronal_015.png","assets/T/mri-3e9b74c4b7e84825/coronal_017.png","assets/T/mri-3e9b74c4b7e84825/coronal_018.png","assets/T/mri-3e9b74c4b7e84825/coronal_019.png","assets/T/mri-3e9b74c4b7e84825/coronal_021.png","assets/T/mri-3e9b74c4b7e84825/coronal_022.png","assets/T/mri-3e9b74c4b7e84825/coronal_024.png","assets/T/mri-3e9b74c4b7e84825/coronal_025.png","assets/T/mri-3e9b74c4b7e84825/coronal_027.png","assets/T/mri-3e9b74c4b7e84825/coronal_028.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":70,"selected_count":50,"source_indices_1based":[1,2,4,5,7,8,9,11,12,14,15,17,18,19,21,22,24,25,26,28,29,31,32,34,35,36,38,39,41,42,43,44,46,47,49,50,52,53,54,56,57,59,60,61,63,64,66,67,69,70]}}
+{"id":"mri-de9e22a5b5b946f0","request_id":"L3-T300:mri-de9e22a5b5b946f0","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-de9e22a5b5b946f0/axial_001.png","assets/T/mri-de9e22a5b5b946f0/axial_002.png","assets/T/mri-de9e22a5b5b946f0/axial_004.png","assets/T/mri-de9e22a5b5b946f0/axial_005.png","assets/T/mri-de9e22a5b5b946f0/axial_006.png","assets/T/mri-de9e22a5b5b946f0/axial_008.png","assets/T/mri-de9e22a5b5b946f0/axial_009.png","assets/T/mri-de9e22a5b5b946f0/axial_010.png","assets/T/mri-de9e22a5b5b946f0/axial_012.png","assets/T/mri-de9e22a5b5b946f0/axial_013.png","assets/T/mri-de9e22a5b5b946f0/axial_014.png","assets/T/mri-de9e22a5b5b946f0/axial_016.png","assets/T/mri-de9e22a5b5b946f0/axial_017.png","assets/T/mri-de9e22a5b5b946f0/axial_018.png","assets/T/mri-de9e22a5b5b946f0/axial_020.png","assets/T/mri-de9e22a5b5b946f0/axial_021.png","assets/T/mri-de9e22a5b5b946f0/axial_022.png","assets/T/mri-de9e22a5b5b946f0/axial_023.png","assets/T/mri-de9e22a5b5b946f0/axial_025.png","assets/T/mri-de9e22a5b5b946f0/axial_026.png","assets/T/mri-de9e22a5b5b946f0/axial_027.png","assets/T/mri-de9e22a5b5b946f0/axial_029.png","assets/T/mri-de9e22a5b5b946f0/axial_030.png","assets/T/mri-de9e22a5b5b946f0/axial_031.png","assets/T/mri-de9e22a5b5b946f0/axial_033.png","assets/T/mri-de9e22a5b5b946f0/axial_034.png","assets/T/mri-de9e22a5b5b946f0/axial_035.png","assets/T/mri-de9e22a5b5b946f0/axial_037.png","assets/T/mri-de9e22a5b5b946f0/axial_038.png","assets/T/mri-de9e22a5b5b946f0/axial_039.png","assets/T/mri-de9e22a5b5b946f0/axial_041.png","assets/T/mri-de9e22a5b5b946f0/axial_042.png","assets/T/mri-de9e22a5b5b946f0/coronal_001.png","assets/T/mri-de9e22a5b5b946f0/coronal_002.png","assets/T/mri-de9e22a5b5b946f0/coronal_004.png","assets/T/mri-de9e22a5b5b946f0/coronal_005.png","assets/T/mri-de9e22a5b5b946f0/coronal_006.png","assets/T/mri-de9e22a5b5b946f0/coronal_008.png","assets/T/mri-de9e22a5b5b946f0/coronal_009.png","assets/T/mri-de9e22a5b5b946f0/coronal_010.png","assets/T/mri-de9e22a5b5b946f0/coronal_012.png","assets/T/mri-de9e22a5b5b946f0/coronal_013.png","assets/T/mri-de9e22a5b5b946f0/coronal_015.png","assets/T/mri-de9e22a5b5b946f0/coronal_016.png","assets/T/mri-de9e22a5b5b946f0/coronal_017.png","assets/T/mri-de9e22a5b5b946f0/coronal_019.png","assets/T/mri-de9e22a5b5b946f0/coronal_020.png","assets/T/mri-de9e22a5b5b946f0/coronal_021.png","assets/T/mri-de9e22a5b5b946f0/coronal_023.png","assets/T/mri-de9e22a5b5b946f0/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":66,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,12,13,14,16,17,18,20,21,22,23,25,26,27,29,30,31,33,34,35,37,38,39,41,42,43,44,46,47,48,50,51,52,54,55,57,58,59,61,62,63,65,66]}}
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+{"id":"mri-8fbe2995ecbf4644","request_id":"L3-T300:mri-8fbe2995ecbf4644","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-8fbe2995ecbf4644/axial_001.png","assets/T/mri-8fbe2995ecbf4644/axial_002.png","assets/T/mri-8fbe2995ecbf4644/axial_004.png","assets/T/mri-8fbe2995ecbf4644/axial_005.png","assets/T/mri-8fbe2995ecbf4644/axial_006.png","assets/T/mri-8fbe2995ecbf4644/axial_008.png","assets/T/mri-8fbe2995ecbf4644/axial_009.png","assets/T/mri-8fbe2995ecbf4644/axial_010.png","assets/T/mri-8fbe2995ecbf4644/axial_012.png","assets/T/mri-8fbe2995ecbf4644/axial_013.png","assets/T/mri-8fbe2995ecbf4644/axial_014.png","assets/T/mri-8fbe2995ecbf4644/axial_016.png","assets/T/mri-8fbe2995ecbf4644/axial_017.png","assets/T/mri-8fbe2995ecbf4644/axial_018.png","assets/T/mri-8fbe2995ecbf4644/axial_020.png","assets/T/mri-8fbe2995ecbf4644/axial_021.png","assets/T/mri-8fbe2995ecbf4644/axial_022.png","assets/T/mri-8fbe2995ecbf4644/axial_023.png","assets/T/mri-8fbe2995ecbf4644/axial_025.png","assets/T/mri-8fbe2995ecbf4644/axial_026.png","assets/T/mri-8fbe2995ecbf4644/axial_027.png","assets/T/mri-8fbe2995ecbf4644/axial_029.png","assets/T/mri-8fbe2995ecbf4644/axial_030.png","assets/T/mri-8fbe2995ecbf4644/axial_031.png","assets/T/mri-8fbe2995ecbf4644/axial_033.png","assets/T/mri-8fbe2995ecbf4644/axial_034.png","assets/T/mri-8fbe2995ecbf4644/axial_035.png","assets/T/mri-8fbe2995ecbf4644/axial_037.png","assets/T/mri-8fbe2995ecbf4644/axial_038.png","assets/T/mri-8fbe2995ecbf4644/axial_039.png","assets/T/mri-8fbe2995ecbf4644/axial_041.png","assets/T/mri-8fbe2995ecbf4644/axial_042.png","assets/T/mri-8fbe2995ecbf4644/coronal_001.png","assets/T/mri-8fbe2995ecbf4644/coronal_002.png","assets/T/mri-8fbe2995ecbf4644/coronal_004.png","assets/T/mri-8fbe2995ecbf4644/coronal_005.png","assets/T/mri-8fbe2995ecbf4644/coronal_006.png","assets/T/mri-8fbe2995ecbf4644/coronal_008.png","assets/T/mri-8fbe2995ecbf4644/coronal_009.png","assets/T/mri-8fbe2995ecbf4644/coronal_010.png","assets/T/mri-8fbe2995ecbf4644/coronal_012.png","assets/T/mri-8fbe2995ecbf4644/coronal_013.png","assets/T/mri-8fbe2995ecbf4644/coronal_015.png","assets/T/mri-8fbe2995ecbf4644/coronal_016.png","assets/T/mri-8fbe2995ecbf4644/coronal_017.png","assets/T/mri-8fbe2995ecbf4644/coronal_019.png","assets/T/mri-8fbe2995ecbf4644/coronal_020.png","assets/T/mri-8fbe2995ecbf4644/coronal_021.png","assets/T/mri-8fbe2995ecbf4644/coronal_023.png","assets/T/mri-8fbe2995ecbf4644/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":66,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,12,13,14,16,17,18,20,21,22,23,25,26,27,29,30,31,33,34,35,37,38,39,41,42,43,44,46,47,48,50,51,52,54,55,57,58,59,61,62,63,65,66]}}
+{"id":"mri-c543bdb39c8642be","request_id":"L3-T300:mri-c543bdb39c8642be","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-c543bdb39c8642be/axial_001.png","assets/T/mri-c543bdb39c8642be/axial_002.png","assets/T/mri-c543bdb39c8642be/axial_004.png","assets/T/mri-c543bdb39c8642be/axial_005.png","assets/T/mri-c543bdb39c8642be/axial_006.png","assets/T/mri-c543bdb39c8642be/axial_008.png","assets/T/mri-c543bdb39c8642be/axial_009.png","assets/T/mri-c543bdb39c8642be/axial_010.png","assets/T/mri-c543bdb39c8642be/axial_012.png","assets/T/mri-c543bdb39c8642be/axial_013.png","assets/T/mri-c543bdb39c8642be/axial_014.png","assets/T/mri-c543bdb39c8642be/axial_016.png","assets/T/mri-c543bdb39c8642be/axial_017.png","assets/T/mri-c543bdb39c8642be/axial_018.png","assets/T/mri-c543bdb39c8642be/axial_020.png","assets/T/mri-c543bdb39c8642be/axial_021.png","assets/T/mri-c543bdb39c8642be/axial_022.png","assets/T/mri-c543bdb39c8642be/axial_023.png","assets/T/mri-c543bdb39c8642be/axial_025.png","assets/T/mri-c543bdb39c8642be/axial_026.png","assets/T/mri-c543bdb39c8642be/axial_027.png","assets/T/mri-c543bdb39c8642be/axial_029.png","assets/T/mri-c543bdb39c8642be/axial_030.png","assets/T/mri-c543bdb39c8642be/axial_031.png","assets/T/mri-c543bdb39c8642be/axial_033.png","assets/T/mri-c543bdb39c8642be/axial_034.png","assets/T/mri-c543bdb39c8642be/axial_035.png","assets/T/mri-c543bdb39c8642be/axial_037.png","assets/T/mri-c543bdb39c8642be/axial_038.png","assets/T/mri-c543bdb39c8642be/axial_039.png","assets/T/mri-c543bdb39c8642be/axial_041.png","assets/T/mri-c543bdb39c8642be/axial_042.png","assets/T/mri-c543bdb39c8642be/coronal_001.png","assets/T/mri-c543bdb39c8642be/coronal_002.png","assets/T/mri-c543bdb39c8642be/coronal_004.png","assets/T/mri-c543bdb39c8642be/coronal_005.png","assets/T/mri-c543bdb39c8642be/coronal_006.png","assets/T/mri-c543bdb39c8642be/coronal_008.png","assets/T/mri-c543bdb39c8642be/coronal_009.png","assets/T/mri-c543bdb39c8642be/coronal_010.png","assets/T/mri-c543bdb39c8642be/coronal_012.png","assets/T/mri-c543bdb39c8642be/coronal_013.png","assets/T/mri-c543bdb39c8642be/coronal_015.png","assets/T/mri-c543bdb39c8642be/coronal_016.png","assets/T/mri-c543bdb39c8642be/coronal_017.png","assets/T/mri-c543bdb39c8642be/coronal_019.png","assets/T/mri-c543bdb39c8642be/coronal_020.png","assets/T/mri-c543bdb39c8642be/coronal_021.png","assets/T/mri-c543bdb39c8642be/coronal_023.png","assets/T/mri-c543bdb39c8642be/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":66,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,12,13,14,16,17,18,20,21,22,23,25,26,27,29,30,31,33,34,35,37,38,39,41,42,43,44,46,47,48,50,51,52,54,55,57,58,59,61,62,63,65,66]}}
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+{"id":"mri-842294051b2440d7","request_id":"L3-T300:mri-842294051b2440d7","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 29 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 21 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-842294051b2440d7/axial_001.png","assets/T/mri-842294051b2440d7/axial_002.png","assets/T/mri-842294051b2440d7/axial_004.png","assets/T/mri-842294051b2440d7/axial_005.png","assets/T/mri-842294051b2440d7/axial_006.png","assets/T/mri-842294051b2440d7/axial_008.png","assets/T/mri-842294051b2440d7/axial_009.png","assets/T/mri-842294051b2440d7/axial_010.png","assets/T/mri-842294051b2440d7/axial_012.png","assets/T/mri-842294051b2440d7/axial_013.png","assets/T/mri-842294051b2440d7/axial_014.png","assets/T/mri-842294051b2440d7/axial_016.png","assets/T/mri-842294051b2440d7/axial_017.png","assets/T/mri-842294051b2440d7/axial_018.png","assets/T/mri-842294051b2440d7/axial_020.png","assets/T/mri-842294051b2440d7/axial_021.png","assets/T/mri-842294051b2440d7/axial_022.png","assets/T/mri-842294051b2440d7/axial_023.png","assets/T/mri-842294051b2440d7/axial_025.png","assets/T/mri-842294051b2440d7/axial_026.png","assets/T/mri-842294051b2440d7/axial_027.png","assets/T/mri-842294051b2440d7/axial_029.png","assets/T/mri-842294051b2440d7/axial_030.png","assets/T/mri-842294051b2440d7/axial_031.png","assets/T/mri-842294051b2440d7/axial_033.png","assets/T/mri-842294051b2440d7/axial_034.png","assets/T/mri-842294051b2440d7/axial_035.png","assets/T/mri-842294051b2440d7/axial_037.png","assets/T/mri-842294051b2440d7/axial_038.png","assets/T/mri-842294051b2440d7/coronal_001.png","assets/T/mri-842294051b2440d7/coronal_002.png","assets/T/mri-842294051b2440d7/coronal_004.png","assets/T/mri-842294051b2440d7/coronal_005.png","assets/T/mri-842294051b2440d7/coronal_006.png","assets/T/mri-842294051b2440d7/coronal_008.png","assets/T/mri-842294051b2440d7/coronal_009.png","assets/T/mri-842294051b2440d7/coronal_010.png","assets/T/mri-842294051b2440d7/coronal_012.png","assets/T/mri-842294051b2440d7/coronal_013.png","assets/T/mri-842294051b2440d7/coronal_015.png","assets/T/mri-842294051b2440d7/coronal_016.png","assets/T/mri-842294051b2440d7/coronal_017.png","assets/T/mri-842294051b2440d7/coronal_019.png","assets/T/mri-842294051b2440d7/coronal_020.png","assets/T/mri-842294051b2440d7/coronal_021.png","assets/T/mri-842294051b2440d7/coronal_023.png","assets/T/mri-842294051b2440d7/coronal_024.png","assets/T/mri-842294051b2440d7/coronal_025.png","assets/T/mri-842294051b2440d7/coronal_027.png","assets/T/mri-842294051b2440d7/coronal_028.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":66,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,12,13,14,16,17,18,20,21,22,23,25,26,27,29,30,31,33,34,35,37,38,39,40,42,43,44,46,47,48,50,51,53,54,55,57,58,59,61,62,63,65,66]}}
+{"id":"mri-02abb54e29f14bca","request_id":"L3-T300:mri-02abb54e29f14bca","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-02abb54e29f14bca/axial_001.png","assets/T/mri-02abb54e29f14bca/axial_002.png","assets/T/mri-02abb54e29f14bca/axial_004.png","assets/T/mri-02abb54e29f14bca/axial_005.png","assets/T/mri-02abb54e29f14bca/axial_006.png","assets/T/mri-02abb54e29f14bca/axial_008.png","assets/T/mri-02abb54e29f14bca/axial_009.png","assets/T/mri-02abb54e29f14bca/axial_010.png","assets/T/mri-02abb54e29f14bca/axial_011.png","assets/T/mri-02abb54e29f14bca/axial_013.png","assets/T/mri-02abb54e29f14bca/axial_014.png","assets/T/mri-02abb54e29f14bca/axial_015.png","assets/T/mri-02abb54e29f14bca/axial_017.png","assets/T/mri-02abb54e29f14bca/axial_018.png","assets/T/mri-02abb54e29f14bca/axial_019.png","assets/T/mri-02abb54e29f14bca/axial_021.png","assets/T/mri-02abb54e29f14bca/axial_022.png","assets/T/mri-02abb54e29f14bca/axial_023.png","assets/T/mri-02abb54e29f14bca/axial_024.png","assets/T/mri-02abb54e29f14bca/axial_026.png","assets/T/mri-02abb54e29f14bca/axial_027.png","assets/T/mri-02abb54e29f14bca/axial_028.png","assets/T/mri-02abb54e29f14bca/axial_030.png","assets/T/mri-02abb54e29f14bca/axial_031.png","assets/T/mri-02abb54e29f14bca/axial_032.png","assets/T/mri-02abb54e29f14bca/axial_034.png","assets/T/mri-02abb54e29f14bca/axial_035.png","assets/T/mri-02abb54e29f14bca/axial_036.png","assets/T/mri-02abb54e29f14bca/axial_037.png","assets/T/mri-02abb54e29f14bca/axial_039.png","assets/T/mri-02abb54e29f14bca/axial_040.png","assets/T/mri-02abb54e29f14bca/coronal_001.png","assets/T/mri-02abb54e29f14bca/coronal_002.png","assets/T/mri-02abb54e29f14bca/coronal_004.png","assets/T/mri-02abb54e29f14bca/coronal_005.png","assets/T/mri-02abb54e29f14bca/coronal_006.png","assets/T/mri-02abb54e29f14bca/coronal_007.png","assets/T/mri-02abb54e29f14bca/coronal_009.png","assets/T/mri-02abb54e29f14bca/coronal_010.png","assets/T/mri-02abb54e29f14bca/coronal_011.png","assets/T/mri-02abb54e29f14bca/coronal_013.png","assets/T/mri-02abb54e29f14bca/coronal_014.png","assets/T/mri-02abb54e29f14bca/coronal_015.png","assets/T/mri-02abb54e29f14bca/coronal_016.png","assets/T/mri-02abb54e29f14bca/coronal_018.png","assets/T/mri-02abb54e29f14bca/coronal_019.png","assets/T/mri-02abb54e29f14bca/coronal_020.png","assets/T/mri-02abb54e29f14bca/coronal_021.png","assets/T/mri-02abb54e29f14bca/coronal_023.png","assets/T/mri-02abb54e29f14bca/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":64,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,11,13,14,15,17,18,19,21,22,23,24,26,27,28,30,31,32,34,35,36,37,39,40,41,42,44,45,46,47,49,50,51,53,54,55,56,58,59,60,61,63,64]}}
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+{"id":"mri-b976847fc598493f","request_id":"L3-T300:mri-b976847fc598493f","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-b976847fc598493f/axial_001.png","assets/T/mri-b976847fc598493f/axial_002.png","assets/T/mri-b976847fc598493f/axial_004.png","assets/T/mri-b976847fc598493f/axial_005.png","assets/T/mri-b976847fc598493f/axial_006.png","assets/T/mri-b976847fc598493f/axial_008.png","assets/T/mri-b976847fc598493f/axial_009.png","assets/T/mri-b976847fc598493f/axial_010.png","assets/T/mri-b976847fc598493f/axial_011.png","assets/T/mri-b976847fc598493f/axial_013.png","assets/T/mri-b976847fc598493f/axial_014.png","assets/T/mri-b976847fc598493f/axial_015.png","assets/T/mri-b976847fc598493f/axial_017.png","assets/T/mri-b976847fc598493f/axial_018.png","assets/T/mri-b976847fc598493f/axial_019.png","assets/T/mri-b976847fc598493f/axial_021.png","assets/T/mri-b976847fc598493f/axial_022.png","assets/T/mri-b976847fc598493f/axial_023.png","assets/T/mri-b976847fc598493f/axial_024.png","assets/T/mri-b976847fc598493f/axial_026.png","assets/T/mri-b976847fc598493f/axial_027.png","assets/T/mri-b976847fc598493f/axial_028.png","assets/T/mri-b976847fc598493f/axial_030.png","assets/T/mri-b976847fc598493f/axial_031.png","assets/T/mri-b976847fc598493f/axial_032.png","assets/T/mri-b976847fc598493f/axial_034.png","assets/T/mri-b976847fc598493f/axial_035.png","assets/T/mri-b976847fc598493f/axial_036.png","assets/T/mri-b976847fc598493f/axial_037.png","assets/T/mri-b976847fc598493f/axial_039.png","assets/T/mri-b976847fc598493f/axial_040.png","assets/T/mri-b976847fc598493f/coronal_001.png","assets/T/mri-b976847fc598493f/coronal_002.png","assets/T/mri-b976847fc598493f/coronal_004.png","assets/T/mri-b976847fc598493f/coronal_005.png","assets/T/mri-b976847fc598493f/coronal_006.png","assets/T/mri-b976847fc598493f/coronal_007.png","assets/T/mri-b976847fc598493f/coronal_009.png","assets/T/mri-b976847fc598493f/coronal_010.png","assets/T/mri-b976847fc598493f/coronal_011.png","assets/T/mri-b976847fc598493f/coronal_013.png","assets/T/mri-b976847fc598493f/coronal_014.png","assets/T/mri-b976847fc598493f/coronal_015.png","assets/T/mri-b976847fc598493f/coronal_016.png","assets/T/mri-b976847fc598493f/coronal_018.png","assets/T/mri-b976847fc598493f/coronal_019.png","assets/T/mri-b976847fc598493f/coronal_020.png","assets/T/mri-b976847fc598493f/coronal_021.png","assets/T/mri-b976847fc598493f/coronal_023.png","assets/T/mri-b976847fc598493f/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":64,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,11,13,14,15,17,18,19,21,22,23,24,26,27,28,30,31,32,34,35,36,37,39,40,41,42,44,45,46,47,49,50,51,53,54,55,56,58,59,60,61,63,64]}}
+{"id":"mri-7ea32cf357cc42b5","request_id":"L3-T300:mri-7ea32cf357cc42b5","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-7ea32cf357cc42b5/axial_001.png","assets/T/mri-7ea32cf357cc42b5/axial_002.png","assets/T/mri-7ea32cf357cc42b5/axial_004.png","assets/T/mri-7ea32cf357cc42b5/axial_005.png","assets/T/mri-7ea32cf357cc42b5/axial_006.png","assets/T/mri-7ea32cf357cc42b5/axial_008.png","assets/T/mri-7ea32cf357cc42b5/axial_009.png","assets/T/mri-7ea32cf357cc42b5/axial_010.png","assets/T/mri-7ea32cf357cc42b5/axial_011.png","assets/T/mri-7ea32cf357cc42b5/axial_013.png","assets/T/mri-7ea32cf357cc42b5/axial_014.png","assets/T/mri-7ea32cf357cc42b5/axial_015.png","assets/T/mri-7ea32cf357cc42b5/axial_017.png","assets/T/mri-7ea32cf357cc42b5/axial_018.png","assets/T/mri-7ea32cf357cc42b5/axial_019.png","assets/T/mri-7ea32cf357cc42b5/axial_021.png","assets/T/mri-7ea32cf357cc42b5/axial_022.png","assets/T/mri-7ea32cf357cc42b5/axial_023.png","assets/T/mri-7ea32cf357cc42b5/axial_024.png","assets/T/mri-7ea32cf357cc42b5/axial_026.png","assets/T/mri-7ea32cf357cc42b5/axial_027.png","assets/T/mri-7ea32cf357cc42b5/axial_028.png","assets/T/mri-7ea32cf357cc42b5/axial_030.png","assets/T/mri-7ea32cf357cc42b5/axial_031.png","assets/T/mri-7ea32cf357cc42b5/axial_032.png","assets/T/mri-7ea32cf357cc42b5/axial_034.png","assets/T/mri-7ea32cf357cc42b5/axial_035.png","assets/T/mri-7ea32cf357cc42b5/axial_036.png","assets/T/mri-7ea32cf357cc42b5/axial_037.png","assets/T/mri-7ea32cf357cc42b5/axial_039.png","assets/T/mri-7ea32cf357cc42b5/axial_040.png","assets/T/mri-7ea32cf357cc42b5/coronal_001.png","assets/T/mri-7ea32cf357cc42b5/coronal_002.png","assets/T/mri-7ea32cf357cc42b5/coronal_004.png","assets/T/mri-7ea32cf357cc42b5/coronal_005.png","assets/T/mri-7ea32cf357cc42b5/coronal_006.png","assets/T/mri-7ea32cf357cc42b5/coronal_007.png","assets/T/mri-7ea32cf357cc42b5/coronal_009.png","assets/T/mri-7ea32cf357cc42b5/coronal_010.png","assets/T/mri-7ea32cf357cc42b5/coronal_011.png","assets/T/mri-7ea32cf357cc42b5/coronal_013.png","assets/T/mri-7ea32cf357cc42b5/coronal_014.png","assets/T/mri-7ea32cf357cc42b5/coronal_015.png","assets/T/mri-7ea32cf357cc42b5/coronal_016.png","assets/T/mri-7ea32cf357cc42b5/coronal_018.png","assets/T/mri-7ea32cf357cc42b5/coronal_019.png","assets/T/mri-7ea32cf357cc42b5/coronal_020.png","assets/T/mri-7ea32cf357cc42b5/coronal_021.png","assets/T/mri-7ea32cf357cc42b5/coronal_023.png","assets/T/mri-7ea32cf357cc42b5/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":64,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,11,13,14,15,17,18,19,21,22,23,24,26,27,28,30,31,32,34,35,36,37,39,40,41,42,44,45,46,47,49,50,51,53,54,55,56,58,59,60,61,63,64]}}
+{"id":"mri-0dc57ca1c41d4864","request_id":"L3-T300:mri-0dc57ca1c41d4864","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-0dc57ca1c41d4864/axial_001.png","assets/T/mri-0dc57ca1c41d4864/axial_002.png","assets/T/mri-0dc57ca1c41d4864/axial_004.png","assets/T/mri-0dc57ca1c41d4864/axial_005.png","assets/T/mri-0dc57ca1c41d4864/axial_006.png","assets/T/mri-0dc57ca1c41d4864/axial_008.png","assets/T/mri-0dc57ca1c41d4864/axial_009.png","assets/T/mri-0dc57ca1c41d4864/axial_010.png","assets/T/mri-0dc57ca1c41d4864/axial_012.png","assets/T/mri-0dc57ca1c41d4864/axial_013.png","assets/T/mri-0dc57ca1c41d4864/axial_014.png","assets/T/mri-0dc57ca1c41d4864/axial_016.png","assets/T/mri-0dc57ca1c41d4864/axial_017.png","assets/T/mri-0dc57ca1c41d4864/axial_018.png","assets/T/mri-0dc57ca1c41d4864/axial_020.png","assets/T/mri-0dc57ca1c41d4864/axial_021.png","assets/T/mri-0dc57ca1c41d4864/axial_022.png","assets/T/mri-0dc57ca1c41d4864/axial_023.png","assets/T/mri-0dc57ca1c41d4864/axial_025.png","assets/T/mri-0dc57ca1c41d4864/axial_026.png","assets/T/mri-0dc57ca1c41d4864/axial_027.png","assets/T/mri-0dc57ca1c41d4864/axial_029.png","assets/T/mri-0dc57ca1c41d4864/axial_030.png","assets/T/mri-0dc57ca1c41d4864/axial_031.png","assets/T/mri-0dc57ca1c41d4864/axial_033.png","assets/T/mri-0dc57ca1c41d4864/axial_034.png","assets/T/mri-0dc57ca1c41d4864/axial_035.png","assets/T/mri-0dc57ca1c41d4864/axial_037.png","assets/T/mri-0dc57ca1c41d4864/axial_038.png","assets/T/mri-0dc57ca1c41d4864/axial_039.png","assets/T/mri-0dc57ca1c41d4864/axial_041.png","assets/T/mri-0dc57ca1c41d4864/axial_042.png","assets/T/mri-0dc57ca1c41d4864/coronal_001.png","assets/T/mri-0dc57ca1c41d4864/coronal_002.png","assets/T/mri-0dc57ca1c41d4864/coronal_004.png","assets/T/mri-0dc57ca1c41d4864/coronal_005.png","assets/T/mri-0dc57ca1c41d4864/coronal_006.png","assets/T/mri-0dc57ca1c41d4864/coronal_008.png","assets/T/mri-0dc57ca1c41d4864/coronal_009.png","assets/T/mri-0dc57ca1c41d4864/coronal_010.png","assets/T/mri-0dc57ca1c41d4864/coronal_012.png","assets/T/mri-0dc57ca1c41d4864/coronal_013.png","assets/T/mri-0dc57ca1c41d4864/coronal_015.png","assets/T/mri-0dc57ca1c41d4864/coronal_016.png","assets/T/mri-0dc57ca1c41d4864/coronal_017.png","assets/T/mri-0dc57ca1c41d4864/coronal_019.png","assets/T/mri-0dc57ca1c41d4864/coronal_020.png","assets/T/mri-0dc57ca1c41d4864/coronal_021.png","assets/T/mri-0dc57ca1c41d4864/coronal_023.png","assets/T/mri-0dc57ca1c41d4864/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":66,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,12,13,14,16,17,18,20,21,22,23,25,26,27,29,30,31,33,34,35,37,38,39,41,42,43,44,46,47,48,50,51,52,54,55,57,58,59,61,62,63,65,66]}}
+{"id":"mri-c3cc2672fd8e420a","request_id":"L3-T300:mri-c3cc2672fd8e420a","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-c3cc2672fd8e420a/axial_001.png","assets/T/mri-c3cc2672fd8e420a/axial_002.png","assets/T/mri-c3cc2672fd8e420a/axial_003.png","assets/T/mri-c3cc2672fd8e420a/axial_005.png","assets/T/mri-c3cc2672fd8e420a/axial_006.png","assets/T/mri-c3cc2672fd8e420a/axial_007.png","assets/T/mri-c3cc2672fd8e420a/axial_008.png","assets/T/mri-c3cc2672fd8e420a/axial_010.png","assets/T/mri-c3cc2672fd8e420a/axial_011.png","assets/T/mri-c3cc2672fd8e420a/axial_012.png","assets/T/mri-c3cc2672fd8e420a/axial_013.png","assets/T/mri-c3cc2672fd8e420a/axial_015.png","assets/T/mri-c3cc2672fd8e420a/axial_016.png","assets/T/mri-c3cc2672fd8e420a/axial_017.png","assets/T/mri-c3cc2672fd8e420a/axial_018.png","assets/T/mri-c3cc2672fd8e420a/axial_020.png","assets/T/mri-c3cc2672fd8e420a/axial_021.png","assets/T/mri-c3cc2672fd8e420a/axial_022.png","assets/T/mri-c3cc2672fd8e420a/axial_023.png","assets/T/mri-c3cc2672fd8e420a/axial_024.png","assets/T/mri-c3cc2672fd8e420a/axial_026.png","assets/T/mri-c3cc2672fd8e420a/axial_027.png","assets/T/mri-c3cc2672fd8e420a/axial_028.png","assets/T/mri-c3cc2672fd8e420a/axial_029.png","assets/T/mri-c3cc2672fd8e420a/axial_031.png","assets/T/mri-c3cc2672fd8e420a/axial_032.png","assets/T/mri-c3cc2672fd8e420a/axial_033.png","assets/T/mri-c3cc2672fd8e420a/axial_034.png","assets/T/mri-c3cc2672fd8e420a/axial_036.png","assets/T/mri-c3cc2672fd8e420a/axial_037.png","assets/T/mri-c3cc2672fd8e420a/axial_038.png","assets/T/mri-c3cc2672fd8e420a/coronal_001.png","assets/T/mri-c3cc2672fd8e420a/coronal_002.png","assets/T/mri-c3cc2672fd8e420a/coronal_004.png","assets/T/mri-c3cc2672fd8e420a/coronal_005.png","assets/T/mri-c3cc2672fd8e420a/coronal_006.png","assets/T/mri-c3cc2672fd8e420a/coronal_007.png","assets/T/mri-c3cc2672fd8e420a/coronal_009.png","assets/T/mri-c3cc2672fd8e420a/coronal_010.png","assets/T/mri-c3cc2672fd8e420a/coronal_011.png","assets/T/mri-c3cc2672fd8e420a/coronal_013.png","assets/T/mri-c3cc2672fd8e420a/coronal_014.png","assets/T/mri-c3cc2672fd8e420a/coronal_015.png","assets/T/mri-c3cc2672fd8e420a/coronal_016.png","assets/T/mri-c3cc2672fd8e420a/coronal_018.png","assets/T/mri-c3cc2672fd8e420a/coronal_019.png","assets/T/mri-c3cc2672fd8e420a/coronal_020.png","assets/T/mri-c3cc2672fd8e420a/coronal_021.png","assets/T/mri-c3cc2672fd8e420a/coronal_023.png","assets/T/mri-c3cc2672fd8e420a/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":62,"selected_count":50,"source_indices_1based":[1,2,3,5,6,7,8,10,11,12,13,15,16,17,18,20,21,22,23,24,26,27,28,29,31,32,33,34,36,37,38,39,40,42,43,44,45,47,48,49,51,52,53,54,56,57,58,59,61,62]}}
+{"id":"mri-17373bfa653f4f94","request_id":"L3-T300:mri-17373bfa653f4f94","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-17373bfa653f4f94/axial_001.png","assets/T/mri-17373bfa653f4f94/axial_002.png","assets/T/mri-17373bfa653f4f94/axial_004.png","assets/T/mri-17373bfa653f4f94/axial_005.png","assets/T/mri-17373bfa653f4f94/axial_006.png","assets/T/mri-17373bfa653f4f94/axial_008.png","assets/T/mri-17373bfa653f4f94/axial_009.png","assets/T/mri-17373bfa653f4f94/axial_010.png","assets/T/mri-17373bfa653f4f94/axial_012.png","assets/T/mri-17373bfa653f4f94/axial_013.png","assets/T/mri-17373bfa653f4f94/axial_014.png","assets/T/mri-17373bfa653f4f94/axial_016.png","assets/T/mri-17373bfa653f4f94/axial_017.png","assets/T/mri-17373bfa653f4f94/axial_018.png","assets/T/mri-17373bfa653f4f94/axial_020.png","assets/T/mri-17373bfa653f4f94/axial_021.png","assets/T/mri-17373bfa653f4f94/axial_022.png","assets/T/mri-17373bfa653f4f94/axial_023.png","assets/T/mri-17373bfa653f4f94/axial_025.png","assets/T/mri-17373bfa653f4f94/axial_026.png","assets/T/mri-17373bfa653f4f94/axial_027.png","assets/T/mri-17373bfa653f4f94/axial_029.png","assets/T/mri-17373bfa653f4f94/axial_030.png","assets/T/mri-17373bfa653f4f94/axial_031.png","assets/T/mri-17373bfa653f4f94/axial_033.png","assets/T/mri-17373bfa653f4f94/axial_034.png","assets/T/mri-17373bfa653f4f94/axial_035.png","assets/T/mri-17373bfa653f4f94/axial_037.png","assets/T/mri-17373bfa653f4f94/axial_038.png","assets/T/mri-17373bfa653f4f94/axial_039.png","assets/T/mri-17373bfa653f4f94/axial_041.png","assets/T/mri-17373bfa653f4f94/axial_042.png","assets/T/mri-17373bfa653f4f94/coronal_001.png","assets/T/mri-17373bfa653f4f94/coronal_002.png","assets/T/mri-17373bfa653f4f94/coronal_004.png","assets/T/mri-17373bfa653f4f94/coronal_005.png","assets/T/mri-17373bfa653f4f94/coronal_006.png","assets/T/mri-17373bfa653f4f94/coronal_008.png","assets/T/mri-17373bfa653f4f94/coronal_009.png","assets/T/mri-17373bfa653f4f94/coronal_010.png","assets/T/mri-17373bfa653f4f94/coronal_012.png","assets/T/mri-17373bfa653f4f94/coronal_013.png","assets/T/mri-17373bfa653f4f94/coronal_015.png","assets/T/mri-17373bfa653f4f94/coronal_016.png","assets/T/mri-17373bfa653f4f94/coronal_017.png","assets/T/mri-17373bfa653f4f94/coronal_019.png","assets/T/mri-17373bfa653f4f94/coronal_020.png","assets/T/mri-17373bfa653f4f94/coronal_021.png","assets/T/mri-17373bfa653f4f94/coronal_023.png","assets/T/mri-17373bfa653f4f94/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":66,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,12,13,14,16,17,18,20,21,22,23,25,26,27,29,30,31,33,34,35,37,38,39,41,42,43,44,46,47,48,50,51,52,54,55,57,58,59,61,62,63,65,66]}}
+{"id":"mri-763095d057044bf9","request_id":"L3-T300:mri-763095d057044bf9","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 30 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 20 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-763095d057044bf9/axial_001.png","assets/T/mri-763095d057044bf9/axial_002.png","assets/T/mri-763095d057044bf9/axial_003.png","assets/T/mri-763095d057044bf9/axial_005.png","assets/T/mri-763095d057044bf9/axial_006.png","assets/T/mri-763095d057044bf9/axial_007.png","assets/T/mri-763095d057044bf9/axial_008.png","assets/T/mri-763095d057044bf9/axial_009.png","assets/T/mri-763095d057044bf9/axial_011.png","assets/T/mri-763095d057044bf9/axial_012.png","assets/T/mri-763095d057044bf9/axial_013.png","assets/T/mri-763095d057044bf9/axial_014.png","assets/T/mri-763095d057044bf9/axial_015.png","assets/T/mri-763095d057044bf9/axial_017.png","assets/T/mri-763095d057044bf9/axial_018.png","assets/T/mri-763095d057044bf9/axial_019.png","assets/T/mri-763095d057044bf9/axial_020.png","assets/T/mri-763095d057044bf9/axial_022.png","assets/T/mri-763095d057044bf9/axial_023.png","assets/T/mri-763095d057044bf9/axial_024.png","assets/T/mri-763095d057044bf9/axial_025.png","assets/T/mri-763095d057044bf9/axial_026.png","assets/T/mri-763095d057044bf9/axial_028.png","assets/T/mri-763095d057044bf9/axial_029.png","assets/T/mri-763095d057044bf9/axial_030.png","assets/T/mri-763095d057044bf9/axial_031.png","assets/T/mri-763095d057044bf9/axial_032.png","assets/T/mri-763095d057044bf9/axial_034.png","assets/T/mri-763095d057044bf9/axial_035.png","assets/T/mri-763095d057044bf9/axial_036.png","assets/T/mri-763095d057044bf9/coronal_001.png","assets/T/mri-763095d057044bf9/coronal_002.png","assets/T/mri-763095d057044bf9/coronal_003.png","assets/T/mri-763095d057044bf9/coronal_005.png","assets/T/mri-763095d057044bf9/coronal_006.png","assets/T/mri-763095d057044bf9/coronal_007.png","assets/T/mri-763095d057044bf9/coronal_008.png","assets/T/mri-763095d057044bf9/coronal_009.png","assets/T/mri-763095d057044bf9/coronal_011.png","assets/T/mri-763095d057044bf9/coronal_012.png","assets/T/mri-763095d057044bf9/coronal_013.png","assets/T/mri-763095d057044bf9/coronal_014.png","assets/T/mri-763095d057044bf9/coronal_016.png","assets/T/mri-763095d057044bf9/coronal_017.png","assets/T/mri-763095d057044bf9/coronal_018.png","assets/T/mri-763095d057044bf9/coronal_019.png","assets/T/mri-763095d057044bf9/coronal_020.png","assets/T/mri-763095d057044bf9/coronal_022.png","assets/T/mri-763095d057044bf9/coronal_023.png","assets/T/mri-763095d057044bf9/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":60,"selected_count":50,"source_indices_1based":[1,2,3,5,6,7,8,9,11,12,13,14,15,17,18,19,20,22,23,24,25,26,28,29,30,31,32,34,35,36,37,38,39,41,42,43,44,45,47,48,49,50,52,53,54,55,56,58,59,60]}}
+{"id":"mri-70df53cf06454db7","request_id":"L3-T300:mri-70df53cf06454db7","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 33 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 17 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-70df53cf06454db7/axial_001.png","assets/T/mri-70df53cf06454db7/axial_002.png","assets/T/mri-70df53cf06454db7/axial_004.png","assets/T/mri-70df53cf06454db7/axial_005.png","assets/T/mri-70df53cf06454db7/axial_007.png","assets/T/mri-70df53cf06454db7/axial_008.png","assets/T/mri-70df53cf06454db7/axial_009.png","assets/T/mri-70df53cf06454db7/axial_011.png","assets/T/mri-70df53cf06454db7/axial_012.png","assets/T/mri-70df53cf06454db7/axial_014.png","assets/T/mri-70df53cf06454db7/axial_015.png","assets/T/mri-70df53cf06454db7/axial_016.png","assets/T/mri-70df53cf06454db7/axial_018.png","assets/T/mri-70df53cf06454db7/axial_019.png","assets/T/mri-70df53cf06454db7/axial_021.png","assets/T/mri-70df53cf06454db7/axial_022.png","assets/T/mri-70df53cf06454db7/axial_024.png","assets/T/mri-70df53cf06454db7/axial_025.png","assets/T/mri-70df53cf06454db7/axial_026.png","assets/T/mri-70df53cf06454db7/axial_028.png","assets/T/mri-70df53cf06454db7/axial_029.png","assets/T/mri-70df53cf06454db7/axial_031.png","assets/T/mri-70df53cf06454db7/axial_032.png","assets/T/mri-70df53cf06454db7/axial_033.png","assets/T/mri-70df53cf06454db7/axial_035.png","assets/T/mri-70df53cf06454db7/axial_036.png","assets/T/mri-70df53cf06454db7/axial_038.png","assets/T/mri-70df53cf06454db7/axial_039.png","assets/T/mri-70df53cf06454db7/axial_040.png","assets/T/mri-70df53cf06454db7/axial_042.png","assets/T/mri-70df53cf06454db7/axial_043.png","assets/T/mri-70df53cf06454db7/axial_045.png","assets/T/mri-70df53cf06454db7/axial_046.png","assets/T/mri-70df53cf06454db7/coronal_001.png","assets/T/mri-70df53cf06454db7/coronal_002.png","assets/T/mri-70df53cf06454db7/coronal_004.png","assets/T/mri-70df53cf06454db7/coronal_005.png","assets/T/mri-70df53cf06454db7/coronal_007.png","assets/T/mri-70df53cf06454db7/coronal_008.png","assets/T/mri-70df53cf06454db7/coronal_010.png","assets/T/mri-70df53cf06454db7/coronal_011.png","assets/T/mri-70df53cf06454db7/coronal_013.png","assets/T/mri-70df53cf06454db7/coronal_014.png","assets/T/mri-70df53cf06454db7/coronal_015.png","assets/T/mri-70df53cf06454db7/coronal_017.png","assets/T/mri-70df53cf06454db7/coronal_018.png","assets/T/mri-70df53cf06454db7/coronal_020.png","assets/T/mri-70df53cf06454db7/coronal_021.png","assets/T/mri-70df53cf06454db7/coronal_023.png","assets/T/mri-70df53cf06454db7/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":70,"selected_count":50,"source_indices_1based":[1,2,4,5,7,8,9,11,12,14,15,16,18,19,21,22,24,25,26,28,29,31,32,33,35,36,38,39,40,42,43,45,46,47,48,50,51,53,54,56,57,59,60,61,63,64,66,67,69,70]}}
+{"id":"mri-59438dc37157453f","request_id":"L3-T300:mri-59438dc37157453f","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-59438dc37157453f/axial_001.png","assets/T/mri-59438dc37157453f/axial_002.png","assets/T/mri-59438dc37157453f/axial_004.png","assets/T/mri-59438dc37157453f/axial_005.png","assets/T/mri-59438dc37157453f/axial_006.png","assets/T/mri-59438dc37157453f/axial_008.png","assets/T/mri-59438dc37157453f/axial_009.png","assets/T/mri-59438dc37157453f/axial_010.png","assets/T/mri-59438dc37157453f/axial_012.png","assets/T/mri-59438dc37157453f/axial_013.png","assets/T/mri-59438dc37157453f/axial_014.png","assets/T/mri-59438dc37157453f/axial_016.png","assets/T/mri-59438dc37157453f/axial_017.png","assets/T/mri-59438dc37157453f/axial_018.png","assets/T/mri-59438dc37157453f/axial_020.png","assets/T/mri-59438dc37157453f/axial_021.png","assets/T/mri-59438dc37157453f/axial_022.png","assets/T/mri-59438dc37157453f/axial_023.png","assets/T/mri-59438dc37157453f/axial_025.png","assets/T/mri-59438dc37157453f/axial_026.png","assets/T/mri-59438dc37157453f/axial_027.png","assets/T/mri-59438dc37157453f/axial_029.png","assets/T/mri-59438dc37157453f/axial_030.png","assets/T/mri-59438dc37157453f/axial_031.png","assets/T/mri-59438dc37157453f/axial_033.png","assets/T/mri-59438dc37157453f/axial_034.png","assets/T/mri-59438dc37157453f/axial_035.png","assets/T/mri-59438dc37157453f/axial_037.png","assets/T/mri-59438dc37157453f/axial_038.png","assets/T/mri-59438dc37157453f/axial_039.png","assets/T/mri-59438dc37157453f/axial_041.png","assets/T/mri-59438dc37157453f/axial_042.png","assets/T/mri-59438dc37157453f/coronal_001.png","assets/T/mri-59438dc37157453f/coronal_002.png","assets/T/mri-59438dc37157453f/coronal_004.png","assets/T/mri-59438dc37157453f/coronal_005.png","assets/T/mri-59438dc37157453f/coronal_006.png","assets/T/mri-59438dc37157453f/coronal_008.png","assets/T/mri-59438dc37157453f/coronal_009.png","assets/T/mri-59438dc37157453f/coronal_010.png","assets/T/mri-59438dc37157453f/coronal_012.png","assets/T/mri-59438dc37157453f/coronal_013.png","assets/T/mri-59438dc37157453f/coronal_015.png","assets/T/mri-59438dc37157453f/coronal_016.png","assets/T/mri-59438dc37157453f/coronal_017.png","assets/T/mri-59438dc37157453f/coronal_019.png","assets/T/mri-59438dc37157453f/coronal_020.png","assets/T/mri-59438dc37157453f/coronal_021.png","assets/T/mri-59438dc37157453f/coronal_023.png","assets/T/mri-59438dc37157453f/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":66,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,12,13,14,16,17,18,20,21,22,23,25,26,27,29,30,31,33,34,35,37,38,39,41,42,43,44,46,47,48,50,51,52,54,55,57,58,59,61,62,63,65,66]}}
+{"id":"mri-458582a19ad64257","request_id":"L3-T300:mri-458582a19ad64257","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-458582a19ad64257/axial_001.png","assets/T/mri-458582a19ad64257/axial_002.png","assets/T/mri-458582a19ad64257/axial_004.png","assets/T/mri-458582a19ad64257/axial_005.png","assets/T/mri-458582a19ad64257/axial_006.png","assets/T/mri-458582a19ad64257/axial_008.png","assets/T/mri-458582a19ad64257/axial_009.png","assets/T/mri-458582a19ad64257/axial_010.png","assets/T/mri-458582a19ad64257/axial_011.png","assets/T/mri-458582a19ad64257/axial_013.png","assets/T/mri-458582a19ad64257/axial_014.png","assets/T/mri-458582a19ad64257/axial_015.png","assets/T/mri-458582a19ad64257/axial_017.png","assets/T/mri-458582a19ad64257/axial_018.png","assets/T/mri-458582a19ad64257/axial_019.png","assets/T/mri-458582a19ad64257/axial_021.png","assets/T/mri-458582a19ad64257/axial_022.png","assets/T/mri-458582a19ad64257/axial_023.png","assets/T/mri-458582a19ad64257/axial_024.png","assets/T/mri-458582a19ad64257/axial_026.png","assets/T/mri-458582a19ad64257/axial_027.png","assets/T/mri-458582a19ad64257/axial_028.png","assets/T/mri-458582a19ad64257/axial_030.png","assets/T/mri-458582a19ad64257/axial_031.png","assets/T/mri-458582a19ad64257/axial_032.png","assets/T/mri-458582a19ad64257/axial_034.png","assets/T/mri-458582a19ad64257/axial_035.png","assets/T/mri-458582a19ad64257/axial_036.png","assets/T/mri-458582a19ad64257/axial_037.png","assets/T/mri-458582a19ad64257/axial_039.png","assets/T/mri-458582a19ad64257/axial_040.png","assets/T/mri-458582a19ad64257/coronal_001.png","assets/T/mri-458582a19ad64257/coronal_002.png","assets/T/mri-458582a19ad64257/coronal_004.png","assets/T/mri-458582a19ad64257/coronal_005.png","assets/T/mri-458582a19ad64257/coronal_006.png","assets/T/mri-458582a19ad64257/coronal_007.png","assets/T/mri-458582a19ad64257/coronal_009.png","assets/T/mri-458582a19ad64257/coronal_010.png","assets/T/mri-458582a19ad64257/coronal_011.png","assets/T/mri-458582a19ad64257/coronal_013.png","assets/T/mri-458582a19ad64257/coronal_014.png","assets/T/mri-458582a19ad64257/coronal_015.png","assets/T/mri-458582a19ad64257/coronal_016.png","assets/T/mri-458582a19ad64257/coronal_018.png","assets/T/mri-458582a19ad64257/coronal_019.png","assets/T/mri-458582a19ad64257/coronal_020.png","assets/T/mri-458582a19ad64257/coronal_021.png","assets/T/mri-458582a19ad64257/coronal_023.png","assets/T/mri-458582a19ad64257/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":64,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,11,13,14,15,17,18,19,21,22,23,24,26,27,28,30,31,32,34,35,36,37,39,40,41,42,44,45,46,47,49,50,51,53,54,55,56,58,59,60,61,63,64]}}
+{"id":"mri-bdfb1b2968c54938","request_id":"L3-T300:mri-bdfb1b2968c54938","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-bdfb1b2968c54938/axial_001.png","assets/T/mri-bdfb1b2968c54938/axial_002.png","assets/T/mri-bdfb1b2968c54938/axial_004.png","assets/T/mri-bdfb1b2968c54938/axial_005.png","assets/T/mri-bdfb1b2968c54938/axial_006.png","assets/T/mri-bdfb1b2968c54938/axial_008.png","assets/T/mri-bdfb1b2968c54938/axial_009.png","assets/T/mri-bdfb1b2968c54938/axial_010.png","assets/T/mri-bdfb1b2968c54938/axial_012.png","assets/T/mri-bdfb1b2968c54938/axial_013.png","assets/T/mri-bdfb1b2968c54938/axial_014.png","assets/T/mri-bdfb1b2968c54938/axial_016.png","assets/T/mri-bdfb1b2968c54938/axial_017.png","assets/T/mri-bdfb1b2968c54938/axial_018.png","assets/T/mri-bdfb1b2968c54938/axial_020.png","assets/T/mri-bdfb1b2968c54938/axial_021.png","assets/T/mri-bdfb1b2968c54938/axial_022.png","assets/T/mri-bdfb1b2968c54938/axial_023.png","assets/T/mri-bdfb1b2968c54938/axial_025.png","assets/T/mri-bdfb1b2968c54938/axial_026.png","assets/T/mri-bdfb1b2968c54938/axial_027.png","assets/T/mri-bdfb1b2968c54938/axial_029.png","assets/T/mri-bdfb1b2968c54938/axial_030.png","assets/T/mri-bdfb1b2968c54938/axial_031.png","assets/T/mri-bdfb1b2968c54938/axial_033.png","assets/T/mri-bdfb1b2968c54938/axial_034.png","assets/T/mri-bdfb1b2968c54938/axial_035.png","assets/T/mri-bdfb1b2968c54938/axial_037.png","assets/T/mri-bdfb1b2968c54938/axial_038.png","assets/T/mri-bdfb1b2968c54938/axial_039.png","assets/T/mri-bdfb1b2968c54938/axial_041.png","assets/T/mri-bdfb1b2968c54938/axial_042.png","assets/T/mri-bdfb1b2968c54938/coronal_001.png","assets/T/mri-bdfb1b2968c54938/coronal_002.png","assets/T/mri-bdfb1b2968c54938/coronal_004.png","assets/T/mri-bdfb1b2968c54938/coronal_005.png","assets/T/mri-bdfb1b2968c54938/coronal_006.png","assets/T/mri-bdfb1b2968c54938/coronal_008.png","assets/T/mri-bdfb1b2968c54938/coronal_009.png","assets/T/mri-bdfb1b2968c54938/coronal_010.png","assets/T/mri-bdfb1b2968c54938/coronal_012.png","assets/T/mri-bdfb1b2968c54938/coronal_013.png","assets/T/mri-bdfb1b2968c54938/coronal_015.png","assets/T/mri-bdfb1b2968c54938/coronal_016.png","assets/T/mri-bdfb1b2968c54938/coronal_017.png","assets/T/mri-bdfb1b2968c54938/coronal_019.png","assets/T/mri-bdfb1b2968c54938/coronal_020.png","assets/T/mri-bdfb1b2968c54938/coronal_021.png","assets/T/mri-bdfb1b2968c54938/coronal_023.png","assets/T/mri-bdfb1b2968c54938/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":66,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,12,13,14,16,17,18,20,21,22,23,25,26,27,29,30,31,33,34,35,37,38,39,41,42,43,44,46,47,48,50,51,52,54,55,57,58,59,61,62,63,65,66]}}
+{"id":"mri-38792095f50d47c9","request_id":"L3-T300:mri-38792095f50d47c9","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-38792095f50d47c9/axial_001.png","assets/T/mri-38792095f50d47c9/axial_002.png","assets/T/mri-38792095f50d47c9/axial_004.png","assets/T/mri-38792095f50d47c9/axial_005.png","assets/T/mri-38792095f50d47c9/axial_006.png","assets/T/mri-38792095f50d47c9/axial_008.png","assets/T/mri-38792095f50d47c9/axial_009.png","assets/T/mri-38792095f50d47c9/axial_010.png","assets/T/mri-38792095f50d47c9/axial_011.png","assets/T/mri-38792095f50d47c9/axial_013.png","assets/T/mri-38792095f50d47c9/axial_014.png","assets/T/mri-38792095f50d47c9/axial_015.png","assets/T/mri-38792095f50d47c9/axial_017.png","assets/T/mri-38792095f50d47c9/axial_018.png","assets/T/mri-38792095f50d47c9/axial_019.png","assets/T/mri-38792095f50d47c9/axial_021.png","assets/T/mri-38792095f50d47c9/axial_022.png","assets/T/mri-38792095f50d47c9/axial_023.png","assets/T/mri-38792095f50d47c9/axial_024.png","assets/T/mri-38792095f50d47c9/axial_026.png","assets/T/mri-38792095f50d47c9/axial_027.png","assets/T/mri-38792095f50d47c9/axial_028.png","assets/T/mri-38792095f50d47c9/axial_030.png","assets/T/mri-38792095f50d47c9/axial_031.png","assets/T/mri-38792095f50d47c9/axial_032.png","assets/T/mri-38792095f50d47c9/axial_034.png","assets/T/mri-38792095f50d47c9/axial_035.png","assets/T/mri-38792095f50d47c9/axial_036.png","assets/T/mri-38792095f50d47c9/axial_037.png","assets/T/mri-38792095f50d47c9/axial_039.png","assets/T/mri-38792095f50d47c9/axial_040.png","assets/T/mri-38792095f50d47c9/coronal_001.png","assets/T/mri-38792095f50d47c9/coronal_002.png","assets/T/mri-38792095f50d47c9/coronal_004.png","assets/T/mri-38792095f50d47c9/coronal_005.png","assets/T/mri-38792095f50d47c9/coronal_006.png","assets/T/mri-38792095f50d47c9/coronal_007.png","assets/T/mri-38792095f50d47c9/coronal_009.png","assets/T/mri-38792095f50d47c9/coronal_010.png","assets/T/mri-38792095f50d47c9/coronal_011.png","assets/T/mri-38792095f50d47c9/coronal_013.png","assets/T/mri-38792095f50d47c9/coronal_014.png","assets/T/mri-38792095f50d47c9/coronal_015.png","assets/T/mri-38792095f50d47c9/coronal_016.png","assets/T/mri-38792095f50d47c9/coronal_018.png","assets/T/mri-38792095f50d47c9/coronal_019.png","assets/T/mri-38792095f50d47c9/coronal_020.png","assets/T/mri-38792095f50d47c9/coronal_021.png","assets/T/mri-38792095f50d47c9/coronal_023.png","assets/T/mri-38792095f50d47c9/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":64,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,11,13,14,15,17,18,19,21,22,23,24,26,27,28,30,31,32,34,35,36,37,39,40,41,42,44,45,46,47,49,50,51,53,54,55,56,58,59,60,61,63,64]}}
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+{"id":"mri-8f7fa7b69467480e","request_id":"L3-T300:mri-8f7fa7b69467480e","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-8f7fa7b69467480e/axial_001.png","assets/T/mri-8f7fa7b69467480e/axial_002.png","assets/T/mri-8f7fa7b69467480e/axial_003.png","assets/T/mri-8f7fa7b69467480e/axial_005.png","assets/T/mri-8f7fa7b69467480e/axial_006.png","assets/T/mri-8f7fa7b69467480e/axial_007.png","assets/T/mri-8f7fa7b69467480e/axial_008.png","assets/T/mri-8f7fa7b69467480e/axial_010.png","assets/T/mri-8f7fa7b69467480e/axial_011.png","assets/T/mri-8f7fa7b69467480e/axial_012.png","assets/T/mri-8f7fa7b69467480e/axial_013.png","assets/T/mri-8f7fa7b69467480e/axial_015.png","assets/T/mri-8f7fa7b69467480e/axial_016.png","assets/T/mri-8f7fa7b69467480e/axial_017.png","assets/T/mri-8f7fa7b69467480e/axial_018.png","assets/T/mri-8f7fa7b69467480e/axial_020.png","assets/T/mri-8f7fa7b69467480e/axial_021.png","assets/T/mri-8f7fa7b69467480e/axial_022.png","assets/T/mri-8f7fa7b69467480e/axial_023.png","assets/T/mri-8f7fa7b69467480e/axial_024.png","assets/T/mri-8f7fa7b69467480e/axial_026.png","assets/T/mri-8f7fa7b69467480e/axial_027.png","assets/T/mri-8f7fa7b69467480e/axial_028.png","assets/T/mri-8f7fa7b69467480e/axial_029.png","assets/T/mri-8f7fa7b69467480e/axial_031.png","assets/T/mri-8f7fa7b69467480e/axial_032.png","assets/T/mri-8f7fa7b69467480e/axial_033.png","assets/T/mri-8f7fa7b69467480e/axial_034.png","assets/T/mri-8f7fa7b69467480e/axial_036.png","assets/T/mri-8f7fa7b69467480e/axial_037.png","assets/T/mri-8f7fa7b69467480e/axial_038.png","assets/T/mri-8f7fa7b69467480e/coronal_001.png","assets/T/mri-8f7fa7b69467480e/coronal_002.png","assets/T/mri-8f7fa7b69467480e/coronal_004.png","assets/T/mri-8f7fa7b69467480e/coronal_005.png","assets/T/mri-8f7fa7b69467480e/coronal_006.png","assets/T/mri-8f7fa7b69467480e/coronal_007.png","assets/T/mri-8f7fa7b69467480e/coronal_009.png","assets/T/mri-8f7fa7b69467480e/coronal_010.png","assets/T/mri-8f7fa7b69467480e/coronal_011.png","assets/T/mri-8f7fa7b69467480e/coronal_013.png","assets/T/mri-8f7fa7b69467480e/coronal_014.png","assets/T/mri-8f7fa7b69467480e/coronal_015.png","assets/T/mri-8f7fa7b69467480e/coronal_016.png","assets/T/mri-8f7fa7b69467480e/coronal_018.png","assets/T/mri-8f7fa7b69467480e/coronal_019.png","assets/T/mri-8f7fa7b69467480e/coronal_020.png","assets/T/mri-8f7fa7b69467480e/coronal_021.png","assets/T/mri-8f7fa7b69467480e/coronal_023.png","assets/T/mri-8f7fa7b69467480e/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":62,"selected_count":50,"source_indices_1based":[1,2,3,5,6,7,8,10,11,12,13,15,16,17,18,20,21,22,23,24,26,27,28,29,31,32,33,34,36,37,38,39,40,42,43,44,45,47,48,49,51,52,53,54,56,57,58,59,61,62]}}
+{"id":"mri-70b5e28526f74079","request_id":"L3-T300:mri-70b5e28526f74079","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-70b5e28526f74079/axial_001.png","assets/T/mri-70b5e28526f74079/axial_002.png","assets/T/mri-70b5e28526f74079/axial_004.png","assets/T/mri-70b5e28526f74079/axial_005.png","assets/T/mri-70b5e28526f74079/axial_006.png","assets/T/mri-70b5e28526f74079/axial_008.png","assets/T/mri-70b5e28526f74079/axial_009.png","assets/T/mri-70b5e28526f74079/axial_010.png","assets/T/mri-70b5e28526f74079/axial_012.png","assets/T/mri-70b5e28526f74079/axial_013.png","assets/T/mri-70b5e28526f74079/axial_014.png","assets/T/mri-70b5e28526f74079/axial_016.png","assets/T/mri-70b5e28526f74079/axial_017.png","assets/T/mri-70b5e28526f74079/axial_018.png","assets/T/mri-70b5e28526f74079/axial_020.png","assets/T/mri-70b5e28526f74079/axial_021.png","assets/T/mri-70b5e28526f74079/axial_022.png","assets/T/mri-70b5e28526f74079/axial_023.png","assets/T/mri-70b5e28526f74079/axial_025.png","assets/T/mri-70b5e28526f74079/axial_026.png","assets/T/mri-70b5e28526f74079/axial_027.png","assets/T/mri-70b5e28526f74079/axial_029.png","assets/T/mri-70b5e28526f74079/axial_030.png","assets/T/mri-70b5e28526f74079/axial_031.png","assets/T/mri-70b5e28526f74079/axial_033.png","assets/T/mri-70b5e28526f74079/axial_034.png","assets/T/mri-70b5e28526f74079/axial_035.png","assets/T/mri-70b5e28526f74079/axial_037.png","assets/T/mri-70b5e28526f74079/axial_038.png","assets/T/mri-70b5e28526f74079/axial_039.png","assets/T/mri-70b5e28526f74079/axial_041.png","assets/T/mri-70b5e28526f74079/axial_042.png","assets/T/mri-70b5e28526f74079/coronal_001.png","assets/T/mri-70b5e28526f74079/coronal_002.png","assets/T/mri-70b5e28526f74079/coronal_004.png","assets/T/mri-70b5e28526f74079/coronal_005.png","assets/T/mri-70b5e28526f74079/coronal_006.png","assets/T/mri-70b5e28526f74079/coronal_008.png","assets/T/mri-70b5e28526f74079/coronal_009.png","assets/T/mri-70b5e28526f74079/coronal_010.png","assets/T/mri-70b5e28526f74079/coronal_012.png","assets/T/mri-70b5e28526f74079/coronal_013.png","assets/T/mri-70b5e28526f74079/coronal_015.png","assets/T/mri-70b5e28526f74079/coronal_016.png","assets/T/mri-70b5e28526f74079/coronal_017.png","assets/T/mri-70b5e28526f74079/coronal_019.png","assets/T/mri-70b5e28526f74079/coronal_020.png","assets/T/mri-70b5e28526f74079/coronal_021.png","assets/T/mri-70b5e28526f74079/coronal_023.png","assets/T/mri-70b5e28526f74079/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":66,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,12,13,14,16,17,18,20,21,22,23,25,26,27,29,30,31,33,34,35,37,38,39,41,42,43,44,46,47,48,50,51,52,54,55,57,58,59,61,62,63,65,66]}}
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+{"id":"mri-38c0615f5e7b48d4","request_id":"L3-T300:mri-38c0615f5e7b48d4","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-38c0615f5e7b48d4/axial_001.png","assets/T/mri-38c0615f5e7b48d4/axial_002.png","assets/T/mri-38c0615f5e7b48d4/axial_004.png","assets/T/mri-38c0615f5e7b48d4/axial_005.png","assets/T/mri-38c0615f5e7b48d4/axial_006.png","assets/T/mri-38c0615f5e7b48d4/axial_008.png","assets/T/mri-38c0615f5e7b48d4/axial_009.png","assets/T/mri-38c0615f5e7b48d4/axial_010.png","assets/T/mri-38c0615f5e7b48d4/axial_011.png","assets/T/mri-38c0615f5e7b48d4/axial_013.png","assets/T/mri-38c0615f5e7b48d4/axial_014.png","assets/T/mri-38c0615f5e7b48d4/axial_015.png","assets/T/mri-38c0615f5e7b48d4/axial_017.png","assets/T/mri-38c0615f5e7b48d4/axial_018.png","assets/T/mri-38c0615f5e7b48d4/axial_019.png","assets/T/mri-38c0615f5e7b48d4/axial_021.png","assets/T/mri-38c0615f5e7b48d4/axial_022.png","assets/T/mri-38c0615f5e7b48d4/axial_023.png","assets/T/mri-38c0615f5e7b48d4/axial_024.png","assets/T/mri-38c0615f5e7b48d4/axial_026.png","assets/T/mri-38c0615f5e7b48d4/axial_027.png","assets/T/mri-38c0615f5e7b48d4/axial_028.png","assets/T/mri-38c0615f5e7b48d4/axial_030.png","assets/T/mri-38c0615f5e7b48d4/axial_031.png","assets/T/mri-38c0615f5e7b48d4/axial_032.png","assets/T/mri-38c0615f5e7b48d4/axial_034.png","assets/T/mri-38c0615f5e7b48d4/axial_035.png","assets/T/mri-38c0615f5e7b48d4/axial_036.png","assets/T/mri-38c0615f5e7b48d4/axial_037.png","assets/T/mri-38c0615f5e7b48d4/axial_039.png","assets/T/mri-38c0615f5e7b48d4/axial_040.png","assets/T/mri-38c0615f5e7b48d4/coronal_001.png","assets/T/mri-38c0615f5e7b48d4/coronal_002.png","assets/T/mri-38c0615f5e7b48d4/coronal_004.png","assets/T/mri-38c0615f5e7b48d4/coronal_005.png","assets/T/mri-38c0615f5e7b48d4/coronal_006.png","assets/T/mri-38c0615f5e7b48d4/coronal_007.png","assets/T/mri-38c0615f5e7b48d4/coronal_009.png","assets/T/mri-38c0615f5e7b48d4/coronal_010.png","assets/T/mri-38c0615f5e7b48d4/coronal_011.png","assets/T/mri-38c0615f5e7b48d4/coronal_013.png","assets/T/mri-38c0615f5e7b48d4/coronal_014.png","assets/T/mri-38c0615f5e7b48d4/coronal_015.png","assets/T/mri-38c0615f5e7b48d4/coronal_016.png","assets/T/mri-38c0615f5e7b48d4/coronal_018.png","assets/T/mri-38c0615f5e7b48d4/coronal_019.png","assets/T/mri-38c0615f5e7b48d4/coronal_020.png","assets/T/mri-38c0615f5e7b48d4/coronal_021.png","assets/T/mri-38c0615f5e7b48d4/coronal_023.png","assets/T/mri-38c0615f5e7b48d4/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":64,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,11,13,14,15,17,18,19,21,22,23,24,26,27,28,30,31,32,34,35,36,37,39,40,41,42,44,45,46,47,49,50,51,53,54,55,56,58,59,60,61,63,64]}}
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+{"id":"mri-4d9005f5f44f4b7b","request_id":"L3-T300:mri-4d9005f5f44f4b7b","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-4d9005f5f44f4b7b/axial_001.png","assets/T/mri-4d9005f5f44f4b7b/axial_002.png","assets/T/mri-4d9005f5f44f4b7b/axial_004.png","assets/T/mri-4d9005f5f44f4b7b/axial_005.png","assets/T/mri-4d9005f5f44f4b7b/axial_006.png","assets/T/mri-4d9005f5f44f4b7b/axial_008.png","assets/T/mri-4d9005f5f44f4b7b/axial_009.png","assets/T/mri-4d9005f5f44f4b7b/axial_010.png","assets/T/mri-4d9005f5f44f4b7b/axial_011.png","assets/T/mri-4d9005f5f44f4b7b/axial_013.png","assets/T/mri-4d9005f5f44f4b7b/axial_014.png","assets/T/mri-4d9005f5f44f4b7b/axial_015.png","assets/T/mri-4d9005f5f44f4b7b/axial_017.png","assets/T/mri-4d9005f5f44f4b7b/axial_018.png","assets/T/mri-4d9005f5f44f4b7b/axial_019.png","assets/T/mri-4d9005f5f44f4b7b/axial_021.png","assets/T/mri-4d9005f5f44f4b7b/axial_022.png","assets/T/mri-4d9005f5f44f4b7b/axial_023.png","assets/T/mri-4d9005f5f44f4b7b/axial_024.png","assets/T/mri-4d9005f5f44f4b7b/axial_026.png","assets/T/mri-4d9005f5f44f4b7b/axial_027.png","assets/T/mri-4d9005f5f44f4b7b/axial_028.png","assets/T/mri-4d9005f5f44f4b7b/axial_030.png","assets/T/mri-4d9005f5f44f4b7b/axial_031.png","assets/T/mri-4d9005f5f44f4b7b/axial_032.png","assets/T/mri-4d9005f5f44f4b7b/axial_034.png","assets/T/mri-4d9005f5f44f4b7b/axial_035.png","assets/T/mri-4d9005f5f44f4b7b/axial_036.png","assets/T/mri-4d9005f5f44f4b7b/axial_037.png","assets/T/mri-4d9005f5f44f4b7b/axial_039.png","assets/T/mri-4d9005f5f44f4b7b/axial_040.png","assets/T/mri-4d9005f5f44f4b7b/coronal_001.png","assets/T/mri-4d9005f5f44f4b7b/coronal_002.png","assets/T/mri-4d9005f5f44f4b7b/coronal_004.png","assets/T/mri-4d9005f5f44f4b7b/coronal_005.png","assets/T/mri-4d9005f5f44f4b7b/coronal_006.png","assets/T/mri-4d9005f5f44f4b7b/coronal_007.png","assets/T/mri-4d9005f5f44f4b7b/coronal_009.png","assets/T/mri-4d9005f5f44f4b7b/coronal_010.png","assets/T/mri-4d9005f5f44f4b7b/coronal_011.png","assets/T/mri-4d9005f5f44f4b7b/coronal_013.png","assets/T/mri-4d9005f5f44f4b7b/coronal_014.png","assets/T/mri-4d9005f5f44f4b7b/coronal_015.png","assets/T/mri-4d9005f5f44f4b7b/coronal_016.png","assets/T/mri-4d9005f5f44f4b7b/coronal_018.png","assets/T/mri-4d9005f5f44f4b7b/coronal_019.png","assets/T/mri-4d9005f5f44f4b7b/coronal_020.png","assets/T/mri-4d9005f5f44f4b7b/coronal_021.png","assets/T/mri-4d9005f5f44f4b7b/coronal_023.png","assets/T/mri-4d9005f5f44f4b7b/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":64,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,11,13,14,15,17,18,19,21,22,23,24,26,27,28,30,31,32,34,35,36,37,39,40,41,42,44,45,46,47,49,50,51,53,54,55,56,58,59,60,61,63,64]}}
+{"id":"mri-d703abecf2bf417e","request_id":"L3-T300:mri-d703abecf2bf417e","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-d703abecf2bf417e/axial_001.png","assets/T/mri-d703abecf2bf417e/axial_002.png","assets/T/mri-d703abecf2bf417e/axial_004.png","assets/T/mri-d703abecf2bf417e/axial_005.png","assets/T/mri-d703abecf2bf417e/axial_006.png","assets/T/mri-d703abecf2bf417e/axial_008.png","assets/T/mri-d703abecf2bf417e/axial_009.png","assets/T/mri-d703abecf2bf417e/axial_010.png","assets/T/mri-d703abecf2bf417e/axial_011.png","assets/T/mri-d703abecf2bf417e/axial_013.png","assets/T/mri-d703abecf2bf417e/axial_014.png","assets/T/mri-d703abecf2bf417e/axial_015.png","assets/T/mri-d703abecf2bf417e/axial_017.png","assets/T/mri-d703abecf2bf417e/axial_018.png","assets/T/mri-d703abecf2bf417e/axial_019.png","assets/T/mri-d703abecf2bf417e/axial_021.png","assets/T/mri-d703abecf2bf417e/axial_022.png","assets/T/mri-d703abecf2bf417e/axial_023.png","assets/T/mri-d703abecf2bf417e/axial_024.png","assets/T/mri-d703abecf2bf417e/axial_026.png","assets/T/mri-d703abecf2bf417e/axial_027.png","assets/T/mri-d703abecf2bf417e/axial_028.png","assets/T/mri-d703abecf2bf417e/axial_030.png","assets/T/mri-d703abecf2bf417e/axial_031.png","assets/T/mri-d703abecf2bf417e/axial_032.png","assets/T/mri-d703abecf2bf417e/axial_034.png","assets/T/mri-d703abecf2bf417e/axial_035.png","assets/T/mri-d703abecf2bf417e/axial_036.png","assets/T/mri-d703abecf2bf417e/axial_037.png","assets/T/mri-d703abecf2bf417e/axial_039.png","assets/T/mri-d703abecf2bf417e/axial_040.png","assets/T/mri-d703abecf2bf417e/coronal_001.png","assets/T/mri-d703abecf2bf417e/coronal_002.png","assets/T/mri-d703abecf2bf417e/coronal_004.png","assets/T/mri-d703abecf2bf417e/coronal_005.png","assets/T/mri-d703abecf2bf417e/coronal_006.png","assets/T/mri-d703abecf2bf417e/coronal_007.png","assets/T/mri-d703abecf2bf417e/coronal_009.png","assets/T/mri-d703abecf2bf417e/coronal_010.png","assets/T/mri-d703abecf2bf417e/coronal_011.png","assets/T/mri-d703abecf2bf417e/coronal_013.png","assets/T/mri-d703abecf2bf417e/coronal_014.png","assets/T/mri-d703abecf2bf417e/coronal_015.png","assets/T/mri-d703abecf2bf417e/coronal_016.png","assets/T/mri-d703abecf2bf417e/coronal_018.png","assets/T/mri-d703abecf2bf417e/coronal_019.png","assets/T/mri-d703abecf2bf417e/coronal_020.png","assets/T/mri-d703abecf2bf417e/coronal_021.png","assets/T/mri-d703abecf2bf417e/coronal_023.png","assets/T/mri-d703abecf2bf417e/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":64,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,11,13,14,15,17,18,19,21,22,23,24,26,27,28,30,31,32,34,35,36,37,39,40,41,42,44,45,46,47,49,50,51,53,54,55,56,58,59,60,61,63,64]}}
+{"id":"mri-822812f3ff034bba","request_id":"L3-T300:mri-822812f3ff034bba","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 30 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 20 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-822812f3ff034bba/axial_001.png","assets/T/mri-822812f3ff034bba/axial_002.png","assets/T/mri-822812f3ff034bba/axial_003.png","assets/T/mri-822812f3ff034bba/axial_005.png","assets/T/mri-822812f3ff034bba/axial_006.png","assets/T/mri-822812f3ff034bba/axial_007.png","assets/T/mri-822812f3ff034bba/axial_008.png","assets/T/mri-822812f3ff034bba/axial_009.png","assets/T/mri-822812f3ff034bba/axial_011.png","assets/T/mri-822812f3ff034bba/axial_012.png","assets/T/mri-822812f3ff034bba/axial_013.png","assets/T/mri-822812f3ff034bba/axial_014.png","assets/T/mri-822812f3ff034bba/axial_015.png","assets/T/mri-822812f3ff034bba/axial_017.png","assets/T/mri-822812f3ff034bba/axial_018.png","assets/T/mri-822812f3ff034bba/axial_019.png","assets/T/mri-822812f3ff034bba/axial_020.png","assets/T/mri-822812f3ff034bba/axial_022.png","assets/T/mri-822812f3ff034bba/axial_023.png","assets/T/mri-822812f3ff034bba/axial_024.png","assets/T/mri-822812f3ff034bba/axial_025.png","assets/T/mri-822812f3ff034bba/axial_026.png","assets/T/mri-822812f3ff034bba/axial_028.png","assets/T/mri-822812f3ff034bba/axial_029.png","assets/T/mri-822812f3ff034bba/axial_030.png","assets/T/mri-822812f3ff034bba/axial_031.png","assets/T/mri-822812f3ff034bba/axial_032.png","assets/T/mri-822812f3ff034bba/axial_034.png","assets/T/mri-822812f3ff034bba/axial_035.png","assets/T/mri-822812f3ff034bba/axial_036.png","assets/T/mri-822812f3ff034bba/coronal_001.png","assets/T/mri-822812f3ff034bba/coronal_002.png","assets/T/mri-822812f3ff034bba/coronal_003.png","assets/T/mri-822812f3ff034bba/coronal_005.png","assets/T/mri-822812f3ff034bba/coronal_006.png","assets/T/mri-822812f3ff034bba/coronal_007.png","assets/T/mri-822812f3ff034bba/coronal_008.png","assets/T/mri-822812f3ff034bba/coronal_009.png","assets/T/mri-822812f3ff034bba/coronal_011.png","assets/T/mri-822812f3ff034bba/coronal_012.png","assets/T/mri-822812f3ff034bba/coronal_013.png","assets/T/mri-822812f3ff034bba/coronal_014.png","assets/T/mri-822812f3ff034bba/coronal_016.png","assets/T/mri-822812f3ff034bba/coronal_017.png","assets/T/mri-822812f3ff034bba/coronal_018.png","assets/T/mri-822812f3ff034bba/coronal_019.png","assets/T/mri-822812f3ff034bba/coronal_020.png","assets/T/mri-822812f3ff034bba/coronal_022.png","assets/T/mri-822812f3ff034bba/coronal_023.png","assets/T/mri-822812f3ff034bba/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":60,"selected_count":50,"source_indices_1based":[1,2,3,5,6,7,8,9,11,12,13,14,15,17,18,19,20,22,23,24,25,26,28,29,30,31,32,34,35,36,37,38,39,41,42,43,44,45,47,48,49,50,52,53,54,55,56,58,59,60]}}
+{"id":"mri-20e02e9841324cfc","request_id":"L3-T300:mri-20e02e9841324cfc","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-20e02e9841324cfc/axial_001.png","assets/T/mri-20e02e9841324cfc/axial_002.png","assets/T/mri-20e02e9841324cfc/axial_004.png","assets/T/mri-20e02e9841324cfc/axial_005.png","assets/T/mri-20e02e9841324cfc/axial_006.png","assets/T/mri-20e02e9841324cfc/axial_008.png","assets/T/mri-20e02e9841324cfc/axial_009.png","assets/T/mri-20e02e9841324cfc/axial_010.png","assets/T/mri-20e02e9841324cfc/axial_012.png","assets/T/mri-20e02e9841324cfc/axial_013.png","assets/T/mri-20e02e9841324cfc/axial_014.png","assets/T/mri-20e02e9841324cfc/axial_016.png","assets/T/mri-20e02e9841324cfc/axial_017.png","assets/T/mri-20e02e9841324cfc/axial_018.png","assets/T/mri-20e02e9841324cfc/axial_020.png","assets/T/mri-20e02e9841324cfc/axial_021.png","assets/T/mri-20e02e9841324cfc/axial_022.png","assets/T/mri-20e02e9841324cfc/axial_023.png","assets/T/mri-20e02e9841324cfc/axial_025.png","assets/T/mri-20e02e9841324cfc/axial_026.png","assets/T/mri-20e02e9841324cfc/axial_027.png","assets/T/mri-20e02e9841324cfc/axial_029.png","assets/T/mri-20e02e9841324cfc/axial_030.png","assets/T/mri-20e02e9841324cfc/axial_031.png","assets/T/mri-20e02e9841324cfc/axial_033.png","assets/T/mri-20e02e9841324cfc/axial_034.png","assets/T/mri-20e02e9841324cfc/axial_035.png","assets/T/mri-20e02e9841324cfc/axial_037.png","assets/T/mri-20e02e9841324cfc/axial_038.png","assets/T/mri-20e02e9841324cfc/axial_039.png","assets/T/mri-20e02e9841324cfc/axial_041.png","assets/T/mri-20e02e9841324cfc/axial_042.png","assets/T/mri-20e02e9841324cfc/coronal_001.png","assets/T/mri-20e02e9841324cfc/coronal_002.png","assets/T/mri-20e02e9841324cfc/coronal_004.png","assets/T/mri-20e02e9841324cfc/coronal_005.png","assets/T/mri-20e02e9841324cfc/coronal_006.png","assets/T/mri-20e02e9841324cfc/coronal_008.png","assets/T/mri-20e02e9841324cfc/coronal_009.png","assets/T/mri-20e02e9841324cfc/coronal_010.png","assets/T/mri-20e02e9841324cfc/coronal_012.png","assets/T/mri-20e02e9841324cfc/coronal_013.png","assets/T/mri-20e02e9841324cfc/coronal_015.png","assets/T/mri-20e02e9841324cfc/coronal_016.png","assets/T/mri-20e02e9841324cfc/coronal_017.png","assets/T/mri-20e02e9841324cfc/coronal_019.png","assets/T/mri-20e02e9841324cfc/coronal_020.png","assets/T/mri-20e02e9841324cfc/coronal_021.png","assets/T/mri-20e02e9841324cfc/coronal_023.png","assets/T/mri-20e02e9841324cfc/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":66,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,12,13,14,16,17,18,20,21,22,23,25,26,27,29,30,31,33,34,35,37,38,39,41,42,43,44,46,47,48,50,51,52,54,55,57,58,59,61,62,63,65,66]}}
+{"id":"mri-4fca7bc4c97948bb","request_id":"L3-T300:mri-4fca7bc4c97948bb","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-4fca7bc4c97948bb/axial_001.png","assets/T/mri-4fca7bc4c97948bb/axial_002.png","assets/T/mri-4fca7bc4c97948bb/axial_004.png","assets/T/mri-4fca7bc4c97948bb/axial_005.png","assets/T/mri-4fca7bc4c97948bb/axial_006.png","assets/T/mri-4fca7bc4c97948bb/axial_008.png","assets/T/mri-4fca7bc4c97948bb/axial_009.png","assets/T/mri-4fca7bc4c97948bb/axial_010.png","assets/T/mri-4fca7bc4c97948bb/axial_012.png","assets/T/mri-4fca7bc4c97948bb/axial_013.png","assets/T/mri-4fca7bc4c97948bb/axial_014.png","assets/T/mri-4fca7bc4c97948bb/axial_016.png","assets/T/mri-4fca7bc4c97948bb/axial_017.png","assets/T/mri-4fca7bc4c97948bb/axial_018.png","assets/T/mri-4fca7bc4c97948bb/axial_020.png","assets/T/mri-4fca7bc4c97948bb/axial_021.png","assets/T/mri-4fca7bc4c97948bb/axial_022.png","assets/T/mri-4fca7bc4c97948bb/axial_023.png","assets/T/mri-4fca7bc4c97948bb/axial_025.png","assets/T/mri-4fca7bc4c97948bb/axial_026.png","assets/T/mri-4fca7bc4c97948bb/axial_027.png","assets/T/mri-4fca7bc4c97948bb/axial_029.png","assets/T/mri-4fca7bc4c97948bb/axial_030.png","assets/T/mri-4fca7bc4c97948bb/axial_031.png","assets/T/mri-4fca7bc4c97948bb/axial_033.png","assets/T/mri-4fca7bc4c97948bb/axial_034.png","assets/T/mri-4fca7bc4c97948bb/axial_035.png","assets/T/mri-4fca7bc4c97948bb/axial_037.png","assets/T/mri-4fca7bc4c97948bb/axial_038.png","assets/T/mri-4fca7bc4c97948bb/axial_039.png","assets/T/mri-4fca7bc4c97948bb/axial_041.png","assets/T/mri-4fca7bc4c97948bb/axial_042.png","assets/T/mri-4fca7bc4c97948bb/coronal_001.png","assets/T/mri-4fca7bc4c97948bb/coronal_002.png","assets/T/mri-4fca7bc4c97948bb/coronal_004.png","assets/T/mri-4fca7bc4c97948bb/coronal_005.png","assets/T/mri-4fca7bc4c97948bb/coronal_006.png","assets/T/mri-4fca7bc4c97948bb/coronal_008.png","assets/T/mri-4fca7bc4c97948bb/coronal_009.png","assets/T/mri-4fca7bc4c97948bb/coronal_010.png","assets/T/mri-4fca7bc4c97948bb/coronal_012.png","assets/T/mri-4fca7bc4c97948bb/coronal_013.png","assets/T/mri-4fca7bc4c97948bb/coronal_015.png","assets/T/mri-4fca7bc4c97948bb/coronal_016.png","assets/T/mri-4fca7bc4c97948bb/coronal_017.png","assets/T/mri-4fca7bc4c97948bb/coronal_019.png","assets/T/mri-4fca7bc4c97948bb/coronal_020.png","assets/T/mri-4fca7bc4c97948bb/coronal_021.png","assets/T/mri-4fca7bc4c97948bb/coronal_023.png","assets/T/mri-4fca7bc4c97948bb/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":66,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,12,13,14,16,17,18,20,21,22,23,25,26,27,29,30,31,33,34,35,37,38,39,41,42,43,44,46,47,48,50,51,52,54,55,57,58,59,61,62,63,65,66]}}
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+{"id":"mri-a79d6c4b9bc54d1e","request_id":"L3-T300:mri-a79d6c4b9bc54d1e","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 30 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 20 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-a79d6c4b9bc54d1e/axial_001.png","assets/T/mri-a79d6c4b9bc54d1e/axial_002.png","assets/T/mri-a79d6c4b9bc54d1e/axial_004.png","assets/T/mri-a79d6c4b9bc54d1e/axial_005.png","assets/T/mri-a79d6c4b9bc54d1e/axial_006.png","assets/T/mri-a79d6c4b9bc54d1e/axial_008.png","assets/T/mri-a79d6c4b9bc54d1e/axial_009.png","assets/T/mri-a79d6c4b9bc54d1e/axial_010.png","assets/T/mri-a79d6c4b9bc54d1e/axial_012.png","assets/T/mri-a79d6c4b9bc54d1e/axial_013.png","assets/T/mri-a79d6c4b9bc54d1e/axial_014.png","assets/T/mri-a79d6c4b9bc54d1e/axial_016.png","assets/T/mri-a79d6c4b9bc54d1e/axial_017.png","assets/T/mri-a79d6c4b9bc54d1e/axial_018.png","assets/T/mri-a79d6c4b9bc54d1e/axial_020.png","assets/T/mri-a79d6c4b9bc54d1e/axial_021.png","assets/T/mri-a79d6c4b9bc54d1e/axial_023.png","assets/T/mri-a79d6c4b9bc54d1e/axial_024.png","assets/T/mri-a79d6c4b9bc54d1e/axial_025.png","assets/T/mri-a79d6c4b9bc54d1e/axial_027.png","assets/T/mri-a79d6c4b9bc54d1e/axial_028.png","assets/T/mri-a79d6c4b9bc54d1e/axial_029.png","assets/T/mri-a79d6c4b9bc54d1e/axial_031.png","assets/T/mri-a79d6c4b9bc54d1e/axial_032.png","assets/T/mri-a79d6c4b9bc54d1e/axial_033.png","assets/T/mri-a79d6c4b9bc54d1e/axial_035.png","assets/T/mri-a79d6c4b9bc54d1e/axial_036.png","assets/T/mri-a79d6c4b9bc54d1e/axial_037.png","assets/T/mri-a79d6c4b9bc54d1e/axial_039.png","assets/T/mri-a79d6c4b9bc54d1e/axial_040.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_001.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_002.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_004.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_005.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_006.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_008.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_009.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_010.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_012.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_013.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_014.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_015.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_017.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_018.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_019.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_021.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_022.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_023.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_025.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_026.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":66,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,12,13,14,16,17,18,20,21,23,24,25,27,28,29,31,32,33,35,36,37,39,40,41,42,44,45,46,48,49,50,52,53,54,55,57,58,59,61,62,63,65,66]}}
+{"id":"mri-58068eea382343a8","request_id":"L3-T300:mri-58068eea382343a8","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 30 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 20 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-58068eea382343a8/axial_001.png","assets/T/mri-58068eea382343a8/axial_002.png","assets/T/mri-58068eea382343a8/axial_004.png","assets/T/mri-58068eea382343a8/axial_005.png","assets/T/mri-58068eea382343a8/axial_006.png","assets/T/mri-58068eea382343a8/axial_008.png","assets/T/mri-58068eea382343a8/axial_009.png","assets/T/mri-58068eea382343a8/axial_010.png","assets/T/mri-58068eea382343a8/axial_012.png","assets/T/mri-58068eea382343a8/axial_013.png","assets/T/mri-58068eea382343a8/axial_014.png","assets/T/mri-58068eea382343a8/axial_016.png","assets/T/mri-58068eea382343a8/axial_017.png","assets/T/mri-58068eea382343a8/axial_018.png","assets/T/mri-58068eea382343a8/axial_020.png","assets/T/mri-58068eea382343a8/axial_021.png","assets/T/mri-58068eea382343a8/axial_023.png","assets/T/mri-58068eea382343a8/axial_024.png","assets/T/mri-58068eea382343a8/axial_025.png","assets/T/mri-58068eea382343a8/axial_027.png","assets/T/mri-58068eea382343a8/axial_028.png","assets/T/mri-58068eea382343a8/axial_029.png","assets/T/mri-58068eea382343a8/axial_031.png","assets/T/mri-58068eea382343a8/axial_032.png","assets/T/mri-58068eea382343a8/axial_033.png","assets/T/mri-58068eea382343a8/axial_035.png","assets/T/mri-58068eea382343a8/axial_036.png","assets/T/mri-58068eea382343a8/axial_037.png","assets/T/mri-58068eea382343a8/axial_039.png","assets/T/mri-58068eea382343a8/axial_040.png","assets/T/mri-58068eea382343a8/coronal_001.png","assets/T/mri-58068eea382343a8/coronal_002.png","assets/T/mri-58068eea382343a8/coronal_004.png","assets/T/mri-58068eea382343a8/coronal_005.png","assets/T/mri-58068eea382343a8/coronal_006.png","assets/T/mri-58068eea382343a8/coronal_008.png","assets/T/mri-58068eea382343a8/coronal_009.png","assets/T/mri-58068eea382343a8/coronal_010.png","assets/T/mri-58068eea382343a8/coronal_012.png","assets/T/mri-58068eea382343a8/coronal_013.png","assets/T/mri-58068eea382343a8/coronal_014.png","assets/T/mri-58068eea382343a8/coronal_015.png","assets/T/mri-58068eea382343a8/coronal_017.png","assets/T/mri-58068eea382343a8/coronal_018.png","assets/T/mri-58068eea382343a8/coronal_019.png","assets/T/mri-58068eea382343a8/coronal_021.png","assets/T/mri-58068eea382343a8/coronal_022.png","assets/T/mri-58068eea382343a8/coronal_023.png","assets/T/mri-58068eea382343a8/coronal_025.png","assets/T/mri-58068eea382343a8/coronal_026.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":66,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,12,13,14,16,17,18,20,21,23,24,25,27,28,29,31,32,33,35,36,37,39,40,41,42,44,45,46,48,49,50,52,53,54,55,57,58,59,61,62,63,65,66]}}
+{"id":"mri-753dcbe2c0cc4d80","request_id":"L3-T300:mri-753dcbe2c0cc4d80","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 33 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 17 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-753dcbe2c0cc4d80/axial_001.png","assets/T/mri-753dcbe2c0cc4d80/axial_002.png","assets/T/mri-753dcbe2c0cc4d80/axial_004.png","assets/T/mri-753dcbe2c0cc4d80/axial_005.png","assets/T/mri-753dcbe2c0cc4d80/axial_007.png","assets/T/mri-753dcbe2c0cc4d80/axial_008.png","assets/T/mri-753dcbe2c0cc4d80/axial_009.png","assets/T/mri-753dcbe2c0cc4d80/axial_011.png","assets/T/mri-753dcbe2c0cc4d80/axial_012.png","assets/T/mri-753dcbe2c0cc4d80/axial_014.png","assets/T/mri-753dcbe2c0cc4d80/axial_015.png","assets/T/mri-753dcbe2c0cc4d80/axial_016.png","assets/T/mri-753dcbe2c0cc4d80/axial_018.png","assets/T/mri-753dcbe2c0cc4d80/axial_019.png","assets/T/mri-753dcbe2c0cc4d80/axial_021.png","assets/T/mri-753dcbe2c0cc4d80/axial_022.png","assets/T/mri-753dcbe2c0cc4d80/axial_024.png","assets/T/mri-753dcbe2c0cc4d80/axial_025.png","assets/T/mri-753dcbe2c0cc4d80/axial_026.png","assets/T/mri-753dcbe2c0cc4d80/axial_028.png","assets/T/mri-753dcbe2c0cc4d80/axial_029.png","assets/T/mri-753dcbe2c0cc4d80/axial_031.png","assets/T/mri-753dcbe2c0cc4d80/axial_032.png","assets/T/mri-753dcbe2c0cc4d80/axial_033.png","assets/T/mri-753dcbe2c0cc4d80/axial_035.png","assets/T/mri-753dcbe2c0cc4d80/axial_036.png","assets/T/mri-753dcbe2c0cc4d80/axial_038.png","assets/T/mri-753dcbe2c0cc4d80/axial_039.png","assets/T/mri-753dcbe2c0cc4d80/axial_040.png","assets/T/mri-753dcbe2c0cc4d80/axial_042.png","assets/T/mri-753dcbe2c0cc4d80/axial_043.png","assets/T/mri-753dcbe2c0cc4d80/axial_045.png","assets/T/mri-753dcbe2c0cc4d80/axial_046.png","assets/T/mri-753dcbe2c0cc4d80/coronal_001.png","assets/T/mri-753dcbe2c0cc4d80/coronal_002.png","assets/T/mri-753dcbe2c0cc4d80/coronal_004.png","assets/T/mri-753dcbe2c0cc4d80/coronal_005.png","assets/T/mri-753dcbe2c0cc4d80/coronal_007.png","assets/T/mri-753dcbe2c0cc4d80/coronal_008.png","assets/T/mri-753dcbe2c0cc4d80/coronal_010.png","assets/T/mri-753dcbe2c0cc4d80/coronal_011.png","assets/T/mri-753dcbe2c0cc4d80/coronal_013.png","assets/T/mri-753dcbe2c0cc4d80/coronal_014.png","assets/T/mri-753dcbe2c0cc4d80/coronal_015.png","assets/T/mri-753dcbe2c0cc4d80/coronal_017.png","assets/T/mri-753dcbe2c0cc4d80/coronal_018.png","assets/T/mri-753dcbe2c0cc4d80/coronal_020.png","assets/T/mri-753dcbe2c0cc4d80/coronal_021.png","assets/T/mri-753dcbe2c0cc4d80/coronal_023.png","assets/T/mri-753dcbe2c0cc4d80/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":70,"selected_count":50,"source_indices_1based":[1,2,4,5,7,8,9,11,12,14,15,16,18,19,21,22,24,25,26,28,29,31,32,33,35,36,38,39,40,42,43,45,46,47,48,50,51,53,54,56,57,59,60,61,63,64,66,67,69,70]}}
+{"id":"mri-f298574041324fad","request_id":"L3-T300:mri-f298574041324fad","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-f298574041324fad/axial_001.png","assets/T/mri-f298574041324fad/axial_002.png","assets/T/mri-f298574041324fad/axial_004.png","assets/T/mri-f298574041324fad/axial_005.png","assets/T/mri-f298574041324fad/axial_006.png","assets/T/mri-f298574041324fad/axial_007.png","assets/T/mri-f298574041324fad/axial_009.png","assets/T/mri-f298574041324fad/axial_010.png","assets/T/mri-f298574041324fad/axial_011.png","assets/T/mri-f298574041324fad/axial_012.png","assets/T/mri-f298574041324fad/axial_014.png","assets/T/mri-f298574041324fad/axial_015.png","assets/T/mri-f298574041324fad/axial_016.png","assets/T/mri-f298574041324fad/axial_017.png","assets/T/mri-f298574041324fad/axial_019.png","assets/T/mri-f298574041324fad/axial_020.png","assets/T/mri-f298574041324fad/axial_021.png","assets/T/mri-f298574041324fad/axial_023.png","assets/T/mri-f298574041324fad/axial_024.png","assets/T/mri-f298574041324fad/axial_025.png","assets/T/mri-f298574041324fad/axial_026.png","assets/T/mri-f298574041324fad/axial_028.png","assets/T/mri-f298574041324fad/axial_029.png","assets/T/mri-f298574041324fad/axial_030.png","assets/T/mri-f298574041324fad/axial_031.png","assets/T/mri-f298574041324fad/axial_033.png","assets/T/mri-f298574041324fad/axial_034.png","assets/T/mri-f298574041324fad/axial_035.png","assets/T/mri-f298574041324fad/axial_036.png","assets/T/mri-f298574041324fad/axial_038.png","assets/T/mri-f298574041324fad/axial_039.png","assets/T/mri-f298574041324fad/coronal_001.png","assets/T/mri-f298574041324fad/coronal_002.png","assets/T/mri-f298574041324fad/coronal_004.png","assets/T/mri-f298574041324fad/coronal_005.png","assets/T/mri-f298574041324fad/coronal_006.png","assets/T/mri-f298574041324fad/coronal_007.png","assets/T/mri-f298574041324fad/coronal_009.png","assets/T/mri-f298574041324fad/coronal_010.png","assets/T/mri-f298574041324fad/coronal_011.png","assets/T/mri-f298574041324fad/coronal_013.png","assets/T/mri-f298574041324fad/coronal_014.png","assets/T/mri-f298574041324fad/coronal_015.png","assets/T/mri-f298574041324fad/coronal_016.png","assets/T/mri-f298574041324fad/coronal_018.png","assets/T/mri-f298574041324fad/coronal_019.png","assets/T/mri-f298574041324fad/coronal_020.png","assets/T/mri-f298574041324fad/coronal_021.png","assets/T/mri-f298574041324fad/coronal_023.png","assets/T/mri-f298574041324fad/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":63,"selected_count":50,"source_indices_1based":[1,2,4,5,6,7,9,10,11,12,14,15,16,17,19,20,21,23,24,25,26,28,29,30,31,33,34,35,36,38,39,40,41,43,44,45,46,48,49,50,52,53,54,55,57,58,59,60,62,63]}}
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+{"id":"mri-f31b184843914d18","request_id":"L3-T300:mri-f31b184843914d18","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-f31b184843914d18/axial_001.png","assets/T/mri-f31b184843914d18/axial_002.png","assets/T/mri-f31b184843914d18/axial_004.png","assets/T/mri-f31b184843914d18/axial_005.png","assets/T/mri-f31b184843914d18/axial_006.png","assets/T/mri-f31b184843914d18/axial_008.png","assets/T/mri-f31b184843914d18/axial_009.png","assets/T/mri-f31b184843914d18/axial_010.png","assets/T/mri-f31b184843914d18/axial_011.png","assets/T/mri-f31b184843914d18/axial_013.png","assets/T/mri-f31b184843914d18/axial_014.png","assets/T/mri-f31b184843914d18/axial_015.png","assets/T/mri-f31b184843914d18/axial_017.png","assets/T/mri-f31b184843914d18/axial_018.png","assets/T/mri-f31b184843914d18/axial_019.png","assets/T/mri-f31b184843914d18/axial_021.png","assets/T/mri-f31b184843914d18/axial_022.png","assets/T/mri-f31b184843914d18/axial_023.png","assets/T/mri-f31b184843914d18/axial_024.png","assets/T/mri-f31b184843914d18/axial_026.png","assets/T/mri-f31b184843914d18/axial_027.png","assets/T/mri-f31b184843914d18/axial_028.png","assets/T/mri-f31b184843914d18/axial_030.png","assets/T/mri-f31b184843914d18/axial_031.png","assets/T/mri-f31b184843914d18/axial_032.png","assets/T/mri-f31b184843914d18/axial_034.png","assets/T/mri-f31b184843914d18/axial_035.png","assets/T/mri-f31b184843914d18/axial_036.png","assets/T/mri-f31b184843914d18/axial_037.png","assets/T/mri-f31b184843914d18/axial_039.png","assets/T/mri-f31b184843914d18/axial_040.png","assets/T/mri-f31b184843914d18/coronal_001.png","assets/T/mri-f31b184843914d18/coronal_002.png","assets/T/mri-f31b184843914d18/coronal_004.png","assets/T/mri-f31b184843914d18/coronal_005.png","assets/T/mri-f31b184843914d18/coronal_006.png","assets/T/mri-f31b184843914d18/coronal_007.png","assets/T/mri-f31b184843914d18/coronal_009.png","assets/T/mri-f31b184843914d18/coronal_010.png","assets/T/mri-f31b184843914d18/coronal_011.png","assets/T/mri-f31b184843914d18/coronal_013.png","assets/T/mri-f31b184843914d18/coronal_014.png","assets/T/mri-f31b184843914d18/coronal_015.png","assets/T/mri-f31b184843914d18/coronal_016.png","assets/T/mri-f31b184843914d18/coronal_018.png","assets/T/mri-f31b184843914d18/coronal_019.png","assets/T/mri-f31b184843914d18/coronal_020.png","assets/T/mri-f31b184843914d18/coronal_021.png","assets/T/mri-f31b184843914d18/coronal_023.png","assets/T/mri-f31b184843914d18/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":64,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,11,13,14,15,17,18,19,21,22,23,24,26,27,28,30,31,32,34,35,36,37,39,40,41,42,44,45,46,47,49,50,51,53,54,55,56,58,59,60,61,63,64]}}
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+{"id":"mri-7f087e4b9fbd4930","request_id":"L3-T300:mri-7f087e4b9fbd4930","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-7f087e4b9fbd4930/axial_001.png","assets/T/mri-7f087e4b9fbd4930/axial_002.png","assets/T/mri-7f087e4b9fbd4930/axial_004.png","assets/T/mri-7f087e4b9fbd4930/axial_005.png","assets/T/mri-7f087e4b9fbd4930/axial_006.png","assets/T/mri-7f087e4b9fbd4930/axial_008.png","assets/T/mri-7f087e4b9fbd4930/axial_009.png","assets/T/mri-7f087e4b9fbd4930/axial_010.png","assets/T/mri-7f087e4b9fbd4930/axial_011.png","assets/T/mri-7f087e4b9fbd4930/axial_013.png","assets/T/mri-7f087e4b9fbd4930/axial_014.png","assets/T/mri-7f087e4b9fbd4930/axial_015.png","assets/T/mri-7f087e4b9fbd4930/axial_017.png","assets/T/mri-7f087e4b9fbd4930/axial_018.png","assets/T/mri-7f087e4b9fbd4930/axial_019.png","assets/T/mri-7f087e4b9fbd4930/axial_021.png","assets/T/mri-7f087e4b9fbd4930/axial_022.png","assets/T/mri-7f087e4b9fbd4930/axial_023.png","assets/T/mri-7f087e4b9fbd4930/axial_024.png","assets/T/mri-7f087e4b9fbd4930/axial_026.png","assets/T/mri-7f087e4b9fbd4930/axial_027.png","assets/T/mri-7f087e4b9fbd4930/axial_028.png","assets/T/mri-7f087e4b9fbd4930/axial_030.png","assets/T/mri-7f087e4b9fbd4930/axial_031.png","assets/T/mri-7f087e4b9fbd4930/axial_032.png","assets/T/mri-7f087e4b9fbd4930/axial_034.png","assets/T/mri-7f087e4b9fbd4930/axial_035.png","assets/T/mri-7f087e4b9fbd4930/axial_036.png","assets/T/mri-7f087e4b9fbd4930/axial_037.png","assets/T/mri-7f087e4b9fbd4930/axial_039.png","assets/T/mri-7f087e4b9fbd4930/axial_040.png","assets/T/mri-7f087e4b9fbd4930/coronal_001.png","assets/T/mri-7f087e4b9fbd4930/coronal_002.png","assets/T/mri-7f087e4b9fbd4930/coronal_004.png","assets/T/mri-7f087e4b9fbd4930/coronal_005.png","assets/T/mri-7f087e4b9fbd4930/coronal_006.png","assets/T/mri-7f087e4b9fbd4930/coronal_007.png","assets/T/mri-7f087e4b9fbd4930/coronal_009.png","assets/T/mri-7f087e4b9fbd4930/coronal_010.png","assets/T/mri-7f087e4b9fbd4930/coronal_011.png","assets/T/mri-7f087e4b9fbd4930/coronal_013.png","assets/T/mri-7f087e4b9fbd4930/coronal_014.png","assets/T/mri-7f087e4b9fbd4930/coronal_015.png","assets/T/mri-7f087e4b9fbd4930/coronal_016.png","assets/T/mri-7f087e4b9fbd4930/coronal_018.png","assets/T/mri-7f087e4b9fbd4930/coronal_019.png","assets/T/mri-7f087e4b9fbd4930/coronal_020.png","assets/T/mri-7f087e4b9fbd4930/coronal_021.png","assets/T/mri-7f087e4b9fbd4930/coronal_023.png","assets/T/mri-7f087e4b9fbd4930/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":64,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,11,13,14,15,17,18,19,21,22,23,24,26,27,28,30,31,32,34,35,36,37,39,40,41,42,44,45,46,47,49,50,51,53,54,55,56,58,59,60,61,63,64]}}
+{"id":"mri-2495921ad88b46a3","request_id":"L3-T300:mri-2495921ad88b46a3","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-2495921ad88b46a3/axial_001.png","assets/T/mri-2495921ad88b46a3/axial_002.png","assets/T/mri-2495921ad88b46a3/axial_004.png","assets/T/mri-2495921ad88b46a3/axial_005.png","assets/T/mri-2495921ad88b46a3/axial_006.png","assets/T/mri-2495921ad88b46a3/axial_008.png","assets/T/mri-2495921ad88b46a3/axial_009.png","assets/T/mri-2495921ad88b46a3/axial_010.png","assets/T/mri-2495921ad88b46a3/axial_011.png","assets/T/mri-2495921ad88b46a3/axial_013.png","assets/T/mri-2495921ad88b46a3/axial_014.png","assets/T/mri-2495921ad88b46a3/axial_015.png","assets/T/mri-2495921ad88b46a3/axial_017.png","assets/T/mri-2495921ad88b46a3/axial_018.png","assets/T/mri-2495921ad88b46a3/axial_019.png","assets/T/mri-2495921ad88b46a3/axial_021.png","assets/T/mri-2495921ad88b46a3/axial_022.png","assets/T/mri-2495921ad88b46a3/axial_023.png","assets/T/mri-2495921ad88b46a3/axial_024.png","assets/T/mri-2495921ad88b46a3/axial_026.png","assets/T/mri-2495921ad88b46a3/axial_027.png","assets/T/mri-2495921ad88b46a3/axial_028.png","assets/T/mri-2495921ad88b46a3/axial_030.png","assets/T/mri-2495921ad88b46a3/axial_031.png","assets/T/mri-2495921ad88b46a3/axial_032.png","assets/T/mri-2495921ad88b46a3/axial_034.png","assets/T/mri-2495921ad88b46a3/axial_035.png","assets/T/mri-2495921ad88b46a3/axial_036.png","assets/T/mri-2495921ad88b46a3/axial_037.png","assets/T/mri-2495921ad88b46a3/axial_039.png","assets/T/mri-2495921ad88b46a3/axial_040.png","assets/T/mri-2495921ad88b46a3/coronal_001.png","assets/T/mri-2495921ad88b46a3/coronal_002.png","assets/T/mri-2495921ad88b46a3/coronal_004.png","assets/T/mri-2495921ad88b46a3/coronal_005.png","assets/T/mri-2495921ad88b46a3/coronal_006.png","assets/T/mri-2495921ad88b46a3/coronal_007.png","assets/T/mri-2495921ad88b46a3/coronal_009.png","assets/T/mri-2495921ad88b46a3/coronal_010.png","assets/T/mri-2495921ad88b46a3/coronal_011.png","assets/T/mri-2495921ad88b46a3/coronal_013.png","assets/T/mri-2495921ad88b46a3/coronal_014.png","assets/T/mri-2495921ad88b46a3/coronal_015.png","assets/T/mri-2495921ad88b46a3/coronal_016.png","assets/T/mri-2495921ad88b46a3/coronal_018.png","assets/T/mri-2495921ad88b46a3/coronal_019.png","assets/T/mri-2495921ad88b46a3/coronal_020.png","assets/T/mri-2495921ad88b46a3/coronal_021.png","assets/T/mri-2495921ad88b46a3/coronal_023.png","assets/T/mri-2495921ad88b46a3/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":64,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,11,13,14,15,17,18,19,21,22,23,24,26,27,28,30,31,32,34,35,36,37,39,40,41,42,44,45,46,47,49,50,51,53,54,55,56,58,59,60,61,63,64]}}
+{"id":"mri-6093448809034145","request_id":"L3-T300:mri-6093448809034145","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 30 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 20 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-6093448809034145/axial_001.png","assets/T/mri-6093448809034145/axial_002.png","assets/T/mri-6093448809034145/axial_004.png","assets/T/mri-6093448809034145/axial_005.png","assets/T/mri-6093448809034145/axial_006.png","assets/T/mri-6093448809034145/axial_008.png","assets/T/mri-6093448809034145/axial_009.png","assets/T/mri-6093448809034145/axial_010.png","assets/T/mri-6093448809034145/axial_012.png","assets/T/mri-6093448809034145/axial_013.png","assets/T/mri-6093448809034145/axial_014.png","assets/T/mri-6093448809034145/axial_016.png","assets/T/mri-6093448809034145/axial_017.png","assets/T/mri-6093448809034145/axial_018.png","assets/T/mri-6093448809034145/axial_020.png","assets/T/mri-6093448809034145/axial_021.png","assets/T/mri-6093448809034145/axial_023.png","assets/T/mri-6093448809034145/axial_024.png","assets/T/mri-6093448809034145/axial_025.png","assets/T/mri-6093448809034145/axial_027.png","assets/T/mri-6093448809034145/axial_028.png","assets/T/mri-6093448809034145/axial_029.png","assets/T/mri-6093448809034145/axial_031.png","assets/T/mri-6093448809034145/axial_032.png","assets/T/mri-6093448809034145/axial_033.png","assets/T/mri-6093448809034145/axial_035.png","assets/T/mri-6093448809034145/axial_036.png","assets/T/mri-6093448809034145/axial_037.png","assets/T/mri-6093448809034145/axial_039.png","assets/T/mri-6093448809034145/axial_040.png","assets/T/mri-6093448809034145/coronal_001.png","assets/T/mri-6093448809034145/coronal_002.png","assets/T/mri-6093448809034145/coronal_004.png","assets/T/mri-6093448809034145/coronal_005.png","assets/T/mri-6093448809034145/coronal_006.png","assets/T/mri-6093448809034145/coronal_008.png","assets/T/mri-6093448809034145/coronal_009.png","assets/T/mri-6093448809034145/coronal_010.png","assets/T/mri-6093448809034145/coronal_012.png","assets/T/mri-6093448809034145/coronal_013.png","assets/T/mri-6093448809034145/coronal_014.png","assets/T/mri-6093448809034145/coronal_015.png","assets/T/mri-6093448809034145/coronal_017.png","assets/T/mri-6093448809034145/coronal_018.png","assets/T/mri-6093448809034145/coronal_019.png","assets/T/mri-6093448809034145/coronal_021.png","assets/T/mri-6093448809034145/coronal_022.png","assets/T/mri-6093448809034145/coronal_023.png","assets/T/mri-6093448809034145/coronal_025.png","assets/T/mri-6093448809034145/coronal_026.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":66,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,12,13,14,16,17,18,20,21,23,24,25,27,28,29,31,32,33,35,36,37,39,40,41,42,44,45,46,48,49,50,52,53,54,55,57,58,59,61,62,63,65,66]}}
+{"id":"mri-cda1302e1734496e","request_id":"L3-T300:mri-cda1302e1734496e","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-cda1302e1734496e/axial_001.png","assets/T/mri-cda1302e1734496e/axial_002.png","assets/T/mri-cda1302e1734496e/axial_004.png","assets/T/mri-cda1302e1734496e/axial_005.png","assets/T/mri-cda1302e1734496e/axial_006.png","assets/T/mri-cda1302e1734496e/axial_008.png","assets/T/mri-cda1302e1734496e/axial_009.png","assets/T/mri-cda1302e1734496e/axial_010.png","assets/T/mri-cda1302e1734496e/axial_011.png","assets/T/mri-cda1302e1734496e/axial_013.png","assets/T/mri-cda1302e1734496e/axial_014.png","assets/T/mri-cda1302e1734496e/axial_015.png","assets/T/mri-cda1302e1734496e/axial_017.png","assets/T/mri-cda1302e1734496e/axial_018.png","assets/T/mri-cda1302e1734496e/axial_019.png","assets/T/mri-cda1302e1734496e/axial_021.png","assets/T/mri-cda1302e1734496e/axial_022.png","assets/T/mri-cda1302e1734496e/axial_023.png","assets/T/mri-cda1302e1734496e/axial_024.png","assets/T/mri-cda1302e1734496e/axial_026.png","assets/T/mri-cda1302e1734496e/axial_027.png","assets/T/mri-cda1302e1734496e/axial_028.png","assets/T/mri-cda1302e1734496e/axial_030.png","assets/T/mri-cda1302e1734496e/axial_031.png","assets/T/mri-cda1302e1734496e/axial_032.png","assets/T/mri-cda1302e1734496e/axial_034.png","assets/T/mri-cda1302e1734496e/axial_035.png","assets/T/mri-cda1302e1734496e/axial_036.png","assets/T/mri-cda1302e1734496e/axial_037.png","assets/T/mri-cda1302e1734496e/axial_039.png","assets/T/mri-cda1302e1734496e/axial_040.png","assets/T/mri-cda1302e1734496e/coronal_001.png","assets/T/mri-cda1302e1734496e/coronal_002.png","assets/T/mri-cda1302e1734496e/coronal_004.png","assets/T/mri-cda1302e1734496e/coronal_005.png","assets/T/mri-cda1302e1734496e/coronal_006.png","assets/T/mri-cda1302e1734496e/coronal_007.png","assets/T/mri-cda1302e1734496e/coronal_009.png","assets/T/mri-cda1302e1734496e/coronal_010.png","assets/T/mri-cda1302e1734496e/coronal_011.png","assets/T/mri-cda1302e1734496e/coronal_013.png","assets/T/mri-cda1302e1734496e/coronal_014.png","assets/T/mri-cda1302e1734496e/coronal_015.png","assets/T/mri-cda1302e1734496e/coronal_016.png","assets/T/mri-cda1302e1734496e/coronal_018.png","assets/T/mri-cda1302e1734496e/coronal_019.png","assets/T/mri-cda1302e1734496e/coronal_020.png","assets/T/mri-cda1302e1734496e/coronal_021.png","assets/T/mri-cda1302e1734496e/coronal_023.png","assets/T/mri-cda1302e1734496e/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":64,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,11,13,14,15,17,18,19,21,22,23,24,26,27,28,30,31,32,34,35,36,37,39,40,41,42,44,45,46,47,49,50,51,53,54,55,56,58,59,60,61,63,64]}}
+{"id":"mri-d514f55b3f3443d5","request_id":"L3-T300:mri-d514f55b3f3443d5","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-d514f55b3f3443d5/axial_001.png","assets/T/mri-d514f55b3f3443d5/axial_002.png","assets/T/mri-d514f55b3f3443d5/axial_004.png","assets/T/mri-d514f55b3f3443d5/axial_005.png","assets/T/mri-d514f55b3f3443d5/axial_007.png","assets/T/mri-d514f55b3f3443d5/axial_008.png","assets/T/mri-d514f55b3f3443d5/axial_009.png","assets/T/mri-d514f55b3f3443d5/axial_011.png","assets/T/mri-d514f55b3f3443d5/axial_012.png","assets/T/mri-d514f55b3f3443d5/axial_013.png","assets/T/mri-d514f55b3f3443d5/axial_015.png","assets/T/mri-d514f55b3f3443d5/axial_016.png","assets/T/mri-d514f55b3f3443d5/axial_018.png","assets/T/mri-d514f55b3f3443d5/axial_019.png","assets/T/mri-d514f55b3f3443d5/axial_020.png","assets/T/mri-d514f55b3f3443d5/axial_022.png","assets/T/mri-d514f55b3f3443d5/axial_023.png","assets/T/mri-d514f55b3f3443d5/axial_025.png","assets/T/mri-d514f55b3f3443d5/axial_026.png","assets/T/mri-d514f55b3f3443d5/axial_027.png","assets/T/mri-d514f55b3f3443d5/axial_029.png","assets/T/mri-d514f55b3f3443d5/axial_030.png","assets/T/mri-d514f55b3f3443d5/axial_032.png","assets/T/mri-d514f55b3f3443d5/axial_033.png","assets/T/mri-d514f55b3f3443d5/axial_034.png","assets/T/mri-d514f55b3f3443d5/axial_036.png","assets/T/mri-d514f55b3f3443d5/axial_037.png","assets/T/mri-d514f55b3f3443d5/axial_038.png","assets/T/mri-d514f55b3f3443d5/axial_040.png","assets/T/mri-d514f55b3f3443d5/axial_041.png","assets/T/mri-d514f55b3f3443d5/axial_043.png","assets/T/mri-d514f55b3f3443d5/axial_044.png","assets/T/mri-d514f55b3f3443d5/coronal_001.png","assets/T/mri-d514f55b3f3443d5/coronal_002.png","assets/T/mri-d514f55b3f3443d5/coronal_004.png","assets/T/mri-d514f55b3f3443d5/coronal_005.png","assets/T/mri-d514f55b3f3443d5/coronal_006.png","assets/T/mri-d514f55b3f3443d5/coronal_008.png","assets/T/mri-d514f55b3f3443d5/coronal_009.png","assets/T/mri-d514f55b3f3443d5/coronal_010.png","assets/T/mri-d514f55b3f3443d5/coronal_012.png","assets/T/mri-d514f55b3f3443d5/coronal_013.png","assets/T/mri-d514f55b3f3443d5/coronal_015.png","assets/T/mri-d514f55b3f3443d5/coronal_016.png","assets/T/mri-d514f55b3f3443d5/coronal_017.png","assets/T/mri-d514f55b3f3443d5/coronal_019.png","assets/T/mri-d514f55b3f3443d5/coronal_020.png","assets/T/mri-d514f55b3f3443d5/coronal_021.png","assets/T/mri-d514f55b3f3443d5/coronal_023.png","assets/T/mri-d514f55b3f3443d5/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":68,"selected_count":50,"source_indices_1based":[1,2,4,5,7,8,9,11,12,13,15,16,18,19,20,22,23,25,26,27,29,30,32,33,34,36,37,38,40,41,43,44,45,46,48,49,50,52,53,54,56,57,59,60,61,63,64,65,67,68]}}
+{"id":"mri-0308881784db400a","request_id":"L3-T300:mri-0308881784db400a","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 33 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 17 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-0308881784db400a/axial_001.png","assets/T/mri-0308881784db400a/axial_002.png","assets/T/mri-0308881784db400a/axial_004.png","assets/T/mri-0308881784db400a/axial_005.png","assets/T/mri-0308881784db400a/axial_007.png","assets/T/mri-0308881784db400a/axial_008.png","assets/T/mri-0308881784db400a/axial_009.png","assets/T/mri-0308881784db400a/axial_011.png","assets/T/mri-0308881784db400a/axial_012.png","assets/T/mri-0308881784db400a/axial_013.png","assets/T/mri-0308881784db400a/axial_015.png","assets/T/mri-0308881784db400a/axial_016.png","assets/T/mri-0308881784db400a/axial_018.png","assets/T/mri-0308881784db400a/axial_019.png","assets/T/mri-0308881784db400a/axial_020.png","assets/T/mri-0308881784db400a/axial_022.png","assets/T/mri-0308881784db400a/axial_023.png","assets/T/mri-0308881784db400a/axial_024.png","assets/T/mri-0308881784db400a/axial_026.png","assets/T/mri-0308881784db400a/axial_027.png","assets/T/mri-0308881784db400a/axial_029.png","assets/T/mri-0308881784db400a/axial_030.png","assets/T/mri-0308881784db400a/axial_031.png","assets/T/mri-0308881784db400a/axial_033.png","assets/T/mri-0308881784db400a/axial_034.png","assets/T/mri-0308881784db400a/axial_035.png","assets/T/mri-0308881784db400a/axial_037.png","assets/T/mri-0308881784db400a/axial_038.png","assets/T/mri-0308881784db400a/axial_040.png","assets/T/mri-0308881784db400a/axial_041.png","assets/T/mri-0308881784db400a/axial_042.png","assets/T/mri-0308881784db400a/axial_044.png","assets/T/mri-0308881784db400a/axial_045.png","assets/T/mri-0308881784db400a/coronal_001.png","assets/T/mri-0308881784db400a/coronal_002.png","assets/T/mri-0308881784db400a/coronal_004.png","assets/T/mri-0308881784db400a/coronal_005.png","assets/T/mri-0308881784db400a/coronal_007.png","assets/T/mri-0308881784db400a/coronal_008.png","assets/T/mri-0308881784db400a/coronal_010.png","assets/T/mri-0308881784db400a/coronal_011.png","assets/T/mri-0308881784db400a/coronal_013.png","assets/T/mri-0308881784db400a/coronal_014.png","assets/T/mri-0308881784db400a/coronal_015.png","assets/T/mri-0308881784db400a/coronal_017.png","assets/T/mri-0308881784db400a/coronal_018.png","assets/T/mri-0308881784db400a/coronal_020.png","assets/T/mri-0308881784db400a/coronal_021.png","assets/T/mri-0308881784db400a/coronal_023.png","assets/T/mri-0308881784db400a/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":69,"selected_count":50,"source_indices_1based":[1,2,4,5,7,8,9,11,12,13,15,16,18,19,20,22,23,24,26,27,29,30,31,33,34,35,37,38,40,41,42,44,45,46,47,49,50,52,53,55,56,58,59,60,62,63,65,66,68,69]}}
+{"id":"mri-4cb8cb63e2d748bd","request_id":"L3-T300:mri-4cb8cb63e2d748bd","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-4cb8cb63e2d748bd/axial_001.png","assets/T/mri-4cb8cb63e2d748bd/axial_002.png","assets/T/mri-4cb8cb63e2d748bd/axial_004.png","assets/T/mri-4cb8cb63e2d748bd/axial_005.png","assets/T/mri-4cb8cb63e2d748bd/axial_007.png","assets/T/mri-4cb8cb63e2d748bd/axial_008.png","assets/T/mri-4cb8cb63e2d748bd/axial_009.png","assets/T/mri-4cb8cb63e2d748bd/axial_011.png","assets/T/mri-4cb8cb63e2d748bd/axial_012.png","assets/T/mri-4cb8cb63e2d748bd/axial_013.png","assets/T/mri-4cb8cb63e2d748bd/axial_015.png","assets/T/mri-4cb8cb63e2d748bd/axial_016.png","assets/T/mri-4cb8cb63e2d748bd/axial_018.png","assets/T/mri-4cb8cb63e2d748bd/axial_019.png","assets/T/mri-4cb8cb63e2d748bd/axial_020.png","assets/T/mri-4cb8cb63e2d748bd/axial_022.png","assets/T/mri-4cb8cb63e2d748bd/axial_023.png","assets/T/mri-4cb8cb63e2d748bd/axial_025.png","assets/T/mri-4cb8cb63e2d748bd/axial_026.png","assets/T/mri-4cb8cb63e2d748bd/axial_027.png","assets/T/mri-4cb8cb63e2d748bd/axial_029.png","assets/T/mri-4cb8cb63e2d748bd/axial_030.png","assets/T/mri-4cb8cb63e2d748bd/axial_032.png","assets/T/mri-4cb8cb63e2d748bd/axial_033.png","assets/T/mri-4cb8cb63e2d748bd/axial_034.png","assets/T/mri-4cb8cb63e2d748bd/axial_036.png","assets/T/mri-4cb8cb63e2d748bd/axial_037.png","assets/T/mri-4cb8cb63e2d748bd/axial_038.png","assets/T/mri-4cb8cb63e2d748bd/axial_040.png","assets/T/mri-4cb8cb63e2d748bd/axial_041.png","assets/T/mri-4cb8cb63e2d748bd/axial_043.png","assets/T/mri-4cb8cb63e2d748bd/axial_044.png","assets/T/mri-4cb8cb63e2d748bd/coronal_001.png","assets/T/mri-4cb8cb63e2d748bd/coronal_002.png","assets/T/mri-4cb8cb63e2d748bd/coronal_004.png","assets/T/mri-4cb8cb63e2d748bd/coronal_005.png","assets/T/mri-4cb8cb63e2d748bd/coronal_006.png","assets/T/mri-4cb8cb63e2d748bd/coronal_008.png","assets/T/mri-4cb8cb63e2d748bd/coronal_009.png","assets/T/mri-4cb8cb63e2d748bd/coronal_010.png","assets/T/mri-4cb8cb63e2d748bd/coronal_012.png","assets/T/mri-4cb8cb63e2d748bd/coronal_013.png","assets/T/mri-4cb8cb63e2d748bd/coronal_015.png","assets/T/mri-4cb8cb63e2d748bd/coronal_016.png","assets/T/mri-4cb8cb63e2d748bd/coronal_017.png","assets/T/mri-4cb8cb63e2d748bd/coronal_019.png","assets/T/mri-4cb8cb63e2d748bd/coronal_020.png","assets/T/mri-4cb8cb63e2d748bd/coronal_021.png","assets/T/mri-4cb8cb63e2d748bd/coronal_023.png","assets/T/mri-4cb8cb63e2d748bd/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":68,"selected_count":50,"source_indices_1based":[1,2,4,5,7,8,9,11,12,13,15,16,18,19,20,22,23,25,26,27,29,30,32,33,34,36,37,38,40,41,43,44,45,46,48,49,50,52,53,54,56,57,59,60,61,63,64,65,67,68]}}
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+{"id":"mri-25f828c643384082","request_id":"L3-T300:mri-25f828c643384082","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-25f828c643384082/axial_001.png","assets/T/mri-25f828c643384082/axial_002.png","assets/T/mri-25f828c643384082/axial_004.png","assets/T/mri-25f828c643384082/axial_005.png","assets/T/mri-25f828c643384082/axial_006.png","assets/T/mri-25f828c643384082/axial_008.png","assets/T/mri-25f828c643384082/axial_009.png","assets/T/mri-25f828c643384082/axial_010.png","assets/T/mri-25f828c643384082/axial_011.png","assets/T/mri-25f828c643384082/axial_013.png","assets/T/mri-25f828c643384082/axial_014.png","assets/T/mri-25f828c643384082/axial_015.png","assets/T/mri-25f828c643384082/axial_017.png","assets/T/mri-25f828c643384082/axial_018.png","assets/T/mri-25f828c643384082/axial_019.png","assets/T/mri-25f828c643384082/axial_021.png","assets/T/mri-25f828c643384082/axial_022.png","assets/T/mri-25f828c643384082/axial_023.png","assets/T/mri-25f828c643384082/axial_024.png","assets/T/mri-25f828c643384082/axial_026.png","assets/T/mri-25f828c643384082/axial_027.png","assets/T/mri-25f828c643384082/axial_028.png","assets/T/mri-25f828c643384082/axial_030.png","assets/T/mri-25f828c643384082/axial_031.png","assets/T/mri-25f828c643384082/axial_032.png","assets/T/mri-25f828c643384082/axial_034.png","assets/T/mri-25f828c643384082/axial_035.png","assets/T/mri-25f828c643384082/axial_036.png","assets/T/mri-25f828c643384082/axial_037.png","assets/T/mri-25f828c643384082/axial_039.png","assets/T/mri-25f828c643384082/axial_040.png","assets/T/mri-25f828c643384082/coronal_001.png","assets/T/mri-25f828c643384082/coronal_002.png","assets/T/mri-25f828c643384082/coronal_004.png","assets/T/mri-25f828c643384082/coronal_005.png","assets/T/mri-25f828c643384082/coronal_006.png","assets/T/mri-25f828c643384082/coronal_007.png","assets/T/mri-25f828c643384082/coronal_009.png","assets/T/mri-25f828c643384082/coronal_010.png","assets/T/mri-25f828c643384082/coronal_011.png","assets/T/mri-25f828c643384082/coronal_013.png","assets/T/mri-25f828c643384082/coronal_014.png","assets/T/mri-25f828c643384082/coronal_015.png","assets/T/mri-25f828c643384082/coronal_016.png","assets/T/mri-25f828c643384082/coronal_018.png","assets/T/mri-25f828c643384082/coronal_019.png","assets/T/mri-25f828c643384082/coronal_020.png","assets/T/mri-25f828c643384082/coronal_021.png","assets/T/mri-25f828c643384082/coronal_023.png","assets/T/mri-25f828c643384082/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":64,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,11,13,14,15,17,18,19,21,22,23,24,26,27,28,30,31,32,34,35,36,37,39,40,41,42,44,45,46,47,49,50,51,53,54,55,56,58,59,60,61,63,64]}}
+{"id":"mri-a4f422bdc4084984","request_id":"L3-T300:mri-a4f422bdc4084984","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-a4f422bdc4084984/axial_001.png","assets/T/mri-a4f422bdc4084984/axial_002.png","assets/T/mri-a4f422bdc4084984/axial_004.png","assets/T/mri-a4f422bdc4084984/axial_005.png","assets/T/mri-a4f422bdc4084984/axial_006.png","assets/T/mri-a4f422bdc4084984/axial_008.png","assets/T/mri-a4f422bdc4084984/axial_009.png","assets/T/mri-a4f422bdc4084984/axial_011.png","assets/T/mri-a4f422bdc4084984/axial_012.png","assets/T/mri-a4f422bdc4084984/axial_013.png","assets/T/mri-a4f422bdc4084984/axial_015.png","assets/T/mri-a4f422bdc4084984/axial_016.png","assets/T/mri-a4f422bdc4084984/axial_017.png","assets/T/mri-a4f422bdc4084984/axial_019.png","assets/T/mri-a4f422bdc4084984/axial_020.png","assets/T/mri-a4f422bdc4084984/axial_022.png","assets/T/mri-a4f422bdc4084984/axial_023.png","assets/T/mri-a4f422bdc4084984/axial_024.png","assets/T/mri-a4f422bdc4084984/axial_026.png","assets/T/mri-a4f422bdc4084984/axial_027.png","assets/T/mri-a4f422bdc4084984/axial_028.png","assets/T/mri-a4f422bdc4084984/axial_030.png","assets/T/mri-a4f422bdc4084984/axial_031.png","assets/T/mri-a4f422bdc4084984/axial_032.png","assets/T/mri-a4f422bdc4084984/axial_034.png","assets/T/mri-a4f422bdc4084984/axial_035.png","assets/T/mri-a4f422bdc4084984/axial_037.png","assets/T/mri-a4f422bdc4084984/axial_038.png","assets/T/mri-a4f422bdc4084984/axial_039.png","assets/T/mri-a4f422bdc4084984/axial_041.png","assets/T/mri-a4f422bdc4084984/axial_042.png","assets/T/mri-a4f422bdc4084984/coronal_001.png","assets/T/mri-a4f422bdc4084984/coronal_002.png","assets/T/mri-a4f422bdc4084984/coronal_004.png","assets/T/mri-a4f422bdc4084984/coronal_005.png","assets/T/mri-a4f422bdc4084984/coronal_007.png","assets/T/mri-a4f422bdc4084984/coronal_008.png","assets/T/mri-a4f422bdc4084984/coronal_009.png","assets/T/mri-a4f422bdc4084984/coronal_011.png","assets/T/mri-a4f422bdc4084984/coronal_012.png","assets/T/mri-a4f422bdc4084984/coronal_014.png","assets/T/mri-a4f422bdc4084984/coronal_015.png","assets/T/mri-a4f422bdc4084984/coronal_016.png","assets/T/mri-a4f422bdc4084984/coronal_018.png","assets/T/mri-a4f422bdc4084984/coronal_019.png","assets/T/mri-a4f422bdc4084984/coronal_020.png","assets/T/mri-a4f422bdc4084984/coronal_022.png","assets/T/mri-a4f422bdc4084984/coronal_023.png","assets/T/mri-a4f422bdc4084984/coronal_025.png","assets/T/mri-a4f422bdc4084984/coronal_026.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":68,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,11,12,13,15,16,17,19,20,22,23,24,26,27,28,30,31,32,34,35,37,38,39,41,42,43,44,46,47,49,50,51,53,54,56,57,58,60,61,62,64,65,67,68]}}
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+{"id":"mri-2bcd51a219d545cc","request_id":"L3-T300:mri-2bcd51a219d545cc","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-2bcd51a219d545cc/axial_001.png","assets/T/mri-2bcd51a219d545cc/axial_002.png","assets/T/mri-2bcd51a219d545cc/axial_004.png","assets/T/mri-2bcd51a219d545cc/axial_005.png","assets/T/mri-2bcd51a219d545cc/axial_006.png","assets/T/mri-2bcd51a219d545cc/axial_008.png","assets/T/mri-2bcd51a219d545cc/axial_009.png","assets/T/mri-2bcd51a219d545cc/axial_010.png","assets/T/mri-2bcd51a219d545cc/axial_012.png","assets/T/mri-2bcd51a219d545cc/axial_013.png","assets/T/mri-2bcd51a219d545cc/axial_014.png","assets/T/mri-2bcd51a219d545cc/axial_016.png","assets/T/mri-2bcd51a219d545cc/axial_017.png","assets/T/mri-2bcd51a219d545cc/axial_018.png","assets/T/mri-2bcd51a219d545cc/axial_020.png","assets/T/mri-2bcd51a219d545cc/axial_021.png","assets/T/mri-2bcd51a219d545cc/axial_022.png","assets/T/mri-2bcd51a219d545cc/axial_023.png","assets/T/mri-2bcd51a219d545cc/axial_025.png","assets/T/mri-2bcd51a219d545cc/axial_026.png","assets/T/mri-2bcd51a219d545cc/axial_027.png","assets/T/mri-2bcd51a219d545cc/axial_029.png","assets/T/mri-2bcd51a219d545cc/axial_030.png","assets/T/mri-2bcd51a219d545cc/axial_031.png","assets/T/mri-2bcd51a219d545cc/axial_033.png","assets/T/mri-2bcd51a219d545cc/axial_034.png","assets/T/mri-2bcd51a219d545cc/axial_035.png","assets/T/mri-2bcd51a219d545cc/axial_037.png","assets/T/mri-2bcd51a219d545cc/axial_038.png","assets/T/mri-2bcd51a219d545cc/axial_039.png","assets/T/mri-2bcd51a219d545cc/axial_041.png","assets/T/mri-2bcd51a219d545cc/axial_042.png","assets/T/mri-2bcd51a219d545cc/coronal_001.png","assets/T/mri-2bcd51a219d545cc/coronal_002.png","assets/T/mri-2bcd51a219d545cc/coronal_004.png","assets/T/mri-2bcd51a219d545cc/coronal_005.png","assets/T/mri-2bcd51a219d545cc/coronal_006.png","assets/T/mri-2bcd51a219d545cc/coronal_008.png","assets/T/mri-2bcd51a219d545cc/coronal_009.png","assets/T/mri-2bcd51a219d545cc/coronal_010.png","assets/T/mri-2bcd51a219d545cc/coronal_012.png","assets/T/mri-2bcd51a219d545cc/coronal_013.png","assets/T/mri-2bcd51a219d545cc/coronal_015.png","assets/T/mri-2bcd51a219d545cc/coronal_016.png","assets/T/mri-2bcd51a219d545cc/coronal_017.png","assets/T/mri-2bcd51a219d545cc/coronal_019.png","assets/T/mri-2bcd51a219d545cc/coronal_020.png","assets/T/mri-2bcd51a219d545cc/coronal_021.png","assets/T/mri-2bcd51a219d545cc/coronal_023.png","assets/T/mri-2bcd51a219d545cc/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":66,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,12,13,14,16,17,18,20,21,22,23,25,26,27,29,30,31,33,34,35,37,38,39,41,42,43,44,46,47,48,50,51,52,54,55,57,58,59,61,62,63,65,66]}}
+{"id":"mri-c4fac316d4d04389","request_id":"L3-T300:mri-c4fac316d4d04389","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-c4fac316d4d04389/axial_001.png","assets/T/mri-c4fac316d4d04389/axial_002.png","assets/T/mri-c4fac316d4d04389/axial_004.png","assets/T/mri-c4fac316d4d04389/axial_005.png","assets/T/mri-c4fac316d4d04389/axial_006.png","assets/T/mri-c4fac316d4d04389/axial_008.png","assets/T/mri-c4fac316d4d04389/axial_009.png","assets/T/mri-c4fac316d4d04389/axial_010.png","assets/T/mri-c4fac316d4d04389/axial_011.png","assets/T/mri-c4fac316d4d04389/axial_013.png","assets/T/mri-c4fac316d4d04389/axial_014.png","assets/T/mri-c4fac316d4d04389/axial_015.png","assets/T/mri-c4fac316d4d04389/axial_017.png","assets/T/mri-c4fac316d4d04389/axial_018.png","assets/T/mri-c4fac316d4d04389/axial_019.png","assets/T/mri-c4fac316d4d04389/axial_021.png","assets/T/mri-c4fac316d4d04389/axial_022.png","assets/T/mri-c4fac316d4d04389/axial_023.png","assets/T/mri-c4fac316d4d04389/axial_024.png","assets/T/mri-c4fac316d4d04389/axial_026.png","assets/T/mri-c4fac316d4d04389/axial_027.png","assets/T/mri-c4fac316d4d04389/axial_028.png","assets/T/mri-c4fac316d4d04389/axial_030.png","assets/T/mri-c4fac316d4d04389/axial_031.png","assets/T/mri-c4fac316d4d04389/axial_032.png","assets/T/mri-c4fac316d4d04389/axial_034.png","assets/T/mri-c4fac316d4d04389/axial_035.png","assets/T/mri-c4fac316d4d04389/axial_036.png","assets/T/mri-c4fac316d4d04389/axial_037.png","assets/T/mri-c4fac316d4d04389/axial_039.png","assets/T/mri-c4fac316d4d04389/axial_040.png","assets/T/mri-c4fac316d4d04389/coronal_001.png","assets/T/mri-c4fac316d4d04389/coronal_002.png","assets/T/mri-c4fac316d4d04389/coronal_004.png","assets/T/mri-c4fac316d4d04389/coronal_005.png","assets/T/mri-c4fac316d4d04389/coronal_006.png","assets/T/mri-c4fac316d4d04389/coronal_007.png","assets/T/mri-c4fac316d4d04389/coronal_009.png","assets/T/mri-c4fac316d4d04389/coronal_010.png","assets/T/mri-c4fac316d4d04389/coronal_011.png","assets/T/mri-c4fac316d4d04389/coronal_013.png","assets/T/mri-c4fac316d4d04389/coronal_014.png","assets/T/mri-c4fac316d4d04389/coronal_015.png","assets/T/mri-c4fac316d4d04389/coronal_016.png","assets/T/mri-c4fac316d4d04389/coronal_018.png","assets/T/mri-c4fac316d4d04389/coronal_019.png","assets/T/mri-c4fac316d4d04389/coronal_020.png","assets/T/mri-c4fac316d4d04389/coronal_021.png","assets/T/mri-c4fac316d4d04389/coronal_023.png","assets/T/mri-c4fac316d4d04389/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":64,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,11,13,14,15,17,18,19,21,22,23,24,26,27,28,30,31,32,34,35,36,37,39,40,41,42,44,45,46,47,49,50,51,53,54,55,56,58,59,60,61,63,64]}}
+{"id":"mri-b6b87fa111a640ca","request_id":"L3-T300:mri-b6b87fa111a640ca","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 30 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 20 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-b6b87fa111a640ca/axial_001.png","assets/T/mri-b6b87fa111a640ca/axial_002.png","assets/T/mri-b6b87fa111a640ca/axial_003.png","assets/T/mri-b6b87fa111a640ca/axial_005.png","assets/T/mri-b6b87fa111a640ca/axial_006.png","assets/T/mri-b6b87fa111a640ca/axial_007.png","assets/T/mri-b6b87fa111a640ca/axial_008.png","assets/T/mri-b6b87fa111a640ca/axial_009.png","assets/T/mri-b6b87fa111a640ca/axial_011.png","assets/T/mri-b6b87fa111a640ca/axial_012.png","assets/T/mri-b6b87fa111a640ca/axial_013.png","assets/T/mri-b6b87fa111a640ca/axial_014.png","assets/T/mri-b6b87fa111a640ca/axial_015.png","assets/T/mri-b6b87fa111a640ca/axial_017.png","assets/T/mri-b6b87fa111a640ca/axial_018.png","assets/T/mri-b6b87fa111a640ca/axial_019.png","assets/T/mri-b6b87fa111a640ca/axial_020.png","assets/T/mri-b6b87fa111a640ca/axial_022.png","assets/T/mri-b6b87fa111a640ca/axial_023.png","assets/T/mri-b6b87fa111a640ca/axial_024.png","assets/T/mri-b6b87fa111a640ca/axial_025.png","assets/T/mri-b6b87fa111a640ca/axial_026.png","assets/T/mri-b6b87fa111a640ca/axial_028.png","assets/T/mri-b6b87fa111a640ca/axial_029.png","assets/T/mri-b6b87fa111a640ca/axial_030.png","assets/T/mri-b6b87fa111a640ca/axial_031.png","assets/T/mri-b6b87fa111a640ca/axial_032.png","assets/T/mri-b6b87fa111a640ca/axial_034.png","assets/T/mri-b6b87fa111a640ca/axial_035.png","assets/T/mri-b6b87fa111a640ca/axial_036.png","assets/T/mri-b6b87fa111a640ca/coronal_001.png","assets/T/mri-b6b87fa111a640ca/coronal_002.png","assets/T/mri-b6b87fa111a640ca/coronal_003.png","assets/T/mri-b6b87fa111a640ca/coronal_005.png","assets/T/mri-b6b87fa111a640ca/coronal_006.png","assets/T/mri-b6b87fa111a640ca/coronal_007.png","assets/T/mri-b6b87fa111a640ca/coronal_008.png","assets/T/mri-b6b87fa111a640ca/coronal_009.png","assets/T/mri-b6b87fa111a640ca/coronal_011.png","assets/T/mri-b6b87fa111a640ca/coronal_012.png","assets/T/mri-b6b87fa111a640ca/coronal_013.png","assets/T/mri-b6b87fa111a640ca/coronal_014.png","assets/T/mri-b6b87fa111a640ca/coronal_016.png","assets/T/mri-b6b87fa111a640ca/coronal_017.png","assets/T/mri-b6b87fa111a640ca/coronal_018.png","assets/T/mri-b6b87fa111a640ca/coronal_019.png","assets/T/mri-b6b87fa111a640ca/coronal_020.png","assets/T/mri-b6b87fa111a640ca/coronal_022.png","assets/T/mri-b6b87fa111a640ca/coronal_023.png","assets/T/mri-b6b87fa111a640ca/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":60,"selected_count":50,"source_indices_1based":[1,2,3,5,6,7,8,9,11,12,13,14,15,17,18,19,20,22,23,24,25,26,28,29,30,31,32,34,35,36,37,38,39,41,42,43,44,45,47,48,49,50,52,53,54,55,56,58,59,60]}}
+{"id":"mri-8e0bb3a4b8ba4d5d","request_id":"L3-T300:mri-8e0bb3a4b8ba4d5d","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 30 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 20 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-8e0bb3a4b8ba4d5d/axial_001.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_002.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_004.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_005.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_006.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_008.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_009.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_010.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_012.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_013.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_014.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_016.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_017.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_018.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_020.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_021.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_023.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_024.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_025.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_027.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_028.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_029.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_031.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_032.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_033.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_035.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_036.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_037.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_039.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_040.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_001.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_002.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_004.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_005.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_006.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_008.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_009.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_010.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_012.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_013.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_014.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_015.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_017.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_018.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_019.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_021.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_022.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_023.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_025.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_026.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":66,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,12,13,14,16,17,18,20,21,23,24,25,27,28,29,31,32,33,35,36,37,39,40,41,42,44,45,46,48,49,50,52,53,54,55,57,58,59,61,62,63,65,66]}}
+{"id":"mri-011d16dc8caa467f","request_id":"L3-T300:mri-011d16dc8caa467f","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-011d16dc8caa467f/axial_001.png","assets/T/mri-011d16dc8caa467f/axial_002.png","assets/T/mri-011d16dc8caa467f/axial_004.png","assets/T/mri-011d16dc8caa467f/axial_005.png","assets/T/mri-011d16dc8caa467f/axial_006.png","assets/T/mri-011d16dc8caa467f/axial_008.png","assets/T/mri-011d16dc8caa467f/axial_009.png","assets/T/mri-011d16dc8caa467f/axial_010.png","assets/T/mri-011d16dc8caa467f/axial_012.png","assets/T/mri-011d16dc8caa467f/axial_013.png","assets/T/mri-011d16dc8caa467f/axial_014.png","assets/T/mri-011d16dc8caa467f/axial_016.png","assets/T/mri-011d16dc8caa467f/axial_017.png","assets/T/mri-011d16dc8caa467f/axial_018.png","assets/T/mri-011d16dc8caa467f/axial_020.png","assets/T/mri-011d16dc8caa467f/axial_021.png","assets/T/mri-011d16dc8caa467f/axial_022.png","assets/T/mri-011d16dc8caa467f/axial_023.png","assets/T/mri-011d16dc8caa467f/axial_025.png","assets/T/mri-011d16dc8caa467f/axial_026.png","assets/T/mri-011d16dc8caa467f/axial_027.png","assets/T/mri-011d16dc8caa467f/axial_029.png","assets/T/mri-011d16dc8caa467f/axial_030.png","assets/T/mri-011d16dc8caa467f/axial_031.png","assets/T/mri-011d16dc8caa467f/axial_033.png","assets/T/mri-011d16dc8caa467f/axial_034.png","assets/T/mri-011d16dc8caa467f/axial_035.png","assets/T/mri-011d16dc8caa467f/axial_037.png","assets/T/mri-011d16dc8caa467f/axial_038.png","assets/T/mri-011d16dc8caa467f/axial_039.png","assets/T/mri-011d16dc8caa467f/axial_041.png","assets/T/mri-011d16dc8caa467f/axial_042.png","assets/T/mri-011d16dc8caa467f/coronal_001.png","assets/T/mri-011d16dc8caa467f/coronal_002.png","assets/T/mri-011d16dc8caa467f/coronal_004.png","assets/T/mri-011d16dc8caa467f/coronal_005.png","assets/T/mri-011d16dc8caa467f/coronal_006.png","assets/T/mri-011d16dc8caa467f/coronal_008.png","assets/T/mri-011d16dc8caa467f/coronal_009.png","assets/T/mri-011d16dc8caa467f/coronal_010.png","assets/T/mri-011d16dc8caa467f/coronal_012.png","assets/T/mri-011d16dc8caa467f/coronal_013.png","assets/T/mri-011d16dc8caa467f/coronal_015.png","assets/T/mri-011d16dc8caa467f/coronal_016.png","assets/T/mri-011d16dc8caa467f/coronal_017.png","assets/T/mri-011d16dc8caa467f/coronal_019.png","assets/T/mri-011d16dc8caa467f/coronal_020.png","assets/T/mri-011d16dc8caa467f/coronal_021.png","assets/T/mri-011d16dc8caa467f/coronal_023.png","assets/T/mri-011d16dc8caa467f/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":66,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,12,13,14,16,17,18,20,21,22,23,25,26,27,29,30,31,33,34,35,37,38,39,41,42,43,44,46,47,48,50,51,52,54,55,57,58,59,61,62,63,65,66]}}
+{"id":"mri-610603bf61ce46e3","request_id":"L3-T300:mri-610603bf61ce46e3","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-610603bf61ce46e3/axial_001.png","assets/T/mri-610603bf61ce46e3/axial_002.png","assets/T/mri-610603bf61ce46e3/axial_004.png","assets/T/mri-610603bf61ce46e3/axial_005.png","assets/T/mri-610603bf61ce46e3/axial_006.png","assets/T/mri-610603bf61ce46e3/axial_008.png","assets/T/mri-610603bf61ce46e3/axial_009.png","assets/T/mri-610603bf61ce46e3/axial_010.png","assets/T/mri-610603bf61ce46e3/axial_011.png","assets/T/mri-610603bf61ce46e3/axial_013.png","assets/T/mri-610603bf61ce46e3/axial_014.png","assets/T/mri-610603bf61ce46e3/axial_015.png","assets/T/mri-610603bf61ce46e3/axial_017.png","assets/T/mri-610603bf61ce46e3/axial_018.png","assets/T/mri-610603bf61ce46e3/axial_019.png","assets/T/mri-610603bf61ce46e3/axial_021.png","assets/T/mri-610603bf61ce46e3/axial_022.png","assets/T/mri-610603bf61ce46e3/axial_023.png","assets/T/mri-610603bf61ce46e3/axial_024.png","assets/T/mri-610603bf61ce46e3/axial_026.png","assets/T/mri-610603bf61ce46e3/axial_027.png","assets/T/mri-610603bf61ce46e3/axial_028.png","assets/T/mri-610603bf61ce46e3/axial_030.png","assets/T/mri-610603bf61ce46e3/axial_031.png","assets/T/mri-610603bf61ce46e3/axial_032.png","assets/T/mri-610603bf61ce46e3/axial_034.png","assets/T/mri-610603bf61ce46e3/axial_035.png","assets/T/mri-610603bf61ce46e3/axial_036.png","assets/T/mri-610603bf61ce46e3/axial_037.png","assets/T/mri-610603bf61ce46e3/axial_039.png","assets/T/mri-610603bf61ce46e3/axial_040.png","assets/T/mri-610603bf61ce46e3/coronal_001.png","assets/T/mri-610603bf61ce46e3/coronal_002.png","assets/T/mri-610603bf61ce46e3/coronal_004.png","assets/T/mri-610603bf61ce46e3/coronal_005.png","assets/T/mri-610603bf61ce46e3/coronal_006.png","assets/T/mri-610603bf61ce46e3/coronal_007.png","assets/T/mri-610603bf61ce46e3/coronal_009.png","assets/T/mri-610603bf61ce46e3/coronal_010.png","assets/T/mri-610603bf61ce46e3/coronal_011.png","assets/T/mri-610603bf61ce46e3/coronal_013.png","assets/T/mri-610603bf61ce46e3/coronal_014.png","assets/T/mri-610603bf61ce46e3/coronal_015.png","assets/T/mri-610603bf61ce46e3/coronal_016.png","assets/T/mri-610603bf61ce46e3/coronal_018.png","assets/T/mri-610603bf61ce46e3/coronal_019.png","assets/T/mri-610603bf61ce46e3/coronal_020.png","assets/T/mri-610603bf61ce46e3/coronal_021.png","assets/T/mri-610603bf61ce46e3/coronal_023.png","assets/T/mri-610603bf61ce46e3/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":64,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,11,13,14,15,17,18,19,21,22,23,24,26,27,28,30,31,32,34,35,36,37,39,40,41,42,44,45,46,47,49,50,51,53,54,55,56,58,59,60,61,63,64]}}
+{"id":"mri-217e2ff416f54d21","request_id":"L3-T300:mri-217e2ff416f54d21","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-217e2ff416f54d21/axial_001.png","assets/T/mri-217e2ff416f54d21/axial_002.png","assets/T/mri-217e2ff416f54d21/axial_004.png","assets/T/mri-217e2ff416f54d21/axial_005.png","assets/T/mri-217e2ff416f54d21/axial_006.png","assets/T/mri-217e2ff416f54d21/axial_008.png","assets/T/mri-217e2ff416f54d21/axial_009.png","assets/T/mri-217e2ff416f54d21/axial_010.png","assets/T/mri-217e2ff416f54d21/axial_011.png","assets/T/mri-217e2ff416f54d21/axial_013.png","assets/T/mri-217e2ff416f54d21/axial_014.png","assets/T/mri-217e2ff416f54d21/axial_015.png","assets/T/mri-217e2ff416f54d21/axial_017.png","assets/T/mri-217e2ff416f54d21/axial_018.png","assets/T/mri-217e2ff416f54d21/axial_019.png","assets/T/mri-217e2ff416f54d21/axial_021.png","assets/T/mri-217e2ff416f54d21/axial_022.png","assets/T/mri-217e2ff416f54d21/axial_023.png","assets/T/mri-217e2ff416f54d21/axial_024.png","assets/T/mri-217e2ff416f54d21/axial_026.png","assets/T/mri-217e2ff416f54d21/axial_027.png","assets/T/mri-217e2ff416f54d21/axial_028.png","assets/T/mri-217e2ff416f54d21/axial_030.png","assets/T/mri-217e2ff416f54d21/axial_031.png","assets/T/mri-217e2ff416f54d21/axial_032.png","assets/T/mri-217e2ff416f54d21/axial_034.png","assets/T/mri-217e2ff416f54d21/axial_035.png","assets/T/mri-217e2ff416f54d21/axial_036.png","assets/T/mri-217e2ff416f54d21/axial_037.png","assets/T/mri-217e2ff416f54d21/axial_039.png","assets/T/mri-217e2ff416f54d21/axial_040.png","assets/T/mri-217e2ff416f54d21/coronal_001.png","assets/T/mri-217e2ff416f54d21/coronal_002.png","assets/T/mri-217e2ff416f54d21/coronal_004.png","assets/T/mri-217e2ff416f54d21/coronal_005.png","assets/T/mri-217e2ff416f54d21/coronal_006.png","assets/T/mri-217e2ff416f54d21/coronal_007.png","assets/T/mri-217e2ff416f54d21/coronal_009.png","assets/T/mri-217e2ff416f54d21/coronal_010.png","assets/T/mri-217e2ff416f54d21/coronal_011.png","assets/T/mri-217e2ff416f54d21/coronal_013.png","assets/T/mri-217e2ff416f54d21/coronal_014.png","assets/T/mri-217e2ff416f54d21/coronal_015.png","assets/T/mri-217e2ff416f54d21/coronal_016.png","assets/T/mri-217e2ff416f54d21/coronal_018.png","assets/T/mri-217e2ff416f54d21/coronal_019.png","assets/T/mri-217e2ff416f54d21/coronal_020.png","assets/T/mri-217e2ff416f54d21/coronal_021.png","assets/T/mri-217e2ff416f54d21/coronal_023.png","assets/T/mri-217e2ff416f54d21/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":64,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,11,13,14,15,17,18,19,21,22,23,24,26,27,28,30,31,32,34,35,36,37,39,40,41,42,44,45,46,47,49,50,51,53,54,55,56,58,59,60,61,63,64]}}
+{"id":"mri-22348de6a516489b","request_id":"L3-T300:mri-22348de6a516489b","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-22348de6a516489b/axial_001.png","assets/T/mri-22348de6a516489b/axial_002.png","assets/T/mri-22348de6a516489b/axial_004.png","assets/T/mri-22348de6a516489b/axial_005.png","assets/T/mri-22348de6a516489b/axial_006.png","assets/T/mri-22348de6a516489b/axial_008.png","assets/T/mri-22348de6a516489b/axial_009.png","assets/T/mri-22348de6a516489b/axial_010.png","assets/T/mri-22348de6a516489b/axial_011.png","assets/T/mri-22348de6a516489b/axial_013.png","assets/T/mri-22348de6a516489b/axial_014.png","assets/T/mri-22348de6a516489b/axial_015.png","assets/T/mri-22348de6a516489b/axial_017.png","assets/T/mri-22348de6a516489b/axial_018.png","assets/T/mri-22348de6a516489b/axial_019.png","assets/T/mri-22348de6a516489b/axial_021.png","assets/T/mri-22348de6a516489b/axial_022.png","assets/T/mri-22348de6a516489b/axial_023.png","assets/T/mri-22348de6a516489b/axial_024.png","assets/T/mri-22348de6a516489b/axial_026.png","assets/T/mri-22348de6a516489b/axial_027.png","assets/T/mri-22348de6a516489b/axial_028.png","assets/T/mri-22348de6a516489b/axial_030.png","assets/T/mri-22348de6a516489b/axial_031.png","assets/T/mri-22348de6a516489b/axial_032.png","assets/T/mri-22348de6a516489b/axial_034.png","assets/T/mri-22348de6a516489b/axial_035.png","assets/T/mri-22348de6a516489b/axial_036.png","assets/T/mri-22348de6a516489b/axial_037.png","assets/T/mri-22348de6a516489b/axial_039.png","assets/T/mri-22348de6a516489b/axial_040.png","assets/T/mri-22348de6a516489b/coronal_001.png","assets/T/mri-22348de6a516489b/coronal_002.png","assets/T/mri-22348de6a516489b/coronal_004.png","assets/T/mri-22348de6a516489b/coronal_005.png","assets/T/mri-22348de6a516489b/coronal_006.png","assets/T/mri-22348de6a516489b/coronal_007.png","assets/T/mri-22348de6a516489b/coronal_009.png","assets/T/mri-22348de6a516489b/coronal_010.png","assets/T/mri-22348de6a516489b/coronal_011.png","assets/T/mri-22348de6a516489b/coronal_013.png","assets/T/mri-22348de6a516489b/coronal_014.png","assets/T/mri-22348de6a516489b/coronal_015.png","assets/T/mri-22348de6a516489b/coronal_016.png","assets/T/mri-22348de6a516489b/coronal_018.png","assets/T/mri-22348de6a516489b/coronal_019.png","assets/T/mri-22348de6a516489b/coronal_020.png","assets/T/mri-22348de6a516489b/coronal_021.png","assets/T/mri-22348de6a516489b/coronal_023.png","assets/T/mri-22348de6a516489b/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":64,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,11,13,14,15,17,18,19,21,22,23,24,26,27,28,30,31,32,34,35,36,37,39,40,41,42,44,45,46,47,49,50,51,53,54,55,56,58,59,60,61,63,64]}}
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+{"id":"mri-b1b1cc7813aa4e54","request_id":"L3-T300:mri-b1b1cc7813aa4e54","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 30 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 20 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-b1b1cc7813aa4e54/axial_001.png","assets/T/mri-b1b1cc7813aa4e54/axial_002.png","assets/T/mri-b1b1cc7813aa4e54/axial_003.png","assets/T/mri-b1b1cc7813aa4e54/axial_005.png","assets/T/mri-b1b1cc7813aa4e54/axial_006.png","assets/T/mri-b1b1cc7813aa4e54/axial_007.png","assets/T/mri-b1b1cc7813aa4e54/axial_008.png","assets/T/mri-b1b1cc7813aa4e54/axial_009.png","assets/T/mri-b1b1cc7813aa4e54/axial_011.png","assets/T/mri-b1b1cc7813aa4e54/axial_012.png","assets/T/mri-b1b1cc7813aa4e54/axial_013.png","assets/T/mri-b1b1cc7813aa4e54/axial_014.png","assets/T/mri-b1b1cc7813aa4e54/axial_015.png","assets/T/mri-b1b1cc7813aa4e54/axial_017.png","assets/T/mri-b1b1cc7813aa4e54/axial_018.png","assets/T/mri-b1b1cc7813aa4e54/axial_019.png","assets/T/mri-b1b1cc7813aa4e54/axial_020.png","assets/T/mri-b1b1cc7813aa4e54/axial_022.png","assets/T/mri-b1b1cc7813aa4e54/axial_023.png","assets/T/mri-b1b1cc7813aa4e54/axial_024.png","assets/T/mri-b1b1cc7813aa4e54/axial_025.png","assets/T/mri-b1b1cc7813aa4e54/axial_026.png","assets/T/mri-b1b1cc7813aa4e54/axial_028.png","assets/T/mri-b1b1cc7813aa4e54/axial_029.png","assets/T/mri-b1b1cc7813aa4e54/axial_030.png","assets/T/mri-b1b1cc7813aa4e54/axial_031.png","assets/T/mri-b1b1cc7813aa4e54/axial_032.png","assets/T/mri-b1b1cc7813aa4e54/axial_034.png","assets/T/mri-b1b1cc7813aa4e54/axial_035.png","assets/T/mri-b1b1cc7813aa4e54/axial_036.png","assets/T/mri-b1b1cc7813aa4e54/coronal_001.png","assets/T/mri-b1b1cc7813aa4e54/coronal_002.png","assets/T/mri-b1b1cc7813aa4e54/coronal_003.png","assets/T/mri-b1b1cc7813aa4e54/coronal_005.png","assets/T/mri-b1b1cc7813aa4e54/coronal_006.png","assets/T/mri-b1b1cc7813aa4e54/coronal_007.png","assets/T/mri-b1b1cc7813aa4e54/coronal_008.png","assets/T/mri-b1b1cc7813aa4e54/coronal_009.png","assets/T/mri-b1b1cc7813aa4e54/coronal_011.png","assets/T/mri-b1b1cc7813aa4e54/coronal_012.png","assets/T/mri-b1b1cc7813aa4e54/coronal_013.png","assets/T/mri-b1b1cc7813aa4e54/coronal_014.png","assets/T/mri-b1b1cc7813aa4e54/coronal_016.png","assets/T/mri-b1b1cc7813aa4e54/coronal_017.png","assets/T/mri-b1b1cc7813aa4e54/coronal_018.png","assets/T/mri-b1b1cc7813aa4e54/coronal_019.png","assets/T/mri-b1b1cc7813aa4e54/coronal_020.png","assets/T/mri-b1b1cc7813aa4e54/coronal_022.png","assets/T/mri-b1b1cc7813aa4e54/coronal_023.png","assets/T/mri-b1b1cc7813aa4e54/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":60,"selected_count":50,"source_indices_1based":[1,2,3,5,6,7,8,9,11,12,13,14,15,17,18,19,20,22,23,24,25,26,28,29,30,31,32,34,35,36,37,38,39,41,42,43,44,45,47,48,49,50,52,53,54,55,56,58,59,60]}}
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+{"id":"mri-f29135603c0e4f4a","request_id":"L3-T300:mri-f29135603c0e4f4a","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-f29135603c0e4f4a/axial_001.png","assets/T/mri-f29135603c0e4f4a/axial_002.png","assets/T/mri-f29135603c0e4f4a/axial_004.png","assets/T/mri-f29135603c0e4f4a/axial_005.png","assets/T/mri-f29135603c0e4f4a/axial_006.png","assets/T/mri-f29135603c0e4f4a/axial_008.png","assets/T/mri-f29135603c0e4f4a/axial_009.png","assets/T/mri-f29135603c0e4f4a/axial_010.png","assets/T/mri-f29135603c0e4f4a/axial_012.png","assets/T/mri-f29135603c0e4f4a/axial_013.png","assets/T/mri-f29135603c0e4f4a/axial_015.png","assets/T/mri-f29135603c0e4f4a/axial_016.png","assets/T/mri-f29135603c0e4f4a/axial_017.png","assets/T/mri-f29135603c0e4f4a/axial_019.png","assets/T/mri-f29135603c0e4f4a/axial_020.png","assets/T/mri-f29135603c0e4f4a/axial_021.png","assets/T/mri-f29135603c0e4f4a/axial_023.png","assets/T/mri-f29135603c0e4f4a/axial_024.png","assets/T/mri-f29135603c0e4f4a/axial_025.png","assets/T/mri-f29135603c0e4f4a/axial_027.png","assets/T/mri-f29135603c0e4f4a/axial_028.png","assets/T/mri-f29135603c0e4f4a/axial_029.png","assets/T/mri-f29135603c0e4f4a/axial_031.png","assets/T/mri-f29135603c0e4f4a/axial_032.png","assets/T/mri-f29135603c0e4f4a/axial_034.png","assets/T/mri-f29135603c0e4f4a/axial_035.png","assets/T/mri-f29135603c0e4f4a/axial_036.png","assets/T/mri-f29135603c0e4f4a/axial_038.png","assets/T/mri-f29135603c0e4f4a/axial_039.png","assets/T/mri-f29135603c0e4f4a/axial_040.png","assets/T/mri-f29135603c0e4f4a/axial_042.png","assets/T/mri-f29135603c0e4f4a/axial_043.png","assets/T/mri-f29135603c0e4f4a/coronal_001.png","assets/T/mri-f29135603c0e4f4a/coronal_002.png","assets/T/mri-f29135603c0e4f4a/coronal_004.png","assets/T/mri-f29135603c0e4f4a/coronal_005.png","assets/T/mri-f29135603c0e4f4a/coronal_006.png","assets/T/mri-f29135603c0e4f4a/coronal_008.png","assets/T/mri-f29135603c0e4f4a/coronal_009.png","assets/T/mri-f29135603c0e4f4a/coronal_010.png","assets/T/mri-f29135603c0e4f4a/coronal_012.png","assets/T/mri-f29135603c0e4f4a/coronal_013.png","assets/T/mri-f29135603c0e4f4a/coronal_015.png","assets/T/mri-f29135603c0e4f4a/coronal_016.png","assets/T/mri-f29135603c0e4f4a/coronal_017.png","assets/T/mri-f29135603c0e4f4a/coronal_019.png","assets/T/mri-f29135603c0e4f4a/coronal_020.png","assets/T/mri-f29135603c0e4f4a/coronal_021.png","assets/T/mri-f29135603c0e4f4a/coronal_023.png","assets/T/mri-f29135603c0e4f4a/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":67,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,12,13,15,16,17,19,20,21,23,24,25,27,28,29,31,32,34,35,36,38,39,40,42,43,44,45,47,48,49,51,52,53,55,56,58,59,60,62,63,64,66,67]}}
+{"id":"mri-a201d3a61de2439a","request_id":"L3-T300:mri-a201d3a61de2439a","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 30 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 20 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-a201d3a61de2439a/axial_001.png","assets/T/mri-a201d3a61de2439a/axial_002.png","assets/T/mri-a201d3a61de2439a/axial_004.png","assets/T/mri-a201d3a61de2439a/axial_005.png","assets/T/mri-a201d3a61de2439a/axial_007.png","assets/T/mri-a201d3a61de2439a/axial_008.png","assets/T/mri-a201d3a61de2439a/axial_009.png","assets/T/mri-a201d3a61de2439a/axial_011.png","assets/T/mri-a201d3a61de2439a/axial_012.png","assets/T/mri-a201d3a61de2439a/axial_014.png","assets/T/mri-a201d3a61de2439a/axial_015.png","assets/T/mri-a201d3a61de2439a/axial_017.png","assets/T/mri-a201d3a61de2439a/axial_018.png","assets/T/mri-a201d3a61de2439a/axial_019.png","assets/T/mri-a201d3a61de2439a/axial_021.png","assets/T/mri-a201d3a61de2439a/axial_022.png","assets/T/mri-a201d3a61de2439a/axial_024.png","assets/T/mri-a201d3a61de2439a/axial_025.png","assets/T/mri-a201d3a61de2439a/axial_026.png","assets/T/mri-a201d3a61de2439a/axial_028.png","assets/T/mri-a201d3a61de2439a/axial_029.png","assets/T/mri-a201d3a61de2439a/axial_031.png","assets/T/mri-a201d3a61de2439a/axial_032.png","assets/T/mri-a201d3a61de2439a/axial_034.png","assets/T/mri-a201d3a61de2439a/axial_035.png","assets/T/mri-a201d3a61de2439a/axial_036.png","assets/T/mri-a201d3a61de2439a/axial_038.png","assets/T/mri-a201d3a61de2439a/axial_039.png","assets/T/mri-a201d3a61de2439a/axial_041.png","assets/T/mri-a201d3a61de2439a/axial_042.png","assets/T/mri-a201d3a61de2439a/coronal_001.png","assets/T/mri-a201d3a61de2439a/coronal_002.png","assets/T/mri-a201d3a61de2439a/coronal_004.png","assets/T/mri-a201d3a61de2439a/coronal_005.png","assets/T/mri-a201d3a61de2439a/coronal_007.png","assets/T/mri-a201d3a61de2439a/coronal_008.png","assets/T/mri-a201d3a61de2439a/coronal_010.png","assets/T/mri-a201d3a61de2439a/coronal_011.png","assets/T/mri-a201d3a61de2439a/coronal_012.png","assets/T/mri-a201d3a61de2439a/coronal_014.png","assets/T/mri-a201d3a61de2439a/coronal_015.png","assets/T/mri-a201d3a61de2439a/coronal_017.png","assets/T/mri-a201d3a61de2439a/coronal_018.png","assets/T/mri-a201d3a61de2439a/coronal_019.png","assets/T/mri-a201d3a61de2439a/coronal_021.png","assets/T/mri-a201d3a61de2439a/coronal_022.png","assets/T/mri-a201d3a61de2439a/coronal_024.png","assets/T/mri-a201d3a61de2439a/coronal_025.png","assets/T/mri-a201d3a61de2439a/coronal_027.png","assets/T/mri-a201d3a61de2439a/coronal_028.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":70,"selected_count":50,"source_indices_1based":[1,2,4,5,7,8,9,11,12,14,15,17,18,19,21,22,24,25,26,28,29,31,32,34,35,36,38,39,41,42,43,44,46,47,49,50,52,53,54,56,57,59,60,61,63,64,66,67,69,70]}}
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+{"id":"mri-2d3b01244e0d4ee4","request_id":"L3-T300:mri-2d3b01244e0d4ee4","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-2d3b01244e0d4ee4/axial_001.png","assets/T/mri-2d3b01244e0d4ee4/axial_002.png","assets/T/mri-2d3b01244e0d4ee4/axial_004.png","assets/T/mri-2d3b01244e0d4ee4/axial_005.png","assets/T/mri-2d3b01244e0d4ee4/axial_006.png","assets/T/mri-2d3b01244e0d4ee4/axial_008.png","assets/T/mri-2d3b01244e0d4ee4/axial_009.png","assets/T/mri-2d3b01244e0d4ee4/axial_011.png","assets/T/mri-2d3b01244e0d4ee4/axial_012.png","assets/T/mri-2d3b01244e0d4ee4/axial_013.png","assets/T/mri-2d3b01244e0d4ee4/axial_015.png","assets/T/mri-2d3b01244e0d4ee4/axial_016.png","assets/T/mri-2d3b01244e0d4ee4/axial_017.png","assets/T/mri-2d3b01244e0d4ee4/axial_019.png","assets/T/mri-2d3b01244e0d4ee4/axial_020.png","assets/T/mri-2d3b01244e0d4ee4/axial_022.png","assets/T/mri-2d3b01244e0d4ee4/axial_023.png","assets/T/mri-2d3b01244e0d4ee4/axial_024.png","assets/T/mri-2d3b01244e0d4ee4/axial_026.png","assets/T/mri-2d3b01244e0d4ee4/axial_027.png","assets/T/mri-2d3b01244e0d4ee4/axial_028.png","assets/T/mri-2d3b01244e0d4ee4/axial_030.png","assets/T/mri-2d3b01244e0d4ee4/axial_031.png","assets/T/mri-2d3b01244e0d4ee4/axial_032.png","assets/T/mri-2d3b01244e0d4ee4/axial_034.png","assets/T/mri-2d3b01244e0d4ee4/axial_035.png","assets/T/mri-2d3b01244e0d4ee4/axial_037.png","assets/T/mri-2d3b01244e0d4ee4/axial_038.png","assets/T/mri-2d3b01244e0d4ee4/axial_039.png","assets/T/mri-2d3b01244e0d4ee4/axial_041.png","assets/T/mri-2d3b01244e0d4ee4/axial_042.png","assets/T/mri-2d3b01244e0d4ee4/coronal_001.png","assets/T/mri-2d3b01244e0d4ee4/coronal_002.png","assets/T/mri-2d3b01244e0d4ee4/coronal_004.png","assets/T/mri-2d3b01244e0d4ee4/coronal_005.png","assets/T/mri-2d3b01244e0d4ee4/coronal_006.png","assets/T/mri-2d3b01244e0d4ee4/coronal_008.png","assets/T/mri-2d3b01244e0d4ee4/coronal_009.png","assets/T/mri-2d3b01244e0d4ee4/coronal_010.png","assets/T/mri-2d3b01244e0d4ee4/coronal_012.png","assets/T/mri-2d3b01244e0d4ee4/coronal_013.png","assets/T/mri-2d3b01244e0d4ee4/coronal_014.png","assets/T/mri-2d3b01244e0d4ee4/coronal_016.png","assets/T/mri-2d3b01244e0d4ee4/coronal_017.png","assets/T/mri-2d3b01244e0d4ee4/coronal_018.png","assets/T/mri-2d3b01244e0d4ee4/coronal_020.png","assets/T/mri-2d3b01244e0d4ee4/coronal_021.png","assets/T/mri-2d3b01244e0d4ee4/coronal_022.png","assets/T/mri-2d3b01244e0d4ee4/coronal_024.png","assets/T/mri-2d3b01244e0d4ee4/coronal_025.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":67,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,11,12,13,15,16,17,19,20,22,23,24,26,27,28,30,31,32,34,35,37,38,39,41,42,43,44,46,47,48,50,51,52,54,55,56,58,59,60,62,63,64,66,67]}}
+{"id":"mri-3a3a1e2f74f04b22","request_id":"L3-T300:mri-3a3a1e2f74f04b22","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-3a3a1e2f74f04b22/axial_001.png","assets/T/mri-3a3a1e2f74f04b22/axial_002.png","assets/T/mri-3a3a1e2f74f04b22/axial_004.png","assets/T/mri-3a3a1e2f74f04b22/axial_005.png","assets/T/mri-3a3a1e2f74f04b22/axial_006.png","assets/T/mri-3a3a1e2f74f04b22/axial_008.png","assets/T/mri-3a3a1e2f74f04b22/axial_009.png","assets/T/mri-3a3a1e2f74f04b22/axial_011.png","assets/T/mri-3a3a1e2f74f04b22/axial_012.png","assets/T/mri-3a3a1e2f74f04b22/axial_013.png","assets/T/mri-3a3a1e2f74f04b22/axial_015.png","assets/T/mri-3a3a1e2f74f04b22/axial_016.png","assets/T/mri-3a3a1e2f74f04b22/axial_017.png","assets/T/mri-3a3a1e2f74f04b22/axial_019.png","assets/T/mri-3a3a1e2f74f04b22/axial_020.png","assets/T/mri-3a3a1e2f74f04b22/axial_022.png","assets/T/mri-3a3a1e2f74f04b22/axial_023.png","assets/T/mri-3a3a1e2f74f04b22/axial_024.png","assets/T/mri-3a3a1e2f74f04b22/axial_026.png","assets/T/mri-3a3a1e2f74f04b22/axial_027.png","assets/T/mri-3a3a1e2f74f04b22/axial_028.png","assets/T/mri-3a3a1e2f74f04b22/axial_030.png","assets/T/mri-3a3a1e2f74f04b22/axial_031.png","assets/T/mri-3a3a1e2f74f04b22/axial_032.png","assets/T/mri-3a3a1e2f74f04b22/axial_034.png","assets/T/mri-3a3a1e2f74f04b22/axial_035.png","assets/T/mri-3a3a1e2f74f04b22/axial_037.png","assets/T/mri-3a3a1e2f74f04b22/axial_038.png","assets/T/mri-3a3a1e2f74f04b22/axial_039.png","assets/T/mri-3a3a1e2f74f04b22/axial_041.png","assets/T/mri-3a3a1e2f74f04b22/axial_042.png","assets/T/mri-3a3a1e2f74f04b22/coronal_001.png","assets/T/mri-3a3a1e2f74f04b22/coronal_002.png","assets/T/mri-3a3a1e2f74f04b22/coronal_004.png","assets/T/mri-3a3a1e2f74f04b22/coronal_005.png","assets/T/mri-3a3a1e2f74f04b22/coronal_006.png","assets/T/mri-3a3a1e2f74f04b22/coronal_008.png","assets/T/mri-3a3a1e2f74f04b22/coronal_009.png","assets/T/mri-3a3a1e2f74f04b22/coronal_010.png","assets/T/mri-3a3a1e2f74f04b22/coronal_012.png","assets/T/mri-3a3a1e2f74f04b22/coronal_013.png","assets/T/mri-3a3a1e2f74f04b22/coronal_014.png","assets/T/mri-3a3a1e2f74f04b22/coronal_016.png","assets/T/mri-3a3a1e2f74f04b22/coronal_017.png","assets/T/mri-3a3a1e2f74f04b22/coronal_018.png","assets/T/mri-3a3a1e2f74f04b22/coronal_020.png","assets/T/mri-3a3a1e2f74f04b22/coronal_021.png","assets/T/mri-3a3a1e2f74f04b22/coronal_022.png","assets/T/mri-3a3a1e2f74f04b22/coronal_024.png","assets/T/mri-3a3a1e2f74f04b22/coronal_025.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":67,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,11,12,13,15,16,17,19,20,22,23,24,26,27,28,30,31,32,34,35,37,38,39,41,42,43,44,46,47,48,50,51,52,54,55,56,58,59,60,62,63,64,66,67]}}
+{"id":"mri-34db59d07ef34640","request_id":"L3-T300:mri-34db59d07ef34640","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-34db59d07ef34640/axial_001.png","assets/T/mri-34db59d07ef34640/axial_002.png","assets/T/mri-34db59d07ef34640/axial_004.png","assets/T/mri-34db59d07ef34640/axial_005.png","assets/T/mri-34db59d07ef34640/axial_006.png","assets/T/mri-34db59d07ef34640/axial_008.png","assets/T/mri-34db59d07ef34640/axial_009.png","assets/T/mri-34db59d07ef34640/axial_010.png","assets/T/mri-34db59d07ef34640/axial_012.png","assets/T/mri-34db59d07ef34640/axial_013.png","assets/T/mri-34db59d07ef34640/axial_014.png","assets/T/mri-34db59d07ef34640/axial_016.png","assets/T/mri-34db59d07ef34640/axial_017.png","assets/T/mri-34db59d07ef34640/axial_018.png","assets/T/mri-34db59d07ef34640/axial_020.png","assets/T/mri-34db59d07ef34640/axial_021.png","assets/T/mri-34db59d07ef34640/axial_022.png","assets/T/mri-34db59d07ef34640/axial_023.png","assets/T/mri-34db59d07ef34640/axial_025.png","assets/T/mri-34db59d07ef34640/axial_026.png","assets/T/mri-34db59d07ef34640/axial_027.png","assets/T/mri-34db59d07ef34640/axial_029.png","assets/T/mri-34db59d07ef34640/axial_030.png","assets/T/mri-34db59d07ef34640/axial_031.png","assets/T/mri-34db59d07ef34640/axial_033.png","assets/T/mri-34db59d07ef34640/axial_034.png","assets/T/mri-34db59d07ef34640/axial_035.png","assets/T/mri-34db59d07ef34640/axial_037.png","assets/T/mri-34db59d07ef34640/axial_038.png","assets/T/mri-34db59d07ef34640/axial_039.png","assets/T/mri-34db59d07ef34640/axial_041.png","assets/T/mri-34db59d07ef34640/axial_042.png","assets/T/mri-34db59d07ef34640/coronal_001.png","assets/T/mri-34db59d07ef34640/coronal_002.png","assets/T/mri-34db59d07ef34640/coronal_004.png","assets/T/mri-34db59d07ef34640/coronal_005.png","assets/T/mri-34db59d07ef34640/coronal_006.png","assets/T/mri-34db59d07ef34640/coronal_008.png","assets/T/mri-34db59d07ef34640/coronal_009.png","assets/T/mri-34db59d07ef34640/coronal_010.png","assets/T/mri-34db59d07ef34640/coronal_012.png","assets/T/mri-34db59d07ef34640/coronal_013.png","assets/T/mri-34db59d07ef34640/coronal_015.png","assets/T/mri-34db59d07ef34640/coronal_016.png","assets/T/mri-34db59d07ef34640/coronal_017.png","assets/T/mri-34db59d07ef34640/coronal_019.png","assets/T/mri-34db59d07ef34640/coronal_020.png","assets/T/mri-34db59d07ef34640/coronal_021.png","assets/T/mri-34db59d07ef34640/coronal_023.png","assets/T/mri-34db59d07ef34640/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":66,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,12,13,14,16,17,18,20,21,22,23,25,26,27,29,30,31,33,34,35,37,38,39,41,42,43,44,46,47,48,50,51,52,54,55,57,58,59,61,62,63,65,66]}}
+{"id":"mri-d9cf4f2c60544daa","request_id":"L3-T300:mri-d9cf4f2c60544daa","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-d9cf4f2c60544daa/axial_001.png","assets/T/mri-d9cf4f2c60544daa/axial_002.png","assets/T/mri-d9cf4f2c60544daa/axial_004.png","assets/T/mri-d9cf4f2c60544daa/axial_005.png","assets/T/mri-d9cf4f2c60544daa/axial_006.png","assets/T/mri-d9cf4f2c60544daa/axial_008.png","assets/T/mri-d9cf4f2c60544daa/axial_009.png","assets/T/mri-d9cf4f2c60544daa/axial_010.png","assets/T/mri-d9cf4f2c60544daa/axial_011.png","assets/T/mri-d9cf4f2c60544daa/axial_013.png","assets/T/mri-d9cf4f2c60544daa/axial_014.png","assets/T/mri-d9cf4f2c60544daa/axial_015.png","assets/T/mri-d9cf4f2c60544daa/axial_017.png","assets/T/mri-d9cf4f2c60544daa/axial_018.png","assets/T/mri-d9cf4f2c60544daa/axial_019.png","assets/T/mri-d9cf4f2c60544daa/axial_021.png","assets/T/mri-d9cf4f2c60544daa/axial_022.png","assets/T/mri-d9cf4f2c60544daa/axial_023.png","assets/T/mri-d9cf4f2c60544daa/axial_024.png","assets/T/mri-d9cf4f2c60544daa/axial_026.png","assets/T/mri-d9cf4f2c60544daa/axial_027.png","assets/T/mri-d9cf4f2c60544daa/axial_028.png","assets/T/mri-d9cf4f2c60544daa/axial_030.png","assets/T/mri-d9cf4f2c60544daa/axial_031.png","assets/T/mri-d9cf4f2c60544daa/axial_032.png","assets/T/mri-d9cf4f2c60544daa/axial_034.png","assets/T/mri-d9cf4f2c60544daa/axial_035.png","assets/T/mri-d9cf4f2c60544daa/axial_036.png","assets/T/mri-d9cf4f2c60544daa/axial_037.png","assets/T/mri-d9cf4f2c60544daa/axial_039.png","assets/T/mri-d9cf4f2c60544daa/axial_040.png","assets/T/mri-d9cf4f2c60544daa/coronal_001.png","assets/T/mri-d9cf4f2c60544daa/coronal_002.png","assets/T/mri-d9cf4f2c60544daa/coronal_004.png","assets/T/mri-d9cf4f2c60544daa/coronal_005.png","assets/T/mri-d9cf4f2c60544daa/coronal_006.png","assets/T/mri-d9cf4f2c60544daa/coronal_007.png","assets/T/mri-d9cf4f2c60544daa/coronal_009.png","assets/T/mri-d9cf4f2c60544daa/coronal_010.png","assets/T/mri-d9cf4f2c60544daa/coronal_011.png","assets/T/mri-d9cf4f2c60544daa/coronal_013.png","assets/T/mri-d9cf4f2c60544daa/coronal_014.png","assets/T/mri-d9cf4f2c60544daa/coronal_015.png","assets/T/mri-d9cf4f2c60544daa/coronal_016.png","assets/T/mri-d9cf4f2c60544daa/coronal_018.png","assets/T/mri-d9cf4f2c60544daa/coronal_019.png","assets/T/mri-d9cf4f2c60544daa/coronal_020.png","assets/T/mri-d9cf4f2c60544daa/coronal_021.png","assets/T/mri-d9cf4f2c60544daa/coronal_023.png","assets/T/mri-d9cf4f2c60544daa/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":64,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,11,13,14,15,17,18,19,21,22,23,24,26,27,28,30,31,32,34,35,36,37,39,40,41,42,44,45,46,47,49,50,51,53,54,55,56,58,59,60,61,63,64]}}
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+{"id":"mri-29505b0ebf294dfd","request_id":"L3-T300:mri-29505b0ebf294dfd","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-29505b0ebf294dfd/axial_001.png","assets/T/mri-29505b0ebf294dfd/axial_002.png","assets/T/mri-29505b0ebf294dfd/axial_004.png","assets/T/mri-29505b0ebf294dfd/axial_005.png","assets/T/mri-29505b0ebf294dfd/axial_006.png","assets/T/mri-29505b0ebf294dfd/axial_008.png","assets/T/mri-29505b0ebf294dfd/axial_009.png","assets/T/mri-29505b0ebf294dfd/axial_010.png","assets/T/mri-29505b0ebf294dfd/axial_012.png","assets/T/mri-29505b0ebf294dfd/axial_013.png","assets/T/mri-29505b0ebf294dfd/axial_014.png","assets/T/mri-29505b0ebf294dfd/axial_016.png","assets/T/mri-29505b0ebf294dfd/axial_017.png","assets/T/mri-29505b0ebf294dfd/axial_018.png","assets/T/mri-29505b0ebf294dfd/axial_020.png","assets/T/mri-29505b0ebf294dfd/axial_021.png","assets/T/mri-29505b0ebf294dfd/axial_022.png","assets/T/mri-29505b0ebf294dfd/axial_023.png","assets/T/mri-29505b0ebf294dfd/axial_025.png","assets/T/mri-29505b0ebf294dfd/axial_026.png","assets/T/mri-29505b0ebf294dfd/axial_027.png","assets/T/mri-29505b0ebf294dfd/axial_029.png","assets/T/mri-29505b0ebf294dfd/axial_030.png","assets/T/mri-29505b0ebf294dfd/axial_031.png","assets/T/mri-29505b0ebf294dfd/axial_033.png","assets/T/mri-29505b0ebf294dfd/axial_034.png","assets/T/mri-29505b0ebf294dfd/axial_035.png","assets/T/mri-29505b0ebf294dfd/axial_037.png","assets/T/mri-29505b0ebf294dfd/axial_038.png","assets/T/mri-29505b0ebf294dfd/axial_039.png","assets/T/mri-29505b0ebf294dfd/axial_041.png","assets/T/mri-29505b0ebf294dfd/axial_042.png","assets/T/mri-29505b0ebf294dfd/coronal_001.png","assets/T/mri-29505b0ebf294dfd/coronal_002.png","assets/T/mri-29505b0ebf294dfd/coronal_004.png","assets/T/mri-29505b0ebf294dfd/coronal_005.png","assets/T/mri-29505b0ebf294dfd/coronal_006.png","assets/T/mri-29505b0ebf294dfd/coronal_008.png","assets/T/mri-29505b0ebf294dfd/coronal_009.png","assets/T/mri-29505b0ebf294dfd/coronal_010.png","assets/T/mri-29505b0ebf294dfd/coronal_012.png","assets/T/mri-29505b0ebf294dfd/coronal_013.png","assets/T/mri-29505b0ebf294dfd/coronal_015.png","assets/T/mri-29505b0ebf294dfd/coronal_016.png","assets/T/mri-29505b0ebf294dfd/coronal_017.png","assets/T/mri-29505b0ebf294dfd/coronal_019.png","assets/T/mri-29505b0ebf294dfd/coronal_020.png","assets/T/mri-29505b0ebf294dfd/coronal_021.png","assets/T/mri-29505b0ebf294dfd/coronal_023.png","assets/T/mri-29505b0ebf294dfd/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":66,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,12,13,14,16,17,18,20,21,22,23,25,26,27,29,30,31,33,34,35,37,38,39,41,42,43,44,46,47,48,50,51,52,54,55,57,58,59,61,62,63,65,66]}}
+{"id":"mri-e2fd54c6f0cc4d8b","request_id":"L3-T300:mri-e2fd54c6f0cc4d8b","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-e2fd54c6f0cc4d8b/axial_001.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_002.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_003.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_005.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_006.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_007.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_008.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_010.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_011.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_012.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_013.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_015.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_016.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_017.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_018.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_020.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_021.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_022.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_023.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_024.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_026.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_027.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_028.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_029.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_031.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_032.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_033.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_034.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_036.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_037.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_038.png","assets/T/mri-e2fd54c6f0cc4d8b/coronal_001.png","assets/T/mri-e2fd54c6f0cc4d8b/coronal_002.png","assets/T/mri-e2fd54c6f0cc4d8b/coronal_004.png","assets/T/mri-e2fd54c6f0cc4d8b/coronal_005.png","assets/T/mri-e2fd54c6f0cc4d8b/coronal_006.png","assets/T/mri-e2fd54c6f0cc4d8b/coronal_007.png","assets/T/mri-e2fd54c6f0cc4d8b/coronal_009.png","assets/T/mri-e2fd54c6f0cc4d8b/coronal_010.png","assets/T/mri-e2fd54c6f0cc4d8b/coronal_011.png","assets/T/mri-e2fd54c6f0cc4d8b/coronal_013.png","assets/T/mri-e2fd54c6f0cc4d8b/coronal_014.png","assets/T/mri-e2fd54c6f0cc4d8b/coronal_015.png","assets/T/mri-e2fd54c6f0cc4d8b/coronal_016.png","assets/T/mri-e2fd54c6f0cc4d8b/coronal_018.png","assets/T/mri-e2fd54c6f0cc4d8b/coronal_019.png","assets/T/mri-e2fd54c6f0cc4d8b/coronal_020.png","assets/T/mri-e2fd54c6f0cc4d8b/coronal_021.png","assets/T/mri-e2fd54c6f0cc4d8b/coronal_023.png","assets/T/mri-e2fd54c6f0cc4d8b/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":62,"selected_count":50,"source_indices_1based":[1,2,3,5,6,7,8,10,11,12,13,15,16,17,18,20,21,22,23,24,26,27,28,29,31,32,33,34,36,37,38,39,40,42,43,44,45,47,48,49,51,52,53,54,56,57,58,59,61,62]}}
+{"id":"mri-e409f2ae4d1b4e1f","request_id":"L3-T300:mri-e409f2ae4d1b4e1f","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-e409f2ae4d1b4e1f/axial_001.png","assets/T/mri-e409f2ae4d1b4e1f/axial_002.png","assets/T/mri-e409f2ae4d1b4e1f/axial_004.png","assets/T/mri-e409f2ae4d1b4e1f/axial_005.png","assets/T/mri-e409f2ae4d1b4e1f/axial_007.png","assets/T/mri-e409f2ae4d1b4e1f/axial_008.png","assets/T/mri-e409f2ae4d1b4e1f/axial_009.png","assets/T/mri-e409f2ae4d1b4e1f/axial_011.png","assets/T/mri-e409f2ae4d1b4e1f/axial_012.png","assets/T/mri-e409f2ae4d1b4e1f/axial_013.png","assets/T/mri-e409f2ae4d1b4e1f/axial_015.png","assets/T/mri-e409f2ae4d1b4e1f/axial_016.png","assets/T/mri-e409f2ae4d1b4e1f/axial_018.png","assets/T/mri-e409f2ae4d1b4e1f/axial_019.png","assets/T/mri-e409f2ae4d1b4e1f/axial_020.png","assets/T/mri-e409f2ae4d1b4e1f/axial_022.png","assets/T/mri-e409f2ae4d1b4e1f/axial_023.png","assets/T/mri-e409f2ae4d1b4e1f/axial_025.png","assets/T/mri-e409f2ae4d1b4e1f/axial_026.png","assets/T/mri-e409f2ae4d1b4e1f/axial_027.png","assets/T/mri-e409f2ae4d1b4e1f/axial_029.png","assets/T/mri-e409f2ae4d1b4e1f/axial_030.png","assets/T/mri-e409f2ae4d1b4e1f/axial_032.png","assets/T/mri-e409f2ae4d1b4e1f/axial_033.png","assets/T/mri-e409f2ae4d1b4e1f/axial_034.png","assets/T/mri-e409f2ae4d1b4e1f/axial_036.png","assets/T/mri-e409f2ae4d1b4e1f/axial_037.png","assets/T/mri-e409f2ae4d1b4e1f/axial_038.png","assets/T/mri-e409f2ae4d1b4e1f/axial_040.png","assets/T/mri-e409f2ae4d1b4e1f/axial_041.png","assets/T/mri-e409f2ae4d1b4e1f/axial_043.png","assets/T/mri-e409f2ae4d1b4e1f/axial_044.png","assets/T/mri-e409f2ae4d1b4e1f/coronal_001.png","assets/T/mri-e409f2ae4d1b4e1f/coronal_002.png","assets/T/mri-e409f2ae4d1b4e1f/coronal_004.png","assets/T/mri-e409f2ae4d1b4e1f/coronal_005.png","assets/T/mri-e409f2ae4d1b4e1f/coronal_006.png","assets/T/mri-e409f2ae4d1b4e1f/coronal_008.png","assets/T/mri-e409f2ae4d1b4e1f/coronal_009.png","assets/T/mri-e409f2ae4d1b4e1f/coronal_010.png","assets/T/mri-e409f2ae4d1b4e1f/coronal_012.png","assets/T/mri-e409f2ae4d1b4e1f/coronal_013.png","assets/T/mri-e409f2ae4d1b4e1f/coronal_015.png","assets/T/mri-e409f2ae4d1b4e1f/coronal_016.png","assets/T/mri-e409f2ae4d1b4e1f/coronal_017.png","assets/T/mri-e409f2ae4d1b4e1f/coronal_019.png","assets/T/mri-e409f2ae4d1b4e1f/coronal_020.png","assets/T/mri-e409f2ae4d1b4e1f/coronal_021.png","assets/T/mri-e409f2ae4d1b4e1f/coronal_023.png","assets/T/mri-e409f2ae4d1b4e1f/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":68,"selected_count":50,"source_indices_1based":[1,2,4,5,7,8,9,11,12,13,15,16,18,19,20,22,23,25,26,27,29,30,32,33,34,36,37,38,40,41,43,44,45,46,48,49,50,52,53,54,56,57,59,60,61,63,64,65,67,68]}}
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+{"id":"mri-7fa3212a93944079","request_id":"L3-T300:mri-7fa3212a93944079","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-7fa3212a93944079/axial_001.png","assets/T/mri-7fa3212a93944079/axial_002.png","assets/T/mri-7fa3212a93944079/axial_004.png","assets/T/mri-7fa3212a93944079/axial_005.png","assets/T/mri-7fa3212a93944079/axial_006.png","assets/T/mri-7fa3212a93944079/axial_008.png","assets/T/mri-7fa3212a93944079/axial_009.png","assets/T/mri-7fa3212a93944079/axial_010.png","assets/T/mri-7fa3212a93944079/axial_011.png","assets/T/mri-7fa3212a93944079/axial_013.png","assets/T/mri-7fa3212a93944079/axial_014.png","assets/T/mri-7fa3212a93944079/axial_015.png","assets/T/mri-7fa3212a93944079/axial_017.png","assets/T/mri-7fa3212a93944079/axial_018.png","assets/T/mri-7fa3212a93944079/axial_019.png","assets/T/mri-7fa3212a93944079/axial_021.png","assets/T/mri-7fa3212a93944079/axial_022.png","assets/T/mri-7fa3212a93944079/axial_023.png","assets/T/mri-7fa3212a93944079/axial_024.png","assets/T/mri-7fa3212a93944079/axial_026.png","assets/T/mri-7fa3212a93944079/axial_027.png","assets/T/mri-7fa3212a93944079/axial_028.png","assets/T/mri-7fa3212a93944079/axial_030.png","assets/T/mri-7fa3212a93944079/axial_031.png","assets/T/mri-7fa3212a93944079/axial_032.png","assets/T/mri-7fa3212a93944079/axial_034.png","assets/T/mri-7fa3212a93944079/axial_035.png","assets/T/mri-7fa3212a93944079/axial_036.png","assets/T/mri-7fa3212a93944079/axial_037.png","assets/T/mri-7fa3212a93944079/axial_039.png","assets/T/mri-7fa3212a93944079/axial_040.png","assets/T/mri-7fa3212a93944079/coronal_001.png","assets/T/mri-7fa3212a93944079/coronal_002.png","assets/T/mri-7fa3212a93944079/coronal_004.png","assets/T/mri-7fa3212a93944079/coronal_005.png","assets/T/mri-7fa3212a93944079/coronal_006.png","assets/T/mri-7fa3212a93944079/coronal_007.png","assets/T/mri-7fa3212a93944079/coronal_009.png","assets/T/mri-7fa3212a93944079/coronal_010.png","assets/T/mri-7fa3212a93944079/coronal_011.png","assets/T/mri-7fa3212a93944079/coronal_013.png","assets/T/mri-7fa3212a93944079/coronal_014.png","assets/T/mri-7fa3212a93944079/coronal_015.png","assets/T/mri-7fa3212a93944079/coronal_016.png","assets/T/mri-7fa3212a93944079/coronal_018.png","assets/T/mri-7fa3212a93944079/coronal_019.png","assets/T/mri-7fa3212a93944079/coronal_020.png","assets/T/mri-7fa3212a93944079/coronal_021.png","assets/T/mri-7fa3212a93944079/coronal_023.png","assets/T/mri-7fa3212a93944079/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":64,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,11,13,14,15,17,18,19,21,22,23,24,26,27,28,30,31,32,34,35,36,37,39,40,41,42,44,45,46,47,49,50,51,53,54,55,56,58,59,60,61,63,64]}}
+{"id":"mri-f3694da4bfe340dd","request_id":"L3-T300:mri-f3694da4bfe340dd","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-f3694da4bfe340dd/axial_001.png","assets/T/mri-f3694da4bfe340dd/axial_002.png","assets/T/mri-f3694da4bfe340dd/axial_004.png","assets/T/mri-f3694da4bfe340dd/axial_005.png","assets/T/mri-f3694da4bfe340dd/axial_006.png","assets/T/mri-f3694da4bfe340dd/axial_008.png","assets/T/mri-f3694da4bfe340dd/axial_009.png","assets/T/mri-f3694da4bfe340dd/axial_010.png","assets/T/mri-f3694da4bfe340dd/axial_011.png","assets/T/mri-f3694da4bfe340dd/axial_013.png","assets/T/mri-f3694da4bfe340dd/axial_014.png","assets/T/mri-f3694da4bfe340dd/axial_015.png","assets/T/mri-f3694da4bfe340dd/axial_017.png","assets/T/mri-f3694da4bfe340dd/axial_018.png","assets/T/mri-f3694da4bfe340dd/axial_019.png","assets/T/mri-f3694da4bfe340dd/axial_021.png","assets/T/mri-f3694da4bfe340dd/axial_022.png","assets/T/mri-f3694da4bfe340dd/axial_023.png","assets/T/mri-f3694da4bfe340dd/axial_024.png","assets/T/mri-f3694da4bfe340dd/axial_026.png","assets/T/mri-f3694da4bfe340dd/axial_027.png","assets/T/mri-f3694da4bfe340dd/axial_028.png","assets/T/mri-f3694da4bfe340dd/axial_030.png","assets/T/mri-f3694da4bfe340dd/axial_031.png","assets/T/mri-f3694da4bfe340dd/axial_032.png","assets/T/mri-f3694da4bfe340dd/axial_034.png","assets/T/mri-f3694da4bfe340dd/axial_035.png","assets/T/mri-f3694da4bfe340dd/axial_036.png","assets/T/mri-f3694da4bfe340dd/axial_037.png","assets/T/mri-f3694da4bfe340dd/axial_039.png","assets/T/mri-f3694da4bfe340dd/axial_040.png","assets/T/mri-f3694da4bfe340dd/coronal_001.png","assets/T/mri-f3694da4bfe340dd/coronal_002.png","assets/T/mri-f3694da4bfe340dd/coronal_004.png","assets/T/mri-f3694da4bfe340dd/coronal_005.png","assets/T/mri-f3694da4bfe340dd/coronal_006.png","assets/T/mri-f3694da4bfe340dd/coronal_007.png","assets/T/mri-f3694da4bfe340dd/coronal_009.png","assets/T/mri-f3694da4bfe340dd/coronal_010.png","assets/T/mri-f3694da4bfe340dd/coronal_011.png","assets/T/mri-f3694da4bfe340dd/coronal_013.png","assets/T/mri-f3694da4bfe340dd/coronal_014.png","assets/T/mri-f3694da4bfe340dd/coronal_015.png","assets/T/mri-f3694da4bfe340dd/coronal_016.png","assets/T/mri-f3694da4bfe340dd/coronal_018.png","assets/T/mri-f3694da4bfe340dd/coronal_019.png","assets/T/mri-f3694da4bfe340dd/coronal_020.png","assets/T/mri-f3694da4bfe340dd/coronal_021.png","assets/T/mri-f3694da4bfe340dd/coronal_023.png","assets/T/mri-f3694da4bfe340dd/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":64,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,11,13,14,15,17,18,19,21,22,23,24,26,27,28,30,31,32,34,35,36,37,39,40,41,42,44,45,46,47,49,50,51,53,54,55,56,58,59,60,61,63,64]}}
+{"id":"mri-d642a887db8749e7","request_id":"L3-T300:mri-d642a887db8749e7","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 30 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 20 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-d642a887db8749e7/axial_001.png","assets/T/mri-d642a887db8749e7/axial_002.png","assets/T/mri-d642a887db8749e7/axial_004.png","assets/T/mri-d642a887db8749e7/axial_005.png","assets/T/mri-d642a887db8749e7/axial_006.png","assets/T/mri-d642a887db8749e7/axial_008.png","assets/T/mri-d642a887db8749e7/axial_009.png","assets/T/mri-d642a887db8749e7/axial_010.png","assets/T/mri-d642a887db8749e7/axial_012.png","assets/T/mri-d642a887db8749e7/axial_013.png","assets/T/mri-d642a887db8749e7/axial_014.png","assets/T/mri-d642a887db8749e7/axial_016.png","assets/T/mri-d642a887db8749e7/axial_017.png","assets/T/mri-d642a887db8749e7/axial_018.png","assets/T/mri-d642a887db8749e7/axial_020.png","assets/T/mri-d642a887db8749e7/axial_021.png","assets/T/mri-d642a887db8749e7/axial_023.png","assets/T/mri-d642a887db8749e7/axial_024.png","assets/T/mri-d642a887db8749e7/axial_025.png","assets/T/mri-d642a887db8749e7/axial_027.png","assets/T/mri-d642a887db8749e7/axial_028.png","assets/T/mri-d642a887db8749e7/axial_029.png","assets/T/mri-d642a887db8749e7/axial_031.png","assets/T/mri-d642a887db8749e7/axial_032.png","assets/T/mri-d642a887db8749e7/axial_033.png","assets/T/mri-d642a887db8749e7/axial_035.png","assets/T/mri-d642a887db8749e7/axial_036.png","assets/T/mri-d642a887db8749e7/axial_037.png","assets/T/mri-d642a887db8749e7/axial_039.png","assets/T/mri-d642a887db8749e7/axial_040.png","assets/T/mri-d642a887db8749e7/coronal_001.png","assets/T/mri-d642a887db8749e7/coronal_002.png","assets/T/mri-d642a887db8749e7/coronal_004.png","assets/T/mri-d642a887db8749e7/coronal_005.png","assets/T/mri-d642a887db8749e7/coronal_006.png","assets/T/mri-d642a887db8749e7/coronal_008.png","assets/T/mri-d642a887db8749e7/coronal_009.png","assets/T/mri-d642a887db8749e7/coronal_010.png","assets/T/mri-d642a887db8749e7/coronal_012.png","assets/T/mri-d642a887db8749e7/coronal_013.png","assets/T/mri-d642a887db8749e7/coronal_014.png","assets/T/mri-d642a887db8749e7/coronal_015.png","assets/T/mri-d642a887db8749e7/coronal_017.png","assets/T/mri-d642a887db8749e7/coronal_018.png","assets/T/mri-d642a887db8749e7/coronal_019.png","assets/T/mri-d642a887db8749e7/coronal_021.png","assets/T/mri-d642a887db8749e7/coronal_022.png","assets/T/mri-d642a887db8749e7/coronal_023.png","assets/T/mri-d642a887db8749e7/coronal_025.png","assets/T/mri-d642a887db8749e7/coronal_026.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":66,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,12,13,14,16,17,18,20,21,23,24,25,27,28,29,31,32,33,35,36,37,39,40,41,42,44,45,46,48,49,50,52,53,54,55,57,58,59,61,62,63,65,66]}}
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+{"id":"mri-64b88c007f454cd4","request_id":"L3-T300:mri-64b88c007f454cd4","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-64b88c007f454cd4/axial_001.png","assets/T/mri-64b88c007f454cd4/axial_002.png","assets/T/mri-64b88c007f454cd4/axial_004.png","assets/T/mri-64b88c007f454cd4/axial_005.png","assets/T/mri-64b88c007f454cd4/axial_006.png","assets/T/mri-64b88c007f454cd4/axial_008.png","assets/T/mri-64b88c007f454cd4/axial_009.png","assets/T/mri-64b88c007f454cd4/axial_011.png","assets/T/mri-64b88c007f454cd4/axial_012.png","assets/T/mri-64b88c007f454cd4/axial_013.png","assets/T/mri-64b88c007f454cd4/axial_015.png","assets/T/mri-64b88c007f454cd4/axial_016.png","assets/T/mri-64b88c007f454cd4/axial_017.png","assets/T/mri-64b88c007f454cd4/axial_019.png","assets/T/mri-64b88c007f454cd4/axial_020.png","assets/T/mri-64b88c007f454cd4/axial_022.png","assets/T/mri-64b88c007f454cd4/axial_023.png","assets/T/mri-64b88c007f454cd4/axial_024.png","assets/T/mri-64b88c007f454cd4/axial_026.png","assets/T/mri-64b88c007f454cd4/axial_027.png","assets/T/mri-64b88c007f454cd4/axial_028.png","assets/T/mri-64b88c007f454cd4/axial_030.png","assets/T/mri-64b88c007f454cd4/axial_031.png","assets/T/mri-64b88c007f454cd4/axial_032.png","assets/T/mri-64b88c007f454cd4/axial_034.png","assets/T/mri-64b88c007f454cd4/axial_035.png","assets/T/mri-64b88c007f454cd4/axial_037.png","assets/T/mri-64b88c007f454cd4/axial_038.png","assets/T/mri-64b88c007f454cd4/axial_039.png","assets/T/mri-64b88c007f454cd4/axial_041.png","assets/T/mri-64b88c007f454cd4/axial_042.png","assets/T/mri-64b88c007f454cd4/coronal_001.png","assets/T/mri-64b88c007f454cd4/coronal_002.png","assets/T/mri-64b88c007f454cd4/coronal_004.png","assets/T/mri-64b88c007f454cd4/coronal_005.png","assets/T/mri-64b88c007f454cd4/coronal_006.png","assets/T/mri-64b88c007f454cd4/coronal_008.png","assets/T/mri-64b88c007f454cd4/coronal_009.png","assets/T/mri-64b88c007f454cd4/coronal_010.png","assets/T/mri-64b88c007f454cd4/coronal_012.png","assets/T/mri-64b88c007f454cd4/coronal_013.png","assets/T/mri-64b88c007f454cd4/coronal_014.png","assets/T/mri-64b88c007f454cd4/coronal_016.png","assets/T/mri-64b88c007f454cd4/coronal_017.png","assets/T/mri-64b88c007f454cd4/coronal_018.png","assets/T/mri-64b88c007f454cd4/coronal_020.png","assets/T/mri-64b88c007f454cd4/coronal_021.png","assets/T/mri-64b88c007f454cd4/coronal_022.png","assets/T/mri-64b88c007f454cd4/coronal_024.png","assets/T/mri-64b88c007f454cd4/coronal_025.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":67,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,11,12,13,15,16,17,19,20,22,23,24,26,27,28,30,31,32,34,35,37,38,39,41,42,43,44,46,47,48,50,51,52,54,55,56,58,59,60,62,63,64,66,67]}}
+{"id":"mri-94083fb208a0400d","request_id":"L3-T300:mri-94083fb208a0400d","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 31 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-94083fb208a0400d/axial_001.png","assets/T/mri-94083fb208a0400d/axial_002.png","assets/T/mri-94083fb208a0400d/axial_004.png","assets/T/mri-94083fb208a0400d/axial_005.png","assets/T/mri-94083fb208a0400d/axial_006.png","assets/T/mri-94083fb208a0400d/axial_008.png","assets/T/mri-94083fb208a0400d/axial_009.png","assets/T/mri-94083fb208a0400d/axial_010.png","assets/T/mri-94083fb208a0400d/axial_011.png","assets/T/mri-94083fb208a0400d/axial_013.png","assets/T/mri-94083fb208a0400d/axial_014.png","assets/T/mri-94083fb208a0400d/axial_015.png","assets/T/mri-94083fb208a0400d/axial_017.png","assets/T/mri-94083fb208a0400d/axial_018.png","assets/T/mri-94083fb208a0400d/axial_019.png","assets/T/mri-94083fb208a0400d/axial_021.png","assets/T/mri-94083fb208a0400d/axial_022.png","assets/T/mri-94083fb208a0400d/axial_023.png","assets/T/mri-94083fb208a0400d/axial_024.png","assets/T/mri-94083fb208a0400d/axial_026.png","assets/T/mri-94083fb208a0400d/axial_027.png","assets/T/mri-94083fb208a0400d/axial_028.png","assets/T/mri-94083fb208a0400d/axial_030.png","assets/T/mri-94083fb208a0400d/axial_031.png","assets/T/mri-94083fb208a0400d/axial_032.png","assets/T/mri-94083fb208a0400d/axial_034.png","assets/T/mri-94083fb208a0400d/axial_035.png","assets/T/mri-94083fb208a0400d/axial_036.png","assets/T/mri-94083fb208a0400d/axial_037.png","assets/T/mri-94083fb208a0400d/axial_039.png","assets/T/mri-94083fb208a0400d/axial_040.png","assets/T/mri-94083fb208a0400d/coronal_001.png","assets/T/mri-94083fb208a0400d/coronal_002.png","assets/T/mri-94083fb208a0400d/coronal_004.png","assets/T/mri-94083fb208a0400d/coronal_005.png","assets/T/mri-94083fb208a0400d/coronal_006.png","assets/T/mri-94083fb208a0400d/coronal_007.png","assets/T/mri-94083fb208a0400d/coronal_009.png","assets/T/mri-94083fb208a0400d/coronal_010.png","assets/T/mri-94083fb208a0400d/coronal_011.png","assets/T/mri-94083fb208a0400d/coronal_013.png","assets/T/mri-94083fb208a0400d/coronal_014.png","assets/T/mri-94083fb208a0400d/coronal_015.png","assets/T/mri-94083fb208a0400d/coronal_016.png","assets/T/mri-94083fb208a0400d/coronal_018.png","assets/T/mri-94083fb208a0400d/coronal_019.png","assets/T/mri-94083fb208a0400d/coronal_020.png","assets/T/mri-94083fb208a0400d/coronal_021.png","assets/T/mri-94083fb208a0400d/coronal_023.png","assets/T/mri-94083fb208a0400d/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":64,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,11,13,14,15,17,18,19,21,22,23,24,26,27,28,30,31,32,34,35,36,37,39,40,41,42,44,45,46,47,49,50,51,53,54,55,56,58,59,60,61,63,64]}}
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+{"id":"mri-cc1823e862844adb","request_id":"L3-T300:mri-cc1823e862844adb","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-cc1823e862844adb/axial_001.png","assets/T/mri-cc1823e862844adb/axial_002.png","assets/T/mri-cc1823e862844adb/axial_004.png","assets/T/mri-cc1823e862844adb/axial_005.png","assets/T/mri-cc1823e862844adb/axial_006.png","assets/T/mri-cc1823e862844adb/axial_008.png","assets/T/mri-cc1823e862844adb/axial_009.png","assets/T/mri-cc1823e862844adb/axial_010.png","assets/T/mri-cc1823e862844adb/axial_012.png","assets/T/mri-cc1823e862844adb/axial_013.png","assets/T/mri-cc1823e862844adb/axial_014.png","assets/T/mri-cc1823e862844adb/axial_016.png","assets/T/mri-cc1823e862844adb/axial_017.png","assets/T/mri-cc1823e862844adb/axial_018.png","assets/T/mri-cc1823e862844adb/axial_020.png","assets/T/mri-cc1823e862844adb/axial_021.png","assets/T/mri-cc1823e862844adb/axial_022.png","assets/T/mri-cc1823e862844adb/axial_023.png","assets/T/mri-cc1823e862844adb/axial_025.png","assets/T/mri-cc1823e862844adb/axial_026.png","assets/T/mri-cc1823e862844adb/axial_027.png","assets/T/mri-cc1823e862844adb/axial_029.png","assets/T/mri-cc1823e862844adb/axial_030.png","assets/T/mri-cc1823e862844adb/axial_031.png","assets/T/mri-cc1823e862844adb/axial_033.png","assets/T/mri-cc1823e862844adb/axial_034.png","assets/T/mri-cc1823e862844adb/axial_035.png","assets/T/mri-cc1823e862844adb/axial_037.png","assets/T/mri-cc1823e862844adb/axial_038.png","assets/T/mri-cc1823e862844adb/axial_039.png","assets/T/mri-cc1823e862844adb/axial_041.png","assets/T/mri-cc1823e862844adb/axial_042.png","assets/T/mri-cc1823e862844adb/coronal_001.png","assets/T/mri-cc1823e862844adb/coronal_002.png","assets/T/mri-cc1823e862844adb/coronal_004.png","assets/T/mri-cc1823e862844adb/coronal_005.png","assets/T/mri-cc1823e862844adb/coronal_006.png","assets/T/mri-cc1823e862844adb/coronal_008.png","assets/T/mri-cc1823e862844adb/coronal_009.png","assets/T/mri-cc1823e862844adb/coronal_010.png","assets/T/mri-cc1823e862844adb/coronal_012.png","assets/T/mri-cc1823e862844adb/coronal_013.png","assets/T/mri-cc1823e862844adb/coronal_015.png","assets/T/mri-cc1823e862844adb/coronal_016.png","assets/T/mri-cc1823e862844adb/coronal_017.png","assets/T/mri-cc1823e862844adb/coronal_019.png","assets/T/mri-cc1823e862844adb/coronal_020.png","assets/T/mri-cc1823e862844adb/coronal_021.png","assets/T/mri-cc1823e862844adb/coronal_023.png","assets/T/mri-cc1823e862844adb/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":66,"selected_count":50,"source_indices_1based":[1,2,4,5,6,8,9,10,12,13,14,16,17,18,20,21,22,23,25,26,27,29,30,31,33,34,35,37,38,39,41,42,43,44,46,47,48,50,51,52,54,55,57,58,59,61,62,63,65,66]}}
+{"id":"mri-2827a4219010408d","request_id":"L3-T300:mri-2827a4219010408d","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 30 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 20 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-2827a4219010408d/axial_001.png","assets/T/mri-2827a4219010408d/axial_002.png","assets/T/mri-2827a4219010408d/axial_003.png","assets/T/mri-2827a4219010408d/axial_005.png","assets/T/mri-2827a4219010408d/axial_006.png","assets/T/mri-2827a4219010408d/axial_007.png","assets/T/mri-2827a4219010408d/axial_008.png","assets/T/mri-2827a4219010408d/axial_009.png","assets/T/mri-2827a4219010408d/axial_011.png","assets/T/mri-2827a4219010408d/axial_012.png","assets/T/mri-2827a4219010408d/axial_013.png","assets/T/mri-2827a4219010408d/axial_014.png","assets/T/mri-2827a4219010408d/axial_015.png","assets/T/mri-2827a4219010408d/axial_017.png","assets/T/mri-2827a4219010408d/axial_018.png","assets/T/mri-2827a4219010408d/axial_019.png","assets/T/mri-2827a4219010408d/axial_020.png","assets/T/mri-2827a4219010408d/axial_022.png","assets/T/mri-2827a4219010408d/axial_023.png","assets/T/mri-2827a4219010408d/axial_024.png","assets/T/mri-2827a4219010408d/axial_025.png","assets/T/mri-2827a4219010408d/axial_026.png","assets/T/mri-2827a4219010408d/axial_028.png","assets/T/mri-2827a4219010408d/axial_029.png","assets/T/mri-2827a4219010408d/axial_030.png","assets/T/mri-2827a4219010408d/axial_031.png","assets/T/mri-2827a4219010408d/axial_032.png","assets/T/mri-2827a4219010408d/axial_034.png","assets/T/mri-2827a4219010408d/axial_035.png","assets/T/mri-2827a4219010408d/axial_036.png","assets/T/mri-2827a4219010408d/coronal_001.png","assets/T/mri-2827a4219010408d/coronal_002.png","assets/T/mri-2827a4219010408d/coronal_003.png","assets/T/mri-2827a4219010408d/coronal_005.png","assets/T/mri-2827a4219010408d/coronal_006.png","assets/T/mri-2827a4219010408d/coronal_007.png","assets/T/mri-2827a4219010408d/coronal_008.png","assets/T/mri-2827a4219010408d/coronal_009.png","assets/T/mri-2827a4219010408d/coronal_011.png","assets/T/mri-2827a4219010408d/coronal_012.png","assets/T/mri-2827a4219010408d/coronal_013.png","assets/T/mri-2827a4219010408d/coronal_014.png","assets/T/mri-2827a4219010408d/coronal_016.png","assets/T/mri-2827a4219010408d/coronal_017.png","assets/T/mri-2827a4219010408d/coronal_018.png","assets/T/mri-2827a4219010408d/coronal_019.png","assets/T/mri-2827a4219010408d/coronal_020.png","assets/T/mri-2827a4219010408d/coronal_022.png","assets/T/mri-2827a4219010408d/coronal_023.png","assets/T/mri-2827a4219010408d/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":60,"selected_count":50,"source_indices_1based":[1,2,3,5,6,7,8,9,11,12,13,14,15,17,18,19,20,22,23,24,25,26,28,29,30,31,32,34,35,36,37,38,39,41,42,43,44,45,47,48,49,50,52,53,54,55,56,58,59,60]}}
+{"id":"mri-814687fc8a704a75","request_id":"L3-T300:mri-814687fc8a704a75","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-814687fc8a704a75/axial_001.png","assets/T/mri-814687fc8a704a75/axial_002.png","assets/T/mri-814687fc8a704a75/axial_004.png","assets/T/mri-814687fc8a704a75/axial_005.png","assets/T/mri-814687fc8a704a75/axial_007.png","assets/T/mri-814687fc8a704a75/axial_008.png","assets/T/mri-814687fc8a704a75/axial_009.png","assets/T/mri-814687fc8a704a75/axial_011.png","assets/T/mri-814687fc8a704a75/axial_012.png","assets/T/mri-814687fc8a704a75/axial_013.png","assets/T/mri-814687fc8a704a75/axial_015.png","assets/T/mri-814687fc8a704a75/axial_016.png","assets/T/mri-814687fc8a704a75/axial_018.png","assets/T/mri-814687fc8a704a75/axial_019.png","assets/T/mri-814687fc8a704a75/axial_020.png","assets/T/mri-814687fc8a704a75/axial_022.png","assets/T/mri-814687fc8a704a75/axial_023.png","assets/T/mri-814687fc8a704a75/axial_025.png","assets/T/mri-814687fc8a704a75/axial_026.png","assets/T/mri-814687fc8a704a75/axial_027.png","assets/T/mri-814687fc8a704a75/axial_029.png","assets/T/mri-814687fc8a704a75/axial_030.png","assets/T/mri-814687fc8a704a75/axial_032.png","assets/T/mri-814687fc8a704a75/axial_033.png","assets/T/mri-814687fc8a704a75/axial_034.png","assets/T/mri-814687fc8a704a75/axial_036.png","assets/T/mri-814687fc8a704a75/axial_037.png","assets/T/mri-814687fc8a704a75/axial_038.png","assets/T/mri-814687fc8a704a75/axial_040.png","assets/T/mri-814687fc8a704a75/axial_041.png","assets/T/mri-814687fc8a704a75/axial_043.png","assets/T/mri-814687fc8a704a75/axial_044.png","assets/T/mri-814687fc8a704a75/coronal_001.png","assets/T/mri-814687fc8a704a75/coronal_002.png","assets/T/mri-814687fc8a704a75/coronal_004.png","assets/T/mri-814687fc8a704a75/coronal_005.png","assets/T/mri-814687fc8a704a75/coronal_006.png","assets/T/mri-814687fc8a704a75/coronal_008.png","assets/T/mri-814687fc8a704a75/coronal_009.png","assets/T/mri-814687fc8a704a75/coronal_010.png","assets/T/mri-814687fc8a704a75/coronal_012.png","assets/T/mri-814687fc8a704a75/coronal_013.png","assets/T/mri-814687fc8a704a75/coronal_015.png","assets/T/mri-814687fc8a704a75/coronal_016.png","assets/T/mri-814687fc8a704a75/coronal_017.png","assets/T/mri-814687fc8a704a75/coronal_019.png","assets/T/mri-814687fc8a704a75/coronal_020.png","assets/T/mri-814687fc8a704a75/coronal_021.png","assets/T/mri-814687fc8a704a75/coronal_023.png","assets/T/mri-814687fc8a704a75/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":68,"selected_count":50,"source_indices_1based":[1,2,4,5,7,8,9,11,12,13,15,16,18,19,20,22,23,25,26,27,29,30,32,33,34,36,37,38,40,41,43,44,45,46,48,49,50,52,53,54,56,57,59,60,61,63,64,65,67,68]}}
+{"id":"mri-2cce79e2ec6f4326","request_id":"L3-T300:mri-2cce79e2ec6f4326","subset":"L3-T300","task":"T","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 32 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 18 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-2cce79e2ec6f4326/axial_001.png","assets/T/mri-2cce79e2ec6f4326/axial_002.png","assets/T/mri-2cce79e2ec6f4326/axial_004.png","assets/T/mri-2cce79e2ec6f4326/axial_005.png","assets/T/mri-2cce79e2ec6f4326/axial_006.png","assets/T/mri-2cce79e2ec6f4326/axial_007.png","assets/T/mri-2cce79e2ec6f4326/axial_009.png","assets/T/mri-2cce79e2ec6f4326/axial_010.png","assets/T/mri-2cce79e2ec6f4326/axial_011.png","assets/T/mri-2cce79e2ec6f4326/axial_013.png","assets/T/mri-2cce79e2ec6f4326/axial_014.png","assets/T/mri-2cce79e2ec6f4326/axial_015.png","assets/T/mri-2cce79e2ec6f4326/axial_016.png","assets/T/mri-2cce79e2ec6f4326/axial_018.png","assets/T/mri-2cce79e2ec6f4326/axial_019.png","assets/T/mri-2cce79e2ec6f4326/axial_020.png","assets/T/mri-2cce79e2ec6f4326/axial_022.png","assets/T/mri-2cce79e2ec6f4326/axial_023.png","assets/T/mri-2cce79e2ec6f4326/axial_024.png","assets/T/mri-2cce79e2ec6f4326/axial_026.png","assets/T/mri-2cce79e2ec6f4326/axial_027.png","assets/T/mri-2cce79e2ec6f4326/axial_028.png","assets/T/mri-2cce79e2ec6f4326/axial_029.png","assets/T/mri-2cce79e2ec6f4326/axial_031.png","assets/T/mri-2cce79e2ec6f4326/axial_032.png","assets/T/mri-2cce79e2ec6f4326/axial_033.png","assets/T/mri-2cce79e2ec6f4326/axial_035.png","assets/T/mri-2cce79e2ec6f4326/axial_036.png","assets/T/mri-2cce79e2ec6f4326/axial_037.png","assets/T/mri-2cce79e2ec6f4326/axial_038.png","assets/T/mri-2cce79e2ec6f4326/axial_040.png","assets/T/mri-2cce79e2ec6f4326/axial_041.png","assets/T/mri-2cce79e2ec6f4326/coronal_001.png","assets/T/mri-2cce79e2ec6f4326/coronal_002.png","assets/T/mri-2cce79e2ec6f4326/coronal_004.png","assets/T/mri-2cce79e2ec6f4326/coronal_005.png","assets/T/mri-2cce79e2ec6f4326/coronal_006.png","assets/T/mri-2cce79e2ec6f4326/coronal_008.png","assets/T/mri-2cce79e2ec6f4326/coronal_009.png","assets/T/mri-2cce79e2ec6f4326/coronal_010.png","assets/T/mri-2cce79e2ec6f4326/coronal_012.png","assets/T/mri-2cce79e2ec6f4326/coronal_013.png","assets/T/mri-2cce79e2ec6f4326/coronal_015.png","assets/T/mri-2cce79e2ec6f4326/coronal_016.png","assets/T/mri-2cce79e2ec6f4326/coronal_017.png","assets/T/mri-2cce79e2ec6f4326/coronal_019.png","assets/T/mri-2cce79e2ec6f4326/coronal_020.png","assets/T/mri-2cce79e2ec6f4326/coronal_021.png","assets/T/mri-2cce79e2ec6f4326/coronal_023.png","assets/T/mri-2cce79e2ec6f4326/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":65,"selected_count":50,"source_indices_1based":[1,2,4,5,6,7,9,10,11,13,14,15,16,18,19,20,22,23,24,26,27,28,29,31,32,33,35,36,37,38,40,41,42,43,45,46,47,49,50,51,53,54,56,57,58,60,61,62,64,65]}}
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+{"id":"mri-5d64214c74e34879","request_id":"L3-N400:mri-5d64214c74e34879","subset":"L3-N400","task":"N","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 50 张图，均来自同一次检查。\n\n- 前 29 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 21 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先综合全部图像中的区域淋巴结影像证据，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，判断该患者的 N 分期，并给出简要影像依据。不要判断 T、M 或总体分期。\n\n`n_stage` 只能输出 N0、N1、N2、N3 之一。\n只输出一个 JSON 对象，不要输出 JSON 以外的解释、markdown 或代码块。\n输出格式：\n{\n  \"n_stage\": \"N0\",\n  \"evidence\": \"简要影像依据\"\n}","images":["assets/N/mri-5d64214c74e34879/axial_001.png","assets/N/mri-5d64214c74e34879/axial_002.png","assets/N/mri-5d64214c74e34879/axial_004.png","assets/N/mri-5d64214c74e34879/axial_005.png","assets/N/mri-5d64214c74e34879/axial_006.png","assets/N/mri-5d64214c74e34879/axial_007.png","assets/N/mri-5d64214c74e34879/axial_009.png","assets/N/mri-5d64214c74e34879/axial_010.png","assets/N/mri-5d64214c74e34879/axial_011.png","assets/N/mri-5d64214c74e34879/axial_013.png","assets/N/mri-5d64214c74e34879/axial_014.png","assets/N/mri-5d64214c74e34879/axial_015.png","assets/N/mri-5d64214c74e34879/axial_016.png","assets/N/mri-5d64214c74e34879/axial_018.png","assets/N/mri-5d64214c74e34879/axial_019.png","assets/N/mri-5d64214c74e34879/axial_020.png","assets/N/mri-5d64214c74e34879/axial_022.png","assets/N/mri-5d64214c74e34879/axial_023.png","assets/N/mri-5d64214c74e34879/axial_024.png","assets/N/mri-5d64214c74e34879/axial_025.png","assets/N/mri-5d64214c74e34879/axial_027.png","assets/N/mri-5d64214c74e34879/axial_028.png","assets/N/mri-5d64214c74e34879/axial_029.png","assets/N/mri-5d64214c74e34879/axial_031.png","assets/N/mri-5d64214c74e34879/axial_032.png","assets/N/mri-5d64214c74e34879/axial_033.png","assets/N/mri-5d64214c74e34879/axial_034.png","assets/N/mri-5d64214c74e34879/axial_036.png","assets/N/mri-5d64214c74e34879/axial_037.png","assets/N/mri-5d64214c74e34879/coronal_001.png","assets/N/mri-5d64214c74e34879/coronal_002.png","assets/N/mri-5d64214c74e34879/coronal_004.png","assets/N/mri-5d64214c74e34879/coronal_005.png","assets/N/mri-5d64214c74e34879/coronal_006.png","assets/N/mri-5d64214c74e34879/coronal_007.png","assets/N/mri-5d64214c74e34879/coronal_009.png","assets/N/mri-5d64214c74e34879/coronal_010.png","assets/N/mri-5d64214c74e34879/coronal_011.png","assets/N/mri-5d64214c74e34879/coronal_012.png","assets/N/mri-5d64214c74e34879/coronal_014.png","assets/N/mri-5d64214c74e34879/coronal_015.png","assets/N/mri-5d64214c74e34879/coronal_016.png","assets/N/mri-5d64214c74e34879/coronal_017.png","assets/N/mri-5d64214c74e34879/coronal_019.png","assets/N/mri-5d64214c74e34879/coronal_020.png","assets/N/mri-5d64214c74e34879/coronal_021.png","assets/N/mri-5d64214c74e34879/coronal_022.png","assets/N/mri-5d64214c74e34879/coronal_024.png","assets/N/mri-5d64214c74e34879/coronal_025.png","assets/N/mri-5d64214c74e34879/coronal_026.png"],"stage_edition":8,"image_sampling":{"method":"proportional axial/coronal allocation, uniform within each group, both endpoints of each group included","source_count":63,"selected_count":50,"source_indices_1based":[1,2,4,5,6,7,9,10,11,13,14,15,16,18,19,20,22,23,24,25,27,28,29,31,32,33,34,36,37,38,39,41,42,43,44,46,47,48,49,51,52,53,54,56,57,58,59,61,62,63]}}
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diff --git a/L3/extensions/requests_internvl.jsonl b/L3/extensions/requests_internvl.jsonl
new file mode 100644
index 0000000000000000000000000000000000000000..00fa3f3cc205d01708c87627487ee44c282e134f
--- /dev/null
+++ b/L3/extensions/requests_internvl.jsonl
@@ -0,0 +1,700 @@
+{"id":"L3-T300:mri-d4c892f0b7e3423f","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-d4c892f0b7e3423f/axial_001.png","assets/T/mri-d4c892f0b7e3423f/axial_003.png","assets/T/mri-d4c892f0b7e3423f/axial_005.png","assets/T/mri-d4c892f0b7e3423f/axial_007.png","assets/T/mri-d4c892f0b7e3423f/axial_009.png","assets/T/mri-d4c892f0b7e3423f/axial_011.png","assets/T/mri-d4c892f0b7e3423f/axial_013.png","assets/T/mri-d4c892f0b7e3423f/axial_015.png","assets/T/mri-d4c892f0b7e3423f/axial_017.png","assets/T/mri-d4c892f0b7e3423f/axial_019.png","assets/T/mri-d4c892f0b7e3423f/axial_022.png","assets/T/mri-d4c892f0b7e3423f/axial_024.png","assets/T/mri-d4c892f0b7e3423f/axial_026.png","assets/T/mri-d4c892f0b7e3423f/axial_028.png","assets/T/mri-d4c892f0b7e3423f/axial_030.png","assets/T/mri-d4c892f0b7e3423f/axial_032.png","assets/T/mri-d4c892f0b7e3423f/axial_034.png","assets/T/mri-d4c892f0b7e3423f/axial_036.png","assets/T/mri-d4c892f0b7e3423f/axial_038.png","assets/T/mri-d4c892f0b7e3423f/axial_040.png","assets/T/mri-d4c892f0b7e3423f/axial_042.png","assets/T/mri-d4c892f0b7e3423f/coronal_001.png","assets/T/mri-d4c892f0b7e3423f/coronal_003.png","assets/T/mri-d4c892f0b7e3423f/coronal_005.png","assets/T/mri-d4c892f0b7e3423f/coronal_007.png","assets/T/mri-d4c892f0b7e3423f/coronal_009.png","assets/T/mri-d4c892f0b7e3423f/coronal_011.png","assets/T/mri-d4c892f0b7e3423f/coronal_014.png","assets/T/mri-d4c892f0b7e3423f/coronal_016.png","assets/T/mri-d4c892f0b7e3423f/coronal_018.png","assets/T/mri-d4c892f0b7e3423f/coronal_020.png","assets/T/mri-d4c892f0b7e3423f/coronal_022.png","assets/T/mri-d4c892f0b7e3423f/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
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+{"id":"L3-T300:mri-e75b60d1d083428e","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-e75b60d1d083428e/axial_001.png","assets/T/mri-e75b60d1d083428e/axial_003.png","assets/T/mri-e75b60d1d083428e/axial_005.png","assets/T/mri-e75b60d1d083428e/axial_007.png","assets/T/mri-e75b60d1d083428e/axial_009.png","assets/T/mri-e75b60d1d083428e/axial_011.png","assets/T/mri-e75b60d1d083428e/axial_013.png","assets/T/mri-e75b60d1d083428e/axial_015.png","assets/T/mri-e75b60d1d083428e/axial_017.png","assets/T/mri-e75b60d1d083428e/axial_019.png","assets/T/mri-e75b60d1d083428e/axial_021.png","assets/T/mri-e75b60d1d083428e/axial_022.png","assets/T/mri-e75b60d1d083428e/axial_024.png","assets/T/mri-e75b60d1d083428e/axial_026.png","assets/T/mri-e75b60d1d083428e/axial_028.png","assets/T/mri-e75b60d1d083428e/axial_030.png","assets/T/mri-e75b60d1d083428e/axial_032.png","assets/T/mri-e75b60d1d083428e/axial_034.png","assets/T/mri-e75b60d1d083428e/axial_036.png","assets/T/mri-e75b60d1d083428e/axial_038.png","assets/T/mri-e75b60d1d083428e/axial_040.png","assets/T/mri-e75b60d1d083428e/coronal_001.png","assets/T/mri-e75b60d1d083428e/coronal_003.png","assets/T/mri-e75b60d1d083428e/coronal_005.png","assets/T/mri-e75b60d1d083428e/coronal_007.png","assets/T/mri-e75b60d1d083428e/coronal_009.png","assets/T/mri-e75b60d1d083428e/coronal_011.png","assets/T/mri-e75b60d1d083428e/coronal_014.png","assets/T/mri-e75b60d1d083428e/coronal_016.png","assets/T/mri-e75b60d1d083428e/coronal_018.png","assets/T/mri-e75b60d1d083428e/coronal_020.png","assets/T/mri-e75b60d1d083428e/coronal_022.png","assets/T/mri-e75b60d1d083428e/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-e3d8eb4d531d4fcf","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-e3d8eb4d531d4fcf/axial_001.png","assets/T/mri-e3d8eb4d531d4fcf/axial_003.png","assets/T/mri-e3d8eb4d531d4fcf/axial_005.png","assets/T/mri-e3d8eb4d531d4fcf/axial_007.png","assets/T/mri-e3d8eb4d531d4fcf/axial_009.png","assets/T/mri-e3d8eb4d531d4fcf/axial_011.png","assets/T/mri-e3d8eb4d531d4fcf/axial_013.png","assets/T/mri-e3d8eb4d531d4fcf/axial_015.png","assets/T/mri-e3d8eb4d531d4fcf/axial_017.png","assets/T/mri-e3d8eb4d531d4fcf/axial_019.png","assets/T/mri-e3d8eb4d531d4fcf/axial_022.png","assets/T/mri-e3d8eb4d531d4fcf/axial_024.png","assets/T/mri-e3d8eb4d531d4fcf/axial_026.png","assets/T/mri-e3d8eb4d531d4fcf/axial_028.png","assets/T/mri-e3d8eb4d531d4fcf/axial_030.png","assets/T/mri-e3d8eb4d531d4fcf/axial_032.png","assets/T/mri-e3d8eb4d531d4fcf/axial_034.png","assets/T/mri-e3d8eb4d531d4fcf/axial_036.png","assets/T/mri-e3d8eb4d531d4fcf/axial_038.png","assets/T/mri-e3d8eb4d531d4fcf/axial_040.png","assets/T/mri-e3d8eb4d531d4fcf/axial_042.png","assets/T/mri-e3d8eb4d531d4fcf/coronal_001.png","assets/T/mri-e3d8eb4d531d4fcf/coronal_003.png","assets/T/mri-e3d8eb4d531d4fcf/coronal_005.png","assets/T/mri-e3d8eb4d531d4fcf/coronal_007.png","assets/T/mri-e3d8eb4d531d4fcf/coronal_009.png","assets/T/mri-e3d8eb4d531d4fcf/coronal_011.png","assets/T/mri-e3d8eb4d531d4fcf/coronal_014.png","assets/T/mri-e3d8eb4d531d4fcf/coronal_016.png","assets/T/mri-e3d8eb4d531d4fcf/coronal_018.png","assets/T/mri-e3d8eb4d531d4fcf/coronal_020.png","assets/T/mri-e3d8eb4d531d4fcf/coronal_022.png","assets/T/mri-e3d8eb4d531d4fcf/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-76a6988d1e084bab","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 34 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 14 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-76a6988d1e084bab/axial_001.png","assets/T/mri-76a6988d1e084bab/axial_003.png","assets/T/mri-76a6988d1e084bab/axial_005.png","assets/T/mri-76a6988d1e084bab/axial_007.png","assets/T/mri-76a6988d1e084bab/axial_008.png","assets/T/mri-76a6988d1e084bab/axial_010.png","assets/T/mri-76a6988d1e084bab/axial_012.png","assets/T/mri-76a6988d1e084bab/axial_014.png","assets/T/mri-76a6988d1e084bab/axial_016.png","assets/T/mri-76a6988d1e084bab/axial_018.png","assets/T/mri-76a6988d1e084bab/axial_019.png","assets/T/mri-76a6988d1e084bab/axial_021.png","assets/T/mri-76a6988d1e084bab/axial_023.png","assets/T/mri-76a6988d1e084bab/axial_025.png","assets/T/mri-76a6988d1e084bab/axial_027.png","assets/T/mri-76a6988d1e084bab/axial_029.png","assets/T/mri-76a6988d1e084bab/axial_030.png","assets/T/mri-76a6988d1e084bab/axial_032.png","assets/T/mri-76a6988d1e084bab/axial_034.png","assets/T/mri-76a6988d1e084bab/axial_036.png","assets/T/mri-76a6988d1e084bab/coronal_001.png","assets/T/mri-76a6988d1e084bab/coronal_003.png","assets/T/mri-76a6988d1e084bab/coronal_005.png","assets/T/mri-76a6988d1e084bab/coronal_006.png","assets/T/mri-76a6988d1e084bab/coronal_008.png","assets/T/mri-76a6988d1e084bab/coronal_010.png","assets/T/mri-76a6988d1e084bab/coronal_012.png","assets/T/mri-76a6988d1e084bab/coronal_013.png","assets/T/mri-76a6988d1e084bab/coronal_015.png","assets/T/mri-76a6988d1e084bab/coronal_017.png","assets/T/mri-76a6988d1e084bab/coronal_019.png","assets/T/mri-76a6988d1e084bab/coronal_020.png","assets/T/mri-76a6988d1e084bab/coronal_022.png","assets/T/mri-76a6988d1e084bab/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":60,"selected_count":34,"source_indices_1based":[1,3,5,7,8,10,12,14,16,18,19,21,23,25,27,29,30,32,34,36,37,39,41,42,44,46,48,49,51,53,55,56,58,60]}}
+{"id":"L3-T300:mri-492555690ebc4338","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-492555690ebc4338/axial_001.png","assets/T/mri-492555690ebc4338/axial_003.png","assets/T/mri-492555690ebc4338/axial_005.png","assets/T/mri-492555690ebc4338/axial_007.png","assets/T/mri-492555690ebc4338/axial_009.png","assets/T/mri-492555690ebc4338/axial_011.png","assets/T/mri-492555690ebc4338/axial_013.png","assets/T/mri-492555690ebc4338/axial_015.png","assets/T/mri-492555690ebc4338/axial_017.png","assets/T/mri-492555690ebc4338/axial_019.png","assets/T/mri-492555690ebc4338/axial_022.png","assets/T/mri-492555690ebc4338/axial_024.png","assets/T/mri-492555690ebc4338/axial_026.png","assets/T/mri-492555690ebc4338/axial_028.png","assets/T/mri-492555690ebc4338/axial_030.png","assets/T/mri-492555690ebc4338/axial_032.png","assets/T/mri-492555690ebc4338/axial_034.png","assets/T/mri-492555690ebc4338/axial_036.png","assets/T/mri-492555690ebc4338/axial_038.png","assets/T/mri-492555690ebc4338/axial_040.png","assets/T/mri-492555690ebc4338/axial_042.png","assets/T/mri-492555690ebc4338/coronal_001.png","assets/T/mri-492555690ebc4338/coronal_003.png","assets/T/mri-492555690ebc4338/coronal_005.png","assets/T/mri-492555690ebc4338/coronal_007.png","assets/T/mri-492555690ebc4338/coronal_009.png","assets/T/mri-492555690ebc4338/coronal_011.png","assets/T/mri-492555690ebc4338/coronal_014.png","assets/T/mri-492555690ebc4338/coronal_016.png","assets/T/mri-492555690ebc4338/coronal_018.png","assets/T/mri-492555690ebc4338/coronal_020.png","assets/T/mri-492555690ebc4338/coronal_022.png","assets/T/mri-492555690ebc4338/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-6075270c70db4d72","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-6075270c70db4d72/axial_001.png","assets/T/mri-6075270c70db4d72/axial_003.png","assets/T/mri-6075270c70db4d72/axial_005.png","assets/T/mri-6075270c70db4d72/axial_007.png","assets/T/mri-6075270c70db4d72/axial_009.png","assets/T/mri-6075270c70db4d72/axial_011.png","assets/T/mri-6075270c70db4d72/axial_013.png","assets/T/mri-6075270c70db4d72/axial_015.png","assets/T/mri-6075270c70db4d72/axial_017.png","assets/T/mri-6075270c70db4d72/axial_019.png","assets/T/mri-6075270c70db4d72/axial_022.png","assets/T/mri-6075270c70db4d72/axial_024.png","assets/T/mri-6075270c70db4d72/axial_026.png","assets/T/mri-6075270c70db4d72/axial_028.png","assets/T/mri-6075270c70db4d72/axial_030.png","assets/T/mri-6075270c70db4d72/axial_032.png","assets/T/mri-6075270c70db4d72/axial_034.png","assets/T/mri-6075270c70db4d72/axial_036.png","assets/T/mri-6075270c70db4d72/axial_038.png","assets/T/mri-6075270c70db4d72/axial_040.png","assets/T/mri-6075270c70db4d72/axial_042.png","assets/T/mri-6075270c70db4d72/coronal_001.png","assets/T/mri-6075270c70db4d72/coronal_003.png","assets/T/mri-6075270c70db4d72/coronal_005.png","assets/T/mri-6075270c70db4d72/coronal_007.png","assets/T/mri-6075270c70db4d72/coronal_009.png","assets/T/mri-6075270c70db4d72/coronal_011.png","assets/T/mri-6075270c70db4d72/coronal_014.png","assets/T/mri-6075270c70db4d72/coronal_016.png","assets/T/mri-6075270c70db4d72/coronal_018.png","assets/T/mri-6075270c70db4d72/coronal_020.png","assets/T/mri-6075270c70db4d72/coronal_022.png","assets/T/mri-6075270c70db4d72/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-a822794800b24433","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-a822794800b24433/axial_001.png","assets/T/mri-a822794800b24433/axial_003.png","assets/T/mri-a822794800b24433/axial_005.png","assets/T/mri-a822794800b24433/axial_007.png","assets/T/mri-a822794800b24433/axial_009.png","assets/T/mri-a822794800b24433/axial_011.png","assets/T/mri-a822794800b24433/axial_013.png","assets/T/mri-a822794800b24433/axial_015.png","assets/T/mri-a822794800b24433/axial_017.png","assets/T/mri-a822794800b24433/axial_019.png","assets/T/mri-a822794800b24433/axial_021.png","assets/T/mri-a822794800b24433/axial_022.png","assets/T/mri-a822794800b24433/axial_024.png","assets/T/mri-a822794800b24433/axial_026.png","assets/T/mri-a822794800b24433/axial_028.png","assets/T/mri-a822794800b24433/axial_030.png","assets/T/mri-a822794800b24433/axial_032.png","assets/T/mri-a822794800b24433/axial_034.png","assets/T/mri-a822794800b24433/axial_036.png","assets/T/mri-a822794800b24433/axial_038.png","assets/T/mri-a822794800b24433/axial_040.png","assets/T/mri-a822794800b24433/coronal_001.png","assets/T/mri-a822794800b24433/coronal_003.png","assets/T/mri-a822794800b24433/coronal_005.png","assets/T/mri-a822794800b24433/coronal_007.png","assets/T/mri-a822794800b24433/coronal_009.png","assets/T/mri-a822794800b24433/coronal_011.png","assets/T/mri-a822794800b24433/coronal_014.png","assets/T/mri-a822794800b24433/coronal_016.png","assets/T/mri-a822794800b24433/coronal_018.png","assets/T/mri-a822794800b24433/coronal_020.png","assets/T/mri-a822794800b24433/coronal_022.png","assets/T/mri-a822794800b24433/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-524c6754989f4a43","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-524c6754989f4a43/axial_001.png","assets/T/mri-524c6754989f4a43/axial_003.png","assets/T/mri-524c6754989f4a43/axial_005.png","assets/T/mri-524c6754989f4a43/axial_007.png","assets/T/mri-524c6754989f4a43/axial_009.png","assets/T/mri-524c6754989f4a43/axial_011.png","assets/T/mri-524c6754989f4a43/axial_013.png","assets/T/mri-524c6754989f4a43/axial_015.png","assets/T/mri-524c6754989f4a43/axial_017.png","assets/T/mri-524c6754989f4a43/axial_019.png","assets/T/mri-524c6754989f4a43/axial_022.png","assets/T/mri-524c6754989f4a43/axial_024.png","assets/T/mri-524c6754989f4a43/axial_026.png","assets/T/mri-524c6754989f4a43/axial_028.png","assets/T/mri-524c6754989f4a43/axial_030.png","assets/T/mri-524c6754989f4a43/axial_032.png","assets/T/mri-524c6754989f4a43/axial_034.png","assets/T/mri-524c6754989f4a43/axial_036.png","assets/T/mri-524c6754989f4a43/axial_038.png","assets/T/mri-524c6754989f4a43/axial_040.png","assets/T/mri-524c6754989f4a43/axial_042.png","assets/T/mri-524c6754989f4a43/coronal_001.png","assets/T/mri-524c6754989f4a43/coronal_003.png","assets/T/mri-524c6754989f4a43/coronal_005.png","assets/T/mri-524c6754989f4a43/coronal_007.png","assets/T/mri-524c6754989f4a43/coronal_009.png","assets/T/mri-524c6754989f4a43/coronal_011.png","assets/T/mri-524c6754989f4a43/coronal_014.png","assets/T/mri-524c6754989f4a43/coronal_016.png","assets/T/mri-524c6754989f4a43/coronal_018.png","assets/T/mri-524c6754989f4a43/coronal_020.png","assets/T/mri-524c6754989f4a43/coronal_022.png","assets/T/mri-524c6754989f4a43/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-43a46f6923804318","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-43a46f6923804318/axial_001.png","assets/T/mri-43a46f6923804318/axial_003.png","assets/T/mri-43a46f6923804318/axial_005.png","assets/T/mri-43a46f6923804318/axial_007.png","assets/T/mri-43a46f6923804318/axial_010.png","assets/T/mri-43a46f6923804318/axial_012.png","assets/T/mri-43a46f6923804318/axial_014.png","assets/T/mri-43a46f6923804318/axial_016.png","assets/T/mri-43a46f6923804318/axial_018.png","assets/T/mri-43a46f6923804318/axial_020.png","assets/T/mri-43a46f6923804318/axial_023.png","assets/T/mri-43a46f6923804318/axial_025.png","assets/T/mri-43a46f6923804318/axial_027.png","assets/T/mri-43a46f6923804318/axial_029.png","assets/T/mri-43a46f6923804318/axial_031.png","assets/T/mri-43a46f6923804318/axial_033.png","assets/T/mri-43a46f6923804318/axial_035.png","assets/T/mri-43a46f6923804318/axial_038.png","assets/T/mri-43a46f6923804318/axial_040.png","assets/T/mri-43a46f6923804318/axial_042.png","assets/T/mri-43a46f6923804318/axial_044.png","assets/T/mri-43a46f6923804318/coronal_001.png","assets/T/mri-43a46f6923804318/coronal_003.png","assets/T/mri-43a46f6923804318/coronal_005.png","assets/T/mri-43a46f6923804318/coronal_007.png","assets/T/mri-43a46f6923804318/coronal_009.png","assets/T/mri-43a46f6923804318/coronal_011.png","assets/T/mri-43a46f6923804318/coronal_014.png","assets/T/mri-43a46f6923804318/coronal_016.png","assets/T/mri-43a46f6923804318/coronal_018.png","assets/T/mri-43a46f6923804318/coronal_020.png","assets/T/mri-43a46f6923804318/coronal_022.png","assets/T/mri-43a46f6923804318/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":68,"selected_count":33,"source_indices_1based":[1,3,5,7,10,12,14,16,18,20,23,25,27,29,31,33,35,38,40,42,44,45,47,49,51,53,55,58,60,62,64,66,68]}}
+{"id":"L3-T300:mri-0f97d76a51a040a4","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 13 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-0f97d76a51a040a4/axial_001.png","assets/T/mri-0f97d76a51a040a4/axial_003.png","assets/T/mri-0f97d76a51a040a4/axial_005.png","assets/T/mri-0f97d76a51a040a4/axial_007.png","assets/T/mri-0f97d76a51a040a4/axial_009.png","assets/T/mri-0f97d76a51a040a4/axial_011.png","assets/T/mri-0f97d76a51a040a4/axial_013.png","assets/T/mri-0f97d76a51a040a4/axial_015.png","assets/T/mri-0f97d76a51a040a4/axial_017.png","assets/T/mri-0f97d76a51a040a4/axial_019.png","assets/T/mri-0f97d76a51a040a4/axial_022.png","assets/T/mri-0f97d76a51a040a4/axial_024.png","assets/T/mri-0f97d76a51a040a4/axial_026.png","assets/T/mri-0f97d76a51a040a4/axial_028.png","assets/T/mri-0f97d76a51a040a4/axial_030.png","assets/T/mri-0f97d76a51a040a4/axial_032.png","assets/T/mri-0f97d76a51a040a4/axial_034.png","assets/T/mri-0f97d76a51a040a4/axial_036.png","assets/T/mri-0f97d76a51a040a4/axial_038.png","assets/T/mri-0f97d76a51a040a4/axial_040.png","assets/T/mri-0f97d76a51a040a4/coronal_001.png","assets/T/mri-0f97d76a51a040a4/coronal_003.png","assets/T/mri-0f97d76a51a040a4/coronal_005.png","assets/T/mri-0f97d76a51a040a4/coronal_007.png","assets/T/mri-0f97d76a51a040a4/coronal_009.png","assets/T/mri-0f97d76a51a040a4/coronal_011.png","assets/T/mri-0f97d76a51a040a4/coronal_014.png","assets/T/mri-0f97d76a51a040a4/coronal_016.png","assets/T/mri-0f97d76a51a040a4/coronal_018.png","assets/T/mri-0f97d76a51a040a4/coronal_020.png","assets/T/mri-0f97d76a51a040a4/coronal_022.png","assets/T/mri-0f97d76a51a040a4/coronal_024.png","assets/T/mri-0f97d76a51a040a4/coronal_026.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-4eff6559f14148d5","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 13 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-4eff6559f14148d5/axial_001.png","assets/T/mri-4eff6559f14148d5/axial_003.png","assets/T/mri-4eff6559f14148d5/axial_005.png","assets/T/mri-4eff6559f14148d5/axial_007.png","assets/T/mri-4eff6559f14148d5/axial_009.png","assets/T/mri-4eff6559f14148d5/axial_011.png","assets/T/mri-4eff6559f14148d5/axial_013.png","assets/T/mri-4eff6559f14148d5/axial_015.png","assets/T/mri-4eff6559f14148d5/axial_017.png","assets/T/mri-4eff6559f14148d5/axial_019.png","assets/T/mri-4eff6559f14148d5/axial_020.png","assets/T/mri-4eff6559f14148d5/axial_022.png","assets/T/mri-4eff6559f14148d5/axial_024.png","assets/T/mri-4eff6559f14148d5/axial_026.png","assets/T/mri-4eff6559f14148d5/axial_028.png","assets/T/mri-4eff6559f14148d5/axial_030.png","assets/T/mri-4eff6559f14148d5/axial_032.png","assets/T/mri-4eff6559f14148d5/axial_034.png","assets/T/mri-4eff6559f14148d5/axial_036.png","assets/T/mri-4eff6559f14148d5/axial_038.png","assets/T/mri-4eff6559f14148d5/coronal_001.png","assets/T/mri-4eff6559f14148d5/coronal_003.png","assets/T/mri-4eff6559f14148d5/coronal_005.png","assets/T/mri-4eff6559f14148d5/coronal_007.png","assets/T/mri-4eff6559f14148d5/coronal_009.png","assets/T/mri-4eff6559f14148d5/coronal_011.png","assets/T/mri-4eff6559f14148d5/coronal_013.png","assets/T/mri-4eff6559f14148d5/coronal_014.png","assets/T/mri-4eff6559f14148d5/coronal_016.png","assets/T/mri-4eff6559f14148d5/coronal_018.png","assets/T/mri-4eff6559f14148d5/coronal_020.png","assets/T/mri-4eff6559f14148d5/coronal_022.png","assets/T/mri-4eff6559f14148d5/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":62,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,20,22,24,26,28,30,32,34,36,38,39,41,43,45,47,49,51,52,54,56,58,60,62]}}
+{"id":"L3-T300:mri-7cb304a3ddd04efa","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 34 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 14 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-7cb304a3ddd04efa/axial_001.png","assets/T/mri-7cb304a3ddd04efa/axial_003.png","assets/T/mri-7cb304a3ddd04efa/axial_005.png","assets/T/mri-7cb304a3ddd04efa/axial_007.png","assets/T/mri-7cb304a3ddd04efa/axial_010.png","assets/T/mri-7cb304a3ddd04efa/axial_012.png","assets/T/mri-7cb304a3ddd04efa/axial_014.png","assets/T/mri-7cb304a3ddd04efa/axial_016.png","assets/T/mri-7cb304a3ddd04efa/axial_018.png","assets/T/mri-7cb304a3ddd04efa/axial_020.png","assets/T/mri-7cb304a3ddd04efa/axial_023.png","assets/T/mri-7cb304a3ddd04efa/axial_025.png","assets/T/mri-7cb304a3ddd04efa/axial_027.png","assets/T/mri-7cb304a3ddd04efa/axial_029.png","assets/T/mri-7cb304a3ddd04efa/axial_031.png","assets/T/mri-7cb304a3ddd04efa/axial_033.png","assets/T/mri-7cb304a3ddd04efa/axial_036.png","assets/T/mri-7cb304a3ddd04efa/axial_038.png","assets/T/mri-7cb304a3ddd04efa/axial_040.png","assets/T/mri-7cb304a3ddd04efa/axial_042.png","assets/T/mri-7cb304a3ddd04efa/coronal_001.png","assets/T/mri-7cb304a3ddd04efa/coronal_003.png","assets/T/mri-7cb304a3ddd04efa/coronal_005.png","assets/T/mri-7cb304a3ddd04efa/coronal_007.png","assets/T/mri-7cb304a3ddd04efa/coronal_009.png","assets/T/mri-7cb304a3ddd04efa/coronal_011.png","assets/T/mri-7cb304a3ddd04efa/coronal_013.png","assets/T/mri-7cb304a3ddd04efa/coronal_016.png","assets/T/mri-7cb304a3ddd04efa/coronal_018.png","assets/T/mri-7cb304a3ddd04efa/coronal_020.png","assets/T/mri-7cb304a3ddd04efa/coronal_022.png","assets/T/mri-7cb304a3ddd04efa/coronal_024.png","assets/T/mri-7cb304a3ddd04efa/coronal_026.png","assets/T/mri-7cb304a3ddd04efa/coronal_028.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":70,"selected_count":34,"source_indices_1based":[1,3,5,7,10,12,14,16,18,20,23,25,27,29,31,33,36,38,40,42,43,45,47,49,51,53,55,58,60,62,64,66,68,70]}}
+{"id":"L3-T300:mri-d2d9da67055048e2","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-d2d9da67055048e2/axial_001.png","assets/T/mri-d2d9da67055048e2/axial_003.png","assets/T/mri-d2d9da67055048e2/axial_005.png","assets/T/mri-d2d9da67055048e2/axial_007.png","assets/T/mri-d2d9da67055048e2/axial_009.png","assets/T/mri-d2d9da67055048e2/axial_011.png","assets/T/mri-d2d9da67055048e2/axial_013.png","assets/T/mri-d2d9da67055048e2/axial_015.png","assets/T/mri-d2d9da67055048e2/axial_017.png","assets/T/mri-d2d9da67055048e2/axial_019.png","assets/T/mri-d2d9da67055048e2/axial_021.png","assets/T/mri-d2d9da67055048e2/axial_022.png","assets/T/mri-d2d9da67055048e2/axial_024.png","assets/T/mri-d2d9da67055048e2/axial_026.png","assets/T/mri-d2d9da67055048e2/axial_028.png","assets/T/mri-d2d9da67055048e2/axial_030.png","assets/T/mri-d2d9da67055048e2/axial_032.png","assets/T/mri-d2d9da67055048e2/axial_034.png","assets/T/mri-d2d9da67055048e2/axial_036.png","assets/T/mri-d2d9da67055048e2/axial_038.png","assets/T/mri-d2d9da67055048e2/axial_040.png","assets/T/mri-d2d9da67055048e2/coronal_001.png","assets/T/mri-d2d9da67055048e2/coronal_003.png","assets/T/mri-d2d9da67055048e2/coronal_005.png","assets/T/mri-d2d9da67055048e2/coronal_007.png","assets/T/mri-d2d9da67055048e2/coronal_009.png","assets/T/mri-d2d9da67055048e2/coronal_011.png","assets/T/mri-d2d9da67055048e2/coronal_014.png","assets/T/mri-d2d9da67055048e2/coronal_016.png","assets/T/mri-d2d9da67055048e2/coronal_018.png","assets/T/mri-d2d9da67055048e2/coronal_020.png","assets/T/mri-d2d9da67055048e2/coronal_022.png","assets/T/mri-d2d9da67055048e2/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-c4103868bea44f56","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 13 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-c4103868bea44f56/axial_001.png","assets/T/mri-c4103868bea44f56/axial_003.png","assets/T/mri-c4103868bea44f56/axial_005.png","assets/T/mri-c4103868bea44f56/axial_007.png","assets/T/mri-c4103868bea44f56/axial_009.png","assets/T/mri-c4103868bea44f56/axial_011.png","assets/T/mri-c4103868bea44f56/axial_013.png","assets/T/mri-c4103868bea44f56/axial_015.png","assets/T/mri-c4103868bea44f56/axial_017.png","assets/T/mri-c4103868bea44f56/axial_019.png","assets/T/mri-c4103868bea44f56/axial_020.png","assets/T/mri-c4103868bea44f56/axial_022.png","assets/T/mri-c4103868bea44f56/axial_024.png","assets/T/mri-c4103868bea44f56/axial_026.png","assets/T/mri-c4103868bea44f56/axial_028.png","assets/T/mri-c4103868bea44f56/axial_030.png","assets/T/mri-c4103868bea44f56/axial_032.png","assets/T/mri-c4103868bea44f56/axial_034.png","assets/T/mri-c4103868bea44f56/axial_036.png","assets/T/mri-c4103868bea44f56/axial_038.png","assets/T/mri-c4103868bea44f56/coronal_001.png","assets/T/mri-c4103868bea44f56/coronal_003.png","assets/T/mri-c4103868bea44f56/coronal_005.png","assets/T/mri-c4103868bea44f56/coronal_007.png","assets/T/mri-c4103868bea44f56/coronal_009.png","assets/T/mri-c4103868bea44f56/coronal_011.png","assets/T/mri-c4103868bea44f56/coronal_013.png","assets/T/mri-c4103868bea44f56/coronal_014.png","assets/T/mri-c4103868bea44f56/coronal_016.png","assets/T/mri-c4103868bea44f56/coronal_018.png","assets/T/mri-c4103868bea44f56/coronal_020.png","assets/T/mri-c4103868bea44f56/coronal_022.png","assets/T/mri-c4103868bea44f56/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":62,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,20,22,24,26,28,30,32,34,36,38,39,41,43,45,47,49,51,52,54,56,58,60,62]}}
+{"id":"L3-T300:mri-a3351c647eb34a73","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-a3351c647eb34a73/axial_001.png","assets/T/mri-a3351c647eb34a73/axial_003.png","assets/T/mri-a3351c647eb34a73/axial_005.png","assets/T/mri-a3351c647eb34a73/axial_007.png","assets/T/mri-a3351c647eb34a73/axial_009.png","assets/T/mri-a3351c647eb34a73/axial_011.png","assets/T/mri-a3351c647eb34a73/axial_013.png","assets/T/mri-a3351c647eb34a73/axial_015.png","assets/T/mri-a3351c647eb34a73/axial_017.png","assets/T/mri-a3351c647eb34a73/axial_019.png","assets/T/mri-a3351c647eb34a73/axial_021.png","assets/T/mri-a3351c647eb34a73/axial_022.png","assets/T/mri-a3351c647eb34a73/axial_024.png","assets/T/mri-a3351c647eb34a73/axial_026.png","assets/T/mri-a3351c647eb34a73/axial_028.png","assets/T/mri-a3351c647eb34a73/axial_030.png","assets/T/mri-a3351c647eb34a73/axial_032.png","assets/T/mri-a3351c647eb34a73/axial_034.png","assets/T/mri-a3351c647eb34a73/axial_036.png","assets/T/mri-a3351c647eb34a73/axial_038.png","assets/T/mri-a3351c647eb34a73/axial_040.png","assets/T/mri-a3351c647eb34a73/coronal_001.png","assets/T/mri-a3351c647eb34a73/coronal_003.png","assets/T/mri-a3351c647eb34a73/coronal_005.png","assets/T/mri-a3351c647eb34a73/coronal_007.png","assets/T/mri-a3351c647eb34a73/coronal_009.png","assets/T/mri-a3351c647eb34a73/coronal_011.png","assets/T/mri-a3351c647eb34a73/coronal_014.png","assets/T/mri-a3351c647eb34a73/coronal_016.png","assets/T/mri-a3351c647eb34a73/coronal_018.png","assets/T/mri-a3351c647eb34a73/coronal_020.png","assets/T/mri-a3351c647eb34a73/coronal_022.png","assets/T/mri-a3351c647eb34a73/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-91686de02cb64fc2","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-91686de02cb64fc2/axial_001.png","assets/T/mri-91686de02cb64fc2/axial_003.png","assets/T/mri-91686de02cb64fc2/axial_005.png","assets/T/mri-91686de02cb64fc2/axial_007.png","assets/T/mri-91686de02cb64fc2/axial_009.png","assets/T/mri-91686de02cb64fc2/axial_011.png","assets/T/mri-91686de02cb64fc2/axial_013.png","assets/T/mri-91686de02cb64fc2/axial_015.png","assets/T/mri-91686de02cb64fc2/axial_017.png","assets/T/mri-91686de02cb64fc2/axial_019.png","assets/T/mri-91686de02cb64fc2/axial_021.png","assets/T/mri-91686de02cb64fc2/axial_022.png","assets/T/mri-91686de02cb64fc2/axial_024.png","assets/T/mri-91686de02cb64fc2/axial_026.png","assets/T/mri-91686de02cb64fc2/axial_028.png","assets/T/mri-91686de02cb64fc2/axial_030.png","assets/T/mri-91686de02cb64fc2/axial_032.png","assets/T/mri-91686de02cb64fc2/axial_034.png","assets/T/mri-91686de02cb64fc2/axial_036.png","assets/T/mri-91686de02cb64fc2/axial_038.png","assets/T/mri-91686de02cb64fc2/axial_040.png","assets/T/mri-91686de02cb64fc2/coronal_001.png","assets/T/mri-91686de02cb64fc2/coronal_003.png","assets/T/mri-91686de02cb64fc2/coronal_005.png","assets/T/mri-91686de02cb64fc2/coronal_007.png","assets/T/mri-91686de02cb64fc2/coronal_009.png","assets/T/mri-91686de02cb64fc2/coronal_011.png","assets/T/mri-91686de02cb64fc2/coronal_014.png","assets/T/mri-91686de02cb64fc2/coronal_016.png","assets/T/mri-91686de02cb64fc2/coronal_018.png","assets/T/mri-91686de02cb64fc2/coronal_020.png","assets/T/mri-91686de02cb64fc2/coronal_022.png","assets/T/mri-91686de02cb64fc2/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-93a27965e6ad4525","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-93a27965e6ad4525/axial_001.png","assets/T/mri-93a27965e6ad4525/axial_003.png","assets/T/mri-93a27965e6ad4525/axial_005.png","assets/T/mri-93a27965e6ad4525/axial_007.png","assets/T/mri-93a27965e6ad4525/axial_010.png","assets/T/mri-93a27965e6ad4525/axial_012.png","assets/T/mri-93a27965e6ad4525/axial_014.png","assets/T/mri-93a27965e6ad4525/axial_016.png","assets/T/mri-93a27965e6ad4525/axial_018.png","assets/T/mri-93a27965e6ad4525/axial_020.png","assets/T/mri-93a27965e6ad4525/axial_023.png","assets/T/mri-93a27965e6ad4525/axial_025.png","assets/T/mri-93a27965e6ad4525/axial_027.png","assets/T/mri-93a27965e6ad4525/axial_029.png","assets/T/mri-93a27965e6ad4525/axial_031.png","assets/T/mri-93a27965e6ad4525/axial_033.png","assets/T/mri-93a27965e6ad4525/axial_035.png","assets/T/mri-93a27965e6ad4525/axial_038.png","assets/T/mri-93a27965e6ad4525/axial_040.png","assets/T/mri-93a27965e6ad4525/axial_042.png","assets/T/mri-93a27965e6ad4525/axial_044.png","assets/T/mri-93a27965e6ad4525/coronal_001.png","assets/T/mri-93a27965e6ad4525/coronal_003.png","assets/T/mri-93a27965e6ad4525/coronal_006.png","assets/T/mri-93a27965e6ad4525/coronal_008.png","assets/T/mri-93a27965e6ad4525/coronal_010.png","assets/T/mri-93a27965e6ad4525/coronal_012.png","assets/T/mri-93a27965e6ad4525/coronal_015.png","assets/T/mri-93a27965e6ad4525/coronal_017.png","assets/T/mri-93a27965e6ad4525/coronal_019.png","assets/T/mri-93a27965e6ad4525/coronal_021.png","assets/T/mri-93a27965e6ad4525/coronal_024.png","assets/T/mri-93a27965e6ad4525/coronal_026.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":70,"selected_count":33,"source_indices_1based":[1,3,5,7,10,12,14,16,18,20,23,25,27,29,31,33,35,38,40,42,44,45,47,50,52,54,56,59,61,63,65,68,70]}}
+{"id":"L3-T300:mri-02211a5df28b41c8","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-02211a5df28b41c8/axial_001.png","assets/T/mri-02211a5df28b41c8/axial_003.png","assets/T/mri-02211a5df28b41c8/axial_005.png","assets/T/mri-02211a5df28b41c8/axial_007.png","assets/T/mri-02211a5df28b41c8/axial_010.png","assets/T/mri-02211a5df28b41c8/axial_012.png","assets/T/mri-02211a5df28b41c8/axial_014.png","assets/T/mri-02211a5df28b41c8/axial_016.png","assets/T/mri-02211a5df28b41c8/axial_018.png","assets/T/mri-02211a5df28b41c8/axial_020.png","assets/T/mri-02211a5df28b41c8/axial_023.png","assets/T/mri-02211a5df28b41c8/axial_025.png","assets/T/mri-02211a5df28b41c8/axial_027.png","assets/T/mri-02211a5df28b41c8/axial_029.png","assets/T/mri-02211a5df28b41c8/axial_031.png","assets/T/mri-02211a5df28b41c8/axial_033.png","assets/T/mri-02211a5df28b41c8/axial_035.png","assets/T/mri-02211a5df28b41c8/axial_038.png","assets/T/mri-02211a5df28b41c8/axial_040.png","assets/T/mri-02211a5df28b41c8/axial_042.png","assets/T/mri-02211a5df28b41c8/axial_044.png","assets/T/mri-02211a5df28b41c8/coronal_001.png","assets/T/mri-02211a5df28b41c8/coronal_003.png","assets/T/mri-02211a5df28b41c8/coronal_005.png","assets/T/mri-02211a5df28b41c8/coronal_007.png","assets/T/mri-02211a5df28b41c8/coronal_009.png","assets/T/mri-02211a5df28b41c8/coronal_011.png","assets/T/mri-02211a5df28b41c8/coronal_014.png","assets/T/mri-02211a5df28b41c8/coronal_016.png","assets/T/mri-02211a5df28b41c8/coronal_018.png","assets/T/mri-02211a5df28b41c8/coronal_020.png","assets/T/mri-02211a5df28b41c8/coronal_022.png","assets/T/mri-02211a5df28b41c8/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":68,"selected_count":33,"source_indices_1based":[1,3,5,7,10,12,14,16,18,20,23,25,27,29,31,33,35,38,40,42,44,45,47,49,51,53,55,58,60,62,64,66,68]}}
+{"id":"L3-T300:mri-aafde48fd76947e0","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-aafde48fd76947e0/axial_001.png","assets/T/mri-aafde48fd76947e0/axial_003.png","assets/T/mri-aafde48fd76947e0/axial_005.png","assets/T/mri-aafde48fd76947e0/axial_007.png","assets/T/mri-aafde48fd76947e0/axial_009.png","assets/T/mri-aafde48fd76947e0/axial_011.png","assets/T/mri-aafde48fd76947e0/axial_013.png","assets/T/mri-aafde48fd76947e0/axial_015.png","assets/T/mri-aafde48fd76947e0/axial_017.png","assets/T/mri-aafde48fd76947e0/axial_019.png","assets/T/mri-aafde48fd76947e0/axial_022.png","assets/T/mri-aafde48fd76947e0/axial_024.png","assets/T/mri-aafde48fd76947e0/axial_026.png","assets/T/mri-aafde48fd76947e0/axial_028.png","assets/T/mri-aafde48fd76947e0/axial_030.png","assets/T/mri-aafde48fd76947e0/axial_032.png","assets/T/mri-aafde48fd76947e0/axial_034.png","assets/T/mri-aafde48fd76947e0/axial_036.png","assets/T/mri-aafde48fd76947e0/axial_038.png","assets/T/mri-aafde48fd76947e0/axial_040.png","assets/T/mri-aafde48fd76947e0/axial_042.png","assets/T/mri-aafde48fd76947e0/coronal_001.png","assets/T/mri-aafde48fd76947e0/coronal_003.png","assets/T/mri-aafde48fd76947e0/coronal_005.png","assets/T/mri-aafde48fd76947e0/coronal_007.png","assets/T/mri-aafde48fd76947e0/coronal_009.png","assets/T/mri-aafde48fd76947e0/coronal_011.png","assets/T/mri-aafde48fd76947e0/coronal_014.png","assets/T/mri-aafde48fd76947e0/coronal_016.png","assets/T/mri-aafde48fd76947e0/coronal_018.png","assets/T/mri-aafde48fd76947e0/coronal_020.png","assets/T/mri-aafde48fd76947e0/coronal_022.png","assets/T/mri-aafde48fd76947e0/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-e62cf64b75ea4c8c","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-e62cf64b75ea4c8c/axial_001.png","assets/T/mri-e62cf64b75ea4c8c/axial_003.png","assets/T/mri-e62cf64b75ea4c8c/axial_005.png","assets/T/mri-e62cf64b75ea4c8c/axial_007.png","assets/T/mri-e62cf64b75ea4c8c/axial_009.png","assets/T/mri-e62cf64b75ea4c8c/axial_011.png","assets/T/mri-e62cf64b75ea4c8c/axial_013.png","assets/T/mri-e62cf64b75ea4c8c/axial_015.png","assets/T/mri-e62cf64b75ea4c8c/axial_017.png","assets/T/mri-e62cf64b75ea4c8c/axial_019.png","assets/T/mri-e62cf64b75ea4c8c/axial_022.png","assets/T/mri-e62cf64b75ea4c8c/axial_024.png","assets/T/mri-e62cf64b75ea4c8c/axial_026.png","assets/T/mri-e62cf64b75ea4c8c/axial_028.png","assets/T/mri-e62cf64b75ea4c8c/axial_030.png","assets/T/mri-e62cf64b75ea4c8c/axial_032.png","assets/T/mri-e62cf64b75ea4c8c/axial_034.png","assets/T/mri-e62cf64b75ea4c8c/axial_036.png","assets/T/mri-e62cf64b75ea4c8c/axial_038.png","assets/T/mri-e62cf64b75ea4c8c/axial_040.png","assets/T/mri-e62cf64b75ea4c8c/axial_042.png","assets/T/mri-e62cf64b75ea4c8c/coronal_001.png","assets/T/mri-e62cf64b75ea4c8c/coronal_003.png","assets/T/mri-e62cf64b75ea4c8c/coronal_005.png","assets/T/mri-e62cf64b75ea4c8c/coronal_007.png","assets/T/mri-e62cf64b75ea4c8c/coronal_009.png","assets/T/mri-e62cf64b75ea4c8c/coronal_011.png","assets/T/mri-e62cf64b75ea4c8c/coronal_014.png","assets/T/mri-e62cf64b75ea4c8c/coronal_016.png","assets/T/mri-e62cf64b75ea4c8c/coronal_018.png","assets/T/mri-e62cf64b75ea4c8c/coronal_020.png","assets/T/mri-e62cf64b75ea4c8c/coronal_022.png","assets/T/mri-e62cf64b75ea4c8c/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-327d5554ba1d4a18","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-327d5554ba1d4a18/axial_001.png","assets/T/mri-327d5554ba1d4a18/axial_003.png","assets/T/mri-327d5554ba1d4a18/axial_005.png","assets/T/mri-327d5554ba1d4a18/axial_007.png","assets/T/mri-327d5554ba1d4a18/axial_009.png","assets/T/mri-327d5554ba1d4a18/axial_011.png","assets/T/mri-327d5554ba1d4a18/axial_013.png","assets/T/mri-327d5554ba1d4a18/axial_015.png","assets/T/mri-327d5554ba1d4a18/axial_017.png","assets/T/mri-327d5554ba1d4a18/axial_019.png","assets/T/mri-327d5554ba1d4a18/axial_021.png","assets/T/mri-327d5554ba1d4a18/axial_022.png","assets/T/mri-327d5554ba1d4a18/axial_024.png","assets/T/mri-327d5554ba1d4a18/axial_026.png","assets/T/mri-327d5554ba1d4a18/axial_028.png","assets/T/mri-327d5554ba1d4a18/axial_030.png","assets/T/mri-327d5554ba1d4a18/axial_032.png","assets/T/mri-327d5554ba1d4a18/axial_034.png","assets/T/mri-327d5554ba1d4a18/axial_036.png","assets/T/mri-327d5554ba1d4a18/axial_038.png","assets/T/mri-327d5554ba1d4a18/axial_040.png","assets/T/mri-327d5554ba1d4a18/coronal_001.png","assets/T/mri-327d5554ba1d4a18/coronal_003.png","assets/T/mri-327d5554ba1d4a18/coronal_005.png","assets/T/mri-327d5554ba1d4a18/coronal_007.png","assets/T/mri-327d5554ba1d4a18/coronal_009.png","assets/T/mri-327d5554ba1d4a18/coronal_011.png","assets/T/mri-327d5554ba1d4a18/coronal_014.png","assets/T/mri-327d5554ba1d4a18/coronal_016.png","assets/T/mri-327d5554ba1d4a18/coronal_018.png","assets/T/mri-327d5554ba1d4a18/coronal_020.png","assets/T/mri-327d5554ba1d4a18/coronal_022.png","assets/T/mri-327d5554ba1d4a18/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-976a2674bc694056","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-976a2674bc694056/axial_001.png","assets/T/mri-976a2674bc694056/axial_003.png","assets/T/mri-976a2674bc694056/axial_005.png","assets/T/mri-976a2674bc694056/axial_007.png","assets/T/mri-976a2674bc694056/axial_009.png","assets/T/mri-976a2674bc694056/axial_011.png","assets/T/mri-976a2674bc694056/axial_013.png","assets/T/mri-976a2674bc694056/axial_015.png","assets/T/mri-976a2674bc694056/axial_017.png","assets/T/mri-976a2674bc694056/axial_019.png","assets/T/mri-976a2674bc694056/axial_021.png","assets/T/mri-976a2674bc694056/axial_022.png","assets/T/mri-976a2674bc694056/axial_024.png","assets/T/mri-976a2674bc694056/axial_026.png","assets/T/mri-976a2674bc694056/axial_028.png","assets/T/mri-976a2674bc694056/axial_030.png","assets/T/mri-976a2674bc694056/axial_032.png","assets/T/mri-976a2674bc694056/axial_034.png","assets/T/mri-976a2674bc694056/axial_036.png","assets/T/mri-976a2674bc694056/axial_038.png","assets/T/mri-976a2674bc694056/axial_040.png","assets/T/mri-976a2674bc694056/coronal_001.png","assets/T/mri-976a2674bc694056/coronal_003.png","assets/T/mri-976a2674bc694056/coronal_005.png","assets/T/mri-976a2674bc694056/coronal_007.png","assets/T/mri-976a2674bc694056/coronal_009.png","assets/T/mri-976a2674bc694056/coronal_011.png","assets/T/mri-976a2674bc694056/coronal_014.png","assets/T/mri-976a2674bc694056/coronal_016.png","assets/T/mri-976a2674bc694056/coronal_018.png","assets/T/mri-976a2674bc694056/coronal_020.png","assets/T/mri-976a2674bc694056/coronal_022.png","assets/T/mri-976a2674bc694056/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-451326ee669447a4","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-451326ee669447a4/axial_001.png","assets/T/mri-451326ee669447a4/axial_003.png","assets/T/mri-451326ee669447a4/axial_005.png","assets/T/mri-451326ee669447a4/axial_007.png","assets/T/mri-451326ee669447a4/axial_009.png","assets/T/mri-451326ee669447a4/axial_011.png","assets/T/mri-451326ee669447a4/axial_013.png","assets/T/mri-451326ee669447a4/axial_015.png","assets/T/mri-451326ee669447a4/axial_017.png","assets/T/mri-451326ee669447a4/axial_019.png","assets/T/mri-451326ee669447a4/axial_022.png","assets/T/mri-451326ee669447a4/axial_024.png","assets/T/mri-451326ee669447a4/axial_026.png","assets/T/mri-451326ee669447a4/axial_028.png","assets/T/mri-451326ee669447a4/axial_030.png","assets/T/mri-451326ee669447a4/axial_032.png","assets/T/mri-451326ee669447a4/axial_034.png","assets/T/mri-451326ee669447a4/axial_036.png","assets/T/mri-451326ee669447a4/axial_038.png","assets/T/mri-451326ee669447a4/axial_040.png","assets/T/mri-451326ee669447a4/axial_042.png","assets/T/mri-451326ee669447a4/coronal_001.png","assets/T/mri-451326ee669447a4/coronal_003.png","assets/T/mri-451326ee669447a4/coronal_005.png","assets/T/mri-451326ee669447a4/coronal_007.png","assets/T/mri-451326ee669447a4/coronal_009.png","assets/T/mri-451326ee669447a4/coronal_011.png","assets/T/mri-451326ee669447a4/coronal_014.png","assets/T/mri-451326ee669447a4/coronal_016.png","assets/T/mri-451326ee669447a4/coronal_018.png","assets/T/mri-451326ee669447a4/coronal_020.png","assets/T/mri-451326ee669447a4/coronal_022.png","assets/T/mri-451326ee669447a4/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-86711ff1ba3b4fe1","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 13 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-86711ff1ba3b4fe1/axial_001.png","assets/T/mri-86711ff1ba3b4fe1/axial_003.png","assets/T/mri-86711ff1ba3b4fe1/axial_005.png","assets/T/mri-86711ff1ba3b4fe1/axial_007.png","assets/T/mri-86711ff1ba3b4fe1/axial_009.png","assets/T/mri-86711ff1ba3b4fe1/axial_011.png","assets/T/mri-86711ff1ba3b4fe1/axial_013.png","assets/T/mri-86711ff1ba3b4fe1/axial_015.png","assets/T/mri-86711ff1ba3b4fe1/axial_017.png","assets/T/mri-86711ff1ba3b4fe1/axial_019.png","assets/T/mri-86711ff1ba3b4fe1/axial_020.png","assets/T/mri-86711ff1ba3b4fe1/axial_022.png","assets/T/mri-86711ff1ba3b4fe1/axial_024.png","assets/T/mri-86711ff1ba3b4fe1/axial_026.png","assets/T/mri-86711ff1ba3b4fe1/axial_028.png","assets/T/mri-86711ff1ba3b4fe1/axial_030.png","assets/T/mri-86711ff1ba3b4fe1/axial_032.png","assets/T/mri-86711ff1ba3b4fe1/axial_034.png","assets/T/mri-86711ff1ba3b4fe1/axial_036.png","assets/T/mri-86711ff1ba3b4fe1/axial_038.png","assets/T/mri-86711ff1ba3b4fe1/coronal_001.png","assets/T/mri-86711ff1ba3b4fe1/coronal_003.png","assets/T/mri-86711ff1ba3b4fe1/coronal_005.png","assets/T/mri-86711ff1ba3b4fe1/coronal_007.png","assets/T/mri-86711ff1ba3b4fe1/coronal_009.png","assets/T/mri-86711ff1ba3b4fe1/coronal_011.png","assets/T/mri-86711ff1ba3b4fe1/coronal_013.png","assets/T/mri-86711ff1ba3b4fe1/coronal_014.png","assets/T/mri-86711ff1ba3b4fe1/coronal_016.png","assets/T/mri-86711ff1ba3b4fe1/coronal_018.png","assets/T/mri-86711ff1ba3b4fe1/coronal_020.png","assets/T/mri-86711ff1ba3b4fe1/coronal_022.png","assets/T/mri-86711ff1ba3b4fe1/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":62,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,20,22,24,26,28,30,32,34,36,38,39,41,43,45,47,49,51,52,54,56,58,60,62]}}
+{"id":"L3-T300:mri-ea272624a53e4790","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-ea272624a53e4790/axial_001.png","assets/T/mri-ea272624a53e4790/axial_003.png","assets/T/mri-ea272624a53e4790/axial_005.png","assets/T/mri-ea272624a53e4790/axial_007.png","assets/T/mri-ea272624a53e4790/axial_009.png","assets/T/mri-ea272624a53e4790/axial_011.png","assets/T/mri-ea272624a53e4790/axial_013.png","assets/T/mri-ea272624a53e4790/axial_015.png","assets/T/mri-ea272624a53e4790/axial_017.png","assets/T/mri-ea272624a53e4790/axial_019.png","assets/T/mri-ea272624a53e4790/axial_022.png","assets/T/mri-ea272624a53e4790/axial_024.png","assets/T/mri-ea272624a53e4790/axial_026.png","assets/T/mri-ea272624a53e4790/axial_028.png","assets/T/mri-ea272624a53e4790/axial_030.png","assets/T/mri-ea272624a53e4790/axial_032.png","assets/T/mri-ea272624a53e4790/axial_034.png","assets/T/mri-ea272624a53e4790/axial_036.png","assets/T/mri-ea272624a53e4790/axial_038.png","assets/T/mri-ea272624a53e4790/axial_040.png","assets/T/mri-ea272624a53e4790/axial_042.png","assets/T/mri-ea272624a53e4790/coronal_001.png","assets/T/mri-ea272624a53e4790/coronal_003.png","assets/T/mri-ea272624a53e4790/coronal_005.png","assets/T/mri-ea272624a53e4790/coronal_007.png","assets/T/mri-ea272624a53e4790/coronal_009.png","assets/T/mri-ea272624a53e4790/coronal_011.png","assets/T/mri-ea272624a53e4790/coronal_014.png","assets/T/mri-ea272624a53e4790/coronal_016.png","assets/T/mri-ea272624a53e4790/coronal_018.png","assets/T/mri-ea272624a53e4790/coronal_020.png","assets/T/mri-ea272624a53e4790/coronal_022.png","assets/T/mri-ea272624a53e4790/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-52410c4d23b24b8a","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-52410c4d23b24b8a/axial_001.png","assets/T/mri-52410c4d23b24b8a/axial_003.png","assets/T/mri-52410c4d23b24b8a/axial_005.png","assets/T/mri-52410c4d23b24b8a/axial_008.png","assets/T/mri-52410c4d23b24b8a/axial_010.png","assets/T/mri-52410c4d23b24b8a/axial_012.png","assets/T/mri-52410c4d23b24b8a/axial_014.png","assets/T/mri-52410c4d23b24b8a/axial_016.png","assets/T/mri-52410c4d23b24b8a/axial_019.png","assets/T/mri-52410c4d23b24b8a/axial_021.png","assets/T/mri-52410c4d23b24b8a/axial_023.png","assets/T/mri-52410c4d23b24b8a/axial_025.png","assets/T/mri-52410c4d23b24b8a/axial_027.png","assets/T/mri-52410c4d23b24b8a/axial_030.png","assets/T/mri-52410c4d23b24b8a/axial_032.png","assets/T/mri-52410c4d23b24b8a/axial_034.png","assets/T/mri-52410c4d23b24b8a/axial_036.png","assets/T/mri-52410c4d23b24b8a/axial_038.png","assets/T/mri-52410c4d23b24b8a/axial_041.png","assets/T/mri-52410c4d23b24b8a/axial_043.png","assets/T/mri-52410c4d23b24b8a/axial_045.png","assets/T/mri-52410c4d23b24b8a/coronal_001.png","assets/T/mri-52410c4d23b24b8a/coronal_003.png","assets/T/mri-52410c4d23b24b8a/coronal_006.png","assets/T/mri-52410c4d23b24b8a/coronal_008.png","assets/T/mri-52410c4d23b24b8a/coronal_010.png","assets/T/mri-52410c4d23b24b8a/coronal_012.png","assets/T/mri-52410c4d23b24b8a/coronal_015.png","assets/T/mri-52410c4d23b24b8a/coronal_017.png","assets/T/mri-52410c4d23b24b8a/coronal_019.png","assets/T/mri-52410c4d23b24b8a/coronal_021.png","assets/T/mri-52410c4d23b24b8a/coronal_024.png","assets/T/mri-52410c4d23b24b8a/coronal_026.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":71,"selected_count":33,"source_indices_1based":[1,3,5,8,10,12,14,16,19,21,23,25,27,30,32,34,36,38,41,43,45,46,48,51,53,55,57,60,62,64,66,69,71]}}
+{"id":"L3-T300:mri-fcc9b515f8994f0e","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-fcc9b515f8994f0e/axial_001.png","assets/T/mri-fcc9b515f8994f0e/axial_003.png","assets/T/mri-fcc9b515f8994f0e/axial_005.png","assets/T/mri-fcc9b515f8994f0e/axial_007.png","assets/T/mri-fcc9b515f8994f0e/axial_009.png","assets/T/mri-fcc9b515f8994f0e/axial_011.png","assets/T/mri-fcc9b515f8994f0e/axial_013.png","assets/T/mri-fcc9b515f8994f0e/axial_015.png","assets/T/mri-fcc9b515f8994f0e/axial_017.png","assets/T/mri-fcc9b515f8994f0e/axial_019.png","assets/T/mri-fcc9b515f8994f0e/axial_021.png","assets/T/mri-fcc9b515f8994f0e/axial_022.png","assets/T/mri-fcc9b515f8994f0e/axial_024.png","assets/T/mri-fcc9b515f8994f0e/axial_026.png","assets/T/mri-fcc9b515f8994f0e/axial_028.png","assets/T/mri-fcc9b515f8994f0e/axial_030.png","assets/T/mri-fcc9b515f8994f0e/axial_032.png","assets/T/mri-fcc9b515f8994f0e/axial_034.png","assets/T/mri-fcc9b515f8994f0e/axial_036.png","assets/T/mri-fcc9b515f8994f0e/axial_038.png","assets/T/mri-fcc9b515f8994f0e/axial_040.png","assets/T/mri-fcc9b515f8994f0e/coronal_001.png","assets/T/mri-fcc9b515f8994f0e/coronal_003.png","assets/T/mri-fcc9b515f8994f0e/coronal_005.png","assets/T/mri-fcc9b515f8994f0e/coronal_007.png","assets/T/mri-fcc9b515f8994f0e/coronal_009.png","assets/T/mri-fcc9b515f8994f0e/coronal_011.png","assets/T/mri-fcc9b515f8994f0e/coronal_014.png","assets/T/mri-fcc9b515f8994f0e/coronal_016.png","assets/T/mri-fcc9b515f8994f0e/coronal_018.png","assets/T/mri-fcc9b515f8994f0e/coronal_020.png","assets/T/mri-fcc9b515f8994f0e/coronal_022.png","assets/T/mri-fcc9b515f8994f0e/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-7a7ad2d70dc5430a","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 34 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 14 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-7a7ad2d70dc5430a/axial_001.png","assets/T/mri-7a7ad2d70dc5430a/axial_003.png","assets/T/mri-7a7ad2d70dc5430a/axial_005.png","assets/T/mri-7a7ad2d70dc5430a/axial_007.png","assets/T/mri-7a7ad2d70dc5430a/axial_008.png","assets/T/mri-7a7ad2d70dc5430a/axial_010.png","assets/T/mri-7a7ad2d70dc5430a/axial_012.png","assets/T/mri-7a7ad2d70dc5430a/axial_014.png","assets/T/mri-7a7ad2d70dc5430a/axial_016.png","assets/T/mri-7a7ad2d70dc5430a/axial_018.png","assets/T/mri-7a7ad2d70dc5430a/axial_019.png","assets/T/mri-7a7ad2d70dc5430a/axial_021.png","assets/T/mri-7a7ad2d70dc5430a/axial_023.png","assets/T/mri-7a7ad2d70dc5430a/axial_025.png","assets/T/mri-7a7ad2d70dc5430a/axial_027.png","assets/T/mri-7a7ad2d70dc5430a/axial_029.png","assets/T/mri-7a7ad2d70dc5430a/axial_030.png","assets/T/mri-7a7ad2d70dc5430a/axial_032.png","assets/T/mri-7a7ad2d70dc5430a/axial_034.png","assets/T/mri-7a7ad2d70dc5430a/axial_036.png","assets/T/mri-7a7ad2d70dc5430a/coronal_001.png","assets/T/mri-7a7ad2d70dc5430a/coronal_003.png","assets/T/mri-7a7ad2d70dc5430a/coronal_005.png","assets/T/mri-7a7ad2d70dc5430a/coronal_006.png","assets/T/mri-7a7ad2d70dc5430a/coronal_008.png","assets/T/mri-7a7ad2d70dc5430a/coronal_010.png","assets/T/mri-7a7ad2d70dc5430a/coronal_012.png","assets/T/mri-7a7ad2d70dc5430a/coronal_013.png","assets/T/mri-7a7ad2d70dc5430a/coronal_015.png","assets/T/mri-7a7ad2d70dc5430a/coronal_017.png","assets/T/mri-7a7ad2d70dc5430a/coronal_019.png","assets/T/mri-7a7ad2d70dc5430a/coronal_020.png","assets/T/mri-7a7ad2d70dc5430a/coronal_022.png","assets/T/mri-7a7ad2d70dc5430a/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":60,"selected_count":34,"source_indices_1based":[1,3,5,7,8,10,12,14,16,18,19,21,23,25,27,29,30,32,34,36,37,39,41,42,44,46,48,49,51,53,55,56,58,60]}}
+{"id":"L3-T300:mri-3ea899b4a60449de","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 13 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-3ea899b4a60449de/axial_001.png","assets/T/mri-3ea899b4a60449de/axial_003.png","assets/T/mri-3ea899b4a60449de/axial_006.png","assets/T/mri-3ea899b4a60449de/axial_008.png","assets/T/mri-3ea899b4a60449de/axial_010.png","assets/T/mri-3ea899b4a60449de/axial_012.png","assets/T/mri-3ea899b4a60449de/axial_015.png","assets/T/mri-3ea899b4a60449de/axial_017.png","assets/T/mri-3ea899b4a60449de/axial_019.png","assets/T/mri-3ea899b4a60449de/axial_021.png","assets/T/mri-3ea899b4a60449de/axial_024.png","assets/T/mri-3ea899b4a60449de/axial_026.png","assets/T/mri-3ea899b4a60449de/axial_028.png","assets/T/mri-3ea899b4a60449de/axial_030.png","assets/T/mri-3ea899b4a60449de/axial_033.png","assets/T/mri-3ea899b4a60449de/axial_035.png","assets/T/mri-3ea899b4a60449de/axial_037.png","assets/T/mri-3ea899b4a60449de/axial_039.png","assets/T/mri-3ea899b4a60449de/axial_042.png","assets/T/mri-3ea899b4a60449de/axial_044.png","assets/T/mri-3ea899b4a60449de/coronal_001.png","assets/T/mri-3ea899b4a60449de/coronal_003.png","assets/T/mri-3ea899b4a60449de/coronal_006.png","assets/T/mri-3ea899b4a60449de/coronal_008.png","assets/T/mri-3ea899b4a60449de/coronal_010.png","assets/T/mri-3ea899b4a60449de/coronal_012.png","assets/T/mri-3ea899b4a60449de/coronal_015.png","assets/T/mri-3ea899b4a60449de/coronal_017.png","assets/T/mri-3ea899b4a60449de/coronal_019.png","assets/T/mri-3ea899b4a60449de/coronal_021.png","assets/T/mri-3ea899b4a60449de/coronal_024.png","assets/T/mri-3ea899b4a60449de/coronal_026.png","assets/T/mri-3ea899b4a60449de/coronal_028.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":72,"selected_count":33,"source_indices_1based":[1,3,6,8,10,12,15,17,19,21,24,26,28,30,33,35,37,39,42,44,45,47,50,52,54,56,59,61,63,65,68,70,72]}}
+{"id":"L3-T300:mri-f5e94b609a994f45","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-f5e94b609a994f45/axial_001.png","assets/T/mri-f5e94b609a994f45/axial_003.png","assets/T/mri-f5e94b609a994f45/axial_005.png","assets/T/mri-f5e94b609a994f45/axial_007.png","assets/T/mri-f5e94b609a994f45/axial_010.png","assets/T/mri-f5e94b609a994f45/axial_012.png","assets/T/mri-f5e94b609a994f45/axial_014.png","assets/T/mri-f5e94b609a994f45/axial_016.png","assets/T/mri-f5e94b609a994f45/axial_018.png","assets/T/mri-f5e94b609a994f45/axial_020.png","assets/T/mri-f5e94b609a994f45/axial_023.png","assets/T/mri-f5e94b609a994f45/axial_025.png","assets/T/mri-f5e94b609a994f45/axial_027.png","assets/T/mri-f5e94b609a994f45/axial_029.png","assets/T/mri-f5e94b609a994f45/axial_031.png","assets/T/mri-f5e94b609a994f45/axial_033.png","assets/T/mri-f5e94b609a994f45/axial_035.png","assets/T/mri-f5e94b609a994f45/axial_038.png","assets/T/mri-f5e94b609a994f45/axial_040.png","assets/T/mri-f5e94b609a994f45/axial_042.png","assets/T/mri-f5e94b609a994f45/axial_044.png","assets/T/mri-f5e94b609a994f45/coronal_001.png","assets/T/mri-f5e94b609a994f45/coronal_003.png","assets/T/mri-f5e94b609a994f45/coronal_006.png","assets/T/mri-f5e94b609a994f45/coronal_008.png","assets/T/mri-f5e94b609a994f45/coronal_010.png","assets/T/mri-f5e94b609a994f45/coronal_012.png","assets/T/mri-f5e94b609a994f45/coronal_015.png","assets/T/mri-f5e94b609a994f45/coronal_017.png","assets/T/mri-f5e94b609a994f45/coronal_019.png","assets/T/mri-f5e94b609a994f45/coronal_021.png","assets/T/mri-f5e94b609a994f45/coronal_024.png","assets/T/mri-f5e94b609a994f45/coronal_026.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":70,"selected_count":33,"source_indices_1based":[1,3,5,7,10,12,14,16,18,20,23,25,27,29,31,33,35,38,40,42,44,45,47,50,52,54,56,59,61,63,65,68,70]}}
+{"id":"L3-T300:mri-9ec9fbbfc5a4455a","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-9ec9fbbfc5a4455a/axial_001.png","assets/T/mri-9ec9fbbfc5a4455a/axial_003.png","assets/T/mri-9ec9fbbfc5a4455a/axial_005.png","assets/T/mri-9ec9fbbfc5a4455a/axial_007.png","assets/T/mri-9ec9fbbfc5a4455a/axial_009.png","assets/T/mri-9ec9fbbfc5a4455a/axial_011.png","assets/T/mri-9ec9fbbfc5a4455a/axial_013.png","assets/T/mri-9ec9fbbfc5a4455a/axial_015.png","assets/T/mri-9ec9fbbfc5a4455a/axial_017.png","assets/T/mri-9ec9fbbfc5a4455a/axial_019.png","assets/T/mri-9ec9fbbfc5a4455a/axial_021.png","assets/T/mri-9ec9fbbfc5a4455a/axial_022.png","assets/T/mri-9ec9fbbfc5a4455a/axial_024.png","assets/T/mri-9ec9fbbfc5a4455a/axial_026.png","assets/T/mri-9ec9fbbfc5a4455a/axial_028.png","assets/T/mri-9ec9fbbfc5a4455a/axial_030.png","assets/T/mri-9ec9fbbfc5a4455a/axial_032.png","assets/T/mri-9ec9fbbfc5a4455a/axial_034.png","assets/T/mri-9ec9fbbfc5a4455a/axial_036.png","assets/T/mri-9ec9fbbfc5a4455a/axial_038.png","assets/T/mri-9ec9fbbfc5a4455a/axial_040.png","assets/T/mri-9ec9fbbfc5a4455a/coronal_001.png","assets/T/mri-9ec9fbbfc5a4455a/coronal_003.png","assets/T/mri-9ec9fbbfc5a4455a/coronal_005.png","assets/T/mri-9ec9fbbfc5a4455a/coronal_007.png","assets/T/mri-9ec9fbbfc5a4455a/coronal_009.png","assets/T/mri-9ec9fbbfc5a4455a/coronal_011.png","assets/T/mri-9ec9fbbfc5a4455a/coronal_014.png","assets/T/mri-9ec9fbbfc5a4455a/coronal_016.png","assets/T/mri-9ec9fbbfc5a4455a/coronal_018.png","assets/T/mri-9ec9fbbfc5a4455a/coronal_020.png","assets/T/mri-9ec9fbbfc5a4455a/coronal_022.png","assets/T/mri-9ec9fbbfc5a4455a/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-5d8f67cc09114eee","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-5d8f67cc09114eee/axial_001.png","assets/T/mri-5d8f67cc09114eee/axial_003.png","assets/T/mri-5d8f67cc09114eee/axial_005.png","assets/T/mri-5d8f67cc09114eee/axial_007.png","assets/T/mri-5d8f67cc09114eee/axial_009.png","assets/T/mri-5d8f67cc09114eee/axial_011.png","assets/T/mri-5d8f67cc09114eee/axial_013.png","assets/T/mri-5d8f67cc09114eee/axial_015.png","assets/T/mri-5d8f67cc09114eee/axial_017.png","assets/T/mri-5d8f67cc09114eee/axial_019.png","assets/T/mri-5d8f67cc09114eee/axial_022.png","assets/T/mri-5d8f67cc09114eee/axial_024.png","assets/T/mri-5d8f67cc09114eee/axial_026.png","assets/T/mri-5d8f67cc09114eee/axial_028.png","assets/T/mri-5d8f67cc09114eee/axial_030.png","assets/T/mri-5d8f67cc09114eee/axial_032.png","assets/T/mri-5d8f67cc09114eee/axial_034.png","assets/T/mri-5d8f67cc09114eee/axial_036.png","assets/T/mri-5d8f67cc09114eee/axial_038.png","assets/T/mri-5d8f67cc09114eee/axial_040.png","assets/T/mri-5d8f67cc09114eee/axial_042.png","assets/T/mri-5d8f67cc09114eee/coronal_001.png","assets/T/mri-5d8f67cc09114eee/coronal_003.png","assets/T/mri-5d8f67cc09114eee/coronal_005.png","assets/T/mri-5d8f67cc09114eee/coronal_007.png","assets/T/mri-5d8f67cc09114eee/coronal_009.png","assets/T/mri-5d8f67cc09114eee/coronal_011.png","assets/T/mri-5d8f67cc09114eee/coronal_014.png","assets/T/mri-5d8f67cc09114eee/coronal_016.png","assets/T/mri-5d8f67cc09114eee/coronal_018.png","assets/T/mri-5d8f67cc09114eee/coronal_020.png","assets/T/mri-5d8f67cc09114eee/coronal_022.png","assets/T/mri-5d8f67cc09114eee/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-812aaa7d98de44b8","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-812aaa7d98de44b8/axial_001.png","assets/T/mri-812aaa7d98de44b8/axial_003.png","assets/T/mri-812aaa7d98de44b8/axial_005.png","assets/T/mri-812aaa7d98de44b8/axial_007.png","assets/T/mri-812aaa7d98de44b8/axial_009.png","assets/T/mri-812aaa7d98de44b8/axial_011.png","assets/T/mri-812aaa7d98de44b8/axial_013.png","assets/T/mri-812aaa7d98de44b8/axial_015.png","assets/T/mri-812aaa7d98de44b8/axial_017.png","assets/T/mri-812aaa7d98de44b8/axial_019.png","assets/T/mri-812aaa7d98de44b8/axial_021.png","assets/T/mri-812aaa7d98de44b8/axial_022.png","assets/T/mri-812aaa7d98de44b8/axial_024.png","assets/T/mri-812aaa7d98de44b8/axial_026.png","assets/T/mri-812aaa7d98de44b8/axial_028.png","assets/T/mri-812aaa7d98de44b8/axial_030.png","assets/T/mri-812aaa7d98de44b8/axial_032.png","assets/T/mri-812aaa7d98de44b8/axial_034.png","assets/T/mri-812aaa7d98de44b8/axial_036.png","assets/T/mri-812aaa7d98de44b8/axial_038.png","assets/T/mri-812aaa7d98de44b8/axial_040.png","assets/T/mri-812aaa7d98de44b8/coronal_001.png","assets/T/mri-812aaa7d98de44b8/coronal_003.png","assets/T/mri-812aaa7d98de44b8/coronal_005.png","assets/T/mri-812aaa7d98de44b8/coronal_007.png","assets/T/mri-812aaa7d98de44b8/coronal_009.png","assets/T/mri-812aaa7d98de44b8/coronal_011.png","assets/T/mri-812aaa7d98de44b8/coronal_014.png","assets/T/mri-812aaa7d98de44b8/coronal_016.png","assets/T/mri-812aaa7d98de44b8/coronal_018.png","assets/T/mri-812aaa7d98de44b8/coronal_020.png","assets/T/mri-812aaa7d98de44b8/coronal_022.png","assets/T/mri-812aaa7d98de44b8/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-d711445434a34edd","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-d711445434a34edd/axial_001.png","assets/T/mri-d711445434a34edd/axial_003.png","assets/T/mri-d711445434a34edd/axial_005.png","assets/T/mri-d711445434a34edd/axial_007.png","assets/T/mri-d711445434a34edd/axial_010.png","assets/T/mri-d711445434a34edd/axial_012.png","assets/T/mri-d711445434a34edd/axial_014.png","assets/T/mri-d711445434a34edd/axial_016.png","assets/T/mri-d711445434a34edd/axial_018.png","assets/T/mri-d711445434a34edd/axial_020.png","assets/T/mri-d711445434a34edd/axial_023.png","assets/T/mri-d711445434a34edd/axial_025.png","assets/T/mri-d711445434a34edd/axial_027.png","assets/T/mri-d711445434a34edd/axial_029.png","assets/T/mri-d711445434a34edd/axial_031.png","assets/T/mri-d711445434a34edd/axial_033.png","assets/T/mri-d711445434a34edd/axial_035.png","assets/T/mri-d711445434a34edd/axial_038.png","assets/T/mri-d711445434a34edd/axial_040.png","assets/T/mri-d711445434a34edd/axial_042.png","assets/T/mri-d711445434a34edd/axial_044.png","assets/T/mri-d711445434a34edd/coronal_001.png","assets/T/mri-d711445434a34edd/coronal_003.png","assets/T/mri-d711445434a34edd/coronal_005.png","assets/T/mri-d711445434a34edd/coronal_007.png","assets/T/mri-d711445434a34edd/coronal_009.png","assets/T/mri-d711445434a34edd/coronal_011.png","assets/T/mri-d711445434a34edd/coronal_014.png","assets/T/mri-d711445434a34edd/coronal_016.png","assets/T/mri-d711445434a34edd/coronal_018.png","assets/T/mri-d711445434a34edd/coronal_020.png","assets/T/mri-d711445434a34edd/coronal_022.png","assets/T/mri-d711445434a34edd/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":68,"selected_count":33,"source_indices_1based":[1,3,5,7,10,12,14,16,18,20,23,25,27,29,31,33,35,38,40,42,44,45,47,49,51,53,55,58,60,62,64,66,68]}}
+{"id":"L3-T300:mri-13f68ff6760b49da","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-13f68ff6760b49da/axial_001.png","assets/T/mri-13f68ff6760b49da/axial_003.png","assets/T/mri-13f68ff6760b49da/axial_005.png","assets/T/mri-13f68ff6760b49da/axial_007.png","assets/T/mri-13f68ff6760b49da/axial_009.png","assets/T/mri-13f68ff6760b49da/axial_011.png","assets/T/mri-13f68ff6760b49da/axial_013.png","assets/T/mri-13f68ff6760b49da/axial_015.png","assets/T/mri-13f68ff6760b49da/axial_017.png","assets/T/mri-13f68ff6760b49da/axial_019.png","assets/T/mri-13f68ff6760b49da/axial_022.png","assets/T/mri-13f68ff6760b49da/axial_024.png","assets/T/mri-13f68ff6760b49da/axial_026.png","assets/T/mri-13f68ff6760b49da/axial_028.png","assets/T/mri-13f68ff6760b49da/axial_030.png","assets/T/mri-13f68ff6760b49da/axial_032.png","assets/T/mri-13f68ff6760b49da/axial_034.png","assets/T/mri-13f68ff6760b49da/axial_036.png","assets/T/mri-13f68ff6760b49da/axial_038.png","assets/T/mri-13f68ff6760b49da/axial_040.png","assets/T/mri-13f68ff6760b49da/axial_042.png","assets/T/mri-13f68ff6760b49da/coronal_001.png","assets/T/mri-13f68ff6760b49da/coronal_003.png","assets/T/mri-13f68ff6760b49da/coronal_005.png","assets/T/mri-13f68ff6760b49da/coronal_007.png","assets/T/mri-13f68ff6760b49da/coronal_009.png","assets/T/mri-13f68ff6760b49da/coronal_011.png","assets/T/mri-13f68ff6760b49da/coronal_014.png","assets/T/mri-13f68ff6760b49da/coronal_016.png","assets/T/mri-13f68ff6760b49da/coronal_018.png","assets/T/mri-13f68ff6760b49da/coronal_020.png","assets/T/mri-13f68ff6760b49da/coronal_022.png","assets/T/mri-13f68ff6760b49da/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-48efb702a3a14741","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-48efb702a3a14741/axial_001.png","assets/T/mri-48efb702a3a14741/axial_003.png","assets/T/mri-48efb702a3a14741/axial_005.png","assets/T/mri-48efb702a3a14741/axial_007.png","assets/T/mri-48efb702a3a14741/axial_009.png","assets/T/mri-48efb702a3a14741/axial_011.png","assets/T/mri-48efb702a3a14741/axial_013.png","assets/T/mri-48efb702a3a14741/axial_015.png","assets/T/mri-48efb702a3a14741/axial_017.png","assets/T/mri-48efb702a3a14741/axial_019.png","assets/T/mri-48efb702a3a14741/axial_021.png","assets/T/mri-48efb702a3a14741/axial_022.png","assets/T/mri-48efb702a3a14741/axial_024.png","assets/T/mri-48efb702a3a14741/axial_026.png","assets/T/mri-48efb702a3a14741/axial_028.png","assets/T/mri-48efb702a3a14741/axial_030.png","assets/T/mri-48efb702a3a14741/axial_032.png","assets/T/mri-48efb702a3a14741/axial_034.png","assets/T/mri-48efb702a3a14741/axial_036.png","assets/T/mri-48efb702a3a14741/axial_038.png","assets/T/mri-48efb702a3a14741/axial_040.png","assets/T/mri-48efb702a3a14741/coronal_001.png","assets/T/mri-48efb702a3a14741/coronal_003.png","assets/T/mri-48efb702a3a14741/coronal_005.png","assets/T/mri-48efb702a3a14741/coronal_007.png","assets/T/mri-48efb702a3a14741/coronal_009.png","assets/T/mri-48efb702a3a14741/coronal_011.png","assets/T/mri-48efb702a3a14741/coronal_014.png","assets/T/mri-48efb702a3a14741/coronal_016.png","assets/T/mri-48efb702a3a14741/coronal_018.png","assets/T/mri-48efb702a3a14741/coronal_020.png","assets/T/mri-48efb702a3a14741/coronal_022.png","assets/T/mri-48efb702a3a14741/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-2036815a13894335","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-2036815a13894335/axial_001.png","assets/T/mri-2036815a13894335/axial_003.png","assets/T/mri-2036815a13894335/axial_005.png","assets/T/mri-2036815a13894335/axial_007.png","assets/T/mri-2036815a13894335/axial_009.png","assets/T/mri-2036815a13894335/axial_012.png","assets/T/mri-2036815a13894335/axial_014.png","assets/T/mri-2036815a13894335/axial_016.png","assets/T/mri-2036815a13894335/axial_018.png","assets/T/mri-2036815a13894335/axial_020.png","assets/T/mri-2036815a13894335/axial_022.png","assets/T/mri-2036815a13894335/axial_024.png","assets/T/mri-2036815a13894335/axial_026.png","assets/T/mri-2036815a13894335/axial_028.png","assets/T/mri-2036815a13894335/axial_030.png","assets/T/mri-2036815a13894335/axial_033.png","assets/T/mri-2036815a13894335/axial_035.png","assets/T/mri-2036815a13894335/axial_037.png","assets/T/mri-2036815a13894335/axial_039.png","assets/T/mri-2036815a13894335/axial_041.png","assets/T/mri-2036815a13894335/axial_043.png","assets/T/mri-2036815a13894335/coronal_001.png","assets/T/mri-2036815a13894335/coronal_003.png","assets/T/mri-2036815a13894335/coronal_005.png","assets/T/mri-2036815a13894335/coronal_007.png","assets/T/mri-2036815a13894335/coronal_009.png","assets/T/mri-2036815a13894335/coronal_011.png","assets/T/mri-2036815a13894335/coronal_014.png","assets/T/mri-2036815a13894335/coronal_016.png","assets/T/mri-2036815a13894335/coronal_018.png","assets/T/mri-2036815a13894335/coronal_020.png","assets/T/mri-2036815a13894335/coronal_022.png","assets/T/mri-2036815a13894335/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":67,"selected_count":33,"source_indices_1based":[1,3,5,7,9,12,14,16,18,20,22,24,26,28,30,33,35,37,39,41,43,44,46,48,50,52,54,57,59,61,63,65,67]}}
+{"id":"L3-T300:mri-b6a2446b183c424d","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 34 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 14 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-b6a2446b183c424d/axial_001.png","assets/T/mri-b6a2446b183c424d/axial_003.png","assets/T/mri-b6a2446b183c424d/axial_005.png","assets/T/mri-b6a2446b183c424d/axial_007.png","assets/T/mri-b6a2446b183c424d/axial_008.png","assets/T/mri-b6a2446b183c424d/axial_010.png","assets/T/mri-b6a2446b183c424d/axial_012.png","assets/T/mri-b6a2446b183c424d/axial_014.png","assets/T/mri-b6a2446b183c424d/axial_016.png","assets/T/mri-b6a2446b183c424d/axial_018.png","assets/T/mri-b6a2446b183c424d/axial_019.png","assets/T/mri-b6a2446b183c424d/axial_021.png","assets/T/mri-b6a2446b183c424d/axial_023.png","assets/T/mri-b6a2446b183c424d/axial_025.png","assets/T/mri-b6a2446b183c424d/axial_027.png","assets/T/mri-b6a2446b183c424d/axial_029.png","assets/T/mri-b6a2446b183c424d/axial_030.png","assets/T/mri-b6a2446b183c424d/axial_032.png","assets/T/mri-b6a2446b183c424d/axial_034.png","assets/T/mri-b6a2446b183c424d/axial_036.png","assets/T/mri-b6a2446b183c424d/coronal_001.png","assets/T/mri-b6a2446b183c424d/coronal_003.png","assets/T/mri-b6a2446b183c424d/coronal_005.png","assets/T/mri-b6a2446b183c424d/coronal_006.png","assets/T/mri-b6a2446b183c424d/coronal_008.png","assets/T/mri-b6a2446b183c424d/coronal_010.png","assets/T/mri-b6a2446b183c424d/coronal_012.png","assets/T/mri-b6a2446b183c424d/coronal_013.png","assets/T/mri-b6a2446b183c424d/coronal_015.png","assets/T/mri-b6a2446b183c424d/coronal_017.png","assets/T/mri-b6a2446b183c424d/coronal_019.png","assets/T/mri-b6a2446b183c424d/coronal_020.png","assets/T/mri-b6a2446b183c424d/coronal_022.png","assets/T/mri-b6a2446b183c424d/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":60,"selected_count":34,"source_indices_1based":[1,3,5,7,8,10,12,14,16,18,19,21,23,25,27,29,30,32,34,36,37,39,41,42,44,46,48,49,51,53,55,56,58,60]}}
+{"id":"L3-T300:mri-38731096d9a3413d","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 34 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 14 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-38731096d9a3413d/axial_001.png","assets/T/mri-38731096d9a3413d/axial_003.png","assets/T/mri-38731096d9a3413d/axial_005.png","assets/T/mri-38731096d9a3413d/axial_007.png","assets/T/mri-38731096d9a3413d/axial_010.png","assets/T/mri-38731096d9a3413d/axial_012.png","assets/T/mri-38731096d9a3413d/axial_014.png","assets/T/mri-38731096d9a3413d/axial_016.png","assets/T/mri-38731096d9a3413d/axial_018.png","assets/T/mri-38731096d9a3413d/axial_020.png","assets/T/mri-38731096d9a3413d/axial_023.png","assets/T/mri-38731096d9a3413d/axial_025.png","assets/T/mri-38731096d9a3413d/axial_027.png","assets/T/mri-38731096d9a3413d/axial_029.png","assets/T/mri-38731096d9a3413d/axial_031.png","assets/T/mri-38731096d9a3413d/axial_033.png","assets/T/mri-38731096d9a3413d/axial_036.png","assets/T/mri-38731096d9a3413d/axial_038.png","assets/T/mri-38731096d9a3413d/axial_040.png","assets/T/mri-38731096d9a3413d/axial_042.png","assets/T/mri-38731096d9a3413d/coronal_001.png","assets/T/mri-38731096d9a3413d/coronal_003.png","assets/T/mri-38731096d9a3413d/coronal_005.png","assets/T/mri-38731096d9a3413d/coronal_007.png","assets/T/mri-38731096d9a3413d/coronal_009.png","assets/T/mri-38731096d9a3413d/coronal_011.png","assets/T/mri-38731096d9a3413d/coronal_013.png","assets/T/mri-38731096d9a3413d/coronal_016.png","assets/T/mri-38731096d9a3413d/coronal_018.png","assets/T/mri-38731096d9a3413d/coronal_020.png","assets/T/mri-38731096d9a3413d/coronal_022.png","assets/T/mri-38731096d9a3413d/coronal_024.png","assets/T/mri-38731096d9a3413d/coronal_026.png","assets/T/mri-38731096d9a3413d/coronal_028.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":70,"selected_count":34,"source_indices_1based":[1,3,5,7,10,12,14,16,18,20,23,25,27,29,31,33,36,38,40,42,43,45,47,49,51,53,55,58,60,62,64,66,68,70]}}
+{"id":"L3-T300:mri-21c6274f45f64906","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-21c6274f45f64906/axial_001.png","assets/T/mri-21c6274f45f64906/axial_003.png","assets/T/mri-21c6274f45f64906/axial_005.png","assets/T/mri-21c6274f45f64906/axial_007.png","assets/T/mri-21c6274f45f64906/axial_009.png","assets/T/mri-21c6274f45f64906/axial_011.png","assets/T/mri-21c6274f45f64906/axial_013.png","assets/T/mri-21c6274f45f64906/axial_015.png","assets/T/mri-21c6274f45f64906/axial_017.png","assets/T/mri-21c6274f45f64906/axial_019.png","assets/T/mri-21c6274f45f64906/axial_022.png","assets/T/mri-21c6274f45f64906/axial_024.png","assets/T/mri-21c6274f45f64906/axial_026.png","assets/T/mri-21c6274f45f64906/axial_028.png","assets/T/mri-21c6274f45f64906/axial_030.png","assets/T/mri-21c6274f45f64906/axial_032.png","assets/T/mri-21c6274f45f64906/axial_034.png","assets/T/mri-21c6274f45f64906/axial_036.png","assets/T/mri-21c6274f45f64906/axial_038.png","assets/T/mri-21c6274f45f64906/axial_040.png","assets/T/mri-21c6274f45f64906/axial_042.png","assets/T/mri-21c6274f45f64906/coronal_001.png","assets/T/mri-21c6274f45f64906/coronal_003.png","assets/T/mri-21c6274f45f64906/coronal_005.png","assets/T/mri-21c6274f45f64906/coronal_007.png","assets/T/mri-21c6274f45f64906/coronal_009.png","assets/T/mri-21c6274f45f64906/coronal_011.png","assets/T/mri-21c6274f45f64906/coronal_014.png","assets/T/mri-21c6274f45f64906/coronal_016.png","assets/T/mri-21c6274f45f64906/coronal_018.png","assets/T/mri-21c6274f45f64906/coronal_020.png","assets/T/mri-21c6274f45f64906/coronal_022.png","assets/T/mri-21c6274f45f64906/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-60382ae47d2949ad","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-60382ae47d2949ad/axial_001.png","assets/T/mri-60382ae47d2949ad/axial_003.png","assets/T/mri-60382ae47d2949ad/axial_005.png","assets/T/mri-60382ae47d2949ad/axial_007.png","assets/T/mri-60382ae47d2949ad/axial_009.png","assets/T/mri-60382ae47d2949ad/axial_011.png","assets/T/mri-60382ae47d2949ad/axial_013.png","assets/T/mri-60382ae47d2949ad/axial_015.png","assets/T/mri-60382ae47d2949ad/axial_017.png","assets/T/mri-60382ae47d2949ad/axial_019.png","assets/T/mri-60382ae47d2949ad/axial_021.png","assets/T/mri-60382ae47d2949ad/axial_022.png","assets/T/mri-60382ae47d2949ad/axial_024.png","assets/T/mri-60382ae47d2949ad/axial_026.png","assets/T/mri-60382ae47d2949ad/axial_028.png","assets/T/mri-60382ae47d2949ad/axial_030.png","assets/T/mri-60382ae47d2949ad/axial_032.png","assets/T/mri-60382ae47d2949ad/axial_034.png","assets/T/mri-60382ae47d2949ad/axial_036.png","assets/T/mri-60382ae47d2949ad/axial_038.png","assets/T/mri-60382ae47d2949ad/axial_040.png","assets/T/mri-60382ae47d2949ad/coronal_001.png","assets/T/mri-60382ae47d2949ad/coronal_003.png","assets/T/mri-60382ae47d2949ad/coronal_005.png","assets/T/mri-60382ae47d2949ad/coronal_007.png","assets/T/mri-60382ae47d2949ad/coronal_009.png","assets/T/mri-60382ae47d2949ad/coronal_011.png","assets/T/mri-60382ae47d2949ad/coronal_014.png","assets/T/mri-60382ae47d2949ad/coronal_016.png","assets/T/mri-60382ae47d2949ad/coronal_018.png","assets/T/mri-60382ae47d2949ad/coronal_020.png","assets/T/mri-60382ae47d2949ad/coronal_022.png","assets/T/mri-60382ae47d2949ad/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-076b103275994f82","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-076b103275994f82/axial_001.png","assets/T/mri-076b103275994f82/axial_003.png","assets/T/mri-076b103275994f82/axial_005.png","assets/T/mri-076b103275994f82/axial_007.png","assets/T/mri-076b103275994f82/axial_009.png","assets/T/mri-076b103275994f82/axial_011.png","assets/T/mri-076b103275994f82/axial_013.png","assets/T/mri-076b103275994f82/axial_015.png","assets/T/mri-076b103275994f82/axial_017.png","assets/T/mri-076b103275994f82/axial_019.png","assets/T/mri-076b103275994f82/axial_021.png","assets/T/mri-076b103275994f82/axial_022.png","assets/T/mri-076b103275994f82/axial_024.png","assets/T/mri-076b103275994f82/axial_026.png","assets/T/mri-076b103275994f82/axial_028.png","assets/T/mri-076b103275994f82/axial_030.png","assets/T/mri-076b103275994f82/axial_032.png","assets/T/mri-076b103275994f82/axial_034.png","assets/T/mri-076b103275994f82/axial_036.png","assets/T/mri-076b103275994f82/axial_038.png","assets/T/mri-076b103275994f82/axial_040.png","assets/T/mri-076b103275994f82/coronal_001.png","assets/T/mri-076b103275994f82/coronal_003.png","assets/T/mri-076b103275994f82/coronal_005.png","assets/T/mri-076b103275994f82/coronal_007.png","assets/T/mri-076b103275994f82/coronal_009.png","assets/T/mri-076b103275994f82/coronal_011.png","assets/T/mri-076b103275994f82/coronal_014.png","assets/T/mri-076b103275994f82/coronal_016.png","assets/T/mri-076b103275994f82/coronal_018.png","assets/T/mri-076b103275994f82/coronal_020.png","assets/T/mri-076b103275994f82/coronal_022.png","assets/T/mri-076b103275994f82/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-bc9d4d6445624b29","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 34 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 14 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-bc9d4d6445624b29/axial_001.png","assets/T/mri-bc9d4d6445624b29/axial_003.png","assets/T/mri-bc9d4d6445624b29/axial_005.png","assets/T/mri-bc9d4d6445624b29/axial_007.png","assets/T/mri-bc9d4d6445624b29/axial_008.png","assets/T/mri-bc9d4d6445624b29/axial_010.png","assets/T/mri-bc9d4d6445624b29/axial_012.png","assets/T/mri-bc9d4d6445624b29/axial_014.png","assets/T/mri-bc9d4d6445624b29/axial_016.png","assets/T/mri-bc9d4d6445624b29/axial_018.png","assets/T/mri-bc9d4d6445624b29/axial_019.png","assets/T/mri-bc9d4d6445624b29/axial_021.png","assets/T/mri-bc9d4d6445624b29/axial_023.png","assets/T/mri-bc9d4d6445624b29/axial_025.png","assets/T/mri-bc9d4d6445624b29/axial_027.png","assets/T/mri-bc9d4d6445624b29/axial_029.png","assets/T/mri-bc9d4d6445624b29/axial_030.png","assets/T/mri-bc9d4d6445624b29/axial_032.png","assets/T/mri-bc9d4d6445624b29/axial_034.png","assets/T/mri-bc9d4d6445624b29/axial_036.png","assets/T/mri-bc9d4d6445624b29/coronal_001.png","assets/T/mri-bc9d4d6445624b29/coronal_003.png","assets/T/mri-bc9d4d6445624b29/coronal_005.png","assets/T/mri-bc9d4d6445624b29/coronal_006.png","assets/T/mri-bc9d4d6445624b29/coronal_008.png","assets/T/mri-bc9d4d6445624b29/coronal_010.png","assets/T/mri-bc9d4d6445624b29/coronal_012.png","assets/T/mri-bc9d4d6445624b29/coronal_013.png","assets/T/mri-bc9d4d6445624b29/coronal_015.png","assets/T/mri-bc9d4d6445624b29/coronal_017.png","assets/T/mri-bc9d4d6445624b29/coronal_019.png","assets/T/mri-bc9d4d6445624b29/coronal_020.png","assets/T/mri-bc9d4d6445624b29/coronal_022.png","assets/T/mri-bc9d4d6445624b29/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":60,"selected_count":34,"source_indices_1based":[1,3,5,7,8,10,12,14,16,18,19,21,23,25,27,29,30,32,34,36,37,39,41,42,44,46,48,49,51,53,55,56,58,60]}}
+{"id":"L3-T300:mri-b0afe5791e844b85","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-b0afe5791e844b85/axial_001.png","assets/T/mri-b0afe5791e844b85/axial_003.png","assets/T/mri-b0afe5791e844b85/axial_005.png","assets/T/mri-b0afe5791e844b85/axial_007.png","assets/T/mri-b0afe5791e844b85/axial_009.png","assets/T/mri-b0afe5791e844b85/axial_011.png","assets/T/mri-b0afe5791e844b85/axial_013.png","assets/T/mri-b0afe5791e844b85/axial_015.png","assets/T/mri-b0afe5791e844b85/axial_017.png","assets/T/mri-b0afe5791e844b85/axial_019.png","assets/T/mri-b0afe5791e844b85/axial_022.png","assets/T/mri-b0afe5791e844b85/axial_024.png","assets/T/mri-b0afe5791e844b85/axial_026.png","assets/T/mri-b0afe5791e844b85/axial_028.png","assets/T/mri-b0afe5791e844b85/axial_030.png","assets/T/mri-b0afe5791e844b85/axial_032.png","assets/T/mri-b0afe5791e844b85/axial_034.png","assets/T/mri-b0afe5791e844b85/axial_036.png","assets/T/mri-b0afe5791e844b85/axial_038.png","assets/T/mri-b0afe5791e844b85/axial_040.png","assets/T/mri-b0afe5791e844b85/axial_042.png","assets/T/mri-b0afe5791e844b85/coronal_001.png","assets/T/mri-b0afe5791e844b85/coronal_003.png","assets/T/mri-b0afe5791e844b85/coronal_005.png","assets/T/mri-b0afe5791e844b85/coronal_007.png","assets/T/mri-b0afe5791e844b85/coronal_009.png","assets/T/mri-b0afe5791e844b85/coronal_011.png","assets/T/mri-b0afe5791e844b85/coronal_014.png","assets/T/mri-b0afe5791e844b85/coronal_016.png","assets/T/mri-b0afe5791e844b85/coronal_018.png","assets/T/mri-b0afe5791e844b85/coronal_020.png","assets/T/mri-b0afe5791e844b85/coronal_022.png","assets/T/mri-b0afe5791e844b85/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-b437689d0567403e","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-b437689d0567403e/axial_001.png","assets/T/mri-b437689d0567403e/axial_003.png","assets/T/mri-b437689d0567403e/axial_005.png","assets/T/mri-b437689d0567403e/axial_007.png","assets/T/mri-b437689d0567403e/axial_009.png","assets/T/mri-b437689d0567403e/axial_011.png","assets/T/mri-b437689d0567403e/axial_013.png","assets/T/mri-b437689d0567403e/axial_015.png","assets/T/mri-b437689d0567403e/axial_017.png","assets/T/mri-b437689d0567403e/axial_019.png","assets/T/mri-b437689d0567403e/axial_022.png","assets/T/mri-b437689d0567403e/axial_024.png","assets/T/mri-b437689d0567403e/axial_026.png","assets/T/mri-b437689d0567403e/axial_028.png","assets/T/mri-b437689d0567403e/axial_030.png","assets/T/mri-b437689d0567403e/axial_032.png","assets/T/mri-b437689d0567403e/axial_034.png","assets/T/mri-b437689d0567403e/axial_036.png","assets/T/mri-b437689d0567403e/axial_038.png","assets/T/mri-b437689d0567403e/axial_040.png","assets/T/mri-b437689d0567403e/axial_042.png","assets/T/mri-b437689d0567403e/coronal_001.png","assets/T/mri-b437689d0567403e/coronal_003.png","assets/T/mri-b437689d0567403e/coronal_005.png","assets/T/mri-b437689d0567403e/coronal_007.png","assets/T/mri-b437689d0567403e/coronal_009.png","assets/T/mri-b437689d0567403e/coronal_011.png","assets/T/mri-b437689d0567403e/coronal_014.png","assets/T/mri-b437689d0567403e/coronal_016.png","assets/T/mri-b437689d0567403e/coronal_018.png","assets/T/mri-b437689d0567403e/coronal_020.png","assets/T/mri-b437689d0567403e/coronal_022.png","assets/T/mri-b437689d0567403e/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-de245813d9f84619","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-de245813d9f84619/axial_001.png","assets/T/mri-de245813d9f84619/axial_003.png","assets/T/mri-de245813d9f84619/axial_005.png","assets/T/mri-de245813d9f84619/axial_007.png","assets/T/mri-de245813d9f84619/axial_009.png","assets/T/mri-de245813d9f84619/axial_011.png","assets/T/mri-de245813d9f84619/axial_013.png","assets/T/mri-de245813d9f84619/axial_015.png","assets/T/mri-de245813d9f84619/axial_017.png","assets/T/mri-de245813d9f84619/axial_019.png","assets/T/mri-de245813d9f84619/axial_021.png","assets/T/mri-de245813d9f84619/axial_022.png","assets/T/mri-de245813d9f84619/axial_024.png","assets/T/mri-de245813d9f84619/axial_026.png","assets/T/mri-de245813d9f84619/axial_028.png","assets/T/mri-de245813d9f84619/axial_030.png","assets/T/mri-de245813d9f84619/axial_032.png","assets/T/mri-de245813d9f84619/axial_034.png","assets/T/mri-de245813d9f84619/axial_036.png","assets/T/mri-de245813d9f84619/axial_038.png","assets/T/mri-de245813d9f84619/axial_040.png","assets/T/mri-de245813d9f84619/coronal_001.png","assets/T/mri-de245813d9f84619/coronal_003.png","assets/T/mri-de245813d9f84619/coronal_005.png","assets/T/mri-de245813d9f84619/coronal_007.png","assets/T/mri-de245813d9f84619/coronal_009.png","assets/T/mri-de245813d9f84619/coronal_011.png","assets/T/mri-de245813d9f84619/coronal_014.png","assets/T/mri-de245813d9f84619/coronal_016.png","assets/T/mri-de245813d9f84619/coronal_018.png","assets/T/mri-de245813d9f84619/coronal_020.png","assets/T/mri-de245813d9f84619/coronal_022.png","assets/T/mri-de245813d9f84619/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-112255f79d7b4cec","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-112255f79d7b4cec/axial_001.png","assets/T/mri-112255f79d7b4cec/axial_003.png","assets/T/mri-112255f79d7b4cec/axial_005.png","assets/T/mri-112255f79d7b4cec/axial_007.png","assets/T/mri-112255f79d7b4cec/axial_009.png","assets/T/mri-112255f79d7b4cec/axial_011.png","assets/T/mri-112255f79d7b4cec/axial_013.png","assets/T/mri-112255f79d7b4cec/axial_015.png","assets/T/mri-112255f79d7b4cec/axial_017.png","assets/T/mri-112255f79d7b4cec/axial_019.png","assets/T/mri-112255f79d7b4cec/axial_021.png","assets/T/mri-112255f79d7b4cec/axial_022.png","assets/T/mri-112255f79d7b4cec/axial_024.png","assets/T/mri-112255f79d7b4cec/axial_026.png","assets/T/mri-112255f79d7b4cec/axial_028.png","assets/T/mri-112255f79d7b4cec/axial_030.png","assets/T/mri-112255f79d7b4cec/axial_032.png","assets/T/mri-112255f79d7b4cec/axial_034.png","assets/T/mri-112255f79d7b4cec/axial_036.png","assets/T/mri-112255f79d7b4cec/axial_038.png","assets/T/mri-112255f79d7b4cec/axial_040.png","assets/T/mri-112255f79d7b4cec/coronal_001.png","assets/T/mri-112255f79d7b4cec/coronal_003.png","assets/T/mri-112255f79d7b4cec/coronal_005.png","assets/T/mri-112255f79d7b4cec/coronal_007.png","assets/T/mri-112255f79d7b4cec/coronal_009.png","assets/T/mri-112255f79d7b4cec/coronal_011.png","assets/T/mri-112255f79d7b4cec/coronal_014.png","assets/T/mri-112255f79d7b4cec/coronal_016.png","assets/T/mri-112255f79d7b4cec/coronal_018.png","assets/T/mri-112255f79d7b4cec/coronal_020.png","assets/T/mri-112255f79d7b4cec/coronal_022.png","assets/T/mri-112255f79d7b4cec/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-e9d0d067dff1443e","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-e9d0d067dff1443e/axial_001.png","assets/T/mri-e9d0d067dff1443e/axial_003.png","assets/T/mri-e9d0d067dff1443e/axial_005.png","assets/T/mri-e9d0d067dff1443e/axial_007.png","assets/T/mri-e9d0d067dff1443e/axial_009.png","assets/T/mri-e9d0d067dff1443e/axial_011.png","assets/T/mri-e9d0d067dff1443e/axial_013.png","assets/T/mri-e9d0d067dff1443e/axial_015.png","assets/T/mri-e9d0d067dff1443e/axial_017.png","assets/T/mri-e9d0d067dff1443e/axial_019.png","assets/T/mri-e9d0d067dff1443e/axial_022.png","assets/T/mri-e9d0d067dff1443e/axial_024.png","assets/T/mri-e9d0d067dff1443e/axial_026.png","assets/T/mri-e9d0d067dff1443e/axial_028.png","assets/T/mri-e9d0d067dff1443e/axial_030.png","assets/T/mri-e9d0d067dff1443e/axial_032.png","assets/T/mri-e9d0d067dff1443e/axial_034.png","assets/T/mri-e9d0d067dff1443e/axial_036.png","assets/T/mri-e9d0d067dff1443e/axial_038.png","assets/T/mri-e9d0d067dff1443e/axial_040.png","assets/T/mri-e9d0d067dff1443e/axial_042.png","assets/T/mri-e9d0d067dff1443e/coronal_001.png","assets/T/mri-e9d0d067dff1443e/coronal_003.png","assets/T/mri-e9d0d067dff1443e/coronal_005.png","assets/T/mri-e9d0d067dff1443e/coronal_007.png","assets/T/mri-e9d0d067dff1443e/coronal_009.png","assets/T/mri-e9d0d067dff1443e/coronal_011.png","assets/T/mri-e9d0d067dff1443e/coronal_014.png","assets/T/mri-e9d0d067dff1443e/coronal_016.png","assets/T/mri-e9d0d067dff1443e/coronal_018.png","assets/T/mri-e9d0d067dff1443e/coronal_020.png","assets/T/mri-e9d0d067dff1443e/coronal_022.png","assets/T/mri-e9d0d067dff1443e/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-92996c65c0034e2b","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-92996c65c0034e2b/axial_001.png","assets/T/mri-92996c65c0034e2b/axial_003.png","assets/T/mri-92996c65c0034e2b/axial_005.png","assets/T/mri-92996c65c0034e2b/axial_007.png","assets/T/mri-92996c65c0034e2b/axial_009.png","assets/T/mri-92996c65c0034e2b/axial_011.png","assets/T/mri-92996c65c0034e2b/axial_013.png","assets/T/mri-92996c65c0034e2b/axial_015.png","assets/T/mri-92996c65c0034e2b/axial_017.png","assets/T/mri-92996c65c0034e2b/axial_019.png","assets/T/mri-92996c65c0034e2b/axial_022.png","assets/T/mri-92996c65c0034e2b/axial_024.png","assets/T/mri-92996c65c0034e2b/axial_026.png","assets/T/mri-92996c65c0034e2b/axial_028.png","assets/T/mri-92996c65c0034e2b/axial_030.png","assets/T/mri-92996c65c0034e2b/axial_032.png","assets/T/mri-92996c65c0034e2b/axial_034.png","assets/T/mri-92996c65c0034e2b/axial_036.png","assets/T/mri-92996c65c0034e2b/axial_038.png","assets/T/mri-92996c65c0034e2b/axial_040.png","assets/T/mri-92996c65c0034e2b/axial_042.png","assets/T/mri-92996c65c0034e2b/coronal_001.png","assets/T/mri-92996c65c0034e2b/coronal_003.png","assets/T/mri-92996c65c0034e2b/coronal_005.png","assets/T/mri-92996c65c0034e2b/coronal_007.png","assets/T/mri-92996c65c0034e2b/coronal_009.png","assets/T/mri-92996c65c0034e2b/coronal_011.png","assets/T/mri-92996c65c0034e2b/coronal_014.png","assets/T/mri-92996c65c0034e2b/coronal_016.png","assets/T/mri-92996c65c0034e2b/coronal_018.png","assets/T/mri-92996c65c0034e2b/coronal_020.png","assets/T/mri-92996c65c0034e2b/coronal_022.png","assets/T/mri-92996c65c0034e2b/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-cd8283ba429a4f34","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-cd8283ba429a4f34/axial_001.png","assets/T/mri-cd8283ba429a4f34/axial_003.png","assets/T/mri-cd8283ba429a4f34/axial_005.png","assets/T/mri-cd8283ba429a4f34/axial_007.png","assets/T/mri-cd8283ba429a4f34/axial_009.png","assets/T/mri-cd8283ba429a4f34/axial_011.png","assets/T/mri-cd8283ba429a4f34/axial_013.png","assets/T/mri-cd8283ba429a4f34/axial_015.png","assets/T/mri-cd8283ba429a4f34/axial_017.png","assets/T/mri-cd8283ba429a4f34/axial_019.png","assets/T/mri-cd8283ba429a4f34/axial_022.png","assets/T/mri-cd8283ba429a4f34/axial_024.png","assets/T/mri-cd8283ba429a4f34/axial_026.png","assets/T/mri-cd8283ba429a4f34/axial_028.png","assets/T/mri-cd8283ba429a4f34/axial_030.png","assets/T/mri-cd8283ba429a4f34/axial_032.png","assets/T/mri-cd8283ba429a4f34/axial_034.png","assets/T/mri-cd8283ba429a4f34/axial_036.png","assets/T/mri-cd8283ba429a4f34/axial_038.png","assets/T/mri-cd8283ba429a4f34/axial_040.png","assets/T/mri-cd8283ba429a4f34/axial_042.png","assets/T/mri-cd8283ba429a4f34/coronal_001.png","assets/T/mri-cd8283ba429a4f34/coronal_003.png","assets/T/mri-cd8283ba429a4f34/coronal_005.png","assets/T/mri-cd8283ba429a4f34/coronal_007.png","assets/T/mri-cd8283ba429a4f34/coronal_009.png","assets/T/mri-cd8283ba429a4f34/coronal_011.png","assets/T/mri-cd8283ba429a4f34/coronal_014.png","assets/T/mri-cd8283ba429a4f34/coronal_016.png","assets/T/mri-cd8283ba429a4f34/coronal_018.png","assets/T/mri-cd8283ba429a4f34/coronal_020.png","assets/T/mri-cd8283ba429a4f34/coronal_022.png","assets/T/mri-cd8283ba429a4f34/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-0ca285ccae614db6","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-0ca285ccae614db6/axial_001.png","assets/T/mri-0ca285ccae614db6/axial_003.png","assets/T/mri-0ca285ccae614db6/axial_005.png","assets/T/mri-0ca285ccae614db6/axial_007.png","assets/T/mri-0ca285ccae614db6/axial_009.png","assets/T/mri-0ca285ccae614db6/axial_011.png","assets/T/mri-0ca285ccae614db6/axial_013.png","assets/T/mri-0ca285ccae614db6/axial_015.png","assets/T/mri-0ca285ccae614db6/axial_017.png","assets/T/mri-0ca285ccae614db6/axial_019.png","assets/T/mri-0ca285ccae614db6/axial_022.png","assets/T/mri-0ca285ccae614db6/axial_024.png","assets/T/mri-0ca285ccae614db6/axial_026.png","assets/T/mri-0ca285ccae614db6/axial_028.png","assets/T/mri-0ca285ccae614db6/axial_030.png","assets/T/mri-0ca285ccae614db6/axial_032.png","assets/T/mri-0ca285ccae614db6/axial_034.png","assets/T/mri-0ca285ccae614db6/axial_036.png","assets/T/mri-0ca285ccae614db6/axial_038.png","assets/T/mri-0ca285ccae614db6/axial_040.png","assets/T/mri-0ca285ccae614db6/axial_042.png","assets/T/mri-0ca285ccae614db6/coronal_001.png","assets/T/mri-0ca285ccae614db6/coronal_003.png","assets/T/mri-0ca285ccae614db6/coronal_005.png","assets/T/mri-0ca285ccae614db6/coronal_007.png","assets/T/mri-0ca285ccae614db6/coronal_009.png","assets/T/mri-0ca285ccae614db6/coronal_011.png","assets/T/mri-0ca285ccae614db6/coronal_014.png","assets/T/mri-0ca285ccae614db6/coronal_016.png","assets/T/mri-0ca285ccae614db6/coronal_018.png","assets/T/mri-0ca285ccae614db6/coronal_020.png","assets/T/mri-0ca285ccae614db6/coronal_022.png","assets/T/mri-0ca285ccae614db6/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-8e2393c214054928","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-8e2393c214054928/axial_001.png","assets/T/mri-8e2393c214054928/axial_003.png","assets/T/mri-8e2393c214054928/axial_005.png","assets/T/mri-8e2393c214054928/axial_007.png","assets/T/mri-8e2393c214054928/axial_010.png","assets/T/mri-8e2393c214054928/axial_012.png","assets/T/mri-8e2393c214054928/axial_014.png","assets/T/mri-8e2393c214054928/axial_016.png","assets/T/mri-8e2393c214054928/axial_018.png","assets/T/mri-8e2393c214054928/axial_020.png","assets/T/mri-8e2393c214054928/axial_023.png","assets/T/mri-8e2393c214054928/axial_025.png","assets/T/mri-8e2393c214054928/axial_027.png","assets/T/mri-8e2393c214054928/axial_029.png","assets/T/mri-8e2393c214054928/axial_031.png","assets/T/mri-8e2393c214054928/axial_033.png","assets/T/mri-8e2393c214054928/axial_035.png","assets/T/mri-8e2393c214054928/axial_038.png","assets/T/mri-8e2393c214054928/axial_040.png","assets/T/mri-8e2393c214054928/axial_042.png","assets/T/mri-8e2393c214054928/axial_044.png","assets/T/mri-8e2393c214054928/coronal_001.png","assets/T/mri-8e2393c214054928/coronal_003.png","assets/T/mri-8e2393c214054928/coronal_005.png","assets/T/mri-8e2393c214054928/coronal_007.png","assets/T/mri-8e2393c214054928/coronal_009.png","assets/T/mri-8e2393c214054928/coronal_011.png","assets/T/mri-8e2393c214054928/coronal_014.png","assets/T/mri-8e2393c214054928/coronal_016.png","assets/T/mri-8e2393c214054928/coronal_018.png","assets/T/mri-8e2393c214054928/coronal_020.png","assets/T/mri-8e2393c214054928/coronal_022.png","assets/T/mri-8e2393c214054928/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":68,"selected_count":33,"source_indices_1based":[1,3,5,7,10,12,14,16,18,20,23,25,27,29,31,33,35,38,40,42,44,45,47,49,51,53,55,58,60,62,64,66,68]}}
+{"id":"L3-T300:mri-964cc314fdba4813","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-964cc314fdba4813/axial_001.png","assets/T/mri-964cc314fdba4813/axial_003.png","assets/T/mri-964cc314fdba4813/axial_005.png","assets/T/mri-964cc314fdba4813/axial_007.png","assets/T/mri-964cc314fdba4813/axial_009.png","assets/T/mri-964cc314fdba4813/axial_011.png","assets/T/mri-964cc314fdba4813/axial_013.png","assets/T/mri-964cc314fdba4813/axial_015.png","assets/T/mri-964cc314fdba4813/axial_017.png","assets/T/mri-964cc314fdba4813/axial_019.png","assets/T/mri-964cc314fdba4813/axial_021.png","assets/T/mri-964cc314fdba4813/axial_022.png","assets/T/mri-964cc314fdba4813/axial_024.png","assets/T/mri-964cc314fdba4813/axial_026.png","assets/T/mri-964cc314fdba4813/axial_028.png","assets/T/mri-964cc314fdba4813/axial_030.png","assets/T/mri-964cc314fdba4813/axial_032.png","assets/T/mri-964cc314fdba4813/axial_034.png","assets/T/mri-964cc314fdba4813/axial_036.png","assets/T/mri-964cc314fdba4813/axial_038.png","assets/T/mri-964cc314fdba4813/axial_040.png","assets/T/mri-964cc314fdba4813/coronal_001.png","assets/T/mri-964cc314fdba4813/coronal_003.png","assets/T/mri-964cc314fdba4813/coronal_005.png","assets/T/mri-964cc314fdba4813/coronal_007.png","assets/T/mri-964cc314fdba4813/coronal_009.png","assets/T/mri-964cc314fdba4813/coronal_011.png","assets/T/mri-964cc314fdba4813/coronal_014.png","assets/T/mri-964cc314fdba4813/coronal_016.png","assets/T/mri-964cc314fdba4813/coronal_018.png","assets/T/mri-964cc314fdba4813/coronal_020.png","assets/T/mri-964cc314fdba4813/coronal_022.png","assets/T/mri-964cc314fdba4813/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-89ad7e4f032e4280","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-89ad7e4f032e4280/axial_001.png","assets/T/mri-89ad7e4f032e4280/axial_003.png","assets/T/mri-89ad7e4f032e4280/axial_005.png","assets/T/mri-89ad7e4f032e4280/axial_007.png","assets/T/mri-89ad7e4f032e4280/axial_009.png","assets/T/mri-89ad7e4f032e4280/axial_012.png","assets/T/mri-89ad7e4f032e4280/axial_014.png","assets/T/mri-89ad7e4f032e4280/axial_016.png","assets/T/mri-89ad7e4f032e4280/axial_018.png","assets/T/mri-89ad7e4f032e4280/axial_020.png","assets/T/mri-89ad7e4f032e4280/axial_022.png","assets/T/mri-89ad7e4f032e4280/axial_024.png","assets/T/mri-89ad7e4f032e4280/axial_026.png","assets/T/mri-89ad7e4f032e4280/axial_028.png","assets/T/mri-89ad7e4f032e4280/axial_030.png","assets/T/mri-89ad7e4f032e4280/axial_033.png","assets/T/mri-89ad7e4f032e4280/axial_035.png","assets/T/mri-89ad7e4f032e4280/axial_037.png","assets/T/mri-89ad7e4f032e4280/axial_039.png","assets/T/mri-89ad7e4f032e4280/axial_041.png","assets/T/mri-89ad7e4f032e4280/axial_043.png","assets/T/mri-89ad7e4f032e4280/coronal_001.png","assets/T/mri-89ad7e4f032e4280/coronal_003.png","assets/T/mri-89ad7e4f032e4280/coronal_005.png","assets/T/mri-89ad7e4f032e4280/coronal_007.png","assets/T/mri-89ad7e4f032e4280/coronal_009.png","assets/T/mri-89ad7e4f032e4280/coronal_011.png","assets/T/mri-89ad7e4f032e4280/coronal_014.png","assets/T/mri-89ad7e4f032e4280/coronal_016.png","assets/T/mri-89ad7e4f032e4280/coronal_018.png","assets/T/mri-89ad7e4f032e4280/coronal_020.png","assets/T/mri-89ad7e4f032e4280/coronal_022.png","assets/T/mri-89ad7e4f032e4280/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":67,"selected_count":33,"source_indices_1based":[1,3,5,7,9,12,14,16,18,20,22,24,26,28,30,33,35,37,39,41,43,44,46,48,50,52,54,57,59,61,63,65,67]}}
+{"id":"L3-T300:mri-17791822e81042f8","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-17791822e81042f8/axial_001.png","assets/T/mri-17791822e81042f8/axial_003.png","assets/T/mri-17791822e81042f8/axial_005.png","assets/T/mri-17791822e81042f8/axial_007.png","assets/T/mri-17791822e81042f8/axial_009.png","assets/T/mri-17791822e81042f8/axial_011.png","assets/T/mri-17791822e81042f8/axial_013.png","assets/T/mri-17791822e81042f8/axial_015.png","assets/T/mri-17791822e81042f8/axial_017.png","assets/T/mri-17791822e81042f8/axial_019.png","assets/T/mri-17791822e81042f8/axial_022.png","assets/T/mri-17791822e81042f8/axial_024.png","assets/T/mri-17791822e81042f8/axial_026.png","assets/T/mri-17791822e81042f8/axial_028.png","assets/T/mri-17791822e81042f8/axial_030.png","assets/T/mri-17791822e81042f8/axial_032.png","assets/T/mri-17791822e81042f8/axial_034.png","assets/T/mri-17791822e81042f8/axial_036.png","assets/T/mri-17791822e81042f8/axial_038.png","assets/T/mri-17791822e81042f8/axial_040.png","assets/T/mri-17791822e81042f8/axial_042.png","assets/T/mri-17791822e81042f8/coronal_001.png","assets/T/mri-17791822e81042f8/coronal_003.png","assets/T/mri-17791822e81042f8/coronal_005.png","assets/T/mri-17791822e81042f8/coronal_007.png","assets/T/mri-17791822e81042f8/coronal_009.png","assets/T/mri-17791822e81042f8/coronal_011.png","assets/T/mri-17791822e81042f8/coronal_014.png","assets/T/mri-17791822e81042f8/coronal_016.png","assets/T/mri-17791822e81042f8/coronal_018.png","assets/T/mri-17791822e81042f8/coronal_020.png","assets/T/mri-17791822e81042f8/coronal_022.png","assets/T/mri-17791822e81042f8/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-e4e91086f13f4cfd","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-e4e91086f13f4cfd/axial_001.png","assets/T/mri-e4e91086f13f4cfd/axial_003.png","assets/T/mri-e4e91086f13f4cfd/axial_005.png","assets/T/mri-e4e91086f13f4cfd/axial_007.png","assets/T/mri-e4e91086f13f4cfd/axial_009.png","assets/T/mri-e4e91086f13f4cfd/axial_011.png","assets/T/mri-e4e91086f13f4cfd/axial_013.png","assets/T/mri-e4e91086f13f4cfd/axial_015.png","assets/T/mri-e4e91086f13f4cfd/axial_017.png","assets/T/mri-e4e91086f13f4cfd/axial_019.png","assets/T/mri-e4e91086f13f4cfd/axial_022.png","assets/T/mri-e4e91086f13f4cfd/axial_024.png","assets/T/mri-e4e91086f13f4cfd/axial_026.png","assets/T/mri-e4e91086f13f4cfd/axial_028.png","assets/T/mri-e4e91086f13f4cfd/axial_030.png","assets/T/mri-e4e91086f13f4cfd/axial_032.png","assets/T/mri-e4e91086f13f4cfd/axial_034.png","assets/T/mri-e4e91086f13f4cfd/axial_036.png","assets/T/mri-e4e91086f13f4cfd/axial_038.png","assets/T/mri-e4e91086f13f4cfd/axial_040.png","assets/T/mri-e4e91086f13f4cfd/axial_042.png","assets/T/mri-e4e91086f13f4cfd/coronal_001.png","assets/T/mri-e4e91086f13f4cfd/coronal_003.png","assets/T/mri-e4e91086f13f4cfd/coronal_005.png","assets/T/mri-e4e91086f13f4cfd/coronal_007.png","assets/T/mri-e4e91086f13f4cfd/coronal_009.png","assets/T/mri-e4e91086f13f4cfd/coronal_011.png","assets/T/mri-e4e91086f13f4cfd/coronal_014.png","assets/T/mri-e4e91086f13f4cfd/coronal_016.png","assets/T/mri-e4e91086f13f4cfd/coronal_018.png","assets/T/mri-e4e91086f13f4cfd/coronal_020.png","assets/T/mri-e4e91086f13f4cfd/coronal_022.png","assets/T/mri-e4e91086f13f4cfd/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-641082354d954f14","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-641082354d954f14/axial_001.png","assets/T/mri-641082354d954f14/axial_003.png","assets/T/mri-641082354d954f14/axial_005.png","assets/T/mri-641082354d954f14/axial_007.png","assets/T/mri-641082354d954f14/axial_009.png","assets/T/mri-641082354d954f14/axial_011.png","assets/T/mri-641082354d954f14/axial_013.png","assets/T/mri-641082354d954f14/axial_015.png","assets/T/mri-641082354d954f14/axial_017.png","assets/T/mri-641082354d954f14/axial_019.png","assets/T/mri-641082354d954f14/axial_022.png","assets/T/mri-641082354d954f14/axial_024.png","assets/T/mri-641082354d954f14/axial_026.png","assets/T/mri-641082354d954f14/axial_028.png","assets/T/mri-641082354d954f14/axial_030.png","assets/T/mri-641082354d954f14/axial_032.png","assets/T/mri-641082354d954f14/axial_034.png","assets/T/mri-641082354d954f14/axial_036.png","assets/T/mri-641082354d954f14/axial_038.png","assets/T/mri-641082354d954f14/axial_040.png","assets/T/mri-641082354d954f14/axial_042.png","assets/T/mri-641082354d954f14/coronal_001.png","assets/T/mri-641082354d954f14/coronal_003.png","assets/T/mri-641082354d954f14/coronal_005.png","assets/T/mri-641082354d954f14/coronal_007.png","assets/T/mri-641082354d954f14/coronal_009.png","assets/T/mri-641082354d954f14/coronal_011.png","assets/T/mri-641082354d954f14/coronal_014.png","assets/T/mri-641082354d954f14/coronal_016.png","assets/T/mri-641082354d954f14/coronal_018.png","assets/T/mri-641082354d954f14/coronal_020.png","assets/T/mri-641082354d954f14/coronal_022.png","assets/T/mri-641082354d954f14/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-b8195ac61cf24d8e","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-b8195ac61cf24d8e/axial_001.png","assets/T/mri-b8195ac61cf24d8e/axial_003.png","assets/T/mri-b8195ac61cf24d8e/axial_005.png","assets/T/mri-b8195ac61cf24d8e/axial_007.png","assets/T/mri-b8195ac61cf24d8e/axial_009.png","assets/T/mri-b8195ac61cf24d8e/axial_011.png","assets/T/mri-b8195ac61cf24d8e/axial_013.png","assets/T/mri-b8195ac61cf24d8e/axial_015.png","assets/T/mri-b8195ac61cf24d8e/axial_017.png","assets/T/mri-b8195ac61cf24d8e/axial_019.png","assets/T/mri-b8195ac61cf24d8e/axial_021.png","assets/T/mri-b8195ac61cf24d8e/axial_022.png","assets/T/mri-b8195ac61cf24d8e/axial_024.png","assets/T/mri-b8195ac61cf24d8e/axial_026.png","assets/T/mri-b8195ac61cf24d8e/axial_028.png","assets/T/mri-b8195ac61cf24d8e/axial_030.png","assets/T/mri-b8195ac61cf24d8e/axial_032.png","assets/T/mri-b8195ac61cf24d8e/axial_034.png","assets/T/mri-b8195ac61cf24d8e/axial_036.png","assets/T/mri-b8195ac61cf24d8e/axial_038.png","assets/T/mri-b8195ac61cf24d8e/axial_040.png","assets/T/mri-b8195ac61cf24d8e/coronal_001.png","assets/T/mri-b8195ac61cf24d8e/coronal_003.png","assets/T/mri-b8195ac61cf24d8e/coronal_005.png","assets/T/mri-b8195ac61cf24d8e/coronal_007.png","assets/T/mri-b8195ac61cf24d8e/coronal_009.png","assets/T/mri-b8195ac61cf24d8e/coronal_011.png","assets/T/mri-b8195ac61cf24d8e/coronal_014.png","assets/T/mri-b8195ac61cf24d8e/coronal_016.png","assets/T/mri-b8195ac61cf24d8e/coronal_018.png","assets/T/mri-b8195ac61cf24d8e/coronal_020.png","assets/T/mri-b8195ac61cf24d8e/coronal_022.png","assets/T/mri-b8195ac61cf24d8e/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-a8825a33e2e244c7","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 35 张图，均来自同一次检查。\n\n- 前 16 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 19 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-a8825a33e2e244c7/axial_001.png","assets/T/mri-a8825a33e2e244c7/axial_002.png","assets/T/mri-a8825a33e2e244c7/axial_004.png","assets/T/mri-a8825a33e2e244c7/axial_005.png","assets/T/mri-a8825a33e2e244c7/axial_006.png","assets/T/mri-a8825a33e2e244c7/axial_007.png","assets/T/mri-a8825a33e2e244c7/axial_009.png","assets/T/mri-a8825a33e2e244c7/axial_010.png","assets/T/mri-a8825a33e2e244c7/axial_011.png","assets/T/mri-a8825a33e2e244c7/axial_012.png","assets/T/mri-a8825a33e2e244c7/axial_014.png","assets/T/mri-a8825a33e2e244c7/axial_015.png","assets/T/mri-a8825a33e2e244c7/axial_016.png","assets/T/mri-a8825a33e2e244c7/axial_017.png","assets/T/mri-a8825a33e2e244c7/axial_019.png","assets/T/mri-a8825a33e2e244c7/axial_020.png","assets/T/mri-a8825a33e2e244c7/coronal_001.png","assets/T/mri-a8825a33e2e244c7/coronal_002.png","assets/T/mri-a8825a33e2e244c7/coronal_004.png","assets/T/mri-a8825a33e2e244c7/coronal_005.png","assets/T/mri-a8825a33e2e244c7/coronal_006.png","assets/T/mri-a8825a33e2e244c7/coronal_007.png","assets/T/mri-a8825a33e2e244c7/coronal_009.png","assets/T/mri-a8825a33e2e244c7/coronal_010.png","assets/T/mri-a8825a33e2e244c7/coronal_011.png","assets/T/mri-a8825a33e2e244c7/coronal_013.png","assets/T/mri-a8825a33e2e244c7/coronal_014.png","assets/T/mri-a8825a33e2e244c7/coronal_015.png","assets/T/mri-a8825a33e2e244c7/coronal_016.png","assets/T/mri-a8825a33e2e244c7/coronal_018.png","assets/T/mri-a8825a33e2e244c7/coronal_019.png","assets/T/mri-a8825a33e2e244c7/coronal_020.png","assets/T/mri-a8825a33e2e244c7/coronal_021.png","assets/T/mri-a8825a33e2e244c7/coronal_023.png","assets/T/mri-a8825a33e2e244c7/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":44,"selected_count":35,"source_indices_1based":[1,2,4,5,6,7,9,10,11,12,14,15,16,17,19,20,21,22,24,25,26,27,29,30,31,33,34,35,36,38,39,40,41,43,44]}}
+{"id":"L3-T300:mri-a66aedc73c134dce","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 13 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-a66aedc73c134dce/axial_001.png","assets/T/mri-a66aedc73c134dce/axial_003.png","assets/T/mri-a66aedc73c134dce/axial_005.png","assets/T/mri-a66aedc73c134dce/axial_007.png","assets/T/mri-a66aedc73c134dce/axial_009.png","assets/T/mri-a66aedc73c134dce/axial_011.png","assets/T/mri-a66aedc73c134dce/axial_013.png","assets/T/mri-a66aedc73c134dce/axial_015.png","assets/T/mri-a66aedc73c134dce/axial_017.png","assets/T/mri-a66aedc73c134dce/axial_019.png","assets/T/mri-a66aedc73c134dce/axial_020.png","assets/T/mri-a66aedc73c134dce/axial_022.png","assets/T/mri-a66aedc73c134dce/axial_024.png","assets/T/mri-a66aedc73c134dce/axial_026.png","assets/T/mri-a66aedc73c134dce/axial_028.png","assets/T/mri-a66aedc73c134dce/axial_030.png","assets/T/mri-a66aedc73c134dce/axial_032.png","assets/T/mri-a66aedc73c134dce/axial_034.png","assets/T/mri-a66aedc73c134dce/axial_036.png","assets/T/mri-a66aedc73c134dce/axial_038.png","assets/T/mri-a66aedc73c134dce/coronal_001.png","assets/T/mri-a66aedc73c134dce/coronal_003.png","assets/T/mri-a66aedc73c134dce/coronal_005.png","assets/T/mri-a66aedc73c134dce/coronal_007.png","assets/T/mri-a66aedc73c134dce/coronal_009.png","assets/T/mri-a66aedc73c134dce/coronal_011.png","assets/T/mri-a66aedc73c134dce/coronal_013.png","assets/T/mri-a66aedc73c134dce/coronal_014.png","assets/T/mri-a66aedc73c134dce/coronal_016.png","assets/T/mri-a66aedc73c134dce/coronal_018.png","assets/T/mri-a66aedc73c134dce/coronal_020.png","assets/T/mri-a66aedc73c134dce/coronal_022.png","assets/T/mri-a66aedc73c134dce/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":62,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,20,22,24,26,28,30,32,34,36,38,39,41,43,45,47,49,51,52,54,56,58,60,62]}}
+{"id":"L3-T300:mri-4fc9388c39ea4bec","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-4fc9388c39ea4bec/axial_001.png","assets/T/mri-4fc9388c39ea4bec/axial_003.png","assets/T/mri-4fc9388c39ea4bec/axial_005.png","assets/T/mri-4fc9388c39ea4bec/axial_007.png","assets/T/mri-4fc9388c39ea4bec/axial_009.png","assets/T/mri-4fc9388c39ea4bec/axial_011.png","assets/T/mri-4fc9388c39ea4bec/axial_013.png","assets/T/mri-4fc9388c39ea4bec/axial_015.png","assets/T/mri-4fc9388c39ea4bec/axial_017.png","assets/T/mri-4fc9388c39ea4bec/axial_019.png","assets/T/mri-4fc9388c39ea4bec/axial_021.png","assets/T/mri-4fc9388c39ea4bec/axial_022.png","assets/T/mri-4fc9388c39ea4bec/axial_024.png","assets/T/mri-4fc9388c39ea4bec/axial_026.png","assets/T/mri-4fc9388c39ea4bec/axial_028.png","assets/T/mri-4fc9388c39ea4bec/axial_030.png","assets/T/mri-4fc9388c39ea4bec/axial_032.png","assets/T/mri-4fc9388c39ea4bec/axial_034.png","assets/T/mri-4fc9388c39ea4bec/axial_036.png","assets/T/mri-4fc9388c39ea4bec/axial_038.png","assets/T/mri-4fc9388c39ea4bec/axial_040.png","assets/T/mri-4fc9388c39ea4bec/coronal_001.png","assets/T/mri-4fc9388c39ea4bec/coronal_003.png","assets/T/mri-4fc9388c39ea4bec/coronal_005.png","assets/T/mri-4fc9388c39ea4bec/coronal_007.png","assets/T/mri-4fc9388c39ea4bec/coronal_009.png","assets/T/mri-4fc9388c39ea4bec/coronal_011.png","assets/T/mri-4fc9388c39ea4bec/coronal_014.png","assets/T/mri-4fc9388c39ea4bec/coronal_016.png","assets/T/mri-4fc9388c39ea4bec/coronal_018.png","assets/T/mri-4fc9388c39ea4bec/coronal_020.png","assets/T/mri-4fc9388c39ea4bec/coronal_022.png","assets/T/mri-4fc9388c39ea4bec/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-1710b5fe45bb4c9b","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-1710b5fe45bb4c9b/axial_001.png","assets/T/mri-1710b5fe45bb4c9b/axial_003.png","assets/T/mri-1710b5fe45bb4c9b/axial_005.png","assets/T/mri-1710b5fe45bb4c9b/axial_007.png","assets/T/mri-1710b5fe45bb4c9b/axial_009.png","assets/T/mri-1710b5fe45bb4c9b/axial_011.png","assets/T/mri-1710b5fe45bb4c9b/axial_013.png","assets/T/mri-1710b5fe45bb4c9b/axial_015.png","assets/T/mri-1710b5fe45bb4c9b/axial_017.png","assets/T/mri-1710b5fe45bb4c9b/axial_019.png","assets/T/mri-1710b5fe45bb4c9b/axial_022.png","assets/T/mri-1710b5fe45bb4c9b/axial_024.png","assets/T/mri-1710b5fe45bb4c9b/axial_026.png","assets/T/mri-1710b5fe45bb4c9b/axial_028.png","assets/T/mri-1710b5fe45bb4c9b/axial_030.png","assets/T/mri-1710b5fe45bb4c9b/axial_032.png","assets/T/mri-1710b5fe45bb4c9b/axial_034.png","assets/T/mri-1710b5fe45bb4c9b/axial_036.png","assets/T/mri-1710b5fe45bb4c9b/axial_038.png","assets/T/mri-1710b5fe45bb4c9b/axial_040.png","assets/T/mri-1710b5fe45bb4c9b/axial_042.png","assets/T/mri-1710b5fe45bb4c9b/coronal_001.png","assets/T/mri-1710b5fe45bb4c9b/coronal_003.png","assets/T/mri-1710b5fe45bb4c9b/coronal_005.png","assets/T/mri-1710b5fe45bb4c9b/coronal_007.png","assets/T/mri-1710b5fe45bb4c9b/coronal_009.png","assets/T/mri-1710b5fe45bb4c9b/coronal_011.png","assets/T/mri-1710b5fe45bb4c9b/coronal_014.png","assets/T/mri-1710b5fe45bb4c9b/coronal_016.png","assets/T/mri-1710b5fe45bb4c9b/coronal_018.png","assets/T/mri-1710b5fe45bb4c9b/coronal_020.png","assets/T/mri-1710b5fe45bb4c9b/coronal_022.png","assets/T/mri-1710b5fe45bb4c9b/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-40ab680e8ff847d6","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-40ab680e8ff847d6/axial_001.png","assets/T/mri-40ab680e8ff847d6/axial_003.png","assets/T/mri-40ab680e8ff847d6/axial_005.png","assets/T/mri-40ab680e8ff847d6/axial_007.png","assets/T/mri-40ab680e8ff847d6/axial_009.png","assets/T/mri-40ab680e8ff847d6/axial_011.png","assets/T/mri-40ab680e8ff847d6/axial_013.png","assets/T/mri-40ab680e8ff847d6/axial_015.png","assets/T/mri-40ab680e8ff847d6/axial_017.png","assets/T/mri-40ab680e8ff847d6/axial_019.png","assets/T/mri-40ab680e8ff847d6/axial_022.png","assets/T/mri-40ab680e8ff847d6/axial_024.png","assets/T/mri-40ab680e8ff847d6/axial_026.png","assets/T/mri-40ab680e8ff847d6/axial_028.png","assets/T/mri-40ab680e8ff847d6/axial_030.png","assets/T/mri-40ab680e8ff847d6/axial_032.png","assets/T/mri-40ab680e8ff847d6/axial_034.png","assets/T/mri-40ab680e8ff847d6/axial_036.png","assets/T/mri-40ab680e8ff847d6/axial_038.png","assets/T/mri-40ab680e8ff847d6/axial_040.png","assets/T/mri-40ab680e8ff847d6/axial_042.png","assets/T/mri-40ab680e8ff847d6/coronal_001.png","assets/T/mri-40ab680e8ff847d6/coronal_003.png","assets/T/mri-40ab680e8ff847d6/coronal_005.png","assets/T/mri-40ab680e8ff847d6/coronal_007.png","assets/T/mri-40ab680e8ff847d6/coronal_009.png","assets/T/mri-40ab680e8ff847d6/coronal_011.png","assets/T/mri-40ab680e8ff847d6/coronal_014.png","assets/T/mri-40ab680e8ff847d6/coronal_016.png","assets/T/mri-40ab680e8ff847d6/coronal_018.png","assets/T/mri-40ab680e8ff847d6/coronal_020.png","assets/T/mri-40ab680e8ff847d6/coronal_022.png","assets/T/mri-40ab680e8ff847d6/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-396b4602039e46f3","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 34 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 14 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-396b4602039e46f3/axial_001.png","assets/T/mri-396b4602039e46f3/axial_003.png","assets/T/mri-396b4602039e46f3/axial_005.png","assets/T/mri-396b4602039e46f3/axial_007.png","assets/T/mri-396b4602039e46f3/axial_008.png","assets/T/mri-396b4602039e46f3/axial_010.png","assets/T/mri-396b4602039e46f3/axial_012.png","assets/T/mri-396b4602039e46f3/axial_014.png","assets/T/mri-396b4602039e46f3/axial_016.png","assets/T/mri-396b4602039e46f3/axial_018.png","assets/T/mri-396b4602039e46f3/axial_019.png","assets/T/mri-396b4602039e46f3/axial_021.png","assets/T/mri-396b4602039e46f3/axial_023.png","assets/T/mri-396b4602039e46f3/axial_025.png","assets/T/mri-396b4602039e46f3/axial_027.png","assets/T/mri-396b4602039e46f3/axial_029.png","assets/T/mri-396b4602039e46f3/axial_030.png","assets/T/mri-396b4602039e46f3/axial_032.png","assets/T/mri-396b4602039e46f3/axial_034.png","assets/T/mri-396b4602039e46f3/axial_036.png","assets/T/mri-396b4602039e46f3/coronal_001.png","assets/T/mri-396b4602039e46f3/coronal_003.png","assets/T/mri-396b4602039e46f3/coronal_005.png","assets/T/mri-396b4602039e46f3/coronal_006.png","assets/T/mri-396b4602039e46f3/coronal_008.png","assets/T/mri-396b4602039e46f3/coronal_010.png","assets/T/mri-396b4602039e46f3/coronal_012.png","assets/T/mri-396b4602039e46f3/coronal_013.png","assets/T/mri-396b4602039e46f3/coronal_015.png","assets/T/mri-396b4602039e46f3/coronal_017.png","assets/T/mri-396b4602039e46f3/coronal_019.png","assets/T/mri-396b4602039e46f3/coronal_020.png","assets/T/mri-396b4602039e46f3/coronal_022.png","assets/T/mri-396b4602039e46f3/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":60,"selected_count":34,"source_indices_1based":[1,3,5,7,8,10,12,14,16,18,19,21,23,25,27,29,30,32,34,36,37,39,41,42,44,46,48,49,51,53,55,56,58,60]}}
+{"id":"L3-T300:mri-0588f21611574c53","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-0588f21611574c53/axial_001.png","assets/T/mri-0588f21611574c53/axial_003.png","assets/T/mri-0588f21611574c53/axial_005.png","assets/T/mri-0588f21611574c53/axial_007.png","assets/T/mri-0588f21611574c53/axial_009.png","assets/T/mri-0588f21611574c53/axial_011.png","assets/T/mri-0588f21611574c53/axial_013.png","assets/T/mri-0588f21611574c53/axial_015.png","assets/T/mri-0588f21611574c53/axial_017.png","assets/T/mri-0588f21611574c53/axial_019.png","assets/T/mri-0588f21611574c53/axial_021.png","assets/T/mri-0588f21611574c53/axial_022.png","assets/T/mri-0588f21611574c53/axial_024.png","assets/T/mri-0588f21611574c53/axial_026.png","assets/T/mri-0588f21611574c53/axial_028.png","assets/T/mri-0588f21611574c53/axial_030.png","assets/T/mri-0588f21611574c53/axial_032.png","assets/T/mri-0588f21611574c53/axial_034.png","assets/T/mri-0588f21611574c53/axial_036.png","assets/T/mri-0588f21611574c53/axial_038.png","assets/T/mri-0588f21611574c53/axial_040.png","assets/T/mri-0588f21611574c53/coronal_001.png","assets/T/mri-0588f21611574c53/coronal_003.png","assets/T/mri-0588f21611574c53/coronal_005.png","assets/T/mri-0588f21611574c53/coronal_007.png","assets/T/mri-0588f21611574c53/coronal_009.png","assets/T/mri-0588f21611574c53/coronal_011.png","assets/T/mri-0588f21611574c53/coronal_014.png","assets/T/mri-0588f21611574c53/coronal_016.png","assets/T/mri-0588f21611574c53/coronal_018.png","assets/T/mri-0588f21611574c53/coronal_020.png","assets/T/mri-0588f21611574c53/coronal_022.png","assets/T/mri-0588f21611574c53/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-f4e104d4b1914b92","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-f4e104d4b1914b92/axial_001.png","assets/T/mri-f4e104d4b1914b92/axial_003.png","assets/T/mri-f4e104d4b1914b92/axial_005.png","assets/T/mri-f4e104d4b1914b92/axial_007.png","assets/T/mri-f4e104d4b1914b92/axial_009.png","assets/T/mri-f4e104d4b1914b92/axial_011.png","assets/T/mri-f4e104d4b1914b92/axial_013.png","assets/T/mri-f4e104d4b1914b92/axial_015.png","assets/T/mri-f4e104d4b1914b92/axial_017.png","assets/T/mri-f4e104d4b1914b92/axial_019.png","assets/T/mri-f4e104d4b1914b92/axial_022.png","assets/T/mri-f4e104d4b1914b92/axial_024.png","assets/T/mri-f4e104d4b1914b92/axial_026.png","assets/T/mri-f4e104d4b1914b92/axial_028.png","assets/T/mri-f4e104d4b1914b92/axial_030.png","assets/T/mri-f4e104d4b1914b92/axial_032.png","assets/T/mri-f4e104d4b1914b92/axial_034.png","assets/T/mri-f4e104d4b1914b92/axial_036.png","assets/T/mri-f4e104d4b1914b92/axial_038.png","assets/T/mri-f4e104d4b1914b92/axial_040.png","assets/T/mri-f4e104d4b1914b92/axial_042.png","assets/T/mri-f4e104d4b1914b92/coronal_001.png","assets/T/mri-f4e104d4b1914b92/coronal_003.png","assets/T/mri-f4e104d4b1914b92/coronal_005.png","assets/T/mri-f4e104d4b1914b92/coronal_007.png","assets/T/mri-f4e104d4b1914b92/coronal_009.png","assets/T/mri-f4e104d4b1914b92/coronal_011.png","assets/T/mri-f4e104d4b1914b92/coronal_014.png","assets/T/mri-f4e104d4b1914b92/coronal_016.png","assets/T/mri-f4e104d4b1914b92/coronal_018.png","assets/T/mri-f4e104d4b1914b92/coronal_020.png","assets/T/mri-f4e104d4b1914b92/coronal_022.png","assets/T/mri-f4e104d4b1914b92/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-d55be5ee6a164720","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-d55be5ee6a164720/axial_001.png","assets/T/mri-d55be5ee6a164720/axial_003.png","assets/T/mri-d55be5ee6a164720/axial_005.png","assets/T/mri-d55be5ee6a164720/axial_007.png","assets/T/mri-d55be5ee6a164720/axial_009.png","assets/T/mri-d55be5ee6a164720/axial_011.png","assets/T/mri-d55be5ee6a164720/axial_013.png","assets/T/mri-d55be5ee6a164720/axial_015.png","assets/T/mri-d55be5ee6a164720/axial_017.png","assets/T/mri-d55be5ee6a164720/axial_019.png","assets/T/mri-d55be5ee6a164720/axial_022.png","assets/T/mri-d55be5ee6a164720/axial_024.png","assets/T/mri-d55be5ee6a164720/axial_026.png","assets/T/mri-d55be5ee6a164720/axial_028.png","assets/T/mri-d55be5ee6a164720/axial_030.png","assets/T/mri-d55be5ee6a164720/axial_032.png","assets/T/mri-d55be5ee6a164720/axial_034.png","assets/T/mri-d55be5ee6a164720/axial_036.png","assets/T/mri-d55be5ee6a164720/axial_038.png","assets/T/mri-d55be5ee6a164720/axial_040.png","assets/T/mri-d55be5ee6a164720/axial_042.png","assets/T/mri-d55be5ee6a164720/coronal_001.png","assets/T/mri-d55be5ee6a164720/coronal_003.png","assets/T/mri-d55be5ee6a164720/coronal_005.png","assets/T/mri-d55be5ee6a164720/coronal_007.png","assets/T/mri-d55be5ee6a164720/coronal_009.png","assets/T/mri-d55be5ee6a164720/coronal_011.png","assets/T/mri-d55be5ee6a164720/coronal_014.png","assets/T/mri-d55be5ee6a164720/coronal_016.png","assets/T/mri-d55be5ee6a164720/coronal_018.png","assets/T/mri-d55be5ee6a164720/coronal_020.png","assets/T/mri-d55be5ee6a164720/coronal_022.png","assets/T/mri-d55be5ee6a164720/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-819452b5910247dc","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 13 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-819452b5910247dc/axial_001.png","assets/T/mri-819452b5910247dc/axial_003.png","assets/T/mri-819452b5910247dc/axial_005.png","assets/T/mri-819452b5910247dc/axial_007.png","assets/T/mri-819452b5910247dc/axial_010.png","assets/T/mri-819452b5910247dc/axial_012.png","assets/T/mri-819452b5910247dc/axial_014.png","assets/T/mri-819452b5910247dc/axial_016.png","assets/T/mri-819452b5910247dc/axial_018.png","assets/T/mri-819452b5910247dc/axial_020.png","assets/T/mri-819452b5910247dc/axial_023.png","assets/T/mri-819452b5910247dc/axial_025.png","assets/T/mri-819452b5910247dc/axial_027.png","assets/T/mri-819452b5910247dc/axial_029.png","assets/T/mri-819452b5910247dc/axial_031.png","assets/T/mri-819452b5910247dc/axial_033.png","assets/T/mri-819452b5910247dc/axial_036.png","assets/T/mri-819452b5910247dc/axial_038.png","assets/T/mri-819452b5910247dc/axial_040.png","assets/T/mri-819452b5910247dc/axial_042.png","assets/T/mri-819452b5910247dc/coronal_001.png","assets/T/mri-819452b5910247dc/coronal_003.png","assets/T/mri-819452b5910247dc/coronal_005.png","assets/T/mri-819452b5910247dc/coronal_007.png","assets/T/mri-819452b5910247dc/coronal_009.png","assets/T/mri-819452b5910247dc/coronal_011.png","assets/T/mri-819452b5910247dc/coronal_014.png","assets/T/mri-819452b5910247dc/coronal_016.png","assets/T/mri-819452b5910247dc/coronal_018.png","assets/T/mri-819452b5910247dc/coronal_020.png","assets/T/mri-819452b5910247dc/coronal_022.png","assets/T/mri-819452b5910247dc/coronal_024.png","assets/T/mri-819452b5910247dc/coronal_026.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":68,"selected_count":33,"source_indices_1based":[1,3,5,7,10,12,14,16,18,20,23,25,27,29,31,33,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66,68]}}
+{"id":"L3-T300:mri-d49832b605474bfa","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-d49832b605474bfa/axial_001.png","assets/T/mri-d49832b605474bfa/axial_003.png","assets/T/mri-d49832b605474bfa/axial_005.png","assets/T/mri-d49832b605474bfa/axial_007.png","assets/T/mri-d49832b605474bfa/axial_009.png","assets/T/mri-d49832b605474bfa/axial_011.png","assets/T/mri-d49832b605474bfa/axial_013.png","assets/T/mri-d49832b605474bfa/axial_015.png","assets/T/mri-d49832b605474bfa/axial_017.png","assets/T/mri-d49832b605474bfa/axial_019.png","assets/T/mri-d49832b605474bfa/axial_021.png","assets/T/mri-d49832b605474bfa/axial_022.png","assets/T/mri-d49832b605474bfa/axial_024.png","assets/T/mri-d49832b605474bfa/axial_026.png","assets/T/mri-d49832b605474bfa/axial_028.png","assets/T/mri-d49832b605474bfa/axial_030.png","assets/T/mri-d49832b605474bfa/axial_032.png","assets/T/mri-d49832b605474bfa/axial_034.png","assets/T/mri-d49832b605474bfa/axial_036.png","assets/T/mri-d49832b605474bfa/axial_038.png","assets/T/mri-d49832b605474bfa/axial_040.png","assets/T/mri-d49832b605474bfa/coronal_001.png","assets/T/mri-d49832b605474bfa/coronal_003.png","assets/T/mri-d49832b605474bfa/coronal_005.png","assets/T/mri-d49832b605474bfa/coronal_007.png","assets/T/mri-d49832b605474bfa/coronal_009.png","assets/T/mri-d49832b605474bfa/coronal_011.png","assets/T/mri-d49832b605474bfa/coronal_014.png","assets/T/mri-d49832b605474bfa/coronal_016.png","assets/T/mri-d49832b605474bfa/coronal_018.png","assets/T/mri-d49832b605474bfa/coronal_020.png","assets/T/mri-d49832b605474bfa/coronal_022.png","assets/T/mri-d49832b605474bfa/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-2bedb86c0d404023","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-2bedb86c0d404023/axial_001.png","assets/T/mri-2bedb86c0d404023/axial_003.png","assets/T/mri-2bedb86c0d404023/axial_005.png","assets/T/mri-2bedb86c0d404023/axial_007.png","assets/T/mri-2bedb86c0d404023/axial_009.png","assets/T/mri-2bedb86c0d404023/axial_011.png","assets/T/mri-2bedb86c0d404023/axial_013.png","assets/T/mri-2bedb86c0d404023/axial_015.png","assets/T/mri-2bedb86c0d404023/axial_017.png","assets/T/mri-2bedb86c0d404023/axial_019.png","assets/T/mri-2bedb86c0d404023/axial_022.png","assets/T/mri-2bedb86c0d404023/axial_024.png","assets/T/mri-2bedb86c0d404023/axial_026.png","assets/T/mri-2bedb86c0d404023/axial_028.png","assets/T/mri-2bedb86c0d404023/axial_030.png","assets/T/mri-2bedb86c0d404023/axial_032.png","assets/T/mri-2bedb86c0d404023/axial_034.png","assets/T/mri-2bedb86c0d404023/axial_036.png","assets/T/mri-2bedb86c0d404023/axial_038.png","assets/T/mri-2bedb86c0d404023/axial_040.png","assets/T/mri-2bedb86c0d404023/axial_042.png","assets/T/mri-2bedb86c0d404023/coronal_001.png","assets/T/mri-2bedb86c0d404023/coronal_003.png","assets/T/mri-2bedb86c0d404023/coronal_005.png","assets/T/mri-2bedb86c0d404023/coronal_007.png","assets/T/mri-2bedb86c0d404023/coronal_009.png","assets/T/mri-2bedb86c0d404023/coronal_011.png","assets/T/mri-2bedb86c0d404023/coronal_014.png","assets/T/mri-2bedb86c0d404023/coronal_016.png","assets/T/mri-2bedb86c0d404023/coronal_018.png","assets/T/mri-2bedb86c0d404023/coronal_020.png","assets/T/mri-2bedb86c0d404023/coronal_022.png","assets/T/mri-2bedb86c0d404023/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-0f94f5ebff6c4b23","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-0f94f5ebff6c4b23/axial_001.png","assets/T/mri-0f94f5ebff6c4b23/axial_003.png","assets/T/mri-0f94f5ebff6c4b23/axial_005.png","assets/T/mri-0f94f5ebff6c4b23/axial_007.png","assets/T/mri-0f94f5ebff6c4b23/axial_009.png","assets/T/mri-0f94f5ebff6c4b23/axial_011.png","assets/T/mri-0f94f5ebff6c4b23/axial_013.png","assets/T/mri-0f94f5ebff6c4b23/axial_015.png","assets/T/mri-0f94f5ebff6c4b23/axial_017.png","assets/T/mri-0f94f5ebff6c4b23/axial_019.png","assets/T/mri-0f94f5ebff6c4b23/axial_021.png","assets/T/mri-0f94f5ebff6c4b23/axial_022.png","assets/T/mri-0f94f5ebff6c4b23/axial_024.png","assets/T/mri-0f94f5ebff6c4b23/axial_026.png","assets/T/mri-0f94f5ebff6c4b23/axial_028.png","assets/T/mri-0f94f5ebff6c4b23/axial_030.png","assets/T/mri-0f94f5ebff6c4b23/axial_032.png","assets/T/mri-0f94f5ebff6c4b23/axial_034.png","assets/T/mri-0f94f5ebff6c4b23/axial_036.png","assets/T/mri-0f94f5ebff6c4b23/axial_038.png","assets/T/mri-0f94f5ebff6c4b23/axial_040.png","assets/T/mri-0f94f5ebff6c4b23/coronal_001.png","assets/T/mri-0f94f5ebff6c4b23/coronal_003.png","assets/T/mri-0f94f5ebff6c4b23/coronal_005.png","assets/T/mri-0f94f5ebff6c4b23/coronal_007.png","assets/T/mri-0f94f5ebff6c4b23/coronal_009.png","assets/T/mri-0f94f5ebff6c4b23/coronal_011.png","assets/T/mri-0f94f5ebff6c4b23/coronal_014.png","assets/T/mri-0f94f5ebff6c4b23/coronal_016.png","assets/T/mri-0f94f5ebff6c4b23/coronal_018.png","assets/T/mri-0f94f5ebff6c4b23/coronal_020.png","assets/T/mri-0f94f5ebff6c4b23/coronal_022.png","assets/T/mri-0f94f5ebff6c4b23/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-2248452041c244a6","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-2248452041c244a6/axial_001.png","assets/T/mri-2248452041c244a6/axial_003.png","assets/T/mri-2248452041c244a6/axial_005.png","assets/T/mri-2248452041c244a6/axial_007.png","assets/T/mri-2248452041c244a6/axial_009.png","assets/T/mri-2248452041c244a6/axial_011.png","assets/T/mri-2248452041c244a6/axial_013.png","assets/T/mri-2248452041c244a6/axial_015.png","assets/T/mri-2248452041c244a6/axial_017.png","assets/T/mri-2248452041c244a6/axial_019.png","assets/T/mri-2248452041c244a6/axial_022.png","assets/T/mri-2248452041c244a6/axial_024.png","assets/T/mri-2248452041c244a6/axial_026.png","assets/T/mri-2248452041c244a6/axial_028.png","assets/T/mri-2248452041c244a6/axial_030.png","assets/T/mri-2248452041c244a6/axial_032.png","assets/T/mri-2248452041c244a6/axial_034.png","assets/T/mri-2248452041c244a6/axial_036.png","assets/T/mri-2248452041c244a6/axial_038.png","assets/T/mri-2248452041c244a6/axial_040.png","assets/T/mri-2248452041c244a6/axial_042.png","assets/T/mri-2248452041c244a6/coronal_001.png","assets/T/mri-2248452041c244a6/coronal_003.png","assets/T/mri-2248452041c244a6/coronal_005.png","assets/T/mri-2248452041c244a6/coronal_007.png","assets/T/mri-2248452041c244a6/coronal_009.png","assets/T/mri-2248452041c244a6/coronal_011.png","assets/T/mri-2248452041c244a6/coronal_014.png","assets/T/mri-2248452041c244a6/coronal_016.png","assets/T/mri-2248452041c244a6/coronal_018.png","assets/T/mri-2248452041c244a6/coronal_020.png","assets/T/mri-2248452041c244a6/coronal_022.png","assets/T/mri-2248452041c244a6/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-a75f78b1241a410a","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 13 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-a75f78b1241a410a/axial_001.png","assets/T/mri-a75f78b1241a410a/axial_003.png","assets/T/mri-a75f78b1241a410a/axial_005.png","assets/T/mri-a75f78b1241a410a/axial_007.png","assets/T/mri-a75f78b1241a410a/axial_009.png","assets/T/mri-a75f78b1241a410a/axial_011.png","assets/T/mri-a75f78b1241a410a/axial_013.png","assets/T/mri-a75f78b1241a410a/axial_015.png","assets/T/mri-a75f78b1241a410a/axial_017.png","assets/T/mri-a75f78b1241a410a/axial_019.png","assets/T/mri-a75f78b1241a410a/axial_022.png","assets/T/mri-a75f78b1241a410a/axial_024.png","assets/T/mri-a75f78b1241a410a/axial_026.png","assets/T/mri-a75f78b1241a410a/axial_028.png","assets/T/mri-a75f78b1241a410a/axial_030.png","assets/T/mri-a75f78b1241a410a/axial_032.png","assets/T/mri-a75f78b1241a410a/axial_034.png","assets/T/mri-a75f78b1241a410a/axial_036.png","assets/T/mri-a75f78b1241a410a/axial_038.png","assets/T/mri-a75f78b1241a410a/axial_040.png","assets/T/mri-a75f78b1241a410a/coronal_001.png","assets/T/mri-a75f78b1241a410a/coronal_003.png","assets/T/mri-a75f78b1241a410a/coronal_005.png","assets/T/mri-a75f78b1241a410a/coronal_007.png","assets/T/mri-a75f78b1241a410a/coronal_009.png","assets/T/mri-a75f78b1241a410a/coronal_011.png","assets/T/mri-a75f78b1241a410a/coronal_014.png","assets/T/mri-a75f78b1241a410a/coronal_016.png","assets/T/mri-a75f78b1241a410a/coronal_018.png","assets/T/mri-a75f78b1241a410a/coronal_020.png","assets/T/mri-a75f78b1241a410a/coronal_022.png","assets/T/mri-a75f78b1241a410a/coronal_024.png","assets/T/mri-a75f78b1241a410a/coronal_026.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-ca4047d888404407","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 13 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-ca4047d888404407/axial_001.png","assets/T/mri-ca4047d888404407/axial_003.png","assets/T/mri-ca4047d888404407/axial_005.png","assets/T/mri-ca4047d888404407/axial_007.png","assets/T/mri-ca4047d888404407/axial_009.png","assets/T/mri-ca4047d888404407/axial_011.png","assets/T/mri-ca4047d888404407/axial_013.png","assets/T/mri-ca4047d888404407/axial_015.png","assets/T/mri-ca4047d888404407/axial_017.png","assets/T/mri-ca4047d888404407/axial_019.png","assets/T/mri-ca4047d888404407/axial_020.png","assets/T/mri-ca4047d888404407/axial_022.png","assets/T/mri-ca4047d888404407/axial_024.png","assets/T/mri-ca4047d888404407/axial_026.png","assets/T/mri-ca4047d888404407/axial_028.png","assets/T/mri-ca4047d888404407/axial_030.png","assets/T/mri-ca4047d888404407/axial_032.png","assets/T/mri-ca4047d888404407/axial_034.png","assets/T/mri-ca4047d888404407/axial_036.png","assets/T/mri-ca4047d888404407/axial_038.png","assets/T/mri-ca4047d888404407/coronal_001.png","assets/T/mri-ca4047d888404407/coronal_003.png","assets/T/mri-ca4047d888404407/coronal_005.png","assets/T/mri-ca4047d888404407/coronal_007.png","assets/T/mri-ca4047d888404407/coronal_009.png","assets/T/mri-ca4047d888404407/coronal_011.png","assets/T/mri-ca4047d888404407/coronal_013.png","assets/T/mri-ca4047d888404407/coronal_014.png","assets/T/mri-ca4047d888404407/coronal_016.png","assets/T/mri-ca4047d888404407/coronal_018.png","assets/T/mri-ca4047d888404407/coronal_020.png","assets/T/mri-ca4047d888404407/coronal_022.png","assets/T/mri-ca4047d888404407/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":62,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,20,22,24,26,28,30,32,34,36,38,39,41,43,45,47,49,51,52,54,56,58,60,62]}}
+{"id":"L3-T300:mri-5bef6cc79ec84d5f","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-5bef6cc79ec84d5f/axial_001.png","assets/T/mri-5bef6cc79ec84d5f/axial_003.png","assets/T/mri-5bef6cc79ec84d5f/axial_005.png","assets/T/mri-5bef6cc79ec84d5f/axial_007.png","assets/T/mri-5bef6cc79ec84d5f/axial_009.png","assets/T/mri-5bef6cc79ec84d5f/axial_011.png","assets/T/mri-5bef6cc79ec84d5f/axial_013.png","assets/T/mri-5bef6cc79ec84d5f/axial_015.png","assets/T/mri-5bef6cc79ec84d5f/axial_017.png","assets/T/mri-5bef6cc79ec84d5f/axial_019.png","assets/T/mri-5bef6cc79ec84d5f/axial_021.png","assets/T/mri-5bef6cc79ec84d5f/axial_022.png","assets/T/mri-5bef6cc79ec84d5f/axial_024.png","assets/T/mri-5bef6cc79ec84d5f/axial_026.png","assets/T/mri-5bef6cc79ec84d5f/axial_028.png","assets/T/mri-5bef6cc79ec84d5f/axial_030.png","assets/T/mri-5bef6cc79ec84d5f/axial_032.png","assets/T/mri-5bef6cc79ec84d5f/axial_034.png","assets/T/mri-5bef6cc79ec84d5f/axial_036.png","assets/T/mri-5bef6cc79ec84d5f/axial_038.png","assets/T/mri-5bef6cc79ec84d5f/axial_040.png","assets/T/mri-5bef6cc79ec84d5f/coronal_001.png","assets/T/mri-5bef6cc79ec84d5f/coronal_003.png","assets/T/mri-5bef6cc79ec84d5f/coronal_005.png","assets/T/mri-5bef6cc79ec84d5f/coronal_007.png","assets/T/mri-5bef6cc79ec84d5f/coronal_009.png","assets/T/mri-5bef6cc79ec84d5f/coronal_011.png","assets/T/mri-5bef6cc79ec84d5f/coronal_014.png","assets/T/mri-5bef6cc79ec84d5f/coronal_016.png","assets/T/mri-5bef6cc79ec84d5f/coronal_018.png","assets/T/mri-5bef6cc79ec84d5f/coronal_020.png","assets/T/mri-5bef6cc79ec84d5f/coronal_022.png","assets/T/mri-5bef6cc79ec84d5f/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-66a44b250d614109","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-66a44b250d614109/axial_001.png","assets/T/mri-66a44b250d614109/axial_003.png","assets/T/mri-66a44b250d614109/axial_005.png","assets/T/mri-66a44b250d614109/axial_007.png","assets/T/mri-66a44b250d614109/axial_009.png","assets/T/mri-66a44b250d614109/axial_011.png","assets/T/mri-66a44b250d614109/axial_013.png","assets/T/mri-66a44b250d614109/axial_015.png","assets/T/mri-66a44b250d614109/axial_017.png","assets/T/mri-66a44b250d614109/axial_019.png","assets/T/mri-66a44b250d614109/axial_022.png","assets/T/mri-66a44b250d614109/axial_024.png","assets/T/mri-66a44b250d614109/axial_026.png","assets/T/mri-66a44b250d614109/axial_028.png","assets/T/mri-66a44b250d614109/axial_030.png","assets/T/mri-66a44b250d614109/axial_032.png","assets/T/mri-66a44b250d614109/axial_034.png","assets/T/mri-66a44b250d614109/axial_036.png","assets/T/mri-66a44b250d614109/axial_038.png","assets/T/mri-66a44b250d614109/axial_040.png","assets/T/mri-66a44b250d614109/axial_042.png","assets/T/mri-66a44b250d614109/coronal_001.png","assets/T/mri-66a44b250d614109/coronal_003.png","assets/T/mri-66a44b250d614109/coronal_005.png","assets/T/mri-66a44b250d614109/coronal_007.png","assets/T/mri-66a44b250d614109/coronal_009.png","assets/T/mri-66a44b250d614109/coronal_011.png","assets/T/mri-66a44b250d614109/coronal_014.png","assets/T/mri-66a44b250d614109/coronal_016.png","assets/T/mri-66a44b250d614109/coronal_018.png","assets/T/mri-66a44b250d614109/coronal_020.png","assets/T/mri-66a44b250d614109/coronal_022.png","assets/T/mri-66a44b250d614109/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-fc63c9cacf214122","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-fc63c9cacf214122/axial_001.png","assets/T/mri-fc63c9cacf214122/axial_003.png","assets/T/mri-fc63c9cacf214122/axial_005.png","assets/T/mri-fc63c9cacf214122/axial_007.png","assets/T/mri-fc63c9cacf214122/axial_009.png","assets/T/mri-fc63c9cacf214122/axial_011.png","assets/T/mri-fc63c9cacf214122/axial_013.png","assets/T/mri-fc63c9cacf214122/axial_015.png","assets/T/mri-fc63c9cacf214122/axial_017.png","assets/T/mri-fc63c9cacf214122/axial_019.png","assets/T/mri-fc63c9cacf214122/axial_022.png","assets/T/mri-fc63c9cacf214122/axial_024.png","assets/T/mri-fc63c9cacf214122/axial_026.png","assets/T/mri-fc63c9cacf214122/axial_028.png","assets/T/mri-fc63c9cacf214122/axial_030.png","assets/T/mri-fc63c9cacf214122/axial_032.png","assets/T/mri-fc63c9cacf214122/axial_034.png","assets/T/mri-fc63c9cacf214122/axial_036.png","assets/T/mri-fc63c9cacf214122/axial_038.png","assets/T/mri-fc63c9cacf214122/axial_040.png","assets/T/mri-fc63c9cacf214122/axial_042.png","assets/T/mri-fc63c9cacf214122/coronal_001.png","assets/T/mri-fc63c9cacf214122/coronal_003.png","assets/T/mri-fc63c9cacf214122/coronal_005.png","assets/T/mri-fc63c9cacf214122/coronal_007.png","assets/T/mri-fc63c9cacf214122/coronal_009.png","assets/T/mri-fc63c9cacf214122/coronal_011.png","assets/T/mri-fc63c9cacf214122/coronal_014.png","assets/T/mri-fc63c9cacf214122/coronal_016.png","assets/T/mri-fc63c9cacf214122/coronal_018.png","assets/T/mri-fc63c9cacf214122/coronal_020.png","assets/T/mri-fc63c9cacf214122/coronal_022.png","assets/T/mri-fc63c9cacf214122/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-37345bffc7aa45be","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-37345bffc7aa45be/axial_001.png","assets/T/mri-37345bffc7aa45be/axial_003.png","assets/T/mri-37345bffc7aa45be/axial_005.png","assets/T/mri-37345bffc7aa45be/axial_007.png","assets/T/mri-37345bffc7aa45be/axial_009.png","assets/T/mri-37345bffc7aa45be/axial_011.png","assets/T/mri-37345bffc7aa45be/axial_013.png","assets/T/mri-37345bffc7aa45be/axial_015.png","assets/T/mri-37345bffc7aa45be/axial_017.png","assets/T/mri-37345bffc7aa45be/axial_019.png","assets/T/mri-37345bffc7aa45be/axial_022.png","assets/T/mri-37345bffc7aa45be/axial_024.png","assets/T/mri-37345bffc7aa45be/axial_026.png","assets/T/mri-37345bffc7aa45be/axial_028.png","assets/T/mri-37345bffc7aa45be/axial_030.png","assets/T/mri-37345bffc7aa45be/axial_032.png","assets/T/mri-37345bffc7aa45be/axial_034.png","assets/T/mri-37345bffc7aa45be/axial_036.png","assets/T/mri-37345bffc7aa45be/axial_038.png","assets/T/mri-37345bffc7aa45be/axial_040.png","assets/T/mri-37345bffc7aa45be/axial_042.png","assets/T/mri-37345bffc7aa45be/coronal_001.png","assets/T/mri-37345bffc7aa45be/coronal_003.png","assets/T/mri-37345bffc7aa45be/coronal_005.png","assets/T/mri-37345bffc7aa45be/coronal_007.png","assets/T/mri-37345bffc7aa45be/coronal_009.png","assets/T/mri-37345bffc7aa45be/coronal_011.png","assets/T/mri-37345bffc7aa45be/coronal_014.png","assets/T/mri-37345bffc7aa45be/coronal_016.png","assets/T/mri-37345bffc7aa45be/coronal_018.png","assets/T/mri-37345bffc7aa45be/coronal_020.png","assets/T/mri-37345bffc7aa45be/coronal_022.png","assets/T/mri-37345bffc7aa45be/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-0394f36828774a62","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 13 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-0394f36828774a62/axial_001.png","assets/T/mri-0394f36828774a62/axial_003.png","assets/T/mri-0394f36828774a62/axial_006.png","assets/T/mri-0394f36828774a62/axial_008.png","assets/T/mri-0394f36828774a62/axial_010.png","assets/T/mri-0394f36828774a62/axial_012.png","assets/T/mri-0394f36828774a62/axial_015.png","assets/T/mri-0394f36828774a62/axial_017.png","assets/T/mri-0394f36828774a62/axial_019.png","assets/T/mri-0394f36828774a62/axial_021.png","assets/T/mri-0394f36828774a62/axial_024.png","assets/T/mri-0394f36828774a62/axial_026.png","assets/T/mri-0394f36828774a62/axial_028.png","assets/T/mri-0394f36828774a62/axial_030.png","assets/T/mri-0394f36828774a62/axial_033.png","assets/T/mri-0394f36828774a62/axial_035.png","assets/T/mri-0394f36828774a62/axial_037.png","assets/T/mri-0394f36828774a62/axial_039.png","assets/T/mri-0394f36828774a62/axial_042.png","assets/T/mri-0394f36828774a62/axial_044.png","assets/T/mri-0394f36828774a62/coronal_001.png","assets/T/mri-0394f36828774a62/coronal_003.png","assets/T/mri-0394f36828774a62/coronal_006.png","assets/T/mri-0394f36828774a62/coronal_008.png","assets/T/mri-0394f36828774a62/coronal_010.png","assets/T/mri-0394f36828774a62/coronal_012.png","assets/T/mri-0394f36828774a62/coronal_015.png","assets/T/mri-0394f36828774a62/coronal_017.png","assets/T/mri-0394f36828774a62/coronal_019.png","assets/T/mri-0394f36828774a62/coronal_021.png","assets/T/mri-0394f36828774a62/coronal_024.png","assets/T/mri-0394f36828774a62/coronal_026.png","assets/T/mri-0394f36828774a62/coronal_028.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":72,"selected_count":33,"source_indices_1based":[1,3,6,8,10,12,15,17,19,21,24,26,28,30,33,35,37,39,42,44,45,47,50,52,54,56,59,61,63,65,68,70,72]}}
+{"id":"L3-T300:mri-1cbc32dff74a4430","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-1cbc32dff74a4430/axial_001.png","assets/T/mri-1cbc32dff74a4430/axial_003.png","assets/T/mri-1cbc32dff74a4430/axial_006.png","assets/T/mri-1cbc32dff74a4430/axial_008.png","assets/T/mri-1cbc32dff74a4430/axial_010.png","assets/T/mri-1cbc32dff74a4430/axial_013.png","assets/T/mri-1cbc32dff74a4430/axial_015.png","assets/T/mri-1cbc32dff74a4430/axial_017.png","assets/T/mri-1cbc32dff74a4430/axial_020.png","assets/T/mri-1cbc32dff74a4430/axial_022.png","assets/T/mri-1cbc32dff74a4430/axial_025.png","assets/T/mri-1cbc32dff74a4430/axial_027.png","assets/T/mri-1cbc32dff74a4430/axial_029.png","assets/T/mri-1cbc32dff74a4430/axial_032.png","assets/T/mri-1cbc32dff74a4430/axial_034.png","assets/T/mri-1cbc32dff74a4430/axial_036.png","assets/T/mri-1cbc32dff74a4430/axial_039.png","assets/T/mri-1cbc32dff74a4430/axial_041.png","assets/T/mri-1cbc32dff74a4430/axial_043.png","assets/T/mri-1cbc32dff74a4430/axial_046.png","assets/T/mri-1cbc32dff74a4430/axial_048.png","assets/T/mri-1cbc32dff74a4430/coronal_001.png","assets/T/mri-1cbc32dff74a4430/coronal_003.png","assets/T/mri-1cbc32dff74a4430/coronal_006.png","assets/T/mri-1cbc32dff74a4430/coronal_008.png","assets/T/mri-1cbc32dff74a4430/coronal_011.png","assets/T/mri-1cbc32dff74a4430/coronal_013.png","assets/T/mri-1cbc32dff74a4430/coronal_016.png","assets/T/mri-1cbc32dff74a4430/coronal_018.png","assets/T/mri-1cbc32dff74a4430/coronal_021.png","assets/T/mri-1cbc32dff74a4430/coronal_023.png","assets/T/mri-1cbc32dff74a4430/coronal_026.png","assets/T/mri-1cbc32dff74a4430/coronal_028.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":76,"selected_count":33,"source_indices_1based":[1,3,6,8,10,13,15,17,20,22,25,27,29,32,34,36,39,41,43,46,48,49,51,54,56,59,61,64,66,69,71,74,76]}}
+{"id":"L3-T300:mri-62733f1276564ed5","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-62733f1276564ed5/axial_001.png","assets/T/mri-62733f1276564ed5/axial_003.png","assets/T/mri-62733f1276564ed5/axial_005.png","assets/T/mri-62733f1276564ed5/axial_007.png","assets/T/mri-62733f1276564ed5/axial_009.png","assets/T/mri-62733f1276564ed5/axial_011.png","assets/T/mri-62733f1276564ed5/axial_013.png","assets/T/mri-62733f1276564ed5/axial_015.png","assets/T/mri-62733f1276564ed5/axial_017.png","assets/T/mri-62733f1276564ed5/axial_019.png","assets/T/mri-62733f1276564ed5/axial_022.png","assets/T/mri-62733f1276564ed5/axial_024.png","assets/T/mri-62733f1276564ed5/axial_026.png","assets/T/mri-62733f1276564ed5/axial_028.png","assets/T/mri-62733f1276564ed5/axial_030.png","assets/T/mri-62733f1276564ed5/axial_032.png","assets/T/mri-62733f1276564ed5/axial_034.png","assets/T/mri-62733f1276564ed5/axial_036.png","assets/T/mri-62733f1276564ed5/axial_038.png","assets/T/mri-62733f1276564ed5/axial_040.png","assets/T/mri-62733f1276564ed5/axial_042.png","assets/T/mri-62733f1276564ed5/coronal_001.png","assets/T/mri-62733f1276564ed5/coronal_003.png","assets/T/mri-62733f1276564ed5/coronal_005.png","assets/T/mri-62733f1276564ed5/coronal_007.png","assets/T/mri-62733f1276564ed5/coronal_009.png","assets/T/mri-62733f1276564ed5/coronal_011.png","assets/T/mri-62733f1276564ed5/coronal_014.png","assets/T/mri-62733f1276564ed5/coronal_016.png","assets/T/mri-62733f1276564ed5/coronal_018.png","assets/T/mri-62733f1276564ed5/coronal_020.png","assets/T/mri-62733f1276564ed5/coronal_022.png","assets/T/mri-62733f1276564ed5/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-5f4e71f281864ee8","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-5f4e71f281864ee8/axial_001.png","assets/T/mri-5f4e71f281864ee8/axial_003.png","assets/T/mri-5f4e71f281864ee8/axial_005.png","assets/T/mri-5f4e71f281864ee8/axial_007.png","assets/T/mri-5f4e71f281864ee8/axial_009.png","assets/T/mri-5f4e71f281864ee8/axial_011.png","assets/T/mri-5f4e71f281864ee8/axial_013.png","assets/T/mri-5f4e71f281864ee8/axial_015.png","assets/T/mri-5f4e71f281864ee8/axial_017.png","assets/T/mri-5f4e71f281864ee8/axial_019.png","assets/T/mri-5f4e71f281864ee8/axial_021.png","assets/T/mri-5f4e71f281864ee8/axial_022.png","assets/T/mri-5f4e71f281864ee8/axial_024.png","assets/T/mri-5f4e71f281864ee8/axial_026.png","assets/T/mri-5f4e71f281864ee8/axial_028.png","assets/T/mri-5f4e71f281864ee8/axial_030.png","assets/T/mri-5f4e71f281864ee8/axial_032.png","assets/T/mri-5f4e71f281864ee8/axial_034.png","assets/T/mri-5f4e71f281864ee8/axial_036.png","assets/T/mri-5f4e71f281864ee8/axial_038.png","assets/T/mri-5f4e71f281864ee8/axial_040.png","assets/T/mri-5f4e71f281864ee8/coronal_001.png","assets/T/mri-5f4e71f281864ee8/coronal_003.png","assets/T/mri-5f4e71f281864ee8/coronal_005.png","assets/T/mri-5f4e71f281864ee8/coronal_007.png","assets/T/mri-5f4e71f281864ee8/coronal_009.png","assets/T/mri-5f4e71f281864ee8/coronal_011.png","assets/T/mri-5f4e71f281864ee8/coronal_014.png","assets/T/mri-5f4e71f281864ee8/coronal_016.png","assets/T/mri-5f4e71f281864ee8/coronal_018.png","assets/T/mri-5f4e71f281864ee8/coronal_020.png","assets/T/mri-5f4e71f281864ee8/coronal_022.png","assets/T/mri-5f4e71f281864ee8/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-d6bbc416db544bc3","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-d6bbc416db544bc3/axial_001.png","assets/T/mri-d6bbc416db544bc3/axial_003.png","assets/T/mri-d6bbc416db544bc3/axial_005.png","assets/T/mri-d6bbc416db544bc3/axial_007.png","assets/T/mri-d6bbc416db544bc3/axial_010.png","assets/T/mri-d6bbc416db544bc3/axial_012.png","assets/T/mri-d6bbc416db544bc3/axial_014.png","assets/T/mri-d6bbc416db544bc3/axial_016.png","assets/T/mri-d6bbc416db544bc3/axial_018.png","assets/T/mri-d6bbc416db544bc3/axial_020.png","assets/T/mri-d6bbc416db544bc3/axial_023.png","assets/T/mri-d6bbc416db544bc3/axial_025.png","assets/T/mri-d6bbc416db544bc3/axial_027.png","assets/T/mri-d6bbc416db544bc3/axial_029.png","assets/T/mri-d6bbc416db544bc3/axial_031.png","assets/T/mri-d6bbc416db544bc3/axial_033.png","assets/T/mri-d6bbc416db544bc3/axial_035.png","assets/T/mri-d6bbc416db544bc3/axial_038.png","assets/T/mri-d6bbc416db544bc3/axial_040.png","assets/T/mri-d6bbc416db544bc3/axial_042.png","assets/T/mri-d6bbc416db544bc3/axial_044.png","assets/T/mri-d6bbc416db544bc3/coronal_001.png","assets/T/mri-d6bbc416db544bc3/coronal_003.png","assets/T/mri-d6bbc416db544bc3/coronal_005.png","assets/T/mri-d6bbc416db544bc3/coronal_007.png","assets/T/mri-d6bbc416db544bc3/coronal_009.png","assets/T/mri-d6bbc416db544bc3/coronal_011.png","assets/T/mri-d6bbc416db544bc3/coronal_014.png","assets/T/mri-d6bbc416db544bc3/coronal_016.png","assets/T/mri-d6bbc416db544bc3/coronal_018.png","assets/T/mri-d6bbc416db544bc3/coronal_020.png","assets/T/mri-d6bbc416db544bc3/coronal_022.png","assets/T/mri-d6bbc416db544bc3/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":68,"selected_count":33,"source_indices_1based":[1,3,5,7,10,12,14,16,18,20,23,25,27,29,31,33,35,38,40,42,44,45,47,49,51,53,55,58,60,62,64,66,68]}}
+{"id":"L3-T300:mri-2d9c445715964c25","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 34 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 14 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-2d9c445715964c25/axial_001.png","assets/T/mri-2d9c445715964c25/axial_003.png","assets/T/mri-2d9c445715964c25/axial_005.png","assets/T/mri-2d9c445715964c25/axial_007.png","assets/T/mri-2d9c445715964c25/axial_010.png","assets/T/mri-2d9c445715964c25/axial_012.png","assets/T/mri-2d9c445715964c25/axial_014.png","assets/T/mri-2d9c445715964c25/axial_016.png","assets/T/mri-2d9c445715964c25/axial_018.png","assets/T/mri-2d9c445715964c25/axial_020.png","assets/T/mri-2d9c445715964c25/axial_023.png","assets/T/mri-2d9c445715964c25/axial_025.png","assets/T/mri-2d9c445715964c25/axial_027.png","assets/T/mri-2d9c445715964c25/axial_029.png","assets/T/mri-2d9c445715964c25/axial_031.png","assets/T/mri-2d9c445715964c25/axial_033.png","assets/T/mri-2d9c445715964c25/axial_036.png","assets/T/mri-2d9c445715964c25/axial_038.png","assets/T/mri-2d9c445715964c25/axial_040.png","assets/T/mri-2d9c445715964c25/axial_042.png","assets/T/mri-2d9c445715964c25/coronal_001.png","assets/T/mri-2d9c445715964c25/coronal_003.png","assets/T/mri-2d9c445715964c25/coronal_005.png","assets/T/mri-2d9c445715964c25/coronal_007.png","assets/T/mri-2d9c445715964c25/coronal_009.png","assets/T/mri-2d9c445715964c25/coronal_011.png","assets/T/mri-2d9c445715964c25/coronal_013.png","assets/T/mri-2d9c445715964c25/coronal_016.png","assets/T/mri-2d9c445715964c25/coronal_018.png","assets/T/mri-2d9c445715964c25/coronal_020.png","assets/T/mri-2d9c445715964c25/coronal_022.png","assets/T/mri-2d9c445715964c25/coronal_024.png","assets/T/mri-2d9c445715964c25/coronal_026.png","assets/T/mri-2d9c445715964c25/coronal_028.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":70,"selected_count":34,"source_indices_1based":[1,3,5,7,10,12,14,16,18,20,23,25,27,29,31,33,36,38,40,42,43,45,47,49,51,53,55,58,60,62,64,66,68,70]}}
+{"id":"L3-T300:mri-aa61cf9331744ddd","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 13 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-aa61cf9331744ddd/axial_001.png","assets/T/mri-aa61cf9331744ddd/axial_003.png","assets/T/mri-aa61cf9331744ddd/axial_005.png","assets/T/mri-aa61cf9331744ddd/axial_007.png","assets/T/mri-aa61cf9331744ddd/axial_009.png","assets/T/mri-aa61cf9331744ddd/axial_011.png","assets/T/mri-aa61cf9331744ddd/axial_013.png","assets/T/mri-aa61cf9331744ddd/axial_015.png","assets/T/mri-aa61cf9331744ddd/axial_017.png","assets/T/mri-aa61cf9331744ddd/axial_019.png","assets/T/mri-aa61cf9331744ddd/axial_020.png","assets/T/mri-aa61cf9331744ddd/axial_022.png","assets/T/mri-aa61cf9331744ddd/axial_024.png","assets/T/mri-aa61cf9331744ddd/axial_026.png","assets/T/mri-aa61cf9331744ddd/axial_028.png","assets/T/mri-aa61cf9331744ddd/axial_030.png","assets/T/mri-aa61cf9331744ddd/axial_032.png","assets/T/mri-aa61cf9331744ddd/axial_034.png","assets/T/mri-aa61cf9331744ddd/axial_036.png","assets/T/mri-aa61cf9331744ddd/axial_038.png","assets/T/mri-aa61cf9331744ddd/coronal_001.png","assets/T/mri-aa61cf9331744ddd/coronal_003.png","assets/T/mri-aa61cf9331744ddd/coronal_005.png","assets/T/mri-aa61cf9331744ddd/coronal_007.png","assets/T/mri-aa61cf9331744ddd/coronal_009.png","assets/T/mri-aa61cf9331744ddd/coronal_011.png","assets/T/mri-aa61cf9331744ddd/coronal_013.png","assets/T/mri-aa61cf9331744ddd/coronal_014.png","assets/T/mri-aa61cf9331744ddd/coronal_016.png","assets/T/mri-aa61cf9331744ddd/coronal_018.png","assets/T/mri-aa61cf9331744ddd/coronal_020.png","assets/T/mri-aa61cf9331744ddd/coronal_022.png","assets/T/mri-aa61cf9331744ddd/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":62,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,20,22,24,26,28,30,32,34,36,38,39,41,43,45,47,49,51,52,54,56,58,60,62]}}
+{"id":"L3-T300:mri-85bf21a1e54d4f86","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 13 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-85bf21a1e54d4f86/axial_001.png","assets/T/mri-85bf21a1e54d4f86/axial_003.png","assets/T/mri-85bf21a1e54d4f86/axial_005.png","assets/T/mri-85bf21a1e54d4f86/axial_007.png","assets/T/mri-85bf21a1e54d4f86/axial_009.png","assets/T/mri-85bf21a1e54d4f86/axial_011.png","assets/T/mri-85bf21a1e54d4f86/axial_013.png","assets/T/mri-85bf21a1e54d4f86/axial_015.png","assets/T/mri-85bf21a1e54d4f86/axial_017.png","assets/T/mri-85bf21a1e54d4f86/axial_019.png","assets/T/mri-85bf21a1e54d4f86/axial_020.png","assets/T/mri-85bf21a1e54d4f86/axial_022.png","assets/T/mri-85bf21a1e54d4f86/axial_024.png","assets/T/mri-85bf21a1e54d4f86/axial_026.png","assets/T/mri-85bf21a1e54d4f86/axial_028.png","assets/T/mri-85bf21a1e54d4f86/axial_030.png","assets/T/mri-85bf21a1e54d4f86/axial_032.png","assets/T/mri-85bf21a1e54d4f86/axial_034.png","assets/T/mri-85bf21a1e54d4f86/axial_036.png","assets/T/mri-85bf21a1e54d4f86/axial_038.png","assets/T/mri-85bf21a1e54d4f86/coronal_001.png","assets/T/mri-85bf21a1e54d4f86/coronal_003.png","assets/T/mri-85bf21a1e54d4f86/coronal_005.png","assets/T/mri-85bf21a1e54d4f86/coronal_007.png","assets/T/mri-85bf21a1e54d4f86/coronal_009.png","assets/T/mri-85bf21a1e54d4f86/coronal_011.png","assets/T/mri-85bf21a1e54d4f86/coronal_013.png","assets/T/mri-85bf21a1e54d4f86/coronal_014.png","assets/T/mri-85bf21a1e54d4f86/coronal_016.png","assets/T/mri-85bf21a1e54d4f86/coronal_018.png","assets/T/mri-85bf21a1e54d4f86/coronal_020.png","assets/T/mri-85bf21a1e54d4f86/coronal_022.png","assets/T/mri-85bf21a1e54d4f86/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":62,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,20,22,24,26,28,30,32,34,36,38,39,41,43,45,47,49,51,52,54,56,58,60,62]}}
+{"id":"L3-T300:mri-cd1d5e72481942cd","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-cd1d5e72481942cd/axial_001.png","assets/T/mri-cd1d5e72481942cd/axial_003.png","assets/T/mri-cd1d5e72481942cd/axial_005.png","assets/T/mri-cd1d5e72481942cd/axial_007.png","assets/T/mri-cd1d5e72481942cd/axial_009.png","assets/T/mri-cd1d5e72481942cd/axial_011.png","assets/T/mri-cd1d5e72481942cd/axial_013.png","assets/T/mri-cd1d5e72481942cd/axial_015.png","assets/T/mri-cd1d5e72481942cd/axial_017.png","assets/T/mri-cd1d5e72481942cd/axial_019.png","assets/T/mri-cd1d5e72481942cd/axial_022.png","assets/T/mri-cd1d5e72481942cd/axial_024.png","assets/T/mri-cd1d5e72481942cd/axial_026.png","assets/T/mri-cd1d5e72481942cd/axial_028.png","assets/T/mri-cd1d5e72481942cd/axial_030.png","assets/T/mri-cd1d5e72481942cd/axial_032.png","assets/T/mri-cd1d5e72481942cd/axial_034.png","assets/T/mri-cd1d5e72481942cd/axial_036.png","assets/T/mri-cd1d5e72481942cd/axial_038.png","assets/T/mri-cd1d5e72481942cd/axial_040.png","assets/T/mri-cd1d5e72481942cd/axial_042.png","assets/T/mri-cd1d5e72481942cd/coronal_001.png","assets/T/mri-cd1d5e72481942cd/coronal_003.png","assets/T/mri-cd1d5e72481942cd/coronal_005.png","assets/T/mri-cd1d5e72481942cd/coronal_007.png","assets/T/mri-cd1d5e72481942cd/coronal_009.png","assets/T/mri-cd1d5e72481942cd/coronal_011.png","assets/T/mri-cd1d5e72481942cd/coronal_014.png","assets/T/mri-cd1d5e72481942cd/coronal_016.png","assets/T/mri-cd1d5e72481942cd/coronal_018.png","assets/T/mri-cd1d5e72481942cd/coronal_020.png","assets/T/mri-cd1d5e72481942cd/coronal_022.png","assets/T/mri-cd1d5e72481942cd/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-07a00ae75e7b4977","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-07a00ae75e7b4977/axial_001.png","assets/T/mri-07a00ae75e7b4977/axial_003.png","assets/T/mri-07a00ae75e7b4977/axial_005.png","assets/T/mri-07a00ae75e7b4977/axial_007.png","assets/T/mri-07a00ae75e7b4977/axial_010.png","assets/T/mri-07a00ae75e7b4977/axial_012.png","assets/T/mri-07a00ae75e7b4977/axial_014.png","assets/T/mri-07a00ae75e7b4977/axial_016.png","assets/T/mri-07a00ae75e7b4977/axial_018.png","assets/T/mri-07a00ae75e7b4977/axial_020.png","assets/T/mri-07a00ae75e7b4977/axial_023.png","assets/T/mri-07a00ae75e7b4977/axial_025.png","assets/T/mri-07a00ae75e7b4977/axial_027.png","assets/T/mri-07a00ae75e7b4977/axial_029.png","assets/T/mri-07a00ae75e7b4977/axial_031.png","assets/T/mri-07a00ae75e7b4977/axial_033.png","assets/T/mri-07a00ae75e7b4977/axial_035.png","assets/T/mri-07a00ae75e7b4977/axial_038.png","assets/T/mri-07a00ae75e7b4977/axial_040.png","assets/T/mri-07a00ae75e7b4977/axial_042.png","assets/T/mri-07a00ae75e7b4977/axial_044.png","assets/T/mri-07a00ae75e7b4977/coronal_001.png","assets/T/mri-07a00ae75e7b4977/coronal_003.png","assets/T/mri-07a00ae75e7b4977/coronal_005.png","assets/T/mri-07a00ae75e7b4977/coronal_007.png","assets/T/mri-07a00ae75e7b4977/coronal_009.png","assets/T/mri-07a00ae75e7b4977/coronal_011.png","assets/T/mri-07a00ae75e7b4977/coronal_014.png","assets/T/mri-07a00ae75e7b4977/coronal_016.png","assets/T/mri-07a00ae75e7b4977/coronal_018.png","assets/T/mri-07a00ae75e7b4977/coronal_020.png","assets/T/mri-07a00ae75e7b4977/coronal_022.png","assets/T/mri-07a00ae75e7b4977/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":68,"selected_count":33,"source_indices_1based":[1,3,5,7,10,12,14,16,18,20,23,25,27,29,31,33,35,38,40,42,44,45,47,49,51,53,55,58,60,62,64,66,68]}}
+{"id":"L3-T300:mri-3640dbda84064e7c","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-3640dbda84064e7c/axial_001.png","assets/T/mri-3640dbda84064e7c/axial_003.png","assets/T/mri-3640dbda84064e7c/axial_005.png","assets/T/mri-3640dbda84064e7c/axial_007.png","assets/T/mri-3640dbda84064e7c/axial_009.png","assets/T/mri-3640dbda84064e7c/axial_011.png","assets/T/mri-3640dbda84064e7c/axial_013.png","assets/T/mri-3640dbda84064e7c/axial_015.png","assets/T/mri-3640dbda84064e7c/axial_017.png","assets/T/mri-3640dbda84064e7c/axial_019.png","assets/T/mri-3640dbda84064e7c/axial_022.png","assets/T/mri-3640dbda84064e7c/axial_024.png","assets/T/mri-3640dbda84064e7c/axial_026.png","assets/T/mri-3640dbda84064e7c/axial_028.png","assets/T/mri-3640dbda84064e7c/axial_030.png","assets/T/mri-3640dbda84064e7c/axial_032.png","assets/T/mri-3640dbda84064e7c/axial_034.png","assets/T/mri-3640dbda84064e7c/axial_036.png","assets/T/mri-3640dbda84064e7c/axial_038.png","assets/T/mri-3640dbda84064e7c/axial_040.png","assets/T/mri-3640dbda84064e7c/axial_042.png","assets/T/mri-3640dbda84064e7c/coronal_001.png","assets/T/mri-3640dbda84064e7c/coronal_003.png","assets/T/mri-3640dbda84064e7c/coronal_005.png","assets/T/mri-3640dbda84064e7c/coronal_007.png","assets/T/mri-3640dbda84064e7c/coronal_009.png","assets/T/mri-3640dbda84064e7c/coronal_011.png","assets/T/mri-3640dbda84064e7c/coronal_014.png","assets/T/mri-3640dbda84064e7c/coronal_016.png","assets/T/mri-3640dbda84064e7c/coronal_018.png","assets/T/mri-3640dbda84064e7c/coronal_020.png","assets/T/mri-3640dbda84064e7c/coronal_022.png","assets/T/mri-3640dbda84064e7c/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-3fb297150b194344","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-3fb297150b194344/axial_001.png","assets/T/mri-3fb297150b194344/axial_003.png","assets/T/mri-3fb297150b194344/axial_005.png","assets/T/mri-3fb297150b194344/axial_007.png","assets/T/mri-3fb297150b194344/axial_009.png","assets/T/mri-3fb297150b194344/axial_012.png","assets/T/mri-3fb297150b194344/axial_014.png","assets/T/mri-3fb297150b194344/axial_016.png","assets/T/mri-3fb297150b194344/axial_018.png","assets/T/mri-3fb297150b194344/axial_020.png","assets/T/mri-3fb297150b194344/axial_022.png","assets/T/mri-3fb297150b194344/axial_024.png","assets/T/mri-3fb297150b194344/axial_026.png","assets/T/mri-3fb297150b194344/axial_028.png","assets/T/mri-3fb297150b194344/axial_030.png","assets/T/mri-3fb297150b194344/axial_033.png","assets/T/mri-3fb297150b194344/axial_035.png","assets/T/mri-3fb297150b194344/axial_037.png","assets/T/mri-3fb297150b194344/axial_039.png","assets/T/mri-3fb297150b194344/axial_041.png","assets/T/mri-3fb297150b194344/axial_043.png","assets/T/mri-3fb297150b194344/coronal_001.png","assets/T/mri-3fb297150b194344/coronal_003.png","assets/T/mri-3fb297150b194344/coronal_005.png","assets/T/mri-3fb297150b194344/coronal_007.png","assets/T/mri-3fb297150b194344/coronal_009.png","assets/T/mri-3fb297150b194344/coronal_011.png","assets/T/mri-3fb297150b194344/coronal_014.png","assets/T/mri-3fb297150b194344/coronal_016.png","assets/T/mri-3fb297150b194344/coronal_018.png","assets/T/mri-3fb297150b194344/coronal_020.png","assets/T/mri-3fb297150b194344/coronal_022.png","assets/T/mri-3fb297150b194344/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":67,"selected_count":33,"source_indices_1based":[1,3,5,7,9,12,14,16,18,20,22,24,26,28,30,33,35,37,39,41,43,44,46,48,50,52,54,57,59,61,63,65,67]}}
+{"id":"L3-T300:mri-e5bad77de70140d2","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-e5bad77de70140d2/axial_001.png","assets/T/mri-e5bad77de70140d2/axial_003.png","assets/T/mri-e5bad77de70140d2/axial_005.png","assets/T/mri-e5bad77de70140d2/axial_007.png","assets/T/mri-e5bad77de70140d2/axial_009.png","assets/T/mri-e5bad77de70140d2/axial_011.png","assets/T/mri-e5bad77de70140d2/axial_013.png","assets/T/mri-e5bad77de70140d2/axial_015.png","assets/T/mri-e5bad77de70140d2/axial_017.png","assets/T/mri-e5bad77de70140d2/axial_019.png","assets/T/mri-e5bad77de70140d2/axial_021.png","assets/T/mri-e5bad77de70140d2/axial_022.png","assets/T/mri-e5bad77de70140d2/axial_024.png","assets/T/mri-e5bad77de70140d2/axial_026.png","assets/T/mri-e5bad77de70140d2/axial_028.png","assets/T/mri-e5bad77de70140d2/axial_030.png","assets/T/mri-e5bad77de70140d2/axial_032.png","assets/T/mri-e5bad77de70140d2/axial_034.png","assets/T/mri-e5bad77de70140d2/axial_036.png","assets/T/mri-e5bad77de70140d2/axial_038.png","assets/T/mri-e5bad77de70140d2/axial_040.png","assets/T/mri-e5bad77de70140d2/coronal_001.png","assets/T/mri-e5bad77de70140d2/coronal_003.png","assets/T/mri-e5bad77de70140d2/coronal_005.png","assets/T/mri-e5bad77de70140d2/coronal_007.png","assets/T/mri-e5bad77de70140d2/coronal_009.png","assets/T/mri-e5bad77de70140d2/coronal_011.png","assets/T/mri-e5bad77de70140d2/coronal_014.png","assets/T/mri-e5bad77de70140d2/coronal_016.png","assets/T/mri-e5bad77de70140d2/coronal_018.png","assets/T/mri-e5bad77de70140d2/coronal_020.png","assets/T/mri-e5bad77de70140d2/coronal_022.png","assets/T/mri-e5bad77de70140d2/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-8a2e314a61574ad4","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-8a2e314a61574ad4/axial_001.png","assets/T/mri-8a2e314a61574ad4/axial_003.png","assets/T/mri-8a2e314a61574ad4/axial_005.png","assets/T/mri-8a2e314a61574ad4/axial_007.png","assets/T/mri-8a2e314a61574ad4/axial_009.png","assets/T/mri-8a2e314a61574ad4/axial_011.png","assets/T/mri-8a2e314a61574ad4/axial_013.png","assets/T/mri-8a2e314a61574ad4/axial_015.png","assets/T/mri-8a2e314a61574ad4/axial_017.png","assets/T/mri-8a2e314a61574ad4/axial_019.png","assets/T/mri-8a2e314a61574ad4/axial_021.png","assets/T/mri-8a2e314a61574ad4/axial_022.png","assets/T/mri-8a2e314a61574ad4/axial_024.png","assets/T/mri-8a2e314a61574ad4/axial_026.png","assets/T/mri-8a2e314a61574ad4/axial_028.png","assets/T/mri-8a2e314a61574ad4/axial_030.png","assets/T/mri-8a2e314a61574ad4/axial_032.png","assets/T/mri-8a2e314a61574ad4/axial_034.png","assets/T/mri-8a2e314a61574ad4/axial_036.png","assets/T/mri-8a2e314a61574ad4/axial_038.png","assets/T/mri-8a2e314a61574ad4/axial_040.png","assets/T/mri-8a2e314a61574ad4/coronal_001.png","assets/T/mri-8a2e314a61574ad4/coronal_003.png","assets/T/mri-8a2e314a61574ad4/coronal_005.png","assets/T/mri-8a2e314a61574ad4/coronal_007.png","assets/T/mri-8a2e314a61574ad4/coronal_009.png","assets/T/mri-8a2e314a61574ad4/coronal_011.png","assets/T/mri-8a2e314a61574ad4/coronal_014.png","assets/T/mri-8a2e314a61574ad4/coronal_016.png","assets/T/mri-8a2e314a61574ad4/coronal_018.png","assets/T/mri-8a2e314a61574ad4/coronal_020.png","assets/T/mri-8a2e314a61574ad4/coronal_022.png","assets/T/mri-8a2e314a61574ad4/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-89e6a98ecc3a4c9f","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-89e6a98ecc3a4c9f/axial_001.png","assets/T/mri-89e6a98ecc3a4c9f/axial_003.png","assets/T/mri-89e6a98ecc3a4c9f/axial_005.png","assets/T/mri-89e6a98ecc3a4c9f/axial_007.png","assets/T/mri-89e6a98ecc3a4c9f/axial_009.png","assets/T/mri-89e6a98ecc3a4c9f/axial_011.png","assets/T/mri-89e6a98ecc3a4c9f/axial_013.png","assets/T/mri-89e6a98ecc3a4c9f/axial_015.png","assets/T/mri-89e6a98ecc3a4c9f/axial_017.png","assets/T/mri-89e6a98ecc3a4c9f/axial_019.png","assets/T/mri-89e6a98ecc3a4c9f/axial_022.png","assets/T/mri-89e6a98ecc3a4c9f/axial_024.png","assets/T/mri-89e6a98ecc3a4c9f/axial_026.png","assets/T/mri-89e6a98ecc3a4c9f/axial_028.png","assets/T/mri-89e6a98ecc3a4c9f/axial_030.png","assets/T/mri-89e6a98ecc3a4c9f/axial_032.png","assets/T/mri-89e6a98ecc3a4c9f/axial_034.png","assets/T/mri-89e6a98ecc3a4c9f/axial_036.png","assets/T/mri-89e6a98ecc3a4c9f/axial_038.png","assets/T/mri-89e6a98ecc3a4c9f/axial_040.png","assets/T/mri-89e6a98ecc3a4c9f/axial_042.png","assets/T/mri-89e6a98ecc3a4c9f/coronal_001.png","assets/T/mri-89e6a98ecc3a4c9f/coronal_003.png","assets/T/mri-89e6a98ecc3a4c9f/coronal_005.png","assets/T/mri-89e6a98ecc3a4c9f/coronal_007.png","assets/T/mri-89e6a98ecc3a4c9f/coronal_009.png","assets/T/mri-89e6a98ecc3a4c9f/coronal_011.png","assets/T/mri-89e6a98ecc3a4c9f/coronal_014.png","assets/T/mri-89e6a98ecc3a4c9f/coronal_016.png","assets/T/mri-89e6a98ecc3a4c9f/coronal_018.png","assets/T/mri-89e6a98ecc3a4c9f/coronal_020.png","assets/T/mri-89e6a98ecc3a4c9f/coronal_022.png","assets/T/mri-89e6a98ecc3a4c9f/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-f38067ba8f3f41c6","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 13 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-f38067ba8f3f41c6/axial_001.png","assets/T/mri-f38067ba8f3f41c6/axial_003.png","assets/T/mri-f38067ba8f3f41c6/axial_005.png","assets/T/mri-f38067ba8f3f41c6/axial_007.png","assets/T/mri-f38067ba8f3f41c6/axial_009.png","assets/T/mri-f38067ba8f3f41c6/axial_011.png","assets/T/mri-f38067ba8f3f41c6/axial_013.png","assets/T/mri-f38067ba8f3f41c6/axial_015.png","assets/T/mri-f38067ba8f3f41c6/axial_017.png","assets/T/mri-f38067ba8f3f41c6/axial_019.png","assets/T/mri-f38067ba8f3f41c6/axial_022.png","assets/T/mri-f38067ba8f3f41c6/axial_024.png","assets/T/mri-f38067ba8f3f41c6/axial_026.png","assets/T/mri-f38067ba8f3f41c6/axial_028.png","assets/T/mri-f38067ba8f3f41c6/axial_030.png","assets/T/mri-f38067ba8f3f41c6/axial_032.png","assets/T/mri-f38067ba8f3f41c6/axial_034.png","assets/T/mri-f38067ba8f3f41c6/axial_036.png","assets/T/mri-f38067ba8f3f41c6/axial_038.png","assets/T/mri-f38067ba8f3f41c6/axial_040.png","assets/T/mri-f38067ba8f3f41c6/coronal_001.png","assets/T/mri-f38067ba8f3f41c6/coronal_003.png","assets/T/mri-f38067ba8f3f41c6/coronal_005.png","assets/T/mri-f38067ba8f3f41c6/coronal_007.png","assets/T/mri-f38067ba8f3f41c6/coronal_009.png","assets/T/mri-f38067ba8f3f41c6/coronal_011.png","assets/T/mri-f38067ba8f3f41c6/coronal_014.png","assets/T/mri-f38067ba8f3f41c6/coronal_016.png","assets/T/mri-f38067ba8f3f41c6/coronal_018.png","assets/T/mri-f38067ba8f3f41c6/coronal_020.png","assets/T/mri-f38067ba8f3f41c6/coronal_022.png","assets/T/mri-f38067ba8f3f41c6/coronal_024.png","assets/T/mri-f38067ba8f3f41c6/coronal_026.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-591cf62b9f5c4f41","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 34 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 14 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-591cf62b9f5c4f41/axial_001.png","assets/T/mri-591cf62b9f5c4f41/axial_003.png","assets/T/mri-591cf62b9f5c4f41/axial_005.png","assets/T/mri-591cf62b9f5c4f41/axial_007.png","assets/T/mri-591cf62b9f5c4f41/axial_009.png","assets/T/mri-591cf62b9f5c4f41/axial_011.png","assets/T/mri-591cf62b9f5c4f41/axial_013.png","assets/T/mri-591cf62b9f5c4f41/axial_015.png","assets/T/mri-591cf62b9f5c4f41/axial_017.png","assets/T/mri-591cf62b9f5c4f41/axial_019.png","assets/T/mri-591cf62b9f5c4f41/axial_022.png","assets/T/mri-591cf62b9f5c4f41/axial_024.png","assets/T/mri-591cf62b9f5c4f41/axial_026.png","assets/T/mri-591cf62b9f5c4f41/axial_028.png","assets/T/mri-591cf62b9f5c4f41/axial_030.png","assets/T/mri-591cf62b9f5c4f41/axial_032.png","assets/T/mri-591cf62b9f5c4f41/axial_034.png","assets/T/mri-591cf62b9f5c4f41/axial_036.png","assets/T/mri-591cf62b9f5c4f41/axial_038.png","assets/T/mri-591cf62b9f5c4f41/axial_040.png","assets/T/mri-591cf62b9f5c4f41/coronal_001.png","assets/T/mri-591cf62b9f5c4f41/coronal_003.png","assets/T/mri-591cf62b9f5c4f41/coronal_005.png","assets/T/mri-591cf62b9f5c4f41/coronal_007.png","assets/T/mri-591cf62b9f5c4f41/coronal_009.png","assets/T/mri-591cf62b9f5c4f41/coronal_011.png","assets/T/mri-591cf62b9f5c4f41/coronal_013.png","assets/T/mri-591cf62b9f5c4f41/coronal_016.png","assets/T/mri-591cf62b9f5c4f41/coronal_018.png","assets/T/mri-591cf62b9f5c4f41/coronal_020.png","assets/T/mri-591cf62b9f5c4f41/coronal_022.png","assets/T/mri-591cf62b9f5c4f41/coronal_024.png","assets/T/mri-591cf62b9f5c4f41/coronal_026.png","assets/T/mri-591cf62b9f5c4f41/coronal_028.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":68,"selected_count":34,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,53,56,58,60,62,64,66,68]}}
+{"id":"L3-T300:mri-a1c6c7fdf7e94572","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-a1c6c7fdf7e94572/axial_001.png","assets/T/mri-a1c6c7fdf7e94572/axial_003.png","assets/T/mri-a1c6c7fdf7e94572/axial_005.png","assets/T/mri-a1c6c7fdf7e94572/axial_007.png","assets/T/mri-a1c6c7fdf7e94572/axial_010.png","assets/T/mri-a1c6c7fdf7e94572/axial_012.png","assets/T/mri-a1c6c7fdf7e94572/axial_014.png","assets/T/mri-a1c6c7fdf7e94572/axial_016.png","assets/T/mri-a1c6c7fdf7e94572/axial_018.png","assets/T/mri-a1c6c7fdf7e94572/axial_020.png","assets/T/mri-a1c6c7fdf7e94572/axial_023.png","assets/T/mri-a1c6c7fdf7e94572/axial_025.png","assets/T/mri-a1c6c7fdf7e94572/axial_027.png","assets/T/mri-a1c6c7fdf7e94572/axial_029.png","assets/T/mri-a1c6c7fdf7e94572/axial_031.png","assets/T/mri-a1c6c7fdf7e94572/axial_033.png","assets/T/mri-a1c6c7fdf7e94572/axial_035.png","assets/T/mri-a1c6c7fdf7e94572/axial_038.png","assets/T/mri-a1c6c7fdf7e94572/axial_040.png","assets/T/mri-a1c6c7fdf7e94572/axial_042.png","assets/T/mri-a1c6c7fdf7e94572/axial_044.png","assets/T/mri-a1c6c7fdf7e94572/coronal_001.png","assets/T/mri-a1c6c7fdf7e94572/coronal_003.png","assets/T/mri-a1c6c7fdf7e94572/coronal_005.png","assets/T/mri-a1c6c7fdf7e94572/coronal_007.png","assets/T/mri-a1c6c7fdf7e94572/coronal_009.png","assets/T/mri-a1c6c7fdf7e94572/coronal_011.png","assets/T/mri-a1c6c7fdf7e94572/coronal_014.png","assets/T/mri-a1c6c7fdf7e94572/coronal_016.png","assets/T/mri-a1c6c7fdf7e94572/coronal_018.png","assets/T/mri-a1c6c7fdf7e94572/coronal_020.png","assets/T/mri-a1c6c7fdf7e94572/coronal_022.png","assets/T/mri-a1c6c7fdf7e94572/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":68,"selected_count":33,"source_indices_1based":[1,3,5,7,10,12,14,16,18,20,23,25,27,29,31,33,35,38,40,42,44,45,47,49,51,53,55,58,60,62,64,66,68]}}
+{"id":"L3-T300:mri-ac7e267005f6465a","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-ac7e267005f6465a/axial_001.png","assets/T/mri-ac7e267005f6465a/axial_003.png","assets/T/mri-ac7e267005f6465a/axial_005.png","assets/T/mri-ac7e267005f6465a/axial_007.png","assets/T/mri-ac7e267005f6465a/axial_009.png","assets/T/mri-ac7e267005f6465a/axial_011.png","assets/T/mri-ac7e267005f6465a/axial_013.png","assets/T/mri-ac7e267005f6465a/axial_015.png","assets/T/mri-ac7e267005f6465a/axial_017.png","assets/T/mri-ac7e267005f6465a/axial_019.png","assets/T/mri-ac7e267005f6465a/axial_021.png","assets/T/mri-ac7e267005f6465a/axial_022.png","assets/T/mri-ac7e267005f6465a/axial_024.png","assets/T/mri-ac7e267005f6465a/axial_026.png","assets/T/mri-ac7e267005f6465a/axial_028.png","assets/T/mri-ac7e267005f6465a/axial_030.png","assets/T/mri-ac7e267005f6465a/axial_032.png","assets/T/mri-ac7e267005f6465a/axial_034.png","assets/T/mri-ac7e267005f6465a/axial_036.png","assets/T/mri-ac7e267005f6465a/axial_038.png","assets/T/mri-ac7e267005f6465a/axial_040.png","assets/T/mri-ac7e267005f6465a/coronal_001.png","assets/T/mri-ac7e267005f6465a/coronal_003.png","assets/T/mri-ac7e267005f6465a/coronal_005.png","assets/T/mri-ac7e267005f6465a/coronal_007.png","assets/T/mri-ac7e267005f6465a/coronal_009.png","assets/T/mri-ac7e267005f6465a/coronal_011.png","assets/T/mri-ac7e267005f6465a/coronal_014.png","assets/T/mri-ac7e267005f6465a/coronal_016.png","assets/T/mri-ac7e267005f6465a/coronal_018.png","assets/T/mri-ac7e267005f6465a/coronal_020.png","assets/T/mri-ac7e267005f6465a/coronal_022.png","assets/T/mri-ac7e267005f6465a/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-df899a3786cb48e5","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-df899a3786cb48e5/axial_001.png","assets/T/mri-df899a3786cb48e5/axial_003.png","assets/T/mri-df899a3786cb48e5/axial_005.png","assets/T/mri-df899a3786cb48e5/axial_007.png","assets/T/mri-df899a3786cb48e5/axial_009.png","assets/T/mri-df899a3786cb48e5/axial_011.png","assets/T/mri-df899a3786cb48e5/axial_013.png","assets/T/mri-df899a3786cb48e5/axial_015.png","assets/T/mri-df899a3786cb48e5/axial_017.png","assets/T/mri-df899a3786cb48e5/axial_019.png","assets/T/mri-df899a3786cb48e5/axial_021.png","assets/T/mri-df899a3786cb48e5/axial_022.png","assets/T/mri-df899a3786cb48e5/axial_024.png","assets/T/mri-df899a3786cb48e5/axial_026.png","assets/T/mri-df899a3786cb48e5/axial_028.png","assets/T/mri-df899a3786cb48e5/axial_030.png","assets/T/mri-df899a3786cb48e5/axial_032.png","assets/T/mri-df899a3786cb48e5/axial_034.png","assets/T/mri-df899a3786cb48e5/axial_036.png","assets/T/mri-df899a3786cb48e5/axial_038.png","assets/T/mri-df899a3786cb48e5/axial_040.png","assets/T/mri-df899a3786cb48e5/coronal_001.png","assets/T/mri-df899a3786cb48e5/coronal_003.png","assets/T/mri-df899a3786cb48e5/coronal_005.png","assets/T/mri-df899a3786cb48e5/coronal_007.png","assets/T/mri-df899a3786cb48e5/coronal_009.png","assets/T/mri-df899a3786cb48e5/coronal_011.png","assets/T/mri-df899a3786cb48e5/coronal_014.png","assets/T/mri-df899a3786cb48e5/coronal_016.png","assets/T/mri-df899a3786cb48e5/coronal_018.png","assets/T/mri-df899a3786cb48e5/coronal_020.png","assets/T/mri-df899a3786cb48e5/coronal_022.png","assets/T/mri-df899a3786cb48e5/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-8a31792e1b9548c6","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-8a31792e1b9548c6/axial_001.png","assets/T/mri-8a31792e1b9548c6/axial_003.png","assets/T/mri-8a31792e1b9548c6/axial_005.png","assets/T/mri-8a31792e1b9548c6/axial_007.png","assets/T/mri-8a31792e1b9548c6/axial_009.png","assets/T/mri-8a31792e1b9548c6/axial_011.png","assets/T/mri-8a31792e1b9548c6/axial_013.png","assets/T/mri-8a31792e1b9548c6/axial_015.png","assets/T/mri-8a31792e1b9548c6/axial_017.png","assets/T/mri-8a31792e1b9548c6/axial_019.png","assets/T/mri-8a31792e1b9548c6/axial_022.png","assets/T/mri-8a31792e1b9548c6/axial_024.png","assets/T/mri-8a31792e1b9548c6/axial_026.png","assets/T/mri-8a31792e1b9548c6/axial_028.png","assets/T/mri-8a31792e1b9548c6/axial_030.png","assets/T/mri-8a31792e1b9548c6/axial_032.png","assets/T/mri-8a31792e1b9548c6/axial_034.png","assets/T/mri-8a31792e1b9548c6/axial_036.png","assets/T/mri-8a31792e1b9548c6/axial_038.png","assets/T/mri-8a31792e1b9548c6/axial_040.png","assets/T/mri-8a31792e1b9548c6/axial_042.png","assets/T/mri-8a31792e1b9548c6/coronal_001.png","assets/T/mri-8a31792e1b9548c6/coronal_003.png","assets/T/mri-8a31792e1b9548c6/coronal_005.png","assets/T/mri-8a31792e1b9548c6/coronal_007.png","assets/T/mri-8a31792e1b9548c6/coronal_009.png","assets/T/mri-8a31792e1b9548c6/coronal_011.png","assets/T/mri-8a31792e1b9548c6/coronal_014.png","assets/T/mri-8a31792e1b9548c6/coronal_016.png","assets/T/mri-8a31792e1b9548c6/coronal_018.png","assets/T/mri-8a31792e1b9548c6/coronal_020.png","assets/T/mri-8a31792e1b9548c6/coronal_022.png","assets/T/mri-8a31792e1b9548c6/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-92679901993c443c","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-92679901993c443c/axial_001.png","assets/T/mri-92679901993c443c/axial_003.png","assets/T/mri-92679901993c443c/axial_005.png","assets/T/mri-92679901993c443c/axial_007.png","assets/T/mri-92679901993c443c/axial_009.png","assets/T/mri-92679901993c443c/axial_011.png","assets/T/mri-92679901993c443c/axial_013.png","assets/T/mri-92679901993c443c/axial_015.png","assets/T/mri-92679901993c443c/axial_017.png","assets/T/mri-92679901993c443c/axial_019.png","assets/T/mri-92679901993c443c/axial_022.png","assets/T/mri-92679901993c443c/axial_024.png","assets/T/mri-92679901993c443c/axial_026.png","assets/T/mri-92679901993c443c/axial_028.png","assets/T/mri-92679901993c443c/axial_030.png","assets/T/mri-92679901993c443c/axial_032.png","assets/T/mri-92679901993c443c/axial_034.png","assets/T/mri-92679901993c443c/axial_036.png","assets/T/mri-92679901993c443c/axial_038.png","assets/T/mri-92679901993c443c/axial_040.png","assets/T/mri-92679901993c443c/axial_042.png","assets/T/mri-92679901993c443c/coronal_001.png","assets/T/mri-92679901993c443c/coronal_003.png","assets/T/mri-92679901993c443c/coronal_005.png","assets/T/mri-92679901993c443c/coronal_007.png","assets/T/mri-92679901993c443c/coronal_009.png","assets/T/mri-92679901993c443c/coronal_011.png","assets/T/mri-92679901993c443c/coronal_014.png","assets/T/mri-92679901993c443c/coronal_016.png","assets/T/mri-92679901993c443c/coronal_018.png","assets/T/mri-92679901993c443c/coronal_020.png","assets/T/mri-92679901993c443c/coronal_022.png","assets/T/mri-92679901993c443c/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-47a7dce19f27448f","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 22 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 11 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-47a7dce19f27448f/axial_001.png","assets/T/mri-47a7dce19f27448f/axial_003.png","assets/T/mri-47a7dce19f27448f/axial_005.png","assets/T/mri-47a7dce19f27448f/axial_007.png","assets/T/mri-47a7dce19f27448f/axial_010.png","assets/T/mri-47a7dce19f27448f/axial_012.png","assets/T/mri-47a7dce19f27448f/axial_014.png","assets/T/mri-47a7dce19f27448f/axial_016.png","assets/T/mri-47a7dce19f27448f/axial_018.png","assets/T/mri-47a7dce19f27448f/axial_020.png","assets/T/mri-47a7dce19f27448f/axial_022.png","assets/T/mri-47a7dce19f27448f/axial_025.png","assets/T/mri-47a7dce19f27448f/axial_027.png","assets/T/mri-47a7dce19f27448f/axial_029.png","assets/T/mri-47a7dce19f27448f/axial_031.png","assets/T/mri-47a7dce19f27448f/axial_033.png","assets/T/mri-47a7dce19f27448f/axial_035.png","assets/T/mri-47a7dce19f27448f/axial_037.png","assets/T/mri-47a7dce19f27448f/axial_040.png","assets/T/mri-47a7dce19f27448f/axial_042.png","assets/T/mri-47a7dce19f27448f/axial_044.png","assets/T/mri-47a7dce19f27448f/axial_046.png","assets/T/mri-47a7dce19f27448f/coronal_001.png","assets/T/mri-47a7dce19f27448f/coronal_003.png","assets/T/mri-47a7dce19f27448f/coronal_006.png","assets/T/mri-47a7dce19f27448f/coronal_008.png","assets/T/mri-47a7dce19f27448f/coronal_010.png","assets/T/mri-47a7dce19f27448f/coronal_013.png","assets/T/mri-47a7dce19f27448f/coronal_015.png","assets/T/mri-47a7dce19f27448f/coronal_017.png","assets/T/mri-47a7dce19f27448f/coronal_019.png","assets/T/mri-47a7dce19f27448f/coronal_022.png","assets/T/mri-47a7dce19f27448f/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":70,"selected_count":33,"source_indices_1based":[1,3,5,7,10,12,14,16,18,20,22,25,27,29,31,33,35,37,40,42,44,46,47,49,52,54,56,59,61,63,65,68,70]}}
+{"id":"L3-T300:mri-a099dc17835b4447","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 13 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-a099dc17835b4447/axial_001.png","assets/T/mri-a099dc17835b4447/axial_003.png","assets/T/mri-a099dc17835b4447/axial_005.png","assets/T/mri-a099dc17835b4447/axial_007.png","assets/T/mri-a099dc17835b4447/axial_010.png","assets/T/mri-a099dc17835b4447/axial_012.png","assets/T/mri-a099dc17835b4447/axial_014.png","assets/T/mri-a099dc17835b4447/axial_016.png","assets/T/mri-a099dc17835b4447/axial_018.png","assets/T/mri-a099dc17835b4447/axial_020.png","assets/T/mri-a099dc17835b4447/axial_023.png","assets/T/mri-a099dc17835b4447/axial_025.png","assets/T/mri-a099dc17835b4447/axial_027.png","assets/T/mri-a099dc17835b4447/axial_029.png","assets/T/mri-a099dc17835b4447/axial_031.png","assets/T/mri-a099dc17835b4447/axial_033.png","assets/T/mri-a099dc17835b4447/axial_036.png","assets/T/mri-a099dc17835b4447/axial_038.png","assets/T/mri-a099dc17835b4447/axial_040.png","assets/T/mri-a099dc17835b4447/axial_042.png","assets/T/mri-a099dc17835b4447/coronal_001.png","assets/T/mri-a099dc17835b4447/coronal_003.png","assets/T/mri-a099dc17835b4447/coronal_005.png","assets/T/mri-a099dc17835b4447/coronal_008.png","assets/T/mri-a099dc17835b4447/coronal_010.png","assets/T/mri-a099dc17835b4447/coronal_012.png","assets/T/mri-a099dc17835b4447/coronal_014.png","assets/T/mri-a099dc17835b4447/coronal_016.png","assets/T/mri-a099dc17835b4447/coronal_018.png","assets/T/mri-a099dc17835b4447/coronal_021.png","assets/T/mri-a099dc17835b4447/coronal_023.png","assets/T/mri-a099dc17835b4447/coronal_025.png","assets/T/mri-a099dc17835b4447/coronal_027.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":69,"selected_count":33,"source_indices_1based":[1,3,5,7,10,12,14,16,18,20,23,25,27,29,31,33,36,38,40,42,43,45,47,50,52,54,56,58,60,63,65,67,69]}}
+{"id":"L3-T300:mri-46d4180f5c9b4ea7","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 34 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 14 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-46d4180f5c9b4ea7/axial_001.png","assets/T/mri-46d4180f5c9b4ea7/axial_003.png","assets/T/mri-46d4180f5c9b4ea7/axial_005.png","assets/T/mri-46d4180f5c9b4ea7/axial_007.png","assets/T/mri-46d4180f5c9b4ea7/axial_010.png","assets/T/mri-46d4180f5c9b4ea7/axial_012.png","assets/T/mri-46d4180f5c9b4ea7/axial_014.png","assets/T/mri-46d4180f5c9b4ea7/axial_016.png","assets/T/mri-46d4180f5c9b4ea7/axial_018.png","assets/T/mri-46d4180f5c9b4ea7/axial_020.png","assets/T/mri-46d4180f5c9b4ea7/axial_023.png","assets/T/mri-46d4180f5c9b4ea7/axial_025.png","assets/T/mri-46d4180f5c9b4ea7/axial_027.png","assets/T/mri-46d4180f5c9b4ea7/axial_029.png","assets/T/mri-46d4180f5c9b4ea7/axial_031.png","assets/T/mri-46d4180f5c9b4ea7/axial_033.png","assets/T/mri-46d4180f5c9b4ea7/axial_036.png","assets/T/mri-46d4180f5c9b4ea7/axial_038.png","assets/T/mri-46d4180f5c9b4ea7/axial_040.png","assets/T/mri-46d4180f5c9b4ea7/axial_042.png","assets/T/mri-46d4180f5c9b4ea7/coronal_001.png","assets/T/mri-46d4180f5c9b4ea7/coronal_003.png","assets/T/mri-46d4180f5c9b4ea7/coronal_005.png","assets/T/mri-46d4180f5c9b4ea7/coronal_008.png","assets/T/mri-46d4180f5c9b4ea7/coronal_010.png","assets/T/mri-46d4180f5c9b4ea7/coronal_012.png","assets/T/mri-46d4180f5c9b4ea7/coronal_014.png","assets/T/mri-46d4180f5c9b4ea7/coronal_017.png","assets/T/mri-46d4180f5c9b4ea7/coronal_019.png","assets/T/mri-46d4180f5c9b4ea7/coronal_021.png","assets/T/mri-46d4180f5c9b4ea7/coronal_023.png","assets/T/mri-46d4180f5c9b4ea7/coronal_026.png","assets/T/mri-46d4180f5c9b4ea7/coronal_028.png","assets/T/mri-46d4180f5c9b4ea7/coronal_030.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":72,"selected_count":34,"source_indices_1based":[1,3,5,7,10,12,14,16,18,20,23,25,27,29,31,33,36,38,40,42,43,45,47,50,52,54,56,59,61,63,65,68,70,72]}}
+{"id":"L3-T300:mri-433ebef7edd64a24","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 34 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 14 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-433ebef7edd64a24/axial_001.png","assets/T/mri-433ebef7edd64a24/axial_003.png","assets/T/mri-433ebef7edd64a24/axial_005.png","assets/T/mri-433ebef7edd64a24/axial_007.png","assets/T/mri-433ebef7edd64a24/axial_010.png","assets/T/mri-433ebef7edd64a24/axial_012.png","assets/T/mri-433ebef7edd64a24/axial_014.png","assets/T/mri-433ebef7edd64a24/axial_016.png","assets/T/mri-433ebef7edd64a24/axial_018.png","assets/T/mri-433ebef7edd64a24/axial_020.png","assets/T/mri-433ebef7edd64a24/axial_023.png","assets/T/mri-433ebef7edd64a24/axial_025.png","assets/T/mri-433ebef7edd64a24/axial_027.png","assets/T/mri-433ebef7edd64a24/axial_029.png","assets/T/mri-433ebef7edd64a24/axial_031.png","assets/T/mri-433ebef7edd64a24/axial_033.png","assets/T/mri-433ebef7edd64a24/axial_036.png","assets/T/mri-433ebef7edd64a24/axial_038.png","assets/T/mri-433ebef7edd64a24/axial_040.png","assets/T/mri-433ebef7edd64a24/axial_042.png","assets/T/mri-433ebef7edd64a24/coronal_001.png","assets/T/mri-433ebef7edd64a24/coronal_003.png","assets/T/mri-433ebef7edd64a24/coronal_005.png","assets/T/mri-433ebef7edd64a24/coronal_007.png","assets/T/mri-433ebef7edd64a24/coronal_009.png","assets/T/mri-433ebef7edd64a24/coronal_011.png","assets/T/mri-433ebef7edd64a24/coronal_013.png","assets/T/mri-433ebef7edd64a24/coronal_016.png","assets/T/mri-433ebef7edd64a24/coronal_018.png","assets/T/mri-433ebef7edd64a24/coronal_020.png","assets/T/mri-433ebef7edd64a24/coronal_022.png","assets/T/mri-433ebef7edd64a24/coronal_024.png","assets/T/mri-433ebef7edd64a24/coronal_026.png","assets/T/mri-433ebef7edd64a24/coronal_028.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":70,"selected_count":34,"source_indices_1based":[1,3,5,7,10,12,14,16,18,20,23,25,27,29,31,33,36,38,40,42,43,45,47,49,51,53,55,58,60,62,64,66,68,70]}}
+{"id":"L3-T300:mri-a593896fc6c34499","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-a593896fc6c34499/axial_001.png","assets/T/mri-a593896fc6c34499/axial_003.png","assets/T/mri-a593896fc6c34499/axial_005.png","assets/T/mri-a593896fc6c34499/axial_007.png","assets/T/mri-a593896fc6c34499/axial_010.png","assets/T/mri-a593896fc6c34499/axial_012.png","assets/T/mri-a593896fc6c34499/axial_014.png","assets/T/mri-a593896fc6c34499/axial_016.png","assets/T/mri-a593896fc6c34499/axial_018.png","assets/T/mri-a593896fc6c34499/axial_020.png","assets/T/mri-a593896fc6c34499/axial_023.png","assets/T/mri-a593896fc6c34499/axial_025.png","assets/T/mri-a593896fc6c34499/axial_027.png","assets/T/mri-a593896fc6c34499/axial_029.png","assets/T/mri-a593896fc6c34499/axial_031.png","assets/T/mri-a593896fc6c34499/axial_033.png","assets/T/mri-a593896fc6c34499/axial_035.png","assets/T/mri-a593896fc6c34499/axial_038.png","assets/T/mri-a593896fc6c34499/axial_040.png","assets/T/mri-a593896fc6c34499/axial_042.png","assets/T/mri-a593896fc6c34499/axial_044.png","assets/T/mri-a593896fc6c34499/coronal_001.png","assets/T/mri-a593896fc6c34499/coronal_003.png","assets/T/mri-a593896fc6c34499/coronal_005.png","assets/T/mri-a593896fc6c34499/coronal_007.png","assets/T/mri-a593896fc6c34499/coronal_009.png","assets/T/mri-a593896fc6c34499/coronal_011.png","assets/T/mri-a593896fc6c34499/coronal_014.png","assets/T/mri-a593896fc6c34499/coronal_016.png","assets/T/mri-a593896fc6c34499/coronal_018.png","assets/T/mri-a593896fc6c34499/coronal_020.png","assets/T/mri-a593896fc6c34499/coronal_022.png","assets/T/mri-a593896fc6c34499/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":68,"selected_count":33,"source_indices_1based":[1,3,5,7,10,12,14,16,18,20,23,25,27,29,31,33,35,38,40,42,44,45,47,49,51,53,55,58,60,62,64,66,68]}}
+{"id":"L3-T300:mri-19b78e282ae648fc","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 13 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-19b78e282ae648fc/axial_001.png","assets/T/mri-19b78e282ae648fc/axial_003.png","assets/T/mri-19b78e282ae648fc/axial_005.png","assets/T/mri-19b78e282ae648fc/axial_007.png","assets/T/mri-19b78e282ae648fc/axial_009.png","assets/T/mri-19b78e282ae648fc/axial_011.png","assets/T/mri-19b78e282ae648fc/axial_013.png","assets/T/mri-19b78e282ae648fc/axial_015.png","assets/T/mri-19b78e282ae648fc/axial_017.png","assets/T/mri-19b78e282ae648fc/axial_019.png","assets/T/mri-19b78e282ae648fc/axial_020.png","assets/T/mri-19b78e282ae648fc/axial_022.png","assets/T/mri-19b78e282ae648fc/axial_024.png","assets/T/mri-19b78e282ae648fc/axial_026.png","assets/T/mri-19b78e282ae648fc/axial_028.png","assets/T/mri-19b78e282ae648fc/axial_030.png","assets/T/mri-19b78e282ae648fc/axial_032.png","assets/T/mri-19b78e282ae648fc/axial_034.png","assets/T/mri-19b78e282ae648fc/axial_036.png","assets/T/mri-19b78e282ae648fc/axial_038.png","assets/T/mri-19b78e282ae648fc/coronal_001.png","assets/T/mri-19b78e282ae648fc/coronal_003.png","assets/T/mri-19b78e282ae648fc/coronal_005.png","assets/T/mri-19b78e282ae648fc/coronal_007.png","assets/T/mri-19b78e282ae648fc/coronal_009.png","assets/T/mri-19b78e282ae648fc/coronal_011.png","assets/T/mri-19b78e282ae648fc/coronal_013.png","assets/T/mri-19b78e282ae648fc/coronal_014.png","assets/T/mri-19b78e282ae648fc/coronal_016.png","assets/T/mri-19b78e282ae648fc/coronal_018.png","assets/T/mri-19b78e282ae648fc/coronal_020.png","assets/T/mri-19b78e282ae648fc/coronal_022.png","assets/T/mri-19b78e282ae648fc/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":62,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,20,22,24,26,28,30,32,34,36,38,39,41,43,45,47,49,51,52,54,56,58,60,62]}}
+{"id":"L3-T300:mri-77d61075f19a4a7e","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 13 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-77d61075f19a4a7e/axial_001.png","assets/T/mri-77d61075f19a4a7e/axial_003.png","assets/T/mri-77d61075f19a4a7e/axial_005.png","assets/T/mri-77d61075f19a4a7e/axial_007.png","assets/T/mri-77d61075f19a4a7e/axial_009.png","assets/T/mri-77d61075f19a4a7e/axial_011.png","assets/T/mri-77d61075f19a4a7e/axial_013.png","assets/T/mri-77d61075f19a4a7e/axial_015.png","assets/T/mri-77d61075f19a4a7e/axial_017.png","assets/T/mri-77d61075f19a4a7e/axial_019.png","assets/T/mri-77d61075f19a4a7e/axial_020.png","assets/T/mri-77d61075f19a4a7e/axial_022.png","assets/T/mri-77d61075f19a4a7e/axial_024.png","assets/T/mri-77d61075f19a4a7e/axial_026.png","assets/T/mri-77d61075f19a4a7e/axial_028.png","assets/T/mri-77d61075f19a4a7e/axial_030.png","assets/T/mri-77d61075f19a4a7e/axial_032.png","assets/T/mri-77d61075f19a4a7e/axial_034.png","assets/T/mri-77d61075f19a4a7e/axial_036.png","assets/T/mri-77d61075f19a4a7e/axial_038.png","assets/T/mri-77d61075f19a4a7e/coronal_001.png","assets/T/mri-77d61075f19a4a7e/coronal_003.png","assets/T/mri-77d61075f19a4a7e/coronal_005.png","assets/T/mri-77d61075f19a4a7e/coronal_007.png","assets/T/mri-77d61075f19a4a7e/coronal_009.png","assets/T/mri-77d61075f19a4a7e/coronal_011.png","assets/T/mri-77d61075f19a4a7e/coronal_013.png","assets/T/mri-77d61075f19a4a7e/coronal_014.png","assets/T/mri-77d61075f19a4a7e/coronal_016.png","assets/T/mri-77d61075f19a4a7e/coronal_018.png","assets/T/mri-77d61075f19a4a7e/coronal_020.png","assets/T/mri-77d61075f19a4a7e/coronal_022.png","assets/T/mri-77d61075f19a4a7e/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":62,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,20,22,24,26,28,30,32,34,36,38,39,41,43,45,47,49,51,52,54,56,58,60,62]}}
+{"id":"L3-T300:mri-531b90fa4b7b430c","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-531b90fa4b7b430c/axial_001.png","assets/T/mri-531b90fa4b7b430c/axial_003.png","assets/T/mri-531b90fa4b7b430c/axial_005.png","assets/T/mri-531b90fa4b7b430c/axial_007.png","assets/T/mri-531b90fa4b7b430c/axial_009.png","assets/T/mri-531b90fa4b7b430c/axial_011.png","assets/T/mri-531b90fa4b7b430c/axial_013.png","assets/T/mri-531b90fa4b7b430c/axial_015.png","assets/T/mri-531b90fa4b7b430c/axial_017.png","assets/T/mri-531b90fa4b7b430c/axial_019.png","assets/T/mri-531b90fa4b7b430c/axial_022.png","assets/T/mri-531b90fa4b7b430c/axial_024.png","assets/T/mri-531b90fa4b7b430c/axial_026.png","assets/T/mri-531b90fa4b7b430c/axial_028.png","assets/T/mri-531b90fa4b7b430c/axial_030.png","assets/T/mri-531b90fa4b7b430c/axial_032.png","assets/T/mri-531b90fa4b7b430c/axial_034.png","assets/T/mri-531b90fa4b7b430c/axial_036.png","assets/T/mri-531b90fa4b7b430c/axial_038.png","assets/T/mri-531b90fa4b7b430c/axial_040.png","assets/T/mri-531b90fa4b7b430c/axial_042.png","assets/T/mri-531b90fa4b7b430c/coronal_001.png","assets/T/mri-531b90fa4b7b430c/coronal_003.png","assets/T/mri-531b90fa4b7b430c/coronal_005.png","assets/T/mri-531b90fa4b7b430c/coronal_007.png","assets/T/mri-531b90fa4b7b430c/coronal_009.png","assets/T/mri-531b90fa4b7b430c/coronal_011.png","assets/T/mri-531b90fa4b7b430c/coronal_014.png","assets/T/mri-531b90fa4b7b430c/coronal_016.png","assets/T/mri-531b90fa4b7b430c/coronal_018.png","assets/T/mri-531b90fa4b7b430c/coronal_020.png","assets/T/mri-531b90fa4b7b430c/coronal_022.png","assets/T/mri-531b90fa4b7b430c/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-3fef1b1edce94fa6","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-3fef1b1edce94fa6/axial_001.png","assets/T/mri-3fef1b1edce94fa6/axial_003.png","assets/T/mri-3fef1b1edce94fa6/axial_005.png","assets/T/mri-3fef1b1edce94fa6/axial_007.png","assets/T/mri-3fef1b1edce94fa6/axial_009.png","assets/T/mri-3fef1b1edce94fa6/axial_011.png","assets/T/mri-3fef1b1edce94fa6/axial_013.png","assets/T/mri-3fef1b1edce94fa6/axial_015.png","assets/T/mri-3fef1b1edce94fa6/axial_017.png","assets/T/mri-3fef1b1edce94fa6/axial_019.png","assets/T/mri-3fef1b1edce94fa6/axial_021.png","assets/T/mri-3fef1b1edce94fa6/axial_022.png","assets/T/mri-3fef1b1edce94fa6/axial_024.png","assets/T/mri-3fef1b1edce94fa6/axial_026.png","assets/T/mri-3fef1b1edce94fa6/axial_028.png","assets/T/mri-3fef1b1edce94fa6/axial_030.png","assets/T/mri-3fef1b1edce94fa6/axial_032.png","assets/T/mri-3fef1b1edce94fa6/axial_034.png","assets/T/mri-3fef1b1edce94fa6/axial_036.png","assets/T/mri-3fef1b1edce94fa6/axial_038.png","assets/T/mri-3fef1b1edce94fa6/axial_040.png","assets/T/mri-3fef1b1edce94fa6/coronal_001.png","assets/T/mri-3fef1b1edce94fa6/coronal_003.png","assets/T/mri-3fef1b1edce94fa6/coronal_005.png","assets/T/mri-3fef1b1edce94fa6/coronal_007.png","assets/T/mri-3fef1b1edce94fa6/coronal_009.png","assets/T/mri-3fef1b1edce94fa6/coronal_011.png","assets/T/mri-3fef1b1edce94fa6/coronal_014.png","assets/T/mri-3fef1b1edce94fa6/coronal_016.png","assets/T/mri-3fef1b1edce94fa6/coronal_018.png","assets/T/mri-3fef1b1edce94fa6/coronal_020.png","assets/T/mri-3fef1b1edce94fa6/coronal_022.png","assets/T/mri-3fef1b1edce94fa6/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-960fac01b62540bb","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 34 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 14 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-960fac01b62540bb/axial_001.png","assets/T/mri-960fac01b62540bb/axial_003.png","assets/T/mri-960fac01b62540bb/axial_005.png","assets/T/mri-960fac01b62540bb/axial_007.png","assets/T/mri-960fac01b62540bb/axial_009.png","assets/T/mri-960fac01b62540bb/axial_011.png","assets/T/mri-960fac01b62540bb/axial_013.png","assets/T/mri-960fac01b62540bb/axial_015.png","assets/T/mri-960fac01b62540bb/axial_017.png","assets/T/mri-960fac01b62540bb/axial_019.png","assets/T/mri-960fac01b62540bb/axial_020.png","assets/T/mri-960fac01b62540bb/axial_022.png","assets/T/mri-960fac01b62540bb/axial_024.png","assets/T/mri-960fac01b62540bb/axial_026.png","assets/T/mri-960fac01b62540bb/axial_028.png","assets/T/mri-960fac01b62540bb/axial_030.png","assets/T/mri-960fac01b62540bb/axial_032.png","assets/T/mri-960fac01b62540bb/axial_034.png","assets/T/mri-960fac01b62540bb/axial_036.png","assets/T/mri-960fac01b62540bb/axial_038.png","assets/T/mri-960fac01b62540bb/coronal_001.png","assets/T/mri-960fac01b62540bb/coronal_003.png","assets/T/mri-960fac01b62540bb/coronal_005.png","assets/T/mri-960fac01b62540bb/coronal_007.png","assets/T/mri-960fac01b62540bb/coronal_009.png","assets/T/mri-960fac01b62540bb/coronal_011.png","assets/T/mri-960fac01b62540bb/coronal_013.png","assets/T/mri-960fac01b62540bb/coronal_014.png","assets/T/mri-960fac01b62540bb/coronal_016.png","assets/T/mri-960fac01b62540bb/coronal_018.png","assets/T/mri-960fac01b62540bb/coronal_020.png","assets/T/mri-960fac01b62540bb/coronal_022.png","assets/T/mri-960fac01b62540bb/coronal_024.png","assets/T/mri-960fac01b62540bb/coronal_026.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":34,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,20,22,24,26,28,30,32,34,36,38,39,41,43,45,47,49,51,52,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-f3c7c9ffe2254cce","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-f3c7c9ffe2254cce/axial_001.png","assets/T/mri-f3c7c9ffe2254cce/axial_003.png","assets/T/mri-f3c7c9ffe2254cce/axial_005.png","assets/T/mri-f3c7c9ffe2254cce/axial_007.png","assets/T/mri-f3c7c9ffe2254cce/axial_010.png","assets/T/mri-f3c7c9ffe2254cce/axial_012.png","assets/T/mri-f3c7c9ffe2254cce/axial_014.png","assets/T/mri-f3c7c9ffe2254cce/axial_016.png","assets/T/mri-f3c7c9ffe2254cce/axial_018.png","assets/T/mri-f3c7c9ffe2254cce/axial_020.png","assets/T/mri-f3c7c9ffe2254cce/axial_023.png","assets/T/mri-f3c7c9ffe2254cce/axial_025.png","assets/T/mri-f3c7c9ffe2254cce/axial_027.png","assets/T/mri-f3c7c9ffe2254cce/axial_029.png","assets/T/mri-f3c7c9ffe2254cce/axial_031.png","assets/T/mri-f3c7c9ffe2254cce/axial_033.png","assets/T/mri-f3c7c9ffe2254cce/axial_035.png","assets/T/mri-f3c7c9ffe2254cce/axial_038.png","assets/T/mri-f3c7c9ffe2254cce/axial_040.png","assets/T/mri-f3c7c9ffe2254cce/axial_042.png","assets/T/mri-f3c7c9ffe2254cce/axial_044.png","assets/T/mri-f3c7c9ffe2254cce/coronal_001.png","assets/T/mri-f3c7c9ffe2254cce/coronal_003.png","assets/T/mri-f3c7c9ffe2254cce/coronal_006.png","assets/T/mri-f3c7c9ffe2254cce/coronal_008.png","assets/T/mri-f3c7c9ffe2254cce/coronal_010.png","assets/T/mri-f3c7c9ffe2254cce/coronal_012.png","assets/T/mri-f3c7c9ffe2254cce/coronal_015.png","assets/T/mri-f3c7c9ffe2254cce/coronal_017.png","assets/T/mri-f3c7c9ffe2254cce/coronal_019.png","assets/T/mri-f3c7c9ffe2254cce/coronal_021.png","assets/T/mri-f3c7c9ffe2254cce/coronal_024.png","assets/T/mri-f3c7c9ffe2254cce/coronal_026.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":70,"selected_count":33,"source_indices_1based":[1,3,5,7,10,12,14,16,18,20,23,25,27,29,31,33,35,38,40,42,44,45,47,50,52,54,56,59,61,63,65,68,70]}}
+{"id":"L3-T300:mri-9be1862b768f4779","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-9be1862b768f4779/axial_001.png","assets/T/mri-9be1862b768f4779/axial_003.png","assets/T/mri-9be1862b768f4779/axial_005.png","assets/T/mri-9be1862b768f4779/axial_007.png","assets/T/mri-9be1862b768f4779/axial_009.png","assets/T/mri-9be1862b768f4779/axial_011.png","assets/T/mri-9be1862b768f4779/axial_013.png","assets/T/mri-9be1862b768f4779/axial_015.png","assets/T/mri-9be1862b768f4779/axial_017.png","assets/T/mri-9be1862b768f4779/axial_019.png","assets/T/mri-9be1862b768f4779/axial_022.png","assets/T/mri-9be1862b768f4779/axial_024.png","assets/T/mri-9be1862b768f4779/axial_026.png","assets/T/mri-9be1862b768f4779/axial_028.png","assets/T/mri-9be1862b768f4779/axial_030.png","assets/T/mri-9be1862b768f4779/axial_032.png","assets/T/mri-9be1862b768f4779/axial_034.png","assets/T/mri-9be1862b768f4779/axial_036.png","assets/T/mri-9be1862b768f4779/axial_038.png","assets/T/mri-9be1862b768f4779/axial_040.png","assets/T/mri-9be1862b768f4779/axial_042.png","assets/T/mri-9be1862b768f4779/coronal_001.png","assets/T/mri-9be1862b768f4779/coronal_003.png","assets/T/mri-9be1862b768f4779/coronal_005.png","assets/T/mri-9be1862b768f4779/coronal_007.png","assets/T/mri-9be1862b768f4779/coronal_009.png","assets/T/mri-9be1862b768f4779/coronal_011.png","assets/T/mri-9be1862b768f4779/coronal_014.png","assets/T/mri-9be1862b768f4779/coronal_016.png","assets/T/mri-9be1862b768f4779/coronal_018.png","assets/T/mri-9be1862b768f4779/coronal_020.png","assets/T/mri-9be1862b768f4779/coronal_022.png","assets/T/mri-9be1862b768f4779/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-27888c92886445dd","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-27888c92886445dd/axial_001.png","assets/T/mri-27888c92886445dd/axial_003.png","assets/T/mri-27888c92886445dd/axial_005.png","assets/T/mri-27888c92886445dd/axial_007.png","assets/T/mri-27888c92886445dd/axial_009.png","assets/T/mri-27888c92886445dd/axial_011.png","assets/T/mri-27888c92886445dd/axial_013.png","assets/T/mri-27888c92886445dd/axial_015.png","assets/T/mri-27888c92886445dd/axial_017.png","assets/T/mri-27888c92886445dd/axial_019.png","assets/T/mri-27888c92886445dd/axial_021.png","assets/T/mri-27888c92886445dd/axial_022.png","assets/T/mri-27888c92886445dd/axial_024.png","assets/T/mri-27888c92886445dd/axial_026.png","assets/T/mri-27888c92886445dd/axial_028.png","assets/T/mri-27888c92886445dd/axial_030.png","assets/T/mri-27888c92886445dd/axial_032.png","assets/T/mri-27888c92886445dd/axial_034.png","assets/T/mri-27888c92886445dd/axial_036.png","assets/T/mri-27888c92886445dd/axial_038.png","assets/T/mri-27888c92886445dd/axial_040.png","assets/T/mri-27888c92886445dd/coronal_001.png","assets/T/mri-27888c92886445dd/coronal_003.png","assets/T/mri-27888c92886445dd/coronal_005.png","assets/T/mri-27888c92886445dd/coronal_007.png","assets/T/mri-27888c92886445dd/coronal_009.png","assets/T/mri-27888c92886445dd/coronal_011.png","assets/T/mri-27888c92886445dd/coronal_014.png","assets/T/mri-27888c92886445dd/coronal_016.png","assets/T/mri-27888c92886445dd/coronal_018.png","assets/T/mri-27888c92886445dd/coronal_020.png","assets/T/mri-27888c92886445dd/coronal_022.png","assets/T/mri-27888c92886445dd/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-52bc4d5404e34274","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-52bc4d5404e34274/axial_001.png","assets/T/mri-52bc4d5404e34274/axial_003.png","assets/T/mri-52bc4d5404e34274/axial_005.png","assets/T/mri-52bc4d5404e34274/axial_007.png","assets/T/mri-52bc4d5404e34274/axial_009.png","assets/T/mri-52bc4d5404e34274/axial_011.png","assets/T/mri-52bc4d5404e34274/axial_013.png","assets/T/mri-52bc4d5404e34274/axial_015.png","assets/T/mri-52bc4d5404e34274/axial_017.png","assets/T/mri-52bc4d5404e34274/axial_019.png","assets/T/mri-52bc4d5404e34274/axial_022.png","assets/T/mri-52bc4d5404e34274/axial_024.png","assets/T/mri-52bc4d5404e34274/axial_026.png","assets/T/mri-52bc4d5404e34274/axial_028.png","assets/T/mri-52bc4d5404e34274/axial_030.png","assets/T/mri-52bc4d5404e34274/axial_032.png","assets/T/mri-52bc4d5404e34274/axial_034.png","assets/T/mri-52bc4d5404e34274/axial_036.png","assets/T/mri-52bc4d5404e34274/axial_038.png","assets/T/mri-52bc4d5404e34274/axial_040.png","assets/T/mri-52bc4d5404e34274/axial_042.png","assets/T/mri-52bc4d5404e34274/coronal_001.png","assets/T/mri-52bc4d5404e34274/coronal_003.png","assets/T/mri-52bc4d5404e34274/coronal_005.png","assets/T/mri-52bc4d5404e34274/coronal_007.png","assets/T/mri-52bc4d5404e34274/coronal_009.png","assets/T/mri-52bc4d5404e34274/coronal_011.png","assets/T/mri-52bc4d5404e34274/coronal_014.png","assets/T/mri-52bc4d5404e34274/coronal_016.png","assets/T/mri-52bc4d5404e34274/coronal_018.png","assets/T/mri-52bc4d5404e34274/coronal_020.png","assets/T/mri-52bc4d5404e34274/coronal_022.png","assets/T/mri-52bc4d5404e34274/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-5893d155cf924e90","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-5893d155cf924e90/axial_001.png","assets/T/mri-5893d155cf924e90/axial_003.png","assets/T/mri-5893d155cf924e90/axial_005.png","assets/T/mri-5893d155cf924e90/axial_007.png","assets/T/mri-5893d155cf924e90/axial_010.png","assets/T/mri-5893d155cf924e90/axial_012.png","assets/T/mri-5893d155cf924e90/axial_014.png","assets/T/mri-5893d155cf924e90/axial_016.png","assets/T/mri-5893d155cf924e90/axial_018.png","assets/T/mri-5893d155cf924e90/axial_020.png","assets/T/mri-5893d155cf924e90/axial_023.png","assets/T/mri-5893d155cf924e90/axial_025.png","assets/T/mri-5893d155cf924e90/axial_027.png","assets/T/mri-5893d155cf924e90/axial_029.png","assets/T/mri-5893d155cf924e90/axial_031.png","assets/T/mri-5893d155cf924e90/axial_033.png","assets/T/mri-5893d155cf924e90/axial_035.png","assets/T/mri-5893d155cf924e90/axial_038.png","assets/T/mri-5893d155cf924e90/axial_040.png","assets/T/mri-5893d155cf924e90/axial_042.png","assets/T/mri-5893d155cf924e90/axial_044.png","assets/T/mri-5893d155cf924e90/coronal_001.png","assets/T/mri-5893d155cf924e90/coronal_003.png","assets/T/mri-5893d155cf924e90/coronal_005.png","assets/T/mri-5893d155cf924e90/coronal_007.png","assets/T/mri-5893d155cf924e90/coronal_009.png","assets/T/mri-5893d155cf924e90/coronal_011.png","assets/T/mri-5893d155cf924e90/coronal_014.png","assets/T/mri-5893d155cf924e90/coronal_016.png","assets/T/mri-5893d155cf924e90/coronal_018.png","assets/T/mri-5893d155cf924e90/coronal_020.png","assets/T/mri-5893d155cf924e90/coronal_022.png","assets/T/mri-5893d155cf924e90/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":68,"selected_count":33,"source_indices_1based":[1,3,5,7,10,12,14,16,18,20,23,25,27,29,31,33,35,38,40,42,44,45,47,49,51,53,55,58,60,62,64,66,68]}}
+{"id":"L3-T300:mri-55ee2875d8c74396","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-55ee2875d8c74396/axial_001.png","assets/T/mri-55ee2875d8c74396/axial_003.png","assets/T/mri-55ee2875d8c74396/axial_005.png","assets/T/mri-55ee2875d8c74396/axial_007.png","assets/T/mri-55ee2875d8c74396/axial_009.png","assets/T/mri-55ee2875d8c74396/axial_011.png","assets/T/mri-55ee2875d8c74396/axial_013.png","assets/T/mri-55ee2875d8c74396/axial_015.png","assets/T/mri-55ee2875d8c74396/axial_017.png","assets/T/mri-55ee2875d8c74396/axial_019.png","assets/T/mri-55ee2875d8c74396/axial_022.png","assets/T/mri-55ee2875d8c74396/axial_024.png","assets/T/mri-55ee2875d8c74396/axial_026.png","assets/T/mri-55ee2875d8c74396/axial_028.png","assets/T/mri-55ee2875d8c74396/axial_030.png","assets/T/mri-55ee2875d8c74396/axial_032.png","assets/T/mri-55ee2875d8c74396/axial_034.png","assets/T/mri-55ee2875d8c74396/axial_036.png","assets/T/mri-55ee2875d8c74396/axial_038.png","assets/T/mri-55ee2875d8c74396/axial_040.png","assets/T/mri-55ee2875d8c74396/axial_042.png","assets/T/mri-55ee2875d8c74396/coronal_001.png","assets/T/mri-55ee2875d8c74396/coronal_003.png","assets/T/mri-55ee2875d8c74396/coronal_005.png","assets/T/mri-55ee2875d8c74396/coronal_007.png","assets/T/mri-55ee2875d8c74396/coronal_009.png","assets/T/mri-55ee2875d8c74396/coronal_011.png","assets/T/mri-55ee2875d8c74396/coronal_014.png","assets/T/mri-55ee2875d8c74396/coronal_016.png","assets/T/mri-55ee2875d8c74396/coronal_018.png","assets/T/mri-55ee2875d8c74396/coronal_020.png","assets/T/mri-55ee2875d8c74396/coronal_022.png","assets/T/mri-55ee2875d8c74396/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-009d069830a941cc","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 13 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-009d069830a941cc/axial_001.png","assets/T/mri-009d069830a941cc/axial_003.png","assets/T/mri-009d069830a941cc/axial_005.png","assets/T/mri-009d069830a941cc/axial_007.png","assets/T/mri-009d069830a941cc/axial_009.png","assets/T/mri-009d069830a941cc/axial_011.png","assets/T/mri-009d069830a941cc/axial_013.png","assets/T/mri-009d069830a941cc/axial_015.png","assets/T/mri-009d069830a941cc/axial_017.png","assets/T/mri-009d069830a941cc/axial_019.png","assets/T/mri-009d069830a941cc/axial_020.png","assets/T/mri-009d069830a941cc/axial_022.png","assets/T/mri-009d069830a941cc/axial_024.png","assets/T/mri-009d069830a941cc/axial_026.png","assets/T/mri-009d069830a941cc/axial_028.png","assets/T/mri-009d069830a941cc/axial_030.png","assets/T/mri-009d069830a941cc/axial_032.png","assets/T/mri-009d069830a941cc/axial_034.png","assets/T/mri-009d069830a941cc/axial_036.png","assets/T/mri-009d069830a941cc/axial_038.png","assets/T/mri-009d069830a941cc/coronal_001.png","assets/T/mri-009d069830a941cc/coronal_003.png","assets/T/mri-009d069830a941cc/coronal_005.png","assets/T/mri-009d069830a941cc/coronal_007.png","assets/T/mri-009d069830a941cc/coronal_009.png","assets/T/mri-009d069830a941cc/coronal_011.png","assets/T/mri-009d069830a941cc/coronal_013.png","assets/T/mri-009d069830a941cc/coronal_014.png","assets/T/mri-009d069830a941cc/coronal_016.png","assets/T/mri-009d069830a941cc/coronal_018.png","assets/T/mri-009d069830a941cc/coronal_020.png","assets/T/mri-009d069830a941cc/coronal_022.png","assets/T/mri-009d069830a941cc/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":62,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,20,22,24,26,28,30,32,34,36,38,39,41,43,45,47,49,51,52,54,56,58,60,62]}}
+{"id":"L3-T300:mri-5927ca297b614ffd","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-5927ca297b614ffd/axial_001.png","assets/T/mri-5927ca297b614ffd/axial_003.png","assets/T/mri-5927ca297b614ffd/axial_005.png","assets/T/mri-5927ca297b614ffd/axial_007.png","assets/T/mri-5927ca297b614ffd/axial_009.png","assets/T/mri-5927ca297b614ffd/axial_011.png","assets/T/mri-5927ca297b614ffd/axial_013.png","assets/T/mri-5927ca297b614ffd/axial_015.png","assets/T/mri-5927ca297b614ffd/axial_017.png","assets/T/mri-5927ca297b614ffd/axial_019.png","assets/T/mri-5927ca297b614ffd/axial_021.png","assets/T/mri-5927ca297b614ffd/axial_022.png","assets/T/mri-5927ca297b614ffd/axial_024.png","assets/T/mri-5927ca297b614ffd/axial_026.png","assets/T/mri-5927ca297b614ffd/axial_028.png","assets/T/mri-5927ca297b614ffd/axial_030.png","assets/T/mri-5927ca297b614ffd/axial_032.png","assets/T/mri-5927ca297b614ffd/axial_034.png","assets/T/mri-5927ca297b614ffd/axial_036.png","assets/T/mri-5927ca297b614ffd/axial_038.png","assets/T/mri-5927ca297b614ffd/axial_040.png","assets/T/mri-5927ca297b614ffd/coronal_001.png","assets/T/mri-5927ca297b614ffd/coronal_003.png","assets/T/mri-5927ca297b614ffd/coronal_005.png","assets/T/mri-5927ca297b614ffd/coronal_007.png","assets/T/mri-5927ca297b614ffd/coronal_009.png","assets/T/mri-5927ca297b614ffd/coronal_011.png","assets/T/mri-5927ca297b614ffd/coronal_014.png","assets/T/mri-5927ca297b614ffd/coronal_016.png","assets/T/mri-5927ca297b614ffd/coronal_018.png","assets/T/mri-5927ca297b614ffd/coronal_020.png","assets/T/mri-5927ca297b614ffd/coronal_022.png","assets/T/mri-5927ca297b614ffd/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-a5b56fee006e4280","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-a5b56fee006e4280/axial_001.png","assets/T/mri-a5b56fee006e4280/axial_003.png","assets/T/mri-a5b56fee006e4280/axial_005.png","assets/T/mri-a5b56fee006e4280/axial_007.png","assets/T/mri-a5b56fee006e4280/axial_009.png","assets/T/mri-a5b56fee006e4280/axial_011.png","assets/T/mri-a5b56fee006e4280/axial_013.png","assets/T/mri-a5b56fee006e4280/axial_015.png","assets/T/mri-a5b56fee006e4280/axial_017.png","assets/T/mri-a5b56fee006e4280/axial_019.png","assets/T/mri-a5b56fee006e4280/axial_021.png","assets/T/mri-a5b56fee006e4280/axial_022.png","assets/T/mri-a5b56fee006e4280/axial_024.png","assets/T/mri-a5b56fee006e4280/axial_026.png","assets/T/mri-a5b56fee006e4280/axial_028.png","assets/T/mri-a5b56fee006e4280/axial_030.png","assets/T/mri-a5b56fee006e4280/axial_032.png","assets/T/mri-a5b56fee006e4280/axial_034.png","assets/T/mri-a5b56fee006e4280/axial_036.png","assets/T/mri-a5b56fee006e4280/axial_038.png","assets/T/mri-a5b56fee006e4280/axial_040.png","assets/T/mri-a5b56fee006e4280/coronal_001.png","assets/T/mri-a5b56fee006e4280/coronal_003.png","assets/T/mri-a5b56fee006e4280/coronal_005.png","assets/T/mri-a5b56fee006e4280/coronal_007.png","assets/T/mri-a5b56fee006e4280/coronal_009.png","assets/T/mri-a5b56fee006e4280/coronal_011.png","assets/T/mri-a5b56fee006e4280/coronal_014.png","assets/T/mri-a5b56fee006e4280/coronal_016.png","assets/T/mri-a5b56fee006e4280/coronal_018.png","assets/T/mri-a5b56fee006e4280/coronal_020.png","assets/T/mri-a5b56fee006e4280/coronal_022.png","assets/T/mri-a5b56fee006e4280/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-db4b9a10a3444950","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-db4b9a10a3444950/axial_001.png","assets/T/mri-db4b9a10a3444950/axial_003.png","assets/T/mri-db4b9a10a3444950/axial_005.png","assets/T/mri-db4b9a10a3444950/axial_007.png","assets/T/mri-db4b9a10a3444950/axial_009.png","assets/T/mri-db4b9a10a3444950/axial_011.png","assets/T/mri-db4b9a10a3444950/axial_013.png","assets/T/mri-db4b9a10a3444950/axial_015.png","assets/T/mri-db4b9a10a3444950/axial_017.png","assets/T/mri-db4b9a10a3444950/axial_019.png","assets/T/mri-db4b9a10a3444950/axial_021.png","assets/T/mri-db4b9a10a3444950/axial_022.png","assets/T/mri-db4b9a10a3444950/axial_024.png","assets/T/mri-db4b9a10a3444950/axial_026.png","assets/T/mri-db4b9a10a3444950/axial_028.png","assets/T/mri-db4b9a10a3444950/axial_030.png","assets/T/mri-db4b9a10a3444950/axial_032.png","assets/T/mri-db4b9a10a3444950/axial_034.png","assets/T/mri-db4b9a10a3444950/axial_036.png","assets/T/mri-db4b9a10a3444950/axial_038.png","assets/T/mri-db4b9a10a3444950/axial_040.png","assets/T/mri-db4b9a10a3444950/coronal_001.png","assets/T/mri-db4b9a10a3444950/coronal_003.png","assets/T/mri-db4b9a10a3444950/coronal_005.png","assets/T/mri-db4b9a10a3444950/coronal_007.png","assets/T/mri-db4b9a10a3444950/coronal_009.png","assets/T/mri-db4b9a10a3444950/coronal_011.png","assets/T/mri-db4b9a10a3444950/coronal_014.png","assets/T/mri-db4b9a10a3444950/coronal_016.png","assets/T/mri-db4b9a10a3444950/coronal_018.png","assets/T/mri-db4b9a10a3444950/coronal_020.png","assets/T/mri-db4b9a10a3444950/coronal_022.png","assets/T/mri-db4b9a10a3444950/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-ec4156cac1c84d7f","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-ec4156cac1c84d7f/axial_001.png","assets/T/mri-ec4156cac1c84d7f/axial_003.png","assets/T/mri-ec4156cac1c84d7f/axial_005.png","assets/T/mri-ec4156cac1c84d7f/axial_007.png","assets/T/mri-ec4156cac1c84d7f/axial_009.png","assets/T/mri-ec4156cac1c84d7f/axial_011.png","assets/T/mri-ec4156cac1c84d7f/axial_013.png","assets/T/mri-ec4156cac1c84d7f/axial_015.png","assets/T/mri-ec4156cac1c84d7f/axial_017.png","assets/T/mri-ec4156cac1c84d7f/axial_019.png","assets/T/mri-ec4156cac1c84d7f/axial_022.png","assets/T/mri-ec4156cac1c84d7f/axial_024.png","assets/T/mri-ec4156cac1c84d7f/axial_026.png","assets/T/mri-ec4156cac1c84d7f/axial_028.png","assets/T/mri-ec4156cac1c84d7f/axial_030.png","assets/T/mri-ec4156cac1c84d7f/axial_032.png","assets/T/mri-ec4156cac1c84d7f/axial_034.png","assets/T/mri-ec4156cac1c84d7f/axial_036.png","assets/T/mri-ec4156cac1c84d7f/axial_038.png","assets/T/mri-ec4156cac1c84d7f/axial_040.png","assets/T/mri-ec4156cac1c84d7f/axial_042.png","assets/T/mri-ec4156cac1c84d7f/coronal_001.png","assets/T/mri-ec4156cac1c84d7f/coronal_003.png","assets/T/mri-ec4156cac1c84d7f/coronal_005.png","assets/T/mri-ec4156cac1c84d7f/coronal_007.png","assets/T/mri-ec4156cac1c84d7f/coronal_009.png","assets/T/mri-ec4156cac1c84d7f/coronal_011.png","assets/T/mri-ec4156cac1c84d7f/coronal_014.png","assets/T/mri-ec4156cac1c84d7f/coronal_016.png","assets/T/mri-ec4156cac1c84d7f/coronal_018.png","assets/T/mri-ec4156cac1c84d7f/coronal_020.png","assets/T/mri-ec4156cac1c84d7f/coronal_022.png","assets/T/mri-ec4156cac1c84d7f/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-b9040a34fa5e4315","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-b9040a34fa5e4315/axial_001.png","assets/T/mri-b9040a34fa5e4315/axial_003.png","assets/T/mri-b9040a34fa5e4315/axial_005.png","assets/T/mri-b9040a34fa5e4315/axial_007.png","assets/T/mri-b9040a34fa5e4315/axial_009.png","assets/T/mri-b9040a34fa5e4315/axial_011.png","assets/T/mri-b9040a34fa5e4315/axial_013.png","assets/T/mri-b9040a34fa5e4315/axial_015.png","assets/T/mri-b9040a34fa5e4315/axial_017.png","assets/T/mri-b9040a34fa5e4315/axial_019.png","assets/T/mri-b9040a34fa5e4315/axial_021.png","assets/T/mri-b9040a34fa5e4315/axial_022.png","assets/T/mri-b9040a34fa5e4315/axial_024.png","assets/T/mri-b9040a34fa5e4315/axial_026.png","assets/T/mri-b9040a34fa5e4315/axial_028.png","assets/T/mri-b9040a34fa5e4315/axial_030.png","assets/T/mri-b9040a34fa5e4315/axial_032.png","assets/T/mri-b9040a34fa5e4315/axial_034.png","assets/T/mri-b9040a34fa5e4315/axial_036.png","assets/T/mri-b9040a34fa5e4315/axial_038.png","assets/T/mri-b9040a34fa5e4315/axial_040.png","assets/T/mri-b9040a34fa5e4315/coronal_001.png","assets/T/mri-b9040a34fa5e4315/coronal_003.png","assets/T/mri-b9040a34fa5e4315/coronal_005.png","assets/T/mri-b9040a34fa5e4315/coronal_007.png","assets/T/mri-b9040a34fa5e4315/coronal_009.png","assets/T/mri-b9040a34fa5e4315/coronal_011.png","assets/T/mri-b9040a34fa5e4315/coronal_014.png","assets/T/mri-b9040a34fa5e4315/coronal_016.png","assets/T/mri-b9040a34fa5e4315/coronal_018.png","assets/T/mri-b9040a34fa5e4315/coronal_020.png","assets/T/mri-b9040a34fa5e4315/coronal_022.png","assets/T/mri-b9040a34fa5e4315/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-7c103c2defd14c13","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-7c103c2defd14c13/axial_001.png","assets/T/mri-7c103c2defd14c13/axial_003.png","assets/T/mri-7c103c2defd14c13/axial_005.png","assets/T/mri-7c103c2defd14c13/axial_007.png","assets/T/mri-7c103c2defd14c13/axial_009.png","assets/T/mri-7c103c2defd14c13/axial_011.png","assets/T/mri-7c103c2defd14c13/axial_013.png","assets/T/mri-7c103c2defd14c13/axial_015.png","assets/T/mri-7c103c2defd14c13/axial_017.png","assets/T/mri-7c103c2defd14c13/axial_019.png","assets/T/mri-7c103c2defd14c13/axial_021.png","assets/T/mri-7c103c2defd14c13/axial_022.png","assets/T/mri-7c103c2defd14c13/axial_024.png","assets/T/mri-7c103c2defd14c13/axial_026.png","assets/T/mri-7c103c2defd14c13/axial_028.png","assets/T/mri-7c103c2defd14c13/axial_030.png","assets/T/mri-7c103c2defd14c13/axial_032.png","assets/T/mri-7c103c2defd14c13/axial_034.png","assets/T/mri-7c103c2defd14c13/axial_036.png","assets/T/mri-7c103c2defd14c13/axial_038.png","assets/T/mri-7c103c2defd14c13/axial_040.png","assets/T/mri-7c103c2defd14c13/coronal_001.png","assets/T/mri-7c103c2defd14c13/coronal_003.png","assets/T/mri-7c103c2defd14c13/coronal_005.png","assets/T/mri-7c103c2defd14c13/coronal_007.png","assets/T/mri-7c103c2defd14c13/coronal_009.png","assets/T/mri-7c103c2defd14c13/coronal_011.png","assets/T/mri-7c103c2defd14c13/coronal_014.png","assets/T/mri-7c103c2defd14c13/coronal_016.png","assets/T/mri-7c103c2defd14c13/coronal_018.png","assets/T/mri-7c103c2defd14c13/coronal_020.png","assets/T/mri-7c103c2defd14c13/coronal_022.png","assets/T/mri-7c103c2defd14c13/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-dce34f88ac514aa2","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-dce34f88ac514aa2/axial_001.png","assets/T/mri-dce34f88ac514aa2/axial_003.png","assets/T/mri-dce34f88ac514aa2/axial_005.png","assets/T/mri-dce34f88ac514aa2/axial_007.png","assets/T/mri-dce34f88ac514aa2/axial_009.png","assets/T/mri-dce34f88ac514aa2/axial_011.png","assets/T/mri-dce34f88ac514aa2/axial_013.png","assets/T/mri-dce34f88ac514aa2/axial_015.png","assets/T/mri-dce34f88ac514aa2/axial_017.png","assets/T/mri-dce34f88ac514aa2/axial_019.png","assets/T/mri-dce34f88ac514aa2/axial_021.png","assets/T/mri-dce34f88ac514aa2/axial_022.png","assets/T/mri-dce34f88ac514aa2/axial_024.png","assets/T/mri-dce34f88ac514aa2/axial_026.png","assets/T/mri-dce34f88ac514aa2/axial_028.png","assets/T/mri-dce34f88ac514aa2/axial_030.png","assets/T/mri-dce34f88ac514aa2/axial_032.png","assets/T/mri-dce34f88ac514aa2/axial_034.png","assets/T/mri-dce34f88ac514aa2/axial_036.png","assets/T/mri-dce34f88ac514aa2/axial_038.png","assets/T/mri-dce34f88ac514aa2/axial_040.png","assets/T/mri-dce34f88ac514aa2/coronal_001.png","assets/T/mri-dce34f88ac514aa2/coronal_003.png","assets/T/mri-dce34f88ac514aa2/coronal_005.png","assets/T/mri-dce34f88ac514aa2/coronal_007.png","assets/T/mri-dce34f88ac514aa2/coronal_009.png","assets/T/mri-dce34f88ac514aa2/coronal_011.png","assets/T/mri-dce34f88ac514aa2/coronal_014.png","assets/T/mri-dce34f88ac514aa2/coronal_016.png","assets/T/mri-dce34f88ac514aa2/coronal_018.png","assets/T/mri-dce34f88ac514aa2/coronal_020.png","assets/T/mri-dce34f88ac514aa2/coronal_022.png","assets/T/mri-dce34f88ac514aa2/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-dcdf6ec887f345f5","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-dcdf6ec887f345f5/axial_001.png","assets/T/mri-dcdf6ec887f345f5/axial_003.png","assets/T/mri-dcdf6ec887f345f5/axial_005.png","assets/T/mri-dcdf6ec887f345f5/axial_007.png","assets/T/mri-dcdf6ec887f345f5/axial_009.png","assets/T/mri-dcdf6ec887f345f5/axial_011.png","assets/T/mri-dcdf6ec887f345f5/axial_013.png","assets/T/mri-dcdf6ec887f345f5/axial_015.png","assets/T/mri-dcdf6ec887f345f5/axial_017.png","assets/T/mri-dcdf6ec887f345f5/axial_019.png","assets/T/mri-dcdf6ec887f345f5/axial_022.png","assets/T/mri-dcdf6ec887f345f5/axial_024.png","assets/T/mri-dcdf6ec887f345f5/axial_026.png","assets/T/mri-dcdf6ec887f345f5/axial_028.png","assets/T/mri-dcdf6ec887f345f5/axial_030.png","assets/T/mri-dcdf6ec887f345f5/axial_032.png","assets/T/mri-dcdf6ec887f345f5/axial_034.png","assets/T/mri-dcdf6ec887f345f5/axial_036.png","assets/T/mri-dcdf6ec887f345f5/axial_038.png","assets/T/mri-dcdf6ec887f345f5/axial_040.png","assets/T/mri-dcdf6ec887f345f5/axial_042.png","assets/T/mri-dcdf6ec887f345f5/coronal_001.png","assets/T/mri-dcdf6ec887f345f5/coronal_003.png","assets/T/mri-dcdf6ec887f345f5/coronal_005.png","assets/T/mri-dcdf6ec887f345f5/coronal_007.png","assets/T/mri-dcdf6ec887f345f5/coronal_009.png","assets/T/mri-dcdf6ec887f345f5/coronal_011.png","assets/T/mri-dcdf6ec887f345f5/coronal_014.png","assets/T/mri-dcdf6ec887f345f5/coronal_016.png","assets/T/mri-dcdf6ec887f345f5/coronal_018.png","assets/T/mri-dcdf6ec887f345f5/coronal_020.png","assets/T/mri-dcdf6ec887f345f5/coronal_022.png","assets/T/mri-dcdf6ec887f345f5/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-dba945687774414a","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-dba945687774414a/axial_001.png","assets/T/mri-dba945687774414a/axial_003.png","assets/T/mri-dba945687774414a/axial_005.png","assets/T/mri-dba945687774414a/axial_007.png","assets/T/mri-dba945687774414a/axial_009.png","assets/T/mri-dba945687774414a/axial_011.png","assets/T/mri-dba945687774414a/axial_013.png","assets/T/mri-dba945687774414a/axial_015.png","assets/T/mri-dba945687774414a/axial_017.png","assets/T/mri-dba945687774414a/axial_019.png","assets/T/mri-dba945687774414a/axial_021.png","assets/T/mri-dba945687774414a/axial_022.png","assets/T/mri-dba945687774414a/axial_024.png","assets/T/mri-dba945687774414a/axial_026.png","assets/T/mri-dba945687774414a/axial_028.png","assets/T/mri-dba945687774414a/axial_030.png","assets/T/mri-dba945687774414a/axial_032.png","assets/T/mri-dba945687774414a/axial_034.png","assets/T/mri-dba945687774414a/axial_036.png","assets/T/mri-dba945687774414a/axial_038.png","assets/T/mri-dba945687774414a/axial_040.png","assets/T/mri-dba945687774414a/coronal_001.png","assets/T/mri-dba945687774414a/coronal_003.png","assets/T/mri-dba945687774414a/coronal_005.png","assets/T/mri-dba945687774414a/coronal_007.png","assets/T/mri-dba945687774414a/coronal_009.png","assets/T/mri-dba945687774414a/coronal_011.png","assets/T/mri-dba945687774414a/coronal_014.png","assets/T/mri-dba945687774414a/coronal_016.png","assets/T/mri-dba945687774414a/coronal_018.png","assets/T/mri-dba945687774414a/coronal_020.png","assets/T/mri-dba945687774414a/coronal_022.png","assets/T/mri-dba945687774414a/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-c676d561104541b6","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 34 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 14 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-c676d561104541b6/axial_001.png","assets/T/mri-c676d561104541b6/axial_003.png","assets/T/mri-c676d561104541b6/axial_005.png","assets/T/mri-c676d561104541b6/axial_007.png","assets/T/mri-c676d561104541b6/axial_008.png","assets/T/mri-c676d561104541b6/axial_010.png","assets/T/mri-c676d561104541b6/axial_012.png","assets/T/mri-c676d561104541b6/axial_014.png","assets/T/mri-c676d561104541b6/axial_016.png","assets/T/mri-c676d561104541b6/axial_018.png","assets/T/mri-c676d561104541b6/axial_019.png","assets/T/mri-c676d561104541b6/axial_021.png","assets/T/mri-c676d561104541b6/axial_023.png","assets/T/mri-c676d561104541b6/axial_025.png","assets/T/mri-c676d561104541b6/axial_027.png","assets/T/mri-c676d561104541b6/axial_029.png","assets/T/mri-c676d561104541b6/axial_030.png","assets/T/mri-c676d561104541b6/axial_032.png","assets/T/mri-c676d561104541b6/axial_034.png","assets/T/mri-c676d561104541b6/axial_036.png","assets/T/mri-c676d561104541b6/coronal_001.png","assets/T/mri-c676d561104541b6/coronal_003.png","assets/T/mri-c676d561104541b6/coronal_005.png","assets/T/mri-c676d561104541b6/coronal_006.png","assets/T/mri-c676d561104541b6/coronal_008.png","assets/T/mri-c676d561104541b6/coronal_010.png","assets/T/mri-c676d561104541b6/coronal_012.png","assets/T/mri-c676d561104541b6/coronal_013.png","assets/T/mri-c676d561104541b6/coronal_015.png","assets/T/mri-c676d561104541b6/coronal_017.png","assets/T/mri-c676d561104541b6/coronal_019.png","assets/T/mri-c676d561104541b6/coronal_020.png","assets/T/mri-c676d561104541b6/coronal_022.png","assets/T/mri-c676d561104541b6/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":60,"selected_count":34,"source_indices_1based":[1,3,5,7,8,10,12,14,16,18,19,21,23,25,27,29,30,32,34,36,37,39,41,42,44,46,48,49,51,53,55,56,58,60]}}
+{"id":"L3-T300:mri-10d48e8b495348d4","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-10d48e8b495348d4/axial_001.png","assets/T/mri-10d48e8b495348d4/axial_003.png","assets/T/mri-10d48e8b495348d4/axial_005.png","assets/T/mri-10d48e8b495348d4/axial_007.png","assets/T/mri-10d48e8b495348d4/axial_009.png","assets/T/mri-10d48e8b495348d4/axial_011.png","assets/T/mri-10d48e8b495348d4/axial_013.png","assets/T/mri-10d48e8b495348d4/axial_015.png","assets/T/mri-10d48e8b495348d4/axial_017.png","assets/T/mri-10d48e8b495348d4/axial_019.png","assets/T/mri-10d48e8b495348d4/axial_022.png","assets/T/mri-10d48e8b495348d4/axial_024.png","assets/T/mri-10d48e8b495348d4/axial_026.png","assets/T/mri-10d48e8b495348d4/axial_028.png","assets/T/mri-10d48e8b495348d4/axial_030.png","assets/T/mri-10d48e8b495348d4/axial_032.png","assets/T/mri-10d48e8b495348d4/axial_034.png","assets/T/mri-10d48e8b495348d4/axial_036.png","assets/T/mri-10d48e8b495348d4/axial_038.png","assets/T/mri-10d48e8b495348d4/axial_040.png","assets/T/mri-10d48e8b495348d4/axial_042.png","assets/T/mri-10d48e8b495348d4/coronal_001.png","assets/T/mri-10d48e8b495348d4/coronal_003.png","assets/T/mri-10d48e8b495348d4/coronal_005.png","assets/T/mri-10d48e8b495348d4/coronal_007.png","assets/T/mri-10d48e8b495348d4/coronal_009.png","assets/T/mri-10d48e8b495348d4/coronal_011.png","assets/T/mri-10d48e8b495348d4/coronal_014.png","assets/T/mri-10d48e8b495348d4/coronal_016.png","assets/T/mri-10d48e8b495348d4/coronal_018.png","assets/T/mri-10d48e8b495348d4/coronal_020.png","assets/T/mri-10d48e8b495348d4/coronal_022.png","assets/T/mri-10d48e8b495348d4/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-911862d19e9e456f","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-911862d19e9e456f/axial_001.png","assets/T/mri-911862d19e9e456f/axial_003.png","assets/T/mri-911862d19e9e456f/axial_005.png","assets/T/mri-911862d19e9e456f/axial_007.png","assets/T/mri-911862d19e9e456f/axial_009.png","assets/T/mri-911862d19e9e456f/axial_011.png","assets/T/mri-911862d19e9e456f/axial_013.png","assets/T/mri-911862d19e9e456f/axial_015.png","assets/T/mri-911862d19e9e456f/axial_017.png","assets/T/mri-911862d19e9e456f/axial_019.png","assets/T/mri-911862d19e9e456f/axial_022.png","assets/T/mri-911862d19e9e456f/axial_024.png","assets/T/mri-911862d19e9e456f/axial_026.png","assets/T/mri-911862d19e9e456f/axial_028.png","assets/T/mri-911862d19e9e456f/axial_030.png","assets/T/mri-911862d19e9e456f/axial_032.png","assets/T/mri-911862d19e9e456f/axial_034.png","assets/T/mri-911862d19e9e456f/axial_036.png","assets/T/mri-911862d19e9e456f/axial_038.png","assets/T/mri-911862d19e9e456f/axial_040.png","assets/T/mri-911862d19e9e456f/axial_042.png","assets/T/mri-911862d19e9e456f/coronal_001.png","assets/T/mri-911862d19e9e456f/coronal_003.png","assets/T/mri-911862d19e9e456f/coronal_005.png","assets/T/mri-911862d19e9e456f/coronal_007.png","assets/T/mri-911862d19e9e456f/coronal_009.png","assets/T/mri-911862d19e9e456f/coronal_011.png","assets/T/mri-911862d19e9e456f/coronal_014.png","assets/T/mri-911862d19e9e456f/coronal_016.png","assets/T/mri-911862d19e9e456f/coronal_018.png","assets/T/mri-911862d19e9e456f/coronal_020.png","assets/T/mri-911862d19e9e456f/coronal_022.png","assets/T/mri-911862d19e9e456f/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-52ab912be8f94df4","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-52ab912be8f94df4/axial_001.png","assets/T/mri-52ab912be8f94df4/axial_003.png","assets/T/mri-52ab912be8f94df4/axial_005.png","assets/T/mri-52ab912be8f94df4/axial_007.png","assets/T/mri-52ab912be8f94df4/axial_009.png","assets/T/mri-52ab912be8f94df4/axial_011.png","assets/T/mri-52ab912be8f94df4/axial_013.png","assets/T/mri-52ab912be8f94df4/axial_015.png","assets/T/mri-52ab912be8f94df4/axial_017.png","assets/T/mri-52ab912be8f94df4/axial_019.png","assets/T/mri-52ab912be8f94df4/axial_022.png","assets/T/mri-52ab912be8f94df4/axial_024.png","assets/T/mri-52ab912be8f94df4/axial_026.png","assets/T/mri-52ab912be8f94df4/axial_028.png","assets/T/mri-52ab912be8f94df4/axial_030.png","assets/T/mri-52ab912be8f94df4/axial_032.png","assets/T/mri-52ab912be8f94df4/axial_034.png","assets/T/mri-52ab912be8f94df4/axial_036.png","assets/T/mri-52ab912be8f94df4/axial_038.png","assets/T/mri-52ab912be8f94df4/axial_040.png","assets/T/mri-52ab912be8f94df4/axial_042.png","assets/T/mri-52ab912be8f94df4/coronal_001.png","assets/T/mri-52ab912be8f94df4/coronal_003.png","assets/T/mri-52ab912be8f94df4/coronal_005.png","assets/T/mri-52ab912be8f94df4/coronal_007.png","assets/T/mri-52ab912be8f94df4/coronal_009.png","assets/T/mri-52ab912be8f94df4/coronal_011.png","assets/T/mri-52ab912be8f94df4/coronal_014.png","assets/T/mri-52ab912be8f94df4/coronal_016.png","assets/T/mri-52ab912be8f94df4/coronal_018.png","assets/T/mri-52ab912be8f94df4/coronal_020.png","assets/T/mri-52ab912be8f94df4/coronal_022.png","assets/T/mri-52ab912be8f94df4/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-ccaecc2dd6674b4c","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 34 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 14 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-ccaecc2dd6674b4c/axial_001.png","assets/T/mri-ccaecc2dd6674b4c/axial_003.png","assets/T/mri-ccaecc2dd6674b4c/axial_005.png","assets/T/mri-ccaecc2dd6674b4c/axial_007.png","assets/T/mri-ccaecc2dd6674b4c/axial_008.png","assets/T/mri-ccaecc2dd6674b4c/axial_010.png","assets/T/mri-ccaecc2dd6674b4c/axial_012.png","assets/T/mri-ccaecc2dd6674b4c/axial_014.png","assets/T/mri-ccaecc2dd6674b4c/axial_016.png","assets/T/mri-ccaecc2dd6674b4c/axial_018.png","assets/T/mri-ccaecc2dd6674b4c/axial_019.png","assets/T/mri-ccaecc2dd6674b4c/axial_021.png","assets/T/mri-ccaecc2dd6674b4c/axial_023.png","assets/T/mri-ccaecc2dd6674b4c/axial_025.png","assets/T/mri-ccaecc2dd6674b4c/axial_027.png","assets/T/mri-ccaecc2dd6674b4c/axial_029.png","assets/T/mri-ccaecc2dd6674b4c/axial_030.png","assets/T/mri-ccaecc2dd6674b4c/axial_032.png","assets/T/mri-ccaecc2dd6674b4c/axial_034.png","assets/T/mri-ccaecc2dd6674b4c/axial_036.png","assets/T/mri-ccaecc2dd6674b4c/coronal_001.png","assets/T/mri-ccaecc2dd6674b4c/coronal_003.png","assets/T/mri-ccaecc2dd6674b4c/coronal_005.png","assets/T/mri-ccaecc2dd6674b4c/coronal_006.png","assets/T/mri-ccaecc2dd6674b4c/coronal_008.png","assets/T/mri-ccaecc2dd6674b4c/coronal_010.png","assets/T/mri-ccaecc2dd6674b4c/coronal_012.png","assets/T/mri-ccaecc2dd6674b4c/coronal_013.png","assets/T/mri-ccaecc2dd6674b4c/coronal_015.png","assets/T/mri-ccaecc2dd6674b4c/coronal_017.png","assets/T/mri-ccaecc2dd6674b4c/coronal_019.png","assets/T/mri-ccaecc2dd6674b4c/coronal_020.png","assets/T/mri-ccaecc2dd6674b4c/coronal_022.png","assets/T/mri-ccaecc2dd6674b4c/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":60,"selected_count":34,"source_indices_1based":[1,3,5,7,8,10,12,14,16,18,19,21,23,25,27,29,30,32,34,36,37,39,41,42,44,46,48,49,51,53,55,56,58,60]}}
+{"id":"L3-T300:mri-20452f5fb9304914","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-20452f5fb9304914/axial_001.png","assets/T/mri-20452f5fb9304914/axial_003.png","assets/T/mri-20452f5fb9304914/axial_005.png","assets/T/mri-20452f5fb9304914/axial_007.png","assets/T/mri-20452f5fb9304914/axial_009.png","assets/T/mri-20452f5fb9304914/axial_011.png","assets/T/mri-20452f5fb9304914/axial_013.png","assets/T/mri-20452f5fb9304914/axial_015.png","assets/T/mri-20452f5fb9304914/axial_017.png","assets/T/mri-20452f5fb9304914/axial_019.png","assets/T/mri-20452f5fb9304914/axial_022.png","assets/T/mri-20452f5fb9304914/axial_024.png","assets/T/mri-20452f5fb9304914/axial_026.png","assets/T/mri-20452f5fb9304914/axial_028.png","assets/T/mri-20452f5fb9304914/axial_030.png","assets/T/mri-20452f5fb9304914/axial_032.png","assets/T/mri-20452f5fb9304914/axial_034.png","assets/T/mri-20452f5fb9304914/axial_036.png","assets/T/mri-20452f5fb9304914/axial_038.png","assets/T/mri-20452f5fb9304914/axial_040.png","assets/T/mri-20452f5fb9304914/axial_042.png","assets/T/mri-20452f5fb9304914/coronal_001.png","assets/T/mri-20452f5fb9304914/coronal_003.png","assets/T/mri-20452f5fb9304914/coronal_005.png","assets/T/mri-20452f5fb9304914/coronal_007.png","assets/T/mri-20452f5fb9304914/coronal_009.png","assets/T/mri-20452f5fb9304914/coronal_011.png","assets/T/mri-20452f5fb9304914/coronal_014.png","assets/T/mri-20452f5fb9304914/coronal_016.png","assets/T/mri-20452f5fb9304914/coronal_018.png","assets/T/mri-20452f5fb9304914/coronal_020.png","assets/T/mri-20452f5fb9304914/coronal_022.png","assets/T/mri-20452f5fb9304914/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-9bc82b4fc3564f98","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-9bc82b4fc3564f98/axial_001.png","assets/T/mri-9bc82b4fc3564f98/axial_003.png","assets/T/mri-9bc82b4fc3564f98/axial_005.png","assets/T/mri-9bc82b4fc3564f98/axial_007.png","assets/T/mri-9bc82b4fc3564f98/axial_009.png","assets/T/mri-9bc82b4fc3564f98/axial_011.png","assets/T/mri-9bc82b4fc3564f98/axial_013.png","assets/T/mri-9bc82b4fc3564f98/axial_015.png","assets/T/mri-9bc82b4fc3564f98/axial_017.png","assets/T/mri-9bc82b4fc3564f98/axial_019.png","assets/T/mri-9bc82b4fc3564f98/axial_022.png","assets/T/mri-9bc82b4fc3564f98/axial_024.png","assets/T/mri-9bc82b4fc3564f98/axial_026.png","assets/T/mri-9bc82b4fc3564f98/axial_028.png","assets/T/mri-9bc82b4fc3564f98/axial_030.png","assets/T/mri-9bc82b4fc3564f98/axial_032.png","assets/T/mri-9bc82b4fc3564f98/axial_034.png","assets/T/mri-9bc82b4fc3564f98/axial_036.png","assets/T/mri-9bc82b4fc3564f98/axial_038.png","assets/T/mri-9bc82b4fc3564f98/axial_040.png","assets/T/mri-9bc82b4fc3564f98/axial_042.png","assets/T/mri-9bc82b4fc3564f98/coronal_001.png","assets/T/mri-9bc82b4fc3564f98/coronal_003.png","assets/T/mri-9bc82b4fc3564f98/coronal_005.png","assets/T/mri-9bc82b4fc3564f98/coronal_007.png","assets/T/mri-9bc82b4fc3564f98/coronal_009.png","assets/T/mri-9bc82b4fc3564f98/coronal_011.png","assets/T/mri-9bc82b4fc3564f98/coronal_014.png","assets/T/mri-9bc82b4fc3564f98/coronal_016.png","assets/T/mri-9bc82b4fc3564f98/coronal_018.png","assets/T/mri-9bc82b4fc3564f98/coronal_020.png","assets/T/mri-9bc82b4fc3564f98/coronal_022.png","assets/T/mri-9bc82b4fc3564f98/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-e7ca4067ba764e60","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-e7ca4067ba764e60/axial_001.png","assets/T/mri-e7ca4067ba764e60/axial_003.png","assets/T/mri-e7ca4067ba764e60/axial_005.png","assets/T/mri-e7ca4067ba764e60/axial_007.png","assets/T/mri-e7ca4067ba764e60/axial_009.png","assets/T/mri-e7ca4067ba764e60/axial_011.png","assets/T/mri-e7ca4067ba764e60/axial_013.png","assets/T/mri-e7ca4067ba764e60/axial_015.png","assets/T/mri-e7ca4067ba764e60/axial_017.png","assets/T/mri-e7ca4067ba764e60/axial_019.png","assets/T/mri-e7ca4067ba764e60/axial_021.png","assets/T/mri-e7ca4067ba764e60/axial_022.png","assets/T/mri-e7ca4067ba764e60/axial_024.png","assets/T/mri-e7ca4067ba764e60/axial_026.png","assets/T/mri-e7ca4067ba764e60/axial_028.png","assets/T/mri-e7ca4067ba764e60/axial_030.png","assets/T/mri-e7ca4067ba764e60/axial_032.png","assets/T/mri-e7ca4067ba764e60/axial_034.png","assets/T/mri-e7ca4067ba764e60/axial_036.png","assets/T/mri-e7ca4067ba764e60/axial_038.png","assets/T/mri-e7ca4067ba764e60/axial_040.png","assets/T/mri-e7ca4067ba764e60/coronal_001.png","assets/T/mri-e7ca4067ba764e60/coronal_003.png","assets/T/mri-e7ca4067ba764e60/coronal_005.png","assets/T/mri-e7ca4067ba764e60/coronal_007.png","assets/T/mri-e7ca4067ba764e60/coronal_009.png","assets/T/mri-e7ca4067ba764e60/coronal_011.png","assets/T/mri-e7ca4067ba764e60/coronal_014.png","assets/T/mri-e7ca4067ba764e60/coronal_016.png","assets/T/mri-e7ca4067ba764e60/coronal_018.png","assets/T/mri-e7ca4067ba764e60/coronal_020.png","assets/T/mri-e7ca4067ba764e60/coronal_022.png","assets/T/mri-e7ca4067ba764e60/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-ca6c28608dc74151","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-ca6c28608dc74151/axial_001.png","assets/T/mri-ca6c28608dc74151/axial_003.png","assets/T/mri-ca6c28608dc74151/axial_005.png","assets/T/mri-ca6c28608dc74151/axial_007.png","assets/T/mri-ca6c28608dc74151/axial_009.png","assets/T/mri-ca6c28608dc74151/axial_011.png","assets/T/mri-ca6c28608dc74151/axial_013.png","assets/T/mri-ca6c28608dc74151/axial_015.png","assets/T/mri-ca6c28608dc74151/axial_017.png","assets/T/mri-ca6c28608dc74151/axial_019.png","assets/T/mri-ca6c28608dc74151/axial_022.png","assets/T/mri-ca6c28608dc74151/axial_024.png","assets/T/mri-ca6c28608dc74151/axial_026.png","assets/T/mri-ca6c28608dc74151/axial_028.png","assets/T/mri-ca6c28608dc74151/axial_030.png","assets/T/mri-ca6c28608dc74151/axial_032.png","assets/T/mri-ca6c28608dc74151/axial_034.png","assets/T/mri-ca6c28608dc74151/axial_036.png","assets/T/mri-ca6c28608dc74151/axial_038.png","assets/T/mri-ca6c28608dc74151/axial_040.png","assets/T/mri-ca6c28608dc74151/axial_042.png","assets/T/mri-ca6c28608dc74151/coronal_001.png","assets/T/mri-ca6c28608dc74151/coronal_003.png","assets/T/mri-ca6c28608dc74151/coronal_005.png","assets/T/mri-ca6c28608dc74151/coronal_007.png","assets/T/mri-ca6c28608dc74151/coronal_009.png","assets/T/mri-ca6c28608dc74151/coronal_011.png","assets/T/mri-ca6c28608dc74151/coronal_014.png","assets/T/mri-ca6c28608dc74151/coronal_016.png","assets/T/mri-ca6c28608dc74151/coronal_018.png","assets/T/mri-ca6c28608dc74151/coronal_020.png","assets/T/mri-ca6c28608dc74151/coronal_022.png","assets/T/mri-ca6c28608dc74151/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-2cda076179fb48e3","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-2cda076179fb48e3/axial_001.png","assets/T/mri-2cda076179fb48e3/axial_003.png","assets/T/mri-2cda076179fb48e3/axial_005.png","assets/T/mri-2cda076179fb48e3/axial_007.png","assets/T/mri-2cda076179fb48e3/axial_009.png","assets/T/mri-2cda076179fb48e3/axial_011.png","assets/T/mri-2cda076179fb48e3/axial_013.png","assets/T/mri-2cda076179fb48e3/axial_015.png","assets/T/mri-2cda076179fb48e3/axial_017.png","assets/T/mri-2cda076179fb48e3/axial_019.png","assets/T/mri-2cda076179fb48e3/axial_022.png","assets/T/mri-2cda076179fb48e3/axial_024.png","assets/T/mri-2cda076179fb48e3/axial_026.png","assets/T/mri-2cda076179fb48e3/axial_028.png","assets/T/mri-2cda076179fb48e3/axial_030.png","assets/T/mri-2cda076179fb48e3/axial_032.png","assets/T/mri-2cda076179fb48e3/axial_034.png","assets/T/mri-2cda076179fb48e3/axial_036.png","assets/T/mri-2cda076179fb48e3/axial_038.png","assets/T/mri-2cda076179fb48e3/axial_040.png","assets/T/mri-2cda076179fb48e3/axial_042.png","assets/T/mri-2cda076179fb48e3/coronal_001.png","assets/T/mri-2cda076179fb48e3/coronal_003.png","assets/T/mri-2cda076179fb48e3/coronal_005.png","assets/T/mri-2cda076179fb48e3/coronal_007.png","assets/T/mri-2cda076179fb48e3/coronal_009.png","assets/T/mri-2cda076179fb48e3/coronal_011.png","assets/T/mri-2cda076179fb48e3/coronal_014.png","assets/T/mri-2cda076179fb48e3/coronal_016.png","assets/T/mri-2cda076179fb48e3/coronal_018.png","assets/T/mri-2cda076179fb48e3/coronal_020.png","assets/T/mri-2cda076179fb48e3/coronal_022.png","assets/T/mri-2cda076179fb48e3/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-bbcf4ba5ac804eee","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-bbcf4ba5ac804eee/axial_001.png","assets/T/mri-bbcf4ba5ac804eee/axial_003.png","assets/T/mri-bbcf4ba5ac804eee/axial_005.png","assets/T/mri-bbcf4ba5ac804eee/axial_007.png","assets/T/mri-bbcf4ba5ac804eee/axial_010.png","assets/T/mri-bbcf4ba5ac804eee/axial_012.png","assets/T/mri-bbcf4ba5ac804eee/axial_014.png","assets/T/mri-bbcf4ba5ac804eee/axial_016.png","assets/T/mri-bbcf4ba5ac804eee/axial_018.png","assets/T/mri-bbcf4ba5ac804eee/axial_020.png","assets/T/mri-bbcf4ba5ac804eee/axial_023.png","assets/T/mri-bbcf4ba5ac804eee/axial_025.png","assets/T/mri-bbcf4ba5ac804eee/axial_027.png","assets/T/mri-bbcf4ba5ac804eee/axial_029.png","assets/T/mri-bbcf4ba5ac804eee/axial_031.png","assets/T/mri-bbcf4ba5ac804eee/axial_033.png","assets/T/mri-bbcf4ba5ac804eee/axial_035.png","assets/T/mri-bbcf4ba5ac804eee/axial_038.png","assets/T/mri-bbcf4ba5ac804eee/axial_040.png","assets/T/mri-bbcf4ba5ac804eee/axial_042.png","assets/T/mri-bbcf4ba5ac804eee/axial_044.png","assets/T/mri-bbcf4ba5ac804eee/coronal_001.png","assets/T/mri-bbcf4ba5ac804eee/coronal_003.png","assets/T/mri-bbcf4ba5ac804eee/coronal_005.png","assets/T/mri-bbcf4ba5ac804eee/coronal_007.png","assets/T/mri-bbcf4ba5ac804eee/coronal_009.png","assets/T/mri-bbcf4ba5ac804eee/coronal_011.png","assets/T/mri-bbcf4ba5ac804eee/coronal_014.png","assets/T/mri-bbcf4ba5ac804eee/coronal_016.png","assets/T/mri-bbcf4ba5ac804eee/coronal_018.png","assets/T/mri-bbcf4ba5ac804eee/coronal_020.png","assets/T/mri-bbcf4ba5ac804eee/coronal_022.png","assets/T/mri-bbcf4ba5ac804eee/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":68,"selected_count":33,"source_indices_1based":[1,3,5,7,10,12,14,16,18,20,23,25,27,29,31,33,35,38,40,42,44,45,47,49,51,53,55,58,60,62,64,66,68]}}
+{"id":"L3-T300:mri-b0306ff4925b498a","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-b0306ff4925b498a/axial_001.png","assets/T/mri-b0306ff4925b498a/axial_003.png","assets/T/mri-b0306ff4925b498a/axial_005.png","assets/T/mri-b0306ff4925b498a/axial_007.png","assets/T/mri-b0306ff4925b498a/axial_010.png","assets/T/mri-b0306ff4925b498a/axial_012.png","assets/T/mri-b0306ff4925b498a/axial_014.png","assets/T/mri-b0306ff4925b498a/axial_016.png","assets/T/mri-b0306ff4925b498a/axial_018.png","assets/T/mri-b0306ff4925b498a/axial_020.png","assets/T/mri-b0306ff4925b498a/axial_023.png","assets/T/mri-b0306ff4925b498a/axial_025.png","assets/T/mri-b0306ff4925b498a/axial_027.png","assets/T/mri-b0306ff4925b498a/axial_029.png","assets/T/mri-b0306ff4925b498a/axial_031.png","assets/T/mri-b0306ff4925b498a/axial_033.png","assets/T/mri-b0306ff4925b498a/axial_035.png","assets/T/mri-b0306ff4925b498a/axial_038.png","assets/T/mri-b0306ff4925b498a/axial_040.png","assets/T/mri-b0306ff4925b498a/axial_042.png","assets/T/mri-b0306ff4925b498a/axial_044.png","assets/T/mri-b0306ff4925b498a/coronal_001.png","assets/T/mri-b0306ff4925b498a/coronal_003.png","assets/T/mri-b0306ff4925b498a/coronal_005.png","assets/T/mri-b0306ff4925b498a/coronal_007.png","assets/T/mri-b0306ff4925b498a/coronal_009.png","assets/T/mri-b0306ff4925b498a/coronal_011.png","assets/T/mri-b0306ff4925b498a/coronal_014.png","assets/T/mri-b0306ff4925b498a/coronal_016.png","assets/T/mri-b0306ff4925b498a/coronal_018.png","assets/T/mri-b0306ff4925b498a/coronal_020.png","assets/T/mri-b0306ff4925b498a/coronal_022.png","assets/T/mri-b0306ff4925b498a/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":68,"selected_count":33,"source_indices_1based":[1,3,5,7,10,12,14,16,18,20,23,25,27,29,31,33,35,38,40,42,44,45,47,49,51,53,55,58,60,62,64,66,68]}}
+{"id":"L3-T300:mri-8369bc80cc524c36","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 34 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 14 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-8369bc80cc524c36/axial_001.png","assets/T/mri-8369bc80cc524c36/axial_003.png","assets/T/mri-8369bc80cc524c36/axial_005.png","assets/T/mri-8369bc80cc524c36/axial_007.png","assets/T/mri-8369bc80cc524c36/axial_008.png","assets/T/mri-8369bc80cc524c36/axial_010.png","assets/T/mri-8369bc80cc524c36/axial_012.png","assets/T/mri-8369bc80cc524c36/axial_014.png","assets/T/mri-8369bc80cc524c36/axial_016.png","assets/T/mri-8369bc80cc524c36/axial_018.png","assets/T/mri-8369bc80cc524c36/axial_019.png","assets/T/mri-8369bc80cc524c36/axial_021.png","assets/T/mri-8369bc80cc524c36/axial_023.png","assets/T/mri-8369bc80cc524c36/axial_025.png","assets/T/mri-8369bc80cc524c36/axial_027.png","assets/T/mri-8369bc80cc524c36/axial_029.png","assets/T/mri-8369bc80cc524c36/axial_030.png","assets/T/mri-8369bc80cc524c36/axial_032.png","assets/T/mri-8369bc80cc524c36/axial_034.png","assets/T/mri-8369bc80cc524c36/axial_036.png","assets/T/mri-8369bc80cc524c36/coronal_001.png","assets/T/mri-8369bc80cc524c36/coronal_003.png","assets/T/mri-8369bc80cc524c36/coronal_005.png","assets/T/mri-8369bc80cc524c36/coronal_006.png","assets/T/mri-8369bc80cc524c36/coronal_008.png","assets/T/mri-8369bc80cc524c36/coronal_010.png","assets/T/mri-8369bc80cc524c36/coronal_012.png","assets/T/mri-8369bc80cc524c36/coronal_013.png","assets/T/mri-8369bc80cc524c36/coronal_015.png","assets/T/mri-8369bc80cc524c36/coronal_017.png","assets/T/mri-8369bc80cc524c36/coronal_019.png","assets/T/mri-8369bc80cc524c36/coronal_020.png","assets/T/mri-8369bc80cc524c36/coronal_022.png","assets/T/mri-8369bc80cc524c36/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":60,"selected_count":34,"source_indices_1based":[1,3,5,7,8,10,12,14,16,18,19,21,23,25,27,29,30,32,34,36,37,39,41,42,44,46,48,49,51,53,55,56,58,60]}}
+{"id":"L3-T300:mri-7850ff7cafae4340","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 13 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-7850ff7cafae4340/axial_001.png","assets/T/mri-7850ff7cafae4340/axial_003.png","assets/T/mri-7850ff7cafae4340/axial_005.png","assets/T/mri-7850ff7cafae4340/axial_007.png","assets/T/mri-7850ff7cafae4340/axial_009.png","assets/T/mri-7850ff7cafae4340/axial_011.png","assets/T/mri-7850ff7cafae4340/axial_013.png","assets/T/mri-7850ff7cafae4340/axial_015.png","assets/T/mri-7850ff7cafae4340/axial_017.png","assets/T/mri-7850ff7cafae4340/axial_019.png","assets/T/mri-7850ff7cafae4340/axial_021.png","assets/T/mri-7850ff7cafae4340/axial_023.png","assets/T/mri-7850ff7cafae4340/axial_025.png","assets/T/mri-7850ff7cafae4340/axial_027.png","assets/T/mri-7850ff7cafae4340/axial_029.png","assets/T/mri-7850ff7cafae4340/axial_031.png","assets/T/mri-7850ff7cafae4340/axial_033.png","assets/T/mri-7850ff7cafae4340/axial_035.png","assets/T/mri-7850ff7cafae4340/axial_037.png","assets/T/mri-7850ff7cafae4340/axial_039.png","assets/T/mri-7850ff7cafae4340/coronal_001.png","assets/T/mri-7850ff7cafae4340/coronal_003.png","assets/T/mri-7850ff7cafae4340/coronal_005.png","assets/T/mri-7850ff7cafae4340/coronal_007.png","assets/T/mri-7850ff7cafae4340/coronal_009.png","assets/T/mri-7850ff7cafae4340/coronal_011.png","assets/T/mri-7850ff7cafae4340/coronal_013.png","assets/T/mri-7850ff7cafae4340/coronal_014.png","assets/T/mri-7850ff7cafae4340/coronal_016.png","assets/T/mri-7850ff7cafae4340/coronal_018.png","assets/T/mri-7850ff7cafae4340/coronal_020.png","assets/T/mri-7850ff7cafae4340/coronal_022.png","assets/T/mri-7850ff7cafae4340/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":63,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,23,25,27,29,31,33,35,37,39,40,42,44,46,48,50,52,53,55,57,59,61,63]}}
+{"id":"L3-T300:mri-ab79773a626e48a4","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 13 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-ab79773a626e48a4/axial_001.png","assets/T/mri-ab79773a626e48a4/axial_003.png","assets/T/mri-ab79773a626e48a4/axial_005.png","assets/T/mri-ab79773a626e48a4/axial_007.png","assets/T/mri-ab79773a626e48a4/axial_010.png","assets/T/mri-ab79773a626e48a4/axial_012.png","assets/T/mri-ab79773a626e48a4/axial_014.png","assets/T/mri-ab79773a626e48a4/axial_016.png","assets/T/mri-ab79773a626e48a4/axial_018.png","assets/T/mri-ab79773a626e48a4/axial_020.png","assets/T/mri-ab79773a626e48a4/axial_023.png","assets/T/mri-ab79773a626e48a4/axial_025.png","assets/T/mri-ab79773a626e48a4/axial_027.png","assets/T/mri-ab79773a626e48a4/axial_029.png","assets/T/mri-ab79773a626e48a4/axial_031.png","assets/T/mri-ab79773a626e48a4/axial_033.png","assets/T/mri-ab79773a626e48a4/axial_036.png","assets/T/mri-ab79773a626e48a4/axial_038.png","assets/T/mri-ab79773a626e48a4/axial_040.png","assets/T/mri-ab79773a626e48a4/axial_042.png","assets/T/mri-ab79773a626e48a4/coronal_001.png","assets/T/mri-ab79773a626e48a4/coronal_003.png","assets/T/mri-ab79773a626e48a4/coronal_005.png","assets/T/mri-ab79773a626e48a4/coronal_007.png","assets/T/mri-ab79773a626e48a4/coronal_009.png","assets/T/mri-ab79773a626e48a4/coronal_011.png","assets/T/mri-ab79773a626e48a4/coronal_014.png","assets/T/mri-ab79773a626e48a4/coronal_016.png","assets/T/mri-ab79773a626e48a4/coronal_018.png","assets/T/mri-ab79773a626e48a4/coronal_020.png","assets/T/mri-ab79773a626e48a4/coronal_022.png","assets/T/mri-ab79773a626e48a4/coronal_024.png","assets/T/mri-ab79773a626e48a4/coronal_026.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":68,"selected_count":33,"source_indices_1based":[1,3,5,7,10,12,14,16,18,20,23,25,27,29,31,33,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66,68]}}
+{"id":"L3-T300:mri-412e83e3a9394b43","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-412e83e3a9394b43/axial_001.png","assets/T/mri-412e83e3a9394b43/axial_003.png","assets/T/mri-412e83e3a9394b43/axial_005.png","assets/T/mri-412e83e3a9394b43/axial_007.png","assets/T/mri-412e83e3a9394b43/axial_009.png","assets/T/mri-412e83e3a9394b43/axial_011.png","assets/T/mri-412e83e3a9394b43/axial_013.png","assets/T/mri-412e83e3a9394b43/axial_015.png","assets/T/mri-412e83e3a9394b43/axial_017.png","assets/T/mri-412e83e3a9394b43/axial_019.png","assets/T/mri-412e83e3a9394b43/axial_021.png","assets/T/mri-412e83e3a9394b43/axial_022.png","assets/T/mri-412e83e3a9394b43/axial_024.png","assets/T/mri-412e83e3a9394b43/axial_026.png","assets/T/mri-412e83e3a9394b43/axial_028.png","assets/T/mri-412e83e3a9394b43/axial_030.png","assets/T/mri-412e83e3a9394b43/axial_032.png","assets/T/mri-412e83e3a9394b43/axial_034.png","assets/T/mri-412e83e3a9394b43/axial_036.png","assets/T/mri-412e83e3a9394b43/axial_038.png","assets/T/mri-412e83e3a9394b43/axial_040.png","assets/T/mri-412e83e3a9394b43/coronal_001.png","assets/T/mri-412e83e3a9394b43/coronal_003.png","assets/T/mri-412e83e3a9394b43/coronal_005.png","assets/T/mri-412e83e3a9394b43/coronal_007.png","assets/T/mri-412e83e3a9394b43/coronal_009.png","assets/T/mri-412e83e3a9394b43/coronal_011.png","assets/T/mri-412e83e3a9394b43/coronal_014.png","assets/T/mri-412e83e3a9394b43/coronal_016.png","assets/T/mri-412e83e3a9394b43/coronal_018.png","assets/T/mri-412e83e3a9394b43/coronal_020.png","assets/T/mri-412e83e3a9394b43/coronal_022.png","assets/T/mri-412e83e3a9394b43/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-16c2f9f2b11e43e7","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-16c2f9f2b11e43e7/axial_001.png","assets/T/mri-16c2f9f2b11e43e7/axial_003.png","assets/T/mri-16c2f9f2b11e43e7/axial_005.png","assets/T/mri-16c2f9f2b11e43e7/axial_007.png","assets/T/mri-16c2f9f2b11e43e7/axial_009.png","assets/T/mri-16c2f9f2b11e43e7/axial_011.png","assets/T/mri-16c2f9f2b11e43e7/axial_013.png","assets/T/mri-16c2f9f2b11e43e7/axial_015.png","assets/T/mri-16c2f9f2b11e43e7/axial_017.png","assets/T/mri-16c2f9f2b11e43e7/axial_019.png","assets/T/mri-16c2f9f2b11e43e7/axial_021.png","assets/T/mri-16c2f9f2b11e43e7/axial_022.png","assets/T/mri-16c2f9f2b11e43e7/axial_024.png","assets/T/mri-16c2f9f2b11e43e7/axial_026.png","assets/T/mri-16c2f9f2b11e43e7/axial_028.png","assets/T/mri-16c2f9f2b11e43e7/axial_030.png","assets/T/mri-16c2f9f2b11e43e7/axial_032.png","assets/T/mri-16c2f9f2b11e43e7/axial_034.png","assets/T/mri-16c2f9f2b11e43e7/axial_036.png","assets/T/mri-16c2f9f2b11e43e7/axial_038.png","assets/T/mri-16c2f9f2b11e43e7/axial_040.png","assets/T/mri-16c2f9f2b11e43e7/coronal_001.png","assets/T/mri-16c2f9f2b11e43e7/coronal_003.png","assets/T/mri-16c2f9f2b11e43e7/coronal_005.png","assets/T/mri-16c2f9f2b11e43e7/coronal_007.png","assets/T/mri-16c2f9f2b11e43e7/coronal_009.png","assets/T/mri-16c2f9f2b11e43e7/coronal_011.png","assets/T/mri-16c2f9f2b11e43e7/coronal_014.png","assets/T/mri-16c2f9f2b11e43e7/coronal_016.png","assets/T/mri-16c2f9f2b11e43e7/coronal_018.png","assets/T/mri-16c2f9f2b11e43e7/coronal_020.png","assets/T/mri-16c2f9f2b11e43e7/coronal_022.png","assets/T/mri-16c2f9f2b11e43e7/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-3f31af08249d42ef","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-3f31af08249d42ef/axial_001.png","assets/T/mri-3f31af08249d42ef/axial_003.png","assets/T/mri-3f31af08249d42ef/axial_005.png","assets/T/mri-3f31af08249d42ef/axial_007.png","assets/T/mri-3f31af08249d42ef/axial_009.png","assets/T/mri-3f31af08249d42ef/axial_011.png","assets/T/mri-3f31af08249d42ef/axial_013.png","assets/T/mri-3f31af08249d42ef/axial_015.png","assets/T/mri-3f31af08249d42ef/axial_017.png","assets/T/mri-3f31af08249d42ef/axial_019.png","assets/T/mri-3f31af08249d42ef/axial_022.png","assets/T/mri-3f31af08249d42ef/axial_024.png","assets/T/mri-3f31af08249d42ef/axial_026.png","assets/T/mri-3f31af08249d42ef/axial_028.png","assets/T/mri-3f31af08249d42ef/axial_030.png","assets/T/mri-3f31af08249d42ef/axial_032.png","assets/T/mri-3f31af08249d42ef/axial_034.png","assets/T/mri-3f31af08249d42ef/axial_036.png","assets/T/mri-3f31af08249d42ef/axial_038.png","assets/T/mri-3f31af08249d42ef/axial_040.png","assets/T/mri-3f31af08249d42ef/axial_042.png","assets/T/mri-3f31af08249d42ef/coronal_001.png","assets/T/mri-3f31af08249d42ef/coronal_003.png","assets/T/mri-3f31af08249d42ef/coronal_005.png","assets/T/mri-3f31af08249d42ef/coronal_007.png","assets/T/mri-3f31af08249d42ef/coronal_009.png","assets/T/mri-3f31af08249d42ef/coronal_011.png","assets/T/mri-3f31af08249d42ef/coronal_014.png","assets/T/mri-3f31af08249d42ef/coronal_016.png","assets/T/mri-3f31af08249d42ef/coronal_018.png","assets/T/mri-3f31af08249d42ef/coronal_020.png","assets/T/mri-3f31af08249d42ef/coronal_022.png","assets/T/mri-3f31af08249d42ef/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-25fd5f6282bd417a","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 22 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 11 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-25fd5f6282bd417a/axial_001.png","assets/T/mri-25fd5f6282bd417a/axial_003.png","assets/T/mri-25fd5f6282bd417a/axial_005.png","assets/T/mri-25fd5f6282bd417a/axial_007.png","assets/T/mri-25fd5f6282bd417a/axial_010.png","assets/T/mri-25fd5f6282bd417a/axial_012.png","assets/T/mri-25fd5f6282bd417a/axial_014.png","assets/T/mri-25fd5f6282bd417a/axial_016.png","assets/T/mri-25fd5f6282bd417a/axial_018.png","assets/T/mri-25fd5f6282bd417a/axial_020.png","assets/T/mri-25fd5f6282bd417a/axial_022.png","assets/T/mri-25fd5f6282bd417a/axial_025.png","assets/T/mri-25fd5f6282bd417a/axial_027.png","assets/T/mri-25fd5f6282bd417a/axial_029.png","assets/T/mri-25fd5f6282bd417a/axial_031.png","assets/T/mri-25fd5f6282bd417a/axial_033.png","assets/T/mri-25fd5f6282bd417a/axial_035.png","assets/T/mri-25fd5f6282bd417a/axial_037.png","assets/T/mri-25fd5f6282bd417a/axial_040.png","assets/T/mri-25fd5f6282bd417a/axial_042.png","assets/T/mri-25fd5f6282bd417a/axial_044.png","assets/T/mri-25fd5f6282bd417a/axial_046.png","assets/T/mri-25fd5f6282bd417a/coronal_001.png","assets/T/mri-25fd5f6282bd417a/coronal_003.png","assets/T/mri-25fd5f6282bd417a/coronal_006.png","assets/T/mri-25fd5f6282bd417a/coronal_008.png","assets/T/mri-25fd5f6282bd417a/coronal_010.png","assets/T/mri-25fd5f6282bd417a/coronal_013.png","assets/T/mri-25fd5f6282bd417a/coronal_015.png","assets/T/mri-25fd5f6282bd417a/coronal_017.png","assets/T/mri-25fd5f6282bd417a/coronal_019.png","assets/T/mri-25fd5f6282bd417a/coronal_022.png","assets/T/mri-25fd5f6282bd417a/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":70,"selected_count":33,"source_indices_1based":[1,3,5,7,10,12,14,16,18,20,22,25,27,29,31,33,35,37,40,42,44,46,47,49,52,54,56,59,61,63,65,68,70]}}
+{"id":"L3-T300:mri-acc2b4aa749d4481","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-acc2b4aa749d4481/axial_001.png","assets/T/mri-acc2b4aa749d4481/axial_003.png","assets/T/mri-acc2b4aa749d4481/axial_005.png","assets/T/mri-acc2b4aa749d4481/axial_007.png","assets/T/mri-acc2b4aa749d4481/axial_009.png","assets/T/mri-acc2b4aa749d4481/axial_011.png","assets/T/mri-acc2b4aa749d4481/axial_013.png","assets/T/mri-acc2b4aa749d4481/axial_015.png","assets/T/mri-acc2b4aa749d4481/axial_017.png","assets/T/mri-acc2b4aa749d4481/axial_019.png","assets/T/mri-acc2b4aa749d4481/axial_021.png","assets/T/mri-acc2b4aa749d4481/axial_022.png","assets/T/mri-acc2b4aa749d4481/axial_024.png","assets/T/mri-acc2b4aa749d4481/axial_026.png","assets/T/mri-acc2b4aa749d4481/axial_028.png","assets/T/mri-acc2b4aa749d4481/axial_030.png","assets/T/mri-acc2b4aa749d4481/axial_032.png","assets/T/mri-acc2b4aa749d4481/axial_034.png","assets/T/mri-acc2b4aa749d4481/axial_036.png","assets/T/mri-acc2b4aa749d4481/axial_038.png","assets/T/mri-acc2b4aa749d4481/axial_040.png","assets/T/mri-acc2b4aa749d4481/coronal_001.png","assets/T/mri-acc2b4aa749d4481/coronal_003.png","assets/T/mri-acc2b4aa749d4481/coronal_005.png","assets/T/mri-acc2b4aa749d4481/coronal_007.png","assets/T/mri-acc2b4aa749d4481/coronal_009.png","assets/T/mri-acc2b4aa749d4481/coronal_011.png","assets/T/mri-acc2b4aa749d4481/coronal_014.png","assets/T/mri-acc2b4aa749d4481/coronal_016.png","assets/T/mri-acc2b4aa749d4481/coronal_018.png","assets/T/mri-acc2b4aa749d4481/coronal_020.png","assets/T/mri-acc2b4aa749d4481/coronal_022.png","assets/T/mri-acc2b4aa749d4481/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-4c6b71e4929542b4","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-4c6b71e4929542b4/axial_001.png","assets/T/mri-4c6b71e4929542b4/axial_003.png","assets/T/mri-4c6b71e4929542b4/axial_005.png","assets/T/mri-4c6b71e4929542b4/axial_007.png","assets/T/mri-4c6b71e4929542b4/axial_009.png","assets/T/mri-4c6b71e4929542b4/axial_011.png","assets/T/mri-4c6b71e4929542b4/axial_013.png","assets/T/mri-4c6b71e4929542b4/axial_015.png","assets/T/mri-4c6b71e4929542b4/axial_017.png","assets/T/mri-4c6b71e4929542b4/axial_019.png","assets/T/mri-4c6b71e4929542b4/axial_022.png","assets/T/mri-4c6b71e4929542b4/axial_024.png","assets/T/mri-4c6b71e4929542b4/axial_026.png","assets/T/mri-4c6b71e4929542b4/axial_028.png","assets/T/mri-4c6b71e4929542b4/axial_030.png","assets/T/mri-4c6b71e4929542b4/axial_032.png","assets/T/mri-4c6b71e4929542b4/axial_034.png","assets/T/mri-4c6b71e4929542b4/axial_036.png","assets/T/mri-4c6b71e4929542b4/axial_038.png","assets/T/mri-4c6b71e4929542b4/axial_040.png","assets/T/mri-4c6b71e4929542b4/axial_042.png","assets/T/mri-4c6b71e4929542b4/coronal_001.png","assets/T/mri-4c6b71e4929542b4/coronal_003.png","assets/T/mri-4c6b71e4929542b4/coronal_005.png","assets/T/mri-4c6b71e4929542b4/coronal_007.png","assets/T/mri-4c6b71e4929542b4/coronal_009.png","assets/T/mri-4c6b71e4929542b4/coronal_011.png","assets/T/mri-4c6b71e4929542b4/coronal_014.png","assets/T/mri-4c6b71e4929542b4/coronal_016.png","assets/T/mri-4c6b71e4929542b4/coronal_018.png","assets/T/mri-4c6b71e4929542b4/coronal_020.png","assets/T/mri-4c6b71e4929542b4/coronal_022.png","assets/T/mri-4c6b71e4929542b4/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-70a24066e1394843","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-70a24066e1394843/axial_001.png","assets/T/mri-70a24066e1394843/axial_003.png","assets/T/mri-70a24066e1394843/axial_005.png","assets/T/mri-70a24066e1394843/axial_007.png","assets/T/mri-70a24066e1394843/axial_010.png","assets/T/mri-70a24066e1394843/axial_012.png","assets/T/mri-70a24066e1394843/axial_014.png","assets/T/mri-70a24066e1394843/axial_016.png","assets/T/mri-70a24066e1394843/axial_018.png","assets/T/mri-70a24066e1394843/axial_020.png","assets/T/mri-70a24066e1394843/axial_023.png","assets/T/mri-70a24066e1394843/axial_025.png","assets/T/mri-70a24066e1394843/axial_027.png","assets/T/mri-70a24066e1394843/axial_029.png","assets/T/mri-70a24066e1394843/axial_031.png","assets/T/mri-70a24066e1394843/axial_033.png","assets/T/mri-70a24066e1394843/axial_035.png","assets/T/mri-70a24066e1394843/axial_038.png","assets/T/mri-70a24066e1394843/axial_040.png","assets/T/mri-70a24066e1394843/axial_042.png","assets/T/mri-70a24066e1394843/axial_044.png","assets/T/mri-70a24066e1394843/coronal_001.png","assets/T/mri-70a24066e1394843/coronal_003.png","assets/T/mri-70a24066e1394843/coronal_005.png","assets/T/mri-70a24066e1394843/coronal_007.png","assets/T/mri-70a24066e1394843/coronal_009.png","assets/T/mri-70a24066e1394843/coronal_011.png","assets/T/mri-70a24066e1394843/coronal_014.png","assets/T/mri-70a24066e1394843/coronal_016.png","assets/T/mri-70a24066e1394843/coronal_018.png","assets/T/mri-70a24066e1394843/coronal_020.png","assets/T/mri-70a24066e1394843/coronal_022.png","assets/T/mri-70a24066e1394843/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":68,"selected_count":33,"source_indices_1based":[1,3,5,7,10,12,14,16,18,20,23,25,27,29,31,33,35,38,40,42,44,45,47,49,51,53,55,58,60,62,64,66,68]}}
+{"id":"L3-T300:mri-3931b6ac51dd4dc5","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 13 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-3931b6ac51dd4dc5/axial_001.png","assets/T/mri-3931b6ac51dd4dc5/axial_003.png","assets/T/mri-3931b6ac51dd4dc5/axial_005.png","assets/T/mri-3931b6ac51dd4dc5/axial_007.png","assets/T/mri-3931b6ac51dd4dc5/axial_009.png","assets/T/mri-3931b6ac51dd4dc5/axial_011.png","assets/T/mri-3931b6ac51dd4dc5/axial_013.png","assets/T/mri-3931b6ac51dd4dc5/axial_015.png","assets/T/mri-3931b6ac51dd4dc5/axial_017.png","assets/T/mri-3931b6ac51dd4dc5/axial_019.png","assets/T/mri-3931b6ac51dd4dc5/axial_020.png","assets/T/mri-3931b6ac51dd4dc5/axial_022.png","assets/T/mri-3931b6ac51dd4dc5/axial_024.png","assets/T/mri-3931b6ac51dd4dc5/axial_026.png","assets/T/mri-3931b6ac51dd4dc5/axial_028.png","assets/T/mri-3931b6ac51dd4dc5/axial_030.png","assets/T/mri-3931b6ac51dd4dc5/axial_032.png","assets/T/mri-3931b6ac51dd4dc5/axial_034.png","assets/T/mri-3931b6ac51dd4dc5/axial_036.png","assets/T/mri-3931b6ac51dd4dc5/axial_038.png","assets/T/mri-3931b6ac51dd4dc5/coronal_001.png","assets/T/mri-3931b6ac51dd4dc5/coronal_003.png","assets/T/mri-3931b6ac51dd4dc5/coronal_005.png","assets/T/mri-3931b6ac51dd4dc5/coronal_007.png","assets/T/mri-3931b6ac51dd4dc5/coronal_009.png","assets/T/mri-3931b6ac51dd4dc5/coronal_011.png","assets/T/mri-3931b6ac51dd4dc5/coronal_013.png","assets/T/mri-3931b6ac51dd4dc5/coronal_014.png","assets/T/mri-3931b6ac51dd4dc5/coronal_016.png","assets/T/mri-3931b6ac51dd4dc5/coronal_018.png","assets/T/mri-3931b6ac51dd4dc5/coronal_020.png","assets/T/mri-3931b6ac51dd4dc5/coronal_022.png","assets/T/mri-3931b6ac51dd4dc5/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":62,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,20,22,24,26,28,30,32,34,36,38,39,41,43,45,47,49,51,52,54,56,58,60,62]}}
+{"id":"L3-T300:mri-94619c73cc6e4b8d","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 13 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-94619c73cc6e4b8d/axial_001.png","assets/T/mri-94619c73cc6e4b8d/axial_003.png","assets/T/mri-94619c73cc6e4b8d/axial_005.png","assets/T/mri-94619c73cc6e4b8d/axial_007.png","assets/T/mri-94619c73cc6e4b8d/axial_009.png","assets/T/mri-94619c73cc6e4b8d/axial_011.png","assets/T/mri-94619c73cc6e4b8d/axial_013.png","assets/T/mri-94619c73cc6e4b8d/axial_015.png","assets/T/mri-94619c73cc6e4b8d/axial_017.png","assets/T/mri-94619c73cc6e4b8d/axial_019.png","assets/T/mri-94619c73cc6e4b8d/axial_022.png","assets/T/mri-94619c73cc6e4b8d/axial_024.png","assets/T/mri-94619c73cc6e4b8d/axial_026.png","assets/T/mri-94619c73cc6e4b8d/axial_028.png","assets/T/mri-94619c73cc6e4b8d/axial_030.png","assets/T/mri-94619c73cc6e4b8d/axial_032.png","assets/T/mri-94619c73cc6e4b8d/axial_034.png","assets/T/mri-94619c73cc6e4b8d/axial_036.png","assets/T/mri-94619c73cc6e4b8d/axial_038.png","assets/T/mri-94619c73cc6e4b8d/axial_040.png","assets/T/mri-94619c73cc6e4b8d/coronal_001.png","assets/T/mri-94619c73cc6e4b8d/coronal_003.png","assets/T/mri-94619c73cc6e4b8d/coronal_005.png","assets/T/mri-94619c73cc6e4b8d/coronal_007.png","assets/T/mri-94619c73cc6e4b8d/coronal_009.png","assets/T/mri-94619c73cc6e4b8d/coronal_011.png","assets/T/mri-94619c73cc6e4b8d/coronal_014.png","assets/T/mri-94619c73cc6e4b8d/coronal_016.png","assets/T/mri-94619c73cc6e4b8d/coronal_018.png","assets/T/mri-94619c73cc6e4b8d/coronal_020.png","assets/T/mri-94619c73cc6e4b8d/coronal_022.png","assets/T/mri-94619c73cc6e4b8d/coronal_024.png","assets/T/mri-94619c73cc6e4b8d/coronal_026.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-d7919e72b6ea42d5","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-d7919e72b6ea42d5/axial_001.png","assets/T/mri-d7919e72b6ea42d5/axial_003.png","assets/T/mri-d7919e72b6ea42d5/axial_005.png","assets/T/mri-d7919e72b6ea42d5/axial_007.png","assets/T/mri-d7919e72b6ea42d5/axial_009.png","assets/T/mri-d7919e72b6ea42d5/axial_011.png","assets/T/mri-d7919e72b6ea42d5/axial_013.png","assets/T/mri-d7919e72b6ea42d5/axial_015.png","assets/T/mri-d7919e72b6ea42d5/axial_017.png","assets/T/mri-d7919e72b6ea42d5/axial_019.png","assets/T/mri-d7919e72b6ea42d5/axial_022.png","assets/T/mri-d7919e72b6ea42d5/axial_024.png","assets/T/mri-d7919e72b6ea42d5/axial_026.png","assets/T/mri-d7919e72b6ea42d5/axial_028.png","assets/T/mri-d7919e72b6ea42d5/axial_030.png","assets/T/mri-d7919e72b6ea42d5/axial_032.png","assets/T/mri-d7919e72b6ea42d5/axial_034.png","assets/T/mri-d7919e72b6ea42d5/axial_036.png","assets/T/mri-d7919e72b6ea42d5/axial_038.png","assets/T/mri-d7919e72b6ea42d5/axial_040.png","assets/T/mri-d7919e72b6ea42d5/axial_042.png","assets/T/mri-d7919e72b6ea42d5/coronal_001.png","assets/T/mri-d7919e72b6ea42d5/coronal_003.png","assets/T/mri-d7919e72b6ea42d5/coronal_005.png","assets/T/mri-d7919e72b6ea42d5/coronal_007.png","assets/T/mri-d7919e72b6ea42d5/coronal_009.png","assets/T/mri-d7919e72b6ea42d5/coronal_011.png","assets/T/mri-d7919e72b6ea42d5/coronal_014.png","assets/T/mri-d7919e72b6ea42d5/coronal_016.png","assets/T/mri-d7919e72b6ea42d5/coronal_018.png","assets/T/mri-d7919e72b6ea42d5/coronal_020.png","assets/T/mri-d7919e72b6ea42d5/coronal_022.png","assets/T/mri-d7919e72b6ea42d5/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-35e2272d24e44428","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 13 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-35e2272d24e44428/axial_001.png","assets/T/mri-35e2272d24e44428/axial_003.png","assets/T/mri-35e2272d24e44428/axial_005.png","assets/T/mri-35e2272d24e44428/axial_007.png","assets/T/mri-35e2272d24e44428/axial_010.png","assets/T/mri-35e2272d24e44428/axial_012.png","assets/T/mri-35e2272d24e44428/axial_014.png","assets/T/mri-35e2272d24e44428/axial_016.png","assets/T/mri-35e2272d24e44428/axial_018.png","assets/T/mri-35e2272d24e44428/axial_020.png","assets/T/mri-35e2272d24e44428/axial_023.png","assets/T/mri-35e2272d24e44428/axial_025.png","assets/T/mri-35e2272d24e44428/axial_027.png","assets/T/mri-35e2272d24e44428/axial_029.png","assets/T/mri-35e2272d24e44428/axial_031.png","assets/T/mri-35e2272d24e44428/axial_033.png","assets/T/mri-35e2272d24e44428/axial_036.png","assets/T/mri-35e2272d24e44428/axial_038.png","assets/T/mri-35e2272d24e44428/axial_040.png","assets/T/mri-35e2272d24e44428/axial_042.png","assets/T/mri-35e2272d24e44428/coronal_001.png","assets/T/mri-35e2272d24e44428/coronal_003.png","assets/T/mri-35e2272d24e44428/coronal_005.png","assets/T/mri-35e2272d24e44428/coronal_007.png","assets/T/mri-35e2272d24e44428/coronal_009.png","assets/T/mri-35e2272d24e44428/coronal_011.png","assets/T/mri-35e2272d24e44428/coronal_014.png","assets/T/mri-35e2272d24e44428/coronal_016.png","assets/T/mri-35e2272d24e44428/coronal_018.png","assets/T/mri-35e2272d24e44428/coronal_020.png","assets/T/mri-35e2272d24e44428/coronal_022.png","assets/T/mri-35e2272d24e44428/coronal_024.png","assets/T/mri-35e2272d24e44428/coronal_026.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":68,"selected_count":33,"source_indices_1based":[1,3,5,7,10,12,14,16,18,20,23,25,27,29,31,33,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66,68]}}
+{"id":"L3-T300:mri-f18cbd80507c4825","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-f18cbd80507c4825/axial_001.png","assets/T/mri-f18cbd80507c4825/axial_003.png","assets/T/mri-f18cbd80507c4825/axial_005.png","assets/T/mri-f18cbd80507c4825/axial_007.png","assets/T/mri-f18cbd80507c4825/axial_010.png","assets/T/mri-f18cbd80507c4825/axial_012.png","assets/T/mri-f18cbd80507c4825/axial_014.png","assets/T/mri-f18cbd80507c4825/axial_016.png","assets/T/mri-f18cbd80507c4825/axial_018.png","assets/T/mri-f18cbd80507c4825/axial_020.png","assets/T/mri-f18cbd80507c4825/axial_023.png","assets/T/mri-f18cbd80507c4825/axial_025.png","assets/T/mri-f18cbd80507c4825/axial_027.png","assets/T/mri-f18cbd80507c4825/axial_029.png","assets/T/mri-f18cbd80507c4825/axial_031.png","assets/T/mri-f18cbd80507c4825/axial_033.png","assets/T/mri-f18cbd80507c4825/axial_035.png","assets/T/mri-f18cbd80507c4825/axial_038.png","assets/T/mri-f18cbd80507c4825/axial_040.png","assets/T/mri-f18cbd80507c4825/axial_042.png","assets/T/mri-f18cbd80507c4825/axial_044.png","assets/T/mri-f18cbd80507c4825/coronal_001.png","assets/T/mri-f18cbd80507c4825/coronal_003.png","assets/T/mri-f18cbd80507c4825/coronal_005.png","assets/T/mri-f18cbd80507c4825/coronal_007.png","assets/T/mri-f18cbd80507c4825/coronal_009.png","assets/T/mri-f18cbd80507c4825/coronal_011.png","assets/T/mri-f18cbd80507c4825/coronal_014.png","assets/T/mri-f18cbd80507c4825/coronal_016.png","assets/T/mri-f18cbd80507c4825/coronal_018.png","assets/T/mri-f18cbd80507c4825/coronal_020.png","assets/T/mri-f18cbd80507c4825/coronal_022.png","assets/T/mri-f18cbd80507c4825/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":68,"selected_count":33,"source_indices_1based":[1,3,5,7,10,12,14,16,18,20,23,25,27,29,31,33,35,38,40,42,44,45,47,49,51,53,55,58,60,62,64,66,68]}}
+{"id":"L3-T300:mri-b03c65e16e9040f7","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 13 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-b03c65e16e9040f7/axial_001.png","assets/T/mri-b03c65e16e9040f7/axial_003.png","assets/T/mri-b03c65e16e9040f7/axial_005.png","assets/T/mri-b03c65e16e9040f7/axial_007.png","assets/T/mri-b03c65e16e9040f7/axial_010.png","assets/T/mri-b03c65e16e9040f7/axial_012.png","assets/T/mri-b03c65e16e9040f7/axial_014.png","assets/T/mri-b03c65e16e9040f7/axial_016.png","assets/T/mri-b03c65e16e9040f7/axial_018.png","assets/T/mri-b03c65e16e9040f7/axial_020.png","assets/T/mri-b03c65e16e9040f7/axial_023.png","assets/T/mri-b03c65e16e9040f7/axial_025.png","assets/T/mri-b03c65e16e9040f7/axial_027.png","assets/T/mri-b03c65e16e9040f7/axial_029.png","assets/T/mri-b03c65e16e9040f7/axial_031.png","assets/T/mri-b03c65e16e9040f7/axial_033.png","assets/T/mri-b03c65e16e9040f7/axial_036.png","assets/T/mri-b03c65e16e9040f7/axial_038.png","assets/T/mri-b03c65e16e9040f7/axial_040.png","assets/T/mri-b03c65e16e9040f7/axial_042.png","assets/T/mri-b03c65e16e9040f7/coronal_001.png","assets/T/mri-b03c65e16e9040f7/coronal_003.png","assets/T/mri-b03c65e16e9040f7/coronal_005.png","assets/T/mri-b03c65e16e9040f7/coronal_007.png","assets/T/mri-b03c65e16e9040f7/coronal_009.png","assets/T/mri-b03c65e16e9040f7/coronal_011.png","assets/T/mri-b03c65e16e9040f7/coronal_014.png","assets/T/mri-b03c65e16e9040f7/coronal_016.png","assets/T/mri-b03c65e16e9040f7/coronal_018.png","assets/T/mri-b03c65e16e9040f7/coronal_020.png","assets/T/mri-b03c65e16e9040f7/coronal_022.png","assets/T/mri-b03c65e16e9040f7/coronal_024.png","assets/T/mri-b03c65e16e9040f7/coronal_026.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":68,"selected_count":33,"source_indices_1based":[1,3,5,7,10,12,14,16,18,20,23,25,27,29,31,33,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66,68]}}
+{"id":"L3-T300:mri-46fd12fc3c8e4db4","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-46fd12fc3c8e4db4/axial_001.png","assets/T/mri-46fd12fc3c8e4db4/axial_003.png","assets/T/mri-46fd12fc3c8e4db4/axial_005.png","assets/T/mri-46fd12fc3c8e4db4/axial_007.png","assets/T/mri-46fd12fc3c8e4db4/axial_009.png","assets/T/mri-46fd12fc3c8e4db4/axial_011.png","assets/T/mri-46fd12fc3c8e4db4/axial_013.png","assets/T/mri-46fd12fc3c8e4db4/axial_015.png","assets/T/mri-46fd12fc3c8e4db4/axial_017.png","assets/T/mri-46fd12fc3c8e4db4/axial_019.png","assets/T/mri-46fd12fc3c8e4db4/axial_021.png","assets/T/mri-46fd12fc3c8e4db4/axial_022.png","assets/T/mri-46fd12fc3c8e4db4/axial_024.png","assets/T/mri-46fd12fc3c8e4db4/axial_026.png","assets/T/mri-46fd12fc3c8e4db4/axial_028.png","assets/T/mri-46fd12fc3c8e4db4/axial_030.png","assets/T/mri-46fd12fc3c8e4db4/axial_032.png","assets/T/mri-46fd12fc3c8e4db4/axial_034.png","assets/T/mri-46fd12fc3c8e4db4/axial_036.png","assets/T/mri-46fd12fc3c8e4db4/axial_038.png","assets/T/mri-46fd12fc3c8e4db4/axial_040.png","assets/T/mri-46fd12fc3c8e4db4/coronal_001.png","assets/T/mri-46fd12fc3c8e4db4/coronal_003.png","assets/T/mri-46fd12fc3c8e4db4/coronal_005.png","assets/T/mri-46fd12fc3c8e4db4/coronal_007.png","assets/T/mri-46fd12fc3c8e4db4/coronal_009.png","assets/T/mri-46fd12fc3c8e4db4/coronal_011.png","assets/T/mri-46fd12fc3c8e4db4/coronal_014.png","assets/T/mri-46fd12fc3c8e4db4/coronal_016.png","assets/T/mri-46fd12fc3c8e4db4/coronal_018.png","assets/T/mri-46fd12fc3c8e4db4/coronal_020.png","assets/T/mri-46fd12fc3c8e4db4/coronal_022.png","assets/T/mri-46fd12fc3c8e4db4/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-f1332bb1d0564e4d","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 13 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-f1332bb1d0564e4d/axial_001.png","assets/T/mri-f1332bb1d0564e4d/axial_003.png","assets/T/mri-f1332bb1d0564e4d/axial_005.png","assets/T/mri-f1332bb1d0564e4d/axial_007.png","assets/T/mri-f1332bb1d0564e4d/axial_009.png","assets/T/mri-f1332bb1d0564e4d/axial_011.png","assets/T/mri-f1332bb1d0564e4d/axial_013.png","assets/T/mri-f1332bb1d0564e4d/axial_015.png","assets/T/mri-f1332bb1d0564e4d/axial_017.png","assets/T/mri-f1332bb1d0564e4d/axial_019.png","assets/T/mri-f1332bb1d0564e4d/axial_020.png","assets/T/mri-f1332bb1d0564e4d/axial_022.png","assets/T/mri-f1332bb1d0564e4d/axial_024.png","assets/T/mri-f1332bb1d0564e4d/axial_026.png","assets/T/mri-f1332bb1d0564e4d/axial_028.png","assets/T/mri-f1332bb1d0564e4d/axial_030.png","assets/T/mri-f1332bb1d0564e4d/axial_032.png","assets/T/mri-f1332bb1d0564e4d/axial_034.png","assets/T/mri-f1332bb1d0564e4d/axial_036.png","assets/T/mri-f1332bb1d0564e4d/axial_038.png","assets/T/mri-f1332bb1d0564e4d/coronal_001.png","assets/T/mri-f1332bb1d0564e4d/coronal_003.png","assets/T/mri-f1332bb1d0564e4d/coronal_005.png","assets/T/mri-f1332bb1d0564e4d/coronal_007.png","assets/T/mri-f1332bb1d0564e4d/coronal_009.png","assets/T/mri-f1332bb1d0564e4d/coronal_011.png","assets/T/mri-f1332bb1d0564e4d/coronal_013.png","assets/T/mri-f1332bb1d0564e4d/coronal_014.png","assets/T/mri-f1332bb1d0564e4d/coronal_016.png","assets/T/mri-f1332bb1d0564e4d/coronal_018.png","assets/T/mri-f1332bb1d0564e4d/coronal_020.png","assets/T/mri-f1332bb1d0564e4d/coronal_022.png","assets/T/mri-f1332bb1d0564e4d/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":62,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,20,22,24,26,28,30,32,34,36,38,39,41,43,45,47,49,51,52,54,56,58,60,62]}}
+{"id":"L3-T300:mri-eb71471006a94a6e","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-eb71471006a94a6e/axial_001.png","assets/T/mri-eb71471006a94a6e/axial_003.png","assets/T/mri-eb71471006a94a6e/axial_005.png","assets/T/mri-eb71471006a94a6e/axial_007.png","assets/T/mri-eb71471006a94a6e/axial_009.png","assets/T/mri-eb71471006a94a6e/axial_011.png","assets/T/mri-eb71471006a94a6e/axial_013.png","assets/T/mri-eb71471006a94a6e/axial_015.png","assets/T/mri-eb71471006a94a6e/axial_017.png","assets/T/mri-eb71471006a94a6e/axial_019.png","assets/T/mri-eb71471006a94a6e/axial_021.png","assets/T/mri-eb71471006a94a6e/axial_022.png","assets/T/mri-eb71471006a94a6e/axial_024.png","assets/T/mri-eb71471006a94a6e/axial_026.png","assets/T/mri-eb71471006a94a6e/axial_028.png","assets/T/mri-eb71471006a94a6e/axial_030.png","assets/T/mri-eb71471006a94a6e/axial_032.png","assets/T/mri-eb71471006a94a6e/axial_034.png","assets/T/mri-eb71471006a94a6e/axial_036.png","assets/T/mri-eb71471006a94a6e/axial_038.png","assets/T/mri-eb71471006a94a6e/axial_040.png","assets/T/mri-eb71471006a94a6e/coronal_001.png","assets/T/mri-eb71471006a94a6e/coronal_003.png","assets/T/mri-eb71471006a94a6e/coronal_005.png","assets/T/mri-eb71471006a94a6e/coronal_007.png","assets/T/mri-eb71471006a94a6e/coronal_009.png","assets/T/mri-eb71471006a94a6e/coronal_011.png","assets/T/mri-eb71471006a94a6e/coronal_014.png","assets/T/mri-eb71471006a94a6e/coronal_016.png","assets/T/mri-eb71471006a94a6e/coronal_018.png","assets/T/mri-eb71471006a94a6e/coronal_020.png","assets/T/mri-eb71471006a94a6e/coronal_022.png","assets/T/mri-eb71471006a94a6e/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-3e9b74c4b7e84825","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 34 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 14 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-3e9b74c4b7e84825/axial_001.png","assets/T/mri-3e9b74c4b7e84825/axial_003.png","assets/T/mri-3e9b74c4b7e84825/axial_005.png","assets/T/mri-3e9b74c4b7e84825/axial_007.png","assets/T/mri-3e9b74c4b7e84825/axial_010.png","assets/T/mri-3e9b74c4b7e84825/axial_012.png","assets/T/mri-3e9b74c4b7e84825/axial_014.png","assets/T/mri-3e9b74c4b7e84825/axial_016.png","assets/T/mri-3e9b74c4b7e84825/axial_018.png","assets/T/mri-3e9b74c4b7e84825/axial_020.png","assets/T/mri-3e9b74c4b7e84825/axial_023.png","assets/T/mri-3e9b74c4b7e84825/axial_025.png","assets/T/mri-3e9b74c4b7e84825/axial_027.png","assets/T/mri-3e9b74c4b7e84825/axial_029.png","assets/T/mri-3e9b74c4b7e84825/axial_031.png","assets/T/mri-3e9b74c4b7e84825/axial_033.png","assets/T/mri-3e9b74c4b7e84825/axial_036.png","assets/T/mri-3e9b74c4b7e84825/axial_038.png","assets/T/mri-3e9b74c4b7e84825/axial_040.png","assets/T/mri-3e9b74c4b7e84825/axial_042.png","assets/T/mri-3e9b74c4b7e84825/coronal_001.png","assets/T/mri-3e9b74c4b7e84825/coronal_003.png","assets/T/mri-3e9b74c4b7e84825/coronal_005.png","assets/T/mri-3e9b74c4b7e84825/coronal_007.png","assets/T/mri-3e9b74c4b7e84825/coronal_009.png","assets/T/mri-3e9b74c4b7e84825/coronal_011.png","assets/T/mri-3e9b74c4b7e84825/coronal_013.png","assets/T/mri-3e9b74c4b7e84825/coronal_016.png","assets/T/mri-3e9b74c4b7e84825/coronal_018.png","assets/T/mri-3e9b74c4b7e84825/coronal_020.png","assets/T/mri-3e9b74c4b7e84825/coronal_022.png","assets/T/mri-3e9b74c4b7e84825/coronal_024.png","assets/T/mri-3e9b74c4b7e84825/coronal_026.png","assets/T/mri-3e9b74c4b7e84825/coronal_028.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":70,"selected_count":34,"source_indices_1based":[1,3,5,7,10,12,14,16,18,20,23,25,27,29,31,33,36,38,40,42,43,45,47,49,51,53,55,58,60,62,64,66,68,70]}}
+{"id":"L3-T300:mri-de9e22a5b5b946f0","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-de9e22a5b5b946f0/axial_001.png","assets/T/mri-de9e22a5b5b946f0/axial_003.png","assets/T/mri-de9e22a5b5b946f0/axial_005.png","assets/T/mri-de9e22a5b5b946f0/axial_007.png","assets/T/mri-de9e22a5b5b946f0/axial_009.png","assets/T/mri-de9e22a5b5b946f0/axial_011.png","assets/T/mri-de9e22a5b5b946f0/axial_013.png","assets/T/mri-de9e22a5b5b946f0/axial_015.png","assets/T/mri-de9e22a5b5b946f0/axial_017.png","assets/T/mri-de9e22a5b5b946f0/axial_019.png","assets/T/mri-de9e22a5b5b946f0/axial_022.png","assets/T/mri-de9e22a5b5b946f0/axial_024.png","assets/T/mri-de9e22a5b5b946f0/axial_026.png","assets/T/mri-de9e22a5b5b946f0/axial_028.png","assets/T/mri-de9e22a5b5b946f0/axial_030.png","assets/T/mri-de9e22a5b5b946f0/axial_032.png","assets/T/mri-de9e22a5b5b946f0/axial_034.png","assets/T/mri-de9e22a5b5b946f0/axial_036.png","assets/T/mri-de9e22a5b5b946f0/axial_038.png","assets/T/mri-de9e22a5b5b946f0/axial_040.png","assets/T/mri-de9e22a5b5b946f0/axial_042.png","assets/T/mri-de9e22a5b5b946f0/coronal_001.png","assets/T/mri-de9e22a5b5b946f0/coronal_003.png","assets/T/mri-de9e22a5b5b946f0/coronal_005.png","assets/T/mri-de9e22a5b5b946f0/coronal_007.png","assets/T/mri-de9e22a5b5b946f0/coronal_009.png","assets/T/mri-de9e22a5b5b946f0/coronal_011.png","assets/T/mri-de9e22a5b5b946f0/coronal_014.png","assets/T/mri-de9e22a5b5b946f0/coronal_016.png","assets/T/mri-de9e22a5b5b946f0/coronal_018.png","assets/T/mri-de9e22a5b5b946f0/coronal_020.png","assets/T/mri-de9e22a5b5b946f0/coronal_022.png","assets/T/mri-de9e22a5b5b946f0/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-973c4546eae9419a","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 13 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-973c4546eae9419a/axial_001.png","assets/T/mri-973c4546eae9419a/axial_003.png","assets/T/mri-973c4546eae9419a/axial_005.png","assets/T/mri-973c4546eae9419a/axial_007.png","assets/T/mri-973c4546eae9419a/axial_009.png","assets/T/mri-973c4546eae9419a/axial_011.png","assets/T/mri-973c4546eae9419a/axial_013.png","assets/T/mri-973c4546eae9419a/axial_015.png","assets/T/mri-973c4546eae9419a/axial_017.png","assets/T/mri-973c4546eae9419a/axial_019.png","assets/T/mri-973c4546eae9419a/axial_020.png","assets/T/mri-973c4546eae9419a/axial_022.png","assets/T/mri-973c4546eae9419a/axial_024.png","assets/T/mri-973c4546eae9419a/axial_026.png","assets/T/mri-973c4546eae9419a/axial_028.png","assets/T/mri-973c4546eae9419a/axial_030.png","assets/T/mri-973c4546eae9419a/axial_032.png","assets/T/mri-973c4546eae9419a/axial_034.png","assets/T/mri-973c4546eae9419a/axial_036.png","assets/T/mri-973c4546eae9419a/axial_038.png","assets/T/mri-973c4546eae9419a/coronal_001.png","assets/T/mri-973c4546eae9419a/coronal_003.png","assets/T/mri-973c4546eae9419a/coronal_005.png","assets/T/mri-973c4546eae9419a/coronal_007.png","assets/T/mri-973c4546eae9419a/coronal_009.png","assets/T/mri-973c4546eae9419a/coronal_011.png","assets/T/mri-973c4546eae9419a/coronal_013.png","assets/T/mri-973c4546eae9419a/coronal_014.png","assets/T/mri-973c4546eae9419a/coronal_016.png","assets/T/mri-973c4546eae9419a/coronal_018.png","assets/T/mri-973c4546eae9419a/coronal_020.png","assets/T/mri-973c4546eae9419a/coronal_022.png","assets/T/mri-973c4546eae9419a/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":62,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,20,22,24,26,28,30,32,34,36,38,39,41,43,45,47,49,51,52,54,56,58,60,62]}}
+{"id":"L3-T300:mri-8fbe2995ecbf4644","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-8fbe2995ecbf4644/axial_001.png","assets/T/mri-8fbe2995ecbf4644/axial_003.png","assets/T/mri-8fbe2995ecbf4644/axial_005.png","assets/T/mri-8fbe2995ecbf4644/axial_007.png","assets/T/mri-8fbe2995ecbf4644/axial_009.png","assets/T/mri-8fbe2995ecbf4644/axial_011.png","assets/T/mri-8fbe2995ecbf4644/axial_013.png","assets/T/mri-8fbe2995ecbf4644/axial_015.png","assets/T/mri-8fbe2995ecbf4644/axial_017.png","assets/T/mri-8fbe2995ecbf4644/axial_019.png","assets/T/mri-8fbe2995ecbf4644/axial_022.png","assets/T/mri-8fbe2995ecbf4644/axial_024.png","assets/T/mri-8fbe2995ecbf4644/axial_026.png","assets/T/mri-8fbe2995ecbf4644/axial_028.png","assets/T/mri-8fbe2995ecbf4644/axial_030.png","assets/T/mri-8fbe2995ecbf4644/axial_032.png","assets/T/mri-8fbe2995ecbf4644/axial_034.png","assets/T/mri-8fbe2995ecbf4644/axial_036.png","assets/T/mri-8fbe2995ecbf4644/axial_038.png","assets/T/mri-8fbe2995ecbf4644/axial_040.png","assets/T/mri-8fbe2995ecbf4644/axial_042.png","assets/T/mri-8fbe2995ecbf4644/coronal_001.png","assets/T/mri-8fbe2995ecbf4644/coronal_003.png","assets/T/mri-8fbe2995ecbf4644/coronal_005.png","assets/T/mri-8fbe2995ecbf4644/coronal_007.png","assets/T/mri-8fbe2995ecbf4644/coronal_009.png","assets/T/mri-8fbe2995ecbf4644/coronal_011.png","assets/T/mri-8fbe2995ecbf4644/coronal_014.png","assets/T/mri-8fbe2995ecbf4644/coronal_016.png","assets/T/mri-8fbe2995ecbf4644/coronal_018.png","assets/T/mri-8fbe2995ecbf4644/coronal_020.png","assets/T/mri-8fbe2995ecbf4644/coronal_022.png","assets/T/mri-8fbe2995ecbf4644/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-c543bdb39c8642be","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-c543bdb39c8642be/axial_001.png","assets/T/mri-c543bdb39c8642be/axial_003.png","assets/T/mri-c543bdb39c8642be/axial_005.png","assets/T/mri-c543bdb39c8642be/axial_007.png","assets/T/mri-c543bdb39c8642be/axial_009.png","assets/T/mri-c543bdb39c8642be/axial_011.png","assets/T/mri-c543bdb39c8642be/axial_013.png","assets/T/mri-c543bdb39c8642be/axial_015.png","assets/T/mri-c543bdb39c8642be/axial_017.png","assets/T/mri-c543bdb39c8642be/axial_019.png","assets/T/mri-c543bdb39c8642be/axial_022.png","assets/T/mri-c543bdb39c8642be/axial_024.png","assets/T/mri-c543bdb39c8642be/axial_026.png","assets/T/mri-c543bdb39c8642be/axial_028.png","assets/T/mri-c543bdb39c8642be/axial_030.png","assets/T/mri-c543bdb39c8642be/axial_032.png","assets/T/mri-c543bdb39c8642be/axial_034.png","assets/T/mri-c543bdb39c8642be/axial_036.png","assets/T/mri-c543bdb39c8642be/axial_038.png","assets/T/mri-c543bdb39c8642be/axial_040.png","assets/T/mri-c543bdb39c8642be/axial_042.png","assets/T/mri-c543bdb39c8642be/coronal_001.png","assets/T/mri-c543bdb39c8642be/coronal_003.png","assets/T/mri-c543bdb39c8642be/coronal_005.png","assets/T/mri-c543bdb39c8642be/coronal_007.png","assets/T/mri-c543bdb39c8642be/coronal_009.png","assets/T/mri-c543bdb39c8642be/coronal_011.png","assets/T/mri-c543bdb39c8642be/coronal_014.png","assets/T/mri-c543bdb39c8642be/coronal_016.png","assets/T/mri-c543bdb39c8642be/coronal_018.png","assets/T/mri-c543bdb39c8642be/coronal_020.png","assets/T/mri-c543bdb39c8642be/coronal_022.png","assets/T/mri-c543bdb39c8642be/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-ff0c8aa579c84949","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-ff0c8aa579c84949/axial_001.png","assets/T/mri-ff0c8aa579c84949/axial_003.png","assets/T/mri-ff0c8aa579c84949/axial_005.png","assets/T/mri-ff0c8aa579c84949/axial_007.png","assets/T/mri-ff0c8aa579c84949/axial_009.png","assets/T/mri-ff0c8aa579c84949/axial_011.png","assets/T/mri-ff0c8aa579c84949/axial_013.png","assets/T/mri-ff0c8aa579c84949/axial_015.png","assets/T/mri-ff0c8aa579c84949/axial_017.png","assets/T/mri-ff0c8aa579c84949/axial_019.png","assets/T/mri-ff0c8aa579c84949/axial_022.png","assets/T/mri-ff0c8aa579c84949/axial_024.png","assets/T/mri-ff0c8aa579c84949/axial_026.png","assets/T/mri-ff0c8aa579c84949/axial_028.png","assets/T/mri-ff0c8aa579c84949/axial_030.png","assets/T/mri-ff0c8aa579c84949/axial_032.png","assets/T/mri-ff0c8aa579c84949/axial_034.png","assets/T/mri-ff0c8aa579c84949/axial_036.png","assets/T/mri-ff0c8aa579c84949/axial_038.png","assets/T/mri-ff0c8aa579c84949/axial_040.png","assets/T/mri-ff0c8aa579c84949/axial_042.png","assets/T/mri-ff0c8aa579c84949/coronal_001.png","assets/T/mri-ff0c8aa579c84949/coronal_003.png","assets/T/mri-ff0c8aa579c84949/coronal_005.png","assets/T/mri-ff0c8aa579c84949/coronal_007.png","assets/T/mri-ff0c8aa579c84949/coronal_009.png","assets/T/mri-ff0c8aa579c84949/coronal_011.png","assets/T/mri-ff0c8aa579c84949/coronal_014.png","assets/T/mri-ff0c8aa579c84949/coronal_016.png","assets/T/mri-ff0c8aa579c84949/coronal_018.png","assets/T/mri-ff0c8aa579c84949/coronal_020.png","assets/T/mri-ff0c8aa579c84949/coronal_022.png","assets/T/mri-ff0c8aa579c84949/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-e3e37a23a6af4277","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-e3e37a23a6af4277/axial_001.png","assets/T/mri-e3e37a23a6af4277/axial_003.png","assets/T/mri-e3e37a23a6af4277/axial_005.png","assets/T/mri-e3e37a23a6af4277/axial_007.png","assets/T/mri-e3e37a23a6af4277/axial_009.png","assets/T/mri-e3e37a23a6af4277/axial_011.png","assets/T/mri-e3e37a23a6af4277/axial_013.png","assets/T/mri-e3e37a23a6af4277/axial_015.png","assets/T/mri-e3e37a23a6af4277/axial_017.png","assets/T/mri-e3e37a23a6af4277/axial_019.png","assets/T/mri-e3e37a23a6af4277/axial_021.png","assets/T/mri-e3e37a23a6af4277/axial_022.png","assets/T/mri-e3e37a23a6af4277/axial_024.png","assets/T/mri-e3e37a23a6af4277/axial_026.png","assets/T/mri-e3e37a23a6af4277/axial_028.png","assets/T/mri-e3e37a23a6af4277/axial_030.png","assets/T/mri-e3e37a23a6af4277/axial_032.png","assets/T/mri-e3e37a23a6af4277/axial_034.png","assets/T/mri-e3e37a23a6af4277/axial_036.png","assets/T/mri-e3e37a23a6af4277/axial_038.png","assets/T/mri-e3e37a23a6af4277/axial_040.png","assets/T/mri-e3e37a23a6af4277/coronal_001.png","assets/T/mri-e3e37a23a6af4277/coronal_003.png","assets/T/mri-e3e37a23a6af4277/coronal_005.png","assets/T/mri-e3e37a23a6af4277/coronal_007.png","assets/T/mri-e3e37a23a6af4277/coronal_009.png","assets/T/mri-e3e37a23a6af4277/coronal_011.png","assets/T/mri-e3e37a23a6af4277/coronal_014.png","assets/T/mri-e3e37a23a6af4277/coronal_016.png","assets/T/mri-e3e37a23a6af4277/coronal_018.png","assets/T/mri-e3e37a23a6af4277/coronal_020.png","assets/T/mri-e3e37a23a6af4277/coronal_022.png","assets/T/mri-e3e37a23a6af4277/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-c32d5d583da8477e","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-c32d5d583da8477e/axial_001.png","assets/T/mri-c32d5d583da8477e/axial_003.png","assets/T/mri-c32d5d583da8477e/axial_005.png","assets/T/mri-c32d5d583da8477e/axial_007.png","assets/T/mri-c32d5d583da8477e/axial_009.png","assets/T/mri-c32d5d583da8477e/axial_011.png","assets/T/mri-c32d5d583da8477e/axial_013.png","assets/T/mri-c32d5d583da8477e/axial_015.png","assets/T/mri-c32d5d583da8477e/axial_017.png","assets/T/mri-c32d5d583da8477e/axial_019.png","assets/T/mri-c32d5d583da8477e/axial_021.png","assets/T/mri-c32d5d583da8477e/axial_022.png","assets/T/mri-c32d5d583da8477e/axial_024.png","assets/T/mri-c32d5d583da8477e/axial_026.png","assets/T/mri-c32d5d583da8477e/axial_028.png","assets/T/mri-c32d5d583da8477e/axial_030.png","assets/T/mri-c32d5d583da8477e/axial_032.png","assets/T/mri-c32d5d583da8477e/axial_034.png","assets/T/mri-c32d5d583da8477e/axial_036.png","assets/T/mri-c32d5d583da8477e/axial_038.png","assets/T/mri-c32d5d583da8477e/axial_040.png","assets/T/mri-c32d5d583da8477e/coronal_001.png","assets/T/mri-c32d5d583da8477e/coronal_003.png","assets/T/mri-c32d5d583da8477e/coronal_005.png","assets/T/mri-c32d5d583da8477e/coronal_007.png","assets/T/mri-c32d5d583da8477e/coronal_009.png","assets/T/mri-c32d5d583da8477e/coronal_011.png","assets/T/mri-c32d5d583da8477e/coronal_014.png","assets/T/mri-c32d5d583da8477e/coronal_016.png","assets/T/mri-c32d5d583da8477e/coronal_018.png","assets/T/mri-c32d5d583da8477e/coronal_020.png","assets/T/mri-c32d5d583da8477e/coronal_022.png","assets/T/mri-c32d5d583da8477e/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-4f33ce82b81a40bc","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-4f33ce82b81a40bc/axial_001.png","assets/T/mri-4f33ce82b81a40bc/axial_003.png","assets/T/mri-4f33ce82b81a40bc/axial_005.png","assets/T/mri-4f33ce82b81a40bc/axial_007.png","assets/T/mri-4f33ce82b81a40bc/axial_009.png","assets/T/mri-4f33ce82b81a40bc/axial_011.png","assets/T/mri-4f33ce82b81a40bc/axial_013.png","assets/T/mri-4f33ce82b81a40bc/axial_015.png","assets/T/mri-4f33ce82b81a40bc/axial_017.png","assets/T/mri-4f33ce82b81a40bc/axial_019.png","assets/T/mri-4f33ce82b81a40bc/axial_022.png","assets/T/mri-4f33ce82b81a40bc/axial_024.png","assets/T/mri-4f33ce82b81a40bc/axial_026.png","assets/T/mri-4f33ce82b81a40bc/axial_028.png","assets/T/mri-4f33ce82b81a40bc/axial_030.png","assets/T/mri-4f33ce82b81a40bc/axial_032.png","assets/T/mri-4f33ce82b81a40bc/axial_034.png","assets/T/mri-4f33ce82b81a40bc/axial_036.png","assets/T/mri-4f33ce82b81a40bc/axial_038.png","assets/T/mri-4f33ce82b81a40bc/axial_040.png","assets/T/mri-4f33ce82b81a40bc/axial_042.png","assets/T/mri-4f33ce82b81a40bc/coronal_001.png","assets/T/mri-4f33ce82b81a40bc/coronal_003.png","assets/T/mri-4f33ce82b81a40bc/coronal_005.png","assets/T/mri-4f33ce82b81a40bc/coronal_007.png","assets/T/mri-4f33ce82b81a40bc/coronal_009.png","assets/T/mri-4f33ce82b81a40bc/coronal_011.png","assets/T/mri-4f33ce82b81a40bc/coronal_014.png","assets/T/mri-4f33ce82b81a40bc/coronal_016.png","assets/T/mri-4f33ce82b81a40bc/coronal_018.png","assets/T/mri-4f33ce82b81a40bc/coronal_020.png","assets/T/mri-4f33ce82b81a40bc/coronal_022.png","assets/T/mri-4f33ce82b81a40bc/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-842294051b2440d7","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 34 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 14 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-842294051b2440d7/axial_001.png","assets/T/mri-842294051b2440d7/axial_003.png","assets/T/mri-842294051b2440d7/axial_005.png","assets/T/mri-842294051b2440d7/axial_007.png","assets/T/mri-842294051b2440d7/axial_009.png","assets/T/mri-842294051b2440d7/axial_011.png","assets/T/mri-842294051b2440d7/axial_013.png","assets/T/mri-842294051b2440d7/axial_015.png","assets/T/mri-842294051b2440d7/axial_017.png","assets/T/mri-842294051b2440d7/axial_019.png","assets/T/mri-842294051b2440d7/axial_020.png","assets/T/mri-842294051b2440d7/axial_022.png","assets/T/mri-842294051b2440d7/axial_024.png","assets/T/mri-842294051b2440d7/axial_026.png","assets/T/mri-842294051b2440d7/axial_028.png","assets/T/mri-842294051b2440d7/axial_030.png","assets/T/mri-842294051b2440d7/axial_032.png","assets/T/mri-842294051b2440d7/axial_034.png","assets/T/mri-842294051b2440d7/axial_036.png","assets/T/mri-842294051b2440d7/axial_038.png","assets/T/mri-842294051b2440d7/coronal_001.png","assets/T/mri-842294051b2440d7/coronal_003.png","assets/T/mri-842294051b2440d7/coronal_005.png","assets/T/mri-842294051b2440d7/coronal_007.png","assets/T/mri-842294051b2440d7/coronal_009.png","assets/T/mri-842294051b2440d7/coronal_011.png","assets/T/mri-842294051b2440d7/coronal_013.png","assets/T/mri-842294051b2440d7/coronal_016.png","assets/T/mri-842294051b2440d7/coronal_018.png","assets/T/mri-842294051b2440d7/coronal_020.png","assets/T/mri-842294051b2440d7/coronal_022.png","assets/T/mri-842294051b2440d7/coronal_024.png","assets/T/mri-842294051b2440d7/coronal_026.png","assets/T/mri-842294051b2440d7/coronal_028.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":34,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,20,22,24,26,28,30,32,34,36,38,39,41,43,45,47,49,51,54,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-02abb54e29f14bca","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-02abb54e29f14bca/axial_001.png","assets/T/mri-02abb54e29f14bca/axial_003.png","assets/T/mri-02abb54e29f14bca/axial_005.png","assets/T/mri-02abb54e29f14bca/axial_007.png","assets/T/mri-02abb54e29f14bca/axial_009.png","assets/T/mri-02abb54e29f14bca/axial_011.png","assets/T/mri-02abb54e29f14bca/axial_013.png","assets/T/mri-02abb54e29f14bca/axial_015.png","assets/T/mri-02abb54e29f14bca/axial_017.png","assets/T/mri-02abb54e29f14bca/axial_019.png","assets/T/mri-02abb54e29f14bca/axial_021.png","assets/T/mri-02abb54e29f14bca/axial_022.png","assets/T/mri-02abb54e29f14bca/axial_024.png","assets/T/mri-02abb54e29f14bca/axial_026.png","assets/T/mri-02abb54e29f14bca/axial_028.png","assets/T/mri-02abb54e29f14bca/axial_030.png","assets/T/mri-02abb54e29f14bca/axial_032.png","assets/T/mri-02abb54e29f14bca/axial_034.png","assets/T/mri-02abb54e29f14bca/axial_036.png","assets/T/mri-02abb54e29f14bca/axial_038.png","assets/T/mri-02abb54e29f14bca/axial_040.png","assets/T/mri-02abb54e29f14bca/coronal_001.png","assets/T/mri-02abb54e29f14bca/coronal_003.png","assets/T/mri-02abb54e29f14bca/coronal_005.png","assets/T/mri-02abb54e29f14bca/coronal_007.png","assets/T/mri-02abb54e29f14bca/coronal_009.png","assets/T/mri-02abb54e29f14bca/coronal_011.png","assets/T/mri-02abb54e29f14bca/coronal_014.png","assets/T/mri-02abb54e29f14bca/coronal_016.png","assets/T/mri-02abb54e29f14bca/coronal_018.png","assets/T/mri-02abb54e29f14bca/coronal_020.png","assets/T/mri-02abb54e29f14bca/coronal_022.png","assets/T/mri-02abb54e29f14bca/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-735dee52e15e4269","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-735dee52e15e4269/axial_001.png","assets/T/mri-735dee52e15e4269/axial_003.png","assets/T/mri-735dee52e15e4269/axial_005.png","assets/T/mri-735dee52e15e4269/axial_007.png","assets/T/mri-735dee52e15e4269/axial_010.png","assets/T/mri-735dee52e15e4269/axial_012.png","assets/T/mri-735dee52e15e4269/axial_014.png","assets/T/mri-735dee52e15e4269/axial_016.png","assets/T/mri-735dee52e15e4269/axial_018.png","assets/T/mri-735dee52e15e4269/axial_020.png","assets/T/mri-735dee52e15e4269/axial_023.png","assets/T/mri-735dee52e15e4269/axial_025.png","assets/T/mri-735dee52e15e4269/axial_027.png","assets/T/mri-735dee52e15e4269/axial_029.png","assets/T/mri-735dee52e15e4269/axial_031.png","assets/T/mri-735dee52e15e4269/axial_033.png","assets/T/mri-735dee52e15e4269/axial_035.png","assets/T/mri-735dee52e15e4269/axial_038.png","assets/T/mri-735dee52e15e4269/axial_040.png","assets/T/mri-735dee52e15e4269/axial_042.png","assets/T/mri-735dee52e15e4269/axial_044.png","assets/T/mri-735dee52e15e4269/coronal_001.png","assets/T/mri-735dee52e15e4269/coronal_003.png","assets/T/mri-735dee52e15e4269/coronal_005.png","assets/T/mri-735dee52e15e4269/coronal_007.png","assets/T/mri-735dee52e15e4269/coronal_009.png","assets/T/mri-735dee52e15e4269/coronal_011.png","assets/T/mri-735dee52e15e4269/coronal_014.png","assets/T/mri-735dee52e15e4269/coronal_016.png","assets/T/mri-735dee52e15e4269/coronal_018.png","assets/T/mri-735dee52e15e4269/coronal_020.png","assets/T/mri-735dee52e15e4269/coronal_022.png","assets/T/mri-735dee52e15e4269/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":68,"selected_count":33,"source_indices_1based":[1,3,5,7,10,12,14,16,18,20,23,25,27,29,31,33,35,38,40,42,44,45,47,49,51,53,55,58,60,62,64,66,68]}}
+{"id":"L3-T300:mri-49da801e248b4e3b","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-49da801e248b4e3b/axial_001.png","assets/T/mri-49da801e248b4e3b/axial_003.png","assets/T/mri-49da801e248b4e3b/axial_005.png","assets/T/mri-49da801e248b4e3b/axial_007.png","assets/T/mri-49da801e248b4e3b/axial_009.png","assets/T/mri-49da801e248b4e3b/axial_011.png","assets/T/mri-49da801e248b4e3b/axial_013.png","assets/T/mri-49da801e248b4e3b/axial_015.png","assets/T/mri-49da801e248b4e3b/axial_017.png","assets/T/mri-49da801e248b4e3b/axial_019.png","assets/T/mri-49da801e248b4e3b/axial_022.png","assets/T/mri-49da801e248b4e3b/axial_024.png","assets/T/mri-49da801e248b4e3b/axial_026.png","assets/T/mri-49da801e248b4e3b/axial_028.png","assets/T/mri-49da801e248b4e3b/axial_030.png","assets/T/mri-49da801e248b4e3b/axial_032.png","assets/T/mri-49da801e248b4e3b/axial_034.png","assets/T/mri-49da801e248b4e3b/axial_036.png","assets/T/mri-49da801e248b4e3b/axial_038.png","assets/T/mri-49da801e248b4e3b/axial_040.png","assets/T/mri-49da801e248b4e3b/axial_042.png","assets/T/mri-49da801e248b4e3b/coronal_001.png","assets/T/mri-49da801e248b4e3b/coronal_003.png","assets/T/mri-49da801e248b4e3b/coronal_005.png","assets/T/mri-49da801e248b4e3b/coronal_007.png","assets/T/mri-49da801e248b4e3b/coronal_009.png","assets/T/mri-49da801e248b4e3b/coronal_011.png","assets/T/mri-49da801e248b4e3b/coronal_014.png","assets/T/mri-49da801e248b4e3b/coronal_016.png","assets/T/mri-49da801e248b4e3b/coronal_018.png","assets/T/mri-49da801e248b4e3b/coronal_020.png","assets/T/mri-49da801e248b4e3b/coronal_022.png","assets/T/mri-49da801e248b4e3b/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-b0849ba65caa4723","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-b0849ba65caa4723/axial_001.png","assets/T/mri-b0849ba65caa4723/axial_003.png","assets/T/mri-b0849ba65caa4723/axial_005.png","assets/T/mri-b0849ba65caa4723/axial_007.png","assets/T/mri-b0849ba65caa4723/axial_009.png","assets/T/mri-b0849ba65caa4723/axial_011.png","assets/T/mri-b0849ba65caa4723/axial_013.png","assets/T/mri-b0849ba65caa4723/axial_015.png","assets/T/mri-b0849ba65caa4723/axial_017.png","assets/T/mri-b0849ba65caa4723/axial_019.png","assets/T/mri-b0849ba65caa4723/axial_022.png","assets/T/mri-b0849ba65caa4723/axial_024.png","assets/T/mri-b0849ba65caa4723/axial_026.png","assets/T/mri-b0849ba65caa4723/axial_028.png","assets/T/mri-b0849ba65caa4723/axial_030.png","assets/T/mri-b0849ba65caa4723/axial_032.png","assets/T/mri-b0849ba65caa4723/axial_034.png","assets/T/mri-b0849ba65caa4723/axial_036.png","assets/T/mri-b0849ba65caa4723/axial_038.png","assets/T/mri-b0849ba65caa4723/axial_040.png","assets/T/mri-b0849ba65caa4723/axial_042.png","assets/T/mri-b0849ba65caa4723/coronal_001.png","assets/T/mri-b0849ba65caa4723/coronal_003.png","assets/T/mri-b0849ba65caa4723/coronal_005.png","assets/T/mri-b0849ba65caa4723/coronal_007.png","assets/T/mri-b0849ba65caa4723/coronal_009.png","assets/T/mri-b0849ba65caa4723/coronal_011.png","assets/T/mri-b0849ba65caa4723/coronal_014.png","assets/T/mri-b0849ba65caa4723/coronal_016.png","assets/T/mri-b0849ba65caa4723/coronal_018.png","assets/T/mri-b0849ba65caa4723/coronal_020.png","assets/T/mri-b0849ba65caa4723/coronal_022.png","assets/T/mri-b0849ba65caa4723/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-b976847fc598493f","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-b976847fc598493f/axial_001.png","assets/T/mri-b976847fc598493f/axial_003.png","assets/T/mri-b976847fc598493f/axial_005.png","assets/T/mri-b976847fc598493f/axial_007.png","assets/T/mri-b976847fc598493f/axial_009.png","assets/T/mri-b976847fc598493f/axial_011.png","assets/T/mri-b976847fc598493f/axial_013.png","assets/T/mri-b976847fc598493f/axial_015.png","assets/T/mri-b976847fc598493f/axial_017.png","assets/T/mri-b976847fc598493f/axial_019.png","assets/T/mri-b976847fc598493f/axial_021.png","assets/T/mri-b976847fc598493f/axial_022.png","assets/T/mri-b976847fc598493f/axial_024.png","assets/T/mri-b976847fc598493f/axial_026.png","assets/T/mri-b976847fc598493f/axial_028.png","assets/T/mri-b976847fc598493f/axial_030.png","assets/T/mri-b976847fc598493f/axial_032.png","assets/T/mri-b976847fc598493f/axial_034.png","assets/T/mri-b976847fc598493f/axial_036.png","assets/T/mri-b976847fc598493f/axial_038.png","assets/T/mri-b976847fc598493f/axial_040.png","assets/T/mri-b976847fc598493f/coronal_001.png","assets/T/mri-b976847fc598493f/coronal_003.png","assets/T/mri-b976847fc598493f/coronal_005.png","assets/T/mri-b976847fc598493f/coronal_007.png","assets/T/mri-b976847fc598493f/coronal_009.png","assets/T/mri-b976847fc598493f/coronal_011.png","assets/T/mri-b976847fc598493f/coronal_014.png","assets/T/mri-b976847fc598493f/coronal_016.png","assets/T/mri-b976847fc598493f/coronal_018.png","assets/T/mri-b976847fc598493f/coronal_020.png","assets/T/mri-b976847fc598493f/coronal_022.png","assets/T/mri-b976847fc598493f/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-7ea32cf357cc42b5","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-7ea32cf357cc42b5/axial_001.png","assets/T/mri-7ea32cf357cc42b5/axial_003.png","assets/T/mri-7ea32cf357cc42b5/axial_005.png","assets/T/mri-7ea32cf357cc42b5/axial_007.png","assets/T/mri-7ea32cf357cc42b5/axial_009.png","assets/T/mri-7ea32cf357cc42b5/axial_011.png","assets/T/mri-7ea32cf357cc42b5/axial_013.png","assets/T/mri-7ea32cf357cc42b5/axial_015.png","assets/T/mri-7ea32cf357cc42b5/axial_017.png","assets/T/mri-7ea32cf357cc42b5/axial_019.png","assets/T/mri-7ea32cf357cc42b5/axial_021.png","assets/T/mri-7ea32cf357cc42b5/axial_022.png","assets/T/mri-7ea32cf357cc42b5/axial_024.png","assets/T/mri-7ea32cf357cc42b5/axial_026.png","assets/T/mri-7ea32cf357cc42b5/axial_028.png","assets/T/mri-7ea32cf357cc42b5/axial_030.png","assets/T/mri-7ea32cf357cc42b5/axial_032.png","assets/T/mri-7ea32cf357cc42b5/axial_034.png","assets/T/mri-7ea32cf357cc42b5/axial_036.png","assets/T/mri-7ea32cf357cc42b5/axial_038.png","assets/T/mri-7ea32cf357cc42b5/axial_040.png","assets/T/mri-7ea32cf357cc42b5/coronal_001.png","assets/T/mri-7ea32cf357cc42b5/coronal_003.png","assets/T/mri-7ea32cf357cc42b5/coronal_005.png","assets/T/mri-7ea32cf357cc42b5/coronal_007.png","assets/T/mri-7ea32cf357cc42b5/coronal_009.png","assets/T/mri-7ea32cf357cc42b5/coronal_011.png","assets/T/mri-7ea32cf357cc42b5/coronal_014.png","assets/T/mri-7ea32cf357cc42b5/coronal_016.png","assets/T/mri-7ea32cf357cc42b5/coronal_018.png","assets/T/mri-7ea32cf357cc42b5/coronal_020.png","assets/T/mri-7ea32cf357cc42b5/coronal_022.png","assets/T/mri-7ea32cf357cc42b5/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-0dc57ca1c41d4864","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-0dc57ca1c41d4864/axial_001.png","assets/T/mri-0dc57ca1c41d4864/axial_003.png","assets/T/mri-0dc57ca1c41d4864/axial_005.png","assets/T/mri-0dc57ca1c41d4864/axial_007.png","assets/T/mri-0dc57ca1c41d4864/axial_009.png","assets/T/mri-0dc57ca1c41d4864/axial_011.png","assets/T/mri-0dc57ca1c41d4864/axial_013.png","assets/T/mri-0dc57ca1c41d4864/axial_015.png","assets/T/mri-0dc57ca1c41d4864/axial_017.png","assets/T/mri-0dc57ca1c41d4864/axial_019.png","assets/T/mri-0dc57ca1c41d4864/axial_022.png","assets/T/mri-0dc57ca1c41d4864/axial_024.png","assets/T/mri-0dc57ca1c41d4864/axial_026.png","assets/T/mri-0dc57ca1c41d4864/axial_028.png","assets/T/mri-0dc57ca1c41d4864/axial_030.png","assets/T/mri-0dc57ca1c41d4864/axial_032.png","assets/T/mri-0dc57ca1c41d4864/axial_034.png","assets/T/mri-0dc57ca1c41d4864/axial_036.png","assets/T/mri-0dc57ca1c41d4864/axial_038.png","assets/T/mri-0dc57ca1c41d4864/axial_040.png","assets/T/mri-0dc57ca1c41d4864/axial_042.png","assets/T/mri-0dc57ca1c41d4864/coronal_001.png","assets/T/mri-0dc57ca1c41d4864/coronal_003.png","assets/T/mri-0dc57ca1c41d4864/coronal_005.png","assets/T/mri-0dc57ca1c41d4864/coronal_007.png","assets/T/mri-0dc57ca1c41d4864/coronal_009.png","assets/T/mri-0dc57ca1c41d4864/coronal_011.png","assets/T/mri-0dc57ca1c41d4864/coronal_014.png","assets/T/mri-0dc57ca1c41d4864/coronal_016.png","assets/T/mri-0dc57ca1c41d4864/coronal_018.png","assets/T/mri-0dc57ca1c41d4864/coronal_020.png","assets/T/mri-0dc57ca1c41d4864/coronal_022.png","assets/T/mri-0dc57ca1c41d4864/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-c3cc2672fd8e420a","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 13 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-c3cc2672fd8e420a/axial_001.png","assets/T/mri-c3cc2672fd8e420a/axial_003.png","assets/T/mri-c3cc2672fd8e420a/axial_005.png","assets/T/mri-c3cc2672fd8e420a/axial_007.png","assets/T/mri-c3cc2672fd8e420a/axial_009.png","assets/T/mri-c3cc2672fd8e420a/axial_011.png","assets/T/mri-c3cc2672fd8e420a/axial_013.png","assets/T/mri-c3cc2672fd8e420a/axial_015.png","assets/T/mri-c3cc2672fd8e420a/axial_017.png","assets/T/mri-c3cc2672fd8e420a/axial_019.png","assets/T/mri-c3cc2672fd8e420a/axial_020.png","assets/T/mri-c3cc2672fd8e420a/axial_022.png","assets/T/mri-c3cc2672fd8e420a/axial_024.png","assets/T/mri-c3cc2672fd8e420a/axial_026.png","assets/T/mri-c3cc2672fd8e420a/axial_028.png","assets/T/mri-c3cc2672fd8e420a/axial_030.png","assets/T/mri-c3cc2672fd8e420a/axial_032.png","assets/T/mri-c3cc2672fd8e420a/axial_034.png","assets/T/mri-c3cc2672fd8e420a/axial_036.png","assets/T/mri-c3cc2672fd8e420a/axial_038.png","assets/T/mri-c3cc2672fd8e420a/coronal_001.png","assets/T/mri-c3cc2672fd8e420a/coronal_003.png","assets/T/mri-c3cc2672fd8e420a/coronal_005.png","assets/T/mri-c3cc2672fd8e420a/coronal_007.png","assets/T/mri-c3cc2672fd8e420a/coronal_009.png","assets/T/mri-c3cc2672fd8e420a/coronal_011.png","assets/T/mri-c3cc2672fd8e420a/coronal_013.png","assets/T/mri-c3cc2672fd8e420a/coronal_014.png","assets/T/mri-c3cc2672fd8e420a/coronal_016.png","assets/T/mri-c3cc2672fd8e420a/coronal_018.png","assets/T/mri-c3cc2672fd8e420a/coronal_020.png","assets/T/mri-c3cc2672fd8e420a/coronal_022.png","assets/T/mri-c3cc2672fd8e420a/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":62,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,20,22,24,26,28,30,32,34,36,38,39,41,43,45,47,49,51,52,54,56,58,60,62]}}
+{"id":"L3-T300:mri-17373bfa653f4f94","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-17373bfa653f4f94/axial_001.png","assets/T/mri-17373bfa653f4f94/axial_003.png","assets/T/mri-17373bfa653f4f94/axial_005.png","assets/T/mri-17373bfa653f4f94/axial_007.png","assets/T/mri-17373bfa653f4f94/axial_009.png","assets/T/mri-17373bfa653f4f94/axial_011.png","assets/T/mri-17373bfa653f4f94/axial_013.png","assets/T/mri-17373bfa653f4f94/axial_015.png","assets/T/mri-17373bfa653f4f94/axial_017.png","assets/T/mri-17373bfa653f4f94/axial_019.png","assets/T/mri-17373bfa653f4f94/axial_022.png","assets/T/mri-17373bfa653f4f94/axial_024.png","assets/T/mri-17373bfa653f4f94/axial_026.png","assets/T/mri-17373bfa653f4f94/axial_028.png","assets/T/mri-17373bfa653f4f94/axial_030.png","assets/T/mri-17373bfa653f4f94/axial_032.png","assets/T/mri-17373bfa653f4f94/axial_034.png","assets/T/mri-17373bfa653f4f94/axial_036.png","assets/T/mri-17373bfa653f4f94/axial_038.png","assets/T/mri-17373bfa653f4f94/axial_040.png","assets/T/mri-17373bfa653f4f94/axial_042.png","assets/T/mri-17373bfa653f4f94/coronal_001.png","assets/T/mri-17373bfa653f4f94/coronal_003.png","assets/T/mri-17373bfa653f4f94/coronal_005.png","assets/T/mri-17373bfa653f4f94/coronal_007.png","assets/T/mri-17373bfa653f4f94/coronal_009.png","assets/T/mri-17373bfa653f4f94/coronal_011.png","assets/T/mri-17373bfa653f4f94/coronal_014.png","assets/T/mri-17373bfa653f4f94/coronal_016.png","assets/T/mri-17373bfa653f4f94/coronal_018.png","assets/T/mri-17373bfa653f4f94/coronal_020.png","assets/T/mri-17373bfa653f4f94/coronal_022.png","assets/T/mri-17373bfa653f4f94/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-763095d057044bf9","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 34 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 14 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-763095d057044bf9/axial_001.png","assets/T/mri-763095d057044bf9/axial_003.png","assets/T/mri-763095d057044bf9/axial_005.png","assets/T/mri-763095d057044bf9/axial_007.png","assets/T/mri-763095d057044bf9/axial_008.png","assets/T/mri-763095d057044bf9/axial_010.png","assets/T/mri-763095d057044bf9/axial_012.png","assets/T/mri-763095d057044bf9/axial_014.png","assets/T/mri-763095d057044bf9/axial_016.png","assets/T/mri-763095d057044bf9/axial_018.png","assets/T/mri-763095d057044bf9/axial_019.png","assets/T/mri-763095d057044bf9/axial_021.png","assets/T/mri-763095d057044bf9/axial_023.png","assets/T/mri-763095d057044bf9/axial_025.png","assets/T/mri-763095d057044bf9/axial_027.png","assets/T/mri-763095d057044bf9/axial_029.png","assets/T/mri-763095d057044bf9/axial_030.png","assets/T/mri-763095d057044bf9/axial_032.png","assets/T/mri-763095d057044bf9/axial_034.png","assets/T/mri-763095d057044bf9/axial_036.png","assets/T/mri-763095d057044bf9/coronal_001.png","assets/T/mri-763095d057044bf9/coronal_003.png","assets/T/mri-763095d057044bf9/coronal_005.png","assets/T/mri-763095d057044bf9/coronal_006.png","assets/T/mri-763095d057044bf9/coronal_008.png","assets/T/mri-763095d057044bf9/coronal_010.png","assets/T/mri-763095d057044bf9/coronal_012.png","assets/T/mri-763095d057044bf9/coronal_013.png","assets/T/mri-763095d057044bf9/coronal_015.png","assets/T/mri-763095d057044bf9/coronal_017.png","assets/T/mri-763095d057044bf9/coronal_019.png","assets/T/mri-763095d057044bf9/coronal_020.png","assets/T/mri-763095d057044bf9/coronal_022.png","assets/T/mri-763095d057044bf9/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":60,"selected_count":34,"source_indices_1based":[1,3,5,7,8,10,12,14,16,18,19,21,23,25,27,29,30,32,34,36,37,39,41,42,44,46,48,49,51,53,55,56,58,60]}}
+{"id":"L3-T300:mri-70df53cf06454db7","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 22 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 11 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-70df53cf06454db7/axial_001.png","assets/T/mri-70df53cf06454db7/axial_003.png","assets/T/mri-70df53cf06454db7/axial_005.png","assets/T/mri-70df53cf06454db7/axial_007.png","assets/T/mri-70df53cf06454db7/axial_010.png","assets/T/mri-70df53cf06454db7/axial_012.png","assets/T/mri-70df53cf06454db7/axial_014.png","assets/T/mri-70df53cf06454db7/axial_016.png","assets/T/mri-70df53cf06454db7/axial_018.png","assets/T/mri-70df53cf06454db7/axial_020.png","assets/T/mri-70df53cf06454db7/axial_022.png","assets/T/mri-70df53cf06454db7/axial_025.png","assets/T/mri-70df53cf06454db7/axial_027.png","assets/T/mri-70df53cf06454db7/axial_029.png","assets/T/mri-70df53cf06454db7/axial_031.png","assets/T/mri-70df53cf06454db7/axial_033.png","assets/T/mri-70df53cf06454db7/axial_035.png","assets/T/mri-70df53cf06454db7/axial_037.png","assets/T/mri-70df53cf06454db7/axial_040.png","assets/T/mri-70df53cf06454db7/axial_042.png","assets/T/mri-70df53cf06454db7/axial_044.png","assets/T/mri-70df53cf06454db7/axial_046.png","assets/T/mri-70df53cf06454db7/coronal_001.png","assets/T/mri-70df53cf06454db7/coronal_003.png","assets/T/mri-70df53cf06454db7/coronal_006.png","assets/T/mri-70df53cf06454db7/coronal_008.png","assets/T/mri-70df53cf06454db7/coronal_010.png","assets/T/mri-70df53cf06454db7/coronal_013.png","assets/T/mri-70df53cf06454db7/coronal_015.png","assets/T/mri-70df53cf06454db7/coronal_017.png","assets/T/mri-70df53cf06454db7/coronal_019.png","assets/T/mri-70df53cf06454db7/coronal_022.png","assets/T/mri-70df53cf06454db7/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":70,"selected_count":33,"source_indices_1based":[1,3,5,7,10,12,14,16,18,20,22,25,27,29,31,33,35,37,40,42,44,46,47,49,52,54,56,59,61,63,65,68,70]}}
+{"id":"L3-T300:mri-59438dc37157453f","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-59438dc37157453f/axial_001.png","assets/T/mri-59438dc37157453f/axial_003.png","assets/T/mri-59438dc37157453f/axial_005.png","assets/T/mri-59438dc37157453f/axial_007.png","assets/T/mri-59438dc37157453f/axial_009.png","assets/T/mri-59438dc37157453f/axial_011.png","assets/T/mri-59438dc37157453f/axial_013.png","assets/T/mri-59438dc37157453f/axial_015.png","assets/T/mri-59438dc37157453f/axial_017.png","assets/T/mri-59438dc37157453f/axial_019.png","assets/T/mri-59438dc37157453f/axial_022.png","assets/T/mri-59438dc37157453f/axial_024.png","assets/T/mri-59438dc37157453f/axial_026.png","assets/T/mri-59438dc37157453f/axial_028.png","assets/T/mri-59438dc37157453f/axial_030.png","assets/T/mri-59438dc37157453f/axial_032.png","assets/T/mri-59438dc37157453f/axial_034.png","assets/T/mri-59438dc37157453f/axial_036.png","assets/T/mri-59438dc37157453f/axial_038.png","assets/T/mri-59438dc37157453f/axial_040.png","assets/T/mri-59438dc37157453f/axial_042.png","assets/T/mri-59438dc37157453f/coronal_001.png","assets/T/mri-59438dc37157453f/coronal_003.png","assets/T/mri-59438dc37157453f/coronal_005.png","assets/T/mri-59438dc37157453f/coronal_007.png","assets/T/mri-59438dc37157453f/coronal_009.png","assets/T/mri-59438dc37157453f/coronal_011.png","assets/T/mri-59438dc37157453f/coronal_014.png","assets/T/mri-59438dc37157453f/coronal_016.png","assets/T/mri-59438dc37157453f/coronal_018.png","assets/T/mri-59438dc37157453f/coronal_020.png","assets/T/mri-59438dc37157453f/coronal_022.png","assets/T/mri-59438dc37157453f/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-458582a19ad64257","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-458582a19ad64257/axial_001.png","assets/T/mri-458582a19ad64257/axial_003.png","assets/T/mri-458582a19ad64257/axial_005.png","assets/T/mri-458582a19ad64257/axial_007.png","assets/T/mri-458582a19ad64257/axial_009.png","assets/T/mri-458582a19ad64257/axial_011.png","assets/T/mri-458582a19ad64257/axial_013.png","assets/T/mri-458582a19ad64257/axial_015.png","assets/T/mri-458582a19ad64257/axial_017.png","assets/T/mri-458582a19ad64257/axial_019.png","assets/T/mri-458582a19ad64257/axial_021.png","assets/T/mri-458582a19ad64257/axial_022.png","assets/T/mri-458582a19ad64257/axial_024.png","assets/T/mri-458582a19ad64257/axial_026.png","assets/T/mri-458582a19ad64257/axial_028.png","assets/T/mri-458582a19ad64257/axial_030.png","assets/T/mri-458582a19ad64257/axial_032.png","assets/T/mri-458582a19ad64257/axial_034.png","assets/T/mri-458582a19ad64257/axial_036.png","assets/T/mri-458582a19ad64257/axial_038.png","assets/T/mri-458582a19ad64257/axial_040.png","assets/T/mri-458582a19ad64257/coronal_001.png","assets/T/mri-458582a19ad64257/coronal_003.png","assets/T/mri-458582a19ad64257/coronal_005.png","assets/T/mri-458582a19ad64257/coronal_007.png","assets/T/mri-458582a19ad64257/coronal_009.png","assets/T/mri-458582a19ad64257/coronal_011.png","assets/T/mri-458582a19ad64257/coronal_014.png","assets/T/mri-458582a19ad64257/coronal_016.png","assets/T/mri-458582a19ad64257/coronal_018.png","assets/T/mri-458582a19ad64257/coronal_020.png","assets/T/mri-458582a19ad64257/coronal_022.png","assets/T/mri-458582a19ad64257/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-bdfb1b2968c54938","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-bdfb1b2968c54938/axial_001.png","assets/T/mri-bdfb1b2968c54938/axial_003.png","assets/T/mri-bdfb1b2968c54938/axial_005.png","assets/T/mri-bdfb1b2968c54938/axial_007.png","assets/T/mri-bdfb1b2968c54938/axial_009.png","assets/T/mri-bdfb1b2968c54938/axial_011.png","assets/T/mri-bdfb1b2968c54938/axial_013.png","assets/T/mri-bdfb1b2968c54938/axial_015.png","assets/T/mri-bdfb1b2968c54938/axial_017.png","assets/T/mri-bdfb1b2968c54938/axial_019.png","assets/T/mri-bdfb1b2968c54938/axial_022.png","assets/T/mri-bdfb1b2968c54938/axial_024.png","assets/T/mri-bdfb1b2968c54938/axial_026.png","assets/T/mri-bdfb1b2968c54938/axial_028.png","assets/T/mri-bdfb1b2968c54938/axial_030.png","assets/T/mri-bdfb1b2968c54938/axial_032.png","assets/T/mri-bdfb1b2968c54938/axial_034.png","assets/T/mri-bdfb1b2968c54938/axial_036.png","assets/T/mri-bdfb1b2968c54938/axial_038.png","assets/T/mri-bdfb1b2968c54938/axial_040.png","assets/T/mri-bdfb1b2968c54938/axial_042.png","assets/T/mri-bdfb1b2968c54938/coronal_001.png","assets/T/mri-bdfb1b2968c54938/coronal_003.png","assets/T/mri-bdfb1b2968c54938/coronal_005.png","assets/T/mri-bdfb1b2968c54938/coronal_007.png","assets/T/mri-bdfb1b2968c54938/coronal_009.png","assets/T/mri-bdfb1b2968c54938/coronal_011.png","assets/T/mri-bdfb1b2968c54938/coronal_014.png","assets/T/mri-bdfb1b2968c54938/coronal_016.png","assets/T/mri-bdfb1b2968c54938/coronal_018.png","assets/T/mri-bdfb1b2968c54938/coronal_020.png","assets/T/mri-bdfb1b2968c54938/coronal_022.png","assets/T/mri-bdfb1b2968c54938/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-38792095f50d47c9","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-38792095f50d47c9/axial_001.png","assets/T/mri-38792095f50d47c9/axial_003.png","assets/T/mri-38792095f50d47c9/axial_005.png","assets/T/mri-38792095f50d47c9/axial_007.png","assets/T/mri-38792095f50d47c9/axial_009.png","assets/T/mri-38792095f50d47c9/axial_011.png","assets/T/mri-38792095f50d47c9/axial_013.png","assets/T/mri-38792095f50d47c9/axial_015.png","assets/T/mri-38792095f50d47c9/axial_017.png","assets/T/mri-38792095f50d47c9/axial_019.png","assets/T/mri-38792095f50d47c9/axial_021.png","assets/T/mri-38792095f50d47c9/axial_022.png","assets/T/mri-38792095f50d47c9/axial_024.png","assets/T/mri-38792095f50d47c9/axial_026.png","assets/T/mri-38792095f50d47c9/axial_028.png","assets/T/mri-38792095f50d47c9/axial_030.png","assets/T/mri-38792095f50d47c9/axial_032.png","assets/T/mri-38792095f50d47c9/axial_034.png","assets/T/mri-38792095f50d47c9/axial_036.png","assets/T/mri-38792095f50d47c9/axial_038.png","assets/T/mri-38792095f50d47c9/axial_040.png","assets/T/mri-38792095f50d47c9/coronal_001.png","assets/T/mri-38792095f50d47c9/coronal_003.png","assets/T/mri-38792095f50d47c9/coronal_005.png","assets/T/mri-38792095f50d47c9/coronal_007.png","assets/T/mri-38792095f50d47c9/coronal_009.png","assets/T/mri-38792095f50d47c9/coronal_011.png","assets/T/mri-38792095f50d47c9/coronal_014.png","assets/T/mri-38792095f50d47c9/coronal_016.png","assets/T/mri-38792095f50d47c9/coronal_018.png","assets/T/mri-38792095f50d47c9/coronal_020.png","assets/T/mri-38792095f50d47c9/coronal_022.png","assets/T/mri-38792095f50d47c9/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-548ab2f74ff34cd7","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 13 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-548ab2f74ff34cd7/axial_001.png","assets/T/mri-548ab2f74ff34cd7/axial_003.png","assets/T/mri-548ab2f74ff34cd7/axial_005.png","assets/T/mri-548ab2f74ff34cd7/axial_007.png","assets/T/mri-548ab2f74ff34cd7/axial_009.png","assets/T/mri-548ab2f74ff34cd7/axial_011.png","assets/T/mri-548ab2f74ff34cd7/axial_013.png","assets/T/mri-548ab2f74ff34cd7/axial_015.png","assets/T/mri-548ab2f74ff34cd7/axial_017.png","assets/T/mri-548ab2f74ff34cd7/axial_019.png","assets/T/mri-548ab2f74ff34cd7/axial_020.png","assets/T/mri-548ab2f74ff34cd7/axial_022.png","assets/T/mri-548ab2f74ff34cd7/axial_024.png","assets/T/mri-548ab2f74ff34cd7/axial_026.png","assets/T/mri-548ab2f74ff34cd7/axial_028.png","assets/T/mri-548ab2f74ff34cd7/axial_030.png","assets/T/mri-548ab2f74ff34cd7/axial_032.png","assets/T/mri-548ab2f74ff34cd7/axial_034.png","assets/T/mri-548ab2f74ff34cd7/axial_036.png","assets/T/mri-548ab2f74ff34cd7/axial_038.png","assets/T/mri-548ab2f74ff34cd7/coronal_001.png","assets/T/mri-548ab2f74ff34cd7/coronal_003.png","assets/T/mri-548ab2f74ff34cd7/coronal_005.png","assets/T/mri-548ab2f74ff34cd7/coronal_007.png","assets/T/mri-548ab2f74ff34cd7/coronal_009.png","assets/T/mri-548ab2f74ff34cd7/coronal_011.png","assets/T/mri-548ab2f74ff34cd7/coronal_013.png","assets/T/mri-548ab2f74ff34cd7/coronal_014.png","assets/T/mri-548ab2f74ff34cd7/coronal_016.png","assets/T/mri-548ab2f74ff34cd7/coronal_018.png","assets/T/mri-548ab2f74ff34cd7/coronal_020.png","assets/T/mri-548ab2f74ff34cd7/coronal_022.png","assets/T/mri-548ab2f74ff34cd7/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":62,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,20,22,24,26,28,30,32,34,36,38,39,41,43,45,47,49,51,52,54,56,58,60,62]}}
+{"id":"L3-T300:mri-8f7fa7b69467480e","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 13 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-8f7fa7b69467480e/axial_001.png","assets/T/mri-8f7fa7b69467480e/axial_003.png","assets/T/mri-8f7fa7b69467480e/axial_005.png","assets/T/mri-8f7fa7b69467480e/axial_007.png","assets/T/mri-8f7fa7b69467480e/axial_009.png","assets/T/mri-8f7fa7b69467480e/axial_011.png","assets/T/mri-8f7fa7b69467480e/axial_013.png","assets/T/mri-8f7fa7b69467480e/axial_015.png","assets/T/mri-8f7fa7b69467480e/axial_017.png","assets/T/mri-8f7fa7b69467480e/axial_019.png","assets/T/mri-8f7fa7b69467480e/axial_020.png","assets/T/mri-8f7fa7b69467480e/axial_022.png","assets/T/mri-8f7fa7b69467480e/axial_024.png","assets/T/mri-8f7fa7b69467480e/axial_026.png","assets/T/mri-8f7fa7b69467480e/axial_028.png","assets/T/mri-8f7fa7b69467480e/axial_030.png","assets/T/mri-8f7fa7b69467480e/axial_032.png","assets/T/mri-8f7fa7b69467480e/axial_034.png","assets/T/mri-8f7fa7b69467480e/axial_036.png","assets/T/mri-8f7fa7b69467480e/axial_038.png","assets/T/mri-8f7fa7b69467480e/coronal_001.png","assets/T/mri-8f7fa7b69467480e/coronal_003.png","assets/T/mri-8f7fa7b69467480e/coronal_005.png","assets/T/mri-8f7fa7b69467480e/coronal_007.png","assets/T/mri-8f7fa7b69467480e/coronal_009.png","assets/T/mri-8f7fa7b69467480e/coronal_011.png","assets/T/mri-8f7fa7b69467480e/coronal_013.png","assets/T/mri-8f7fa7b69467480e/coronal_014.png","assets/T/mri-8f7fa7b69467480e/coronal_016.png","assets/T/mri-8f7fa7b69467480e/coronal_018.png","assets/T/mri-8f7fa7b69467480e/coronal_020.png","assets/T/mri-8f7fa7b69467480e/coronal_022.png","assets/T/mri-8f7fa7b69467480e/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":62,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,20,22,24,26,28,30,32,34,36,38,39,41,43,45,47,49,51,52,54,56,58,60,62]}}
+{"id":"L3-T300:mri-70b5e28526f74079","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-70b5e28526f74079/axial_001.png","assets/T/mri-70b5e28526f74079/axial_003.png","assets/T/mri-70b5e28526f74079/axial_005.png","assets/T/mri-70b5e28526f74079/axial_007.png","assets/T/mri-70b5e28526f74079/axial_009.png","assets/T/mri-70b5e28526f74079/axial_011.png","assets/T/mri-70b5e28526f74079/axial_013.png","assets/T/mri-70b5e28526f74079/axial_015.png","assets/T/mri-70b5e28526f74079/axial_017.png","assets/T/mri-70b5e28526f74079/axial_019.png","assets/T/mri-70b5e28526f74079/axial_022.png","assets/T/mri-70b5e28526f74079/axial_024.png","assets/T/mri-70b5e28526f74079/axial_026.png","assets/T/mri-70b5e28526f74079/axial_028.png","assets/T/mri-70b5e28526f74079/axial_030.png","assets/T/mri-70b5e28526f74079/axial_032.png","assets/T/mri-70b5e28526f74079/axial_034.png","assets/T/mri-70b5e28526f74079/axial_036.png","assets/T/mri-70b5e28526f74079/axial_038.png","assets/T/mri-70b5e28526f74079/axial_040.png","assets/T/mri-70b5e28526f74079/axial_042.png","assets/T/mri-70b5e28526f74079/coronal_001.png","assets/T/mri-70b5e28526f74079/coronal_003.png","assets/T/mri-70b5e28526f74079/coronal_005.png","assets/T/mri-70b5e28526f74079/coronal_007.png","assets/T/mri-70b5e28526f74079/coronal_009.png","assets/T/mri-70b5e28526f74079/coronal_011.png","assets/T/mri-70b5e28526f74079/coronal_014.png","assets/T/mri-70b5e28526f74079/coronal_016.png","assets/T/mri-70b5e28526f74079/coronal_018.png","assets/T/mri-70b5e28526f74079/coronal_020.png","assets/T/mri-70b5e28526f74079/coronal_022.png","assets/T/mri-70b5e28526f74079/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-59351260374f4914","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 34 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 14 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-59351260374f4914/axial_001.png","assets/T/mri-59351260374f4914/axial_003.png","assets/T/mri-59351260374f4914/axial_005.png","assets/T/mri-59351260374f4914/axial_007.png","assets/T/mri-59351260374f4914/axial_010.png","assets/T/mri-59351260374f4914/axial_012.png","assets/T/mri-59351260374f4914/axial_014.png","assets/T/mri-59351260374f4914/axial_016.png","assets/T/mri-59351260374f4914/axial_018.png","assets/T/mri-59351260374f4914/axial_020.png","assets/T/mri-59351260374f4914/axial_023.png","assets/T/mri-59351260374f4914/axial_025.png","assets/T/mri-59351260374f4914/axial_027.png","assets/T/mri-59351260374f4914/axial_029.png","assets/T/mri-59351260374f4914/axial_031.png","assets/T/mri-59351260374f4914/axial_033.png","assets/T/mri-59351260374f4914/axial_036.png","assets/T/mri-59351260374f4914/axial_038.png","assets/T/mri-59351260374f4914/axial_040.png","assets/T/mri-59351260374f4914/axial_042.png","assets/T/mri-59351260374f4914/coronal_001.png","assets/T/mri-59351260374f4914/coronal_003.png","assets/T/mri-59351260374f4914/coronal_005.png","assets/T/mri-59351260374f4914/coronal_008.png","assets/T/mri-59351260374f4914/coronal_010.png","assets/T/mri-59351260374f4914/coronal_012.png","assets/T/mri-59351260374f4914/coronal_014.png","assets/T/mri-59351260374f4914/coronal_017.png","assets/T/mri-59351260374f4914/coronal_019.png","assets/T/mri-59351260374f4914/coronal_021.png","assets/T/mri-59351260374f4914/coronal_023.png","assets/T/mri-59351260374f4914/coronal_026.png","assets/T/mri-59351260374f4914/coronal_028.png","assets/T/mri-59351260374f4914/coronal_030.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":72,"selected_count":34,"source_indices_1based":[1,3,5,7,10,12,14,16,18,20,23,25,27,29,31,33,36,38,40,42,43,45,47,50,52,54,56,59,61,63,65,68,70,72]}}
+{"id":"L3-T300:mri-38c0615f5e7b48d4","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-38c0615f5e7b48d4/axial_001.png","assets/T/mri-38c0615f5e7b48d4/axial_003.png","assets/T/mri-38c0615f5e7b48d4/axial_005.png","assets/T/mri-38c0615f5e7b48d4/axial_007.png","assets/T/mri-38c0615f5e7b48d4/axial_009.png","assets/T/mri-38c0615f5e7b48d4/axial_011.png","assets/T/mri-38c0615f5e7b48d4/axial_013.png","assets/T/mri-38c0615f5e7b48d4/axial_015.png","assets/T/mri-38c0615f5e7b48d4/axial_017.png","assets/T/mri-38c0615f5e7b48d4/axial_019.png","assets/T/mri-38c0615f5e7b48d4/axial_021.png","assets/T/mri-38c0615f5e7b48d4/axial_022.png","assets/T/mri-38c0615f5e7b48d4/axial_024.png","assets/T/mri-38c0615f5e7b48d4/axial_026.png","assets/T/mri-38c0615f5e7b48d4/axial_028.png","assets/T/mri-38c0615f5e7b48d4/axial_030.png","assets/T/mri-38c0615f5e7b48d4/axial_032.png","assets/T/mri-38c0615f5e7b48d4/axial_034.png","assets/T/mri-38c0615f5e7b48d4/axial_036.png","assets/T/mri-38c0615f5e7b48d4/axial_038.png","assets/T/mri-38c0615f5e7b48d4/axial_040.png","assets/T/mri-38c0615f5e7b48d4/coronal_001.png","assets/T/mri-38c0615f5e7b48d4/coronal_003.png","assets/T/mri-38c0615f5e7b48d4/coronal_005.png","assets/T/mri-38c0615f5e7b48d4/coronal_007.png","assets/T/mri-38c0615f5e7b48d4/coronal_009.png","assets/T/mri-38c0615f5e7b48d4/coronal_011.png","assets/T/mri-38c0615f5e7b48d4/coronal_014.png","assets/T/mri-38c0615f5e7b48d4/coronal_016.png","assets/T/mri-38c0615f5e7b48d4/coronal_018.png","assets/T/mri-38c0615f5e7b48d4/coronal_020.png","assets/T/mri-38c0615f5e7b48d4/coronal_022.png","assets/T/mri-38c0615f5e7b48d4/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-d05109903e3240f3","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-d05109903e3240f3/axial_001.png","assets/T/mri-d05109903e3240f3/axial_003.png","assets/T/mri-d05109903e3240f3/axial_005.png","assets/T/mri-d05109903e3240f3/axial_007.png","assets/T/mri-d05109903e3240f3/axial_009.png","assets/T/mri-d05109903e3240f3/axial_011.png","assets/T/mri-d05109903e3240f3/axial_013.png","assets/T/mri-d05109903e3240f3/axial_015.png","assets/T/mri-d05109903e3240f3/axial_017.png","assets/T/mri-d05109903e3240f3/axial_019.png","assets/T/mri-d05109903e3240f3/axial_021.png","assets/T/mri-d05109903e3240f3/axial_022.png","assets/T/mri-d05109903e3240f3/axial_024.png","assets/T/mri-d05109903e3240f3/axial_026.png","assets/T/mri-d05109903e3240f3/axial_028.png","assets/T/mri-d05109903e3240f3/axial_030.png","assets/T/mri-d05109903e3240f3/axial_032.png","assets/T/mri-d05109903e3240f3/axial_034.png","assets/T/mri-d05109903e3240f3/axial_036.png","assets/T/mri-d05109903e3240f3/axial_038.png","assets/T/mri-d05109903e3240f3/axial_040.png","assets/T/mri-d05109903e3240f3/coronal_001.png","assets/T/mri-d05109903e3240f3/coronal_003.png","assets/T/mri-d05109903e3240f3/coronal_005.png","assets/T/mri-d05109903e3240f3/coronal_007.png","assets/T/mri-d05109903e3240f3/coronal_009.png","assets/T/mri-d05109903e3240f3/coronal_011.png","assets/T/mri-d05109903e3240f3/coronal_014.png","assets/T/mri-d05109903e3240f3/coronal_016.png","assets/T/mri-d05109903e3240f3/coronal_018.png","assets/T/mri-d05109903e3240f3/coronal_020.png","assets/T/mri-d05109903e3240f3/coronal_022.png","assets/T/mri-d05109903e3240f3/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-3589d3f1b2ff4daa","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-3589d3f1b2ff4daa/axial_001.png","assets/T/mri-3589d3f1b2ff4daa/axial_003.png","assets/T/mri-3589d3f1b2ff4daa/axial_005.png","assets/T/mri-3589d3f1b2ff4daa/axial_008.png","assets/T/mri-3589d3f1b2ff4daa/axial_010.png","assets/T/mri-3589d3f1b2ff4daa/axial_012.png","assets/T/mri-3589d3f1b2ff4daa/axial_014.png","assets/T/mri-3589d3f1b2ff4daa/axial_016.png","assets/T/mri-3589d3f1b2ff4daa/axial_019.png","assets/T/mri-3589d3f1b2ff4daa/axial_021.png","assets/T/mri-3589d3f1b2ff4daa/axial_023.png","assets/T/mri-3589d3f1b2ff4daa/axial_025.png","assets/T/mri-3589d3f1b2ff4daa/axial_027.png","assets/T/mri-3589d3f1b2ff4daa/axial_030.png","assets/T/mri-3589d3f1b2ff4daa/axial_032.png","assets/T/mri-3589d3f1b2ff4daa/axial_034.png","assets/T/mri-3589d3f1b2ff4daa/axial_036.png","assets/T/mri-3589d3f1b2ff4daa/axial_038.png","assets/T/mri-3589d3f1b2ff4daa/axial_041.png","assets/T/mri-3589d3f1b2ff4daa/axial_043.png","assets/T/mri-3589d3f1b2ff4daa/axial_045.png","assets/T/mri-3589d3f1b2ff4daa/coronal_001.png","assets/T/mri-3589d3f1b2ff4daa/coronal_003.png","assets/T/mri-3589d3f1b2ff4daa/coronal_006.png","assets/T/mri-3589d3f1b2ff4daa/coronal_008.png","assets/T/mri-3589d3f1b2ff4daa/coronal_010.png","assets/T/mri-3589d3f1b2ff4daa/coronal_012.png","assets/T/mri-3589d3f1b2ff4daa/coronal_015.png","assets/T/mri-3589d3f1b2ff4daa/coronal_017.png","assets/T/mri-3589d3f1b2ff4daa/coronal_019.png","assets/T/mri-3589d3f1b2ff4daa/coronal_021.png","assets/T/mri-3589d3f1b2ff4daa/coronal_024.png","assets/T/mri-3589d3f1b2ff4daa/coronal_026.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":71,"selected_count":33,"source_indices_1based":[1,3,5,8,10,12,14,16,19,21,23,25,27,30,32,34,36,38,41,43,45,46,48,51,53,55,57,60,62,64,66,69,71]}}
+{"id":"L3-T300:mri-07e7c88bd85942d7","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-07e7c88bd85942d7/axial_001.png","assets/T/mri-07e7c88bd85942d7/axial_003.png","assets/T/mri-07e7c88bd85942d7/axial_005.png","assets/T/mri-07e7c88bd85942d7/axial_007.png","assets/T/mri-07e7c88bd85942d7/axial_009.png","assets/T/mri-07e7c88bd85942d7/axial_011.png","assets/T/mri-07e7c88bd85942d7/axial_013.png","assets/T/mri-07e7c88bd85942d7/axial_015.png","assets/T/mri-07e7c88bd85942d7/axial_017.png","assets/T/mri-07e7c88bd85942d7/axial_019.png","assets/T/mri-07e7c88bd85942d7/axial_022.png","assets/T/mri-07e7c88bd85942d7/axial_024.png","assets/T/mri-07e7c88bd85942d7/axial_026.png","assets/T/mri-07e7c88bd85942d7/axial_028.png","assets/T/mri-07e7c88bd85942d7/axial_030.png","assets/T/mri-07e7c88bd85942d7/axial_032.png","assets/T/mri-07e7c88bd85942d7/axial_034.png","assets/T/mri-07e7c88bd85942d7/axial_036.png","assets/T/mri-07e7c88bd85942d7/axial_038.png","assets/T/mri-07e7c88bd85942d7/axial_040.png","assets/T/mri-07e7c88bd85942d7/axial_042.png","assets/T/mri-07e7c88bd85942d7/coronal_001.png","assets/T/mri-07e7c88bd85942d7/coronal_003.png","assets/T/mri-07e7c88bd85942d7/coronal_005.png","assets/T/mri-07e7c88bd85942d7/coronal_007.png","assets/T/mri-07e7c88bd85942d7/coronal_009.png","assets/T/mri-07e7c88bd85942d7/coronal_011.png","assets/T/mri-07e7c88bd85942d7/coronal_014.png","assets/T/mri-07e7c88bd85942d7/coronal_016.png","assets/T/mri-07e7c88bd85942d7/coronal_018.png","assets/T/mri-07e7c88bd85942d7/coronal_020.png","assets/T/mri-07e7c88bd85942d7/coronal_022.png","assets/T/mri-07e7c88bd85942d7/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-01305085ab2542e9","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-01305085ab2542e9/axial_001.png","assets/T/mri-01305085ab2542e9/axial_003.png","assets/T/mri-01305085ab2542e9/axial_005.png","assets/T/mri-01305085ab2542e9/axial_007.png","assets/T/mri-01305085ab2542e9/axial_010.png","assets/T/mri-01305085ab2542e9/axial_012.png","assets/T/mri-01305085ab2542e9/axial_014.png","assets/T/mri-01305085ab2542e9/axial_016.png","assets/T/mri-01305085ab2542e9/axial_018.png","assets/T/mri-01305085ab2542e9/axial_020.png","assets/T/mri-01305085ab2542e9/axial_023.png","assets/T/mri-01305085ab2542e9/axial_025.png","assets/T/mri-01305085ab2542e9/axial_027.png","assets/T/mri-01305085ab2542e9/axial_029.png","assets/T/mri-01305085ab2542e9/axial_031.png","assets/T/mri-01305085ab2542e9/axial_033.png","assets/T/mri-01305085ab2542e9/axial_035.png","assets/T/mri-01305085ab2542e9/axial_038.png","assets/T/mri-01305085ab2542e9/axial_040.png","assets/T/mri-01305085ab2542e9/axial_042.png","assets/T/mri-01305085ab2542e9/axial_044.png","assets/T/mri-01305085ab2542e9/coronal_001.png","assets/T/mri-01305085ab2542e9/coronal_003.png","assets/T/mri-01305085ab2542e9/coronal_005.png","assets/T/mri-01305085ab2542e9/coronal_007.png","assets/T/mri-01305085ab2542e9/coronal_009.png","assets/T/mri-01305085ab2542e9/coronal_011.png","assets/T/mri-01305085ab2542e9/coronal_014.png","assets/T/mri-01305085ab2542e9/coronal_016.png","assets/T/mri-01305085ab2542e9/coronal_018.png","assets/T/mri-01305085ab2542e9/coronal_020.png","assets/T/mri-01305085ab2542e9/coronal_022.png","assets/T/mri-01305085ab2542e9/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":68,"selected_count":33,"source_indices_1based":[1,3,5,7,10,12,14,16,18,20,23,25,27,29,31,33,35,38,40,42,44,45,47,49,51,53,55,58,60,62,64,66,68]}}
+{"id":"L3-T300:mri-b4f8ba5eda964d53","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-b4f8ba5eda964d53/axial_001.png","assets/T/mri-b4f8ba5eda964d53/axial_003.png","assets/T/mri-b4f8ba5eda964d53/axial_005.png","assets/T/mri-b4f8ba5eda964d53/axial_007.png","assets/T/mri-b4f8ba5eda964d53/axial_009.png","assets/T/mri-b4f8ba5eda964d53/axial_011.png","assets/T/mri-b4f8ba5eda964d53/axial_013.png","assets/T/mri-b4f8ba5eda964d53/axial_015.png","assets/T/mri-b4f8ba5eda964d53/axial_017.png","assets/T/mri-b4f8ba5eda964d53/axial_019.png","assets/T/mri-b4f8ba5eda964d53/axial_022.png","assets/T/mri-b4f8ba5eda964d53/axial_024.png","assets/T/mri-b4f8ba5eda964d53/axial_026.png","assets/T/mri-b4f8ba5eda964d53/axial_028.png","assets/T/mri-b4f8ba5eda964d53/axial_030.png","assets/T/mri-b4f8ba5eda964d53/axial_032.png","assets/T/mri-b4f8ba5eda964d53/axial_034.png","assets/T/mri-b4f8ba5eda964d53/axial_036.png","assets/T/mri-b4f8ba5eda964d53/axial_038.png","assets/T/mri-b4f8ba5eda964d53/axial_040.png","assets/T/mri-b4f8ba5eda964d53/axial_042.png","assets/T/mri-b4f8ba5eda964d53/coronal_001.png","assets/T/mri-b4f8ba5eda964d53/coronal_003.png","assets/T/mri-b4f8ba5eda964d53/coronal_005.png","assets/T/mri-b4f8ba5eda964d53/coronal_007.png","assets/T/mri-b4f8ba5eda964d53/coronal_009.png","assets/T/mri-b4f8ba5eda964d53/coronal_011.png","assets/T/mri-b4f8ba5eda964d53/coronal_014.png","assets/T/mri-b4f8ba5eda964d53/coronal_016.png","assets/T/mri-b4f8ba5eda964d53/coronal_018.png","assets/T/mri-b4f8ba5eda964d53/coronal_020.png","assets/T/mri-b4f8ba5eda964d53/coronal_022.png","assets/T/mri-b4f8ba5eda964d53/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-845f9f6401284877","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-845f9f6401284877/axial_001.png","assets/T/mri-845f9f6401284877/axial_003.png","assets/T/mri-845f9f6401284877/axial_005.png","assets/T/mri-845f9f6401284877/axial_007.png","assets/T/mri-845f9f6401284877/axial_009.png","assets/T/mri-845f9f6401284877/axial_011.png","assets/T/mri-845f9f6401284877/axial_013.png","assets/T/mri-845f9f6401284877/axial_015.png","assets/T/mri-845f9f6401284877/axial_017.png","assets/T/mri-845f9f6401284877/axial_019.png","assets/T/mri-845f9f6401284877/axial_021.png","assets/T/mri-845f9f6401284877/axial_022.png","assets/T/mri-845f9f6401284877/axial_024.png","assets/T/mri-845f9f6401284877/axial_026.png","assets/T/mri-845f9f6401284877/axial_028.png","assets/T/mri-845f9f6401284877/axial_030.png","assets/T/mri-845f9f6401284877/axial_032.png","assets/T/mri-845f9f6401284877/axial_034.png","assets/T/mri-845f9f6401284877/axial_036.png","assets/T/mri-845f9f6401284877/axial_038.png","assets/T/mri-845f9f6401284877/axial_040.png","assets/T/mri-845f9f6401284877/coronal_001.png","assets/T/mri-845f9f6401284877/coronal_003.png","assets/T/mri-845f9f6401284877/coronal_005.png","assets/T/mri-845f9f6401284877/coronal_007.png","assets/T/mri-845f9f6401284877/coronal_009.png","assets/T/mri-845f9f6401284877/coronal_011.png","assets/T/mri-845f9f6401284877/coronal_014.png","assets/T/mri-845f9f6401284877/coronal_016.png","assets/T/mri-845f9f6401284877/coronal_018.png","assets/T/mri-845f9f6401284877/coronal_020.png","assets/T/mri-845f9f6401284877/coronal_022.png","assets/T/mri-845f9f6401284877/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-4d9005f5f44f4b7b","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-4d9005f5f44f4b7b/axial_001.png","assets/T/mri-4d9005f5f44f4b7b/axial_003.png","assets/T/mri-4d9005f5f44f4b7b/axial_005.png","assets/T/mri-4d9005f5f44f4b7b/axial_007.png","assets/T/mri-4d9005f5f44f4b7b/axial_009.png","assets/T/mri-4d9005f5f44f4b7b/axial_011.png","assets/T/mri-4d9005f5f44f4b7b/axial_013.png","assets/T/mri-4d9005f5f44f4b7b/axial_015.png","assets/T/mri-4d9005f5f44f4b7b/axial_017.png","assets/T/mri-4d9005f5f44f4b7b/axial_019.png","assets/T/mri-4d9005f5f44f4b7b/axial_021.png","assets/T/mri-4d9005f5f44f4b7b/axial_022.png","assets/T/mri-4d9005f5f44f4b7b/axial_024.png","assets/T/mri-4d9005f5f44f4b7b/axial_026.png","assets/T/mri-4d9005f5f44f4b7b/axial_028.png","assets/T/mri-4d9005f5f44f4b7b/axial_030.png","assets/T/mri-4d9005f5f44f4b7b/axial_032.png","assets/T/mri-4d9005f5f44f4b7b/axial_034.png","assets/T/mri-4d9005f5f44f4b7b/axial_036.png","assets/T/mri-4d9005f5f44f4b7b/axial_038.png","assets/T/mri-4d9005f5f44f4b7b/axial_040.png","assets/T/mri-4d9005f5f44f4b7b/coronal_001.png","assets/T/mri-4d9005f5f44f4b7b/coronal_003.png","assets/T/mri-4d9005f5f44f4b7b/coronal_005.png","assets/T/mri-4d9005f5f44f4b7b/coronal_007.png","assets/T/mri-4d9005f5f44f4b7b/coronal_009.png","assets/T/mri-4d9005f5f44f4b7b/coronal_011.png","assets/T/mri-4d9005f5f44f4b7b/coronal_014.png","assets/T/mri-4d9005f5f44f4b7b/coronal_016.png","assets/T/mri-4d9005f5f44f4b7b/coronal_018.png","assets/T/mri-4d9005f5f44f4b7b/coronal_020.png","assets/T/mri-4d9005f5f44f4b7b/coronal_022.png","assets/T/mri-4d9005f5f44f4b7b/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-d703abecf2bf417e","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-d703abecf2bf417e/axial_001.png","assets/T/mri-d703abecf2bf417e/axial_003.png","assets/T/mri-d703abecf2bf417e/axial_005.png","assets/T/mri-d703abecf2bf417e/axial_007.png","assets/T/mri-d703abecf2bf417e/axial_009.png","assets/T/mri-d703abecf2bf417e/axial_011.png","assets/T/mri-d703abecf2bf417e/axial_013.png","assets/T/mri-d703abecf2bf417e/axial_015.png","assets/T/mri-d703abecf2bf417e/axial_017.png","assets/T/mri-d703abecf2bf417e/axial_019.png","assets/T/mri-d703abecf2bf417e/axial_021.png","assets/T/mri-d703abecf2bf417e/axial_022.png","assets/T/mri-d703abecf2bf417e/axial_024.png","assets/T/mri-d703abecf2bf417e/axial_026.png","assets/T/mri-d703abecf2bf417e/axial_028.png","assets/T/mri-d703abecf2bf417e/axial_030.png","assets/T/mri-d703abecf2bf417e/axial_032.png","assets/T/mri-d703abecf2bf417e/axial_034.png","assets/T/mri-d703abecf2bf417e/axial_036.png","assets/T/mri-d703abecf2bf417e/axial_038.png","assets/T/mri-d703abecf2bf417e/axial_040.png","assets/T/mri-d703abecf2bf417e/coronal_001.png","assets/T/mri-d703abecf2bf417e/coronal_003.png","assets/T/mri-d703abecf2bf417e/coronal_005.png","assets/T/mri-d703abecf2bf417e/coronal_007.png","assets/T/mri-d703abecf2bf417e/coronal_009.png","assets/T/mri-d703abecf2bf417e/coronal_011.png","assets/T/mri-d703abecf2bf417e/coronal_014.png","assets/T/mri-d703abecf2bf417e/coronal_016.png","assets/T/mri-d703abecf2bf417e/coronal_018.png","assets/T/mri-d703abecf2bf417e/coronal_020.png","assets/T/mri-d703abecf2bf417e/coronal_022.png","assets/T/mri-d703abecf2bf417e/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-822812f3ff034bba","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 34 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 14 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-822812f3ff034bba/axial_001.png","assets/T/mri-822812f3ff034bba/axial_003.png","assets/T/mri-822812f3ff034bba/axial_005.png","assets/T/mri-822812f3ff034bba/axial_007.png","assets/T/mri-822812f3ff034bba/axial_008.png","assets/T/mri-822812f3ff034bba/axial_010.png","assets/T/mri-822812f3ff034bba/axial_012.png","assets/T/mri-822812f3ff034bba/axial_014.png","assets/T/mri-822812f3ff034bba/axial_016.png","assets/T/mri-822812f3ff034bba/axial_018.png","assets/T/mri-822812f3ff034bba/axial_019.png","assets/T/mri-822812f3ff034bba/axial_021.png","assets/T/mri-822812f3ff034bba/axial_023.png","assets/T/mri-822812f3ff034bba/axial_025.png","assets/T/mri-822812f3ff034bba/axial_027.png","assets/T/mri-822812f3ff034bba/axial_029.png","assets/T/mri-822812f3ff034bba/axial_030.png","assets/T/mri-822812f3ff034bba/axial_032.png","assets/T/mri-822812f3ff034bba/axial_034.png","assets/T/mri-822812f3ff034bba/axial_036.png","assets/T/mri-822812f3ff034bba/coronal_001.png","assets/T/mri-822812f3ff034bba/coronal_003.png","assets/T/mri-822812f3ff034bba/coronal_005.png","assets/T/mri-822812f3ff034bba/coronal_006.png","assets/T/mri-822812f3ff034bba/coronal_008.png","assets/T/mri-822812f3ff034bba/coronal_010.png","assets/T/mri-822812f3ff034bba/coronal_012.png","assets/T/mri-822812f3ff034bba/coronal_013.png","assets/T/mri-822812f3ff034bba/coronal_015.png","assets/T/mri-822812f3ff034bba/coronal_017.png","assets/T/mri-822812f3ff034bba/coronal_019.png","assets/T/mri-822812f3ff034bba/coronal_020.png","assets/T/mri-822812f3ff034bba/coronal_022.png","assets/T/mri-822812f3ff034bba/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":60,"selected_count":34,"source_indices_1based":[1,3,5,7,8,10,12,14,16,18,19,21,23,25,27,29,30,32,34,36,37,39,41,42,44,46,48,49,51,53,55,56,58,60]}}
+{"id":"L3-T300:mri-20e02e9841324cfc","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-20e02e9841324cfc/axial_001.png","assets/T/mri-20e02e9841324cfc/axial_003.png","assets/T/mri-20e02e9841324cfc/axial_005.png","assets/T/mri-20e02e9841324cfc/axial_007.png","assets/T/mri-20e02e9841324cfc/axial_009.png","assets/T/mri-20e02e9841324cfc/axial_011.png","assets/T/mri-20e02e9841324cfc/axial_013.png","assets/T/mri-20e02e9841324cfc/axial_015.png","assets/T/mri-20e02e9841324cfc/axial_017.png","assets/T/mri-20e02e9841324cfc/axial_019.png","assets/T/mri-20e02e9841324cfc/axial_022.png","assets/T/mri-20e02e9841324cfc/axial_024.png","assets/T/mri-20e02e9841324cfc/axial_026.png","assets/T/mri-20e02e9841324cfc/axial_028.png","assets/T/mri-20e02e9841324cfc/axial_030.png","assets/T/mri-20e02e9841324cfc/axial_032.png","assets/T/mri-20e02e9841324cfc/axial_034.png","assets/T/mri-20e02e9841324cfc/axial_036.png","assets/T/mri-20e02e9841324cfc/axial_038.png","assets/T/mri-20e02e9841324cfc/axial_040.png","assets/T/mri-20e02e9841324cfc/axial_042.png","assets/T/mri-20e02e9841324cfc/coronal_001.png","assets/T/mri-20e02e9841324cfc/coronal_003.png","assets/T/mri-20e02e9841324cfc/coronal_005.png","assets/T/mri-20e02e9841324cfc/coronal_007.png","assets/T/mri-20e02e9841324cfc/coronal_009.png","assets/T/mri-20e02e9841324cfc/coronal_011.png","assets/T/mri-20e02e9841324cfc/coronal_014.png","assets/T/mri-20e02e9841324cfc/coronal_016.png","assets/T/mri-20e02e9841324cfc/coronal_018.png","assets/T/mri-20e02e9841324cfc/coronal_020.png","assets/T/mri-20e02e9841324cfc/coronal_022.png","assets/T/mri-20e02e9841324cfc/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-4fca7bc4c97948bb","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-4fca7bc4c97948bb/axial_001.png","assets/T/mri-4fca7bc4c97948bb/axial_003.png","assets/T/mri-4fca7bc4c97948bb/axial_005.png","assets/T/mri-4fca7bc4c97948bb/axial_007.png","assets/T/mri-4fca7bc4c97948bb/axial_009.png","assets/T/mri-4fca7bc4c97948bb/axial_011.png","assets/T/mri-4fca7bc4c97948bb/axial_013.png","assets/T/mri-4fca7bc4c97948bb/axial_015.png","assets/T/mri-4fca7bc4c97948bb/axial_017.png","assets/T/mri-4fca7bc4c97948bb/axial_019.png","assets/T/mri-4fca7bc4c97948bb/axial_022.png","assets/T/mri-4fca7bc4c97948bb/axial_024.png","assets/T/mri-4fca7bc4c97948bb/axial_026.png","assets/T/mri-4fca7bc4c97948bb/axial_028.png","assets/T/mri-4fca7bc4c97948bb/axial_030.png","assets/T/mri-4fca7bc4c97948bb/axial_032.png","assets/T/mri-4fca7bc4c97948bb/axial_034.png","assets/T/mri-4fca7bc4c97948bb/axial_036.png","assets/T/mri-4fca7bc4c97948bb/axial_038.png","assets/T/mri-4fca7bc4c97948bb/axial_040.png","assets/T/mri-4fca7bc4c97948bb/axial_042.png","assets/T/mri-4fca7bc4c97948bb/coronal_001.png","assets/T/mri-4fca7bc4c97948bb/coronal_003.png","assets/T/mri-4fca7bc4c97948bb/coronal_005.png","assets/T/mri-4fca7bc4c97948bb/coronal_007.png","assets/T/mri-4fca7bc4c97948bb/coronal_009.png","assets/T/mri-4fca7bc4c97948bb/coronal_011.png","assets/T/mri-4fca7bc4c97948bb/coronal_014.png","assets/T/mri-4fca7bc4c97948bb/coronal_016.png","assets/T/mri-4fca7bc4c97948bb/coronal_018.png","assets/T/mri-4fca7bc4c97948bb/coronal_020.png","assets/T/mri-4fca7bc4c97948bb/coronal_022.png","assets/T/mri-4fca7bc4c97948bb/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-0a0ac98f64f647a1","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 34 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 14 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-0a0ac98f64f647a1/axial_001.png","assets/T/mri-0a0ac98f64f647a1/axial_003.png","assets/T/mri-0a0ac98f64f647a1/axial_005.png","assets/T/mri-0a0ac98f64f647a1/axial_007.png","assets/T/mri-0a0ac98f64f647a1/axial_010.png","assets/T/mri-0a0ac98f64f647a1/axial_012.png","assets/T/mri-0a0ac98f64f647a1/axial_014.png","assets/T/mri-0a0ac98f64f647a1/axial_016.png","assets/T/mri-0a0ac98f64f647a1/axial_018.png","assets/T/mri-0a0ac98f64f647a1/axial_020.png","assets/T/mri-0a0ac98f64f647a1/axial_023.png","assets/T/mri-0a0ac98f64f647a1/axial_025.png","assets/T/mri-0a0ac98f64f647a1/axial_027.png","assets/T/mri-0a0ac98f64f647a1/axial_029.png","assets/T/mri-0a0ac98f64f647a1/axial_031.png","assets/T/mri-0a0ac98f64f647a1/axial_033.png","assets/T/mri-0a0ac98f64f647a1/axial_036.png","assets/T/mri-0a0ac98f64f647a1/axial_038.png","assets/T/mri-0a0ac98f64f647a1/axial_040.png","assets/T/mri-0a0ac98f64f647a1/axial_042.png","assets/T/mri-0a0ac98f64f647a1/coronal_001.png","assets/T/mri-0a0ac98f64f647a1/coronal_003.png","assets/T/mri-0a0ac98f64f647a1/coronal_005.png","assets/T/mri-0a0ac98f64f647a1/coronal_007.png","assets/T/mri-0a0ac98f64f647a1/coronal_009.png","assets/T/mri-0a0ac98f64f647a1/coronal_011.png","assets/T/mri-0a0ac98f64f647a1/coronal_013.png","assets/T/mri-0a0ac98f64f647a1/coronal_016.png","assets/T/mri-0a0ac98f64f647a1/coronal_018.png","assets/T/mri-0a0ac98f64f647a1/coronal_020.png","assets/T/mri-0a0ac98f64f647a1/coronal_022.png","assets/T/mri-0a0ac98f64f647a1/coronal_024.png","assets/T/mri-0a0ac98f64f647a1/coronal_026.png","assets/T/mri-0a0ac98f64f647a1/coronal_028.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":70,"selected_count":34,"source_indices_1based":[1,3,5,7,10,12,14,16,18,20,23,25,27,29,31,33,36,38,40,42,43,45,47,49,51,53,55,58,60,62,64,66,68,70]}}
+{"id":"L3-T300:mri-cabf153e164d4bbc","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-cabf153e164d4bbc/axial_001.png","assets/T/mri-cabf153e164d4bbc/axial_003.png","assets/T/mri-cabf153e164d4bbc/axial_005.png","assets/T/mri-cabf153e164d4bbc/axial_007.png","assets/T/mri-cabf153e164d4bbc/axial_009.png","assets/T/mri-cabf153e164d4bbc/axial_011.png","assets/T/mri-cabf153e164d4bbc/axial_013.png","assets/T/mri-cabf153e164d4bbc/axial_015.png","assets/T/mri-cabf153e164d4bbc/axial_017.png","assets/T/mri-cabf153e164d4bbc/axial_019.png","assets/T/mri-cabf153e164d4bbc/axial_022.png","assets/T/mri-cabf153e164d4bbc/axial_024.png","assets/T/mri-cabf153e164d4bbc/axial_026.png","assets/T/mri-cabf153e164d4bbc/axial_028.png","assets/T/mri-cabf153e164d4bbc/axial_030.png","assets/T/mri-cabf153e164d4bbc/axial_032.png","assets/T/mri-cabf153e164d4bbc/axial_034.png","assets/T/mri-cabf153e164d4bbc/axial_036.png","assets/T/mri-cabf153e164d4bbc/axial_038.png","assets/T/mri-cabf153e164d4bbc/axial_040.png","assets/T/mri-cabf153e164d4bbc/axial_042.png","assets/T/mri-cabf153e164d4bbc/coronal_001.png","assets/T/mri-cabf153e164d4bbc/coronal_003.png","assets/T/mri-cabf153e164d4bbc/coronal_005.png","assets/T/mri-cabf153e164d4bbc/coronal_007.png","assets/T/mri-cabf153e164d4bbc/coronal_009.png","assets/T/mri-cabf153e164d4bbc/coronal_011.png","assets/T/mri-cabf153e164d4bbc/coronal_014.png","assets/T/mri-cabf153e164d4bbc/coronal_016.png","assets/T/mri-cabf153e164d4bbc/coronal_018.png","assets/T/mri-cabf153e164d4bbc/coronal_020.png","assets/T/mri-cabf153e164d4bbc/coronal_022.png","assets/T/mri-cabf153e164d4bbc/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-be161e475b244f3d","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-be161e475b244f3d/axial_001.png","assets/T/mri-be161e475b244f3d/axial_003.png","assets/T/mri-be161e475b244f3d/axial_005.png","assets/T/mri-be161e475b244f3d/axial_007.png","assets/T/mri-be161e475b244f3d/axial_009.png","assets/T/mri-be161e475b244f3d/axial_011.png","assets/T/mri-be161e475b244f3d/axial_013.png","assets/T/mri-be161e475b244f3d/axial_015.png","assets/T/mri-be161e475b244f3d/axial_017.png","assets/T/mri-be161e475b244f3d/axial_019.png","assets/T/mri-be161e475b244f3d/axial_021.png","assets/T/mri-be161e475b244f3d/axial_022.png","assets/T/mri-be161e475b244f3d/axial_024.png","assets/T/mri-be161e475b244f3d/axial_026.png","assets/T/mri-be161e475b244f3d/axial_028.png","assets/T/mri-be161e475b244f3d/axial_030.png","assets/T/mri-be161e475b244f3d/axial_032.png","assets/T/mri-be161e475b244f3d/axial_034.png","assets/T/mri-be161e475b244f3d/axial_036.png","assets/T/mri-be161e475b244f3d/axial_038.png","assets/T/mri-be161e475b244f3d/axial_040.png","assets/T/mri-be161e475b244f3d/coronal_001.png","assets/T/mri-be161e475b244f3d/coronal_003.png","assets/T/mri-be161e475b244f3d/coronal_005.png","assets/T/mri-be161e475b244f3d/coronal_007.png","assets/T/mri-be161e475b244f3d/coronal_009.png","assets/T/mri-be161e475b244f3d/coronal_011.png","assets/T/mri-be161e475b244f3d/coronal_014.png","assets/T/mri-be161e475b244f3d/coronal_016.png","assets/T/mri-be161e475b244f3d/coronal_018.png","assets/T/mri-be161e475b244f3d/coronal_020.png","assets/T/mri-be161e475b244f3d/coronal_022.png","assets/T/mri-be161e475b244f3d/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-6b684b9630fa40eb","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-6b684b9630fa40eb/axial_001.png","assets/T/mri-6b684b9630fa40eb/axial_003.png","assets/T/mri-6b684b9630fa40eb/axial_005.png","assets/T/mri-6b684b9630fa40eb/axial_007.png","assets/T/mri-6b684b9630fa40eb/axial_009.png","assets/T/mri-6b684b9630fa40eb/axial_011.png","assets/T/mri-6b684b9630fa40eb/axial_013.png","assets/T/mri-6b684b9630fa40eb/axial_015.png","assets/T/mri-6b684b9630fa40eb/axial_017.png","assets/T/mri-6b684b9630fa40eb/axial_019.png","assets/T/mri-6b684b9630fa40eb/axial_022.png","assets/T/mri-6b684b9630fa40eb/axial_024.png","assets/T/mri-6b684b9630fa40eb/axial_026.png","assets/T/mri-6b684b9630fa40eb/axial_028.png","assets/T/mri-6b684b9630fa40eb/axial_030.png","assets/T/mri-6b684b9630fa40eb/axial_032.png","assets/T/mri-6b684b9630fa40eb/axial_034.png","assets/T/mri-6b684b9630fa40eb/axial_036.png","assets/T/mri-6b684b9630fa40eb/axial_038.png","assets/T/mri-6b684b9630fa40eb/axial_040.png","assets/T/mri-6b684b9630fa40eb/axial_042.png","assets/T/mri-6b684b9630fa40eb/coronal_001.png","assets/T/mri-6b684b9630fa40eb/coronal_003.png","assets/T/mri-6b684b9630fa40eb/coronal_005.png","assets/T/mri-6b684b9630fa40eb/coronal_007.png","assets/T/mri-6b684b9630fa40eb/coronal_009.png","assets/T/mri-6b684b9630fa40eb/coronal_011.png","assets/T/mri-6b684b9630fa40eb/coronal_014.png","assets/T/mri-6b684b9630fa40eb/coronal_016.png","assets/T/mri-6b684b9630fa40eb/coronal_018.png","assets/T/mri-6b684b9630fa40eb/coronal_020.png","assets/T/mri-6b684b9630fa40eb/coronal_022.png","assets/T/mri-6b684b9630fa40eb/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-38142f670d79447e","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-38142f670d79447e/axial_001.png","assets/T/mri-38142f670d79447e/axial_003.png","assets/T/mri-38142f670d79447e/axial_005.png","assets/T/mri-38142f670d79447e/axial_007.png","assets/T/mri-38142f670d79447e/axial_009.png","assets/T/mri-38142f670d79447e/axial_011.png","assets/T/mri-38142f670d79447e/axial_013.png","assets/T/mri-38142f670d79447e/axial_015.png","assets/T/mri-38142f670d79447e/axial_017.png","assets/T/mri-38142f670d79447e/axial_019.png","assets/T/mri-38142f670d79447e/axial_022.png","assets/T/mri-38142f670d79447e/axial_024.png","assets/T/mri-38142f670d79447e/axial_026.png","assets/T/mri-38142f670d79447e/axial_028.png","assets/T/mri-38142f670d79447e/axial_030.png","assets/T/mri-38142f670d79447e/axial_032.png","assets/T/mri-38142f670d79447e/axial_034.png","assets/T/mri-38142f670d79447e/axial_036.png","assets/T/mri-38142f670d79447e/axial_038.png","assets/T/mri-38142f670d79447e/axial_040.png","assets/T/mri-38142f670d79447e/axial_042.png","assets/T/mri-38142f670d79447e/coronal_001.png","assets/T/mri-38142f670d79447e/coronal_003.png","assets/T/mri-38142f670d79447e/coronal_005.png","assets/T/mri-38142f670d79447e/coronal_007.png","assets/T/mri-38142f670d79447e/coronal_009.png","assets/T/mri-38142f670d79447e/coronal_011.png","assets/T/mri-38142f670d79447e/coronal_014.png","assets/T/mri-38142f670d79447e/coronal_016.png","assets/T/mri-38142f670d79447e/coronal_018.png","assets/T/mri-38142f670d79447e/coronal_020.png","assets/T/mri-38142f670d79447e/coronal_022.png","assets/T/mri-38142f670d79447e/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-3d5d3d0b166a4855","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-3d5d3d0b166a4855/axial_001.png","assets/T/mri-3d5d3d0b166a4855/axial_003.png","assets/T/mri-3d5d3d0b166a4855/axial_005.png","assets/T/mri-3d5d3d0b166a4855/axial_007.png","assets/T/mri-3d5d3d0b166a4855/axial_009.png","assets/T/mri-3d5d3d0b166a4855/axial_011.png","assets/T/mri-3d5d3d0b166a4855/axial_013.png","assets/T/mri-3d5d3d0b166a4855/axial_015.png","assets/T/mri-3d5d3d0b166a4855/axial_017.png","assets/T/mri-3d5d3d0b166a4855/axial_019.png","assets/T/mri-3d5d3d0b166a4855/axial_022.png","assets/T/mri-3d5d3d0b166a4855/axial_024.png","assets/T/mri-3d5d3d0b166a4855/axial_026.png","assets/T/mri-3d5d3d0b166a4855/axial_028.png","assets/T/mri-3d5d3d0b166a4855/axial_030.png","assets/T/mri-3d5d3d0b166a4855/axial_032.png","assets/T/mri-3d5d3d0b166a4855/axial_034.png","assets/T/mri-3d5d3d0b166a4855/axial_036.png","assets/T/mri-3d5d3d0b166a4855/axial_038.png","assets/T/mri-3d5d3d0b166a4855/axial_040.png","assets/T/mri-3d5d3d0b166a4855/axial_042.png","assets/T/mri-3d5d3d0b166a4855/coronal_001.png","assets/T/mri-3d5d3d0b166a4855/coronal_003.png","assets/T/mri-3d5d3d0b166a4855/coronal_005.png","assets/T/mri-3d5d3d0b166a4855/coronal_007.png","assets/T/mri-3d5d3d0b166a4855/coronal_009.png","assets/T/mri-3d5d3d0b166a4855/coronal_011.png","assets/T/mri-3d5d3d0b166a4855/coronal_014.png","assets/T/mri-3d5d3d0b166a4855/coronal_016.png","assets/T/mri-3d5d3d0b166a4855/coronal_018.png","assets/T/mri-3d5d3d0b166a4855/coronal_020.png","assets/T/mri-3d5d3d0b166a4855/coronal_022.png","assets/T/mri-3d5d3d0b166a4855/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-433b0da09eee4d64","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 13 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-433b0da09eee4d64/axial_001.png","assets/T/mri-433b0da09eee4d64/axial_003.png","assets/T/mri-433b0da09eee4d64/axial_005.png","assets/T/mri-433b0da09eee4d64/axial_007.png","assets/T/mri-433b0da09eee4d64/axial_009.png","assets/T/mri-433b0da09eee4d64/axial_011.png","assets/T/mri-433b0da09eee4d64/axial_013.png","assets/T/mri-433b0da09eee4d64/axial_015.png","assets/T/mri-433b0da09eee4d64/axial_017.png","assets/T/mri-433b0da09eee4d64/axial_019.png","assets/T/mri-433b0da09eee4d64/axial_020.png","assets/T/mri-433b0da09eee4d64/axial_022.png","assets/T/mri-433b0da09eee4d64/axial_024.png","assets/T/mri-433b0da09eee4d64/axial_026.png","assets/T/mri-433b0da09eee4d64/axial_028.png","assets/T/mri-433b0da09eee4d64/axial_030.png","assets/T/mri-433b0da09eee4d64/axial_032.png","assets/T/mri-433b0da09eee4d64/axial_034.png","assets/T/mri-433b0da09eee4d64/axial_036.png","assets/T/mri-433b0da09eee4d64/axial_038.png","assets/T/mri-433b0da09eee4d64/coronal_001.png","assets/T/mri-433b0da09eee4d64/coronal_003.png","assets/T/mri-433b0da09eee4d64/coronal_005.png","assets/T/mri-433b0da09eee4d64/coronal_007.png","assets/T/mri-433b0da09eee4d64/coronal_009.png","assets/T/mri-433b0da09eee4d64/coronal_011.png","assets/T/mri-433b0da09eee4d64/coronal_013.png","assets/T/mri-433b0da09eee4d64/coronal_014.png","assets/T/mri-433b0da09eee4d64/coronal_016.png","assets/T/mri-433b0da09eee4d64/coronal_018.png","assets/T/mri-433b0da09eee4d64/coronal_020.png","assets/T/mri-433b0da09eee4d64/coronal_022.png","assets/T/mri-433b0da09eee4d64/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":62,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,20,22,24,26,28,30,32,34,36,38,39,41,43,45,47,49,51,52,54,56,58,60,62]}}
+{"id":"L3-T300:mri-a79d6c4b9bc54d1e","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 13 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-a79d6c4b9bc54d1e/axial_001.png","assets/T/mri-a79d6c4b9bc54d1e/axial_003.png","assets/T/mri-a79d6c4b9bc54d1e/axial_005.png","assets/T/mri-a79d6c4b9bc54d1e/axial_007.png","assets/T/mri-a79d6c4b9bc54d1e/axial_009.png","assets/T/mri-a79d6c4b9bc54d1e/axial_011.png","assets/T/mri-a79d6c4b9bc54d1e/axial_013.png","assets/T/mri-a79d6c4b9bc54d1e/axial_015.png","assets/T/mri-a79d6c4b9bc54d1e/axial_017.png","assets/T/mri-a79d6c4b9bc54d1e/axial_019.png","assets/T/mri-a79d6c4b9bc54d1e/axial_022.png","assets/T/mri-a79d6c4b9bc54d1e/axial_024.png","assets/T/mri-a79d6c4b9bc54d1e/axial_026.png","assets/T/mri-a79d6c4b9bc54d1e/axial_028.png","assets/T/mri-a79d6c4b9bc54d1e/axial_030.png","assets/T/mri-a79d6c4b9bc54d1e/axial_032.png","assets/T/mri-a79d6c4b9bc54d1e/axial_034.png","assets/T/mri-a79d6c4b9bc54d1e/axial_036.png","assets/T/mri-a79d6c4b9bc54d1e/axial_038.png","assets/T/mri-a79d6c4b9bc54d1e/axial_040.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_001.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_003.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_005.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_007.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_009.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_011.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_014.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_016.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_018.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_020.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_022.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_024.png","assets/T/mri-a79d6c4b9bc54d1e/coronal_026.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-58068eea382343a8","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 13 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-58068eea382343a8/axial_001.png","assets/T/mri-58068eea382343a8/axial_003.png","assets/T/mri-58068eea382343a8/axial_005.png","assets/T/mri-58068eea382343a8/axial_007.png","assets/T/mri-58068eea382343a8/axial_009.png","assets/T/mri-58068eea382343a8/axial_011.png","assets/T/mri-58068eea382343a8/axial_013.png","assets/T/mri-58068eea382343a8/axial_015.png","assets/T/mri-58068eea382343a8/axial_017.png","assets/T/mri-58068eea382343a8/axial_019.png","assets/T/mri-58068eea382343a8/axial_022.png","assets/T/mri-58068eea382343a8/axial_024.png","assets/T/mri-58068eea382343a8/axial_026.png","assets/T/mri-58068eea382343a8/axial_028.png","assets/T/mri-58068eea382343a8/axial_030.png","assets/T/mri-58068eea382343a8/axial_032.png","assets/T/mri-58068eea382343a8/axial_034.png","assets/T/mri-58068eea382343a8/axial_036.png","assets/T/mri-58068eea382343a8/axial_038.png","assets/T/mri-58068eea382343a8/axial_040.png","assets/T/mri-58068eea382343a8/coronal_001.png","assets/T/mri-58068eea382343a8/coronal_003.png","assets/T/mri-58068eea382343a8/coronal_005.png","assets/T/mri-58068eea382343a8/coronal_007.png","assets/T/mri-58068eea382343a8/coronal_009.png","assets/T/mri-58068eea382343a8/coronal_011.png","assets/T/mri-58068eea382343a8/coronal_014.png","assets/T/mri-58068eea382343a8/coronal_016.png","assets/T/mri-58068eea382343a8/coronal_018.png","assets/T/mri-58068eea382343a8/coronal_020.png","assets/T/mri-58068eea382343a8/coronal_022.png","assets/T/mri-58068eea382343a8/coronal_024.png","assets/T/mri-58068eea382343a8/coronal_026.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-753dcbe2c0cc4d80","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 22 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 11 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-753dcbe2c0cc4d80/axial_001.png","assets/T/mri-753dcbe2c0cc4d80/axial_003.png","assets/T/mri-753dcbe2c0cc4d80/axial_005.png","assets/T/mri-753dcbe2c0cc4d80/axial_007.png","assets/T/mri-753dcbe2c0cc4d80/axial_010.png","assets/T/mri-753dcbe2c0cc4d80/axial_012.png","assets/T/mri-753dcbe2c0cc4d80/axial_014.png","assets/T/mri-753dcbe2c0cc4d80/axial_016.png","assets/T/mri-753dcbe2c0cc4d80/axial_018.png","assets/T/mri-753dcbe2c0cc4d80/axial_020.png","assets/T/mri-753dcbe2c0cc4d80/axial_022.png","assets/T/mri-753dcbe2c0cc4d80/axial_025.png","assets/T/mri-753dcbe2c0cc4d80/axial_027.png","assets/T/mri-753dcbe2c0cc4d80/axial_029.png","assets/T/mri-753dcbe2c0cc4d80/axial_031.png","assets/T/mri-753dcbe2c0cc4d80/axial_033.png","assets/T/mri-753dcbe2c0cc4d80/axial_035.png","assets/T/mri-753dcbe2c0cc4d80/axial_037.png","assets/T/mri-753dcbe2c0cc4d80/axial_040.png","assets/T/mri-753dcbe2c0cc4d80/axial_042.png","assets/T/mri-753dcbe2c0cc4d80/axial_044.png","assets/T/mri-753dcbe2c0cc4d80/axial_046.png","assets/T/mri-753dcbe2c0cc4d80/coronal_001.png","assets/T/mri-753dcbe2c0cc4d80/coronal_003.png","assets/T/mri-753dcbe2c0cc4d80/coronal_006.png","assets/T/mri-753dcbe2c0cc4d80/coronal_008.png","assets/T/mri-753dcbe2c0cc4d80/coronal_010.png","assets/T/mri-753dcbe2c0cc4d80/coronal_013.png","assets/T/mri-753dcbe2c0cc4d80/coronal_015.png","assets/T/mri-753dcbe2c0cc4d80/coronal_017.png","assets/T/mri-753dcbe2c0cc4d80/coronal_019.png","assets/T/mri-753dcbe2c0cc4d80/coronal_022.png","assets/T/mri-753dcbe2c0cc4d80/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":70,"selected_count":33,"source_indices_1based":[1,3,5,7,10,12,14,16,18,20,22,25,27,29,31,33,35,37,40,42,44,46,47,49,52,54,56,59,61,63,65,68,70]}}
+{"id":"L3-T300:mri-f298574041324fad","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 13 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-f298574041324fad/axial_001.png","assets/T/mri-f298574041324fad/axial_003.png","assets/T/mri-f298574041324fad/axial_005.png","assets/T/mri-f298574041324fad/axial_007.png","assets/T/mri-f298574041324fad/axial_009.png","assets/T/mri-f298574041324fad/axial_011.png","assets/T/mri-f298574041324fad/axial_013.png","assets/T/mri-f298574041324fad/axial_015.png","assets/T/mri-f298574041324fad/axial_017.png","assets/T/mri-f298574041324fad/axial_019.png","assets/T/mri-f298574041324fad/axial_021.png","assets/T/mri-f298574041324fad/axial_023.png","assets/T/mri-f298574041324fad/axial_025.png","assets/T/mri-f298574041324fad/axial_027.png","assets/T/mri-f298574041324fad/axial_029.png","assets/T/mri-f298574041324fad/axial_031.png","assets/T/mri-f298574041324fad/axial_033.png","assets/T/mri-f298574041324fad/axial_035.png","assets/T/mri-f298574041324fad/axial_037.png","assets/T/mri-f298574041324fad/axial_039.png","assets/T/mri-f298574041324fad/coronal_001.png","assets/T/mri-f298574041324fad/coronal_003.png","assets/T/mri-f298574041324fad/coronal_005.png","assets/T/mri-f298574041324fad/coronal_007.png","assets/T/mri-f298574041324fad/coronal_009.png","assets/T/mri-f298574041324fad/coronal_011.png","assets/T/mri-f298574041324fad/coronal_013.png","assets/T/mri-f298574041324fad/coronal_014.png","assets/T/mri-f298574041324fad/coronal_016.png","assets/T/mri-f298574041324fad/coronal_018.png","assets/T/mri-f298574041324fad/coronal_020.png","assets/T/mri-f298574041324fad/coronal_022.png","assets/T/mri-f298574041324fad/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":63,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,23,25,27,29,31,33,35,37,39,40,42,44,46,48,50,52,53,55,57,59,61,63]}}
+{"id":"L3-T300:mri-2f3a9a16a54948d4","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 22 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 11 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-2f3a9a16a54948d4/axial_001.png","assets/T/mri-2f3a9a16a54948d4/axial_003.png","assets/T/mri-2f3a9a16a54948d4/axial_005.png","assets/T/mri-2f3a9a16a54948d4/axial_007.png","assets/T/mri-2f3a9a16a54948d4/axial_009.png","assets/T/mri-2f3a9a16a54948d4/axial_011.png","assets/T/mri-2f3a9a16a54948d4/axial_014.png","assets/T/mri-2f3a9a16a54948d4/axial_016.png","assets/T/mri-2f3a9a16a54948d4/axial_018.png","assets/T/mri-2f3a9a16a54948d4/axial_020.png","assets/T/mri-2f3a9a16a54948d4/axial_022.png","assets/T/mri-2f3a9a16a54948d4/axial_024.png","assets/T/mri-2f3a9a16a54948d4/axial_026.png","assets/T/mri-2f3a9a16a54948d4/axial_028.png","assets/T/mri-2f3a9a16a54948d4/axial_030.png","assets/T/mri-2f3a9a16a54948d4/axial_032.png","assets/T/mri-2f3a9a16a54948d4/axial_035.png","assets/T/mri-2f3a9a16a54948d4/axial_037.png","assets/T/mri-2f3a9a16a54948d4/axial_039.png","assets/T/mri-2f3a9a16a54948d4/axial_041.png","assets/T/mri-2f3a9a16a54948d4/axial_043.png","assets/T/mri-2f3a9a16a54948d4/axial_045.png","assets/T/mri-2f3a9a16a54948d4/coronal_001.png","assets/T/mri-2f3a9a16a54948d4/coronal_003.png","assets/T/mri-2f3a9a16a54948d4/coronal_006.png","assets/T/mri-2f3a9a16a54948d4/coronal_008.png","assets/T/mri-2f3a9a16a54948d4/coronal_010.png","assets/T/mri-2f3a9a16a54948d4/coronal_013.png","assets/T/mri-2f3a9a16a54948d4/coronal_015.png","assets/T/mri-2f3a9a16a54948d4/coronal_017.png","assets/T/mri-2f3a9a16a54948d4/coronal_019.png","assets/T/mri-2f3a9a16a54948d4/coronal_022.png","assets/T/mri-2f3a9a16a54948d4/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":69,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,14,16,18,20,22,24,26,28,30,32,35,37,39,41,43,45,46,48,51,53,55,58,60,62,64,67,69]}}
+{"id":"L3-T300:mri-a1e9759b1342485d","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 34 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 14 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-a1e9759b1342485d/axial_001.png","assets/T/mri-a1e9759b1342485d/axial_003.png","assets/T/mri-a1e9759b1342485d/axial_005.png","assets/T/mri-a1e9759b1342485d/axial_007.png","assets/T/mri-a1e9759b1342485d/axial_008.png","assets/T/mri-a1e9759b1342485d/axial_010.png","assets/T/mri-a1e9759b1342485d/axial_012.png","assets/T/mri-a1e9759b1342485d/axial_014.png","assets/T/mri-a1e9759b1342485d/axial_016.png","assets/T/mri-a1e9759b1342485d/axial_018.png","assets/T/mri-a1e9759b1342485d/axial_019.png","assets/T/mri-a1e9759b1342485d/axial_021.png","assets/T/mri-a1e9759b1342485d/axial_023.png","assets/T/mri-a1e9759b1342485d/axial_025.png","assets/T/mri-a1e9759b1342485d/axial_027.png","assets/T/mri-a1e9759b1342485d/axial_029.png","assets/T/mri-a1e9759b1342485d/axial_030.png","assets/T/mri-a1e9759b1342485d/axial_032.png","assets/T/mri-a1e9759b1342485d/axial_034.png","assets/T/mri-a1e9759b1342485d/axial_036.png","assets/T/mri-a1e9759b1342485d/coronal_001.png","assets/T/mri-a1e9759b1342485d/coronal_003.png","assets/T/mri-a1e9759b1342485d/coronal_005.png","assets/T/mri-a1e9759b1342485d/coronal_006.png","assets/T/mri-a1e9759b1342485d/coronal_008.png","assets/T/mri-a1e9759b1342485d/coronal_010.png","assets/T/mri-a1e9759b1342485d/coronal_012.png","assets/T/mri-a1e9759b1342485d/coronal_013.png","assets/T/mri-a1e9759b1342485d/coronal_015.png","assets/T/mri-a1e9759b1342485d/coronal_017.png","assets/T/mri-a1e9759b1342485d/coronal_019.png","assets/T/mri-a1e9759b1342485d/coronal_020.png","assets/T/mri-a1e9759b1342485d/coronal_022.png","assets/T/mri-a1e9759b1342485d/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":60,"selected_count":34,"source_indices_1based":[1,3,5,7,8,10,12,14,16,18,19,21,23,25,27,29,30,32,34,36,37,39,41,42,44,46,48,49,51,53,55,56,58,60]}}
+{"id":"L3-T300:mri-7d52e0807d5e4ece","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 13 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-7d52e0807d5e4ece/axial_001.png","assets/T/mri-7d52e0807d5e4ece/axial_003.png","assets/T/mri-7d52e0807d5e4ece/axial_005.png","assets/T/mri-7d52e0807d5e4ece/axial_007.png","assets/T/mri-7d52e0807d5e4ece/axial_009.png","assets/T/mri-7d52e0807d5e4ece/axial_011.png","assets/T/mri-7d52e0807d5e4ece/axial_013.png","assets/T/mri-7d52e0807d5e4ece/axial_015.png","assets/T/mri-7d52e0807d5e4ece/axial_017.png","assets/T/mri-7d52e0807d5e4ece/axial_019.png","assets/T/mri-7d52e0807d5e4ece/axial_020.png","assets/T/mri-7d52e0807d5e4ece/axial_022.png","assets/T/mri-7d52e0807d5e4ece/axial_024.png","assets/T/mri-7d52e0807d5e4ece/axial_026.png","assets/T/mri-7d52e0807d5e4ece/axial_028.png","assets/T/mri-7d52e0807d5e4ece/axial_030.png","assets/T/mri-7d52e0807d5e4ece/axial_032.png","assets/T/mri-7d52e0807d5e4ece/axial_034.png","assets/T/mri-7d52e0807d5e4ece/axial_036.png","assets/T/mri-7d52e0807d5e4ece/axial_038.png","assets/T/mri-7d52e0807d5e4ece/coronal_001.png","assets/T/mri-7d52e0807d5e4ece/coronal_003.png","assets/T/mri-7d52e0807d5e4ece/coronal_005.png","assets/T/mri-7d52e0807d5e4ece/coronal_007.png","assets/T/mri-7d52e0807d5e4ece/coronal_009.png","assets/T/mri-7d52e0807d5e4ece/coronal_011.png","assets/T/mri-7d52e0807d5e4ece/coronal_013.png","assets/T/mri-7d52e0807d5e4ece/coronal_014.png","assets/T/mri-7d52e0807d5e4ece/coronal_016.png","assets/T/mri-7d52e0807d5e4ece/coronal_018.png","assets/T/mri-7d52e0807d5e4ece/coronal_020.png","assets/T/mri-7d52e0807d5e4ece/coronal_022.png","assets/T/mri-7d52e0807d5e4ece/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":62,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,20,22,24,26,28,30,32,34,36,38,39,41,43,45,47,49,51,52,54,56,58,60,62]}}
+{"id":"L3-T300:mri-9871a28e414f4455","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-9871a28e414f4455/axial_001.png","assets/T/mri-9871a28e414f4455/axial_003.png","assets/T/mri-9871a28e414f4455/axial_005.png","assets/T/mri-9871a28e414f4455/axial_007.png","assets/T/mri-9871a28e414f4455/axial_009.png","assets/T/mri-9871a28e414f4455/axial_011.png","assets/T/mri-9871a28e414f4455/axial_013.png","assets/T/mri-9871a28e414f4455/axial_015.png","assets/T/mri-9871a28e414f4455/axial_017.png","assets/T/mri-9871a28e414f4455/axial_019.png","assets/T/mri-9871a28e414f4455/axial_021.png","assets/T/mri-9871a28e414f4455/axial_022.png","assets/T/mri-9871a28e414f4455/axial_024.png","assets/T/mri-9871a28e414f4455/axial_026.png","assets/T/mri-9871a28e414f4455/axial_028.png","assets/T/mri-9871a28e414f4455/axial_030.png","assets/T/mri-9871a28e414f4455/axial_032.png","assets/T/mri-9871a28e414f4455/axial_034.png","assets/T/mri-9871a28e414f4455/axial_036.png","assets/T/mri-9871a28e414f4455/axial_038.png","assets/T/mri-9871a28e414f4455/axial_040.png","assets/T/mri-9871a28e414f4455/coronal_001.png","assets/T/mri-9871a28e414f4455/coronal_003.png","assets/T/mri-9871a28e414f4455/coronal_005.png","assets/T/mri-9871a28e414f4455/coronal_007.png","assets/T/mri-9871a28e414f4455/coronal_009.png","assets/T/mri-9871a28e414f4455/coronal_011.png","assets/T/mri-9871a28e414f4455/coronal_014.png","assets/T/mri-9871a28e414f4455/coronal_016.png","assets/T/mri-9871a28e414f4455/coronal_018.png","assets/T/mri-9871a28e414f4455/coronal_020.png","assets/T/mri-9871a28e414f4455/coronal_022.png","assets/T/mri-9871a28e414f4455/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-7ea324ec1d394d0a","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 22 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 11 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-7ea324ec1d394d0a/axial_001.png","assets/T/mri-7ea324ec1d394d0a/axial_003.png","assets/T/mri-7ea324ec1d394d0a/axial_005.png","assets/T/mri-7ea324ec1d394d0a/axial_008.png","assets/T/mri-7ea324ec1d394d0a/axial_010.png","assets/T/mri-7ea324ec1d394d0a/axial_012.png","assets/T/mri-7ea324ec1d394d0a/axial_014.png","assets/T/mri-7ea324ec1d394d0a/axial_017.png","assets/T/mri-7ea324ec1d394d0a/axial_019.png","assets/T/mri-7ea324ec1d394d0a/axial_021.png","assets/T/mri-7ea324ec1d394d0a/axial_023.png","assets/T/mri-7ea324ec1d394d0a/axial_026.png","assets/T/mri-7ea324ec1d394d0a/axial_028.png","assets/T/mri-7ea324ec1d394d0a/axial_030.png","assets/T/mri-7ea324ec1d394d0a/axial_032.png","assets/T/mri-7ea324ec1d394d0a/axial_035.png","assets/T/mri-7ea324ec1d394d0a/axial_037.png","assets/T/mri-7ea324ec1d394d0a/axial_039.png","assets/T/mri-7ea324ec1d394d0a/axial_041.png","assets/T/mri-7ea324ec1d394d0a/axial_044.png","assets/T/mri-7ea324ec1d394d0a/axial_046.png","assets/T/mri-7ea324ec1d394d0a/axial_048.png","assets/T/mri-7ea324ec1d394d0a/coronal_001.png","assets/T/mri-7ea324ec1d394d0a/coronal_003.png","assets/T/mri-7ea324ec1d394d0a/coronal_006.png","assets/T/mri-7ea324ec1d394d0a/coronal_008.png","assets/T/mri-7ea324ec1d394d0a/coronal_010.png","assets/T/mri-7ea324ec1d394d0a/coronal_013.png","assets/T/mri-7ea324ec1d394d0a/coronal_015.png","assets/T/mri-7ea324ec1d394d0a/coronal_017.png","assets/T/mri-7ea324ec1d394d0a/coronal_019.png","assets/T/mri-7ea324ec1d394d0a/coronal_022.png","assets/T/mri-7ea324ec1d394d0a/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":72,"selected_count":33,"source_indices_1based":[1,3,5,8,10,12,14,17,19,21,23,26,28,30,32,35,37,39,41,44,46,48,49,51,54,56,58,61,63,65,67,70,72]}}
+{"id":"L3-T300:mri-f31b184843914d18","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-f31b184843914d18/axial_001.png","assets/T/mri-f31b184843914d18/axial_003.png","assets/T/mri-f31b184843914d18/axial_005.png","assets/T/mri-f31b184843914d18/axial_007.png","assets/T/mri-f31b184843914d18/axial_009.png","assets/T/mri-f31b184843914d18/axial_011.png","assets/T/mri-f31b184843914d18/axial_013.png","assets/T/mri-f31b184843914d18/axial_015.png","assets/T/mri-f31b184843914d18/axial_017.png","assets/T/mri-f31b184843914d18/axial_019.png","assets/T/mri-f31b184843914d18/axial_021.png","assets/T/mri-f31b184843914d18/axial_022.png","assets/T/mri-f31b184843914d18/axial_024.png","assets/T/mri-f31b184843914d18/axial_026.png","assets/T/mri-f31b184843914d18/axial_028.png","assets/T/mri-f31b184843914d18/axial_030.png","assets/T/mri-f31b184843914d18/axial_032.png","assets/T/mri-f31b184843914d18/axial_034.png","assets/T/mri-f31b184843914d18/axial_036.png","assets/T/mri-f31b184843914d18/axial_038.png","assets/T/mri-f31b184843914d18/axial_040.png","assets/T/mri-f31b184843914d18/coronal_001.png","assets/T/mri-f31b184843914d18/coronal_003.png","assets/T/mri-f31b184843914d18/coronal_005.png","assets/T/mri-f31b184843914d18/coronal_007.png","assets/T/mri-f31b184843914d18/coronal_009.png","assets/T/mri-f31b184843914d18/coronal_011.png","assets/T/mri-f31b184843914d18/coronal_014.png","assets/T/mri-f31b184843914d18/coronal_016.png","assets/T/mri-f31b184843914d18/coronal_018.png","assets/T/mri-f31b184843914d18/coronal_020.png","assets/T/mri-f31b184843914d18/coronal_022.png","assets/T/mri-f31b184843914d18/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-fa2f991b797a46e9","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-fa2f991b797a46e9/axial_001.png","assets/T/mri-fa2f991b797a46e9/axial_003.png","assets/T/mri-fa2f991b797a46e9/axial_005.png","assets/T/mri-fa2f991b797a46e9/axial_007.png","assets/T/mri-fa2f991b797a46e9/axial_010.png","assets/T/mri-fa2f991b797a46e9/axial_012.png","assets/T/mri-fa2f991b797a46e9/axial_014.png","assets/T/mri-fa2f991b797a46e9/axial_016.png","assets/T/mri-fa2f991b797a46e9/axial_018.png","assets/T/mri-fa2f991b797a46e9/axial_020.png","assets/T/mri-fa2f991b797a46e9/axial_023.png","assets/T/mri-fa2f991b797a46e9/axial_025.png","assets/T/mri-fa2f991b797a46e9/axial_027.png","assets/T/mri-fa2f991b797a46e9/axial_029.png","assets/T/mri-fa2f991b797a46e9/axial_031.png","assets/T/mri-fa2f991b797a46e9/axial_033.png","assets/T/mri-fa2f991b797a46e9/axial_035.png","assets/T/mri-fa2f991b797a46e9/axial_038.png","assets/T/mri-fa2f991b797a46e9/axial_040.png","assets/T/mri-fa2f991b797a46e9/axial_042.png","assets/T/mri-fa2f991b797a46e9/axial_044.png","assets/T/mri-fa2f991b797a46e9/coronal_001.png","assets/T/mri-fa2f991b797a46e9/coronal_003.png","assets/T/mri-fa2f991b797a46e9/coronal_005.png","assets/T/mri-fa2f991b797a46e9/coronal_007.png","assets/T/mri-fa2f991b797a46e9/coronal_009.png","assets/T/mri-fa2f991b797a46e9/coronal_011.png","assets/T/mri-fa2f991b797a46e9/coronal_014.png","assets/T/mri-fa2f991b797a46e9/coronal_016.png","assets/T/mri-fa2f991b797a46e9/coronal_018.png","assets/T/mri-fa2f991b797a46e9/coronal_020.png","assets/T/mri-fa2f991b797a46e9/coronal_022.png","assets/T/mri-fa2f991b797a46e9/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":68,"selected_count":33,"source_indices_1based":[1,3,5,7,10,12,14,16,18,20,23,25,27,29,31,33,35,38,40,42,44,45,47,49,51,53,55,58,60,62,64,66,68]}}
+{"id":"L3-T300:mri-1f3aecd6708d424a","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 34 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 14 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-1f3aecd6708d424a/axial_001.png","assets/T/mri-1f3aecd6708d424a/axial_003.png","assets/T/mri-1f3aecd6708d424a/axial_005.png","assets/T/mri-1f3aecd6708d424a/axial_007.png","assets/T/mri-1f3aecd6708d424a/axial_010.png","assets/T/mri-1f3aecd6708d424a/axial_012.png","assets/T/mri-1f3aecd6708d424a/axial_014.png","assets/T/mri-1f3aecd6708d424a/axial_016.png","assets/T/mri-1f3aecd6708d424a/axial_018.png","assets/T/mri-1f3aecd6708d424a/axial_020.png","assets/T/mri-1f3aecd6708d424a/axial_023.png","assets/T/mri-1f3aecd6708d424a/axial_025.png","assets/T/mri-1f3aecd6708d424a/axial_027.png","assets/T/mri-1f3aecd6708d424a/axial_029.png","assets/T/mri-1f3aecd6708d424a/axial_031.png","assets/T/mri-1f3aecd6708d424a/axial_033.png","assets/T/mri-1f3aecd6708d424a/axial_036.png","assets/T/mri-1f3aecd6708d424a/axial_038.png","assets/T/mri-1f3aecd6708d424a/axial_040.png","assets/T/mri-1f3aecd6708d424a/axial_042.png","assets/T/mri-1f3aecd6708d424a/coronal_001.png","assets/T/mri-1f3aecd6708d424a/coronal_003.png","assets/T/mri-1f3aecd6708d424a/coronal_005.png","assets/T/mri-1f3aecd6708d424a/coronal_007.png","assets/T/mri-1f3aecd6708d424a/coronal_009.png","assets/T/mri-1f3aecd6708d424a/coronal_011.png","assets/T/mri-1f3aecd6708d424a/coronal_013.png","assets/T/mri-1f3aecd6708d424a/coronal_016.png","assets/T/mri-1f3aecd6708d424a/coronal_018.png","assets/T/mri-1f3aecd6708d424a/coronal_020.png","assets/T/mri-1f3aecd6708d424a/coronal_022.png","assets/T/mri-1f3aecd6708d424a/coronal_024.png","assets/T/mri-1f3aecd6708d424a/coronal_026.png","assets/T/mri-1f3aecd6708d424a/coronal_028.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":70,"selected_count":34,"source_indices_1based":[1,3,5,7,10,12,14,16,18,20,23,25,27,29,31,33,36,38,40,42,43,45,47,49,51,53,55,58,60,62,64,66,68,70]}}
+{"id":"L3-T300:mri-b17592ae382c4024","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 13 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-b17592ae382c4024/axial_001.png","assets/T/mri-b17592ae382c4024/axial_003.png","assets/T/mri-b17592ae382c4024/axial_005.png","assets/T/mri-b17592ae382c4024/axial_007.png","assets/T/mri-b17592ae382c4024/axial_009.png","assets/T/mri-b17592ae382c4024/axial_011.png","assets/T/mri-b17592ae382c4024/axial_013.png","assets/T/mri-b17592ae382c4024/axial_015.png","assets/T/mri-b17592ae382c4024/axial_017.png","assets/T/mri-b17592ae382c4024/axial_019.png","assets/T/mri-b17592ae382c4024/axial_020.png","assets/T/mri-b17592ae382c4024/axial_022.png","assets/T/mri-b17592ae382c4024/axial_024.png","assets/T/mri-b17592ae382c4024/axial_026.png","assets/T/mri-b17592ae382c4024/axial_028.png","assets/T/mri-b17592ae382c4024/axial_030.png","assets/T/mri-b17592ae382c4024/axial_032.png","assets/T/mri-b17592ae382c4024/axial_034.png","assets/T/mri-b17592ae382c4024/axial_036.png","assets/T/mri-b17592ae382c4024/axial_038.png","assets/T/mri-b17592ae382c4024/coronal_001.png","assets/T/mri-b17592ae382c4024/coronal_003.png","assets/T/mri-b17592ae382c4024/coronal_005.png","assets/T/mri-b17592ae382c4024/coronal_007.png","assets/T/mri-b17592ae382c4024/coronal_009.png","assets/T/mri-b17592ae382c4024/coronal_011.png","assets/T/mri-b17592ae382c4024/coronal_013.png","assets/T/mri-b17592ae382c4024/coronal_014.png","assets/T/mri-b17592ae382c4024/coronal_016.png","assets/T/mri-b17592ae382c4024/coronal_018.png","assets/T/mri-b17592ae382c4024/coronal_020.png","assets/T/mri-b17592ae382c4024/coronal_022.png","assets/T/mri-b17592ae382c4024/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":62,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,20,22,24,26,28,30,32,34,36,38,39,41,43,45,47,49,51,52,54,56,58,60,62]}}
+{"id":"L3-T300:mri-0bbaeb3ce596430a","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-0bbaeb3ce596430a/axial_001.png","assets/T/mri-0bbaeb3ce596430a/axial_003.png","assets/T/mri-0bbaeb3ce596430a/axial_005.png","assets/T/mri-0bbaeb3ce596430a/axial_007.png","assets/T/mri-0bbaeb3ce596430a/axial_009.png","assets/T/mri-0bbaeb3ce596430a/axial_011.png","assets/T/mri-0bbaeb3ce596430a/axial_013.png","assets/T/mri-0bbaeb3ce596430a/axial_015.png","assets/T/mri-0bbaeb3ce596430a/axial_017.png","assets/T/mri-0bbaeb3ce596430a/axial_019.png","assets/T/mri-0bbaeb3ce596430a/axial_022.png","assets/T/mri-0bbaeb3ce596430a/axial_024.png","assets/T/mri-0bbaeb3ce596430a/axial_026.png","assets/T/mri-0bbaeb3ce596430a/axial_028.png","assets/T/mri-0bbaeb3ce596430a/axial_030.png","assets/T/mri-0bbaeb3ce596430a/axial_032.png","assets/T/mri-0bbaeb3ce596430a/axial_034.png","assets/T/mri-0bbaeb3ce596430a/axial_036.png","assets/T/mri-0bbaeb3ce596430a/axial_038.png","assets/T/mri-0bbaeb3ce596430a/axial_040.png","assets/T/mri-0bbaeb3ce596430a/axial_042.png","assets/T/mri-0bbaeb3ce596430a/coronal_001.png","assets/T/mri-0bbaeb3ce596430a/coronal_003.png","assets/T/mri-0bbaeb3ce596430a/coronal_005.png","assets/T/mri-0bbaeb3ce596430a/coronal_007.png","assets/T/mri-0bbaeb3ce596430a/coronal_009.png","assets/T/mri-0bbaeb3ce596430a/coronal_011.png","assets/T/mri-0bbaeb3ce596430a/coronal_014.png","assets/T/mri-0bbaeb3ce596430a/coronal_016.png","assets/T/mri-0bbaeb3ce596430a/coronal_018.png","assets/T/mri-0bbaeb3ce596430a/coronal_020.png","assets/T/mri-0bbaeb3ce596430a/coronal_022.png","assets/T/mri-0bbaeb3ce596430a/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-7f087e4b9fbd4930","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-7f087e4b9fbd4930/axial_001.png","assets/T/mri-7f087e4b9fbd4930/axial_003.png","assets/T/mri-7f087e4b9fbd4930/axial_005.png","assets/T/mri-7f087e4b9fbd4930/axial_007.png","assets/T/mri-7f087e4b9fbd4930/axial_009.png","assets/T/mri-7f087e4b9fbd4930/axial_011.png","assets/T/mri-7f087e4b9fbd4930/axial_013.png","assets/T/mri-7f087e4b9fbd4930/axial_015.png","assets/T/mri-7f087e4b9fbd4930/axial_017.png","assets/T/mri-7f087e4b9fbd4930/axial_019.png","assets/T/mri-7f087e4b9fbd4930/axial_021.png","assets/T/mri-7f087e4b9fbd4930/axial_022.png","assets/T/mri-7f087e4b9fbd4930/axial_024.png","assets/T/mri-7f087e4b9fbd4930/axial_026.png","assets/T/mri-7f087e4b9fbd4930/axial_028.png","assets/T/mri-7f087e4b9fbd4930/axial_030.png","assets/T/mri-7f087e4b9fbd4930/axial_032.png","assets/T/mri-7f087e4b9fbd4930/axial_034.png","assets/T/mri-7f087e4b9fbd4930/axial_036.png","assets/T/mri-7f087e4b9fbd4930/axial_038.png","assets/T/mri-7f087e4b9fbd4930/axial_040.png","assets/T/mri-7f087e4b9fbd4930/coronal_001.png","assets/T/mri-7f087e4b9fbd4930/coronal_003.png","assets/T/mri-7f087e4b9fbd4930/coronal_005.png","assets/T/mri-7f087e4b9fbd4930/coronal_007.png","assets/T/mri-7f087e4b9fbd4930/coronal_009.png","assets/T/mri-7f087e4b9fbd4930/coronal_011.png","assets/T/mri-7f087e4b9fbd4930/coronal_014.png","assets/T/mri-7f087e4b9fbd4930/coronal_016.png","assets/T/mri-7f087e4b9fbd4930/coronal_018.png","assets/T/mri-7f087e4b9fbd4930/coronal_020.png","assets/T/mri-7f087e4b9fbd4930/coronal_022.png","assets/T/mri-7f087e4b9fbd4930/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-2495921ad88b46a3","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-2495921ad88b46a3/axial_001.png","assets/T/mri-2495921ad88b46a3/axial_003.png","assets/T/mri-2495921ad88b46a3/axial_005.png","assets/T/mri-2495921ad88b46a3/axial_007.png","assets/T/mri-2495921ad88b46a3/axial_009.png","assets/T/mri-2495921ad88b46a3/axial_011.png","assets/T/mri-2495921ad88b46a3/axial_013.png","assets/T/mri-2495921ad88b46a3/axial_015.png","assets/T/mri-2495921ad88b46a3/axial_017.png","assets/T/mri-2495921ad88b46a3/axial_019.png","assets/T/mri-2495921ad88b46a3/axial_021.png","assets/T/mri-2495921ad88b46a3/axial_022.png","assets/T/mri-2495921ad88b46a3/axial_024.png","assets/T/mri-2495921ad88b46a3/axial_026.png","assets/T/mri-2495921ad88b46a3/axial_028.png","assets/T/mri-2495921ad88b46a3/axial_030.png","assets/T/mri-2495921ad88b46a3/axial_032.png","assets/T/mri-2495921ad88b46a3/axial_034.png","assets/T/mri-2495921ad88b46a3/axial_036.png","assets/T/mri-2495921ad88b46a3/axial_038.png","assets/T/mri-2495921ad88b46a3/axial_040.png","assets/T/mri-2495921ad88b46a3/coronal_001.png","assets/T/mri-2495921ad88b46a3/coronal_003.png","assets/T/mri-2495921ad88b46a3/coronal_005.png","assets/T/mri-2495921ad88b46a3/coronal_007.png","assets/T/mri-2495921ad88b46a3/coronal_009.png","assets/T/mri-2495921ad88b46a3/coronal_011.png","assets/T/mri-2495921ad88b46a3/coronal_014.png","assets/T/mri-2495921ad88b46a3/coronal_016.png","assets/T/mri-2495921ad88b46a3/coronal_018.png","assets/T/mri-2495921ad88b46a3/coronal_020.png","assets/T/mri-2495921ad88b46a3/coronal_022.png","assets/T/mri-2495921ad88b46a3/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-6093448809034145","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 13 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-6093448809034145/axial_001.png","assets/T/mri-6093448809034145/axial_003.png","assets/T/mri-6093448809034145/axial_005.png","assets/T/mri-6093448809034145/axial_007.png","assets/T/mri-6093448809034145/axial_009.png","assets/T/mri-6093448809034145/axial_011.png","assets/T/mri-6093448809034145/axial_013.png","assets/T/mri-6093448809034145/axial_015.png","assets/T/mri-6093448809034145/axial_017.png","assets/T/mri-6093448809034145/axial_019.png","assets/T/mri-6093448809034145/axial_022.png","assets/T/mri-6093448809034145/axial_024.png","assets/T/mri-6093448809034145/axial_026.png","assets/T/mri-6093448809034145/axial_028.png","assets/T/mri-6093448809034145/axial_030.png","assets/T/mri-6093448809034145/axial_032.png","assets/T/mri-6093448809034145/axial_034.png","assets/T/mri-6093448809034145/axial_036.png","assets/T/mri-6093448809034145/axial_038.png","assets/T/mri-6093448809034145/axial_040.png","assets/T/mri-6093448809034145/coronal_001.png","assets/T/mri-6093448809034145/coronal_003.png","assets/T/mri-6093448809034145/coronal_005.png","assets/T/mri-6093448809034145/coronal_007.png","assets/T/mri-6093448809034145/coronal_009.png","assets/T/mri-6093448809034145/coronal_011.png","assets/T/mri-6093448809034145/coronal_014.png","assets/T/mri-6093448809034145/coronal_016.png","assets/T/mri-6093448809034145/coronal_018.png","assets/T/mri-6093448809034145/coronal_020.png","assets/T/mri-6093448809034145/coronal_022.png","assets/T/mri-6093448809034145/coronal_024.png","assets/T/mri-6093448809034145/coronal_026.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-cda1302e1734496e","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-cda1302e1734496e/axial_001.png","assets/T/mri-cda1302e1734496e/axial_003.png","assets/T/mri-cda1302e1734496e/axial_005.png","assets/T/mri-cda1302e1734496e/axial_007.png","assets/T/mri-cda1302e1734496e/axial_009.png","assets/T/mri-cda1302e1734496e/axial_011.png","assets/T/mri-cda1302e1734496e/axial_013.png","assets/T/mri-cda1302e1734496e/axial_015.png","assets/T/mri-cda1302e1734496e/axial_017.png","assets/T/mri-cda1302e1734496e/axial_019.png","assets/T/mri-cda1302e1734496e/axial_021.png","assets/T/mri-cda1302e1734496e/axial_022.png","assets/T/mri-cda1302e1734496e/axial_024.png","assets/T/mri-cda1302e1734496e/axial_026.png","assets/T/mri-cda1302e1734496e/axial_028.png","assets/T/mri-cda1302e1734496e/axial_030.png","assets/T/mri-cda1302e1734496e/axial_032.png","assets/T/mri-cda1302e1734496e/axial_034.png","assets/T/mri-cda1302e1734496e/axial_036.png","assets/T/mri-cda1302e1734496e/axial_038.png","assets/T/mri-cda1302e1734496e/axial_040.png","assets/T/mri-cda1302e1734496e/coronal_001.png","assets/T/mri-cda1302e1734496e/coronal_003.png","assets/T/mri-cda1302e1734496e/coronal_005.png","assets/T/mri-cda1302e1734496e/coronal_007.png","assets/T/mri-cda1302e1734496e/coronal_009.png","assets/T/mri-cda1302e1734496e/coronal_011.png","assets/T/mri-cda1302e1734496e/coronal_014.png","assets/T/mri-cda1302e1734496e/coronal_016.png","assets/T/mri-cda1302e1734496e/coronal_018.png","assets/T/mri-cda1302e1734496e/coronal_020.png","assets/T/mri-cda1302e1734496e/coronal_022.png","assets/T/mri-cda1302e1734496e/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-d514f55b3f3443d5","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-d514f55b3f3443d5/axial_001.png","assets/T/mri-d514f55b3f3443d5/axial_003.png","assets/T/mri-d514f55b3f3443d5/axial_005.png","assets/T/mri-d514f55b3f3443d5/axial_007.png","assets/T/mri-d514f55b3f3443d5/axial_010.png","assets/T/mri-d514f55b3f3443d5/axial_012.png","assets/T/mri-d514f55b3f3443d5/axial_014.png","assets/T/mri-d514f55b3f3443d5/axial_016.png","assets/T/mri-d514f55b3f3443d5/axial_018.png","assets/T/mri-d514f55b3f3443d5/axial_020.png","assets/T/mri-d514f55b3f3443d5/axial_023.png","assets/T/mri-d514f55b3f3443d5/axial_025.png","assets/T/mri-d514f55b3f3443d5/axial_027.png","assets/T/mri-d514f55b3f3443d5/axial_029.png","assets/T/mri-d514f55b3f3443d5/axial_031.png","assets/T/mri-d514f55b3f3443d5/axial_033.png","assets/T/mri-d514f55b3f3443d5/axial_035.png","assets/T/mri-d514f55b3f3443d5/axial_038.png","assets/T/mri-d514f55b3f3443d5/axial_040.png","assets/T/mri-d514f55b3f3443d5/axial_042.png","assets/T/mri-d514f55b3f3443d5/axial_044.png","assets/T/mri-d514f55b3f3443d5/coronal_001.png","assets/T/mri-d514f55b3f3443d5/coronal_003.png","assets/T/mri-d514f55b3f3443d5/coronal_005.png","assets/T/mri-d514f55b3f3443d5/coronal_007.png","assets/T/mri-d514f55b3f3443d5/coronal_009.png","assets/T/mri-d514f55b3f3443d5/coronal_011.png","assets/T/mri-d514f55b3f3443d5/coronal_014.png","assets/T/mri-d514f55b3f3443d5/coronal_016.png","assets/T/mri-d514f55b3f3443d5/coronal_018.png","assets/T/mri-d514f55b3f3443d5/coronal_020.png","assets/T/mri-d514f55b3f3443d5/coronal_022.png","assets/T/mri-d514f55b3f3443d5/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":68,"selected_count":33,"source_indices_1based":[1,3,5,7,10,12,14,16,18,20,23,25,27,29,31,33,35,38,40,42,44,45,47,49,51,53,55,58,60,62,64,66,68]}}
+{"id":"L3-T300:mri-0308881784db400a","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 22 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 11 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-0308881784db400a/axial_001.png","assets/T/mri-0308881784db400a/axial_003.png","assets/T/mri-0308881784db400a/axial_005.png","assets/T/mri-0308881784db400a/axial_007.png","assets/T/mri-0308881784db400a/axial_009.png","assets/T/mri-0308881784db400a/axial_011.png","assets/T/mri-0308881784db400a/axial_014.png","assets/T/mri-0308881784db400a/axial_016.png","assets/T/mri-0308881784db400a/axial_018.png","assets/T/mri-0308881784db400a/axial_020.png","assets/T/mri-0308881784db400a/axial_022.png","assets/T/mri-0308881784db400a/axial_024.png","assets/T/mri-0308881784db400a/axial_026.png","assets/T/mri-0308881784db400a/axial_028.png","assets/T/mri-0308881784db400a/axial_030.png","assets/T/mri-0308881784db400a/axial_032.png","assets/T/mri-0308881784db400a/axial_035.png","assets/T/mri-0308881784db400a/axial_037.png","assets/T/mri-0308881784db400a/axial_039.png","assets/T/mri-0308881784db400a/axial_041.png","assets/T/mri-0308881784db400a/axial_043.png","assets/T/mri-0308881784db400a/axial_045.png","assets/T/mri-0308881784db400a/coronal_001.png","assets/T/mri-0308881784db400a/coronal_003.png","assets/T/mri-0308881784db400a/coronal_006.png","assets/T/mri-0308881784db400a/coronal_008.png","assets/T/mri-0308881784db400a/coronal_010.png","assets/T/mri-0308881784db400a/coronal_013.png","assets/T/mri-0308881784db400a/coronal_015.png","assets/T/mri-0308881784db400a/coronal_017.png","assets/T/mri-0308881784db400a/coronal_019.png","assets/T/mri-0308881784db400a/coronal_022.png","assets/T/mri-0308881784db400a/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":69,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,14,16,18,20,22,24,26,28,30,32,35,37,39,41,43,45,46,48,51,53,55,58,60,62,64,67,69]}}
+{"id":"L3-T300:mri-4cb8cb63e2d748bd","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-4cb8cb63e2d748bd/axial_001.png","assets/T/mri-4cb8cb63e2d748bd/axial_003.png","assets/T/mri-4cb8cb63e2d748bd/axial_005.png","assets/T/mri-4cb8cb63e2d748bd/axial_007.png","assets/T/mri-4cb8cb63e2d748bd/axial_010.png","assets/T/mri-4cb8cb63e2d748bd/axial_012.png","assets/T/mri-4cb8cb63e2d748bd/axial_014.png","assets/T/mri-4cb8cb63e2d748bd/axial_016.png","assets/T/mri-4cb8cb63e2d748bd/axial_018.png","assets/T/mri-4cb8cb63e2d748bd/axial_020.png","assets/T/mri-4cb8cb63e2d748bd/axial_023.png","assets/T/mri-4cb8cb63e2d748bd/axial_025.png","assets/T/mri-4cb8cb63e2d748bd/axial_027.png","assets/T/mri-4cb8cb63e2d748bd/axial_029.png","assets/T/mri-4cb8cb63e2d748bd/axial_031.png","assets/T/mri-4cb8cb63e2d748bd/axial_033.png","assets/T/mri-4cb8cb63e2d748bd/axial_035.png","assets/T/mri-4cb8cb63e2d748bd/axial_038.png","assets/T/mri-4cb8cb63e2d748bd/axial_040.png","assets/T/mri-4cb8cb63e2d748bd/axial_042.png","assets/T/mri-4cb8cb63e2d748bd/axial_044.png","assets/T/mri-4cb8cb63e2d748bd/coronal_001.png","assets/T/mri-4cb8cb63e2d748bd/coronal_003.png","assets/T/mri-4cb8cb63e2d748bd/coronal_005.png","assets/T/mri-4cb8cb63e2d748bd/coronal_007.png","assets/T/mri-4cb8cb63e2d748bd/coronal_009.png","assets/T/mri-4cb8cb63e2d748bd/coronal_011.png","assets/T/mri-4cb8cb63e2d748bd/coronal_014.png","assets/T/mri-4cb8cb63e2d748bd/coronal_016.png","assets/T/mri-4cb8cb63e2d748bd/coronal_018.png","assets/T/mri-4cb8cb63e2d748bd/coronal_020.png","assets/T/mri-4cb8cb63e2d748bd/coronal_022.png","assets/T/mri-4cb8cb63e2d748bd/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":68,"selected_count":33,"source_indices_1based":[1,3,5,7,10,12,14,16,18,20,23,25,27,29,31,33,35,38,40,42,44,45,47,49,51,53,55,58,60,62,64,66,68]}}
+{"id":"L3-T300:mri-b95098426a0148f8","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-b95098426a0148f8/axial_001.png","assets/T/mri-b95098426a0148f8/axial_003.png","assets/T/mri-b95098426a0148f8/axial_005.png","assets/T/mri-b95098426a0148f8/axial_007.png","assets/T/mri-b95098426a0148f8/axial_009.png","assets/T/mri-b95098426a0148f8/axial_011.png","assets/T/mri-b95098426a0148f8/axial_013.png","assets/T/mri-b95098426a0148f8/axial_015.png","assets/T/mri-b95098426a0148f8/axial_017.png","assets/T/mri-b95098426a0148f8/axial_019.png","assets/T/mri-b95098426a0148f8/axial_022.png","assets/T/mri-b95098426a0148f8/axial_024.png","assets/T/mri-b95098426a0148f8/axial_026.png","assets/T/mri-b95098426a0148f8/axial_028.png","assets/T/mri-b95098426a0148f8/axial_030.png","assets/T/mri-b95098426a0148f8/axial_032.png","assets/T/mri-b95098426a0148f8/axial_034.png","assets/T/mri-b95098426a0148f8/axial_036.png","assets/T/mri-b95098426a0148f8/axial_038.png","assets/T/mri-b95098426a0148f8/axial_040.png","assets/T/mri-b95098426a0148f8/axial_042.png","assets/T/mri-b95098426a0148f8/coronal_001.png","assets/T/mri-b95098426a0148f8/coronal_003.png","assets/T/mri-b95098426a0148f8/coronal_005.png","assets/T/mri-b95098426a0148f8/coronal_007.png","assets/T/mri-b95098426a0148f8/coronal_009.png","assets/T/mri-b95098426a0148f8/coronal_011.png","assets/T/mri-b95098426a0148f8/coronal_014.png","assets/T/mri-b95098426a0148f8/coronal_016.png","assets/T/mri-b95098426a0148f8/coronal_018.png","assets/T/mri-b95098426a0148f8/coronal_020.png","assets/T/mri-b95098426a0148f8/coronal_022.png","assets/T/mri-b95098426a0148f8/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-8cded41e93b4457b","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-8cded41e93b4457b/axial_001.png","assets/T/mri-8cded41e93b4457b/axial_003.png","assets/T/mri-8cded41e93b4457b/axial_005.png","assets/T/mri-8cded41e93b4457b/axial_007.png","assets/T/mri-8cded41e93b4457b/axial_009.png","assets/T/mri-8cded41e93b4457b/axial_011.png","assets/T/mri-8cded41e93b4457b/axial_013.png","assets/T/mri-8cded41e93b4457b/axial_015.png","assets/T/mri-8cded41e93b4457b/axial_017.png","assets/T/mri-8cded41e93b4457b/axial_019.png","assets/T/mri-8cded41e93b4457b/axial_022.png","assets/T/mri-8cded41e93b4457b/axial_024.png","assets/T/mri-8cded41e93b4457b/axial_026.png","assets/T/mri-8cded41e93b4457b/axial_028.png","assets/T/mri-8cded41e93b4457b/axial_030.png","assets/T/mri-8cded41e93b4457b/axial_032.png","assets/T/mri-8cded41e93b4457b/axial_034.png","assets/T/mri-8cded41e93b4457b/axial_036.png","assets/T/mri-8cded41e93b4457b/axial_038.png","assets/T/mri-8cded41e93b4457b/axial_040.png","assets/T/mri-8cded41e93b4457b/axial_042.png","assets/T/mri-8cded41e93b4457b/coronal_001.png","assets/T/mri-8cded41e93b4457b/coronal_003.png","assets/T/mri-8cded41e93b4457b/coronal_005.png","assets/T/mri-8cded41e93b4457b/coronal_007.png","assets/T/mri-8cded41e93b4457b/coronal_009.png","assets/T/mri-8cded41e93b4457b/coronal_011.png","assets/T/mri-8cded41e93b4457b/coronal_014.png","assets/T/mri-8cded41e93b4457b/coronal_016.png","assets/T/mri-8cded41e93b4457b/coronal_018.png","assets/T/mri-8cded41e93b4457b/coronal_020.png","assets/T/mri-8cded41e93b4457b/coronal_022.png","assets/T/mri-8cded41e93b4457b/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-25f828c643384082","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-25f828c643384082/axial_001.png","assets/T/mri-25f828c643384082/axial_003.png","assets/T/mri-25f828c643384082/axial_005.png","assets/T/mri-25f828c643384082/axial_007.png","assets/T/mri-25f828c643384082/axial_009.png","assets/T/mri-25f828c643384082/axial_011.png","assets/T/mri-25f828c643384082/axial_013.png","assets/T/mri-25f828c643384082/axial_015.png","assets/T/mri-25f828c643384082/axial_017.png","assets/T/mri-25f828c643384082/axial_019.png","assets/T/mri-25f828c643384082/axial_021.png","assets/T/mri-25f828c643384082/axial_022.png","assets/T/mri-25f828c643384082/axial_024.png","assets/T/mri-25f828c643384082/axial_026.png","assets/T/mri-25f828c643384082/axial_028.png","assets/T/mri-25f828c643384082/axial_030.png","assets/T/mri-25f828c643384082/axial_032.png","assets/T/mri-25f828c643384082/axial_034.png","assets/T/mri-25f828c643384082/axial_036.png","assets/T/mri-25f828c643384082/axial_038.png","assets/T/mri-25f828c643384082/axial_040.png","assets/T/mri-25f828c643384082/coronal_001.png","assets/T/mri-25f828c643384082/coronal_003.png","assets/T/mri-25f828c643384082/coronal_005.png","assets/T/mri-25f828c643384082/coronal_007.png","assets/T/mri-25f828c643384082/coronal_009.png","assets/T/mri-25f828c643384082/coronal_011.png","assets/T/mri-25f828c643384082/coronal_014.png","assets/T/mri-25f828c643384082/coronal_016.png","assets/T/mri-25f828c643384082/coronal_018.png","assets/T/mri-25f828c643384082/coronal_020.png","assets/T/mri-25f828c643384082/coronal_022.png","assets/T/mri-25f828c643384082/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-a4f422bdc4084984","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 13 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-a4f422bdc4084984/axial_001.png","assets/T/mri-a4f422bdc4084984/axial_003.png","assets/T/mri-a4f422bdc4084984/axial_005.png","assets/T/mri-a4f422bdc4084984/axial_007.png","assets/T/mri-a4f422bdc4084984/axial_010.png","assets/T/mri-a4f422bdc4084984/axial_012.png","assets/T/mri-a4f422bdc4084984/axial_014.png","assets/T/mri-a4f422bdc4084984/axial_016.png","assets/T/mri-a4f422bdc4084984/axial_018.png","assets/T/mri-a4f422bdc4084984/axial_020.png","assets/T/mri-a4f422bdc4084984/axial_023.png","assets/T/mri-a4f422bdc4084984/axial_025.png","assets/T/mri-a4f422bdc4084984/axial_027.png","assets/T/mri-a4f422bdc4084984/axial_029.png","assets/T/mri-a4f422bdc4084984/axial_031.png","assets/T/mri-a4f422bdc4084984/axial_033.png","assets/T/mri-a4f422bdc4084984/axial_036.png","assets/T/mri-a4f422bdc4084984/axial_038.png","assets/T/mri-a4f422bdc4084984/axial_040.png","assets/T/mri-a4f422bdc4084984/axial_042.png","assets/T/mri-a4f422bdc4084984/coronal_001.png","assets/T/mri-a4f422bdc4084984/coronal_003.png","assets/T/mri-a4f422bdc4084984/coronal_005.png","assets/T/mri-a4f422bdc4084984/coronal_007.png","assets/T/mri-a4f422bdc4084984/coronal_009.png","assets/T/mri-a4f422bdc4084984/coronal_011.png","assets/T/mri-a4f422bdc4084984/coronal_014.png","assets/T/mri-a4f422bdc4084984/coronal_016.png","assets/T/mri-a4f422bdc4084984/coronal_018.png","assets/T/mri-a4f422bdc4084984/coronal_020.png","assets/T/mri-a4f422bdc4084984/coronal_022.png","assets/T/mri-a4f422bdc4084984/coronal_024.png","assets/T/mri-a4f422bdc4084984/coronal_026.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":68,"selected_count":33,"source_indices_1based":[1,3,5,7,10,12,14,16,18,20,23,25,27,29,31,33,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66,68]}}
+{"id":"L3-T300:mri-6e692a723bbd4c7c","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-6e692a723bbd4c7c/axial_001.png","assets/T/mri-6e692a723bbd4c7c/axial_003.png","assets/T/mri-6e692a723bbd4c7c/axial_005.png","assets/T/mri-6e692a723bbd4c7c/axial_007.png","assets/T/mri-6e692a723bbd4c7c/axial_009.png","assets/T/mri-6e692a723bbd4c7c/axial_011.png","assets/T/mri-6e692a723bbd4c7c/axial_013.png","assets/T/mri-6e692a723bbd4c7c/axial_015.png","assets/T/mri-6e692a723bbd4c7c/axial_017.png","assets/T/mri-6e692a723bbd4c7c/axial_019.png","assets/T/mri-6e692a723bbd4c7c/axial_022.png","assets/T/mri-6e692a723bbd4c7c/axial_024.png","assets/T/mri-6e692a723bbd4c7c/axial_026.png","assets/T/mri-6e692a723bbd4c7c/axial_028.png","assets/T/mri-6e692a723bbd4c7c/axial_030.png","assets/T/mri-6e692a723bbd4c7c/axial_032.png","assets/T/mri-6e692a723bbd4c7c/axial_034.png","assets/T/mri-6e692a723bbd4c7c/axial_036.png","assets/T/mri-6e692a723bbd4c7c/axial_038.png","assets/T/mri-6e692a723bbd4c7c/axial_040.png","assets/T/mri-6e692a723bbd4c7c/axial_042.png","assets/T/mri-6e692a723bbd4c7c/coronal_001.png","assets/T/mri-6e692a723bbd4c7c/coronal_003.png","assets/T/mri-6e692a723bbd4c7c/coronal_005.png","assets/T/mri-6e692a723bbd4c7c/coronal_007.png","assets/T/mri-6e692a723bbd4c7c/coronal_009.png","assets/T/mri-6e692a723bbd4c7c/coronal_011.png","assets/T/mri-6e692a723bbd4c7c/coronal_014.png","assets/T/mri-6e692a723bbd4c7c/coronal_016.png","assets/T/mri-6e692a723bbd4c7c/coronal_018.png","assets/T/mri-6e692a723bbd4c7c/coronal_020.png","assets/T/mri-6e692a723bbd4c7c/coronal_022.png","assets/T/mri-6e692a723bbd4c7c/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-59fcd8564a7d4a06","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-59fcd8564a7d4a06/axial_001.png","assets/T/mri-59fcd8564a7d4a06/axial_003.png","assets/T/mri-59fcd8564a7d4a06/axial_005.png","assets/T/mri-59fcd8564a7d4a06/axial_007.png","assets/T/mri-59fcd8564a7d4a06/axial_010.png","assets/T/mri-59fcd8564a7d4a06/axial_012.png","assets/T/mri-59fcd8564a7d4a06/axial_014.png","assets/T/mri-59fcd8564a7d4a06/axial_016.png","assets/T/mri-59fcd8564a7d4a06/axial_018.png","assets/T/mri-59fcd8564a7d4a06/axial_020.png","assets/T/mri-59fcd8564a7d4a06/axial_023.png","assets/T/mri-59fcd8564a7d4a06/axial_025.png","assets/T/mri-59fcd8564a7d4a06/axial_027.png","assets/T/mri-59fcd8564a7d4a06/axial_029.png","assets/T/mri-59fcd8564a7d4a06/axial_031.png","assets/T/mri-59fcd8564a7d4a06/axial_033.png","assets/T/mri-59fcd8564a7d4a06/axial_035.png","assets/T/mri-59fcd8564a7d4a06/axial_038.png","assets/T/mri-59fcd8564a7d4a06/axial_040.png","assets/T/mri-59fcd8564a7d4a06/axial_042.png","assets/T/mri-59fcd8564a7d4a06/axial_044.png","assets/T/mri-59fcd8564a7d4a06/coronal_001.png","assets/T/mri-59fcd8564a7d4a06/coronal_003.png","assets/T/mri-59fcd8564a7d4a06/coronal_005.png","assets/T/mri-59fcd8564a7d4a06/coronal_007.png","assets/T/mri-59fcd8564a7d4a06/coronal_009.png","assets/T/mri-59fcd8564a7d4a06/coronal_011.png","assets/T/mri-59fcd8564a7d4a06/coronal_014.png","assets/T/mri-59fcd8564a7d4a06/coronal_016.png","assets/T/mri-59fcd8564a7d4a06/coronal_018.png","assets/T/mri-59fcd8564a7d4a06/coronal_020.png","assets/T/mri-59fcd8564a7d4a06/coronal_022.png","assets/T/mri-59fcd8564a7d4a06/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":68,"selected_count":33,"source_indices_1based":[1,3,5,7,10,12,14,16,18,20,23,25,27,29,31,33,35,38,40,42,44,45,47,49,51,53,55,58,60,62,64,66,68]}}
+{"id":"L3-T300:mri-0aa35f3168d04d3c","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-0aa35f3168d04d3c/axial_001.png","assets/T/mri-0aa35f3168d04d3c/axial_003.png","assets/T/mri-0aa35f3168d04d3c/axial_005.png","assets/T/mri-0aa35f3168d04d3c/axial_007.png","assets/T/mri-0aa35f3168d04d3c/axial_009.png","assets/T/mri-0aa35f3168d04d3c/axial_011.png","assets/T/mri-0aa35f3168d04d3c/axial_013.png","assets/T/mri-0aa35f3168d04d3c/axial_015.png","assets/T/mri-0aa35f3168d04d3c/axial_017.png","assets/T/mri-0aa35f3168d04d3c/axial_019.png","assets/T/mri-0aa35f3168d04d3c/axial_021.png","assets/T/mri-0aa35f3168d04d3c/axial_022.png","assets/T/mri-0aa35f3168d04d3c/axial_024.png","assets/T/mri-0aa35f3168d04d3c/axial_026.png","assets/T/mri-0aa35f3168d04d3c/axial_028.png","assets/T/mri-0aa35f3168d04d3c/axial_030.png","assets/T/mri-0aa35f3168d04d3c/axial_032.png","assets/T/mri-0aa35f3168d04d3c/axial_034.png","assets/T/mri-0aa35f3168d04d3c/axial_036.png","assets/T/mri-0aa35f3168d04d3c/axial_038.png","assets/T/mri-0aa35f3168d04d3c/axial_040.png","assets/T/mri-0aa35f3168d04d3c/coronal_001.png","assets/T/mri-0aa35f3168d04d3c/coronal_003.png","assets/T/mri-0aa35f3168d04d3c/coronal_005.png","assets/T/mri-0aa35f3168d04d3c/coronal_007.png","assets/T/mri-0aa35f3168d04d3c/coronal_009.png","assets/T/mri-0aa35f3168d04d3c/coronal_011.png","assets/T/mri-0aa35f3168d04d3c/coronal_014.png","assets/T/mri-0aa35f3168d04d3c/coronal_016.png","assets/T/mri-0aa35f3168d04d3c/coronal_018.png","assets/T/mri-0aa35f3168d04d3c/coronal_020.png","assets/T/mri-0aa35f3168d04d3c/coronal_022.png","assets/T/mri-0aa35f3168d04d3c/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-2bcd51a219d545cc","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-2bcd51a219d545cc/axial_001.png","assets/T/mri-2bcd51a219d545cc/axial_003.png","assets/T/mri-2bcd51a219d545cc/axial_005.png","assets/T/mri-2bcd51a219d545cc/axial_007.png","assets/T/mri-2bcd51a219d545cc/axial_009.png","assets/T/mri-2bcd51a219d545cc/axial_011.png","assets/T/mri-2bcd51a219d545cc/axial_013.png","assets/T/mri-2bcd51a219d545cc/axial_015.png","assets/T/mri-2bcd51a219d545cc/axial_017.png","assets/T/mri-2bcd51a219d545cc/axial_019.png","assets/T/mri-2bcd51a219d545cc/axial_022.png","assets/T/mri-2bcd51a219d545cc/axial_024.png","assets/T/mri-2bcd51a219d545cc/axial_026.png","assets/T/mri-2bcd51a219d545cc/axial_028.png","assets/T/mri-2bcd51a219d545cc/axial_030.png","assets/T/mri-2bcd51a219d545cc/axial_032.png","assets/T/mri-2bcd51a219d545cc/axial_034.png","assets/T/mri-2bcd51a219d545cc/axial_036.png","assets/T/mri-2bcd51a219d545cc/axial_038.png","assets/T/mri-2bcd51a219d545cc/axial_040.png","assets/T/mri-2bcd51a219d545cc/axial_042.png","assets/T/mri-2bcd51a219d545cc/coronal_001.png","assets/T/mri-2bcd51a219d545cc/coronal_003.png","assets/T/mri-2bcd51a219d545cc/coronal_005.png","assets/T/mri-2bcd51a219d545cc/coronal_007.png","assets/T/mri-2bcd51a219d545cc/coronal_009.png","assets/T/mri-2bcd51a219d545cc/coronal_011.png","assets/T/mri-2bcd51a219d545cc/coronal_014.png","assets/T/mri-2bcd51a219d545cc/coronal_016.png","assets/T/mri-2bcd51a219d545cc/coronal_018.png","assets/T/mri-2bcd51a219d545cc/coronal_020.png","assets/T/mri-2bcd51a219d545cc/coronal_022.png","assets/T/mri-2bcd51a219d545cc/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-c4fac316d4d04389","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-c4fac316d4d04389/axial_001.png","assets/T/mri-c4fac316d4d04389/axial_003.png","assets/T/mri-c4fac316d4d04389/axial_005.png","assets/T/mri-c4fac316d4d04389/axial_007.png","assets/T/mri-c4fac316d4d04389/axial_009.png","assets/T/mri-c4fac316d4d04389/axial_011.png","assets/T/mri-c4fac316d4d04389/axial_013.png","assets/T/mri-c4fac316d4d04389/axial_015.png","assets/T/mri-c4fac316d4d04389/axial_017.png","assets/T/mri-c4fac316d4d04389/axial_019.png","assets/T/mri-c4fac316d4d04389/axial_021.png","assets/T/mri-c4fac316d4d04389/axial_022.png","assets/T/mri-c4fac316d4d04389/axial_024.png","assets/T/mri-c4fac316d4d04389/axial_026.png","assets/T/mri-c4fac316d4d04389/axial_028.png","assets/T/mri-c4fac316d4d04389/axial_030.png","assets/T/mri-c4fac316d4d04389/axial_032.png","assets/T/mri-c4fac316d4d04389/axial_034.png","assets/T/mri-c4fac316d4d04389/axial_036.png","assets/T/mri-c4fac316d4d04389/axial_038.png","assets/T/mri-c4fac316d4d04389/axial_040.png","assets/T/mri-c4fac316d4d04389/coronal_001.png","assets/T/mri-c4fac316d4d04389/coronal_003.png","assets/T/mri-c4fac316d4d04389/coronal_005.png","assets/T/mri-c4fac316d4d04389/coronal_007.png","assets/T/mri-c4fac316d4d04389/coronal_009.png","assets/T/mri-c4fac316d4d04389/coronal_011.png","assets/T/mri-c4fac316d4d04389/coronal_014.png","assets/T/mri-c4fac316d4d04389/coronal_016.png","assets/T/mri-c4fac316d4d04389/coronal_018.png","assets/T/mri-c4fac316d4d04389/coronal_020.png","assets/T/mri-c4fac316d4d04389/coronal_022.png","assets/T/mri-c4fac316d4d04389/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-b6b87fa111a640ca","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 34 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 14 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-b6b87fa111a640ca/axial_001.png","assets/T/mri-b6b87fa111a640ca/axial_003.png","assets/T/mri-b6b87fa111a640ca/axial_005.png","assets/T/mri-b6b87fa111a640ca/axial_007.png","assets/T/mri-b6b87fa111a640ca/axial_008.png","assets/T/mri-b6b87fa111a640ca/axial_010.png","assets/T/mri-b6b87fa111a640ca/axial_012.png","assets/T/mri-b6b87fa111a640ca/axial_014.png","assets/T/mri-b6b87fa111a640ca/axial_016.png","assets/T/mri-b6b87fa111a640ca/axial_018.png","assets/T/mri-b6b87fa111a640ca/axial_019.png","assets/T/mri-b6b87fa111a640ca/axial_021.png","assets/T/mri-b6b87fa111a640ca/axial_023.png","assets/T/mri-b6b87fa111a640ca/axial_025.png","assets/T/mri-b6b87fa111a640ca/axial_027.png","assets/T/mri-b6b87fa111a640ca/axial_029.png","assets/T/mri-b6b87fa111a640ca/axial_030.png","assets/T/mri-b6b87fa111a640ca/axial_032.png","assets/T/mri-b6b87fa111a640ca/axial_034.png","assets/T/mri-b6b87fa111a640ca/axial_036.png","assets/T/mri-b6b87fa111a640ca/coronal_001.png","assets/T/mri-b6b87fa111a640ca/coronal_003.png","assets/T/mri-b6b87fa111a640ca/coronal_005.png","assets/T/mri-b6b87fa111a640ca/coronal_006.png","assets/T/mri-b6b87fa111a640ca/coronal_008.png","assets/T/mri-b6b87fa111a640ca/coronal_010.png","assets/T/mri-b6b87fa111a640ca/coronal_012.png","assets/T/mri-b6b87fa111a640ca/coronal_013.png","assets/T/mri-b6b87fa111a640ca/coronal_015.png","assets/T/mri-b6b87fa111a640ca/coronal_017.png","assets/T/mri-b6b87fa111a640ca/coronal_019.png","assets/T/mri-b6b87fa111a640ca/coronal_020.png","assets/T/mri-b6b87fa111a640ca/coronal_022.png","assets/T/mri-b6b87fa111a640ca/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":60,"selected_count":34,"source_indices_1based":[1,3,5,7,8,10,12,14,16,18,19,21,23,25,27,29,30,32,34,36,37,39,41,42,44,46,48,49,51,53,55,56,58,60]}}
+{"id":"L3-T300:mri-8e0bb3a4b8ba4d5d","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 13 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-8e0bb3a4b8ba4d5d/axial_001.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_003.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_005.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_007.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_009.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_011.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_013.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_015.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_017.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_019.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_022.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_024.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_026.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_028.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_030.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_032.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_034.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_036.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_038.png","assets/T/mri-8e0bb3a4b8ba4d5d/axial_040.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_001.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_003.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_005.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_007.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_009.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_011.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_014.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_016.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_018.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_020.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_022.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_024.png","assets/T/mri-8e0bb3a4b8ba4d5d/coronal_026.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-011d16dc8caa467f","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-011d16dc8caa467f/axial_001.png","assets/T/mri-011d16dc8caa467f/axial_003.png","assets/T/mri-011d16dc8caa467f/axial_005.png","assets/T/mri-011d16dc8caa467f/axial_007.png","assets/T/mri-011d16dc8caa467f/axial_009.png","assets/T/mri-011d16dc8caa467f/axial_011.png","assets/T/mri-011d16dc8caa467f/axial_013.png","assets/T/mri-011d16dc8caa467f/axial_015.png","assets/T/mri-011d16dc8caa467f/axial_017.png","assets/T/mri-011d16dc8caa467f/axial_019.png","assets/T/mri-011d16dc8caa467f/axial_022.png","assets/T/mri-011d16dc8caa467f/axial_024.png","assets/T/mri-011d16dc8caa467f/axial_026.png","assets/T/mri-011d16dc8caa467f/axial_028.png","assets/T/mri-011d16dc8caa467f/axial_030.png","assets/T/mri-011d16dc8caa467f/axial_032.png","assets/T/mri-011d16dc8caa467f/axial_034.png","assets/T/mri-011d16dc8caa467f/axial_036.png","assets/T/mri-011d16dc8caa467f/axial_038.png","assets/T/mri-011d16dc8caa467f/axial_040.png","assets/T/mri-011d16dc8caa467f/axial_042.png","assets/T/mri-011d16dc8caa467f/coronal_001.png","assets/T/mri-011d16dc8caa467f/coronal_003.png","assets/T/mri-011d16dc8caa467f/coronal_005.png","assets/T/mri-011d16dc8caa467f/coronal_007.png","assets/T/mri-011d16dc8caa467f/coronal_009.png","assets/T/mri-011d16dc8caa467f/coronal_011.png","assets/T/mri-011d16dc8caa467f/coronal_014.png","assets/T/mri-011d16dc8caa467f/coronal_016.png","assets/T/mri-011d16dc8caa467f/coronal_018.png","assets/T/mri-011d16dc8caa467f/coronal_020.png","assets/T/mri-011d16dc8caa467f/coronal_022.png","assets/T/mri-011d16dc8caa467f/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-610603bf61ce46e3","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-610603bf61ce46e3/axial_001.png","assets/T/mri-610603bf61ce46e3/axial_003.png","assets/T/mri-610603bf61ce46e3/axial_005.png","assets/T/mri-610603bf61ce46e3/axial_007.png","assets/T/mri-610603bf61ce46e3/axial_009.png","assets/T/mri-610603bf61ce46e3/axial_011.png","assets/T/mri-610603bf61ce46e3/axial_013.png","assets/T/mri-610603bf61ce46e3/axial_015.png","assets/T/mri-610603bf61ce46e3/axial_017.png","assets/T/mri-610603bf61ce46e3/axial_019.png","assets/T/mri-610603bf61ce46e3/axial_021.png","assets/T/mri-610603bf61ce46e3/axial_022.png","assets/T/mri-610603bf61ce46e3/axial_024.png","assets/T/mri-610603bf61ce46e3/axial_026.png","assets/T/mri-610603bf61ce46e3/axial_028.png","assets/T/mri-610603bf61ce46e3/axial_030.png","assets/T/mri-610603bf61ce46e3/axial_032.png","assets/T/mri-610603bf61ce46e3/axial_034.png","assets/T/mri-610603bf61ce46e3/axial_036.png","assets/T/mri-610603bf61ce46e3/axial_038.png","assets/T/mri-610603bf61ce46e3/axial_040.png","assets/T/mri-610603bf61ce46e3/coronal_001.png","assets/T/mri-610603bf61ce46e3/coronal_003.png","assets/T/mri-610603bf61ce46e3/coronal_005.png","assets/T/mri-610603bf61ce46e3/coronal_007.png","assets/T/mri-610603bf61ce46e3/coronal_009.png","assets/T/mri-610603bf61ce46e3/coronal_011.png","assets/T/mri-610603bf61ce46e3/coronal_014.png","assets/T/mri-610603bf61ce46e3/coronal_016.png","assets/T/mri-610603bf61ce46e3/coronal_018.png","assets/T/mri-610603bf61ce46e3/coronal_020.png","assets/T/mri-610603bf61ce46e3/coronal_022.png","assets/T/mri-610603bf61ce46e3/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-217e2ff416f54d21","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-217e2ff416f54d21/axial_001.png","assets/T/mri-217e2ff416f54d21/axial_003.png","assets/T/mri-217e2ff416f54d21/axial_005.png","assets/T/mri-217e2ff416f54d21/axial_007.png","assets/T/mri-217e2ff416f54d21/axial_009.png","assets/T/mri-217e2ff416f54d21/axial_011.png","assets/T/mri-217e2ff416f54d21/axial_013.png","assets/T/mri-217e2ff416f54d21/axial_015.png","assets/T/mri-217e2ff416f54d21/axial_017.png","assets/T/mri-217e2ff416f54d21/axial_019.png","assets/T/mri-217e2ff416f54d21/axial_021.png","assets/T/mri-217e2ff416f54d21/axial_022.png","assets/T/mri-217e2ff416f54d21/axial_024.png","assets/T/mri-217e2ff416f54d21/axial_026.png","assets/T/mri-217e2ff416f54d21/axial_028.png","assets/T/mri-217e2ff416f54d21/axial_030.png","assets/T/mri-217e2ff416f54d21/axial_032.png","assets/T/mri-217e2ff416f54d21/axial_034.png","assets/T/mri-217e2ff416f54d21/axial_036.png","assets/T/mri-217e2ff416f54d21/axial_038.png","assets/T/mri-217e2ff416f54d21/axial_040.png","assets/T/mri-217e2ff416f54d21/coronal_001.png","assets/T/mri-217e2ff416f54d21/coronal_003.png","assets/T/mri-217e2ff416f54d21/coronal_005.png","assets/T/mri-217e2ff416f54d21/coronal_007.png","assets/T/mri-217e2ff416f54d21/coronal_009.png","assets/T/mri-217e2ff416f54d21/coronal_011.png","assets/T/mri-217e2ff416f54d21/coronal_014.png","assets/T/mri-217e2ff416f54d21/coronal_016.png","assets/T/mri-217e2ff416f54d21/coronal_018.png","assets/T/mri-217e2ff416f54d21/coronal_020.png","assets/T/mri-217e2ff416f54d21/coronal_022.png","assets/T/mri-217e2ff416f54d21/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-22348de6a516489b","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-22348de6a516489b/axial_001.png","assets/T/mri-22348de6a516489b/axial_003.png","assets/T/mri-22348de6a516489b/axial_005.png","assets/T/mri-22348de6a516489b/axial_007.png","assets/T/mri-22348de6a516489b/axial_009.png","assets/T/mri-22348de6a516489b/axial_011.png","assets/T/mri-22348de6a516489b/axial_013.png","assets/T/mri-22348de6a516489b/axial_015.png","assets/T/mri-22348de6a516489b/axial_017.png","assets/T/mri-22348de6a516489b/axial_019.png","assets/T/mri-22348de6a516489b/axial_021.png","assets/T/mri-22348de6a516489b/axial_022.png","assets/T/mri-22348de6a516489b/axial_024.png","assets/T/mri-22348de6a516489b/axial_026.png","assets/T/mri-22348de6a516489b/axial_028.png","assets/T/mri-22348de6a516489b/axial_030.png","assets/T/mri-22348de6a516489b/axial_032.png","assets/T/mri-22348de6a516489b/axial_034.png","assets/T/mri-22348de6a516489b/axial_036.png","assets/T/mri-22348de6a516489b/axial_038.png","assets/T/mri-22348de6a516489b/axial_040.png","assets/T/mri-22348de6a516489b/coronal_001.png","assets/T/mri-22348de6a516489b/coronal_003.png","assets/T/mri-22348de6a516489b/coronal_005.png","assets/T/mri-22348de6a516489b/coronal_007.png","assets/T/mri-22348de6a516489b/coronal_009.png","assets/T/mri-22348de6a516489b/coronal_011.png","assets/T/mri-22348de6a516489b/coronal_014.png","assets/T/mri-22348de6a516489b/coronal_016.png","assets/T/mri-22348de6a516489b/coronal_018.png","assets/T/mri-22348de6a516489b/coronal_020.png","assets/T/mri-22348de6a516489b/coronal_022.png","assets/T/mri-22348de6a516489b/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-3eb8d731a99e4f47","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-3eb8d731a99e4f47/axial_001.png","assets/T/mri-3eb8d731a99e4f47/axial_003.png","assets/T/mri-3eb8d731a99e4f47/axial_005.png","assets/T/mri-3eb8d731a99e4f47/axial_007.png","assets/T/mri-3eb8d731a99e4f47/axial_009.png","assets/T/mri-3eb8d731a99e4f47/axial_011.png","assets/T/mri-3eb8d731a99e4f47/axial_013.png","assets/T/mri-3eb8d731a99e4f47/axial_015.png","assets/T/mri-3eb8d731a99e4f47/axial_017.png","assets/T/mri-3eb8d731a99e4f47/axial_019.png","assets/T/mri-3eb8d731a99e4f47/axial_021.png","assets/T/mri-3eb8d731a99e4f47/axial_022.png","assets/T/mri-3eb8d731a99e4f47/axial_024.png","assets/T/mri-3eb8d731a99e4f47/axial_026.png","assets/T/mri-3eb8d731a99e4f47/axial_028.png","assets/T/mri-3eb8d731a99e4f47/axial_030.png","assets/T/mri-3eb8d731a99e4f47/axial_032.png","assets/T/mri-3eb8d731a99e4f47/axial_034.png","assets/T/mri-3eb8d731a99e4f47/axial_036.png","assets/T/mri-3eb8d731a99e4f47/axial_038.png","assets/T/mri-3eb8d731a99e4f47/axial_040.png","assets/T/mri-3eb8d731a99e4f47/coronal_001.png","assets/T/mri-3eb8d731a99e4f47/coronal_003.png","assets/T/mri-3eb8d731a99e4f47/coronal_005.png","assets/T/mri-3eb8d731a99e4f47/coronal_007.png","assets/T/mri-3eb8d731a99e4f47/coronal_009.png","assets/T/mri-3eb8d731a99e4f47/coronal_011.png","assets/T/mri-3eb8d731a99e4f47/coronal_014.png","assets/T/mri-3eb8d731a99e4f47/coronal_016.png","assets/T/mri-3eb8d731a99e4f47/coronal_018.png","assets/T/mri-3eb8d731a99e4f47/coronal_020.png","assets/T/mri-3eb8d731a99e4f47/coronal_022.png","assets/T/mri-3eb8d731a99e4f47/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-f84a1e34850340b0","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 34 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 14 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-f84a1e34850340b0/axial_001.png","assets/T/mri-f84a1e34850340b0/axial_003.png","assets/T/mri-f84a1e34850340b0/axial_005.png","assets/T/mri-f84a1e34850340b0/axial_007.png","assets/T/mri-f84a1e34850340b0/axial_010.png","assets/T/mri-f84a1e34850340b0/axial_012.png","assets/T/mri-f84a1e34850340b0/axial_014.png","assets/T/mri-f84a1e34850340b0/axial_016.png","assets/T/mri-f84a1e34850340b0/axial_018.png","assets/T/mri-f84a1e34850340b0/axial_020.png","assets/T/mri-f84a1e34850340b0/axial_023.png","assets/T/mri-f84a1e34850340b0/axial_025.png","assets/T/mri-f84a1e34850340b0/axial_027.png","assets/T/mri-f84a1e34850340b0/axial_029.png","assets/T/mri-f84a1e34850340b0/axial_031.png","assets/T/mri-f84a1e34850340b0/axial_033.png","assets/T/mri-f84a1e34850340b0/axial_036.png","assets/T/mri-f84a1e34850340b0/axial_038.png","assets/T/mri-f84a1e34850340b0/axial_040.png","assets/T/mri-f84a1e34850340b0/axial_042.png","assets/T/mri-f84a1e34850340b0/coronal_001.png","assets/T/mri-f84a1e34850340b0/coronal_003.png","assets/T/mri-f84a1e34850340b0/coronal_005.png","assets/T/mri-f84a1e34850340b0/coronal_007.png","assets/T/mri-f84a1e34850340b0/coronal_009.png","assets/T/mri-f84a1e34850340b0/coronal_011.png","assets/T/mri-f84a1e34850340b0/coronal_013.png","assets/T/mri-f84a1e34850340b0/coronal_016.png","assets/T/mri-f84a1e34850340b0/coronal_018.png","assets/T/mri-f84a1e34850340b0/coronal_020.png","assets/T/mri-f84a1e34850340b0/coronal_022.png","assets/T/mri-f84a1e34850340b0/coronal_024.png","assets/T/mri-f84a1e34850340b0/coronal_026.png","assets/T/mri-f84a1e34850340b0/coronal_028.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":70,"selected_count":34,"source_indices_1based":[1,3,5,7,10,12,14,16,18,20,23,25,27,29,31,33,36,38,40,42,43,45,47,49,51,53,55,58,60,62,64,66,68,70]}}
+{"id":"L3-T300:mri-65339b3e03744861","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-65339b3e03744861/axial_001.png","assets/T/mri-65339b3e03744861/axial_003.png","assets/T/mri-65339b3e03744861/axial_005.png","assets/T/mri-65339b3e03744861/axial_007.png","assets/T/mri-65339b3e03744861/axial_009.png","assets/T/mri-65339b3e03744861/axial_011.png","assets/T/mri-65339b3e03744861/axial_013.png","assets/T/mri-65339b3e03744861/axial_015.png","assets/T/mri-65339b3e03744861/axial_017.png","assets/T/mri-65339b3e03744861/axial_019.png","assets/T/mri-65339b3e03744861/axial_022.png","assets/T/mri-65339b3e03744861/axial_024.png","assets/T/mri-65339b3e03744861/axial_026.png","assets/T/mri-65339b3e03744861/axial_028.png","assets/T/mri-65339b3e03744861/axial_030.png","assets/T/mri-65339b3e03744861/axial_032.png","assets/T/mri-65339b3e03744861/axial_034.png","assets/T/mri-65339b3e03744861/axial_036.png","assets/T/mri-65339b3e03744861/axial_038.png","assets/T/mri-65339b3e03744861/axial_040.png","assets/T/mri-65339b3e03744861/axial_042.png","assets/T/mri-65339b3e03744861/coronal_001.png","assets/T/mri-65339b3e03744861/coronal_003.png","assets/T/mri-65339b3e03744861/coronal_005.png","assets/T/mri-65339b3e03744861/coronal_007.png","assets/T/mri-65339b3e03744861/coronal_009.png","assets/T/mri-65339b3e03744861/coronal_011.png","assets/T/mri-65339b3e03744861/coronal_014.png","assets/T/mri-65339b3e03744861/coronal_016.png","assets/T/mri-65339b3e03744861/coronal_018.png","assets/T/mri-65339b3e03744861/coronal_020.png","assets/T/mri-65339b3e03744861/coronal_022.png","assets/T/mri-65339b3e03744861/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-b1b1cc7813aa4e54","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 34 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 14 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-b1b1cc7813aa4e54/axial_001.png","assets/T/mri-b1b1cc7813aa4e54/axial_003.png","assets/T/mri-b1b1cc7813aa4e54/axial_005.png","assets/T/mri-b1b1cc7813aa4e54/axial_007.png","assets/T/mri-b1b1cc7813aa4e54/axial_008.png","assets/T/mri-b1b1cc7813aa4e54/axial_010.png","assets/T/mri-b1b1cc7813aa4e54/axial_012.png","assets/T/mri-b1b1cc7813aa4e54/axial_014.png","assets/T/mri-b1b1cc7813aa4e54/axial_016.png","assets/T/mri-b1b1cc7813aa4e54/axial_018.png","assets/T/mri-b1b1cc7813aa4e54/axial_019.png","assets/T/mri-b1b1cc7813aa4e54/axial_021.png","assets/T/mri-b1b1cc7813aa4e54/axial_023.png","assets/T/mri-b1b1cc7813aa4e54/axial_025.png","assets/T/mri-b1b1cc7813aa4e54/axial_027.png","assets/T/mri-b1b1cc7813aa4e54/axial_029.png","assets/T/mri-b1b1cc7813aa4e54/axial_030.png","assets/T/mri-b1b1cc7813aa4e54/axial_032.png","assets/T/mri-b1b1cc7813aa4e54/axial_034.png","assets/T/mri-b1b1cc7813aa4e54/axial_036.png","assets/T/mri-b1b1cc7813aa4e54/coronal_001.png","assets/T/mri-b1b1cc7813aa4e54/coronal_003.png","assets/T/mri-b1b1cc7813aa4e54/coronal_005.png","assets/T/mri-b1b1cc7813aa4e54/coronal_006.png","assets/T/mri-b1b1cc7813aa4e54/coronal_008.png","assets/T/mri-b1b1cc7813aa4e54/coronal_010.png","assets/T/mri-b1b1cc7813aa4e54/coronal_012.png","assets/T/mri-b1b1cc7813aa4e54/coronal_013.png","assets/T/mri-b1b1cc7813aa4e54/coronal_015.png","assets/T/mri-b1b1cc7813aa4e54/coronal_017.png","assets/T/mri-b1b1cc7813aa4e54/coronal_019.png","assets/T/mri-b1b1cc7813aa4e54/coronal_020.png","assets/T/mri-b1b1cc7813aa4e54/coronal_022.png","assets/T/mri-b1b1cc7813aa4e54/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":60,"selected_count":34,"source_indices_1based":[1,3,5,7,8,10,12,14,16,18,19,21,23,25,27,29,30,32,34,36,37,39,41,42,44,46,48,49,51,53,55,56,58,60]}}
+{"id":"L3-T300:mri-78c66b5d279f4442","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 13 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-78c66b5d279f4442/axial_001.png","assets/T/mri-78c66b5d279f4442/axial_003.png","assets/T/mri-78c66b5d279f4442/axial_005.png","assets/T/mri-78c66b5d279f4442/axial_007.png","assets/T/mri-78c66b5d279f4442/axial_010.png","assets/T/mri-78c66b5d279f4442/axial_012.png","assets/T/mri-78c66b5d279f4442/axial_014.png","assets/T/mri-78c66b5d279f4442/axial_016.png","assets/T/mri-78c66b5d279f4442/axial_018.png","assets/T/mri-78c66b5d279f4442/axial_020.png","assets/T/mri-78c66b5d279f4442/axial_023.png","assets/T/mri-78c66b5d279f4442/axial_025.png","assets/T/mri-78c66b5d279f4442/axial_027.png","assets/T/mri-78c66b5d279f4442/axial_029.png","assets/T/mri-78c66b5d279f4442/axial_031.png","assets/T/mri-78c66b5d279f4442/axial_033.png","assets/T/mri-78c66b5d279f4442/axial_036.png","assets/T/mri-78c66b5d279f4442/axial_038.png","assets/T/mri-78c66b5d279f4442/axial_040.png","assets/T/mri-78c66b5d279f4442/axial_042.png","assets/T/mri-78c66b5d279f4442/coronal_001.png","assets/T/mri-78c66b5d279f4442/coronal_003.png","assets/T/mri-78c66b5d279f4442/coronal_005.png","assets/T/mri-78c66b5d279f4442/coronal_007.png","assets/T/mri-78c66b5d279f4442/coronal_009.png","assets/T/mri-78c66b5d279f4442/coronal_011.png","assets/T/mri-78c66b5d279f4442/coronal_014.png","assets/T/mri-78c66b5d279f4442/coronal_016.png","assets/T/mri-78c66b5d279f4442/coronal_018.png","assets/T/mri-78c66b5d279f4442/coronal_020.png","assets/T/mri-78c66b5d279f4442/coronal_022.png","assets/T/mri-78c66b5d279f4442/coronal_024.png","assets/T/mri-78c66b5d279f4442/coronal_026.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":68,"selected_count":33,"source_indices_1based":[1,3,5,7,10,12,14,16,18,20,23,25,27,29,31,33,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66,68]}}
+{"id":"L3-T300:mri-6727868cac9449ce","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 34 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 14 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-6727868cac9449ce/axial_001.png","assets/T/mri-6727868cac9449ce/axial_003.png","assets/T/mri-6727868cac9449ce/axial_005.png","assets/T/mri-6727868cac9449ce/axial_007.png","assets/T/mri-6727868cac9449ce/axial_009.png","assets/T/mri-6727868cac9449ce/axial_011.png","assets/T/mri-6727868cac9449ce/axial_013.png","assets/T/mri-6727868cac9449ce/axial_015.png","assets/T/mri-6727868cac9449ce/axial_017.png","assets/T/mri-6727868cac9449ce/axial_019.png","assets/T/mri-6727868cac9449ce/axial_022.png","assets/T/mri-6727868cac9449ce/axial_024.png","assets/T/mri-6727868cac9449ce/axial_026.png","assets/T/mri-6727868cac9449ce/axial_028.png","assets/T/mri-6727868cac9449ce/axial_030.png","assets/T/mri-6727868cac9449ce/axial_032.png","assets/T/mri-6727868cac9449ce/axial_034.png","assets/T/mri-6727868cac9449ce/axial_036.png","assets/T/mri-6727868cac9449ce/axial_038.png","assets/T/mri-6727868cac9449ce/axial_040.png","assets/T/mri-6727868cac9449ce/coronal_001.png","assets/T/mri-6727868cac9449ce/coronal_003.png","assets/T/mri-6727868cac9449ce/coronal_005.png","assets/T/mri-6727868cac9449ce/coronal_007.png","assets/T/mri-6727868cac9449ce/coronal_009.png","assets/T/mri-6727868cac9449ce/coronal_011.png","assets/T/mri-6727868cac9449ce/coronal_013.png","assets/T/mri-6727868cac9449ce/coronal_016.png","assets/T/mri-6727868cac9449ce/coronal_018.png","assets/T/mri-6727868cac9449ce/coronal_020.png","assets/T/mri-6727868cac9449ce/coronal_022.png","assets/T/mri-6727868cac9449ce/coronal_024.png","assets/T/mri-6727868cac9449ce/coronal_026.png","assets/T/mri-6727868cac9449ce/coronal_028.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":68,"selected_count":34,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,53,56,58,60,62,64,66,68]}}
+{"id":"L3-T300:mri-4ba3b56eb4514153","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 22 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 11 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-4ba3b56eb4514153/axial_001.png","assets/T/mri-4ba3b56eb4514153/axial_003.png","assets/T/mri-4ba3b56eb4514153/axial_005.png","assets/T/mri-4ba3b56eb4514153/axial_007.png","assets/T/mri-4ba3b56eb4514153/axial_009.png","assets/T/mri-4ba3b56eb4514153/axial_011.png","assets/T/mri-4ba3b56eb4514153/axial_014.png","assets/T/mri-4ba3b56eb4514153/axial_016.png","assets/T/mri-4ba3b56eb4514153/axial_018.png","assets/T/mri-4ba3b56eb4514153/axial_020.png","assets/T/mri-4ba3b56eb4514153/axial_022.png","assets/T/mri-4ba3b56eb4514153/axial_024.png","assets/T/mri-4ba3b56eb4514153/axial_026.png","assets/T/mri-4ba3b56eb4514153/axial_028.png","assets/T/mri-4ba3b56eb4514153/axial_030.png","assets/T/mri-4ba3b56eb4514153/axial_032.png","assets/T/mri-4ba3b56eb4514153/axial_035.png","assets/T/mri-4ba3b56eb4514153/axial_037.png","assets/T/mri-4ba3b56eb4514153/axial_039.png","assets/T/mri-4ba3b56eb4514153/axial_041.png","assets/T/mri-4ba3b56eb4514153/axial_043.png","assets/T/mri-4ba3b56eb4514153/axial_045.png","assets/T/mri-4ba3b56eb4514153/coronal_001.png","assets/T/mri-4ba3b56eb4514153/coronal_003.png","assets/T/mri-4ba3b56eb4514153/coronal_006.png","assets/T/mri-4ba3b56eb4514153/coronal_008.png","assets/T/mri-4ba3b56eb4514153/coronal_010.png","assets/T/mri-4ba3b56eb4514153/coronal_013.png","assets/T/mri-4ba3b56eb4514153/coronal_015.png","assets/T/mri-4ba3b56eb4514153/coronal_017.png","assets/T/mri-4ba3b56eb4514153/coronal_019.png","assets/T/mri-4ba3b56eb4514153/coronal_022.png","assets/T/mri-4ba3b56eb4514153/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":69,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,14,16,18,20,22,24,26,28,30,32,35,37,39,41,43,45,46,48,51,53,55,58,60,62,64,67,69]}}
+{"id":"L3-T300:mri-f29135603c0e4f4a","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-f29135603c0e4f4a/axial_001.png","assets/T/mri-f29135603c0e4f4a/axial_003.png","assets/T/mri-f29135603c0e4f4a/axial_005.png","assets/T/mri-f29135603c0e4f4a/axial_007.png","assets/T/mri-f29135603c0e4f4a/axial_009.png","assets/T/mri-f29135603c0e4f4a/axial_012.png","assets/T/mri-f29135603c0e4f4a/axial_014.png","assets/T/mri-f29135603c0e4f4a/axial_016.png","assets/T/mri-f29135603c0e4f4a/axial_018.png","assets/T/mri-f29135603c0e4f4a/axial_020.png","assets/T/mri-f29135603c0e4f4a/axial_022.png","assets/T/mri-f29135603c0e4f4a/axial_024.png","assets/T/mri-f29135603c0e4f4a/axial_026.png","assets/T/mri-f29135603c0e4f4a/axial_028.png","assets/T/mri-f29135603c0e4f4a/axial_030.png","assets/T/mri-f29135603c0e4f4a/axial_033.png","assets/T/mri-f29135603c0e4f4a/axial_035.png","assets/T/mri-f29135603c0e4f4a/axial_037.png","assets/T/mri-f29135603c0e4f4a/axial_039.png","assets/T/mri-f29135603c0e4f4a/axial_041.png","assets/T/mri-f29135603c0e4f4a/axial_043.png","assets/T/mri-f29135603c0e4f4a/coronal_001.png","assets/T/mri-f29135603c0e4f4a/coronal_003.png","assets/T/mri-f29135603c0e4f4a/coronal_005.png","assets/T/mri-f29135603c0e4f4a/coronal_007.png","assets/T/mri-f29135603c0e4f4a/coronal_009.png","assets/T/mri-f29135603c0e4f4a/coronal_011.png","assets/T/mri-f29135603c0e4f4a/coronal_014.png","assets/T/mri-f29135603c0e4f4a/coronal_016.png","assets/T/mri-f29135603c0e4f4a/coronal_018.png","assets/T/mri-f29135603c0e4f4a/coronal_020.png","assets/T/mri-f29135603c0e4f4a/coronal_022.png","assets/T/mri-f29135603c0e4f4a/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":67,"selected_count":33,"source_indices_1based":[1,3,5,7,9,12,14,16,18,20,22,24,26,28,30,33,35,37,39,41,43,44,46,48,50,52,54,57,59,61,63,65,67]}}
+{"id":"L3-T300:mri-a201d3a61de2439a","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 34 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 14 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-a201d3a61de2439a/axial_001.png","assets/T/mri-a201d3a61de2439a/axial_003.png","assets/T/mri-a201d3a61de2439a/axial_005.png","assets/T/mri-a201d3a61de2439a/axial_007.png","assets/T/mri-a201d3a61de2439a/axial_010.png","assets/T/mri-a201d3a61de2439a/axial_012.png","assets/T/mri-a201d3a61de2439a/axial_014.png","assets/T/mri-a201d3a61de2439a/axial_016.png","assets/T/mri-a201d3a61de2439a/axial_018.png","assets/T/mri-a201d3a61de2439a/axial_020.png","assets/T/mri-a201d3a61de2439a/axial_023.png","assets/T/mri-a201d3a61de2439a/axial_025.png","assets/T/mri-a201d3a61de2439a/axial_027.png","assets/T/mri-a201d3a61de2439a/axial_029.png","assets/T/mri-a201d3a61de2439a/axial_031.png","assets/T/mri-a201d3a61de2439a/axial_033.png","assets/T/mri-a201d3a61de2439a/axial_036.png","assets/T/mri-a201d3a61de2439a/axial_038.png","assets/T/mri-a201d3a61de2439a/axial_040.png","assets/T/mri-a201d3a61de2439a/axial_042.png","assets/T/mri-a201d3a61de2439a/coronal_001.png","assets/T/mri-a201d3a61de2439a/coronal_003.png","assets/T/mri-a201d3a61de2439a/coronal_005.png","assets/T/mri-a201d3a61de2439a/coronal_007.png","assets/T/mri-a201d3a61de2439a/coronal_009.png","assets/T/mri-a201d3a61de2439a/coronal_011.png","assets/T/mri-a201d3a61de2439a/coronal_013.png","assets/T/mri-a201d3a61de2439a/coronal_016.png","assets/T/mri-a201d3a61de2439a/coronal_018.png","assets/T/mri-a201d3a61de2439a/coronal_020.png","assets/T/mri-a201d3a61de2439a/coronal_022.png","assets/T/mri-a201d3a61de2439a/coronal_024.png","assets/T/mri-a201d3a61de2439a/coronal_026.png","assets/T/mri-a201d3a61de2439a/coronal_028.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":70,"selected_count":34,"source_indices_1based":[1,3,5,7,10,12,14,16,18,20,23,25,27,29,31,33,36,38,40,42,43,45,47,49,51,53,55,58,60,62,64,66,68,70]}}
+{"id":"L3-T300:mri-da21bfabb3a34410","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 34 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 14 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-da21bfabb3a34410/axial_001.png","assets/T/mri-da21bfabb3a34410/axial_003.png","assets/T/mri-da21bfabb3a34410/axial_005.png","assets/T/mri-da21bfabb3a34410/axial_007.png","assets/T/mri-da21bfabb3a34410/axial_008.png","assets/T/mri-da21bfabb3a34410/axial_010.png","assets/T/mri-da21bfabb3a34410/axial_012.png","assets/T/mri-da21bfabb3a34410/axial_014.png","assets/T/mri-da21bfabb3a34410/axial_016.png","assets/T/mri-da21bfabb3a34410/axial_018.png","assets/T/mri-da21bfabb3a34410/axial_019.png","assets/T/mri-da21bfabb3a34410/axial_021.png","assets/T/mri-da21bfabb3a34410/axial_023.png","assets/T/mri-da21bfabb3a34410/axial_025.png","assets/T/mri-da21bfabb3a34410/axial_027.png","assets/T/mri-da21bfabb3a34410/axial_029.png","assets/T/mri-da21bfabb3a34410/axial_030.png","assets/T/mri-da21bfabb3a34410/axial_032.png","assets/T/mri-da21bfabb3a34410/axial_034.png","assets/T/mri-da21bfabb3a34410/axial_036.png","assets/T/mri-da21bfabb3a34410/coronal_001.png","assets/T/mri-da21bfabb3a34410/coronal_003.png","assets/T/mri-da21bfabb3a34410/coronal_005.png","assets/T/mri-da21bfabb3a34410/coronal_006.png","assets/T/mri-da21bfabb3a34410/coronal_008.png","assets/T/mri-da21bfabb3a34410/coronal_010.png","assets/T/mri-da21bfabb3a34410/coronal_012.png","assets/T/mri-da21bfabb3a34410/coronal_013.png","assets/T/mri-da21bfabb3a34410/coronal_015.png","assets/T/mri-da21bfabb3a34410/coronal_017.png","assets/T/mri-da21bfabb3a34410/coronal_019.png","assets/T/mri-da21bfabb3a34410/coronal_020.png","assets/T/mri-da21bfabb3a34410/coronal_022.png","assets/T/mri-da21bfabb3a34410/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":60,"selected_count":34,"source_indices_1based":[1,3,5,7,8,10,12,14,16,18,19,21,23,25,27,29,30,32,34,36,37,39,41,42,44,46,48,49,51,53,55,56,58,60]}}
+{"id":"L3-T300:mri-c148e76e611e4ad8","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 34 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 14 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-c148e76e611e4ad8/axial_001.png","assets/T/mri-c148e76e611e4ad8/axial_003.png","assets/T/mri-c148e76e611e4ad8/axial_005.png","assets/T/mri-c148e76e611e4ad8/axial_007.png","assets/T/mri-c148e76e611e4ad8/axial_010.png","assets/T/mri-c148e76e611e4ad8/axial_012.png","assets/T/mri-c148e76e611e4ad8/axial_014.png","assets/T/mri-c148e76e611e4ad8/axial_016.png","assets/T/mri-c148e76e611e4ad8/axial_018.png","assets/T/mri-c148e76e611e4ad8/axial_020.png","assets/T/mri-c148e76e611e4ad8/axial_023.png","assets/T/mri-c148e76e611e4ad8/axial_025.png","assets/T/mri-c148e76e611e4ad8/axial_027.png","assets/T/mri-c148e76e611e4ad8/axial_029.png","assets/T/mri-c148e76e611e4ad8/axial_031.png","assets/T/mri-c148e76e611e4ad8/axial_033.png","assets/T/mri-c148e76e611e4ad8/axial_036.png","assets/T/mri-c148e76e611e4ad8/axial_038.png","assets/T/mri-c148e76e611e4ad8/axial_040.png","assets/T/mri-c148e76e611e4ad8/axial_042.png","assets/T/mri-c148e76e611e4ad8/coronal_001.png","assets/T/mri-c148e76e611e4ad8/coronal_003.png","assets/T/mri-c148e76e611e4ad8/coronal_005.png","assets/T/mri-c148e76e611e4ad8/coronal_008.png","assets/T/mri-c148e76e611e4ad8/coronal_010.png","assets/T/mri-c148e76e611e4ad8/coronal_012.png","assets/T/mri-c148e76e611e4ad8/coronal_014.png","assets/T/mri-c148e76e611e4ad8/coronal_017.png","assets/T/mri-c148e76e611e4ad8/coronal_019.png","assets/T/mri-c148e76e611e4ad8/coronal_021.png","assets/T/mri-c148e76e611e4ad8/coronal_023.png","assets/T/mri-c148e76e611e4ad8/coronal_026.png","assets/T/mri-c148e76e611e4ad8/coronal_028.png","assets/T/mri-c148e76e611e4ad8/coronal_030.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":72,"selected_count":34,"source_indices_1based":[1,3,5,7,10,12,14,16,18,20,23,25,27,29,31,33,36,38,40,42,43,45,47,50,52,54,56,59,61,63,65,68,70,72]}}
+{"id":"L3-T300:mri-b723d84d978e4a08","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-b723d84d978e4a08/axial_001.png","assets/T/mri-b723d84d978e4a08/axial_003.png","assets/T/mri-b723d84d978e4a08/axial_005.png","assets/T/mri-b723d84d978e4a08/axial_007.png","assets/T/mri-b723d84d978e4a08/axial_009.png","assets/T/mri-b723d84d978e4a08/axial_011.png","assets/T/mri-b723d84d978e4a08/axial_013.png","assets/T/mri-b723d84d978e4a08/axial_015.png","assets/T/mri-b723d84d978e4a08/axial_017.png","assets/T/mri-b723d84d978e4a08/axial_019.png","assets/T/mri-b723d84d978e4a08/axial_022.png","assets/T/mri-b723d84d978e4a08/axial_024.png","assets/T/mri-b723d84d978e4a08/axial_026.png","assets/T/mri-b723d84d978e4a08/axial_028.png","assets/T/mri-b723d84d978e4a08/axial_030.png","assets/T/mri-b723d84d978e4a08/axial_032.png","assets/T/mri-b723d84d978e4a08/axial_034.png","assets/T/mri-b723d84d978e4a08/axial_036.png","assets/T/mri-b723d84d978e4a08/axial_038.png","assets/T/mri-b723d84d978e4a08/axial_040.png","assets/T/mri-b723d84d978e4a08/axial_042.png","assets/T/mri-b723d84d978e4a08/coronal_001.png","assets/T/mri-b723d84d978e4a08/coronal_003.png","assets/T/mri-b723d84d978e4a08/coronal_005.png","assets/T/mri-b723d84d978e4a08/coronal_007.png","assets/T/mri-b723d84d978e4a08/coronal_009.png","assets/T/mri-b723d84d978e4a08/coronal_011.png","assets/T/mri-b723d84d978e4a08/coronal_014.png","assets/T/mri-b723d84d978e4a08/coronal_016.png","assets/T/mri-b723d84d978e4a08/coronal_018.png","assets/T/mri-b723d84d978e4a08/coronal_020.png","assets/T/mri-b723d84d978e4a08/coronal_022.png","assets/T/mri-b723d84d978e4a08/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-9febd5bfd7e4411a","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-9febd5bfd7e4411a/axial_001.png","assets/T/mri-9febd5bfd7e4411a/axial_003.png","assets/T/mri-9febd5bfd7e4411a/axial_005.png","assets/T/mri-9febd5bfd7e4411a/axial_007.png","assets/T/mri-9febd5bfd7e4411a/axial_009.png","assets/T/mri-9febd5bfd7e4411a/axial_011.png","assets/T/mri-9febd5bfd7e4411a/axial_013.png","assets/T/mri-9febd5bfd7e4411a/axial_015.png","assets/T/mri-9febd5bfd7e4411a/axial_017.png","assets/T/mri-9febd5bfd7e4411a/axial_019.png","assets/T/mri-9febd5bfd7e4411a/axial_022.png","assets/T/mri-9febd5bfd7e4411a/axial_024.png","assets/T/mri-9febd5bfd7e4411a/axial_026.png","assets/T/mri-9febd5bfd7e4411a/axial_028.png","assets/T/mri-9febd5bfd7e4411a/axial_030.png","assets/T/mri-9febd5bfd7e4411a/axial_032.png","assets/T/mri-9febd5bfd7e4411a/axial_034.png","assets/T/mri-9febd5bfd7e4411a/axial_036.png","assets/T/mri-9febd5bfd7e4411a/axial_038.png","assets/T/mri-9febd5bfd7e4411a/axial_040.png","assets/T/mri-9febd5bfd7e4411a/axial_042.png","assets/T/mri-9febd5bfd7e4411a/coronal_001.png","assets/T/mri-9febd5bfd7e4411a/coronal_003.png","assets/T/mri-9febd5bfd7e4411a/coronal_005.png","assets/T/mri-9febd5bfd7e4411a/coronal_007.png","assets/T/mri-9febd5bfd7e4411a/coronal_009.png","assets/T/mri-9febd5bfd7e4411a/coronal_011.png","assets/T/mri-9febd5bfd7e4411a/coronal_014.png","assets/T/mri-9febd5bfd7e4411a/coronal_016.png","assets/T/mri-9febd5bfd7e4411a/coronal_018.png","assets/T/mri-9febd5bfd7e4411a/coronal_020.png","assets/T/mri-9febd5bfd7e4411a/coronal_022.png","assets/T/mri-9febd5bfd7e4411a/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-9bf4932ed3d546a2","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-9bf4932ed3d546a2/axial_001.png","assets/T/mri-9bf4932ed3d546a2/axial_003.png","assets/T/mri-9bf4932ed3d546a2/axial_005.png","assets/T/mri-9bf4932ed3d546a2/axial_007.png","assets/T/mri-9bf4932ed3d546a2/axial_009.png","assets/T/mri-9bf4932ed3d546a2/axial_011.png","assets/T/mri-9bf4932ed3d546a2/axial_013.png","assets/T/mri-9bf4932ed3d546a2/axial_015.png","assets/T/mri-9bf4932ed3d546a2/axial_017.png","assets/T/mri-9bf4932ed3d546a2/axial_019.png","assets/T/mri-9bf4932ed3d546a2/axial_022.png","assets/T/mri-9bf4932ed3d546a2/axial_024.png","assets/T/mri-9bf4932ed3d546a2/axial_026.png","assets/T/mri-9bf4932ed3d546a2/axial_028.png","assets/T/mri-9bf4932ed3d546a2/axial_030.png","assets/T/mri-9bf4932ed3d546a2/axial_032.png","assets/T/mri-9bf4932ed3d546a2/axial_034.png","assets/T/mri-9bf4932ed3d546a2/axial_036.png","assets/T/mri-9bf4932ed3d546a2/axial_038.png","assets/T/mri-9bf4932ed3d546a2/axial_040.png","assets/T/mri-9bf4932ed3d546a2/axial_042.png","assets/T/mri-9bf4932ed3d546a2/coronal_001.png","assets/T/mri-9bf4932ed3d546a2/coronal_003.png","assets/T/mri-9bf4932ed3d546a2/coronal_005.png","assets/T/mri-9bf4932ed3d546a2/coronal_007.png","assets/T/mri-9bf4932ed3d546a2/coronal_009.png","assets/T/mri-9bf4932ed3d546a2/coronal_011.png","assets/T/mri-9bf4932ed3d546a2/coronal_014.png","assets/T/mri-9bf4932ed3d546a2/coronal_016.png","assets/T/mri-9bf4932ed3d546a2/coronal_018.png","assets/T/mri-9bf4932ed3d546a2/coronal_020.png","assets/T/mri-9bf4932ed3d546a2/coronal_022.png","assets/T/mri-9bf4932ed3d546a2/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-2d3b01244e0d4ee4","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-2d3b01244e0d4ee4/axial_001.png","assets/T/mri-2d3b01244e0d4ee4/axial_003.png","assets/T/mri-2d3b01244e0d4ee4/axial_005.png","assets/T/mri-2d3b01244e0d4ee4/axial_007.png","assets/T/mri-2d3b01244e0d4ee4/axial_009.png","assets/T/mri-2d3b01244e0d4ee4/axial_011.png","assets/T/mri-2d3b01244e0d4ee4/axial_013.png","assets/T/mri-2d3b01244e0d4ee4/axial_015.png","assets/T/mri-2d3b01244e0d4ee4/axial_017.png","assets/T/mri-2d3b01244e0d4ee4/axial_019.png","assets/T/mri-2d3b01244e0d4ee4/axial_022.png","assets/T/mri-2d3b01244e0d4ee4/axial_024.png","assets/T/mri-2d3b01244e0d4ee4/axial_026.png","assets/T/mri-2d3b01244e0d4ee4/axial_028.png","assets/T/mri-2d3b01244e0d4ee4/axial_030.png","assets/T/mri-2d3b01244e0d4ee4/axial_032.png","assets/T/mri-2d3b01244e0d4ee4/axial_034.png","assets/T/mri-2d3b01244e0d4ee4/axial_036.png","assets/T/mri-2d3b01244e0d4ee4/axial_038.png","assets/T/mri-2d3b01244e0d4ee4/axial_040.png","assets/T/mri-2d3b01244e0d4ee4/axial_042.png","assets/T/mri-2d3b01244e0d4ee4/coronal_001.png","assets/T/mri-2d3b01244e0d4ee4/coronal_003.png","assets/T/mri-2d3b01244e0d4ee4/coronal_005.png","assets/T/mri-2d3b01244e0d4ee4/coronal_008.png","assets/T/mri-2d3b01244e0d4ee4/coronal_010.png","assets/T/mri-2d3b01244e0d4ee4/coronal_012.png","assets/T/mri-2d3b01244e0d4ee4/coronal_014.png","assets/T/mri-2d3b01244e0d4ee4/coronal_016.png","assets/T/mri-2d3b01244e0d4ee4/coronal_018.png","assets/T/mri-2d3b01244e0d4ee4/coronal_021.png","assets/T/mri-2d3b01244e0d4ee4/coronal_023.png","assets/T/mri-2d3b01244e0d4ee4/coronal_025.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":67,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,50,52,54,56,58,60,63,65,67]}}
+{"id":"L3-T300:mri-3a3a1e2f74f04b22","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-3a3a1e2f74f04b22/axial_001.png","assets/T/mri-3a3a1e2f74f04b22/axial_003.png","assets/T/mri-3a3a1e2f74f04b22/axial_005.png","assets/T/mri-3a3a1e2f74f04b22/axial_007.png","assets/T/mri-3a3a1e2f74f04b22/axial_009.png","assets/T/mri-3a3a1e2f74f04b22/axial_011.png","assets/T/mri-3a3a1e2f74f04b22/axial_013.png","assets/T/mri-3a3a1e2f74f04b22/axial_015.png","assets/T/mri-3a3a1e2f74f04b22/axial_017.png","assets/T/mri-3a3a1e2f74f04b22/axial_019.png","assets/T/mri-3a3a1e2f74f04b22/axial_022.png","assets/T/mri-3a3a1e2f74f04b22/axial_024.png","assets/T/mri-3a3a1e2f74f04b22/axial_026.png","assets/T/mri-3a3a1e2f74f04b22/axial_028.png","assets/T/mri-3a3a1e2f74f04b22/axial_030.png","assets/T/mri-3a3a1e2f74f04b22/axial_032.png","assets/T/mri-3a3a1e2f74f04b22/axial_034.png","assets/T/mri-3a3a1e2f74f04b22/axial_036.png","assets/T/mri-3a3a1e2f74f04b22/axial_038.png","assets/T/mri-3a3a1e2f74f04b22/axial_040.png","assets/T/mri-3a3a1e2f74f04b22/axial_042.png","assets/T/mri-3a3a1e2f74f04b22/coronal_001.png","assets/T/mri-3a3a1e2f74f04b22/coronal_003.png","assets/T/mri-3a3a1e2f74f04b22/coronal_005.png","assets/T/mri-3a3a1e2f74f04b22/coronal_008.png","assets/T/mri-3a3a1e2f74f04b22/coronal_010.png","assets/T/mri-3a3a1e2f74f04b22/coronal_012.png","assets/T/mri-3a3a1e2f74f04b22/coronal_014.png","assets/T/mri-3a3a1e2f74f04b22/coronal_016.png","assets/T/mri-3a3a1e2f74f04b22/coronal_018.png","assets/T/mri-3a3a1e2f74f04b22/coronal_021.png","assets/T/mri-3a3a1e2f74f04b22/coronal_023.png","assets/T/mri-3a3a1e2f74f04b22/coronal_025.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":67,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,50,52,54,56,58,60,63,65,67]}}
+{"id":"L3-T300:mri-34db59d07ef34640","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-34db59d07ef34640/axial_001.png","assets/T/mri-34db59d07ef34640/axial_003.png","assets/T/mri-34db59d07ef34640/axial_005.png","assets/T/mri-34db59d07ef34640/axial_007.png","assets/T/mri-34db59d07ef34640/axial_009.png","assets/T/mri-34db59d07ef34640/axial_011.png","assets/T/mri-34db59d07ef34640/axial_013.png","assets/T/mri-34db59d07ef34640/axial_015.png","assets/T/mri-34db59d07ef34640/axial_017.png","assets/T/mri-34db59d07ef34640/axial_019.png","assets/T/mri-34db59d07ef34640/axial_022.png","assets/T/mri-34db59d07ef34640/axial_024.png","assets/T/mri-34db59d07ef34640/axial_026.png","assets/T/mri-34db59d07ef34640/axial_028.png","assets/T/mri-34db59d07ef34640/axial_030.png","assets/T/mri-34db59d07ef34640/axial_032.png","assets/T/mri-34db59d07ef34640/axial_034.png","assets/T/mri-34db59d07ef34640/axial_036.png","assets/T/mri-34db59d07ef34640/axial_038.png","assets/T/mri-34db59d07ef34640/axial_040.png","assets/T/mri-34db59d07ef34640/axial_042.png","assets/T/mri-34db59d07ef34640/coronal_001.png","assets/T/mri-34db59d07ef34640/coronal_003.png","assets/T/mri-34db59d07ef34640/coronal_005.png","assets/T/mri-34db59d07ef34640/coronal_007.png","assets/T/mri-34db59d07ef34640/coronal_009.png","assets/T/mri-34db59d07ef34640/coronal_011.png","assets/T/mri-34db59d07ef34640/coronal_014.png","assets/T/mri-34db59d07ef34640/coronal_016.png","assets/T/mri-34db59d07ef34640/coronal_018.png","assets/T/mri-34db59d07ef34640/coronal_020.png","assets/T/mri-34db59d07ef34640/coronal_022.png","assets/T/mri-34db59d07ef34640/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-d9cf4f2c60544daa","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-d9cf4f2c60544daa/axial_001.png","assets/T/mri-d9cf4f2c60544daa/axial_003.png","assets/T/mri-d9cf4f2c60544daa/axial_005.png","assets/T/mri-d9cf4f2c60544daa/axial_007.png","assets/T/mri-d9cf4f2c60544daa/axial_009.png","assets/T/mri-d9cf4f2c60544daa/axial_011.png","assets/T/mri-d9cf4f2c60544daa/axial_013.png","assets/T/mri-d9cf4f2c60544daa/axial_015.png","assets/T/mri-d9cf4f2c60544daa/axial_017.png","assets/T/mri-d9cf4f2c60544daa/axial_019.png","assets/T/mri-d9cf4f2c60544daa/axial_021.png","assets/T/mri-d9cf4f2c60544daa/axial_022.png","assets/T/mri-d9cf4f2c60544daa/axial_024.png","assets/T/mri-d9cf4f2c60544daa/axial_026.png","assets/T/mri-d9cf4f2c60544daa/axial_028.png","assets/T/mri-d9cf4f2c60544daa/axial_030.png","assets/T/mri-d9cf4f2c60544daa/axial_032.png","assets/T/mri-d9cf4f2c60544daa/axial_034.png","assets/T/mri-d9cf4f2c60544daa/axial_036.png","assets/T/mri-d9cf4f2c60544daa/axial_038.png","assets/T/mri-d9cf4f2c60544daa/axial_040.png","assets/T/mri-d9cf4f2c60544daa/coronal_001.png","assets/T/mri-d9cf4f2c60544daa/coronal_003.png","assets/T/mri-d9cf4f2c60544daa/coronal_005.png","assets/T/mri-d9cf4f2c60544daa/coronal_007.png","assets/T/mri-d9cf4f2c60544daa/coronal_009.png","assets/T/mri-d9cf4f2c60544daa/coronal_011.png","assets/T/mri-d9cf4f2c60544daa/coronal_014.png","assets/T/mri-d9cf4f2c60544daa/coronal_016.png","assets/T/mri-d9cf4f2c60544daa/coronal_018.png","assets/T/mri-d9cf4f2c60544daa/coronal_020.png","assets/T/mri-d9cf4f2c60544daa/coronal_022.png","assets/T/mri-d9cf4f2c60544daa/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-26f2f06937804ccf","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-26f2f06937804ccf/axial_001.png","assets/T/mri-26f2f06937804ccf/axial_003.png","assets/T/mri-26f2f06937804ccf/axial_005.png","assets/T/mri-26f2f06937804ccf/axial_007.png","assets/T/mri-26f2f06937804ccf/axial_009.png","assets/T/mri-26f2f06937804ccf/axial_011.png","assets/T/mri-26f2f06937804ccf/axial_013.png","assets/T/mri-26f2f06937804ccf/axial_015.png","assets/T/mri-26f2f06937804ccf/axial_017.png","assets/T/mri-26f2f06937804ccf/axial_019.png","assets/T/mri-26f2f06937804ccf/axial_021.png","assets/T/mri-26f2f06937804ccf/axial_022.png","assets/T/mri-26f2f06937804ccf/axial_024.png","assets/T/mri-26f2f06937804ccf/axial_026.png","assets/T/mri-26f2f06937804ccf/axial_028.png","assets/T/mri-26f2f06937804ccf/axial_030.png","assets/T/mri-26f2f06937804ccf/axial_032.png","assets/T/mri-26f2f06937804ccf/axial_034.png","assets/T/mri-26f2f06937804ccf/axial_036.png","assets/T/mri-26f2f06937804ccf/axial_038.png","assets/T/mri-26f2f06937804ccf/axial_040.png","assets/T/mri-26f2f06937804ccf/coronal_001.png","assets/T/mri-26f2f06937804ccf/coronal_003.png","assets/T/mri-26f2f06937804ccf/coronal_005.png","assets/T/mri-26f2f06937804ccf/coronal_007.png","assets/T/mri-26f2f06937804ccf/coronal_009.png","assets/T/mri-26f2f06937804ccf/coronal_011.png","assets/T/mri-26f2f06937804ccf/coronal_014.png","assets/T/mri-26f2f06937804ccf/coronal_016.png","assets/T/mri-26f2f06937804ccf/coronal_018.png","assets/T/mri-26f2f06937804ccf/coronal_020.png","assets/T/mri-26f2f06937804ccf/coronal_022.png","assets/T/mri-26f2f06937804ccf/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-629c4e4164da4fae","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 13 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-629c4e4164da4fae/axial_001.png","assets/T/mri-629c4e4164da4fae/axial_003.png","assets/T/mri-629c4e4164da4fae/axial_006.png","assets/T/mri-629c4e4164da4fae/axial_008.png","assets/T/mri-629c4e4164da4fae/axial_010.png","assets/T/mri-629c4e4164da4fae/axial_012.png","assets/T/mri-629c4e4164da4fae/axial_015.png","assets/T/mri-629c4e4164da4fae/axial_017.png","assets/T/mri-629c4e4164da4fae/axial_019.png","assets/T/mri-629c4e4164da4fae/axial_021.png","assets/T/mri-629c4e4164da4fae/axial_024.png","assets/T/mri-629c4e4164da4fae/axial_026.png","assets/T/mri-629c4e4164da4fae/axial_028.png","assets/T/mri-629c4e4164da4fae/axial_030.png","assets/T/mri-629c4e4164da4fae/axial_033.png","assets/T/mri-629c4e4164da4fae/axial_035.png","assets/T/mri-629c4e4164da4fae/axial_037.png","assets/T/mri-629c4e4164da4fae/axial_039.png","assets/T/mri-629c4e4164da4fae/axial_042.png","assets/T/mri-629c4e4164da4fae/axial_044.png","assets/T/mri-629c4e4164da4fae/coronal_001.png","assets/T/mri-629c4e4164da4fae/coronal_003.png","assets/T/mri-629c4e4164da4fae/coronal_006.png","assets/T/mri-629c4e4164da4fae/coronal_008.png","assets/T/mri-629c4e4164da4fae/coronal_010.png","assets/T/mri-629c4e4164da4fae/coronal_012.png","assets/T/mri-629c4e4164da4fae/coronal_015.png","assets/T/mri-629c4e4164da4fae/coronal_017.png","assets/T/mri-629c4e4164da4fae/coronal_019.png","assets/T/mri-629c4e4164da4fae/coronal_021.png","assets/T/mri-629c4e4164da4fae/coronal_024.png","assets/T/mri-629c4e4164da4fae/coronal_026.png","assets/T/mri-629c4e4164da4fae/coronal_028.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":72,"selected_count":33,"source_indices_1based":[1,3,6,8,10,12,15,17,19,21,24,26,28,30,33,35,37,39,42,44,45,47,50,52,54,56,59,61,63,65,68,70,72]}}
+{"id":"L3-T300:mri-29505b0ebf294dfd","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-29505b0ebf294dfd/axial_001.png","assets/T/mri-29505b0ebf294dfd/axial_003.png","assets/T/mri-29505b0ebf294dfd/axial_005.png","assets/T/mri-29505b0ebf294dfd/axial_007.png","assets/T/mri-29505b0ebf294dfd/axial_009.png","assets/T/mri-29505b0ebf294dfd/axial_011.png","assets/T/mri-29505b0ebf294dfd/axial_013.png","assets/T/mri-29505b0ebf294dfd/axial_015.png","assets/T/mri-29505b0ebf294dfd/axial_017.png","assets/T/mri-29505b0ebf294dfd/axial_019.png","assets/T/mri-29505b0ebf294dfd/axial_022.png","assets/T/mri-29505b0ebf294dfd/axial_024.png","assets/T/mri-29505b0ebf294dfd/axial_026.png","assets/T/mri-29505b0ebf294dfd/axial_028.png","assets/T/mri-29505b0ebf294dfd/axial_030.png","assets/T/mri-29505b0ebf294dfd/axial_032.png","assets/T/mri-29505b0ebf294dfd/axial_034.png","assets/T/mri-29505b0ebf294dfd/axial_036.png","assets/T/mri-29505b0ebf294dfd/axial_038.png","assets/T/mri-29505b0ebf294dfd/axial_040.png","assets/T/mri-29505b0ebf294dfd/axial_042.png","assets/T/mri-29505b0ebf294dfd/coronal_001.png","assets/T/mri-29505b0ebf294dfd/coronal_003.png","assets/T/mri-29505b0ebf294dfd/coronal_005.png","assets/T/mri-29505b0ebf294dfd/coronal_007.png","assets/T/mri-29505b0ebf294dfd/coronal_009.png","assets/T/mri-29505b0ebf294dfd/coronal_011.png","assets/T/mri-29505b0ebf294dfd/coronal_014.png","assets/T/mri-29505b0ebf294dfd/coronal_016.png","assets/T/mri-29505b0ebf294dfd/coronal_018.png","assets/T/mri-29505b0ebf294dfd/coronal_020.png","assets/T/mri-29505b0ebf294dfd/coronal_022.png","assets/T/mri-29505b0ebf294dfd/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-e2fd54c6f0cc4d8b","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 13 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-e2fd54c6f0cc4d8b/axial_001.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_003.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_005.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_007.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_009.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_011.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_013.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_015.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_017.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_019.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_020.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_022.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_024.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_026.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_028.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_030.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_032.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_034.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_036.png","assets/T/mri-e2fd54c6f0cc4d8b/axial_038.png","assets/T/mri-e2fd54c6f0cc4d8b/coronal_001.png","assets/T/mri-e2fd54c6f0cc4d8b/coronal_003.png","assets/T/mri-e2fd54c6f0cc4d8b/coronal_005.png","assets/T/mri-e2fd54c6f0cc4d8b/coronal_007.png","assets/T/mri-e2fd54c6f0cc4d8b/coronal_009.png","assets/T/mri-e2fd54c6f0cc4d8b/coronal_011.png","assets/T/mri-e2fd54c6f0cc4d8b/coronal_013.png","assets/T/mri-e2fd54c6f0cc4d8b/coronal_014.png","assets/T/mri-e2fd54c6f0cc4d8b/coronal_016.png","assets/T/mri-e2fd54c6f0cc4d8b/coronal_018.png","assets/T/mri-e2fd54c6f0cc4d8b/coronal_020.png","assets/T/mri-e2fd54c6f0cc4d8b/coronal_022.png","assets/T/mri-e2fd54c6f0cc4d8b/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":62,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,20,22,24,26,28,30,32,34,36,38,39,41,43,45,47,49,51,52,54,56,58,60,62]}}
+{"id":"L3-T300:mri-e409f2ae4d1b4e1f","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-e409f2ae4d1b4e1f/axial_001.png","assets/T/mri-e409f2ae4d1b4e1f/axial_003.png","assets/T/mri-e409f2ae4d1b4e1f/axial_005.png","assets/T/mri-e409f2ae4d1b4e1f/axial_007.png","assets/T/mri-e409f2ae4d1b4e1f/axial_010.png","assets/T/mri-e409f2ae4d1b4e1f/axial_012.png","assets/T/mri-e409f2ae4d1b4e1f/axial_014.png","assets/T/mri-e409f2ae4d1b4e1f/axial_016.png","assets/T/mri-e409f2ae4d1b4e1f/axial_018.png","assets/T/mri-e409f2ae4d1b4e1f/axial_020.png","assets/T/mri-e409f2ae4d1b4e1f/axial_023.png","assets/T/mri-e409f2ae4d1b4e1f/axial_025.png","assets/T/mri-e409f2ae4d1b4e1f/axial_027.png","assets/T/mri-e409f2ae4d1b4e1f/axial_029.png","assets/T/mri-e409f2ae4d1b4e1f/axial_031.png","assets/T/mri-e409f2ae4d1b4e1f/axial_033.png","assets/T/mri-e409f2ae4d1b4e1f/axial_035.png","assets/T/mri-e409f2ae4d1b4e1f/axial_038.png","assets/T/mri-e409f2ae4d1b4e1f/axial_040.png","assets/T/mri-e409f2ae4d1b4e1f/axial_042.png","assets/T/mri-e409f2ae4d1b4e1f/axial_044.png","assets/T/mri-e409f2ae4d1b4e1f/coronal_001.png","assets/T/mri-e409f2ae4d1b4e1f/coronal_003.png","assets/T/mri-e409f2ae4d1b4e1f/coronal_005.png","assets/T/mri-e409f2ae4d1b4e1f/coronal_007.png","assets/T/mri-e409f2ae4d1b4e1f/coronal_009.png","assets/T/mri-e409f2ae4d1b4e1f/coronal_011.png","assets/T/mri-e409f2ae4d1b4e1f/coronal_014.png","assets/T/mri-e409f2ae4d1b4e1f/coronal_016.png","assets/T/mri-e409f2ae4d1b4e1f/coronal_018.png","assets/T/mri-e409f2ae4d1b4e1f/coronal_020.png","assets/T/mri-e409f2ae4d1b4e1f/coronal_022.png","assets/T/mri-e409f2ae4d1b4e1f/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":68,"selected_count":33,"source_indices_1based":[1,3,5,7,10,12,14,16,18,20,23,25,27,29,31,33,35,38,40,42,44,45,47,49,51,53,55,58,60,62,64,66,68]}}
+{"id":"L3-T300:mri-9e12e91c8dc74f98","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-9e12e91c8dc74f98/axial_001.png","assets/T/mri-9e12e91c8dc74f98/axial_003.png","assets/T/mri-9e12e91c8dc74f98/axial_005.png","assets/T/mri-9e12e91c8dc74f98/axial_007.png","assets/T/mri-9e12e91c8dc74f98/axial_009.png","assets/T/mri-9e12e91c8dc74f98/axial_011.png","assets/T/mri-9e12e91c8dc74f98/axial_013.png","assets/T/mri-9e12e91c8dc74f98/axial_015.png","assets/T/mri-9e12e91c8dc74f98/axial_017.png","assets/T/mri-9e12e91c8dc74f98/axial_019.png","assets/T/mri-9e12e91c8dc74f98/axial_021.png","assets/T/mri-9e12e91c8dc74f98/axial_022.png","assets/T/mri-9e12e91c8dc74f98/axial_024.png","assets/T/mri-9e12e91c8dc74f98/axial_026.png","assets/T/mri-9e12e91c8dc74f98/axial_028.png","assets/T/mri-9e12e91c8dc74f98/axial_030.png","assets/T/mri-9e12e91c8dc74f98/axial_032.png","assets/T/mri-9e12e91c8dc74f98/axial_034.png","assets/T/mri-9e12e91c8dc74f98/axial_036.png","assets/T/mri-9e12e91c8dc74f98/axial_038.png","assets/T/mri-9e12e91c8dc74f98/axial_040.png","assets/T/mri-9e12e91c8dc74f98/coronal_001.png","assets/T/mri-9e12e91c8dc74f98/coronal_003.png","assets/T/mri-9e12e91c8dc74f98/coronal_005.png","assets/T/mri-9e12e91c8dc74f98/coronal_007.png","assets/T/mri-9e12e91c8dc74f98/coronal_009.png","assets/T/mri-9e12e91c8dc74f98/coronal_011.png","assets/T/mri-9e12e91c8dc74f98/coronal_014.png","assets/T/mri-9e12e91c8dc74f98/coronal_016.png","assets/T/mri-9e12e91c8dc74f98/coronal_018.png","assets/T/mri-9e12e91c8dc74f98/coronal_020.png","assets/T/mri-9e12e91c8dc74f98/coronal_022.png","assets/T/mri-9e12e91c8dc74f98/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-ae6a7613901c4b94","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-ae6a7613901c4b94/axial_001.png","assets/T/mri-ae6a7613901c4b94/axial_003.png","assets/T/mri-ae6a7613901c4b94/axial_005.png","assets/T/mri-ae6a7613901c4b94/axial_007.png","assets/T/mri-ae6a7613901c4b94/axial_009.png","assets/T/mri-ae6a7613901c4b94/axial_011.png","assets/T/mri-ae6a7613901c4b94/axial_013.png","assets/T/mri-ae6a7613901c4b94/axial_015.png","assets/T/mri-ae6a7613901c4b94/axial_017.png","assets/T/mri-ae6a7613901c4b94/axial_019.png","assets/T/mri-ae6a7613901c4b94/axial_021.png","assets/T/mri-ae6a7613901c4b94/axial_022.png","assets/T/mri-ae6a7613901c4b94/axial_024.png","assets/T/mri-ae6a7613901c4b94/axial_026.png","assets/T/mri-ae6a7613901c4b94/axial_028.png","assets/T/mri-ae6a7613901c4b94/axial_030.png","assets/T/mri-ae6a7613901c4b94/axial_032.png","assets/T/mri-ae6a7613901c4b94/axial_034.png","assets/T/mri-ae6a7613901c4b94/axial_036.png","assets/T/mri-ae6a7613901c4b94/axial_038.png","assets/T/mri-ae6a7613901c4b94/axial_040.png","assets/T/mri-ae6a7613901c4b94/coronal_001.png","assets/T/mri-ae6a7613901c4b94/coronal_003.png","assets/T/mri-ae6a7613901c4b94/coronal_005.png","assets/T/mri-ae6a7613901c4b94/coronal_007.png","assets/T/mri-ae6a7613901c4b94/coronal_009.png","assets/T/mri-ae6a7613901c4b94/coronal_011.png","assets/T/mri-ae6a7613901c4b94/coronal_014.png","assets/T/mri-ae6a7613901c4b94/coronal_016.png","assets/T/mri-ae6a7613901c4b94/coronal_018.png","assets/T/mri-ae6a7613901c4b94/coronal_020.png","assets/T/mri-ae6a7613901c4b94/coronal_022.png","assets/T/mri-ae6a7613901c4b94/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-fd066ee0a9c14d5b","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 13 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-fd066ee0a9c14d5b/axial_001.png","assets/T/mri-fd066ee0a9c14d5b/axial_003.png","assets/T/mri-fd066ee0a9c14d5b/axial_005.png","assets/T/mri-fd066ee0a9c14d5b/axial_007.png","assets/T/mri-fd066ee0a9c14d5b/axial_010.png","assets/T/mri-fd066ee0a9c14d5b/axial_012.png","assets/T/mri-fd066ee0a9c14d5b/axial_014.png","assets/T/mri-fd066ee0a9c14d5b/axial_016.png","assets/T/mri-fd066ee0a9c14d5b/axial_018.png","assets/T/mri-fd066ee0a9c14d5b/axial_020.png","assets/T/mri-fd066ee0a9c14d5b/axial_023.png","assets/T/mri-fd066ee0a9c14d5b/axial_025.png","assets/T/mri-fd066ee0a9c14d5b/axial_027.png","assets/T/mri-fd066ee0a9c14d5b/axial_029.png","assets/T/mri-fd066ee0a9c14d5b/axial_031.png","assets/T/mri-fd066ee0a9c14d5b/axial_033.png","assets/T/mri-fd066ee0a9c14d5b/axial_036.png","assets/T/mri-fd066ee0a9c14d5b/axial_038.png","assets/T/mri-fd066ee0a9c14d5b/axial_040.png","assets/T/mri-fd066ee0a9c14d5b/axial_042.png","assets/T/mri-fd066ee0a9c14d5b/coronal_001.png","assets/T/mri-fd066ee0a9c14d5b/coronal_003.png","assets/T/mri-fd066ee0a9c14d5b/coronal_005.png","assets/T/mri-fd066ee0a9c14d5b/coronal_007.png","assets/T/mri-fd066ee0a9c14d5b/coronal_009.png","assets/T/mri-fd066ee0a9c14d5b/coronal_011.png","assets/T/mri-fd066ee0a9c14d5b/coronal_014.png","assets/T/mri-fd066ee0a9c14d5b/coronal_016.png","assets/T/mri-fd066ee0a9c14d5b/coronal_018.png","assets/T/mri-fd066ee0a9c14d5b/coronal_020.png","assets/T/mri-fd066ee0a9c14d5b/coronal_022.png","assets/T/mri-fd066ee0a9c14d5b/coronal_024.png","assets/T/mri-fd066ee0a9c14d5b/coronal_026.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":68,"selected_count":33,"source_indices_1based":[1,3,5,7,10,12,14,16,18,20,23,25,27,29,31,33,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66,68]}}
+{"id":"L3-T300:mri-19abf1bad6184b68","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 34 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 14 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-19abf1bad6184b68/axial_001.png","assets/T/mri-19abf1bad6184b68/axial_003.png","assets/T/mri-19abf1bad6184b68/axial_005.png","assets/T/mri-19abf1bad6184b68/axial_007.png","assets/T/mri-19abf1bad6184b68/axial_008.png","assets/T/mri-19abf1bad6184b68/axial_010.png","assets/T/mri-19abf1bad6184b68/axial_012.png","assets/T/mri-19abf1bad6184b68/axial_014.png","assets/T/mri-19abf1bad6184b68/axial_016.png","assets/T/mri-19abf1bad6184b68/axial_018.png","assets/T/mri-19abf1bad6184b68/axial_019.png","assets/T/mri-19abf1bad6184b68/axial_021.png","assets/T/mri-19abf1bad6184b68/axial_023.png","assets/T/mri-19abf1bad6184b68/axial_025.png","assets/T/mri-19abf1bad6184b68/axial_027.png","assets/T/mri-19abf1bad6184b68/axial_029.png","assets/T/mri-19abf1bad6184b68/axial_030.png","assets/T/mri-19abf1bad6184b68/axial_032.png","assets/T/mri-19abf1bad6184b68/axial_034.png","assets/T/mri-19abf1bad6184b68/axial_036.png","assets/T/mri-19abf1bad6184b68/coronal_001.png","assets/T/mri-19abf1bad6184b68/coronal_003.png","assets/T/mri-19abf1bad6184b68/coronal_005.png","assets/T/mri-19abf1bad6184b68/coronal_006.png","assets/T/mri-19abf1bad6184b68/coronal_008.png","assets/T/mri-19abf1bad6184b68/coronal_010.png","assets/T/mri-19abf1bad6184b68/coronal_012.png","assets/T/mri-19abf1bad6184b68/coronal_013.png","assets/T/mri-19abf1bad6184b68/coronal_015.png","assets/T/mri-19abf1bad6184b68/coronal_017.png","assets/T/mri-19abf1bad6184b68/coronal_019.png","assets/T/mri-19abf1bad6184b68/coronal_020.png","assets/T/mri-19abf1bad6184b68/coronal_022.png","assets/T/mri-19abf1bad6184b68/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":60,"selected_count":34,"source_indices_1based":[1,3,5,7,8,10,12,14,16,18,19,21,23,25,27,29,30,32,34,36,37,39,41,42,44,46,48,49,51,53,55,56,58,60]}}
+{"id":"L3-T300:mri-c5d6081e8d9f448c","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-c5d6081e8d9f448c/axial_001.png","assets/T/mri-c5d6081e8d9f448c/axial_003.png","assets/T/mri-c5d6081e8d9f448c/axial_005.png","assets/T/mri-c5d6081e8d9f448c/axial_007.png","assets/T/mri-c5d6081e8d9f448c/axial_009.png","assets/T/mri-c5d6081e8d9f448c/axial_011.png","assets/T/mri-c5d6081e8d9f448c/axial_013.png","assets/T/mri-c5d6081e8d9f448c/axial_015.png","assets/T/mri-c5d6081e8d9f448c/axial_017.png","assets/T/mri-c5d6081e8d9f448c/axial_019.png","assets/T/mri-c5d6081e8d9f448c/axial_021.png","assets/T/mri-c5d6081e8d9f448c/axial_022.png","assets/T/mri-c5d6081e8d9f448c/axial_024.png","assets/T/mri-c5d6081e8d9f448c/axial_026.png","assets/T/mri-c5d6081e8d9f448c/axial_028.png","assets/T/mri-c5d6081e8d9f448c/axial_030.png","assets/T/mri-c5d6081e8d9f448c/axial_032.png","assets/T/mri-c5d6081e8d9f448c/axial_034.png","assets/T/mri-c5d6081e8d9f448c/axial_036.png","assets/T/mri-c5d6081e8d9f448c/axial_038.png","assets/T/mri-c5d6081e8d9f448c/axial_040.png","assets/T/mri-c5d6081e8d9f448c/coronal_001.png","assets/T/mri-c5d6081e8d9f448c/coronal_003.png","assets/T/mri-c5d6081e8d9f448c/coronal_005.png","assets/T/mri-c5d6081e8d9f448c/coronal_007.png","assets/T/mri-c5d6081e8d9f448c/coronal_009.png","assets/T/mri-c5d6081e8d9f448c/coronal_011.png","assets/T/mri-c5d6081e8d9f448c/coronal_014.png","assets/T/mri-c5d6081e8d9f448c/coronal_016.png","assets/T/mri-c5d6081e8d9f448c/coronal_018.png","assets/T/mri-c5d6081e8d9f448c/coronal_020.png","assets/T/mri-c5d6081e8d9f448c/coronal_022.png","assets/T/mri-c5d6081e8d9f448c/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-a2c56cae231d4f86","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-a2c56cae231d4f86/axial_001.png","assets/T/mri-a2c56cae231d4f86/axial_003.png","assets/T/mri-a2c56cae231d4f86/axial_005.png","assets/T/mri-a2c56cae231d4f86/axial_007.png","assets/T/mri-a2c56cae231d4f86/axial_009.png","assets/T/mri-a2c56cae231d4f86/axial_011.png","assets/T/mri-a2c56cae231d4f86/axial_013.png","assets/T/mri-a2c56cae231d4f86/axial_015.png","assets/T/mri-a2c56cae231d4f86/axial_017.png","assets/T/mri-a2c56cae231d4f86/axial_019.png","assets/T/mri-a2c56cae231d4f86/axial_021.png","assets/T/mri-a2c56cae231d4f86/axial_022.png","assets/T/mri-a2c56cae231d4f86/axial_024.png","assets/T/mri-a2c56cae231d4f86/axial_026.png","assets/T/mri-a2c56cae231d4f86/axial_028.png","assets/T/mri-a2c56cae231d4f86/axial_030.png","assets/T/mri-a2c56cae231d4f86/axial_032.png","assets/T/mri-a2c56cae231d4f86/axial_034.png","assets/T/mri-a2c56cae231d4f86/axial_036.png","assets/T/mri-a2c56cae231d4f86/axial_038.png","assets/T/mri-a2c56cae231d4f86/axial_040.png","assets/T/mri-a2c56cae231d4f86/coronal_001.png","assets/T/mri-a2c56cae231d4f86/coronal_003.png","assets/T/mri-a2c56cae231d4f86/coronal_005.png","assets/T/mri-a2c56cae231d4f86/coronal_007.png","assets/T/mri-a2c56cae231d4f86/coronal_009.png","assets/T/mri-a2c56cae231d4f86/coronal_011.png","assets/T/mri-a2c56cae231d4f86/coronal_014.png","assets/T/mri-a2c56cae231d4f86/coronal_016.png","assets/T/mri-a2c56cae231d4f86/coronal_018.png","assets/T/mri-a2c56cae231d4f86/coronal_020.png","assets/T/mri-a2c56cae231d4f86/coronal_022.png","assets/T/mri-a2c56cae231d4f86/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-30dff32cc2994f01","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-30dff32cc2994f01/axial_001.png","assets/T/mri-30dff32cc2994f01/axial_003.png","assets/T/mri-30dff32cc2994f01/axial_005.png","assets/T/mri-30dff32cc2994f01/axial_007.png","assets/T/mri-30dff32cc2994f01/axial_010.png","assets/T/mri-30dff32cc2994f01/axial_012.png","assets/T/mri-30dff32cc2994f01/axial_014.png","assets/T/mri-30dff32cc2994f01/axial_016.png","assets/T/mri-30dff32cc2994f01/axial_018.png","assets/T/mri-30dff32cc2994f01/axial_020.png","assets/T/mri-30dff32cc2994f01/axial_023.png","assets/T/mri-30dff32cc2994f01/axial_025.png","assets/T/mri-30dff32cc2994f01/axial_027.png","assets/T/mri-30dff32cc2994f01/axial_029.png","assets/T/mri-30dff32cc2994f01/axial_031.png","assets/T/mri-30dff32cc2994f01/axial_033.png","assets/T/mri-30dff32cc2994f01/axial_035.png","assets/T/mri-30dff32cc2994f01/axial_038.png","assets/T/mri-30dff32cc2994f01/axial_040.png","assets/T/mri-30dff32cc2994f01/axial_042.png","assets/T/mri-30dff32cc2994f01/axial_044.png","assets/T/mri-30dff32cc2994f01/coronal_001.png","assets/T/mri-30dff32cc2994f01/coronal_003.png","assets/T/mri-30dff32cc2994f01/coronal_005.png","assets/T/mri-30dff32cc2994f01/coronal_007.png","assets/T/mri-30dff32cc2994f01/coronal_009.png","assets/T/mri-30dff32cc2994f01/coronal_011.png","assets/T/mri-30dff32cc2994f01/coronal_014.png","assets/T/mri-30dff32cc2994f01/coronal_016.png","assets/T/mri-30dff32cc2994f01/coronal_018.png","assets/T/mri-30dff32cc2994f01/coronal_020.png","assets/T/mri-30dff32cc2994f01/coronal_022.png","assets/T/mri-30dff32cc2994f01/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":68,"selected_count":33,"source_indices_1based":[1,3,5,7,10,12,14,16,18,20,23,25,27,29,31,33,35,38,40,42,44,45,47,49,51,53,55,58,60,62,64,66,68]}}
+{"id":"L3-T300:mri-89ab62d7f29d44ef","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-89ab62d7f29d44ef/axial_001.png","assets/T/mri-89ab62d7f29d44ef/axial_003.png","assets/T/mri-89ab62d7f29d44ef/axial_005.png","assets/T/mri-89ab62d7f29d44ef/axial_007.png","assets/T/mri-89ab62d7f29d44ef/axial_009.png","assets/T/mri-89ab62d7f29d44ef/axial_011.png","assets/T/mri-89ab62d7f29d44ef/axial_013.png","assets/T/mri-89ab62d7f29d44ef/axial_015.png","assets/T/mri-89ab62d7f29d44ef/axial_017.png","assets/T/mri-89ab62d7f29d44ef/axial_019.png","assets/T/mri-89ab62d7f29d44ef/axial_022.png","assets/T/mri-89ab62d7f29d44ef/axial_024.png","assets/T/mri-89ab62d7f29d44ef/axial_026.png","assets/T/mri-89ab62d7f29d44ef/axial_028.png","assets/T/mri-89ab62d7f29d44ef/axial_030.png","assets/T/mri-89ab62d7f29d44ef/axial_032.png","assets/T/mri-89ab62d7f29d44ef/axial_034.png","assets/T/mri-89ab62d7f29d44ef/axial_036.png","assets/T/mri-89ab62d7f29d44ef/axial_038.png","assets/T/mri-89ab62d7f29d44ef/axial_040.png","assets/T/mri-89ab62d7f29d44ef/axial_042.png","assets/T/mri-89ab62d7f29d44ef/coronal_001.png","assets/T/mri-89ab62d7f29d44ef/coronal_003.png","assets/T/mri-89ab62d7f29d44ef/coronal_005.png","assets/T/mri-89ab62d7f29d44ef/coronal_007.png","assets/T/mri-89ab62d7f29d44ef/coronal_009.png","assets/T/mri-89ab62d7f29d44ef/coronal_011.png","assets/T/mri-89ab62d7f29d44ef/coronal_014.png","assets/T/mri-89ab62d7f29d44ef/coronal_016.png","assets/T/mri-89ab62d7f29d44ef/coronal_018.png","assets/T/mri-89ab62d7f29d44ef/coronal_020.png","assets/T/mri-89ab62d7f29d44ef/coronal_022.png","assets/T/mri-89ab62d7f29d44ef/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-7fa3212a93944079","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-7fa3212a93944079/axial_001.png","assets/T/mri-7fa3212a93944079/axial_003.png","assets/T/mri-7fa3212a93944079/axial_005.png","assets/T/mri-7fa3212a93944079/axial_007.png","assets/T/mri-7fa3212a93944079/axial_009.png","assets/T/mri-7fa3212a93944079/axial_011.png","assets/T/mri-7fa3212a93944079/axial_013.png","assets/T/mri-7fa3212a93944079/axial_015.png","assets/T/mri-7fa3212a93944079/axial_017.png","assets/T/mri-7fa3212a93944079/axial_019.png","assets/T/mri-7fa3212a93944079/axial_021.png","assets/T/mri-7fa3212a93944079/axial_022.png","assets/T/mri-7fa3212a93944079/axial_024.png","assets/T/mri-7fa3212a93944079/axial_026.png","assets/T/mri-7fa3212a93944079/axial_028.png","assets/T/mri-7fa3212a93944079/axial_030.png","assets/T/mri-7fa3212a93944079/axial_032.png","assets/T/mri-7fa3212a93944079/axial_034.png","assets/T/mri-7fa3212a93944079/axial_036.png","assets/T/mri-7fa3212a93944079/axial_038.png","assets/T/mri-7fa3212a93944079/axial_040.png","assets/T/mri-7fa3212a93944079/coronal_001.png","assets/T/mri-7fa3212a93944079/coronal_003.png","assets/T/mri-7fa3212a93944079/coronal_005.png","assets/T/mri-7fa3212a93944079/coronal_007.png","assets/T/mri-7fa3212a93944079/coronal_009.png","assets/T/mri-7fa3212a93944079/coronal_011.png","assets/T/mri-7fa3212a93944079/coronal_014.png","assets/T/mri-7fa3212a93944079/coronal_016.png","assets/T/mri-7fa3212a93944079/coronal_018.png","assets/T/mri-7fa3212a93944079/coronal_020.png","assets/T/mri-7fa3212a93944079/coronal_022.png","assets/T/mri-7fa3212a93944079/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-f3694da4bfe340dd","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-f3694da4bfe340dd/axial_001.png","assets/T/mri-f3694da4bfe340dd/axial_003.png","assets/T/mri-f3694da4bfe340dd/axial_005.png","assets/T/mri-f3694da4bfe340dd/axial_007.png","assets/T/mri-f3694da4bfe340dd/axial_009.png","assets/T/mri-f3694da4bfe340dd/axial_011.png","assets/T/mri-f3694da4bfe340dd/axial_013.png","assets/T/mri-f3694da4bfe340dd/axial_015.png","assets/T/mri-f3694da4bfe340dd/axial_017.png","assets/T/mri-f3694da4bfe340dd/axial_019.png","assets/T/mri-f3694da4bfe340dd/axial_021.png","assets/T/mri-f3694da4bfe340dd/axial_022.png","assets/T/mri-f3694da4bfe340dd/axial_024.png","assets/T/mri-f3694da4bfe340dd/axial_026.png","assets/T/mri-f3694da4bfe340dd/axial_028.png","assets/T/mri-f3694da4bfe340dd/axial_030.png","assets/T/mri-f3694da4bfe340dd/axial_032.png","assets/T/mri-f3694da4bfe340dd/axial_034.png","assets/T/mri-f3694da4bfe340dd/axial_036.png","assets/T/mri-f3694da4bfe340dd/axial_038.png","assets/T/mri-f3694da4bfe340dd/axial_040.png","assets/T/mri-f3694da4bfe340dd/coronal_001.png","assets/T/mri-f3694da4bfe340dd/coronal_003.png","assets/T/mri-f3694da4bfe340dd/coronal_005.png","assets/T/mri-f3694da4bfe340dd/coronal_007.png","assets/T/mri-f3694da4bfe340dd/coronal_009.png","assets/T/mri-f3694da4bfe340dd/coronal_011.png","assets/T/mri-f3694da4bfe340dd/coronal_014.png","assets/T/mri-f3694da4bfe340dd/coronal_016.png","assets/T/mri-f3694da4bfe340dd/coronal_018.png","assets/T/mri-f3694da4bfe340dd/coronal_020.png","assets/T/mri-f3694da4bfe340dd/coronal_022.png","assets/T/mri-f3694da4bfe340dd/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-d642a887db8749e7","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 13 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-d642a887db8749e7/axial_001.png","assets/T/mri-d642a887db8749e7/axial_003.png","assets/T/mri-d642a887db8749e7/axial_005.png","assets/T/mri-d642a887db8749e7/axial_007.png","assets/T/mri-d642a887db8749e7/axial_009.png","assets/T/mri-d642a887db8749e7/axial_011.png","assets/T/mri-d642a887db8749e7/axial_013.png","assets/T/mri-d642a887db8749e7/axial_015.png","assets/T/mri-d642a887db8749e7/axial_017.png","assets/T/mri-d642a887db8749e7/axial_019.png","assets/T/mri-d642a887db8749e7/axial_022.png","assets/T/mri-d642a887db8749e7/axial_024.png","assets/T/mri-d642a887db8749e7/axial_026.png","assets/T/mri-d642a887db8749e7/axial_028.png","assets/T/mri-d642a887db8749e7/axial_030.png","assets/T/mri-d642a887db8749e7/axial_032.png","assets/T/mri-d642a887db8749e7/axial_034.png","assets/T/mri-d642a887db8749e7/axial_036.png","assets/T/mri-d642a887db8749e7/axial_038.png","assets/T/mri-d642a887db8749e7/axial_040.png","assets/T/mri-d642a887db8749e7/coronal_001.png","assets/T/mri-d642a887db8749e7/coronal_003.png","assets/T/mri-d642a887db8749e7/coronal_005.png","assets/T/mri-d642a887db8749e7/coronal_007.png","assets/T/mri-d642a887db8749e7/coronal_009.png","assets/T/mri-d642a887db8749e7/coronal_011.png","assets/T/mri-d642a887db8749e7/coronal_014.png","assets/T/mri-d642a887db8749e7/coronal_016.png","assets/T/mri-d642a887db8749e7/coronal_018.png","assets/T/mri-d642a887db8749e7/coronal_020.png","assets/T/mri-d642a887db8749e7/coronal_022.png","assets/T/mri-d642a887db8749e7/coronal_024.png","assets/T/mri-d642a887db8749e7/coronal_026.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-7cb6b3bc5a694c2f","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-7cb6b3bc5a694c2f/axial_001.png","assets/T/mri-7cb6b3bc5a694c2f/axial_003.png","assets/T/mri-7cb6b3bc5a694c2f/axial_005.png","assets/T/mri-7cb6b3bc5a694c2f/axial_007.png","assets/T/mri-7cb6b3bc5a694c2f/axial_009.png","assets/T/mri-7cb6b3bc5a694c2f/axial_011.png","assets/T/mri-7cb6b3bc5a694c2f/axial_013.png","assets/T/mri-7cb6b3bc5a694c2f/axial_015.png","assets/T/mri-7cb6b3bc5a694c2f/axial_017.png","assets/T/mri-7cb6b3bc5a694c2f/axial_019.png","assets/T/mri-7cb6b3bc5a694c2f/axial_021.png","assets/T/mri-7cb6b3bc5a694c2f/axial_022.png","assets/T/mri-7cb6b3bc5a694c2f/axial_024.png","assets/T/mri-7cb6b3bc5a694c2f/axial_026.png","assets/T/mri-7cb6b3bc5a694c2f/axial_028.png","assets/T/mri-7cb6b3bc5a694c2f/axial_030.png","assets/T/mri-7cb6b3bc5a694c2f/axial_032.png","assets/T/mri-7cb6b3bc5a694c2f/axial_034.png","assets/T/mri-7cb6b3bc5a694c2f/axial_036.png","assets/T/mri-7cb6b3bc5a694c2f/axial_038.png","assets/T/mri-7cb6b3bc5a694c2f/axial_040.png","assets/T/mri-7cb6b3bc5a694c2f/coronal_001.png","assets/T/mri-7cb6b3bc5a694c2f/coronal_003.png","assets/T/mri-7cb6b3bc5a694c2f/coronal_005.png","assets/T/mri-7cb6b3bc5a694c2f/coronal_007.png","assets/T/mri-7cb6b3bc5a694c2f/coronal_009.png","assets/T/mri-7cb6b3bc5a694c2f/coronal_011.png","assets/T/mri-7cb6b3bc5a694c2f/coronal_014.png","assets/T/mri-7cb6b3bc5a694c2f/coronal_016.png","assets/T/mri-7cb6b3bc5a694c2f/coronal_018.png","assets/T/mri-7cb6b3bc5a694c2f/coronal_020.png","assets/T/mri-7cb6b3bc5a694c2f/coronal_022.png","assets/T/mri-7cb6b3bc5a694c2f/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-1174f5a99f0e400b","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-1174f5a99f0e400b/axial_001.png","assets/T/mri-1174f5a99f0e400b/axial_003.png","assets/T/mri-1174f5a99f0e400b/axial_005.png","assets/T/mri-1174f5a99f0e400b/axial_007.png","assets/T/mri-1174f5a99f0e400b/axial_009.png","assets/T/mri-1174f5a99f0e400b/axial_011.png","assets/T/mri-1174f5a99f0e400b/axial_013.png","assets/T/mri-1174f5a99f0e400b/axial_015.png","assets/T/mri-1174f5a99f0e400b/axial_017.png","assets/T/mri-1174f5a99f0e400b/axial_019.png","assets/T/mri-1174f5a99f0e400b/axial_022.png","assets/T/mri-1174f5a99f0e400b/axial_024.png","assets/T/mri-1174f5a99f0e400b/axial_026.png","assets/T/mri-1174f5a99f0e400b/axial_028.png","assets/T/mri-1174f5a99f0e400b/axial_030.png","assets/T/mri-1174f5a99f0e400b/axial_032.png","assets/T/mri-1174f5a99f0e400b/axial_034.png","assets/T/mri-1174f5a99f0e400b/axial_036.png","assets/T/mri-1174f5a99f0e400b/axial_038.png","assets/T/mri-1174f5a99f0e400b/axial_040.png","assets/T/mri-1174f5a99f0e400b/axial_042.png","assets/T/mri-1174f5a99f0e400b/coronal_001.png","assets/T/mri-1174f5a99f0e400b/coronal_003.png","assets/T/mri-1174f5a99f0e400b/coronal_005.png","assets/T/mri-1174f5a99f0e400b/coronal_007.png","assets/T/mri-1174f5a99f0e400b/coronal_009.png","assets/T/mri-1174f5a99f0e400b/coronal_011.png","assets/T/mri-1174f5a99f0e400b/coronal_014.png","assets/T/mri-1174f5a99f0e400b/coronal_016.png","assets/T/mri-1174f5a99f0e400b/coronal_018.png","assets/T/mri-1174f5a99f0e400b/coronal_020.png","assets/T/mri-1174f5a99f0e400b/coronal_022.png","assets/T/mri-1174f5a99f0e400b/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-1c71d049f590457f","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 13 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-1c71d049f590457f/axial_001.png","assets/T/mri-1c71d049f590457f/axial_003.png","assets/T/mri-1c71d049f590457f/axial_006.png","assets/T/mri-1c71d049f590457f/axial_008.png","assets/T/mri-1c71d049f590457f/axial_010.png","assets/T/mri-1c71d049f590457f/axial_012.png","assets/T/mri-1c71d049f590457f/axial_015.png","assets/T/mri-1c71d049f590457f/axial_017.png","assets/T/mri-1c71d049f590457f/axial_019.png","assets/T/mri-1c71d049f590457f/axial_021.png","assets/T/mri-1c71d049f590457f/axial_024.png","assets/T/mri-1c71d049f590457f/axial_026.png","assets/T/mri-1c71d049f590457f/axial_028.png","assets/T/mri-1c71d049f590457f/axial_030.png","assets/T/mri-1c71d049f590457f/axial_033.png","assets/T/mri-1c71d049f590457f/axial_035.png","assets/T/mri-1c71d049f590457f/axial_037.png","assets/T/mri-1c71d049f590457f/axial_039.png","assets/T/mri-1c71d049f590457f/axial_042.png","assets/T/mri-1c71d049f590457f/axial_044.png","assets/T/mri-1c71d049f590457f/coronal_001.png","assets/T/mri-1c71d049f590457f/coronal_003.png","assets/T/mri-1c71d049f590457f/coronal_006.png","assets/T/mri-1c71d049f590457f/coronal_008.png","assets/T/mri-1c71d049f590457f/coronal_010.png","assets/T/mri-1c71d049f590457f/coronal_012.png","assets/T/mri-1c71d049f590457f/coronal_015.png","assets/T/mri-1c71d049f590457f/coronal_017.png","assets/T/mri-1c71d049f590457f/coronal_019.png","assets/T/mri-1c71d049f590457f/coronal_021.png","assets/T/mri-1c71d049f590457f/coronal_024.png","assets/T/mri-1c71d049f590457f/coronal_026.png","assets/T/mri-1c71d049f590457f/coronal_028.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":72,"selected_count":33,"source_indices_1based":[1,3,6,8,10,12,15,17,19,21,24,26,28,30,33,35,37,39,42,44,45,47,50,52,54,56,59,61,63,65,68,70,72]}}
+{"id":"L3-T300:mri-dc051be38c594e64","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-dc051be38c594e64/axial_001.png","assets/T/mri-dc051be38c594e64/axial_003.png","assets/T/mri-dc051be38c594e64/axial_005.png","assets/T/mri-dc051be38c594e64/axial_007.png","assets/T/mri-dc051be38c594e64/axial_009.png","assets/T/mri-dc051be38c594e64/axial_011.png","assets/T/mri-dc051be38c594e64/axial_013.png","assets/T/mri-dc051be38c594e64/axial_015.png","assets/T/mri-dc051be38c594e64/axial_017.png","assets/T/mri-dc051be38c594e64/axial_019.png","assets/T/mri-dc051be38c594e64/axial_021.png","assets/T/mri-dc051be38c594e64/axial_022.png","assets/T/mri-dc051be38c594e64/axial_024.png","assets/T/mri-dc051be38c594e64/axial_026.png","assets/T/mri-dc051be38c594e64/axial_028.png","assets/T/mri-dc051be38c594e64/axial_030.png","assets/T/mri-dc051be38c594e64/axial_032.png","assets/T/mri-dc051be38c594e64/axial_034.png","assets/T/mri-dc051be38c594e64/axial_036.png","assets/T/mri-dc051be38c594e64/axial_038.png","assets/T/mri-dc051be38c594e64/axial_040.png","assets/T/mri-dc051be38c594e64/coronal_001.png","assets/T/mri-dc051be38c594e64/coronal_003.png","assets/T/mri-dc051be38c594e64/coronal_005.png","assets/T/mri-dc051be38c594e64/coronal_007.png","assets/T/mri-dc051be38c594e64/coronal_009.png","assets/T/mri-dc051be38c594e64/coronal_011.png","assets/T/mri-dc051be38c594e64/coronal_014.png","assets/T/mri-dc051be38c594e64/coronal_016.png","assets/T/mri-dc051be38c594e64/coronal_018.png","assets/T/mri-dc051be38c594e64/coronal_020.png","assets/T/mri-dc051be38c594e64/coronal_022.png","assets/T/mri-dc051be38c594e64/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-7b8493c771024704","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-7b8493c771024704/axial_001.png","assets/T/mri-7b8493c771024704/axial_003.png","assets/T/mri-7b8493c771024704/axial_005.png","assets/T/mri-7b8493c771024704/axial_007.png","assets/T/mri-7b8493c771024704/axial_010.png","assets/T/mri-7b8493c771024704/axial_012.png","assets/T/mri-7b8493c771024704/axial_014.png","assets/T/mri-7b8493c771024704/axial_016.png","assets/T/mri-7b8493c771024704/axial_018.png","assets/T/mri-7b8493c771024704/axial_020.png","assets/T/mri-7b8493c771024704/axial_023.png","assets/T/mri-7b8493c771024704/axial_025.png","assets/T/mri-7b8493c771024704/axial_027.png","assets/T/mri-7b8493c771024704/axial_029.png","assets/T/mri-7b8493c771024704/axial_031.png","assets/T/mri-7b8493c771024704/axial_033.png","assets/T/mri-7b8493c771024704/axial_035.png","assets/T/mri-7b8493c771024704/axial_038.png","assets/T/mri-7b8493c771024704/axial_040.png","assets/T/mri-7b8493c771024704/axial_042.png","assets/T/mri-7b8493c771024704/axial_044.png","assets/T/mri-7b8493c771024704/coronal_001.png","assets/T/mri-7b8493c771024704/coronal_003.png","assets/T/mri-7b8493c771024704/coronal_005.png","assets/T/mri-7b8493c771024704/coronal_007.png","assets/T/mri-7b8493c771024704/coronal_009.png","assets/T/mri-7b8493c771024704/coronal_011.png","assets/T/mri-7b8493c771024704/coronal_014.png","assets/T/mri-7b8493c771024704/coronal_016.png","assets/T/mri-7b8493c771024704/coronal_018.png","assets/T/mri-7b8493c771024704/coronal_020.png","assets/T/mri-7b8493c771024704/coronal_022.png","assets/T/mri-7b8493c771024704/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":68,"selected_count":33,"source_indices_1based":[1,3,5,7,10,12,14,16,18,20,23,25,27,29,31,33,35,38,40,42,44,45,47,49,51,53,55,58,60,62,64,66,68]}}
+{"id":"L3-T300:mri-5ce68cec7138451f","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-5ce68cec7138451f/axial_001.png","assets/T/mri-5ce68cec7138451f/axial_003.png","assets/T/mri-5ce68cec7138451f/axial_005.png","assets/T/mri-5ce68cec7138451f/axial_007.png","assets/T/mri-5ce68cec7138451f/axial_009.png","assets/T/mri-5ce68cec7138451f/axial_011.png","assets/T/mri-5ce68cec7138451f/axial_013.png","assets/T/mri-5ce68cec7138451f/axial_015.png","assets/T/mri-5ce68cec7138451f/axial_017.png","assets/T/mri-5ce68cec7138451f/axial_019.png","assets/T/mri-5ce68cec7138451f/axial_022.png","assets/T/mri-5ce68cec7138451f/axial_024.png","assets/T/mri-5ce68cec7138451f/axial_026.png","assets/T/mri-5ce68cec7138451f/axial_028.png","assets/T/mri-5ce68cec7138451f/axial_030.png","assets/T/mri-5ce68cec7138451f/axial_032.png","assets/T/mri-5ce68cec7138451f/axial_034.png","assets/T/mri-5ce68cec7138451f/axial_036.png","assets/T/mri-5ce68cec7138451f/axial_038.png","assets/T/mri-5ce68cec7138451f/axial_040.png","assets/T/mri-5ce68cec7138451f/axial_042.png","assets/T/mri-5ce68cec7138451f/coronal_001.png","assets/T/mri-5ce68cec7138451f/coronal_003.png","assets/T/mri-5ce68cec7138451f/coronal_005.png","assets/T/mri-5ce68cec7138451f/coronal_007.png","assets/T/mri-5ce68cec7138451f/coronal_009.png","assets/T/mri-5ce68cec7138451f/coronal_011.png","assets/T/mri-5ce68cec7138451f/coronal_014.png","assets/T/mri-5ce68cec7138451f/coronal_016.png","assets/T/mri-5ce68cec7138451f/coronal_018.png","assets/T/mri-5ce68cec7138451f/coronal_020.png","assets/T/mri-5ce68cec7138451f/coronal_022.png","assets/T/mri-5ce68cec7138451f/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-64b88c007f454cd4","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-64b88c007f454cd4/axial_001.png","assets/T/mri-64b88c007f454cd4/axial_003.png","assets/T/mri-64b88c007f454cd4/axial_005.png","assets/T/mri-64b88c007f454cd4/axial_007.png","assets/T/mri-64b88c007f454cd4/axial_009.png","assets/T/mri-64b88c007f454cd4/axial_011.png","assets/T/mri-64b88c007f454cd4/axial_013.png","assets/T/mri-64b88c007f454cd4/axial_015.png","assets/T/mri-64b88c007f454cd4/axial_017.png","assets/T/mri-64b88c007f454cd4/axial_019.png","assets/T/mri-64b88c007f454cd4/axial_022.png","assets/T/mri-64b88c007f454cd4/axial_024.png","assets/T/mri-64b88c007f454cd4/axial_026.png","assets/T/mri-64b88c007f454cd4/axial_028.png","assets/T/mri-64b88c007f454cd4/axial_030.png","assets/T/mri-64b88c007f454cd4/axial_032.png","assets/T/mri-64b88c007f454cd4/axial_034.png","assets/T/mri-64b88c007f454cd4/axial_036.png","assets/T/mri-64b88c007f454cd4/axial_038.png","assets/T/mri-64b88c007f454cd4/axial_040.png","assets/T/mri-64b88c007f454cd4/axial_042.png","assets/T/mri-64b88c007f454cd4/coronal_001.png","assets/T/mri-64b88c007f454cd4/coronal_003.png","assets/T/mri-64b88c007f454cd4/coronal_005.png","assets/T/mri-64b88c007f454cd4/coronal_008.png","assets/T/mri-64b88c007f454cd4/coronal_010.png","assets/T/mri-64b88c007f454cd4/coronal_012.png","assets/T/mri-64b88c007f454cd4/coronal_014.png","assets/T/mri-64b88c007f454cd4/coronal_016.png","assets/T/mri-64b88c007f454cd4/coronal_018.png","assets/T/mri-64b88c007f454cd4/coronal_021.png","assets/T/mri-64b88c007f454cd4/coronal_023.png","assets/T/mri-64b88c007f454cd4/coronal_025.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":67,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,50,52,54,56,58,60,63,65,67]}}
+{"id":"L3-T300:mri-94083fb208a0400d","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-94083fb208a0400d/axial_001.png","assets/T/mri-94083fb208a0400d/axial_003.png","assets/T/mri-94083fb208a0400d/axial_005.png","assets/T/mri-94083fb208a0400d/axial_007.png","assets/T/mri-94083fb208a0400d/axial_009.png","assets/T/mri-94083fb208a0400d/axial_011.png","assets/T/mri-94083fb208a0400d/axial_013.png","assets/T/mri-94083fb208a0400d/axial_015.png","assets/T/mri-94083fb208a0400d/axial_017.png","assets/T/mri-94083fb208a0400d/axial_019.png","assets/T/mri-94083fb208a0400d/axial_021.png","assets/T/mri-94083fb208a0400d/axial_022.png","assets/T/mri-94083fb208a0400d/axial_024.png","assets/T/mri-94083fb208a0400d/axial_026.png","assets/T/mri-94083fb208a0400d/axial_028.png","assets/T/mri-94083fb208a0400d/axial_030.png","assets/T/mri-94083fb208a0400d/axial_032.png","assets/T/mri-94083fb208a0400d/axial_034.png","assets/T/mri-94083fb208a0400d/axial_036.png","assets/T/mri-94083fb208a0400d/axial_038.png","assets/T/mri-94083fb208a0400d/axial_040.png","assets/T/mri-94083fb208a0400d/coronal_001.png","assets/T/mri-94083fb208a0400d/coronal_003.png","assets/T/mri-94083fb208a0400d/coronal_005.png","assets/T/mri-94083fb208a0400d/coronal_007.png","assets/T/mri-94083fb208a0400d/coronal_009.png","assets/T/mri-94083fb208a0400d/coronal_011.png","assets/T/mri-94083fb208a0400d/coronal_014.png","assets/T/mri-94083fb208a0400d/coronal_016.png","assets/T/mri-94083fb208a0400d/coronal_018.png","assets/T/mri-94083fb208a0400d/coronal_020.png","assets/T/mri-94083fb208a0400d/coronal_022.png","assets/T/mri-94083fb208a0400d/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-0671b570b9dd4f82","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 13 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-0671b570b9dd4f82/axial_001.png","assets/T/mri-0671b570b9dd4f82/axial_003.png","assets/T/mri-0671b570b9dd4f82/axial_005.png","assets/T/mri-0671b570b9dd4f82/axial_007.png","assets/T/mri-0671b570b9dd4f82/axial_009.png","assets/T/mri-0671b570b9dd4f82/axial_011.png","assets/T/mri-0671b570b9dd4f82/axial_013.png","assets/T/mri-0671b570b9dd4f82/axial_015.png","assets/T/mri-0671b570b9dd4f82/axial_017.png","assets/T/mri-0671b570b9dd4f82/axial_019.png","assets/T/mri-0671b570b9dd4f82/axial_020.png","assets/T/mri-0671b570b9dd4f82/axial_022.png","assets/T/mri-0671b570b9dd4f82/axial_024.png","assets/T/mri-0671b570b9dd4f82/axial_026.png","assets/T/mri-0671b570b9dd4f82/axial_028.png","assets/T/mri-0671b570b9dd4f82/axial_030.png","assets/T/mri-0671b570b9dd4f82/axial_032.png","assets/T/mri-0671b570b9dd4f82/axial_034.png","assets/T/mri-0671b570b9dd4f82/axial_036.png","assets/T/mri-0671b570b9dd4f82/axial_038.png","assets/T/mri-0671b570b9dd4f82/coronal_001.png","assets/T/mri-0671b570b9dd4f82/coronal_003.png","assets/T/mri-0671b570b9dd4f82/coronal_005.png","assets/T/mri-0671b570b9dd4f82/coronal_007.png","assets/T/mri-0671b570b9dd4f82/coronal_009.png","assets/T/mri-0671b570b9dd4f82/coronal_011.png","assets/T/mri-0671b570b9dd4f82/coronal_013.png","assets/T/mri-0671b570b9dd4f82/coronal_014.png","assets/T/mri-0671b570b9dd4f82/coronal_016.png","assets/T/mri-0671b570b9dd4f82/coronal_018.png","assets/T/mri-0671b570b9dd4f82/coronal_020.png","assets/T/mri-0671b570b9dd4f82/coronal_022.png","assets/T/mri-0671b570b9dd4f82/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":62,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,20,22,24,26,28,30,32,34,36,38,39,41,43,45,47,49,51,52,54,56,58,60,62]}}
+{"id":"L3-T300:mri-2571bcb8b69c4c36","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 34 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 14 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-2571bcb8b69c4c36/axial_001.png","assets/T/mri-2571bcb8b69c4c36/axial_003.png","assets/T/mri-2571bcb8b69c4c36/axial_005.png","assets/T/mri-2571bcb8b69c4c36/axial_007.png","assets/T/mri-2571bcb8b69c4c36/axial_010.png","assets/T/mri-2571bcb8b69c4c36/axial_012.png","assets/T/mri-2571bcb8b69c4c36/axial_014.png","assets/T/mri-2571bcb8b69c4c36/axial_016.png","assets/T/mri-2571bcb8b69c4c36/axial_018.png","assets/T/mri-2571bcb8b69c4c36/axial_020.png","assets/T/mri-2571bcb8b69c4c36/axial_023.png","assets/T/mri-2571bcb8b69c4c36/axial_025.png","assets/T/mri-2571bcb8b69c4c36/axial_027.png","assets/T/mri-2571bcb8b69c4c36/axial_029.png","assets/T/mri-2571bcb8b69c4c36/axial_031.png","assets/T/mri-2571bcb8b69c4c36/axial_033.png","assets/T/mri-2571bcb8b69c4c36/axial_036.png","assets/T/mri-2571bcb8b69c4c36/axial_038.png","assets/T/mri-2571bcb8b69c4c36/axial_040.png","assets/T/mri-2571bcb8b69c4c36/axial_042.png","assets/T/mri-2571bcb8b69c4c36/coronal_001.png","assets/T/mri-2571bcb8b69c4c36/coronal_003.png","assets/T/mri-2571bcb8b69c4c36/coronal_005.png","assets/T/mri-2571bcb8b69c4c36/coronal_008.png","assets/T/mri-2571bcb8b69c4c36/coronal_010.png","assets/T/mri-2571bcb8b69c4c36/coronal_012.png","assets/T/mri-2571bcb8b69c4c36/coronal_014.png","assets/T/mri-2571bcb8b69c4c36/coronal_017.png","assets/T/mri-2571bcb8b69c4c36/coronal_019.png","assets/T/mri-2571bcb8b69c4c36/coronal_021.png","assets/T/mri-2571bcb8b69c4c36/coronal_023.png","assets/T/mri-2571bcb8b69c4c36/coronal_026.png","assets/T/mri-2571bcb8b69c4c36/coronal_028.png","assets/T/mri-2571bcb8b69c4c36/coronal_030.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":72,"selected_count":34,"source_indices_1based":[1,3,5,7,10,12,14,16,18,20,23,25,27,29,31,33,36,38,40,42,43,45,47,50,52,54,56,59,61,63,65,68,70,72]}}
+{"id":"L3-T300:mri-5fc5c21fa8b64c4f","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 13 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-5fc5c21fa8b64c4f/axial_001.png","assets/T/mri-5fc5c21fa8b64c4f/axial_003.png","assets/T/mri-5fc5c21fa8b64c4f/axial_005.png","assets/T/mri-5fc5c21fa8b64c4f/axial_007.png","assets/T/mri-5fc5c21fa8b64c4f/axial_010.png","assets/T/mri-5fc5c21fa8b64c4f/axial_012.png","assets/T/mri-5fc5c21fa8b64c4f/axial_014.png","assets/T/mri-5fc5c21fa8b64c4f/axial_016.png","assets/T/mri-5fc5c21fa8b64c4f/axial_018.png","assets/T/mri-5fc5c21fa8b64c4f/axial_020.png","assets/T/mri-5fc5c21fa8b64c4f/axial_023.png","assets/T/mri-5fc5c21fa8b64c4f/axial_025.png","assets/T/mri-5fc5c21fa8b64c4f/axial_027.png","assets/T/mri-5fc5c21fa8b64c4f/axial_029.png","assets/T/mri-5fc5c21fa8b64c4f/axial_031.png","assets/T/mri-5fc5c21fa8b64c4f/axial_033.png","assets/T/mri-5fc5c21fa8b64c4f/axial_036.png","assets/T/mri-5fc5c21fa8b64c4f/axial_038.png","assets/T/mri-5fc5c21fa8b64c4f/axial_040.png","assets/T/mri-5fc5c21fa8b64c4f/axial_042.png","assets/T/mri-5fc5c21fa8b64c4f/coronal_001.png","assets/T/mri-5fc5c21fa8b64c4f/coronal_003.png","assets/T/mri-5fc5c21fa8b64c4f/coronal_005.png","assets/T/mri-5fc5c21fa8b64c4f/coronal_007.png","assets/T/mri-5fc5c21fa8b64c4f/coronal_009.png","assets/T/mri-5fc5c21fa8b64c4f/coronal_011.png","assets/T/mri-5fc5c21fa8b64c4f/coronal_014.png","assets/T/mri-5fc5c21fa8b64c4f/coronal_016.png","assets/T/mri-5fc5c21fa8b64c4f/coronal_018.png","assets/T/mri-5fc5c21fa8b64c4f/coronal_020.png","assets/T/mri-5fc5c21fa8b64c4f/coronal_022.png","assets/T/mri-5fc5c21fa8b64c4f/coronal_024.png","assets/T/mri-5fc5c21fa8b64c4f/coronal_026.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":68,"selected_count":33,"source_indices_1based":[1,3,5,7,10,12,14,16,18,20,23,25,27,29,31,33,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66,68]}}
+{"id":"L3-T300:mri-cc1823e862844adb","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-cc1823e862844adb/axial_001.png","assets/T/mri-cc1823e862844adb/axial_003.png","assets/T/mri-cc1823e862844adb/axial_005.png","assets/T/mri-cc1823e862844adb/axial_007.png","assets/T/mri-cc1823e862844adb/axial_009.png","assets/T/mri-cc1823e862844adb/axial_011.png","assets/T/mri-cc1823e862844adb/axial_013.png","assets/T/mri-cc1823e862844adb/axial_015.png","assets/T/mri-cc1823e862844adb/axial_017.png","assets/T/mri-cc1823e862844adb/axial_019.png","assets/T/mri-cc1823e862844adb/axial_022.png","assets/T/mri-cc1823e862844adb/axial_024.png","assets/T/mri-cc1823e862844adb/axial_026.png","assets/T/mri-cc1823e862844adb/axial_028.png","assets/T/mri-cc1823e862844adb/axial_030.png","assets/T/mri-cc1823e862844adb/axial_032.png","assets/T/mri-cc1823e862844adb/axial_034.png","assets/T/mri-cc1823e862844adb/axial_036.png","assets/T/mri-cc1823e862844adb/axial_038.png","assets/T/mri-cc1823e862844adb/axial_040.png","assets/T/mri-cc1823e862844adb/axial_042.png","assets/T/mri-cc1823e862844adb/coronal_001.png","assets/T/mri-cc1823e862844adb/coronal_003.png","assets/T/mri-cc1823e862844adb/coronal_005.png","assets/T/mri-cc1823e862844adb/coronal_007.png","assets/T/mri-cc1823e862844adb/coronal_009.png","assets/T/mri-cc1823e862844adb/coronal_011.png","assets/T/mri-cc1823e862844adb/coronal_014.png","assets/T/mri-cc1823e862844adb/coronal_016.png","assets/T/mri-cc1823e862844adb/coronal_018.png","assets/T/mri-cc1823e862844adb/coronal_020.png","assets/T/mri-cc1823e862844adb/coronal_022.png","assets/T/mri-cc1823e862844adb/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-2827a4219010408d","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 34 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 14 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-2827a4219010408d/axial_001.png","assets/T/mri-2827a4219010408d/axial_003.png","assets/T/mri-2827a4219010408d/axial_005.png","assets/T/mri-2827a4219010408d/axial_007.png","assets/T/mri-2827a4219010408d/axial_008.png","assets/T/mri-2827a4219010408d/axial_010.png","assets/T/mri-2827a4219010408d/axial_012.png","assets/T/mri-2827a4219010408d/axial_014.png","assets/T/mri-2827a4219010408d/axial_016.png","assets/T/mri-2827a4219010408d/axial_018.png","assets/T/mri-2827a4219010408d/axial_019.png","assets/T/mri-2827a4219010408d/axial_021.png","assets/T/mri-2827a4219010408d/axial_023.png","assets/T/mri-2827a4219010408d/axial_025.png","assets/T/mri-2827a4219010408d/axial_027.png","assets/T/mri-2827a4219010408d/axial_029.png","assets/T/mri-2827a4219010408d/axial_030.png","assets/T/mri-2827a4219010408d/axial_032.png","assets/T/mri-2827a4219010408d/axial_034.png","assets/T/mri-2827a4219010408d/axial_036.png","assets/T/mri-2827a4219010408d/coronal_001.png","assets/T/mri-2827a4219010408d/coronal_003.png","assets/T/mri-2827a4219010408d/coronal_005.png","assets/T/mri-2827a4219010408d/coronal_006.png","assets/T/mri-2827a4219010408d/coronal_008.png","assets/T/mri-2827a4219010408d/coronal_010.png","assets/T/mri-2827a4219010408d/coronal_012.png","assets/T/mri-2827a4219010408d/coronal_013.png","assets/T/mri-2827a4219010408d/coronal_015.png","assets/T/mri-2827a4219010408d/coronal_017.png","assets/T/mri-2827a4219010408d/coronal_019.png","assets/T/mri-2827a4219010408d/coronal_020.png","assets/T/mri-2827a4219010408d/coronal_022.png","assets/T/mri-2827a4219010408d/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":60,"selected_count":34,"source_indices_1based":[1,3,5,7,8,10,12,14,16,18,19,21,23,25,27,29,30,32,34,36,37,39,41,42,44,46,48,49,51,53,55,56,58,60]}}
+{"id":"L3-T300:mri-814687fc8a704a75","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-814687fc8a704a75/axial_001.png","assets/T/mri-814687fc8a704a75/axial_003.png","assets/T/mri-814687fc8a704a75/axial_005.png","assets/T/mri-814687fc8a704a75/axial_007.png","assets/T/mri-814687fc8a704a75/axial_010.png","assets/T/mri-814687fc8a704a75/axial_012.png","assets/T/mri-814687fc8a704a75/axial_014.png","assets/T/mri-814687fc8a704a75/axial_016.png","assets/T/mri-814687fc8a704a75/axial_018.png","assets/T/mri-814687fc8a704a75/axial_020.png","assets/T/mri-814687fc8a704a75/axial_023.png","assets/T/mri-814687fc8a704a75/axial_025.png","assets/T/mri-814687fc8a704a75/axial_027.png","assets/T/mri-814687fc8a704a75/axial_029.png","assets/T/mri-814687fc8a704a75/axial_031.png","assets/T/mri-814687fc8a704a75/axial_033.png","assets/T/mri-814687fc8a704a75/axial_035.png","assets/T/mri-814687fc8a704a75/axial_038.png","assets/T/mri-814687fc8a704a75/axial_040.png","assets/T/mri-814687fc8a704a75/axial_042.png","assets/T/mri-814687fc8a704a75/axial_044.png","assets/T/mri-814687fc8a704a75/coronal_001.png","assets/T/mri-814687fc8a704a75/coronal_003.png","assets/T/mri-814687fc8a704a75/coronal_005.png","assets/T/mri-814687fc8a704a75/coronal_007.png","assets/T/mri-814687fc8a704a75/coronal_009.png","assets/T/mri-814687fc8a704a75/coronal_011.png","assets/T/mri-814687fc8a704a75/coronal_014.png","assets/T/mri-814687fc8a704a75/coronal_016.png","assets/T/mri-814687fc8a704a75/coronal_018.png","assets/T/mri-814687fc8a704a75/coronal_020.png","assets/T/mri-814687fc8a704a75/coronal_022.png","assets/T/mri-814687fc8a704a75/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":68,"selected_count":33,"source_indices_1based":[1,3,5,7,10,12,14,16,18,20,23,25,27,29,31,33,35,38,40,42,44,45,47,49,51,53,55,58,60,62,64,66,68]}}
+{"id":"L3-T300:mri-2cce79e2ec6f4326","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-2cce79e2ec6f4326/axial_001.png","assets/T/mri-2cce79e2ec6f4326/axial_003.png","assets/T/mri-2cce79e2ec6f4326/axial_005.png","assets/T/mri-2cce79e2ec6f4326/axial_007.png","assets/T/mri-2cce79e2ec6f4326/axial_009.png","assets/T/mri-2cce79e2ec6f4326/axial_011.png","assets/T/mri-2cce79e2ec6f4326/axial_013.png","assets/T/mri-2cce79e2ec6f4326/axial_015.png","assets/T/mri-2cce79e2ec6f4326/axial_017.png","assets/T/mri-2cce79e2ec6f4326/axial_019.png","assets/T/mri-2cce79e2ec6f4326/axial_021.png","assets/T/mri-2cce79e2ec6f4326/axial_023.png","assets/T/mri-2cce79e2ec6f4326/axial_025.png","assets/T/mri-2cce79e2ec6f4326/axial_027.png","assets/T/mri-2cce79e2ec6f4326/axial_029.png","assets/T/mri-2cce79e2ec6f4326/axial_031.png","assets/T/mri-2cce79e2ec6f4326/axial_033.png","assets/T/mri-2cce79e2ec6f4326/axial_035.png","assets/T/mri-2cce79e2ec6f4326/axial_037.png","assets/T/mri-2cce79e2ec6f4326/axial_039.png","assets/T/mri-2cce79e2ec6f4326/axial_041.png","assets/T/mri-2cce79e2ec6f4326/coronal_001.png","assets/T/mri-2cce79e2ec6f4326/coronal_003.png","assets/T/mri-2cce79e2ec6f4326/coronal_005.png","assets/T/mri-2cce79e2ec6f4326/coronal_007.png","assets/T/mri-2cce79e2ec6f4326/coronal_009.png","assets/T/mri-2cce79e2ec6f4326/coronal_011.png","assets/T/mri-2cce79e2ec6f4326/coronal_014.png","assets/T/mri-2cce79e2ec6f4326/coronal_016.png","assets/T/mri-2cce79e2ec6f4326/coronal_018.png","assets/T/mri-2cce79e2ec6f4326/coronal_020.png","assets/T/mri-2cce79e2ec6f4326/coronal_022.png","assets/T/mri-2cce79e2ec6f4326/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":65,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,23,25,27,29,31,33,35,37,39,41,42,44,46,48,50,52,55,57,59,61,63,65]}}
+{"id":"L3-T300:mri-babf41133d3f434f","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-babf41133d3f434f/axial_001.png","assets/T/mri-babf41133d3f434f/axial_003.png","assets/T/mri-babf41133d3f434f/axial_005.png","assets/T/mri-babf41133d3f434f/axial_007.png","assets/T/mri-babf41133d3f434f/axial_009.png","assets/T/mri-babf41133d3f434f/axial_011.png","assets/T/mri-babf41133d3f434f/axial_013.png","assets/T/mri-babf41133d3f434f/axial_015.png","assets/T/mri-babf41133d3f434f/axial_017.png","assets/T/mri-babf41133d3f434f/axial_019.png","assets/T/mri-babf41133d3f434f/axial_022.png","assets/T/mri-babf41133d3f434f/axial_024.png","assets/T/mri-babf41133d3f434f/axial_026.png","assets/T/mri-babf41133d3f434f/axial_028.png","assets/T/mri-babf41133d3f434f/axial_030.png","assets/T/mri-babf41133d3f434f/axial_032.png","assets/T/mri-babf41133d3f434f/axial_034.png","assets/T/mri-babf41133d3f434f/axial_036.png","assets/T/mri-babf41133d3f434f/axial_038.png","assets/T/mri-babf41133d3f434f/axial_040.png","assets/T/mri-babf41133d3f434f/axial_042.png","assets/T/mri-babf41133d3f434f/coronal_001.png","assets/T/mri-babf41133d3f434f/coronal_003.png","assets/T/mri-babf41133d3f434f/coronal_005.png","assets/T/mri-babf41133d3f434f/coronal_007.png","assets/T/mri-babf41133d3f434f/coronal_009.png","assets/T/mri-babf41133d3f434f/coronal_011.png","assets/T/mri-babf41133d3f434f/coronal_014.png","assets/T/mri-babf41133d3f434f/coronal_016.png","assets/T/mri-babf41133d3f434f/coronal_018.png","assets/T/mri-babf41133d3f434f/coronal_020.png","assets/T/mri-babf41133d3f434f/coronal_022.png","assets/T/mri-babf41133d3f434f/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-839bb04435614c8f","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 13 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-839bb04435614c8f/axial_001.png","assets/T/mri-839bb04435614c8f/axial_003.png","assets/T/mri-839bb04435614c8f/axial_005.png","assets/T/mri-839bb04435614c8f/axial_007.png","assets/T/mri-839bb04435614c8f/axial_009.png","assets/T/mri-839bb04435614c8f/axial_011.png","assets/T/mri-839bb04435614c8f/axial_013.png","assets/T/mri-839bb04435614c8f/axial_015.png","assets/T/mri-839bb04435614c8f/axial_017.png","assets/T/mri-839bb04435614c8f/axial_019.png","assets/T/mri-839bb04435614c8f/axial_020.png","assets/T/mri-839bb04435614c8f/axial_022.png","assets/T/mri-839bb04435614c8f/axial_024.png","assets/T/mri-839bb04435614c8f/axial_026.png","assets/T/mri-839bb04435614c8f/axial_028.png","assets/T/mri-839bb04435614c8f/axial_030.png","assets/T/mri-839bb04435614c8f/axial_032.png","assets/T/mri-839bb04435614c8f/axial_034.png","assets/T/mri-839bb04435614c8f/axial_036.png","assets/T/mri-839bb04435614c8f/axial_038.png","assets/T/mri-839bb04435614c8f/coronal_001.png","assets/T/mri-839bb04435614c8f/coronal_003.png","assets/T/mri-839bb04435614c8f/coronal_005.png","assets/T/mri-839bb04435614c8f/coronal_007.png","assets/T/mri-839bb04435614c8f/coronal_009.png","assets/T/mri-839bb04435614c8f/coronal_011.png","assets/T/mri-839bb04435614c8f/coronal_013.png","assets/T/mri-839bb04435614c8f/coronal_014.png","assets/T/mri-839bb04435614c8f/coronal_016.png","assets/T/mri-839bb04435614c8f/coronal_018.png","assets/T/mri-839bb04435614c8f/coronal_020.png","assets/T/mri-839bb04435614c8f/coronal_022.png","assets/T/mri-839bb04435614c8f/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":62,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,20,22,24,26,28,30,32,34,36,38,39,41,43,45,47,49,51,52,54,56,58,60,62]}}
+{"id":"L3-T300:mri-40c6389b9ccc4000","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-40c6389b9ccc4000/axial_001.png","assets/T/mri-40c6389b9ccc4000/axial_003.png","assets/T/mri-40c6389b9ccc4000/axial_005.png","assets/T/mri-40c6389b9ccc4000/axial_007.png","assets/T/mri-40c6389b9ccc4000/axial_009.png","assets/T/mri-40c6389b9ccc4000/axial_011.png","assets/T/mri-40c6389b9ccc4000/axial_013.png","assets/T/mri-40c6389b9ccc4000/axial_015.png","assets/T/mri-40c6389b9ccc4000/axial_017.png","assets/T/mri-40c6389b9ccc4000/axial_019.png","assets/T/mri-40c6389b9ccc4000/axial_021.png","assets/T/mri-40c6389b9ccc4000/axial_022.png","assets/T/mri-40c6389b9ccc4000/axial_024.png","assets/T/mri-40c6389b9ccc4000/axial_026.png","assets/T/mri-40c6389b9ccc4000/axial_028.png","assets/T/mri-40c6389b9ccc4000/axial_030.png","assets/T/mri-40c6389b9ccc4000/axial_032.png","assets/T/mri-40c6389b9ccc4000/axial_034.png","assets/T/mri-40c6389b9ccc4000/axial_036.png","assets/T/mri-40c6389b9ccc4000/axial_038.png","assets/T/mri-40c6389b9ccc4000/axial_040.png","assets/T/mri-40c6389b9ccc4000/coronal_001.png","assets/T/mri-40c6389b9ccc4000/coronal_003.png","assets/T/mri-40c6389b9ccc4000/coronal_005.png","assets/T/mri-40c6389b9ccc4000/coronal_007.png","assets/T/mri-40c6389b9ccc4000/coronal_009.png","assets/T/mri-40c6389b9ccc4000/coronal_011.png","assets/T/mri-40c6389b9ccc4000/coronal_014.png","assets/T/mri-40c6389b9ccc4000/coronal_016.png","assets/T/mri-40c6389b9ccc4000/coronal_018.png","assets/T/mri-40c6389b9ccc4000/coronal_020.png","assets/T/mri-40c6389b9ccc4000/coronal_022.png","assets/T/mri-40c6389b9ccc4000/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":64,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,21,22,24,26,28,30,32,34,36,38,40,41,43,45,47,49,51,54,56,58,60,62,64]}}
+{"id":"L3-T300:mri-d50e7ed4292a41b6","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-d50e7ed4292a41b6/axial_001.png","assets/T/mri-d50e7ed4292a41b6/axial_003.png","assets/T/mri-d50e7ed4292a41b6/axial_005.png","assets/T/mri-d50e7ed4292a41b6/axial_007.png","assets/T/mri-d50e7ed4292a41b6/axial_009.png","assets/T/mri-d50e7ed4292a41b6/axial_011.png","assets/T/mri-d50e7ed4292a41b6/axial_013.png","assets/T/mri-d50e7ed4292a41b6/axial_015.png","assets/T/mri-d50e7ed4292a41b6/axial_017.png","assets/T/mri-d50e7ed4292a41b6/axial_019.png","assets/T/mri-d50e7ed4292a41b6/axial_022.png","assets/T/mri-d50e7ed4292a41b6/axial_024.png","assets/T/mri-d50e7ed4292a41b6/axial_026.png","assets/T/mri-d50e7ed4292a41b6/axial_028.png","assets/T/mri-d50e7ed4292a41b6/axial_030.png","assets/T/mri-d50e7ed4292a41b6/axial_032.png","assets/T/mri-d50e7ed4292a41b6/axial_034.png","assets/T/mri-d50e7ed4292a41b6/axial_036.png","assets/T/mri-d50e7ed4292a41b6/axial_038.png","assets/T/mri-d50e7ed4292a41b6/axial_040.png","assets/T/mri-d50e7ed4292a41b6/axial_042.png","assets/T/mri-d50e7ed4292a41b6/coronal_001.png","assets/T/mri-d50e7ed4292a41b6/coronal_003.png","assets/T/mri-d50e7ed4292a41b6/coronal_005.png","assets/T/mri-d50e7ed4292a41b6/coronal_007.png","assets/T/mri-d50e7ed4292a41b6/coronal_009.png","assets/T/mri-d50e7ed4292a41b6/coronal_011.png","assets/T/mri-d50e7ed4292a41b6/coronal_014.png","assets/T/mri-d50e7ed4292a41b6/coronal_016.png","assets/T/mri-d50e7ed4292a41b6/coronal_018.png","assets/T/mri-d50e7ed4292a41b6/coronal_020.png","assets/T/mri-d50e7ed4292a41b6/coronal_022.png","assets/T/mri-d50e7ed4292a41b6/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-c3378b4651c34176","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-c3378b4651c34176/axial_001.png","assets/T/mri-c3378b4651c34176/axial_003.png","assets/T/mri-c3378b4651c34176/axial_005.png","assets/T/mri-c3378b4651c34176/axial_007.png","assets/T/mri-c3378b4651c34176/axial_009.png","assets/T/mri-c3378b4651c34176/axial_011.png","assets/T/mri-c3378b4651c34176/axial_013.png","assets/T/mri-c3378b4651c34176/axial_015.png","assets/T/mri-c3378b4651c34176/axial_017.png","assets/T/mri-c3378b4651c34176/axial_019.png","assets/T/mri-c3378b4651c34176/axial_022.png","assets/T/mri-c3378b4651c34176/axial_024.png","assets/T/mri-c3378b4651c34176/axial_026.png","assets/T/mri-c3378b4651c34176/axial_028.png","assets/T/mri-c3378b4651c34176/axial_030.png","assets/T/mri-c3378b4651c34176/axial_032.png","assets/T/mri-c3378b4651c34176/axial_034.png","assets/T/mri-c3378b4651c34176/axial_036.png","assets/T/mri-c3378b4651c34176/axial_038.png","assets/T/mri-c3378b4651c34176/axial_040.png","assets/T/mri-c3378b4651c34176/axial_042.png","assets/T/mri-c3378b4651c34176/coronal_001.png","assets/T/mri-c3378b4651c34176/coronal_003.png","assets/T/mri-c3378b4651c34176/coronal_005.png","assets/T/mri-c3378b4651c34176/coronal_007.png","assets/T/mri-c3378b4651c34176/coronal_009.png","assets/T/mri-c3378b4651c34176/coronal_011.png","assets/T/mri-c3378b4651c34176/coronal_014.png","assets/T/mri-c3378b4651c34176/coronal_016.png","assets/T/mri-c3378b4651c34176/coronal_018.png","assets/T/mri-c3378b4651c34176/coronal_020.png","assets/T/mri-c3378b4651c34176/coronal_022.png","assets/T/mri-c3378b4651c34176/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-a10d3a7baeb04f59","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-a10d3a7baeb04f59/axial_001.png","assets/T/mri-a10d3a7baeb04f59/axial_003.png","assets/T/mri-a10d3a7baeb04f59/axial_005.png","assets/T/mri-a10d3a7baeb04f59/axial_007.png","assets/T/mri-a10d3a7baeb04f59/axial_009.png","assets/T/mri-a10d3a7baeb04f59/axial_011.png","assets/T/mri-a10d3a7baeb04f59/axial_013.png","assets/T/mri-a10d3a7baeb04f59/axial_015.png","assets/T/mri-a10d3a7baeb04f59/axial_017.png","assets/T/mri-a10d3a7baeb04f59/axial_019.png","assets/T/mri-a10d3a7baeb04f59/axial_022.png","assets/T/mri-a10d3a7baeb04f59/axial_024.png","assets/T/mri-a10d3a7baeb04f59/axial_026.png","assets/T/mri-a10d3a7baeb04f59/axial_028.png","assets/T/mri-a10d3a7baeb04f59/axial_030.png","assets/T/mri-a10d3a7baeb04f59/axial_032.png","assets/T/mri-a10d3a7baeb04f59/axial_034.png","assets/T/mri-a10d3a7baeb04f59/axial_036.png","assets/T/mri-a10d3a7baeb04f59/axial_038.png","assets/T/mri-a10d3a7baeb04f59/axial_040.png","assets/T/mri-a10d3a7baeb04f59/axial_042.png","assets/T/mri-a10d3a7baeb04f59/coronal_001.png","assets/T/mri-a10d3a7baeb04f59/coronal_003.png","assets/T/mri-a10d3a7baeb04f59/coronal_005.png","assets/T/mri-a10d3a7baeb04f59/coronal_007.png","assets/T/mri-a10d3a7baeb04f59/coronal_009.png","assets/T/mri-a10d3a7baeb04f59/coronal_011.png","assets/T/mri-a10d3a7baeb04f59/coronal_014.png","assets/T/mri-a10d3a7baeb04f59/coronal_016.png","assets/T/mri-a10d3a7baeb04f59/coronal_018.png","assets/T/mri-a10d3a7baeb04f59/coronal_020.png","assets/T/mri-a10d3a7baeb04f59/coronal_022.png","assets/T/mri-a10d3a7baeb04f59/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-T300:mri-802ae4b0d5084e52","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-802ae4b0d5084e52/axial_001.png","assets/T/mri-802ae4b0d5084e52/axial_003.png","assets/T/mri-802ae4b0d5084e52/axial_005.png","assets/T/mri-802ae4b0d5084e52/axial_007.png","assets/T/mri-802ae4b0d5084e52/axial_009.png","assets/T/mri-802ae4b0d5084e52/axial_011.png","assets/T/mri-802ae4b0d5084e52/axial_013.png","assets/T/mri-802ae4b0d5084e52/axial_015.png","assets/T/mri-802ae4b0d5084e52/axial_017.png","assets/T/mri-802ae4b0d5084e52/axial_019.png","assets/T/mri-802ae4b0d5084e52/axial_022.png","assets/T/mri-802ae4b0d5084e52/axial_024.png","assets/T/mri-802ae4b0d5084e52/axial_026.png","assets/T/mri-802ae4b0d5084e52/axial_028.png","assets/T/mri-802ae4b0d5084e52/axial_030.png","assets/T/mri-802ae4b0d5084e52/axial_032.png","assets/T/mri-802ae4b0d5084e52/axial_034.png","assets/T/mri-802ae4b0d5084e52/axial_036.png","assets/T/mri-802ae4b0d5084e52/axial_038.png","assets/T/mri-802ae4b0d5084e52/axial_040.png","assets/T/mri-802ae4b0d5084e52/axial_042.png","assets/T/mri-802ae4b0d5084e52/coronal_001.png","assets/T/mri-802ae4b0d5084e52/coronal_003.png","assets/T/mri-802ae4b0d5084e52/coronal_005.png","assets/T/mri-802ae4b0d5084e52/coronal_007.png","assets/T/mri-802ae4b0d5084e52/coronal_009.png","assets/T/mri-802ae4b0d5084e52/coronal_011.png","assets/T/mri-802ae4b0d5084e52/coronal_014.png","assets/T/mri-802ae4b0d5084e52/coronal_016.png","assets/T/mri-802ae4b0d5084e52/coronal_018.png","assets/T/mri-802ae4b0d5084e52/coronal_020.png","assets/T/mri-802ae4b0d5084e52/coronal_022.png","assets/T/mri-802ae4b0d5084e52/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
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+{"id":"L3-T300:mri-d1e14b3341084373","task":"L3-T300","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 33 张图，均来自同一次检查。\n\n- 前 21 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 12 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["assets/T/mri-d1e14b3341084373/axial_001.png","assets/T/mri-d1e14b3341084373/axial_003.png","assets/T/mri-d1e14b3341084373/axial_005.png","assets/T/mri-d1e14b3341084373/axial_007.png","assets/T/mri-d1e14b3341084373/axial_009.png","assets/T/mri-d1e14b3341084373/axial_011.png","assets/T/mri-d1e14b3341084373/axial_013.png","assets/T/mri-d1e14b3341084373/axial_015.png","assets/T/mri-d1e14b3341084373/axial_017.png","assets/T/mri-d1e14b3341084373/axial_019.png","assets/T/mri-d1e14b3341084373/axial_022.png","assets/T/mri-d1e14b3341084373/axial_024.png","assets/T/mri-d1e14b3341084373/axial_026.png","assets/T/mri-d1e14b3341084373/axial_028.png","assets/T/mri-d1e14b3341084373/axial_030.png","assets/T/mri-d1e14b3341084373/axial_032.png","assets/T/mri-d1e14b3341084373/axial_034.png","assets/T/mri-d1e14b3341084373/axial_036.png","assets/T/mri-d1e14b3341084373/axial_038.png","assets/T/mri-d1e14b3341084373/axial_040.png","assets/T/mri-d1e14b3341084373/axial_042.png","assets/T/mri-d1e14b3341084373/coronal_001.png","assets/T/mri-d1e14b3341084373/coronal_003.png","assets/T/mri-d1e14b3341084373/coronal_005.png","assets/T/mri-d1e14b3341084373/coronal_007.png","assets/T/mri-d1e14b3341084373/coronal_009.png","assets/T/mri-d1e14b3341084373/coronal_011.png","assets/T/mri-d1e14b3341084373/coronal_014.png","assets/T/mri-d1e14b3341084373/coronal_016.png","assets/T/mri-d1e14b3341084373/coronal_018.png","assets/T/mri-d1e14b3341084373/coronal_020.png","assets/T/mri-d1e14b3341084373/coronal_022.png","assets/T/mri-d1e14b3341084373/coronal_024.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":66,"selected_count":33,"source_indices_1based":[1,3,5,7,9,11,13,15,17,19,22,24,26,28,30,32,34,36,38,40,42,43,45,47,49,51,53,56,58,60,62,64,66]}}
+{"id":"L3-N400:mri-5d64214c74e34879","task":"L3-N400","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 34 张图，均来自同一次检查。\n\n- 前 20 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 14 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先综合全部图像中的区域淋巴结影像证据，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，判断该患者的 N 分期，并给出简要影像依据。不要判断 T、M 或总体分期。\n\n`n_stage` 只能输出 N0、N1、N2、N3 之一。\n只输出一个 JSON 对象，不要输出 JSON 以外的解释、markdown 或代码块。\n输出格式：\n{\n  \"n_stage\": \"N0\",\n  \"evidence\": \"简要影像依据\"\n}","images":["assets/N/mri-5d64214c74e34879/axial_001.png","assets/N/mri-5d64214c74e34879/axial_003.png","assets/N/mri-5d64214c74e34879/axial_005.png","assets/N/mri-5d64214c74e34879/axial_007.png","assets/N/mri-5d64214c74e34879/axial_009.png","assets/N/mri-5d64214c74e34879/axial_010.png","assets/N/mri-5d64214c74e34879/axial_012.png","assets/N/mri-5d64214c74e34879/axial_014.png","assets/N/mri-5d64214c74e34879/axial_016.png","assets/N/mri-5d64214c74e34879/axial_018.png","assets/N/mri-5d64214c74e34879/axial_020.png","assets/N/mri-5d64214c74e34879/axial_022.png","assets/N/mri-5d64214c74e34879/axial_024.png","assets/N/mri-5d64214c74e34879/axial_026.png","assets/N/mri-5d64214c74e34879/axial_028.png","assets/N/mri-5d64214c74e34879/axial_029.png","assets/N/mri-5d64214c74e34879/axial_031.png","assets/N/mri-5d64214c74e34879/axial_033.png","assets/N/mri-5d64214c74e34879/axial_035.png","assets/N/mri-5d64214c74e34879/axial_037.png","assets/N/mri-5d64214c74e34879/coronal_001.png","assets/N/mri-5d64214c74e34879/coronal_003.png","assets/N/mri-5d64214c74e34879/coronal_005.png","assets/N/mri-5d64214c74e34879/coronal_007.png","assets/N/mri-5d64214c74e34879/coronal_009.png","assets/N/mri-5d64214c74e34879/coronal_011.png","assets/N/mri-5d64214c74e34879/coronal_013.png","assets/N/mri-5d64214c74e34879/coronal_014.png","assets/N/mri-5d64214c74e34879/coronal_016.png","assets/N/mri-5d64214c74e34879/coronal_018.png","assets/N/mri-5d64214c74e34879/coronal_020.png","assets/N/mri-5d64214c74e34879/coronal_022.png","assets/N/mri-5d64214c74e34879/coronal_024.png","assets/N/mri-5d64214c74e34879/coronal_026.png"],"stage_edition":8,"image_sampling":{"method":"maximum fitting uniform groups, proportional axial/coronal, preserve group endpoints","source_count":63,"selected_count":34,"source_indices_1based":[1,3,5,7,9,10,12,14,16,18,20,22,24,26,28,29,31,33,35,37,38,40,42,44,46,48,50,51,53,55,57,59,61,63]}}
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diff --git a/L3/requests/T400.jsonl b/L3/requests/T400.jsonl
new file mode 100644
index 0000000000000000000000000000000000000000..103cbc17fa36ef7c991a0b0a5133c60dde87e323
--- /dev/null
+++ b/L3/requests/T400.jsonl
@@ -0,0 +1,400 @@
+{"id":"T-Stg-705808a155e0b13d7aa9ea63","task":"L3-T400","stage_edition":8,"input_format":"structure_cards","prompt":"你将看到同一鼻咽癌患者的一组 MRI 结构卡片，共 27 张图。\n\n每张图都是一张结构卡片：\n- 每张结构卡片都是固定 4x3 布局\n- 可见的黄色矩形框标记当前讨论的解剖结构\n- 不同图片对应不同结构\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["primary_l3_inputs/assets/sha256/8a/8a4deb2a9fb07a49f36bb6c1a017d42a10b71c9c634b8c3f2a0caab6b7b0bed3.jpg","primary_l3_inputs/assets/sha256/c2/c227fe1013253e48c525786428e9fc40c3d6f425ffebeafbd9f694d4b21dd611.jpg","primary_l3_inputs/assets/sha256/32/3271ce146828bfa7d4eaef4b59457bcc57c74cde141feed349d493c132037f44.jpg","primary_l3_inputs/assets/sha256/04/046e2f977aaf32f2110aee6ed6f72b9a449f7381dec4c08e0cc2bfcbe4d1a339.jpg","primary_l3_inputs/assets/sha256/2c/2c0d1e44991ab6c2dbb0a7c91ccd626730ea1fad9de6443325d7f827c862285f.jpg","primary_l3_inputs/assets/sha256/af/af689873714c3f60e5ba604c1bce589cadda05ec51c104435fbd1e82b2dae809.jpg","primary_l3_inputs/assets/sha256/a3/a313cc237aae81f7514e41cd8df926a830edb89c38eb4913637851a909bf405e.jpg","primary_l3_inputs/assets/sha256/6c/6c88d4aa194b6cd57bee27788d51ea8ed79f0d3ac499a7eb291d6918a7dc9ac3.jpg","primary_l3_inputs/assets/sha256/34/34c458d765e1fa7c49ea9f2ffe3902d355bba876d34be74d3576e267bffa3c5e.jpg","primary_l3_inputs/assets/sha256/00/00e9dbbacb4ade555e4ed2ec0cc272f8aa250c7e2c7eec884a2e024500cf57de.jpg","primary_l3_inputs/assets/sha256/ee/ee65aba6d8b1c8e3b0cec22894405866377c1d8f37785d5b6dac7d5c7916f529.jpg","primary_l3_inputs/assets/sha256/bf/bf88b0572c41177d4a187e4ab8cf1133b1762b49c08131278a88e203eaabdfba.jpg","primary_l3_inputs/assets/sha256/13/139aac7195a6d1a9bd1644f55da1aca05c19ae82403e2eca52aa2711496e2ef7.jpg","primary_l3_inputs/assets/sha256/fb/fb3eed6a73579a2f55abae16d6527d29a011d5d35e7db513bf30860f7603aff8.jpg","primary_l3_inputs/assets/sha256/81/81d09781fd413f32ba4a24973e96a1b8bb20165da425f0eff3e62012b2246a58.jpg","primary_l3_inputs/assets/sha256/1f/1f906849fd70a4aa9387f07cd0e44942a688bf858dfe149117757632700c715d.jpg","primary_l3_inputs/assets/sha256/54/54e6f8bd9df32873567196e4fa6e265f90045aad8bb16b06169232400691186c.jpg","primary_l3_inputs/assets/sha256/73/7366d80df9a68428ca9dedf69bdc1f5198a03d47fbf81c284881571874ba51c5.jpg","primary_l3_inputs/assets/sha256/c8/c83893b309d94141c74d9da1ef91c11cc4cf05b8b774526c707a2a8111104049.jpg","primary_l3_inputs/assets/sha256/60/60a529edb5e4090e85e44cf091eec8d2705e2728919a0ace205f8829a471a703.jpg","primary_l3_inputs/assets/sha256/3f/3f462158d3c52eaea7f06213643cb7634a8e43a938cd3180537527e42bce5901.jpg","primary_l3_inputs/assets/sha256/53/5334e982f566cc94f514a9c3fab4dd71af1b709535f8e1a0a97ffc64d3a0176f.jpg","primary_l3_inputs/assets/sha256/4b/4bf75cac9d327026ca11bf69f39168a40cea80fe2cc7975c0c8400edc96fb49a.jpg","primary_l3_inputs/assets/sha256/f9/f90286ca6946d2a673700bb335934e6a07fe6d2c6d8524f244421d9da1310409.jpg","primary_l3_inputs/assets/sha256/e7/e78922998fb305eb79d375fc0daa0efdbcdef4552e48c662d2a82f2d4e3eada9.jpg","primary_l3_inputs/assets/sha256/e9/e976a5e4acbbe61eb534c0f1040d2671a3a1e40487a2df5790748f5611d94c5e.jpg","primary_l3_inputs/assets/sha256/1d/1d0565fdbc87bb77ab7fb0e47eb445829b37548436a6b4d2fbd64f5da597c706.jpg"]}
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+{"id":"T-Stg-916f0f4f3d1a28c242340677","task":"L3-T400","stage_edition":8,"input_format":"structure_cards","prompt":"你将看到同一鼻咽癌患者的一组 MRI 结构卡片，共 27 张图。\n\n每张图都是一张结构卡片：\n- 每张结构卡片都是固定 4x3 布局\n- 可见的黄色矩形框标记当前讨论的解剖结构\n- 不同图片对应不同结构\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["primary_l3_inputs/assets/sha256/59/59316d02d243cec2a79f5642efcff991b398454f5413e99324ec2a84632d0bf3.jpg","primary_l3_inputs/assets/sha256/e5/e50869c51512f8274b5281b8b1fc372ef342ece6859f797340651cafaf84ae88.jpg","primary_l3_inputs/assets/sha256/2e/2eb53eaa89d68c4ec1d6fe8247496b3600a38b81eae7061f91d308dfa4a3d8ae.jpg","primary_l3_inputs/assets/sha256/51/519fea65fb0abbaacf1d102f6acaf72ab210341abd5abb2804c725e9d3847520.jpg","primary_l3_inputs/assets/sha256/ba/bae0121d0441baab6eaf508ac49cdefdbcc5e409bf10f40e5ba8d7186f8f412c.jpg","primary_l3_inputs/assets/sha256/ca/cac85fbc754e1f19fdc8ca89bd530a33f4b1ed16c5f555efeee21ccad2308287.jpg","primary_l3_inputs/assets/sha256/cd/cdda0ed67f10778a58bf7ad784a22dc771478ffaf9ec6d62b5b21fce39e39694.jpg","primary_l3_inputs/assets/sha256/9c/9cb41bb8ca8846d0ff031912e94b4c36ee793e9ef54d4428a46ecac33d6fbfa9.jpg","primary_l3_inputs/assets/sha256/24/24669c9c495f6b39bd0ec3989bd9b90231768a3820846393758305b36e30f012.jpg","primary_l3_inputs/assets/sha256/ab/ab221c5d477a2d457b2101529ce1d0357e6ed7f4826c245bcdd82b24aab65667.jpg","primary_l3_inputs/assets/sha256/37/37325d26513573f14eab9b02572a4bc5887fd043dd2a9a12e7a4d7bfa2ec38a1.jpg","primary_l3_inputs/assets/sha256/ad/ad02c271d4c5e95b662ba4df1497e0859c31ae540767de0201a22d8996051e8c.jpg","primary_l3_inputs/assets/sha256/16/163f19b7f2788896cec41b7f0cebf04208c8a9bc5e3369c436ce6929d83b771d.jpg","primary_l3_inputs/assets/sha256/d8/d836a1332009a0830f281ea5eab57379e5a28d540b83037f464c4ff694f068c8.jpg","primary_l3_inputs/assets/sha256/91/917b754cbf55d57d15f9d6cadd7f851cf60cdd6bc31f6cb93bd9699204f0db84.jpg","primary_l3_inputs/assets/sha256/c5/c52b46596bb80cf48bffbc3fe2c7686361e935d4540c23af2edf3e3deb19ed2d.jpg","primary_l3_inputs/assets/sha256/86/861bdb4e19c151f96b859179eb3cf8ac5cb21d2b439b9b7ed8c152500b10e91f.jpg","primary_l3_inputs/assets/sha256/64/64228647b1c10c8900cd37e8d554ccc1054841835ef3edd31724d2e03800f9e6.jpg","primary_l3_inputs/assets/sha256/8c/8ce30658b36ada21e27763defc19200ee683e355f91c3c404cd272220b38d19e.jpg","primary_l3_inputs/assets/sha256/ef/efbe99d34c18f245b55fc9fd10caf757e46a204ee22d1d1c772a9bb41ffbbf88.jpg","primary_l3_inputs/assets/sha256/88/8865629730716971d7ba64ca5b8543a2362f2e02a992e6fcd0da7d4d25f54d78.jpg","primary_l3_inputs/assets/sha256/18/18d117f9aa72607f0fadaf251ddaaa3833bbb2301718a689fa6f645da6721327.jpg","primary_l3_inputs/assets/sha256/97/97adfc0029390b5e8f9daf513a47092ffb4d34ad62055217af7670690c6369ab.jpg","primary_l3_inputs/assets/sha256/57/578a45f81d4ef35c544d82eb32cab173c7b1a89010f718f03c3e46393b3ef354.jpg","primary_l3_inputs/assets/sha256/76/76089ef7375c4a6d8319c10b23eeb24427944787600661186f457d5966b6a47a.jpg","primary_l3_inputs/assets/sha256/22/220145d11c6d9b26bf5b3b4596cf7034c45b0466fac9c604c614f488ee0d31dd.jpg","primary_l3_inputs/assets/sha256/15/15f7595cbc824684e26ca4b1cca620a2cb93fd1e603079bacfead7fdfda8d6da.jpg"]}
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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-1a77d0c1afdc43b7","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-492555690ebc4338","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-02211a5df28b41c8","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 68 张图，均来自同一次检查。\n\n- 前 44 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-9ec9fbbfc5a4455a","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-5d8f67cc09114eee","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-812aaa7d98de44b8","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["extensions/assets/T/mri-812aaa7d98de44b8/axial_001.png","extensions/assets/T/mri-812aaa7d98de44b8/axial_002.png","extensions/assets/T/mri-812aaa7d98de44b8/axial_003.png","extensions/assets/T/mri-812aaa7d98de44b8/axial_004.png","extensions/assets/T/mri-812aaa7d98de44b8/axial_005.png","extensions/assets/T/mri-812aaa7d98de44b8/axial_006.png","extensions/assets/T/mri-812aaa7d98de44b8/axial_007.png","extensions/assets/T/mri-812aaa7d98de44b8/axial_008.png","extensions/assets/T/mri-812aaa7d98de44b8/axial_009.png","extensions/assets/T/mri-812aaa7d98de44b8/axial_010.png","extensions/assets/T/mri-812aaa7d98de44b8/axial_011.png","extensions/assets/T/mri-812aaa7d98de44b8/axial_012.png","extensions/assets/T/mri-812aaa7d98de44b8/axial_013.png","extensions/assets/T/mri-812aaa7d98de44b8/axial_014.png","extensions/assets/T/mri-812aaa7d98de44b8/axial_015.png","extensions/assets/T/mri-812aaa7d98de44b8/axial_016.png","extensions/assets/T/mri-812aaa7d98de44b8/axial_017.png","extensions/assets/T/mri-812aaa7d98de44b8/axial_018.png","extensions/assets/T/mri-812aaa7d98de44b8/axial_019.png","extensions/assets/T/mri-812aaa7d98de44b8/axial_020.png","extensions/assets/T/mri-812aaa7d98de44b8/axial_021.png","extensions/assets/T/mri-812aaa7d98de44b8/axial_022.png","extensions/assets/T/mri-812aaa7d98de44b8/axial_023.png","extensions/assets/T/mri-812aaa7d98de44b8/axial_024.png","extensions/assets/T/mri-812aaa7d98de44b8/axial_025.png","extensions/assets/T/mri-812aaa7d98de44b8/axial_026.png","extensions/assets/T/mri-812aaa7d98de44b8/axial_027.png","extensions/assets/T/mri-812aaa7d98de44b8/axial_028.png","extensions/assets/T/mri-812aaa7d98de44b8/axial_029.png","extensions/assets/T/mri-812aaa7d98de44b8/axial_030.png","extensions/assets/T/mri-812aaa7d98de44b8/axial_031.png","extensions/assets/T/mri-812aaa7d98de44b8/axial_032.png","extensions/assets/T/mri-812aaa7d98de44b8/axial_033.png","extensions/assets/T/mri-812aaa7d98de44b8/axial_034.png","extensions/assets/T/mri-812aaa7d98de44b8/axial_035.png","extensions/assets/T/mri-812aaa7d98de44b8/axial_036.png","extensions/assets/T/mri-812aaa7d98de44b8/axial_037.png","extensions/assets/T/mri-812aaa7d98de44b8/axial_038.png","extensions/assets/T/mri-812aaa7d98de44b8/axial_039.png","extensions/assets/T/mri-812aaa7d98de44b8/axial_040.png","extensions/assets/T/mri-812aaa7d98de44b8/coronal_001.png","extensions/assets/T/mri-812aaa7d98de44b8/coronal_002.png","extensions/assets/T/mri-812aaa7d98de44b8/coronal_003.png","extensions/assets/T/mri-812aaa7d98de44b8/coronal_004.png","extensions/assets/T/mri-812aaa7d98de44b8/coronal_005.png","extensions/assets/T/mri-812aaa7d98de44b8/coronal_006.png","extensions/assets/T/mri-812aaa7d98de44b8/coronal_007.png","extensions/assets/T/mri-812aaa7d98de44b8/coronal_008.png","extensions/assets/T/mri-812aaa7d98de44b8/coronal_009.png","extensions/assets/T/mri-812aaa7d98de44b8/coronal_010.png","extensions/assets/T/mri-812aaa7d98de44b8/coronal_011.png","extensions/assets/T/mri-812aaa7d98de44b8/coronal_012.png","extensions/assets/T/mri-812aaa7d98de44b8/coronal_013.png","extensions/assets/T/mri-812aaa7d98de44b8/coronal_014.png","extensions/assets/T/mri-812aaa7d98de44b8/coronal_015.png","extensions/assets/T/mri-812aaa7d98de44b8/coronal_016.png","extensions/assets/T/mri-812aaa7d98de44b8/coronal_017.png","extensions/assets/T/mri-812aaa7d98de44b8/coronal_018.png","extensions/assets/T/mri-812aaa7d98de44b8/coronal_019.png","extensions/assets/T/mri-812aaa7d98de44b8/coronal_020.png","extensions/assets/T/mri-812aaa7d98de44b8/coronal_021.png","extensions/assets/T/mri-812aaa7d98de44b8/coronal_022.png","extensions/assets/T/mri-812aaa7d98de44b8/coronal_023.png","extensions/assets/T/mri-812aaa7d98de44b8/coronal_024.png"],"task":"L3-T400","stage_edition":8,"input_format":"plane_groups"}
+{"id":"L3-T300:mri-d711445434a34edd","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 68 张图，均来自同一次检查。\n\n- 前 44 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-b437689d0567403e","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-de245813d9f84619","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-964cc314fdba4813","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-396b4602039e46f3","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 60 张图，均来自同一次检查。\n\n- 前 36 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["extensions/assets/T/mri-396b4602039e46f3/axial_001.png","extensions/assets/T/mri-396b4602039e46f3/axial_002.png","extensions/assets/T/mri-396b4602039e46f3/axial_003.png","extensions/assets/T/mri-396b4602039e46f3/axial_004.png","extensions/assets/T/mri-396b4602039e46f3/axial_005.png","extensions/assets/T/mri-396b4602039e46f3/axial_006.png","extensions/assets/T/mri-396b4602039e46f3/axial_007.png","extensions/assets/T/mri-396b4602039e46f3/axial_008.png","extensions/assets/T/mri-396b4602039e46f3/axial_009.png","extensions/assets/T/mri-396b4602039e46f3/axial_010.png","extensions/assets/T/mri-396b4602039e46f3/axial_011.png","extensions/assets/T/mri-396b4602039e46f3/axial_012.png","extensions/assets/T/mri-396b4602039e46f3/axial_013.png","extensions/assets/T/mri-396b4602039e46f3/axial_014.png","extensions/assets/T/mri-396b4602039e46f3/axial_015.png","extensions/assets/T/mri-396b4602039e46f3/axial_016.png","extensions/assets/T/mri-396b4602039e46f3/axial_017.png","extensions/assets/T/mri-396b4602039e46f3/axial_018.png","extensions/assets/T/mri-396b4602039e46f3/axial_019.png","extensions/assets/T/mri-396b4602039e46f3/axial_020.png","extensions/assets/T/mri-396b4602039e46f3/axial_021.png","extensions/assets/T/mri-396b4602039e46f3/axial_022.png","extensions/assets/T/mri-396b4602039e46f3/axial_023.png","extensions/assets/T/mri-396b4602039e46f3/axial_024.png","extensions/assets/T/mri-396b4602039e46f3/axial_025.png","extensions/assets/T/mri-396b4602039e46f3/axial_026.png","extensions/assets/T/mri-396b4602039e46f3/axial_027.png","extensions/assets/T/mri-396b4602039e46f3/axial_028.png","extensions/assets/T/mri-396b4602039e46f3/axial_029.png","extensions/assets/T/mri-396b4602039e46f3/axial_030.png","extensions/assets/T/mri-396b4602039e46f3/axial_031.png","extensions/assets/T/mri-396b4602039e46f3/axial_032.png","extensions/assets/T/mri-396b4602039e46f3/axial_033.png","extensions/assets/T/mri-396b4602039e46f3/axial_034.png","extensions/assets/T/mri-396b4602039e46f3/axial_035.png","extensions/assets/T/mri-396b4602039e46f3/axial_036.png","extensions/assets/T/mri-396b4602039e46f3/coronal_001.png","extensions/assets/T/mri-396b4602039e46f3/coronal_002.png","extensions/assets/T/mri-396b4602039e46f3/coronal_003.png","extensions/assets/T/mri-396b4602039e46f3/coronal_004.png","extensions/assets/T/mri-396b4602039e46f3/coronal_005.png","extensions/assets/T/mri-396b4602039e46f3/coronal_006.png","extensions/assets/T/mri-396b4602039e46f3/coronal_007.png","extensions/assets/T/mri-396b4602039e46f3/coronal_008.png","extensions/assets/T/mri-396b4602039e46f3/coronal_009.png","extensions/assets/T/mri-396b4602039e46f3/coronal_010.png","extensions/assets/T/mri-396b4602039e46f3/coronal_011.png","extensions/assets/T/mri-396b4602039e46f3/coronal_012.png","extensions/assets/T/mri-396b4602039e46f3/coronal_013.png","extensions/assets/T/mri-396b4602039e46f3/coronal_014.png","extensions/assets/T/mri-396b4602039e46f3/coronal_015.png","extensions/assets/T/mri-396b4602039e46f3/coronal_016.png","extensions/assets/T/mri-396b4602039e46f3/coronal_017.png","extensions/assets/T/mri-396b4602039e46f3/coronal_018.png","extensions/assets/T/mri-396b4602039e46f3/coronal_019.png","extensions/assets/T/mri-396b4602039e46f3/coronal_020.png","extensions/assets/T/mri-396b4602039e46f3/coronal_021.png","extensions/assets/T/mri-396b4602039e46f3/coronal_022.png","extensions/assets/T/mri-396b4602039e46f3/coronal_023.png","extensions/assets/T/mri-396b4602039e46f3/coronal_024.png"],"task":"L3-T400","stage_edition":8,"input_format":"plane_groups"}
+{"id":"L3-T300:mri-0588f21611574c53","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-f4e104d4b1914b92","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-d55be5ee6a164720","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-819452b5910247dc","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 68 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 26 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-fc63c9cacf214122","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-37345bffc7aa45be","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-85bf21a1e54d4f86","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 62 张图，均来自同一次检查。\n\n- 前 38 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-cd1d5e72481942cd","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    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+{"id":"L3-T300:mri-3fb297150b194344","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 67 张图，均来自同一次检查。\n\n- 前 43 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-e5bad77de70140d2","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-8a2e314a61574ad4","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    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+{"id":"L3-T300:mri-8a31792e1b9548c6","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-92679901993c443c","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-47a7dce19f27448f","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 70 张图，均来自同一次检查。\n\n- 前 46 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-a099dc17835b4447","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 69 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 27 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-46d4180f5c9b4ea7","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 72 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 30 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-009d069830a941cc","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 62 张图，均来自同一次检查。\n\n- 前 38 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-5927ca297b614ffd","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-a5b56fee006e4280","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-7c103c2defd14c13","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-dce34f88ac514aa2","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-52ab912be8f94df4","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-ccaecc2dd6674b4c","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 60 张图，均来自同一次检查。\n\n- 前 36 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["extensions/assets/T/mri-ccaecc2dd6674b4c/axial_001.png","extensions/assets/T/mri-ccaecc2dd6674b4c/axial_002.png","extensions/assets/T/mri-ccaecc2dd6674b4c/axial_003.png","extensions/assets/T/mri-ccaecc2dd6674b4c/axial_004.png","extensions/assets/T/mri-ccaecc2dd6674b4c/axial_005.png","extensions/assets/T/mri-ccaecc2dd6674b4c/axial_006.png","extensions/assets/T/mri-ccaecc2dd6674b4c/axial_007.png","extensions/assets/T/mri-ccaecc2dd6674b4c/axial_008.png","extensions/assets/T/mri-ccaecc2dd6674b4c/axial_009.png","extensions/assets/T/mri-ccaecc2dd6674b4c/axial_010.png","extensions/assets/T/mri-ccaecc2dd6674b4c/axial_011.png","extensions/assets/T/mri-ccaecc2dd6674b4c/axial_012.png","extensions/assets/T/mri-ccaecc2dd6674b4c/axial_013.png","extensions/assets/T/mri-ccaecc2dd6674b4c/axial_014.png","extensions/assets/T/mri-ccaecc2dd6674b4c/axial_015.png","extensions/assets/T/mri-ccaecc2dd6674b4c/axial_016.png","extensions/assets/T/mri-ccaecc2dd6674b4c/axial_017.png","extensions/assets/T/mri-ccaecc2dd6674b4c/axial_018.png","extensions/assets/T/mri-ccaecc2dd6674b4c/axial_019.png","extensions/assets/T/mri-ccaecc2dd6674b4c/axial_020.png","extensions/assets/T/mri-ccaecc2dd6674b4c/axial_021.png","extensions/assets/T/mri-ccaecc2dd6674b4c/axial_022.png","extensions/assets/T/mri-ccaecc2dd6674b4c/axial_023.png","extensions/assets/T/mri-ccaecc2dd6674b4c/axial_024.png","extensions/assets/T/mri-ccaecc2dd6674b4c/axial_025.png","extensions/assets/T/mri-ccaecc2dd6674b4c/axial_026.png","extensions/assets/T/mri-ccaecc2dd6674b4c/axial_027.png","extensions/assets/T/mri-ccaecc2dd6674b4c/axial_028.png","extensions/assets/T/mri-ccaecc2dd6674b4c/axial_029.png","extensions/assets/T/mri-ccaecc2dd6674b4c/axial_030.png","extensions/assets/T/mri-ccaecc2dd6674b4c/axial_031.png","extensions/assets/T/mri-ccaecc2dd6674b4c/axial_032.png","extensions/assets/T/mri-ccaecc2dd6674b4c/axial_033.png","extensions/assets/T/mri-ccaecc2dd6674b4c/axial_034.png","extensions/assets/T/mri-ccaecc2dd6674b4c/axial_035.png","extensions/assets/T/mri-ccaecc2dd6674b4c/axial_036.png","extensions/assets/T/mri-ccaecc2dd6674b4c/coronal_001.png","extensions/assets/T/mri-ccaecc2dd6674b4c/coronal_002.png","extensions/assets/T/mri-ccaecc2dd6674b4c/coronal_003.png","extensions/assets/T/mri-ccaecc2dd6674b4c/coronal_004.png","extensions/assets/T/mri-ccaecc2dd6674b4c/coronal_005.png","extensions/assets/T/mri-ccaecc2dd6674b4c/coronal_006.png","extensions/assets/T/mri-ccaecc2dd6674b4c/coronal_007.png","extensions/assets/T/mri-ccaecc2dd6674b4c/coronal_008.png","extensions/assets/T/mri-ccaecc2dd6674b4c/coronal_009.png","extensions/assets/T/mri-ccaecc2dd6674b4c/coronal_010.png","extensions/assets/T/mri-ccaecc2dd6674b4c/coronal_011.png","extensions/assets/T/mri-ccaecc2dd6674b4c/coronal_012.png","extensions/assets/T/mri-ccaecc2dd6674b4c/coronal_013.png","extensions/assets/T/mri-ccaecc2dd6674b4c/coronal_014.png","extensions/assets/T/mri-ccaecc2dd6674b4c/coronal_015.png","extensions/assets/T/mri-ccaecc2dd6674b4c/coronal_016.png","extensions/assets/T/mri-ccaecc2dd6674b4c/coronal_017.png","extensions/assets/T/mri-ccaecc2dd6674b4c/coronal_018.png","extensions/assets/T/mri-ccaecc2dd6674b4c/coronal_019.png","extensions/assets/T/mri-ccaecc2dd6674b4c/coronal_020.png","extensions/assets/T/mri-ccaecc2dd6674b4c/coronal_021.png","extensions/assets/T/mri-ccaecc2dd6674b4c/coronal_022.png","extensions/assets/T/mri-ccaecc2dd6674b4c/coronal_023.png","extensions/assets/T/mri-ccaecc2dd6674b4c/coronal_024.png"],"task":"L3-T400","stage_edition":8,"input_format":"plane_groups"}
+{"id":"L3-T300:mri-20452f5fb9304914","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["extensions/assets/T/mri-20452f5fb9304914/axial_001.png","extensions/assets/T/mri-20452f5fb9304914/axial_002.png","extensions/assets/T/mri-20452f5fb9304914/axial_003.png","extensions/assets/T/mri-20452f5fb9304914/axial_004.png","extensions/assets/T/mri-20452f5fb9304914/axial_005.png","extensions/assets/T/mri-20452f5fb9304914/axial_006.png","extensions/assets/T/mri-20452f5fb9304914/axial_007.png","extensions/assets/T/mri-20452f5fb9304914/axial_008.png","extensions/assets/T/mri-20452f5fb9304914/axial_009.png","extensions/assets/T/mri-20452f5fb9304914/axial_010.png","extensions/assets/T/mri-20452f5fb9304914/axial_011.png","extensions/assets/T/mri-20452f5fb9304914/axial_012.png","extensions/assets/T/mri-20452f5fb9304914/axial_013.png","extensions/assets/T/mri-20452f5fb9304914/axial_014.png","extensions/assets/T/mri-20452f5fb9304914/axial_015.png","extensions/assets/T/mri-20452f5fb9304914/axial_016.png","extensions/assets/T/mri-20452f5fb9304914/axial_017.png","extensions/assets/T/mri-20452f5fb9304914/axial_018.png","extensions/assets/T/mri-20452f5fb9304914/axial_019.png","extensions/assets/T/mri-20452f5fb9304914/axial_020.png","extensions/assets/T/mri-20452f5fb9304914/axial_021.png","extensions/assets/T/mri-20452f5fb9304914/axial_022.png","extensions/assets/T/mri-20452f5fb9304914/axial_023.png","extensions/assets/T/mri-20452f5fb9304914/axial_024.png","extensions/assets/T/mri-20452f5fb9304914/axial_025.png","extensions/assets/T/mri-20452f5fb9304914/axial_026.png","extensions/assets/T/mri-20452f5fb9304914/axial_027.png","extensions/assets/T/mri-20452f5fb9304914/axial_028.png","extensions/assets/T/mri-20452f5fb9304914/axial_029.png","extensions/assets/T/mri-20452f5fb9304914/axial_030.png","extensions/assets/T/mri-20452f5fb9304914/axial_031.png","extensions/assets/T/mri-20452f5fb9304914/axial_032.png","extensions/assets/T/mri-20452f5fb9304914/axial_033.png","extensions/assets/T/mri-20452f5fb9304914/axial_034.png","extensions/assets/T/mri-20452f5fb9304914/axial_035.png","extensions/assets/T/mri-20452f5fb9304914/axial_036.png","extensions/assets/T/mri-20452f5fb9304914/axial_037.png","extensions/assets/T/mri-20452f5fb9304914/axial_038.png","extensions/assets/T/mri-20452f5fb9304914/axial_039.png","extensions/assets/T/mri-20452f5fb9304914/axial_040.png","extensions/assets/T/mri-20452f5fb9304914/axial_041.png","extensions/assets/T/mri-20452f5fb9304914/axial_042.png","extensions/assets/T/mri-20452f5fb9304914/coronal_001.png","extensions/assets/T/mri-20452f5fb9304914/coronal_002.png","extensions/assets/T/mri-20452f5fb9304914/coronal_003.png","extensions/assets/T/mri-20452f5fb9304914/coronal_004.png","extensions/assets/T/mri-20452f5fb9304914/coronal_005.png","extensions/assets/T/mri-20452f5fb9304914/coronal_006.png","extensions/assets/T/mri-20452f5fb9304914/coronal_007.png","extensions/assets/T/mri-20452f5fb9304914/coronal_008.png","extensions/assets/T/mri-20452f5fb9304914/coronal_009.png","extensions/assets/T/mri-20452f5fb9304914/coronal_010.png","extensions/assets/T/mri-20452f5fb9304914/coronal_011.png","extensions/assets/T/mri-20452f5fb9304914/coronal_012.png","extensions/assets/T/mri-20452f5fb9304914/coronal_013.png","extensions/assets/T/mri-20452f5fb9304914/coronal_014.png","extensions/assets/T/mri-20452f5fb9304914/coronal_015.png","extensions/assets/T/mri-20452f5fb9304914/coronal_016.png","extensions/assets/T/mri-20452f5fb9304914/coronal_017.png","extensions/assets/T/mri-20452f5fb9304914/coronal_018.png","extensions/assets/T/mri-20452f5fb9304914/coronal_019.png","extensions/assets/T/mri-20452f5fb9304914/coronal_020.png","extensions/assets/T/mri-20452f5fb9304914/coronal_021.png","extensions/assets/T/mri-20452f5fb9304914/coronal_022.png","extensions/assets/T/mri-20452f5fb9304914/coronal_023.png","extensions/assets/T/mri-20452f5fb9304914/coronal_024.png"],"task":"L3-T400","stage_edition":8,"input_format":"plane_groups"}
+{"id":"L3-T300:mri-9bc82b4fc3564f98","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-7850ff7cafae4340","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 63 张图，均来自同一次检查。\n\n- 前 39 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-3f31af08249d42ef","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-25fd5f6282bd417a","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 70 张图，均来自同一次检查。\n\n- 前 46 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    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+{"id":"L3-T300:mri-4c6b71e4929542b4","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-70a24066e1394843","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 68 张图，均来自同一次检查。\n\n- 前 44 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-3931b6ac51dd4dc5","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 62 张图，均来自同一次检查。\n\n- 前 38 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-b03c65e16e9040f7","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 68 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 26 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-c3cc2672fd8e420a","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 62 张图，均来自同一次检查。\n\n- 前 38 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-763095d057044bf9","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 60 张图，均来自同一次检查。\n\n- 前 36 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["extensions/assets/T/mri-763095d057044bf9/axial_001.png","extensions/assets/T/mri-763095d057044bf9/axial_002.png","extensions/assets/T/mri-763095d057044bf9/axial_003.png","extensions/assets/T/mri-763095d057044bf9/axial_004.png","extensions/assets/T/mri-763095d057044bf9/axial_005.png","extensions/assets/T/mri-763095d057044bf9/axial_006.png","extensions/assets/T/mri-763095d057044bf9/axial_007.png","extensions/assets/T/mri-763095d057044bf9/axial_008.png","extensions/assets/T/mri-763095d057044bf9/axial_009.png","extensions/assets/T/mri-763095d057044bf9/axial_010.png","extensions/assets/T/mri-763095d057044bf9/axial_011.png","extensions/assets/T/mri-763095d057044bf9/axial_012.png","extensions/assets/T/mri-763095d057044bf9/axial_013.png","extensions/assets/T/mri-763095d057044bf9/axial_014.png","extensions/assets/T/mri-763095d057044bf9/axial_015.png","extensions/assets/T/mri-763095d057044bf9/axial_016.png","extensions/assets/T/mri-763095d057044bf9/axial_017.png","extensions/assets/T/mri-763095d057044bf9/axial_018.png","extensions/assets/T/mri-763095d057044bf9/axial_019.png","extensions/assets/T/mri-763095d057044bf9/axial_020.png","extensions/assets/T/mri-763095d057044bf9/axial_021.png","extensions/assets/T/mri-763095d057044bf9/axial_022.png","extensions/assets/T/mri-763095d057044bf9/axial_023.png","extensions/assets/T/mri-763095d057044bf9/axial_024.png","extensions/assets/T/mri-763095d057044bf9/axial_025.png","extensions/assets/T/mri-763095d057044bf9/axial_026.png","extensions/assets/T/mri-763095d057044bf9/axial_027.png","extensions/assets/T/mri-763095d057044bf9/axial_028.png","extensions/assets/T/mri-763095d057044bf9/axial_029.png","extensions/assets/T/mri-763095d057044bf9/axial_030.png","extensions/assets/T/mri-763095d057044bf9/axial_031.png","extensions/assets/T/mri-763095d057044bf9/axial_032.png","extensions/assets/T/mri-763095d057044bf9/axial_033.png","extensions/assets/T/mri-763095d057044bf9/axial_034.png","extensions/assets/T/mri-763095d057044bf9/axial_035.png","extensions/assets/T/mri-763095d057044bf9/axial_036.png","extensions/assets/T/mri-763095d057044bf9/coronal_001.png","extensions/assets/T/mri-763095d057044bf9/coronal_002.png","extensions/assets/T/mri-763095d057044bf9/coronal_003.png","extensions/assets/T/mri-763095d057044bf9/coronal_004.png","extensions/assets/T/mri-763095d057044bf9/coronal_005.png","extensions/assets/T/mri-763095d057044bf9/coronal_006.png","extensions/assets/T/mri-763095d057044bf9/coronal_007.png","extensions/assets/T/mri-763095d057044bf9/coronal_008.png","extensions/assets/T/mri-763095d057044bf9/coronal_009.png","extensions/assets/T/mri-763095d057044bf9/coronal_010.png","extensions/assets/T/mri-763095d057044bf9/coronal_011.png","extensions/assets/T/mri-763095d057044bf9/coronal_012.png","extensions/assets/T/mri-763095d057044bf9/coronal_013.png","extensions/assets/T/mri-763095d057044bf9/coronal_014.png","extensions/assets/T/mri-763095d057044bf9/coronal_015.png","extensions/assets/T/mri-763095d057044bf9/coronal_016.png","extensions/assets/T/mri-763095d057044bf9/coronal_017.png","extensions/assets/T/mri-763095d057044bf9/coronal_018.png","extensions/assets/T/mri-763095d057044bf9/coronal_019.png","extensions/assets/T/mri-763095d057044bf9/coronal_020.png","extensions/assets/T/mri-763095d057044bf9/coronal_021.png","extensions/assets/T/mri-763095d057044bf9/coronal_022.png","extensions/assets/T/mri-763095d057044bf9/coronal_023.png","extensions/assets/T/mri-763095d057044bf9/coronal_024.png"],"task":"L3-T400","stage_edition":8,"input_format":"plane_groups"}
+{"id":"L3-T300:mri-70df53cf06454db7","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 70 张图，均来自同一次检查。\n\n- 前 46 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-59438dc37157453f","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-458582a19ad64257","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-3589d3f1b2ff4daa","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 71 张图，均来自同一次检查。\n\n- 前 45 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 26 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-822812f3ff034bba","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 60 张图，均来自同一次检查。\n\n- 前 36 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["extensions/assets/T/mri-822812f3ff034bba/axial_001.png","extensions/assets/T/mri-822812f3ff034bba/axial_002.png","extensions/assets/T/mri-822812f3ff034bba/axial_003.png","extensions/assets/T/mri-822812f3ff034bba/axial_004.png","extensions/assets/T/mri-822812f3ff034bba/axial_005.png","extensions/assets/T/mri-822812f3ff034bba/axial_006.png","extensions/assets/T/mri-822812f3ff034bba/axial_007.png","extensions/assets/T/mri-822812f3ff034bba/axial_008.png","extensions/assets/T/mri-822812f3ff034bba/axial_009.png","extensions/assets/T/mri-822812f3ff034bba/axial_010.png","extensions/assets/T/mri-822812f3ff034bba/axial_011.png","extensions/assets/T/mri-822812f3ff034bba/axial_012.png","extensions/assets/T/mri-822812f3ff034bba/axial_013.png","extensions/assets/T/mri-822812f3ff034bba/axial_014.png","extensions/assets/T/mri-822812f3ff034bba/axial_015.png","extensions/assets/T/mri-822812f3ff034bba/axial_016.png","extensions/assets/T/mri-822812f3ff034bba/axial_017.png","extensions/assets/T/mri-822812f3ff034bba/axial_018.png","extensions/assets/T/mri-822812f3ff034bba/axial_019.png","extensions/assets/T/mri-822812f3ff034bba/axial_020.png","extensions/assets/T/mri-822812f3ff034bba/axial_021.png","extensions/assets/T/mri-822812f3ff034bba/axial_022.png","extensions/assets/T/mri-822812f3ff034bba/axial_023.png","extensions/assets/T/mri-822812f3ff034bba/axial_024.png","extensions/assets/T/mri-822812f3ff034bba/axial_025.png","extensions/assets/T/mri-822812f3ff034bba/axial_026.png","extensions/assets/T/mri-822812f3ff034bba/axial_027.png","extensions/assets/T/mri-822812f3ff034bba/axial_028.png","extensions/assets/T/mri-822812f3ff034bba/axial_029.png","extensions/assets/T/mri-822812f3ff034bba/axial_030.png","extensions/assets/T/mri-822812f3ff034bba/axial_031.png","extensions/assets/T/mri-822812f3ff034bba/axial_032.png","extensions/assets/T/mri-822812f3ff034bba/axial_033.png","extensions/assets/T/mri-822812f3ff034bba/axial_034.png","extensions/assets/T/mri-822812f3ff034bba/axial_035.png","extensions/assets/T/mri-822812f3ff034bba/axial_036.png","extensions/assets/T/mri-822812f3ff034bba/coronal_001.png","extensions/assets/T/mri-822812f3ff034bba/coronal_002.png","extensions/assets/T/mri-822812f3ff034bba/coronal_003.png","extensions/assets/T/mri-822812f3ff034bba/coronal_004.png","extensions/assets/T/mri-822812f3ff034bba/coronal_005.png","extensions/assets/T/mri-822812f3ff034bba/coronal_006.png","extensions/assets/T/mri-822812f3ff034bba/coronal_007.png","extensions/assets/T/mri-822812f3ff034bba/coronal_008.png","extensions/assets/T/mri-822812f3ff034bba/coronal_009.png","extensions/assets/T/mri-822812f3ff034bba/coronal_010.png","extensions/assets/T/mri-822812f3ff034bba/coronal_011.png","extensions/assets/T/mri-822812f3ff034bba/coronal_012.png","extensions/assets/T/mri-822812f3ff034bba/coronal_013.png","extensions/assets/T/mri-822812f3ff034bba/coronal_014.png","extensions/assets/T/mri-822812f3ff034bba/coronal_015.png","extensions/assets/T/mri-822812f3ff034bba/coronal_016.png","extensions/assets/T/mri-822812f3ff034bba/coronal_017.png","extensions/assets/T/mri-822812f3ff034bba/coronal_018.png","extensions/assets/T/mri-822812f3ff034bba/coronal_019.png","extensions/assets/T/mri-822812f3ff034bba/coronal_020.png","extensions/assets/T/mri-822812f3ff034bba/coronal_021.png","extensions/assets/T/mri-822812f3ff034bba/coronal_022.png","extensions/assets/T/mri-822812f3ff034bba/coronal_023.png","extensions/assets/T/mri-822812f3ff034bba/coronal_024.png"],"task":"L3-T400","stage_edition":8,"input_format":"plane_groups"}
+{"id":"L3-T300:mri-20e02e9841324cfc","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["extensions/assets/T/mri-20e02e9841324cfc/axial_001.png","extensions/assets/T/mri-20e02e9841324cfc/axial_002.png","extensions/assets/T/mri-20e02e9841324cfc/axial_003.png","extensions/assets/T/mri-20e02e9841324cfc/axial_004.png","extensions/assets/T/mri-20e02e9841324cfc/axial_005.png","extensions/assets/T/mri-20e02e9841324cfc/axial_006.png","extensions/assets/T/mri-20e02e9841324cfc/axial_007.png","extensions/assets/T/mri-20e02e9841324cfc/axial_008.png","extensions/assets/T/mri-20e02e9841324cfc/axial_009.png","extensions/assets/T/mri-20e02e9841324cfc/axial_010.png","extensions/assets/T/mri-20e02e9841324cfc/axial_011.png","extensions/assets/T/mri-20e02e9841324cfc/axial_012.png","extensions/assets/T/mri-20e02e9841324cfc/axial_013.png","extensions/assets/T/mri-20e02e9841324cfc/axial_014.png","extensions/assets/T/mri-20e02e9841324cfc/axial_015.png","extensions/assets/T/mri-20e02e9841324cfc/axial_016.png","extensions/assets/T/mri-20e02e9841324cfc/axial_017.png","extensions/assets/T/mri-20e02e9841324cfc/axial_018.png","extensions/assets/T/mri-20e02e9841324cfc/axial_019.png","extensions/assets/T/mri-20e02e9841324cfc/axial_020.png","extensions/assets/T/mri-20e02e9841324cfc/axial_021.png","extensions/assets/T/mri-20e02e9841324cfc/axial_022.png","extensions/assets/T/mri-20e02e9841324cfc/axial_023.png","extensions/assets/T/mri-20e02e9841324cfc/axial_024.png","extensions/assets/T/mri-20e02e9841324cfc/axial_025.png","extensions/assets/T/mri-20e02e9841324cfc/axial_026.png","extensions/assets/T/mri-20e02e9841324cfc/axial_027.png","extensions/assets/T/mri-20e02e9841324cfc/axial_028.png","extensions/assets/T/mri-20e02e9841324cfc/axial_029.png","extensions/assets/T/mri-20e02e9841324cfc/axial_030.png","extensions/assets/T/mri-20e02e9841324cfc/axial_031.png","extensions/assets/T/mri-20e02e9841324cfc/axial_032.png","extensions/assets/T/mri-20e02e9841324cfc/axial_033.png","extensions/assets/T/mri-20e02e9841324cfc/axial_034.png","extensions/assets/T/mri-20e02e9841324cfc/axial_035.png","extensions/assets/T/mri-20e02e9841324cfc/axial_036.png","extensions/assets/T/mri-20e02e9841324cfc/axial_037.png","extensions/assets/T/mri-20e02e9841324cfc/axial_038.png","extensions/assets/T/mri-20e02e9841324cfc/axial_039.png","extensions/assets/T/mri-20e02e9841324cfc/axial_040.png","extensions/assets/T/mri-20e02e9841324cfc/axial_041.png","extensions/assets/T/mri-20e02e9841324cfc/axial_042.png","extensions/assets/T/mri-20e02e9841324cfc/coronal_001.png","extensions/assets/T/mri-20e02e9841324cfc/coronal_002.png","extensions/assets/T/mri-20e02e9841324cfc/coronal_003.png","extensions/assets/T/mri-20e02e9841324cfc/coronal_004.png","extensions/assets/T/mri-20e02e9841324cfc/coronal_005.png","extensions/assets/T/mri-20e02e9841324cfc/coronal_006.png","extensions/assets/T/mri-20e02e9841324cfc/coronal_007.png","extensions/assets/T/mri-20e02e9841324cfc/coronal_008.png","extensions/assets/T/mri-20e02e9841324cfc/coronal_009.png","extensions/assets/T/mri-20e02e9841324cfc/coronal_010.png","extensions/assets/T/mri-20e02e9841324cfc/coronal_011.png","extensions/assets/T/mri-20e02e9841324cfc/coronal_012.png","extensions/assets/T/mri-20e02e9841324cfc/coronal_013.png","extensions/assets/T/mri-20e02e9841324cfc/coronal_014.png","extensions/assets/T/mri-20e02e9841324cfc/coronal_015.png","extensions/assets/T/mri-20e02e9841324cfc/coronal_016.png","extensions/assets/T/mri-20e02e9841324cfc/coronal_017.png","extensions/assets/T/mri-20e02e9841324cfc/coronal_018.png","extensions/assets/T/mri-20e02e9841324cfc/coronal_019.png","extensions/assets/T/mri-20e02e9841324cfc/coronal_020.png","extensions/assets/T/mri-20e02e9841324cfc/coronal_021.png","extensions/assets/T/mri-20e02e9841324cfc/coronal_022.png","extensions/assets/T/mri-20e02e9841324cfc/coronal_023.png","extensions/assets/T/mri-20e02e9841324cfc/coronal_024.png"],"task":"L3-T400","stage_edition":8,"input_format":"plane_groups"}
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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-6b684b9630fa40eb","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-6093448809034145","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 26 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    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+{"id":"L3-T300:mri-0308881784db400a","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 69 张图，均来自同一次检查。\n\n- 前 45 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-b95098426a0148f8","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-b6b87fa111a640ca","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 60 张图，均来自同一次检查。\n\n- 前 36 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["extensions/assets/T/mri-b6b87fa111a640ca/axial_001.png","extensions/assets/T/mri-b6b87fa111a640ca/axial_002.png","extensions/assets/T/mri-b6b87fa111a640ca/axial_003.png","extensions/assets/T/mri-b6b87fa111a640ca/axial_004.png","extensions/assets/T/mri-b6b87fa111a640ca/axial_005.png","extensions/assets/T/mri-b6b87fa111a640ca/axial_006.png","extensions/assets/T/mri-b6b87fa111a640ca/axial_007.png","extensions/assets/T/mri-b6b87fa111a640ca/axial_008.png","extensions/assets/T/mri-b6b87fa111a640ca/axial_009.png","extensions/assets/T/mri-b6b87fa111a640ca/axial_010.png","extensions/assets/T/mri-b6b87fa111a640ca/axial_011.png","extensions/assets/T/mri-b6b87fa111a640ca/axial_012.png","extensions/assets/T/mri-b6b87fa111a640ca/axial_013.png","extensions/assets/T/mri-b6b87fa111a640ca/axial_014.png","extensions/assets/T/mri-b6b87fa111a640ca/axial_015.png","extensions/assets/T/mri-b6b87fa111a640ca/axial_016.png","extensions/assets/T/mri-b6b87fa111a640ca/axial_017.png","extensions/assets/T/mri-b6b87fa111a640ca/axial_018.png","extensions/assets/T/mri-b6b87fa111a640ca/axial_019.png","extensions/assets/T/mri-b6b87fa111a640ca/axial_020.png","extensions/assets/T/mri-b6b87fa111a640ca/axial_021.png","extensions/assets/T/mri-b6b87fa111a640ca/axial_022.png","extensions/assets/T/mri-b6b87fa111a640ca/axial_023.png","extensions/assets/T/mri-b6b87fa111a640ca/axial_024.png","extensions/assets/T/mri-b6b87fa111a640ca/axial_025.png","extensions/assets/T/mri-b6b87fa111a640ca/axial_026.png","extensions/assets/T/mri-b6b87fa111a640ca/axial_027.png","extensions/assets/T/mri-b6b87fa111a640ca/axial_028.png","extensions/assets/T/mri-b6b87fa111a640ca/axial_029.png","extensions/assets/T/mri-b6b87fa111a640ca/axial_030.png","extensions/assets/T/mri-b6b87fa111a640ca/axial_031.png","extensions/assets/T/mri-b6b87fa111a640ca/axial_032.png","extensions/assets/T/mri-b6b87fa111a640ca/axial_033.png","extensions/assets/T/mri-b6b87fa111a640ca/axial_034.png","extensions/assets/T/mri-b6b87fa111a640ca/axial_035.png","extensions/assets/T/mri-b6b87fa111a640ca/axial_036.png","extensions/assets/T/mri-b6b87fa111a640ca/coronal_001.png","extensions/assets/T/mri-b6b87fa111a640ca/coronal_002.png","extensions/assets/T/mri-b6b87fa111a640ca/coronal_003.png","extensions/assets/T/mri-b6b87fa111a640ca/coronal_004.png","extensions/assets/T/mri-b6b87fa111a640ca/coronal_005.png","extensions/assets/T/mri-b6b87fa111a640ca/coronal_006.png","extensions/assets/T/mri-b6b87fa111a640ca/coronal_007.png","extensions/assets/T/mri-b6b87fa111a640ca/coronal_008.png","extensions/assets/T/mri-b6b87fa111a640ca/coronal_009.png","extensions/assets/T/mri-b6b87fa111a640ca/coronal_010.png","extensions/assets/T/mri-b6b87fa111a640ca/coronal_011.png","extensions/assets/T/mri-b6b87fa111a640ca/coronal_012.png","extensions/assets/T/mri-b6b87fa111a640ca/coronal_013.png","extensions/assets/T/mri-b6b87fa111a640ca/coronal_014.png","extensions/assets/T/mri-b6b87fa111a640ca/coronal_015.png","extensions/assets/T/mri-b6b87fa111a640ca/coronal_016.png","extensions/assets/T/mri-b6b87fa111a640ca/coronal_017.png","extensions/assets/T/mri-b6b87fa111a640ca/coronal_018.png","extensions/assets/T/mri-b6b87fa111a640ca/coronal_019.png","extensions/assets/T/mri-b6b87fa111a640ca/coronal_020.png","extensions/assets/T/mri-b6b87fa111a640ca/coronal_021.png","extensions/assets/T/mri-b6b87fa111a640ca/coronal_022.png","extensions/assets/T/mri-b6b87fa111a640ca/coronal_023.png","extensions/assets/T/mri-b6b87fa111a640ca/coronal_024.png"],"task":"L3-T400","stage_edition":8,"input_format":"plane_groups"}
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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-22348de6a516489b","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-78c66b5d279f4442","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 68 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 26 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-9bf4932ed3d546a2","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-2d3b01244e0d4ee4","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 67 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 25 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-26f2f06937804ccf","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-e409f2ae4d1b4e1f","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 68 张图，均来自同一次检查。\n\n- 前 44 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-fd066ee0a9c14d5b","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 68 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 26 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-19abf1bad6184b68","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 60 张图，均来自同一次检查。\n\n- 前 36 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": \"T1\"\n}","images":["extensions/assets/T/mri-19abf1bad6184b68/axial_001.png","extensions/assets/T/mri-19abf1bad6184b68/axial_002.png","extensions/assets/T/mri-19abf1bad6184b68/axial_003.png","extensions/assets/T/mri-19abf1bad6184b68/axial_004.png","extensions/assets/T/mri-19abf1bad6184b68/axial_005.png","extensions/assets/T/mri-19abf1bad6184b68/axial_006.png","extensions/assets/T/mri-19abf1bad6184b68/axial_007.png","extensions/assets/T/mri-19abf1bad6184b68/axial_008.png","extensions/assets/T/mri-19abf1bad6184b68/axial_009.png","extensions/assets/T/mri-19abf1bad6184b68/axial_010.png","extensions/assets/T/mri-19abf1bad6184b68/axial_011.png","extensions/assets/T/mri-19abf1bad6184b68/axial_012.png","extensions/assets/T/mri-19abf1bad6184b68/axial_013.png","extensions/assets/T/mri-19abf1bad6184b68/axial_014.png","extensions/assets/T/mri-19abf1bad6184b68/axial_015.png","extensions/assets/T/mri-19abf1bad6184b68/axial_016.png","extensions/assets/T/mri-19abf1bad6184b68/axial_017.png","extensions/assets/T/mri-19abf1bad6184b68/axial_018.png","extensions/assets/T/mri-19abf1bad6184b68/axial_019.png","extensions/assets/T/mri-19abf1bad6184b68/axial_020.png","extensions/assets/T/mri-19abf1bad6184b68/axial_021.png","extensions/assets/T/mri-19abf1bad6184b68/axial_022.png","extensions/assets/T/mri-19abf1bad6184b68/axial_023.png","extensions/assets/T/mri-19abf1bad6184b68/axial_024.png","extensions/assets/T/mri-19abf1bad6184b68/axial_025.png","extensions/assets/T/mri-19abf1bad6184b68/axial_026.png","extensions/assets/T/mri-19abf1bad6184b68/axial_027.png","extensions/assets/T/mri-19abf1bad6184b68/axial_028.png","extensions/assets/T/mri-19abf1bad6184b68/axial_029.png","extensions/assets/T/mri-19abf1bad6184b68/axial_030.png","extensions/assets/T/mri-19abf1bad6184b68/axial_031.png","extensions/assets/T/mri-19abf1bad6184b68/axial_032.png","extensions/assets/T/mri-19abf1bad6184b68/axial_033.png","extensions/assets/T/mri-19abf1bad6184b68/axial_034.png","extensions/assets/T/mri-19abf1bad6184b68/axial_035.png","extensions/assets/T/mri-19abf1bad6184b68/axial_036.png","extensions/assets/T/mri-19abf1bad6184b68/coronal_001.png","extensions/assets/T/mri-19abf1bad6184b68/coronal_002.png","extensions/assets/T/mri-19abf1bad6184b68/coronal_003.png","extensions/assets/T/mri-19abf1bad6184b68/coronal_004.png","extensions/assets/T/mri-19abf1bad6184b68/coronal_005.png","extensions/assets/T/mri-19abf1bad6184b68/coronal_006.png","extensions/assets/T/mri-19abf1bad6184b68/coronal_007.png","extensions/assets/T/mri-19abf1bad6184b68/coronal_008.png","extensions/assets/T/mri-19abf1bad6184b68/coronal_009.png","extensions/assets/T/mri-19abf1bad6184b68/coronal_010.png","extensions/assets/T/mri-19abf1bad6184b68/coronal_011.png","extensions/assets/T/mri-19abf1bad6184b68/coronal_012.png","extensions/assets/T/mri-19abf1bad6184b68/coronal_013.png","extensions/assets/T/mri-19abf1bad6184b68/coronal_014.png","extensions/assets/T/mri-19abf1bad6184b68/coronal_015.png","extensions/assets/T/mri-19abf1bad6184b68/coronal_016.png","extensions/assets/T/mri-19abf1bad6184b68/coronal_017.png","extensions/assets/T/mri-19abf1bad6184b68/coronal_018.png","extensions/assets/T/mri-19abf1bad6184b68/coronal_019.png","extensions/assets/T/mri-19abf1bad6184b68/coronal_020.png","extensions/assets/T/mri-19abf1bad6184b68/coronal_021.png","extensions/assets/T/mri-19abf1bad6184b68/coronal_022.png","extensions/assets/T/mri-19abf1bad6184b68/coronal_023.png","extensions/assets/T/mri-19abf1bad6184b68/coronal_024.png"],"task":"L3-T400","stage_edition":8,"input_format":"plane_groups"}
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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-7b8493c771024704","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 68 张图，均来自同一次检查。\n\n- 前 44 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-5ce68cec7138451f","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-94083fb208a0400d","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 64 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-814687fc8a704a75","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 68 张图，均来自同一次检查。\n\n- 前 44 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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\"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-fc649370f6644c8c","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 40 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 26 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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+{"id":"L3-T300:mri-d1e14b3341084373","prompt":"你将看到同一鼻咽癌患者的一组 MRI 多序列、多层面图组，共 66 张图，均来自同一次检查。\n\n- 前 42 张为横断位图组；每张自上而下为同一解剖层面的 T1 平扫、T2、T1 增强\n- 后 24 张为冠状位图组；每张自上而下为同一解剖层面的 T1 增强（压脂）、T1 平扫（不压脂）\n- 每组按原有层面顺序排列；请综合所有图组判断同一位患者\n\n请先判断每一个基础解剖结构是否受侵犯，再按照 AJCC/UICC 第八版鼻咽癌 TNM 分期标准，综合全部相关结构以及对应的受侵犯状况，判断该患者的总 T 分期。\n基础结构不区分左右侧；如果同一基础结构任意一侧受侵，则该基础结构记为 1，否则记为 0。\n\n必须评估以下基础结构：\n- nasal_passage\n- oropharynx\n- levator_veli_palatini\n- parapharyngeal_space\n- carotid_sheath\n- longus_capitis\n- medial_pterygoid\n- lateral_pterygoid\n- pterygoid_base\n- sphenoid_base\n- clivus\n- petrous_apex\n- atlas\n- axis\n- sphenoid_sinus\n- ethmoid_sinus\n- maxillary_sinus\n- cavernous_sinus\n\n`structure_invasion` 中每个基础结构只能输出 0 或 1，其中 0=未受侵，1=受侵。\n`t_stage` 只能输出 T1、T2、T3、T4 之一。\n只输出一个 JSON 对象，不要输出任何解释、markdown 或代码块。\n输出格式：\n{\n  \"structure_invasion\": {\n    \"nasal_passage\": 0,\n    \"oropharynx\": 0,\n    \"levator_veli_palatini\": 0,\n    \"parapharyngeal_space\": 0,\n    \"carotid_sheath\": 0,\n    \"longus_capitis\": 0,\n    \"medial_pterygoid\": 0,\n    \"lateral_pterygoid\": 0,\n    \"pterygoid_base\": 0,\n    \"sphenoid_base\": 0,\n    \"clivus\": 0,\n    \"petrous_apex\": 0,\n    \"atlas\": 0,\n    \"axis\": 0,\n    \"sphenoid_sinus\": 0,\n    \"ethmoid_sinus\": 0,\n    \"maxillary_sinus\": 0,\n    \"cavernous_sinus\": 0\n  },\n  \"t_stage\": 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diff --git a/L3/secondary_labels/cards.jsonl b/L3/secondary_labels/cards.jsonl
new file mode 100644
index 0000000000000000000000000000000000000000..0ccd67df94d1deaf74711bcfe0a2060694b4acae
--- /dev/null
+++ b/L3/secondary_labels/cards.jsonl
@@ -0,0 +1,2700 @@
+{"id": "Struct-de1b797d714e85b6bf3c57f5", "patient_case_id": "T-Stg-705808a155e0b13d7aa9ea63", "base_structure_id_gt": "nasal_passage", "invasion_gt": 1}
+{"id": "Struct-3703948681b97c9ec03e4401", "patient_case_id": "T-Stg-705808a155e0b13d7aa9ea63", "base_structure_id_gt": "oropharynx", "invasion_gt": 0}
+{"id": "Struct-db159312358be129cdb6fb5c", "patient_case_id": "T-Stg-705808a155e0b13d7aa9ea63", "base_structure_id_gt": "levator_veli_palatini", "invasion_gt": 1}
+{"id": "Struct-265ef66827f45f0590f07e7f", "patient_case_id": "T-Stg-705808a155e0b13d7aa9ea63", "base_structure_id_gt": "levator_veli_palatini", "invasion_gt": 0}
+{"id": "Struct-d0f3aec89617b82473fbed00", "patient_case_id": "T-Stg-705808a155e0b13d7aa9ea63", "base_structure_id_gt": "parapharyngeal_space", "invasion_gt": 0}
+{"id": "Struct-4ef56740cce32814e6fbe979", "patient_case_id": "T-Stg-705808a155e0b13d7aa9ea63", "base_structure_id_gt": "parapharyngeal_space", "invasion_gt": 0}
+{"id": "Struct-0289c768b011528617b6733c", "patient_case_id": "T-Stg-705808a155e0b13d7aa9ea63", "base_structure_id_gt": "carotid_sheath", "invasion_gt": 0}
+{"id": "Struct-f3c5ce1dc3e08cf21a69f238", "patient_case_id": "T-Stg-705808a155e0b13d7aa9ea63", "base_structure_id_gt": "carotid_sheath", "invasion_gt": 0}
+{"id": "Struct-ead3d6ae216d718e4c011d0a", "patient_case_id": "T-Stg-705808a155e0b13d7aa9ea63", "base_structure_id_gt": "longus_capitis", "invasion_gt": 0}
+{"id": "Struct-3cfc02f65457cb112ca59a13", "patient_case_id": "T-Stg-705808a155e0b13d7aa9ea63", "base_structure_id_gt": "longus_capitis", "invasion_gt": 0}
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diff --git a/L3/secondary_labels/patients.jsonl b/L3/secondary_labels/patients.jsonl
new file mode 100644
index 0000000000000000000000000000000000000000..5ab64ec1bd2a2f27a0be501ea1410e95f2bc9cc8
--- /dev/null
+++ b/L3/secondary_labels/patients.jsonl
@@ -0,0 +1,100 @@
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+{"id": "T-Stg-c8d4d827c090e9cc11490615", "patient_case_id": "T-Stg-c8d4d827c090e9cc11490615", "t_stage_gt": "T4", "base_structure_invasion_gt": {"nasal_passage": 1, "oropharynx": 0, "levator_veli_palatini": 1, "parapharyngeal_space": 1, "carotid_sheath": 0, "longus_capitis": 1, "medial_pterygoid": 0, "lateral_pterygoid": 0, "pterygoid_base": 1, "sphenoid_base": 1, "clivus": 1, "petrous_apex": 1, "atlas": 0, "axis": 0, "sphenoid_sinus": 1, "ethmoid_sinus": 1, "maxillary_sinus": 0, "cavernous_sinus": 1}}
+{"id": "T-Stg-a910c3e8fa482143154e7e77", "patient_case_id": "T-Stg-a910c3e8fa482143154e7e77", "t_stage_gt": "T4", "base_structure_invasion_gt": {"nasal_passage": 1, "oropharynx": 0, "levator_veli_palatini": 1, "parapharyngeal_space": 1, "carotid_sheath": 1, "longus_capitis": 1, "medial_pterygoid": 1, "lateral_pterygoid": 0, "pterygoid_base": 1, "sphenoid_base": 1, "clivus": 1, "petrous_apex": 1, "atlas": 0, "axis": 0, "sphenoid_sinus": 1, "ethmoid_sinus": 1, "maxillary_sinus": 0, "cavernous_sinus": 1}}
+{"id": "T-Stg-a1c4f8978d79ff1eced874fd", "patient_case_id": "T-Stg-a1c4f8978d79ff1eced874fd", "t_stage_gt": "T4", "base_structure_invasion_gt": {"nasal_passage": 1, "oropharynx": 0, "levator_veli_palatini": 1, "parapharyngeal_space": 1, "carotid_sheath": 1, "longus_capitis": 1, "medial_pterygoid": 0, "lateral_pterygoid": 0, "pterygoid_base": 1, "sphenoid_base": 1, "clivus": 1, "petrous_apex": 1, "atlas": 0, "axis": 0, "sphenoid_sinus": 1, "ethmoid_sinus": 1, "maxillary_sinus": 0, "cavernous_sinus": 1}}
+{"id": "T-Stg-0856b825bbdbdde4b77e87da", "patient_case_id": "T-Stg-0856b825bbdbdde4b77e87da", "t_stage_gt": "T4", "base_structure_invasion_gt": {"nasal_passage": 1, "oropharynx": 0, "levator_veli_palatini": 1, "parapharyngeal_space": 1, "carotid_sheath": 1, "longus_capitis": 1, "medial_pterygoid": 1, "lateral_pterygoid": 0, "pterygoid_base": 1, "sphenoid_base": 1, "clivus": 1, "petrous_apex": 1, "atlas": 1, "axis": 0, "sphenoid_sinus": 0, "ethmoid_sinus": 0, "maxillary_sinus": 0, "cavernous_sinus": 1}}
+{"id": "T-Stg-84f4fab48b3fea65ead5f446", "patient_case_id": "T-Stg-84f4fab48b3fea65ead5f446", "t_stage_gt": "T4", "base_structure_invasion_gt": {"nasal_passage": 1, "oropharynx": 0, "levator_veli_palatini": 1, "parapharyngeal_space": 1, "carotid_sheath": 0, "longus_capitis": 1, "medial_pterygoid": 1, "lateral_pterygoid": 1, "pterygoid_base": 1, "sphenoid_base": 1, "clivus": 1, "petrous_apex": 1, "atlas": 0, "axis": 0, "sphenoid_sinus": 1, "ethmoid_sinus": 1, "maxillary_sinus": 1, "cavernous_sinus": 1}}
+{"id": "T-Stg-d65088c2d3a99056ccca807d", "patient_case_id": "T-Stg-d65088c2d3a99056ccca807d", "t_stage_gt": "T4", "base_structure_invasion_gt": {"nasal_passage": 1, "oropharynx": 1, "levator_veli_palatini": 1, "parapharyngeal_space": 1, "carotid_sheath": 1, "longus_capitis": 1, "medial_pterygoid": 1, "lateral_pterygoid": 1, "pterygoid_base": 1, "sphenoid_base": 1, "clivus": 1, "petrous_apex": 1, "atlas": 1, "axis": 0, "sphenoid_sinus": 0, "ethmoid_sinus": 0, "maxillary_sinus": 0, "cavernous_sinus": 1}}
+{"id": "T-Stg-137d37cecab57743444d5bd0", "patient_case_id": "T-Stg-137d37cecab57743444d5bd0", "t_stage_gt": "T4", "base_structure_invasion_gt": {"nasal_passage": 1, "oropharynx": 0, "levator_veli_palatini": 1, "parapharyngeal_space": 1, "carotid_sheath": 0, "longus_capitis": 0, "medial_pterygoid": 1, "lateral_pterygoid": 1, "pterygoid_base": 1, "sphenoid_base": 1, "clivus": 1, "petrous_apex": 1, "atlas": 0, "axis": 0, "sphenoid_sinus": 1, "ethmoid_sinus": 1, "maxillary_sinus": 0, "cavernous_sinus": 1}}
+{"id": "T-Stg-b31499e766029b12f9f307e9", "patient_case_id": "T-Stg-b31499e766029b12f9f307e9", "t_stage_gt": "T4", "base_structure_invasion_gt": {"nasal_passage": 1, "oropharynx": 0, "levator_veli_palatini": 1, "parapharyngeal_space": 1, "carotid_sheath": 0, "longus_capitis": 1, "medial_pterygoid": 1, "lateral_pterygoid": 1, "pterygoid_base": 1, "sphenoid_base": 1, "clivus": 1, "petrous_apex": 1, "atlas": 0, "axis": 0, "sphenoid_sinus": 1, "ethmoid_sinus": 1, "maxillary_sinus": 0, "cavernous_sinus": 1}}
+{"id": "T-Stg-9a66f3a19beca94493f36638", "patient_case_id": "T-Stg-9a66f3a19beca94493f36638", "t_stage_gt": "T4", "base_structure_invasion_gt": {"nasal_passage": 0, "oropharynx": 0, "levator_veli_palatini": 1, "parapharyngeal_space": 1, "carotid_sheath": 0, "longus_capitis": 1, "medial_pterygoid": 1, "lateral_pterygoid": 1, "pterygoid_base": 1, "sphenoid_base": 1, "clivus": 1, "petrous_apex": 1, "atlas": 0, "axis": 0, "sphenoid_sinus": 1, "ethmoid_sinus": 1, "maxillary_sinus": 0, "cavernous_sinus": 1}}
+{"id": "T-Stg-6d65df139e47a8c061310fbe", "patient_case_id": "T-Stg-6d65df139e47a8c061310fbe", "t_stage_gt": "T4", "base_structure_invasion_gt": {"nasal_passage": 0, "oropharynx": 0, "levator_veli_palatini": 1, "parapharyngeal_space": 0, "carotid_sheath": 0, "longus_capitis": 0, "medial_pterygoid": 0, "lateral_pterygoid": 0, "pterygoid_base": 1, "sphenoid_base": 1, "clivus": 1, "petrous_apex": 1, "atlas": 0, "axis": 0, "sphenoid_sinus": 1, "ethmoid_sinus": 1, "maxillary_sinus": 0, "cavernous_sinus": 1}}
+{"id": "T-Stg-43a7c3294ec3e8df6d134943", "patient_case_id": "T-Stg-43a7c3294ec3e8df6d134943", "t_stage_gt": "T4", "base_structure_invasion_gt": {"nasal_passage": 1, "oropharynx": 0, "levator_veli_palatini": 1, "parapharyngeal_space": 1, "carotid_sheath": 0, "longus_capitis": 0, "medial_pterygoid": 1, "lateral_pterygoid": 1, "pterygoid_base": 1, "sphenoid_base": 1, "clivus": 0, "petrous_apex": 0, "atlas": 0, "axis": 0, "sphenoid_sinus": 1, "ethmoid_sinus": 1, "maxillary_sinus": 0, "cavernous_sinus": 1}}
+{"id": "T-Stg-916f0f4f3d1a28c242340677", "patient_case_id": "T-Stg-916f0f4f3d1a28c242340677", "t_stage_gt": "T4", "base_structure_invasion_gt": {"nasal_passage": 0, "oropharynx": 0, "levator_veli_palatini": 1, "parapharyngeal_space": 1, "carotid_sheath": 0, "longus_capitis": 1, "medial_pterygoid": 1, "lateral_pterygoid": 0, "pterygoid_base": 1, "sphenoid_base": 1, "clivus": 1, "petrous_apex": 1, "atlas": 1, "axis": 0, "sphenoid_sinus": 1, "ethmoid_sinus": 0, "maxillary_sinus": 0, "cavernous_sinus": 1}}
diff --git a/L4/README.md b/L4/README.md
new file mode 100644
index 0000000000000000000000000000000000000000..c05172cf0ec37b322542b07d1312f316b64cb77f
--- /dev/null
+++ b/L4/README.md
@@ -0,0 +1,7 @@
+# L4: case-level planning
+
+165 questions from 84 patients, scored by patient-macro accuracy. Combine `vignette`, `question` and `options` for the model input; do not include the answer or explanation.
+
+Two questions are marked `question_type: multiple_choice`. Return the complete applicable option set, for example `\boxed{B,D}`; extra or missing choices receive no credit. Other questions require one option.
+
+Clinical consultation and treatment dates are retained when they determine the applicable guideline version. Dates of birth and direct identifiers are removed; clinically relevant age is preserved.
diff --git a/L4/questions.jsonl b/L4/questions.jsonl
new file mode 100644
index 0000000000000000000000000000000000000000..03da18168e6abfd9711042b71c2170c438ba5ddf
--- /dev/null
+++ b/L4/questions.jsonl
@@ -0,0 +1,165 @@
+{"id":"l4-sample-2857ee6a46c94ed49e74dfef","question":"基于患者当前病变情况，最合理的后续治疗策略是：","options":{"A":"吉西他滨 + 顺铂（GP）联合化疗","B":"TPF 诱导化疗联合再程放疗的综合治疗方案","C":"以挽救性超分割再程 IMRT 为主的局部治疗策略","D":"口服氟嘧啶类维持治疗（如替加氟）","E":"卡瑞利珠单抗 + 阿帕替尼","F":"卡培他滨单药全身化疗方案"},"answer":"C","vignette":"患者男，48 岁。2016-11-11 确诊鼻咽未分化型非角化性癌。\n既往已完成根治性放疗。\n2017-01-17 复查提示鼻咽局部持续/复发病灶，PET/CT 未见远处转移。\nMRI 显示病灶局限于鼻咽及邻近软组织，不适合内镜挽救切除。\n当前 KPS 90，ALT/AST 基本正常；但近期肾功能资料缺失，且患者拒绝进一步侵袭性检查。","patient_id":"l4-patient-1664d257380892652c959832"}
+{"id":"l4-sample-6ee460247c0d7dc6ff914bdc","question":"此时最合理的下一步处理是：","options":{"A":"吉西他滨 + 顺铂（GP方案）全身化疗","B":"多西他赛 + 顺铂 + 氟尿嘧啶（TPF方案）诱导化疗","C":"替加氟单药口服维持治疗","D":"暂时停用吉西他滨/顺铂等潜在肾毒性药物，立即完善肾损伤及吉西他滨相关TMA评估"},"answer":"D","vignette":"患者男，48岁。2016年11月确诊为鼻咽未分化型非角化性癌。既往无高血压、糖尿病史，KPS 90 分。外院曾于 2016 年 12 月接受两次低剂量吉西他滨治疗，并联合尼妥珠单抗短期用药，但从未接受根治性放疗。2017 年 1 月复查 MRI 显示鼻咽原发灶及颈部淋巴结病灶较前增大；PET-CT 未见远处转移。\n\n本次入院查体见晨起眼睑轻度浮肿、双下肢轻度凹陷性水肿，近 3 天尿量减少。实验室检查：Scr 2.3 mg/dL，BUN 35 mg/dL，eGFR 32 mL/min/1.73m²，尿蛋白（2+），Hgb 96 g/L，PLT 92×10⁹/L，LDH 升高。结合近期吉西他滨暴露，临床考虑药物相关肾损伤并需警惕吉西他滨相关血栓性微血管病。患者当前一般情况尚可，无远处转移证据。","patient_id":"l4-patient-1664d257380892652c959832"}
+{"id":"l4-sample-5dd59992db627bde4944a725","question":"下一步相对更优的治疗方案是？","options":{"A":"继续原方案：泽菲 + 诺欣（第2周期），并加用贝伐珠单抗","B":"更换方案：吉西他滨 + 顺铂（GP方案） + 替雷利珠单抗","C":"更换方案：替雷利珠单抗 + 多西他赛 + 卡培他滨","D":"更换方案：单药替雷利珠单抗维持治疗"},"answer":"C","vignette":"患者女，63岁，体重48kg。既往确诊鼻咽癌，于2025-07-08确诊复发（cT3cN1cM0）。\n\n既往治疗记录显示：\n1. 2025-07-02 病理示未分化型非角化性癌，EBERs(+)。\n2. 2025-07-11 接受化疗：'泽菲(1.55g)+诺欣(41.23mg)'（诺欣连用3天）。\n3. 2025-08-04 复诊，查体：KPS:90.0，体表淋巴结未触及肿大。患者诉近期涕中带血增多。\n\n辅助检查：\n- 今日（2025-08-04）鼻咽MRI：顶后壁病灶较2025-07-07片范围增大约25%，侵犯斜坡。\n- 血常规：WBC 3.8×10^9/L, Hgb 108g/L, PLT 155×10^9/L。\n- 生化全项：ALT 22 U/L, Alb 38 g/L, BUN 8.1 mmol/L, **Cr 115 μmol/L**。\n- 既往史：高血压病史5年，控制尚可；青霉素过敏史。","patient_id":"l4-patient-70b0b30158fc1de1ca19d01c"}
+{"id":"l4-sample-61d444edb699dee8f3df3bf2","question":"2025-08-04 时，该患者下一步应如何处理？","options":{"A":"今日继续原方案：吉西他滨 + 奈达铂，按上周期原剂量给药","B":"今日继续原方案，但奈达铂进一步减量，吉西他滨维持原剂量","C":"今日改为标准一线 GP：吉西他滨 + 顺铂","D":"今日改为吉西他滨 + 顺铂 + 替雷利珠单抗","E":"今日改为吉西他滨 + 卡铂","F":"今日改为卡培他滨减量口服单药","G":"今日改为替雷利珠单抗单药","H":"今日改为多西他赛 + 替雷利珠单抗","I":"今日暂缓本周期系统治疗，先处理并动态复查治疗相关骨髓抑制与肾功能异常","J":"今日直接终止全部抗肿瘤治疗，仅予最佳支持治疗"},"answer":"I","vignette":"63岁女性。鼻咽未分化型非角化性癌病史。既往在外院接受过根治性放化疗，病历复印件不全，仅见“鼻咽区约70Gy、双颈约60Gy、同期含铂”字样。2025年6月因鼻塞、涕中带血、耳闷及头痛再次就诊，鼻咽镜活检提示复发；MRI提示鼻咽顶后壁及左侧壁复发灶，向咽旁间隙及颅底方向侵犯，颈部可见复发淋巴结，临床记录写作“cT3N1M0复发”。PET/CT未提示远处转移。\n\n门诊病程摘要另记载：头颈外科、放疗科、肿瘤内科 MDT 讨论认为，病灶紧邻颈内动脉并累及既往高剂量照射区域，再程放疗严重毒性风险高，外科亦无把握获得安全根治性切除，当前按姑息性系统治疗路径处理。患者既往无高血压、糖尿病史，曾行阑尾切除术。平时生活基本自理。\n\n2025-07-11 起接受姑息化疗，医嘱单写为：“泽菲 1.55 g + 诺欣 41.23 mg”。出院后无发热，无明显恶心呕吐，自述“就是人有点虚，胃口差，刷牙时偶尔牙龈渗血，小便比以前少一点”。2025-08-04 回院。查体：KPS 90分，体重41 kg，身高155 cm，体表面积1.36 m²，双肺呼吸音清，心律齐；目前无活动性大出血、气道受压、急性颅神经功能恶化等需要立即缩瘤的并发症。\n\n当日化验：WBC 3.1×10^9/L，NEUT 1.8×10^9/L，Hb 105 g/L，PLT 68×10^9/L；ALT 25 U/L，AST 22 U/L，BUN 9.1 mmol/L，Cr 142 μmol/L，Alb 38 g/L；EBV-DNA 2.1×10^3 copies/ml。","patient_id":"l4-patient-70b0b30158fc1de1ca19d01c"}
+{"id":"l4-sample-e2cb88f43e81c06e73c513a5","question":"在完成上述诱导化疗并拟开始根治性放疗的此时，下列哪项同期治疗策略更适合该患者？","options":{"A":"标准方案之一：顺铂 100 mg/m² q3w 同期化疗（本题不选）","B":"标准方案之一：顺铂 40 mg/m² weekly × 6–7 周 同期化疗（本题不选）","C":"方案调整：奈达铂 100 mg/m² q3w 同期化疗","D":"继续原方案：吉西他滨 1.78 g + 奈达铂 71 mg q3w 同期化疗","E":"降阶梯治疗：单纯放疗（IMRT），不再行同期化疗","F":"替代方案之一：卡铂 AUC 5 q3w 同期化疗（本题不选）","G":"经验性减量：奈达铂 50 mg/m² q3w 同期化疗（本题不选）"},"answer":"C","vignette":"患者男，60 岁，确诊鼻咽未分化型非角化性癌 cT3N1M0，AJCC 第 8 版分期为 III 期。既往史提示有窦性心律不齐，曾行阑尾切除术。一般情况：身高 175 cm，体重 62 kg，体表面积约 1.75 m²。\n\n【既往治疗史（原始医嘱记录）】\n患者于 2022-08-24 和 2022-09-14 接受两周期以吉西他滨联合奈达铂的诱导化疗，具体用药如下：\n\n2022-08-24：泽菲（吉西他滨）1.79 g d1 + 诺欣（奈达铂）71.0 mg d1\n2022-09-14：泽菲（吉西他滨）1.78 g d1 + 诺欣（奈达铂）71.0 mg d1\n\n【目前状态】\n日期：2022-10-12。完成上述诱导化疗后复查，EBV-DNA 由初诊时 1.56E+03 copy/mL 降至 0 copy/mL。KPS 评分 90 分，拟开始根治性调强放疗（IMRT）。血常规：Hgb 105 g/L，PLT 185×10^9/L，WBC 在正常范围。肝肾功能检查未见明显异常。","patient_id":"l4-patient-560525d18ae058f9c2b95ac8"}
+{"id":"l4-sample-c0ae0a7c0f514b97db1262b1","question":"此时最合适的同期化疗决策是：","options":{"A":"顺铂 100 mg/m² q3w 同期化疗","B":"顺铂 40 mg/m² q1w 同期化疗","C":"顺铂 80 mg/m² q3w 同期化疗","D":"洛铂 20 mg/m² q1w 同期化疗","E":"洛铂 30 mg/m² q3w 同期化疗","F":"奈达铂 100 mg/m² q3w 同期化疗","G":"力扑素 + 诺欣（TP 方案）同期化疗","H":"单纯 IMRT，不再加同期化疗"},"answer":"F","vignette":"患者男，2017年约34岁。2017-03-27 因“鼻塞、右耳闷胀伴颈部肿物”就诊，鼻咽镜活检示鼻咽右侧壁未分化型非角化癌。病历首页记载：cT4N3M0，IVb期。\n既往史无特殊，KPS 评分一直约 90 分。\n\n【既往治疗史（原始医嘱记录）】\n2017-04-05 至 2017-06-19 于我科行 TP 诱导化疗 3 周期，具体方案为：\n\n-力扑素（紫杉醇脂质体）300 mg d1\n-诺欣（奈达铂）50 mg d1-2\n\n病程记录仅见“化疗过程顺利”，未见严重骨髓抑制记载。\n\n【当前时间】\n2017-07-08，拟开始同期放化疗（CCRT）。\n\n【查体与辅助检查】\n\n1. 身高 172 cm，体重 46 kg，较确诊时下降 4 kg，BMI 15.5。\n2. 血常规：Hgb 108 g/L，PLT 185×10^9/L，NEUT 3.1×10^9/L。\n3. 生化：ALT 35 U/L，AST 42 U/L，BUN 7.8 mmol/L，Cr 132 μmol/L，Alb 38 g/L。\n4. 听力测试：双耳高频听力轻度下降（25 dB）。\n5. 心电图：窦性心律，HR 78 bpm，大致正常心电图。","patient_id":"l4-patient-e02352c0e74de460d3d92f08"}
+{"id":"l4-sample-493527ccf3b5fac08a9880b6","question":"对于该患者，基于当时（2017 年）指南，在完成诱导化疗及同期放化疗后，下一步辅助治疗的策略应如何选择？","options":{"A":"给予标准辅助化疗：顺铂 (Cisplatin) 80mg/m² + 氟尿嘧啶 (5-FU) 1000mg/m² d1-4，q4w。","B":"给予单药维持治疗：替吉奥 (S-1) 或 卡培他滨 (Capecitabine) 口服至1年。","C":"给予强化辅助化疗：力扑素 (Paclitaxel Liposome) + 诺欣 (Nedaplatin) + 氟尿嘧啶 (5-FU)。","D":"目前处于放疗恢复期，且诱导+同期治疗强度已足够，建议定期随访观察 (Observation)。"},"answer":"D","vignette":"患者男，34岁。\n【现病史】\n2017-05-22 入院确诊：鼻咽右侧壁未分化型非角化癌 cT4N3M0 IVA期（UICC/AJCC 8th）。\n\n【既往治疗记录】\n1. **诱导化疗 (2017-06-19)**：\n   - 力扑素 (Paclitaxel Liposome) 300.0 mg d1\n   - 诺欣 (Nedaplatin) 50.0 mg d1\n   - KPS: 90.0\n\n2. **同期放化疗期间 (2017-07-10 至 2017-08-22)**：\n   - 接受“注射用洛铂 (Lobaplatin) 20.0 mg”方案，分别于 07-10, 07-27, 08-17, 08-22 给药。\n   - 期间多次记录 KPS: 90.0。\n\n【当前状态 (2017-09-18)】\n放疗结束约4周，患者返院复查。体格检查：颈部淋巴结明显缩小，鼻咽部肿物消退。血生化示：ALT 35 U/L, AST 28 U/L, Cr 88 μmol/L, BUN 5.2 mmol/L。血常规：WBC 3.8×10^9/L, NEUT 1.9×10^9/L, PLT 145×10^9/L。既往有“窦性心律不齐”史，无糖尿病、高血压病史。","patient_id":"l4-patient-e02352c0e74de460d3d92f08"}
+{"id":"l4-sample-d18e3af9911966a45d2ec9ce","question":"在当前情况下，下一步最佳治疗策略是？","options":{"A":"立即重启吉西他滨 + 顺铂（GP）全身化疗","B":"将希罗达加量至 2000 mg bid，以期控制微小残留病灶","C":"继续替加氟（250 mg tid）单药维持","D":"卡瑞利珠单抗联合阿帕替尼","E":"特瑞普利单抗单药","F":"吉西他滨单药","G":"观察随访，待 EBV-DNA 明显升高后再处理"},"answer":"E","vignette":"患者男，37岁。确诊鼻咽癌 cT4N3M1（病历首页记为 IVB 期）综合治疗后约 1 年。\n既往病史：2019-11-29 初诊时存在肝转移，接受 GP 方案化疗联合“维康达（60 mg bid）”治疗。2020-01 复查 EBV-DNA 转阴，后门诊改为替加氟（250 mg tid）维持。2020-06-10 复查时 EBV-DNA 3.33E+02 copy/mL，影像学提示肝转移灶进展，遂于 2020-07-01 改为希罗达单药（1500 mg bid）。治疗期间 KPS 一直约 90 分。2020-09-03 复查提示新发骨转移，EBV-DNA 再次转阴。患者既往有慢性乙肝小三阳史，肝肾功能基本正常，但自述 2020 年 7 月后口服治疗期间出现明显手足皲裂、行走痛及腹泻，曾自行减量。\n当前时间点为 2020-11-10，门诊复查 EBV-DNA 波动至 2.43E+02 copy/mL，体征平稳。","patient_id":"l4-patient-e02352c0e74de460d3d92f08"}
+{"id":"l4-sample-89974a706715675888434f54","question":"根据相关指南，下列哪项最符合该患者的初始治疗策略？","options":{"A":"TPF 方案（多西他赛 + 顺铂 + 5-FU）×3 周期，后接顺铂 100 mg/m² q3w 同步放疗","B":"GP 方案（吉西他滨 + 顺铂）×3 周期，后接顺铂 100 mg/m² q3w 同步放疗","C":"GP 方案（吉西他滨 + 顺铂）×3 周期，后接顺铂 40 mg/m² weekly 同步放疗","D":"紫杉醇脂质体（力扑素）+ 奈达铂（诺欣）q3w 诱导化疗，后接奈达铂同步放疗","E":"洛铂 + 5-FU 诱导化疗，后接洛铂同步放疗","F":"单药高剂量顺铂（100 mg/m²）+ 同步放疗","G":"卡铂 concurrent chemoradiotherapy，不做诱导化疗"},"answer":"E","vignette":"患者男，初诊时 34 岁。\n\n[2017-03-27] 门诊确诊：鼻咽侧壁恶性肿瘤（ICD10: C11.201）。MRI 提示鼻咽顶后壁及双侧侧壁增厚，咽旁间隙受累，双侧颈部淋巴结肿大，病历首页分期记录为 T3N2M0，III期。\n\n【体格检查与基线数据】\n\n-身高 174 cm，体重 48.0 kg，BMI 15.8。\n-既往史：幼年行扁桃体切除术，否认高血压、糖尿病。\n-体能状态：KPS 90.0。\n\n【2017-03-28 治疗前实验室检查】\n\n-血常规：WBC 5.8×10^9/L，Hb 105 g/L，PLT 245×10^9/L。\n-肝肾功能：ALT 28 U/L，AST 24 U/L，TBIL 10.2 μmol/L，BUN 7.1 mmol/L，Cr 132 μmol/L。\n-电解质：K 4.1 mmol/L，Na 139 mmol/L，Ca 2.25 mmol/L。\n-心电图：窦性心律，大致正常心电图。","patient_id":"l4-patient-e02352c0e74de460d3d92f08"}
+{"id":"l4-sample-d2d0ed5d3107a385acb6ed9e","question":"2024-11-12 时，该患者下一步应如何处理？","options":{"A":"属于复发一线治疗进展后的维持阶段，建议改用标准一线方案：吉西他滨 + 顺铂（GP方案）再次诱导","B":"加用免疫检查点抑制剂（如特瑞普利单抗）联合吉西他滨化疗","C":"继续给予卓仑（1500mg bid）单药口服维持治疗","D":"患者处于稳定期，且既往化疗结束已超过6个月，暂停药物治疗，进入观察随访期"},"answer":"C","vignette":"患者男，52岁（1971年生），既往有窦性心律不齐史，20年前行阑尾切除术。2024年1月13日确诊复发性鼻咽癌（rT3N3M0，未分化型非角化性癌）。\n\n查阅既往治疗记录（原始医嘱抓取）：\n- 2024-01-22：诺欣(44.01mg) + 泽菲(1.65g)\n- 2024-02-18：诺欣(53.95mg) + 泽菲(1.33g)\n- 2024-03-11：诺欣(83.5mg)\n- 2024-04-04：诺欣(44.01mg)\n- 2024-04-26：诺欣(49.2mg)\n- 2024-03-12至2024-05-08：行头颈部放疗。\n- 2024-04-26 诺欣(静脉滴注)结束; 2024-05-30 开始口服卓仑(1500mg bid)。\n\n患者目前（2024-11-12）返院复查，KPS 90分，复查鼻咽部MRI示病灶较前相仿（SD），无新发远处转移。血常规示：WBC 3.9×10^9/L，NEUT 2.1×10^9/L，PLT 110×10^9/L。","patient_id":"l4-patient-61f9d38023489b2064959d33"}
+{"id":"l4-sample-b011b86d3084aea3915ac175","question":"拟于明日（9月5日）进行下一阶段药物治疗，并于9月7日开始放疗，此时最合理的药物医嘱组合是？","options":{"A":"继续维持原方案：泰欣生 400mg + 洛铂 50mg + 紫杉醇(白蛋白) 391mg，以保持诱导化疗的高强度压制。","B":"更改为标准同步放化疗方案：单药 顺铂 100mg/m² (q3w) + 泰欣生 400mg，停用洛铂和紫杉醇。","C":"调整方案为：泰欣生 400mg + 洛铂 50mg，停用紫杉醇(白蛋白)。","D":"鉴于即将放疗，暂停所有细胞毒性化疗药物，仅给予 泰欣生 400mg 单药增敏，以避免骨髓抑制干扰放疗进程。"},"answer":"C","vignette":"患者男，42岁，2024年6月确诊鼻咽未分化型非角化性癌复发。既往体健，无高血压、糖尿病史。KPS评分 90分。\n\n【既往治疗回顾】\n患者于2024年7月3日、7月24日、8月15日及8月16日分次接受了三个周期的全身治疗。查阅医嘱系统，前三周期方案完全一致，具体药物包括：\n1. 泰欣生 (Nimotuzumab) 400mg ivgtt qd\n2. 注射用洛铂 (Lobaplatin) 50mg ivgtt qd\n3. 紫杉醇(白蛋白) (nab-Paclitaxel) 391mg ivgtt q3w\n\n【当前状态】\n时间：2024年9月4日。经过3周期治疗后，复查影像学评估病灶较前缩小（PR）。经MDT讨论，计划于本周内启动根治性放疗（IMRT）。\n\n【查体与辅查】\n查体：颈部淋巴结缩小，口腔黏膜无溃疡。心肺听诊无殊。\n血常规：WBC 3.8×10^9/L, NEUT 1.9×10^9/L, HGB 108g/L (轻度贫血), PLT 145×10^9/L。\n生化：ALT 35 U/L, AST 28 U/L, Cr 78 μmol/L, BUN 5.2 mmol/L。\n\n拟定于明日（9月5日）进行下一阶段药物治疗，并于9月7日开始放疗。","patient_id":"l4-patient-4e83550578ff02b8b8d37522"}
+{"id":"l4-sample-927d70dea997ba22b7e8a2cc","question":"2024-09-27 起，该患者下一阶段应采用哪种治疗方案？","options":{"A":"恢复诱导期方案：泰欣生 + 洛铂 + 紫杉醇(白蛋白)，以强化全身控制","B":"更换为同步放化疗方案：顺铂 (100mg/m²) + 泰欣生，于放疗中途改用标准铂类方案","C":"维持2024-09-05方案：泰欣生 + 洛铂，继续同步放化疗","D":"停止化疗，仅行泰欣生靶向治疗 + 放疗，认为已完成3周期诱导化疗后可免同步期化疗"},"answer":"C","vignette":"患者男，42岁。2024年6月确诊鼻咽未分化型非角化性癌，分期为 cT2N1M0 II期 (AJCC 8th)。既往体健，2015年行阑尾切除术，查体示窦性心律，HR 88bpm。KPS评分持续维持90分。治疗记录显示：\n- 2024-07-03：给予“泰欣生 400mg + 洛铂 50mg + 紫杉醇(白蛋白) 391mg”治疗；\n- 2024-07-24：重复上述三药联合方案；\n- 2024-08-16：重复上述三药联合方案；\n- 2024-09-05：给予“洛铂 50mg + 泰欣生 400mg”治疗；\n- 2024-09-07：正式开始IMRT放疗计划。\n\n今日为2024-09-27，患者返院复查，血常规及肝肾功能无明显绝对禁忌（Cr 82 μmol/L），准备接受下一阶段治疗。","patient_id":"l4-patient-4e83550578ff02b8b8d37522"}
+{"id":"l4-sample-8220637fd564e3cf57cfa39a","question":"在上述情况下，依据当前指南和药物说明书，最合理的起始系统治疗方案是？","options":{"A":"吉西他滨 + 顺铂 (GP方案) + 卡瑞利珠单抗","B":"多西他赛 + 顺铂 (TP方案) + 帕博利珠单抗","C":"白蛋白结合型紫杉醇 + 卡瑞利珠单抗 + 阿帕替尼 + 卡培他滨","D":"吉西他滨 + 卡铂","E":"单药卡瑞利珠单抗","F":"卡培他滨减量单药","G":"最佳支持治疗"},"answer":"D","vignette":"患者男，38岁。\n[2025-02-08] 确诊鼻咽未分化型非角化性癌复发。既往无吸烟史，2019年曾行阑尾切除术。当前 KPS 90 分。入院查体：BMI 19.1，体重 52 kg，身高 165 cm，窦性心律不齐。\n入院化验：ALT 28 U/L，AST 32 U/L，Alb 38 g/L，BUN 8.2 mmol/L，Cr 148 μmol/L；Hb 102 g/L，WBC 5.1×10^9/L，PLT 220×10^9/L。既往治疗耐受性尚可，无严重过敏史。\n经 MDT 评估，当前复发灶不适合挽救手术及再程放疗，拟按复发/转移鼻咽癌的一线系统治疗起始处理。","patient_id":"l4-patient-bd95b13a6407c3acdee5a382"}
+{"id":"l4-sample-a051d394006105f4d0851730","question":"基于患者目前的生理指标及既往用药史，2025-04-15 同步放化疗期间，下列最佳的全身治疗医嘱组合是？","options":{"A":"同步放疗 + 顺铂 100mg/m² ivgtt q3w + 卡瑞利珠单抗 200mg ivgtt q3w","B":"同步放疗 + 奈达铂 87mg ivgtt q3w + 卡瑞利珠单抗 200mg ivgtt q3w","C":"同步放疗 + 白蛋白紫杉醇 350mg + 奈达铂 87mg + 卡瑞利珠单抗 200mg (维持原诱导方案)","D":"同步放疗 + 西妥昔单抗 400mg/m² 首剂负荷量，随后 250mg/m² qw"},"answer":"B","vignette":"患者男，39岁（1986年生），于2025年2月确诊鼻咽癌 cT4N3M0 (IVa期)。\n\n【既往治疗史】\n2025-02-12至2025-03-27期间，行3周期诱导治疗，具体方案为：\n- 艾坦 (阿帕替尼) 0.25g po qw\n- 卓仑 (卡培他滨) 1500mg po bid\n- 诺欣 (奈达铂) 53mg ivgtt d1-3 (分次给药)\n- 艾瑞卡 (卡瑞利珠单抗) 200mg ivgtt d1\n- 白蛋白紫杉醇 352mg ivgtt d1\n\n【当前状态】\n2025-04-15 拟开始行根治性放疗（IMRT）。\n\n【查体与辅助检查 (2025-04-14)】\n- 体格检查：身高 172cm，**体重 58kg**。ECOG PS 0分，**KPS 90分**。\n- 血常规：WBC 3.9×10^9/L, NEUT 2.1×10^9/L, **Hgb 104 g/L**, PLT 185×10^9/L。\n- 血生化：ALT 35 U/L, AST 28 U/L, **Cr 138 μmol/L**, BUN 8.1 mmol/L, Alb 38 g/L。\n- 听力测试：双耳高频听力轻度下降（1级）。\n- 心电图：窦性心律，大致正常心电图。\n\n患者依从性良好，无经济困难，要求积极治疗。","patient_id":"l4-patient-bd95b13a6407c3acdee5a382"}
+{"id":"l4-sample-7a340d738d6cbca61e039b9d","question":"根据当前指南及循证证据，对于该患者今日应给予的后续治疗医嘱是？","options":{"A":"卡培他滨单药节拍维持治疗","B":"卡瑞利珠单抗单药辅助/维持治疗","C":"卡瑞利珠单抗 + 卡培他滨双药维持","D":"吉西他滨 + 顺铂（GP）辅助化疗","E":"定期随访观察，暂不进行药物干预","F":"替吉奥（S-1）单药维持","G":"特瑞普利单抗单药辅助治疗"},"answer":"B","vignette":"患者男，39岁（1986年生），确诊鼻咽癌 cT4N3M0，IVa期。\n\n【既往治疗史回顾】\n\n1. 诱导治疗（2025-03-06 起）：接受“卓仑（卡培他滨）+ 艾瑞卡（卡瑞利珠单抗）+ 锐贝（白蛋白紫杉醇）+ 诺欣（奈达铂）”方案治疗。\n2025-03-27 第二周期给药前查体记录显示：\n“双足底可见散在水泡及明显脱皮，患者诉行走时疼痛剧烈（NRS 7 分），严重影响日常生活。”\n2. 同期放化疗（2025-04-15 ~ 2025-05-30）：完成根治性放疗（PGTVnx 70 Gy/33f），同期给予“诺欣 + 艾瑞卡”治疗。\n\n【当前状态（2025-09-08）】\n放疗结束约 3 个月返院复查。鼻咽镜及头颈部 MRI 示原发灶及淋巴结临床完全缓解（CR），EBV-DNA 转阴。\n今日查体：KPS 90 分，体重 68 kg。双肺听诊呼吸音清。心电图示窦性心律，HR 72 次/分。\n血生化：ALT 42 U/L，AST 35 U/L，Cr 88 μmol/L，BUN 5.2 mmol/L。\n血常规：WBC 4.1×10^9/L，NEUT# 2.2×10^9/L，HGB 108 g/L，PLT 155×10^9/L。","patient_id":"l4-patient-bd95b13a6407c3acdee5a382"}
+{"id":"l4-sample-9f9ce780e59a7fe6cb9cbe3d","question":"根据当前循证证据和指南推荐，下列哪项最符合该患者的初始治疗策略？","options":{"A":"同步放化疗：IMRT + 顺铂 100 mg/m² q3w × 2–3 周期（不行诱导化疗，直接进入同步放化疗）","B":"诱导化疗：吉西他滨 + 顺铂 × 3 周期，后接顺铂同步放化疗（全程以顺铂为主轴）","C":"同步放化疗：IMRT + 奈达铂 80–100 mg/m² + 尼妥珠单抗（不做诱导化疗，仅在同步阶段改用奈达铂+靶向）","D":"诱导化疗：洛铂 + 5-FU × 3 周期，后接洛铂同步放化疗（全程以洛铂为主轴的 IC-CCRT）","E":"诱导化疗：TPF × 3 周期，后接 weekly 顺铂同步放化疗（诱导+同步阶段均使用顺铂）","F":"同步放化疗：IMRT + 卡铂 q3w（不做诱导化疗，仅将同步药物改为卡铂）","G":"单纯根治性放疗（IMRT），不合并任何全身系统治疗"},"answer":"D","vignette":"患者男，2023年约64岁。\n2023 年 4 月 6 日确诊为鼻咽未分化型非角化性癌。MRI 及分期记录示 T3N2M0（AJCC 8th，III期）。既往有阑尾切除术史，否认高血压、糖尿病病史。\n\n2023 年 5 月 11 日入院拟行根治性治疗。\n入院查体：KPS 90 分，身高 168 cm，体重 58 kg，体表面积约 1.63 m²。\n血常规：Hb 108 g/L，WBC 5.2×10⁹/L，PLT 210×10⁹/L。\n生化：ALT 24 U/L，AST 28 U/L，白蛋白 38 g/L，BUN 8.2 mmol/L，Cr 128 μmol/L。\nEBV-DNA：2.4×10⁴ copies/mL。","patient_id":"l4-patient-c9b033c9d7c5dde89304b186"}
+{"id":"l4-sample-e720fa23d8c467f0b6c31415","question":"基于患者的既往用药史、累积毒性及当前临床特征，下一步最合理的治疗方案是？","options":{"A":"吉西他滨 + 顺铂 (GP方案) + 停止特瑞普利单抗/尼妥珠单抗","B":"白蛋白紫杉醇 + 奈达铂 (原方案再挑战)","C":"单药卡培他滨口服化疗，停用特瑞普利单抗及尼妥珠单抗；如骨转移管理仍有需要，可继续地舒单抗","D":"单药卡培他滨维持 + 切换为帕博利珠单抗 (Keytruda)"},"answer":"C","vignette":"患者男，32岁。\n\n【既往核心治疗史】\n1. **一线诱导 (2022-03-10 至 2022-06-27)**：接受“注射用紫杉醇(白蛋白结合型)(石药) 400mg + 诺欣(奈达铂) 40mg (分次) + 拓益(特瑞普利单抗) 240mg + 艾滨/艾瑞卡”方案共4周期。末次化疗时间为2022-06-27。\n2. **放疗与维持 (2022-07-21 至 2023-04-20)**：2022-07-21启动放疗，期间联合“泰欣生(尼妥珠单抗) + 拓益”。放疗结束后，持续使用“拓益 (q3w) + 泰欣生 (qw) + 安加维(地舒单抗) (q4w)”维持治疗至2023年4月。\n\n【当前状态 2023-05-10】\n复查影像学提示肝脏转移灶较前增大（PD）。\n\n【体格与辅助检查】\n- KPS评分: 90.0。体重 65kg。\n- 血常规: Hgb 105 g/L, ANC 2.1×10^9/L, PLT 185×10^9/L。\n- 生化: ALT 35 U/L, AST 40 U/L, **Cr 92 μmol/L**。\n- 神经系统: 患者自述双足趾端及指尖持续麻木感（CTCAE 2级），系2022年含紫杉类化疗后遗留。\n- 听力: 纯音测听示双耳高频听力轻度下降（既往含铂化疗累积效应）。\n- 既往史: 2015年行阑尾切除术，窦性心律不齐。","patient_id":"l4-patient-d0aac7d60214266b43765686"}
+{"id":"l4-sample-1ea0ee967aec592e1b19e48e","question":"在该患者于一线免疫联合化疗及维持治疗进展后，此时最合理的后续全身系统治疗方案是？","options":{"A":"吉西他滨 + 顺铂（GP 方案）","B":"多西他赛 + 顺铂（TP 方案）","C":"吉西他滨 + 替雷利珠单抗 + 尼妥珠单抗 + 卡培他滨","D":"卡瑞利珠单抗 + 阿帕替尼","E":"卡培他滨单药加量","F":"特瑞普利单抗单药"},"answer":"D","vignette":"患者男，32岁，既往无吸烟史。2023年5月10日因“复查发现肝脏病灶增大”入院。\n\n【既往关键病史数据】\n\n初治详情：2022-03-07 确诊鼻咽未分化型非角化性癌 cT4N3M1（骨、肝转移）。病理免疫组化示：CK(+)，EGFR(+)，EBERs(+)。\n-一线治疗：2022-03-10 至 2022-06-27 行“奈达铂 + 白蛋白紫杉醇 + 替雷利珠单抗”方案共 6 周期。\n-维持与放疗：2022-07-21 至 2022-09-09 行原发灶及颈部淋巴结放疗；同期及放疗后予“替雷利珠单抗 + 卡培他滨”维持治疗至 2023 年 4 月。\n-本次复查：2023-05-10 MRI 示肝 S6 段病灶较前增大（由 1.2 cm 增至 2.5 cm），判定为 PD。\n\n【查体与辅助检查】\n\n-ECOG PS 0，体重 62 kg，BSA 1.7 m²。\n-血常规：WBC 4.5×10^9/L，Hgb 108 g/L，PLT 185×10^9/L。\n-生化：ALT 35 U/L，AST 40 U/L，Cr 78 μmol/L。\n-神经系统查体：四肢末端痛温觉减退，双手指尖麻木感明显，扣纽扣稍困难（CTCAE 2级周围神经病变）。\n-心电图：窦性心律，HR 72 次/分。","patient_id":"l4-patient-d0aac7d60214266b43765686"}
+{"id":"l4-sample-d6c818336ce911006f0b5103","question":"该患者下一步系统治疗的最佳策略是？","options":{"A":"吉西他滨 (Gemcitabine) + 顺铂 (Cisplatin) + 特瑞普利单抗 (Toripalimab)","B":"卡培他滨 (Capecitabine) 单药口服化疗","C":"吉西他滨 (Gemcitabine) + 尼妥珠单抗 (Nimotuzumab) + 卡培他滨 (Capecitabine) + 特瑞普利单抗 (Toripalimab)","D":"白蛋白紫杉醇 (nab-Paclitaxel) + 氟尿嘧啶 (5-FU)"},"answer":"B","vignette":"患者男，32岁，既往确诊鼻咽未分化型非角化性癌 (cT4N3M1, IVB期)。\n\n【既往治疗史】\n1. 2022-03-10起行GP（吉西他滨+顺铂）诱导化疗，因严重消化道反应及耳鸣，第二疗程起更换为 TP（白蛋白紫杉醇+奈达铂）方案，并在后续维持治疗中使用了特瑞普利单抗（拓益）+安加维。\n2. 2022-07-21至2022-09-09完成鼻咽及颈部放疗，期间配合尼妥珠单抗（泰欣生）增敏。\n3. 放疗后继续维持特瑞普利单抗至2023-04-20。\n\n【近期复查与现状】\n2023-05-11复查影像学提示：肝S6段及肺部多发结节较前增大，伴新发骨转移灶。查体ECOG PS 1分（KPS 90），体重62kg。\n\n【辅助检查数据】\n- 血常规：WBC 3.8×10^9/L, NEUT 2.1×10^9/L, HGB 105g/L, PLT 145×10^9/L。\n- 生化指标：ALT 35 U/L, AST 42 U/L, TBIL 18 μmol/L, Alb 38g/L, **Cr 118 μmol/L** (基线Cr 75 μmol/L)。\n- 既往史补充：患者自述放疗后出现持续性双耳高频听力下降，近期伴间歇性手足麻木感（CTCAE 1级）。","patient_id":"l4-patient-d0aac7d60214266b43765686"}
+{"id":"l4-sample-c4755652ecbea1de3c7268e8","question":"下列哪项调整最符合最佳临床实践？","options":{"A":"维持当前方案：替雷利珠单抗 200mg q3w + 卓仑 1500mg bid，密切随访神经毒性。","B":"疾病稳定且EBV清零，降级治疗：停用替雷利珠单抗，仅保留卓仑 1500mg bid 维持。","C":"剂量优化：维持替雷利珠单抗，将卓仑剂量调整为 2000mg bid。","D":"更换方案：因既往多线免疫暴露，更换为 (白蛋白)紫杉醇 + 艾坦 以克服潜在耐药。"},"answer":"C","vignette":"患者男，32岁。确诊鼻咽癌 cT4N3M1 (IVB期) 16个月。既往于2022年6月起行多线治疗。包含“拓益+泰欣生”方案及放疗。\n\n【近期用药记录快照】：\n[2023-08-07] (住院) 泽菲 1.7g d1,8 + 拓益 240mg q3w + 希罗达 1500mg bid。\n[2023-09-21] (门诊) 替雷利珠单抗 200mg q3w + 卓仑 1500mg bid + 安加维 120mg q4w。\n[2023-10-17] (门诊) 卓仑 1500mg bid + 安加维 120mg q4w。\n\n【当前查体与辅助检查 (2023-11-01)】：\n身高 180cm，体重 85kg。KPS评分 90。查体示双手指端轻度麻木(Grade 1)。\n血常规：WBC 4.1×10^9/L, Hgb 108 g/L (轻度贫血), PLT 125×10^9/L。\n生化：ALT 35 U/L, Cr 78 μmol/L, BUN 5.2 mmol/L。\nEBV-DNA: 0 copy/mL (持续转阴)。\n心电图：窦性心律，大致正常心电图。","patient_id":"l4-patient-d0aac7d60214266b43765686"}
+{"id":"l4-sample-01e32eec44e49b4e0fd95cc6","question":"2024-06-13，根据当前可见资料，关于将GP（吉西他滨+顺铂）作为后线治疗选择的评估，以下哪项判断最合理？（单选）","options":{"A":"既往使用吉西他滨后更换过方案，已足以判定吉西他滨耐药，应永久排除GP方案","B":"先核实既往吉西他滨疗效与停药原因、近期顺铂治疗结果及耐受性，再结合当前病情个体化评估GP的后线适用性","C":"当前血清肌酐及ECOG评分已足以支持立即采用GP，无需进一步核对既往疗效和治疗耐受性","D":"近期医嘱执行结束且颈部淋巴结稍增大，已足以判定含顺铂方案治疗失败，应直接排除GP方案"},"answer":"B","vignette":"患者男，33岁。确诊鼻咽癌IVB期（cT4N3M1）近2年。查体：ECOG PS 0-1，BP 128/78 mmHg，双颈部可触及数个质硬淋巴结。既往无高血压、糖尿病史。辅助检查示血常规：HGB 108g/L，WBC 4.5×10^9/L，PLT 210×10^9/L；生化：ALT 35 U/L，Cr 88 μmol/L。\n\n既往治疗史回顾（提取自HIS原始记录）：\n1. [2023-05-12] 开始使用“健择(Gemcitabine) 1.7g d1,8 + 希罗达(Capecitabine) + 拓益(Toripalimab)”方案，维持至2023年8月。\n2. [2023-09-21] 方案调整为“替雷利珠单抗 + 卓仑(Capecitabine)”，末次用药时间2024-02-20。\n3. [2024-04-12] 影像学提示进展，启动新方案：\n   - 医嘱A: (基)紫杉醇(汇宇) 267mg d1\n   - 医嘱B: 诺欣(Cisplatin) 53mg d1\n   - 医嘱C: 艾瑞卡(Camrelizumab) 200mg d1\n4. [2024-05-21] 上述紫杉醇+诺欣方案执行结束，患者诉输注期间轻度胸闷，现复查颈部淋巴结较前稍增大。\n\n今日（2024-06-13）患者入院拟行下一步治疗。","patient_id":"l4-patient-d0aac7d60214266b43765686"}
+{"id":"l4-sample-c5e36d34f589cf3906833b90","question":"下一步最合理的治疗方案是：","options":{"A":"吉西他滨 + 顺铂 + 特瑞普利单抗","B":"多西他赛 + 顺铂 + 5-FU（TPF 方案）","C":"紫杉醇 + 奈达铂 + 卡培他滨 + 替雷利珠单抗","D":"单药替雷利珠单抗","E":"吉西他滨 + 卡铂 + 特瑞普利单抗","F":"吉西他滨 + 顺铂","G":"再程放疗联合每周顺铂","H":"挽救性鼻咽/颈部手术","I":"最佳支持治疗","J":"紫杉醇 + 顺铂 + 卡培他滨"},"answer":"E","vignette":"患者女，2023年约27岁。\n2023 年 12 月 30 日因“回吸性涕血”入院，完善检查后诊断为鼻咽未分化型非角化癌，按 AJCC 第 9 版临床分期为 cT3N2M0（IVA 期）。2024 年 1 月至 2024 年 5 月已完成根治性综合治疗。2025 年 1 月 3 日因再次出现回吸性涕血并伴颈部肿块复查，经 MRI、PET/CT 及病理评估提示局部区域复发，MDT 评估为 rT3N2M0。结合病灶侵犯范围、既往高剂量放疗史及正常组织耐受情况，当前评估认为患者不适合挽救性手术，亦不适宜再程放疗。\n\n治疗前查体：KPS 90 分。既往史：窦性心律不齐，2018 年行阑尾切除术。身高 160 cm，体重 41 kg，体表面积 1.32 m²。实验室检查示：WBC 5.1×10^9/L，NEUT 3.2×10^9/L，HGB 110 g/L，PLT 215×10^9/L；ALT 21 U/L，AST 18 U/L，TBIL 10.2 μmol/L，BUN 6.8 mmol/L，Scr 112 μmol/L。乙肝表面抗原（-）。患者无听力下降主诉，心电图除窦性心律不齐外无明显异常。","patient_id":"l4-patient-98745ce03470e5bbbebb7817"}
+{"id":"l4-sample-e9bb19d4986058f52c92b687","question":"若将当前治疗调整为复发鼻咽癌一线推荐方案，应选择哪项？","options":{"A":"维持原方案：紫杉醇 + 顺铂 + 卡培他滨","B":"取消诱导化疗，立即转入同期放化疗，首选顺铂 100 mg/m²","C":"在原 TP+C 基础上新增替雷利珠单抗 200 mg q3w","D":"更换为吉西他滨 + 顺铂（GP）","E":"更换为吉西他滨 + 顺铂 + 替雷利珠单抗","F":"更换为吉西他滨 + 卡铂"},"answer":"E","vignette":"患者女，28 岁。\n\n【病历资料】\n\n[2024-12-30] 入院诊断：鼻咽未分化型非角化性癌，核定分期为 T3N2M0（AJCC 第九版）II 期。\n[2025-01-03] 复发确诊。\n[2025-01-07] 病理结论：（鼻咽肿物）镜检为未分化型非角化性癌，EBERs（+）。\n[2025-01-08] 医嘱执行：给予方案为紫杉醇 223.5 mg d1 + 顺铂（诺欣）44.7 mg d1–3 + 卡培他滨 1500 mg bid。\n\n【当前状况】\n- 当前时间为 2025-02-05。患者返院准备进行第二周期治疗。查体：生命体征平稳，KPS 90 分。\n- 既往史：轻度窦性心律不齐，无慢性肾病史。\n- 实验室检查：血常规提示 I 度骨髓抑制，肝肾功能未见明显异常。\n- 经 MDT 评估，当前复发灶暂不考虑挽救手术及再程放疗，全身系统治疗方案需进一步权衡与调整。","patient_id":"l4-patient-98745ce03470e5bbbebb7817"}
+{"id":"l4-sample-ddcd0a4afb8606ae3c20fcdc","question":"若本周期复查符合给药条件，拟延续原方案，应选择哪项医嘱？","options":{"A":"顺铂 100mg/m² IV gtt d1（单药）","B":"顺铂 80mg/m² IV gtt d1 + 5-FU 1000mg/m² CIV 96h","C":"顺铂（诺欣）58 mg d1–2 + 替雷利珠单抗200 mg d1","D":"暂停同步化疗，仅行放射治疗，继续替雷利珠单抗维持"},"answer":"C","vignette":"患者女，28岁。确诊鼻咽未分化型非角化性癌，cT3N2M0 II期 (AJCC 9th)。\n\n【既往治疗史关键节点】\n1. 诱导化疗阶段：\n- [2025-01-08] 开始TP方案+卡培他滨：紫杉醇 223.5 mg d1 + 诺欣（顺铂，Cisplatin）44.7 mg（1/8–1/10）+ 卓仑（Capecitabine）1500 mg bid。\n- [2025-02-05] 方案同前。\n- [2025-02-25] 方案调整：紫杉醇 222 mg + 诺欣 45 mg（2/25–2/26）+ 卓仑 1500 mg bid + 替雷利珠单抗 200 mg。\n\n2. 同步放化疗阶段：\n- [2025-03-18] 放疗开始（计划至 2025-05-10）。\n- [2025-03-18] 同步系统治疗：诺欣 58 mg（3/18–3/19）+ 替雷利珠单抗 200 mg。\n\n【当前状态 2025-04-10】\n- 查体：口腔黏膜 II 度反应，颈部皮肤 I 度反应。听诊可闻窦性心律不齐。\n- 体能状态监测：\n- [2024-12-30] KPS 评分：90.0\n- [2025-02-25] KPS 评分：90.0\n- [2025-03-18] KPS 评分：90.0\n- [2025-04-10] KPS 评分：90.0\n- 距上一周期系统治疗已过 23 天。","patient_id":"l4-patient-98745ce03470e5bbbebb7817"}
+{"id":"l4-sample-6e04053e040fbcb6fbf32278","question":"本次复发确诊后、首次全身治疗前，结合患者肾功能，以下哪项全身治疗原则最合理？（单选）","options":{"A":"由MDT结合肾功能及耐受性选择适用的非顺铂全身治疗方案，评估联合免疫治疗的适用性，并调整药物剂量、监测毒性","B":"多西他赛 + 顺铂 + 5-氟尿嘧啶 (TPF方案) 诱导化疗","C":"紫杉醇 + 奈达铂 + 卡培他滨 + 替雷利珠单抗（后续适时介入放疗）","D":"单药顺铂 (100mg/m²) 同步放疗 (CCRT)"},"answer":"A","vignette":"患者女，28岁。[2024-12-30] 入院完善检查，影像学及病理提示鼻咽未分化型非角化性癌，分期为 cT3N2M0（AJCC第九版，II期）。患者既往有鼻咽癌放化疗史，本次病情于[2025-01-03] 明确为复发，目前拟开始本次复发后的首次全身治疗。入院查体：KPS 90分，身高160 cm，体重42 kg。既往史：否认高血压、糖尿病。辅助检查：血常规 WBC 5.1×10^9/L，Hgb 115 g/L，PLT 245×10^9/L；血生化示 ALB 38 g/L，BUN 8.2 mmol/L，Cr 118 μmol/L。EBV-DNA 4.5×10^4 copies/ml。患者目前无明显耳鸣、听力下降等主诉。","patient_id":"l4-patient-98745ce03470e5bbbebb7817"}
+{"id":"l4-sample-44b2427039323f18a4016cb9","question":"根据当前指南，对于该患者，下一步最合理的同步治疗方案是？","options":{"A":"再程 IMRT + 顺铂 100 mg/m² q3w","B":"再程 IMRT + 顺铂 40 mg/m² weekly","C":"再程 IMRT + 奈达铂同步增敏","D":"先行吉西他滨 + 顺铂诱导化疗后再考虑放疗","E":"经鼻内镜鼻咽切除术后观察","F":"再程 IMRT 单独治疗，不联合任何系统药物"},"answer":"C","vignette":"患者女，33 岁。既往于 2021 年确诊鼻咽癌 T3N2M0，病理类型为鼻咽癌非角化型/未分化型，接受 TPF 诱导化疗 + 同期放化疗后评估为 CR。\n\n2024-08-06 复查鼻咽镜及 MRI 示鼻咽顶后壁软组织增厚，活检病理提示鼻咽癌（非角化型或未分化型）局部复发，分期 rT2N0M0，目前影像学未见远处转移证据。\n\n经 MDT 讨论：综合复发灶位置及范围评估后，认为不适合经鼻内镜手术切除，拟考虑挽救性再程放疗方案。\n\n入院查体：身高 160 cm，体重 41 kg，BMI 16.0。心肺听诊无殊，双下肢无水肿。既往史：10 年前行阑尾切除术，窦性心律不齐。\n\n辅助检查：\n- KPS 90 分\n- 血常规：WBC 5.1×10^9/L，Hb 108 g/L，PLT 210×10^9/L\n- 生化：ALT 21 U/L，AST 19 U/L，BUN 8.2 mmol/L，Cr 105 μmol/L\n- 听力测试：双耳高频听力轻度下降（较 2021 年无明显变化）","patient_id":"l4-patient-7a71313519830c08602922e9"}
+{"id":"l4-sample-70821714837f603846e79359","question":"下列哪项最符合该患者的同期增敏医嘱？","options":{"A":"顺铂 60 mg，静脉滴注，d1–2，Q3W","B":"顺铂 60 mg，静脉滴注，d1，QW","C":"顺铂 76 mg，静脉滴注，d1–2，Q3W（本院采用三周总剂量 100 mg/m² 的顺铂方案，允许拆分至 d1–2 给药）","D":"奈达铂 80 mg，静脉滴注，d1，Q3W","E":"顺铂 152 mg，静脉滴注，d1，Q3W（本院采用的 100 mg/m² 三周方案在部分科室也可一次性于 d1 给药）","F":"顺铂 45 mg，静脉滴注，d1，QW","G":"卡铂 AUC 2，静脉滴注，d1，QW","H":"仅继续特瑞普利单抗 240 mg Q3W，不加同期增敏化疗","I":"顺铂 61 mg，静脉滴注，d1–2，Q3W","J":"顺铂 76 mg，静脉滴注，d1，QW"},"answer":"C","vignette":"患者男，23 岁。2025-03-08 经 MDT 评估确诊为鼻咽癌局部区域复发，拟行根治性挽救治疗。既往体健，KPS 评分稳定 90 分。近期查体示窦性心律不齐；复查肾功能、听力学评估及血常规均可耐受含铂同期放化疗。患者于 2025-03-14 启动诱导免疫化疗，前两周期记录如下：\n\n周期 1（2025-03-14）：特瑞普利单抗 240 mg d1 + 白蛋白紫杉醇 395 mg d1 + 顺铂 60 mg d1–2\n周期 2（2025-04-03）：特瑞普利单抗 240 mg d1 + 白蛋白紫杉醇 397 mg d1 + 顺铂 61 mg d1–2\n\n2025-04-21 按计划开始接受挽救性 IMRT。2025-04-24，医师拟开具放疗同期增敏化疗医嘱。\n已知临床允许将三周方案的总顺铂剂量拆分至 d1–2 给药。","patient_id":"l4-patient-49124cc4bf6863ed24322fba"}
+{"id":"l4-sample-736c2fa4a031a241e283c0de","question":"根据上述病情演变及目前复查结果，在本次拟行的下一周期治疗中，最合理的药物组合及剂量是？","options":{"A":"继续维持原方案：紫杉醇(白蛋白) 320mg d1 + 替雷利珠单抗 200mg d1 (联合免疫治疗)","B":"剂量调整：紫杉醇(白蛋白) 256mg d1 + 替雷利珠单抗 200mg d1","C":"再次挑战铂类：顺铂 80mg/m² d1 + 替雷利珠单抗 200mg d1","D":"更换二线方案：吉西他滨 1.0g/m² d1,8 + 替雷利珠单抗 200mg d1"},"answer":"B","vignette":"患者女，51岁。2024-11确诊鼻咽未分化型非角化性癌 (cT3N3M0, IVA期)。既往无吸烟史，KPS评分长期维持90分。\n\n【既往治疗经过】：\n1. [2024-11-12] 启动诱导治疗：泽菲 1.56g d1,8 + 诺欣 62mg d1-2 + 拓益 240mg d1。\n2. [2024-12-03] 泽菲 1.56g + 诺欣 62mg + 拓益 240mg。\n3. [2025-01-08] 泽菲 1.27g + 诺欣 (剂量调整) + 拓益。\n4. [2025-01-15] 影像学复查提示：肝脏S6段新发结节，考虑远处转移 (cM1)。\n5. [2025-02-05] 更改方案为：卓仑 1500mg bid + 紫杉醇(白蛋白)-锐贝 320.0mg q3w。\n6. [2025-02-25] 第二周期：紫杉醇(白蛋白)-锐贝 320.0mg q3w。\n\n当前时间：[2025-03-24]。患者返院复查，主诉轻度乏力，纳差改善。血常规回报：WBC 3.1×10^9/L, NEUT 1.6×10^9/L, PLT 85×10^9/L (较前次化疗后最低值PLT 45×10^9/L有所回升)。心电图示窦性心律，HR 72bpm。拟行下一周期治疗。","patient_id":"l4-patient-2986b533c6672220c7d420fc"}
+{"id":"l4-sample-82c5676a5aa6ba0f9325c291","question":"下列哪项是当前最合理的放疗期联合治疗策略？","options":{"A":"同步给予顺铂（100 mg/m² q3w 或 40 mg/m² qw）作为增敏治疗","B":"继续“白蛋白紫杉醇 + 替雷利珠单抗”原剂量治疗并与放疗同步进行","C":"联合尼妥珠单抗（nimotuzumab）靶向治疗","D":"联合西妥昔单抗（cetuximab）负荷剂量 400 mg/m²，随后 250 mg/m² qw","E":"放疗期间暂停所有系统治疗，仅完成局部姑息放疗","F":"每周奈达铂同步放疗","G":"继续替雷利珠单抗单药与放疗同步","H":"联合阿帕替尼口服维持并同步放疗","I":"联合卡培他滨口服并同步放疗","J":"放疗期间恢复 GP + PD-1 方案"},"answer":"E","vignette":"患者女，51 岁。2024 年 11 月确诊鼻咽未分化型非角化性癌，EBER（+）。初诊分期为 cT3N3M0（AJCC 第 9 版，III 期）。既往无高血压、糖尿病史，2010 年曾行阑尾切除术。KPS 评分长期维持在 90 分。\n\n现病史与治疗回顾\n\n患者在确诊后接受了以下系统治疗，HIS 记录较为碎片化：\n\n一线治疗（2024.11–2025.01）\n\n采用含铂化疗联合 PD-1 抑制剂方案。HIS 记录可见：\n\n[2024-12-03] 吉西他滨 1.56 g + 特瑞普利单抗 240 mg\n[2025-01-08] 吉西他滨 1.27 g + 顺铂 26 mg（后停嘱）\n[2025-01-15] 复查提示肝 S6 段新发结节，评估为远处转移（cM1）\n后续治疗（2025.02–2025.03）\n\n疾病进展后调整为以白蛋白紫杉醇为主的后线方案，曾合并口服抗肿瘤药物，后续又叠加替雷利珠单抗：\n\n[2025-02-05] 口服抗肿瘤药 + 白蛋白紫杉醇 320 mg\n[2025-02-25] 白蛋白紫杉醇 320 mg\n[2025-03-24] 替雷利珠单抗 200 mg + 白蛋白紫杉醇 256 mg\n当前状态\n\n2025-04-22，患者开始接受鼻咽原发灶及颈部淋巴结局部姑息性放疗，目标以局部症状控制和区域病灶压缩为主，而非根治性同步放化疗。\n2025-04-26 MDT 讨论拟制定放疗期间的联合治疗策略。查体：KPS 80，颈部淋巴结较前缩小，Child-Pugh A 级。近 2 周乏力较前加重，食欲下降；复查血常规示 WBC 3.2×10^9/L、PLT 92×10^9/L，提示多线系统治疗后已出现一定累积骨髓毒性。","patient_id":"l4-patient-2986b533c6672220c7d420fc"}
+{"id":"l4-sample-895419c584d6e6e4a8c8b7ff","question":"针对该患者2020年9月30日的治疗调整，结合既往用药史及放疗安排，下列关于治疗策略的分析最准确的是？","options":{"A":"患者KPS评分稳定在90分，且年轻（42岁），应继续维持原标准剂量顺铂（100mg/m²）同步放疗，以保证疗效，不应减量。","B":"患者处于复发后诱导化疗序贯同步放化疗阶段，考虑到9月14日已开始放疗，9月30日的化疗方案应调整为吉西他滨单药增敏，避免铂类毒性。","C":"患者在9月10日周期顺铂剂量曾提升至63mg/d（总剂量约189mg，>100mg/m²），但在放疗开始后的9月30日周期，顺铂剂量下调至44mg/d（总剂量132mg，约75mg/m²），这符合同步放化疗期间降低累积毒性的策略。","D":"根据2020年7月30日和8月20日的记录，患者使用的是吉西他滨+顺铂（GP）方案，9月30日应继续使用足量GP方案（吉西他滨1.93g + 顺铂51mg/d）同步放疗，以达到最大杀伤效果。"},"answer":"C","vignette":"患者男，42岁，既往无烟酒嗜好。2020年7月8日因“颈部包块伴回吸性涕血”复查，确诊鼻咽癌复发。既往史记录显示：2020年7月23日、8月19日、9月8日、9月18日、9月29日及10月20日多次评估KPS评分均为90分。入院查体：身高172cm，体重68kg，BSA 1.8m²。心电图示窦性心律，大致正常心电图。血常规示：Hb 132g/L，PLT 215×10^9/L，WBC 5.2×10^9/L。肝肾功能：ALT 35 U/L，AST 28 U/L，Cr 88 μmol/L。\n\n既往治疗记录如下：\n患者于2020年7月30日开始行吉西他滨（1.93g d1, d8）联合顺铂化疗。顺铂具体给药记录为：\n- 2020-07-30：诺欣 51.0 mg/d × 3天\n- 2020-08-20：诺欣 51.0 mg/d × 3天\n- 2020-09-10：诺欣 63.0 mg/d × 3天\n\n随后，患者于2020年9月14日开始行调强放疗（IMRT）。放疗期间，于2020年9月30日再次行化疗，医嘱记录显示：诺欣 44.0 mg/d × 3天。","patient_id":"l4-patient-e4109ee2515a5f17c71befae"}
+{"id":"l4-sample-4d4c6ff0be0e8fd6a1d65d89","question":"根据现有指南，该患者目前最合适的后续治疗方案是？","options":{"A":"吉西他滨 + 顺铂 (GP方案) 全身化疗（常规剂量）","B":"多西他赛 + 顺铂 + 氟尿嘧啶 (TPF方案) 诱导/强化化疗（常规剂量）","C":"卡瑞利珠单抗 (PD-1单抗) 200mg q2w 单药维持/姑息治疗","D":"替加氟 (Tegafur) 单药口服治疗"},"answer":"D","vignette":"患者男，75岁。\n\n【既往史】\n2019年3月确诊鼻咽未分化型非角化性癌复发（rT3N2M0）。\n既往治疗记录显示：\n- \"2019-04-16 放疗开始... 2019-05-30 放疗结束\";\n- \"2019-04-18 泰欣生(Nimotuzumab) 200mg... 2019-05-17 泰欣生 200mg...\";\n- 放疗期间同步应用“天恩福”。\n\n【现病史】\n2019年10月8日复诊。患者诉近期轻微乏力，纳差。既往有陈旧性肺结核史，窦性心律不齐。\n\n【查体与辅助检查】\n- ECOG PS 1分，[2019-04-16] KPS评分:90.0（近期维持）。\n- 身高 168cm，**体重 46kg**。\n- 鼻咽镜：咽隐窝粘膜稍粗糙，未见明显新生物。\n- 头颈部MRI：鼻咽壁增厚较前相仿，颈部淋巴结缩小。\n- [2019-09-18] 分子诊断：EBV-DNA 2.26E+02 copy/mL。\n- 血常规：WBC 3.8×10^9/L, HGB 102g/L, PLT 110×10^9/L。\n- 血生化：ALT 25 U/L, Alb 32 g/L, BUN 8.2 mmol/L, **Cr 136 μmol/L**。","patient_id":"l4-patient-d60402c55abcfa90fa2f9c14"}
+{"id":"l4-sample-6b4ed19259216e3e8f7da19b","question":"2020-01-08 时，该患者应选择哪种治疗策略？","options":{"A":"疾病复发一线标准治疗：立即停止口服替加氟，切换为 吉西他滨(Gemcitabine) + 顺铂(Cisplatin) 方案全身系统性化疗","B":"考虑高龄及肾功能风险：在目前无明确肿瘤复发证据情况下，将 替加氟片 剂量回调至 150mg tid 继续单药口服维持治疗","C":"维持原方案：在目前无明确肿瘤复发证据情况下，继续 替加氟片(齐鲁) 250mg tid 单药口服维持治疗","D":"联合免疫治疗：在当前口服替加氟基础上加用 PD-1抑制剂 作为联合全身系统性抗肿瘤治疗"},"answer":"C","vignette":"患者男，75岁。既往确诊鼻咽未分化型非角化性癌。2019-04-02 确诊复发。随后于 2019-04-16 至 2019-05-30 行鼻咽部调强放疗，期间联合 泰欣生(Nimotuzumab) 200mg/w 治疗。放疗结束后，患者进入维持治疗阶段：2019-10-08 开始口服 替加氟片(齐鲁) 150mg tid；2019-11-18 调整剂量为 替加氟片 250mg tid。 \n\n当前时间为 2020年1月8日，患者返院复查。查体示：KPS评分 90.0，窦性心律，听力轻度下降。既往有阑尾切除术史。辅助检查显示：[2019-12-24] 分子诊断 EBV-DNA定量检测: 0 copy/mL。今日血生化提示：BUN 8.2 mmol/L，Cr 118 μmol/L。患者当前体重 50kg。","patient_id":"l4-patient-d60402c55abcfa90fa2f9c14"}
+{"id":"l4-sample-89ce4961077fc6e636a67071","question":"结合该患者的基线情况及中国临床肿瘤学会（CSCO）鼻咽癌诊疗指南，对于同期综合治疗方案的选择，下列哪项更为合适？","options":{"A":"同期大剂量顺铂（100mg/m² q3w）+ 根治性放疗","B":"同期尼妥珠单抗（200mg/周）+ 根治性放疗","C":"同期多西他赛 + 顺铂（TP方案）+ 根治性放疗","D":"单纯根治性放疗，不联合任何药物"},"answer":"B","vignette":"患者男，2019年约75岁。当前就诊日期：2019-04-10。\n\n【现病史】\n患者因“回吸性涕血”就诊。2019-03-28 鼻咽活检病理示：未分化型非角化性癌。原单位免疫组化：CK5/6（+），P63（+），LCA（-），EMA（+），Ki67（30%+）。\n\n【查体与评估】\n[2019-04-04] KPS评分: 90.0。查体：双侧颈部II区可触及质硬淋巴结，最大径约3.5cm，活动度差。心肺听诊未见明显异常。\n\n【辅助检查】\nMRI提示：鼻咽顶后壁增厚，侵犯斜坡及咽旁间隙，双侧颈部淋巴结肿大（符合T3N2M0，III期）。\n血常规：WBC 5.8×10^9/L, HGB 128 g/L (轻度贫血), PLT 210×10^9/L。\n生化：ALT 35 U/L, AST 32 U/L, Cr 88 μmol/L, BUN 6.1 mmol/L。\n既往史：10年前行“阑尾切除术”，否认高血压、糖尿病史。\n\n【拟定计划】\n经MDT讨论，计划于2019-04-16开始行根治性调强放疗（IMRT）。","patient_id":"l4-patient-d60402c55abcfa90fa2f9c14"}
+{"id":"l4-sample-61d5f354e849aa56d144c176","question":"基于患者的诊疗历程，同期放化疗期间最佳的系统治疗方案及剂量策略是？","options":{"A":"改为 尼妥珠单抗 (Nimotuzumab) 200mg/w 同期治疗，以避免肌酐进一步升高及贫血加重。","B":"继续使用 顺铂 (Cisplatin) 总剂量 80 mg/m² 分3天给药 (Q3W)，保持诱导期间耐受良好的剂量强度。","C":"调整为 顺铂 (Cisplatin) 总剂量 100 mg/m² 分3天给药 (Q3W)，以达到同期放化疗的标准剂量强度。","D":"改为 顺铂 (Cisplatin) 约 40 mg/m² 每周方案，以降低肾毒性风险。","E":"改为 卡铂 (Carboplatin) AUC 5 (Q3W)，仅依据血肌酐较基线升高 >25%。"},"answer":"C","vignette":"患者女，41岁，因“回吸性涕血”确诊鼻咽未分化非角化性癌。入院查体：身高 172 cm，体重 82 kg，KPS 90分。既往无慢性病史。\n\n【既往治疗记录】\n[2024-06-28] 病理诊断：鼻咽未分化非角化型癌，EBERs(+)，EGFR(+)。\n[2024-07-05] 诊断：T3N1M0 III期 (AJCC 8th)。\n[2024-07-03] 泽菲(吉西他滨) 1.36 g d1,8 + 诺欣(顺铂) 54.0 mg (开始时间:2024-07-03, 结束时间:2024-07-05)。\n[2024-07-25] 泽菲(吉西他滨) 1.36 g d1,8 + 诺欣(顺铂) 54.0 mg (开始时间:2024-07-25, 结束时间:2024-07-26)。\n\n【辅助检查】\n[2024-07-24] 复查血生化：ALT 35 U/L, AST 28 U/L, Cr 82 μmol/L (基线 65 μmol/L), BUN 5.1 mmol/L。\n[2024-07-26] 血常规：WBC 3.8×10^9/L, NEUT 1.9×10^9/L, HGB 105 g/L (轻度贫血)。\n\n患者现已完成2周期诱导化疗，复查MRI示鼻咽病灶缩小30%，拟于2024-08-21开始同期放化疗（IMRT）。","patient_id":"l4-patient-e1ff355aab4044b95dde8007"}
+{"id":"l4-sample-1dc024ebecaf0dfd411343f8","question":"下列哪项是对该患者更为合适的同期放化疗药物医嘱？","options":{"A":"顺铂 100 mg/m² q3w，与放疗同期","B":"顺铂 40 mg/m² qw，与放疗同期","C":"顺铂约 50 mg/m² q3w，与放疗同期，分 2–3 天给药","D":"卡铂 AUC=5 q3w，与放疗同期","E":"奈达铂 100 mg/m² q3w，与放疗同期","F":"单纯 IMRT，不联合系统药物"},"answer":"C","vignette":"患者女，40 岁。\n2024-06-28 经鼻咽镜活检确诊鼻咽未分化型非角化性癌（EBERs+，EGFR+）。MRI 提示局部晚期鼻咽癌。入院时 KPS 90 分，身高 160 cm，体重 42 kg。既往史无特殊，否认高血压、糖尿病。初诊实验室检查：HGB 105 g/L，WBC 5.2×10^9/L，PLT 210×10^9/L，ALT 25 U/L，AST 22 U/L，Scr 115 μmol/L。\n\n患者于 2024-07-03 及 2024-07-25 完成两个周期诱导化疗，方案为吉西他滨 1.36 g d1,8 + 顺铂分次给药。诱导治疗期间未出现 AKI，无明显耳鸣或听力下降，最低血镁轻度下降，经补充后恢复。\n\n2024-08-20 复评：病灶部分缓解（PR）。考虑患者低体重且肾功能边缘，入院补液后复测：Scr 92 μmol/L；按 Cockcroft–Gault 公式估算 CrCl 约 50–52 mL/min。听力学检查未见明显异常。拟于 2024-08-21 开始同期放化疗。","patient_id":"l4-patient-e1ff355aab4044b95dde8007"}
+{"id":"l4-sample-ac4931dbd4ab4545eaf89324","question":"根据当前相关指南，下一步最合理的处理是？","options":{"A":"吉西他滨 + 顺铂全身化疗，待系统控制后再考虑局部治疗","B":"单药 PD-1 抑制剂，优先观察颅内病灶反应","C":"全脑放疗（WBRT）+ 阿帕替尼","D":"针对右侧颞叶病灶行局部放疗/立体定向放射外科（SRS/FSRT），必要时短程激素减轻水肿","E":"局部放疗 + 尼妥珠单抗","F":"经神经外科评估后，如病灶位置可及且头痛等症状在药物/放疗下仍进行性加重，可考虑手术切除并辅以腔道 SRS/FSRT"},"answer":"D","vignette":"患者女，41 岁。既往确诊鼻咽癌，经根治性放化疗后达 CR 并定期随访。\n\n【近期病史】\n2022 年 2 月 1 日因头痛就诊，复查提示复发。\n\n【既往用药史（原始记录）】\n\n[2021-07-17] 艾坦 0.5 g\n[2021-08-21] 艾坦 0.25 g（剂量减半）\n[2021-08-24 至 2022-01-04] 拓益 + 卓仑\n\n（注：以上时间已按病程顺序整理，但仍保留原始药名噪声）\n\n【2022-02-14 影像学】\n头颅 MRI 平扫+增强示：右侧颞叶可见一类圆形 T1 低信号、T2 高信号影，增强扫描明显强化，大小约 1.2 cm × 1.5 cm，周围可见片状水肿带。胸腹盆 CT 未见明确转移灶。\n\n【体格检查与实验室】\n\n-ECOG PS 1\n-体重 45 kg\n-血常规：HGB 105 g/L，WBC 3.8×10^9/L，PLT 180×10^9/L\n-肝肾功能基本正常","patient_id":"l4-patient-22da0b5b3867bfc142d5b99a"}
+{"id":"l4-sample-75a8e0a5cdd5fc0c5ccddc28","question":"当前应选择哪种系统治疗方案？","options":{"A":"吉西他滨 + 顺铂 + 特瑞普利单抗（GP + PD-1）","B":"卡培他滨 + 特瑞普利单抗","C":"特瑞普利单抗单药","D":"多西他赛 + 顺铂 + 5-FU（TPF）","E":"卡培他滨单药","F":"尼妥珠单抗单药维持","G":"卡瑞利珠单抗 + 阿帕替尼","H":"单纯观察随访"},"answer":"C","vignette":"患者女，2021年约41岁。既往于 2021-09-01 至 2021-11-20 完成鼻咽癌根治性治疗：TPF 诱导 + 顺铂同期放化疗。\n\n【复发经过】\n\n2022-02-01：复查 MRI 提示右颞叶异常信号；\n2022-02-22：行右颞叶病灶切除术，术后病理：分化差的癌转移，EBER(+)；\n2022-04-18 至 2022-05-13：术后局部放疗联合尼妥珠单抗治疗；\n2022-06-21：复查 EBV-DNA 0 copy/mL，头颅局部病灶控制稳定，未见新发颅内病灶。\n\n【当前状态（2022-06-22）】\n\nKPS 80，BMI 21.5\n血常规：WBC 3.5×10^9/L，NEUT 1.8×10^9/L，HGB 105 g/L，PLT 125×10^9/L\n肝肾功能基本正常\n既往无高血压、糖尿病，窦性心律不齐\n\n【MDT补充前提】\n结合“放化疗结束后不足 6 个月即出现远处转移”及当前轻度骨髓抑制，MDT 认为患者已属早期含铂失败/铂类难治风险高人群；\n同时，患者脑转移灶已完成手术 + 局部放疗控制，现阶段不再考虑立即重复含铂双药化疗，但建议启动药物系统治疗以降低再次远处进展风险。","patient_id":"l4-patient-22da0b5b3867bfc142d5b99a"}
+{"id":"l4-sample-41ed273856d2fc3c66963fe3","question":"2024-05-28 时，该患者在维持治疗方面应如何处理？","options":{"A":"既往铂类治疗结束已超过 6 个月，按“铂敏感复发”处理，改回 GP（吉西他滨 + 顺铂）强化治疗","B":"恢复卡培他滨 1000 mg bid + 替雷利珠单抗 200 mg q3w","C":"剂量爬坡，重启卡培他滨 1500 mg bid + 替雷利珠单抗 200 mg q3w","D":"因既往出现过 2 级 HFS，永久停用卡培他滨，仅维持替雷利珠单抗单药","E":"改为阿帕替尼 500 mg qd 联合卡培他滨 1000 mg/m² bid","F":"改为安罗替尼 12 mg qd 单药跨线治疗"},"answer":"B","vignette":"患者女，56岁。\n\n既往关键治疗史\n2023年4月：确诊鼻咽癌复发（rT3N1M0）\n2023-05-04 至 2023-06-17：诱导治疗：吉西他滨 + 奈达铂 + 尼妥珠单抗 + 特瑞普利单抗\n2023-07-06 至 2023-08-18：根治性放疗\n2023-11-23 起进入维持治疗阶段：替雷利珠单抗 200 mg q3w + 卡培他滨 1000 mg bid\n近期治疗轨迹\n2024-01-26：替雷利珠单抗 + 卡培他滨 1000 mg bid\n2024-02-27：替雷利珠单抗 + 卡培他滨 1000 mg bid\n2024-03-29：仅给予替雷利珠单抗 200 mg（未见口服化疗医嘱）\n2024-04-26：仅给予替雷利珠单抗 200 mg（未见口服化疗医嘱）\n\n追问病史得知：患者在 3–4 月期间曾因 2 级手足综合征（HFS） 暂停卡培他滨，现已完全缓解。\n\n当前就诊（2024-05-28）\n-身高 162 cm，体重 60 kg，BSA ≈ 1.63 m²\n-KPS 80\n-既往 HFS 已由 2 级恢复至 0 级\n-Hb 112 g/L，WBC 4.5×10^9/L，PLT 185×10^9/L\n-ALT 35 U/L，Cr 78 μmol/L\n-MRI 评估：SD（病情稳定）","patient_id":"l4-patient-22da0b5b3867bfc142d5b99a"}
+{"id":"l4-sample-3ed7a5ce7a40a12d6ca72618","question":"下列哪项后续治疗策略最合适？","options":{"A":"吉西他滨 + 顺铂 (GP方案)","B":"阿帕替尼加量至 0.5g qd + 卡瑞利珠单抗","C":"泰欣生 (尼妥珠单抗) + 拓益 (特瑞普利单抗) 免疫联合治疗","D":"多西他赛 + 顺铂 + 氟尿嘧啶 (TPF方案)"},"answer":"C","vignette":"患者女，44岁，确诊鼻咽癌综合治疗后复发。ECOG评分 1分。查体：BMI 19.2，轻度贫血貌，心肺听诊（-）。\n\n既往治疗史原始记录如下（请仔细审阅时间轴与剂量）：\n1. [2023-08-24至2024-03-04] 拓益+卓仑；\n2. [2024-07-17] 艾坦 0.5g；\n3. [2024-08-21] 艾坦 0.25g (剂量发生减半)；\n\n2025年6月26日复查MRI示：鼻咽顶后壁软组织增厚较前进展，双侧颈部淋巴结短径增大至1.5cm。今日（2025-06-30）拟制定后续治疗方案。\n\n最新血常规及生化回报：WBC 3.1×10^9/L，Hgb 94g/L，**PLT 68×10^9/L**，NEUT# 1.6×10^9/L；ALB 32g/L，TBIL 18μmol/L，Scr 62μmol/L，EBV-DNA 4.2×10^3 copies/mL。","patient_id":"l4-patient-22da0b5b3867bfc142d5b99a"}
+{"id":"l4-sample-2aefa4944db731fdb7d22ed5","question":"在上述病情和检查结果基础上，此时应如何选择同步放疗阶段的全身治疗医嘱方案？","options":{"A":"同步放疗 + 顺铂 100 mg/m² q3w + 信迪利单抗 200 mg q3w","B":"同步放疗 + 吉西他滨 1.75 g q3w + 顺铂 73 mg q3w + 信迪利单抗 200 mg q3w","C":"同步放疗 + 奈达铂 73 mg + 信迪利单抗 200 mg，后续按耐受性动态减量","D":"同步放疗 + 多西他赛 60 mg/m² + 顺铂 60 mg/m² q3w","E":"同步放疗 + 信迪利单抗单药","F":"同步放疗 + 信迪利单抗单药（省略同步铂类）"},"answer":"A","vignette":"患者男，19 岁。2024-08-27 确诊鼻咽癌，AJCC 8 版 IVA期，cT3N3M0。既往体健，KPS 90。\n\n2024-08-28 起接受 3 周期诱导治疗：\n\n吉西他滨 1.93 g d1,8 + 顺铂 52 mg d1-3 + 信迪利单抗 200 mg d1，q3w\n第 3 周期开始时，血常规示 PLT 78×10^9/L，NEUT 1.8×10^9/L；吉西他滨由计划 1.97 g 实际减至 1.75 g，顺铂维持原计划剂量。\n\n2024-11-05 复查 MRI：鼻咽顶后壁病灶 PR，颈部淋巴结较前缩小。拟于 2024-11-07 启动 IMRT。当前：\n-WBC 4.6×10^9/L，NEUT 2.3×10^9/L，PLT 128×10^9/L\n-Cr 88 μmol/L\n-无耳鸣、无听力下降","patient_id":"l4-patient-7841d3aae0a3ba376fc550ba"}
+{"id":"l4-sample-4576b3532b64490617f5e577","question":"在2022年1月25日这一时间点，针对该患者，应选择下列哪项治疗方案？","options":{"A":"继续维持原剂量 GP 方案（吉西他滨 1.55g + 顺铂 62mg）联合放疗，以保证根治性疗效","B":"将化疗方案调整为 TPF 诱导化疗（多西他赛+顺铂+氟尿嘧啶），以加强对复发灶的控制","C":"下调化疗药物剂量（吉西他滨降至约1.26g，顺铂降至约50mg），并联合PD-1单抗（卡瑞利珠单抗）进行综合治疗","D":"立即停用所有化疗药物，仅保留放疗，并加用靶向药物（如尼妥珠单抗）"},"answer":"C","vignette":"患者女，18岁，于2021年11月4日经鼻咽镜活检提示左侧咽隐窝粘膜慢性炎伴核增大细胞，需结合免疫组化进一步确诊为鼻咽癌复发。基线EBV-DNA定量检测为6.50E+02 copy/mL。既往史无特殊，ECOG评分0–1分。此后患者接受了含吉西他滨和顺铂的多周期化疗，用药记录如下：\n1. 2021-11-16：泽菲（吉西他滨）1.55 g + 诺欣（顺铂）62 mg qd。\n2. 2021-12-14：泽菲 1.26 g + 诺欣 50 mg qd。\n3. 2022-01-04：泽菲 1.26 g + 诺欣 50 mg qd。\n\n辅助检查：近期血常规示WBC 3.1×10^9/L，NEUT 1.8×10^9/L，HGB 108 g/L，PLT 95×10^9/L；肝肾功能基本正常。患者于2022年1月18日已开始同步放疗。于2022年1月25日需进一步评估并决策后续全身抗肿瘤治疗方案。","patient_id":"l4-patient-3d66b8f5e67a24b886416fbd"}
+{"id":"l4-sample-0925f71ac54dcc63e1a8f351","question":"在当前治疗进程下，下一步最合理的同期系统治疗策略是：","options":{"A":"改用顺铂同步放疗（未明确具体剂量方案）","B":"继续卡瑞利珠单抗 200 mg + 奈达铂 50 mg 同期治疗","C":"改为卡瑞利珠单抗 200 mg + 吉西他滨同步治疗（剂量按常规方案）","D":"暂停所有系统治疗，仅继续放疗","E":"改为卡瑞利珠单抗单药同步放疗","F":"改为奈达铂 70 mg + 卡瑞利珠单抗 同期治疗","G":"改为尼妥珠单抗 + 奈达铂 50 mg 同期治疗（更换为抗 EGFR 方案）","H":"停止免疫治疗，仅保留奈达铂 50 mg 同期治疗"},"answer":"B","vignette":"患者女，18 岁，2021-11 确诊鼻咽未分化型非角化性癌，cT3N3M0（AJCC 8th，IVa）。既往无特殊病史，KPS 90。\n\n既往治疗史：\n\n2021-11-16、2021-12-14、2022-01-04：接受 3 周期诱导化疗，方案为 吉西他滨 + 奈达铂（首周期后因耐受性调整，后两周期剂量下调）。\n2022-01-18 至 2022-03-10：进入根治性 IMRT 同期治疗阶段。\n2022-01-25：给予 卡瑞利珠单抗 200 mg + 奈达铂，其中奈达铂最初拟开 70 mg，后调整为 50 mg。\n2022-02-05：血常规示 WBC 2.8×10^9/L、HGB 105 g/L、PLT 95×10^9/L；肝肾功能基本正常，EBV-DNA 0 copy/mL。\n\n当前日期：2022-02-16，放疗进行中；当日复查血常规示 WBC 4.5×10^9/L、PLT 120×10^9/L（较前恢复），拟定下一周期同期系统治疗方案。","patient_id":"l4-patient-3d66b8f5e67a24b886416fbd"}
+{"id":"l4-sample-bc594ea60a8d12da0e4f616c","question":"2022-06-20 时，该患者下一步应选择哪种治疗策略？","options":{"A":"辅助化疗：吉西他滨 1000 mg/m² d1,8 + 顺铂 80 mg/m² d1，q3w × 3 周期","B":"继续卡瑞利珠单抗 200 mg q3w，作为辅助免疫治疗至预定总疗程结束","C":"辅助化疗：5-FU 4000 mg/m² 持续泵入 + 顺铂 80 mg/m² d1，q3w × 3 周期","D":"结束全部抗肿瘤治疗，直接进入随访观察","E":"改为替雷利珠单抗 + 卡培他滨维持","F":"单药尼妥珠单抗维持","G":"节拍卡培他滨 650 mg/m² bid × 1 年，停用免疫","H":"继续顺铂单药巩固 2 周期"},"answer":"B","vignette":"患者女，2022年约19岁。2022 年 1 月确诊鼻咽未分化非角化性癌，cT3N3M0，IVa 期（AJCC 第8版）。\n\n【既往治疗】\n诱导化疗后序贯同期放化疗，放疗于 2022-03-10 结束。\n既往医嘱记录显示：\n2021-11：吉西他滨 1.55 g + 顺铂 62 mg\n2021-12：吉西他滨 1.26 g + 顺铂 50 mg\n2022-01 同期阶段：卡瑞利珠单抗 200 mg + 顺铂 70 mg（后调整为 50 mg）\n放疗期间 KPS 一直维持 90 分。\n\n【其他病史】\n2022-06-14：因“左侧卵巢成熟型畸胎瘤”行腹腔镜手术，术后恢复良好，病理未见转移。\n\n【当前状态（2022-06-20）】\n-一般查体无殊\n-血常规及生化基本正常\n-EBV-DNA：0 copy/mL","patient_id":"l4-patient-3d66b8f5e67a24b886416fbd"}
+{"id":"l4-sample-71b365b1cd89775efd12e416","question":"下一步最合理的治疗方案是？","options":{"A":"吉西他滨 (1000mg/m² d1,8) + 顺铂 (80mg/m² d1) + 尼妥珠单抗","B":"吉西他滨 (1000mg/m² d1,8) + 奈达铂 (80mg/m² d1) + 尼妥珠单抗","C":"多西他赛 + 顺铂 + 5-FU (TPF方案诱导化疗，后序再行含铂方案)","D":"帕博利珠单抗 (200mg q3w) 单药免疫治疗，替代含铂化疗一线方案"},"answer":"B","vignette":"患者男，34岁。\n【现病史】\n2023年6月8日因“涕中带血”行鼻内镜活检。病理回报：（右顶后壁）未分化型非角化性癌；免疫组化：CK(+), EGFR(+), EBERs(+)。确诊为鼻咽癌复发。\n【体格检查】\n身高168cm，体重46kg。ECOG PS 0-1分（[2023-06-14] KPS评分:90.0）。心肺听诊未见明显异常。\n【辅助检查】\n血常规：WBC 5.1×10^9/L, Hb 108 g/L (轻度贫血), PLT 215×10^9/L。\n血生化：ALT 24 U/L, AST 28 U/L, Alb 38 g/L, BUN 7.2 mmol/L, Cr 122 μmol/L。\n心电图：窦性心律，大致正常心电图。\n既往史：幼年行阑尾切除术，否认高血压、糖尿病史。\n【影像学】\nMRI提示右侧顶后壁软组织增厚，侵犯邻近深层结构，无远处转移征象。\n【MDT评估】\n经多学科会诊(MDT)评估，患者局部病变侵犯深层结构，暂不宜行根治性挽救手术或再程放疗，拟先行系统治疗。","patient_id":"l4-patient-7ef75b2e8e418a4210deb020"}
+{"id":"l4-sample-c266104a6986992efc281b28","question":"若拟行后续辅助化疗，以下哪项更合适？","options":{"A":"辅助 顺铂 + 5-FU 3 周期","B":"继续 帕博利珠单抗 单药维持治疗 1 年","C":"节拍卡培他滨辅助化疗 1 年","D":"定期随访观察，暂不进行药物干预","E":"辅助 吉西他滨 + 顺铂 2–3 周期","F":"继续原诱导方案 吉西他滨 + 奈达铂 2 周期"},"answer":"C","vignette":"患者男，36 岁。2023 年 7 月确诊鼻咽未分化型非角化性癌，EBER 阳性。影像学及相关检查提示 AJCC 第 8 版分期为 cT3N2M0，对应 III 期。既往体健，伴窦性心律不齐。\n\n【治疗经过】\n\n2023 年 7 月至 9 月接受吉西他滨 + 奈达铂 + 帕博利珠单抗诱导治疗 3 周期，治疗过程顺利。\n2023 年 9 月 25 日启动 IMRT 放疗（PGTVnx 70 Gy/33f），同步化疗采用奈达铂 100 mg/m² q3w。医嘱系统记录显示：\n\n2023-09-26：奈达铂 172.0 mg\n2023-10-17：奈达铂 167.0 mg\n\n放疗期间未见吉西他滨继续使用。\n2023 年 11 月 9 日完成放疗。期间曾出现 2 级骨髓抑制及 1 级口腔黏膜炎，目前症状已明显缓解，KPS 90。","patient_id":"l4-patient-770397f90941e8d21d622d6a"}
+{"id":"l4-sample-5d0e976030fd0e4de4ab153d","question":"以下哪项最符合当前（2025 NCCN/CSCO 及关键随机研究）的诊疗策略？","options":{"A":"Pembrolizumab 200 mg q3w 继续维持 6 个月","B":"卡培他滨 1000 mg/m² bid，d1–14，q3w × 8 周期","C":"卡培他滨 650 mg/m² bid，持续口服 1 年（若患者无法耐受足量 1000 mg/m² 方案时的可选降阶策略）","D":"卡培他滨 650 mg/m² bid，持续口服 1 年","E":"改为卡瑞利珠单抗辅助治疗 1 年","F":"尼妥珠单抗单药维持","G":"吉西他滨 + 顺铂巩固化疗 2 周期"},"answer":"B","vignette":"患者男，36 岁，既往仅有阑尾切除术史，余无特殊。确诊为鼻咽未分化型非角化癌，基线分期 cT3N2M0（AJCC 8 版，III 期）。\n\n【既往治疗经过】\n诱导阶段接受 3 个周期含吉西他滨 + 奈达铂 + pembrolizumab 的方案：\n- 2023-07-22：吉西他滨 1.71 g + 奈达铂 136 mg + pembrolizumab 200 mg\n- 2023-08-12：吉西他滨 1.72 g + 奈达铂 137 mg + pembrolizumab 200 mg\n- 2023-09-01：吉西他滨 1.72 g + 奈达铂 137 mg + pembrolizumab 200 mg\n\n随后行同步放化疗：\n- 2023-09-25：开始鼻咽及颈部 IMRT 70 Gy/33F\n- 2023-09-26：同期奈达铂 172 mg\n- 2023-10-17：同期奈达铂 167 mg\n- 2023-11-09：放疗结束\n\n【当前评估】\n2023-11-30 复查 MRI 显示鼻咽原发灶及颈部淋巴结病灶影像学达到 CR。查体示 KPS 90 分，颈部皮肤 I 度放射反应，无明显影响日常生活的毒性反应。血常规：Hgb 118 g/L，WBC 4.5×10^9/L，PLT 210×10^9/L；肝肾功能基本正常，整体全身状况良好。\n\n经 MDT 讨论并与患者充分沟通，在当前影像学 CR 且一般情况良好的前提下，团队和患者已共同决定：后续不采用“单纯随访”策略，而是在此基础上追加一种系统性辅助或维持治疗方案。需在现有指南（2025 年 NCCN/CSCO）及关键随机研究支持的策略中进行选择。","patient_id":"l4-patient-770397f90941e8d21d622d6a"}
+{"id":"l4-sample-25b853743d4051c346f9b3fb","question":"下列哪项是该患者相对更优的治疗方案？","options":{"A":"吉西他滨 (1000 mg/m²) + 顺铂 (80 mg/m²) + 特瑞普利单抗","B":"多西他赛 (75 mg/m²) + 顺铂 (75 mg/m²) + 5-FU (750 mg/m²/d civ 120h)","C":"尼妥珠单抗（200-400 mg）+ 紫杉醇（135-175 mg/m²）+ 奈达铂（80-100 mg/m² 或分次）+ 卡培他滨","D":"单药尼妥珠单抗（200 mg）联合调强放疗（IMRT）"},"answer":"D","vignette":"患者男，2024年约41岁。于 [2024-01-04] 鼻咽镜活检提示：未分化型非角化性癌，影像学确诊为鼻咽癌放化疗后局部复发（rT3N1M0）。既往无高血压、糖尿病史，2年前行阑尾切除术。入院查体：KPS评分 90.0，身高 172cm，体重 48kg。入组临床试验前基线实验室检查：WBC 5.1×10^9/L, NEUT 3.2×10^9/L, HGB 108 g/L, PLT 210×10^9/L。血生化示：ALT 21 U/L, AST 19 U/L, TBIL 12.1 μmol/L, Scr 136 μmol/L, BUN 8.2 mmol/L。心电图示：窦性心律，大致正常心电图。患者既往对顺铂耐受性尚可，无听力下降主诉。","patient_id":"l4-patient-93d4eff6796d7c2c107956fe"}
+{"id":"l4-sample-0061c82f5a598cdb9c44d752","question":"基于该患者的具体临床特征及既往治疗反应，放疗期间最佳的同步系统治疗策略是？","options":{"A":"同步顺铂 (100mg/m² q3w) + 尼妥珠单抗 (200mg w)","B":"继续维持原方案：同步泰欣生 + 紫杉醇 + 卓仑 + 诺欣","C":"同步奈达铂 (80-100mg/m² q3w) + 尼妥珠单抗 (200mg w)","D":"同步单药尼妥珠单抗 (200mg w) + 最佳支持治疗"},"answer":"C","vignette":"患者男，40岁。2024年1月因鼻咽未分化型非角化性癌复发就诊，分期为 rT3N2M0。既往无高血压、糖尿病史。查体：身高162 cm，体重52 kg，KPS 90分。颈部淋巴结触及较前缩小。既往治疗记录显示：\n[2024-01-15] 方案：帕博利珠单抗联合紫杉醇、卡铂和卡培他滨口服化疗。\n[2024-02-05] 重复上述方案一周期。\n[2024-02-28] 开始行头颈部调强放疗（IMRT）。\n\n放疗定位时复查血生化及血常规示：WBC 4.1×10^9/L, NEUT% 62%, Hgb 108 g/L, PLT 185×10^9/L；ALT 28 U/L, AST 32 U/L, TBIL 12.1 μmol/L, Scr 128 μmol/L, BUN 8.2 mmol/L, K 4.1 mmol/L。心电图示窦性心律，T波改变。","patient_id":"l4-patient-93d4eff6796d7c2c107956fe"}
+{"id":"l4-sample-a1f3d81965a4a91c785aec89","question":"针对该患者术后颈部淋巴结复发的情况，下一步应选择哪种系统治疗方案？","options":{"A":"吉西他滨 + 顺铂 (GP方案) + 替雷利珠单抗","B":"卡培他滨单药节拍化疗","C":"信迪利单抗单药维持治疗","D":"卡培他滨 + 替雷利珠单抗"},"answer":"D","vignette":"患者男，49岁，既往确诊鼻咽未分化型非角化性癌（cT4N3M0 IV期，AJCC 8th）。2022年5月30日至2022年8月9日期间，接受了“替雷利珠单抗+吉西他滨+顺铂（GP方案）”诱导化疗联合同期放化疗（CCRT），末次顺铂治疗时间为2022年6月21日，末次替雷利珠单抗维持治疗至2022年8月9日。治疗后复查EBV-DNA持续转阴。2023年10月8日，患者因颈部肿物复诊，查体见右颈部V区质硬淋巴结。穿刺活检及免疫组化证实为鼻咽癌转移（EBERs+）。既往史：高血压病史5年，控制可。体格检查：ECOG PS评分 0分，身高170cm，体重68kg。辅助检查：血常规 WBC 4.2×10^9/L, NEUT 2.1×10^9/L, PLT 155×10^9/L, HGB 110 g/L。生化检查：ALT 25 U/L, AST 32 U/L, TBIL 15 μmol/L, Cr 88 μmol/L (参考值 57-111)。2023年10月18日行“右颈淋巴结清扫术”，术后病理确认为鼻咽癌放疗后颈部淋巴结复发。本次复发距放疗结束约13个月。","patient_id":"l4-patient-c20e0d49038b311c3e25150f"}
+{"id":"l4-sample-c06f3e5aaa2c83ca635e8d84","question":"下一步最佳的用药策略是？","options":{"A":"恢复含铂双药化疗（卡铂 AUC=5 + 白蛋白紫杉醇 260mg/m²），以强化疗效","B":"单药替雷利珠单抗维持治疗，暂停所有细胞毒及抗血管生成药物","C":"继续使用白蛋白紫杉醇单药维持，并联合卡铂减量至 AUC=4","D":"继续当前口服靶向药物（呋喹替尼）治疗，作为后线维持或巩固方案，避免再次使用含铂化疗"},"answer":"D","vignette":"患者男，49岁，确诊鼻咽癌IV期（T4N3M0）1年余。既往于2022年8月行TP方案（多西他赛+顺铂）联合替雷利珠单抗治疗，后行根治性放疗。2023年10月复查发现右颈部淋巴结肿大，穿刺活检证实为转移性癌（EBV+，p40+），诊断为鼻咽癌放疗后颈部淋巴结复发。患者既往有阑尾切除术史，近期偶有窦性心律不齐。目前ECOG评分 0分，KPS 90分。近期治疗记录如下：\n2024-06-11 给予伯尔定（卡铂）384.0 mg；\n2024-06-12 给予紫杉醇(白蛋白) 300.0 mg；\n2024-07-26 再次给予伯尔定 384.0 mg，此后未见卡铂类药物医嘱；\n2024-08-19 给予紫杉醇(白蛋白) 400.0 mg (剂量由300mg上调)；\n2024-09-30 开始使用福可维（呋喹替尼）8.0 mg。\n\n现患者再次返院复查，体格检查及血生化基本正常，但回顾既往化疗期间记录，患者在7月底化疗后曾出现IV度骨髓抑制及严重疲乏，需升白处理。目前拟制定下一步维持或巩固治疗策略。","patient_id":"l4-patient-c20e0d49038b311c3e25150f"}
+{"id":"l4-sample-f63204056649b2b8de590420","question":"对于该患者，2022年7月19日应选择的最佳后续治疗策略是？","options":{"A":"继续原方案（泽菲 + 诺欣 + 替雷利珠单抗）治疗至6周期，随后维持治疗","B":"更换二线系统治疗方案（紫杉醇 + 卡铂 + 替雷利珠单抗），暂不实施放疗","C":"同步放化疗：调强放疗(IMRT) + 顺铂(100mg/m²) + 替雷利珠单抗","D":"同步放化疗：调强放疗(IMRT) + 诺欣(奈达铂) + 替雷利珠单抗"},"answer":"D","vignette":"患者男，48岁，，体重52kg。既往阑尾切除术后5年。2022年4月确诊鼻咽恶性肿瘤复发，分期rT4N3M0（IV期）。\n\n【既往治疗史（原始记录）】\n- 2022-05-07：给予“泽菲 1.6g d1,8 + 诺欣 43mg d1-3 + 替雷利珠单抗 200mg”方案治疗。当日EBV-DNA: 3.41E+01 copy/mL。\n- 2022-05-31：给予第二周期同方案化疗。当日EBV-DNA飙升至 3.36E+02 copy/mL。\n- 2022-06-20：给予第三周期同方案化疗。6-21复查EBV-DNA: 6.38E+01 copy/mL；6-29复查EBV-DNA: 3.66E+01 copy/mL (参考值<20)。\n- 期间多次记录KPS评分均为90.0。\n\n【当前查体与生化（2022-07-15）】\n患者无明显骨髓抑制主诉。血生化显示：BUN 7.5 mmol/L，Cr 118 μmol/L，ALB 38 g/L。鼻咽镜示顶后壁肿物较前缩小，但未完全消退。","patient_id":"l4-patient-c20e0d49038b311c3e25150f"}
+{"id":"l4-sample-a40b2ad5759db2864bbde0be","question":"在上述复发转移一线治疗方案（已完成5周期）后，于2025-07-29复查时，对该患者当日最合适的治疗决策是？","options":{"A":"复发转移一线治疗仍采用含铂方案，切换为“吉西他滨 + 顺铂”（GP方案）以遵循CSCO指南I级推荐","B":"已完成5周期联合治疗，疗效评价PR，考虑到化疗毒性累积，即刻停用化疗，改为卡瑞利珠单抗单药维持","C":"继续原方案（白蛋白紫杉醇 + 卡培他滨 + 卡瑞利珠单抗）治疗第6周期","D":"因病理提示EGFR（+），在原免疫联合化疗基础上加用尼妥珠单抗（泰欣生）"},"answer":"C","vignette":"患者男，38岁。\n【既往史】2024年11月确诊鼻咽癌（cT3N2M0），于外院行TPF诱导化疗3周期，后行同期放化疗（DDP 100mg/m² q3w ×2），末次顺铂给药日期为 **2025-02-15**，放疗于2025-02-28结束。\n【现病史】2025-04-01复查发现胸骨、肋骨及胸椎多发高代谢病灶，[2025-04-07] 【复发确诊】。随后于本院启动“白蛋白紫杉醇 + 卡培他滨 + 艾瑞卡（卡瑞利珠单抗）”方案治疗。\n【当前状态】2025-07-29 患者返院复查，已完成5周期治疗。主诉骨痛明显缓解。查体：颈部未及肿大淋巴结，心肺（-）。\n【辅助检查】\n[2025-04-10] 【病理】...EBERs（+），EGFR（+）...\n[2025-07-29] 【体能】 KPS评分:90.0\n血常规：WBC 3.8×10^9/L, NEUT 1.9×10^9/L, HGB 112g/L, PLT 145×10^9/L。\n生化：ALT 42 U/L, AST 38 U/L, Cr 85 μmol/L, BUN 6.1 mmol/L。","patient_id":"l4-patient-29ddd7a42ccbf5ec9d674070"}
+{"id":"l4-sample-5d126a91e34fc43cd46eddfa","question":"下列哪项诱导治疗方案相对更可行？","options":{"A":"吉西他滨 1000mg/m² d1,8 + 顺铂 80mg/m² d1, q3w","B":"多西他赛 75mg/m² d1 + 顺铂 75mg/m² d1 + 5-FU 750mg/m² civ d1-5, q3w","C":"吉西他滨 + 卡铂 + 特瑞普利单抗","D":"特瑞普利单抗 240mg d1 + 吉西他滨 1000mg/m² d1,8, q3w"},"answer":"C","vignette":"患者男，42岁 。2023年8月23日因'涕中带血伴右颈部包块'入院。既往2018年曾行鼻咽癌根治性放化疗（具体不详），此次入院完善检查。\n\n【体能评估】[2023-08-23] KPS评分:100.0。\n【病理诊断】[2023-08-24] [标本02]（右侧鼻咽）及[标本01]（右颈淋巴结）均提示：未分化型非角化性癌，EBER(+)。\n【分期】cT2N2M0，临床III期（复发）。\n\n【既往史与查体】\n既往行阑尾切除术。自诉2018年首次化疗使用'紫杉醇'（溶剂型）时曾发生严重的呼吸困难和低血压（III度过敏反应），后更换方案。入院查体：身高174cm，体重46kg（较前明显下降）。心肺听诊无殊，窦性心律，心率78次/分。\n\n【辅助检查】\n血常规：WBC 4.8×10^9/L, Hb 105 g/L, PLT 215×10^9/L。\n生化全项：ALT 28 U/L, AST 24 U/L, Alb 39 g/L, BUN 8.2 mmol/L, Cr 132 μmol/L。血糖 5.4 mmol/L。","patient_id":"l4-patient-a204fd75eb8c301e6c75f8c2"}
+{"id":"l4-sample-0b3bc91a07a7fb0e7d95f380","question":"当前应选择哪种诱导系统治疗方案？","options":{"A":"特瑞普利单抗 + 吉西他滨 + 顺铂，q3w × 3 周期，疗效评估后再讨论再程放疗","B":"多西他赛 + 顺铂 + 5-FU（TPF）× 3 周期","C":"白蛋白紫杉醇 + 奈达铂 + 卡培他滨 + 尼妥珠单抗 × 3 周期","D":"帕博利珠单抗单药","E":"吉西他滨 + 顺铂（GP）× 3 周期","F":"尼妥珠单抗 + 再程放疗同步起始（不同于 MDT 方案的‘先诱导系统治疗后再讨论放疗’策略）","G":"吉西他滨 + 卡铂 + 西妥昔单抗","H":"不进行任何诱导系统治疗或全身治疗，直接实施再程放疗作为当前首选处理"},"answer":"A","vignette":"患者男，42 岁。2023-08-23 入院评估，KPS 100。体查：右侧颈部可及肿大淋巴结，质硬、固定。既往 2 年前曾行根治性放化疗（具体剂量不详），本次复查发现异常。\n\n【病理/影像】\n\n2023-08-23：分期评估 cT2N2M0，III期（AJCC 8th）\n2023-08-24：右侧鼻咽活检：未分化型非角化性癌，EBER(+)\n2023-08-24：淋巴结穿刺：转移性癌\n2023-08-30：补充检测 PD-L1（22C3）TPS=30%，IHC 显示 EGFR(+)\n\n【当前一般情况】\n\nHb 105 g/L，肝肾功能基本正常\n心电图：窦性心律\n患者自诉既往化疗期间曾出现严重静脉炎及顽固性呃逆\n\n【MDT补充前提】\n综合影像及既往放疗史，当前判定为局部区域复发；\n由于病灶范围及既往照射区重叠，暂不适合立即手术或直接启动再程放疗，拟先行诱导系统治疗 2–3 周期，疗效评估后再讨论再程根治性局部治疗。","patient_id":"l4-patient-a204fd75eb8c301e6c75f8c2"}
+{"id":"l4-sample-3327bbee38c1b07ec6d2f204","question":"在上述病情及治疗背景下，下一步更合适的同步治疗方案选择是？","options":{"A":"继续使用顺铂单药同步化疗，标准剂量 100 mg/m² q3w，以确保放疗增敏效果。","B":"继续使用顺铂单药同步化疗，改为 40 mg/m² qw 方案，以降低毒性风险。","C":"鉴于肌酐清除率下降及听力受损风险，将同步化疗方案更改为奈达铂（Nedaplatin）单药增敏。","D":"暂停同步化疗，仅行单纯放疗，待肾功能完全恢复后再考虑辅助化疗。"},"answer":"C","vignette":"患者男，56岁。主因“回吸性涕血伴左颈部包块”入院。2025年1月19日鼻咽活检示：未分化型非角化性癌（EBERs +++）。2025年1月21日完善分期检查示：cT3N2M0，III期（AJCC 8th）。既往史：高血压病史5年，规律服药控制尚可；窦性心律不齐。体格检查：ECOG PS 0–1分（KPS 90分），身高172cm，体重68kg。患者于2025年1月20日启动诱导化疗，具体方案为：“特瑞普利单抗 240mg d1 + 吉西他滨 1.73g d1,8 + 顺铂 69.2mg d1-2 q3w”。首周期治疗顺利。2025年2月13日行第2周期同方案化疗。拟于2025年3月6日行第3周期治疗前，实验室检查提示：WBC 3.1×10^9/L，NEUT 1.8×10^9/L，PLT 110×10^9/L；血生化示：ALT 42 U/L，AST 38 U/L，BUN 8.2 mmol/L，Cr 108 μmol/L（基线Cr 75 μmol/L）。听力测试提示双耳高频听力轻度下降（约15 dB）。经多学科讨论及与患者沟通后，将第3周期（2025-03-06）方案调整为：特瑞普利单抗 240mg + 吉西他滨 1.72g d1,8 + 顺铂 68.8mg d1-2。随后于2025年4月2日开始行根治性放疗（IMRT），同步化疗具体方案正在制定中。","patient_id":"l4-patient-3e2528a7b3324c9517bc6271"}
+{"id":"l4-sample-a3a6c20cad620855d7736c7c","question":"对于该患者，在2024-07-04及其后续阶段应选择哪种治疗策略？","options":{"A":"给予辅助化疗：吉西他滨 + 顺铂 (GP方案) × 3周期","B":"给予辅助免疫治疗：特瑞普利单抗 240mg q3w 维持1年，用作辅助/维持治疗","C":"给予卡培他滨节拍辅助治疗（如 650mg/m² bid 持续口服）作为辅助/维持治疗","D":"观察等待，定期复查 (每3个月一次MRI及相关随访)","E":"在放疗结束后再次给予奈达铂 (80mg/m²) 作为辅助化疗"},"answer":"C","vignette":"患者女性，35岁。2024-03-14确诊为鼻咽未分化型非角化癌，分期为cT3N3M0（IVA期）。既往有窦性心律不齐病史，曾行阑尾切除术。2024-03-13至2024-06-14多次门诊及住院记录显示，KPS评分长期波动于80分左右。\n\n治疗经过如下：\n1. 诱导化疗阶段（2024-03-21至2024-05-01）：采用“诺欣(奈达铂) 135mg/m² 第1天 + 泽菲(吉西他滨) 1.7g 第1天”方案，周期性给药，患者依从性尚可，期间未见需要永久停药的严重急性不良反应，常规实验室检查及影像随访提示病灶有一定程度缓解趋势。\n2. 同步放化疗阶段（2024-05-23至2024-07-06）：在行鼻咽及颈淋巴结放疗过程中，同步给予“诺欣(奈达铂)”静脉化疗。医嘱记录显示，2024-05-23及2024-06-14两次给药的实际剂量调整为55mg，且相关医嘱一度显示为“已停止”，提示在同步阶段曾根据患者当时的耐受情况和检查结果对同步化疗方案作出剂量及给药安排调整。\n3. 辅助/维持阶段：2024-07-04患者完成放疗后准备出院，复查情况显示总体一般，生命体征平稳，无需急诊处理。此时拟进一步评估其全身状况、治疗耐受性及病灶控制情况，以制定后续的辅助或维持治疗方案。\n\n需要在此基础上权衡疗效与毒性、患者体能状况和潜在获益，选择2024-07-04及之后阶段的合适治疗策略。","patient_id":"l4-patient-fe098a94f2b0f8eb520eb7cf"}
+{"id":"l4-sample-58226f355cd75f8921d7d394","question":"2025-05-26 时，该患者下一步应如何处理？","options":{"A":"立即启动含顺铂+氟尿嘧啶（PF方案）的辅助化疗，以期巩固根治性放化疗疗效","B":"考虑复发风险高，给予 PD-1 抑制剂单药维持治疗 1 年","C":"给予卡培他滨节拍化疗（如 650 mg/m² bid，持续 1 年）作为维持治疗","D":"停止所有抗肿瘤药物治疗，进入单纯观察随访阶段"},"answer":"C","vignette":"一名45岁男性，广东籍，办公室职员。2025年2月确诊鼻咽未分化型非角化性鼻咽癌。影像学示鼻咽右侧肿瘤侵犯咽隐窝并累及右侧颅底骨质，右侧颈部 II、III 区多发淋巴结肿大；胸部 CT、上腹部增强 CT 及骨扫描未见明确远处转移，EBV DNA 明显升高，KPS 90。患者于 2025 年 2 月至 3 月完成诱导化疗，随后于 2025 年 3 月至 5 月顺利完成同期放化疗。今日（2025-05-26）为放疗结束后的首次疗效评估：MRI 及鼻咽镜提示原发灶和颈部病灶明显退缩，综合评估为 PR，无远处转移证据；血常规及肝肾功能基本恢复，可耐受后续口服治疗。患者今日复诊，希望明确下一步规范处理。","patient_id":"l4-patient-fe098a94f2b0f8eb520eb7cf"}
+{"id":"l4-sample-6844380b3f3e1caa8f8eb85d","question":"下一步最佳的治疗方案是？","options":{"A":"继续原一线诱导/全身方案：泽菲(吉西他滨) + 诺欣(奈达铂) + 拓益(特瑞普利单抗) 维持原强度静脉化疗","B":"更换为二线强化静脉化疗：多西他赛 + 顺铂 (TP方案) + 拓益(特瑞普利单抗) 作为二线全身治疗","C":"调整为减毒维持：拓益(特瑞普利单抗) + 卓仑(卡培他滨) 口服维持治疗","D":"调整为低强度维持：拓益(特瑞普利单抗) 单药免疫维持治疗"},"answer":"C","vignette":"患者男，34岁。既往确诊鼻咽癌并于2023年8月1日发现骨、肝多发远处转移。既往无高血压、糖尿病史，窦性心律。近期治疗记录如下：\n1. **2024-09-27**：给予泽菲(吉西他滨) 1.56g d1,8 + 诺欣(奈达铂) + 拓益(特瑞普利单抗) 治疗。\n2. **2024-10-18**：泽菲(吉西他滨) 1.54g d1,8 + 诺欣(奈达铂) 41.12mg + 拓益。\n3. **2024-11-08 至 2024-12-21**：针对鼻咽及颈部病灶行调强放疗(IMRT)。\n4. **2024-12-02**：放疗期间同步给予诺欣(奈达铂) 76.5mg + 泰欣生。\n\n患者于 **2025-02-07** 返院复查。体格检查：神清，体重52kg，KPS 90分，双手指端轻度麻木感。血常规示：WBC 2.8×10⁹/L，NEUT 1.4×10⁹/L，HGB 98g/L，**PLT 74×10⁹/L**。生化示：ALT 45 U/L，AST 38 U/L，Cr 85 μmol/L。影像学评估：鼻咽部病灶CR，肝脏转移灶较前缩小但仍可见（SD/PR）。","patient_id":"l4-patient-b01e7ce11e57b6ac953453cd"}
+{"id":"l4-sample-d70f5fdecbb1622f6dd5e0ce","question":"34岁男性，鼻咽未分化型非角化癌伴肝、骨多发转移（cT3N3M1），一线曾接受特瑞普利单抗联合吉西他滨+含铂方案及尼妥珠单抗并行原发灶及颈部淋巴结放疗，后维持尼妥珠单抗及骨改良治疗；现肝内病灶影像学评估为进展（PD），ECOG PS 1，轻度贫血，血常规及肝肾功能基本可耐受治疗，且患者乏力明显，希望以后尽量以居家口服治疗为主、减少住院输液。此时更合适的全身抗肿瘤治疗方案为？","options":{"A":"特瑞普利单抗 + 吉西他滨 + 顺铂（GP）","B":"特瑞普利单抗 + 替吉奥（S-1）","C":"特瑞普利单抗 + 卡培他滨","D":"特瑞普利单抗 + 多西他赛","E":"卡培他滨单药","F":"卡瑞利珠单抗 + 阿帕替尼"},"answer":"E","vignette":"患者男，34岁，鼻咽未分化型非角化性癌伴肝、骨多发转移（cT3N3M1）。\n\n【既往治疗史】\n\n1. 2024-09-04 起一线治疗：特瑞普利单抗 + 吉西他滨（1.56 g d1,8）+ 含铂方案 + 尼妥珠单抗。\n其中吉西他滨末次给药 2024-10-18，含铂末次给药 2024-12-02。\n2. 2024-11-08 至 2024-12-21：原发灶及颈部淋巴结放疗。\n3. 之后维持尼妥珠单抗及骨改良治疗。\n\n【当前病情】\n2025-02-05 复查提示：肝内病灶较前增大，并出现新发微小结节，评估为 PD。\n查体：ECOG PS 1，轻度贫血貌。\n实验室：WBC 3.8×10^9/L，HGB 105 g/L，PLT 110×10^9/L；ALT 35 U/L，AST 40 U/L，Cr 82 μmol/L。\n患者主诉乏力明显，明确表示希望以后尽量以居家口服治疗为主，减少住院输液。","patient_id":"l4-patient-b01e7ce11e57b6ac953453cd"}
+{"id":"l4-sample-aaccb8d731b039bc6ecae2cd","question":"2025-02-07 针对该患者的最佳治疗调整策略是？","options":{"A":"继续原方案：泽菲(吉西他滨) + 诺欣(顺铂) + 拓益(特瑞普利单抗)","B":"更换二线方案：多西他奇(Docetaxel) + 诺欣(顺铂) + 5-FU (TPF方案)","C":"维持治疗：单药 拓益(特瑞普利单抗) 维持","D":"更换方案：拓益(特瑞普利单抗) + 卓仑(卡培他滨)"},"answer":"D","vignette":"患者男，34岁。确诊鼻咽癌肝骨转移5个月余。既往无高血压糖尿病史。\n\n【既往治疗史（原始记录）】：\n患者于2024-09-27接受泽菲(吉西他滨) 1.56g x2 + 诺欣(顺铂) 62.4mg治疗；2024-10-18行泽菲 1.54g x2 + 诺欣 41.12mg；2024-11-11接受诺欣 77.5mg；并于2024-11-08至2024-12-21完成鼻咽及颈部放疗。末次铂类药物（诺欣）给药时间为2024-12-02（剂量76.5mg），同步联合安加维及泰欣生/拓益治疗。\n\n【2025-02-07 复诊评估】：\n患者诉轻度乏力，纳差。查体：ECOG 1分，窦性心律，腹软。\n辅助检查：\n1. 血常规：Hb 98 g/L，WBC 3.5×10^9/L，PLT 82×10^9/L。\n2. 生化全项：ALT 45 U/L，AST 38 U/L，ALB 32 g/L，BUN 8.2 mmol/L，Scr 152 μmol/L。\n3. 影像学对比（2024-12-02 vs 2025-02-06）：鼻咽部病灶稳定，但肝S6段病灶较前增大25%，并可见L3椎体核素浓聚影范围轻度扩大。\n4. 患者当前体重：48 kg。","patient_id":"l4-patient-b01e7ce11e57b6ac953453cd"}
+{"id":"l4-sample-cb96d24c30f73fbef008100d","question":"下列最符合真实临床逻辑的治疗决策是？","options":{"A":"继续原方案：泽菲 1.61g + 诺欣 128mg，加强止吐及水化处理","B":"剂量调整：泽菲 1.28g (80%) + 诺欣 96mg (75%)，以减轻耳毒性","C":"方案更替：泽菲 1.55g + 波贝(Carboplatin) 381mg","D":"方案升级：在原方案基础上联合泰欣生(Nimotuzumab) 200mg qw以提高疗效","E":"终止化疗：直接转入放疗科行根治性放疗"},"answer":"C","vignette":"患者男，2025年约54岁，既往确诊鼻咽未分化型非角化性癌，于2025-05-09确诊复发。既往体健，KPS 90分。\n\n【既往治疗记录】：\n2025-05-14 接受一线化疗：泽菲(Gemcitabine) 1.61g d1,8 + 诺欣(Cisplatin) 128mg d1 ivgtt q3w。\n\n【2025-06-06 复诊评估】：\n患者诉首疗程后出现持续性耳鸣及严重恶心呕吐，近期进食差。查体：KPS 90.0，身高172cm，体重由上周期的65kg下降至60kg。听诊心律齐，腹软。\n\n【辅助检查】：\n血常规：WBC 3.8×10^9/L, NEUT 1.9×10^9/L, PLT 95×10^9/L, HGB 108g/L。\n生化指标：ALT 35 U/L, AST 40 U/L, TBIL 12.1 μmol/L, BUN 8.2 mmol/L, Scr 126 μmol/L, K 3.4 mmol/L, Na 139 mmol/L。\n\n现拟行第二周期化疗，请制定具体的用药方案。","patient_id":"l4-patient-ebca81416c4f1e4a8fa93b74"}
+{"id":"l4-sample-7426f4dcd63e08d1ded0a8ea","question":"该患者同期放化疗（CCRT）的最佳药物选择是？","options":{"A":"标准方案：顺铂 (Cisplatin) 100 mg/m²，每3周一次，同期放疗。","B":"继续诱导：吉西他滨 (Gemcitabine) + 顺铂 (Cisplatin) 方案再行2周期诱导化疗，期间暂不开始同期放疗。","C":"调整方案：单药卡铂 (Carboplatin) AUC=5-6 同期放疗","D":"降阶梯方案：因诱导化疗有效，仅行单纯调强放疗 (IMRT)，不加用同期系统治疗。"},"answer":"C","vignette":"患者男，54岁，确诊鼻咽未分化型非角化性癌（cT3N1M0）。既往体健，无糖尿病高血压史，ECOG 0-1分。\n\n【治疗经过回顾】：\n1. 2025-05-14 开始诱导化疗，医嘱记录显示：使用顺铂(诺欣)128mg; 吉西他滨(泽菲)1.61g。第 1 周期后因出现 III 度胃肠道反应并伴肾功能指标受损倾向，第 2 周期起医嘱调整为卡铂方案。\n2. 2025-06-06 第二周期化疗，医嘱调整为：更换为卡铂(波贝)，剂量381mg; 吉西他滨剂量降至1.55g。\n3. 2025-06-26 第三周期化疗，医嘱记录：卡铂(波贝)剂量调整为455mg; 吉西他滨1.56g。\n\n【当前状态 2025-07-21】：\n患者准备开始根治性放疗。今日查体 KPS 90.0，体表淋巴结未及明显肿大，心肺听诊无殊。血常规示 Hb 108g/L，PLT 155×10^9/L。今日拟定化疗方案时，计算卡铂(波贝)目标剂量为 435.7mg。\n\n辅助检查：EBV-DNA 拷贝数较初诊下降 2log，但仍高于正常值。鼻咽MRI示原发灶较前缩小，但仍有残留。","patient_id":"l4-patient-ebca81416c4f1e4a8fa93b74"}
+{"id":"l4-sample-3a2f854e41e3fb5126bbd1a5","question":"在当前放疗中段这一时间点，下一步最合理的同步增敏策略是？","options":{"A":"在密切监测血象和黏膜毒性的前提下，继续当前卡铂同步放疗，不增加其他增敏药物","B":"恢复顺铂 100 mg/m² q3w 同步放疗","C":"停用铂类同步化疗，改为尼妥珠单抗联合放疗","D":"改为紫杉醇 + 5-FU 双药联合放疗","E":"停用铂类同步化疗，但暂不加用其他全身增敏药物，仅在支持治疗下尽量按计划完成剩余放疗"},"answer":"C","vignette":"患者男，54 岁，确诊鼻咽未分化型非角化性癌（cT3N1M0，AJCC 9th stage III）。\n2025-05-14 启动治疗，首周期给予 顺铂 128 mg + 吉西他滨 1.61 g；\n2025-06-06 第 2 周期改为 卡铂 381 mg + 吉西他滨 1.55 g；\n2025-06-26 第 3 周期为 卡铂 455 mg + 吉西他滨 1.56 g；\n2025-07-21 第 4 周期为 卡铂 435.7 mg。\n\n患者 KPS 始终维持 90 分，双侧颈部淋巴结较前缩小。既往有“窦性心律不齐”病史。\n已于 2025-07-24 开始同步放疗，当前时间点为 2025-08-12（放疗中段）。\n\n【当前状态补充】\n- 自诉吞咽疼痛较前加重，进食量下降\n- 查体：口腔黏膜炎 II 度，颈部皮肤反应 I 度\n- 近 2 周体重由 70 kg 降至 67 kg\n- 血常规：WBC 3.2×10^9/L，Hgb 101 g/L，PLT 96×10^9/L\n- 肝肾功能检测结果未提示明显器官衰竭证据","patient_id":"l4-patient-ebca81416c4f1e4a8fa93b74"}
+{"id":"l4-sample-c36c6bb09084819479a143a1","question":"基于患者的复发治疗经过及当前生理指标，既往未接受过免疫治疗，下一步最佳的维持/辅助治疗策略是？","options":{"A":"启动卡瑞利珠单抗（PD-1单抗）维持治疗","B":"给予吉西他滨 + 顺铂（GP方案）辅助化疗 2-4 周期","C":"口服卡培他滨（Capecitabine）节拍辅助治疗","D":"定期随访观察，暂不予以药物干预"},"answer":"C","vignette":"患者女，34岁。\n\n【既往史】\n2019年曾行鼻咽癌根治性放化疗（具体方案不详）。2010年行阑尾切除术。否认高血压、糖尿病史。既往未系统应用过 PD‑1/PD‑L1 抑制剂类免疫治疗药物。\n\n【现病史：复发治疗全记录】\n[2024-04-26] 因鼻咽部不适及影像检查提示异常，完善检查后确诊鼻咽癌复发。\n[2024-04-29] 鼻咽顶后壁病理提示：未分化型非角化性癌，EBERs(+)，EGFR(+)。\n[2024-05-02] 影像学及相关检查评估为 rT3N2M0 (III期) 复发。\n[2024-04-28] 在复发后启动诱导治疗：(集采)紫杉醇(白蛋白) 387.4 mg q3w + 泰欣生(尼妥珠单抗) 200 mg qw。\n[2024-05-24 至 2024-07-09] 行再程放疗（Re-RT），期间同步应用泰欣生 200 mg qw 周疗（末次泰欣生时间：2024-06-25）。\n\n【当前访视：2024-08-27】\n患者结束再程放疗约7周后复诊。复查鼻咽及颈部 MRI 示鼻咽部原复发病灶较前明显缩小，颈部淋巴结未见明显肿大或新发病灶。目前一般状况良好，KPS 评分 100 分，日常生活与体力活动未见明显受限。体重 48 kg，较放疗结束时基本平稳。\n\n【辅助检查（2024-08-26）】\n1. 血常规：WBC 4.1×10^9/L，HGB 115 g/L，PLT 188×10^9/L。\n2. 肝肾功能：ALT 22 U/L，AST 19 U/L，Cr 68 μmol/L，eGFR 102 ml/min，未见明显肝肾功能异常。\n3. 甲状腺功能：TSH <0.005 mIU/L（参考值 0.27–4.2），FT4 38.4 pmol/L（参考值 12–22），TRAb 18.5 IU/L（参考值 0–1.75），提示甲状腺功能异常及相关抗体升高，需结合临床进一步评估可能的病因及对后续治疗的影响。\n4. 听力测定：双耳 4000 Hz 气导听阈 75 dB，提示存在感音神经性听力损失。\n5. 心电图：窦性心律，心率 88 次/分，未见明显异常改变。\n\n目前已完成再程放疗及上述系统治疗，需在此基础上综合评估后续维持或辅助系统治疗策略。","patient_id":"l4-patient-2fdac91a0aeb4e17c9305f44"}
+{"id":"l4-sample-913bf50cbc6d65e148f56b58","question":"根据CSCO/NCCN指南，该患者此时应启动的最佳全身化疗方案是？","options":{"A":"吉西他滨 (1000 mg/m² d1,8) + 顺铂 (80 mg/m² d1) q3w","B":"多西他赛 (75 mg/m² d1) + 顺铂 (75 mg/m² d1) + 5-FU (750 mg/m²/d civ d1-5) q3w","C":"吉西他滨 (1000 mg/m² d1,8) + 奈达铂 (80 mg/m² 分3天给药) q3w","D":"单药特瑞普利单抗 (240 mg d1) q3w（免疫治疗方案，非细胞毒全身化疗）"},"answer":"C","vignette":"患者男，2025年约26岁。既往确诊鼻咽癌，经放化疗综合治疗后缓解。本次因鼻塞伴头痛复诊。\n\n【病程节点】\n[2025-05-29] 鼻咽顶后壁活检病理：送检组织中见核稍增大的细胞，不除外肿瘤。\n[2025-06-06] 结合免疫组化及影像学，确诊为鼻咽癌局部复发。\n\n【查体与评估】\n[2025-06-09] KPS评分:90.0。身高 172cm，体重 50kg。心率 92次/分，律齐。既往有阑尾切除术史。\n\n【辅助检查】\n血常规：WBC 5.1×10^9/L, Hgb 102 g/L, PLT 210×10^9/L。\n生化全项：ALT 21 U/L, AST 18 U/L, TBIL 12.1 μmol/L, Alb 38 g/L, BUN 8.2 mmol/L, Scr 138 μmol/L。\n听力测试：双耳高频听力轻度下降（1级）。","patient_id":"l4-patient-cbed1da030f8adc60ae48b05"}
+{"id":"l4-sample-307d8072f6b5786cf31d72ff","question":"结合患者目前的病情进展与一般状况，此时应选择哪种系统治疗方案？","options":{"A":"吉西他滨 + 顺铂 (GP) + 帕博利珠单抗","B":"单药 帕博利珠单抗（免疫治疗单药）","C":"特瑞普利单抗单药免疫治疗","D":"卡培他滨 单药口服化疗","E":"多西他赛 + 顺铂 + 氟尿嘧啶 (TPF)"},"answer":"C","vignette":"患者男，2013年约22岁，因“确诊鼻咽癌9个月，发现多发转移1周”入院。既往无高血压、糖尿病史，否认药物过敏史。2013年曾行阑尾切除术。\n\n【既往治疗史】\n- 2023-02-15：确诊鼻咽非角化性癌（T3N2M0）。\n- 2023-02-20 至 2023-04-25：行TPF方案诱导化疗3周期。\n- 2023-05-10 至 2023-08-15：行根治性调强放疗（IMRT），同步顺铂（100mg/m² q3w × 2周期）。\n- 2023-11-24：复查PET-CT示：鼻咽部病灶稳定，但肝S6/S8段出现新发高代谢结节（最大径2.1cm），双肺散在小结节。考虑远处转移。\n\n【入院评估 (2023-12-05)】\n- 体格检查：神志清，步行入病房，自诉每日可慢跑2公里。颈部未及明显肿大淋巴结。\n- 实验室检查：WBC 5.1×10⁹/L, NEUT 3.2×10⁹/L, HGB 118g/L, PLT 210×10⁹/L。ALT 35 U/L, AST 28 U/L, TBIL 10.2 μmol/L。Scr 78 μmol/L。EBV-DNA 4.5×10⁴ copies/mL。\n- 心电图：窦性心律，大致正常心电图。\n- 评估记录：[2023-12-06] KPS评分: 90.0。","patient_id":"l4-patient-a62c839e0ec72d3e6fb70e1e"}
+{"id":"l4-sample-35005f165cec80fb88d47483","question":"对于该局部区域复发且计划行根治性再放疗的患者，目前最合理的 concurrent phase 方案是：","options":{"A":"继续原诱导四药方案（特瑞普利单抗 + 尼妥珠单抗 + 白蛋白紫杉醇 + 顺铂）并发 IMRT","B":"停用所有细胞毒药物，仅以特瑞普利单抗 + 尼妥珠单抗并发 IMRT","C":"以含铂同步放化疗为核心方案（如每周或三周一顺铂）并发 IMRT，停用白蛋白紫杉醇；至于是否合并特瑞普利单抗/尼妥珠单抗，由 MDT 个体化决定，非标准必选项","D":"改为吉西他滨 + 顺铂（GP）并发 IMRT，以克服潜在紫杉类耐药","E":"仅行 IMRT，不联合任何系统治疗","F":"改为卡铂 + IMRT，因为第 3 周期顺铂医嘱曾停止","G":"改为特瑞普利单抗单药并发 IMRT","H":"改为尼妥珠单抗单药并发 IMRT"},"answer":"C","vignette":"患者男，2023年约32岁。2023 年 11 月 24 日确诊鼻咽癌局部区域复发。病理示：（右颈部淋巴结）EBV(+) 未分化型非角化性癌。影像学评估分期为 cT2N2M0（rIII 期）。\n\n【既往治疗经过】\n2023-12-06：开始诱导治疗，方案为特瑞普利单抗 240 mg + 尼妥珠单抗 400 mg + 白蛋白紫杉醇 455 mg + 顺铂 131 mg；\n2023-12-28：第 2 周期：同上方案；\n2024-01-18：第 3 周期：特瑞普利单抗 240 mg + 尼妥珠单抗 400 mg + 白蛋白紫杉醇 452 mg，当日顺铂医嘱剂量为 43.5 mg，状态显示“已停止”；\n2024-02-18：返院评估，拟进入根治性再放疗阶段。\n\n【当前一般情况及化验结果】\nKPS 评分 90 分；\n血常规：WBC 3.8×10^9/L，NEUT 1.9×10^9/L，HB 108 g/L，PLT 145×10^9/L；\n生化：ALT 35 U/L，Cr 88 μmol/L；\n既往体健，无慢性基础疾病。\n\n【治疗相关前提】\n经 MDT 讨论，目前局部区域复发病灶不适合直接手术切除，计划行根治性再放疗，需要在放疗同步阶段选择合适的全身抗肿瘤治疗方案。","patient_id":"l4-patient-a62c839e0ec72d3e6fb70e1e"}
+{"id":"l4-sample-34fdde6fa785e797695d7137","question":"今日(2025-05-29)的最佳治疗决策是？","options":{"A":"属于局部晚期高危患者，如在放疗结束后4–6周内，可考虑序贯辅助化疗：吉西他滨 + 顺铂 (GP方案) x 3周期，但目前已超过合适时间窗，不再适用","B":"继续给予 卡培他滨 (卓仑) 1500mg bid 维持治疗","C":"考虑洛铂耐药可能，更换为 替吉奥 (S-1) 单药维持治疗","D":"治疗已结束，停止所有药物，进入单纯随访观察阶段"},"answer":"B","vignette":"患者男，55岁 。2025年5月29日门诊复诊。既往确诊鼻咽癌 (cT3N2M0 III期，AJCC 8th)。\n\n【原始治疗数据】\n既往用药记录显示：\n1. \"[2024-11-05/11-26] (集采)紫杉醇(白蛋白)-锐贝 450.0 mg\"\n2. \"[2025-01-06/01-26/02-18] 注射用洛铂(国际,长安) 40.0 mg\"\n3. \"[2025-01-02至02-19] 放疗\"\n4. \"末次静脉化疗时间: 2025-02-18 (洛铂+泰欣生)\"\n5. \"末次口服化疗开立: 2025-03-20 (卓仑 1500mg bid)\"\n\n【当前状态】\n今日(2025-05-29) 鼻咽镜示：鼻咽部粘膜充血，未见明显新生物。颈部MRI示：双颈淋巴结较前缩小，结构不清，呈放疗后改变。查体：BP 132/84 mmHg，听力轻度下降（自诉），腹部平软，既往有阑尾切除术史。\"2024-11-05至2025-02-18 多次记录: KPS评分:90.0\"，目前ECOG PS 1分。","patient_id":"l4-patient-8f3580d2a51f5f890f42a611"}
+{"id":"l4-sample-5350141ddbe6fcac928e2121","question":"基于患者的治疗时间轴和当前状态，目前下列哪种临床处理最为恰当？","options":{"A":"辅助治疗疗程已达标准（6个月），停止口服卓仑，进入单纯观察随访期。","B":"继续口服卓仑（Capecitabine）维持治疗。","C":"鉴于T3N2高危因素，联合特瑞普利单抗（Toripalimab）增强辅助治疗强度。","D":"患者出现1级手足综合征且伴轻度贫血，应立即下调卓仑剂量至 1000mg bid 继续维持。"},"answer":"B","vignette":"患者男，55岁。2024年11月确诊鼻咽癌，分期为cT3N2M0 III期（AJCC 8th）。\n\n【既往治疗回顾】\n1. 2024-11-05至2024-11-26：行TP诱导化疗（紫杉醇白蛋白结合型 + 泰欣生）2周期。\n2. 2025-01-02至2025-02-19：行根治性放疗（PGTVnx 70Gy/33F），同步化疗方案为洛铂（Lobaplatin 40mg）+ 泰欣生，末次同步化疗时间为2025-02-18。\n3. 2025-02-19：开始口服辅助治疗（卓仑 1500mg bid），期间规律随访。\n\n【当前就诊：2025-08-28】\n患者今日复查。体格检查：KPS 90，双足底皮肤轻度发红、脱屑，无疼痛（NCI-CTCAE 1级）。\n辅助检查：\n- 血常规：WBC 3.8×10^9/L, NEUT 2.1×10^9/L, HGB 108 g/L（轻度贫血）, PLT 145×10^9/L。\n- 生化：ALT 42 U/L, AST 35 U/L, TBIL 18.2 μmol/L, Cr 82 μmol/L。\n- EBV-DNA：< 500 copies/ml。\n- 鼻咽+颈部MRI：鼻咽顶后壁增厚较前相仿，无强化结节；双侧颈部淋巴结小，未见明确肿大淋巴结。\n\n基于患者的治疗时间轴和当前状态，目前下列哪种临床处理最为恰当？","patient_id":"l4-patient-8f3580d2a51f5f890f42a611"}
+{"id":"l4-sample-094e68f3d2a01a8c247ac971","question":"下列哪项分析更符合临床决策逻辑？","options":{"A":"患者属于局部晚期鼻咽癌，根据CSCO指南，同期化疗首选单药顺铂 100mg/m² q3w 方案。该患者采用的是分割给药模式（40mg qd d1-3），第二周期略微调整为38mg qd d1-3，属于在标准推荐范围内根据个体耐受进行的小幅度剂量优化，并不能简单认定为“明显低于标准治疗强度”，也不必“立即改为”三周一次100mg/m² 方案以保证疗效。","B":"患者虽KPS评分良好（90分），但第二周期顺铂剂量出现微调（40mg 调整为 38mg），提示临床医生可能基于体表面积的精确再计算或对前次轻微毒性（恶心呕吐、轻度耳鸣）的顾虑进行了经验性下调。目前的治疗策略实质为“尼妥珠单抗联合顺铂同步放化疗”，属于在指南框架内、兼顾疗效与耐受性的合理选择，可视为对不能或不宜承受高强度三周方案患者的一种较低毒性方案，而非明显不足的治疗强度。","C":"患者使用了尼妥珠单抗（泰欣生），说明患者EGFR表达强阳性。鉴于患者出现了顺铂相关的耳毒性前兆（耳鸣），下一步应立即停用顺铂，单用尼妥珠单抗联合放疗，因为靶向药物足以替代同期化疗的作用。","D":"患者第一周期顺铂累积剂量仅120mg（40mg×3天），远低于标准三周方案的强度。第二周期剂量进一步降低至38mg，说明患者已产生顺铂耐药。应立即更换为卡铂或奈达铂进行同期化疗。"},"answer":"B","vignette":"患者女，54岁（1969年生），2023年12月7日初诊确诊为鼻咽非角化性癌，分期为T3N2M0，临床IV期。既往史无特殊，无高血压、糖尿病史，否认吸烟、饮酒史。体能状态评估：[2024-01-03] KPS评分90。入院前查血常规：WBC 5.1×10^9/L，Hb 118 g/L（轻度贫血），PLT 210×10^9/L；肝肾功能基本正常。心电图提示窦性心律，偶发房早。患者于2024年1月3日启动根治性放疗（IMRT），并计划行同期放化疗。当日给予“泰欣生（尼妥珠单抗）标准剂量静脉滴注，每周一次 + 顺铂 100 mg/m² 静脉滴注，每3周一周期”的方案进行同期放化疗。实际顺铂给药采用分割剂量方式，即第一周期顺铂按40 mg qd 连续3天静脉滴注（d1-3），三周总剂量约等同于100 mg/m²。完成第一周期顺铂给药后，放疗持续进行中。2024年1月22日，患者返院准备开始第二周期同期治疗，再次评估KPS评分为90。复查血生化及血常规未见IV度骨髓抑制，患者自述上一周期治疗后出现明显恶心呕吐及轻度耳鸣。本周期拟继续给予尼妥珠单抗原方案维持，同时计划顺铂仍按每3周一周期方案给药，但分割剂量计划从第一周期的40 mg qd d1-3略微调整为38 mg qd d1-3，正在讨论是否需要根据患者耐受情况进一步调整具体剂量或用药策略。","patient_id":"l4-patient-c07b91d864ecd083064fd293"}
+{"id":"l4-sample-ef3d9e8249f7aef99deb662e","question":"若仅依据以上资料，放疗期间最合理的同期全身治疗安排是：","options":{"A":"延续 9–10 月全部药物，与 IMRT 同期进行，避免远处病灶出现治疗空窗","B":"全部停用既往药物，改为顺铂 100 mg/m² q3w 同期放疗","C":"去除锐贝与卓仑，保留诺欣 + 泰欣生 + 拓益同期放疗","D":"去除锐贝、诺欣、泰欣生及卓仑，仅保留拓益贯穿放疗","E":"去除锐贝、诺欣及卓仑，保留泰欣生 + 拓益同期放疗","F":"放疗期间停用全部系统治疗，待首轮放疗后评估再决定是否恢复","G":"去除锐贝与卓仑，保留诺欣 + 拓益同期放疗","H":"去除锐贝与拓益，保留诺欣 + 泰欣生同期放疗","I":"去除锐贝、诺欣与泰欣生，保留卓仑 + 拓益同期放疗","J":"因已有耳鸣与肢端麻木，取消局部放疗，继续原系统治疗即可"},"answer":"D","vignette":"患者男，49岁。病理示未分化型非角化性癌，EBER 阳性。门诊病历系统显示其既往曾接受根治性治疗，后出现鼻咽及双颈病灶进展，并伴骨及远处淋巴结受累。\n\n近期系统中可调阅到如下片段化记录：\n\n2024-05 至 2024-07：曾用“诺欣 + 泽菲 + 拓益”方案；\n2024-07-25：因局部病灶控制欠佳调整全身治疗；\n2024-09-05、2024-09-26、2024-10-17、2024-10-18：多次记录 KPS 90；\n2024-09-26 至 2024-10-18 医嘱中反复出现：\n锐贝 320–330 mg\n诺欣 48 mg\n泰欣生 400 mg\n卓仑 1500 mg\n拓益 240 mg\n\n2024-11-08 复评：\n\n鼻咽及颈部病灶较前缩小；\n骨及远处淋巴结未见新发，既有病灶较前减低；\nHb 108 g/L，WBC 4.1×10^9/L，PLT 正常；\n肌酐、转氨酶未见明显异常；\n近 3 周自诉耳鸣较前明显，电话交流仍可；夜间足趾及指尖偶有发麻；\n心电图：窦性心律，HR 78 次/分。\n\nMDT 拟于 2024-11-13 起对鼻咽及双颈病灶行 IMRT。","patient_id":"l4-patient-6d72d846926ee50f0e0c7e0c"}
+{"id":"l4-sample-51ee62dd597df64571ef49a3","question":"关于该患者此次复发时的一线系统治疗，应如何选择？","options":{"A":"吉西他滨 + 顺铂 + PD-1 抑制剂（如特瑞普利单抗）","B":"卡培他滨 + 贝伐珠单抗","C":"白蛋白结合型紫杉醇 + 奈达铂","D":"特瑞普利单抗单药"},"answer":"A","vignette":"患者男，29岁。\n\n【既往史】\n- 2013-02-01 诊断为鼻咽未分化型非角化性癌（T3N2M0）。\n- 2013-02-05 起接受含『力扑素 260mg d1 + 奥先达 50mg d1-3』方案的诱导化疗，共3周期，之后行放疗，此后无病生存至2019年。\n- 2019-05 至 2020-07 口服『替加氟片』维持治疗。\n- 2021-07-20 出现局部复发，予『艾滨 1000mg bid』同步放疗。\n- 2021-08 至 2022-01-25 继续口服『艾滨』作为维持治疗，末次用药日期为2022-01-25。\n\n【当前就诊】\n- 就诊日期：2024-07-18\n- 查体：KPS 90分，体重 65 kg，体表浅表淋巴结未触及肿大。\n- 辅助检查：鼻咽部 MRI 提示局部病灶较前增大，伴颈部淋巴结肿大，影像学考虑疾病进展（PD）。血生化检查结果在正常范围内，EBV-DNA 4.5E+03 copy/mL。\n- 既往毒性记录：2013年化疗期间出现 I 度周围神经毒性，无严重听力下降的记录。","patient_id":"l4-patient-3a07299c5fe1ba83fdbe0cb9"}
+{"id":"l4-sample-0e55d4ed1f577d5ad5d784a5","question":"基于上述病情和既往治疗史，目前对于该患者最合理的全身系统抗肿瘤药物治疗方案是？","options":{"A":"特瑞普利单抗 + 吉西他滨 + 顺铂","B":"特瑞普利单抗 + 吉西他滨 + 卡铂","C":"派安普利单抗 + 白蛋白紫杉醇 + 安罗替尼","D":"卡培他滨单药","E":"多西他赛 + 顺铂 + 5-FU","F":"特瑞普利单抗单药","G":"紫杉醇 + 卡铂","H":"白蛋白紫杉醇 + 顺铂 + 卡培他滨","I":"卡瑞利珠单抗 + 阿帕替尼","J":"安罗替尼单药"},"answer":"B","vignette":"患者男，29岁。\n2024-07-18 因咳嗽入院。PET/CT 提示双肺、胸膜及多发骨病灶代谢增高，结合病史考虑鼻咽癌远处转移。既往病理为非角化未分化癌，EBER 阳性。\n\n门诊和住院系统可检索到以下既往治疗片段：\n\n2013-02 至 2013-03：接受诱导治疗后同步放化疗，放疗剂量 70 Gy/33f；同期医嘱出现“力扑素 260 mg + 奥先达 50 mg”；\n2019-05 至 2020-07：长期口服“替加氟片 250 mg tid”；\n2021-07 至 2022-01：因颈部复发接受二程放疗及化疗，末次记录“艾滨 1000 mg bid”；\n2022-07-05：EBV-DNA 为 0 copy/mL。\n\n本次入院评估：\n\nKPS 90；BMI 19.5；\nWBC 4.5×10^9/L，Hb 118 g/L，PLT 210×10^9/L；\n肌酐、肝酶未见明显异常；\n纯音测听：0.5–2 kHz 平均听阈左 25 dB、右 30 dB；4000 Hz 左 65 dB、右 70 dB；\n神经系统查体：四肢腱反射减弱，指鼻试验稳准；\n本次血浆 EBV-DNA：4.5×10^4 copy/mL。","patient_id":"l4-patient-3a07299c5fe1ba83fdbe0cb9"}
+{"id":"l4-sample-ec1fe2494d9d209a40c11afb","question":"若采用卡铂AUC 6同步放疗，按估算CrCl计算，应选择哪项？","options":{"A":"同步放疗 + 顺铂 150 mg d1，q3w","B":"同步放疗 + 顺铂 60 mg，每周 1 次","C":"同步放疗 + 奈达铂 150 mg d1，q3w","D":"同步放疗 + 奈达铂 120 mg d1，q3w","E":"同步放疗 + 奈达铂 67 mg d1，q3w","F":"同步放疗 + 吉西他滨 1.68 g（d1, d8）+ 顺铂 150 mg，q3w","G":"同步放疗 + 卡铂 410 mg d1，q3w","H":"同步放疗 + 奥沙利铂 110 mg，每周 1 次","I":"仅行同步放疗，不合并任何系统治疗","J":"再追加 1 周期诱导化疗后再进入同步阶段"},"answer":"G","vignette":"患者男，57岁，确诊鼻咽未分化型非角化性癌（cT2N3M0，IVA期，AJCC第8版）。\n\n【既往治疗记录】\n患者已完成 3 周期诱导化疗，具体用药如下：\n\n2023-05-17：诺欣（顺铂）66 mg + 泽菲（吉西他滨）1.65 g（d1, d8）\n2023-06-07：诺欣 66 mg + 泽菲 1.65 g（d1, d8）\n2023-06-30：诺欣 67 mg + 泽菲 1.68 g（d1, d8）\n\n【当前临床评估（2023-07-21）】\n患者拟开始调强放疗并进入同步治疗阶段。\n\n-KPS评分：90\n-既往史：阑尾切除术后10年，窦性心律不齐\n-体格检查：双颈淋巴结较前明显缩小，质软\n-身高：165 cm\n-体重：50 kg\n-辅助检查：\n-血常规：WBC 3.5×10^9/L，NEUT 1.8×10^9/L，PLT 108×10^9/L\n-生化：BUN 8.2 mmol/L，Cr 118 μmol/L","patient_id":"l4-patient-aa404d8b78925c1ac7603181"}
+{"id":"l4-sample-d963236c325736c8ae3907a4","question":"2019-08-09 时，该患者下一步应如何处理？","options":{"A":"继续第 3 周期非标准单药铂类诱导，将日剂量回调至 44 mg/d × 3 天，以尽量恢复剂量强度","B":"继续第 3 周期非标准单药铂类诱导，维持 40 mg/d × 3 天，以减少耳毒性","C":"将第 3 周期改为卡铂 AUC=5 单药诱导，完成 3 周期诱导后再放疗","D":"停止继续这种非标准单药铂类诱导，按指南尽快转入 IMRT 联合单药顺铂同期放化疗作为根治性主路径","E":"补做 1 个周期标准 GP 诱导化疗后，再行 IMRT + 同期顺铂放化疗","F":"因 EBV-DNA 已转阴而直接进入 IMRT 单纯放疗，省略后续根治性同步化疗","G":"以尼妥珠单抗 + IMRT 取代规范的同期含铂放化疗方案","H":"临时改为 PD-1 联合系统治疗并推迟根治性放疗启动，待数周期后再考虑放疗","I":"直接进入节拍卡培他滨辅助治疗，放弃后续根治性同步放化疗阶段","J":"此时转入特瑞普利单抗 + GP 的复发转移一线治疗方案，放弃局部根治性放化疗"},"answer":"D","vignette":"患者女，2019年约56岁。\n2019 年 6 月确诊 EBV 相关鼻咽未分化型非角化性癌。现为回顾性 benchmark 题：要求考生站在 2025 年 NCCN/CSCO 视角，对该患者 2019-08-09 这一时间点的最佳下一步治疗进行判断。\n\n基线信息\n初诊分期补充为：cT3N2M0，无远处转移。\n既往无高血压、糖尿病史，20 年前行阑尾切除术。\nECOG PS 0–1 / KPS 90 分。\n已接受治疗\n2019-06-27 启动诱导治疗：病历医嘱仅记录“诺欣 45 mg qd × 4 天”。\n2019-07-18 第 2 周期：病历医嘱记录“诺欣 40 mg qd × 4 天”。\n2019-08-08 复查 EBV-DNA：0 copy/mL。\n2019-08-09 当前状态\nKPS 90 分。\n血肌酐 88 μmol/L，尿素氮 5.2 mmol/L。\n身高 160 cm，体重 50 kg。\n上一周期后出现明显恶心呕吐及轻度耳鸣。","patient_id":"l4-patient-9ed8cd87ef581dbf35358b35"}
+{"id":"l4-sample-7a29413f878da9f34c7f6634","question":"根据 2025 版 NCCN 指南，下一步系统治疗应选择哪种方案？","options":{"A":"继续紫杉醇 + 奈达铂 + 卡培他滨，并恢复奈达铂满量","B":"吉西他滨 + 顺铂","C":"吉西他滨 + 顺铂 + 特瑞普利单抗","D":"特瑞普利单抗单药","E":"卡瑞利珠单抗单药","F":"阿帕替尼单药（临床试验或无免疫治疗可及时的探索性选项）","G":"卡瑞利珠单抗 + 阿帕替尼（局限于临床研究或无规范免疫路径地区）","H":"卡培他滨低剂量节拍治疗（姑息性或后线尝试）","I":"白蛋白紫杉醇 + 安罗替尼（缺乏一线/二线标准证据的探索性方案）","J":"最佳支持治疗（仅限全身状况或意愿不适合抗肿瘤治疗时）"},"answer":"D","vignette":"患者女，2019年约37岁。\n既往鼻咽癌根治治疗后出现鼻咽局部复发。2019-11-15 鼻咽活检：未分化型非角化性癌，CK(+)，Ki67 约40%+，EBV(-)，EBER(-)。\n\n系统可见既往治疗记录：\n\n2019-11-27：紫杉醇 225 mg d1 + 奈达铂 90 mg d1 + 卡培他滨 1500 mg bid d1–14\n2019-12-19：紫杉醇 234 mg d1 + 奈达铂 90 mg d1 + 卡培他滨同前\n2020-01-09：紫杉醇同前 + 奈达铂 75 mg d1 + 卡培他滨同前\n2020-01-11：以上方案结束\n\n2020-02-25 复查时 KPS 100；\nMRI 示鼻咽部病灶较前略增大；\n未见明确新发远处转移；\nMDT 追溯评估显示：病灶邻近颅底关键结构，不适合鼻内镜 R0 切除；调取既往放疗计划后提示常规再程放疗难以满足脑干/颞叶剂量限制；\n患者此前 3 周期含奈达铂方案后局部未控，且第 3 周期曾因血象下降而减量。","patient_id":"l4-patient-0575d61128e08a053cafbe0e"}
+{"id":"l4-sample-bbb76be69e1704dce89e136d","question":"基于上述治疗时间轴、复评结果及当前血象状态，最合理的解释及下一步治疗策略是：","options":{"A":"已完成 4 周期诱导并取得疾病控制，当前进入放疗整合阶段；因骨髓储备下降，不宜继续原三药诱导，改为 IMRT 为主，必要时采用低毒增敏策略（如尼妥珠单抗）","B":"发生 IV 度骨髓抑制，必须中止一切系统治疗，仅待血象恢复后再考虑放疗","C":"原方案已明确 PD 或严重不耐受，改尼妥珠单抗属挽救性靶向治疗","D":"发生 PD-1 超进展，应立即改为二线 GP 化疗","E":"诱导疗效满意，应继续 2 个周期原免疫化疗后再放疗","F":"因 PD-L1 高表达，应改为替雷利珠单抗单药并同步放疗"},"answer":"A","vignette":"患者男，45 岁。2025-06-09 初诊鼻咽未分化型非角化性癌，分期 cT4N2M0（AJCC 8th，IVa）。基线 IHC：EGFR(+)、EBER(+)、PD-L1 TPS 50%。\n\n2025-06-17 启动诱导治疗：替雷利珠单抗 200 mg q3w + 白蛋白紫杉醇 444.6 mg q3w + 奈达铂 68.4 mg q3w。\n给药时间：\n2025-06-17\n2025-07-08\n2025-07-29\n2025-08-19：第 4 周期，奈达铂减量至 56.0 mg\n\n2025-08-20 复评影像：原发灶及颈部淋巴结较前缩小，无新发病灶，评估为 SD/轻度缩小，未达进展。\n2025-08-21 完成放疗定位并拟于近日启动 IMRT。 同日停用原诱导化疗及免疫治疗，改为 尼妥珠单抗 200 mg。\n\n2025-08-21 血常规：WBC 3.1×10^9/L，HGB 105 g/L，PLT 95×10^9/L；ECOG 1；肝肾功能基本正常。","patient_id":"l4-patient-293dfc9ecc601f4c5ad503a0"}
+{"id":"l4-sample-0aba68a28413a8f296ba3df3","question":"基于该患者的具体临床特征及复发状态，下一步最佳治疗策略是？","options":{"A":"吉西他滨 + 顺铂（GP方案）全身化疗","B":"调强放疗（IMRT）再程放疗（60Gy/30f）","C":"内镜下鼻咽病灶切除术","D":"卡瑞利珠单抗 + 阿帕替尼","E":"多西他赛 + 顺铂 + 氟尿嘧啶（TPF方案）诱导化疗"},"answer":"C","vignette":"患者男，42岁，因“回吸性涕血伴右耳闷塞感1月”入院。患者既往于2022年5月确诊鼻咽非角化性癌（T3N2M0），行TP方案诱导化疗+同期调强放疗（PGTVnx 70Gy/33f），治疗于2022年8月结束，疗后复查CR。本次入院查体：ECOG PS 1分，KPS 90分。鼻咽镜示右侧咽隐窝饱满，粘膜粗糙。2025-02-26病理活检提示：（鼻咽右侧壁）未分化型非角化性癌，EBERs(+)。头颈部MRI提示：鼻咽右侧壁软组织增厚，边界不清，累及翼内肌，颅底骨质未见明显破坏，双侧颈部未见肿大淋巴结。胸腹盆CT未见远处转移。既往史：乙肝小三阳，DNA定量正常；2年前因外伤行“脾切除术”。入院血常规：Hb 105g/L，WBC 4.2×10^9/L，PLT 285×10^9/L。生化：ALT 35 U/L，AST 42 U/L，BUN 6.8 mmol/L，Cr 88 μmol/L。患者身高172cm，体重50kg。","patient_id":"l4-patient-310be33fe0bbaa04d25ef578"}
+{"id":"l4-sample-6f4e40e749affd9651261b1b","question":"下一步最佳的系统治疗策略是？","options":{"A":"联合 特瑞普利单抗 + 吉西他滨 + 顺铂 (GP方案)","B":"多西他赛 + 顺铂 (TP方案)","C":"卡培他滨 单药维持/治疗","D":"局部姑息放疗 + 最佳支持治疗 (BSC)"},"answer":"C","vignette":"患者女，52岁，既往确诊鼻咽癌（rT3N2M0），2021年3月完成根治性放化疗。2022年2月确诊局部复发。既往史：2012年行阑尾切除术，窦性心律不齐（无症状）。\n\n当前就诊日期：2022年8月5日。\n\n【最新检查】\n2022-08-03 全身骨显像：'躯干骨及四肢骨多处异常放射性浓聚，符合骨转移（新发）'。\n\n【治疗历史追溯】\n调阅HIS系统医嘱执行记录，患者近期有一段密集的化疗记录，原始日志显示：'2022-06-09至2022-07-14期间多次给药(1.0 g/m² + 75.0 mg/m²)'。期间血常规曾提示III度中性粒细胞减少，经G-CSF升白后恢复。\n查体：ECOG PS 1分，BMI 21.0，四肢指端轻微麻木感（I度）。","patient_id":"l4-patient-c5ad7a24fefeb9c4495ff6e3"}
+{"id":"l4-sample-da1d2910660b9866b0d6127e","question":"今日开具维持治疗处方，最佳的剂量决策是？","options":{"A":"卡培他滨 1500 mg PO bid（恢复至标准推荐剂量以保证疗效）","B":"卡培他滨 1000 mg PO bid（维持当前剂量）","C":"改回吉西他滨+顺铂方案进行含铂联合治疗","D":"卡培他滨 2000 mg PO bid（根据BSA计算的足量标准）"},"answer":"B","vignette":"患者女，53岁（1969年生）。确诊鼻咽癌 IVB期（cT3N2M1，伴骨、肺、肝、肾上腺转移）。\n\n【既往治疗记录片段】：\n1. 2022-06-09至2022-07-14期间多次给药：\"(1.0 mg/m² + 75.0 mg/m²)\"。\n2. 2022-10-17 处方记录：'卓仑 1500.0 mg bid'。\n3. 2022-11-09 处方记录：'卓仑 1000.0 mg bid'。\n\n【当前访视 2022-11-23】：\n患者今日复诊，一般情况可，ECOG 1分。自述近期手足皮肤状况较前好转，现仅有轻微脱屑，无疼痛（Grade 1）。\n体格检查：身高 163 cm，体重 61 kg。BP 132/80 mmHg，HR 78 bpm。\n辅助检查：Hgb 109 g/L（轻度贫血），Alb 39 g/L，Cr 72 μmol/L。复查CT提示病灶较前相仿（SD）。","patient_id":"l4-patient-c5ad7a24fefeb9c4495ff6e3"}
+{"id":"l4-sample-20931de9d24578cec1f1ec64","question":"鉴于患者复发且不可局部治疗，以下哪个方案是下一步最佳且最安全的治疗策略？","options":{"A":"吉西他滨 + 顺铂（GP方案）","B":"卡培他滨 + 顺铂（XP方案）","C":"免疫检查点抑制剂单药治疗","D":"吉西他滨单药或联合免疫治疗（避免使用氟尿嘧啶类）","E":"多西他赛 + 顺铂 + 氟尿嘧啶（TPF方案）"},"answer":"D","vignette":"患者女，53岁（1969年生），确诊鼻咽癌（cT3N2M0 III期）综合治疗后。既往史：2021-03-25行鼻咽活检确诊，ECOG PS 1分。既往治疗史回顾：患者于2022-06-09至2022-07-14期间接受了多次静脉化疗（具体药物记录为：1.0 g/m² + 75.0 mg/m²）。此后进入维持治疗阶段，2022-10-17开始口服卡培他滨（卓仑）1500.0 mg bid，但在2022-11-09复诊时，处方调整为卓仑 1000.0 mg bid。近日复查鼻咽部MRI提示局部病灶复发，伴颈部淋巴结肿大，且不可手术或再次放疗。查体：体表面积 1.55 m²，手足皮肤可见轻度色素沉着，无明显皮疹。血常规：WBC 3.8×10^9/L, NEUT 1.9×10^9/L, Hb 105 g/L, PLT 110×10^9/L。肝肾功能基本正常。","patient_id":"l4-patient-c5ad7a24fefeb9c4495ff6e3"}
+{"id":"l4-sample-ea1cd849c9de1c8ac008cd9d","question":"在上述病情及检查结果基础上，于 2023-02-13 最合理的同步增敏系统治疗方案是：","options":{"A":"同步顺铂周疗（40 mg/m²）","B":"同步顺铂三周疗（100 mg/m² q3w）","C":"同步卡瑞利珠单抗（200 mg q3w）","D":"同步尼妥珠单抗（200 mg qw，首剂加倍）","E":"同步奈达铂（80 mg/m² q3w）","F":"同步卡铂（AUC 5 q3w）","G":"继续白蛋白紫杉醇 + 奈达铂 + 卡瑞利珠单抗，与放疗并行","H":"同步特瑞普利单抗（240 mg q3w）","I":"仅行放疗，不加任何同步系统治疗","J":"同步西妥昔单抗（400 mg/m² 首剂，后 250 mg/m² qw）"},"answer":"A","vignette":"患者女，35岁。既往接受过根治性放化疗，首次放疗结束时间为 2019-03-15。2022-11-11 确认局部复发。\nMRI 示 rT4N1M0，病灶累及颅底及咽旁间隙，MDT 评估为不可切除，拟行根治性再程 IMRT。病理为未分化型非角化性癌，EBERs(+)，EGFR(+)。\n2022-11-23 与 2022-12-14 已给予 2 周期诱导治疗：白蛋白紫杉醇 + 奈达铂 + 卡瑞利珠单抗。\n2023-02-06 启动再程放疗。\n2023-02-13（放疗第 2 周）评估：\nKPS 90；HGB 108 g/L，WBC 3.8×10^9/L，ANC 2.3×10^9/L，PLT 176×10^9/L；Scr 59 μmol/L，CrCl 约 95 mL/min；听力学检查无明显异常；无 ≥2 级周围神经毒性；鼻咽 MRI 未见大范围坏死或颈内动脉暴露；无哨兵出血。","patient_id":"l4-patient-1ea612d31dd3e21059405c9c"}
+{"id":"l4-sample-1c13343e432a5ee44190041f","question":"基于患者既往用药耐受性及当前恢复情况，启动 CCRT 时最合理的药物方案是：","options":{"A":"顺铂 100 mg/m² q3w + 信迪利单抗 200 mg q3w","B":"吉西他滨 1.75 g q3w + 顺铂 73 mg q3w + 信迪利单抗 200 mg q3w","C":"奈达铂 73 mg + 信迪利单抗 200 mg，后续按耐受性动态减量","D":"多西他赛 60 mg/m² + 顺铂 60 mg/m² q3w","E":"顺铂 80 mg/m² q3w + 放疗，不再继续信迪利单抗","F":"不再使用化疗，仅继续信迪利单抗 200 mg q3w + 放疗"},"answer":"A","vignette":"患者男，19 岁。2024-08-27 确诊鼻咽癌，AJCC 8 版 cT3N3M0（IVa 期）。既往体健，KPS 90。\n\n2024-08-28 起行诱导治疗：\n\n吉西他滨 1.93 g d1,8 + 顺铂 52 mg d1-3 + 信迪利单抗 200 mg d1，q3w\n2024-09-18：第 2 周期同方案\n2024-10-14：第 3 周期开始时，血常规示 PLT 78×10^9/L，NEUT 1.8×10^9/L；计划吉西他滨 1.97 g，后实际减量至 1.75 g；顺铂维持原计划剂量\n\n2024-11-05 复查 MRI：鼻咽顶后壁病灶 PR，颈部淋巴结较前缩小。拟于 2024-11-07 启动 IMRT。\n当前评估：\n\nWBC 4.6×10^9/L，NEUT 2.3×10^9/L，PLT 128×10^9/L\nCr 88 μmol/L\n无耳鸣、无听力下降","patient_id":"l4-patient-dad554d164965d74b5bbbf07"}
+{"id":"l4-sample-4fe2ddc91c4c423511b52b88","question":"计划于11月7日开始头颈部根治性放疗（IMRT）后，同期系统治疗的最佳策略是？","options":{"A":"继续维持原方案：泽菲（1.75g q3w）+ 诺欣（80mg/m² q3w）+ 达伯舒同期放疗","B":"更换为标准方案：顺铂（100mg/m² q3w）+ 达伯舒同期放疗","C":"停用泽菲，调整为：诺欣（单药增敏，剂量重算）+ 达伯舒同期放疗","D":"鉴于10月16日出现剂量调整，提示耐受性差，仅行单纯放疗 + 达伯舒维持"},"answer":"C","vignette":"患者男，19岁。既往行阑尾切除术。2024年8月22日确诊鼻咽癌复发（rT3N3M0，IVA期）。\n\n2024年8月28日启动诱导治疗，方案为：泽菲（Gemcitabine）1.93 g d1,8 + 诺欣（Nedaplatin）52 mg d1-3 + 达伯舒（Sintilimab）200 mg d1，q3w。治疗期间KPS评分维持在90分。\n\n查阅化疗执行记录：\n- 10月14日医嘱：泽菲 1.97 g，诺欣 53 mg；\n- 10月16日医嘱（C3 D8）：泽菲给药剂量调整为 1.75 g，诺欣按原计划执行。\n\n2024年11月5日，患者完成诱导治疗后复查，拟于11月7日开始行头颈部根治性放疗（IMRT）。11月5日当日医嘱显示：泽菲 1.97 g（医嘱状态：已停止/未执行），诺欣 53 mg（医嘱状态：已停止/未执行）。","patient_id":"l4-patient-dad554d164965d74b5bbbf07"}
+{"id":"l4-sample-4c063df0cdf6558b513810fa","question":"以下哪项是该患者放疗结束后更合适的下一步辅助治疗方案？","options":{"A":"单纯观察随访；既然 MRI 已达 PR，不追加任何辅助全身治疗","B":"继续 pembrolizumab 200 mg q3w，累计至围放疗免疫满 1 年","C":"改用 camrelizumab 200 mg q3w × 12 周期","D":"给予 GP 或 PF 辅助化疗 2–3 周期，以覆盖 N3 的远转高风险","E":"启动 metronomic capecitabine 650 mg/m² bid 持续 1 年，全程按标准剂量给药，不根据肾功能减量","F":"启动节拍卡培他滨辅助治疗，并按肾功能情况减量起始","G":"改用 toripalimab 240 mg q3w 维持 1 年","H":"给予 capecitabine 1000 mg bid d1–14 q3w × 8 周期","I":"给予 卡铂 + 5-FU 辅助 2 周期","J":"追加鼻咽原发灶 boost 放疗后，再决定是否做辅助治疗"},"answer":"F","vignette":"患者男，45岁。2023年11月确诊鼻咽癌，病理为未分化型非角化性癌，分期 cT3N3M0（AJCC 8th，IVA期）。既往史：窦性心律不齐，10年前行阑尾切除术。\n\n已完成治疗\n2023-11-10 至 2023-12-07：完成 吉西他滨 + 铂类 诱导化疗 2 周期。\n2024-01-09 至 2024-02-26：完成 IMRT 根治性放疗（70 Gy/33F）。\n同期系统治疗记录：\n2024-01-11：波贝（卡铂）440 mg\n2024-02-01：波贝（卡铂）\n2024-02-02：可瑞达（帕博利珠单抗）200 mg\n2024-02-23：波贝（卡铂）\n2024-02-25：可瑞达（帕博利珠单抗）200 mg\n2024-02-27 评估\nKPS 90分。\n颈部淋巴结未触及肿大，口腔黏膜 I 度反应。\n鼻咽 MRI：原发灶及颈部淋巴结明显缩小，评估 PR。\n血常规：WBC 3.8×10^9/L，HGB 105 g/L，PLT 120×10^9/L。\n生化：ALT 28 U/L，AST 32 U/L，BUN 8.9 mmol/L，Cr 152 μmol/L。\n尿常规：蛋白阴性，潜血阴性；无嗜酸细胞增多；TSH 正常。\n48 小时补液后复测 Cr：146 μmol/L。\n身高 172 cm，体重 58 kg。\n无既往自身免疫病史；同期 2 次 pembrolizumab 期间未发生 ≥2 级免疫相关不良事件。","patient_id":"l4-patient-d5e0349664e428b03d70b41e"}
+{"id":"l4-sample-41d8b456b8a85ba06fa45c6f","question":"当前应如何处理？","options":{"A":"因 N3 属高危，追加 GP 辅助化疗 2–3 周期","B":"继续当前 PD-1 单药维持，直至满 2 年","C":"因影像学仅为 SD，提示免疫治疗耐药，改为吉西他滨 + 卡铂","D":"结束当前免疫治疗，转入规范随访与肾功能/代谢管理","E":"在 PD-1 基础上加用尼妥珠单抗强化局部控制","F":"因肌酐升高，按免疫相关肾炎处理，停用免疫并给予激素","G":"继续免疫，同时经验性减量后延长给药间隔","H":"因糖尿病和肌酐升高，转最佳支持治疗","I":"追加节拍卡培他滨 1 年","J":"行 PET/CT 后，若仍为 SD 即判定失败并换线"},"answer":"D","vignette":"患者男，2025年约46岁。2025-01-15 复诊。既往 2023-12 确诊鼻咽未分化型非角化性癌，cT3N3M0（IVA期）。\n病历系统可见：\n\n2024-01-09 至 2024-02-26 完成根治性放疗；\n2024-01 至 2025-01 期间规律接受抗 PD-1 治疗；\n既往有 2 型糖尿病病史 5 年，血糖控制一般。\n\n2025-01-15 评估：\n\nECOG PS 1，KPS 90，身高 172 cm，体重 52 kg；\n鼻咽镜及 MRI：鼻咽顶后壁增厚较前相仿，颈部淋巴结未见明显肿大；\n评估：无明确局部复发或远处转移证据，按 RECIST 倾向 SD；\nWBC 4.1×10^9/L，Hb 105 g/L，PLT 180×10^9/L；\nALT 25 U/L，Alb 38 g/L，Glucose 8.1 mmol/L，BUN 8.5 mmol/L，Cr 152 μmol/L；\n尿常规：蛋白 ±，无血尿；甲功正常；无肺炎、结肠炎、肝炎、皮疹等明确 irAE 证据。","patient_id":"l4-patient-d5e0349664e428b03d70b41e"}
+{"id":"l4-sample-168e9d36832710886ab5d645","question":"在目前复诊时的病情与检查结果基础上，下一步治疗应如何选择？","options":{"A":"在目前影像学稳定情况下，提前结束免疫维持，改为联合吉西他滨 + 顺铂 (GP方案) 进行挽救性化疗","B":"在目前影像学稳定情况下，提前结束免疫维持，改为联合吉西他滨 + 卡铂 (GC方案) 以期进一步缩小病灶","C":"维持原免疫检查点抑制剂单药治疗，加强血糖与肾功能管理","D":"暂停抗肿瘤治疗，仅进行最佳支持治疗 (BSC)"},"answer":"C","vignette":"患者男，2024年约45岁。2024年1月11日初诊确诊为鼻咽未分化型非角化性癌（cT3N3M0 IVA期），既往合并糖尿病史多年，血糖控制不佳。2024年1月至2月期间完成了诱导化疗及同期放化疗，期间病历记录显示使用了'波贝'及'可瑞达'等免疫检查点抑制剂。此后患者规律返院进行维持治疗，最近一次用药记录为2025年5月9日。2025年6月6日患者复诊，诉近期感乏力，无发热。查体：KPS 90分，身高165cm，**体重48kg**，心肺（-），双下肢轻度水肿。辅助检查：血常规示 Hb 102 g/L（轻度贫血），WBC 3.8×10^9/L，PLT 180×10^9/L；血生化示：ALT 25 U/L，AST 30 U/L，**BUN 9.2 mmol/L，Cr 158 μmol/L**，空腹血糖 11.2 mmol/L。鼻咽部MRI提示：鼻咽顶后壁软组织增厚影，较2025年2月片未见明显变化，颈部淋巴结缩小至临床缓解。家属因担心长期单药治疗产生耐药，咨询是否需要升级方案。","patient_id":"l4-patient-d5e0349664e428b03d70b41e"}
+{"id":"l4-sample-1df265066fc623921cd817c3","question":"针对该患者2025年8月下旬的后续治疗策略，以下哪项推断最为合理且符合临床逻辑？","options":{"A":"患者出现严重骨髓抑制，应立即停止所有化疗，仅维持放疗，并加用长效升白药。","B":"患者出现了铂类耐药迹象，应将化疗方案更换为紫杉醇或多西他赛单药维持治疗。","C":"患者处于同步放化疗期间，考虑到放疗增敏及潜在毒性叠加风险，维持当前减量后的奈达铂单药同步化疗是最佳选择。","D":"患者KPS评分良好，说明耐受性佳，应将诺欣剂量恢复至初始水平（90mg以上）以保证疗效，并继续联合吉西他滨。","E":"患者体重出现急剧下降导致体表面积缩小，必须重新计算吉西他滨剂量并恢复双药联合方案。"},"answer":"C","vignette":"患者男，35岁，既往体健，无吸烟史。2025年5月10日因原发病灶复查时被确诊为鼻咽癌复发。ECOG 评分 0 分，既往病史无特殊。患者于 2025年5月27日开始第一周期化疗，方案为：泽菲（吉西他滨）2.27 g d1,8 + 诺欣（奈达铂）90.8 mg d1，q3w。2025年6月17日行第二周期化疗，剂量调整为：泽菲 2.3 g d1,8 + 诺欣 92.0 mg d1。随后在准备第三周期治疗时（2025年7月9日），治疗策略出现调整：在患者 KPS 评分于 7月9日、7月31日、8月22日三次评估中均为 90 分、且患者无明确主诉不适的情况下，第三周期（7月9日）及第四周期（7月31日）的诺欣剂量被下调至约 76.59–76.66 mg，并在之后维持在相对较低水平。与此同时，放疗科病程记录提示患者于 2025年7月9日开始接受放疗计划。查体：生命体征平稳，无贫血貌。","patient_id":"l4-patient-1c78a62127870bd8c49f497c"}
+{"id":"l4-sample-6977997a60d38855d75fddab","question":"2025-07-31 时，该患者应采用哪种化疗医嘱方案？","options":{"A":"更换为标准同步方案：顺铂 (Cisplatin) 80–100 mg/m²（足量给药），静脉滴注，d1","B":"恢复诱导期强度：诺欣 (Nedaplatin) 92.0 mg，静脉滴注，d1","C":"维持剂量调整策略：诺欣 (Nedaplatin) 76.66 mg，静脉滴注，d1","D":"停止同步化疗，仅进行放射治疗（单纯放疗）"},"answer":"C","vignette":"患者男，35岁，确诊鼻咽未分化型非角化性癌（rT1N3M0，IV期）。既往无吸烟史，乙肝表面抗原(-)。\n\n【治疗经过与原始数据】\n1. **诱导化疗期**：\n- [2025-05-27] 给予“泽菲”+“诺欣”方案。医嘱记录显示：诺欣（奈达铂）给药剂量 **90.8 mg**。\n- [2025-06-17] 第二周期：诺欣给药剂量 **92.0 mg**。\n2. **放疗同步期**：\n- [2025-07-09] 启动同步放疗。同日住院医嘱显示：诺欣给药剂量调整为 **76.59 mg**。\n\n【当前状态 2025-07-31】\n患者今日返院准备行下一周期治疗。查体：KPS 90分，口腔黏膜炎II度，轻度张口受限。辅助检查：WBC 3.8×10^9/L，NEUT 2.1×10^9/L，HGB 108 g/L（轻度贫血）。\n\n**今日生化结果**：ALT 21 U/L，AST 18 U/L，**血清肌酐(Cr) 128 μmol/L**，BUN 7.5 mmol/L。患者自诉近期进食减少，**当前实际体重 51 kg**。","patient_id":"l4-patient-1c78a62127870bd8c49f497c"}
+{"id":"l4-sample-2c34688af1f72d92543e4941","question":"最合理的药物治疗策略调整是？","options":{"A":"继续维持原“四药联合”方案（白蛋白紫杉醇+诺欣+泰欣生+拓益），以确保证据确凿的生存获益","B":"调整为标准同步放化疗：改为顺铂（100mg/m² q3w）+ 拓益（240mg q3w），停用泰欣生","C":"降阶梯同步治疗：保留诺欣 + 泰欣生，停用白蛋白紫杉醇与拓益","D":"因前期诱导强度大，目前仅推荐单纯放疗，不再同步使用任何系统药物"},"answer":"C","vignette":"患者男，63岁。2025年1月14日确诊为复发性鼻咽未分化型非角化性癌。既往有阑尾切除术史，窦性心律（HR 82bpm）。\n\n【既往治疗史（原始医嘱记录）】：\n- 2025-01-17至2025-03-26：接受4周期诱导治疗。方案如下：\n  1. (集采)紫杉醇(白蛋白)-锐贝 440mg d1 q3w\n  2. 诺欣 45 mg d1-3 (静脉滴注, qd)\n  3. 泰欣生 200mg q2w\n  4. 拓益 240mg q2w\n- 期间KPS评分保持在90.0分。\n\n【当前状态】：\n2025-04-14 患者开始接受放疗（IMRT）。\n2025-04-21 复查血生化：BUN 7.2 mmol/L，Cr 108 μmol/L。患者当前体重 51kg。查体示：口腔黏膜I度反应，双下肢轻度麻木。","patient_id":"l4-patient-1ff3287de4d4c2cdad608e68"}
+{"id":"l4-sample-dc470d2278769f6d4b24a4eb","question":"该患者2022年7月最合理的治疗方案是？","options":{"A":"调强放射治疗(IMRT) + 同期顺铂 (100mg/m² q3w)","B":"吉西他滨 + 顺铂 (GP方案) 诱导化疗","C":"调强放射治疗(IMRT) + 同期尼妥珠单抗 (200mg qw)","D":"最佳支持治疗 (Best Supportive Care)"},"answer":"C","vignette":"患者男，2019年约58岁。既往于2019年行鼻咽癌根治性放化疗，过程顺利。2022年4月因回吸性涕血复诊。\n\n【病例资料摘录】\n[2022-04-26] 查体：身高 168cm，体重 48kg。ECOG 1分。听诊窦性心律不齐，余(-)。\n[2022-04-27] 鼻咽部MRI：鼻咽顶后壁软组织增厚，侵犯斜坡骨质，未见颈部淋巴结肿大。提示局部复发(rT3N0M0)。\n[2022-04-27] 检查名称:EBV-DNA定量检测, 病理结论:检测结果： 5.54E+02 copy/mL (参考值：0～20 copy/mL)。\n[2022-04-27] 血生化回报：ALB 36 g/L, BUN 8.2 mmol/L, Scr 126 μmol/L, ALT 24 U/L。\n[体能状态记录]：\n[2022-04-26] KPS评分:90.0; [2022-05-05] KPS评分:90.0; [2022-06-13] KPS评分:90.0; [2022-07-01] KPS评分:90.0\n\n既往史：20年前行阑尾切除术。否认高血压、糖尿病史。\n患者于2022年7月办理住院准备开始治疗。","patient_id":"l4-patient-cf8ce5530583337be34a82dd"}
+{"id":"l4-sample-69eacfca75ffbdfba2cbcfc5","question":"在目前血小板计数及治疗反应的基础上，下一步最合适的全身治疗决策是？","options":{"A":"推迟治疗1周，待PLT恢复后继续原方案（泽菲+诺欣+泰欣生+拓益），并下调化疗药物剂量20%。","B":"立即给予升血小板治疗，按原剂量继续使用“泽菲+诺欣+泰欣生+拓益”方案，以保证疗效。","C":"停止化疗药物（泽菲+诺欣），即刻给予“泰欣生+拓益”维持治疗。","D":"继续当前方案的免疫和靶向治疗，但将化疗方案调整为单药吉西他滨（去除诺欣），并根据血小板情况个体化减量"},"answer":"C","vignette":"患者男，36岁，确诊鼻咽癌复发（rIVa期）。\n\n【既往治疗史】\n患者于2023-06-12启动全身治疗，方案为：“泽菲 (Gemcitabine) 1.57g d1,8 + 诺欣 (Nedaplatin) 63mg d1-3 + 泰欣生 (Nimotuzumab) 400mg d1 + 拓益 (Toripalimab) 240mg d1, q3w”。\n\n【病程记录片段】\n- [2023-07-10] 行第2周期治疗。顺利完成。\n- [2023-07-22] 门诊血常规：WBC 1.8×10^9/L, **PLT 18×10^9/L**。患者诉刷牙时牙龈出血不止，急诊予TPO及血小板输注。\n- [2023-07-31] 行第3周期治疗。查体：KPS 90分。治疗前血常规：ANC 1.6×10^9/L, PLT 95×10^9/L。本周期调整诺欣剂量为60mg d1-2。\n- [2023-08-21] 拟行下一周期治疗。查体：KPS 90分，鼻咽镜示肿瘤病灶较前缩小约60%。\n- [2023-08-21] 辅助检查：\n  * 血生化：ALT 42 U/L, AST 35 U/L, Alb 39 g/L, **Cr 88 μmol/L**。\n  * 血常规：Hb 102 g/L, WBC 3.1×10^9/L, ANC 1.9×10^9/L, **PLT 68×10^9/L**。\n  * 尿常规：蛋白(-)，潜血(+)。","patient_id":"l4-patient-fe67beb7bfd4d8db6b760a38"}
+{"id":"l4-sample-d8bf72c5da6066d5b934817b","question":"在 2023-08-22 这一复评时点，该患者最合理的下一步系统治疗决策是：","options":{"A":"继续原四药方案，完成第 4 周期","B":"停用化疗与 EGFR 单抗，仅保留特瑞普利单抗单药维持","C":"停用化疗，保留尼妥珠单抗 + 特瑞普利单抗双靶维持","D":"改为白蛋白紫杉醇 + 顺铂 + 特瑞普利单抗","E":"改为 GP + 特瑞普利单抗，再做 2–3 周期","F":"停用特瑞普利单抗，仅保留尼妥珠单抗维持","G":"改为卡瑞利珠单抗 + 阿帕替尼","H":"改为特瑞普利单抗 + 西妥昔单抗","I":"因 PD-L1 CPS 80 极高而升级为双免疫方案，不再按证据选择单药 PD-1 维持","J":"不因 EGFR(+) 而继续尼妥珠单抗维持，应优先考虑免疫单药维持策略"},"answer":"B","vignette":"患者男，36岁，既往鼻咽未分化型非角化癌病史，2023-06-06 证实局部复发，分期为 rT4N1M0。病理示 EBERs(+)，EGFR(+)，PD-L1（22C3）CPS 80，KPS 持续 90 分。自 2023-06-12 起接受一线含铂联合化疗加抗 EGFR 抗体及 PD-1 抑制剂的全身系统治疗方案，共完成 3 个周期（分别于 2023-06-12、2023-07-10、2023-07-31 给药）。其中铂类药物为奈达铂，首周期给药 3 天，后两周期为 2 天，单日剂量由 63 mg 调整为 60 mg。2023-08-22 复评：MRI 示原发灶及颈部病灶较前缩小，影像学评估为部分缓解（PR）。复查血常规：WBC 2.8×10^9/L，ANC 1.3×10^9/L，PLT 78×10^9/L，Hb 103 g/L；肾功能：Scr 96 μmol/L，估算 CrCl 52 mL/min；存在 2 级周围神经毒性，无 ≥2 级免疫相关不良反应。多学科团队讨论后，认为当前仍需在系统治疗与局部治疗策略间进行权衡。","patient_id":"l4-patient-fe67beb7bfd4d8db6b760a38"}
+{"id":"l4-sample-9c9fabd6927f15a6b4c06fe3","question":"基于该患者的具体临床特征及既往治疗史，下一步最佳治疗策略是？","options":{"A":"联合GP方案（吉西他滨 + 顺铂）化疗，同步使用卡瑞利珠单抗","B":"联合TP方案（多西他赛 + 顺铂）化疗，同步使用卡瑞利珠单抗","C":"继续给予卡瑞利珠单抗单药维持治疗","D":"停用免疫治疗，仅给予最佳支持治疗（BSC）"},"answer":"C","vignette":"患者男，51岁。确诊鼻咽癌肝转移（r/mNPC）2年余。既往于2021年4月确诊肝转移，经多线治疗后病情波动。2023年2月24日及3月10日给予“艾瑞卡”治疗，期间于2023年3月13日至17日针对局部疼痛病灶行姑息性放疗。2023年4月3日复诊，拟定后续方案。查体：体温 36.5℃，P 88次/分，R 20次/分，BP 128/76 mmHg。身高 172cm，**体重 51kg**，ECOG PS 1分。既往史：阑尾切除术后10年，窦性心律不齐。辅助检查：血常规示 WBC 3.5×10^9/L, NEUT# 1.9×10^9/L, Hb 98 g/L, PLT 110×10^9/L。生化全项示：ALT 42 U/L, AST 38 U/L, ALB 35 g/L, TBIL 18.2 μmol/L, BUN 8.1 mmol/L, **Cr 132 μmol/L**。患者自诉近期有双耳高频耳鸣，听力轻度下降。","patient_id":"l4-patient-bb0f165f770c4270247847e9"}
+{"id":"l4-sample-f8b477b441bc243515c55dcb","question":"结合上述检查结果，关于下一步“初治决策”，下列哪项处理更为合适？","options":{"A":"立即行根治性调强放疗（IMRT）+ 同期顺铂化疗","B":"吉西他滨 + 顺铂（GP方案）诱导化疗以明确化疗敏感性","C":"给予抗感染治疗，密切随访观察，暂不启动抗肿瘤治疗","D":"免疫检查点抑制剂（PD-1单抗）单药治疗"},"answer":"C","vignette":"患者男，47岁。因“回吸性涕血伴鼻塞”就诊。既往行阑尾切除术，心电图示窦性心律不齐。查体：鼻咽顶后壁粘膜粗糙。相关辅助检查原始数据如下：\n1. [2018-08-15] 【病理】活检部位:鼻咽, 病理结论:（鼻咽坏死组织）镜下为坏死组织及少量细菌菌团样结构，未见癌。\n2. 此后患者未规律复诊，自行抗炎治疗。\n3. [2019-07-18] 【检验】EBV-DNA定量检测: 4.54E+01 copy/mL (参考值：＜1000 copy/mL)。\n4. 同期MRI提示鼻咽顶后壁软组织轻度增厚，增强扫描强化不明显。","patient_id":"l4-patient-bb0f165f770c4270247847e9"}
+{"id":"l4-sample-8dc0ae9add81e1fa5a9c6544","question":"以下哪一项最适合作为该患者的初始完整治疗路径？","options":{"A":"标准 GP 诱导化疗 3 周期 → 同期顺铂放化疗（不设后续辅助或免疫）","B":"仅行根治性同步放化疗（含顺铂），放疗结束后再根据 EBV-DNA 决定是否补加辅助治疗","C":"特瑞普利单抗＋GP诱导3周期 → IMRT＋特瑞普利单抗3周期（不加同期顺铂）→ 特瑞普利单抗辅助11周期","D":"参照 CONTINUUM 路径：诱导化疗（GP 为主） → 同期放化疗（含顺铂） → 全程联合 sintilimab 免疫治疗","E":"诱导化疗（GP 为主） → 同期放化疗（含顺铂） → 节拍卡培他滨辅助治疗 1 年","F":"参照 DIPPER 路径：标准同步放化疗（含顺铂） → 放疗后序贯辅助卡瑞利珠单抗","G":"先行减量放疗缓解局部肿块 → 再视情况补充系统治疗（未常规安排诱导或同步化疗）","H":"单药 PD-1 诱导治疗 → 接根治性放疗（不联合同步化疗及后续辅助）"},"answer":"C","vignette":"患者女性，2025年约50岁。\n2025-01-13 入院，诊断为 鼻咽未分化型非角化性癌，cT4N3M0（AJCC 第九版，III 期）。既往体健，无糖尿病、高血压病史。既往无放疗、化疗或免疫治疗史。\n\n入院查体：KPS 90 分，身高 156 cm，体重 44 kg，BSA 1.38 m²。双侧颈部可触及多发肿大淋巴结，直径约 2–4 cm 不等，质硬，活动差。\n\n2025-01-15 基线实验室检查：\nWBC 5.1×10^9/L，NEUT% 65%，HGB 108 g/L，PLT 220×10^9/L；\nALT 21 U/L，AST 19 U/L，TBIL 12.0 μmol/L；\nBUN 8.1 mmol/L，Cr 75 μmol/L；\nNa 139 mmol/L，K 4.1 mmol/L，Mg 0.85 mmol/L。\n心电图：窦性心律，HR 78 bpm，T 波轻度改变。\n\n目前患者肿瘤负荷较高，且肾功能储备接近顺铂常规全剂量使用的安全边缘。拟于 2025-01-20 启动全程规范综合治疗方案的制定与实施。","patient_id":"l4-patient-52893adcc8b0494e12f3f737"}
+{"id":"l4-sample-acdc9bea02b07dd21c3b2a88","question":"拟制定下一步辅助治疗方案，最佳治疗策略是？","options":{"A":"给予标准双药辅助化疗：吉西他滨 1000mg/m² d1,8 + 顺铂 80mg/m² d1，q3w，共3周期","B":"给予单药辅助治疗：卓仑（卡培他滨）1500mg bid，持续治疗","C":"目前无需辅助治疗，建议进入随访观察期","D":"给予免疫维持治疗：特瑞普利单抗 240mg q3w，维持1年"},"answer":"B","vignette":"患者女性，2025年约50岁，2025 年 5 月 16 日复诊。既往确诊“鼻咽未分化型非角化性癌 cT4N3M0（AJCC 第 9 版分期）”。\n\n【体格检查】：身高 172 cm，体重 78 kg，BSA 1.91 m²。ECOG PS 1，听力粗测正常。心率 78 次/分，律齐。\n\n【既往治疗史（原始医嘱记录）】：\n1. **诱导化疗**：\n- 2025-01-20：紫杉醇 237 mg + 诺欣 47 mg + 卓仑 1500 mg bid po\n- 2025-02-10：紫杉醇 242 mg + 诺欣 48 mg + 卓仑 1500 mg bid po\n- 2025-03-03：紫杉醇 237 mg + 诺欣 47.4 mg + 卓仑 1500 mg bid po\n2. **放疗**：\n- 2025-03-24 至 2025-05-10 完成根治性放疗。\n3. **同期化疗**：\n- 2025-04-09：诺欣 62 mg ivgtt ×1 次。\n\n【辅助检查】：\n血常规：WBC 3.9×10^9/L，NEUT 2.1×10^9/L，Hgb 108 g/L，PLT 125×10^9/L。\nEBV-DNA：低于检测下限。\n肝功能：ALT 21 U/L，AST 18 U/L。\n\n患者自诉既往化疗期间有轻度恶心，无严重呕吐。","patient_id":"l4-patient-52893adcc8b0494e12f3f737"}
+{"id":"l4-sample-77a40c3b9474467004a93466","question":"对于该患者，目前最合理的治疗调整策略是？","options":{"A":"给予卡培他滨 1500mg bid 辅助治疗至满1年。","B":"鉴于T4N3高危因素，联合PD-1单抗（如特瑞普利单抗）加强辅助治疗。","C":"在评估耐受性良好的前提下，给予卡培他滨 2500mg bid 辅助治疗。","D":"给予卡培他滨节拍辅助化疗（650 mg/m² bid，持续口服1年）。"},"answer":"D","vignette":"患者女，50岁。今日（2025-08-15）门诊复查。\n\n【既往史与治疗史】\n2025年1月因“反复鼻咽部不适并颈部肿块”就诊，经鼻咽活检及影像学检查确诊为鼻咽未分化型非角化癌 T4N3M0 IV期（AJCC 第9版）。确诊时体重约 74 kg，身高 172 cm，体表面积约 1.85 m²，无明显内科合并症，肝肾功能正常。治疗前血浆 EBV DNA 为 2.6×10^5 copies/mL。\n\n确诊后于 2025-01-20 开始含铂诱导化疗，共 3 个周期；第 2 周期后 EBV DNA 仍为 6.8×10^4 copies/mL，第 3 周期后为 1.2×10^4 copies/mL，下降缓慢。随后于 2025-03-24 至 2025-05-10 接受根治性 IMRT + 同期顺铂治疗；同期阶段曾出现较明显恶心呕吐和血象下降，提示对足量铂类耐受性一般。放疗结束时 EBV DNA 首次转阴。\n\n【今日查体与辅助检查】\n- 查体：身高 172 cm，体重 76 kg，体表面积约 1.87 m²，KPS 90。口腔黏膜光滑，未见溃疡或明显黏膜炎表现。颈部触诊未及肿大淋巴结。心肺听诊未闻及明显异常，心律齐。\n- 实验室检查（2025-08-14）：WBC 4.5×10^9/L，HGB 108 g/L（轻度贫血），PLT 185×10^9/L。生化：ALT 21 U/L，AST 19 U/L，Cr 68 μmol/L，BUN 5.2 mmol/L，均在可接受范围。\n- 影像学：鼻咽部 MRI 增强扫描示鼻咽顶及后壁软组织信号与前次检查相比未见明显进展，未见明确局部复发或远处转移的影像学证据。\n- 患者自诉：目前除轻微乏力外，日常生活能自理，无明显耳鸣、听力明显下降、手足麻木、皮疹脱皮或腹泻等症状。近期未有发热、咳嗽、咯血、骨痛或体重明显下降。","patient_id":"l4-patient-52893adcc8b0494e12f3f737"}
+{"id":"l4-sample-f0493e293287462da09d5c49","question":"当前应采用哪种同期联合治疗策略？","options":{"A":"IMRT + 同期顺铂 40 mg/m² weekly","B":"IMRT + 同期顺铂 100 mg/m² q3w（在本题设定下不优于 weekly 给药）","C":"IMRT + 同期尼妥珠单抗 200 mg weekly","D":"IMRT + 同期吉西他滨 300 mg/m² weekly","E":"IMRT + 同期卡铂 AUC2 weekly（仅在顺铂不耐受时作为替代）","F":"IMRT 单独治疗","G":"继续吉西他滨 + 尼妥珠单抗，再做 2 周期，待 CR 后再放疗","H":"IMRT + 同期特瑞普利单抗 240 mg q3w","I":"IMRT + 同期尼妥珠单抗 + 特瑞普利单抗","J":"IMRT + 同期西妥昔单抗负荷后每周维持"},"answer":"A","vignette":"患者女，39 岁。既往接受过根治性放化疗，首次放疗结束时间为 2022-01-10。2025-02-05 影像学及相关检查确认局部区域复发，MRI 评估为 rT3N2M0（AJCC 第 8 版）。经 MDT 讨论，病灶目前评估为不可切除，拟行根治性再程 IMRT。\n2025-02-21 与 2025-03-17 已完成 2 周期诱导化疗，方案为吉西他滨联合顺铂；复查 MRI 示原发灶及颈部病灶均较前缩小，疗效评估为 PR。\n2025-04-09 拟开始再程放疗。入院评估：KPS 100 分；WBC 3.8×10^9/L，NEUT 1.9×10^9/L，HGB 108 g/L，PLT 125×10^9/L；Scr 58 μmol/L，估算 CrCl 约 96 mL/min；听力学检查无明显异常；无 ≥2 级周围神经毒性；肝肾功能基本正常；未见鼻咽坏死、颈内动脉暴露或哨兵出血。","patient_id":"l4-patient-32f1b5397e580f9b6d59e35e"}
+{"id":"l4-sample-53e23be5c50d972254dadb20","question":"最合理的药物医嘱是：","options":{"A":"继续原诱导方案：诺欣 137 mg d1 + 泽菲 1.72 g d1,8 + 可瑞达 200 mg d1，同步 IMRT","B":"改为“标准方案”：顺铂 80–85 mg q3w，同步 IMRT","C":"停用泽菲和可瑞达，改为诺欣 172 mg d1 q3w，同步 IMRT，并加强补液及肾功能/听力监测","D":"因 Scr 略高于正常上限，停用含铂药，改为泽菲 1.72 g weekly 同步 IMRT","E":"改为卡铂 AUC 5 q3w，同步 IMRT","F":"仅继续 IMRT，不再联合任何系统治疗"},"answer":"C","vignette":"患者男，35 岁，体重 52 kg。既往体健，无吸烟史。2023 年 7 月确诊复发性鼻咽未分化型非角化性癌（rT3N2M0）。经 MDT 评估后，拟采取根治意图的诱导治疗后转入 IMRT 的综合策略。\n\n既往治疗记录\n2023-07-22：予“诺欣 136 mg d1 + 泽菲 1.71 g d1,8 + 可瑞达 200 mg d1”\n2023-08-12：予“诺欣 137 mg d1 + 泽菲 1.72 g d1,8 + 可瑞达 200 mg d1”\n2023-09-01：予“诺欣 137 mg d1 + 泽菲 1.72 g d1,8 + 可瑞达 200 mg d1”\n2023-09-25 复查：颈部淋巴结较前缩小，诱导治疗评估有效，决定进入根治性 IMRT。\n\n2023-09-26（放疗次日）情况\n-KPS 90\n-体表淋巴结未触及肿大\n-血常规：WBC 4.1×10^9/L，Hgb 102 g/L，PLT 185×10^9/L\n-生化：ALT 21 U/L，AST 18 U/L，Alb 39 g/L，Scr 118 μmol/L，BUN 6.5 mmol/L\n-听力：双耳高频听力下降 25 dB（CTCAE 1级）\n-心电图：窦性心律，HR 72 次/分\n-体表面积（BSA）：1.72 m²","patient_id":"l4-patient-32f1b5397e580f9b6d59e35e"}
+{"id":"l4-sample-2cfbb2994ad8e18d9f74bd6e","question":"此时该患者最合理的后续主动治疗策略是？","options":{"A":"继续 拓益 240 mg q3w 单药，作为放疗后限程免疫治疗，总疗程补足至 7 个周期后停药","B":"启动拓益 + 卡培他滨联合治疗，每 3 周为 1 个周期，共 6 个周期","C":"改用 卡瑞利珠单抗 q3w × 12 周期","D":"继续 拓益 + 泰欣生 双药维持治疗，总维持时间 6 个月后评估","E":"恢复 吉西他滨 + 铂类 + 拓益 三药方案，作为再巩固化疗 2–4 个周期后停药","F":"启动 卡培他滨单药 治疗 6–8 周期"},"answer":"B","vignette":"患者女，1986年生。既往鼻咽未分化型非角化性癌。2023-10-20 确诊局部区域复发，分期 cT4N2M0（AJCC 第8版，IVA期）。经 MDT 评估：病灶不适合挽救性手术，拟行治愈意图再程放疗。\n\n复发后治疗经过\n2023-10-24：泽菲 1.6 g + 拓益 240 mg + 泰欣生 400 mg + 诺欣 64 mg\n2023-11-15：泽菲 1.6 g + 拓益 240 mg + 泰欣生 400 mg + 诺欣 64 mg\n2023-12-08：泽菲 1.6 g + 拓益 240 mg + 泰欣生 400 mg + 诺欣 64 mg\n2023-12-28：拓益 240 mg + 泰欣生 200 mg\n2023-12-29 至 2024-02-07：鼻咽部复发灶完成再程放疗\n2024-03-05 当前状态\n轻度口干，颈部皮肤色素沉着\nHb 108 g/L，WBC 4.5×10^9/L，PLT 185×10^9/L\n肝肾功能无明显异常，未发生 ≥2 级免疫相关不良事件\n2024-03-03 MRI：鼻咽顶后壁仍见 1.3 cm 结节样强化灶，较放疗前缩小但未消失\n2024-03-04 鼻咽镜活检：可见散在存活的未分化型非角化性癌细胞\n2024-03-05 血浆 EBV-DNA：1.6×10³ copy/mL\nMDT 评估：病灶靠近颅底与颈内动脉，短期内不宜再次局部手术或再次加量放疗","patient_id":"l4-patient-d6a37d98675a1fec1d8f9401"}
+{"id":"l4-sample-cbcaa54fb02260e0ff0dd7d9","question":"进入放疗阶段时，应采用哪种药物策略？","options":{"A":"停用特瑞普利单抗，改为标准顺铂 100 mg/m² q3w 同期放疗","B":"保留特瑞普利单抗，并采用每周低剂量顺铂同步放疗","C":"保留特瑞普利单抗，但省略同期铂类，行放疗 + 免疫","D":"改用奈达铂 + 特瑞普利单抗同期放疗","E":"改用奈达铂 + 尼妥珠单抗 + 特瑞普利单抗同期放疗","F":"改用多西他赛 + 尼妥珠单抗 + 特瑞普利单抗同期放疗","G":"因第二周期减量，定义为铂类绝对禁忌，放疗期仅保留尼妥珠单抗","H":"诱导已有效，应停用全部系统治疗，仅行单纯放疗","I":"因 EBV DNA 已清零，可直接跳过同步阶段，转入辅助免疫","J":"继续原诱导四药与放疗同期进行"},"answer":"C","vignette":"患者男，35 岁。初诊局部晚期鼻咽癌，累及鼻腔后部。2023-02-21 启动诱导治疗，医嘱记录：奈达铂 50 mg d1、5-FU 7.5 g civ 120 h、脂质体紫杉醇 271.35 mg d1、特瑞普利单抗 240 mg d1。\n2023-03-14 第二周期：奈达铂 40 mg d1、5-FU 7.5 g civ 120 h、脂质体紫杉醇 270 mg d1、特瑞普利单抗 240 mg d1。\n\n拟于 2023-04-10 开始 IMRT，2023-04-04 同步前补充资料如下：\n\n第 2 周期前：WBC 3.1×10^9/L，ANC 1.4×10^9/L，PLT 86×10^9/L；\n2023-04-03 复查：WBC 4.0×10^9/L，ANC 2.0×10^9/L，PLT 128×10^9/L；\n肌酐 96 μmol/L，按 Cockcroft-Gault 估算 CrCl 约 60 mL/min；\n听力学与神经系统查体无明显异常；\n第 2 周期后恶心呕吐较前明显，2 周体重下降 3.5 kg；\nMRI：原发灶明显缩小，颈部结节退缩；\nEBV DNA：治疗前 1.9×10^4 copies/mL，第二周期后未检出；\nKPS 持续 90。","patient_id":"l4-patient-a5158a29ec3abd2783c34718"}
+{"id":"l4-sample-f1d80fda1e9e78d8e257fa05","question":"后续最合理的辅助/维持药物治疗策略是：","options":{"A":"顺铂 + 5-FU 辅助化疗 3 周期","B":"吉西他滨 + 顺铂 辅助化疗 2–3 周期","C":"特瑞普利单抗 + 尼妥珠单抗 + 替吉奥联合维持","D":"节拍卡培他滨维持治疗 1 年","E":"全剂量卡培他滨（d1–14，q3w）辅助化疗 8 周期","F":"替吉奥维持治疗 6–12 个月","G":"特瑞普利单抗单药维持至 1 年","H":"尼妥珠单抗单药每周维持","I":"卡铂 + 5-FU 辅助化疗 3 周期","J":"白蛋白紫杉醇单药辅助化疗 2–3 周期"},"answer":"D","vignette":"患者男，34岁，EBV 相关鼻咽未分化型非角化性癌，cT3N3M0，KPS 90。无吸烟史。\n\n治疗经过\n2023-02-21 启动诱导治疗：含 脂质体紫杉醇 + 5-FU + 奈达铂 + 特瑞普利单抗\n原始记录显示：\n2023-02-21 奈达铂 50.0 mg\n2023-03-14 奈达铂 40.0 mg\n2023-04-04 起调整为同步放疗方案，停用脂质体紫杉醇与 5-FU，改为 卡铂 + 尼妥珠单抗 联合同步放疗\n2023-04-10 至 2023-05-30 完成 IMRT\n同步期原始记录显示：\n2023-04-27 卡铂 500.0 mg\n2023-05-26 卡铂 400.0 mg\n2023-05-30 放疗结束时：KPS 90\n放疗结束后 2 周复评：\n-MRI：原发灶及颈部病灶明显缩小，未见明确进展\n-PET/CT：无远处转移\n-EBV DNA：仍可检出\n-血常规：Hb 104 g/L，WBC 3.6×10^9/L，PLT 112×10^9/L\n-肝肾功能：基本正常","patient_id":"l4-patient-a5158a29ec3abd2783c34718"}
+{"id":"l4-sample-1675a164376056f676e8c67a","question":"对于该患者，目前最合理的治疗策略是？","options":{"A":"直接启动 GP + 特瑞普利单抗 4–6 周期，全程以内科系统治疗为主，不再优先考虑局部根治","B":"不考虑手术，直接行再程 IMRT + weekly cisplatin 30 mg/m² 作为主要根治手段","C":"先行挽救性颈清扫术","D":"直接行 toripalimab 单药全身治疗，待肿物缩小或病情稳定后，再视情况考虑是否需要局部治疗","E":"放弃手术机会，直接行 nimotuzumab + 再程放疗，作为颈部复发的主要治疗","F":"先给予 TPF 诱导化疗 2 周期，再视全身及局部疗效评估能否手术或放疗"},"answer":"C","vignette":"患者男，50岁。既往鼻咽癌经根治性放化疗后缓解。本次因左侧颈部肿物入院。\n\n当前评估\n2023-08-24 门诊查体：左侧颈部可触及约 3.5 cm 肿大淋巴结，质硬，活动差；KPS 80 分。\n2023-08-25 鼻咽镜活检：明显胶原纤维增生，局灶核增大深染细胞，未能证实明确鼻咽局部复发。\n2023-08-28 左侧 II 区淋巴结穿刺病理：分化差的癌浸润，IHC：CK(+), p63(-), EBER1/2(+/-)，符合鼻咽癌转移性淋巴结复发。\n-MRI/PET-CT：仅见左侧 II–III 区淋巴结复发，未见明确鼻咽局部活动灶及远处转移。\n-影像补充：肿大淋巴结与胸锁乳突肌关系密切，但未见颈总/颈内动脉包绕 >180°，无明确颅底或纵隔侵犯；MDT 评估为技术上可切除。\n-实验室：HGB 128 g/L，ALB 39 g/L，Cr 82 μmol/L。\n-既往史：阑尾切除术后 10 年，窦性心律不齐。","patient_id":"l4-patient-b175c8ecb1a1efbe66f02013"}
+{"id":"l4-sample-b33aa017a82db1b14b980606","question":"在 2023-09-26 开始根治性 IMRT 时，最合理的药物医嘱是：","options":{"A":"继续原诱导方案：顺铂 137 mg d1 + 吉西他滨 1.72 g d1,8 + 帕博利珠单抗 200 mg d1，同步 IMRT","B":"改为每周顺铂 40 mg/m² 同步 IMRT，以降低肾毒性与耳毒性风险","C":"停用吉西他滨和帕博利珠单抗，改为顺铂 172 mg d1 q3w 同步 IMRT，并加强补液及肾功能/听力监测","D":"因 Scr 略高于正常上限，改用卡铂 AUC 5 q3w 同步 IMRT","E":"停用含铂药，仅以吉西他滨 1.72 g d1,8 weekly 同步 IMRT","F":"不再联合系统治疗，仅行 IMRT"},"answer":"C","vignette":"患者男，35 岁，体重 52 kg。既往体健，无吸烟史。2023 年 7 月确诊复发性鼻咽未分化型非角化性癌（rT3N2M0）。经 MDT 评估后，拟采取根治意图的诱导化疗后转入 IMRT 的综合治疗路径。\n\n诱导治疗记录\n2023-07-22：顺铂 136 mg d1 + 吉西他滨 1.71 g d1,8 + 帕博利珠单抗 200 mg d1\n2023-08-12：顺铂 137 mg d1 + 吉西他滨 1.72 g d1,8 + 帕博利珠单抗 200 mg d1\n2023-09-01：顺铂 137 mg d1 + 吉西他滨 1.72 g d1,8 + 帕博利珠单抗 200 mg d1\n\n2023-09-25 复查：颈部淋巴结较前缩小，评估为诱导有效，决定于当日开始根治性 IMRT。\n\n2023-09-26（放疗次日）基线情况\nKPS 90\n体表淋巴结未触及肿大\n血常规：WBC 4.1×10^9/L，Hgb 102 g/L，PLT 185×10^9/L\n生化：ALT 21 U/L，AST 18 U/L，Alb 39 g/L，Scr 118 μmol/L，BUN 6.5 mmol/L\n听力：双耳高频听力下降 25 dB（CTCAE 1级）\n心电图：窦性心律，HR 72 次/分","patient_id":"l4-patient-1fe5b06ae31d3e28923c837c"}
+{"id":"l4-sample-be1c92a7052004a68703448f","question":"2024-05-20 时，该患者应采用哪种同期系统治疗策略？","options":{"A":"IMRT + 顺铂 100 mg/m² q3w","B":"IMRT + 每周顺铂 40 mg/m²","C":"IMRT + 每周卡铂（如 AUC 2）同步，不额外叠加 EGFR 或 PD-1","D":"IMRT + 特瑞普利单抗，同期省略铂类","E":"IMRT + 奈达铂分 3 天给药 + 尼妥珠单抗","F":"IMRT + 每周顺铂 + 特瑞普利单抗","G":"IMRT 单独治疗","H":"IMRT + 尼妥珠单抗","I":"IMRT + 吉西他滨 d1,8","J":"IMRT + 卡铂 + 尼妥珠单抗"},"answer":"C","vignette":"患者男，27 岁。\n2024-04-03 证实鼻咽未分化型非角化性癌局部区域复发，MRI 评估为 rT3N1M0。既往 2021 年已完成根治性放化疗。\n\n系统中可检索到如下原始医嘱记录：\n\n[2024-04-08 11:02:10] 泽菲 2.49 g，qw\n[2024-04-08 11:03:07] 诺欣 64.0 mg，qd，结束时间 2024-04-10\n[2024-04-29 11:04:29] 泽菲 2.46 g，qw\n[2024-04-29 11:31:26] 诺欣 65.0 mg，qd，结束时间 2024-05-01\n\n补充资料：\n\n2024-04-05 纯音测听：双耳 4000 Hz 听阈 55 dB，感音神经性听力下降；\n2024-04-26 血浆 EBV DNA：由治疗前 8.7×10^3 copies/mL 下降至未检出；\n2024-05-18 复查：Hgb 132 g/L，WBC 4.5×10^9/L，PLT 210×10^9/L，Cr 78 μmol/L，BUN 5.1 mmol/L；\n-估算 CrCl 约 92 mL/min；\n-无明确 2 级以上周围神经毒性，无耳鸣加重主诉；\n-距首程放疗结束约 34 个月，既往无 ≥3 级晚期放疗不良反应；\n-MRI 示原发灶较前缩小，颈部病灶较前减小；\n-KPS 100。\n\n2024-05-19 MDT 评估后拟于次日开始 IMRT 再程放疗。","patient_id":"l4-patient-2bf879fa19f079ae6ba0878f"}
+{"id":"l4-sample-cc63ccbe17798b9474741fbd","question":"在本次复诊评估到患者一般情况良好、毒性可耐受且肿瘤及 EBV DNA 明显缓解的基础上，当前应如何选择后续同步放化疗阶段的系统治疗方案？","options":{"A":"停用奈达铂，改为标准每周或 q3w 顺铂同步放疗","B":"继续当前放疗，并按既定节律完成下一周期奈达铂分次同步，同时继续尼妥珠单抗","C":"继续奈达铂同步，但停用尼妥珠单抗，因为 EGFR 高表达并非经验证的预测性生物标志物","D":"停用奈达铂，改为放疗 + 特瑞普利单抗","E":"在当前奈达铂 + 尼妥珠单抗基础上加用 PD-1 单抗","F":"因 EBV DNA 已清零且病灶缩小，暂停一切系统治疗，仅继续单纯放疗","G":"恢复诱导期 GP 方案，与放疗同步以强化全身控制","H":"因仅达部分缓解而非 CR，判定当前同步方案无效，应立即换线"},"answer":"B","vignette":"患者男，27 岁。2024-04-01 确诊鼻咽未分化型非角化性癌，AJCC 9th：T3N1M0（III期）。既往体健。\n\n原始医嘱可见：\n\n2024-04-08：泽菲 2.49 g d1 + 诺欣 64 mg qd（d1–3）\n2024-04-29：泽菲 2.46 g d1 + 诺欣 65 mg qd（d1–3）\n2024-05-20：开始 IMRT\n2024-05-20：诺欣 82 mg qd（d1–3）\n2024-05-21：泰欣生 200 mg d1\n\n补充病历碎片：\n\n2024-06-03 病理补充：EGFR（95%+）\n2024-06-06 血浆 EBV DNA：由治疗前 2.1×10^4 copies/mL 降至未检出\n2024-06-11 复诊：KPS 100；WBC 4.4×10^9/L，Hb 126 g/L，PLT 178×10^9/L，Cr 72 μmol/L；仅 1 级咽痛，无 ≥2 级黏膜炎、皮疹或明显消化道反应\n鼻咽镜提示原发灶较前缩小，颈部结节较前减小\n今日恰为上一次同步化疗后第 22 天。","patient_id":"l4-patient-2bf879fa19f079ae6ba0878f"}
+{"id":"l4-sample-148c5835454316e96f1222d0","question":"在 2018-02-22 时，结合上述累积用药情况、生理指标及当前处于放疗第 7 周的阶段，关于后续同步化疗与放疗的处理安排，下列哪项最为合适？","options":{"A":"鉴于患者已完成两周期大剂量顺铂且出现耳毒性（听力下降），认为累积剂量已达标阈值，故应停止后续同步化疗，仅继续放疗至结束。","B":"考虑患者血肌酐值及听力受损风险，且处于放疗末期，应将同步化疗方案调整为尼妥珠单抗（泰欣生）或西妥昔单抗增敏。","C":"计算由于肌酐清除率(Ccr) < 60 ml/min，且出现骨髓抑制趋势，应将化疗方案调整为奈达铂（Nedaplatin） 80mg/m² 同步放疗。","D":"继续给予顺铂（或同类药物）47mg ivgtt d1-3，并联合胸腺五肽（天恩福）支持治疗。","E":"患者KPS 80分且出现白细胞下降，不耐受静脉化疗，改为口服卡培他滨单药同步放疗。"},"answer":"D","vignette":"患者女，2017年约30岁。既往确诊鼻咽癌，于 2017-12-13 行鼻咽内镜活检，病理示：（鼻咽左顶壁、右侧壁）未分化型非角化性癌，EBERs（+）。2018-01-08 开始行根治性放疗。既往同期/序贯化疗记录如下：\n1. [2018-01-04] 于放疗正式开始前给予顺铂 100 mg/m²，按体表面积换算静脉滴注（ivgtt），qd × 3 天；\n2. [2018-02-02] 在根治性放疗进行过程中再次给予顺铂 100 mg/m²，按体表面积换算静脉滴注（ivgtt），qd × 3 天。\n\n当前时间：2018-02-22，患者处于根治性放疗第 7 周。查体：体重 51 kg，身高 162 cm，体表面积（BSA）约 1.52 m²，KPS 评分 80 分。主诉轻度乏力，听力轻度下降。辅助检查：血常规示 WBC 3.2×10^9/L，ANC 1.8×10^9/L；血生化示：ALT 35 U/L，BUN 7.2 mmol/L，Cr 86 μmol/L。EBV-DNA 阴性。","patient_id":"l4-patient-ff5b83a9296117affbe150ef"}
+{"id":"l4-sample-67d02e674f580b61f8b353cf","question":"2021-03-11 时，该患者应如何处理？","options":{"A":"联合免疫治疗：启动特瑞普利单抗(PD-1单抗) + 吉西他滨 + 顺铂 (GP方案)","B":"原方案再挑战：重启 尼妥珠单抗 + 奈达铂 + 吉西他滨 静脉化疗","C":"单药维持治疗：口服 替加氟 (Tegafur)","D":"局部放疗：针对肝脏残留病灶行SBRT治疗"},"answer":"C","vignette":"患者女，33岁。确诊鼻咽未分化型非角化性癌(T3N2M0) 3年余。既往于2017-2018年行诱导化疗+CCRT。2018年8月出现颈部淋巴结复发，2019年11月确诊肝多发转移。随后行多周期“英择(吉西他滨) + 诺欣(奈达铂) + 泰欣生(尼妥珠单抗)”解救治疗，末次静脉化疗时间为2020年6月。此后病情稳定。\n\n2021年3月11日复诊资料如下：\n[体能] KPS评分: 80.0。\n[既往史] 2008年行阑尾切除术；2015年因颜面部红斑于风湿免疫科确诊某系统性疾病，长期口服小剂量泼尼松维持，目前病情平稳。\n[辅助检查] 血常规：WBC 3.1×10^9/L, HGB 108 g/L, PLT 85×10^9/L。生化：ALT 21 U/L, AST 18 U/L, Cr 62 μmol/L。EBV-DNA定量检测: 0 copy/mL (连续3次复查均为0)。\n[免疫及其他] 查体见光过敏痕迹；近期免疫全套示：ANA 阳性(1:320, 均质型), 抗dsDNA抗体 (+), 补体C3 0.48 g/L (偏低)。心电图示窦性心律不齐。","patient_id":"l4-patient-ff5b83a9296117affbe150ef"}
+{"id":"l4-sample-bb984a309faafee992104d3d","question":"肝转移经重复穿刺证实后，以下哪项后线系统治疗可考虑？","options":{"A":"吉西他滨 + 顺铂 (GP) + 信迪利单抗","B":"白蛋白结合型紫杉醇 + 信迪利单抗","C":"单药替吉奥（替加氟/吉美嘧啶/奥替拉西钾，S-1）加量维持","D":"肝S3病灶立体定向放疗 (SBRT) + 尼妥珠单抗"},"answer":"B","vignette":"患者女，35岁。\n\n【既往治疗史摘要】\n- [2020-01-16] 开始“英择 (Gemcitabine)” 1.4g d1,8 + “泰欣生 (Nimotuzumab)” 200mg qw 诱导治疗。\n- [2020-03-11] 增加“诺欣（顺铂，Cisplatin）”40mg 联合治疗。\n- [2020-05-09] 调整为“维康达 (S-1)” 口服维持。\n- [2021-03-11] 门诊长期口服“替加氟片”维持，期间多次复查 EBV-DNA 均为 0 copy/mL。\n\n【近期病情变化】\n- [2022-03-16] EBV-DNA 升高至 2.51E+02 copy/mL。\n- [2022-03-22] 肝S3肿物穿刺：镜下见汇管区纤维增生伴炎性浸润，未见明确肿瘤。建议随访。\n- [2022-04] 至 [2022-08] 期间，EBV-DNA 在 37~963 copy/mL 间波动，患者无明显主诉。\n- [2022-09-09] 复查 EBV-DNA 飙升至 1.59E+03 copy/mL。影像学提示肝S3结节较前增大，考虑复发转移。\n- [2022-09-15] 对肝S3病灶重复穿刺，病理证实鼻咽癌转移；全身 PET/CT 未见其他进展，评估为孤立性肝转移。结合既往含铂方案治疗后疗效不佳。\n- [2022-09-09] 体能评分：[2022-09-07] KPS 80.0。\n\n【其他信息】\n患者既往有剖宫产史，窦性心律，心率78次/分。入院查血常规：HGB 108 g/L，PLT 185×10^9/L。","patient_id":"l4-patient-ff5b83a9296117affbe150ef"}
+{"id":"l4-sample-69f10806a0ff1033697cf677","question":"2023-06-05 时，该患者应如何处理？","options":{"A":"继续联合方案：拓益 240mg + 注射用紫杉醇(白蛋白结合型) 200mg","B":"去化疗，转为维持治疗：拓益 240mg 单药维持","C":"更换化疗方案：拓益 240mg + 吉西他滨 1000mg/m²","D":"病情稳定，停止所有药物治疗，进入观察期"},"answer":"B","vignette":"患者女，36岁（1987年生）。2022年3月因体检发现“肝S3肿物”行穿刺活检，病理示汇管区纤维增生伴炎症细胞浸润，EBERs(-)，当时检测EBV-DNA 为 2.42×10^2 copy/mL。之后随访中，2022年9月复查提示EBV-DNA 升至 1.59×10^3 copy/mL，结合既往病史及影像学/相关检查，最终确诊为复发转移性鼻咽癌。\n\n回顾治疗史（依据原始医嘱记录整理）：\n1. 2022-09-09 至 2023-04-03：以含铂化疗联合抗血管生成靶向药物方案为主，例如“抗血管生成靶向药物 诺欣 60 mg 静脉滴注，每3–4周重复一周期，联合紫杉类化疗药物（如注射用紫杉醇〔白蛋白结合型〕，按体表面积计算常规剂量，治疗日静脉滴注），周期性给予，整体给药节律为每3–4周一周期”。\n2. 2023-04-24：方案调整为“PD-1 单抗（拓益，特瑞普利单抗）240 mg 静脉滴注，每3周一次（q3w），联合紫杉类化疗药物（如注射用紫杉醇〔白蛋白结合型〕，按体表面积计算常规剂量，于该周期化疗日静脉滴注）”。\n3. 2023-05-15：在上一周期基础上继续给予“拓益 240 mg 静脉滴注联合注射用紫杉醇（白蛋白结合型）常规剂量静脉滴注”，作为下一周期治疗的一部分。\n\n今日为 2023-06-05，患者返院复诊。一般情况尚可，KPS 评分 80，体重 52 kg。既往无高血压、糖尿病等慢性内科疾病史。血常规示轻度贫血（血红蛋白 105 g/L），其余暂未见明显异常。需在既往系统治疗时间线和当前状态基础上，评估后续全身抗肿瘤治疗策略及相关支持治疗安排。","patient_id":"l4-patient-ff5b83a9296117affbe150ef"}
+{"id":"l4-sample-b6046dc7411b358868a22095","question":"后续最合理的全身治疗策略是?","options":{"A":"改用吉西他滨 + 顺铂 + 特瑞普利单抗","B":"改用顺铂 + 5-FU 二线化疗","C":"继续特瑞普利单抗 240 mg q3w","D":"改用特瑞普利单抗 + 卡培他滨","E":"改用 S-1 单药维持","F":"改用卡瑞利珠单抗 + 阿帕替尼","G":"在特瑞普利单抗基础上改用单药尼妥珠单抗","H":"改用白蛋白紫杉醇 + 顺铂 + 特瑞普利单抗","I":"停止免疫治疗，仅最佳支持治疗","J":"改用纳武利尤单抗 + 伊匹木单抗"},"answer":"C","vignette":"患者女，36岁，既往诊断 多发转移性鼻咽未分化型非角化性癌，EBV 相关。既往无高血压、糖尿病。\n\n既往系统治疗\n2022-09 至 2023-04：接受含白蛋白紫杉醇 + 吉西他滨的一线系统治疗，期间 -EBV DNA 由 9.63×10² copies/mL 下降至 6.68×10¹ copies/mL\n2023-04-24 起：调整为 特瑞普利单抗 240 mg q3w ± 白蛋白紫杉醇\n2023-07 之后：逐步过渡为 特瑞普利单抗单药维持\n截至 2024-01-24：患者已从当前 PD-1 治疗中获得约 10 个月持续临床获益，-----KPS 稳定约 80，无 ≥2 级免疫相关不良反应\n-近期病情变化\n2024-02 复查：仅鼻咽原发区/局部区域病灶增大，既往远处病灶未见明确新发或同步进展\n-PET/CT：未见新的远处转移灶\n-MDT 认定：当前属于 局部寡进展（oligoprogression），而非系统性全面进展\n2024-02-20 至 2024-03-01：完成局部放疗\n放疗结束后 6 周复评：\n-MRI：照射区病灶较放疗前明显缩小，但仍可见残余强化影\n-PET/CT：未见新的远处病灶\n-EBV DNA：仍可检出，但较放疗前下降\n-WBC 3.8×10^9/L，HGB 105 g/L，PLT 145×10^9/L\n-肝肾功能基本正常\n-KPS 80","patient_id":"l4-patient-ff5b83a9296117affbe150ef"}
+{"id":"l4-sample-d051684e6f7d7725725b1d05","question":"该患者影像学证实鼻咽癌复发，拟行全身挽救性化疗。下列哪种治疗方案更适合作为本次全身挽救性化疗方案？","options":{"A":"吉西他滨 + 顺铂 (GP方案)","B":"白蛋白结合型紫杉醇 + 奈达铂","C":"多西他赛 + 顺铂 + 氟尿嘧啶 (TPF方案)","D":"帕博利珠单抗单药治疗"},"answer":"B","vignette":"患者男，2024年约32岁，于2024-02-02因“鼻咽癌随访复查异常”入院。既往无高血压、糖尿病史，10年前行阑尾切除术。身高172cm，体重41kg，ECOG PS评分0–1分（[2024-02-02] KPS评分：90）。\n\n既往病史及肿瘤治疗经过：\n[2022-06] 患者因鼻咽部肿物伴颈部淋巴结肿大在外院确诊为“鼻咽未分化型非角化性癌（T3N1M0，III期，AJCC第8版）”，行根治性同步放化疗：\n- 放疗：鼻咽及颈部放疗，总剂量按当时规范完成；\n- 化疗：以含铂方案（顺铂为主）为同步放化疗基础方案，疗程按当时计划完成。\n[2023-01] 复查影像学评估为无明显肿瘤残留，进入定期随访阶段。\n\n本次入院经过：\n[2024-02-02] 入院诊断为“鼻咽未分化型非角化性癌（T3N1M0, III期, AJCC第8版）”，为“既往同步放化疗后随访中的鼻咽癌患者”，因近期随访影像学检查提示鼻咽局部及（或）颈部可疑病灶而收入院进一步评估。\n[2024-02-04] 影像学复查结合既往病史提示鼻咽癌复发（较前次治疗后影像学缓解状态出现新的病灶或原病灶再增大），拟评估后行全身挽救性系统治疗。\n\n实验室检查（2024-02-05回报）：\n血常规：WBC 5.1×10^9/L，NEUT% 62%，HGB 108 g/L，PLT 215×10^9/L。\n血生化：ALT 22 U/L，AST 18 U/L，Alb 31 g/L，Cr 110 μmol/L，BUN 7.2 mmol/L，K 3.8 mmol/L。\n\n辅助检查：\n心电图示窦性心律，大致正常心电图。心脏超声示LVEF 65%。\n\n目前患者因影像学证实鼻咽癌复发，计划评估后拟行全身挽救性化疗方案的选择。","patient_id":"l4-patient-8a196daaa54db8e32278c61b"}
+{"id":"l4-sample-dc45e1061dbdf44768cc521f","question":"当前应采用哪种同期系统治疗医嘱？","options":{"A":"顺铂 40 mg/m²，每周 1 次，同期放疗","B":"顺铂 100 mg/m²，每 3 周 1 次，同期放疗","C":"奈达铂周疗 + 尼妥珠单抗 200 mg 周疗，同期放疗","D":"奈达铂 80 mg/m² q3w，同期放疗","E":"尼妥珠单抗 200 mg 周疗，同期放疗","F":"白蛋白紫杉醇 + 奈达铂 + 尼妥珠单抗原方案继续，同期放疗","G":"卡铂 AUC 2 周疗，同期放疗","H":"单纯放疗，不联合任何系统治疗","I":"顺铂 + 尼妥珠单抗双药同步放疗","J":"特瑞普利单抗单药联合放疗"},"answer":"A","vignette":"患者男，2023年约17岁。2023-05-30 确诊鼻咽癌，分期 cT4N2M0（AJCC 8th，IVA期），病理提示分化差的癌。基线 KPS 90。既往史：轻度窦性心律不齐，幼年行阑尾切除术。基线血生化：ALT 21 U/L，Cr 68 μmol/L。\n\n已完成治疗\n\n患者于 2023-06-05 至 2023-07-19 完成 3 周期诱导治疗，HIS 原始医嘱如下：\n\n2023-06-05：白蛋白紫杉醇 400 mg d1 + 奈达铂 43 mg d1–3 + 尼妥珠单抗 400 mg d1，q3w\n2023-06-28：同方案\n2023-07-19：同方案\n\n2023-08-08 复查 MRI：鼻咽原发灶及颈部淋巴结较前明显缩小，疗效评价 PR。\n2023-08-09 拟开始根治性 IMRT。\n当前评估：KPS 90；肝肾功能无明显异常；无已知 ≥2 级听力损害；无 ≥2 级周围神经毒性；无明确顺铂绝对禁忌信息。","patient_id":"l4-patient-11c6934b66e96c7e24437ae5"}
+{"id":"l4-sample-a5efae8d87e3bc3f3fac7a4f","question":"在该患者当前治疗阶段，以下哪种方案最为合适？","options":{"A":"继续原诱导方案：白蛋白紫杉醇 + 奈达铂 + 尼妥珠单抗 同步 IMRT","B":"转入 IMRT + 以顺铂为基础的同步放化疗（如每周顺铂）","C":"沿用 2023-08-08 的处方思路：IMRT + 奈达铂 + 尼妥珠单抗","D":"改为单纯 IMRT，省略所有同期系统治疗","E":"IMRT + PD-1 方案，豁免同期顺铂","F":"改为 IMRT + 特瑞普利单抗 + 尼妥珠单抗双生物治疗"},"answer":"B","vignette":"患者男。2023-05-30 确诊鼻咽未分化型非角化性癌，分期 cT4N2M0（AJCC 第8版，IVA期）。\n\n既往治疗记录\n2023-06-05、2023-06-28、2023-07-19：\n白蛋白紫杉醇 400 mg + 诺欣 43–44 mg + 泰欣生 400 mg，q3w，共 3 周期\n2023-08-08：\n泰欣生 200 mg + 诺欣 44 mg\n2023-08-09：拟启动 IMRT（70 Gy/33f）\n2023-08-08 当前状态\n-’年龄：16 岁\n-KPS 90 分\n-颈部淋巴结较前明显缩小，评估 PR\n-Hgb 118 g/L，WBC 4.5×10^9/L，PLT 210×10^9/L\n-无明确肝肾功能异常\n-既往青霉素过敏史","patient_id":"l4-patient-11c6934b66e96c7e24437ae5"}
+{"id":"l4-sample-9897c4c3aae159ade287c64b","question":"放疗结束后，该患者下一步最合理的处理策略是：","options":{"A":"节拍卡培他滨 650 mg/m² bid，持续 1 年","B":"辅助卡瑞利珠单抗 q3w，维持 1 年","C":"IFN-β 100000 IU/kg，每周 3 次，维持 6 个月","D":"因颅底区仍有残留影像，立即追加局部 boost 至 72 Gy","E":"辅助 GP 方案 3 周期","F":"以 EBV DNA 未转阴为由，立即改行 PD-1 + GP","G":"单纯结束放疗，进入随访观察，不追加任何后续抗肿瘤治疗","H":"先做 PET/CT；若仍有代谢残留，再启动节拍卡培他滨"},"answer":"C","vignette":"患者男，17 岁。2023-05-30 确诊鼻咽未分化型非角化性癌，AJCC 9th：cT4N2M0。既往体健，按儿童/青少年鼻咽癌治疗路径接受治疗。\n\n治疗经过记录：\n\n2023-06-05 至 2023-07-19：诱导化疗采用 PF 方案，共 3 周期：顺铂 80 mg/m² d1 + 氟尿嘧啶 1000 mg/m²/d 持续静脉输注 d1-4，q3w；治疗过程中未出现不可耐受毒性。\n2023-08-09：开始 IMRT，按儿童/青少年方案控制放疗剂量，鼻咽原发灶及受累颈部区域计划剂量 59.4 Gy，分 33 次完成；高危区域同步整合加量不超过 59.4 Gy，以降低远期毒性风险。\n2023-09-13：完成放疗。\n\n放疗结束后复查资料：\n\n- 治疗前血浆 EBV DNA：3.4×10^4 copies/mL；2023-09-13 复测：620 copies/mL，较前明显下降但未完全转阴；\n- 2023-09-15 MRI：鼻咽原发灶显著退缩，残留信号主要位于既往颅底骨质破坏区，未见明确新发病灶；\n- 鼻咽镜：黏膜充血、水肿，未见明确菜花样新生物；\n- WBC 3.9×10^9/L，Hb 112 g/L，PLT 168×10^9/L，Cr 70 μmol/L；\n- 当前仅 1 级咽痛和轻度乏力，无 ≥2 级黏膜炎。","patient_id":"l4-patient-11c6934b66e96c7e24437ae5"}
+{"id":"l4-sample-147434bf459ae2dbe118de81","question":"2024-02-19 起，该患者应采用哪种治疗调整策略？","options":{"A":"继续白蛋白紫杉醇 + 顺铂完成第 3 周期诱导，待神经毒性稳定后再开始放疗","B":"立即开始 IMRT + 顺铂 100 mg/m² q3w，并同步加用特瑞普利单抗","C":"立即开始 IMRT + 顺铂 40 mg/m² weekly，永久停用白蛋白紫杉醇","D":"立即开始 IMRT + 顺铂 80 mg/m² q3w，并同步加用特瑞普利单抗","E":"立即开始 IMRT + 卡铂 AUC 5 q3w，并同步加用特瑞普利单抗","F":"立即开始 IMRT + 特瑞普利单抗单药，去掉所有铂类","G":"立即开始 IMRT + 奈达铂 80 mg/m² q3w","H":"仅行 IMRT，不再合并任何系统治疗"},"answer":"C","vignette":"患者男，49岁。2023-11-15 鼻咽部活检病理示右侧鼻咽未分化型非角化性癌，EBER(+)；2023-11-16 综合评估为局部晚期鼻咽癌。既往体健，无高血压、糖尿病史。KPS 长期 90。\n\n既往治疗经过\n2023-11-22：白蛋白紫杉醇 480 mg d1 + 顺铂 50 mg d1–3，q3w\n2024-01-02：同方案第 2 周期\n-两周期后：患者诉四肢末端麻木逐渐加重，持物稍感费力，伴轻度耳鸣\n-血常规：WBC 3.2×10^9/L，Hb 105 g/L，PLT 110×10^9/L\n-当前状态（2024-02-19）\n\n拟于次日开始同期放化疗。\n\n-ALT 35 U/L，AST 40 U/L，TBIL 12.1 μmol/L\n-Scr 88 μmol/L（基线 72 μmol/L）\n-身高 170 cm\n-近期体重由 75 kg 下降至 58 kg\n-KPS 90\n-纯音测听未证实 ≥2级听力损伤\n-无已知 ≥2级周围神经病变以外的顺铂绝对禁忌信息","patient_id":"l4-patient-f7889fc6c45c6f178ff44df1"}
+{"id":"l4-sample-8d572c46e5caa86105b15517","question":"根据指南与现有研究证据，以下哪项是该患者最合理的同期系统治疗决策？","options":{"A":"停用白蛋白紫杉醇与特瑞普利单抗，转为 IMRT + 每周顺铂同步放化疗","B":"停用白蛋白紫杉醇，保留 顺铂 + 特瑞普利单抗 同期放疗","C":"参照 DIAMOND 路径：保留特瑞普利单抗，同期放疗时去掉顺铂","D":"因 WBC/ANC 已下降，改用 卡铂 + IMRT 同期治疗，不再联合特瑞普利单抗","E":"继续 白蛋白紫杉醇 + 顺铂 + 特瑞普利单抗 同期放疗","F":"改为 IMRT 单纯放疗，放疗后再决定是否补系统治疗"},"answer":"A","vignette":"患者男，2023年约49岁。2023 年 11 月确诊鼻咽未分化型非角化性癌，分期 cT2N3M0（AJCC 第8版，IVa期）。\n\n已完成治疗\n2023-11-21：顺铂 50 mg d1–3\n2023-11-22：白蛋白紫杉醇 480 mg q3w\n2024-01-02：白蛋白紫杉醇 480 mg q3w\n2024-01-02：顺铂 50 mg d1–3\n2024-01-02：特瑞普利单抗 240 mg q3w\n2024-02-19 当前状态\n拟开始 IMRT（根治意图）\n-KPS 90 分，体重 78 kg，身高 175 cm\n-双颈部淋巴结较前明显缩小，评估 PR\n-血常规：WBC 3.6×10^9/L，ANC 1.8×10^9/L，HGB 108 g/L，PLT 155×10^9/L\n-生化：ALT 21 U/L，Alb 39 g/L，Cr 82 μmol/L\n-无明确免疫相关不良事件病史","patient_id":"l4-patient-f7889fc6c45c6f178ff44df1"}
+{"id":"l4-sample-809008273ea5fa1d5c2e48a5","question":"结合肾功能及骨转移情况，下列哪些治疗方案可考虑？（多选）","options":{"A":"吉西他滨 + 顺铂 + 特瑞普利单抗 + 唑来膦酸","B":"吉西他滨 + 奈达铂 + 特瑞普利单抗\n（暂缓启动骨改良药，先行补钙/维生素 D 及口腔处理后再评估）","C":"多西他赛 + 顺铂 + 5-FU + 帕米膦酸二钠","D":"吉西他滨 + 卡铂 + 派安普利单抗；补钙、补充维生素D并完成口腔评估及必要处理后，再评估启动地舒单抗","E":"吉西他滨 + 卡铂 + 特瑞普利单抗 + 唑来膦酸（按肾功能减量）","F":"特瑞普利单抗单药\n（暂缓启动骨改良药，先行补钙/维生素 D 及口腔处理后再评估）"},"answer":"B+D","vignette":"患者男，42 岁。既往因鼻咽癌在当地医院接受过放化疗。2025-02-10 起出现持续腰痛，活动后加重，口服止痛药效果欠佳，于 2025-02-24 因腰痛加重入院评估进一步诊治。\n\n入院时一般情况：KPS 90，身高 170 cm，体重 50 kg。既往史：阑尾切除术；窦性心律不齐，无抗凝用药史，无严重心肺基础疾病及明显肝功能异常病史。\n\n2025-02-18 影像学检查提示骨转移病灶，考虑鼻咽癌复发转移可能。2025-02-20 行左侧颈部淋巴结活检：未分化型非角化性癌，EBER(+)，结合既往病史支持鼻咽癌复发并远处转移。2025-02-22 依据影像学及病理结果评估分期：cT2N3M1，骨转移。\n\n入院相关实验室检查（2025-02-24）：\n- 血常规：WBC 4.5×10^9/L，HGB 105 g/L，PLT 180×10^9/L\n- 生化：ALT 21 U/L，AST 18 U/L，Scr 145 μmol/L，Ca 2.35 mmol/L，Alb 34 g/L\n- 25-OH Vit D：13 ng/mL\n\n口腔评估：慢性牙周炎，暂无需立即拔牙的病灶，无明显活动性口腔感染。\n\n拟于 2025-02-24 启动一线系统治疗，需要在含铂化疗、免疫检查点抑制剂及骨转移相关支持治疗等标准方案中进行综合权衡和选择。","patient_id":"l4-patient-87fa7d7e41717773fc624eed","question_type":"multiple_choice"}
+{"id":"l4-sample-208c306992cdd88d483fb37d","question":"对于该患者在2021年5月至8月这一阶段，一线姑息治疗方案应如何调整？","options":{"A":"患者处于一线治疗后的维持阶段，标准推荐应继续原GP+免疫方案直至疾病进展，不应单药维持。","B":"不推荐在GP+免疫一线方案完成后改用卡培他滨等其它化疗药物单药维持，缺乏与特瑞普利单药维持等同的高等级循证依据。","C":"鉴于患者已完成6周期含铂双药化疗且疗效评估为SD/PR（EBV转阴），根据JUPITER-02研究模式及化疗耐受性考量，转入特瑞普利单抗单药维持治疗。","D":"目前仅有轻度骨髓抑制（I度），无需因毒性永久终止免疫治疗，可继续特瑞普利单药维持并密切监测血象。"},"answer":"C","vignette":"患者男，37岁，2018年6月确诊鼻咽未分化型非角化性癌（cT4N3M0，IVb期），起初接受以吉西他滨联合顺铂为基础的诱导化疗后同步放化疗。2019年7月复查提示颈部淋巴结复发并出现多发骨转移，肿瘤分期仍为IVb期。自2020年12月起开始一线姑息全身治疗：吉西他滨 1.4 g d1,8 + 顺铂 50 mg d1-3，每3周为一周期，并联合特瑞普利单抗 240 mg d1 q3w。既往治疗记录显示：2021年4月12日完成第6周期联合化疗。此后在2021年5月13日的医嘱记录中，仅继续给予特瑞普利单抗单药维持治疗，并在随后至2021年8月的医嘱中均沿用该单药方案。查体：ECOG PS 1分，轻度贫血貌。近期辅助检查：EBV-DNA 0 copy/mL（持续转阴）。血常规：WBC 3.1×10^9/L，NEUT 1.6×10^9/L，PLT 95×10^9/L。生化：ALT 35 U/L，Cr 78 μmol/L。既往史：否认高血压、糖尿病。","patient_id":"l4-patient-39d89affceeddb81a8cfa5c4"}
+{"id":"l4-sample-78628906b478ef1dc03d1c89","question":"2021-08-02 时，该患者应采用哪种医嘱方案？","options":{"A":"联合治疗：拓益 240mg d1 + 希罗达 1000mg/m² bid d1-14（加强维持）","B":"恢复原方案：拓益 240mg + 健择 1.4g + 诺欣 50mg（巩固疗效）","C":"单药维持：拓益 240mg d1","D":"停药观察：进入药物假期（Drug Holiday）"},"answer":"C","vignette":"患者男，38岁。确诊鼻咽未分化型非角化性癌（cT4N3M0，临床分期IVb期）。既往无吸烟史，BMI 22.5。2021年8月2日复诊，KPS 90分，主诉轻度乏力，查体无殊。血生化：ALT 21 U/L，Cr 78 μmol/L。近期EBV-DNA持续为0 copy/mL。\n\n既往治疗记录提取如下（请仔细核对给药时间轴）：\n1. 2020-12-14：健择(1.4g) + 拓益(240mg) + 诺欣(50mg)\n2. 2021-01-04：健择(1.4g) + 拓益(240mg) + 诺欣(50mg)\n3. 2021-02-01：健择(1.4g) + 拓益(240mg) + 诺欣(50mg)\n4. 2021-02-25：健择(1.4g) + 拓益(240mg) + 诺欣(50mg)\n5. 2021-03-22：健择(1.4g) + 拓益(240mg) + 诺欣(50mg)\n6. 2021-04-12：健择(1.4g) + 拓益(240mg) + 诺欣(50mg)\n\n【重要药物变更记录】：2021-05-13起，处方变更为“仅单药拓益(特瑞普利单抗)维持治疗，未见化疗药物”。\n\n【随访依从性数据】：系统监测到2021年5月至7月间，患者给药间隔分别为25天、28天、28天（标准周期为21天）。\n\n患者今日（2021-08-02）复查鼻咽MRI示：鼻咽顶后壁软组织影较前相仿，左侧腮腺区结节较前缩小，未见新发病灶。","patient_id":"l4-patient-39d89affceeddb81a8cfa5c4"}
+{"id":"l4-sample-bebb0a2422f080a4beb672b0","question":"2021-11-22 时，该患者应作出哪种临床决策？","options":{"A":"鉴于患者治疗中断超过6周（2021-08-30至2021-10-18间隔49天），视为免疫维持治疗失败或“脱落”，应重新联合吉西他滨+顺铂（GP方案）进行再诱导。","B":"患者既往联合化疗仅持续至2021年4月（不足6个月），且近期给药间隔不规律，存在肿瘤“免疫逃逸”高风险，建议加用卡培他滨口服以增强疗效。","C":"继续给予特瑞普利单抗（拓益）240mg 单药维持治疗。","D":"患者已完成一线治疗并通过了EBV-DNA清零的“观察窗口期”，考虑到给药间隔显著延长（>6周）且病情稳定，可停止免疫治疗进入“药物假期”密切随访。"},"answer":"C","vignette":"患者男，38岁。确诊鼻咽未分化型非角化性癌（T4N3M0 IVb期，2018年首诊，2020年12月确诊腮腺淋巴结复发）。\n\n当前处于复发转移一线治疗维持阶段。今日日期为 **2021-11-22**，患者返院复诊。\n\n**既往治疗原始记录（部分）**：\n- 2020-12-14：开始“健择(1.4g)+诺欣(50mg)+拓益(240mg)”方案。\n- 2021-04-12：执行该联合方案的最后一次给药。\n- 2021-05-13：转为“拓益(240mg)”单药维持。\n\n**近期给药与检查记录**：\n- 2021-08-02：拓益 240mg ivgtt；EBV-DNA 0 copy/mL。\n- 2021-08-30：拓益 240mg ivgtt；EBV-DNA 0 copy/mL。\n- **2021-10-18**：拓益 240mg ivgtt；EBV-DNA 0 copy/mL。\n- 2021-11-22（今日）：查体ECOG 0分，无新发主诉，既往化疗期间曾出现II度皮疹（已愈）。EBV-DNA检测结果待报（既往均为0）。\n\n**干扰信息**：患者自诉8-10月期间因疫情封控及个人原因导致就诊时间不规律。血常规示Hgb 105 g/L，BUN 6.8 mmol/L，Cr 82 μmol/L。","patient_id":"l4-patient-39d89affceeddb81a8cfa5c4"}
+{"id":"l4-sample-28e8dc07db38a8cbfe5e4541","question":"2021-12-27 时，该患者下一步应如何处理？","options":{"A":"停用特瑞普利单抗，改卡培他滨单药二线治疗","B":"重启吉西他滨+顺铂+特瑞普利单抗","C":"继续特瑞普利单抗 240 mg q3w 单药维持","D":"因 EBV-DNA 已转阴，立即停用全部抗肿瘤药物，仅随访观察","E":"将特瑞普利单抗改为 3 mg/kg q2w，按后线单药方案重新给药","F":"加用卡培他滨与特瑞普利单抗联合维持，以弥补前期漏药","G":"立即改用纳武利尤单抗，避免对特瑞普利单抗形成继发耐药","H":"不考虑左腮腺区挽救手术，继续系统治疗随访","I":"不考虑再程放疗同步化疗，继续系统治疗随访","J":"继续随访和对症支持，但不因为本次漏诊期而永久停用免疫治疗"},"answer":"C","vignette":"患者男，38岁。既往鼻咽未分化型非角化性癌，初诊分期 cT4N3M0（IVa期），2018 年已行根治性放化疗。2019 年出现左侧腮腺区淋巴结复发；2020 年 12 月再次复发，经 MDT 评估为不适合手术切除及再程放疗，遂行姑息一线系统治疗。\n\n查阅既往治疗记录：\n\n2020-12-14 至 2021-04-12，接受“健择（吉西他滨）1.4 g d1,8 + 诺欣（顺铂）50 mg d1-3 + 拓益（特瑞普利单抗）240 mg d1，q3w”共 6 个周期；\n2021-05-13 起改为“拓益 240 mg q3w”单药维持；\n近期实际给药时间为 2021-08-30、2021-10-18；本次就诊日期为 2021-12-27；\n2021-11-22 EBV-DNA 为 0 copy/mL；\n2021-12-24 鼻咽镜未见新生物；鼻咽+颈部 MRI、胸部 CT、上腹部 CT 提示原病灶及腮腺区残余病灶较前稳定，未见 RECIST 意义下进展；\n既往无 ≥2 级免疫相关肺炎、肝炎、结肠炎、心肌炎或需系统激素处理的不良反应；\n今日化验：Hgb 108 g/L，Alb 39 g/L；KPS 90 分，窦性心律。","patient_id":"l4-patient-39d89affceeddb81a8cfa5c4"}
+{"id":"l4-sample-addffcef13fbd712c55bef87","question":"在 2021-09-07 该时间点，对此患者最合理的策略是：","options":{"A":"PF 辅助化疗 q3w × 2–3 周期","B":"节拍卡培他滨 650 mg/m² bid，持续 1 年","C":"卡瑞利珠单抗 200 mg q3w，作为放疗后辅助免疫治疗，共 12 周期","D":"IFN-β 100000 IU/kg，每周 3 次，作为放疗后辅助治疗，持续 6 个月","E":"单纯随访观察，不予任何放疗后全身辅助治疗","F":"卡培他滨 1000 mg/m² bid，d1–14，q21d，作为经典剂量辅助化疗，共 8 周期"},"answer":"B","vignette":"患者男，19 岁。2021 年 1 月确诊鼻咽未分化型非角化性癌，cT3N2M0。\n既往治疗记录：\n\n2021-02-22、2021-03-17、2021-04-08：健择 1.7 g + 诺欣 135–136 mg；\n2021-04-29 至 2021-06-11：根治性放疗；\n2021-04-30、2021-05-20：诺欣 168–169 mg 同期。\n补充资料：\n治疗前 EBV DNA 3.33E+02 copies/mL；2021-03-23 转阴并维持至 2021-09-01；\n2021-09-07 复查：KPS 100，血常规/肝肾功能正常；\n-MRI：鼻咽原发灶未见明确可测量残余软组织肿块，颅底区仍见治疗后骨髓信号异常；\n-鼻咽镜：黏膜恢复，未见新生物；\n-无 ≥2 级口腔黏膜炎、手足综合征或免疫相关不良反应。","patient_id":"l4-patient-bd3e3a51730b2628be86c060"}
+{"id":"l4-sample-24429f3ec416e21f743746e5","question":"在目前时点，针对该患者的最佳诊疗方式是？","options":{"A":"立即启动 PF 辅助化疗：顺铂 + 5-FU，q4w × 3 周期","B":"立即启动 GP 辅助化疗：吉西他滨 + 顺铂，q3w × 3 周期","C":"立即启动尼妥珠单抗单药 q3w 维持治疗 1 年","D":"单纯观察随访，不再考虑任何后续系统治疗","E":"立即补做 1–2 周期顺铂单药，以“补足累计铂剂量”","F":"立即启动特瑞普利单抗辅助治疗 8–12 周期","G":"因 EBV-DNA 已转阴，应行预防性颈淋巴结清扫术","H":"先进入恢复与密切随访阶段；末次放疗后约 12–16 周复评，若仍无复发证据，可启动节拍卡培他滨 650 mg/m² bid 辅助治疗，疗程 1 年","I":"以卡铂替代顺铂，立即开始辅助 PF 方案","J":"立即加用西妥昔单抗维持治疗"},"answer":"H","vignette":"患者男，19 岁。确诊鼻咽未分化型非角化性癌，cT3N2M0，III期（AJCC 第8版）。\n\n【原始医嘱记录节选】\n\n2021-02-22、2021-03-17、2021-04-08：健择 1.7 g；诺欣 135–136 mg\n2021-04-29 至 2021-06-11：根治性 IMRT\n同期用药：2021-04-30 诺欣 169 mg；2021-05-20 诺欣 168 mg\n\n【疗效与状态】\n\n2021-05-26：EBV-DNA 0 copy/mL\n2021-07-01：颈部淋巴结未及肿大，鼻咽部黏膜光滑\n-血常规：HGB 128 g/L，WBC 4.2×10^9/L，PLT 185×10^9/L\n-肝肾功能：ALT 22 U/L，Cr 68 μmol/L\n-KPS 100","patient_id":"l4-patient-bd3e3a51730b2628be86c060"}
+{"id":"l4-sample-9117afb0b7b7f7e22a74b769","question":"根据上述病例的既往治疗经过及目前复查情况，下一步最佳处理是？","options":{"A":"定期随访观察","B":"PF（顺铂+5-FU）×3 周期","C":"TP（多西他赛+顺铂）×3 周期","D":"GP（吉西他滨+奈达铂）×3 周期","E":"节拍卡培他滨口服辅助 1 年（根治性放化疗后 12–16 周、确认无残留或转移时启动）","F":"卡瑞利珠单抗 200 mg q3w ×12 周期辅助治疗（参照已完成诱导化疗+同步放化疗后序贯 PD-1 辅助的最新 III 期证据）","G":"信迪利珠单抗 200 mg q3w ×12 周期，从当前时点直接启动（与诱导期即联合免疫的整合方案不符）","H":"特瑞普利单抗单药辅助 1 年","I":"吉西他滨+顺铂 ×3 周期辅助化疗","J":"仅复查 EBV-DNA，待其再次升高后再决定是否强化治疗"},"answer":"F","vignette":"患者男，2021年约19岁。鼻咽未分化型非角化性癌，cT3N2M0（IV期/IVA）。\n2021-02-22、2021-03-17、2021-04-08 分别接受诺欣（顺铂）135–136 mg + 健择（吉西他滨）1.7 g，共 3 周期诱导化疗；\n2021-04-29 至 2021-06-11 完成根治性 IMRT，同期于 2021-04-30、2021-05-20 分别给予诺欣（顺铂）169 mg、168 mg。\n2021-07-05 复查：KPS 100，颈部未触及肿大淋巴结，Hgb 118 g/L，WBC 3.8×10^9/L，PLT 145×10^9/L，肝肾功能基本正常，无活动性感染及明确免疫治疗禁忌。","patient_id":"l4-patient-bd3e3a51730b2628be86c060"}
+{"id":"l4-sample-2252115c2dd18a176b1f9c1c","question":"最符合真实且规范化临床决策的是：","options":{"A":"继续维持原诱导方案 2 个周期：多西他赛106 mg + 氟尿嘧啶4.5 g + 诺欣35 mg + 泰欣生200 mg，待出现 ≥3级毒性后再考虑减药","B":"既然已达到PR，直接停止所有抗肿瘤治疗，仅观察随访，待影像再次进展后再决定是否局部处理","C":"结束诱导期，按既往 MDT 计划转入再程放疗同步期：停用多西他赛与氟尿嘧啶，保留泰欣生，并将含铂治疗调整为再程放疗同步期常规方案","D":"判定原方案一线失败，立即更换为GP方案（吉西他滨+顺铂）重新开始系统治疗","E":"转入单药泰欣生200 mg每周维持治疗，不再联合局部治疗","F":"因既往已接受过放疗，局部复发原则上不应再行放疗，因此继续系统化疗是唯一可行选择","G":"既然病灶局限于鼻咽，应立即改行鼻内镜手术切除，不再考虑放疗","H":"因当前血象提示明显骨髓抑制，应永久停用全部抗肿瘤药物，仅予支持治疗","I":"直接停用泰欣生，仅保留诺欣单药60 mg治疗","J":"保留多西他赛并停用铂类和5-FU，以“去铂去氟”方式继续冲击 2 周期，再决定是否放疗"},"answer":"C","vignette":"患者男，43岁，既往因鼻咽未分化型非角化性癌接受根治性放化疗后获得缓解。2025年6月复查鼻咽镜及活检证实鼻咽局部复发。进一步完善鼻咽+颈部增强MRI及全身PET/CT示：复发灶局限于鼻咽顶后壁并累及浅层咽旁间隙，未见区域淋巴结复发及远处转移。耳鼻喉-头颈外科 MDT 评估认为病灶位置深、难以获得安全阴性切缘，不适宜手术切除；患者距首程放疗已超过5年，既往无 ≥3级晚期放疗毒性，KPS 90分，GTV 18 cm³，综合评估为适宜再程放疗。\n\n为缩小肿瘤体积、改善后续局部治疗条件，2025-07-10起先行多药联合诱导治疗，方案包含“多西他赛+氟尿嘧啶+诺欣+泰欣生”。医嘱记录如下：\n\n2025-07-10（C1）：多西他赛108 mg，氟尿嘧啶4.5 g，诺欣36 mg，泰欣生200 mg；\n2025-07-31（C2）：多西他赛106 mg，氟尿嘧啶4.25 g，诺欣35 mg，泰欣生200 mg；\n2025-08-21（C3）：多西他赛106 mg，氟尿嘧啶4.5 g，诺欣35 mg，泰欣生200 mg。\n\n2025-09-10复查MRI示原发复发灶较基线缩小约34%，无新发病灶，疗效评估为PR。放疗科计划于2025-09-12启动再程IMRT。现时间为2025-09-11，患者入院拟行下一步治疗。查体：KPS 90分，颈部淋巴结未触及肿大，口腔黏膜轻度充血。血常规：WBC 3.8×10^9/L，NEUT 1.9×10^9/L，PLT 120×10^9/L。既往有青霉素过敏史。","patient_id":"l4-patient-33a6f024ed024bdd8b47ef4e"}
+{"id":"l4-sample-cf73c353d6ffeb326e77c11b","question":"基于患者既往用药史及当前耐受情况，2024-01-11开始的同期放化疗阶段，最合理的药物方案调整是？","options":{"A":"不做任何药物调整：继续沿用原方案（泰欣生 + 洛铂 + 白蛋白紫杉醇）联合同期放疗","B":"更换为标准单药方案：顺铂 (100mg/m²) + 同期放疗","C":"调整方案：去除白蛋白紫杉醇，维持泰欣生 + 洛铂 + 同期放疗","D":"降级方案：仅行单纯放疗，不再联合任何化疗药物"},"answer":"C","vignette":"患者男，45岁，既往确诊鼻咽癌。2023-10-26因鼻咽顶后壁活检确诊复发。既往体健，KPS 90分。实验室检查：HGB 125g/L，WBC 5.2×10^9/L，PLT 210×10^9/L，ALT 28 U/L，Cr 78 μmol/L。2023-11-02起行诱导化疗，具体方案为：泰欣生 200mg qd + 洛铂 55mg qd + 白蛋白紫杉醇 473mg qd (D1)，每21天一周期。连续完成3周期后，于2023-12-14结束第三周期化疗。期间患者诉双手足指端麻木感明显，且逐渐加重，影响系扣子等精细动作（NCI-CTCAE 2级），余无明显不良反应。2024-01-11复查评估，病灶较前缩小，拟行同期放化疗。","patient_id":"l4-patient-f31f9f8af7b96df04282a5dd"}
+{"id":"l4-sample-12bdf627d6eabcef2846b164","question":"以下哪一项最适合作为同期方案？","options":{"A":"再程放疗 + 顺铂 100 mg/m² q3w","B":"再程放疗 + 顺铂 40 mg/m² qw","C":"再程放疗 + 泰欣生 200 mg qw + 洛铂 52.2 mg q3w","D":"再程放疗 + 泰欣生 200 mg qw + 白蛋白紫杉醇 260 mg/m² q3w","E":"再程放疗 + 泰欣生 200 mg qw 单药","F":"再程放疗 + 洛铂 52.2 mg q3w 单药","G":"再程放疗 + 卡铂 AUC 2 qw","H":"再程放疗 + 特瑞普利单抗 240 mg q3w + 洛铂 55 mg q3w","I":"完成再程根治性放疗后，再视评估结果考虑补充 2 周期系统治疗","J":"再程放疗期间不加任何系统治疗，结束后随访观察"},"answer":"C","vignette":"患者男，45 岁。既往 5 年前接受过根治性放疗。2023 年 10 月确诊鼻咽局部复发，病理示鼻咽未分化型非角化性癌，EBERs(+)，EGFR(+)；分期 rT3N0M0。MDT 评估认为病灶不适合手术切除，但符合再程根治性放疗条件。既往首程治疗中曾接受累计顺铂治疗，遗留持续性 2 级耳鸣及高频听力下降，MDT 认为本次再程放疗期间不宜再用顺铂。无既往 ≥3 级晚期放疗毒性。KPS 90。\n\n复发后于 2023-11-02、2023-11-23、2023-12-14 接受 3 周期诱导治疗：\n泰欣生 200 mg + 洛铂 55 mg + 白蛋白紫杉醇 473–476 mg。\n诱导后影像评估 PR，血常规及肝肾功能基本正常，无 ≥2 级输液反应。2024-01-11 拟启动再程根治性放疗。","patient_id":"l4-patient-f31f9f8af7b96df04282a5dd"}
+{"id":"l4-sample-4bd24f2e9936a528be257581","question":"最合理的后续系统治疗方案是：","options":{"A":"吉西他滨 + 顺铂（GP）","B":"白蛋白紫杉醇 + 卡铂","C":"吉西他滨 + 卡铂","D":"仑伐替尼 + 帕博利珠单抗","E":"替雷利珠单抗 + 西妥昔单抗 + 卡培他滨","F":"卡培他滨单药","G":"替雷利珠单抗单药","H":"卡铂 + 西妥昔单抗","I":"伊立替康单药","J":"优先进入临床试验，不再建议任何标准系统治疗"},"answer":"C","vignette":"患者男，34岁。确诊鼻咽癌未分化型非角化性癌（cT4N2M1，IVb期）4年余。既往治疗史回顾：\n\n2016-05：诱导化疗（PF方案），随后行同步放化疗（顺铂单药增敏），累计顺铂用量约 550 mg。\n2016-12：出现多发骨、肝转移。\n2017-12：接受阿帕替尼 + 卡培他滨。\n2019-03：接受特瑞普利单抗；2019-05 调整为信迪利单抗 + 卡培他滨。\n2020-09：疾病进展，调整为信迪利单抗 + 安罗替尼。\n2020-11：再次进展，调整为信迪利单抗 + 呋喹替尼。\n\n当前时间：2021-03-18。患者一般情况良好，ECOG 0 分。查体：双下肢轻度水肿。\n辅助检查：\n\n血常规：WBC 4.1×10^9/L，HGB 105 g/L，PLT 125×10^9/L\n生化：ALT 35 U/L，AST 40 U/L，ALB 38 g/L，Cr 118 μmol/L；体重 52 kg\n乙肝 DNA：<100 IU/mL\n听力测试：2016 年含顺铂治疗后出现双耳高频听力下降（4000 Hz 气导听阈 65 dB）\n影像学：肝转移灶较前增大约 20%，提示疾病进展","patient_id":"l4-patient-a3128abd6564d34c06077445"}
+{"id":"l4-sample-c3aa28fee7d947d393d60c54","question":"相对最佳诊疗方案是?","options":{"A":"吉西他滨 + 顺铂 (GP方案)","B":"白蛋白紫杉醇 + 卡铂","C":"卡培他滨 + 信迪利单抗","D":"继续特瑞普利单抗单药","E":"卡培他滨单药","F":"吉西他滨单药","G":"卡瑞利珠单抗 + 阿帕替尼","H":"Cadonilimab + TPF 化疗"},"answer":"E","vignette":"患者男，32 岁，体重 52 kg。2016 年 5 月确诊鼻咽未分化型非角化性癌（T4N2M0），接受 TPF 诱导化疗 + CCRT，末次顺铂给药时间为 2016-09-22。2016-12-26 影像学提示肝、骨、肺及肾上腺多发转移。其后先后接受阿帕替尼、沙利度胺等治疗。\n2018-09 至 2019-04 外院记录显示先后接受紫杉醇 180 mg，后续多次减量至 90 mg；2019-03-05 给予特瑞普利单抗 240 mg 1 次。\n2019-05-07 复查提示肝转移灶较前增大，EBV-DNA 较前升高，评估为疾病进展。当前 PS 1 分，轻度贫血，持续 2 级周围感觉神经病变（手足麻木），肝肾功能可耐受口服氟嘧啶；既往已使用阿帕替尼并进展。","patient_id":"l4-patient-a3128abd6564d34c06077445"}
+{"id":"l4-sample-41d3d8f353d0d9976d57568e","question":"最合理的后线治疗策略是：","options":{"A":"吉西他滨 1000 mg/m² + 顺铂 80 mg/m² + 信迪利单抗","B":"多西他赛 75 mg/m² + 顺铂 75 mg/m² + 信迪利单抗","C":"多西他赛 60 mg 固定剂量 + 信迪利单抗 + 卡培他滨 500 mg bid","D":"白蛋白结合型紫杉醇 260 mg/m² + 信迪利单抗 + 安罗替尼 12 mg","E":"卡培他滨单药后线治疗，并按 Ccr 30–50 mL/min 的原则起始减量 25%","F":"继续原“吉西他滨 + 卡培他滨 + 信迪利单抗”方案，因为 ECOG 仍为 1","G":"吉西他滨 + 卡铂 + 信迪利单抗","H":"帕博利珠单抗单药","I":"最佳支持治疗，不再给予任何抗肿瘤治疗","J":"多西他赛 75 mg/m² 单药"},"answer":"E","vignette":"患者男，35岁。既往 2016 年确诊鼻咽未分化型非角化性癌伴远处转移，接受含顺铂的同期放化疗后获得疾病控制。2021 年 10 月起因复发/转移性疾病接受“吉西他滨 + 卡培他滨 + 信迪利单抗”系统治疗。当前时间为 2022 年 2 月 24 日。\n近期监测显示：2020 年 10 月 EBV-DNA 为 0 copy/mL，2021 年 11 月升至 1.46×10^3 copy/mL，2022 年 2 月 24 日复查为 2.1×10^3 copy/mL。ECOG PS 1，体重 48 kg，BMI 17.6。实验室：ALT 25 U/L，AST 30 U/L，BUN 8.2 mmol/L，Cr 138 μmol/L。\n2022 年 2 月 28 日完善鼻咽+颈部 MRI 及 PET/CT，提示多发骨转移灶较前增多，并新发肝转移灶，RECIST 1.1 评估为 PD；MDT 认为当前无可行局部根治性治疗机会。\n另据2021年既往病历记载，患者曾因紫杉醇 180 mg 后出现 4 级中性粒细胞减少，后续减量至 90 mg 后方能耐受。","patient_id":"l4-patient-a3128abd6564d34c06077445"}
+{"id":"l4-sample-7ee9cc244658e7fd5e63e98d","question":"下一步应选择哪种治疗策略？","options":{"A":"白蛋白紫杉醇 260 mg/m² q3w + 顺铂 75 mg/m² q3w","B":"保留信迪利单抗，改用呋喹替尼并联合吉西他滨","C":"卡瑞利珠单抗 200 mg q3w + 阿帕替尼 250 mg qd + 紫杉醇 135 mg/m² q3w","D":"卡瑞利珠单抗 200 mg q3w + 阿帕替尼 125 mg qod + 紫杉醇 80 mg/m² q3w（低剂量低频方案）","E":"卡瑞利珠单抗 200 mg q3w + 阿帕替尼 250 mg qd","F":"伊立替康单药","G":"甲氨蝶呤单药","H":"卡铂 + 西妥昔单抗","I":"优先推荐入组临床试验","J":"最佳支持治疗，不再给予任何抗肿瘤治疗"},"answer":"I","vignette":"患者男，35岁，确诊鼻咽癌多发转移（肝、骨、肺、腹膜）6年余。既往接受过多线系统治疗，包括顺铂、卡培他滨、特瑞普利单抗、替雷利珠单抗等。2021-12-08 医嘱记录为“泽菲（吉西他滨）0.5 g + 达伯舒（信迪利单抗）100 mg + 艾滨（卡培他滨）500 mg bid”；2022-03-02 因病情进展调整为“多西他赛 60 mg + 达伯舒 100 mg + 艾滨 500 mg bid”。治疗期间患者诉指端麻木，评估为 Grade 2 周围神经毒性。\n\n当前时间：2022-06-28。复查影像学提示肝脏病灶较前增大约 25%，评效 PD。体格检查：ECOG 1 分，体重 52 kg，身高 168 cm。血生化：ALT 45 U/L，AST 38 U/L，Cr 78 μmol/L。患者明确表示希望继续积极治疗。","patient_id":"l4-patient-a3128abd6564d34c06077445"}
+{"id":"l4-sample-fb4c825cdadeb9665710da6a","question":"在当前时间节点（2025-01-25），本例患者后续全身治疗方案应如何选择或调整？","options":{"A":"继续给予“诺欣(78mg) + 泰欣生(200mg)”同步放化疗，维持原剂量强度以保证疗效。","B":"更换为标准方案“顺铂(100mg/m²) + 泰欣生(200mg)”同步放化疗，符合CSCO头颈部肿瘤指南I级推荐。","C":"药物变更为“注射用洛铂(46mg) + 泰欣生(200mg)”同步放化疗。","D":"暂停化疗，仅给予“泰欣生(200mg)”联合放疗，因患者近期化疗剂量波动提示耐受性极差。"},"answer":"C","vignette":"患者男，2024年约38岁。既往于2024-11-21确诊肿瘤复发。查体：ECOG 0-1，[2024-11-19] KPS评分:90.0，近期[2025-01-24] KPS评分保持90.0。既往无高血压、糖尿病史，窦性心律。 \n\n【既往治疗及原始医嘱记录】：\n1. 2024-11-25：诺欣(50mg) + 紫杉醇(白蛋白)(300mg) ivgtt + 卓仑(1500mg bid) po。\n2. 2024-12-16：诺欣(47mg) + 紫杉醇(白蛋白)(300mg) ivgtt + 卓仑(1500mg bid) po。\n3. 2025-01-03：开始放疗（计划结束时间2025-02-19）。\n4. 2025-01-06：诺欣(78mg) + 泰欣生(200mg) ivgtt。\n\n当前时间为2025-01-25，患者按计划返院进行下一周期治疗。血常规示轻度贫血（Hgb 105g/L），肝功能基本正常。","patient_id":"l4-patient-425ec49263caaa88fb6c7168"}
+{"id":"l4-sample-094df7dae1621405f0df4383","question":"最符合临床逻辑的初始处理是：","options":{"A":"立即启动 GP 方案（吉西他滨 + 顺铂）联合 PD-1 抑制剂","B":"在 PET/CT、MRI 及骨肿瘤 MDT 全部完成前，仅给予镇痛支持治疗，暂不启动任何抗肿瘤药物","C":"在尽快完成分期与 MDT 的同时，先以吉西他滨单药作为低强度过渡性全身治疗，并同步强化镇痛及骨病灶局部控制评估","D":"直接按局部晚期鼻咽癌处理，立即启动 TPF 诱导化疗（多西他赛 + 顺铂 + 氟尿嘧啶），待后续影像补全后再决定肱骨病灶性质","E":"优先行右肱骨广泛切除/固定术，鼻部病灶暂不处理","F":"直接行鼻咽部及肱骨病灶同步放化疗，配伍高剂量顺铂","G":"优先行 PD-1 抑制剂单药治疗，待肱骨病理复核后再决定是否加化疗","H":"优先采用蒽环/异环磷酰胺类肉瘤化疗，鼻部病灶暂按第二原发待查处理"},"answer":"C","vignette":"患者男，40岁（1984年生），既往体健，无吸烟史。因“右侧鼻塞伴右上臂疼痛”就诊。\n\n【2024-12-10 病理资料】\n-鼻部病灶活检（[标本13]）：右侧下鼻道肿物。免疫组化：p63(-), EGFR(部分+), Ki-67(60%), CK(AE1/AE3)(少量弱+), S-100(-), SATB2(+), CD20(-), EBERs(+)。病理意见：倾向 未分化型非角化性癌。\n-右肱骨穿刺（[标本14]）：软骨组织增生，可见双核软骨样细胞。免疫组化：Vimentin(+++), S-100(++), SATB2(+), p53(5%), Ki-67(5%)。病理意见：倾向 软骨肉瘤。\n【治疗前短期状态变化】\n2024-12-13 入院评估：KPS 90分。\n2024-12-16 疼痛明显加重，夜间痛影响睡眠，右上臂活动受限，KPS降至 70分。\n2025-01-03 复查：KPS进一步降至 50分，卧床时间 >50%。\n【辅助检查】\n-血常规：Hb 105 g/L，WBC 4.5×10^9/L，PLT 210×10^9/L\n-生化：ALT 35 U/L，Cr 78 μmol/L\n-EBV-DNA：2.1×10^4 copies/mL\n【当时诊疗背景】\n\n2024-12中旬时，鼻咽/头颈 MRI 及 PET/CT 尚在完善中，骨肿瘤 MDT 讨论结果未回。患者右上臂疼痛进行性加重，需尽快开始抗肿瘤及症状控制治疗。","patient_id":"l4-patient-8ba6ea8f2b1bc870f423d5b4"}
+{"id":"l4-sample-4e7fb0f95ab8abcc7d8efee1","question":"放疗期间最合理的同期系统治疗方案是：","options":{"A":"顺铂 100 mg/m² q3w 同期放疗","B":"卡铂 AUC 2 weekly 同期放疗","C":"洛铂 50 mg/m² q3w 同期放疗","D":"尼妥珠单抗 200 mg qw 同期放疗","E":"特瑞普利单抗 240 mg q3w 作为单药同期放疗","F":"吉西他滨 1000 mg/m² d1,8 同期放疗（单药放疗增敏）","G":"顺铂 + 尼妥珠单抗 双药同期放疗","H":"卡瑞利珠单抗 200 mg q3w 于放疗中段加入，作为唯一系统治疗","I":"奈达铂 80 mg/m² q3w 同期放疗","J":"奥沙利铂 100 mg/m² q3w 同期放疗"},"answer":"A","vignette":"患者男，40岁。主诉右侧鼻塞伴右上肢疼痛。2024-12-10 鼻咽镜活检（右侧下鼻道/鼻咽）示：未分化型非角化性癌，EBERs(+)，Ki-67 60%+；右肱骨穿刺活检示：软骨肉瘤（G2），考虑同步第二原发肿瘤，不作为鼻咽癌远处转移证据。\n\n2024-12-16 先给予吉西他滨 1.6 g d1,8。2025-01-03 复查时因肿瘤相关症状及全身状态差，生活需协助，日间卧床时间 >50%。经支持治疗及局部处理后，2025-03-06 开始鼻咽部根治性放疗；2025-03-20 查房时一般情况较前明显改善，ECOG 0–1。实验室检查：Hb 105 g/L，WBC 4.2×10^9/L，ALT 21 U/L，Cr 76 μmol/L，电解质正常；无听力损伤、无明显外周神经病变、无顺铂严重不良反应史记录。","patient_id":"l4-patient-8ba6ea8f2b1bc870f423d5b4"}
+{"id":"l4-sample-d53e44d1d85d1a1bf247055a","question":"结合该患者当前为局部区域复发M0且经评估不适合手术切除的情况，2023-02-21 时应选择的后续治疗策略是：","options":{"A":"吉西他滨 + 顺铂 + 卡瑞利珠单抗，按复发/转移一线系统治疗处理","B":"继续卡培他滨 + 白蛋白紫杉醇 + 顺铂，并加用尼妥珠单抗，计划后续序贯放疗","C":"立即行鼻咽部及颈部淋巴结挽救性手术","D":"超分割再程 IMRT 同期顺铂放化疗，以根治为目的","E":"常规分割再程 IMRT + 尼妥珠单抗单药同步","F":"常规分割再程 IMRT + 卡铂同步","G":"TPF 诱导化疗 3 周期后再决定是否放疗","H":"卡瑞利珠单抗 + 阿帕替尼作为主要治疗","I":"单纯再程 IMRT，不联合任何系统治疗","J":"白蛋白紫杉醇 + 卡培他滨维持治疗，待再次进展后再考虑局部治疗"},"answer":"D","vignette":"患者男，48岁（1975年生）。\n既往于 2020 年接受过根治性 IMRT 同步含铂治疗。\n2023-01-28 再次入院，KPS 100。MRI 及鼻咽镜提示鼻咽局部复发并双侧颈部淋巴结复发；PET/CT 未见远处转移。经 MDT 讨论，判定为 rT3rN2M0（AJCC 8th，局部区域复发）。病程记录于 2023-01-31 明确记载“复发确诊”。\n\n2023-01-29 起曾给予桥接性系统治疗：\n-卡培他滨 1500 mg po bid\n-白蛋白紫杉醇 340 mg iv\n-顺铂 51 mg iv（2 天）\n\n2023-02-21 再次入院拟行下一步治疗。查体：ECOG 0 分，血生化基本正常。进一步 MDT 评估认为：\n-复发灶范围广、毗邻颅底，不适合内镜挽救切除；\n-OAR 剂量评估后可行根治性再程放疗；\n-无听力损伤、无 Ccr <60 mL/min、无其他顺铂明确禁忌。","patient_id":"l4-patient-9c610d6acf1c4683e7c47466"}
+{"id":"l4-sample-f6fae77a0e67997a4708e615","question":"以下哪一项是当前最合理的下一步全身治疗策略？","options":{"A":"吉西他滨 + 顺铂 + 卡瑞利珠单抗","B":"白蛋白紫杉醇 + 顺铂 + 卡培他滨","C":"吉西他滨 + 顺铂 + 纳武利尤单抗","D":"纳武利尤单抗单药","E":"卡瑞利珠单抗 + 阿帕替尼","F":"卡培他滨单药","G":"吉西他滨单药","H":"特瑞普利单抗单药"},"answer":"E","vignette":"患者男，49岁。既往确诊鼻咽未分化型非角化性癌，cT3N2M0。\n\n【既往治疗史】\n2023-01-28 起接受诱导治疗：卡培他滨 + 白蛋白紫杉醇 + 顺铂。\n-后续完成同步放化疗：顺铂 + 尼妥珠单抗。\n2023-05-19 至 2023-06-16 接受强化治疗：吉西他滨 d1,8 + 顺铂 d1 + 卡瑞利珠单抗 d1，q3w。\n-此后继续 卡瑞利珠单抗 200 mg q3w 维持治疗，末次给药时间为 2024-01-05。\n\n【近期病情】\n2024-01-19 复查腹部 MRI 及穿刺病理示：肝 S6 段新发结节，病理 CK(+), p40(+), EBERs(+)；确诊为鼻咽癌肝转移。\n-目前 ECOG 0–1，KPS 100，肝肾功能可耐受系统治疗。\n-既往白蛋白紫杉醇治疗后遗留 1–2 级周围神经麻木，患者明确不愿再次接受紫杉类方案。\n-暂不考虑临床试验入组。","patient_id":"l4-patient-9c610d6acf1c4683e7c47466"}
+{"id":"l4-sample-4cec43926b837d57f01dfa31","question":"结合该患者目前出现鼻咽癌肝转移的复发转移状态，并参考CSCO/NCCN指南，2024年2月起更适合的系统治疗策略是？","options":{"A":"属于铂类及PD-1难治性复发，换用二线方案：卡培他滨单药或联合抗血管生成药物（如阿帕替尼）。","B":"既往已使用PD-1抑制剂（艾瑞卡），考虑免疫耐药，换用不同机制的免疫检查点抑制剂（如替雷利珠单抗）联合白蛋白紫杉醇。","C":"原方案再挑战（Re-challenge）：重启 吉西他滨 + 铂类（诺欣） + 卡瑞利珠单抗（艾瑞卡） 方案。","D":"患者ECOG 0分且无症状，考虑到多线化疗毒性累积，建议仅行卡瑞利珠单抗单药维持治疗。"},"answer":"C","vignette":"患者男，49岁，既往体健，无高血压糖尿病史，20年前曾行阑尾切除术。2023年初确诊鼻咽癌（cT3N2M0, III期）。\n\n既往治疗史如下（原始医嘱记录）：\n1. 2023-01-29至2023-02-21：行TP方案诱导化疗（白蛋白紫杉醇+诺欣）。\n2. 2023-03-14至2023-04-25：行同期放化疗。期间用药记录显示：\"2023-04-06: 泰欣生(尼妥珠单抗) 200mg + 诺欣(顺铂/奈达铂等铂类) 69mg\"。\n3. 放疗结束后行辅助/巩固治疗，记录显示：\"2023-05-19: 泽菲(吉西他滨) 1.72g + 诺欣 69mg + 艾瑞卡(卡瑞利珠单抗) 200mg\"；\"2023-06-16: 泽菲 1.73g + 诺欣 69mg + 艾瑞卡 200mg\"。此后未再行抗肿瘤治疗。\n\n2024-01-19 患者复查发现肝脏新发占位，穿刺病理提示：EBV(+) 淋巴上皮癌，符合鼻咽癌肝转移。\n\n当前体能评估：\"2024-02-05 KPS:100 ECOG:0\"。血生化显示：ALT 25 U/L, AST 30 U/L, Cr 78 μmol/L, BUN 5.2 mmol/L。心电图示：窦性心律，大致正常心电图。","patient_id":"l4-patient-9c610d6acf1c4683e7c47466"}
+{"id":"l4-sample-1a6feede4e0abf9f3eddf2f4","question":"2023-06-16 时，该患者应如何处理？","options":{"A":"吉西他滨 + 卡瑞利珠单抗","B":"5月19日已进入“吉西他滨 + 诺欣 + 卡瑞利珠单抗”新方案节律，当前 PS 极佳、血象和肝肾功能可接受，今日应继续该联合方案进入下一周期","C":"今日应在“GP+卡瑞利珠单抗”基础上加回泰欣生以增强抗 EGFR 作用","D":"虽无明显严重毒性，但考虑既往已有多周期含铂暴露，今日应提前结束联合治疗，直接转为卡瑞利珠单抗单药维持","E":"为预防后续铂类累积毒性，今日应主动将诺欣替换为卡铂，与吉西他滨和卡瑞利珠单抗联合","F":"由于 rT3N2 局部负荷仍高，今日应暂停全身治疗，优先转入鼻咽及颈部再照射同步放化疗","G":"既往含紫杉类方案失败，提示吉西他滨方案获益有限；今日更合理的是改为“多西他赛 + 卡瑞利珠单抗”二线治疗","H":"鉴于患者目前症状轻、PS 好，可先观察，待明确出现影像学进展或 ≥2 级毒性后再决定是否继续 GP+免疫"},"answer":"B","vignette":"患者男，48岁。2016年曾接受根治性放化疗。2023年初因鼻咽癌复发再次就诊。\n2023年2月、3月曾接受含紫杉类 + 诺欣 + 泰欣生（尼妥珠单抗）的姑息系统治疗；2023-04-06 继续执行“泰欣生 200 mg + 诺欣 69 mg”方案。随后复评发现病灶模式与前期治疗目标不匹配，治疗策略调整。\n\n【复评后关键信息】\n影像学评估提示：鼻咽及颈部复发病灶持续存在，并合并远处转移，综合评估为 rT3N2M1；\n-MDT 认为当前无手术或根治性再照射机会，应以全身治疗为主；\n2023-05-19 起改用新方案：\n-泽菲（吉西他滨）1.72 g d1,8 + 诺欣 69 mg d1,2 + 艾瑞卡（卡瑞利珠单抗）200 mg d1；\n2023-05-26 已完成该周期 d8 吉西他滨。\n【2023-06-16 今日复查】\n-ECOG 0 分，KPS 100；\n-Hgb 108 g/L，WBC 4.1×10^9/L，PLT 185×10^9/L；\n-ALT 25 U/L，Cr 78 μmol/L；\n-患者仅诉既往轻度恶心，已缓解，无明显感染、出血或器官功能异常。","patient_id":"l4-patient-9c610d6acf1c4683e7c47466"}
+{"id":"l4-sample-2e8b6049507845345d8311da","question":"2025-04-10 时，该患者应采用哪种同期系统治疗策略？","options":{"A":"继续顺铂 100 mg/m² d1，q3w，同期放疗","B":"顺铂 80 mg/m² d1 + 5-FU 1000 mg/m² d1-4（PF）同期放疗","C":"停用顺铂，改为奈达铂 100 mg/m² q3w（或等效分次 d1-3）继续同期放疗","D":"停用顺铂，改为卡铂 AUC 5 q3w 同期放疗","E":"暂停全部化疗，仅继续放疗","F":"吉西他滨 1000 mg/m² d1,8 同期放疗","G":"尼妥珠单抗 200 mg qw 同期放疗","H":"顺铂减量至 40 mg/m² weekly 同期放疗"},"answer":"C","vignette":"患者男，2025年约54岁。确诊鼻咽未分化型非角化性癌，分期 cT3N0M0（AJCC 8th III期）。2025-03-18 开始根治性 IMRT。\n2025-03-17 至 2025-03-19 接受第一周期同期化疗：顺铂（诺欣）58 mg d1-3。\n\n当前时间：2025-04-10，拟行第二周期同期系统治疗。\n查体与辅助检查：\n-KPS 80，神清，精神稍差\n-身高 165 cm，体重 48 kg\n-口腔黏膜 I 度反应\n-WBC 3.5×10^9/L，NEUT 1.8×10^9/L，HGB 102 g/L，PLT 145×10^9/L\n-ALT 35 U/L，AST 40 U/L，Cr 124 μmol/L，BUN 8.2 mmol/L\n-心电图：窦性心律，未见明显异常","patient_id":"l4-patient-f36363284c62b9db744cffe5"}
+{"id":"l4-sample-ed3aec0732ca36334910104a","question":"以下哪一项是当前最合理的一线治疗决策？","options":{"A":"诱导化疗（TPF：多西他赛 + 顺铂 + 5-FU）2–3 周期后序贯 IMRT","B":"IMRT + 顺铂 100 mg/m² q3w × 2–3 周期","C":"IMRT + 每周顺铂 40 mg/m² × 6–7 周","D":"IMRT + 奈达铂 100 mg/m² q3w","E":"IMRT + 卡铂 AUC 5 q3w","F":"单纯 IMRT","G":"诱导 GP（吉西他滨 + 顺铂）2–3 周期后 IMRT","H":"IMRT + 特瑞普利单抗同步治疗"},"answer":"F","vignette":"患者男，2025年约54岁。因“回吸性涕血”入院。既往有“慢性胃炎”病史，否认高血压、糖尿病。入院查体：身高 165 cm，体重 42 kg，心率 78 次/分，律齐。\n\nMRI 及鼻咽镜提示：鼻咽右侧咽隐窝肿物，侵犯翼外肌。\n病理活检（2025-03-11）：未分化型非角化性癌，EBERs（+++）。\n按 AJCC/UICC 第9版 评估为 cT3N0M0（II期）。\n\n【关键检查】\n\n体能状态：\n2025−03−04 KPS 80；\n2025−03−17 KPS 80。\n-治疗前血浆 EBV DNA 1.2×10³ copies/mL。\n-原发肿瘤体积评估：非 bulky；无颈部淋巴结转移，无 IV/Vb 区淋巴结受累。\n-血生化：白蛋白 36 g/L，BUN 7.8 mmol/L，Cr 118 μmol/L，LDH 180 U/L。\n-心脏彩超：LVEF 62%。\n\n患者于 2025-03-17 准备开始根治性治疗。","patient_id":"l4-patient-f36363284c62b9db744cffe5"}
+{"id":"l4-sample-603d818c39201b7b23486c7b","question":"2025-04-11 放疗结束后的最合理后续系统治疗策略是：","options":{"A":"给予 PF 方案（顺铂 + 5-FU）辅助化疗 3 周期","B":"在充分告知证据局限的前提下，可考虑恢复并延续卡培他滨（卓仑）1500 mg bid 口服维持/巩固治疗，先行 1 个周期后评估耐受性与疗效，必要时调整或中止","C":"继续顺铂（诺欣）66 mg q3w 巩固 2 周期","D":"给予 TP 方案（紫杉醇 + 顺铂）辅助化疗 2 周期","E":"放疗已结束且当前无明确脏器功能损害，直接观察随访，不再给予任何全身治疗","F":"继续“诺欣（尼妥珠单抗）”维持治疗 6 个月","G":"将顺铂改为卡铂，给予卡铂 + 5-FU 巩固 2 周期"},"answer":"B","vignette":"患者男，40 岁。2021 年曾接受鼻咽癌根治性放化疗。2024-12-12 复查评估为鼻咽癌局部区域复发，分期 rT4N1M0。\n\n复发后原始全身及局部治疗医嘱记录如下（药物按医嘱原文记录，不对具体通用名作预判）：\n\n2024-12-17：卓仑 1500 mg bid + 紫杉醇 249 mg + 诺欣 50 mg\n2025-01-07：同方案\n2025-02-05：同方案\n2025-02-24：诺欣 66 mg\n2025-02-27：放疗开始\n2025-03-17：诺欣 66 mg\n2025-04-11：放疗结束\n\n按身高 166 cm、体重 52 kg 估算，体表面积（BSA）约 1.56 m²，此前诱导阶段紫杉醇 249 mg 属于剂量较高的一档。\n\n2025-04-11 放疗结束时患者情况：\n- ECOG 体能状态评分 1 分\n- 实验室检查：ALT 35 U/L，血清肌酐（Cr）72 μmol/L\n- 既往病史：慢性胃炎，幽门螺杆菌检测阴性\n- 主诉：双足底麻木明显，伴踩棉花样感觉，手部系扣稍有困难\n- 纯音测听：双耳 4000 Hz 听阈 25 dB\n\n需在此基础上考虑后续系统治疗策略。","patient_id":"l4-patient-2b87b834790012b3edb5cc08"}
+{"id":"l4-sample-1e0e514538026797a284b594","question":"最合理的药物医嘱建议是：","options":{"A":"继续 卓仑 1500 mg bid 连续口服","B":"上调至 卓仑 2000 mg bid 连续口服","C":"下调至 卓仑 1000 mg bid 连续口服","D":"停用卓仑，改为铂类 q3w 维持","E":"改为 卓仑 1000 mg/m² bid，d1–14，q3w","F":"改为 卓仑 650 mg/m² bid 连续口服","G":"停用卓仑，改为尼妥珠单抗维持","H":"停用全部口服治疗，改为吉西他滨单药"},"answer":"A","vignette":"患者男，41岁，既往确诊鼻咽癌复发（rT4N1M0）。\n\n【既往治疗史】\n\n2024-12-17、2025-01-07、2025-02-05：接受 TPC 诱导治疗（卓仑 1500 mg bid + 紫杉醇 249 mg + 铂类 50 mg）\n2025-02-27 至 2025-04-11：接受放疗；同期于 2025-02-24、2025-03-17 分别接受铂类增敏\n2025-04-11 起进入口服卓仑维持治疗，剂量为 1500 mg bid，连续口服；2025-07-11 继续原剂量续方\n\n【当前就诊】\n2025-08-26 返院复查：身高 172 cm，体重 75 kg，KPS 90，WBC 4.2×10^9/L，Hgb 128 g/L，PLT 185×10^9/L，Cr 82 μmol/L；患者自述手足皮肤无明显破溃或疼痛（HFS 0 级），无腹泻。","patient_id":"l4-patient-2b87b834790012b3edb5cc08"}
+{"id":"l4-sample-1341749340de42d32541bdb5","question":"最合理的治疗决策是：","options":{"A":"继续当前含铂 + 尼妥珠单抗 + 放疗，原剂量不变","B":"改为高剂量顺铂（100 mg/m² q3w）+ 放疗","C":"改为白蛋白紫杉醇 + 尼妥珠单抗 + 放疗","D":"暂停进一步细胞毒同步治疗，继续完成当前 IMRT 计划；可保留尼妥珠单抗联合放疗","E":"改为每周卡铂 AUC 2 + 放疗","F":"暂停放疗与全部抗肿瘤治疗，待肾功能完全恢复后再重启","G":"改为奥沙利铂 + 尼妥珠单抗 + 放疗","H":"放疗结束后再补 2 周期多西他赛 + 含铂治疗"},"answer":"D","vignette":"患者男，50 岁。确诊鼻咽未分化型非角化性癌，cT3N1M0（III期），EBER(+)。\n\n【既往治疗史】\n2022-12-20、2023-01-13：完成 2 周期诱导治疗，方案为多西他赛 + 含铂方案 + 尼妥珠单抗。\n2023-02-06：开始根治性 IMRT；同期治疗为含铂方案 + 尼妥珠单抗，停用多西他赛。\n放疗期间不良反应：恶心 II 度、乏力 I 度。\n\n【2023-02-27 当前评估】\n-KPS 90 分，体型消瘦，口腔黏膜炎 I 度，颈部淋巴结触诊阴性。\n-血常规：WBC 3.2×10^9/L，NEUT 1.8×10^9/L，Hb 96 g/L，PLT 110×10^9/L。\n-生化：ALT 32 U/L，AST 28 U/L，Scr 142 μmol/L，BUN 8.5 mmol/L，Alb 38 g/L。\n-身高 172 cm，体重 45 kg。\n-既往青霉素皮试阳性。","patient_id":"l4-patient-c091609a7b34fb0196ac7ef6"}
+{"id":"l4-sample-08c21850fcbc362c0012bd33","question":"结合上述病情与检查结果，目前应选择哪种抗肿瘤治疗策略？","options":{"A":"同步放化疗：顺铂 100mg/m² q3w + 泰欣生 200mg qw + IMRT","B":"同步放化疗：继续维持原方案（多西他赛 111mg + 诺欣 37mg + 泰欣生 200mg）+ IMRT","C":"同步放化疗：诺欣（奈达铂）80-100mg/m² q3w + 泰欣生 200mg qw + IMRT，并不再联合多西他赛","D":"诱导化疗：调整为 TPF 方案（多西他赛 + 顺铂 + 氟尿嘧啶）继续诱导2周期后再行放疗"},"answer":"C","vignette":"患者男，2022年约49岁。既往确诊鼻咽癌，于2022-12-16经病理（活检部位：鼻咽）证实为“未分化型非角化性癌”，EBERs(+)，临床分期rT3N1M0 (III期)。\n\n既往治疗史如下：\n1. 2022-12-20：予以“多西他赛 110mg + 诺欣 36mg + 泰欣生 200mg”方案治疗，KPS 90。\n2. 2023-01-13：予以“多西他赛 111mg + 诺欣 37mg + 泰欣生 200mg”方案治疗。护士记录显示该次多西他赛输注期间患者曾出现短暂面部潮红及胸闷，经对症处理后缓解。KPS 90。\n\n当前时间为2023-02-06。拟行根治性放疗。查体：ECOG PS 1分，体重 52kg。辅助检查显示：血常规WBC 3.8×10^9/L，NEUT 1.9×10^9/L，HGB 105g/L（轻度贫血）；生化检查示 ALT 28 U/L，AST 32 U/L，血清肌酐(Cr) 138 μmol/L。纯音测听示双耳高频听力轻度下降（25dB）。","patient_id":"l4-patient-c091609a7b34fb0196ac7ef6"}
+{"id":"l4-sample-3b2c2cf282041848b73dc7ab","question":"针对该患者当前的器官功能状态，最合理且安全的同期系统增敏决策是什么？","options":{"A":"顺铂 100 mg/m² q3w 同期放疗","B":"尼妥珠单抗 200 mg qw 同期放疗","C":"顺铂 40 mg/m² weekly 同期放疗","D":"奈达铂 100 mg/m² q3w 同期放疗","E":"卡铂 AUC 5 q3w 同期放疗","F":"IMRT 单独治疗","G":"多西他赛 + 顺铂诱导后单纯放疗","H":"尼妥珠单抗 + 卡铂 同期放疗"},"answer":"E","vignette":"患者男，43 岁。\n2023-09-05 鼻咽镜活检示：鼻咽未分化型非角化性癌，EBER(+）。\n2023-09-11 影像学评估：cT3N0M0。\n补充检查：治疗前血浆 EBV DNA 18,500 copies/mL；颈部淋巴结均 <3 cm，无 IV/Vb 区淋巴结，无影像学包膜外侵。\nKPS 90。\n实验室：WBC 5.1×10^9/L，HGB 131 g/L，PLT 210×10^9/L；ALT 22 U/L，AST 18 U/L，ALB 39 g/L，Scr 132 μmol/L，BUN 6.8 mmol/L。\n体格：身高 172 cm，体重 50 kg。\n计划于 2023-09-21 开始 IMRT。","patient_id":"l4-patient-79ee5f3a984ec25826465367"}
+{"id":"l4-sample-62fd35c134c8bac78805d881","question":"结合该患者的风险分层，以下哪一项是当前最合理的即刻启动治疗方案？","options":{"A":"诱导化疗（吉西他滨 + 顺铂）2–3 周期后序贯 IMRT + 顺铂同步放化疗","B":"单纯 IMRT","C":"IMRT + 尼妥珠单抗 200 mg/周","D":"IMRT + 卡培他滨单药口服同步治疗","E":"【不推荐】IMRT + 顺铂 100 mg/m² q3w（针对存在 EBV DNA 高负荷或 bulky 肿瘤等高危因素者）","F":"【不推荐】IMRT + 每周顺铂 40 mg/m²（针对存在 EBV DNA 高负荷或 bulky 肿瘤等高危因素者）","G":"诱导 TPF（多西他赛 + 顺铂 + 5-FU）后 IMRT","H":"IMRT + 特瑞普利单抗同步治疗"},"answer":"B","vignette":"患者男，43 岁，既往体健，无吸烟史。2023-08-28 因“回吸性涕血”就诊。\n鼻咽镜及活检（2023-09-05）提示：鼻咽顶后壁新生物，病理确认为未分化型非角化性癌（EBER+）。\n\n【分期与影像】\n-MRI：鼻咽顶后壁增厚，侵犯斜坡骨质及咽旁间隙；\n-双侧颈部 II 区可见多发小淋巴结，短径均 <5 mm，MRI 未达转移判定标准；\n-PET/CT 未见阳性颈淋巴结及远处转移；\n-临床分期：cT3N0M0。\n\n【关键评估数据】\n[2023-08-28] KPS 90\n[2023-09-11] KPS 90\n[2023-09-20] KPS 90\n-血常规：WBC 5.2×10^9/L，HGB 135 g/L，PLT 210×10^9/L\n-生化：ALT 25 U/L，AST 28 U/L，TBIL 12 μmol/L\n-心电图：窦性心律，大致正常\n-治疗前血浆 EBV DNA：1,200 copies/mL\n-原发灶体积评估：非 bulky\n-既往无慢性肾病、听力下降或化疗禁忌证记录","patient_id":"l4-patient-79ee5f3a984ec25826465367"}
+{"id":"l4-sample-d674275c11ff4292be0660a6","question":"根据该患者目前的临床情况及影像学表现，下一步首选的治疗方案是？","options":{"A":"鼻内镜下鼻咽病损切除术（Endoscopic Nasopharyngectomy）","B":"姑息性化疗（Gemcitabine + Cisplatin）维持治疗","C":"调强放射治疗（IMRT）再程放疗","D":"最佳支持治疗（BSC）"},"answer":"C","vignette":"患者女，2018年约44岁。2018-03-05 因“涕中带血伴右侧鼻塞1个月”入院。既往史：2012年确诊鼻咽癌（T2N1M0），行根治性放化疗，末次治疗时间2012-08-15，此后定期复查无异常。无高血压、糖尿病史，2001年行剖宫产术。\n\n【入院检查数据】\n[2018-03-05] EBV-DNA定量检测: 4.53E+04 copies/ml。\n[2018-03-09] 体能状态评估: KPS评分 90.0。\n[2018-03-06] 血常规: WBC 5.1×10^9/L, Hgb 114 g/L, PLT 205×10^9/L。\n[2018-03-06] 鼻咽+颈部MRI报告（原始文本）：鼻咽顶后壁软组织增厚，T1WI呈等信号，T2WI呈稍高信号，病变累及右侧咽旁间隙，斜坡骨质可见T1WI低信号影取代高信号骨髓影。病灶包绕右侧颈内动脉（ICA），包绕角度约280°，与动脉壁分界不清。双侧颈部未见明显肿大淋巴结。胸腹部CT未见远处转移征象。","patient_id":"l4-patient-f403cb90c0f1c2ea880d7372"}
+{"id":"l4-sample-8a99d8fe2f26afe7e1551a66","question":"该患者下一步最佳的全身系统治疗策略是？","options":{"A":"GP方案（吉西他滨 + 顺铂）","B":"TP方案（多西他赛 + 顺铂）","C":"重新启用含洛铂的双药联合方案（如洛铂 + 氟尿嘧啶）","D":"免疫检查点抑制剂单药治疗（如特瑞普利单抗或卡瑞利珠单抗）"},"answer":"D","vignette":"患者男，42岁，确诊鼻咽未分化型非角化性癌（cT3N2M0）。\n\n【既往治疗史】\n1. 2024-11-12起行诱导化疗联合同期放疗。化疗方案为注射用洛铂+氟尿嘧啶。首周期（2024-11-12）洛铂剂量57mg。第二周期（2024-12-03）洛铂剂量57mg。第三周期（2024-12-23）洛铂剂量调整为53mg。\n2. 放疗于2024-12-31结束。\n3. 2025-01-22至2025-06-18 口服卡培他滨维持治疗。\n4. 2025-07-15 复查发现颈部淋巴结增大，穿刺证实复发，随即开始泽菲（吉西他滨）单药治疗。\n\n【当前状况】\n2025-09-08复查，患者主诉轻微乏力，食欲尚可。查体：ECOG PS 0分（KPS 90），BMI 22.5，心肺听诊无殊，既往有阑尾切除术史。血常规示：Hb 105g/L，WBC 3.8×10^9/L，PLT 95×10^9/L。生化全项：ALT 28 U/L, AST 32 U/L, Cr 88 μmol/L。EBV-DNA 4.5×10^3 copies/ml。\n\n影像学评估提示病情进展（PD），现拟调整下一线治疗方案。","patient_id":"l4-patient-1958d0c397a125801420afc5"}
+{"id":"l4-sample-77ae402a3126d40db1e7c80e","question":"以下哪一项是当前最合理的一线系统治疗方案？","options":{"A":"吉西他滨 + 顺铂（GP）","B":"特瑞普利单抗 + 吉西他滨 + 顺铂","C":"吉西他滨单药化疗","D":"多西他赛 + 顺铂 + 5-FU (TPF方案)","E":"特瑞普利单抗单药","F":"卡培他滨 + 阿帕替尼","G":"卡瑞利珠单抗 + 阿帕替尼","H":"先行骨转移姑息放疗，同时尽快启动全身系统治疗"},"answer":"B","vignette":"患者男，42 岁。2024 年 9 月确诊鼻咽未分化型非角化性癌，cT3N3M0。\n\n【既往治疗】\n2024-11-12 至 2024-12-31：完成根治性 IMRT，同期联合洛铂化疗；\n2024-11-12：洛铂 57 mg\n2024-12-03：洛铂 57 mg\n2024-12-23：洛铂 53 mg\n2025-01-22 至 2025-06-18：规律口服卡培他滨 2000 mg bid 辅助治疗。\n既往未接受任何 PD-1/PD-L1 抑制剂治疗。\n\n【当前状态】\n2025-06-27：因腰痛复查，PET-CT 提示：\n-肝 S6 段新发结节 2.3 cm；\n-L3–L4 椎体骨质破坏，代谢活跃；\n-结合病史考虑多发远处转移。\n-ECOG PS 1，KPS 90。\n-身高 172 cm，体重 65 kg。\n-血常规：WBC 4.1×10^9/L，NEUT 2.5×10^9/L，PLT 110×10^9/L，Hgb 105 g/L。\n-生化：Cr 82 μmol/L，肝功能基本正常。\n-既往窦性心律不齐，无糖尿病。","patient_id":"l4-patient-1958d0c397a125801420afc5"}
+{"id":"l4-sample-05fe75eef217cf1a3eb6cc6f","question":"在该患者目前治疗完成后的随访节点，下一步最合适的系统治疗策略是：","options":{"A":"吉西他滨 1000 mg/m² d1,8 + 顺铂 80 mg/m² d1，q3w ×3","B":"多西他赛 75 mg/m² + 顺铂 75 mg/m²，q3w ×3","C":"替加氟单药口服维持","D":"节拍卡培他滨 650 mg/m² bid，连续口服 1 年，用于复发高危但不符合常规辅助卡培他滨人群的探讨性方案","E":"辅助卡培他滨，按中度肾功能不全起始减量（约 75% 标准起始剂量，如 750 mg/m² bid，d1–14，q3w，共 8 周期）","F":"再追加一疗程高剂量顺铂 100 mg/m²","G":"单用卡瑞利珠单抗维持（不作为当前根治性放化疗后标准辅助方案）","H":"卡铂 + 5-FU 辅助化疗"},"answer":"E","vignette":"患者男，67 岁。确诊鼻咽未分化型非角化性癌，临床分期 cT4N0M0（AJCC 8th IVA 期）。治疗前血浆 EBV DNA：32,000 copies/mL。\n\n【既往治疗记录】\n诱导化疗阶段（均为 3 周一周期方案）：\n2024-11-12：以铂类为基础的联合化疗，第 1 周给药，顺铂剂量约 80 mg/m²，d1；联合药物按常规剂量给药\n2024-12-03：以铂类为基础的联合化疗，第 2 周期，顺铂剂量约 80 mg/m²，d1；联合药物按常规剂量给药\n\n同步放化疗阶段：\n2024-12-25：放疗开始，同期给顺铂约 100 mg/m²，d1\n2025-01-17：同步化疗继续，顺铂约 100 mg/m²，d1\n2025-02-12：放疗结束，完成根治性同步放化疗。\n\n2025-02-18 复查：\n- KPS 90\n- 口腔黏膜 I 度反应\n- WBC 3.1×10^9/L，HGB 108 g/L，PLT 110×10^9/L\n- ALT 28 U/L，AST 32 U/L，BUN 8.5 mmol/L，Cr 112 μmol/L\n- 体重 48 kg\n- 复查头颅及颈部 MRI：原发灶及颈部淋巴结较治疗前明显缩小，未见明确进展征象；是否存在极少量残余病灶需随访动态评估\n- 复查胸部及上腹部影像学检查：未见远处转移的影像学证据\n- 当前随访评估阶段的主要目标为在完成根治性同步放化疗后，根据患者全身状况和近期疗效评估结果，考虑后续是否需要进一步全身系统治疗或仅随访观察。","patient_id":"l4-patient-6dce48ce01f237aeb1d3fc01"}
+{"id":"l4-sample-d04287fae4fc692473e24fc1","question":"以下哪一项是当前最合理的诱导化疗选择？","options":{"A":"TPF：多西他赛 75 mg/m² + 顺铂 75 mg/m² + 5-FU 750 mg/m²/d","B":"GP：吉西他滨 1000 mg/m² d1,8 + 顺铂 80 mg/m² d1，强化水化并严密监测肾功能","C":"奈达铂 80–100 mg/m² + 5-FU 750–1000 mg/m²/d","D":"单纯 IMRT，不做诱导化疗","E":"TPC：白蛋白紫杉醇 + 顺铂 + 卡培他滨","F":"多西他赛 + 奈达铂 + 5-FU","G":"直接进入同步放化疗，不做诱导化疗","H":"GP + PD-1 抑制剂诱导后序贯同步放化疗"},"answer":"B","vignette":"患者男，36 岁。2022 年 10 月 26 日因“回吸性涕血”就诊，鼻咽镜活检病理示：未分化型非角化性癌。\n2022 年 10 月 28 日完善检查：EBV-DNA 4.43×10³ copy/mL。MRI 提示鼻咽顶后壁肿物侵犯颅底骨质，双侧颈部多发肿大淋巴结，最大径约 5.5 cm，并见包膜外侵犯。临床分期 cT3N2M0（III期，CNTS 2017）。\n\n【既往史】\n2015 年阑尾切除术。否认高血压、糖尿病。吸烟 10 年，约 1 包/日。\n\n【入院评估】\n-ECOG 0 分\n-身高 172 cm，体重 50 kg，近期因吞咽困难下降 5 kg\n-血常规正常\n-听力测试正常\n-心电图：窦性心律\n-生化：BUN 7.2 mmol/L，Cr 116 μmol/L，Alb 38 g/L","patient_id":"l4-patient-af65b2d32394ce30ff18d208"}
+{"id":"l4-sample-60c87e8a24576d40f69ba76e","question":"哪一项最符合现阶段二线治疗的规范化选择？","options":{"A":"吉西他滨 + 顺铂 + 继续原 PD-1（拓益）","B":"卡培他滨单药","C":"吉西他滨 + 长春瑞滨（诺维本）","D":"替雷利珠单抗 + 吉西他滨 + 长春瑞滨","E":"原方案（洛铂 + 白蛋白紫杉醇 + 拓益）加量，并联合抗血管生成药物","F":"伊立替康单药","G":"卡瑞利珠单抗 + 阿帕替尼","H":"先对肺部病灶及远处淋巴结行局部放疗，暂不更换全身治疗"},"answer":"C","vignette":"患者男，38岁。2022-10 确诊鼻咽未分化型非角化性癌，后按局部晚期路径完成诱导化疗及同期放化疗。2024-01-10 复查发现多发肺转移及远处淋巴结转移，进入复发/转移阶段。\n\n2024-01-12 起接受一线姑息系统治疗：\n洛铂 50 mg d1 + 白蛋白紫杉醇 400 mg d1 + 拓益（特瑞普利单抗）240 mg d1，q3w。\n病历显示该方案末次用药时间为 2024-03-15。\n2024-04-08 复查 CT：肺部病灶较前增大，远处淋巴结较前增多，评估为 PD。\n\n当前状态：KPS 90，ECOG 0，血常规及生化基本正常，既往仅有轻度窦性心律不齐。患者此前未接受过吉西他滨、长春瑞滨或伊立替康。","patient_id":"l4-patient-af65b2d32394ce30ff18d208"}
+{"id":"l4-sample-f6d6c4138388329bd6f299ac","question":"最合理的医嘱建议是：","options":{"A":"维持原剂量：吉西他滨 1.71 g + 长春瑞滨 34 mg；并常规预防性使用长效升白针","B":"继续当前方案，但对吉西他滨按 d8 血液学毒性减至约 75% 剂量（约 1.25–1.30 g），长春瑞滨维持 34 mg","C":"暂停化疗，仅给予替雷利珠单抗 200 mg 维持，待血象完全恢复后再恢复化疗","D":"停止当前方案，改为尼妥珠单抗 + 替雷利珠单抗双药治疗","E":"当日全部停药，1 周后复查血常规再决定","F":"长春瑞滨减量至 50%，吉西他滨维持原剂量","G":"吉西他滨减量至 50%，长春瑞滨维持原剂量","H":"两药均减量 25%，并按常规计划完成本周期治疗"},"answer":"B","vignette":"患者男，38岁。确诊鼻咽癌未分化型非角化性癌（cT3N2M0）一年半后出现多发转移。既往史：2010年行阑尾切除术，窦性心律不齐。关键治疗时间轴如下：\n\n2024-01-12 至 2024-03-15：接受 洛铂 + 白蛋白紫杉醇 + 特瑞普利单抗。\n2024-04-08：因病情需要调整为 吉西他滨 1.72 g + 长春瑞滨 34 mg + 替雷利珠单抗 200 mg。\n2024-04-16：完成该周期 d8 给药：吉西他滨 1.71 g + 长春瑞滨 34 mg。\n2024-04-30：进入下一周期 d1：吉西他滨 1.71 g + 长春瑞滨 34 mg + 替雷利珠单抗 200 mg。\n\n今日日期：2024-05-07，为当前方案 d8 节点。\n患者自觉乏力，ECOG 1 分。\n实验室检查：\n-WBC 3.1×10^9/L\n-NEUT 1.6×10^9/L\n-PLT 88×10^9/L\n-HGB 108 g/L\n-肝肾功能基本正常（Cr 72 μmol/L）","patient_id":"l4-patient-af65b2d32394ce30ff18d208"}
+{"id":"l4-sample-ce3508588cb7c755c5eea6ec","question":"以下哪一项是最合理的下一步策略？","options":{"A":"继续第 4 周期减量诱导化疗，待血象进一步恢复后再开始放疗","B":"立即开始 IMRT，同期继续采用吉西他滨 + 铂类双药增敏","C":"立即开始 IMRT；同期仅保留单药铂类增敏，不再继续吉西他滨","D":"改为 PD-1 单药维持治疗，待疾病进展后再行局部治疗","E":"立即开始 IMRT，但完全取消所有同步系统治疗","F":"先行 2 周营养支持和升白治疗，待血红蛋白恢复正常后再决定是否放疗","G":"改为口服卡培他滨同步放疗，以避免再次出现中性粒细胞减少","H":"因既往出现 3 级中性粒细胞减少，应终止根治性综合治疗，改为姑息治疗"},"answer":"C","vignette":"患者男，64 岁。确诊鼻咽未分化型非角化性癌，cT4N1M0。既往行阑尾切除术，窦性心律，LVEF 62%。\n\n【治疗经过】\n2025-06-18（C1）及 2025-07-10（C2）：接受诱导化疗，方案为吉西他滨 + 铂类。\n2025-07-30 复查血常规：WBC 2.1×10⁹/L，NEUT 0.9×10⁹/L，PLT 68×10⁹/L。\n因出现3级中性粒细胞减少 + 2级血小板减少，2025-07-31（C3）化疗调整为减量方案。\n2025-08-27 距上周期 27 天返院，拟进入下一阶段治疗。\n\n【当前状态（2025-08-27）】\n-体重 48 kg，身高 165 cm，KPS 90 分\n-CBC 已恢复至：WBC 4.0×10⁹/L，NEUT 2.2×10⁹/L，PLT 132×10⁹/L，Hgb 103 g/L\n-生化：ALB 38 g/L，ALT 24 U/L，BUN 8.1 mmol/L，Cr 122 μmol/L","patient_id":"l4-patient-3d604d8be9f91f698f5622cf"}
+{"id":"l4-sample-2fb0423a27c2eb640c625fc7","question":"考虑患者肾功能，以下哪些诱导化疗方案可考虑？（多选）","options":{"A":"TPF：多西他赛 75 mg/m² d1 + 顺铂 75 mg/m² d1 + 5-FU 750 mg/m²/d 持续静滴 d1–5","B":"GP：吉西他滨 1000 mg/m² d1,8 + 顺铂 80 mg/m² d1","C":"吉西他滨1000 mg/m² d1,8 + 奈达铂（按肾功能调整剂量）","D":"GP：吉西他滨 1000 mg/m² d1,8 + 分次顺铂 25 mg/m² d1–3","E":"吉西他滨 1000 mg/m² d1,8 + 卡铂 AUC 5 d1","F":"吉西他滨单药 1000 mg/m² d1,8,15"},"answer":"C+E","vignette":"患者男，2025年约64岁。2025-06-13 行鼻咽镜活检，病理提示：（鼻咽右隐窝）镜下形态符合为癌。2025-06-18 入院进一步评估。既往体健，否认高血压、糖尿病史。\n查体：T 36.5℃，P 78 次/分，R 19 次/分，BP 125/78 mmHg。身高 168 cm，体重 52 kg。ECOG PS 0–1，KPS 90。\n实验室：WBC 5.1×10^9/L，NEUT 3.2×10^9/L，HGB 128 g/L，PLT 215×10^9/L；ALT 21 U/L，AST 19 U/L，TBIL 10.2 μmol/L，Alb 39.5 g/L，BUN 8.1 mmol/L，Cr 138 μmol/L。心电图示窦性心律。MRI 提示鼻咽顶后壁增厚，双侧颈部淋巴结肿大（cN2）。胸腹部评估未见明确远处转移，MDT拟进入鼻咽癌诱导化疗路径。","patient_id":"l4-patient-3d604d8be9f91f698f5622cf","question_type":"multiple_choice"}
+{"id":"l4-sample-af46f48995072887dcda8787","question":"基于该患者局部复发的特点、再程放疗计划及肾功能状况，最合理的同期增敏治疗方案是：","options":{"A":"顺铂 100 mg/m² q3w ×2–3 周期同步 Re-IMRT","B":"顺铂 40 mg/m² weekly ×6–7 周期同步 Re-IMRT","C":"卡铂（如 AUC 2 weekly 或等效方案）同步 Re-IMRT","D":"多西他赛 20–25 mg weekly 同步 Re-IMRT","E":"TPF ×2 周期后序贯 Re-IMRT（以根治为目的的一线系统治疗方案）","F":"尼妥珠单抗 200 mg weekly 同步 Re-IMRT","G":"多西他赛 + 西妥昔单抗 weekly 同步 Re-IMRT","H":"不予同步增敏，仅行免疫治疗或其他全身治疗"},"answer":"C","vignette":"患者女，48 岁。\n\n【现病史】\n既往鼻咽癌，2019 年于外院完成根治性放化疗。2022-06-28 复查发现鼻咽部复发，未即刻治疗。2022-11-14 鼻咽部活检病理示：未分化型非角化性癌。MRI 提示鼻咽顶后壁软组织增厚并侵犯斜坡骨质，未见远处转移。经 MDT 讨论：局部复发，病灶不适合手术切除，拟行挽救性 Re-IMRT。\n\n【基线情况（2022-11-22）】\n\n身高 158 cm，体重 42 kg\nECOG 0，KPS 90\nWBC 4.5×10^9/L，Hgb 108 g/L，PLT 210×10^9/L\nALT 18 U/L，AST 22 U/L，ALB 38 g/L\nBUN 8.2 mmol/L，Scr 128 μmol/L\n无高血压、糖尿病史","patient_id":"l4-patient-e239ad45c7484265986060f7"}
+{"id":"l4-sample-6b8c4bf3ed131dfbddb88f40","question":"当前应选择哪种一线系统治疗方案？","options":{"A":"吉西他滨 + 顺铂 + 特瑞普利单抗，q3w","B":"吉西他滨 + 白蛋白结合型紫杉醇 + 信迪利单抗，q3w","C":"多西他赛 + 顺铂 + 5-FU（TPF），q3w","D":"信迪利单抗单药，q3w","E":"吉西他滨 + 特瑞普利单抗，q3w","F":"紫杉醇 + 卡铂 + 西妥昔单抗","G":"吉西他滨单药","H":"继续观察，待肾功能进一步恶化后再开始治疗"},"answer":"E","vignette":"患者男，2025年约42岁。2025 年 7 月 25 日因“回吸性涕血伴颈部包块复发”入院。既往鼻咽癌 T3N2M0，于 2022 年 3 月完成 TP 诱导化疗 + 同期放化疗。\n\n【本次复发评估】\n-鼻咽 MRI：顶后壁软组织增厚，伴颈部淋巴结肿大，提示局部复发伴区域淋巴结复发。\n-MDT 讨论认为：复发灶范围较广，不适合直接手术；既往放疗靶区与当前复发区重叠明显，不宜立即行再照射，计划先行系统治疗后再评估局部挽救可能性。\n-ECOG PS 0–1，体重 64.5 kg，身高 174 cm。\n-血常规：WBC 5.1×10^9/L，Hb 108 g/L，PLT 215×10^9/L。\n-生化：ALT 28 U/L，AST 32 U/L，TBIL 12.1 μmol/L，ALB 39.5 g/L，BUN 8.9 mmol/L，Cr 158 μmol/L。\n-尿常规：蛋白(++)，隐血(-)。\n-既往无免疫治疗暴露。","patient_id":"l4-patient-f9a0e775203a3d9c35838513"}
+{"id":"l4-sample-0fe40ad1c49d12a793c58cd5","question":"在当前轻度骨髓抑制且放疗已进入最后一周的情况下，以下哪项最符合该患者第三次同步化疗处方的调整逻辑？","options":{"A":"维持原方案不变：奈达铂 54 mg/d × 3 天","B":"暂停第三次同步化疗，仅完成剩余放疗，以避免血液学毒性进一步加重","C":"改为顺铂 25 mg/m²/d × 3 天同步放疗","D":"将第三次奈达铂调整为 40 mg/m²/d × 3 天，在单周期总量适度下调的前提下压缩末周期给药时间，以适配放疗收尾","E":"将第三次奈达铂减为 40 mg/d × 2 天，以骨髓保护优先，允许总量明显下降","F":"改为卡铂 AUC 2 每周一次，直至放疗结束","G":"将第三次化疗顺延至 11-20 放疗结束后 1 周执行，避免同步期叠加毒性","H":"维持奈达铂 54 mg/d × 3 天，同时预防性加用 G-CSF 后继续同步","I":"取消本次铂类，仅加用尼妥珠单抗周疗法完成放疗收尾"},"answer":"A","vignette":"患者男，55岁。2024年9月因右颈部肿物就诊。鼻咽及右颈淋巴结活检均提示未分化型非角化性癌，综合评估为局部区域复发性鼻咽癌。经 MDT 讨论后，拟行再程根治性 IMRT，并采用单药铂类同步增敏策略。\n\n治疗时间轴\n放疗开始：2024-10-08\n计划放疗结束：2024-11-20\n第一次同步化疗（2024-10-01 至 10-03）：奈达铂 54 mg/d × 3 天\n第二次同步化疗（2024-10-23 至 10-25）：奈达铂 54 mg/d × 3 天\n体能及实验室\n-KPS：2024-09-19 / 09-30 / 10-23 / 11-13 均为 90\n2024-11-13（拟进行第三次同步化疗前）：\n-WBC 3.1×10^9/L\n-NEUT 1.8×10^9/L\n-PLT 95×10^9/L\n-HGB 105 g/L\n-ALT 35 U/L\n-Cr 88 μmol/L\n\n患者当前无发热、无活动性出血，食纳尚可，放疗已进入最后 1 周，需决定第三次同步化疗处方。","patient_id":"l4-patient-c60ba9a83039daaa18050e23"}
+{"id":"l4-sample-13518586edc7b1b12f62422c","question":"对于该患者，在肺部姑息放疗期间最合理的药物调整策略是：","options":{"A":"维持原方案：白蛋白紫杉醇 + 奈达铂 + 尼妥珠单抗 同步放疗","B":"方案降级：停用白蛋白紫杉醇和奈达铂，保留尼妥珠单抗，同步放疗","C":"更换为高剂量顺铂 100 mg/m² q3w 同步放疗","D":"放疗期间暂停系统药物，仅完成肺部放疗；放疗结束后再按转移性鼻咽癌标准系统治疗路径重评","E":"改为吉西他滨 + 顺铂 + PD-1 与肺部放疗同步启动","F":"改为单用尼妥珠单抗同步放疗"},"answer":"D","vignette":"患者男，2024年约61岁，EBV 相关鼻咽癌复发/转移，双肺多发转移。\n既往于 2024-10-18 和 2024-11-08 接受 2 周期全身治疗：\n-奈达铂 35 mg d1–3\n-尼妥珠单抗\n-白蛋白紫杉醇\n\n治疗期间曾出现 I 度骨髓抑制，后恢复。\n2024-11-28 起因肺部病灶症状明显，MDT 决定先行姑息性肺部放疗。\n2024-11-29 评估：患者生活可自理，但不能进行正常活动或工作，KPS 70。生命体征平稳。","patient_id":"l4-patient-7418b00645c59dda546ed27f"}
+{"id":"l4-sample-1e03afc0b5af7777f49206be","question":"在2023年12月15日复诊时，应如何调整或维持该患者的当前治疗方案？","options":{"A":"将卡培他滨剂量调整为 1500mg bid (约 1000mg/m²)，联合替雷利珠单抗维持治疗","B":"维持卡培他滨 1000mg bid，联合替雷利珠单抗治疗","C":"停用卡培他滨，单药使用替雷利珠单抗维持","D":"患者既往GP方案PFS < 6个月，提示铂耐药，换用吉西他滨单药维持"},"answer":"B","vignette":"患者女，55岁（1968年生）。\n\n【既往史】\n2023-04-25 确诊鼻咽未分化型非角化性癌（rT3N1M0）。\n2023-05-04 至 2023-06-19 行“泽菲(吉西他滨) + 诺欣(顺铂/奈达铂) + 泰欣生(尼妥珠单抗) + 拓益(特瑞普利单抗)”方案化疗联合免疫治疗。\n2023-07-06 至 2023-08-18 行放疗。\n2023-11-23 门诊医嘱调整为：替雷利珠单抗 200mg q3w + 卓仑(卡培他滨) 1000mg bid。\n\n【2023-12-15 复诊资料】\n查体：身高 160cm，体重 52kg (BSA ≈ 1.52 m²)。ECOG PS 1分。双足底可见轻度色素沉着及脱屑。\n实验室检查：HGB 108g/L (轻度贫血)，WBC 4.1×10^9/L，PLT 155×10^9/L。生化：ALT 25 U/L，AST 30 U/L，Cr 72 μmol/L (eGFR > 60)。心电图示窦性心律，HR 82次/分。\n\n【重要病史记录】\n查阅既往用药反馈记录（智能抓取）：'希罗达/卓仑 (1500mg bid 调整为 1000mg bid)'，备注提示既往尝试标准剂量时出现耐受性问题。","patient_id":"l4-patient-af24b92b505a08aa6623c2f0"}
+{"id":"l4-sample-1a2ad976336730b41fcfbb28","question":"站在最新的鼻咽癌临床指南的角度，最合理的治疗调整策略是：","options":{"A":"属于“铂敏感复发”，改回 GP（吉西他滨 + 顺铂）强化治疗","B":"恢复卡培他滨 1000 mg bid + 替雷利珠单抗 200 mg q3w","C":"剂量爬坡，重启卡培他滨 1500 mg bid + 替雷利珠单抗 200 mg q3w","D":"因既往出现过 2 级 HFS，永久停用卡培他滨，仅维持替雷利珠单抗单药","E":"改为固定低剂量卡培他滨 650 mg bid + 替雷利珠单抗"},"answer":"B","vignette":"患者女，56岁。\n\n既往病史\n\n2023年4月确诊鼻咽癌复发（rT3N1M0）。\n2023-05-04 至 2023-06-17 行诱导治疗：吉西他滨 + 奈达铂 + 尼妥珠单抗 + 特瑞普利单抗。\n2023-07-06 至 2023-08-18 行根治性放疗。\n2023-11-23 起进入维持治疗阶段，方案调整为：替雷利珠单抗 200 mg q3w + 卡培他滨（卓仑）1000 mg bid。\n\n近期治疗轨迹\n2024-01-26：替雷利珠单抗 + 卡培他滨 1000 mg bid\n2024-02-27：替雷利珠单抗 + 卡培他滨 1000 mg bid\n2024-03-29：仅给予替雷利珠单抗 200 mg（未见口服化疗医嘱）\n2024-04-26：仅给予替雷利珠单抗 200 mg（未见口服化疗医嘱）\n\n追问病史得知：患者 3–4 月期间因 2 级手足综合征（HFS） 暂停卡培他滨，现已完全缓解。\n\n当前就诊（2024-05-28）\n-身高 162 cm，体重 60 kg，BSA ≈ 1.63 m²\n-KPS 80\n-既往 HFS 已由 2 级恢复至 0 级\n-Hb 112 g/L，WBC 4.5×10^9/L，PLT 185×10^9/L\n-ALT 35 U/L，Cr 78 μmol/L\n-影像学评估：SD（病情稳定）","patient_id":"l4-patient-af24b92b505a08aa6623c2f0"}
+{"id":"l4-sample-64070dc4db3b1e16aebebc6e","question":"针对该患者当前疾病进展的情况，下一步最佳的治疗调整策略是？","options":{"A":"换用 GP 方案（吉西他滨 + 顺铂）再挑战","B":"将卡培他滨剂量恢复至 1500mg bid，联合替雷利珠单抗继续治疗","C":"在继续替雷利珠单抗治疗基础上，加用福可维（呋喹替尼），改为免疫联合抗血管生成靶向治疗的无化疗方案","D":"换用多西他赛 + 顺铂（TP方案）化疗"},"answer":"C","vignette":"患者女，2023年约55岁。2023年4月因“反复鼻咽部不适伴耳闷、颈部包块”就诊，经鼻咽部病理活检及影像学检查确诊为复发性鼻咽未分化型非角化性癌（rT3N1M0）。既往于2023年5月起接受吉西他滨联合铂类（GP方案）诱导化疗3周期，之后行同期放化疗，完成根治性放疗后于2023年11月起进入维持随访与系统治疗阶段。既往史：10年前行阑尾切除术；有窦性心律不齐病史，平素无明显心悸、胸闷不适，未见明确心功能不全记录。\n\n肿瘤相关实验室与分子检测方面：初诊及复发后多次复查EBV DNA水平均有升高趋势；2023年复发评估时行肿瘤组织及外周血分子检测，未见明确EGFR、ALK、ROS1等驱动基因可靶向突变。补充行FGFR家族相关基因检测，结果提示存在FGFR2基因相关异常表达/扩增改变（报告提示为潜在可靶向通路之一），但当时未根据此结果启动相应靶向治疗，仅作为后续治疗策略储备信息记录于病历中。\n\n2024年起，因影像学评估提示局部复发病灶仍有活动，患者在系统评估其一般状况尚可（ECOG 0–1分）后，开始接受免疫联合口服化疗药物的系统治疗。HIS用药记录显示：自2024-04-26起使用替雷利珠单抗维持抗肿瘤免疫治疗，至2025-09-09已累计约14个周期；2024-05-28起联合口服卡培他滨（希罗达/卓仑），初始剂量为1500 mg bid，因长期用药及耐受情况，于2024-12-13后调整为1000 mg bid，并间断根据血象和毒性反应做过给药间期与剂量微调。期间门诊随访记录提示患者对上述方案总体耐受尚可，偶有轻中度乏力、手足皮肤反应，未见≥3级肝肾功能异常。\n\n2025年7月4日复诊时，患者主诉近1个月来自觉右侧颈部胀痛感加重，日常活动较前稍易疲劳。查体：一般情况尚可，ECOG 评分1分，体重46 kg，身高158 cm；右侧颈部可触及多个肿大淋巴结，质中偏硬，活动度稍差，局部轻度压痛。心肺查体未见明显阳性体征，下肢无水肿。\n\n当日复查头颈部MRI显示：右侧颈链区域淋巴结较既往影像明显增大，部分结节融合，边界欠清；与前次评估相比，按实体瘤疗效评价标准判断为疾病进展（PD）。\n\n2025-07-04 实验室检查：\n- 血常规：WBC 3.8×10^9/L，Hb 102 g/L，PLT 135×10^9/L，提示轻度贫血及轻度骨髓抑制；\n- 生化全项：ALT 24 U/L，AST 28 U/L，BUN 8.1 mmol/L；肌酐（Cr）118 μmol/L，较以往略有升高，肾功能处于轻度受损范围，需在后续方案选择时兼顾药物的肾毒性风险与剂量调整原则。\n\n目前患者仍在接受替雷利珠单抗及口服卡培他滨治疗过程中，既往已经完成一线含铂化疗联合放疗，存在FGFR2相关分子异常记录，同时合并轻度肾功能损害和骨髓抑制表现。现因颈部病灶进展再次就诊，需在评估其全身状况、既往用药史和分子检测结果的基础上，综合考虑后续系统治疗与局部治疗的调整策略。","patient_id":"l4-patient-af24b92b505a08aa6623c2f0"}
+{"id":"l4-sample-f4e350273e852e059688d8af","question":"以下哪一项是当前最合理的下一步策略？","options":{"A":"继续维持原方案：替雷利珠单抗 200 mg q3w + 卡培他滨 1000 mg bid","B":"停止所有抗肿瘤药物，进入规范随访观察","C":"停用卡培他滨，仅保留替雷利珠单抗 200 mg q3w 单药维持","D":"更换为特瑞普利单抗，并联合低剂量节拍化疗","E":"改为替雷利珠单抗 + 阿帕替尼维持","F":"继续卡培他滨单药，停用 PD-1","G":"因病灶稳定，改为 q6w 替雷利珠单抗减量维持","H":"停用免疫治疗，但继续低剂量节拍卡培他滨 1 年"},"answer":"B","vignette":"患者女，57 岁（1968 年生），既往确诊鼻咽未分化型非角化性癌，cT3N1M0。\n\n【既往治疗】\n2023 年 5 月起：诱导治疗，方案为 吉西他滨 + 顺铂 + 特瑞普利单抗。\n随后完成根治性同步放化疗：放疗 + 尼妥珠单抗增敏。\n2023 年 11 月起进入后续治疗阶段：\n替雷利珠单抗 200 mg q3w，自 2023-11-23 持续至 2025-08-11，约 26 个周期；\n卡培他滨 自 2023 年 11 月起 1000 mg bid，2024-05-28 曾上调至 1500 mg bid，但 2024-12-13 因耐受性问题下调回 1000 mg bid，并维持至今。\n\n【当前状态（2025-09-09）】\n-KPS 80\n-MRI：鼻咽部病灶稳定，无新发转移\n-血常规：WBC 3.8×10^9/L，HGB 105 g/L，PLT 110×10^9/L\n-既往无特殊基础病，偶有窦性心律不齐","patient_id":"l4-patient-af24b92b505a08aa6623c2f0"}
diff --git a/L5/README.md b/L5/README.md
new file mode 100644
index 0000000000000000000000000000000000000000..36e6a69611750dfd4f9ef23e0a2a820012f0fc8d
--- /dev/null
+++ b/L5/README.md
@@ -0,0 +1,7 @@
+# L5: longitudinal decisions
+
+305 turns from 100 patients. Use the complete `prompt` as the model input. The answer, clinical explanation and decisive-condition fields are reference annotations, not input. Each prompt already contains its options.
+
+`全程D0` denotes the patient's first admission; `全程Dk` denotes the day relative to that admission. Dates are transformed within each patient without changing resolved intervals. `某年某月` retains the imprecise timing present in the source.
+
+Score turn accuracy and the fraction of patients with every evaluated turn correct. Auxiliary history conditions have their own inputs and should be evaluated as separate paired conditions.
diff --git a/L5/questions.jsonl b/L5/questions.jsonl
new file mode 100644
index 0000000000000000000000000000000000000000..4130ba4a8cecde1e770a6319d7e72b8c2ee0465d
--- /dev/null
+++ b/L5/questions.jsonl
@@ -0,0 +1,3 @@
+version https://git-lfs.github.com/spec/v1
+oid sha256:608f73877223a5b2d69fddd9ae87bfb9462a4660b9fc080edcc014f7c66dbfe7
+size 10885650
diff --git a/L6/carepath.tar.gz b/L6/carepath.tar.gz
new file mode 100644
index 0000000000000000000000000000000000000000..59a2961029b2517b529ee3176f820f14f06700bf
--- /dev/null
+++ b/L6/carepath.tar.gz
@@ -0,0 +1,3 @@
+version https://git-lfs.github.com/spec/v1
+oid sha256:d8d9740d5513bfabbb58a04785ed3794757600354656678055afa04205fb8bdc
+size 1881576721
diff --git a/L6/full100_inputs_scored217/README.md b/L6/full100_inputs_scored217/README.md
new file mode 100644
index 0000000000000000000000000000000000000000..513d22d4d6207b5c5b65059efc4054ef080d8337
--- /dev/null
+++ b/L6/full100_inputs_scored217/README.md
@@ -0,0 +1,12 @@
+# CarePath cohort
+
+Download `L6/carepath.tar.gz` and extract it into `L6/`. The extracted directory
+contains pathology and MRI inputs, care templates, reference labels, and episode
+membership. MRI T staging uses AJCC edition 9. Integrated clinical TNM can also
+reflect PET/CT and other examinations.
+
+Insert each model's pathology and MRI predictions into the care templates.
+Score 217 care decisions across 100 patients. Patient-level joint success
+requires correct pathology, correct MRI T stage, and every scored care answer.
+The cohort includes 25 matched pathology specimens and 75 assigned specimens.
+Six excluded questions and their reasons are in `unscored/care_pending_review.jsonl`.
diff --git a/L6/full100_inputs_scored217/data/care_streaming_templates.jsonl b/L6/full100_inputs_scored217/data/care_streaming_templates.jsonl
new file mode 100644
index 0000000000000000000000000000000000000000..f5e579dce8dbd3707ceed43c19a2ee97bc9e1e03
--- /dev/null
+++ b/L6/full100_inputs_scored217/data/care_streaming_templates.jsonl
@@ -0,0 +1,217 @@
+{"sample_id":"sample-c56105087904f0da386b7001","patient_id":"patient-5fa48522b2703f35ead0224b","turn_id":"turn02","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- 暂无可展示的初诊主诉/入院资料。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 正常范围心电图\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽左顶壁、左顶后壁、左侧壁增厚，并见团块状软组织信号影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，鼻咽右侧壁粘膜未见增厚，左侧咽隐窝闭塞，右侧咽隐窝存在，左侧咽旁脂肪间隙狭窄。左侧腭帆提肌、腭帆张肌、头长肌、翼内肌受侵犯，余咽旁诸肌未见异常； 左侧咽后见肿大的淋巴结，短径22mm，右侧咽后见小淋巴结，短径5mm。 病灶向前堵塞左侧后鼻孔，口咽左侧壁受侵增厚。 左侧翼腭窝软组织影稍增多，右侧翼腭窝、双侧颞下窝未见异常。 蝶骨基底部、斜坡左侧份、左侧岩尖骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、上颌窦粘膜增厚；蝶窦、双侧乳突气化良好，未见异常信号影；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。 双颈II区、左颈III区见多个淋巴结，较大者短径24mm，信号欠均匀，增强扫描不均匀强化。；检查结论: 鼻咽左顶后壁、左侧壁病灶，考虑鼻咽癌，侵犯左侧咽旁、口咽左侧壁。 颅底骨质破坏。 双侧咽后、双颈II区、左颈III区淋巴结，考虑转移瘤。 副鼻窦炎。\n- [全程D5] 检验组合: 红细胞比容(Hct)-静脉血: 38.9%；血红蛋白(Hb)-静脉血: 131.6g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.5mmolL；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；总蛋白(TP)-静脉血: 69.64g/L；总钙(Ca)-静脉血: 2.26mmol/L；白蛋白(ALB)-静脉血: 43.1g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.42mmol/L；磷(P)-静脉血: 1.22mmol/L；凝血酶时间(TT)-静脉血: 17.3sec.；淋巴细胞百分比(Lymph%)-静脉血: 0.325；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；钠离子(Na+)-静脉血: 140.5mmol/L；单核细胞百分比(Mono%)-静脉血: 0.0954；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；载脂蛋白AI(apoAI)-静脉血: 1.38g/L；丙氨酸氨基转移酶(ALT)-静脉血: 21.7U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；氯离子(Cl-)-静脉血: 103.9mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；血小板计数(PLT#)-静脉血: 270.910E9/L；总胆固醇(TC)-静脉血: 5.3mmol/L；C-反应蛋白(CRP)-静脉血: 0.37mg/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.69mmol/L；甘油三酯(TG)-静脉血: 0.78mmol/L；淋巴细胞计数(Lymph#)-静脉血: 210E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.568；凝血酶原时间活动度(PTA)-静脉血: 94%；活化部分凝血活酶时间(APTT)-静脉血: 25.3sec.；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；平均红细胞血红蛋白含量(MCH)-静脉血: 30.2pg；凝血酶原时间(PT)-静脉血: 11.4sec.；纤维蛋白原(Fbg)-静脉血: 2.62g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.11；间接胆红素(IBIL)-静脉血: 7.7umolL；乳酸脱氢酶(LDH)-静脉血: 279.1U/L；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 11umol/L；D-二聚体(D-Dimer)-静脉血: 0.19ug/ml；阴离子间隙(AG)-静脉血: 12；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.99；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善血浆EBV-DNA检测，若结果阳性则临床确诊鼻咽癌并启动根治性放疗\nB. 行鼻咽肿物开放性切除活检以明确病理诊断，并完善胸腹部CT及骨扫描\nC. 行颈部淋巴结切除活检以明确病理诊断，暂缓全身远处转移排查\nD. 行颈部淋巴结细针穿刺细胞学检查（FNAC）作为最终确诊依据，并完善全身分期检查\nE. 行鼻咽镜下活检以明确病理诊断，无需常规进行胸腹部影像学分期\nF. 优先行全身PET-CT检查，若无远处转移则直接开始诱导化疗\nG. 行双侧颈部淋巴结清扫术并送常规病理，确诊后安排术后放疗\nH. 行鼻咽镜下活检以明确病理诊断，并仅行头颈部增强CT以补充评估颅底骨质破坏\nI. 行鼻咽镜下活检以明确病理诊断，并直接安排诱导化疗，化疗后补充全身分期检查\nJ. 行颈部淋巴结穿刺活检或鼻咽镜活检以明确病理诊断，并完善全身分期检查\nK. 密切观察鼻咽部病灶及颈部淋巴结变化，1个月后复查头颈部MRI决定是否活检\nL. 行颈部淋巴结穿刺活检，确诊后直接启动根治性放疗，无需全身分期检查\n\n请仅输出一个选项字母（A-L）。","gold_letter":"J","gold_action":"行颈部淋巴结穿刺活检或鼻咽镜活检以明确病理诊断，并完善全身分期检查（如胸腹部CT、骨扫描或PET-CT）。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"完善血浆EBV-DNA检测，若结果阳性则临床确诊鼻咽癌并启动根治性放疗"},{"letter":"B","text":"行鼻咽肿物开放性切除活检以明确病理诊断，并完善胸腹部CT及骨扫描"},{"letter":"C","text":"行颈部淋巴结切除活检以明确病理诊断，暂缓全身远处转移排查"},{"letter":"D","text":"行颈部淋巴结细针穿刺细胞学检查（FNAC）作为最终确诊依据，并完善全身分期检查"},{"letter":"E","text":"行鼻咽镜下活检以明确病理诊断，无需常规进行胸腹部影像学分期"},{"letter":"F","text":"优先行全身PET-CT检查，若无远处转移则直接开始诱导化疗"},{"letter":"G","text":"行双侧颈部淋巴结清扫术并送常规病理，确诊后安排术后放疗"},{"letter":"H","text":"行鼻咽镜下活检以明确病理诊断，并仅行头颈部增强CT以补充评估颅底骨质破坏"},{"letter":"I","text":"行鼻咽镜下活检以明确病理诊断，并直接安排诱导化疗，化疗后补充全身分期检查"},{"letter":"J","text":"行颈部淋巴结穿刺活检或鼻咽镜活检以明确病理诊断，并完善全身分期检查"},{"letter":"K","text":"密切观察鼻咽部病灶及颈部淋巴结变化，1个月后复查头颈部MRI决定是否活检"},{"letter":"L","text":"行颈部淋巴结穿刺活检，确诊后直接启动根治性放疗，无需全身分期检查"}]}
+{"sample_id":"sample-9b76347b9a2749777a06cd80","patient_id":"patient-5fa48522b2703f35ead0224b","turn_id":"turn04","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 正常范围心电图\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽左顶壁、左顶后壁、左侧壁增厚，并见团块状软组织信号影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，鼻咽右侧壁粘膜未见增厚，左侧咽隐窝闭塞，右侧咽隐窝存在，左侧咽旁脂肪间隙狭窄。左侧腭帆提肌、腭帆张肌、头长肌、翼内肌受侵犯，余咽旁诸肌未见异常； 左侧咽后见肿大的淋巴结，短径22mm，右侧咽后见小淋巴结，短径5mm。 病灶向前堵塞左侧后鼻孔，口咽左侧壁受侵增厚。 左侧翼腭窝软组织影稍增多，右侧翼腭窝、双侧颞下窝未见异常。 蝶骨基底部、斜坡左侧份、左侧岩尖骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、上颌窦粘膜增厚；蝶窦、双侧乳突气化良好，未见异常信号影；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。 双颈II区、左颈III区见多个淋巴结，较大者短径24mm，信号欠均匀，增强扫描不均匀强化。；检查结论: 鼻咽左顶后壁、左侧壁病灶，考虑鼻咽癌，侵犯左侧咽旁、口咽左侧壁。 颅底骨质破坏。 双侧咽后、双颈II区、左颈III区淋巴结，考虑转移瘤。 副鼻窦炎。\n- [全程D5] 检验组合: 红细胞比容(Hct)-静脉血: 38.9%；血红蛋白(Hb)-静脉血: 131.6g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.5mmolL；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；总蛋白(TP)-静脉血: 69.64g/L；总钙(Ca)-静脉血: 2.26mmol/L；白蛋白(ALB)-静脉血: 43.1g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.42mmol/L；磷(P)-静脉血: 1.22mmol/L；凝血酶时间(TT)-静脉血: 17.3sec.；淋巴细胞百分比(Lymph%)-静脉血: 0.325；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；钠离子(Na+)-静脉血: 140.5mmol/L；单核细胞百分比(Mono%)-静脉血: 0.0954；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；载脂蛋白AI(apoAI)-静脉血: 1.38g/L；丙氨酸氨基转移酶(ALT)-静脉血: 21.7U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；氯离子(Cl-)-静脉血: 103.9mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；血小板计数(PLT#)-静脉血: 270.910E9/L；总胆固醇(TC)-静脉血: 5.3mmol/L；C-反应蛋白(CRP)-静脉血: 0.37mg/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.69mmol/L；甘油三酯(TG)-静脉血: 0.78mmol/L；淋巴细胞计数(Lymph#)-静脉血: 210E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.568；凝血酶原时间活动度(PTA)-静脉血: 94%；活化部分凝血活酶时间(APTT)-静脉血: 25.3sec.；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；平均红细胞血红蛋白含量(MCH)-静脉血: 30.2pg；凝血酶原时间(PT)-静脉血: 11.4sec.；纤维蛋白原(Fbg)-静脉血: 2.62g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.11；间接胆红素(IBIL)-静脉血: 7.7umolL；乳酸脱氢酶(LDH)-静脉血: 279.1U/L；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 11umol/L；D-二聚体(D-Dimer)-静脉血: 0.19ug/ml；阴离子间隙(AG)-静脉血: 12；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.99；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D8] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见:；检查结论:\n- [全程D14] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；透明质酸(HA)-静脉血: 76.89ng/ml；III型前胶原氨基端肽(PIIINP)-静脉血: 28.08ng/ml；葡萄糖(Glu)-尿液: -（参考: 阴性）；降钙素(CT)-静脉血: 22.05pg/ml；总蛋白(TP)-尿液: -（参考: 阴性）；IV型胶原(C-IV)-静脉血: 28.93ng/ml；比重(SG)-尿液: 1.008；颜色-尿液: 无色；酸碱度(pH)-尿液: 6.5；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；层粘连蛋白(LN)-静脉血: 35.29ng/ml；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D15] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T6水平，估计导管末端位于上腔静脉内。；检查结论: PICC管末端位置如上述。\n- [全程D15] 检验组合: 骨钙素N端中分子片段(N-MID)-静脉血: 11.9ng/ml；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.318ng/ml\n- 治疗前病程记录所载检查结果为：PET-CT提示左侧腋窝淋巴结代谢活跃，SUV9.0，不排除转移。彩超提示左侧腋窝淋巴结形态正常，淋巴门存在，不建议穿刺活检。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 同步放化疗（顺铂单药方案）\nB. 诱导化疗（吉西他滨+顺铂方案）联合PD-1抑制剂\nC. 根治性放疗联合辅助化疗（顺铂+氟尿嘧啶方案）\nD. 诱导化疗（紫杉醇+卡铂方案）\nE. 诱导化疗（多西他赛+顺铂+氟尿嘧啶方案）联合西妥昔单抗\nF. 根治性放疗（单纯放疗）\nG. 诱导化疗（卡培他滨单药方案）\nH. 靶向治疗（尼妥珠单抗）联合同步放化疗\nI. 诱导化疗（依托泊苷+顺铂方案）\nJ. 姑息性化疗（顺铂+氟尿嘧啶方案）\nK. 诱导化疗（顺铂单药方案）\nL. 复核左腋窝淋巴结及远处转移状态，结合分期与耐受性制定初始治疗方案；若无远处转移，以根治性放疗为基础安排综合治疗；若证实远处转移，以系统治疗为基础评估后续局部治疗\n\n请仅输出一个选项字母（A-L）。","gold_letter":"L","gold_action":"复核左腋窝淋巴结及远处转移状态，结合分期与耐受性制定初始治疗方案；若无远处转移，以根治性放疗为基础安排综合治疗；若证实远处转移，以系统治疗为基础评估后续局部治疗","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"同步放化疗（顺铂单药方案）"},{"letter":"B","text":"诱导化疗（吉西他滨+顺铂方案）联合PD-1抑制剂"},{"letter":"C","text":"根治性放疗联合辅助化疗（顺铂+氟尿嘧啶方案）"},{"letter":"D","text":"诱导化疗（紫杉醇+卡铂方案）"},{"letter":"E","text":"诱导化疗（多西他赛+顺铂+氟尿嘧啶方案）联合西妥昔单抗"},{"letter":"F","text":"根治性放疗（单纯放疗）"},{"letter":"G","text":"诱导化疗（卡培他滨单药方案）"},{"letter":"H","text":"靶向治疗（尼妥珠单抗）联合同步放化疗"},{"letter":"I","text":"诱导化疗（依托泊苷+顺铂方案）"},{"letter":"J","text":"姑息性化疗（顺铂+氟尿嘧啶方案）"},{"letter":"K","text":"诱导化疗（顺铂单药方案）"},{"letter":"L","text":"复核左腋窝淋巴结及远处转移状态，结合分期与耐受性制定初始治疗方案；若无远处转移，以根治性放疗为基础安排综合治疗；若证实远处转移，以系统治疗为基础评估后续局部治疗"}]}
+{"sample_id":"sample-ad9c851cda35b0e3c9061982","patient_id":"patient-5fa48522b2703f35ead0224b","turn_id":"turn05","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- 暂无可展示的初诊主诉/入院资料。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 正常范围心电图\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽左顶壁、左顶后壁、左侧壁增厚，并见团块状软组织信号影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，鼻咽右侧壁粘膜未见增厚，左侧咽隐窝闭塞，右侧咽隐窝存在，左侧咽旁脂肪间隙狭窄。左侧腭帆提肌、腭帆张肌、头长肌、翼内肌受侵犯，余咽旁诸肌未见异常； 左侧咽后见肿大的淋巴结，短径22mm，右侧咽后见小淋巴结，短径5mm。 病灶向前堵塞左侧后鼻孔，口咽左侧壁受侵增厚。 左侧翼腭窝软组织影稍增多，右侧翼腭窝、双侧颞下窝未见异常。 蝶骨基底部、斜坡左侧份、左侧岩尖骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、上颌窦粘膜增厚；蝶窦、双侧乳突气化良好，未见异常信号影；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。 双颈II区、左颈III区见多个淋巴结，较大者短径24mm，信号欠均匀，增强扫描不均匀强化。；检查结论: 鼻咽左顶后壁、左侧壁病灶，考虑鼻咽癌，侵犯左侧咽旁、口咽左侧壁。 颅底骨质破坏。 双侧咽后、双颈II区、左颈III区淋巴结，考虑转移瘤。 副鼻窦炎。\n- [全程D5] 检验组合: 红细胞比容(Hct)-静脉血: 38.9%；血红蛋白(Hb)-静脉血: 131.6g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.5mmolL；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；总蛋白(TP)-静脉血: 69.64g/L；总钙(Ca)-静脉血: 2.26mmol/L；白蛋白(ALB)-静脉血: 43.1g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.42mmol/L；磷(P)-静脉血: 1.22mmol/L；凝血酶时间(TT)-静脉血: 17.3sec.；淋巴细胞百分比(Lymph%)-静脉血: 0.325；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；钠离子(Na+)-静脉血: 140.5mmol/L；单核细胞百分比(Mono%)-静脉血: 0.0954；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；载脂蛋白AI(apoAI)-静脉血: 1.38g/L；丙氨酸氨基转移酶(ALT)-静脉血: 21.7U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；氯离子(Cl-)-静脉血: 103.9mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；血小板计数(PLT#)-静脉血: 270.910E9/L；总胆固醇(TC)-静脉血: 5.3mmol/L；C-反应蛋白(CRP)-静脉血: 0.37mg/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.69mmol/L；甘油三酯(TG)-静脉血: 0.78mmol/L；淋巴细胞计数(Lymph#)-静脉血: 210E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.568；凝血酶原时间活动度(PTA)-静脉血: 94%；活化部分凝血活酶时间(APTT)-静脉血: 25.3sec.；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；平均红细胞血红蛋白含量(MCH)-静脉血: 30.2pg；凝血酶原时间(PT)-静脉血: 11.4sec.；纤维蛋白原(Fbg)-静脉血: 2.62g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.11；间接胆红素(IBIL)-静脉血: 7.7umolL；乳酸脱氢酶(LDH)-静脉血: 279.1U/L；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 11umol/L；D-二聚体(D-Dimer)-静脉血: 0.19ug/ml；阴离子间隙(AG)-静脉血: 12；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.99；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D14] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；透明质酸(HA)-静脉血: 76.89ng/ml；III型前胶原氨基端肽(PIIINP)-静脉血: 28.08ng/ml；葡萄糖(Glu)-尿液: -（参考: 阴性）；降钙素(CT)-静脉血: 22.05pg/ml；总蛋白(TP)-尿液: -（参考: 阴性）；IV型胶原(C-IV)-静脉血: 28.93ng/ml；比重(SG)-尿液: 1.008；颜色-尿液: 无色；酸碱度(pH)-尿液: 6.5；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；层粘连蛋白(LN)-静脉血: 35.29ng/ml；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D15] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T6水平，估计导管末端位于上腔静脉内。；检查结论: PICC管末端位置如上述。\n- [全程D15] 检验组合: 骨钙素N端中分子片段(N-MID)-静脉血: 11.9ng/ml；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.318ng/ml\n- [全程D16] 检验组合: 浊度(TRUB)-尿液: 清亮；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: +-（参考: 阴性）；酸碱度(pH)-尿液: 7；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.016；葡萄糖(Glu)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 3/μL\n- [全程D17] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 31/μL；颜色-尿液: Yellow；鳞状上皮细胞计数(SQEP#)-尿液: 7/μL；白细胞计数(WBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.021；浊度(TRUB)-尿液: 清亮；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D19] 检验组合: 总钙(Ca)-静脉血: 2.15mmol/L；钠离子(Na+)-静脉血: 138.8mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.2mmol/L；钾离子(K+)-静脉血: 3.08mmol/L；氯离子(Cl-)-静脉血: 102.2mmol/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；磷(P)-静脉血: 1.19mmol/L；阴离子间隙(AG)-静脉血: 15.4\n- [全程D20] 超声；双侧腋窝淋巴结彩超(套): 检查类型: 超声；检查名称: 双侧腋窝淋巴结彩超(套)；检查部位:；检查所见: 左侧腋窝腋下组可见1个淋巴结回声，大小约16x4mm，椭圆形，边界清，皮髓质分界清，淋巴门结构可探及。腋上组及腋中组未见明显异常淋巴结回声。 CDFI：上述淋巴结内可见门型血流信号。；检查结论: 左侧腋窝腋下组淋巴结，符合良性淋巴结声像。\n- [全程D20] 检验组合: 血小板计数(PLT#)-静脉血: 250.210E9/L；肌酐(Crea)-静脉血: 54umol/L；总胆红素(TBIL)-静脉血: 13.7umol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；阴离子间隙(AG)-静脉血: 12.4；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；碱性磷酸酶(ALP)-静脉血: 59.5U/L；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；球蛋白(GLO)-静脉血: 25.26g/L；葡萄糖(Glu)-静脉血: 4.81mmol/L；白蛋白(ALB)-静脉血: 40.9g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；尿素氮(BUN)-静脉血: 3.9mmol/L；血小板分布宽度(PDW)-静脉血: 15.8%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.38mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.05mmolL；乳酸脱氢酶(LDH)-静脉血: 275.2U/L；单核细胞百分比(Mono%)-静脉血: 0.0621；中性粒细胞计数(Neut#)-静脉血: 4.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.711；γ-谷氨酰基转移酶(GGT)-静脉血: 19.5U/L；甘油三酯(TG)-静脉血: 1.23mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.5pg；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.0032；磷(P)-静脉血: 1.37mmol/L；总钙(Ca)-静脉血: 2.23mmol/L；间接胆红素(IBIL)-静脉血: 9umolL；血小板比容-静脉血: 20.8%；C-反应蛋白(CRP)-静脉血: 0.65mg/L；载脂蛋白AI(apoAI)-静脉血: 1.12g/L；总蛋白(TP)-静脉血: 66.16g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.62；单核细胞计数(Mono#)-静脉血: 0.410E9/L；钠离子(Na+)-静脉血: 137.8mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 27.7U/L；丙氨酸氨基转移酶(ALT)-静脉血: 25.7U/L；载脂蛋白B(apoB)-静脉血: 0.77g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.0057；血红蛋白(Hb)-静脉血: 126.3g/L；有核红细胞百分比(NRBC%)-静脉血: 0；红细胞计数(RBC#)-静脉血: 4.2810E12/L；平均血小板体积(MPV)-静脉血: 8.31fL；总胆汁酸(TBA)-静脉血: 1.2umol/L\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D15] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。上级医师信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D20] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗结束，诉呕吐 次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。上级医师信息已隐藏：患者第1程5-FU+顺铂方案诱导化疗结束，无诉特殊不适，可予出院，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 办理出院，予以胸腺五肽皮下注射支持治疗，嘱每周复查血常规及生化，按期返院行第2程诱导化疗。\nB. 暂缓出院，继续静脉给予5-HT3受体拮抗剂及补液支持，待恶心呕吐完全缓解后出院。\nC. 办理出院，嘱每周复查血常规及生化，第2程诱导化疗将顺铂剂量下调20%。\nD. 办理出院，嘱每周复查血常规及生化，第2程诱导化疗更改为吉西他滨+顺铂（GP）方案。\nE. 办理出院，予以重组人粒细胞集落刺激因子（G-CSF）皮下注射，按期返院行第2程诱导化疗。\nF. 办理出院，予以重组人促红素（EPO）皮下注射，按期返院行第2程诱导化疗。\nG. 办理出院，予以胸腺五肽皮下注射支持治疗，并安排左侧腋窝淋巴结穿刺活检。\nH. 办理出院，予以胸腺五肽皮下注射支持治疗，嘱返院直接开始根治性放疗及同步化疗。\nI. 办理出院，予以口服阿瑞匹坦带药，嘱第2程诱导化疗推迟1周进行。\nJ. 办理出院，予以重组人血小板生成素（rhTPO）皮下注射，按期返院行第2程诱导化疗。\nK. 暂缓出院，复查鼻咽及颈部MRI评估近期疗效，结果决定第2程化疗方案。\nL. 办理出院，予以胸腺五肽皮下注射支持治疗，嘱第2程诱导化疗加用尼妥珠单抗。\n\n请仅输出一个选项字母（A-L）。","gold_letter":"A","gold_action":"办理出院，予以胸腺五肽皮下注射支持治疗，嘱每周复查血常规及生化，按期返院行第2程诱导化疗。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"办理出院，予以胸腺五肽皮下注射支持治疗，嘱每周复查血常规及生化，按期返院行第2程诱导化疗。"},{"letter":"B","text":"暂缓出院，继续静脉给予5-HT3受体拮抗剂及补液支持，待恶心呕吐完全缓解后出院。"},{"letter":"C","text":"办理出院，嘱每周复查血常规及生化，第2程诱导化疗将顺铂剂量下调20%。"},{"letter":"D","text":"办理出院，嘱每周复查血常规及生化，第2程诱导化疗更改为吉西他滨+顺铂（GP）方案。"},{"letter":"E","text":"办理出院，予以重组人粒细胞集落刺激因子（G-CSF）皮下注射，按期返院行第2程诱导化疗。"},{"letter":"F","text":"办理出院，予以重组人促红素（EPO）皮下注射，按期返院行第2程诱导化疗。"},{"letter":"G","text":"办理出院，予以胸腺五肽皮下注射支持治疗，并安排左侧腋窝淋巴结穿刺活检。"},{"letter":"H","text":"办理出院，予以胸腺五肽皮下注射支持治疗，嘱返院直接开始根治性放疗及同步化疗。"},{"letter":"I","text":"办理出院，予以口服阿瑞匹坦带药，嘱第2程诱导化疗推迟1周进行。"},{"letter":"J","text":"办理出院，予以重组人血小板生成素（rhTPO）皮下注射，按期返院行第2程诱导化疗。"},{"letter":"K","text":"暂缓出院，复查鼻咽及颈部MRI评估近期疗效，结果决定第2程化疗方案。"},{"letter":"L","text":"办理出院，予以胸腺五肽皮下注射支持治疗，嘱第2程诱导化疗加用尼妥珠单抗。"}]}
+{"sample_id":"sample-ba3079ee7b3ef01162117027","patient_id":"patient-5fa48522b2703f35ead0224b","turn_id":"turn07","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 正常范围心电图\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽左顶壁、左顶后壁、左侧壁增厚，并见团块状软组织信号影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，鼻咽右侧壁粘膜未见增厚，左侧咽隐窝闭塞，右侧咽隐窝存在，左侧咽旁脂肪间隙狭窄。左侧腭帆提肌、腭帆张肌、头长肌、翼内肌受侵犯，余咽旁诸肌未见异常； 左侧咽后见肿大的淋巴结，短径22mm，右侧咽后见小淋巴结，短径5mm。 病灶向前堵塞左侧后鼻孔，口咽左侧壁受侵增厚。 左侧翼腭窝软组织影稍增多，右侧翼腭窝、双侧颞下窝未见异常。 蝶骨基底部、斜坡左侧份、左侧岩尖骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、上颌窦粘膜增厚；蝶窦、双侧乳突气化良好，未见异常信号影；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。 双颈II区、左颈III区见多个淋巴结，较大者短径24mm，信号欠均匀，增强扫描不均匀强化。；检查结论: 鼻咽左顶后壁、左侧壁病灶，考虑鼻咽癌，侵犯左侧咽旁、口咽左侧壁。 颅底骨质破坏。 双侧咽后、双颈II区、左颈III区淋巴结，考虑转移瘤。 副鼻窦炎。\n- [全程D5] 检验组合: 红细胞比容(Hct)-静脉血: 38.9%；血红蛋白(Hb)-静脉血: 131.6g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.5mmolL；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；总蛋白(TP)-静脉血: 69.64g/L；总钙(Ca)-静脉血: 2.26mmol/L；白蛋白(ALB)-静脉血: 43.1g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.42mmol/L；磷(P)-静脉血: 1.22mmol/L；凝血酶时间(TT)-静脉血: 17.3sec.；淋巴细胞百分比(Lymph%)-静脉血: 0.325；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；钠离子(Na+)-静脉血: 140.5mmol/L；单核细胞百分比(Mono%)-静脉血: 0.0954；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；载脂蛋白AI(apoAI)-静脉血: 1.38g/L；丙氨酸氨基转移酶(ALT)-静脉血: 21.7U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；氯离子(Cl-)-静脉血: 103.9mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；血小板计数(PLT#)-静脉血: 270.910E9/L；总胆固醇(TC)-静脉血: 5.3mmol/L；C-反应蛋白(CRP)-静脉血: 0.37mg/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.69mmol/L；甘油三酯(TG)-静脉血: 0.78mmol/L；淋巴细胞计数(Lymph#)-静脉血: 210E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.568；凝血酶原时间活动度(PTA)-静脉血: 94%；活化部分凝血活酶时间(APTT)-静脉血: 25.3sec.；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；平均红细胞血红蛋白含量(MCH)-静脉血: 30.2pg；凝血酶原时间(PT)-静脉血: 11.4sec.；纤维蛋白原(Fbg)-静脉血: 2.62g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.11；间接胆红素(IBIL)-静脉血: 7.7umolL；乳酸脱氢酶(LDH)-静脉血: 279.1U/L；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 11umol/L；D-二聚体(D-Dimer)-静脉血: 0.19ug/ml；阴离子间隙(AG)-静脉血: 12；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.99；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D15] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T6水平，估计导管末端位于上腔静脉内。；检查结论: PICC管末端位置如上述。\n- [全程D15] 检验组合: 骨钙素N端中分子片段(N-MID)-静脉血: 11.9ng/ml；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.318ng/ml\n- [全程D16] 检验组合: 浊度(TRUB)-尿液: 清亮；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: +-（参考: 阴性）；酸碱度(pH)-尿液: 7；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.016；葡萄糖(Glu)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 3/μL\n- [全程D17] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 31/μL；颜色-尿液: Yellow；鳞状上皮细胞计数(SQEP#)-尿液: 7/μL；白细胞计数(WBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.021；浊度(TRUB)-尿液: 清亮；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D19] 检验组合: 总钙(Ca)-静脉血: 2.15mmol/L；钠离子(Na+)-静脉血: 138.8mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.2mmol/L；钾离子(K+)-静脉血: 3.08mmol/L；氯离子(Cl-)-静脉血: 102.2mmol/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；磷(P)-静脉血: 1.19mmol/L；阴离子间隙(AG)-静脉血: 15.4\n- [全程D20] 超声；双侧腋窝淋巴结彩超(套): 检查类型: 超声；检查名称: 双侧腋窝淋巴结彩超(套)；检查部位:；检查所见: 左侧腋窝腋下组可见1个淋巴结回声，大小约16x4mm，椭圆形，边界清，皮髓质分界清，淋巴门结构可探及。腋上组及腋中组未见明显异常淋巴结回声。 CDFI：上述淋巴结内可见门型血流信号。；检查结论: 左侧腋窝腋下组淋巴结，符合良性淋巴结声像。\n- [全程D20] 检验组合: 血小板计数(PLT#)-静脉血: 250.210E9/L；肌酐(Crea)-静脉血: 54umol/L；总胆红素(TBIL)-静脉血: 13.7umol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；阴离子间隙(AG)-静脉血: 12.4；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；碱性磷酸酶(ALP)-静脉血: 59.5U/L；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；球蛋白(GLO)-静脉血: 25.26g/L；葡萄糖(Glu)-静脉血: 4.81mmol/L；白蛋白(ALB)-静脉血: 40.9g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；尿素氮(BUN)-静脉血: 3.9mmol/L；血小板分布宽度(PDW)-静脉血: 15.8%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.38mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.05mmolL；乳酸脱氢酶(LDH)-静脉血: 275.2U/L；单核细胞百分比(Mono%)-静脉血: 0.0621；中性粒细胞计数(Neut#)-静脉血: 4.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.711；γ-谷氨酰基转移酶(GGT)-静脉血: 19.5U/L；甘油三酯(TG)-静脉血: 1.23mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.5pg；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.0032；磷(P)-静脉血: 1.37mmol/L；总钙(Ca)-静脉血: 2.23mmol/L；间接胆红素(IBIL)-静脉血: 9umolL；血小板比容-静脉血: 20.8%；C-反应蛋白(CRP)-静脉血: 0.65mg/L；载脂蛋白AI(apoAI)-静脉血: 1.12g/L；总蛋白(TP)-静脉血: 66.16g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.62；单核细胞计数(Mono#)-静脉血: 0.410E9/L；钠离子(Na+)-静脉血: 137.8mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 27.7U/L；丙氨酸氨基转移酶(ALT)-静脉血: 25.7U/L；载脂蛋白B(apoB)-静脉血: 0.77g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.0057；血红蛋白(Hb)-静脉血: 126.3g/L；有核红细胞百分比(NRBC%)-静脉血: 0；红细胞计数(RBC#)-静脉血: 4.2810E12/L；平均血小板体积(MPV)-静脉血: 8.31fL；总胆汁酸(TBA)-静脉血: 1.2umol/L\n- [全程D34] 检验组合: 中性粒细胞百分比(Neut%)-静脉血: 0.356；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329.8g/L；中性粒细胞计数(Neut#)-静脉血: 1.210E9/L；载脂蛋白AI(apoAI)-静脉血: 1.23g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 1.9umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.3；平均红细胞体积(MCV)-静脉血: 89.7fL；钾离子(K+)-静脉血: 3.9mmol/L；总蛋白(TP)-静脉血: 68.46g/L；球蛋白(GLO)-静脉血: 29.66g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.5%；血小板分布宽度(PDW)-静脉血: 16%；白细胞计数(WBC#)-静脉血: 3.2410E9/L；磷(P)-静脉血: 1.24mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.0079；间接胆红素(IBIL)-静脉血: 2.8umolL；镁离子(Mg2+)-静脉血: 0.89mmol/L；碱性磷酸酶(ALP)-静脉血: 66.5U/L；红细胞比容(Hct)-静脉血: 36.1%；丙氨酸氨基转移酶(ALT)-静脉血: 18.5U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.51；单核细胞百分比(Mono%)-静脉血: 0.1112；尿素氮(BUN)-静脉血: 5.39mmol/L；红细胞计数(RBC#)-静脉血: 4.0210E12/L；血小板计数(PLT#)-静脉血: 240.610E9/L；胱抑素(Cys-C)-静脉血: 0.87mg/L；天门冬氨酸氨基转移酶(AST)-静脉血: 22.2U/L；C-反应蛋白(CRP)-静脉血: 0.37mg/L；阴离子间隙(AG)-静脉血: 13；总胆汁酸(TBA)-静脉血: 0.8umol/L；葡萄糖(Glu)-静脉血: 4.81mmol/L；总钙(Ca)-静脉血: 2.31mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；总胆红素(TBIL)-静脉血: 4.7umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.2；平均血小板体积(MPV)-静脉血: 7.45fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.6pg；单核细胞计数(Mono#)-静脉血: 0.410E9/L；血红蛋白(Hb)-静脉血: 119.1g/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.9mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 17.9U/L\n- [全程D35] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁、后壁及左侧壁增厚放射性浓聚，SUV约22.8，病灶向下侵犯软腭及口咽左侧壁；病灶侵犯左头长肌、左侧腭帆提张肌及左咽旁间隙，左侧咽隐窝消失，左侧咽旁间隙消失。左咽后肿大淋巴结放射性浓聚，SUV约19.2，与鼻咽病灶分界不清。喉咽结构及放射性分布未见明显异常。额窦、蝶窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。左颈II、III区数个淋巴结放射性浓聚，SUV约20.2，最大约1.8×3.3cm；右颈II、Va区数个小淋巴结部分放射性分布略浓密，SUV约3.3，最大约0.6×1.1cm；余双颈小淋巴结放射性分布未见异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。心脏及纵隔大血管未见明显异常。左腋窝淋巴结放射性分布浓密，SUV约9.0，大小约0.9×1.5cm；纵隔、双肺门及右侧腋窝未见肿大淋巴结及异常放射性分布。双侧乳腺放射性分布未见明显异常。 肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 子宫体积增大，外形呈波浪状，放射性分布未见异常；子宫旁见高密度节育器影；膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，病灶侵犯软腭、口咽左侧壁及左咽旁间隙；左咽后及左颈II、III区淋巴结代谢活跃，考虑转移；左腋窝淋巴结代谢活跃，不排除转移。 右颈II、Va区小淋巴结部分代谢略活跃，疑炎性病变，请结合临床。 疑子宫肌瘤。\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D15] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。上级医师信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D20] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗结束，诉呕吐 次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。上级医师信息已隐藏：患者第1程5-FU+顺铂方案诱导化疗结束，无诉特殊不适，可予出院，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即按原剂量启动第二程5-FU+顺铂方案化疗，并预防性给予长效重组人粒细胞刺激因子皮下注射\nB. 立即按原剂量启动第二程5-FU+顺铂方案化疗，化疗期间同步给予短效重组人粒细胞刺激因子皮下注射\nC. 暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，动态监测血常规，待中性粒细胞计数恢复后再行下一程化疗\nD. 暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射及广谱抗菌药物静脉滴注，待中性粒细胞计数恢复后再行化疗\nE. 终止诱导化疗，直接进入根治性放疗阶段，并给予重组人粒细胞刺激因子皮下注射\nF. 暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，待中性粒细胞恢复后调整下一程化疗方案为单药顺铂\nG. 暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，待中性粒细胞恢复后将5-FU与顺铂剂量均减低20%行下一程化疗\nH. 暂缓本周期化疗，仅予密切观察和口服升白药物，待中性粒细胞计数自然恢复后再行化疗\nI. 暂缓本周期化疗，行左侧腋窝淋巴结穿刺活检，同时给予重组人粒细胞刺激因子皮下注射\nJ. 立即按原剂量启动第二程5-FU+顺铂方案化疗，化疗结束后48小时给予重组人粒细胞刺激因子皮下注射\nK. 暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，并安排全身PET-CT重新评估肿瘤范围\nL. 终止诱导化疗，改为靶向治疗联合重组人粒细胞刺激因子皮下注射，动态监测血常规\n\n请仅输出一个选项字母（A-L）。","gold_letter":"C","gold_action":"暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，动态监测血常规，待中性粒细胞计数恢复后再行下一程化疗。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"立即按原剂量启动第二程5-FU+顺铂方案化疗，并预防性给予长效重组人粒细胞刺激因子皮下注射"},{"letter":"B","text":"立即按原剂量启动第二程5-FU+顺铂方案化疗，化疗期间同步给予短效重组人粒细胞刺激因子皮下注射"},{"letter":"C","text":"暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，动态监测血常规，待中性粒细胞计数恢复后再行下一程化疗"},{"letter":"D","text":"暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射及广谱抗菌药物静脉滴注，待中性粒细胞计数恢复后再行化疗"},{"letter":"E","text":"终止诱导化疗，直接进入根治性放疗阶段，并给予重组人粒细胞刺激因子皮下注射"},{"letter":"F","text":"暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，待中性粒细胞恢复后调整下一程化疗方案为单药顺铂"},{"letter":"G","text":"暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，待中性粒细胞恢复后将5-FU与顺铂剂量均减低20%行下一程化疗"},{"letter":"H","text":"暂缓本周期化疗，仅予密切观察和口服升白药物，待中性粒细胞计数自然恢复后再行化疗"},{"letter":"I","text":"暂缓本周期化疗，行左侧腋窝淋巴结穿刺活检，同时给予重组人粒细胞刺激因子皮下注射"},{"letter":"J","text":"立即按原剂量启动第二程5-FU+顺铂方案化疗，化疗结束后48小时给予重组人粒细胞刺激因子皮下注射"},{"letter":"K","text":"暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，并安排全身PET-CT重新评估肿瘤范围"},{"letter":"L","text":"终止诱导化疗，改为靶向治疗联合重组人粒细胞刺激因子皮下注射，动态监测血常规"}]}
+{"sample_id":"sample-800192dfaf82bbe4edb2533a","patient_id":"patient-5fa48522b2703f35ead0224b","turn_id":"turn08","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 正常范围心电图\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽左顶壁、左顶后壁、左侧壁增厚，并见团块状软组织信号影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，鼻咽右侧壁粘膜未见增厚，左侧咽隐窝闭塞，右侧咽隐窝存在，左侧咽旁脂肪间隙狭窄。左侧腭帆提肌、腭帆张肌、头长肌、翼内肌受侵犯，余咽旁诸肌未见异常； 左侧咽后见肿大的淋巴结，短径22mm，右侧咽后见小淋巴结，短径5mm。 病灶向前堵塞左侧后鼻孔，口咽左侧壁受侵增厚。 左侧翼腭窝软组织影稍增多，右侧翼腭窝、双侧颞下窝未见异常。 蝶骨基底部、斜坡左侧份、左侧岩尖骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、上颌窦粘膜增厚；蝶窦、双侧乳突气化良好，未见异常信号影；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。 双颈II区、左颈III区见多个淋巴结，较大者短径24mm，信号欠均匀，增强扫描不均匀强化。；检查结论: 鼻咽左顶后壁、左侧壁病灶，考虑鼻咽癌，侵犯左侧咽旁、口咽左侧壁。 颅底骨质破坏。 双侧咽后、双颈II区、左颈III区淋巴结，考虑转移瘤。 副鼻窦炎。\n- [全程D5] 检验组合: 红细胞比容(Hct)-静脉血: 38.9%；血红蛋白(Hb)-静脉血: 131.6g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.5mmolL；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；总蛋白(TP)-静脉血: 69.64g/L；总钙(Ca)-静脉血: 2.26mmol/L；白蛋白(ALB)-静脉血: 43.1g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.42mmol/L；磷(P)-静脉血: 1.22mmol/L；凝血酶时间(TT)-静脉血: 17.3sec.；淋巴细胞百分比(Lymph%)-静脉血: 0.325；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；钠离子(Na+)-静脉血: 140.5mmol/L；单核细胞百分比(Mono%)-静脉血: 0.0954；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；载脂蛋白AI(apoAI)-静脉血: 1.38g/L；丙氨酸氨基转移酶(ALT)-静脉血: 21.7U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；氯离子(Cl-)-静脉血: 103.9mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；血小板计数(PLT#)-静脉血: 270.910E9/L；总胆固醇(TC)-静脉血: 5.3mmol/L；C-反应蛋白(CRP)-静脉血: 0.37mg/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.69mmol/L；甘油三酯(TG)-静脉血: 0.78mmol/L；淋巴细胞计数(Lymph#)-静脉血: 210E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.568；凝血酶原时间活动度(PTA)-静脉血: 94%；活化部分凝血活酶时间(APTT)-静脉血: 25.3sec.；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；平均红细胞血红蛋白含量(MCH)-静脉血: 30.2pg；凝血酶原时间(PT)-静脉血: 11.4sec.；纤维蛋白原(Fbg)-静脉血: 2.62g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.11；间接胆红素(IBIL)-静脉血: 7.7umolL；乳酸脱氢酶(LDH)-静脉血: 279.1U/L；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 11umol/L；D-二聚体(D-Dimer)-静脉血: 0.19ug/ml；阴离子间隙(AG)-静脉血: 12；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.99；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D34] 检验组合: 中性粒细胞百分比(Neut%)-静脉血: 0.356；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329.8g/L；中性粒细胞计数(Neut#)-静脉血: 1.210E9/L；载脂蛋白AI(apoAI)-静脉血: 1.23g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 1.9umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.3；平均红细胞体积(MCV)-静脉血: 89.7fL；钾离子(K+)-静脉血: 3.9mmol/L；总蛋白(TP)-静脉血: 68.46g/L；球蛋白(GLO)-静脉血: 29.66g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.5%；血小板分布宽度(PDW)-静脉血: 16%；白细胞计数(WBC#)-静脉血: 3.2410E9/L；磷(P)-静脉血: 1.24mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.0079；间接胆红素(IBIL)-静脉血: 2.8umolL；镁离子(Mg2+)-静脉血: 0.89mmol/L；碱性磷酸酶(ALP)-静脉血: 66.5U/L；红细胞比容(Hct)-静脉血: 36.1%；丙氨酸氨基转移酶(ALT)-静脉血: 18.5U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.51；单核细胞百分比(Mono%)-静脉血: 0.1112；尿素氮(BUN)-静脉血: 5.39mmol/L；红细胞计数(RBC#)-静脉血: 4.0210E12/L；血小板计数(PLT#)-静脉血: 240.610E9/L；胱抑素(Cys-C)-静脉血: 0.87mg/L；天门冬氨酸氨基转移酶(AST)-静脉血: 22.2U/L；C-反应蛋白(CRP)-静脉血: 0.37mg/L；阴离子间隙(AG)-静脉血: 13；总胆汁酸(TBA)-静脉血: 0.8umol/L；葡萄糖(Glu)-静脉血: 4.81mmol/L；总钙(Ca)-静脉血: 2.31mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；总胆红素(TBIL)-静脉血: 4.7umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.2；平均血小板体积(MPV)-静脉血: 7.45fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.6pg；单核细胞计数(Mono#)-静脉血: 0.410E9/L；血红蛋白(Hb)-静脉血: 119.1g/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.9mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 17.9U/L\n- [全程D35] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁、后壁及左侧壁增厚放射性浓聚，SUV约22.8，病灶向下侵犯软腭及口咽左侧壁；病灶侵犯左头长肌、左侧腭帆提张肌及左咽旁间隙，左侧咽隐窝消失，左侧咽旁间隙消失。左咽后肿大淋巴结放射性浓聚，SUV约19.2，与鼻咽病灶分界不清。喉咽结构及放射性分布未见明显异常。额窦、蝶窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。左颈II、III区数个淋巴结放射性浓聚，SUV约20.2，最大约1.8×3.3cm；右颈II、Va区数个小淋巴结部分放射性分布略浓密，SUV约3.3，最大约0.6×1.1cm；余双颈小淋巴结放射性分布未见异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。心脏及纵隔大血管未见明显异常。左腋窝淋巴结放射性分布浓密，SUV约9.0，大小约0.9×1.5cm；纵隔、双肺门及右侧腋窝未见肿大淋巴结及异常放射性分布。双侧乳腺放射性分布未见明显异常。 肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 子宫体积增大，外形呈波浪状，放射性分布未见异常；子宫旁见高密度节育器影；膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，病灶侵犯软腭、口咽左侧壁及左咽旁间隙；左咽后及左颈II、III区淋巴结代谢活跃，考虑转移；左腋窝淋巴结代谢活跃，不排除转移。 右颈II、Va区小淋巴结部分代谢略活跃，疑炎性病变，请结合临床。 疑子宫肌瘤。\n- [全程D37] 检验组合: 嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.4；红细胞比容(Hct)-静脉血: 35.6%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞体积(MCV)-静脉血: 89.9fL；单核细胞百分比(Mono%)-静脉血: 0.046；血小板计数(PLT#)-静脉血: 21310E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.8pg；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.9；平均血小板体积(MPV)-静脉血: 9.2fL；单核细胞计数(Mono#)-静脉血: 0.410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；中性粒细胞百分比(Neut%)-静脉血: 0.79；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；血小板比容-静脉血: 20%；血红蛋白(Hb)-静脉血: 118g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.009；淋巴细胞百分比(Lymph%)-静脉血: 0.147；红细胞计数(RBC#)-静脉血: 3.9610E12/L；血小板分布宽度(PDW)-静脉血: 9.9%；大血小板百分比(P-LCR%)-静脉血: 18.7%；中性粒细胞计数(Neut#)-静脉血: 7.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；白细胞计数(WBC#)-静脉血: 910E9/L\n- [全程D40] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.018；草酸钙结晶计数(CAOX#)-尿液: 10/μL；红细胞计数(RBC#)-尿液: 4/μL；总蛋白(TP)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: 无色；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D41] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；红细胞计数(RBC#)-尿液: 4/μL；白细胞(LEU)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；酮体(KET)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 1/μL；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.024；颜色-尿液: Light-Yellow\n- [全程D42] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 6/μL；隐血(OB)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 4/μL；总蛋白(TP)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7；颜色-尿液: Light-Yellow；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.023；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）；细菌计数(BACT#)-尿液: 8/μL\n- [全程D47] 超声；双侧腋窝淋巴结彩超(套): 检查类型: 超声；检查名称: 双侧腋窝淋巴结彩超(套)；检查部位:；检查所见: 双侧侧腋窝腋下组可见多个淋巴结回声，最大约12x6mm，椭圆形，边界清，皮髓质分界清，淋巴门结构可探及。腋上组及腋中组未见明显异常淋巴结回声。 CDFI：上述淋巴结内可见门型血流信号。；检查结论: 左侧腋窝腋下组淋巴结，符合良性淋巴结声像。\n- [全程D47] 检验组合: 有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 89.5fL；钠离子(Na+)-静脉血: 135.9mmol/L；尿酸(UA)-静脉血: 277.5umol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.0062；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；血红蛋白(Hb)-静脉血: 115.6g/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 332.5g/L；碱性磷酸酶(ALP)-静脉血: 63.1U/L；白蛋白(ALB)-静脉血: 39.9g/L；单核细胞百分比(Mono%)-静脉血: 0.056；α-L-岩藻糖苷酶(AFU)-静脉血: 42.7U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.315；尿素氮(BUN)-静脉血: 5.4mmol/L；白细胞计数(WBC#)-静脉血: 4.0510E9/L；总胆固醇(TC)-静脉血: 4.12mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24U/L；氯离子(Cl-)-静脉血: 99.2mmol/L；载脂蛋白B(apoB)-静脉血: 0.78g/L；丙氨酸氨基转移酶(ALT)-静脉血: 41.3U/L；总胆汁酸(TBA)-静脉血: 0.5umol/L；血小板计数(PLT#)-静脉血: 196.310E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.5%；葡萄糖(Glu)-静脉血: 4.67mmol/L；球蛋白(GLO)-静脉血: 23.82g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.3mmol/L；间接胆红素(IBIL)-静脉血: 7umolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.0051；镁离子(Mg2+)-静脉血: 0.69mmol/L；磷(P)-静脉血: 1.4mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 3.7umol/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；总钙(Ca)-静脉血: 2.27mmol/L；胱抑素(Cys-C)-静脉血: 0.95mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.68；中性粒细胞百分比(Neut%)-静脉血: 0.617；总胆红素(TBIL)-静脉血: 10.7umol/L；红细胞比容(Hct)-静脉血: 34.7%；有核红细胞百分比(NRBC%)-静脉血: 0；总蛋白(TP)-静脉血: 63.72g/L；肌酐(Crea)-静脉血: 75.2umol/L；C-反应蛋白(CRP)-静脉血: 0.28mg/L；血小板分布宽度(PDW)-静脉血: 15.6%\n\n【既往治疗与反应】\n- [全程D36] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者复查血常规：中性粒细胞1.2×109/L。郭医生信息已隐藏：暂停化疗，予以患者升中西粒细胞处理。\n- [全程D37] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 患者入院第三天，继续升白细胞处理，今日复查血常规，白细胞已经恢复正常，郭医生信息已隐藏：下周一予以患者第二程化疗。\n- [全程D40] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，上级医师信息已隐藏示：患者无明显化疗禁忌症，可于今日执行第2程5-FU+顺铂方案诱导化疗，注意化疗不良反应。\n- [全程D43] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者第2程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。上级医师信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D47] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者第2程5-FU+顺铂方案诱导化疗结束，诉恶心、食欲下降，无发热、呕吐、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。上级医师信息已隐藏：患者第2程5-FU+顺铂方案诱导化疗结束，无诉特殊不适，嘱其完成鼻咽、颈MRI复查，以及放疗定位扫描，定期返院治疗。遵嘱。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动顺铂同期化放疗\nB. 完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动第3程5-FU+顺铂诱导化疗\nC. 完善左侧腋窝淋巴结穿刺活检，行放疗定位扫描，并启动顺铂同期化放疗\nD. 完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动尼妥珠单抗联合根治性放疗\nE. 完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动单纯根治性放疗\nF. 完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动信迪利单抗联合根治性放疗\nG. 完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动尼妥珠单抗联合顺铂同期化放疗\nH. 完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动卡培他滨同期化放疗\nI. 完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动西妥昔单抗联合根治性放疗\nJ. 完善全身PET-CT复查，行放疗定位扫描，并启动尼妥珠单抗联合根治性放疗\nK. 完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动吉西他滨联合顺铂同期化放疗\nL. 完善鼻咽及颈部MRI复查，暂缓放疗定位，启动第3程5-FU+顺铂诱导化疗\n\n请仅输出一个选项字母（A-L）。","gold_letter":"A","gold_action":"完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动顺铂同期化放疗","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动顺铂同期化放疗"},{"letter":"B","text":"完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动第3程5-FU+顺铂诱导化疗"},{"letter":"C","text":"完善左侧腋窝淋巴结穿刺活检，行放疗定位扫描，并启动顺铂同期化放疗"},{"letter":"D","text":"完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动尼妥珠单抗联合根治性放疗"},{"letter":"E","text":"完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动单纯根治性放疗"},{"letter":"F","text":"完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动信迪利单抗联合根治性放疗"},{"letter":"G","text":"完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动尼妥珠单抗联合顺铂同期化放疗"},{"letter":"H","text":"完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动卡培他滨同期化放疗"},{"letter":"I","text":"完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动西妥昔单抗联合根治性放疗"},{"letter":"J","text":"完善全身PET-CT复查，行放疗定位扫描，并启动尼妥珠单抗联合根治性放疗"},{"letter":"K","text":"完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动吉西他滨联合顺铂同期化放疗"},{"letter":"L","text":"完善鼻咽及颈部MRI复查，暂缓放疗定位，启动第3程5-FU+顺铂诱导化疗"}]}
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+{"sample_id":"sample-8976031a638416cb5f037a59","patient_id":"patient-5ee5dba6116030961a7a97b5","turn_id":"turn04","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 涕血半年伴右颈肿物2周；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D10] 入院记录: 主诉: 涕血半年伴右颈肿物2周.；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D3] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁增厚，可见软组织肿块形成，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。双侧咽隐窝见软组织占据，双侧咽旁脂肪间隙受压变窄，病灶侵犯双侧腭帆提肌。双侧腭帆张肌、头长肌未见受侵。 双侧翼腭窝、颞下窝未见异常；口咽双侧壁未见受累增厚，病变未累及后鼻孔。 双侧翼突基底内份、蝶骨基底部右份骨髓信号减低，增强可见轻度强化。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 双侧咽后间隙见肿大淋巴结，右侧大小约为7mm ×8 mm，左侧大小约3mm×4mm。双颈II区、III区见数个淋巴结，最大位于右颈II区，大小约为15mm×27mm。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽肿块，考虑鼻咽癌。 颅底骨质破坏。 右侧咽后及右颈淋巴结肿大，考虑转移瘤。 左侧咽后及左颈小淋巴结。 鼻窦炎、右乳突炎。\n- [全程D3] 检验组合: 平均红细胞体积(MCV)-静脉血: 93.7fL；凝血酶原时间活动度(PTA)-静脉血: 97%；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；中性粒细胞计数(Neut#)-静脉血: 3.610E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.7sec.；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；尿酸(UA)-静脉血: 413.6umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；血小板分布宽度(PDW)-静脉血: 14.7%；间接胆红素(IBIL)-静脉血: 9.7umolL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；丙氨酸氨基转移酶(ALT)-静脉血: 24U/L；碱性磷酸酶(ALP)-静脉血: 84.3U/L；总胆汁酸(TBA)-静脉血: 2.2umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.3mmol/L；葡萄糖(Glu)-静脉血: 4.51mmol/L；磷(P)-静脉血: 1.39mmol/L；C-反应蛋白(CRP)-静脉血: 4.68mg/L；血小板比容-静脉血: 25%；大血小板百分比(P-LCR%)-静脉血: 35.8%；血小板计数(PLT#)-静脉血: 21810E9/L；红细胞计数(RBC#)-静脉血: 4.5910E12/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；阴离子间隙(AG)-静脉血: 18；凝血酶时间(TT)-静脉血: 21.4sec.；红细胞比容(Hct)-静脉血: 43%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 344g/L；纤维蛋白原(Fbg)-静脉血: 3.09g/L；乳酸脱氢酶(LDH)-静脉血: 116.6U/L；总蛋白(TP)-静脉血: 69.58g/L；总钙(Ca)-静脉血: 2.31mmol/L；总胆固醇(TC)-静脉血: 5.94mmol/L；甘油三酯(TG)-静脉血: 1.79mmol/L；总胆红素(TBIL)-静脉血: 13.9umol/L；尿素氮(BUN)-静脉血: 4.08mmol/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；天门冬氨酸氨基转移酶(AST)-静脉血: 16.6U/L；血液二氧化碳含量ctCO2(B)-静脉血: 18.7mmol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；直接胆红素(DBIL)-静脉血: 4.2umol/L；氯离子(Cl-)-静脉血: 106.7mmol/L；血红蛋白(Hb)-静脉血: 148g/L；中性粒细胞百分比(Neut%)-静脉血: 0.591\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D4] 检验组合: 乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D5] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶后壁及双侧壁粘膜增厚放射性浓聚，SUV约23.1；病灶填塞双侧鼻后孔，向上侵犯蝶骨基底部、双翼突基底部、犁骨及枕骨斜坡，局部骨质稍模糊放射性分布浓密。双侧破裂孔未见明显异常。双侧咽隐窝变浅。双侧咽旁间隙结构尚清。右侧咽后淋巴结放射性浓聚，SUV约11.4，大小约0.7×1.0cm；左侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见异常。筛窦、右上颌窦及右乳突稍低密度影放射性分布未见异常；额窦、蝶窦、左侧上颌窦及左乳突结构及放射性分布未见明显异常。口咽、喉咽未见明显异常。甲状腺放射性分布未见异常。双颈Ⅱ区肿大淋巴结放射性浓聚，SUV约10.2，最大约1.6×2.6cm；余双侧颈部未见肿大淋巴结及异常放射性分布。 双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺纹理清晰，双侧肺野未见确切病灶和异常放射性分布。气管、支气管通畅。心脏及大血管放射性分布未见异常。胸壁未见确切病灶和异常放射性分布。双肺门、纵隔及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏密度不均匀降低，放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管及胆总管未见扩张。胆囊、胃及十二指肠放射性分布未见异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、肠管等形态、结构及放射性分布未见明显异常。前列腺点状高密度影放射性分布未见异常。双侧髂血管旁及腹股沟未见明显肿大淋巴结及异常放射性分布。 余所见颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，病灶侵犯颅底骨；右咽后及双颈Ⅱ区淋巴结代谢较活跃，考虑转移。 鼻窦炎；右乳突炎。 脂肪肝。 前列腺钙化灶。\n- [全程D10] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: 右臂静脉插管, 导管末端位于胸椎右旁T 7上缘水平，估计位于上腔静脉下段。；检查结论: 导管末端位置如上述。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-J 选项中选择唯一最合适的答案。\nA. 行吉西他滨+顺铂方案诱导化疗联合PD-1抑制剂\nB. 行单纯根治性放射治疗\nC. 行紫杉醇+顺铂+氟尿嘧啶方案诱导化疗联合西妥昔单抗\nD. 行鼻咽原发灶及颈部淋巴结根治性切除术\nE. 行洛铂+氟尿嘧啶方案姑息性化疗\nF. 行卡培他滨单药节拍化疗\nG. 行洛铂+氟尿嘧啶方案诱导化疗后序贯颈部淋巴结清扫术\nH. 行多西他赛+顺铂方案同期放化疗\nI. 行吉西他滨单药诱导化疗\nJ. 行依托泊苷+顺铂方案诱导化疗\n\n请仅输出一个选项字母（A-J）。","gold_letter":"A","gold_action":"行吉西他滨+顺铂方案诱导化疗联合PD-1抑制剂","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"行吉西他滨+顺铂方案诱导化疗联合PD-1抑制剂"},{"letter":"B","text":"行单纯根治性放射治疗"},{"letter":"C","text":"行紫杉醇+顺铂+氟尿嘧啶方案诱导化疗联合西妥昔单抗"},{"letter":"D","text":"行鼻咽原发灶及颈部淋巴结根治性切除术"},{"letter":"E","text":"行洛铂+氟尿嘧啶方案姑息性化疗"},{"letter":"F","text":"行卡培他滨单药节拍化疗"},{"letter":"G","text":"行洛铂+氟尿嘧啶方案诱导化疗后序贯颈部淋巴结清扫术"},{"letter":"H","text":"行多西他赛+顺铂方案同期放化疗"},{"letter":"I","text":"行吉西他滨单药诱导化疗"},{"letter":"J","text":"行依托泊苷+顺铂方案诱导化疗"}]}
+{"sample_id":"sample-5d943566dde88ca9f3640bc0","patient_id":"patient-5ee5dba6116030961a7a97b5","turn_id":"turn05","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 涕血半年伴右颈肿物2周；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D10] 入院记录: 主诉: 涕血半年伴右颈肿物2周.；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D10] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: 右臂静脉插管, 导管末端位于胸椎右旁T 7上缘水平，估计位于上腔静脉下段。；检查结论: 导管末端位置如上述。\n- [全程D39] 检验组合: 胱抑素(Cys-C)-静脉血: 0.78mg/L；血小板比容-静脉血: 14.8%；中性粒细胞百分比(Neut%)-静脉血: 0.61；γ-谷氨酰基转移酶(GGT)-静脉血: 57.8U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；总蛋白(TP)-静脉血: 67.84g/L；平均红细胞体积(MCV)-静脉血: 96.4fL；镁离子(Mg2+)-静脉血: 0.92mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.05mmolL；钠离子(Na+)-静脉血: 139.4mmol/L；磷(P)-静脉血: 1.36mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.302；氯离子(Cl-)-静脉血: 103.4mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.54；平均红细胞血红蛋白含量(MCH)-静脉血: 32.7pg；平均血小板体积(MPV)-静脉血: 8.84fL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.59；钾离子(K+)-静脉血: 3.79mmol/L；单核细胞百分比(Mono%)-静脉血: 0.06；白细胞计数(WBC#)-静脉血: 5.4510E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；α-L-岩藻糖苷酶(AFU)-静脉血: 35.8U/L；血小板分布宽度(PDW)-静脉血: 16.9%；红细胞比容(Hct)-静脉血: 40.3%；乳酸脱氢酶(LDH)-静脉血: 149.5U/L；红细胞计数(RBC#)-静脉血: 4.1810E12/L；C-反应蛋白(CRP)-静脉血: 2.31mg/L；总钙(Ca)-静脉血: 2.19mmol/L；尿素氮(BUN)-静脉血: 3.8mmol/L；尿酸(UA)-静脉血: 285umol/L；阴离子间隙(AG)-静脉血: 11.3；葡萄糖(Glu)-静脉血: 4.38mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339.2g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 32.4U/L；甘油三酯(TG)-静脉血: 2.32mmol/L；白蛋白(ALB)-静脉血: 41.6g/L；血小板计数(PLT#)-静脉血: 167.810E9/L；中性粒细胞计数(Neut#)-静脉血: 3.310E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.710E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.7mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；碱性磷酸酶(ALP)-静脉血: 76U/L；总胆固醇(TC)-静脉血: 5.49mmol/L；直接胆红素(DBIL)-静脉血: 3.9umol/L\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D34] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者今日洛铂+5-FU化疗第2天，诉食欲较差，无恶心、呕吐等不适，精神、睡眠尚可，大小便正常。查体基本同前。上级医师信息已隐藏：患者化疗第2日，一般情况可，嘱患者注意饮食，加强营养，续行化疗。密切观察化疗反应，必要时加强处理。现已按查房指示执行。\n- [全程D35] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者今日洛铂+5-FU化疗第3天，诉食欲较差，无恶心、呕吐等不适，精神、睡眠尚可，大小便正常。查体基本同前。上级医师信息已隐藏：患者化疗第3日，一般情况可，密切观察化疗反应，必要时加强处理。现已按查房指示执行。\n- [全程D39] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者计划于今日完成第2程洛铂+5-FU方案诱导化疗，未诉特殊不适。上级医师信息已隐藏：患者现完成第2程洛铂+5-FU方案诱导化疗，一般情况可，予今日出院。嘱患者出院后定期每周复查血常规、肝肾功能，2周后返院续治。现已按查房指示执行。\n- [时间未明] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 现已按查房指示执行。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 办理出院，嘱每3天复查血常规及肝肾功能，1周后返院继续下一阶段治疗\nB. 予以重组人粒细胞刺激因子皮下注射后办理出院，嘱每周复查血常规，2周后返院\nC. 办理出院，嘱每周复查血常规及肝肾功能，2周后返院继续下一阶段治疗\nD. 办理出院，嘱每2周复查血常规及肝肾功能，3周后返院继续下一阶段治疗\nE. 暂缓出院，继续住院观察并每日复查血常规，待血液学指标进一步稳定后出院\nF. 办理出院，嘱每月复查血常规及肝肾功能，4周后返院评估疗效并决定后续治疗\nG. 予以静脉滴注保肝药物治疗，待复查肝功能指标完全正常后办理出院\nH. 办理出院，处方口服升血小板药物，嘱每周复查血常规，2周后返院\nI. 办理出院，处方口服卡培他滨单药维持，嘱每周复查血常规，3周后返院\nJ. 办理出院，嘱每周复查血常规及肝肾功能，4周后返院行MRI复查评估疗效\nK. 予以口服氯化钾缓释片补钾治疗，每日监测电解质，待血钾水平上升后办理出院\nL. 办理出院，无需定期复查化验指标，嘱出现发热或出血症状时急诊就诊，3周后返院\n\n请仅输出一个选项字母（A-L）。","gold_letter":"C","gold_action":"办理出院，嘱每周复查血常规及肝肾功能，2周后返院继续下一阶段治疗。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"办理出院，嘱每3天复查血常规及肝肾功能，1周后返院继续下一阶段治疗"},{"letter":"B","text":"予以重组人粒细胞刺激因子皮下注射后办理出院，嘱每周复查血常规，2周后返院"},{"letter":"C","text":"办理出院，嘱每周复查血常规及肝肾功能，2周后返院继续下一阶段治疗"},{"letter":"D","text":"办理出院，嘱每2周复查血常规及肝肾功能，3周后返院继续下一阶段治疗"},{"letter":"E","text":"暂缓出院，继续住院观察并每日复查血常规，待血液学指标进一步稳定后出院"},{"letter":"F","text":"办理出院，嘱每月复查血常规及肝肾功能，4周后返院评估疗效并决定后续治疗"},{"letter":"G","text":"予以静脉滴注保肝药物治疗，待复查肝功能指标完全正常后办理出院"},{"letter":"H","text":"办理出院，处方口服升血小板药物，嘱每周复查血常规，2周后返院"},{"letter":"I","text":"办理出院，处方口服卡培他滨单药维持，嘱每周复查血常规，3周后返院"},{"letter":"J","text":"办理出院，嘱每周复查血常规及肝肾功能，4周后返院行MRI复查评估疗效"},{"letter":"K","text":"予以口服氯化钾缓释片补钾治疗，每日监测电解质，待血钾水平上升后办理出院"},{"letter":"L","text":"办理出院，无需定期复查化验指标，嘱出现发热或出血症状时急诊就诊，3周后返院"}]}
+{"sample_id":"sample-90c3b83f1d4c9db69ef01572","patient_id":"patient-5ee5dba6116030961a7a97b5","turn_id":"turn06","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 涕血半年伴右颈肿物2周；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D39] 检验组合: 胱抑素(Cys-C)-静脉血: 0.78mg/L；血小板比容-静脉血: 14.8%；中性粒细胞百分比(Neut%)-静脉血: 0.61；γ-谷氨酰基转移酶(GGT)-静脉血: 57.8U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；总蛋白(TP)-静脉血: 67.84g/L；平均红细胞体积(MCV)-静脉血: 96.4fL；镁离子(Mg2+)-静脉血: 0.92mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.05mmolL；钠离子(Na+)-静脉血: 139.4mmol/L；磷(P)-静脉血: 1.36mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.302；氯离子(Cl-)-静脉血: 103.4mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.54；平均红细胞血红蛋白含量(MCH)-静脉血: 32.7pg；平均血小板体积(MPV)-静脉血: 8.84fL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.59；钾离子(K+)-静脉血: 3.79mmol/L；单核细胞百分比(Mono%)-静脉血: 0.06；白细胞计数(WBC#)-静脉血: 5.4510E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；α-L-岩藻糖苷酶(AFU)-静脉血: 35.8U/L；血小板分布宽度(PDW)-静脉血: 16.9%；红细胞比容(Hct)-静脉血: 40.3%；乳酸脱氢酶(LDH)-静脉血: 149.5U/L；红细胞计数(RBC#)-静脉血: 4.1810E12/L；C-反应蛋白(CRP)-静脉血: 2.31mg/L；总钙(Ca)-静脉血: 2.19mmol/L；尿素氮(BUN)-静脉血: 3.8mmol/L；尿酸(UA)-静脉血: 285umol/L；阴离子间隙(AG)-静脉血: 11.3；葡萄糖(Glu)-静脉血: 4.38mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339.2g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 32.4U/L；甘油三酯(TG)-静脉血: 2.32mmol/L；白蛋白(ALB)-静脉血: 41.6g/L；血小板计数(PLT#)-静脉血: 167.810E9/L；中性粒细胞计数(Neut#)-静脉血: 3.310E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.710E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.7mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；碱性磷酸酶(ALP)-静脉血: 76U/L；总胆固醇(TC)-静脉血: 5.49mmol/L；直接胆红素(DBIL)-静脉血: 3.9umol/L\n- [全程D45] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌2程化疗后，与某次就诊时间片对比： 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁增厚，可见软组织肿块形成，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，对比前片，较前明显缩小。双侧咽隐窝见软组织占据，双侧咽旁脂肪间隙受压变窄，病灶侵犯双侧腭帆提肌，范围较前稍缩小。双侧腭帆张肌、头长肌未见受侵。 双侧翼腭窝、颞下窝未见异常；口咽双侧壁未见受累增厚，病变未累及后鼻孔。 双侧翼突基底内份、蝶骨基底部右份骨髓信号减低，增强可见轻度强化。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 双侧咽后间隙见肿大淋巴结，右侧大小约为6mm ×7 mm，左侧大小约4mm×6mm。双颈II区、III区见数个淋巴结，最大位于右颈II区，大小约为11mm×24mm，较前明显缩小。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌2程化疗后： 鼻咽病灶较前明显缩小。 颅底骨质破坏。 双侧咽后及颈部淋巴结，较前明显缩小。 鼻窦炎、右乳突炎。\n- [全程D60] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 28.3U/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.1g/L；平均红细胞体积(MCV)-静脉血: 97.9fL；血液二氧化碳含量ctCO2(B)-静脉血: 22.6mmol/L；血小板计数(PLT#)-静脉血: 152.910E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；钾离子(K+)-静脉血: 4.2mmol/L；碱性磷酸酶(ALP)-静脉血: 76.4U/L；单核细胞百分比(Mono%)-静脉血: 0.073；γ-谷氨酰基转移酶(GGT)-静脉血: 46.4U/L；血红蛋白(Hb)-静脉血: 145.2g/L；胱抑素(Cys-C)-静脉血: 0.82mg/L；阴离子间隙(AG)-静脉血: 18；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；甘油三酯(TG)-静脉血: 1.57mmol/L；直接胆红素(DBIL)-静脉血: 6.7umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 345.2g/L；间接胆红素(IBIL)-静脉血: 17.9umolL；中性粒细胞百分比(Neut%)-静脉血: 0.676；乳酸脱氢酶(LDH)-静脉血: 132.5U/L；总蛋白(TP)-静脉血: 71.34g/L；总胆固醇(TC)-静脉血: 6.52mmol/L；总钙(Ca)-静脉血: 2.33mmol/L；血小板分布宽度(PDW)-静脉血: 16.9%；血小板比容-静脉血: 13%；尿酸(UA)-静脉血: 305.5umol/L；平均血小板体积(MPV)-静脉血: 8.53fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1%；淋巴细胞百分比(Lymph%)-静脉血: 0.221；钠离子(Na+)-静脉血: 139.5mmol/L；载脂蛋白B(apoB)-静脉血: 1.31g/L；有核红细胞百分比(NRBC%)-静脉血: 0；总胆汁酸(TBA)-静脉血: 3.6umol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总胆红素(TBIL)-静脉血: 24.6umol/L；氯离子(Cl-)-静脉血: 99.3mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.5；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.16mmolL；白细胞计数(WBC#)-静脉血: 5.8210E9/L；C-反应蛋白(CRP)-静脉血: 1.53mg/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.025；红细胞比容(Hct)-静脉血: 42%\n\n【既往治疗与反应】\n- [全程D39] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者计划于今日完成第2程洛铂+5-FU方案诱导化疗，未诉特殊不适。上级医师信息已隐藏：患者现完成第2程洛铂+5-FU方案诱导化疗，一般情况可，予今日出院。嘱患者出院后定期每周复查血常规、肝肾功能，2周后返院续治。现已按查房指示执行。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D55] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者未诉特殊不适，饮食、睡眠、精神尚可，大小便正常。查体：基本同前。上级医师信息已隐藏：患者诊断明确，已完成患者靶区设计，并通过全科会诊，剂量分布均匀，予GTVnx:70Gy/30F,GTVnd(L):66Gy/30F,GTVnd(R):66Gy/30F。考虑联合洛铂同期放化疗，告知患者放疗及化疗的可能获益及相关风险，患者表示已知情并同意。续观。现已按查房指示执行。\n- [全程D56] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者现放疗1F，未诉特殊不适。生命体征平稳。查体情况大致同前。上级医师信息已隐藏：考虑患者一般情况可，继续放疗，密切关注放疗副反应，必要时加强处理。现已按查房指示执行。\n- [时间未明] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 现已按查房指示执行。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 继续同期放化疗，予以重组人粒细胞刺激因子皮下注射及甲氧氯普胺口服止吐。\nB. 继续同期放化疗，予以重组人血小板生成素皮下注射及脂肪乳氨基酸葡萄糖静脉营养。\nC. 继续同期放化疗，予以多烯磷脂酰胆碱静脉滴注保肝及甲氧氯普胺口服止吐。\nD. 继续同期放化疗，予以甲氧氯普胺口服止吐，加用脂肪乳氨基酸葡萄糖静脉营养及胸腺五肽支持治疗。\nE. 暂停同期化疗，仅行单纯放疗，予以甲氧氯普胺口服止吐及脂肪乳氨基酸葡萄糖静脉营养。\nF. 继续同期放化疗，予以促红细胞生成素皮下注射及胸腺五肽支持治疗。\nG. 暂停放化疗，予以静脉输注红细胞悬液及脂肪乳氨基酸葡萄糖静脉营养。\nH. 继续同期放化疗，予以5-HT3受体拮抗剂静脉推注强化止吐，暂不予静脉营养支持。\nI. 继续同期放化疗，予以水化碱化尿液及甲氧氯普胺口服止吐。\nJ. 暂停放化疗，予以广谱抗生素静脉滴注抗感染及胸腺五肽支持治疗。\nK. 继续同期放化疗，予以甲氧氯普胺口服止吐，暂不予静脉营养及免疫调节支持。\nL. 继续同期放化疗，予以重组人粒细胞刺激因子及促红细胞生成素双重支持。\n\n请仅输出一个选项字母（A-L）。","gold_letter":"K","gold_action":"继续同期放化疗，予以甲氧氯普胺口服止吐，暂不予静脉营养及免疫调节支持。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"继续同期放化疗，予以重组人粒细胞刺激因子皮下注射及甲氧氯普胺口服止吐。"},{"letter":"B","text":"继续同期放化疗，予以重组人血小板生成素皮下注射及脂肪乳氨基酸葡萄糖静脉营养。"},{"letter":"C","text":"继续同期放化疗，予以多烯磷脂酰胆碱静脉滴注保肝及甲氧氯普胺口服止吐。"},{"letter":"D","text":"继续同期放化疗，予以甲氧氯普胺口服止吐，加用脂肪乳氨基酸葡萄糖静脉营养及胸腺五肽支持治疗。"},{"letter":"E","text":"暂停同期化疗，仅行单纯放疗，予以甲氧氯普胺口服止吐及脂肪乳氨基酸葡萄糖静脉营养。"},{"letter":"F","text":"继续同期放化疗，予以促红细胞生成素皮下注射及胸腺五肽支持治疗。"},{"letter":"G","text":"暂停放化疗，予以静脉输注红细胞悬液及脂肪乳氨基酸葡萄糖静脉营养。"},{"letter":"H","text":"继续同期放化疗，予以5-HT3受体拮抗剂静脉推注强化止吐，暂不予静脉营养支持。"},{"letter":"I","text":"继续同期放化疗，予以水化碱化尿液及甲氧氯普胺口服止吐。"},{"letter":"J","text":"暂停放化疗，予以广谱抗生素静脉滴注抗感染及胸腺五肽支持治疗。"},{"letter":"K","text":"继续同期放化疗，予以甲氧氯普胺口服止吐，暂不予静脉营养及免疫调节支持。"},{"letter":"L","text":"继续同期放化疗，予以重组人粒细胞刺激因子及促红细胞生成素双重支持。"}]}
+{"sample_id":"sample-c2aa48d510cb846f4ee51384","patient_id":"patient-5ee5dba6116030961a7a97b5","turn_id":"turn08","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 涕血半年伴右颈肿物2周；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D60] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 28.3U/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.1g/L；平均红细胞体积(MCV)-静脉血: 97.9fL；血液二氧化碳含量ctCO2(B)-静脉血: 22.6mmol/L；血小板计数(PLT#)-静脉血: 152.910E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；钾离子(K+)-静脉血: 4.2mmol/L；碱性磷酸酶(ALP)-静脉血: 76.4U/L；单核细胞百分比(Mono%)-静脉血: 0.073；γ-谷氨酰基转移酶(GGT)-静脉血: 46.4U/L；血红蛋白(Hb)-静脉血: 145.2g/L；胱抑素(Cys-C)-静脉血: 0.82mg/L；阴离子间隙(AG)-静脉血: 18；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；甘油三酯(TG)-静脉血: 1.57mmol/L；直接胆红素(DBIL)-静脉血: 6.7umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 345.2g/L；间接胆红素(IBIL)-静脉血: 17.9umolL；中性粒细胞百分比(Neut%)-静脉血: 0.676；乳酸脱氢酶(LDH)-静脉血: 132.5U/L；总蛋白(TP)-静脉血: 71.34g/L；总胆固醇(TC)-静脉血: 6.52mmol/L；总钙(Ca)-静脉血: 2.33mmol/L；血小板分布宽度(PDW)-静脉血: 16.9%；血小板比容-静脉血: 13%；尿酸(UA)-静脉血: 305.5umol/L；平均血小板体积(MPV)-静脉血: 8.53fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1%；淋巴细胞百分比(Lymph%)-静脉血: 0.221；钠离子(Na+)-静脉血: 139.5mmol/L；载脂蛋白B(apoB)-静脉血: 1.31g/L；有核红细胞百分比(NRBC%)-静脉血: 0；总胆汁酸(TBA)-静脉血: 3.6umol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总胆红素(TBIL)-静脉血: 24.6umol/L；氯离子(Cl-)-静脉血: 99.3mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.5；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.16mmolL；白细胞计数(WBC#)-静脉血: 5.8210E9/L；C-反应蛋白(CRP)-静脉血: 1.53mg/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.025；红细胞比容(Hct)-静脉血: 42%\n- [全程D67] 检验组合: 平均红细胞血红蛋白浓度(MCHC)-静脉血: 349g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.5；血小板比容-静脉血: 12%；总蛋白(TP)-静脉血: 64.55g/L；镁离子(Mg2+)-静脉血: 0.9mmol/L；乳酸脱氢酶(LDH)-静脉血: 113.1U/L；总胆固醇(TC)-静脉血: 5.45mmol/L；葡萄糖(Glu)-静脉血: 4.72mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.5；钠离子(Na+)-静脉血: 142.5mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 33.4pg；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.022；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；总胆汁酸(TBA)-静脉血: 2.5umol/L；阴离子间隙(AG)-静脉血: 10；胱抑素(Cys-C)-静脉血: 0.75mg/L；间接胆红素(IBIL)-静脉血: 8.9umolL；钾离子(K+)-静脉血: 3.8mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 36.7U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；红细胞比容(Hct)-静脉血: 39%；血小板分布宽度(PDW)-静脉血: 12.4%；中性粒细胞百分比(Neut%)-静脉血: 0.753；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；球蛋白(GLO)-静脉血: 26.65g/L；甘油三酯(TG)-静脉血: 1.38mmol/L；碱性磷酸酶(ALP)-静脉血: 67.5U/L；白细胞计数(WBC#)-静脉血: 5.0810E9/L；总胆红素(TBIL)-静脉血: 13.1umol/L；单核细胞百分比(Mono%)-静脉血: 0.089；α-L-岩藻糖苷酶(AFU)-静脉血: 26U/L；尿酸(UA)-静脉血: 318.1umol/L；尿素氮(BUN)-静脉血: 3.21mmol/L；平均血小板体积(MPV)-静脉血: 10.4fL；载脂蛋白B(apoB)-静脉血: 1.08g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；血红蛋白(Hb)-静脉血: 136g/L；氯离子(Cl-)-静脉血: 105.1mmol/L；C-反应蛋白(CRP)-静脉血: 6.86mg/L；血小板计数(PLT#)-静脉血: 11810E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.8mmol/L；总钙(Ca)-静脉血: 2.23mmol/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；磷(P)-静脉血: 1.38mmol/L\n- [全程D74] 检验组合: 有核红细胞计数(NRBC#)-静脉血: 010E9/L；乳酸脱氢酶(LDH)-静脉血: 120.6U/L；磷(P)-静脉血: 1.42mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.111；天门冬氨酸氨基转移酶(AST)-静脉血: 20.1U/L；直接胆红素(DBIL)-静脉血: 5.8umol/L；胱抑素(Cys-C)-静脉血: 0.73mg/L；血小板比容-静脉血: 12.1%；载脂蛋白AI(apoAI)-静脉血: 1.03g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；C-反应蛋白(CRP)-静脉血: 12.33mg/L；血红蛋白(Hb)-静脉血: 131.8g/L；尿素氮(BUN)-静脉血: 4.01mmol/L；载脂蛋白B(apoB)-静脉血: 1.28g/L；甘油三酯(TG)-静脉血: 1.16mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 34pg；单核细胞百分比(Mono%)-静脉血: 0.103；总钙(Ca)-静脉血: 2.21mmol/L；红细胞计数(RBC#)-静脉血: 3.8710E12/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；尿酸(UA)-静脉血: 319.8umol/L；总胆红素(TBIL)-静脉血: 18.5umol/L；钠离子(Na+)-静脉血: 140.1mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.11mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347.8g/L；中性粒细胞百分比(Neut%)-静脉血: 0.746；红细胞比容(Hct)-静脉血: 37.8%；血小板分布宽度(PDW)-静脉血: 16.7%；球蛋白(GLO)-静脉血: 21.96g/L；肌酐(Crea)-静脉血: 61.6umol/L；总胆汁酸(TBA)-静脉血: 3.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 34.1U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.01mmolL；碱性磷酸酶(ALP)-静脉血: 65.6U/L；葡萄糖(Glu)-静脉血: 5.14mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.036；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；镁离子(Mg2+)-静脉血: 0.97mmol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；平均红细胞体积(MCV)-静脉血: 97.9fL；平均血小板体积(MPV)-静脉血: 7.88fL；间接胆红素(IBIL)-静脉血: 12.7umolL；钾离子(K+)-静脉血: 3.8mmol/L；总蛋白(TP)-静脉血: 60.86g/L\n- [全程D81] 检验组合: 红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.6；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.77；平均红细胞体积(MCV)-静脉血: 95.3fL；直接胆红素(DBIL)-静脉血: 6.5umol/L；平均血小板体积(MPV)-静脉血: 10fL；大血小板百分比(P-LCR%)-静脉血: 25.7%；白蛋白(ALB)-静脉血: 41.6g/L；肌酐(Crea)-静脉血: 53.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.75；钠离子(Na+)-静脉血: 137.9mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.7U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7；间接胆红素(IBIL)-静脉血: 17.4umolL；球蛋白(GLO)-静脉血: 23.48g/L；总胆固醇(TC)-静脉血: 5.17mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.833；胱抑素(Cys-C)-静脉血: 0.67mg/L；乳酸脱氢酶(LDH)-静脉血: 137.4U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.51mmol/L；血小板分布宽度(PDW)-静脉血: 11.9%；白细胞计数(WBC#)-静脉血: 3.7810E9/L；载脂蛋白B(apoB)-静脉血: 1.17g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 38.7U/L；中性粒细胞计数(Neut#)-静脉血: 3.210E9/L；总胆红素(TBIL)-静脉血: 23.9umol/L；阴离子间隙(AG)-静脉血: 11.3；α-L-岩藻糖苷酶(AFU)-静脉血: 30.5U/L；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；血小板比容-静脉血: 15%；C-反应蛋白(CRP)-静脉血: 15.45mg/L；氯离子(Cl-)-静脉血: 100.4mmol/L；总胆汁酸(TBA)-静脉血: 1.2umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.024；尿素氮(BUN)-静脉血: 4.4mmol/L；血红蛋白(Hb)-静脉血: 134g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.8U/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；血小板计数(PLT#)-静脉血: 14510E9/L；红细胞比容(Hct)-静脉血: 38.6%；磷(P)-静脉血: 1.33mmol/L；单核细胞百分比(Mono%)-静脉血: 0.079；总蛋白(TP)-静脉血: 65.08g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；钾离子(K+)-静脉血: 3.93mmol/L\n- [全程D88] 检验组合: C-反应蛋白(CRP)-静脉血: 7.88mg/L；甘油三酯(TG)-静脉血: 1.18mmol/L；平均红细胞体积(MCV)-静脉血: 96.4fL；载脂蛋白B(apoB)-静脉血: 1.03g/L；血小板计数(PLT#)-静脉血: 92.910E9/L；总胆红素(TBIL)-静脉血: 29umol/L；中性粒细胞计数(Neut#)-静脉血: 2.810E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 30.3U/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；葡萄糖(Glu)-静脉血: 4.55mmol/L；总胆汁酸(TBA)-静脉血: 2.3umol/L；血小板比容-静脉血: 7.5%；红细胞比容(Hct)-静脉血: 32.9%；中性粒细胞百分比(Neut%)-静脉血: 0.784；载脂蛋白AI(apoAI)-静脉血: 0.93g/L；血红蛋白(Hb)-静脉血: 117.2g/L；间接胆红素(IBIL)-静脉血: 20.4umolL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；白细胞计数(WBC#)-静脉血: 3.5310E9/L；总胆固醇(TC)-静脉血: 4.84mmol/L；总钙(Ca)-静脉血: 2.27mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；平均红细胞血红蛋白含量(MCH)-静脉血: 34.2pg；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总蛋白(TP)-静脉血: 62g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.86mmolL；单核细胞计数(Mono#)-静脉血: 0.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.108；直接胆红素(DBIL)-静脉血: 8.6umol/L；钠离子(Na+)-静脉血: 141mmol/L；镁离子(Mg2+)-静脉血: 0.94mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.088；钾离子(K+)-静脉血: 4.2mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 48.3U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；尿酸(UA)-静脉血: 281.5umol/L；白蛋白(ALB)-静脉血: 40.1g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；红细胞计数(RBC#)-静脉血: 3.4210E12/L；α-L-岩藻糖苷酶(AFU)-静脉血: 25U/L；氯离子(Cl-)-静脉血: 104mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1%；肌酐(Crea)-静脉血: 65.4umol/L；血小板分布宽度(PDW)-静脉血: 17.3%\n- [全程D94] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理清晰，走行自然，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影形态、大小未见异常。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见异常。\n\n【既往治疗与反应】\n- [全程D71] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者现放疗13F，诉口干，轻微咽痛，偶有咳嗽，食欲欠佳，无恶心、呕吐等不适，精神、睡眠欠佳，大小便正常。查体基本同前。上级医师信息已隐藏：患者放疗初期出现口腔粘膜反应，予止咳、止痛等对症处理，继续放疗，密切关注放疗副反应，定期复查血常规，必要时加强处理。现已按查房指示执行。\n- [全程D76] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者现放疗16F，DDP同期化疗第1日，诉咽痛较前加重，偶有咳嗽，食欲欠佳，无恶心、呕吐等不适，精神、睡眠欠佳，大小便正常。查体基本同前。上级医师信息已隐藏：患者咽痛较前加重，予加强止痛。患者今日洛铂同期化疗第1日，密切观察化疗反应，加强止呕处理，注意放化疗叠加副反应，继续喷喉、洗鼻等对症处理，续行放疗。现已按查房指示执行。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D91] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者现放疗26F，诉口干，咽痛较前明显，食欲较前变差，余无不适，精神、睡眠一般。查体基本同前。上级医师信息已隐藏：患者现于同时期放化疗中，放射性口腔粘膜反应1度，予止痛、静脉营养支持等加强处理，继续予喷喉、洗鼻等对症处理，定期复查血常规，续行放疗。现已按查房指示执行。\n- [时间未明] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 现已按查房指示执行。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行鼻咽部MRI及全身PET-CT全面评估疗效，若疑有残留即刻行局部挽救性手术。\nB. 行电子鼻咽镜检查并对原发灶区域行多点活检，明确病理缓解情况后决定是否追加化疗。\nC. 暂缓局部内镜检查，继续原方案洛铂单药辅助化疗2个周期后再行全面评估。\nD. 行电子鼻咽镜检查评估局部疗效，并继续住院行第3周期洛铂同期化疗。\nE. 直接安排出院，嘱3个月后返院行鼻咽镜及MRI检查，期间停用所有处方药物。\nF. 行电子鼻咽镜检查（不活检）评估局部情况，安排出院并予以镇痛、黏膜保护及雾化等对症药物。\nG. 行鼻咽部及颈部增强CT评估病灶退缩情况，若有残留予以局部追加放疗推量。\nH. 行电子鼻咽镜检查评估局部疗效，安排出院并立即开始PD-1抑制剂维持治疗半年。\nI. 行全身骨扫描及腹部超声评估远处转移情况，若阴性则安排出院并定期随访。\nJ. 行电子鼻咽镜检查（不活检）评估局部情况，并转入头颈外科行右颈淋巴结清扫术。\nK. 安排出院并予以镇痛药物，1个月后返院行鼻咽镜下活检以明确是否达到病理完全缓解。\nL. 行鼻咽部MRI评估局部疗效，若达到完全缓解则安排出院并逐步停用所有镇痛药物。\n\n请仅输出一个选项字母（A-L）。","gold_letter":"F","gold_action":"行电子鼻咽镜检查（不活检）评估局部情况，安排出院并予以镇痛、黏膜保护及雾化等对症药物。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"行鼻咽部MRI及全身PET-CT全面评估疗效，若疑有残留即刻行局部挽救性手术。"},{"letter":"B","text":"行电子鼻咽镜检查并对原发灶区域行多点活检，明确病理缓解情况后决定是否追加化疗。"},{"letter":"C","text":"暂缓局部内镜检查，继续原方案洛铂单药辅助化疗2个周期后再行全面评估。"},{"letter":"D","text":"行电子鼻咽镜检查评估局部疗效，并继续住院行第3周期洛铂同期化疗。"},{"letter":"E","text":"直接安排出院，嘱3个月后返院行鼻咽镜及MRI检查，期间停用所有处方药物。"},{"letter":"F","text":"行电子鼻咽镜检查（不活检）评估局部情况，安排出院并予以镇痛、黏膜保护及雾化等对症药物。"},{"letter":"G","text":"行鼻咽部及颈部增强CT评估病灶退缩情况，若有残留予以局部追加放疗推量。"},{"letter":"H","text":"行电子鼻咽镜检查评估局部疗效，安排出院并立即开始PD-1抑制剂维持治疗半年。"},{"letter":"I","text":"行全身骨扫描及腹部超声评估远处转移情况，若阴性则安排出院并定期随访。"},{"letter":"J","text":"行电子鼻咽镜检查（不活检）评估局部情况，并转入头颈外科行右颈淋巴结清扫术。"},{"letter":"K","text":"安排出院并予以镇痛药物，1个月后返院行鼻咽镜下活检以明确是否达到病理完全缓解。"},{"letter":"L","text":"行鼻咽部MRI评估局部疗效，若达到完全缓解则安排出院并逐步停用所有镇痛药物。"}]}
+{"sample_id":"sample-6bc929b6a549b509a4ffbecf","patient_id":"patient-867f2373fc1b04e0b8b80452","turn_id":"turn01","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D1750] 入院记录: 主诉: 间断性涕血3月，面麻、复视1月，耳鸣20天；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 复视,涕血,双面麻；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟1包，30年，不嗜酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：88次/分，R：20次/分，BP：114/69mmHg,Ht：170cm，Wt：62kg，BSA：1.71m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 电子鼻咽镜下活检，鼻咽及颈部CT平扫加增强，常规血液学检查\nB. 鼻咽及颈部MRI平扫加增强，全身PET-CT检查，常规血液学检查\nC. 电子鼻咽镜下活检，鼻咽MRI平扫加增强，常规血液学检查\nD. 电子鼻咽镜下活检，鼻咽及颈部MRI平扫，常规血液学检查\nE. 鼻咽及颈部CT平扫加增强，全身骨扫描，常规血液学检查\nF. 电子鼻咽镜下活检，鼻咽及颈部MRI平扫加增强，腰椎穿刺脑脊液检查\nG. 电子鼻咽镜下活检，全身PET-CT检查，常规血液学检查\nH. 鼻咽刷片细胞学检查，鼻咽及颈部MRI平扫加增强，常规血液学检查\nI. 电子鼻咽镜下活检，鼻咽及颈部MRI平扫加增强，颈部淋巴结穿刺活检\nJ. 电子鼻咽镜下活检，鼻咽及颈部超声检查，常规血液学检查\nK. 电子鼻咽镜下活检，鼻咽及颈部MRI平扫加增强，常规血液学检查\nL. 鼻咽及颈部MRI平扫加增强，常规血液学检查，择期行鼻咽肿物切除术\n\n请仅输出一个选项字母（A-L）。","gold_letter":"K","gold_action":"行电子鼻咽镜检查及组织活检以明确病理诊断，同时完善鼻咽及颈部MRI平扫加增强进行局部区域分期，并进行常规血液学检查。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"电子鼻咽镜下活检，鼻咽及颈部CT平扫加增强，常规血液学检查"},{"letter":"B","text":"鼻咽及颈部MRI平扫加增强，全身PET-CT检查，常规血液学检查"},{"letter":"C","text":"电子鼻咽镜下活检，鼻咽MRI平扫加增强，常规血液学检查"},{"letter":"D","text":"电子鼻咽镜下活检，鼻咽及颈部MRI平扫，常规血液学检查"},{"letter":"E","text":"鼻咽及颈部CT平扫加增强，全身骨扫描，常规血液学检查"},{"letter":"F","text":"电子鼻咽镜下活检，鼻咽及颈部MRI平扫加增强，腰椎穿刺脑脊液检查"},{"letter":"G","text":"电子鼻咽镜下活检，全身PET-CT检查，常规血液学检查"},{"letter":"H","text":"鼻咽刷片细胞学检查，鼻咽及颈部MRI平扫加增强，常规血液学检查"},{"letter":"I","text":"电子鼻咽镜下活检，鼻咽及颈部MRI平扫加增强，颈部淋巴结穿刺活检"},{"letter":"J","text":"电子鼻咽镜下活检，鼻咽及颈部超声检查，常规血液学检查"},{"letter":"K","text":"电子鼻咽镜下活检，鼻咽及颈部MRI平扫加增强，常规血液学检查"},{"letter":"L","text":"鼻咽及颈部MRI平扫加增强，常规血液学检查，择期行鼻咽肿物切除术"}]}
+{"sample_id":"sample-31a839b9f99ab6bf0a218575","patient_id":"patient-867f2373fc1b04e0b8b80452","turn_id":"turn02","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D1750] 入院记录: 主诉: 间断性涕血3月，面麻、复视1月，耳鸣20天；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 复视,涕血,双面麻；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟1包，30年，不嗜酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：88次/分，R：20次/分，BP：114/69mmHg,Ht：170cm，Wt：62kg，BSA：1.71m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D1751] 检验组合: 阴离子间隙(AG)-静脉血: 18.2；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；平均血小板体积(MPV)-静脉血: 9.8fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.8；白细胞计数(WBC#)-静脉血: 6.2310E9/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 64.8umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阳性(+)（参考: 阴性）；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.92mmol/L；透明质酸(HA)-静脉血: 91.434ng/ml；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.4U/L；氯离子(Cl-)-静脉血: 101.8mmol/L；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 1.43ng/ml（参考: <0.704）；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；血小板比容-静脉血: 20%；活化部分凝血活酶时间(APTT)-静脉血: 27.5sec.；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.62；梅毒非特异性抗体甲苯胺红不加热血清试验(TRUST)-静脉血: 阴性(-)（参考: 阴性）；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；总钙(Ca)-静脉血: 2.27mmol/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.43；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；凝血酶时间(TT)-静脉血: 17.6sec.；间接胆红素(IBIL)-静脉血: 6.6umolL；凝血酶原时间活动度(PTA)-静脉血: 97.9%；降钙素(CT)-静脉血: 25.774pg/ml；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 44.9U/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体颗粒凝集试验(TPPA)-静脉血: 1:80（参考: 阴性）；甘油三酯(TG)-静脉血: 0.81mmol/L；总蛋白(TP)-静脉血: 69.47g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.36mmolL；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7；丙氨酸氨基转移酶(ALT)-静脉血: 34.4U/L；胱抑素(Cys-C)-静脉血: 0.84mg/L；血小板分布宽度(PDW)-静脉血: 11.4%；钠离子(Na+)-静脉血: 141mmol/L；凝血酶原时间(PT)-静脉血: 11.1sec.；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善全身远处转移排查及血浆EBV-DNA检测，并直接安排单纯根治性放射治疗定位。\nB. 完善全身远处转移排查及血浆EBV-DNA检测，并请头颈外科会诊评估鼻咽及颈部病灶根治性切除可能。\nC. 完善胸部X线、腹部超声及血浆EBV-DNA检测进行分期，并行超声引导下中心静脉穿刺置管及X线定位，为全身化疗做准备。\nD. 完善全身远处转移排查及血浆EBV-DNA检测，并预防性行经皮内镜下胃造瘘术（PEG）以保障放化疗期间营养。\nE. 安排鼻咽镜下再次活检以明确组织学亚型，暂缓全身远处转移排查及静脉置管，待病理亚型确诊后再行后续安排。\nF. 完善全身远处转移排查及血浆EBV-DNA检测，并直接通过外周静脉留置针（PIV）启动全身化疗。\nG. 完善全身骨扫描及血浆EBV-DNA检测，并行超声引导下中心静脉穿刺置管及X线定位，为全身化疗做准备。\nH. 完善全身远处转移排查及血浆EBV-DNA检测，并先行双侧颈部淋巴结清扫术，术后行全身化疗。\nI. 完善全身远处转移排查及血浆EBV-DNA检测，并安排单药免疫治疗作为诱导治疗，无需中心静脉置管。\nJ. 完善全身远处转移排查及血浆EBV-DNA检测，并安排超声引导下颈部淋巴结穿刺活检以病理确诊N分期。\nK. 完善全身远处转移排查及血浆EBV-DNA检测，并常规安排腰椎穿刺脑脊液检查以排除脑膜转移。\nL. 完善全身远处转移排查（如PET-CT或胸腹部CT联合骨扫描）及血浆EBV-DNA检测，并行超声引导下中心静脉穿刺置管及X线定位，为全身化疗做准备。\n\n请仅输出一个选项字母（A-L）。","gold_letter":"L","gold_action":"完善全身远处转移排查（如PET-CT或胸腹部CT联合骨扫描）及血浆EBV-DNA检测，并行超声引导下中心静脉穿刺置管及X线定位，为全身化疗做准备。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"完善全身远处转移排查及血浆EBV-DNA检测，并直接安排单纯根治性放射治疗定位。"},{"letter":"B","text":"完善全身远处转移排查及血浆EBV-DNA检测，并请头颈外科会诊评估鼻咽及颈部病灶根治性切除可能。"},{"letter":"C","text":"完善胸部X线、腹部超声及血浆EBV-DNA检测进行分期，并行超声引导下中心静脉穿刺置管及X线定位，为全身化疗做准备。"},{"letter":"D","text":"完善全身远处转移排查及血浆EBV-DNA检测，并预防性行经皮内镜下胃造瘘术（PEG）以保障放化疗期间营养。"},{"letter":"E","text":"安排鼻咽镜下再次活检以明确组织学亚型，暂缓全身远处转移排查及静脉置管，待病理亚型确诊后再行后续安排。"},{"letter":"F","text":"完善全身远处转移排查及血浆EBV-DNA检测，并直接通过外周静脉留置针（PIV）启动全身化疗。"},{"letter":"G","text":"完善全身骨扫描及血浆EBV-DNA检测，并行超声引导下中心静脉穿刺置管及X线定位，为全身化疗做准备。"},{"letter":"H","text":"完善全身远处转移排查及血浆EBV-DNA检测，并先行双侧颈部淋巴结清扫术，术后行全身化疗。"},{"letter":"I","text":"完善全身远处转移排查及血浆EBV-DNA检测，并安排单药免疫治疗作为诱导治疗，无需中心静脉置管。"},{"letter":"J","text":"完善全身远处转移排查及血浆EBV-DNA检测，并安排超声引导下颈部淋巴结穿刺活检以病理确诊N分期。"},{"letter":"K","text":"完善全身远处转移排查及血浆EBV-DNA检测，并常规安排腰椎穿刺脑脊液检查以排除脑膜转移。"},{"letter":"L","text":"完善全身远处转移排查（如PET-CT或胸腹部CT联合骨扫描）及血浆EBV-DNA检测，并行超声引导下中心静脉穿刺置管及X线定位，为全身化疗做准备。"}]}
+{"sample_id":"sample-9833293530ca96a9a65dbbb8","patient_id":"patient-867f2373fc1b04e0b8b80452","turn_id":"turn04","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D1750] 入院记录: 主诉: 间断性涕血3月，面麻、复视1月，耳鸣20天；现病史: 缘于3月余前患者无明显诱因出现间断性回吸性涕血，未予重视，一月前患者出现双侧面麻、复视，无鼻塞、头痛、视力下降等不适，遂就诊当地医院行鼻咽活检病理确诊鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 复视,涕血,双面麻；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟1包，30年，不嗜酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：88次/分，R：20次/分，BP：114/69mmHg,Ht：170cm，Wt：62kg，BSA：1.71m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率88次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1751] 检验组合: 阴离子间隙(AG)-静脉血: 18.2；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；平均血小板体积(MPV)-静脉血: 9.8fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.8；白细胞计数(WBC#)-静脉血: 6.2310E9/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 64.8umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阳性(+)（参考: 阴性）；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.92mmol/L；透明质酸(HA)-静脉血: 91.434ng/ml；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.4U/L；氯离子(Cl-)-静脉血: 101.8mmol/L；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 1.43ng/ml（参考: <0.704）；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；血小板比容-静脉血: 20%；活化部分凝血活酶时间(APTT)-静脉血: 27.5sec.；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.62；梅毒非特异性抗体甲苯胺红不加热血清试验(TRUST)-静脉血: 阴性(-)（参考: 阴性）；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；总钙(Ca)-静脉血: 2.27mmol/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.43；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；凝血酶时间(TT)-静脉血: 17.6sec.；间接胆红素(IBIL)-静脉血: 6.6umolL；凝血酶原时间活动度(PTA)-静脉血: 97.9%；降钙素(CT)-静脉血: 25.774pg/ml；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 44.9U/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体颗粒凝集试验(TPPA)-静脉血: 1:80（参考: 阴性）；甘油三酯(TG)-静脉血: 0.81mmol/L；总蛋白(TP)-静脉血: 69.47g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.36mmolL；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7；丙氨酸氨基转移酶(ALT)-静脉血: 34.4U/L；胱抑素(Cys-C)-静脉血: 0.84mg/L；血小板分布宽度(PDW)-静脉血: 11.4%；钠离子(Na+)-静脉血: 141mmol/L；凝血酶原时间(PT)-静脉血: 11.1sec.；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 诱导化疗（吉西他滨+顺铂）序贯单纯根治性放疗\nB. 诱导化疗（洛铂+氟尿嘧啶）序贯同期放化疗\nC. 同期放化疗（顺铂单药）序贯辅助化疗\nD. 诱导化疗（多西他赛+顺铂+氟尿嘧啶）序贯单纯根治性放疗\nE. 诱导化疗（紫杉醇+卡铂）序贯同期放化疗\nF. 靶向治疗（西妥昔单抗）联合根治性放疗\nG. 诱导化疗（洛铂+氟尿嘧啶）联合特瑞普利单抗序贯同期放化疗\nH. 诱导化疗（依托泊苷+顺铂）序贯同期放化疗\nI. 单纯根治性放疗序贯辅助化疗\nJ. 诱导化疗（顺铂+氟尿嘧啶）序贯单纯根治性放疗\nK. 诱导化疗（吉西他滨+卡培他滨）序贯同期放化疗\nL. 姑息性化疗（洛铂+氟尿嘧啶）序贯姑息性放疗\n\n请仅输出一个选项字母（A-L）。","gold_letter":"B","gold_action":"诱导化疗（洛铂+氟尿嘧啶）序贯同期放化疗","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"诱导化疗（吉西他滨+顺铂）序贯单纯根治性放疗"},{"letter":"B","text":"诱导化疗（洛铂+氟尿嘧啶）序贯同期放化疗"},{"letter":"C","text":"同期放化疗（顺铂单药）序贯辅助化疗"},{"letter":"D","text":"诱导化疗（多西他赛+顺铂+氟尿嘧啶）序贯单纯根治性放疗"},{"letter":"E","text":"诱导化疗（紫杉醇+卡铂）序贯同期放化疗"},{"letter":"F","text":"靶向治疗（西妥昔单抗）联合根治性放疗"},{"letter":"G","text":"诱导化疗（洛铂+氟尿嘧啶）联合特瑞普利单抗序贯同期放化疗"},{"letter":"H","text":"诱导化疗（依托泊苷+顺铂）序贯同期放化疗"},{"letter":"I","text":"单纯根治性放疗序贯辅助化疗"},{"letter":"J","text":"诱导化疗（顺铂+氟尿嘧啶）序贯单纯根治性放疗"},{"letter":"K","text":"诱导化疗（吉西他滨+卡培他滨）序贯同期放化疗"},{"letter":"L","text":"姑息性化疗（洛铂+氟尿嘧啶）序贯姑息性放疗"}]}
+{"sample_id":"sample-be610c2d167fae3585440ece","patient_id":"patient-867f2373fc1b04e0b8b80452","turn_id":"turn06","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D1750] 入院记录: 主诉: 间断性涕血3月，面麻、复视1月，耳鸣20天；现病史: 缘于3月余前患者无明显诱因出现间断性回吸性涕血，未予重视，一月前患者出现双侧面麻、复视，无鼻塞、头痛、视力下降等不适，遂就诊当地医院行鼻咽活检病理确诊鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 复视,涕血,双面麻；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟1包，30年，不嗜酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：88次/分，R：20次/分，BP：114/69mmHg,Ht：170cm，Wt：62kg，BSA：1.71m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率88次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1751] 检验组合: 阴离子间隙(AG)-静脉血: 18.2；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；平均血小板体积(MPV)-静脉血: 9.8fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.8；白细胞计数(WBC#)-静脉血: 6.2310E9/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 64.8umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阳性(+)（参考: 阴性）；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.92mmol/L；透明质酸(HA)-静脉血: 91.434ng/ml；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.4U/L；氯离子(Cl-)-静脉血: 101.8mmol/L；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 1.43ng/ml（参考: <0.704）；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；血小板比容-静脉血: 20%；活化部分凝血活酶时间(APTT)-静脉血: 27.5sec.；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.62；梅毒非特异性抗体甲苯胺红不加热血清试验(TRUST)-静脉血: 阴性(-)（参考: 阴性）；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；总钙(Ca)-静脉血: 2.27mmol/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.43；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；凝血酶时间(TT)-静脉血: 17.6sec.；间接胆红素(IBIL)-静脉血: 6.6umolL；凝血酶原时间活动度(PTA)-静脉血: 97.9%；降钙素(CT)-静脉血: 25.774pg/ml；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 44.9U/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体颗粒凝集试验(TPPA)-静脉血: 1:80（参考: 阴性）；甘油三酯(TG)-静脉血: 0.81mmol/L；总蛋白(TP)-静脉血: 69.47g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.36mmolL；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7；丙氨酸氨基转移酶(ALT)-静脉血: 34.4U/L；胱抑素(Cys-C)-静脉血: 0.84mg/L；血小板分布宽度(PDW)-静脉血: 11.4%；钠离子(Na+)-静脉血: 141mmol/L；凝血酶原时间(PT)-静脉血: 11.1sec.；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1754] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右旁T7椎体上缘水平，估计位于上腔静脉内。；检查结论: PICC管位置如上所述。\n- [全程D1758] 检验组合: 红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.410E9/L；总胆红素(TBIL)-静脉血: 15.3umol/L；葡萄糖(Glu)-静脉血: 4.9mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.6pg；间接胆红素(IBIL)-静脉血: 10.2umolL；肌酐(Crea)-静脉血: 67.1umol/L；血小板计数(PLT#)-静脉血: 159.110E9/L；中性粒细胞计数(Neut#)-静脉血: 5.210E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；血小板比容-静脉血: 13.7%；氯离子(Cl-)-静脉血: 100.4mmol/L；尿素氮(BUN)-静脉血: 5.1mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；平均血小板体积(MPV)-静脉血: 8.66fL；白蛋白(ALB)-静脉血: 36.6g/L；载脂蛋白B(apoB)-静脉血: 0.97g/L；C-反应蛋白(CRP)-静脉血: 17.22mg/L；乳酸脱氢酶(LDH)-静脉血: 196.7U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.69mmol/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；尿酸(UA)-静脉血: 195.2umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.759；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.37；总胆固醇(TC)-静脉血: 4.18mmol/L；钾离子(K+)-静脉血: 4.29mmol/L；单核细胞百分比(Mono%)-静脉血: 0.062；α-L-岩藻糖苷酶(AFU)-静脉血: 34.2U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.97；直接胆红素(DBIL)-静脉血: 5.1umol/L；碱性磷酸酶(ALP)-静脉血: 54.4U/L；有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞体积(MCV)-静脉血: 90.4fL；白细胞计数(WBC#)-静脉血: 6.810E9/L；总蛋白(TP)-静脉血: 63.4g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15U/L；甘油三酯(TG)-静脉血: 0.61mmol/L；球蛋白(GLO)-静脉血: 26.8g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.122；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.051；血液二氧化碳含量ctCO2(B)-静脉血: 25.8mmol/L；血红蛋白(Hb)-静脉血: 128.4g/L；丙氨酸氨基转移酶(ALT)-静脉血: 15.5U/L；血小板分布宽度(PDW)-静脉血: 16.5%；γ-谷氨酰基转移酶(GGT)-静脉血: 32.8U/L\n- [全程D1772] 检验组合: 总胆红素(TBIL)-静脉血: 7.6umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.472；红细胞计数(RBC#)-静脉血: 4.2810E12/L；直接胆红素(DBIL)-静脉血: 1.4umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.281；中性粒细胞计数(Neut#)-静脉血: 1.810E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.07；载脂蛋白B(apoB)-静脉血: 1.11g/L；血小板比容-静脉血: 18%；磷(P)-静脉血: 1.23mmol/L；总蛋白(TP)-静脉血: 70.84g/L；平均红细胞体积(MCV)-静脉血: 93.5fL；间接胆红素(IBIL)-静脉血: 6.2umolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.78；丙氨酸氨基转移酶(ALT)-静脉血: 20.8U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.6pg；乳酸脱氢酶(LDH)-静脉血: 173.8U/L；白蛋白(ALB)-静脉血: 41.6g/L；钾离子(K+)-静脉血: 4.12mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 20.8mmol/L；钠离子(Na+)-静脉血: 140.8mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.55mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.33g/L；尿素氮(BUN)-静脉血: 5.1mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.42；甘油三酯(TG)-静脉血: 0.99mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.2；碱性磷酸酶(ALP)-静脉血: 67.2U/L；肌酐(Crea)-静脉血: 68.4umol/L；C-反应蛋白(CRP)-静脉血: 1.24mg/L；血小板计数(PLT#)-静脉血: 18110E9/L；红细胞比容(Hct)-静脉血: 40%；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 30.4U/L；血红蛋白(Hb)-静脉血: 131g/L；镁离子(Mg2+)-静脉血: 0.92mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；平均血小板体积(MPV)-静脉血: 9.8fL；总钙(Ca)-静脉血: 2.21mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.016；单核细胞计数(Mono#)-静脉血: 0.610E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.31mmolL；胱抑素(Cys-C)-静脉血: 0.85mg/L；氯离子(Cl-)-静脉血: 102.1mmol/L\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1751] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者入院第二天，无特殊不适主诉，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。复查血常规、生化常规结果无异常。上级医师信息已隐藏：现等待患者鼻咽颈部影像学检查结果，明确分期后再行进一步诊治，病情继观。\n- [全程D1752] 上级查房记录；[姓名已隐去]医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医师查房记录；病程内容: 患者入院第三天，无诉，体查情况基本同前，[姓名已隐去]医师查房后示：等待患者影像学检查结果，明确分期后再行进一步诊治，余治疗同前，继观。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1758] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者处于一程洛铂+5FU方案诱导化疗中，诉恶心、呕吐，一般情况可，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。复查血常规、生化常规结果基本正常，上级医师信息已隐藏：现患者已完成一程诱导化疗，情况尚可，予以止呕、护胃等对症支持，嘱今日可予以出院，按期返院，不适随诊。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂缓化疗，予以重组人粒细胞集落刺激因子升白治疗，待中性粒细胞绝对值恢复至2.0×10^9/L以上再行第二周期化疗\nB. 开展第二周期洛铂+5-FU诱导化疗，将洛铂剂量下调20%，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃\nC. 终止诱导化疗，直接进入同期放化疗阶段，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nD. 按计划开展第二周期洛铂+5-FU诱导化疗，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nE. 开展第二周期洛铂+5-FU诱导化疗，暂不予以预防性止吐，待出现恶心呕吐症状时再予以甲氧氯普胺解痉止吐\nF. 更改化疗方案为紫杉醇+顺铂方案进行第二周期诱导化疗，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃\nG. 开展第二周期洛铂+5-FU诱导化疗，并预防性予以阿瑞匹坦、地塞米松联合5-HT3受体拮抗剂三联强效止吐\nH. 暂缓化疗，复查鼻咽颈部MRI评估一程化疗疗效，若肿瘤缩小则继续原方案，否则更改为紫杉醇+顺铂方案\nI. 开展第二周期洛铂+5-FU诱导化疗，将5-FU剂量下调25%，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃\nJ. 暂缓化疗，予以静脉高营养支持及补液治疗，待消化道症状完全缓解、体重增加后再行第二周期诱导化疗\nK. 退出临床试验，更改为顺铂+5-FU方案进行第二周期诱导化疗，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃\nL. 开展第二周期洛铂+5-FU诱导化疗，并预防性予以奥氮平联合地塞米松双联止吐及质子泵抑制剂护胃支持治疗\n\n请仅输出一个选项字母（A-L）。","gold_letter":"D","gold_action":"按计划开展第二周期洛铂+5-FU诱导化疗，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"暂缓化疗，予以重组人粒细胞集落刺激因子升白治疗，待中性粒细胞绝对值恢复至2.0×10^9/L以上再行第二周期化疗"},{"letter":"B","text":"开展第二周期洛铂+5-FU诱导化疗，将洛铂剂量下调20%，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃"},{"letter":"C","text":"终止诱导化疗，直接进入同期放化疗阶段，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗"},{"letter":"D","text":"按计划开展第二周期洛铂+5-FU诱导化疗，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗"},{"letter":"E","text":"开展第二周期洛铂+5-FU诱导化疗，暂不予以预防性止吐，待出现恶心呕吐症状时再予以甲氧氯普胺解痉止吐"},{"letter":"F","text":"更改化疗方案为紫杉醇+顺铂方案进行第二周期诱导化疗，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃"},{"letter":"G","text":"开展第二周期洛铂+5-FU诱导化疗，并预防性予以阿瑞匹坦、地塞米松联合5-HT3受体拮抗剂三联强效止吐"},{"letter":"H","text":"暂缓化疗，复查鼻咽颈部MRI评估一程化疗疗效，若肿瘤缩小则继续原方案，否则更改为紫杉醇+顺铂方案"},{"letter":"I","text":"开展第二周期洛铂+5-FU诱导化疗，将5-FU剂量下调25%，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃"},{"letter":"J","text":"暂缓化疗，予以静脉高营养支持及补液治疗，待消化道症状完全缓解、体重增加后再行第二周期诱导化疗"},{"letter":"K","text":"退出临床试验，更改为顺铂+5-FU方案进行第二周期诱导化疗，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃"},{"letter":"L","text":"开展第二周期洛铂+5-FU诱导化疗，并预防性予以奥氮平联合地塞米松双联止吐及质子泵抑制剂护胃支持治疗"}]}
+{"sample_id":"sample-08c11518d363599b5511b9c9","patient_id":"patient-867f2373fc1b04e0b8b80452","turn_id":"turn07","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D1750] 入院记录: 主诉: 间断性涕血3月，面麻、复视1月，耳鸣20天；现病史: 缘于3月余前患者无明显诱因出现间断性回吸性涕血，未予重视，一月前患者出现双侧面麻、复视，无鼻塞、头痛、视力下降等不适，遂就诊当地医院行鼻咽活检病理确诊鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 复视,涕血,双面麻；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟1包，30年，不嗜酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：88次/分，R：20次/分，BP：114/69mmHg,Ht：170cm，Wt：62kg，BSA：1.71m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率88次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1754] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右旁T7椎体上缘水平，估计位于上腔静脉内。；检查结论: PICC管位置如上所述。\n- [全程D1758] 检验组合: 红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.410E9/L；总胆红素(TBIL)-静脉血: 15.3umol/L；葡萄糖(Glu)-静脉血: 4.9mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.6pg；间接胆红素(IBIL)-静脉血: 10.2umolL；肌酐(Crea)-静脉血: 67.1umol/L；血小板计数(PLT#)-静脉血: 159.110E9/L；中性粒细胞计数(Neut#)-静脉血: 5.210E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；血小板比容-静脉血: 13.7%；氯离子(Cl-)-静脉血: 100.4mmol/L；尿素氮(BUN)-静脉血: 5.1mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；平均血小板体积(MPV)-静脉血: 8.66fL；白蛋白(ALB)-静脉血: 36.6g/L；载脂蛋白B(apoB)-静脉血: 0.97g/L；C-反应蛋白(CRP)-静脉血: 17.22mg/L；乳酸脱氢酶(LDH)-静脉血: 196.7U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.69mmol/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；尿酸(UA)-静脉血: 195.2umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.759；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.37；总胆固醇(TC)-静脉血: 4.18mmol/L；钾离子(K+)-静脉血: 4.29mmol/L；单核细胞百分比(Mono%)-静脉血: 0.062；α-L-岩藻糖苷酶(AFU)-静脉血: 34.2U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.97；直接胆红素(DBIL)-静脉血: 5.1umol/L；碱性磷酸酶(ALP)-静脉血: 54.4U/L；有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞体积(MCV)-静脉血: 90.4fL；白细胞计数(WBC#)-静脉血: 6.810E9/L；总蛋白(TP)-静脉血: 63.4g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15U/L；甘油三酯(TG)-静脉血: 0.61mmol/L；球蛋白(GLO)-静脉血: 26.8g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.122；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.051；血液二氧化碳含量ctCO2(B)-静脉血: 25.8mmol/L；血红蛋白(Hb)-静脉血: 128.4g/L；丙氨酸氨基转移酶(ALT)-静脉血: 15.5U/L；血小板分布宽度(PDW)-静脉血: 16.5%；γ-谷氨酰基转移酶(GGT)-静脉血: 32.8U/L\n- [全程D1772] 检验组合: 总胆红素(TBIL)-静脉血: 7.6umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.472；红细胞计数(RBC#)-静脉血: 4.2810E12/L；直接胆红素(DBIL)-静脉血: 1.4umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.281；中性粒细胞计数(Neut#)-静脉血: 1.810E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.07；载脂蛋白B(apoB)-静脉血: 1.11g/L；血小板比容-静脉血: 18%；磷(P)-静脉血: 1.23mmol/L；总蛋白(TP)-静脉血: 70.84g/L；平均红细胞体积(MCV)-静脉血: 93.5fL；间接胆红素(IBIL)-静脉血: 6.2umolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.78；丙氨酸氨基转移酶(ALT)-静脉血: 20.8U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.6pg；乳酸脱氢酶(LDH)-静脉血: 173.8U/L；白蛋白(ALB)-静脉血: 41.6g/L；钾离子(K+)-静脉血: 4.12mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 20.8mmol/L；钠离子(Na+)-静脉血: 140.8mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.55mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.33g/L；尿素氮(BUN)-静脉血: 5.1mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.42；甘油三酯(TG)-静脉血: 0.99mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.2；碱性磷酸酶(ALP)-静脉血: 67.2U/L；肌酐(Crea)-静脉血: 68.4umol/L；C-反应蛋白(CRP)-静脉血: 1.24mg/L；血小板计数(PLT#)-静脉血: 18110E9/L；红细胞比容(Hct)-静脉血: 40%；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 30.4U/L；血红蛋白(Hb)-静脉血: 131g/L；镁离子(Mg2+)-静脉血: 0.92mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；平均血小板体积(MPV)-静脉血: 9.8fL；总钙(Ca)-静脉血: 2.21mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.016；单核细胞计数(Mono#)-静脉血: 0.610E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.31mmolL；胱抑素(Cys-C)-静脉血: 0.85mg/L；氯离子(Cl-)-静脉血: 102.1mmol/L\n- [全程D1777] 检验组合: 低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.92mmol/L；尿素氮(BUN)-静脉血: 5.65mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；载脂蛋白B(apoB)-静脉血: 1.12g/L；平均红细胞体积(MCV)-静脉血: 91.7fL；中性粒细胞计数(Neut#)-静脉血: 3.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.108；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336.6g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.8；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.23mmolL；血小板比容-静脉血: 11.1%；血红蛋白(Hb)-静脉血: 131.2g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.6mmol/L；甘油三酯(TG)-静脉血: 0.96mmol/L；镁离子(Mg2+)-静脉血: 1.02mmol/L；总胆固醇(TC)-静脉血: 5.75mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.510E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；直接胆红素(DBIL)-静脉血: 5.7umol/L；总蛋白(TP)-静脉血: 68.83g/L；白蛋白(ALB)-静脉血: 37.6g/L；钾离子(K+)-静脉血: 4.1mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；尿酸(UA)-静脉血: 299.7umol/L；碱性磷酸酶(ALP)-静脉血: 64.4U/L；阴离子间隙(AG)-静脉血: 13；氯离子(Cl-)-静脉血: 101.5mmol/L；球蛋白(GLO)-静脉血: 31.23g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1%；血小板分布宽度(PDW)-静脉血: 17.9%；间接胆红素(IBIL)-静脉血: 12.7umolL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；丙氨酸氨基转移酶(ALT)-静脉血: 23.7U/L；C-反应蛋白(CRP)-静脉血: 2.73mg/L；钠离子(Na+)-静脉血: 139.9mmol/L；磷(P)-静脉血: 1.51mmol/L；红细胞计数(RBC#)-静脉血: 4.2410E12/L；平均血小板体积(MPV)-静脉血: 8.48fL；总胆红素(TBIL)-静脉血: 18.4umol/L；葡萄糖(Glu)-静脉血: 4.89mmol/L；肌酐(Crea)-静脉血: 72.4umol/L\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- [全程D1758] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者处于一程洛铂+5FU方案诱导化疗中，诉恶心、呕吐，一般情况可，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。复查血常规、生化常规结果基本正常，上级医师信息已隐藏：现患者已完成一程诱导化疗，情况尚可，予以止呕、护胃等对症支持，嘱今日可予以出院，按期返院，不适随诊。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1774] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者入院第二天，诉复视、面麻未见好转，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经（-）。复查血常规、生化常规结果无异常。上级医师信息已隐藏：现患者入院行第一程洛铂+5FU方案诱导化疗中，目前患者情况尚可，继续予以止呕、护胃、加强营养等对症支持治疗，病情继观。\n- [全程D1775] 上级查房记录；[姓名已隐去]医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医师查房记录；病程内容: 患者入院第三天，无诉，体查情况基本同前，[姓名已隐去]医师查房后示：现患者第一程洛铂+5FU方案诱导化疗中，目前患者情况尚可，继续予以对症支持治疗，病情继观。\n- [全程D1779] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者现基本完成一程诱导化疗，诉恶心，一般情况尚可，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经（-）。复查血常规、生化常规结果基本正常，上级医师信息已隐藏：现患者情况尚可，嘱今日可予以出院，按期返院，不适随诊。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 继续行洛铂联合5-FU方案第3程诱导化疗，予以重组人粒细胞刺激因子支持治疗，暂缓放疗。\nB. 启动根治性放疗及同步化疗，每周复查血常规，暂不予以重组人白介素-11及粒细胞刺激因子。\nC. 准备行根治性放疗及同步化疗，予以重组人促红素及重组人粒细胞刺激因子支持治疗，动态复查血常规。\nD. 更改化疗方案为吉西他滨联合顺铂诱导化疗，予以重组人白介素-11支持治疗，暂缓放疗。\nE. 准备行根治性放疗及同步化疗，予以输注单采血小板及红细胞悬液支持治疗，动态复查血常规。\nF. 准备行根治性放疗及同步化疗，因骨髓抑制降低同步化疗药物剂量，予以重组人粒细胞刺激因子支持治疗。\nG. 继续行洛铂联合5-FU方案第3程诱导化疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗。\nH. 准备行单纯根治性放疗，取消同步化疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗。\nI. 转为姑息性放疗及最佳支持治疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗。\nJ. 准备行根治性放疗及同步化疗，予以重组人血小板生成素支持治疗，暂不使用粒细胞刺激因子。\nK. 暂停抗肿瘤治疗，待血象自然恢复后，再行第3程洛铂联合5-FU方案诱导化疗，暂缓放疗。\n\n请仅输出一个选项字母（A-K）。","gold_letter":"B","gold_action":"启动根治性放疗及同步化疗，每周复查血常规，暂不予以重组人白介素-11及粒细胞刺激因子。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"继续行洛铂联合5-FU方案第3程诱导化疗，予以重组人粒细胞刺激因子支持治疗，暂缓放疗。"},{"letter":"B","text":"启动根治性放疗及同步化疗，每周复查血常规，暂不予以重组人白介素-11及粒细胞刺激因子。"},{"letter":"C","text":"准备行根治性放疗及同步化疗，予以重组人促红素及重组人粒细胞刺激因子支持治疗，动态复查血常规。"},{"letter":"D","text":"更改化疗方案为吉西他滨联合顺铂诱导化疗，予以重组人白介素-11支持治疗，暂缓放疗。"},{"letter":"E","text":"准备行根治性放疗及同步化疗，予以输注单采血小板及红细胞悬液支持治疗，动态复查血常规。"},{"letter":"F","text":"准备行根治性放疗及同步化疗，因骨髓抑制降低同步化疗药物剂量，予以重组人粒细胞刺激因子支持治疗。"},{"letter":"G","text":"继续行洛铂联合5-FU方案第3程诱导化疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗。"},{"letter":"H","text":"准备行单纯根治性放疗，取消同步化疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗。"},{"letter":"I","text":"转为姑息性放疗及最佳支持治疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗。"},{"letter":"J","text":"准备行根治性放疗及同步化疗，予以重组人血小板生成素支持治疗，暂不使用粒细胞刺激因子。"},{"letter":"K","text":"暂停抗肿瘤治疗，待血象自然恢复后，再行第3程洛铂联合5-FU方案诱导化疗，暂缓放疗。"}]}
+{"sample_id":"sample-070df43e0c39a4c5f77b459e","patient_id":"patient-867f2373fc1b04e0b8b80452","turn_id":"turn08","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D1750] 入院记录: 主诉: 间断性涕血3月，面麻、复视1月，耳鸣20天；现病史: 缘于3月余前患者无明显诱因出现间断性回吸性涕血，未予重视，一月前患者出现双侧面麻、复视，无鼻塞、头痛、视力下降等不适，遂就诊当地医院行鼻咽活检病理确诊鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 复视,涕血,双面麻；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟1包，30年，不嗜酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：88次/分，R：20次/分，BP：114/69mmHg,Ht：170cm，Wt：62kg，BSA：1.71m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率88次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1754] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右旁T7椎体上缘水平，估计位于上腔静脉内。；检查结论: PICC管位置如上所述。\n- [全程D1758] 检验组合: 红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.410E9/L；总胆红素(TBIL)-静脉血: 15.3umol/L；葡萄糖(Glu)-静脉血: 4.9mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.6pg；间接胆红素(IBIL)-静脉血: 10.2umolL；肌酐(Crea)-静脉血: 67.1umol/L；血小板计数(PLT#)-静脉血: 159.110E9/L；中性粒细胞计数(Neut#)-静脉血: 5.210E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；血小板比容-静脉血: 13.7%；氯离子(Cl-)-静脉血: 100.4mmol/L；尿素氮(BUN)-静脉血: 5.1mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；平均血小板体积(MPV)-静脉血: 8.66fL；白蛋白(ALB)-静脉血: 36.6g/L；载脂蛋白B(apoB)-静脉血: 0.97g/L；C-反应蛋白(CRP)-静脉血: 17.22mg/L；乳酸脱氢酶(LDH)-静脉血: 196.7U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.69mmol/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；尿酸(UA)-静脉血: 195.2umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.759；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.37；总胆固醇(TC)-静脉血: 4.18mmol/L；钾离子(K+)-静脉血: 4.29mmol/L；单核细胞百分比(Mono%)-静脉血: 0.062；α-L-岩藻糖苷酶(AFU)-静脉血: 34.2U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.97；直接胆红素(DBIL)-静脉血: 5.1umol/L；碱性磷酸酶(ALP)-静脉血: 54.4U/L；有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞体积(MCV)-静脉血: 90.4fL；白细胞计数(WBC#)-静脉血: 6.810E9/L；总蛋白(TP)-静脉血: 63.4g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15U/L；甘油三酯(TG)-静脉血: 0.61mmol/L；球蛋白(GLO)-静脉血: 26.8g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.122；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.051；血液二氧化碳含量ctCO2(B)-静脉血: 25.8mmol/L；血红蛋白(Hb)-静脉血: 128.4g/L；丙氨酸氨基转移酶(ALT)-静脉血: 15.5U/L；血小板分布宽度(PDW)-静脉血: 16.5%；γ-谷氨酰基转移酶(GGT)-静脉血: 32.8U/L\n- [全程D1772] 检验组合: 总胆红素(TBIL)-静脉血: 7.6umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.472；红细胞计数(RBC#)-静脉血: 4.2810E12/L；直接胆红素(DBIL)-静脉血: 1.4umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.281；中性粒细胞计数(Neut#)-静脉血: 1.810E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.07；载脂蛋白B(apoB)-静脉血: 1.11g/L；血小板比容-静脉血: 18%；磷(P)-静脉血: 1.23mmol/L；总蛋白(TP)-静脉血: 70.84g/L；平均红细胞体积(MCV)-静脉血: 93.5fL；间接胆红素(IBIL)-静脉血: 6.2umolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.78；丙氨酸氨基转移酶(ALT)-静脉血: 20.8U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.6pg；乳酸脱氢酶(LDH)-静脉血: 173.8U/L；白蛋白(ALB)-静脉血: 41.6g/L；钾离子(K+)-静脉血: 4.12mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 20.8mmol/L；钠离子(Na+)-静脉血: 140.8mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.55mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.33g/L；尿素氮(BUN)-静脉血: 5.1mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.42；甘油三酯(TG)-静脉血: 0.99mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.2；碱性磷酸酶(ALP)-静脉血: 67.2U/L；肌酐(Crea)-静脉血: 68.4umol/L；C-反应蛋白(CRP)-静脉血: 1.24mg/L；血小板计数(PLT#)-静脉血: 18110E9/L；红细胞比容(Hct)-静脉血: 40%；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 30.4U/L；血红蛋白(Hb)-静脉血: 131g/L；镁离子(Mg2+)-静脉血: 0.92mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；平均血小板体积(MPV)-静脉血: 9.8fL；总钙(Ca)-静脉血: 2.21mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.016；单核细胞计数(Mono#)-静脉血: 0.610E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.31mmolL；胱抑素(Cys-C)-静脉血: 0.85mg/L；氯离子(Cl-)-静脉血: 102.1mmol/L\n- [全程D1777] 检验组合: 低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.92mmol/L；尿素氮(BUN)-静脉血: 5.65mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；载脂蛋白B(apoB)-静脉血: 1.12g/L；平均红细胞体积(MCV)-静脉血: 91.7fL；中性粒细胞计数(Neut#)-静脉血: 3.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.108；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336.6g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.8；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.23mmolL；血小板比容-静脉血: 11.1%；血红蛋白(Hb)-静脉血: 131.2g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.6mmol/L；甘油三酯(TG)-静脉血: 0.96mmol/L；镁离子(Mg2+)-静脉血: 1.02mmol/L；总胆固醇(TC)-静脉血: 5.75mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.510E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；直接胆红素(DBIL)-静脉血: 5.7umol/L；总蛋白(TP)-静脉血: 68.83g/L；白蛋白(ALB)-静脉血: 37.6g/L；钾离子(K+)-静脉血: 4.1mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；尿酸(UA)-静脉血: 299.7umol/L；碱性磷酸酶(ALP)-静脉血: 64.4U/L；阴离子间隙(AG)-静脉血: 13；氯离子(Cl-)-静脉血: 101.5mmol/L；球蛋白(GLO)-静脉血: 31.23g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1%；血小板分布宽度(PDW)-静脉血: 17.9%；间接胆红素(IBIL)-静脉血: 12.7umolL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；丙氨酸氨基转移酶(ALT)-静脉血: 23.7U/L；C-反应蛋白(CRP)-静脉血: 2.73mg/L；钠离子(Na+)-静脉血: 139.9mmol/L；磷(P)-静脉血: 1.51mmol/L；红细胞计数(RBC#)-静脉血: 4.2410E12/L；平均血小板体积(MPV)-静脉血: 8.48fL；总胆红素(TBIL)-静脉血: 18.4umol/L；葡萄糖(Glu)-静脉血: 4.89mmol/L；肌酐(Crea)-静脉血: 72.4umol/L\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1782] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及双侧壁粘膜增厚形成软组织影放射性浓聚，SUV约15.6，病灶侵犯蝶窦、蝶骨体、右侧蝶骨翼、蝶骨基底部、枕骨基底部、枕骨斜坡、右侧颈动脉孔、右侧破裂孔、右侧岩枕裂、右侧桥小脑角、右侧颞骨岩尖、双侧翼突基底部、右翼突内/外板、双侧鼻后孔、右翼腭窝、鼻中隔后份、双侧中鼻甲后份、左侧下鼻甲后份、右侧咽旁/咽后间隙、右侧头长肌、右侧腭帆张/提肌及右翼内肌，累及左侧翼腭窝，堵塞鼻咽腔。双侧咽隐窝消失。双侧咽后小淋巴结放射性较浓密，SUV约4.1，大者约0.8×0.9cm。口咽、喉咽未见异常。蝶窦、筛窦、双侧上颌窦及双侧乳突内低密度影放射性分布未见明显异常。双侧海绵窦放射性分布未见明显异常。甲状腺放射性分布未见明显异常。左颈II区数个淋巴结放射性浓聚，SUV约21.9，大者约1.1×1.5cm；右颈II区数个小淋巴结放射性较浓密，SUV约2.7，大者约0.6×0.7cm；余双颈未见肿大淋巴结及异常放射性分布。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺多发条片影放射性分布未见明显异常；余双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔右下气管旁及右肺门数个小淋巴结放射性略浓密。左肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏形态、结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺、膀胱、肠管等形态、结构及放射性分布未见明显异常。双侧髂血管旁及双侧腹股沟未见肿大淋巴结及异常放射性分布。 L5棘突局部放射性略浓密（良性病变）。左髂骨小片状低密度影放射性稀疏（良性病变）。所见颅盖骨、余躯干骨及四肢骨结构及放射性分布未见明显异常。 鼻咽局部代谢较活跃，双侧扁桃体代谢较活跃，双颈II区小淋巴结代谢稍活跃，考虑炎性病变。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，侵犯范围如上述；双侧咽后小淋巴结代谢较活跃，左颈II区数个淋巴结代谢活跃，考虑转移。 右颈II区数个小淋巴结代谢较活跃，疑炎性病变。 双肺多发条片影代谢未见明显异常，考虑炎性病变。 副鼻窦炎症；双侧乳突炎症。\n\n【既往治疗与反应】\n- [全程D1758] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者处于一程洛铂+5FU方案诱导化疗中，诉恶心、呕吐，一般情况可，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。复查血常规、生化常规结果基本正常，上级医师信息已隐藏：现患者已完成一程诱导化疗，情况尚可，予以止呕、护胃等对症支持，嘱今日可予以出院，按期返院，不适随诊。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1774] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者入院第二天，诉复视、面麻未见好转，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经（-）。复查血常规、生化常规结果无异常。上级医师信息已隐藏：现患者入院行第一程洛铂+5FU方案诱导化疗中，目前患者情况尚可，继续予以止呕、护胃、加强营养等对症支持治疗，病情继观。\n- [全程D1775] 上级查房记录；[姓名已隐去]医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医师查房记录；病程内容: 患者入院第三天，无诉，体查情况基本同前，[姓名已隐去]医师查房后示：现患者第一程洛铂+5FU方案诱导化疗中，目前患者情况尚可，继续予以对症支持治疗，病情继观。\n- [全程D1779] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者现基本完成一程诱导化疗，诉恶心，一般情况尚可，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经（-）。复查血常规、生化常规结果基本正常，上级医师信息已隐藏：现患者情况尚可，嘱今日可予以出院，按期返院，不适随诊。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即开展根治性放疗及顺铂同步化疗，期间定期监测血常规，暂不予造血生长因子干预。\nB. 予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及顺铂同步化疗。\nC. 仅予以重组人白介素-11升血小板治疗，动态复查血常规，并序贯开展根治性放疗及顺铂同步化疗。\nD. 立即开展根治性放疗及洛铂同步化疗，期间定期监测血常规，暂不予造血生长因子干预。\nE. 仅予以重组人粒细胞刺激因子升白细胞治疗，动态复查血常规，并序贯开展根治性放疗及洛铂同步化疗。\nF. 予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及洛铂同步化疗。\nG. 予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并转为洛铂单药姑息性化疗。\nH. 予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展开放性手术切除原发灶及颈部淋巴结。\nI. 予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及西妥昔单抗靶向治疗。\nJ. 予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及PD-1抑制剂免疫治疗。\nK. 暂暂停抗肿瘤治疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，待血象恢复后继续行第三程洛铂+5FU诱导化疗。\nL. 予以输注单采血小板及洗涤红细胞支持治疗，动态复查血常规，并序贯开展根治性放疗及洛铂同步化疗。\n\n请仅输出一个选项字母（A-L）。","gold_letter":"D","gold_action":"立即开展根治性放疗及洛铂同步化疗，期间定期监测血常规，暂不予造血生长因子干预。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"立即开展根治性放疗及顺铂同步化疗，期间定期监测血常规，暂不予造血生长因子干预。"},{"letter":"B","text":"予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及顺铂同步化疗。"},{"letter":"C","text":"仅予以重组人白介素-11升血小板治疗，动态复查血常规，并序贯开展根治性放疗及顺铂同步化疗。"},{"letter":"D","text":"立即开展根治性放疗及洛铂同步化疗，期间定期监测血常规，暂不予造血生长因子干预。"},{"letter":"E","text":"仅予以重组人粒细胞刺激因子升白细胞治疗，动态复查血常规，并序贯开展根治性放疗及洛铂同步化疗。"},{"letter":"F","text":"予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及洛铂同步化疗。"},{"letter":"G","text":"予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并转为洛铂单药姑息性化疗。"},{"letter":"H","text":"予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展开放性手术切除原发灶及颈部淋巴结。"},{"letter":"I","text":"予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及西妥昔单抗靶向治疗。"},{"letter":"J","text":"予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及PD-1抑制剂免疫治疗。"},{"letter":"K","text":"暂暂停抗肿瘤治疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，待血象恢复后继续行第三程洛铂+5FU诱导化疗。"},{"letter":"L","text":"予以输注单采血小板及洗涤红细胞支持治疗，动态复查血常规，并序贯开展根治性放疗及洛铂同步化疗。"}]}
+{"sample_id":"sample-9d5015177e675883e0c4ec7b","patient_id":"patient-9149023ec8599161ec3e5cfd","turn_id":"turn01","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现双颈肿物半年余；现病史: 者半年余前无明显诱因出现左侧颈部肿物，无疼痛，逐渐增大，伴有鼻塞、流涕，至当地医院予抗炎对症治疗后，肿物能减小；2月前患者始出现右侧颈部肿物，逐渐增大，伴有鼻塞、流涕，间中有涕血，无发热、畏寒，无头晕、头痛，无周身骨痛等，于当地医院检查ＣＴ示：鼻咽肿物，遂转至我院进一步诊治。门诊拟诊“鼻咽肿物”收入我科进一步治疗。患者起病以来精神、睡眠欠佳，胃纳尚可，二便正常，体重无明显下降。；阳性症状体征: 鼻塞,睡眠欠佳,鼻咽肿物,涕血,右颈部肿物,左颈部肿物,流涕；既往史: 体健，无高血压、心脏病等慢性病，无糖尿病、肾病等全身性疾病，无乙肝、结核等传染病，无外伤史。；个人史: 生于原籍，有吸烟史30年,无饮酒，无其他嗜好，否认冶游史。；家族史: 家族中无类似患者，无家族性遗传病患者，无重大精神病患者。；体格检查:；专科检查:；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 电子鼻咽镜检查及活检，颈部超声，胸部X线片，腹部超声\nB. 电子鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，全身PET-CT\nC. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部及上腹部CT平扫+增强，全身骨显像\nD. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，暂不安排胸腹部及骨骼影像学检查\nE. 鼻咽及颈部MRI平扫+增强，胸部及上腹部CT平扫+增强，全身骨显像，暂不安排内镜活检\nF. 颈部淋巴结切除活检，鼻咽及颈部MRI平扫+增强，胸部及上腹部CT平扫+增强，全身骨显像\nG. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫，胸部及上腹部CT平扫，全身骨显像\nH. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部CT平扫+增强，腹部超声\nI. 电子鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸部及上腹部CT平扫+增强，全身骨显像\nJ. 颈部淋巴结细针穿刺活检，鼻咽及颈部MRI平扫+增强，胸部及上腹部CT平扫+增强，全身骨显像\nK. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身骨显像，头颅MRI平扫+增强\nL. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部及上腹部CT平扫+增强，骨髓穿刺活检\n\n请仅输出一个选项字母（A-L）。","gold_letter":"C","gold_action":"行电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部及上腹部CT平扫+增强，全身骨显像。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"电子鼻咽镜检查及活检，颈部超声，胸部X线片，腹部超声"},{"letter":"B","text":"电子鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，全身PET-CT"},{"letter":"C","text":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部及上腹部CT平扫+增强，全身骨显像"},{"letter":"D","text":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，暂不安排胸腹部及骨骼影像学检查"},{"letter":"E","text":"鼻咽及颈部MRI平扫+增强，胸部及上腹部CT平扫+增强，全身骨显像，暂不安排内镜活检"},{"letter":"F","text":"颈部淋巴结切除活检，鼻咽及颈部MRI平扫+增强，胸部及上腹部CT平扫+增强，全身骨显像"},{"letter":"G","text":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫，胸部及上腹部CT平扫，全身骨显像"},{"letter":"H","text":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部CT平扫+增强，腹部超声"},{"letter":"I","text":"电子鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸部及上腹部CT平扫+增强，全身骨显像"},{"letter":"J","text":"颈部淋巴结细针穿刺活检，鼻咽及颈部MRI平扫+增强，胸部及上腹部CT平扫+增强，全身骨显像"},{"letter":"K","text":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身骨显像，头颅MRI平扫+增强"},{"letter":"L","text":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部及上腹部CT平扫+增强，骨髓穿刺活检"}]}
+{"sample_id":"sample-220f428c46f369e75a66e1ab","patient_id":"patient-9149023ec8599161ec3e5cfd","turn_id":"turn04","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现双颈肿物半年余；现病史: 者半年余前无明显诱因出现左侧颈部肿物，无疼痛，逐渐增大，伴有鼻塞、流涕，至当地医院予抗炎对症治疗后，肿物能减小；2月前患者始出现右侧颈部肿物，逐渐增大，伴有鼻塞、流涕，间中有涕血，无发热、畏寒，无头晕、头痛，无周身骨痛等，于当地医院检查ＣＴ示：鼻咽肿物，遂转至我院进一步诊治。门诊拟诊“鼻咽肿物”收入我科进一步治疗。患者起病以来精神、睡眠欠佳，胃纳尚可，二便正常，体重无明显下降。；阳性症状体征: 鼻塞,睡眠欠佳,鼻咽肿物,涕血,右颈部肿物,左颈部肿物,流涕；既往史: 体健，无高血压、心脏病等慢性病，无糖尿病、肾病等全身性疾病，无乙肝、结核等传染病，无外伤史。；个人史: 生于原籍，有吸烟史30年,无饮酒，无其他嗜好，否认冶游史。；家族史: 家族中无类似患者，无家族性遗传病患者，无重大精神病患者。；体格检查:；专科检查:；KPS:；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D0] 检验组合: 磷(P)-静脉血: 1.15mmol/L；平均红细胞体积(MCV)-静脉血: 87fL；肌酐(Crea)-静脉血: 58.2umol/L；C-反应蛋白(CRP)-静脉血: 1.11mg/L；尿酸(UA)-静脉血: 148.1umol/L；葡萄糖(Glu)-静脉血: 5.38mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.29；总胆红素(TBIL)-静脉血: 7.6umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.39mmolL；凝血酶时间(TT)-静脉血: 19.1sec.；钾离子(K+)-静脉血: 4.25mmol/L；阴离子间隙(AG)-静脉血: 10.3；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；白细胞计数(WBC#)-静脉血: 710E9/L；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阳性(169.39U/mL)（参考: 阴性）；载脂蛋白AI(apoAI)-静脉血: 1.57g/L；纤维蛋白原(Fbg)-静脉血: 3.35g/L；中性粒细胞计数(Neut#)-静脉血: 4.210E9/L；平均血小板体积(MPV)-静脉血: 9.6fL；有核红细胞百分比(NRBC%)-静脉血: 0；血小板比容-静脉血: 29%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 27mmol/L；凝血酶原时间活动度(PTA)-静脉血: 85.4%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；ABO血型-静脉血: O；甘油三酯(TG)-静脉血: 1.43mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.04S/CO；球蛋白(GLO)-静脉血: 33.45g/L；总钙(Ca)-静脉血: 2.26mmol/L；血小板分布宽度(PDW)-静脉血: 9.7%；间接胆红素(IBIL)-静脉血: 5.8umolL；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0IU/mL；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；单核细胞百分比(Mono%)-静脉血: 0.073；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:80（参考: 阴性）；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 28.4U/L；载脂蛋白B(apoB)-静脉血: 1.13g/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 1.05；淋巴细胞百分比(Lymph%)-静脉血: 0.316；尿素氮(BUN)-静脉血: 2.7mmol/L；总胆固醇(TC)-静脉血: 5.23mmol/L\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1] CT；胸、上腹CT平扫+增强: 检查类型: CT；检查名称: 胸、上腹CT平扫+增强；检查部位:；检查所见: 双肺纹理清晰，左肺下叶外基底段见条索状高密度影，边界清；余双肺内未见明显实质性病变。 气管及支气管分支通畅。 双肺门及纵隔未见明显肿大淋巴结。 双侧胸腔未见积液。双侧胸膜未见增厚、粘连。 肝脏形态未见异常，轮廓光整，各叶比例在正常范围以内，密度均匀。 肝内胆管未见明显异常。胆囊不大、壁不厚，其内未见结石。胆总管未见扩张，其内未见结石。 肝门区结构清晰。门静脉未见明显异常。 脾脏大小、形态未见明显异常，密度均匀。 胰腺大小、形态未见明显异常，密度均匀。 所示双肾及双侧肾上腺大小、形态未见明显异常，密度均匀。 膈脚后、肝门区、腹主动脉旁、腹腔干周围未见明显肿大淋巴结。 扫描层面内未见明显骨质破坏。；检查结论: 左肺下叶外基底段条索影，考虑纤维灶。 上腹部未见明显异常。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 鼻咽部见片状放射性浓密影。胸骨、锁骨、肩胛骨、肋骨、颈椎、胸椎、腰椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 鼻咽部代谢活跃，考虑鼻咽癌所致。 余全身骨骼未见明显异常。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 单纯根治性放疗\nB. 同步放化疗\nC. 诱导化疗序贯单纯根治性放疗\nD. 同步放化疗序贯辅助化疗\nE. 诱导化疗联合靶向治疗序贯放疗\nF. 诱导化疗序贯同步放化疗\nG. 根治性放疗序贯辅助化疗\nH. 诱导化疗序贯免疫联合同步放化疗\nI. 姑息性化疗联合免疫治疗\nJ. 鼻咽放疗联合颈部淋巴结清扫术\nK. 靶向治疗联合同步放化疗\nL. 诱导化疗序贯颈部淋巴结清扫术\n\n请仅输出一个选项字母（A-L）。","gold_letter":"F","gold_action":"诱导化疗序贯同步放化疗","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"单纯根治性放疗"},{"letter":"B","text":"同步放化疗"},{"letter":"C","text":"诱导化疗序贯单纯根治性放疗"},{"letter":"D","text":"同步放化疗序贯辅助化疗"},{"letter":"E","text":"诱导化疗联合靶向治疗序贯放疗"},{"letter":"F","text":"诱导化疗序贯同步放化疗"},{"letter":"G","text":"根治性放疗序贯辅助化疗"},{"letter":"H","text":"诱导化疗序贯免疫联合同步放化疗"},{"letter":"I","text":"姑息性化疗联合免疫治疗"},{"letter":"J","text":"鼻咽放疗联合颈部淋巴结清扫术"},{"letter":"K","text":"靶向治疗联合同步放化疗"},{"letter":"L","text":"诱导化疗序贯颈部淋巴结清扫术"}]}
+{"sample_id":"sample-ed1b449691d94cea18e7b28b","patient_id":"patient-9149023ec8599161ec3e5cfd","turn_id":"turn05","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现双颈肿物半年余；现病史: 者半年余前无明显诱因出现左侧颈部肿物，无疼痛，逐渐增大，伴有鼻塞、流涕，至当地医院予抗炎对症治疗后，肿物能减小；2月前患者始出现右侧颈部肿物，逐渐增大，伴有鼻塞、流涕，间中有涕血，无发热、畏寒，无头晕、头痛，无周身骨痛等，于当地医院检查ＣＴ示：鼻咽肿物，遂转至我院进一步诊治。门诊拟诊“鼻咽肿物”收入我科进一步治疗。患者起病以来精神、睡眠欠佳，胃纳尚可，二便正常，体重无明显下降。；阳性症状体征: 鼻塞,睡眠欠佳,鼻咽肿物,涕血,右颈部肿物,左颈部肿物,流涕；既往史: 体健，无高血压、心脏病等慢性病，无糖尿病、肾病等全身性疾病，无乙肝、结核等传染病，无外伤史。；个人史: 生于原籍，有吸烟史30年,无饮酒，无其他嗜好，否认冶游史。；家族史: 家族中无类似患者，无家族性遗传病患者，无重大精神病患者。；体格检查:；专科检查:；KPS:；ECOG:\n- [全程D986] 门急诊记录: 主诉: 鼻咽癌放化疗结束2年，诉轻度口干，听力视力正常，无头晕、头痛。体查：鼻咽未见明确肿物，双颈未扪及明显肿大淋巴结，颅神经（-）甲功五项示正常。鼻咽MRI未见明确复发，腹部B超、胸片未见明确转移。EBV-DNA:0；现病史:；既往史:；个人史:；家族史:；体格检查:\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D985] MRI；鼻咽部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部MR平扫+增强；检查部位:；检查所见: 鼻咽癌放疗后复查，对比某次就诊时间片： 鼻咽腔未见狭窄，鼻咽顶壁、顶后壁、右侧壁轻度增厚，均匀强化，右侧咽隐窝变浅，考虑放疗后改变，较前相仿。 蝶骨基底部、左侧枕骨基底部、左侧岩尖、左侧翼突基底部骨质信号下降，增强扫描轻度不均匀强化，较前相仿。 左侧破裂孔见少许软组织影，增强扫描轻度强化，较前相仿。 双侧咽后间隙见小淋巴结，大者短径约3mm，较前相仿。 右颈II区见多个淋巴结，最大短径约为5mm，部分边界欠清，增强扫描不均匀强化，较前稍缩小。 双侧上颌窦、筛窦、额窦粘膜增厚，考虑副鼻窦炎，较前相仿。 扫描所见颅脑未见明确异常。；检查结论:\n- [全程D985] MRI；颈部MR平扫+增强: 检查类型: MRI；检查名称: 颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌放疗后复查，对比某次就诊时间片： 鼻咽腔未见狭窄，鼻咽顶壁、顶后壁、右侧壁轻度增厚，均匀强化，右侧咽隐窝变浅，考虑放疗后改变，较前相仿。 蝶骨基底部、左侧枕骨基底部、左侧岩尖、左侧翼突基底部骨质信号下降，增强扫描轻度不均匀强化，较前相仿。 左侧破裂孔见少许软组织影，增强扫描轻度强化，较前相仿。 双侧咽后间隙见小淋巴结，大者短径约3mm，较前相仿。 右颈II区见多个淋巴结，最大短径约为5mm，部分边界欠清，增强扫描不均匀强化，较前稍缩小。 双侧上颌窦、筛窦、额窦粘膜增厚，考虑副鼻窦炎，较前相仿。 扫描所见颅脑未见明确异常。；检查结论:\n- [全程D1168] 检验组合: 游离甲状腺素(FT4)-静脉血: 14.91pmol/L；甲状腺过氧化物酶抗体(TPO-Ab)-静脉血: 12.55U/ml；游离三碘甲状腺原氨酸(FT3)-静脉血: 4.97pmol/L；甲状腺球蛋白(TG)-静脉血: 1.12ng/ml；促甲状腺激素(TSH)-静脉血: 1.59uIU/ml\n- [全程D1169] 超声；肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径不宽，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1170] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，走行自然，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n- [全程D1380] 检验组合: 游离三碘甲状腺原氨酸(FT3)-静脉血: 5.27pmol/L；游离甲状腺素(FT4)-静脉血: 13.84pmol/L；胆碱酯酶(ChE)-静脉血: 10374U/L；总钙(Ca)-静脉血: 2.33mmol/L；中性粒细胞百分比(Neut%)-静脉血: 56.6%；γ-谷氨酰基转移酶(GGT)-静脉血: 25.6U/L；肌酸激酶(CK)-静脉血: 80U/L；肌酐(Crea)-静脉血: 59.7umol/L；总蛋白(TP)-静脉血: 72.07g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 27.9pg；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.29mmol/L；淋巴细胞计数(Lymph#)-静脉血: 2.110E9/L；镁离子(Mg2+)-静脉血: 1.02mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.3mmol/L；碱性磷酸酶(ALP)-静脉血: 75.5U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.2510E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.2%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.1fL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；大血小板百分比(P-LCR%)-静脉血: 21.4%；白蛋白(ALB)-静脉血: 43.8g/L；载脂蛋白AI(apoAI)-静脉血: 1.52g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.55；总胆固醇(TC)-静脉血: 6.32mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.7U/L；阴离子间隙(AG)-静脉血: 18.4；血红蛋白(Hb)-静脉血: 131g/L；甲状腺球蛋白(TG)-静脉血: 1.4ng/ml；平均红细胞血红蛋白浓度(MCHC)-静脉血: 300g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.34mmolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 2.4；钾离子(K+)-静脉血: 3.9mmol/L；红细胞比容(Hct)-静脉血: 43.7%；未成熟粒细胞百分比(IG%)-静脉血: 0.5%；磷(P)-静脉血: 1.39mmol/L；钠离子(Na+)-静脉血: 141.4mmol/L；间接胆红素(IBIL)-静脉血: 6.5umol/L；甘油三酯(TG)-静脉血: 2.59mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 33%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.5%；血小板分布宽度(PDW)-静脉血: 10.7fL；C-反应蛋白(CRP)-静脉血: 1.46mg/L；胱抑素(Cys-C)-静脉血: 0.83mg/L；丙氨酸氨基转移酶(ALT)-静脉血: 7.8U/L；中性粒细胞计数(Neut#)-静脉血: 3.610E9/L\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- [全程D986] 门急诊记录: 主诉: 鼻咽癌放化疗结束2年，诉轻度口干，听力视力正常，无头晕、头痛。体查：鼻咽未见明确肿物，双颈未扪及明显肿大淋巴结，颅神经（-）甲功五项示正常。鼻咽MRI未见明确复发，腹部B超、胸片未见明确转移。EBV-DNA:0；现病史:；既往史:；个人史:；家族史:；体格检查:\n- [全程D1174] 门急诊记录: 主诉: 鼻咽癌放化疗结束2年，诉轻度口干，听力视力正常，无头晕、头痛。体查：鼻咽未见明确肿物，双颈未扪及明显肿大淋巴结，颅神经（-）甲功五项示正常。鼻咽MRI未见明确复发，腹部B超、胸片未见明确转移。EBV-DNA:0；现病史:；既往史:；个人史:；家族史:；体格检查:\n- [时间未明] 门急诊记录: 主诉:；现病史: 者半年余前无明显诱因出现左侧颈部肿物，无疼痛，逐渐增大，伴有鼻塞、流涕，至当地医院予抗炎对症治疗后，肿物能减小；2月前患者始出现右侧颈部肿物，逐渐增大，伴有鼻塞、流涕，间中有涕血，无发热、畏寒，无头晕、头痛，无周身骨痛等，于当地医院检查ＣＴ示：鼻咽肿物，遂转至我院进一步诊治。门诊拟诊“鼻咽肿物”收入我科进一步治疗。患者起病以来精神、睡眠欠佳，胃纳尚可，二便正常，体重无明显下降。；既往史: 否认高血压、糖尿病及心脏病史，否认结核等传染病史、否认手术、外伤及输血史。；个人史:；家族史: 家族中无类似患者，无家族性遗传病患者，无重大精神病患者。；体格检查: KPS90，一般状况可，鼻咽左侧壁、顶后壁肿物，双颈扪及肿大淋巴结，右颈多枚肿大淋巴结，较大者约6*4及2*2cm,质硬，活动差，左上颈可及一淋巴结，约3*3cm，质中，活动度可，无融合，无皮肤浸润等，左中颈可及一大小约1*1cm质硬淋巴结；张口门齿距约4cm，颅神经征阴性。。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 给予大剂量糖皮质激素冲击治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超\nB. 给予贝伐珠单抗靶向治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项\nC. 安排头颅PET-CT检查鉴别左侧颞叶病变性质，并安排胸部X线、腹部彩超、甲功五项\nD. 安排立体定向脑活检明确左侧颞叶病变性质，并安排胸部X线、腹部彩超、甲功五项\nE. 给予高压氧治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项\nF. 给予甘露醇静脉滴注脱水降颅压，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超\nG. 安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项及EBV-DNA定量检测\nH. 给予神经营养药物治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项\nI. 安排鼻咽及颈部CT平扫+增强、胸部CT平扫、腹部CT平扫、甲功五项及EBV-DNA定量检测\nJ. 安排立体定向放射外科治疗左侧颞叶病变，并安排胸部X线、腹部彩超、甲功五项\nK. 安排鼻咽及颈部MRI平扫+增强、头颅MRI平扫+增强，暂缓胸部X线及腹部彩超检查\nL. 给予抗癫痫药物预防性治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超\n\n请仅输出一个选项字母（A-L）。","gold_letter":"K","gold_action":"安排鼻咽及颈部MRI平扫+增强、头颅MRI平扫+增强，暂缓胸部X线及腹部彩超检查，作为当前时点针对左侧颞叶新发病灶的重点影像随访；常规胸片、腹部彩超、EBV-DNA及甲功等全身随访可在下一随访窗口期再行安排。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"给予大剂量糖皮质激素冲击治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超"},{"letter":"B","text":"给予贝伐珠单抗靶向治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项"},{"letter":"C","text":"安排头颅PET-CT检查鉴别左侧颞叶病变性质，并安排胸部X线、腹部彩超、甲功五项"},{"letter":"D","text":"安排立体定向脑活检明确左侧颞叶病变性质，并安排胸部X线、腹部彩超、甲功五项"},{"letter":"E","text":"给予高压氧治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项"},{"letter":"F","text":"给予甘露醇静脉滴注脱水降颅压，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超"},{"letter":"G","text":"安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项及EBV-DNA定量检测"},{"letter":"H","text":"给予神经营养药物治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项"},{"letter":"I","text":"安排鼻咽及颈部CT平扫+增强、胸部CT平扫、腹部CT平扫、甲功五项及EBV-DNA定量检测"},{"letter":"J","text":"安排立体定向放射外科治疗左侧颞叶病变，并安排胸部X线、腹部彩超、甲功五项"},{"letter":"K","text":"安排鼻咽及颈部MRI平扫+增强、头颅MRI平扫+增强，暂缓胸部X线及腹部彩超检查"},{"letter":"L","text":"给予抗癫痫药物预防性治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超"}]}
+{"sample_id":"sample-2fc2bca32acf3eb67f65396b","patient_id":"patient-9149023ec8599161ec3e5cfd","turn_id":"turn07","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现双颈肿物半年余；现病史: 者半年余前无明显诱因出现左侧颈部肿物，无疼痛，逐渐增大，伴有鼻塞、流涕，至当地医院予抗炎对症治疗后，肿物能减小；2月前患者始出现右侧颈部肿物，逐渐增大，伴有鼻塞、流涕，间中有涕血，无发热、畏寒，无头晕、头痛，无周身骨痛等，于当地医院检查ＣＴ示：鼻咽肿物，遂转至我院进一步诊治。门诊拟诊“鼻咽肿物”收入我科进一步治疗。患者起病以来精神、睡眠欠佳，胃纳尚可，二便正常，体重无明显下降。；阳性症状体征: 鼻塞,睡眠欠佳,鼻咽肿物,涕血,右颈部肿物,左颈部肿物,流涕；既往史: 体健，无高血压、心脏病等慢性病，无糖尿病、肾病等全身性疾病，无乙肝、结核等传染病，无外伤史。；个人史: 生于原籍，有吸烟史30年,无饮酒，无其他嗜好，否认冶游史。；家族史: 家族中无类似患者，无家族性遗传病患者，无重大精神病患者。；体格检查:；专科检查:；KPS:；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D46] 检验组合: 中性粒细胞百分比(Neut%)-静脉血: 0.568；血液二氧化碳含量ctCO2(B)-静脉血: 23mmol/L；钾离子(K+)-静脉血: 3.97mmol/L；镁离子(Mg2+)-静脉血: 0.79mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.383；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.55；钠离子(Na+)-静脉血: 130mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；平均红细胞体积(MCV)-静脉血: 82.6fL；单核细胞百分比(Mono%)-静脉血: 0.042；肌酐(Crea)-静脉血: 46.6umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 44U/L；血红蛋白(Hb)-静脉血: 118g/L；磷(P)-静脉血: 1.18mmol/L；总胆红素(TBIL)-静脉血: 7.2umol/L；平均血小板体积(MPV)-静脉血: 9fL；总蛋白(TP)-静脉血: 67.1g/L；乳酸脱氢酶(LDH)-静脉血: 137.5U/L；间接胆红素(IBIL)-静脉血: 5.3umolL；球蛋白(GLO)-静脉血: 28.1g/L；尿酸(UA)-静脉血: 102.4umol/L；白蛋白(ALB)-静脉血: 39g/L；有核红细胞百分比(NRBC%)-静脉血: 0；单核细胞计数(Mono#)-静脉血: 0.210E9/L；红细胞比容(Hct)-静脉血: 36%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血小板分布宽度(PDW)-静脉血: 9%；阴离子间隙(AG)-静脉血: 14.1；直接胆红素(DBIL)-静脉血: 1.9umol/L；总胆汁酸(TBA)-静脉血: 1.5umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.4；有核红细胞计数(NRBC#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.710E9/L；大血小板百分比(P-LCR%)-静脉血: 16.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 27.1pg；γ-谷氨酰基转移酶(GGT)-静脉血: 62.8U/L；尿素氮(BUN)-静脉血: 3.4mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.39；红细胞计数(RBC#)-静脉血: 4.3610E12/L；总钙(Ca)-静脉血: 2.2mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 12.1U/L；血小板计数(PLT#)-静脉血: 41610E9/L；氯离子(Cl-)-静脉血: 92.9mmol/L；白细胞计数(WBC#)-静脉血: 4.3310E9/L；中性粒细胞计数(Neut#)-静脉血: 2.510E9/L\n- [全程D55] 检验组合: 平均红细胞血红蛋白含量(MCH)-静脉血: 27.3pg；天门冬氨酸氨基转移酶(AST)-静脉血: 14.5U/L；碱性磷酸酶(ALP)-静脉血: 103.1U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；淋巴细胞计数(Lymph#)-静脉血: 2.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.145；红细胞计数(RBC#)-静脉血: 3.7410E12/L；有核红细胞百分比(NRBC%)-静脉血: 0；大血小板百分比(P-LCR%)-静脉血: 18.5%；红细胞比容(Hct)-静脉血: 32.5%；淋巴细胞百分比(Lymph%)-静脉血: 0.531；丙氨酸氨基转移酶(ALT)-静脉血: 7.8U/L；氯离子(Cl-)-静脉血: 102mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；间接胆红素(IBIL)-静脉血: 1.7umolL；平均血小板体积(MPV)-静脉血: 9.3fL；总钙(Ca)-静脉血: 2.22mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；总蛋白(TP)-静脉血: 64.51g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.6mmol/L；血红蛋白(Hb)-静脉血: 102g/L；血小板比容-静脉血: 15%；中性粒细胞计数(Neut#)-静脉血: 1.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.318；白细胞计数(WBC#)-静脉血: 4.4810E9/L；镁离子(Mg2+)-静脉血: 0.78mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 35.3U/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 314g/L；乳酸脱氢酶(LDH)-静脉血: 139.5U/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；钠离子(Na+)-静脉血: 137.5mmol/L；总胆红素(TBIL)-静脉血: 2.4umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.86；尿素氮(BUN)-静脉血: 3.4mmol/L；肌酐(Crea)-静脉血: 64.6umol/L；总胆汁酸(TBA)-静脉血: 3.8umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 55.2U/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；钾离子(K+)-静脉血: 4.2mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；血小板计数(PLT#)-静脉血: 16410E9/L；尿酸(UA)-静脉血: 216.3umol/L；平均红细胞体积(MCV)-静脉血: 86.9fL；阴离子间隙(AG)-静脉血: 9.9；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.46\n- [全程D61] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- [全程D61] 检验组合: 碱性磷酸酶(ALP)-静脉血: 108.3U/L；丙氨酸氨基转移酶(ALT)-静脉血: 14.3U/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；直接胆红素(DBIL)-静脉血: 0.6umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24U/L；中性粒细胞百分比(Neut%)-静脉血: 0.512；α-L-岩藻糖苷酶(AFU)-静脉血: 44.3U/L；钾离子(K+)-静脉血: 4.3mmol/L；平均红细胞体积(MCV)-静脉血: 87.2fL；白细胞计数(WBC#)-静脉血: 7.6610E9/L；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；血小板比容-静脉血: 24%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；平均红细胞血红蛋白含量(MCH)-静脉血: 27.2pg；乳酸脱氢酶(LDH)-静脉血: 151.5U/L；阴离子间隙(AG)-静脉血: 16.2；肌酐(Crea)-静脉血: 58.2umol/L；总胆汁酸(TBA)-静脉血: 12.2umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.9mmol/L；球蛋白(GLO)-静脉血: 28.8g/L；淋巴细胞计数(Lymph#)-静脉血: 2.710E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 312g/L；氯离子(Cl-)-静脉血: 100.7mmol/L；尿酸(UA)-静脉血: 217.3umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.47；总钙(Ca)-静脉血: 2.18mmol/L；白蛋白(ALB)-静脉血: 42.2g/L；大血小板百分比(P-LCR%)-静脉血: 17.6%；γ-谷氨酰基转移酶(GGT)-静脉血: 62.4U/L；平均血小板体积(MPV)-静脉血: 9.1fL；磷(P)-静脉血: 1.45mmol/L；间接胆红素(IBIL)-静脉血: 2.4umolL；血小板计数(PLT#)-静脉血: 26810E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；血小板分布宽度(PDW)-静脉血: 9.4%；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.68；总胆红素(TBIL)-静脉血: 3umol/L；单核细胞百分比(Mono%)-静脉血: 0.106；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.9；总蛋白(TP)-静脉血: 71g/L；红细胞比容(Hct)-静脉血: 36.2%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.355；尿素氮(BUN)-静脉血: 2.2mmol/L\n- [全程D68] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后，对比某次就诊时间片： 鼻咽腔狭窄，鼻咽顶壁、顶后壁、左侧壁见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强后明显强化，肿物占据左侧咽隐窝，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，向前累及双侧后鼻孔，范围较前缩小，右侧咽隐窝变浅，右侧咽旁脂肪间隙及颈动脉鞘区未见异常。 左侧腭帆张提肌、左侧翼内肌上缘及双侧头长肌受侵，右侧腭帆提肌、腭帆张肌未见受侵征象。左侧翼腭窝可见软组织稍增厚，大致同前，右侧翼腭窝、右侧颞下窝未见异常；口咽双侧壁未见增厚。 斜坡、蝶骨基底部、左侧枕骨基底部、左侧岩尖、左侧翼突基底部、左侧翼突内外板、左侧蝶骨大翼骨质破坏，增强扫描后明显强化，大致同前。 左侧破裂孔及左侧海绵窦下份见少许软组织影，增强扫描后明显强化，较前变化不大，右侧海绵窦形态正常。 左侧上颌窦、筛窦、蝶窦、双侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 双侧咽后间隙见小淋巴结，最大短径约3mm，较前稍缩小；双颈II区见肿大淋巴结，最大约为20mm×30mm，边界清楚，信号不均匀，部分见囊变坏死，增强后不均匀强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗后，对比某次就诊时间片： 鼻咽病灶较前范围稍缩小。 颅底骨质破坏，大致同前。 双侧咽后淋巴结小淋巴结，较前稍缩小；双颈II区淋巴结肿大，考虑转移，部分较前缩小。 鼻窦炎、双侧乳突炎。\n- [全程D68] 检验组合: 阴离子间隙(AG)-静脉血: 14.8；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.75；白蛋白(ALB)-静脉血: 42.2g/L；间接胆红素(IBIL)-静脉血: 6.1umolL；总胆红素(TBIL)-静脉血: 8umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.6；血小板分布宽度(PDW)-静脉血: 8.4%；平均红细胞血红蛋白含量(MCH)-静脉血: 27.1pg；钠离子(Na+)-静脉血: 132.5mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 323g/L；直接胆红素(DBIL)-静脉血: 1.9umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 65.5U/L；钾离子(K+)-静脉血: 4.64mmol/L；碱性磷酸酶(ALP)-静脉血: 83.1U/L；白细胞计数(WBC#)-静脉血: 3.3810E9/L；血红蛋白(Hb)-静脉血: 107g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞比容(Hct)-静脉血: 33.1%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44.7；α-L-岩藻糖苷酶(AFU)-静脉血: 49.8U/L；中性粒细胞百分比(Neut%)-静脉血: 0.558；乳酸脱氢酶(LDH)-静脉血: 136.8U/L；尿素氮(BUN)-静脉血: 2.6mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.3mmol/L；单核细胞计数(Mono#)-静脉血: 0.110E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.033；氯离子(Cl-)-静脉血: 94.4mmol/L；肌酐(Crea)-静脉血: 53.8umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.9U/L；球蛋白(GLO)-静脉血: 28.48g/L；平均血小板体积(MPV)-静脉血: 8.3fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；中性粒细胞计数(Neut#)-静脉血: 1.910E9/L；总胆汁酸(TBA)-静脉血: 2.7umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.373；血小板比容-静脉血: 31%；总蛋白(TP)-静脉血: 70.68g/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；平均红细胞体积(MCV)-静脉血: 83.8fL；总钙(Ca)-静脉血: 2.37mmol/L；尿酸(UA)-静脉血: 123.4umol/L；单核细胞百分比(Mono%)-静脉血: 0.03；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.48；丙氨酸氨基转移酶(ALT)-静脉血: 11.4U/L\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D62] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日查房时自述精神食欲可，睡眠休息好。查体：KPS 90，一般状况可，鼻咽左侧壁、顶后壁肿物，双颈扪及肿大淋巴结，右颈多枚肿大淋巴结，较大者约6*4及2*2cm,质硬，活动差，左上颈可及一淋巴结，约3*3cm，质中，活动度可，无融合，无皮肤浸润等，左中颈可及一大小约1*1cm质硬淋巴结；张口门齿距约4cm，颅神经征阴性。上级医师信息已隐藏：该病人为鼻咽癌，已接受GP方案诱导化疗2周期。目前排除化疗禁忌症，今日水化，明日再予GP方案行第三周期化疗，遵执。\n- [全程D63] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日查房时无特殊不适主诉，精神食欲可，昨日水化顺利。查体大致同前。上级医师信息已隐藏：该病人继续按原方案（吉西他滨 1g/m2d1、d8+顺铂 80mg/m2d1）化疗，注意护胃、止吐等对症支持处理，遵执。\n- [全程D66] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 患者化疗输液顺利完成。今日查房时自诉精神食欲可，二便通畅。今继续对症支持治疗，择期复查血常规及血生化。\n- [时间未明] 门急诊记录: 主诉:；现病史: 者半年余前无明显诱因出现左侧颈部肿物，无疼痛，逐渐增大，伴有鼻塞、流涕，至当地医院予抗炎对症治疗后，肿物能减小；2月前患者始出现右侧颈部肿物，逐渐增大，伴有鼻塞、流涕，间中有涕血，无发热、畏寒，无头晕、头痛，无周身骨痛等，于当地医院检查ＣＴ示：鼻咽肿物，遂转至我院进一步诊治。门诊拟诊“鼻咽肿物”收入我科进一步治疗。患者起病以来精神、睡眠欠佳，胃纳尚可，二便正常，体重无明显下降。；既往史: 否认高血压、糖尿病及心脏病史，否认结核等传染病史、否认手术、外伤及输血史。；个人史:；家族史: 家族中无类似患者，无家族性遗传病患者，无重大精神病患者。；体格检查: KPS90，一般状况可，鼻咽左侧壁、顶后壁肿物，双颈扪及肿大淋巴结，右颈多枚肿大淋巴结，较大者约6*4及2*2cm,质硬，活动差，左上颈可及一淋巴结，约3*3cm，质中，活动度可，无融合，无皮肤浸润等，左中颈可及一大小约1*1cm质硬淋巴结；张口门齿距约4cm，颅神经征阴性。。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 提前终止第3周期诱导化疗，直接进入根治性同步放化疗阶段。\nB. 暂停第8天化疗，予重组人粒细胞集落刺激因子升白治疗后复查血常规。\nC. 更改诱导化疗方案为TP（多西他赛+顺铂）进行第4周期治疗。\nD. 继续行第3周期GP方案第8天化疗（吉西他滨联合顺铂），并安排出院。\nE. 计划在第3周期结束后，继续行第4周期GP方案诱导化疗。\nF. 暂停化疗，行双侧颈部淋巴结清扫术及鼻咽原发灶切除术。\nG. 终止后续放疗计划，按完全缓解（CR）状态进入定期随访观察。\nH. 将第8天吉西他滨剂量下调25%后给药，并密切监测血常规。\nI. 继续行第3周期GP方案第8天化疗（吉西他滨），辅以肠内营养支持，并安排出院。\nJ. 暂停治疗，行全身PET-CT检查以重新评估全身肿瘤负荷。\nK. 在第8天化疗基础上加用PD-1抑制剂（如特瑞普利单抗）进行联合治疗。\nL. 立即启动根治性调强放疗，并同步给予吉西他滨单药化疗。\n\n请仅输出一个选项字母（A-L）。","gold_letter":"I","gold_action":"继续行第3周期GP方案第8天化疗（吉西他滨），辅以肠内营养支持，并安排出院。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"提前终止第3周期诱导化疗，直接进入根治性同步放化疗阶段。"},{"letter":"B","text":"暂停第8天化疗，予重组人粒细胞集落刺激因子升白治疗后复查血常规。"},{"letter":"C","text":"更改诱导化疗方案为TP（多西他赛+顺铂）进行第4周期治疗。"},{"letter":"D","text":"继续行第3周期GP方案第8天化疗（吉西他滨联合顺铂），并安排出院。"},{"letter":"E","text":"计划在第3周期结束后，继续行第4周期GP方案诱导化疗。"},{"letter":"F","text":"暂停化疗，行双侧颈部淋巴结清扫术及鼻咽原发灶切除术。"},{"letter":"G","text":"终止后续放疗计划，按完全缓解（CR）状态进入定期随访观察。"},{"letter":"H","text":"将第8天吉西他滨剂量下调25%后给药，并密切监测血常规。"},{"letter":"I","text":"继续行第3周期GP方案第8天化疗（吉西他滨），辅以肠内营养支持，并安排出院。"},{"letter":"J","text":"暂停治疗，行全身PET-CT检查以重新评估全身肿瘤负荷。"},{"letter":"K","text":"在第8天化疗基础上加用PD-1抑制剂（如特瑞普利单抗）进行联合治疗。"},{"letter":"L","text":"立即启动根治性调强放疗，并同步给予吉西他滨单药化疗。"}]}
+{"sample_id":"sample-655ad2033595c09c6c4ce571","patient_id":"patient-4e3ac84b9e1451cea981f98e","turn_id":"turn01","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D37] 入院记录: 主诉: 回吸性涕血3月；现病史: 患者于某次就诊时间无明显诱因出现涕中带血，量少，色鲜红，呈间歇性，未引起重视。近2个月间歇性出现耳鸣，伴左颈肿物，遂就诊我院。患者无头痛、面麻、复视、听力下降等症状。左侧腭帆提肌、头长肌受侵，右侧腭帆提肌、双侧腭帆张肌及右侧头长肌未见受侵征象。颅底骨质未见破坏征象。右侧咽后淋巴结、左颈II区淋巴肿大。第3、7胸椎局部代谢活跃，建议随诊。胸部平片、腹部彩超未见明显异常。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,涕中带血,左颈肿物,淋巴肿大；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.8℃，P：18次/分，R: 76次/分，BP：116/68mmHg,Ht：165cm，Wt：56.5kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；双侧顶后壁，左侧隐窝可见结节状肿物，左颈II区可扪及肿大淋巴结，大小约10*15mm,质韧，无压痛，活动度可，与周围组织分界清楚。颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善血常规、肝肾功能、EBV-DNA检测，并安排全身PET-CT。\nB. 完善血常规、肝肾功能、凝血功能，并安排鼻咽部活检。\nC. 完善血常规、肝功能、EBV-DNA检测，并直接开始诱导化疗。\nD. 完善血常规、肝功能、甲状腺功能检测，并安排胸部CT和腹部增强CT。\nE. 完善血常规、肝功能、肾功能及心电图检查，暂不检测内分泌功能。\nF. 完善血常规、肝功能、脑垂体激素五项检测，暂不检测甲状腺功能。\nG. 完善血常规、肝功能、甲状腺功能及性激素六项检测。\nH. 完善血常规、肝功能检测，并安排骨扫描。\nI. 完善血常规、肝功能、甲状腺功能及肾上腺皮质激素检测。\nJ. 完善血常规、肝功能、甲状腺功能及脑垂体激素五项检测。\nK. 完善血常规、肝功能、甲状腺功能及脑垂体激素五项检测，并立即行胸椎穿刺活检。\nL. 完善血常规、肝功能检测，并安排全身骨髓穿刺。\n\n请仅输出一个选项字母（A-L）。","gold_letter":"B","gold_action":"完善血常规、肝肾功能、凝血功能，并安排鼻咽部活检。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"完善血常规、肝肾功能、EBV-DNA检测，并安排全身PET-CT。"},{"letter":"B","text":"完善血常规、肝肾功能、凝血功能，并安排鼻咽部活检。"},{"letter":"C","text":"完善血常规、肝功能、EBV-DNA检测，并直接开始诱导化疗。"},{"letter":"D","text":"完善血常规、肝功能、甲状腺功能检测，并安排胸部CT和腹部增强CT。"},{"letter":"E","text":"完善血常规、肝功能、肾功能及心电图检查，暂不检测内分泌功能。"},{"letter":"F","text":"完善血常规、肝功能、脑垂体激素五项检测，暂不检测甲状腺功能。"},{"letter":"G","text":"完善血常规、肝功能、甲状腺功能及性激素六项检测。"},{"letter":"H","text":"完善血常规、肝功能检测，并安排骨扫描。"},{"letter":"I","text":"完善血常规、肝功能、甲状腺功能及肾上腺皮质激素检测。"},{"letter":"J","text":"完善血常规、肝功能、甲状腺功能及脑垂体激素五项检测。"},{"letter":"K","text":"完善血常规、肝功能、甲状腺功能及脑垂体激素五项检测，并立即行胸椎穿刺活检。"},{"letter":"L","text":"完善血常规、肝功能检测，并安排全身骨髓穿刺。"}]}
+{"sample_id":"sample-49bfe4582a9d9a75f21d4be4","patient_id":"patient-4e3ac84b9e1451cea981f98e","turn_id":"turn02","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- 暂无可展示的初诊主诉/入院资料。\n\n【已完成检查与客观结果】\n- [全程D1] 检验组合: 尿酸(UA)-静脉血: 316.2umol/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 5.28mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 7.2umol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；球蛋白(GLO)-静脉血: 32.53g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.54mmol/L；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；磷(P)-静脉血: 1.06mmol/L；总胆汁酸(TBA)-静脉血: 2.6umol/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；Rh血型-静脉血: 阳性；血红蛋白(Hb)-静脉血: 153g/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.94；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.93mg/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；血小板分布宽度(PDW)-静脉血: 11.2%；血小板计数(PLT#)-静脉血: 29810E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；白蛋白(ALB)-静脉血: 48g/L；直接胆红素(DBIL)-静脉血: 1.8umol/L；活化部分凝血活酶时间(APTT)-静脉血: 24.9sec.；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；钠离子(Na+)-静脉血: 139.1mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.39；尿素氮(BUN)-静脉血: 5.9mmol/L；钾离子(K+)-静脉血: 4.04mmol/L；C-反应蛋白(CRP)-静脉血: 9.58mg/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22.5U/L；纤维蛋白原(Fbg)-静脉血: 4.77g/L；凝血酶原时间活动度(PTA)-静脉血: 125.5%；淋巴细胞计数(Lymph#)-静脉血: 1.910E9/L；中性粒细胞计数(Neut#)-静脉血: 3.610E9/L；白细胞计数(WBC#)-静脉血: 6.0810E9/L；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；单核细胞计数(Mono#)-静脉血: 0.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.086；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.7；阴离子间隙(AG)-静脉血: 17.1；肌酐(Crea)-静脉血: 83.5umol/L；氯离子(Cl-)-静脉血: 99.5mmol/L；间接胆红素(IBIL)-静脉血: 5.4umolL\n- [全程D18] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- [全程D18] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约25cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约45×26×26mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D19] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显斑片或结节影。双侧肺门影未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见病变。\n- [全程D20] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 第3、7胸椎及右股骨上段见片状放射性浓聚影。颅骨、胸骨、锁骨、肩胛骨、肋骨、颈椎、腰椎、骶尾骨、髋骨及上肢骨骼放射性分布未见明显异常。；检查结论: 右股骨上段局部代谢活跃，疑良性病变，缺血性坏死待排。 第3、7胸椎局部代谢活跃，建议随诊。\n- [全程D20] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁及左侧壁明显增厚，见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。左侧咽隐窝见肿物占据，右侧咽隐窝存在。左侧腭帆提肌、头长肌受侵，右侧腭帆提肌、双侧腭帆张肌及右侧头长肌未见受侵征象。病灶堵塞左侧后鼻孔。 双侧翼腭窝、双侧颞下窝未见异常；口咽未见异常。 颅底骨质未见破坏征象。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦粘膜未见增厚，双侧乳突充气良好，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 左侧咽后间隙见肿大淋巴结，大小约11mm×14mm；右侧咽后间隙见淋巴结，边界欠清，较大者短径约5mm。 左颈II区见数个淋巴结，部分信号不均匀，较大者大小约10mm×13mm，不均匀强化。颈部双侧Ⅰ、ⅡI区见小淋巴结，边界清，较大者短径约5mm，孤立散在。 甲状腺未见异常信号灶。喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 扫描范围颈椎未见明确骨质破坏。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质未见破坏征象。 左侧咽后淋巴结，考虑转移。右侧咽后淋巴结，考虑转移可能性大。 左颈II区淋巴结，考虑转移可能性大。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 临床分期为 cT1N1M0（AJCC v9 IB期），病变局限于鼻咽腔及咽隐窝，未见明确周围软组织受侵，骨显像异常考虑良性。\nB. 临床分期为 cT2N2M0（AJCC v9 II期），双侧咽后淋巴结受累按分期规则应评为N2，骨显像异常考虑良性。\nC. 临床分期为 cT2N1M1（AJCC v9 IVB期），骨显像胸椎及股骨代谢活跃表现已达到多发骨转移诊断标准。\nD. 临床分期为 cT3N1M0（AJCC v9 II期），病灶堵塞后鼻孔已构成鼻腔侵犯，按分期规则应评为T3。\nE. 临床分期为 cT2N1M0（AJCC v9 II期），头长肌受侵定为T2，单侧颈部淋巴结转移定为N1，综合评为II期。\nF. 临床分期暂定 cT2N1Mx，骨显像异常代谢灶性质未明，需常规补充全身PET-CT或骨活检明确M分期。\nG. 临床分期为 cT1N2M0（AJCC v9 II期），左侧咽后及左颈II区淋巴结转移评为N2，未见明确T2结构受侵。\nH. 临床分期为 cT3N1M0（AJCC v9 II期），腭帆提肌受侵代表侵犯咽旁间隙以外结构，按分期规则应评为T3。\nI. 临床分期为 cT2N0M0（AJCC v9 IB期），咽后及颈部淋巴结短径均小于15mm，未达转移诊断标准，应评为N0。\nJ. 临床分期为 cT4N1M0（AJCC v9 III期），病变侵犯头长肌属于广泛软组织受侵，按分期规则应评为T4。\nK. 临床分期为 cT2N1M0（AJCC v9 IB期），头长肌受侵定为T2，双侧咽后及单侧颈部淋巴结转移定为N1，骨显像异常考虑良性暂定M0。\nL. 临床分期为 cT2N1M0（AJCC v9 IB期），腭帆提肌受侵定为T2，建议加做全身PET-CT以排除隐匿性转移。\n\n请仅输出一个选项字母（A-L）。","gold_letter":"K","gold_action":"临床分期为 cT2N1M0（AJCC v9 IB期），头长肌受侵定为T2，双侧咽后及单侧颈部淋巴结转移定为N1，骨显像异常考虑良性暂定M0。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"临床分期为 cT1N1M0（AJCC v9 IB期），病变局限于鼻咽腔及咽隐窝，未见明确周围软组织受侵，骨显像异常考虑良性。"},{"letter":"B","text":"临床分期为 cT2N2M0（AJCC v9 II期），双侧咽后淋巴结受累按分期规则应评为N2，骨显像异常考虑良性。"},{"letter":"C","text":"临床分期为 cT2N1M1（AJCC v9 IVB期），骨显像胸椎及股骨代谢活跃表现已达到多发骨转移诊断标准。"},{"letter":"D","text":"临床分期为 cT3N1M0（AJCC v9 II期），病灶堵塞后鼻孔已构成鼻腔侵犯，按分期规则应评为T3。"},{"letter":"E","text":"临床分期为 cT2N1M0（AJCC v9 II期），头长肌受侵定为T2，单侧颈部淋巴结转移定为N1，综合评为II期。"},{"letter":"F","text":"临床分期暂定 cT2N1Mx，骨显像异常代谢灶性质未明，需常规补充全身PET-CT或骨活检明确M分期。"},{"letter":"G","text":"临床分期为 cT1N2M0（AJCC v9 II期），左侧咽后及左颈II区淋巴结转移评为N2，未见明确T2结构受侵。"},{"letter":"H","text":"临床分期为 cT3N1M0（AJCC v9 II期），腭帆提肌受侵代表侵犯咽旁间隙以外结构，按分期规则应评为T3。"},{"letter":"I","text":"临床分期为 cT2N0M0（AJCC v9 IB期），咽后及颈部淋巴结短径均小于15mm，未达转移诊断标准，应评为N0。"},{"letter":"J","text":"临床分期为 cT4N1M0（AJCC v9 III期），病变侵犯头长肌属于广泛软组织受侵，按分期规则应评为T4。"},{"letter":"K","text":"临床分期为 cT2N1M0（AJCC v9 IB期），头长肌受侵定为T2，双侧咽后及单侧颈部淋巴结转移定为N1，骨显像异常考虑良性暂定M0。"},{"letter":"L","text":"临床分期为 cT2N1M0（AJCC v9 IB期），腭帆提肌受侵定为T2，建议加做全身PET-CT以排除隐匿性转移。"}]}
+{"sample_id":"sample-04c8674f03cec4de991fcf32","patient_id":"patient-4e3ac84b9e1451cea981f98e","turn_id":"turn04","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D1] 检验组合: 尿酸(UA)-静脉血: 316.2umol/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 5.28mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 7.2umol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；球蛋白(GLO)-静脉血: 32.53g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.54mmol/L；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；磷(P)-静脉血: 1.06mmol/L；总胆汁酸(TBA)-静脉血: 2.6umol/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；Rh血型-静脉血: 阳性；血红蛋白(Hb)-静脉血: 153g/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.94；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.93mg/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；血小板分布宽度(PDW)-静脉血: 11.2%；血小板计数(PLT#)-静脉血: 29810E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；白蛋白(ALB)-静脉血: 48g/L；直接胆红素(DBIL)-静脉血: 1.8umol/L；活化部分凝血活酶时间(APTT)-静脉血: 24.9sec.；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；钠离子(Na+)-静脉血: 139.1mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.39；尿素氮(BUN)-静脉血: 5.9mmol/L；钾离子(K+)-静脉血: 4.04mmol/L；C-反应蛋白(CRP)-静脉血: 9.58mg/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22.5U/L；纤维蛋白原(Fbg)-静脉血: 4.77g/L；凝血酶原时间活动度(PTA)-静脉血: 125.5%；淋巴细胞计数(Lymph#)-静脉血: 1.910E9/L；中性粒细胞计数(Neut#)-静脉血: 3.610E9/L；白细胞计数(WBC#)-静脉血: 6.0810E9/L；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；单核细胞计数(Mono#)-静脉血: 0.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.086；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.7；阴离子间隙(AG)-静脉血: 17.1；肌酐(Crea)-静脉血: 83.5umol/L；氯离子(Cl-)-静脉血: 99.5mmol/L；间接胆红素(IBIL)-静脉血: 5.4umolL\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D18] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- [全程D18] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约25cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约45×26×26mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D19] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显斑片或结节影。双侧肺门影未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见病变。\n- [全程D20] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 第3、7胸椎及右股骨上段见片状放射性浓聚影。颅骨、胸骨、锁骨、肩胛骨、肋骨、颈椎、腰椎、骶尾骨、髋骨及上肢骨骼放射性分布未见明显异常。；检查结论: 右股骨上段局部代谢活跃，疑良性病变，缺血性坏死待排。 第3、7胸椎局部代谢活跃，建议随诊。\n- [全程D20] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁及左侧壁明显增厚，见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。左侧咽隐窝见肿物占据，右侧咽隐窝存在。左侧腭帆提肌、头长肌受侵，右侧腭帆提肌、双侧腭帆张肌及右侧头长肌未见受侵征象。病灶堵塞左侧后鼻孔。 双侧翼腭窝、双侧颞下窝未见异常；口咽未见异常。 颅底骨质未见破坏征象。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦粘膜未见增厚，双侧乳突充气良好，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 左侧咽后间隙见肿大淋巴结，大小约11mm×14mm；右侧咽后间隙见淋巴结，边界欠清，较大者短径约5mm。 左颈II区见数个淋巴结，部分信号不均匀，较大者大小约10mm×13mm，不均匀强化。颈部双侧Ⅰ、ⅡI区见小淋巴结，边界清，较大者短径约5mm，孤立散在。 甲状腺未见异常信号灶。喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 扫描范围颈椎未见明确骨质破坏。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质未见破坏征象。 左侧咽后淋巴结，考虑转移。右侧咽后淋巴结，考虑转移可能性大。 左颈II区淋巴结，考虑转移可能性大。\n- [全程D23] 检验组合: 天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.75；乳酸脱氢酶(LDH)-静脉血: 285.9U/L；总胆汁酸(TBA)-静脉血: 12.7umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 220U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 20.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 249.9U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 165.4U/L；碱性磷酸酶(ALP)-静脉血: 161.1U/L\n- [全程D37] 检验组合: 甲状腺球蛋白(TG)-静脉血: 13.08ng/ml；平均血小板体积(MPV)-静脉血: 9.9fL；α-L-岩藻糖苷酶(AFU)-静脉血: 21.1U/L；促卵泡刺激素(FSH)-静脉血: 6.26mIU/ml；血小板比容-静脉血: 29%；血小板分布宽度(PDW)-静脉血: 11.3%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.2；催乳素(PRL)-静脉血: 277.6uIU/ml；大血小板百分比(P-LCR%)-静脉血: 23.9%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；促黄体生成素(LH)-静脉血: 9.22mIU/ml；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；血小板计数(PLT#)-静脉血: 29710E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.262；γ-谷氨酰基转移酶(GGT)-静脉血: 227.5U/L；生长激素(GH)-静脉血: 0.54ng/ml；碱性磷酸酶(ALP)-静脉血: 164.9U/L；乳酸脱氢酶(LDH)-静脉血: 170.2U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 38.5；平均红细胞体积(MCV)-静脉血: 94fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；血红蛋白(Hb)-静脉血: 140g/L；中性粒细胞计数(Neut#)-静脉血: 4.410E9/L；促甲状腺激素(TSH)-静脉血: 4.45uIU/ml；有核红细胞计数(NRBC#)-静脉血: 010E9/L；单核细胞百分比(Mono%)-静脉血: 0.105；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.619；红细胞计数(RBC#)-静脉血: 4.5110E12/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；红细胞比容(Hct)-静脉血: 42.4%；总胆汁酸(TBA)-静脉血: 2umol/L；甲状腺过氧化物酶抗体(TPO-Ab)-静脉血: 14.45U/ml；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.58；丙氨酸氨基转移酶(ALT)-静脉血: 45.6U/L；淋巴细胞计数(Lymph#)-静脉血: 1.910E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 26.6U/L；单核细胞计数(Mono#)-静脉血: 0.810E9/L；游离甲状腺素(FT4)-静脉血: 15.93pmol/L；游离三碘甲状腺原氨酸(FT3)-静脉血: 4.98pmol/L；促甲状腺激素(TSH)-静脉血: 4.46uIU/ml；白细胞计数(WBC#)-静脉血: 7.1310E9/L\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 单纯根治性放射治疗或根治性放化疗\nB. 诱导化疗后序贯单纯根治性放射治疗\nC. 诱导化疗后序贯根治性放化疗\nD. 单纯根治性放射治疗后序贯辅助化疗\nE. 根治性放化疗后序贯辅助化疗\nF. 诱导化疗后序贯根治性放化疗及辅助化疗\nG. 姑息性放射治疗联合全身系统性化疗\nH. 单纯根治性放射治疗联合EGFR靶向治疗\nI. 诱导化疗联合EGFR靶向治疗后序贯放疗\nJ. 根治性放化疗联合PD-1抑制剂治疗\nK. 诱导化疗联合PD-1抑制剂后序贯放化疗\nL. 单纯全身系统性化疗\n\n请仅输出一个选项字母（A-L）。","gold_letter":"A","gold_action":"单纯根治性放射治疗或根治性放化疗","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"单纯根治性放射治疗或根治性放化疗"},{"letter":"B","text":"诱导化疗后序贯单纯根治性放射治疗"},{"letter":"C","text":"诱导化疗后序贯根治性放化疗"},{"letter":"D","text":"单纯根治性放射治疗后序贯辅助化疗"},{"letter":"E","text":"根治性放化疗后序贯辅助化疗"},{"letter":"F","text":"诱导化疗后序贯根治性放化疗及辅助化疗"},{"letter":"G","text":"姑息性放射治疗联合全身系统性化疗"},{"letter":"H","text":"单纯根治性放射治疗联合EGFR靶向治疗"},{"letter":"I","text":"诱导化疗联合EGFR靶向治疗后序贯放疗"},{"letter":"J","text":"根治性放化疗联合PD-1抑制剂治疗"},{"letter":"K","text":"诱导化疗联合PD-1抑制剂后序贯放化疗"},{"letter":"L","text":"单纯全身系统性化疗"}]}
+{"sample_id":"sample-453547f6b6c780c6834cd926","patient_id":"patient-4e3ac84b9e1451cea981f98e","turn_id":"turn05","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D1] 检验组合: 尿酸(UA)-静脉血: 316.2umol/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 5.28mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 7.2umol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；球蛋白(GLO)-静脉血: 32.53g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.54mmol/L；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；磷(P)-静脉血: 1.06mmol/L；总胆汁酸(TBA)-静脉血: 2.6umol/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；Rh血型-静脉血: 阳性；血红蛋白(Hb)-静脉血: 153g/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.94；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.93mg/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；血小板分布宽度(PDW)-静脉血: 11.2%；血小板计数(PLT#)-静脉血: 29810E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；白蛋白(ALB)-静脉血: 48g/L；直接胆红素(DBIL)-静脉血: 1.8umol/L；活化部分凝血活酶时间(APTT)-静脉血: 24.9sec.；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；钠离子(Na+)-静脉血: 139.1mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.39；尿素氮(BUN)-静脉血: 5.9mmol/L；钾离子(K+)-静脉血: 4.04mmol/L；C-反应蛋白(CRP)-静脉血: 9.58mg/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22.5U/L；纤维蛋白原(Fbg)-静脉血: 4.77g/L；凝血酶原时间活动度(PTA)-静脉血: 125.5%；淋巴细胞计数(Lymph#)-静脉血: 1.910E9/L；中性粒细胞计数(Neut#)-静脉血: 3.610E9/L；白细胞计数(WBC#)-静脉血: 6.0810E9/L；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；单核细胞计数(Mono#)-静脉血: 0.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.086；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.7；阴离子间隙(AG)-静脉血: 17.1；肌酐(Crea)-静脉血: 83.5umol/L；氯离子(Cl-)-静脉血: 99.5mmol/L；间接胆红素(IBIL)-静脉血: 5.4umolL\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D18] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- [全程D18] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约25cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约45×26×26mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D19] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显斑片或结节影。双侧肺门影未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见病变。\n- [全程D20] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 第3、7胸椎及右股骨上段见片状放射性浓聚影。颅骨、胸骨、锁骨、肩胛骨、肋骨、颈椎、腰椎、骶尾骨、髋骨及上肢骨骼放射性分布未见明显异常。；检查结论: 右股骨上段局部代谢活跃，疑良性病变，缺血性坏死待排。 第3、7胸椎局部代谢活跃，建议随诊。\n- [全程D20] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁及左侧壁明显增厚，见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。左侧咽隐窝见肿物占据，右侧咽隐窝存在。左侧腭帆提肌、头长肌受侵，右侧腭帆提肌、双侧腭帆张肌及右侧头长肌未见受侵征象。病灶堵塞左侧后鼻孔。 双侧翼腭窝、双侧颞下窝未见异常；口咽未见异常。 颅底骨质未见破坏征象。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦粘膜未见增厚，双侧乳突充气良好，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 左侧咽后间隙见肿大淋巴结，大小约11mm×14mm；右侧咽后间隙见淋巴结，边界欠清，较大者短径约5mm。 左颈II区见数个淋巴结，部分信号不均匀，较大者大小约10mm×13mm，不均匀强化。颈部双侧Ⅰ、ⅡI区见小淋巴结，边界清，较大者短径约5mm，孤立散在。 甲状腺未见异常信号灶。喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 扫描范围颈椎未见明确骨质破坏。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质未见破坏征象。 左侧咽后淋巴结，考虑转移。右侧咽后淋巴结，考虑转移可能性大。 左颈II区淋巴结，考虑转移可能性大。\n- [全程D23] 检验组合: 天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.75；乳酸脱氢酶(LDH)-静脉血: 285.9U/L；总胆汁酸(TBA)-静脉血: 12.7umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 220U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 20.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 249.9U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 165.4U/L；碱性磷酸酶(ALP)-静脉血: 161.1U/L\n- [全程D37] 检验组合: 甲状腺球蛋白(TG)-静脉血: 13.08ng/ml；平均血小板体积(MPV)-静脉血: 9.9fL；α-L-岩藻糖苷酶(AFU)-静脉血: 21.1U/L；促卵泡刺激素(FSH)-静脉血: 6.26mIU/ml；血小板比容-静脉血: 29%；血小板分布宽度(PDW)-静脉血: 11.3%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.2；催乳素(PRL)-静脉血: 277.6uIU/ml；大血小板百分比(P-LCR%)-静脉血: 23.9%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；促黄体生成素(LH)-静脉血: 9.22mIU/ml；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；血小板计数(PLT#)-静脉血: 29710E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.262；γ-谷氨酰基转移酶(GGT)-静脉血: 227.5U/L；生长激素(GH)-静脉血: 0.54ng/ml；碱性磷酸酶(ALP)-静脉血: 164.9U/L；乳酸脱氢酶(LDH)-静脉血: 170.2U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 38.5；平均红细胞体积(MCV)-静脉血: 94fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；血红蛋白(Hb)-静脉血: 140g/L；中性粒细胞计数(Neut#)-静脉血: 4.410E9/L；促甲状腺激素(TSH)-静脉血: 4.45uIU/ml；有核红细胞计数(NRBC#)-静脉血: 010E9/L；单核细胞百分比(Mono%)-静脉血: 0.105；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.619；红细胞计数(RBC#)-静脉血: 4.5110E12/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；红细胞比容(Hct)-静脉血: 42.4%；总胆汁酸(TBA)-静脉血: 2umol/L；甲状腺过氧化物酶抗体(TPO-Ab)-静脉血: 14.45U/ml；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.58；丙氨酸氨基转移酶(ALT)-静脉血: 45.6U/L；淋巴细胞计数(Lymph#)-静脉血: 1.910E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 26.6U/L；单核细胞计数(Mono#)-静脉血: 0.810E9/L；游离甲状腺素(FT4)-静脉血: 15.93pmol/L；游离三碘甲状腺原氨酸(FT3)-静脉血: 4.98pmol/L；促甲状腺激素(TSH)-静脉血: 4.46uIU/ml；白细胞计数(WBC#)-静脉血: 7.1310E9/L\n- [全程D44] 检验组合: 平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；单核细胞百分比(Mono%)-静脉血: 0.084；载脂蛋白B(apoB)-静脉血: 1.02g/L；磷(P)-静脉血: 1.54mmol/L；钠离子(Na+)-静脉血: 137mmol/L；白蛋白(ALB)-静脉血: 41.2g/L；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 38.1U/L；总胆固醇(TC)-静脉血: 5.9mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；中性粒细胞百分比(Neut%)-静脉血: 0.789；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.65mmol/L；间接胆红素(IBIL)-静脉血: 5.6umolL；尿素氮(BUN)-静脉血: 7.73mmol/L；总胆红素(TBIL)-静脉血: 7.4umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.4mmol/L；C-反应蛋白(CRP)-静脉血: 9.62mg/L；血小板比容-静脉血: 27%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；大血小板百分比(P-LCR%)-静脉血: 26.8%；α-L-岩藻糖苷酶(AFU)-静脉血: 35U/L；钾离子(K+)-静脉血: 4.2mmol/L；直接胆红素(DBIL)-静脉血: 1.8umol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.6；尿酸(UA)-静脉血: 288.4umol/L；碱性磷酸酶(ALP)-静脉血: 138.4U/L；中性粒细胞计数(Neut#)-静脉血: 11.910E9/L；总钙(Ca)-静脉血: 2.25mmol/L；肌酐(Crea)-静脉血: 84umol/L；总胆汁酸(TBA)-静脉血: 4.1umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.24；球蛋白(GLO)-静脉血: 33.12g/L；氯离子(Cl-)-静脉血: 97.5mmol/L；甘油三酯(TG)-静脉血: 2.9mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 64U/L；红细胞比容(Hct)-静脉血: 41.2%；血小板分布宽度(PDW)-静脉血: 11.5%；阴离子间隙(AG)-静脉血: 15；血小板计数(PLT#)-静脉血: 26710E9/L；总蛋白(TP)-静脉血: 74.32g/L；单核细胞计数(Mono#)-静脉血: 1.310E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.123\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D39] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者一般情况可，未诉特殊不适。按[计划性表述已隐藏]同期放化疗，放疗技术采用调强放疗9野，处方剂量：PTVp 7029cGy/33F， PTVn_L 6600cGy/33F,PTVn_R 6000cGy/33F,PTV1 6000cGy/33F,PTV2 5400cGy/33F。目前放疗计划已完善，予以今日复位验证后执行放疗。\n- [全程D40] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者精神食欲可，放疗2次，无特殊不适，查体无特殊。今日按[计划性表述已隐藏]第一程DDP同期化疗（顺铂 80mg/m2），若无特殊不适，今日化疗结束后予以出院。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，给予静脉保肝降酶药物，待转氨酶正常后重启放疗\nB. 继续调强放疗，定期监测血常规及肝肾功能，暂不予特殊药物干预\nC. 暂停放疗，经验性静脉滴注广谱抗生素，待中性粒细胞正常后重启放疗\nD. 继续调强放疗，皮下注射重组人粒细胞集落刺激因子\nE. 暂停放疗，给予大剂量静脉水化及利尿治疗\nF. 继续调强放疗，计划在下一周期将顺铂剂量下调20%\nG. 暂停放疗，完善血培养及降钙素原检查\nH. 继续调强放疗，静脉滴注大剂量糖皮质激素\nI. 暂停放疗，给予静脉输注人血白蛋白及肠外营养支持\nJ. 继续调强放疗，计划将下一周期同期化疗药物替换为卡铂\nK. 暂停放疗，复查鼻咽及颈部增强MRI\nL. 继续调强放疗，取消后续同期化疗周期\n\n请仅输出一个选项字母（A-L）。","gold_letter":"B","gold_action":"继续当前调强放疗，定期监测血常规及肝肾功能，暂不予特殊药物干预。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"暂停放疗，给予静脉保肝降酶药物，待转氨酶正常后重启放疗"},{"letter":"B","text":"继续调强放疗，定期监测血常规及肝肾功能，暂不予特殊药物干预"},{"letter":"C","text":"暂停放疗，经验性静脉滴注广谱抗生素，待中性粒细胞正常后重启放疗"},{"letter":"D","text":"继续调强放疗，皮下注射重组人粒细胞集落刺激因子"},{"letter":"E","text":"暂停放疗，给予大剂量静脉水化及利尿治疗"},{"letter":"F","text":"继续调强放疗，计划在下一周期将顺铂剂量下调20%"},{"letter":"G","text":"暂停放疗，完善血培养及降钙素原检查"},{"letter":"H","text":"继续调强放疗，静脉滴注大剂量糖皮质激素"},{"letter":"I","text":"暂停放疗，给予静脉输注人血白蛋白及肠外营养支持"},{"letter":"J","text":"继续调强放疗，计划将下一周期同期化疗药物替换为卡铂"},{"letter":"K","text":"暂停放疗，复查鼻咽及颈部增强MRI"},{"letter":"L","text":"继续调强放疗，取消后续同期化疗周期"}]}
+{"sample_id":"sample-192932039e740110f5fb9ae6","patient_id":"patient-4e3ac84b9e1451cea981f98e","turn_id":"turn06","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D1] 检验组合: 尿酸(UA)-静脉血: 316.2umol/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 5.28mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 7.2umol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；球蛋白(GLO)-静脉血: 32.53g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.54mmol/L；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；磷(P)-静脉血: 1.06mmol/L；总胆汁酸(TBA)-静脉血: 2.6umol/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；Rh血型-静脉血: 阳性；血红蛋白(Hb)-静脉血: 153g/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.94；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.93mg/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；血小板分布宽度(PDW)-静脉血: 11.2%；血小板计数(PLT#)-静脉血: 29810E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；白蛋白(ALB)-静脉血: 48g/L；直接胆红素(DBIL)-静脉血: 1.8umol/L；活化部分凝血活酶时间(APTT)-静脉血: 24.9sec.；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；钠离子(Na+)-静脉血: 139.1mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.39；尿素氮(BUN)-静脉血: 5.9mmol/L；钾离子(K+)-静脉血: 4.04mmol/L；C-反应蛋白(CRP)-静脉血: 9.58mg/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22.5U/L；纤维蛋白原(Fbg)-静脉血: 4.77g/L；凝血酶原时间活动度(PTA)-静脉血: 125.5%；淋巴细胞计数(Lymph#)-静脉血: 1.910E9/L；中性粒细胞计数(Neut#)-静脉血: 3.610E9/L；白细胞计数(WBC#)-静脉血: 6.0810E9/L；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；单核细胞计数(Mono#)-静脉血: 0.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.086；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.7；阴离子间隙(AG)-静脉血: 17.1；肌酐(Crea)-静脉血: 83.5umol/L；氯离子(Cl-)-静脉血: 99.5mmol/L；间接胆红素(IBIL)-静脉血: 5.4umolL\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D20] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 第3、7胸椎及右股骨上段见片状放射性浓聚影。颅骨、胸骨、锁骨、肩胛骨、肋骨、颈椎、腰椎、骶尾骨、髋骨及上肢骨骼放射性分布未见明显异常。；检查结论: 右股骨上段局部代谢活跃，疑良性病变，缺血性坏死待排。 第3、7胸椎局部代谢活跃，建议随诊。\n- [全程D20] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁及左侧壁明显增厚，见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。左侧咽隐窝见肿物占据，右侧咽隐窝存在。左侧腭帆提肌、头长肌受侵，右侧腭帆提肌、双侧腭帆张肌及右侧头长肌未见受侵征象。病灶堵塞左侧后鼻孔。 双侧翼腭窝、双侧颞下窝未见异常；口咽未见异常。 颅底骨质未见破坏征象。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦粘膜未见增厚，双侧乳突充气良好，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 左侧咽后间隙见肿大淋巴结，大小约11mm×14mm；右侧咽后间隙见淋巴结，边界欠清，较大者短径约5mm。 左颈II区见数个淋巴结，部分信号不均匀，较大者大小约10mm×13mm，不均匀强化。颈部双侧Ⅰ、ⅡI区见小淋巴结，边界清，较大者短径约5mm，孤立散在。 甲状腺未见异常信号灶。喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 扫描范围颈椎未见明确骨质破坏。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质未见破坏征象。 左侧咽后淋巴结，考虑转移。右侧咽后淋巴结，考虑转移可能性大。 左颈II区淋巴结，考虑转移可能性大。\n- [全程D23] 检验组合: 天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.75；乳酸脱氢酶(LDH)-静脉血: 285.9U/L；总胆汁酸(TBA)-静脉血: 12.7umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 220U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 20.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 249.9U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 165.4U/L；碱性磷酸酶(ALP)-静脉血: 161.1U/L\n- [全程D37] 检验组合: 甲状腺球蛋白(TG)-静脉血: 13.08ng/ml；平均血小板体积(MPV)-静脉血: 9.9fL；α-L-岩藻糖苷酶(AFU)-静脉血: 21.1U/L；促卵泡刺激素(FSH)-静脉血: 6.26mIU/ml；血小板比容-静脉血: 29%；血小板分布宽度(PDW)-静脉血: 11.3%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.2；催乳素(PRL)-静脉血: 277.6uIU/ml；大血小板百分比(P-LCR%)-静脉血: 23.9%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；促黄体生成素(LH)-静脉血: 9.22mIU/ml；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；血小板计数(PLT#)-静脉血: 29710E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.262；γ-谷氨酰基转移酶(GGT)-静脉血: 227.5U/L；生长激素(GH)-静脉血: 0.54ng/ml；碱性磷酸酶(ALP)-静脉血: 164.9U/L；乳酸脱氢酶(LDH)-静脉血: 170.2U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 38.5；平均红细胞体积(MCV)-静脉血: 94fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；血红蛋白(Hb)-静脉血: 140g/L；中性粒细胞计数(Neut#)-静脉血: 4.410E9/L；促甲状腺激素(TSH)-静脉血: 4.45uIU/ml；有核红细胞计数(NRBC#)-静脉血: 010E9/L；单核细胞百分比(Mono%)-静脉血: 0.105；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.619；红细胞计数(RBC#)-静脉血: 4.5110E12/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；红细胞比容(Hct)-静脉血: 42.4%；总胆汁酸(TBA)-静脉血: 2umol/L；甲状腺过氧化物酶抗体(TPO-Ab)-静脉血: 14.45U/ml；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.58；丙氨酸氨基转移酶(ALT)-静脉血: 45.6U/L；淋巴细胞计数(Lymph#)-静脉血: 1.910E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 26.6U/L；单核细胞计数(Mono#)-静脉血: 0.810E9/L；游离甲状腺素(FT4)-静脉血: 15.93pmol/L；游离三碘甲状腺原氨酸(FT3)-静脉血: 4.98pmol/L；促甲状腺激素(TSH)-静脉血: 4.46uIU/ml；白细胞计数(WBC#)-静脉血: 7.1310E9/L\n- [全程D44] 检验组合: 平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；单核细胞百分比(Mono%)-静脉血: 0.084；载脂蛋白B(apoB)-静脉血: 1.02g/L；磷(P)-静脉血: 1.54mmol/L；钠离子(Na+)-静脉血: 137mmol/L；白蛋白(ALB)-静脉血: 41.2g/L；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 38.1U/L；总胆固醇(TC)-静脉血: 5.9mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；中性粒细胞百分比(Neut%)-静脉血: 0.789；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.65mmol/L；间接胆红素(IBIL)-静脉血: 5.6umolL；尿素氮(BUN)-静脉血: 7.73mmol/L；总胆红素(TBIL)-静脉血: 7.4umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.4mmol/L；C-反应蛋白(CRP)-静脉血: 9.62mg/L；血小板比容-静脉血: 27%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；大血小板百分比(P-LCR%)-静脉血: 26.8%；α-L-岩藻糖苷酶(AFU)-静脉血: 35U/L；钾离子(K+)-静脉血: 4.2mmol/L；直接胆红素(DBIL)-静脉血: 1.8umol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.6；尿酸(UA)-静脉血: 288.4umol/L；碱性磷酸酶(ALP)-静脉血: 138.4U/L；中性粒细胞计数(Neut#)-静脉血: 11.910E9/L；总钙(Ca)-静脉血: 2.25mmol/L；肌酐(Crea)-静脉血: 84umol/L；总胆汁酸(TBA)-静脉血: 4.1umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.24；球蛋白(GLO)-静脉血: 33.12g/L；氯离子(Cl-)-静脉血: 97.5mmol/L；甘油三酯(TG)-静脉血: 2.9mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 64U/L；红细胞比容(Hct)-静脉血: 41.2%；血小板分布宽度(PDW)-静脉血: 11.5%；阴离子间隙(AG)-静脉血: 15；血小板计数(PLT#)-静脉血: 26710E9/L；总蛋白(TP)-静脉血: 74.32g/L；单核细胞计数(Mono#)-静脉血: 1.310E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.123\n- [全程D47] 检验组合: 血小板分布宽度(PDW)-静脉血: 13.9%；白细胞计数(WBC#)-静脉血: 6.3810E9/L；单核细胞计数(Mono#)-静脉血: 1.410E9/L；红细胞比容(Hct)-静脉血: 43.9%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 38.1；平均红细胞血红蛋白浓度(MCHC)-静脉血: 333g/L；血小板计数(PLT#)-静脉血: 26510E9/L；平均红细胞体积(MCV)-静脉血: 93.6fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；大血小板百分比(P-LCR%)-静脉血: 34.5%；血小板比容-静脉血: 30%；平均血小板体积(MPV)-静脉血: 11.2fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 146g/L；中性粒细胞百分比(Neut%)-静脉血: 0.569；单核细胞百分比(Mono%)-静脉血: 0.216；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；红细胞计数(RBC#)-静脉血: 4.6910E12/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；中性粒细胞计数(Neut#)-静脉血: 3.610E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.205；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.5；平均红细胞血红蛋白含量(MCH)-静脉血: 31.1pg\n- [全程D54] 检验组合: 直接胆红素(DBIL)-静脉血: 1.3umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 337g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.173；血小板计数(PLT#)-静脉血: 14810E9/L；碱性磷酸酶(ALP)-静脉血: 120.1U/L；氯离子(Cl-)-静脉血: 101.8mmol/L；总胆固醇(TC)-静脉血: 5.93mmol/L；钾离子(K+)-静脉血: 3.93mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 127.6U/L；有核红细胞百分比(NRBC%)-静脉血: 0；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.51；甘油三酯(TG)-静脉血: 2.02mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 38.4；单核细胞计数(Mono#)-静脉血: 0.710E9/L；平均血小板体积(MPV)-静脉血: 10.1fL；白细胞计数(WBC#)-静脉血: 5.910E9/L；钠离子(Na+)-静脉血: 140.2mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；中性粒细胞计数(Neut#)-静脉血: 4.110E9/L；红细胞比容(Hct)-静脉血: 40.7%；尿素氮(BUN)-静脉血: 3.9mmol/L；平均红细胞体积(MCV)-静脉血: 91.3fL；总胆红素(TBIL)-静脉血: 9.5umol/L；总胆汁酸(TBA)-静脉血: 6.5umol/L；C-反应蛋白(CRP)-静脉血: 5.08mg/L；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.7pg；总蛋白(TP)-静脉血: 72.34g/L；总钙(Ca)-静脉血: 2.35mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.6mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.2mmolL；载脂蛋白AI(apoAI)-静脉血: 1.36g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 36.9U/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.9；红细胞计数(RBC#)-静脉血: 4.4610E12/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.13mmol/L；葡萄糖(Glu)-静脉血: 5.21mmol/L；肌酐(Crea)-静脉血: 88umol/L；白蛋白(ALB)-静脉血: 43.5g/L；胱抑素(Cys-C)-静脉血: 1.05mg/L；阴离子间隙(AG)-静脉血: 14.8；丙氨酸氨基转移酶(ALT)-静脉血: 55.6U/L；血小板分布宽度(PDW)-静脉血: 11.9%\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D39] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者一般情况可，未诉特殊不适。按[计划性表述已隐藏]同期放化疗，放疗技术采用调强放疗9野，处方剂量：PTVp 7029cGy/33F， PTVn_L 6600cGy/33F,PTVn_R 6000cGy/33F,PTV1 6000cGy/33F,PTV2 5400cGy/33F。目前放疗计划已完善，予以今日复位验证后执行放疗。\n- [全程D40] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者精神食欲可，放疗2次，无特殊不适，查体无特殊。今日按[计划性表述已隐藏]第一程DDP同期化疗（顺铂 80mg/m2），若无特殊不适，今日化疗结束后予以出院。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，给予重组人粒细胞刺激因子皮下注射\nB. 继续放疗，给予重组人血小板生成素皮下注射\nC. 继续按计划执行调强放疗，定期复查血常规及肝肾功能\nD. 暂停放疗，给予静脉保肝降酶治疗并密切监测\nE. 继续放疗，立即启动第二周期顺铂同期化疗\nF. 继续放疗，将第二周期顺铂同期化疗剂量下调20%\nG. 继续放疗，将第二周期同期化疗药物更换为卡铂\nH. 暂停放疗，完善鼻咽及颈部MRI评估近期疗效\nI. 继续放疗，给予大剂量静脉水化及利尿促排治疗\nJ. 继续放疗，联合尼妥珠单抗靶向治疗以增强疗效\nK. 继续放疗，给予促红细胞生成素皮下注射纠正贫血\nL. 终止放疗，转为全身静脉化疗并评估后续方案\n\n请仅输出一个选项字母（A-L）。","gold_letter":"C","gold_action":"继续按计划执行调强放疗，定期复查血常规及肝肾功能","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"暂停放疗，给予重组人粒细胞刺激因子皮下注射"},{"letter":"B","text":"继续放疗，给予重组人血小板生成素皮下注射"},{"letter":"C","text":"继续按计划执行调强放疗，定期复查血常规及肝肾功能"},{"letter":"D","text":"暂停放疗，给予静脉保肝降酶治疗并密切监测"},{"letter":"E","text":"继续放疗，立即启动第二周期顺铂同期化疗"},{"letter":"F","text":"继续放疗，将第二周期顺铂同期化疗剂量下调20%"},{"letter":"G","text":"继续放疗，将第二周期同期化疗药物更换为卡铂"},{"letter":"H","text":"暂停放疗，完善鼻咽及颈部MRI评估近期疗效"},{"letter":"I","text":"继续放疗，给予大剂量静脉水化及利尿促排治疗"},{"letter":"J","text":"继续放疗，联合尼妥珠单抗靶向治疗以增强疗效"},{"letter":"K","text":"继续放疗，给予促红细胞生成素皮下注射纠正贫血"},{"letter":"L","text":"终止放疗，转为全身静脉化疗并评估后续方案"}]}
+{"sample_id":"sample-23bcdf34802b996618f9500b","patient_id":"patient-e45c55cc63c050892e6b2467","turn_id":"turn01","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D2] 入院记录: 主诉: 发现右颈部肿物5月余；现病史: 患者于入院前5月前（某次就诊时间10月）高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；阳性症状体征: 体重下降,疼痛,高热,右颈部肿物,颈部酸痛；既往史: 既往有“肾病综合征”病史，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。；家族史: 否认肿瘤家族史。；体格检查: T：36℃，P：68次/分，R：20次/分，BP：91/58mmHg,Ht：144cm，Wt：31kg，BSA：1.135m2，KPS：KPS 90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，暂缓全身影像学分期检查。\nB. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，PET-CT全身显像。\nC. 右颈部肿物切除活检，鼻咽及颈部MRI平扫+增强，全身骨显像，腹部彩超。\nD. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫，全身骨显像，腹部彩超，心电图。\nE. 鼻咽镜检查及活检，头颅MRI平扫+增强，颈部彩超，全身骨显像，腹部彩超。\nF. 鼻咽刷片细胞学检查，鼻咽及颈部MRI平扫+增强，全身骨显像，腹部彩超。\nG. 鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，全身骨显像，腹部彩超，心电图。\nH. 右颈部肿物细针穿刺活检，鼻咽及颈部MRI平扫+增强，全身骨显像，腹部彩超。\nI. 鼻咽镜检查及活检，鼻咽MRI平扫+增强，全身骨显像，腹部彩超，心电图。\nJ. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，骨髓穿刺活检，腹部彩超。\nK. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部及腹部MRI平扫+增强。\nL. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身骨显像、腹部彩超及心电图等基线检查。\n\n请仅输出一个选项字母（A-L）。","gold_letter":"L","gold_action":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身骨显像、腹部彩超及心电图等基线检查。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，暂缓全身影像学分期检查。"},{"letter":"B","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，PET-CT全身显像。"},{"letter":"C","text":"右颈部肿物切除活检，鼻咽及颈部MRI平扫+增强，全身骨显像，腹部彩超。"},{"letter":"D","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫，全身骨显像，腹部彩超，心电图。"},{"letter":"E","text":"鼻咽镜检查及活检，头颅MRI平扫+增强，颈部彩超，全身骨显像，腹部彩超。"},{"letter":"F","text":"鼻咽刷片细胞学检查，鼻咽及颈部MRI平扫+增强，全身骨显像，腹部彩超。"},{"letter":"G","text":"鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，全身骨显像，腹部彩超，心电图。"},{"letter":"H","text":"右颈部肿物细针穿刺活检，鼻咽及颈部MRI平扫+增强，全身骨显像，腹部彩超。"},{"letter":"I","text":"鼻咽镜检查及活检，鼻咽MRI平扫+增强，全身骨显像，腹部彩超，心电图。"},{"letter":"J","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，骨髓穿刺活检，腹部彩超。"},{"letter":"K","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部及腹部MRI平扫+增强。"},{"letter":"L","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身骨显像、腹部彩超及心电图等基线检查。"}]}
+{"sample_id":"sample-6cb68b4fe11abd5f5e27ea88","patient_id":"patient-e45c55cc63c050892e6b2467","turn_id":"turn02","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D1] 门急诊记录: 主诉: 右颈部肿物6月余；现病史: 患者某次就诊时间10月份高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；既往史: 肾病综合征。否认高血压、糖尿病、冠心病、肾病等慢性病史，否认乙肝、结核等传染病史，否认重大外伤史，否认献血输血及使用血制品史，否认食物药物过敏史。；个人史: 原籍出生长大，否认疫区疫水接触史，否认化学毒性及放射性物质接触史。；家族史: 否认家族类似病史及肿瘤病史。；体格检查: KPS90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。\n- [全程D2] 入院记录: 主诉: 发现右颈部肿物5月余；现病史: 患者于入院前5月前（某次就诊时间10月）高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；阳性症状体征: 体重下降,疼痛,高热,右颈部肿物,颈部酸痛；既往史: 既往有“肾病综合征”病史，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。；家族史: 否认肿瘤家族史。；体格检查: T：36℃，P：68次/分，R：20次/分，BP：91/58mmHg,Ht：144cm，Wt：31kg，BSA：1.135m2，KPS：KPS 90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D3] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见: 心电图大致正常；检查结论: 窦性心律不齐 心电图大致正常\n- [全程D3] 检验组合: 乳酸脱氢酶(LDH)-静脉血: 198.2U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 10.4U/L；总胆红素(TBIL)-静脉血: 4.2umol/L；葡萄糖(Glu)-静脉血: 4.55mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.495COI；α-L-岩藻糖苷酶(AFU)-静脉血: 35U/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；铁蛋白(Ferr)-静脉血: 91.44ng/ml；磷(P)-静脉血: 1.76mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阴性(-)（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.21ug/ml；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阳性(129.78U/mL)（参考: 阴性）；淋巴细胞百分比(Lymph%)-静脉血: 0.426；碱性磷酸酶(ALP)-静脉血: 130.2U/L；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；纤维蛋白原(Fbg)-静脉血: 2.78g/L；钾离子(K+)-静脉血: 3.5mmol/L；免疫球蛋白游离λ轻链(F-Lambda)-静脉血: 阴性(-)（参考: 阴性(-)）；平均血小板体积(MPV)-静脉血: 8.8fL；尿酸(UA)-静脉血: 200umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.24mmolL；天门冬氨酸氨基转移酶(AST)-静脉血: 18.5U/L；尿素氮(BUN)-静脉血: 3.59mmol/L；总胆固醇(TC)-静脉血: 3.29mmol/L；直接胆红素(DBIL)-静脉血: 1.6umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 11.9U/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.98；中性粒细胞百分比(Neut%)-静脉血: 0.516；肌酐(Crea)-静脉血: 35.7umol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞体积(MCV)-静脉血: 82.1fL；单核细胞百分比(Mono%)-静脉血: 0.042；骨钙素N端中分子片段(N-MID)-静脉血: 45.63ng/ml；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.05；甘油三酯(TG)-静脉血: 1.12mmol/L；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；氯离子(Cl-)-静脉血: 104.1mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.1mmol/L；活化部分凝血活酶时间(APTT)-静脉血: 29.7sec.；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 1.71COI；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.1；平均红细胞血红蛋白含量(MCH)-静脉血: 26.7pg\n- [全程D4] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约24cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行鼻咽镜检查及活检，并完善胸片或胸部CT检查。\nB. 行右颈部肿大淋巴结切除活检，并完善胸片或胸部CT检查。\nC. 行鼻咽镜检查及活检，并完善头颅增强MRI检查。\nD. 行右颈部肿大淋巴结细针穿刺活检，并完善全身骨扫描。\nE. 行全身PET-CT检查，暂缓鼻咽及颈部活检。\nF. 行鼻咽镜检查及活检，暂不安排其他部位影像学检查。\nG. 完善胸部及全腹部增强CT检查，待结果回报后再行活检。\nH. 行鼻咽镜检查及活检，并复查颈部彩超评估淋巴结。\nI. 安排鼻咽及颈部根治性放疗，同步完善胸片或胸部CT检查。\nJ. 行鼻咽镜检查及活检，并完善全身骨扫描检查。\nK. 给予抗炎治疗2周后复查鼻咽MRI，再决定是否行鼻咽活检。\nL. 行鼻咽镜检查及活检，并完善血浆EBV-DNA检测，暂缓胸部影像学检查。\n\n请仅输出一个选项字母（A-L）。","gold_letter":"A","gold_action":"行鼻咽镜检查及活检，并完善胸片或胸部CT检查。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"行鼻咽镜检查及活检，并完善胸片或胸部CT检查。"},{"letter":"B","text":"行右颈部肿大淋巴结切除活检，并完善胸片或胸部CT检查。"},{"letter":"C","text":"行鼻咽镜检查及活检，并完善头颅增强MRI检查。"},{"letter":"D","text":"行右颈部肿大淋巴结细针穿刺活检，并完善全身骨扫描。"},{"letter":"E","text":"行全身PET-CT检查，暂缓鼻咽及颈部活检。"},{"letter":"F","text":"行鼻咽镜检查及活检，暂不安排其他部位影像学检查。"},{"letter":"G","text":"完善胸部及全腹部增强CT检查，待结果回报后再行活检。"},{"letter":"H","text":"行鼻咽镜检查及活检，并复查颈部彩超评估淋巴结。"},{"letter":"I","text":"安排鼻咽及颈部根治性放疗，同步完善胸片或胸部CT检查。"},{"letter":"J","text":"行鼻咽镜检查及活检，并完善全身骨扫描检查。"},{"letter":"K","text":"给予抗炎治疗2周后复查鼻咽MRI，再决定是否行鼻咽活检。"},{"letter":"L","text":"行鼻咽镜检查及活检，并完善血浆EBV-DNA检测，暂缓胸部影像学检查。"}]}
+{"sample_id":"sample-51ced222567a8eb77bc8161d","patient_id":"patient-e45c55cc63c050892e6b2467","turn_id":"turn04","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 入院记录: 主诉: 发现右颈部肿物5月余；现病史: 患者于入院前5月前（某次就诊时间10月）高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。行右颈部肿物活检病理回报：提示鼻咽部鳞癌转移。鼻咽部MR示：鼻咽顶后壁及两侧壁粘膜增厚，右侧翼内肌、咽鼓管、头长肌受侵，右侧斜坡，颞骨岩部，寰椎前弓骨质破坏。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；阳性症状体征: 体重下降,疼痛,高热,右颈部肿物,颈部酸痛；既往史: 既往有“肾病综合征”病史，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。；家族史: 否认肿瘤家族史。；体格检查: T：36℃，P：68次/分，R：20次/分，BP：91/58mmHg,Ht：144cm，Wt：31kg，BSA：1.135m2，KPS：KPS 90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。右颈扪及肿物，约4*3cm,无压痛，质硬，活动差，边界尚清，未扪及明显融合，活检伤口愈合良好。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D3] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见: 心电图大致正常；检查结论: 窦性心律不齐 心电图大致正常\n- [全程D3] 检验组合: 乳酸脱氢酶(LDH)-静脉血: 198.2U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 10.4U/L；总胆红素(TBIL)-静脉血: 4.2umol/L；葡萄糖(Glu)-静脉血: 4.55mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.495COI；α-L-岩藻糖苷酶(AFU)-静脉血: 35U/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；铁蛋白(Ferr)-静脉血: 91.44ng/ml；磷(P)-静脉血: 1.76mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阴性(-)（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.21ug/ml；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阳性(129.78U/mL)（参考: 阴性）；淋巴细胞百分比(Lymph%)-静脉血: 0.426；碱性磷酸酶(ALP)-静脉血: 130.2U/L；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；纤维蛋白原(Fbg)-静脉血: 2.78g/L；钾离子(K+)-静脉血: 3.5mmol/L；免疫球蛋白游离λ轻链(F-Lambda)-静脉血: 阴性(-)（参考: 阴性(-)）；平均血小板体积(MPV)-静脉血: 8.8fL；尿酸(UA)-静脉血: 200umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.24mmolL；天门冬氨酸氨基转移酶(AST)-静脉血: 18.5U/L；尿素氮(BUN)-静脉血: 3.59mmol/L；总胆固醇(TC)-静脉血: 3.29mmol/L；直接胆红素(DBIL)-静脉血: 1.6umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 11.9U/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.98；中性粒细胞百分比(Neut%)-静脉血: 0.516；肌酐(Crea)-静脉血: 35.7umol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞体积(MCV)-静脉血: 82.1fL；单核细胞百分比(Mono%)-静脉血: 0.042；骨钙素N端中分子片段(N-MID)-静脉血: 45.63ng/ml；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.05；甘油三酯(TG)-静脉血: 1.12mmol/L；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；氯离子(Cl-)-静脉血: 104.1mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.1mmol/L；活化部分凝血活酶时间(APTT)-静脉血: 29.7sec.；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 1.71COI；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.1；平均红细胞血红蛋白含量(MCH)-静脉血: 26.7pg\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 予以根治性单纯放疗\nB. 予以诱导化疗序贯同期放化疗\nC. 予以诱导化疗序贯单纯放疗\nD. 予以同期放化疗序贯辅助化疗\nE. 予以靶向治疗联合同期放化疗\nF. 予以免疫治疗联合同期放化疗\nG. 予以诱导化疗序贯靶向治疗联合放疗\nH. 行颈部淋巴结清扫术序贯根治性放疗\nI. 行鼻咽原发灶切除联合颈部淋巴结清扫术\nJ. 予以姑息性化疗联合局部姑息性放疗\nK. 予以诱导化疗序贯根治性手术切除\n\n请仅输出一个选项字母（A-K）。","gold_letter":"B","gold_action":"予以诱导化疗序贯同期放化疗","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"予以根治性单纯放疗"},{"letter":"B","text":"予以诱导化疗序贯同期放化疗"},{"letter":"C","text":"予以诱导化疗序贯单纯放疗"},{"letter":"D","text":"予以同期放化疗序贯辅助化疗"},{"letter":"E","text":"予以靶向治疗联合同期放化疗"},{"letter":"F","text":"予以免疫治疗联合同期放化疗"},{"letter":"G","text":"予以诱导化疗序贯靶向治疗联合放疗"},{"letter":"H","text":"行颈部淋巴结清扫术序贯根治性放疗"},{"letter":"I","text":"行鼻咽原发灶切除联合颈部淋巴结清扫术"},{"letter":"J","text":"予以姑息性化疗联合局部姑息性放疗"},{"letter":"K","text":"予以诱导化疗序贯根治性手术切除"}]}
+{"sample_id":"sample-31164fa636b978a86d54f0c9","patient_id":"patient-e45c55cc63c050892e6b2467","turn_id":"turn05","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 入院记录: 主诉: 发现右颈部肿物5月余；现病史: 患者于入院前5月前（某次就诊时间10月）高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。行右颈部肿物活检病理回报：提示鼻咽部鳞癌转移。鼻咽部MR示：鼻咽顶后壁及两侧壁粘膜增厚，右侧翼内肌、咽鼓管、头长肌受侵，右侧斜坡，颞骨岩部，寰椎前弓骨质破坏。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；阳性症状体征: 体重下降,疼痛,高热,右颈部肿物,颈部酸痛；既往史: 既往有“肾病综合征”病史，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。；家族史: 否认肿瘤家族史。；体格检查: T：36℃，P：68次/分，R：20次/分，BP：91/58mmHg,Ht：144cm，Wt：31kg，BSA：1.135m2，KPS：KPS 90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。右颈扪及肿物，约4*3cm,无压痛，质硬，活动差，边界尚清，未扪及明显融合，活检伤口愈合良好。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D3] 检验组合: 乳酸脱氢酶(LDH)-静脉血: 198.2U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 10.4U/L；总胆红素(TBIL)-静脉血: 4.2umol/L；葡萄糖(Glu)-静脉血: 4.55mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.495COI；α-L-岩藻糖苷酶(AFU)-静脉血: 35U/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；铁蛋白(Ferr)-静脉血: 91.44ng/ml；磷(P)-静脉血: 1.76mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阴性(-)（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.21ug/ml；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阳性(129.78U/mL)（参考: 阴性）；淋巴细胞百分比(Lymph%)-静脉血: 0.426；碱性磷酸酶(ALP)-静脉血: 130.2U/L；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；纤维蛋白原(Fbg)-静脉血: 2.78g/L；钾离子(K+)-静脉血: 3.5mmol/L；免疫球蛋白游离λ轻链(F-Lambda)-静脉血: 阴性(-)（参考: 阴性(-)）；平均血小板体积(MPV)-静脉血: 8.8fL；尿酸(UA)-静脉血: 200umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.24mmolL；天门冬氨酸氨基转移酶(AST)-静脉血: 18.5U/L；尿素氮(BUN)-静脉血: 3.59mmol/L；总胆固醇(TC)-静脉血: 3.29mmol/L；直接胆红素(DBIL)-静脉血: 1.6umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 11.9U/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.98；中性粒细胞百分比(Neut%)-静脉血: 0.516；肌酐(Crea)-静脉血: 35.7umol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞体积(MCV)-静脉血: 82.1fL；单核细胞百分比(Mono%)-静脉血: 0.042；骨钙素N端中分子片段(N-MID)-静脉血: 45.63ng/ml；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.05；甘油三酯(TG)-静脉血: 1.12mmol/L；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；氯离子(Cl-)-静脉血: 104.1mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.1mmol/L；活化部分凝血活酶时间(APTT)-静脉血: 29.7sec.；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 1.71COI；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.1；平均红细胞血红蛋白含量(MCH)-静脉血: 26.7pg\n- [全程D4] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约24cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D21] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显占位病变，肺门纵隔未见明显增宽，心影无增大，双侧肋膈角锐利。；检查结论: 心肺未见病变。\n- [全程D21] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 23mmol/L；总胆红素(TBIL)-静脉血: 7.6umol/L；C-反应蛋白(CRP)-静脉血: 4.9mg/L；总胆固醇(TC)-静脉血: 4.18mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.5mmolL；总胆汁酸(TBA)-静脉血: 2.5umol/L；血型抗体筛查-静脉血: 阴性；ABO血型-静脉血: B；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；大血小板百分比(P-LCR%)-静脉血: 24.7%；血小板比容-静脉血: 32%；血小板分布宽度(PDW)-静脉血: 11.1%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；总蛋白(TP)-静脉血: 74.14g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.011；平均红细胞血红蛋白含量(MCH)-静脉血: 28.1pg；白蛋白(ALB)-静脉血: 38.9g/L；甘油三酯(TG)-静脉血: 0.81mmol/L；磷(P)-静脉血: 1.55mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.1；直接胆红素(DBIL)-静脉血: 2.5umol/L；平均红细胞体积(MCV)-静脉血: 84.5fL；平均血小板体积(MPV)-静脉血: 10.1fL；钠离子(Na+)-静脉血: 136.6mmol/L；氯离子(Cl-)-静脉血: 101.1mmol/L；镁离子(Mg2+)-静脉血: 0.72mmol/L；肌酐(Crea)-静脉血: 33.8umol/L；Rh血型-静脉血: 阳性；载脂蛋白AI(apoAI)-静脉血: 1.34g/L；尿素氮(BUN)-静脉血: 5.75mmol/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；淋巴细胞计数(Lymph#)-静脉血: 2.810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.591；白细胞计数(WBC#)-静脉血: 8.5610E9/L；钾离子(K+)-静脉血: 4.3mmol/L；总钙(Ca)-静脉血: 2.26mmol/L；尿酸(UA)-静脉血: 204.9umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24.5U/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.8；乳酸脱氢酶(LDH)-静脉血: 196U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 38U/L；血小板计数(PLT#)-静脉血: 32310E9/L；单核细胞百分比(Mono%)-静脉血: 0.062\n\n【既往治疗与反应】\n- [全程D3] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日随接诊医生信息已隐藏，患者颈背部酸痛较前有好转，无发热畏寒，无恶心呕吐，无胸闷心悸，胃纳睡眠尚可，二便未见明显异常，体查：KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。右颈扪及肿物，约4*3cm,无压痛，质硬，活动差，边界尚清，未扪及明显融合，活检伤口愈合良好。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。右颈部肿物活检病理回报：提示鼻咽部鳞癌转移。鼻咽部MR示：鼻咽顶后壁及两侧壁粘膜增厚，右侧翼内肌、咽鼓管、头长肌受侵，右侧斜坡，颞骨岩部，寰椎前弓骨质破坏。目前患者诊断：鼻咽癌，患者病理活检部位为右颈部肿物，提示转移性鳞癌，建议其行鼻咽部肿物病理活检，患者家属不同意，有放疗适应症，无相对放疗禁忌症，告知患者放疗风险及副反应，患者家属表示理解病情，现治疗后患者要求出院，予以办理，嘱注意休息合理饮食，定期复诊，不适随诊。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D19] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。凝血、乙肝两对半、肝炎四项、HIV/梅毒等检验结果无明显异常。上级医师查房后，患者因年龄较小，完成活检等操作不配合，家属要求全麻下行活检明确病理，完善相关检查后择期手术，遵嘱执行。\n- [全程D20] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。上级医师查房后示，完善术前相关检验检查，做好术前准备，遵嘱执行。\n- [全程D21] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。血常规、生化常规回报无明显异常。输血三项回报：B型、RH阳性、抗体筛选阴性。上级医师查房后示，结合患者各项检查，未见明显手术禁忌，拟明日在气管内吸入全麻下经鼻内镜行鼻咽肿物活检+颈部肿物活检术，做好术前准备，遵嘱执行。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善局麻下鼻咽及颈部肿物活检术前准备，予以口服地西泮镇静及配血备用。\nB. 完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注头孢类抗生素预防感染。\nC. 完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注氨甲环酸预防术中出血。\nD. 完善全麻下鼻咽及颈部肿物活检术前准备，予以配血备用及口服地西泮镇静。\nE. 完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注人血白蛋白及复方氨基酸。\nF. 完善全麻下鼻咽及颈部肿物活检术前准备，予以皮下注射低分子肝素及下肢气压治疗。\nG. 完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉滴注地塞米松及雾化吸入。\nH. 完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉补充氯化钾及晶体液扩容。\nI. 暂缓活检手术，予以静脉输注广谱抗生素及补液支持治疗。\nJ. 暂缓活检手术，予以口服非甾体类抗炎药及局部热敷理疗。\nK. 完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注单采血小板及冷沉淀。\nL. 完善全麻下鼻咽及颈部肿物活检术前准备，予以口服氯雷他定及局部涂抹糖皮质激素。\n\n请仅输出一个选项字母（A-L）。","gold_letter":"D","gold_action":"完善全麻下鼻咽及颈部肿物活检术前准备，予以配血备用及口服地西泮镇静。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"完善局麻下鼻咽及颈部肿物活检术前准备，予以口服地西泮镇静及配血备用。"},{"letter":"B","text":"完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注头孢类抗生素预防感染。"},{"letter":"C","text":"完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注氨甲环酸预防术中出血。"},{"letter":"D","text":"完善全麻下鼻咽及颈部肿物活检术前准备，予以配血备用及口服地西泮镇静。"},{"letter":"E","text":"完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注人血白蛋白及复方氨基酸。"},{"letter":"F","text":"完善全麻下鼻咽及颈部肿物活检术前准备，予以皮下注射低分子肝素及下肢气压治疗。"},{"letter":"G","text":"完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉滴注地塞米松及雾化吸入。"},{"letter":"H","text":"完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉补充氯化钾及晶体液扩容。"},{"letter":"I","text":"暂缓活检手术，予以静脉输注广谱抗生素及补液支持治疗。"},{"letter":"J","text":"暂缓活检手术，予以口服非甾体类抗炎药及局部热敷理疗。"},{"letter":"K","text":"完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注单采血小板及冷沉淀。"},{"letter":"L","text":"完善全麻下鼻咽及颈部肿物活检术前准备，予以口服氯雷他定及局部涂抹糖皮质激素。"}]}
+{"sample_id":"sample-6d0ec36f585feac9ee8c0aa5","patient_id":"patient-a48d1d72efa6c4217cf5b79c","turn_id":"turn01","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现颈部肿物伴涕血、鼻塞2月；患者未予相关诊治，转至我院就诊。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,涕血,颈部肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。偶伴吸烟、饮酒15年，3两/天，。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：90次/分，R：20次/分，BP：120/70mmHg,Ht：172cm，Wt：73kg，BSA：1.85m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.0cm；鼻咽双侧顶后壁结节状肿物；双侧颈部IIa区可扪及1个淋巴结，最大径2×2cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸腹部CT平扫\nB. 颈部淋巴结切除活检，鼻咽及颈部MRI平扫+增强，全身PET/CT检查\nC. 鼻咽镜检查及活检，鼻咽部MRI平扫+增强，胸部X线，腹部B超\nD. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，暂不进行全身分期检查\nE. 颈部淋巴结细针穿刺活检，鼻咽及颈部CT平扫+增强，全身骨扫描\nF. 鼻咽镜检查及活检，鼻咽部MRI平扫+增强，全身PET/CT检查\nG. 鼻咽及颈部MRI平扫+增强，全身PET/CT检查，直接安排根治性放疗\nH. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT检查\nI. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫，胸腹部CT平扫+增强，全身骨扫描\nJ. 鼻咽脱落细胞学涂片，鼻咽及颈部MRI平扫+增强，全身PET/CT检查\nK. 鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，全身PET/CT检查\nL. 鼻咽及颈部MRI平扫+增强，EBV-DNA检测，胸腹部CT平扫+增强\n\n请仅输出一个选项字母（A-L）。","gold_letter":"H","gold_action":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT检查","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸腹部CT平扫"},{"letter":"B","text":"颈部淋巴结切除活检，鼻咽及颈部MRI平扫+增强，全身PET/CT检查"},{"letter":"C","text":"鼻咽镜检查及活检，鼻咽部MRI平扫+增强，胸部X线，腹部B超"},{"letter":"D","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，暂不进行全身分期检查"},{"letter":"E","text":"颈部淋巴结细针穿刺活检，鼻咽及颈部CT平扫+增强，全身骨扫描"},{"letter":"F","text":"鼻咽镜检查及活检，鼻咽部MRI平扫+增强，全身PET/CT检查"},{"letter":"G","text":"鼻咽及颈部MRI平扫+增强，全身PET/CT检查，直接安排根治性放疗"},{"letter":"H","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT检查"},{"letter":"I","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫，胸腹部CT平扫+增强，全身骨扫描"},{"letter":"J","text":"鼻咽脱落细胞学涂片，鼻咽及颈部MRI平扫+增强，全身PET/CT检查"},{"letter":"K","text":"鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，全身PET/CT检查"},{"letter":"L","text":"鼻咽及颈部MRI平扫+增强，EBV-DNA检测，胸腹部CT平扫+增强"}]}
+{"sample_id":"sample-11ca3bd9dd2a5877fa6a6b49","patient_id":"patient-a48d1d72efa6c4217cf5b79c","turn_id":"turn02","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现颈部肿物伴涕血、鼻塞2月；患者未予相关诊治，转至我院就诊。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,涕血,颈部肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。偶伴吸烟、饮酒15年，3两/天，。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：90次/分，R：20次/分，BP：120/70mmHg,Ht：172cm，Wt：73kg，BSA：1.85m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.0cm；鼻咽双侧顶后壁结节状肿物；双侧颈部IIa区可扪及1个淋巴结，最大径2×2cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 甘油三酯(TG)-静脉血: 1.1mmol/L；透明质酸(HA)-静脉血: 34.26ng/ml；中性粒细胞计数(Neut#)-静脉血: 3.710E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；层粘连蛋白(LN)-静脉血: 11.97ng/ml；凝血酶原时间活动度(PTA)-静脉血: 125.5%；总胆固醇(TC)-静脉血: 4.12mmol/L；凝血酶原时间(PT)-静脉血: 10.8sec.；碱性磷酸酶(ALP)-静脉血: 83.4U/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；ABO血型-静脉血: O；镁离子(Mg2+)-静脉血: 0.88mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.005；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 65.2umol/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；尿素氮(BUN)-静脉血: 5.1mmol/L；总蛋白(TP)-静脉血: 75.4g/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 22.8U/L；钾离子(K+)-静脉血: 3.71mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 17.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 18.1U/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；乳酸脱氢酶(LDH)-静脉血: 142.3U/L；III型前胶原氨基端肽(PIIINP)-静脉血: 17.25ng/ml；尿酸(UA)-静脉血: 293.9umol/L；血小板计数(PLT#)-静脉血: 18910E9/L；Rh血型-静脉血: 阳性；总胆汁酸(TBA)-静脉血: 2.8umol/L；IV型胶原(C-IV)-静脉血: 21.48ng/ml；天门冬氨酸氨基转移酶(AST)-静脉血: 15.4U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；氯离子(Cl-)-静脉血: 103.6mmol/L；磷(P)-静脉血: 0.78mmol/L；凝血酶时间(TT)-静脉血: 16.2sec.；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；血小板比容-静脉血: 23%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.42；载脂蛋白AI(apoAI)-静脉血: 1.38g/L；中性粒细胞百分比(Neut%)-静脉血: 0.674；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；白蛋白(ALB)-静脉血: 44.3g/L\n- [全程D2] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D8] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、右侧壁见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。肿物占据双侧咽隐窝，向后外推移右侧咽旁脂肪间隙，前方浸润右侧筛窦及上鼻道，左侧咽旁脂肪间隙及左侧颈动脉鞘区未见异常。 右侧腭帆提肌、腭帆张肌受侵；左侧腭帆提肌、腭帆张肌、头长肌未见受累征象。 右侧翼腭窝及右侧上颌后脂肪间隙稍变窄；左侧翼腭窝、左上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽未见明显异常。 斜坡、蝶骨基底部、右侧翼突基底部及右侧蝶骨大翼信号降低，增强后强化。 双侧海绵窦未见明显异常。 双侧上颌窦、筛窦、右侧蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，无强化，骨壁完整。双眼大小、形态、位置均属正常、信号均匀。蝶鞍形态正常，其内未见占位性病变。 右侧咽后间隙见淋巴结，较大者约11mm×10mm；左侧咽后间隙未见肿大淋巴结。双颈Ⅱ区、右颈Ⅲ区见多个淋巴结，部分融合，边界清，不均匀明显强化，较大者约大小约24mm×13mm。 所见甲状腺双叶形态正常、喉咽腔、双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 符合鼻咽癌。 颅底骨质破坏。 左侧咽后、双颈Ⅱ区及右颈Ⅲ区肿大淋巴结，考虑转移。 副鼻窦炎、乳突炎。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 影像评估为 cT4N2，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nB. 影像评估为 cT3N1，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nC. 影像评估为 cT3N2，需完善鼻咽镜及活检明确病理，无需常规进行胸腹部及骨骼的远处转移筛查\nD. 影像评估为 cT4N3，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nE. 影像评估为 cT2N2，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nF. 影像评估为 cT3N2，需完善颈部淋巴结穿刺活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nG. 影像评估为 cT3N2，已具备影像学确诊条件，直接安排诱导化疗及后续根治性放疗\nH. 影像评估为 cT4N2，需完善颈部淋巴结穿刺活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nI. 影像评估为 cT3N2，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nJ. 影像评估为 cT3N3，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nK. 影像评估为 cT2N1，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nL. 影像评估为 cT3N2，需完善鼻咽镜及活检明确病理，并完善头颅MRI及脑脊液检查以排除中枢神经系统转移\n\n请仅输出一个选项字母（A-L）。","gold_letter":"I","gold_action":"影像评估为 cT3N2，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"影像评估为 cT4N2，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期"},{"letter":"B","text":"影像评估为 cT3N1，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期"},{"letter":"C","text":"影像评估为 cT3N2，需完善鼻咽镜及活检明确病理，无需常规进行胸腹部及骨骼的远处转移筛查"},{"letter":"D","text":"影像评估为 cT4N3，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期"},{"letter":"E","text":"影像评估为 cT2N2，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期"},{"letter":"F","text":"影像评估为 cT3N2，需完善颈部淋巴结穿刺活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期"},{"letter":"G","text":"影像评估为 cT3N2，已具备影像学确诊条件，直接安排诱导化疗及后续根治性放疗"},{"letter":"H","text":"影像评估为 cT4N2，需完善颈部淋巴结穿刺活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期"},{"letter":"I","text":"影像评估为 cT3N2，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期"},{"letter":"J","text":"影像评估为 cT3N3，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期"},{"letter":"K","text":"影像评估为 cT2N1，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期"},{"letter":"L","text":"影像评估为 cT3N2，需完善鼻咽镜及活检明确病理，并完善头颅MRI及脑脊液检查以排除中枢神经系统转移"}]}
+{"sample_id":"sample-b061f796c98789c2958f0baf","patient_id":"patient-a48d1d72efa6c4217cf5b79c","turn_id":"turn04","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现颈部肿物伴涕血、鼻塞2月；现病史: 患者2月前无明显诱因出现颈部肿物，拇指大小，偶伴涕血、鼻塞，右侧明显，无面麻、复视等其他不适，未予重视，逐渐加重，患者遂于某次就诊时间行颈部彩超示：右侧颈部低回声，行鼻咽镜示：鼻咽肿物，建议活检。患者未予相关诊治，转至我院就诊。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,涕血,颈部肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。偶伴吸烟、饮酒15年，3两/天，。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：90次/分，R：20次/分，BP：120/70mmHg,Ht：172cm，Wt：73kg，BSA：1.85m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率90次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.0cm；鼻咽双侧顶后壁结节状肿物；双侧颈部IIa区可扪及1个淋巴结，最大径2×2cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1] 检验组合: 甘油三酯(TG)-静脉血: 1.1mmol/L；透明质酸(HA)-静脉血: 34.26ng/ml；中性粒细胞计数(Neut#)-静脉血: 3.710E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；层粘连蛋白(LN)-静脉血: 11.97ng/ml；凝血酶原时间活动度(PTA)-静脉血: 125.5%；总胆固醇(TC)-静脉血: 4.12mmol/L；凝血酶原时间(PT)-静脉血: 10.8sec.；碱性磷酸酶(ALP)-静脉血: 83.4U/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；ABO血型-静脉血: O；镁离子(Mg2+)-静脉血: 0.88mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.005；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 65.2umol/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；尿素氮(BUN)-静脉血: 5.1mmol/L；总蛋白(TP)-静脉血: 75.4g/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 22.8U/L；钾离子(K+)-静脉血: 3.71mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 17.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 18.1U/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；乳酸脱氢酶(LDH)-静脉血: 142.3U/L；III型前胶原氨基端肽(PIIINP)-静脉血: 17.25ng/ml；尿酸(UA)-静脉血: 293.9umol/L；血小板计数(PLT#)-静脉血: 18910E9/L；Rh血型-静脉血: 阳性；总胆汁酸(TBA)-静脉血: 2.8umol/L；IV型胶原(C-IV)-静脉血: 21.48ng/ml；天门冬氨酸氨基转移酶(AST)-静脉血: 15.4U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；氯离子(Cl-)-静脉血: 103.6mmol/L；磷(P)-静脉血: 0.78mmol/L；凝血酶时间(TT)-静脉血: 16.2sec.；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；血小板比容-静脉血: 23%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.42；载脂蛋白AI(apoAI)-静脉血: 1.38g/L；中性粒细胞百分比(Neut%)-静脉血: 0.674；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；白蛋白(ALB)-静脉血: 44.3g/L\n- [全程D2] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D8] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、右侧壁见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。肿物占据双侧咽隐窝，向后外推移右侧咽旁脂肪间隙，前方浸润右侧筛窦及上鼻道，左侧咽旁脂肪间隙及左侧颈动脉鞘区未见异常。 右侧腭帆提肌、腭帆张肌受侵；左侧腭帆提肌、腭帆张肌、头长肌未见受累征象。 右侧翼腭窝及右侧上颌后脂肪间隙稍变窄；左侧翼腭窝、左上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽未见明显异常。 斜坡、蝶骨基底部、右侧翼突基底部及右侧蝶骨大翼信号降低，增强后强化。 双侧海绵窦未见明显异常。 双侧上颌窦、筛窦、右侧蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，无强化，骨壁完整。双眼大小、形态、位置均属正常、信号均匀。蝶鞍形态正常，其内未见占位性病变。 右侧咽后间隙见淋巴结，较大者约11mm×10mm；左侧咽后间隙未见肿大淋巴结。双颈Ⅱ区、右颈Ⅲ区见多个淋巴结，部分融合，边界清，不均匀明显强化，较大者约大小约24mm×13mm。 所见甲状腺双叶形态正常、喉咽腔、双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 符合鼻咽癌。 颅底骨质破坏。 左侧咽后、双颈Ⅱ区及右颈Ⅲ区肿大淋巴结，考虑转移。 副鼻窦炎、乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 启动首周期同步放化疗（辅以水化、止吐预处理），不考虑诱导化疗\nB. 启动首周期诱导化疗，计划序贯根治性单纯放疗\nC. 启动首周期诱导化疗联合PD-1抑制剂，计划序贯根治性同步放化疗\nD. 启动首周期诱导化疗，计划序贯手术切除原发灶及颈部淋巴结\nE. 启动根治性单纯放疗，计划放疗结束后行多周期辅助化疗\nF. 启动根治性放疗联合EGFR靶向治疗，免除全身静脉化疗\nG. 优先行双侧颈部淋巴结清扫术，术后行根治性同步放化疗\nH. 优先行鼻咽原发灶内镜下切除术，术后行根治性同步放化疗\nI. 启动首周期姑息性化疗，计划化疗后行局部姑息性放疗\nJ. 启动首周期诱导化疗，若疗效达完全缓解（CR）则免除后续放疗\nK. 启动首周期诱导化疗（辅以水化、止吐预处理），计划序贯根治性同步放化疗\nL. 启动首周期同步放化疗，计划放疗结束后行多周期辅助化疗\n\n请仅输出一个选项字母（A-L）。","gold_letter":"K","gold_action":"启动首周期诱导化疗（辅以水化、止吐预处理），计划序贯根治性同步放化疗","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"启动首周期同步放化疗（辅以水化、止吐预处理），不考虑诱导化疗"},{"letter":"B","text":"启动首周期诱导化疗，计划序贯根治性单纯放疗"},{"letter":"C","text":"启动首周期诱导化疗联合PD-1抑制剂，计划序贯根治性同步放化疗"},{"letter":"D","text":"启动首周期诱导化疗，计划序贯手术切除原发灶及颈部淋巴结"},{"letter":"E","text":"启动根治性单纯放疗，计划放疗结束后行多周期辅助化疗"},{"letter":"F","text":"启动根治性放疗联合EGFR靶向治疗，免除全身静脉化疗"},{"letter":"G","text":"优先行双侧颈部淋巴结清扫术，术后行根治性同步放化疗"},{"letter":"H","text":"优先行鼻咽原发灶内镜下切除术，术后行根治性同步放化疗"},{"letter":"I","text":"启动首周期姑息性化疗，计划化疗后行局部姑息性放疗"},{"letter":"J","text":"启动首周期诱导化疗，若疗效达完全缓解（CR）则免除后续放疗"},{"letter":"K","text":"启动首周期诱导化疗（辅以水化、止吐预处理），计划序贯根治性同步放化疗"},{"letter":"L","text":"启动首周期同步放化疗，计划放疗结束后行多周期辅助化疗"}]}
+{"sample_id":"sample-c54efc446616b72b81ae7555","patient_id":"patient-a48d1d72efa6c4217cf5b79c","turn_id":"turn08","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现颈部肿物伴涕血、鼻塞2月；现病史: 患者2月前无明显诱因出现颈部肿物，拇指大小，偶伴涕血、鼻塞，右侧明显，无面麻、复视等其他不适，未予重视，逐渐加重，患者遂于某次就诊时间行颈部彩超示：右侧颈部低回声，行鼻咽镜示：鼻咽肿物，建议活检。患者未予相关诊治，转至我院就诊。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,涕血,颈部肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。偶伴吸烟、饮酒15年，3两/天，。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：90次/分，R：20次/分，BP：120/70mmHg,Ht：172cm，Wt：73kg，BSA：1.85m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率90次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.0cm；鼻咽双侧顶后壁结节状肿物；双侧颈部IIa区可扪及1个淋巴结，最大径2×2cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D29] 检验组合: 碱性磷酸酶(ALP)-静脉血: 72.7U/L；钠离子(Na+)-静脉血: 140.9mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0.3；大血小板百分比(P-LCR%)-静脉血: 28.3%；葡萄糖(Glu)-静脉血: 4.98mmol/L；载脂蛋白B(apoB)-静脉血: 0.9g/L；磷(P)-静脉血: 0.95mmol/L；球蛋白(GLO)-静脉血: 26.2g/L；氯离子(Cl-)-静脉血: 102.9mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.9U/L；镁离子(Mg2+)-静脉血: 0.81mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.67mmol/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；红细胞计数(RBC#)-静脉血: 4.2510E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.9；总蛋白(TP)-静脉血: 63.5g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 88.7fL；红细胞比容(Hct)-静脉血: 37.7%；总胆固醇(TC)-静脉血: 3.9mmol/L；乳酸脱氢酶(LDH)-静脉血: 144.8U/L；载脂蛋白AI(apoAI)-静脉血: 1.05g/L；丙氨酸氨基转移酶(ALT)-静脉血: 18.8U/L；甘油三酯(TG)-静脉血: 1mmol/L；尿酸(UA)-静脉血: 351.4umol/L；尿素氮(BUN)-静脉血: 6mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；单核细胞百分比(Mono%)-静脉血: 0.077；胱抑素(Cys-C)-静脉血: 0.99mg/L；血小板分布宽度(PDW)-静脉血: 11.5%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；有核红细胞计数(NRBC#)-静脉血: 0.0110E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 38；白细胞计数(WBC#)-静脉血: 3.6610E9/L；平均血小板体积(MPV)-静脉血: 10.5fL；血小板比容-静脉血: 20%；单核细胞计数(Mono#)-静脉血: 0.310E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；总胆汁酸(TBA)-静脉血: 1.4umol/L；阴离子间隙(AG)-静脉血: 13.1；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.82mmolL；γ-谷氨酰基转移酶(GGT)-静脉血: 31.1U/L；C-反应蛋白(CRP)-静脉血: 2.16mg/L；淋巴细胞百分比(Lymph%)-静脉血: 0.123；总胆红素(TBIL)-静脉血: 8.95umol/L\n- [全程D36] 检验组合: 酸碱度(pH)-尿液: 6.5；丙氨酸氨基转移酶(ALT)-静脉血: 18.7U/L；阴离子间隙(AG)-静脉血: 12.9；钾离子(K+)-静脉血: 3.75mmol/L；磷(P)-静脉血: 0.98mmol/L；球蛋白(GLO)-静脉血: 29.5g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；酮体(KET)-尿液: -（参考: 阴性）；总胆固醇(TC)-静脉血: 4.56mmol/L；尿素氮(BUN)-静脉血: 4.6mmol/L；红细胞计数(RBC#)-静脉血: 4.4810E12/L；比重(SG)-尿液: 1.008；γ-谷氨酰基转移酶(GGT)-静脉血: 28U/L；红细胞比容(Hct)-静脉血: 39.4%；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.755；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.4；总胆红素(TBIL)-静脉血: 9.28umol/L；葡萄糖(Glu)-静脉血: 5.08mmol/L；钠离子(Na+)-静脉血: 141.1mmol/L；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 25.4mmol/L；颜色-尿液: colorless；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.046；乳酸脱氢酶(LDH)-静脉血: 144U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22.6U/L；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.37；C-反应蛋白(CRP)-静脉血: 7.02mg/L；间接胆红素(IBIL)-静脉血: 6.27umolL；血红蛋白(Hb)-静脉血: 135g/L；单核细胞百分比(Mono%)-静脉血: 0.08；淋巴细胞百分比(Lymph%)-静脉血: 0.113；总钙(Ca)-静脉血: 2.18mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.68；平均血小板体积(MPV)-静脉血: 10fL；淋巴细胞计数(Lymph#)-静脉血: 0.410E9/L；胆红素(BIL)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 1/μL；浊度(TRUB)-尿液: clear；血小板比容-静脉血: 16%；载脂蛋白AI(apoAI)-静脉血: 1.24g/L\n- [全程D37] 检验组合: 亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 1/μL；酸碱度(pH)-尿液: 6.5；白细胞计数(WBC#)-尿液: 8/μL；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 1/μL；颜色-尿液: colorless；尿胆原(URO)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；胆红素(BIL)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.006；酮体(KET)-尿液: -（参考: 阴性）\n- [全程D38] 检验组合: 白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.006；尿胆原(URO)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；细菌计数(BACT#)-尿液: 2/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 1/μL；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；颜色-尿液: colorless；浊度(TRUB)-尿液: clear；隐血(OB)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 6.5\n- [全程D43] 检验组合: 尿素氮(BUN)-静脉血: 7.4mmol/L；直接胆红素(DBIL)-静脉血: 3.4umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.3mmol/L；白蛋白(ALB)-静脉血: 41.2g/L；磷(P)-静脉血: 1.12mmol/L；氯离子(Cl-)-静脉血: 97.6mmol/L；总蛋白(TP)-静脉血: 72.16g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 45.7U/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；血小板分布宽度(PDW)-静脉血: 11.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；碱性磷酸酶(ALP)-静脉血: 88.2U/L；C-反应蛋白(CRP)-静脉血: 1.75mg/L；红细胞计数(RBC#)-静脉血: 4.4910E12/L；白细胞计数(WBC#)-静脉血: 3.910E9/L；血小板比容-静脉血: 15%；淋巴细胞百分比(Lymph%)-静脉血: 0.062；总胆固醇(TC)-静脉血: 4.41mmol/L；球蛋白(GLO)-静脉血: 30.96g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.55；α-L-岩藻糖苷酶(AFU)-静脉血: 38.6U/L；钠离子(Na+)-静脉血: 138mmol/L；总胆红素(TBIL)-静脉血: 10.5umol/L；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；血小板计数(PLT#)-静脉血: 15010E9/L；平均血小板体积(MPV)-静脉血: 10.3fL；葡萄糖(Glu)-静脉血: 5.12mmol/L；载脂蛋白B(apoB)-静脉血: 0.95g/L；甘油三酯(TG)-静脉血: 1.59mmol/L；血红蛋白(Hb)-静脉血: 139g/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；胱抑素(Cys-C)-静脉血: 1.23mg/L；载脂蛋白AI(apoAI)-静脉血: 1.33g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.07mmolL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.33；乳酸脱氢酶(LDH)-静脉血: 158.1U/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 38.3；中性粒细胞计数(Neut#)-静脉血: 3.110E9/L；单核细胞百分比(Mono%)-静脉血: 0.118；大血小板百分比(P-LCR%)-静脉血: 27.3%；平均红细胞体积(MCV)-静脉血: 86.9fL；总钙(Ca)-静脉血: 2.22mmol/L；间接胆红素(IBIL)-静脉血: 7.1umolL\n- [全程D50] 检验组合: 乳酸脱氢酶(LDH)-静脉血: 164U/L；葡萄糖(Glu)-静脉血: 5.3mmol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；肌酐(Crea)-静脉血: 108.9umol/L；平均红细胞体积(MCV)-静脉血: 85.7fL；间接胆红素(IBIL)-静脉血: 7.8umolL；磷(P)-静脉血: 1.01mmol/L；球蛋白(GLO)-静脉血: 29.5g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；总胆固醇(TC)-静脉血: 4.57mmol/L；总蛋白(TP)-静脉血: 69g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15.2U/L；大血小板百分比(P-LCR%)-静脉血: 20.1%；钾离子(K+)-静脉血: 3.73mmol/L；碱性磷酸酶(ALP)-静脉血: 81.5U/L；阴离子间隙(AG)-静脉血: 16.9；胱抑素(Cys-C)-静脉血: 1.07mg/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；直接胆红素(DBIL)-静脉血: 3.9umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；血小板计数(PLT#)-静脉血: 18610E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 25.2U/L；细菌名称-咽拭子: 细菌涂片3；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.03；平均红细胞血红蛋白含量(MCH)-静脉血: 29.8pg；白细胞计数(WBC#)-静脉血: 3.6610E9/L；尿素氮(BUN)-静脉血: 4.8mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 24U/L；氯离子(Cl-)-静脉血: 97.1mmol/L；血小板分布宽度(PDW)-静脉血: 10.4%；淋巴细胞百分比(Lymph%)-静脉血: 0.085；血液二氧化碳含量ctCO2(B)-静脉血: 23.3mmol/L；钠离子(Na+)-静脉血: 137.3mmol/L；总胆红素(TBIL)-静脉血: 11.7umol/L；C-反应蛋白(CRP)-静脉血: 11.52mg/L；总胆汁酸(TBA)-静脉血: 1.4umol/L；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.4；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 41.9U/L；总钙(Ca)-静脉血: 2.19mmol/L；甘油三酯(TG)-静脉血: 1.2mmol/L；镁离子(Mg2+)-静脉血: 0.83mmol/L\n- [全程D55] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约12mm，肝S5可见一无回声灶，大小约11×9mm,椭圆形，边界清，内透声可，后方回声增强。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约19cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱不充盈。 前列腺大小形态正常，大小约38×30×37mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝囊肿。 胆囊、脾脏、胰腺、双肾、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D56] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理清晰，双肺野内未见明显实质性病变。双侧肺门未见增大，纵隔未见增宽，心影形态、大小未见异常。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见异常。\n- [全程D56] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌治疗后，对比某次就诊时间片： 鼻咽腔狭窄，鼻咽顶壁、顶后壁、右侧壁稍增厚，粘膜表面欠光滑，增强后较明显强化，较前明显缩小，双侧咽隐窝稍变浅，鼻中隔后缘见少许软组织，增强后较明显强化，右侧咽旁间隙稍变窄，左侧咽旁脂肪间隙及左侧颈动脉鞘区未见异常。 右侧腭帆提肌稍模糊；左侧腭帆提肌、腭帆张肌、头长肌未见受累征象。 左侧中下鼻甲明显肥厚。 双侧翼腭窝、双上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽未见明显异常。 斜坡、蝶骨基底部、右侧翼突基底部信号降低，增强后强化，较前范围稍缩小。 双侧海绵窦未见明显异常。 双侧上颌窦、筛窦、右侧蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，无强化，骨壁完整。双眼大小、形态、位置均属正常、信号均匀。蝶鞍形态正常，其内未见占位性病变。 右侧咽后间隙见淋巴结，较大者约7mm×6mm，信号欠均匀，增强后明显强化，较前缩小；左侧咽后间隙未见肿大淋巴结。双颈Ⅱ区、右颈Ⅲ区见多个淋巴结，边界欠清，最大约10mm×7mm，增强后不均匀强化，较前缩小、数目减少。 所见甲状腺双叶形态正常、喉咽腔、双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌治疗后，对比某次就诊时间片： 鼻咽病灶较前明显缩小。 颅底骨质破坏，较前修复。 右侧咽后淋巴结肿大，较前明显缩小。 双颈II区、右颈III区小淋巴结，较前明显缩小、数目减少。 鼻窦炎及右侧乳突炎。 左侧中下鼻甲肥厚。\n\n【既往治疗与反应】\n- [全程D32] 阶段小结；阶段小结: 病程类型: 阶段小结；病程主题: 阶段小结；病程内容: 患者[姓名已隐去]，男，51岁，因“颈部肿物，偶伴涕血、鼻塞2月”于某次就诊时间入院。征求患者同意并签字入住顺铂三周/单周方案联合IMRT治疗局部中晚期鼻咽癌三期临床试验，抽签入三周顺铂100mg/m2组。目前放疗14次，同时期化疗1次。3次靶向治疗，继续原方案治疗，并予患者营养支持治疗。\n- [全程D37] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者诉咽喉疼痛，目前放疗17次，今日行第2次顺铂同时期化疗，查体：患者鼻咽壁肿物明显缩小，双颈未扪及淋巴结，面部、双颈部皮肤色素沉着。上级医师信息已隐藏：密切关注患者放化疗副反应，遵嘱执行。\n- [全程D42] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者诉咽喉疼痛，目前放疗20次，已行2次顺铂同时期化疗，4次靶向治疗，诉食欲不佳，查体：患者鼻咽顶后壁肿物明显缩小，双颈未扪及淋巴结，面部、双颈部皮肤色素沉着。上级医师信息已隐藏：嘱患者加强营养及日常休息。密切关注患者放化疗副反应。 遵嘱。\n- [全程D47] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者目前放疗24次，已行2次顺铂同时期化疗，5次靶向治疗，诉咽喉疼痛，纳差，乏力。查体：患者鼻咽顶后壁稍增厚，双颈未扪及淋巴结，面部、双颈部皮肤色素沉着。上级医师信息已隐藏：予以抗炎对症处理，并予患者行营养支持治疗，并密切关注患者血象变化。\n- [全程D52] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者目前放疗27次，已行2次顺铂同时期化疗，6次靶向治疗，诉咽喉疼痛，纳差，乏力。查体：患者鼻咽右侧壁肿物已基本消退，双颈未扪及淋巴结，面部、双颈部皮肤色素沉着。上级医师信息已隐藏：予患者行营养支持治疗，并密切关注患者血象变化。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行电子鼻咽镜检查并在可疑残留区域取活检，继续静脉滴注莫西沙星及地塞米松预防感染与水肿，暂不予抗肿瘤治疗。\nB. 安排全身PET-CT检查评估放化疗后全身代谢缓解情况，并继续静脉滴注脂肪乳及氨基酸等营养支持治疗。\nC. 行电子鼻咽镜检查评估局部肿瘤退缩情况，并继续使用重组人表皮生长因子、重组人粒细胞巨噬细胞刺激因子等含漱药物促进粘膜修复。\nD. 对右侧咽后及颈部残留淋巴结行局部追加放疗推量，并继续使用重组人表皮生长因子等含漱药物促进粘膜修复。\nE. 行电子鼻咽镜检查评估局部疗效，并启动吉西他滨联合顺铂方案进行2至3个周期的辅助化疗以巩固全身疗效。\nF. 行右侧颈部淋巴结清扫术处理残留淋巴结，术后继续使用重组人表皮生长因子外用溶液促进局部创面愈合。\nG. 行鼻咽及颈部超声检查评估淋巴结结构，并加用卡培他滨口服进行为期1年的节拍化疗作为维持治疗。\nH. 暂不进行鼻咽镜检查，直接出院，嘱1个月后返院行鼻咽部活检及MRI复查，期间继续静脉营养支持。\nI. 行电子鼻咽镜检查评估局部疗效，并继续静脉滴注脂肪乳、氨基酸及复方氯化钠注射液加强全身营养支持。\nJ. 安排头颅增强MRI及全身骨扫描排除远处转移，并继续原方案靶向治疗至满1年，辅以局部含漱药物治疗。\nK. 行电子鼻咽镜检查评估局部疗效，若发现粘膜坏死则立即行内镜下清创术，并静脉滴注大剂量抗生素抗感染。\nL. 继续静脉滴注莫西沙星及地塞米松抗炎治疗2周以控制鼻窦炎及乳突炎，并定期复查鼻窦CT评估炎症吸收情况。\n\n请仅输出一个选项字母（A-L）。","gold_letter":"C","gold_action":"行电子鼻咽镜检查评估局部肿瘤退缩情况，并继续使用重组人表皮生长因子、重组人粒细胞巨噬细胞刺激因子等含漱药物促进粘膜修复。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"行电子鼻咽镜检查并在可疑残留区域取活检，继续静脉滴注莫西沙星及地塞米松预防感染与水肿，暂不予抗肿瘤治疗。"},{"letter":"B","text":"安排全身PET-CT检查评估放化疗后全身代谢缓解情况，并继续静脉滴注脂肪乳及氨基酸等营养支持治疗。"},{"letter":"C","text":"行电子鼻咽镜检查评估局部肿瘤退缩情况，并继续使用重组人表皮生长因子、重组人粒细胞巨噬细胞刺激因子等含漱药物促进粘膜修复。"},{"letter":"D","text":"对右侧咽后及颈部残留淋巴结行局部追加放疗推量，并继续使用重组人表皮生长因子等含漱药物促进粘膜修复。"},{"letter":"E","text":"行电子鼻咽镜检查评估局部疗效，并启动吉西他滨联合顺铂方案进行2至3个周期的辅助化疗以巩固全身疗效。"},{"letter":"F","text":"行右侧颈部淋巴结清扫术处理残留淋巴结，术后继续使用重组人表皮生长因子外用溶液促进局部创面愈合。"},{"letter":"G","text":"行鼻咽及颈部超声检查评估淋巴结结构，并加用卡培他滨口服进行为期1年的节拍化疗作为维持治疗。"},{"letter":"H","text":"暂不进行鼻咽镜检查，直接出院，嘱1个月后返院行鼻咽部活检及MRI复查，期间继续静脉营养支持。"},{"letter":"I","text":"行电子鼻咽镜检查评估局部疗效，并继续静脉滴注脂肪乳、氨基酸及复方氯化钠注射液加强全身营养支持。"},{"letter":"J","text":"安排头颅增强MRI及全身骨扫描排除远处转移，并继续原方案靶向治疗至满1年，辅以局部含漱药物治疗。"},{"letter":"K","text":"行电子鼻咽镜检查评估局部疗效，若发现粘膜坏死则立即行内镜下清创术，并静脉滴注大剂量抗生素抗感染。"},{"letter":"L","text":"继续静脉滴注莫西沙星及地塞米松抗炎治疗2周以控制鼻窦炎及乳突炎，并定期复查鼻窦CT评估炎症吸收情况。"}]}
+{"sample_id":"sample-37f31044df5e45295b88793a","patient_id":"patient-e90c2443e271b2e927262653","turn_id":"turn01","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 间断性回吸性涕血1年余。；现病史: 患者近一年以来无明显原因出现回吸性涕血、近一个月左侧鼻塞明显，间断鼻衄。双侧耳鸣伴左耳听力下降，左侧头痛，双颈肿块。无面麻、张口困难、软腭麻痹，无咳嗽咳痰、呼吸困难。伴双侧咽后、颈部淋巴结转移。现为进一步诊治入院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重下降1Kg。；阳性症状体征: 体重下降,听力下降,双颈肿物,双耳鸣,涕血,鼻衄,左鼻塞,左侧头痛；既往史: 既往体健。4年前妊娠期间高血糖。3年前剖宫产。否认肝炎、结核等传染病史。否认心脏病、高血压史。预防接种史不详。过敏史:无药物及食物过敏史。；个人史: 出生于原籍，无烟酒药物等嗜好，无疫水接触史，否认不洁性生活史。无工业毒物，粉尘，放射性物质接触史。；家族史: 否认家族其他成员中有类似病患者或肿瘤患者。；体格检查: T36.5℃P78次/分R19次/分BP115/70mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。无鼻翼扇动、鼻衄。牙龈无肿胀、出血。气管居中，甲状腺不大。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率70bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。；专科检查: KPS 90。双颈II区触及多枚肿大淋巴结，直径约1.0cm，质韧、固定、相互融合。颅神经（-）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 电子鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸部DR、腹部彩超、全身骨显像\nB. 鼻咽及颈部MRI平扫+增强，胸部DR、腹部彩超、全身骨显像，暂缓鼻咽镜及活检\nC. 颈部淋巴结切除活检，鼻咽及颈部MRI平扫+增强，胸部DR、腹部彩超、全身骨显像\nD. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部DR、腹部彩超、全身骨显像\nE. 电子鼻咽镜检查及活检，鼻咽MRI平扫+增强，胸部DR、腹部彩超、全身骨显像\nF. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，暂缓胸腹部及骨骼影像学筛查\nG. 全身PET-CT检查，颈部淋巴结细针穿刺活检，暂缓电子鼻咽镜检查及活检\nH. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫，胸部DR、腹部彩超、全身骨显像\nI. 电子鼻咽镜检查，鼻咽及颈部MRI平扫+增强，胸部CT、腹部CT，暂缓组织活检\nJ. 颈部淋巴结穿刺活检，鼻咽及颈部CT平扫+增强，胸部DR、腹部彩超、全身骨显像\nK. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，头颅CT平扫，暂缓远处转移筛查\nL. 电子鼻咽镜检查及活检，鼻咽及颈部超声检查，胸部DR、腹部彩超、全身骨显像\n\n请仅输出一个选项字母（A-L）。","gold_letter":"D","gold_action":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部DR、腹部彩超、全身骨显像","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"电子鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸部DR、腹部彩超、全身骨显像"},{"letter":"B","text":"鼻咽及颈部MRI平扫+增强，胸部DR、腹部彩超、全身骨显像，暂缓鼻咽镜及活检"},{"letter":"C","text":"颈部淋巴结切除活检，鼻咽及颈部MRI平扫+增强，胸部DR、腹部彩超、全身骨显像"},{"letter":"D","text":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部DR、腹部彩超、全身骨显像"},{"letter":"E","text":"电子鼻咽镜检查及活检，鼻咽MRI平扫+增强，胸部DR、腹部彩超、全身骨显像"},{"letter":"F","text":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，暂缓胸腹部及骨骼影像学筛查"},{"letter":"G","text":"全身PET-CT检查，颈部淋巴结细针穿刺活检，暂缓电子鼻咽镜检查及活检"},{"letter":"H","text":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫，胸部DR、腹部彩超、全身骨显像"},{"letter":"I","text":"电子鼻咽镜检查，鼻咽及颈部MRI平扫+增强，胸部CT、腹部CT，暂缓组织活检"},{"letter":"J","text":"颈部淋巴结穿刺活检，鼻咽及颈部CT平扫+增强，胸部DR、腹部彩超、全身骨显像"},{"letter":"K","text":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，头颅CT平扫，暂缓远处转移筛查"},{"letter":"L","text":"电子鼻咽镜检查及活检，鼻咽及颈部超声检查，胸部DR、腹部彩超、全身骨显像"}]}
+{"sample_id":"sample-6fba8e9f22d1b7d086664e36","patient_id":"patient-e90c2443e271b2e927262653","turn_id":"turn02","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 间断性回吸性涕血1年余。；现病史: 患者近一年以来无明显原因出现回吸性涕血、近一个月左侧鼻塞明显，间断鼻衄。双侧耳鸣伴左耳听力下降，左侧头痛，双颈肿块。无面麻、张口困难、软腭麻痹，无咳嗽咳痰、呼吸困难。伴双侧咽后、颈部淋巴结转移。现为进一步诊治入院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重下降1Kg。；阳性症状体征: 体重下降,听力下降,双颈肿物,双耳鸣,涕血,鼻衄,左鼻塞,左侧头痛；既往史: 既往体健。4年前妊娠期间高血糖。3年前剖宫产。否认肝炎、结核等传染病史。否认心脏病、高血压史。预防接种史不详。过敏史:无药物及食物过敏史。；个人史: 出生于原籍，无烟酒药物等嗜好，无疫水接触史，否认不洁性生活史。无工业毒物，粉尘，放射性物质接触史。；家族史: 否认家族其他成员中有类似病患者或肿瘤患者。；体格检查: T36.5℃P78次/分R19次/分BP115/70mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。无鼻翼扇动、鼻衄。牙龈无肿胀、出血。气管居中，甲状腺不大。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率70bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。；专科检查: KPS 90。双颈II区触及多枚肿大淋巴结，直径约1.0cm，质韧、固定、相互融合。颅神经（-）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 正常范围心电图\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理清晰，走行自然，双肺野内未见明确实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。双上胸膜略厚。；检查结论: 心肺未见明显病变。\n- [全程D1] 检验组合: 胱抑素(Cys-C)-静脉血: 0.8mg/L；钾离子(K+)-静脉血: 4.14mmol/L；肌酐(Crea)-静脉血: 65umol/L；葡萄糖(Glu)-静脉血: 5.25mmol/L；载脂蛋白B(apoB)-静脉血: 0.81g/L；碱性磷酸酶(ALP)-静脉血: 47U/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:20（参考: 阴性）；乳酸脱氢酶(LDH)-静脉血: 210.4U/L；纤维蛋白原(Fbg)-静脉血: 2.89g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.62；天门冬氨酸氨基转移酶(AST)-静脉血: 19.6U/L；阴离子间隙(AG)-静脉血: 14.7；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.376COI；总胆固醇(TC)-静脉血: 4.58mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.7mmolL；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.56g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.5mmol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 1.79COI；总胆汁酸(TBA)-静脉血: 2umol/L；平均血小板体积(MPV)-静脉血: 10.5fL；磷(P)-静脉血: 1.23mmol/L；单核细胞百分比(Mono%)-静脉血: 0.042；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 0.009COI；甘油三酯(TG)-静脉血: 0.86mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.1mmol/L；平均红细胞体积(MCV)-静脉血: 96.1fL；丙氨酸氨基转移酶(ALT)-静脉血: 15U/L；血小板分布宽度(PDW)-静脉血: 12.1%；C-反应蛋白(CRP)-静脉血: 0.28mg/L；α-L-岩藻糖苷酶(AFU)-静脉血: 33.2U/L；尿素氮(BUN)-静脉血: 4.7mmol/L；球蛋白(GLO)-静脉血: 28.21g/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 0.109COI；中性粒细胞百分比(Neut%)-静脉血: 0.642；血红蛋白(Hb)-静脉血: 140g/L；间接胆红素(IBIL)-静脉血: 7.3umolL；淋巴细胞百分比(Lymph%)-静脉血: 0.304；活化部分凝血活酶时间(APTT)-静脉血: 25.6sec.；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性（参考: 阴性）；红细胞计数(RBC#)-静脉血: 4.410E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.01；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.31\n- [全程D2] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁 、顶后壁、左侧壁增厚，见软组织肿物影。左侧咽隐窝消失，右侧咽隐窝变浅；病灶呈稍长分期信息见历史辅助诊断节点稍长分期信息见历史辅助诊断节点信号，增强扫描强化明显。 口咽双侧壁未见增厚。鼻腔未见肿物影。 左侧咽旁脂肪间隙变窄，左侧颈动脉鞘区见肿物占据。左侧腭帆张提肌及左侧头长肌受侵。 左侧翼腭窝见软组织影；右侧翼腭窝、双侧颞下窝未见异常。 斜坡、左侧岩尖、左侧破裂孔，左侧蝶骨大翼、左侧翼突、左侧翼管、左侧圆孔、蝶骨基底部骨质破坏。 蝶窦见软组织肿物；右侧乳突、双侧上颌窦充气良好；蝶窦、筛窦及左侧乳突见分泌物。 双眼未见异常。 左侧海绵窦见可疑肿物侵犯。 双侧咽后淋巴结肿大，左侧短径大小约为15mm，见包膜外侵；右侧短径大小约为11mm。双侧II区见多个肿大淋巴结，相互融合，最大短径大小约为18mm。 右侧腮腺见小淋巴结，短径约为7mm。 双侧腮腺。颌下腺、甲状腺未见异常。；检查结论: 考虑鼻咽癌，左侧咽旁间隙、颅底骨质； 可疑左侧海绵窦受侵。 双侧咽后淋巴结，双侧II区淋巴结肿大，考虑转移。 右侧腮腺小淋巴结，性质待定。 副鼻窦炎症。 左侧乳突炎症。\n- [全程D2] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，肝内血管走行自然，门静脉内径约10mm，未见明确肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约26cm/s。 胆囊大小正常，壁不厚，光滑，其内未见异常回声。 脾脏大小正常，包膜光滑，实质回声均匀。 胰腺大小正常，包膜光滑，实质回声均匀，胰管无扩张。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位性病变。 腹主动脉旁未见明确占位病变。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善颈部淋巴结细针穿刺活检及全身骨扫描\nB. 完善颈部淋巴结切除活检及全身PET-CT\nC. 完善电子鼻咽镜检查及鼻咽脱落细胞学检查\nD. 完善鼻咽肿物切除活检及全身骨扫描检查\nE. 完善电子鼻咽镜检查及鼻咽肿物活检\nF. 完善全身骨扫描检查并直接启动根治性放疗\nG. 完善鼻内镜下鼻咽肿物扩大切除及组织活检\nH. 完善颈部淋巴结切除活检及EB病毒DNA检测\nI. 完善电子鼻咽镜检查及鼻咽部多点盲取活检\nJ. 完善电子鼻咽镜检查及鼻咽肿物细针穿刺活检\nK. 完善脑部增强MRI检查及颈部淋巴结穿刺活检\nL. 完善电子鼻咽镜检查及活检并立即启动化疗\n\n请仅输出一个选项字母（A-L）。","gold_letter":"E","gold_action":"完善电子鼻咽镜检查及鼻咽肿物活检。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"完善颈部淋巴结细针穿刺活检及全身骨扫描"},{"letter":"B","text":"完善颈部淋巴结切除活检及全身PET-CT"},{"letter":"C","text":"完善电子鼻咽镜检查及鼻咽脱落细胞学检查"},{"letter":"D","text":"完善鼻咽肿物切除活检及全身骨扫描检查"},{"letter":"E","text":"完善电子鼻咽镜检查及鼻咽肿物活检"},{"letter":"F","text":"完善全身骨扫描检查并直接启动根治性放疗"},{"letter":"G","text":"完善鼻内镜下鼻咽肿物扩大切除及组织活检"},{"letter":"H","text":"完善颈部淋巴结切除活检及EB病毒DNA检测"},{"letter":"I","text":"完善电子鼻咽镜检查及鼻咽部多点盲取活检"},{"letter":"J","text":"完善电子鼻咽镜检查及鼻咽肿物细针穿刺活检"},{"letter":"K","text":"完善脑部增强MRI检查及颈部淋巴结穿刺活检"},{"letter":"L","text":"完善电子鼻咽镜检查及活检并立即启动化疗"}]}
+{"sample_id":"sample-4caf9a9989bff46283725cce","patient_id":"patient-e90c2443e271b2e927262653","turn_id":"turn04","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 间断性回吸性涕血1年余。；现病史: 患者近一年以来无明显原因出现回吸性涕血、近一个月左侧鼻塞明显，间断鼻衄。双侧耳鸣伴左耳听力下降，左侧头痛，双颈肿块。无面麻、张口困难、软腭麻痹，无咳嗽咳痰、呼吸困难。当地医院CT提示：鼻咽癌侵犯枕斜坡双侧蝶窦。伴双侧咽后、颈部淋巴结转移。现为进一步诊治入院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重下降1Kg。；阳性症状体征: 体重下降,听力下降,双颈肿物,双耳鸣,涕血,鼻衄,左鼻塞,左侧头痛；既往史: 既往体健。4年前妊娠期间高血糖。3年前剖宫产。否认肝炎、结核等传染病史。否认心脏病、高血压史。预防接种史不详。过敏史:无药物及食物过敏史。；个人史: 出生于原籍，无烟酒药物等嗜好，无疫水接触史，否认不洁性生活史。无工业毒物，粉尘，放射性物质接触史。；家族史: 否认家族其他成员中有类似病患者或肿瘤患者。；体格检查: T36.5℃P78次/分R19次/分BP115/70mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。无鼻翼扇动、鼻衄。牙龈无肿胀、出血。气管居中，甲状腺不大。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率70bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。肛门外生殖器未见异常，生理反射存在，病理反射未引出。；专科检查: KPS 90。张口门齿距4.5cm，间接鼻咽镜：见鼻咽左侧壁肿物肿物；双颈II区触及多枚肿大淋巴结，直径约1.0cm，质韧、固定、相互融合。颅神经（-）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 正常范围心电图\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 单纯根治性放疗\nB. 同步放化疗序贯辅助化疗\nC. 诱导化疗序贯单纯根治性放疗\nD. 根治性手术切除序贯术后放化疗\nE. 诱导化疗序贯靶向治疗联合放疗\nF. 姑息性化疗联合免疫治疗\nG. 诱导化疗序贯同步放化疗\nH. 同步放化疗联合靶向治疗\nI. 诱导化疗序贯根治性颈清扫术\nJ. 单纯同步放化疗\nK. 靶向治疗联合同步放化疗\nL. 诱导化疗联合免疫治疗序贯单纯放疗\n\n请仅输出一个选项字母（A-L）。","gold_letter":"G","gold_action":"诱导化疗序贯同步放化疗","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"单纯根治性放疗"},{"letter":"B","text":"同步放化疗序贯辅助化疗"},{"letter":"C","text":"诱导化疗序贯单纯根治性放疗"},{"letter":"D","text":"根治性手术切除序贯术后放化疗"},{"letter":"E","text":"诱导化疗序贯靶向治疗联合放疗"},{"letter":"F","text":"姑息性化疗联合免疫治疗"},{"letter":"G","text":"诱导化疗序贯同步放化疗"},{"letter":"H","text":"同步放化疗联合靶向治疗"},{"letter":"I","text":"诱导化疗序贯根治性颈清扫术"},{"letter":"J","text":"单纯同步放化疗"},{"letter":"K","text":"靶向治疗联合同步放化疗"},{"letter":"L","text":"诱导化疗联合免疫治疗序贯单纯放疗"}]}
+{"sample_id":"sample-3b37bb5b3505f87a241c1a6f","patient_id":"patient-e90c2443e271b2e927262653","turn_id":"turn06","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 间断性回吸性涕血1年余。；现病史: 患者近一年以来无明显原因出现回吸性涕血、近一个月左侧鼻塞明显，间断鼻衄。双侧耳鸣伴左耳听力下降，左侧头痛，双颈肿块。无面麻、张口困难、软腭麻痹，无咳嗽咳痰、呼吸困难。当地医院CT提示：鼻咽癌侵犯枕斜坡双侧蝶窦。伴双侧咽后、颈部淋巴结转移。现为进一步诊治入院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重下降1Kg。；阳性症状体征: 体重下降,听力下降,双颈肿物,双耳鸣,涕血,鼻衄,左鼻塞,左侧头痛；既往史: 既往体健。4年前妊娠期间高血糖。3年前剖宫产。否认肝炎、结核等传染病史。否认心脏病、高血压史。预防接种史不详。过敏史:无药物及食物过敏史。；个人史: 出生于原籍，无烟酒药物等嗜好，无疫水接触史，否认不洁性生活史。无工业毒物，粉尘，放射性物质接触史。；家族史: 否认家族其他成员中有类似病患者或肿瘤患者。；体格检查: T36.5℃P78次/分R19次/分BP115/70mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。无鼻翼扇动、鼻衄。牙龈无肿胀、出血。气管居中，甲状腺不大。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率70bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。肛门外生殖器未见异常，生理反射存在，病理反射未引出。；专科检查: KPS 90。张口门齿距4.5cm，间接鼻咽镜：见鼻咽左侧壁肿物肿物；双颈II区触及多枚肿大淋巴结，直径约1.0cm，质韧、固定、相互融合。颅神经（-）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 正常范围心电图\n- [全程D9] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；白细胞计数(WBC#)-静脉血: 9.210E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.812；单核细胞百分比(Mono%)-静脉血: 0.005；平均血小板体积(MPV)-静脉血: 11.2fL；平均红细胞体积(MCV)-静脉血: 95.5fL；血小板比容-静脉血: 21%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.1；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339g/L；大血小板百分比(P-LCR%)-静脉血: 36.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.178；平均红细胞血红蛋白含量(MCH)-静脉血: 32.4pg；单核细胞计数(Mono#)-静脉血: 0.110E9/L；红细胞计数(RBC#)-静脉血: 3.5210E12/L；血小板分布宽度(PDW)-静脉血: 13.8%；血小板计数(PLT#)-静脉血: 19010E9/L；红细胞比容(Hct)-静脉血: 33.6%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 114g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.4；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；中性粒细胞计数(Neut#)-静脉血: 7.410E9/L\n- [全程D13] 检验组合: 嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；大血小板百分比(P-LCR%)-静脉血: 33.8%；淋巴细胞百分比(Lymph%)-静脉血: 0.645；平均红细胞血红蛋白含量(MCH)-静脉血: 32.1pg；血红蛋白(Hb)-静脉血: 130g/L；白细胞计数(WBC#)-静脉血: 1.710E9/L；平均红细胞体积(MCV)-静脉血: 92.6fL；红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；单核细胞百分比(Mono%)-静脉血: 0.114；血小板分布宽度(PDW)-静脉血: 13%；中性粒细胞百分比(Neut%)-静脉血: 0.229；红细胞比容(Hct)-静脉血: 37.5%；单核细胞计数(Mono#)-静脉血: 0.210E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 35.6；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；血小板比容-静脉血: 27%；中性粒细胞计数(Neut#)-静脉血: 0.410E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.006；血小板计数(PLT#)-静脉血: 24210E9/L；平均血小板体积(MPV)-静脉血: 11fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 10.6；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L\n- [全程D14] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；淋巴细胞百分比(Lymph%)-静脉血: 0.51；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板比容-静脉血: 23%；红细胞计数(RBC#)-静脉血: 3.8110E12/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.8pg；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.8；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；白细胞计数(WBC#)-静脉血: 2.510E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.151；大血小板百分比(P-LCR%)-静脉血: 28.8%；红细胞比容(Hct)-静脉血: 34.9%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 121g/L；平均红细胞体积(MCV)-静脉血: 91.6fL；血小板分布宽度(PDW)-静脉血: 12.4%；单核细胞百分比(Mono%)-静脉血: 0.291；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；中性粒细胞计数(Neut#)-静脉血: 0.410E9/L；平均血小板体积(MPV)-静脉血: 10.4fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.3；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；血小板计数(PLT#)-静脉血: 22010E9/L\n- [全程D15] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；红细胞计数(RBC#)-静脉血: 3.8910E12/L；血小板分布宽度(PDW)-静脉血: 12.8%；平均红细胞体积(MCV)-静脉血: 94.6fL；中性粒细胞计数(Neut#)-静脉血: 2.610E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 35.8；平均血小板体积(MPV)-静脉血: 10.4fL；中性粒细胞百分比(Neut%)-静脉血: 0.496；淋巴细胞百分比(Lymph%)-静脉血: 0.292；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 334g/L；血红蛋白(Hb)-静脉血: 123g/L；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.202；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 10.8；白细胞计数(WBC#)-静脉血: 5.210E9/L；血小板计数(PLT#)-静脉血: 25410E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.6pg；血小板比容-静脉血: 26%；大血小板百分比(P-LCR%)-静脉血: 29%；红细胞比容(Hct)-静脉血: 36.8%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；单核细胞计数(Mono#)-静脉血: 1.110E9/L\n- [全程D16] 检验组合: 红细胞体积分布宽度SD(RDW-SD)-静脉血: 37；大血小板百分比(P-LCR%)-静脉血: 29.9%；红细胞比容(Hct)-静脉血: 34.2%；血小板计数(PLT#)-静脉血: 26510E9/L；单核细胞计数(Mono#)-静脉血: 1.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.128；血小板比容-静脉血: 28%；白细胞计数(WBC#)-静脉血: 11.810E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；血红蛋白(Hb)-静脉血: 113g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.8pg；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11；中性粒细胞计数(Neut#)-静脉血: 7.910E9/L；血小板分布宽度(PDW)-静脉血: 12.3%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；红细胞计数(RBC#)-静脉血: 3.5510E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.667；平均血小板体积(MPV)-静脉血: 10.5fL；淋巴细胞计数(Lymph#)-静脉血: 2.310E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.197；平均红细胞体积(MCV)-静脉血: 96.3fL\n- [全程D26] 检验组合: 直接胆红素(DBIL)-静脉血: 1.5umol/L；C-反应蛋白(CRP)-静脉血: 6.47mg/L；红细胞比容(Hct)-静脉血: 35.4%；阴离子间隙(AG)-静脉血: 8；血小板分布宽度(PDW)-静脉血: 10.3%；总钙(Ca)-静脉血: 2.27mmol/L；甘油三酯(TG)-静脉血: 0.74mmol/L；尿素氮(BUN)-静脉血: 4.68mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 32.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 32.4U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；葡萄糖(Glu)-静脉血: 5.39mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；白细胞计数(WBC#)-静脉血: 410E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 34U/L；磷(P)-静脉血: 1.35mmol/L；乳酸脱氢酶(LDH)-静脉血: 198.6U/L；血小板计数(PLT#)-静脉血: 25510E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.4；碱性磷酸酶(ALP)-静脉血: 92.4U/L；钾离子(K+)-静脉血: 3.9mmol/L；总蛋白(TP)-静脉血: 64.1g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.435；钠离子(Na+)-静脉血: 140.2mmol/L；胱抑素(Cys-C)-静脉血: 0.82mg/L；大血小板百分比(P-LCR%)-静脉血: 19.1%；间接胆红素(IBIL)-静脉血: 3.9umolL；红细胞计数(RBC#)-静脉血: 3.710E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.6pg；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；平均血小板体积(MPV)-静脉血: 9.3fL；氯离子(Cl-)-静脉血: 100.2mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.23g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.9；淋巴细胞百分比(Lymph%)-静脉血: 0.481；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.9；中性粒细胞计数(Neut#)-静脉血: 1.810E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.22mmolL；血小板比容-静脉血: 24%；平均红细胞体积(MCV)-静脉血: 95.7fL；肌酐(Crea)-静脉血: 55.6umol/L；白蛋白(ALB)-静脉血: 34.4g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.24mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L\n\n【既往治疗与反应】\n- [全程D13] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。胡医生信息已隐藏：患者予复查血象变化，密切观察患者病情变化。遵嘱。\n- [全程D16] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。检查回报：白细胞 2.5×109/L 。胡医生信息已隐藏：患者出现II度骨髓抑制，考虑化疗引起的副反应，予升白等对症处理，密切观察患者病情变化。遵嘱。\n- [全程D19] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。检查结果回报：白细胞 11.8×109/L。胡医生信息已隐藏：患者血象已恢复正常，密切观察患者病情变化。遵嘱。\n- [全程D22] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。胡医生信息已隐藏：患者予对症处理，密切观察患者病情变化。遵嘱。\n- [全程D25] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。胡医生信息已隐藏：患者予对症处理，密切观察患者病情变化。遵嘱。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 预防性给予重组人粒细胞集落刺激因子（G-CSF）皮下注射，并推迟后续抗肿瘤治疗。\nB. 立即输注红细胞悬液2U，并皮下注射促红细胞生成素（EPO）纠正贫血。\nC. 启动异甘草酸镁及多烯磷脂酰胆碱静脉滴注，进行双靶点强化保肝治疗。\nD. 建立中心静脉通道，给予10%氯化钾注射液微量泵持续静脉泵入补钾。\nE. 留取血培养后，经验性静脉滴注头孢哌酮舒巴坦等广谱抗菌药物抗感染。\nF. 每日静脉输注人血白蛋白10g，并配合静脉推注呋塞米进行利尿消肿。\nG. 给予碳酸氢钠静脉滴注碱化尿液，并进行每日3000ml以上大剂量水化。\nH. 启动胰岛素泵持续皮下泵入强化降糖治疗，并严格限制碳水化合物摄入。\nI. 暂不需集落刺激因子支持，予以复方氨基酸及转化糖电解质静脉营养支持，并进行动静脉置管护理。\nJ. 持续静脉泵入质子泵抑制剂及5-HT3受体拮抗剂，进行强化抑酸止吐。\nK. 预防性输注单采血小板1个治疗量，并皮下注射重组人血小板生成素。\nL. 给予拉布立酶静脉滴注，并配合大剂量静脉水化预防肿瘤溶解综合征。\n\n请仅输出一个选项字母（A-L）。","gold_letter":"I","gold_action":"暂不需集落刺激因子支持，予以复方氨基酸及转化糖电解质静脉营养支持，并进行动静脉置管护理。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"预防性给予重组人粒细胞集落刺激因子（G-CSF）皮下注射，并推迟后续抗肿瘤治疗。"},{"letter":"B","text":"立即输注红细胞悬液2U，并皮下注射促红细胞生成素（EPO）纠正贫血。"},{"letter":"C","text":"启动异甘草酸镁及多烯磷脂酰胆碱静脉滴注，进行双靶点强化保肝治疗。"},{"letter":"D","text":"建立中心静脉通道，给予10%氯化钾注射液微量泵持续静脉泵入补钾。"},{"letter":"E","text":"留取血培养后，经验性静脉滴注头孢哌酮舒巴坦等广谱抗菌药物抗感染。"},{"letter":"F","text":"每日静脉输注人血白蛋白10g，并配合静脉推注呋塞米进行利尿消肿。"},{"letter":"G","text":"给予碳酸氢钠静脉滴注碱化尿液，并进行每日3000ml以上大剂量水化。"},{"letter":"H","text":"启动胰岛素泵持续皮下泵入强化降糖治疗，并严格限制碳水化合物摄入。"},{"letter":"I","text":"暂不需集落刺激因子支持，予以复方氨基酸及转化糖电解质静脉营养支持，并进行动静脉置管护理。"},{"letter":"J","text":"持续静脉泵入质子泵抑制剂及5-HT3受体拮抗剂，进行强化抑酸止吐。"},{"letter":"K","text":"预防性输注单采血小板1个治疗量，并皮下注射重组人血小板生成素。"},{"letter":"L","text":"给予拉布立酶静脉滴注，并配合大剂量静脉水化预防肿瘤溶解综合征。"}]}
+{"sample_id":"sample-00fdb85efc65b944f8959fc3","patient_id":"patient-e90c2443e271b2e927262653","turn_id":"turn07","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 间断性回吸性涕血1年余。；现病史: 患者近一年以来无明显原因出现回吸性涕血、近一个月左侧鼻塞明显，间断鼻衄。双侧耳鸣伴左耳听力下降，左侧头痛，双颈肿块。无面麻、张口困难、软腭麻痹，无咳嗽咳痰、呼吸困难。当地医院CT提示：鼻咽癌侵犯枕斜坡双侧蝶窦。伴双侧咽后、颈部淋巴结转移。现为进一步诊治入院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重下降1Kg。；阳性症状体征: 体重下降,听力下降,双颈肿物,双耳鸣,涕血,鼻衄,左鼻塞,左侧头痛；既往史: 既往体健。4年前妊娠期间高血糖。3年前剖宫产。否认肝炎、结核等传染病史。否认心脏病、高血压史。预防接种史不详。过敏史:无药物及食物过敏史。；个人史: 出生于原籍，无烟酒药物等嗜好，无疫水接触史，否认不洁性生活史。无工业毒物，粉尘，放射性物质接触史。；家族史: 否认家族其他成员中有类似病患者或肿瘤患者。；体格检查: T36.5℃P78次/分R19次/分BP115/70mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。无鼻翼扇动、鼻衄。牙龈无肿胀、出血。气管居中，甲状腺不大。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率70bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。肛门外生殖器未见异常，生理反射存在，病理反射未引出。；专科检查: KPS 90。张口门齿距4.5cm，间接鼻咽镜：见鼻咽左侧壁肿物肿物；双颈II区触及多枚肿大淋巴结，直径约1.0cm，质韧、固定、相互融合。颅神经（-）。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 正常范围心电图\n- [全程D26] 检验组合: 直接胆红素(DBIL)-静脉血: 1.5umol/L；C-反应蛋白(CRP)-静脉血: 6.47mg/L；红细胞比容(Hct)-静脉血: 35.4%；阴离子间隙(AG)-静脉血: 8；血小板分布宽度(PDW)-静脉血: 10.3%；总钙(Ca)-静脉血: 2.27mmol/L；甘油三酯(TG)-静脉血: 0.74mmol/L；尿素氮(BUN)-静脉血: 4.68mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 32.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 32.4U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；葡萄糖(Glu)-静脉血: 5.39mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；白细胞计数(WBC#)-静脉血: 410E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 34U/L；磷(P)-静脉血: 1.35mmol/L；乳酸脱氢酶(LDH)-静脉血: 198.6U/L；血小板计数(PLT#)-静脉血: 25510E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.4；碱性磷酸酶(ALP)-静脉血: 92.4U/L；钾离子(K+)-静脉血: 3.9mmol/L；总蛋白(TP)-静脉血: 64.1g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.435；钠离子(Na+)-静脉血: 140.2mmol/L；胱抑素(Cys-C)-静脉血: 0.82mg/L；大血小板百分比(P-LCR%)-静脉血: 19.1%；间接胆红素(IBIL)-静脉血: 3.9umolL；红细胞计数(RBC#)-静脉血: 3.710E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.6pg；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；平均血小板体积(MPV)-静脉血: 9.3fL；氯离子(Cl-)-静脉血: 100.2mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.23g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.9；淋巴细胞百分比(Lymph%)-静脉血: 0.481；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.9；中性粒细胞计数(Neut#)-静脉血: 1.810E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.22mmolL；血小板比容-静脉血: 24%；平均红细胞体积(MCV)-静脉血: 95.7fL；肌酐(Crea)-静脉血: 55.6umol/L；白蛋白(ALB)-静脉血: 34.4g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.24mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L\n- [全程D36] 检验组合: 总胆固醇(TC)-静脉血: 4.01mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.55；γ-谷氨酰基转移酶(GGT)-静脉血: 22.5U/L；平均血小板体积(MPV)-静脉血: 10.1fL；淋巴细胞计数(Lymph#)-静脉血: 0.910E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.04；丙氨酸氨基转移酶(ALT)-静脉血: 42.3U/L；尿素氮(BUN)-静脉血: 6.2mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 26.3U/L；总胆红素(TBIL)-静脉血: 14.1umol/L；钠离子(Na+)-静脉血: 136mmol/L；碱性磷酸酶(ALP)-静脉血: 68U/L；白细胞计数(WBC#)-静脉血: 4.310E9/L；直接胆红素(DBIL)-静脉血: 4.6umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；单核细胞计数(Mono#)-静脉血: 0.110E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；磷(P)-静脉血: 0.99mmol/L；血红蛋白(Hb)-静脉血: 122g/L；氯离子(Cl-)-静脉血: 95mmol/L；血小板分布宽度(PDW)-静脉血: 12.3%；平均红细胞体积(MCV)-静脉血: 93.9fL；α-L-岩藻糖苷酶(AFU)-静脉血: 48.7U/L；阴离子间隙(AG)-静脉血: 14.1；钾离子(K+)-静脉血: 4.06mmol/L；红细胞比容(Hct)-静脉血: 35.7%；血小板比容-静脉血: 23%；白蛋白(ALB)-静脉血: 40.7g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；C-反应蛋白(CRP)-静脉血: 3.19mg/L；球蛋白(GLO)-静脉血: 26.19g/L；胱抑素(Cys-C)-静脉血: 0.64mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.04mmol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；载脂蛋白B(apoB)-静脉血: 0.72g/L；间接胆红素(IBIL)-静脉血: 9.5umolL；中性粒细胞百分比(Neut%)-静脉血: 0.729；尿酸(UA)-静脉血: 258.1umol/L；单核细胞百分比(Mono%)-静脉血: 0.012；甘油三酯(TG)-静脉血: 1.28mmol/L；大血小板百分比(P-LCR%)-静脉血: 26.4%；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.46mmolL；总钙(Ca)-静脉血: 2.22mmol/L；乳酸脱氢酶(LDH)-静脉血: 202.5U/L；载脂蛋白AI(apoAI)-静脉血: 1.47g/L\n- [全程D49] 检验组合: 单核细胞百分比(Mono%)-静脉血: 0.066；C-反应蛋白(CRP)-静脉血: 0.26mg/L；乳酸脱氢酶(LDH)-静脉血: 257.7U/L；氯离子(Cl-)-静脉血: 105.6mmol/L；总蛋白(TP)-静脉血: 65.51g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.002；甘油三酯(TG)-静脉血: 0.97mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.25mmolL；红细胞比容(Hct)-静脉血: 34.7%；间接胆红素(IBIL)-静脉血: 5.5umolL；单核细胞计数(Mono#)-静脉血: 0.310E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.5U/L；红细胞计数(RBC#)-静脉血: 3.5110E12/L；总钙(Ca)-静脉血: 2.08mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.94；葡萄糖(Glu)-静脉血: 4.89mmol/L；直接胆红素(DBIL)-静脉血: 2.4umol/L；镁离子(Mg2+)-静脉血: 1.09mmol/L；胱抑素(Cys-C)-静脉血: 0.69mg/L；总胆汁酸(TBA)-静脉血: 1.9umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 35.4U/L；肌酐(Crea)-静脉血: 52.4umol/L；载脂蛋白B(apoB)-静脉血: 0.81g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 48.8；平均红细胞血红蛋白含量(MCH)-静脉血: 32.5pg；钠离子(Na+)-静脉血: 141.4mmol/L；白蛋白(ALB)-静脉血: 40.9g/L；血小板分布宽度(PDW)-静脉血: 11%；血小板计数(PLT#)-静脉血: 19910E9/L；磷(P)-静脉血: 1.21mmol/L；钾离子(K+)-静脉血: 3.94mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.66；总胆固醇(TC)-静脉血: 4.19mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.55mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.465；中性粒细胞计数(Neut#)-静脉血: 2.110E9/L；血小板比容-静脉血: 20%；平均血小板体积(MPV)-静脉血: 9.9fL；中性粒细胞百分比(Neut%)-静脉血: 0.456；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；阴离子间隙(AG)-静脉血: 13；尿素氮(BUN)-静脉血: 6.7mmol/L；球蛋白(GLO)-静脉血: 24.61g/L\n- [全程D57] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后复查，对比某次就诊时间片： 鼻咽腔稍狭窄，鼻咽肿物较前明显缩小，鼻咽顶壁及双侧壁粘膜欠光滑，双侧咽隐窝变浅，鼻咽未见明显肿物，左侧腭帆提肌张肌及头长肌轮廓不清，其内及左侧咽后区见异常信号灶，增强扫描轻度强化，病灶范围较前明显缩小，强化程度较前降低。 左侧咽旁脂肪间隙变窄，左侧颈动脉鞘区见肿物占据，范围较前缩小，强化程度较前降低。左侧腭帆张提肌及左侧头长肌受侵。 口咽双侧壁未见增厚。鼻腔未见肿物。 左侧翼腭窝见少许软组织影，大致同前。右侧翼腭窝、双侧颞下窝未见异常。 斜坡、左侧岩尖、左侧破裂孔，左侧蝶骨大翼、左侧翼突、左侧翼管、左侧圆孔、蝶骨基底部骨质破坏，大致同前。 蝶窦见软组织肿物，较前明显缩小。 双侧上颌窦、蝶窦、筛窦粘膜增厚，左侧乳突少量分泌物。 双侧眼眶未见异常。左侧海绵窦未见明显右侧。 左侧咽后淋巴结肿大，短径约10mm，较前稍缩小。右侧咽后见小淋巴结，短径约4mm，较前明显缩小。双侧II区见多个淋巴结，相互融合，边界不清，较前明显缩小。右侧腮腺见小淋巴结，短径约为4mm。明显强化 左侧腮腺及双侧颌下腺未见异常。所示甲状腺未见异常。 所示脑实质常规MR及DTI未见明显异常信号灶。；检查结论: 鼻咽癌化疗后，鼻咽未见明显肿物，左侧咽旁、蝶窦肿物较前明显缩小。 颅底骨质破坏，大致同前。 双侧咽后及双颈II区淋巴结，较前缩小。 右侧腮腺小淋巴结。 鼻窦炎，左侧乳突炎症。\n- [全程D57] MRI；脑功能成像、DTI: 检查类型: MRI；检查名称: 脑功能成像、DTI；检查部位:；检查所见: 鼻咽癌化疗后复查，对比某次就诊时间片： 鼻咽腔稍狭窄，鼻咽肿物较前明显缩小，鼻咽顶壁及双侧壁粘膜欠光滑，双侧咽隐窝变浅，鼻咽未见明显肿物，左侧腭帆提肌张肌及头长肌轮廓不清，其内及左侧咽后区见异常信号灶，增强扫描轻度强化，病灶范围较前明显缩小，强化程度较前降低。 左侧咽旁脂肪间隙变窄，左侧颈动脉鞘区见肿物占据，范围较前缩小，强化程度较前降低。左侧腭帆张提肌及左侧头长肌受侵。 口咽双侧壁未见增厚。鼻腔未见肿物。 左侧翼腭窝见少许软组织影，大致同前。右侧翼腭窝、双侧颞下窝未见异常。 斜坡、左侧岩尖、左侧破裂孔，左侧蝶骨大翼、左侧翼突、左侧翼管、左侧圆孔、蝶骨基底部骨质破坏，大致同前。 蝶窦见软组织肿物，较前明显缩小。 双侧上颌窦、蝶窦、筛窦粘膜增厚，左侧乳突少量分泌物。 双侧眼眶未见异常。左侧海绵窦未见明显右侧。 左侧咽后淋巴结肿大，短径约10mm，较前稍缩小。右侧咽后见小淋巴结，短径约4mm，较前明显缩小。双侧II区见多个淋巴结，相互融合，边界不清，较前明显缩小。右侧腮腺见小淋巴结，短径约为4mm。明显强化 左侧腮腺及双侧颌下腺未见异常。所示甲状腺未见异常。 所示脑实质常规MR及DTI未见明显异常信号灶。；检查结论: 鼻咽癌化疗后，鼻咽未见明显肿物，左侧咽旁、蝶窦肿物较前明显缩小。 颅底骨质破坏，大致同前。 双侧咽后及双颈II区淋巴结，较前缩小。 右侧腮腺小淋巴结。 鼻窦炎，左侧乳突炎症。\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D51] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者入院第2天，一般情况可，血常规、生化检查无明显异常。上级医师信息已隐藏示：目前患者诊断明确，今日水化，明日开始第三程诱导化疗。\n- [全程D52] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，血常规、生化检查无明显异常。今日开始予多西他赛90mg/d1+PDD35mg/d1-3方案化疗。上级医师信息已隐藏示：目前患者诊断明确，今日开始化疗，密切观察病情变化。\n- [全程D55] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，未诉特殊不适。上级医师信息已隐藏示：目前患者今日化疗结束，密切观病情变化，如有不适，及时对症处理。\n- [全程D57] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，未诉特殊不适。上级医师信息已隐藏示：目前患者化疗结束，病情稳定，可予出院。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估为完全缓解（CR），结束诱导化疗，直接进入随访观察阶段，定期复查鼻咽及颈部MRI。\nB. 评估为疾病稳定（SD），更换为吉西他滨联合顺铂方案继续化疗2周期。\nC. 评估为疾病进展（PD），转为姑息性放疗及靶向治疗。\nD. 评估为部分缓解（PR），继续原方案（多西他赛联合顺铂）诱导化疗第4-6周期。\nE. 评估为部分缓解（PR），先行双侧颈部淋巴结清扫术，术后行根治性放疗。\nF. 评估为部分缓解（PR），结束诱导化疗，择期行单纯根治性放疗。\nG. 评估为部分缓解（PR），行鼻咽内镜下颅底肿瘤切除术联合术后放疗。\nH. 评估为部分缓解（PR），结束诱导化疗，择期行根治性放疗及同期靶向治疗。\nI. 评估为疾病稳定（SD），提前终止化疗，立即开始根治性放疗及同期化疗。\nJ. 评估为部分缓解（PR），结束诱导化疗，出院休养并定期监测血象，择期行根治性放疗及同期化疗。\nK. 评估为部分缓解（PR），结束诱导化疗，行全身PET-CT检查排除远处转移后再决定后续治疗。\nL. 评估为完全缓解（CR），结束诱导化疗，择期行预防性低剂量放疗。\n\n请仅输出一个选项字母（A-L）。","gold_letter":"J","gold_action":"评估为部分缓解（PR），结束诱导化疗，出院休养并定期监测血象，择期行根治性放疗及同期化疗。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"评估为完全缓解（CR），结束诱导化疗，直接进入随访观察阶段，定期复查鼻咽及颈部MRI。"},{"letter":"B","text":"评估为疾病稳定（SD），更换为吉西他滨联合顺铂方案继续化疗2周期。"},{"letter":"C","text":"评估为疾病进展（PD），转为姑息性放疗及靶向治疗。"},{"letter":"D","text":"评估为部分缓解（PR），继续原方案（多西他赛联合顺铂）诱导化疗第4-6周期。"},{"letter":"E","text":"评估为部分缓解（PR），先行双侧颈部淋巴结清扫术，术后行根治性放疗。"},{"letter":"F","text":"评估为部分缓解（PR），结束诱导化疗，择期行单纯根治性放疗。"},{"letter":"G","text":"评估为部分缓解（PR），行鼻咽内镜下颅底肿瘤切除术联合术后放疗。"},{"letter":"H","text":"评估为部分缓解（PR），结束诱导化疗，择期行根治性放疗及同期靶向治疗。"},{"letter":"I","text":"评估为疾病稳定（SD），提前终止化疗，立即开始根治性放疗及同期化疗。"},{"letter":"J","text":"评估为部分缓解（PR），结束诱导化疗，出院休养并定期监测血象，择期行根治性放疗及同期化疗。"},{"letter":"K","text":"评估为部分缓解（PR），结束诱导化疗，行全身PET-CT检查排除远处转移后再决定后续治疗。"},{"letter":"L","text":"评估为完全缓解（CR），结束诱导化疗，择期行预防性低剂量放疗。"}]}
+{"sample_id":"sample-c754017abe0842c4e67e064f","patient_id":"patient-e90c2443e271b2e927262653","turn_id":"turn08","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 间断性回吸性涕血1年余。；现病史: 患者近一年以来无明显原因出现回吸性涕血、近一个月左侧鼻塞明显，间断鼻衄。双侧耳鸣伴左耳听力下降，左侧头痛，双颈肿块。无面麻、张口困难、软腭麻痹，无咳嗽咳痰、呼吸困难。当地医院CT提示：鼻咽癌侵犯枕斜坡双侧蝶窦。伴双侧咽后、颈部淋巴结转移。现为进一步诊治入院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重下降1Kg。；阳性症状体征: 体重下降,听力下降,双颈肿物,双耳鸣,涕血,鼻衄,左鼻塞,左侧头痛；既往史: 既往体健。4年前妊娠期间高血糖。3年前剖宫产。否认肝炎、结核等传染病史。否认心脏病、高血压史。预防接种史不详。过敏史:无药物及食物过敏史。；个人史: 出生于原籍，无烟酒药物等嗜好，无疫水接触史，否认不洁性生活史。无工业毒物，粉尘，放射性物质接触史。；家族史: 否认家族其他成员中有类似病患者或肿瘤患者。；体格检查: T36.5℃P78次/分R19次/分BP115/70mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。无鼻翼扇动、鼻衄。牙龈无肿胀、出血。气管居中，甲状腺不大。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率70bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。肛门外生殖器未见异常，生理反射存在，病理反射未引出。；专科检查: KPS 90。张口门齿距4.5cm，间接鼻咽镜：见鼻咽左侧壁肿物肿物；双颈II区触及多枚肿大淋巴结，直径约1.0cm，质韧、固定、相互融合。颅神经（-）。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 正常范围心电图\n- [全程D26] 检验组合: 直接胆红素(DBIL)-静脉血: 1.5umol/L；C-反应蛋白(CRP)-静脉血: 6.47mg/L；红细胞比容(Hct)-静脉血: 35.4%；阴离子间隙(AG)-静脉血: 8；血小板分布宽度(PDW)-静脉血: 10.3%；总钙(Ca)-静脉血: 2.27mmol/L；甘油三酯(TG)-静脉血: 0.74mmol/L；尿素氮(BUN)-静脉血: 4.68mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 32.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 32.4U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；葡萄糖(Glu)-静脉血: 5.39mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；白细胞计数(WBC#)-静脉血: 410E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 34U/L；磷(P)-静脉血: 1.35mmol/L；乳酸脱氢酶(LDH)-静脉血: 198.6U/L；血小板计数(PLT#)-静脉血: 25510E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.4；碱性磷酸酶(ALP)-静脉血: 92.4U/L；钾离子(K+)-静脉血: 3.9mmol/L；总蛋白(TP)-静脉血: 64.1g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.435；钠离子(Na+)-静脉血: 140.2mmol/L；胱抑素(Cys-C)-静脉血: 0.82mg/L；大血小板百分比(P-LCR%)-静脉血: 19.1%；间接胆红素(IBIL)-静脉血: 3.9umolL；红细胞计数(RBC#)-静脉血: 3.710E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.6pg；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；平均血小板体积(MPV)-静脉血: 9.3fL；氯离子(Cl-)-静脉血: 100.2mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.23g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.9；淋巴细胞百分比(Lymph%)-静脉血: 0.481；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.9；中性粒细胞计数(Neut#)-静脉血: 1.810E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.22mmolL；血小板比容-静脉血: 24%；平均红细胞体积(MCV)-静脉血: 95.7fL；肌酐(Crea)-静脉血: 55.6umol/L；白蛋白(ALB)-静脉血: 34.4g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.24mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L\n- [全程D36] 检验组合: 总胆固醇(TC)-静脉血: 4.01mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.55；γ-谷氨酰基转移酶(GGT)-静脉血: 22.5U/L；平均血小板体积(MPV)-静脉血: 10.1fL；淋巴细胞计数(Lymph#)-静脉血: 0.910E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.04；丙氨酸氨基转移酶(ALT)-静脉血: 42.3U/L；尿素氮(BUN)-静脉血: 6.2mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 26.3U/L；总胆红素(TBIL)-静脉血: 14.1umol/L；钠离子(Na+)-静脉血: 136mmol/L；碱性磷酸酶(ALP)-静脉血: 68U/L；白细胞计数(WBC#)-静脉血: 4.310E9/L；直接胆红素(DBIL)-静脉血: 4.6umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；单核细胞计数(Mono#)-静脉血: 0.110E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；磷(P)-静脉血: 0.99mmol/L；血红蛋白(Hb)-静脉血: 122g/L；氯离子(Cl-)-静脉血: 95mmol/L；血小板分布宽度(PDW)-静脉血: 12.3%；平均红细胞体积(MCV)-静脉血: 93.9fL；α-L-岩藻糖苷酶(AFU)-静脉血: 48.7U/L；阴离子间隙(AG)-静脉血: 14.1；钾离子(K+)-静脉血: 4.06mmol/L；红细胞比容(Hct)-静脉血: 35.7%；血小板比容-静脉血: 23%；白蛋白(ALB)-静脉血: 40.7g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；C-反应蛋白(CRP)-静脉血: 3.19mg/L；球蛋白(GLO)-静脉血: 26.19g/L；胱抑素(Cys-C)-静脉血: 0.64mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.04mmol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；载脂蛋白B(apoB)-静脉血: 0.72g/L；间接胆红素(IBIL)-静脉血: 9.5umolL；中性粒细胞百分比(Neut%)-静脉血: 0.729；尿酸(UA)-静脉血: 258.1umol/L；单核细胞百分比(Mono%)-静脉血: 0.012；甘油三酯(TG)-静脉血: 1.28mmol/L；大血小板百分比(P-LCR%)-静脉血: 26.4%；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.46mmolL；总钙(Ca)-静脉血: 2.22mmol/L；乳酸脱氢酶(LDH)-静脉血: 202.5U/L；载脂蛋白AI(apoAI)-静脉血: 1.47g/L\n- [全程D49] 检验组合: 单核细胞百分比(Mono%)-静脉血: 0.066；C-反应蛋白(CRP)-静脉血: 0.26mg/L；乳酸脱氢酶(LDH)-静脉血: 257.7U/L；氯离子(Cl-)-静脉血: 105.6mmol/L；总蛋白(TP)-静脉血: 65.51g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.002；甘油三酯(TG)-静脉血: 0.97mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.25mmolL；红细胞比容(Hct)-静脉血: 34.7%；间接胆红素(IBIL)-静脉血: 5.5umolL；单核细胞计数(Mono#)-静脉血: 0.310E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.5U/L；红细胞计数(RBC#)-静脉血: 3.5110E12/L；总钙(Ca)-静脉血: 2.08mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.94；葡萄糖(Glu)-静脉血: 4.89mmol/L；直接胆红素(DBIL)-静脉血: 2.4umol/L；镁离子(Mg2+)-静脉血: 1.09mmol/L；胱抑素(Cys-C)-静脉血: 0.69mg/L；总胆汁酸(TBA)-静脉血: 1.9umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 35.4U/L；肌酐(Crea)-静脉血: 52.4umol/L；载脂蛋白B(apoB)-静脉血: 0.81g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 48.8；平均红细胞血红蛋白含量(MCH)-静脉血: 32.5pg；钠离子(Na+)-静脉血: 141.4mmol/L；白蛋白(ALB)-静脉血: 40.9g/L；血小板分布宽度(PDW)-静脉血: 11%；血小板计数(PLT#)-静脉血: 19910E9/L；磷(P)-静脉血: 1.21mmol/L；钾离子(K+)-静脉血: 3.94mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.66；总胆固醇(TC)-静脉血: 4.19mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.55mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.465；中性粒细胞计数(Neut#)-静脉血: 2.110E9/L；血小板比容-静脉血: 20%；平均血小板体积(MPV)-静脉血: 9.9fL；中性粒细胞百分比(Neut%)-静脉血: 0.456；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；阴离子间隙(AG)-静脉血: 13；尿素氮(BUN)-静脉血: 6.7mmol/L；球蛋白(GLO)-静脉血: 24.61g/L\n- [全程D57] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后复查，对比某次就诊时间片： 鼻咽腔稍狭窄，鼻咽肿物较前明显缩小，鼻咽顶壁及双侧壁粘膜欠光滑，双侧咽隐窝变浅，鼻咽未见明显肿物，左侧腭帆提肌张肌及头长肌轮廓不清，其内及左侧咽后区见异常信号灶，增强扫描轻度强化，病灶范围较前明显缩小，强化程度较前降低。 左侧咽旁脂肪间隙变窄，左侧颈动脉鞘区见肿物占据，范围较前缩小，强化程度较前降低。左侧腭帆张提肌及左侧头长肌受侵。 口咽双侧壁未见增厚。鼻腔未见肿物。 左侧翼腭窝见少许软组织影，大致同前。右侧翼腭窝、双侧颞下窝未见异常。 斜坡、左侧岩尖、左侧破裂孔，左侧蝶骨大翼、左侧翼突、左侧翼管、左侧圆孔、蝶骨基底部骨质破坏，大致同前。 蝶窦见软组织肿物，较前明显缩小。 双侧上颌窦、蝶窦、筛窦粘膜增厚，左侧乳突少量分泌物。 双侧眼眶未见异常。左侧海绵窦未见明显右侧。 左侧咽后淋巴结肿大，短径约10mm，较前稍缩小。右侧咽后见小淋巴结，短径约4mm，较前明显缩小。双侧II区见多个淋巴结，相互融合，边界不清，较前明显缩小。右侧腮腺见小淋巴结，短径约为4mm。明显强化 左侧腮腺及双侧颌下腺未见异常。所示甲状腺未见异常。 所示脑实质常规MR及DTI未见明显异常信号灶。；检查结论: 鼻咽癌化疗后，鼻咽未见明显肿物，左侧咽旁、蝶窦肿物较前明显缩小。 颅底骨质破坏，大致同前。 双侧咽后及双颈II区淋巴结，较前缩小。 右侧腮腺小淋巴结。 鼻窦炎，左侧乳突炎症。\n- [全程D57] MRI；脑功能成像、DTI: 检查类型: MRI；检查名称: 脑功能成像、DTI；检查部位:；检查所见: 鼻咽癌化疗后复查，对比某次就诊时间片： 鼻咽腔稍狭窄，鼻咽肿物较前明显缩小，鼻咽顶壁及双侧壁粘膜欠光滑，双侧咽隐窝变浅，鼻咽未见明显肿物，左侧腭帆提肌张肌及头长肌轮廓不清，其内及左侧咽后区见异常信号灶，增强扫描轻度强化，病灶范围较前明显缩小，强化程度较前降低。 左侧咽旁脂肪间隙变窄，左侧颈动脉鞘区见肿物占据，范围较前缩小，强化程度较前降低。左侧腭帆张提肌及左侧头长肌受侵。 口咽双侧壁未见增厚。鼻腔未见肿物。 左侧翼腭窝见少许软组织影，大致同前。右侧翼腭窝、双侧颞下窝未见异常。 斜坡、左侧岩尖、左侧破裂孔，左侧蝶骨大翼、左侧翼突、左侧翼管、左侧圆孔、蝶骨基底部骨质破坏，大致同前。 蝶窦见软组织肿物，较前明显缩小。 双侧上颌窦、蝶窦、筛窦粘膜增厚，左侧乳突少量分泌物。 双侧眼眶未见异常。左侧海绵窦未见明显右侧。 左侧咽后淋巴结肿大，短径约10mm，较前稍缩小。右侧咽后见小淋巴结，短径约4mm，较前明显缩小。双侧II区见多个淋巴结，相互融合，边界不清，较前明显缩小。右侧腮腺见小淋巴结，短径约为4mm。明显强化 左侧腮腺及双侧颌下腺未见异常。所示甲状腺未见异常。 所示脑实质常规MR及DTI未见明显异常信号灶。；检查结论: 鼻咽癌化疗后，鼻咽未见明显肿物，左侧咽旁、蝶窦肿物较前明显缩小。 颅底骨质破坏，大致同前。 双侧咽后及双颈II区淋巴结，较前缩小。 右侧腮腺小淋巴结。 鼻窦炎，左侧乳突炎症。\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D51] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者入院第2天，一般情况可，血常规、生化检查无明显异常。上级医师信息已隐藏示：目前患者诊断明确，今日水化，明日开始第三程诱导化疗。\n- [全程D52] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，血常规、生化检查无明显异常。今日开始予多西他赛90mg/d1+PDD35mg/d1-3方案化疗。上级医师信息已隐藏示：目前患者诊断明确，今日开始化疗，密切观察病情变化。\n- [全程D55] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，未诉特殊不适。上级医师信息已隐藏示：目前患者今日化疗结束，密切观病情变化，如有不适，及时对症处理。\n- [全程D57] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，未诉特殊不适。上级医师信息已隐藏示：目前患者化疗结束，病情稳定，可予出院。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估为诱导化疗后完全缓解（CR），予以出院并定期随访观察，暂缓后续放化疗。\nB. 评估为诱导化疗后部分缓解（PR），继续原方案（多西他赛+顺铂）行第4周期诱导化疗。\nC. 评估为诱导化疗后疾病稳定（SD），更改化疗方案为吉西他滨+顺铂继续诱导化疗。\nD. 评估为诱导化疗后疾病进展（PD），建议行姑息性放疗及靶向治疗。\nE. 评估为诱导化疗后部分缓解（PR），立即行双侧颈部淋巴结清扫术及鼻咽原发灶切除术。\nF. 评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排单纯根治性放疗。\nG. 评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排根治性放疗及靶向治疗。\nH. 评估为诱导化疗后完全缓解（CR），予以出院及对症支持治疗，并择期安排根治性放疗及同期化疗。\nI. 评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排根治性放疗及免疫治疗。\nJ. 评估为诱导化疗后部分缓解（PR），继续住院观察，待血象恢复后立即行第4周期诱导化疗。\nK. 评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排根治性放疗及同期化疗。\nL. 评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排姑息性放疗。\n\n请仅输出一个选项字母（A-L）。","gold_letter":"K","gold_action":"评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排根治性放疗及同期化疗。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"评估为诱导化疗后完全缓解（CR），予以出院并定期随访观察，暂缓后续放化疗。"},{"letter":"B","text":"评估为诱导化疗后部分缓解（PR），继续原方案（多西他赛+顺铂）行第4周期诱导化疗。"},{"letter":"C","text":"评估为诱导化疗后疾病稳定（SD），更改化疗方案为吉西他滨+顺铂继续诱导化疗。"},{"letter":"D","text":"评估为诱导化疗后疾病进展（PD），建议行姑息性放疗及靶向治疗。"},{"letter":"E","text":"评估为诱导化疗后部分缓解（PR），立即行双侧颈部淋巴结清扫术及鼻咽原发灶切除术。"},{"letter":"F","text":"评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排单纯根治性放疗。"},{"letter":"G","text":"评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排根治性放疗及靶向治疗。"},{"letter":"H","text":"评估为诱导化疗后完全缓解（CR），予以出院及对症支持治疗，并择期安排根治性放疗及同期化疗。"},{"letter":"I","text":"评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排根治性放疗及免疫治疗。"},{"letter":"J","text":"评估为诱导化疗后部分缓解（PR），继续住院观察，待血象恢复后立即行第4周期诱导化疗。"},{"letter":"K","text":"评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排根治性放疗及同期化疗。"},{"letter":"L","text":"评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排姑息性放疗。"}]}
+{"sample_id":"sample-c81d5e1363b1f79117650da1","patient_id":"patient-7c0941dbdd4694260fd4de38","turn_id":"turn01","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 反复右中耳积液半年余。；现病史: 简要入院病史:患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；阳性症状体征:；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史: 吸烟2包/日×20年，否认疫区接触史，否认冶游史，否认嗜酒。；家族史: 无特殊。；体格检查:；专科检查:；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 颈部CT平扫+增强、电子鼻咽镜检查、全身PET-CT检查\nB. 颈部MRI平扫、间接鼻咽镜检查、腹部超声检查\nC. 颈部MRI平扫+增强、电子鼻咽镜下活检、腹部超声检查\nD. 颈部超声、电子鼻咽镜检查、胸腹部CT平扫\nE. 颈部CT平扫、电子鼻咽镜检查、腹部超声检查\nF. 颈部MRI平扫+增强、间接鼻咽镜检查、胸部X线片\nG. 鼻咽及颈部CT平扫+增强、电子鼻咽镜检查、全身骨扫描\nH. 颈部MRI平扫、电子鼻咽镜检查、腹部超声检查\nI. 颈部MRI平扫+增强、鼻咽活检、全身骨扫描\nJ. 鼻咽部CT平扫、电子鼻咽镜检查、全身PET-CT检查\nK. 颈部MRI平扫+增强、电子鼻咽镜检查、全身骨扫描\nL. 颈部MRI平扫+增强、电子鼻咽镜检查、腹部超声检查\n\n请仅输出一个选项字母（A-L）。","gold_letter":"L","gold_action":"颈部MRI平扫+增强、电子鼻咽镜检查、腹部超声检查。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"颈部CT平扫+增强、电子鼻咽镜检查、全身PET-CT检查"},{"letter":"B","text":"颈部MRI平扫、间接鼻咽镜检查、腹部超声检查"},{"letter":"C","text":"颈部MRI平扫+增强、电子鼻咽镜下活检、腹部超声检查"},{"letter":"D","text":"颈部超声、电子鼻咽镜检查、胸腹部CT平扫"},{"letter":"E","text":"颈部CT平扫、电子鼻咽镜检查、腹部超声检查"},{"letter":"F","text":"颈部MRI平扫+增强、间接鼻咽镜检查、胸部X线片"},{"letter":"G","text":"鼻咽及颈部CT平扫+增强、电子鼻咽镜检查、全身骨扫描"},{"letter":"H","text":"颈部MRI平扫、电子鼻咽镜检查、腹部超声检查"},{"letter":"I","text":"颈部MRI平扫+增强、鼻咽活检、全身骨扫描"},{"letter":"J","text":"鼻咽部CT平扫、电子鼻咽镜检查、全身PET-CT检查"},{"letter":"K","text":"颈部MRI平扫+增强、电子鼻咽镜检查、全身骨扫描"},{"letter":"L","text":"颈部MRI平扫+增强、电子鼻咽镜检查、腹部超声检查"}]}
+{"sample_id":"sample-72b57dbdb0633da918062d61","patient_id":"patient-7c0941dbdd4694260fd4de38","turn_id":"turn02","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [时间未明] 门急诊记录: 主诉: 反复右中耳积液半年余。；现病史: 患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史:；家族史: 无特殊。；体格检查: KPS90分，DG4.0cm，鼻咽右侧隆突肿物，接近右侧后鼻孔，双颈未触及肿大淋巴结，颅神经检查阴性，心肺腹未及异常，全身骨无压痛。\n\n【已完成检查与客观结果】\n- [全程D8] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽右侧咽隐窝区软组织影放射性浓聚，SUV41.8，病灶侵犯右腭帆肌群、右头长肌，病灶与蝶骨基底部右份及右翼突内板分界不清。右咽旁间隙变浅，右咽隐窝消失，左侧咽隐窝未见明显异常。口咽及喉咽结构及放射性分布未见明显异常。双侧上颌窦低密度影放射性分布未见异常；额窦、蝶窦、筛窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双颈多个小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 右中肺小片状影放射性分布未见异常；余双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏弥漫性密度减低，CT值约46Hu（脾脏CT值约58Hu），形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 盆腔放射性分布均匀，膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 右乳突气房内低密度影放射性分布未见异常；余颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽右咽隐窝病灶代谢活跃，符合鼻咽癌，病灶疑累及蝶骨基底部右份及右翼突内板。 双上颌窦炎症；右乳突炎症。 右中肺小片状影代谢未见异常，考虑增殖灶。 轻度脂肪肝。\n- [全程D8] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 早期复极改变 其余未见异常\n- [全程D8] 检验组合: 红细胞计数(RBC#)-静脉血: 5.2310E12/L；血液二氧化碳含量ctCO2(B)-静脉血: 25mmol/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.766COI；血小板分布宽度(PDW)-静脉血: 16.4%；单核细胞百分比(Mono%)-静脉血: 0.077；红细胞比容(Hct)-静脉血: 48.4%；凝血酶时间(TT)-静脉血: 19.8sec.；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 32.8U/L；凝血酶原时间(PT)-静脉血: 9.9sec.；淋巴细胞计数(Lymph#)-静脉血: 2.310E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.025；白蛋白(ALB)-静脉血: 46g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.61；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.08；胱抑素(Cys-C)-静脉血: 0.98mg/L；尿素氮(BUN)-静脉血: 5.5mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.597；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 6.1umolL；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；碱性磷酸酶(ALP)-静脉血: 60.9U/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 0.006COI；C-反应蛋白(CRP)-静脉血: 1.86mg/L；Rh血型-静脉血: 阳性；总钙(Ca)-静脉血: 2.14mmol/L；总胆汁酸(TBA)-静脉血: 8.3umol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.1ug/ml；丙氨酸氨基转移酶(ALT)-静脉血: 46.9U/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；氯离子(Cl-)-静脉血: 104.3mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.89mmol/L；肌酐(Crea)-静脉血: 73.6umol/L；钾离子(K+)-静脉血: 4.29mmol/L；钠离子(Na+)-静脉血: 141.6mmol/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: >1000IU/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；平均红细胞体积(MCV)-静脉血: 92.5fL；血小板比容-静脉血: 18.1%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行电子鼻咽镜检查及鼻咽肿物活检，并辅以颈部淋巴结彩超及穿刺活检\nB. 行电子鼻咽镜检查及鼻咽肿物活检，颈部淋巴结仅作临床触诊及随访\nC. 行颈部淋巴结切除活检明确病理，暂缓鼻咽部有创检查及活检\nD. 行鼻内镜下鼻咽肿物扩大切除术，同步完成病理诊断与局部治疗\nE. 行颈部淋巴结彩超及穿刺活检，若确诊转移则免于鼻咽部活检\nF. 行鼻咽部脱落细胞学涂片及血浆EBV-DNA检测，替代组织学活检\nG. 启动根治性放化疗，免于组织学活检及颈部淋巴结穿刺评估\nH. 行电子鼻咽镜检查及活检，并预防性行双侧颈部淋巴结清扫术\nI. 补充全身骨扫描及头颅增强MRI，暂缓鼻咽及颈部组织学活检\nJ. 行电子鼻咽镜评估局部侵犯范围，免于鼻咽肿物组织学活检\nK. 优先行鼓膜穿刺置管术缓解中耳积液，暂缓鼻咽部及颈部检查\nL. 予以诊断性抗炎治疗2周，随后复查PET/CT评估局部代谢变化\n\n请仅输出一个选项字母（A-L）。","gold_letter":"A","gold_action":"行电子鼻咽镜检查及鼻咽肿物活检，并辅以颈部淋巴结彩超及穿刺活检，以明确病理诊断及淋巴结分期。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"行电子鼻咽镜检查及鼻咽肿物活检，并辅以颈部淋巴结彩超及穿刺活检"},{"letter":"B","text":"行电子鼻咽镜检查及鼻咽肿物活检，颈部淋巴结仅作临床触诊及随访"},{"letter":"C","text":"行颈部淋巴结切除活检明确病理，暂缓鼻咽部有创检查及活检"},{"letter":"D","text":"行鼻内镜下鼻咽肿物扩大切除术，同步完成病理诊断与局部治疗"},{"letter":"E","text":"行颈部淋巴结彩超及穿刺活检，若确诊转移则免于鼻咽部活检"},{"letter":"F","text":"行鼻咽部脱落细胞学涂片及血浆EBV-DNA检测，替代组织学活检"},{"letter":"G","text":"启动根治性放化疗，免于组织学活检及颈部淋巴结穿刺评估"},{"letter":"H","text":"行电子鼻咽镜检查及活检，并预防性行双侧颈部淋巴结清扫术"},{"letter":"I","text":"补充全身骨扫描及头颅增强MRI，暂缓鼻咽及颈部组织学活检"},{"letter":"J","text":"行电子鼻咽镜评估局部侵犯范围，免于鼻咽肿物组织学活检"},{"letter":"K","text":"优先行鼓膜穿刺置管术缓解中耳积液，暂缓鼻咽部及颈部检查"},{"letter":"L","text":"予以诊断性抗炎治疗2周，随后复查PET/CT评估局部代谢变化"}]}
+{"sample_id":"sample-3ed269e9b5e894b444089bf3","patient_id":"patient-7c0941dbdd4694260fd4de38","turn_id":"turn04","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 反复右中耳积液半年余。；现病史: 简要入院病史:患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。后来我院，我院病理示未分化非角化性癌。我院鼻咽+颈部MR：鼻咽部肿物，考虑鼻咽癌。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；阳性症状体征:；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史: 吸烟2包/日×20年，否认疫区接触史，否认冶游史，否认嗜酒。；家族史: 无特殊。；体格检查:；专科检查:；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D8] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽右侧咽隐窝区软组织影放射性浓聚，SUV41.8，病灶侵犯右腭帆肌群、右头长肌，病灶与蝶骨基底部右份及右翼突内板分界不清。右咽旁间隙变浅，右咽隐窝消失，左侧咽隐窝未见明显异常。口咽及喉咽结构及放射性分布未见明显异常。双侧上颌窦低密度影放射性分布未见异常；额窦、蝶窦、筛窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双颈多个小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 右中肺小片状影放射性分布未见异常；余双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏弥漫性密度减低，CT值约46Hu（脾脏CT值约58Hu），形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 盆腔放射性分布均匀，膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 右乳突气房内低密度影放射性分布未见异常；余颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽右咽隐窝病灶代谢活跃，符合鼻咽癌，病灶疑累及蝶骨基底部右份及右翼突内板。 双上颌窦炎症；右乳突炎症。 右中肺小片状影代谢未见异常，考虑增殖灶。 轻度脂肪肝。\n- [全程D8] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 早期复极改变 其余未见异常\n- [全程D8] 检验组合: 红细胞计数(RBC#)-静脉血: 5.2310E12/L；血液二氧化碳含量ctCO2(B)-静脉血: 25mmol/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.766COI；血小板分布宽度(PDW)-静脉血: 16.4%；单核细胞百分比(Mono%)-静脉血: 0.077；红细胞比容(Hct)-静脉血: 48.4%；凝血酶时间(TT)-静脉血: 19.8sec.；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 32.8U/L；凝血酶原时间(PT)-静脉血: 9.9sec.；淋巴细胞计数(Lymph#)-静脉血: 2.310E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.025；白蛋白(ALB)-静脉血: 46g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.61；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.08；胱抑素(Cys-C)-静脉血: 0.98mg/L；尿素氮(BUN)-静脉血: 5.5mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.597；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 6.1umolL；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；碱性磷酸酶(ALP)-静脉血: 60.9U/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 0.006COI；C-反应蛋白(CRP)-静脉血: 1.86mg/L；Rh血型-静脉血: 阳性；总钙(Ca)-静脉血: 2.14mmol/L；总胆汁酸(TBA)-静脉血: 8.3umol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.1ug/ml；丙氨酸氨基转移酶(ALT)-静脉血: 46.9U/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；氯离子(Cl-)-静脉血: 104.3mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.89mmol/L；肌酐(Crea)-静脉血: 73.6umol/L；钾离子(K+)-静脉血: 4.29mmol/L；钠离子(Na+)-静脉血: 141.6mmol/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: >1000IU/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；平均红细胞体积(MCV)-静脉血: 92.5fL；血小板比容-静脉血: 18.1%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D9] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁明显增厚，右侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描强化较明显。左侧咽隐窝存在。肿块累及右侧口咽壁。 右侧咽旁脂肪间隙变窄；左侧咽旁间隙未见明显狭窄。右侧腭帆张提肌受侵，左侧腭帆张提肌、双侧头长肌、双侧翼内外肌未见受侵。 鼻腔内未见肿物。 双侧翼腭窝、双侧上颌后脂肪间隙及咀嚼肌间隙未见异常。 颅底骨质信号均匀，增强扫描未见异常强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧上颌窦内见囊性灶，最大长径约27mm，边界清，无强化。右侧乳突见分泌物。左乳突充气良好，骨壁完整。 右侧咽后见一肿大淋巴结，大小约6mm×9mm，增强扫描明显强化。左侧咽后未见肿大淋巴结。颈部双侧见多个小淋巴结，最大者约8mm×11mm，未见坏死及包膜外侵。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。 扫描范围脑实质信号未见异常。；检查结论: 鼻咽肿物，考虑鼻咽癌。 颅底骨质未见破坏。 右侧咽后肿大淋巴结，考虑转移。 颈部小淋巴结。 双侧上颌窦囊肿，右侧乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见: 双颈II区可见几个小淋巴结，最大约11mm×4mm（右），12mm×5mm（左），边界清，椭圆形，皮髓质分界清，淋巴门可见。 CDFI:上述淋巴结内可见点状血流信号。 双侧颈部淋巴结穿刺活检： （1）右侧颈部淋巴结穿刺活检：常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以16G穿刺针穿刺入右颈淋巴结内，进针2次，取出长约0.5-1cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。 （2）左侧颈部淋巴结穿刺活检：常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以18G穿刺针穿刺入左颈淋巴结内，进针2次，取出长约0.8-1cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。；检查结论: 双侧颈部淋巴结穿刺活检。 不适随诊。 4个工作日后凭发票到2号楼6楼病理科取结果。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 诱导化疗序贯单纯根治性放疗（鼻咽及双侧颈部）\nB. 同期放化疗（鼻咽及双侧颈部）\nC. 单纯根治性放疗（鼻咽及双侧颈部）\nD. 诱导化疗序贯同期放化疗（鼻咽及双侧颈部）\nE. 鼻咽原发灶切除术联合术后辅助放疗\nF. 靶向治疗联合单纯根治性放疗（鼻咽及双侧颈部）\nG. 免疫治疗联合单纯根治性放疗（鼻咽及双侧颈部）\nH. 诱导化疗联合免疫治疗序贯同期放化疗\nI. 单纯根治性放疗（仅照射鼻咽及右侧颈部）\nJ. 姑息性全身化疗联合鼻咽局部减症放疗\nK. 诱导化疗后肿瘤退缩情况决定是否行根治性放疗\nL. 同期放化疗序贯全身辅助化疗\n\n请仅输出一个选项字母（A-L）。","gold_letter":"C","gold_action":"单纯根治性放疗（鼻咽及双侧颈部）","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"诱导化疗序贯单纯根治性放疗（鼻咽及双侧颈部）"},{"letter":"B","text":"同期放化疗（鼻咽及双侧颈部）"},{"letter":"C","text":"单纯根治性放疗（鼻咽及双侧颈部）"},{"letter":"D","text":"诱导化疗序贯同期放化疗（鼻咽及双侧颈部）"},{"letter":"E","text":"鼻咽原发灶切除术联合术后辅助放疗"},{"letter":"F","text":"靶向治疗联合单纯根治性放疗（鼻咽及双侧颈部）"},{"letter":"G","text":"免疫治疗联合单纯根治性放疗（鼻咽及双侧颈部）"},{"letter":"H","text":"诱导化疗联合免疫治疗序贯同期放化疗"},{"letter":"I","text":"单纯根治性放疗（仅照射鼻咽及右侧颈部）"},{"letter":"J","text":"姑息性全身化疗联合鼻咽局部减症放疗"},{"letter":"K","text":"诱导化疗后肿瘤退缩情况决定是否行根治性放疗"},{"letter":"L","text":"同期放化疗序贯全身辅助化疗"}]}
+{"sample_id":"sample-f6df1555c3bac7ae4b972cd4","patient_id":"patient-7c0941dbdd4694260fd4de38","turn_id":"turn05","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 反复右中耳积液半年余。；现病史: 简要入院病史:患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。后来我院，我院病理示未分化非角化性癌。我院鼻咽+颈部MR：鼻咽部肿物，考虑鼻咽癌。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；阳性症状体征:；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史: 吸烟2包/日×20年，否认疫区接触史，否认冶游史，否认嗜酒。；家族史: 无特殊。；体格检查:；专科检查:；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D8] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽右侧咽隐窝区软组织影放射性浓聚，SUV41.8，病灶侵犯右腭帆肌群、右头长肌，病灶与蝶骨基底部右份及右翼突内板分界不清。右咽旁间隙变浅，右咽隐窝消失，左侧咽隐窝未见明显异常。口咽及喉咽结构及放射性分布未见明显异常。双侧上颌窦低密度影放射性分布未见异常；额窦、蝶窦、筛窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双颈多个小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 右中肺小片状影放射性分布未见异常；余双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏弥漫性密度减低，CT值约46Hu（脾脏CT值约58Hu），形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 盆腔放射性分布均匀，膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 右乳突气房内低密度影放射性分布未见异常；余颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽右咽隐窝病灶代谢活跃，符合鼻咽癌，病灶疑累及蝶骨基底部右份及右翼突内板。 双上颌窦炎症；右乳突炎症。 右中肺小片状影代谢未见异常，考虑增殖灶。 轻度脂肪肝。\n- [全程D8] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 早期复极改变 其余未见异常\n- [全程D8] 检验组合: 红细胞计数(RBC#)-静脉血: 5.2310E12/L；血液二氧化碳含量ctCO2(B)-静脉血: 25mmol/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.766COI；血小板分布宽度(PDW)-静脉血: 16.4%；单核细胞百分比(Mono%)-静脉血: 0.077；红细胞比容(Hct)-静脉血: 48.4%；凝血酶时间(TT)-静脉血: 19.8sec.；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 32.8U/L；凝血酶原时间(PT)-静脉血: 9.9sec.；淋巴细胞计数(Lymph#)-静脉血: 2.310E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.025；白蛋白(ALB)-静脉血: 46g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.61；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.08；胱抑素(Cys-C)-静脉血: 0.98mg/L；尿素氮(BUN)-静脉血: 5.5mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.597；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 6.1umolL；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；碱性磷酸酶(ALP)-静脉血: 60.9U/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 0.006COI；C-反应蛋白(CRP)-静脉血: 1.86mg/L；Rh血型-静脉血: 阳性；总钙(Ca)-静脉血: 2.14mmol/L；总胆汁酸(TBA)-静脉血: 8.3umol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.1ug/ml；丙氨酸氨基转移酶(ALT)-静脉血: 46.9U/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；氯离子(Cl-)-静脉血: 104.3mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.89mmol/L；肌酐(Crea)-静脉血: 73.6umol/L；钾离子(K+)-静脉血: 4.29mmol/L；钠离子(Na+)-静脉血: 141.6mmol/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: >1000IU/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；平均红细胞体积(MCV)-静脉血: 92.5fL；血小板比容-静脉血: 18.1%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D9] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁明显增厚，右侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描强化较明显。左侧咽隐窝存在。肿块累及右侧口咽壁。 右侧咽旁脂肪间隙变窄；左侧咽旁间隙未见明显狭窄。右侧腭帆张提肌受侵，左侧腭帆张提肌、双侧头长肌、双侧翼内外肌未见受侵。 鼻腔内未见肿物。 双侧翼腭窝、双侧上颌后脂肪间隙及咀嚼肌间隙未见异常。 颅底骨质信号均匀，增强扫描未见异常强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧上颌窦内见囊性灶，最大长径约27mm，边界清，无强化。右侧乳突见分泌物。左乳突充气良好，骨壁完整。 右侧咽后见一肿大淋巴结，大小约6mm×9mm，增强扫描明显强化。左侧咽后未见肿大淋巴结。颈部双侧见多个小淋巴结，最大者约8mm×11mm，未见坏死及包膜外侵。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。 扫描范围脑实质信号未见异常。；检查结论: 鼻咽肿物，考虑鼻咽癌。 颅底骨质未见破坏。 右侧咽后肿大淋巴结，考虑转移。 颈部小淋巴结。 双侧上颌窦囊肿，右侧乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见: 双颈II区可见几个小淋巴结，最大约11mm×4mm（右），12mm×5mm（左），边界清，椭圆形，皮髓质分界清，淋巴门可见。 CDFI:上述淋巴结内可见点状血流信号。 双侧颈部淋巴结穿刺活检： （1）右侧颈部淋巴结穿刺活检：常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以16G穿刺针穿刺入右颈淋巴结内，进针2次，取出长约0.5-1cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。 （2）左侧颈部淋巴结穿刺活检：常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以18G穿刺针穿刺入左颈淋巴结内，进针2次，取出长约0.8-1cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。；检查结论: 双侧颈部淋巴结穿刺活检。 不适随诊。 4个工作日后凭发票到2号楼6楼病理科取结果。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D28] 检验组合: 总蛋白(TP)-静脉血: 67.97g/L；总胆红素(TBIL)-静脉血: 13.8umol/L；载脂蛋白B(apoB)-静脉血: 1.32g/L；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.99mmolL；大血小板百分比(P-LCR%)-静脉血: 25.7%；球蛋白(GLO)-静脉血: 23.97g/L；总钙(Ca)-静脉血: 2.26mmol/L；红细胞比容(Hct)-静脉血: 46.8%；血小板计数(PLT#)-静脉血: 20110E9/L；磷(P)-静脉血: 1.5mmol/L；血小板比容-静脉血: 20%；肌酐(Crea)-静脉血: 84.5umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.3；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；总胆汁酸(TBA)-静脉血: 3.5umol/L；钾离子(K+)-静脉血: 4mmol/L；C-反应蛋白(CRP)-静脉血: 2.01mg/L；间接胆红素(IBIL)-静脉血: 9.7umolL；胱抑素(Cys-C)-静脉血: 1.04mg/L；尿素氮(BUN)-静脉血: 6.93mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.6；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.11mmol/L；碱性磷酸酶(ALP)-静脉血: 50.9U/L；平均红细胞体积(MCV)-静脉血: 91.4fL；单核细胞计数(Mono#)-静脉血: 0.710E9/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；单核细胞百分比(Mono%)-静脉血: 0.081；红细胞计数(RBC#)-静脉血: 5.1210E12/L；白细胞计数(WBC#)-静脉血: 8.4210E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；平均血小板体积(MPV)-静脉血: 10.2fL；总胆固醇(TC)-静脉血: 5.98mmol/L；血红蛋白(Hb)-静脉血: 159g/L；直接胆红素(DBIL)-静脉血: 4.1umol/L；氯离子(Cl-)-静脉血: 105.9mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 340g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；天门冬氨酸氨基转移酶(AST)-静脉血: 26.3U/L；丙氨酸氨基转移酶(ALT)-静脉血: 45.9U/L；中性粒细胞计数(Neut#)-静脉血: 5.110E9/L；阴离子间隙(AG)-静脉血: 14；中性粒细胞百分比(Neut%)-静脉血: 0.6；平均红细胞血红蛋白含量(MCH)-静脉血: 31.1pg；乳酸脱氢酶(LDH)-静脉血: 165.4U/L\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D27] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗1次，无特殊主诉。Rx：1.继续放疗。2.定期复查血常规等。3.对症支持。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 继续放疗，加用多烯磷脂酰胆碱等保肝药物。\nB. 继续放疗，皮下注射重组人粒细胞刺激因子。\nC. 暂停放疗，完善超声心动图及动态心电图检查。\nD. 继续根治性放疗计划，定期常规监测血象及生化。\nE. 继续放疗，加用阿托伐他汀等降脂药物。\nF. 继续放疗，给予静脉补液及利尿治疗。\nG. 暂停放疗，静脉滴注广谱抗生素抗感染治疗。\nH. 继续放疗，口服头孢类抗生素及促排痰药物。\nI. 继续放疗，静脉滴注地塞米松及甘露醇。\nJ. 调整放疗计划，降低右侧中耳及乳突区的照射剂量。\nK. 继续放疗，皮下注射促红细胞生成素。\nL. 暂停放疗，行鼻内镜下鼓膜穿刺置管引流术。\n\n请仅输出一个选项字母（A-L）。","gold_letter":"D","gold_action":"继续当前根治性放疗计划，定期常规监测血象及生化。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"继续放疗，加用多烯磷脂酰胆碱等保肝药物。"},{"letter":"B","text":"继续放疗，皮下注射重组人粒细胞刺激因子。"},{"letter":"C","text":"暂停放疗，完善超声心动图及动态心电图检查。"},{"letter":"D","text":"继续根治性放疗计划，定期常规监测血象及生化。"},{"letter":"E","text":"继续放疗，加用阿托伐他汀等降脂药物。"},{"letter":"F","text":"继续放疗，给予静脉补液及利尿治疗。"},{"letter":"G","text":"暂停放疗，静脉滴注广谱抗生素抗感染治疗。"},{"letter":"H","text":"继续放疗，口服头孢类抗生素及促排痰药物。"},{"letter":"I","text":"继续放疗，静脉滴注地塞米松及甘露醇。"},{"letter":"J","text":"调整放疗计划，降低右侧中耳及乳突区的照射剂量。"},{"letter":"K","text":"继续放疗，皮下注射促红细胞生成素。"},{"letter":"L","text":"暂停放疗，行鼻内镜下鼓膜穿刺置管引流术。"}]}
+{"sample_id":"sample-f1eec05ca151dc9bde0f1f55","patient_id":"patient-7c0941dbdd4694260fd4de38","turn_id":"turn06","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 反复右中耳积液半年余。；现病史: 简要入院病史:患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。后来我院，我院病理示未分化非角化性癌。我院鼻咽+颈部MR：鼻咽部肿物，考虑鼻咽癌。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；阳性症状体征:；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史: 吸烟2包/日×20年，否认疫区接触史，否认冶游史，否认嗜酒。；家族史: 无特殊。；体格检查:；专科检查:；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D8] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽右侧咽隐窝区软组织影放射性浓聚，SUV41.8，病灶侵犯右腭帆肌群、右头长肌，病灶与蝶骨基底部右份及右翼突内板分界不清。右咽旁间隙变浅，右咽隐窝消失，左侧咽隐窝未见明显异常。口咽及喉咽结构及放射性分布未见明显异常。双侧上颌窦低密度影放射性分布未见异常；额窦、蝶窦、筛窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双颈多个小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 右中肺小片状影放射性分布未见异常；余双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏弥漫性密度减低，CT值约46Hu（脾脏CT值约58Hu），形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 盆腔放射性分布均匀，膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 右乳突气房内低密度影放射性分布未见异常；余颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽右咽隐窝病灶代谢活跃，符合鼻咽癌，病灶疑累及蝶骨基底部右份及右翼突内板。 双上颌窦炎症；右乳突炎症。 右中肺小片状影代谢未见异常，考虑增殖灶。 轻度脂肪肝。\n- [全程D8] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 早期复极改变 其余未见异常\n- [全程D8] 检验组合: 红细胞计数(RBC#)-静脉血: 5.2310E12/L；血液二氧化碳含量ctCO2(B)-静脉血: 25mmol/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.766COI；血小板分布宽度(PDW)-静脉血: 16.4%；单核细胞百分比(Mono%)-静脉血: 0.077；红细胞比容(Hct)-静脉血: 48.4%；凝血酶时间(TT)-静脉血: 19.8sec.；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 32.8U/L；凝血酶原时间(PT)-静脉血: 9.9sec.；淋巴细胞计数(Lymph#)-静脉血: 2.310E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.025；白蛋白(ALB)-静脉血: 46g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.61；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.08；胱抑素(Cys-C)-静脉血: 0.98mg/L；尿素氮(BUN)-静脉血: 5.5mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.597；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 6.1umolL；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；碱性磷酸酶(ALP)-静脉血: 60.9U/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 0.006COI；C-反应蛋白(CRP)-静脉血: 1.86mg/L；Rh血型-静脉血: 阳性；总钙(Ca)-静脉血: 2.14mmol/L；总胆汁酸(TBA)-静脉血: 8.3umol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.1ug/ml；丙氨酸氨基转移酶(ALT)-静脉血: 46.9U/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；氯离子(Cl-)-静脉血: 104.3mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.89mmol/L；肌酐(Crea)-静脉血: 73.6umol/L；钾离子(K+)-静脉血: 4.29mmol/L；钠离子(Na+)-静脉血: 141.6mmol/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: >1000IU/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；平均红细胞体积(MCV)-静脉血: 92.5fL；血小板比容-静脉血: 18.1%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L\n- [全程D9] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁明显增厚，右侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描强化较明显。左侧咽隐窝存在。肿块累及右侧口咽壁。 右侧咽旁脂肪间隙变窄；左侧咽旁间隙未见明显狭窄。右侧腭帆张提肌受侵，左侧腭帆张提肌、双侧头长肌、双侧翼内外肌未见受侵。 鼻腔内未见肿物。 双侧翼腭窝、双侧上颌后脂肪间隙及咀嚼肌间隙未见异常。 颅底骨质信号均匀，增强扫描未见异常强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧上颌窦内见囊性灶，最大长径约27mm，边界清，无强化。右侧乳突见分泌物。左乳突充气良好，骨壁完整。 右侧咽后见一肿大淋巴结，大小约6mm×9mm，增强扫描明显强化。左侧咽后未见肿大淋巴结。颈部双侧见多个小淋巴结，最大者约8mm×11mm，未见坏死及包膜外侵。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。 扫描范围脑实质信号未见异常。；检查结论: 鼻咽肿物，考虑鼻咽癌。 颅底骨质未见破坏。 右侧咽后肿大淋巴结，考虑转移。 颈部小淋巴结。 双侧上颌窦囊肿，右侧乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见: 双颈II区可见几个小淋巴结，最大约11mm×4mm（右），12mm×5mm（左），边界清，椭圆形，皮髓质分界清，淋巴门可见。 CDFI:上述淋巴结内可见点状血流信号。 双侧颈部淋巴结穿刺活检： （1）右侧颈部淋巴结穿刺活检：常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以16G穿刺针穿刺入右颈淋巴结内，进针2次，取出长约0.5-1cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。 （2）左侧颈部淋巴结穿刺活检：常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以18G穿刺针穿刺入左颈淋巴结内，进针2次，取出长约0.8-1cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。；检查结论: 双侧颈部淋巴结穿刺活检。 不适随诊。 4个工作日后凭发票到2号楼6楼病理科取结果。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D28] 检验组合: 总蛋白(TP)-静脉血: 67.97g/L；总胆红素(TBIL)-静脉血: 13.8umol/L；载脂蛋白B(apoB)-静脉血: 1.32g/L；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.99mmolL；大血小板百分比(P-LCR%)-静脉血: 25.7%；球蛋白(GLO)-静脉血: 23.97g/L；总钙(Ca)-静脉血: 2.26mmol/L；红细胞比容(Hct)-静脉血: 46.8%；血小板计数(PLT#)-静脉血: 20110E9/L；磷(P)-静脉血: 1.5mmol/L；血小板比容-静脉血: 20%；肌酐(Crea)-静脉血: 84.5umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.3；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；总胆汁酸(TBA)-静脉血: 3.5umol/L；钾离子(K+)-静脉血: 4mmol/L；C-反应蛋白(CRP)-静脉血: 2.01mg/L；间接胆红素(IBIL)-静脉血: 9.7umolL；胱抑素(Cys-C)-静脉血: 1.04mg/L；尿素氮(BUN)-静脉血: 6.93mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.6；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.11mmol/L；碱性磷酸酶(ALP)-静脉血: 50.9U/L；平均红细胞体积(MCV)-静脉血: 91.4fL；单核细胞计数(Mono#)-静脉血: 0.710E9/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；单核细胞百分比(Mono%)-静脉血: 0.081；红细胞计数(RBC#)-静脉血: 5.1210E12/L；白细胞计数(WBC#)-静脉血: 8.4210E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；平均血小板体积(MPV)-静脉血: 10.2fL；总胆固醇(TC)-静脉血: 5.98mmol/L；血红蛋白(Hb)-静脉血: 159g/L；直接胆红素(DBIL)-静脉血: 4.1umol/L；氯离子(Cl-)-静脉血: 105.9mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 340g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；天门冬氨酸氨基转移酶(AST)-静脉血: 26.3U/L；丙氨酸氨基转移酶(ALT)-静脉血: 45.9U/L；中性粒细胞计数(Neut#)-静脉血: 5.110E9/L；阴离子间隙(AG)-静脉血: 14；中性粒细胞百分比(Neut%)-静脉血: 0.6；平均红细胞血红蛋白含量(MCH)-静脉血: 31.1pg；乳酸脱氢酶(LDH)-静脉血: 165.4U/L\n- [全程D36] 检验组合: 血小板比容-静脉血: 21%；红细胞计数(RBC#)-静脉血: 5.3510E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 327g/L；血小板计数(PLT#)-静脉血: 20710E9/L；大血小板百分比(P-LCR%)-静脉血: 25.9%；单核细胞计数(Mono#)-静脉血: 0.410E9/L；白细胞计数(WBC#)-静脉血: 5.9110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.654；血小板分布宽度(PDW)-静脉血: 11.9%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4；红细胞比容(Hct)-静脉血: 49.8%；单核细胞百分比(Mono%)-静脉血: 0.059；平均血小板体积(MPV)-静脉血: 10.1fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.9；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.262；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.022；平均红细胞体积(MCV)-静脉血: 93.1fL；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；血红蛋白(Hb)-静脉血: 163g/L\n- [全程D41] 检验组合: 红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.3%；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；血小板比容-静脉血: 15.7%；γ-谷氨酰基转移酶(GGT)-静脉血: 29.2U/L；红细胞计数(RBC#)-静脉血: 4.9510E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.024；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 338.3g/L；钠离子(Na+)-静脉血: 141.9mmol/L；单核细胞百分比(Mono%)-静脉血: 0.068；尿酸(UA)-静脉血: 478.3umol/L；钾离子(K+)-静脉血: 4.3mmol/L；间接胆红素(IBIL)-静脉血: 16.8umolL；乳酸脱氢酶(LDH)-静脉血: 152.4U/L；平均红细胞体积(MCV)-静脉血: 91.7fL；碱性磷酸酶(ALP)-静脉血: 56.1U/L；白蛋白(ALB)-静脉血: 45.9g/L；白细胞计数(WBC#)-静脉血: 8.1810E9/L；葡萄糖(Glu)-静脉血: 4.49mmol/L；阴离子间隙(AG)-静脉血: 17；血小板计数(PLT#)-静脉血: 193.210E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；总蛋白(TP)-静脉血: 70.66g/L；总钙(Ca)-静脉血: 2.29mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.9；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；中性粒细胞计数(Neut#)-静脉血: 610E9/L；胱抑素(Cys-C)-静脉血: 0.96mg/L；C-反应蛋白(CRP)-静脉血: 5.9mg/L；载脂蛋白B(apoB)-静脉血: 1.37g/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.5mmol/L；红细胞比容(Hct)-静脉血: 45.4%；丙氨酸氨基转移酶(ALT)-静脉血: 37.9U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.77mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 25.2U/L；血红蛋白(Hb)-静脉血: 153.7g/L；总胆红素(TBIL)-静脉血: 23.6umol/L；肌酐(Crea)-静脉血: 95.6umol/L；血小板分布宽度(PDW)-静脉血: 15.9%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；平均血小板体积(MPV)-静脉血: 8.15fL；直接胆红素(DBIL)-静脉血: 6.8umol/L；磷(P)-静脉血: 1.34mmol/L\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D27] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗1次，无特殊主诉。Rx：1.继续放疗。2.定期复查血常规等。3.对症支持。\n- [全程D34] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗6次，无特殊主诉。复查血常规、生化未见明显异常。Rx：1.继续放疗。2.定期复查血常规等。3.对症支持。\n- [全程D41] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗11次，无特殊主诉。查体见鼻咽顶壁、右顶侧壁可见多个小结节，较前有所缩小，粘膜可见小片状白膜，双颈淋巴结未触及肿大，颅神经检查阴性，全身骨无压痛。和11-10复查血常规、血生化均未见明显异常。皮肤反应：0 Rx：1.继续放疗。粘膜反应：Ⅱ° 2.定期复查血常规等。3.对症支持。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停调强放疗，待口腔黏膜炎恢复至Ⅰ度后恢复放疗，期间加强静脉营养支持。\nB. 继续调强放疗，加用全身静脉广谱抗生素，定期复查血常规及生化。\nC. 继续调强放疗，降低单次靶区照射剂量，给予局部含漱等对症处理。\nD. 继续调强放疗，加用静脉糖皮质激素，定期复查血常规及生化。\nE. 继续调强放疗，给予局部含漱等对症处理，定期复查血常规及生化。\nF. 暂停调强放疗，加用全身抗真菌药物，待黏膜白膜消退后恢复放疗。\nG. 继续调强放疗，加用顺铂单药同步化疗，给予局部含漱等对症处理。\nH. 继续调强放疗，给予重组人粒细胞刺激因子皮下注射，定期复查血常规。\nI. 暂停调强放疗，行鼻咽黏膜活检明确白膜性质，给予局部含漱等对症处理。\nJ. 继续调强放疗，加用尼妥珠单抗靶向治疗，给予局部含漱等对症处理。\nK. 终止根治性放疗，转为姑息性放疗，加强镇痛及口腔局部护理。\nL. 继续调强放疗，预防性留置胃管，给予局部含漱等对症处理。\n\n请仅输出一个选项字母（A-L）。","gold_letter":"E","gold_action":"继续调强放疗，给予局部含漱等对症处理，定期复查血常规及生化。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"暂停调强放疗，待口腔黏膜炎恢复至Ⅰ度后恢复放疗，期间加强静脉营养支持。"},{"letter":"B","text":"继续调强放疗，加用全身静脉广谱抗生素，定期复查血常规及生化。"},{"letter":"C","text":"继续调强放疗，降低单次靶区照射剂量，给予局部含漱等对症处理。"},{"letter":"D","text":"继续调强放疗，加用静脉糖皮质激素，定期复查血常规及生化。"},{"letter":"E","text":"继续调强放疗，给予局部含漱等对症处理，定期复查血常规及生化。"},{"letter":"F","text":"暂停调强放疗，加用全身抗真菌药物，待黏膜白膜消退后恢复放疗。"},{"letter":"G","text":"继续调强放疗，加用顺铂单药同步化疗，给予局部含漱等对症处理。"},{"letter":"H","text":"继续调强放疗，给予重组人粒细胞刺激因子皮下注射，定期复查血常规。"},{"letter":"I","text":"暂停调强放疗，行鼻咽黏膜活检明确白膜性质，给予局部含漱等对症处理。"},{"letter":"J","text":"继续调强放疗，加用尼妥珠单抗靶向治疗，给予局部含漱等对症处理。"},{"letter":"K","text":"终止根治性放疗，转为姑息性放疗，加强镇痛及口腔局部护理。"},{"letter":"L","text":"继续调强放疗，预防性留置胃管，给予局部含漱等对症处理。"}]}
+{"sample_id":"sample-be3624e29a98e9da91fced75","patient_id":"patient-7c0941dbdd4694260fd4de38","turn_id":"turn07","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D8] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽右侧咽隐窝区软组织影放射性浓聚，SUV41.8，病灶侵犯右腭帆肌群、右头长肌，病灶与蝶骨基底部右份及右翼突内板分界不清。右咽旁间隙变浅，右咽隐窝消失，左侧咽隐窝未见明显异常。口咽及喉咽结构及放射性分布未见明显异常。双侧上颌窦低密度影放射性分布未见异常；额窦、蝶窦、筛窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双颈多个小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 右中肺小片状影放射性分布未见异常；余双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏弥漫性密度减低，CT值约46Hu（脾脏CT值约58Hu），形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 盆腔放射性分布均匀，膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 右乳突气房内低密度影放射性分布未见异常；余颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽右咽隐窝病灶代谢活跃，符合鼻咽癌，病灶疑累及蝶骨基底部右份及右翼突内板。 双上颌窦炎症；右乳突炎症。 右中肺小片状影代谢未见异常，考虑增殖灶。 轻度脂肪肝。\n- [全程D8] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 早期复极改变 其余未见异常\n- [全程D8] 检验组合: 红细胞计数(RBC#)-静脉血: 5.2310E12/L；血液二氧化碳含量ctCO2(B)-静脉血: 25mmol/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.766COI；血小板分布宽度(PDW)-静脉血: 16.4%；单核细胞百分比(Mono%)-静脉血: 0.077；红细胞比容(Hct)-静脉血: 48.4%；凝血酶时间(TT)-静脉血: 19.8sec.；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 32.8U/L；凝血酶原时间(PT)-静脉血: 9.9sec.；淋巴细胞计数(Lymph#)-静脉血: 2.310E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.025；白蛋白(ALB)-静脉血: 46g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.61；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.08；胱抑素(Cys-C)-静脉血: 0.98mg/L；尿素氮(BUN)-静脉血: 5.5mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.597；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 6.1umolL；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；碱性磷酸酶(ALP)-静脉血: 60.9U/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 0.006COI；C-反应蛋白(CRP)-静脉血: 1.86mg/L；Rh血型-静脉血: 阳性；总钙(Ca)-静脉血: 2.14mmol/L；总胆汁酸(TBA)-静脉血: 8.3umol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.1ug/ml；丙氨酸氨基转移酶(ALT)-静脉血: 46.9U/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；氯离子(Cl-)-静脉血: 104.3mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.89mmol/L；肌酐(Crea)-静脉血: 73.6umol/L；钾离子(K+)-静脉血: 4.29mmol/L；钠离子(Na+)-静脉血: 141.6mmol/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: >1000IU/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；平均红细胞体积(MCV)-静脉血: 92.5fL；血小板比容-静脉血: 18.1%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L\n- [全程D50] 检验组合: 平均红细胞体积(MCV)-静脉血: 92.2fL；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.727；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.033；血小板计数(PLT#)-静脉血: 15910E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.165；单核细胞百分比(Mono%)-静脉血: 0.073；血红蛋白(Hb)-静脉血: 162g/L；平均血小板体积(MPV)-静脉血: 10.6fL；白细胞计数(WBC#)-静脉血: 4.210E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.9；红细胞计数(RBC#)-静脉血: 5.2310E12/L；中性粒细胞计数(Neut#)-静脉血: 3.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；大血小板百分比(P-LCR%)-静脉血: 28.7%；血小板分布宽度(PDW)-静脉血: 11.3%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.4；血小板比容-静脉血: 17%；单核细胞计数(Mono#)-静脉血: 0.310E9/L；红细胞比容(Hct)-静脉血: 48.2%\n- [全程D56] 检验组合: 血小板分布宽度(PDW)-静脉血: 12.4%；中性粒细胞百分比(Neut%)-静脉血: 0.84；单核细胞计数(Mono#)-静脉血: 0.410E9/L；血小板比容-静脉血: 19%；血红蛋白(Hb)-静脉血: 158g/L；红细胞计数(RBC#)-静脉血: 5.2110E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.7；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均血小板体积(MPV)-静脉血: 10.5fL；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；红细胞比容(Hct)-静脉血: 47.9%；血小板计数(PLT#)-静脉血: 17710E9/L；平均红细胞体积(MCV)-静脉血: 91.9fL；淋巴细胞百分比(Lymph%)-静脉血: 0.077；平均红细胞血红蛋白含量(MCH)-静脉血: 30.3pg；中性粒细胞计数(Neut#)-静脉血: 5.310E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；单核细胞百分比(Mono%)-静脉血: 0.061；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.9；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；大血小板百分比(P-LCR%)-静脉血: 28.7%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.016；白细胞计数(WBC#)-静脉血: 6.3510E9/L\n- [全程D62] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；血小板分布宽度(PDW)-静脉血: 13.6%；单核细胞计数(Mono#)-静脉血: 0.310E9/L；白细胞计数(WBC#)-静脉血: 5.1610E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.798；红细胞比容(Hct)-静脉血: 47.9%；单核细胞百分比(Mono%)-静脉血: 0.066；大血小板百分比(P-LCR%)-静脉血: 30.3%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.7；血小板计数(PLT#)-静脉血: 21110E9/L；血小板比容-静脉血: 22%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.7；平均红细胞体积(MCV)-静脉血: 91.6fL；平均红细胞血红蛋白含量(MCH)-静脉血: 30.4pg；红细胞计数(RBC#)-静脉血: 5.2310E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞计数(Neut#)-静脉血: 4.110E9/L；血红蛋白(Hb)-静脉血: 159g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；淋巴细胞百分比(Lymph%)-静脉血: 0.109；平均红细胞血红蛋白浓度(MCHC)-静脉血: 332g/L；平均血小板体积(MPV)-静脉血: 10.5fL；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L\n- [全程D63] 检验组合: 低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.79mmol/L；总蛋白(TP)-静脉血: 66.06g/L；乳酸脱氢酶(LDH)-静脉血: 190U/L；葡萄糖(Glu)-静脉血: 4.43mmol/L；C-反应蛋白(CRP)-静脉血: 8.61mg/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.48；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.01mmolL；γ-谷氨酰基转移酶(GGT)-静脉血: 16.1U/L；镁离子(Mg2+)-静脉血: 0.98mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21U/L；总胆固醇(TC)-静脉血: 5.22mmol/L；阴离子间隙(AG)-静脉血: 15.7；氯离子(Cl-)-静脉血: 99.4mmol/L；碱性磷酸酶(ALP)-静脉血: 59.5U/L；磷(P)-静脉血: 1.2mmol/L；钾离子(K+)-静脉血: 3.7mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.11；甘油三酯(TG)-静脉血: 1.21mmol/L；肌酐(Crea)-静脉血: 80.4umol/L；总胆红素(TBIL)-静脉血: 23.7umol/L；载脂蛋白B(apoB)-静脉血: 1.27g/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.4mmol/L；总钙(Ca)-静脉血: 2.2mmol/L；尿素氮(BUN)-静脉血: 6.6mmol/L；钠离子(Na+)-静脉血: 142.5mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 14.2U/L；载脂蛋白AI(apoAI)-静脉血: 0.95g/L；间接胆红素(IBIL)-静脉血: 17.2umolL；直接胆红素(DBIL)-静脉血: 6.5umol/L；尿酸(UA)-静脉血: 490.3umol/L；总胆汁酸(TBA)-静脉血: 3.4umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 15.5U/L；球蛋白(GLO)-静脉血: 21.26g/L；白蛋白(ALB)-静脉血: 44.8g/L；胱抑素(Cys-C)-静脉血: 0.81mg/L\n- [全程D65] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:80（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:20（参考: 阴性）\n- [全程D160] 超声；腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约12cm/s。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、脾脏未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D160] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺野纹理清晰，双肺野未见明显实质性病变。双侧肺门无增大，纵隔未见增宽，心影形态、大小、位置未见异常。双膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n- [全程D160] 检验组合: EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- [全程D55] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗21次，诉口干、咽痛较前明显，乏力，余无特殊主诉。查体见鼻咽右顶侧壁稍增厚，炎性分泌物较多，粘膜充血水肿，双颈淋巴结未触及肿大，颅神经检查阴性，全身骨无压痛。复查血常规未见明显异常。皮肤反应：I°Rx：1.继续放疗。粘膜反应：Ⅱ° 2.定期复查血常规等。3.抗炎、止痛、营养对症支持。\n- [全程D62] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗26次，诉口干、咽痛较前缓解，仍觉乏力，无特殊主诉。和12-01复查血常规、生化均未见明显异常。皮肤反应：Ⅰ°Rx：1.继续放疗。粘膜反应：Ⅱ° 2.定期复查血常规等。3.营养对症支持。\n- [全程D65] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗28次，诉口干、咽痛好转，自觉体力虚弱，并拒绝最后2次放疗。皮肤反应：Ⅰ° Rx：1.定期复查。粘膜反应：Ⅰ° 2.不适随诊。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 安排鼻咽及颈部活检，准备行挽救性内镜下鼻咽切除术。\nB. 启动含铂双药方案全身化疗4-6个周期。\nC. 行全身PET/CT评估，若有局部高代谢灶则行挽救性放疗。\nD. 予以原发灶及颈部引流区局部推量补照4-6Gy。\nE. 给予卡培他滨单药口服维持治疗半年至一年。\nF. 维持规范随访观察，可症状给予一般对症及支持治疗。\nG. 行鼻咽及颈部MRI增强扫描，若有可疑残留则行诱导化疗。\nH. 启动PD-1抑制剂联合含铂双药全身化疗。\nI. 安排鼻咽内镜活检，若病理阳性则行双侧颈部淋巴结清扫术。\nJ. 补充顺铂单药全身化疗2个周期以强化局部控制。\nK. 行全身骨扫描及头颅MRI，排除远处转移后行局部挽救性放疗。\nL. 予以吉西他滨联合顺铂全身化疗4-6个周期。\n\n请仅输出一个选项字母（A-L）。","gold_letter":"F","gold_action":"维持规范随访观察，可根据症状给予一般对症及支持治疗，不启动挽救性局部治疗或全身抗肿瘤治疗。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"安排鼻咽及颈部活检，准备行挽救性内镜下鼻咽切除术。"},{"letter":"B","text":"启动含铂双药方案全身化疗4-6个周期。"},{"letter":"C","text":"行全身PET/CT评估，若有局部高代谢灶则行挽救性放疗。"},{"letter":"D","text":"予以原发灶及颈部引流区局部推量补照4-6Gy。"},{"letter":"E","text":"给予卡培他滨单药口服维持治疗半年至一年。"},{"letter":"F","text":"维持规范随访观察，可症状给予一般对症及支持治疗。"},{"letter":"G","text":"行鼻咽及颈部MRI增强扫描，若有可疑残留则行诱导化疗。"},{"letter":"H","text":"启动PD-1抑制剂联合含铂双药全身化疗。"},{"letter":"I","text":"安排鼻咽内镜活检，若病理阳性则行双侧颈部淋巴结清扫术。"},{"letter":"J","text":"补充顺铂单药全身化疗2个周期以强化局部控制。"},{"letter":"K","text":"行全身骨扫描及头颅MRI，排除远处转移后行局部挽救性放疗。"},{"letter":"L","text":"予以吉西他滨联合顺铂全身化疗4-6个周期。"}]}
+{"sample_id":"sample-46fc2f7bd9dd0872ef1b356e","patient_id":"patient-36d433557e63f939b878347d","turn_id":"turn02","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D1078] 入院记录: 主诉: 外院可疑鼻咽癌；现病史: 简要入院病史:患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n- [全程D1081] 入院记录: 主诉: 回吸性涕血3月余；现病史: 患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：70次/分，R：14次/分，BP：126/71mmHg,Ht：155cm，Wt：48kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左颈Ⅱ区触及肿大淋巴结，约2×1.5cm，无融合，质地硬，边界尚清，活动度中等，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- [全程D1078] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 Ⅱ、Ⅲ、aVF、V4～V6导联ST段下移\n- [全程D1078] 检验组合: 镁离子(Mg2+)-静脉血: 0.96mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.6；Rh血型-静脉血: 阳性；直接胆红素(DBIL)-静脉血: 2umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.61COI；白蛋白(ALB)-静脉血: 45.5g/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 0.085COI；γ-谷氨酰基转移酶(GGT)-静脉血: 13.6U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.2fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；葡萄糖(Glu)-静脉血: 4.67mmol/L；总胆红素(TBIL)-静脉血: 8.3umol/L；单核细胞百分比(Mono%)-静脉血: 0.074；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.5U/L；红细胞比容(Hct)-静脉血: 41%；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 1.56COI；单核细胞计数(Mono#)-静脉血: 0.310E9/L；中性粒细胞计数(Neut#)-静脉血: 2.510E9/L；胱抑素(Cys-C)-静脉血: 0.84mg/L；碱性磷酸酶(ALP)-静脉血: 80.5U/L；钠离子(Na+)-静脉血: 143.8mmol/L；乳酸脱氢酶(LDH)-静脉血: 194.4U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；平均红细胞血红蛋白浓度(MCHC)-静脉血: 324g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21.7U/L；氯离子(Cl-)-静脉血: 105.2mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.74；平均红细胞体积(MCV)-静脉血: 92.8fL；C-反应蛋白(CRP)-静脉血: 1.78mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.4；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: >1000IU/L；总胆固醇(TC)-静脉血: 5.98mmol/L；血红蛋白(Hb)-静脉血: 133g/L；大血小板百分比(P-LCR%)-静脉血: 26.1%；间接胆红素(IBIL)-静脉血: 6.3umolL；甘油三酯(TG)-静脉血: 1.04mmol/L；钾离子(K+)-静脉血: 4.23mmol/L；尿素氮(BUN)-静脉血: 5.6mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；中性粒细胞百分比(Neut%)-静脉血: 0.579；阴离子间隙(AG)-静脉血: 12.9；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.66mmol/L\n- [全程D1079] 检验组合: 梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）\n- [全程D1081] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 多个颈腰椎、双侧膝关节可见片状放射性浓集灶。余颅骨、胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 考虑多个颈腰椎、双侧膝关节骨质退行性变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行鼻咽镜下肿物活检；影像学评估为 cT3N2M0\nB. 行鼻咽镜下肿物活检；影像学评估为 cT4N1M0\nC. 行颈部淋巴结穿刺活检；影像学评估为 cT4N2M0\nD. 完善血浆EBV-DNA检测；影像学评估为 cT4N2M0\nE. 行鼻咽镜下肿物活检；影像学评估为 cT4N2M0\nF. 安排诱导化疗联合根治性放疗；影像学评估为 cT4N2M0\nG. 行鼻咽镜下肿物活检；影像学评估为 cT4N3M0\nH. 行鼻咽镜下肿物活检；影像学评估为 cT3N1M0\nI. 行全身PET-CT检查；影像学评估为 cT4N2M0\nJ. 行鼻咽镜下肿物活检；影像学评估为 cT2N2M0\nK. 行鼻咽镜下肿物活检；影像学评估为 cT4N0M0\nL. 行鼻咽镜下肿物活检；影像学评估为 cT1N2M0\n\n请仅输出一个选项字母（A-L）。","gold_letter":"E","gold_action":"行鼻咽镜下肿物活检以明确病理诊断；当前影像学评估为 cT4N2M0","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"行鼻咽镜下肿物活检；影像学评估为 cT3N2M0"},{"letter":"B","text":"行鼻咽镜下肿物活检；影像学评估为 cT4N1M0"},{"letter":"C","text":"行颈部淋巴结穿刺活检；影像学评估为 cT4N2M0"},{"letter":"D","text":"完善血浆EBV-DNA检测；影像学评估为 cT4N2M0"},{"letter":"E","text":"行鼻咽镜下肿物活检；影像学评估为 cT4N2M0"},{"letter":"F","text":"安排诱导化疗联合根治性放疗；影像学评估为 cT4N2M0"},{"letter":"G","text":"行鼻咽镜下肿物活检；影像学评估为 cT4N3M0"},{"letter":"H","text":"行鼻咽镜下肿物活检；影像学评估为 cT3N1M0"},{"letter":"I","text":"行全身PET-CT检查；影像学评估为 cT4N2M0"},{"letter":"J","text":"行鼻咽镜下肿物活检；影像学评估为 cT2N2M0"},{"letter":"K","text":"行鼻咽镜下肿物活检；影像学评估为 cT4N0M0"},{"letter":"L","text":"行鼻咽镜下肿物活检；影像学评估为 cT1N2M0"}]}
+{"sample_id":"sample-7c52866e0776802e0c94516f","patient_id":"patient-36d433557e63f939b878347d","turn_id":"turn04","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D1078] 入院记录: 主诉: 外院可疑鼻咽癌；现病史: 简要入院病史:患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。某次就诊时间再次出现回吸性涕血，遂行鼻咽镜检查，活检示：鼻咽炎性渗出。行鼻咽部CT示：鼻咽左侧可见软组织占位。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- [全程D1078] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 Ⅱ、Ⅲ、aVF、V4～V6导联ST段下移\n- [全程D1078] 检验组合: 镁离子(Mg2+)-静脉血: 0.96mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.6；Rh血型-静脉血: 阳性；直接胆红素(DBIL)-静脉血: 2umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.61COI；白蛋白(ALB)-静脉血: 45.5g/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 0.085COI；γ-谷氨酰基转移酶(GGT)-静脉血: 13.6U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.2fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；葡萄糖(Glu)-静脉血: 4.67mmol/L；总胆红素(TBIL)-静脉血: 8.3umol/L；单核细胞百分比(Mono%)-静脉血: 0.074；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.5U/L；红细胞比容(Hct)-静脉血: 41%；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 1.56COI；单核细胞计数(Mono#)-静脉血: 0.310E9/L；中性粒细胞计数(Neut#)-静脉血: 2.510E9/L；胱抑素(Cys-C)-静脉血: 0.84mg/L；碱性磷酸酶(ALP)-静脉血: 80.5U/L；钠离子(Na+)-静脉血: 143.8mmol/L；乳酸脱氢酶(LDH)-静脉血: 194.4U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；平均红细胞血红蛋白浓度(MCHC)-静脉血: 324g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21.7U/L；氯离子(Cl-)-静脉血: 105.2mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.74；平均红细胞体积(MCV)-静脉血: 92.8fL；C-反应蛋白(CRP)-静脉血: 1.78mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.4；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: >1000IU/L；总胆固醇(TC)-静脉血: 5.98mmol/L；血红蛋白(Hb)-静脉血: 133g/L；大血小板百分比(P-LCR%)-静脉血: 26.1%；间接胆红素(IBIL)-静脉血: 6.3umolL；甘油三酯(TG)-静脉血: 1.04mmol/L；钾离子(K+)-静脉血: 4.23mmol/L；尿素氮(BUN)-静脉血: 5.6mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；中性粒细胞百分比(Neut%)-静脉血: 0.579；阴离子间隙(AG)-静脉血: 12.9；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.66mmol/L\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂缓影像学分期检查，直接启动根治性同步放化疗\nB. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行单纯根治性放疗\nC. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行诱导化疗序贯单纯根治性放疗\nD. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行根治性手术切除序贯术后放疗\nE. 完善头颈部增强CT及全身分期检查，若评估为局部晚期，行诱导化疗序贯同步放化疗\nF. 完善头颈部MRI及全身分期检查，若评估为早期（I期），行诱导化疗序贯同步放化疗\nG. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行诱导化疗序贯同步放化疗\nH. 完善头颈部MRI及全身分期检查，无论分期结果，均行诱导化疗序贯同步放化疗\nI. 仅行全身PET-CT替代所有常规分期检查，若评估为局部晚期，行诱导化疗序贯同步放化疗\nJ. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行抗EGFR单抗靶向治疗替代放疗\nK. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行PD-1抑制剂单药根治性治疗\nL. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行姑息性化疗联合最佳支持治疗\n\n请仅输出一个选项字母（A-L）。","gold_letter":"G","gold_action":"完善头颈部MRI及全身分期检查，若评估为局部晚期，行诱导化疗序贯同步放化疗","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"暂缓影像学分期检查，直接启动根治性同步放化疗"},{"letter":"B","text":"完善头颈部MRI及全身分期检查，若评估为局部晚期，行单纯根治性放疗"},{"letter":"C","text":"完善头颈部MRI及全身分期检查，若评估为局部晚期，行诱导化疗序贯单纯根治性放疗"},{"letter":"D","text":"完善头颈部MRI及全身分期检查，若评估为局部晚期，行根治性手术切除序贯术后放疗"},{"letter":"E","text":"完善头颈部增强CT及全身分期检查，若评估为局部晚期，行诱导化疗序贯同步放化疗"},{"letter":"F","text":"完善头颈部MRI及全身分期检查，若评估为早期（I期），行诱导化疗序贯同步放化疗"},{"letter":"G","text":"完善头颈部MRI及全身分期检查，若评估为局部晚期，行诱导化疗序贯同步放化疗"},{"letter":"H","text":"完善头颈部MRI及全身分期检查，无论分期结果，均行诱导化疗序贯同步放化疗"},{"letter":"I","text":"仅行全身PET-CT替代所有常规分期检查，若评估为局部晚期，行诱导化疗序贯同步放化疗"},{"letter":"J","text":"完善头颈部MRI及全身分期检查，若评估为局部晚期，行抗EGFR单抗靶向治疗替代放疗"},{"letter":"K","text":"完善头颈部MRI及全身分期检查，若评估为局部晚期，行PD-1抑制剂单药根治性治疗"},{"letter":"L","text":"完善头颈部MRI及全身分期检查，若评估为局部晚期，行姑息性化疗联合最佳支持治疗"}]}
+{"sample_id":"sample-ce21ad4c82d0349356f5fbb9","patient_id":"patient-36d433557e63f939b878347d","turn_id":"turn05","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D1078] 入院记录: 主诉: 外院可疑鼻咽癌；现病史: 简要入院病史:患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。某次就诊时间再次出现回吸性涕血，遂行鼻咽镜检查，活检示：鼻咽炎性渗出。行鼻咽部CT示：鼻咽左侧可见软组织占位。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n- [全程D1081] 入院记录: 主诉: 回吸性涕血3月余；现病史: 患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。某次就诊时间再次出现回吸性涕血，遂行鼻咽镜检查，活检示：鼻咽炎性渗出。行鼻咽部CT示：鼻咽左侧可见软组织占位。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：70次/分，R：14次/分，BP：126/71mmHg,Ht：155cm，Wt：48kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率70次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左颈Ⅱ区触及肿大淋巴结，约2×1.5cm，无融合，质地硬，边界尚清，活动度中等，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- [全程D1078] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 Ⅱ、Ⅲ、aVF、V4～V6导联ST段下移\n- [全程D1078] 检验组合: 镁离子(Mg2+)-静脉血: 0.96mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.6；Rh血型-静脉血: 阳性；直接胆红素(DBIL)-静脉血: 2umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.61COI；白蛋白(ALB)-静脉血: 45.5g/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 0.085COI；γ-谷氨酰基转移酶(GGT)-静脉血: 13.6U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.2fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；葡萄糖(Glu)-静脉血: 4.67mmol/L；总胆红素(TBIL)-静脉血: 8.3umol/L；单核细胞百分比(Mono%)-静脉血: 0.074；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.5U/L；红细胞比容(Hct)-静脉血: 41%；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 1.56COI；单核细胞计数(Mono#)-静脉血: 0.310E9/L；中性粒细胞计数(Neut#)-静脉血: 2.510E9/L；胱抑素(Cys-C)-静脉血: 0.84mg/L；碱性磷酸酶(ALP)-静脉血: 80.5U/L；钠离子(Na+)-静脉血: 143.8mmol/L；乳酸脱氢酶(LDH)-静脉血: 194.4U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；平均红细胞血红蛋白浓度(MCHC)-静脉血: 324g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21.7U/L；氯离子(Cl-)-静脉血: 105.2mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.74；平均红细胞体积(MCV)-静脉血: 92.8fL；C-反应蛋白(CRP)-静脉血: 1.78mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.4；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: >1000IU/L；总胆固醇(TC)-静脉血: 5.98mmol/L；血红蛋白(Hb)-静脉血: 133g/L；大血小板百分比(P-LCR%)-静脉血: 26.1%；间接胆红素(IBIL)-静脉血: 6.3umolL；甘油三酯(TG)-静脉血: 1.04mmol/L；钾离子(K+)-静脉血: 4.23mmol/L；尿素氮(BUN)-静脉血: 5.6mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；中性粒细胞百分比(Neut%)-静脉血: 0.579；阴离子间隙(AG)-静脉血: 12.9；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.66mmol/L\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1081] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 多个颈腰椎、双侧膝关节可见片状放射性浓集灶。余颅骨、胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 考虑多个颈腰椎、双侧膝关节骨质退行性变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1092] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.006；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；颜色-尿液: 无色；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮\n- [全程D1094] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 28/μL；比重(SG)-尿液: 1.025；葡萄糖(Glu)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 36/μL；白细胞计数(WBC#)-尿液: 5/μL；酸碱度(pH)-尿液: 6.5；颜色-尿液: Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D1095] 检验组合: 白蛋白(ALB)-静脉血: 40.5g/L；镁离子(Mg2+)-静脉血: 0.84mmol/L；碱性磷酸酶(ALP)-静脉血: 63.2U/L；载脂蛋白B(apoB)-静脉血: 0.8g/L；葡萄糖(Glu)-静脉血: 5.31mmol/L；血小板比容-静脉血: 19%；直接胆红素(DBIL)-静脉血: 2.3umol/L；载脂蛋白AI(apoAI)-静脉血: 1.4g/L；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；总胆固醇(TC)-静脉血: 5.3mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.69mmolL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 325g/L；红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.9pg；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；γ-谷氨酰基转移酶(GGT)-静脉血: 16.8U/L；间接胆红素(IBIL)-静脉血: 5.6umolL；红细胞比容(Hct)-静脉血: 37.2%；钠离子(Na+)-静脉血: 141.6mmol/L；尿酸(UA)-静脉血: 219.2umol/L；总钙(Ca)-静脉血: 2.16mmol/L；尿素氮(BUN)-静脉血: 4.72mmol/L；平均红细胞体积(MCV)-静脉血: 91.9fL；球蛋白(GLO)-静脉血: 22.71g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.1；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14；乳酸脱氢酶(LDH)-静脉血: 179.4U/L；总胆红素(TBIL)-静脉血: 7.9umol/L；阴离子间隙(AG)-静脉血: 12；中性粒细胞百分比(Neut%)-静脉血: 0.814；血红蛋白(Hb)-静脉血: 121g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.1；丙氨酸氨基转移酶(ALT)-静脉血: 55.1U/L；白细胞计数(WBC#)-静脉血: 6.1210E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 36.2U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.58mmol/L；胱抑素(Cys-C)-静脉血: 0.95mg/L；大血小板百分比(P-LCR%)-静脉血: 17.3%；总胆汁酸(TBA)-静脉血: 1.6umol/L；血小板计数(PLT#)-静脉血: 20610E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；甘油三酯(TG)-静脉血: 1.54mmol/L；血小板分布宽度(PDW)-静脉血: 9.5%；总蛋白(TP)-静脉血: 63.21g/L\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1082] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，上级医师信息已隐藏示：患者目前诊断明确，[计划性表述已隐藏]根治性放疗及同期化疗。向患者及其家属交代病情，治疗方案及治疗风险，做好治疗前准备工作。\n- [全程D1083] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者入院第三天，无明显不适主诉，查体情况：一般情况可，余同入院。预约放疗。\n- [全程D1088] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 今日查房，患者无明显不适主诉，生命体征平稳。已予预约放疗。候治疗。\n- [全程D1093] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 今日查房，患者无明显不适主诉，生命体征平稳。查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常。患者现放疗计划已设计完成并通过全科会诊，靶区剂量分布均匀，正常组织剂量在可接受范围内。上级医师信息已隐藏示：患者无明显放化疗禁忌症，拟于今日开始行根治性放疗+同时期化疗。向患者及其家属交代病情及化疗风险，表示理解并已签署知情同意书，可于今日执行第1程顺铂方案同时期化疗，注意化疗不良反应。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停同期化疗，给予静脉保肝药物治疗，待转氨酶降至正常后再启动顺铂化疗\nB. 按原计划执行顺铂同期化疗，暂不予特殊保肝处理，常规监测肝功能\nC. 给予口服保肝药物，将顺铂剂量下调20%后执行同期化疗\nD. 给予静脉双重保肝药物，按原计划执行顺铂同期化疗，并动态复查肝功能\nE. 停用顺铂，更改为卡铂方案执行同期化疗，并给予口服保肝药物\nF. 给予口服保肝药物，推迟顺铂化疗1周，期间正常进行放疗\nG. 停用顺铂，更改为西妥昔单抗靶向治疗联合放疗，并给予口服保肝药物\nH. 给予口服保肝药物（如复方甘草酸苷、葡醛内酯），按原计划执行顺铂同期化疗，并动态复查肝功能\nI. 暂停放化疗，行腹部增强CT排查肝脏转移，并给予静脉保肝治疗\nJ. 给予口服保肝药物，按原计划执行顺铂同期化疗，并预防性使用重组人粒细胞刺激因子\nK. 给予口服保肝药物，按原计划执行顺铂同期化疗，并预防性使用广谱抗生素\nL. 给予口服保肝药物，将顺铂方案更改为奈达铂方案执行同期化疗\n\n请仅输出一个选项字母（A-L）。","gold_letter":"H","gold_action":"给予口服保肝药物（如复方甘草酸苷、葡醛内酯），按原计划执行顺铂同期化疗，并动态复查肝功能。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"暂停同期化疗，给予静脉保肝药物治疗，待转氨酶降至正常后再启动顺铂化疗"},{"letter":"B","text":"按原计划执行顺铂同期化疗，暂不予特殊保肝处理，常规监测肝功能"},{"letter":"C","text":"给予口服保肝药物，将顺铂剂量下调20%后执行同期化疗"},{"letter":"D","text":"给予静脉双重保肝药物，按原计划执行顺铂同期化疗，并动态复查肝功能"},{"letter":"E","text":"停用顺铂，更改为卡铂方案执行同期化疗，并给予口服保肝药物"},{"letter":"F","text":"给予口服保肝药物，推迟顺铂化疗1周，期间正常进行放疗"},{"letter":"G","text":"停用顺铂，更改为西妥昔单抗靶向治疗联合放疗，并给予口服保肝药物"},{"letter":"H","text":"给予口服保肝药物（如复方甘草酸苷、葡醛内酯），按原计划执行顺铂同期化疗，并动态复查肝功能"},{"letter":"I","text":"暂停放化疗，行腹部增强CT排查肝脏转移，并给予静脉保肝治疗"},{"letter":"J","text":"给予口服保肝药物，按原计划执行顺铂同期化疗，并预防性使用重组人粒细胞刺激因子"},{"letter":"K","text":"给予口服保肝药物，按原计划执行顺铂同期化疗，并预防性使用广谱抗生素"},{"letter":"L","text":"给予口服保肝药物，将顺铂方案更改为奈达铂方案执行同期化疗"}]}
+{"sample_id":"sample-c47048c6a3961cfb24a6bb12","patient_id":"patient-36d433557e63f939b878347d","turn_id":"turn06","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D1078] 入院记录: 主诉: 外院可疑鼻咽癌；现病史: 简要入院病史:患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。某次就诊时间再次出现回吸性涕血，遂行鼻咽镜检查，活检示：鼻咽炎性渗出。行鼻咽部CT示：鼻咽左侧可见软组织占位。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- [全程D1078] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 Ⅱ、Ⅲ、aVF、V4～V6导联ST段下移\n- [全程D1078] 检验组合: 镁离子(Mg2+)-静脉血: 0.96mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.6；Rh血型-静脉血: 阳性；直接胆红素(DBIL)-静脉血: 2umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.61COI；白蛋白(ALB)-静脉血: 45.5g/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 0.085COI；γ-谷氨酰基转移酶(GGT)-静脉血: 13.6U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.2fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；葡萄糖(Glu)-静脉血: 4.67mmol/L；总胆红素(TBIL)-静脉血: 8.3umol/L；单核细胞百分比(Mono%)-静脉血: 0.074；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.5U/L；红细胞比容(Hct)-静脉血: 41%；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 1.56COI；单核细胞计数(Mono#)-静脉血: 0.310E9/L；中性粒细胞计数(Neut#)-静脉血: 2.510E9/L；胱抑素(Cys-C)-静脉血: 0.84mg/L；碱性磷酸酶(ALP)-静脉血: 80.5U/L；钠离子(Na+)-静脉血: 143.8mmol/L；乳酸脱氢酶(LDH)-静脉血: 194.4U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；平均红细胞血红蛋白浓度(MCHC)-静脉血: 324g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21.7U/L；氯离子(Cl-)-静脉血: 105.2mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.74；平均红细胞体积(MCV)-静脉血: 92.8fL；C-反应蛋白(CRP)-静脉血: 1.78mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.4；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: >1000IU/L；总胆固醇(TC)-静脉血: 5.98mmol/L；血红蛋白(Hb)-静脉血: 133g/L；大血小板百分比(P-LCR%)-静脉血: 26.1%；间接胆红素(IBIL)-静脉血: 6.3umolL；甘油三酯(TG)-静脉血: 1.04mmol/L；钾离子(K+)-静脉血: 4.23mmol/L；尿素氮(BUN)-静脉血: 5.6mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；中性粒细胞百分比(Neut%)-静脉血: 0.579；阴离子间隙(AG)-静脉血: 12.9；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.66mmol/L\n- [全程D1081] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 多个颈腰椎、双侧膝关节可见片状放射性浓集灶。余颅骨、胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 考虑多个颈腰椎、双侧膝关节骨质退行性变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1092] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.006；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；颜色-尿液: 无色；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮\n- [全程D1094] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 28/μL；比重(SG)-尿液: 1.025；葡萄糖(Glu)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 36/μL；白细胞计数(WBC#)-尿液: 5/μL；酸碱度(pH)-尿液: 6.5；颜色-尿液: Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D1095] 检验组合: 白蛋白(ALB)-静脉血: 40.5g/L；镁离子(Mg2+)-静脉血: 0.84mmol/L；碱性磷酸酶(ALP)-静脉血: 63.2U/L；载脂蛋白B(apoB)-静脉血: 0.8g/L；葡萄糖(Glu)-静脉血: 5.31mmol/L；血小板比容-静脉血: 19%；直接胆红素(DBIL)-静脉血: 2.3umol/L；载脂蛋白AI(apoAI)-静脉血: 1.4g/L；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；总胆固醇(TC)-静脉血: 5.3mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.69mmolL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 325g/L；红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.9pg；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；γ-谷氨酰基转移酶(GGT)-静脉血: 16.8U/L；间接胆红素(IBIL)-静脉血: 5.6umolL；红细胞比容(Hct)-静脉血: 37.2%；钠离子(Na+)-静脉血: 141.6mmol/L；尿酸(UA)-静脉血: 219.2umol/L；总钙(Ca)-静脉血: 2.16mmol/L；尿素氮(BUN)-静脉血: 4.72mmol/L；平均红细胞体积(MCV)-静脉血: 91.9fL；球蛋白(GLO)-静脉血: 22.71g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.1；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14；乳酸脱氢酶(LDH)-静脉血: 179.4U/L；总胆红素(TBIL)-静脉血: 7.9umol/L；阴离子间隙(AG)-静脉血: 12；中性粒细胞百分比(Neut%)-静脉血: 0.814；血红蛋白(Hb)-静脉血: 121g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.1；丙氨酸氨基转移酶(ALT)-静脉血: 55.1U/L；白细胞计数(WBC#)-静脉血: 6.1210E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 36.2U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.58mmol/L；胱抑素(Cys-C)-静脉血: 0.95mg/L；大血小板百分比(P-LCR%)-静脉血: 17.3%；总胆汁酸(TBA)-静脉血: 1.6umol/L；血小板计数(PLT#)-静脉血: 20610E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；甘油三酯(TG)-静脉血: 1.54mmol/L；血小板分布宽度(PDW)-静脉血: 9.5%；总蛋白(TP)-静脉血: 63.21g/L\n- [全程D1102] 检验组合: 尿酸(UA)-静脉血: 238.2umol/L；总胆红素(TBIL)-静脉血: 6.2umol/L；白细胞计数(WBC#)-静脉血: 3.5310E9/L；间接胆红素(IBIL)-静脉血: 4.8umolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.3；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.02；阴离子间隙(AG)-静脉血: 15.1；磷(P)-静脉血: 1.08mmol/L；钠离子(Na+)-静脉血: 137.5mmol/L；总钙(Ca)-静脉血: 2.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 26.7U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.8；直接胆红素(DBIL)-静脉血: 1.4umol/L；球蛋白(GLO)-静脉血: 27.56g/L；载脂蛋白AI(apoAI)-静脉血: 1.46g/L；红细胞计数(RBC#)-静脉血: 4.6610E12/L；载脂蛋白B(apoB)-静脉血: 1.09g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；血红蛋白(Hb)-静脉血: 142g/L；葡萄糖(Glu)-静脉血: 5.62mmol/L；甘油三酯(TG)-静脉血: 0.98mmol/L；镁离子(Mg2+)-静脉血: 0.97mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；血小板分布宽度(PDW)-静脉血: 9.2%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；总胆固醇(TC)-静脉血: 5.85mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336g/L；平均血小板体积(MPV)-静脉血: 9fL；血小板计数(PLT#)-静脉血: 19010E9/L；血小板比容-静脉血: 17%；红细胞比容(Hct)-静脉血: 42.3%；总胆汁酸(TBA)-静脉血: 1.8umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.76mmolL；胱抑素(Cys-C)-静脉血: 0.89mg/L；肌酐(Crea)-静脉血: 54.9umol/L；白蛋白(ALB)-静脉血: 46.6g/L；氯离子(Cl-)-静脉血: 97.8mmol/L；钾离子(K+)-静脉血: 3.78mmol/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；大血小板百分比(P-LCR%)-静脉血: 16.6%；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；平均红细胞体积(MCV)-静脉血: 90.8fL；α-L-岩藻糖苷酶(AFU)-静脉血: 28.3U/L；中性粒细胞计数(Neut#)-静脉血: 2.310E9/L\n\n【既往治疗与反应】\n- [全程D1082] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，上级医师信息已隐藏示：患者目前诊断明确，[计划性表述已隐藏]根治性放疗及同期化疗。向患者及其家属交代病情，治疗方案及治疗风险，做好治疗前准备工作。\n- [全程D1083] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者入院第三天，无明显不适主诉，查体情况：一般情况可，余同入院。预约放疗。\n- [全程D1088] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 今日查房，患者无明显不适主诉，生命体征平稳。已予预约放疗。候治疗。\n- [全程D1093] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 今日查房，患者无明显不适主诉，生命体征平稳。查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常。患者现放疗计划已设计完成并通过全科会诊，靶区剂量分布均匀，正常组织剂量在可接受范围内。上级医师信息已隐藏示：患者无明显放化疗禁忌症，拟于今日开始行根治性放疗+同时期化疗。向患者及其家属交代病情及化疗风险，表示理解并已签署知情同意书，可于今日执行第1程顺铂方案同时期化疗，注意化疗不良反应。\n- [全程D1098] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者根治性放疗中，第1程顺铂方案同时期化疗结束。今日查房，患者诉呕吐2次，咽痛、恶心、食欲下降，伴头晕，无腹痛、腹泻等不适。复查血常规、肝肾功能大致正常。上级医师信息已隐藏：予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放化疗，给予重组人粒细胞集落刺激因子治疗，待白细胞恢复后继续\nB. 暂停同期化疗，仅继续根治性放疗，并给予重组人粒细胞集落刺激因子\nC. 继续根治性放疗及同期化疗，下一疗程顺铂剂量减量20%\nD. 继续根治性放疗及同期化疗，加用重组人粒细胞集落刺激因子\nE. 暂停放化疗，给予静脉高营养及强效止吐、补液支持，暂缓抗肿瘤治疗\nF. 继续根治性放疗及同期化疗，加用重组人血小板生成素\nG. 暂停同期化疗，将后续全身治疗更换为尼妥珠单抗靶向治疗\nH. 继续根治性放疗及同期化疗，加用促红细胞生成素及铁剂\nI. 继续根治性放疗及同期化疗，暂不予集落刺激因子支持，密切监测血常规\nJ. 暂停放化疗，行骨髓穿刺评估造血功能后再决定后续治疗\nK. 继续根治性放疗，终止同期化疗，放疗结束后改为辅助化疗\nL. 继续根治性放疗及同期化疗，降低放疗靶区处方剂量\n\n请仅输出一个选项字母（A-L）。","gold_letter":"I","gold_action":"继续根治性放疗及同期化疗，暂不予集落刺激因子支持，密切监测血常规","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"暂停放化疗，给予重组人粒细胞集落刺激因子治疗，待白细胞恢复后继续"},{"letter":"B","text":"暂停同期化疗，仅继续根治性放疗，并给予重组人粒细胞集落刺激因子"},{"letter":"C","text":"继续根治性放疗及同期化疗，下一疗程顺铂剂量减量20%"},{"letter":"D","text":"继续根治性放疗及同期化疗，加用重组人粒细胞集落刺激因子"},{"letter":"E","text":"暂停放化疗，给予静脉高营养及强效止吐、补液支持，暂缓抗肿瘤治疗"},{"letter":"F","text":"继续根治性放疗及同期化疗，加用重组人血小板生成素"},{"letter":"G","text":"暂停同期化疗，将后续全身治疗更换为尼妥珠单抗靶向治疗"},{"letter":"H","text":"继续根治性放疗及同期化疗，加用促红细胞生成素及铁剂"},{"letter":"I","text":"继续根治性放疗及同期化疗，暂不予集落刺激因子支持，密切监测血常规"},{"letter":"J","text":"暂停放化疗，行骨髓穿刺评估造血功能后再决定后续治疗"},{"letter":"K","text":"继续根治性放疗，终止同期化疗，放疗结束后改为辅助化疗"},{"letter":"L","text":"继续根治性放疗及同期化疗，降低放疗靶区处方剂量"}]}
+{"sample_id":"sample-40b7a6f655350cf46e9ce33c","patient_id":"patient-36d433557e63f939b878347d","turn_id":"turn08","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D1078] 入院记录: 主诉: 外院可疑鼻咽癌；现病史: 简要入院病史:患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。某次就诊时间再次出现回吸性涕血，遂行鼻咽镜检查，活检示：鼻咽炎性渗出。行鼻咽部CT示：鼻咽左侧可见软组织占位。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- [全程D1078] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 Ⅱ、Ⅲ、aVF、V4～V6导联ST段下移\n- [全程D1109] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 28.2mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；钾离子(K+)-静脉血: 3.77mmol/L；甘油三酯(TG)-静脉血: 0.8mmol/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；红细胞计数(RBC#)-静脉血: 4.2410E12/L；总胆固醇(TC)-静脉血: 5.21mmol/L；镁离子(Mg2+)-静脉血: 0.97mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.6；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；总胆汁酸(TBA)-静脉血: 0.6umol/L；总胆红素(TBIL)-静脉血: 8.6umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.119；红细胞比容(Hct)-静脉血: 38.7%；尿素氮(BUN)-静脉血: 4.1mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；间接胆红素(IBIL)-静脉血: 6.5umolL；C-反应蛋白(CRP)-静脉血: 2.85mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.53mmolL；血小板分布宽度(PDW)-静脉血: 17.4%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.29mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；阴离子间隙(AG)-静脉血: 15；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；血小板计数(PLT#)-静脉血: 204.310E9/L；平均红细胞体积(MCV)-静脉血: 91.1fL；丙氨酸氨基转移酶(ALT)-静脉血: 12.3U/L；总蛋白(TP)-静脉血: 69.21g/L；直接胆红素(DBIL)-静脉血: 2.1umol/L；氯离子(Cl-)-静脉血: 95.7mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.784；中性粒细胞计数(Neut#)-静脉血: 2.310E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22.8U/L；平均血小板体积(MPV)-静脉血: 6.38fL；γ-谷氨酰基转移酶(GGT)-静脉血: 23.6U/L；总钙(Ca)-静脉血: 2.22mmol/L；单核细胞百分比(Mono%)-静脉血: 0.081；碱性磷酸酶(ALP)-静脉血: 70.6U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.9pg；胱抑素(Cys-C)-静脉血: 0.76mg/L；尿酸(UA)-静脉血: 181umol/L；白细胞计数(WBC#)-静脉血: 2.8910E9/L；葡萄糖(Glu)-静脉血: 4.95mmol/L；血小板比容-静脉血: 13%\n- [全程D1113] 检验组合: 血小板比容-静脉血: 15%；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 6.5；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.734；平均红细胞体积(MCV)-静脉血: 91.5fL；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；隐血(OB)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；中性粒细胞计数(Neut#)-静脉血: 2.310E9/L；总蛋白(TP)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 1/μL；红细胞计数(RBC#)-静脉血: 4.1310E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；血小板计数(PLT#)-静脉血: 16810E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；比重(SG)-尿液: 1.009；浊度(TRUB)-尿液: 清亮；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.05；大血小板百分比(P-LCR%)-静脉血: 18%；单核细胞计数(Mono#)-静脉血: 0.410E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.5；酮体(KET)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 13/μL；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-静脉血: 3.210E9/L；白细胞(LEU)-尿液: -（参考: 阴性）；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；红细胞比容(Hct)-静脉血: 37.8%；血红蛋白(Hb)-静脉血: 126g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.5；血小板分布宽度(PDW)-静脉血: 9.3%；淋巴细胞百分比(Lymph%)-静脉血: 0.103；平均红细胞血红蛋白浓度(MCHC)-静脉血: 333g/L；平均血小板体积(MPV)-静脉血: 8.9fL；单核细胞百分比(Mono%)-静脉血: 0.11\n- [全程D1114] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 16/μL；颜色-尿液: Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: +- 0.1g（参考: 阴性）；酮体(KET)-尿液: 1+ 1mmol（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 6.5；比重(SG)-尿液: 1.022；白细胞计数(WBC#)-尿液: 10/μL；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）\n- [全程D1116] 检验组合: 亚硝酸盐(NIT)-尿液: -（参考: 阴性）；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336.3g/L；阴离子间隙(AG)-静脉血: 12；总蛋白(TP)-尿液: -（参考: 阴性）；磷(P)-静脉血: 0.93mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20U/L；尿酸(UA)-静脉血: 199.4umol/L；平均红细胞体积(MCV)-静脉血: 92.9fL；碱性磷酸酶(ALP)-静脉血: 61.6U/L；酸碱度(pH)-尿液: 6.5；血小板分布宽度(PDW)-静脉血: 17%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.032；隐血(OB)-尿液: -（参考: 阴性）；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.44mmolL；肌酐(Crea)-静脉血: 67.5umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.2；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；氯离子(Cl-)-静脉血: 102.9mmol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；总胆红素(TBIL)-静脉血: 6.7umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14%；血小板计数(PLT#)-静脉血: 176.710E9/L；总蛋白(TP)-静脉血: 65.51g/L；尿素氮(BUN)-静脉血: 3.95mmol/L；红细胞计数(RBC#)-静脉血: 3.8510E12/L；甘油三酯(TG)-静脉血: 1.05mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；α-L-岩藻糖苷酶(AFU)-静脉血: 30U/L；间接胆红素(IBIL)-静脉血: 4.4umolL；总胆固醇(TC)-静脉血: 5.25mmol/L；浊度(TRUB)-尿液: 清亮；平均血小板体积(MPV)-静脉血: 6.6fL；胆红素(BIL)-尿液: -（参考: 阴性）；总胆汁酸(TBA)-静脉血: 0.2umol/L；载脂蛋白B(apoB)-静脉血: 0.98g/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；中性粒细胞计数(Neut#)-静脉血: 2.810E9/L；钾离子(K+)-静脉血: 3.3mmol/L；白蛋白(ALB)-静脉血: 39.1g/L；血小板比容-静脉血: 11.6%；胱抑素(Cys-C)-静脉血: 1.06mg/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；酮体(KET)-尿液: -（参考: 阴性）\n- [全程D1123] 检验组合: 红细胞计数(RBC#)-静脉血: 4.3710E12/L；中性粒细胞计数(Neut#)-静脉血: 310E9/L；平均红细胞体积(MCV)-静脉血: 90fL；甘油三酯(TG)-静脉血: 1.06mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.55；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.072；白蛋白(ALB)-静脉血: 44.8g/L；单核细胞百分比(Mono%)-静脉血: 0.081；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；红细胞比容(Hct)-静脉血: 39.4%；总钙(Ca)-静脉血: 2.44mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.8pg；血小板比容-静脉血: 10%；氯离子(Cl-)-静脉血: 92.5mmol/L；血小板计数(PLT#)-静脉血: 143.810E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.98mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4%；中性粒细胞百分比(Neut%)-静脉血: 0.841；总胆固醇(TC)-静脉血: 6.12mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 343.2g/L；间接胆红素(IBIL)-静脉血: 6.2umolL；尿素氮(BUN)-静脉血: 7.4mmol/L；平均血小板体积(MPV)-静脉血: 6.98fL；总胆红素(TBIL)-静脉血: 8.2umol/L；胱抑素(Cys-C)-静脉血: 0.86mg/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；载脂蛋白B(apoB)-静脉血: 1.37g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.9U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；C-反应蛋白(CRP)-静脉血: 10.49mg/L；球蛋白(GLO)-静脉血: 30.65g/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.46；葡萄糖(Glu)-静脉血: 5.64mmol/L；磷(P)-静脉血: 1.16mmol/L；乳酸脱氢酶(LDH)-静脉血: 199.5U/L；钾离子(K+)-静脉血: 2.83mmol/L；血小板分布宽度(PDW)-静脉血: 18%；载脂蛋白AI(apoAI)-静脉血: 1.38g/L；总胆汁酸(TBA)-静脉血: 0.6umol/L；血红蛋白(Hb)-静脉血: 135.3g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.48mmolL；钠离子(Na+)-静脉血: 138.8mmol/L\n- [全程D1125] 检验组合: 总钙(Ca)-静脉血: 2.38mmol/L；阴离子间隙(AG)-静脉血: 12.7；磷(P)-静脉血: 0.81mmol/L；氯离子(Cl-)-静脉血: 92.5mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 28.7mmol/L；钾离子(K+)-静脉血: 3.68mmol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；钠离子(Na+)-静脉血: 133.9mmol/L\n- [全程D1130] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对侧，双肺野纹理清晰，未见明显实质性病变。双侧肺门不大，纵隔不宽，心影形态、大小、位置未见异常。双膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见异常。\n- [全程D1130] 超声；肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。\n- [全程D1130] 检验组合: 有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞血红蛋白含量(MCH)-静脉血: 31.3pg；淋巴细胞百分比(Lymph%)-静脉血: 0.09；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4%；单核细胞计数(Mono#)-静脉血: 0.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.184；白蛋白(ALB)-静脉血: 43.5g/L；球蛋白(GLO)-静脉血: 29.66g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.32mmolL；总胆固醇(TC)-静脉血: 5.82mmol/L；葡萄糖(Glu)-静脉血: 5.74mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21U/L；中性粒细胞计数(Neut#)-静脉血: 1.510E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.9U/L；中性粒细胞百分比(Neut%)-静脉血: 0.715；尿酸(UA)-静脉血: 242.7umol/L；总胆汁酸(TBA)-静脉血: 0.2umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.005；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；血红蛋白(Hb)-静脉血: 125g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血小板分布宽度(PDW)-静脉血: 17.2%；总胆红素(TBIL)-静脉血: 6.6umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 28.4mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 344.5g/L；钾离子(K+)-静脉血: 3.7mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.8U/L；载脂蛋白B(apoB)-静脉血: 1.31g/L；红细胞计数(RBC#)-静脉血: 3.9910E12/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.4；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 90.9fL；总蛋白(TP)-静脉血: 73.16g/L；平均血小板体积(MPV)-静脉血: 6.84fL；血小板计数(PLT#)-静脉血: 181.410E9/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.91mmol/L；胱抑素(Cys-C)-静脉血: 0.92mg/L；间接胆红素(IBIL)-静脉血: 4.2umolL；碱性磷酸酶(ALP)-静脉血: 83.1U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；阴离子间隙(AG)-静脉血: 15；直接胆红素(DBIL)-静脉血: 2.4umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板比容-静脉血: 12.4%\n\n【既往治疗与反应】\n- [全程D1108] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者根治性放疗中。今日查房，患者无明显不适主诉，生命体征平稳。上级医师信息已隐藏：继续治疗。\n- [全程D1113] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者根治性放疗中。今日查房，患者无明显不适主诉，生命体征平稳。查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，上级医师信息已隐藏示：可于今日水化，明日执行第2程DDP方案同时期化疗，注意化疗不良反应。\n- [全程D1118] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者根治性放疗中，第2程顺铂方案同时期化疗结束。诉咽痛、恶心、食欲下降，呕吐1次，伴头晕，无腹痛、腹泻等不适。复查血常规、肝肾功能大致正常。上级医师信息已隐藏：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D1123] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者根治性放疗中。今日查房，患者无明显不适主诉，生命体征平稳。上级医师信息已隐藏：患者治疗疗程过半，予预约治疗结束后影像学复查。继续治疗。\n- [全程D1129] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者根治性放疗中。今日查房，患者无明显不适主诉，生命体征平稳。上级医师信息已隐藏：嘱患者冲洗鼻咽，保持鼻咽清洁。继续治疗。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即行鼻咽及颈部MRI复查，视近期疗效评估结果调整放疗靶区及剂量。\nB. 安排第3程顺铂同期化疗，并继续住院完成剩余根治性放疗疗程。\nC. 暂停放疗，行全身PET-CT检查以排除远处转移，待结果回报后决定后续方案。\nD. 办理出院，结束所有抗肿瘤治疗，进入定期随访阶段，1个月后复查MRI。\nE. 调整化疗方案为紫杉醇+顺铂，继续住院行第3程同期化疗及放疗。\nF. 立即行鼻咽镜检查及活检，视病理退缩情况调整后续放疗方案。\nG. 办理出院，转门诊继续放疗，并加用西妥昔单抗靶向治疗。\nH. 继续住院完成剩余放疗，期间每周复查血常规及生化，待放疗结束后出院。\nI. 办理出院，转门诊继续放疗，并立即启动顺铂+氟尿嘧啶方案辅助化疗。\nJ. 立即行胸部CT及腹部增强CT，视全面评估结果决定是否继续门诊放疗。\nK. 办理出院，转门诊继续完成根治性放疗，每周复查血常规及生化，指导鼻腔冲洗与功能锻炼。\nL. 暂停放疗，给予重组人粒细胞刺激因子及升血小板治疗，待血象完全恢复正常后继续放疗。\n\n请仅输出一个选项字母（A-L）。","gold_letter":"K","gold_action":"办理出院，转门诊继续完成根治性放疗，每周复查血常规及生化，指导鼻腔冲洗与功能锻炼。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"立即行鼻咽及颈部MRI复查，视近期疗效评估结果调整放疗靶区及剂量。"},{"letter":"B","text":"安排第3程顺铂同期化疗，并继续住院完成剩余根治性放疗疗程。"},{"letter":"C","text":"暂停放疗，行全身PET-CT检查以排除远处转移，待结果回报后决定后续方案。"},{"letter":"D","text":"办理出院，结束所有抗肿瘤治疗，进入定期随访阶段，1个月后复查MRI。"},{"letter":"E","text":"调整化疗方案为紫杉醇+顺铂，继续住院行第3程同期化疗及放疗。"},{"letter":"F","text":"立即行鼻咽镜检查及活检，视病理退缩情况调整后续放疗方案。"},{"letter":"G","text":"办理出院，转门诊继续放疗，并加用西妥昔单抗靶向治疗。"},{"letter":"H","text":"继续住院完成剩余放疗，期间每周复查血常规及生化，待放疗结束后出院。"},{"letter":"I","text":"办理出院，转门诊继续放疗，并立即启动顺铂+氟尿嘧啶方案辅助化疗。"},{"letter":"J","text":"立即行胸部CT及腹部增强CT，视全面评估结果决定是否继续门诊放疗。"},{"letter":"K","text":"办理出院，转门诊继续完成根治性放疗，每周复查血常规及生化，指导鼻腔冲洗与功能锻炼。"},{"letter":"L","text":"暂停放疗，给予重组人粒细胞刺激因子及升血小板治疗，待血象完全恢复正常后继续放疗。"}]}
+{"sample_id":"sample-58cbc880ddd38089d56cda8c","patient_id":"patient-79fa00752e4405e2980f6292","turn_id":"turn02","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- 暂无可展示的初诊主诉/入院资料。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 Ⅰ、Ⅱ、Ⅲ、aVF、V4～V6导联ST段下移\n- [全程D1] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；球蛋白(GLO)-静脉血: 30.03g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.9mmol/L；D-二聚体(D-Dimer)-静脉血: 0.13ug/ml；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；氯离子(Cl-)-静脉血: 98.1mmol/L；平均红细胞体积(MCV)-静脉血: 87.2fL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.91；大血小板百分比(P-LCR%)-静脉血: 33.4%；甘油三酯(TG)-静脉血: 1.01mmol/L；总钙(Ca)-静脉血: 2.28mmol/L；总胆固醇(TC)-静脉血: 5.44mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 25.2U/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 40.9umol/L；纤维蛋白原(Fbg)-静脉血: 2.51g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 20U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.34mmolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.58mmol/L；白细胞计数(WBC#)-静脉血: 6.9810E9/L；凝血酶时间(TT)-静脉血: 17.5sec.；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.013；红细胞计数(RBC#)-静脉血: 4.6710E12/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.98；直接胆红素(DBIL)-静脉血: 3.4umol/L；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 26.3mmol/L；磷(P)-静脉血: 1.03mmol/L；尿酸(UA)-静脉血: 391.1umol/L；碱性磷酸酶(ALP)-静脉血: 108U/L；血小板分布宽度(PDW)-静脉血: 13.4%；总蛋白(TP)-静脉血: 78.13g/L；白蛋白(ALB)-静脉血: 48.1g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 101U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 22.9U/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 327g/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；总胆汁酸(TBA)-静脉血: 5.4umol/L；ABO血型-静脉血: O；钠离子(Na+)-静脉血: 139.3mmol/L；阴离子间隙(AG)-静脉血: 14.9\n- [全程D5] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁及右侧壁粘膜增厚放射性浓聚，SUV约7.3，病灶疑累及蝶骨基底部；右侧咽隐窝变浅；双侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见明显异常。口咽及喉咽结构及放射性分布未见明显异常。额窦、蝶窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双上颈小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。双乳腺结构及放射性分布未见明显异常。 肝S7点状高密度影放射性缺损，CT值约124Hu；其余肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 子宫边缘弧形改变，见结节状稍高密度影放射性分布未见明显异常，大小约3.8×4.3cm；左附件囊性低密度影放射性稀疏，大小约2.2×2.3cm，CT值约22Hu。膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 所见颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽顶壁及右侧壁粘膜增厚代谢活跃，考虑鼻咽癌，疑累及蝶骨基底部。 肝S7肝内胆管结石。 子宫肌瘤。 左附件囊肿。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行鼻咽镜检查及局部活检，并完善鼻咽及颈部增强MRI\nB. 行鼻咽镜检查及局部活检，并完善鼻咽及颈部平扫CT\nC. 行鼻咽镜检查及局部活检，无需补充其他局部影像学检查\nD. 完善鼻咽及颈部增强MRI，并直接开始根治性放疗\nE. 行鼻咽镜检查及局部活检，并完善全身骨扫描及胸部平扫CT\nF. 行鼻咽镜检查及局部活检，并完善头颅增强MRI及颈部超声\nG. 完善鼻咽及颈部增强MRI，并择期行鼻咽部肿物切除术\nH. 行鼻咽镜检查及局部活检，并完善颈部淋巴结穿刺活检\nI. 行鼻咽镜检查及局部活检，并完善鼻咽及颈部增强CT\nJ. 完善鼻咽及颈部增强MRI，并完善外周血EBV-DNA定量检测\nK. 行鼻咽镜检查及局部活检，并完善盆腔增强MRI及妇科超声\nL. 行鼻咽镜检查及局部活检，并完善脑脊液脱落细胞学检查\n\n请仅输出一个选项字母（A-L）。","gold_letter":"A","gold_action":"行鼻咽镜检查及局部活检，并完善鼻咽及颈部增强MRI","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"行鼻咽镜检查及局部活检，并完善鼻咽及颈部增强MRI"},{"letter":"B","text":"行鼻咽镜检查及局部活检，并完善鼻咽及颈部平扫CT"},{"letter":"C","text":"行鼻咽镜检查及局部活检，无需补充其他局部影像学检查"},{"letter":"D","text":"完善鼻咽及颈部增强MRI，并直接开始根治性放疗"},{"letter":"E","text":"行鼻咽镜检查及局部活检，并完善全身骨扫描及胸部平扫CT"},{"letter":"F","text":"行鼻咽镜检查及局部活检，并完善头颅增强MRI及颈部超声"},{"letter":"G","text":"完善鼻咽及颈部增强MRI，并择期行鼻咽部肿物切除术"},{"letter":"H","text":"行鼻咽镜检查及局部活检，并完善颈部淋巴结穿刺活检"},{"letter":"I","text":"行鼻咽镜检查及局部活检，并完善鼻咽及颈部增强CT"},{"letter":"J","text":"完善鼻咽及颈部增强MRI，并完善外周血EBV-DNA定量检测"},{"letter":"K","text":"行鼻咽镜检查及局部活检，并完善盆腔增强MRI及妇科超声"},{"letter":"L","text":"行鼻咽镜检查及局部活检，并完善脑脊液脱落细胞学检查"}]}
+{"sample_id":"sample-cc72c6bbde9abe2a112ce0fc","patient_id":"patient-79fa00752e4405e2980f6292","turn_id":"turn07","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D52] 入院记录: 主诉: 鼻咽癌一程化疗后两周余；现病史: 缘于1年前患者无明显诱因出现回吸性涕血，无头痛、鼻塞、耳鸣、复视、面麻等不适，未予重视，3个月前出现前额部疼痛，伴鼻衅，并于当地医院行鼻咽活检病理考虑鼻咽低分化型癌可能性大。于某次就诊时间10月底来我科就诊，并行根治性放疗计划设计，于某次就诊时间开始行根治性放疗，同时期予以DDP化疗1程，治疗过程顺利。今同期化疗到期来我科继续治疗，患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 额部疼痛,涕血；既往史: 高血压10年余服药治疗中，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.9℃，P：72次/分，R：20次/分，BP：127/91mmHg,Ht：160cm，Wt：62.5kg，BSA：1.65m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率72次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽右侧顶后壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 Ⅰ、Ⅱ、Ⅲ、aVF、V4～V6导联ST段下移\n- [全程D1] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；球蛋白(GLO)-静脉血: 30.03g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.9mmol/L；D-二聚体(D-Dimer)-静脉血: 0.13ug/ml；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；氯离子(Cl-)-静脉血: 98.1mmol/L；平均红细胞体积(MCV)-静脉血: 87.2fL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.91；大血小板百分比(P-LCR%)-静脉血: 33.4%；甘油三酯(TG)-静脉血: 1.01mmol/L；总钙(Ca)-静脉血: 2.28mmol/L；总胆固醇(TC)-静脉血: 5.44mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 25.2U/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 40.9umol/L；纤维蛋白原(Fbg)-静脉血: 2.51g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 20U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.34mmolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.58mmol/L；白细胞计数(WBC#)-静脉血: 6.9810E9/L；凝血酶时间(TT)-静脉血: 17.5sec.；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.013；红细胞计数(RBC#)-静脉血: 4.6710E12/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.98；直接胆红素(DBIL)-静脉血: 3.4umol/L；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 26.3mmol/L；磷(P)-静脉血: 1.03mmol/L；尿酸(UA)-静脉血: 391.1umol/L；碱性磷酸酶(ALP)-静脉血: 108U/L；血小板分布宽度(PDW)-静脉血: 13.4%；总蛋白(TP)-静脉血: 78.13g/L；白蛋白(ALB)-静脉血: 48.1g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 101U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 22.9U/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 327g/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；总胆汁酸(TBA)-静脉血: 5.4umol/L；ABO血型-静脉血: O；钠离子(Na+)-静脉血: 139.3mmol/L；阴离子间隙(AG)-静脉血: 14.9\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D27] 检验组合: 血小板分布宽度(PDW)-静脉血: 12.2%；平均血小板体积(MPV)-静脉血: 11.2fL；红细胞比容(Hct)-静脉血: 37.5%；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；红细胞比容(Hct)-静脉血: 35.5%；碱性磷酸酶(ALP)-静脉血: 91.7U/L；白蛋白(ALB)-静脉血: 45.5g/L；C-反应蛋白(CRP)-静脉血: 1.15mg/L；血红蛋白(Hb)-静脉血: 121g/L；直接胆红素(DBIL)-静脉血: 3.7umol/L；血红蛋白(Hb)-静脉血: 111g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.4；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；葡萄糖(Glu)-静脉血: 5.1mmol/L；白细胞计数(WBC#)-静脉血: 13.710E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.51mmolL；红细胞计数(RBC#)-静脉血: 3.8810E12/L；颜色-尿液: Light-Orange；尿素氮(BUN)-静脉血: 5.77mmol/L；胱抑素(Cys-C)-静脉血: 0.99mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.59；钾离子(K+)-静脉血: 4.2mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 19U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 266.5U/L；磷(P)-静脉血: 1.03mmol/L；中性粒细胞计数(Neut#)-静脉血: 4.110E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.241；平均红细胞体积(MCV)-静脉血: 82.9fL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.81mmol/L；大血小板百分比(P-LCR%)-静脉血: 27.5%；红细胞计数(RBC#)-静脉血: 4.1410E12/L；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；甘油三酯(TG)-静脉血: 1.02mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.9；尿酸(UA)-静脉血: 295.4umol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；单核细胞百分比(Mono%)-静脉血: 0.034；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；总胆红素(TBIL)-静脉血: 22.9umol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.1pg；钠离子(Na+)-静脉血: 139.4mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.4U/L；间接胆红素(IBIL)-静脉血: 7.6umolL；红细胞计数(RBC#)-静脉血: 4.2810E12/L\n- [全程D31] 检验组合: 丙氨酸氨基转移酶(ALT)-静脉血: 91.9U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 30.5U/L；碱性磷酸酶(ALP)-静脉血: 104.1U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 114U/L；乳酸脱氢酶(LDH)-静脉血: 159.5U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 23.5U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.33；总胆汁酸(TBA)-静脉血: 2umol/L\n- [全程D42] 检验组合: 磷(P)-静脉血: 1.12mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.66；钠离子(Na+)-静脉血: 139.9mmol/L；白蛋白(ALB)-静脉血: 43.7g/L；镁离子(Mg2+)-静脉血: 0.74mmol/L；钾离子(K+)-静脉血: 4.14mmol/L；氯离子(Cl-)-静脉血: 98mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 91.5U/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.5U/L；总胆红素(TBIL)-静脉血: 10.2umol/L；尿素氮(BUN)-静脉血: 5.7mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.7mmol/L；阴离子间隙(AG)-静脉血: 16.2；直接胆红素(DBIL)-静脉血: 3.2umol/L；尿酸(UA)-静脉血: 335.2umol/L；碱性磷酸酶(ALP)-静脉血: 75.1U/L；间接胆红素(IBIL)-静脉血: 7umolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.28；α-L-岩藻糖苷酶(AFU)-静脉血: 18.2U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.3U/L；球蛋白(GLO)-静脉血: 26.28g/L；总钙(Ca)-静脉血: 2.33mmol/L；肌酐(Crea)-静脉血: 77.8umol/L；总蛋白(TP)-静脉血: 69.98g/L；乳酸脱氢酶(LDH)-静脉血: 203.7U/L；总胆汁酸(TBA)-静脉血: 1.9umol/L\n- [全程D52] 检验组合: 白细胞计数(WBC#)-尿液: 2/μL；非鳞状上皮细胞计数-尿液: 3/μL；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；酸碱度(pH)-尿液: 6.5；红细胞计数(RBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；隐血(OB)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.014；尿胆原(URO)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 28/μL；总蛋白(TP)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 26/μL；白细胞(LEU)-尿液: -（参考: 阴性）\n- [全程D54] 检验组合: 红细胞计数(RBC#)-静脉血: 3.9510E12/L；血小板分布宽度(PDW)-静脉血: 12.5%；载脂蛋白B(apoB)-静脉血: 1.08g/L；酸碱度(pH)-尿液: 6.5；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.002；丙氨酸氨基转移酶(ALT)-静脉血: 12.3U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.092；尿素氮(BUN)-静脉血: 4.3mmol/L；酮体(KET)-尿液: 1+ 2mmol（参考: 阴性）；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.6；阴离子间隙(AG)-静脉血: 13.6；浊度(TRUB)-尿液: Turbid；颜色-尿液: Yellow；隐血(OB)-尿液: -（参考: 阴性）；镁离子(Mg2+)-静脉血: 0.61mmol/L；透明管型计数(HYAL#)-尿液: 1/μL；总胆红素(TBIL)-静脉血: 12umol/L；磷(P)-静脉血: 1.12mmol/L；浊度(TRUB)-尿液: Turbid；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿酸(UA)-静脉血: 317.3umol/L；总蛋白(TP)-尿液: 1+ 0.3g（参考: 阴性）；白蛋白(ALB)-静脉血: 42.2g/L；平均血小板体积(MPV)-静脉血: 10.8fL；中性粒细胞计数(Neut#)-静脉血: 3.410E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.1U/L；透明管型计数(HYAL#)-尿液: 2/μL；直接胆红素(DBIL)-静脉血: 3.8umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.67；白细胞计数(WBC#)-尿液: 25/μL；钾离子(K+)-静脉血: 3.33mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.6；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.08mmolL；比重(SG)-尿液: 1.024；未分类管型计数(UNCC#)-尿液: 2/μL；载脂蛋白AI(apoAI)-静脉血: 1.1g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.6pg；未分类管型计数(UNCC#)-尿液: 4/μL；隐血(OB)-尿液: -（参考: 阴性）；球蛋白(GLO)-静脉血: 25.25g/L；红细胞比容(Hct)-静脉血: 33.2%；血红蛋白(Hb)-静脉血: 113g/L；C-反应蛋白(CRP)-静脉血: 0.62mg/L；比重(SG)-尿液: 1.033；血小板计数(PLT#)-静脉血: 18310E9/L\n- [全程D55] 检验组合: 中性粒细胞计数(Neut#)-静脉血: 8.410E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；直接胆红素(DBIL)-静脉血: 7umol/L；血小板计数(PLT#)-静脉血: 16910E9/L；红细胞计数(RBC#)-静脉血: 3.2710E12/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0；血小板比容-静脉血: 17%；碱性磷酸酶(ALP)-静脉血: 79.8U/L；阴离子间隙(AG)-静脉血: 13；天门冬氨酸氨基转移酶(AST)-静脉血: 19.5U/L；碱性磷酸酶(ALP)-静脉血: 58.6U/L；载脂蛋白AI(apoAI)-静脉血: 0.97g/L；丙氨酸氨基转移酶(ALT)-静脉血: 31.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；钾离子(K+)-静脉血: 3.14mmol/L；胱抑素(Cys-C)-静脉血: 1.36mg/L；血红蛋白(Hb)-静脉血: 96g/L；平均血小板体积(MPV)-静脉血: 9.9fL；血小板分布宽度(PDW)-静脉血: 16.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 30.3pg；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.66；载脂蛋白B(apoB)-静脉血: 1.48g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.5U/L；白细胞计数(WBC#)-静脉血: 9.3910E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.48mmolL；淋巴细胞百分比(Lymph%)-静脉血: 0.064；总钙(Ca)-静脉血: 2.53mmol/L；甘油三酯(TG)-静脉血: 1.31mmol/L；尿酸(UA)-静脉血: 560.6umol/L；阴离子间隙(AG)-静脉血: 17；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.81mmol/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；尿素氮(BUN)-静脉血: 4.58mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.04mmolL；尿酸(UA)-静脉血: 415.9umol/L；白蛋白(ALB)-静脉血: 47.6g/L；红细胞比容(Hct)-静脉血: 28.4%；球蛋白(GLO)-静脉血: 28.72g/L；肌酐(Crea)-静脉血: 101.9umol/L；间接胆红素(IBIL)-静脉血: 12.3umolL；红细胞计数(RBC#)-静脉血: 4.1210E12/L；血液二氧化碳含量ctCO2(B)-静脉血: 33.6mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.1g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 19U/L；载脂蛋白AI(apoAI)-静脉血: 1.28g/L\n- [全程D64] 超声；腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径9mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约22cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确肿物回声。 膀胱未充盈。；检查结论: 肝脏、胆囊、脾脏、胰腺、双肾未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n\n【既往治疗与反应】\n- [全程D31] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者现处于放化综合治疗中，放疗4F，现已基本完成一程同期化疗，诉口干、腹胀、纳差，体查：张口门齿距4.5cm；鼻咽右侧顶后壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。复查生化常规结果示：ALT87.0U/L，上级医师信息已隐藏：患者在院行一程同期化疗期间，出现肝功轻度损伤，期间予以护肝等对症处理，现患者复查生化示肝功指标仍有轻度升高，继续予以护肝等对症处理，今日可出院，每周定期复查血常规、生化常规，定期门诊复诊，门诊继续放疗，按期[计划性表述已隐藏]下程治疗，不适随诊。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D53] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者入院第二天，现处于放化综合治疗中，放疗21F，诉口苦，体查情况：张口门齿距4.5cm；鼻咽右侧顶后壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。复查血常规、生化常规结果基本正常。上级医师信息已隐藏：现患者入院[计划性表述已隐藏]第二程顺铂同期方案化疗，昨日开始予以水化，目前患者情况尚可，今日可行化疗，并予以止呕、护胃、加强营养等对症支持治疗，针对患者口苦症状，为放疗引起常见急性不良反应，予以对症处理，病情继观。\n- [全程D54] 上级查房记录；[姓名已隐去]医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医师查房记录；病程内容: 患者入院第三天，现处于放化综合治疗中，放疗22F，诉恶心、呕吐，体查情况基本同前。[姓名已隐去]医师查房后示：现患者处于DDP方案同期化疗中，目前患者情况尚可，继续予以止呕、护胃、加强营养等对症支持治疗，病情继观。\n- [全程D56] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者现处于放化综合治疗中，放疗24F，诉恶心、呕吐较前好转，体查情况：KPS 90分；鼻咽部右侧壁肿物，双颈部淋巴结未触及；颅神经检查：阴性。上级医师信息已隐藏：现患者基本完成二程DDP方案同期化疗，目前患者情况尚可，继续予以对症支持，今日可予以出院，并嘱按时[计划性表述已隐藏]治疗后复查，不适随诊。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估腹部无转移征象，继续根治性放疗，予以重组人粒细胞刺激因子皮下注射，待血常规恢复后重启化疗。\nB. 评估腹部无转移征象，继续根治性放疗，予以重组人促红素皮下注射改善贫血，并动态复查血常规。\nC. 腹部彩超见可疑占位，暂停放疗，行肝脏MRI平扫+增强以明确病变性质。\nD. 评估腹部无转移征象，继续根治性放疗，并即刻启动第三程顺铂同期化疗。\nE. 评估腹部无转移征象，提前结束放疗，转为顺铂联合氟尿嘧啶方案辅助化疗。\nF. 评估腹部无转移征象，继续根治性放疗，予以利可君口服改善骨髓抑制，并动态复查血常规。\nG. 评估腹部无转移征象，继续根治性放疗，予以异甘草酸镁静脉滴注强化保肝治疗。\nH. 评估腹部无转移征象，继续根治性放疗，予以输注单采血小板预防出血，并动态复查血常规。\nI. 评估腹部无转移征象，暂停放疗，行全身PET/CT检查以全面评估近期疗效。\nJ. 评估腹部无转移征象，继续根治性放疗，予以昂丹司琼强化止吐，并预防性放置胃管。\nK. 评估腹部无转移征象，继续根治性放疗，加用尼妥珠单抗靶向治疗以提高局部控制率。\nL. 评估腹部无转移征象，继续根治性放疗，予以地塞米松口服改善骨髓抑制，并动态复查血常规。\n\n请仅输出一个选项字母（A-L）。","gold_letter":"B","gold_action":"评估腹部无转移征象，继续根治性放疗，予以重组人促红素皮下注射改善贫血，并动态复查血常规。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"评估腹部无转移征象，继续根治性放疗，予以重组人粒细胞刺激因子皮下注射，待血常规恢复后重启化疗。"},{"letter":"B","text":"评估腹部无转移征象，继续根治性放疗，予以重组人促红素皮下注射改善贫血，并动态复查血常规。"},{"letter":"C","text":"腹部彩超见可疑占位，暂停放疗，行肝脏MRI平扫+增强以明确病变性质。"},{"letter":"D","text":"评估腹部无转移征象，继续根治性放疗，并即刻启动第三程顺铂同期化疗。"},{"letter":"E","text":"评估腹部无转移征象，提前结束放疗，转为顺铂联合氟尿嘧啶方案辅助化疗。"},{"letter":"F","text":"评估腹部无转移征象，继续根治性放疗，予以利可君口服改善骨髓抑制，并动态复查血常规。"},{"letter":"G","text":"评估腹部无转移征象，继续根治性放疗，予以异甘草酸镁静脉滴注强化保肝治疗。"},{"letter":"H","text":"评估腹部无转移征象，继续根治性放疗，予以输注单采血小板预防出血，并动态复查血常规。"},{"letter":"I","text":"评估腹部无转移征象，暂停放疗，行全身PET/CT检查以全面评估近期疗效。"},{"letter":"J","text":"评估腹部无转移征象，继续根治性放疗，予以昂丹司琼强化止吐，并预防性放置胃管。"},{"letter":"K","text":"评估腹部无转移征象，继续根治性放疗，加用尼妥珠单抗靶向治疗以提高局部控制率。"},{"letter":"L","text":"评估腹部无转移征象，继续根治性放疗，予以地塞米松口服改善骨髓抑制，并动态复查血常规。"}]}
+{"sample_id":"sample-38fe8a3260ea673c5c5ddb90","patient_id":"patient-e7eec542502a097814d58d8a","turn_id":"turn01","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 双侧耳鸣2年，发现右颈肿物3天；现病史: 患者2年前无明显诱因间断出现双侧耳鸣，近2周自觉右侧耳鸣症状加重，无鼻塞、涕血等不适。今为进一步诊治收入我院。起病以来，患者无发热、咳嗽，无胸闷、胸痛，无恶心、呕吐，胃纳、睡眠、精神可，大小便正常，体重无明显变化。；阳性症状体征: 双耳鸣,右颈部肿物,右耳鸣；既往史: 10+年前因“腰椎间盘突出”行手术治疗，并予输血，无“输血反应”。否认\"肝炎\"、\"结核\"、\"高血压\"、\"糖尿病\"等疾病史；无外伤病史。过敏史:否认药物、食物过敏史。；个人史: 原籍出生、长大，无疫水、疫区暴露史；无吸烟、酗酒等不良嗜好。；家族史: 否认家族其他成员有肿瘤病史及遗传病史。；体格检查: T：36.0℃ P：81bpm R：18bpm BP：111/76mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。牙龈无肿胀、出血，咽无充血，双扁桃体无肿大。颈部检查详见肿瘤专科 检查。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率81bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善鼻咽镜检查及活检，行头颈部CT平扫+增强，颈部及腹部彩超，常规血液学与心电图检查。\nB. 行右颈部肿物切除活检，待病理确诊后再行头颈部MRI平扫+增强，颈部及腹部彩超，全身骨显像。\nC. 完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，全身PET-CT显像，常规血液学与心电图检查。\nD. 完善鼻咽镜检查及活检，行头颈部MRI平扫，颈部及腹部彩超，全身骨显像，常规血液学与心电图检查。\nE. 行右颈部肿物细针穿刺活检，待病理确诊后再行鼻咽镜检查，头颈部MRI平扫+增强，全身骨显像。\nF. 完善鼻咽镜检查及活检，行头颈部CT平扫，颈部及腹部彩超，全身骨显像，常规血液学与心电图检查。\nG. 完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部彩超，常规血液学与心电图检查，暂缓全身骨显像。\nH. 完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部及腹部彩超，全身骨显像，常规血液学与心电图检查。\nI. 完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部彩超，全身骨显像，常规血液学与心电图检查。\nJ. 完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部及腹部彩超，头颅MRI平扫+增强，常规血液学检查。\nK. 完善鼻咽镜检查及活检，行头颈部CT平扫+增强，颈部及腹部彩超，全身骨显像，常规血液学与心电图检查。\nL. 完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部及腹部彩超，全身骨显像，骨髓穿刺活检。\n\n请仅输出一个选项字母（A-L）。","gold_letter":"H","gold_action":"完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部及腹部彩超，全身骨显像，常规血液学与心电图检查。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"完善鼻咽镜检查及活检，行头颈部CT平扫+增强，颈部及腹部彩超，常规血液学与心电图检查。"},{"letter":"B","text":"行右颈部肿物切除活检，待病理确诊后再行头颈部MRI平扫+增强，颈部及腹部彩超，全身骨显像。"},{"letter":"C","text":"完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，全身PET-CT显像，常规血液学与心电图检查。"},{"letter":"D","text":"完善鼻咽镜检查及活检，行头颈部MRI平扫，颈部及腹部彩超，全身骨显像，常规血液学与心电图检查。"},{"letter":"E","text":"行右颈部肿物细针穿刺活检，待病理确诊后再行鼻咽镜检查，头颈部MRI平扫+增强，全身骨显像。"},{"letter":"F","text":"完善鼻咽镜检查及活检，行头颈部CT平扫，颈部及腹部彩超，全身骨显像，常规血液学与心电图检查。"},{"letter":"G","text":"完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部彩超，常规血液学与心电图检查，暂缓全身骨显像。"},{"letter":"H","text":"完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部及腹部彩超，全身骨显像，常规血液学与心电图检查。"},{"letter":"I","text":"完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部彩超，全身骨显像，常规血液学与心电图检查。"},{"letter":"J","text":"完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部及腹部彩超，头颅MRI平扫+增强，常规血液学检查。"},{"letter":"K","text":"完善鼻咽镜检查及活检，行头颈部CT平扫+增强，颈部及腹部彩超，全身骨显像，常规血液学与心电图检查。"},{"letter":"L","text":"完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部及腹部彩超，全身骨显像，骨髓穿刺活检。"}]}
+{"sample_id":"sample-06aacdbb23f806198bd0b70c","patient_id":"patient-e7eec542502a097814d58d8a","turn_id":"turn02","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 双侧耳鸣2年，发现右颈肿物3天；现病史: 患者2年前无明显诱因间断出现双侧耳鸣，近2周自觉右侧耳鸣症状加重，无鼻塞、涕血等不适。今为进一步诊治收入我院。起病以来，患者无发热、咳嗽，无胸闷、胸痛，无恶心、呕吐，胃纳、睡眠、精神可，大小便正常，体重无明显变化。；阳性症状体征: 双耳鸣,右颈部肿物,右耳鸣；既往史: 10+年前因“腰椎间盘突出”行手术治疗，并予输血，无“输血反应”。否认\"肝炎\"、\"结核\"、\"高血压\"、\"糖尿病\"等疾病史；无外伤病史。过敏史:否认药物、食物过敏史。；个人史: 原籍出生、长大，无疫水、疫区暴露史；无吸烟、酗酒等不良嗜好。；家族史: 否认家族其他成员有肿瘤病史及遗传病史。；体格检查: T：36.0℃ P：81bpm R：18bpm BP：111/76mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。牙龈无肿胀、出血，咽无充血，双扁桃体无肿大。颈部检查详见肿瘤专科 检查。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率81bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显斑片或结节影。双侧肺门影未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见明显病变。\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 间接胆红素(IBIL)-静脉血: 9.6umolL；尿胆原(URO)-尿液: -（参考: 阴性）；钾离子(K+)-静脉血: 4mmol/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；总胆固醇(TC)-静脉血: 6.89mmol/L；肿瘤特异性生长因子(TSGF)-静脉血: 32U/mL；红细胞计数(RBC#)-静脉血: 4.9610E12/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.5U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.3pg；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 13.4umol/L；总蛋白(TP)-尿液: -（参考: 阴性）；血小板计数(PLT#)-静脉血: 319.310E9/L；比重(SG)-尿液: LAMPL.；凝血酶原时间活动度(PTA)-静脉血: 113.8%；直接胆红素(DBIL)-静脉血: 3.8umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-静脉血: 10.310E9/L；平均血小板体积(MPV)-静脉血: 7.46fL；镁离子(Mg2+)-静脉血: 0.98mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.310E9/L；鳞状细胞癌相关抗原(SCC)-静脉血: 0.4ng/ml；低密度脂蛋白胆固醇(LDL-C)-静脉血: 5.13mmol/L；血小板比容-静脉血: 23.8%；Rh血型-静脉血: 阳性；总前列腺特异性抗原(TPSA)-静脉血: 1ng/ml；神经元特异性烯醇化酶(NSE)-静脉血: 12.85ng/ml；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；游离/总前列腺特异性抗原比值(FPSA/TPSA)-静脉血: 0.23（参考: >0.27）；γ-谷氨酰基转移酶(GGT)-静脉血: 59.8U/L；酸碱度(pH)-尿液: 5.5；丙氨酸氨基转移酶(ALT)-静脉血: 28.2U/L；氯离子(Cl-)-静脉血: 102mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 335g/L；糖类抗原CA724-静脉血: 0.961U/ml；红细胞比容(Hct)-静脉血: 44.9%；载脂蛋白B(apoB)-静脉血: 1.52g/L；葡萄糖(Glu)-静脉血: 5.83mmol/L\n- [全程D2] 检验组合: CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 0.8%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 3%；CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 24.9%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 9.8%；CD3+T淋巴细胞百分比-静脉血: 60.3%；CD4+/CD8+辅助/抑制T淋巴细胞比值(Th/Ts比值)-静脉血: 1.7；CD3-CD16+CD56+自然杀伤细胞百分比(NK%)-静脉血: 15.5%；CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 3.1%；CD3+CD4+辅助/诱导T淋巴细胞百分比(Th/Ti%)-静脉血: 29%；CD19+B淋巴细胞百分比-静脉血: 23%；CD3+CD8+抑制/细胞毒T淋巴细胞百分比(Ts/Tc%)-静脉血: 18.4%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 27.7%\n- [全程D7] 超声；双侧颈部、锁骨上区淋巴结彩超(套): 检查类型: 超声；检查名称: 双侧颈部、锁骨上区淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉内径约14mm，门静脉最大血流速度约17cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约44×36×33mm，包膜光滑，实质回声不均匀，可见强回声斑。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 前列腺钙化。 胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D7] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 右侧颈部II区可见数个淋巴结回声，最大约23×12mm，椭圆形，边界清，皮髓质分界不清，未见淋巴门。余右侧颈部未见明确异常淋巴结。 CDFI：上述最大淋巴结内可见周边型血流信号。 左侧颈部及锁骨上区未见明确异常淋巴结回声。；检查结论: 右侧颈部II区淋巴结，恶性待排，建议穿刺活检。 左侧颈部及锁骨上区未见明确异常淋巴结声像。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行右侧颈部淋巴结切除活检术\nB. 行右侧颈部淋巴结细针穿刺抽吸活检\nC. 安排诱导化疗联合同期放化疗\nD. 行全身PET-CT检查\nE. 行全身骨显像检查\nF. 行鼻内镜下鼻咽部肿物切除术\nG. 行鼻咽部高分辨率CT检查\nH. 行右侧颈部淋巴结微创旋切活检术\nI. 行鼻咽镜检查并取鼻咽部肿物活检\nJ. 行胸部增强CT及腹部增强CT检查\nK. 抽取外周血行血浆EBV-DNA定量检测\nL. 密切观察随访，1个月后复查鼻咽部MRI\n\n请仅输出一个选项字母（A-L）。","gold_letter":"I","gold_action":"行鼻咽镜检查并取鼻咽部肿物活检。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"行右侧颈部淋巴结切除活检术"},{"letter":"B","text":"行右侧颈部淋巴结细针穿刺抽吸活检"},{"letter":"C","text":"安排诱导化疗联合同期放化疗"},{"letter":"D","text":"行全身PET-CT检查"},{"letter":"E","text":"行全身骨显像检查"},{"letter":"F","text":"行鼻内镜下鼻咽部肿物切除术"},{"letter":"G","text":"行鼻咽部高分辨率CT检查"},{"letter":"H","text":"行右侧颈部淋巴结微创旋切活检术"},{"letter":"I","text":"行鼻咽镜检查并取鼻咽部肿物活检"},{"letter":"J","text":"行胸部增强CT及腹部增强CT检查"},{"letter":"K","text":"抽取外周血行血浆EBV-DNA定量检测"},{"letter":"L","text":"密切观察随访，1个月后复查鼻咽部MRI"}]}
+{"sample_id":"sample-9713cef7ba61651ea6a5f02e","patient_id":"patient-e7eec542502a097814d58d8a","turn_id":"turn05","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 双侧耳鸣2年，发现右颈肿物3天；现病史: 患者2年前无明显诱因间断出现双侧耳鸣，近2周自觉右侧耳鸣症状加重，无鼻塞、涕血等不适。3天前无明显诱因发现右颈部肿物，遂就诊外院行CT检查示：鼻咽右侧壁增厚，考虑鼻咽癌可能，伴右侧乳突阻塞性炎症。今为进一步诊治收入我院。起病以来，患者无发热、咳嗽，无胸闷、胸痛，无恶心、呕吐，胃纳、睡眠、精神可，大小便正常，体重无明显变化。；阳性症状体征: 双耳鸣,右颈部肿物,右耳鸣；既往史: 10+年前因“腰椎间盘突出”行手术治疗，并予输血，无“输血反应”。否认\"肝炎\"、\"结核\"、\"高血压\"、\"糖尿病\"等疾病史；无外伤病史。过敏史:否认药物、食物过敏史。；个人史: 原籍出生、长大，无疫水、疫区暴露史；无吸烟、酗酒等不良嗜好。；家族史: 否认家族其他成员有肿瘤病史及遗传病史。；体格检查: T：36.0℃ P：81bpm R：18bpm BP：111/76mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。牙龈无肿胀、出血，咽无充血，双扁桃体无肿大。颈部检查详见肿瘤专科 检查。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率81bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。肛门外生殖器未见异常，生理反射存在，病理反射未引出。；专科检查: 间接鼻咽镜检查见双侧鼻腔通畅，内未窥及明显肿物；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显斑片或结节影。双侧肺门影未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见明显病变。\n- [全程D7] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 右侧颈部II区可见数个淋巴结回声，最大约23×12mm，椭圆形，边界清，皮髓质分界不清，未见淋巴门。余右侧颈部未见明确异常淋巴结。 CDFI：上述最大淋巴结内可见周边型血流信号。 左侧颈部及锁骨上区未见明确异常淋巴结回声。；检查结论: 右侧颈部II区淋巴结，恶性待排，建议穿刺活检。 左侧颈部及锁骨上区未见明确异常淋巴结声像。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D24] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽右顶壁及右侧壁粘膜增厚放射性浓聚，SUV约16.7，病灶累及右翼突基底部及内侧板、右侧腭帆张提肌。右侧咽隐窝消失，左侧咽隐窝存在。双侧咽后未见肿大淋巴结及异常放射性分布。口咽、喉咽未见异常。筛窦、左上颌窦及右乳突内低密度影放射性稀疏；额窦、蝶窦、右上颌窦及左乳突结构及放射性分布未见明显异常。双侧海绵窦放射性分布未见明显异常。甲状腺结构及放射性分布未见明显异常。右颈II区数个淋巴结放射性浓聚，SUV约18.0，大者约1.5×2.2cm；余双颈小淋巴结放射性分布未见异常。 所见脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔主肺动脉窗小淋巴结放射性分布未见明显异常，大小约0.9×1.0cm。双肺门未见肿大淋巴结及异常放射性分布。双侧腋窝小淋巴结放射性未见明显异常。 肝脏密度减低，CT值约36Hu（脾脏CT值约56Hu），结构及放射性分布未见异常；肝门区未见占位及异常放射性分布。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。左肾上腺体部小结节影放射性略浓密，大小约1.0×1.1cm。脾脏、双肾、右肾上腺及胰腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺大小正常，内见数个点状钙化灶。膀胱及肠管形态、结构及放射性分布未见明显异常。双髂血管旁及双侧腹股沟未见肿大淋巴结及异常放射性分布。 颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，病灶累及右翼突基底部及内侧板、右侧腭帆张提肌；右颈II区数个淋巴结代谢活跃，考虑转移。 左肾上腺体部小结节代谢稍活跃，疑良性增生病变。 前列腺多发钙化灶。 脂肪肝。 副鼻窦炎症；右乳突炎症。\n- [全程D28] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T6上缘水平，估计导管末端位于上腔静脉上段内。；检查结论: PICC管末端位置如上述。\n- [全程D28] 检验组合: 红细胞计数(RBC#)-静脉血: 4.710E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7；钾离子(K+)-静脉血: 4.2mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 32.3U/L；尿素氮(BUN)-静脉血: 8.2mmol/L；间接胆红素(IBIL)-静脉血: 6.2umolL；氯离子(Cl-)-静脉血: 100.2mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 326g/L；红细胞比容(Hct)-静脉血: 43.5%；总胆固醇(TC)-静脉血: 5.88mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 22.9U/L；载脂蛋白AI(apoAI)-静脉血: 1.32g/L；血小板比容-静脉血: 32%；葡萄糖(Glu)-静脉血: 5.95mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.8mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.2pg；乳酸脱氢酶(LDH)-静脉血: 159.8U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.279；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.67；白细胞计数(WBC#)-静脉血: 10.7710E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 16.9U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.99mmol/L；中性粒细胞计数(Neut#)-静脉血: 6.410E9/L；平均红细胞体积(MCV)-静脉血: 92.6fL；平均血小板体积(MPV)-静脉血: 9.2fL；总胆红素(TBIL)-静脉血: 8.6umol/L；血小板分布宽度(PDW)-静脉血: 10%；磷(P)-静脉血: 1.6mmol/L；肌酐(Crea)-静脉血: 64.4umol/L；血小板计数(PLT#)-静脉血: 34410E9/L；C-反应蛋白(CRP)-静脉血: 3.29mg/L；碱性磷酸酶(ALP)-静脉血: 102.6U/L；白蛋白(ALB)-静脉血: 46.3g/L；淋巴细胞计数(Lymph#)-静脉血: 310E9/L；单核细胞计数(Mono#)-静脉血: 0.810E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 54U/L；大血小板百分比(P-LCR%)-静脉血: 18.4%；单核细胞百分比(Mono%)-静脉血: 0.071；直接胆红素(DBIL)-静脉血: 2.4umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.510E9/L；血红蛋白(Hb)-静脉血: 142g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.046；载脂蛋白B(apoB)-静脉血: 1.35g/L；总钙(Ca)-静脉血: 2.32mmol/L；钠离子(Na+)-静脉血: 139.9mmol/L\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- [全程D9] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，无发热、涕血等不适症状。查体：生命体征平稳。电子喉镜检查示：鼻咽右隆突肿物，符合鼻咽癌。并取肿物活检，等待病理结果。上级医师示，结合患者病情及相关检查，诊断考虑鼻咽癌可能性大，明确诊断，予鼻咽科进一步诊治。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D15] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：KPS 90分；鼻咽右侧壁、顶后壁结节状肿物，右颈Ⅱ区可扪及已肿大淋巴结，大小约2*1cm，颅神经检查（-）。今日上级医师信息已隐藏后示：患者已完善相关检查，并预约放疗，今日可结账出院，嘱出院后按时[计划性表述已隐藏]放化综合治疗，不适随诊。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂不予静脉水化及电解质补充，待明日行顺铂化疗时同步予以补液支持。\nB. 予以静脉水化，暂不补充钾离子，嘱计24小时尿量，并常规行PICC导管护理。\nC. 予以静脉水化及电解质补充，常规静脉推注呋塞米强效利尿，并计24小时尿量。\nD. 予以静脉水化及电解质补充，皮下注射重组人粒细胞集落刺激因子预防骨髓抑制。\nE. 予以静脉水化及电解质补充，静脉滴注右丙亚胺预防大剂量顺铂相关心脏毒性。\nF. 予以静脉水化及电解质补充，静脉滴注阿米福汀预防大剂量顺铂相关肾毒性。\nG. 予以静脉水化及电解质补充，嘱计24小时尿量，并静脉滴注头孢菌素预防感染。\nH. 予以静脉水化及电解质补充，静脉滴注地塞米松及帕洛诺司琼进行止吐预处理。\nI. 予以静脉水化及电解质补充，静脉输注人血白蛋白以预防大剂量化疗后低蛋白血症。\nJ. 予以静脉水化及电解质补充，静脉滴注异甘草酸镁预防大剂量顺铂相关肝损伤。\nK. 予以静脉水化及电解质补充，嘱计24小时尿量，并皮下注射促红细胞生成素。\nL. 予以静脉水化及电解质（含钾）补充，嘱计24小时尿量，并常规行PICC导管护理。\n\n请仅输出一个选项字母（A-L）。","gold_letter":"L","gold_action":"予以静脉水化及电解质（含钾）补充，嘱计24小时尿量，并常规行PICC导管护理。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"暂不予静脉水化及电解质补充，待明日行顺铂化疗时同步予以补液支持。"},{"letter":"B","text":"予以静脉水化，暂不补充钾离子，嘱计24小时尿量，并常规行PICC导管护理。"},{"letter":"C","text":"予以静脉水化及电解质补充，常规静脉推注呋塞米强效利尿，并计24小时尿量。"},{"letter":"D","text":"予以静脉水化及电解质补充，皮下注射重组人粒细胞集落刺激因子预防骨髓抑制。"},{"letter":"E","text":"予以静脉水化及电解质补充，静脉滴注右丙亚胺预防大剂量顺铂相关心脏毒性。"},{"letter":"F","text":"予以静脉水化及电解质补充，静脉滴注阿米福汀预防大剂量顺铂相关肾毒性。"},{"letter":"G","text":"予以静脉水化及电解质补充，嘱计24小时尿量，并静脉滴注头孢菌素预防感染。"},{"letter":"H","text":"予以静脉水化及电解质补充，静脉滴注地塞米松及帕洛诺司琼进行止吐预处理。"},{"letter":"I","text":"予以静脉水化及电解质补充，静脉输注人血白蛋白以预防大剂量化疗后低蛋白血症。"},{"letter":"J","text":"予以静脉水化及电解质补充，静脉滴注异甘草酸镁预防大剂量顺铂相关肝损伤。"},{"letter":"K","text":"予以静脉水化及电解质补充，嘱计24小时尿量，并皮下注射促红细胞生成素。"},{"letter":"L","text":"予以静脉水化及电解质（含钾）补充，嘱计24小时尿量，并常规行PICC导管护理。"}]}
+{"sample_id":"sample-e0f912ad55b7b1f092a1b468","patient_id":"patient-e7eec542502a097814d58d8a","turn_id":"turn06","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 双侧耳鸣2年，发现右颈肿物3天；现病史: 患者2年前无明显诱因间断出现双侧耳鸣，近2周自觉右侧耳鸣症状加重，无鼻塞、涕血等不适。3天前无明显诱因发现右颈部肿物，遂就诊外院行CT检查示：鼻咽右侧壁增厚，考虑鼻咽癌可能，伴右侧乳突阻塞性炎症。今为进一步诊治收入我院。起病以来，患者无发热、咳嗽，无胸闷、胸痛，无恶心、呕吐，胃纳、睡眠、精神可，大小便正常，体重无明显变化。；阳性症状体征: 双耳鸣,右颈部肿物,右耳鸣；既往史: 10+年前因“腰椎间盘突出”行手术治疗，并予输血，无“输血反应”。否认\"肝炎\"、\"结核\"、\"高血压\"、\"糖尿病\"等疾病史；无外伤病史。过敏史:否认药物、食物过敏史。；个人史: 原籍出生、长大，无疫水、疫区暴露史；无吸烟、酗酒等不良嗜好。；家族史: 否认家族其他成员有肿瘤病史及遗传病史。；体格检查: T：36.0℃ P：81bpm R：18bpm BP：111/76mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。牙龈无肿胀、出血，咽无充血，双扁桃体无肿大。颈部检查详见肿瘤专科 检查。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率81bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。肛门外生殖器未见异常，生理反射存在，病理反射未引出。；专科检查: 间接鼻咽镜检查见双侧鼻腔通畅，内未窥及明显肿物；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显斑片或结节影。双侧肺门影未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见明显病变。\n- [全程D24] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽右顶壁及右侧壁粘膜增厚放射性浓聚，SUV约16.7，病灶累及右翼突基底部及内侧板、右侧腭帆张提肌。右侧咽隐窝消失，左侧咽隐窝存在。双侧咽后未见肿大淋巴结及异常放射性分布。口咽、喉咽未见异常。筛窦、左上颌窦及右乳突内低密度影放射性稀疏；额窦、蝶窦、右上颌窦及左乳突结构及放射性分布未见明显异常。双侧海绵窦放射性分布未见明显异常。甲状腺结构及放射性分布未见明显异常。右颈II区数个淋巴结放射性浓聚，SUV约18.0，大者约1.5×2.2cm；余双颈小淋巴结放射性分布未见异常。 所见脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔主肺动脉窗小淋巴结放射性分布未见明显异常，大小约0.9×1.0cm。双肺门未见肿大淋巴结及异常放射性分布。双侧腋窝小淋巴结放射性未见明显异常。 肝脏密度减低，CT值约36Hu（脾脏CT值约56Hu），结构及放射性分布未见异常；肝门区未见占位及异常放射性分布。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。左肾上腺体部小结节影放射性略浓密，大小约1.0×1.1cm。脾脏、双肾、右肾上腺及胰腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺大小正常，内见数个点状钙化灶。膀胱及肠管形态、结构及放射性分布未见明显异常。双髂血管旁及双侧腹股沟未见肿大淋巴结及异常放射性分布。 颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，病灶累及右翼突基底部及内侧板、右侧腭帆张提肌；右颈II区数个淋巴结代谢活跃，考虑转移。 左肾上腺体部小结节代谢稍活跃，疑良性增生病变。 前列腺多发钙化灶。 脂肪肝。 副鼻窦炎症；右乳突炎症。\n- [全程D28] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T6上缘水平，估计导管末端位于上腔静脉上段内。；检查结论: PICC管末端位置如上述。\n- [全程D28] 检验组合: 红细胞计数(RBC#)-静脉血: 4.710E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7；钾离子(K+)-静脉血: 4.2mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 32.3U/L；尿素氮(BUN)-静脉血: 8.2mmol/L；间接胆红素(IBIL)-静脉血: 6.2umolL；氯离子(Cl-)-静脉血: 100.2mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 326g/L；红细胞比容(Hct)-静脉血: 43.5%；总胆固醇(TC)-静脉血: 5.88mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 22.9U/L；载脂蛋白AI(apoAI)-静脉血: 1.32g/L；血小板比容-静脉血: 32%；葡萄糖(Glu)-静脉血: 5.95mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.8mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.2pg；乳酸脱氢酶(LDH)-静脉血: 159.8U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.279；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.67；白细胞计数(WBC#)-静脉血: 10.7710E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 16.9U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.99mmol/L；中性粒细胞计数(Neut#)-静脉血: 6.410E9/L；平均红细胞体积(MCV)-静脉血: 92.6fL；平均血小板体积(MPV)-静脉血: 9.2fL；总胆红素(TBIL)-静脉血: 8.6umol/L；血小板分布宽度(PDW)-静脉血: 10%；磷(P)-静脉血: 1.6mmol/L；肌酐(Crea)-静脉血: 64.4umol/L；血小板计数(PLT#)-静脉血: 34410E9/L；C-反应蛋白(CRP)-静脉血: 3.29mg/L；碱性磷酸酶(ALP)-静脉血: 102.6U/L；白蛋白(ALB)-静脉血: 46.3g/L；淋巴细胞计数(Lymph#)-静脉血: 310E9/L；单核细胞计数(Mono#)-静脉血: 0.810E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 54U/L；大血小板百分比(P-LCR%)-静脉血: 18.4%；单核细胞百分比(Mono%)-静脉血: 0.071；直接胆红素(DBIL)-静脉血: 2.4umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.510E9/L；血红蛋白(Hb)-静脉血: 142g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.046；载脂蛋白B(apoB)-静脉血: 1.35g/L；总钙(Ca)-静脉血: 2.32mmol/L；钠离子(Na+)-静脉血: 139.9mmol/L\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D29] 检验组合: 隐血(OB)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；淀粉样蛋白A(SAA)-静脉血: 3.65mg/L；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；白细胞计数(WBC#)-尿液: 7/μL；比重(SG)-尿液: 1.027；总蛋白(TP)-尿液: +- 0.2g（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；葡萄糖(Glu)-尿液: 3+ 17mmol（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 80/μL\n- [全程D30] 检验组合: 颜色-尿液: Yellow；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 13/μL；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 6；总蛋白(TP)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.023\n- [全程D35] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.7；单核细胞计数(Mono#)-静脉血: 0.810E9/L；甘油三酯(TG)-静脉血: 2.15mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；载脂蛋白AI(apoAI)-静脉血: 1.26g/L；中性粒细胞百分比(Neut%)-静脉血: 0.702；葡萄糖(Glu)-静脉血: 6.03mmol/L；尿素氮(BUN)-静脉血: 7.02mmol/L；直接胆红素(DBIL)-静脉血: 4.8umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20U/L；C-反应蛋白(CRP)-静脉血: 2.65mg/L；乳酸脱氢酶(LDH)-静脉血: 166.9U/L；红细胞计数(RBC#)-静脉血: 4.7510E12/L；总胆汁酸(TBA)-静脉血: 1.5umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；总蛋白(TP)-静脉血: 71.69g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；肌酐(Crea)-静脉血: 69.7umol/L；总钙(Ca)-静脉血: 2.31mmol/L；白细胞计数(WBC#)-静脉血: 7.4610E9/L；镁离子(Mg2+)-静脉血: 1mmol/L；平均红细胞体积(MCV)-静脉血: 88.8fL；总胆固醇(TC)-静脉血: 5.15mmol/L；磷(P)-静脉血: 1.3mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；总胆红素(TBIL)-静脉血: 15umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；阴离子间隙(AG)-静脉血: 17；间接胆红素(IBIL)-静脉血: 10.2umolL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.18mmolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4；球蛋白(GLO)-静脉血: 26.39g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.168；血小板分布宽度(PDW)-静脉血: 9.8%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.015；血红蛋白(Hb)-静脉血: 141g/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；血小板比容-静脉血: 28%；血小板计数(PLT#)-静脉血: 31510E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 334g/L；中性粒细胞计数(Neut#)-静脉血: 5.310E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 43U/L；红细胞比容(Hct)-静脉血: 42.2%；白蛋白(ALB)-静脉血: 45.3g/L\n\n【既往治疗与反应】\n- [全程D15] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：KPS 90分；鼻咽右侧壁、顶后壁结节状肿物，右颈Ⅱ区可扪及已肿大淋巴结，大小约2*1cm，颅神经检查（-）。今日上级医师信息已隐藏后示：患者已完善相关检查，并预约放疗，今日可结账出院，嘱出院后按时[计划性表述已隐藏]放化综合治疗，不适随诊。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D29] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者放疗1次。患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：基本同前。今日上级医师信息已隐藏后示：患于今日行第一程DDP方案化疗（100mg/m2）。继续放疗，续观。\n- [全程D34] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：KPS 90分； 间接鼻咽镜检查见双侧鼻腔通畅，内未窥及明显肿物；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。复查血常规、生化常规未见明显异常。今日上级医师信息已隐藏后示：患者已结束第一程同时期DDP方案化疗（100mg/m2），治疗过程顺利，今日可结账出院，嘱出院后继续在门诊放疗，每周复查血常规、肝肾功能，并按时[计划性表述已隐藏]下一程治疗，不适随诊。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 在无明显感染或疼痛症状的情况下经验性给予阿莫西林口服抗感染及酚咖片止痛，并复查血常规、生化常规及EBV-DNA定量\nB. 在无明显感染或疼痛症状的情况下静脉滴注头孢类抗生素并酚咖片止痛，同时复查血常规、生化常规及EBV-DNA定量\nC. 经验性给予阿莫西林口服抗感染及酚咖片止痛，并暂停放疗直至症状完全缓解\nD. 经验性给予酚咖片对症止痛，暂不予抗感染治疗，并复查血常规、生化常规及EBV-DNA定量\nE. 经验性给予阿莫西林口服抗感染，暂不予止痛治疗，并复查血常规、生化常规及EBV-DNA定量\nF. 经验性给予阿莫西林口服抗感染及酚咖片止痛，并提前安排第二程顺铂化疗\nG. 经验性给予阿莫西林口服抗感染及酚咖片止痛，并加用静脉地塞米松减轻局部水肿\nH. 经验性给予静脉滴注广谱抗生素及曲马多止痛，并复查血常规、生化常规及EBV-DNA定量\nI. 经验性给予阿莫西林口服抗感染及酚咖片止痛，并取消后续顺铂化疗计划\nJ. 经验性给予阿莫西林口服抗感染及酚咖片止痛，并复查鼻咽颈部MRI评估近期疗效\nK. 经验性给予口服抗真菌药物及酚咖片止痛，并复查血常规、生化常规及EBV-DNA定量\nL. 仅常规复查血常规、生化常规及EBV-DNA定量，暂不予特殊药物干预\n\n请仅输出一个选项字母（A-L）。","gold_letter":"L","gold_action":"仅常规复查血常规、生化常规及EBV-DNA定量，暂不予特殊药物干预","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"在无明显感染或疼痛症状的情况下经验性给予阿莫西林口服抗感染及酚咖片止痛，并复查血常规、生化常规及EBV-DNA定量"},{"letter":"B","text":"在无明显感染或疼痛症状的情况下静脉滴注头孢类抗生素并酚咖片止痛，同时复查血常规、生化常规及EBV-DNA定量"},{"letter":"C","text":"经验性给予阿莫西林口服抗感染及酚咖片止痛，并暂停放疗直至症状完全缓解"},{"letter":"D","text":"经验性给予酚咖片对症止痛，暂不予抗感染治疗，并复查血常规、生化常规及EBV-DNA定量"},{"letter":"E","text":"经验性给予阿莫西林口服抗感染，暂不予止痛治疗，并复查血常规、生化常规及EBV-DNA定量"},{"letter":"F","text":"经验性给予阿莫西林口服抗感染及酚咖片止痛，并提前安排第二程顺铂化疗"},{"letter":"G","text":"经验性给予阿莫西林口服抗感染及酚咖片止痛，并加用静脉地塞米松减轻局部水肿"},{"letter":"H","text":"经验性给予静脉滴注广谱抗生素及曲马多止痛，并复查血常规、生化常规及EBV-DNA定量"},{"letter":"I","text":"经验性给予阿莫西林口服抗感染及酚咖片止痛，并取消后续顺铂化疗计划"},{"letter":"J","text":"经验性给予阿莫西林口服抗感染及酚咖片止痛，并复查鼻咽颈部MRI评估近期疗效"},{"letter":"K","text":"经验性给予口服抗真菌药物及酚咖片止痛，并复查血常规、生化常规及EBV-DNA定量"},{"letter":"L","text":"仅常规复查血常规、生化常规及EBV-DNA定量，暂不予特殊药物干预"}]}
+{"sample_id":"sample-67a2318574aada2f5af690c0","patient_id":"patient-e7eec542502a097814d58d8a","turn_id":"turn07","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 双侧耳鸣2年，发现右颈肿物3天；现病史: 患者2年前无明显诱因间断出现双侧耳鸣，近2周自觉右侧耳鸣症状加重，无鼻塞、涕血等不适。3天前无明显诱因发现右颈部肿物，遂就诊外院行CT检查示：鼻咽右侧壁增厚，考虑鼻咽癌可能，伴右侧乳突阻塞性炎症。今为进一步诊治收入我院。起病以来，患者无发热、咳嗽，无胸闷、胸痛，无恶心、呕吐，胃纳、睡眠、精神可，大小便正常，体重无明显变化。；阳性症状体征: 双耳鸣,右颈部肿物,右耳鸣；既往史: 10+年前因“腰椎间盘突出”行手术治疗，并予输血，无“输血反应”。否认\"肝炎\"、\"结核\"、\"高血压\"、\"糖尿病\"等疾病史；无外伤病史。过敏史:否认药物、食物过敏史。；个人史: 原籍出生、长大，无疫水、疫区暴露史；无吸烟、酗酒等不良嗜好。；家族史: 否认家族其他成员有肿瘤病史及遗传病史。；体格检查: T：36.0℃ P：81bpm R：18bpm BP：111/76mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。牙龈无肿胀、出血，咽无充血，双扁桃体无肿大。颈部检查详见肿瘤专科 检查。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率81bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。肛门外生殖器未见异常，生理反射存在，病理反射未引出。；专科检查: 间接鼻咽镜检查见双侧鼻腔通畅，内未窥及明显肿物；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显斑片或结节影。双侧肺门影未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见明显病变。\n- [全程D49] 检验组合: 丙氨酸氨基转移酶(ALT)-静脉血: 18.4U/L；球蛋白(GLO)-静脉血: 27.24g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；γ-谷氨酰基转移酶(GGT)-静脉血: 42U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 16.9U/L；平均红细胞体积(MCV)-静脉血: 90.3fL；血小板比容-静脉血: 11.8%；血小板分布宽度(PDW)-静脉血: 16.8%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；钠离子(Na+)-静脉血: 138mmol/L；平均血小板体积(MPV)-静脉血: 6.76fL；总胆汁酸(TBA)-静脉血: 2.9umol/L；载脂蛋白B(apoB)-静脉血: 1.36g/L；总钙(Ca)-静脉血: 2.22mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.16g/L；红细胞计数(RBC#)-静脉血: 4.3410E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.019；血红蛋白(Hb)-静脉血: 133.6g/L；阴离子间隙(AG)-静脉血: 15.6；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；C-反应蛋白(CRP)-静脉血: 10.3mg/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.6mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.17；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.87mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9%；淀粉样蛋白A(SAA)-静脉血: 24.6mg/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.7pg；甘油三酯(TG)-静脉血: 2.36mmol/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；总蛋白(TP)-静脉血: 71.04g/L；碱性磷酸酶(ALP)-静脉血: 108.1U/L；总胆固醇(TC)-静脉血: 5.6mmol/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.104；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.92；平均红细胞血红蛋白浓度(MCHC)-静脉血: 340.7g/L；中性粒细胞百分比(Neut%)-静脉血: 0.702；血小板计数(PLT#)-静脉血: 174.810E9/L；尿素氮(BUN)-静脉血: 5.4mmol/L；红细胞比容(Hct)-静脉血: 39.2%；氯离子(Cl-)-静脉血: 98.8mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.61；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.05mmolL；肌酐(Crea)-静脉血: 62.3umol/L\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D55] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位置位于第3胸椎体右下缘，估计位于右侧头臂静脉内。；检查结论: PICC管末端位置如上所述。\n- [全程D55] 检验组合: 葡萄糖(Glu)-尿液: +- 2.8mmol（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: 1+ 0.3g（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 3/μL；白细胞计数(WBC#)-尿液: 20/μL；酸碱度(pH)-尿液: 5.5；颜色-尿液: Yellow；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: +- 0.1g（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；比重(SG)-尿液: 1.021；红细胞计数(RBC#)-尿液: 2/μL；红细胞计数(RBC#)-尿液: 2/μL；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.025；浊度(TRUB)-尿液: 清亮；粘液丝计数(MUCS#)-尿液: 80/μL；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；葡萄糖(Glu)-尿液: 3+ 17mmol（参考: 阴性）；白细胞计数(WBC#)-尿液: 4/μL\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D63] 检验组合: 红细胞计数(RBC#)-静脉血: 3.910E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞计数(Neut#)-静脉血: 5.210E9/L；阴离子间隙(AG)-静脉血: 16.2；尿酸(UA)-静脉血: 364.7umol/L；钠离子(Na+)-静脉血: 132.6mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；球蛋白(GLO)-静脉血: 26.68g/L；单核细胞计数(Mono#)-静脉血: 1.110E9/L；葡萄糖(Glu)-静脉血: 4.06mmol/L；单核细胞百分比(Mono%)-静脉血: 0.166；平均血小板体积(MPV)-静脉血: 8.1fL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；尿素氮(BUN)-静脉血: 7.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 20.7U/L；白细胞计数(WBC#)-静脉血: 6.6710E9/L；甘油三酯(TG)-静脉血: 1.04mmol/L；氯离子(Cl-)-静脉血: 93.2mmol/L；磷(P)-静脉血: 1.24mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.2mmol/L；平均红细胞体积(MCV)-静脉血: 89.2fL；总胆汁酸(TBA)-静脉血: 0.9umol/L；载脂蛋白B(apoB)-静脉血: 1.28g/L；总钙(Ca)-静脉血: 2.2mmol/L；镁离子(Mg2+)-静脉血: 1.01mmol/L；红细胞比容(Hct)-静脉血: 34.8%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；乳酸脱氢酶(LDH)-静脉血: 151.8U/L；间接胆红素(IBIL)-静脉血: 9umolL；载脂蛋白AI(apoAI)-静脉血: 0.91g/L；总胆红素(TBIL)-静脉血: 12.8umol/L；大血小板百分比(P-LCR%)-静脉血: 9.3%；中性粒细胞百分比(Neut%)-静脉血: 0.782；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；血小板分布宽度(PDW)-静脉血: 8%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.1；碱性磷酸酶(ALP)-静脉血: 113.9U/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 342g/L；肌酐(Crea)-静脉血: 56.3umol/L；白蛋白(ALB)-静脉血: 40.5g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 27U/L；C-反应蛋白(CRP)-静脉血: 39.54mg/L；钾离子(K+)-静脉血: 4.07mmol/L；直接胆红素(DBIL)-静脉血: 3.8umol/L\n- [全程D69] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌治疗后，与某次就诊时间0日片对比: 鼻咽腔未见明显狭窄，鼻咽顶后壁、右侧壁轻度增厚，见少许软组织影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，右侧咽隐窝消失。鼻咽左侧壁未见明显增厚，左侧咽隐窝稍浅。右侧咽旁脂肪间隙稍变窄，左侧咽旁脂肪间隙未见异常。 右侧腭帆提张肌信号不均匀，左侧腭帆提张肌、双侧头长肌未见受侵征象。 双侧翼腭窝、上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 口咽双侧壁未见受累增厚，病变未累及双侧后鼻孔。 右侧翼突内份及内板、蝶骨基底部右份骨质信号减低，增强扫描轻度强化，范围较前缩小。余颅底未见明确骨质破坏征象。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦、右侧乳突粘膜增厚，双侧上颌窦见少量分泌物，蝶窦、左侧乳突充气良好，骨壁完整。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 右侧咽后淋巴结短径约6mm，较前缩小。左侧咽后未见肿大淋巴结。 右颈IIb区见稍大淋巴结，较大者短径约7mm，增强扫描明显强化，较前缩小。双颈IIa区见数个小淋巴结，较大者短径约5mm，增强扫描轻度强化，大致同前。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 扫描所见脑实质未见明显异常。；检查结论: 鼻咽癌治疗后，与某次就诊时间0日片对比: 鼻咽病变较前缩小。 颅底骨质破坏，较前有修复。 右侧咽后肿大淋巴结，考虑转移，较前缩小。 右颈IIb区淋巴结肿大，考虑转移，较前缩小。 双颈IIa区小淋巴结。 副鼻窦炎，右侧乳突炎。\n- [全程D69] 检验组合: 直接胆红素(DBIL)-静脉血: 3.2umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.033；阴离子间隙(AG)-静脉血: 16.9；白细胞计数(WBC#)-静脉血: 3.510E9/L；总胆红素(TBIL)-静脉血: 11.7umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 24.1U/L；尿酸(UA)-静脉血: 468.3umol/L；白蛋白(ALB)-静脉血: 39.4g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.016；红细胞比容(Hct)-静脉血: 33.6%；磷(P)-静脉血: 1.09mmol/L；C-反应蛋白(CRP)-静脉血: 20.73mg/L；载脂蛋白B(apoB)-静脉血: 1.37g/L；葡萄糖(Glu)-静脉血: 4.3mmol/L；单核细胞百分比(Mono%)-静脉血: 0.112；血小板比容-静脉血: 15.3%；肌酐(Crea)-静脉血: 62.2umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4%；碱性磷酸酶(ALP)-静脉血: 92.8U/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.9mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.57；总蛋白(TP)-静脉血: 64.43g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.86；淋巴细胞计数(Lymph#)-静脉血: 0.110E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；球蛋白(GLO)-静脉血: 25.03g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 36.2U/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.839；甘油三酯(TG)-静脉血: 1.02mmol/L；间接胆红素(IBIL)-静脉血: 8.5umolL；丙氨酸氨基转移酶(ALT)-静脉血: 16.3U/L；血小板计数(PLT#)-静脉血: 266.210E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.27mmol/L；平均血小板体积(MPV)-静脉血: 5.77fL；胱抑素(Cys-C)-静脉血: 0.73mg/L；尿素氮(BUN)-静脉血: 5mmol/L；血小板分布宽度(PDW)-静脉血: 16%；乳酸脱氢酶(LDH)-静脉血: 125.9U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.95mmolL；载脂蛋白AI(apoAI)-静脉血: 0.91g/L；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32.1pg；镁离子(Mg2+)-静脉血: 0.97mmol/L；总胆固醇(TC)-静脉血: 4.88mmol/L\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D54] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者放疗16次，口腔黏膜反应2度，放射性皮炎1度，患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：KPS 90分；张口门齿距4.5cm，鼻咽顶后壁、右侧壁肿物，较前缩小；右颈II区扪及一肿大淋巴结，大小约1X1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。颅神经检查：阴性。今日上级医师信息已隐藏后示：今日开始行第2程同时期DDP方案（DDP100mg/m2）化疗，继续放疗，续观。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D64] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者放疗22次，口腔黏膜反应2度，放射性皮炎1度，患者诉喉痛，余未诉特殊不适。生命体征平稳。查体：KPS 90分；张口门齿距4.5cm，鼻咽顶后壁、右侧壁肿物，较前缩小；双颈未触及肿大淋巴结；颅神经检查：阴性。今日上级医师信息已隐藏后示：患者诉喉痛，予患者奥施康定止痛，继续放疗，续观。\n- [全程D69] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者放疗26次，口腔黏膜反应3度，放射性皮炎2度，患者诉喉痛，余未诉特殊不适。生命体征平稳。查体：KPS 90分；张口门齿距4.5cm，鼻咽肿物已不明显；双颈未触及肿大淋巴结；颅神经检查：阴性。今日上级医师信息已隐藏后示：患者诉喉痛，继续予患者奥施康定止痛，继续放疗，续观。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 提前终止放疗，转为单纯全身化疗或靶向治疗，并给予静脉营养支持。\nB. 继续完成原计划的根治性放疗，给予阿片类药物镇痛及静脉补液与营养支持治疗。\nC. 暂停放疗直至口腔黏膜反应降至1度，期间给予广谱抗生素及静脉糖皮质激素治疗。\nD. 继续放疗，重新定位并缩减放疗靶区及处方剂量，同时给予非甾体类抗炎药镇痛。\nE. 暂停放疗，更改全身治疗方案为TPF方案化疗，待局部症状好转后择期恢复放疗。\nF. 继续完成根治性放疗，给予局部利多卡因含漱液及非甾体类抗炎药镇痛，并仅口服营养支持，无需静脉补液。\nG. 终止放疗，行右侧颈部淋巴结清扫术及鼻咽原发灶挽救性切除术。\nH. 继续放疗并同步行第3程大剂量顺铂化疗，给予阿片类药物镇痛，暂不予静脉补液。\nI. 暂停放疗，行鼻咽部内镜下微创手术切除残留病灶，术后继续静脉补液支持。\nJ. 继续完成根治性放疗，行经皮内镜下胃造瘘术（PEG）以建立长期肠内营养途径。\nK. 提前终止放疗，改为PD-1抑制剂联合化疗的全身系统性维持治疗。\nL. 继续放疗，给予大剂量静脉糖皮质激素冲击治疗缓解黏膜反应，并继续口服营养液。\n\n请仅输出一个选项字母（A-L）。","gold_letter":"B","gold_action":"继续完成原计划的根治性放疗，给予阿片类药物镇痛及静脉补液与营养支持治疗。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"提前终止放疗，转为单纯全身化疗或靶向治疗，并给予静脉营养支持。"},{"letter":"B","text":"继续完成原计划的根治性放疗，给予阿片类药物镇痛及静脉补液与营养支持治疗。"},{"letter":"C","text":"暂停放疗直至口腔黏膜反应降至1度，期间给予广谱抗生素及静脉糖皮质激素治疗。"},{"letter":"D","text":"继续放疗，重新定位并缩减放疗靶区及处方剂量，同时给予非甾体类抗炎药镇痛。"},{"letter":"E","text":"暂停放疗，更改全身治疗方案为TPF方案化疗，待局部症状好转后择期恢复放疗。"},{"letter":"F","text":"继续完成根治性放疗，给予局部利多卡因含漱液及非甾体类抗炎药镇痛，并仅口服营养支持，无需静脉补液。"},{"letter":"G","text":"终止放疗，行右侧颈部淋巴结清扫术及鼻咽原发灶挽救性切除术。"},{"letter":"H","text":"继续放疗并同步行第3程大剂量顺铂化疗，给予阿片类药物镇痛，暂不予静脉补液。"},{"letter":"I","text":"暂停放疗，行鼻咽部内镜下微创手术切除残留病灶，术后继续静脉补液支持。"},{"letter":"J","text":"继续完成根治性放疗，行经皮内镜下胃造瘘术（PEG）以建立长期肠内营养途径。"},{"letter":"K","text":"提前终止放疗，改为PD-1抑制剂联合化疗的全身系统性维持治疗。"},{"letter":"L","text":"继续放疗，给予大剂量静脉糖皮质激素冲击治疗缓解黏膜反应，并继续口服营养液。"}]}
+{"sample_id":"sample-5549469386bb20d944ce932b","patient_id":"patient-e7eec542502a097814d58d8a","turn_id":"turn08","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 双侧耳鸣2年，发现右颈肿物3天；现病史: 患者2年前无明显诱因间断出现双侧耳鸣，近2周自觉右侧耳鸣症状加重，无鼻塞、涕血等不适。3天前无明显诱因发现右颈部肿物，遂就诊外院行CT检查示：鼻咽右侧壁增厚，考虑鼻咽癌可能，伴右侧乳突阻塞性炎症。今为进一步诊治收入我院。起病以来，患者无发热、咳嗽，无胸闷、胸痛，无恶心、呕吐，胃纳、睡眠、精神可，大小便正常，体重无明显变化。；阳性症状体征: 双耳鸣,右颈部肿物,右耳鸣；既往史: 10+年前因“腰椎间盘突出”行手术治疗，并予输血，无“输血反应”。否认\"肝炎\"、\"结核\"、\"高血压\"、\"糖尿病\"等疾病史；无外伤病史。过敏史:否认药物、食物过敏史。；个人史: 原籍出生、长大，无疫水、疫区暴露史；无吸烟、酗酒等不良嗜好。；家族史: 否认家族其他成员有肿瘤病史及遗传病史。；体格检查: T：36.0℃ P：81bpm R：18bpm BP：111/76mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。牙龈无肿胀、出血，咽无充血，双扁桃体无肿大。颈部检查详见肿瘤专科 检查。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率81bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。肛门外生殖器未见异常，生理反射存在，病理反射未引出。；专科检查: 间接鼻咽镜检查见双侧鼻腔通畅，内未窥及明显肿物；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显斑片或结节影。双侧肺门影未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见明显病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D55] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位置位于第3胸椎体右下缘，估计位于右侧头臂静脉内。；检查结论: PICC管末端位置如上所述。\n- [全程D55] 检验组合: 葡萄糖(Glu)-尿液: +- 2.8mmol（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: 1+ 0.3g（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 3/μL；白细胞计数(WBC#)-尿液: 20/μL；酸碱度(pH)-尿液: 5.5；颜色-尿液: Yellow；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: +- 0.1g（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；比重(SG)-尿液: 1.021；红细胞计数(RBC#)-尿液: 2/μL；红细胞计数(RBC#)-尿液: 2/μL；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.025；浊度(TRUB)-尿液: 清亮；粘液丝计数(MUCS#)-尿液: 80/μL；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；葡萄糖(Glu)-尿液: 3+ 17mmol（参考: 阴性）；白细胞计数(WBC#)-尿液: 4/μL\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D63] 检验组合: 红细胞计数(RBC#)-静脉血: 3.910E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞计数(Neut#)-静脉血: 5.210E9/L；阴离子间隙(AG)-静脉血: 16.2；尿酸(UA)-静脉血: 364.7umol/L；钠离子(Na+)-静脉血: 132.6mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；球蛋白(GLO)-静脉血: 26.68g/L；单核细胞计数(Mono#)-静脉血: 1.110E9/L；葡萄糖(Glu)-静脉血: 4.06mmol/L；单核细胞百分比(Mono%)-静脉血: 0.166；平均血小板体积(MPV)-静脉血: 8.1fL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；尿素氮(BUN)-静脉血: 7.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 20.7U/L；白细胞计数(WBC#)-静脉血: 6.6710E9/L；甘油三酯(TG)-静脉血: 1.04mmol/L；氯离子(Cl-)-静脉血: 93.2mmol/L；磷(P)-静脉血: 1.24mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.2mmol/L；平均红细胞体积(MCV)-静脉血: 89.2fL；总胆汁酸(TBA)-静脉血: 0.9umol/L；载脂蛋白B(apoB)-静脉血: 1.28g/L；总钙(Ca)-静脉血: 2.2mmol/L；镁离子(Mg2+)-静脉血: 1.01mmol/L；红细胞比容(Hct)-静脉血: 34.8%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；乳酸脱氢酶(LDH)-静脉血: 151.8U/L；间接胆红素(IBIL)-静脉血: 9umolL；载脂蛋白AI(apoAI)-静脉血: 0.91g/L；总胆红素(TBIL)-静脉血: 12.8umol/L；大血小板百分比(P-LCR%)-静脉血: 9.3%；中性粒细胞百分比(Neut%)-静脉血: 0.782；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；血小板分布宽度(PDW)-静脉血: 8%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.1；碱性磷酸酶(ALP)-静脉血: 113.9U/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 342g/L；肌酐(Crea)-静脉血: 56.3umol/L；白蛋白(ALB)-静脉血: 40.5g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 27U/L；C-反应蛋白(CRP)-静脉血: 39.54mg/L；钾离子(K+)-静脉血: 4.07mmol/L；直接胆红素(DBIL)-静脉血: 3.8umol/L\n- [全程D69] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌治疗后，与某次就诊时间0日片对比: 鼻咽腔未见明显狭窄，鼻咽顶后壁、右侧壁轻度增厚，见少许软组织影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，右侧咽隐窝消失。鼻咽左侧壁未见明显增厚，左侧咽隐窝稍浅。右侧咽旁脂肪间隙稍变窄，左侧咽旁脂肪间隙未见异常。 右侧腭帆提张肌信号不均匀，左侧腭帆提张肌、双侧头长肌未见受侵征象。 双侧翼腭窝、上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 口咽双侧壁未见受累增厚，病变未累及双侧后鼻孔。 右侧翼突内份及内板、蝶骨基底部右份骨质信号减低，增强扫描轻度强化，范围较前缩小。余颅底未见明确骨质破坏征象。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦、右侧乳突粘膜增厚，双侧上颌窦见少量分泌物，蝶窦、左侧乳突充气良好，骨壁完整。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 右侧咽后淋巴结短径约6mm，较前缩小。左侧咽后未见肿大淋巴结。 右颈IIb区见稍大淋巴结，较大者短径约7mm，增强扫描明显强化，较前缩小。双颈IIa区见数个小淋巴结，较大者短径约5mm，增强扫描轻度强化，大致同前。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 扫描所见脑实质未见明显异常。；检查结论: 鼻咽癌治疗后，与某次就诊时间0日片对比: 鼻咽病变较前缩小。 颅底骨质破坏，较前有修复。 右侧咽后肿大淋巴结，考虑转移，较前缩小。 右颈IIb区淋巴结肿大，考虑转移，较前缩小。 双颈IIa区小淋巴结。 副鼻窦炎，右侧乳突炎。\n- [全程D69] 检验组合: 直接胆红素(DBIL)-静脉血: 3.2umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.033；阴离子间隙(AG)-静脉血: 16.9；白细胞计数(WBC#)-静脉血: 3.510E9/L；总胆红素(TBIL)-静脉血: 11.7umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 24.1U/L；尿酸(UA)-静脉血: 468.3umol/L；白蛋白(ALB)-静脉血: 39.4g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.016；红细胞比容(Hct)-静脉血: 33.6%；磷(P)-静脉血: 1.09mmol/L；C-反应蛋白(CRP)-静脉血: 20.73mg/L；载脂蛋白B(apoB)-静脉血: 1.37g/L；葡萄糖(Glu)-静脉血: 4.3mmol/L；单核细胞百分比(Mono%)-静脉血: 0.112；血小板比容-静脉血: 15.3%；肌酐(Crea)-静脉血: 62.2umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4%；碱性磷酸酶(ALP)-静脉血: 92.8U/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.9mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.57；总蛋白(TP)-静脉血: 64.43g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.86；淋巴细胞计数(Lymph#)-静脉血: 0.110E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；球蛋白(GLO)-静脉血: 25.03g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 36.2U/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.839；甘油三酯(TG)-静脉血: 1.02mmol/L；间接胆红素(IBIL)-静脉血: 8.5umolL；丙氨酸氨基转移酶(ALT)-静脉血: 16.3U/L；血小板计数(PLT#)-静脉血: 266.210E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.27mmol/L；平均血小板体积(MPV)-静脉血: 5.77fL；胱抑素(Cys-C)-静脉血: 0.73mg/L；尿素氮(BUN)-静脉血: 5mmol/L；血小板分布宽度(PDW)-静脉血: 16%；乳酸脱氢酶(LDH)-静脉血: 125.9U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.95mmolL；载脂蛋白AI(apoAI)-静脉血: 0.91g/L；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32.1pg；镁离子(Mg2+)-静脉血: 0.97mmol/L；总胆固醇(TC)-静脉血: 4.88mmol/L\n- [全程D70] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质回声均匀，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉内径约11mm，门静脉最大血流速度约23cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约40×35×31mm，包膜光滑，实质回声不均匀，可见强回声斑。 腹主动脉旁未见明确肿物回声。；检查结论: 前列腺钙化。 肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D54] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者放疗16次，口腔黏膜反应2度，放射性皮炎1度，患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：KPS 90分；张口门齿距4.5cm，鼻咽顶后壁、右侧壁肿物，较前缩小；右颈II区扪及一肿大淋巴结，大小约1X1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。颅神经检查：阴性。今日上级医师信息已隐藏后示：今日开始行第2程同时期DDP方案（DDP100mg/m2）化疗，继续放疗，续观。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D64] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者放疗22次，口腔黏膜反应2度，放射性皮炎1度，患者诉喉痛，余未诉特殊不适。生命体征平稳。查体：KPS 90分；张口门齿距4.5cm，鼻咽顶后壁、右侧壁肿物，较前缩小；双颈未触及肿大淋巴结；颅神经检查：阴性。今日上级医师信息已隐藏后示：患者诉喉痛，予患者奥施康定止痛，继续放疗，续观。\n- [全程D69] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者放疗26次，口腔黏膜反应3度，放射性皮炎2度，患者诉喉痛，余未诉特殊不适。生命体征平稳。查体：KPS 90分；张口门齿距4.5cm，鼻咽肿物已不明显；双颈未触及肿大淋巴结；颅神经检查：阴性。今日上级医师信息已隐藏后示：患者诉喉痛，继续予患者奥施康定止痛，继续放疗，续观。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 影像学评估病灶较前缩小，疗效肯定，需暂停放疗，待3度放射性口腔黏膜炎恢复至1度后再恢复放疗，期间予静脉营养支持。\nB. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，局部使用含漱液及非甾体类抗炎药镇痛，停用阿片类药物。\nC. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎伴咽痛，继续予羟考酮镇痛及静脉营养支持，并常规行PICC导管护理。\nD. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，行预防性气管切开以防气道水肿梗阻，并予静脉营养支持。\nE. 影像学评估病灶较前缩小，疗效肯定，已完成26次放疗且出现3度黏膜炎，提前结束放疗并转为辅助化疗，同时予羟考酮镇痛。\nF. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，拔除PICC导管以预防导管相关性血流感染，改用外周静脉营养。\nG. 影像学评估病灶未见明显缩小，疗效评价为疾病稳定（SD），重新定位更改放疗靶区并提高局部照射剂量，同时予羟考酮镇痛及静脉营养支持。\nH. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，立即行经皮内镜下胃造瘘术（PEG）以保证肠内营养。\nI. 影像学评估病灶完全消失，疗效评价为完全缓解（CR），提前终止放疗，进入随访观察期，对咽痛继续予羟考酮镇痛。\nJ. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；放疗已达26次且肿瘤退缩，同步加用西妥昔单抗以增强局部控制，并予静脉营养支持。\nK. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，静脉大剂量使用糖皮质激素以快速减轻炎症反应。\nL. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；出现3度放射性口腔黏膜炎，将后续放疗改为姑息性低剂量放疗，并予羟考酮镇痛。\n\n请仅输出一个选项字母（A-L）。","gold_letter":"C","gold_action":"影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；针对3度放射性口腔黏膜炎伴咽痛，继续予羟考酮镇痛及静脉营养支持，并常规行PICC导管护理。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"影像学评估病灶较前缩小，疗效肯定，需暂停放疗，待3度放射性口腔黏膜炎恢复至1度后再恢复放疗，期间予静脉营养支持。"},{"letter":"B","text":"影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，局部使用含漱液及非甾体类抗炎药镇痛，停用阿片类药物。"},{"letter":"C","text":"影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎伴咽痛，继续予羟考酮镇痛及静脉营养支持，并常规行PICC导管护理。"},{"letter":"D","text":"影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，行预防性气管切开以防气道水肿梗阻，并予静脉营养支持。"},{"letter":"E","text":"影像学评估病灶较前缩小，疗效肯定，已完成26次放疗且出现3度黏膜炎，提前结束放疗并转为辅助化疗，同时予羟考酮镇痛。"},{"letter":"F","text":"影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，拔除PICC导管以预防导管相关性血流感染，改用外周静脉营养。"},{"letter":"G","text":"影像学评估病灶未见明显缩小，疗效评价为疾病稳定（SD），重新定位更改放疗靶区并提高局部照射剂量，同时予羟考酮镇痛及静脉营养支持。"},{"letter":"H","text":"影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，立即行经皮内镜下胃造瘘术（PEG）以保证肠内营养。"},{"letter":"I","text":"影像学评估病灶完全消失，疗效评价为完全缓解（CR），提前终止放疗，进入随访观察期，对咽痛继续予羟考酮镇痛。"},{"letter":"J","text":"影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；放疗已达26次且肿瘤退缩，同步加用西妥昔单抗以增强局部控制，并予静脉营养支持。"},{"letter":"K","text":"影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，静脉大剂量使用糖皮质激素以快速减轻炎症反应。"},{"letter":"L","text":"影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；出现3度放射性口腔黏膜炎，将后续放疗改为姑息性低剂量放疗，并予羟考酮镇痛。"}]}
+{"sample_id":"sample-5aa9d7b50db0b59d009dcc69","patient_id":"patient-f509f093a998dace3479c00a","episode_id":"episode-7d0ea6bbfde1f9f6f10a8b7b","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；主诉: 发现颈部包块4月余、腰痛20余天。；现病史: 患者2019底无明显诱因出现牙齿坏死、右颈部包块，大小约2×2cm，质韧，后颈部包块进行性增大。现患者双侧颈部多发淋巴肿大、左侧下颌部位面部麻木，腰部疼痛，为咨询诊治。；既往疾病史: 是否有过敏史无过敏史。是否有吸烟史吸烟史详情 【病理资料1】既往时点补充报告： （左鼻腔）结合免疫组化及原位杂交结果，符合未分化型非角化性癌。 免疫组化：标本84：CK(AE1/AE3)（+），CK5/6（+），p40（+），EGFR（+），CD56（少量+），Syn（-），CgA（-），Ki-67（约70%+）。 原位杂交：EBERs（+）。 【影像与分期资料1】鼻咽病灶代谢活跃，考虑鼻咽癌，侵犯范围如上所述；双侧咽后、左侧腮腺区、双颈Ib-V区多发肿大淋巴结代谢活跃，考虑转移；肝内多发低密度结节代谢活跃，考虑转移；全身多发骨病灶代谢活跃，考虑转移。 双上颌窦炎症。 右中肺纤维增殖灶。 右侧腋窝小淋巴结炎症。 子宫多发肌瘤，部分伴变性。 左侧肩关节炎症；左侧臀中小肌及左侧阔筋膜张肌炎症；右侧骶髂关节良性病变。 ；鼻咽病变，考虑鼻咽癌；左侧海绵窦受侵。 颅底骨质破坏。 双侧咽后肿大淋巴结，考虑转移。 颈部肿大淋巴结，考虑转移。 副鼻窦炎。；检查部位: 鼻咽部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 24.0；区域淋巴结转移部位: 颈部淋巴结,双侧咽后淋巴结；是否区域复发: 否\n\n\n【当前需要决策的问题】\n病理已完成，治疗前分期资料如下：鼻咽病灶代谢活跃，考虑鼻咽癌，侵犯范围如上所述；双侧咽后、左侧腮腺区、双颈Ib-V区多发肿大淋巴结代谢活跃，考虑转移；肝内多发低密度结节代谢活跃，考虑转移；全身多发骨病灶代谢活跃，考虑转移。 双上颌窦炎症。 右中肺纤维增殖灶。 右侧腋窝小淋巴结炎症。 子宫多发肌瘤，部分伴变性。 左侧肩关节炎症；左侧臀中小肌及左侧阔筋膜张肌炎症；右侧骶髂关节良性病变。 ；鼻咽病变，考虑鼻咽癌；左侧海绵窦受侵。 颅底骨质破坏。 双侧咽后肿大淋巴结，考虑转移。 颈部肿大淋巴结，考虑转移。 副鼻窦炎。；检查部位: 鼻咽部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 24.0；区域淋巴结转移部位: 颈部淋巴结,双侧咽后淋巴结；是否区域复发: 否。请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T3 / N0 / cM0\nB. T1 / N2 / cM1\nC. T3 / N2 / cM0\nD. T4 / N3 / cM0\nE. T2 / N1 / cM1\nF. T2 / N3 / cM0\nG. T1 / N0 / cM0\nH. T4 / N2 / cM0\nI. T2 / N1 / cM0\nJ. T3 / N0 / cM1\nK. T4 / N3 / cM1\nL. T4 / N1 / cM1\n\n请仅输出一个选项字母（A-L）。","gold_letter":"K","gold_action":"T4 / N3 / cM1","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T3 / N0 / cM0","B":"T1 / N2 / cM1","C":"T3 / N2 / cM0","D":"T4 / N3 / cM0","E":"T2 / N1 / cM1","F":"T2 / N3 / cM0","G":"T1 / N0 / cM0","H":"T4 / N2 / cM0","I":"T2 / N1 / cM0","J":"T3 / N0 / cM1","K":"T4 / N3 / cM1","L":"T4 / N1 / cM1"}}
+{"sample_id":"sample-9b34ea64e80ae7672cb101d5","patient_id":"patient-a6aa1737ddf626a453650fc7","episode_id":"episode-71bbc530a2c41c9fb72f2f2e","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；病历特点: 患者A，男，56岁，因\"头痛4月余，复视20余天。\"于既往时点，步行入院。一、病例特点: 1、患者A，男性，56岁，[详细地址已隐藏]。2、现病史：缘于既往时点患者无明显诱因出现头痛，无头晕，无复视、视力模糊，无耳鸣、听力下降，无鼻塞、涕血，无面麻等不适，未予重视，逐渐加重，遂至外院A就诊。 后续既往时点患者无明显诱因出现复视，遂至外院A就诊，行鼻咽活检病理示：鼻咽未分化型非角化性癌，未行治疗。 后为进一步治疗就诊于来本院门诊。 患者发病以来，精神可，饮食睡眠一般，大小便正常，体重无明显变化。 3、肿瘤专科检查:张口门齿距4.0cm；鼻咽双侧顶后壁结节状肿物；左侧颈部扪及一肿大淋巴结，最大径2×2cm，无融合，质地中，边界清，活动度欠佳，无压痛，无皮肤浸润，无溃疡；；颅神经检查:阴性。示图: 【病理资料1】（右侧咽隐窝）镜检为未分化型非角化性癌。 本院免疫组化结果：EGFR（3+）。；活检部位: 右侧咽隐窝；肿瘤部位: 右侧咽隐窝；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】鼻咽病变，考虑鼻咽癌。右侧海绵窦受侵。 颅底骨质破坏。 双侧咽后数个肿大淋巴结，考虑转移。 副鼻窦炎；右侧乳突炎。；检查部位: 鼻咽部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；咽后淋巴结大者短径(mm): 12.0；区域淋巴结转移部位: 双侧咽后淋巴结；是否区域复发: 否\n治疗前外院PET/CT报告记载，双肺多发类结节，代谢不高，考虑增殖灶可能性大，建议随诊。 纵膈4R、7组、双侧肺门、双侧腋窝淋巴结，代谢稍活跃，考虑反应性增生可能性大。 肝脏多发囊肿。 左侧髂骨结节，代谢活跃，暂考虑良性病变可能，建议随诊除外其他。 双侧髂骨、骶骨病灶，部分代谢稍活跃，考虑良性病变。\n\n【当前需要决策的问题】\n病理已完成，治疗前分期资料如下：鼻咽病变，考虑鼻咽癌。右侧海绵窦受侵。 颅底骨质破坏。 双侧咽后数个肿大淋巴结，考虑转移。 副鼻窦炎；右侧乳突炎。；检查部位: 鼻咽部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；咽后淋巴结大者短径(mm): 12.0；区域淋巴结转移部位: 双侧咽后淋巴结；是否区域复发: 否。治疗前外院PET/CT报告记载，双肺多发类结节，代谢不高，考虑增殖灶可能性大，建议随诊。 纵膈4R、7组、双侧肺门、双侧腋窝淋巴结，代谢稍活跃，考虑反应性增生可能性大。 肝脏多发囊肿。 左侧髂骨结节，代谢活跃，暂考虑良性病变可能，建议随诊除外其他。 双侧髂骨、骶骨病灶，部分代谢稍活跃，考虑良性病变。请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T2 / N3 / cM0\nB. T3 / N2 / cM0\nC. T3 / N0 / cM1\nD. T4 / N1 / cM0\nE. T3 / N1 / cM1\nF. T3 / N3 / cM1\nG. T3 / N3 / cM0\nH. T4 / N2 / cM0\nI. T4 / N1 / cM1\nJ. T4 / N0 / cM1\nK. T1 / N1 / cM0\nL. T1 / N0 / cM0\n\n请仅输出一个选项字母（A-L）。","gold_letter":"D","gold_action":"T4 / N1 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T2 / N3 / cM0","B":"T3 / N2 / cM0","C":"T3 / N0 / cM1","D":"T4 / N1 / cM0","E":"T3 / N1 / cM1","F":"T3 / N3 / cM1","G":"T3 / N3 / cM0","H":"T4 / N2 / cM0","I":"T4 / N1 / cM1","J":"T4 / N0 / cM1","K":"T1 / N1 / cM0","L":"T1 / N0 / cM0"}}
+{"sample_id":"sample-6c783a17c32024820c766c17","patient_id":"patient-2636abbed83572883f5aa8f0","episode_id":"episode-1c5fc087f8bf3605dbb0d172","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；主诉: 右耳堵塞感4个月；现病史: 患者既往时点无明显诱因出现右耳闷胀感，伴耳鸣，听力下降，曾有涕血。内镜：鼻咽部顶后壁粘膜增厚。门诊既往史；既往疾病史: 肺结核5年余，无肿瘤遗传病史是否有过敏史无过敏史。是否有吸烟史无吸烟史。吸烟史详情月经史月经史: 有未绝经；体格检查: 鼻咽顶后壁见结节，双颈淋巴结未及明显肿大，颅神经阴性。心肺腹部无明显异常。 【病理资料1】（鼻咽）镜下：形态考虑为未分化型非角化性癌，建议交费用已送检的白片行免疫组化（CK、EGFR）及原位杂交检测（EBER）协助进一步诊断。；活检部位: 鼻咽；肿瘤部位: 鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】鼻咽病灶代谢活跃，结合病史，考虑恶性病变（鼻咽癌），具体侵及范围见上述；右侧咽后淋巴结代谢活跃，右侧颈部II区肿大淋巴结代谢活跃，考虑转移；余右颈II区小淋巴结代谢略活跃，转移待排。 鼻窦炎；右侧乳突炎。 双颈II区小淋巴结炎症。 右肺上叶尖段、前段及左肺上叶上舌段纤维增殖钙化灶（陈旧性肺结核？）；左肺门淋巴结钙化灶。 升结肠局灶代谢较活跃，疑炎症/生理性摄取。 ；鼻咽病变，考虑鼻咽癌； 颅底骨质破坏。 右侧咽后肿大淋巴结，考虑转移。 颈部右侧II区见肿大淋巴结，考虑转移。 副鼻窦炎；右侧乳突炎。 双侧扁桃体对称性增大，考虑反应性改变可能，建议复查。\n\n【当前需要决策的问题】\n病理已完成，治疗前分期资料如下：鼻咽病灶代谢活跃，结合病史，考虑恶性病变（鼻咽癌），具体侵及范围见上述；右侧咽后淋巴结代谢活跃，右侧颈部II区肿大淋巴结代谢活跃，考虑转移；余右颈II区小淋巴结代谢略活跃，转移待排。 鼻窦炎；右侧乳突炎。 双颈II区小淋巴结炎症。 右肺上叶尖段、前段及左肺上叶上舌段纤维增殖钙化灶（陈旧性肺结核？）；左肺门淋巴结钙化灶。 升结肠局灶代谢较活跃，疑炎症/生理性摄取。 ；鼻咽病变，考虑鼻咽癌； 颅底骨质破坏。 右侧咽后肿大淋巴结，考虑转移。 颈部右侧II区见肿大淋巴结，考虑转移。 副鼻窦炎；右侧乳突炎。 双侧扁桃体对称性增大，考虑反应性改变可能，建议复查。请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T2 / N3 / cM1\nB. T2 / N0 / cM1\nC. T3 / N1 / cM0\nD. T2 / N1 / cM1\nE. T3 / N2 / cM0\nF. T4 / N0 / cM0\nG. T4 / N0 / cM1\nH. T3 / N3 / cM0\nI. T1 / N0 / cM1\nJ. T3 / N3 / cM1\nK. T1 / N0 / cM0\nL. T1 / N3 / cM0\n\n请仅输出一个选项字母（A-L）。","gold_letter":"C","gold_action":"T3 / N1 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T2 / N3 / cM1","B":"T2 / N0 / cM1","C":"T3 / N1 / cM0","D":"T2 / N1 / cM1","E":"T3 / N2 / cM0","F":"T4 / N0 / cM0","G":"T4 / N0 / cM1","H":"T3 / N3 / cM0","I":"T1 / N0 / cM1","J":"T3 / N3 / cM1","K":"T1 / N0 / cM0","L":"T1 / N3 / cM0"}}
+{"sample_id":"sample-eafa2f73acd299285a01561d","patient_id":"patient-14905446c8bcef1504c57491","episode_id":"episode-304eb0cb49da166331ae53fd","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；主诉: 头痛4月，耳鸣4天；现病史: 患者4月前，4天前出现耳鸣，无鼻塞，无涕血。未行治疗，现为进一步诊治就诊于本院。；既往疾病史: 乙肝小三阳10余年，未行治疗是否有过敏史无过敏史。是否有吸烟史吸烟史详情；体格检查: 鼻咽未查，双侧颈部未扪及肿大淋巴结，颅神经（-） 【病理资料1】（左侧鼻咽部组织）镜检为恶性肿瘤，形态较符合为未分化型非角化性癌，必要时建议加行免疫组化及原位杂交进一步诊断；另见小块组织呈炎性肉芽组织改变。；活检部位: 左侧鼻咽；肿瘤部位: 左侧鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】鼻咽病灶代谢活跃，考虑鼻咽癌，病灶侵犯范围如上述；双侧咽后及双颈Ⅱ区淋巴结代谢较活跃/略活跃，疑转移，请结合临床。 双侧扁桃体代谢活跃，疑炎性病变。 鼻窦炎。 疑结节性甲状腺肿。 左上肺小结节代谢未见明显异常，疑增殖灶，建议随诊。 ；鼻咽病变，符合鼻咽癌。 颅底骨质破坏。 颈部双侧II区见数个小淋巴结，性质待定，转移待排。 副鼻窦炎。 甲状腺左侧叶肿大及多个结节，考虑结节性甲状腺肿可能，建议超声检查。\n\n【当前需要决策的问题】\n病理已完成，治疗前分期报告现已全部可见：鼻咽病灶代谢活跃，考虑鼻咽癌，病灶侵犯范围如上述；双侧咽后及双颈Ⅱ区淋巴结代谢较活跃/略活跃，疑转移，请结合临床。 双侧扁桃体代谢活跃，疑炎性病变。 鼻窦炎。 疑结节性甲状腺肿。 左上肺小结节代谢未见明显异常，疑增殖灶，建议随诊。 ；鼻咽病变，符合鼻咽癌。 颅底骨质破坏。 颈部双侧II区见数个小淋巴结，性质待定，转移待排。 副鼻窦炎。 甲状腺左侧叶肿大及多个结节，考虑结节性甲状腺肿可能，建议超声检查。请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T2 / N1 / cM1\nB. T2 / N3 / cM1\nC. T2 / N2 / cM1\nD. T3 / N0 / cM0\nE. T1 / N3 / cM0\nF. T2 / N2 / cM0\nG. T1 / N2 / cM0\nH. T3 / N2 / cM0\nI. T2 / N1 / cM0\nJ. T3 / N2 / cM1\nK. T3 / N3 / cM0\nL. T2 / N0 / cM0\n\n请仅输出一个选项字母（A-L）。","gold_letter":"H","gold_action":"T3 / N2 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T2 / N1 / cM1","B":"T2 / N3 / cM1","C":"T2 / N2 / cM1","D":"T3 / N0 / cM0","E":"T1 / N3 / cM0","F":"T2 / N2 / cM0","G":"T1 / N2 / cM0","H":"T3 / N2 / cM0","I":"T2 / N1 / cM0","J":"T3 / N2 / cM1","K":"T3 / N3 / cM0","L":"T2 / N0 / cM0"}}
+{"sample_id":"sample-47a7b87986732c5ef2170726","patient_id":"patient-8fc9073eeef1f579602c53c2","episode_id":"episode-c30a22dc2c2d600290fdf264","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；主诉: 涕血、头痛和鼻塞3月；门诊既往史；既往疾病史: 是否有过敏史无过敏史。是否有吸烟史吸烟史详情 【病理资料1】（鼻咽肿物/活检）未分化型非角化性癌。 原单位免疫组化结果：CK5/6（+++）,p40（+）,Ki-67（90%+）,EGFR（+++）,CK（+++）。 原位杂交结果：EBER Probe（+++）。 已送外白片[记录编号已隐去] 本院HE、免疫组化，待结果再后续补充报告！；活检部位: 鼻咽；肿瘤部位: 鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 双侧咽后淋巴结，考虑转移。 颈部双侧II区、双侧III区数个淋巴结，性质待定。 副鼻窦炎。 同期首次病程的临床诊断将远处转移分期记录为M0。\n\n【当前需要决策的问题】\n病理已完成，当前可见分期资料如下：鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 双侧咽后淋巴结，考虑转移。 颈部双侧II区、双侧III区数个淋巴结，性质待定。 副鼻窦炎。同期首次病程的临床诊断将远处转移分期记录为M0。请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T1 / N1 / cM1\nB. T3 / N2 / cM1\nC. T2 / N2 / cM0\nD. T2 / N1 / cM1\nE. T4 / N1 / cM1\nF. T1 / N0 / cM1\nG. T3 / N1 / cM0\nH. T1 / N0 / cM0\nI. T4 / N0 / cM0\nJ. T2 / N0 / cM0\nK. T2 / N3 / cM0\nL. T3 / N0 / cM1\n\n请仅输出一个选项字母（A-L）。","gold_letter":"G","gold_action":"T3 / N1 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T1 / N1 / cM1","B":"T3 / N2 / cM1","C":"T2 / N2 / cM0","D":"T2 / N1 / cM1","E":"T4 / N1 / cM1","F":"T1 / N0 / cM1","G":"T3 / N1 / cM0","H":"T1 / N0 / cM0","I":"T4 / N0 / cM0","J":"T2 / N0 / cM0","K":"T2 / N3 / cM0","L":"T3 / N0 / cM1"}}
+{"sample_id":"sample-ad8b9c4dd184be380d0d363c","patient_id":"patient-d35b8662b9cf177265f9f63d","episode_id":"episode-fc43bd1cc1cfa3618b2e3130","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】入院时间: 既往时点；现病史: 缘于既往时点月余前患者无明显发现右颈肿物，大小约3×3cm，质地硬，无压痛。患者A，精神可，饮食睡眠一般，大小便正常，体重无明显变化。；鼻症状: 无；耳症状: 无；眼症状: 无；头部症状: 无；是否有颈部肿物: 是；体重改变性质: 未变 【病理资料1】（鼻咽部）镜检为未分化型非角化性癌。；活检部位: 鼻咽；肿瘤部位: 鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】鼻咽病变，考虑鼻咽癌；右侧海绵窦、右侧眼眶受侵。 颅底骨质破坏。 双侧咽后多个肿大淋巴结，考虑转移。 颈部双侧II区见多个肿大淋巴结，考虑转移。 副鼻窦炎；双侧乳突炎。 治疗前外院PET/CT报告记载，右肺上叶陈旧性病变，左肺上叶钙化灶，双肺多发结节灶FDG代谢未见增高，建议胸部CT随访。直肠条片状FDG代谢轻度增高，考虑：炎性病变或生理性摄取可能，随访。脑显像FDG代谢未见明显异常。\n\n【当前需要决策的问题】\n病理已完成，治疗前分期报告现已全部可见：鼻咽病变，考虑鼻咽癌；右侧海绵窦、右侧眼眶受侵。 颅底骨质破坏。 双侧咽后多个肿大淋巴结，考虑转移。 颈部双侧II区见多个肿大淋巴结，考虑转移。 副鼻窦炎；双侧乳突炎。 治疗前外院PET/CT报告记载，右肺上叶陈旧性病变，左肺上叶钙化灶，双肺多发结节灶FDG代谢未见增高，建议胸部CT随访。直肠条片状FDG代谢轻度增高，考虑：炎性病变或生理性摄取可能，随访。脑显像FDG代谢未见明显异常。请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T1 / N2 / cM1\nB. T1 / N0 / cM0\nC. T3 / N1 / cM1\nD. T1 / N3 / cM1\nE. T4 / N2 / cM0\nF. T2 / N0 / cM0\nG. T2 / N1 / cM0\nH. T3 / N3 / cM0\nI. T2 / N2 / cM0\nJ. T1 / N2 / cM0\nK. T2 / N0 / cM1\nL. T4 / N1 / cM1\n\n请仅输出一个选项字母（A-L）。","gold_letter":"E","gold_action":"T4 / N2 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T1 / N2 / cM1","B":"T1 / N0 / cM0","C":"T3 / N1 / cM1","D":"T1 / N3 / cM1","E":"T4 / N2 / cM0","F":"T2 / N0 / cM0","G":"T2 / N1 / cM0","H":"T3 / N3 / cM0","I":"T2 / N2 / cM0","J":"T1 / N2 / cM0","K":"T2 / N0 / cM1","L":"T4 / N1 / cM1"}}
+{"sample_id":"sample-a31838b71e7cefc5d078c3b2","patient_id":"patient-a1f42fd798b22a2ae5c5a7bc","episode_id":"episode-ff70aa701c4512110d467742","turn_id":"P2_01","turn_number":2,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 当前阶段尚未释放病理、MRI或TNM结论。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；主诉: 左侧鼻塞10月余；门诊既往史；既往疾病史: 是否有过敏史无过敏史。是否有吸烟史吸烟史详情 【病理资料1】（鼻咽肿物）镜检为恶性肿瘤，考虑为未分化型非角化性癌，建议交费用已送检的白片行免疫组化（CK、EGFR）及原位杂交检测（EBER）协助进一步诊断。 备注：请带回本次会诊的所有外院病理切片及纸质资料。；活检部位: 鼻咽；肿瘤部位: 鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是\n\n【当前需要决策的问题】\n此前初诊线索为：记录时间: 既往时点；主诉: 左侧鼻塞10月余；门诊既往史；既往疾病史: 是否有过敏史无过敏史。是否有吸烟史吸烟史详情。本诊断节点新释放患者本人正式病理报告：（鼻咽肿物）镜检为恶性肿瘤，考虑为未分化型非角化性癌，建议交费用已送检的白片行免疫组化（CK、EGFR）及原位杂交检测（EBER）协助进一步诊断。 备注：请带回本次会诊的所有外院病理切片及纸质资料。；活检部位: 鼻咽；肿瘤部位: 鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是。此时最准确的组织学诊断是什么，哪些证据只能作为支持而不能单独替代正式病理？\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 鼻咽黏膜慢性炎症，EBER阳性即可排除恶性肿瘤\nB. 角化型鳞状细胞癌，仅凭EBV-DNA升高即可确诊\nC. 弥漫大B细胞淋巴瘤，CK阳性是其特异诊断依据\nD. NK/T细胞淋巴瘤，任何EBER阳性都足以替代组织形态\nE. 嗅神经母细胞瘤，以颈部淋巴结转移作为唯一证据\nF. 腺样囊性癌，未见腺样结构也可直接确诊\nG. 小细胞神经内分泌癌，Syn和CgA阴性仍应优先考虑\nH. 转移性甲状腺癌，不需要核对鼻咽取材部位\nI. 鼻咽部未定性恶性肿瘤，正式病理尚不能支持具体诊断\nJ. 鼻咽未分化型非角化性癌，正式组织病理为诊断核心，EBER/IHC为支持证据\nK. 良性淋巴组织增生，异型上皮巢不具有诊断价值\nL. 仅能判断EB病毒感染，不能据正式病理判断是否为癌\n\n请仅输出一个选项字母（A-L）。","gold_letter":"J","gold_action":"鼻咽未分化型非角化性癌，正式组织病理为诊断核心，EBER/IHC为支持证据","context_placeholders":[],"options":{"A":"鼻咽黏膜慢性炎症，EBER阳性即可排除恶性肿瘤","B":"角化型鳞状细胞癌，仅凭EBV-DNA升高即可确诊","C":"弥漫大B细胞淋巴瘤，CK阳性是其特异诊断依据","D":"NK/T细胞淋巴瘤，任何EBER阳性都足以替代组织形态","E":"嗅神经母细胞瘤，以颈部淋巴结转移作为唯一证据","F":"腺样囊性癌，未见腺样结构也可直接确诊","G":"小细胞神经内分泌癌，Syn和CgA阴性仍应优先考虑","H":"转移性甲状腺癌，不需要核对鼻咽取材部位","I":"鼻咽部未定性恶性肿瘤，正式病理尚不能支持具体诊断","J":"鼻咽未分化型非角化性癌，正式组织病理为诊断核心，EBER/IHC为支持证据","K":"良性淋巴组织增生，异型上皮巢不具有诊断价值","L":"仅能判断EB病毒感染，不能据正式病理判断是否为癌"}}
+{"sample_id":"sample-194fb948af9bd008180f8752","patient_id":"patient-a1f42fd798b22a2ae5c5a7bc","episode_id":"episode-ff70aa701c4512110d467742","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；主诉: 左侧鼻塞10月余；门诊既往史；既往疾病史: 是否有过敏史无过敏史。是否有吸烟史吸烟史详情 【病理资料1】（鼻咽肿物）镜检为恶性肿瘤，考虑为未分化型非角化性癌，建议交费用已送检的白片行免疫组化（CK、EGFR）及原位杂交检测（EBER）协助进一步诊断。 备注：请带回本次会诊的所有外院病理切片及纸质资料。；活检部位: 鼻咽；肿瘤部位: 鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 双侧咽后数个肿大淋巴结，考虑转移。 颈部双侧II、III区小淋巴结，性质待定。 副鼻窦炎；右侧乳突炎。 双侧扁桃体对称性增大，考虑炎性病变可能，请结合临床。 ；1.鼻咽病灶代谢活跃，考虑鼻咽癌，侵犯左侧腭帆肌群；双侧咽后淋巴结代谢较活跃，考虑转移。 2.双扁桃体炎；颈部双侧Ⅱ区淋巴结代谢较活跃，疑炎性病变。 3.鼻窦炎。 4.双肺纤维增殖灶。 5.双侧腋窝小淋巴结炎症。 6.肝多发小囊肿。\n\n【当前需要决策的问题】\n病理已完成，治疗前分期报告现已全部可见：鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 双侧咽后数个肿大淋巴结，考虑转移。 颈部双侧II、III区小淋巴结，性质待定。 副鼻窦炎；右侧乳突炎。 双侧扁桃体对称性增大，考虑炎性病变可能，请结合临床。 ；1.鼻咽病灶代谢活跃，考虑鼻咽癌，侵犯左侧腭帆肌群；双侧咽后淋巴结代谢较活跃，考虑转移。 2.双扁桃体炎；颈部双侧Ⅱ区淋巴结代谢较活跃，疑炎性病变。 3.鼻窦炎。 4.双肺纤维增殖灶。 5.双侧腋窝小淋巴结炎症。 6.肝多发小囊肿。请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T1 / N3 / cM0\nB. T1 / N2 / cM0\nC. T3 / N0 / cM0\nD. T4 / N0 / cM0\nE. T3 / N0 / cM1\nF. T3 / N1 / cM0\nG. T2 / N3 / cM1\nH. T1 / N3 / cM1\nI. T4 / N1 / cM0\nJ. T1 / N2 / cM1\nK. T4 / N2 / cM0\nL. T4 / N3 / cM0\n\n请仅输出一个选项字母（A-L）。","gold_letter":"F","gold_action":"T3 / N1 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T1 / N3 / cM0","B":"T1 / N2 / cM0","C":"T3 / N0 / cM0","D":"T4 / N0 / cM0","E":"T3 / N0 / cM1","F":"T3 / N1 / cM0","G":"T2 / N3 / cM1","H":"T1 / N3 / cM1","I":"T4 / N1 / cM0","J":"T1 / N2 / cM1","K":"T4 / N2 / cM0","L":"T4 / N3 / cM0"}}
+{"sample_id":"sample-33dd5087bcfcf496a216f2fb","patient_id":"patient-e84ab9973716353b1e20d968","episode_id":"episode-563539faffd2f523e1cdf970","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；主诉: 左耳堵塞感2年；；既往疾病史: 无高血压糖尿病，无乙肝是否有过敏史无过敏史。是否有吸烟史有吸烟史。40年吸烟史详情；体格检查: 鼻咽未查，颈部淋巴结（-),颅神经（-）； 【影像与分期资料1】鼻咽病灶代谢活跃，考虑鼻咽癌，侵犯颅底骨、左颈动脉管及左海绵窦，具体侵犯范围如上述；左侧咽后淋巴结代谢活跃，考虑转移。 双颈II区小淋巴结代谢略活跃，疑炎症。 双肺肺气肿；双肺散在纤维增殖灶。 肝囊肿。 前列腺钙化。 ；鼻咽病变，考虑鼻咽癌；左侧海绵窦受侵。 颅底骨质破坏。 左侧咽后1个肿大淋巴结，考虑转移。 颈部双侧II区、双侧III区、左侧IV区、左侧腮腺区见数个小淋巴结，考虑转移。\n\n【当前需要决策的问题】\n病理已完成，治疗前分期资料如下：鼻咽病灶代谢活跃，考虑鼻咽癌，侵犯颅底骨、左颈动脉管及左海绵窦，具体侵犯范围如上述；左侧咽后淋巴结代谢活跃，考虑转移。 双颈II区小淋巴结代谢略活跃，疑炎症。 双肺肺气肿；双肺散在纤维增殖灶。 肝囊肿。 前列腺钙化。 ；鼻咽病变，考虑鼻咽癌；左侧海绵窦受侵。 颅底骨质破坏。 左侧咽后1个肿大淋巴结，考虑转移。 颈部双侧II区、双侧III区、左侧IV区、左侧腮腺区见数个小淋巴结，考虑转移。请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T2 / N0 / cM0\nB. T1 / N3 / cM0\nC. T1 / N0 / cM0\nD. T3 / N3 / cM0\nE. T2 / N2 / cM0\nF. T2 / N1 / cM0\nG. T1 / N1 / cM0\nH. T4 / N3 / cM0\nI. T1 / N2 / cM1\nJ. T2 / N3 / cM0\nK. T4 / N3 / cM1\nL. T4 / N1 / cM0\n\n请仅输出一个选项字母（A-L）。","gold_letter":"H","gold_action":"T4 / N3 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T2 / N0 / cM0","B":"T1 / N3 / cM0","C":"T1 / N0 / cM0","D":"T3 / N3 / cM0","E":"T2 / N2 / cM0","F":"T2 / N1 / cM0","G":"T1 / N1 / cM0","H":"T4 / N3 / cM0","I":"T1 / N2 / cM1","J":"T2 / N3 / cM0","K":"T4 / N3 / cM1","L":"T4 / N1 / cM0"}}
+{"sample_id":"sample-9e2e2146ac009f7756158c05","patient_id":"patient-f229dd9bf4b869b8294dd81a","episode_id":"episode-939442b70ce83d9134e66386","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；主诉: 左颈淋巴结肿大10余天，外院A检查发现鼻咽肿物。； 【病理资料1】（双侧鼻咽肿物）恶性肿瘤，考虑为癌，建议用送检白片来我科交费行免疫组化及原位杂交检查协助诊断。 既往时点补充报告： （双侧鼻咽肿物）镜检为未分化型非角化性癌。 本院免疫组化：#[编号已隐藏]：EGFR（+），CK(AE1/AE3)（+）。 本院原位杂交：#[编号已隐藏]：EBERs（+）。；活检部位: 双侧鼻咽；肿瘤部位: 双侧鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】鼻咽病灶代谢活跃，考虑鼻咽癌，侵犯范围如上述；左侧咽后、左颈II-V区多发肿大淋巴结代谢活跃，考虑转移；右侧咽后及右颈II 区淋巴结代谢较活跃，疑转移。 鼻窦炎。 疑右侧枕叶钙化灶。 左肺上叶小增殖灶；右中肺及双下肺少许纤维灶。 脂肪肝。 ；鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 双侧咽后多个肿大淋巴结，考虑转移。 颈部左侧II-V区多个肿大淋巴结，考虑转移；侵犯左颈内静脉，疑并癌栓；左颈内动脉壁可疑受侵。 颈部右侧II区淋巴结，性质待定，建议随诊。\n\n【当前需要决策的问题】\n病理已完成，治疗前分期资料如下：鼻咽病灶代谢活跃，考虑鼻咽癌，侵犯范围如上述；左侧咽后、左颈II-V区多发肿大淋巴结代谢活跃，考虑转移；右侧咽后及右颈II 区淋巴结代谢较活跃，疑转移。 鼻窦炎。 疑右侧枕叶钙化灶。 左肺上叶小增殖灶；右中肺及双下肺少许纤维灶。 脂肪肝。 ；鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 双侧咽后多个肿大淋巴结，考虑转移。 颈部左侧II-V区多个肿大淋巴结，考虑转移；侵犯左颈内静脉，疑并癌栓；左颈内动脉壁可疑受侵。 颈部右侧II区淋巴结，性质待定，建议随诊。请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T2 / N3 / cM0\nB. T1 / N0 / cM0\nC. T4 / N3 / cM0\nD. T2 / N3 / cM1\nE. T4 / N0 / cM0\nF. T3 / N3 / cM0\nG. T3 / N2 / cM0\nH. T4 / N1 / cM0\nI. T1 / N3 / cM1\nJ. T3 / N1 / cM1\nK. T3 / N1 / cM0\nL. T3 / N2 / cM1\n\n请仅输出一个选项字母（A-L）。","gold_letter":"F","gold_action":"T3 / N3 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T2 / N3 / cM0","B":"T1 / N0 / cM0","C":"T4 / N3 / cM0","D":"T2 / N3 / cM1","E":"T4 / N0 / cM0","F":"T3 / N3 / cM0","G":"T3 / N2 / cM0","H":"T4 / N1 / cM0","I":"T1 / N3 / cM1","J":"T3 / N1 / cM1","K":"T3 / N1 / cM0","L":"T3 / N2 / cM1"}}
+{"sample_id":"sample-e58c5dfb735f0d14b773c631","patient_id":"patient-5c77cf118819bdf31fcf8f42","episode_id":"episode-968cc61ba4cec0913e7e38e1","turn_id":"P2_01","turn_number":2,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 当前阶段尚未释放病理、MRI或TNM结论。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；病历特点: 患者A，女，32岁，因\"左侧头痛2月余\"于既往时点，步行入院。患者A，精神可，饮食睡眠一般，大小便正常，体重无明显变化。3、肿瘤专科检查:张口门齿距3cm；鼻咽双侧顶后壁结节状肿物；左侧颈部IIa区可扪及1个淋巴结，最大径1.5×1cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查:阴性。 【病理资料1】（左咽隐窝肿物）镜下：考虑为未分化型非角化性癌，建议免疫组化及原位杂交协助诊断。；活检部位: 左侧咽隐窝；肿瘤部位: 左侧咽隐窝；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是\n\n【当前需要决策的问题】\n此前初诊线索为：记录时间: 既往时点；病历特点: 患者A，女，32岁，因\"左侧头痛2月余\"于既往时点，步行入院。患者A，精神可，饮食睡眠一般，大小便正常，体重无明显变化。3、肿瘤专科检查:张口门齿距3cm；鼻咽双侧顶后壁结节状肿物；左侧颈部IIa区可扪及1个淋巴结，最大径1.5×1cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查:阴性。。本诊断节点新释放患者本人正式病理报告：（左咽隐窝肿物）镜下：考虑为未分化型非角化性癌，建议免疫组化及原位杂交协助诊断。；活检部位: 左侧咽隐窝；肿瘤部位: 左侧咽隐窝；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是。此时最准确的组织学诊断是什么，哪些证据只能作为支持而不能单独替代正式病理？\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 鼻咽黏膜慢性炎症，EBER阳性即可排除恶性肿瘤\nB. 角化型鳞状细胞癌，仅凭EBV-DNA升高即可确诊\nC. 弥漫大B细胞淋巴瘤，CK阳性是其特异诊断依据\nD. NK/T细胞淋巴瘤，任何EBER阳性都足以替代组织形态\nE. 嗅神经母细胞瘤，以颈部淋巴结转移作为唯一证据\nF. 腺样囊性癌，未见腺样结构也可直接确诊\nG. 鼻咽未分化型非角化性癌，正式组织病理为诊断核心，EBER/IHC为支持证据\nH. 小细胞神经内分泌癌，Syn和CgA阴性仍应优先考虑\nI. 转移性甲状腺癌，不需要核对鼻咽取材部位\nJ. 鼻咽部未定性恶性肿瘤，正式病理尚不能支持具体诊断\nK. 良性淋巴组织增生，异型上皮巢不具有诊断价值\nL. 仅能判断EB病毒感染，不能据正式病理判断是否为癌\n\n请仅输出一个选项字母（A-L）。","gold_letter":"G","gold_action":"鼻咽未分化型非角化性癌，正式组织病理为诊断核心，EBER/IHC为支持证据","context_placeholders":[],"options":{"A":"鼻咽黏膜慢性炎症，EBER阳性即可排除恶性肿瘤","B":"角化型鳞状细胞癌，仅凭EBV-DNA升高即可确诊","C":"弥漫大B细胞淋巴瘤，CK阳性是其特异诊断依据","D":"NK/T细胞淋巴瘤，任何EBER阳性都足以替代组织形态","E":"嗅神经母细胞瘤，以颈部淋巴结转移作为唯一证据","F":"腺样囊性癌，未见腺样结构也可直接确诊","G":"鼻咽未分化型非角化性癌，正式组织病理为诊断核心，EBER/IHC为支持证据","H":"小细胞神经内分泌癌，Syn和CgA阴性仍应优先考虑","I":"转移性甲状腺癌，不需要核对鼻咽取材部位","J":"鼻咽部未定性恶性肿瘤，正式病理尚不能支持具体诊断","K":"良性淋巴组织增生，异型上皮巢不具有诊断价值","L":"仅能判断EB病毒感染，不能据正式病理判断是否为癌"}}
+{"sample_id":"sample-55c7b635645a064213d9dc14","patient_id":"patient-5c77cf118819bdf31fcf8f42","episode_id":"episode-968cc61ba4cec0913e7e38e1","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；病历特点: 患者A，女，32岁，因\"左侧头痛2月余\"于既往时点，步行入院。患者A，精神可，饮食睡眠一般，大小便正常，体重无明显变化。3、肿瘤专科检查:张口门齿距3cm；鼻咽双侧顶后壁结节状肿物；左侧颈部IIa区可扪及1个淋巴结，最大径1.5×1cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查:阴性。 【病理资料1】（左咽隐窝肿物）镜下：考虑为未分化型非角化性癌，建议免疫组化及原位杂交协助诊断。；活检部位: 左侧咽隐窝；肿瘤部位: 左侧咽隐窝；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 双侧咽后多个肿大淋巴结，考虑转移。 颈部双侧II~V区多发淋巴结，性质待定。；检查部位: 鼻咽部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 20.0；区域淋巴结转移部位: 双侧咽后淋巴结；是否区域复发: 否 ；1.鼻咽病灶代谢活跃，考虑鼻咽癌，病灶侵犯颅底骨质及颅底孔道，余侵犯范围如上述；双侧咽后、颈部左侧Ⅱ区淋巴结代谢活跃，考虑转移；颈部右侧Ⅱ区淋巴结代谢略活跃，转移待排，建议随诊。 2.双肺多发小结节影、小斑片影代谢未见明显异常，考虑炎性病变、增殖灶。\n\n【当前需要决策的问题】\n病理已完成，治疗前分期资料如下：鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 双侧咽后多个肿大淋巴结，考虑转移。 颈部双侧II~V区多发淋巴结，性质待定。；检查部位: 鼻咽部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 20.0；区域淋巴结转移部位: 双侧咽后淋巴结；是否区域复发: 否 ；1.鼻咽病灶代谢活跃，考虑鼻咽癌，病灶侵犯颅底骨质及颅底孔道，余侵犯范围如上述；双侧咽后、颈部左侧Ⅱ区淋巴结代谢活跃，考虑转移；颈部右侧Ⅱ区淋巴结代谢略活跃，转移待排，建议随诊。 2.双肺多发小结节影、小斑片影代谢未见明显异常，考虑炎性病变、增殖灶。请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T3 / N0 / cM0\nB. T1 / N0 / cM0\nC. T4 / N3 / cM0\nD. T3 / N1 / cM0\nE. T2 / N2 / cM1\nF. T4 / N1 / cM1\nG. T1 / N2 / cM0\nH. T4 / N3 / cM1\nI. T1 / N3 / cM1\nJ. T1 / N3 / cM0\nK. T2 / N2 / cM0\nL. T4 / N2 / cM0\n\n请仅输出一个选项字母（A-L）。","gold_letter":"D","gold_action":"T3 / N1 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T3 / N0 / cM0","B":"T1 / N0 / cM0","C":"T4 / N3 / cM0","D":"T3 / N1 / cM0","E":"T2 / N2 / cM1","F":"T4 / N1 / cM1","G":"T1 / N2 / cM0","H":"T4 / N3 / cM1","I":"T1 / N3 / cM1","J":"T1 / N3 / cM0","K":"T2 / N2 / cM0","L":"T4 / N2 / cM0"}}
+{"sample_id":"sample-c4d2fd4296aed32b65eec9c4","patient_id":"patient-eefab65cf080ff1d932d6946","episode_id":"episode-f65d77313fc2e3e8a51a5af2","turn_id":"P2_01","turn_number":2,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 当前阶段尚未释放病理、MRI或TNM结论。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；主诉: 左上颈肿物1年余；现病史: 患者1年前出现左上颈肿物，因近日见增大明显，单无鼻塞、涕血、头疼、面麻等不适，经当地NPB拟诊NPC来诊。PE：左颈II区扪及约2X3cm ，颅神经（-）。门诊既往史；既往疾病史: 无是否有过敏史无过敏史。是否有吸烟史吸烟史详情 【病理资料1】（鼻咽肿物）镜下：送检组织中可见少量核大异型细胞呈巢团状排列，形态结合原单位免疫组化及原位杂交结果，考虑未分化型非角化性癌，但组织挤压变形，原单位原位杂交结果表达不典型，建议切涂胶白片5张来我科交费加行免疫组化及原位杂交检查协助诊断。 原单位免疫组化结果：CK（+）。 原单位原位杂交结果：EBER（考虑部分细胞+）。 既往时点补充报告： （鼻咽肿物）镜下形态结合免疫组化及原位杂交结果，符合未分化型非角化性癌，病变细胞数量少且伴有挤压变形，原位杂交EBERs表达不典型，请结合临床。 本院免疫组化：#[编号已隐藏]：EGFR（+），p63（+）。 本院原味杂交：#[编号已隐藏]：EBERs（部分+）（已重复）。；活检部位: 鼻咽；肿瘤部位: 鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是\n\n【当前需要决策的问题】\n此前初诊线索为：记录时间: 既往时点；主诉: 左上颈肿物1年余；现病史: 患者1年前出现左上颈肿物，因近日见增大明显，单无鼻塞、涕血、头疼、面麻等不适，经当地NPB拟诊NPC来诊。PE：左颈II区扪及约2X3cm ，颅神经（-）。门诊既往史；既往疾病史: 无是否有过敏史无过敏史。是否有吸烟史吸烟史详情。本诊断节点新释放患者本人正式病理报告：（鼻咽肿物）镜下：送检组织中可见少量核大异型细胞呈巢团状排列，形态结合原单位免疫组化及原位杂交结果，考虑未分化型非角化性癌，但组织挤压变形，原单位原位杂交结果表达不典型，建议切涂胶白片5张来我科交费加行免疫组化及原位杂交检查协助诊断。 原单位免疫组化结果：CK（+）。 原单位原位杂交结果：EBER（考虑部分细胞+）。 既往时点补充报告： （鼻咽肿物）镜下形态结合免疫组化及原位杂交结果，符合未分化型非角化性癌，病变细胞数量少且伴有挤压变形，原位杂交EBERs表达不典型，请结合临床。 本院免疫组化：#[编号已隐藏]：EGFR（+），p63（+）。 本院原味杂交：#[编号已隐藏]：EBERs（部分+）（已重复）。；活检部位: 鼻咽；肿瘤部位: 鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是。此时最准确的组织学诊断是什么，哪些证据只能作为支持而不能单独替代正式病理？\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 鼻咽黏膜慢性炎症，EBER阳性即可排除恶性肿瘤\nB. 角化型鳞状细胞癌，仅凭EBV-DNA升高即可确诊\nC. 弥漫大B细胞淋巴瘤，CK阳性是其特异诊断依据\nD. NK/T细胞淋巴瘤，任何EBER阳性都足以替代组织形态\nE. 嗅神经母细胞瘤，以颈部淋巴结转移作为唯一证据\nF. 腺样囊性癌，未见腺样结构也可直接确诊\nG. 小细胞神经内分泌癌，Syn和CgA阴性仍应优先考虑\nH. 转移性甲状腺癌，不需要核对鼻咽取材部位\nI. 鼻咽部未定性恶性肿瘤，正式病理尚不能支持具体诊断\nJ. 良性淋巴组织增生，异型上皮巢不具有诊断价值\nK. 鼻咽未分化型非角化性癌，正式组织病理为诊断核心，EBER/IHC为支持证据\nL. 仅能判断EB病毒感染，不能据正式病理判断是否为癌\n\n请仅输出一个选项字母（A-L）。","gold_letter":"K","gold_action":"鼻咽未分化型非角化性癌，正式组织病理为诊断核心，EBER/IHC为支持证据","context_placeholders":[],"options":{"A":"鼻咽黏膜慢性炎症，EBER阳性即可排除恶性肿瘤","B":"角化型鳞状细胞癌，仅凭EBV-DNA升高即可确诊","C":"弥漫大B细胞淋巴瘤，CK阳性是其特异诊断依据","D":"NK/T细胞淋巴瘤，任何EBER阳性都足以替代组织形态","E":"嗅神经母细胞瘤，以颈部淋巴结转移作为唯一证据","F":"腺样囊性癌，未见腺样结构也可直接确诊","G":"小细胞神经内分泌癌，Syn和CgA阴性仍应优先考虑","H":"转移性甲状腺癌，不需要核对鼻咽取材部位","I":"鼻咽部未定性恶性肿瘤，正式病理尚不能支持具体诊断","J":"良性淋巴组织增生，异型上皮巢不具有诊断价值","K":"鼻咽未分化型非角化性癌，正式组织病理为诊断核心，EBER/IHC为支持证据","L":"仅能判断EB病毒感染，不能据正式病理判断是否为癌"}}
+{"sample_id":"sample-e7b0b6719d83ed12029944ab","patient_id":"patient-eefab65cf080ff1d932d6946","episode_id":"episode-f65d77313fc2e3e8a51a5af2","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；主诉: 左上颈肿物1年余；现病史: 患者1年前出现左上颈肿物，因近日见增大明显，单无鼻塞、涕血、头疼、面麻等不适，经当地NPB拟诊NPC来诊。PE：左颈II区扪及约2X3cm ，颅神经（-）。门诊既往史；既往疾病史: 无是否有过敏史无过敏史。是否有吸烟史吸烟史详情 【病理资料1】（鼻咽肿物）镜下：送检组织中可见少量核大异型细胞呈巢团状排列，形态结合原单位免疫组化及原位杂交结果，考虑未分化型非角化性癌，但组织挤压变形，原单位原位杂交结果表达不典型，建议切涂胶白片5张来我科交费加行免疫组化及原位杂交检查协助诊断。 原单位免疫组化结果：CK（+）。 原单位原位杂交结果：EBER（考虑部分细胞+）。 既往时点补充报告： （鼻咽肿物）镜下形态结合免疫组化及原位杂交结果，符合未分化型非角化性癌，病变细胞数量少且伴有挤压变形，原位杂交EBERs表达不典型，请结合临床。 本院免疫组化：#[编号已隐藏]：EGFR（+），p63（+）。 本院原味杂交：#[编号已隐藏]：EBERs（部分+）（已重复）。；活检部位: 鼻咽；肿瘤部位: 鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】肝S8稍低回声结节，不均匀脂肪肝？建议超声造影检查。 胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。 ；鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 双侧咽后数个淋巴结，考虑转移。 颈部双侧II区、双侧III区、左侧V区见多个淋巴结，考虑转移。 副鼻窦炎。 ；筛窦、双上颌骨、右下颌骨、左乳突炎症。 数个颈胸腰椎退行性变、炎性变。；检查部位: 骨 ；左肺下叶及右肺上叶小结节，多考虑为增殖灶。 肝S6/7肿块，多考虑为血管瘤。 肝内散在低密度灶，考虑肝囊肿可能，建议随诊。 右肾结石。；检查部位: 上腹部\n\n【当前需要决策的问题】\n病理已完成，治疗前分期资料如下：肝S8稍低回声结节，不均匀脂肪肝？建议超声造影检查。 胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。 ；鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 双侧咽后数个淋巴结，考虑转移。 颈部双侧II区、双侧III区、左侧V区见多个淋巴结，考虑转移。 副鼻窦炎。 ；筛窦、双上颌骨、右下颌骨、左乳突炎症。 数个颈胸腰椎退行性变、炎性变。；检查部位: 骨 ；左肺下叶及右肺上叶小结节，多考虑为增殖灶。 肝S6/7肿块，多考虑为血管瘤。 肝内散在低密度灶，考虑肝囊肿可能，建议随诊。 右肾结石。；检查部位: 上腹部。请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T3 / N0 / cM0\nB. T2 / N3 / cM0\nC. T3 / N3 / cM1\nD. T3 / N0 / cM1\nE. T1 / N3 / cM1\nF. T3 / N2 / cM0\nG. T4 / N1 / cM0\nH. T4 / N1 / cM1\nI. T2 / N1 / cM1\nJ. T2 / N0 / cM1\nK. T2 / N0 / cM0\nL. T2 / N3 / cM1\n\n请仅输出一个选项字母（A-L）。","gold_letter":"F","gold_action":"T3 / N2 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T3 / N0 / cM0","B":"T2 / N3 / cM0","C":"T3 / N3 / cM1","D":"T3 / N0 / cM1","E":"T1 / N3 / cM1","F":"T3 / N2 / cM0","G":"T4 / N1 / cM0","H":"T4 / N1 / cM1","I":"T2 / N1 / cM1","J":"T2 / N0 / cM1","K":"T2 / N0 / cM0","L":"T2 / N3 / cM1"}}
+{"sample_id":"sample-a91663bc20c440d1417ed5f3","patient_id":"patient-28f7f3a688fe8d84fcbc1ce9","episode_id":"episode-b2a5dcb7478e91215352ae14","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；病历特点: 患者A，女，60岁，因\"涕血3月余\"于既往时点，步行入院。患者未行治疗。今为求进一步诊治来本院。患者A，精神可，饮食睡眠一般，大小便正常，体重无明显变化。3、肿瘤专科检查:张口门齿距4cm；鼻咽肿物；双侧颈部II-III区可扪及2个肿大淋巴结，大小约1.5*1.5cm,z质硬，无融合；颅神经检查:阴性。 【病理资料1】（左后鼻孔）镜下：形态符合未分化型非角化性癌，建议加做免疫组化协助进一步诊断。；活检部位: 左侧鼻孔 【影像与分期资料1】鼻咽病灶代谢活跃，考虑鼻咽癌，病灶侵犯颅底骨（蝶骨基底部、左翼突基底部、枕骨斜坡、左岩尖）、左破裂孔、左腭帆肌群、左头长肌及左咽旁咽后间隙；左咽后、右颈Ⅱ区及左颈Ⅴ区多个肿大淋巴结代谢活跃，考虑转移。 左颈Ⅱ区淋巴结代谢略活跃，疑炎性病变，转移待排，请结合临床。 鼻窦炎。 双肺增殖灶。 肝囊肿。 左肾结石。 多个颈胸腰椎退行性变；L3/4、L4/5椎间盘突出。 ；鼻咽病变，考虑鼻咽癌。 颅底骨质未见明显破坏。 左侧咽后数个肿大淋巴结，考虑转移。 颈部右侧II区、左侧V A区见多个肿大淋巴结，考虑转移。 副鼻窦炎。；检查部位: 鼻咽部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域淋巴结转移部位: 右侧II区淋巴结,左侧咽后淋巴结；是否区域复发: 否\n\n【当前需要决策的问题】\n病理已完成，治疗前分期报告现已全部可见：鼻咽病灶代谢活跃，考虑鼻咽癌，病灶侵犯颅底骨（蝶骨基底部、左翼突基底部、枕骨斜坡、左岩尖）、左破裂孔、左腭帆肌群、左头长肌及左咽旁咽后间隙；左咽后、右颈Ⅱ区及左颈Ⅴ区多个肿大淋巴结代谢活跃，考虑转移。 左颈Ⅱ区淋巴结代谢略活跃，疑炎性病变，转移待排，请结合临床。 鼻窦炎。 双肺增殖灶。 肝囊肿。 左肾结石。 多个颈胸腰椎退行性变；L3/4、L4/5椎间盘突出。 ；鼻咽病变，考虑鼻咽癌。 颅底骨质未见明显破坏。 左侧咽后数个肿大淋巴结，考虑转移。 颈部右侧II区、左侧V A区见多个肿大淋巴结，考虑转移。 副鼻窦炎。；检查部位: 鼻咽部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域淋巴结转移部位: 右侧II区淋巴结,左侧咽后淋巴结；是否区域复发: 否。请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T4 / N0 / cM1\nB. T1 / N1 / cM0\nC. T3 / N0 / cM0\nD. T2 / N3 / cM0\nE. T4 / N3 / cM0\nF. T4 / N3 / cM1\nG. T3 / N3 / cM0\nH. T2 / N1 / cM0\nI. T4 / N2 / cM1\nJ. T2 / N0 / cM0\nK. T1 / N2 / cM0\nL. T3 / N2 / cM0\n\n请仅输出一个选项字母（A-L）。","gold_letter":"L","gold_action":"T3 / N2 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T4 / N0 / cM1","B":"T1 / N1 / cM0","C":"T3 / N0 / cM0","D":"T2 / N3 / cM0","E":"T4 / N3 / cM0","F":"T4 / N3 / cM1","G":"T3 / N3 / cM0","H":"T2 / N1 / cM0","I":"T4 / N2 / cM1","J":"T2 / N0 / cM0","K":"T1 / N2 / cM0","L":"T3 / N2 / cM0"}}
+{"sample_id":"sample-205dc23b6aab9afa28a0e2e4","patient_id":"patient-28f7f3a688fe8d84fcbc1ce9","episode_id":"episode-b2a5dcb7478e91215352ae14","turn_id":"P5_02","turn_number":6,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM：{{TNM_STATUS}}；总分期：{{OVERALL_STAGE}}。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；病历特点: 患者A，女，60岁，因\"涕血3月余\"于既往时点，步行入院。患者未行治疗。今为求进一步诊治来本院。患者A，精神可，饮食睡眠一般，大小便正常，体重无明显变化。3、肿瘤专科检查:张口门齿距4cm；鼻咽肿物；双侧颈部II-III区可扪及2个肿大淋巴结，大小约1.5*1.5cm,z质硬，无融合；颅神经检查:阴性。 【病理资料1】（左后鼻孔）镜下：形态符合未分化型非角化性癌，建议加做免疫组化协助进一步诊断。；活检部位: 左侧鼻孔 【影像与分期资料1】鼻咽病灶代谢活跃，考虑鼻咽癌，病灶侵犯颅底骨（蝶骨基底部、左翼突基底部、枕骨斜坡、左岩尖）、左破裂孔、左腭帆肌群、左头长肌及左咽旁咽后间隙；左咽后、右颈Ⅱ区及左颈Ⅴ区多个肿大淋巴结代谢活跃，考虑转移。 左颈Ⅱ区淋巴结代谢略活跃，疑炎性病变，转移待排，请结合临床。 鼻窦炎。 双肺增殖灶。 肝囊肿。 左肾结石。 多个颈胸腰椎退行性变；L3/4、L4/5椎间盘突出。 ；鼻咽病变，考虑鼻咽癌。 颅底骨质未见明显破坏。 左侧咽后数个肿大淋巴结，考虑转移。 颈部右侧II区、左侧V A区见多个肿大淋巴结，考虑转移。 副鼻窦炎。；检查部位: 鼻咽部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域淋巴结转移部位: 右侧II区淋巴结,左侧咽后淋巴结；是否区域复发: 否 【治疗经过1】记录时间: 既往时点；病历特点: 患者A，女，60岁，因\"涕血3月余\"于既往时点，步行入院。 一、病例特点: 1、患者A，女性，60岁，广东省[地点已隐去]人 2、现病史:缘于既往时点月下旬患者无明显诱因出现涕血，偶感头晕、头痛，无复视、视力模糊，无耳鸣、听力下降，无鼻塞，无面麻等不适，未予重视，逐渐加重，遂至外院A就诊，既往时点行鼻咽活检病理示：鼻咽非角化性癌，行鼻咽颈部CT示左侧鼻咽Ca并左侧颈动脉鞘周围、左侧颈深淋巴结肿大。 患者未行治疗。 今为求进一步诊治来本院。 患者发病以来，精神可，饮食睡眠一般，大小便正常，体重无明显变化。 3、肿瘤专科检查:张口门齿距4cm；鼻咽肿物；右颈部II、左颈V区可扪及2个肿大淋巴结，大小约1.5*1.5cm,质硬，无融合；颅神经检查:阴性。 4、辅助检查:既往时点 外院A 鼻咽活检病理示：鼻咽非角化性癌， 既往时点 外院A 鼻咽颈部CT示：左侧鼻咽Ca并左侧颈动脉鞘周围、左侧颈深淋巴结肿大。 既往时点 鼻咽部磁共振平扫＋增强(1.5T以上)(套) 检查结果： 鼻咽腔狭窄，鼻咽双侧顶壁、双侧顶后壁、左侧壁增厚，明显强化。 左侧咽隐窝受侵，右侧咽隐窝未见异常。 左侧咽旁间隙受侵。 左侧腭帆提肌、左侧腭帆张肌、左侧头长肌受侵。 余咽旁肌未见明显异常。 左侧咽后见数个肿大淋巴结，大者短径9mm，明显强化，部分可见中央坏死。 颈部右侧II区、左侧V A区见多个肿大淋巴结，大者短径11mm，明显强化。 双侧上颌窦、双侧筛窦粘膜增厚。 检查诊断： 鼻咽病变，考虑鼻咽癌。 颅底骨质未见明显破坏。 左侧咽后数个肿大淋巴结，考虑转移。 颈部右侧II区、左侧V A区见多个肿大淋巴结，考虑转移。 副鼻窦炎。 既往时点 PET/CT全身显像（套） 鼻咽顶壁、顶后壁及左侧壁粘膜增厚放射性浓聚，SUV约23.3，病灶侵犯颅底骨（蝶骨基底部、左翼突基底部、枕骨斜坡、左岩尖）、左破裂孔、左腭帆肌群、左头长肌及左咽旁咽后间隙。 右侧破裂孔未见明显异常。 右咽后小淋巴结放射性分布未见明显异常。 双侧海绵窦结构及放射性分布未见异常。 筛窦及左侧上颌窦低密度影放射性分布未见明显异常。 口咽、喉咽未见明显异常。 甲状腺放射性分布未见异常。 左咽后、右颈Ⅱ区及左颈Ⅴ区多个肿大淋巴结放射性浓聚，SUV约16.4，最大约1.2×1.5cm；左颈Ⅱ区淋巴结放射性分布略浓密，SUV约2.3，最大约0.7×1.0cm；余双颈小淋巴结放射性分布未见明显异常。 检查诊断： 鼻咽病灶代谢活跃，考虑鼻咽癌，病灶侵犯范围如上述；左咽后、右颈Ⅱ区及左颈Ⅴ区多个肿大淋巴结代谢活跃，考虑转移。 左颈Ⅱ区淋巴结代谢略活跃，疑炎性病变，转移待排，请结合临床。 鼻窦炎。 双肺增殖灶。 肝囊肿。 左肾结石。 多个颈胸腰椎退行性变；L3/4、L4/5椎间盘突出。 【治疗反应与不良反应1】既往时点 鼻咽癌化疗后3度中性粒细胞降低，患者A，呕吐；既往疾病史: 是否有过敏史无过敏史。是否有吸烟史吸烟史详情月经史月经史:；客观检验：白细胞计数(WBC#)-静脉血：2.56×10^9/L（低于参考范围，参考约3.5-9.5×10^9/L） || 中性粒细胞计数(Neut#)-静脉血：0.72×10^9/L（与前述WBC为同次检验） || 血红蛋白(Hb)-静脉血：106.0g/L 【治疗反应与不良反应2】记录时间: 既往时点；主诉: 鼻咽癌治疗中；现病史: 患者于既往时点开始行诱导化疗 既往时点：现患者无明显不适，预约检验 既往时点 患者1级皮疹 既往时点 Iv度NE减少，嘱患者A，避免去人群密集处。 既往时点 鼻咽癌化疗后3度中性粒细胞降低，患者A，呕吐；既往疾病史: 是否有过敏史无过敏史。是否有吸烟史吸烟史详情月经史月经史:；客观检验：血红蛋白(Hb)-静脉血：100.0g/L（低于参考范围，参考约115-150g/L） || 氯离子(Cl-)-静脉血：98.8mmol/L（低于参考范围，参考约99-110mmol/L） || 肌酐(Crea)-静脉血：89.9μmol/L（高于参考范围，参考约41-73μmol/L）\n\n【当前需要决策的问题】\n治疗开始后约第82天，本患者出现第2个独立的黏膜及胃肠毒性里程碑：记录时间: 既往时点；主诉: 鼻咽癌治疗中；现病史: 患者于既往时点开始行诱导化疗 既往时点：现患者无明显不适，预约检验 既往时点 患者1级皮疹 既往时点 Iv度NE减少，嘱患者A，避免去人群密集处。 既往时点 鼻咽癌化疗后3度中性粒细胞降低，患者A，呕吐；既往疾病史: 是否有过敏史无过敏史。是否有吸烟史吸烟史详情月经史月经史:；客观检验：血红蛋白(Hb)-静脉血：100.0g/L（低于参考范围，参考约115-150g/L） || 氯离子(Cl-)-静脉血：98.8mmol/L（低于参考范围，参考约99-110mmol/L） || 肌酐(Crea)-静脉血：89.9μmol/L（高于参考范围，参考约41-73μmol/L）。该事件最符合哪类治疗相关毒性，当前应采取怎样的支持处理、监测及治疗节奏调整？\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 忽略当前异常并按原剂量、原时间继续治疗，不增加复查\nB. 永久停止全部抗肿瘤治疗，不再判断毒性是否可逆\nC. 立即提高化疗剂量，以补偿既往可能损失的剂量强度\nD. 按黏膜/胃肠毒性分级给予止吐、镇痛、补液和营养支持，并监测进食与体重\nE. 仅复查肿瘤影像，不复查血常规、生化或相关器官功能\nF. 直接改为另一套强化联合方案，不等待毒性恢复\nG. 仅口头安慰并观察，不给予症状处理或近期监测\nH. 把当前异常判断为疾病进展并立即进入后线挽救治疗\nI. 仅依据一次EBV-DNA结果决定停药或换药\nJ. 继续原方案并取消止吐、补液或营养等支持治疗\nK. 立即扩大放疗范围，将所有不适均按肿瘤侵犯处理\nL. 三个月后再复查当前异常，期间不调整治疗节奏\n\n请仅输出一个选项字母（A-L）。","gold_letter":"D","gold_action":"按黏膜/胃肠毒性分级给予止吐、镇痛、补液和营养支持，并监测进食与体重","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":{"A":"忽略当前异常并按原剂量、原时间继续治疗，不增加复查","B":"永久停止全部抗肿瘤治疗，不再判断毒性是否可逆","C":"立即提高化疗剂量，以补偿既往可能损失的剂量强度","D":"按黏膜/胃肠毒性分级给予止吐、镇痛、补液和营养支持，并监测进食与体重","E":"仅复查肿瘤影像，不复查血常规、生化或相关器官功能","F":"直接改为另一套强化联合方案，不等待毒性恢复","G":"仅口头安慰并观察，不给予症状处理或近期监测","H":"把当前异常判断为疾病进展并立即进入后线挽救治疗","I":"仅依据一次EBV-DNA结果决定停药或换药","J":"继续原方案并取消止吐、补液或营养等支持治疗","K":"立即扩大放疗范围，将所有不适均按肿瘤侵犯处理","L":"三个月后再复查当前异常，期间不调整治疗节奏"}}
+{"sample_id":"sample-589d7e4a972a2f4995798711","patient_id":"patient-28f7f3a688fe8d84fcbc1ce9","episode_id":"episode-b2a5dcb7478e91215352ae14","turn_id":"P5_03","turn_number":7,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM：{{TNM_STATUS}}；总分期：{{OVERALL_STAGE}}。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；病历特点: 患者A，女，60岁，因\"涕血3月余\"于既往时点，步行入院。患者未行治疗。今为求进一步诊治来本院。患者A，精神可，饮食睡眠一般，大小便正常，体重无明显变化。3、肿瘤专科检查:张口门齿距4cm；鼻咽肿物；双侧颈部II-III区可扪及2个肿大淋巴结，大小约1.5*1.5cm,z质硬，无融合；颅神经检查:阴性。 【病理资料1】（左后鼻孔）镜下：形态符合未分化型非角化性癌，建议加做免疫组化协助进一步诊断。；活检部位: 左侧鼻孔 【影像与分期资料1】鼻咽病灶代谢活跃，考虑鼻咽癌，病灶侵犯颅底骨（蝶骨基底部、左翼突基底部、枕骨斜坡、左岩尖）、左破裂孔、左腭帆肌群、左头长肌及左咽旁咽后间隙；左咽后、右颈Ⅱ区及左颈Ⅴ区多个肿大淋巴结代谢活跃，考虑转移。 左颈Ⅱ区淋巴结代谢略活跃，疑炎性病变，转移待排，请结合临床。 鼻窦炎。 双肺增殖灶。 肝囊肿。 左肾结石。 多个颈胸腰椎退行性变；L3/4、L4/5椎间盘突出。 ；鼻咽病变，考虑鼻咽癌。 颅底骨质未见明显破坏。 左侧咽后数个肿大淋巴结，考虑转移。 颈部右侧II区、左侧V A区见多个肿大淋巴结，考虑转移。 副鼻窦炎。；检查部位: 鼻咽部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域淋巴结转移部位: 右侧II区淋巴结,左侧咽后淋巴结；是否区域复发: 否 【治疗经过1】记录时间: 既往时点；病历特点: 患者A，女，60岁，因\"涕血3月余\"于既往时点，步行入院。 一、病例特点: 1、患者A，女性，60岁，广东省[地点已隐去]人 2、现病史:缘于既往时点月下旬患者无明显诱因出现涕血，偶感头晕、头痛，无复视、视力模糊，无耳鸣、听力下降，无鼻塞，无面麻等不适，未予重视，逐渐加重，遂至外院A就诊，既往时点行鼻咽活检病理示：鼻咽非角化性癌，行鼻咽颈部CT示左侧鼻咽Ca并左侧颈动脉鞘周围、左侧颈深淋巴结肿大。 患者未行治疗。 今为求进一步诊治来本院。 患者发病以来，精神可，饮食睡眠一般，大小便正常，体重无明显变化。 3、肿瘤专科检查:张口门齿距4cm；鼻咽肿物；右颈部II、左颈V区可扪及2个肿大淋巴结，大小约1.5*1.5cm,质硬，无融合；颅神经检查:阴性。 4、辅助检查:既往时点 外院A 鼻咽活检病理示：鼻咽非角化性癌， 既往时点 外院A 鼻咽颈部CT示：左侧鼻咽Ca并左侧颈动脉鞘周围、左侧颈深淋巴结肿大。 既往时点 鼻咽部磁共振平扫＋增强(1.5T以上)(套) 检查结果： 鼻咽腔狭窄，鼻咽双侧顶壁、双侧顶后壁、左侧壁增厚，明显强化。 左侧咽隐窝受侵，右侧咽隐窝未见异常。 左侧咽旁间隙受侵。 左侧腭帆提肌、左侧腭帆张肌、左侧头长肌受侵。 余咽旁肌未见明显异常。 左侧咽后见数个肿大淋巴结，大者短径9mm，明显强化，部分可见中央坏死。 颈部右侧II区、左侧V A区见多个肿大淋巴结，大者短径11mm，明显强化。 双侧上颌窦、双侧筛窦粘膜增厚。 检查诊断： 鼻咽病变，考虑鼻咽癌。 颅底骨质未见明显破坏。 左侧咽后数个肿大淋巴结，考虑转移。 颈部右侧II区、左侧V A区见多个肿大淋巴结，考虑转移。 副鼻窦炎。 既往时点 PET/CT全身显像（套） 鼻咽顶壁、顶后壁及左侧壁粘膜增厚放射性浓聚，SUV约23.3，病灶侵犯颅底骨（蝶骨基底部、左翼突基底部、枕骨斜坡、左岩尖）、左破裂孔、左腭帆肌群、左头长肌及左咽旁咽后间隙。 右侧破裂孔未见明显异常。 右咽后小淋巴结放射性分布未见明显异常。 双侧海绵窦结构及放射性分布未见异常。 筛窦及左侧上颌窦低密度影放射性分布未见明显异常。 口咽、喉咽未见明显异常。 甲状腺放射性分布未见异常。 左咽后、右颈Ⅱ区及左颈Ⅴ区多个肿大淋巴结放射性浓聚，SUV约16.4，最大约1.2×1.5cm；左颈Ⅱ区淋巴结放射性分布略浓密，SUV约2.3，最大约0.7×1.0cm；余双颈小淋巴结放射性分布未见明显异常。 检查诊断： 鼻咽病灶代谢活跃，考虑鼻咽癌，病灶侵犯范围如上述；左咽后、右颈Ⅱ区及左颈Ⅴ区多个肿大淋巴结代谢活跃，考虑转移。 左颈Ⅱ区淋巴结代谢略活跃，疑炎性病变，转移待排，请结合临床。 鼻窦炎。 双肺增殖灶。 肝囊肿。 左肾结石。 多个颈胸腰椎退行性变；L3/4、L4/5椎间盘突出。 【治疗反应与不良反应1】既往时点 鼻咽癌化疗后3度中性粒细胞降低，患者A，呕吐；既往疾病史: 是否有过敏史无过敏史。是否有吸烟史吸烟史详情月经史月经史:；客观检验：白细胞计数(WBC#)-静脉血：2.56×10^9/L（低于参考范围，参考约3.5-9.5×10^9/L） || 中性粒细胞计数(Neut#)-静脉血：0.72×10^9/L（与前述WBC为同次检验） || 血红蛋白(Hb)-静脉血：106.0g/L 【治疗反应与不良反应2】记录时间: 既往时点；主诉: 鼻咽癌治疗中；现病史: 患者于既往时点开始行诱导化疗 既往时点：现患者无明显不适，预约检验 既往时点 患者1级皮疹 既往时点 Iv度NE减少，嘱患者A，避免去人群密集处。 既往时点 鼻咽癌化疗后3度中性粒细胞降低，患者A，呕吐；既往疾病史: 是否有过敏史无过敏史。是否有吸烟史吸烟史详情月经史月经史:；客观检验：血红蛋白(Hb)-静脉血：100.0g/L（低于参考范围，参考约115-150g/L） || 氯离子(Cl-)-静脉血：98.8mmol/L（低于参考范围，参考约99-110mmol/L） || 肌酐(Crea)-静脉血：89.9μmol/L（高于参考范围，参考约41-73μmol/L） 【治疗反应与不良反应3】记录时间: 既往时点；主诉: 鼻咽癌治疗中；现病史: 患者于既往时点开始行诱导化疗 既往时点：现患者无明显不适，预约检验 既往时点 患者1级皮疹 既往时点 Iv度NE减少，嘱患者A，避免去人群密集处。 既往时点 鼻咽癌化疗后3度中性粒细胞降低，患者A，呕吐门诊既往史；既往疾病史: 既往史:是否有过敏史无过敏史。是否有吸烟史吸烟史详情月经史月经史:；客观检验：肌酐(Crea)-静脉血：96.1μmol/L（高于参考范围，参考约41-73μmol/L） || 中性粒细胞计数(Neut#)-静脉血：1.45×10^9/L（低于参考范围） || 血红蛋白(Hb)-静脉血：90.0g/L（低于参考范围，参考约115-150g/L）\n\n【当前需要决策的问题】\n治疗开始后约第107天，本患者出现第3个独立的黏膜及胃肠毒性里程碑：记录时间: 既往时点；主诉: 鼻咽癌治疗中；现病史: 患者于既往时点开始行诱导化疗 既往时点：现患者无明显不适，预约检验 既往时点 患者1级皮疹 既往时点 Iv度NE减少，嘱患者A，避免去人群密集处。 既往时点 鼻咽癌化疗后3度中性粒细胞降低，患者A，呕吐门诊既往史；既往疾病史: 既往史:是否有过敏史无过敏史。是否有吸烟史吸烟史详情月经史月经史:；客观检验：肌酐(Crea)-静脉血：96.1μmol/L（高于参考范围，参考约41-73μmol/L） || 中性粒细胞计数(Neut#)-静脉血：1.45×10^9/L（低于参考范围） || 血红蛋白(Hb)-静脉血：90.0g/L（低于参考范围，参考约115-150g/L）。该事件最符合哪类治疗相关毒性，当前应采取怎样的支持处理、监测及治疗节奏调整？\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 忽略当前异常并按原剂量、原时间继续治疗，不增加复查\nB. 永久停止全部抗肿瘤治疗，不再判断毒性是否可逆\nC. 立即提高化疗剂量，以补偿既往可能损失的剂量强度\nD. 仅复查肿瘤影像，不复查血常规、生化或相关器官功能\nE. 直接改为另一套强化联合方案，不等待毒性恢复\nF. 仅口头安慰并观察，不给予症状处理或近期监测\nG. 把当前异常判断为疾病进展并立即进入后线挽救治疗\nH. 仅依据一次EBV-DNA结果决定停药或换药\nI. 继续原方案并取消止吐、补液或营养等支持治疗\nJ. 立即扩大放疗范围，将所有不适均按肿瘤侵犯处理\nK. 按黏膜/胃肠毒性分级给予止吐、镇痛、补液和营养支持，并监测进食与体重\nL. 三个月后再复查当前异常，期间不调整治疗节奏\n\n请仅输出一个选项字母（A-L）。","gold_letter":"K","gold_action":"按黏膜/胃肠毒性分级给予止吐、镇痛、补液和营养支持，并监测进食与体重","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":{"A":"忽略当前异常并按原剂量、原时间继续治疗，不增加复查","B":"永久停止全部抗肿瘤治疗，不再判断毒性是否可逆","C":"立即提高化疗剂量，以补偿既往可能损失的剂量强度","D":"仅复查肿瘤影像，不复查血常规、生化或相关器官功能","E":"直接改为另一套强化联合方案，不等待毒性恢复","F":"仅口头安慰并观察，不给予症状处理或近期监测","G":"把当前异常判断为疾病进展并立即进入后线挽救治疗","H":"仅依据一次EBV-DNA结果决定停药或换药","I":"继续原方案并取消止吐、补液或营养等支持治疗","J":"立即扩大放疗范围，将所有不适均按肿瘤侵犯处理","K":"按黏膜/胃肠毒性分级给予止吐、镇痛、补液和营养支持，并监测进食与体重","L":"三个月后再复查当前异常，期间不调整治疗节奏"}}
+{"sample_id":"sample-3344d4e3af87c6bb2276e6c7","patient_id":"patient-fe3907002c96678650d6585c","episode_id":"episode-5ca9974b41c64877bd2fda5b","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；主诉: 痰中带血10月余，发现左颈包块半年余；既往时点月左右，患者发现左颈包块，鸡蛋大小，无压痛触痛，偶有头痛，偶有右耳耳鸣，无听力下降；无面麻复视，外院A检查。；既往疾病史: 是否有过敏史无过敏史。是否有吸烟史吸烟史详情；体格检查: 张口门齿距3cm，鼻咽未检查，颈部左侧II区可扪及1个肿大淋巴结，大者大小约2cm×2cm，质硬，无明显压痛，边界尚清；颅神经检查（-）。 【病理资料1】（鼻咽活检组织）镜下：形态符合未分化型非角化性癌。建议加做免疫组化及原位杂交协助诊断和指导治疗。；活检部位: 鼻咽；肿瘤部位: 鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 左侧咽后数个肿大淋巴结，考虑转移。 颈部双侧II区、左侧III区多发肿大淋巴结，考虑转移。 颈部左侧VI、V区小淋巴结，考虑反应性淋巴结可能。 右侧舌根囊肿。 ；鼻咽病灶代谢较活跃，结合病史，符合鼻咽癌；颅底骨骼骨质不均匀致密代谢未见异常，请结合临床；左侧咽后、左颈II区肿大淋巴结代谢活跃，考虑转移。 胃幽门区管壁稍增厚代谢活跃，建议胃镜进一步检查。 右颈IIa区及左颈III区小淋巴结代谢略活跃，疑炎性病变。 右肺中叶内侧段水平裂下结节代谢略活跃，疑增殖灶；双肺散在纤维增殖灶。 纵隔、双肺门多发淋巴结代谢较活跃，考虑炎症。 胆囊小结石。右肾囊肿伴钙化。 前列腺小钙化灶。\n\n【当前需要决策的问题】\n病理已完成，治疗前分期报告现已全部可见：鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 左侧咽后数个肿大淋巴结，考虑转移。 颈部双侧II区、左侧III区多发肿大淋巴结，考虑转移。 颈部左侧VI、V区小淋巴结，考虑反应性淋巴结可能。 右侧舌根囊肿。 ；鼻咽病灶代谢较活跃，结合病史，符合鼻咽癌；颅底骨骼骨质不均匀致密代谢未见异常，请结合临床；左侧咽后、左颈II区肿大淋巴结代谢活跃，考虑转移。 胃幽门区管壁稍增厚代谢活跃，建议胃镜进一步检查。 右颈IIa区及左颈III区小淋巴结代谢略活跃，疑炎性病变。 右肺中叶内侧段水平裂下结节代谢略活跃，疑增殖灶；双肺散在纤维增殖灶。 纵隔、双肺门多发淋巴结代谢较活跃，考虑炎症。 胆囊小结石。右肾囊肿伴钙化。 前列腺小钙化灶。请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T3 / N1 / cM0\nB. T4 / N1 / cM0\nC. T4 / N0 / cM1\nD. T1 / N2 / cM1\nE. T1 / N0 / cM1\nF. T3 / N2 / cM0\nG. T1 / N0 / cM0\nH. T3 / N3 / cM0\nI. T1 / N1 / cM1\nJ. T4 / N0 / cM0\nK. T4 / N3 / cM1\nL. T3 / N3 / cM1\n\n请仅输出一个选项字母（A-L）。","gold_letter":"F","gold_action":"T3 / N2 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T3 / N1 / cM0","B":"T4 / N1 / cM0","C":"T4 / N0 / cM1","D":"T1 / N2 / cM1","E":"T1 / N0 / cM1","F":"T3 / N2 / cM0","G":"T1 / N0 / cM0","H":"T3 / N3 / cM0","I":"T1 / N1 / cM1","J":"T4 / N0 / cM0","K":"T4 / N3 / cM1","L":"T3 / N3 / cM1"}}
+{"sample_id":"sample-ec24565a480a3c28493acf62","patient_id":"patient-08132992947b1cf09e7de6ed","episode_id":"episode-4726afdf04581ccd3cc6bb98","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；主诉: 涕血1月，颈部肿物2周；现病史: 涕血1月，颈部肿物2周。；既往疾病史: 是否有过敏史无过敏史。是否有吸烟史吸烟史详情 【病理资料1】（鼻咽肿物）符合未分化型非角化性癌。 待免疫组化（EGFR）结果再补充报告。 既往时点补充报告： 外白片131621 本院HE、免疫组化： EGFR（+++）。 （鼻咽肿物）符合未分化型非角化性癌。 建议已送白片131621加做免疫组化、原位杂交检查！；活检部位: 鼻咽；肿瘤部位: 鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 左侧枕骨基底部斑片状异常强化灶，性质待定，建议复查。 右侧咽后肿大淋巴结，考虑转移。 颈部右侧II、III区多个肿大淋巴结，考虑转移。 左侧咽后、颈部左侧II、III区数个淋巴结，性质待定，建议复查。 副鼻窦炎；右侧乳突炎。\n\n【当前需要决策的问题】\n病理已完成，治疗前分期报告现已全部可见：鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 左侧枕骨基底部斑片状异常强化灶，性质待定，建议复查。 右侧咽后肿大淋巴结，考虑转移。 颈部右侧II、III区多个肿大淋巴结，考虑转移。 左侧咽后、颈部左侧II、III区数个淋巴结，性质待定，建议复查。 副鼻窦炎；右侧乳突炎。请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T2 / N2 / cM1\nB. T3 / N1 / cM1\nC. T4 / N0 / cM0\nD. T3 / N3 / cM0\nE. T3 / N1 / cM0\nF. T3 / N0 / cM1\nG. T1 / N1 / cM0\nH. T1 / N0 / cM0\nI. T2 / N0 / cM1\nJ. T2 / N2 / cM0\nK. T1 / N3 / cM0\nL. T4 / N1 / cM1\n\n请仅输出一个选项字母（A-L）。","gold_letter":"E","gold_action":"T3 / N1 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T2 / N2 / cM1","B":"T3 / N1 / cM1","C":"T4 / N0 / cM0","D":"T3 / N3 / cM0","E":"T3 / N1 / cM0","F":"T3 / N0 / cM1","G":"T1 / N1 / cM0","H":"T1 / N0 / cM0","I":"T2 / N0 / cM1","J":"T2 / N2 / cM0","K":"T1 / N3 / cM0","L":"T4 / N1 / cM1"}}
+{"sample_id":"sample-bbe6f00426332668224445e9","patient_id":"patient-08132992947b1cf09e7de6ed","episode_id":"episode-4726afdf04581ccd3cc6bb98","turn_id":"P5_01","turn_number":5,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM：{{TNM_STATUS}}；总分期：{{OVERALL_STAGE}}。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；主诉: 涕血1月，颈部肿物2周；现病史: 涕血1月，颈部肿物2周。；既往疾病史: 是否有过敏史无过敏史。是否有吸烟史吸烟史详情 【病理资料1】（鼻咽肿物）符合未分化型非角化性癌。 待免疫组化（EGFR）结果再补充报告。 既往时点补充报告： 外白片131621 本院HE、免疫组化： EGFR（+++）。 （鼻咽肿物）符合未分化型非角化性癌。 建议已送白片131621加做免疫组化、原位杂交检查！；活检部位: 鼻咽；肿瘤部位: 鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 左侧枕骨基底部斑片状异常强化灶，性质待定，建议复查。 右侧咽后肿大淋巴结，考虑转移。 颈部右侧II、III区多个肿大淋巴结，考虑转移。 左侧咽后、颈部左侧II、III区数个淋巴结，性质待定，建议复查。 副鼻窦炎；右侧乳突炎。 【治疗经过1】记录时间: 既往时点；病历特点: 患者A，男，41岁，因\"涕血1月，颈部肿物2周\"于既往时点，步行入院。 一、病例特点: 1、患者A，男性，41岁，广东[详细地址已隐藏]、复视等不适，故未予重视。 2周后又发现颈部肿物，即在外院A就诊，行鼻咽活组织检查，病理诊断为鼻咽未分化型非角化性癌，今为求进一步诊治来本院。 患者发病以来，精神可，饮食睡眠一般，大小便正常，体重无明显变化。 3、肿瘤专科检查:张口门齿距4.5cm；鼻咽顶后壁结节状肿物；右侧颈部淋巴结3×3cm，质地硬，边界尚清，无压痛，无皮肤浸润，无融合；颅神经检查:阴性。 4、辅助检查:1）既往时点在本院（病理号:[编号已隐藏]）鼻咽活检病理示:未分化型非角化癌 （2）既往时点在本院鼻咽＋颈部MRI检查:鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 左侧枕骨基底部斑片状异常强化灶，性质待定，建议复查。 右侧咽后肿大淋巴结，考虑转移。 颈部右侧II、III区多个肿大淋巴结，考虑转移。 左侧咽后、颈部左侧II、III区数个淋巴结，性质待定，建议复查。 副鼻窦炎；右侧乳突炎。 （3）既往时点PET/CT检查:鼻咽病灶代谢活跃，符合鼻咽癌，病灶疑累及颅底骨；右颈Ⅱ、Ⅲ、Ⅴ区多个淋巴结代谢活跃，考虑转移。 左上颌窦炎症。 其它部位未见异常 【治疗反应与不良反应1】记录时间: 既往时点；病程主题: 上级查房记录；病程内容: 患者TPF诱导化疗后，食欲稍差，间恶心，无呕吐、腹痛腹泻等不适，一般情况尚好。 上级医生A查房后示，患者治疗过程顺利，可于今日结账出院，定期复查血常规、肝肾功能；按时返院治疗；不适随诊。；客观检验：丙氨酸氨基转移酶(ALT)-静脉血：56.5U/L（高于参考范围，参考约7-40U/L）\n\n【当前需要决策的问题】\n治疗开始后约第5天，本患者出现第1个独立的黏膜及胃肠毒性里程碑：记录时间: 既往时点；病程主题: 上级查房记录；病程内容: 患者TPF诱导化疗后，食欲稍差，间恶心，无呕吐、腹痛腹泻等不适，一般情况尚好。 上级医生A查房后示，患者治疗过程顺利，可于今日结账出院，定期复查血常规、肝肾功能；按时返院治疗；不适随诊。；客观检验：丙氨酸氨基转移酶(ALT)-静脉血：56.5U/L（高于参考范围，参考约7-40U/L）。该事件最符合哪类治疗相关毒性，当前应采取怎样的支持处理、监测及治疗节奏调整？\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 忽略当前异常并按原剂量、原时间继续治疗，不增加复查\nB. 永久停止全部抗肿瘤治疗，不再判断毒性是否可逆\nC. 立即提高化疗剂量，以补偿既往可能损失的剂量强度\nD. 仅复查肿瘤影像，不复查血常规、生化或相关器官功能\nE. 直接改为另一套强化联合方案，不等待毒性恢复\nF. 按黏膜/胃肠毒性分级给予止吐、镇痛、补液和营养支持，并监测进食与体重\nG. 仅口头安慰并观察，不给予症状处理或近期监测\nH. 把当前异常判断为疾病进展并立即进入后线挽救治疗\nI. 仅依据一次EBV-DNA结果决定停药或换药\nJ. 继续原方案并取消止吐、补液或营养等支持治疗\nK. 立即扩大放疗范围，将所有不适均按肿瘤侵犯处理\nL. 三个月后再复查当前异常，期间不调整治疗节奏\n\n请仅输出一个选项字母（A-L）。","gold_letter":"F","gold_action":"按黏膜/胃肠毒性分级给予止吐、镇痛、补液和营养支持，并监测进食与体重","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":{"A":"忽略当前异常并按原剂量、原时间继续治疗，不增加复查","B":"永久停止全部抗肿瘤治疗，不再判断毒性是否可逆","C":"立即提高化疗剂量，以补偿既往可能损失的剂量强度","D":"仅复查肿瘤影像，不复查血常规、生化或相关器官功能","E":"直接改为另一套强化联合方案，不等待毒性恢复","F":"按黏膜/胃肠毒性分级给予止吐、镇痛、补液和营养支持，并监测进食与体重","G":"仅口头安慰并观察，不给予症状处理或近期监测","H":"把当前异常判断为疾病进展并立即进入后线挽救治疗","I":"仅依据一次EBV-DNA结果决定停药或换药","J":"继续原方案并取消止吐、补液或营养等支持治疗","K":"立即扩大放疗范围，将所有不适均按肿瘤侵犯处理","L":"三个月后再复查当前异常，期间不调整治疗节奏"}}
+{"sample_id":"sample-8a907704e382ad20298c993c","patient_id":"patient-2904f892de88d1d694b3a4f3","episode_id":"episode-e6f88d1380c156be92ed05cf","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；病历特点: 患者A，男，50岁，因\"发现右侧颈部肿物1月\"于既往时点，步行入院。患者A，精神、胃纳可，睡眠一般，大小便正常，体重无明显变化。3、肿瘤专科检查:张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；右侧颈部II区可扪及1个淋巴结，最大径3×1cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查:阴性。 【病理资料1】（鼻咽顶后壁肿物）未分化型非角化性癌。 本院免疫组化结果：CK（+），EGFR（+）。 本院原位杂交结果：EBERs（+）。；活检部位: 顶后壁,鼻咽；肿瘤部位: 顶后壁,鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 右侧咽后多个肿大淋巴结，考虑转移。 颈部右侧II、III区多个肿大淋巴结，考虑转移。 左侧咽后、颈部左侧II、III区多发淋巴结，性质待定。 副鼻窦炎；右侧乳突炎。 左侧翼内、外肌片状异常信号影，性质待定，建议复查。 双侧牙槽骨周围软组织肿胀并异常信号影，炎性病变？请结合临床。\n\n【当前需要决策的问题】\n病理已完成，治疗前分期报告现已全部可见：鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 右侧咽后多个肿大淋巴结，考虑转移。 颈部右侧II、III区多个肿大淋巴结，考虑转移。 左侧咽后、颈部左侧II、III区多发淋巴结，性质待定。 副鼻窦炎；右侧乳突炎。 左侧翼内、外肌片状异常信号影，性质待定，建议复查。 双侧牙槽骨周围软组织肿胀并异常信号影，炎性病变？请结合临床。请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T2 / N3 / cM0\nB. T4 / N3 / cM0\nC. T4 / N2 / cM0\nD. T3 / N3 / cM0\nE. T1 / N0 / cM1\nF. T3 / N2 / cM0\nG. T4 / N1 / cM1\nH. T1 / N1 / cM0\nI. T1 / N2 / cM0\nJ. T2 / N3 / cM1\nK. T3 / N1 / cM0\nL. T2 / N1 / cM1\n\n请仅输出一个选项字母（A-L）。","gold_letter":"K","gold_action":"T3 / N1 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T2 / N3 / cM0","B":"T4 / N3 / cM0","C":"T4 / N2 / cM0","D":"T3 / N3 / cM0","E":"T1 / N0 / cM1","F":"T3 / N2 / cM0","G":"T4 / N1 / cM1","H":"T1 / N1 / cM0","I":"T1 / N2 / cM0","J":"T2 / N3 / cM1","K":"T3 / N1 / cM0","L":"T2 / N1 / cM1"}}
+{"sample_id":"sample-fc02d2364fa226cf666d67f3","patient_id":"patient-658c901d241197123d75230c","episode_id":"episode-23c8c7e2d66dadcbb6642995","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；主诉: 涕血6月；门诊既往史；既往疾病史: 是否有过敏史无过敏史。是否有吸烟史吸烟史详情 【病理资料1】（右后壁）镜下：组织形态结合免疫组化及原位杂交结果，符合未分化型非角化性癌。 免疫组化：CK(AE1/AE3)（+），p63（+），EGFR（+）。 原位杂交：EBERs（+）。 【影像与分期资料1】鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 右侧咽后间隙稍大淋巴结，可疑转移。 颈部右侧II区见数个肿大淋巴结，考虑转移。 副鼻窦炎，右侧上颌窦粘膜下囊肿；右侧乳突炎。 ；鼻咽病灶代谢活跃，符合鼻咽癌，侵犯范围如上所述；右侧咽后及右颈Ⅱ区数个淋巴结代谢活跃，考虑转移。 左上肺尖后段磨玻璃样小结节代谢未见异常，建议随诊。 双侧上下牙龈组织局部炎症；双颈Ib区数个小淋巴结炎症。 右侧乳突炎症；右侧上颌窦黏膜下囊肿。 双侧腋窝、双侧腹股沟多个小淋巴结炎症。 左肾囊肿。 前列腺小钙化灶。 肛管代谢活跃，痔疮？ L4-S1椎间盘突出。 多个颈胸腰椎骨质增生；双侧髌骨退行性变；左侧内踝关节炎症。\n\n【当前需要决策的问题】\n病理已完成，治疗前分期报告现已全部可见：鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 右侧咽后间隙稍大淋巴结，可疑转移。 颈部右侧II区见数个肿大淋巴结，考虑转移。 副鼻窦炎，右侧上颌窦粘膜下囊肿；右侧乳突炎。 ；鼻咽病灶代谢活跃，符合鼻咽癌，侵犯范围如上所述；右侧咽后及右颈Ⅱ区数个淋巴结代谢活跃，考虑转移。 左上肺尖后段磨玻璃样小结节代谢未见异常，建议随诊。 双侧上下牙龈组织局部炎症；双颈Ib区数个小淋巴结炎症。 右侧乳突炎症；右侧上颌窦黏膜下囊肿。 双侧腋窝、双侧腹股沟多个小淋巴结炎症。 左肾囊肿。 前列腺小钙化灶。 肛管代谢活跃，痔疮？ L4-S1椎间盘突出。 多个颈胸腰椎骨质增生；双侧髌骨退行性变；左侧内踝关节炎症。请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T3 / N1 / cM0\nB. T1 / N1 / cM0\nC. T1 / N3 / cM0\nD. T4 / N0 / cM1\nE. T4 / N1 / cM0\nF. T1 / N2 / cM1\nG. T2 / N1 / cM0\nH. T4 / N2 / cM0\nI. T3 / N2 / cM0\nJ. T2 / N2 / cM0\nK. T4 / N1 / cM1\nL. T1 / N0 / cM1\n\n请仅输出一个选项字母（A-L）。","gold_letter":"A","gold_action":"T3 / N1 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T3 / N1 / cM0","B":"T1 / N1 / cM0","C":"T1 / N3 / cM0","D":"T4 / N0 / cM1","E":"T4 / N1 / cM0","F":"T1 / N2 / cM1","G":"T2 / N1 / cM0","H":"T4 / N2 / cM0","I":"T3 / N2 / cM0","J":"T2 / N2 / cM0","K":"T4 / N1 / cM1","L":"T1 / N0 / cM1"}}
+{"sample_id":"sample-6de28d449c630d172f422713","patient_id":"patient-658c901d241197123d75230c","episode_id":"episode-23c8c7e2d66dadcbb6642995","turn_id":"P5_02","turn_number":6,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM：{{TNM_STATUS}}；总分期：{{OVERALL_STAGE}}。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；主诉: 涕血6月；门诊既往史；既往疾病史: 是否有过敏史无过敏史。是否有吸烟史吸烟史详情 【病理资料1】（右后壁）镜下：组织形态结合免疫组化及原位杂交结果，符合未分化型非角化性癌。 免疫组化：CK(AE1/AE3)（+），p63（+），EGFR（+）。 原位杂交：EBERs（+）。 【影像与分期资料1】鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 右侧咽后间隙稍大淋巴结，可疑转移。 颈部右侧II区见数个肿大淋巴结，考虑转移。 副鼻窦炎，右侧上颌窦粘膜下囊肿；右侧乳突炎。 ；鼻咽病灶代谢活跃，符合鼻咽癌，侵犯范围如上所述；右侧咽后及右颈Ⅱ区数个淋巴结代谢活跃，考虑转移。 左上肺尖后段磨玻璃样小结节代谢未见异常，建议随诊。 双侧上下牙龈组织局部炎症；双颈Ib区数个小淋巴结炎症。 右侧乳突炎症；右侧上颌窦黏膜下囊肿。 双侧腋窝、双侧腹股沟多个小淋巴结炎症。 左肾囊肿。 前列腺小钙化灶。 肛管代谢活跃，痔疮？ L4-S1椎间盘突出。 多个颈胸腰椎骨质增生；双侧髌骨退行性变；左侧内踝关节炎症。 【治疗经过1】记录时间: 既往时点；主诉: 患者6月前回吸性涕血6月余，外院CT考虑鼻咽癌，来本院进一步完善检查。；现病史: 无明显不适。舌质淡红舌苔薄黄脉滑；体格检查: 无明显不适。舌质淡红舌苔薄黄脉滑 【治疗反应与不良反应1】记录时间: 既往时点；病程主题: 上级查房记录；病程内容: 既往时点08时16分 上级医生A查房记录 今上级医生A查房，患者无不适主诉，患者恶心、呕吐症状较前缓解，查体基本同前。 上级医生A查看患者后示：患者已完成GP化疗第1程，予以5-HT受体阻滞剂、NK-1受体阻滞剂、地塞米松三联止吐，嘱患者输液后呕吐时口服昂丹司琼或阿瑞匹坦，交代患者出院后注意事项，按时进行吉西他滨d8治疗，嘱密切监测化疗相关不良反应，指示今日办理出院。；客观检验：肌酐(Crea)-静脉血：77.1μmol/L（高于参考范围，参考约41-73μmol/L） 【治疗反应与不良反应2】记录时间: 既往时点；病程主题: 上级查房记录；病程内容: 既往时点08时16分 上级医生A查房记录 今上级医生A查房，患者无不适主诉，患者恶心、呕吐症状较前缓解，查体基本同前。 上级医生A查看患者后示：患者已完成GP化疗第2程，予以5-HT受体阻滞剂、NK-1受体阻滞剂、地塞米松三联止吐，嘱患者输液后呕吐时口服昂丹司琼或阿瑞匹坦，交代患者出院后注意事项，按时进行吉西他滨d8治疗，嘱密切监测化疗相关不良反应，指示今日办理出院。；客观检验：肌酐(Crea)-静脉血：128.8μmol/L（高于参考范围，参考约41-73μmol/L） || 肌酐(Crea)-静脉血：112.2μmol/L（高于参考范围，参考约41-73μmol/L）\n\n【当前需要决策的问题】\n治疗开始后约第23天，本患者出现第2个独立的黏膜及胃肠毒性里程碑：记录时间: 既往时点；病程主题: 上级查房记录；病程内容: 既往时点08时16分 上级医生A查房记录 今上级医生A查房，患者无不适主诉，患者恶心、呕吐症状较前缓解，查体基本同前。 上级医生A查看患者后示：患者已完成GP化疗第2程，予以5-HT受体阻滞剂、NK-1受体阻滞剂、地塞米松三联止吐，嘱患者输液后呕吐时口服昂丹司琼或阿瑞匹坦，交代患者出院后注意事项，按时进行吉西他滨d8治疗，嘱密切监测化疗相关不良反应，指示今日办理出院。；客观检验：肌酐(Crea)-静脉血：128.8μmol/L（高于参考范围，参考约41-73μmol/L） || 肌酐(Crea)-静脉血：112.2μmol/L（高于参考范围，参考约41-73μmol/L）。该事件最符合哪类治疗相关毒性，当前应采取怎样的支持处理、监测及治疗节奏调整？\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 忽略当前异常并按原剂量、原时间继续治疗，不增加复查\nB. 永久停止全部抗肿瘤治疗，不再判断毒性是否可逆\nC. 立即提高化疗剂量，以补偿既往可能损失的剂量强度\nD. 仅复查肿瘤影像，不复查血常规、生化或相关器官功能\nE. 直接改为另一套强化联合方案，不等待毒性恢复\nF. 仅口头安慰并观察，不给予症状处理或近期监测\nG. 按黏膜/胃肠毒性分级给予止吐、镇痛、补液和营养支持，并监测进食与体重\nH. 把当前异常判断为疾病进展并立即进入后线挽救治疗\nI. 仅依据一次EBV-DNA结果决定停药或换药\nJ. 继续原方案并取消止吐、补液或营养等支持治疗\nK. 立即扩大放疗范围，将所有不适均按肿瘤侵犯处理\nL. 三个月后再复查当前异常，期间不调整治疗节奏\n\n请仅输出一个选项字母（A-L）。","gold_letter":"G","gold_action":"按黏膜/胃肠毒性分级给予止吐、镇痛、补液和营养支持，并监测进食与体重","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":{"A":"忽略当前异常并按原剂量、原时间继续治疗，不增加复查","B":"永久停止全部抗肿瘤治疗，不再判断毒性是否可逆","C":"立即提高化疗剂量，以补偿既往可能损失的剂量强度","D":"仅复查肿瘤影像，不复查血常规、生化或相关器官功能","E":"直接改为另一套强化联合方案，不等待毒性恢复","F":"仅口头安慰并观察，不给予症状处理或近期监测","G":"按黏膜/胃肠毒性分级给予止吐、镇痛、补液和营养支持，并监测进食与体重","H":"把当前异常判断为疾病进展并立即进入后线挽救治疗","I":"仅依据一次EBV-DNA结果决定停药或换药","J":"继续原方案并取消止吐、补液或营养等支持治疗","K":"立即扩大放疗范围，将所有不适均按肿瘤侵犯处理","L":"三个月后再复查当前异常，期间不调整治疗节奏"}}
+{"sample_id":"sample-866512bf03166c69c0a32a27","patient_id":"patient-658c901d241197123d75230c","episode_id":"episode-23c8c7e2d66dadcbb6642995","turn_id":"P5_03","turn_number":7,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM：{{TNM_STATUS}}；总分期：{{OVERALL_STAGE}}。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；主诉: 涕血6月；门诊既往史；既往疾病史: 是否有过敏史无过敏史。是否有吸烟史吸烟史详情 【病理资料1】（右后壁）镜下：组织形态结合免疫组化及原位杂交结果，符合未分化型非角化性癌。 免疫组化：CK(AE1/AE3)（+），p63（+），EGFR（+）。 原位杂交：EBERs（+）。 【影像与分期资料1】鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 右侧咽后间隙稍大淋巴结，可疑转移。 颈部右侧II区见数个肿大淋巴结，考虑转移。 副鼻窦炎，右侧上颌窦粘膜下囊肿；右侧乳突炎。 ；鼻咽病灶代谢活跃，符合鼻咽癌，侵犯范围如上所述；右侧咽后及右颈Ⅱ区数个淋巴结代谢活跃，考虑转移。 左上肺尖后段磨玻璃样小结节代谢未见异常，建议随诊。 双侧上下牙龈组织局部炎症；双颈Ib区数个小淋巴结炎症。 右侧乳突炎症；右侧上颌窦黏膜下囊肿。 双侧腋窝、双侧腹股沟多个小淋巴结炎症。 左肾囊肿。 前列腺小钙化灶。 肛管代谢活跃，痔疮？ L4-S1椎间盘突出。 多个颈胸腰椎骨质增生；双侧髌骨退行性变；左侧内踝关节炎症。 【治疗经过1】记录时间: 既往时点；主诉: 患者6月前回吸性涕血6月余，外院CT考虑鼻咽癌，来本院进一步完善检查。；现病史: 无明显不适。舌质淡红舌苔薄黄脉滑；体格检查: 无明显不适。舌质淡红舌苔薄黄脉滑 【治疗反应与不良反应1】记录时间: 既往时点；病程主题: 上级查房记录；病程内容: 既往时点08时16分 上级医生A查房记录 今上级医生A查房，患者无不适主诉，患者恶心、呕吐症状较前缓解，查体基本同前。 上级医生A查看患者后示：患者已完成GP化疗第1程，予以5-HT受体阻滞剂、NK-1受体阻滞剂、地塞米松三联止吐，嘱患者输液后呕吐时口服昂丹司琼或阿瑞匹坦，交代患者出院后注意事项，按时进行吉西他滨d8治疗，嘱密切监测化疗相关不良反应，指示今日办理出院。；客观检验：肌酐(Crea)-静脉血：77.1μmol/L（高于参考范围，参考约41-73μmol/L） 【治疗反应与不良反应2】记录时间: 既往时点；病程主题: 上级查房记录；病程内容: 既往时点08时16分 上级医生A查房记录 今上级医生A查房，患者无不适主诉，患者恶心、呕吐症状较前缓解，查体基本同前。 上级医生A查看患者后示：患者已完成GP化疗第2程，予以5-HT受体阻滞剂、NK-1受体阻滞剂、地塞米松三联止吐，嘱患者输液后呕吐时口服昂丹司琼或阿瑞匹坦，交代患者出院后注意事项，按时进行吉西他滨d8治疗，嘱密切监测化疗相关不良反应，指示今日办理出院。；客观检验：肌酐(Crea)-静脉血：128.8μmol/L（高于参考范围，参考约41-73μmol/L） || 肌酐(Crea)-静脉血：112.2μmol/L（高于参考范围，参考约41-73μmol/L） 【治疗反应与不良反应3】记录时间: 既往时点；主诉: 鼻咽癌2程化疗后；现病史: 患者于既往时点确诊为鼻咽未分化型非角化性癌 T3N1M0 III期 (AJCC分期第八版)。于既往时点予吉西他滨+顺铂方案化疗1程。。于既往时点予吉西他滨+顺铂方案辅助化疗1程。末次住院于既往时点，出院诊断为：鼻咽未分化型非角化性癌 T3N1M0 III期 (AJCC分期第八版)，诉恶心，呕吐。门诊既往史；既往疾病史: 既往史:是否有过敏史无过敏史。是否有吸烟史吸烟史详情；客观检验：血红蛋白(Hb)-静脉血：111.0g/L（低于参考范围，参考约115-150g/L） || 肌酐(Crea)-静脉血：109.9μmol/L（高于参考范围，参考约41-73μmol/L）\n\n【当前需要决策的问题】\n治疗开始后约第64天，本患者出现第3个独立的黏膜及胃肠毒性里程碑：记录时间: 既往时点；主诉: 鼻咽癌2程化疗后；现病史: 患者于既往时点确诊为鼻咽未分化型非角化性癌 T3N1M0 III期 (AJCC分期第八版)。于既往时点予吉西他滨+顺铂方案化疗1程。。于既往时点予吉西他滨+顺铂方案辅助化疗1程。末次住院于既往时点，出院诊断为：鼻咽未分化型非角化性癌 T3N1M0 III期 (AJCC分期第八版)，诉恶心，呕吐。门诊既往史；既往疾病史: 既往史:是否有过敏史无过敏史。是否有吸烟史吸烟史详情；客观检验：血红蛋白(Hb)-静脉血：111.0g/L（低于参考范围，参考约115-150g/L） || 肌酐(Crea)-静脉血：109.9μmol/L（高于参考范围，参考约41-73μmol/L）。该事件最符合哪类治疗相关毒性，当前应采取怎样的支持处理、监测及治疗节奏调整？\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 忽略当前异常并按原剂量、原时间继续治疗，不增加复查\nB. 永久停止全部抗肿瘤治疗，不再判断毒性是否可逆\nC. 立即提高化疗剂量，以补偿既往可能损失的剂量强度\nD. 仅复查肿瘤影像，不复查血常规、生化或相关器官功能\nE. 直接改为另一套强化联合方案，不等待毒性恢复\nF. 仅口头安慰并观察，不给予症状处理或近期监测\nG. 把当前异常判断为疾病进展并立即进入后线挽救治疗\nH. 仅依据一次EBV-DNA结果决定停药或换药\nI. 按黏膜/胃肠毒性分级给予止吐、镇痛、补液和营养支持，并监测进食与体重\nJ. 继续原方案并取消止吐、补液或营养等支持治疗\nK. 立即扩大放疗范围，将所有不适均按肿瘤侵犯处理\nL. 三个月后再复查当前异常，期间不调整治疗节奏\n\n请仅输出一个选项字母（A-L）。","gold_letter":"I","gold_action":"按黏膜/胃肠毒性分级给予止吐、镇痛、补液和营养支持，并监测进食与体重","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":{"A":"忽略当前异常并按原剂量、原时间继续治疗，不增加复查","B":"永久停止全部抗肿瘤治疗，不再判断毒性是否可逆","C":"立即提高化疗剂量，以补偿既往可能损失的剂量强度","D":"仅复查肿瘤影像，不复查血常规、生化或相关器官功能","E":"直接改为另一套强化联合方案，不等待毒性恢复","F":"仅口头安慰并观察，不给予症状处理或近期监测","G":"把当前异常判断为疾病进展并立即进入后线挽救治疗","H":"仅依据一次EBV-DNA结果决定停药或换药","I":"按黏膜/胃肠毒性分级给予止吐、镇痛、补液和营养支持，并监测进食与体重","J":"继续原方案并取消止吐、补液或营养等支持治疗","K":"立即扩大放疗范围，将所有不适均按肿瘤侵犯处理","L":"三个月后再复查当前异常，期间不调整治疗节奏"}}
+{"sample_id":"sample-36db45ec87d495f2350ccaec","patient_id":"patient-09adf80599b6978210d6c9c8","episode_id":"episode-e8ae70fb6162a09e10515ff8","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】入院时间: 既往时点；患者A，精神可，饮食睡眠一般，大小便正常，体重无明显变化。；鼻症状: 无；耳症状: 无；眼症状: 无；头部症状: 无；是否有颈部肿物: 是；阳性症状体征: 双颈肿物,双颈疼痛；体重改变性质: 未变 【病理资料1】（鼻咽部）组织形态结合免疫组化及原位杂交结果，病变诊断为未分化型非角化性癌。 原单位免疫组化结果：CK(+),CK5/6(+),p40(+),Syn(-),S-100(-),CD3(-),CD20(-),CD56(-),CD10(-),CD21(-),CD30(-),Ki-67(90%+)。 原单位原位杂交结果：EBER(+)。 本单位免疫组化结果：PD-L1(22C3)（TPS=40%），PD-L1(22C3-N)（-），EGFR（+）。；活检部位: C3,鼻咽；肿瘤部位: 鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 双侧咽后小淋巴结，性质待定。 颈部双侧II区、左侧III区淋巴结，考虑转移。 副鼻窦炎；双侧乳突炎。 甲状腺右侧叶结节，考虑结节性甲状腺肿。\n\n【当前需要决策的问题】\n病理已完成，治疗前分期报告现已全部可见：鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 双侧咽后小淋巴结，性质待定。 颈部双侧II区、左侧III区淋巴结，考虑转移。 副鼻窦炎；双侧乳突炎。 甲状腺右侧叶结节，考虑结节性甲状腺肿。请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T3 / N0 / cM1\nB. T3 / N1 / cM1\nC. T4 / N1 / cM1\nD. T3 / N1 / cM0\nE. T4 / N2 / cM0\nF. T2 / N0 / cM1\nG. T3 / N3 / cM1\nH. T3 / N2 / cM0\nI. T4 / N0 / cM0\nJ. T4 / N0 / cM1\nK. T1 / N2 / cM1\nL. T1 / N0 / cM0\n\n请仅输出一个选项字母（A-L）。","gold_letter":"H","gold_action":"T3 / N2 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T3 / N0 / cM1","B":"T3 / N1 / cM1","C":"T4 / N1 / cM1","D":"T3 / N1 / cM0","E":"T4 / N2 / cM0","F":"T2 / N0 / cM1","G":"T3 / N3 / cM1","H":"T3 / N2 / cM0","I":"T4 / N0 / cM0","J":"T4 / N0 / cM1","K":"T1 / N2 / cM1","L":"T1 / N0 / cM0"}}
+{"sample_id":"sample-e323add0eb082ef5ca6b97b4","patient_id":"patient-30c44ba207e66a3175f648ed","episode_id":"episode-4d56ed64ec75115988b7cbac","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】入院时间: 既往时点；现为进一步治疗入本院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重无下降。；鼻症状: 无；耳症状: 无；眼症状: 无；头部症状: 无；是否有颈部肿物: 是；阳性症状体征: 右颈部肿物；体重改变性质: 未变 【病理资料1】（鼻咽部）镜检为未分化型非角化性癌。；活检部位: 鼻咽；肿瘤部位: 鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】鼻咽右侧咽隐窝粘膜增厚代谢活跃，符合鼻咽癌；右咽后、右颈II-III多发淋巴结代谢活跃， 考虑转移；右颈IV区小淋巴结代谢略活跃，转移待排。 胃体部胃壁结节代谢略活跃，恶性待排(GIST?)，请结合胃镜检查。 双肺多发小结节代谢未见异常，疑增殖灶。 盆腔少量积液。 ；鼻咽病变，考虑鼻咽癌。 右侧咽旁间隙受侵。 颅底骨质未见明显骨质破坏。 右侧咽后数个肿大淋巴结，考虑转移。 颈部右侧II、III、IV区多个肿大淋巴结，考虑转移。 副鼻窦炎。\n\n【当前需要决策的问题】\n病理已完成，治疗前分期报告现已全部可见：鼻咽右侧咽隐窝粘膜增厚代谢活跃，符合鼻咽癌；右咽后、右颈II-III多发淋巴结代谢活跃， 考虑转移；右颈IV区小淋巴结代谢略活跃，转移待排。 胃体部胃壁结节代谢略活跃，恶性待排(GIST?)，请结合胃镜检查。 双肺多发小结节代谢未见异常，疑增殖灶。 盆腔少量积液。 ；鼻咽病变，考虑鼻咽癌。 右侧咽旁间隙受侵。 颅底骨质未见明显骨质破坏。 右侧咽后数个肿大淋巴结，考虑转移。 颈部右侧II、III、IV区多个肿大淋巴结，考虑转移。 副鼻窦炎。请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T2 / N1 / cM0\nB. T3 / N3 / cM1\nC. T1 / N1 / cM1\nD. T3 / N1 / cM0\nE. T4 / N3 / cM1\nF. T3 / N1 / cM1\nG. T2 / N2 / cM0\nH. T2 / N3 / cM0\nI. T3 / N0 / cM0\nJ. T1 / N2 / cM1\nK. T1 / N3 / cM1\nL. T2 / N0 / cM0\n\n请仅输出一个选项字母（A-L）。","gold_letter":"H","gold_action":"T2 / N3 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T2 / N1 / cM0","B":"T3 / N3 / cM1","C":"T1 / N1 / cM1","D":"T3 / N1 / cM0","E":"T4 / N3 / cM1","F":"T3 / N1 / cM1","G":"T2 / N2 / cM0","H":"T2 / N3 / cM0","I":"T3 / N0 / cM0","J":"T1 / N2 / cM1","K":"T1 / N3 / cM1","L":"T2 / N0 / cM0"}}
+{"sample_id":"sample-84be1a90a0f81a7bfa821673","patient_id":"patient-817588890ea7d1df0cf353ab","episode_id":"episode-6465dd782345ae1720bb9d79","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；主诉: 发现鼻咽肿物2月；既往疾病史: 肺ca术后是否有过敏史无过敏史。是否有吸烟史吸烟史详情月经史月经史: 【病理资料1】（鼻咽部活检）镜下形态结合原单位免疫组化结果，考虑为未分化型非角化性癌，建议用送检白片来我科交费行原位杂交EBER检测协助诊断。 原单位免疫组化结果：#[编号已隐藏]-1：CD56（-），NUT（-），CK(Pan)（+），CK5/6（+），Syn（个别细胞+），TTF-1（-），CK7（-），Napsin（-），p40（+），EGFR（+），Ki-67（约60%+）。 既往时点补充报告： （鼻咽部活检）镜检为未分化型非角化性癌。 本院原位杂交：#[编号已隐藏]：EBERs（+）。；活检部位: 鼻咽；肿瘤部位: 鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】鼻咽病灶代谢活跃，符合鼻咽癌，侵犯/累及范围如上所述；右侧咽后小淋巴结代谢略活跃，转移待排；右颈II区淋巴结代谢活跃，考虑转移。 肺癌术后：右肺及右侧胸壁术区呈术后改变。 甲状腺右叶结节代谢活跃，甲状腺癌待排，建议必要时行B超等进一步检查。 右侧额叶深面-右基底节区及右侧枕叶软化灶；鼻窦炎症。 左上肺及右下肺多个小磨玻璃结节代谢未见异常，建议随诊；左上肺及右中下肺纤维增殖灶。 右侧胸腔少量积液。 左肾囊肿。 右侧第3-7肋骨折后改变；左侧第6肋骨岛；多个椎体及椎间盘退行性变。 动脉硬化。 ；鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 右侧咽后肿大淋巴结，考虑转移。 颈部双侧II-IV区多发小淋巴结，可疑转移。 副鼻窦炎；右侧乳突炎。 扫及右侧侧脑室后角后方脑实质病变，软化灶？请结合临床，必要时进一步颅脑MR。\n\n【当前需要决策的问题】\n病理已完成，治疗前分期报告现已全部可见：鼻咽病灶代谢活跃，符合鼻咽癌，侵犯/累及范围如上所述；右侧咽后小淋巴结代谢略活跃，转移待排；右颈II区淋巴结代谢活跃，考虑转移。 肺癌术后：右肺及右侧胸壁术区呈术后改变。 甲状腺右叶结节代谢活跃，甲状腺癌待排，建议必要时行B超等进一步检查。 右侧额叶深面-右基底节区及右侧枕叶软化灶；鼻窦炎症。 左上肺及右下肺多个小磨玻璃结节代谢未见异常，建议随诊；左上肺及右中下肺纤维增殖灶。 右侧胸腔少量积液。 左肾囊肿。 右侧第3-7肋骨折后改变；左侧第6肋骨岛；多个椎体及椎间盘退行性变。 动脉硬化。 ；鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 右侧咽后肿大淋巴结，考虑转移。 颈部双侧II-IV区多发小淋巴结，可疑转移。 副鼻窦炎；右侧乳突炎。 扫及右侧侧脑室后角后方脑实质病变，软化灶？请结合临床，必要时进一步颅脑MR。请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T3 / N1 / cM1\nB. T3 / N3 / cM0\nC. T1 / N0 / cM0\nD. T4 / N3 / cM0\nE. T2 / N3 / cM1\nF. T1 / N3 / cM0\nG. T1 / N3 / cM1\nH. T3 / N1 / cM0\nI. T1 / N2 / cM0\nJ. T2 / N3 / cM0\nK. T3 / N0 / cM0\nL. T3 / N0 / cM1\n\n请仅输出一个选项字母（A-L）。","gold_letter":"H","gold_action":"T3 / N1 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T3 / N1 / cM1","B":"T3 / N3 / cM0","C":"T1 / N0 / cM0","D":"T4 / N3 / cM0","E":"T2 / N3 / cM1","F":"T1 / N3 / cM0","G":"T1 / N3 / cM1","H":"T3 / N1 / cM0","I":"T1 / N2 / cM0","J":"T2 / N3 / cM0","K":"T3 / N0 / cM0","L":"T3 / N0 / cM1"}}
+{"sample_id":"sample-5de6f777c3079603714346bc","patient_id":"patient-5f7d232ab1dbb3e235a22839","episode_id":"episode-c522fd1aa6f4f67f429d68ab","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；病历特点: 患者A，男，主因“面麻5月余，耳鸣伴听力下降、血涕20余天”于既往时点步行入院。一.病例特点: 1、患者61岁 男性。2、现病史:患者于既往时点出现右侧眼裂以上面部麻木感，未予重视。既往时点初无诱因出现右侧耳鸣伴轻度右侧听力下降，右侧清晨回吸性血涕，无视物模糊、视野缺损，无头痛、鼻塞、耳闷塞感等不适。 遂于既往时点就诊外院A，查头颅MRI：考虑右侧鼻咽癌，并右侧乳突炎，建议进一步检查。 鼻咽平扫CT：右侧鼻咽改变，应注意鼻咽肿瘤，建议进一步检查。 鼻咽镜：鼻咽肿物，性质待查；病理：鼻咽恶性肿瘤。 今为求进一步诊治来本院。 拟“鼻咽恶性肿瘤”收入院。 患者发病以来，精神佳，饮食、睡眠佳，大小便正常，体重无减轻。 3、体格检查: T:36.70℃ P:107次/分 R:18次/分 BP:159/108mmHg Ht: 172cm Wt: 75.80kg BSA: 1.8879m2 KPS:80 神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科情况。 头颅五官无畸形，眼睑无浮肿，无下垂;巩膜无黄染，结膜无充血、无苍白;眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。 耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。 听力正常，鼓膜无穿孔。 鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。 口腔粘膜正常。 齿龈无红肿，扁桃体无肿大。 颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。 胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。 心前区无隆起，未触及震颤。 心率107次/分，心整齐，各瓣膜听诊区未闻及病理性杂音。 腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。 肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛;移动性浊音阴性，肠鸣音正常。 肛律门、外生殖器未查。 脊柱四肢无畸形，肌力、肌张力正常。 生理反射存在，病理神经反射未引出。 4. 【病理资料1】（右侧鼻咽）镜检为未分化型非角化性癌。；活检部位: 右侧鼻咽；肿瘤部位: 右侧鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】左侧桡骨中部局部代谢较活跃，疑良性病变，请结合临床。 双上颌骨炎症。 第7颈椎、骶椎骨质增生。 左胸锁关节、双侧膝关节炎。；检查部位: 骨 ；双肺上叶小结节，考虑炎性结节或小增殖灶可能性大。 双肺尖胸膜稍增厚。 右肺中叶内侧段及左肺下叶后基底段慢性炎症。 左肾小囊肿。；检查部位: 上腹部 ；鼻咽病变，考虑鼻咽癌，侵犯右侧咽旁间隙、右侧咀嚼肌间隙、右侧破裂孔。 颅底骨质破坏。 右侧咽后多个肿大淋巴结，考虑转移。 颈部右侧II区小淋巴结，建议随诊。 副鼻窦炎；右侧乳突炎。 右侧腮腺区囊性灶，考虑良性病变可能。\n\n【当前需要决策的问题】\n病理已完成，治疗前分期报告现已全部可见：左侧桡骨中部局部代谢较活跃，疑良性病变，请结合临床。 双上颌骨炎症。 第7颈椎、骶椎骨质增生。 左胸锁关节、双侧膝关节炎。；检查部位: 骨 ；双肺上叶小结节，考虑炎性结节或小增殖灶可能性大。 双肺尖胸膜稍增厚。 右肺中叶内侧段及左肺下叶后基底段慢性炎症。 左肾小囊肿。；检查部位: 上腹部 ；鼻咽病变，考虑鼻咽癌，侵犯右侧咽旁间隙、右侧咀嚼肌间隙、右侧破裂孔。 颅底骨质破坏。 右侧咽后多个肿大淋巴结，考虑转移。 颈部右侧II区小淋巴结，建议随诊。 副鼻窦炎；右侧乳突炎。 右侧腮腺区囊性灶，考虑良性病变可能。请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T3 / N3 / cM0\nB. T4 / N1 / cM0\nC. T3 / N3 / cM1\nD. T4 / N0 / cM1\nE. T4 / N2 / cM1\nF. T3 / N1 / cM0\nG. T4 / N3 / cM0\nH. T1 / N3 / cM1\nI. T2 / N2 / cM1\nJ. T2 / N3 / cM1\nK. T3 / N2 / cM0\nL. T3 / N2 / cM1\n\n请仅输出一个选项字母（A-L）。","gold_letter":"B","gold_action":"T4 / N1 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T3 / N3 / cM0","B":"T4 / N1 / cM0","C":"T3 / N3 / cM1","D":"T4 / N0 / cM1","E":"T4 / N2 / cM1","F":"T3 / N1 / cM0","G":"T4 / N3 / cM0","H":"T1 / N3 / cM1","I":"T2 / N2 / cM1","J":"T2 / N3 / cM1","K":"T3 / N2 / cM0","L":"T3 / N2 / cM1"}}
+{"sample_id":"sample-a53b36a98215a35f157e0d9e","patient_id":"patient-8b32cb25120a42a552884380","episode_id":"episode-61139552257a138926f89e96","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；病历特点: 患者A，男，59岁，因\"鼻塞2+月，发现左颈包块10+天\"于既往时点，步行入院。一、病例特点： 1、患者A，男性，59岁。2、现病史:患者于既往时点月无明显诱因出现鼻塞，当时未予特殊处理；10+天前无意发现左侧颈部包块，约鸡蛋大小；无明显疼痛，无皮肤红肿及破溃，偶伴涕血、鼻出血，无耳鸣、听力减退、面麻，后患者出现头痛，无恶心、呕吐，无晕厥及抽搐，无视物模糊、复视；遂于既往时点患者于外院A行鼻咽镜考虑鼻咽占位；鼻咽CT回示：考虑鼻咽癌并左侧颈部淋巴结转移，建议进一步检查。 现为进一步明确及治疗就诊于本院门诊，以“鼻咽癌”收入院。 患者自起病以来，睡眠欠佳，精神、饮食良好，二便正常，体重无明显变化。 3、体格检查: kps：90，张口距门齿5cm,双侧鼻咽粘膜增厚，鼻咽部组织隆起增厚；左颈部可扪及一大小约4X5cm肿大淋巴结，质地韧，活动欠佳，边界不清，无压痛；余全身浅表淋巴结未扪及；颅神经检查：视神经、动眼神经、滑车神经及外展神经查体阴性。 【病理资料1】（鼻咽左侧肿物）镜下：形态符合未分化型非角化性癌。；活检部位: 鼻咽；肿瘤部位: 鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】鼻咽病灶代谢活跃，考虑恶性病变（鼻咽癌？），侵犯范围如上述；左咽后及左颈II-V区多发淋巴结代谢活跃，考虑转移。 鼻窦炎症。 双肺纤维增殖灶。 肝多发囊肿；肝左叶胆管结石伴邻近胆管扩张。 左肾多发囊肿（部分为复杂性囊肿）。 腰椎骨质增生。 ；鼻咽病变，考虑鼻咽癌；左侧颈静脉孔受侵。 颅底骨质破坏。 左侧咽后数个肿大淋巴结，考虑转移。 颈部左侧II区、左侧III区、左侧IV区、左侧V区见多个肿大淋巴结，考虑转移。 左侧下颌下腺前上缘淋巴结，性质待定。 副鼻窦炎。\n\n【当前需要决策的问题】\n病理已完成，治疗前分期报告现已全部可见：鼻咽病灶代谢活跃，考虑恶性病变（鼻咽癌？），侵犯范围如上述；左咽后及左颈II-V区多发淋巴结代谢活跃，考虑转移。 鼻窦炎症。 双肺纤维增殖灶。 肝多发囊肿；肝左叶胆管结石伴邻近胆管扩张。 左肾多发囊肿（部分为复杂性囊肿）。 腰椎骨质增生。 ；鼻咽病变，考虑鼻咽癌；左侧颈静脉孔受侵。 颅底骨质破坏。 左侧咽后数个肿大淋巴结，考虑转移。 颈部左侧II区、左侧III区、左侧IV区、左侧V区见多个肿大淋巴结，考虑转移。 左侧下颌下腺前上缘淋巴结，性质待定。 副鼻窦炎。请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T1 / N3 / cM1\nB. T1 / N0 / cM1\nC. T4 / N0 / cM1\nD. T3 / N1 / cM0\nE. T3 / N1 / cM1\nF. T1 / N0 / cM0\nG. T4 / N1 / cM1\nH. T4 / N2 / cM0\nI. T3 / N3 / cM0\nJ. T3 / N0 / cM0\nK. T3 / N3 / cM1\nL. T4 / N0 / cM0\n\n请仅输出一个选项字母（A-L）。","gold_letter":"I","gold_action":"T3 / N3 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T1 / N3 / cM1","B":"T1 / N0 / cM1","C":"T4 / N0 / cM1","D":"T3 / N1 / cM0","E":"T3 / N1 / cM1","F":"T1 / N0 / cM0","G":"T4 / N1 / cM1","H":"T4 / N2 / cM0","I":"T3 / N3 / cM0","J":"T3 / N0 / cM0","K":"T3 / N3 / cM1","L":"T4 / N0 / cM0"}}
+{"sample_id":"sample-37ddd9469a5643f20a716197","patient_id":"patient-772412c07d2776f303790dfa","episode_id":"episode-c419e87243d98431f874ae27","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；病历特点: 患者A，男，34岁，因\"回吸性涕血半年\"于既往时点，步行入院。患者A，精神可，饮食睡眠一般，大小便正常，体重减轻4千克。3、肿瘤专科检查:张口门齿距5cm；鼻咽双侧顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径2×2cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查:阴性。 【影像与分期资料1】鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 右侧咽后淋巴结，考虑转移。 颈部右侧II区淋巴结，考虑转移。 左侧咽后及颈部左侧II区、双侧III区淋巴结，性质待定，建议随诊。 副鼻窦炎。 ；鼻咽病灶代谢活跃，考虑恶性病变（鼻咽癌？），病灶侵犯颅底骨等，疑累及左侧翼腭窝。双侧咽后及右颈IIb区肿大淋巴结代谢活跃，考虑转移。左颈IIb区小淋巴结代谢略活跃，转移待排。 鼻窦炎。双侧扁桃体炎症。 右肺中叶纤维增殖灶。\n\n【当前需要决策的问题】\n病理已完成，治疗前分期报告现已全部可见：鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 右侧咽后淋巴结，考虑转移。 颈部右侧II区淋巴结，考虑转移。 左侧咽后及颈部左侧II区、双侧III区淋巴结，性质待定，建议随诊。 副鼻窦炎。 ；鼻咽病灶代谢活跃，考虑恶性病变（鼻咽癌？），病灶侵犯颅底骨等，疑累及左侧翼腭窝。双侧咽后及右颈IIb区肿大淋巴结代谢活跃，考虑转移。左颈IIb区小淋巴结代谢略活跃，转移待排。 鼻窦炎。双侧扁桃体炎症。 右肺中叶纤维增殖灶。请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T3 / N1 / cM1\nB. T3 / N1 / cM0\nC. T4 / N2 / cM1\nD. T4 / N0 / cM1\nE. T2 / N3 / cM0\nF. T2 / N1 / cM1\nG. T2 / N0 / cM1\nH. T1 / N0 / cM0\nI. T1 / N1 / cM1\nJ. T2 / N2 / cM0\nK. T1 / N3 / cM1\nL. T1 / N3 / cM0\n\n请仅输出一个选项字母（A-L）。","gold_letter":"B","gold_action":"T3 / N1 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T3 / N1 / cM1","B":"T3 / N1 / cM0","C":"T4 / N2 / cM1","D":"T4 / N0 / cM1","E":"T2 / N3 / cM0","F":"T2 / N1 / cM1","G":"T2 / N0 / cM1","H":"T1 / N0 / cM0","I":"T1 / N1 / cM1","J":"T2 / N2 / cM0","K":"T1 / N3 / cM1","L":"T1 / N3 / cM0"}}
+{"sample_id":"sample-ec684c81b7f832d1a1e723e6","patient_id":"patient-772412c07d2776f303790dfa","episode_id":"episode-c419e87243d98431f874ae27","turn_id":"P5_03","turn_number":7,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM：{{TNM_STATUS}}；总分期：{{OVERALL_STAGE}}。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；病历特点: 患者A，男，34岁，因\"回吸性涕血半年\"于既往时点，步行入院。患者A，精神可，饮食睡眠一般，大小便正常，体重减轻4千克。3、肿瘤专科检查:张口门齿距5cm；鼻咽双侧顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径2×2cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查:阴性。 【影像与分期资料1】鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 右侧咽后淋巴结，考虑转移。 颈部右侧II区淋巴结，考虑转移。 左侧咽后及颈部左侧II区、双侧III区淋巴结，性质待定，建议随诊。 副鼻窦炎。 ；鼻咽病灶代谢活跃，考虑恶性病变（鼻咽癌？），病灶侵犯颅底骨等，疑累及左侧翼腭窝。双侧咽后及右颈IIb区肿大淋巴结代谢活跃，考虑转移。左颈IIb区小淋巴结代谢略活跃，转移待排。 鼻窦炎。双侧扁桃体炎症。 右肺中叶纤维增殖灶。 【治疗经过1】记录时间: 既往时点；病历特点: 患者A，男，34岁，因\"回吸性涕血半年\"于既往时点，步行入院。 一、病例特点: 1、患者A，男性，34岁，广东省人 2、现病史:缘于既往时点年前患者无明显诱因出现回吸性涕血，伴鼻塞涕血，无头晕、头痛，无复视、视力模糊，无耳鸣、听力下降，无面麻等不适，未予重视，逐渐加重，遂至外院A就诊，行鼻咽活检病理示：鼻咽未分化型非角化性癌，未行治疗，今为求进一步诊治来本院。 患者发病以来，精神可，饮食睡眠一般，大小便正常，体重减轻4千克。 3、肿瘤专科检查:张口门齿距5cm；鼻咽双侧顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径2×2cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查:阴性。 4、辅助检查:（1）既往时点在本院（病理号:[编号已隐藏]）鼻咽活检病理示:未分化型非角化癌 CK(Pan)（+），EGFR（+），Ki-67（+，90%），p63（-），CK5/6（-）。 （2）既往时点在本院鼻咽＋颈部MRI检查:鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 右侧咽后淋巴结，考虑转移。 颈部右侧II区淋巴结，考虑转移。 左侧咽后及颈部左侧II区、双侧III区淋巴结，性质待定，建议随诊。 副鼻窦炎。 （3）既往时点在本院PET/CT检查:1.鼻咽病灶代谢活跃，考虑恶性病变（鼻咽癌？），病灶侵犯颅底骨等，疑累及左侧翼腭窝。 双侧咽后及右颈IIb区肿大淋巴结代谢活跃，考虑转移。 左颈IIb区小淋巴结代谢略活跃，转移待排。 2.鼻窦炎。 双侧扁桃体炎症。 3.右肺中叶纤维增殖灶。 （4）既往时点在本院EBV DNA数据:低于检测下限 【治疗反应与不良反应1】记录时间: 既往时点；病程主题: 上级查房记录；病程内容: 患者PF诱导化疗后，食欲稍差，间恶心，无呕吐、腹痛腹泻等不适，一般情况尚好。 上级医生A查房后示，患者治疗过程顺利，可于今日结账出院，定期复查血常规、肝肾功能；按时返院治疗；不适随诊。；客观检验：颜色-尿液：淡黄色 || 葡萄糖(Glu)-尿液：- || 尿胆原(URO)-尿液：- || 比重(SG)-尿液：1.015 【治疗反应与不良反应2】记录时间: 既往时点；病程主题: 上级查房记录；病程内容: 患者PF诱导化疗后，食欲稍差，间恶心，无呕吐、腹痛腹泻等不适，一般情况尚好。 上级医生A查房后示，患者治疗过程顺利，可于今日结账出院，定期复查血常规、肝肾功能；按时返院治疗；不适随诊。；客观检验：尿胆原(URO)-尿液：- || 隐血(OB)-尿液：- || 颜色-尿液：淡黄色 || 总蛋白(TP)-尿液：- 【治疗反应与不良反应3】记录时间: 既往时点；病程主题: 上级查房记录；病程内容: 今日患者已完成第二程同期顺铂化疗，诉恶心、食欲下降，无发热、呕吐、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。 复查血常规、肝肾功能大致正常。 上级医生A查房指示：患者现化疗结束，无诉特殊不适，可予出院，嘱其门诊监测血常规、肝肾功能，定期返院治疗。 遵嘱。；客观检验：肌酐(Crea)-静脉血：82.8μmol/L（高于参考范围，参考约41-73μmol/L）\n\n【当前需要决策的问题】\n治疗开始后约第88天，本患者出现第3个独立的黏膜及胃肠毒性里程碑：记录时间: 既往时点；病程主题: 上级查房记录；病程内容: 今日患者已完成第二程同期顺铂化疗，诉恶心、食欲下降，无发热、呕吐、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。 复查血常规、肝肾功能大致正常。 上级医生A查房指示：患者现化疗结束，无诉特殊不适，可予出院，嘱其门诊监测血常规、肝肾功能，定期返院治疗。 遵嘱。；客观检验：肌酐(Crea)-静脉血：82.8μmol/L（高于参考范围，参考约41-73μmol/L）。该事件最符合哪类治疗相关毒性，当前应采取怎样的支持处理、监测及治疗节奏调整？\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 忽略当前异常并按原剂量、原时间继续治疗，不增加复查\nB. 永久停止全部抗肿瘤治疗，不再判断毒性是否可逆\nC. 按黏膜/胃肠毒性分级给予止吐、镇痛、补液和营养支持，并监测进食与体重\nD. 立即提高化疗剂量，以补偿既往可能损失的剂量强度\nE. 仅复查肿瘤影像，不复查血常规、生化或相关器官功能\nF. 直接改为另一套强化联合方案，不等待毒性恢复\nG. 仅口头安慰并观察，不给予症状处理或近期监测\nH. 把当前异常判断为疾病进展并立即进入后线挽救治疗\nI. 仅依据一次EBV-DNA结果决定停药或换药\nJ. 继续原方案并取消止吐、补液或营养等支持治疗\nK. 立即扩大放疗范围，将所有不适均按肿瘤侵犯处理\nL. 三个月后再复查当前异常，期间不调整治疗节奏\n\n请仅输出一个选项字母（A-L）。","gold_letter":"C","gold_action":"按黏膜/胃肠毒性分级给予止吐、镇痛、补液和营养支持，并监测进食与体重","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":{"A":"忽略当前异常并按原剂量、原时间继续治疗，不增加复查","B":"永久停止全部抗肿瘤治疗，不再判断毒性是否可逆","C":"按黏膜/胃肠毒性分级给予止吐、镇痛、补液和营养支持，并监测进食与体重","D":"立即提高化疗剂量，以补偿既往可能损失的剂量强度","E":"仅复查肿瘤影像，不复查血常规、生化或相关器官功能","F":"直接改为另一套强化联合方案，不等待毒性恢复","G":"仅口头安慰并观察，不给予症状处理或近期监测","H":"把当前异常判断为疾病进展并立即进入后线挽救治疗","I":"仅依据一次EBV-DNA结果决定停药或换药","J":"继续原方案并取消止吐、补液或营养等支持治疗","K":"立即扩大放疗范围，将所有不适均按肿瘤侵犯处理","L":"三个月后再复查当前异常，期间不调整治疗节奏"}}
+{"sample_id":"sample-85aa9e54072da6d024dd6afa","patient_id":"patient-37545afdde23568d4e27a6d4","episode_id":"episode-8768fe40427afd9b86177d79","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；主诉: 涕血2月；既往疾病史: 是否有过敏史无过敏史。是否有吸烟史吸烟史详情月经史月经史: 【病理资料1】（左侧鼻咽）镜检为恶性肿瘤，考虑为未分化型非角化性癌，建议回原单位切涂胶白片5张并来我科交费行免疫组化（CK、EGFR）及原位杂交(EBER)检测协助进一步诊断。 备注：请带回本次会诊的所有外院病理切片及纸质资料。；活检部位: 左侧鼻咽；肿瘤部位: 左侧鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 左侧咽后淋巴结，考虑转移可能性大。 颈部左侧II、III区淋巴结，考虑转移可能性大。 副鼻窦炎；双侧乳突炎。 甲状腺病变，考虑结节性甲状腺肿可能，建议超声检查。\n治疗前PET/CT报告记载，1.鼻咽病灶代谢活跃，考虑鼻咽癌，侵犯范围如上述；左侧咽后、颈部左侧Ⅱ-Ⅲ区、左侧Ⅴ区淋巴结代谢活跃，考虑转移；右侧咽后、颈部右侧Ⅱ区淋巴结代谢较活跃，转移待排，建议随诊。 2.鼻窦炎。 左侧乳突炎症。 3.疑结节性甲状腺肿。 4.双肺炎症/纤维增殖灶。 5.纵隔及双肺门小淋巴结炎。 6.肝脏多发囊肿。 7.多个椎体退行性变。\n\n【当前需要决策的问题】\n病理已完成，治疗前分期报告现已全部可见：鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 左侧咽后淋巴结，考虑转移可能性大。 颈部左侧II、III区淋巴结，考虑转移可能性大。 副鼻窦炎；双侧乳突炎。 甲状腺病变，考虑结节性甲状腺肿可能，建议超声检查。治疗前PET/CT报告记载，1.鼻咽病灶代谢活跃，考虑鼻咽癌，侵犯范围如上述；左侧咽后、颈部左侧Ⅱ-Ⅲ区、左侧Ⅴ区淋巴结代谢活跃，考虑转移；右侧咽后、颈部右侧Ⅱ区淋巴结代谢较活跃，转移待排，建议随诊。 2.鼻窦炎。 左侧乳突炎症。 3.疑结节性甲状腺肿。 4.双肺炎症/纤维增殖灶。 5.纵隔及双肺门小淋巴结炎。 6.肝脏多发囊肿。 7.多个椎体退行性变。请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T1 / N1 / cM0\nB. T1 / N2 / cM0\nC. T2 / N0 / cM1\nD. T1 / N1 / cM1\nE. T3 / N3 / cM1\nF. T1 / N0 / cM0\nG. T3 / N1 / cM0\nH. T4 / N0 / cM0\nI. T2 / N0 / cM0\nJ. T2 / N2 / cM1\nK. T2 / N3 / cM1\nL. T3 / N1 / cM1\n\n请仅输出一个选项字母（A-L）。","gold_letter":"G","gold_action":"T3 / N1 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T1 / N1 / cM0","B":"T1 / N2 / cM0","C":"T2 / N0 / cM1","D":"T1 / N1 / cM1","E":"T3 / N3 / cM1","F":"T1 / N0 / cM0","G":"T3 / N1 / cM0","H":"T4 / N0 / cM0","I":"T2 / N0 / cM0","J":"T2 / N2 / cM1","K":"T2 / N3 / cM1","L":"T3 / N1 / cM1"}}
+{"sample_id":"sample-26c75fc3d7b885944cf96bd6","patient_id":"patient-e03e0bb9f04b511dce152fc5","episode_id":"episode-93a1993c7cac64bdaf801e0e","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；主诉: 发现右上颈部包块1个月。；现病史: 体检发现左上肺结节1月。现予以复查。患者现双肾及右输尿管多发结石，并右肾、右输尿管轻度积水。；既往疾病史: 无特殊是否有过敏史无过敏史。是否有吸烟史有吸烟史。吸烟史详情抽咽30年，每天一包。；体格检查: 右上颈2*2cm质地较硬包块，欠活动，无压痛。 【病理资料1】（鼻咽病变）送检组织中见呈片巢状的异型细胞，结合免疫组化和原位杂交结果，病变符合未分化型非角化性癌。 原单位免疫组化结果（Z既往时点27-1）：PCK（+）,CK5/6（+）,S-100(单)（-）,CD3（-）,CD20（-）,Ki-67（30%+） 原单位原位杂交结果（Z既往时点27-1）：EBER（+）。；活检部位: 鼻咽；肿瘤部位: 鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】左肺尖后段两个结节，考虑增殖钙化灶可能性大。 双上肺类结节，考虑增殖灶。 肝钙化灶。 胆囊多发结石。 双肾及右输尿管多发结石，并右肾、右输尿管轻度积水。 ；鼻咽病灶代谢活跃，符合鼻咽癌，侵犯范围如上所述；双侧咽后、右颈II-III区多发淋巴结代谢活跃，考虑转移；左颈II区数个小淋巴结代谢略活跃，请结合临床。 左上肺尖后段伴钙化结节代谢未见异常，陈旧性病变？余左上肺及右上肺后段多发小结节代谢未见明显异常，请结合临床。 鼻中隔偏曲。 鼻窦炎症。 右颈Ib区小淋巴结炎症。 纵隔及双肺门多发小淋巴结炎症。 肝脏S6肝包膜下钙化灶。 双肾结石；左肾囊肿。 双侧腹股沟数个小淋巴结反应性增生。 多个腰椎间盘突出。 骨质疏松。 ；鼻咽病变，符合鼻咽癌。 颅底骨质破坏。 右侧咽后数个肿大淋巴结，考虑转移。 颈部右侧II区、右侧III区见数个肿大淋巴结，考虑转移。 颈部左侧II-V区数个淋巴结，性质待定。 副鼻窦炎。\n\n【当前需要决策的问题】\n病理已完成，治疗前分期报告现已全部可见：左肺尖后段两个结节，考虑增殖钙化灶可能性大。 双上肺类结节，考虑增殖灶。 肝钙化灶。 胆囊多发结石。 双肾及右输尿管多发结石，并右肾、右输尿管轻度积水。 ；鼻咽病灶代谢活跃，符合鼻咽癌，侵犯范围如上所述；双侧咽后、右颈II-III区多发淋巴结代谢活跃，考虑转移；左颈II区数个小淋巴结代谢略活跃，请结合临床。 左上肺尖后段伴钙化结节代谢未见异常，陈旧性病变？余左上肺及右上肺后段多发小结节代谢未见明显异常，请结合临床。 鼻中隔偏曲。 鼻窦炎症。 右颈Ib区小淋巴结炎症。 纵隔及双肺门多发小淋巴结炎症。 肝脏S6肝包膜下钙化灶。 双肾结石；左肾囊肿。 双侧腹股沟数个小淋巴结反应性增生。 多个腰椎间盘突出。 骨质疏松。 ；鼻咽病变，符合鼻咽癌。 颅底骨质破坏。 右侧咽后数个肿大淋巴结，考虑转移。 颈部右侧II区、右侧III区见数个肿大淋巴结，考虑转移。 颈部左侧II-V区数个淋巴结，性质待定。 副鼻窦炎。请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T2 / N1 / cM1\nB. T3 / N1 / cM0\nC. T4 / N3 / cM0\nD. T4 / N1 / cM0\nE. T4 / N0 / cM1\nF. T4 / N2 / cM0\nG. T1 / N3 / cM1\nH. T1 / N2 / cM1\nI. T1 / N1 / cM0\nJ. T2 / N2 / cM1\nK. T3 / N2 / cM0\nL. T1 / N0 / cM1\n\n请仅输出一个选项字母（A-L）。","gold_letter":"B","gold_action":"T3 / N1 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T2 / N1 / cM1","B":"T3 / N1 / cM0","C":"T4 / N3 / cM0","D":"T4 / N1 / cM0","E":"T4 / N0 / cM1","F":"T4 / N2 / cM0","G":"T1 / N3 / cM1","H":"T1 / N2 / cM1","I":"T1 / N1 / cM0","J":"T2 / N2 / cM1","K":"T3 / N2 / cM0","L":"T1 / N0 / cM1"}}
+{"sample_id":"sample-8a483588811152bc8e8be94b","patient_id":"patient-91e3c16145c17bad01196479","episode_id":"episode-8ad5c3ea4942ef9c8abb27e5","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；病历特点: 患者A，男，24岁，因\"涕血2月。\"于既往时点，步行入院。患者A，精神可，饮食睡眠一般，大小便正常，体重无明显变化。3、肿瘤专科检查:张口门齿距5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结，无皮肤浸润，无溃疡；颅神经检查:阴性。 【病理资料1】（鼻咽肿物）未分化型非角化性癌。建议必要时用送检的涂胶白片行免疫组化检测EGFR。 既往时点补充报告： 本院免疫组化结果：EGFR（+）。；活检部位: 鼻咽；肿瘤部位: 鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】全身骨骼未见明显异常。 建议定期复查。；检查部位: 骨；是否骨转移: 否 ；肝脏、胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。 ；左肺下叶前内基底段、右肺上叶、右肺中叶外侧段实性结节，考虑增殖灶可能，建议随诊。 右肺中叶内侧段钙化灶。 右肺上叶胸膜下肺大泡。；检查部位: 胸部 ；鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 左侧咽后多个肿大淋巴结，可疑转移。 左侧咽后见多个肿大淋巴结，大者短径7mm↑(0-5mm)，明显强化。 颈双侧I-III区多个淋巴结，考虑反应性淋巴结可能。 副鼻窦炎。；检查部位: 颈部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 不确定；是否区域复发: 否\n\n【当前需要决策的问题】\n病理已完成，治疗前分期报告现已全部可见：全身骨骼未见明显异常。 建议定期复查。；检查部位: 骨；是否骨转移: 否 ；肝脏、胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。 ；左肺下叶前内基底段、右肺上叶、右肺中叶外侧段实性结节，考虑增殖灶可能，建议随诊。 右肺中叶内侧段钙化灶。 右肺上叶胸膜下肺大泡。；检查部位: 胸部 ；鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 左侧咽后多个肿大淋巴结，可疑转移。 左侧咽后见多个肿大淋巴结，大者短径7mm↑(0-5mm)，明显强化。 颈双侧I-III区多个淋巴结，考虑反应性淋巴结可能。 副鼻窦炎。；检查部位: 颈部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 不确定；是否区域复发: 否。请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T3 / N3 / cM0\nB. T2 / N1 / cM1\nC. T4 / N1 / cM1\nD. T4 / N3 / cM1\nE. T2 / N0 / cM0\nF. T3 / N1 / cM0\nG. T4 / N2 / cM0\nH. T1 / N0 / cM1\nI. T2 / N2 / cM0\nJ. T1 / N1 / cM1\nK. T1 / N2 / cM1\nL. T4 / N1 / cM0\n\n请仅输出一个选项字母（A-L）。","gold_letter":"F","gold_action":"T3 / N1 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T3 / N3 / cM0","B":"T2 / N1 / cM1","C":"T4 / N1 / cM1","D":"T4 / N3 / cM1","E":"T2 / N0 / cM0","F":"T3 / N1 / cM0","G":"T4 / N2 / cM0","H":"T1 / N0 / cM1","I":"T2 / N2 / cM0","J":"T1 / N1 / cM1","K":"T1 / N2 / cM1","L":"T4 / N1 / cM0"}}
+{"sample_id":"sample-8d9fffa5ab0b97ae4fb670f0","patient_id":"patient-722916e6f49e457dd9fb890f","episode_id":"episode-ac7f8490c144daa81aff16db","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；病历特点: 患者A，女，主因“鼻塞3月。”于既往时点步行入院。一.病例特点: 1、患者69岁 女性。2、现病史:患者自诉3个月前“新冠感染”后开始出现鼻塞，伴左耳鸣、左耳听力进行性下降，无头晕、头痛、抽吸性血涕、复视，无咳嗽、胸闷、腹痛、腹胀。近1个月患者精神、食欲、睡眠可，大小便正常，体重变化不大。 3、体格检查: T:36.80℃ P:76次/分 R:20次/分 BP:138/94 mmHg Ht: 156.50cm Wt: 54.80kg BSA: 1.5359m2 KPS:90 神智清楚，表情自然，发育正常，营养中等。 自主体位，检查合作。 皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科情况。头颅五官无畸形，眼睑无浮肿，无下垂;巩膜无黄染，结膜无充血、无苍白;眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。 耳廓无畸形，左耳听力粗测下降，外耳道无溢脓溢液，乳突区无压痛。 右耳听力正常，鼓膜无穿孔。 鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。 口腔粘膜正常。 齿龈无红肿，扁桃体无肿大。 颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。 胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。 心前区无隆起，未触及震颤。 心率76次/分，心律齐，各瓣膜听诊区未闻及病理性杂音。 腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。 肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛;移动性浊音阴性，肠鸣音正常。 肛门、外生殖器未查。 脊柱四肢无畸形，肌力、肌张力正常。 生理反射存在，病理反射未引出。 4. 【病理资料1】（鼻咽肿物）组织形态结合免疫组化及原位杂交结果，病变符合未分化型非角化性癌。 原单位免疫组化结果：CK（+），p40（+），p16（斑驳+），p53（部分+），EGFR（+），Ki-67（60%+）。 原单位原位杂交结果：EBERs（部分+）。；活检部位: 鼻咽；肿瘤部位: 鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 左侧咽后数个肿大淋巴结，考虑转移。 颈部双侧II区、双侧III区、右侧V区见数个小淋巴结，性质待定，建议随诊。 副鼻窦炎；左侧乳突炎。 【治疗前外院PET/CT远处评估摘录】其他部位未见高代谢恶性肿瘤征象。右肺中叶外侧段实性结节、右肺上叶后段及左肺下舌段微小结节，代谢未见异常，考虑炎性或良性病变。【治疗前全身骨ECT摘录】全身骨显像未见明显骨质代谢异常。\n\n【当前需要决策的问题】\n病理已完成，治疗前分期报告现已全部可见：鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 左侧咽后数个肿大淋巴结，考虑转移。 颈部双侧II区、双侧III区、右侧V区见数个小淋巴结，性质待定，建议随诊。 副鼻窦炎；左侧乳突炎。 【治疗前外院PET/CT远处评估摘录】其他部位未见高代谢恶性肿瘤征象。右肺中叶外侧段实性结节、右肺上叶后段及左肺下舌段微小结节，代谢未见异常，考虑炎性或良性病变。【治疗前全身骨ECT摘录】全身骨显像未见明显骨质代谢异常。请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T1 / N3 / cM0\nB. T1 / N2 / cM1\nC. T3 / N1 / cM0\nD. T2 / N2 / cM0\nE. T3 / N2 / cM1\nF. T2 / N0 / cM0\nG. T2 / N2 / cM1\nH. T4 / N0 / cM0\nI. T1 / N0 / cM0\nJ. T4 / N0 / cM1\nK. T3 / N3 / cM1\nL. T2 / N1 / cM1\n\n请仅输出一个选项字母（A-L）。","gold_letter":"C","gold_action":"T3 / N1 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T1 / N3 / cM0","B":"T1 / N2 / cM1","C":"T3 / N1 / cM0","D":"T2 / N2 / cM0","E":"T3 / N2 / cM1","F":"T2 / N0 / cM0","G":"T2 / N2 / cM1","H":"T4 / N0 / cM0","I":"T1 / N0 / cM0","J":"T4 / N0 / cM1","K":"T3 / N3 / cM1","L":"T2 / N1 / cM1"}}
+{"sample_id":"sample-fa3783d32b44972874998a48","patient_id":"patient-8f9d5f890b71f169b48cfb7a","episode_id":"episode-2fa82b834ca4e296c0a917d4","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；主诉: 鼻塞3年，听力下降1月余。；；既往疾病史: 是否有过敏史无过敏史。是否有吸烟史吸烟史详情 【病理资料1】（鼻咽）未分化型非角化性癌。 原单位免疫组化结果：CK5/6（+/-），P40（+），P53（90%+），P16（-），INI-1（+，即表达无缺失），BRG1（+，即表达无缺失），EGFR（+），Ki-67（30%+）； 原单位原位杂交结果：EBER（+）。；活检部位: 鼻咽；肿瘤部位: 鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】肝S8高回声结节，考虑血管瘤可能性大。 脾脏、胰腺未见占位性病变。；检查部位: 腹部 ；1. 双侧膝关节及右侧踝关节炎。 2、余全身骨显像未见明显异常，建议随诊。；检查部位: 骨；是否骨转移: 否 ；右肾下极囊性病变，符合Bosniak IV级。 肝S8结节灶，考虑为血管瘤。 双肾囊肿。 双肺多发小结节及类结节灶，考虑增殖灶可能性大，建议随诊。 右肺散在条索影及条片影，多考虑为纤维增殖灶并局限性肺不张。 右侧胸腔少量积液。 ；鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 双侧咽后、颈部双侧II区见数个小淋巴结，性质待定。 副鼻窦炎；双侧乳突炎。；检查部位: 颈部；肿瘤部位: 鼻咽；是否区域复发: 否\n\n【当前需要决策的问题】\n病理已完成，治疗前分期报告现已全部可见：肝S8高回声结节，考虑血管瘤可能性大。 脾脏、胰腺未见占位性病变。；检查部位: 腹部 ；1. 双侧膝关节及右侧踝关节炎。 2、余全身骨显像未见明显异常，建议随诊。；检查部位: 骨；是否骨转移: 否 ；右肾下极囊性病变，符合Bosniak IV级。 肝S8结节灶，考虑为血管瘤。 双肾囊肿。 双肺多发小结节及类结节灶，考虑增殖灶可能性大，建议随诊。 右肺散在条索影及条片影，多考虑为纤维增殖灶并局限性肺不张。 右侧胸腔少量积液。 ；鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 双侧咽后、颈部双侧II区见数个小淋巴结，性质待定。 副鼻窦炎；双侧乳突炎。；检查部位: 颈部；肿瘤部位: 鼻咽；是否区域复发: 否。请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T3 / N0 / cM0\nB. T2 / N1 / cM0\nC. T3 / N0 / cM1\nD. T4 / N0 / cM0\nE. T1 / N1 / cM1\nF. T4 / N2 / cM0\nG. T4 / N1 / cM0\nH. T4 / N1 / cM1\nI. T1 / N3 / cM1\nJ. T4 / N3 / cM0\nK. T2 / N2 / cM0\nL. T2 / N2 / cM1\n\n请仅输出一个选项字母（A-L）。","gold_letter":"A","gold_action":"T3 / N0 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T3 / N0 / cM0","B":"T2 / N1 / cM0","C":"T3 / N0 / cM1","D":"T4 / N0 / cM0","E":"T1 / N1 / cM1","F":"T4 / N2 / cM0","G":"T4 / N1 / cM0","H":"T4 / N1 / cM1","I":"T1 / N3 / cM1","J":"T4 / N3 / cM0","K":"T2 / N2 / cM0","L":"T2 / N2 / cM1"}}
+{"sample_id":"sample-deba9006bc120b2ef16d87bc","patient_id":"patient-48b354132fb0421b229210e0","episode_id":"episode-bcc0f2462a7fbb9f7dd8fc54","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；病历特点: 患者A，女，37岁，因\"鼻塞2月余\"于既往时点，步行入院。患者A，精神可，饮食睡眠一般，大小便正常，体重无明显变化。3、肿瘤专科检查:张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查:阴性。 【影像与分期资料1】1.鼻咽病灶代谢活跃，符合鼻咽癌，侵犯左侧海绵窦、颅底孔道、蝶窦及颅底骨骼，具体侵犯范围如上述；双侧咽后、颈部双侧Ⅱ区淋巴结代谢活跃，考虑转移；颈部双侧Ⅲ区淋巴结代谢略活跃，转移待排，建议随诊。 2.右肺中叶数个小结节代谢略活跃，疑炎症。 3.双侧扁桃体增大代谢活跃，考虑炎症；鼻窦炎；左侧乳突炎症。 4.左肺上叶舌段胸膜下小类结节影代谢未见异常，疑增殖灶。 5.子宫颈及阴道条状代谢较活跃，疑炎性生理性摄取；盆腔少量积液。 6.双侧腹股沟淋巴结炎症。 ；鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 双侧破裂孔、双侧海绵窦、左侧翼腭窝受侵，见软组织灶，明显强化。 双侧咽后数个淋巴结，考虑转移。 颈部双侧II区见数个小淋巴结，性质待定。 副鼻窦炎；双侧乳突炎。\n\n【当前需要决策的问题】\n病理已完成，治疗前分期报告现已全部可见：1.鼻咽病灶代谢活跃，符合鼻咽癌，侵犯左侧海绵窦、颅底孔道、蝶窦及颅底骨骼，具体侵犯范围如上述；双侧咽后、颈部双侧Ⅱ区淋巴结代谢活跃，考虑转移；颈部双侧Ⅲ区淋巴结代谢略活跃，转移待排，建议随诊。 2.右肺中叶数个小结节代谢略活跃，疑炎症。 3.双侧扁桃体增大代谢活跃，考虑炎症；鼻窦炎；左侧乳突炎症。 4.左肺上叶舌段胸膜下小类结节影代谢未见异常，疑增殖灶。 5.子宫颈及阴道条状代谢较活跃，疑炎性生理性摄取；盆腔少量积液。 6.双侧腹股沟淋巴结炎症。 ；鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 双侧破裂孔、双侧海绵窦、左侧翼腭窝受侵，见软组织灶，明显强化。 双侧咽后数个淋巴结，考虑转移。 颈部双侧II区见数个小淋巴结，性质待定。 副鼻窦炎；双侧乳突炎。请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T4 / N2 / cM0\nB. T2 / N1 / cM0\nC. T1 / N2 / cM0\nD. T1 / N2 / cM1\nE. T4 / N0 / cM1\nF. T3 / N2 / cM0\nG. T1 / N0 / cM1\nH. T3 / N0 / cM1\nI. T2 / N2 / cM1\nJ. T3 / N1 / cM1\nK. T3 / N2 / cM1\nL. T2 / N3 / cM1\n\n请仅输出一个选项字母（A-L）。","gold_letter":"A","gold_action":"T4 / N2 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T4 / N2 / cM0","B":"T2 / N1 / cM0","C":"T1 / N2 / cM0","D":"T1 / N2 / cM1","E":"T4 / N0 / cM1","F":"T3 / N2 / cM0","G":"T1 / N0 / cM1","H":"T3 / N0 / cM1","I":"T2 / N2 / cM1","J":"T3 / N1 / cM1","K":"T3 / N2 / cM1","L":"T2 / N3 / cM1"}}
+{"sample_id":"sample-110679613a5dd4d1e5f0b7b1","patient_id":"patient-26124904f2562282e2449ddc","episode_id":"episode-0d65a6762a9d8948196ac2b3","turn_id":"P1_01","turn_number":1,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 当前阶段尚未释放病理、MRI或TNM结论。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；主诉: 发现双颈部包块5个月余。；未行治疗，今为求进一步诊治来本院。患者A，精神可，饮食睡眠一般，大小便正常，体重无明显变化。；既往疾病史: 既往“高血压”8年，口服药物不详，平时血压控制在140-150/90-100，否认“肝炎、结核、伤寒”等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤史；否认输血史及献血史。；家族史: 否认家族中有恶性肿瘤病史、遗传病史及精神病史。；体格检查: T:36.50℃ P:105次/分 R:20次/分 BP:150/115mmHg Ht: 152.50cm Wt:69.20kg BSA:1.6645m2 KPS:90 神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。 耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。 听力正常，鼓膜无穿孔。 鼻外观无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。 口腔粘膜正常。 齿龈无红肿，扁桃体无肿大。 颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。 胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。 心前区无隆起，未触及震颤。 心率105次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。 腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。 肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。 肛门、外生殖器未查。 脊柱四肢无畸形，肌力、肌张力正常。 生理反射存在，病理神经反射未引出。 张口门齿距4cm；鼻咽双侧顶后壁结节状肿物；双侧颈部IIa区可扪及1个淋巴结，最大径2×1cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查:阴性。\n\n【当前需要决策的问题】\n当前仅开放初诊病史与体征：记录时间: 既往时点；主诉: 发现双颈部包块5个月余。；未行治疗，今为求进一步诊治来本院。患者A，精神可，饮食睡眠一般，大小便正常，体重无明显变化。；既往疾病史: 既往“高血压”8年，口服药物不详，平时血压控制在140-150/90-100，否认“肝炎、结核、伤寒”等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤史；否认输血史及献血史。；家族史: 否认家族中有恶性肿瘤病史、遗传病史及精神病史。；体格检查: T:36.50℃ P:105次/分 R:20次/分 BP:150/115mmHg Ht: 152.50cm Wt:69.20kg BSA:1.6645m2 KPS:90 神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。 耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。 听力正常，鼓膜无穿孔。 鼻外观无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。 口腔粘膜正常。 齿龈无红肿，扁桃体无肿大。 颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。 胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。 心前区无隆起，未触及震颤。 心率105次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。 腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。 肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。 肛门、外生殖器未查。 脊柱四肢无畸形，肌力、肌张力正常。 生理反射存在，病理神经反射未引出。 张口门齿距4cm；鼻咽双侧顶后壁结节状肿物；双侧颈部IIa区可扪及1个淋巴结，最大径2×1cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查:阴性。在不能查看病理、IHC/EBER及影像结论的前提下，下一步最合理且能逐步完成确诊与分期的检查路径是什么？\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 仅给予止血、止痛等对症治疗，3个月后症状持续时再复诊\nB. 直接按鼻咽癌开始同步放化疗，不再补充组织学和分期证据\nC. 仅复查EBV-DNA，以单次病毒载量作为确诊和分期依据\nD. 仅行胸部CT，若无肺转移即结束本次诊断流程\nE. 先经验性使用抗生素两周，不安排鼻咽专科检查\nF. 仅行颈部淋巴结超声随访，不评估鼻咽原发部位\nG. 直接切除颈部肿大淋巴结，不先完成鼻咽原发灶评估\nH. 可疑病灶组织活检并取得正式病理；增强鼻咽及颈部MRI；PET/CT或等效全身分期；鼻咽专科检查/内镜\nI. 仅凭症状诊断鼻窦炎并长期观察，不安排组织取材\nJ. 先开始免疫单药治疗，再根据疗效反推肿瘤诊断\nK. 只做常规血液检查，结果正常即排除恶性肿瘤\nL. 立即行姑息性骨放疗，不核对原发灶和全身疾病范围\n\n请仅输出一个选项字母（A-L）。","gold_letter":"H","gold_action":"可疑病灶组织活检并取得正式病理；增强鼻咽及颈部MRI；PET/CT或等效全身分期；鼻咽专科检查/内镜","context_placeholders":[],"options":{"A":"仅给予止血、止痛等对症治疗，3个月后症状持续时再复诊","B":"直接按鼻咽癌开始同步放化疗，不再补充组织学和分期证据","C":"仅复查EBV-DNA，以单次病毒载量作为确诊和分期依据","D":"仅行胸部CT，若无肺转移即结束本次诊断流程","E":"先经验性使用抗生素两周，不安排鼻咽专科检查","F":"仅行颈部淋巴结超声随访，不评估鼻咽原发部位","G":"直接切除颈部肿大淋巴结，不先完成鼻咽原发灶评估","H":"可疑病灶组织活检并取得正式病理；增强鼻咽及颈部MRI；PET/CT或等效全身分期；鼻咽专科检查/内镜","I":"仅凭症状诊断鼻窦炎并长期观察，不安排组织取材","J":"先开始免疫单药治疗，再根据疗效反推肿瘤诊断","K":"只做常规血液检查，结果正常即排除恶性肿瘤","L":"立即行姑息性骨放疗，不核对原发灶和全身疾病范围"}}
+{"sample_id":"sample-1b0bddc3306d119848b41841","patient_id":"patient-26124904f2562282e2449ddc","episode_id":"episode-0d65a6762a9d8948196ac2b3","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；主诉: 发现双颈部包块5个月余。；未行治疗，今为求进一步诊治来本院。患者A，精神可，饮食睡眠一般，大小便正常，体重无明显变化。；既往疾病史: 既往“高血压”8年，口服药物不详，平时血压控制在140-150/90-100，否认“肝炎、结核、伤寒”等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤史；否认输血史及献血史。；家族史: 否认家族中有恶性肿瘤病史、遗传病史及精神病史。；体格检查: T:36.50℃ P:105次/分 R:20次/分 BP:150/115mmHg Ht: 152.50cm Wt:69.20kg BSA:1.6645m2 KPS:90 神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。 耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。 听力正常，鼓膜无穿孔。 鼻外观无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。 口腔粘膜正常。 齿龈无红肿，扁桃体无肿大。 颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。 胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。 心前区无隆起，未触及震颤。 心率105次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。 腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。 肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。 肛门、外生殖器未查。 脊柱四肢无畸形，肌力、肌张力正常。 生理反射存在，病理神经反射未引出。 张口门齿距4cm；鼻咽双侧顶后壁结节状肿物；双侧颈部IIa区可扪及1个淋巴结，最大径2×1cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查:阴性。 【病理资料1】（右颈II区淋巴）镜下：穿刺淋巴组织中见分化差的癌，结合免疫组化及原位杂交结果，符合淋巴上皮瘤样癌/未分化型非角化性癌，建议临床进一步检查鼻咽、涎腺、肺等部位。 免疫组化：标本08：CK(AE1/AE3)（+）； 原位杂交：标本08：EBERs（+）。；是否鼻咽癌: 否 【影像与分期资料1】鼻咽病变，考虑鼻咽癌可能。 左侧咽后肿大淋巴结，考虑转移。 颈部双侧II区、右侧III区见数个肿大淋巴结，考虑转移。 副鼻窦炎。；检查部位: 颈部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 23.0；区域淋巴结转移部位: 左侧咽后淋巴结,右侧III区淋巴结,双侧II区淋巴结；是否区域复发: 否 ；鼻咽病灶代谢活跃，考虑鼻咽癌，侵犯范围如上述；左侧咽后、双颈II区、右颈Va区多个肿大淋巴结代谢活跃，考虑转移；右咽后、右颈III区、左颈Va区数个小淋巴结代谢稍活跃，疑转移。 双肺纤维增殖灶伴炎症。纵隔及双肺门淋巴结炎症。 肝S5结节代谢未见异常，疑良性病变（血管瘤？）；肝囊肿。 双肾囊肿。 T11椎体血管瘤。 鼻窦炎。\n\n【当前需要决策的问题】\n病理已完成，治疗前分期报告现已全部可见：鼻咽病变，考虑鼻咽癌可能。 左侧咽后肿大淋巴结，考虑转移。 颈部双侧II区、右侧III区见数个肿大淋巴结，考虑转移。 副鼻窦炎。；检查部位: 颈部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 23.0；区域淋巴结转移部位: 左侧咽后淋巴结,右侧III区淋巴结,双侧II区淋巴结；是否区域复发: 否 ；鼻咽病灶代谢活跃，考虑鼻咽癌，侵犯范围如上述；左侧咽后、双颈II区、右颈Va区多个肿大淋巴结代谢活跃，考虑转移；右咽后、右颈III区、左颈Va区数个小淋巴结代谢稍活跃，疑转移。 双肺纤维增殖灶伴炎症。纵隔及双肺门淋巴结炎症。 肝S5结节代谢未见异常，疑良性病变（血管瘤？）；肝囊肿。 双肾囊肿。 T11椎体血管瘤。 鼻窦炎。请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T3 / N0 / cM0\nB. T1 / N2 / cM0\nC. T1 / N2 / cM1\nD. T2 / N0 / cM0\nE. T2 / N2 / cM1\nF. T4 / N2 / cM1\nG. T1 / N0 / cM0\nH. T3 / N2 / cM1\nI. T1 / N3 / cM1\nJ. T4 / N0 / cM0\nK. T4 / N1 / cM0\nL. T4 / N0 / cM1\n\n请仅输出一个选项字母（A-L）。","gold_letter":"B","gold_action":"T1 / N2 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T3 / N0 / cM0","B":"T1 / N2 / cM0","C":"T1 / N2 / cM1","D":"T2 / N0 / cM0","E":"T2 / N2 / cM1","F":"T4 / N2 / cM1","G":"T1 / N0 / cM0","H":"T3 / N2 / cM1","I":"T1 / N3 / cM1","J":"T4 / N0 / cM0","K":"T4 / N1 / cM0","L":"T4 / N0 / cM1"}}
+{"sample_id":"sample-086a90067947320ded457260","patient_id":"patient-8977b4b1d24f1a473b242981","episode_id":"episode-e905505d4c1e962f8a333538","turn_id":"P2_01","turn_number":2,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 当前阶段尚未释放病理、MRI或TNM结论。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；主诉: 双颈淋巴结肿大半年；现病史: 既往时点月出现双颈无痛性淋巴结肿大，无伴头晕头痛，无鼻塞或涕血，无耳鸣，无吞咽不适。患者为进一步诊治来本院。起病以来无发热、盗汗或其他不适，一般情况好，二便如常，体重无减轻。；既往疾病史: 平素体健是否有过敏史无过敏史。是否有吸烟史吸烟史详情；体格检查: 双侧颈部II区至V区可扪及多发肿大淋巴结，直径2-3.5cm，部分融合，质中，可活动。 【病理资料1】（右侧颈部淋巴结）结合形态及免疫组化等结果，病变符合EBV阳性的癌，倾向转移性未分化型非角化性癌或淋巴上皮瘤样癌，建议临床查鼻咽、肺及涎腺等。 本院免疫组化：CK（+），CK7（-），TTF1（-），CK8/18（+），SATB2（-），PSA（-），Syn（-），CgA（-），Ki67（约35%+），P40（+）。 本院原位杂交：EBERs（+）。；活检部位: 右侧颈部淋巴结；颈部转移淋巴结部位: 右侧颈部淋巴结；是否鼻咽癌: 否\n\n【当前需要决策的问题】\n此前初诊线索为：记录时间: 既往时点；主诉: 双颈淋巴结肿大半年；现病史: 既往时点月出现双颈无痛性淋巴结肿大，无伴头晕头痛，无鼻塞或涕血，无耳鸣，无吞咽不适。患者为进一步诊治来本院。起病以来无发热、盗汗或其他不适，一般情况好，二便如常，体重无减轻。；既往疾病史: 平素体健是否有过敏史无过敏史。是否有吸烟史吸烟史详情；体格检查: 双侧颈部II区至V区可扪及多发肿大淋巴结，直径2-3.5cm，部分融合，质中，可活动。本诊断节点新释放患者本人正式病理报告：（右侧颈部淋巴结）结合形态及免疫组化等结果，病变符合EBV阳性的癌，倾向转移性未分化型非角化性癌或淋巴上皮瘤样癌，建议临床查鼻咽、肺及涎腺等。 本院免疫组化：CK（+），CK7（-），TTF1（-），CK8/18（+），SATB2（-），PSA（-），Syn（-），CgA（-），Ki67（约35%+），P40（+）。 本院原位杂交：EBERs（+）。；活检部位: 右侧颈部淋巴结；颈部转移淋巴结部位: 右侧颈部淋巴结；是否鼻咽癌: 否。此时最准确的组织学诊断是什么，哪些证据只能作为支持而不能单独替代正式病理？\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 鼻咽未分化型非角化性癌，正式组织病理为诊断核心，EBER/IHC为支持证据\nB. 鼻咽黏膜慢性炎症，EBER阳性即可排除恶性肿瘤\nC. 角化型鳞状细胞癌，仅凭EBV-DNA升高即可确诊\nD. 弥漫大B细胞淋巴瘤，CK阳性是其特异诊断依据\nE. NK/T细胞淋巴瘤，任何EBER阳性都足以替代组织形态\nF. 嗅神经母细胞瘤，以颈部淋巴结转移作为唯一证据\nG. 腺样囊性癌，未见腺样结构也可直接确诊\nH. 小细胞神经内分泌癌，Syn和CgA阴性仍应优先考虑\nI. 转移性甲状腺癌，不需要核对鼻咽取材部位\nJ. 鼻咽未分化型非角化性癌并淋巴结转移；正式组织形态为诊断核心，IHC/EBER仅作支持\nK. 鼻咽部未定性恶性肿瘤，正式病理尚不能支持具体诊断\nL. 良性淋巴组织增生，异型上皮巢不具有诊断价值\n\n请仅输出一个选项字母（A-L）。","gold_letter":"J","gold_action":"鼻咽未分化型非角化性癌并淋巴结转移；正式组织形态为诊断核心，IHC/EBER仅作支持","context_placeholders":[],"options":{"A":"鼻咽未分化型非角化性癌，正式组织病理为诊断核心，EBER/IHC为支持证据","B":"鼻咽黏膜慢性炎症，EBER阳性即可排除恶性肿瘤","C":"角化型鳞状细胞癌，仅凭EBV-DNA升高即可确诊","D":"弥漫大B细胞淋巴瘤，CK阳性是其特异诊断依据","E":"NK/T细胞淋巴瘤，任何EBER阳性都足以替代组织形态","F":"嗅神经母细胞瘤，以颈部淋巴结转移作为唯一证据","G":"腺样囊性癌，未见腺样结构也可直接确诊","H":"小细胞神经内分泌癌，Syn和CgA阴性仍应优先考虑","I":"转移性甲状腺癌，不需要核对鼻咽取材部位","J":"鼻咽未分化型非角化性癌并淋巴结转移；正式组织形态为诊断核心，IHC/EBER仅作支持","K":"鼻咽部未定性恶性肿瘤，正式病理尚不能支持具体诊断","L":"良性淋巴组织增生，异型上皮巢不具有诊断价值"}}
+{"sample_id":"sample-c6666b946f25cc0865651fbc","patient_id":"patient-8977b4b1d24f1a473b242981","episode_id":"episode-e905505d4c1e962f8a333538","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；主诉: 双颈淋巴结肿大半年；现病史: 既往时点月出现双颈无痛性淋巴结肿大，无伴头晕头痛，无鼻塞或涕血，无耳鸣，无吞咽不适。患者为进一步诊治来本院。起病以来无发热、盗汗或其他不适，一般情况好，二便如常，体重无减轻。；既往疾病史: 平素体健是否有过敏史无过敏史。是否有吸烟史吸烟史详情；体格检查: 双侧颈部II区至V区可扪及多发肿大淋巴结，直径2-3.5cm，部分融合，质中，可活动。 【病理资料1】（右侧颈部淋巴结）结合形态及免疫组化等结果，病变符合EBV阳性的癌，倾向转移性未分化型非角化性癌或淋巴上皮瘤样癌，建议临床查鼻咽、肺及涎腺等。 本院免疫组化：CK（+），CK7（-），TTF1（-），CK8/18（+），SATB2（-），PSA（-），Syn（-），CgA（-），Ki67（约35%+），P40（+）。 本院原位杂交：EBERs（+）。；活检部位: 右侧颈部淋巴结；颈部转移淋巴结部位: 右侧颈部淋巴结；是否鼻咽癌: 否 【影像与分期资料1】鼻咽顶壁、顶后壁及右侧壁粘膜增厚代谢活跃，考虑鼻咽癌；双颈II-V区多发肿大淋巴结代谢较活跃，考虑转移。 鼻窦炎。 疑右上肺尖段小增殖灶；左侧冠状动脉硬化。 胆囊小结石。 前列腺钙化灶。 L5/S1椎间盘突出；疑左侧足背皮肤炎性病变。 ；鼻咽病变，考虑鼻咽癌。 右侧咽旁间隙受侵。 颅底骨质未见骨质破坏征象。 双侧咽后小淋巴结，考虑转移。 颈部双侧II区、双侧III区、右侧IV区、双侧V区见多个肿大淋巴结，考虑转移。 副鼻窦炎。\n\n【当前需要决策的问题】\n病理已完成，治疗前分期报告现已全部可见：鼻咽顶壁、顶后壁及右侧壁粘膜增厚代谢活跃，考虑鼻咽癌；双颈II-V区多发肿大淋巴结代谢较活跃，考虑转移。 鼻窦炎。 疑右上肺尖段小增殖灶；左侧冠状动脉硬化。 胆囊小结石。 前列腺钙化灶。 L5/S1椎间盘突出；疑左侧足背皮肤炎性病变。 ；鼻咽病变，考虑鼻咽癌。 右侧咽旁间隙受侵。 颅底骨质未见骨质破坏征象。 双侧咽后小淋巴结，考虑转移。 颈部双侧II区、双侧III区、右侧IV区、双侧V区见多个肿大淋巴结，考虑转移。 副鼻窦炎。请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T3 / N3 / cM0\nB. T4 / N2 / cM0\nC. T3 / N3 / cM1\nD. T2 / N0 / cM0\nE. T2 / N2 / cM1\nF. T2 / N1 / cM1\nG. T3 / N0 / cM0\nH. T2 / N3 / cM0\nI. T4 / N1 / cM0\nJ. T1 / N1 / cM0\nK. T1 / N0 / cM1\nL. T1 / N3 / cM0\n\n请仅输出一个选项字母（A-L）。","gold_letter":"H","gold_action":"T2 / N3 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T3 / N3 / cM0","B":"T4 / N2 / cM0","C":"T3 / N3 / cM1","D":"T2 / N0 / cM0","E":"T2 / N2 / cM1","F":"T2 / N1 / cM1","G":"T3 / N0 / cM0","H":"T2 / N3 / cM0","I":"T4 / N1 / cM0","J":"T1 / N1 / cM0","K":"T1 / N0 / cM1","L":"T1 / N3 / cM0"}}
+{"sample_id":"sample-83005086edbc8aa147d192f1","patient_id":"patient-11503878835da201ca5804cc","episode_id":"episode-33ff75aa1d41d1710539b2d3","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；主诉: 左侧鼻塞半年；现病史: 左侧鼻塞半年，偶有鼻衄，当地鼻咽镜检查示鼻咽顶后肿物，现为进一步诊治来诊。 【影像与分期资料1】鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 双侧咽后数个小淋巴结，考虑转移可能。 颈部双侧II区见多个小淋巴结，性质待定。 副鼻窦炎。；检查部位: 鼻咽部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 不确定；是否区域复发: 否 ；鼻咽病灶代谢活跃，疑鼻咽癌，侵犯范围如上所述；双侧咽后及左颈II区多发小淋巴结代谢略活跃，疑转移。 筛窦炎症。 甲状腺右叶结节伴钙化灶代谢未见异常，考虑良性病变。 双肺门数个小淋巴结炎症。 心腔内血液密度低于室间隔，符合贫血。 右下肺前基底段增殖灶。 胆囊结石。 左肾囊肿。 前列腺小钙化灶。 L3-S1椎间盘突出。 多个腰椎骨质增生；骶骨S1腰化；骶椎隐裂。\n\n【当前需要决策的问题】\n病理已完成，治疗前分期报告现已全部可见：鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 双侧咽后数个小淋巴结，考虑转移可能。 颈部双侧II区见多个小淋巴结，性质待定。 副鼻窦炎。；检查部位: 鼻咽部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 不确定；是否区域复发: 否 ；鼻咽病灶代谢活跃，疑鼻咽癌，侵犯范围如上所述；双侧咽后及左颈II区多发小淋巴结代谢略活跃，疑转移。 筛窦炎症。 甲状腺右叶结节伴钙化灶代谢未见异常，考虑良性病变。 双肺门数个小淋巴结炎症。 心腔内血液密度低于室间隔，符合贫血。 右下肺前基底段增殖灶。 胆囊结石。 左肾囊肿。 前列腺小钙化灶。 L3-S1椎间盘突出。 多个腰椎骨质增生；骶骨S1腰化；骶椎隐裂。请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T2 / N3 / cM0\nB. T2 / N0 / cM1\nC. T1 / N2 / cM1\nD. T4 / N0 / cM0\nE. T4 / N0 / cM1\nF. T3 / N1 / cM0\nG. T3 / N3 / cM1\nH. T1 / N0 / cM0\nI. T2 / N1 / cM0\nJ. T4 / N1 / cM1\nK. T1 / N1 / cM1\nL. T4 / N2 / cM0\n\n请仅输出一个选项字母（A-L）。","gold_letter":"F","gold_action":"T3 / N1 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T2 / N3 / cM0","B":"T2 / N0 / cM1","C":"T1 / N2 / cM1","D":"T4 / N0 / cM0","E":"T4 / N0 / cM1","F":"T3 / N1 / cM0","G":"T3 / N3 / cM1","H":"T1 / N0 / cM0","I":"T2 / N1 / cM0","J":"T4 / N1 / cM1","K":"T1 / N1 / cM1","L":"T4 / N2 / cM0"}}
+{"sample_id":"sample-0e53efa06b3f3d513f5dc614","patient_id":"patient-9eee365a9ef54e00d4f99666","episode_id":"episode-8e56bfbb8e670af161db7828","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；主诉: 上眼皮红肿1月余。；现病史: 上眼皮红肿1月余。偶有头痛，耳鸣，余无特殊不适。门诊既往史；既往疾病史: 是否有过敏史无过敏史。是否有吸烟史吸烟史详情月经史月经史: 【病理资料1】（鼻咽）镜下见片巢状异型细胞，形态可符合为未分化型非角化性癌，必要时建议切涂胶白片6张加做免疫组化CK、EGFR及原位杂交EBERs以进一步诊断及协助治疗。 既往时点补充报告： 结合本院免疫组化示 CK（+），EGFR（+）；原位杂交EBERs（+），支持诊断为（鼻咽）未分化型非角化性癌。；活检部位: 鼻咽；肿瘤部位: 鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】鼻咽病灶代谢活跃，符合鼻咽癌，病灶侵犯左侧头长肌、疑累及蝶骨基底部。 双颈Ib、II区数个淋巴结代谢较活跃/略活跃，疑炎性病变。 双侧扁桃体炎。 右肺中叶类结节代谢未见异常，考虑增殖灶。 脂肪肝。 子宫内膜区代谢活跃，疑生理性改变。 ；鼻咽病变，考虑鼻咽癌。 颅底骨质未见破坏。 双侧咽后、颈部双侧Ⅰ-Ⅳ区、左侧Ⅴ区淋巴结，性质待定，建议随诊。 双侧腭扁桃体体积增大，考虑炎性病变可能性大。 桥脑左旁见一强化小结节（se1001-6），脑膜瘤？神经鞘瘤？\n\n【当前需要决策的问题】\n病理已完成，治疗前分期报告现已全部可见：鼻咽病灶代谢活跃，符合鼻咽癌，病灶侵犯左侧头长肌、疑累及蝶骨基底部。 双颈Ib、II区数个淋巴结代谢较活跃/略活跃，疑炎性病变。 双侧扁桃体炎。 右肺中叶类结节代谢未见异常，考虑增殖灶。 脂肪肝。 子宫内膜区代谢活跃，疑生理性改变。 ；鼻咽病变，考虑鼻咽癌。 颅底骨质未见破坏。 双侧咽后、颈部双侧Ⅰ-Ⅳ区、左侧Ⅴ区淋巴结，性质待定，建议随诊。 双侧腭扁桃体体积增大，考虑炎性病变可能性大。 桥脑左旁见一强化小结节（se1001-6），脑膜瘤？神经鞘瘤？。请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T3 / N1 / cM1\nB. T3 / N0 / cM1\nC. T1 / N2 / cM1\nD. T1 / N0 / cM1\nE. T2 / N0 / cM1\nF. T3 / N2 / cM1\nG. T2 / N0 / cM0\nH. T4 / N1 / cM0\nI. T1 / N0 / cM0\nJ. T1 / N3 / cM0\nK. T2 / N2 / cM0\nL. T4 / N2 / cM1\n\n请仅输出一个选项字母（A-L）。","gold_letter":"G","gold_action":"T2 / N0 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T3 / N1 / cM1","B":"T3 / N0 / cM1","C":"T1 / N2 / cM1","D":"T1 / N0 / cM1","E":"T2 / N0 / cM1","F":"T3 / N2 / cM1","G":"T2 / N0 / cM0","H":"T4 / N1 / cM0","I":"T1 / N0 / cM0","J":"T1 / N3 / cM0","K":"T2 / N2 / cM0","L":"T4 / N2 / cM1"}}
+{"sample_id":"sample-f14be2b25e6f9aced7128070","patient_id":"patient-9eee365a9ef54e00d4f99666","episode_id":"episode-8e56bfbb8e670af161db7828","turn_id":"P6_01","turn_number":6,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM：{{TNM_STATUS}}；总分期：{{OVERALL_STAGE}}。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；主诉: 上眼皮红肿1月余。；现病史: 上眼皮红肿1月余。偶有头痛，耳鸣，余无特殊不适。门诊既往史；既往疾病史: 是否有过敏史无过敏史。是否有吸烟史吸烟史详情月经史月经史: 【病理资料1】（鼻咽）镜下见片巢状异型细胞，形态可符合为未分化型非角化性癌，必要时建议切涂胶白片6张加做免疫组化CK、EGFR及原位杂交EBERs以进一步诊断及协助治疗。 既往时点补充报告： 结合本院免疫组化示 CK（+），EGFR（+）；原位杂交EBERs（+），支持诊断为（鼻咽）未分化型非角化性癌。；活检部位: 鼻咽；肿瘤部位: 鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】鼻咽病灶代谢活跃，符合鼻咽癌，病灶侵犯左侧头长肌、疑累及蝶骨基底部。 双颈Ib、II区数个淋巴结代谢较活跃/略活跃，疑炎性病变。 双侧扁桃体炎。 右肺中叶类结节代谢未见异常，考虑增殖灶。 脂肪肝。 子宫内膜区代谢活跃，疑生理性改变。 ；鼻咽病变，考虑鼻咽癌。 颅底骨质未见破坏。 双侧咽后、颈部双侧Ⅰ-Ⅳ区、左侧Ⅴ区淋巴结，性质待定，建议随诊。 双侧腭扁桃体体积增大，考虑炎性病变可能性大。 桥脑左旁见一强化小结节（se1001-6），脑膜瘤？神经鞘瘤？ 【治疗经过1】记录时间: 既往时点；病历特点: 患者A，女，43岁，因\"左侧上眼皮红肿1月余。 \"于既往时点，步行入院。 一、病例特点: 1、患者A，女性，43岁，广东省[地点已隐去]人 2、现病史:缘于1月前患者无明显诱因出现上眼皮红肿，偶有头痛，耳鸣，无头晕，无复视、视力模糊，听力下降，无鼻塞、涕血，无面麻等不适，未予重视，逐渐加重，遂至外院A就诊，既往时点行鼻咽活检病理示：鼻咽未分化型非角化性癌，未行治疗，今为求进一步诊治来本院。 患者发病以来，精神可，饮食睡眠一般，大小便正常，体重无明显变化。 3、肿瘤专科检查:张口门齿距5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结;颅神经检查:阴性。 4、辅助检查:（1）既往时点在本院病理会诊（病理号:[编号已隐藏]）鼻咽活检病理示:未分化型非角化癌 既往时点本院颅脑MRI见“桥脑左旁见一强化小结节（se1001-6），脑膜瘤？神经鞘瘤？” 【治疗反应与不良反应1】既往时点 患者放化疗中电解质紊乱，予以对症处理，建议饮食偏咸些，增强营养，必要时急诊随诊。门诊既往史；既往疾病史: 既往史:是否有过敏史无过敏史。是否有吸烟史吸烟史详情月经史月经史:；客观检验：氯离子(Cl-)-静脉血：97.0mmol/L（低于参考范围，参考约99-110mmol/L） || 钾离子(K+)-静脉血：3.0mmol/L || 钠离子(Na+)-静脉血：136.1mmol/L 【P6-Follow-up 1】鼻咽癌放化疗后复查，对比既往时点 MR： 鼻咽黏膜增厚，呈放化疗后改变。 颅底骨质未见破坏。 双侧咽后、颈部双侧Ⅰ-Ⅳ区、左侧Ⅴ区淋巴结，较前缩小，建议随诊。 双侧腭扁桃体现无明显增大。 桥脑左旁见一强化小结节，脑膜瘤？神经鞘瘤？较前相仿。\n\n【当前需要决策的问题】\n该患者治疗前为T2N0cM0（主要MRI阳性结构：鼻咽）。治疗完成后约1天的0_3_months节点返回以下新证据：鼻咽癌放化疗后复查，对比既往时点 MR： 鼻咽黏膜增厚，呈放化疗后改变。 颅底骨质未见破坏。 双侧咽后、颈部双侧Ⅰ-Ⅳ区、左侧Ⅴ区淋巴结，较前缩小，建议随诊。 双侧腭扁桃体现无明显增大。 桥脑左旁见一强化小结节，脑膜瘤？神经鞘瘤？较前相仿。与既往治疗和检查相比，当前疗效或疾病状态如何，下一步复查或治疗衔接最合理是什么？\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 鼻咽呈放化疗后改变，区域淋巴结较前缩小，桥脑旁结节稳定。继续规范随访，并结合症状及复查结果复评。\nB. 不比较既往影像，直接判定完全缓解并终止所有复查\nC. 仅依据单次EBV-DNA判断复发，不结合影像和临床\nD. 把所有治疗后改变均判定为明确进展并立即更换方案\nE. 无论影像趋势如何均继续原方案，取消近期再评估\nF. 只随访鼻咽局部，不评估区域淋巴结和远处病灶\nG. 仅进行症状随访，今后不再安排任何客观检查\nH. 立即进行鼻咽手术，不核对复发部位及既往放疗范围\nI. 将稳定或缩小的病灶按新发转移处理并启动后线治疗\nJ. 将明确新发或增大的病灶视为治疗后改变，延后一年复查\nK. 仅重复病理活检，不先核对本次影像与既往影像\nL. 完成本次检查后永久失访，不设置下一次复查节点\n\n请仅输出一个选项字母（A-L）。","gold_letter":"A","gold_action":"鼻咽呈放化疗后改变，区域淋巴结较前缩小，桥脑旁结节稳定。继续规范随访，并结合症状及复查结果复评。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":{"A":"鼻咽呈放化疗后改变，区域淋巴结较前缩小，桥脑旁结节稳定。继续规范随访，并结合症状及复查结果复评。","B":"不比较既往影像，直接判定完全缓解并终止所有复查","C":"仅依据单次EBV-DNA判断复发，不结合影像和临床","D":"把所有治疗后改变均判定为明确进展并立即更换方案","E":"无论影像趋势如何均继续原方案，取消近期再评估","F":"只随访鼻咽局部，不评估区域淋巴结和远处病灶","G":"仅进行症状随访，今后不再安排任何客观检查","H":"立即进行鼻咽手术，不核对复发部位及既往放疗范围","I":"将稳定或缩小的病灶按新发转移处理并启动后线治疗","J":"将明确新发或增大的病灶视为治疗后改变，延后一年复查","K":"仅重复病理活检，不先核对本次影像与既往影像","L":"完成本次检查后永久失访，不设置下一次复查节点"}}
+{"sample_id":"sample-a70e82288ec5649cf5980324","patient_id":"patient-9eee365a9ef54e00d4f99666","episode_id":"episode-8e56bfbb8e670af161db7828","turn_id":"P6_02","turn_number":7,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM：{{TNM_STATUS}}；总分期：{{OVERALL_STAGE}}。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；主诉: 上眼皮红肿1月余。；现病史: 上眼皮红肿1月余。偶有头痛，耳鸣，余无特殊不适。门诊既往史；既往疾病史: 是否有过敏史无过敏史。是否有吸烟史吸烟史详情月经史月经史: 【病理资料1】（鼻咽）镜下见片巢状异型细胞，形态可符合为未分化型非角化性癌，必要时建议切涂胶白片6张加做免疫组化CK、EGFR及原位杂交EBERs以进一步诊断及协助治疗。 既往时点补充报告： 结合本院免疫组化示 CK（+），EGFR（+）；原位杂交EBERs（+），支持诊断为（鼻咽）未分化型非角化性癌。；活检部位: 鼻咽；肿瘤部位: 鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】鼻咽病灶代谢活跃，符合鼻咽癌，病灶侵犯左侧头长肌、疑累及蝶骨基底部。 双颈Ib、II区数个淋巴结代谢较活跃/略活跃，疑炎性病变。 双侧扁桃体炎。 右肺中叶类结节代谢未见异常，考虑增殖灶。 脂肪肝。 子宫内膜区代谢活跃，疑生理性改变。 ；鼻咽病变，考虑鼻咽癌。 颅底骨质未见破坏。 双侧咽后、颈部双侧Ⅰ-Ⅳ区、左侧Ⅴ区淋巴结，性质待定，建议随诊。 双侧腭扁桃体体积增大，考虑炎性病变可能性大。 桥脑左旁见一强化小结节（se1001-6），脑膜瘤？神经鞘瘤？ 【治疗经过1】记录时间: 既往时点；病历特点: 患者A，女，43岁，因\"左侧上眼皮红肿1月余。 \"于既往时点，步行入院。 一、病例特点: 1、患者A，女性，43岁，广东省[地点已隐去]人 2、现病史:缘于1月前患者无明显诱因出现上眼皮红肿，偶有头痛，耳鸣，无头晕，无复视、视力模糊，听力下降，无鼻塞、涕血，无面麻等不适，未予重视，逐渐加重，遂至外院A就诊，既往时点行鼻咽活检病理示：鼻咽未分化型非角化性癌，未行治疗，今为求进一步诊治来本院。 患者发病以来，精神可，饮食睡眠一般，大小便正常，体重无明显变化。 3、肿瘤专科检查:张口门齿距5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结;颅神经检查:阴性。 4、辅助检查:（1）既往时点在本院病理会诊（病理号:[编号已隐藏]）鼻咽活检病理示:未分化型非角化癌 既往时点本院颅脑MRI见“桥脑左旁见一强化小结节（se1001-6），脑膜瘤？神经鞘瘤？” 【治疗反应与不良反应1】既往时点 患者放化疗中电解质紊乱，予以对症处理，建议饮食偏咸些，增强营养，必要时急诊随诊。门诊既往史；既往疾病史: 既往史:是否有过敏史无过敏史。是否有吸烟史吸烟史详情月经史月经史:；客观检验：氯离子(Cl-)-静脉血：97.0mmol/L（低于参考范围，参考约99-110mmol/L） || 钾离子(K+)-静脉血：3.0mmol/L || 钠离子(Na+)-静脉血：136.1mmol/L 【P6-Follow-up 1】鼻咽癌放化疗后复查，对比既往时点 MR： 鼻咽黏膜增厚，呈放化疗后改变。 颅底骨质未见破坏。 双侧咽后、颈部双侧Ⅰ-Ⅳ区、左侧Ⅴ区淋巴结，较前缩小，建议随诊。 双侧腭扁桃体现无明显增大。 桥脑左旁见一强化小结节，脑膜瘤？神经鞘瘤？较前相仿。 【P6-Follow-up 2】鼻咽癌放化疗后复查，对比既往时点 MR： 鼻咽黏膜增厚、肿胀，较前明显，呈放化疗后改变。 颅底骨质未见破坏。 双侧咽后、颈部双侧Ⅰ-Ⅳ区、左侧Ⅴ区淋巴结，部分较前缩小，建议随诊。 鼻窦炎，左侧乳突炎。 桥脑左旁见一强化小结节，脑膜瘤？神经鞘瘤？较前相仿。\n\n【当前需要决策的问题】\n该患者治疗前为T2N0cM0（主要MRI阳性结构：鼻咽）。治疗完成后约101天的3_6_months节点返回以下新证据：鼻咽癌放化疗后复查，对比既往时点 MR： 鼻咽黏膜增厚、肿胀，较前明显，呈放化疗后改变。 颅底骨质未见破坏。 双侧咽后、颈部双侧Ⅰ-Ⅳ区、左侧Ⅴ区淋巴结，部分较前缩小，建议随诊。 鼻窦炎，左侧乳突炎。 桥脑左旁见一强化小结节，脑膜瘤？神经鞘瘤？较前相仿。与既往治疗和检查相比，当前疗效或疾病状态如何，下一步复查或治疗衔接最合理是什么？\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 不比较既往影像，直接判定完全缓解并终止所有复查\nB. 仅依据单次EBV-DNA判断复发，不结合影像和临床\nC. 把所有治疗后改变均判定为明确进展并立即更换方案\nD. 无论影像趋势如何均继续原方案，取消近期再评估\nE. 只随访鼻咽局部，不评估区域淋巴结和远处病灶\nF. 仅进行症状随访，今后不再安排任何客观检查\nG. 立即进行鼻咽手术，不核对复发部位及既往放疗范围\nH. 将稳定或缩小的病灶按新发转移处理并启动后线治疗\nI. 将明确新发或增大的病灶视为治疗后改变，延后一年复查\nJ. 仅重复病理活检，不先核对本次影像与既往影像\nK. 鼻咽黏膜增厚、肿胀较前明显，报告解释为放化疗后改变，区域淋巴结部分较前缩小，桥脑旁结节稳定。继续规范随访，并结合症状及复查结果复评。\nL. 完成本次检查后永久失访，不设置下一次复查节点\n\n请仅输出一个选项字母（A-L）。","gold_letter":"K","gold_action":"鼻咽黏膜增厚、肿胀较前明显，报告解释为放化疗后改变，区域淋巴结部分较前缩小，桥脑旁结节稳定。继续规范随访，并结合症状及复查结果复评。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":{"A":"不比较既往影像，直接判定完全缓解并终止所有复查","B":"仅依据单次EBV-DNA判断复发，不结合影像和临床","C":"把所有治疗后改变均判定为明确进展并立即更换方案","D":"无论影像趋势如何均继续原方案，取消近期再评估","E":"只随访鼻咽局部，不评估区域淋巴结和远处病灶","F":"仅进行症状随访，今后不再安排任何客观检查","G":"立即进行鼻咽手术，不核对复发部位及既往放疗范围","H":"将稳定或缩小的病灶按新发转移处理并启动后线治疗","I":"将明确新发或增大的病灶视为治疗后改变，延后一年复查","J":"仅重复病理活检，不先核对本次影像与既往影像","K":"鼻咽黏膜增厚、肿胀较前明显，报告解释为放化疗后改变，区域淋巴结部分较前缩小，桥脑旁结节稳定。继续规范随访，并结合症状及复查结果复评。","L":"完成本次检查后永久失访，不设置下一次复查节点"}}
+{"sample_id":"sample-e64f11fa26d77374e949c0db","patient_id":"patient-9eee365a9ef54e00d4f99666","episode_id":"episode-8e56bfbb8e670af161db7828","turn_id":"P6_03","turn_number":8,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM：{{TNM_STATUS}}；总分期：{{OVERALL_STAGE}}。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；主诉: 上眼皮红肿1月余。；现病史: 上眼皮红肿1月余。偶有头痛，耳鸣，余无特殊不适。门诊既往史；既往疾病史: 是否有过敏史无过敏史。是否有吸烟史吸烟史详情月经史月经史: 【病理资料1】（鼻咽）镜下见片巢状异型细胞，形态可符合为未分化型非角化性癌，必要时建议切涂胶白片6张加做免疫组化CK、EGFR及原位杂交EBERs以进一步诊断及协助治疗。 既往时点补充报告： 结合本院免疫组化示 CK（+），EGFR（+）；原位杂交EBERs（+），支持诊断为（鼻咽）未分化型非角化性癌。；活检部位: 鼻咽；肿瘤部位: 鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】鼻咽病灶代谢活跃，符合鼻咽癌，病灶侵犯左侧头长肌、疑累及蝶骨基底部。 双颈Ib、II区数个淋巴结代谢较活跃/略活跃，疑炎性病变。 双侧扁桃体炎。 右肺中叶类结节代谢未见异常，考虑增殖灶。 脂肪肝。 子宫内膜区代谢活跃，疑生理性改变。 ；鼻咽病变，考虑鼻咽癌。 颅底骨质未见破坏。 双侧咽后、颈部双侧Ⅰ-Ⅳ区、左侧Ⅴ区淋巴结，性质待定，建议随诊。 双侧腭扁桃体体积增大，考虑炎性病变可能性大。 桥脑左旁见一强化小结节（se1001-6），脑膜瘤？神经鞘瘤？ 【治疗经过1】记录时间: 既往时点；病历特点: 患者A，女，43岁，因\"左侧上眼皮红肿1月余。 \"于既往时点，步行入院。 一、病例特点: 1、患者A，女性，43岁，广东省[地点已隐去]人 2、现病史:缘于1月前患者无明显诱因出现上眼皮红肿，偶有头痛，耳鸣，无头晕，无复视、视力模糊，听力下降，无鼻塞、涕血，无面麻等不适，未予重视，逐渐加重，遂至外院A就诊，既往时点行鼻咽活检病理示：鼻咽未分化型非角化性癌，未行治疗，今为求进一步诊治来本院。 患者发病以来，精神可，饮食睡眠一般，大小便正常，体重无明显变化。 3、肿瘤专科检查:张口门齿距5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结;颅神经检查:阴性。 4、辅助检查:（1）既往时点在本院病理会诊（病理号:[编号已隐藏]）鼻咽活检病理示:未分化型非角化癌 既往时点本院颅脑MRI见“桥脑左旁见一强化小结节（se1001-6），脑膜瘤？神经鞘瘤？” 【治疗反应与不良反应1】既往时点 患者放化疗中电解质紊乱，予以对症处理，建议饮食偏咸些，增强营养，必要时急诊随诊。门诊既往史；既往疾病史: 既往史:是否有过敏史无过敏史。是否有吸烟史吸烟史详情月经史月经史:；客观检验：氯离子(Cl-)-静脉血：97.0mmol/L（低于参考范围，参考约99-110mmol/L） || 钾离子(K+)-静脉血：3.0mmol/L || 钠离子(Na+)-静脉血：136.1mmol/L 【P6-Follow-up 1】鼻咽癌放化疗后复查，对比既往时点 MR： 鼻咽黏膜增厚，呈放化疗后改变。 颅底骨质未见破坏。 双侧咽后、颈部双侧Ⅰ-Ⅳ区、左侧Ⅴ区淋巴结，较前缩小，建议随诊。 双侧腭扁桃体现无明显增大。 桥脑左旁见一强化小结节，脑膜瘤？神经鞘瘤？较前相仿。 【P6-Follow-up 2】鼻咽癌放化疗后复查，对比既往时点 MR： 鼻咽黏膜增厚、肿胀，较前明显，呈放化疗后改变。 颅底骨质未见破坏。 双侧咽后、颈部双侧Ⅰ-Ⅳ区、左侧Ⅴ区淋巴结，部分较前缩小，建议随诊。 鼻窦炎，左侧乳突炎。 桥脑左旁见一强化小结节，脑膜瘤？神经鞘瘤？较前相仿。 【P6-Follow-up 3】鼻咽癌放化疗后复查，对比既往时点 MR： 鼻咽黏膜增厚、肿胀，较前略减轻，呈放化疗后改变。 颅底骨质未见破坏。 双侧咽后、颈部双侧Ⅰ-Ⅳ区、左侧Ⅴ区淋巴结，部分较前缩小，建议随诊。 鼻窦炎，左侧乳突炎。 桥脑左旁见一强化小结节，脑膜瘤？神经鞘瘤？较前相仿。\n\n【当前需要决策的问题】\n该患者治疗前为T2N0cM0（主要MRI阳性结构：鼻咽）。治疗完成后约283天的6_12_months节点返回以下新证据：鼻咽癌放化疗后复查，对比既往时点 MR： 鼻咽黏膜增厚、肿胀，较前略减轻，呈放化疗后改变。 颅底骨质未见破坏。 双侧咽后、颈部双侧Ⅰ-Ⅳ区、左侧Ⅴ区淋巴结，部分较前缩小，建议随诊。 鼻窦炎，左侧乳突炎。 桥脑左旁见一强化小结节，脑膜瘤？神经鞘瘤？较前相仿。与既往治疗和检查相比，当前疗效或疾病状态如何，下一步复查或治疗衔接最合理是什么？\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 不比较既往影像，直接判定完全缓解并终止所有复查\nB. 仅依据单次EBV-DNA判断复发，不结合影像和临床\nC. 把所有治疗后改变均判定为明确进展并立即更换方案\nD. 无论影像趋势如何均继续原方案，取消近期再评估\nE. 只随访鼻咽局部，不评估区域淋巴结和远处病灶\nF. 仅进行症状随访，今后不再安排任何客观检查\nG. 立即进行鼻咽手术，不核对复发部位及既往放疗范围\nH. 将稳定或缩小的病灶按新发转移处理并启动后线治疗\nI. 将明确新发或增大的病灶视为治疗后改变，延后一年复查\nJ. 鼻咽黏膜增厚、肿胀较前略减轻，呈放化疗后改变，区域淋巴结部分较前缩小，桥脑旁结节稳定。继续规范随访，并结合症状及复查结果复评。\nK. 仅重复病理活检，不先核对本次影像与既往影像\nL. 完成本次检查后永久失访，不设置下一次复查节点\n\n请仅输出一个选项字母（A-L）。","gold_letter":"J","gold_action":"鼻咽黏膜增厚、肿胀较前略减轻，呈放化疗后改变，区域淋巴结部分较前缩小，桥脑旁结节稳定。继续规范随访，并结合症状及复查结果复评。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":{"A":"不比较既往影像，直接判定完全缓解并终止所有复查","B":"仅依据单次EBV-DNA判断复发，不结合影像和临床","C":"把所有治疗后改变均判定为明确进展并立即更换方案","D":"无论影像趋势如何均继续原方案，取消近期再评估","E":"只随访鼻咽局部，不评估区域淋巴结和远处病灶","F":"仅进行症状随访，今后不再安排任何客观检查","G":"立即进行鼻咽手术，不核对复发部位及既往放疗范围","H":"将稳定或缩小的病灶按新发转移处理并启动后线治疗","I":"将明确新发或增大的病灶视为治疗后改变，延后一年复查","J":"鼻咽黏膜增厚、肿胀较前略减轻，呈放化疗后改变，区域淋巴结部分较前缩小，桥脑旁结节稳定。继续规范随访，并结合症状及复查结果复评。","K":"仅重复病理活检，不先核对本次影像与既往影像","L":"完成本次检查后永久失访，不设置下一次复查节点"}}
+{"sample_id":"sample-368dd0f6ab32da6cedbf7476","patient_id":"patient-4912d2bc95150726fba7d603","episode_id":"episode-73bafcd2d14697159b5d1b7b","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；一.病例特点: 1、患者31岁 女性。2、现病史:患者诉缘于1年前无明显诱因出现间断性回吸性血涕，无头晕、头痛，无复视、视力模糊，无面麻等不适，当时未治疗。遂为求进一步治疗，遂来本院就诊，现为求进一步治疗入院，患者A，精神可，饮食睡眠一般，大小便正常，体重无明显变化。 3、体格检查: T:36.70℃ P:89次/分 R:20次/分 BP:97 / 70mmHg Ht:165 Cm Wt:54.50 Kg BSA: 1.5922 m2 kps:90 神智清楚，表情自然，发育良好，营养良好。 自主体位，检查合作。 皮肤粘膜正常，无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。 全身浅表淋巴结未及明显肿大。 头颅五官端正，无畸形，眼睑无浮肿，无下垂。巩膜无黄染，结膜无充血，无苍白，眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。 听力正常，鼓膜正常。 鼻无畸形，鼻中隔居中，副鼻窦无压痛、扣痛。 口腔粘膜正常。 齿龈无红肿，扁桃体无肿大。 颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。 胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。 心前区无隆起，未触及震颤。 心率89次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。 腹部平软，未见胃型、肠型、蠕动波，全腹无压痛，反跳痛，未扪及包块。 肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛，移动性浊音阴性，肠鸣音正常。 肛门、外生殖器未查。 脊柱四肢无畸形，肌力、肌张力正常。 生理反射存在，病理反射未引出。 4. 【病理资料1】（鼻咽顶壁肿物）镜检为未分化型非角化性癌。 免疫组化：标本06：CK(AE1/AE3)（+），EGFR（+）。 原位杂交：标本06：EBERs（+）。；活检部位: 顶壁,鼻咽；肿瘤部位: 顶壁,鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 颈部双侧II-III区见数个小淋巴结，性质待定。 副鼻窦炎。；检查部位: 鼻咽部；肿瘤部位: 鼻咽；是否区域复发: 否 ；鼻咽病灶，考虑鼻咽癌；右侧咽后淋巴结代谢略活跃，考虑转移。 双侧颈部Ⅱ区淋巴结代谢略活跃，疑炎性病变。 鼻窦炎。 双肺纤维增殖灶。\n\n【当前需要决策的问题】\n病理已完成，治疗前分期报告现已全部可见：鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 颈部双侧II-III区见数个小淋巴结，性质待定。 副鼻窦炎。；检查部位: 鼻咽部；肿瘤部位: 鼻咽；是否区域复发: 否 ；鼻咽病灶，考虑鼻咽癌；右侧咽后淋巴结代谢略活跃，考虑转移。 双侧颈部Ⅱ区淋巴结代谢略活跃，疑炎性病变。 鼻窦炎。 双肺纤维增殖灶。请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T3 / N3 / cM1\nB. T4 / N2 / cM1\nC. T1 / N0 / cM1\nD. T1 / N2 / cM0\nE. T2 / N1 / cM1\nF. T4 / N3 / cM0\nG. T3 / N1 / cM0\nH. T1 / N1 / cM1\nI. T2 / N1 / cM0\nJ. T1 / N1 / cM0\nK. T2 / N3 / cM0\nL. T1 / N0 / cM0\n\n请仅输出一个选项字母（A-L）。","gold_letter":"G","gold_action":"T3 / N1 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T3 / N3 / cM1","B":"T4 / N2 / cM1","C":"T1 / N0 / cM1","D":"T1 / N2 / cM0","E":"T2 / N1 / cM1","F":"T4 / N3 / cM0","G":"T3 / N1 / cM0","H":"T1 / N1 / cM1","I":"T2 / N1 / cM0","J":"T1 / N1 / cM0","K":"T2 / N3 / cM0","L":"T1 / N0 / cM0"}}
+{"sample_id":"sample-ab2aba14c3bb787e2fee0756","patient_id":"patient-a8747d2f636013b6aaea5e0e","episode_id":"episode-9438c84351019b41c9873d52","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；病历特点: 患者A，男，69岁，因\"脓涕1周余。\"于既往时点，步行入院。一、病例特点： 1、患者A，男性，69岁。2、现病史:患者既往时点初无明显诱因出现双侧脓涕，伴有臭味，无鼻塞、涕血、耳鸣、耳堵塞感、头痛、面麻、复视等不适。患者为进一步治疗就诊本院，门诊以“鼻咽肿物性质待查”收入院。 患者发病以来，精神佳，饮食睡眠佳，大小便正常，体重无减轻。 3、体格检查: 张口门齿距4.5cm；鼻咽双侧顶后壁、后壁、右侧壁结节状肿物，累及右侧后鼻孔，未累及左侧后鼻孔。左侧颈部II区扪及1枚肿大淋巴结，约3×2cm，质硬、边界清、固定，无压痛。颅神经检查（-）。 【影像与分期资料1】鼻咽病变，考虑鼻咽癌可能性大。 颅底骨质破坏。 双侧咽后多个肿大淋巴结，考虑转移。 颈部左侧II区、左侧III区见多个肿大淋巴结，考虑转移。 颈部右侧II、III区及双侧V区多个小淋巴结，性质待定，建议复查。 副鼻窦炎；双侧乳突炎。 ；双肺散在结节影，考虑增殖灶。 双肺小叶中心性肺气肿。 肝脏囊肿。 左侧肾上腺不均匀增粗，考虑增生。；检查部位: 下腹部 ；鼻窦、双上颌骨、右侧下颌骨炎症。 多个颈腰椎及附件退行性变。 双第1肋骨良性病变。；检查部位: 骨\n\n【当前需要决策的问题】\n病理已完成，治疗前分期报告现已全部可见：鼻咽病变，考虑鼻咽癌可能性大。 颅底骨质破坏。 双侧咽后多个肿大淋巴结，考虑转移。 颈部左侧II区、左侧III区见多个肿大淋巴结，考虑转移。 颈部右侧II、III区及双侧V区多个小淋巴结，性质待定，建议复查。 副鼻窦炎；双侧乳突炎。 ；双肺散在结节影，考虑增殖灶。 双肺小叶中心性肺气肿。 肝脏囊肿。 左侧肾上腺不均匀增粗，考虑增生。；检查部位: 下腹部 ；鼻窦、双上颌骨、右侧下颌骨炎症。 多个颈腰椎及附件退行性变。 双第1肋骨良性病变。；检查部位: 骨。请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T1 / N3 / cM1\nB. T2 / N1 / cM1\nC. T2 / N1 / cM0\nD. T3 / N1 / cM0\nE. T4 / N0 / cM1\nF. T4 / N3 / cM1\nG. T2 / N0 / cM0\nH. T3 / N0 / cM0\nI. T1 / N0 / cM1\nJ. T3 / N3 / cM0\nK. T1 / N2 / cM1\nL. T2 / N3 / cM1\n\n请仅输出一个选项字母（A-L）。","gold_letter":"D","gold_action":"T3 / N1 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T1 / N3 / cM1","B":"T2 / N1 / cM1","C":"T2 / N1 / cM0","D":"T3 / N1 / cM0","E":"T4 / N0 / cM1","F":"T4 / N3 / cM1","G":"T2 / N0 / cM0","H":"T3 / N0 / cM0","I":"T1 / N0 / cM1","J":"T3 / N3 / cM0","K":"T1 / N2 / cM1","L":"T2 / N3 / cM1"}}
+{"sample_id":"sample-9485071c200ab8e51ef64392","patient_id":"patient-476cb2a0d6afea80b42088a3","episode_id":"episode-7a0da86bc143e4bb56beefcf","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；病历特点: 患者A，女，58岁，因\"左耳鸣2年余\"于既往时点，步行入院。患者A，精神可，饮食睡眠一般，大小便正常，体重无明显变化。3、肿瘤专科检查:张口门齿距5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查:阴性。 【病理资料1】（鼻咽）镜下：病变考虑为未分化型非角化性癌，建议回原单位切涂胶白片6张（烤干）来我科交费加做免疫组化及原位杂交协助诊断。 既往时点补充报告： （鼻咽）未分化型非角化性癌。 本单位免疫组化结果：CK(AE1/AE3)（+），EGFR（弱+）。 本单位原位杂交结果：EBERs（+）。；活检部位: 鼻咽；肿瘤部位: 鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】颅底骨代谢活跃，考虑鼻咽癌所致。 疑右侧第4-6肋骨折后改变。 右胸锁关节及双侧骶髂关节局部代谢活跃，疑炎性病变/退行性变，请结合临床。 疑多个颈胸腰椎退行性变。；检查部位: 骨 ；左肺下叶外基底段、右肺上叶多发实性结节，考虑增殖灶可能。 左肺上叶上舌段钙化灶。 双肺少许纤维增殖灶。 脾内多发钙化灶。脾内结节，良性可能性大。左肾结石。 脊柱侧弯。右侧第3-7肋骨陈旧性骨折可能。 ；鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 左侧咽后见数个小淋巴结，大者短径3mm(0-5mm)，明显强化。 左侧咽后数个小淋巴结，转移待排。 颈部双侧未见明显肿大淋巴结。 副鼻窦炎；左侧乳突炎。；检查部位: 颈部,鼻咽部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 不确定；是否区域复发: 否 ；脂肪肝、 脾钙化灶。 胆囊、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n\n【当前需要决策的问题】\n病理已完成，治疗前分期报告现已全部可见：颅底骨代谢活跃，考虑鼻咽癌所致。 疑右侧第4-6肋骨折后改变。 右胸锁关节及双侧骶髂关节局部代谢活跃，疑炎性病变/退行性变，请结合临床。 疑多个颈胸腰椎退行性变。；检查部位: 骨 ；左肺下叶外基底段、右肺上叶多发实性结节，考虑增殖灶可能。 左肺上叶上舌段钙化灶。 双肺少许纤维增殖灶。 脾内多发钙化灶。脾内结节，良性可能性大。左肾结石。 脊柱侧弯。右侧第3-7肋骨陈旧性骨折可能。 ；鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 左侧咽后见数个小淋巴结，大者短径3mm(0-5mm)，明显强化。 左侧咽后数个小淋巴结，转移待排。 颈部双侧未见明显肿大淋巴结。 副鼻窦炎；左侧乳突炎。；检查部位: 颈部,鼻咽部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 不确定；是否区域复发: 否 ；脂肪肝、 脾钙化灶。 胆囊、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T1 / N2 / cM1\nB. T1 / N0 / cM0\nC. T3 / N0 / cM0\nD. T1 / N3 / cM1\nE. T3 / N2 / cM1\nF. T4 / N2 / cM0\nG. T2 / N3 / cM0\nH. T3 / N3 / cM0\nI. T1 / N0 / cM1\nJ. T2 / N1 / cM1\nK. T4 / N0 / cM1\nL. T2 / N1 / cM0\n\n请仅输出一个选项字母（A-L）。","gold_letter":"C","gold_action":"T3 / N0 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T1 / N2 / cM1","B":"T1 / N0 / cM0","C":"T3 / N0 / cM0","D":"T1 / N3 / cM1","E":"T3 / N2 / cM1","F":"T4 / N2 / cM0","G":"T2 / N3 / cM0","H":"T3 / N3 / cM0","I":"T1 / N0 / cM1","J":"T2 / N1 / cM1","K":"T4 / N0 / cM1","L":"T2 / N1 / cM0"}}
+{"sample_id":"sample-954cb854d91df27e17413f77","patient_id":"patient-f81cca3c5327e5165d731767","episode_id":"episode-144c2f9333adde8a7cf8758a","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；病历特点: 患者A，女，主因“回吸性涕血3月”于既往时点步行入院。一.病例特点: 1、患者34岁 女性。2、现病史:患者3月前食用“炒粉”后出现回吸性涕血，量不多，近3月间断出现5-6次，偶伴耳鸣，尤以左侧严重，无听力下降，无复视、视力下降，无面麻、张口困难，偶有头痛。 遂至外院A就诊，服用“消炎药”、“中药”后未见明显改善。 既往时点至外院A就诊，查鼻咽镜+活检提示鼻咽癌。 现为进一步治疗入院。 自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重下降2kg。 3、体格检查: T:36.3℃ P:68次/分 R:20次/分 BP:95 / 64mmHg Ht: 158.50cm Wt: 65.20kg BSA: 1.6689m2 KPS:90 发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。 无鼻翼扇动、鼻衄。 牙龈无肿胀、出血。 气管居中，甲状腺不大。 胸骨无压痛。 双肺呼吸音清，未闻及干湿啰音。 心率68bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。 腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。 肛门外生殖器未见异常，生理反射存在，病理反射未引出。 4. 【影像与分期资料1】全身骨骼未见明显异常。；检查部位: 骨；是否骨转移: 否 ；胸、上腹部未见明显占位性病变。；检查部位: 胸部,上腹部 ；鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 左侧咽后肿大淋巴结，考虑转移。 颈部双侧II区淋巴结，转移待排。 双侧腮腺区、颈部双侧III-V区多发淋巴结，性质待定。 副鼻窦炎。 空蝶鞍。\n\n【当前需要决策的问题】\n病理已完成，治疗前分期报告现已全部可见：全身骨骼未见明显异常。；检查部位: 骨；是否骨转移: 否 ；胸、上腹部未见明显占位性病变。；检查部位: 胸部,上腹部 ；鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 左侧咽后肿大淋巴结，考虑转移。 颈部双侧II区淋巴结，转移待排。 双侧腮腺区、颈部双侧III-V区多发淋巴结，性质待定。 副鼻窦炎。 空蝶鞍。请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T1 / N0 / cM0\nB. T1 / N1 / cM0\nC. T2 / N2 / cM0\nD. T4 / N1 / cM1\nE. T3 / N1 / cM1\nF. T4 / N1 / cM0\nG. T2 / N2 / cM1\nH. T3 / N2 / cM1\nI. T3 / N1 / cM0\nJ. T3 / N3 / cM1\nK. T4 / N2 / cM1\nL. T2 / N3 / cM1\n\n请仅输出一个选项字母（A-L）。","gold_letter":"I","gold_action":"T3 / N1 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T1 / N0 / cM0","B":"T1 / N1 / cM0","C":"T2 / N2 / cM0","D":"T4 / N1 / cM1","E":"T3 / N1 / cM1","F":"T4 / N1 / cM0","G":"T2 / N2 / cM1","H":"T3 / N2 / cM1","I":"T3 / N1 / cM0","J":"T3 / N3 / cM1","K":"T4 / N2 / cM1","L":"T2 / N3 / cM1"}}
+{"sample_id":"sample-dc7500fdaa8eb806721b7fc7","patient_id":"patient-641b087096be76a631a78061","episode_id":"episode-ebfee8142953531864f40945","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】入院时间: 既往时点；患者A，精神可，饮食睡眠一般，大小便正常，体重无明显变化。；鼻症状: 无；耳症状: 耳鸣；眼症状: 无；口咽症状: 血痰；头部症状: 头痛；是否有颈部肿物: 是；阳性症状体征: 左耳鸣,太阳穴刺痛,头部刺痛,痰中带血,左颈部无痛性肿物；体重改变性质: 未变 【病理资料1】（鼻咽顶后壁）镜下：形态结合免疫组化结果，符合未分化型非角化性癌。 免疫组化：标本86：CK(AE1/AE3)（+），EGFR（+）。 原位杂交：EBERs（+）。；活检部位: 顶后壁,鼻咽；肿瘤部位: 顶后壁,鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】鼻咽病灶代谢活跃，结合病史，考虑鼻咽癌，累及颅底骨；左颈II区肿大淋巴结代谢活跃，考虑转移。 疑甲状腺左叶结节性肿。 双肺散在纤维增殖灶；疑双肺下叶炎症；纵隔及双肺门多发淋巴结代谢活跃，疑炎性改变，建议随诊。 双侧肾上腺增粗代谢略活跃，考虑良性增生性病变；双肾小结石；左肾囊肿。 多发脊柱退行性变；腰椎侧弯。 ；鼻咽病变，考虑鼻咽癌。 双侧咽后数个小淋巴结，性质待定。 颈部左侧II区、双侧III区数个淋巴结，考虑转移。；检查部位: 颈部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 12.0；区域淋巴结转移部位: 双侧III区淋巴结,左侧II区淋巴结；是否区域复发: 否\n\n【当前需要决策的问题】\n病理已完成，治疗前分期报告现已全部可见：鼻咽病灶代谢活跃，结合病史，考虑鼻咽癌，累及颅底骨；左颈II区肿大淋巴结代谢活跃，考虑转移。 疑甲状腺左叶结节性肿。 双肺散在纤维增殖灶；疑双肺下叶炎症；纵隔及双肺门多发淋巴结代谢活跃，疑炎性改变，建议随诊。 双侧肾上腺增粗代谢略活跃，考虑良性增生性病变；双肾小结石；左肾囊肿。 多发脊柱退行性变；腰椎侧弯。 ；鼻咽病变，考虑鼻咽癌。 双侧咽后数个小淋巴结，性质待定。 颈部左侧II区、双侧III区数个淋巴结，考虑转移。；检查部位: 颈部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 12.0；区域淋巴结转移部位: 双侧III区淋巴结,左侧II区淋巴结；是否区域复发: 否。请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T3 / N2 / cM0\nB. T4 / N3 / cM0\nC. T3 / N3 / cM1\nD. T3 / N0 / cM1\nE. T2 / N0 / cM1\nF. T3 / N1 / cM0\nG. T4 / N2 / cM0\nH. T2 / N3 / cM1\nI. T4 / N1 / cM1\nJ. T2 / N3 / cM0\nK. T1 / N3 / cM1\nL. T1 / N2 / cM1\n\n请仅输出一个选项字母（A-L）。","gold_letter":"F","gold_action":"T3 / N1 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T3 / N2 / cM0","B":"T4 / N3 / cM0","C":"T3 / N3 / cM1","D":"T3 / N0 / cM1","E":"T2 / N0 / cM1","F":"T3 / N1 / cM0","G":"T4 / N2 / cM0","H":"T2 / N3 / cM1","I":"T4 / N1 / cM1","J":"T2 / N3 / cM0","K":"T1 / N3 / cM1","L":"T1 / N2 / cM1"}}
+{"sample_id":"sample-24fcf179fd55c53c88358a4c","patient_id":"patient-5990e6fe34e7e300b080c17a","episode_id":"episode-890a0d227eac6599e59bc35c","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；病历特点: 患者A，男，主因“发现右颈部肿物9月余。”于既往时点步行入院。一.病例特点: 1、患者49岁 男性。现为求进一步诊治来本院。患者A，精神佳，饮食睡眠佳，大小便正常，近期体重无明显下降。3、体格检查: T:36.8℃ P:89次/分 R:18次/分 BP:122/79 mmHg Ht: 171cm Wt: 78.40kg BSA: 1.9071m2 KPS:90 神智清楚，表情自然，发育正常，营养中等。 自主体位，检查合作。 皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。 浅表淋巴结见专科情况。 头颅五官无畸形，眼睑无浮肿，无下垂;巩膜无黄染，结膜无充血、无苍白;眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。 口腔粘膜正常。 齿龈无红肿，扁桃体无肿大。 颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。 胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。 心前区无隆起，未触及震颤。 心率89次/分，心整齐，各瓣膜听诊区未闻及病理性杂音。 腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。 肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛;移动性浊音阴性，肠鸣音正常。 肛律门、外生殖器未查。 脊柱四肢无畸形，肌力、肌张力正常。 生理反射存在，病理神经反射未引出。 4. 【病理资料1】（右侧鼻咽部）（鼻咽）镜下形态符合未分化型非角化性癌，建议到用送检蜡块加行免疫组化及原位杂交检测协助诊断。；活检部位: 右侧鼻咽,鼻咽；肿瘤部位: 右侧鼻咽,鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】鼻咽病灶代谢活跃，考虑鼻咽癌，侵犯右侧腭帆肌群；右侧咽后、右颈II-III区、右颈Va区多发肿大淋巴结代谢活跃，考虑转移；左侧咽后、左颈II区、左颈Va区多发淋巴结代谢较活跃，转移待排。 脂肪肝。 双肺纤维增殖灶。 纵隔及双肺门小淋巴结炎症。 前列腺小钙化灶。 ；鼻咽病变，考虑鼻咽癌。 右侧咽旁间隙受侵。 右侧咽后淋巴结，考虑转移。 颈部右侧II、III、V区淋巴结，考虑转移。 颈部左侧II、III、V区多发淋巴结，性质待定。 副鼻窦炎；右侧乳突炎。\n\n【当前需要决策的问题】\n病理已完成，治疗前分期报告现已全部可见：鼻咽病灶代谢活跃，考虑鼻咽癌，侵犯右侧腭帆肌群；右侧咽后、右颈II-III区、右颈Va区多发肿大淋巴结代谢活跃，考虑转移；左侧咽后、左颈II区、左颈Va区多发淋巴结代谢较活跃，转移待排。 脂肪肝。 双肺纤维增殖灶。 纵隔及双肺门小淋巴结炎症。 前列腺小钙化灶。 ；鼻咽病变，考虑鼻咽癌。 右侧咽旁间隙受侵。 右侧咽后淋巴结，考虑转移。 颈部右侧II、III、V区淋巴结，考虑转移。 颈部左侧II、III、V区多发淋巴结，性质待定。 副鼻窦炎；右侧乳突炎。请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T1 / N1 / cM0\nB. T4 / N2 / cM0\nC. T3 / N1 / cM0\nD. T2 / N2 / cM0\nE. T1 / N3 / cM1\nF. T2 / N1 / cM0\nG. T2 / N2 / cM1\nH. T1 / N3 / cM0\nI. T1 / N2 / cM0\nJ. T3 / N3 / cM1\nK. T1 / N0 / cM0\nL. T4 / N1 / cM0\n\n请仅输出一个选项字母（A-L）。","gold_letter":"F","gold_action":"T2 / N1 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T1 / N1 / cM0","B":"T4 / N2 / cM0","C":"T3 / N1 / cM0","D":"T2 / N2 / cM0","E":"T1 / N3 / cM1","F":"T2 / N1 / cM0","G":"T2 / N2 / cM1","H":"T1 / N3 / cM0","I":"T1 / N2 / cM0","J":"T3 / N3 / cM1","K":"T1 / N0 / cM0","L":"T4 / N1 / cM0"}}
+{"sample_id":"sample-1a7cec18df1c66d68f69d55f","patient_id":"patient-84fa3d6098d10a1d14b6b19e","turn_id":"turn01","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左耳听力下降1年余；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右耳鸣；既往史: 某次就诊时间患“结核性胸膜炎”已治愈，某次就诊时间患“急性胰腺炎”已治愈。否认\"肝炎、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟史30年，1包每天，常饮酒，两天/次，每次500ml。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：120/80mmHg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧壁、顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸腹部CT平扫，常规血液学检查。\nB. 鼻咽及颈部MRI平扫+增强，全身PET/CT，常规血液学检查，直接安排诱导化疗。\nC. 鼻咽镜检查及活检，鼻咽MRI平扫+增强，胸部X线片，腹部超声，全身骨扫描。\nD. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫，全身PET/CT，常规血液学及心电图检查。\nE. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT，常规血液学、心电图与超声检查。\nF. 颈部淋巴结穿刺活检，鼻咽及颈部MRI平扫+增强，全身PET/CT，常规血液学检查。\nG. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，暂缓全身影像学检查待病理结果回报。\nH. 鼻咽镜检查及活检，头颅CT平扫，颈部超声，胸腹部CT平扫+增强，常规血液学检查。\nI. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部CT平扫，腹部超声，暂不进行骨骼检查。\nJ. 鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，全身PET/CT，常规血液学及心电图检查。\nK. 鼻咽镜检查，鼻咽及颈部MRI平扫+增强，全身PET/CT，待影像学评估后再行内镜活检。\nL. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT，同步进行根治性放疗定位。\n\n请仅输出一个选项字母（A-L）。","gold_letter":"E","gold_action":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT，常规血液学、心电图与超声检查。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸腹部CT平扫，常规血液学检查。"},{"letter":"B","text":"鼻咽及颈部MRI平扫+增强，全身PET/CT，常规血液学检查，直接安排诱导化疗。"},{"letter":"C","text":"鼻咽镜检查及活检，鼻咽MRI平扫+增强，胸部X线片，腹部超声，全身骨扫描。"},{"letter":"D","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫，全身PET/CT，常规血液学及心电图检查。"},{"letter":"E","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT，常规血液学、心电图与超声检查。"},{"letter":"F","text":"颈部淋巴结穿刺活检，鼻咽及颈部MRI平扫+增强，全身PET/CT，常规血液学检查。"},{"letter":"G","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，暂缓全身影像学检查待病理结果回报。"},{"letter":"H","text":"鼻咽镜检查及活检，头颅CT平扫，颈部超声，胸腹部CT平扫+增强，常规血液学检查。"},{"letter":"I","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部CT平扫，腹部超声，暂不进行骨骼检查。"},{"letter":"J","text":"鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，全身PET/CT，常规血液学及心电图检查。"},{"letter":"K","text":"鼻咽镜检查，鼻咽及颈部MRI平扫+增强，全身PET/CT，待影像学评估后再行内镜活检。"},{"letter":"L","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT，同步进行根治性放疗定位。"}]}
+{"sample_id":"sample-13d0893c195434e9115bcbbc","patient_id":"patient-84fa3d6098d10a1d14b6b19e","turn_id":"turn02","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左耳听力下降1年余；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右耳鸣；既往史: 某次就诊时间患“结核性胸膜炎”已治愈，某次就诊时间患“急性胰腺炎”已治愈。否认\"肝炎、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟史30年，1包每天，常饮酒，两天/次，每次500ml。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：120/80mmHg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧壁、顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善基线血液学检查，包含血常规、生化常规及凝血功能，暂缓检测EB病毒DNA及骨代谢标志物。\nB. 完善基线血液学检查，包含生化常规、凝血功能及传染病筛查，并安排全身PET-CT替代常规影像学分期。\nC. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能及传染病筛查，暂缓检测骨代谢标志物。\nD. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查，并安排颈部淋巴结穿刺活检明确病理。\nE. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查，并安排头颅增强MRI评估颅内侵犯。\nF. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测。\nG. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并安排全身PET-CT替代所有常规分期检查。\nH. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并安排鼻咽部平扫MRI。\nI. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并安排颈部超声指导淋巴结清扫。\nJ. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并安排鼻咽镜评估治疗疗效。\nK. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并首选胸部X线片排除肺转移。\nL. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并常规安排骨髓穿刺排除骨髓转移。\n\n请仅输出一个选项字母（A-L）。","gold_letter":"F","gold_action":"完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"完善基线血液学检查，包含血常规、生化常规及凝血功能，暂缓检测EB病毒DNA及骨代谢标志物。"},{"letter":"B","text":"完善基线血液学检查，包含生化常规、凝血功能及传染病筛查，并安排全身PET-CT替代常规影像学分期。"},{"letter":"C","text":"完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能及传染病筛查，暂缓检测骨代谢标志物。"},{"letter":"D","text":"完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查，并安排颈部淋巴结穿刺活检明确病理。"},{"letter":"E","text":"完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查，并安排头颅增强MRI评估颅内侵犯。"},{"letter":"F","text":"完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测。"},{"letter":"G","text":"完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并安排全身PET-CT替代所有常规分期检查。"},{"letter":"H","text":"完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并安排鼻咽部平扫MRI。"},{"letter":"I","text":"完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并安排颈部超声指导淋巴结清扫。"},{"letter":"J","text":"完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并安排鼻咽镜评估治疗疗效。"},{"letter":"K","text":"完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并首选胸部X线片排除肺转移。"},{"letter":"L","text":"完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并常规安排骨髓穿刺排除骨髓转移。"}]}
+{"sample_id":"sample-474b60646fc04122e2c1c7ce","patient_id":"patient-84fa3d6098d10a1d14b6b19e","turn_id":"turn04","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D3] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D3] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 38mm AO 26mm MV E 0.79m/s EF 75% LV 50mm IVS 11mm A 0.67m/s FS 45% RA 33mm LVPW 8mm RV 20mm PA 19mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 左房稍大，余各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 左房稍大 各房室腔及大血管未探及异常血流信号 心功能正常\n- [全程D3] 检验组合: 丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D4] CT；胸部CT平扫＋增强: 检查类型: CT；检查名称: 胸部CT平扫＋增强；检查部位:；检查所见: 右中肺及双下肺见数个类结节影，最大者直径约 5 mm，病灶边界清楚而不规则，密度较高而不均匀；气管及支气管分枝通畅，未见明显软组织肿物或受压变窄；双侧肺门及纵隔未见明确肿大淋巴结；双侧胸腔未见积液；胸膜未见增厚；扫描范围内胸椎、胸壁骨未见骨质破坏征象。；检查结论: 双肺类结节影，转移瘤可能性大。\n- [全程D4] 检验组合: 酮体(KET)-尿液: +-（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；尿胆原(URO)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 4/μL；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；白细胞计数(WBC#)-尿液: 26/μL；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；酸碱度(pH)-尿液: 6；总蛋白(TP)-尿液: -（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性（参考: 阴性）；颜色-尿液: Light-Yellow；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；非鳞状上皮细胞计数-尿液: 2/μL；比重(SG)-尿液: 1.032；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.05；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 顺铂单药同期放化疗\nB. 多西他赛+顺铂（TP方案）姑息化疗\nC. 鼻咽及颈部根治性放射治疗\nD. 顺铂+多西他赛（TP方案）同期放化疗\nE. 依托泊苷+顺铂（EP方案）诱导化疗\nF. 顺铂+氟尿嘧啶（PF方案）姑息化疗\nG. 西妥昔单抗联合根治性放疗\nH. 顺铂+氟尿嘧啶（PF方案）诱导化疗\nI. 氟尿嘧啶单药诱导化疗\nJ. 吉西他滨+顺铂（GP方案）姑息化疗\nK. 顺铂单药诱导化疗\nL. 卡瑞利珠单抗联合PF方案姑息化疗\n\n请仅输出一个选项字母（A-L）。","gold_letter":"H","gold_action":"顺铂+氟尿嘧啶（PF方案）诱导化疗","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"顺铂单药同期放化疗"},{"letter":"B","text":"多西他赛+顺铂（TP方案）姑息化疗"},{"letter":"C","text":"鼻咽及颈部根治性放射治疗"},{"letter":"D","text":"顺铂+多西他赛（TP方案）同期放化疗"},{"letter":"E","text":"依托泊苷+顺铂（EP方案）诱导化疗"},{"letter":"F","text":"顺铂+氟尿嘧啶（PF方案）姑息化疗"},{"letter":"G","text":"西妥昔单抗联合根治性放疗"},{"letter":"H","text":"顺铂+氟尿嘧啶（PF方案）诱导化疗"},{"letter":"I","text":"氟尿嘧啶单药诱导化疗"},{"letter":"J","text":"吉西他滨+顺铂（GP方案）姑息化疗"},{"letter":"K","text":"顺铂单药诱导化疗"},{"letter":"L","text":"卡瑞利珠单抗联合PF方案姑息化疗"}]}
+{"sample_id":"sample-654cb1177e5cb9c5732eccb0","patient_id":"patient-84fa3d6098d10a1d14b6b19e","turn_id":"turn05","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: 右臂静脉插管,导管末端位于T 6右旁，估计位于上腔静脉中段。；检查结论: 导管末端位置如上述。\n- [全程D2] 检验组合: 血小板分布宽度(PDW)-静脉血: 13.8%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；淋巴细胞百分比(Lymph%)-静脉血: 0.262；单核细胞计数(Mono#)-静脉血: 0.510E9/L；胱抑素(Cys-C)-静脉血: 1.01mg/L；总蛋白(TP)-静脉血: 68.46g/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.16COI；透明质酸(HA)-静脉血: 61.97ng/ml；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；大血小板百分比(P-LCR%)-静脉血: 32.4%；白蛋白(ALB)-静脉血: 43.7g/L；总胆固醇(TC)-静脉血: 5.59mmol/L；总胆红素(TBIL)-静脉血: 14.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.84；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.009；丙氨酸氨基转移酶(ALT)-静脉血: 27U/L；氯离子(Cl-)-静脉血: 103.1mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；淋巴细胞计数(Lymph#)-静脉血: 2.510E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.63mmol/L；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.06S/CO；血小板比容-静脉血: 21%；载脂蛋白B(apoB)-静脉血: 1.22g/L；C-反应蛋白(CRP)-静脉血: 4.05mg/L；ABO血型-静脉血: A；载脂蛋白AI(apoAI)-静脉血: 1.2g/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；单核细胞百分比(Mono%)-静脉血: 0.049；钠离子(Na+)-静脉血: 139.6mmol/L；凝血酶原时间(PT)-静脉血: 10.3sec.；球蛋白(GLO)-静脉血: 24.76g/L；纤维蛋白原(Fbg)-静脉血: 2.49g/L；凝血酶时间(TT)-静脉血: 20sec.；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44.6；Rh血型-静脉血: 阳性；平均红细胞体积(MCV)-静脉血: 85.8fL；直接胆红素(DBIL)-静脉血: 3.3umol/L；凝血酶原时间活动度(PTA)-静脉血: 113.8%；中性粒细胞百分比(Neut%)-静脉血: 0.677；阴离子间隙(AG)-静脉血: 15；葡萄糖(Glu)-静脉血: 5.27mmol/L；白细胞计数(WBC#)-静脉血: 9.510E9/L；平均血小板体积(MPV)-静脉血: 10.9fL；IV型胶原(C-IV)-静脉血: 29.89ng/ml；平均红细胞血红蛋白含量(MCH)-静脉血: 28.1pg\n- [全程D3] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D3] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 38mm AO 26mm MV E 0.79m/s EF 75% LV 50mm IVS 11mm A 0.67m/s FS 45% RA 33mm LVPW 8mm RV 20mm PA 19mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 左房稍大，余各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 左房稍大 各房室腔及大血管未探及异常血流信号 心功能正常\n- [全程D3] 检验组合: 丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D4] CT；胸部CT平扫＋增强: 检查类型: CT；检查名称: 胸部CT平扫＋增强；检查部位:；检查所见: 右中肺及双下肺见数个类结节影，最大者直径约 5 mm，病灶边界清楚而不规则，密度较高而不均匀；气管及支气管分枝通畅，未见明显软组织肿物或受压变窄；双侧肺门及纵隔未见明确肿大淋巴结；双侧胸腔未见积液；胸膜未见增厚；扫描范围内胸椎、胸壁骨未见骨质破坏征象。；检查结论: 双肺类结节影，转移瘤可能性大。\n- [全程D4] 检验组合: 酮体(KET)-尿液: +-（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；尿胆原(URO)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 4/μL；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；白细胞计数(WBC#)-尿液: 26/μL；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；酸碱度(pH)-尿液: 6；总蛋白(TP)-尿液: -（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性（参考: 阴性）；颜色-尿液: Light-Yellow；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；非鳞状上皮细胞计数-尿液: 2/μL；比重(SG)-尿液: 1.032；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.05；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D5] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: 3+500Leu（参考: 阴性）；白细胞计数(WBC#)-尿液: 18/μL；鳞状上皮细胞计数(SQEP#)-尿液: 5/μL；比重(SG)-尿液: 1.02；总蛋白(TP)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: Turbid；隐血(OB)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；未分类结晶计数(UNCX#)-尿液: 25/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；非鳞状上皮细胞计数-尿液: 5/μL\n- [全程D9] 检验组合: 钾离子(K+)-静脉血: 3.73mmol/L；红细胞比容(Hct)-静脉血: 48.1%；血小板比容-静脉血: 19%；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.94mmolL；尿素氮(BUN)-静脉血: 9.5mmol/L；钠离子(Na+)-静脉血: 137.8mmol/L；血红蛋白(Hb)-静脉血: 159g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.095；总钙(Ca)-静脉血: 1.93mmol/L；血小板分布宽度(PDW)-静脉血: 13.3%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；丙氨酸氨基转移酶(ALT)-静脉血: 94.9U/L；载脂蛋白B(apoB)-静脉血: 1.06g/L；白蛋白(ALB)-静脉血: 40.3g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.46；白细胞计数(WBC#)-静脉血: 14.910E9/L；胱抑素(Cys-C)-静脉血: 1.26mg/L；平均血小板体积(MPV)-静脉血: 10.4fL；中性粒细胞百分比(Neut%)-静脉血: 0.837；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.45mmol/L；血小板计数(PLT#)-静脉血: 17910E9/L；总胆固醇(TC)-静脉血: 5.1mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.4；球蛋白(GLO)-静脉血: 23.17g/L；磷(P)-静脉血: 1.26mmol/L；间接胆红素(IBIL)-静脉血: 13.1umolL；红细胞计数(RBC#)-静脉血: 5.5910E12/L；直接胆红素(DBIL)-静脉血: 5.4umol/L；总胆汁酸(TBA)-静脉血: 0.1umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；单核细胞百分比(Mono%)-静脉血: 0.06；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 42.8U/L；肌酐(Crea)-静脉血: 101.5umol/L；载脂蛋白AI(apoAI)-静脉血: 0.99g/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.4mmol/L；单核细胞计数(Mono#)-静脉血: 0.910E9/L；总胆红素(TBIL)-静脉血: 18.5umol/L；中性粒细胞计数(Neut#)-静脉血: 12.510E9/L；平均红细胞体积(MCV)-静脉血: 86fL；天门冬氨酸氨基转移酶(AST)-静脉血: 43.3U/L；甘油三酯(TG)-静脉血: 2.29mmol/L；乳酸脱氢酶(LDH)-静脉血: 191.9U/L；尿酸(UA)-静脉血: 489.4umol/L\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者无诉特殊不适，完善各项检查中，体查同入院时，上级医师查房指示，待各项检查完成明确分期后，再决定下一步治疗。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D8] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。上级医师信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停化疗，静脉滴注还原型谷胱甘肽进行保肝治疗，待肝功能恢复正常后重启化疗。\nB. 暂停化疗，静脉滴注头孢类抗生素进行经验性抗感染治疗，待白细胞计数恢复正常后重启化疗。\nC. 继续化疗，皮下注射重组人粒细胞集落刺激因子预防中性粒细胞缺乏。\nD. 终止诱导化疗，提前进入根治性放疗阶段，并静脉滴注保肝药物。\nE. 继续化疗，静脉滴注异甘草酸镁注射液进行保肝治疗，并每日复查肝功能。\nF. 暂停化疗，行腹部CT增强扫描以排除肝脏转移或化疗引起的急性肝损伤。\nG. 继续化疗，停用所有止吐及护胃药物以减轻肝脏代谢负担。\nH. 暂停化疗，静脉推注地塞米松及异丙嗪进行抗过敏治疗。\nI. 继续化疗及对症支持治疗，执行动静脉置管常规护理，并常规监测血常规与生化指标。\nJ. 继续化疗，拔除动静脉置管以预防导管相关性血流感染，改用外周静脉穿刺。\nK. 暂停化疗，静脉滴注氯化钾进行补钾治疗，待血钾明显上升后继续化疗。\nL. 继续化疗，静脉推注呋塞米促进顺铂排泄，预防急性肾功能损伤。\n\n请仅输出一个选项字母（A-L）。","gold_letter":"I","gold_action":"继续化疗及对症支持治疗，执行动静脉置管常规护理，并常规监测血常规与生化指标。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"暂停化疗，静脉滴注还原型谷胱甘肽进行保肝治疗，待肝功能恢复正常后重启化疗。"},{"letter":"B","text":"暂停化疗，静脉滴注头孢类抗生素进行经验性抗感染治疗，待白细胞计数恢复正常后重启化疗。"},{"letter":"C","text":"继续化疗，皮下注射重组人粒细胞集落刺激因子预防中性粒细胞缺乏。"},{"letter":"D","text":"终止诱导化疗，提前进入根治性放疗阶段，并静脉滴注保肝药物。"},{"letter":"E","text":"继续化疗，静脉滴注异甘草酸镁注射液进行保肝治疗，并每日复查肝功能。"},{"letter":"F","text":"暂停化疗，行腹部CT增强扫描以排除肝脏转移或化疗引起的急性肝损伤。"},{"letter":"G","text":"继续化疗，停用所有止吐及护胃药物以减轻肝脏代谢负担。"},{"letter":"H","text":"暂停化疗，静脉推注地塞米松及异丙嗪进行抗过敏治疗。"},{"letter":"I","text":"继续化疗及对症支持治疗，执行动静脉置管常规护理，并常规监测血常规与生化指标。"},{"letter":"J","text":"继续化疗，拔除动静脉置管以预防导管相关性血流感染，改用外周静脉穿刺。"},{"letter":"K","text":"暂停化疗，静脉滴注氯化钾进行补钾治疗，待血钾明显上升后继续化疗。"},{"letter":"L","text":"继续化疗，静脉推注呋塞米促进顺铂排泄，预防急性肾功能损伤。"}]}
+{"sample_id":"sample-237ee315803b648b5eb4c67f","patient_id":"patient-84fa3d6098d10a1d14b6b19e","turn_id":"turn07","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 检验组合: 血小板分布宽度(PDW)-静脉血: 13.8%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；淋巴细胞百分比(Lymph%)-静脉血: 0.262；单核细胞计数(Mono#)-静脉血: 0.510E9/L；胱抑素(Cys-C)-静脉血: 1.01mg/L；总蛋白(TP)-静脉血: 68.46g/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.16COI；透明质酸(HA)-静脉血: 61.97ng/ml；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；大血小板百分比(P-LCR%)-静脉血: 32.4%；白蛋白(ALB)-静脉血: 43.7g/L；总胆固醇(TC)-静脉血: 5.59mmol/L；总胆红素(TBIL)-静脉血: 14.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.84；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.009；丙氨酸氨基转移酶(ALT)-静脉血: 27U/L；氯离子(Cl-)-静脉血: 103.1mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；淋巴细胞计数(Lymph#)-静脉血: 2.510E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.63mmol/L；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.06S/CO；血小板比容-静脉血: 21%；载脂蛋白B(apoB)-静脉血: 1.22g/L；C-反应蛋白(CRP)-静脉血: 4.05mg/L；ABO血型-静脉血: A；载脂蛋白AI(apoAI)-静脉血: 1.2g/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；单核细胞百分比(Mono%)-静脉血: 0.049；钠离子(Na+)-静脉血: 139.6mmol/L；凝血酶原时间(PT)-静脉血: 10.3sec.；球蛋白(GLO)-静脉血: 24.76g/L；纤维蛋白原(Fbg)-静脉血: 2.49g/L；凝血酶时间(TT)-静脉血: 20sec.；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44.6；Rh血型-静脉血: 阳性；平均红细胞体积(MCV)-静脉血: 85.8fL；直接胆红素(DBIL)-静脉血: 3.3umol/L；凝血酶原时间活动度(PTA)-静脉血: 113.8%；中性粒细胞百分比(Neut%)-静脉血: 0.677；阴离子间隙(AG)-静脉血: 15；葡萄糖(Glu)-静脉血: 5.27mmol/L；白细胞计数(WBC#)-静脉血: 9.510E9/L；平均血小板体积(MPV)-静脉血: 10.9fL；IV型胶原(C-IV)-静脉血: 29.89ng/ml；平均红细胞血红蛋白含量(MCH)-静脉血: 28.1pg\n- [全程D3] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D3] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 38mm AO 26mm MV E 0.79m/s EF 75% LV 50mm IVS 11mm A 0.67m/s FS 45% RA 33mm LVPW 8mm RV 20mm PA 19mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 左房稍大，余各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 左房稍大 各房室腔及大血管未探及异常血流信号 心功能正常\n- [全程D3] 检验组合: 丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D4] CT；胸部CT平扫＋增强: 检查类型: CT；检查名称: 胸部CT平扫＋增强；检查部位:；检查所见: 右中肺及双下肺见数个类结节影，最大者直径约 5 mm，病灶边界清楚而不规则，密度较高而不均匀；气管及支气管分枝通畅，未见明显软组织肿物或受压变窄；双侧肺门及纵隔未见明确肿大淋巴结；双侧胸腔未见积液；胸膜未见增厚；扫描范围内胸椎、胸壁骨未见骨质破坏征象。；检查结论: 双肺类结节影，转移瘤可能性大。\n- [全程D4] 检验组合: 酮体(KET)-尿液: +-（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；尿胆原(URO)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 4/μL；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；白细胞计数(WBC#)-尿液: 26/μL；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；酸碱度(pH)-尿液: 6；总蛋白(TP)-尿液: -（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性（参考: 阴性）；颜色-尿液: Light-Yellow；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；非鳞状上皮细胞计数-尿液: 2/μL；比重(SG)-尿液: 1.032；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.05；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D5] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: 3+500Leu（参考: 阴性）；白细胞计数(WBC#)-尿液: 18/μL；鳞状上皮细胞计数(SQEP#)-尿液: 5/μL；比重(SG)-尿液: 1.02；总蛋白(TP)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: Turbid；隐血(OB)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；未分类结晶计数(UNCX#)-尿液: 25/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；非鳞状上皮细胞计数-尿液: 5/μL\n- [全程D9] 检验组合: 钾离子(K+)-静脉血: 3.73mmol/L；红细胞比容(Hct)-静脉血: 48.1%；血小板比容-静脉血: 19%；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.94mmolL；尿素氮(BUN)-静脉血: 9.5mmol/L；钠离子(Na+)-静脉血: 137.8mmol/L；血红蛋白(Hb)-静脉血: 159g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.095；总钙(Ca)-静脉血: 1.93mmol/L；血小板分布宽度(PDW)-静脉血: 13.3%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；丙氨酸氨基转移酶(ALT)-静脉血: 94.9U/L；载脂蛋白B(apoB)-静脉血: 1.06g/L；白蛋白(ALB)-静脉血: 40.3g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.46；白细胞计数(WBC#)-静脉血: 14.910E9/L；胱抑素(Cys-C)-静脉血: 1.26mg/L；平均血小板体积(MPV)-静脉血: 10.4fL；中性粒细胞百分比(Neut%)-静脉血: 0.837；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.45mmol/L；血小板计数(PLT#)-静脉血: 17910E9/L；总胆固醇(TC)-静脉血: 5.1mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.4；球蛋白(GLO)-静脉血: 23.17g/L；磷(P)-静脉血: 1.26mmol/L；间接胆红素(IBIL)-静脉血: 13.1umolL；红细胞计数(RBC#)-静脉血: 5.5910E12/L；直接胆红素(DBIL)-静脉血: 5.4umol/L；总胆汁酸(TBA)-静脉血: 0.1umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；单核细胞百分比(Mono%)-静脉血: 0.06；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 42.8U/L；肌酐(Crea)-静脉血: 101.5umol/L；载脂蛋白AI(apoAI)-静脉血: 0.99g/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.4mmol/L；单核细胞计数(Mono#)-静脉血: 0.910E9/L；总胆红素(TBIL)-静脉血: 18.5umol/L；中性粒细胞计数(Neut#)-静脉血: 12.510E9/L；平均红细胞体积(MCV)-静脉血: 86fL；天门冬氨酸氨基转移酶(AST)-静脉血: 43.3U/L；甘油三酯(TG)-静脉血: 2.29mmol/L；乳酸脱氢酶(LDH)-静脉血: 191.9U/L；尿酸(UA)-静脉血: 489.4umol/L\n- [全程D16] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及双侧壁增厚放射性浓聚，SUV约11.9，双侧咽隐窝消失；病灶侵犯双侧腭帆提肌、左侧腭帆张肌、左翼内肌，左咽旁间隙及左咽后间隙消失；病灶向上侵犯蝶骨基底部、左翼突区、左蝶骨大翼、左卵圆孔及左海绵窦；向前侵犯左翼腭窝、左上颌后脂肪间隙、左眶尖及左眶内后份，左框内病灶与视神经分界不清。右咽后小淋巴结放射性分布未见明显异常。双侧扁桃体放射性浓聚，SUV约9.4；喉咽结构及放射性分布未见明显异常。双侧上颌窦低密度影放射性分布未见异常；额窦、蝶窦、筛窦结构及放射性分布未见明显异常。甲状腺双叶密度减低，放射性分布未见异常。双颈多个小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺散在多发结节影放射性分布未见明显异常，最大约0.6×0.8cm；左上肺舌段条索影放射性分布未见异常；气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。心脏及纵隔大血管未见明显异常。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏弥漫性密度减低，CT值约36Hu（脾脏CT值约51Hu），放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾门区结节影放射性分布未见异常，大小约1.1×1.4cm（副脾）；脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 双侧乳突气房内低密度影放射性分布未见异常；余颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌病灶，侵犯左咽后及左咽旁间隙、颅底骨骼、左卵圆孔、左海绵窦、左翼腭窝、左上颌后脂肪间隙、左眶尖及左眶内后份，累及左视神经。 双肺多发小结节影代谢未见异常，疑增殖灶。 双侧上颌窦炎症；双侧乳突炎症。 双侧扁桃体代谢活跃，考虑炎性病变。 脂肪肝。\n\n【既往治疗与反应】\n- [全程D2] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者无诉特殊不适，完善各项检查中，体查同入院时，上级医师查房指示，待各项检查完成明确分期后，再决定下一步治疗。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D8] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。上级医师信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D10] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗结束，诉呕吐2次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。上级医师信息已隐藏：患者第1程5-FU+顺铂方案诱导化疗结束，无诉特殊不适，可予请假至全程D25，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n- [全程D15] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者请假至.吕星\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估PET/CT双侧扁桃体代谢活跃为淋巴结转移，双肺结节无代谢活性；调整为GP方案（吉西他滨+顺铂）行第2程诱导化疗，并加强静脉导管护理。\nB. 评估PET/CT证实双肺结节无代谢活性（排除M1）；已完成1程诱导化疗，直接进入根治性放疗阶段，并辅以同期顺铂化疗，定期复查生化常规。\nC. 评估PET/CT见双肺多发结节伴鼻咽病灶广泛侵犯，考虑为IVB期（M1）；调整为姑息性化疗，采用TP方案联合PD-1抑制剂，并维持静脉通路。\nD. 评估PET/CT证实双肺结节无代谢活性；病灶侵犯视神经及海绵窦，第2程诱导化疗需升级为TPF方案（多西他赛+顺铂+5-FU），并复查生化。\nE. 评估PET/CT证实双肺结节无代谢活性；拔除原有静脉置管以防血栓，复查生化常规后，继续行第2程PF方案（5-FU+顺铂）诱导化疗。\nF. 评估PET/CT证实双肺结节无代谢活性；局部病灶侵犯广泛，暂停化疗，优先行局部病灶减瘤术以解除视神经压迫，术后继续PF方案化疗。\nG. 评估PET/CT证实双肺结节无代谢活性；为加强局部控制，第2程诱导化疗在PF方案基础上加用西妥昔单抗靶向治疗，并常规维护静脉导管。\nH. 评估PET/CT证实双肺结节无代谢活性；第1程化疗后出现胃肠道反应，第2程化疗将顺铂替换为卡铂，行5-FU+卡铂方案，复查生化常规。\nI. 评估PET/CT证实双肺结节无代谢活性；行静脉置管护理，复查生化常规后，提前终止诱导化疗，开始单纯根治性放疗，密切监测不良反应。\nJ. 评估PET/CT证实双肺结节无代谢活性，鼻咽病灶SUV值偏高说明原方案疗效欠佳；换用吉西他滨+顺铂方案行第2程诱导化疗，并复查生化。\nK. 评估PET/CT证实双肺结节无代谢活性（排除M1），维持局部晚期诊断；行静脉置管护理与通畅性维护，复查生化常规后，继续行第2程PF方案诱导化疗。\nL. 评估PET/CT证实双肺结节无代谢活性；病灶累及颅底及海绵窦，行第2程PF方案诱导化疗的同时，加用局部姑息性放疗，并维护静脉导管。\n\n请仅输出一个选项字母（A-L）。","gold_letter":"K","gold_action":"评估PET/CT证实双肺结节无代谢活性（排除M1），维持局部晚期诊断；行静脉置管护理与通畅性维护，复查生化常规后，继续行第2程PF方案诱导化疗。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"评估PET/CT双侧扁桃体代谢活跃为淋巴结转移，双肺结节无代谢活性；调整为GP方案（吉西他滨+顺铂）行第2程诱导化疗，并加强静脉导管护理。"},{"letter":"B","text":"评估PET/CT证实双肺结节无代谢活性（排除M1）；已完成1程诱导化疗，直接进入根治性放疗阶段，并辅以同期顺铂化疗，定期复查生化常规。"},{"letter":"C","text":"评估PET/CT见双肺多发结节伴鼻咽病灶广泛侵犯，考虑为IVB期（M1）；调整为姑息性化疗，采用TP方案联合PD-1抑制剂，并维持静脉通路。"},{"letter":"D","text":"评估PET/CT证实双肺结节无代谢活性；病灶侵犯视神经及海绵窦，第2程诱导化疗需升级为TPF方案（多西他赛+顺铂+5-FU），并复查生化。"},{"letter":"E","text":"评估PET/CT证实双肺结节无代谢活性；拔除原有静脉置管以防血栓，复查生化常规后，继续行第2程PF方案（5-FU+顺铂）诱导化疗。"},{"letter":"F","text":"评估PET/CT证实双肺结节无代谢活性；局部病灶侵犯广泛，暂停化疗，优先行局部病灶减瘤术以解除视神经压迫，术后继续PF方案化疗。"},{"letter":"G","text":"评估PET/CT证实双肺结节无代谢活性；为加强局部控制，第2程诱导化疗在PF方案基础上加用西妥昔单抗靶向治疗，并常规维护静脉导管。"},{"letter":"H","text":"评估PET/CT证实双肺结节无代谢活性；第1程化疗后出现胃肠道反应，第2程化疗将顺铂替换为卡铂，行5-FU+卡铂方案，复查生化常规。"},{"letter":"I","text":"评估PET/CT证实双肺结节无代谢活性；行静脉置管护理，复查生化常规后，提前终止诱导化疗，开始单纯根治性放疗，密切监测不良反应。"},{"letter":"J","text":"评估PET/CT证实双肺结节无代谢活性，鼻咽病灶SUV值偏高说明原方案疗效欠佳；换用吉西他滨+顺铂方案行第2程诱导化疗，并复查生化。"},{"letter":"K","text":"评估PET/CT证实双肺结节无代谢活性（排除M1），维持局部晚期诊断；行静脉置管护理与通畅性维护，复查生化常规后，继续行第2程PF方案诱导化疗。"},{"letter":"L","text":"评估PET/CT证实双肺结节无代谢活性；病灶累及颅底及海绵窦，行第2程PF方案诱导化疗的同时，加用局部姑息性放疗，并维护静脉导管。"}]}
+{"sample_id":"sample-eb32294d1506d6b48368496f","patient_id":"patient-34616c327ce5d69194ca7f4d","turn_id":"turn01","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D3189] 门急诊记录: 主诉: 鼻咽癌治疗后8年；患者家属自述行放疗（具体方案不详）。患者家属来诊，诉近来头后部疼痛，持续二月余，逐渐加重，无其他明显，来诊咨询诊疗意见。；既往史: 是否有过敏史无过敏史。是否有吸烟史吸烟史详情；个人史:；家族史:；体格检查:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善鼻咽镜检查及活检，检测EBV DNA定量、常规血液学指标，并进行胸部DR与腹盆腔彩超检查\nB. 完善鼻咽镜检查及活检，检测EBV DNA定量，并进行全身PET-CT检查，暂缓常规血液学指标检测\nC. 完善鼻咽镜检查及活检，检测EBV DNA定量，并进行胸腹部增强CT检查，暂缓常规血液学指标检测\nD. 行头颈部MRI及颅底薄层CT检查，待影像学显示异常后再行鼻咽镜活检及EBV DNA检测\nE. 检测EBV DNA定量及常规血液学指标，待EBV DNA结果阳性后再行鼻咽镜活检及影像学检查\nF. 完善鼻咽镜检查及活检，检测常规血液学指标，并进行胸部DR与腹盆腔彩超检查，暂不检测EBV DNA\nG. 完善鼻咽镜检查（暂不活检），检测EBV DNA定量、常规血液学指标，并进行胸部DR与腹盆腔彩超检查\nH. 行全身骨扫描及头颅增强MRI检查，暂缓鼻咽镜活检及EBV DNA定量检测\nI. 完善鼻咽镜检查及活检，检测EBV DNA定量，并进行全身骨扫描，暂缓胸部及腹盆腔影像学检查\nJ. 完善鼻咽镜检查及活检，检测EBV DNA定量、常规血液学指标，仅行胸部CT检查，暂不进行腹盆腔影像学评估\nK. 行常规血液学指标检测及基础影像学检查（胸部DR、腹盆腔彩超），暂缓鼻咽镜活检及EBV DNA检测\nL. 完善鼻咽镜检查及活检，检测常规血液学指标，行头颈部PET-CT检查，暂不检测EBV DNA定量\n\n请仅输出一个选项字母（A-L）。","gold_letter":"A","gold_action":"完善鼻咽镜检查及活检，检测EBV DNA定量、常规血液学指标，并进行胸部DR与腹盆腔彩超检查","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"完善鼻咽镜检查及活检，检测EBV DNA定量、常规血液学指标，并进行胸部DR与腹盆腔彩超检查"},{"letter":"B","text":"完善鼻咽镜检查及活检，检测EBV DNA定量，并进行全身PET-CT检查，暂缓常规血液学指标检测"},{"letter":"C","text":"完善鼻咽镜检查及活检，检测EBV DNA定量，并进行胸腹部增强CT检查，暂缓常规血液学指标检测"},{"letter":"D","text":"行头颈部MRI及颅底薄层CT检查，待影像学显示异常后再行鼻咽镜活检及EBV DNA检测"},{"letter":"E","text":"检测EBV DNA定量及常规血液学指标，待EBV DNA结果阳性后再行鼻咽镜活检及影像学检查"},{"letter":"F","text":"完善鼻咽镜检查及活检，检测常规血液学指标，并进行胸部DR与腹盆腔彩超检查，暂不检测EBV DNA"},{"letter":"G","text":"完善鼻咽镜检查（暂不活检），检测EBV DNA定量、常规血液学指标，并进行胸部DR与腹盆腔彩超检查"},{"letter":"H","text":"行全身骨扫描及头颅增强MRI检查，暂缓鼻咽镜活检及EBV DNA定量检测"},{"letter":"I","text":"完善鼻咽镜检查及活检，检测EBV DNA定量，并进行全身骨扫描，暂缓胸部及腹盆腔影像学检查"},{"letter":"J","text":"完善鼻咽镜检查及活检，检测EBV DNA定量、常规血液学指标，仅行胸部CT检查，暂不进行腹盆腔影像学评估"},{"letter":"K","text":"行常规血液学指标检测及基础影像学检查（胸部DR、腹盆腔彩超），暂缓鼻咽镜活检及EBV DNA检测"},{"letter":"L","text":"完善鼻咽镜检查及活检，检测常规血液学指标，行头颈部PET-CT检查，暂不检测EBV DNA定量"}]}
+{"sample_id":"sample-f19200235c8a99467249ed0c","patient_id":"patient-34616c327ce5d69194ca7f4d","turn_id":"turn02","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- 暂无可展示的初诊主诉/入院资料。\n\n【已完成检查与客观结果】\n- [全程D0] 检验组合: 嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；凝血酶原时间活动度(PTA)-静脉血: 89%；平均血小板体积(MPV)-静脉血: 9.4fL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 334g/L；D-二聚体(D-Dimer)-静脉血: 0.29ug/ml；凝血酶原国际标准化比值(PT-INR)-静脉血: 1.02；纤维蛋白原(Fbg)-静脉血: 3.21g/L；红细胞比容(Hct)-静脉血: 48.2%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；平均红细胞血红蛋白含量(MCH)-静脉血: 32pg；红细胞计数(RBC#)-静脉血: 5.0310E12/L；淋巴细胞百分比(Lymph%)-静脉血: 0.271；中性粒细胞计数(Neut#)-静脉血: 5.910E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.65；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.8；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；大血小板百分比(P-LCR%)-静脉血: 20.8%；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；血小板比容-静脉血: 27%；平均红细胞体积(MCV)-静脉血: 95.8fL；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.06S/CO；血小板分布宽度(PDW)-静脉血: 10.8%；单核细胞计数(Mono#)-静脉血: 0.510E9/L；活化部分凝血活酶时间(APTT)-静脉血: 29.2sec.；凝血酶原时间(PT)-静脉血: 11.4sec.；纤维蛋白原降解产物(FDP)-静脉血: 2.8ug/ml；淋巴细胞计数(Lymph#)-静脉血: 2.510E9/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.01IU/mL；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.13COI；凝血酶时间(TT)-静脉血: 20sec.；血小板计数(PLT#)-静脉血: 28910E9/L；Rh血型-静脉血: 阳性；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.06S/CO；血红蛋白(Hb)-静脉血: 161g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；白细胞计数(WBC#)-静脉血: 9.210E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.5；单核细胞百分比(Mono%)-静脉血: 0.057；ABO血型-静脉血: A；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003\n- [全程D14] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 左前分支阻滞\n- [全程D14] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理稍增粗，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见重要病变。\n- [全程D15] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 右侧乳突可见片状放射性浓集灶。胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 右侧乳突炎症。 余全身骨骼未见明显异常。\n- [全程D16] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，肝S7可见一强回声斑，直径约5mm，后方伴声影。血管走行清晰、自然，肝内胆管不扩张，门静脉内径14mm。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约21cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约36×26×23mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝S7强回声斑，考虑肝内胆管结石。 胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估影像分期为 cT3N1M0（AJCC 第9版 II期），直接安排诱导化疗联合同期放化疗，并补充生化常规检查\nB. 评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nC. 评估影像分期为 cT4N1M0（AJCC 第9版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nD. 评估影像分期为 cT3N2M0（AJCC 第9版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nE. 评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽镜及活检以获取病理确诊，并补充全身PET-CT检查\nF. 评估影像分期为 cT2N1M0（AJCC 第9版 I期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nG. 评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽镜及活检以获取病理确诊，并补充头颅增强MRI检查\nH. 评估影像分期为 cT3N1M1（AJCC 第9版 IVB期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nI. 评估影像分期为 cT3N1M0（AJCC 第8版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nJ. 评估影像分期为 cT4N2M0（AJCC 第9版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nK. 评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽肿物切除活检以获取病理确诊，并补充生化常规检查\nL. 评估影像分期为 cT3N1M0（AJCC 第9版 II期），行右颈部淋巴结穿刺活检以获取病理确诊，并补充生化常规检查\n\n请仅输出一个选项字母（A-L）。","gold_letter":"B","gold_action":"评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"评估影像分期为 cT3N1M0（AJCC 第9版 II期），直接安排诱导化疗联合同期放化疗，并补充生化常规检查"},{"letter":"B","text":"评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查"},{"letter":"C","text":"评估影像分期为 cT4N1M0（AJCC 第9版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查"},{"letter":"D","text":"评估影像分期为 cT3N2M0（AJCC 第9版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查"},{"letter":"E","text":"评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽镜及活检以获取病理确诊，并补充全身PET-CT检查"},{"letter":"F","text":"评估影像分期为 cT2N1M0（AJCC 第9版 I期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查"},{"letter":"G","text":"评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽镜及活检以获取病理确诊，并补充头颅增强MRI检查"},{"letter":"H","text":"评估影像分期为 cT3N1M1（AJCC 第9版 IVB期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查"},{"letter":"I","text":"评估影像分期为 cT3N1M0（AJCC 第8版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查"},{"letter":"J","text":"评估影像分期为 cT4N2M0（AJCC 第9版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查"},{"letter":"K","text":"评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽肿物切除活检以获取病理确诊，并补充生化常规检查"},{"letter":"L","text":"评估影像分期为 cT3N1M0（AJCC 第9版 II期），行右颈部淋巴结穿刺活检以获取病理确诊，并补充生化常规检查"}]}
+{"sample_id":"sample-2288420a623ad83bf0b0a558","patient_id":"patient-34616c327ce5d69194ca7f4d","turn_id":"turn04","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- 暂无可展示的初诊主诉/入院资料。\n\n【已完成检查与客观结果】\n- [全程D0] 检验组合: 嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；凝血酶原时间活动度(PTA)-静脉血: 89%；平均血小板体积(MPV)-静脉血: 9.4fL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 334g/L；D-二聚体(D-Dimer)-静脉血: 0.29ug/ml；凝血酶原国际标准化比值(PT-INR)-静脉血: 1.02；纤维蛋白原(Fbg)-静脉血: 3.21g/L；红细胞比容(Hct)-静脉血: 48.2%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；平均红细胞血红蛋白含量(MCH)-静脉血: 32pg；红细胞计数(RBC#)-静脉血: 5.0310E12/L；淋巴细胞百分比(Lymph%)-静脉血: 0.271；中性粒细胞计数(Neut#)-静脉血: 5.910E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.65；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.8；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；大血小板百分比(P-LCR%)-静脉血: 20.8%；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；血小板比容-静脉血: 27%；平均红细胞体积(MCV)-静脉血: 95.8fL；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.06S/CO；血小板分布宽度(PDW)-静脉血: 10.8%；单核细胞计数(Mono#)-静脉血: 0.510E9/L；活化部分凝血活酶时间(APTT)-静脉血: 29.2sec.；凝血酶原时间(PT)-静脉血: 11.4sec.；纤维蛋白原降解产物(FDP)-静脉血: 2.8ug/ml；淋巴细胞计数(Lymph#)-静脉血: 2.510E9/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.01IU/mL；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.13COI；凝血酶时间(TT)-静脉血: 20sec.；血小板计数(PLT#)-静脉血: 28910E9/L；Rh血型-静脉血: 阳性；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.06S/CO；血红蛋白(Hb)-静脉血: 161g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；白细胞计数(WBC#)-静脉血: 9.210E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.5；单核细胞百分比(Mono%)-静脉血: 0.057；ABO血型-静脉血: A；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D14] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 左前分支阻滞\n- [全程D14] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理稍增粗，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见重要病变。\n- [全程D15] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 右侧乳突可见片状放射性浓集灶。胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 右侧乳突炎症。 余全身骨骼未见明显异常。\n- [全程D16] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，肝S7可见一强回声斑，直径约5mm，后方伴声影。血管走行清晰、自然，肝内胆管不扩张，门静脉内径14mm。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约21cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约36×26×23mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝S7强回声斑，考虑肝内胆管结石。 胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D22] 检验组合: 钾离子(K+)-静脉血: 4.18mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 46.8U/L；氯离子(Cl-)-静脉血: 101.7mmol/L；直接胆红素(DBIL)-静脉血: 2.5umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；乳酸脱氢酶(LDH)-静脉血: 172.2U/L；尿酸(UA)-静脉血: 299umol/L；碱性磷酸酶(ALP)-静脉血: 35.4U/L；载脂蛋白B(apoB)-静脉血: 0.71g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.09mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.82；γ-谷氨酰基转移酶(GGT)-静脉血: 23.1U/L；总钙(Ca)-静脉血: 2.31mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.1U/L；间接胆红素(IBIL)-静脉血: 4.8umolL；血液二氧化碳含量ctCO2(B)-静脉血: 22.5mmol/L；总蛋白(TP)-静脉血: 76.15g/L；阴离子间隙(AG)-静脉血: 16.8；总胆固醇(TC)-静脉血: 4.05mmol/L；总胆汁酸(TBA)-静脉血: 3.1umol/L；总胆红素(TBIL)-静脉血: 7.3umol/L；肌酐(Crea)-静脉血: 58.1umol/L；载脂蛋白AI(apoAI)-静脉血: 1.48g/L；球蛋白(GLO)-静脉血: 30.25g/L；C-反应蛋白(CRP)-静脉血: 3.66mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.33mmolL；镁离子(Mg2+)-静脉血: 0.86mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.3U/L；胱抑素(Cys-C)-静脉血: 0.88mg/L；尿素氮(BUN)-静脉血: 3.4mmol/L；葡萄糖(Glu)-静脉血: 5.59mmol/L；甘油三酯(TG)-静脉血: 2.5mmol/L；磷(P)-静脉血: 1.15mmol/L；白蛋白(ALB)-静脉血: 45.9g/L；钠离子(Na+)-静脉血: 141mmol/L\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 单纯根治性调强放射治疗\nB. 含铂双药方案诱导化疗序贯单纯根治性放疗\nC. 根治性放疗联合含铂方案同步化疗，序贯含铂双药辅助化疗\nD. 含铂方案诱导化疗序贯根治性放化疗，或根治性放疗联合含铂方案同步化疗\nE. 根治性放疗联合西妥昔单抗等EGFR靶向治疗\nF. 根治性放疗联合PD-1抑制剂同步免疫治疗\nG. 姑息性全身化疗联合局部病灶姑息性放疗\nH. 含铂双药方案诱导化疗序贯鼻咽原发灶切除及颈部淋巴结清扫术\nI. 根治性放疗联合大分子抗血管生成靶向治疗\nJ. 单纯含铂双药方案全身化疗4-6个周期\nK. 鼻咽原发灶切除及颈部淋巴结清扫术序贯术后辅助放化疗\nL. 含铂双药方案诱导化疗序贯根治性放疗及PD-1抑制剂维持治疗\n\n请仅输出一个选项字母（A-L）。","gold_letter":"D","gold_action":"含铂方案诱导化疗序贯根治性放化疗，或根治性放疗联合含铂方案同步化疗","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"单纯根治性调强放射治疗"},{"letter":"B","text":"含铂双药方案诱导化疗序贯单纯根治性放疗"},{"letter":"C","text":"根治性放疗联合含铂方案同步化疗，序贯含铂双药辅助化疗"},{"letter":"D","text":"含铂方案诱导化疗序贯根治性放化疗，或根治性放疗联合含铂方案同步化疗"},{"letter":"E","text":"根治性放疗联合西妥昔单抗等EGFR靶向治疗"},{"letter":"F","text":"根治性放疗联合PD-1抑制剂同步免疫治疗"},{"letter":"G","text":"姑息性全身化疗联合局部病灶姑息性放疗"},{"letter":"H","text":"含铂双药方案诱导化疗序贯鼻咽原发灶切除及颈部淋巴结清扫术"},{"letter":"I","text":"根治性放疗联合大分子抗血管生成靶向治疗"},{"letter":"J","text":"单纯含铂双药方案全身化疗4-6个周期"},{"letter":"K","text":"鼻咽原发灶切除及颈部淋巴结清扫术序贯术后辅助放化疗"},{"letter":"L","text":"含铂双药方案诱导化疗序贯根治性放疗及PD-1抑制剂维持治疗"}]}
+{"sample_id":"sample-258f93513eac99791d84464c","patient_id":"patient-34616c327ce5d69194ca7f4d","turn_id":"turn05","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- 暂无可展示的初诊主诉/入院资料。\n\n【已完成检查与客观结果】\n- [全程D0] 检验组合: 嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；凝血酶原时间活动度(PTA)-静脉血: 89%；平均血小板体积(MPV)-静脉血: 9.4fL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 334g/L；D-二聚体(D-Dimer)-静脉血: 0.29ug/ml；凝血酶原国际标准化比值(PT-INR)-静脉血: 1.02；纤维蛋白原(Fbg)-静脉血: 3.21g/L；红细胞比容(Hct)-静脉血: 48.2%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；平均红细胞血红蛋白含量(MCH)-静脉血: 32pg；红细胞计数(RBC#)-静脉血: 5.0310E12/L；淋巴细胞百分比(Lymph%)-静脉血: 0.271；中性粒细胞计数(Neut#)-静脉血: 5.910E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.65；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.8；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；大血小板百分比(P-LCR%)-静脉血: 20.8%；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；血小板比容-静脉血: 27%；平均红细胞体积(MCV)-静脉血: 95.8fL；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.06S/CO；血小板分布宽度(PDW)-静脉血: 10.8%；单核细胞计数(Mono#)-静脉血: 0.510E9/L；活化部分凝血活酶时间(APTT)-静脉血: 29.2sec.；凝血酶原时间(PT)-静脉血: 11.4sec.；纤维蛋白原降解产物(FDP)-静脉血: 2.8ug/ml；淋巴细胞计数(Lymph#)-静脉血: 2.510E9/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.01IU/mL；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.13COI；凝血酶时间(TT)-静脉血: 20sec.；血小板计数(PLT#)-静脉血: 28910E9/L；Rh血型-静脉血: 阳性；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.06S/CO；血红蛋白(Hb)-静脉血: 161g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；白细胞计数(WBC#)-静脉血: 9.210E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.5；单核细胞百分比(Mono%)-静脉血: 0.057；ABO血型-静脉血: A；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D14] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 左前分支阻滞\n- [全程D14] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理稍增粗，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见重要病变。\n- [全程D15] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 右侧乳突可见片状放射性浓集灶。胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 右侧乳突炎症。 余全身骨骼未见明显异常。\n- [全程D16] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，肝S7可见一强回声斑，直径约5mm，后方伴声影。血管走行清晰、自然，肝内胆管不扩张，门静脉内径14mm。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约21cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约36×26×23mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝S7强回声斑，考虑肝内胆管结石。 胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D22] 检验组合: 钾离子(K+)-静脉血: 4.18mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 46.8U/L；氯离子(Cl-)-静脉血: 101.7mmol/L；直接胆红素(DBIL)-静脉血: 2.5umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；乳酸脱氢酶(LDH)-静脉血: 172.2U/L；尿酸(UA)-静脉血: 299umol/L；碱性磷酸酶(ALP)-静脉血: 35.4U/L；载脂蛋白B(apoB)-静脉血: 0.71g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.09mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.82；γ-谷氨酰基转移酶(GGT)-静脉血: 23.1U/L；总钙(Ca)-静脉血: 2.31mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.1U/L；间接胆红素(IBIL)-静脉血: 4.8umolL；血液二氧化碳含量ctCO2(B)-静脉血: 22.5mmol/L；总蛋白(TP)-静脉血: 76.15g/L；阴离子间隙(AG)-静脉血: 16.8；总胆固醇(TC)-静脉血: 4.05mmol/L；总胆汁酸(TBA)-静脉血: 3.1umol/L；总胆红素(TBIL)-静脉血: 7.3umol/L；肌酐(Crea)-静脉血: 58.1umol/L；载脂蛋白AI(apoAI)-静脉血: 1.48g/L；球蛋白(GLO)-静脉血: 30.25g/L；C-反应蛋白(CRP)-静脉血: 3.66mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.33mmolL；镁离子(Mg2+)-静脉血: 0.86mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.3U/L；胱抑素(Cys-C)-静脉血: 0.88mg/L；尿素氮(BUN)-静脉血: 3.4mmol/L；葡萄糖(Glu)-静脉血: 5.59mmol/L；甘油三酯(TG)-静脉血: 2.5mmol/L；磷(P)-静脉血: 1.15mmol/L；白蛋白(ALB)-静脉血: 45.9g/L；钠离子(Na+)-静脉血: 141mmol/L\n- [全程D70] 检验组合: 低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.66mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.6；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32pg；白细胞计数(WBC#)-静脉血: 7.7410E9/L；血红蛋白(Hb)-静脉血: 164g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 27.3U/L；磷(P)-静脉血: 1.31mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 20.8mmol/L；尿酸(UA)-静脉血: 323.7umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 44.8U/L；C-反应蛋白(CRP)-静脉血: 1.33mg/L；血小板比容-静脉血: 22%；血小板计数(PLT#)-静脉血: 23710E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.35mmolL；总胆红素(TBIL)-静脉血: 10.7umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 36.6U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.75；平均红细胞血红蛋白浓度(MCHC)-静脉血: 342g/L；肌酐(Crea)-静脉血: 62.3umol/L；总蛋白(TP)-静脉血: 75.99g/L；单核细胞百分比(Mono%)-静脉血: 0.056；平均红细胞血红蛋白浓度(MCHC)-静脉血: 337g/L；平均血小板体积(MPV)-静脉血: 9.5fL；血小板计数(PLT#)-静脉血: 24810E9/L；甘油三酯(TG)-静脉血: 1.02mmol/L；单核细胞百分比(Mono%)-静脉血: 0.081；球蛋白(GLO)-静脉血: 29.79g/L；平均红细胞体积(MCV)-静脉血: 95.1fL；总钙(Ca)-静脉血: 2.3mmol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；直接胆红素(DBIL)-静脉血: 3.9umol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；载脂蛋白AI(apoAI)-静脉血: 1.36g/L；大血小板百分比(P-LCR%)-静脉血: 17.2%；血红蛋白(Hb)-静脉血: 158g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32pg；血小板比容-静脉血: 22%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.1；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；乳酸脱氢酶(LDH)-静脉血: 185.2U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；间接胆红素(IBIL)-静脉血: 6.8umolL；红细胞计数(RBC#)-静脉血: 5.1210E12/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.55\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D64] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者近日精神好，胃纳尚可，暂无特殊不适。体查大致同入院。患者目前无放疗禁忌症，开始予以行鼻咽癌放疗。靶区剂量为：GTV70Gy/31F。放疗期间予同期化疗，并予加强对症、支持治疗。注意观察放疗不良反应表现。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停同期化疗，继续单纯放疗，并加用保肝药物\nB. 暂停放化疗，给予重组人粒细胞刺激因子支持治疗\nC. 继续放疗，将同期化疗剂量减低20%\nD. 继续放化疗方案，给予重组人血小板生成素\nE. 继续放化疗方案，定期复查血常规及生化指标\nF. 暂停放化疗，给予还原型谷胱甘肽保肝治疗\nG. 继续放化疗方案，加用双环醇保肝治疗\nH. 继续放化疗方案，给予重组人粒细胞刺激因子\nI. 暂停同期化疗，给予静脉补液及利尿处理\nJ. 继续放疗，取消同期化疗，改为西妥昔单抗治疗\nK. 暂停放疗，继续同期化疗，给予促红细胞生成素治疗\nL. 继续放化疗方案，输注单采血小板\n\n请仅输出一个选项字母（A-L）。","gold_letter":"E","gold_action":"继续放化疗方案，定期复查血常规及生化指标","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"暂停同期化疗，继续单纯放疗，并加用保肝药物"},{"letter":"B","text":"暂停放化疗，给予重组人粒细胞刺激因子支持治疗"},{"letter":"C","text":"继续放疗，将同期化疗剂量减低20%"},{"letter":"D","text":"继续放化疗方案，给予重组人血小板生成素"},{"letter":"E","text":"继续放化疗方案，定期复查血常规及生化指标"},{"letter":"F","text":"暂停放化疗，给予还原型谷胱甘肽保肝治疗"},{"letter":"G","text":"继续放化疗方案，加用双环醇保肝治疗"},{"letter":"H","text":"继续放化疗方案，给予重组人粒细胞刺激因子"},{"letter":"I","text":"暂停同期化疗，给予静脉补液及利尿处理"},{"letter":"J","text":"继续放疗，取消同期化疗，改为西妥昔单抗治疗"},{"letter":"K","text":"暂停放疗，继续同期化疗，给予促红细胞生成素治疗"},{"letter":"L","text":"继续放化疗方案，输注单采血小板"}]}
+{"sample_id":"sample-a4894f941ebb70f32d9155cc","patient_id":"patient-9bf5c8c03860cdf61108611d","turn_id":"turn01","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 听力下降8月，发现左颈部包块1月余；现病史: 患者于某次就诊时间初开始无明显诱因出现听力下降，以右侧为著，未予重视。某次就诊时间7月初患者无意中发现左颈部包块，大小约4×4cm，无疼痛，无表面皮肤发红，未就诊，肿物进行性增大。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,左颈部包块,颈部肿物；既往史: 发现血糖升高一年余，未行药物治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟：30－40支/天×30余。否认饮酒史。否认不洁性生活史。；家族史: 两个舅舅分别患有肝癌及骨肿瘤。；体格检查: T：36.4℃，P：83次/分，R：20次/分，BP：100/65mmHg,Ht：164cm，Wt：87kg，BSA：1.93m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左侧颈部IIa区可扪及1个淋巴结，最大径7×3cm，无融合，质地硬，边界清，活动度差，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 电子鼻咽镜检查及活检，鼻咽及颈部平扫CT，胸部X线、腹部彩超，暂缓全身骨显像及EBV检测\nB. 左颈部淋巴结切除活检，鼻咽及颈部增强MRI，胸部X线、腹部彩超、全身骨显像及EBV检测\nC. 电子鼻咽镜检查及活检，鼻咽及颈部增强CT，胸部X线、腹部彩超、全身骨显像，暂缓EBV检测\nD. 电子鼻咽镜检查（暂不活检），鼻咽及颈部增强MRI，全身PET-CT，以及EBV抗体检测\nE. 左颈部淋巴结细针穿刺活检，鼻咽及颈部平扫MRI，胸部X线、腹部彩超、全身骨显像\nF. 电子鼻咽镜检查及活检，鼻咽及颈部增强MRI，仅行胸部X线及腹部彩超，无需全身骨显像\nG. 电子鼻咽镜检查及活检，鼻咽及颈部增强MRI，胸部X线、腹部彩超、全身骨显像，以及EBV抗体检测\nH. 电子鼻咽镜检查及活检，鼻咽及颈部增强MRI，头颅增强MRI，全身骨髓穿刺活检及EBV检测\nI. 电子鼻咽镜检查及活检，鼻咽及颈部增强MRI，胸部X线、腹部彩超、全身骨显像，并预防性气管切开\nJ. 电子鼻咽镜检查及活检，鼻咽及颈部平扫MRI，胸部X线、腹部彩超、全身骨显像，以及EBV抗体检测\nK. 鼻咽及颈部增强MRI，胸部X线、腹部彩超、全身骨显像，待影像学出具恶性报告后再行鼻咽镜活检\nL. 电子鼻咽镜检查及活检，鼻咽及颈部增强MRI，直接行全身骨显像及头颅CT，免除胸腹部影像学检查\n\n请仅输出一个选项字母（A-L）。","gold_letter":"G","gold_action":"电子鼻咽镜检查及活检，鼻咽及颈部增强MRI，胸部X线、腹部彩超、全身骨显像，以及EBV抗体检测","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"电子鼻咽镜检查及活检，鼻咽及颈部平扫CT，胸部X线、腹部彩超，暂缓全身骨显像及EBV检测"},{"letter":"B","text":"左颈部淋巴结切除活检，鼻咽及颈部增强MRI，胸部X线、腹部彩超、全身骨显像及EBV检测"},{"letter":"C","text":"电子鼻咽镜检查及活检，鼻咽及颈部增强CT，胸部X线、腹部彩超、全身骨显像，暂缓EBV检测"},{"letter":"D","text":"电子鼻咽镜检查（暂不活检），鼻咽及颈部增强MRI，全身PET-CT，以及EBV抗体检测"},{"letter":"E","text":"左颈部淋巴结细针穿刺活检，鼻咽及颈部平扫MRI，胸部X线、腹部彩超、全身骨显像"},{"letter":"F","text":"电子鼻咽镜检查及活检，鼻咽及颈部增强MRI，仅行胸部X线及腹部彩超，无需全身骨显像"},{"letter":"G","text":"电子鼻咽镜检查及活检，鼻咽及颈部增强MRI，胸部X线、腹部彩超、全身骨显像，以及EBV抗体检测"},{"letter":"H","text":"电子鼻咽镜检查及活检，鼻咽及颈部增强MRI，头颅增强MRI，全身骨髓穿刺活检及EBV检测"},{"letter":"I","text":"电子鼻咽镜检查及活检，鼻咽及颈部增强MRI，胸部X线、腹部彩超、全身骨显像，并预防性气管切开"},{"letter":"J","text":"电子鼻咽镜检查及活检，鼻咽及颈部平扫MRI，胸部X线、腹部彩超、全身骨显像，以及EBV抗体检测"},{"letter":"K","text":"鼻咽及颈部增强MRI，胸部X线、腹部彩超、全身骨显像，待影像学出具恶性报告后再行鼻咽镜活检"},{"letter":"L","text":"电子鼻咽镜检查及活检，鼻咽及颈部增强MRI，直接行全身骨显像及头颅CT，免除胸腹部影像学检查"}]}
+{"sample_id":"sample-487e8333de7d37de56947d09","patient_id":"patient-9bf5c8c03860cdf61108611d","turn_id":"turn02","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 听力下降8月，发现左颈部包块1月余；现病史: 患者于某次就诊时间初开始无明显诱因出现听力下降，以右侧为著，未予重视。某次就诊时间7月初患者无意中发现左颈部包块，大小约4×4cm，无疼痛，无表面皮肤发红，未就诊，肿物进行性增大。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,左颈部包块,颈部肿物；既往史: 发现血糖升高一年余，未行药物治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟：30－40支/天×30余。否认饮酒史。否认不洁性生活史。；家族史: 两个舅舅分别患有肝癌及骨肿瘤。；体格检查: T：36.4℃，P：83次/分，R：20次/分，BP：100/65mmHg,Ht：164cm，Wt：87kg，BSA：1.93m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左侧颈部IIa区可扪及1个淋巴结，最大径7×3cm，无融合，质地硬，边界清，活动度差，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D0] 检验组合: 隐血(OB)-粪便: 阴性（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-粪便: 棕色；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；比重(SG)-尿液: 1.021；浊度(TRUB)-尿液: 清亮；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 5.5；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；白细胞计数(WBC#)-尿液: 3/μL；虫卵-粪便: 未见虫卵（参考: 未见虫卵）\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理增多增粗，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，右肋膈角锐利，左肋膈角模糊。；检查结论: 考虑双肺慢性支气管炎X线改变。 左侧胸膜稍增厚。\n- [全程D1] 检验组合: 人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；载脂蛋白B(apoB)-静脉血: 1.08g/L；间接胆红素(IBIL)-静脉血: 5.9umolL；钾离子(K+)-静脉血: 4.1mmol/L；阴离子间隙(AG)-静脉血: 17.5；血红蛋白(Hb)-静脉血: 151g/L；凝血酶原时间活动度(PTA)-静脉血: 113.8%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；单核细胞计数(Mono#)-静脉血: 0.610E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.99mmol/L；ABO血型-静脉血: O；中性粒细胞百分比(Neut%)-静脉血: 0.578；血小板比容-静脉血: 24%；Rh血型-静脉血: 阳性；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 5.12mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；梅毒非特异性抗体甲苯胺红不加热血清试验(TRUST)-静脉血: 阴性(-)（参考: 阴性）；淋巴细胞百分比(Lymph%)-静脉血: 0.307；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.9；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 7.9umol/L；白细胞计数(WBC#)-静脉血: 7.610E9/L；直接胆红素(DBIL)-静脉血: 2umol/L；红细胞计数(RBC#)-静脉血: 5.2510E12/L；白蛋白(ALB)-静脉血: 42.2g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；红细胞比容(Hct)-静脉血: 44.7%；糖化血红蛋白A1c(HbA1c)-静脉血: 7.2%；总蛋白(TP)-静脉血: 76.24g/L；凝血酶时间(TT)-静脉血: 18.9sec.；纤维蛋白原(Fbg)-静脉血: 2.44g/L；钠离子(Na+)-静脉血: 137.9mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 32.1U/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.2；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；镁离子(Mg2+)-静脉血: 0.82mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 55.9U/L；载脂蛋白AI(apoAI)-静脉血: 1.23g/L；平均红细胞体积(MCV)-静脉血: 85.1fL；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）\n- [全程D4] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔变窄，鼻咽各壁粘膜明显增厚，见结节状肿物向鼻咽腔内突出，T1WI呈等信号，T2WI呈稍高信号，增强扫描轻度不均匀强化，双侧咽隐窝见肿物填塞。口咽双侧壁未见受累增厚，病变未累及双侧后鼻孔。 双侧腭帆提肌受侵，双侧腭帆张肌及头长肌、双侧翼内外肌未见受侵征象。 双侧翼腭窝、双侧上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 颅底骨质未见破坏。 双侧海绵窦形态未见异常。 双侧筛窦、双侧上颌窦粘膜增厚，增强扫描呈轻度强化。双侧乳突未见分泌物。 双眼未见异常，球后未见占位性病变。蝶鞍形态未见异常，其内未见占位性病变。 双侧咽后见淋巴结，大小约7mm×9mm，增强扫描明显强化。 双颈II区、左颈III区见多个肿大淋巴结，最大约33mm×27mm，边界欠清，增强扫描呈明显强化。 右颈III区、双颈I区见数个小淋巴结，最大约5mm×11mm，边界清楚，孤立散在。 甲状腺双叶及峡部形态未见异常，信号均匀，未见占位性病变。喉咽腔形态未见异常，未见占位性病变。双侧颌下腺、腮腺大小、形态未见异常，信号均匀，未见占位性病变。 扫描所见脑组织未见明确异常。；检查结论: 鼻咽肿物，考虑鼻咽癌。 颅底骨质未见破坏。 双侧咽后、双颈II区、左颈III区肿大淋巴结，考虑转移。 鼻窦炎。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善颈部淋巴结细针穿刺活检作为首选病理确诊手段。\nB. 完善全身PET-CT检查，若无远处转移则直接开始根治性放疗。\nC. 完善电子鼻咽镜检查评估局部侵犯范围，暂不取活检以防大出血。\nD. 完善鼻咽镜检查并取活检，同时行颈部淋巴结切除活检以明确分期。\nE. 完善鼻咽部刷片细胞学检查明确病理诊断。\nF. 完善鼻内镜下鼻咽肿物切除术，术后送常规病理。\nG. 完善电子鼻咽镜检查并取活检，若首次活检阴性则按临床诊断开始化疗。\nH. 完善电子鼻咽镜检查并取活检明确病理诊断。\nI. 完善颈部淋巴结切除活检作为首选病理确诊手段。\nJ. 完善电子鼻咽镜检查并取活检，同时行预防性气管切开。\nK. 完善鼻咽镜检查并取活检，同时行扁桃体切除活检排除隐匿原发灶。\nL. 完善全身骨扫描及腹部超声，待全身分期明确后再行鼻咽活检。\n\n请仅输出一个选项字母（A-L）。","gold_letter":"H","gold_action":"完善电子鼻咽镜检查并取活检明确病理诊断。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"完善颈部淋巴结细针穿刺活检作为首选病理确诊手段。"},{"letter":"B","text":"完善全身PET-CT检查，若无远处转移则直接开始根治性放疗。"},{"letter":"C","text":"完善电子鼻咽镜检查评估局部侵犯范围，暂不取活检以防大出血。"},{"letter":"D","text":"完善鼻咽镜检查并取活检，同时行颈部淋巴结切除活检以明确分期。"},{"letter":"E","text":"完善鼻咽部刷片细胞学检查明确病理诊断。"},{"letter":"F","text":"完善鼻内镜下鼻咽肿物切除术，术后送常规病理。"},{"letter":"G","text":"完善电子鼻咽镜检查并取活检，若首次活检阴性则按临床诊断开始化疗。"},{"letter":"H","text":"完善电子鼻咽镜检查并取活检明确病理诊断。"},{"letter":"I","text":"完善颈部淋巴结切除活检作为首选病理确诊手段。"},{"letter":"J","text":"完善电子鼻咽镜检查并取活检，同时行预防性气管切开。"},{"letter":"K","text":"完善鼻咽镜检查并取活检，同时行扁桃体切除活检排除隐匿原发灶。"},{"letter":"L","text":"完善全身骨扫描及腹部超声，待全身分期明确后再行鼻咽活检。"}]}
+{"sample_id":"sample-7ff1cd1ea3ebf1a9891b521d","patient_id":"patient-9bf5c8c03860cdf61108611d","turn_id":"turn05","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D8] 入院记录: 主诉: 听力下降8月，发现左颈部包块1月余；现病史: 简要入院病史:患者于某次就诊时间初开始无明显诱因出现听力下降，以右侧为著，未予重视。某次就诊时间7月初患者无意中发现左颈部包块，大小约4×4cm，无疼痛，无表面皮肤发红，未就诊，肿物进行性增大。8月初肿物增大至鸡蛋大小，就诊地域信息已隐藏，行颈部肿块穿刺，病理回报：转移癌可能性大。8－11行鼻咽＋颈部MRI提示：鼻咽双侧壁及顶后壁软组织增厚，考虑鼻咽癌并双侧咽后、双颈部多发淋巴结肿大。胸部MRI检查未见异常。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,左颈部包块,颈部肿物；既往史: 发现血糖升高一年余，未行药物治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、肾病”病史；否认手术、外伤、输血史及献血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D0] 检验组合: 隐血(OB)-粪便: 阴性（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-粪便: 棕色；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；比重(SG)-尿液: 1.021；浊度(TRUB)-尿液: 清亮；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 5.5；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；白细胞计数(WBC#)-尿液: 3/μL；虫卵-粪便: 未见虫卵（参考: 未见虫卵）\n- [全程D4] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔变窄，鼻咽各壁粘膜明显增厚，见结节状肿物向鼻咽腔内突出，T1WI呈等信号，T2WI呈稍高信号，增强扫描轻度不均匀强化，双侧咽隐窝见肿物填塞。口咽双侧壁未见受累增厚，病变未累及双侧后鼻孔。 双侧腭帆提肌受侵，双侧腭帆张肌及头长肌、双侧翼内外肌未见受侵征象。 双侧翼腭窝、双侧上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 颅底骨质未见破坏。 双侧海绵窦形态未见异常。 双侧筛窦、双侧上颌窦粘膜增厚，增强扫描呈轻度强化。双侧乳突未见分泌物。 双眼未见异常，球后未见占位性病变。蝶鞍形态未见异常，其内未见占位性病变。 双侧咽后见淋巴结，大小约7mm×9mm，增强扫描明显强化。 双颈II区、左颈III区见多个肿大淋巴结，最大约33mm×27mm，边界欠清，增强扫描呈明显强化。 右颈III区、双颈I区见数个小淋巴结，最大约5mm×11mm，边界清楚，孤立散在。 甲状腺双叶及峡部形态未见异常，信号均匀，未见占位性病变。喉咽腔形态未见异常，未见占位性病变。双侧颌下腺、腮腺大小、形态未见异常，信号均匀，未见占位性病变。 扫描所见脑组织未见明确异常。；检查结论: 鼻咽肿物，考虑鼻咽癌。 颅底骨质未见破坏。 双侧咽后、双颈II区、左颈III区肿大淋巴结，考虑转移。 鼻窦炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D5] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约15cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D7] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 双上颌骨可见片状放射性浓集灶。胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 双上颌骨炎症。 余全身骨骼未见明显异常。\n- [全程D12] 检验组合: 平均红细胞血红蛋白浓度(MCHC)-静脉血: 340g/L；血小板比容-静脉血: 24%；单核细胞计数(Mono#)-静脉血: 0.110E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；红细胞比容(Hct)-静脉血: 41.8%；平均红细胞血红蛋白含量(MCH)-静脉血: 29pg；单核细胞百分比(Mono%)-静脉血: 0.016；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.1；平均血小板体积(MPV)-静脉血: 10.3fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.007；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；红细胞计数(RBC#)-静脉血: 4.8910E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；大血小板百分比(P-LCR%)-静脉血: 27%；淋巴细胞百分比(Lymph%)-静脉血: 0.422；血小板计数(PLT#)-静脉血: 23710E9/L；平均红细胞体积(MCV)-静脉血: 85.5fL；淋巴细胞计数(Lymph#)-静脉血: 310E9/L；白细胞计数(WBC#)-静脉血: 710E9/L；血小板分布宽度(PDW)-静脉血: 11.6%；血红蛋白(Hb)-静脉血: 142g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；中性粒细胞百分比(Neut%)-静脉血: 0.552\n- [全程D15] 检验组合: 单核细胞计数(Mono#)-静脉血: 0.310E9/L；血小板计数(PLT#)-静脉血: 19810E9/L；红细胞比容(Hct)-静脉血: 44.3%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13；大血小板百分比(P-LCR%)-静脉血: 22.1%；红细胞计数(RBC#)-静脉血: 5.2510E12/L；淋巴细胞百分比(Lymph%)-静脉血: 0.443；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；血小板比容-静脉血: 19%；血红蛋白(Hb)-静脉血: 151g/L；血小板分布宽度(PDW)-静脉血: 11.5%；平均红细胞体积(MCV)-静脉血: 84.4fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.033；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；单核细胞百分比(Mono%)-静脉血: 0.059；平均血小板体积(MPV)-静脉血: 9.5fL；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.46；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；白细胞计数(WBC#)-静脉血: 5.7610E9/L；淋巴细胞计数(Lymph#)-静脉血: 2.610E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.8\n- [全程D19] 检验组合: 中性粒细胞计数(Neut#)-静脉血: 5.210E9/L；单核细胞计数(Mono#)-静脉血: 0.110E9/L；血红蛋白(Hb)-静脉血: 131g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.231；红细胞计数(RBC#)-静脉血: 4.510E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.742；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；大血小板百分比(P-LCR%)-静脉血: 21.7%；血小板计数(PLT#)-静脉血: 14310E9/L；血小板分布宽度(PDW)-静脉血: 10.7%；平均红细胞体积(MCV)-静脉血: 88.9fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.6；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；血小板比容-静脉血: 14%；白细胞计数(WBC#)-静脉血: 710E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.3；单核细胞百分比(Mono%)-静脉血: 0.01；平均血小板体积(MPV)-静脉血: 9.5fL；红细胞比容(Hct)-静脉血: 40%；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L\n- [全程D27] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 拟不完全性右束支传导阻滞\n- [全程D27] 检验组合: 镁离子(Mg2+)-静脉血: 0.82mmol/L；氯离子(Cl-)-静脉血: 103.6mmol/L；总胆固醇(TC)-静脉血: 5.1mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.25mmol/L；总胆汁酸(TBA)-静脉血: 4.1umol/L；肌酐(Crea)-静脉血: 76.9umol/L；直接胆红素(DBIL)-静脉血: 1.6umol/L；总钙(Ca)-静脉血: 2.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 19.8U/L；总蛋白(TP)-静脉血: 75.08g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.29；尿酸(UA)-静脉血: 440.4umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 19.1mmol/L；磷(P)-静脉血: 1.09mmol/L；胱抑素(Cys-C)-静脉血: 1.21mg/L；C-反应蛋白(CRP)-静脉血: 4.53mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.06mmolL；碱性磷酸酶(ALP)-静脉血: 84.7U/L；白蛋白(ALB)-静脉血: 42.3g/L；载脂蛋白B(apoB)-静脉血: 1.13g/L；球蛋白(GLO)-静脉血: 32.78g/L；尿素氮(BUN)-静脉血: 7.3mmol/L；钠离子(Na+)-静脉血: 138.8mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 47.8U/L；甘油三酯(TG)-静脉血: 2.38mmol/L；乳酸脱氢酶(LDH)-静脉血: 183.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 54U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.2U/L；葡萄糖(Glu)-静脉血: 7.26mmol/L；总胆红素(TBIL)-静脉血: 5.3umol/L；载脂蛋白AI(apoAI)-静脉血: 1.29g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.92；钾离子(K+)-静脉血: 4.48mmol/L；间接胆红素(IBIL)-静脉血: 3.7umolL；阴离子间隙(AG)-静脉血: 16.1\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂缓化疗，给予重组人血小板生成素升血小板治疗，待血小板恢复至正常范围后原剂量行第二程GP诱导化疗。\nB. 行第二程GP诱导化疗，吉西他滨剂量下调25%，顺铂维持原剂量，辅以常规止吐及水化利尿等支持治疗。\nC. 停用GP诱导化疗方案，直接转入根治性单纯放疗阶段，并安排心血管专科随访与干预。\nD. 更改诱导化疗方案，将第二程方案由GP（吉西他滨+顺铂）调整为TP（多西他赛+顺铂）方案并按原剂量给药。\nE. 按原剂量行第二程GP诱导化疗，并于化疗结束后预防性给予聚乙二醇化重组人粒细胞刺激因子支持。\nF. 暂缓化疗，请心血管内科会诊并完善超声心动图等检查，待心血管专科评估通过后再行第二程GP化疗。\nG. 按原剂量行第二程GP诱导化疗，并同步皮下注射重组人促红细胞生成素以提升血红蛋白水平。\nH. 行第二程GP诱导化疗，顺铂剂量下调25%，吉西他滨维持原剂量，辅以常规止吐及水化利尿等支持治疗。\nI. 终止诱导化疗，直接进入根治性同步放化疗阶段，同步化疗采用单药顺铂标准剂量方案。\nJ. 按原剂量行第二程GP诱导化疗，化疗前预防性输注单采血小板1个治疗量以降低出血风险。\nK. 按原剂量行第二程GP诱导化疗，并辅以常规止吐、护胃及水化利尿等支持治疗。\nL. 按原剂量行第二程GP诱导化疗，并预防性加用异甘草酸镁等保肝药物以防止化疗相关肝损伤。\n\n请仅输出一个选项字母（A-L）。","gold_letter":"K","gold_action":"按原剂量行第二程GP诱导化疗，并辅以常规止吐、护胃及水化利尿等支持治疗。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"暂缓化疗，给予重组人血小板生成素升血小板治疗，待血小板恢复至正常范围后原剂量行第二程GP诱导化疗。"},{"letter":"B","text":"行第二程GP诱导化疗，吉西他滨剂量下调25%，顺铂维持原剂量，辅以常规止吐及水化利尿等支持治疗。"},{"letter":"C","text":"停用GP诱导化疗方案，直接转入根治性单纯放疗阶段，并安排心血管专科随访与干预。"},{"letter":"D","text":"更改诱导化疗方案，将第二程方案由GP（吉西他滨+顺铂）调整为TP（多西他赛+顺铂）方案并按原剂量给药。"},{"letter":"E","text":"按原剂量行第二程GP诱导化疗，并于化疗结束后预防性给予聚乙二醇化重组人粒细胞刺激因子支持。"},{"letter":"F","text":"暂缓化疗，请心血管内科会诊并完善超声心动图等检查，待心血管专科评估通过后再行第二程GP化疗。"},{"letter":"G","text":"按原剂量行第二程GP诱导化疗，并同步皮下注射重组人促红细胞生成素以提升血红蛋白水平。"},{"letter":"H","text":"行第二程GP诱导化疗，顺铂剂量下调25%，吉西他滨维持原剂量，辅以常规止吐及水化利尿等支持治疗。"},{"letter":"I","text":"终止诱导化疗，直接进入根治性同步放化疗阶段，同步化疗采用单药顺铂标准剂量方案。"},{"letter":"J","text":"按原剂量行第二程GP诱导化疗，化疗前预防性输注单采血小板1个治疗量以降低出血风险。"},{"letter":"K","text":"按原剂量行第二程GP诱导化疗，并辅以常规止吐、护胃及水化利尿等支持治疗。"},{"letter":"L","text":"按原剂量行第二程GP诱导化疗，并预防性加用异甘草酸镁等保肝药物以防止化疗相关肝损伤。"}]}
+{"sample_id":"sample-9fc5959f48286f0a038d3acb","patient_id":"patient-9bf5c8c03860cdf61108611d","turn_id":"turn07","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D69] 入院记录: 主诉: 鼻咽癌3程诱导化疗后2周；现病史: 患者于某次就诊时间初开始无明显诱因出现听力下降，以右侧为著，未予重视。某次就诊时间7月初患者无意中发现左颈部包块，大小约4×4cm，无疼痛，无表面皮肤发红，未就诊，肿物进行性增大。8月初肿物增大至鸡蛋大小，就诊地域信息已隐藏，行颈部肿块穿刺，病理回报：转移癌可能性大。8－11行鼻咽＋颈部MRI提示：鼻咽双侧壁及顶后壁软组织增厚，考虑鼻咽癌并双侧咽后、双颈部多发淋巴结肿大。胸部MRI检查未见异常。于某次就诊时间、某次就诊时间、某次就诊时间我院各行一程GP诱导化疗，（剂量：吉西他滨：1g/m^2,d1,d8;顺铂：80mg/m^2,d1），现为同期放化疗入院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,左颈部包块,颈部肿物；既往史: 发现血糖升高一年余，未行药物治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、肾病”病史；否认手术、外伤、输血史及献血史。；个人史: 长期居于原籍，无疫区居住史。吸烟：30－40支/天×30余。否认饮酒史。否认不洁性生活史。；家族史: 两个舅舅分别患有肝癌及骨肿瘤。；体格检查:；专科检查:；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D0] 检验组合: 隐血(OB)-粪便: 阴性（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-粪便: 棕色；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；比重(SG)-尿液: 1.021；浊度(TRUB)-尿液: 清亮；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 5.5；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；白细胞计数(WBC#)-尿液: 3/μL；虫卵-粪便: 未见虫卵（参考: 未见虫卵）\n- [全程D64] 检验组合: 肌酐(Crea)-静脉血: 160.7umol/L；葡萄糖(Glu)-静脉血: 8.34mmol/L；碱性磷酸酶(ALP)-静脉血: 72.1U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 55U/L；C-反应蛋白(CRP)-静脉血: 2.43mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.94mmol/L；总胆固醇(TC)-静脉血: 4.9mmol/L；镁离子(Mg2+)-静脉血: 0.61mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；总钙(Ca)-静脉血: 2.32mmol/L；氯离子(Cl-)-静脉血: 96.3mmol/L；甘油三酯(TG)-静脉血: 2.49mmol/L；尿素氮(BUN)-静脉血: 9.9mmol/L；直接胆红素(DBIL)-静脉血: 2.6umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.2mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 23.9U/L；载脂蛋白B(apoB)-静脉血: 1.05g/L；乳酸脱氢酶(LDH)-静脉血: 221.5U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.43；间接胆红素(IBIL)-静脉血: 5.8umolL；尿酸(UA)-静脉血: 602.1umol/L；球蛋白(GLO)-静脉血: 30.83g/L；胱抑素(Cys-C)-静脉血: 1.84mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.13mmolL；γ-谷氨酰基转移酶(GGT)-静脉血: 54.4U/L；总胆红素(TBIL)-静脉血: 8.4umol/L；钾离子(K+)-静脉血: 3.86mmol/L；白蛋白(ALB)-静脉血: 44g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.97；丙氨酸氨基转移酶(ALT)-静脉血: 24.7U/L；磷(P)-静脉血: 1.33mmol/L；总胆汁酸(TBA)-静脉血: 2.2umol/L；钠离子(Na+)-静脉血: 136.5mmol/L；阴离子间隙(AG)-静脉血: 15；总蛋白(TP)-静脉血: 74.83g/L\n- [全程D71] 检验组合: 平均红细胞体积(MCV)-静脉血: 86.5fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.015；中性粒细胞计数(Neut#)-静脉血: 2.210E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.8；血红蛋白(Hb)-静脉血: 111g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.011；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.36；平均红细胞血红蛋白浓度(MCHC)-静脉血: 352g/L；红细胞计数(RBC#)-静脉血: 3.6410E12/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.482；大血小板百分比(P-LCR%)-静脉血: 19.1%；血小板比容-静脉血: 10%；平均血小板体积(MPV)-静脉血: 9.3fL；红细胞比容(Hct)-静脉血: 31.5%；单核细胞百分比(Mono%)-静脉血: 0.132；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；血小板分布宽度(PDW)-静脉血: 9.1%；血小板计数(PLT#)-静脉血: 10910E9/L；白细胞计数(WBC#)-静脉血: 4.610E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.1\n- [全程D78] 检验组合: 嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；红细胞比容(Hct)-静脉血: 31.2%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；血小板计数(PLT#)-静脉血: 22110E9/L；血小板比容-静脉血: 20%；大血小板百分比(P-LCR%)-静脉血: 19.1%；单核细胞百分比(Mono%)-静脉血: 0.108；血红蛋白(Hb)-静脉血: 108g/L；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；血小板分布宽度(PDW)-静脉血: 10%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.02；白细胞计数(WBC#)-静脉血: 4.510E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.653；平均红细胞体积(MCV)-静脉血: 86.9fL；平均血小板体积(MPV)-静脉血: 9.2fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.9；中性粒细胞计数(Neut#)-静脉血: 310E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.215；平均红细胞血红蛋白浓度(MCHC)-静脉血: 346g/L；红细胞计数(RBC#)-静脉血: 3.5910E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；单核细胞计数(Mono#)-静脉血: 0.510E9/L\n- [全程D85] 检验组合: 平均血小板体积(MPV)-静脉血: 9fL；血小板计数(PLT#)-静脉血: 26310E9/L；血小板分布宽度(PDW)-静脉血: 9.9%；淋巴细胞计数(Lymph#)-静脉血: 1.210E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.9；血红蛋白(Hb)-静脉血: 103g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；平均红细胞体积(MCV)-静脉血: 88.5fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.7；白细胞计数(WBC#)-静脉血: 4.2910E9/L；大血小板百分比(P-LCR%)-静脉血: 17.7%；单核细胞百分比(Mono%)-静脉血: 0.191；平均红细胞血红蛋白含量(MCH)-静脉血: 30.3pg；血小板比容-静脉血: 24%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 342g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞计数(RBC#)-静脉血: 3.410E12/L；红细胞比容(Hct)-静脉血: 30.1%；淋巴细胞百分比(Lymph%)-静脉血: 0.27；中性粒细胞百分比(Neut%)-静脉血: 0.513；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.021；单核细胞计数(Mono#)-静脉血: 0.810E9/L；中性粒细胞计数(Neut#)-静脉血: 2.210E9/L\n- [全程D85] 检验组合: 总胆固醇(TC)-静脉血: 5mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 41U/L；球蛋白(GLO)-静脉血: 29.79g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.3；血液二氧化碳含量ctCO2(B)-静脉血: 20.9mmol/L；钠离子(Na+)-静脉血: 137.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.12g/L；载脂蛋白B(apoB)-静脉血: 1.02g/L；丙氨酸氨基转移酶(ALT)-静脉血: 15.3U/L；阴离子间隙(AG)-静脉血: 16；氯离子(Cl-)-静脉血: 100.4mmol/L；磷(P)-静脉血: 1.27mmol/L；总钙(Ca)-静脉血: 2.29mmol/L；总胆红素(TBIL)-静脉血: 10.7umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 32.1U/L；尿酸(UA)-静脉血: 642.2umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.2mmol/L；钾离子(K+)-静脉血: 4.6mmol/L；镁离子(Mg2+)-静脉血: 0.56mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20.5U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；间接胆红素(IBIL)-静脉血: 6.8umolL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；胱抑素(Cys-C)-静脉血: 1.89mg/L；肌酐(Crea)-静脉血: 171.5umol/L；碱性磷酸酶(ALP)-静脉血: 55.8U/L；乳酸脱氢酶(LDH)-静脉血: 182U/L；总胆汁酸(TBA)-静脉血: 1.2umol/L；总蛋白(TP)-静脉血: 72.99g/L；直接胆红素(DBIL)-静脉血: 3.9umol/L；C-反应蛋白(CRP)-静脉血: 2.96mg/L；甘油三酯(TG)-静脉血: 2.22mmol/L；葡萄糖(Glu)-静脉血: 6.63mmol/L；尿素氮(BUN)-静脉血: 10.78mmol/L；白蛋白(ALB)-静脉血: 43.2g/L\n- [全程D92] 检验组合: 嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；单核细胞百分比(Mono%)-静脉血: 0.13；中性粒细胞计数(Neut#)-静脉血: 5.310E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.7pg；血小板比容-静脉血: 24%；红细胞计数(RBC#)-静脉血: 3.3610E12/L；平均红细胞体积(MCV)-静脉血: 89.9fL；血红蛋白(Hb)-静脉血: 103g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.9；单核细胞计数(Mono#)-静脉血: 0.910E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；血小板计数(PLT#)-静脉血: 26210E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；大血小板百分比(P-LCR%)-静脉血: 17.3%；白细胞计数(WBC#)-静脉血: 710E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.103；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.8；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；中性粒细胞百分比(Neut%)-静脉血: 0.757；红细胞比容(Hct)-静脉血: 30.2%；血小板分布宽度(PDW)-静脉血: 9.9%；平均血小板体积(MPV)-静脉血: 9.1fL\n- [全程D99] 检验组合: 球蛋白(GLO)-静脉血: 25.82g/L；血小板比容-静脉血: 12%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 4.5umol/L；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 14.7mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.104；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；总胆红素(TBIL)-静脉血: 11.3umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 33.1U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.1；总钙(Ca)-静脉血: 1.94mmol/L；间接胆红素(IBIL)-静脉血: 6.8umolL；血红蛋白(Hb)-静脉血: 92g/L；肌酐(Crea)-静脉血: 230.6umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.53；单核细胞计数(Mono#)-静脉血: 0.710E9/L；磷(P)-静脉血: 1.43mmol/L；尿素氮(BUN)-静脉血: 14.3mmol/L；尿酸(UA)-静脉血: 664.3umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.5；氯离子(Cl-)-静脉血: 101.4mmol/L；镁离子(Mg2+)-静脉血: 0.39mmol/L；载脂蛋白AI(apoAI)-静脉血: 0.93g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；红细胞比容(Hct)-静脉血: 27.4%；γ-谷氨酰基转移酶(GGT)-静脉血: 32.2U/L；阴离子间隙(AG)-静脉血: 22；血小板分布宽度(PDW)-静脉血: 10.5%；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.41；总蛋白(TP)-静脉血: 65.22g/L；单核细胞百分比(Mono%)-静脉血: 0.138；白蛋白(ALB)-静脉血: 39.4g/L；乳酸脱氢酶(LDH)-静脉血: 174.3U/L；C-反应蛋白(CRP)-静脉血: 5.63mg/L；血小板计数(PLT#)-静脉血: 13410E9/L；总胆汁酸(TBA)-静脉血: 1.9umol/L；胱抑素(Cys-C)-静脉血: 2.57mg/L；葡萄糖(Glu)-静脉血: 6.63mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.1U/L；钠离子(Na+)-静脉血: 138.1mmol/L；总胆固醇(TC)-静脉血: 3.96mmol/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L\n- [全程D103] 检验组合: 白蛋白(ALB)-静脉血: 38.8g/L；肌酐(Crea)-静脉血: 213.9umol/L；球蛋白(GLO)-静脉血: 26.15g/L；间接胆红素(IBIL)-静脉血: 6.6umolL；总胆红素(TBIL)-静脉血: 10.9umol/L；总蛋白(TP)-静脉血: 64.95g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.48；直接胆红素(DBIL)-静脉血: 4.3umol/L；尿素氮(BUN)-静脉血: 14.5mmol/L；尿酸(UA)-静脉血: 660.5umol/L\n- [全程D106] 检验组合: 平均血小板体积(MPV)-静脉血: 9.5fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44.6；血小板计数(PLT#)-静脉血: 7110E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；血红蛋白(Hb)-静脉血: 75g/L；红细胞比容(Hct)-静脉血: 21.6%；白细胞计数(WBC#)-静脉血: 3.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.089；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；单核细胞计数(Mono#)-静脉血: 0.310E9/L；血小板分布宽度(PDW)-静脉血: 9.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 31.9pg；中性粒细胞百分比(Neut%)-静脉血: 0.784；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；大血小板百分比(P-LCR%)-静脉血: 20.6%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.098；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板比容-静脉血: 6%；红细胞计数(RBC#)-静脉血: 2.3510E12/L；平均红细胞体积(MCV)-静脉血: 91.9fL\n- [全程D109] 检验组合: 红细胞比容(Hct)-静脉血: 21.5%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.7；白细胞计数(WBC#)-静脉血: 4.210E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.4pg；单核细胞百分比(Mono%)-静脉血: 0.057；平均红细胞血红蛋白浓度(MCHC)-静脉血: 335g/L；血红蛋白(Hb)-静脉血: 72g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；红细胞计数(RBC#)-静脉血: 2.2910E12/L；血小板计数(PLT#)-静脉血: 6210E9/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.041；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；大血小板百分比(P-LCR%)-静脉血: 21.1%；平均血小板体积(MPV)-静脉血: 9.4fL；平均红细胞体积(MCV)-静脉血: 93.9fL；血小板比容-静脉血: 6%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；血小板分布宽度(PDW)-静脉血: 10.3%；中性粒细胞百分比(Neut%)-静脉血: 0.847；淋巴细胞百分比(Lymph%)-静脉血: 0.05；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L\n- [全程D113] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.082；血小板分布宽度(PDW)-静脉血: 10.8%；淋巴细胞百分比(Lymph%)-静脉血: 0.114；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；红细胞比容(Hct)-静脉血: 22.8%；平均血小板体积(MPV)-静脉血: 9.8fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 48.1；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；中性粒细胞计数(Neut#)-静脉血: 1.610E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1；白细胞计数(WBC#)-静脉血: 2.210E9/L；血小板计数(PLT#)-静脉血: 11810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.722；大血小板百分比(P-LCR%)-静脉血: 24.7%；单核细胞计数(Mono#)-静脉血: 0.210E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 320g/L；红细胞计数(RBC#)-静脉血: 2.2910E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.9pg；血小板比容-静脉血: 12%；血红蛋白(Hb)-静脉血: 73g/L；平均红细胞体积(MCV)-静脉血: 99.6fL；单核细胞百分比(Mono%)-静脉血: 0.077；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L\n- [全程D117] 检验组合: 天门冬氨酸氨基转移酶(AST)-静脉血: 14.1U/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；镁离子(Mg2+)-静脉血: 0.67mmol/L；血小板计数(PLT#)-静脉血: 23410E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.72mmolL；中性粒细胞计数(Neut#)-静脉血: 2.410E9/L；胱抑素(Cys-C)-静脉血: 2.73mg/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；血小板分布宽度(PDW)-静脉血: 10.4%；总蛋白(TP)-静脉血: 69.47g/L；大血小板百分比(P-LCR%)-静脉血: 22%；球蛋白(GLO)-静脉血: 32.07g/L；氯离子(Cl-)-静脉血: 102.3mmol/L；尿素氮(BUN)-静脉血: 14.7mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.136；丙氨酸氨基转移酶(ALT)-静脉血: 11.2U/L；葡萄糖(Glu)-静脉血: 7.22mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 19.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 0.81g/L；总胆固醇(TC)-静脉血: 4.12mmol/L；血小板比容-静脉血: 22%；C-反应蛋白(CRP)-静脉血: 15.19mg/L；总胆汁酸(TBA)-静脉血: 2.1umol/L；直接胆红素(DBIL)-静脉血: 2.3umol/L；尿酸(UA)-静脉血: 692umol/L；白细胞计数(WBC#)-静脉血: 3.710E9/L；乳酸脱氢酶(LDH)-静脉血: 178.2U/L；中性粒细胞百分比(Neut%)-静脉血: 0.651；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；肌酐(Crea)-静脉血: 220.1umol/L；红细胞计数(RBC#)-静脉血: 2.3510E12/L；钠离子(Na+)-静脉血: 138.8mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.26；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.6mmol/L；红细胞比容(Hct)-静脉血: 23.1%；钾离子(K+)-静脉血: 4.79mmol/L；白蛋白(ALB)-静脉血: 37.4g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 76g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7；平均红细胞血红蛋白含量(MCH)-静脉血: 32.3pg；总钙(Ca)-静脉血: 2.32mmol/L；阴离子间隙(AG)-静脉血: 17.1；单核细胞计数(Mono#)-静脉血: 0.710E9/L\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 完善鼻咽及颈部MRI评估疗效；取消同期顺铂化疗，予以纠正贫血并单纯根治性调强放疗（或联合靶向治疗）。\nB. 完善鼻咽及颈部MRI评估疗效；按原计划行同期顺铂化疗联合根治性调强放疗。\nC. 完善鼻咽及颈部MRI评估疗效；将同期顺铂减量至40mg/m2周疗，联合根治性调强放疗。\nD. 完善鼻咽及颈部MRI评估疗效；将同期化疗方案更换为卡铂，联合根治性调强放疗。\nE. 完善鼻咽及颈部MRI评估疗效；暂停抗肿瘤治疗，待血红蛋白恢复至100g/L以上后再行同期放化疗。\nF. 完善鼻咽及颈部MRI评估疗效；予以输血支持，待贫血纠正后按原计划行同期顺铂化疗联合调强放疗。\nG. 完善鼻咽及颈部MRI评估疗效；取消同期顺铂化疗，直接行根治性调强放疗，暂不予纠正贫血。\nH. 完善鼻咽及颈部MRI评估疗效；将同期化疗方案更换为氟尿嘧啶单药，联合根治性调强放疗。\nI. 完善鼻咽及颈部MRI评估疗效；取消同期顺铂化疗，予以纠正贫血并联合PD-1抑制剂及调强放疗。\nJ. 完善鼻咽及颈部MRI评估疗效；将同期化疗方案更换为吉西他滨单药，联合根治性调强放疗。\nK. 完善鼻咽及颈部MRI评估疗效；取消放疗，继续行非铂类方案（如紫杉醇单药）化疗。\n\n请仅输出一个选项字母（A-K）。","gold_letter":"A","gold_action":"完善鼻咽及颈部MRI评估疗效；取消同期顺铂化疗，予以纠正贫血并单纯根治性调强放疗（或联合靶向治疗）。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"完善鼻咽及颈部MRI评估疗效；取消同期顺铂化疗，予以纠正贫血并单纯根治性调强放疗（或联合靶向治疗）。"},{"letter":"B","text":"完善鼻咽及颈部MRI评估疗效；按原计划行同期顺铂化疗联合根治性调强放疗。"},{"letter":"C","text":"完善鼻咽及颈部MRI评估疗效；将同期顺铂减量至40mg/m2周疗，联合根治性调强放疗。"},{"letter":"D","text":"完善鼻咽及颈部MRI评估疗效；将同期化疗方案更换为卡铂，联合根治性调强放疗。"},{"letter":"E","text":"完善鼻咽及颈部MRI评估疗效；暂停抗肿瘤治疗，待血红蛋白恢复至100g/L以上后再行同期放化疗。"},{"letter":"F","text":"完善鼻咽及颈部MRI评估疗效；予以输血支持，待贫血纠正后按原计划行同期顺铂化疗联合调强放疗。"},{"letter":"G","text":"完善鼻咽及颈部MRI评估疗效；取消同期顺铂化疗，直接行根治性调强放疗，暂不予纠正贫血。"},{"letter":"H","text":"完善鼻咽及颈部MRI评估疗效；将同期化疗方案更换为氟尿嘧啶单药，联合根治性调强放疗。"},{"letter":"I","text":"完善鼻咽及颈部MRI评估疗效；取消同期顺铂化疗，予以纠正贫血并联合PD-1抑制剂及调强放疗。"},{"letter":"J","text":"完善鼻咽及颈部MRI评估疗效；将同期化疗方案更换为吉西他滨单药，联合根治性调强放疗。"},{"letter":"K","text":"完善鼻咽及颈部MRI评估疗效；取消放疗，继续行非铂类方案（如紫杉醇单药）化疗。"}]}
+{"sample_id":"sample-340a8b44018e54c31bcf1d9c","patient_id":"patient-9bf5c8c03860cdf61108611d","turn_id":"turn08","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D0] 检验组合: 隐血(OB)-粪便: 阴性（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-粪便: 棕色；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；比重(SG)-尿液: 1.021；浊度(TRUB)-尿液: 清亮；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 5.5；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；白细胞计数(WBC#)-尿液: 3/μL；虫卵-粪便: 未见虫卵（参考: 未见虫卵）\n- [全程D78] 检验组合: 嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；红细胞比容(Hct)-静脉血: 31.2%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；血小板计数(PLT#)-静脉血: 22110E9/L；血小板比容-静脉血: 20%；大血小板百分比(P-LCR%)-静脉血: 19.1%；单核细胞百分比(Mono%)-静脉血: 0.108；血红蛋白(Hb)-静脉血: 108g/L；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；血小板分布宽度(PDW)-静脉血: 10%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.02；白细胞计数(WBC#)-静脉血: 4.510E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.653；平均红细胞体积(MCV)-静脉血: 86.9fL；平均血小板体积(MPV)-静脉血: 9.2fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.9；中性粒细胞计数(Neut#)-静脉血: 310E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.215；平均红细胞血红蛋白浓度(MCHC)-静脉血: 346g/L；红细胞计数(RBC#)-静脉血: 3.5910E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；单核细胞计数(Mono#)-静脉血: 0.510E9/L\n- [全程D85] 检验组合: 平均血小板体积(MPV)-静脉血: 9fL；血小板计数(PLT#)-静脉血: 26310E9/L；血小板分布宽度(PDW)-静脉血: 9.9%；淋巴细胞计数(Lymph#)-静脉血: 1.210E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.9；血红蛋白(Hb)-静脉血: 103g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；平均红细胞体积(MCV)-静脉血: 88.5fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.7；白细胞计数(WBC#)-静脉血: 4.2910E9/L；大血小板百分比(P-LCR%)-静脉血: 17.7%；单核细胞百分比(Mono%)-静脉血: 0.191；平均红细胞血红蛋白含量(MCH)-静脉血: 30.3pg；血小板比容-静脉血: 24%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 342g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞计数(RBC#)-静脉血: 3.410E12/L；红细胞比容(Hct)-静脉血: 30.1%；淋巴细胞百分比(Lymph%)-静脉血: 0.27；中性粒细胞百分比(Neut%)-静脉血: 0.513；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.021；单核细胞计数(Mono#)-静脉血: 0.810E9/L；中性粒细胞计数(Neut#)-静脉血: 2.210E9/L\n- [全程D85] 检验组合: 总胆固醇(TC)-静脉血: 5mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 41U/L；球蛋白(GLO)-静脉血: 29.79g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.3；血液二氧化碳含量ctCO2(B)-静脉血: 20.9mmol/L；钠离子(Na+)-静脉血: 137.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.12g/L；载脂蛋白B(apoB)-静脉血: 1.02g/L；丙氨酸氨基转移酶(ALT)-静脉血: 15.3U/L；阴离子间隙(AG)-静脉血: 16；氯离子(Cl-)-静脉血: 100.4mmol/L；磷(P)-静脉血: 1.27mmol/L；总钙(Ca)-静脉血: 2.29mmol/L；总胆红素(TBIL)-静脉血: 10.7umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 32.1U/L；尿酸(UA)-静脉血: 642.2umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.2mmol/L；钾离子(K+)-静脉血: 4.6mmol/L；镁离子(Mg2+)-静脉血: 0.56mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20.5U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；间接胆红素(IBIL)-静脉血: 6.8umolL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；胱抑素(Cys-C)-静脉血: 1.89mg/L；肌酐(Crea)-静脉血: 171.5umol/L；碱性磷酸酶(ALP)-静脉血: 55.8U/L；乳酸脱氢酶(LDH)-静脉血: 182U/L；总胆汁酸(TBA)-静脉血: 1.2umol/L；总蛋白(TP)-静脉血: 72.99g/L；直接胆红素(DBIL)-静脉血: 3.9umol/L；C-反应蛋白(CRP)-静脉血: 2.96mg/L；甘油三酯(TG)-静脉血: 2.22mmol/L；葡萄糖(Glu)-静脉血: 6.63mmol/L；尿素氮(BUN)-静脉血: 10.78mmol/L；白蛋白(ALB)-静脉血: 43.2g/L\n- [全程D92] 检验组合: 嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；单核细胞百分比(Mono%)-静脉血: 0.13；中性粒细胞计数(Neut#)-静脉血: 5.310E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.7pg；血小板比容-静脉血: 24%；红细胞计数(RBC#)-静脉血: 3.3610E12/L；平均红细胞体积(MCV)-静脉血: 89.9fL；血红蛋白(Hb)-静脉血: 103g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.9；单核细胞计数(Mono#)-静脉血: 0.910E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；血小板计数(PLT#)-静脉血: 26210E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；大血小板百分比(P-LCR%)-静脉血: 17.3%；白细胞计数(WBC#)-静脉血: 710E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.103；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.8；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；中性粒细胞百分比(Neut%)-静脉血: 0.757；红细胞比容(Hct)-静脉血: 30.2%；血小板分布宽度(PDW)-静脉血: 9.9%；平均血小板体积(MPV)-静脉血: 9.1fL\n- [全程D99] 检验组合: 球蛋白(GLO)-静脉血: 25.82g/L；血小板比容-静脉血: 12%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 4.5umol/L；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 14.7mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.104；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；总胆红素(TBIL)-静脉血: 11.3umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 33.1U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.1；总钙(Ca)-静脉血: 1.94mmol/L；间接胆红素(IBIL)-静脉血: 6.8umolL；血红蛋白(Hb)-静脉血: 92g/L；肌酐(Crea)-静脉血: 230.6umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.53；单核细胞计数(Mono#)-静脉血: 0.710E9/L；磷(P)-静脉血: 1.43mmol/L；尿素氮(BUN)-静脉血: 14.3mmol/L；尿酸(UA)-静脉血: 664.3umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.5；氯离子(Cl-)-静脉血: 101.4mmol/L；镁离子(Mg2+)-静脉血: 0.39mmol/L；载脂蛋白AI(apoAI)-静脉血: 0.93g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；红细胞比容(Hct)-静脉血: 27.4%；γ-谷氨酰基转移酶(GGT)-静脉血: 32.2U/L；阴离子间隙(AG)-静脉血: 22；血小板分布宽度(PDW)-静脉血: 10.5%；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.41；总蛋白(TP)-静脉血: 65.22g/L；单核细胞百分比(Mono%)-静脉血: 0.138；白蛋白(ALB)-静脉血: 39.4g/L；乳酸脱氢酶(LDH)-静脉血: 174.3U/L；C-反应蛋白(CRP)-静脉血: 5.63mg/L；血小板计数(PLT#)-静脉血: 13410E9/L；总胆汁酸(TBA)-静脉血: 1.9umol/L；胱抑素(Cys-C)-静脉血: 2.57mg/L；葡萄糖(Glu)-静脉血: 6.63mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.1U/L；钠离子(Na+)-静脉血: 138.1mmol/L；总胆固醇(TC)-静脉血: 3.96mmol/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L\n- [全程D103] 检验组合: 白蛋白(ALB)-静脉血: 38.8g/L；肌酐(Crea)-静脉血: 213.9umol/L；球蛋白(GLO)-静脉血: 26.15g/L；间接胆红素(IBIL)-静脉血: 6.6umolL；总胆红素(TBIL)-静脉血: 10.9umol/L；总蛋白(TP)-静脉血: 64.95g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.48；直接胆红素(DBIL)-静脉血: 4.3umol/L；尿素氮(BUN)-静脉血: 14.5mmol/L；尿酸(UA)-静脉血: 660.5umol/L\n- [全程D106] 检验组合: 平均血小板体积(MPV)-静脉血: 9.5fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44.6；血小板计数(PLT#)-静脉血: 7110E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；血红蛋白(Hb)-静脉血: 75g/L；红细胞比容(Hct)-静脉血: 21.6%；白细胞计数(WBC#)-静脉血: 3.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.089；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；单核细胞计数(Mono#)-静脉血: 0.310E9/L；血小板分布宽度(PDW)-静脉血: 9.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 31.9pg；中性粒细胞百分比(Neut%)-静脉血: 0.784；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；大血小板百分比(P-LCR%)-静脉血: 20.6%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.098；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板比容-静脉血: 6%；红细胞计数(RBC#)-静脉血: 2.3510E12/L；平均红细胞体积(MCV)-静脉血: 91.9fL\n- [全程D109] 检验组合: 红细胞比容(Hct)-静脉血: 21.5%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.7；白细胞计数(WBC#)-静脉血: 4.210E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.4pg；单核细胞百分比(Mono%)-静脉血: 0.057；平均红细胞血红蛋白浓度(MCHC)-静脉血: 335g/L；血红蛋白(Hb)-静脉血: 72g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；红细胞计数(RBC#)-静脉血: 2.2910E12/L；血小板计数(PLT#)-静脉血: 6210E9/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.041；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；大血小板百分比(P-LCR%)-静脉血: 21.1%；平均血小板体积(MPV)-静脉血: 9.4fL；平均红细胞体积(MCV)-静脉血: 93.9fL；血小板比容-静脉血: 6%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；血小板分布宽度(PDW)-静脉血: 10.3%；中性粒细胞百分比(Neut%)-静脉血: 0.847；淋巴细胞百分比(Lymph%)-静脉血: 0.05；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L\n- [全程D113] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.082；血小板分布宽度(PDW)-静脉血: 10.8%；淋巴细胞百分比(Lymph%)-静脉血: 0.114；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；红细胞比容(Hct)-静脉血: 22.8%；平均血小板体积(MPV)-静脉血: 9.8fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 48.1；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；中性粒细胞计数(Neut#)-静脉血: 1.610E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1；白细胞计数(WBC#)-静脉血: 2.210E9/L；血小板计数(PLT#)-静脉血: 11810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.722；大血小板百分比(P-LCR%)-静脉血: 24.7%；单核细胞计数(Mono#)-静脉血: 0.210E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 320g/L；红细胞计数(RBC#)-静脉血: 2.2910E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.9pg；血小板比容-静脉血: 12%；血红蛋白(Hb)-静脉血: 73g/L；平均红细胞体积(MCV)-静脉血: 99.6fL；单核细胞百分比(Mono%)-静脉血: 0.077；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L\n- [全程D117] 检验组合: 天门冬氨酸氨基转移酶(AST)-静脉血: 14.1U/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；镁离子(Mg2+)-静脉血: 0.67mmol/L；血小板计数(PLT#)-静脉血: 23410E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.72mmolL；中性粒细胞计数(Neut#)-静脉血: 2.410E9/L；胱抑素(Cys-C)-静脉血: 2.73mg/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；血小板分布宽度(PDW)-静脉血: 10.4%；总蛋白(TP)-静脉血: 69.47g/L；大血小板百分比(P-LCR%)-静脉血: 22%；球蛋白(GLO)-静脉血: 32.07g/L；氯离子(Cl-)-静脉血: 102.3mmol/L；尿素氮(BUN)-静脉血: 14.7mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.136；丙氨酸氨基转移酶(ALT)-静脉血: 11.2U/L；葡萄糖(Glu)-静脉血: 7.22mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 19.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 0.81g/L；总胆固醇(TC)-静脉血: 4.12mmol/L；血小板比容-静脉血: 22%；C-反应蛋白(CRP)-静脉血: 15.19mg/L；总胆汁酸(TBA)-静脉血: 2.1umol/L；直接胆红素(DBIL)-静脉血: 2.3umol/L；尿酸(UA)-静脉血: 692umol/L；白细胞计数(WBC#)-静脉血: 3.710E9/L；乳酸脱氢酶(LDH)-静脉血: 178.2U/L；中性粒细胞百分比(Neut%)-静脉血: 0.651；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；肌酐(Crea)-静脉血: 220.1umol/L；红细胞计数(RBC#)-静脉血: 2.3510E12/L；钠离子(Na+)-静脉血: 138.8mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.26；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.6mmol/L；红细胞比容(Hct)-静脉血: 23.1%；钾离子(K+)-静脉血: 4.79mmol/L；白蛋白(ALB)-静脉血: 37.4g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 76g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7；平均红细胞血红蛋白含量(MCH)-静脉血: 32.3pg；总钙(Ca)-静脉血: 2.32mmol/L；阴离子间隙(AG)-静脉血: 17.1；单核细胞计数(Mono#)-静脉血: 0.710E9/L\n- [全程D209] CT；胸、上腹CT平扫+增强: 检查类型: CT；检查名称: 胸、上腹CT平扫+增强；检查部位:；检查所见: 双肺纹理清晰，未见结节影；气管及支气管分枝通畅，未见明显软组织肿物或受压变窄；双锁上、双腋窝、双肺门及纵隔未见明显肿大淋巴结；双侧胸腔未见积液；胸膜未见增厚。 肝脏形态正常，比例正常，外形轮廓光整，密度均匀，快速注射造影剂后，动脉期未见明确异常强化灶，门脉期及平衡期未见明确低密度区，肝内见数个（约3个）囊肿影，大小约为 4 × 3 mm至 12 × 10 mm，边界清楚，密度均匀，未见强化；肝内胆管未见扩张，胆囊大小正常，内未见结石影，胆总管未见扩张；肝门区未见肿大淋巴结；门静脉未见充盈缺损；脾大小正常，密度均匀；胰腺大小、形态正常，密度均匀；双肾大小、形态正常，排泌功能正常，双肾见多个囊肿影，大小约为 3 × 3 mm 至 60 × 40 mm；双侧肾上腺大小、形态、密度正常；膈脚后、腹主动脉旁未见肿大淋巴结。 扫描范围内胸椎、腰椎、肋骨未见明确骨质破坏征象。；检查结论: 胸部、腹部未见明显占位性病变， 肝、肾囊肿。\n- [全程D210] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌放疗后复查： 鼻咽腔变窄，鼻咽各壁粘膜增厚，T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化，双侧咽隐窝变浅。口咽双侧壁未见受累增厚，病变未累及双侧后鼻孔。 双侧腭帆提肌结构欠清晰，双侧腭帆张肌及头长肌、双侧翼内外肌未见受侵征象。 双侧翼腭窝、双侧上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 双侧翼突基底部及内板骨质信号减低，增强扫描可见轻度强化。 双侧海绵窦形态未见异常。 双侧筛窦、双侧上颌窦粘膜增厚，增强扫描呈轻度强化。双侧乳突内见分泌物。 双眼未见异常，球后未见占位性病变。蝶鞍形态未见异常，其内未见占位性病变。 双侧咽后未见肿大淋巴结。 双颈II区、III区见多个小淋巴结，最大约6mm×13mm，部分边界欠，呈明显强化。 甲状腺双叶及峡部形态未见异常，信号均匀，未见占位性病变。 喉咽腔形态未见异常，未见占位性病变。 双侧颌下腺、腮腺大小、形态未见异常，信号均匀，未见占位性病变。 扫描所见脑组织未见明确异常。；检查结论: 鼻咽癌放疗后复查，与某次就诊时间片比较： 鼻咽肿物已不明显，现鼻咽粘膜增厚，考虑放疗后改变可能，建议随诊。 颅底骨质异常信号，放疗后改变？建议随诊。 双侧咽后未见肿大淋巴结。 双颈II、III区小淋巴结，较前明显缩小。 鼻窦炎；双侧乳突炎。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 判定为局部残留，行鼻咽及颈部挽救性手术\nB. 判定为放疗后改变或临床完全缓解，进入定期随访观察\nC. 判定为局部残留，行鼻咽及颈部局部追加放疗\nD. 判定为疾病稳定，启动卡培他滨维持化疗\nE. 判定为疾病进展，启动含铂双药联合免疫全身治疗\nF. 判定为放疗后改变，启动尼妥珠单抗靶向维持治疗\nG. 判定为颈部淋巴结残留，行双侧颈淋巴结清扫术\nH. 判定为颅底骨质受侵进展，行颅底病灶切除术\nI. 判定为疗效不确定，行全身PET-CT检查明确病灶活性\nJ. 判定为放疗后改变，行鼻咽黏膜活检排除微小残留\nK. 判定为临床完全缓解，启动PD-1抑制剂维持治疗\nL. 判定为局部残留，行原全身化疗方案追加2个周期\n\n请仅输出一个选项字母（A-L）。","gold_letter":"B","gold_action":"判定为放疗后改变或临床完全缓解，进入定期随访观察","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"判定为局部残留，行鼻咽及颈部挽救性手术"},{"letter":"B","text":"判定为放疗后改变或临床完全缓解，进入定期随访观察"},{"letter":"C","text":"判定为局部残留，行鼻咽及颈部局部追加放疗"},{"letter":"D","text":"判定为疾病稳定，启动卡培他滨维持化疗"},{"letter":"E","text":"判定为疾病进展，启动含铂双药联合免疫全身治疗"},{"letter":"F","text":"判定为放疗后改变，启动尼妥珠单抗靶向维持治疗"},{"letter":"G","text":"判定为颈部淋巴结残留，行双侧颈淋巴结清扫术"},{"letter":"H","text":"判定为颅底骨质受侵进展，行颅底病灶切除术"},{"letter":"I","text":"判定为疗效不确定，行全身PET-CT检查明确病灶活性"},{"letter":"J","text":"判定为放疗后改变，行鼻咽黏膜活检排除微小残留"},{"letter":"K","text":"判定为临床完全缓解，启动PD-1抑制剂维持治疗"},{"letter":"L","text":"判定为局部残留，行原全身化疗方案追加2个周期"}]}
+{"sample_id":"sample-6a54e1ca8d841063a11b801b","patient_id":"patient-f402aced5926698da3194c37","turn_id":"turn01","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左颈肿物20余天；现病史: 20余天前患者无明显诱因自觉左颈肿物，无发热、疼痛，伴涕血、左耳堵塞感。无头痛、面麻、鼻塞、复视、张口困难等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左耳闷胀感,涕血,左颈肿物；既往史: 高血压10余年，规律服药，血压控制在130/80mmHg左右。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:穿山甲壳、蜂蛹、伟哥过敏。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 大儿子患“脑胶质瘤”，已病逝。；体格检查: T：36.4℃，P：66次/分，R：20次/分，BP：134/81mmHg,Ht：175cm，Wt：84kg，BSA：2.0m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽顶后壁、左侧壁结节状肿物；双侧颈部II区可扪及1个淋巴结，最大径6×5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 电子鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸部及腹部CT平扫，常规血液学检查。\nB. 颈部淋巴结切除活检，鼻咽及颈部MRI平扫+增强，全身PET/CT显像，常规血液学检查。\nC. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，颈部超声，暂缓全身影像学分期。\nD. 鼻咽及颈部MRI平扫+增强，全身PET/CT显像，先行诱导化疗待肿瘤缩小后行鼻咽活检。\nE. 电子鼻咽镜检查及活检，鼻咽MRI平扫+增强，胸部X线，腹部超声，全身骨显像。\nF. 颈部淋巴结细针穿刺活检，鼻咽及颈部CT平扫+增强，全身PET/CT显像，常规血液学检查。\nG. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT显像，常规血液学、心电图与心脏彩超检查。\nH. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸腹部CT平扫+增强，免除全身骨显像。\nI. 电子鼻咽镜检查及活检，头颅MRI平扫+增强，颈部超声，全身PET/CT显像，常规血液学检查。\nJ. 鼻咽刷片细胞学检查，鼻咽及颈部MRI平扫+增强，全身PET/CT显像，常规血液学检查。\nK. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫，全身PET/CT显像，常规血液学检查。\nL. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT显像，同步安排根治性放疗定位。\n\n请仅输出一个选项字母（A-L）。","gold_letter":"G","gold_action":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT显像，常规血液学、心电图与心脏彩超检查。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"电子鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸部及腹部CT平扫，常规血液学检查。"},{"letter":"B","text":"颈部淋巴结切除活检，鼻咽及颈部MRI平扫+增强，全身PET/CT显像，常规血液学检查。"},{"letter":"C","text":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，颈部超声，暂缓全身影像学分期。"},{"letter":"D","text":"鼻咽及颈部MRI平扫+增强，全身PET/CT显像，先行诱导化疗待肿瘤缩小后行鼻咽活检。"},{"letter":"E","text":"电子鼻咽镜检查及活检，鼻咽MRI平扫+增强，胸部X线，腹部超声，全身骨显像。"},{"letter":"F","text":"颈部淋巴结细针穿刺活检，鼻咽及颈部CT平扫+增强，全身PET/CT显像，常规血液学检查。"},{"letter":"G","text":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT显像，常规血液学、心电图与心脏彩超检查。"},{"letter":"H","text":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸腹部CT平扫+增强，免除全身骨显像。"},{"letter":"I","text":"电子鼻咽镜检查及活检，头颅MRI平扫+增强，颈部超声，全身PET/CT显像，常规血液学检查。"},{"letter":"J","text":"鼻咽刷片细胞学检查，鼻咽及颈部MRI平扫+增强，全身PET/CT显像，常规血液学检查。"},{"letter":"K","text":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫，全身PET/CT显像，常规血液学检查。"},{"letter":"L","text":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT显像，同步安排根治性放疗定位。"}]}
+{"sample_id":"sample-1d99d3a2f71afa9bcb3f941a","patient_id":"patient-f402aced5926698da3194c37","turn_id":"turn02","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左颈肿物20余天；现病史: 20余天前患者无明显诱因自觉左颈肿物，无发热、疼痛，伴涕血、左耳堵塞感。无头痛、面麻、鼻塞、复视、张口困难等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左耳闷胀感,涕血,左颈肿物；既往史: 高血压10余年，规律服药，血压控制在130/80mmHg左右。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:穿山甲壳、蜂蛹、伟哥过敏。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 大儿子患“脑胶质瘤”，已病逝。；体格检查: T：36.4℃，P：66次/分，R：20次/分，BP：134/81mmHg,Ht：175cm，Wt：84kg，BSA：2.0m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽顶后壁、左侧壁结节状肿物；双侧颈部II区可扪及1个淋巴结，最大径6×5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 ST-T轻度改变\n- [全程D1] 检验组合: 梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；有核红细胞计数(NRBC#)-静脉血: 010E9/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；单核细胞计数(Mono#)-静脉血: 0.510E9/L；胱抑素(Cys-C)-静脉血: 0.76mg/L；磷(P)-静脉血: 1.12mmol/L；纤维蛋白原(Fbg)-静脉血: 3.32g/L；Rh血型-静脉血: 阳性；血红蛋白(Hb)-静脉血: 136.2g/L；ABO血型-静脉血: O；骨钙素N端中分子片段(N-MID)-静脉血: 14.08ng/ml；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；直接胆红素(DBIL)-静脉血: 3.1umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 28.5U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；中性粒细胞百分比(Neut%)-静脉血: 0.617；镁离子(Mg2+)-静脉血: 0.88mmol/L；白细胞计数(WBC#)-静脉血: 7.0810E9/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 26.4U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.295ng/ml（参考: <0.704）；凝血酶原时间活动度(PTA)-静脉血: 120%；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.9mmol/L；血小板比容-静脉血: 18.3%；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.05S/CO；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.23mmolL；平均红细胞血红蛋白含量(MCH)-静脉血: 30pg；单核细胞百分比(Mono%)-静脉血: 0.072；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；总蛋白(TP)-静脉血: 71.09g/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；尿素氮(BUN)-静脉血: 5.28mmol/L；中性粒细胞计数(Neut#)-静脉血: 4.410E9/L；白蛋白(ALB)-静脉血: 40.3g/L；层粘连蛋白(LN)-静脉血: 26.4ng/ml；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: > 250.00IU/mL；血小板计数(PLT#)-静脉血: 27710E9/L；氯离子(Cl-)-静脉血: 107.2mmol/L；D-二聚体(D-Dimer)-静脉血: 0.55ug/ml；红细胞比容(Hct)-静脉血: 40.3%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.46mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.6mmol/L\n- [全程D3] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及左侧壁粘膜增厚放射性浓聚，SUV约14.5，病灶累及蝶骨基底部、枕骨斜坡、左侧翼突、左岩尖、左侧破裂孔及左侧鼻后孔。双侧咽隐窝消失。双侧咽后未见明显肿大淋巴结及异常放射性分布。口咽及喉咽结构及放射性分布未见明显异常。左侧上颌窦及蝶窦内见低密度影放射性分布未见明显异常，额窦、筛窦及右侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双颈Ⅱ区多发肿大淋巴结放射性浓聚，SUV约14.2，最大约2.2×2.6cm。 双侧苍白球钙化放射性分布缺损，余所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。左肾盂小结石放射性分布缺损。脾脏、胰腺、右肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺小点状钙化灶。余盆腔放射性分布均匀，膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 所见颅盖骨、余躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽顶壁、顶后壁及左侧壁粘膜增厚代谢活跃，考虑鼻咽癌，病灶累及颅底骨、左侧破裂孔及左侧鼻后孔；双颈Ⅱ区多发肿大淋巴结代谢活跃，考虑转移。 左侧上颌窦及蝶窦炎症。 左肾盂小结石。 前列腺钙化。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行颈部淋巴结细针穿刺活检，完善鼻咽及颈部CT平扫+增强，查乙肝病毒DNA定量\nB. 行鼻咽内镜组织活检，完善鼻咽及颈部CT平扫+增强，查乙肝病毒DNA定量\nC. 行鼻咽内镜组织活检，完善鼻咽及颈部MRI平扫+增强，暂不查乙肝病毒DNA定量\nD. 行颈部淋巴结切除活检，完善鼻咽及颈部MRI平扫+增强，查乙肝病毒DNA定量\nE. 行鼻咽内镜组织活检，完善鼻咽及颈部CT平扫+增强，查丙肝病毒RNA定量\nF. 行鼻咽内镜组织活检，完善头颅MRI平扫+增强，查乙肝病毒DNA定量\nG. 行颈部淋巴结细针穿刺活检，完善鼻咽及颈部MRI平扫+增强，暂不查乙肝病毒DNA定量\nH. 行鼻咽内镜组织活检，完善鼻咽及颈部MRI平扫+增强，查乙肝病毒DNA定量\nI. 行鼻咽内镜组织活检及颈部淋巴结穿刺活检，完善鼻咽及颈部MRI平扫+增强\nJ. 行鼻咽内镜组织活检，完善鼻咽及颈部MRI平扫+增强，查丙肝病毒RNA定量\nK. 行鼻咽内镜组织活检，完善颈部超声造影，查乙肝病毒DNA定量\nL. 行鼻咽内镜组织活检，完善全身骨扫描，查乙肝病毒DNA定量\n\n请仅输出一个选项字母（A-L）。","gold_letter":"H","gold_action":"行鼻咽内镜组织活检，完善鼻咽及颈部MRI平扫+增强，查乙肝病毒DNA定量","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"行颈部淋巴结细针穿刺活检，完善鼻咽及颈部CT平扫+增强，查乙肝病毒DNA定量"},{"letter":"B","text":"行鼻咽内镜组织活检，完善鼻咽及颈部CT平扫+增强，查乙肝病毒DNA定量"},{"letter":"C","text":"行鼻咽内镜组织活检，完善鼻咽及颈部MRI平扫+增强，暂不查乙肝病毒DNA定量"},{"letter":"D","text":"行颈部淋巴结切除活检，完善鼻咽及颈部MRI平扫+增强，查乙肝病毒DNA定量"},{"letter":"E","text":"行鼻咽内镜组织活检，完善鼻咽及颈部CT平扫+增强，查丙肝病毒RNA定量"},{"letter":"F","text":"行鼻咽内镜组织活检，完善头颅MRI平扫+增强，查乙肝病毒DNA定量"},{"letter":"G","text":"行颈部淋巴结细针穿刺活检，完善鼻咽及颈部MRI平扫+增强，暂不查乙肝病毒DNA定量"},{"letter":"H","text":"行鼻咽内镜组织活检，完善鼻咽及颈部MRI平扫+增强，查乙肝病毒DNA定量"},{"letter":"I","text":"行鼻咽内镜组织活检及颈部淋巴结穿刺活检，完善鼻咽及颈部MRI平扫+增强"},{"letter":"J","text":"行鼻咽内镜组织活检，完善鼻咽及颈部MRI平扫+增强，查丙肝病毒RNA定量"},{"letter":"K","text":"行鼻咽内镜组织活检，完善颈部超声造影，查乙肝病毒DNA定量"},{"letter":"L","text":"行鼻咽内镜组织活检，完善全身骨扫描，查乙肝病毒DNA定量"}]}
+{"sample_id":"sample-9fa3bde2f5d0ac4e910cb3cb","patient_id":"patient-f402aced5926698da3194c37","turn_id":"turn05","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 ST-T轻度改变\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D3] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及左侧壁粘膜增厚放射性浓聚，SUV约14.5，病灶累及蝶骨基底部、枕骨斜坡、左侧翼突、左岩尖、左侧破裂孔及左侧鼻后孔。双侧咽隐窝消失。双侧咽后未见明显肿大淋巴结及异常放射性分布。口咽及喉咽结构及放射性分布未见明显异常。左侧上颌窦及蝶窦内见低密度影放射性分布未见明显异常，额窦、筛窦及右侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双颈Ⅱ区多发肿大淋巴结放射性浓聚，SUV约14.2，最大约2.2×2.6cm。 双侧苍白球钙化放射性分布缺损，余所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。左肾盂小结石放射性分布缺损。脾脏、胰腺、右肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺小点状钙化灶。余盆腔放射性分布均匀，膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 所见颅盖骨、余躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽顶壁、顶后壁及左侧壁粘膜增厚代谢活跃，考虑鼻咽癌，病灶累及颅底骨、左侧破裂孔及左侧鼻后孔；双颈Ⅱ区多发肿大淋巴结代谢活跃，考虑转移。 左侧上颌窦及蝶窦炎症。 左肾盂小结石。 前列腺钙化。\n- [全程D6] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽左侧壁、顶壁及后壁增厚，见软组织灶形成，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，病灶占据左侧咽隐窝，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，右侧咽隐窝稍变浅，右侧咽旁脂肪间隙及颈动脉鞘区未见异常； 左侧腭帆提肌、双侧头长肌直接受侵；病灶累及左侧破裂孔、左侧后鼻孔； 双侧侧翼腭窝、颞下窝未见异常；口咽各壁无受累增厚。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部骨质破坏。 双侧海绵窦形态正常，未见增宽。 左侧上颌窦、蝶窦、左侧乳突粘膜稍增厚，双侧筛窦、右侧乳突气化好，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 左侧咽后间隙见小淋巴结，短径约4mm；双颈II区见肿大淋巴结，较大者短径约25mm；左颈III、V区见多发淋巴结，边界清，信号均匀，较大者短径约7mm。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 考虑鼻咽癌可能性大。 颅底骨质破坏。 左侧咽后小淋巴结。 双颈II区淋巴结肿大。\n- [全程D6] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T7上缘水平，估计导管末端位于上腔静脉下段内。；检查结论: PICC管末端位置如上述。\n- [全程D6] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 28mm AO 29mm MV E 0.51m/s EF 73% LV 49mm IVS 9mm A 0.73m/s FS 42% RA 28mm LVPW 10mm RV 18mm PA 20mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 心脏结构及运动未见异常 各房室腔及大血管未探及异常血流信号 左室舒张功能减低，收缩功能正常\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] 检验组合: 镁离子(Mg2+)-静脉血: 0.89mmol/L；总胆红素(TBIL)-静脉血: 13.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 23.7U/L；丙氨酸氨基转移酶(ALT)-静脉血: 21.4U/L；总钙(Ca)-静脉血: 2.2mmol/L；氯离子(Cl-)-静脉血: 104mmol/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；直接胆红素(DBIL)-静脉血: 5umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6；红细胞比容(Hct)-静脉血: 38.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.358；间接胆红素(IBIL)-静脉血: 8.3umolL；平均红细胞体积(MCV)-静脉血: 87.1fL；载脂蛋白AI(apoAI)-静脉血: 1.11g/L；球蛋白(GLO)-静脉血: 29.01g/L；C-反应蛋白(CRP)-静脉血: 13.69mg/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；白细胞计数(WBC#)-静脉血: 4.8310E9/L；碱性磷酸酶(ALP)-静脉血: 70.4U/L；血小板比容-静脉血: 18%；载脂蛋白B(apoB)-静脉血: 0.67g/L；中性粒细胞百分比(Neut%)-静脉血: 0.566；淋巴细胞计数(Lymph#)-静脉血: 1.710E9/L；钾离子(K+)-静脉血: 4.1mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；乳酸脱氢酶(LDH)-静脉血: 203.5U/L；阴离子间隙(AG)-静脉血: 14；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；甘油三酯(TG)-静脉血: 1.28mmol/L；红细胞计数(RBC#)-静脉血: 4.4310E12/L；血小板分布宽度(PDW)-静脉血: 8.5%；单核细胞百分比(Mono%)-静脉血: 0.058；大血小板百分比(P-LCR%)-静脉血: 11.6%；血液二氧化碳含量ctCO2(B)-静脉血: 25.1mmol/L；白蛋白(ALB)-静脉血: 40.2g/L；尿素氮(BUN)-静脉血: 5.8mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.3U/L；尿酸(UA)-静脉血: 378.8umol/L；总胆固醇(TC)-静脉血: 3.66mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；单核细胞计数(Mono#)-静脉血: 0.310E9/L；葡萄糖(Glu)-静脉血: 6.14mmol/L；钠离子(Na+)-静脉血: 142.7mmol/L；血小板计数(PLT#)-静脉血: 22110E9/L；磷(P)-静脉血: 1.1mmol/L\n- [全程D21] 检验组合: 单核细胞百分比(Mono%)-静脉血: 0.062；中性粒细胞百分比(Neut%)-静脉血: 0.67；白细胞计数(WBC#)-静脉血: 5.9710E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.9；平均红细胞血红蛋白含量(MCH)-静脉血: 29.3pg；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 134g/L；红细胞比容(Hct)-静脉血: 41.3%；血小板比容-静脉血: 13%；平均红细胞体积(MCV)-静脉血: 90.4fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；平均血小板体积(MPV)-静脉血: 9.4fL；血小板计数(PLT#)-静脉血: 13810E9/L；中性粒细胞计数(Neut#)-静脉血: 410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 324g/L；血小板分布宽度(PDW)-静脉血: 9.9%；大血小板百分比(P-LCR%)-静脉血: 21.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.255；单核细胞计数(Mono#)-静脉血: 0.410E9/L；红细胞计数(RBC#)-静脉血: 4.5710E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.2\n- [全程D27] 检验组合: 红细胞计数(RBC#)-静脉血: 4.3410E12/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.85mmol/L；血小板计数(PLT#)-静脉血: 255.510E9/L；白细胞计数(WBC#)-静脉血: 6.210E9/L；氯离子(Cl-)-静脉血: 104.9mmol/L；总胆汁酸(TBA)-静脉血: 1umol/L；肌酐(Crea)-静脉血: 96.8umol/L；钾离子(K+)-静脉血: 4.5mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.386；乳酸脱氢酶(LDH)-静脉血: 212.1U/L；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.33mmolL；淋巴细胞计数(Lymph#)-静脉血: 2.410E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21U/L；平均红细胞体积(MCV)-静脉血: 90.1fL；总蛋白(TP)-静脉血: 70.21g/L；丙氨酸氨基转移酶(ALT)-静脉血: 19.6U/L；间接胆红素(IBIL)-静脉血: 4.6umolL；尿酸(UA)-静脉血: 469.1umol/L；血小板比容-静脉血: 15.3%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；甘油三酯(TG)-静脉血: 1.12mmol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白B(apoB)-静脉血: 0.9g/L；平均血小板体积(MPV)-静脉血: 6.02fL；总钙(Ca)-静脉血: 2.25mmol/L；单核细胞百分比(Mono%)-静脉血: 0.066；红细胞比容(Hct)-静脉血: 39.1%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；γ-谷氨酰基转移酶(GGT)-静脉血: 25.5U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.7pg；尿素氮(BUN)-静脉血: 4.22mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341.2g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；中性粒细胞计数(Neut#)-静脉血: 3.310E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总胆固醇(TC)-静脉血: 4.6mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.5U/L；镁离子(Mg2+)-静脉血: 0.96mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.5mmol/L；碱性磷酸酶(ALP)-静脉血: 71.3U/L；钠离子(Na+)-静脉血: 142.8mmol/L；球蛋白(GLO)-静脉血: 29.01g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.6%\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者第1程5-FU+洛铂方案诱导化疗结束，诉呕吐1次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。上级医师信息已隐藏：患者第1程5-FU+洛铂方案诱导化疗结束，无诉特殊不适，可予出院，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 将第2程洛铂+5-FU诱导化疗减量20%，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nB. 暂停第2程诱导化疗，仅给予肠内营养及护胃支持，待胃肠道症状完全缓解后再评估化疗指征\nC. 按原剂量执行第2程洛铂+5-FU诱导化疗，并预防性给予重组人粒细胞集落刺激因子及止吐护胃支持治疗\nD. 按原剂量执行第2程洛铂+5-FU诱导化疗，并预防性给予重组人血小板生成素及止吐护胃支持治疗\nE. 将第2程诱导化疗方案更改为吉西他滨+顺铂，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nF. 将第2程诱导化疗方案更改为多西他赛+顺铂，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nG. 终止诱导化疗直接进入根治性放疗及同期化疗，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nH. 延迟第2程诱导化疗1周，期间给予护胃及止吐支持，待胃肠道症状完全缓解后再按原剂量化疗\nI. 按原剂量执行第2程洛铂+5-FU诱导化疗，取消常规止吐及护胃支持，仅在出现严重呕吐时给予解救治疗\nJ. 将第2程洛铂+5-FU诱导化疗减量25%，并预防性给予重组人粒细胞集落刺激因子及止吐护胃支持治疗\nK. 按原剂量执行第2程洛铂+5-FU诱导化疗，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nL. 停用静脉化疗，改为口服卡培他滨单药化疗，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\n\n请仅输出一个选项字母（A-L）。","gold_letter":"K","gold_action":"按原剂量执行第2程洛铂+5-FU诱导化疗，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"将第2程洛铂+5-FU诱导化疗减量20%，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗"},{"letter":"B","text":"暂停第2程诱导化疗，仅给予肠内营养及护胃支持，待胃肠道症状完全缓解后再评估化疗指征"},{"letter":"C","text":"按原剂量执行第2程洛铂+5-FU诱导化疗，并预防性给予重组人粒细胞集落刺激因子及止吐护胃支持治疗"},{"letter":"D","text":"按原剂量执行第2程洛铂+5-FU诱导化疗，并预防性给予重组人血小板生成素及止吐护胃支持治疗"},{"letter":"E","text":"将第2程诱导化疗方案更改为吉西他滨+顺铂，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗"},{"letter":"F","text":"将第2程诱导化疗方案更改为多西他赛+顺铂，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗"},{"letter":"G","text":"终止诱导化疗直接进入根治性放疗及同期化疗，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗"},{"letter":"H","text":"延迟第2程诱导化疗1周，期间给予护胃及止吐支持，待胃肠道症状完全缓解后再按原剂量化疗"},{"letter":"I","text":"按原剂量执行第2程洛铂+5-FU诱导化疗，取消常规止吐及护胃支持，仅在出现严重呕吐时给予解救治疗"},{"letter":"J","text":"将第2程洛铂+5-FU诱导化疗减量25%，并预防性给予重组人粒细胞集落刺激因子及止吐护胃支持治疗"},{"letter":"K","text":"按原剂量执行第2程洛铂+5-FU诱导化疗，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗"},{"letter":"L","text":"停用静脉化疗，改为口服卡培他滨单药化疗，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗"}]}
+{"sample_id":"sample-cc3b58d3bf4229805e8c7b84","patient_id":"patient-f402aced5926698da3194c37","turn_id":"turn06","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 ST-T轻度改变\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D6] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 28mm AO 29mm MV E 0.51m/s EF 73% LV 49mm IVS 9mm A 0.73m/s FS 42% RA 28mm LVPW 10mm RV 18mm PA 20mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 心脏结构及运动未见异常 各房室腔及大血管未探及异常血流信号 左室舒张功能减低，收缩功能正常\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] 检验组合: 镁离子(Mg2+)-静脉血: 0.89mmol/L；总胆红素(TBIL)-静脉血: 13.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 23.7U/L；丙氨酸氨基转移酶(ALT)-静脉血: 21.4U/L；总钙(Ca)-静脉血: 2.2mmol/L；氯离子(Cl-)-静脉血: 104mmol/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；直接胆红素(DBIL)-静脉血: 5umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6；红细胞比容(Hct)-静脉血: 38.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.358；间接胆红素(IBIL)-静脉血: 8.3umolL；平均红细胞体积(MCV)-静脉血: 87.1fL；载脂蛋白AI(apoAI)-静脉血: 1.11g/L；球蛋白(GLO)-静脉血: 29.01g/L；C-反应蛋白(CRP)-静脉血: 13.69mg/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；白细胞计数(WBC#)-静脉血: 4.8310E9/L；碱性磷酸酶(ALP)-静脉血: 70.4U/L；血小板比容-静脉血: 18%；载脂蛋白B(apoB)-静脉血: 0.67g/L；中性粒细胞百分比(Neut%)-静脉血: 0.566；淋巴细胞计数(Lymph#)-静脉血: 1.710E9/L；钾离子(K+)-静脉血: 4.1mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；乳酸脱氢酶(LDH)-静脉血: 203.5U/L；阴离子间隙(AG)-静脉血: 14；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；甘油三酯(TG)-静脉血: 1.28mmol/L；红细胞计数(RBC#)-静脉血: 4.4310E12/L；血小板分布宽度(PDW)-静脉血: 8.5%；单核细胞百分比(Mono%)-静脉血: 0.058；大血小板百分比(P-LCR%)-静脉血: 11.6%；血液二氧化碳含量ctCO2(B)-静脉血: 25.1mmol/L；白蛋白(ALB)-静脉血: 40.2g/L；尿素氮(BUN)-静脉血: 5.8mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.3U/L；尿酸(UA)-静脉血: 378.8umol/L；总胆固醇(TC)-静脉血: 3.66mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；单核细胞计数(Mono#)-静脉血: 0.310E9/L；葡萄糖(Glu)-静脉血: 6.14mmol/L；钠离子(Na+)-静脉血: 142.7mmol/L；血小板计数(PLT#)-静脉血: 22110E9/L；磷(P)-静脉血: 1.1mmol/L\n- [全程D21] 检验组合: 单核细胞百分比(Mono%)-静脉血: 0.062；中性粒细胞百分比(Neut%)-静脉血: 0.67；白细胞计数(WBC#)-静脉血: 5.9710E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.9；平均红细胞血红蛋白含量(MCH)-静脉血: 29.3pg；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 134g/L；红细胞比容(Hct)-静脉血: 41.3%；血小板比容-静脉血: 13%；平均红细胞体积(MCV)-静脉血: 90.4fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；平均血小板体积(MPV)-静脉血: 9.4fL；血小板计数(PLT#)-静脉血: 13810E9/L；中性粒细胞计数(Neut#)-静脉血: 410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 324g/L；血小板分布宽度(PDW)-静脉血: 9.9%；大血小板百分比(P-LCR%)-静脉血: 21.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.255；单核细胞计数(Mono#)-静脉血: 0.410E9/L；红细胞计数(RBC#)-静脉血: 4.5710E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.2\n- [全程D27] 检验组合: 红细胞计数(RBC#)-静脉血: 4.3410E12/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.85mmol/L；血小板计数(PLT#)-静脉血: 255.510E9/L；白细胞计数(WBC#)-静脉血: 6.210E9/L；氯离子(Cl-)-静脉血: 104.9mmol/L；总胆汁酸(TBA)-静脉血: 1umol/L；肌酐(Crea)-静脉血: 96.8umol/L；钾离子(K+)-静脉血: 4.5mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.386；乳酸脱氢酶(LDH)-静脉血: 212.1U/L；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.33mmolL；淋巴细胞计数(Lymph#)-静脉血: 2.410E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21U/L；平均红细胞体积(MCV)-静脉血: 90.1fL；总蛋白(TP)-静脉血: 70.21g/L；丙氨酸氨基转移酶(ALT)-静脉血: 19.6U/L；间接胆红素(IBIL)-静脉血: 4.6umolL；尿酸(UA)-静脉血: 469.1umol/L；血小板比容-静脉血: 15.3%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；甘油三酯(TG)-静脉血: 1.12mmol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白B(apoB)-静脉血: 0.9g/L；平均血小板体积(MPV)-静脉血: 6.02fL；总钙(Ca)-静脉血: 2.25mmol/L；单核细胞百分比(Mono%)-静脉血: 0.066；红细胞比容(Hct)-静脉血: 39.1%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；γ-谷氨酰基转移酶(GGT)-静脉血: 25.5U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.7pg；尿素氮(BUN)-静脉血: 4.22mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341.2g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；中性粒细胞计数(Neut#)-静脉血: 3.310E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总胆固醇(TC)-静脉血: 4.6mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.5U/L；镁离子(Mg2+)-静脉血: 0.96mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.5mmol/L；碱性磷酸酶(ALP)-静脉血: 71.3U/L；钠离子(Na+)-静脉血: 142.8mmol/L；球蛋白(GLO)-静脉血: 29.01g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.6%\n- [全程D33] 检验组合: 尿素氮(BUN)-静脉血: 3.5mmol/L；直接胆红素(DBIL)-静脉血: 9umol/L；红细胞计数(RBC#)-静脉血: 3.8710E12/L；球蛋白(GLO)-静脉血: 27.06g/L；总胆红素(TBIL)-静脉血: 28.4umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.08mmolL；钾离子(K+)-静脉血: 3.68mmol/L；钠离子(Na+)-静脉血: 140.7mmol/L；肌酐(Crea)-静脉血: 71.4umol/L；红细胞比容(Hct)-静脉血: 34.5%；血小板比容-静脉血: 13.9%；总胆固醇(TC)-静脉血: 3.79mmol/L；磷(P)-静脉血: 1.21mmol/L；阴离子间隙(AG)-静脉血: 14.8；C-反应蛋白(CRP)-静脉血: 15.32mg/L；有核红细胞百分比(NRBC%)-静脉血: 0；乳酸脱氢酶(LDH)-静脉血: 214.8U/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15.3U/L；间接胆红素(IBIL)-静脉血: 19.4umolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.21mmol/L；白蛋白(ALB)-静脉血: 36.4g/L；总钙(Ca)-静脉血: 2.01mmol/L；载脂蛋白B(apoB)-静脉血: 0.79g/L；中性粒细胞计数(Neut#)-静脉血: 3.210E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.308；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.02；平均红细胞血红蛋白含量(MCH)-静脉血: 30.6pg；载脂蛋白AI(apoAI)-静脉血: 1.04g/L；尿酸(UA)-静脉血: 290.1umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.35；平均红细胞体积(MCV)-静脉血: 89.1fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；碱性磷酸酶(ALP)-静脉血: 60.5U/L；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；血小板计数(PLT#)-静脉血: 230.610E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 20.5U/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.4mmol/L；血红蛋白(Hb)-静脉血: 119g/L；总胆汁酸(TBA)-静脉血: 1.6umol/L；镁离子(Mg2+)-静脉血: 0.9mmol/L；总蛋白(TP)-静脉血: 63.46g/L；葡萄糖(Glu)-静脉血: 5.5mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 344.4g/L\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者第1程5-FU+洛铂方案诱导化疗结束，诉呕吐1次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。上级医师信息已隐藏：患者第1程5-FU+洛铂方案诱导化疗结束，无诉特殊不适，可予出院，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D28] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，上级医师信息已隐藏示：患者无明显化疗禁忌症，可于今日执行第2程5-FU+洛铂方案诱导化疗，注意化疗不良反应。\n- [全程D29] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者第2程5-FU+洛铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。上级医师信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 予以静脉输注红细胞悬液，并常规监测血常规、生化常规\nB. 予以重组人促红素（EPO）皮下注射，并常规监测血常规、生化常规\nC. 予以静脉滴注蔗糖铁注射液，并常规监测血常规、生化常规\nD. 暂不予特殊药物支持治疗，仅常规监测血常规、生化常规\nE. 予以粒细胞集落刺激因子（G-CSF）皮下注射，并常规监测血常规、生化常规\nF. 予以重组人血小板生成素（rhTPO）皮下注射，并常规监测血常规、生化常规\nG. 予以静脉滴注人血白蛋白，并常规监测血常规、生化常规\nH. 予以口服叶酸及维生素B12片，并常规监测血常规、生化常规\nI. 予以口服利血生及鲨肝醇片，并常规监测血常规、生化常规\nJ. 予以静脉滴注右旋糖酐铁注射液，并常规监测血常规、生化常规\nK. 予以静脉滴注地塞米松及托烷司琼，并常规监测血常规、生化常规\nL. 予以口服多糖铁复合物胶囊，并常规监测血常规、生化常规\n\n请仅输出一个选项字母（A-L）。","gold_letter":"D","gold_action":"暂不予特殊药物支持治疗，仅常规监测血常规、生化常规","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"予以静脉输注红细胞悬液，并常规监测血常规、生化常规"},{"letter":"B","text":"予以重组人促红素（EPO）皮下注射，并常规监测血常规、生化常规"},{"letter":"C","text":"予以静脉滴注蔗糖铁注射液，并常规监测血常规、生化常规"},{"letter":"D","text":"暂不予特殊药物支持治疗，仅常规监测血常规、生化常规"},{"letter":"E","text":"予以粒细胞集落刺激因子（G-CSF）皮下注射，并常规监测血常规、生化常规"},{"letter":"F","text":"予以重组人血小板生成素（rhTPO）皮下注射，并常规监测血常规、生化常规"},{"letter":"G","text":"予以静脉滴注人血白蛋白，并常规监测血常规、生化常规"},{"letter":"H","text":"予以口服叶酸及维生素B12片，并常规监测血常规、生化常规"},{"letter":"I","text":"予以口服利血生及鲨肝醇片，并常规监测血常规、生化常规"},{"letter":"J","text":"予以静脉滴注右旋糖酐铁注射液，并常规监测血常规、生化常规"},{"letter":"K","text":"予以静脉滴注地塞米松及托烷司琼，并常规监测血常规、生化常规"},{"letter":"L","text":"予以口服多糖铁复合物胶囊，并常规监测血常规、生化常规"}]}
+{"sample_id":"sample-80438584d0b66a199c599a7d","patient_id":"patient-f402aced5926698da3194c37","turn_id":"turn07","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 ST-T轻度改变\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] 检验组合: 镁离子(Mg2+)-静脉血: 0.89mmol/L；总胆红素(TBIL)-静脉血: 13.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 23.7U/L；丙氨酸氨基转移酶(ALT)-静脉血: 21.4U/L；总钙(Ca)-静脉血: 2.2mmol/L；氯离子(Cl-)-静脉血: 104mmol/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；直接胆红素(DBIL)-静脉血: 5umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6；红细胞比容(Hct)-静脉血: 38.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.358；间接胆红素(IBIL)-静脉血: 8.3umolL；平均红细胞体积(MCV)-静脉血: 87.1fL；载脂蛋白AI(apoAI)-静脉血: 1.11g/L；球蛋白(GLO)-静脉血: 29.01g/L；C-反应蛋白(CRP)-静脉血: 13.69mg/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；白细胞计数(WBC#)-静脉血: 4.8310E9/L；碱性磷酸酶(ALP)-静脉血: 70.4U/L；血小板比容-静脉血: 18%；载脂蛋白B(apoB)-静脉血: 0.67g/L；中性粒细胞百分比(Neut%)-静脉血: 0.566；淋巴细胞计数(Lymph#)-静脉血: 1.710E9/L；钾离子(K+)-静脉血: 4.1mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；乳酸脱氢酶(LDH)-静脉血: 203.5U/L；阴离子间隙(AG)-静脉血: 14；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；甘油三酯(TG)-静脉血: 1.28mmol/L；红细胞计数(RBC#)-静脉血: 4.4310E12/L；血小板分布宽度(PDW)-静脉血: 8.5%；单核细胞百分比(Mono%)-静脉血: 0.058；大血小板百分比(P-LCR%)-静脉血: 11.6%；血液二氧化碳含量ctCO2(B)-静脉血: 25.1mmol/L；白蛋白(ALB)-静脉血: 40.2g/L；尿素氮(BUN)-静脉血: 5.8mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.3U/L；尿酸(UA)-静脉血: 378.8umol/L；总胆固醇(TC)-静脉血: 3.66mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；单核细胞计数(Mono#)-静脉血: 0.310E9/L；葡萄糖(Glu)-静脉血: 6.14mmol/L；钠离子(Na+)-静脉血: 142.7mmol/L；血小板计数(PLT#)-静脉血: 22110E9/L；磷(P)-静脉血: 1.1mmol/L\n- [全程D21] 检验组合: 单核细胞百分比(Mono%)-静脉血: 0.062；中性粒细胞百分比(Neut%)-静脉血: 0.67；白细胞计数(WBC#)-静脉血: 5.9710E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.9；平均红细胞血红蛋白含量(MCH)-静脉血: 29.3pg；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 134g/L；红细胞比容(Hct)-静脉血: 41.3%；血小板比容-静脉血: 13%；平均红细胞体积(MCV)-静脉血: 90.4fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；平均血小板体积(MPV)-静脉血: 9.4fL；血小板计数(PLT#)-静脉血: 13810E9/L；中性粒细胞计数(Neut#)-静脉血: 410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 324g/L；血小板分布宽度(PDW)-静脉血: 9.9%；大血小板百分比(P-LCR%)-静脉血: 21.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.255；单核细胞计数(Mono#)-静脉血: 0.410E9/L；红细胞计数(RBC#)-静脉血: 4.5710E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.2\n- [全程D27] 检验组合: 红细胞计数(RBC#)-静脉血: 4.3410E12/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.85mmol/L；血小板计数(PLT#)-静脉血: 255.510E9/L；白细胞计数(WBC#)-静脉血: 6.210E9/L；氯离子(Cl-)-静脉血: 104.9mmol/L；总胆汁酸(TBA)-静脉血: 1umol/L；肌酐(Crea)-静脉血: 96.8umol/L；钾离子(K+)-静脉血: 4.5mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.386；乳酸脱氢酶(LDH)-静脉血: 212.1U/L；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.33mmolL；淋巴细胞计数(Lymph#)-静脉血: 2.410E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21U/L；平均红细胞体积(MCV)-静脉血: 90.1fL；总蛋白(TP)-静脉血: 70.21g/L；丙氨酸氨基转移酶(ALT)-静脉血: 19.6U/L；间接胆红素(IBIL)-静脉血: 4.6umolL；尿酸(UA)-静脉血: 469.1umol/L；血小板比容-静脉血: 15.3%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；甘油三酯(TG)-静脉血: 1.12mmol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白B(apoB)-静脉血: 0.9g/L；平均血小板体积(MPV)-静脉血: 6.02fL；总钙(Ca)-静脉血: 2.25mmol/L；单核细胞百分比(Mono%)-静脉血: 0.066；红细胞比容(Hct)-静脉血: 39.1%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；γ-谷氨酰基转移酶(GGT)-静脉血: 25.5U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.7pg；尿素氮(BUN)-静脉血: 4.22mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341.2g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；中性粒细胞计数(Neut#)-静脉血: 3.310E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总胆固醇(TC)-静脉血: 4.6mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.5U/L；镁离子(Mg2+)-静脉血: 0.96mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.5mmol/L；碱性磷酸酶(ALP)-静脉血: 71.3U/L；钠离子(Na+)-静脉血: 142.8mmol/L；球蛋白(GLO)-静脉血: 29.01g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.6%\n- [全程D33] 检验组合: 尿素氮(BUN)-静脉血: 3.5mmol/L；直接胆红素(DBIL)-静脉血: 9umol/L；红细胞计数(RBC#)-静脉血: 3.8710E12/L；球蛋白(GLO)-静脉血: 27.06g/L；总胆红素(TBIL)-静脉血: 28.4umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.08mmolL；钾离子(K+)-静脉血: 3.68mmol/L；钠离子(Na+)-静脉血: 140.7mmol/L；肌酐(Crea)-静脉血: 71.4umol/L；红细胞比容(Hct)-静脉血: 34.5%；血小板比容-静脉血: 13.9%；总胆固醇(TC)-静脉血: 3.79mmol/L；磷(P)-静脉血: 1.21mmol/L；阴离子间隙(AG)-静脉血: 14.8；C-反应蛋白(CRP)-静脉血: 15.32mg/L；有核红细胞百分比(NRBC%)-静脉血: 0；乳酸脱氢酶(LDH)-静脉血: 214.8U/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15.3U/L；间接胆红素(IBIL)-静脉血: 19.4umolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.21mmol/L；白蛋白(ALB)-静脉血: 36.4g/L；总钙(Ca)-静脉血: 2.01mmol/L；载脂蛋白B(apoB)-静脉血: 0.79g/L；中性粒细胞计数(Neut#)-静脉血: 3.210E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.308；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.02；平均红细胞血红蛋白含量(MCH)-静脉血: 30.6pg；载脂蛋白AI(apoAI)-静脉血: 1.04g/L；尿酸(UA)-静脉血: 290.1umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.35；平均红细胞体积(MCV)-静脉血: 89.1fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；碱性磷酸酶(ALP)-静脉血: 60.5U/L；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；血小板计数(PLT#)-静脉血: 230.610E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 20.5U/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.4mmol/L；血红蛋白(Hb)-静脉血: 119g/L；总胆汁酸(TBA)-静脉血: 1.6umol/L；镁离子(Mg2+)-静脉血: 0.9mmol/L；总蛋白(TP)-静脉血: 63.46g/L；葡萄糖(Glu)-静脉血: 5.5mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 344.4g/L\n- [全程D36] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后，与某次就诊时间片对比， 鼻咽腔狭窄，鼻咽左侧壁、顶壁及后壁增厚，见软组织灶形成，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，病灶占据左侧咽隐窝，向前堵塞左侧后鼻孔，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，右侧咽隐窝稍变浅，范围较前缩小，右侧咽旁脂肪间隙及颈动脉鞘区未见异常。 左侧腭帆提肌、双侧头长肌受侵。 双侧翼腭窝、咀嚼肌间隙未见明显异常；口咽各壁无受累增厚。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部骨质破坏。双侧海绵窦形态正常，未见增宽。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。蝶鞍形态正常，其内未见占位性病变。 双侧上颌窦、蝶窦、筛窦、左侧乳突粘膜增厚，见不等量分泌物，右侧乳突气化好，骨壁完整。 左侧咽后间隙见小淋巴结，短径约4mm，较前未见明显变化。 双颈II区见肿大淋巴结，较大者短径约22mm，较前稍缩小。 左颈III、V区见多发小淋巴结，边界清，信号均匀，较大者短径约7mm，较前未见明显变化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。 喉咽腔形态正常，未见占位性病变。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗后，鼻咽肿物较前缩小。 颅底骨质破坏。 左侧咽后小淋巴结，较前未见明显变化。 双颈II区淋巴结肿大，较前稍缩小。 左颈III、V区多发小淋巴结，较前未见明显变化。 副鼻窦炎、左侧乳突炎。\n\n【既往治疗与反应】\n- [全程D13] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者第1程5-FU+洛铂方案诱导化疗结束，诉呕吐1次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。上级医师信息已隐藏：患者第1程5-FU+洛铂方案诱导化疗结束，无诉特殊不适，可予出院，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D28] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，上级医师信息已隐藏示：患者无明显化疗禁忌症，可于今日执行第2程5-FU+洛铂方案诱导化疗，注意化疗不良反应。\n- [全程D29] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者第2程5-FU+洛铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。上级医师信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D34] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者第2程5-FU+洛铂方案诱导化疗结束，诉恶心、食欲下降，无发热、呕吐、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规示轻度贫血，肝肾功能大致正常。上级医师信息已隐藏：患者第2程5-FU+洛铂方案诱导化疗结束，无诉特殊不适，血象提示轻度贫血，予铁剂口服等纠正贫血治疗，下周及时监测血常规、肝肾功能，备行同时期放化疗+靶向治疗。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 疗效评估为部分缓解（PR），启动靶向治疗（西妥昔单抗）联合同期放化疗\nB. 疗效评估为部分缓解（PR），启动靶向治疗（尼妥珠单抗）联合同期放化疗\nC. 疗效评估为部分缓解（PR），继续原方案（洛铂+5-FU）第3程诱导化疗\nD. 疗效评估为部分缓解（PR），启动同期放化疗，暂不联合靶向治疗\nE. 疗效评估为疾病稳定（SD），启动免疫治疗（卡瑞利珠单抗）联合同期放化疗\nF. 疗效评估为疾病进展（PD），更改化疗方案为吉西他滨+顺铂诱导化疗\nG. 疗效评估为部分缓解（PR），行鼻咽及颈部根治性放疗，不联合全身治疗\nH. 疗效评估为部分缓解（PR），暂停抗肿瘤治疗，单纯行纠正贫血支持治疗\nI. 疗效评估为部分缓解（PR），行双侧颈部淋巴结清扫术，术后辅助放疗\nJ. 疗效评估为完全缓解（CR），启动靶向治疗（西妥昔单抗）联合同期放化疗\nK. 疗效评估为部分缓解（PR），启动靶向治疗（贝伐珠单抗）联合同期放化疗\nL. 疗效评估为部分缓解（PR），启动免疫治疗（帕博利珠单抗）联合同期放化疗\n\n请仅输出一个选项字母（A-L）。","gold_letter":"A","gold_action":"疗效评估为部分缓解（PR），启动靶向治疗（西妥昔单抗）联合同期放化疗","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"疗效评估为部分缓解（PR），启动靶向治疗（西妥昔单抗）联合同期放化疗"},{"letter":"B","text":"疗效评估为部分缓解（PR），启动靶向治疗（尼妥珠单抗）联合同期放化疗"},{"letter":"C","text":"疗效评估为部分缓解（PR），继续原方案（洛铂+5-FU）第3程诱导化疗"},{"letter":"D","text":"疗效评估为部分缓解（PR），启动同期放化疗，暂不联合靶向治疗"},{"letter":"E","text":"疗效评估为疾病稳定（SD），启动免疫治疗（卡瑞利珠单抗）联合同期放化疗"},{"letter":"F","text":"疗效评估为疾病进展（PD），更改化疗方案为吉西他滨+顺铂诱导化疗"},{"letter":"G","text":"疗效评估为部分缓解（PR），行鼻咽及颈部根治性放疗，不联合全身治疗"},{"letter":"H","text":"疗效评估为部分缓解（PR），暂停抗肿瘤治疗，单纯行纠正贫血支持治疗"},{"letter":"I","text":"疗效评估为部分缓解（PR），行双侧颈部淋巴结清扫术，术后辅助放疗"},{"letter":"J","text":"疗效评估为完全缓解（CR），启动靶向治疗（西妥昔单抗）联合同期放化疗"},{"letter":"K","text":"疗效评估为部分缓解（PR），启动靶向治疗（贝伐珠单抗）联合同期放化疗"},{"letter":"L","text":"疗效评估为部分缓解（PR），启动免疫治疗（帕博利珠单抗）联合同期放化疗"}]}
+{"sample_id":"sample-9e8ddeeab49a15f0eb3930d7","patient_id":"patient-51e6f99c527367bbd97aebd8","turn_id":"turn01","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D6] 入院记录: 主诉: 涕血2月；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血；既往史: “胃溃疡”病史22年，于某次就诊时间、某次就诊时间发生2次“胃出血”，经“输血”、“药物”治疗后好转，具体不详。某次就诊时间发现“胃底息肉”，行“内镜下胃底息肉切除术”。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：114/69mmHg,Ht：157cm，Wt：53kg，BSA：1.52m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽左侧壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 完善鼻咽及颈部CT平扫+增强、胸腹部CT平扫+增强、全身骨扫描，并进行病理会诊或鼻咽活检。\nB. 完善鼻咽MRI平扫+增强、胸腹部CT平扫+增强、全身骨扫描，暂缓病理检查。\nC. 完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像，并进行病理会诊或鼻咽活检及心电图等基线检查。\nD. 完善鼻咽及颈部MRI平扫、PET/CT全身显像，并进行病理会诊或鼻咽活检。\nE. 完善鼻咽及颈部MRI平扫+增强、头颅MRI平扫+增强，直接安排放疗定位。\nF. 完善鼻咽及颈部CT平扫、PET/CT全身显像，并进行鼻咽肿物切除活检。\nG. 完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像，并进行颈部淋巴结穿刺活检。\nH. 完善鼻咽及颈部MRI平扫+增强、胸部X线、腹部超声，并进行病理会诊或鼻咽活检。\nI. 完善鼻咽及颈部MRI平扫+增强、全身骨扫描，并进行病理会诊或鼻咽活检。\nJ. 完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像，直接开始诱导化疗。\nK. 完善鼻咽及颈部MRI平扫+增强、胸腹部CT平扫+增强、全身骨扫描，并进行鼻内镜下鼻咽肿物扩大切除术。\n\n请仅输出一个选项字母（A-K）。","gold_letter":"C","gold_action":"完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像，并进行病理会诊或鼻咽活检及心电图等基线检查。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"完善鼻咽及颈部CT平扫+增强、胸腹部CT平扫+增强、全身骨扫描，并进行病理会诊或鼻咽活检。"},{"letter":"B","text":"完善鼻咽MRI平扫+增强、胸腹部CT平扫+增强、全身骨扫描，暂缓病理检查。"},{"letter":"C","text":"完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像，并进行病理会诊或鼻咽活检及心电图等基线检查。"},{"letter":"D","text":"完善鼻咽及颈部MRI平扫、PET/CT全身显像，并进行病理会诊或鼻咽活检。"},{"letter":"E","text":"完善鼻咽及颈部MRI平扫+增强、头颅MRI平扫+增强，直接安排放疗定位。"},{"letter":"F","text":"完善鼻咽及颈部CT平扫、PET/CT全身显像，并进行鼻咽肿物切除活检。"},{"letter":"G","text":"完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像，并进行颈部淋巴结穿刺活检。"},{"letter":"H","text":"完善鼻咽及颈部MRI平扫+增强、胸部X线、腹部超声，并进行病理会诊或鼻咽活检。"},{"letter":"I","text":"完善鼻咽及颈部MRI平扫+增强、全身骨扫描，并进行病理会诊或鼻咽活检。"},{"letter":"J","text":"完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像，直接开始诱导化疗。"},{"letter":"K","text":"完善鼻咽及颈部MRI平扫+增强、胸腹部CT平扫+增强、全身骨扫描，并进行鼻内镜下鼻咽肿物扩大切除术。"}]}
+{"sample_id":"sample-78b27b455a910a93bd013384","patient_id":"patient-51e6f99c527367bbd97aebd8","turn_id":"turn02","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D6] 入院记录: 主诉: 涕血2月；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血；既往史: “胃溃疡”病史22年，于某次就诊时间、某次就诊时间发生2次“胃出血”，经“输血”、“药物”治疗后好转，具体不详。某次就诊时间发现“胃底息肉”，行“内镜下胃底息肉切除术”。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：114/69mmHg,Ht：157cm，Wt：53kg，BSA：1.52m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽左侧壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D7] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- [全程D7] 检验组合: 平均红细胞体积(MCV)-静脉血: 91.1fL；总钙(Ca)-静脉血: 2.21mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24.2U/L；碱性磷酸酶(ALP)-静脉血: 74.3U/L；IV型胶原(C-IV)-静脉血: 12.97ng/ml；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 35.9U/L；钾离子(K+)-静脉血: 3.76mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；D-二聚体(D-Dimer)-静脉血: 0.07ug/ml；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；淀粉样蛋白A(SAA)-静脉血: 2.44mg/L；C-反应蛋白(CRP)-静脉血: 1.92mg/L；凝血酶原时间活动度(PTA)-静脉血: 120%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.67；载脂蛋白B(apoB)-静脉血: 1.07g/L；球蛋白(GLO)-静脉血: 26.18g/L；磷(P)-静脉血: 1.03mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；胱抑素(Cys-C)-静脉血: 0.79mg/L；红细胞计数(RBC#)-静脉血: 5.2710E12/L；单核细胞计数(Mono#)-静脉血: 110E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.6sec.；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.87；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.411ng/ml（参考: <0.584）；尿素氮(BUN)-静脉血: 4.7mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；血小板计数(PLT#)-静脉血: 21810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.578；凝血酶原时间(PT)-静脉血: 10.1sec.；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.05mmol/L；尿酸(UA)-静脉血: 331.5umol/L；阴离子间隙(AG)-静脉血: 15.7；层粘连蛋白(LN)-静脉血: 21.36ng/ml；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 64.3U/L；血红蛋白(Hb)-静脉血: 158g/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；凝血酶时间(TT)-静脉血: 19.9sec.；直接胆红素(DBIL)-静脉血: 2.1umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.015；红细胞体积分布宽度SD(RDW-SD)-静脉血: 42；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.47mmolL\n- [全程D10] 内镜；胃镜: 检查类型: 内镜；检查名称: 胃镜；检查部位:；检查所见: 插镜情况：顺利 送达部位：十二指肠降部。 食 管：粘膜光滑, 舒缩好。 贲 门：开闭好, E-G线清楚。 胃 底：粘液湖清亮，粘膜光滑，无静脉曲张。 胃 体：花斑样充血，未见溃疡肿物。 胃 角：弧形， 光滑。 胃 窦：蠕动好，粘膜呈花斑样充血，未见溃疡肿物。 幽 门：圆， 开闭好。 球 部：球腔变形，后壁可见霜斑样溃疡，表面附着白苔。 降 部：十二指肠乳头及降部粘膜未见异常。 请4个工作日后到病理科（5楼）取活检结果。；检查结论: 十二指肠球部霜斑样溃疡 慢性浅表性胃炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 明确鼻咽癌临床分期为 cT2N0M0，II期（肿瘤累及左侧后鼻孔，无颈部淋巴结转移）\nB. 明确鼻咽癌临床分期为 cT1N1M0，II期（肿瘤局限于鼻咽，伴单侧咽后淋巴结转移）\nC. 明确鼻咽癌临床分期为 cT2N1M0，II期（肿瘤累及左侧后鼻孔及咽旁间隙，伴单侧颈部淋巴结转移）\nD. 明确鼻咽癌临床分期为 cT1N0M0，IA期（肿瘤累及鼻咽及左侧后鼻孔，无颈部淋巴结转移）\nE. 明确鼻咽癌临床分期为 cT3N0M0，III期（肿瘤累及颅底骨质，无颈部淋巴结转移）\nF. 明确鼻咽癌临床分期为 cT1N0M0，IA期（肿瘤局限于鼻咽，未累及鼻腔及口咽等邻近结构）\nG. 明确鼻咽癌临床分期为 cT2N0M0，II期（肿瘤累及鼻咽及口咽，无颈部淋巴结转移）\nH. 明确鼻咽癌临床分期为 cT1N2M0，III期（肿瘤累及左侧后鼻孔，伴双侧颈部淋巴结转移）\nI. 明确鼻咽癌临床分期为 cT3N1M0，III期（肿瘤累及翼内肌，伴单侧颈部淋巴结转移）\nJ. 明确鼻咽癌临床分期为 cT4N0M0，IVA期（肿瘤累及海绵窦，无颈部淋巴结转移）\nK. 明确鼻咽癌临床分期为 cT1N0M1，IVB期（肿瘤累及左侧后鼻孔，伴远处器官转移）\nL. 明确鼻咽癌临床分期为 cT2N2M0，III期（肿瘤累及咽旁间隙，伴双侧颈部淋巴结转移）\n\n请仅输出一个选项字母（A-L）。","gold_letter":"D","gold_action":"明确鼻咽癌临床分期为 cT1N0M0，IA期（肿瘤累及鼻咽及左侧后鼻孔，无颈部淋巴结转移）","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"明确鼻咽癌临床分期为 cT2N0M0，II期（肿瘤累及左侧后鼻孔，无颈部淋巴结转移）"},{"letter":"B","text":"明确鼻咽癌临床分期为 cT1N1M0，II期（肿瘤局限于鼻咽，伴单侧咽后淋巴结转移）"},{"letter":"C","text":"明确鼻咽癌临床分期为 cT2N1M0，II期（肿瘤累及左侧后鼻孔及咽旁间隙，伴单侧颈部淋巴结转移）"},{"letter":"D","text":"明确鼻咽癌临床分期为 cT1N0M0，IA期（肿瘤累及鼻咽及左侧后鼻孔，无颈部淋巴结转移）"},{"letter":"E","text":"明确鼻咽癌临床分期为 cT3N0M0，III期（肿瘤累及颅底骨质，无颈部淋巴结转移）"},{"letter":"F","text":"明确鼻咽癌临床分期为 cT1N0M0，IA期（肿瘤局限于鼻咽，未累及鼻腔及口咽等邻近结构）"},{"letter":"G","text":"明确鼻咽癌临床分期为 cT2N0M0，II期（肿瘤累及鼻咽及口咽，无颈部淋巴结转移）"},{"letter":"H","text":"明确鼻咽癌临床分期为 cT1N2M0，III期（肿瘤累及左侧后鼻孔，伴双侧颈部淋巴结转移）"},{"letter":"I","text":"明确鼻咽癌临床分期为 cT3N1M0，III期（肿瘤累及翼内肌，伴单侧颈部淋巴结转移）"},{"letter":"J","text":"明确鼻咽癌临床分期为 cT4N0M0，IVA期（肿瘤累及海绵窦，无颈部淋巴结转移）"},{"letter":"K","text":"明确鼻咽癌临床分期为 cT1N0M1，IVB期（肿瘤累及左侧后鼻孔，伴远处器官转移）"},{"letter":"L","text":"明确鼻咽癌临床分期为 cT2N2M0，III期（肿瘤累及咽旁间隙，伴双侧颈部淋巴结转移）"}]}
+{"sample_id":"sample-db8d6d3eabcfcb123b0c3cb1","patient_id":"patient-51e6f99c527367bbd97aebd8","turn_id":"turn05","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D7] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D10] 内镜；胃镜: 检查类型: 内镜；检查名称: 胃镜；检查部位:；检查所见: 插镜情况：顺利 送达部位：十二指肠降部。 食 管：粘膜光滑, 舒缩好。 贲 门：开闭好, E-G线清楚。 胃 底：粘液湖清亮，粘膜光滑，无静脉曲张。 胃 体：花斑样充血，未见溃疡肿物。 胃 角：弧形， 光滑。 胃 窦：蠕动好，粘膜呈花斑样充血，未见溃疡肿物。 幽 门：圆， 开闭好。 球 部：球腔变形，后壁可见霜斑样溃疡，表面附着白苔。 降 部：十二指肠乳头及降部粘膜未见异常。 请4个工作日后到病理科（5楼）取活检结果。；检查结论: 十二指肠球部霜斑样溃疡 慢性浅表性胃炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D24] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽左侧顶后壁及左侧壁局部粘膜增厚形成软组织影放射性浓聚，SUV约21.0，堵塞左侧鼻后孔，鼻咽腔变窄，累及左侧翼突基底部及犁骨。左侧咽隐窝变，右侧咽隐窝未见明显异常，双侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。口咽及喉咽结构及放射性分布未见明显异常。额窦、蝶窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双上颈小淋巴结放射性分布未见明显异常。 双上肺尖、右中肺内侧段及左下肺后基底段少许条索影放射性分布未见明显异常；其余双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏S4低密度影放射性分布未见明显异常，大小约0.6×0.6cm，边界尚清，密度欠均匀，CT值约26Hu；其余肝脏密度减低，CT值约50Hu，结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。盆腔盆底静脉内多发点状/小结节状高密度影放射性缺损。 所见颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，侵犯左侧鼻后孔，累及颅底骨。 肝S4低密度影代谢未见明显异常，建议随诊。 脂肪肝。\n- [全程D29] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.013；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 6.5\n- [全程D30] 检验组合: 浊度(TRUB)-尿液: 清亮；白细胞计数(WBC#)-尿液: 3/μL；白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.023；酮体(KET)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 13/μL；颜色-尿液: Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；隐血(OB)-尿液: 1+ 0.6mg（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D31] 检验组合: 红细胞计数(RBC#)-静脉血: 4.6210E12/L；血小板计数(PLT#)-静脉血: 22810E9/L；大血小板百分比(P-LCR%)-静脉血: 21.2%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.61mmol/L；白蛋白(ALB)-静脉血: 38.5g/L；间接胆红素(IBIL)-静脉血: 8.4umolL；球蛋白(GLO)-静脉血: 25.82g/L；单核细胞百分比(Mono%)-静脉血: 0.093；血小板分布宽度(PDW)-静脉血: 10.8%；红细胞比容(Hct)-静脉血: 41.4%；总蛋白(TP)-静脉血: 64.32g/L；单核细胞计数(Mono#)-静脉血: 1.510E9/L；葡萄糖(Glu)-静脉血: 5.98mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.6；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；总胆红素(TBIL)-静脉血: 12.9umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 176.9U/L；甘油三酯(TG)-静脉血: 1.4mmol/L；乳酸脱氢酶(LDH)-静脉血: 239U/L；总胆汁酸(TBA)-静脉血: 3umol/L；直接胆红素(DBIL)-静脉血: 4.5umol/L；肌酐(Crea)-静脉血: 70umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.7；尿素氮(BUN)-静脉血: 6.02mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 136.5U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；天门冬氨酸氨基转移酶(AST)-静脉血: 104.5U/L；磷(P)-静脉血: 1.34mmol/L；钠离子(Na+)-静脉血: 138.8mmol/L；平均红细胞体积(MCV)-静脉血: 89.6fL；白细胞计数(WBC#)-静脉血: 15.9910E9/L；载脂蛋白AI(apoAI)-静脉血: 1.29g/L；阴离子间隙(AG)-静脉血: 14；C-反应蛋白(CRP)-静脉血: 1.98mg/L；钾离子(K+)-静脉血: 3.5mmol/L；碱性磷酸酶(ALP)-静脉血: 61.4U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.54mmolL；血小板比容-静脉血: 22%；尿酸(UA)-静脉血: 330.4umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 62U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.05；镁离子(Mg2+)-静脉血: 0.91mmol/L；血红蛋白(Hb)-静脉血: 137g/L\n\n【既往治疗与反应】\n- [全程D8] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者相关检查完善中，请假未回病房。\n- [全程D13] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者相关检查完善中，请假未回病房。\n- [全程D19] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者元旦假期请假中。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D29] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者无明显不适主诉，查体情况：一般情况可，余同入院。放疗计划已完善。上级医师信息已隐藏示：患者无明显化疗禁忌症，向患者及其家属交代病情及化疗风险，表示理解并已签署知情同意书，同意入组三周/单周DDP同时期化疗临床试验，抽签入三周组，可于今日执行第1程顺铂方案同时期化疗，注意化疗不良反应，开始放疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放化疗，给予多烯磷脂酰胆碱、还原型谷胱甘肽等静脉保肝治疗，待肝功能恢复正常后恢复放化疗。\nB. 继续放化疗，仅密切监测肝功能变化，暂不给予静脉保肝药物干预。\nC. 继续放化疗，给予广谱抗生素静脉滴注预防感染，并辅以雾化吸入及止吐等对症支持处理。\nD. 将顺铂方案调整为卡铂方案同时期化疗，并给予静脉保肝治疗及止吐等对症支持处理。\nE. 顺铂剂量减低25%继续同时期化疗，给予静脉保肝治疗，辅以雾化吸入及止吐等对症支持处理。\nF. 暂停顺铂化疗，继续单纯放疗，给予静脉保肝治疗，待肝功能恢复后补足化疗周期。\nG. 给予多烯磷脂酰胆碱、还原型谷胱甘肽、复方甘草酸苷等静脉保肝治疗，辅以雾化吸入及止吐等对症支持处理。\nH. 给予大剂量质子泵抑制剂静脉滴注预防消化道出血，暂缓保肝治疗，继续放化疗。\nI. 暂停放疗，继续顺铂化疗，给予静脉保肝治疗及止吐等对症支持处理。\nJ. 给予静脉保肝治疗，行骨髓穿刺检查排除血液系统异常，继续放化疗。\nK. 终止临床试验，转为常规单药顺铂同时期放化疗，并给予静脉保肝治疗。\nL. 给予口服保肝药物治疗，辅以雾化吸入及止吐等对症支持处理，继续放化疗。\n\n请仅输出一个选项字母（A-L）。","gold_letter":"F","gold_action":"暂停顺铂化疗，继续单纯放疗，给予静脉保肝治疗，待肝功能恢复后补足化疗周期。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"暂停放化疗，给予多烯磷脂酰胆碱、还原型谷胱甘肽等静脉保肝治疗，待肝功能恢复正常后恢复放化疗。"},{"letter":"B","text":"继续放化疗，仅密切监测肝功能变化，暂不给予静脉保肝药物干预。"},{"letter":"C","text":"继续放化疗，给予广谱抗生素静脉滴注预防感染，并辅以雾化吸入及止吐等对症支持处理。"},{"letter":"D","text":"将顺铂方案调整为卡铂方案同时期化疗，并给予静脉保肝治疗及止吐等对症支持处理。"},{"letter":"E","text":"顺铂剂量减低25%继续同时期化疗，给予静脉保肝治疗，辅以雾化吸入及止吐等对症支持处理。"},{"letter":"F","text":"暂停顺铂化疗，继续单纯放疗，给予静脉保肝治疗，待肝功能恢复后补足化疗周期。"},{"letter":"G","text":"给予多烯磷脂酰胆碱、还原型谷胱甘肽、复方甘草酸苷等静脉保肝治疗，辅以雾化吸入及止吐等对症支持处理。"},{"letter":"H","text":"给予大剂量质子泵抑制剂静脉滴注预防消化道出血，暂缓保肝治疗，继续放化疗。"},{"letter":"I","text":"暂停放疗，继续顺铂化疗，给予静脉保肝治疗及止吐等对症支持处理。"},{"letter":"J","text":"给予静脉保肝治疗，行骨髓穿刺检查排除血液系统异常，继续放化疗。"},{"letter":"K","text":"终止临床试验，转为常规单药顺铂同时期放化疗，并给予静脉保肝治疗。"},{"letter":"L","text":"给予口服保肝药物治疗，辅以雾化吸入及止吐等对症支持处理，继续放化疗。"}]}
+{"sample_id":"sample-5eba0030ab5d024288a0d69d","patient_id":"patient-51e6f99c527367bbd97aebd8","turn_id":"turn07","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D7] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- [全程D41] 检验组合: 中性粒细胞计数(Neut#)-静脉血: 6.110E9/L；钠离子(Na+)-静脉血: 139.4mmol/L；尿素氮(BUN)-静脉血: 7.2mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.53；淋巴细胞计数(Lymph#)-静脉血: 0.910E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 42.7U/L；丙氨酸氨基转移酶(ALT)-静脉血: 35.4U/L；甘油三酯(TG)-静脉血: 1.71mmol/L；白细胞计数(WBC#)-静脉血: 7.7810E9/L；总蛋白(TP)-静脉血: 62.51g/L；血红蛋白(Hb)-静脉血: 131g/L；总钙(Ca)-静脉血: 2.05mmol/L；肌酐(Crea)-静脉血: 81.5umol/L；载脂蛋白B(apoB)-静脉血: 1.23g/L；白蛋白(ALB)-静脉血: 36.6g/L；中性粒细胞百分比(Neut%)-静脉血: 0.79；红细胞比容(Hct)-静脉血: 38.9%；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.6；淋巴细胞百分比(Lymph%)-静脉血: 0.113；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.006；大血小板百分比(P-LCR%)-静脉血: 15.3%；乳酸脱氢酶(LDH)-静脉血: 185.9U/L；间接胆红素(IBIL)-静脉血: 6.7umolL；氯离子(Cl-)-静脉血: 100.4mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.8U/L；血小板计数(PLT#)-静脉血: 15410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.3g/L；平均血小板体积(MPV)-静脉血: 8.9fL；胱抑素(Cys-C)-静脉血: 0.86mg/L；γ-谷氨酰基转移酶(GGT)-静脉血: 268.3U/L；总胆红素(TBIL)-静脉血: 8umol/L；葡萄糖(Glu)-静脉血: 5.28mmol/L；红细胞计数(RBC#)-静脉血: 4.3510E12/L；总胆汁酸(TBA)-静脉血: 2.7umol/L；血小板分布宽度(PDW)-静脉血: 9.1%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.3；血液二氧化碳含量ctCO2(B)-静脉血: 19.4mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；总胆固醇(TC)-静脉血: 5.59mmol/L；球蛋白(GLO)-静脉血: 25.91g/L；C-反应蛋白(CRP)-静脉血: 7.92mg/L；直接胆红素(DBIL)-静脉血: 1.3umol/L\n- [全程D49] 检验组合: 红细胞计数(RBC#)-尿液: 6/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；白细胞计数(WBC#)-尿液: 1/μL；比重(SG)-尿液: 1.009；胆红素(BIL)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: 无色；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮\n- [全程D50] 检验组合: 浊度(TRUB)-尿液: clear；酮体(KET)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 13/μL；比重(SG)-尿液: 1.017；白细胞计数(WBC#)-尿液: 10/μL；隐血(OB)-尿液: 1+0.6mg（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；总蛋白(TP)-尿液: -（参考: 阴性）；非鳞状上皮细胞计数-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 3/μL；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow\n- [全程D51] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；比重(SG)-尿液: 1.013；白细胞计数(WBC#)-尿液: 13/μL；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 8/μL；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；白细胞(LEU)-尿液: -（参考: 阴性）\n- [全程D52] 检验组合: 淋巴细胞百分比(Lymph%)-静脉血: 0.1；镁离子(Mg2+)-静脉血: 0.52mmol/L；尿素氮(BUN)-静脉血: 6.1mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.14mmolL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；总蛋白(TP)-静脉血: 64.42g/L；磷(P)-静脉血: 1.33mmol/L；总胆红素(TBIL)-静脉血: 6umol/L；氯离子(Cl-)-静脉血: 99.5mmol/L；红细胞比容(Hct)-静脉血: 36.9%；平均红细胞体积(MCV)-静脉血: 89.1fL；红细胞计数(RBC#)-静脉血: 4.1410E12/L；C-反应蛋白(CRP)-静脉血: 4.91mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；白细胞计数(WBC#)-静脉血: 3.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.253；血小板比容-静脉血: 20%；丙氨酸氨基转移酶(ALT)-静脉血: 42.9U/L；血液二氧化碳含量ctCO2(B)-静脉血: 26.2mmol/L；胱抑素(Cys-C)-静脉血: 1.28mg/L；球蛋白(GLO)-静脉血: 29.62g/L；甘油三酯(TG)-静脉血: 1.61mmol/L；尿酸(UA)-静脉血: 292.8umol/L；血小板分布宽度(PDW)-静脉血: 8.6%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.8；单核细胞计数(Mono#)-静脉血: 0.910E9/L；肌酐(Crea)-静脉血: 109.5umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.015；总胆固醇(TC)-静脉血: 5.96mmol/L；阴离子间隙(AG)-静脉血: 12；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 47U/L；平均血小板体积(MPV)-静脉血: 8.8fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.4；中性粒细胞百分比(Neut%)-静脉血: 0.626；总钙(Ca)-静脉血: 1.94mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.8；平均红细胞血红蛋白浓度(MCHC)-静脉血: 333g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 144.4U/L；钠离子(Na+)-静脉血: 137.3mmol/L；乳酸脱氢酶(LDH)-静脉血: 151.2U/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；间接胆红素(IBIL)-静脉血: 4.1umolL；天门冬氨酸氨基转移酶(AST)-静脉血: 36.1U/L\n- [全程D61] 超声；肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声不均匀，肝S5可见2个无回声灶，直径约3-4mm，边界清,内透声可，后方回声增强。血管走行清晰、自然，肝内胆管不扩张，门静脉内径约7mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约28cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约43×27×32mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝S5囊性灶，考虑肝囊肿可能性大。 胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D61] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，走行自然，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n\n【既往治疗与反应】\n- [全程D41] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者放疗中，诉口感、咽痛，余无不适。查体同前。复查血常规：基本正常，生化常规：正常。上级医师信息已隐藏：患者DDP化疗后出现肝酶升高，考虑为药物性肝损害，经多种滑竿药物治疗后肝功能恢复正常，今日可办理出院，继续门诊放疗。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D50] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，上级医师信息已隐藏示：患者无明显化疗禁忌症，向患者及其家属交代病情及化疗风险，表示理解并已签署知情同意书，可于今日水化，明日执行第2程DDP方案同时期化疗，注意化疗不良反应。\n- [全程D51] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者第2程DDP方案同时期化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。上级医师信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D52] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者第二程DDP单药同期化疗结束，诉咽痛、恶心、食欲下降，呕吐1次，伴头晕，无腹痛、腹泻等不适。复查血常规、肝肾功能大致正常。上级医师信息已隐藏：患者同时期化疗结束，一般情况可，可以今日结账出院，门诊继续放疗。嘱定期复查血常规及肝肾功能，行放疗结束前常规检查。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，给予静脉滴注广谱抗菌药物及大剂量糖皮质激素。\nB. 暂停放疗，行肝脏穿刺活检明确肝脏病灶性质后调整全身系统性化疗方案。\nC. 继续根治性放疗，给予重组人粒细胞集落刺激因子（G-CSF）皮下注射。\nD. 继续根治性放疗，加用第3程顺铂同期化疗，并给予静脉保肝药物。\nE. 终止放疗，转为TPF方案全身系统性化疗。\nF. 继续根治性放疗，局部外用强效糖皮质激素软膏，并口服非甾体抗炎药。\nG. 暂停放疗，复查鼻咽及颈部MRI以决定是否降低后续放疗靶区剂量。\nH. 继续根治性放疗，给予静脉异甘草酸镁及还原型谷胱甘肽保肝治疗。\nI. 继续根治性放疗，给予雾化吸入氨溴索与地塞米松，并局部外用三乙醇胺乳膏。\nJ. 继续根治性放疗，联合靶向药物尼妥珠单抗及PD-1抑制剂治疗。\nK. 继续根治性放疗，给予静脉滴注地塞米松，并局部外用莫匹罗星软膏。\nL. 结束放化疗综合治疗，进入随访观察期，定期复查鼻咽MRI及颈部超声。\n\n请仅输出一个选项字母（A-L）。","gold_letter":"I","gold_action":"继续根治性放疗，给予雾化吸入氨溴索与地塞米松，并局部外用三乙醇胺乳膏。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"暂停放疗，给予静脉滴注广谱抗菌药物及大剂量糖皮质激素。"},{"letter":"B","text":"暂停放疗，行肝脏穿刺活检明确肝脏病灶性质后调整全身系统性化疗方案。"},{"letter":"C","text":"继续根治性放疗，给予重组人粒细胞集落刺激因子（G-CSF）皮下注射。"},{"letter":"D","text":"继续根治性放疗，加用第3程顺铂同期化疗，并给予静脉保肝药物。"},{"letter":"E","text":"终止放疗，转为TPF方案全身系统性化疗。"},{"letter":"F","text":"继续根治性放疗，局部外用强效糖皮质激素软膏，并口服非甾体抗炎药。"},{"letter":"G","text":"暂停放疗，复查鼻咽及颈部MRI以决定是否降低后续放疗靶区剂量。"},{"letter":"H","text":"继续根治性放疗，给予静脉异甘草酸镁及还原型谷胱甘肽保肝治疗。"},{"letter":"I","text":"继续根治性放疗，给予雾化吸入氨溴索与地塞米松，并局部外用三乙醇胺乳膏。"},{"letter":"J","text":"继续根治性放疗，联合靶向药物尼妥珠单抗及PD-1抑制剂治疗。"},{"letter":"K","text":"继续根治性放疗，给予静脉滴注地塞米松，并局部外用莫匹罗星软膏。"},{"letter":"L","text":"结束放化疗综合治疗，进入随访观察期，定期复查鼻咽MRI及颈部超声。"}]}
+{"sample_id":"sample-ce0b8b89ec8b1d9a2405353d","patient_id":"patient-5731cc38ced94b2ee39c442a","turn_id":"turn01","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 左耳闷涉不适1年，涕血2月。；某次就诊时间特来我院门诊进一步诊治，完善相关检查，诊断明确后，今日入院系统治疗。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,左耳闷胀感,涕血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。有吸烟史1年，日7支；少量饮酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：90次/分，R：20次/分，BP：131/86mmHg,Ht：171cm，Wt：76.5kg，BSA1.89m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶壁、顶后壁、双侧壁结节状肿物；左侧颈部II区可扪及1个淋巴结，最大径2cm×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善鼻咽+颈部增强CT，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查，择期行颈部淋巴结穿刺活检。\nB. 完善鼻咽镜及活检，鼻咽+颈部增强CT，胸腹部超声及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。\nC. 完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，常规血液学检查，暂缓EBV相关检测。\nD. 完善鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查，若影像典型直接开始放化疗。\nE. 完善鼻咽镜及活检，头颅增强MRI，颈部超声，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。\nF. 完善鼻咽镜及活检，鼻咽+颈部平扫MRI，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。\nG. 完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描（或PET-CT），EBV-DNA及抗体检测，常规血液学检查。\nH. 完善鼻咽镜及活检，鼻咽+颈部增强MRI，EBV-DNA及抗体检测，常规血液学检查，待局部放疗结束后再行全身转移排查。\nI. 完善颈部淋巴结切除活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。\nJ. 完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，常规血液学检查，并立即行诱导化疗。\nK. 完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸部X线，腹部超声，全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。\nL. 完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查，并预防性行气管切开。\n\n请仅输出一个选项字母（A-L）。","gold_letter":"G","gold_action":"完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描（或PET-CT），EBV-DNA及抗体检测，常规血液学检查。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"完善鼻咽+颈部增强CT，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查，择期行颈部淋巴结穿刺活检。"},{"letter":"B","text":"完善鼻咽镜及活检，鼻咽+颈部增强CT，胸腹部超声及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。"},{"letter":"C","text":"完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，常规血液学检查，暂缓EBV相关检测。"},{"letter":"D","text":"完善鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查，若影像典型直接开始放化疗。"},{"letter":"E","text":"完善鼻咽镜及活检，头颅增强MRI，颈部超声，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。"},{"letter":"F","text":"完善鼻咽镜及活检，鼻咽+颈部平扫MRI，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。"},{"letter":"G","text":"完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描（或PET-CT），EBV-DNA及抗体检测，常规血液学检查。"},{"letter":"H","text":"完善鼻咽镜及活检，鼻咽+颈部增强MRI，EBV-DNA及抗体检测，常规血液学检查，待局部放疗结束后再行全身转移排查。"},{"letter":"I","text":"完善颈部淋巴结切除活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。"},{"letter":"J","text":"完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，常规血液学检查，并立即行诱导化疗。"},{"letter":"K","text":"完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸部X线，腹部超声，全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。"},{"letter":"L","text":"完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查，并预防性行气管切开。"}]}
+{"sample_id":"sample-e3ed1270448c84eefbda9f61","patient_id":"patient-5731cc38ced94b2ee39c442a","turn_id":"turn02","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- 暂无可展示的初诊主诉/入院资料。\n\n【已完成检查与客观结果】\n- [全程D0] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.51；平均红细胞血红蛋白含量(MCH)-静脉血: 27.4pg；磷(P)-静脉血: 0.9mmol/L；直接胆红素(DBIL)-静脉血: 4.7umol/L；凝血酶时间(TT)-静脉血: 22.7sec.；D-二聚体(D-Dimer)-静脉血: 0.29ug/ml；活化部分凝血活酶时间(APTT)-静脉血: 38.5sec.；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.04S/CO；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.82mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.6；单核细胞百分比(Mono%)-静脉血: 0.047；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；间接胆红素(IBIL)-静脉血: 10.5umolL；白蛋白(ALB)-静脉血: 48g/L；氯离子(Cl-)-静脉血: 101.7mmol/L；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.718；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.1COI；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；白细胞计数(WBC#)-静脉血: 6.9510E9/L；红细胞比容(Hct)-静脉血: 46.8%；尿酸(UA)-静脉血: 431.8umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 81.8umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 26mmol/L；血小板分布宽度(PDW)-静脉血: 11.2%；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.04S/CO；平均血小板体积(MPV)-静脉血: 9.7fL；中性粒细胞计数(Neut#)-静脉血: 510E9/L；载脂蛋白B(apoB)-静脉血: 0.96g/L；凝血酶原时间(PT)-静脉血: 11.8sec.；钠离子(Na+)-静脉血: 138.7mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；甘油三酯(TG)-静脉血: 2.2mmol/L；总胆红素(TBIL)-静脉血: 15.2umol/L；乳酸脱氢酶(LDH)-静脉血: 172.2U/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；总钙(Ca)-静脉血: 2.37mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0IU/mL；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；总胆固醇(TC)-静脉血: 4.17mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.03g/L\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 Ⅱ、Ⅲ、aVF、V5、V6导联T波低平\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、后壁及双侧壁增厚，见软组织肿物向鼻咽腔内突出，在T1WI上呈等信号，在T2WI上呈稍高信号，增强扫描明显强化。双侧咽隐窝变浅，见软组织肿物填充。病灶侵犯左侧后鼻孔，侵犯左侧腭帆张提肌、左侧翼内肌头部、左侧咽旁脂肪间隙，侵犯蝶窦左侧份及左侧翼腭窝，侵犯左侧破裂孔、左侧海绵窦。 右侧咽旁间隙及双侧颈动脉鞘区血管未见明显异常。右侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常。口咽双侧壁未见增厚。 斜坡、左侧岩尖、蝶骨基底部、左侧翼突区骨质信号减低，增强扫描明显强化。 右侧海绵窦形态正常，未见增宽。 双侧筛窦、左侧上颌窦、蝶窦及右侧乳突粘膜增厚，左侧乳突内见大量长分期信息见历史辅助诊断节点长分期信息见历史辅助诊断节点信号分泌物。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变。 左侧咽后可见数个小淋巴结，较大短径约4mm；右侧咽后可见小淋巴结，短径约2mm。左颈II、III区可见数个淋巴结，最大约21mm×15mm，部分呈相互融合改变，边界欠清，增强扫描可见明显强化。右颈II、III区可见数个淋巴结，最大约12mm×7mm，边界清。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 左颈II、III区淋巴结肿大，考虑转移。 左侧咽后、右颈II、III区淋巴结，不排除转移。 右侧咽后小淋巴结。 鼻窦炎。双侧乳突炎。\n- [全程D5] 检验组合: EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；Rh血型-静脉血: 阳性；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；ABO血型-静脉血: O\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善胸部CT、腹部CT及全身骨扫描，并补充颈部淋巴结切除活检\nB. 完善全身PET-CT检查，并补充颈部淋巴结穿刺活检\nC. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充头颈部CTA检查\nD. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充颈部淋巴结穿刺活检\nE. 完善胸部CT、腹部CT，并补充脑部MRI平扫及增强\nF. 完善全身骨扫描及脑部MRI增强，并补充血浆EBV DNA定量检测\nG. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充鼻咽脱落细胞学检查\nH. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充血浆EBV DNA定量检测\nI. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充骨髓穿刺活检\nJ. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充EBV抗体滴度复查\nK. 完善胸部CT、腹部CT及全身骨扫描，并补充头颅PET-MR检查\nL. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并立即开始诱导化疗\n\n请仅输出一个选项字母（A-L）。","gold_letter":"H","gold_action":"完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充血浆EBV DNA定量检测","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"完善胸部CT、腹部CT及全身骨扫描，并补充颈部淋巴结切除活检"},{"letter":"B","text":"完善全身PET-CT检查，并补充颈部淋巴结穿刺活检"},{"letter":"C","text":"完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充头颈部CTA检查"},{"letter":"D","text":"完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充颈部淋巴结穿刺活检"},{"letter":"E","text":"完善胸部CT、腹部CT，并补充脑部MRI平扫及增强"},{"letter":"F","text":"完善全身骨扫描及脑部MRI增强，并补充血浆EBV DNA定量检测"},{"letter":"G","text":"完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充鼻咽脱落细胞学检查"},{"letter":"H","text":"完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充血浆EBV DNA定量检测"},{"letter":"I","text":"完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充骨髓穿刺活检"},{"letter":"J","text":"完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充EBV抗体滴度复查"},{"letter":"K","text":"完善胸部CT、腹部CT及全身骨扫描，并补充头颅PET-MR检查"},{"letter":"L","text":"完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并立即开始诱导化疗"}]}
+{"sample_id":"sample-cd1385d4e13dda199ba81658","patient_id":"patient-5731cc38ced94b2ee39c442a","turn_id":"turn05","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D0] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.51；平均红细胞血红蛋白含量(MCH)-静脉血: 27.4pg；磷(P)-静脉血: 0.9mmol/L；直接胆红素(DBIL)-静脉血: 4.7umol/L；凝血酶时间(TT)-静脉血: 22.7sec.；D-二聚体(D-Dimer)-静脉血: 0.29ug/ml；活化部分凝血活酶时间(APTT)-静脉血: 38.5sec.；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.04S/CO；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.82mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.6；单核细胞百分比(Mono%)-静脉血: 0.047；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；间接胆红素(IBIL)-静脉血: 10.5umolL；白蛋白(ALB)-静脉血: 48g/L；氯离子(Cl-)-静脉血: 101.7mmol/L；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.718；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.1COI；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；白细胞计数(WBC#)-静脉血: 6.9510E9/L；红细胞比容(Hct)-静脉血: 46.8%；尿酸(UA)-静脉血: 431.8umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 81.8umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 26mmol/L；血小板分布宽度(PDW)-静脉血: 11.2%；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.04S/CO；平均血小板体积(MPV)-静脉血: 9.7fL；中性粒细胞计数(Neut#)-静脉血: 510E9/L；载脂蛋白B(apoB)-静脉血: 0.96g/L；凝血酶原时间(PT)-静脉血: 11.8sec.；钠离子(Na+)-静脉血: 138.7mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；甘油三酯(TG)-静脉血: 2.2mmol/L；总胆红素(TBIL)-静脉血: 15.2umol/L；乳酸脱氢酶(LDH)-静脉血: 172.2U/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；总钙(Ca)-静脉血: 2.37mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0IU/mL；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；总胆固醇(TC)-静脉血: 4.17mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.03g/L\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 Ⅱ、Ⅲ、aVF、V5、V6导联T波低平\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D24] 检验组合: 天门冬氨酸氨基转移酶(AST)-静脉血: 20.1U/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；血小板分布宽度(PDW)-静脉血: 11.9%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.1；尿素氮(BUN)-静脉血: 3.6mmol/L；磷(P)-静脉血: 0.97mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21.8U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.55；丙氨酸氨基转移酶(ALT)-静脉血: 41U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.19mmol/L；葡萄糖(Glu)-静脉血: 5.41mmol/L；白蛋白(ALB)-静脉血: 46.9g/L；白细胞计数(WBC#)-静脉血: 5.2810E9/L；红细胞计数(RBC#)-静脉血: 5.3910E12/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.6；尿酸(UA)-静脉血: 386.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 27U/L；C-反应蛋白(CRP)-静脉血: 4.25mg/L；钾离子(K+)-静脉血: 4.08mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.051；载脂蛋白B(apoB)-静脉血: 1.1g/L；球蛋白(GLO)-静脉血: 30.3g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；平均血小板体积(MPV)-静脉血: 10.3fL；总胆汁酸(TBA)-静脉血: 1.8umol/L；总蛋白(TP)-静脉血: 77.2g/L；间接胆红素(IBIL)-静脉血: 11.1umolL；甘油三酯(TG)-静脉血: 1.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.08g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.310E9/L；氯离子(Cl-)-静脉血: 102.2mmol/L；单核细胞百分比(Mono%)-静脉血: 0.072；碱性磷酸酶(ALP)-静脉血: 82.4U/L；总胆红素(TBIL)-静脉血: 15.1umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.49；总胆固醇(TC)-静脉血: 4.74mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.237；血小板比容-静脉血: 19%；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.94mmolL；平均红细胞血红蛋白含量(MCH)-静脉血: 28.2pg；血液二氧化碳含量ctCO2(B)-静脉血: 22.7mmol/L；肌酐(Crea)-静脉血: 68.7umol/L；钠离子(Na+)-静脉血: 136.2mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.634；中性粒细胞计数(Neut#)-静脉血: 3.410E9/L\n- [全程D25] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右侧约平T6椎体下缘水平，估计导管末端位于上腔静脉下段内。；检查结论: PICC管位置如上所述。\n- [全程D25] 检验组合: 浊度(TRUB)-尿液: clear；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 5.5；葡萄糖(Glu)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；虫卵-粪便: 未见虫卵（参考: 未见虫卵）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 30/μL；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；隐血(OB)-粪便: 阴性（参考: 阴性）；比重(SG)-尿液: 1.021；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-粪便: 棕色；酮体(KET)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D29] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；磷(P)-静脉血: 1.54mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.4U/L；总胆固醇(TC)-静脉血: 6.28mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.3pg；镁离子(Mg2+)-静脉血: 1.06mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=2.00)（参考: 阴性）；肌酐(Crea)-静脉血: 76.5umol/L；球蛋白(GLO)-静脉血: 31.62g/L；白蛋白(ALB)-静脉血: 48.1g/L；白细胞计数(WBC#)-静脉血: 5.310E9/L；血小板分布宽度(PDW)-静脉血: 14.3%；单核细胞百分比(Mono%)-静脉血: 0.011；淋巴细胞百分比(Lymph%)-静脉血: 0.128；血小板计数(PLT#)-静脉血: 18310E9/L；甘油三酯(TG)-静脉血: 1.83mmol/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；碱性磷酸酶(ALP)-静脉血: 76.4U/L；总胆汁酸(TBA)-静脉血: 14.5umol/L；总蛋白(TP)-静脉血: 79.72g/L；有核红细胞百分比(NRBC%)-静脉血: 0；红细胞比容(Hct)-静脉血: 44.3%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.7；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.42mmolL；胱抑素(Cys-C)-静脉血: 1.15mg/L；尿酸(UA)-静脉血: 254.8umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；间接胆红素(IBIL)-静脉血: 27.2umolL；钾离子(K+)-静脉血: 4.43mmol/L；乳酸脱氢酶(LDH)-静脉血: 200.6U/L；C-反应蛋白(CRP)-静脉血: 1.97mg/L；浊度(TRUB)-尿液: clear；酸碱度(pH)-尿液: 5.5；平均红细胞体积(MCV)-静脉血: 83fL；中性粒细胞计数(Neut#)-静脉血: 4.610E9/L；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；中性粒细胞百分比(Neut%)-静脉血: 0.861；钠离子(Na+)-静脉血: 137.2mmol/L；氯离子(Cl-)-静脉血: 99.1mmol/L；载脂蛋白B(apoB)-静脉血: 1.3g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D26] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 化疗第2天，患者一般情况可，未诉特殊不适。查体：左侧颈部II区可扪及1个淋巴结，最大径2cm×2.5cm2，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。上级医师信息已隐藏示：目前暂未出现明显副反应，继续行化疗，密切观察病情。\n- [全程D29] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 化疗第5天，患者一般情况可。体查：KPS90分，张口门齿距4.5cm。鼻咽顶壁、顶后壁、双侧壁结节状肿物；左侧颈部II区可扪及1个淋巴结，最大径2cm×2cm2，无融合，质中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。复查血常规无明显异常。生化示：ALT 77.8U/L↑、IBIL27.20 umolL↑、TBIL35.1umol/L↑。上级医师信息已隐藏示:第1程化疗结束，病情稳定，今日予办理出院。嘱其注意休息及营养支持，保持口腔清洁；出院后每周复查血常规2次，生化1次常规；按时[计划性表述已隐藏]下一程诱导化疗；若有不适，及时就诊。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 办理出院，暂不予保肝药物干预，嘱每周复查血常规和生化，按期返院行下一程诱导化疗。\nB. 暂缓出院，予静脉滴注保肝降酶药物，待转氨酶及胆红素完全恢复正常后出院，按期行下一程诱导化疗。\nC. 办理出院，开具口服保肝药物，终止后续诱导化疗计划，择期直接开始根治性同期放化疗。\nD. 办理出院，开具口服保肝药物，下一程诱导化疗直接将多西他赛及顺铂剂量下调20%。\nE. 办理出院，开具口服保肝药物，下一程诱导化疗方案更改为吉西他滨联合顺铂（GP方案）。\nF. 暂缓出院，请感染内科会诊排除乙肝病毒再激活，待专科意见明确后再决定后续抗肿瘤治疗计划。\nG. 办理出院，开具口服保肝药物，嘱每周复查血常规和生化，将下一程诱导化疗推迟1至2周进行。\nH. 办理出院，开具口服保肝药物，并预防性给予长效G-CSF支持，按期返院行下一程诱导化疗。\nI. 暂缓出院，按重度药物性肝损伤启动多学科联合诊疗，待肝功能好转后，按期行下一程诱导化疗。\nJ. 办理出院，开具口服保肝药物，下一程治疗停用尼妥珠单抗，仅行TPF方案诱导化疗。\nK. 办理出院，开具口服保肝药物（如多烯磷脂酰胆碱等），嘱每周复查血常规和生化，按期返院行下一程诱导化疗。\nL. 办理出院，开具口服保肝药物，下一程诱导化疗剔除氟尿嘧啶，改为多西他赛联合顺铂双药方案。\n\n请仅输出一个选项字母（A-L）。","gold_letter":"K","gold_action":"办理出院，开具口服保肝药物（如多烯磷脂酰胆碱等），嘱每周复查血常规和生化，按期返院行下一程诱导化疗。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"办理出院，暂不予保肝药物干预，嘱每周复查血常规和生化，按期返院行下一程诱导化疗。"},{"letter":"B","text":"暂缓出院，予静脉滴注保肝降酶药物，待转氨酶及胆红素完全恢复正常后出院，按期行下一程诱导化疗。"},{"letter":"C","text":"办理出院，开具口服保肝药物，终止后续诱导化疗计划，择期直接开始根治性同期放化疗。"},{"letter":"D","text":"办理出院，开具口服保肝药物，下一程诱导化疗直接将多西他赛及顺铂剂量下调20%。"},{"letter":"E","text":"办理出院，开具口服保肝药物，下一程诱导化疗方案更改为吉西他滨联合顺铂（GP方案）。"},{"letter":"F","text":"暂缓出院，请感染内科会诊排除乙肝病毒再激活，待专科意见明确后再决定后续抗肿瘤治疗计划。"},{"letter":"G","text":"办理出院，开具口服保肝药物，嘱每周复查血常规和生化，将下一程诱导化疗推迟1至2周进行。"},{"letter":"H","text":"办理出院，开具口服保肝药物，并预防性给予长效G-CSF支持，按期返院行下一程诱导化疗。"},{"letter":"I","text":"暂缓出院，按重度药物性肝损伤启动多学科联合诊疗，待肝功能好转后，按期行下一程诱导化疗。"},{"letter":"J","text":"办理出院，开具口服保肝药物，下一程治疗停用尼妥珠单抗，仅行TPF方案诱导化疗。"},{"letter":"K","text":"办理出院，开具口服保肝药物（如多烯磷脂酰胆碱等），嘱每周复查血常规和生化，按期返院行下一程诱导化疗。"},{"letter":"L","text":"办理出院，开具口服保肝药物，下一程诱导化疗剔除氟尿嘧啶，改为多西他赛联合顺铂双药方案。"}]}
+{"sample_id":"sample-ad5a1060b6801c87debff9d0","patient_id":"patient-5731cc38ced94b2ee39c442a","turn_id":"turn06","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D0] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.51；平均红细胞血红蛋白含量(MCH)-静脉血: 27.4pg；磷(P)-静脉血: 0.9mmol/L；直接胆红素(DBIL)-静脉血: 4.7umol/L；凝血酶时间(TT)-静脉血: 22.7sec.；D-二聚体(D-Dimer)-静脉血: 0.29ug/ml；活化部分凝血活酶时间(APTT)-静脉血: 38.5sec.；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.04S/CO；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.82mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.6；单核细胞百分比(Mono%)-静脉血: 0.047；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；间接胆红素(IBIL)-静脉血: 10.5umolL；白蛋白(ALB)-静脉血: 48g/L；氯离子(Cl-)-静脉血: 101.7mmol/L；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.718；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.1COI；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；白细胞计数(WBC#)-静脉血: 6.9510E9/L；红细胞比容(Hct)-静脉血: 46.8%；尿酸(UA)-静脉血: 431.8umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 81.8umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 26mmol/L；血小板分布宽度(PDW)-静脉血: 11.2%；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.04S/CO；平均血小板体积(MPV)-静脉血: 9.7fL；中性粒细胞计数(Neut#)-静脉血: 510E9/L；载脂蛋白B(apoB)-静脉血: 0.96g/L；凝血酶原时间(PT)-静脉血: 11.8sec.；钠离子(Na+)-静脉血: 138.7mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；甘油三酯(TG)-静脉血: 2.2mmol/L；总胆红素(TBIL)-静脉血: 15.2umol/L；乳酸脱氢酶(LDH)-静脉血: 172.2U/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；总钙(Ca)-静脉血: 2.37mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0IU/mL；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；总胆固醇(TC)-静脉血: 4.17mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.03g/L\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 Ⅱ、Ⅲ、aVF、V5、V6导联T波低平\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D24] 检验组合: 天门冬氨酸氨基转移酶(AST)-静脉血: 20.1U/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；血小板分布宽度(PDW)-静脉血: 11.9%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.1；尿素氮(BUN)-静脉血: 3.6mmol/L；磷(P)-静脉血: 0.97mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21.8U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.55；丙氨酸氨基转移酶(ALT)-静脉血: 41U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.19mmol/L；葡萄糖(Glu)-静脉血: 5.41mmol/L；白蛋白(ALB)-静脉血: 46.9g/L；白细胞计数(WBC#)-静脉血: 5.2810E9/L；红细胞计数(RBC#)-静脉血: 5.3910E12/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.6；尿酸(UA)-静脉血: 386.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 27U/L；C-反应蛋白(CRP)-静脉血: 4.25mg/L；钾离子(K+)-静脉血: 4.08mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.051；载脂蛋白B(apoB)-静脉血: 1.1g/L；球蛋白(GLO)-静脉血: 30.3g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；平均血小板体积(MPV)-静脉血: 10.3fL；总胆汁酸(TBA)-静脉血: 1.8umol/L；总蛋白(TP)-静脉血: 77.2g/L；间接胆红素(IBIL)-静脉血: 11.1umolL；甘油三酯(TG)-静脉血: 1.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.08g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.310E9/L；氯离子(Cl-)-静脉血: 102.2mmol/L；单核细胞百分比(Mono%)-静脉血: 0.072；碱性磷酸酶(ALP)-静脉血: 82.4U/L；总胆红素(TBIL)-静脉血: 15.1umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.49；总胆固醇(TC)-静脉血: 4.74mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.237；血小板比容-静脉血: 19%；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.94mmolL；平均红细胞血红蛋白含量(MCH)-静脉血: 28.2pg；血液二氧化碳含量ctCO2(B)-静脉血: 22.7mmol/L；肌酐(Crea)-静脉血: 68.7umol/L；钠离子(Na+)-静脉血: 136.2mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.634；中性粒细胞计数(Neut#)-静脉血: 3.410E9/L\n- [全程D25] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右侧约平T6椎体下缘水平，估计导管末端位于上腔静脉下段内。；检查结论: PICC管位置如上所述。\n- [全程D25] 检验组合: 浊度(TRUB)-尿液: clear；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 5.5；葡萄糖(Glu)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；虫卵-粪便: 未见虫卵（参考: 未见虫卵）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 30/μL；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；隐血(OB)-粪便: 阴性（参考: 阴性）；比重(SG)-尿液: 1.021；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-粪便: 棕色；酮体(KET)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D29] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；磷(P)-静脉血: 1.54mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.4U/L；总胆固醇(TC)-静脉血: 6.28mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.3pg；镁离子(Mg2+)-静脉血: 1.06mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=2.00)（参考: 阴性）；肌酐(Crea)-静脉血: 76.5umol/L；球蛋白(GLO)-静脉血: 31.62g/L；白蛋白(ALB)-静脉血: 48.1g/L；白细胞计数(WBC#)-静脉血: 5.310E9/L；血小板分布宽度(PDW)-静脉血: 14.3%；单核细胞百分比(Mono%)-静脉血: 0.011；淋巴细胞百分比(Lymph%)-静脉血: 0.128；血小板计数(PLT#)-静脉血: 18310E9/L；甘油三酯(TG)-静脉血: 1.83mmol/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；碱性磷酸酶(ALP)-静脉血: 76.4U/L；总胆汁酸(TBA)-静脉血: 14.5umol/L；总蛋白(TP)-静脉血: 79.72g/L；有核红细胞百分比(NRBC%)-静脉血: 0；红细胞比容(Hct)-静脉血: 44.3%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.7；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.42mmolL；胱抑素(Cys-C)-静脉血: 1.15mg/L；尿酸(UA)-静脉血: 254.8umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；间接胆红素(IBIL)-静脉血: 27.2umolL；钾离子(K+)-静脉血: 4.43mmol/L；乳酸脱氢酶(LDH)-静脉血: 200.6U/L；C-反应蛋白(CRP)-静脉血: 1.97mg/L；浊度(TRUB)-尿液: clear；酸碱度(pH)-尿液: 5.5；平均红细胞体积(MCV)-静脉血: 83fL；中性粒细胞计数(Neut#)-静脉血: 4.610E9/L；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；中性粒细胞百分比(Neut%)-静脉血: 0.861；钠离子(Na+)-静脉血: 137.2mmol/L；氯离子(Cl-)-静脉血: 99.1mmol/L；载脂蛋白B(apoB)-静脉血: 1.3g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D32] 检验组合: 间接胆红素(IBIL)-静脉血: 13.9umolL；肌酐(Crea)-静脉血: 83.3umol/L；碱性磷酸酶(ALP)-静脉血: 80.7U/L；镁离子(Mg2+)-静脉血: 1.02mmol/L；总胆红素(TBIL)-静脉血: 19.3umol/L；胱抑素(Cys-C)-静脉血: 0.87mg/L；尿素氮(BUN)-静脉血: 4.5mmol/L；载脂蛋白B(apoB)-静脉血: 1.13g/L；白细胞计数(WBC#)-静脉血: 3.0510E9/L；总胆汁酸(TBA)-静脉血: 1.7umol/L；血小板分布宽度(PDW)-静脉血: 12.5%；血小板比容-静脉血: 17%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.01；单核细胞百分比(Mono%)-静脉血: 0.013；平均血小板体积(MPV)-静脉血: 10.9fL；乳酸脱氢酶(LDH)-静脉血: 186U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.36；平均红细胞血红蛋白含量(MCH)-静脉血: 27.7pg；平均红细胞体积(MCV)-静脉血: 81.7fL；单核细胞计数(Mono#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 15410E9/L；氯离子(Cl-)-静脉血: 96.9mmol/L；钾离子(K+)-静脉血: 3.58mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.4mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 28U/L；甘油三酯(TG)-静脉血: 1.46mmol/L；红细胞比容(Hct)-静脉血: 44.3%；中性粒细胞百分比(Neut%)-静脉血: 0.748；总钙(Ca)-静脉血: 2.27mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 34.1；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 25.5U/L；葡萄糖(Glu)-静脉血: 5.55mmol/L；尿酸(UA)-静脉血: 325.7umol/L；直接胆红素(DBIL)-静脉血: 5.4umol/L；钠离子(Na+)-静脉血: 133.9mmol/L；大血小板百分比(P-LCR%)-静脉血: 31.7%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.5；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.07mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 77.3U/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339g/L；磷(P)-静脉血: 1.06mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.51；总胆固醇(TC)-静脉血: 4.68mmol/L；总蛋白(TP)-静脉血: 73.01g/L\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D26] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 化疗第2天，患者一般情况可，未诉特殊不适。查体：左侧颈部II区可扪及1个淋巴结，最大径2cm×2.5cm2，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。上级医师信息已隐藏示：目前暂未出现明显副反应，继续行化疗，密切观察病情。\n- [全程D29] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 化疗第5天，患者一般情况可。体查：KPS90分，张口门齿距4.5cm。鼻咽顶壁、顶后壁、双侧壁结节状肿物；左侧颈部II区可扪及1个淋巴结，最大径2cm×2cm2，无融合，质中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。复查血常规无明显异常。生化示：ALT 77.8U/L↑、IBIL27.20 umolL↑、TBIL35.1umol/L↑。上级医师信息已隐藏示:第1程化疗结束，病情稳定，今日予办理出院。嘱其注意休息及营养支持，保持口腔清洁；出院后每周复查血常规2次，生化1次常规；按时[计划性表述已隐藏]下一程诱导化疗；若有不适，及时就诊。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 予以皮下注射重组人粒细胞集落刺激因子（G-CSF），并静脉滴注异甘草酸镁进行保肝治疗。\nB. 嘱多饮水及注意休息，暂不予药物干预，定期门诊复查血常规及肝肾功能以评估毒性。\nC. 开具口服升白细胞药物（如咖啡酸片）及保肝药物（如复方甘草酸苷），暂不使用护胃止吐药物。\nD. 立即收治入院，予以静脉滴注质子泵抑制剂、止吐药及保肝药物，并密切监测血常规变化。\nE. 开具口服抑酸护胃及促胃动力药物（如艾司奥美拉唑、多潘立酮），暂不处理白细胞及肝功能异常。\nF. 提前开始第二周期TPF诱导化疗，并预防性给予长效G-CSF及静脉保肝药物支持治疗。\nG. 开具口服保肝药物（如复方甘草酸苷）及护胃止吐药物，暂不予口服升白细胞药物进行干预。\nH. 予以皮下注射重组人促红素（EPO），并开具口服保肝、护胃及促动力药物进行对症支持。\nI. 开具口服升白细胞药物（如咖啡酸片）、抑酸护胃及促胃动力药物，暂不予保肝药物治疗。\nJ. 安排骨髓穿刺检查以明确白细胞减少原因，同时开具口服保肝及护胃药物进行对症支持。\nK. 门诊静脉推注地塞米松及昂丹司琼强化止吐，并开具口服保肝及升白药物进行对症支持。\nL. 开具口服升白细胞药物（如咖啡酸片）、保肝药物（如复方甘草酸苷）及抑酸护胃、促动力药物进行对症支持。\n\n请仅输出一个选项字母（A-L）。","gold_letter":"L","gold_action":"开具口服升白细胞药物（如咖啡酸片）、保肝药物（如复方甘草酸苷）及抑酸护胃、促动力药物进行对症支持。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"予以皮下注射重组人粒细胞集落刺激因子（G-CSF），并静脉滴注异甘草酸镁进行保肝治疗。"},{"letter":"B","text":"嘱多饮水及注意休息，暂不予药物干预，定期门诊复查血常规及肝肾功能以评估毒性。"},{"letter":"C","text":"开具口服升白细胞药物（如咖啡酸片）及保肝药物（如复方甘草酸苷），暂不使用护胃止吐药物。"},{"letter":"D","text":"立即收治入院，予以静脉滴注质子泵抑制剂、止吐药及保肝药物，并密切监测血常规变化。"},{"letter":"E","text":"开具口服抑酸护胃及促胃动力药物（如艾司奥美拉唑、多潘立酮），暂不处理白细胞及肝功能异常。"},{"letter":"F","text":"提前开始第二周期TPF诱导化疗，并预防性给予长效G-CSF及静脉保肝药物支持治疗。"},{"letter":"G","text":"开具口服保肝药物（如复方甘草酸苷）及护胃止吐药物，暂不予口服升白细胞药物进行干预。"},{"letter":"H","text":"予以皮下注射重组人促红素（EPO），并开具口服保肝、护胃及促动力药物进行对症支持。"},{"letter":"I","text":"开具口服升白细胞药物（如咖啡酸片）、抑酸护胃及促胃动力药物，暂不予保肝药物治疗。"},{"letter":"J","text":"安排骨髓穿刺检查以明确白细胞减少原因，同时开具口服保肝及护胃药物进行对症支持。"},{"letter":"K","text":"门诊静脉推注地塞米松及昂丹司琼强化止吐，并开具口服保肝及升白药物进行对症支持。"},{"letter":"L","text":"开具口服升白细胞药物（如咖啡酸片）、保肝药物（如复方甘草酸苷）及抑酸护胃、促动力药物进行对症支持。"}]}
+{"sample_id":"sample-b10ed2b10a17f1626353b252","patient_id":"patient-5731cc38ced94b2ee39c442a","turn_id":"turn07","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D0] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.51；平均红细胞血红蛋白含量(MCH)-静脉血: 27.4pg；磷(P)-静脉血: 0.9mmol/L；直接胆红素(DBIL)-静脉血: 4.7umol/L；凝血酶时间(TT)-静脉血: 22.7sec.；D-二聚体(D-Dimer)-静脉血: 0.29ug/ml；活化部分凝血活酶时间(APTT)-静脉血: 38.5sec.；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.04S/CO；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.82mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.6；单核细胞百分比(Mono%)-静脉血: 0.047；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；间接胆红素(IBIL)-静脉血: 10.5umolL；白蛋白(ALB)-静脉血: 48g/L；氯离子(Cl-)-静脉血: 101.7mmol/L；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.718；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.1COI；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；白细胞计数(WBC#)-静脉血: 6.9510E9/L；红细胞比容(Hct)-静脉血: 46.8%；尿酸(UA)-静脉血: 431.8umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 81.8umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 26mmol/L；血小板分布宽度(PDW)-静脉血: 11.2%；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.04S/CO；平均血小板体积(MPV)-静脉血: 9.7fL；中性粒细胞计数(Neut#)-静脉血: 510E9/L；载脂蛋白B(apoB)-静脉血: 0.96g/L；凝血酶原时间(PT)-静脉血: 11.8sec.；钠离子(Na+)-静脉血: 138.7mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；甘油三酯(TG)-静脉血: 2.2mmol/L；总胆红素(TBIL)-静脉血: 15.2umol/L；乳酸脱氢酶(LDH)-静脉血: 172.2U/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；总钙(Ca)-静脉血: 2.37mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0IU/mL；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；总胆固醇(TC)-静脉血: 4.17mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.03g/L\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 Ⅱ、Ⅲ、aVF、V5、V6导联T波低平\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D50] 检验组合: 碱性磷酸酶(ALP)-静脉血: 79.1U/L；总胆红素(TBIL)-静脉血: 18.4umol/L；血小板比容-静脉血: 24%；磷(P)-静脉血: 1.77mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=4.50)（参考: 阴性）；白蛋白(ALB)-静脉血: 44g/L；C-反应蛋白(CRP)-静脉血: 2.48mg/L；球蛋白(GLO)-静脉血: 30.07g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 5.18mmol/L；总胆汁酸(TBA)-静脉血: 3umol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.9；平均红细胞血红蛋白浓度(MCHC)-静脉血: 332g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0；淋巴细胞百分比(Lymph%)-静脉血: 0.212；胱抑素(Cys-C)-静脉血: 1.1mg/L；乳酸脱氢酶(LDH)-静脉血: 209.6U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 51.1U/L；氯离子(Cl-)-静脉血: 99.5mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 45.8U/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.7mmol/L；载脂蛋白B(apoB)-静脉血: 1.54g/L；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.726；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.18mmolL；镁离子(Mg2+)-静脉血: 0.94mmol/L；钾离子(K+)-静脉血: 4.21mmol/L；阴离子间隙(AG)-静脉血: 15；单核细胞百分比(Mono%)-静脉血: 0.06；直接胆红素(DBIL)-静脉血: 3.3umol/L；总蛋白(TP)-静脉血: 74.07g/L；红细胞比容(Hct)-静脉血: 41.9%；血小板计数(PLT#)-静脉血: 24410E9/L；EB病毒Zta蛋白抗体IgA(EBV-Zta-IgA)-静脉血: 阳性(SCO=5.00)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 32.5U/L；载脂蛋白AI(apoAI)-静脉血: 1.2g/L；总钙(Ca)-静脉血: 2.42mmol/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:640（参考: 阴性）；平均红细胞血红蛋白含量(MCH)-静脉血: 26.9pg；尿素氮(BUN)-静脉血: 8.9mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.5；平均红细胞体积(MCV)-静脉血: 81.2fL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.46；甘油三酯(TG)-静脉血: 2.02mmol/L\n- [全程D53] 检验组合: 单核细胞计数(Mono#)-静脉血: 0.210E9/L；平均血小板体积(MPV)-静脉血: 10.1fL；平均红细胞血红蛋白含量(MCH)-静脉血: 27.5pg；氯离子(Cl-)-静脉血: 102.2mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；血小板分布宽度(PDW)-静脉血: 11.6%；钾离子(K+)-静脉血: 4.44mmol/L；血红蛋白(Hb)-静脉血: 146g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.4U/L；血小板比容-静脉血: 24%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 23610E9/L；肌酐(Crea)-静脉血: 78umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.97mmolL；直接胆红素(DBIL)-静脉血: 2.9umol/L；镁离子(Mg2+)-静脉血: 0.89mmol/L；白细胞计数(WBC#)-静脉血: 4.8410E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.9；有核红细胞计数(NRBC#)-静脉血: 010E9/L；尿酸(UA)-静脉血: 396.5umol/L；白蛋白(ALB)-静脉血: 43.6g/L；有核红细胞百分比(NRBC%)-静脉血: 0；单核细胞百分比(Mono%)-静脉血: 0.041；甘油三酯(TG)-静脉血: 1.5mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.5；总胆汁酸(TBA)-静脉血: 3.2umol/L；总钙(Ca)-静脉血: 2.29mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 29.4U/L；碱性磷酸酶(ALP)-静脉血: 88.9U/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.5mmol/L；平均红细胞体积(MCV)-静脉血: 84fL；丙氨酸氨基转移酶(ALT)-静脉血: 34.7U/L；红细胞比容(Hct)-静脉血: 44.5%；尿素氮(BUN)-静脉血: 6.4mmol/L；胱抑素(Cys-C)-静脉血: 0.8mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.32mmol/L；总胆固醇(TC)-静脉血: 5.95mmol/L；间接胆红素(IBIL)-静脉血: 7umolL；淋巴细胞百分比(Lymph%)-静脉血: 0.227；大血小板百分比(P-LCR%)-静脉血: 26.3%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.002；载脂蛋白AI(apoAI)-静脉血: 1.08g/L\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D64] 检验组合: 磷(P)-静脉血: 1.1mmol/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；平均红细胞血红蛋白含量(MCH)-静脉血: 27.3pg；平均血小板体积(MPV)-静脉血: 9.4fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.4；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；总钙(Ca)-静脉血: 2.24mmol/L；总蛋白(TP)-静脉血: 73.3g/L；氯离子(Cl-)-静脉血: 104.7mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 46.1U/L；单核细胞百分比(Mono%)-静脉血: 0.094；α-L-岩藻糖苷酶(AFU)-静脉血: 31.3U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.93mmol/L；尿素氮(BUN)-静脉血: 6.4mmol/L；总胆固醇(TC)-静脉血: 5.7mmol/L；血小板计数(PLT#)-静脉血: 15510E9/L；球蛋白(GLO)-静脉血: 28g/L；直接胆红素(DBIL)-静脉血: 2.3umol/L；总胆汁酸(TBA)-静脉血: 1.8umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.09mmolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.74；载脂蛋白B(apoB)-静脉血: 1.34g/L；钠离子(Na+)-静脉血: 141.6mmol/L；C-反应蛋白(CRP)-静脉血: 4.1mg/L；血小板比容-静脉血: 15%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；葡萄糖(Glu)-静脉血: 5.4mmol/L；白蛋白(ALB)-静脉血: 45.3g/L；有核红细胞计数(NRBC#)-静脉血: 0.0110E9/L；尿酸(UA)-静脉血: 511.6umol/L；甘油三酯(TG)-静脉血: 1.82mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.5mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 26.8U/L；大血小板百分比(P-LCR%)-静脉血: 19.5%；中性粒细胞计数(Neut#)-静脉血: 3.110E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 319g/L；乳酸脱氢酶(LDH)-静脉血: 210U/L；碱性磷酸酶(ALP)-静脉血: 94.9U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.261；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.62；中性粒细胞百分比(Neut%)-静脉血: 0.639；钾离子(K+)-静脉血: 4.48mmol/L；镁离子(Mg2+)-静脉血: 0.91mmol/L；阴离子间隙(AG)-静脉血: 13.4\n- [全程D71] 检验组合: γ-谷氨酰基转移酶(GGT)-静脉血: 47U/L；尿酸(UA)-静脉血: 339.1umol/L；阴离子间隙(AG)-静脉血: 16.7；白细胞计数(WBC#)-静脉血: 5.8510E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 27.4pg；有核红细胞计数(NRBC#)-静脉血: 010E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.156；EB病毒Zta蛋白抗体IgA(EBV-Zta-IgA)-静脉血: 阳性(SCO=4.00)（参考: 阴性）；磷(P)-静脉血: 1.25mmol/L；肌酐(Crea)-静脉血: 80.9umol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:20（参考: 阴性）；单核细胞百分比(Mono%)-静脉血: 0.029；中性粒细胞计数(Neut#)-静脉血: 4.810E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.7mmol/L；红细胞比容(Hct)-静脉血: 43.3%；总胆红素(TBIL)-静脉血: 18.3umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 6.04mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；平均血小板体积(MPV)-静脉血: 10.9fL；碱性磷酸酶(ALP)-静脉血: 81.8U/L；葡萄糖(Glu)-静脉血: 5.79mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.6；间接胆红素(IBIL)-静脉血: 15umolL；α-L-岩藻糖苷酶(AFU)-静脉血: 41.6U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.48mmolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.3；载脂蛋白AI(apoAI)-静脉血: 1.28g/L；甘油三酯(TG)-静脉血: 2.29mmol/L；平均红细胞体积(MCV)-静脉血: 83.1fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板比容-静脉血: 17%；球蛋白(GLO)-静脉血: 29.1g/L；载脂蛋白B(apoB)-静脉血: 1.64g/L；乳酸脱氢酶(LDH)-静脉血: 229.2U/L；镁离子(Mg2+)-静脉血: 0.76mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.64；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；钠离子(Na+)-静脉血: 139.3mmol/L；尿素氮(BUN)-静脉血: 9mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 34U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.49；红细胞计数(RBC#)-静脉血: 5.2110E12/L；淋巴细胞计数(Lymph#)-静脉血: 0.910E9/L；胱抑素(Cys-C)-静脉血: 1.19mg/L\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D75] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后，对比某次就诊时间片： 鼻咽腔稍狭窄，鼻咽左顶壁及左侧壁增厚，在T1WI上呈等信号，在T2WI上呈稍高信号，增强扫描明显强化，较前明显缩小，左侧破裂孔、海绵窦、翼腭窝及蝶窦左份仍可见软组织灶，边界欠清，明显强化。右侧咽隐窝存在，左侧咽隐窝变浅 左侧腭帆张提肌、左侧翼内肌上缘信号不均匀，可见强化。 左侧咽旁间隙变窄，右侧咽旁间隙及双侧颈动脉鞘区血管未见明显异常。 右侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常。口咽双侧壁未见增厚。 斜坡、左侧岩尖、蝶骨基底部、左侧翼突区骨质信号减低，增强扫描明显强化。 右侧海绵窦形态正常，未见增宽。 双侧筛窦、左侧上颌窦、蝶窦粘膜增厚，左侧乳突内见少量信号分泌物。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变。 双侧咽后未见明确肿大淋巴结。 双颈II区及左颈III区可见数个淋巴结，最大约14mm×5mm，边界欠清，增强扫描可见明显强化。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。 所示脑实质未见明确异常。；检查结论: 鼻咽癌化疗后，范围较前明显缩小。 颅底骨质破坏。 双颈淋巴结，考虑转移，较前缩小、减少。 双侧咽后未见肿大淋巴结。 鼻窦炎。 左侧乳突炎。\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D65] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日患者症状体征基本同前，无诉其余特殊不适。上级医师信息已隐藏示：患者诊断明确，复查血常规、生化常规无明显化疗禁忌症，拟按期于某次就诊时间开始行TPF诱导化疗， 具体用药：DOC60mg/㎡d1+DDP60mg/㎡ d2+5-FU2.5g/㎡civ48hQ3w，并指示化疗期间给予护肝、护胃、止吐及营养支持治疗，昨日已行泰欣生靶向治疗，密切观察患者病情变化。\n- [全程D66] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，未诉恶心、呕吐、腹痛、腹泻等不适，大小便正常。上级医师信息已隐藏出，患者目前一般情况可，予明日按TPF方案行第3周期化疗，注意化疗结束后复查血、生化常规，及时对症处理。\n- [全程D69] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日为化疗第3天，诉间有恶心，无呕吐，无咳嗽、咳痰，无头痛、头晕，大小便正常。上级医师信息已隐藏出，患者化疗后出现胃肠道反应I度，予继续对症处理，减轻化疗后反应。\n- [全程D71] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日患者症状体征基本同前，无诉其余特殊不适。今日复查血常规及生化常规未见明显异常。上级医师信息已隐藏示：患者病情平稳，一般情况良好，目前予完善相关放疗前准备，今日予办理出院。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 结束诱导化疗，序贯开展根治性放射治疗\nB. 继续原方案（TPF联合尼妥珠单抗）诱导化疗至第6周期后再行放射治疗\nC. 更换为GP方案（吉西他滨联合顺铂）继续诱导化疗2个周期\nD. 行鼻咽原发灶及双侧颈部淋巴结根治性切除术\nE. 行双侧颈部淋巴结清扫术，术后序贯鼻咽局部放射治疗\nF. 加用PD-1抑制剂联合原方案继续诱导化疗2个周期\nG. 暂停抗肿瘤治疗，进入定期随访观察阶段\nH. 完善全身PET-CT重新分期后再决定后续局部治疗方案\nI. 仅行根治性放射治疗，处理鼻咽原发灶，颈部病灶继续随访观察\nJ. 结束诱导化疗，序贯开展尼妥珠单抗单药靶向维持治疗\nK. 行放射性粒子植入术，处理鼻咽及颈部残留病灶直接\nL. 采用卡培他滨单药维持化疗，推迟局部放射治疗\n\n请仅输出一个选项字母（A-L）。","gold_letter":"A","gold_action":"结束诱导化疗，序贯开展根治性放射治疗","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"结束诱导化疗，序贯开展根治性放射治疗"},{"letter":"B","text":"继续原方案（TPF联合尼妥珠单抗）诱导化疗至第6周期后再行放射治疗"},{"letter":"C","text":"更换为GP方案（吉西他滨联合顺铂）继续诱导化疗2个周期"},{"letter":"D","text":"行鼻咽原发灶及双侧颈部淋巴结根治性切除术"},{"letter":"E","text":"行双侧颈部淋巴结清扫术，术后序贯鼻咽局部放射治疗"},{"letter":"F","text":"加用PD-1抑制剂联合原方案继续诱导化疗2个周期"},{"letter":"G","text":"暂停抗肿瘤治疗，进入定期随访观察阶段"},{"letter":"H","text":"完善全身PET-CT重新分期后再决定后续局部治疗方案"},{"letter":"I","text":"仅行根治性放射治疗，处理鼻咽原发灶，颈部病灶继续随访观察"},{"letter":"J","text":"结束诱导化疗，序贯开展尼妥珠单抗单药靶向维持治疗"},{"letter":"K","text":"行放射性粒子植入术，处理鼻咽及颈部残留病灶直接"},{"letter":"L","text":"采用卡培他滨单药维持化疗，推迟局部放射治疗"}]}
+{"sample_id":"sample-95ccde5ff1e164e8d7edc6f5","patient_id":"patient-5731cc38ced94b2ee39c442a","turn_id":"turn08","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- 暂无可展示的初诊主诉/入院资料。\n\n【已完成检查与客观结果】\n- [全程D0] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.51；平均红细胞血红蛋白含量(MCH)-静脉血: 27.4pg；磷(P)-静脉血: 0.9mmol/L；直接胆红素(DBIL)-静脉血: 4.7umol/L；凝血酶时间(TT)-静脉血: 22.7sec.；D-二聚体(D-Dimer)-静脉血: 0.29ug/ml；活化部分凝血活酶时间(APTT)-静脉血: 38.5sec.；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.04S/CO；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.82mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.6；单核细胞百分比(Mono%)-静脉血: 0.047；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；间接胆红素(IBIL)-静脉血: 10.5umolL；白蛋白(ALB)-静脉血: 48g/L；氯离子(Cl-)-静脉血: 101.7mmol/L；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.718；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.1COI；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；白细胞计数(WBC#)-静脉血: 6.9510E9/L；红细胞比容(Hct)-静脉血: 46.8%；尿酸(UA)-静脉血: 431.8umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 81.8umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 26mmol/L；血小板分布宽度(PDW)-静脉血: 11.2%；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.04S/CO；平均血小板体积(MPV)-静脉血: 9.7fL；中性粒细胞计数(Neut#)-静脉血: 510E9/L；载脂蛋白B(apoB)-静脉血: 0.96g/L；凝血酶原时间(PT)-静脉血: 11.8sec.；钠离子(Na+)-静脉血: 138.7mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；甘油三酯(TG)-静脉血: 2.2mmol/L；总胆红素(TBIL)-静脉血: 15.2umol/L；乳酸脱氢酶(LDH)-静脉血: 172.2U/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；总钙(Ca)-静脉血: 2.37mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0IU/mL；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；总胆固醇(TC)-静脉血: 4.17mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.03g/L\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 Ⅱ、Ⅲ、aVF、V5、V6导联T波低平\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D120] 检验组合: 尿酸(UA)-静脉血: 409.8umol/L；球蛋白(GLO)-静脉血: 27.4g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.63；总钙(Ca)-静脉血: 2.24mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 25U/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；γ-谷氨酰基转移酶(GGT)-静脉血: 55.3U/L；中性粒细胞百分比(Neut%)-静脉血: 0.859；白细胞计数(WBC#)-静脉血: 5.710E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.058；间接胆红素(IBIL)-静脉血: 6.28umolL；C-反应蛋白(CRP)-静脉血: 88.14mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 48；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；碱性磷酸酶(ALP)-静脉血: 82.1U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15.7U/L；磷(P)-静脉血: 1.36mmol/L；白蛋白(ALB)-静脉血: 41.7g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.78mmolL；镁离子(Mg2+)-静脉血: 0.9mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.79mmol/L；钠离子(Na+)-静脉血: 139.5mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 15.1；中性粒细胞计数(Neut#)-静脉血: 4.910E9/L；血红蛋白(Hb)-静脉血: 113g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.3fL；氯离子(Cl-)-静脉血: 101.6mmol/L；红细胞比容(Hct)-静脉血: 34.4%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；乳酸脱氢酶(LDH)-静脉血: 163.4U/L；总胆汁酸(TBA)-静脉血: 5.6umol/L；尿素氮(BUN)-静脉血: 6mmol/L；血小板比容-静脉血: 10%；大血小板百分比(P-LCR%)-静脉血: 25%；葡萄糖(Glu)-静脉血: 5.42mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；甘油三酯(TG)-静脉血: 1.97mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.7mmol/L；阴离子间隙(AG)-静脉血: 16.2；直接胆红素(DBIL)-静脉血: 2.28umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 80.7umol/L\n- [全程D127] 检验组合: 红细胞比容(Hct)-静脉血: 27.7%；血红蛋白(Hb)-静脉血: 88g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.005；尿酸(UA)-静脉血: 268.3umol/L；直接胆红素(DBIL)-静脉血: 2.1umol/L；乳酸脱氢酶(LDH)-静脉血: 105.9U/L；碱性磷酸酶(ALP)-静脉血: 82.3U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.72；中性粒细胞百分比(Neut%)-静脉血: 0.798；尿素氮(BUN)-静脉血: 4.9mmol/L；载脂蛋白B(apoB)-静脉血: 1.41g/L；C-反应蛋白(CRP)-静脉血: 198.52mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.26；总胆汁酸(TBA)-静脉血: 1.1umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 9.6U/L；球蛋白(GLO)-静脉血: 27.52g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.03；总钙(Ca)-静脉血: 2.35mmol/L；甘油三酯(TG)-静脉血: 2.27mmol/L；氯离子(Cl-)-静脉血: 102.6mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28pg；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.74mmolL；白蛋白(ALB)-静脉血: 34.8g/L；载脂蛋白AI(apoAI)-静脉血: 0.71g/L；单核细胞百分比(Mono%)-静脉血: 0.167；淋巴细胞计数(Lymph#)-静脉血: 0.110E9/L；血小板比容-静脉血: 11%；肌酐(Crea)-静脉血: 68.7umol/L；总胆固醇(TC)-静脉血: 5.14mmol/L；胱抑素(Cys-C)-静脉血: 0.91mg/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 60.6U/L；镁离子(Mg2+)-静脉血: 0.81mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 12610E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.2mmol/L；大血小板百分比(P-LCR%)-静脉血: 16.5%；丙氨酸氨基转移酶(ALT)-静脉血: 13.4U/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.8mmol/L；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 49.8；单核细胞计数(Mono#)-静脉血: 0.610E9/L；血小板分布宽度(PDW)-静脉血: 9.6%；钾离子(K+)-静脉血: 4mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 25.9U/L\n- [全程D132] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D167] 检验组合: EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:80（参考: 阴性）\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D222] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:80（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）\n- [全程D222] 检验组合: 氯离子(Cl-)-静脉血: 103.6mmol/L；血小板分布宽度(PDW)-静脉血: 10.7%；C-反应蛋白(CRP)-静脉血: 1.07mg/L；甘油三酯(TG)-静脉血: 1.41mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.89；白蛋白(ALB)-静脉血: 46.7g/L；葡萄糖(Glu)-静脉血: 5.1mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.68；血小板比容-静脉血: 17%；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L；直接胆红素(DBIL)-静脉血: 2.1umol/L；磷(P)-静脉血: 1.27mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 317g/L；大血小板百分比(P-LCR%)-静脉血: 24.8%；丙氨酸氨基转移酶(ALT)-静脉血: 19.3U/L；总蛋白(TP)-静脉血: 74.5g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 18.4U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.2U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.63mmol/L；总胆固醇(TC)-静脉血: 5.21mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 15.7U/L；乳酸脱氢酶(LDH)-静脉血: 168.2U/L；间接胆红素(IBIL)-静脉血: 6.8umolL；平均红细胞体积(MCV)-静脉血: 87.3fL；红细胞比容(Hct)-静脉血: 39.7%；中性粒细胞百分比(Neut%)-静脉血: 0.657；钠离子(Na+)-静脉血: 139.4mmol/L；碱性磷酸酶(ALP)-静脉血: 72U/L；单核细胞百分比(Mono%)-静脉血: 0.101；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.05；阴离子间隙(AG)-静脉血: 13.3；总胆汁酸(TBA)-静脉血: 2.7umol/L；镁离子(Mg2+)-静脉血: 0.92mmol/L；总胆红素(TBIL)-静脉血: 8.9umol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 42.4；肌酐(Crea)-静脉血: 74.3umol/L；白细胞计数(WBC#)-静脉血: 4.3710E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；有核红细胞百分比(NRBC%)-静脉血: 0；平均血小板体积(MPV)-静脉血: 10.2fL；总钙(Ca)-静脉血: 2.43mmol/L；尿素氮(BUN)-静脉血: 4.2mmol/L；球蛋白(GLO)-静脉血: 27.8g/L\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D223] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理清晰，未见明确实质性病变。双侧肺门未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n\n【既往治疗与反应】\n- [全程D121] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今天完成放疗24次，仍有轻度口干，口咽疼痛NRS1分，无恶心、呕吐，无头晕、头痛。查体：口咽部放射性粘膜炎Ⅱ°，颈部放射性皮炎Ⅰ°。某次就诊时间血常规HGB113g/L，生化大致正常。上级医师信息已隐藏：继续予加强止痛、营养、改善贫血等对症支持治疗，密切观察病情变化。\n- [全程D124] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者昨天行第6次泰欣生分子靶向治疗，今天完成放疗26次，仍有轻度口干，口咽疼痛NRS1分，无恶心、呕吐，无发热、畏寒，查体：口咽部放射性粘膜炎Ⅱ°，颈部放射性皮炎Ⅰ°。上级医师信息已隐藏示：患者放射性口咽炎仍明显，需加强局部冲洗、止痛等支持治疗，继续予按计划放疗。\n- [全程D127] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今天完成放疗29次，仍有轻度口干，口咽疼痛NRS1分，无发热、畏寒，无恶心、呕吐，查体：口咽部放射性粘膜炎Ⅰ°，颈部放射性皮炎Ⅰ°。某次就诊时间血常规示WBC3.6510E9/L， NE#2.9*10E9/L， HGB88.0g/L，PLT126.0*10E9/L，上级医师信息已隐藏：患者白细胞稍低，但血红蛋白较前下降，考虑营养摄入不足和放化疗后骨髓抑制所致，予口服升白、改善贫血药治疗，加强口腔局部冲洗，密切观察病情变化。\n- [全程D130] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今天完成放疗30次，仍有轻度口干，口咽疼痛NRS2分，无发热、畏寒，无恶心、呕吐，查体：口咽部放射性粘膜炎Ⅱ°，颈部放射性皮炎Ⅰ°。上级医师信息已隐藏：患者今天予第7次泰欣生分子靶向治疗。患者口咽痛反复，继续加强止痛治疗，辅以局部冲洗等护理，观察病情变化。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行全身PET-CT扫描评估全身肿瘤负荷及近期疗效\nB. 行鼻咽及颈部MRI增强扫描评估近期疗效，继续定期随访\nC. 行鼻咽镜检查并对原发灶区域进行常规多点活检排除残留\nD. 启动卡培他滨节拍性维持化疗降低远处转移风险\nE. 启动PD-1抑制剂维持治疗巩固靶向联合放疗的近期疗效\nF. 仅定期复查血常规、生化及EBV-DNA，暂不复查局部影像学\nG. 直接安排鼻咽原发灶内镜下挽救性切除手术\nH. 直接安排鼻咽原发灶挽救性立体定向放疗\nI. 行胸部及全腹部增强CT扫描，暂缓头颈部局部影像学复查\nJ. 行全身骨扫描及头颅MRI排除无症状的远处器官转移风险\nK. 启动吉西他滨联合顺铂方案全身化疗清除潜在微小转移灶\nL. 继续使用尼妥珠单抗单药维持治疗至满一年巩固局部疗效\n\n请仅输出一个选项字母（A-L）。","gold_letter":"B","gold_action":"行鼻咽及颈部MRI增强扫描评估近期疗效，继续定期随访","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"行全身PET-CT扫描评估全身肿瘤负荷及近期疗效"},{"letter":"B","text":"行鼻咽及颈部MRI增强扫描评估近期疗效，继续定期随访"},{"letter":"C","text":"行鼻咽镜检查并对原发灶区域进行常规多点活检排除残留"},{"letter":"D","text":"启动卡培他滨节拍性维持化疗降低远处转移风险"},{"letter":"E","text":"启动PD-1抑制剂维持治疗巩固靶向联合放疗的近期疗效"},{"letter":"F","text":"仅定期复查血常规、生化及EBV-DNA，暂不复查局部影像学"},{"letter":"G","text":"直接安排鼻咽原发灶内镜下挽救性切除手术"},{"letter":"H","text":"直接安排鼻咽原发灶挽救性立体定向放疗"},{"letter":"I","text":"行胸部及全腹部增强CT扫描，暂缓头颈部局部影像学复查"},{"letter":"J","text":"行全身骨扫描及头颅MRI排除无症状的远处器官转移风险"},{"letter":"K","text":"启动吉西他滨联合顺铂方案全身化疗清除潜在微小转移灶"},{"letter":"L","text":"继续使用尼妥珠单抗单药维持治疗至满一年巩固局部疗效"}]}
+{"sample_id":"sample-7fddfe1b2a584f133c3b89f7","patient_id":"patient-e5fcd31b4b8b85194b146991","turn_id":"turn01","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 回吸性涕血1月余。；现病史: 缘于1月前患者无意中出现抽吸性血涕，痰中带血；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻咽角化,涕血,痰中带血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：78次/分，R：20次/分，BP：125/80mmHg,Ht：162cm，Wt：61kg，BSA：1.6483m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善鼻咽及颈部CT平扫+增强、胸腹部CT、全身骨扫描、电子鼻咽镜检查及活检。\nB. 完善鼻咽及颈部MRI平扫+增强、胸腹部CT、全身骨扫描、电子鼻咽镜检查及活检。\nC. 完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像、电子鼻咽镜检查及活检。\nD. 完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像、电子鼻咽镜检查及病理会诊。\nE. 完善鼻咽及颈部MRI平扫+增强、胸腹部CT、全身骨扫描、电子鼻咽镜检查及病理会诊。\nF. 完善鼻咽及颈部CT平扫+增强、PET/CT全身显像、电子鼻咽镜检查及病理会诊。\nG. 完善鼻咽MRI平扫+增强、颈部超声、PET/CT全身显像、电子鼻咽镜检查及病理会诊。\nH. 完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像、直接安排诱导化疗。\nI. 完善鼻咽及颈部MRI平扫+增强、胸腹部CT、全身骨扫描、直接安排根治性放疗。\nJ. 完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像、鼻内镜下鼻咽肿物切除术。\nK. 完善鼻咽及颈部CT平扫+增强、胸腹部CT、全身骨扫描、电子鼻咽镜检查及病理会诊。\nL. 完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像、EBV-DNA检测、暂缓病理确诊。\n\n请仅输出一个选项字母（A-L）。","gold_letter":"B","gold_action":"完善鼻咽及颈部MRI平扫+增强、胸腹部CT、全身骨扫描、电子鼻咽镜检查及活检。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"完善鼻咽及颈部CT平扫+增强、胸腹部CT、全身骨扫描、电子鼻咽镜检查及活检。"},{"letter":"B","text":"完善鼻咽及颈部MRI平扫+增强、胸腹部CT、全身骨扫描、电子鼻咽镜检查及活检。"},{"letter":"C","text":"完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像、电子鼻咽镜检查及活检。"},{"letter":"D","text":"完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像、电子鼻咽镜检查及病理会诊。"},{"letter":"E","text":"完善鼻咽及颈部MRI平扫+增强、胸腹部CT、全身骨扫描、电子鼻咽镜检查及病理会诊。"},{"letter":"F","text":"完善鼻咽及颈部CT平扫+增强、PET/CT全身显像、电子鼻咽镜检查及病理会诊。"},{"letter":"G","text":"完善鼻咽MRI平扫+增强、颈部超声、PET/CT全身显像、电子鼻咽镜检查及病理会诊。"},{"letter":"H","text":"完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像、直接安排诱导化疗。"},{"letter":"I","text":"完善鼻咽及颈部MRI平扫+增强、胸腹部CT、全身骨扫描、直接安排根治性放疗。"},{"letter":"J","text":"完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像、鼻内镜下鼻咽肿物切除术。"},{"letter":"K","text":"完善鼻咽及颈部CT平扫+增强、胸腹部CT、全身骨扫描、电子鼻咽镜检查及病理会诊。"},{"letter":"L","text":"完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像、EBV-DNA检测、暂缓病理确诊。"}]}
+{"sample_id":"sample-49519c2b08d621c382f2a093","patient_id":"patient-e5fcd31b4b8b85194b146991","turn_id":"turn04","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 回吸性涕血1月余。；现病史: 缘于1月前患者无意中出现抽吸性血涕，痰中带血；无头痛、面麻，无视力下降、复视，无听力下降、耳鸣等不适，于当地乡镇医院予滴鼻治疗，具体药物不详，未见好转，遂于某次就诊时间往[地点已隐去]人民医院检查，某次就诊时间病理活检示：鼻咽未分化型角化性癌。某次就诊时间鼻咽MRI示：左侧鼻咽部占位病变，考虑鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻咽角化,涕血,痰中带血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：78次/分，R：20次/分，BP：125/80mmHg,Ht：162cm，Wt：61kg，BSA：1.6483m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率100次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1] 检验组合: 胱抑素(Cys-C)-静脉血: 0.77mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.69mmol/L；阴离子间隙(AG)-静脉血: 13；磷(P)-静脉血: 0.92mmol/L；总胆红素(TBIL)-静脉血: 12.4umol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；肌酐(Crea)-静脉血: 80.5umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.58；Rh血型-静脉血: 阳性；总钙(Ca)-静脉血: 2.44mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；血小板计数(PLT#)-静脉血: 21910E9/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 4.81mmol/L；直接胆红素(DBIL)-静脉血: 4.2umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.64mmolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.013；载脂蛋白B(apoB)-静脉血: 0.73g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.3pg；α-L-岩藻糖苷酶(AFU)-静脉血: 24U/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 8.2umolL；白蛋白(ALB)-静脉血: 45.8g/L；血小板比容-静脉血: 21%；ABO血型-静脉血: O；尿素氮(BUN)-静脉血: 3.6mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；凝血酶时间(TT)-静脉血: 20.2sec.；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；载脂蛋白AI(apoAI)-静脉血: 1.33g/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；C-反应蛋白(CRP)-静脉血: 0.36mg/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；单核细胞计数(Mono#)-静脉血: 0.510E9/L；葡萄糖(Glu)-静脉血: 5.55mmol/L；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；纤维蛋白原降解产物(FDP)-静脉血: 3.7ug/ml；中性粒细胞计数(Neut#)-静脉血: 3.610E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 38.3；白细胞计数(WBC#)-静脉血: 5.4410E9/L；红细胞比容(Hct)-静脉血: 42%\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔稍狭窄，鼻咽左侧壁明显增厚，左侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。肿物侵犯左侧腭帆张提肌，左侧咽旁脂肪间隙变窄。鼻咽顶后壁稍增厚，右侧壁未见明显增厚，右侧咽隐窝清晰。 右侧腭帆张提肌、双侧头长肌、翼内外肌未见明显异常。 双侧翼腭窝、上颌后脂肪间隙、咀嚼肌间隙未见异常。 口咽各壁未见增厚。鼻腔内未见肿物。 蝶骨基底部、左侧翼突基底部及内侧板骨质信号降低，增强扫描可见强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦粘膜稍增厚，双侧乳突未见明显异常。 左侧咽后见几个淋巴结，最大者约8mm×5mm，边界欠清，明显强化。双颈II区见多个淋巴结，最大者约16mm×8mm，边界尚清，较均匀明显强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽左侧壁增厚，左侧咽隐窝肿物，考虑鼻咽癌。 颅底骨质破坏。 左侧咽后、双颈II区淋巴结，可疑转移。 轻度鼻窦炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右侧约平T6椎体水平，估计导管末端位于上腔静脉上段内。；检查结论: PICC管位置如上所述。\n- [全程D13] 检验组合: 酸碱度(pH)-尿液: 5.5；粘液丝计数(MUCS#)-尿液: 11/μL；酮体(KET)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 1/μL；红细胞计数(RBC#)-尿液: 3/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: colorless；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；比重(SG)-尿液: 1.008\n- [全程D14] 检验组合: 总蛋白(TP)-尿液: +- 0.2g（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；红细胞计数(RBC#)-尿液: 1/μL；葡萄糖(Glu)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.02；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；粘液丝计数(MUCS#)-尿液: 4/μL；白细胞(LEU)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；胆红素(BIL)-尿液: -（参考: 阴性）\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 根治性单纯放疗\nB. 诱导化疗（紫杉醇+卡铂）\nC. 诱导化疗（吉西他滨+奥沙利铂）\nD. 同期放化疗（顺铂）\nE. 诱导化疗（依托泊苷+顺铂）\nF. 诱导化疗（长春瑞滨+顺铂）\nG. 诱导化疗（顺铂+氟尿嘧啶）\nH. 靶向单药治疗（西妥昔单抗）\nI. 诱导化疗（多柔比星+环磷酰胺）\nJ. 姑息性单药化疗（卡培他滨）\nK. 免疫单药治疗（帕博利珠单抗）\nL. 鼻咽及颈部淋巴结根治性切除术\n\n请仅输出一个选项字母（A-L）。","gold_letter":"G","gold_action":"诱导化疗（顺铂+氟尿嘧啶）","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"根治性单纯放疗"},{"letter":"B","text":"诱导化疗（紫杉醇+卡铂）"},{"letter":"C","text":"诱导化疗（吉西他滨+奥沙利铂）"},{"letter":"D","text":"同期放化疗（顺铂）"},{"letter":"E","text":"诱导化疗（依托泊苷+顺铂）"},{"letter":"F","text":"诱导化疗（长春瑞滨+顺铂）"},{"letter":"G","text":"诱导化疗（顺铂+氟尿嘧啶）"},{"letter":"H","text":"靶向单药治疗（西妥昔单抗）"},{"letter":"I","text":"诱导化疗（多柔比星+环磷酰胺）"},{"letter":"J","text":"姑息性单药化疗（卡培他滨）"},{"letter":"K","text":"免疫单药治疗（帕博利珠单抗）"},{"letter":"L","text":"鼻咽及颈部淋巴结根治性切除术"}]}
+{"sample_id":"sample-ba0bc8aff143756f9ee645b5","patient_id":"patient-e5fcd31b4b8b85194b146991","turn_id":"turn05","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 回吸性涕血1月余。；现病史: 缘于1月前患者无意中出现抽吸性血涕，痰中带血；无头痛、面麻，无视力下降、复视，无听力下降、耳鸣等不适，于当地乡镇医院予滴鼻治疗，具体药物不详，未见好转，遂于某次就诊时间往[地点已隐去]人民医院检查，某次就诊时间病理活检示：鼻咽未分化型角化性癌。某次就诊时间鼻咽MRI示：左侧鼻咽部占位病变，考虑鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻咽角化,涕血,痰中带血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：78次/分，R：20次/分，BP：125/80mmHg,Ht：162cm，Wt：61kg，BSA：1.6483m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率100次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔稍狭窄，鼻咽左侧壁明显增厚，左侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。肿物侵犯左侧腭帆张提肌，左侧咽旁脂肪间隙变窄。鼻咽顶后壁稍增厚，右侧壁未见明显增厚，右侧咽隐窝清晰。 右侧腭帆张提肌、双侧头长肌、翼内外肌未见明显异常。 双侧翼腭窝、上颌后脂肪间隙、咀嚼肌间隙未见异常。 口咽各壁未见增厚。鼻腔内未见肿物。 蝶骨基底部、左侧翼突基底部及内侧板骨质信号降低，增强扫描可见强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦粘膜稍增厚，双侧乳突未见明显异常。 左侧咽后见几个淋巴结，最大者约8mm×5mm，边界欠清，明显强化。双颈II区见多个淋巴结，最大者约16mm×8mm，边界尚清，较均匀明显强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽左侧壁增厚，左侧咽隐窝肿物，考虑鼻咽癌。 颅底骨质破坏。 左侧咽后、双颈II区淋巴结，可疑转移。 轻度鼻窦炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右侧约平T6椎体水平，估计导管末端位于上腔静脉上段内。；检查结论: PICC管位置如上所述。\n- [全程D13] 检验组合: 酸碱度(pH)-尿液: 5.5；粘液丝计数(MUCS#)-尿液: 11/μL；酮体(KET)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 1/μL；红细胞计数(RBC#)-尿液: 3/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: colorless；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；比重(SG)-尿液: 1.008\n- [全程D14] 检验组合: 总蛋白(TP)-尿液: +- 0.2g（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；红细胞计数(RBC#)-尿液: 1/μL；葡萄糖(Glu)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.02；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；粘液丝计数(MUCS#)-尿液: 4/μL；白细胞(LEU)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D15] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 11/μL；酮体(KET)-尿液: -（参考: 阴性）；酵母菌(YEAST)-尿液: 1/μL；白细胞(LEU)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 1/μL；比重(SG)-尿液: 1.019；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 7/μL；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；酸碱度(pH)-尿液: 6.5；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D19] 检验组合: 氯离子(Cl-)-静脉血: 96.7mmol/L；总蛋白(TP)-静脉血: 73.8g/L；甘油三酯(TG)-静脉血: 1mmol/L；血小板计数(PLT#)-静脉血: 18410E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.2；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.27；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.44mmolL；球蛋白(GLO)-静脉血: 27.4g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；丙氨酸氨基转移酶(ALT)-静脉血: 16.1U/L；总钙(Ca)-静脉血: 2.31mmol/L；血小板比容-静脉血: 18%；血红蛋白(Hb)-静脉血: 144g/L；血液二氧化碳含量ctCO2(B)-静脉血: 26.5mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 356g/L；胱抑素(Cys-C)-静脉血: 0.75mg/L；γ-谷氨酰基转移酶(GGT)-静脉血: 18.1U/L；红细胞计数(RBC#)-静脉血: 4.5310E12/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.1；淋巴细胞百分比(Lymph%)-静脉血: 0.277；平均红细胞血红蛋白含量(MCH)-静脉血: 31.8pg；尿酸(UA)-静脉血: 231.9umol/L；乳酸脱氢酶(LDH)-静脉血: 158.8U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；载脂蛋白B(apoB)-静脉血: 0.78g/L；中性粒细胞百分比(Neut%)-静脉血: 0.597；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；血小板分布宽度(PDW)-静脉血: 10.5%；间接胆红素(IBIL)-静脉血: 11.1umolL；单核细胞百分比(Mono%)-静脉血: 0.101；天门冬氨酸氨基转移酶(AST)-静脉血: 20.5U/L；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L；白细胞计数(WBC#)-静脉血: 4.8310E9/L；镁离子(Mg2+)-静脉血: 0.93mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.36g/L；总胆红素(TBIL)-静脉血: 16.1umol/L；平均红细胞体积(MCV)-静脉血: 89.2fL；单核细胞计数(Mono#)-静脉血: 0.510E9/L；总胆固醇(TC)-静脉血: 4.24mmol/L；尿素氮(BUN)-静脉血: 4.8mmol/L；葡萄糖(Glu)-静脉血: 5.12mmol/L；总胆汁酸(TBA)-静脉血: 3.3umol/L；阴离子间隙(AG)-静脉血: 14；钠离子(Na+)-静脉血: 137.2mmol/L\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D17] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者第一程诱导化疗后，诉轻度恶心呕吐，精神睡眠尚可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。钱医生信息已隐藏：患者03-02开始予5-Fu6.6g,DDP130mg化疗，患者未诉特殊不适，注意观察不良反应。\n- [全程D19] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者化疗后，诉轻度恶心，精神睡眠尚可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。医生信息已隐藏：患者第一程诱导化疗顺利，一般情况可，予出院。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 办理出院，无需特殊用药，嘱出院后每2周复查血常规及肝肾功能，按计划返院行下一程诱导化疗。\nB. 暂缓出院，予以静脉营养支持及强效止吐治疗，待恶心症状完全缓解后出院，按计划返院行下一程化疗。\nC. 办理出院，予以止吐处理并预防性给予长效G-CSF支持，嘱出院后每周复查血常规，按计划返院行下一程化疗。\nD. 办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，下一程化疗方案需减量20%并延迟1周进行。\nE. 暂缓出院，予以保肝降酶及护胃治疗，待复查肝功能及消化道症状好转后出院，按计划返院行下一程化疗。\nF. 办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，下一阶段直接转入同期放化疗。\nG. 办理出院，予以止吐处理，嘱出院后每3天复查肾功能及电解质，按计划返院行下一程诱导化疗。\nH. 办理出院，予以帕洛诺司琼等止吐处理，嘱出院后每周复查血常规及肝肾功能，按计划返院行下一程化疗。\nI. 暂缓出院，予以静脉补液及纠正电解质紊乱治疗，复查生化指标正常后出院，按计划返院行下一程化疗。\nJ. 办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，下一程化疗更改为单药方案以减轻反应。\nK. 办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，按计划返院行靶向治疗联合放疗。\nL. 暂缓出院，予以质子泵抑制剂静脉滴注预防应激性溃疡，观察3天后出院，按计划返院行下一程化疗。\n\n请仅输出一个选项字母（A-L）。","gold_letter":"H","gold_action":"办理出院，予以帕洛诺司琼等止吐处理，嘱出院后每周复查血常规及肝肾功能，按计划返院行下一程化疗。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"办理出院，无需特殊用药，嘱出院后每2周复查血常规及肝肾功能，按计划返院行下一程诱导化疗。"},{"letter":"B","text":"暂缓出院，予以静脉营养支持及强效止吐治疗，待恶心症状完全缓解后出院，按计划返院行下一程化疗。"},{"letter":"C","text":"办理出院，予以止吐处理并预防性给予长效G-CSF支持，嘱出院后每周复查血常规，按计划返院行下一程化疗。"},{"letter":"D","text":"办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，下一程化疗方案需减量20%并延迟1周进行。"},{"letter":"E","text":"暂缓出院，予以保肝降酶及护胃治疗，待复查肝功能及消化道症状好转后出院，按计划返院行下一程化疗。"},{"letter":"F","text":"办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，下一阶段直接转入同期放化疗。"},{"letter":"G","text":"办理出院，予以止吐处理，嘱出院后每3天复查肾功能及电解质，按计划返院行下一程诱导化疗。"},{"letter":"H","text":"办理出院，予以帕洛诺司琼等止吐处理，嘱出院后每周复查血常规及肝肾功能，按计划返院行下一程化疗。"},{"letter":"I","text":"暂缓出院，予以静脉补液及纠正电解质紊乱治疗，复查生化指标正常后出院，按计划返院行下一程化疗。"},{"letter":"J","text":"办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，下一程化疗更改为单药方案以减轻反应。"},{"letter":"K","text":"办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，按计划返院行靶向治疗联合放疗。"},{"letter":"L","text":"暂缓出院，予以质子泵抑制剂静脉滴注预防应激性溃疡，观察3天后出院，按计划返院行下一程化疗。"}]}
+{"sample_id":"sample-f5ab8fe6b2ae40df32eed56b","patient_id":"patient-e5fcd31b4b8b85194b146991","turn_id":"turn06","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 回吸性涕血1月余。；现病史: 缘于1月前患者无意中出现抽吸性血涕，痰中带血；无头痛、面麻，无视力下降、复视，无听力下降、耳鸣等不适，于当地乡镇医院予滴鼻治疗，具体药物不详，未见好转，遂于某次就诊时间往[地点已隐去]人民医院检查，某次就诊时间病理活检示：鼻咽未分化型角化性癌。某次就诊时间鼻咽MRI示：左侧鼻咽部占位病变，考虑鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻咽角化,涕血,痰中带血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：78次/分，R：20次/分，BP：125/80mmHg,Ht：162cm，Wt：61kg，BSA：1.6483m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率100次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右侧约平T6椎体水平，估计导管末端位于上腔静脉上段内。；检查结论: PICC管位置如上所述。\n- [全程D13] 检验组合: 酸碱度(pH)-尿液: 5.5；粘液丝计数(MUCS#)-尿液: 11/μL；酮体(KET)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 1/μL；红细胞计数(RBC#)-尿液: 3/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: colorless；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；比重(SG)-尿液: 1.008\n- [全程D14] 检验组合: 总蛋白(TP)-尿液: +- 0.2g（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；红细胞计数(RBC#)-尿液: 1/μL；葡萄糖(Glu)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.02；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；粘液丝计数(MUCS#)-尿液: 4/μL；白细胞(LEU)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D15] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 11/μL；酮体(KET)-尿液: -（参考: 阴性）；酵母菌(YEAST)-尿液: 1/μL；白细胞(LEU)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 1/μL；比重(SG)-尿液: 1.019；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 7/μL；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；酸碱度(pH)-尿液: 6.5；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D19] 检验组合: 氯离子(Cl-)-静脉血: 96.7mmol/L；总蛋白(TP)-静脉血: 73.8g/L；甘油三酯(TG)-静脉血: 1mmol/L；血小板计数(PLT#)-静脉血: 18410E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.2；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.27；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.44mmolL；球蛋白(GLO)-静脉血: 27.4g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；丙氨酸氨基转移酶(ALT)-静脉血: 16.1U/L；总钙(Ca)-静脉血: 2.31mmol/L；血小板比容-静脉血: 18%；血红蛋白(Hb)-静脉血: 144g/L；血液二氧化碳含量ctCO2(B)-静脉血: 26.5mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 356g/L；胱抑素(Cys-C)-静脉血: 0.75mg/L；γ-谷氨酰基转移酶(GGT)-静脉血: 18.1U/L；红细胞计数(RBC#)-静脉血: 4.5310E12/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.1；淋巴细胞百分比(Lymph%)-静脉血: 0.277；平均红细胞血红蛋白含量(MCH)-静脉血: 31.8pg；尿酸(UA)-静脉血: 231.9umol/L；乳酸脱氢酶(LDH)-静脉血: 158.8U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；载脂蛋白B(apoB)-静脉血: 0.78g/L；中性粒细胞百分比(Neut%)-静脉血: 0.597；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；血小板分布宽度(PDW)-静脉血: 10.5%；间接胆红素(IBIL)-静脉血: 11.1umolL；单核细胞百分比(Mono%)-静脉血: 0.101；天门冬氨酸氨基转移酶(AST)-静脉血: 20.5U/L；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L；白细胞计数(WBC#)-静脉血: 4.8310E9/L；镁离子(Mg2+)-静脉血: 0.93mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.36g/L；总胆红素(TBIL)-静脉血: 16.1umol/L；平均红细胞体积(MCV)-静脉血: 89.2fL；单核细胞计数(Mono#)-静脉血: 0.510E9/L；总胆固醇(TC)-静脉血: 4.24mmol/L；尿素氮(BUN)-静脉血: 4.8mmol/L；葡萄糖(Glu)-静脉血: 5.12mmol/L；总胆汁酸(TBA)-静脉血: 3.3umol/L；阴离子间隙(AG)-静脉血: 14；钠离子(Na+)-静脉血: 137.2mmol/L\n- [全程D34] 检验组合: 阴离子间隙(AG)-静脉血: 10.5；乳酸脱氢酶(LDH)-静脉血: 175.1U/L；肌酐(Crea)-静脉血: 86umol/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；钾离子(K+)-静脉血: 3.9mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.43；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.18；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；甘油三酯(TG)-静脉血: 0.79mmol/L；总蛋白(TP)-静脉血: 76.5g/L；大血小板百分比(P-LCR%)-静脉血: 15.9%；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.537；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；总钙(Ca)-静脉血: 2.39mmol/L；尿酸(UA)-静脉血: 334.3umol/L；钠离子(Na+)-静脉血: 142.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.53g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；单核细胞百分比(Mono%)-静脉血: 0.102；有核红细胞百分比(NRBC%)-静脉血: 0；单核细胞计数(Mono#)-静脉血: 0.510E9/L；碱性磷酸酶(ALP)-静脉血: 63.6U/L；间接胆红素(IBIL)-静脉血: 6.8umolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.028；平均红细胞体积(MCV)-静脉血: 90.7fL；淋巴细胞百分比(Lymph%)-静脉血: 0.325；血液二氧化碳含量ctCO2(B)-静脉血: 29.6mmol/L；血小板分布宽度(PDW)-静脉血: 8.8%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.3；平均血小板体积(MPV)-静脉血: 8.9fL；球蛋白(GLO)-静脉血: 31.5g/L；血红蛋白(Hb)-静脉血: 130g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 29U/L；白蛋白(ALB)-静脉血: 45g/L；总胆汁酸(TBA)-静脉血: 5.6umol/L；总胆固醇(TC)-静脉血: 5.01mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 16.3U/L；C-反应蛋白(CRP)-静脉血: 1.18mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.53mmolL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；胱抑素(Cys-C)-静脉血: 0.8mg/L；氯离子(Cl-)-静脉血: 102.3mmol/L\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D17] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者第一程诱导化疗后，诉轻度恶心呕吐，精神睡眠尚可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。钱医生信息已隐藏：患者03-02开始予5-Fu6.6g,DDP130mg化疗，患者未诉特殊不适，注意观察不良反应。\n- [全程D19] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者化疗后，诉轻度恶心，精神睡眠尚可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。医生信息已隐藏：患者第一程诱导化疗顺利，一般情况可，予出院。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 拔除PICC导管改行外周静脉穿刺，并完善间接鼻咽镜检查准备下一周期治疗。\nB. 予重组人粒细胞刺激因子皮下注射，并行动静脉置管常规护理准备下一周期治疗。\nC. 予静脉补钾、补镁及水化利尿治疗，并行动静脉置管常规护理准备下一周期治疗。\nD. 予静脉输注红细胞悬液，并行动静脉置管常规护理准备下一周期治疗。\nE. 予静脉滴注广谱抗菌药物，并完善间接鼻咽镜检查准备下一周期治疗。\nF. 拔除PICC导管更换为锁骨下静脉置管，并完善间接鼻咽镜检查准备下一周期治疗。\nG. 予静脉滴注5-HT3受体拮抗剂，并行动静脉置管常规护理准备下一周期治疗。\nH. 予静脉输注肠外营养液，并完善间接鼻咽镜检查准备下一周期治疗。\nI. 行PICC导管常规维护（更换敷料与正压接头），并完善间接鼻咽镜检查准备下一周期治疗。\nJ. 行鼻咽内镜下组织活检，并行动静脉置管常规护理准备下一周期治疗。\nK. 予静脉输注人血白蛋白，并行动静脉置管常规护理准备下一周期治疗。\nL. 予口服保肝药物，并完善间接鼻咽镜检查准备下一周期治疗。\n\n请仅输出一个选项字母（A-L）。","gold_letter":"I","gold_action":"行PICC导管常规维护（更换敷料与正压接头），并完善间接鼻咽镜检查准备下一周期治疗。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"拔除PICC导管改行外周静脉穿刺，并完善间接鼻咽镜检查准备下一周期治疗。"},{"letter":"B","text":"予重组人粒细胞刺激因子皮下注射，并行动静脉置管常规护理准备下一周期治疗。"},{"letter":"C","text":"予静脉补钾、补镁及水化利尿治疗，并行动静脉置管常规护理准备下一周期治疗。"},{"letter":"D","text":"予静脉输注红细胞悬液，并行动静脉置管常规护理准备下一周期治疗。"},{"letter":"E","text":"予静脉滴注广谱抗菌药物，并完善间接鼻咽镜检查准备下一周期治疗。"},{"letter":"F","text":"拔除PICC导管更换为锁骨下静脉置管，并完善间接鼻咽镜检查准备下一周期治疗。"},{"letter":"G","text":"予静脉滴注5-HT3受体拮抗剂，并行动静脉置管常规护理准备下一周期治疗。"},{"letter":"H","text":"予静脉输注肠外营养液，并完善间接鼻咽镜检查准备下一周期治疗。"},{"letter":"I","text":"行PICC导管常规维护（更换敷料与正压接头），并完善间接鼻咽镜检查准备下一周期治疗。"},{"letter":"J","text":"行鼻咽内镜下组织活检，并行动静脉置管常规护理准备下一周期治疗。"},{"letter":"K","text":"予静脉输注人血白蛋白，并行动静脉置管常规护理准备下一周期治疗。"},{"letter":"L","text":"予口服保肝药物，并完善间接鼻咽镜检查准备下一周期治疗。"}]}
+{"sample_id":"sample-dd7067359645093ab08b6c16","patient_id":"patient-e5fcd31b4b8b85194b146991","turn_id":"turn07","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 回吸性涕血1月余。；现病史: 缘于1月前患者无意中出现抽吸性血涕，痰中带血；无头痛、面麻，无视力下降、复视，无听力下降、耳鸣等不适，于当地乡镇医院予滴鼻治疗，具体药物不详，未见好转，遂于某次就诊时间往[地点已隐去]人民医院检查，某次就诊时间病理活检示：鼻咽未分化型角化性癌。某次就诊时间鼻咽MRI示：左侧鼻咽部占位病变，考虑鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻咽角化,涕血,痰中带血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：78次/分，R：20次/分，BP：125/80mmHg,Ht：162cm，Wt：61kg，BSA：1.6483m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率100次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D19] 检验组合: 氯离子(Cl-)-静脉血: 96.7mmol/L；总蛋白(TP)-静脉血: 73.8g/L；甘油三酯(TG)-静脉血: 1mmol/L；血小板计数(PLT#)-静脉血: 18410E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.2；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.27；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.44mmolL；球蛋白(GLO)-静脉血: 27.4g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；丙氨酸氨基转移酶(ALT)-静脉血: 16.1U/L；总钙(Ca)-静脉血: 2.31mmol/L；血小板比容-静脉血: 18%；血红蛋白(Hb)-静脉血: 144g/L；血液二氧化碳含量ctCO2(B)-静脉血: 26.5mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 356g/L；胱抑素(Cys-C)-静脉血: 0.75mg/L；γ-谷氨酰基转移酶(GGT)-静脉血: 18.1U/L；红细胞计数(RBC#)-静脉血: 4.5310E12/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.1；淋巴细胞百分比(Lymph%)-静脉血: 0.277；平均红细胞血红蛋白含量(MCH)-静脉血: 31.8pg；尿酸(UA)-静脉血: 231.9umol/L；乳酸脱氢酶(LDH)-静脉血: 158.8U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；载脂蛋白B(apoB)-静脉血: 0.78g/L；中性粒细胞百分比(Neut%)-静脉血: 0.597；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；血小板分布宽度(PDW)-静脉血: 10.5%；间接胆红素(IBIL)-静脉血: 11.1umolL；单核细胞百分比(Mono%)-静脉血: 0.101；天门冬氨酸氨基转移酶(AST)-静脉血: 20.5U/L；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L；白细胞计数(WBC#)-静脉血: 4.8310E9/L；镁离子(Mg2+)-静脉血: 0.93mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.36g/L；总胆红素(TBIL)-静脉血: 16.1umol/L；平均红细胞体积(MCV)-静脉血: 89.2fL；单核细胞计数(Mono#)-静脉血: 0.510E9/L；总胆固醇(TC)-静脉血: 4.24mmol/L；尿素氮(BUN)-静脉血: 4.8mmol/L；葡萄糖(Glu)-静脉血: 5.12mmol/L；总胆汁酸(TBA)-静脉血: 3.3umol/L；阴离子间隙(AG)-静脉血: 14；钠离子(Na+)-静脉血: 137.2mmol/L\n- [全程D34] 检验组合: 阴离子间隙(AG)-静脉血: 10.5；乳酸脱氢酶(LDH)-静脉血: 175.1U/L；肌酐(Crea)-静脉血: 86umol/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；钾离子(K+)-静脉血: 3.9mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.43；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.18；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；甘油三酯(TG)-静脉血: 0.79mmol/L；总蛋白(TP)-静脉血: 76.5g/L；大血小板百分比(P-LCR%)-静脉血: 15.9%；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.537；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；总钙(Ca)-静脉血: 2.39mmol/L；尿酸(UA)-静脉血: 334.3umol/L；钠离子(Na+)-静脉血: 142.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.53g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；单核细胞百分比(Mono%)-静脉血: 0.102；有核红细胞百分比(NRBC%)-静脉血: 0；单核细胞计数(Mono#)-静脉血: 0.510E9/L；碱性磷酸酶(ALP)-静脉血: 63.6U/L；间接胆红素(IBIL)-静脉血: 6.8umolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.028；平均红细胞体积(MCV)-静脉血: 90.7fL；淋巴细胞百分比(Lymph%)-静脉血: 0.325；血液二氧化碳含量ctCO2(B)-静脉血: 29.6mmol/L；血小板分布宽度(PDW)-静脉血: 8.8%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.3；平均血小板体积(MPV)-静脉血: 8.9fL；球蛋白(GLO)-静脉血: 31.5g/L；血红蛋白(Hb)-静脉血: 130g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 29U/L；白蛋白(ALB)-静脉血: 45g/L；总胆汁酸(TBA)-静脉血: 5.6umol/L；总胆固醇(TC)-静脉血: 5.01mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 16.3U/L；C-反应蛋白(CRP)-静脉血: 1.18mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.53mmolL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；胱抑素(Cys-C)-静脉血: 0.8mg/L；氯离子(Cl-)-静脉血: 102.3mmol/L\n- [全程D35] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；比重(SG)-尿液: 1.015；白细胞计数(WBC#)-尿液: 2/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 6.5；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）\n- [全程D36] 检验组合: 浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 7.5；隐血(OB)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；胆红素(BIL)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.022；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）\n- [全程D37] 检验组合: 颜色-尿液: Yellow；葡萄糖(Glu)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.018；隐血(OB)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 3/μL；酸碱度(pH)-尿液: 7；酮体(KET)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D41] 检验组合: 总胆固醇(TC)-静脉血: 4.84mmol/L；红细胞计数(RBC#)-静脉血: 4.2110E12/L；红细胞比容(Hct)-静脉血: 36.6%；血小板分布宽度(PDW)-静脉血: 7.9%；白蛋白(ALB)-静脉血: 42.1g/L；尿素氮(BUN)-静脉血: 4.8mmol/L；总钙(Ca)-静脉血: 2.25mmol/L；乳酸脱氢酶(LDH)-静脉血: 148.6U/L；钾离子(K+)-静脉血: 3.3mmol/L；阴离子间隙(AG)-静脉血: 14.2；血液二氧化碳含量ctCO2(B)-静脉血: 25mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；胱抑素(Cys-C)-静脉血: 0.8mg/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 350g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.4pg；平均红细胞体积(MCV)-静脉血: 86.9fL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；氯离子(Cl-)-静脉血: 97.5mmol/L；葡萄糖(Glu)-静脉血: 5.35mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.89；镁离子(Mg2+)-静脉血: 0.78mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.34mmolL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；中性粒细胞计数(Neut#)-静脉血: 1.710E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.13mmol/L；直接胆红素(DBIL)-静脉血: 2.5umol/L；磷(P)-静脉血: 1.18mmol/L；球蛋白(GLO)-静脉血: 28.13g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.01；白细胞计数(WBC#)-静脉血: 3.0210E9/L；平均血小板体积(MPV)-静脉血: 8.8fL；总胆红素(TBIL)-静脉血: 9.3umol/L；碱性磷酸酶(ALP)-静脉血: 57.9U/L；中性粒细胞百分比(Neut%)-静脉血: 0.55；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；血小板计数(PLT#)-静脉血: 13810E9/L；肌酐(Crea)-静脉血: 90.1umol/L；血红蛋白(Hb)-静脉血: 128g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 34.9；单核细胞百分比(Mono%)-静脉血: 0.175；血小板比容-静脉血: 12%；有核红细胞百分比(NRBC%)-静脉血: 0；丙氨酸氨基转移酶(ALT)-静脉血: 19.5U/L；间接胆红素(IBIL)-静脉血: 6.8umolL；大血小板百分比(P-LCR%)-静脉血: 15.3%\n- [全程D42] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后复查： 鼻咽腔稍狭窄，鼻咽双侧壁、顶后壁增厚，左侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。右侧咽隐窝变窄。肿物侵犯左侧腭帆张提肌，右侧腭帆提肌结构稍模糊，右侧腭帆张提肌间隙稍模糊。 双侧头长肌、翼内外肌未见明显异常。 双侧翼腭窝、上颌后脂肪间隙、咀嚼肌间隙未见异常。 口咽各壁未见增厚。鼻腔内未见肿物。 蝶骨基底部、左侧翼突基底部及内侧板骨质信号降低，增强扫描可见强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦粘膜稍增厚，双侧乳突未见明显异常。 左侧咽后见几个淋巴结，最大者约8mm×5mm，边界欠清，明显强化。双颈II区见多个淋巴结，最大者约15mm×12mm，边界尚清，较均匀明显强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗后复查，对比某次就诊时间片： 鼻咽部肿物，较前明显缩小。 颅底骨质破坏，较前未见明显变化。 左侧咽后、双颈II区淋巴结，可疑转移，其中右颈IIa区淋巴结较前增大，余较前未见明显变化。 轻度鼻窦炎。\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D35] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者未诉特殊不适，精神睡眠可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。03-22血生化常规未见异常。上级医师信息已隐藏：患者1程PF方案诱导化疗后，一般情况可，已排除化疗禁忌症，今日水化，明日开始化疗（DDP 130mg d1 ; 5-Fu6.5g civ）。并予对症支持治疗。\n- [全程D36] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉稍恶心呕吐，无头痛、头晕，精神睡眠可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。上级医师信息已隐藏：加强对症治疗，患者一般情况可，继续完成化疗，注意休息，加强营养。\n- [全程D37] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉稍恶心，无明显呕吐，无头痛、头晕，精神睡眠可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。上级医师信息已隐藏：患者一般情况可继续完成化疗，\n- [全程D41] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者诉恶心呕吐，盗汗，头晕鼻塞，精神睡眠可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。03-29血常规示：WBC3.0*109/L NE1.7*109/L 生化示：血钾 3.3mmol/L上级医师信息已隐藏：患者第二程诱导化疗，出现I度骨髓抑制，予香伏益血。胃肠道反应相比上次稍重，嘱少食多餐，加强营养。今日化疗结束，嘱明日出院。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即启动第三程PF方案诱导化疗，随后再行根治性放射治疗。\nB. 更改化疗方案为TP或GP方案继续诱导化疗，随后再行根治性放射治疗。\nC. 立即行鼻咽及颈部根治性手术切除，术后辅以根治性放射治疗。\nD. 出院休养，待化疗副反应恢复后，行右颈部淋巴结清扫术，再行根治性放疗。\nE. 立即予以全量根治性放射治疗，并联合靶向药物如西妥昔单抗。\nF. 出院休养，行颈部淋巴结穿刺活检明确病理，再决定后续放疗方案。\nG. 立即启动根治性放射治疗，暂缓处理骨髓抑制及胃肠道反应。\nH. 出院休养，待化疗副反应恢复后，行姑息性放射治疗联合免疫治疗。\nI. 行全身PET-CT重新评估远处转移情况，再决定是否启动根治性放疗。\nJ. 出院休养并对症处理化疗副反应，定期复查血常规及肝肾功能，按计划返院行根治性放射治疗。\nK. 出院休养，定期复查血常规及肝肾功能，待恢复后返院行第三程PF方案诱导化疗。\nL. 立即予以同期放化疗，并对右颈淋巴结局部推量加量放疗。\n\n请仅输出一个选项字母（A-L）。","gold_letter":"J","gold_action":"出院休养并对症处理化疗副反应，定期复查血常规及肝肾功能，按计划返院行根治性放射治疗。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"立即启动第三程PF方案诱导化疗，随后再行根治性放射治疗。"},{"letter":"B","text":"更改化疗方案为TP或GP方案继续诱导化疗，随后再行根治性放射治疗。"},{"letter":"C","text":"立即行鼻咽及颈部根治性手术切除，术后辅以根治性放射治疗。"},{"letter":"D","text":"出院休养，待化疗副反应恢复后，行右颈部淋巴结清扫术，再行根治性放疗。"},{"letter":"E","text":"立即予以全量根治性放射治疗，并联合靶向药物如西妥昔单抗。"},{"letter":"F","text":"出院休养，行颈部淋巴结穿刺活检明确病理，再决定后续放疗方案。"},{"letter":"G","text":"立即启动根治性放射治疗，暂缓处理骨髓抑制及胃肠道反应。"},{"letter":"H","text":"出院休养，待化疗副反应恢复后，行姑息性放射治疗联合免疫治疗。"},{"letter":"I","text":"行全身PET-CT重新评估远处转移情况，再决定是否启动根治性放疗。"},{"letter":"J","text":"出院休养并对症处理化疗副反应，定期复查血常规及肝肾功能，按计划返院行根治性放射治疗。"},{"letter":"K","text":"出院休养，定期复查血常规及肝肾功能，待恢复后返院行第三程PF方案诱导化疗。"},{"letter":"L","text":"立即予以同期放化疗，并对右颈淋巴结局部推量加量放疗。"}]}
+{"sample_id":"sample-9cd68a6b9c75f1d90e6a9dbe","patient_id":"patient-e5fcd31b4b8b85194b146991","turn_id":"turn08","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 回吸性涕血1月余。；现病史: 缘于1月前患者无意中出现抽吸性血涕，痰中带血；无头痛、面麻，无视力下降、复视，无听力下降、耳鸣等不适，于当地乡镇医院予滴鼻治疗，具体药物不详，未见好转，遂于某次就诊时间往[地点已隐去]人民医院检查，某次就诊时间病理活检示：鼻咽未分化型角化性癌。某次就诊时间鼻咽MRI示：左侧鼻咽部占位病变，考虑鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻咽角化,涕血,痰中带血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：78次/分，R：20次/分，BP：125/80mmHg,Ht：162cm，Wt：61kg，BSA：1.6483m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率100次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D76] 检验组合: 钠离子(Na+)-静脉血: 138.3mmol/L；球蛋白(GLO)-静脉血: 27.6g/L；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 14.1U/L；碱性磷酸酶(ALP)-静脉血: 64.9U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 26.4U/L；平均血小板体积(MPV)-静脉血: 9fL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；红细胞比容(Hct)-静脉血: 29.5%；白蛋白(ALB)-静脉血: 44.6g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.62；α-L-岩藻糖苷酶(AFU)-静脉血: 24U/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；尿酸(UA)-静脉血: 284.2umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 8.7U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.73mmol/L；平均红细胞体积(MCV)-静脉血: 87.5fL；血小板比容-静脉血: 14%；单核细胞百分比(Mono%)-静脉血: 0.136；间接胆红素(IBIL)-静脉血: 7.16umolL；血液二氧化碳含量ctCO2(B)-静脉血: 23.6mmol/L；尿素氮(BUN)-静脉血: 5.4mmol/L；乳酸脱氢酶(LDH)-静脉血: 140.2U/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 104g/L；直接胆红素(DBIL)-静脉血: 3.72umol/L；载脂蛋白B(apoB)-静脉血: 0.86g/L；钾离子(K+)-静脉血: 4.1mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.129；中性粒细胞百分比(Neut%)-静脉血: 0.713；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.2；平均红细胞血红蛋白浓度(MCHC)-静脉血: 353g/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L；红细胞计数(RBC#)-静脉血: 3.3710E12/L；C-反应蛋白(CRP)-静脉血: 3.81mg/L；总蛋白(TP)-静脉血: 72.2g/L；阴离子间隙(AG)-静脉血: 14.6；胱抑素(Cys-C)-静脉血: 0.7mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.29mmolL；镁离子(Mg2+)-静脉血: 0.85mmol/L；总胆固醇(TC)-静脉血: 4.27mmol/L；血小板计数(PLT#)-静脉血: 15310E9/L\n- [全程D83] 检验组合: 碱性磷酸酶(ALP)-静脉血: 52.7U/L；血红蛋白(Hb)-静脉血: 96g/L；总胆汁酸(TBA)-静脉血: 2.4umol/L；磷(P)-静脉血: 1.26mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.41mmol/L；尿酸(UA)-静脉血: 329.6umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.76；血小板比容-静脉血: 11%；淋巴细胞计数(Lymph#)-静脉血: 0.410E9/L；红细胞计数(RBC#)-静脉血: 3.0610E12/L；间接胆红素(IBIL)-静脉血: 6.3umolL；血液二氧化碳含量ctCO2(B)-静脉血: 24.5mmol/L；钾离子(K+)-静脉血: 3.83mmol/L；葡萄糖(Glu)-静脉血: 4.88mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 356g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.56；氯离子(Cl-)-静脉血: 102.9mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总胆固醇(TC)-静脉血: 3.96mmol/L；平均红细胞体积(MCV)-静脉血: 88.2fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.9；中性粒细胞计数(Neut#)-静脉血: 1.310E9/L；阴离子间隙(AG)-静脉血: 12.6；尿素氮(BUN)-静脉血: 5.9mmol/L；肌酐(Crea)-静脉血: 89.8umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 20.3U/L；球蛋白(GLO)-静脉血: 25.51g/L；镁离子(Mg2+)-静脉血: 0.77mmol/L；乳酸脱氢酶(LDH)-静脉血: 128.5U/L；C-反应蛋白(CRP)-静脉血: 0.49mg/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.4pg；总蛋白(TP)-静脉血: 65.31g/L；红细胞比容(Hct)-静脉血: 27%；单核细胞计数(Mono#)-静脉血: 0.310E9/L；血小板分布宽度(PDW)-静脉血: 8.1%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.009；单核细胞百分比(Mono%)-静脉血: 0.156；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；甘油三酯(TG)-静脉血: 0.55mmol/L；载脂蛋白B(apoB)-静脉血: 0.79g/L；钠离子(Na+)-静脉血: 140mmol/L；大血小板百分比(P-LCR%)-静脉血: 15.5%；直接胆红素(DBIL)-静脉血: 2.9umol/L；总钙(Ca)-静脉血: 2.24mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.7U/L\n- [全程D90] 检验组合: 尿素氮(BUN)-静脉血: 5.1mmol/L；总胆汁酸(TBA)-静脉血: 3.6umol/L；总钙(Ca)-静脉血: 2.27mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 21.5U/L；总胆红素(TBIL)-静脉血: 11.71umol/L；载脂蛋白AI(apoAI)-静脉血: 1.59g/L；载脂蛋白B(apoB)-静脉血: 0.85g/L；氯离子(Cl-)-静脉血: 99.7mmol/L；白蛋白(ALB)-静脉血: 46.3g/L；有核红细胞百分比(NRBC%)-静脉血: 0；血小板计数(PLT#)-静脉血: 14210E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；血小板比容-静脉血: 13%；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.58；嗜酸性粒细胞计数(Eos#)-静脉血: 0.410E9/L；血小板分布宽度(PDW)-静脉血: 9%；磷(P)-静脉血: 1.33mmol/L；尿酸(UA)-静脉血: 467.8umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.78；甘油三酯(TG)-静脉血: 0.58mmol/L；C-反应蛋白(CRP)-静脉血: 0.4mg/L；平均红细胞体积(MCV)-静脉血: 91.4fL；α-L-岩藻糖苷酶(AFU)-静脉血: 22.5U/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1；中性粒细胞计数(Neut#)-静脉血: 2.210E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 346g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；白细胞计数(WBC#)-静脉血: 3.4910E9/L；钾离子(K+)-静脉血: 3.89mmol/L；血红蛋白(Hb)-静脉血: 118g/L；平均血小板体积(MPV)-静脉血: 9fL；中性粒细胞百分比(Neut%)-静脉血: 0.636；红细胞计数(RBC#)-静脉血: 3.7310E12/L；肌酐(Crea)-静脉血: 91.5umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.132；总胆固醇(TC)-静脉血: 4.55mmol/L；阴离子间隙(AG)-静脉血: 14.7；胱抑素(Cys-C)-静脉血: 0.75mg/L；天门冬氨酸氨基转移酶(AST)-静脉血: 13.2U/L；碱性磷酸酶(ALP)-静脉血: 83U/L；球蛋白(GLO)-静脉血: 29.3g/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；大血小板百分比(P-LCR%)-静脉血: 17%；乳酸脱氢酶(LDH)-静脉血: 156.3U/L\n- [全程D91] 检验组合: 比重(SG)-尿液: 1.011；酮体(KET)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5；隐血(OB)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；总蛋白(TP)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；白细胞计数(WBC#)-尿液: 3/μL\n- [全程D92] 检验组合: 亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；隐血(OB)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 2/μL；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；比重(SG)-尿液: 1.018；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）\n- [全程D94] 检验组合: 亚硝酸盐(NIT)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 11/μL；颜色-尿液: Yellow；白细胞计数(WBC#)-尿液: 5/μL；酮体(KET)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 28/μL；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.014；酸碱度(pH)-尿液: 6\n- [全程D97] 检验组合: 低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.8mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；平均红细胞体积(MCV)-静脉血: 86.8fL；载脂蛋白AI(apoAI)-静脉血: 1.3g/L；甘油三酯(TG)-静脉血: 0.75mmol/L；钠离子(Na+)-静脉血: 139mmol/L；总钙(Ca)-静脉血: 2.24mmol/L；氯离子(Cl-)-静脉血: 98.2mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 13.3U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.65；α-L-岩藻糖苷酶(AFU)-静脉血: 24.8U/L；碱性磷酸酶(ALP)-静脉血: 57U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 21.5U/L；血小板比容-静脉血: 12%；直接胆红素(DBIL)-静脉血: 4.61umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.642；白细胞计数(WBC#)-静脉血: 2.0410E9/L；大血小板百分比(P-LCR%)-静脉血: 11.5%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.127；血液二氧化碳含量ctCO2(B)-静脉血: 27.4mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 357g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.5；总蛋白(TP)-静脉血: 67.8g/L；血红蛋白(Hb)-静脉血: 96g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.310E9/L；尿酸(UA)-静脉血: 356.9umol/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；血小板计数(PLT#)-静脉血: 14210E9/L；钾离子(K+)-静脉血: 3.77mmol/L；载脂蛋白B(apoB)-静脉血: 0.86g/L；单核细胞百分比(Mono%)-静脉血: 0.083；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.37；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.02；胱抑素(Cys-C)-静脉血: 0.71mg/L；白蛋白(ALB)-静脉血: 42.2g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞计数(Neut#)-静脉血: 1.310E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.29mmolL；肌酐(Crea)-静脉血: 97.1umol/L；球蛋白(GLO)-静脉血: 25.6g/L；镁离子(Mg2+)-静脉血: 0.8mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 9.7U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43；总胆汁酸(TBA)-静脉血: 3.9umol/L；磷(P)-静脉血: 1.6mmol/L\n- [全程D98] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗放疗后复查： 鼻咽腔无狭窄，鼻咽壁无增厚，粘膜规整无增厚，双侧咽隐窝、咽旁脂肪间隙未见异常。双侧腭帆张、提肌、双侧头长肌、翼内外肌未见明显异常。 双侧翼腭窝、上颌后脂肪间隙、咀嚼肌间隙未见异常。 口咽各壁未见增厚。鼻腔内未见肿物。 蝶骨基底部左份、左侧翼突基底部及内侧骨质信号降低，增强扫描可见强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦粘膜稍增厚，骨壁完整。左乳头见少许渗出影。 双侧咽后未见肿大淋巴结。双颈II区见多个淋巴结，最大者约8mm×5mm，边界尚清，较均匀明显强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗放疗后复查，对比某次就诊时间片： 鼻咽未见明显病灶。 颅底骨质破坏，较前未见明显变化。 左侧咽后淋巴结消失，双颈II区淋巴结缩小。 鼻窦炎，左乳突炎。\n- [全程D98] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称。双肺纹理清晰；双肺野未见明显实质性病变；双侧肺门无增大。纵隔未见增宽。心影大小、形态正常。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n\n【既往治疗与反应】\n- [全程D77] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 今行放疗第15次，患者口干咽痛，稍恶心、呕吐，食纳、睡眠欠佳。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。某次就诊时间日查血常规、肝肾功能电解质无明显异常。上级医师信息已隐藏：予口腔粘膜保护等对症治疗，加强营养支持治疗，继续完成放疗。\n- [全程D82] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今行放疗第18次，患者口干咽痛，稍恶心、呕吐，食纳、睡眠欠佳。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物，较前缩小；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。上级医师信息已隐藏：予口腔粘膜保护等对症治疗，加强营养支持治疗，明日复查血常规、肝肾功能，继续完成放疗。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D91] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今行放疗第25次，患者口干咽痛，稍恶心、呕吐，食纳、睡眠欠佳。查体：张口门齿距4.5cm；鼻咽肿物不明显；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。昨日查血常规、肝肾功能未见明显异常。上级医师信息已隐藏：予口腔粘膜保护等对症治疗，加强营养支持治疗，明日予同期DDP化疗，密切观察放化疗反应，继续完成放疗。\n- [全程D96] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 今行放疗第28次，患者口干咽痛，稍恶心、呕吐，食纳、睡眠欠佳。查体：张口门齿距4.5cm；鼻咽肿物不明显；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。上级医师信息已隐藏：予口腔粘膜保护等对症治疗，加强营养支持治疗，明日复查血常规、肝肾功能，继续完成放疗。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估为原发灶缓解但颈部淋巴结残留，行双侧颈部淋巴结清扫术，术后定期随访复查。\nB. 评估为颅底骨质破坏未缓解，局部追加立体定向放射治疗推量，并定期随访复查。\nC. 评估为放化疗后部分缓解，继续原方案辅助化疗2个周期以巩固疗效。\nD. 评估为放化疗后临床缓解，按计划结疗出院，序贯PD-1抑制剂维持治疗1年。\nE. 评估为原发灶残留，行鼻咽内镜下挽救性切除术，术后配合张口及颈部功能锻炼。\nF. 评估为放化疗后临床缓解，按计划结疗出院，3个月后行PET-CT评估，期间无需特殊干预。\nG. 评估为放化疗后病情稳定，更改化疗方案为吉西他滨联合顺铂进行二线化疗。\nH. 评估为放化疗后临床缓解，按计划结疗出院，预防性给予全脑放射治疗。\nI. 评估为颈部淋巴结残留，局部追加电子线放射治疗推量，并加强营养支持。\nJ. 评估为放化疗后临床缓解，按计划结疗出院，序贯口服卡培他滨节拍维持治疗1年。\nK. 评估为放化疗后临床缓解，按计划结疗出院，嘱鼻腔冲洗、张口及颈部功能锻炼，定期随访复查。\nL. 评估为颅底病灶残留，转诊行质子重离子放射治疗以提高局部控制率。\n\n请仅输出一个选项字母（A-L）。","gold_letter":"K","gold_action":"评估为放化疗后临床缓解，按计划结疗出院，嘱鼻腔冲洗、张口及颈部功能锻炼，定期随访复查。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"评估为原发灶缓解但颈部淋巴结残留，行双侧颈部淋巴结清扫术，术后定期随访复查。"},{"letter":"B","text":"评估为颅底骨质破坏未缓解，局部追加立体定向放射治疗推量，并定期随访复查。"},{"letter":"C","text":"评估为放化疗后部分缓解，继续原方案辅助化疗2个周期以巩固疗效。"},{"letter":"D","text":"评估为放化疗后临床缓解，按计划结疗出院，序贯PD-1抑制剂维持治疗1年。"},{"letter":"E","text":"评估为原发灶残留，行鼻咽内镜下挽救性切除术，术后配合张口及颈部功能锻炼。"},{"letter":"F","text":"评估为放化疗后临床缓解，按计划结疗出院，3个月后行PET-CT评估，期间无需特殊干预。"},{"letter":"G","text":"评估为放化疗后病情稳定，更改化疗方案为吉西他滨联合顺铂进行二线化疗。"},{"letter":"H","text":"评估为放化疗后临床缓解，按计划结疗出院，预防性给予全脑放射治疗。"},{"letter":"I","text":"评估为颈部淋巴结残留，局部追加电子线放射治疗推量，并加强营养支持。"},{"letter":"J","text":"评估为放化疗后临床缓解，按计划结疗出院，序贯口服卡培他滨节拍维持治疗1年。"},{"letter":"K","text":"评估为放化疗后临床缓解，按计划结疗出院，嘱鼻腔冲洗、张口及颈部功能锻炼，定期随访复查。"},{"letter":"L","text":"评估为颅底病灶残留，转诊行质子重离子放射治疗以提高局部控制率。"}]}
+{"sample_id":"sample-deb84ffb5f7c209f58040b0d","patient_id":"patient-d6812a1c46ed21fda9ebb9f8","turn_id":"turn01","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 右侧耳鸣、鼻塞3月余，加重1周。；现病史: 缘于某次就诊时间11月下旬患者无意中出现右侧耳鸣、鼻塞，伴有右耳听力下降、头痛症状，无鼻出血，无面麻，无视物模糊、复视，无呛咳等症状；未予重视，逐渐加重，于某次就诊时间在[机构已隐去]就诊；建议患者住院治疗，患者及家属不同意。近1周来，耳鸣、鼻塞及头痛症状加重，今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,听力下降,右耳鸣,头痛；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：75次/分，R：20次/分，BP：110/65mmHg,Ht：150cm，Wt：41kg，BSA：1.316m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶壁、顶后壁、右侧壁明显增厚，左侧壁稍增厚，并见结节状肿物突出；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸部X线，腹部彩超\nB. 鼻咽及颈部MRI平扫+增强，全身PET-CT检查，暂缓鼻咽活检\nC. 鼻咽镜检查及活检，仅行鼻咽MRI平扫+增强，胸部CT，腹部彩超\nD. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部X线，腹部彩超及心电图\nE. 鼻咽镜检查及活检，全身PET-CT检查，头颅MRI平扫+增强\nF. 鼻咽及颈部根治性放疗，同步行胸部及腹部影像学检查\nG. 鼻咽肿物切除活检，鼻咽及颈部MRI平扫+增强，胸部X线，腹部彩超\nH. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，暂不进行胸腹部影像学检查\nI. 鼻咽镜检查及活检，鼻咽CT平扫+增强，颈部超声，胸部X线，腹部彩超\nJ. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身骨扫描，头颅CT\nK. 鼻咽脱落细胞学检查，鼻咽及颈部MRI平扫+增强，胸部CT，腹部彩超\nL. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，预防性颈部淋巴结清扫术\n\n请仅输出一个选项字母（A-L）。","gold_letter":"D","gold_action":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部X线，腹部彩超及心电图","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸部X线，腹部彩超"},{"letter":"B","text":"鼻咽及颈部MRI平扫+增强，全身PET-CT检查，暂缓鼻咽活检"},{"letter":"C","text":"鼻咽镜检查及活检，仅行鼻咽MRI平扫+增强，胸部CT，腹部彩超"},{"letter":"D","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部X线，腹部彩超及心电图"},{"letter":"E","text":"鼻咽镜检查及活检，全身PET-CT检查，头颅MRI平扫+增强"},{"letter":"F","text":"鼻咽及颈部根治性放疗，同步行胸部及腹部影像学检查"},{"letter":"G","text":"鼻咽肿物切除活检，鼻咽及颈部MRI平扫+增强，胸部X线，腹部彩超"},{"letter":"H","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，暂不进行胸腹部影像学检查"},{"letter":"I","text":"鼻咽镜检查及活检，鼻咽CT平扫+增强，颈部超声，胸部X线，腹部彩超"},{"letter":"J","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身骨扫描，头颅CT"},{"letter":"K","text":"鼻咽脱落细胞学检查，鼻咽及颈部MRI平扫+增强，胸部CT，腹部彩超"},{"letter":"L","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，预防性颈部淋巴结清扫术"}]}
+{"sample_id":"sample-76e183c8ae4202bcecbc9d87","patient_id":"patient-d6812a1c46ed21fda9ebb9f8","turn_id":"turn02","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 右侧耳鸣、鼻塞3月余，加重1周。；现病史: 缘于某次就诊时间11月下旬患者无意中出现右侧耳鸣、鼻塞，伴有右耳听力下降、头痛症状，无鼻出血，无面麻，无视物模糊、复视，无呛咳等症状；未予重视，逐渐加重，于某次就诊时间在[机构已隐去]就诊；建议患者住院治疗，患者及家属不同意。近1周来，耳鸣、鼻塞及头痛症状加重，今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,听力下降,右耳鸣,头痛；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：75次/分，R：20次/分，BP：110/65mmHg,Ht：150cm，Wt：41kg，BSA：1.316m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶壁、顶后壁、右侧壁明显增厚，左侧壁稍增厚，并见结节状肿物突出；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见: 轻度ST段下移；检查结论: 窦性心律 轻度ST段下移\n- [全程D1] 检验组合: 淋巴细胞百分比(Lymph%)-静脉血: 0.35；平均红细胞血红蛋白含量(MCH)-静脉血: 28.7pg；总钙(Ca)-静脉血: 2.32mmol/L；凝血酶时间(TT)-静脉血: 19.8sec.；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阳性(+)（参考: 阴性）；总胆汁酸(TBA)-静脉血: 4.1umol/L；钾离子(K+)-静脉血: 3.82mmol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；红细胞计数(RBC#)-静脉血: 5.0210E12/L；钠离子(Na+)-静脉血: 142.9mmol/L；尿素氮(BUN)-静脉血: 4.2mmol/L；葡萄糖(Glu)-静脉血: 5.36mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.66mmolL；球蛋白(GLO)-静脉血: 25.7g/L；尿酸(UA)-静脉血: 214.3umol/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；ABO血型-静脉血: O；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.98mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.76；中性粒细胞百分比(Neut%)-静脉血: 0.579；阴离子间隙(AG)-静脉血: 11.5；γ-谷氨酰基转移酶(GGT)-静脉血: 12.3U/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 23.4U/L；载脂蛋白B(apoB)-静脉血: 0.98g/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 6.4umolL；中性粒细胞计数(Neut#)-静脉血: 3.710E9/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；载脂蛋白AI(apoAI)-静脉血: 1.79g/L；肌酐(Crea)-静脉血: 50.2umol/L；总蛋白(TP)-静脉血: 70.9g/L；总胆固醇(TC)-静脉血: 5.02mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；血小板计数(PLT#)-静脉血: 19010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.1；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；血红蛋白(Hb)-静脉血: 144g/L；血小板分布宽度(PDW)-静脉血: 10.3%；纤维蛋白原降解产物(FDP)-静脉血: 1.7ug/ml；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；红细胞比容(Hct)-静脉血: 43.9%\n- [全程D2] 超声；双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声欠均匀，肝内可见多个无回声灶，较大者约43×29mm，椭圆形，边界清，内透声好，部分可见高回声分隔，后方回声增强。血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：上述病灶内未见明确血流信号。肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声欠均匀，右肾多个无回声灶，较大者约15×13mm，类圆形，边界清，内透声好，后方回声增强。左肾未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确肿物回声。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。；检查结论: 肝多发囊肿。 右肾多发囊肿。 胆囊、脾脏、胰腺、左肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D2] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对侧，双肺野纹理稍增多、增粗，未见明显实质性病变。双侧肺门不大，纵隔不宽，心影形态、大小、位置未见异常。双膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明确病变。\n- [全程D7] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、右侧壁明显增厚，左侧壁稍增厚，并见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号增强扫描明显强化，肿物占据右侧咽隐窝。双侧鼻腔及口咽各壁未见异常。 右侧腭帆张提肌、右侧头长肌及右侧翼内肌受侵，病变包绕右侧颈内动静脉。 右侧腭帆提肌、腭帆张肌、双侧头长肌受侵；左侧腭帆提肌、腭帆张肌未见受侵征象。 双侧翼腭窝、颞下窝未见异常；口咽侧壁未见受累增厚。 蝶骨基底部右份及右侧翼突基底部内侧、右侧翼突内板骨质信号减低，增强扫描不均匀强化。余颅底骨质未见明确异常。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、右侧乳突粘膜增厚，双侧上颌窦、蝶窦、左侧乳突充气良好，骨壁完整；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 右侧咽后见多个肿大淋巴结，最大者短径13mm，增强后明显强化，融合。左侧咽后及双颈II区见多发小淋巴结，最大者短径约7mm，未见坏死及包膜外侵。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺左叶见一结节，大小约11mm×11mm，边界尚清， T1WI及T2WI均呈混杂高信号，增强扫描部分区域强化较明显。甲状腺右叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。；检查结论: 鼻咽病变侵犯右侧咽旁间隙、椎前间隙右份及右侧翼内肌，考虑鼻咽癌可能性大。 蝶骨基底部右份、右侧翼突基底部内侧及右侧翼突内板骨质信号异常，考虑肿瘤浸润可能性大。 右侧咽后肿大淋巴结，考虑转移瘤。 左侧咽后及双颈II区小淋巴结，未排除转移可能。 鼻窦炎；右侧乳突炎。 甲状腺左叶结节灶，建议超声检查。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行鼻咽肿物活检明确病理诊断，并安排全身PET-CT检查\nB. 行鼻咽肿物活检明确病理诊断，并安排全身骨扫描检查\nC. 行颈部淋巴结细针穿刺活检明确病理诊断，并安排甲状腺超声检查\nD. 行鼻咽肿物活检明确病理诊断，并直接安排甲状腺结节细针穿刺活检\nE. 行鼻咽肿物活检明确病理诊断，并安排甲状腺超声检查\nF. 行鼻咽肿物活检明确病理诊断，并安排胸部增强CT检查\nG. 行鼻咽肿物活检明确病理诊断，并安排头颅增强MRI检查\nH. 行鼻咽肿物活检明确病理诊断，并安排甲状腺功能生化检查\nI. 行鼻咽肿物活检明确病理诊断，并安排颈部超声检查\nJ. 行鼻咽肿物活检明确病理诊断，并安排肝脏增强MRI检查\nK. 行鼻咽肿物活检明确病理诊断，并安排甲状腺核素扫描检查\nL. 暂缓活检操作，先行诊断性抗炎治疗两周后复查鼻咽部MRI\n\n请仅输出一个选项字母（A-L）。","gold_letter":"E","gold_action":"行鼻咽肿物活检明确病理诊断，并安排甲状腺超声检查","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"行鼻咽肿物活检明确病理诊断，并安排全身PET-CT检查"},{"letter":"B","text":"行鼻咽肿物活检明确病理诊断，并安排全身骨扫描检查"},{"letter":"C","text":"行颈部淋巴结细针穿刺活检明确病理诊断，并安排甲状腺超声检查"},{"letter":"D","text":"行鼻咽肿物活检明确病理诊断，并直接安排甲状腺结节细针穿刺活检"},{"letter":"E","text":"行鼻咽肿物活检明确病理诊断，并安排甲状腺超声检查"},{"letter":"F","text":"行鼻咽肿物活检明确病理诊断，并安排胸部增强CT检查"},{"letter":"G","text":"行鼻咽肿物活检明确病理诊断，并安排头颅增强MRI检查"},{"letter":"H","text":"行鼻咽肿物活检明确病理诊断，并安排甲状腺功能生化检查"},{"letter":"I","text":"行鼻咽肿物活检明确病理诊断，并安排颈部超声检查"},{"letter":"J","text":"行鼻咽肿物活检明确病理诊断，并安排肝脏增强MRI检查"},{"letter":"K","text":"行鼻咽肿物活检明确病理诊断，并安排甲状腺核素扫描检查"},{"letter":"L","text":"暂缓活检操作，先行诊断性抗炎治疗两周后复查鼻咽部MRI"}]}
+{"sample_id":"sample-bf94c856279752df44d2b5a5","patient_id":"patient-d6812a1c46ed21fda9ebb9f8","turn_id":"turn05","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见: 轻度ST段下移；检查结论: 窦性心律 轻度ST段下移\n- [全程D42] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位置位于第5胸椎体下缘，估计位于上腔静脉上段。；检查结论: PICC管末端位置如上所述。\n- [全程D42] 检验组合: 阴离子间隙(AG)-静脉血: 11；丙氨酸氨基转移酶(ALT)-静脉血: 12.8U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；钠离子(Na+)-静脉血: 143.3mmol/L；总钙(Ca)-静脉血: 2.2mmol/L；总胆红素(TBIL)-静脉血: 8.4umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.3U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.86；C-反应蛋白(CRP)-静脉血: 0.85mg/L；胱抑素(Cys-C)-静脉血: 0.61mg/L；磷(P)-静脉血: 1.14mmol/L；总胆固醇(TC)-静脉血: 4.61mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.292；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；载脂蛋白B(apoB)-静脉血: 0.93g/L；间接胆红素(IBIL)-静脉血: 6.4umolL；甘油三酯(TG)-静脉血: 0.64mmol/L；碱性磷酸酶(ALP)-静脉血: 87.2U/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 2umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；尿酸(UA)-静脉血: 194.8umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.02mmol/L；总胆汁酸(TBA)-静脉血: 2.1umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.96；钾离子(K+)-静脉血: 3.83mmol/L；红细胞比容(Hct)-静脉血: 40.7%；氯离子(Cl-)-静脉血: 107.6mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；肌酐(Crea)-静脉血: 46.2umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.810E9/L；血小板分布宽度(PDW)-静脉血: 10.6%；平均血小板体积(MPV)-静脉血: 9.5fL；白蛋白(ALB)-静脉血: 43.5g/L；尿素氮(BUN)-静脉血: 3.6mmol/L；白细胞计数(WBC#)-静脉血: 6.3110E9/L；球蛋白(GLO)-静脉血: 23.33g/L；葡萄糖(Glu)-静脉血: 5.23mmol/L；总蛋白(TP)-静脉血: 66.83g/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.7mmol/L；血小板计数(PLT#)-静脉血: 17310E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.62；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D43] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.016；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: 1+ 0.6mg（参考: 阴性）；浊度(TRUB)-尿液: 清亮；葡萄糖(Glu)-尿液: +- 1.7mmol（参考: 阴性）；酸碱度(pH)-尿液: 6.5；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；红细胞计数(RBC#)-尿液: 8/μL；酮体(KET)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 7/μL；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D44] 检验组合: 白蛋白(ALB)-静脉血: 37.7g/L；总胆红素(TBIL)-静脉血: 9umol/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；钠离子(Na+)-静脉血: 133.7mmol/L；直接胆红素(DBIL)-静脉血: 2.1umol/L；总胆汁酸(TBA)-静脉血: 1.4umol/L；尿酸(UA)-静脉血: 164.1umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.6U/L；总蛋白(TP)-静脉血: 58.49g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 23.7U/L；碱性磷酸酶(ALP)-静脉血: 72.8U/L；肌酐(Crea)-静脉血: 44.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.95；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.81；尿素氮(BUN)-静脉血: 4.4mmol/L；磷(P)-静脉血: 0.93mmol/L；总钙(Ca)-静脉血: 2.02mmol/L；乳酸脱氢酶(LDH)-静脉血: 210.9U/L；氯离子(Cl-)-静脉血: 100.2mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 12.3U/L；间接胆红素(IBIL)-静脉血: 6.9umolL；钾离子(K+)-静脉血: 2.94mmol/L；阴离子间隙(AG)-静脉血: 12.1；血液二氧化碳含量ctCO2(B)-静脉血: 21.4mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.3U/L；球蛋白(GLO)-静脉血: 20.79g/L\n- [全程D45] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 1/μL；钠离子(Na+)-静脉血: 131.1mmol/L；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；阴离子间隙(AG)-静脉血: 14.5；浊度(TRUB)-尿液: clear；胆红素(BIL)-尿液: -（参考: 阴性）；镁离子(Mg2+)-静脉血: 0.79mmol/L；钾离子(K+)-静脉血: 3.17mmol/L；红细胞计数(RBC#)-尿液: 17/μL；磷(P)-静脉血: 0.95mmol/L；氯离子(Cl-)-静脉血: 96.2mmol/L；白细胞计数(WBC#)-尿液: 5/μL；总钙(Ca)-静脉血: 1.92mmol/L；颜色-尿液: Light-Yellow；比重(SG)-尿液: 1.011；葡萄糖(Glu)-尿液: 1+ 5.6mmol（参考: 阴性）；隐血(OB)-尿液: +-0.3mg（参考: 阴性）；未分类结晶计数(UNCX#)-尿液: 5/μL；血液二氧化碳含量ctCO2(B)-静脉血: 20.4mmol/L；酸碱度(pH)-尿液: 6.5；尿胆原(URO)-尿液: -（参考: 阴性）\n- [全程D46] 检验组合: 阴离子间隙(AG)-静脉血: 17.7；血液二氧化碳含量ctCO2(B)-静脉血: 19.3mmol/L；氯离子(Cl-)-静脉血: 85.6mmol/L；总钙(Ca)-静脉血: 2.04mmol/L；钠离子(Na+)-静脉血: 122.6mmol/L；钾离子(K+)-静脉血: 3.26mmol/L；镁离子(Mg2+)-静脉血: 0.77mmol/L；磷(P)-静脉血: 0.51mmol/L\n- [全程D47] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 20.9mmol/L；总钙(Ca)-静脉血: 2.12mmol/L；阴离子间隙(AG)-静脉血: 14.5；磷(P)-静脉血: 0.67mmol/L；钾离子(K+)-静脉血: 4.06mmol/L；氯离子(Cl-)-静脉血: 89.8mmol/L；钠离子(Na+)-静脉血: 125.2mmol/L；镁离子(Mg2+)-静脉血: 0.93mmol/L\n- [全程D49] 检验组合: 镁离子(Mg2+)-静脉血: 0.89mmol/L；血小板分布宽度(PDW)-静脉血: 11.2%；有核红细胞百分比(NRBC%)-静脉血: 0；白蛋白(ALB)-静脉血: 44.2g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 33.1U/L；丙氨酸氨基转移酶(ALT)-静脉血: 22.6U/L；葡萄糖(Glu)-静脉血: 5.17mmol/L；间接胆红素(IBIL)-静脉血: 8.9umolL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.09mmolL；载脂蛋白B(apoB)-静脉血: 0.78g/L；总胆汁酸(TBA)-静脉血: 7.4umol/L；磷(P)-静脉血: 0.8mmol/L；肌酐(Crea)-静脉血: 38.9umol/L；甘油三酯(TG)-静脉血: 1.35mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29pg；平均红细胞体积(MCV)-静脉血: 83.3fL；单核细胞计数(Mono#)-静脉血: 0.710E9/L；总胆固醇(TC)-静脉血: 3.61mmol/L；总蛋白(TP)-静脉血: 67.8g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.003；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；总胆红素(TBIL)-静脉血: 12.8umol/L；血小板计数(PLT#)-静脉血: 19410E9/L；血小板比容-静脉血: 20%；天门冬氨酸氨基转移酶(AST)-静脉血: 12.9U/L；阴离子间隙(AG)-静脉血: 14.6；直接胆红素(DBIL)-静脉血: 3.9umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.05mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.2mmol/L；大血小板百分比(P-LCR%)-静脉血: 25.6%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 35.8；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.87；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；C-反应蛋白(CRP)-静脉血: 0.28mg/L；尿酸(UA)-静脉血: 110.7umol/L；单核细胞百分比(Mono%)-静脉血: 0.107；中性粒细胞百分比(Neut%)-静脉血: 0.736；钠离子(Na+)-静脉血: 129.8mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 36.2U/L；球蛋白(GLO)-静脉血: 23.6g/L；红细胞比容(Hct)-静脉血: 40.8%；碱性磷酸酶(ALP)-静脉血: 64.3U/L；钾离子(K+)-静脉血: 3.21mmol/L\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D11] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者检查完善，已完成放疗预约，嘱今日出院，按期行放疗前准备及放疗前口腔检查。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 继续静脉滴注氯化钾及氯化钠注射液，暂缓出院继续住院观察。\nB. 停止静脉输液，停用所有补钾药物，拔除PICC导管，安排出院休养。\nC. 停止静脉输液，予以口服氯化钾缓释片，拔除PICC导管，安排出院休养。\nD. 继续静脉滴注氯化钾，行PICC导管常规护理，暂缓出院继续住院观察。\nE. 停止静脉输液，停用所有补钾药物，行PICC导管常规护理，安排出院休养。\nF. 予以静脉推注氯化钾注射液，行PICC导管常规护理，暂缓出院继续住院观察。\nG. 停止静脉输液，予以口服氯化钾缓释片及螺内酯，行PICC导管常规护理，安排出院休养。\nH. 停止静脉输液，予以口服氯化钾缓释片，行PICC导管常规护理，安排出院休养。\nI. 继续静脉滴注氯化钠注射液，予以口服氯化钾缓释片，行PICC导管常规护理，暂缓出院。\nJ. 停止静脉输液，予以口服聚苯乙烯磺酸钙散，行PICC导管常规护理，安排出院休养。\nK. 停止静脉输液，予以静脉泵入氯化钾注射液，行PICC导管常规护理，暂缓出院。\nL. 继续静脉滴注氯化钾及氯化钠注射液，行PICC导管常规护理，带静脉输液装置出院。\n\n请仅输出一个选项字母（A-L）。","gold_letter":"H","gold_action":"停止静脉输液，予以口服氯化钾缓释片，行PICC导管常规护理，安排出院休养。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"继续静脉滴注氯化钾及氯化钠注射液，暂缓出院继续住院观察。"},{"letter":"B","text":"停止静脉输液，停用所有补钾药物，拔除PICC导管，安排出院休养。"},{"letter":"C","text":"停止静脉输液，予以口服氯化钾缓释片，拔除PICC导管，安排出院休养。"},{"letter":"D","text":"继续静脉滴注氯化钾，行PICC导管常规护理，暂缓出院继续住院观察。"},{"letter":"E","text":"停止静脉输液，停用所有补钾药物，行PICC导管常规护理，安排出院休养。"},{"letter":"F","text":"予以静脉推注氯化钾注射液，行PICC导管常规护理，暂缓出院继续住院观察。"},{"letter":"G","text":"停止静脉输液，予以口服氯化钾缓释片及螺内酯，行PICC导管常规护理，安排出院休养。"},{"letter":"H","text":"停止静脉输液，予以口服氯化钾缓释片，行PICC导管常规护理，安排出院休养。"},{"letter":"I","text":"继续静脉滴注氯化钠注射液，予以口服氯化钾缓释片，行PICC导管常规护理，暂缓出院。"},{"letter":"J","text":"停止静脉输液，予以口服聚苯乙烯磺酸钙散，行PICC导管常规护理，安排出院休养。"},{"letter":"K","text":"停止静脉输液，予以静脉泵入氯化钾注射液，行PICC导管常规护理，暂缓出院。"},{"letter":"L","text":"继续静脉滴注氯化钾及氯化钠注射液，行PICC导管常规护理，带静脉输液装置出院。"}]}
+{"sample_id":"sample-9549c3c98f10ace802cbb08b","patient_id":"patient-d6812a1c46ed21fda9ebb9f8","turn_id":"turn06","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见: 轻度ST段下移；检查结论: 窦性心律 轻度ST段下移\n- [全程D42] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位置位于第5胸椎体下缘，估计位于上腔静脉上段。；检查结论: PICC管末端位置如上所述。\n- [全程D42] 检验组合: 阴离子间隙(AG)-静脉血: 11；丙氨酸氨基转移酶(ALT)-静脉血: 12.8U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；钠离子(Na+)-静脉血: 143.3mmol/L；总钙(Ca)-静脉血: 2.2mmol/L；总胆红素(TBIL)-静脉血: 8.4umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.3U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.86；C-反应蛋白(CRP)-静脉血: 0.85mg/L；胱抑素(Cys-C)-静脉血: 0.61mg/L；磷(P)-静脉血: 1.14mmol/L；总胆固醇(TC)-静脉血: 4.61mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.292；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；载脂蛋白B(apoB)-静脉血: 0.93g/L；间接胆红素(IBIL)-静脉血: 6.4umolL；甘油三酯(TG)-静脉血: 0.64mmol/L；碱性磷酸酶(ALP)-静脉血: 87.2U/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 2umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；尿酸(UA)-静脉血: 194.8umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.02mmol/L；总胆汁酸(TBA)-静脉血: 2.1umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.96；钾离子(K+)-静脉血: 3.83mmol/L；红细胞比容(Hct)-静脉血: 40.7%；氯离子(Cl-)-静脉血: 107.6mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；肌酐(Crea)-静脉血: 46.2umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.810E9/L；血小板分布宽度(PDW)-静脉血: 10.6%；平均血小板体积(MPV)-静脉血: 9.5fL；白蛋白(ALB)-静脉血: 43.5g/L；尿素氮(BUN)-静脉血: 3.6mmol/L；白细胞计数(WBC#)-静脉血: 6.3110E9/L；球蛋白(GLO)-静脉血: 23.33g/L；葡萄糖(Glu)-静脉血: 5.23mmol/L；总蛋白(TP)-静脉血: 66.83g/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.7mmol/L；血小板计数(PLT#)-静脉血: 17310E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.62；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D43] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.016；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: 1+ 0.6mg（参考: 阴性）；浊度(TRUB)-尿液: 清亮；葡萄糖(Glu)-尿液: +- 1.7mmol（参考: 阴性）；酸碱度(pH)-尿液: 6.5；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；红细胞计数(RBC#)-尿液: 8/μL；酮体(KET)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 7/μL；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D44] 检验组合: 白蛋白(ALB)-静脉血: 37.7g/L；总胆红素(TBIL)-静脉血: 9umol/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；钠离子(Na+)-静脉血: 133.7mmol/L；直接胆红素(DBIL)-静脉血: 2.1umol/L；总胆汁酸(TBA)-静脉血: 1.4umol/L；尿酸(UA)-静脉血: 164.1umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.6U/L；总蛋白(TP)-静脉血: 58.49g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 23.7U/L；碱性磷酸酶(ALP)-静脉血: 72.8U/L；肌酐(Crea)-静脉血: 44.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.95；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.81；尿素氮(BUN)-静脉血: 4.4mmol/L；磷(P)-静脉血: 0.93mmol/L；总钙(Ca)-静脉血: 2.02mmol/L；乳酸脱氢酶(LDH)-静脉血: 210.9U/L；氯离子(Cl-)-静脉血: 100.2mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 12.3U/L；间接胆红素(IBIL)-静脉血: 6.9umolL；钾离子(K+)-静脉血: 2.94mmol/L；阴离子间隙(AG)-静脉血: 12.1；血液二氧化碳含量ctCO2(B)-静脉血: 21.4mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.3U/L；球蛋白(GLO)-静脉血: 20.79g/L\n- [全程D45] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 1/μL；钠离子(Na+)-静脉血: 131.1mmol/L；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；阴离子间隙(AG)-静脉血: 14.5；浊度(TRUB)-尿液: clear；胆红素(BIL)-尿液: -（参考: 阴性）；镁离子(Mg2+)-静脉血: 0.79mmol/L；钾离子(K+)-静脉血: 3.17mmol/L；红细胞计数(RBC#)-尿液: 17/μL；磷(P)-静脉血: 0.95mmol/L；氯离子(Cl-)-静脉血: 96.2mmol/L；白细胞计数(WBC#)-尿液: 5/μL；总钙(Ca)-静脉血: 1.92mmol/L；颜色-尿液: Light-Yellow；比重(SG)-尿液: 1.011；葡萄糖(Glu)-尿液: 1+ 5.6mmol（参考: 阴性）；隐血(OB)-尿液: +-0.3mg（参考: 阴性）；未分类结晶计数(UNCX#)-尿液: 5/μL；血液二氧化碳含量ctCO2(B)-静脉血: 20.4mmol/L；酸碱度(pH)-尿液: 6.5；尿胆原(URO)-尿液: -（参考: 阴性）\n- [全程D46] 检验组合: 阴离子间隙(AG)-静脉血: 17.7；血液二氧化碳含量ctCO2(B)-静脉血: 19.3mmol/L；氯离子(Cl-)-静脉血: 85.6mmol/L；总钙(Ca)-静脉血: 2.04mmol/L；钠离子(Na+)-静脉血: 122.6mmol/L；钾离子(K+)-静脉血: 3.26mmol/L；镁离子(Mg2+)-静脉血: 0.77mmol/L；磷(P)-静脉血: 0.51mmol/L\n- [全程D47] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 20.9mmol/L；总钙(Ca)-静脉血: 2.12mmol/L；阴离子间隙(AG)-静脉血: 14.5；磷(P)-静脉血: 0.67mmol/L；钾离子(K+)-静脉血: 4.06mmol/L；氯离子(Cl-)-静脉血: 89.8mmol/L；钠离子(Na+)-静脉血: 125.2mmol/L；镁离子(Mg2+)-静脉血: 0.93mmol/L\n- [全程D49] 检验组合: 镁离子(Mg2+)-静脉血: 0.89mmol/L；血小板分布宽度(PDW)-静脉血: 11.2%；有核红细胞百分比(NRBC%)-静脉血: 0；白蛋白(ALB)-静脉血: 44.2g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 33.1U/L；丙氨酸氨基转移酶(ALT)-静脉血: 22.6U/L；葡萄糖(Glu)-静脉血: 5.17mmol/L；间接胆红素(IBIL)-静脉血: 8.9umolL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.09mmolL；载脂蛋白B(apoB)-静脉血: 0.78g/L；总胆汁酸(TBA)-静脉血: 7.4umol/L；磷(P)-静脉血: 0.8mmol/L；肌酐(Crea)-静脉血: 38.9umol/L；甘油三酯(TG)-静脉血: 1.35mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29pg；平均红细胞体积(MCV)-静脉血: 83.3fL；单核细胞计数(Mono#)-静脉血: 0.710E9/L；总胆固醇(TC)-静脉血: 3.61mmol/L；总蛋白(TP)-静脉血: 67.8g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.003；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；总胆红素(TBIL)-静脉血: 12.8umol/L；血小板计数(PLT#)-静脉血: 19410E9/L；血小板比容-静脉血: 20%；天门冬氨酸氨基转移酶(AST)-静脉血: 12.9U/L；阴离子间隙(AG)-静脉血: 14.6；直接胆红素(DBIL)-静脉血: 3.9umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.05mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.2mmol/L；大血小板百分比(P-LCR%)-静脉血: 25.6%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 35.8；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.87；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；C-反应蛋白(CRP)-静脉血: 0.28mg/L；尿酸(UA)-静脉血: 110.7umol/L；单核细胞百分比(Mono%)-静脉血: 0.107；中性粒细胞百分比(Neut%)-静脉血: 0.736；钠离子(Na+)-静脉血: 129.8mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 36.2U/L；球蛋白(GLO)-静脉血: 23.6g/L；红细胞比容(Hct)-静脉血: 40.8%；碱性磷酸酶(ALP)-静脉血: 64.3U/L；钾离子(K+)-静脉血: 3.21mmol/L\n- [全程D60] 检验组合: α-L-岩藻糖苷酶(AFU)-静脉血: 20.3U/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；总胆固醇(TC)-静脉血: 3.99mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.68；天门冬氨酸氨基转移酶(AST)-静脉血: 11.8U/L；总钙(Ca)-静脉血: 2.22mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.05；有核红细胞计数(NRBC#)-静脉血: 010E9/L；白细胞计数(WBC#)-静脉血: 3.5710E9/L；钾离子(K+)-静脉血: 3.88mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.14；碱性磷酸酶(ALP)-静脉血: 52.6U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.62mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.89mmolL；氯离子(Cl-)-静脉血: 103mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；阴离子间隙(AG)-静脉血: 11；球蛋白(GLO)-静脉血: 22.9g/L；总胆汁酸(TBA)-静脉血: 0.9umol/L；镁离子(Mg2+)-静脉血: 0.9mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336g/L；血红蛋白(Hb)-静脉血: 115g/L；红细胞计数(RBC#)-静脉血: 3.910E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；甘油三酯(TG)-静脉血: 0.63mmol/L；磷(P)-静脉血: 1.02mmol/L；直接胆红素(DBIL)-静脉血: 2.86umol/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；单核细胞百分比(Mono%)-静脉血: 0.101；红细胞比容(Hct)-静脉血: 34.2%；血小板比容-静脉血: 17%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.5pg；平均血小板体积(MPV)-静脉血: 9.5fL；尿酸(UA)-静脉血: 152.4umol/L；肌酐(Crea)-静脉血: 43umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 11.2U/L；葡萄糖(Glu)-静脉血: 5.18mmol/L；间接胆红素(IBIL)-静脉血: 4.98umolL；胱抑素(Cys-C)-静脉血: 0.52mg/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.6mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；C-反应蛋白(CRP)-静脉血: 19.04mg/L；载脂蛋白AI(apoAI)-静脉血: 0.92g/L\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D11] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者检查完善，已完成放疗预约，嘱今日出院，按期行放疗前准备及放疗前口腔检查。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停化疗，给予重组人粒细胞集落刺激因子升白细胞治疗，待白细胞恢复后继续顺铂化疗。\nB. 暂停化疗，给予3%氯化钠注射液强化纠正低钠血症，待血钠持续稳定正常后再考虑恢复顺铂化疗。\nC. 将化疗方案调整为卡铂单药，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化支持治疗。\nD. 继续顺铂化疗，并给予地塞米松、甲氧氯普胺、奥美拉唑止吐，无需常规静脉水化及补钾。\nE. 继续顺铂化疗，并给予昂丹司琼单药止吐，辅以静脉水化及补钾支持治疗。\nF. 继续顺铂联合5-氟尿嘧啶化疗，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化支持治疗。\nG. 继续顺铂化疗，并给予地塞米松、甲氧氯普胺、奥美拉唑止吐，同时预防性使用重组人粒细胞集落刺激因子。\nH. 终止化疗，仅行单纯放射治疗，并给予静脉水化及营养支持。\nI. 继续顺铂化疗，并给予地塞米松、甲氧氯普胺、奥美拉唑止吐，辅以静脉水化及补钾支持治疗。\nJ. 继续顺铂化疗，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化，同时加用呋塞米强迫利尿且不补钾。\nK. 暂停化疗，给予保肝降酶治疗，待肝功能恢复后继续顺铂化疗。\nL. 将化疗方案调整为紫杉醇单药，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化支持治疗。\n\n请仅输出一个选项字母（A-L）。","gold_letter":"I","gold_action":"继续顺铂化疗，并给予地塞米松、甲氧氯普胺、奥美拉唑止吐，辅以静脉水化及补钾支持治疗。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"暂停化疗，给予重组人粒细胞集落刺激因子升白细胞治疗，待白细胞恢复后继续顺铂化疗。"},{"letter":"B","text":"暂停化疗，给予3%氯化钠注射液强化纠正低钠血症，待血钠持续稳定正常后再考虑恢复顺铂化疗。"},{"letter":"C","text":"将化疗方案调整为卡铂单药，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化支持治疗。"},{"letter":"D","text":"继续顺铂化疗，并给予地塞米松、甲氧氯普胺、奥美拉唑止吐，无需常规静脉水化及补钾。"},{"letter":"E","text":"继续顺铂化疗，并给予昂丹司琼单药止吐，辅以静脉水化及补钾支持治疗。"},{"letter":"F","text":"继续顺铂联合5-氟尿嘧啶化疗，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化支持治疗。"},{"letter":"G","text":"继续顺铂化疗，并给予地塞米松、甲氧氯普胺、奥美拉唑止吐，同时预防性使用重组人粒细胞集落刺激因子。"},{"letter":"H","text":"终止化疗，仅行单纯放射治疗，并给予静脉水化及营养支持。"},{"letter":"I","text":"继续顺铂化疗，并给予地塞米松、甲氧氯普胺、奥美拉唑止吐，辅以静脉水化及补钾支持治疗。"},{"letter":"J","text":"继续顺铂化疗，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化，同时加用呋塞米强迫利尿且不补钾。"},{"letter":"K","text":"暂停化疗，给予保肝降酶治疗，待肝功能恢复后继续顺铂化疗。"},{"letter":"L","text":"将化疗方案调整为紫杉醇单药，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化支持治疗。"}]}
+{"sample_id":"sample-5acaafa7f13a3c4be08160aa","patient_id":"patient-d6812a1c46ed21fda9ebb9f8","turn_id":"turn07","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见: 轻度ST段下移；检查结论: 窦性心律 轻度ST段下移\n- [全程D60] 检验组合: α-L-岩藻糖苷酶(AFU)-静脉血: 20.3U/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；总胆固醇(TC)-静脉血: 3.99mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.68；天门冬氨酸氨基转移酶(AST)-静脉血: 11.8U/L；总钙(Ca)-静脉血: 2.22mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.05；有核红细胞计数(NRBC#)-静脉血: 010E9/L；白细胞计数(WBC#)-静脉血: 3.5710E9/L；钾离子(K+)-静脉血: 3.88mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.14；碱性磷酸酶(ALP)-静脉血: 52.6U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.62mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.89mmolL；氯离子(Cl-)-静脉血: 103mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；阴离子间隙(AG)-静脉血: 11；球蛋白(GLO)-静脉血: 22.9g/L；总胆汁酸(TBA)-静脉血: 0.9umol/L；镁离子(Mg2+)-静脉血: 0.9mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336g/L；血红蛋白(Hb)-静脉血: 115g/L；红细胞计数(RBC#)-静脉血: 3.910E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；甘油三酯(TG)-静脉血: 0.63mmol/L；磷(P)-静脉血: 1.02mmol/L；直接胆红素(DBIL)-静脉血: 2.86umol/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；单核细胞百分比(Mono%)-静脉血: 0.101；红细胞比容(Hct)-静脉血: 34.2%；血小板比容-静脉血: 17%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.5pg；平均血小板体积(MPV)-静脉血: 9.5fL；尿酸(UA)-静脉血: 152.4umol/L；肌酐(Crea)-静脉血: 43umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 11.2U/L；葡萄糖(Glu)-静脉血: 5.18mmol/L；间接胆红素(IBIL)-静脉血: 4.98umolL；胱抑素(Cys-C)-静脉血: 0.52mg/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.6mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；C-反应蛋白(CRP)-静脉血: 19.04mg/L；载脂蛋白AI(apoAI)-静脉血: 0.92g/L\n- [全程D68] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0；有核红细胞计数(NRBC#)-静脉血: 010E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0；大血小板百分比(P-LCR%)-静脉血: 20.1%；尿酸(UA)-静脉血: 120.2umol/L；总胆固醇(TC)-静脉血: 4.11mmol/L；总钙(Ca)-静脉血: 2.22mmol/L；平均红细胞体积(MCV)-静脉血: 84.4fL；单核细胞百分比(Mono%)-静脉血: 0.155；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；淋巴细胞百分比(Lymph%)-静脉血: 0.088；总胆汁酸(TBA)-静脉血: 2.6umol/L；白蛋白(ALB)-静脉血: 40.1g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.22mmolL；总蛋白(TP)-静脉血: 62.7g/L；载脂蛋白AI(apoAI)-静脉血: 1.32g/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.5U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.77；中性粒细胞百分比(Neut%)-静脉血: 0.757；α-L-岩藻糖苷酶(AFU)-静脉血: 42.2U/L；C-反应蛋白(CRP)-静脉血: 0.25mg/L；阴离子间隙(AG)-静脉血: 13.4；肌酐(Crea)-静脉血: 43.4umol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.7；中性粒细胞计数(Neut#)-静脉血: 4.210E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.9U/L；钠离子(Na+)-静脉血: 134mmol/L；单核细胞计数(Mono#)-静脉血: 0.910E9/L；血小板分布宽度(PDW)-静脉血: 10.6%；镁离子(Mg2+)-静脉血: 0.72mmol/L；血小板比容-静脉血: 19%；白细胞计数(WBC#)-静脉血: 5.4810E9/L；胱抑素(Cys-C)-静脉血: 0.92mg/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.3；葡萄糖(Glu)-静脉血: 4.71mmol/L；直接胆红素(DBIL)-静脉血: 2.12umol/L；血红蛋白(Hb)-静脉血: 123g/L；碱性磷酸酶(ALP)-静脉血: 49.9U/L；红细胞比容(Hct)-静脉血: 35.6%；乳酸脱氢酶(LDH)-静脉血: 180.1U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.96；平均红细胞血红蛋白浓度(MCHC)-静脉血: 346g/L；载脂蛋白B(apoB)-静脉血: 0.81g/L；氯离子(Cl-)-静脉血: 96.3mmol/L\n- [全程D70] 检验组合: 淋巴细胞百分比(Lymph%)-静脉血: 0.097；血小板分布宽度(PDW)-静脉血: 10.4%；白细胞计数(WBC#)-静脉血: 5.3710E9/L；平均血小板体积(MPV)-静脉血: 9.5fL；乳酸脱氢酶(LDH)-静脉血: 191.8U/L；直接胆红素(DBIL)-静脉血: 2.52umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20.6U/L；氯离子(Cl-)-静脉血: 92.5mmol/L；尿素氮(BUN)-静脉血: 5mmol/L；血小板比容-静脉血: 21%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总钙(Ca)-静脉血: 2.25mmol/L；尿酸(UA)-静脉血: 198umol/L；总胆红素(TBIL)-静脉血: 9.15umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 37.3U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.006；中性粒细胞计数(Neut#)-静脉血: 4.110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.77；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；间接胆红素(IBIL)-静脉血: 6.63umolL；碱性磷酸酶(ALP)-静脉血: 58U/L；单核细胞百分比(Mono%)-静脉血: 0.125；载脂蛋白B(apoB)-静脉血: 1.02g/L；C-反应蛋白(CRP)-静脉血: 1.01mg/L；γ-谷氨酰基转移酶(GGT)-静脉血: 27.6U/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.3mmol/L；甘油三酯(TG)-静脉血: 1.4mmol/L；总胆汁酸(TBA)-静脉血: 3.6umol/L；球蛋白(GLO)-静脉血: 24.2g/L；白蛋白(ALB)-静脉血: 41.8g/L；葡萄糖(Glu)-静脉血: 5.35mmol/L；平均红细胞体积(MCV)-静脉血: 83.5fL；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 348g/L；胱抑素(Cys-C)-静脉血: 0.79mg/L；丙氨酸氨基转移酶(ALT)-静脉血: 24U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.88mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.2；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.21mmolL；磷(P)-静脉血: 1.13mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.3；血红蛋白(Hb)-静脉血: 141g/L；总蛋白(TP)-静脉血: 66g/L；镁离子(Mg2+)-静脉血: 0.85mmol/L\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D77] 检验组合: 总胆红素(TBIL)-静脉血: 9.1umol/L；血小板分布宽度(PDW)-静脉血: 10.7%；乳酸脱氢酶(LDH)-静脉血: 184.4U/L；直接胆红素(DBIL)-静脉血: 2.92umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.9mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 24U/L；总胆固醇(TC)-静脉血: 4.36mmol/L；平均血小板体积(MPV)-静脉血: 9.7fL；白细胞计数(WBC#)-静脉血: 6.0610E9/L；氯离子(Cl-)-静脉血: 97.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 9.2U/L；阴离子间隙(AG)-静脉血: 15.2；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞计数(RBC#)-静脉血: 4.0510E12/L；总胆汁酸(TBA)-静脉血: 1.1umol/L；C-反应蛋白(CRP)-静脉血: 6.66mg/L；磷(P)-静脉血: 1.11mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.012；中性粒细胞百分比(Neut%)-静脉血: 0.799；淋巴细胞计数(Lymph#)-静脉血: 0.410E9/L；总钙(Ca)-静脉血: 2.14mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.03mmol/L；球蛋白(GLO)-静脉血: 22g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.99mmolL；淋巴细胞百分比(Lymph%)-静脉血: 0.064；血小板计数(PLT#)-静脉血: 12010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.2；钾离子(K+)-静脉血: 3.15mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.09；碱性磷酸酶(ALP)-静脉血: 49.9U/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 44.5umol/L；中性粒细胞计数(Neut#)-静脉血: 4.810E9/L；间接胆红素(IBIL)-静脉血: 6.18umolL；尿素氮(BUN)-静脉血: 5.3mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.7；天门冬氨酸氨基转移酶(AST)-静脉血: 10U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.73；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；尿酸(UA)-静脉血: 198umol/L；葡萄糖(Glu)-静脉血: 4.85mmol/L；甘油三酯(TG)-静脉血: 0.9mmol/L；白蛋白(ALB)-静脉血: 38g/L；总蛋白(TP)-静脉血: 60g/L\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D79] 超声；双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 双肾大小形态正常，右肾探及几个无回声灶，大者约16×13mm，边界清，内透声可，后方回声增强。左肾实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确肿物回声。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。；检查结论: 右肾多发囊性灶，考虑肾囊肿。 左肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位性病变。\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D66] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者诉恶心，食欲差，于未诉特殊不适，查体基本同前。患者第二程DDP同时期化疗。予加强止呕及营养支持治疗，防治放化毒副反应。续观。\n- [全程D70] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者诉恶心，进食差，余未诉特殊不适，查体基本同前。今日上级医师信息已隐藏后示：患者已完成第二程DDP同时期化疗，予加强营养支持治疗。一般情况平稳，嘱今日补液结束后出院，于门诊继续放疗。按期返院继续治疗。遵嘱。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 疗效评估为疾病进展，存在低钾血症，暂停放疗，改为单药靶向治疗并静脉补钾。\nB. 疗效评估为放化疗有效，存在低钾血症及进食差，终止同期化疗，仅继续单纯放疗及口服补钾。\nC. 疗效评估为放化疗有效，存在低钾血症，暂停放疗及化疗，待血钾恢复正常后再恢复原方案。\nD. 疗效评估为疾病稳定，存在骨髓抑制，给予重组人血小板生成素并推迟后续化疗。\nE. 疗效评估为放化疗有效，右肾多发囊肿，请泌尿外科急会诊行囊肿穿刺引流，暂缓化疗。\nF. 疗效评估为疾病进展，复查鼻咽 MRI 及全身 PET-CT，更改化疗方案为吉西他滨联合顺铂。\nG. 疗效评估为放化疗有效，进食差，行经皮胃造瘘术进行肠内营养，继续放化疗。\nH. 疗效评估为放化疗有效，存在低钾血症，门诊口服氯化钾缓释片，继续放疗，取消第三程化疗。\nI. 疗效评估为放化疗有效，存在肝功能损害，停用顺铂，改为西妥昔单抗靶向治疗并保肝处理。\nJ. 疗效评估为放化疗有效，予以静脉营养支持及补钾，处理进食差及低钾血症，继续根治性放疗并按期行第三程同期化疗。\nK. 疗效评估为放化疗有效，予以静脉补钾，处理低钾血症，结束同期化疗阶段，后续仅需完成单纯放疗。\nL. 疗效评估为疾病稳定，存在恶心呕吐，预防性给予三联止吐方案，提前结束放疗并转为辅助化疗。\n\n请仅输出一个选项字母（A-L）。","gold_letter":"J","gold_action":"疗效评估为放化疗有效，予以静脉营养支持及补钾，处理进食差及低钾血症，继续根治性放疗并按期行第三程同期化疗。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"疗效评估为疾病进展，存在低钾血症，暂停放疗，改为单药靶向治疗并静脉补钾。"},{"letter":"B","text":"疗效评估为放化疗有效，存在低钾血症及进食差，终止同期化疗，仅继续单纯放疗及口服补钾。"},{"letter":"C","text":"疗效评估为放化疗有效，存在低钾血症，暂停放疗及化疗，待血钾恢复正常后再恢复原方案。"},{"letter":"D","text":"疗效评估为疾病稳定，存在骨髓抑制，给予重组人血小板生成素并推迟后续化疗。"},{"letter":"E","text":"疗效评估为放化疗有效，右肾多发囊肿，请泌尿外科急会诊行囊肿穿刺引流，暂缓化疗。"},{"letter":"F","text":"疗效评估为疾病进展，复查鼻咽 MRI 及全身 PET-CT，更改化疗方案为吉西他滨联合顺铂。"},{"letter":"G","text":"疗效评估为放化疗有效，进食差，行经皮胃造瘘术进行肠内营养，继续放化疗。"},{"letter":"H","text":"疗效评估为放化疗有效，存在低钾血症，门诊口服氯化钾缓释片，继续放疗，取消第三程化疗。"},{"letter":"I","text":"疗效评估为放化疗有效，存在肝功能损害，停用顺铂，改为西妥昔单抗靶向治疗并保肝处理。"},{"letter":"J","text":"疗效评估为放化疗有效，予以静脉营养支持及补钾，处理进食差及低钾血症，继续根治性放疗并按期行第三程同期化疗。"},{"letter":"K","text":"疗效评估为放化疗有效，予以静脉补钾，处理低钾血症，结束同期化疗阶段，后续仅需完成单纯放疗。"},{"letter":"L","text":"疗效评估为疾病稳定，存在恶心呕吐，预防性给予三联止吐方案，提前结束放疗并转为辅助化疗。"}]}
+{"sample_id":"sample-47e9b2e315a805773d669325","patient_id":"patient-d6812a1c46ed21fda9ebb9f8","turn_id":"turn08","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见: 轻度ST段下移；检查结论: 窦性心律 轻度ST段下移\n- [全程D68] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0；有核红细胞计数(NRBC#)-静脉血: 010E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0；大血小板百分比(P-LCR%)-静脉血: 20.1%；尿酸(UA)-静脉血: 120.2umol/L；总胆固醇(TC)-静脉血: 4.11mmol/L；总钙(Ca)-静脉血: 2.22mmol/L；平均红细胞体积(MCV)-静脉血: 84.4fL；单核细胞百分比(Mono%)-静脉血: 0.155；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；淋巴细胞百分比(Lymph%)-静脉血: 0.088；总胆汁酸(TBA)-静脉血: 2.6umol/L；白蛋白(ALB)-静脉血: 40.1g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.22mmolL；总蛋白(TP)-静脉血: 62.7g/L；载脂蛋白AI(apoAI)-静脉血: 1.32g/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.5U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.77；中性粒细胞百分比(Neut%)-静脉血: 0.757；α-L-岩藻糖苷酶(AFU)-静脉血: 42.2U/L；C-反应蛋白(CRP)-静脉血: 0.25mg/L；阴离子间隙(AG)-静脉血: 13.4；肌酐(Crea)-静脉血: 43.4umol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.7；中性粒细胞计数(Neut#)-静脉血: 4.210E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.9U/L；钠离子(Na+)-静脉血: 134mmol/L；单核细胞计数(Mono#)-静脉血: 0.910E9/L；血小板分布宽度(PDW)-静脉血: 10.6%；镁离子(Mg2+)-静脉血: 0.72mmol/L；血小板比容-静脉血: 19%；白细胞计数(WBC#)-静脉血: 5.4810E9/L；胱抑素(Cys-C)-静脉血: 0.92mg/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.3；葡萄糖(Glu)-静脉血: 4.71mmol/L；直接胆红素(DBIL)-静脉血: 2.12umol/L；血红蛋白(Hb)-静脉血: 123g/L；碱性磷酸酶(ALP)-静脉血: 49.9U/L；红细胞比容(Hct)-静脉血: 35.6%；乳酸脱氢酶(LDH)-静脉血: 180.1U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.96；平均红细胞血红蛋白浓度(MCHC)-静脉血: 346g/L；载脂蛋白B(apoB)-静脉血: 0.81g/L；氯离子(Cl-)-静脉血: 96.3mmol/L\n- [全程D70] 检验组合: 淋巴细胞百分比(Lymph%)-静脉血: 0.097；血小板分布宽度(PDW)-静脉血: 10.4%；白细胞计数(WBC#)-静脉血: 5.3710E9/L；平均血小板体积(MPV)-静脉血: 9.5fL；乳酸脱氢酶(LDH)-静脉血: 191.8U/L；直接胆红素(DBIL)-静脉血: 2.52umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20.6U/L；氯离子(Cl-)-静脉血: 92.5mmol/L；尿素氮(BUN)-静脉血: 5mmol/L；血小板比容-静脉血: 21%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总钙(Ca)-静脉血: 2.25mmol/L；尿酸(UA)-静脉血: 198umol/L；总胆红素(TBIL)-静脉血: 9.15umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 37.3U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.006；中性粒细胞计数(Neut#)-静脉血: 4.110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.77；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；间接胆红素(IBIL)-静脉血: 6.63umolL；碱性磷酸酶(ALP)-静脉血: 58U/L；单核细胞百分比(Mono%)-静脉血: 0.125；载脂蛋白B(apoB)-静脉血: 1.02g/L；C-反应蛋白(CRP)-静脉血: 1.01mg/L；γ-谷氨酰基转移酶(GGT)-静脉血: 27.6U/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.3mmol/L；甘油三酯(TG)-静脉血: 1.4mmol/L；总胆汁酸(TBA)-静脉血: 3.6umol/L；球蛋白(GLO)-静脉血: 24.2g/L；白蛋白(ALB)-静脉血: 41.8g/L；葡萄糖(Glu)-静脉血: 5.35mmol/L；平均红细胞体积(MCV)-静脉血: 83.5fL；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 348g/L；胱抑素(Cys-C)-静脉血: 0.79mg/L；丙氨酸氨基转移酶(ALT)-静脉血: 24U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.88mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.2；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.21mmolL；磷(P)-静脉血: 1.13mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.3；血红蛋白(Hb)-静脉血: 141g/L；总蛋白(TP)-静脉血: 66g/L；镁离子(Mg2+)-静脉血: 0.85mmol/L\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D77] 检验组合: 总胆红素(TBIL)-静脉血: 9.1umol/L；血小板分布宽度(PDW)-静脉血: 10.7%；乳酸脱氢酶(LDH)-静脉血: 184.4U/L；直接胆红素(DBIL)-静脉血: 2.92umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.9mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 24U/L；总胆固醇(TC)-静脉血: 4.36mmol/L；平均血小板体积(MPV)-静脉血: 9.7fL；白细胞计数(WBC#)-静脉血: 6.0610E9/L；氯离子(Cl-)-静脉血: 97.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 9.2U/L；阴离子间隙(AG)-静脉血: 15.2；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞计数(RBC#)-静脉血: 4.0510E12/L；总胆汁酸(TBA)-静脉血: 1.1umol/L；C-反应蛋白(CRP)-静脉血: 6.66mg/L；磷(P)-静脉血: 1.11mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.012；中性粒细胞百分比(Neut%)-静脉血: 0.799；淋巴细胞计数(Lymph#)-静脉血: 0.410E9/L；总钙(Ca)-静脉血: 2.14mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.03mmol/L；球蛋白(GLO)-静脉血: 22g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.99mmolL；淋巴细胞百分比(Lymph%)-静脉血: 0.064；血小板计数(PLT#)-静脉血: 12010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.2；钾离子(K+)-静脉血: 3.15mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.09；碱性磷酸酶(ALP)-静脉血: 49.9U/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 44.5umol/L；中性粒细胞计数(Neut#)-静脉血: 4.810E9/L；间接胆红素(IBIL)-静脉血: 6.18umolL；尿素氮(BUN)-静脉血: 5.3mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.7；天门冬氨酸氨基转移酶(AST)-静脉血: 10U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.73；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；尿酸(UA)-静脉血: 198umol/L；葡萄糖(Glu)-静脉血: 4.85mmol/L；甘油三酯(TG)-静脉血: 0.9mmol/L；白蛋白(ALB)-静脉血: 38g/L；总蛋白(TP)-静脉血: 60g/L\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D79] 超声；双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 双肾大小形态正常，右肾探及几个无回声灶，大者约16×13mm，边界清，内透声可，后方回声增强。左肾实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确肿物回声。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。；检查结论: 右肾多发囊性灶，考虑肾囊肿。 左肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位性病变。\n- [全程D80] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌放疗后，对比某次就诊时间日MR： 鼻咽腔狭窄，鼻咽顶壁、顶后壁、右侧壁明显增厚，并见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化，肿物占据右侧咽隐窝。鼻咽左侧壁未见增厚，左侧咽隐窝正常，左侧咽旁及颈动脉鞘区未见异常。双侧鼻腔及口咽各壁未见异常。 右侧腭帆张提肌、右侧头长肌及右侧翼内肌受侵，病变包绕右侧颈内动静脉。 左侧腭帆提肌、腭帆张肌、头长肌未见受侵征象。 双侧翼腭窝、颞下窝未见异常；口咽侧壁未见增厚。 蝶骨基底部右份及右侧翼突基底部内侧、右侧翼突内板骨质信号减低，增强扫描不均匀强化。余颅底骨质未见明确异常。双侧海绵窦形态正常，未见增宽。 双侧筛窦、上颌窦、蝶窦及双侧乳突粘膜增厚，可见大量分泌物，骨壁完整；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 右侧咽后见多个肿大淋巴结，最大者短径9mm，增强后明显强化，融合。左侧咽后及双颈II区见多发小淋巴结，最大者短径约7mm，未见坏死及包膜外侵。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺左叶见一结节，大小约11mm×11mm，边界尚清， T1WI及T2WI均呈混杂高信号，增强扫描部分区域强化较明显。甲状腺右叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。；检查结论: 鼻咽癌放疗后，右侧咽旁见肿瘤残留，病变范围较前缩小。 颅底骨质破坏，范围大致同前。 右侧咽后肿大淋巴结，考虑转移，较前缩小。 左侧咽后及双颈II区小淋巴结，较前未见明显变化。 鼻窦炎；乳突炎，较前明显。 甲状腺左叶结节灶，大致同前。\n- [全程D80] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理稍粗，走行自然，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显病变。\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D66] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者诉恶心，食欲差，于未诉特殊不适，查体基本同前。患者第二程DDP同时期化疗。予加强止呕及营养支持治疗，防治放化毒副反应。续观。\n- [全程D70] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者诉恶心，进食差，余未诉特殊不适，查体基本同前。今日上级医师信息已隐藏后示：患者已完成第二程DDP同时期化疗，予加强营养支持治疗。一般情况平稳，嘱今日补液结束后出院，于门诊继续放疗。按期返院继续治疗。遵嘱。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 疗效评估为疾病进展（PD），终止放化疗计划，改行鼻咽及颈部挽救性手术切除。\nB. 疗效评估为疾病进展（PD），停用顺铂，更改化疗方案为吉西他滨联合氟尿嘧啶并继续放疗。\nC. 疗效评估为部分缓解（PR），继续完成根治性放疗，对鼻咽及颈部残留病灶局部加量至76Gy。\nD. 疗效评估为部分缓解（PR），继续完成根治性放疗，取消后续化疗计划，仅予口服补钾与营养支持。\nE. 疗效评估为部分缓解（PR），继续完成根治性放疗及既定化疗计划，并加用尼妥珠单抗靶向治疗。\nF. 疗效评估为完全缓解（CR），提前终止放疗与化疗，拔除静脉通道，转入定期门诊随访观察阶段。\nG. 疗效评估为部分缓解（PR），继续完成根治性放疗，并行局部清扫术，处理右侧咽旁及咽后残留病灶。\nH. 疗效评估为疾病稳定（SD），继续放疗，并联合PD-1抑制剂以增强局部控制与全身抗肿瘤反应。\nI. 疗效评估为部分缓解（PR），暂停放疗优先纠正低钾血症与营养不良，待电解质完全恢复后重启放疗。\nJ. 疗效评估为部分缓解（PR），继续完成根治性放疗及既定化疗计划，无需特殊支持治疗，定期复查即可。\nK. 疗效评估为部分缓解（PR），继续完成根治性放疗及既定化疗计划，并加强静脉营养支持与补钾等对症处理。\nL. 疗效评估为疾病稳定（SD），继续完成根治性放疗，将后续化疗方案调整为紫杉醇联合卡铂以克服耐药。\n\n请仅输出一个选项字母（A-L）。","gold_letter":"K","gold_action":"疗效评估为部分缓解（PR），继续完成根治性放疗及既定化疗计划，并加强静脉营养支持与补钾等对症处理。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"疗效评估为疾病进展（PD），终止放化疗计划，改行鼻咽及颈部挽救性手术切除。"},{"letter":"B","text":"疗效评估为疾病进展（PD），停用顺铂，更改化疗方案为吉西他滨联合氟尿嘧啶并继续放疗。"},{"letter":"C","text":"疗效评估为部分缓解（PR），继续完成根治性放疗，对鼻咽及颈部残留病灶局部加量至76Gy。"},{"letter":"D","text":"疗效评估为部分缓解（PR），继续完成根治性放疗，取消后续化疗计划，仅予口服补钾与营养支持。"},{"letter":"E","text":"疗效评估为部分缓解（PR），继续完成根治性放疗及既定化疗计划，并加用尼妥珠单抗靶向治疗。"},{"letter":"F","text":"疗效评估为完全缓解（CR），提前终止放疗与化疗，拔除静脉通道，转入定期门诊随访观察阶段。"},{"letter":"G","text":"疗效评估为部分缓解（PR），继续完成根治性放疗，并行局部清扫术，处理右侧咽旁及咽后残留病灶。"},{"letter":"H","text":"疗效评估为疾病稳定（SD），继续放疗，并联合PD-1抑制剂以增强局部控制与全身抗肿瘤反应。"},{"letter":"I","text":"疗效评估为部分缓解（PR），暂停放疗优先纠正低钾血症与营养不良，待电解质完全恢复后重启放疗。"},{"letter":"J","text":"疗效评估为部分缓解（PR），继续完成根治性放疗及既定化疗计划，无需特殊支持治疗，定期复查即可。"},{"letter":"K","text":"疗效评估为部分缓解（PR），继续完成根治性放疗及既定化疗计划，并加强静脉营养支持与补钾等对症处理。"},{"letter":"L","text":"疗效评估为疾病稳定（SD），继续完成根治性放疗，将后续化疗方案调整为紫杉醇联合卡铂以克服耐药。"}]}
+{"sample_id":"sample-7a40e0f2bd95183560f7b041","patient_id":"patient-eecadcdf172a1efe8947b052","turn_id":"turn01","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D7] 入院记录: 主诉: 头痛伴耳鸣、听力下降3月余。；颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。今患者为进一步诊治，予收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,双咽后淋巴结肿大,头痛；既往史: 否认\"乙肝、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认饮酒史。否认不洁性生活史。；家族史: 患者叔叔因肺癌死亡。；体格检查: T：36.2℃，P：82次/分，R：20次/分，BP：128/74mmHg,Ht：172cm，Wt：80kg，BSA：1.92m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无叩痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约1cm*0.8cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 直接安排根治性同步放化疗，暂缓病理活检及血液学检查\nB. 行鼻咽及颈部增强CT评估局部病变，暂缓病理活检及血液学检查\nC. 行颈部淋巴结切除活检明确病理，并完善全身PET-CT及基线血液学检查\nD. 行鼻咽镜下活检明确病理，并直接开始诱导化疗，暂缓基线血液学检查\nE. 抽血查EBV-DNA及肿瘤标志物，若阳性则直接开始根治性放疗\nF. 行全身骨扫描及头颅增强MRI，待排除远处转移后再行鼻咽局部活检\nG. 行鼻咽镜下活检明确病理，并预防性行双侧颈部淋巴结清扫术\nH. 行鼻咽镜下活检明确病理，并抽血查血常规、生化、EBV-DNA等基线指标\nI. 行鼻咽脱落细胞学检查明确病理，并抽血查血常规、生化、EBV-DNA等基线指标\nJ. 行胸腹部增强CT及全身骨扫描，待排除远处转移后再行鼻咽活检及血液学检查\nK. 行鼻咽镜下活检明确病理，并立即给予大剂量甲氨蝶呤静脉化疗\nL. 行颈部淋巴结细针穿刺活检明确病理，并抽血查血常规、生化、EBV-DNA等基线指标\n\n请仅输出一个选项字母（A-L）。","gold_letter":"H","gold_action":"行鼻咽镜下活检明确病理，并抽血查血常规、生化、EBV-DNA等基线指标","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"直接安排根治性同步放化疗，暂缓病理活检及血液学检查"},{"letter":"B","text":"行鼻咽及颈部增强CT评估局部病变，暂缓病理活检及血液学检查"},{"letter":"C","text":"行颈部淋巴结切除活检明确病理，并完善全身PET-CT及基线血液学检查"},{"letter":"D","text":"行鼻咽镜下活检明确病理，并直接开始诱导化疗，暂缓基线血液学检查"},{"letter":"E","text":"抽血查EBV-DNA及肿瘤标志物，若阳性则直接开始根治性放疗"},{"letter":"F","text":"行全身骨扫描及头颅增强MRI，待排除远处转移后再行鼻咽局部活检"},{"letter":"G","text":"行鼻咽镜下活检明确病理，并预防性行双侧颈部淋巴结清扫术"},{"letter":"H","text":"行鼻咽镜下活检明确病理，并抽血查血常规、生化、EBV-DNA等基线指标"},{"letter":"I","text":"行鼻咽脱落细胞学检查明确病理，并抽血查血常规、生化、EBV-DNA等基线指标"},{"letter":"J","text":"行胸腹部增强CT及全身骨扫描，待排除远处转移后再行鼻咽活检及血液学检查"},{"letter":"K","text":"行鼻咽镜下活检明确病理，并立即给予大剂量甲氨蝶呤静脉化疗"},{"letter":"L","text":"行颈部淋巴结细针穿刺活检明确病理，并抽血查血常规、生化、EBV-DNA等基线指标"}]}
+{"sample_id":"sample-fd63f0707132f4eb9174ab3e","patient_id":"patient-eecadcdf172a1efe8947b052","turn_id":"turn02","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- 暂无可展示的初诊主诉/入院资料。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 早期复极改变\n- [全程D0] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.6；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:20（参考: 阴性）；活化部分凝血活酶时间(APTT)-静脉血: 23.1sec.；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；血红蛋白(Hb)-静脉血: 158g/L；血小板比容-静脉血: 26%；氯离子(Cl-)-静脉血: 105.3mmol/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 1.04；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；尿酸(UA)-静脉血: 341umol/L；甘油三酯(TG)-静脉血: 1.27mmol/L；总蛋白(TP)-静脉血: 73.53g/L；尿素氮(BUN)-静脉血: 6.35mmol/L；C-反应蛋白(CRP)-静脉血: 1.45mg/L；载脂蛋白B(apoB)-静脉血: 0.8g/L；总胆汁酸(TBA)-静脉血: 4.7umol/L；葡萄糖(Glu)-静脉血: 4.78mmol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；乳酸脱氢酶(LDH)-静脉血: 160.3U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；大血小板百分比(P-LCR%)-静脉血: 30.4%；中性粒细胞计数(Neut#)-静脉血: 6.410E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；丙氨酸氨基转移酶(ALT)-静脉血: 12.1U/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；ABO血型-静脉血: B；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.7fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；球蛋白(GLO)-静脉血: 28.23g/L；凝血酶时间(TT)-静脉血: 17.5sec.；红细胞计数(RBC#)-静脉血: 5.3710E12/L；平均红细胞体积(MCV)-静脉血: 87fL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.17mmolL；磷(P)-静脉血: 1.03mmol/L；总钙(Ca)-静脉血: 2.36mmol/L；单核细胞百分比(Mono%)-静脉血: 0.076；血小板分布宽度(PDW)-静脉血: 13.5%；血液二氧化碳含量ctCO2(B)-静脉血: 22.8mmol/L；总胆固醇(TC)-静脉血: 4.65mmol/L；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 4.5mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.1；胱抑素(Cys-C)-静脉血: 1.06mg/L\n- [全程D3] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理稍粗，未见明确实质性病变。双侧肺门不大，纵隔居中、无增宽。双膈形态正常。双侧肋膈角锐利。心影形态、大小、位置未见异常。；检查结论: 心肺未见明显异常。\n- [全程D3] 超声；双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约11cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约37×31×26mm，包膜光滑，实质回声不均匀，可见强回声斑。 腹主动脉旁未见明确肿物回声。；检查结论: 前列腺钙化。 肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、左侧壁见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强后明显强化，肿物占据鼻咽顶壁、左侧咽隐窝、左侧咽后间隙，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，右侧咽隐窝变浅，右侧咽旁脂肪间隙及颈动脉鞘区未见异常。 左侧腭帆张提肌及左侧头长肌受侵，右侧腭帆提肌、腭帆张肌、头长肌未见受侵征象。 双侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽双侧壁未见增厚。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部、翼突内外板、左侧枕骨基底部及左侧枕骨髁骨质信号减低，增强扫描后明显强化，斜坡局部见不规则软组织肿物影累及斜坡后份脑膜及蝶鞍后份，部分层面与垂体后叶分界欠清。双侧海绵窦形态正常，未见增宽。筛窦、蝶窦、左侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 左侧咽后间隙见肿大淋巴结，大小约为11mm ×9 mm，右侧咽后见肿大淋巴结，短径约6mm，均匀强化。 双颈I、II区见多个淋巴结，边界清，信号均匀，最大短径约8mm，均匀强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。 颅底骨质破坏。 双侧咽后淋巴结肿大，考虑转移。 双颈Ib、II区小淋巴结，性质待定。 副鼻窦炎、左侧乳突炎。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 明确临床分期为T3N1M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。\nB. 明确临床分期为T4N2M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。\nC. 明确临床分期为T4N1M0，并直接安排鼻咽及颈部根治性放疗，暂不留置静脉导管。\nD. 明确临床分期为T4N1M0，并安排全身PET-CT以进一步明确双颈部淋巴结性质。\nE. 明确临床分期为T4N0M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。\nF. 明确临床分期为T3N2M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。\nG. 明确临床分期为T4N1M0，并安排垂体MRI动态增强扫描以明确垂体受累情况。\nH. 明确临床分期为T4N1M0，并安排颈部淋巴结穿刺活检以明确N分期。\nI. 明确临床分期为T4N1M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。\nJ. 明确临床分期为T4N1M0，并安排骨扫描及头颅CT以排除远处转移。\nK. 明确临床分期为T4N1M0，并安排鼻咽肿物再次活检以进行EBV相关基因检测。\nL. 明确临床分期为T4N1M0，并留置CVC导管及行胸部CT确认管端位置，为后续静脉给药做准备。\n\n请仅输出一个选项字母（A-L）。","gold_letter":"I","gold_action":"明确临床分期为T4N1M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"明确临床分期为T3N1M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。"},{"letter":"B","text":"明确临床分期为T4N2M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。"},{"letter":"C","text":"明确临床分期为T4N1M0，并直接安排鼻咽及颈部根治性放疗，暂不留置静脉导管。"},{"letter":"D","text":"明确临床分期为T4N1M0，并安排全身PET-CT以进一步明确双颈部淋巴结性质。"},{"letter":"E","text":"明确临床分期为T4N0M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。"},{"letter":"F","text":"明确临床分期为T3N2M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。"},{"letter":"G","text":"明确临床分期为T4N1M0，并安排垂体MRI动态增强扫描以明确垂体受累情况。"},{"letter":"H","text":"明确临床分期为T4N1M0，并安排颈部淋巴结穿刺活检以明确N分期。"},{"letter":"I","text":"明确临床分期为T4N1M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。"},{"letter":"J","text":"明确临床分期为T4N1M0，并安排骨扫描及头颅CT以排除远处转移。"},{"letter":"K","text":"明确临床分期为T4N1M0，并安排鼻咽肿物再次活检以进行EBV相关基因检测。"},{"letter":"L","text":"明确临床分期为T4N1M0，并留置CVC导管及行胸部CT确认管端位置，为后续静脉给药做准备。"}]}
+{"sample_id":"sample-32fca5d8e1da4de5e54c5c0b","patient_id":"patient-290a042206ccfe67e72f9a19","turn_id":"turn01","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现颈部肿物1月余；当地诊断：鼻咽癌。于某次就诊时间在[机构已隐去]行力扑素270mgd1+奈达铂120mgd1+泰欣生200mgd1化疗一程，化疗后出现四度中性粒细胞减少，无发热、腹泻、寒战等，予升白处理后中性粒细胞恢复。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物,中性粒细胞减少,颈部肿物；既往史: 颈椎病史10年，既往有慢性肠炎病史。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：362.℃，P：100次/分，R：20次/分，BP：126/74mmHg,Ht：168cm，Wt：63kg，BSA：1.72m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；双侧颈部IIa区各可扪及1个淋巴结，左颈2×3cm，右颈2×2cm,无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行电子鼻咽镜检查（不活检），并完善鼻咽及颈部CT平扫+增强，常规心电图检查\nB. 行颈部淋巴结切除活检，并完善鼻咽及颈部MRI平扫+增强，常规心电图检查\nC. 行电子鼻咽镜检查及活检，并完善鼻咽及颈部MRI平扫（不增强），常规心电图检查\nD. 行电子鼻咽镜检查及活检，并完善鼻咽及颈部MRI平扫+增强，常规心电图检查\nE. 行电子鼻咽镜检查及活检，并完善鼻咽MRI平扫+增强，暂缓颈部影像学检查\nF. 直接行全身PET-CT检查，暂缓电子鼻咽镜及活检与局部MRI\nG. 行电子鼻咽镜检查及活检，并完善胸部及腹部CT平扫+增强，暂缓头颈部MRI\nH. 行鼻咽及颈部MRI平扫+增强，常规心电图检查，暂缓鼻咽镜检查及活检\nI. 行电子鼻咽镜检查及活检，并完善鼻咽及颈部CT平扫，常规心电图检查\nJ. 行颈部淋巴结穿刺活检，并完善鼻咽及颈部MRI平扫+增强，常规心电图检查\nK. 行电子鼻咽镜检查（不活检），并完善全身PET-CT检查，常规心电图检查\nL. 行电子鼻咽镜检查及活检，并完善鼻咽及颈部超声检查，常规心电图检查\n\n请仅输出一个选项字母（A-L）。","gold_letter":"D","gold_action":"行电子鼻咽镜检查及活检，并完善鼻咽及颈部MRI平扫+增强，常规心电图检查","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"行电子鼻咽镜检查（不活检），并完善鼻咽及颈部CT平扫+增强，常规心电图检查"},{"letter":"B","text":"行颈部淋巴结切除活检，并完善鼻咽及颈部MRI平扫+增强，常规心电图检查"},{"letter":"C","text":"行电子鼻咽镜检查及活检，并完善鼻咽及颈部MRI平扫（不增强），常规心电图检查"},{"letter":"D","text":"行电子鼻咽镜检查及活检，并完善鼻咽及颈部MRI平扫+增强，常规心电图检查"},{"letter":"E","text":"行电子鼻咽镜检查及活检，并完善鼻咽MRI平扫+增强，暂缓颈部影像学检查"},{"letter":"F","text":"直接行全身PET-CT检查，暂缓电子鼻咽镜及活检与局部MRI"},{"letter":"G","text":"行电子鼻咽镜检查及活检，并完善胸部及腹部CT平扫+增强，暂缓头颈部MRI"},{"letter":"H","text":"行鼻咽及颈部MRI平扫+增强，常规心电图检查，暂缓鼻咽镜检查及活检"},{"letter":"I","text":"行电子鼻咽镜检查及活检，并完善鼻咽及颈部CT平扫，常规心电图检查"},{"letter":"J","text":"行颈部淋巴结穿刺活检，并完善鼻咽及颈部MRI平扫+增强，常规心电图检查"},{"letter":"K","text":"行电子鼻咽镜检查（不活检），并完善全身PET-CT检查，常规心电图检查"},{"letter":"L","text":"行电子鼻咽镜检查及活检，并完善鼻咽及颈部超声检查，常规心电图检查"}]}
+{"sample_id":"sample-95b51d663e429afb86c572e7","patient_id":"patient-290a042206ccfe67e72f9a19","turn_id":"turn02","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现颈部肿物1月余；当地诊断：鼻咽癌。于某次就诊时间在[机构已隐去]行力扑素270mgd1+奈达铂120mgd1+泰欣生200mgd1化疗一程，化疗后出现四度中性粒细胞减少，无发热、腹泻、寒战等，予升白处理后中性粒细胞恢复。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物,中性粒细胞减少,颈部肿物；既往史: 颈椎病史10年，既往有慢性肠炎病史。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：362.℃，P：100次/分，R：20次/分，BP：126/74mmHg,Ht：168cm，Wt：63kg，BSA：1.72m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；双侧颈部IIa区各可扪及1个淋巴结，左颈2×3cm，右颈2×2cm,无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 电轴左偏(轻度) 心电图大致正常\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1] 检验组合: 纤维蛋白原降解产物(FDP)-静脉血: 2ug/ml；平均红细胞体积(MCV)-静脉血: 93.5fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6；甘油三酯(TG)-静脉血: 2.17mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 51.4U/L；胱抑素(Cys-C)-静脉血: 0.91mg/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.08COI；总钙(Ca)-静脉血: 2.24mmol/L；淋巴细胞计数(Lymph#)-静脉血: 2.610E9/L；葡萄糖(Glu)-静脉血: 5.18mmol/L；球蛋白(GLO)-静脉血: 26.59g/L；有核红细胞计数(NRBC#)-静脉血: 0.0410E9/L；平均血小板体积(MPV)-静脉血: 9.5fL；大血小板百分比(P-LCR%)-静脉血: 20.5%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.003；红细胞计数(RBC#)-静脉血: 4.1410E12/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.07S/CO；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.55mmol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0IU/mL；血小板分布宽度(PDW)-静脉血: 9.8%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.014；载脂蛋白B(apoB)-静脉血: 0.91g/L；C-反应蛋白(CRP)-静脉血: 2.8mg/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；镁离子(Mg2+)-静脉血: 0.83mmol/L；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；肌酐(Crea)-静脉血: 77umol/L；钾离子(K+)-静脉血: 4mmol/L；白蛋白(ALB)-静脉血: 40.9g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；凝血酶原时间活动度(PTA)-静脉血: 90.4%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.54；阴离子间隙(AG)-静脉血: 12；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 3.2umolL；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.6；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 38U/L；总胆固醇(TC)-静脉血: 4.73mmol/L；碱性磷酸酶(ALP)-静脉血: 66.7U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 32.4U/L；有核红细胞百分比(NRBC%)-静脉血: 0.6\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 行鼻咽镜下重新活检，完善胸部CT、腹部超声及全身骨扫描，检测血浆EBV DNA\nB. 行外院疑难病理会诊，完善胸部CT、腹部超声，暂缓全身骨扫描，检测血浆EBV DNA\nC. 沿用外院病理诊断，完善PET/CT全身显像及血浆EBV DNA检测\nD. 行外院疑难病理会诊，完善胸部增强CT及腹部增强CT，暂缓全身骨扫描\nE. 行外院疑难病理会诊，完善PET/CT全身显像及血浆EBV DNA检测\nF. 行鼻咽镜下重新活检，完善PET/CT全身显像及血浆EBV DNA检测\nG. 行外院疑难病理会诊，完善PET/CT全身显像，暂缓血浆EBV DNA检测\nH. 行外院疑难病理会诊，完善胸部CT及腹部CT，暂缓全身骨扫描及血浆EBV DNA检测\nI. 沿用外院病理诊断，完善PET/CT全身显像，暂缓血浆EBV DNA检测\nJ. 行外院疑难病理会诊，完善头颈部局部PET/CT及血浆EBV DNA检测\nK. 行鼻咽镜下重新活检，完善胸部CT及腹部CT，暂缓血浆EBV DNA检测\n\n请仅输出一个选项字母（A-K）。","gold_letter":"E","gold_action":"行外院疑难病理会诊，完善PET/CT全身显像及血浆EBV DNA检测","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"行鼻咽镜下重新活检，完善胸部CT、腹部超声及全身骨扫描，检测血浆EBV DNA"},{"letter":"B","text":"行外院疑难病理会诊，完善胸部CT、腹部超声，暂缓全身骨扫描，检测血浆EBV DNA"},{"letter":"C","text":"沿用外院病理诊断，完善PET/CT全身显像及血浆EBV DNA检测"},{"letter":"D","text":"行外院疑难病理会诊，完善胸部增强CT及腹部增强CT，暂缓全身骨扫描"},{"letter":"E","text":"行外院疑难病理会诊，完善PET/CT全身显像及血浆EBV DNA检测"},{"letter":"F","text":"行鼻咽镜下重新活检，完善PET/CT全身显像及血浆EBV DNA检测"},{"letter":"G","text":"行外院疑难病理会诊，完善PET/CT全身显像，暂缓血浆EBV DNA检测"},{"letter":"H","text":"行外院疑难病理会诊，完善胸部CT及腹部CT，暂缓全身骨扫描及血浆EBV DNA检测"},{"letter":"I","text":"沿用外院病理诊断，完善PET/CT全身显像，暂缓血浆EBV DNA检测"},{"letter":"J","text":"行外院疑难病理会诊，完善头颈部局部PET/CT及血浆EBV DNA检测"},{"letter":"K","text":"行鼻咽镜下重新活检，完善胸部CT及腹部CT，暂缓血浆EBV DNA检测"}]}
+{"sample_id":"sample-ac55ce5273aeb2587f3051e7","patient_id":"patient-290a042206ccfe67e72f9a19","turn_id":"turn05","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 电轴左偏(轻度) 心电图大致正常\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1] 检验组合: 纤维蛋白原降解产物(FDP)-静脉血: 2ug/ml；平均红细胞体积(MCV)-静脉血: 93.5fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6；甘油三酯(TG)-静脉血: 2.17mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 51.4U/L；胱抑素(Cys-C)-静脉血: 0.91mg/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.08COI；总钙(Ca)-静脉血: 2.24mmol/L；淋巴细胞计数(Lymph#)-静脉血: 2.610E9/L；葡萄糖(Glu)-静脉血: 5.18mmol/L；球蛋白(GLO)-静脉血: 26.59g/L；有核红细胞计数(NRBC#)-静脉血: 0.0410E9/L；平均血小板体积(MPV)-静脉血: 9.5fL；大血小板百分比(P-LCR%)-静脉血: 20.5%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.003；红细胞计数(RBC#)-静脉血: 4.1410E12/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.07S/CO；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.55mmol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0IU/mL；血小板分布宽度(PDW)-静脉血: 9.8%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.014；载脂蛋白B(apoB)-静脉血: 0.91g/L；C-反应蛋白(CRP)-静脉血: 2.8mg/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；镁离子(Mg2+)-静脉血: 0.83mmol/L；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；肌酐(Crea)-静脉血: 77umol/L；钾离子(K+)-静脉血: 4mmol/L；白蛋白(ALB)-静脉血: 40.9g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；凝血酶原时间活动度(PTA)-静脉血: 90.4%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.54；阴离子间隙(AG)-静脉血: 12；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 3.2umolL；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.6；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 38U/L；总胆固醇(TC)-静脉血: 4.73mmol/L；碱性磷酸酶(ALP)-静脉血: 66.7U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 32.4U/L；有核红细胞百分比(NRBC%)-静脉血: 0.6\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D8] 检验组合: 单核细胞百分比(Mono%)-静脉血: 0.065；血红蛋白(Hb)-静脉血: 129g/L；淋巴细胞计数(Lymph#)-静脉血: 2.110E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；大血小板百分比(P-LCR%)-静脉血: 22%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.013；平均红细胞体积(MCV)-静脉血: 93.8fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.2；红细胞比容(Hct)-静脉血: 39.2%；中性粒细胞百分比(Neut%)-静脉血: 0.53；单核细胞计数(Mono#)-静脉血: 0.410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；白细胞计数(WBC#)-静脉血: 5.3910E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血小板分布宽度(PDW)-静脉血: 10.3%；平均红细胞血红蛋白含量(MCH)-静脉血: 30.9pg；血小板计数(PLT#)-静脉血: 14810E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.8；淋巴细胞百分比(Lymph%)-静脉血: 0.39；有核红细胞计数(NRBC#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.002；血小板比容-静脉血: 14%；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；红细胞计数(RBC#)-静脉血: 4.1810E12/L；平均血小板体积(MPV)-静脉血: 9.7fL；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L\n- [全程D9] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: 输液港走行于右锁骨下静脉，导管末端位于脊柱右旁T6椎体下缘水平，估计位于上腔静脉上段。；检查结论: 导管末端位置如上述。\n- [全程D9] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；非鳞状上皮细胞计数-尿液: 1/μL；颜色-尿液: Light-Yellow；粘液丝计数(MUCS#)-尿液: 5/μL；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-尿液: colorless；比重(SG)-尿液: 1.013；白细胞(LEU)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；白细胞(LEU)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 1/μL；酸碱度(pH)-尿液: 6.5；浊度(TRUB)-尿液: clear；比重(SG)-尿液: 1.016；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D10] 检验组合: 红细胞计数(RBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 6；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 7/μL；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.017；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 1/μL；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow\n- [全程D14] 检验组合: 总胆固醇(TC)-静脉血: 5.88mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜碱性粒细胞百分比(Baso%)-静脉血: 0；单核细胞百分比(Mono%)-静脉血: 0.008；丙氨酸氨基转移酶(ALT)-静脉血: 65.5U/L；血小板分布宽度(PDW)-静脉血: 13.8%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.9；白蛋白(ALB)-静脉血: 42.5g/L；球蛋白(GLO)-静脉血: 26g/L；胱抑素(Cys-C)-静脉血: 1.11mg/L；总蛋白(TP)-静脉血: 68.5g/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.7mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞计数(RBC#)-静脉血: 4.4510E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；总胆红素(TBIL)-静脉血: 15.4umol/L；钾离子(K+)-静脉血: 4.03mmol/L；葡萄糖(Glu)-静脉血: 5.74mmol/L；乳酸脱氢酶(LDH)-静脉血: 175U/L；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；肌酐(Crea)-静脉血: 80umol/L；总钙(Ca)-静脉血: 2.18mmol/L；钠离子(Na+)-静脉血: 132.2mmol/L；大血小板百分比(P-LCR%)-静脉血: 34.4%；红细胞比容(Hct)-静脉血: 39.3%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；阴离子间隙(AG)-静脉血: 17.8；γ-谷氨酰基转移酶(GGT)-静脉血: 26.8U/L；白细胞计数(WBC#)-静脉血: 5.2310E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.83mmol/L；平均血小板体积(MPV)-静脉血: 11.2fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.01；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.51mmolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.35；碱性磷酸酶(ALP)-静脉血: 57.4U/L；直接胆红素(DBIL)-静脉血: 4.1umol/L；镁离子(Mg2+)-静脉血: 0.93mmol/L；血红蛋白(Hb)-静脉血: 138g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.7；中性粒细胞计数(Neut#)-静脉血: 410E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 35.1U/L；C-反应蛋白(CRP)-静脉血: 3.09mg/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 351g/L；间接胆红素(IBIL)-静脉血: 11.3umolL\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者各项检查继续完善中。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D10] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者第1程多西紫杉醇＋DDP+5-FU方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。上级医师信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 予以短效重组人粒细胞刺激因子（rhG-CSF）皮下注射，暂不予口服保肝药物治疗，并复查血常规及生化后继续住院观察。\nB. 暂不予粒细胞集落刺激因子预防，仅口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。\nC. 予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，静脉滴注头孢菌素预防感染，并复查血常规及生化后安排出院。\nD. 予以短效重组人粒细胞刺激因子（rhG-CSF）皮下注射，静脉滴注异甘草酸镁强效保肝，并复查血常规及生化后继续住院观察。\nE. 暂不予粒细胞集落刺激因子预防，暂不予口服保肝药物治疗，直接安排出院并嘱院外定期复查血常规及生化。\nF. 予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，口服恩替卡韦抗病毒治疗，并复查血常规及生化后安排出院。\nG. 予以短效重组人粒细胞刺激因子（rhG-CSF）皮下注射，口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。\nH. 予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。\nI. 予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，暂不予口服保肝药物治疗，并复查血常规及生化后安排出院。\nJ. 予以重组人促血小板生成素（rhTPO）皮下注射，口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。\nK. 予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，静脉滴注还原型谷胱甘肽保肝，并复查血常规及生化后继续住院观察。\nL. 暂不予任何药物处理，直接安排出院，嘱院外定期复查血常规及生化，若出现发热再返院使用粒细胞集落刺激因子。\n\n请仅输出一个选项字母（A-L）。","gold_letter":"I","gold_action":"予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，暂不予口服保肝药物治疗，并复查血常规及生化后安排出院。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"予以短效重组人粒细胞刺激因子（rhG-CSF）皮下注射，暂不予口服保肝药物治疗，并复查血常规及生化后继续住院观察。"},{"letter":"B","text":"暂不予粒细胞集落刺激因子预防，仅口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。"},{"letter":"C","text":"予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，静脉滴注头孢菌素预防感染，并复查血常规及生化后安排出院。"},{"letter":"D","text":"予以短效重组人粒细胞刺激因子（rhG-CSF）皮下注射，静脉滴注异甘草酸镁强效保肝，并复查血常规及生化后继续住院观察。"},{"letter":"E","text":"暂不予粒细胞集落刺激因子预防，暂不予口服保肝药物治疗，直接安排出院并嘱院外定期复查血常规及生化。"},{"letter":"F","text":"予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，口服恩替卡韦抗病毒治疗，并复查血常规及生化后安排出院。"},{"letter":"G","text":"予以短效重组人粒细胞刺激因子（rhG-CSF）皮下注射，口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。"},{"letter":"H","text":"予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。"},{"letter":"I","text":"予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，暂不予口服保肝药物治疗，并复查血常规及生化后安排出院。"},{"letter":"J","text":"予以重组人促血小板生成素（rhTPO）皮下注射，口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。"},{"letter":"K","text":"予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，静脉滴注还原型谷胱甘肽保肝，并复查血常规及生化后继续住院观察。"},{"letter":"L","text":"暂不予任何药物处理，直接安排出院，嘱院外定期复查血常规及生化，若出现发热再返院使用粒细胞集落刺激因子。"}]}
+{"sample_id":"sample-6d1ca43d48e1d74031505487","patient_id":"patient-290a042206ccfe67e72f9a19","turn_id":"turn07","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 电轴左偏(轻度) 心电图大致正常\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D14] 检验组合: 总胆固醇(TC)-静脉血: 5.88mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜碱性粒细胞百分比(Baso%)-静脉血: 0；单核细胞百分比(Mono%)-静脉血: 0.008；丙氨酸氨基转移酶(ALT)-静脉血: 65.5U/L；血小板分布宽度(PDW)-静脉血: 13.8%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.9；白蛋白(ALB)-静脉血: 42.5g/L；球蛋白(GLO)-静脉血: 26g/L；胱抑素(Cys-C)-静脉血: 1.11mg/L；总蛋白(TP)-静脉血: 68.5g/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.7mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞计数(RBC#)-静脉血: 4.4510E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；总胆红素(TBIL)-静脉血: 15.4umol/L；钾离子(K+)-静脉血: 4.03mmol/L；葡萄糖(Glu)-静脉血: 5.74mmol/L；乳酸脱氢酶(LDH)-静脉血: 175U/L；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；肌酐(Crea)-静脉血: 80umol/L；总钙(Ca)-静脉血: 2.18mmol/L；钠离子(Na+)-静脉血: 132.2mmol/L；大血小板百分比(P-LCR%)-静脉血: 34.4%；红细胞比容(Hct)-静脉血: 39.3%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；阴离子间隙(AG)-静脉血: 17.8；γ-谷氨酰基转移酶(GGT)-静脉血: 26.8U/L；白细胞计数(WBC#)-静脉血: 5.2310E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.83mmol/L；平均血小板体积(MPV)-静脉血: 11.2fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.01；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.51mmolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.35；碱性磷酸酶(ALP)-静脉血: 57.4U/L；直接胆红素(DBIL)-静脉血: 4.1umol/L；镁离子(Mg2+)-静脉血: 0.93mmol/L；血红蛋白(Hb)-静脉血: 138g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.7；中性粒细胞计数(Neut#)-静脉血: 410E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 35.1U/L；C-反应蛋白(CRP)-静脉血: 3.09mg/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 351g/L；间接胆红素(IBIL)-静脉血: 11.3umolL\n- [全程D29] 检验组合: γ-谷氨酰基转移酶(GGT)-静脉血: 24.3U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.69；中性粒细胞计数(Neut#)-静脉血: 5.710E9/L；载脂蛋白AI(apoAI)-静脉血: 1.44g/L；血红蛋白(Hb)-静脉血: 117g/L；总胆固醇(TC)-静脉血: 5.21mmol/L；血小板分布宽度(PDW)-静脉血: 9.2%；乳酸脱氢酶(LDH)-静脉血: 181.3U/L；总胆汁酸(TBA)-静脉血: 3.1umol/L；直接胆红素(DBIL)-静脉血: 2umol/L；白蛋白(ALB)-静脉血: 39.2g/L；总胆红素(TBIL)-静脉血: 7.9umol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；平均红细胞体积(MCV)-静脉血: 92.9fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.647；C-反应蛋白(CRP)-静脉血: 1.01mg/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.3；红细胞计数(RBC#)-静脉血: 3.9410E12/L；白细胞计数(WBC#)-静脉血: 8.7310E9/L；肌酐(Crea)-静脉血: 102.7umol/L；钠离子(Na+)-静脉血: 141.8mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.56；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.32mmolL；总钙(Ca)-静脉血: 2.29mmol/L；胱抑素(Cys-C)-静脉血: 1.08mg/L；血液二氧化碳含量ctCO2(B)-静脉血: 26.3mmol/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；碱性磷酸酶(ALP)-静脉血: 61.9U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.5U/L；甘油三酯(TG)-静脉血: 1.82mmol/L；氯离子(Cl-)-静脉血: 103.6mmol/L；间接胆红素(IBIL)-静脉血: 5.9umolL；大血小板百分比(P-LCR%)-静脉血: 13.5%；淋巴细胞百分比(Lymph%)-静脉血: 0.282；葡萄糖(Glu)-静脉血: 5.18mmol/L；尿素氮(BUN)-静脉血: 6.2mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 29.9U/L；平均血小板体积(MPV)-静脉血: 8.6fL；总蛋白(TP)-静脉血: 62.46g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；磷(P)-静脉血: 1.1mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 320g/L；阴离子间隙(AG)-静脉血: 11.9\n- [全程D31] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 2/μL；胆红素(BIL)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.011；比重(SG)-尿液: 1.017；隐血(OB)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 1/μL；胆红素(BIL)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 10/μL；白细胞(LEU)-尿液: -（参考: 阴性）；颜色-尿液: 无色；浊度(TRUB)-尿液: clear；总蛋白(TP)-尿液: -（参考: 阴性）\n- [全程D33] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.016；浊度(TRUB)-尿液: 清亮；总蛋白(TP)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；隐血(OB)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7；白细胞计数(WBC#)-尿液: 1/μL；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）\n- [全程D34] 检验组合: 隐血(OB)-粪便: 阴性（参考: 阴性）；阴离子间隙(AG)-静脉血: 10.6；颜色-粪便: 棕色；钠离子(Na+)-静脉血: 136.7mmol/L；虫卵-粪便: 未见虫卵（参考: 未见虫卵）；血液二氧化碳含量ctCO2(B)-静脉血: 26.2mmol/L；氯离子(Cl-)-静脉血: 99.9mmol/L；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；磷(P)-静脉血: 1.16mmol/L；总钙(Ca)-静脉血: 1.98mmol/L；镁离子(Mg2+)-静脉血: 0.59mmol/L；钾离子(K+)-静脉血: 3.49mmol/L；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）\n- [全程D36] 检验组合: 钾离子(K+)-静脉血: 4.1mmol/L；碱性磷酸酶(ALP)-静脉血: 51.9U/L；球蛋白(GLO)-静脉血: 20.23g/L；钠离子(Na+)-静脉血: 136.6mmol/L；阴离子间隙(AG)-静脉血: 13；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.82mmol/L；总胆红素(TBIL)-静脉血: 15.3umol/L；镁离子(Mg2+)-静脉血: 0.51mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.14g/L；氯离子(Cl-)-静脉血: 99mmol/L；单核细胞计数(Mono#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.3；乳酸脱氢酶(LDH)-静脉血: 169.8U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15.6U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.78；磷(P)-静脉血: 1.11mmol/L；葡萄糖(Glu)-静脉血: 5.25mmol/L；总钙(Ca)-静脉血: 2.08mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 27.3U/L；血小板计数(PLT#)-静脉血: 10410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 327g/L；单核细胞百分比(Mono%)-静脉血: 0.005；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；总胆固醇(TC)-静脉血: 5.03mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 28U/L；平均红细胞体积(MCV)-静脉血: 90.6fL；血红蛋白(Hb)-静脉血: 110g/L；血小板分布宽度(PDW)-静脉血: 11.8%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.6pg；白蛋白(ALB)-静脉血: 36g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1；血液二氧化碳含量ctCO2(B)-静脉血: 24.8mmol/L；总蛋白(TP)-静脉血: 56.23g/L；间接胆红素(IBIL)-静脉血: 10umolL；总胆汁酸(TBA)-静脉血: 4.4umol/L；载脂蛋白B(apoB)-静脉血: 0.9g/L；C-反应蛋白(CRP)-静脉血: 1.75mg/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；白细胞计数(WBC#)-静脉血: 3.7610E9/L；红细胞比容(Hct)-静脉血: 33.6%；中性粒细胞百分比(Neut%)-静脉血: 0.758；平均血小板体积(MPV)-静脉血: 9.9fL；直接胆红素(DBIL)-静脉血: 5.3umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.6\n- [全程D37] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后复查，与某次就诊时间对比： 鼻咽腔稍狭窄，鼻咽顶壁、顶后壁、后壁及双侧壁稍增厚，T1WI呈等信号，T2WI呈稍高信号，增强扫描强化明显，粘膜表面不光整。双侧咽隐窝变浅。双侧咽旁间隙未见明显狭窄。双侧腭帆张提肌、头长肌信号不均匀，增强后不均匀强化。双侧翼内外肌未见受侵。 口咽双侧壁未见增厚，左侧鼻甲明显肿大，气道狭窄。双侧鼻腔未见肿物。 双侧翼腭窝、上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 斜坡、枕骨基底部、蝶骨基底部、双侧翼突基底、翼内板、右侧岩尖骨质信号降低，增强扫描强化明显。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶窦、筛窦及右侧乳突气房内见积液，双侧上颌窦及左侧乳突充气良好，骨壁完整。 左侧咽后见淋巴结，大小约4mm×7mm，较前缩小；右侧咽后见小淋巴结，大小约3mm×4mm，较前缩小。双颈II、III区见数个淋巴结，大者大小约8mm×14mm，边界欠清，信号不均匀，增强扫描不均匀明显强化，较前缩小。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗后复查，与某次就诊时间对比： 鼻咽病变，较前明显好转。 颅底骨质破坏，较前好转。 双侧咽后淋巴结，较前缩小。 双颈II、III区淋巴结，考虑转移，较前缩小。 鼻窦炎，右侧乳突炎。\n\n【既往治疗与反应】\n- [全程D15] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者第1程TPF方案诱导化疗结束，诉呕吐1次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部IIa区各可扪及1个淋巴结，左颈2×2cm，右颈1.5×1.5cm,无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。复查血常规、肝肾功能大致正常。上级医师信息已隐藏：患者第1程TPF方案诱导化疗结束，无诉特殊不适，可予出院，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D30] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，上级医师信息已隐藏示：患者无明显化疗禁忌症，可于今日水化，明日执行第2程多西紫杉醇＋DDP+5-FU方案诱导化疗，注意化疗不良反应。\n- [全程D31] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者第2程多西紫杉醇＋DDP+5-FU方案诱导化疗第一天，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。上级医师信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D35] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者第2程多西紫杉醇＋DDP+5-FU方案诱导化疗结束，诉反酸、恶心，无发热、腹痛、腹泻，无关节酸痛等。复查血常规、肝肾功能大致正常。上级医师信息已隐藏：患者第2程多西紫杉醇＋DDP+5-FU方案诱导化疗结束后出现反酸、恶心现象，予抑酸护胃、补液等对症处理，继观。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即启动根治性调强放疗联合同步顺铂化疗，停止静脉高营养以避免导管相关感染。\nB. 更换为吉西他滨联合顺铂方案进行第四周期诱导化疗，并继续抑酸护胃治疗。\nC. 安排鼻咽原发灶及双侧颈部淋巴结根治性切除术，术后辅以静脉营养支持。\nD. 维持静脉营养支持，并立即启动根治性放疗联合PD-1抑制剂及靶向治疗。\nE. 继续原方案（多西紫杉醇+顺铂+5-FU）进行第四周期诱导化疗，并辅以抑酸护胃治疗。\nF. 暂停所有抗肿瘤治疗，仅维持静脉营养支持及抑酸治疗，1个月后复查MRI决定后续方案。\nG. 安排全身PET-CT检查评估全身情况，若无远处转移则继续原方案诱导化疗两周期。\nH. 行局部清扫术，处理颈部残留淋巴结，术后序贯鼻咽部根治性放疗及静脉营养支持。\nI. 调整为卡培他滨节拍化疗联合静脉营养支持，待消化道反应完全缓解后启动放疗。\nJ. 继续予以抑酸护胃及静脉高营养等对症支持治疗，待体能恢复后序贯开展根治性放疗或同步放化疗。\nK. 启动姑息性放疗控制局部及颈部病灶，并联合阿帕替尼等抗血管生成药物治疗。\nL. 维持静脉营养支持，并安排鼻咽镜下局部病灶再次活检以病理确认肿瘤退缩程度。\n\n请仅输出一个选项字母（A-L）。","gold_letter":"J","gold_action":"继续予以抑酸护胃及静脉高营养等对症支持治疗，待体能恢复后序贯开展根治性放疗或同步放化疗。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"立即启动根治性调强放疗联合同步顺铂化疗，停止静脉高营养以避免导管相关感染。"},{"letter":"B","text":"更换为吉西他滨联合顺铂方案进行第四周期诱导化疗，并继续抑酸护胃治疗。"},{"letter":"C","text":"安排鼻咽原发灶及双侧颈部淋巴结根治性切除术，术后辅以静脉营养支持。"},{"letter":"D","text":"维持静脉营养支持，并立即启动根治性放疗联合PD-1抑制剂及靶向治疗。"},{"letter":"E","text":"继续原方案（多西紫杉醇+顺铂+5-FU）进行第四周期诱导化疗，并辅以抑酸护胃治疗。"},{"letter":"F","text":"暂停所有抗肿瘤治疗，仅维持静脉营养支持及抑酸治疗，1个月后复查MRI决定后续方案。"},{"letter":"G","text":"安排全身PET-CT检查评估全身情况，若无远处转移则继续原方案诱导化疗两周期。"},{"letter":"H","text":"行局部清扫术，处理颈部残留淋巴结，术后序贯鼻咽部根治性放疗及静脉营养支持。"},{"letter":"I","text":"调整为卡培他滨节拍化疗联合静脉营养支持，待消化道反应完全缓解后启动放疗。"},{"letter":"J","text":"继续予以抑酸护胃及静脉高营养等对症支持治疗，待体能恢复后序贯开展根治性放疗或同步放化疗。"},{"letter":"K","text":"启动姑息性放疗控制局部及颈部病灶，并联合阿帕替尼等抗血管生成药物治疗。"},{"letter":"L","text":"维持静脉营养支持，并安排鼻咽镜下局部病灶再次活检以病理确认肿瘤退缩程度。"}]}
+{"sample_id":"sample-5737526b7d92f1b3d5423663","patient_id":"patient-02ca51eed4fedbb13e4db76d","turn_id":"turn01","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左颈肿物20天；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物；既往史: 20余年前患“血吸虫”病行脾脏切除术，当地医院检查示“早期肝硬化”，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：37.3℃，P：62次/分，R：20次/分，BP：121/75mmHg,Ht：165cm，Wt：58kg，BSA：1.63m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽左侧顶后壁粘膜稍隆起；左侧颈部II区可扪及1个淋巴结，最大径1×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善电子鼻咽镜检查及活检，行鼻咽及颈部CT平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。\nB. 完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，并直接行全身PET-CT评估远处转移。\nC. 完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，暂不进行胸腹部影像学检查待病理确诊。\nD. 完善间接鼻咽镜检查，行鼻咽及颈部MRI平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。\nE. 完善颈部淋巴结细针穿刺活检，行鼻咽及颈部MRI平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。\nF. 完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。\nG. 完善电子鼻咽镜检查及活检，行鼻咽及颈部CT平扫，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。\nH. 完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。\nI. 完善颈部淋巴结切除活检，行鼻咽及颈部MRI平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。\nJ. 完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，并完善骨扫描及头颅MRI检查。\nK. 完善电子鼻咽镜检查及活检，仅行鼻咽MRI平扫+增强，颈部行彩超评估，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。\nL. 完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，并完善全身骨髓穿刺活检。\n\n请仅输出一个选项字母（A-L）。","gold_letter":"H","gold_action":"完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"完善电子鼻咽镜检查及活检，行鼻咽及颈部CT平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。"},{"letter":"B","text":"完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，并直接行全身PET-CT评估远处转移。"},{"letter":"C","text":"完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，暂不进行胸腹部影像学检查待病理确诊。"},{"letter":"D","text":"完善间接鼻咽镜检查，行鼻咽及颈部MRI平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。"},{"letter":"E","text":"完善颈部淋巴结细针穿刺活检，行鼻咽及颈部MRI平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。"},{"letter":"F","text":"完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。"},{"letter":"G","text":"完善电子鼻咽镜检查及活检，行鼻咽及颈部CT平扫，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。"},{"letter":"H","text":"完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。"},{"letter":"I","text":"完善颈部淋巴结切除活检，行鼻咽及颈部MRI平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。"},{"letter":"J","text":"完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，并完善骨扫描及头颅MRI检查。"},{"letter":"K","text":"完善电子鼻咽镜检查及活检，仅行鼻咽MRI平扫+增强，颈部行彩超评估，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。"},{"letter":"L","text":"完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，并完善全身骨髓穿刺活检。"}]}
+{"sample_id":"sample-84b4eab1f1613c7517fd613a","patient_id":"patient-02ca51eed4fedbb13e4db76d","turn_id":"turn02","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左颈肿物20天；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物；既往史: 20余年前患“血吸虫”病行脾脏切除术，当地医院检查示“早期肝硬化”，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：37.3℃，P：62次/分，R：20次/分，BP：121/75mmHg,Ht：165cm，Wt：58kg，BSA：1.63m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽左侧顶后壁粘膜稍隆起；左侧颈部II区可扪及1个淋巴结，最大径1×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 逆钟向转位 正常范围心电图\n- [全程D1] 检验组合: 肌酐(Crea)-静脉血: 56.1umol/L；阴离子间隙(AG)-静脉血: 11.1；α-L-岩藻糖苷酶(AFU)-静脉血: 35.5U/L；凝血酶原时间(PT)-静脉血: 11.7sec.；胱抑素(Cys-C)-静脉血: 0.85mg/L；淋巴细胞百分比(Lymph%)-静脉血: 0.428；骨钙素N端中分子片段(N-MID)-静脉血: 19.3ng/ml；纤维蛋白原(Fbg)-静脉血: 2.07g/L；钠离子(Na+)-静脉血: 140.5mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；总钙(Ca)-静脉血: 2.29mmol/L；乳酸脱氢酶(LDH)-静脉血: 164U/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.44；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.35mmol/L；血小板分布宽度(PDW)-静脉血: 15.9%；平均红细胞血红蛋白含量(MCH)-静脉血: 31.5pg；总胆固醇(TC)-静脉血: 4.12mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；Rh血型-静脉血: 阳性；红细胞比容(Hct)-静脉血: 41.2%；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 9.9umolL；D-二聚体(D-Dimer)-静脉血: 5.09ug/ml；钾离子(K+)-静脉血: 4.24mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.424；直接胆红素(DBIL)-静脉血: 5.8umol/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；天门冬氨酸氨基转移酶(AST)-静脉血: 18.6U/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；透明质酸(HA)-静脉血: 71.337ng/ml；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.5；纤维蛋白原降解产物(FDP)-静脉血: 19ug/ml；载脂蛋白B(apoB)-静脉血: 0.75g/L；尿素氮(BUN)-静脉血: 6.9mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.35mmolL；单核细胞计数(Mono#)-静脉血: 0.510E9/L；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；层粘连蛋白(LN)-静脉血: 29.89ng/ml；尿酸(UA)-静脉血: 269.1umol/L；大血小板百分比(P-LCR%)-静脉血: 41.9%；血液二氧化碳含量ctCO2(B)-静脉血: 27.5mmol/L；中性粒细胞计数(Neut#)-静脉血: 1.810E9/L\n- [全程D2] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双下肺纹理稍粗，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n- [全程D4] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏形态失常，表面凸凹不平，边缘钝，肝实质回声不均匀，明显增强、粗糙，肝内未见明确肿块回声。门静脉主干内径约15mm。肝静脉、门静脉内未见异常回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约14cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏术后缺如。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约35×24×23mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝硬化声像。 脾脏术后缺如。 胆囊、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D7] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 左上颌骨可见片状放射性浓集灶。胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 左上颌骨炎症。 余全身骨骼未见明显异常。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行PET-CT检查以重新评估全身分期\nB. 行左侧颈部淋巴结切除活检以明确病理诊断\nC. 行左侧颈部淋巴结细针穿刺活检(FNAC)以明确病理诊断\nD. 行鼻咽脱落细胞涂片检查以替代组织活检\nE. 行肝脏增强MRI检查以进一步排查肝脏转移灶\nF. 行右侧颈部II区小淋巴结切除活检以明确对侧转移情况\nG. 行外周血EB病毒DNA定量检测作为确诊依据\nH. 行左上颌骨病灶穿刺活检以明确骨扫描异常灶性质\nI. 行鼻咽镜下鼻咽原发灶活检以明确病理诊断\nJ. 行鼻咽肿物广泛切除术以达到诊断与治疗目的\nK. 行颈部超声造影检查以进一步评估右颈淋巴结性质\nL. 行鼻咽及颈部CT平扫加增强以补充评估颅底骨质破坏\n\n请仅输出一个选项字母（A-L）。","gold_letter":"I","gold_action":"行鼻咽镜下鼻咽原发灶活检以明确病理诊断","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"行PET-CT检查以重新评估全身分期"},{"letter":"B","text":"行左侧颈部淋巴结切除活检以明确病理诊断"},{"letter":"C","text":"行左侧颈部淋巴结细针穿刺活检(FNAC)以明确病理诊断"},{"letter":"D","text":"行鼻咽脱落细胞涂片检查以替代组织活检"},{"letter":"E","text":"行肝脏增强MRI检查以进一步排查肝脏转移灶"},{"letter":"F","text":"行右侧颈部II区小淋巴结切除活检以明确对侧转移情况"},{"letter":"G","text":"行外周血EB病毒DNA定量检测作为确诊依据"},{"letter":"H","text":"行左上颌骨病灶穿刺活检以明确骨扫描异常灶性质"},{"letter":"I","text":"行鼻咽镜下鼻咽原发灶活检以明确病理诊断"},{"letter":"J","text":"行鼻咽肿物广泛切除术以达到诊断与治疗目的"},{"letter":"K","text":"行颈部超声造影检查以进一步评估右颈淋巴结性质"},{"letter":"L","text":"行鼻咽及颈部CT平扫加增强以补充评估颅底骨质破坏"}]}
+{"sample_id":"sample-9895c4d0f7c600fd0c046a50","patient_id":"patient-02ca51eed4fedbb13e4db76d","turn_id":"turn05","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左颈肿物20天；现病史: 缘于20天前患者无意中出现左颈肿物，未伴涕血、耳鸣、听力下降、头痛、面麻等不适，某次就诊时间在当地医院行左颈淋巴结穿刺，病理示未见癌，某次就诊时间行鼻咽活检病理示鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物；既往史: 20余年前患“血吸虫”病行脾脏切除术，当地医院检查示“早期肝硬化”，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：37.3℃，P：62次/分，R：20次/分，BP：121/75mmHg,Ht：165cm，Wt：58kg，BSA：1.63m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率62次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽左侧顶后壁粘膜稍隆起；左侧颈部II区可扪及1个淋巴结，最大径1×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D27] 入院记录: 主诉: 确诊鼻咽癌1月余；现病史: 缘于某次就诊时间9月下旬患者无意中出现左颈肿物，未伴涕血、耳鸣、听力下降、头痛、面麻等不适，某次就诊时间在当地医院行左颈淋巴结穿刺，病理示未见癌，某次就诊时间行鼻咽活检病理示分化非角化癌。某次就诊时间日入院予以治疗前相关检查，明确诊断为鼻咽分化非角化癌，[分期信息见历史辅助诊断节点],III期，予以行放疗计划设计，现放疗计划设计完成，入院行放化综合治疗。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物；既往史: 20余年前患“血吸虫”病行脾脏切除术，当地医院检查示“早期肝硬化”，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：37.3℃，P：62次/分，R：20次/分，BP：121/75mmHg,Ht：165cm，Wt：58kg，BSA：1.63m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率62次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽左侧顶后壁粘膜稍隆起；左侧颈部II区可扪及1个淋巴结，最大径1×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 逆钟向转位 正常范围心电图\n- [全程D2] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双下肺纹理稍粗，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n- [全程D4] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏形态失常，表面凸凹不平，边缘钝，肝实质回声不均匀，明显增强、粗糙，肝内未见明确肿块回声。门静脉主干内径约15mm。肝静脉、门静脉内未见异常回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约14cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏术后缺如。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约35×24×23mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝硬化声像。 脾脏术后缺如。 胆囊、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D7] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 左上颌骨可见片状放射性浓集灶。胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 左上颌骨炎症。 余全身骨骼未见明显异常。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D35] 检验组合: 碱性磷酸酶(ALP)-静脉血: 93.6U/L；丙氨酸氨基转移酶(ALT)-静脉血: 26.3U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.2U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 34.4U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.73；α-L-岩藻糖苷酶(AFU)-静脉血: 38.5U/L；乳酸脱氢酶(LDH)-静脉血: 195.7U/L；总胆汁酸(TBA)-静脉血: 2.9umol/L\n- [全程D39] 检验组合: 胱抑素(Cys-C)-静脉血: 0.84mg/L；肌酐(Crea)-静脉血: 62.7umol/L；阴离子间隙(AG)-静脉血: 11；单核细胞计数(Mono#)-静脉血: 0.510E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.8mmol/L；载脂蛋白B(apoB)-静脉血: 0.81g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.8U/L；平均红细胞体积(MCV)-静脉血: 93.8fL；单核细胞百分比(Mono%)-静脉血: 0.149；C-反应蛋白(CRP)-静脉血: 0.37mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；淋巴细胞百分比(Lymph%)-静脉血: 0.352；有核红细胞百分比(NRBC%)-静脉血: 0；尿素氮(BUN)-静脉血: 7.54mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.17g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 40U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；直接胆红素(DBIL)-静脉血: 6.9umol/L；平均血小板体积(MPV)-静脉血: 9.04fL；红细胞计数(RBC#)-静脉血: 4.2310E12/L；总胆固醇(TC)-静脉血: 4.39mmol/L；总钙(Ca)-静脉血: 2.39mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.21mmolL；丙氨酸氨基转移酶(ALT)-静脉血: 28.6U/L；间接胆红素(IBIL)-静脉血: 11.6umolL；甘油三酯(TG)-静脉血: 0.5mmol/L；尿酸(UA)-静脉血: 332.9umol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32.2pg；中性粒细胞计数(Neut#)-静脉血: 1.510E9/L；总胆红素(TBIL)-静脉血: 18.5umol/L；乳酸脱氢酶(LDH)-静脉血: 145.6U/L；磷(P)-静脉血: 1.34mmol/L；碱性磷酸酶(ALP)-静脉血: 93.2U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.009；钾离子(K+)-静脉血: 4mmol/L；总蛋白(TP)-静脉血: 80g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 136.5g/L；白蛋白(ALB)-静脉血: 43.2g/L；葡萄糖(Glu)-静脉血: 5.05mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.463；平均红细胞血红蛋白浓度(MCHC)-静脉血: 343.6g/L\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D28] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者今日返院，一般情况可，无明显不适主诉，体查情况基本同前，患者现放疗计划已设计完成并通过全科会诊，NPDT70Gy/30F,CTV1:60Gy/30F,CTV2：54Gy/30F，靶区剂量分布均匀，正常组织剂量在可接受范围内。上级医师信息已隐藏，患者放疗计划设计完成，可行放疗前复位及验证等准备，开始放疗，患者既往血吸虫肝硬化病史，患者化疗后可能出现肝功能损伤，肝衰竭，严重者可危及生命，与患者及家属沟通后，患者及家属表示愿意承担化疗风险，予以择期行DDP单药每周同时期化疗。\n- [全程D29] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 今日查房，患者一般情况可，无明显不适主诉，体查同入院。上级医师信息已隐藏示：依约开始放疗，嘱患者注意营养与休息。\n- [全程D34] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者已开始行根治性放疗，现放疗2F，昨日完成一程同期化疗，诉额、双侧颞部头痛，一般情况尚可，体查情况基本同前。上级医师信息已隐藏：现患者已开始放疗，一程化疗结束，针对患者主诉，考虑放疗引起不良反应，予以止痛等对症处理，病情继观。\n- [全程D39] 上级查房记录；上级医师查房记录: 病程类型: 上级查房记录；病程主题: 上级医师信息已隐藏；病程内容: 患者现处于放化综合治疗中，放疗3F，无诉，体查情况基本同前，血常规、生化常规结果示：WBC3.33*10E9/L、中性粒1.5*10E9/L；上级医师信息已隐藏：现患者血象稍低，明日予以行同期化疗二程，化疗后予以复查血象后再予以升白等对症处理，密观病情。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停同期化疗，单纯行根治性放疗，立即予以重组人粒细胞集落刺激因子升白细胞治疗。\nB. 暂停放化疗，立即予以重组人粒细胞集落刺激因子，待白细胞恢复正常后再恢复放化综合治疗。\nC. 延迟第2程同期化疗，继续放疗，观察3天后复查血常规，若中性粒细胞达标再行化疗。\nD. 继续行第2程同期化疗，化疗前予以长效聚乙二醇化重组人粒细胞集落刺激因子预防性升白细胞。\nE. 继续行第2程同期化疗，化疗期间同步予以口服抗生素预防感染及静脉营养支持。\nF. 继续行第2程同期化疗，将顺铂剂量下调20%，并给予静脉营养、补液及通便等对症支持。\nG. 终止同期化疗，改为单纯放疗联合西妥昔单抗靶向治疗，并予以静脉营养支持。\nH. 继续行第2程同期化疗，化疗后立即常规予以重组人粒细胞集落刺激因子连续升白细胞治疗3天。\nI. 暂停放疗，按计划行第2程同期化疗，化疗后复查血象视情况予以升白细胞治疗。\nJ. 继续行第2程同期化疗，将顺铂更换为卡铂，并给予静脉营养、补液及通便等对症支持。\nK. 延迟第2程同期化疗，予以静脉营养、补液及通便等对症支持，待1周后复查血象再决定是否化疗。\nL. 继续行第2程同期化疗，化疗后复查血象视情况予以升白细胞治疗，并给予静脉营养、补液及通便等对症支持。\n\n请仅输出一个选项字母（A-L）。","gold_letter":"L","gold_action":"继续行第2程同期化疗，化疗后复查血象视情况予以升白细胞治疗，并给予静脉营养、补液及通便等对症支持。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"暂停同期化疗，单纯行根治性放疗，立即予以重组人粒细胞集落刺激因子升白细胞治疗。"},{"letter":"B","text":"暂停放化疗，立即予以重组人粒细胞集落刺激因子，待白细胞恢复正常后再恢复放化综合治疗。"},{"letter":"C","text":"延迟第2程同期化疗，继续放疗，观察3天后复查血常规，若中性粒细胞达标再行化疗。"},{"letter":"D","text":"继续行第2程同期化疗，化疗前予以长效聚乙二醇化重组人粒细胞集落刺激因子预防性升白细胞。"},{"letter":"E","text":"继续行第2程同期化疗，化疗期间同步予以口服抗生素预防感染及静脉营养支持。"},{"letter":"F","text":"继续行第2程同期化疗，将顺铂剂量下调20%，并给予静脉营养、补液及通便等对症支持。"},{"letter":"G","text":"终止同期化疗，改为单纯放疗联合西妥昔单抗靶向治疗，并予以静脉营养支持。"},{"letter":"H","text":"继续行第2程同期化疗，化疗后立即常规予以重组人粒细胞集落刺激因子连续升白细胞治疗3天。"},{"letter":"I","text":"暂停放疗，按计划行第2程同期化疗，化疗后复查血象视情况予以升白细胞治疗。"},{"letter":"J","text":"继续行第2程同期化疗，将顺铂更换为卡铂，并给予静脉营养、补液及通便等对症支持。"},{"letter":"K","text":"延迟第2程同期化疗，予以静脉营养、补液及通便等对症支持，待1周后复查血象再决定是否化疗。"},{"letter":"L","text":"继续行第2程同期化疗，化疗后复查血象视情况予以升白细胞治疗，并给予静脉营养、补液及通便等对症支持。"}]}
+{"sample_id":"sample-cef4654d5f291c72b760bfcf","patient_id":"patient-f25e20b1e5c6eea840d4cc21","turn_id":"turn02","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现右颈部肿块伴耳鸣、听力下降4个月。；现病史: 缘于4个月前患者无意中发现右颈部包块，如拇指大小，无压痛，伴耳鸣、听力下降，颈部包块后逐渐增大，近1周偶发头痛，白天明显，视物如常，无鼻塞、鼻血、面麻、等不适。为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,鼻咽肿物,右颈部包块,头痛；既往史: 4年前患痔疮，已治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:青霉素皮试阳性。；个人史: 长期居于原籍，无疫区居住史。吸烟3-4支/天*10年，饮酒1-2次/月。否认不洁性生活史。；家族史: 舅舅患鼻咽癌，舅妈患肺癌。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：103/73mmHg,Ht：174cm，Wt：79kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；右颈IIa区可扪及1个淋巴结，最大径2.5×2.5cm，左颈IIa区扪及1个淋巴结，最大径约3*3cm，无融合，质地韧，边界模糊，活动度好，无压痛，无皮肤浸润，无溃疡，右颈III区可见一长约4cm手术疤痕；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 电轴左偏(轻度) 正常范围心电图\n- [全程D1] 检验组合: 血小板比容-静脉血: 19%；载脂蛋白B(apoB)-静脉血: 1.03g/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；肌酐(Crea)-静脉血: 66.2umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.1；球蛋白(GLO)-静脉血: 31.61g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.011；尿胆原(URO)-尿液: -（参考: 阴性）；红细胞比容(Hct)-静脉血: 48.9%；凝血酶原时间活动度(PTA)-静脉血: 111.2%；隐血(OB)-粪便: 阴性（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.91mg/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；碱性磷酸酶(ALP)-静脉血: 76.3U/L；载脂蛋白AI(apoAI)-静脉血: 1.04g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；葡萄糖(Glu)-静脉血: 4.96mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.5；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；血小板分布宽度(PDW)-静脉血: 13.9%；淋巴细胞百分比(Lymph%)-静脉血: 0.315；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；总胆红素(TBIL)-静脉血: 7umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.910E9/L；Rh血型-静脉血: 阳性；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.2sec.；酮体(KET)-尿液: -（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 21.9mmol/L；浊度(TRUB)-尿液: 清亮；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 4.88mmol/L；C-反应蛋白(CRP)-静脉血: 3.45mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.91mmolL；凝血酶原时间(PT)-静脉血: 10.4sec.；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；单核细胞百分比(Mono%)-静脉血: 0.121；尿酸(UA)-静脉血: 424umol/L；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；镁离子(Mg2+)-静脉血: 0.55mmol/L；纤维蛋白原(Fbg)-静脉血: 2.66g/L\n- [全程D3] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D7] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及双侧壁增厚，以右侧为著，T1WI呈等信号，T2WI呈稍高信号，增强扫描强化明显，右侧咽隐窝消失，见增厚组织占据，左侧咽隐窝变浅。病变与右侧中鼻甲分界不清，口咽双侧壁未见增厚。 右侧咽旁间隙及右侧咽后间隙见不规则肿物突入。双侧腭帆提肌、右侧腭帆张肌、右侧头长肌受侵。左侧腭帆张肌、双侧翼内肌及双侧翼外肌未见受侵。 右侧翼腭窝内见少许软组织信号，增强扫描明显强化。 左侧翼腭窝、双侧上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 斜坡、蝶骨基底部、右侧翼突基底部及内外板、右侧蝶骨大翼及右侧岩尖骨质信号减低，增强扫描见不均匀强化。 右侧破裂扩大，右侧海绵窦增宽，内见不规则软组织信号灶，右侧蝶窦内见软组织信号灶突入，增强扫描上述病变强化明显。 左侧海绵窦未见增宽。蝶鞍形态正常，其内未见占位性病变。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧上颌窦、筛窦及蝶窦粘膜增厚。右侧乳突内见大量分泌物。 右侧咽后见肿大淋巴结，大者约12mm×17mm，增强扫描强化明显。双颈II、III、V区见多个肿大淋巴结，最大者约23mm×29mm，部分边界欠清晰，包膜不完整，信号欠均匀，增强扫描明显不均匀强化。双侧腮腺内及腮腺旁见数个淋巴结，大者短径约6mm，增强扫描强化明显。双颈I区见数个淋巴结，大者短径约7mm，信号尚均匀。 甲状腺双叶及峡部、喉咽、双侧颌下腺信号均匀，未见占位性病变。；检查结论: 鼻咽病变，考虑鼻咽癌，侵犯范围如上述。 颅底骨质破坏。 右侧咽后、双颈II、III、V区多发肿大淋巴结，考虑转移。 双侧腮腺内及腮腺旁数个淋巴结，性质待定。 鼻窦炎、右侧乳突炎。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 安排适形调强放射治疗（IMRT）及同步化疗\nB. 行鼻咽镜下活检，并补充头颅PET-MR评估颅底受侵范围\nC. 行右颈部淋巴结细针穿刺活检，并补充胸部CT及全身骨扫描\nD. 行鼻咽镜下活检，并补充腹部增强CT排查肝脏转移\nE. 行鼻咽镜下活检，并补充胸部CT、全身骨扫描及血清EBV DNA检测\nF. 行鼻咽镜下活检，直接进行放疗定位及靶区勾画\nG. 行全身PET-CT进行分期，随后开始诱导化疗\nH. 行鼻咽镜下活检，并补充颈部超声评估淋巴结包膜外侵犯\nI. 行鼻咽镜下活检，并补充胸部X线及头颅CT平扫\nJ. 行鼻咽镜下活检，并补充骨髓穿刺排除骨髓转移\nK. 行鼻咽镜下活检，并补充全身骨扫描，暂缓胸部影像学检查\nL. 行右颈部淋巴结切除活检，并补充胸部CT及血清EBV DNA检测\n\n请仅输出一个选项字母（A-L）。","gold_letter":"E","gold_action":"行鼻咽镜下活检，并补充胸部CT、全身骨扫描及血清EBV DNA检测","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"安排适形调强放射治疗（IMRT）及同步化疗"},{"letter":"B","text":"行鼻咽镜下活检，并补充头颅PET-MR评估颅底受侵范围"},{"letter":"C","text":"行右颈部淋巴结细针穿刺活检，并补充胸部CT及全身骨扫描"},{"letter":"D","text":"行鼻咽镜下活检，并补充腹部增强CT排查肝脏转移"},{"letter":"E","text":"行鼻咽镜下活检，并补充胸部CT、全身骨扫描及血清EBV DNA检测"},{"letter":"F","text":"行鼻咽镜下活检，直接进行放疗定位及靶区勾画"},{"letter":"G","text":"行全身PET-CT进行分期，随后开始诱导化疗"},{"letter":"H","text":"行鼻咽镜下活检，并补充颈部超声评估淋巴结包膜外侵犯"},{"letter":"I","text":"行鼻咽镜下活检，并补充胸部X线及头颅CT平扫"},{"letter":"J","text":"行鼻咽镜下活检，并补充骨髓穿刺排除骨髓转移"},{"letter":"K","text":"行鼻咽镜下活检，并补充全身骨扫描，暂缓胸部影像学检查"},{"letter":"L","text":"行右颈部淋巴结切除活检，并补充胸部CT及血清EBV DNA检测"}]}
+{"sample_id":"sample-5ae78b6dca4ce8a61a44d0ca","patient_id":"patient-f25e20b1e5c6eea840d4cc21","turn_id":"turn04","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现右颈部肿块伴耳鸣、听力下降4个月。；现病史: 缘于4个月前患者无意中发现右颈部包块，如拇指大小，无压痛，伴耳鸣、听力下降，颈部包块后逐渐增大，近1周偶发头痛，白天明显，视物如常，无鼻塞、鼻血、面麻、等不适。就诊[机构已隐去]，行右颈部淋巴结活检术，病理示转移性低分化鳞癌，行电子鼻咽镜检查见鼻咽肿物，取活检病理示可疑癌。为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,鼻咽肿物,右颈部包块,头痛；既往史: 4年前患痔疮，已治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:青霉素皮试阳性。；个人史: 长期居于原籍，无疫区居住史。吸烟3-4支/天*10年，饮酒1-2次/月。否认不洁性生活史。；家族史: 舅舅患鼻咽癌，舅妈患肺癌。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：103/73mmHg,Ht：174cm，Wt：79kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；右颈IIa区可扪及1个淋巴结，最大径2.5×2.5cm，左颈IIa区扪及1个淋巴结，最大径约3*3cm，无融合，质地韧，边界模糊，活动度好，无压痛，无皮肤浸润，无溃疡，右颈III区可见一长约4cm手术疤痕；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 单纯根治性放疗\nB. 诱导化疗序贯单纯根治性放疗\nC. 同步放化疗序贯辅助化疗\nD. 根治性颈淋巴结清扫术序贯辅助放化疗\nE. 姑息性全身化疗联合靶向治疗\nF. 诱导化疗序贯根治性手术\nG. 诱导化疗序贯同步放化疗\nH. 免疫治疗联合同步放化疗\nI. 靶向治疗联合同步放化疗\nJ. 诱导化疗序贯同步放化疗联合辅助化疗\nK. 根治性放疗序贯辅助化疗\n\n请仅输出一个选项字母（A-K）。","gold_letter":"G","gold_action":"诱导化疗序贯同步放化疗","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"单纯根治性放疗"},{"letter":"B","text":"诱导化疗序贯单纯根治性放疗"},{"letter":"C","text":"同步放化疗序贯辅助化疗"},{"letter":"D","text":"根治性颈淋巴结清扫术序贯辅助放化疗"},{"letter":"E","text":"姑息性全身化疗联合靶向治疗"},{"letter":"F","text":"诱导化疗序贯根治性手术"},{"letter":"G","text":"诱导化疗序贯同步放化疗"},{"letter":"H","text":"免疫治疗联合同步放化疗"},{"letter":"I","text":"靶向治疗联合同步放化疗"},{"letter":"J","text":"诱导化疗序贯同步放化疗联合辅助化疗"},{"letter":"K","text":"根治性放疗序贯辅助化疗"}]}
+{"sample_id":"sample-b03a0a9310651ef3f13754f1","patient_id":"patient-9fcde7a95f4d57501ecbf7b2","turn_id":"turn01","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D1] 入院记录: 主诉: 右颈肿物半年，右耳听力下降半月；现病史: 缘于6月前患者无意中出现右颈肿物，未予重视，进行性增大，半月前出现右耳听力下降，无头痛、复视，无涕血、面麻等，就诊于当地医院，发现鼻咽肿物。今为求进一步诊治来我院。患者发病以来,精神、饮食、睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟20支/日*5年，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.3℃，P：79次/分，R：20次/分，BP：105/65mmHg,Ht：168cm，Wt：56kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 行鼻咽及颈部CT平扫+增强、间接鼻咽镜检查，并完善心电图及基线抽血化验。\nB. 行鼻咽及颈部MRI平扫（不加增强）、间接鼻咽镜检查，并完善心电图及基线抽血化验。\nC. 行鼻咽及颈部MRI平扫+增强，暂缓鼻咽镜检查，先行颈部淋巴结细针穿刺活检。\nD. 行鼻咽及颈部CT平扫+增强，暂缓鼻咽镜检查，先行颈部淋巴结切除活检。\nE. 行鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查，并直接安排全身骨扫描及肝脏超声。\nF. 行鼻咽及颈部MRI平扫+增强、鼻内镜下鼻腔扩宽术，并完善心电图及基线抽血化验。\nG. 行鼻咽及颈部超声检查、间接鼻咽镜检查，并完善心电图及基线抽血化验。\nH. 行鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查，并完善心电图，暂缓抽血化验。\nI. 行鼻咽及颈部MRI平扫+增强、直接喉镜检查，并完善心电图及基线抽血化验。\nJ. 行鼻咽及颈部CT平扫+增强、间接鼻咽镜检查，并直接安排胸腹部CT平扫+增强。\nK. 行鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查，并完善心电图及基线抽血化验。\n\n请仅输出一个选项字母（A-K）。","gold_letter":"K","gold_action":"行鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查，并完善心电图及基线抽血化验。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"行鼻咽及颈部CT平扫+增强、间接鼻咽镜检查，并完善心电图及基线抽血化验。"},{"letter":"B","text":"行鼻咽及颈部MRI平扫（不加增强）、间接鼻咽镜检查，并完善心电图及基线抽血化验。"},{"letter":"C","text":"行鼻咽及颈部MRI平扫+增强，暂缓鼻咽镜检查，先行颈部淋巴结细针穿刺活检。"},{"letter":"D","text":"行鼻咽及颈部CT平扫+增强，暂缓鼻咽镜检查，先行颈部淋巴结切除活检。"},{"letter":"E","text":"行鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查，并直接安排全身骨扫描及肝脏超声。"},{"letter":"F","text":"行鼻咽及颈部MRI平扫+增强、鼻内镜下鼻腔扩宽术，并完善心电图及基线抽血化验。"},{"letter":"G","text":"行鼻咽及颈部超声检查、间接鼻咽镜检查，并完善心电图及基线抽血化验。"},{"letter":"H","text":"行鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查，并完善心电图，暂缓抽血化验。"},{"letter":"I","text":"行鼻咽及颈部MRI平扫+增强、直接喉镜检查，并完善心电图及基线抽血化验。"},{"letter":"J","text":"行鼻咽及颈部CT平扫+增强、间接鼻咽镜检查，并直接安排胸腹部CT平扫+增强。"},{"letter":"K","text":"行鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查，并完善心电图及基线抽血化验。"}]}
+{"sample_id":"sample-057bee25fe3533856610d5c8","patient_id":"patient-9fcde7a95f4d57501ecbf7b2","turn_id":"turn02","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D1] 入院记录: 主诉: 右颈肿物半年，右耳听力下降半月；现病史: 缘于6月前患者无意中出现右颈肿物，未予重视，进行性增大，半月前出现右耳听力下降，无头痛、复视，无涕血、面麻等，就诊于当地医院，发现鼻咽肿物。今为求进一步诊治来我院。患者发病以来,精神、饮食、睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟20支/日*5年，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.3℃，P：79次/分，R：20次/分，BP：105/65mmHg,Ht：168cm，Wt：56kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D4] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 V5～V6导联低电压 V1～V3导联r波递增不良\n- [全程D4] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 25.6U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.341；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；平均红细胞体积(MCV)-静脉血: 94.7fL；白细胞计数(WBC#)-静脉血: 4.5110E9/L；平均血小板体积(MPV)-静脉血: 12fL；D-二聚体(D-Dimer)-静脉血: 0.1ug/ml；单核细胞计数(Mono#)-静脉血: 0.510E9/L；磷(P)-静脉血: 1.36mmol/L；甘油三酯(TG)-静脉血: 2.22mmol/L；间接胆红素(IBIL)-静脉血: 5.2umolL；白蛋白(ALB)-静脉血: 44.8g/L；碱性磷酸酶(ALP)-静脉血: 81.9U/L；凝血酶时间(TT)-静脉血: 18.5sec.；载脂蛋白B(apoB)-静脉血: 0.57g/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.1U/L；阴离子间隙(AG)-静脉血: 11；血小板比容-静脉血: 15%；凝血酶原时间(PT)-静脉血: 11.7sec.；肌酐(Crea)-静脉血: 82.7umol/L；总胆红素(TBIL)-静脉血: 8.2umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.503；球蛋白(GLO)-静脉血: 25.56g/L；红细胞计数(RBC#)-静脉血: 4.5210E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；大血小板百分比(P-LCR%)-静脉血: 40%；血小板分布宽度(PDW)-静脉血: 14.2%；凝血酶原时间活动度(PTA)-静脉血: 90.4%；乳酸脱氢酶(LDH)-静脉血: 359.7U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32.3pg；ABO血型-静脉血: B；总钙(Ca)-静脉血: 2.3mmol/L；镁离子(Mg2+)-静脉血: 0.99mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 146g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；γ-谷氨酰基转移酶(GGT)-静脉血: 14.6U/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.1mmol/L；Rh血型-静脉血: 阳性；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.009；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 1.02；中性粒细胞计数(Neut#)-静脉血: 2.310E9/L；纤维蛋白原降解产物(FDP)-静脉血: 0.6ug/ml\n- [全程D5] 检验组合: 乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阳性(+)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D6] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、双侧壁明显不均匀增厚，平扫T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，双侧咽隐窝变浅，双侧咽旁脂肪间隙稍狭窄；双侧腭帆提肌、腭帆张肌、头长肌受压。双侧咽后见肿大淋巴结，左侧较大者短径11mm，右侧较大者短径12mm。 双侧后鼻孔堵塞，口咽双侧壁未见受累增厚。 双侧翼腭窝、颞下窝未见异常。 蝶骨基底部、斜坡、双侧岩尖、双侧枕骨基底部骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽；双侧筛窦、蝶窦，右乳突内见积液；上颌窦、左乳突充气良好，骨壁完整；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双颈II区、右颈III、IV区见淋巴结肿大，部分融合，较大者短径28mm，信号欠均匀，增强较明显不均匀强化。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。；检查结论: 鼻咽顶壁、顶后壁、双侧壁明显不均匀增厚，考虑鼻咽癌。 颅底骨质破坏。 双侧咽后、双颈部多发淋巴结肿大，考虑转移瘤。 副鼻窦炎；右乳突炎。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 电子鼻咽镜检查及鼻咽肿物活检\nB. 颈部淋巴结切开活检术\nC. 超声引导下颈部淋巴结细针穿刺活检\nD. 全身PET-CT检查\nE. 胸部CT、腹部超声及全身骨扫描\nF. 鼻内镜下鼻咽肿物切除术\nG. 诊断性抗炎治疗2周后复查MRI\nH. 外周血EBV-DNA定量检测\nI. 鼻咽脱落细胞学检查\nJ. 鼻咽及颈部CT平扫+增强\nK. 鼻咽颅底三维CT重建\nL. 颈部淋巴结清扫术\n\n请仅输出一个选项字母（A-L）。","gold_letter":"A","gold_action":"电子鼻咽镜检查及鼻咽肿物活检","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"电子鼻咽镜检查及鼻咽肿物活检"},{"letter":"B","text":"颈部淋巴结切开活检术"},{"letter":"C","text":"超声引导下颈部淋巴结细针穿刺活检"},{"letter":"D","text":"全身PET-CT检查"},{"letter":"E","text":"胸部CT、腹部超声及全身骨扫描"},{"letter":"F","text":"鼻内镜下鼻咽肿物切除术"},{"letter":"G","text":"诊断性抗炎治疗2周后复查MRI"},{"letter":"H","text":"外周血EBV-DNA定量检测"},{"letter":"I","text":"鼻咽脱落细胞学检查"},{"letter":"J","text":"鼻咽及颈部CT平扫+增强"},{"letter":"K","text":"鼻咽颅底三维CT重建"},{"letter":"L","text":"颈部淋巴结清扫术"}]}
+{"sample_id":"sample-ea63b7a358722be15870f84c","patient_id":"patient-9fcde7a95f4d57501ecbf7b2","turn_id":"turn04","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D1] 入院记录: 主诉: 右颈肿物半年，右耳听力下降半月；现病史: 缘于6月前患者无意中出现右颈肿物，未予重视，进行性增大，半月前出现右耳听力下降，无头痛、复视，无涕血、面麻等，就诊于当地医院，发现鼻咽肿物。今为求进一步诊治来我院。患者发病以来,精神、饮食、睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟20支/日*5年，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.3℃，P：79次/分，R：20次/分，BP：105/65mmHg,Ht：168cm，Wt：56kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率79次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D4] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 V5～V6导联低电压 V1～V3导联r波递增不良\n- [全程D4] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 25.6U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.341；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；平均红细胞体积(MCV)-静脉血: 94.7fL；白细胞计数(WBC#)-静脉血: 4.5110E9/L；平均血小板体积(MPV)-静脉血: 12fL；D-二聚体(D-Dimer)-静脉血: 0.1ug/ml；单核细胞计数(Mono#)-静脉血: 0.510E9/L；磷(P)-静脉血: 1.36mmol/L；甘油三酯(TG)-静脉血: 2.22mmol/L；间接胆红素(IBIL)-静脉血: 5.2umolL；白蛋白(ALB)-静脉血: 44.8g/L；碱性磷酸酶(ALP)-静脉血: 81.9U/L；凝血酶时间(TT)-静脉血: 18.5sec.；载脂蛋白B(apoB)-静脉血: 0.57g/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.1U/L；阴离子间隙(AG)-静脉血: 11；血小板比容-静脉血: 15%；凝血酶原时间(PT)-静脉血: 11.7sec.；肌酐(Crea)-静脉血: 82.7umol/L；总胆红素(TBIL)-静脉血: 8.2umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.503；球蛋白(GLO)-静脉血: 25.56g/L；红细胞计数(RBC#)-静脉血: 4.5210E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；大血小板百分比(P-LCR%)-静脉血: 40%；血小板分布宽度(PDW)-静脉血: 14.2%；凝血酶原时间活动度(PTA)-静脉血: 90.4%；乳酸脱氢酶(LDH)-静脉血: 359.7U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32.3pg；ABO血型-静脉血: B；总钙(Ca)-静脉血: 2.3mmol/L；镁离子(Mg2+)-静脉血: 0.99mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 146g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；γ-谷氨酰基转移酶(GGT)-静脉血: 14.6U/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.1mmol/L；Rh血型-静脉血: 阳性；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.009；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 1.02；中性粒细胞计数(Neut#)-静脉血: 2.310E9/L；纤维蛋白原降解产物(FDP)-静脉血: 0.6ug/ml\n- [全程D5] 检验组合: 乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阳性(+)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D6] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、双侧壁明显不均匀增厚，平扫T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，双侧咽隐窝变浅，双侧咽旁脂肪间隙稍狭窄；双侧腭帆提肌、腭帆张肌、头长肌受压。双侧咽后见肿大淋巴结，左侧较大者短径11mm，右侧较大者短径12mm。 双侧后鼻孔堵塞，口咽双侧壁未见受累增厚。 双侧翼腭窝、颞下窝未见异常。 蝶骨基底部、斜坡、双侧岩尖、双侧枕骨基底部骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽；双侧筛窦、蝶窦，右乳突内见积液；上颌窦、左乳突充气良好，骨壁完整；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双颈II区、右颈III、IV区见淋巴结肿大，部分融合，较大者短径28mm，信号欠均匀，增强较明显不均匀强化。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。；检查结论: 鼻咽顶壁、顶后壁、双侧壁明显不均匀增厚，考虑鼻咽癌。 颅底骨质破坏。 双侧咽后、双颈部多发淋巴结肿大，考虑转移瘤。 副鼻窦炎；右乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见: 左颈II区可见多个大小不一肿大淋巴结，最大约22mm×12mm，边界清，椭圆形，内部回声均匀，后方回声稍增强，淋巴门未探及。 CDFI:上述淋巴结内可见周边型血流信号。 左颈淋巴结穿刺活检： 常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以16G穿刺针穿刺入左颈肿物内，进针2次，取出长约2cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。；检查结论: 左侧颈部肿大淋巴结穿刺活检。 不适随诊。 4个工作日后凭发票到2号楼6楼病理科取结果。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善中心静脉置管，直接行根治性同期放化疗\nB. 完善中心静脉置管，行诱导化疗序贯单纯根治性放疗\nC. 完善中心静脉置管，行诱导化疗序贯根治性同期放化疗\nD. 完善中心静脉置管，行诱导化疗序贯根治性同期放化疗及辅助化疗\nE. 完善中心静脉置管，行诱导化疗联合PD-1单抗序贯根治性同期放化疗\nF. 完善中心静脉置管，直接行根治性同期放化疗及辅助化疗\nG. 完善中心静脉置管，行诱导化疗序贯根治性放疗联合EGFR单抗\nH. 完善中心静脉置管，行诱导化疗，放疗前行右颈部淋巴结清扫术\nI. 完善中心静脉置管，行姑息性化疗，视颈部淋巴结退缩情况决定放疗时机\nJ. 完善中心静脉置管，直接行根治性放疗联合EGFR单抗\nK. 完善中心静脉置管，行诱导化疗序贯根治性放疗及辅助化疗\nL. 完善中心静脉置管，行诱导化疗联合EGFR单抗序贯单纯根治性放疗\n\n请仅输出一个选项字母（A-L）。","gold_letter":"C","gold_action":"完善中心静脉置管，行诱导化疗序贯根治性同期放化疗","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"完善中心静脉置管，直接行根治性同期放化疗"},{"letter":"B","text":"完善中心静脉置管，行诱导化疗序贯单纯根治性放疗"},{"letter":"C","text":"完善中心静脉置管，行诱导化疗序贯根治性同期放化疗"},{"letter":"D","text":"完善中心静脉置管，行诱导化疗序贯根治性同期放化疗及辅助化疗"},{"letter":"E","text":"完善中心静脉置管，行诱导化疗联合PD-1单抗序贯根治性同期放化疗"},{"letter":"F","text":"完善中心静脉置管，直接行根治性同期放化疗及辅助化疗"},{"letter":"G","text":"完善中心静脉置管，行诱导化疗序贯根治性放疗联合EGFR单抗"},{"letter":"H","text":"完善中心静脉置管，行诱导化疗，放疗前行右颈部淋巴结清扫术"},{"letter":"I","text":"完善中心静脉置管，行姑息性化疗，视颈部淋巴结退缩情况决定放疗时机"},{"letter":"J","text":"完善中心静脉置管，直接行根治性放疗联合EGFR单抗"},{"letter":"K","text":"完善中心静脉置管，行诱导化疗序贯根治性放疗及辅助化疗"},{"letter":"L","text":"完善中心静脉置管，行诱导化疗联合EGFR单抗序贯单纯根治性放疗"}]}
+{"sample_id":"sample-6fc96ea65282f416f15f852e","patient_id":"patient-9fcde7a95f4d57501ecbf7b2","turn_id":"turn06","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D1] 入院记录: 主诉: 右颈肿物半年，右耳听力下降半月；现病史: 缘于6月前患者无意中出现右颈肿物，未予重视，进行性增大，半月前出现右耳听力下降，无头痛、复视，无涕血、面麻等，就诊于当地医院，发现鼻咽肿物。今为求进一步诊治来我院。患者发病以来,精神、饮食、睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟20支/日*5年，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.3℃，P：79次/分，R：20次/分，BP：105/65mmHg,Ht：168cm，Wt：56kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率79次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D20] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右旁T7椎体横突水平，估计位于上腔静脉内。；检查结论: PICC管位置如上所述。\n- [全程D20] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 24mm AO 28mm MV E 0.53m/s EF 63% LV 37mm IVS 8mm A 0.41m/s FS 34% RA 35mm LVPW 6mm RV 16mm PA 14mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 心脏结构及运动未见异常 各房室腔及大血管未探及异常血流信号 心功能正常\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D21] 检验组合: 隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；酮体(KET)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；比重(SG)-尿液: 1.021；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D22] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 5.5；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.012；颜色-尿液: Light-Yellow；隐血(OB)-尿液: -（参考: 阴性）\n- [全程D28] 检验组合: 钠离子(Na+)-静脉血: 138.4mmol/L；胱抑素(Cys-C)-静脉血: 0.85mg/L；葡萄糖(Glu)-静脉血: 4.19mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；碱性磷酸酶(ALP)-静脉血: 77.2U/L；尿素氮(BUN)-静脉血: 4.1mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 32.5pg；淋巴细胞百分比(Lymph%)-静脉血: 0.13；C-反应蛋白(CRP)-静脉血: 2.54mg/L；氯离子(Cl-)-静脉血: 98.1mmol/L；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.64；阴离子间隙(AG)-静脉血: 16；红细胞比容(Hct)-静脉血: 43.3%；磷(P)-静脉血: 1.38mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.695；血液二氧化碳含量ctCO2(B)-静脉血: 24.3mmol/L；总胆汁酸(TBA)-静脉血: 2.1umol/L；总钙(Ca)-静脉血: 2.12mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 32.1U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.86；γ-谷氨酰基转移酶(GGT)-静脉血: 21.1U/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；甘油三酯(TG)-静脉血: 0.75mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；载脂蛋白B(apoB)-静脉血: 0.58g/L；直接胆红素(DBIL)-静脉血: 4.7umol/L；乳酸脱氢酶(LDH)-静脉血: 269.3U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 36.1U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；平均红细胞体积(MCV)-静脉血: 95.9fL；单核细胞百分比(Mono%)-静脉血: 0.13；总胆固醇(TC)-静脉血: 2.75mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339g/L；球蛋白(GLO)-静脉血: 21.89g/L；肌酐(Crea)-静脉血: 63.3umol/L；血小板分布宽度(PDW)-静脉血: 16.7%；白细胞计数(WBC#)-静脉血: 5.1710E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.43mmol/L；镁离子(Mg2+)-静脉血: 0.91mmol/L；血红蛋白(Hb)-静脉血: 146.9g/L；有核红细胞百分比(NRBC%)-静脉血: 0；尿酸(UA)-静脉血: 248.4umol/L\n- [全程D35] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；镁离子(Mg2+)-静脉血: 0.88mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44；载脂蛋白B(apoB)-静脉血: 0.56g/L；钠离子(Na+)-静脉血: 143.1mmol/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞比容(Hct)-静脉血: 37.1%；甘油三酯(TG)-静脉血: 0.68mmol/L；葡萄糖(Glu)-静脉血: 4.35mmol/L；C-反应蛋白(CRP)-静脉血: 16.07mg/L；平均血小板体积(MPV)-静脉血: 11.3fL；血红蛋白(Hb)-静脉血: 125g/L；载脂蛋白AI(apoAI)-静脉血: 0.89g/L；红细胞计数(RBC#)-静脉血: 3.9410E12/L；血小板比容-静脉血: 10%；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；血小板计数(PLT#)-静脉血: 8910E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.14；天门冬氨酸氨基转移酶(AST)-静脉血: 16U/L；丙氨酸氨基转移酶(ALT)-静脉血: 16.4U/L；总钙(Ca)-静脉血: 2.03mmol/L；钾离子(K+)-静脉血: 3.4mmol/L；磷(P)-静脉血: 1.05mmol/L；白蛋白(ALB)-静脉血: 36.3g/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 337g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；直接胆红素(DBIL)-静脉血: 5.4umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 94.2fL；氯离子(Cl-)-静脉血: 105.6mmol/L；肌酐(Crea)-静脉血: 70umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；胱抑素(Cys-C)-静脉血: 0.85mg/L；球蛋白(GLO)-静脉血: 21.19g/L；间接胆红素(IBIL)-静脉血: 5.9umolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.58mmol/L；总蛋白(TP)-静脉血: 57.49g/L；总胆汁酸(TBA)-静脉血: 1.5umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.7mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 25U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 14.2U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L\n\n【既往治疗与反应】\n- [全程D14] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉右耳听力下降，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。上级医师信息已隐藏，指示尽快完成放疗计划，遵嘱执行。\n- [全程D19] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉右耳听力下降，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。上级医师信息已隐藏，考虑患者放疗计划即将完成，指示可提前2天先予以化疗，指示今日予以DDP方案化疗第1程，做好水化、护胃、止呕等对症支持处理，密切观察化疗中副反应，遵嘱执行。\n- [全程D24] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉恶心，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，较前缩小，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。上级医师信息已隐藏，认为患者化疗顺利完成，指示继续放疗，密切观察放疗中副反应，遵嘱执行。\n- [全程D29] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，未诉特殊不适，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，较前缩小，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。上级医师信息已隐藏，指示继续放疗，密切观察放疗中副反应，遵嘱执行。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，予以重组人血小板生成素（rhTPO）皮下注射，待血小板恢复后继续放疗。\nB. 继续放疗，予以重组人白介素-11（rhIL-11）皮下注射，复查血常规与生化常规。\nC. 暂停放疗，输注单采血小板1个治疗量，复查血常规与生化常规。\nD. 继续放疗，予以重组人粒细胞集落刺激因子（rhG-CSF）皮下注射，复查血常规。\nE. 继续放疗，予以洗鼻、免疫调节/辅助支持（如香菇多糖）及动静脉置管护理，复查血常规与生化常规。\nF. 暂停放疗，予以促红细胞生成素（EPO）皮下注射，待血红蛋白恢复后继续放疗。\nG. 继续放疗，予以低分子肝素皮下注射预防血栓，复查凝血功能与血常规。\nH. 暂停放疗，予以甲泼尼龙静脉滴注提升血小板，复查血常规与生化常规。\nI. 继续放疗，予以静脉输注人免疫球蛋白（IVIG），复查血常规与生化常规。\nJ. 终止放疗，予以单药化疗维持，配合洗鼻及动静脉置管护理。\nK. 继续放疗，予以重组人血小板生成素与重组人粒细胞集落刺激因子联合皮下注射。\nL. 暂停放疗，予以洗鼻及动静脉置管护理，暂不予升血小板药物干预。\n\n请仅输出一个选项字母（A-L）。","gold_letter":"E","gold_action":"继续放疗，予以洗鼻、免疫调节/辅助支持（如香菇多糖）及动静脉置管护理，复查血常规与生化常规。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"暂停放疗，予以重组人血小板生成素（rhTPO）皮下注射，待血小板恢复后继续放疗。"},{"letter":"B","text":"继续放疗，予以重组人白介素-11（rhIL-11）皮下注射，复查血常规与生化常规。"},{"letter":"C","text":"暂停放疗，输注单采血小板1个治疗量，复查血常规与生化常规。"},{"letter":"D","text":"继续放疗，予以重组人粒细胞集落刺激因子（rhG-CSF）皮下注射，复查血常规。"},{"letter":"E","text":"继续放疗，予以洗鼻、免疫调节/辅助支持（如香菇多糖）及动静脉置管护理，复查血常规与生化常规。"},{"letter":"F","text":"暂停放疗，予以促红细胞生成素（EPO）皮下注射，待血红蛋白恢复后继续放疗。"},{"letter":"G","text":"继续放疗，予以低分子肝素皮下注射预防血栓，复查凝血功能与血常规。"},{"letter":"H","text":"暂停放疗，予以甲泼尼龙静脉滴注提升血小板，复查血常规与生化常规。"},{"letter":"I","text":"继续放疗，予以静脉输注人免疫球蛋白（IVIG），复查血常规与生化常规。"},{"letter":"J","text":"终止放疗，予以单药化疗维持，配合洗鼻及动静脉置管护理。"},{"letter":"K","text":"继续放疗，予以重组人血小板生成素与重组人粒细胞集落刺激因子联合皮下注射。"},{"letter":"L","text":"暂停放疗，予以洗鼻及动静脉置管护理，暂不予升血小板药物干预。"}]}
+{"sample_id":"sample-08d32abcf26a92c62d1dc762","patient_id":"patient-9fcde7a95f4d57501ecbf7b2","turn_id":"turn07","prompt":"你正在参与一名鼻咽癌相关患者的 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步提供。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。\n\n【已知病史与当前主诉】\n- [全程D1] 入院记录: 主诉: 右颈肿物半年，右耳听力下降半月；现病史: 缘于6月前患者无意中出现右颈肿物，未予重视，进行性增大，半月前出现右耳听力下降，无头痛、复视，无涕血、面麻等，就诊于当地医院，发现鼻咽肿物。今为求进一步诊治来我院。患者发病以来,精神、饮食、睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟20支/日*5年，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.3℃，P：79次/分，R：20次/分，BP：105/65mmHg,Ht：168cm，Wt：56kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率79次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D35] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；镁离子(Mg2+)-静脉血: 0.88mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44；载脂蛋白B(apoB)-静脉血: 0.56g/L；钠离子(Na+)-静脉血: 143.1mmol/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞比容(Hct)-静脉血: 37.1%；甘油三酯(TG)-静脉血: 0.68mmol/L；葡萄糖(Glu)-静脉血: 4.35mmol/L；C-反应蛋白(CRP)-静脉血: 16.07mg/L；平均血小板体积(MPV)-静脉血: 11.3fL；血红蛋白(Hb)-静脉血: 125g/L；载脂蛋白AI(apoAI)-静脉血: 0.89g/L；红细胞计数(RBC#)-静脉血: 3.9410E12/L；血小板比容-静脉血: 10%；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；血小板计数(PLT#)-静脉血: 8910E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.14；天门冬氨酸氨基转移酶(AST)-静脉血: 16U/L；丙氨酸氨基转移酶(ALT)-静脉血: 16.4U/L；总钙(Ca)-静脉血: 2.03mmol/L；钾离子(K+)-静脉血: 3.4mmol/L；磷(P)-静脉血: 1.05mmol/L；白蛋白(ALB)-静脉血: 36.3g/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 337g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；直接胆红素(DBIL)-静脉血: 5.4umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 94.2fL；氯离子(Cl-)-静脉血: 105.6mmol/L；肌酐(Crea)-静脉血: 70umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；胱抑素(Cys-C)-静脉血: 0.85mg/L；球蛋白(GLO)-静脉血: 21.19g/L；间接胆红素(IBIL)-静脉血: 5.9umolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.58mmol/L；总蛋白(TP)-静脉血: 57.49g/L；总胆汁酸(TBA)-静脉血: 1.5umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.7mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 25U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 14.2U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L\n- [全程D40] 检验组合: 钾离子(K+)-静脉血: 3.64mmol/L；血小板比容-静脉血: 12%；平均红细胞体积(MCV)-静脉血: 94.1fL；乳酸脱氢酶(LDH)-静脉血: 181.7U/L；碱性磷酸酶(ALP)-静脉血: 62.2U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.2；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.83mmolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.7；中性粒细胞计数(Neut#)-静脉血: 1.710E9/L；尿酸(UA)-静脉血: 230.6umol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.9pg；直接胆红素(DBIL)-静脉血: 3.3umol/L；磷(P)-静脉血: 1.27mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 13.3U/L；总胆固醇(TC)-静脉血: 2.44mmol/L；血小板分布宽度(PDW)-静脉血: 12%；平均血小板体积(MPV)-静脉血: 10.9fL；间接胆红素(IBIL)-静脉血: 3.9umolL；阴离子间隙(AG)-静脉血: 10.4；大血小板百分比(P-LCR%)-静脉血: 31.2%；镁离子(Mg2+)-静脉血: 0.87mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.028；低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.25mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 29.7mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.118；白细胞计数(WBC#)-静脉血: 2.4610E9/L；单核细胞百分比(Mono%)-静脉血: 0.179；单核细胞计数(Mono#)-静脉血: 0.410E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.16；丙氨酸氨基转移酶(ALT)-静脉血: 11.5U/L；C-反应蛋白(CRP)-静脉血: 17.05mg/L；白蛋白(ALB)-静脉血: 36.9g/L；总钙(Ca)-静脉血: 2.05mmol/L；总胆汁酸(TBA)-静脉血: 6.7umol/L；红细胞比容(Hct)-静脉血: 36.9%；葡萄糖(Glu)-静脉血: 5.02mmol/L；氯离子(Cl-)-静脉血: 102.1mmol/L；血小板计数(PLT#)-静脉血: 10510E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；球蛋白(GLO)-静脉血: 23.56g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；载脂蛋白B(apoB)-静脉血: 0.54g/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 13.4U/L；肌酐(Crea)-静脉血: 67.9umol/L\n- [全程D42] 检验组合: 比重(SG)-尿液: 1.015；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 5；颜色-尿液: Light-Yellow；总蛋白(TP)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）\n- [全程D43] 检验组合: 颜色-尿液: Yellow；总蛋白(TP)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酮体(KET)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 10/μL；酸碱度(pH)-尿液: 5.5；胆红素(BIL)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 2/μL；比重(SG)-尿液: 1.02；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D46] 检验组合: 红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8%；间接胆红素(IBIL)-静脉血: 5.4umolL；尿酸(UA)-静脉血: 292.3umol/L；血小板分布宽度(PDW)-静脉血: 16.6%；磷(P)-静脉血: 1.39mmol/L；白细胞计数(WBC#)-静脉血: 3.2610E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 29.4U/L；中性粒细胞计数(Neut#)-静脉血: 2.510E9/L；总钙(Ca)-静脉血: 2.23mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 33pg；低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.63mmol/L；阴离子间隙(AG)-静脉血: 12；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.7；钠离子(Na+)-静脉血: 142mmol/L；钾离子(K+)-静脉血: 3.3mmol/L；氯离子(Cl-)-静脉血: 97.5mmol/L；白蛋白(ALB)-静脉血: 42.8g/L；总胆汁酸(TBA)-静脉血: 2.9umol/L；单核细胞百分比(Mono%)-静脉血: 0.143；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞比容(Hct)-静脉血: 40.8%；肌酐(Crea)-静脉血: 84.7umol/L；碱性磷酸酶(ALP)-静脉血: 64.7U/L；尿素氮(BUN)-静脉血: 5.06mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；总胆红素(TBIL)-静脉血: 9.3umol/L；载脂蛋白B(apoB)-静脉血: 0.65g/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；葡萄糖(Glu)-静脉血: 5.63mmol/L；球蛋白(GLO)-静脉血: 24.97g/L；C-反应蛋白(CRP)-静脉血: 6.22mg/L；镁离子(Mg2+)-静脉血: 0.97mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；α-L-岩藻糖苷酶(AFU)-静脉血: 40U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.009；平均红细胞血红蛋白浓度(MCHC)-静脉血: 342.2g/L；载脂蛋白AI(apoAI)-静脉血: 0.96g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 28.7U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血小板比容-静脉血: 12.4%；中性粒细胞百分比(Neut%)-静脉血: 0.765；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.85mmolL；平均红细胞体积(MCV)-静脉血: 96.6fL；胱抑素(Cys-C)-静脉血: 1.13mg/L；总蛋白(TP)-静脉血: 67.77g/L\n- [全程D56] 检验组合: 碱性磷酸酶(ALP)-静脉血: 64.1U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；钾离子(K+)-静脉血: 3.65mmol/L；总蛋白(TP)-静脉血: 62.2g/L；血液二氧化碳含量ctCO2(B)-静脉血: 32mmol/L；胱抑素(Cys-C)-静脉血: 0.81mg/L；钠离子(Na+)-静脉血: 139.1mmol/L；红细胞比容(Hct)-静脉血: 38.2%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.5；载脂蛋白B(apoB)-静脉血: 0.72g/L；阴离子间隙(AG)-静脉血: 7.6；平均血小板体积(MPV)-静脉血: 10.7fL；丙氨酸氨基转移酶(ALT)-静脉血: 8.1U/L；中性粒细胞百分比(Neut%)-静脉血: 0.707；低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.56mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 13.8U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.69mmolL；总胆固醇(TC)-静脉血: 2.82mmol/L；总胆红素(TBIL)-静脉血: 9.5umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 14U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；乳酸脱氢酶(LDH)-静脉血: 146.4U/L；单核细胞百分比(Mono%)-静脉血: 0.202；血小板分布宽度(PDW)-静脉血: 12.5%；α-L-岩藻糖苷酶(AFU)-静脉血: 22.8U/L；肌酐(Crea)-静脉血: 73.2umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；磷(P)-静脉血: 1.17mmol/L；氯离子(Cl-)-静脉血: 99.5mmol/L；尿素氮(BUN)-静脉血: 4.3mmol/L；血小板比容-静脉血: 11%；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；总胆汁酸(TBA)-静脉血: 3.7umol/L；甘油三酯(TG)-静脉血: 0.85mmol/L；间接胆红素(IBIL)-静脉血: 5.5umolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.7；直接胆红素(DBIL)-静脉血: 4umol/L；总钙(Ca)-静脉血: 2.1mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 338g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.067；大血小板百分比(P-LCR%)-静脉血: 28.9%；载脂蛋白AI(apoAI)-静脉血: 0.73g/L；C-反应蛋白(CRP)-静脉血: 26.78mg/L；镁离子(Mg2+)-静脉血: 0.83mmol/L\n- [全程D62] 检验组合: 细菌涂片3-咽拭子: 未发现念珠状菌\n- [全程D63] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径10mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约27cm/s。 胆囊餐后改变，胆囊内可见一强回声团，直径约9mm，后方伴声影。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约33×27×24mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 胆囊结石。 肝脏、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n\n【既往治疗与反应】\n- [全程D42] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉咽痛，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。BR、生化常规大致正常。上级医师信息已隐藏，考虑患者上次化疗已达3周，指示今日按[计划性表述已隐藏]以DDP方案化疗第二程，做好水化、护肝等对症支持处理，继续放疗，密切观察放化疗副反应，遵嘱执行。\n- [全程D47] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉咽痛，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。上级医师信息已隐藏，认为患者化疗顺利完成，指示继续放疗，密切观察放疗副反应，遵嘱执行。\n- [全程D52] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉咽痛，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。上级医师信息已隐藏，指示予以止痛、口腔粘膜保护对症处理，加强营养支持，继续放疗。\n- [全程D57] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，未诉明显特殊不适，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。上级医师信息已隐藏，指示继续放疗，遵嘱执行。\n- [全程D61] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，未诉明显特殊不适，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。上级医师信息已隐藏，考虑患者化疗即将到期，建议患者行第三程化疗，但患者拒绝，遂指示今日予以出院，于门诊继续放疗，遵嘱执行。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 强制收治入院完成第三程同期化疗，期间暂停放疗，待化疗结束后恢复放疗。\nB. 取消第三程同期化疗，加用西妥昔单抗靶向治疗联合放疗，放疗结束后行疗效评估。\nC. 提前终止放疗，行全身PET-CT及头颈部MRI评估，视肿瘤退缩情况决定后续辅助化疗方案。\nD. 取消第三程同期化疗，下调原定放疗处方剂量以减轻黏膜反应，放疗结束后即刻行鼻咽镜活检。\nE. 安排入院行TPF方案补充化疗，同时继续放疗，放疗结束后行全面疗效评估。\nF. 取消第三程同期化疗，按原计划完成根治性放疗，胆囊结石暂予观察，放疗结束后择期行全面疗效评估。\nG. 请普外科急会诊行腹腔镜胆囊切除术，术后择期恢复放疗，并取消后续化疗。\nH. 改用口服卡培他滨单药替代静脉化疗，继续门诊放疗，放疗结束后行辅助化疗。\nI. 立即行鼻咽及颈部MRI复查，若肿瘤已完全消退则提前结束放疗，进入随访阶段。\nJ. 取消第三程同期化疗，增加放疗靶区外扩范围及处方剂量，放疗结束后择期行全面疗效评估。\nK. 暂停放疗，待咽痛及口腔黏膜反应完全缓解后再恢复放疗，并补充第三程化疗。\nL. 采用中药及针灸治疗替代第三程化疗，继续门诊放疗，放疗结束后常规行全身骨扫描。\n\n请仅输出一个选项字母（A-L）。","gold_letter":"F","gold_action":"取消第三程同期化疗，按原计划完成根治性放疗，胆囊结石暂予观察，放疗结束后择期行全面疗效评估。","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":[{"letter":"A","text":"强制收治入院完成第三程同期化疗，期间暂停放疗，待化疗结束后恢复放疗。"},{"letter":"B","text":"取消第三程同期化疗，加用西妥昔单抗靶向治疗联合放疗，放疗结束后行疗效评估。"},{"letter":"C","text":"提前终止放疗，行全身PET-CT及头颈部MRI评估，视肿瘤退缩情况决定后续辅助化疗方案。"},{"letter":"D","text":"取消第三程同期化疗，下调原定放疗处方剂量以减轻黏膜反应，放疗结束后即刻行鼻咽镜活检。"},{"letter":"E","text":"安排入院行TPF方案补充化疗，同时继续放疗，放疗结束后行全面疗效评估。"},{"letter":"F","text":"取消第三程同期化疗，按原计划完成根治性放疗，胆囊结石暂予观察，放疗结束后择期行全面疗效评估。"},{"letter":"G","text":"请普外科急会诊行腹腔镜胆囊切除术，术后择期恢复放疗，并取消后续化疗。"},{"letter":"H","text":"改用口服卡培他滨单药替代静脉化疗，继续门诊放疗，放疗结束后行辅助化疗。"},{"letter":"I","text":"立即行鼻咽及颈部MRI复查，若肿瘤已完全消退则提前结束放疗，进入随访阶段。"},{"letter":"J","text":"取消第三程同期化疗，增加放疗靶区外扩范围及处方剂量，放疗结束后择期行全面疗效评估。"},{"letter":"K","text":"暂停放疗，待咽痛及口腔黏膜反应完全缓解后再恢复放疗，并补充第三程化疗。"},{"letter":"L","text":"采用中药及针灸治疗替代第三程化疗，继续门诊放疗，放疗结束后常规行全身骨扫描。"}]}
+{"sample_id":"sample-fb530d32740ae5581f0e5a0d","patient_id":"patient-8e2d677e2677ad4a75d70dcb","episode_id":"episode-cbd48024353d8acfd3ec8d52","turn_id":"P5_01","turn_number":5,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM：{{TNM_STATUS}}；总分期：{{OVERALL_STAGE}}。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；病历特点: 患者A，女，31岁，因\"复视18日\"于既往时点，步行入院。患者A，精神可，饮食略有下降，睡眠一般，时有便秘，小便正常，体重减轻2千克。3、肿瘤专科检查:张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部II区及Va区各扪及1个淋巴结，最大径2×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查:VI（+）。 【病理资料1】（鼻咽部鼻粘膜，活检）结合形态及原单位免疫组化等结果，病变符合未分化型非角化性癌。 原单位免疫组化结果标本01：S100（-），SMA（-），AE1/AE3（+），P63（+），P53（+++），CK5/6（+），Ki67（约70%+），EGFR（+）。 原单位原位杂交结果标本01：EBER（+）。；活检部位: 鼻咽；肿瘤部位: 鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁、后壁及双侧壁粘膜增厚放射性分布浓聚，SUV约12.6，病灶侵犯蝶窦、双侧颈动脉管、双侧破裂孔、鼻中隔后份、颅底骨（蝶鞍、蝶骨基底部、枕骨斜坡、左蝶骨大翼、双侧翼突、双侧岩尖、枕骨基底部、双侧枕髁）、双侧舌下神经管、双侧腭帆肌群及双侧头长肌。右咽后未见肿大淋巴结及异常放射性分布。右乳突内低密度影放射性分布未见异常。额窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。口咽、喉咽未见明显异常。甲状腺放射性分布未见异常。左咽后、右颈Ⅱ-Ⅴ区及左颈Ⅱ、Ⅲ、Ⅴ区多个淋巴结放射性浓聚，SUV约15.7，最大约1.7×2.6cm；余双颈小淋巴结放射性分布未见异常。 双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺纹理清晰，双侧肺野未见确切病灶和异常放射性分布。气管、支气管通畅。双侧乳腺未见确切病灶及异常放射性分布。心脏及大血管放射性分布未见异常。食管放射性分布未见明显异常。胸壁未见确切病灶和异常放射性分布。双肺门、纵隔及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝S8点状致密影放射性分布缺损；余肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管及胆总管未见扩张。胆囊、胃及十二指肠放射性分布未见异常。脾脏、胰腺、双肾及双侧肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 子宫内膜放射性分布略浓密（生理性摄取）；膀胱、肠管等形态、结构及放射性分布未见明显异常。右髂外血管旁小淋巴结放射性分布浓密，SUV约3.3，大小约0.5×0.9cm。左侧髂血管旁及双侧腹股沟小淋巴结放射性分布未见明显异常。 骶骨小片状致密影放射性分布未见异常（骨岛）；余颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，病灶侵犯范围如上所述；左咽后、右颈Ⅱ-Ⅴ区及左颈Ⅱ、Ⅲ、Ⅴ区多个淋巴结代谢活跃，考虑转移。 肝内胆管结石. 右髂外血管旁小淋巴结代谢较活跃，疑炎性病变，建议随诊。；检查部位: 全身；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 26.0 ；报告日期: 既往时点；检查名称: 颈部磁共振平扫＋增强（3.0T及以上）(套)；检查所见: 鼻咽腔狭窄，鼻咽双侧顶壁、双侧顶后壁、双侧后壁、双侧壁增厚，明显强化。双侧咽隐窝受侵。 双侧腭帆提肌、双侧头长肌受侵。余咽旁肌未见明显异常。 双侧翼突基底部、蝶骨基底部、斜坡、双侧岩尖、双侧枕骨基底部、寰椎受侵，余颅底骨质未见明显异常。蝶窦受侵。 双侧破裂孔、双侧圆孔、双侧舌下神经孔受侵。 双侧海绵窦、双侧颈静脉孔受侵。 双侧咽后见多个淋巴结，大者短径9mm，明显强化，可见融合。 颈部双侧II区、双侧III区、右侧IV区、右侧V区见多个肿大淋巴结，大者短径17mm，明显强化，可见融合、中央坏死。 双侧上颌窦、双侧筛窦、双侧蝶窦粘膜增厚。右侧乳突见少量分泌物。双侧腮腺、颌下腺、甲状腺未见占位病变。；检查结论: 鼻咽病变，考虑鼻咽癌；双侧海绵窦、双侧颈静脉孔受侵。 颅底骨质破坏。 双侧咽后多个淋巴结，考虑转移。 颈部双侧II区、双侧III区、右侧IV区、右侧V区见多个肿大淋巴结，考虑转移。 副鼻窦炎；右侧乳突炎。；检查部位: 颈部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 17.0；是否区域复发: 否 【治疗经过1】报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁、后壁及双侧壁粘膜增厚放射性分布浓聚，SUV约12.6，病灶侵犯蝶窦、双侧颈动脉管、双侧破裂孔、鼻中隔后份、颅底骨（蝶鞍、蝶骨基底部、枕骨斜坡、左蝶骨大翼、双侧翼突、双侧岩尖、枕骨基底部、双侧枕髁）、双侧舌下神经管、双侧腭帆肌群及双侧头长肌。右咽后未见肿大淋巴结及异常放射性分布。右乳突内低密度影放射性分布未见异常。额窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。口咽、喉咽未见明显异常。甲状腺放射性分布未见异常。左咽后、右颈Ⅱ-Ⅴ区及左颈Ⅱ、Ⅲ、Ⅴ区多个淋巴结放射性浓聚，SUV约15.7，最大约1.7×2.6cm；余双颈小淋巴结放射性分布未见异常。 双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺纹理清晰，双侧肺野未见确切病灶和异常放射性分布。气管、支气管通畅。双侧乳腺未见确切病灶及异常放射性分布。心脏及大血管放射性分布未见异常。食管放射性分布未见明显异常。胸壁未见确切病灶和异常放射性分布。双肺门、纵隔及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝S8点状致密影放射性分布缺损；余肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管及胆总管未见扩张。胆囊、胃及十二指肠放射性分布未见异常。脾脏、胰腺、双肾及双侧肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 子宫内膜放射性分布略浓密（生理性摄取）；膀胱、肠管等形态、结构及放射性分布未见明显异常。右髂外血管旁小淋巴结放射性分布浓密，SUV约3.3，大小约0.5×0.9cm。左侧髂血管旁及双侧腹股沟小淋巴结放射性分布未见明显异常。 骶骨小片状致密影放射性分布未见异常（骨岛）；余颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，病灶侵犯范围如上所述；左咽后、右颈Ⅱ-Ⅴ区及左颈Ⅱ、Ⅲ、Ⅴ区多个淋巴结代谢活跃，考虑转移。 肝内胆管结石. 右髂外血管旁小淋巴结代谢较活跃，疑炎性病变，建议随诊。；检查部位: 全身；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 26.0\n报告日期: 既往时点；检查名称: 颈部磁共振平扫＋增强（3.0T及以上）(套)；检查所见: 鼻咽腔狭窄，鼻咽双侧顶壁、双侧顶后壁、双侧后壁、双侧壁增厚，明显强化。双侧咽隐窝受侵。 双侧腭帆提肌、双侧头长肌受侵。余咽旁肌未见明显异常。 双侧翼突基底部、蝶骨基底部、斜坡、双侧岩尖、双侧枕骨基底部、寰椎受侵，余颅底骨质未见明显异常。蝶窦受侵。 双侧破裂孔、双侧圆孔、双侧舌下神经孔受侵。 双侧海绵窦、双侧颈静脉孔受侵。 双侧咽后见多个淋巴结，大者短径9mm，明显强化，可见融合。 颈部双侧II区、双侧III区、右侧IV区、右侧V区见多个肿大淋巴结，大者短径17mm，明显强化，可见融合、中央坏死。 双侧上颌窦、双侧筛窦、双侧蝶窦粘膜增厚。右侧乳突见少量分泌物。双侧腮腺、颌下腺、甲状腺未见占位病变。；检查结论: 鼻咽病变，考虑鼻咽癌；双侧海绵窦、双侧颈静脉孔受侵。 颅底骨质破坏。 双侧咽后多个淋巴结，考虑转移。 颈部双侧II区、双侧III区、右侧IV区、右侧V区见多个肿大淋巴结，考虑转移。 副鼻窦炎；右侧乳突炎。；检查部位: 颈部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 17.0；是否区域复发: 否 【治疗反应与不良反应1】记录时间: 既往时点；病程主题: 上级查房记录；病程内容: 患者PF方案化疗后，食欲稍差，间恶心，无呕吐、腹痛腹泻等不适，一般情况尚好。 上级医生A查房后示，患者治疗过程顺利，可于今日办理出院。；客观检验：丙氨酸氨基转移酶(ALT)-静脉血：62.6U/L（高于参考范围，参考约7-40U/L）\n\n【当前需要决策的问题】\n治疗开始后约第6天，本患者出现第1个独立的黏膜及胃肠毒性里程碑：记录时间: 既往时点；病程主题: 上级查房记录；病程内容: 患者PF方案化疗后，食欲稍差，间恶心，无呕吐、腹痛腹泻等不适，一般情况尚好。 上级医生A查房后示，患者治疗过程顺利，可于今日办理出院。；客观检验：丙氨酸氨基转移酶(ALT)-静脉血：62.6U/L（高于参考范围，参考约7-40U/L）。该事件最符合哪类治疗相关毒性，当前应采取怎样的支持处理、监测及治疗节奏调整？\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 按黏膜/胃肠毒性分级给予止吐、镇痛、补液和营养支持，并监测进食与体重\nB. 忽略当前异常并按原剂量、原时间继续治疗，不增加复查\nC. 永久停止全部抗肿瘤治疗，不再判断毒性是否可逆\nD. 立即提高化疗剂量，以补偿既往可能损失的剂量强度\nE. 仅复查肿瘤影像，不复查血常规、生化或相关器官功能\nF. 直接改为另一套强化联合方案，不等待毒性恢复\nG. 仅口头安慰并观察，不给予症状处理或近期监测\nH. 把当前异常判断为疾病进展并立即进入后线挽救治疗\nI. 仅依据一次EBV-DNA结果决定停药或换药\nJ. 继续原方案并取消止吐、补液或营养等支持治疗\nK. 立即扩大放疗范围，将所有不适均按肿瘤侵犯处理\nL. 三个月后再复查当前异常，期间不调整治疗节奏\n\n请仅输出一个选项字母（A-L）。","gold_letter":"A","gold_action":"按黏膜/胃肠毒性分级给予止吐、镇痛、补液和营养支持，并监测进食与体重","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":{"A":"按黏膜/胃肠毒性分级给予止吐、镇痛、补液和营养支持，并监测进食与体重","B":"忽略当前异常并按原剂量、原时间继续治疗，不增加复查","C":"永久停止全部抗肿瘤治疗，不再判断毒性是否可逆","D":"立即提高化疗剂量，以补偿既往可能损失的剂量强度","E":"仅复查肿瘤影像，不复查血常规、生化或相关器官功能","F":"直接改为另一套强化联合方案，不等待毒性恢复","G":"仅口头安慰并观察，不给予症状处理或近期监测","H":"把当前异常判断为疾病进展并立即进入后线挽救治疗","I":"仅依据一次EBV-DNA结果决定停药或换药","J":"继续原方案并取消止吐、补液或营养等支持治疗","K":"立即扩大放疗范围，将所有不适均按肿瘤侵犯处理","L":"三个月后再复查当前异常，期间不调整治疗节奏"}}
+{"sample_id":"sample-54afd4d027293e937b4fd07a","patient_id":"patient-8e2d677e2677ad4a75d70dcb","episode_id":"episode-cbd48024353d8acfd3ec8d52","turn_id":"P5_03","turn_number":7,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM：{{TNM_STATUS}}；总分期：{{OVERALL_STAGE}}。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；病历特点: 患者A，女，31岁，因\"复视18日\"于既往时点，步行入院。患者A，精神可，饮食略有下降，睡眠一般，时有便秘，小便正常，体重减轻2千克。3、肿瘤专科检查:张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部II区及Va区各扪及1个淋巴结，最大径2×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查:VI（+）。 【病理资料1】（鼻咽部鼻粘膜，活检）结合形态及原单位免疫组化等结果，病变符合未分化型非角化性癌。 原单位免疫组化结果标本01：S100（-），SMA（-），AE1/AE3（+），P63（+），P53（+++），CK5/6（+），Ki67（约70%+），EGFR（+）。 原单位原位杂交结果标本01：EBER（+）。；活检部位: 鼻咽；肿瘤部位: 鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁、后壁及双侧壁粘膜增厚放射性分布浓聚，SUV约12.6，病灶侵犯蝶窦、双侧颈动脉管、双侧破裂孔、鼻中隔后份、颅底骨（蝶鞍、蝶骨基底部、枕骨斜坡、左蝶骨大翼、双侧翼突、双侧岩尖、枕骨基底部、双侧枕髁）、双侧舌下神经管、双侧腭帆肌群及双侧头长肌。右咽后未见肿大淋巴结及异常放射性分布。右乳突内低密度影放射性分布未见异常。额窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。口咽、喉咽未见明显异常。甲状腺放射性分布未见异常。左咽后、右颈Ⅱ-Ⅴ区及左颈Ⅱ、Ⅲ、Ⅴ区多个淋巴结放射性浓聚，SUV约15.7，最大约1.7×2.6cm；余双颈小淋巴结放射性分布未见异常。 双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺纹理清晰，双侧肺野未见确切病灶和异常放射性分布。气管、支气管通畅。双侧乳腺未见确切病灶及异常放射性分布。心脏及大血管放射性分布未见异常。食管放射性分布未见明显异常。胸壁未见确切病灶和异常放射性分布。双肺门、纵隔及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝S8点状致密影放射性分布缺损；余肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管及胆总管未见扩张。胆囊、胃及十二指肠放射性分布未见异常。脾脏、胰腺、双肾及双侧肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 子宫内膜放射性分布略浓密（生理性摄取）；膀胱、肠管等形态、结构及放射性分布未见明显异常。右髂外血管旁小淋巴结放射性分布浓密，SUV约3.3，大小约0.5×0.9cm。左侧髂血管旁及双侧腹股沟小淋巴结放射性分布未见明显异常。 骶骨小片状致密影放射性分布未见异常（骨岛）；余颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，病灶侵犯范围如上所述；左咽后、右颈Ⅱ-Ⅴ区及左颈Ⅱ、Ⅲ、Ⅴ区多个淋巴结代谢活跃，考虑转移。 肝内胆管结石. 右髂外血管旁小淋巴结代谢较活跃，疑炎性病变，建议随诊。；检查部位: 全身；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 26.0 ；报告日期: 既往时点；检查名称: 颈部磁共振平扫＋增强（3.0T及以上）(套)；检查所见: 鼻咽腔狭窄，鼻咽双侧顶壁、双侧顶后壁、双侧后壁、双侧壁增厚，明显强化。双侧咽隐窝受侵。 双侧腭帆提肌、双侧头长肌受侵。余咽旁肌未见明显异常。 双侧翼突基底部、蝶骨基底部、斜坡、双侧岩尖、双侧枕骨基底部、寰椎受侵，余颅底骨质未见明显异常。蝶窦受侵。 双侧破裂孔、双侧圆孔、双侧舌下神经孔受侵。 双侧海绵窦、双侧颈静脉孔受侵。 双侧咽后见多个淋巴结，大者短径9mm，明显强化，可见融合。 颈部双侧II区、双侧III区、右侧IV区、右侧V区见多个肿大淋巴结，大者短径17mm，明显强化，可见融合、中央坏死。 双侧上颌窦、双侧筛窦、双侧蝶窦粘膜增厚。右侧乳突见少量分泌物。双侧腮腺、颌下腺、甲状腺未见占位病变。；检查结论: 鼻咽病变，考虑鼻咽癌；双侧海绵窦、双侧颈静脉孔受侵。 颅底骨质破坏。 双侧咽后多个淋巴结，考虑转移。 颈部双侧II区、双侧III区、右侧IV区、右侧V区见多个肿大淋巴结，考虑转移。 副鼻窦炎；右侧乳突炎。；检查部位: 颈部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 17.0；是否区域复发: 否 【治疗经过1】报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁、后壁及双侧壁粘膜增厚放射性分布浓聚，SUV约12.6，病灶侵犯蝶窦、双侧颈动脉管、双侧破裂孔、鼻中隔后份、颅底骨（蝶鞍、蝶骨基底部、枕骨斜坡、左蝶骨大翼、双侧翼突、双侧岩尖、枕骨基底部、双侧枕髁）、双侧舌下神经管、双侧腭帆肌群及双侧头长肌。右咽后未见肿大淋巴结及异常放射性分布。右乳突内低密度影放射性分布未见异常。额窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。口咽、喉咽未见明显异常。甲状腺放射性分布未见异常。左咽后、右颈Ⅱ-Ⅴ区及左颈Ⅱ、Ⅲ、Ⅴ区多个淋巴结放射性浓聚，SUV约15.7，最大约1.7×2.6cm；余双颈小淋巴结放射性分布未见异常。 双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺纹理清晰，双侧肺野未见确切病灶和异常放射性分布。气管、支气管通畅。双侧乳腺未见确切病灶及异常放射性分布。心脏及大血管放射性分布未见异常。食管放射性分布未见明显异常。胸壁未见确切病灶和异常放射性分布。双肺门、纵隔及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝S8点状致密影放射性分布缺损；余肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管及胆总管未见扩张。胆囊、胃及十二指肠放射性分布未见异常。脾脏、胰腺、双肾及双侧肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 子宫内膜放射性分布略浓密（生理性摄取）；膀胱、肠管等形态、结构及放射性分布未见明显异常。右髂外血管旁小淋巴结放射性分布浓密，SUV约3.3，大小约0.5×0.9cm。左侧髂血管旁及双侧腹股沟小淋巴结放射性分布未见明显异常。 骶骨小片状致密影放射性分布未见异常（骨岛）；余颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，病灶侵犯范围如上所述；左咽后、右颈Ⅱ-Ⅴ区及左颈Ⅱ、Ⅲ、Ⅴ区多个淋巴结代谢活跃，考虑转移。 肝内胆管结石. 右髂外血管旁小淋巴结代谢较活跃，疑炎性病变，建议随诊。；检查部位: 全身；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 26.0\n报告日期: 既往时点；检查名称: 颈部磁共振平扫＋增强（3.0T及以上）(套)；检查所见: 鼻咽腔狭窄，鼻咽双侧顶壁、双侧顶后壁、双侧后壁、双侧壁增厚，明显强化。双侧咽隐窝受侵。 双侧腭帆提肌、双侧头长肌受侵。余咽旁肌未见明显异常。 双侧翼突基底部、蝶骨基底部、斜坡、双侧岩尖、双侧枕骨基底部、寰椎受侵，余颅底骨质未见明显异常。蝶窦受侵。 双侧破裂孔、双侧圆孔、双侧舌下神经孔受侵。 双侧海绵窦、双侧颈静脉孔受侵。 双侧咽后见多个淋巴结，大者短径9mm，明显强化，可见融合。 颈部双侧II区、双侧III区、右侧IV区、右侧V区见多个肿大淋巴结，大者短径17mm，明显强化，可见融合、中央坏死。 双侧上颌窦、双侧筛窦、双侧蝶窦粘膜增厚。右侧乳突见少量分泌物。双侧腮腺、颌下腺、甲状腺未见占位病变。；检查结论: 鼻咽病变，考虑鼻咽癌；双侧海绵窦、双侧颈静脉孔受侵。 颅底骨质破坏。 双侧咽后多个淋巴结，考虑转移。 颈部双侧II区、双侧III区、右侧IV区、右侧V区见多个肿大淋巴结，考虑转移。 副鼻窦炎；右侧乳突炎。；检查部位: 颈部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 17.0；是否区域复发: 否 【治疗反应与不良反应1】记录时间: 既往时点；病程主题: 上级查房记录；病程内容: 患者PF方案化疗后，食欲稍差，间恶心，无呕吐、腹痛腹泻等不适，一般情况尚好。 上级医生A查房后示，患者治疗过程顺利，可于今日办理出院。；客观检验：丙氨酸氨基转移酶(ALT)-静脉血：62.6U/L（高于参考范围，参考约7-40U/L） 【治疗反应与不良反应2】记录时间: 既往时点；病程主题: 上级查房记录；病程内容: 患者PF诱导化疗后，食欲稍差，间恶心，无呕吐、腹痛腹泻等不适，一般情况尚好。 上级医生A查房后示，患者治疗过程顺利，可于今日结账出院，定期复查血常规、肝肾功能；按时返院治疗；不适随诊。；客观检验：天门冬氨酸氨基转移酶(AST)-静脉血：37.8U/L（高于参考范围，参考约13-35U/L） || 丙氨酸氨基转移酶(ALT)-静脉血：54.7U/L（高于参考范围，参考约7-40U/L） 【治疗反应与不良反应3】记录时间: 既往时点；病程主题: 上级查房记录；病程内容: 患者一般情况可，未诉特殊不适。体查情况基本同前。目前患者放疗中14次，皮肤反应1度，黏膜反应2度，上级医生A示：按计划放疗，注意放疗期间反应，支持对症处理相关并发症。患者昨日充分水化，今日行顺铂同时期化疗第2程。；客观检验： … ，参考约125-350×10^9/L） || 血红蛋白(Hb)-静脉血：110 … -静脉血：91.0g/L（低于参考范围，参考约115-150g/L）\n\n【当前需要决策的问题】\n治疗开始后约第86天，本患者出现第3个独立的皮肤毒性里程碑：记录时间: 既往时点；病程主题: 上级查房记录；病程内容: 患者一般情况可，未诉特殊不适。体查情况基本同前。目前患者放疗中14次，皮肤反应1度，黏膜反应2度，上级医生A示：按计划放疗，注意放疗期间反应，支持对症处理相关并发症。患者昨日充分水化，今日行顺铂同时期化疗第2程。；客观检验：血小板计数(PLT#)-静脉血：103.0×10^9/L（低于参考范围，参考约125-350×10^9/L） || 血红蛋白(Hb)-静脉血：110.0g/L（低于参考范围，参考约115- … || 血红蛋白(Hb)-静脉血：91.0g/L（低于参考范围，参考约115-150g/L）。该事件最符合哪类治疗相关毒性，当前应采取怎样的支持处理、监测及治疗节奏调整？\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 忽略当前异常并按原剂量、原时间继续治疗，不增加复查\nB. 永久停止全部抗肿瘤治疗，不再判断毒性是否可逆\nC. 评估放射性或药物性皮肤反应分级，局部护理并据严重度调整治疗\nD. 立即提高化疗剂量，以补偿既往可能损失的剂量强度\nE. 仅复查肿瘤影像，不复查血常规、生化或相关器官功能\nF. 直接改为另一套强化联合方案，不等待毒性恢复\nG. 仅口头安慰并观察，不给予症状处理或近期监测\nH. 把当前异常判断为疾病进展并立即进入后线挽救治疗\nI. 仅依据一次EBV-DNA结果决定停药或换药\nJ. 继续原方案并取消止吐、补液或营养等支持治疗\nK. 立即扩大放疗范围，将所有不适均按肿瘤侵犯处理\nL. 三个月后再复查当前异常，期间不调整治疗节奏\n\n请仅输出一个选项字母（A-L）。","gold_letter":"C","gold_action":"评估放射性或药物性皮肤反应分级，局部护理并据严重度调整治疗","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":{"A":"忽略当前异常并按原剂量、原时间继续治疗，不增加复查","B":"永久停止全部抗肿瘤治疗，不再判断毒性是否可逆","C":"评估放射性或药物性皮肤反应分级，局部护理并据严重度调整治疗","D":"立即提高化疗剂量，以补偿既往可能损失的剂量强度","E":"仅复查肿瘤影像，不复查血常规、生化或相关器官功能","F":"直接改为另一套强化联合方案，不等待毒性恢复","G":"仅口头安慰并观察，不给予症状处理或近期监测","H":"把当前异常判断为疾病进展并立即进入后线挽救治疗","I":"仅依据一次EBV-DNA结果决定停药或换药","J":"继续原方案并取消止吐、补液或营养等支持治疗","K":"立即扩大放疗范围，将所有不适均按肿瘤侵犯处理","L":"三个月后再复查当前异常，期间不调整治疗节奏"}}
+{"sample_id":"sample-17d0e72650199ef8ee1a60fb","patient_id":"patient-b574ac1f42cd6a06d5a529d9","episode_id":"episode-1dbc81bede33e5dfc0ba5be8","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；病历特点: 患者A ，男，主因“一侧头痛、耳鸣20余天，回吸涕血5天。 ”于既往时点步行入院。 一.病例特点: 1、患者59岁 男性。 2、现病史:患者缘于20余天前无明显诱因出现一侧头痛症状，以左侧为甚，之后逐渐出现耳鸣症状，自服“中药”十余天无好转，5天开始出现回吸涕血症状，无视物模糊、无咽痛发热等其他不适，外院A就诊，既往时点查鼻咽颈部MR提示：鼻咽部所见，考虑鼻咽癌，并侵犯双侧头长肌、腭帆张肌、腭帆提肌、翼内肌可能，双侧颞骨岩尖、枕骨斜坡、蝶骨翼骨骨质破坏。 双侧颈部多发淋巴结。 现为求进一步诊治来本院。 患者发病以来，精神佳，饮食睡眠佳，大小便正常，近期体重无明显下降。 3、体格检查: T:36.9℃ P:72次/分 R:20次/分 BP:130/84 mmHg Ht: 167cm Wt: 55kg BSA: 1.6125m2 KPS:90 神智清楚，表情自然，发育正常，营养中等。 自主体位，检查合作。 皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。 浅表淋巴结见专科情况。 头颅五官无畸形，眼睑无浮肿，无下垂;巩膜无黄染，结膜无充血、无苍白;眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。 耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。 听力正常，鼓膜无穿孔。 鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。 口腔粘膜正常。 齿龈无红肿，扁桃体无肿大。 颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。 胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。 心前区无隆起，未触及震颤。 心率72次/分，心整齐，各瓣膜听诊区未闻及病理性杂音。 腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。 肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛;移动性浊音阴性，肠鸣音正常。 肛律门、外生殖器未查。 脊柱四肢无畸形，肌力、肌张力正常。 生理反射存在，病理神经反射未引出。 4. 【病理资料1】（左侧鼻咽肿物）镜检为未分化型非角化性癌。；活检部位: 左侧鼻咽；肿瘤部位: 左侧鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】报告日期: 既往时点；检查名称: 鼻咽部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 鼻咽腔狭窄，鼻咽双侧顶壁、双侧顶后壁、双侧后壁、双侧壁增厚，明显强化。双侧咽隐窝受侵。双侧后鼻道受侵； 双侧咽旁间隙受侵。双侧腭帆提肌、左侧腭帆张肌、双侧翼内肌、双侧头长肌受侵。余咽旁肌未见明显异常。 双侧翼突基底部、蝶骨基底部、斜坡、双侧岩尖、双侧枕骨基底部受侵，余颅底骨质未见明显异常。 双侧破裂孔受侵。 双侧海绵窦受侵。 双侧咽后见数个小淋巴结，大者短径4mm，明显强化，边界欠清。 颈部双侧未见明显肿大淋巴结。 双侧上颌窦、双侧筛窦、双侧蝶窦粘膜增厚。双侧乳突见少量分泌物。 甲状腺右侧叶见一结节，边界清，直径约11mm，T1WI呈等信号，T2WI呈稍高信号，增强扫描见强化。 双侧腮腺、颌下腺、喉部、所见脑实质未见明显异常。；检查结论: 鼻咽病变，考虑鼻咽癌；双侧海绵窦受侵。 颅底骨质破坏。 双侧咽后数个小淋巴结，考虑转移可能性大。 副鼻窦炎；双侧乳突炎。 甲状腺右侧叶结节，考虑结节性甲状腺肿可能性大。\n报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及双侧壁粘膜增厚形成软组织肿块影，放射性浓聚，SUV约21.7，突入左侧破裂孔及左颈动脉管内致其增宽，与左侧腭帆肌群、双侧头长肌及邻近颅底骨（蝶骨基底部、斜坡、左侧眼肌、双侧翼突基底部及左侧翼突内侧板）分界不清伴骨质破坏/致密改变，推压左侧咽旁间隙致其变窄。右侧咽后未见明显肿大淋巴结及异常放射性分布。左侧咽旁小淋巴结放射性分布略浓密。双颈II区多个小淋巴结放射性分布浓密，SUV约5.1；其余双颈小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。口咽及喉咽结构及放射性分布未见明显异常。左侧乳突炎症。鼻窦炎症。甲状腺右叶低密度结节影放射性分布略浓密，SUV约3.3，大小约1.0×0.9cm，呈类圆形，边界尚清，密度较均匀；其余甲状腺密度及放射性分布未见异常。 双侧肺纹理稀疏，右中下肺小结节影放射性分布未见明显异常，大者约0.4×0.3cm。气管、支气管通畅。纵隔、双肺门多个小淋巴结放射性浓聚/浓密/略浓密，SUV约10.0，密度较高。双侧腋窝未见肿大淋巴结及异常放射性分布。双侧胸壁未见确切病灶和异常放射性分布。 肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺、膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 T7局部密度增高，放射性分布未见明显异常；L5左侧椎弓峡部连续性中断‘其余所见颅盖骨、各躯干骨、四肢骨结构及放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，侵犯/累及范围如上所述；左侧咽后小淋巴结代谢略活跃，转移待排。 双颈II区小淋巴结代谢较活跃，疑炎症，建议随诊。 甲状腺右叶结节代谢略活跃，建议B超检查。 鼻窦炎症；左侧乳突炎症。 双肺肺气肿；右中下肺小增殖灶；纵隔及双肺门小淋巴结炎症。 T7良性病变；L5左侧椎弓峡部裂。\n临床分期评估：治疗前MRI示鼻咽病灶侵犯双侧海绵窦，伴颅底骨质破坏。双侧咽后小淋巴结考虑转移，最大径均≤6 cm，均位于环状软骨下缘以上，未见明确结外侵犯。双侧颈部未见转移性淋巴结。治疗前全身分期检查未见远处转移。另见副鼻窦炎及双侧乳突炎。\n\n【当前需要决策的问题】\n病理已完成。报告日期: 既往时点；检查名称: 鼻咽部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 鼻咽腔狭窄，鼻咽双侧顶壁、双侧顶后壁、双侧后壁、双侧壁增厚，明显强化。双侧咽隐窝受侵。双侧后鼻道受侵； 双侧咽旁间隙受侵。双侧腭帆提肌、左侧腭帆张肌、双侧翼内肌、双侧头长肌受侵。余咽旁肌未见明显异常。 双侧翼突基底部、蝶骨基底部、斜坡、双侧岩尖、双侧枕骨基底部受侵，余颅底骨质未见明显异常。 双侧破裂孔受侵。 双侧海绵窦受侵。 双侧咽后见数个小淋巴结，大者短径4mm，明显强化，边界欠清。 颈部双侧未见明显肿大淋巴结。 双侧上颌窦、双侧筛窦、双侧蝶窦粘膜增厚。双侧乳突见少量分泌物。 甲状腺右侧叶见一结节，边界清，直径约11mm，T1WI呈等信号，T2WI呈稍高信号，增强扫描见强化。 双侧腮腺、颌下腺、喉部、所见脑实质未见明显异常。；检查结论: 鼻咽病变，考虑鼻咽癌；双侧海绵窦受侵。 颅底骨质破坏。 双侧咽后数个小淋巴结，考虑转移可能性大。 副鼻窦炎；双侧乳突炎。 甲状腺右侧叶结节，考虑结节性甲状腺肿可能性大。\n报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及双侧壁粘膜增厚形成软组织肿块影，放射性浓聚，SUV约21.7，突入左侧破裂孔及左颈动脉管内致其增宽，与左侧腭帆肌群、双侧头长肌及邻近颅底骨（蝶骨基底部、斜坡、左侧眼肌、双侧翼突基底部及左侧翼突内侧板）分界不清伴骨质破坏/致密改变，推压左侧咽旁间隙致其变窄。右侧咽后未见明显肿大淋巴结及异常放射性分布。左侧咽旁小淋巴结放射性分布略浓密。双颈II区多个小淋巴结放射性分布浓密，SUV约5.1；其余双颈小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。口咽及喉咽结构及放射性分布未见明显异常。左侧乳突炎症。鼻窦炎症。甲状腺右叶低密度结节影放射性分布略浓密，SUV约3.3，大小约1.0×0.9cm，呈类圆形，边界尚清，密度较均匀；其余甲状腺密度及放射性分布未见异常。 双侧肺纹理稀疏，右中下肺小结节影放射性分布未见明显异常，大者约0.4×0.3cm。气管、支气管通畅。纵隔、双肺门多个小淋巴结放射性浓聚/浓密/略浓密，SUV约10.0，密度较高。双侧腋窝未见肿大淋巴结及异常放射性分布。双侧胸壁未见确切病灶和异常放射性分布。 肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺、膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 T7局部密度增高，放射性分布未见明显异常；L5左侧椎弓峡部连续性中断‘其余所见颅盖骨、各躯干骨、四肢骨结构及放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，侵犯/累及范围如上所述；左侧咽后小淋巴结代谢略活跃，转移待排。 双颈II区小淋巴结代谢较活跃，疑炎症，建议随诊。 甲状腺右叶结节代谢略活跃，建议B超检查。 鼻窦炎症；左侧乳突炎症。 双肺肺气肿；右中下肺小增殖灶；纵隔及双肺门小淋巴结炎症。 T7良性病变；L5左侧椎弓峡部裂。\n临床分期评估：治疗前MRI示鼻咽病灶侵犯双侧海绵窦，伴颅底骨质破坏。双侧咽后小淋巴结考虑转移，最大径均≤6 cm，均位于环状软骨下缘以上，未见明确结外侵犯。双侧颈部未见转移性淋巴结。治疗前全身分期检查未见远处转移。另见副鼻窦炎及双侧乳突炎。请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T1 / N3 / cM1\nB. T4 / N1 / cM1\nC. T4 / N0 / cM1\nD. T1 / N1 / cM1\nE. T3 / N2 / cM0\nF. T1 / N1 / cM0\nG. T4 / N2 / cM0\nH. T3 / N2 / cM1\nI. T1 / N2 / cM1\nJ. T4 / N1 / cM0\nK. T1 / N0 / cM1\nL. T1 / N0 / cM0\n\n请仅输出一个选项字母（A-L）。","gold_letter":"J","gold_action":"T4 / N1 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T1 / N3 / cM1","B":"T4 / N1 / cM1","C":"T4 / N0 / cM1","D":"T1 / N1 / cM1","E":"T3 / N2 / cM0","F":"T1 / N1 / cM0","G":"T4 / N2 / cM0","H":"T3 / N2 / cM1","I":"T1 / N2 / cM1","J":"T4 / N1 / cM0","K":"T1 / N0 / cM1","L":"T1 / N0 / cM0"}}
+{"sample_id":"sample-05a255bce72429d9789712a9","patient_id":"patient-cdb749e199be2356a7040391","episode_id":"episode-e7ae15858304871768c07f47","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；主诉: 鼻塞1月余。；；既往疾病史: 是否有过敏史无过敏史。是否有吸烟史吸烟史详情 【病理资料1】（鼻咽活检组织）镜下：形态符合未分化型非角化性癌。建议加做免疫组化及原位杂交协助诊断和指导治疗。 既往时点补充报告： 结合免疫组化及原位杂交结果，病变诊断为（鼻咽）未分化型非角化性癌。 本院免疫组化结果：EGFR（+++），CK（+）。 本院原位杂交结果：EBERs（+）。；活检部位: 鼻咽；肿瘤部位: 鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】报告日期: 既往时点；检查名称: PET/CT全身显像+局部CT增强（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息60min后行全身PET/CT断层显像+局部增强，影像清晰。 鼻咽顶壁、顶后壁、双侧壁粘膜增厚放射性分布浓密，SUV约6.6，病灶侵犯双侧腭帆肌群、双侧头长肌，与右侧翼突基底部、枕骨斜坡分界不清，增强扫描见强化。余颅底骨放射性分布未见明显异常。双侧破裂孔未见明显异常。双侧海绵窦结构及放射性分布未见异常。右侧乳突、额窦、蝶窦、筛窦及双侧上颌窦低密度影放射性分布未见明显异常。口咽、喉咽未见明显异常。甲状腺放射性分布未见异常。双侧咽后、双颈II-V区多发淋巴结放射性分布浓密/较浓密，SUV约6.5，大者约2.0×2.5cm，增强扫描见强化。 双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双上肺多发斑/条片、小结节、条索影放射性分布略浓密，SUV约2.1，部分伴钙化；右上肺肺大泡。气管、支气管通畅。心脏及大血管放射性分布未见异常。食管放射性分布未见明显异常。胸壁未见确切病灶和异常放射性分布。双肺门、纵隔（右上下气管旁、隆突下、主动脉旁）多发淋巴结放射性分布略浓密，SUV约3.5，部分伴钙化。双侧腋窝未见肿大淋巴结及异常放射性分布。 肝右叶多发小囊性影放射性分布稀疏；余肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管及胆总管未见扩张。胆囊、胃及十二指肠放射性分布未见异常。脾脏点状致密影放射性分布缺损；左肾小囊肿；胰腺、右肾及双侧肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺小片致密影放射性分布缺损；膀胱、肠管等形态、结构及放射性分布未见明显异常。双侧髂血管旁及双侧腹股沟未见明显肿大淋巴结及异常放射性分布。 左肩胛骨、左侧第（2、5、6）肋骨、T3椎体及棘突、T11椎体、T12椎体、L4棘突多发骨质破坏放射性分布浓密/较浓密，SUV约5.9；右侧耻骨边缘骨质模糊放射性分布略浓密，SUV约3.5；多个椎体骨赘形成放射性分布未见异常；余所见颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽部病灶代谢活跃，符合鼻咽癌；双侧咽后、双颈II-V区多发淋巴结代谢活跃，考虑转移；全身多发骨病灶代谢活跃/较活跃，考虑转移。 右侧乳突炎；鼻窦炎。 双上肺多发斑/条片、小结节、条索影伴钙化代谢略活跃，疑陈旧性病变；右上肺肺大泡；纵隔及双肺门淋巴结炎症。 肝右叶小囊肿。脾钙化灶；左肾囊肿。 前列腺钙化灶。 右侧耻骨边缘骨质模糊代谢略活跃，疑退行性变；多个椎体退行性变。\n报告日期: 既往时点；检查名称: 磁共振血管成像(MRA)(增强血管成像)；检查所见: 鼻咽腔狭窄，鼻咽双侧顶壁、双侧顶后壁、双侧壁增厚，明显强化。右侧咽隐窝受侵，左侧咽隐窝狭窄。 右侧咽旁间隙受侵。双侧腭帆提肌、腭帆张肌受侵。余咽旁肌未见明显异常。 双侧翼突基底部、双侧翼突内板、蝶骨基底部、斜坡、双侧岩尖受侵，余颅底骨质未见明显异常。 双侧破裂孔、海绵窦受侵。 左侧咽后见1个肿大淋巴结，大者短径7mm，明显强化。 颈部双侧II~V区见多个肿大淋巴结，大者短径18mm，明显强化，可见融合。 双侧上颌窦、双侧筛窦、双侧蝶窦粘膜增厚，左侧乳突见较多分泌物。 双侧腮腺、颌下腺、甲状腺、喉部、所见脑实质未见明显异常。 颈部MRA示：所示双侧颈总、颈内、颈外动脉、椎动脉、基底动脉显影良好，管壁光滑，管腔未见异常增宽或狭窄。；检查结论: 鼻咽病变，考虑鼻咽癌；双侧海绵窦受侵。 颅底骨质破坏。 左侧咽后肿大淋巴结，考虑转移。 颈部双侧II~V区多个肿大淋巴结，考虑转移。 副鼻窦炎，左侧乳突炎。\n\n【当前需要决策的问题】\n病理已完成。\n报告日期: 既往时点；检查名称: PET/CT全身显像+局部CT增强（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息60min后行全身PET/CT断层显像+局部增强，影像清晰。 鼻咽顶壁、顶后壁、双侧壁粘膜增厚放射性分布浓密，SUV约6.6，病灶侵犯双侧腭帆肌群、双侧头长肌，与右侧翼突基底部、枕骨斜坡分界不清，增强扫描见强化。余颅底骨放射性分布未见明显异常。双侧破裂孔未见明显异常。双侧海绵窦结构及放射性分布未见异常。右侧乳突、额窦、蝶窦、筛窦及双侧上颌窦低密度影放射性分布未见明显异常。口咽、喉咽未见明显异常。甲状腺放射性分布未见异常。双侧咽后、双颈II-V区多发淋巴结放射性分布浓密/较浓密，SUV约6.5，大者约2.0×2.5cm，增强扫描见强化。 双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双上肺多发斑/条片、小结节、条索影放射性分布略浓密，SUV约2.1，部分伴钙化；右上肺肺大泡。气管、支气管通畅。心脏及大血管放射性分布未见异常。食管放射性分布未见明显异常。胸壁未见确切病灶和异常放射性分布。双肺门、纵隔（右上下气管旁、隆突下、主动脉旁）多发淋巴结放射性分布略浓密，SUV约3.5，部分伴钙化。双侧腋窝未见肿大淋巴结及异常放射性分布。 肝右叶多发小囊性影放射性分布稀疏；余肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管及胆总管未见扩张。胆囊、胃及十二指肠放射性分布未见异常。脾脏点状致密影放射性分布缺损；左肾小囊肿；胰腺、右肾及双侧肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺小片致密影放射性分布缺损；膀胱、肠管等形态、结构及放射性分布未见明显异常。双侧髂血管旁及双侧腹股沟未见明显肿大淋巴结及异常放射性分布。 左肩胛骨、左侧第（2、5、6）肋骨、T3椎体及棘突、T11椎体、T12椎体、L4棘突多发骨质破坏放射性分布浓密/较浓密，SUV约5.9；右侧耻骨边缘骨质模糊放射性分布略浓密，SUV约3.5；多个椎体骨赘形成放射性分布未见异常；余所见颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽部病灶代谢活跃，符合鼻咽癌；双侧咽后、双颈II-V区多发淋巴结代谢活跃，考虑转移；全身多发骨病灶代谢活跃/较活跃，考虑转移。 右侧乳突炎；鼻窦炎。 双上肺多发斑/条片、小结节、条索影伴钙化代谢略活跃，疑陈旧性病变；右上肺肺大泡；纵隔及双肺门淋巴结炎症。 肝右叶小囊肿。脾钙化灶；左肾囊肿。 前列腺钙化灶。 右侧耻骨边缘骨质模糊代谢略活跃，疑退行性变；多个椎体退行性变。\n报告日期: 既往时点；检查名称: 磁共振血管成像(MRA)(增强血管成像)；检查所见: 鼻咽腔狭窄，鼻咽双侧顶壁、双侧顶后壁、双侧壁增厚，明显强化。右侧咽隐窝受侵，左侧咽隐窝狭窄。 右侧咽旁间隙受侵。双侧腭帆提肌、腭帆张肌受侵。余咽旁肌未见明显异常。 双侧翼突基底部、双侧翼突内板、蝶骨基底部、斜坡、双侧岩尖受侵，余颅底骨质未见明显异常。 双侧破裂孔、海绵窦受侵。 左侧咽后见1个肿大淋巴结，大者短径7mm，明显强化。 颈部双侧II~V区见多个肿大淋巴结，大者短径18mm，明显强化，可见融合。 双侧上颌窦、双侧筛窦、双侧蝶窦粘膜增厚，左侧乳突见较多分泌物。 双侧腮腺、颌下腺、甲状腺、喉部、所见脑实质未见明显异常。 颈部MRA示：所示双侧颈总、颈内、颈外动脉、椎动脉、基底动脉显影良好，管壁光滑，管腔未见异常增宽或狭窄。；检查结论: 鼻咽病变，考虑鼻咽癌；双侧海绵窦受侵。 颅底骨质破坏。 左侧咽后肿大淋巴结，考虑转移。 颈部双侧II~V区多个肿大淋巴结，考虑转移。 副鼻窦炎，左侧乳突炎。\n请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T2 / N1 / cM1\nB. T1 / N3 / cM0\nC. T3 / N2 / cM1\nD. T1 / N0 / cM1\nE. T3 / N2 / cM0\nF. T3 / N1 / cM1\nG. T3 / N0 / cM0\nH. T3 / N3 / cM0\nI. T4 / N0 / cM1\nJ. T2 / N0 / cM1\nK. T4 / N3 / cM1\nL. T3 / N3 / cM1\n\n请仅输出一个选项字母（A-L）。","gold_letter":"K","gold_action":"T4 / N3 / cM1","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T2 / N1 / cM1","B":"T1 / N3 / cM0","C":"T3 / N2 / cM1","D":"T1 / N0 / cM1","E":"T3 / N2 / cM0","F":"T3 / N1 / cM1","G":"T3 / N0 / cM0","H":"T3 / N3 / cM0","I":"T4 / N0 / cM1","J":"T2 / N0 / cM1","K":"T4 / N3 / cM1","L":"T3 / N3 / cM1"}}
+{"sample_id":"sample-49be118893951235a7b5b9ff","patient_id":"patient-960f6ab1e16dbdd23090f492","episode_id":"episode-fe88e2e4561e858898d501fa","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；主诉: 耳鸣听力下降6月，头痛2月；门诊既往史；既往疾病史: 体健是否有过敏史无过敏史。是否有吸烟史有吸烟史。吸烟史详情偶有吸烟饮酒；体格检查: 一般情况可，鼻咽顶后壁左侧壁肿物，双颈未扪及明显肿大淋巴结，颅神经（-）。 【病理资料1】1（左侧壁）、2（顶后壁）镜检为未分化型非角化性癌。 免疫组化：#A-1：CK(AE1/AE3)（+），EGFR（+）； 原位杂交：#A-1：EBERs（+）。 【影像与分期资料1】报告日期: 既往时点；检查名称: 颈部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 鼻咽腔狭窄，鼻咽左侧顶壁、左侧顶后壁、左侧壁增厚，明显强化。左侧咽隐窝受侵。 左侧咽旁间隙、左侧颈动脉鞘受侵。左侧腭帆提肌、左侧腭帆张肌、左侧头长肌受侵。余咽旁肌未见明显异常。 左侧翼突基底部、左侧翼突内板、左侧翼突外板、蝶骨基底部、斜坡、左侧岩尖、左侧枕骨基底部受侵，余颅底骨质未见明显异常。 左侧破裂孔、左侧圆孔受侵。 左侧咽后见1个肿大淋巴结，大者短径16mm↑(0-5mm)，明显强化，可见中央坏死、包膜外侵犯。 颈部左侧II区见数个小淋巴结，大者短径7mm(0-10mm)，明显强化。 双侧筛窦粘膜增厚。左侧乳突见较多分泌物。 双侧腮腺、颌下腺、甲状腺、喉部、所见脑实质未见明显异常。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 左侧咽后肿大淋巴结，考虑转移。 颈部左侧II区数个小淋巴结，性质待定。 副鼻窦炎；左侧乳突炎。\n报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽不对称缩窄。鼻咽顶壁、顶后壁、左侧壁可见黏膜增厚，放射性分布浓聚，SUV约15.1；病灶侵犯周围软组织（左侧头长肌、左侧腭帆肌群、左侧翼内肌）、颅底骨（左侧翼突基底部、左侧翼突内板、蝶骨基底部、斜坡、枕骨基底部、左侧岩尖）、颅底孔道（左侧破裂孔、左侧颈动脉管内口、左侧卵圆孔），病灶侵及左侧咽旁间隙、左侧颈动脉鞘，左侧咽隐窝消失、右侧咽隐窝存在。口咽、喉咽结构及放射性分布未见明显异常；左侧咽后、颈部左侧Ⅱ区多发淋巴结放射性分布浓聚，SUV约19.9，伴坏死，最大者大小约2.6cm×2.0cm；余颈部小淋巴结放射性分布未见明显异常。 双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。双侧上颌窦、双侧筛窦内见低密度影放射性分布稀疏。左侧乳突见低密度影放射性分布稀疏；余乳突结构及放射性分布未见明显异常。双侧腮腺结构及放射性分布未见异常。甲状腺结构及放射性分布未见明显异常。 右肺上叶尖段不规则斑片影放射性略浓密，SUV约0.7，大小约0.5×0.4cm。右肺上叶后段实性结节放射性分布略浓密，SUV约1.0，直径约0.6cm；余双肺散在类结节、条索影放射性未见明显异常；余双肺未见明确病灶及异常放射性分布。心脏及大血管放射性分布未见明显异常。食管未见明显占位影及异常放射性分布。双侧胸壁未见确切病灶和异常放射性分布。纵隔（右侧最上纵隔、右上气管旁、双下气管旁、隆突下、食管旁）及双肺门区多发淋巴结放射性浓密，SUV约6.7，大者约1.4×1.2cm；腋窝未见肿大淋巴结及异常放射性分布。 肝内可见多发囊状低密度影放射性分布稀疏，最大者大小约1.3cm×1.0cm；余肝脏形态、结构及放射性分布未见异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊形态、结构及放射性分布未见明显异常。胃及十二指肠放射性分布未见明显异常。胰腺结构及放射性分布未见异常。脾门区见一等密度结节，大小约1.0cm×0.7cm。双肾放射性分布未见明显异常。双肾上腺放射性分布未见明显异常。腹腔未见肿大淋巴结及异常放射性分布。腹膜后小淋巴结放射性分布未见明显异常。 前列腺体积增大，实质内可见钙化灶。膀胱形态、结构及放射性分布未见明显异常。肠管区形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 L1椎体轻度压缩变扁，放射性未见明显异常；余所见颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。左侧股骨头肌腱附着点炎症。；检查结论: 1.鼻咽病灶代谢活跃，符合鼻咽癌，侵犯范围如上述；左侧咽后、颈部左侧Ⅱ区淋巴结代谢活跃，考虑转移。 2.右肺上叶后段实性结节代谢略活跃，建议密切随诊。 3.右肺尖斑片影代谢略活跃，疑炎症。余双肺散在增殖灶。 4.纵隔及双肺门区多发淋巴结代谢较活跃，疑炎症。 5.鼻窦炎。左侧乳突炎症。 6.肝脏多发囊肿。副脾。 7.前列腺增生；前列腺钙化灶。 8.L1椎体轻度压缩变扁。左侧股骨头肌腱附着点炎症。\n临床影像评估：鼻咽病灶侵犯海绵窦，伴颅底骨质破坏。左侧咽后及左侧颈II区淋巴结考虑转移，最大径均≤6 cm，均位于环状软骨下缘以上。左侧咽后淋巴结可见中央坏死、包膜外侵犯；颈部淋巴结未见明确结外侵犯。右侧颈部未见转移性淋巴结。治疗前全身分期检查未见远处转移。另见副鼻窦炎。\n\n【当前需要决策的问题】\n病理已完成。\n报告日期: 既往时点；检查名称: 颈部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 鼻咽腔狭窄，鼻咽左侧顶壁、左侧顶后壁、左侧壁增厚，明显强化。左侧咽隐窝受侵。 左侧咽旁间隙、左侧颈动脉鞘受侵。左侧腭帆提肌、左侧腭帆张肌、左侧头长肌受侵。余咽旁肌未见明显异常。 左侧翼突基底部、左侧翼突内板、左侧翼突外板、蝶骨基底部、斜坡、左侧岩尖、左侧枕骨基底部受侵，余颅底骨质未见明显异常。 左侧破裂孔、左侧圆孔受侵。 左侧咽后见1个肿大淋巴结，大者短径16mm↑(0-5mm)，明显强化，可见中央坏死、包膜外侵犯。 颈部左侧II区见数个小淋巴结，大者短径7mm(0-10mm)，明显强化。 双侧筛窦粘膜增厚。左侧乳突见较多分泌物。 双侧腮腺、颌下腺、甲状腺、喉部、所见脑实质未见明显异常。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 左侧咽后肿大淋巴结，考虑转移。 颈部左侧II区数个小淋巴结，性质待定。 副鼻窦炎；左侧乳突炎。\n报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽不对称缩窄。鼻咽顶壁、顶后壁、左侧壁可见黏膜增厚，放射性分布浓聚，SUV约15.1；病灶侵犯周围软组织（左侧头长肌、左侧腭帆肌群、左侧翼内肌）、颅底骨（左侧翼突基底部、左侧翼突内板、蝶骨基底部、斜坡、枕骨基底部、左侧岩尖）、颅底孔道（左侧破裂孔、左侧颈动脉管内口、左侧卵圆孔），病灶侵及左侧咽旁间隙、左侧颈动脉鞘，左侧咽隐窝消失、右侧咽隐窝存在。口咽、喉咽结构及放射性分布未见明显异常；左侧咽后、颈部左侧Ⅱ区多发淋巴结放射性分布浓聚，SUV约19.9，伴坏死，最大者大小约2.6cm×2.0cm；余颈部小淋巴结放射性分布未见明显异常。 双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。双侧上颌窦、双侧筛窦内见低密度影放射性分布稀疏。左侧乳突见低密度影放射性分布稀疏；余乳突结构及放射性分布未见明显异常。双侧腮腺结构及放射性分布未见异常。甲状腺结构及放射性分布未见明显异常。 右肺上叶尖段不规则斑片影放射性略浓密，SUV约0.7，大小约0.5×0.4cm。右肺上叶后段实性结节放射性分布略浓密，SUV约1.0，直径约0.6cm；余双肺散在类结节、条索影放射性未见明显异常；余双肺未见明确病灶及异常放射性分布。心脏及大血管放射性分布未见明显异常。食管未见明显占位影及异常放射性分布。双侧胸壁未见确切病灶和异常放射性分布。纵隔（右侧最上纵隔、右上气管旁、双下气管旁、隆突下、食管旁）及双肺门区多发淋巴结放射性浓密，SUV约6.7，大者约1.4×1.2cm；腋窝未见肿大淋巴结及异常放射性分布。 肝内可见多发囊状低密度影放射性分布稀疏，最大者大小约1.3cm×1.0cm；余肝脏形态、结构及放射性分布未见异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊形态、结构及放射性分布未见明显异常。胃及十二指肠放射性分布未见明显异常。胰腺结构及放射性分布未见异常。脾门区见一等密度结节，大小约1.0cm×0.7cm。双肾放射性分布未见明显异常。双肾上腺放射性分布未见明显异常。腹腔未见肿大淋巴结及异常放射性分布。腹膜后小淋巴结放射性分布未见明显异常。 前列腺体积增大，实质内可见钙化灶。膀胱形态、结构及放射性分布未见明显异常。肠管区形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 L1椎体轻度压缩变扁，放射性未见明显异常；余所见颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。左侧股骨头肌腱附着点炎症。；检查结论: 1.鼻咽病灶代谢活跃，符合鼻咽癌，侵犯范围如上述；左侧咽后、颈部左侧Ⅱ区淋巴结代谢活跃，考虑转移。 2.右肺上叶后段实性结节代谢略活跃，建议密切随诊。 3.右肺尖斑片影代谢略活跃，疑炎症。余双肺散在增殖灶。 4.纵隔及双肺门区多发淋巴结代谢较活跃，疑炎症。 5.鼻窦炎。左侧乳突炎症。 6.肝脏多发囊肿。副脾。 7.前列腺增生；前列腺钙化灶。 8.L1椎体轻度压缩变扁。左侧股骨头肌腱附着点炎症。\n临床影像评估：鼻咽病灶侵犯海绵窦，伴颅底骨质破坏。左侧咽后及左侧颈II区淋巴结考虑转移，最大径均≤6 cm，均位于环状软骨下缘以上。左侧咽后淋巴结可见中央坏死、包膜外侵犯；颈部淋巴结未见明确结外侵犯。右侧颈部未见转移性淋巴结。治疗前全身分期检查未见远处转移。另见副鼻窦炎。\n请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T4 / N1 / cM0\nB. T4 / N3 / cM1\nC. T1 / N2 / cM0\nD. T1 / N1 / cM0\nE. T3 / N2 / cM0\nF. T4 / N0 / cM0\nG. T1 / N3 / cM1\nH. T2 / N0 / cM1\nI. T3 / N0 / cM1\nJ. T3 / N1 / cM1\nK. T1 / N1 / cM1\nL. T3 / N0 / cM0\n\n请仅输出一个选项字母（A-L）。","gold_letter":"A","gold_action":"T4 / N1 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T4 / N1 / cM0","B":"T4 / N3 / cM1","C":"T1 / N2 / cM0","D":"T1 / N1 / cM0","E":"T3 / N2 / cM0","F":"T4 / N0 / cM0","G":"T1 / N3 / cM1","H":"T2 / N0 / cM1","I":"T3 / N0 / cM1","J":"T3 / N1 / cM1","K":"T1 / N1 / cM1","L":"T3 / N0 / cM0"}}
+{"sample_id":"sample-d25636dad30b0584910fc0cd","patient_id":"patient-960f6ab1e16dbdd23090f492","episode_id":"episode-fe88e2e4561e858898d501fa","turn_id":"P5_02","turn_number":6,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM：{{TNM_STATUS}}；总分期：{{OVERALL_STAGE}}。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；主诉: 耳鸣听力下降6月，头痛2月；门诊既往史；既往疾病史: 体健是否有过敏史无过敏史。是否有吸烟史有吸烟史。吸烟史详情偶有吸烟饮酒；体格检查: 一般情况可，鼻咽顶后壁左侧壁肿物，双颈未扪及明显肿大淋巴结，颅神经（-）。 【病理资料1】1（左侧壁）、2（顶后壁）镜检为未分化型非角化性癌。 免疫组化：#A-1：CK(AE1/AE3)（+），EGFR（+）； 原位杂交：#A-1：EBERs（+）。 【影像与分期资料1】报告日期: 既往时点；检查名称: 颈部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 鼻咽腔狭窄，鼻咽左侧顶壁、左侧顶后壁、左侧壁增厚，明显强化。左侧咽隐窝受侵。 左侧咽旁间隙、左侧颈动脉鞘受侵。左侧腭帆提肌、左侧腭帆张肌、左侧头长肌受侵。余咽旁肌未见明显异常。 左侧翼突基底部、左侧翼突内板、左侧翼突外板、蝶骨基底部、斜坡、左侧岩尖、左侧枕骨基底部受侵，余颅底骨质未见明显异常。 左侧破裂孔、左侧圆孔受侵。 左侧咽后见1个肿大淋巴结，大者短径16mm↑(0-5mm)，明显强化，可见中央坏死、包膜外侵犯。 颈部左侧II区见数个小淋巴结，大者短径7mm(0-10mm)，明显强化。 双侧筛窦粘膜增厚。左侧乳突见较多分泌物。 双侧腮腺、颌下腺、甲状腺、喉部、所见脑实质未见明显异常。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 左侧咽后肿大淋巴结，考虑转移。 颈部左侧II区数个小淋巴结，性质待定。 副鼻窦炎；左侧乳突炎。\n报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽不对称缩窄。鼻咽顶壁、顶后壁、左侧壁可见黏膜增厚，放射性分布浓聚，SUV约15.1；病灶侵犯周围软组织（左侧头长肌、左侧腭帆肌群、左侧翼内肌）、颅底骨（左侧翼突基底部、左侧翼突内板、蝶骨基底部、斜坡、枕骨基底部、左侧岩尖）、颅底孔道（左侧破裂孔、左侧颈动脉管内口、左侧卵圆孔），病灶侵及左侧咽旁间隙、左侧颈动脉鞘，左侧咽隐窝消失、右侧咽隐窝存在。口咽、喉咽结构及放射性分布未见明显异常；左侧咽后、颈部左侧Ⅱ区多发淋巴结放射性分布浓聚，SUV约19.9，伴坏死，最大者大小约2.6cm×2.0cm；余颈部小淋巴结放射性分布未见明显异常。 双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。双侧上颌窦、双侧筛窦内见低密度影放射性分布稀疏。左侧乳突见低密度影放射性分布稀疏；余乳突结构及放射性分布未见明显异常。双侧腮腺结构及放射性分布未见异常。甲状腺结构及放射性分布未见明显异常。 右肺上叶尖段不规则斑片影放射性略浓密，SUV约0.7，大小约0.5×0.4cm。右肺上叶后段实性结节放射性分布略浓密，SUV约1.0，直径约0.6cm；余双肺散在类结节、条索影放射性未见明显异常；余双肺未见明确病灶及异常放射性分布。心脏及大血管放射性分布未见明显异常。食管未见明显占位影及异常放射性分布。双侧胸壁未见确切病灶和异常放射性分布。纵隔（右侧最上纵隔、右上气管旁、双下气管旁、隆突下、食管旁）及双肺门区多发淋巴结放射性浓密，SUV约6.7，大者约1.4×1.2cm；腋窝未见肿大淋巴结及异常放射性分布。 肝内可见多发囊状低密度影放射性分布稀疏，最大者大小约1.3cm×1.0cm；余肝脏形态、结构及放射性分布未见异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊形态、结构及放射性分布未见明显异常。胃及十二指肠放射性分布未见明显异常。胰腺结构及放射性分布未见异常。脾门区见一等密度结节，大小约1.0cm×0.7cm。双肾放射性分布未见明显异常。双肾上腺放射性分布未见明显异常。腹腔未见肿大淋巴结及异常放射性分布。腹膜后小淋巴结放射性分布未见明显异常。 前列腺体积增大，实质内可见钙化灶。膀胱形态、结构及放射性分布未见明显异常。肠管区形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 L1椎体轻度压缩变扁，放射性未见明显异常；余所见颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。左侧股骨头肌腱附着点炎症。；检查结论: 1.鼻咽病灶代谢活跃，符合鼻咽癌，侵犯范围如上述；左侧咽后、颈部左侧Ⅱ区淋巴结代谢活跃，考虑转移。 2.右肺上叶后段实性结节代谢略活跃，建议密切随诊。 3.右肺尖斑片影代谢略活跃，疑炎症。余双肺散在增殖灶。 4.纵隔及双肺门区多发淋巴结代谢较活跃，疑炎症。 5.鼻窦炎。左侧乳突炎症。 6.肝脏多发囊肿。副脾。 7.前列腺增生；前列腺钙化灶。 8.L1椎体轻度压缩变扁。左侧股骨头肌腱附着点炎症。\n临床影像评估：鼻咽病灶侵犯海绵窦，伴颅底骨质破坏。左侧咽后及左侧颈II区淋巴结考虑转移，最大径均≤6 cm，均位于环状软骨下缘以上。左侧咽后淋巴结可见中央坏死、包膜外侵犯；颈部淋巴结未见明确结外侵犯。右侧颈部未见转移性淋巴结。治疗前全身分期检查未见远处转移。另见副鼻窦炎。 【治疗经过1】记录时间: 既往时点；病历特点: 患者A，男，59岁，因\"头痛、耳鸣3月余。 \"于既往时点，步行入院。 一、病例特点: 1、患者A，男性，59岁，江西省人 2、现病史:缘于既往时点月患者无明显诱因出现头痛，以左侧为主，无头晕，无复视、视力模糊，伴左耳鸣、听力下降，无鼻塞、涕血，无面麻等不适，未予重视，逐渐加重，遂至外院A就诊，既往时点行鼻咽活检病理示：鼻咽未分化型非角化性癌，未行治疗，今为求进一步诊治来本院。 患者发病以来，精神可，饮食睡眠一般，大小便正常，体重无明显变化。 3、肿瘤专科检查:张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查:阴性。 4、辅助检查:（1）既往时点 鼻咽部磁共振平扫＋增强检查结果： 鼻咽腔狭窄，鼻咽左侧顶壁、左侧顶后壁、左侧壁增厚，明显强化。 左侧咽隐窝受侵。 左侧咽旁间隙、左侧颈动脉鞘受侵。 左侧腭帆提肌、左侧腭帆张肌、左侧头长肌受侵。 余咽旁肌未见明显异常。 左侧翼突基底部、左侧翼突内板、左侧翼突外板、蝶骨基底部、斜坡、左侧岩尖、左侧枕骨基底部受侵，余颅底骨质未见明显异常。 左侧破裂孔、左侧圆孔受侵。 左侧咽后见1个肿大淋巴结，大者短径16mm↑(0-5mm)，明显强化，可见中央坏死、包膜外侵犯。 颈部左侧II区见数个小淋巴结，大者短径7mm(0-10mm)，明显强化。 双侧筛窦粘膜增厚。 左侧乳突见较多分泌物。 双侧腮腺、颌下腺、甲状腺、喉部、所见脑实质未见明显异常。 检查诊断： 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 左侧咽后肿大淋巴结，考虑转移。 颈部左侧II区数个小淋巴结，性质待定。 副鼻窦炎；左侧乳突炎。 （2）既往时点 病理结果： 1（左侧壁）、2（顶后壁）镜检为未分化型非角化性癌。 CK(AE1/AE3)（+），EGFR（+）；EBERs（+）。 （3）既往时点 PET/CT全身显像检查结果： 鼻咽不对称缩窄。 鼻咽顶壁、顶后壁、左侧壁可见黏膜增厚，放射性分布浓聚，SUV约15.1；病灶侵犯周围软组织（左侧头长肌、左侧腭帆肌群、左侧翼内肌）、颅底骨（左侧翼突基底部、左侧翼突内板、蝶骨基底部、斜坡、枕骨基底部、左侧岩尖）、颅底孔道（左侧破裂孔、左侧颈动脉管内口、左侧卵圆孔），病灶侵及左侧咽旁间隙、左侧颈动脉鞘，左侧咽隐窝消失、右侧咽隐窝存在。 口咽、喉咽结构及放射性分布未见明显异常；左侧咽后、颈部左侧Ⅱ区多发淋巴结放射性分布浓聚，SUV约19.9，伴坏死，最大者大小约2.6cm×2.0cm；余颈部小淋巴结放射性分布未见明显异常。 右肺上叶尖段不规则斑片影放射性略浓密，SUV约0.7，大小约0.5×0.4cm。 右肺上叶后段实性结节放射性分布略浓密，SUV约1.0，直径约0.6cm；余双肺散在类结节、条索影放射性未见明显异常；余双肺未见明确病灶及异常放射性分布。 心脏及大血管放射性分布未见明显异常。 食管未见明显占位影及异常放射性分布。 双侧胸壁未见确切病灶和异常放射性分布。 纵隔（右侧最上纵隔、右上气管旁、双下气管旁、隆突下、食管旁）及双肺门区多发淋巴结放射性浓密，SUV约6.7，大者约1.4×1.2cm；腋窝未见肿大淋巴结及异常放射性分布。 检查诊断： 1.鼻咽病灶代谢活跃，符合鼻咽癌，侵犯范围如上述；左侧咽后、颈部左侧Ⅱ区淋巴结代谢活跃，考虑转移。 2.右肺上叶后段实性结节代谢略活跃，建议密切随诊。 3.右肺尖斑片影代谢略活跃，疑炎症。 余双肺散在增殖灶。 4.纵隔及双肺门区多发淋巴结代谢较活跃，疑炎症。 5.鼻窦炎。 左侧乳突炎症。 6.肝脏多发囊肿。 副脾。 7.前列腺增生；前列腺钙化灶。 8.L1椎体轻度压缩变扁。 左侧股骨头肌腱附着点炎症。 （4）EBV-DNA定量检测[既往时点]：EBV-DNA:1724copy/ml; 【治疗反应与不良反应1】记录时间: 既往时点；病程主题: 上级查房记录；病程内容: 患者吉吉西他滨+顺铂+泰欣生+特瑞普利单抗化疗后，食欲稍差，间恶心，无呕吐、腹痛腹泻等不适，一般情况尚好。 上级医生A查房后示，患者治疗过程顺利，可于今日结账出院，定期复查血常规、肝肾功能；按时返院治疗；不适随诊。；客观检验 … 1-73μmol/L） || 钾离子(K+)-静脉血：3.45mmol/L（低 … .24mmol/L（低于参考范围，参考约3.5-5.3mmol/L） 【治疗反应与不良反应2】既往时点 患者开立复查门诊既往史；既往疾病史: 体健是否有过敏史无过敏史。是否有吸烟史有吸烟史。吸烟史详情偶有吸烟饮酒；体格检查: 一般情况可，鼻咽顶后壁左侧壁肿物，双颈未扪及明显肿大淋巴结，颅神经（-）。；客观检验：血红蛋白(Hb)-静脉血：103.0g/L（低于参考范围，参考约115-150g/L） || 中性粒细胞计数(Neut#)-静脉血：0.42×10^ … 0×10^9/L（低于参考范围，参考约125-350×10^9/L）\n\n【当前需要决策的问题】\n治疗开始后约第18天，本患者出现第2个独立的血液学毒性、肾毒性里程碑：既往时点 患者开立复查门诊既往史；既往疾病史: 体健是否有过敏史无过敏史。是否有吸烟史有吸烟史。吸烟史详情偶有吸烟饮酒；体格检查: 一般情况可，鼻咽顶后壁左侧壁肿物，双颈未扪及明显肿大淋巴结，颅神经（-）。；客观检验：血红蛋白(Hb)-静脉血：103.0g/L（低于参考范围，参考约115-150g/L） || 中性粒细胞计数(Neut#)-静脉血：0.42×10^9/L（低于参考范围，参考约1.8-6. … LT#)-静脉血：65.0×10^9/L（低于参考范围，参考约125-350×10^9/L）。该事件最符合哪类治疗相关毒性，当前应采取怎样的支持处理、监测及治疗节奏调整？\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 忽略当前异常并按原剂量、原时间继续治疗，不增加复查\nB. 永久停止全部抗肿瘤治疗，不再判断毒性是否可逆\nC. 立即提高化疗剂量，以补偿既往可能损失的剂量强度\nD. 仅复查肿瘤影像，不复查血常规、生化或相关器官功能\nE. 直接改为另一套强化联合方案，不等待毒性恢复\nF. 仅口头安慰并观察，不给予症状处理或近期监测\nG. 把当前异常判断为疾病进展并立即进入后线挽救治疗\nH. 仅依据一次EBV-DNA结果决定停药或换药\nI. 继续原方案并取消止吐、补液或营养等支持治疗\nJ. 立即扩大放疗范围，将所有不适均按肿瘤侵犯处理\nK. 按血象严重度暂缓或调整骨髓抑制性治疗，复查CBC，并按需升白、升板或输血；暂停或调整肾毒性铂类，补液护肾并复查肌酐/CrCl后再决定恢复\nL. 三个月后再复查当前异常，期间不调整治疗节奏\n\n请仅输出一个选项字母（A-L）。","gold_letter":"K","gold_action":"按血象严重度暂缓或调整骨髓抑制性治疗，复查CBC，并按需升白、升板或输血；暂停或调整肾毒性铂类，补液护肾并复查肌酐/CrCl后再决定恢复","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":{"A":"忽略当前异常并按原剂量、原时间继续治疗，不增加复查","B":"永久停止全部抗肿瘤治疗，不再判断毒性是否可逆","C":"立即提高化疗剂量，以补偿既往可能损失的剂量强度","D":"仅复查肿瘤影像，不复查血常规、生化或相关器官功能","E":"直接改为另一套强化联合方案，不等待毒性恢复","F":"仅口头安慰并观察，不给予症状处理或近期监测","G":"把当前异常判断为疾病进展并立即进入后线挽救治疗","H":"仅依据一次EBV-DNA结果决定停药或换药","I":"继续原方案并取消止吐、补液或营养等支持治疗","J":"立即扩大放疗范围，将所有不适均按肿瘤侵犯处理","K":"按血象严重度暂缓或调整骨髓抑制性治疗，复查CBC，并按需升白、升板或输血；暂停或调整肾毒性铂类，补液护肾并复查肌酐/CrCl后再决定恢复","L":"三个月后再复查当前异常，期间不调整治疗节奏"}}
+{"sample_id":"sample-4ff2c20a48f3e42933c9d923","patient_id":"patient-0adb245ab94b19ab3ec93940","episode_id":"episode-8ac33a6865b53a7d23281bad","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；主诉: 涕血2月，颈部肿物24月；现病史: 涕血2月，颈部肿物24月。右颈淋巴5*5；既往疾病史: 是否有过敏史无过敏史。是否有吸烟史吸烟史详情 【病理资料1】（右鼻咽）形态符合未分化型非角化性癌。 建议用会诊白片来我科交费行免疫组化检查（CK，EBERS)进一步诊断。 应临床要求，加做免疫组化结果：EGFR(3+)。；活检部位: 右侧鼻咽；肿瘤部位: 右侧鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】报告日期: 既往时点；检查名称: 颈部磁共振平扫＋增强（3.0T及以上）(套)；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、后壁、双侧壁增厚，见软组织肿物，明显强化。双侧咽隐窝受侵。右侧后鼻道受侵；右侧咽旁间隙受侵。 右侧腭帆提肌、腭帆张肌、翼内肌、头长肌受侵。余咽旁肌未见明显异常。 双侧翼突基底部、右侧翼突内板、右侧翼突外板、蝶骨基底部、斜坡、右侧岩尖、右侧枕骨基底部受侵，余颅底骨质未见明显异常。 右侧破裂孔、翼腭窝、圆孔、卵圆孔、舌下神经孔受侵。 右侧海绵窦受侵。 右侧咽后见多个肿大淋巴结，大者短径约20mm，明显强化。 颈部右侧II区见多个肿大淋巴结，大者短径约27mm，明显强化，部分可见坏死。 左侧咽后、左侧颈部Ⅱ区、右侧颈部Ⅲ区见多发淋巴结，大者短径约8mm，明确强化。 右侧上颌窦、双侧筛窦、蝶窦粘膜增厚。右侧乳突见较多分泌物。 双侧腮腺、颌下腺、甲状腺、喉部、所见脑实质未见明显异常。；检查结论: 鼻咽病变，考虑鼻咽癌；右侧海绵窦受侵。 颅底骨质破坏。 右侧咽后、颈部右侧II区多个肿大淋巴结，考虑转移。 左侧咽后、左侧颈部Ⅱ区、右侧颈部Ⅲ区多个淋巴结，可疑转移。 副鼻窦炎；右侧乳突炎。\n临床分期评估：治疗前MRI示鼻咽病灶侵犯右侧海绵窦，伴颅底骨质破坏。右侧咽后及右侧颈II区多个淋巴结考虑转移，最大径均≤6 cm，均位于环状软骨下缘以上，未见明确结外侵犯。左侧颈部未见转移性淋巴结。治疗前全身分期检查未见远处转移。\n\n【当前需要决策的问题】\n病理已完成。报告日期: 既往时点；检查名称: 颈部磁共振平扫＋增强（3.0T及以上）(套)；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、后壁、双侧壁增厚，见软组织肿物，明显强化。双侧咽隐窝受侵。右侧后鼻道受侵；右侧咽旁间隙受侵。 右侧腭帆提肌、腭帆张肌、翼内肌、头长肌受侵。余咽旁肌未见明显异常。 双侧翼突基底部、右侧翼突内板、右侧翼突外板、蝶骨基底部、斜坡、右侧岩尖、右侧枕骨基底部受侵，余颅底骨质未见明显异常。 右侧破裂孔、翼腭窝、圆孔、卵圆孔、舌下神经孔受侵。 右侧海绵窦受侵。 右侧咽后见多个肿大淋巴结，大者短径约20mm，明显强化。 颈部右侧II区见多个肿大淋巴结，大者短径约27mm，明显强化，部分可见坏死。 左侧咽后、左侧颈部Ⅱ区、右侧颈部Ⅲ区见多发淋巴结，大者短径约8mm，明确强化。 右侧上颌窦、双侧筛窦、蝶窦粘膜增厚。右侧乳突见较多分泌物。 双侧腮腺、颌下腺、甲状腺、喉部、所见脑实质未见明显异常。；检查结论: 鼻咽病变，考虑鼻咽癌；右侧海绵窦受侵。 颅底骨质破坏。 右侧咽后、颈部右侧II区多个肿大淋巴结，考虑转移。 左侧咽后、左侧颈部Ⅱ区、右侧颈部Ⅲ区多个淋巴结，可疑转移。 副鼻窦炎；右侧乳突炎。\n临床分期评估：治疗前MRI示鼻咽病灶侵犯右侧海绵窦，伴颅底骨质破坏。右侧咽后及右侧颈II区多个淋巴结考虑转移，最大径均≤6 cm，均位于环状软骨下缘以上，未见明确结外侵犯。左侧颈部未见转移性淋巴结。治疗前全身分期检查未见远处转移。请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T4 / N3 / cM0\nB. T1 / N2 / cM1\nC. T3 / N2 / cM0\nD. T2 / N1 / cM1\nE. T1 / N2 / cM0\nF. T1 / N0 / cM1\nG. T1 / N0 / cM0\nH. T2 / N0 / cM0\nI. T2 / N2 / cM1\nJ. T3 / N0 / cM1\nK. T3 / N3 / cM1\nL. T4 / N1 / cM0\n\n请仅输出一个选项字母（A-L）。","gold_letter":"L","gold_action":"T4 / N1 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T4 / N3 / cM0","B":"T1 / N2 / cM1","C":"T3 / N2 / cM0","D":"T2 / N1 / cM1","E":"T1 / N2 / cM0","F":"T1 / N0 / cM1","G":"T1 / N0 / cM0","H":"T2 / N0 / cM0","I":"T2 / N2 / cM1","J":"T3 / N0 / cM1","K":"T3 / N3 / cM1","L":"T4 / N1 / cM0"}}
+{"sample_id":"sample-9ef7444ce9c1b01acec34e33","patient_id":"patient-c37f6b32f02ac91bd1ae7799","episode_id":"episode-3a21a82d60daa0c7defbdd77","turn_id":"P2_01","turn_number":2,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 当前阶段尚未释放病理、MRI或TNM结论。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；病历特点: 患者A，女，56岁，因\"鼻塞、涕血2月余。\"于既往时点，步行入院。患者A，精神可，饮食睡眠一般，大小便正常，体重无明显变化。3、肿瘤专科检查:张口门齿距4cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查:阴性。 【病理资料1】（右顶后壁）镜下：病变符合未分化型非角化性癌。 免疫组化：标本98：CK(AE1/AE3)（+），P40（+），EGFR（+）。 原位杂交：标本98：EBERs（+）。\n\n【当前需要决策的问题】\n此前初诊线索为：记录时间: 既往时点；病历特点: 患者A，女，56岁，因\"鼻塞、涕血2月余。\"于既往时点，步行入院。患者A，精神可，饮食睡眠一般，大小便正常，体重无明显变化。3、肿瘤专科检查:张口门齿距4cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查:阴性。。本诊断节点新释放患者本人正式病理报告：（右顶后壁）镜下：病变符合未分化型非角化性癌。 免疫组化：标本98：CK(AE1/AE3)（+），P40（+），EGFR（+）。 原位杂交：标本98：EBERs（+）。。此时最准确的组织学诊断是什么，哪些证据只能作为支持而不能单独替代正式病理？\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 鼻咽黏膜慢性炎症，EBER阳性即可排除恶性肿瘤\nB. 角化型鳞状细胞癌，仅凭EBV-DNA升高即可确诊\nC. 弥漫大B细胞淋巴瘤，CK阳性是其特异诊断依据\nD. NK/T细胞淋巴瘤，任何EBER阳性都足以替代组织形态\nE. 鼻咽未分化型非角化性癌，正式组织病理为诊断核心，EBER/IHC为支持证据\nF. 嗅神经母细胞瘤，以颈部淋巴结转移作为唯一证据\nG. 腺样囊性癌，未见腺样结构也可直接确诊\nH. 小细胞神经内分泌癌，Syn和CgA阴性仍应优先考虑\nI. 转移性甲状腺癌，不需要核对鼻咽取材部位\nJ. 鼻咽部未定性恶性肿瘤，正式病理尚不能支持具体诊断\nK. 良性淋巴组织增生，异型上皮巢不具有诊断价值\nL. 仅能判断EB病毒感染，不能据正式病理判断是否为癌\n\n请仅输出一个选项字母（A-L）。","gold_letter":"E","gold_action":"鼻咽未分化型非角化性癌，正式组织病理为诊断核心，EBER/IHC为支持证据","context_placeholders":[],"options":{"A":"鼻咽黏膜慢性炎症，EBER阳性即可排除恶性肿瘤","B":"角化型鳞状细胞癌，仅凭EBV-DNA升高即可确诊","C":"弥漫大B细胞淋巴瘤，CK阳性是其特异诊断依据","D":"NK/T细胞淋巴瘤，任何EBER阳性都足以替代组织形态","E":"鼻咽未分化型非角化性癌，正式组织病理为诊断核心，EBER/IHC为支持证据","F":"嗅神经母细胞瘤，以颈部淋巴结转移作为唯一证据","G":"腺样囊性癌，未见腺样结构也可直接确诊","H":"小细胞神经内分泌癌，Syn和CgA阴性仍应优先考虑","I":"转移性甲状腺癌，不需要核对鼻咽取材部位","J":"鼻咽部未定性恶性肿瘤，正式病理尚不能支持具体诊断","K":"良性淋巴组织增生，异型上皮巢不具有诊断价值","L":"仅能判断EB病毒感染，不能据正式病理判断是否为癌"}}
+{"sample_id":"sample-6d85f2cedba0c0e04f68af9f","patient_id":"patient-c37f6b32f02ac91bd1ae7799","episode_id":"episode-3a21a82d60daa0c7defbdd77","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；病历特点: 患者A，女，56岁，因\"鼻塞、涕血2月余。\"于既往时点，步行入院。患者A，精神可，饮食睡眠一般，大小便正常，体重无明显变化。3、肿瘤专科检查:张口门齿距4cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查:阴性。 【病理资料1】（右顶后壁）镜下：病变符合未分化型非角化性癌。 免疫组化：标本98：CK(AE1/AE3)（+），P40（+），EGFR（+）。 原位杂交：标本98：EBERs（+）。 【影像与分期资料1】报告日期: 既往时点；检查名称: 颈部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、左侧壁增厚，明显强化，病灶与左侧咽后淋巴结分界不清。左侧咽隐窝受侵。 左侧咽旁间隙受侵。左侧腭帆提肌、左侧腭帆张肌、左侧头长肌受侵。余咽旁肌未见明显异常。 蝶骨基底部受侵，余颅底骨质未见明显异常。 左侧咽后淋巴结与鼻咽病灶分界不清。 颈部双侧II区见多个淋巴结，大者短径7mm，明显强化。 口咽双侧壁无增厚。 双侧海绵窦形态正常，未见增宽。 双眼球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽病变，考虑鼻咽癌。 蝶骨基底部骨质破坏。 左侧咽后淋巴结，可疑转移。 颈部双侧II区见多个小淋巴结，考虑反应性淋巴结可能。\n报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及左侧壁粘膜增厚形成软组织影凸入鼻咽腔放射性浓聚，SUV约14.7，病灶侵犯颅底骨（蝶骨基底部、左侧翼突、左侧岩尖）及左侧腭帆肌群、左侧头长肌、左侧咽旁间隙、左侧破裂孔，与左咽后淋巴结分界不清。左侧咽隐窝消失，右侧咽隐窝变浅。口咽、喉咽未见异常。鼻窦炎症。双侧海绵窦放射性分布未见明显异常。双侧乳突结构及放射性分布未见明显异常。甲状腺结构及放射性分布未见明显异常。左颈Ib、双颈II区淋巴结放射性分布浓密，SUV约3.3，大者约0.9×0.7cm。余双颈小淋巴结放射性分布未见异常。 所见脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 右肺下叶外侧基底段斑片影放射性分布未见明显异常；余双肺纹理未见明显异常。气管、支气管通畅。心脏及大血管未见明显异常。食管未见明显占位影及异常放射性分布。双侧乳腺及双侧胸壁未见确切病灶和异常放射性分布。纵隔（右下气管旁、主动脉旁、隆突下）及双肺门稍高密度淋巴结放射性分布浓密。双侧腋窝小淋巴结放射性未见明显异常。 肝S8钙化灶；余肝脏结构及放射性分布未见异常；肝门区未见占位及异常放射性分布。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。胰腺、脾脏、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后小淋巴结放射性分布未见明显异常。 盆腔放射性分布均匀，子宫、膀胱、肠管等形态、结构及放射性分布未见明显异常。双侧髂血管旁及双侧腹股沟未见肿大淋巴结及异常放射性分布。 颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，侵犯范围如上述；左咽后淋巴结可疑转移。 左颈Ib、双颈II区淋巴结代谢较活跃，疑炎症，建议随诊。 鼻窦炎症。 右肺下叶外侧基底段纤维增殖灶。 纵隔及双肺门淋巴结炎症。 肝S8钙化灶。\n临床分期评估：治疗前MRI示鼻咽病灶侵犯蝶骨基底部，伴骨质破坏。左侧咽后淋巴结考虑转移，最大径≤6 cm，位于环状软骨下缘以上，未见明确结外侵犯。双侧颈部小淋巴结考虑反应性改变，未见转移性颈部淋巴结。治疗前全身分期检查未见远处转移。\n\n【当前需要决策的问题】\n病理已完成。报告日期: 既往时点；检查名称: 颈部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、左侧壁增厚，明显强化，病灶与左侧咽后淋巴结分界不清。左侧咽隐窝受侵。 左侧咽旁间隙受侵。左侧腭帆提肌、左侧腭帆张肌、左侧头长肌受侵。余咽旁肌未见明显异常。 蝶骨基底部受侵，余颅底骨质未见明显异常。 左侧咽后淋巴结与鼻咽病灶分界不清。 颈部双侧II区见多个淋巴结，大者短径7mm，明显强化。 口咽双侧壁无增厚。 双侧海绵窦形态正常，未见增宽。 双眼球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽病变，考虑鼻咽癌。 蝶骨基底部骨质破坏。 左侧咽后淋巴结，可疑转移。 颈部双侧II区见多个小淋巴结，考虑反应性淋巴结可能。\n报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及左侧壁粘膜增厚形成软组织影凸入鼻咽腔放射性浓聚，SUV约14.7，病灶侵犯颅底骨（蝶骨基底部、左侧翼突、左侧岩尖）及左侧腭帆肌群、左侧头长肌、左侧咽旁间隙、左侧破裂孔，与左咽后淋巴结分界不清。左侧咽隐窝消失，右侧咽隐窝变浅。口咽、喉咽未见异常。鼻窦炎症。双侧海绵窦放射性分布未见明显异常。双侧乳突结构及放射性分布未见明显异常。甲状腺结构及放射性分布未见明显异常。左颈Ib、双颈II区淋巴结放射性分布浓密，SUV约3.3，大者约0.9×0.7cm。余双颈小淋巴结放射性分布未见异常。 所见脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 右肺下叶外侧基底段斑片影放射性分布未见明显异常；余双肺纹理未见明显异常。气管、支气管通畅。心脏及大血管未见明显异常。食管未见明显占位影及异常放射性分布。双侧乳腺及双侧胸壁未见确切病灶和异常放射性分布。纵隔（右下气管旁、主动脉旁、隆突下）及双肺门稍高密度淋巴结放射性分布浓密。双侧腋窝小淋巴结放射性未见明显异常。 肝S8钙化灶；余肝脏结构及放射性分布未见异常；肝门区未见占位及异常放射性分布。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。胰腺、脾脏、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后小淋巴结放射性分布未见明显异常。 盆腔放射性分布均匀，子宫、膀胱、肠管等形态、结构及放射性分布未见明显异常。双侧髂血管旁及双侧腹股沟未见肿大淋巴结及异常放射性分布。 颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，侵犯范围如上述；左咽后淋巴结可疑转移。 左颈Ib、双颈II区淋巴结代谢较活跃，疑炎症，建议随诊。 鼻窦炎症。 右肺下叶外侧基底段纤维增殖灶。 纵隔及双肺门淋巴结炎症。 肝S8钙化灶。\n临床分期评估：治疗前MRI示鼻咽病灶侵犯蝶骨基底部，伴骨质破坏。左侧咽后淋巴结考虑转移，最大径≤6 cm，位于环状软骨下缘以上，未见明确结外侵犯。双侧颈部小淋巴结考虑反应性改变，未见转移性颈部淋巴结。治疗前全身分期检查未见远处转移。请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T2 / N2 / cM1\nB. T2 / N0 / cM1\nC. T1 / N3 / cM0\nD. T3 / N0 / cM0\nE. T3 / N1 / cM0\nF. T2 / N3 / cM0\nG. T3 / N3 / cM1\nH. T2 / N1 / cM0\nI. T2 / N0 / cM0\nJ. T4 / N0 / cM0\nK. T4 / N1 / cM0\nL. T3 / N3 / cM0\n\n请仅输出一个选项字母（A-L）。","gold_letter":"E","gold_action":"T3 / N1 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T2 / N2 / cM1","B":"T2 / N0 / cM1","C":"T1 / N3 / cM0","D":"T3 / N0 / cM0","E":"T3 / N1 / cM0","F":"T2 / N3 / cM0","G":"T3 / N3 / cM1","H":"T2 / N1 / cM0","I":"T2 / N0 / cM0","J":"T4 / N0 / cM0","K":"T4 / N1 / cM0","L":"T3 / N3 / cM0"}}
+{"sample_id":"sample-97cf0ccfc98bd93f68029db8","patient_id":"patient-5800309a4e814fbcbd295754","episode_id":"episode-737be18a99d3ec757e8a2981","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；病历特点: 患者A ，男，主因“耳鸣7月余，痰中带血1月余。 ”于既往时点步行入院。 一.病例特点: 1、患者42岁 男性。 2、现病史:缘于7月前患者无意中出现耳鸣，无听力下降，无面麻、头痛，未予重视，1月前出现痰中带血，既往时点于外院A就诊，行电子鼻咽镜检查活示1、鼻咽肿物；2、分泌性中耳炎。 行颞骨螺旋CT平扫+MPR示：1、鼻咽右侧壁肿胀，性质待查，建议进一步检查；2、拟右侧中耳乳突炎；3、拟双侧上颌窦、筛窦、蝶窦炎症；4、鼻中隔弯曲。 为求进一步诊治患者遂于既往时点转入本院。 门诊拟诊“鼻咽肿物”收入院。 患者发病以来，精神、饮食佳，睡眠不佳，大小便正常，体重无减轻。 3、体格检查: T:36.80℃ P:57次/分 R:20次/分 BP:127/79 mmHg Ht: 160cm Wt: 56.70kg BSA: 1.5835m2 KPS:90 神智清楚，表情自然，发育正常，营养中等。 自主体位，检查合作。 皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。 浅表淋巴结见专科情况。 头颅五官无畸形，眼睑无浮肿，无下垂;巩膜无黄染，结膜无充血、无苍白;眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。 耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。 听力正常，鼓膜无穿孔。 鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。 口腔粘膜正常。 齿龈无红肿，扁桃体无肿大。 颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。 胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。 心前区无隆起，未触及震颤。 心率79次/分，心整齐，各瓣膜听诊区未闻及病理性杂音。 腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。 肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛;移动性浊音阴性，肠鸣音正常。 肛律门、外生殖器未查。 脊柱四肢无畸形，肌力、肌张力正常。 生理反射存在，病理神经反射未引出。 4. 【病理资料1】（鼻咽右侧新生物）粘膜组织中见少量异型细胞呈小巢状排列，疑为癌，待免疫组化及原位杂交进一步诊断。 既往时点补充报告： （鼻咽右侧新生物）未分化型非角化性癌。 本院免疫组化：P40（+），CK5/6（+），EGFR（+），CK（+）。 本院原位杂交：EBERs（+）。；活检部位: 鼻咽；肿瘤部位: 鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】报告日期: 既往时点；检查名称: 颈部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 鼻咽腔狭窄，鼻咽双侧顶壁、双侧顶后壁、双侧后壁、双侧壁增厚，明显强化。双侧咽隐窝受侵。 右侧咽旁间隙、右侧颈动脉鞘、右侧咀嚼肌间隙、椎前间隙受侵。右侧腭帆提肌、右侧腭帆张肌、右侧翼内肌、右侧翼外肌、双侧头长肌受侵。余咽旁肌未见明显异常。 右侧翼突基底部、右侧翼突内板、右侧翼突外板、蝶骨基底部、斜坡、双侧岩尖、右侧枕骨基底部受侵，余颅底骨质未见明显异常。右侧蝶骨大翼 右侧破裂孔、右侧翼腭窝、右侧舌下神经孔、右侧蝶窦底部受侵。 右侧海绵窦受侵。右侧下颌神经受侵。 双侧咽后见多个肿大淋巴结，大者短径9mm，明显强化。 颈部双侧II区见淋巴结，大者短径9mm，边界尚清，增强扫描较明显强化。 双侧上颌窦、双侧筛窦、双侧蝶窦粘膜增厚。右侧乳突见较多分泌物。 双侧腮腺、颌下腺、甲状腺、喉部、所见脑实质未见明显异常。；检查结论: 鼻咽病变，考虑鼻咽癌，侵犯范围如上述。 颅底骨质破坏，考虑肿瘤浸润。 双侧咽后多个肿大淋巴结，考虑转移。 颈部双侧II区淋巴结，可疑转移瘤。 副鼻窦炎；右侧乳突炎。\n报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽不对称缩窄。鼻咽顶壁、顶后壁、右侧壁可见黏膜增厚，放射性分布浓聚，SUV约8.7；病灶侵犯周围软组织（双侧头长肌、右侧腭帆肌群、右侧翼内肌、右侧翼外肌）、颅底骨（双侧翼突基底部、右侧翼突内板、右侧翼突外板、蝶骨基底部、斜坡、枕骨基底部、右侧岩尖、右侧蝶骨大翼）、颅底孔道（右侧破裂孔、右侧翼腭窝、右侧颈动脉管内口、右侧卵圆孔、右侧舌下神经管、右侧颈静脉孔、右侧棘孔）、副鼻窦（蝶窦），延伸至双侧鼻腔后1/2，侵及右侧咽旁间隙、右侧颈动脉鞘，左侧咽隐窝变浅、右侧咽隐窝消失。口咽、喉咽结构及放射性分布未见明显异常；双侧咽后多发淋巴结放射性分布较浓密，SUV约4.3，最大者大小约1.2cm×1.0cm；颈部双侧Ⅱ区多发淋巴结放射性分布较浓密，SUV约4.3，最大者大小约1.3cm×1.0cm；颈部左侧Ⅲ区、左侧Ⅳa区多发淋巴结放射性分布略浓密，SUV约2.6；余颈部小淋巴结放射性分布未见明显异常。 双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。右侧上颌窦、双侧筛窦、蝶窦内见低密度影放射性分布稀疏。右侧乳突见低密度影放射性分布稀疏；余乳突结构及放射性分布未见明显异常。双侧腮腺结构及放射性分布未见异常。甲状腺双侧叶见低密度结节，放射性分布未见异常。右侧颞肌放射性浓聚（生理性摄取？）。 左肺斜裂小结节放射性未见明显异常，大小约0.3×0.2cm；余双肺未见明确病灶及异常放射性分布。心脏及大血管放射性分布未见明显异常。食管未见明显占位影及异常放射性分布。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊腔内见结节状稍高密度影放射性分布缺损，（最大者）长径约0.9cm。胃及十二指肠放射性分布未见明显异常。胰腺、脾脏、双肾及双肾上腺形态、结构及放射性分布未见异常。腹腔未见肿大淋巴结及异常放射性分布。腹膜后小淋巴结放射性分布未见明显异常。 前列腺实质内可见钙化灶。膀胱形态、结构及放射性分布未见明显异常。肠管区形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 所见颅盖骨、各躯干骨及四肢骨结构及放射性分布未见明显异常。；检查结论: 1.鼻咽病灶代谢活跃，考虑鼻咽癌，病灶侵犯颅底骨、蝶窦及右翼腭窝，侵犯范围如上述；双侧咽后淋巴结代谢较活跃，考虑转移；颈部双侧Ⅱ区淋巴结代谢较活跃，可疑转移。 2.颈部左侧Ⅲ-Ⅳ区小淋巴结代谢略活跃，建议随诊。 3.鼻窦炎。右侧乳突炎症。 4.疑结节性甲状腺肿。 5.左肺斜裂小结节代谢未见明显异常，考虑增殖灶。 6.胆囊结石。 7.前列腺钙化灶。\n临床分期评估：治疗前MRI示鼻咽病灶侵犯海绵窦，伴颅底骨质破坏。双侧咽后多个淋巴结考虑转移，最大径均≤6 cm，均位于环状软骨下缘以上，未见明确结外侵犯。双侧颈部未见转移性淋巴结。治疗前全身分期检查未见远处转移。\n\n【当前需要决策的问题】\n病理已完成。报告日期: 既往时点；检查名称: 颈部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 鼻咽腔狭窄，鼻咽双侧顶壁、双侧顶后壁、双侧后壁、双侧壁增厚，明显强化。双侧咽隐窝受侵。 右侧咽旁间隙、右侧颈动脉鞘、右侧咀嚼肌间隙、椎前间隙受侵。右侧腭帆提肌、右侧腭帆张肌、右侧翼内肌、右侧翼外肌、双侧头长肌受侵。余咽旁肌未见明显异常。 右侧翼突基底部、右侧翼突内板、右侧翼突外板、蝶骨基底部、斜坡、双侧岩尖、右侧枕骨基底部受侵，余颅底骨质未见明显异常。右侧蝶骨大翼 右侧破裂孔、右侧翼腭窝、右侧舌下神经孔、右侧蝶窦底部受侵。 右侧海绵窦受侵。右侧下颌神经受侵。 双侧咽后见多个肿大淋巴结，大者短径9mm，明显强化。 颈部双侧II区见淋巴结，大者短径9mm，边界尚清，增强扫描较明显强化。 双侧上颌窦、双侧筛窦、双侧蝶窦粘膜增厚。右侧乳突见较多分泌物。 双侧腮腺、颌下腺、甲状腺、喉部、所见脑实质未见明显异常。；检查结论: 鼻咽病变，考虑鼻咽癌，侵犯范围如上述。 颅底骨质破坏，考虑肿瘤浸润。 双侧咽后多个肿大淋巴结，考虑转移。 颈部双侧II区淋巴结，可疑转移瘤。 副鼻窦炎；右侧乳突炎。\n报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽不对称缩窄。鼻咽顶壁、顶后壁、右侧壁可见黏膜增厚，放射性分布浓聚，SUV约8.7；病灶侵犯周围软组织（双侧头长肌、右侧腭帆肌群、右侧翼内肌、右侧翼外肌）、颅底骨（双侧翼突基底部、右侧翼突内板、右侧翼突外板、蝶骨基底部、斜坡、枕骨基底部、右侧岩尖、右侧蝶骨大翼）、颅底孔道（右侧破裂孔、右侧翼腭窝、右侧颈动脉管内口、右侧卵圆孔、右侧舌下神经管、右侧颈静脉孔、右侧棘孔）、副鼻窦（蝶窦），延伸至双侧鼻腔后1/2，侵及右侧咽旁间隙、右侧颈动脉鞘，左侧咽隐窝变浅、右侧咽隐窝消失。口咽、喉咽结构及放射性分布未见明显异常；双侧咽后多发淋巴结放射性分布较浓密，SUV约4.3，最大者大小约1.2cm×1.0cm；颈部双侧Ⅱ区多发淋巴结放射性分布较浓密，SUV约4.3，最大者大小约1.3cm×1.0cm；颈部左侧Ⅲ区、左侧Ⅳa区多发淋巴结放射性分布略浓密，SUV约2.6；余颈部小淋巴结放射性分布未见明显异常。 双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。右侧上颌窦、双侧筛窦、蝶窦内见低密度影放射性分布稀疏。右侧乳突见低密度影放射性分布稀疏；余乳突结构及放射性分布未见明显异常。双侧腮腺结构及放射性分布未见异常。甲状腺双侧叶见低密度结节，放射性分布未见异常。右侧颞肌放射性浓聚（生理性摄取？）。 左肺斜裂小结节放射性未见明显异常，大小约0.3×0.2cm；余双肺未见明确病灶及异常放射性分布。心脏及大血管放射性分布未见明显异常。食管未见明显占位影及异常放射性分布。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊腔内见结节状稍高密度影放射性分布缺损，（最大者）长径约0.9cm。胃及十二指肠放射性分布未见明显异常。胰腺、脾脏、双肾及双肾上腺形态、结构及放射性分布未见异常。腹腔未见肿大淋巴结及异常放射性分布。腹膜后小淋巴结放射性分布未见明显异常。 前列腺实质内可见钙化灶。膀胱形态、结构及放射性分布未见明显异常。肠管区形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 所见颅盖骨、各躯干骨及四肢骨结构及放射性分布未见明显异常。；检查结论: 1.鼻咽病灶代谢活跃，考虑鼻咽癌，病灶侵犯颅底骨、蝶窦及右翼腭窝，侵犯范围如上述；双侧咽后淋巴结代谢较活跃，考虑转移；颈部双侧Ⅱ区淋巴结代谢较活跃，可疑转移。 2.颈部左侧Ⅲ-Ⅳ区小淋巴结代谢略活跃，建议随诊。 3.鼻窦炎。右侧乳突炎症。 4.疑结节性甲状腺肿。 5.左肺斜裂小结节代谢未见明显异常，考虑增殖灶。 6.胆囊结石。 7.前列腺钙化灶。\n临床分期评估：治疗前MRI示鼻咽病灶侵犯海绵窦，伴颅底骨质破坏。双侧咽后多个淋巴结考虑转移，最大径均≤6 cm，均位于环状软骨下缘以上，未见明确结外侵犯。双侧颈部未见转移性淋巴结。治疗前全身分期检查未见远处转移。请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T3 / N2 / cM1\nB. T1 / N3 / cM1\nC. T4 / N1 / cM0\nD. T3 / N0 / cM1\nE. T4 / N0 / cM0\nF. T2 / N3 / cM1\nG. T1 / N3 / cM0\nH. T4 / N0 / cM1\nI. T3 / N3 / cM0\nJ. T1 / N0 / cM1\nK. T4 / N3 / cM1\nL. T3 / N1 / cM0\n\n请仅输出一个选项字母（A-L）。","gold_letter":"C","gold_action":"T4 / N1 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T3 / N2 / cM1","B":"T1 / N3 / cM1","C":"T4 / N1 / cM0","D":"T3 / N0 / cM1","E":"T4 / N0 / cM0","F":"T2 / N3 / cM1","G":"T1 / N3 / cM0","H":"T4 / N0 / cM1","I":"T3 / N3 / cM0","J":"T1 / N0 / cM1","K":"T4 / N3 / cM1","L":"T3 / N1 / cM0"}}
+{"sample_id":"sample-8a031ef6f07ed6ffd7fc792f","patient_id":"patient-e675eddb370b74337da96684","episode_id":"episode-a497473159d5918dea507327","turn_id":"P1_01","turn_number":1,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 当前阶段尚未释放病理、MRI或TNM结论。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；病历特点: 患者A，男，35岁，因\"左耳胀、听力下降2月余。\"于既往时点，步行入院。一、病例特点： 1、患者A，男性，35岁。现为进一步治疗到本院门诊就诊，门诊拟“鼻咽恶性肿瘤”收入院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重无下降。3、体格检查:颈软，气管居中，甲状腺外形正常，颈部未扪及肿大淋巴结。\n\n【当前需要决策的问题】\n当前仅开放初诊病史与体征：记录时间: 既往时点；病历特点: 患者A，男，35岁，因\"左耳胀、听力下降2月余。\"于既往时点，步行入院。一、病例特点： 1、患者A，男性，35岁。现为进一步治疗到本院门诊就诊，门诊拟“鼻咽恶性肿瘤”收入院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重无下降。3、体格检查:颈软，气管居中，甲状腺外形正常，颈部未扪及肿大淋巴结。。在不能查看病理、IHC/EBER及影像结论的前提下，下一步最合理且能逐步完成确诊与分期的检查路径是什么？\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 仅给予止血、止痛等对症治疗，3个月后症状持续时再复诊\nB. 直接按鼻咽癌开始同步放化疗，不再补充组织学和分期证据\nC. 仅复查EBV-DNA，以单次病毒载量作为确诊和分期依据\nD. 仅行胸部CT，若无肺转移即结束本次诊断流程\nE. 先经验性使用抗生素两周，不安排鼻咽专科检查\nF. 鼻咽专科检查/内镜；可疑病灶组织活检并取得正式病理；增强鼻咽及颈部MRI；根据风险补充PET/CT或胸腹骨远处评估\nG. 仅行颈部淋巴结超声随访，不评估鼻咽原发部位\nH. 直接切除颈部肿大淋巴结，不先完成鼻咽原发灶评估\nI. 仅凭症状诊断鼻窦炎并长期观察，不安排组织取材\nJ. 先开始免疫单药治疗，再根据疗效反推肿瘤诊断\nK. 只做常规血液检查，结果正常即排除恶性肿瘤\nL. 立即行姑息性骨放疗，不核对原发灶和全身疾病范围\n\n请仅输出一个选项字母（A-L）。","gold_letter":"F","gold_action":"鼻咽专科检查/内镜；可疑病灶组织活检并取得正式病理；增强鼻咽及颈部MRI；根据风险补充PET/CT或胸腹骨远处评估","context_placeholders":[],"options":{"A":"仅给予止血、止痛等对症治疗，3个月后症状持续时再复诊","B":"直接按鼻咽癌开始同步放化疗，不再补充组织学和分期证据","C":"仅复查EBV-DNA，以单次病毒载量作为确诊和分期依据","D":"仅行胸部CT，若无肺转移即结束本次诊断流程","E":"先经验性使用抗生素两周，不安排鼻咽专科检查","F":"鼻咽专科检查/内镜；可疑病灶组织活检并取得正式病理；增强鼻咽及颈部MRI；根据风险补充PET/CT或胸腹骨远处评估","G":"仅行颈部淋巴结超声随访，不评估鼻咽原发部位","H":"直接切除颈部肿大淋巴结，不先完成鼻咽原发灶评估","I":"仅凭症状诊断鼻窦炎并长期观察，不安排组织取材","J":"先开始免疫单药治疗，再根据疗效反推肿瘤诊断","K":"只做常规血液检查，结果正常即排除恶性肿瘤","L":"立即行姑息性骨放疗，不核对原发灶和全身疾病范围"}}
+{"sample_id":"sample-f6ded4003c29b6da778afe85","patient_id":"patient-e675eddb370b74337da96684","episode_id":"episode-a497473159d5918dea507327","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；病历特点: 患者A，男，35岁，因\"左耳胀、听力下降2月余。\"于既往时点，步行入院。一、病例特点： 1、患者A，男性，35岁。现为进一步治疗到本院门诊就诊，门诊拟“鼻咽恶性肿瘤”收入院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重无下降。3、体格检查:颈软，气管居中，甲状腺外形正常，颈部未扪及肿大淋巴结。 【病理资料1】（鼻咽肿物）镜检为恶性肿瘤，形态考虑为未分化型非角化性癌，建议回原单位切涂胶白片10张来我科缴费加做免疫组化（CK、EGFR、p40、HE）及原位杂交（EBERs）协助诊断。 既往时点补充报告： （鼻咽肿物）镜下：组织形态结合免疫组化及原位杂交结果，病变诊断为未分化型非角化性癌。 本 … 果：#23-18585：EBERs（+）。；活检部位: 鼻咽；肿瘤部位: 鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】报告日期: 既往时点；检查名称: 鼻咽部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 鼻咽腔狭窄，鼻咽左侧顶后壁、左侧后壁、左侧壁增厚，明显强化。左侧咽隐窝受侵，右侧咽隐窝狭窄。口咽左侧壁受侵。 左侧咽旁间隙、左侧颈动脉鞘受侵。左侧腭帆提肌、左侧腭帆张肌、左侧翼内肌、左侧翼外肌、左侧头长肌受侵。余咽旁肌未见明显异常。 左侧翼突基底部、左侧翼突内板、左侧翼突外板、左侧岩尖、左侧枕骨基底部受侵，余颅底骨质未见明显异常。 左侧破裂孔、左侧卵圆孔受侵。 左侧咽后见数个肿大淋巴结，大者短径12mm，明显强化。 颈部双侧II区见数个淋巴结，大者短径8mm，明显强化。 双侧上颌窦粘膜内见囊性灶，大者直径约21mm，未见强化。左侧乳突见较多分泌物。 双侧腮腺、颌下腺、甲状腺、喉部、所见脑实质未见明显异常。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 左侧咽后数个肿大淋巴结，考虑转移。 颈部双侧II区见数个淋巴结，考虑转移。 副鼻窦炎；左侧乳突炎。；检查部位: 鼻咽部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 12.0；是否区域复发: 否 ；报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽左侧咽隐窝、左侧咽旁间隙、左侧咽后间隙见片状软组织影放射性浓聚，SUV约17.2，边界欠清，浓聚灶最大平面约2.3×2.9cm，病灶侵犯左侧腭帆肌群、左侧翼内肌、左侧头长肌、左侧破裂孔、左侧卵圆孔、左棘孔、左颈动脉管、颅底骨（左颞骨岩部、左蝶骨大翼）；右侧咽隐窝变浅、左侧咽隐窝消失；右侧咽旁间隙清晰。余颅底骨未见明显骨质破坏及异常放射性分布。双侧翼腭窝、双侧海绵窦结构及放射性分布未见明显异常。左侧咽后数个增大淋巴结放射性分布较浓密，SUV约4.0，最大约1.3×1.7cm；右侧咽后未见明显肿大淋巴结及异常放射性分布。双侧扁桃体对称性放射性分布较浓密，SUV约6.7（炎性/生理性摄取），内见多发小结石。余口咽及喉咽结构及放射性分布未见明显异常。双上颌窦丘状低密度影放射性分布稀疏。左侧乳突炎症。筛窦低密度影放射性分布未见明显异常。额窦、蝶窦放射性分布未见明显异常。甲状腺密度欠均匀放射性分布未见明显异常。双颈II区多发淋巴结放射性分布较浓密，SUV约3.7，部分融合，最大约0.9×2.0cm；双颈Ib区数个小淋巴结放射性分布略浓密；余双颈小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 右肺中叶条索影放射性分布未见明显异常；余双肺未见确切病灶及异常放射性分布。气管、支气管通畅。心脏及大血管未见明显异常。食管未见明显占位影及异常放射性分布。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门未见肿大淋巴结及异常放射性分布。双侧腋窝多发小淋巴结放射性分布未见明显异常。 肝内多发小囊肿；余肝脏形态、结构及放射性分布未见明显异常。肝内、外胆管未见扩张。十二指肠放射性分布略浓密，SUV约3.2。胆囊、胃放射性分布未见明显异常。左肾多发结石，最大直径约0.6cm。脾脏、胰腺、右肾及双肾上腺形态、结构及放射性分布未见异常。腹腔未见肿大淋巴结及异常放射性分布。腹膜后小淋巴结放射性分布未见明显异常。 前列腺、膀胱、肠管等形态、结构及放射性分布未见明显异常。双侧髂血管旁及双侧腹股沟未见肿大淋巴结及异常放射性分布。 所见颅盖骨、各躯干骨及四肢骨结构及放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，侵犯左侧破裂孔、左侧卵圆孔、左棘孔、左颈动脉管、颅底骨；左侧咽后淋巴结代谢较活跃，考虑转移；双颈II区淋巴结代谢较活跃，疑转移。 双颈Ib区淋巴结代谢略活跃，疑炎症。 双上颌窦粘膜下囊肿；筛窦炎症；左侧乳突炎症。 右肺中叶纤维灶。 肝内多发小囊肿。 左肾多发结石。 十二指肠代谢略活跃，考虑炎症。；检查部位: 全身；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 17.0\n\n【当前需要决策的问题】\n病理已完成。\n报告日期: 既往时点；检查名称: 鼻咽部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 鼻咽腔狭窄，鼻咽左侧顶后壁、左侧后壁、左侧壁增厚，明显强化。左侧咽隐窝受侵，右侧咽隐窝狭窄。口咽左侧壁受侵。 左侧咽旁间隙、左侧颈动脉鞘受侵。左侧腭帆提肌、左侧腭帆张肌、左侧翼内肌、左侧翼外肌、左侧头长肌受侵。余咽旁肌未见明显异常。 左侧翼突基底部、左侧翼突内板、左侧翼突外板、左侧岩尖、左侧枕骨基底部受侵，余颅底骨质未见明显异常。 左侧破裂孔、左侧卵圆孔受侵。 左侧咽后见数个肿大淋巴结，大者短径12mm，明显强化。 颈部双侧II区见数个淋巴结，大者短径8mm，明显强化。 双侧上颌窦粘膜内见囊性灶，大者直径约21mm，未见强化。左侧乳突见较多分泌物。 双侧腮腺、颌下腺、甲状腺、喉部、所见脑实质未见明显异常。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 左侧咽后数个肿大淋巴结，考虑转移。 颈部双侧II区见数个淋巴结，考虑转移。 副鼻窦炎；左侧乳突炎。；检查部位: 鼻咽部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 12.0；是否区域复发: 否 ；报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽左侧咽隐窝、左侧咽旁间隙、左侧咽后间隙见片状软组织影放射性浓聚，SUV约17.2，边界欠清，浓聚灶最大平面约2.3×2.9cm，病灶侵犯左侧腭帆肌群、左侧翼内肌、左侧头长肌、左侧破裂孔、左侧卵圆孔、左棘孔、左颈动脉管、颅底骨（左颞骨岩部、左蝶骨大翼）；右侧咽隐窝变浅、左侧咽隐窝消失；右侧咽旁间隙清晰。余颅底骨未见明显骨质破坏及异常放射性分布。双侧翼腭窝、双侧海绵窦结构及放射性分布未见明显异常。左侧咽后数个增大淋巴结放射性分布较浓密，SUV约4.0，最大约1.3×1.7cm；右侧咽后未见明显肿大淋巴结及异常放射性分布。双侧扁桃体对称性放射性分布较浓密，SUV约6.7（炎性/生理性摄取），内见多发小结石。余口咽及喉咽结构及放射性分布未见明显异常。双上颌窦丘状低密度影放射性分布稀疏。左侧乳突炎症。筛窦低密度影放射性分布未见明显异常。额窦、蝶窦放射性分布未见明显异常。甲状腺密度欠均匀放射性分布未见明显异常。双颈II区多发淋巴结放射性分布较浓密，SUV约3.7，部分融合，最大约0.9×2.0cm；双颈Ib区数个小淋巴结放射性分布略浓密；余双颈小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 右肺中叶条索影放射性分布未见明显异常；余双肺未见确切病灶及异常放射性分布。气管、支气管通畅。心脏及大血管未见明显异常。食管未见明显占位影及异常放射性分布。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门未见肿大淋巴结及异常放射性分布。双侧腋窝多发小淋巴结放射性分布未见明显异常。 肝内多发小囊肿；余肝脏形态、结构及放射性分布未见明显异常。肝内、外胆管未见扩张。十二指肠放射性分布略浓密，SUV约3.2。胆囊、胃放射性分布未见明显异常。左肾多发结石，最大直径约0.6cm。脾脏、胰腺、右肾及双肾上腺形态、结构及放射性分布未见异常。腹腔未见肿大淋巴结及异常放射性分布。腹膜后小淋巴结放射性分布未见明显异常。 前列腺、膀胱、肠管等形态、结构及放射性分布未见明显异常。双侧髂血管旁及双侧腹股沟未见肿大淋巴结及异常放射性分布。 所见颅盖骨、各躯干骨及四肢骨结构及放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，侵犯左侧破裂孔、左侧卵圆孔、左棘孔、左颈动脉管、颅底骨；左侧咽后淋巴结代谢较活跃，考虑转移；双颈II区淋巴结代谢较活跃，疑转移。 双颈Ib区淋巴结代谢略活跃，疑炎症。 双上颌窦粘膜下囊肿；筛窦炎症；左侧乳突炎症。 右肺中叶纤维灶。 肝内多发小囊肿。 左肾多发结石。 十二指肠代谢略活跃，考虑炎症。；检查部位: 全身；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 17.0\n请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T3 / N0 / cM1\nB. T4 / N2 / cM1\nC. T3 / N2 / cM1\nD. T4 / N1 / cM0\nE. T1 / N1 / cM1\nF. T1 / N2 / cM1\nG. T1 / N3 / cM1\nH. T3 / N3 / cM1\nI. T3 / N3 / cM0\nJ. T3 / N1 / cM1\nK. T3 / N2 / cM0\nL. T1 / N3 / cM0\n\n请仅输出一个选项字母（A-L）。","gold_letter":"K","gold_action":"T3 / N2 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T3 / N0 / cM1","B":"T4 / N2 / cM1","C":"T3 / N2 / cM1","D":"T4 / N1 / cM0","E":"T1 / N1 / cM1","F":"T1 / N2 / cM1","G":"T1 / N3 / cM1","H":"T3 / N3 / cM1","I":"T3 / N3 / cM0","J":"T3 / N1 / cM1","K":"T3 / N2 / cM0","L":"T1 / N3 / cM0"}}
+{"sample_id":"sample-7144596d83326d05f468f910","patient_id":"patient-49de37b11211aa728bd7cf39","episode_id":"episode-ea2e98517aa28441a6182e86","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；主诉: 涕血和鼻塞1月；门诊既往史；既往疾病史: 是否有过敏史无过敏史。是否有吸烟史吸烟史详情月经史月经史: 【病理资料1】（右后鼻孔）镜下：结合HE形态、免疫组化及原位杂交结果，病变诊断为未分化型非角化性癌。 免疫组化：CK(AE1/AE3)（+），EGFR（+）。 原位杂交：EBERs（+）。；活检部位: 右侧鼻孔 【影像与分期资料1】报告日期: 既往时点；检查名称: 鼻咽部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 鼻咽腔狭窄，鼻咽右侧顶壁、右侧顶后壁、右侧后壁、右侧壁增厚，明显强化。右侧咽隐窝受侵。右侧后鼻道受侵；右侧咽旁间隙、右侧颈动脉鞘受侵。 右侧腭帆提肌、右侧腭帆张肌、右侧翼内肌、右侧翼外肌、右侧头长肌受侵。余咽旁肌未见明显异常。 双侧翼突基底部、蝶骨基底部、斜坡、右侧岩尖、右侧蝶骨大翼受侵，余颅底骨质未见明显异常。蝶窦受侵。 右侧破裂孔、右侧翼腭窝、右侧卵圆孔受侵。 右侧咽后见肿大，短径约6mm。左侧咽后未见明显肿大淋巴结。 颈部双侧II区、双侧III区见多个小淋巴结，大者短径7mm，明显强化。 右侧上颌窦、双侧筛窦、双侧蝶窦粘膜增厚。 双侧腮腺、颌下腺、甲状腺、喉部、所见脑实质未见明显异常。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 右侧咽后肿大淋巴结，考虑转移。 颈部双侧II区、双侧III区多个小淋巴结，性质待定。 副鼻窦炎。；检查部位: 鼻咽部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 6.0；是否区域复发: 否\n治疗前外院PET/CT摘要：1、考虑鼻咽癌，病灶堵塞右后鼻孔，侵犯相邻右侧翼突及蝶骨体右侧，侵犯软腭；2、右侧颈部VIIa区增大淋巴结，伴代谢增高，考虑转移。\n治疗前全身分期评估未见明确远处转移。\n\n【当前需要决策的问题】\n病理已完成。\n报告日期: 既往时点；检查名称: 鼻咽部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 鼻咽腔狭窄，鼻咽右侧顶壁、右侧顶后壁、右侧后壁、右侧壁增厚，明显强化。右侧咽隐窝受侵。右侧后鼻道受侵；右侧咽旁间隙、右侧颈动脉鞘受侵。 右侧腭帆提肌、右侧腭帆张肌、右侧翼内肌、右侧翼外肌、右侧头长肌受侵。余咽旁肌未见明显异常。 双侧翼突基底部、蝶骨基底部、斜坡、右侧岩尖、右侧蝶骨大翼受侵，余颅底骨质未见明显异常。蝶窦受侵。 右侧破裂孔、右侧翼腭窝、右侧卵圆孔受侵。 右侧咽后见肿大，短径约6mm。左侧咽后未见明显肿大淋巴结。 颈部双侧II区、双侧III区见多个小淋巴结，大者短径7mm，明显强化。 右侧上颌窦、双侧筛窦、双侧蝶窦粘膜增厚。 双侧腮腺、颌下腺、甲状腺、喉部、所见脑实质未见明显异常。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 右侧咽后肿大淋巴结，考虑转移。 颈部双侧II区、双侧III区多个小淋巴结，性质待定。 副鼻窦炎。；检查部位: 鼻咽部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 6.0；是否区域复发: 否\n治疗前外院PET/CT摘要：1、考虑鼻咽癌，病灶堵塞右后鼻孔，侵犯相邻右侧翼突及蝶骨体右侧，侵犯软腭；2、右侧颈部VIIa区增大淋巴结，伴代谢增高，考虑转移。\n治疗前全身分期评估未见明确远处转移。\n请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T3 / N1 / cM1\nB. T3 / N2 / cM0\nC. T1 / N2 / cM1\nD. T4 / N3 / cM0\nE. T2 / N3 / cM0\nF. T1 / N3 / cM0\nG. T3 / N1 / cM0\nH. T2 / N2 / cM0\nI. T4 / N2 / cM1\nJ. T4 / N3 / cM1\nK. T4 / N0 / cM1\nL. T3 / N0 / cM0\n\n请仅输出一个选项字母（A-L）。","gold_letter":"G","gold_action":"T3 / N1 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T3 / N1 / cM1","B":"T3 / N2 / cM0","C":"T1 / N2 / cM1","D":"T4 / N3 / cM0","E":"T2 / N3 / cM0","F":"T1 / N3 / cM0","G":"T3 / N1 / cM0","H":"T2 / N2 / cM0","I":"T4 / N2 / cM1","J":"T4 / N3 / cM1","K":"T4 / N0 / cM1","L":"T3 / N0 / cM0"}}
+{"sample_id":"sample-4220f3446c6f8d73156923d1","patient_id":"patient-49de37b11211aa728bd7cf39","episode_id":"episode-ea2e98517aa28441a6182e86","turn_id":"P5_01","turn_number":5,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM：{{TNM_STATUS}}；总分期：{{OVERALL_STAGE}}。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；主诉: 涕血和鼻塞1月；门诊既往史；既往疾病史: 是否有过敏史无过敏史。是否有吸烟史吸烟史详情月经史月经史: 【病理资料1】（右后鼻孔）镜下：结合HE形态、免疫组化及原位杂交结果，病变诊断为未分化型非角化性癌。 免疫组化：CK(AE1/AE3)（+），EGFR（+）。 原位杂交：EBERs（+）。；活检部位: 右侧鼻孔 【影像与分期资料1】报告日期: 既往时点；检查名称: 鼻咽部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 鼻咽腔狭窄，鼻咽右侧顶壁、右侧顶后壁、右侧后壁、右侧壁增厚，明显强化。右侧咽隐窝受侵。右侧后鼻道受侵；右侧咽旁间隙、右侧颈动脉鞘受侵。 右侧腭帆提肌、右侧腭帆张肌、右侧翼内肌、右侧翼外肌、右侧头长肌受侵。余咽旁肌未见明显异常。 双侧翼突基底部、蝶骨基底部、斜坡、右侧岩尖、右侧蝶骨大翼受侵，余颅底骨质未见明显异常。蝶窦受侵。 右侧破裂孔、右侧翼腭窝、右侧卵圆孔受侵。 右侧咽后见肿大，短径约6mm。左侧咽后未见明显肿大淋巴结。 颈部双侧II区、双侧III区见多个小淋巴结，大者短径7mm，明显强化。 右侧上颌窦、双侧筛窦、双侧蝶窦粘膜增厚。 双侧腮腺、颌下腺、甲状腺、喉部、所见脑实质未见明显异常。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 右侧咽后肿大淋巴结，考虑转移。 颈部双侧II区、双侧III区多个小淋巴结，性质待定。 副鼻窦炎。；检查部位: 鼻咽部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 6.0；是否区域复发: 否\n治疗前外院PET/CT摘要：1、考虑鼻咽癌，病灶堵塞右后鼻孔，侵犯相邻右侧翼突及蝶骨体右侧，侵犯软腭；2、右侧颈部VIIa区增大淋巴结，伴代谢增高，考虑转移。\n治疗前全身分期评估未见明确远处转移。 【治疗经过1】报告日期: 既往时点；检查名称: 鼻咽部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 鼻咽腔狭窄，鼻咽右侧顶壁、右侧顶后壁、右侧后壁、右侧壁增厚，明显强化。右侧咽隐窝受侵。右侧后鼻道受侵；右侧咽旁间隙、右侧颈动脉鞘受侵。 右侧腭帆提肌、右侧腭帆张肌、右侧翼内肌、右侧翼外肌、右侧头长肌受侵。余咽旁肌未见明显异常。 双侧翼突基底部、蝶骨基底部、斜坡、右侧岩尖、右侧蝶骨大翼受侵，余颅底骨质未见明显异常。蝶窦受侵。 右侧破裂孔、右侧翼腭窝、右侧卵圆孔受侵。 右侧咽后见肿大，短径约6mm。左侧咽后未见明显肿大淋巴结。 颈部双侧II区、双侧III区见多个小淋巴结，大者短径7mm，明显强化。 右侧上颌窦、双侧筛窦、双侧蝶窦粘膜增厚。 双侧腮腺、颌下腺、甲状腺、喉部、所见脑实质未见明显异常。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 右侧咽后肿大淋巴结，考虑转移。 颈部双侧II区、双侧III区多个小淋巴结，性质待定。 副鼻窦炎。；检查部位: 鼻咽部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 6.0；是否区域复发: 否 【治疗反应与不良反应1】记录时间: 既往时点；病程主题: 上级查房记录；病程内容: 患者TPF诱导化疗后，食欲稍差，间恶心，无呕吐、腹痛腹泻等不适，一般情况尚好。 上级医生A查房后示，患者治疗过程顺利，可于今日结账出院，定期复查血常规、肝肾功能；按时返院治疗；不适随诊。；客观检验：总胆红素(TBIL)-静脉 … 约5-21μmol/L） || 丙氨酸氨基转移酶(ALT)-静脉血：64.7U … 94.5mmol/L（低于参考范围，参考约99-110mmol/L）\n\n【当前需要决策的问题】\n治疗开始后约第4天，本患者出现第1个独立的黏膜及胃肠毒性里程碑：记录时间: 既往时点；病程主题: 上级查房记录；病程内容: 患者TPF诱导化疗后，食欲稍差，间恶心，无呕吐、腹痛腹泻等不适，一般情况尚好。 上级医生A查房后示，患者治疗过程顺利，可于今日结账出院，定期复查血常规、肝肾功能；按时返院治疗；不适随诊。；客观检验：总胆红素(TBIL)-静脉血：25.9μmol/L（高于参考范围，参考约5-21μmol/L） || 丙氨酸氨基转移酶(ALT)-静脉血：64.7U/L（高于参考范围，参考约7-40U/L … 离子(Cl-)-静脉血：94.5mmol/L（低于参考范围，参考约99-110mmol/L）。该事件最符合哪类治疗相关毒性，当前应采取怎样的支持处理、监测及治疗节奏调整？\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 忽略当前异常并按原剂量、原时间继续治疗，不增加复查\nB. 永久停止全部抗肿瘤治疗，不再判断毒性是否可逆\nC. 立即提高化疗剂量，以补偿既往可能损失的剂量强度\nD. 仅复查肿瘤影像，不复查血常规、生化或相关器官功能\nE. 直接改为另一套强化联合方案，不等待毒性恢复\nF. 仅口头安慰并观察，不给予症状处理或近期监测\nG. 按黏膜/胃肠毒性分级给予止吐、镇痛、补液和营养支持，并监测进食与体重\nH. 把当前异常判断为疾病进展并立即进入后线挽救治疗\nI. 仅依据一次EBV-DNA结果决定停药或换药\nJ. 继续原方案并取消止吐、补液或营养等支持治疗\nK. 立即扩大放疗范围，将所有不适均按肿瘤侵犯处理\nL. 三个月后再复查当前异常，期间不调整治疗节奏\n\n请仅输出一个选项字母（A-L）。","gold_letter":"G","gold_action":"按黏膜/胃肠毒性分级给予止吐、镇痛、补液和营养支持，并监测进食与体重","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":{"A":"忽略当前异常并按原剂量、原时间继续治疗，不增加复查","B":"永久停止全部抗肿瘤治疗，不再判断毒性是否可逆","C":"立即提高化疗剂量，以补偿既往可能损失的剂量强度","D":"仅复查肿瘤影像，不复查血常规、生化或相关器官功能","E":"直接改为另一套强化联合方案，不等待毒性恢复","F":"仅口头安慰并观察，不给予症状处理或近期监测","G":"按黏膜/胃肠毒性分级给予止吐、镇痛、补液和营养支持，并监测进食与体重","H":"把当前异常判断为疾病进展并立即进入后线挽救治疗","I":"仅依据一次EBV-DNA结果决定停药或换药","J":"继续原方案并取消止吐、补液或营养等支持治疗","K":"立即扩大放疗范围，将所有不适均按肿瘤侵犯处理","L":"三个月后再复查当前异常，期间不调整治疗节奏"}}
+{"sample_id":"sample-6f8542fba9b5e51a575ee4c1","patient_id":"patient-f5101794bd0a287128017a19","episode_id":"episode-0f652c1828a2a8c265c8cb88","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；病历特点: 患者A，男，64岁，因\"咳血2月余。\"于既往时点，步行入院。患者A，精神可，饮食睡眠一般，大小便正常，体重无明显变化。3、肿瘤专科检查:张口门齿距4cm；鼻咽双侧顶后壁结节状肿物；双侧颈部IIa区可扪及1个淋巴结，最大径1×1cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查:阴性。 【病理资料1】1（左颈II区淋巴结）镜检为分化差的癌，结合免疫组化及原位杂交结果，符合鼻咽未分化型非角化性癌转移。 免疫组化：标本19：CK(AE1/AE3)（+）； 原位杂交：标本19：EBERs（+）。；活检部位: 右侧腮腺,左侧II区淋巴结；肿瘤部位: 鼻咽；颈部转移淋巴结部位: 左侧II区淋巴结；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】报告日期: 既往时点；检查名称: 颈部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 鼻咽腔狭窄，鼻咽双侧顶壁增厚，明显强化。右侧后鼻道受侵。 双侧咽旁间隙未见异常。 蝶骨基底部可疑受侵，余颅底骨质未见明显异常。 右侧咽后见1个肿大淋巴结，大者短径9mm↑(0-5mm)，明显强化，可见中央坏死。 颈部双侧II区、左侧III区、左侧V区见数个肿大淋巴结，大者短径15mm↑(0-10mm)，明显强化，部分可见中央坏死。右侧腮腺区见数个小淋巴结，大者短径约6mm，明显强化。 双侧上颌窦、双侧筛窦、双侧蝶窦粘膜增厚。 双侧腮腺、颌下腺、甲状腺、喉部、所见脑实质未见明显异常。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底可疑骨质破坏。 右侧咽后1个肿大淋巴结，考虑转移。 颈部双侧II区、左侧III区、左侧V区见数个肿大淋巴结，考虑转移。 右侧腮腺区小淋巴结，性质待定。 副鼻窦炎。；检查部位: 颈部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 15.0；是否区域复发: 否 ；报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及双侧壁粘膜增厚放射性浓聚，SUV约13.5，右侧明显，与右侧腭帆肌群、双侧头长肌及邻近颅底骨（蝶骨基底部、右侧翼突基底部及斜坡）分界不清伴骨质致密改变，病灶突入右侧破裂孔内致其稍增宽，病灶上缘似可见突入蝶窦内，病灶与鼻中隔后部分界不清，并推压右侧咽旁间隙致其变窄。左侧破裂孔、双侧海绵窦等结构及放射性分布未见明显异常。双侧咽后小淋巴结放射性分布未见明显异常。双颈II区、左颈Va区多个淋巴结放射性浓聚/浓密，SUV约16.8，最大者约2.1cm×1.5cm。左颈Ib区小淋巴结放射性分布略浓密。其余双颈小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。口咽及喉咽结构及放射性分布未见明显异常。双侧上颌窦粘膜下囊肿；鼻窦少许炎症。右腮腺数个小结节影放射性分布略浓密，大者约0.6×0.5cm。甲状腺放射性分布未见异常。 双肺多发磨玻璃小结节影放射性分布未见明显异常，最大者位于右肺上叶尖段，大小约0.7cm×0.6cm，内见血管穿行；另双肺多发实性小结节影放射性分布未见明显异常。气管、支气管通畅。纵隔、双肺门及右侧腋窝多个小淋巴结放射性分布略浓密。左侧侧腋窝未见肿大淋巴结及异常放射性分布。左侧肩背部背阔肌深面脂肪瘤，大小约7.6×3.6cm。 肝S6内见小圆形稍低密度影放射性分布浓密，SUV约4.0，范围约1.2cm×1.1cm，边界不清；其余肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊多发结石，胆泥淤积。胃及十二指肠放射性分布未见明显异常。双肾数个小圆形低密度影放射性分布稀疏；左肾小结石。脾脏、胰腺、双肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后小淋巴结放射性分布未见明显异常。 前列腺钙化灶。膀胱及肠管等形态、结构及放射性分布未见明显异常。右髂血管旁未见肿大淋巴结及异常放射性分布。左侧髂外血管旁及双侧腹股沟多个小淋巴结放射性分布略浓密。 顶枕骨呈术后改变。多个椎体前缘见骨赘形成，多个椎间盘向周围突出/膨出，部分放射性分布浓密/略浓密，SUV约5.6。右肱骨上段髓腔内局部骨质密度略增高、内见斑点状高密度影，放射性分布浓密，SUV约3.3。左侧髂骨高密度结节影放射性分布较浓密，形态不规则，边界清晰。左股骨上段见一环形高密度影放射性分布略浓密，SUV约2.6。左肩关节韧带附着点处局部放射性分布浓密，SUV约4.9；右侧第1胸肋关节、左肩锁关节局部放射性分布浓密/略浓密，SUV约3.5。L5双侧椎弓峡部裂，L5及以上椎体I°前滑脱。其余所见颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，侵犯/累及范围如上所述；双颈II区、左颈Va区代谢活跃/较活跃，考虑转移。 肝S6稍低密度结节代谢较活跃，转移瘤可能性大，不除外原发性肝癌可能，请结合临床。 右腮腺小结节代谢略活跃，良性可能性大，建议随诊。 双侧上颌窦粘膜下囊肿；鼻窦炎症；左颈Ib区小淋巴结炎症。 双肺多发磨玻璃结节影，建议随访；双肺多发小增殖灶；纵隔、双肺门及右侧腋窝小淋巴结炎症。 胆囊多发结石；双肾多发囊肿；左肾小结石；前列腺钙化灶。 左侧髂外血管旁及双侧腹股沟小淋巴结炎症。 右肱骨上段病灶代谢较活跃，考虑内生骨软骨瘤。 左侧髂骨高密度结节代谢较活跃，良性病变可能性大，建议随诊；左侧股骨良性病变；右侧第1胸肋关节、左肩锁关节炎症；多个椎体及椎间盘退行性变部分伴炎症；L5双侧椎弓峡部裂，L5及以上椎体I°前滑脱。 左侧肩背部背阔肌深面脂肪瘤。；检查部位: 全身；肿瘤部位: 鼻咽；是否远处转移: 是；远处转移部位: 肝 ；肝S6实性低回声灶，考虑肝M造影声像 ；肝脏肿物穿刺活检。 不适随诊。 4个工作日后请于自助打印机打印病理结果。 （自助打印机位于1号楼1楼、2楼和2号楼1楼）；检查部位: 肝\n治疗前上腹部MRI检查结论：肝S6结节，考虑转移瘤可能性大。 胆囊结石。 双肾囊肿。 胸10椎体右份小片状强化灶，考虑良性可能，建议复查。\n结合PET/CT、肝超声造影及腹部MRI，临床综合评估肝S6单发病灶为鼻咽癌转移。\n\n【当前需要决策的问题】\n病理已完成。\n报告日期: 既往时点；检查名称: 颈部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 鼻咽腔狭窄，鼻咽双侧顶壁增厚，明显强化。右侧后鼻道受侵。 双侧咽旁间隙未见异常。 蝶骨基底部可疑受侵，余颅底骨质未见明显异常。 右侧咽后见1个肿大淋巴结，大者短径9mm↑(0-5mm)，明显强化，可见中央坏死。 颈部双侧II区、左侧III区、左侧V区见数个肿大淋巴结，大者短径15mm↑(0-10mm)，明显强化，部分可见中央坏死。右侧腮腺区见数个小淋巴结，大者短径约6mm，明显强化。 双侧上颌窦、双侧筛窦、双侧蝶窦粘膜增厚。 双侧腮腺、颌下腺、甲状腺、喉部、所见脑实质未见明显异常。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底可疑骨质破坏。 右侧咽后1个肿大淋巴结，考虑转移。 颈部双侧II区、左侧III区、左侧V区见数个肿大淋巴结，考虑转移。 右侧腮腺区小淋巴结，性质待定。 副鼻窦炎。；检查部位: 颈部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 15.0；是否区域复发: 否 ；报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及双侧壁粘膜增厚放射性浓聚，SUV约13.5，右侧明显，与右侧腭帆肌群、双侧头长肌及邻近颅底骨（蝶骨基底部、右侧翼突基底部及斜坡）分界不清伴骨质致密改变，病灶突入右侧破裂孔内致其稍增宽，病灶上缘似可见突入蝶窦内，病灶与鼻中隔后部分界不清，并推压右侧咽旁间隙致其变窄。左侧破裂孔、双侧海绵窦等结构及放射性分布未见明显异常。双侧咽后小淋巴结放射性分布未见明显异常。双颈II区、左颈Va区多个淋巴结放射性浓聚/浓密，SUV约16.8，最大者约2.1cm×1.5cm。左颈Ib区小淋巴结放射性分布略浓密。其余双颈小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。口咽及喉咽结构及放射性分布未见明显异常。双侧上颌窦粘膜下囊肿；鼻窦少许炎症。右腮腺数个小结节影放射性分布略浓密，大者约0.6×0.5cm。甲状腺放射性分布未见异常。 双肺多发磨玻璃小结节影放射性分布未见明显异常，最大者位于右肺上叶尖段，大小约0.7cm×0.6cm，内见血管穿行；另双肺多发实性小结节影放射性分布未见明显异常。气管、支气管通畅。纵隔、双肺门及右侧腋窝多个小淋巴结放射性分布略浓密。左侧侧腋窝未见肿大淋巴结及异常放射性分布。左侧肩背部背阔肌深面脂肪瘤，大小约7.6×3.6cm。 肝S6内见小圆形稍低密度影放射性分布浓密，SUV约4.0，范围约1.2cm×1.1cm，边界不清；其余肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊多发结石，胆泥淤积。胃及十二指肠放射性分布未见明显异常。双肾数个小圆形低密度影放射性分布稀疏；左肾小结石。脾脏、胰腺、双肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后小淋巴结放射性分布未见明显异常。 前列腺钙化灶。膀胱及肠管等形态、结构及放射性分布未见明显异常。右髂血管旁未见肿大淋巴结及异常放射性分布。左侧髂外血管旁及双侧腹股沟多个小淋巴结放射性分布略浓密。 顶枕骨呈术后改变。多个椎体前缘见骨赘形成，多个椎间盘向周围突出/膨出，部分放射性分布浓密/略浓密，SUV约5.6。右肱骨上段髓腔内局部骨质密度略增高、内见斑点状高密度影，放射性分布浓密，SUV约3.3。左侧髂骨高密度结节影放射性分布较浓密，形态不规则，边界清晰。左股骨上段见一环形高密度影放射性分布略浓密，SUV约2.6。左肩关节韧带附着点处局部放射性分布浓密，SUV约4.9；右侧第1胸肋关节、左肩锁关节局部放射性分布浓密/略浓密，SUV约3.5。L5双侧椎弓峡部裂，L5及以上椎体I°前滑脱。其余所见颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，侵犯/累及范围如上所述；双颈II区、左颈Va区代谢活跃/较活跃，考虑转移。 肝S6稍低密度结节代谢较活跃，转移瘤可能性大，不除外原发性肝癌可能，请结合临床。 右腮腺小结节代谢略活跃，良性可能性大，建议随诊。 双侧上颌窦粘膜下囊肿；鼻窦炎症；左颈Ib区小淋巴结炎症。 双肺多发磨玻璃结节影，建议随访；双肺多发小增殖灶；纵隔、双肺门及右侧腋窝小淋巴结炎症。 胆囊多发结石；双肾多发囊肿；左肾小结石；前列腺钙化灶。 左侧髂外血管旁及双侧腹股沟小淋巴结炎症。 右肱骨上段病灶代谢较活跃，考虑内生骨软骨瘤。 左侧髂骨高密度结节代谢较活跃，良性病变可能性大，建议随诊；左侧股骨良性病变；右侧第1胸肋关节、左肩锁关节炎症；多个椎体及椎间盘退行性变部分伴炎症；L5双侧椎弓峡部裂，L5及以上椎体I°前滑脱。 左侧肩背部背阔肌深面脂肪瘤。；检查部位: 全身；肿瘤部位: 鼻咽；是否远处转移: 是；远处转移部位: 肝 ；肝S6实性低回声灶，考虑肝M造影声像 ；肝脏肿物穿刺活检。 不适随诊。 4个工作日后请于自助打印机打印病理结果。 （自助打印机位于1号楼1楼、2楼和2号楼1楼）；检查部位: 肝\n治疗前上腹部MRI检查结论：肝S6结节，考虑转移瘤可能性大。 胆囊结石。 双肾囊肿。 胸10椎体右份小片状强化灶，考虑良性可能，建议复查。\n结合PET/CT、肝超声造影及腹部MRI，临床综合评估肝S6单发病灶为鼻咽癌转移。\n请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T4 / N1 / cM0\nB. T2 / N0 / cM1\nC. T2 / N3 / cM1\nD. T3 / N2 / cM1\nE. T1 / N1 / cM0\nF. T1 / N1 / cM1\nG. T2 / N0 / cM0\nH. T4 / N2 / cM0\nI. T1 / N0 / cM0\nJ. T4 / N2 / cM1\nK. T2 / N3 / cM0\nL. T1 / N3 / cM0\n\n请仅输出一个选项字母（A-L）。","gold_letter":"D","gold_action":"T3 / N2 / cM1","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T4 / N1 / cM0","B":"T2 / N0 / cM1","C":"T2 / N3 / cM1","D":"T3 / N2 / cM1","E":"T1 / N1 / cM0","F":"T1 / N1 / cM1","G":"T2 / N0 / cM0","H":"T4 / N2 / cM0","I":"T1 / N0 / cM0","J":"T4 / N2 / cM1","K":"T2 / N3 / cM0","L":"T1 / N3 / cM0"}}
+{"sample_id":"sample-f01278485870edc029757815","patient_id":"patient-b933c2f377b80fd439ace547","episode_id":"episode-62ffec9ba756d317f0179da2","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；主诉: 涕血、双侧耳鸣4月，左面麻1周；既往疾病史: 无特殊是否有过敏史无过敏史。是否有吸烟史吸烟史详情月经史月经史:；体格检查: 鼻咽见肿物，双颈未及肿大淋巴结，颅神经阴性 【病理资料1】（鼻咽活检组织）镜下：形态符合未分化型非角化性癌。建议切涂胶白片5张加做免疫组化及原位杂交协助诊断和指导治疗。；活检部位: 鼻咽；肿瘤部位: 鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】报告日期: 既往时点；检查名称: 颈部磁共振平扫＋增强（3.0T及以上）(套)；检查所见: 鼻咽腔狭窄，鼻咽双侧顶壁、双侧顶后壁、双侧后壁、双侧壁增厚，明显强化。双侧咽隐窝受侵。双侧后鼻道受侵；口咽左侧壁受侵。 双侧咽旁间隙、双侧颈动脉鞘受侵。双侧腭帆提肌、双侧腭帆张肌、双侧翼内肌、左侧头长肌受侵。余咽旁肌未见明显异常。 左侧翼突基底部、左侧翼突内板、蝶骨基底部受侵，余颅底骨质未见明显异常。 双侧破裂孔、左侧卵圆孔受侵。 左侧海绵窦受侵。 双侧咽后见多个肿大淋巴结，大者短径17mm，明显强化。 颈部双侧II区、右侧III区见多个肿大淋巴结，大者短径10mm，明显强化。 双侧筛窦、双侧蝶窦粘膜增厚。双侧乳突见较多分泌物。；检查结论: 鼻咽病变，考虑鼻咽癌；左侧海绵窦受侵。 颅底骨质破坏。 双侧咽后多个肿大淋巴结，考虑转移。 颈部双侧II区、右侧III区见多个肿大淋巴结，考虑转移。 副鼻窦炎；双侧乳突炎。；检查部位: 颈部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 17.0；是否区域复发: 否 ；右中肺内侧段及左上肺舌段条片影，考虑纤维增殖灶。 肝S5/6见致密灶，肝内胆管结石可能。 右肾囊肿。 盆腔未见明确肿物。；检查部位: 上腹部 ；鼻咽左侧壁、颅底骨代谢较活跃，考虑鼻咽癌颅底骨侵犯。 左上颌骨炎。；检查部位: 骨\n\n【当前需要决策的问题】\n病理已完成。\n报告日期: 既往时点；检查名称: 颈部磁共振平扫＋增强（3.0T及以上）(套)；检查所见: 鼻咽腔狭窄，鼻咽双侧顶壁、双侧顶后壁、双侧后壁、双侧壁增厚，明显强化。双侧咽隐窝受侵。双侧后鼻道受侵；口咽左侧壁受侵。 双侧咽旁间隙、双侧颈动脉鞘受侵。双侧腭帆提肌、双侧腭帆张肌、双侧翼内肌、左侧头长肌受侵。余咽旁肌未见明显异常。 左侧翼突基底部、左侧翼突内板、蝶骨基底部受侵，余颅底骨质未见明显异常。 双侧破裂孔、左侧卵圆孔受侵。 左侧海绵窦受侵。 双侧咽后见多个肿大淋巴结，大者短径17mm，明显强化。 颈部双侧II区、右侧III区见多个肿大淋巴结，大者短径10mm，明显强化。 双侧筛窦、双侧蝶窦粘膜增厚。双侧乳突见较多分泌物。；检查结论: 鼻咽病变，考虑鼻咽癌；左侧海绵窦受侵。 颅底骨质破坏。 双侧咽后多个肿大淋巴结，考虑转移。 颈部双侧II区、右侧III区见多个肿大淋巴结，考虑转移。 副鼻窦炎；双侧乳突炎。；检查部位: 颈部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 17.0；是否区域复发: 否 ；右中肺内侧段及左上肺舌段条片影，考虑纤维增殖灶。 肝S5/6见致密灶，肝内胆管结石可能。 右肾囊肿。 盆腔未见明确肿物。；检查部位: 上腹部 ；鼻咽左侧壁、颅底骨代谢较活跃，考虑鼻咽癌颅底骨侵犯。 左上颌骨炎。；检查部位: 骨\n请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T1 / N0 / cM0\nB. T2 / N3 / cM1\nC. T2 / N2 / cM1\nD. T4 / N0 / cM0\nE. T3 / N2 / cM0\nF. T3 / N0 / cM0\nG. T4 / N1 / cM1\nH. T4 / N3 / cM0\nI. T3 / N1 / cM1\nJ. T4 / N2 / cM0\nK. T3 / N3 / cM0\nL. T2 / N1 / cM1\n\n请仅输出一个选项字母（A-L）。","gold_letter":"J","gold_action":"T4 / N2 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T1 / N0 / cM0","B":"T2 / N3 / cM1","C":"T2 / N2 / cM1","D":"T4 / N0 / cM0","E":"T3 / N2 / cM0","F":"T3 / N0 / cM0","G":"T4 / N1 / cM1","H":"T4 / N3 / cM0","I":"T3 / N1 / cM1","J":"T4 / N2 / cM0","K":"T3 / N3 / cM0","L":"T2 / N1 / cM1"}}
+{"sample_id":"sample-b49fad3bacd7ae40162f10e8","patient_id":"patient-16c0f88f348c8b36a4e0ba3d","episode_id":"episode-dab7f4ebfe3b20b0503fd7e4","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；主诉: 听力下降1月；门诊既往史；既往疾病史: 既往史:是否有过敏史无过敏史。是否有吸烟史吸烟史详情月经史月经史: 【病理资料1】（鼻咽部）送检少量粘膜组织及较多坏死物，粘膜内见小巢异型细胞，形态较符合未分化型非角化性癌。 本院免疫组化结果：EGFR（+）。；活检部位: 鼻咽；肿瘤部位: 鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】报告日期: 既往时点；检查名称: 颈部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 鼻咽腔狭窄，鼻咽双侧顶壁、双侧顶后壁、双侧后壁、左侧壁增厚，明显强化。双侧咽隐窝受侵。双侧后鼻道受侵； 左侧咽旁间隙受侵。双侧腭帆提肌、双侧腭帆张肌、双侧头长肌受侵。余咽旁肌未见明显异常。 左侧翼突基底部受侵，余颅底骨质未见明显异常。 双侧咽后见数个肿大淋巴结，大者短径6mm↑(0-5mm)，明显强化。 颈部双侧II区见多个小淋巴结，大者短径4mm(0-10mm)，明显强化。 右侧上颌窦粘膜增厚。左侧乳突见较多分泌物。双侧腮腺、颌下腺、甲状腺、喉部、所见脑实质未见明显异常。；检查结论: 鼻咽病变，考虑鼻咽癌。 左侧翼突基底部可疑受侵。 双侧咽后数个肿大淋巴结，可疑转移。 颈部双侧II区多个小淋巴结，性质待定。 副鼻窦炎；左侧乳突炎。；检查部位: 颈部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 不确定；是否区域复发: 否 ；报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及双侧壁粘膜增厚放射性浓聚，SUV约18.5，病灶侵犯颅底骨（蝶骨基底部左份、左翼突基底部）、鼻中隔后份、双腭帆肌群、左头长肌及左咽旁咽后脂肪间隙，局部与双侧破裂孔分界欠清。左侧咽隐窝消失；右侧咽隐窝变浅。双侧海绵窦结构及放射性分布未见明显异常。双咽后及双颈Ⅱ区多个小淋巴结放射性分布略浓密，SUV约2.7，最大约1.0×0.5cm；余双颈小淋巴结放射性分布未见明显异常。 双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。口咽、喉咽未见异常。鼻窦炎。左乳突炎。甲状腺放射性分布未见异常。 左上肺上舌段小斑片影放射性分布未见明显异常；余双肺未见确切病灶和异常放射性分布。气管、支气管通畅。前纵隔见胸腺组织放射性分布略浓密。心脏及大血管放射性分布未见异常。食管放射性分布未见明显异常。双侧乳腺未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏S6包膜下稍低密度结节影放射性分布未见明显异常，大小约2.0×1.5cm；余肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管及胆总管未见扩张。胆囊、胃及十二指肠放射性分布未见异常。右肾囊肿。脾脏、胰腺、左肾及双侧肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 子宫内膜区局部放射性分布较浓密，SUV约4.1（生理性摄取）。膀胱、肠管等形态、结构及放射性分布未见明显异常。双侧髂血管旁及双侧腹股沟未见明显肿大淋巴结及异常放射性分布。盆腔少量积液。 双侧致密性髂骨炎。L5椎体良性病变。所见颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，病灶侵犯颅底骨等，余侵犯范围如上述；双咽后小淋巴结代谢略活跃，转移待排。 双颈Ⅱ区小淋巴结代谢略活跃，疑炎性病变。 鼻窦炎。左乳突炎。 左上肺小增殖灶。 肝脏S6包膜下结节影代谢未见明显异常，考虑良性病变（海绵状血管瘤？）。 右肾囊肿。 双侧致密性髂骨炎。L5椎体良性病变。 盆腔少量积液。；检查部位: 全身；肿瘤部位: 鼻咽；是否区域淋巴结转移: 不确定\n\n【当前需要决策的问题】\n病理已完成。\n报告日期: 既往时点；检查名称: 颈部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 鼻咽腔狭窄，鼻咽双侧顶壁、双侧顶后壁、双侧后壁、左侧壁增厚，明显强化。双侧咽隐窝受侵。双侧后鼻道受侵； 左侧咽旁间隙受侵。双侧腭帆提肌、双侧腭帆张肌、双侧头长肌受侵。余咽旁肌未见明显异常。 左侧翼突基底部受侵，余颅底骨质未见明显异常。 双侧咽后见数个肿大淋巴结，大者短径6mm↑(0-5mm)，明显强化。 颈部双侧II区见多个小淋巴结，大者短径4mm(0-10mm)，明显强化。 右侧上颌窦粘膜增厚。左侧乳突见较多分泌物。双侧腮腺、颌下腺、甲状腺、喉部、所见脑实质未见明显异常。；检查结论: 鼻咽病变，考虑鼻咽癌。 左侧翼突基底部可疑受侵。 双侧咽后数个肿大淋巴结，可疑转移。 颈部双侧II区多个小淋巴结，性质待定。 副鼻窦炎；左侧乳突炎。；检查部位: 颈部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 不确定；是否区域复发: 否 ；报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及双侧壁粘膜增厚放射性浓聚，SUV约18.5，病灶侵犯颅底骨（蝶骨基底部左份、左翼突基底部）、鼻中隔后份、双腭帆肌群、左头长肌及左咽旁咽后脂肪间隙，局部与双侧破裂孔分界欠清。左侧咽隐窝消失；右侧咽隐窝变浅。双侧海绵窦结构及放射性分布未见明显异常。双咽后及双颈Ⅱ区多个小淋巴结放射性分布略浓密，SUV约2.7，最大约1.0×0.5cm；余双颈小淋巴结放射性分布未见明显异常。 双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。口咽、喉咽未见异常。鼻窦炎。左乳突炎。甲状腺放射性分布未见异常。 左上肺上舌段小斑片影放射性分布未见明显异常；余双肺未见确切病灶和异常放射性分布。气管、支气管通畅。前纵隔见胸腺组织放射性分布略浓密。心脏及大血管放射性分布未见异常。食管放射性分布未见明显异常。双侧乳腺未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏S6包膜下稍低密度结节影放射性分布未见明显异常，大小约2.0×1.5cm；余肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管及胆总管未见扩张。胆囊、胃及十二指肠放射性分布未见异常。右肾囊肿。脾脏、胰腺、左肾及双侧肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 子宫内膜区局部放射性分布较浓密，SUV约4.1（生理性摄取）。膀胱、肠管等形态、结构及放射性分布未见明显异常。双侧髂血管旁及双侧腹股沟未见明显肿大淋巴结及异常放射性分布。盆腔少量积液。 双侧致密性髂骨炎。L5椎体良性病变。所见颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，病灶侵犯颅底骨等，余侵犯范围如上述；双咽后小淋巴结代谢略活跃，转移待排。 双颈Ⅱ区小淋巴结代谢略活跃，疑炎性病变。 鼻窦炎。左乳突炎。 左上肺小增殖灶。 肝脏S6包膜下结节影代谢未见明显异常，考虑良性病变（海绵状血管瘤？）。 右肾囊肿。 双侧致密性髂骨炎。L5椎体良性病变。 盆腔少量积液。；检查部位: 全身；肿瘤部位: 鼻咽；是否区域淋巴结转移: 不确定\n请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T4 / N1 / cM1\nB. T1 / N1 / cM0\nC. T3 / N1 / cM0\nD. T1 / N0 / cM0\nE. T4 / N0 / cM1\nF. T2 / N2 / cM0\nG. T1 / N2 / cM0\nH. T2 / N0 / cM0\nI. T2 / N2 / cM1\nJ. T2 / N1 / cM1\nK. T4 / N2 / cM0\nL. T2 / N0 / cM1\n\n请仅输出一个选项字母（A-L）。","gold_letter":"C","gold_action":"T3 / N1 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T4 / N1 / cM1","B":"T1 / N1 / cM0","C":"T3 / N1 / cM0","D":"T1 / N0 / cM0","E":"T4 / N0 / cM1","F":"T2 / N2 / cM0","G":"T1 / N2 / cM0","H":"T2 / N0 / cM0","I":"T2 / N2 / cM1","J":"T2 / N1 / cM1","K":"T4 / N2 / cM0","L":"T2 / N0 / cM1"}}
+{"sample_id":"sample-779f191e37fb11d16470fdc2","patient_id":"patient-01cb4effba96aca19ec352ef","episode_id":"episode-7df3bbb6010cb5c4d8e350d0","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；主诉: 涕血2月。无明显头痛、面麻及复视等症状。； 【病理资料1】（右顶后壁）镜下：结合免疫组化及原位杂交结果，病变符合未分化型非角化性癌。 免疫组化：#A-0：CK(AE1/AE3)（+），EGFR（+）。 原位杂交：#A-0：EBERs（+）。 【影像与分期资料1】治疗前MRI报告：检查名称: 颈部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 鼻咽腔狭窄，鼻咽顶壁、后壁、双侧壁不均匀明显增厚，以右侧壁为著，明显强化。双侧咽隐窝受侵。 双侧咽旁间隙受侵。双侧腭帆提肌、双侧腭帆张肌受侵。 颅底骨质未见明显破坏。 双侧咽后见小淋巴结，大者位于右侧，短径4mm，明显强化。 颈部双侧II区、左侧III区见多个淋巴结，大者位于左侧II区，短径12mm，明显强化，见成簇分布。 双侧上颌窦、筛窦、蝶窦、双侧乳突未见明显异常。 双侧腮腺、颌下腺、甲状腺、喉部、所见脑实质未见明显异常。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质未见明显破坏。 双侧咽后小淋巴结，性质待定。 颈部双侧II区、左侧III区淋巴结，可疑转移。；检查部位: 颈部 ；报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及双侧壁粘膜增厚放射性浓聚，SUV约7.8，病灶侵犯颅底骨（斜坡、蝶骨基底部）、双侧腭帆肌群及双侧头长肌。右侧咽隐窝消失，左侧咽隐窝变浅。双侧咽后未见肿大淋巴结及异常放射性分布。口咽、喉咽未见异常。筛窦低密度影放射性分布稀疏；额窦、蝶窦及双侧上颌窦结构及放射性分布未见明显异常。双侧海绵窦放射性分布未见明显异常。双侧乳突结构及放射性分布未见明显异常。甲状腺双侧叶密度减低放射性浓密，SUV约8.1。左颈II区肿大淋巴结放射性浓聚，SUV约13.7，大小约1.3×2.0cm。余双颈小淋巴结部分放射性略浓密。 所见脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 左上肺前段小斑片影放射性分布未见异常；余双肺纹理未见明显异常。气管、支气管通畅。心脏及大血管未见明显异常。食管未见明显占位影及异常放射性分布。双侧胸壁未见确切病灶和异常放射性分布。右肺门小淋巴结放射性略浓密。纵隔及左肺门未见肿大淋巴结及异常放射性分布。双侧腋窝小淋巴结放射性未见明显异常。 肝左右叶多发囊肿；余肝脏结构及放射性分布未见异常；肝门区未见占位及异常放射性分布。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。双肾弥漫多发蜂窝样囊性低密度影放射性稀疏，最大约3.7×3.8cm；双肾小结石。胰腺、脾脏、双肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后小淋巴结放射性分布未见明显异常。 前列腺小钙化灶。膀胱及肠管形态、结构及放射性分布未见明显异常。双髂血管旁及双侧腹股沟未见肿大淋巴结及异常放射性分布。 L5/S1椎间盘局部密度减低放射性浓密，SUV约5.1；余颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，侵犯范围如上述；左颈II区肿大淋巴结代谢活跃，考虑转移。 余双颈小淋巴结部分代谢略活跃，疑炎性病变。 双肾弥漫多发囊肿，不排除多囊肾可能。双肾小结石。 甲状腺双侧叶密度减低代谢活跃，疑炎性病变。 左上肺前段小斑片影代谢未见异常，疑炎性增殖灶。 筛窦炎。 右肺门小淋巴结代谢略活跃，疑炎性病变。 肝多发囊肿。 前列腺小钙化灶。 L5/S1椎间盘局部密度减低代谢较活跃，疑炎性病变。；检查部位: 全身；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 20.0\n治疗前综合影像评估：斜坡及蝶骨基底部受侵。\n\n【当前需要决策的问题】\n病理已完成。\n治疗前MRI报告：检查名称: 颈部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 鼻咽腔狭窄，鼻咽顶壁、后壁、双侧壁不均匀明显增厚，以右侧壁为著，明显强化。双侧咽隐窝受侵。 双侧咽旁间隙受侵。双侧腭帆提肌、双侧腭帆张肌受侵。 颅底骨质未见明显破坏。 双侧咽后见小淋巴结，大者位于右侧，短径4mm，明显强化。 颈部双侧II区、左侧III区见多个淋巴结，大者位于左侧II区，短径12mm，明显强化，见成簇分布。 双侧上颌窦、筛窦、蝶窦、双侧乳突未见明显异常。 双侧腮腺、颌下腺、甲状腺、喉部、所见脑实质未见明显异常。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质未见明显破坏。 双侧咽后小淋巴结，性质待定。 颈部双侧II区、左侧III区淋巴结，可疑转移。；检查部位: 颈部 ；报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及双侧壁粘膜增厚放射性浓聚，SUV约7.8，病灶侵犯颅底骨（斜坡、蝶骨基底部）、双侧腭帆肌群及双侧头长肌。右侧咽隐窝消失，左侧咽隐窝变浅。双侧咽后未见肿大淋巴结及异常放射性分布。口咽、喉咽未见异常。筛窦低密度影放射性分布稀疏；额窦、蝶窦及双侧上颌窦结构及放射性分布未见明显异常。双侧海绵窦放射性分布未见明显异常。双侧乳突结构及放射性分布未见明显异常。甲状腺双侧叶密度减低放射性浓密，SUV约8.1。左颈II区肿大淋巴结放射性浓聚，SUV约13.7，大小约1.3×2.0cm。余双颈小淋巴结部分放射性略浓密。 所见脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 左上肺前段小斑片影放射性分布未见异常；余双肺纹理未见明显异常。气管、支气管通畅。心脏及大血管未见明显异常。食管未见明显占位影及异常放射性分布。双侧胸壁未见确切病灶和异常放射性分布。右肺门小淋巴结放射性略浓密。纵隔及左肺门未见肿大淋巴结及异常放射性分布。双侧腋窝小淋巴结放射性未见明显异常。 肝左右叶多发囊肿；余肝脏结构及放射性分布未见异常；肝门区未见占位及异常放射性分布。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。双肾弥漫多发蜂窝样囊性低密度影放射性稀疏，最大约3.7×3.8cm；双肾小结石。胰腺、脾脏、双肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后小淋巴结放射性分布未见明显异常。 前列腺小钙化灶。膀胱及肠管形态、结构及放射性分布未见明显异常。双髂血管旁及双侧腹股沟未见肿大淋巴结及异常放射性分布。 L5/S1椎间盘局部密度减低放射性浓密，SUV约5.1；余颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，侵犯范围如上述；左颈II区肿大淋巴结代谢活跃，考虑转移。 余双颈小淋巴结部分代谢略活跃，疑炎性病变。 双肾弥漫多发囊肿，不排除多囊肾可能。双肾小结石。 甲状腺双侧叶密度减低代谢活跃，疑炎性病变。 左上肺前段小斑片影代谢未见异常，疑炎性增殖灶。 筛窦炎。 右肺门小淋巴结代谢略活跃，疑炎性病变。 肝多发囊肿。 前列腺小钙化灶。 L5/S1椎间盘局部密度减低代谢较活跃，疑炎性病变。；检查部位: 全身；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 20.0\n治疗前综合影像评估：斜坡及蝶骨基底部受侵。\n请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T1 / N3 / cM0\nB. T2 / N3 / cM0\nC. T2 / N0 / cM1\nD. T3 / N1 / cM1\nE. T2 / N3 / cM1\nF. T2 / N2 / cM0\nG. T2 / N2 / cM1\nH. T4 / N2 / cM0\nI. T2 / N0 / cM0\nJ. T3 / N1 / cM0\nK. T3 / N2 / cM0\nL. T1 / N0 / cM1\n\n请仅输出一个选项字母（A-L）。","gold_letter":"J","gold_action":"T3 / N1 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T1 / N3 / cM0","B":"T2 / N3 / cM0","C":"T2 / N0 / cM1","D":"T3 / N1 / cM1","E":"T2 / N3 / cM1","F":"T2 / N2 / cM0","G":"T2 / N2 / cM1","H":"T4 / N2 / cM0","I":"T2 / N0 / cM0","J":"T3 / N1 / cM0","K":"T3 / N2 / cM0","L":"T1 / N0 / cM1"}}
+{"sample_id":"sample-f2b1ffd0815ecf5ba2cd82d7","patient_id":"patient-4aef168669533556a36bc39e","episode_id":"episode-29323c3c332a6548756495be","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；病历特点: 患者A ，男，主因“发现左颌下肿物2月余。 ”于既往时点步行入院。 一.病例特点: 1、患者28岁 男性。 2、现病史:患者既往时点无意中发现左侧颌下肿物，约2cm大小，无红肿疼痛，当时未予重视。 既往时点出现过1次鼻衄症状，量少，色鲜红。 患者就诊外院A，行左颌下肿物穿刺活检，病理：（左颈部）符合恶性肿瘤，首先考虑为鳞癌转移，以鼻咽部可能性为大，请临床结合其他检查。 既往时点电子鼻咽镜示：鼻咽部隆起型新生物，表面粘膜糜烂（未行活检）。 诉既往时点搭乘飞机后出现左耳鸣症状，无耳堵塞感、听力下降、鼻塞、回吸性涕血、面麻、复视等不适。 现患者为进一步诊治就诊本院，门诊以“鼻咽癌？”收入院。 自起病以来，患者精神、睡眠可，食欲如常，小便正常，大便2-3次/天，偶成型便偶稀便，体重无下降。 3、体格检查: T:36.70℃ P:70次/分 R:20次/分 BP:116/73 mmHg Ht: 162cm Wt: 66.60kg BSA: 1.7110m2 KPS:90 发育正常，营养一般，神志清楚，自主体位，查体合作。 全身皮肤粘膜无苍白、黄染、水肿、出血。 巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。 无鼻翼扇动、鼻衄。 牙龈无肿胀、出血。 气管居中，甲状腺不大。 胸骨无压痛。 双肺呼吸音清，未闻及干湿啰音。 心率70bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。 腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。 肛门外生殖器未见异常，生理反射存在，病理反射未引出。 4. 【病理资料1】（鼻咽右顶壁肿物）镜下：符合未分化型非角化性癌。；活检部位: 右侧顶壁,鼻咽；肿瘤部位: 右侧顶壁,鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】治疗前MRI报告：检查名称: 鼻咽部磁共振平扫＋增强（3.0T及以上）(套)；检查所见: 鼻咽腔狭窄，鼻咽双侧顶壁、双侧顶后壁、双侧后壁、双侧壁增厚，明显强化。双侧咽隐窝受侵。左侧后鼻道受侵。 双侧咽旁间隙未见异常。双侧腭帆提肌受侵。余咽旁肌未见明显异常。 颅底骨质未见明显异常。 双侧咽后未见明显肿大淋巴结。 左侧I B区见1个肿大淋巴结，短径26mm，明显强化。 颈部双侧II区可见小淋巴结，大者短径约8mm。 右侧上颌窦粘膜增厚。左侧乳突见较多分泌物。 双侧腮腺、颌下腺、甲状腺、喉部、所见脑实质未见明显异常。；检查结论: 鼻咽病变，考虑鼻咽癌。 左侧I B区见1个肿大淋巴结，考虑转移。 颈部双侧II区淋巴结，考虑反应性淋巴结可能。 副鼻窦炎；左侧乳突炎。；检查部位: 鼻咽部 ；报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁、后壁及双侧壁粘膜增厚形成软组织密度影突入鼻咽腔，放射性浓聚，SUV约14.8，左侧咽隐窝消失，右侧咽隐窝存在；双侧咽旁间隙结构清晰。病灶向周围侵犯双侧腭帆提肌；向前侵犯双侧后鼻孔、鼻中隔后缘、左侧翼腭窝；向上侵犯颅底骨（蝶骨基底部、左侧翼突基底部）。双侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见异常。左颈Ib区肿大淋巴结放射性浓聚，SUV约8.0，内见低密度坏死区放射性分布稀疏，大小约2.7×3.6cm；余左颈I区、左颈II-III区及右颈II区多发淋巴结放射性分布浓密，SUV约4.0，最大者约1.2×1.5cm。余双侧颈部未见肿大淋巴结及异常放射性分布。 双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。右侧上颌窦及左侧乳突炎症，右侧乳突、额窦、蝶窦、筛窦及左侧上颌窦结构及放射性分布未见明显异常。口咽、喉咽未见明显异常。甲状腺放射性分布未见异常。 右上肺后段、右中肺外侧段及左下肺外基底段数个小结节放射性分布未见异常；右中肺内侧段及左上肺下舌段局限性肺不张；左下肺背段肺大泡。气管、支气管通畅。心脏及大血管放射性分布未见异常。食管放射性分布未见明显异常。胸壁未见确切病灶和异常放射性分布。双肺门、纵隔及双侧腋窝未见肿大淋巴结及异常放射性分布。 脂肪肝。肝门结构及放射性分布未见明显异常。肝内、外胆管及胆总管未见扩张。胆囊、胃及十二指肠放射性分布未见异常。脾脏、胰腺、双肾及双侧肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、肠管、前列腺等形态、结构及放射性分布未见明显异常。双侧髂血管旁未见明显肿大淋巴结及异常放射性分布。双侧腹股沟数个小淋巴结放射性分布略浓密。 余颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，疑鼻咽癌，侵犯范围如上所述；左颈Ib区肿大淋巴结代谢活跃，疑转移；余左颈I区、左颈II-III区及右颈II区多发小淋巴结代谢较活跃，请结合临床。 右侧上颌窦及左侧乳突炎症。 右上肺后段、右中肺外侧段及左下肺外基底段数个小结节代谢未见异常，疑增殖灶；右中肺内侧段及左上肺下舌段局限性肺不张；左下肺背段肺大泡。 脂肪肝。 双侧腹股沟数个小淋巴结反应性增生。；检查部位: 全身；肿瘤部位: 鼻咽；是否区域淋巴结转移: 不确定\n治疗前综合影像评估：蝶骨基底部、左侧翼突基底部受侵；左颈Ib区淋巴结考虑转移，右颈II区小淋巴结倾向反应性。\n\n【当前需要决策的问题】\n病理已完成。\n治疗前MRI报告：检查名称: 鼻咽部磁共振平扫＋增强（3.0T及以上）(套)；检查所见: 鼻咽腔狭窄，鼻咽双侧顶壁、双侧顶后壁、双侧后壁、双侧壁增厚，明显强化。双侧咽隐窝受侵。左侧后鼻道受侵。 双侧咽旁间隙未见异常。双侧腭帆提肌受侵。余咽旁肌未见明显异常。 颅底骨质未见明显异常。 双侧咽后未见明显肿大淋巴结。 左侧I B区见1个肿大淋巴结，短径26mm，明显强化。 颈部双侧II区可见小淋巴结，大者短径约8mm。 右侧上颌窦粘膜增厚。左侧乳突见较多分泌物。 双侧腮腺、颌下腺、甲状腺、喉部、所见脑实质未见明显异常。；检查结论: 鼻咽病变，考虑鼻咽癌。 左侧I B区见1个肿大淋巴结，考虑转移。 颈部双侧II区淋巴结，考虑反应性淋巴结可能。 副鼻窦炎；左侧乳突炎。；检查部位: 鼻咽部 ；报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁、后壁及双侧壁粘膜增厚形成软组织密度影突入鼻咽腔，放射性浓聚，SUV约14.8，左侧咽隐窝消失，右侧咽隐窝存在；双侧咽旁间隙结构清晰。病灶向周围侵犯双侧腭帆提肌；向前侵犯双侧后鼻孔、鼻中隔后缘、左侧翼腭窝；向上侵犯颅底骨（蝶骨基底部、左侧翼突基底部）。双侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见异常。左颈Ib区肿大淋巴结放射性浓聚，SUV约8.0，内见低密度坏死区放射性分布稀疏，大小约2.7×3.6cm；余左颈I区、左颈II-III区及右颈II区多发淋巴结放射性分布浓密，SUV约4.0，最大者约1.2×1.5cm。余双侧颈部未见肿大淋巴结及异常放射性分布。 双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。右侧上颌窦及左侧乳突炎症，右侧乳突、额窦、蝶窦、筛窦及左侧上颌窦结构及放射性分布未见明显异常。口咽、喉咽未见明显异常。甲状腺放射性分布未见异常。 右上肺后段、右中肺外侧段及左下肺外基底段数个小结节放射性分布未见异常；右中肺内侧段及左上肺下舌段局限性肺不张；左下肺背段肺大泡。气管、支气管通畅。心脏及大血管放射性分布未见异常。食管放射性分布未见明显异常。胸壁未见确切病灶和异常放射性分布。双肺门、纵隔及双侧腋窝未见肿大淋巴结及异常放射性分布。 脂肪肝。肝门结构及放射性分布未见明显异常。肝内、外胆管及胆总管未见扩张。胆囊、胃及十二指肠放射性分布未见异常。脾脏、胰腺、双肾及双侧肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、肠管、前列腺等形态、结构及放射性分布未见明显异常。双侧髂血管旁未见明显肿大淋巴结及异常放射性分布。双侧腹股沟数个小淋巴结放射性分布略浓密。 余颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，疑鼻咽癌，侵犯范围如上所述；左颈Ib区肿大淋巴结代谢活跃，疑转移；余左颈I区、左颈II-III区及右颈II区多发小淋巴结代谢较活跃，请结合临床。 右侧上颌窦及左侧乳突炎症。 右上肺后段、右中肺外侧段及左下肺外基底段数个小结节代谢未见异常，疑增殖灶；右中肺内侧段及左上肺下舌段局限性肺不张；左下肺背段肺大泡。 脂肪肝。 双侧腹股沟数个小淋巴结反应性增生。；检查部位: 全身；肿瘤部位: 鼻咽；是否区域淋巴结转移: 不确定\n治疗前综合影像评估：蝶骨基底部、左侧翼突基底部受侵；左颈Ib区淋巴结考虑转移，右颈II区小淋巴结倾向反应性。\n请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T3 / N3 / cM0\nB. T3 / N1 / cM0\nC. T1 / N3 / cM0\nD. T3 / N3 / cM1\nE. T1 / N2 / cM1\nF. T2 / N2 / cM0\nG. T2 / N0 / cM1\nH. T4 / N1 / cM0\nI. T3 / N0 / cM1\nJ. T4 / N1 / cM1\nK. T4 / N3 / cM0\nL. T1 / N0 / cM1\n\n请仅输出一个选项字母（A-L）。","gold_letter":"B","gold_action":"T3 / N1 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T3 / N3 / cM0","B":"T3 / N1 / cM0","C":"T1 / N3 / cM0","D":"T3 / N3 / cM1","E":"T1 / N2 / cM1","F":"T2 / N2 / cM0","G":"T2 / N0 / cM1","H":"T4 / N1 / cM0","I":"T3 / N0 / cM1","J":"T4 / N1 / cM1","K":"T4 / N3 / cM0","L":"T1 / N0 / cM1"}}
+{"sample_id":"sample-ac39b8f4457aec5e405dad86","patient_id":"patient-4aef168669533556a36bc39e","episode_id":"episode-29323c3c332a6548756495be","turn_id":"P5_02","turn_number":6,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM：{{TNM_STATUS}}；总分期：{{OVERALL_STAGE}}。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；病历特点: 患者A ，男，主因“发现左颌下肿物2月余。 ”于既往时点步行入院。 一.病例特点: 1、患者28岁 男性。 2、现病史:患者既往时点无意中发现左侧颌下肿物，约2cm大小，无红肿疼痛，当时未予重视。 既往时点出现过1次鼻衄症状，量少，色鲜红。 患者就诊外院A，行左颌下肿物穿刺活检，病理：（左颈部）符合恶性肿瘤，首先考虑为鳞癌转移，以鼻咽部可能性为大，请临床结合其他检查。 既往时点电子鼻咽镜示：鼻咽部隆起型新生物，表面粘膜糜烂（未行活检）。 诉既往时点搭乘飞机后出现左耳鸣症状，无耳堵塞感、听力下降、鼻塞、回吸性涕血、面麻、复视等不适。 现患者为进一步诊治就诊本院，门诊以“鼻咽癌？”收入院。 自起病以来，患者精神、睡眠可，食欲如常，小便正常，大便2-3次/天，偶成型便偶稀便，体重无下降。 3、体格检查: T:36.70℃ P:70次/分 R:20次/分 BP:116/73 mmHg Ht: 162cm Wt: 66.60kg BSA: 1.7110m2 KPS:90 发育正常，营养一般，神志清楚，自主体位，查体合作。 全身皮肤粘膜无苍白、黄染、水肿、出血。 巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。 无鼻翼扇动、鼻衄。 牙龈无肿胀、出血。 气管居中，甲状腺不大。 胸骨无压痛。 双肺呼吸音清，未闻及干湿啰音。 心率70bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。 腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。 肛门外生殖器未见异常，生理反射存在，病理反射未引出。 4. 【病理资料1】（鼻咽右顶壁肿物）镜下：符合未分化型非角化性癌。；活检部位: 右侧顶壁,鼻咽；肿瘤部位: 右侧顶壁,鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】治疗前MRI报告：检查名称: 鼻咽部磁共振平扫＋增强（3.0T及以上）(套)；检查所见: 鼻咽腔狭窄，鼻咽双侧顶壁、双侧顶后壁、双侧后壁、双侧壁增厚，明显强化。双侧咽隐窝受侵。左侧后鼻道受侵。 双侧咽旁间隙未见异常。双侧腭帆提肌受侵。余咽旁肌未见明显异常。 颅底骨质未见明显异常。 双侧咽后未见明显肿大淋巴结。 左侧I B区见1个肿大淋巴结，短径26mm，明显强化。 颈部双侧II区可见小淋巴结，大者短径约8mm。 右侧上颌窦粘膜增厚。左侧乳突见较多分泌物。 双侧腮腺、颌下腺、甲状腺、喉部、所见脑实质未见明显异常。；检查结论: 鼻咽病变，考虑鼻咽癌。 左侧I B区见1个肿大淋巴结，考虑转移。 颈部双侧II区淋巴结，考虑反应性淋巴结可能。 副鼻窦炎；左侧乳突炎。；检查部位: 鼻咽部 ；报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁、后壁及双侧壁粘膜增厚形成软组织密度影突入鼻咽腔，放射性浓聚，SUV约14.8，左侧咽隐窝消失，右侧咽隐窝存在；双侧咽旁间隙结构清晰。病灶向周围侵犯双侧腭帆提肌；向前侵犯双侧后鼻孔、鼻中隔后缘、左侧翼腭窝；向上侵犯颅底骨（蝶骨基底部、左侧翼突基底部）。双侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见异常。左颈Ib区肿大淋巴结放射性浓聚，SUV约8.0，内见低密度坏死区放射性分布稀疏，大小约2.7×3.6cm；余左颈I区、左颈II-III区及右颈II区多发淋巴结放射性分布浓密，SUV约4.0，最大者约1.2×1.5cm。余双侧颈部未见肿大淋巴结及异常放射性分布。 双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。右侧上颌窦及左侧乳突炎症，右侧乳突、额窦、蝶窦、筛窦及左侧上颌窦结构及放射性分布未见明显异常。口咽、喉咽未见明显异常。甲状腺放射性分布未见异常。 右上肺后段、右中肺外侧段及左下肺外基底段数个小结节放射性分布未见异常；右中肺内侧段及左上肺下舌段局限性肺不张；左下肺背段肺大泡。气管、支气管通畅。心脏及大血管放射性分布未见异常。食管放射性分布未见明显异常。胸壁未见确切病灶和异常放射性分布。双肺门、纵隔及双侧腋窝未见肿大淋巴结及异常放射性分布。 脂肪肝。肝门结构及放射性分布未见明显异常。肝内、外胆管及胆总管未见扩张。胆囊、胃及十二指肠放射性分布未见异常。脾脏、胰腺、双肾及双侧肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、肠管、前列腺等形态、结构及放射性分布未见明显异常。双侧髂血管旁未见明显肿大淋巴结及异常放射性分布。双侧腹股沟数个小淋巴结放射性分布略浓密。 余颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，疑鼻咽癌，侵犯范围如上所述；左颈Ib区肿大淋巴结代谢活跃，疑转移；余左颈I区、左颈II-III区及右颈II区多发小淋巴结代谢较活跃，请结合临床。 右侧上颌窦及左侧乳突炎症。 右上肺后段、右中肺外侧段及左下肺外基底段数个小结节代谢未见异常，疑增殖灶；右中肺内侧段及左上肺下舌段局限性肺不张；左下肺背段肺大泡。 脂肪肝。 双侧腹股沟数个小淋巴结反应性增生。；检查部位: 全身；肿瘤部位: 鼻咽；是否区域淋巴结转移: 不确定\n治疗前综合影像评估：蝶骨基底部、左侧翼突基底部受侵；左颈Ib区淋巴结考虑转移，右颈II区小淋巴结倾向反应性。 【治疗经过1】报告日期: 既往时点；检查名称: 鼻咽部磁共振平扫＋增强（3.0T及以上）(套)；检查所见: 鼻咽腔狭窄，鼻咽双侧顶壁、双侧顶后壁、双侧后壁、双侧壁增厚，明显强化。双侧咽隐窝受侵。左侧后鼻道受侵。 双侧咽旁间隙未见异常。双侧腭帆提肌受侵。余咽旁肌未见明显异常。 颅底骨质未见明显异常。 双侧咽后未见明显肿大淋巴结。 左侧I B区见1个肿大淋巴结，短径26mm，明显强化。 颈部双侧II区可见小淋巴结，大者短径约8mm。 右侧上颌窦粘膜增厚。左侧乳突见较多分泌物。 双侧腮腺、颌下腺、甲状腺、喉部、所见脑实质未见明显异常。；检查结论: 鼻咽病变，考虑鼻咽癌。 左侧I B区见1个肿大淋巴结，考虑转移。 颈部双侧II区淋巴结，考虑反应性淋巴结可能。 副鼻窦炎；左侧乳突炎。；检查部位: 鼻咽部；肿瘤部位: 鼻咽；区域转移淋巴结最大径(mm): 26.0；是否区域复发: 否\n报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁、后壁及双侧壁粘膜增厚形成软组织密度影突入鼻咽腔，放射性浓聚，SUV约14.8，左侧咽隐窝消失，右侧咽隐窝存在；双侧咽旁间隙结构清晰。病灶向周围侵犯双侧腭帆提肌；向前侵犯双侧后鼻孔、鼻中隔后缘、左侧翼腭窝；向上侵犯颅底骨（蝶骨基底部、左侧翼突基底部）。双侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见异常。左颈Ib区肿大淋巴结放射性浓聚，SUV约8.0，内见低密度坏死区放射性分布稀疏，大小约2.7×3.6cm；余左颈I区、左颈II-III区及右颈II区多发淋巴结放射性分布浓密，SUV约4.0，最大者约1.2×1.5cm。余双侧颈部未见肿大淋巴结及异常放射性分布。 双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。右侧上颌窦及左侧乳突炎症，右侧乳突、额窦、蝶窦、筛窦及左侧上颌窦结构及放射性分布未见明显异常。口咽、喉咽未见明显异常。甲状腺放射性分布未见异常。 右上肺后段、右中肺外侧段及左下肺外基底段数个小结节放射性分布未见异常；右中肺内侧段及左上肺下舌段局限性肺不张；左下肺背段肺大泡。气管、支气管通畅。心脏及大血管放射性分布未见异常。食管放射性分布未见明显异常。胸壁未见确切病灶和异常放射性分布。双肺门、纵隔及双侧腋窝未见肿大淋巴结及异常放射性分布。 脂肪肝。肝门结构及放射性分布未见明显异常。肝内、外胆管及胆总管未见扩张。胆囊、胃及十二指肠放射性分布未见异常。脾脏、胰腺、双肾及双侧肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、肠管、前列腺等形态、结构及放射性分布未见明显异常。双侧髂血管旁未见明显肿大淋巴结及异常放射性分布。双侧腹股沟数个小淋巴结放射性分布略浓密。 余颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，疑鼻咽癌，侵犯范围如上所述；左颈Ib区肿大淋巴结代谢活跃，疑转移；余左颈I区、左颈II-III区及右颈II区多发小淋巴结代谢较活跃，请结合临床。 右侧上颌窦及左侧乳突炎症。 右上肺后段、右中肺外侧段及左下肺外基底段数个小结节代谢未见异常，疑增殖灶；右中肺内侧段及左上肺下舌段局限性肺不张；左下肺背段肺大泡。 脂肪肝。 双侧腹股沟数个小淋巴结反应性增生。；检查部位: 全身；肿瘤部位: 鼻咽；是否区域淋巴结转移: 不确定 【治疗反应与不良反应1】记录时间: 既往时点；病程主题: 上级查房记录；病程内容: 既往时点 上级医生A查房记录 今日查房，患者诉咳嗽好转，无胸痛。 查体同前。 上级医生A查看患者后示：今日行胸部CT检查，继续护肝降酶治疗。 医嘱内容；客观检验：天门冬氨酸氨基转移酶(AST)-静脉血：42.3U/L（高于参考范围，参考约13-35U/L） || 丙氨酸氨基转移酶(ALT)-静脉血：120.7 … T)-静脉血：104.2U/L（高于参考范围，参考约7-40U/L） 【治疗反应与不良反应2】记录时间: 既往时点；病程主题: 上级查房记录；病程内容: 既往时点 上级医生A查房记录 GP化疗第2天，患者A，无恶心呕吐。 查体同前。 上级医生A查看患者后示：患者未见明显不适，今日予继续第2天顺铂化疗。 医嘱内容；客观检验：丙氨酸氨基转移酶(ALT)-静脉血：78.0U/L（高于参考范围，参考约7-40U/L） || 天门冬氨酸氨基转移酶(AST)-静脉血：43.4U/L（高于参考范围，参考约13-35U/L）\n\n【当前需要决策的问题】\n治疗开始后约第47天，本患者出现第2个独立的黏膜及胃肠毒性里程碑：记录时间: 既往时点；病程主题: 上级查房记录；病程内容: 既往时点 上级医生A查房记录 GP化疗第2天，患者A，无恶心呕吐。 查体同前。 上级医生A查看患者后示：患者未见明显不适，今日予继续第2天顺铂化疗。 医嘱内容；客观检验：丙氨酸氨基转移酶(ALT)-静脉血：78.0U/L（高于参考范围，参考约7-40U/L） || 天门冬氨酸氨基转移酶(AST)-静脉血：43.4U/L（高于参考范围，参考约13-35U/L）。该事件最符合哪类治疗相关毒性，当前应采取怎样的支持处理、监测及治疗节奏调整？\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 忽略当前异常并按原剂量、原时间继续治疗，不增加复查\nB. 永久停止全部抗肿瘤治疗，不再判断毒性是否可逆\nC. 立即提高化疗剂量，以补偿既往可能损失的剂量强度\nD. 按黏膜/胃肠毒性分级给予止吐、镇痛、补液和营养支持，并监测进食与体重\nE. 仅复查肿瘤影像，不复查血常规、生化或相关器官功能\nF. 直接改为另一套强化联合方案，不等待毒性恢复\nG. 仅口头安慰并观察，不给予症状处理或近期监测\nH. 把当前异常判断为疾病进展并立即进入后线挽救治疗\nI. 仅依据一次EBV-DNA结果决定停药或换药\nJ. 继续原方案并取消止吐、补液或营养等支持治疗\nK. 立即扩大放疗范围，将所有不适均按肿瘤侵犯处理\nL. 三个月后再复查当前异常，期间不调整治疗节奏\n\n请仅输出一个选项字母（A-L）。","gold_letter":"D","gold_action":"按黏膜/胃肠毒性分级给予止吐、镇痛、补液和营养支持，并监测进食与体重","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":{"A":"忽略当前异常并按原剂量、原时间继续治疗，不增加复查","B":"永久停止全部抗肿瘤治疗，不再判断毒性是否可逆","C":"立即提高化疗剂量，以补偿既往可能损失的剂量强度","D":"按黏膜/胃肠毒性分级给予止吐、镇痛、补液和营养支持，并监测进食与体重","E":"仅复查肿瘤影像，不复查血常规、生化或相关器官功能","F":"直接改为另一套强化联合方案，不等待毒性恢复","G":"仅口头安慰并观察，不给予症状处理或近期监测","H":"把当前异常判断为疾病进展并立即进入后线挽救治疗","I":"仅依据一次EBV-DNA结果决定停药或换药","J":"继续原方案并取消止吐、补液或营养等支持治疗","K":"立即扩大放疗范围，将所有不适均按肿瘤侵犯处理","L":"三个月后再复查当前异常，期间不调整治疗节奏"}}
+{"sample_id":"sample-37bbf80846ae0b6fd8d8fc5b","patient_id":"patient-393a69d1a905e05600212d51","episode_id":"episode-316ca44099c55186ce6cf1ad","turn_id":"P2_01","turn_number":2,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 当前阶段尚未释放病理、MRI或TNM结论。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；病历特点: 患者A，男，36岁，因\"反复涕血6月。\"于既往时点，步行入院。一、病例特点： 1、患者A，男性，36岁。今为求进一步诊治来本院。患者A，精神佳，饮食睡眠佳，大小便正常，体重无减轻。3、体格检查: 张口门齿距cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结，双侧颈部IIa区可扪及1个淋巴结，最大径×cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查： 【病理资料1】（右颈淋巴结）镜下：结合免疫组化及原位杂交结果，病变诊断为转移性淋巴上皮瘤样癌，请检查鼻咽及肺等部位。 免疫组化：[标本05]-0：CK(AE1/AE3)（+），p40（+），CK5/6（+），CK7（-）。 原位杂交：EBERs（+）。；颈部转移淋巴结部位: 右侧颈部淋巴结；是否鼻咽癌: 否\n\n【当前需要决策的问题】\n此前初诊线索为：记录时间: 既往时点；病历特点: 患者A，男，36岁，因\"反复涕血6月。\"于既往时点，步行入院。一、病例特点： 1、患者A，男性，36岁。今为求进一步诊治来本院。患者A，精神佳，饮食睡眠佳，大小便正常，体重无减轻。3、体格 … IIa区可扪及1个淋巴结，最大径×cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：。本诊断节点新释放患者本人正式病理报告：（右颈淋巴结）镜下：结合免疫组化及原位杂交结果，病变诊断为转移性淋巴上皮瘤样癌，请检查鼻咽及肺等部位。 免疫组化：[标本05]-0：CK(AE1/AE3)（+），p40（+），CK5/6（+），CK7（-）。 原位杂交：EBERs（+）。；颈部转移淋巴结部位: 右侧颈部淋巴结；是否鼻咽癌: 否。此时最准确的组织学诊断是什么，哪些证据只能作为支持而不能单独替代正式病理？\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 鼻咽未分化型非角化性癌，正式组织病理为诊断核心，EBER/IHC为支持证据\nB. 鼻咽未分化型非角化性癌并淋巴结转移；正式组织形态为诊断核心，IHC/EBER仅作支持\nC. 鼻咽黏膜慢性炎症，EBER阳性即可排除恶性肿瘤\nD. 角化型鳞状细胞癌，仅凭EBV-DNA升高即可确诊\nE. 弥漫大B细胞淋巴瘤，CK阳性是其特异诊断依据\nF. NK/T细胞淋巴瘤，任何EBER阳性都足以替代组织形态\nG. 嗅神经母细胞瘤，以颈部淋巴结转移作为唯一证据\nH. 腺样囊性癌，未见腺样结构也可直接确诊\nI. 小细胞神经内分泌癌，Syn和CgA阴性仍应优先考虑\nJ. 转移性甲状腺癌，不需要核对鼻咽取材部位\nK. 鼻咽部未定性恶性肿瘤，正式病理尚不能支持具体诊断\nL. 良性淋巴组织增生，异型上皮巢不具有诊断价值\n\n请仅输出一个选项字母（A-L）。","gold_letter":"B","gold_action":"鼻咽未分化型非角化性癌并淋巴结转移；正式组织形态为诊断核心，IHC/EBER仅作支持","context_placeholders":[],"options":{"A":"鼻咽未分化型非角化性癌，正式组织病理为诊断核心，EBER/IHC为支持证据","B":"鼻咽未分化型非角化性癌并淋巴结转移；正式组织形态为诊断核心，IHC/EBER仅作支持","C":"鼻咽黏膜慢性炎症，EBER阳性即可排除恶性肿瘤","D":"角化型鳞状细胞癌，仅凭EBV-DNA升高即可确诊","E":"弥漫大B细胞淋巴瘤，CK阳性是其特异诊断依据","F":"NK/T细胞淋巴瘤，任何EBER阳性都足以替代组织形态","G":"嗅神经母细胞瘤，以颈部淋巴结转移作为唯一证据","H":"腺样囊性癌，未见腺样结构也可直接确诊","I":"小细胞神经内分泌癌，Syn和CgA阴性仍应优先考虑","J":"转移性甲状腺癌，不需要核对鼻咽取材部位","K":"鼻咽部未定性恶性肿瘤，正式病理尚不能支持具体诊断","L":"良性淋巴组织增生，异型上皮巢不具有诊断价值"}}
+{"sample_id":"sample-cb4962ae6318fad7587f7e78","patient_id":"patient-393a69d1a905e05600212d51","episode_id":"episode-316ca44099c55186ce6cf1ad","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；病历特点: 患者A，男，36岁，因\"反复涕血6月。\"于既往时点，步行入院。一、病例特点： 1、患者A，男性，36岁。今为求进一步诊治来本院。患者A，精神佳，饮食睡眠佳，大小便正常，体重无减轻。3、体格检查: 张口门齿距cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结，双侧颈部IIa区可扪及1个淋巴结，最大径×cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查： 【病理资料1】（右颈淋巴结）镜下：结合免疫组化及原位杂交结果，病变诊断为转移性淋巴上皮瘤样癌，请检查鼻咽及肺等部位。 免疫组化：[标本05]-0：CK(AE1/AE3)（+），p40（+），CK5/6（+），CK7（-）。 原位杂交：EBERs（+）。；颈部转移淋巴结部位: 右侧颈部淋巴结；是否鼻咽癌: 否 【影像与分期资料1】报告日期: 既往时点；检查名称: 鼻咽部磁共振平扫＋增强（3.0T及以上）(套)；检查所见: 鼻咽腔狭窄，鼻咽双侧顶壁、双侧顶后壁、双侧后壁、双侧壁增厚，明显强化。双侧咽隐窝受侵。口咽、双侧后鼻孔未见明显异常。 右侧咽旁间隙受侵。双侧腭帆提肌、双侧腭帆张肌、右侧翼内肌、双侧头长肌受侵。余咽旁肌未见明显异常。 双侧翼突基底部、双侧翼突内板、蝶骨基底部、斜坡、双侧岩尖、双侧枕骨基底部受侵，余颅底骨质未见明显异常。 双侧破裂孔受侵。 双侧咽后见小淋巴结，大者短径4mm，明显强化。 颈部双侧II A区、右侧II B区、右侧III区、右侧V A区见数个肿大淋巴结，大者短径18mm，明显强化，部分可见中央坏死。 双侧上颌窦、双侧筛窦、双侧蝶窦粘膜增厚。右侧乳突见较多分泌物。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 双侧咽后小淋巴结，转移待排。 颈部双侧II A区、右侧II B区、右侧III区、右侧V A区数个淋巴结，考虑转移。 副鼻窦炎；右侧乳突炎。；检查部位: 鼻咽部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 18.0；是否区域复发: 否 ；报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁、双侧壁粘膜明显增厚放射性分布浓聚，SUV约12.1，病灶侵犯双侧头长肌、双侧翼腭肌群、右侧翼内肌、颅底骨（蝶骨基底部、双侧翼突基底部及内侧板、枕骨斜坡及髁部、右侧岩尖）、蝶窦、鼻中隔、双侧翼腭窝、双侧破裂孔。双侧咽隐窝消失。双侧海绵窦结构及放射性分布未见异常。筛窦及双侧上颌窦部分低密度影放射性分布稀疏；额窦及蝶窦结构及放射性分布未见明显异常。双侧乳突结构及放射性分布未见异常。口咽、喉咽未见明显异常。甲状腺放射性分布未见异常。右颈II-III区多发肿大淋巴结放射性分布浓聚，SUV约8.0，大者约1.6×2.2cm；左颈II区肿大淋巴结放射性分布浓密，SUV约4.7，大小约0.8×1.3cm；余双侧颈部小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺纹理清晰，双侧肺野未见确切病灶和异常放射性分布。气管、支气管通畅。心脏及大血管放射性分布未见异常。食管放射性分布未见明显异常。胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管及胆总管未见扩张。胆囊、胃及十二指肠放射性分布未见异常。脾脏、胰腺、双肾及双侧肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 盆腔放射性分布均匀，膀胱、肠管、前列腺等形态、结构及放射性分布未见明显异常。双侧髂血管旁及双侧腹股沟未见明显肿大淋巴结及异常放射性分布。 右侧第6肋骨皮质连续性中断放射性分布浓聚，SUV约8.5；左侧肩关节放射性分布浓聚，SUV约3.4；余所见颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，病灶侵犯颅底骨、蝶窦及双翼腭窝，具体范围如上所述；右颈II-III区多发肿大淋巴结代谢活跃，考虑转移；左颈II区肿大淋巴结代谢稍活跃，疑转移。 鼻窦炎。 右侧第6肋骨折改变；左侧肩关节炎症。；检查部位: 全身；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 22.0\n治疗前颈部超声检查结论：双侧颈部II区、右侧颈部III、Va区淋巴结，考虑转移性淋巴结，建议超声引导下穿刺活检。 双侧颈部Ib区淋巴结，考虑反应性淋巴结可能性大。\n\n【当前需要决策的问题】\n病理已完成。\n报告日期: 既往时点；检查名称: 鼻咽部磁共振平扫＋增强（3.0T及以上）(套)；检查所见: 鼻咽腔狭窄，鼻咽双侧顶壁、双侧顶后壁、双侧后壁、双侧壁增厚，明显强化。双侧咽隐窝受侵。口咽、双侧后鼻孔未见明显异常。 右侧咽旁间隙受侵。双侧腭帆提肌、双侧腭帆张肌、右侧翼内肌、双侧头长肌受侵。余咽旁肌未见明显异常。 双侧翼突基底部、双侧翼突内板、蝶骨基底部、斜坡、双侧岩尖、双侧枕骨基底部受侵，余颅底骨质未见明显异常。 双侧破裂孔受侵。 双侧咽后见小淋巴结，大者短径4mm，明显强化。 颈部双侧II A区、右侧II B区、右侧III区、右侧V A区见数个肿大淋巴结，大者短径18mm，明显强化，部分可见中央坏死。 双侧上颌窦、双侧筛窦、双侧蝶窦粘膜增厚。右侧乳突见较多分泌物。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 双侧咽后小淋巴结，转移待排。 颈部双侧II A区、右侧II B区、右侧III区、右侧V A区数个淋巴结，考虑转移。 副鼻窦炎；右侧乳突炎。；检查部位: 鼻咽部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 18.0；是否区域复发: 否 ；报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁、双侧壁粘膜明显增厚放射性分布浓聚，SUV约12.1，病灶侵犯双侧头长肌、双侧翼腭肌群、右侧翼内肌、颅底骨（蝶骨基底部、双侧翼突基底部及内侧板、枕骨斜坡及髁部、右侧岩尖）、蝶窦、鼻中隔、双侧翼腭窝、双侧破裂孔。双侧咽隐窝消失。双侧海绵窦结构及放射性分布未见异常。筛窦及双侧上颌窦部分低密度影放射性分布稀疏；额窦及蝶窦结构及放射性分布未见明显异常。双侧乳突结构及放射性分布未见异常。口咽、喉咽未见明显异常。甲状腺放射性分布未见异常。右颈II-III区多发肿大淋巴结放射性分布浓聚，SUV约8.0，大者约1.6×2.2cm；左颈II区肿大淋巴结放射性分布浓密，SUV约4.7，大小约0.8×1.3cm；余双侧颈部小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺纹理清晰，双侧肺野未见确切病灶和异常放射性分布。气管、支气管通畅。心脏及大血管放射性分布未见异常。食管放射性分布未见明显异常。胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管及胆总管未见扩张。胆囊、胃及十二指肠放射性分布未见异常。脾脏、胰腺、双肾及双侧肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 盆腔放射性分布均匀，膀胱、肠管、前列腺等形态、结构及放射性分布未见明显异常。双侧髂血管旁及双侧腹股沟未见明显肿大淋巴结及异常放射性分布。 右侧第6肋骨皮质连续性中断放射性分布浓聚，SUV约8.5；左侧肩关节放射性分布浓聚，SUV约3.4；余所见颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，病灶侵犯颅底骨、蝶窦及双翼腭窝，具体范围如上所述；右颈II-III区多发肿大淋巴结代谢活跃，考虑转移；左颈II区肿大淋巴结代谢稍活跃，疑转移。 鼻窦炎。 右侧第6肋骨折改变；左侧肩关节炎症。；检查部位: 全身；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 22.0\n治疗前颈部超声检查结论：双侧颈部II区、右侧颈部III、Va区淋巴结，考虑转移性淋巴结，建议超声引导下穿刺活检。 双侧颈部Ib区淋巴结，考虑反应性淋巴结可能性大。\n请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T3 / N1 / cM0\nB. T3 / N2 / cM0\nC. T2 / N2 / cM0\nD. T3 / N0 / cM1\nE. T2 / N0 / cM0\nF. T4 / N1 / cM1\nG. T1 / N0 / cM0\nH. T1 / N2 / cM1\nI. T1 / N2 / cM0\nJ. T4 / N2 / cM0\nK. T1 / N3 / cM1\nL. T4 / N2 / cM1\n\n请仅输出一个选项字母（A-L）。","gold_letter":"B","gold_action":"T3 / N2 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T3 / N1 / cM0","B":"T3 / N2 / cM0","C":"T2 / N2 / cM0","D":"T3 / N0 / cM1","E":"T2 / N0 / cM0","F":"T4 / N1 / cM1","G":"T1 / N0 / cM0","H":"T1 / N2 / cM1","I":"T1 / N2 / cM0","J":"T4 / N2 / cM0","K":"T1 / N3 / cM1","L":"T4 / N2 / cM1"}}
+{"sample_id":"sample-028c22134e5daac788d3d7c9","patient_id":"patient-1f701280917a20dc32022e52","episode_id":"episode-1a36457d46abab9b03795658","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；主诉: 右侧听力下降1月余；门诊既往史；既往疾病史: 是否有过敏史无过敏史。是否有吸烟史吸烟史详情 【病理资料1】（右咽隐窝肿物）考虑未分化型非角化性癌，建议用送检白片交费行免疫组化及原位杂交协助诊断（CK、EGFR、P40、EBERs）。 既往时点补充报告： （右咽隐窝肿物）未分化型非角化性癌。 本院免疫组化：CK(AE1/AE3)（+），EGFR（弱+），p40（+）。 本院原位杂交：EBERs（+）。；活检部位: 右侧咽隐窝；肿瘤部位: 右侧咽隐窝；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】报告日期: 既往时点；检查名称: 鼻咽部、颈部磁共振平扫+增强(1.5T以上)、磁共振功能成像(套)；检查所见: 鼻咽腔狭窄，鼻咽双侧顶壁、双侧顶后壁、右侧后壁、右侧壁增厚，明显强化。右侧咽隐窝受侵，左侧咽隐窝异常。 右侧咽旁间隙受侵。右侧腭帆提肌、右侧腭帆张肌受侵。余咽旁肌未见明显异常。 蝶骨基底部、右侧岩尖、右侧破裂孔受侵。 右侧咽后见1个肿大淋巴结，大者短径6mm↑(0-5mm)，明显强化，可见中央坏死。 颈部双侧见多个小淋巴结大者短径约5mm。 双侧上颌窦粘膜增厚。右侧乳突见较多分泌物。双侧腮腺、颌下腺、甲状腺、喉部、所见脑实质未见明显异常。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 右侧咽后肿大淋巴结，考虑转移。 颈部双侧见多个小淋巴结，性质待定。 副鼻窦炎；右侧乳突炎。；检查部位: 颈部,鼻咽部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 6.0；是否区域复发: 否 ；报告日期: 既往时点；检查名称: PET/CT显像(全视野)（套）（特）(自费)；检查所见: 空腹6h以上，静脉注射18F-FDG，静息60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及右侧壁粘膜增厚放射性浓聚，SUV约10.8，病灶侵犯颅底骨（蝶骨基底部、右翼突基底部、右岩尖）、右颈动脉管、右破裂孔、右腭帆肌群及右头长肌。左侧破裂孔未见明显异常。左侧咽后小淋巴结放射性分布未见明显异常。双侧海绵窦结构及放射性分布未见异常。右乳突、筛窦及双侧上颌窦低密度影放射性分布未见明显异常。双侧扁桃体放射性分布浓密，SUV约8.1；余口咽、喉咽未见明显异常。甲状腺放射性分布未见异常。右咽后及右颈Ⅱ区数个淋巴结放射性浓聚/浓密，SUV约8.8，最大约0.7×1.0cm；左颈Ⅱ区淋巴结放射性分布略浓密，SUV约2.9，最大约0.6×1.0cm；余双颈小淋巴结放射性分布未见明显异常。 双侧脑实质平扫未见确切病灶和异常放射性分布，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺散在小结节放射性分布未见明显异常，最大直径约0.5cm。气管、支气管通畅。心脏及大血管放射性分布未见异常。食管放射性分布未见明显异常。纵隔（右上下气管旁、主动脉下、隆突下、食管旁）及双肺门多个淋巴结放射性浓聚/浓密，SUV约12.7，最大约0.9×1.3cm。双侧腋窝小淋巴结放射性分布未见明显异常。 肝脏S4片状稍低密度影放射性分布未见明显异常，边界模糊，大小约1.4×2.1cm；余肝脏散在小片状高密度影放射性分布未见异常。肝内、外胆管及胆总管未见扩张。胆囊、胃及十二指肠放射性分布未见异常。左肾囊性低密度影放射性分布稀疏，直径约0.9cm。脾脏、胰腺、右肾及双侧肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后小淋巴结放射性分布未见明显异常。 前列腺点状高密度影放射性分布未见异常。膀胱、肠管等形态、结构及放射性分布未见明显异常。双侧髂血管旁及双侧腹股沟小淋巴结放射性分布未见明显异常。 余颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，病灶侵犯范围如上述；右咽后及右颈Ⅱ区淋巴结代谢活跃/较活跃，考虑转移。 双侧扁桃体代谢较活跃，左颈Ⅱ区淋巴结代谢略活跃，疑炎性病变。 双肺散在小结节代谢未见明显异常，疑炎性病变/增殖灶，转移待排，建议随诊。 纵隔及双肺门多个淋巴结代谢活跃/较活跃，疑炎性病变，请结合临床。 鼻窦炎；右乳突炎。 肝脏S4片状稍低密度影代谢未见明显异常，疑良性病变（血管瘤？）；肝内胆管结石。 左肾囊肿。 前列腺钙化灶。；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 10.0；是否远处转移: 不确定\n\n【当前需要决策的问题】\n病理已完成。\n报告日期: 既往时点；检查名称: 鼻咽部、颈部磁共振平扫+增强(1.5T以上)、磁共振功能成像(套)；检查所见: 鼻咽腔狭窄，鼻咽双侧顶壁、双侧顶后壁、右侧后壁、右侧壁增厚，明显强化。右侧咽隐窝受侵，左侧咽隐窝异常。 右侧咽旁间隙受侵。右侧腭帆提肌、右侧腭帆张肌受侵。余咽旁肌未见明显异常。 蝶骨基底部、右侧岩尖、右侧破裂孔受侵。 右侧咽后见1个肿大淋巴结，大者短径6mm↑(0-5mm)，明显强化，可见中央坏死。 颈部双侧见多个小淋巴结大者短径约5mm。 双侧上颌窦粘膜增厚。右侧乳突见较多分泌物。双侧腮腺、颌下腺、甲状腺、喉部、所见脑实质未见明显异常。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 右侧咽后肿大淋巴结，考虑转移。 颈部双侧见多个小淋巴结，性质待定。 副鼻窦炎；右侧乳突炎。；检查部位: 颈部,鼻咽部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 6.0；是否区域复发: 否 ；报告日期: 既往时点；检查名称: PET/CT显像(全视野)（套）（特）(自费)；检查所见: 空腹6h以上，静脉注射18F-FDG，静息60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及右侧壁粘膜增厚放射性浓聚，SUV约10.8，病灶侵犯颅底骨（蝶骨基底部、右翼突基底部、右岩尖）、右颈动脉管、右破裂孔、右腭帆肌群及右头长肌。左侧破裂孔未见明显异常。左侧咽后小淋巴结放射性分布未见明显异常。双侧海绵窦结构及放射性分布未见异常。右乳突、筛窦及双侧上颌窦低密度影放射性分布未见明显异常。双侧扁桃体放射性分布浓密，SUV约8.1；余口咽、喉咽未见明显异常。甲状腺放射性分布未见异常。右咽后及右颈Ⅱ区数个淋巴结放射性浓聚/浓密，SUV约8.8，最大约0.7×1.0cm；左颈Ⅱ区淋巴结放射性分布略浓密，SUV约2.9，最大约0.6×1.0cm；余双颈小淋巴结放射性分布未见明显异常。 双侧脑实质平扫未见确切病灶和异常放射性分布，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺散在小结节放射性分布未见明显异常，最大直径约0.5cm。气管、支气管通畅。心脏及大血管放射性分布未见异常。食管放射性分布未见明显异常。纵隔（右上下气管旁、主动脉下、隆突下、食管旁）及双肺门多个淋巴结放射性浓聚/浓密，SUV约12.7，最大约0.9×1.3cm。双侧腋窝小淋巴结放射性分布未见明显异常。 肝脏S4片状稍低密度影放射性分布未见明显异常，边界模糊，大小约1.4×2.1cm；余肝脏散在小片状高密度影放射性分布未见异常。肝内、外胆管及胆总管未见扩张。胆囊、胃及十二指肠放射性分布未见异常。左肾囊性低密度影放射性分布稀疏，直径约0.9cm。脾脏、胰腺、右肾及双侧肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后小淋巴结放射性分布未见明显异常。 前列腺点状高密度影放射性分布未见异常。膀胱、肠管等形态、结构及放射性分布未见明显异常。双侧髂血管旁及双侧腹股沟小淋巴结放射性分布未见明显异常。 余颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，病灶侵犯范围如上述；右咽后及右颈Ⅱ区淋巴结代谢活跃/较活跃，考虑转移。 双侧扁桃体代谢较活跃，左颈Ⅱ区淋巴结代谢略活跃，疑炎性病变。 双肺散在小结节代谢未见明显异常，疑炎性病变/增殖灶，转移待排，建议随诊。 纵隔及双肺门多个淋巴结代谢活跃/较活跃，疑炎性病变，请结合临床。 鼻窦炎；右乳突炎。 肝脏S4片状稍低密度影代谢未见明显异常，疑良性病变（血管瘤？）；肝内胆管结石。 左肾囊肿。 前列腺钙化灶。；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 10.0；是否远处转移: 不确定\n请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T4 / N3 / cM0\nB. T3 / N3 / cM1\nC. T1 / N0 / cM0\nD. T3 / N1 / cM0\nE. T1 / N2 / cM0\nF. T4 / N1 / cM1\nG. T4 / N3 / cM1\nH. T2 / N3 / cM1\nI. T3 / N2 / cM1\nJ. T3 / N3 / cM0\nK. T4 / N0 / cM1\nL. T1 / N1 / cM1\n\n请仅输出一个选项字母（A-L）。","gold_letter":"D","gold_action":"T3 / N1 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T4 / N3 / cM0","B":"T3 / N3 / cM1","C":"T1 / N0 / cM0","D":"T3 / N1 / cM0","E":"T1 / N2 / cM0","F":"T4 / N1 / cM1","G":"T4 / N3 / cM1","H":"T2 / N3 / cM1","I":"T3 / N2 / cM1","J":"T3 / N3 / cM0","K":"T4 / N0 / cM1","L":"T1 / N1 / cM1"}}
+{"sample_id":"sample-0c720b4ef512446ae78df25a","patient_id":"patient-1189badad5e7374b82a3cc86","episode_id":"episode-a0c2f0312a8c0ed207ee86f9","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；病历特点: 患者A，女，47岁，因\"鼻塞9月余\"于既往时点，步行入院。患者A，精神可，饮食睡眠一般，大小便正常，体重无明显变化。3、肿瘤专科检查:张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查:阴性。 【病理资料1】（右鼻咽新生物）组织形态结合免疫组化及原位杂交结果，病变诊断为未分化型非角化性癌。 原单位免疫组化结果：CK（+），P63（+），EGFR（+），INI1（+），BRG1（+）。 原单位原位杂交结果：EBER（+）。 本单位免疫组化结果：CK(AE1/AE3)（+），EGFR（+） 本单位原位杂交结果：EBERs（+）。；活检部位: 右侧鼻咽；肿瘤部位: 右侧鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】筛骨、上颌骨炎症。；检查部位: 骨 ；报告日期: 既往时点；检查名称: 颈部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 鼻咽腔狭窄，鼻咽双侧顶壁、双侧顶后壁、双侧后壁、左侧壁增厚，明显强化。左侧咽隐窝受侵。左侧后鼻道受侵。 左侧咽旁间隙受侵。左侧腭帆提肌、左侧腭帆张肌受侵。余咽旁肌未见明显异常。 左侧翼突基底部、左侧翼突内板、左侧翼突外板、蝶骨基底部受侵，余颅底骨质未见明显异常。蝶窦、筛窦受侵。 左侧翼腭窝受侵。 左侧咽后见1个小淋巴结，大者短径5mm(0-5mm)，明显强化。 颈部左侧II区见数个小淋巴结，大者短径10mm(0-10mm)，明显强化。 右侧咽后、颈右侧II区及颈双侧III-V区、右侧项部见多发小淋巴结，大者短径约6mm(0-10mm)，明显强化。 双侧上颌窦、双侧筛窦、双侧蝶窦粘膜增厚。 双侧腮腺、颌下腺、甲状腺、喉部、所见脑实质未见明显异常。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 左侧咽后1个小淋巴结，可疑转移。 颈部左侧II区见数个小淋巴结，可疑转移。 右侧咽后、颈右侧II区及颈双侧III-V区、右侧项部小淋巴结，性质待定。 副鼻窦炎。；检查部位: 颈部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 不确定；是否区域复发: 否 ；左肺上叶舌段及双肺斜裂结节，增殖灶可能。 右肺中叶及左肺上叶舌段少许纤维条索。 肝S8小囊肿。 胆囊结石。；检查部位: 上腹部\n治疗前临床综合评估：左侧咽后及左颈II区淋巴结按转移考虑，全身分期评估未见明确远处转移。\n\n【当前需要决策的问题】\n病理已完成。\n筛骨、上颌骨炎症。；检查部位: 骨 ；报告日期: 既往时点；检查名称: 颈部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 鼻咽腔狭窄，鼻咽双侧顶壁、双侧顶后壁、双侧后壁、左侧壁增厚，明显强化。左侧咽隐窝受侵。左侧后鼻道受侵。 左侧咽旁间隙受侵。左侧腭帆提肌、左侧腭帆张肌受侵。余咽旁肌未见明显异常。 左侧翼突基底部、左侧翼突内板、左侧翼突外板、蝶骨基底部受侵，余颅底骨质未见明显异常。蝶窦、筛窦受侵。 左侧翼腭窝受侵。 左侧咽后见1个小淋巴结，大者短径5mm(0-5mm)，明显强化。 颈部左侧II区见数个小淋巴结，大者短径10mm(0-10mm)，明显强化。 右侧咽后、颈右侧II区及颈双侧III-V区、右侧项部见多发小淋巴结，大者短径约6mm(0-10mm)，明显强化。 双侧上颌窦、双侧筛窦、双侧蝶窦粘膜增厚。 双侧腮腺、颌下腺、甲状腺、喉部、所见脑实质未见明显异常。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 左侧咽后1个小淋巴结，可疑转移。 颈部左侧II区见数个小淋巴结，可疑转移。 右侧咽后、颈右侧II区及颈双侧III-V区、右侧项部小淋巴结，性质待定。 副鼻窦炎。；检查部位: 颈部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 不确定；是否区域复发: 否 ；左肺上叶舌段及双肺斜裂结节，增殖灶可能。 右肺中叶及左肺上叶舌段少许纤维条索。 肝S8小囊肿。 胆囊结石。；检查部位: 上腹部\n治疗前临床综合评估：左侧咽后及左颈II区淋巴结按转移考虑，全身分期评估未见明确远处转移。\n请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T3 / N2 / cM1\nB. T4 / N3 / cM1\nC. T3 / N1 / cM0\nD. T4 / N2 / cM1\nE. T3 / N1 / cM1\nF. T1 / N0 / cM1\nG. T4 / N1 / cM0\nH. T4 / N1 / cM1\nI. T3 / N3 / cM0\nJ. T2 / N0 / cM1\nK. T2 / N2 / cM1\nL. T1 / N0 / cM0\n\n请仅输出一个选项字母（A-L）。","gold_letter":"C","gold_action":"T3 / N1 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T3 / N2 / cM1","B":"T4 / N3 / cM1","C":"T3 / N1 / cM0","D":"T4 / N2 / cM1","E":"T3 / N1 / cM1","F":"T1 / N0 / cM1","G":"T4 / N1 / cM0","H":"T4 / N1 / cM1","I":"T3 / N3 / cM0","J":"T2 / N0 / cM1","K":"T2 / N2 / cM1","L":"T1 / N0 / cM0"}}
+{"sample_id":"sample-f0d2c2c4a4f97f31ae9623ce","patient_id":"patient-1189badad5e7374b82a3cc86","episode_id":"episode-a0c2f0312a8c0ed207ee86f9","turn_id":"P6_03","turn_number":9,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM：{{TNM_STATUS}}；总分期：{{OVERALL_STAGE}}。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；病历特点: 患者A，女，47岁，因\"鼻塞9月余\"于既往时点，步行入院。患者A，精神可，饮食睡眠一般，大小便正常，体重无明显变化。3、肿瘤专科检查:张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查:阴性。 【病理资料1】（右鼻咽新生物）组织形态结合免疫组化及原位杂交结果，病变诊断为未分化型非角化性癌。 原单位免疫组化结果：CK（+），P63（+），EGFR（+），INI1（+），BRG1（+）。 原单位原位杂交结果：EBER（+）。 本单位免疫组化结果：CK(AE1/AE3)（+），EGFR（+） 本单位原位杂交结果：EBERs（+）。；活检部位: 右侧鼻咽；肿瘤部位: 右侧鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】筛骨、上颌骨炎症。；检查部位: 骨 ；报告日期: 既往时点；检查名称: 颈部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 鼻咽腔狭窄，鼻咽双侧顶壁、双侧顶后壁、双侧后壁、左侧壁增厚，明显强化。左侧咽隐窝受侵。左侧后鼻道受侵。 左侧咽旁间隙受侵。左侧腭帆提肌、左侧腭帆张肌受侵。余咽旁肌未见明显异常。 左侧翼突基底部、左侧翼突内板、左侧翼突外板、蝶骨基底部受侵，余颅底骨质未见明显异常。蝶窦、筛窦受侵。 左侧翼腭窝受侵。 左侧咽后见1个小淋巴结，大者短径5mm(0-5mm)，明显强化。 颈部左侧II区见数个小淋巴结，大者短径10mm(0-10mm)，明显强化。 右侧咽后、颈右侧II区及颈双侧III-V区、右侧项部见多发小淋巴结，大者短径约6mm(0-10mm)，明显强化。 双侧上颌窦、双侧筛窦、双侧蝶窦粘膜增厚。 双侧腮腺、颌下腺、甲状腺、喉部、所见脑实质未见明显异常。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 左侧咽后1个小淋巴结，可疑转移。 颈部左侧II区见数个小淋巴结，可疑转移。 右侧咽后、颈右侧II区及颈双侧III-V区、右侧项部小淋巴结，性质待定。 副鼻窦炎。；检查部位: 颈部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 不确定；是否区域复发: 否 ；左肺上叶舌段及双肺斜裂结节，增殖灶可能。 右肺中叶及左肺上叶舌段少许纤维条索。 肝S8小囊肿。 胆囊结石。；检查部位: 上腹部\n治疗前临床综合评估：左侧咽后及左颈II区淋巴结按转移考虑，全身分期评估未见明确远处转移。 【治疗经过1】记录时间: 既往时点；病程主题: 上级查房记录；病程内容: 既往时点 11：30 上级医生A查房记录 患者无特殊不适主诉，体查情况基本同前。 既往时点 颈部磁共振平扫＋增强(1.5T以上)(套)检查诊断： 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 左侧咽后1个小淋巴结，可疑转移。 颈部 … 肿。 胆囊结石。 上级医生A查房后示：结合本院MR、PET-CT等检查结果，明确诊断：鼻咽未分化型非角化性癌（T3N1M0，III期，AJCC第8版）。 【治疗反应与不良反应1】记录时间: 既往时点；病程主题: 上级查房记录；病程内容: 既往时点 日 11：00 上级医生A查房记录 患者本次顺铂+白蛋白紫杉醇+卡培他滨化疗结束，食欲欠佳，无恶心、上腹不适、发热、腹痛、腹泻等不适。 查体：同前。 复 … 况可，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，今日可予以出院，定期复查血常规、生化，按期返院，不适随诊。；客观检验：血红蛋白(Hb)-静脉血：87.0g/L（低于参考范围，参考约115-150g/L） 【治疗反应与不良反应2】既往时点 放疗中，血象基本正常，继续同期化疗及靶向治疗。下周预约C2同期化疗。 20241.22 放疗中，诉咽痛，血象基本正常，咽反应2度,wt43KG门诊既往史；既往疾病史: 既往史:是否有过敏史无过敏史。是否有吸烟史吸烟史详情月经史月经史:；体格检查: 左颈2区小淋巴结约1cm。 … -150g/L） || 镁离子(Mg2+)-静脉血：0.7mmol/L（低于参 … 98.9mmol/L（低于参考范围，参考约99-110mmol/L） 【P6-Follow-up 1】报告日期: 既往时点；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径不宽，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。 胆囊餐后改变，胆囊内可见数个强回声斑，较大直径约5mm，后方伴声影。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈欠佳。 腹主动脉旁未见明确肿物回声。；检查结论: 胆囊结石。 肝脏、脾脏、胰腺、双肾未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。；检查部位: 腹部,前列腺,淋巴结,输尿管,膀胱,肾 【P6-Follow-up 2】报告日期: 既往时点；检查名称: 鼻咽部MR平扫+增强 颈部MR平扫+增强；检查所见: 鼻咽癌治疗后： 鼻咽腔稍狭窄，鼻咽左顶壁、左顶后壁、左侧壁增厚，明显强化。左侧咽隐窝变窄。蝶窦底壁、左侧翼腭窝受侵。 左侧咽旁间隙稍模糊。左侧腭帆提肌、左侧腭帆张肌模糊。余咽旁肌未见明显异常。 左侧翼突基底部、左侧翼突内外板、蝶骨基底部骨质信号减低，可见强化。 双眼大小、形态、位置、信号均未见异常，球后未见占位性病变。 蝶鞍内信号均匀，未见占位性病变。 左侧咽后见小淋巴结，大者短径4mm，明显强化。 颈部左侧II区见数个淋巴结，大者短径6mm，明显强化。 右侧咽后、颈右侧II区及颈双侧III-V区、右侧项部见多发小淋巴结，大者短径约6mm，明显强化。 双侧筛窦、蝶窦、上颌窦粘膜稍增厚。双侧乳突见少量分泌物。 甲状腺左侧叶体积小，原右叶小结节，现显示不清。 双侧腮腺、颌下腺、喉部、所见脑实质未见明显异常。；检查结论: 鼻咽癌治疗后，对比既往时点 MR： 鼻咽病变，考虑鼻咽癌，较前缩小。 颅底骨质信号改变，较前相仿。 左侧咽后间隙淋巴结，较前相仿。 颈部左侧II区见数个小淋巴结，较前缩小。 右侧咽后、颈右侧II区及颈双侧III-V区、右侧项部小淋巴结，部分较前缩小。 甲状腺左侧叶体积小，原右叶小结节现显示不清，请结合超声检查。 轻度副鼻窦炎。双侧乳突炎。；检查部位: 颈部,鼻咽部；肿瘤部位: 鼻咽；是否区域复发: 否 【P6-Follow-up 3】报告日期: 既往时点；检查名称: 胸部CT平扫(套)；检查所见: 鼻咽癌治疗后复查： 右肺下叶背段（SE202，IM153）见实性结节影，大小约16mm×12mm，可见分叶、毛刺，跨右侧斜裂累及右上肺。 左肺上叶上舌段（SE202，IM144）、右斜裂（SE202，IM142）、左斜裂（SE202，IM167）见多发结节影，长径范围约3-4mm，较大者位于左肺斜裂，大小约4mm×3mm。 右肺中叶、左肺上叶舌段见条片状高密度影。 气管及支气管分支通畅。 双侧锁骨上区、双肺门及纵隔、双侧腋窝未见明显肿大淋巴结。 双侧胸腔未见积液。双侧胸膜无增厚、粘连。 扫描层面肝S8见一类圆形低密度灶，长径约6mm。胆囊不大，其内见结石影，长径约4mm。 扫描所见骨质未见破坏征象。；检查结论: 鼻咽癌治疗后复查，对比既往时点CT： 右肺下叶背段结节，较前新见，考虑转移瘤可能。 左肺上叶舌段及双斜裂结节，较前未见明显变化，考虑增殖灶可能。 右肺中叶、左肺上叶舌段条片影，考虑局限性肺不张，较前相仿。 肝S8小囊肿。 胆囊结石。；检查部位: 胸部；肿瘤部位: 鼻咽；是否远处转移: 不确定\n\n【当前需要决策的问题】\n该患者治疗前为T3N1cM0（主要MRI阳性结构：鼻咽、腭帆提肌、咽旁间隙）。治疗完成后约592天的1_2_years节点返回以下新证据：报告日期: 既往时点；检查名称: 胸部CT平扫(套)；检查所见: 鼻咽癌治疗后复查： 右肺下叶背段（SE202，IM153）见实性结节影，大小约16mm×12mm，可见分叶、毛刺，跨右侧斜裂累及右上肺。 左肺上叶上舌段（SE202，IM144）、右斜裂（SE202，IM142）、左斜裂（SE202，IM167）见多发结节影，长径范围约3-4mm，较大者位于左肺斜裂，大小约4mm×3mm。 右肺中叶、左肺上叶舌段见条片状高密度影。 气管及支气管分支通畅。 双侧锁骨上区、双肺门及纵隔、双侧腋窝未见明显肿大淋巴结。 双侧胸腔未见积液。双侧胸膜无增厚、粘连。 扫描层面肝S8见一类圆形低密度灶，长径约6mm。胆囊不大，其内见结石影，长径约4mm。 扫描所见骨质未见破坏征象。；检查结论: 鼻咽癌治疗后复查，对比既往时点CT： 右肺下叶背段结节，较前新见，考虑转移瘤可能。 左肺上叶舌段及双斜裂结节，较前未见明显变化，考虑增殖灶可能。 右肺中叶、左肺上叶舌段条片影，考虑局限性肺不张，较前相仿。 肝S8小囊肿。 胆囊结石。；检查部位: 胸部；肿瘤部位: 鼻咽；是否远处转移: 不确定。与既往治疗和检查相比，当前疗效或疾病状态如何，下一步复查或治疗衔接最合理是什么？\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 不比较既往影像，直接判定完全缓解并终止所有复查\nB. 仅依据单次EBV-DNA判断复发，不结合影像和临床\nC. 把所有治疗后改变均判定为明确进展并立即更换方案\nD. 无论影像趋势如何均继续原方案，取消近期再评估\nE. 只随访鼻咽局部，不评估区域淋巴结和远处病灶\nF. 仅进行症状随访，今后不再安排任何客观检查\nG. 治疗后状态尚需结合既往片和后续复查确认；核对既往片并设置近期复查节点，避免依据单次模糊结果改变全部治疗\nH. 立即进行鼻咽手术，不核对复发部位及既往放疗范围\nI. 将稳定或缩小的病灶按新发转移处理并启动后线治疗\nJ. 将明确新发或增大的病灶视为治疗后改变，延后一年复查\nK. 仅重复病理活检，不先核对本次影像与既往影像\nL. 完成本次检查后永久失访，不设置下一次复查节点\n\n请仅输出一个选项字母（A-L）。","gold_letter":"G","gold_action":"治疗后状态尚需结合既往片和后续复查确认；核对既往片并设置近期复查节点，避免依据单次模糊结果改变全部治疗","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":{"A":"不比较既往影像，直接判定完全缓解并终止所有复查","B":"仅依据单次EBV-DNA判断复发，不结合影像和临床","C":"把所有治疗后改变均判定为明确进展并立即更换方案","D":"无论影像趋势如何均继续原方案，取消近期再评估","E":"只随访鼻咽局部，不评估区域淋巴结和远处病灶","F":"仅进行症状随访，今后不再安排任何客观检查","G":"治疗后状态尚需结合既往片和后续复查确认；核对既往片并设置近期复查节点，避免依据单次模糊结果改变全部治疗","H":"立即进行鼻咽手术，不核对复发部位及既往放疗范围","I":"将稳定或缩小的病灶按新发转移处理并启动后线治疗","J":"将明确新发或增大的病灶视为治疗后改变，延后一年复查","K":"仅重复病理活检，不先核对本次影像与既往影像","L":"完成本次检查后永久失访，不设置下一次复查节点"}}
+{"sample_id":"sample-33fc2ba79545d7ac0a5dfa6c","patient_id":"patient-cd8d5017ed5c739576ddc3c8","episode_id":"episode-68b1d188c7b92730f1d82175","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；主诉: 右耳闷塞感1年。无明显涕血、头痛、面麻及复视等症状。；现病史: 右耳闷塞感1年。无明显涕血、头痛、面麻及复视等症状。门诊既往史；既往疾病史: 既往史:是否有过敏史无过敏史。是否有吸烟史吸烟史详情 【影像与分期资料1】报告日期: 既往时点；检查名称: 颈部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、右侧壁增厚，局部见少许软组织灶，增强扫描明显强化。病灶向外侧累及右侧咽隐窝、右侧咽旁间隙。 右侧腭帆提肌、右侧腭帆张肌、右侧头长肌受侵。余咽旁肌未见明显异常。 右侧翼突基底部、蝶骨基底部受侵，余颅底骨质未见明显异常。 颈部右侧II区见肿大淋巴结，短径10mm(0-10mm)，明显强化。 左侧颈II区、双侧颈III、IV区见数个小淋巴结，大者短径约5mm。 双侧上颌窦、双侧筛窦、双侧蝶窦粘膜增厚。右侧乳突见分泌物。 甲状腺双叶体积稍增大，增强扫描呈稍不均匀强化。 双侧腮腺、颌下腺、喉部、所见脑实质未见明显异常。；检查结论: 鼻咽病变，考虑鼻咽癌可能，范围如上述。 颅底骨质破坏。 颈部右侧II区肿大淋巴结，可疑转移。 左侧颈II区、双侧颈III、IV区数个小淋巴结，性质待定。 副鼻窦炎；右侧乳突炎。；检查部位: 颈部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 不确定；是否区域复发: 否 ；报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽右侧顶壁、顶后壁、右侧壁可见粘膜增厚，放射性分布浓聚，SUV约11.3；病灶侵犯右侧头长肌、右侧腭帆肌群、右侧翼突基底部、蝶骨基底部、斜坡、右侧岩尖。左侧咽隐窝变浅、右侧咽隐窝消失。口咽、喉咽结构及放射性分布未见明显异常。颈部双侧Ⅱa区多发淋巴结放射性分布略浓密，SUV约3.6，最大者位于右颈IIa区，大小约1.3cm×0.7cm；余颈部小淋巴结放射性分布未见明显异常。 右侧上颌窦内见低密度影。右侧乳突见低密度影。放射性分布未见异常。双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺肺气肿。心脏及大血管放射性分布未见明显异常。食管未见明显占位影及异常放射性分布。双侧胸壁未见确切病灶和异常放射性分布。纵隔（右上下气管旁、主动脉旁、隆突下）及双肺门多发稍高密度淋巴结放射性分布略浓密，SUV约3.4；腋窝未见肿大淋巴结及异常放射性分布。 肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊形态、结构及放射性分布未见明显异常。胃及十二指肠放射性分布未见明显异常。胰腺结构及放射性分布未见异常。脾脏放射性分布未见明显异常。双肾见囊性低密度影放射性分布稀疏，（最大者）长径约4.5cm。双肾上腺放射性分布未见明显异常。腹腔未见肿大淋巴结及异常放射性分布。腹膜后小淋巴结放射性分布未见明显异常。 前列腺实质内可见钙化灶。膀胱形态、结构及放射性分布未见明显异常。肠管区形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 所见颅盖骨、各躯干骨及四肢骨结构及放射性分布未见明显异常。多发动脉硬化。；检查结论: 1.鼻咽病灶代谢活跃，考虑恶性病变（鼻咽癌？），侵犯范围如上述。 2.双颈Ⅱa区数个淋巴结代谢略活跃，疑炎性病变，建议随诊。 3.鼻窦炎。右侧乳突炎症。 4.双肺肺气肿。纵隔及双肺门多发淋巴结代谢略活跃，考虑炎症。 5.双肾多发囊肿。 6.前列腺钙化灶。 7.多发动脉硬化。；检查部位: 全身；肿瘤部位: 鼻咽\n综合MRI、PET及临床评估，右颈II区淋巴结按转移考虑，其余颈部小淋巴结暂不按转移考虑。\n\n【当前需要决策的问题】\n病理已完成。\n报告日期: 既往时点；检查名称: 颈部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、右侧壁增厚，局部见少许软组织灶，增强扫描明显强化。病灶向外侧累及右侧咽隐窝、右侧咽旁间隙。 右侧腭帆提肌、右侧腭帆张肌、右侧头长肌受侵。余咽旁肌未见明显异常。 右侧翼突基底部、蝶骨基底部受侵，余颅底骨质未见明显异常。 颈部右侧II区见肿大淋巴结，短径10mm(0-10mm)，明显强化。 左侧颈II区、双侧颈III、IV区见数个小淋巴结，大者短径约5mm。 双侧上颌窦、双侧筛窦、双侧蝶窦粘膜增厚。右侧乳突见分泌物。 甲状腺双叶体积稍增大，增强扫描呈稍不均匀强化。 双侧腮腺、颌下腺、喉部、所见脑实质未见明显异常。；检查结论: 鼻咽病变，考虑鼻咽癌可能，范围如上述。 颅底骨质破坏。 颈部右侧II区肿大淋巴结，可疑转移。 左侧颈II区、双侧颈III、IV区数个小淋巴结，性质待定。 副鼻窦炎；右侧乳突炎。；检查部位: 颈部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 不确定；是否区域复发: 否 ；报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽右侧顶壁、顶后壁、右侧壁可见粘膜增厚，放射性分布浓聚，SUV约11.3；病灶侵犯右侧头长肌、右侧腭帆肌群、右侧翼突基底部、蝶骨基底部、斜坡、右侧岩尖。左侧咽隐窝变浅、右侧咽隐窝消失。口咽、喉咽结构及放射性分布未见明显异常。颈部双侧Ⅱa区多发淋巴结放射性分布略浓密，SUV约3.6，最大者位于右颈IIa区，大小约1.3cm×0.7cm；余颈部小淋巴结放射性分布未见明显异常。 右侧上颌窦内见低密度影。右侧乳突见低密度影。放射性分布未见异常。双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺肺气肿。心脏及大血管放射性分布未见明显异常。食管未见明显占位影及异常放射性分布。双侧胸壁未见确切病灶和异常放射性分布。纵隔（右上下气管旁、主动脉旁、隆突下）及双肺门多发稍高密度淋巴结放射性分布略浓密，SUV约3.4；腋窝未见肿大淋巴结及异常放射性分布。 肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊形态、结构及放射性分布未见明显异常。胃及十二指肠放射性分布未见明显异常。胰腺结构及放射性分布未见异常。脾脏放射性分布未见明显异常。双肾见囊性低密度影放射性分布稀疏，（最大者）长径约4.5cm。双肾上腺放射性分布未见明显异常。腹腔未见肿大淋巴结及异常放射性分布。腹膜后小淋巴结放射性分布未见明显异常。 前列腺实质内可见钙化灶。膀胱形态、结构及放射性分布未见明显异常。肠管区形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 所见颅盖骨、各躯干骨及四肢骨结构及放射性分布未见明显异常。多发动脉硬化。；检查结论: 1.鼻咽病灶代谢活跃，考虑恶性病变（鼻咽癌？），侵犯范围如上述。 2.双颈Ⅱa区数个淋巴结代谢略活跃，疑炎性病变，建议随诊。 3.鼻窦炎。右侧乳突炎症。 4.双肺肺气肿。纵隔及双肺门多发淋巴结代谢略活跃，考虑炎症。 5.双肾多发囊肿。 6.前列腺钙化灶。 7.多发动脉硬化。；检查部位: 全身；肿瘤部位: 鼻咽\n综合MRI、PET及临床评估，右颈II区淋巴结按转移考虑，其余颈部小淋巴结暂不按转移考虑。\n请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T3 / N1 / cM0\nB. T1 / N0 / cM1\nC. T4 / N2 / cM0\nD. T1 / N3 / cM1\nE. T4 / N3 / cM0\nF. T3 / N0 / cM0\nG. T2 / N0 / cM0\nH. T3 / N0 / cM1\nI. T4 / N3 / cM1\nJ. T2 / N2 / cM1\nK. T1 / N0 / cM0\nL. T2 / N3 / cM0\n\n请仅输出一个选项字母（A-L）。","gold_letter":"A","gold_action":"T3 / N1 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T3 / N1 / cM0","B":"T1 / N0 / cM1","C":"T4 / N2 / cM0","D":"T1 / N3 / cM1","E":"T4 / N3 / cM0","F":"T3 / N0 / cM0","G":"T2 / N0 / cM0","H":"T3 / N0 / cM1","I":"T4 / N3 / cM1","J":"T2 / N2 / cM1","K":"T1 / N0 / cM0","L":"T2 / N3 / cM0"}}
+{"sample_id":"sample-5a1de61727aee904e5778a53","patient_id":"patient-684941835dbbdf1c83ea8f14","episode_id":"episode-51d166259136fa22278847ed","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；病历特点: 患者A ，男，主因“鼻塞、涕血6月余。 ”于既往时点步行入院。 一.病例特点: 1、患者33岁 男性。 2、现病史:患者自诉于既往时点月初开始出现鼻塞、涕血，无耳鸣、听力下降、头痛等不适，未予处理。 外院A就诊，既往时点当地内镜检查提示双侧顶后壁见肿物隆起，表面粗糙，左侧明显堵塞后鼻孔。 左侧外耳道通畅，鼓膜完整，鼓室内积液；右侧外耳道壁、底部、鼓膜表面见分泌物干痂 、表面霉菌样物。 考虑鼻咽顶壁隆起待查，左侧分泌性中耳炎，右侧真菌性外耳道炎。 既往时点于当地行磁共振鼻咽部+颈部平扫增强，影像提示鼻咽左侧顶后壁见一肿块影，最大径约42mm*28mm，增强后明显强化。 双侧咽鼓管咽口、圆枕正常结构消失。 左侧头长肌、腭帆肌受侵，右侧腭帆肌、翼内肌信号未见异常，左侧咽旁间隙稍变窄。 双侧海绵窦形态信号未见异常。 双侧颈深部、双侧颈动脉鞘旁、双侧咽旁见多个肿大淋巴结，以右侧为主。 最大者位于右侧颈深部，大小约15mm*8mm。 考虑鼻咽癌。 现为进一步治疗到本院门诊就诊，门诊拟“鼻咽癌？”收入院。 自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重无下降。 3、体格检查: T:36.5℃ P:79次/分 R:20次/分 BP:142/98 mmHg Ht: 175.50cm Wt: 84.80kg BSA: 2.0093m2 KPS:90 发育正常，营养一般，神志清楚，自主体位，查体合作。 全身皮肤粘膜无苍白、黄染、水肿、出血。 巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。 无鼻翼扇动、鼻衄。 牙龈无肿胀、出血。 气管居中，甲状腺不大。 胸骨无压痛。 双肺呼吸音清，未闻及干湿啰音。 心率79bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。 腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。 肛门外生殖器未见异常，生理反射存在，病理反射未引出。 4. 【病理资料1】（左侧后鼻孔）镜下：结合免疫组化及原位杂交结果，符合未分化型非角化性癌。 本院免疫组化：[标本09]-0：CK(AE1/AE3)（+），EGFR（3+） 本院原位：[标本09]-0：EBERs（+）。；活检部位: 左侧鼻孔 【影像与分期资料1】报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽不对称缩窄。鼻咽顶壁、顶后壁、后壁、左侧壁可见黏膜增厚，放射性分布浓聚，SUV约19.8；病灶侵犯周围软组织（双侧头长肌、左侧腭帆肌群），左侧咽隐窝消失、右侧咽隐窝变浅，颅底骨质结构未见明显异常。口咽、喉咽结构及放射性分布未见明显异常；双侧咽后多发淋巴结放射性分布浓密，SUV约5.4，最大者大小约0.8cm×1.6cm；颈部右侧Ⅱb区、左侧Ⅴa区多发淋巴结放射性分布浓聚，SUV约9.3；余颈部小淋巴结放射性分布未见明显异常。 第五脑室形成；余脑实质结构及放射性分布未见明显异常。双侧上颌窦内见低密度影。双侧乳突结构及放射性分布未见明显异常。双侧腮腺结构及放射性分布未见异常。甲状腺结构及放射性分布未见明显异常。 左肺可见散在条片影放射性分布未见明显异常；余双肺未见明确病灶及异常放射性分布。心脏及大血管放射性分布未见明显异常。食管未见明显占位影及异常放射性分布。双侧胸壁未见确切病灶和异常放射性分布。左侧腋窝数个小淋巴结放射性分布浓聚，SUV约6.7；纵隔、双肺门未见肿大淋巴结及异常放射性分布。 肝脏密度弥漫减低，CT值约33.5HU（同层面脾脏CT值约53.9HU）；余肝脏形态、结构及放射性分布未见异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊形态、结构及放射性分布未见明显异常。胃及十二指肠放射性分布未见明显异常。胰腺结构及放射性分布未见异常。脾脏放射性分布未见明显异常。左肾见结节状高密度影放射性分布缺损，（最大者）长径约0.8cm；余肾放射性分布未见明显异常。双肾上腺放射性分布未见明显异常。腹腔未见肿大淋巴结及异常放射性分布。腹膜后小淋巴结放射性分布未见明显异常。 前列腺放射性分布未见明显异常。膀胱形态、结构及放射性分布未见明显异常。肠管区形态、结构及放射性分布未见明显异常。双侧髂血管旁未见肿大淋巴结及异常放射性分布。双侧腹股沟多发小淋巴结放射性分布浓聚，SUV约7.5。 所见颅盖骨、各躯干骨及四肢骨结构及放射性分布未见明显异常。；检查结论: 1.鼻咽病灶代谢活跃，考虑鼻咽癌；双侧咽后淋巴结代谢较活跃，考虑转移；颈部右侧Ⅱ区、左侧Ⅴ区淋巴结代谢活跃，疑转移。 2.鼻窦炎。 3.左肺纤维增殖灶。 4.左侧腋窝及双侧腹股沟数个小淋巴结代谢活跃，疑炎性病变。 5.脂肪肝；左肾结石。 6.第五脑室形成。；检查部位: 全身；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 16.0 ；报告日期: 既往时点；检查名称: 鼻咽部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 鼻咽腔狭窄，鼻咽双侧顶壁、双侧顶后壁、双侧后壁、左侧壁增厚，明显强化。左侧咽隐窝受侵，右侧咽隐窝变窄。左侧后鼻道受侵。 左侧腭帆提肌、左侧腭帆张肌、左侧头长肌受侵。余咽旁肌未见明显异常。 颅底骨质未见破坏。 双侧咽后见多个肿大淋巴结，大者短径6mm↑(0-5mm)，明显强化。 颈部双侧II区、左侧III区、左侧V区见多个淋巴结，大者短径9mm(0-10mm)，明显强化。 双侧上颌窦、双侧筛窦粘膜增厚。左侧乳突见少量分泌物。 双侧扁桃体对称性肿大，强化均匀。 双侧腮腺、颌下腺、甲状腺、喉部、所见脑实质未见明显异常。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质未见破坏。 双侧咽后多个肿大淋巴结，考虑转移。 颈部双侧II区、左侧III区、左侧V区多个淋巴结，可疑转移。 副鼻窦炎；左侧乳突炎。 双侧扁桃体对称性肿大，考虑炎性病变可能性大。；检查部位: 鼻咽部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 6.0；是否区域复发: 否\n综合MRI、PET及临床评估，双侧咽后及右颈IIb区、左颈Va区淋巴结按转移考虑；左侧腋窝及双侧腹股沟小淋巴结倾向炎性，全身分期评估未见明确远处转移。\n\n【当前需要决策的问题】\n病理已完成。\n报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽不对称缩窄。鼻咽顶壁、顶后壁、后壁、左侧壁可见黏膜增厚，放射性分布浓聚，SUV约19.8；病灶侵犯周围软组织（双侧头长肌、左侧腭帆肌群），左侧咽隐窝消失、右侧咽隐窝变浅，颅底骨质结构未见明显异常。口咽、喉咽结构及放射性分布未见明显异常；双侧咽后多发淋巴结放射性分布浓密，SUV约5.4，最大者大小约0.8cm×1.6cm；颈部右侧Ⅱb区、左侧Ⅴa区多发淋巴结放射性分布浓聚，SUV约9.3；余颈部小淋巴结放射性分布未见明显异常。 第五脑室形成；余脑实质结构及放射性分布未见明显异常。双侧上颌窦内见低密度影。双侧乳突结构及放射性分布未见明显异常。双侧腮腺结构及放射性分布未见异常。甲状腺结构及放射性分布未见明显异常。 左肺可见散在条片影放射性分布未见明显异常；余双肺未见明确病灶及异常放射性分布。心脏及大血管放射性分布未见明显异常。食管未见明显占位影及异常放射性分布。双侧胸壁未见确切病灶和异常放射性分布。左侧腋窝数个小淋巴结放射性分布浓聚，SUV约6.7；纵隔、双肺门未见肿大淋巴结及异常放射性分布。 肝脏密度弥漫减低，CT值约33.5HU（同层面脾脏CT值约53.9HU）；余肝脏形态、结构及放射性分布未见异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊形态、结构及放射性分布未见明显异常。胃及十二指肠放射性分布未见明显异常。胰腺结构及放射性分布未见异常。脾脏放射性分布未见明显异常。左肾见结节状高密度影放射性分布缺损，（最大者）长径约0.8cm；余肾放射性分布未见明显异常。双肾上腺放射性分布未见明显异常。腹腔未见肿大淋巴结及异常放射性分布。腹膜后小淋巴结放射性分布未见明显异常。 前列腺放射性分布未见明显异常。膀胱形态、结构及放射性分布未见明显异常。肠管区形态、结构及放射性分布未见明显异常。双侧髂血管旁未见肿大淋巴结及异常放射性分布。双侧腹股沟多发小淋巴结放射性分布浓聚，SUV约7.5。 所见颅盖骨、各躯干骨及四肢骨结构及放射性分布未见明显异常。；检查结论: 1.鼻咽病灶代谢活跃，考虑鼻咽癌；双侧咽后淋巴结代谢较活跃，考虑转移；颈部右侧Ⅱ区、左侧Ⅴ区淋巴结代谢活跃，疑转移。 2.鼻窦炎。 3.左肺纤维增殖灶。 4.左侧腋窝及双侧腹股沟数个小淋巴结代谢活跃，疑炎性病变。 5.脂肪肝；左肾结石。 6.第五脑室形成。；检查部位: 全身；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 16.0 ；报告日期: 既往时点；检查名称: 鼻咽部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 鼻咽腔狭窄，鼻咽双侧顶壁、双侧顶后壁、双侧后壁、左侧壁增厚，明显强化。左侧咽隐窝受侵，右侧咽隐窝变窄。左侧后鼻道受侵。 左侧腭帆提肌、左侧腭帆张肌、左侧头长肌受侵。余咽旁肌未见明显异常。 颅底骨质未见破坏。 双侧咽后见多个肿大淋巴结，大者短径6mm↑(0-5mm)，明显强化。 颈部双侧II区、左侧III区、左侧V区见多个淋巴结，大者短径9mm(0-10mm)，明显强化。 双侧上颌窦、双侧筛窦粘膜增厚。左侧乳突见少量分泌物。 双侧扁桃体对称性肿大，强化均匀。 双侧腮腺、颌下腺、甲状腺、喉部、所见脑实质未见明显异常。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质未见破坏。 双侧咽后多个肿大淋巴结，考虑转移。 颈部双侧II区、左侧III区、左侧V区多个淋巴结，可疑转移。 副鼻窦炎；左侧乳突炎。 双侧扁桃体对称性肿大，考虑炎性病变可能性大。；检查部位: 鼻咽部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 6.0；是否区域复发: 否\n综合MRI、PET及临床评估，双侧咽后及右颈IIb区、左颈Va区淋巴结按转移考虑；左侧腋窝及双侧腹股沟小淋巴结倾向炎性，全身分期评估未见明确远处转移。\n请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T1 / N0 / cM1\nB. T1 / N3 / cM0\nC. T4 / N3 / cM0\nD. T4 / N0 / cM0\nE. T1 / N3 / cM1\nF. T3 / N1 / cM0\nG. T4 / N2 / cM0\nH. T2 / N1 / cM1\nI. T3 / N2 / cM1\nJ. T3 / N0 / cM1\nK. T2 / N2 / cM0\nL. T1 / N2 / cM0\n\n请仅输出一个选项字母（A-L）。","gold_letter":"K","gold_action":"T2 / N2 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T1 / N0 / cM1","B":"T1 / N3 / cM0","C":"T4 / N3 / cM0","D":"T4 / N0 / cM0","E":"T1 / N3 / cM1","F":"T3 / N1 / cM0","G":"T4 / N2 / cM0","H":"T2 / N1 / cM1","I":"T3 / N2 / cM1","J":"T3 / N0 / cM1","K":"T2 / N2 / cM0","L":"T1 / N2 / cM0"}}
+{"sample_id":"sample-9858701f13be06887c0a645b","patient_id":"patient-2cf7bbf9c878504492560fe8","episode_id":"episode-624f4f754ab4d53ded67040a","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；主诉: 右侧耳朵耳鸣1月余；门诊既往史；既往疾病史: 是否有过敏史无过敏史。是否有吸烟史吸烟史详情 【病理资料1】（鼻咽）送检粘膜中见散在或小团的异型细胞，结合免疫组化及原位杂交结果，符合未分化型非角化性癌。 原单位免疫组化结果：[记录编号已隐去]# CKpan（+），CK5/6（+），P40（+），EGFR（+），Ki67（30%+）； 原单位原位杂交结果：EBERs（+）。；活检部位: 鼻咽；肿瘤部位: 鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】报告日期: 既往时点；检查名称: 鼻咽部、颈部磁共振平扫+增强(1.5T以上)、磁共振功能成像(套)；检查所见: 鼻咽腔狭窄，鼻咽双侧顶壁、双侧顶后壁、双侧后壁、双侧壁增厚，明显强化。双侧咽隐窝受侵。 双侧咽旁间隙未见异常。双侧腭帆提肌受侵。余咽旁肌未见明显异常。 颅底骨质未见明显异常。 双侧海绵窦、眼眶、余颅内未见明显异常。 双侧咽后见数个肿大淋巴结，大者短径6mm，明显强化。 颈部双侧II区、双侧III区见数个小淋巴结，大者短径8mm(0-10mm)，明显强化。 左侧上颌窦、双侧筛窦粘膜增厚。少量分泌物。双侧腮腺、颌下腺、甲状腺、喉部未见明显异常。 T2FLAIR及3D-T1WI矢状位平扫所示双侧大脑、小脑及脑干形态未见异常。各脑室及脑池大小、形态未见异常。大脑中线结构未见移位。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质未见破坏。 双侧咽后淋巴结，考虑转移。 颈部双侧II区、双侧III区小淋巴结，性质待定。 副鼻窦炎。；检查部位: 颈部,鼻咽部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 6.0；是否区域复发: 否\n外院PET/CT提示双侧颈部（Ib-V区）多发淋巴结炎性增生，建议随诊；肺内微结节及肺门、纵隔淋巴结倾向良性或炎性，全身其他部位未见明显异常。\n综合MRI及外院PET资料，双侧咽后淋巴结按转移考虑，颈部II、III区小淋巴结暂不按转移考虑，全身分期评估未见明确远处转移。\n\n【当前需要决策的问题】\n病理已完成。\n报告日期: 既往时点；检查名称: 鼻咽部、颈部磁共振平扫+增强(1.5T以上)、磁共振功能成像(套)；检查所见: 鼻咽腔狭窄，鼻咽双侧顶壁、双侧顶后壁、双侧后壁、双侧壁增厚，明显强化。双侧咽隐窝受侵。 双侧咽旁间隙未见异常。双侧腭帆提肌受侵。余咽旁肌未见明显异常。 颅底骨质未见明显异常。 双侧海绵窦、眼眶、余颅内未见明显异常。 双侧咽后见数个肿大淋巴结，大者短径6mm，明显强化。 颈部双侧II区、双侧III区见数个小淋巴结，大者短径8mm(0-10mm)，明显强化。 左侧上颌窦、双侧筛窦粘膜增厚。少量分泌物。双侧腮腺、颌下腺、甲状腺、喉部未见明显异常。 T2FLAIR及3D-T1WI矢状位平扫所示双侧大脑、小脑及脑干形态未见异常。各脑室及脑池大小、形态未见异常。大脑中线结构未见移位。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质未见破坏。 双侧咽后淋巴结，考虑转移。 颈部双侧II区、双侧III区小淋巴结，性质待定。 副鼻窦炎。；检查部位: 颈部,鼻咽部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 6.0；是否区域复发: 否\n外院PET/CT提示双侧颈部（Ib-V区）多发淋巴结炎性增生，建议随诊；肺内微结节及肺门、纵隔淋巴结倾向良性或炎性，全身其他部位未见明显异常。\n综合MRI及外院PET资料，双侧咽后淋巴结按转移考虑，颈部II、III区小淋巴结暂不按转移考虑，全身分期评估未见明确远处转移。\n请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T4 / N2 / cM1\nB. T2 / N3 / cM1\nC. T1 / N2 / cM0\nD. T4 / N0 / cM1\nE. T2 / N1 / cM0\nF. T3 / N3 / cM0\nG. T4 / N1 / cM1\nH. T4 / N1 / cM0\nI. T4 / N3 / cM1\nJ. T2 / N2 / cM0\nK. T4 / N3 / cM0\nL. T3 / N0 / cM0\n\n请仅输出一个选项字母（A-L）。","gold_letter":"E","gold_action":"T2 / N1 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T4 / N2 / cM1","B":"T2 / N3 / cM1","C":"T1 / N2 / cM0","D":"T4 / N0 / cM1","E":"T2 / N1 / cM0","F":"T3 / N3 / cM0","G":"T4 / N1 / cM1","H":"T4 / N1 / cM0","I":"T4 / N3 / cM1","J":"T2 / N2 / cM0","K":"T4 / N3 / cM0","L":"T3 / N0 / cM0"}}
+{"sample_id":"sample-a122809d3220ba45711afe82","patient_id":"patient-f89d81ee7716a74d2854d920","episode_id":"episode-83ad0e040d299176b6085b33","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】入院时间: 既往时点；专科检查: 张口门齿距4cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查:阴性。 示图:；是否颈部淋巴结肿大: 否；体格检查: T:36.30℃ P:70次/分 R:20次/分 BP:103/51 mmHg Ht: 164cm Wt:52.30kg BSA:1.5577m2 KPS:90 神智清楚，表情自然，发育正常，营养中等。 自主体位，检查合作。 皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。 浅表淋巴结见专科情况。 头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。 耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。 听力正常，鼓膜无穿孔。 鼻外观无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。 口腔粘膜正常。 齿龈无红肿，扁桃体无肿大。 颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。 胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。 心前区无隆起，未触及震颤。 心率70次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。 腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。 肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。 肛门、外生殖器未查。 脊柱四肢无畸形，肌力、肌张力正常。 生理反射存在，病理神经反射未引出。；是否颅神经损伤: 否；颈部淋巴结肿大部位: NA 【影像与分期资料1】报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁、后壁及双侧壁粘膜增厚形成软组织密度肿块影，放射性浓聚，SUV约18.6，突入右眶尖、右眶上裂、右侧圆孔、双侧破裂孔、双侧翼腭窝及蝶窦内，与邻近颅底骨（蝶骨体、双侧蝶骨大小翼、双侧岩尖、斜坡、双侧翼突基底部及左侧翼突内侧板）分界不清伴骨质破坏/致密改变，与左侧海绵窦底部、左侧圆孔、左侧翼内肌、双侧腭帆肌群、双侧头长肌及软腭分界不清，推压双侧咽旁间隙致其变窄，堵塞双侧后鼻腔。右侧海绵窦放射性分布未见明显异常。双侧咽后及右颈II区多个淋巴结放射性浓聚，SUV约13.7，最大者约0.7×0.9cm。右颈Ib区小淋巴结放射性分布浓密，SUV约5.2；左颈II区小淋巴结放射性分布略浓密。其余双颈小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。口咽及喉咽结构及放射性分布未见明显异常。鼻窦炎症；双侧乳突炎症。甲状腺弥漫性放射性分布略浓密。 双上肺间隔旁型肺气肿；右中肺外侧段小结节影放射性分布未见明显异常，大小约0.2×0.2cm；其余双侧肺纹理未见明显异常，气管、支气管通畅。纵隔、双肺门及双侧腋窝多个小淋巴结放射性分布略浓密。 肝上叶小钙化灶；其余肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后小淋巴结放射性分布未见明显异常。 前列腺小钙化灶。膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟小淋巴结放射性分布未见明显异常。 右下牙槽骨局部放射性浓聚，SUV约12.9；其余所见颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，侵犯/累及范围广泛，具体如上所述；双侧咽后及右颈II区多个淋巴结代谢活跃，考虑转移。 左颈II区小淋巴结代谢略活跃，疑炎症；右颈Ib区小淋巴结炎症。 鼻窦炎症；双侧乳突炎症；右下牙槽骨炎症。 甲状腺炎待排。 双上肺肺气肿；右中肺小增殖灶；纵隔、双肺门及双侧腋窝小淋巴结炎症。 肝右上叶小钙化灶。 前列腺小钙化灶。；检查部位: 全身；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 9.0 ；报告日期: 既往时点；检查名称: 鼻咽部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 鼻咽腔狭窄，鼻咽双侧顶壁、双侧顶后壁、双侧后壁、双侧壁增厚，明显强化。双侧咽隐窝受侵。双侧后鼻道受侵。 双侧咽旁间隙受侵。双侧腭帆提肌、双侧腭帆张肌、左侧翼内肌、双侧头长肌受侵。余咽旁肌未见明显异常。 双侧翼突基底部、左侧翼突内板、左侧翼突外板、蝶骨基底部、斜坡、双侧岩尖受侵，余颅底骨质未见明显异常。蝶窦受侵。 双侧破裂孔、双侧翼腭窝、右侧圆孔受侵。 左侧海绵窦、右侧眼眶受侵。 双侧咽后见多个淋巴结，大者短径11mm，内见囊变坏死，不均匀明显强化。 颈部双侧II区见多个淋巴结，大者短径7mm，明显强化。 双侧上颌窦、双侧筛窦、双侧蝶窦粘膜增厚，见分泌物。双侧乳突见分泌物。双侧腮腺、颌下腺、甲状腺、喉部、所见脑实质未见明显异常。；检查结论: 鼻咽病变，考虑鼻咽癌，侵犯范围广泛，见上述。 颅底骨质破坏。 双侧咽后多个淋巴结，考虑转移。 颈部双侧II区多个淋巴结，可疑转移。 副鼻窦炎；双侧乳突炎。；检查部位: 鼻咽部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 11.0；是否区域复发: 否\n治疗前综合评估：双侧咽后及右颈II区淋巴结按转移考虑，左颈II区小淋巴结倾向炎性，全身分期评估未见明确远处转移。\n\n【当前需要决策的问题】\n病理已完成。\n报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁、后壁及双侧壁粘膜增厚形成软组织密度肿块影，放射性浓聚，SUV约18.6，突入右眶尖、右眶上裂、右侧圆孔、双侧破裂孔、双侧翼腭窝及蝶窦内，与邻近颅底骨（蝶骨体、双侧蝶骨大小翼、双侧岩尖、斜坡、双侧翼突基底部及左侧翼突内侧板）分界不清伴骨质破坏/致密改变，与左侧海绵窦底部、左侧圆孔、左侧翼内肌、双侧腭帆肌群、双侧头长肌及软腭分界不清，推压双侧咽旁间隙致其变窄，堵塞双侧后鼻腔。右侧海绵窦放射性分布未见明显异常。双侧咽后及右颈II区多个淋巴结放射性浓聚，SUV约13.7，最大者约0.7×0.9cm。右颈Ib区小淋巴结放射性分布浓密，SUV约5.2；左颈II区小淋巴结放射性分布略浓密。其余双颈小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。口咽及喉咽结构及放射性分布未见明显异常。鼻窦炎症；双侧乳突炎症。甲状腺弥漫性放射性分布略浓密。 双上肺间隔旁型肺气肿；右中肺外侧段小结节影放射性分布未见明显异常，大小约0.2×0.2cm；其余双侧肺纹理未见明显异常，气管、支气管通畅。纵隔、双肺门及双侧腋窝多个小淋巴结放射性分布略浓密。 肝上叶小钙化灶；其余肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后小淋巴结放射性分布未见明显异常。 前列腺小钙化灶。膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟小淋巴结放射性分布未见明显异常。 右下牙槽骨局部放射性浓聚，SUV约12.9；其余所见颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，侵犯/累及范围广泛，具体如上所述；双侧咽后及右颈II区多个淋巴结代谢活跃，考虑转移。 左颈II区小淋巴结代谢略活跃，疑炎症；右颈Ib区小淋巴结炎症。 鼻窦炎症；双侧乳突炎症；右下牙槽骨炎症。 甲状腺炎待排。 双上肺肺气肿；右中肺小增殖灶；纵隔、双肺门及双侧腋窝小淋巴结炎症。 肝右上叶小钙化灶。 前列腺小钙化灶。；检查部位: 全身；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 9.0 ；报告日期: 既往时点；检查名称: 鼻咽部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 鼻咽腔狭窄，鼻咽双侧顶壁、双侧顶后壁、双侧后壁、双侧壁增厚，明显强化。双侧咽隐窝受侵。双侧后鼻道受侵。 双侧咽旁间隙受侵。双侧腭帆提肌、双侧腭帆张肌、左侧翼内肌、双侧头长肌受侵。余咽旁肌未见明显异常。 双侧翼突基底部、左侧翼突内板、左侧翼突外板、蝶骨基底部、斜坡、双侧岩尖受侵，余颅底骨质未见明显异常。蝶窦受侵。 双侧破裂孔、双侧翼腭窝、右侧圆孔受侵。 左侧海绵窦、右侧眼眶受侵。 双侧咽后见多个淋巴结，大者短径11mm，内见囊变坏死，不均匀明显强化。 颈部双侧II区见多个淋巴结，大者短径7mm，明显强化。 双侧上颌窦、双侧筛窦、双侧蝶窦粘膜增厚，见分泌物。双侧乳突见分泌物。双侧腮腺、颌下腺、甲状腺、喉部、所见脑实质未见明显异常。；检查结论: 鼻咽病变，考虑鼻咽癌，侵犯范围广泛，见上述。 颅底骨质破坏。 双侧咽后多个淋巴结，考虑转移。 颈部双侧II区多个淋巴结，可疑转移。 副鼻窦炎；双侧乳突炎。；检查部位: 鼻咽部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 11.0；是否区域复发: 否\n治疗前综合评估：双侧咽后及右颈II区淋巴结按转移考虑，左颈II区小淋巴结倾向炎性，全身分期评估未见明确远处转移。\n请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T4 / N2 / cM0\nB. T2 / N1 / cM1\nC. T2 / N2 / cM1\nD. T3 / N3 / cM1\nE. T4 / N3 / cM0\nF. T1 / N2 / cM0\nG. T3 / N2 / cM0\nH. T4 / N1 / cM0\nI. T3 / N0 / cM1\nJ. T1 / N0 / cM1\nK. T3 / N1 / cM0\nL. T2 / N0 / cM1\n\n请仅输出一个选项字母（A-L）。","gold_letter":"H","gold_action":"T4 / N1 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T4 / N2 / cM0","B":"T2 / N1 / cM1","C":"T2 / N2 / cM1","D":"T3 / N3 / cM1","E":"T4 / N3 / cM0","F":"T1 / N2 / cM0","G":"T3 / N2 / cM0","H":"T4 / N1 / cM0","I":"T3 / N0 / cM1","J":"T1 / N0 / cM1","K":"T3 / N1 / cM0","L":"T2 / N0 / cM1"}}
+{"sample_id":"sample-a8778563665f97c14fd5ffdd","patient_id":"patient-a578b52d91765d2dc023e7ca","episode_id":"episode-ac21e4459ab839ae8cd29cdd","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；主诉: 涕中带血半年。；现病史: 患者半年前无诱因出现涕中带血，无头痛、头昏、鼻塞、面麻、耳鸣、听力下降等不适；既往时点单位体检行EBV DNA：5.233COI；右侧咽后及双颈部多发肿大淋巴结。；既往疾病史: 既往体健。是否有过敏史无过敏史。是否有吸烟史有吸烟史。吸烟史详情吸烟20+年，10支/天；时有饮酒。；体格检查: 张口距门齿4.5cm，鼻咽右侧壁见粘膜隆起，双颈部未扪及肿大淋巴结，颅神经（-）。心肺腹部无明显异常。 【病理资料1】（鼻咽部肿物）镜下形态符合未分化型非角化性癌，建议切涂胶白片5张到我科加做免疫组化（CK、EGFR）及原位杂交（EBERs）检测协助诊断。 既往时点补充报告 （鼻咽部肿物）结合HE形态、免疫组化及原位杂交结果，病变诊断为未分化型非角化性癌。 本院免疫组化结果：CK(AE1/AE3)（ … 本院原位杂交结果：EBERs（+++）。；活检部位: 鼻咽；肿瘤部位: 鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】报告日期: 既往时点；检查名称: 颈部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 鼻咽腔狭窄，鼻咽双侧顶壁、双侧顶后壁、双侧后壁、右侧壁增厚，明显强化。双侧咽隐窝变浅。 双侧咽旁间隙受侵。双侧腭帆提肌、双侧腭帆张肌、右侧头长肌受侵。余咽旁肌未见明显异常。 蝶骨基底部受侵，余颅底骨质未见明显异常。 双侧咽后见多个淋巴结，大者短径9mm，明显强化。 颈部右侧II区见多个小淋巴结，大者短径9mm，明显强化。颈部左侧II区见小淋巴结，短径约6mm，较明显强化。 双侧腮腺、颌下腺、甲状腺、喉部、所见脑实质未见明显异常。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 双侧咽后多个淋巴结，考虑转移。 颈部右侧II区淋巴结，考虑转移。 颈部左侧II区小淋巴结，性质待定。；检查部位: 颈部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 9.0；是否区域复发: 否 ；报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽右侧咽隐窝粘膜结节状增厚放射性浓聚，SUV约13.3，病灶累及右侧腭帆肌群及右侧头长肌。右侧咽隐窝消失，左侧咽隐窝变浅。双侧扁桃体肿大放射性浓聚，SUV约9.8；余口咽、喉咽未见异常。副鼻窦、双侧乳突结构及放射性分布未见明显异常。双侧海绵窦放射性分布未见明显异常。甲状腺结构及放射性分布未见明显异常。双侧咽后肿大淋巴结放射性浓聚，SUV约10.4，大者约0.7×0.9cm；双颈II区小淋巴结放射性分布略浓密，SUV约2.9，大者约0.8×1.2cm。 所见脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 右肺斜裂小实性结节放射性分布未见明显异常，大小约0.3×0.4cm；余双肺散在条索影放射性分布未见明显异常。气管、支气管通畅。心脏及大血管未见明显异常。食管未见明显占位影及异常放射性分布。双侧乳腺轻度发育；双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏结构及放射性分布未见异常；肝门区未见占位及异常放射性分布。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、双肾、肾上腺及胰腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 肛管局部放射性分布较浓密，SUV约7.6；前列腺、膀胱及肠管形态、结构及放射性分布未见明显异常。双髂血管旁及双侧腹股沟未见肿大淋巴结及异常放射性分布。 颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽右侧咽隐窝粘膜增厚代谢活跃，考虑鼻咽癌，累及右侧腭帆肌群及右侧头长肌；双侧咽后肿大淋巴结代谢活跃，考虑转移。 双侧扁桃体炎症；双颈II区小淋巴结代谢略活跃，疑炎性病变。 双肺散在纤维增殖灶。 肛管局部代谢较活跃，疑炎性病变。；检查部位: 全身；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 9.0\n\n【当前需要决策的问题】\n病理已完成。\n报告日期: 既往时点；检查名称: 颈部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 鼻咽腔狭窄，鼻咽双侧顶壁、双侧顶后壁、双侧后壁、右侧壁增厚，明显强化。双侧咽隐窝变浅。 双侧咽旁间隙受侵。双侧腭帆提肌、双侧腭帆张肌、右侧头长肌受侵。余咽旁肌未见明显异常。 蝶骨基底部受侵，余颅底骨质未见明显异常。 双侧咽后见多个淋巴结，大者短径9mm，明显强化。 颈部右侧II区见多个小淋巴结，大者短径9mm，明显强化。颈部左侧II区见小淋巴结，短径约6mm，较明显强化。 双侧腮腺、颌下腺、甲状腺、喉部、所见脑实质未见明显异常。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 双侧咽后多个淋巴结，考虑转移。 颈部右侧II区淋巴结，考虑转移。 颈部左侧II区小淋巴结，性质待定。；检查部位: 颈部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 9.0；是否区域复发: 否 ；报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽右侧咽隐窝粘膜结节状增厚放射性浓聚，SUV约13.3，病灶累及右侧腭帆肌群及右侧头长肌。右侧咽隐窝消失，左侧咽隐窝变浅。双侧扁桃体肿大放射性浓聚，SUV约9.8；余口咽、喉咽未见异常。副鼻窦、双侧乳突结构及放射性分布未见明显异常。双侧海绵窦放射性分布未见明显异常。甲状腺结构及放射性分布未见明显异常。双侧咽后肿大淋巴结放射性浓聚，SUV约10.4，大者约0.7×0.9cm；双颈II区小淋巴结放射性分布略浓密，SUV约2.9，大者约0.8×1.2cm。 所见脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 右肺斜裂小实性结节放射性分布未见明显异常，大小约0.3×0.4cm；余双肺散在条索影放射性分布未见明显异常。气管、支气管通畅。心脏及大血管未见明显异常。食管未见明显占位影及异常放射性分布。双侧乳腺轻度发育；双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏结构及放射性分布未见异常；肝门区未见占位及异常放射性分布。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、双肾、肾上腺及胰腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 肛管局部放射性分布较浓密，SUV约7.6；前列腺、膀胱及肠管形态、结构及放射性分布未见明显异常。双髂血管旁及双侧腹股沟未见肿大淋巴结及异常放射性分布。 颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽右侧咽隐窝粘膜增厚代谢活跃，考虑鼻咽癌，累及右侧腭帆肌群及右侧头长肌；双侧咽后肿大淋巴结代谢活跃，考虑转移。 双侧扁桃体炎症；双颈II区小淋巴结代谢略活跃，疑炎性病变。 双肺散在纤维增殖灶。 肛管局部代谢较活跃，疑炎性病变。；检查部位: 全身；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 9.0\n请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T4 / N3 / cM0\nB. T4 / N2 / cM0\nC. T2 / N1 / cM0\nD. T3 / N1 / cM0\nE. T2 / N1 / cM1\nF. T1 / N2 / cM0\nG. T1 / N3 / cM0\nH. T1 / N2 / cM1\nI. T2 / N0 / cM0\nJ. T2 / N3 / cM0\nK. T2 / N3 / cM1\nL. T1 / N0 / cM0\n\n请仅输出一个选项字母（A-L）。","gold_letter":"D","gold_action":"T3 / N1 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T4 / N3 / cM0","B":"T4 / N2 / cM0","C":"T2 / N1 / cM0","D":"T3 / N1 / cM0","E":"T2 / N1 / cM1","F":"T1 / N2 / cM0","G":"T1 / N3 / cM0","H":"T1 / N2 / cM1","I":"T2 / N0 / cM0","J":"T2 / N3 / cM0","K":"T2 / N3 / cM1","L":"T1 / N0 / cM0"}}
+{"sample_id":"sample-4b225f7279997f00c2e4de21","patient_id":"patient-640515b141269ff2b238a29f","episode_id":"episode-89d124238e77089df9ae5f57","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；\"于既往时点，步行入院。一、病例特点： 1、患者A，男性，49岁。2、现病史:患者既往时点月初体检发现EBV抗体升高，自诉近2年偶有回吸性涕血，无鼻塞、耳堵塞感、耳鸣、头痛、面麻、复视等不适。现为进一步治疗入院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重无下降。3、体格检查:张口门齿距4.5cm。鼻咽右侧顶后壁粘膜粗糙隆起。鼻咽左侧壁未见明显异常。双侧颈部未扪及肿大淋巴结。颅神经检查（-）。 【病理资料1】（鼻咽）结合HE形态、原单位免疫组化及原位杂交结果，病变诊断为未分化型非角化性癌。 原单位免疫组化结果：CK（+++），EGFR（+++）。 原单位原位杂交结果：EBERs（+++）。；活检部位: 鼻咽；肿瘤部位: 鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】报告日期: 既往时点；检查名称: 鼻咽部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 鼻咽腔狭窄，鼻咽双侧顶壁、双侧顶后壁、双侧后壁、双侧壁增厚，右侧为著，明显强化。右侧咽隐窝受侵，左侧咽隐窝变浅。 右侧腭帆提肌受侵。余咽旁肌未见明显异常。 右侧翼突基底部、右侧翼突内板、蝶骨基底部骨质信号减低，增强扫描可见强化，余颅底骨质未见明显异常。 双侧咽后见数个肿大淋巴结，大者短径6mm，明显强化。 颈部双侧II~V区见多个小淋巴结，大者短径9mm，明显强化。 右侧上颌窦、双侧筛窦粘膜增厚。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 双侧咽后数个肿大淋巴结，考虑转移。 颈部双侧II~V区见多个小淋巴结，性质待定。 副鼻窦炎。；检查部位: 鼻咽部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域淋巴结转移部位: 双侧咽后淋巴结；是否区域复发: 否 ；报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及右侧壁粘膜增厚放射性分布浓密，SUV约15.0；病灶侵犯双侧腭帆肌群、右侧头长肌，与蝶骨基底部及右侧翼突基底部分界不清。双侧咽隐窝变浅。喉咽未见异常。额窦、筛窦、蝶窦及双侧上颌窦放射性分布未见明显异常。双侧海绵窦放射性分布未见明显异常。甲状腺结构及放射性分布未见明显异常。左侧咽后淋巴结放射性分布浓密，SUV约9.2，大小约0.7×0.8cm；右颈II区淋巴结放射性分布浓密，SUV约6.8，大者约0.8×0.8cm。余双颈小淋巴结放射性分布未见明显异常。 所见脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 左肺上叶尖后段、右肺上叶后段、双肺斜裂散在小结节、类结节影放射性分布未见明显异常；双肺散在条索影放射性分布未见明显异常。气管、支气管通畅。心脏及大血管未见明显异常。食管未见明显占位影及异常放射性分布。双侧胸壁未见确切病灶和异常放射性分布。纵隔及双肺门小淋巴结放射性分布略浓密。双侧腋窝未见明显肿大淋巴结及异常放射性分布。 肝S4、S5囊性低密度影放射性分布稀疏，大小约0.6×0.7cm；余肝脏结构及放射性分布未见异常；肝门区未见占位及异常放射性分布。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。胰腺、脾脏、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后小淋巴结放射性分布未见明显异常。 前列腺放射性分布未见明显异常，内见灶状致密影。结肠条状放射性分布浓密，SUV约6.3。膀胱及余肠管形态、结构及放射性分布未见明显异常。左侧髂血管旁数个小淋巴结放射性略浓密。右侧髂血管旁及双侧腹股沟未见肿大淋巴结及异常放射性分布。 腰5、骶1椎体见内固定影，腰5/骶1椎间盘内见短条状金属影（术后改变）。余颅骨、余躯干骨、余四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，侵犯范围如上述；左侧咽后、右颈II区淋巴结代谢活跃，疑转移。 双肺纤维增殖灶。 纵隔及双肺门小淋巴结炎。 肝脏小囊肿。 前列腺钙化灶。 左侧髂血管旁小淋巴结炎。 腰5/骶1椎间盘及椎体术后改变。；检查部位: 全身；肿瘤部位: 鼻咽；是否区域淋巴结转移: 不确定\n\n【当前需要决策的问题】\n病理已完成。\n报告日期: 既往时点；检查名称: 鼻咽部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 鼻咽腔狭窄，鼻咽双侧顶壁、双侧顶后壁、双侧后壁、双侧壁增厚，右侧为著，明显强化。右侧咽隐窝受侵，左侧咽隐窝变浅。 右侧腭帆提肌受侵。余咽旁肌未见明显异常。 右侧翼突基底部、右侧翼突内板、蝶骨基底部骨质信号减低，增强扫描可见强化，余颅底骨质未见明显异常。 双侧咽后见数个肿大淋巴结，大者短径6mm，明显强化。 颈部双侧II~V区见多个小淋巴结，大者短径9mm，明显强化。 右侧上颌窦、双侧筛窦粘膜增厚。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 双侧咽后数个肿大淋巴结，考虑转移。 颈部双侧II~V区见多个小淋巴结，性质待定。 副鼻窦炎。；检查部位: 鼻咽部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域淋巴结转移部位: 双侧咽后淋巴结；是否区域复发: 否 ；报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及右侧壁粘膜增厚放射性分布浓密，SUV约15.0；病灶侵犯双侧腭帆肌群、右侧头长肌，与蝶骨基底部及右侧翼突基底部分界不清。双侧咽隐窝变浅。喉咽未见异常。额窦、筛窦、蝶窦及双侧上颌窦放射性分布未见明显异常。双侧海绵窦放射性分布未见明显异常。甲状腺结构及放射性分布未见明显异常。左侧咽后淋巴结放射性分布浓密，SUV约9.2，大小约0.7×0.8cm；右颈II区淋巴结放射性分布浓密，SUV约6.8，大者约0.8×0.8cm。余双颈小淋巴结放射性分布未见明显异常。 所见脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 左肺上叶尖后段、右肺上叶后段、双肺斜裂散在小结节、类结节影放射性分布未见明显异常；双肺散在条索影放射性分布未见明显异常。气管、支气管通畅。心脏及大血管未见明显异常。食管未见明显占位影及异常放射性分布。双侧胸壁未见确切病灶和异常放射性分布。纵隔及双肺门小淋巴结放射性分布略浓密。双侧腋窝未见明显肿大淋巴结及异常放射性分布。 肝S4、S5囊性低密度影放射性分布稀疏，大小约0.6×0.7cm；余肝脏结构及放射性分布未见异常；肝门区未见占位及异常放射性分布。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。胰腺、脾脏、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后小淋巴结放射性分布未见明显异常。 前列腺放射性分布未见明显异常，内见灶状致密影。结肠条状放射性分布浓密，SUV约6.3。膀胱及余肠管形态、结构及放射性分布未见明显异常。左侧髂血管旁数个小淋巴结放射性略浓密。右侧髂血管旁及双侧腹股沟未见肿大淋巴结及异常放射性分布。 腰5、骶1椎体见内固定影，腰5/骶1椎间盘内见短条状金属影（术后改变）。余颅骨、余躯干骨、余四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，侵犯范围如上述；左侧咽后、右颈II区淋巴结代谢活跃，疑转移。 双肺纤维增殖灶。 纵隔及双肺门小淋巴结炎。 肝脏小囊肿。 前列腺钙化灶。 左侧髂血管旁小淋巴结炎。 腰5/骶1椎间盘及椎体术后改变。；检查部位: 全身；肿瘤部位: 鼻咽；是否区域淋巴结转移: 不确定\n请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T2 / N3 / cM0\nB. T4 / N1 / cM1\nC. T4 / N3 / cM0\nD. T2 / N0 / cM0\nE. T4 / N0 / cM0\nF. T1 / N3 / cM1\nG. T3 / N1 / cM0\nH. T4 / N3 / cM1\nI. T2 / N1 / cM0\nJ. T2 / N0 / cM1\nK. T2 / N1 / cM1\nL. T4 / N2 / cM0\n\n请仅输出一个选项字母（A-L）。","gold_letter":"G","gold_action":"T3 / N1 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T2 / N3 / cM0","B":"T4 / N1 / cM1","C":"T4 / N3 / cM0","D":"T2 / N0 / cM0","E":"T4 / N0 / cM0","F":"T1 / N3 / cM1","G":"T3 / N1 / cM0","H":"T4 / N3 / cM1","I":"T2 / N1 / cM0","J":"T2 / N0 / cM1","K":"T2 / N1 / cM1","L":"T4 / N2 / cM0"}}
+{"sample_id":"sample-3b8fd95eed12e970e75dd3e7","patient_id":"patient-412a1cb9536aabf4688e2144","episode_id":"episode-e9291d53fc8b58ff1fc2d049","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；主诉: 左耳鸣1月余。；现病史: 左耳鸣1月余。门诊既往史；既往疾病史: 是否有过敏史无过敏史。是否有吸烟史吸烟史详情月经史月经史: 【影像与分期资料1】报告日期: 既往时点；检查名称: 鼻咽部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 鼻咽腔狭窄，鼻咽左侧顶壁、左侧顶后壁、左侧后壁、左侧壁增厚，明显强化。左侧咽隐窝受侵，右侧咽隐窝狭窄。 左侧咽旁间隙受侵。左侧腭帆提肌、左侧腭帆张肌、左侧头长肌受侵。余咽旁肌未见明显异常。 左侧翼突基底部、左侧翼突内板、蝶骨基底部、斜坡受侵，余颅底骨质未见明显异常。 左侧破裂孔、左侧卵圆孔受侵。 左侧咽后见数个小淋巴结，大者短径4mm(0-5mm)，明显强化，；右侧咽后见小淋巴结，短径约2mm。 颈部双侧II区见数个小淋巴结，大者短径6mm(0-10mm)，明显强化。 左侧乳突见分泌物。 双侧腮腺、颌下腺、甲状腺、喉部、所见脑实质未见明显异常。；检查结论: 鼻咽病变，考虑鼻咽癌可能性大。 颅底骨质破坏。 左侧咽后数个小淋巴结，可疑转移。 颈部双侧II区见数个小淋巴结，性质待定，建议复查。 右侧咽后小淋巴结。 左侧乳突炎。；检查部位: 鼻咽部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 不确定；是否区域复发: 否 ；鼻窦、双上颌骨炎症。 枕骨退行性变。 双骶髂关节、双膝关节炎性病变。；检查部位: 骨 ；左肺上叶下舌段少量慢性炎症。 双肾小囊肿。；检查部位: 胸部\n治疗前综合评估：左侧咽后淋巴结按转移考虑，全身分期评估未见明确远处转移。\n\n【当前需要决策的问题】\n病理已完成。\n报告日期: 既往时点；检查名称: 鼻咽部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 鼻咽腔狭窄，鼻咽左侧顶壁、左侧顶后壁、左侧后壁、左侧壁增厚，明显强化。左侧咽隐窝受侵，右侧咽隐窝狭窄。 左侧咽旁间隙受侵。左侧腭帆提肌、左侧腭帆张肌、左侧头长肌受侵。余咽旁肌未见明显异常。 左侧翼突基底部、左侧翼突内板、蝶骨基底部、斜坡受侵，余颅底骨质未见明显异常。 左侧破裂孔、左侧卵圆孔受侵。 左侧咽后见数个小淋巴结，大者短径4mm(0-5mm)，明显强化，；右侧咽后见小淋巴结，短径约2mm。 颈部双侧II区见数个小淋巴结，大者短径6mm(0-10mm)，明显强化。 左侧乳突见分泌物。 双侧腮腺、颌下腺、甲状腺、喉部、所见脑实质未见明显异常。；检查结论: 鼻咽病变，考虑鼻咽癌可能性大。 颅底骨质破坏。 左侧咽后数个小淋巴结，可疑转移。 颈部双侧II区见数个小淋巴结，性质待定，建议复查。 右侧咽后小淋巴结。 左侧乳突炎。；检查部位: 鼻咽部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 不确定；是否区域复发: 否 ；鼻窦、双上颌骨炎症。 枕骨退行性变。 双骶髂关节、双膝关节炎性病变。；检查部位: 骨 ；左肺上叶下舌段少量慢性炎症。 双肾小囊肿。；检查部位: 胸部\n治疗前综合评估：左侧咽后淋巴结按转移考虑，全身分期评估未见明确远处转移。\n请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T4 / N2 / cM1\nB. T1 / N3 / cM1\nC. T1 / N1 / cM1\nD. T3 / N1 / cM0\nE. T2 / N2 / cM1\nF. T3 / N2 / cM0\nG. T2 / N1 / cM0\nH. T3 / N0 / cM0\nI. T1 / N0 / cM0\nJ. T3 / N0 / cM1\nK. T4 / N3 / cM0\nL. T2 / N3 / cM0\n\n请仅输出一个选项字母（A-L）。","gold_letter":"D","gold_action":"T3 / N1 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T4 / N2 / cM1","B":"T1 / N3 / cM1","C":"T1 / N1 / cM1","D":"T3 / N1 / cM0","E":"T2 / N2 / cM1","F":"T3 / N2 / cM0","G":"T2 / N1 / cM0","H":"T3 / N0 / cM0","I":"T1 / N0 / cM0","J":"T3 / N0 / cM1","K":"T4 / N3 / cM0","L":"T2 / N3 / cM0"}}
+{"sample_id":"sample-6c73a1fc40e11a86443d86c1","patient_id":"patient-283ba4356f86fb9f68ac5c06","episode_id":"episode-71246b6d60cce2d954eb05e2","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；主诉: 复视伴吞咽困难2月余；；既往疾病史: 是否有过敏史无过敏史。是否有吸烟史吸烟史详情；体格检查: 左颈II区淋巴结，左侧眼球外展障碍，无面麻 【病理资料1】（鼻咽粘膜活检）镜下：形态考虑为未分化型非角化性癌，建议免疫组化协助诊断。；活检部位: 鼻咽粘膜；肿瘤部位: 鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】报告日期: 既往时点；检查名称: 颈部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 鼻咽顶壁、后壁、双侧壁增厚，明显强化。双侧咽隐窝、鼻中隔受侵。 双侧腭帆提肌受侵。 双侧翼突基底部、蝶骨基底部、斜坡、双侧岩尖、双侧枕骨基底部受侵。 双侧海绵窦受侵。 左侧咽后见肿大淋巴结，大者短径15mm，明显强化，可见坏死。 颈部双侧II、III、IV区见多个淋巴结，大者短径14mm，明显强化，可见中央坏死、成簇。 双侧上颌窦、双侧蝶窦粘膜增厚。 双侧腮腺、颌下腺、甲状腺、喉部、所见脑实质未见明显异常。；检查结论: 鼻咽病变，考虑鼻咽癌；双侧海绵窦受侵。 颅底骨质破坏。 左侧咽后转移淋巴结。 颈部双侧II、III、IV区转移淋巴结。 副鼻窦炎。；检查部位: 颈部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；是否区域复发: 否 ；报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及双侧壁粘膜增厚放射性浓聚，SUV约13.2，病灶侵犯颅底骨（枕骨基底部、双侧枕髁、双侧岩尖、蝶骨基底部、双侧翼突基底部、蝶骨体）、蝶窦、蝶鞍、双侧海绵窦、右翼腭窝、右卵圆孔、双侧颈动脉管、双侧破裂孔及双侧腭帆肌群。双侧咽隐窝变浅。右侧咽后未见肿大淋巴结及异常放射性分布。口咽、喉咽未见异常。鼻窦炎；右乳突炎。双侧海绵窦放射性分布未见明显异常。甲状腺结构及放射性分布未见明显异常。左咽后、双颈II区及右颈V区多发淋巴结放射性浓聚/分布浓密，SUV约15.3，大者约1.3×2.1cm。余双颈小淋巴结放射性分布未见异常。 所见脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺纹理未见明显异常。气管、支气管通畅。心脏及大血管未见明显异常。食管未见明显占位影及异常放射性分布。双侧胸壁未见确切病灶和异常放射性分布。纵隔及双肺门未见肿大淋巴结及异常放射性分布。双侧腋窝小淋巴结放射性未见明显异常。 肝脏结构及放射性分布未见异常；肝门区未见占位及异常放射性分布。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。胰腺、脾脏、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后小淋巴结放射性分布未见明显异常。右腰大肌外侧钙化小结节影放射性分布未见异常。 前列腺、膀胱及肠管形态、结构及放射性分布未见明显异常。双髂血管旁及双侧腹股沟未见肿大淋巴结及异常放射性分布。 颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，广泛侵犯范围如上述；左咽后、双颈II区及右颈V区多发淋巴结代谢活跃，考虑转移。 鼻窦炎症。右乳突炎。 右腰大肌外侧钙化小结节代谢未见异常，考虑良性病变。；检查部位: 全身；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 21.0\n\n【当前需要决策的问题】\n病理已完成。\n报告日期: 既往时点；检查名称: 颈部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 鼻咽顶壁、后壁、双侧壁增厚，明显强化。双侧咽隐窝、鼻中隔受侵。 双侧腭帆提肌受侵。 双侧翼突基底部、蝶骨基底部、斜坡、双侧岩尖、双侧枕骨基底部受侵。 双侧海绵窦受侵。 左侧咽后见肿大淋巴结，大者短径15mm，明显强化，可见坏死。 颈部双侧II、III、IV区见多个淋巴结，大者短径14mm，明显强化，可见中央坏死、成簇。 双侧上颌窦、双侧蝶窦粘膜增厚。 双侧腮腺、颌下腺、甲状腺、喉部、所见脑实质未见明显异常。；检查结论: 鼻咽病变，考虑鼻咽癌；双侧海绵窦受侵。 颅底骨质破坏。 左侧咽后转移淋巴结。 颈部双侧II、III、IV区转移淋巴结。 副鼻窦炎。；检查部位: 颈部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；是否区域复发: 否 ；报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及双侧壁粘膜增厚放射性浓聚，SUV约13.2，病灶侵犯颅底骨（枕骨基底部、双侧枕髁、双侧岩尖、蝶骨基底部、双侧翼突基底部、蝶骨体）、蝶窦、蝶鞍、双侧海绵窦、右翼腭窝、右卵圆孔、双侧颈动脉管、双侧破裂孔及双侧腭帆肌群。双侧咽隐窝变浅。右侧咽后未见肿大淋巴结及异常放射性分布。口咽、喉咽未见异常。鼻窦炎；右乳突炎。双侧海绵窦放射性分布未见明显异常。甲状腺结构及放射性分布未见明显异常。左咽后、双颈II区及右颈V区多发淋巴结放射性浓聚/分布浓密，SUV约15.3，大者约1.3×2.1cm。余双颈小淋巴结放射性分布未见异常。 所见脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺纹理未见明显异常。气管、支气管通畅。心脏及大血管未见明显异常。食管未见明显占位影及异常放射性分布。双侧胸壁未见确切病灶和异常放射性分布。纵隔及双肺门未见肿大淋巴结及异常放射性分布。双侧腋窝小淋巴结放射性未见明显异常。 肝脏结构及放射性分布未见异常；肝门区未见占位及异常放射性分布。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。胰腺、脾脏、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后小淋巴结放射性分布未见明显异常。右腰大肌外侧钙化小结节影放射性分布未见异常。 前列腺、膀胱及肠管形态、结构及放射性分布未见明显异常。双髂血管旁及双侧腹股沟未见肿大淋巴结及异常放射性分布。 颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，广泛侵犯范围如上述；左咽后、双颈II区及右颈V区多发淋巴结代谢活跃，考虑转移。 鼻窦炎症。右乳突炎。 右腰大肌外侧钙化小结节代谢未见异常，考虑良性病变。；检查部位: 全身；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 21.0\n请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T4 / N1 / cM0\nB. T1 / N0 / cM0\nC. T4 / N3 / cM0\nD. T1 / N3 / cM1\nE. T2 / N3 / cM1\nF. T1 / N2 / cM1\nG. T1 / N1 / cM1\nH. T3 / N3 / cM0\nI. T3 / N1 / cM1\nJ. T1 / N3 / cM0\nK. T4 / N1 / cM1\nL. T1 / N0 / cM1\n\n请仅输出一个选项字母（A-L）。","gold_letter":"C","gold_action":"T4 / N3 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T4 / N1 / cM0","B":"T1 / N0 / cM0","C":"T4 / N3 / cM0","D":"T1 / N3 / cM1","E":"T2 / N3 / cM1","F":"T1 / N2 / cM1","G":"T1 / N1 / cM1","H":"T3 / N3 / cM0","I":"T3 / N1 / cM1","J":"T1 / N3 / cM0","K":"T4 / N1 / cM1","L":"T1 / N0 / cM1"}}
+{"sample_id":"sample-c5e73d20a86a500ee3719a61","patient_id":"patient-9eaf0b40aec7a0f326916f11","episode_id":"episode-f495615a61c275fa23a32e3a","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；主诉: 头痛2月；既往疾病史: 是否有过敏史无过敏史。是否有吸烟史吸烟史详情 【病理资料1】（鼻咽肿物）镜下形态符合未分化型非角化性癌，建议切涂胶白片5张到我科加做CK、EGFR及EBERs检测协助诊断。 原单位特殊染色结果：Ag（+）。；活检部位: 鼻咽；肿瘤部位: 鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】报告日期: 既往时点；检查名称: 颈部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 鼻咽腔狭窄，鼻咽双侧顶壁、双侧顶后壁、双侧后壁、双侧壁增厚，明显强化。双侧咽隐窝受侵。双侧后鼻道受侵；口咽后壁受侵； 右侧咽旁间隙受侵。双侧腭帆提肌、右侧腭帆张肌、右侧翼内肌、双侧头长肌受侵。 右侧翼突基底部、右侧翼突内板、蝶骨基底部、斜坡、右侧岩尖、右侧枕骨基底部受侵。 右侧破裂孔、右侧卵圆孔受侵。 双侧海绵窦、眼眶、余颅内未见明显异常。 右侧咽后见1个肿大淋巴结，短径约16mm，明显强化，可见包膜外侵犯。 左侧咽后见小淋巴结，短径约4mm，明显强化. 颈部双侧II区、双侧III区见数个淋巴结，大者短径约10mm，明显强化。 双侧上颌窦、双侧筛窦、双侧蝶窦粘膜增厚。右侧乳突见少量分泌物。 舌骨体左前下缘见长T1、长T2信号灶，未见强化。 双侧腮腺、颌下腺、甲状腺、喉部、所见脑实质未见明显异常。 C4-6椎体信号欠均匀，增强后轻度强化。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 右侧咽后肿大淋巴结，考虑转移。 左侧咽后、颈部双侧II区、双侧III区淋巴结，考虑转移可能。 副鼻窦炎；右侧乳突炎。 C4-6椎体信号欠均匀，考虑退行性改变可能，建议随诊。；检查部位: 颈部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 16.0；是否区域复发: 否 ；报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁、双侧壁黏膜增厚放射性分布浓聚，SUV约19.1，病灶侵犯双侧头长肌、双侧腭帆肌群、右侧咽旁间隙、颅底骨（右侧翼突基底部及内外侧板、右蝶骨大翼、蝶骨基底部、斜坡、枕骨基底部、右侧岩尖）、颅底孔隙（右侧破裂孔）；双侧咽隐窝消失，双侧翼腭窝及海绵窦放射性分布未见明显异常；右侧咽后肿大淋巴结放射性分布浓聚，SUV约19.2，大小约1.8×2.5cm。左侧咽后数个淋巴结放射性分布略浓密，SUV约2.3，较大者约0.7×1.0cm。双颈II区数个淋巴结放射性分布浓聚，SUV约15.2（左颈II区），较大者约1.1×2.0cm（左颈II区）。双颈I区多个淋巴结放射性分布较浓密，SUV约4.1（右颈Ib区），大小约0.7×1.1cm（右颈Ib区）。余双颈小淋巴结放射性分布未见明显异常。 双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。鼻咽、口咽及喉咽结构及放射性分布未见明显异常。蝶窦、双侧上颌窦、筛窦及右侧乳突片状低密度影放射性稀疏。左侧乳突、额窦结构及放射性分布未见明显异常。甲状腺密度欠均匀放射性略浓密，SUV约3.5。 双肺多发类结节影放射性分布未见明显异常，较大者约0.4×0.6cm（左肺斜裂）。双上肺多发透亮囊状影放射性分布稀疏。气管、支气管通畅。纵隔及双肺门多个小淋巴结放射性分布未见明显异常。食管形态及放射性分布未见明显异常。心脏及纵隔大血管放射性分布未见明显异常。双侧胸壁未见确切病灶和异常放射性分布。双侧腋窝数个淋巴结代谢较活跃，SUV约4.0，大小约0.8×1.4cm，可见淋巴结门。 肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及双肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺、膀胱、肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 多个胸腰椎见许莫氏结节放射性分布未见明显异常。余颅骨、余各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，侵犯颅底骨及右侧破裂孔，具体侵犯范围如上述；右侧咽后肿大淋巴结、双颈II区多个淋巴结代谢活跃，考虑转移；左侧咽后数个淋巴结代谢略活跃，疑转移。 双颈I区淋巴结炎。鼻窦炎；右侧乳突炎。 双肺多发类结节代谢未见明显异常，考虑纤维增殖灶；双上肺肺小疱。 双侧腋窝数个淋巴结代谢较活跃，考虑炎性病变。 多个胸腰椎许莫氏结节。；检查部位: 全身；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 25.0\n\n【当前需要决策的问题】\n病理已完成。\n报告日期: 既往时点；检查名称: 颈部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 鼻咽腔狭窄，鼻咽双侧顶壁、双侧顶后壁、双侧后壁、双侧壁增厚，明显强化。双侧咽隐窝受侵。双侧后鼻道受侵；口咽后壁受侵； 右侧咽旁间隙受侵。双侧腭帆提肌、右侧腭帆张肌、右侧翼内肌、双侧头长肌受侵。 右侧翼突基底部、右侧翼突内板、蝶骨基底部、斜坡、右侧岩尖、右侧枕骨基底部受侵。 右侧破裂孔、右侧卵圆孔受侵。 双侧海绵窦、眼眶、余颅内未见明显异常。 右侧咽后见1个肿大淋巴结，短径约16mm，明显强化，可见包膜外侵犯。 左侧咽后见小淋巴结，短径约4mm，明显强化. 颈部双侧II区、双侧III区见数个淋巴结，大者短径约10mm，明显强化。 双侧上颌窦、双侧筛窦、双侧蝶窦粘膜增厚。右侧乳突见少量分泌物。 舌骨体左前下缘见长T1、长T2信号灶，未见强化。 双侧腮腺、颌下腺、甲状腺、喉部、所见脑实质未见明显异常。 C4-6椎体信号欠均匀，增强后轻度强化。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 右侧咽后肿大淋巴结，考虑转移。 左侧咽后、颈部双侧II区、双侧III区淋巴结，考虑转移可能。 副鼻窦炎；右侧乳突炎。 C4-6椎体信号欠均匀，考虑退行性改变可能，建议随诊。；检查部位: 颈部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 16.0；是否区域复发: 否 ；报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁、双侧壁黏膜增厚放射性分布浓聚，SUV约19.1，病灶侵犯双侧头长肌、双侧腭帆肌群、右侧咽旁间隙、颅底骨（右侧翼突基底部及内外侧板、右蝶骨大翼、蝶骨基底部、斜坡、枕骨基底部、右侧岩尖）、颅底孔隙（右侧破裂孔）；双侧咽隐窝消失，双侧翼腭窝及海绵窦放射性分布未见明显异常；右侧咽后肿大淋巴结放射性分布浓聚，SUV约19.2，大小约1.8×2.5cm。左侧咽后数个淋巴结放射性分布略浓密，SUV约2.3，较大者约0.7×1.0cm。双颈II区数个淋巴结放射性分布浓聚，SUV约15.2（左颈II区），较大者约1.1×2.0cm（左颈II区）。双颈I区多个淋巴结放射性分布较浓密，SUV约4.1（右颈Ib区），大小约0.7×1.1cm（右颈Ib区）。余双颈小淋巴结放射性分布未见明显异常。 双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。鼻咽、口咽及喉咽结构及放射性分布未见明显异常。蝶窦、双侧上颌窦、筛窦及右侧乳突片状低密度影放射性稀疏。左侧乳突、额窦结构及放射性分布未见明显异常。甲状腺密度欠均匀放射性略浓密，SUV约3.5。 双肺多发类结节影放射性分布未见明显异常，较大者约0.4×0.6cm（左肺斜裂）。双上肺多发透亮囊状影放射性分布稀疏。气管、支气管通畅。纵隔及双肺门多个小淋巴结放射性分布未见明显异常。食管形态及放射性分布未见明显异常。心脏及纵隔大血管放射性分布未见明显异常。双侧胸壁未见确切病灶和异常放射性分布。双侧腋窝数个淋巴结代谢较活跃，SUV约4.0，大小约0.8×1.4cm，可见淋巴结门。 肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及双肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺、膀胱、肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 多个胸腰椎见许莫氏结节放射性分布未见明显异常。余颅骨、余各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，侵犯颅底骨及右侧破裂孔，具体侵犯范围如上述；右侧咽后肿大淋巴结、双颈II区多个淋巴结代谢活跃，考虑转移；左侧咽后数个淋巴结代谢略活跃，疑转移。 双颈I区淋巴结炎。鼻窦炎；右侧乳突炎。 双肺多发类结节代谢未见明显异常，考虑纤维增殖灶；双上肺肺小疱。 双侧腋窝数个淋巴结代谢较活跃，考虑炎性病变。 多个胸腰椎许莫氏结节。；检查部位: 全身；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 25.0\n请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T3 / N3 / cM0\nB. T3 / N1 / cM0\nC. T1 / N0 / cM1\nD. T4 / N0 / cM0\nE. T2 / N0 / cM1\nF. T1 / N2 / cM1\nG. T3 / N2 / cM0\nH. T4 / N1 / cM0\nI. T2 / N0 / cM0\nJ. T2 / N2 / cM1\nK. T3 / N3 / cM1\nL. T1 / N1 / cM0\n\n请仅输出一个选项字母（A-L）。","gold_letter":"G","gold_action":"T3 / N2 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T3 / N3 / cM0","B":"T3 / N1 / cM0","C":"T1 / N0 / cM1","D":"T4 / N0 / cM0","E":"T2 / N0 / cM1","F":"T1 / N2 / cM1","G":"T3 / N2 / cM0","H":"T4 / N1 / cM0","I":"T2 / N0 / cM0","J":"T2 / N2 / cM1","K":"T3 / N3 / cM1","L":"T1 / N1 / cM0"}}
+{"sample_id":"sample-086705c09192c353abedb20a","patient_id":"patient-9aa3715525d6a6720ad66982","episode_id":"episode-7520d0606065154fbfaf68dc","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；主诉: 回吸性涕血2周；既往疾病史: 既往史:是否有过敏史无过敏史。是否有吸烟史吸烟史详情 【病理资料1】（鼻咽部新生物）镜检为恶性肿瘤，考虑为未分化型非角化性癌，建议交费用已送检的白片行免疫组化（CK、EGFR）及原位杂交检测（EBER）协助进一步诊断。 备注：请带回本次会诊的所有外院病理切片及纸质资料。；活检部位: 鼻咽；肿瘤部位: 鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】报告日期: 既往时点；检查名称: 鼻咽部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 鼻咽腔狭窄，鼻咽双侧顶壁、右侧顶后壁、右侧后壁、右侧壁增厚，明显强化。右侧咽隐窝受侵。 右侧咽旁间隙受侵。右侧腭帆提肌、右侧腭帆张肌、右侧头长肌受侵。余咽旁肌未见明显异常。 右侧翼突基底部、蝶骨基底部、斜坡、右侧岩尖受侵，余颅底骨质未见明显异常。 右侧破裂孔、右侧翼腭窝受侵。 双侧咽后见数个小淋巴结，大者短径3mm(0-5mm)，明显强化。 颈部双侧II区、双侧III区、双侧IV区见多个小淋巴结，大者短径5mm(0-10mm)，明显强化。 双侧上颌窦、双侧筛窦、右侧蝶窦粘膜增厚。 双侧腮腺、颌下腺、甲状腺、喉部、所见脑实质未见明显异常。；检查结论: 鼻咽病变，考虑鼻咽癌可能性大。 颅底骨质破坏。 双侧咽后小淋巴结，建议复查。 颈部双侧II区、双侧III区、双侧IV区小淋巴结。 副鼻窦炎。；检查部位: 鼻咽部；肿瘤部位: 鼻咽；是否区域复发: 否 ；报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁、右侧壁粘膜增厚放射性分布浓聚，SUV约13.6，病灶侵犯右侧腭帆肌群、右侧头长肌、右侧咽旁间隙、右侧翼腭窝、右侧破裂孔、颅底骨（蝶骨基底部、右侧翼突基底部、枕骨斜坡、右侧岩尖）。左侧破裂孔未见明显异常。双侧海绵窦结构及放射性分布未见异常。筛窦低密度影放射性分布未见明显异常。口咽、喉咽未见明显异常。甲状腺放射性分布未见异常。双颈II区小淋巴结放射性分布略浓密，大者约0.8×1.1cm；余双侧颈部小淋巴结放射性分布未见异常。 双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺纹理清晰，双侧肺野未见确切病灶和异常放射性分布。气管、支气管通畅。心脏及大血管放射性分布未见异常。食管放射性分布未见明显异常。胸壁未见确切病灶和异常放射性分布。双肺门、纵隔及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管及胆总管未见扩张。胆囊、胃及十二指肠放射性分布未见异常。双肾盂点状致密影放射性分布缺损；双肾多发囊性密度影放射性分布稀疏，大者约2.0×2.0cm；脾脏、胰腺及双侧肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺点状致密影放射性分布缺损；膀胱、肠管等形态、结构及放射性分布未见明显异常。双侧髂血管旁及双侧腹股沟未见明显肿大淋巴结及异常放射性分布。 所见颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽顶壁、顶后壁、右侧壁粘膜增厚代谢活跃，符合鼻咽癌，病灶侵犯右侧咽旁间隙、右侧翼腭窝、右侧破裂孔、颅底骨。 双颈II区小淋巴结炎症。 筛窦炎。 双肾小结石；双肾多发囊肿。 前列腺钙化灶。；检查部位: 全身；肿瘤部位: 鼻咽\n\n【当前需要决策的问题】\n病理已完成。\n报告日期: 既往时点；检查名称: 鼻咽部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 鼻咽腔狭窄，鼻咽双侧顶壁、右侧顶后壁、右侧后壁、右侧壁增厚，明显强化。右侧咽隐窝受侵。 右侧咽旁间隙受侵。右侧腭帆提肌、右侧腭帆张肌、右侧头长肌受侵。余咽旁肌未见明显异常。 右侧翼突基底部、蝶骨基底部、斜坡、右侧岩尖受侵，余颅底骨质未见明显异常。 右侧破裂孔、右侧翼腭窝受侵。 双侧咽后见数个小淋巴结，大者短径3mm(0-5mm)，明显强化。 颈部双侧II区、双侧III区、双侧IV区见多个小淋巴结，大者短径5mm(0-10mm)，明显强化。 双侧上颌窦、双侧筛窦、右侧蝶窦粘膜增厚。 双侧腮腺、颌下腺、甲状腺、喉部、所见脑实质未见明显异常。；检查结论: 鼻咽病变，考虑鼻咽癌可能性大。 颅底骨质破坏。 双侧咽后小淋巴结，建议复查。 颈部双侧II区、双侧III区、双侧IV区小淋巴结。 副鼻窦炎。；检查部位: 鼻咽部；肿瘤部位: 鼻咽；是否区域复发: 否 ；报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁、右侧壁粘膜增厚放射性分布浓聚，SUV约13.6，病灶侵犯右侧腭帆肌群、右侧头长肌、右侧咽旁间隙、右侧翼腭窝、右侧破裂孔、颅底骨（蝶骨基底部、右侧翼突基底部、枕骨斜坡、右侧岩尖）。左侧破裂孔未见明显异常。双侧海绵窦结构及放射性分布未见异常。筛窦低密度影放射性分布未见明显异常。口咽、喉咽未见明显异常。甲状腺放射性分布未见异常。双颈II区小淋巴结放射性分布略浓密，大者约0.8×1.1cm；余双侧颈部小淋巴结放射性分布未见异常。 双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺纹理清晰，双侧肺野未见确切病灶和异常放射性分布。气管、支气管通畅。心脏及大血管放射性分布未见异常。食管放射性分布未见明显异常。胸壁未见确切病灶和异常放射性分布。双肺门、纵隔及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管及胆总管未见扩张。胆囊、胃及十二指肠放射性分布未见异常。双肾盂点状致密影放射性分布缺损；双肾多发囊性密度影放射性分布稀疏，大者约2.0×2.0cm；脾脏、胰腺及双侧肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺点状致密影放射性分布缺损；膀胱、肠管等形态、结构及放射性分布未见明显异常。双侧髂血管旁及双侧腹股沟未见明显肿大淋巴结及异常放射性分布。 所见颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽顶壁、顶后壁、右侧壁粘膜增厚代谢活跃，符合鼻咽癌，病灶侵犯右侧咽旁间隙、右侧翼腭窝、右侧破裂孔、颅底骨。 双颈II区小淋巴结炎症。 筛窦炎。 双肾小结石；双肾多发囊肿。 前列腺钙化灶。；检查部位: 全身；肿瘤部位: 鼻咽\n请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T2 / N2 / cM1\nB. T3 / N1 / cM0\nC. T2 / N1 / cM0\nD. T4 / N1 / cM1\nE. T2 / N0 / cM0\nF. T4 / N2 / cM1\nG. T1 / N0 / cM0\nH. T1 / N1 / cM0\nI. T3 / N0 / cM1\nJ. T2 / N0 / cM1\nK. T3 / N0 / cM0\nL. T1 / N2 / cM1\n\n请仅输出一个选项字母（A-L）。","gold_letter":"K","gold_action":"T3 / N0 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T2 / N2 / cM1","B":"T3 / N1 / cM0","C":"T2 / N1 / cM0","D":"T4 / N1 / cM1","E":"T2 / N0 / cM0","F":"T4 / N2 / cM1","G":"T1 / N0 / cM0","H":"T1 / N1 / cM0","I":"T3 / N0 / cM1","J":"T2 / N0 / cM1","K":"T3 / N0 / cM0","L":"T1 / N2 / cM1"}}
+{"sample_id":"sample-1410fa8252f8df3e9cad2ec0","patient_id":"patient-9aa3715525d6a6720ad66982","episode_id":"episode-7520d0606065154fbfaf68dc","turn_id":"P5_01","turn_number":5,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM：{{TNM_STATUS}}；总分期：{{OVERALL_STAGE}}。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；主诉: 回吸性涕血2周；既往疾病史: 既往史:是否有过敏史无过敏史。是否有吸烟史吸烟史详情 【病理资料1】（鼻咽部新生物）镜检为恶性肿瘤，考虑为未分化型非角化性癌，建议交费用已送检的白片行免疫组化（CK、EGFR）及原位杂交检测（EBER）协助进一步诊断。 备注：请带回本次会诊的所有外院病理切片及纸质资料。；活检部位: 鼻咽；肿瘤部位: 鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】报告日期: 既往时点；检查名称: 鼻咽部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 鼻咽腔狭窄，鼻咽双侧顶壁、右侧顶后壁、右侧后壁、右侧壁增厚，明显强化。右侧咽隐窝受侵。 右侧咽旁间隙受侵。右侧腭帆提肌、右侧腭帆张肌、右侧头长肌受侵。余咽旁肌未见明显异常。 右侧翼突基底部、蝶骨基底部、斜坡、右侧岩尖受侵，余颅底骨质未见明显异常。 右侧破裂孔、右侧翼腭窝受侵。 双侧咽后见数个小淋巴结，大者短径3mm(0-5mm)，明显强化。 颈部双侧II区、双侧III区、双侧IV区见多个小淋巴结，大者短径5mm(0-10mm)，明显强化。 双侧上颌窦、双侧筛窦、右侧蝶窦粘膜增厚。 双侧腮腺、颌下腺、甲状腺、喉部、所见脑实质未见明显异常。；检查结论: 鼻咽病变，考虑鼻咽癌可能性大。 颅底骨质破坏。 双侧咽后小淋巴结，建议复查。 颈部双侧II区、双侧III区、双侧IV区小淋巴结。 副鼻窦炎。；检查部位: 鼻咽部；肿瘤部位: 鼻咽；是否区域复发: 否 ；报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁、右侧壁粘膜增厚放射性分布浓聚，SUV约13.6，病灶侵犯右侧腭帆肌群、右侧头长肌、右侧咽旁间隙、右侧翼腭窝、右侧破裂孔、颅底骨（蝶骨基底部、右侧翼突基底部、枕骨斜坡、右侧岩尖）。左侧破裂孔未见明显异常。双侧海绵窦结构及放射性分布未见异常。筛窦低密度影放射性分布未见明显异常。口咽、喉咽未见明显异常。甲状腺放射性分布未见异常。双颈II区小淋巴结放射性分布略浓密，大者约0.8×1.1cm；余双侧颈部小淋巴结放射性分布未见异常。 双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺纹理清晰，双侧肺野未见确切病灶和异常放射性分布。气管、支气管通畅。心脏及大血管放射性分布未见异常。食管放射性分布未见明显异常。胸壁未见确切病灶和异常放射性分布。双肺门、纵隔及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管及胆总管未见扩张。胆囊、胃及十二指肠放射性分布未见异常。双肾盂点状致密影放射性分布缺损；双肾多发囊性密度影放射性分布稀疏，大者约2.0×2.0cm；脾脏、胰腺及双侧肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺点状致密影放射性分布缺损；膀胱、肠管等形态、结构及放射性分布未见明显异常。双侧髂血管旁及双侧腹股沟未见明显肿大淋巴结及异常放射性分布。 所见颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽顶壁、顶后壁、右侧壁粘膜增厚代谢活跃，符合鼻咽癌，病灶侵犯右侧咽旁间隙、右侧翼腭窝、右侧破裂孔、颅底骨。 双颈II区小淋巴结炎症。 筛窦炎。 双肾小结石；双肾多发囊肿。 前列腺钙化灶。；检查部位: 全身；肿瘤部位: 鼻咽 【治疗经过1】记录时间: 既往时点；病历特点: 患者A，男，43岁，因\"痰中带血近1月。 \"于既往时点，步行入院。 一、病例特点: 1、患者A，男性，43岁，贵州人 2、现病史:缘于既往时点患者无明显诱因出现痰中带血，无头晕、头痛，无复视、视力模糊，无耳鸣、听力下降，无鼻塞、涕血，无面麻等不适，遂至外院A就诊，既往时点行鼻咽活检病理示：疑鼻咽肿瘤，未行治疗，既往时点患者至本院完善相关检查后诊断为：鼻咽未分化型非角化性癌 T3N0M0 III期AJCC第八版分期。 今为求进一步诊治来本院。 患者发病以来，精神可，饮食睡眠一般，大小便正常，体重无明显变化。 3、肿瘤专科检查:张口门齿距5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部IIa区可扪及多个个淋巴结，最大径0.5×0.3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查:阴性。 4、辅助检查:（1）既往时点，外院A，鼻咽MR增强扫描 鼻咽部增多增厚软组织，以顶部及右侧壁为著 双侧颈部多发淋巴结 （2）既往时点，外院A，鼻咽部取材病理 黏膜组织固有层见少许异型细胞团，疑肿瘤。 既往时点 十五导联心电图检查(套) 检查结果： 窦性心律 顺钟向转位 心电图大致正常 检查诊断： 窦性心律 顺钟向转位 心电图大致正常窦性心律 顺钟向转位 心电图大致正常 既往时点 心脏彩超(套) 检查结果： 心脏超声测值： LA 24mm (20mm-38mm) AO 24mm (22mm-35mm) MV E 0.96m/s (<2) EF 70% (50-75%) LV 44mm (35mm-55mm) IVS 10mm (6mm-12mm) A 0.53m/s (<2) FS 39% (25-45%) RA 32mm (25mm-40mm) LVPW 10mm (6mm-12mm) RV 29mm (20mm-30mm) PA 21mm (16mm-26mm) 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 各房室腔径正常。 室壁厚度及运动正常。 房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。 检查诊断： 心脏结构及运动未见异常 各房室腔及大血管未探及异常血流信号 左心收缩功能正常 既往时点 PET/CT全身显像（套） 检查诊断： 鼻咽顶壁、顶后壁、右侧壁粘膜增厚代谢活跃，符合鼻咽癌，病灶侵犯右侧咽旁间隙、右侧翼腭窝、右侧破裂孔、颅底骨。 双颈II区小淋巴结炎症。 筛窦炎。 双肾小结石；双肾多发囊肿。 前列腺钙化灶。 既往时点 鼻咽部磁共振平扫＋增强(1.5T以上)(套) 检查诊断： 鼻咽病变，考虑鼻咽癌可能性大。 颅底骨质破坏。 双侧咽后小淋巴结，建议复查。 颈部双侧II区、双侧III区、双侧IV区小淋巴结。 副鼻窦炎。 既往时点 电子鼻咽镜检查(表麻下)(含活检)(套) 检查结果： 双侧鼻腔通畅， 鼻咽可见结节状隆起性肿物 检查诊断： 鼻咽肿物性质待查四个工作日后请凭诊疗卡到一号楼二楼和二号楼一楼自助打印机取病理报告。 既往时点 病理号： PIS 检查结果： （左顶后壁）镜下：送检鼻咽粘膜组织中，局灶可见少量核稍增大、核仁明显细胞小巢团状分布，结合免疫组化及原位杂交结果，符合未分化型非角化性癌。 免疫组化：#A-0：CK(AE1/AE3)（+），EGFR（+）； 原位杂交：#A-0：EBERs（+）。 检查诊断： （左顶后壁）送检组织1块，直径为0.6cm。\n拟行以根治性放疗为基础、联合尼妥珠单抗的治疗；治疗前完成器官功能及耐受性评估。 【治疗反应与不良反应1】既往时点 鼻咽癌放疗12F，放射性口腔炎2级，皮炎1级，予口腔、皮肤护理指导。门诊既往史；既往疾病史: 既往史:是否有过敏史无过敏史。是否有吸烟史吸烟史详情；客观检验：白细胞计数(WBC#)-静脉血：3.02×10^9/L（低于参考范围，参考约3.5-9.5×10^9/L） || 肌酐(Crea)-静脉血：77.3 … 血：22.5μmol/L（高于参考范围，参考约5-21μmol/L）\n\n【当前需要决策的问题】\n治疗开始后约第18天，本患者出现第1个独立的黏膜及胃肠毒性里程碑：既往时点 鼻咽癌放疗12F，放射性口腔炎2级，皮炎1级，予口腔、皮肤护理指导。门诊既往史；既往疾病史: 既往史:是否有过敏史无过敏史。是否有吸烟史吸烟史详情；客观检验：白细胞计数(WBC#)-静脉血：3.02×10^9/L（低于参考范围，参考约3.5-9.5×10^9/L） || 肌酐(Crea)-静脉血：77.3μmol/L（高于参考范围，参考约41- … 胆红素(TBIL)-静脉血：22.5μmol/L（高于参考范围，参考约5-21μmol/L）。该事件最符合哪类治疗相关毒性，当前应采取怎样的支持处理、监测及治疗节奏调整？\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 忽略当前异常并按原剂量、原时间继续治疗，不增加复查\nB. 永久停止全部抗肿瘤治疗，不再判断毒性是否可逆\nC. 立即提高化疗剂量，以补偿既往可能损失的剂量强度\nD. 按黏膜/胃肠毒性分级给予止吐、镇痛、补液和营养支持，并监测进食与体重\nE. 仅复查肿瘤影像，不复查血常规、生化或相关器官功能\nF. 直接改为另一套强化联合方案，不等待毒性恢复\nG. 仅口头安慰并观察，不给予症状处理或近期监测\nH. 把当前异常判断为疾病进展并立即进入后线挽救治疗\nI. 仅依据一次EBV-DNA结果决定停药或换药\nJ. 继续原方案并取消止吐、补液或营养等支持治疗\nK. 立即扩大放疗范围，将所有不适均按肿瘤侵犯处理\nL. 三个月后再复查当前异常，期间不调整治疗节奏\n\n请仅输出一个选项字母（A-L）。","gold_letter":"D","gold_action":"按黏膜/胃肠毒性分级给予止吐、镇痛、补液和营养支持，并监测进食与体重","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":{"A":"忽略当前异常并按原剂量、原时间继续治疗，不增加复查","B":"永久停止全部抗肿瘤治疗，不再判断毒性是否可逆","C":"立即提高化疗剂量，以补偿既往可能损失的剂量强度","D":"按黏膜/胃肠毒性分级给予止吐、镇痛、补液和营养支持，并监测进食与体重","E":"仅复查肿瘤影像，不复查血常规、生化或相关器官功能","F":"直接改为另一套强化联合方案，不等待毒性恢复","G":"仅口头安慰并观察，不给予症状处理或近期监测","H":"把当前异常判断为疾病进展并立即进入后线挽救治疗","I":"仅依据一次EBV-DNA结果决定停药或换药","J":"继续原方案并取消止吐、补液或营养等支持治疗","K":"立即扩大放疗范围，将所有不适均按肿瘤侵犯处理","L":"三个月后再复查当前异常，期间不调整治疗节奏"}}
+{"sample_id":"sample-aab54b8795fa56ea3aae1b1f","patient_id":"patient-b65cb84467c638c61d55d3fd","episode_id":"episode-8badb2e4e6cfd527bcf5f982","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；病历特点: 患者A，女，58岁，因\"涕血半月余\"于既往时点，步行入院。未行治疗，今为求进一步诊治来本院。患者A，精神可，饮食睡眠一般，大小便正常，体重无明显变化。3、肿瘤专科检查:张口门齿距3cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结，颅神经检查:阴性。 【病理资料1】（顶后壁）镜下：结合免疫组化及原位杂交结果，病变符合未分化型非角化性癌。 免疫组化：标本16：CK(AE1/AE3)（+），EGFR（+）。 原位杂交：标本16：EBERs（+）。 【影像与分期资料1】报告日期: 既往时点；检查名称: 鼻咽部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 鼻咽腔狭窄，鼻咽双侧顶壁、顶后壁、后壁、双侧壁增厚，明显强化。双侧咽隐窝受侵。 左侧咽旁间隙受侵。双侧腭帆提肌、左侧腭帆张肌、双侧头长肌受侵。余咽旁肌未见明显异常。 右侧颞骨可见斑片状异常信号影（Se801, Im7），增强化可见明显强化。余颅底骨质未见明显异常。 双侧咽后见数个小淋巴结，大者短径4mm(0-5mm)，明显强化。 颈部双侧II区、双侧III区见数个淋巴结，大者短径6mm(0-10mm)，明显强化。 双侧乳突见少量分泌物。双侧上颌窦、筛窦充气良好。 甲状腺右侧叶见一异常信号灶，长径约6mm，T1WI呈等信号，T2WI呈稍高信号，增强扫描均匀强化。喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽病变，考虑鼻咽癌。 右侧颞骨斑片状异常信号影，转移待排。 双侧咽后数个小淋巴结，考虑转移。 颈部双侧II区、双侧III区数个小淋巴结，转移待排。 双侧乳突炎。 甲状腺右侧叶结节，考虑结节性甲状腺肿可能。；检查部位: 鼻咽部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 4.0；是否区域复发: 否\n右侧颞骨病灶临床按局部颅底骨侵犯考虑，双侧咽后淋巴结按转移考虑；其余颈部小淋巴结仍待随访，临床评估未见明确远处转移。\n\n【当前需要决策的问题】\n病理已完成。\n报告日期: 既往时点；检查名称: 鼻咽部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 鼻咽腔狭窄，鼻咽双侧顶壁、顶后壁、后壁、双侧壁增厚，明显强化。双侧咽隐窝受侵。 左侧咽旁间隙受侵。双侧腭帆提肌、左侧腭帆张肌、双侧头长肌受侵。余咽旁肌未见明显异常。 右侧颞骨可见斑片状异常信号影（Se801, Im7），增强化可见明显强化。余颅底骨质未见明显异常。 双侧咽后见数个小淋巴结，大者短径4mm(0-5mm)，明显强化。 颈部双侧II区、双侧III区见数个淋巴结，大者短径6mm(0-10mm)，明显强化。 双侧乳突见少量分泌物。双侧上颌窦、筛窦充气良好。 甲状腺右侧叶见一异常信号灶，长径约6mm，T1WI呈等信号，T2WI呈稍高信号，增强扫描均匀强化。喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽病变，考虑鼻咽癌。 右侧颞骨斑片状异常信号影，转移待排。 双侧咽后数个小淋巴结，考虑转移。 颈部双侧II区、双侧III区数个小淋巴结，转移待排。 双侧乳突炎。 甲状腺右侧叶结节，考虑结节性甲状腺肿可能。；检查部位: 鼻咽部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 4.0；是否区域复发: 否\n右侧颞骨病灶临床按局部颅底骨侵犯考虑，双侧咽后淋巴结按转移考虑；其余颈部小淋巴结仍待随访，临床评估未见明确远处转移。\n请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T1 / N0 / cM0\nB. T3 / N3 / cM0\nC. T2 / N2 / cM1\nD. T3 / N0 / cM1\nE. T3 / N1 / cM0\nF. T1 / N3 / cM1\nG. T4 / N2 / cM1\nH. T2 / N1 / cM1\nI. T2 / N1 / cM0\nJ. T1 / N2 / cM0\nK. T3 / N0 / cM0\nL. T1 / N3 / cM0\n\n请仅输出一个选项字母（A-L）。","gold_letter":"E","gold_action":"T3 / N1 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T1 / N0 / cM0","B":"T3 / N3 / cM0","C":"T2 / N2 / cM1","D":"T3 / N0 / cM1","E":"T3 / N1 / cM0","F":"T1 / N3 / cM1","G":"T4 / N2 / cM1","H":"T2 / N1 / cM1","I":"T2 / N1 / cM0","J":"T1 / N2 / cM0","K":"T3 / N0 / cM0","L":"T1 / N3 / cM0"}}
+{"sample_id":"sample-271aef6aa06fc93cf6626f1d","patient_id":"patient-003420d0da40426e1c7e0974","episode_id":"episode-fc873559262aed37641c8cfa","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】入院时间: 既往时点；患者A，精神可，饮食睡眠一般，大小便正常，体重无明显变化。；鼻症状: 无；耳症状: 无；眼症状: 无；头部症状: 无；是否有颈部肿物: 是；阳性症状体征: 右颈肿物；体重改变性质: 未变 【病理资料1】（右隐窝）镜下：粘膜组织中见少量核大、深染的细胞巢状分布，结合免疫组化结果，考虑未分化型非角化性癌。活检组织少，请结合临床诊断，必要时进一步检查。 免疫组化：标本96：CK(AE1/AE3)（+），p63（+），EGFR（+），Ki-67（20%+）。 原位杂交：EBERs（+）。 【影像与分期资料1】报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽右侧咽隐窝粘膜局部增厚放射性分布浓密，SUV约4.8。双侧咽旁间隙清晰。颅底骨、双侧破裂孔、双侧海绵窦等结构及放射性分布未见明显异常。双侧咽后未见明显肿大淋巴结及异常放射性分布。双颈小淋巴结放射性分布未见明显异常。右颈Va区皮下小片状低密度影放射性分布浓密，SUV约4.4。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。口咽及喉咽结构及放射性分布未见明显异常。额窦、蝶窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。 双肺间隔旁型肺气肿；左下肺多个小斑片/小磨玻璃影放射性分布未见明显异常，贴近胸膜分布。左下肺实性小结节影放射性分布未见明显异常，大小约0.4×0.5cm。右中肺条索影放射性分布未见明显异常。其余双侧肺纹理未见明显异常，气管、支气管通畅。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后小淋巴结放射性分布未见明显异常。 前列腺钙化灶。膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟小淋巴结放射性分布未见明显异常。 所见颅骨、各躯干骨、四肢骨放射性分布未见明显异常。L5双侧椎弓峡部连续性中断。；检查结论: 鼻咽右侧咽隐窝粘膜局部增厚代谢较活跃，结合病史，可符合鼻咽癌。 右颈Va区皮下低密度影代谢较活跃，考虑术后改变。 双肺间隔旁型肺气肿；左下肺及右中肺纤维增殖灶。 前列腺钙化灶。 L5椎弓峡部裂。；检查部位: 全身；肿瘤部位: 鼻咽 ；报告日期: 既往时点；检查名称: 鼻咽部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 右侧颈部淋巴结切除术后复查： 鼻咽腔狭窄，鼻咽右侧顶壁、右侧顶后壁、右侧壁增厚，明显强化。右侧咽隐窝受侵，左侧咽隐窝存在。双侧咽旁间隙未见异常。 右侧腭帆提肌可疑受侵。余咽旁肌未见明显异常。 颅底骨质未见明显骨质破坏。 双侧海绵窦未见明显异常。 双侧咽后未见肿大淋巴结。 颈部右侧Va区见一团片状异常信号，大小约14mm×7mm，明显不均匀强化。颈部左侧Vb区见一淋巴结，短径约6mm，明显均匀强化。 双侧上颌窦、筛窦粘膜增厚。双侧乳突充气良好，骨壁完整。 双侧腮腺、颌下腺、甲状腺、喉部、所见脑实质未见明显异常。；检查结论: 右侧颈部淋巴结切除术后复查： 鼻咽病变，考虑鼻咽癌。 颅底骨质未见明显骨质破坏。 双侧咽后未见肿大淋巴结。 颈部右侧Va区团片状异常信号，考虑术后改变可能，建议复查。 颈部左侧Vb区淋巴结，考虑反应性淋巴结可能，建议复查。 副鼻窦炎。；检查部位: 鼻咽部；肿瘤部位: 鼻咽；是否区域复发: 否\n外院右颈淋巴结切除活检：反应性增生，未见癌转移。\n综合影像及临床资料，右侧腭帆提肌暂不按明确侵犯考虑；咽后及双侧颈部淋巴结暂不按转移考虑。\n\n【当前需要决策的问题】\n病理已完成。\n报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽右侧咽隐窝粘膜局部增厚放射性分布浓密，SUV约4.8。双侧咽旁间隙清晰。颅底骨、双侧破裂孔、双侧海绵窦等结构及放射性分布未见明显异常。双侧咽后未见明显肿大淋巴结及异常放射性分布。双颈小淋巴结放射性分布未见明显异常。右颈Va区皮下小片状低密度影放射性分布浓密，SUV约4.4。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。口咽及喉咽结构及放射性分布未见明显异常。额窦、蝶窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。 双肺间隔旁型肺气肿；左下肺多个小斑片/小磨玻璃影放射性分布未见明显异常，贴近胸膜分布。左下肺实性小结节影放射性分布未见明显异常，大小约0.4×0.5cm。右中肺条索影放射性分布未见明显异常。其余双侧肺纹理未见明显异常，气管、支气管通畅。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后小淋巴结放射性分布未见明显异常。 前列腺钙化灶。膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟小淋巴结放射性分布未见明显异常。 所见颅骨、各躯干骨、四肢骨放射性分布未见明显异常。L5双侧椎弓峡部连续性中断。；检查结论: 鼻咽右侧咽隐窝粘膜局部增厚代谢较活跃，结合病史，可符合鼻咽癌。 右颈Va区皮下低密度影代谢较活跃，考虑术后改变。 双肺间隔旁型肺气肿；左下肺及右中肺纤维增殖灶。 前列腺钙化灶。 L5椎弓峡部裂。；检查部位: 全身；肿瘤部位: 鼻咽 ；报告日期: 既往时点；检查名称: 鼻咽部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 右侧颈部淋巴结切除术后复查： 鼻咽腔狭窄，鼻咽右侧顶壁、右侧顶后壁、右侧壁增厚，明显强化。右侧咽隐窝受侵，左侧咽隐窝存在。双侧咽旁间隙未见异常。 右侧腭帆提肌可疑受侵。余咽旁肌未见明显异常。 颅底骨质未见明显骨质破坏。 双侧海绵窦未见明显异常。 双侧咽后未见肿大淋巴结。 颈部右侧Va区见一团片状异常信号，大小约14mm×7mm，明显不均匀强化。颈部左侧Vb区见一淋巴结，短径约6mm，明显均匀强化。 双侧上颌窦、筛窦粘膜增厚。双侧乳突充气良好，骨壁完整。 双侧腮腺、颌下腺、甲状腺、喉部、所见脑实质未见明显异常。；检查结论: 右侧颈部淋巴结切除术后复查： 鼻咽病变，考虑鼻咽癌。 颅底骨质未见明显骨质破坏。 双侧咽后未见肿大淋巴结。 颈部右侧Va区团片状异常信号，考虑术后改变可能，建议复查。 颈部左侧Vb区淋巴结，考虑反应性淋巴结可能，建议复查。 副鼻窦炎。；检查部位: 鼻咽部；肿瘤部位: 鼻咽；是否区域复发: 否\n外院右颈淋巴结切除活检：反应性增生，未见癌转移。\n综合影像及临床资料，右侧腭帆提肌暂不按明确侵犯考虑；咽后及双侧颈部淋巴结暂不按转移考虑。\n请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T2 / N2 / cM0\nB. T4 / N3 / cM1\nC. T2 / N1 / cM1\nD. T1 / N0 / cM0\nE. T2 / N3 / cM1\nF. T2 / N2 / cM1\nG. T4 / N1 / cM1\nH. T4 / N0 / cM0\nI. T4 / N3 / cM0\nJ. T1 / N2 / cM1\nK. T2 / N3 / cM0\nL. T2 / N1 / cM0\n\n请仅输出一个选项字母（A-L）。","gold_letter":"D","gold_action":"T1 / N0 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T2 / N2 / cM0","B":"T4 / N3 / cM1","C":"T2 / N1 / cM1","D":"T1 / N0 / cM0","E":"T2 / N3 / cM1","F":"T2 / N2 / cM1","G":"T4 / N1 / cM1","H":"T4 / N0 / cM0","I":"T4 / N3 / cM0","J":"T1 / N2 / cM1","K":"T2 / N3 / cM0","L":"T2 / N1 / cM0"}}
+{"sample_id":"sample-f8cd2d4eb80f97e4e7ef1c30","patient_id":"patient-5d0c932da06a8cecf1430be4","episode_id":"episode-be6d8476caaa1d931711bffa","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；主诉: 双侧鼻塞、耳塞感1年。；现病史: 双侧鼻塞、耳塞感1年。门诊既往史；既往疾病史: 是否有过敏史无过敏史。是否有吸烟史吸烟史详情 【病理资料1】（鼻咽肿物活检）结合HE形态及免疫组化结果，符合为未分化型非角化性癌。 免疫组化：标本15：CK(AE1/AE3)（+），EGFR（+）； 原位杂交：标本15：EBERs（+）。；活检部位: 鼻咽；肿瘤部位: 鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】报告日期: 既往时点；检查名称: 鼻咽部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 鼻咽腔狭窄，鼻咽双侧顶壁、双侧顶后壁、双侧后壁、双侧壁增厚，明显强化。双侧咽隐窝受侵。双侧后鼻道受侵； 双侧腭帆提肌、双侧头长肌受侵。余咽旁肌未见明显异常。 双侧翼突基底部、蝶骨基底部受侵，余颅底骨质未见明显异常。 双侧咽后见数个肿大淋巴结，大者短径7mm↑(0-5mm)，明显强化。 颈部双侧II区、双侧III区见数个小淋巴结，大者短径8mm(0-10mm)，明显强化。 右侧上颌窦粘膜增厚。双侧乳突见分泌物。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 双侧咽后数个肿大淋巴结，考虑转移。 颈部双侧II区、双侧III区见数个小淋巴结。 副鼻窦炎；双侧乳突炎。；检查部位: 鼻咽部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 7.0；是否区域复发: 否 ；报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽不对称缩窄。鼻咽顶壁、顶后壁、后壁、双侧壁可见软组织肿块影，放射性分布浓聚，SUV约36.5，大小约3.2cm×4.1cm；病灶侵犯颅底骨（双侧翼突基底部、双侧翼突内板、蝶骨基底部）、犁骨、周围软组织（双侧头长肌、双侧腭帆肌群），延伸至双侧鼻腔后1/2，双侧咽隐窝消失。双侧扁桃体见点状致密影放射性分布缺损；余口咽、喉咽结构及放射性分布未见明显异常；双侧咽后多发淋巴结放射性分布略浓密，SUV约3.3，最大者大小约0.8cm×1.0cm；颈部右侧Ⅰb-Ⅱ区多发淋巴结放射性分布较浓密，SUV约6.4；余颈部小淋巴结放射性分布未见明显异常。 双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。右侧上颌窦内见低密度影放射性分布未见异常。左侧乳突见低密度影放射性分布未见异常；余乳突结构及放射性分布未见明显异常。双侧腮腺结构及放射性分布未见异常。甲状腺结构及放射性分布未见明显异常。 双肺纹理未见明显异常，气管、支气管通畅。心脏及大血管放射性分布未见明显异常。食管未见明显占位影及异常放射性分布。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏密度弥漫减低，CT值约44HU（同层面脾脏CT值约49HU）；余肝脏形态、结构及放射性分布未见异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊形态、结构及放射性分布未见明显异常。胃及十二指肠放射性分布未见明显异常。胰腺、脾脏、双肾及双肾上腺形态、结构及放射性分布未见异常。腹腔未见肿大淋巴结及异常放射性分布。腹膜后小淋巴结放射性分布未见明显异常。 前列腺放射性分布未见明显异常。膀胱形态、结构及放射性分布未见明显异常。肠管区形态、结构及放射性分布未见明显异常。双侧髂血管旁及双侧腹股沟未见肿大淋巴结及异常放射性分布。 所见颅盖骨、各躯干骨及四肢骨结构及放射性分布未见明显异常。；检查结论: 1. 鼻咽顶壁、顶后壁、后壁、双侧壁软组织肿块影代谢活跃，结合病史，符合鼻咽癌，病灶侵犯颅底骨；双侧咽后淋巴结代谢略活跃，疑转移。 2. 右颈Ib-II区小淋巴结炎。 3. 副鼻窦炎；左侧乳突炎。 4. 双侧扁桃体结石。 5. 脂肪肝。；检查部位: 全身；肿瘤部位: 鼻咽；是否区域淋巴结转移: 不确定\n\n【当前需要决策的问题】\n病理已完成。\n报告日期: 既往时点；检查名称: 鼻咽部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 鼻咽腔狭窄，鼻咽双侧顶壁、双侧顶后壁、双侧后壁、双侧壁增厚，明显强化。双侧咽隐窝受侵。双侧后鼻道受侵； 双侧腭帆提肌、双侧头长肌受侵。余咽旁肌未见明显异常。 双侧翼突基底部、蝶骨基底部受侵，余颅底骨质未见明显异常。 双侧咽后见数个肿大淋巴结，大者短径7mm↑(0-5mm)，明显强化。 颈部双侧II区、双侧III区见数个小淋巴结，大者短径8mm(0-10mm)，明显强化。 右侧上颌窦粘膜增厚。双侧乳突见分泌物。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 双侧咽后数个肿大淋巴结，考虑转移。 颈部双侧II区、双侧III区见数个小淋巴结。 副鼻窦炎；双侧乳突炎。；检查部位: 鼻咽部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 7.0；是否区域复发: 否 ；报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽不对称缩窄。鼻咽顶壁、顶后壁、后壁、双侧壁可见软组织肿块影，放射性分布浓聚，SUV约36.5，大小约3.2cm×4.1cm；病灶侵犯颅底骨（双侧翼突基底部、双侧翼突内板、蝶骨基底部）、犁骨、周围软组织（双侧头长肌、双侧腭帆肌群），延伸至双侧鼻腔后1/2，双侧咽隐窝消失。双侧扁桃体见点状致密影放射性分布缺损；余口咽、喉咽结构及放射性分布未见明显异常；双侧咽后多发淋巴结放射性分布略浓密，SUV约3.3，最大者大小约0.8cm×1.0cm；颈部右侧Ⅰb-Ⅱ区多发淋巴结放射性分布较浓密，SUV约6.4；余颈部小淋巴结放射性分布未见明显异常。 双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。右侧上颌窦内见低密度影放射性分布未见异常。左侧乳突见低密度影放射性分布未见异常；余乳突结构及放射性分布未见明显异常。双侧腮腺结构及放射性分布未见异常。甲状腺结构及放射性分布未见明显异常。 双肺纹理未见明显异常，气管、支气管通畅。心脏及大血管放射性分布未见明显异常。食管未见明显占位影及异常放射性分布。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏密度弥漫减低，CT值约44HU（同层面脾脏CT值约49HU）；余肝脏形态、结构及放射性分布未见异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊形态、结构及放射性分布未见明显异常。胃及十二指肠放射性分布未见明显异常。胰腺、脾脏、双肾及双肾上腺形态、结构及放射性分布未见异常。腹腔未见肿大淋巴结及异常放射性分布。腹膜后小淋巴结放射性分布未见明显异常。 前列腺放射性分布未见明显异常。膀胱形态、结构及放射性分布未见明显异常。肠管区形态、结构及放射性分布未见明显异常。双侧髂血管旁及双侧腹股沟未见肿大淋巴结及异常放射性分布。 所见颅盖骨、各躯干骨及四肢骨结构及放射性分布未见明显异常。；检查结论: 1. 鼻咽顶壁、顶后壁、后壁、双侧壁软组织肿块影代谢活跃，结合病史，符合鼻咽癌，病灶侵犯颅底骨；双侧咽后淋巴结代谢略活跃，疑转移。 2. 右颈Ib-II区小淋巴结炎。 3. 副鼻窦炎；左侧乳突炎。 4. 双侧扁桃体结石。 5. 脂肪肝。；检查部位: 全身；肿瘤部位: 鼻咽；是否区域淋巴结转移: 不确定\n请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T3 / N3 / cM0\nB. T3 / N2 / cM1\nC. T1 / N3 / cM1\nD. T3 / N0 / cM1\nE. T1 / N0 / cM0\nF. T4 / N2 / cM1\nG. T4 / N3 / cM0\nH. T3 / N3 / cM1\nI. T2 / N3 / cM0\nJ. T1 / N1 / cM1\nK. T3 / N1 / cM0\nL. T4 / N1 / cM1\n\n请仅输出一个选项字母（A-L）。","gold_letter":"K","gold_action":"T3 / N1 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T3 / N3 / cM0","B":"T3 / N2 / cM1","C":"T1 / N3 / cM1","D":"T3 / N0 / cM1","E":"T1 / N0 / cM0","F":"T4 / N2 / cM1","G":"T4 / N3 / cM0","H":"T3 / N3 / cM1","I":"T2 / N3 / cM0","J":"T1 / N1 / cM1","K":"T3 / N1 / cM0","L":"T4 / N1 / cM1"}}
+{"sample_id":"sample-a0641190ee4da7a1c9b2a08c","patient_id":"patient-5d0c932da06a8cecf1430be4","episode_id":"episode-be6d8476caaa1d931711bffa","turn_id":"P5_01","turn_number":5,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM：{{TNM_STATUS}}；总分期：{{OVERALL_STAGE}}。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；主诉: 双侧鼻塞、耳塞感1年。；现病史: 双侧鼻塞、耳塞感1年。门诊既往史；既往疾病史: 是否有过敏史无过敏史。是否有吸烟史吸烟史详情 【病理资料1】（鼻咽肿物活检）结合HE形态及免疫组化结果，符合为未分化型非角化性癌。 免疫组化：标本15：CK(AE1/AE3)（+），EGFR（+）； 原位杂交：标本15：EBERs（+）。；活检部位: 鼻咽；肿瘤部位: 鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】报告日期: 既往时点；检查名称: 鼻咽部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 鼻咽腔狭窄，鼻咽双侧顶壁、双侧顶后壁、双侧后壁、双侧壁增厚，明显强化。双侧咽隐窝受侵。双侧后鼻道受侵； 双侧腭帆提肌、双侧头长肌受侵。余咽旁肌未见明显异常。 双侧翼突基底部、蝶骨基底部受侵，余颅底骨质未见明显异常。 双侧咽后见数个肿大淋巴结，大者短径7mm↑(0-5mm)，明显强化。 颈部双侧II区、双侧III区见数个小淋巴结，大者短径8mm(0-10mm)，明显强化。 右侧上颌窦粘膜增厚。双侧乳突见分泌物。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 双侧咽后数个肿大淋巴结，考虑转移。 颈部双侧II区、双侧III区见数个小淋巴结。 副鼻窦炎；双侧乳突炎。；检查部位: 鼻咽部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 7.0；是否区域复发: 否 ；报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽不对称缩窄。鼻咽顶壁、顶后壁、后壁、双侧壁可见软组织肿块影，放射性分布浓聚，SUV约36.5，大小约3.2cm×4.1cm；病灶侵犯颅底骨（双侧翼突基底部、双侧翼突内板、蝶骨基底部）、犁骨、周围软组织（双侧头长肌、双侧腭帆肌群），延伸至双侧鼻腔后1/2，双侧咽隐窝消失。双侧扁桃体见点状致密影放射性分布缺损；余口咽、喉咽结构及放射性分布未见明显异常；双侧咽后多发淋巴结放射性分布略浓密，SUV约3.3，最大者大小约0.8cm×1.0cm；颈部右侧Ⅰb-Ⅱ区多发淋巴结放射性分布较浓密，SUV约6.4；余颈部小淋巴结放射性分布未见明显异常。 双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。右侧上颌窦内见低密度影放射性分布未见异常。左侧乳突见低密度影放射性分布未见异常；余乳突结构及放射性分布未见明显异常。双侧腮腺结构及放射性分布未见异常。甲状腺结构及放射性分布未见明显异常。 双肺纹理未见明显异常，气管、支气管通畅。心脏及大血管放射性分布未见明显异常。食管未见明显占位影及异常放射性分布。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏密度弥漫减低，CT值约44HU（同层面脾脏CT值约49HU）；余肝脏形态、结构及放射性分布未见异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊形态、结构及放射性分布未见明显异常。胃及十二指肠放射性分布未见明显异常。胰腺、脾脏、双肾及双肾上腺形态、结构及放射性分布未见异常。腹腔未见肿大淋巴结及异常放射性分布。腹膜后小淋巴结放射性分布未见明显异常。 前列腺放射性分布未见明显异常。膀胱形态、结构及放射性分布未见明显异常。肠管区形态、结构及放射性分布未见明显异常。双侧髂血管旁及双侧腹股沟未见肿大淋巴结及异常放射性分布。 所见颅盖骨、各躯干骨及四肢骨结构及放射性分布未见明显异常。；检查结论: 1. 鼻咽顶壁、顶后壁、后壁、双侧壁软组织肿块影代谢活跃，结合病史，符合鼻咽癌，病灶侵犯颅底骨；双侧咽后淋巴结代谢略活跃，疑转移。 2. 右颈Ib-II区小淋巴结炎。 3. 副鼻窦炎；左侧乳突炎。 4. 双侧扁桃体结石。 5. 脂肪肝。；检查部位: 全身；肿瘤部位: 鼻咽；是否区域淋巴结转移: 不确定 【治疗经过1】记录时间: 既往时点；病程主题: 上级查房记录；病程内容: 患者各项检查继续完善中。 【治疗反应与不良反应1】记录时间: 既往时点；病程主题: 上级查房记录；病程内容: 患者第1程DDP同期化疗第2天，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。 查体：基本同前。 上级医生A查房后指示：患者A，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。；客观检验：肌酐(Crea)-静脉血：93.4μmol/L（高于参考范围，参考约41-73μmol/L）\n\n【当前需要决策的问题】\n治疗开始后约第1天，本患者出现第1个独立的黏膜及胃肠毒性里程碑：记录时间: 既往时点；病程主题: 上级查房记录；病程内容: 患者第1程DDP同期化疗第2天，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。 查体：基本同前。 上级医生A查房后指示：患者A，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。；客观检验：肌酐(Crea)-静脉血：93.4μmol/L（高于参考范围，参考约41-73μmol/L）。该事件最符合哪类治疗相关毒性，当前应采取怎样的支持处理、监测及治疗节奏调整？\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 忽略当前异常并按原剂量、原时间继续治疗，不增加复查\nB. 永久停止全部抗肿瘤治疗，不再判断毒性是否可逆\nC. 立即提高化疗剂量，以补偿既往可能损失的剂量强度\nD. 按黏膜/胃肠毒性分级给予止吐、镇痛、补液和营养支持，并监测进食与体重\nE. 仅复查肿瘤影像，不复查血常规、生化或相关器官功能\nF. 直接改为另一套强化联合方案，不等待毒性恢复\nG. 仅口头安慰并观察，不给予症状处理或近期监测\nH. 把当前异常判断为疾病进展并立即进入后线挽救治疗\nI. 仅依据一次EBV-DNA结果决定停药或换药\nJ. 继续原方案并取消止吐、补液或营养等支持治疗\nK. 立即扩大放疗范围，将所有不适均按肿瘤侵犯处理\nL. 三个月后再复查当前异常，期间不调整治疗节奏\n\n请仅输出一个选项字母（A-L）。","gold_letter":"D","gold_action":"按黏膜/胃肠毒性分级给予止吐、镇痛、补液和营养支持，并监测进食与体重","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":{"A":"忽略当前异常并按原剂量、原时间继续治疗，不增加复查","B":"永久停止全部抗肿瘤治疗，不再判断毒性是否可逆","C":"立即提高化疗剂量，以补偿既往可能损失的剂量强度","D":"按黏膜/胃肠毒性分级给予止吐、镇痛、补液和营养支持，并监测进食与体重","E":"仅复查肿瘤影像，不复查血常规、生化或相关器官功能","F":"直接改为另一套强化联合方案，不等待毒性恢复","G":"仅口头安慰并观察，不给予症状处理或近期监测","H":"把当前异常判断为疾病进展并立即进入后线挽救治疗","I":"仅依据一次EBV-DNA结果决定停药或换药","J":"继续原方案并取消止吐、补液或营养等支持治疗","K":"立即扩大放疗范围，将所有不适均按肿瘤侵犯处理","L":"三个月后再复查当前异常，期间不调整治疗节奏"}}
+{"sample_id":"sample-1f6c8e07d406deca8c9056a4","patient_id":"patient-aa7bbd78f73aee5acf2a27c4","episode_id":"episode-b6dc152d2a67ded0567be0e7","turn_id":"P2_01","turn_number":2,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 当前阶段尚未释放病理、MRI或TNM结论。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；主诉: 回吸性涕血、左鼻塞、左面麻3月余。；未予处理，现为进一步治疗就诊本院。；既往疾病史: 无特殊是否有过敏史无过敏史。是否有吸烟史无吸烟史。吸烟史详情；体格检查: 鼻咽左顶后壁见结节，左口腔颊粘膜肿胀，质软，浅表淋巴结未触及肿大，颅神经检查正常。心肺腹查体未见明显阳性体征。； 【病理资料1】（鼻咽肿物）镜检为分化差的癌，考虑为未分化型非角化性癌，建议来我科交费用已送白片加做原位杂交协助诊断。 原单位免疫组化结果：CK（+）,EGFR（+）,Ki-67（90%+）,p40（+）。；活检部位: 鼻咽；肿瘤部位: 鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是\n\n【当前需要决策的问题】\n此前初诊线索为：记录时间: 既往时点；主诉: 回吸性涕血、左鼻塞、左面麻3月余。；未予处理，现为进一步治疗就诊本院。；既往疾病史: 无特殊是否有过敏史无过敏史。是否有吸烟史无吸烟史。吸烟史详情；体格检查: 鼻咽左顶后壁见结节，左口腔颊粘膜肿胀，质软，浅表淋巴结未触及肿大，颅神经检查正常。心肺腹查体未见明显阳性体征。；。本诊断节点新释放患者本人正式病理报告：（鼻咽肿物）镜检为分化差的癌，考虑为未分化型非角化性癌，建议来我科交费用已送白片加做原位杂交协助诊断。 原单位免疫组化结果：CK（+）,EGFR（+）,Ki-67（90%+）,p40（+）。；活检部位: 鼻咽；肿瘤部位: 鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是。此时最准确的组织学诊断是什么，哪些证据只能作为支持而不能单独替代正式病理？\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 鼻咽黏膜慢性炎症，EBER阳性即可排除恶性肿瘤\nB. 角化型鳞状细胞癌，仅凭EBV-DNA升高即可确诊\nC. 弥漫大B细胞淋巴瘤，CK阳性是其特异诊断依据\nD. NK/T细胞淋巴瘤，任何EBER阳性都足以替代组织形态\nE. 嗅神经母细胞瘤，以颈部淋巴结转移作为唯一证据\nF. 腺样囊性癌，未见腺样结构也可直接确诊\nG. 小细胞神经内分泌癌，Syn和CgA阴性仍应优先考虑\nH. 鼻咽未分化型非角化性癌，正式组织病理为诊断核心，EBER/IHC为支持证据\nI. 转移性甲状腺癌，不需要核对鼻咽取材部位\nJ. 鼻咽部未定性恶性肿瘤，正式病理尚不能支持具体诊断\nK. 良性淋巴组织增生，异型上皮巢不具有诊断价值\nL. 仅能判断EB病毒感染，不能据正式病理判断是否为癌\n\n请仅输出一个选项字母（A-L）。","gold_letter":"H","gold_action":"鼻咽未分化型非角化性癌，正式组织病理为诊断核心，EBER/IHC为支持证据","context_placeholders":[],"options":{"A":"鼻咽黏膜慢性炎症，EBER阳性即可排除恶性肿瘤","B":"角化型鳞状细胞癌，仅凭EBV-DNA升高即可确诊","C":"弥漫大B细胞淋巴瘤，CK阳性是其特异诊断依据","D":"NK/T细胞淋巴瘤，任何EBER阳性都足以替代组织形态","E":"嗅神经母细胞瘤，以颈部淋巴结转移作为唯一证据","F":"腺样囊性癌，未见腺样结构也可直接确诊","G":"小细胞神经内分泌癌，Syn和CgA阴性仍应优先考虑","H":"鼻咽未分化型非角化性癌，正式组织病理为诊断核心，EBER/IHC为支持证据","I":"转移性甲状腺癌，不需要核对鼻咽取材部位","J":"鼻咽部未定性恶性肿瘤，正式病理尚不能支持具体诊断","K":"良性淋巴组织增生，异型上皮巢不具有诊断价值","L":"仅能判断EB病毒感染，不能据正式病理判断是否为癌"}}
+{"sample_id":"sample-b518c3aec0084b1080c7fdce","patient_id":"patient-aa7bbd78f73aee5acf2a27c4","episode_id":"episode-b6dc152d2a67ded0567be0e7","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；主诉: 回吸性涕血、左鼻塞、左面麻3月余。；未予处理，现为进一步治疗就诊本院。；既往疾病史: 无特殊是否有过敏史无过敏史。是否有吸烟史无吸烟史。吸烟史详情；体格检查: 鼻咽左顶后壁见结节，左口腔颊粘膜肿胀，质软，浅表淋巴结未触及肿大，颅神经检查正常。心肺腹查体未见明显阳性体征。； 【病理资料1】（鼻咽肿物）镜检为分化差的癌，考虑为未分化型非角化性癌，建议来我科交费用已送白片加做原位杂交协助诊断。 原单位免疫组化结果：CK（+）,EGFR（+）,Ki-67（90%+）,p40（+）。；活检部位: 鼻咽；肿瘤部位: 鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】鼻咽病变，符合鼻咽癌。 颅底骨质破坏。 双侧咽后及双侧颈部未见肿大淋巴结。 副鼻窦炎。；检查部位: 鼻咽部；肿瘤部位: 鼻咽；是否区域复发: 否 ；报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁、后壁、双侧壁粘膜增厚放射性浓聚，SUV约12.1，病灶侵犯双侧头长肌、双侧腭帆肌群；向上侵犯颅底骨质（蝶骨基底部、双侧翼突基底部、右侧岩尖）。双侧咽隐窝变浅。右侧咽后淋巴结放射性浓密，SUV约5.1，大小约0.6×0.9cm。左侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦放射性分布未见明显异常。双颈II区小淋巴结放射性分布未见异常；余双颈多个小淋巴结放射性分布未见明显异常。 所见脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。口咽、喉咽结构及放射性分布未见异常。双侧上颌窦低密度影放射性稀疏。筛窦、额窦、蝶窦结构及放射性分布未见明显异常。双侧乳突气化良好。甲状腺结构及放射性分布未见明显异常。 右肺中叶内侧段实性小结节影放射性分布未见异常；余双侧肺纹理放射性分布未见异常。气管、支气管通畅。食管结构及放射性分布未见异常。心脏各壁及纵隔大血管未见异常。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏密度弥漫性减低（73Hu，脾脏86Hu）结构及放射性分布未见异常；肝门区未见占位及异常放射性分布。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、双肾、肾上腺及胰腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺钙化灶；膀胱及肠管形态、结构及放射性分布未见明显异常。双髂血管旁及双侧腹股沟未见肿大淋巴结及异常放射性分布。 右侧髂骨内见高密度斑片影放射性分布稀疏（骨岛）；余所见颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，结合病史，符合鼻咽癌，病灶侵犯颅底骨；右侧咽后淋巴结代谢活跃，考虑转移。 双颈II区小淋巴结代谢未见异常，疑炎性淋巴结。 鼻窦炎。 右肺中叶内侧段实性小结节影代谢未见异常，考虑炎症增殖灶。 轻度脂肪肝。 前列腺钙化灶。；检查部位: 全身；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 9.0\n\n【当前需要决策的问题】\n病理已完成。\n鼻咽病变，符合鼻咽癌。 颅底骨质破坏。 双侧咽后及双侧颈部未见肿大淋巴结。 副鼻窦炎。；检查部位: 鼻咽部；肿瘤部位: 鼻咽；是否区域复发: 否 ；报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁、后壁、双侧壁粘膜增厚放射性浓聚，SUV约12.1，病灶侵犯双侧头长肌、双侧腭帆肌群；向上侵犯颅底骨质（蝶骨基底部、双侧翼突基底部、右侧岩尖）。双侧咽隐窝变浅。右侧咽后淋巴结放射性浓密，SUV约5.1，大小约0.6×0.9cm。左侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦放射性分布未见明显异常。双颈II区小淋巴结放射性分布未见异常；余双颈多个小淋巴结放射性分布未见明显异常。 所见脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。口咽、喉咽结构及放射性分布未见异常。双侧上颌窦低密度影放射性稀疏。筛窦、额窦、蝶窦结构及放射性分布未见明显异常。双侧乳突气化良好。甲状腺结构及放射性分布未见明显异常。 右肺中叶内侧段实性小结节影放射性分布未见异常；余双侧肺纹理放射性分布未见异常。气管、支气管通畅。食管结构及放射性分布未见异常。心脏各壁及纵隔大血管未见异常。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏密度弥漫性减低（73Hu，脾脏86Hu）结构及放射性分布未见异常；肝门区未见占位及异常放射性分布。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、双肾、肾上腺及胰腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺钙化灶；膀胱及肠管形态、结构及放射性分布未见明显异常。双髂血管旁及双侧腹股沟未见肿大淋巴结及异常放射性分布。 右侧髂骨内见高密度斑片影放射性分布稀疏（骨岛）；余所见颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，结合病史，符合鼻咽癌，病灶侵犯颅底骨；右侧咽后淋巴结代谢活跃，考虑转移。 双颈II区小淋巴结代谢未见异常，疑炎性淋巴结。 鼻窦炎。 右肺中叶内侧段实性小结节影代谢未见异常，考虑炎症增殖灶。 轻度脂肪肝。 前列腺钙化灶。；检查部位: 全身；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 9.0\n请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T2 / N2 / cM1\nB. T1 / N2 / cM1\nC. T3 / N1 / cM0\nD. T2 / N3 / cM1\nE. T3 / N0 / cM1\nF. T3 / N1 / cM1\nG. T2 / N0 / cM1\nH. T4 / N1 / cM0\nI. T4 / N0 / cM1\nJ. T3 / N2 / cM1\nK. T2 / N1 / cM0\nL. T1 / N3 / cM1\n\n请仅输出一个选项字母（A-L）。","gold_letter":"C","gold_action":"T3 / N1 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T2 / N2 / cM1","B":"T1 / N2 / cM1","C":"T3 / N1 / cM0","D":"T2 / N3 / cM1","E":"T3 / N0 / cM1","F":"T3 / N1 / cM1","G":"T2 / N0 / cM1","H":"T4 / N1 / cM0","I":"T4 / N0 / cM1","J":"T3 / N2 / cM1","K":"T2 / N1 / cM0","L":"T1 / N3 / cM1"}}
+{"sample_id":"sample-cc139040ea87843f364e5867","patient_id":"patient-8711d6dac046e543146e43a2","episode_id":"episode-b46a5afefea116979b7e9d14","turn_id":"P2_01","turn_number":2,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 当前阶段尚未释放病理、MRI或TNM结论。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；主诉: 右侧颈淋巴结肿大4月余；现病史: 右侧颈淋巴结肿大4月余，质硬，固定既往时点 患者A，诉双侧颈淋巴结肿大伴胀痛及耳鸣（右侧为甚），咨询完善相关检查。PE：双颈部多发淋巴结肿大，质硬固定，1-3cm，部分融合。门诊既往史；既往疾病史: 既往史:是否有过敏史无过敏史。是否有吸烟史吸烟史详情 【病理资料1】（右颈V区淋巴结）镜下：穿刺纤维组织中见分化差的癌浸润，结合病史，符合鼻咽（未分化型非角化性癌）转移。；活检部位: 右侧V区淋巴结；肿瘤部位: 鼻咽；颈部转移淋巴结部位: 右侧V区淋巴结；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是\n\n【当前需要决策的问题】\n此前初诊线索为：记录时间: 既往时点；主诉: 右侧颈淋巴结肿大4月余；现病史: 右侧颈淋巴结肿大4月余，质硬，固定既往时点 患者A，诉双侧颈淋巴结肿大伴胀痛及耳鸣（右侧为甚），咨询完善相关检查。PE：双颈部多发淋巴结肿大，质硬固定，1-3cm，部分融合。门诊既往史；既往疾病史: 既往史:是否有过敏史无过敏史。是否有吸烟史吸烟史详情。本诊断节点新释放患者本人正式病理报告：（右颈V区淋巴结）镜下：穿刺纤维组织中见分化差的癌浸润，结合病史，符合鼻咽（未分化型非角化性癌）转移。；活检部位: 右侧V区淋巴结；肿瘤部位: 鼻咽；颈部转移淋巴结部位: 右侧V区淋巴结；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是。此时最准确的组织学诊断是什么，哪些证据只能作为支持而不能单独替代正式病理？\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 鼻咽未分化型非角化性癌，正式组织病理为诊断核心，EBER/IHC为支持证据\nB. 鼻咽黏膜慢性炎症，EBER阳性即可排除恶性肿瘤\nC. 角化型鳞状细胞癌，仅凭EBV-DNA升高即可确诊\nD. 弥漫大B细胞淋巴瘤，CK阳性是其特异诊断依据\nE. NK/T细胞淋巴瘤，任何EBER阳性都足以替代组织形态\nF. 嗅神经母细胞瘤，以颈部淋巴结转移作为唯一证据\nG. 腺样囊性癌，未见腺样结构也可直接确诊\nH. 小细胞神经内分泌癌，Syn和CgA阴性仍应优先考虑\nI. 转移性甲状腺癌，不需要核对鼻咽取材部位\nJ. 鼻咽未分化型非角化性癌并淋巴结转移；正式组织形态为诊断核心，IHC/EBER仅作支持\nK. 鼻咽部未定性恶性肿瘤，正式病理尚不能支持具体诊断\nL. 良性淋巴组织增生，异型上皮巢不具有诊断价值\n\n请仅输出一个选项字母（A-L）。","gold_letter":"J","gold_action":"鼻咽未分化型非角化性癌并淋巴结转移；正式组织形态为诊断核心，IHC/EBER仅作支持","context_placeholders":[],"options":{"A":"鼻咽未分化型非角化性癌，正式组织病理为诊断核心，EBER/IHC为支持证据","B":"鼻咽黏膜慢性炎症，EBER阳性即可排除恶性肿瘤","C":"角化型鳞状细胞癌，仅凭EBV-DNA升高即可确诊","D":"弥漫大B细胞淋巴瘤，CK阳性是其特异诊断依据","E":"NK/T细胞淋巴瘤，任何EBER阳性都足以替代组织形态","F":"嗅神经母细胞瘤，以颈部淋巴结转移作为唯一证据","G":"腺样囊性癌，未见腺样结构也可直接确诊","H":"小细胞神经内分泌癌，Syn和CgA阴性仍应优先考虑","I":"转移性甲状腺癌，不需要核对鼻咽取材部位","J":"鼻咽未分化型非角化性癌并淋巴结转移；正式组织形态为诊断核心，IHC/EBER仅作支持","K":"鼻咽部未定性恶性肿瘤，正式病理尚不能支持具体诊断","L":"良性淋巴组织增生，异型上皮巢不具有诊断价值"}}
+{"sample_id":"sample-aa0d497de8449598bffd2417","patient_id":"patient-8711d6dac046e543146e43a2","episode_id":"episode-b46a5afefea116979b7e9d14","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；主诉: 右侧颈淋巴结肿大4月余；现病史: 右侧颈淋巴结肿大4月余，质硬，固定既往时点 患者A，诉双侧颈淋巴结肿大伴胀痛及耳鸣（右侧为甚），咨询完善相关检查。PE：双颈部多发淋巴结肿大，质硬固定，1-3cm，部分融合。门诊既往史；既往疾病史: 既往史:是否有过敏史无过敏史。是否有吸烟史吸烟史详情 【病理资料1】（右颈V区淋巴结）镜下：穿刺纤维组织中见分化差的癌浸润，结合病史，符合鼻咽（未分化型非角化性癌）转移。；活检部位: 右侧V区淋巴结；肿瘤部位: 鼻咽；颈部转移淋巴结部位: 右侧V区淋巴结；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及双侧壁粘膜增厚放射性浓聚，SUV约14.0，病灶侵犯颅底骨（蝶骨基底部、斜坡、右岩尖）、蝶窦、右颈动脉内口、右破裂孔、右翼腭窝、双腭帆肌群、双头长肌及双侧咽旁间隙，局部与双咽后淋巴结分界不清。双侧咽隐窝消失。左侧破裂孔及左翼腭窝放射性分布未见异常。双海绵窦结构及放射性分布未见异常。右腮腺区、双咽后、右颈Ib区双颈II-VI区（包括双锁上）、右侧腋窝及纵隔（血管前、右上气管旁）多发肿大淋巴结放射性浓聚/较浓密，SUV约11.1，部分融合，最大约5.3×3.4cm，部分内见低密度影放射性分布稀疏，部分病灶侵犯邻近肌群；左颈I区数个淋巴结放射性分布较浓密，SUV约5.7，最大约1.6×1.1cm。 双侧脑实质密度、形态正常，放射性分布均匀、对称。诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。口咽、喉咽未见异常。蝶窦、筛窦、右上颌窦及右乳突低密度影放射性分布未见异常。额窦及左侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。 右中肺内侧段小斑片影放射性分布未见异常，大小约0.5×0.4cm；右上肺前段及右下肺前基底段小斑片致密影放射性分布缺损，最大约0.8×0.3cm；双肺多发簇状囊性无肺纹理透亮影放射性分布稀疏。余双肺未见确切病灶和异常放射性分布。气管、支气管通畅。心脏及大血管放射性分布未见异常。食管放射性分布未见明显异常。胸壁未见确切病灶和异常放射性分布。余纵隔、双肺门及左侧腋窝多个小淋巴结放射性分布较浓密/略浓密，SUV约5.0，最大约1.2×0.8cm，可见淋巴门。 肝脏多个囊性低密度影放射性分布稀疏，最大阿月1.4×1.2cm；余肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管及胆总管未见扩张。胆囊、胃及十二指肠放射性分布未见异常。脾脏、胰腺、双肾及双侧肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺放射性分布未见异常，内见点状致密影。膀胱、肠管等形态、结构及放射性分布未见明显异常。双侧髂血管旁及双侧腹股沟未见明显肿大淋巴结及异常放射性分布。 右第3、7肋骨、T10椎体、L2椎体及右股骨局部骨质致密放射性分布较浓密，SUV约4.7；右侧4、9肋骨、胸骨及余多个颈胸腰椎椎体骨质稍致密放射性分布未见异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，病灶侵犯右破裂孔、蝶窦及颅底骨等，余侵犯范围如上述；双咽后、双颈II-VI区多发肿大淋巴结代谢活跃，考虑转移；右第3、7肋骨、T10椎体、L2椎体及右股骨局部骨质致密代谢较活跃，考虑转移；右腮腺区、右颈Ib区、右侧腋窝及纵隔（血管前、右上气管旁）多发淋巴结代谢活跃，疑转移；余全身多发骨病灶代谢未见异常，建议随诊。 鼻窦炎。左颈I区多个小淋巴结代谢略活跃，考虑炎症可能。 右中肺增殖灶。右肺数个钙化灶。余纵隔、双肺门多个小淋巴结代谢较活跃/略活跃，疑炎症；左侧腋窝小淋巴结炎症。 肝囊肿。；检查部位: 全身；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 53.0；是否远处转移: 是；远处转移部位: 骨 ；报告日期: 既往时点；检查名称: 鼻咽部MR平扫+增强 颈部MR平扫+增强；检查所见: 鼻咽腔狭窄，鼻咽双侧顶壁、双侧顶后壁、双侧后壁、双侧壁增厚，明显强化。双侧咽隐窝受侵。口咽后壁受侵； 右侧咽旁间隙受侵。双侧腭帆提肌、右侧腭帆张肌受侵。余咽旁肌未见明显异常。 右侧翼突基底部、蝶骨基底部、斜坡、右侧岩尖、双侧枕骨基底部、寰椎受侵，余颅底骨质未见明显异常。 右侧破裂孔受侵。双侧海绵窦、眼眶、余颅内未见明显异常。 双侧咽后见多个肿大淋巴结，大者短径14mm↑(0-5mm)，明显强化，部分可见中央坏死。 颈部双侧II区、双侧III区、双侧IV区、双侧V区、右侧VI区、右侧腮腺区见多个肿大淋巴结，大者短径36mm↑(0-10mm)，明显强化，部分可见中央坏死、包膜外侵犯、融合。 颈部双侧I区见多个淋巴结，大者短径约12mm，明显强化。 右侧上颌窦、双侧蝶窦粘膜增厚。右侧乳突见较多分泌物。 左腮腺、双侧颌下腺、甲状腺、喉部、所见脑实质未见明显异常。 颈6椎体见斑片强化影，T1WI及T2WI骨质信号降低不明显。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 双侧咽后多个肿大淋巴结，考虑转移。 颈部双侧II~V区、右侧V I区、右侧腮腺区见多个肿大淋巴结，考虑转移。 颈部双侧I区见多个淋巴结，部分肿大，可疑转移。 副鼻窦炎；右侧乳突炎。 颈6椎体见斑片强化影，可疑炎性，转移待排。；检查部位: 颈部,鼻咽部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 36.0；是否远处转移: 不确定；是否区域复发: 否\n\n【当前需要决策的问题】\n病理已完成。\n报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及双侧壁粘膜增厚放射性浓聚，SUV约14.0，病灶侵犯颅底骨（蝶骨基底部、斜坡、右岩尖）、蝶窦、右颈动脉内口、右破裂孔、右翼腭窝、双腭帆肌群、双头长肌及双侧咽旁间隙，局部与双咽后淋巴结分界不清。双侧咽隐窝消失。左侧破裂孔及左翼腭窝放射性分布未见异常。双海绵窦结构及放射性分布未见异常。右腮腺区、双咽后、右颈Ib区双颈II-VI区（包括双锁上）、右侧腋窝及纵隔（血管前、右上气管旁）多发肿大淋巴结放射性浓聚/较浓密，SUV约11.1，部分融合，最大约5.3×3.4cm，部分内见低密度影放射性分布稀疏，部分病灶侵犯邻近肌群；左颈I区数个淋巴结放射性分布较浓密，SUV约5.7，最大约1.6×1.1cm。 双侧脑实质密度、形态正常，放射性分布均匀、对称。诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。口咽、喉咽未见异常。蝶窦、筛窦、右上颌窦及右乳突低密度影放射性分布未见异常。额窦及左侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。 右中肺内侧段小斑片影放射性分布未见异常，大小约0.5×0.4cm；右上肺前段及右下肺前基底段小斑片致密影放射性分布缺损，最大约0.8×0.3cm；双肺多发簇状囊性无肺纹理透亮影放射性分布稀疏。余双肺未见确切病灶和异常放射性分布。气管、支气管通畅。心脏及大血管放射性分布未见异常。食管放射性分布未见明显异常。胸壁未见确切病灶和异常放射性分布。余纵隔、双肺门及左侧腋窝多个小淋巴结放射性分布较浓密/略浓密，SUV约5.0，最大约1.2×0.8cm，可见淋巴门。 肝脏多个囊性低密度影放射性分布稀疏，最大阿月1.4×1.2cm；余肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管及胆总管未见扩张。胆囊、胃及十二指肠放射性分布未见异常。脾脏、胰腺、双肾及双侧肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺放射性分布未见异常，内见点状致密影。膀胱、肠管等形态、结构及放射性分布未见明显异常。双侧髂血管旁及双侧腹股沟未见明显肿大淋巴结及异常放射性分布。 右第3、7肋骨、T10椎体、L2椎体及右股骨局部骨质致密放射性分布较浓密，SUV约4.7；右侧4、9肋骨、胸骨及余多个颈胸腰椎椎体骨质稍致密放射性分布未见异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，病灶侵犯右破裂孔、蝶窦及颅底骨等，余侵犯范围如上述；双咽后、双颈II-VI区多发肿大淋巴结代谢活跃，考虑转移；右第3、7肋骨、T10椎体、L2椎体及右股骨局部骨质致密代谢较活跃，考虑转移；右腮腺区、右颈Ib区、右侧腋窝及纵隔（血管前、右上气管旁）多发淋巴结代谢活跃，疑转移；余全身多发骨病灶代谢未见异常，建议随诊。 鼻窦炎。左颈I区多个小淋巴结代谢略活跃，考虑炎症可能。 右中肺增殖灶。右肺数个钙化灶。余纵隔、双肺门多个小淋巴结代谢较活跃/略活跃，疑炎症；左侧腋窝小淋巴结炎症。 肝囊肿。；检查部位: 全身；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 53.0；是否远处转移: 是；远处转移部位: 骨 ；报告日期: 既往时点；检查名称: 鼻咽部MR平扫+增强 颈部MR平扫+增强；检查所见: 鼻咽腔狭窄，鼻咽双侧顶壁、双侧顶后壁、双侧后壁、双侧壁增厚，明显强化。双侧咽隐窝受侵。口咽后壁受侵； 右侧咽旁间隙受侵。双侧腭帆提肌、右侧腭帆张肌受侵。余咽旁肌未见明显异常。 右侧翼突基底部、蝶骨基底部、斜坡、右侧岩尖、双侧枕骨基底部、寰椎受侵，余颅底骨质未见明显异常。 右侧破裂孔受侵。双侧海绵窦、眼眶、余颅内未见明显异常。 双侧咽后见多个肿大淋巴结，大者短径14mm↑(0-5mm)，明显强化，部分可见中央坏死。 颈部双侧II区、双侧III区、双侧IV区、双侧V区、右侧VI区、右侧腮腺区见多个肿大淋巴结，大者短径36mm↑(0-10mm)，明显强化，部分可见中央坏死、包膜外侵犯、融合。 颈部双侧I区见多个淋巴结，大者短径约12mm，明显强化。 右侧上颌窦、双侧蝶窦粘膜增厚。右侧乳突见较多分泌物。 左腮腺、双侧颌下腺、甲状腺、喉部、所见脑实质未见明显异常。 颈6椎体见斑片强化影，T1WI及T2WI骨质信号降低不明显。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 双侧咽后多个肿大淋巴结，考虑转移。 颈部双侧II~V区、右侧V I区、右侧腮腺区见多个肿大淋巴结，考虑转移。 颈部双侧I区见多个淋巴结，部分肿大，可疑转移。 副鼻窦炎；右侧乳突炎。 颈6椎体见斑片强化影，可疑炎性，转移待排。；检查部位: 颈部,鼻咽部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 36.0；是否远处转移: 不确定；是否区域复发: 否\n请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T4 / N0 / cM0\nB. T3 / N1 / cM1\nC. T1 / N0 / cM1\nD. T1 / N2 / cM0\nE. T1 / N3 / cM0\nF. T2 / N1 / cM1\nG. T2 / N3 / cM0\nH. T3 / N3 / cM1\nI. T3 / N3 / cM0\nJ. T2 / N2 / cM1\nK. T2 / N2 / cM0\nL. T3 / N1 / cM0\n\n请仅输出一个选项字母（A-L）。","gold_letter":"H","gold_action":"T3 / N3 / cM1","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T4 / N0 / cM0","B":"T3 / N1 / cM1","C":"T1 / N0 / cM1","D":"T1 / N2 / cM0","E":"T1 / N3 / cM0","F":"T2 / N1 / cM1","G":"T2 / N3 / cM0","H":"T3 / N3 / cM1","I":"T3 / N3 / cM0","J":"T2 / N2 / cM1","K":"T2 / N2 / cM0","L":"T3 / N1 / cM0"}}
+{"sample_id":"sample-1fb3867c709ff3cfc901fa17","patient_id":"patient-23d7450690ac27c41cf2d08a","episode_id":"episode-b891096a56abb09eefbfbfb7","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；病历特点: 患者A ，男，主因“发现右眼下睑肿物1月余，左颈部肿物1周余”于既往时点步行入院。 一.病例特点: 1、患者53岁 男性。 2、现病史:患者既往时点无明显诱因发现右眼下睑出现一大小约1*2cm的无压痛肿块，质韧，边界清，活动度一般，右眼视力略下降，无眼红眼痛，无复视，无鼻塞，无头晕头痛，无耳鸣。 1周余前左侧颈部出现一大小约2*3cm无痛性肿块，质硬，边界不清，活动度较差。 于当地检查：既往时点眼眶CT：右侧眼眶内下象限软组织肿块影，考虑炎性假瘤？肿瘤病变？鼻咽顶后壁增厚。 既往时点鼻咽活检病理示：鼻咽未分化型非角化性癌。 在当地未行治疗，现为进一步治疗入院。 患者现在仍有鼻塞涕血，自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重无下降。 3、体格检查: T:36.5℃ P:75次/分 R:18次/分 BP:130/90 mmHg Ht: 170cm Wt: 53.20kg BSA: 1.6105m2 KPS:90 发育正常，营养一般，神志清楚，自主体位，查体合作。 全身皮肤粘膜无苍白、黄染、水肿、出血。 巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。 无鼻翼扇动、鼻衄。 牙龈无肿胀、出血。 气管居中，甲状腺不大。 胸骨无压痛。 双肺呼吸音清，未闻及干湿啰音。 心率75bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。 腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。 肛门外生殖器未见异常，生理反射存在，病理反射未引出。 4. 【病理资料1】（右眼周肿物）镜下：穿刺送检组织中见异型细胞呈巢团状排列，伴灶性淋巴细胞浸润，结合病史，未除外未分化型非角化性癌转移的可能，待免疫组化及原位杂交结果补充报告。 【影像与分期资料1】报告日期: 既往时点；检查名称: 颈部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 鼻咽腔狭窄，鼻咽双侧顶壁、双侧顶后壁、双侧后壁、双侧壁增厚，明显强化。双侧咽隐窝受侵。口咽、双侧后鼻孔未见明显异常。双侧咽旁间隙受侵。 双侧腭帆提肌受侵。余咽旁肌未见明显异常。 双侧翼突基底部、蝶骨基底部受侵，余颅底骨质未见明显异常。 双侧海绵窦未见明显异常。 双侧咽后见数个肿大淋巴结，大者短径约10mm，明显强化。 颈部双侧Ib、II区、左侧III、IV区见多个肿大淋巴结，大者短径约19mm，明显强化，部分内见坏死、融合。双侧腮腺区见数个淋巴结，大者短径约7mm，明显均匀强化。 双侧上颌窦、双侧筛窦、右侧蝶窦粘膜增厚。 右眼内眦及下眼睑见一软组织灶，范围约27mm×12mm，边界欠清，T2WI呈稍高信号，T1WI呈稍低信号，增强扫描明显强化。 双侧颌下腺、甲状腺、喉部、所见脑实质未见明显异常。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 双侧咽后肿大淋巴结，考虑转移。 颈部双侧Ib、II区、左侧III、IV区肿大淋巴结，考虑转移。 双侧腮腺区淋巴结，性质待定。 右眼内眦及下眼睑软组织灶，恶性待排。 副鼻窦炎。；检查部位: 颈部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 19.0；是否区域复发: 否 ；报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及双侧壁粘膜增厚放射性浓聚，SUV约7.1，病灶侵犯颅底骨（蝶骨基底部、双侧翼突基底部、双侧岩尖）、双侧头长肌、双侧腭帆提肌。双侧咽隐窝变浅。双侧破裂孔未见明显异常。双侧海绵窦放射性分布未见异常。额窦、筛窦及双侧上颌窦内低密度影放射性分布略浓密；鼻腔粘膜放射性分布略浓密。口咽、喉咽未见明显异常。甲状腺放射性分布未见异常。双侧咽后、双颈II-III区多发肿大淋巴结放射性浓聚/浓密，SUV约12.6，大者约1.8×2.7cm，部分II区淋巴结推压双侧颌下腺且与后者分界欠清；双颈Ib多发淋巴结放射性分布浓密，SUV约3.9，大者位于右侧，约1.3×1.6cm；余双颈小淋巴结放射性分布未见明显异常。 右眼内眦及下眼睑见条片状软组织密度影放射性分布浓密，SUV约3.8，最大层面约1.4×2.5cm；左眼形态、结构及放射性分布未见明显异常。所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 左肺上叶透亮无肺纹理区放射性分布稀疏，大者直径约3.4×5.8cm；余双肺多发小类圆形透亮影；双肺多发条索、条片影放射性分布未见明显异常。气管、支气管通畅。心脏及大血管放射性分布未见异常。食管放射性分布未见明显异常。胸壁未见确切病灶和异常放射性分布。双肺门数个稍高密度小淋巴结放射性浓聚/浓密，SUV约8.2，大者直径约0.6cm；纵隔及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管及胆总管未见扩张。胆囊、胃及十二指肠放射性分布未见异常。脾脏、胰腺、双肾及双侧肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、肠管、前列腺等形态、结构及放射性分布未见明显异常。双侧髂血管旁及双侧腹股沟未见明显肿大淋巴结及异常放射性分布。 右上牙槽骨炎症。多个颈胸腰椎边缘骨质增生/骨赘形成，放射性分布未见明显异常；左侧股骨颈骨岛；所见颅盖骨、余躯干骨、余四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，病灶侵犯颅底骨、双侧头长肌、双侧腭帆提肌。双侧咽后、双颈II-III区多发肿大淋巴结代谢活跃/较活跃，考虑转移。 双颈Ib区多发淋巴结代谢较活跃，转移待排，请结合临床。 右眼内眦及下眼睑见条片状软组织灶代谢较活跃，恶性待排。 鼻窦炎症；双侧鼻腔粘膜炎症；右上牙槽骨炎症。 双肺肺气肿伴左肺上叶肺大泡。双肺纤维增殖灶。双肺门小淋巴结炎症。 多个颈胸腰椎退行性变。；检查部位: 全身；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 27.0\n治疗前右眼周肿物穿刺初步报告：（右眼周肿物）镜下：穿刺送检组织中见异型细胞呈巢团状排列，伴灶性淋巴细胞浸润，结合病史，未除外未分化型非角化性癌转移的可能，待免疫组化及原位杂交结果补充报告。\n综合治疗前MRI、PET/CT及右眼周病灶穿刺初步病理，临床将右眼周病灶按鼻咽癌远处转移考虑。\n\n【当前需要决策的问题】\n病理已完成。\n报告日期: 既往时点；检查名称: 颈部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 鼻咽腔狭窄，鼻咽双侧顶壁、双侧顶后壁、双侧后壁、双侧壁增厚，明显强化。双侧咽隐窝受侵。口咽、双侧后鼻孔未见明显异常。双侧咽旁间隙受侵。 双侧腭帆提肌受侵。余咽旁肌未见明显异常。 双侧翼突基底部、蝶骨基底部受侵，余颅底骨质未见明显异常。 双侧海绵窦未见明显异常。 双侧咽后见数个肿大淋巴结，大者短径约10mm，明显强化。 颈部双侧Ib、II区、左侧III、IV区见多个肿大淋巴结，大者短径约19mm，明显强化，部分内见坏死、融合。双侧腮腺区见数个淋巴结，大者短径约7mm，明显均匀强化。 双侧上颌窦、双侧筛窦、右侧蝶窦粘膜增厚。 右眼内眦及下眼睑见一软组织灶，范围约27mm×12mm，边界欠清，T2WI呈稍高信号，T1WI呈稍低信号，增强扫描明显强化。 双侧颌下腺、甲状腺、喉部、所见脑实质未见明显异常。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 双侧咽后肿大淋巴结，考虑转移。 颈部双侧Ib、II区、左侧III、IV区肿大淋巴结，考虑转移。 双侧腮腺区淋巴结，性质待定。 右眼内眦及下眼睑软组织灶，恶性待排。 副鼻窦炎。；检查部位: 颈部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 19.0；是否区域复发: 否 ；报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及双侧壁粘膜增厚放射性浓聚，SUV约7.1，病灶侵犯颅底骨（蝶骨基底部、双侧翼突基底部、双侧岩尖）、双侧头长肌、双侧腭帆提肌。双侧咽隐窝变浅。双侧破裂孔未见明显异常。双侧海绵窦放射性分布未见异常。额窦、筛窦及双侧上颌窦内低密度影放射性分布略浓密；鼻腔粘膜放射性分布略浓密。口咽、喉咽未见明显异常。甲状腺放射性分布未见异常。双侧咽后、双颈II-III区多发肿大淋巴结放射性浓聚/浓密，SUV约12.6，大者约1.8×2.7cm，部分II区淋巴结推压双侧颌下腺且与后者分界欠清；双颈Ib多发淋巴结放射性分布浓密，SUV约3.9，大者位于右侧，约1.3×1.6cm；余双颈小淋巴结放射性分布未见明显异常。 右眼内眦及下眼睑见条片状软组织密度影放射性分布浓密，SUV约3.8，最大层面约1.4×2.5cm；左眼形态、结构及放射性分布未见明显异常。所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 左肺上叶透亮无肺纹理区放射性分布稀疏，大者直径约3.4×5.8cm；余双肺多发小类圆形透亮影；双肺多发条索、条片影放射性分布未见明显异常。气管、支气管通畅。心脏及大血管放射性分布未见异常。食管放射性分布未见明显异常。胸壁未见确切病灶和异常放射性分布。双肺门数个稍高密度小淋巴结放射性浓聚/浓密，SUV约8.2，大者直径约0.6cm；纵隔及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管及胆总管未见扩张。胆囊、胃及十二指肠放射性分布未见异常。脾脏、胰腺、双肾及双侧肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、肠管、前列腺等形态、结构及放射性分布未见明显异常。双侧髂血管旁及双侧腹股沟未见明显肿大淋巴结及异常放射性分布。 右上牙槽骨炎症。多个颈胸腰椎边缘骨质增生/骨赘形成，放射性分布未见明显异常；左侧股骨颈骨岛；所见颅盖骨、余躯干骨、余四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，病灶侵犯颅底骨、双侧头长肌、双侧腭帆提肌。双侧咽后、双颈II-III区多发肿大淋巴结代谢活跃/较活跃，考虑转移。 双颈Ib区多发淋巴结代谢较活跃，转移待排，请结合临床。 右眼内眦及下眼睑见条片状软组织灶代谢较活跃，恶性待排。 鼻窦炎症；双侧鼻腔粘膜炎症；右上牙槽骨炎症。 双肺肺气肿伴左肺上叶肺大泡。双肺纤维增殖灶。双肺门小淋巴结炎症。 多个颈胸腰椎退行性变。；检查部位: 全身；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 27.0\n治疗前右眼周肿物穿刺初步报告：（右眼周肿物）镜下：穿刺送检组织中见异型细胞呈巢团状排列，伴灶性淋巴细胞浸润，结合病史，未除外未分化型非角化性癌转移的可能，待免疫组化及原位杂交结果补充报告。\n综合治疗前MRI、PET/CT及右眼周病灶穿刺初步病理，临床将右眼周病灶按鼻咽癌远处转移考虑。\n请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T3 / N2 / cM1\nB. T3 / N3 / cM1\nC. T1 / N1 / cM0\nD. T1 / N3 / cM0\nE. T2 / N0 / cM0\nF. T3 / N0 / cM1\nG. T4 / N3 / cM0\nH. T4 / N1 / cM0\nI. T4 / N3 / cM1\nJ. T4 / N2 / cM0\nK. T2 / N2 / cM1\nL. T3 / N3 / cM0\n\n请仅输出一个选项字母（A-L）。","gold_letter":"B","gold_action":"T3 / N3 / cM1","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T3 / N2 / cM1","B":"T3 / N3 / cM1","C":"T1 / N1 / cM0","D":"T1 / N3 / cM0","E":"T2 / N0 / cM0","F":"T3 / N0 / cM1","G":"T4 / N3 / cM0","H":"T4 / N1 / cM0","I":"T4 / N3 / cM1","J":"T4 / N2 / cM0","K":"T2 / N2 / cM1","L":"T3 / N3 / cM0"}}
+{"sample_id":"sample-134275487ed8076144cc8812","patient_id":"patient-ea6494e889c7facfd6a5b961","episode_id":"episode-3515696cdbf760c07f633c35","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；主诉: 涕血3月；现病史: 涕血3月；既往疾病史: 是否有过敏史无过敏史。是否有吸烟史吸烟史详情月经史月经史: 【影像与分期资料1】报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁、双侧壁粘膜增厚放射性分布浓聚，SUV约23.5，病灶侵犯双侧腭帆肌群、双侧头长肌、颅底骨（蝶骨基底部、双侧翼突基底部）。双侧咽隐窝未见明显异常。余颅底骨质结构未见明显异常。双侧破裂孔未见明显异常。双侧海绵窦结构及放射性分布未见异常。额窦、蝶窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。口咽、喉咽未见明显异常。甲状腺右叶低密度结节放射性分布浓聚，SUV约34.8，大者约2.2×2.6cm，边界不清；余甲状腺密度欠均匀放射性分布未见明显异常。双颈II区、右颈Va区多发淋巴结放射性分布浓密/较浓密，SUV约11.1，大者约1.2×1.6cm；余双侧颈部小淋巴结放射性分布未见异常。 双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺纹理清晰，双侧肺野未见确切病灶和异常放射性分布。气管、支气管通畅。心脏及大血管放射性分布未见异常。食管放射性分布未见明显异常。双侧乳腺未见确切病灶和异常放射性分布。双肺门、纵隔及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝左右叶多发囊性密度影放射性分布稀疏，大者约4.8×5.3cm；余肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管及胆总管未见扩张。胆囊、胃及十二指肠放射性分布未见异常。脾脏、胰腺、双肾及双侧肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、肠管、子宫等形态、结构及放射性分布未见明显异常。双侧髂血管旁及双侧腹股沟未见明显肿大淋巴结及异常放射性分布。 L4椎体上缘局部放射性分布较浓密，SUV约4.1，骨质密度未见明显改变；余所见颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽顶壁、顶后壁、双侧壁粘膜增厚代谢活跃，符合鼻咽癌，病灶侵犯颅底骨；双颈II区多个淋巴结代谢活跃，疑转移；右颈Va区小淋巴结代谢较活跃，转移待排；L4椎体代谢较活跃，转移待排，请结合临床。 甲状腺右侧叶低密度结节代谢活跃，甲状腺癌待排，建议活检。 肝多发囊肿。；检查部位: 全身；肿瘤部位: 鼻咽；是否区域淋巴结转移: 不确定；是否远处转移: 不确定 ；报告日期: 既往时点；检查名称: 鼻咽部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 鼻咽腔狭窄，鼻咽双侧顶壁、双侧顶后壁、双侧后壁、双侧壁增厚，明显强化。双侧咽隐窝受侵。右侧后鼻道受侵；右侧咽旁间隙受侵。 双侧腭帆提肌、双侧腭帆张肌、右侧翼内肌受侵。余咽旁肌未见明显异常。 双侧翼突基底部、蝶骨基底部、斜坡受侵，余颅底骨质未见明显异常。 双侧破裂孔受侵。 双侧咽后未见明显肿大淋巴结。 颈部双侧II区、右侧V区见数个淋巴结，大者短径10mm(0-10mm)，明显强化。 右侧上颌窦、双侧筛窦粘膜增厚。 双侧腮腺、颌下腺、甲状腺、喉部、所见脑实质未见明显异常。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 双侧咽后未见大肿淋巴结。 颈部双侧II区、右侧V区见淋巴结，考虑转移可能。 副鼻窦炎。；检查部位: 鼻咽部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 不确定；是否区域复发: 否\n治疗前腰椎MRI结论：腰椎退行性变，L4/5、L5/S1椎间盘变性、膨出。 L5、S1椎体终板炎。\n治疗前甲状腺左叶结节穿刺病理：（甲状腺左叶结节）液基片及常规涂片、细胞块切片见滤泡上皮呈片状或乳头状增生，细胞排列拥挤重叠，核增大拉长，可见核沟，病变考虑为甲状腺乳头状癌（TBSRTC分类：V类）。\n综合治疗前检查，临床未见明确鼻咽癌远处转移证据；PET所示甲状腺右叶结节及L4病灶继续评估随访。\n\n【当前需要决策的问题】\n病理已完成。\n报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁、双侧壁粘膜增厚放射性分布浓聚，SUV约23.5，病灶侵犯双侧腭帆肌群、双侧头长肌、颅底骨（蝶骨基底部、双侧翼突基底部）。双侧咽隐窝未见明显异常。余颅底骨质结构未见明显异常。双侧破裂孔未见明显异常。双侧海绵窦结构及放射性分布未见异常。额窦、蝶窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。口咽、喉咽未见明显异常。甲状腺右叶低密度结节放射性分布浓聚，SUV约34.8，大者约2.2×2.6cm，边界不清；余甲状腺密度欠均匀放射性分布未见明显异常。双颈II区、右颈Va区多发淋巴结放射性分布浓密/较浓密，SUV约11.1，大者约1.2×1.6cm；余双侧颈部小淋巴结放射性分布未见异常。 双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺纹理清晰，双侧肺野未见确切病灶和异常放射性分布。气管、支气管通畅。心脏及大血管放射性分布未见异常。食管放射性分布未见明显异常。双侧乳腺未见确切病灶和异常放射性分布。双肺门、纵隔及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝左右叶多发囊性密度影放射性分布稀疏，大者约4.8×5.3cm；余肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管及胆总管未见扩张。胆囊、胃及十二指肠放射性分布未见异常。脾脏、胰腺、双肾及双侧肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、肠管、子宫等形态、结构及放射性分布未见明显异常。双侧髂血管旁及双侧腹股沟未见明显肿大淋巴结及异常放射性分布。 L4椎体上缘局部放射性分布较浓密，SUV约4.1，骨质密度未见明显改变；余所见颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽顶壁、顶后壁、双侧壁粘膜增厚代谢活跃，符合鼻咽癌，病灶侵犯颅底骨；双颈II区多个淋巴结代谢活跃，疑转移；右颈Va区小淋巴结代谢较活跃，转移待排；L4椎体代谢较活跃，转移待排，请结合临床。 甲状腺右侧叶低密度结节代谢活跃，甲状腺癌待排，建议活检。 肝多发囊肿。；检查部位: 全身；肿瘤部位: 鼻咽；是否区域淋巴结转移: 不确定；是否远处转移: 不确定 ；报告日期: 既往时点；检查名称: 鼻咽部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 鼻咽腔狭窄，鼻咽双侧顶壁、双侧顶后壁、双侧后壁、双侧壁增厚，明显强化。双侧咽隐窝受侵。右侧后鼻道受侵；右侧咽旁间隙受侵。 双侧腭帆提肌、双侧腭帆张肌、右侧翼内肌受侵。余咽旁肌未见明显异常。 双侧翼突基底部、蝶骨基底部、斜坡受侵，余颅底骨质未见明显异常。 双侧破裂孔受侵。 双侧咽后未见明显肿大淋巴结。 颈部双侧II区、右侧V区见数个淋巴结，大者短径10mm(0-10mm)，明显强化。 右侧上颌窦、双侧筛窦粘膜增厚。 双侧腮腺、颌下腺、甲状腺、喉部、所见脑实质未见明显异常。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 双侧咽后未见大肿淋巴结。 颈部双侧II区、右侧V区见淋巴结，考虑转移可能。 副鼻窦炎。；检查部位: 鼻咽部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 不确定；是否区域复发: 否\n治疗前腰椎MRI结论：腰椎退行性变，L4/5、L5/S1椎间盘变性、膨出。 L5、S1椎体终板炎。\n治疗前甲状腺左叶结节穿刺病理：（甲状腺左叶结节）液基片及常规涂片、细胞块切片见滤泡上皮呈片状或乳头状增生，细胞排列拥挤重叠，核增大拉长，可见核沟，病变考虑为甲状腺乳头状癌（TBSRTC分类：V类）。\n综合治疗前检查，临床未见明确鼻咽癌远处转移证据；PET所示甲状腺右叶结节及L4病灶继续评估随访。\n请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T1 / N2 / cM0\nB. T3 / N2 / cM0\nC. T3 / N0 / cM0\nD. T2 / N3 / cM0\nE. T2 / N2 / cM0\nF. T4 / N2 / cM1\nG. T3 / N3 / cM1\nH. T4 / N3 / cM1\nI. T1 / N0 / cM0\nJ. T2 / N2 / cM1\nK. T1 / N2 / cM1\nL. T2 / N0 / cM1\n\n请仅输出一个选项字母（A-L）。","gold_letter":"B","gold_action":"T3 / N2 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T1 / N2 / cM0","B":"T3 / N2 / cM0","C":"T3 / N0 / cM0","D":"T2 / N3 / cM0","E":"T2 / N2 / cM0","F":"T4 / N2 / cM1","G":"T3 / N3 / cM1","H":"T4 / N3 / cM1","I":"T1 / N0 / cM0","J":"T2 / N2 / cM1","K":"T1 / N2 / cM1","L":"T2 / N0 / cM1"}}
+{"sample_id":"sample-56f38b2602175ecaacb70bc5","patient_id":"patient-174236bff64528c2f91d7aa7","episode_id":"episode-a1045667688ade95c72a9eae","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；病历特点: 患者A，男，58岁，因\"左耳听力下降2月余。\"于既往时点，步行入院。患者A，精神可，饮食睡眠一般，大小便正常，体重无明显变化。3、肿瘤专科检查:张口门齿距4cm；鼻咽左侧壁结节状肿物；双侧颈部未触及明显肿大淋巴结；颅神经检查:阴性。 【病理资料1】（左侧鼻咽部）形态符合未分化型非角化性癌。 待用会诊白片在我科行免疫组化检查后（CK，EGFR，EBERS)补充报告。 既往时点补充报告： （左侧鼻咽部）镜检为未分化型非角化性癌。 本院免疫组化结果：CK（+），EGFR（+）； 本院原位杂交结果：EBERs（+）。；活检部位: 左侧鼻咽；肿瘤部位: 左侧鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】报告日期: 既往时点；检查名称: 鼻咽部磁共振平扫＋增强（3.0T及以上）(套)；检查所见: 鼻咽腔狭窄，鼻咽左侧顶壁、左侧顶后壁、左侧壁增厚，明显强化。左侧咽隐窝受侵，右侧咽隐窝存在。口咽、双侧后鼻孔未见明显异常。 左侧咽旁间隙受侵。左侧腭帆提肌、左侧腭帆张肌、左侧翼内肌、左侧头长肌受侵。 左侧翼突基底部、左侧翼突内板、蝶骨基底部受侵。 左侧破裂孔、左侧卵圆孔受侵。 双侧海绵窦、眼眶、余颅内未见明显异常。 左侧咽后见小淋巴结，大者短径5mm，与鼻咽病灶分界欠清，明显强化。 颈部双侧II区、双侧III区见多个小淋巴结，大者短径6mm，明显强化。 右侧上颌窦、左侧乳突黏膜增厚。 喉咽、甲状腺、双侧颌下腺及腮腺未见明确病变。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 左侧咽后小淋巴结，可疑转移。 颈部双侧II区、双侧III区小淋巴结，性质待定。 少许副鼻窦炎。左侧乳突炎。；检查部位: 鼻咽部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 不确定；是否区域复发: 否 ；报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁、左侧壁粘膜增厚放射性浓聚，SUV约22.0，病灶侵犯颅底骨（斜坡、蝶骨基底部，左侧翼突基底部可疑受侵）、左侧腭帆肌群，与左侧头长肌分界欠清。左侧咽隐窝变浅，右侧咽隐窝存在，双侧咽旁间隙未见异常。双侧海绵窦、双侧翼腭窝、双侧破裂孔结构及放射性分布未见明显异常。左侧咽后小淋巴结放射性分布未见明显异常，大小约0.6×0.6cm。右侧咽后未见肿大淋巴结及异常放射性分布。左颈II区淋巴结放射性分布略浓密，SUV约1.6，大小约0.6×1.2cm。双颈Ib区、右颈II区淋巴结放射性分布较浓密，SUV约3.3，大小约0.7×1.3cm。其余双颈小淋巴结放射性分布未见明显异常。 双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。口咽及喉咽结构及放射性分布未见明显异常。左侧乳突少许低密度影放射性分布未见明显异常。额窦、蝶窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见明显异常。 双肺多发薄壁透亮肺纹理稀疏区；双上肺胸膜下数个肺大泡。气管、支气管通畅。心脏及大血管未见明显异常。食管未见明显占位影及异常放射性分布。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门数个稍高密度小淋巴结放射性分布略浓密。双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏S8小囊肿。其余肝脏形态、结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。胰腺、脾脏、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔未见肿大淋巴结及异常放射性分布。腹膜后小淋巴结放射性分布未见明显异常。 前列腺钙化灶。膀胱、肠管等形态、结构及放射性分布未见明显异常。双侧髂血管旁及双侧腹股沟小淋巴结放射性分布未见明显异常。 右上臂皮下小斑片影放射性分布略浓密。T5椎体放射性分布较浓密，SUV约3.5，未见骨质破坏。所见颅盖骨、各躯干骨及四肢骨结构及放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，侵犯颅底骨，余侵犯/累及范围如上所述；左侧咽后小淋巴结代谢未见明显异常，建议随诊。 双颈II区淋巴结代谢较活跃/略活跃，疑炎症，建议随诊；双颈Ib区小淋巴结考虑炎症。 左侧乳突少许炎症。 双肺肺气肿、肺大泡；纵隔及双肺门炎性淋巴结。 肝脏S8小囊肿。 前列腺钙化灶。 T5椎体代谢较活跃，疑生理性放射性分布不均匀，建议随诊。 右上臂皮下小斑片影代谢略活跃，考虑炎性病变。；检查部位: 全身；肿瘤部位: 鼻咽\n治疗前颈部超声结论：双侧腮腺内多发淋巴结，考虑良性淋巴结声像。 双侧颈部II区淋巴结，考虑良性淋巴结声像。\n综合MRI、PET/CT及超声，左侧咽后淋巴结按转移考虑，其余颈部小淋巴结暂不按转移考虑。\n\n【当前需要决策的问题】\n病理已完成。\n报告日期: 既往时点；检查名称: 鼻咽部磁共振平扫＋增强（3.0T及以上）(套)；检查所见: 鼻咽腔狭窄，鼻咽左侧顶壁、左侧顶后壁、左侧壁增厚，明显强化。左侧咽隐窝受侵，右侧咽隐窝存在。口咽、双侧后鼻孔未见明显异常。 左侧咽旁间隙受侵。左侧腭帆提肌、左侧腭帆张肌、左侧翼内肌、左侧头长肌受侵。 左侧翼突基底部、左侧翼突内板、蝶骨基底部受侵。 左侧破裂孔、左侧卵圆孔受侵。 双侧海绵窦、眼眶、余颅内未见明显异常。 左侧咽后见小淋巴结，大者短径5mm，与鼻咽病灶分界欠清，明显强化。 颈部双侧II区、双侧III区见多个小淋巴结，大者短径6mm，明显强化。 右侧上颌窦、左侧乳突黏膜增厚。 喉咽、甲状腺、双侧颌下腺及腮腺未见明确病变。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 左侧咽后小淋巴结，可疑转移。 颈部双侧II区、双侧III区小淋巴结，性质待定。 少许副鼻窦炎。左侧乳突炎。；检查部位: 鼻咽部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 不确定；是否区域复发: 否 ；报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁、左侧壁粘膜增厚放射性浓聚，SUV约22.0，病灶侵犯颅底骨（斜坡、蝶骨基底部，左侧翼突基底部可疑受侵）、左侧腭帆肌群，与左侧头长肌分界欠清。左侧咽隐窝变浅，右侧咽隐窝存在，双侧咽旁间隙未见异常。双侧海绵窦、双侧翼腭窝、双侧破裂孔结构及放射性分布未见明显异常。左侧咽后小淋巴结放射性分布未见明显异常，大小约0.6×0.6cm。右侧咽后未见肿大淋巴结及异常放射性分布。左颈II区淋巴结放射性分布略浓密，SUV约1.6，大小约0.6×1.2cm。双颈Ib区、右颈II区淋巴结放射性分布较浓密，SUV约3.3，大小约0.7×1.3cm。其余双颈小淋巴结放射性分布未见明显异常。 双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。口咽及喉咽结构及放射性分布未见明显异常。左侧乳突少许低密度影放射性分布未见明显异常。额窦、蝶窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见明显异常。 双肺多发薄壁透亮肺纹理稀疏区；双上肺胸膜下数个肺大泡。气管、支气管通畅。心脏及大血管未见明显异常。食管未见明显占位影及异常放射性分布。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门数个稍高密度小淋巴结放射性分布略浓密。双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏S8小囊肿。其余肝脏形态、结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。胰腺、脾脏、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔未见肿大淋巴结及异常放射性分布。腹膜后小淋巴结放射性分布未见明显异常。 前列腺钙化灶。膀胱、肠管等形态、结构及放射性分布未见明显异常。双侧髂血管旁及双侧腹股沟小淋巴结放射性分布未见明显异常。 右上臂皮下小斑片影放射性分布略浓密。T5椎体放射性分布较浓密，SUV约3.5，未见骨质破坏。所见颅盖骨、各躯干骨及四肢骨结构及放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，侵犯颅底骨，余侵犯/累及范围如上所述；左侧咽后小淋巴结代谢未见明显异常，建议随诊。 双颈II区淋巴结代谢较活跃/略活跃，疑炎症，建议随诊；双颈Ib区小淋巴结考虑炎症。 左侧乳突少许炎症。 双肺肺气肿、肺大泡；纵隔及双肺门炎性淋巴结。 肝脏S8小囊肿。 前列腺钙化灶。 T5椎体代谢较活跃，疑生理性放射性分布不均匀，建议随诊。 右上臂皮下小斑片影代谢略活跃，考虑炎性病变。；检查部位: 全身；肿瘤部位: 鼻咽\n治疗前颈部超声结论：双侧腮腺内多发淋巴结，考虑良性淋巴结声像。 双侧颈部II区淋巴结，考虑良性淋巴结声像。\n综合MRI、PET/CT及超声，左侧咽后淋巴结按转移考虑，其余颈部小淋巴结暂不按转移考虑。\n请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T3 / N1 / cM0\nB. T1 / N1 / cM0\nC. T1 / N2 / cM1\nD. T4 / N0 / cM0\nE. T4 / N1 / cM1\nF. T4 / N0 / cM1\nG. T1 / N0 / cM0\nH. T3 / N1 / cM1\nI. T2 / N1 / cM0\nJ. T3 / N0 / cM0\nK. T4 / N2 / cM1\nL. T4 / N1 / cM0\n\n请仅输出一个选项字母（A-L）。","gold_letter":"A","gold_action":"T3 / N1 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T3 / N1 / cM0","B":"T1 / N1 / cM0","C":"T1 / N2 / cM1","D":"T4 / N0 / cM0","E":"T4 / N1 / cM1","F":"T4 / N0 / cM1","G":"T1 / N0 / cM0","H":"T3 / N1 / cM1","I":"T2 / N1 / cM0","J":"T3 / N0 / cM0","K":"T4 / N2 / cM1","L":"T4 / N1 / cM0"}}
+{"sample_id":"sample-497d71c43c5649bdaa4f9e7e","patient_id":"patient-45e4c46d921f3565452c0d71","episode_id":"episode-23c5eaba9bba6e6c4c4cd184","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；主诉: 右侧头疼1周；；既往疾病史: 既往“高血压病史”4年，未服药，“血糖偏高”3年，未治疗。否认肝炎、结核病史。是否有过敏史无过敏史。是否有吸烟史无吸烟史。吸烟史详情；体格检查: 鼻咽右顶后壁增厚，双颈部淋巴结阴性，颅神经阴性。 【病理资料1】（鼻咽部肿物）镜下：鼻咽粘膜组织中见少许异型细胞小巢团状分布，细胞核空泡状，核仁明显，形态结合免疫组化结果，病变符合未分化型非角化性癌，因病变细胞太少，建议结合临床情况诊断或重取活检。 原单位免疫组化结果：CK（+），CK5/6（+），p40（+），CD56（个别+），CgA（-）， … 色结果：网状纤维（显示网状纤维巢状分布）。；活检部位: 鼻咽；肿瘤部位: 鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】治疗前MRI报告：检查名称: 颈部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 鼻咽腔稍狭窄，鼻咽右侧顶壁、右侧顶后壁增厚，明显强化。双侧咽隐窝异常。 颅底骨质未见破坏。 双侧海绵窦、眼眶、余颅内未见明显异常。 右侧咽后见1个小淋巴结，大者短径5mm，明显强化。 颈部右侧II区见数个小淋巴结，大者短径5mm，明显强化。 各副鼻窦、双侧乳突未见异常。 双侧腮腺、颌下腺、甲状腺、喉部、所见脑实质未见明显异常。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质未见破坏。 右侧咽后1个小淋巴结，性质待定。 颈部右侧II区见数个小淋巴结，性质待定。；检查部位: 颈部 ；报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行头部至大腿中上段PET/CT断层显像，影像清晰。 鼻咽右顶壁粘膜稍增厚放射性略浓密，SUV约3.0。颅底骨未见明显占位影及异常放射性分布。右侧咽隐窝变浅，左侧咽隐窝存在。双侧咽后未见肿大淋巴结及异常放射性分布。口咽、喉咽未见异常。鼻窦炎。双侧海绵窦放射性分布未见明显异常。双侧乳突结构及放射性分布未见明显异常。甲状腺结构及放射性分布未见明显异常。双颈小淋巴结放射性分布未见异常。 所见脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺纹理未见明显异常。气管、支气管通畅。心脏及大血管未见明显异常。食管未见明显占位影及异常放射性分布。双侧胸壁未见确切病灶和异常放射性分布。纵隔及双肺门未见肿大淋巴结及异常放射性分布。双侧腋窝小淋巴结放射性未见明显异常。 肝多发囊肿；余肝脏结构及放射性分布未见异常；肝门区未见占位及异常放射性分布。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。右肾小囊肿伴点状钙化灶。脾脏、左肾、肾上腺及胰腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺点状钙化灶。膀胱及肠管形态、结构及放射性分布未见明显异常。双髂血管旁及双侧腹股沟未见肿大淋巴结及异常放射性分布。 颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽右顶壁粘膜稍增厚代谢稍活跃，结合病史，符合鼻咽癌，不排除为活检术后改变。 双肺少许纤维增殖灶。 肝囊肿。 右肾小囊肿伴点状钙化灶。 前列腺钙化灶。 鼻窦炎。；检查部位: 全身；肿瘤部位: 鼻咽\n综合治疗前MRI、PET/CT及临床评估，咽后及颈部小淋巴结暂不按转移考虑。\n\n【当前需要决策的问题】\n病理已完成。\n治疗前MRI报告：检查名称: 颈部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 鼻咽腔稍狭窄，鼻咽右侧顶壁、右侧顶后壁增厚，明显强化。双侧咽隐窝异常。 颅底骨质未见破坏。 双侧海绵窦、眼眶、余颅内未见明显异常。 右侧咽后见1个小淋巴结，大者短径5mm，明显强化。 颈部右侧II区见数个小淋巴结，大者短径5mm，明显强化。 各副鼻窦、双侧乳突未见异常。 双侧腮腺、颌下腺、甲状腺、喉部、所见脑实质未见明显异常。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质未见破坏。 右侧咽后1个小淋巴结，性质待定。 颈部右侧II区见数个小淋巴结，性质待定。；检查部位: 颈部 ；报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行头部至大腿中上段PET/CT断层显像，影像清晰。 鼻咽右顶壁粘膜稍增厚放射性略浓密，SUV约3.0。颅底骨未见明显占位影及异常放射性分布。右侧咽隐窝变浅，左侧咽隐窝存在。双侧咽后未见肿大淋巴结及异常放射性分布。口咽、喉咽未见异常。鼻窦炎。双侧海绵窦放射性分布未见明显异常。双侧乳突结构及放射性分布未见明显异常。甲状腺结构及放射性分布未见明显异常。双颈小淋巴结放射性分布未见异常。 所见脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺纹理未见明显异常。气管、支气管通畅。心脏及大血管未见明显异常。食管未见明显占位影及异常放射性分布。双侧胸壁未见确切病灶和异常放射性分布。纵隔及双肺门未见肿大淋巴结及异常放射性分布。双侧腋窝小淋巴结放射性未见明显异常。 肝多发囊肿；余肝脏结构及放射性分布未见异常；肝门区未见占位及异常放射性分布。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。右肾小囊肿伴点状钙化灶。脾脏、左肾、肾上腺及胰腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺点状钙化灶。膀胱及肠管形态、结构及放射性分布未见明显异常。双髂血管旁及双侧腹股沟未见肿大淋巴结及异常放射性分布。 颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽右顶壁粘膜稍增厚代谢稍活跃，结合病史，符合鼻咽癌，不排除为活检术后改变。 双肺少许纤维增殖灶。 肝囊肿。 右肾小囊肿伴点状钙化灶。 前列腺钙化灶。 鼻窦炎。；检查部位: 全身；肿瘤部位: 鼻咽\n综合治疗前MRI、PET/CT及临床评估，咽后及颈部小淋巴结暂不按转移考虑。\n请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T4 / N2 / cM0\nB. T1 / N2 / cM1\nC. T3 / N1 / cM0\nD. T3 / N0 / cM0\nE. T4 / N0 / cM1\nF. T4 / N3 / cM0\nG. T1 / N1 / cM0\nH. T1 / N0 / cM0\nI. T4 / N2 / cM1\nJ. T1 / N2 / cM0\nK. T3 / N0 / cM1\nL. T4 / N1 / cM0\n\n请仅输出一个选项字母（A-L）。","gold_letter":"H","gold_action":"T1 / N0 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T4 / N2 / cM0","B":"T1 / N2 / cM1","C":"T3 / N1 / cM0","D":"T3 / N0 / cM0","E":"T4 / N0 / cM1","F":"T4 / N3 / cM0","G":"T1 / N1 / cM0","H":"T1 / N0 / cM0","I":"T4 / N2 / cM1","J":"T1 / N2 / cM0","K":"T3 / N0 / cM1","L":"T4 / N1 / cM0"}}
+{"sample_id":"sample-91370f05584788580ecb06ee","patient_id":"patient-45e4c46d921f3565452c0d71","episode_id":"episode-23c5eaba9bba6e6c4c4cd184","turn_id":"P5_01","turn_number":5,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM：{{TNM_STATUS}}；总分期：{{OVERALL_STAGE}}。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；主诉: 右侧头疼1周；；既往疾病史: 既往“高血压病史”4年，未服药，“血糖偏高”3年，未治疗。否认肝炎、结核病史。是否有过敏史无过敏史。是否有吸烟史无吸烟史。吸烟史详情；体格检查: 鼻咽右顶后壁增厚，双颈部淋巴结阴性，颅神经阴性。 【病理资料1】（鼻咽部肿物）镜下：鼻咽粘膜组织中见少许异型细胞小巢团状分布，细胞核空泡状，核仁明显，形态结合免疫组化结果，病变符合未分化型非角化性癌，因病变细胞太少，建议结合临床情况诊断或重取活检。 原单位免疫组化结果：CK（+），CK5/6（+），p40（+），CD56（个别+），CgA（-）， … 色结果：网状纤维（显示网状纤维巢状分布）。；活检部位: 鼻咽；肿瘤部位: 鼻咽；组织学分型: 未分化型非角化性癌；组织学分级: 未分化；是否鼻咽癌: 是 【影像与分期资料1】治疗前MRI报告：检查名称: 颈部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 鼻咽腔稍狭窄，鼻咽右侧顶壁、右侧顶后壁增厚，明显强化。双侧咽隐窝异常。 颅底骨质未见破坏。 双侧海绵窦、眼眶、余颅内未见明显异常。 右侧咽后见1个小淋巴结，大者短径5mm，明显强化。 颈部右侧II区见数个小淋巴结，大者短径5mm，明显强化。 各副鼻窦、双侧乳突未见异常。 双侧腮腺、颌下腺、甲状腺、喉部、所见脑实质未见明显异常。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质未见破坏。 右侧咽后1个小淋巴结，性质待定。 颈部右侧II区见数个小淋巴结，性质待定。；检查部位: 颈部 ；报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行头部至大腿中上段PET/CT断层显像，影像清晰。 鼻咽右顶壁粘膜稍增厚放射性略浓密，SUV约3.0。颅底骨未见明显占位影及异常放射性分布。右侧咽隐窝变浅，左侧咽隐窝存在。双侧咽后未见肿大淋巴结及异常放射性分布。口咽、喉咽未见异常。鼻窦炎。双侧海绵窦放射性分布未见明显异常。双侧乳突结构及放射性分布未见明显异常。甲状腺结构及放射性分布未见明显异常。双颈小淋巴结放射性分布未见异常。 所见脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺纹理未见明显异常。气管、支气管通畅。心脏及大血管未见明显异常。食管未见明显占位影及异常放射性分布。双侧胸壁未见确切病灶和异常放射性分布。纵隔及双肺门未见肿大淋巴结及异常放射性分布。双侧腋窝小淋巴结放射性未见明显异常。 肝多发囊肿；余肝脏结构及放射性分布未见异常；肝门区未见占位及异常放射性分布。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。右肾小囊肿伴点状钙化灶。脾脏、左肾、肾上腺及胰腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺点状钙化灶。膀胱及肠管形态、结构及放射性分布未见明显异常。双髂血管旁及双侧腹股沟未见肿大淋巴结及异常放射性分布。 颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽右顶壁粘膜稍增厚代谢稍活跃，结合病史，符合鼻咽癌，不排除为活检术后改变。 双肺少许纤维增殖灶。 肝囊肿。 右肾小囊肿伴点状钙化灶。 前列腺钙化灶。 鼻窦炎。；检查部位: 全身；肿瘤部位: 鼻咽\n综合治疗前MRI、PET/CT及临床评估，咽后及颈部小淋巴结暂不按转移考虑。 【治疗经过1】记录时间: 既往时点；病历特点: 患者A ，男，主因“确诊鼻咽癌10余天”于既往时点步行入院。 一.病例特点: 1、患者53岁 男性。 2、现病史:患者1周前无明显诱因出现头痛，后于外院A就诊，完善鼻咽镜提示鼻咽右侧壁肿物，活检示：鼻咽癌。 后转入本院。 行既往时点 PET/CT全身显像（套）检查结果： 鼻咽右顶壁粘膜稍增厚代谢稍活跃，结合病史，符合鼻咽癌，不排除为活检术后改变。 双肺少许纤维增殖灶。 肝囊肿。 右肾小囊肿伴点状钙化灶。 前列腺钙化灶。 鼻窦炎。 既往时点 检查结果： （鼻咽部肿物）镜下：鼻咽粘膜组织中见少许异型细胞小巢团状分布，细胞核空泡状，核仁明显，形态结合免疫组化结果，病变符合未分化型非角化性癌，因病变细胞太少，建议结合临床情况诊断或重取活检。 原单位免疫组化结果：CK（+），CK5/6（+），p40（+），CD56（个别+），CgA（-），Syn（-），CD3（淋巴细胞+），CD20（大细胞-），CD21（弱+），CD30（个别+），Bcl-2、Bcl-6（淋巴细胞+），CD10（生发中心+），MUM1（浆细胞+），p53（个别+），Ki67（40%+）；原单位原位杂交结果：EBERs（+）；既往时点 颈部磁共振平扫＋增强(1.5T以上)(套)检查结果： 鼻咽病变，考虑鼻咽癌。 颅底骨质未见破坏。 右侧咽后1个小淋巴结，性质待定。 颈部右侧II区见数个小淋巴结，性质待定。 后收入院。 自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重无下降。 3、体格检查: T:36.40℃ P:73次/分 R:20次/分 BP:140/94 mmHg Ht: 166cm Wt: 72.70kg BSA: 1.8076m2 KPS:90 发育正常，营养一般，神志清楚，自主体位，查体合作。 全身皮肤粘膜无苍白、黄染、水肿、出血。 巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。 无鼻翼扇动、鼻衄。 牙龈无肿胀、出血。 气管居中，甲状腺不大。 胸骨无压痛。 双肺呼吸音清，未闻及干湿啰音。 心率73bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。 腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。 肛门外生殖器未见异常，生理反射存在，病理反射未引出。 4. 【治疗反应与不良反应1】既往时点放疗24次，复查血象未见明显异常，口腔粘膜II°，面颈部皮肤反应I°。；既往疾病史: 既往“高血压病史”4年，未服药，“血糖偏高”3年，未治疗。否认肝炎、结核病史。是否有过敏史无过敏史。是否有吸烟史无吸烟史。吸烟史详情；体格检查: 鼻咽右顶后壁增厚，双颈部淋巴结阴性，颅神经阴性。；客观检验：肌酐(Crea)-静脉血：84.6μmol/L（高于参考范围，参考约41-73μmol/L）\n\n【当前需要决策的问题】\n治疗开始后约第30天，本患者出现第1个独立的皮肤毒性里程碑：既往时点放疗24次，复查血象未见明显异常，口腔粘膜II°，面颈部皮肤反应I°。；既往疾病史: 既往“高血压病史”4年，未服药，“血糖偏高”3年，未治疗。否认肝炎、结核病史。是否有过敏史无过敏史。是否有吸烟史无吸烟史。吸烟史详情；体格检查: 鼻咽右顶后壁增厚，双颈部淋巴结阴性，颅神经阴性。；客观检验：肌酐(Crea)-静脉血：84.6μmol/L（高于参考范围，参考约41-73μmol/L）。该事件最符合哪类治疗相关毒性，当前应采取怎样的支持处理、监测及治疗节奏调整？\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 忽略当前异常并按原剂量、原时间继续治疗，不增加复查\nB. 永久停止全部抗肿瘤治疗，不再判断毒性是否可逆\nC. 立即提高化疗剂量，以补偿既往可能损失的剂量强度\nD. 仅复查肿瘤影像，不复查血常规、生化或相关器官功能\nE. 直接改为另一套强化联合方案，不等待毒性恢复\nF. 仅口头安慰并观察，不给予症状处理或近期监测\nG. 把当前异常判断为疾病进展并立即进入后线挽救治疗\nH. 仅依据一次EBV-DNA结果决定停药或换药\nI. 继续原方案并取消止吐、补液或营养等支持治疗\nJ. 评估放射性或药物性皮肤反应分级，局部护理并据严重度调整治疗\nK. 立即扩大放疗范围，将所有不适均按肿瘤侵犯处理\nL. 三个月后再复查当前异常，期间不调整治疗节奏\n\n请仅输出一个选项字母（A-L）。","gold_letter":"J","gold_action":"评估放射性或药物性皮肤反应分级，局部护理并据严重度调整治疗","context_placeholders":["PATHOLOGY_RESULT","MRI_T_STAGE","MRI_INVOLVED_STRUCTURES","N_STAGE","M_STAGE","TNM_STATUS","OVERALL_STAGE"],"options":{"A":"忽略当前异常并按原剂量、原时间继续治疗，不增加复查","B":"永久停止全部抗肿瘤治疗，不再判断毒性是否可逆","C":"立即提高化疗剂量，以补偿既往可能损失的剂量强度","D":"仅复查肿瘤影像，不复查血常规、生化或相关器官功能","E":"直接改为另一套强化联合方案，不等待毒性恢复","F":"仅口头安慰并观察，不给予症状处理或近期监测","G":"把当前异常判断为疾病进展并立即进入后线挽救治疗","H":"仅依据一次EBV-DNA结果决定停药或换药","I":"继续原方案并取消止吐、补液或营养等支持治疗","J":"评估放射性或药物性皮肤反应分级，局部护理并据严重度调整治疗","K":"立即扩大放疗范围，将所有不适均按肿瘤侵犯处理","L":"三个月后再复查当前异常，期间不调整治疗节奏"}}
+{"sample_id":"sample-2c6c4c67364685b893f71ce7","patient_id":"patient-d0d7ee4ee410114ceb96522e","episode_id":"episode-57a4063adfcbd062f71c23f1","turn_id":"P3_01","turn_number":3,"prompt":"你正在参与一名鼻咽癌相关患者的纵向诊疗模拟。\n资料按临床时间逐步提供。请只根据当前节点可见证据作答，不要使用未来记录。\n\n【历史辅助诊断节点】\n- 已释放病理判断：{{PATHOLOGY_RESULT}}。\n- 当前节点需根据已提供的分期证据独立判断TNM。\n\n【截至当前节点可见证据】\n【初诊资料1】记录时间: 既往时点；主诉: 发现双颈肿物4+月；现病史: 4个多月（既往时点）前患者无明显诱因扪双侧上颈结节，约黄豆大小，质较硬，无压痛，伴左侧耳闷，无明显听力下降，无回吸性涕血，无面麻、复视等不适，于外院A就诊，无特殊处理。病程中，患自觉颈部肿物缓慢增大伴左侧头痛，无面麻、复视， … 右侧最大约9×6cm，左侧最大约7×5cm，现患者进一步治疗诊。既往疾病史: 发现高血压数月，没有规则服药。是否有过敏史无过敏史。是否有吸烟史吸烟史详情 【影像与分期资料1】报告日期: 既往时点；检查名称: 鼻咽部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 鼻咽腔狭窄，鼻咽双侧顶壁、双侧顶后壁、双侧后壁、双侧壁增厚，明显强化。左侧咽隐窝受侵，右侧咽隐窝变浅。左侧后鼻道、口咽左侧壁受侵。 左侧咽旁间隙、左侧颈动脉鞘受侵。左侧腭帆提肌、左侧腭帆张肌、左侧翼内肌头端、左侧头长肌受侵。余咽旁肌未见明显异常。 左侧翼突基底部、左侧翼突内板、左侧翼突外板、蝶骨基底部、左侧岩尖受侵，余颅底骨质未见明显异常。蝶窦受侵。 左侧破裂孔、左侧翼腭窝受侵。 双侧咽后见数个肿大淋巴结，大者短径18mm，明显强化，部分可见中央坏死。 颈部双侧II~V区、左侧腮腺区见多个肿大淋巴结，大者短径29mm，明显强化，部分可见中央坏死、融合。 双侧上颌窦、双侧筛窦、双侧蝶窦粘膜增厚。双侧乳突见较多分泌物。 双侧腮腺、颌下腺、甲状腺、喉部未见明显异常。 T2FlAIR见双侧额顶叶数个斑片状高信号灶，边界尚清。T2FLAIR及3D-T1WI矢状位平扫所示余大脑实质、小脑及脑干形态、信号未见明显异常。各脑室及脑池大小、形态未见异常。大脑中线结构未见移位。；检查结论: 鼻咽病变，结合病史，符合鼻咽癌，侵犯范围见上述。 颅底骨质破坏。 双侧咽后数个肿大淋巴结，考虑转移。 颈部双侧II区~V区、左侧腮腺区见多个肿大淋巴结，考虑转移。 副鼻窦炎；双侧乳突炎。 双侧额顶叶数个缺血灶。；检查部位: 鼻咽部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 29.0；是否区域复发: 否 ；报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁、左侧壁及右侧咽隐窝粘膜增厚放射性浓聚，SUV约25.0，病灶侵犯左侧腭帆肌群、左侧翼内肌、左侧头长肌、颅底骨（蝶骨基底部、左侧翼突基底部、斜坡、左侧岩尖）及左侧破裂孔。双侧咽隐窝变浅。口咽、喉咽未见异常。鼻窦炎。双侧海绵窦放射性分布未见明显异常。右乳突炎；左侧乳突结构及放射性分布未见明显异常。甲状腺结构及放射性分布未见明显异常。双侧咽后、左颈Ib、II、III、V区、左腮腺区及腮腺下方、右颈II、III区多个肿大淋巴结/软组织密度结节影放射性浓聚，SUV约19.2，大者约2.8×3.9cm，部分见坏死区放射性稀疏；右颈Ib、V区及双锁上小淋巴结放射性略浓密，SUV约1.7，大者约1.0×1.2cm。 所见脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺数个小钙化灶放射性分布未见明显异常。气管、支气管通畅。心脏及大血管未见明显异常。食管未见明显占位影及异常放射性分布。双侧胸壁未见确切病灶和异常放射性分布。纵隔及双肺门未见肿大淋巴结及异常放射性分布。双侧腋窝小淋巴结放射性略浓密。 肝脏结构及放射性分布未见异常；肝门区未见占位及异常放射性分布。肝内、外胆管未见扩张。胆囊小结石。胃及十二指肠放射性分布未见明显异常。脾脏、双肾、肾上腺及胰腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺钙化灶。膀胱及肠管形态、结构及放射性分布未见明显异常。双髂血管旁及双侧腹股沟未见肿大淋巴结及异常放射性分布。 右股骨颈小片状高密度影放射性略浓密，SUV约2.3，大小约0.9×1.1cm。其余颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，侵犯范围如上述；双侧咽后、左颈Ib、II、III、V区、右颈II、III区多个肿大淋巴结代谢活跃，考虑转移；左腮腺区及腮腺下方淋巴结/结节代谢活跃，转移与腮腺瘤鉴别；右颈V区及双锁上小淋巴结代谢稍活跃，疑转移。 右股骨颈小片状高密度影代谢稍活跃，疑良性病变，建议随诊。 右颈Ib区、双侧腋窝小淋巴结代谢稍活跃，疑炎性病变。 双肺钙化灶。 胆囊结石。 前列腺钙化灶。 鼻窦炎。右乳突炎。；检查部位: 全身；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 39.0\n\n【当前需要决策的问题】\n病理已完成。\n报告日期: 既往时点；检查名称: 鼻咽部磁共振平扫＋增强(1.5T以上)(套)；检查所见: 鼻咽腔狭窄，鼻咽双侧顶壁、双侧顶后壁、双侧后壁、双侧壁增厚，明显强化。左侧咽隐窝受侵，右侧咽隐窝变浅。左侧后鼻道、口咽左侧壁受侵。 左侧咽旁间隙、左侧颈动脉鞘受侵。左侧腭帆提肌、左侧腭帆张肌、左侧翼内肌头端、左侧头长肌受侵。余咽旁肌未见明显异常。 左侧翼突基底部、左侧翼突内板、左侧翼突外板、蝶骨基底部、左侧岩尖受侵，余颅底骨质未见明显异常。蝶窦受侵。 左侧破裂孔、左侧翼腭窝受侵。 双侧咽后见数个肿大淋巴结，大者短径18mm，明显强化，部分可见中央坏死。 颈部双侧II~V区、左侧腮腺区见多个肿大淋巴结，大者短径29mm，明显强化，部分可见中央坏死、融合。 双侧上颌窦、双侧筛窦、双侧蝶窦粘膜增厚。双侧乳突见较多分泌物。 双侧腮腺、颌下腺、甲状腺、喉部未见明显异常。 T2FlAIR见双侧额顶叶数个斑片状高信号灶，边界尚清。T2FLAIR及3D-T1WI矢状位平扫所示余大脑实质、小脑及脑干形态、信号未见明显异常。各脑室及脑池大小、形态未见异常。大脑中线结构未见移位。；检查结论: 鼻咽病变，结合病史，符合鼻咽癌，侵犯范围见上述。 颅底骨质破坏。 双侧咽后数个肿大淋巴结，考虑转移。 颈部双侧II区~V区、左侧腮腺区见多个肿大淋巴结，考虑转移。 副鼻窦炎；双侧乳突炎。 双侧额顶叶数个缺血灶。；检查部位: 鼻咽部；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 29.0；是否区域复发: 否 ；报告日期: 既往时点；检查名称: PET/CT全身显像（套）；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁、左侧壁及右侧咽隐窝粘膜增厚放射性浓聚，SUV约25.0，病灶侵犯左侧腭帆肌群、左侧翼内肌、左侧头长肌、颅底骨（蝶骨基底部、左侧翼突基底部、斜坡、左侧岩尖）及左侧破裂孔。双侧咽隐窝变浅。口咽、喉咽未见异常。鼻窦炎。双侧海绵窦放射性分布未见明显异常。右乳突炎；左侧乳突结构及放射性分布未见明显异常。甲状腺结构及放射性分布未见明显异常。双侧咽后、左颈Ib、II、III、V区、左腮腺区及腮腺下方、右颈II、III区多个肿大淋巴结/软组织密度结节影放射性浓聚，SUV约19.2，大者约2.8×3.9cm，部分见坏死区放射性稀疏；右颈Ib、V区及双锁上小淋巴结放射性略浓密，SUV约1.7，大者约1.0×1.2cm。 所见脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺数个小钙化灶放射性分布未见明显异常。气管、支气管通畅。心脏及大血管未见明显异常。食管未见明显占位影及异常放射性分布。双侧胸壁未见确切病灶和异常放射性分布。纵隔及双肺门未见肿大淋巴结及异常放射性分布。双侧腋窝小淋巴结放射性略浓密。 肝脏结构及放射性分布未见异常；肝门区未见占位及异常放射性分布。肝内、外胆管未见扩张。胆囊小结石。胃及十二指肠放射性分布未见明显异常。脾脏、双肾、肾上腺及胰腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺钙化灶。膀胱及肠管形态、结构及放射性分布未见明显异常。双髂血管旁及双侧腹股沟未见肿大淋巴结及异常放射性分布。 右股骨颈小片状高密度影放射性略浓密，SUV约2.3，大小约0.9×1.1cm。其余颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，侵犯范围如上述；双侧咽后、左颈Ib、II、III、V区、右颈II、III区多个肿大淋巴结代谢活跃，考虑转移；左腮腺区及腮腺下方淋巴结/结节代谢活跃，转移与腮腺瘤鉴别；右颈V区及双锁上小淋巴结代谢稍活跃，疑转移。 右股骨颈小片状高密度影代谢稍活跃，疑良性病变，建议随诊。 右颈Ib区、双侧腋窝小淋巴结代谢稍活跃，疑炎性病变。 双肺钙化灶。 胆囊结石。 前列腺钙化灶。 鼻窦炎。右乳突炎。；检查部位: 全身；肿瘤部位: 鼻咽；是否区域淋巴结转移: 是；区域转移淋巴结最大径(mm): 39.0\n请按AJCC第9版，综合局部侵犯、区域淋巴结及远处证据，选择最一致的T/N/M组合。\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. T1 / N3 / cM1\nB. T2 / N3 / cM1\nC. T2 / N3 / cM0\nD. T3 / N2 / cM0\nE. T1 / N1 / cM0\nF. T1 / N0 / cM1\nG. T4 / N1 / cM0\nH. T3 / N3 / cM0\nI. T1 / N3 / cM0\nJ. T4 / N3 / cM0\nK. T1 / N2 / cM0\nL. T4 / N3 / cM1\n\n请仅输出一个选项字母（A-L）。","gold_letter":"H","gold_action":"T3 / N3 / cM0","context_placeholders":["PATHOLOGY_RESULT"],"options":{"A":"T1 / N3 / cM1","B":"T2 / N3 / cM1","C":"T2 / N3 / cM0","D":"T3 / N2 / cM0","E":"T1 / N1 / cM0","F":"T1 / N0 / cM1","G":"T4 / N1 / cM0","H":"T3 / N3 / cM0","I":"T1 / N3 / cM0","J":"T4 / N3 / cM0","K":"T1 / N2 / cM0","L":"T4 / N3 / cM1"}}
diff --git a/L6/full100_inputs_scored217/data/hardcore93_ids.json b/L6/full100_inputs_scored217/data/hardcore93_ids.json
new file mode 100644
index 0000000000000000000000000000000000000000..7940aaab4af76d2eb1c649cb42d1a3db63a7dc0e
--- /dev/null
+++ b/L6/full100_inputs_scored217/data/hardcore93_ids.json
@@ -0,0 +1,95 @@
+[
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+  "sample-0c720b4ef512446ae78df25a",
+  "sample-9e2e2146ac009f7756158c05",
+  "sample-779f191e37fb11d16470fdc2",
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+  "sample-f14be2b25e6f9aced7128070",
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+  "sample-f2b1ffd0815ecf5ba2cd82d7",
+  "sample-f6ded4003c29b6da778afe85",
+  "sample-83005086edbc8aa147d192f1",
+  "sample-3344d4e3af87c6bb2276e6c7",
+  "sample-eafa2f73acd299285a01561d",
+  "sample-05a255bce72429d9789712a9",
+  "sample-26c75fc3d7b885944cf96bd6",
+  "sample-aa0d497de8449598bffd2417",
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+  "sample-1b0bddc3306d119848b41841",
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+  "sample-aab54b8795fa56ea3aae1b1f",
+  "sample-5aa9d7b50db0b59d009dcc69",
+  "sample-dc7500fdaa8eb806721b7fc7",
+  "sample-e323add0eb082ef5ca6b97b4",
+  "sample-2c6c4c67364685b893f71ce7",
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+  "sample-c2aa48d510cb846f4ee51384",
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+  "sample-ed1b449691d94cea18e7b28b",
+  "sample-2fc2bca32acf3eb67f65396b",
+  "sample-655ad2033595c09c6c4ce571",
+  "sample-49bfe4582a9d9a75f21d4be4",
+  "sample-04c8674f03cec4de991fcf32",
+  "sample-7fddfe1b2a584f133c3b89f7",
+  "sample-49519c2b08d621c382f2a093",
+  "sample-deb84ffb5f7c209f58040b0d",
+  "sample-76e183c8ae4202bcecbc9d87",
+  "sample-9549c3c98f10ace802cbb08b",
+  "sample-5acaafa7f13a3c4be08160aa",
+  "sample-fd63f0707132f4eb9174ab3e",
+  "sample-95b51d663e429afb86c572e7",
+  "sample-ac55ce5273aeb2587f3051e7",
+  "sample-6cb68b4fe11abd5f5e27ea88",
+  "sample-31164fa636b978a86d54f0c9",
+  "sample-6d0ec36f585feac9ee8c0aa5",
+  "sample-4caf9a9989bff46283725cce",
+  "sample-00fdb85efc65b944f8959fc3",
+  "sample-72b57dbdb0633da918062d61",
+  "sample-3ed269e9b5e894b444089bf3",
+  "sample-40b7a6f655350cf46e9ce33c",
+  "sample-58cbc880ddd38089d56cda8c",
+  "sample-cc72c6bbde9abe2a112ce0fc",
+  "sample-38fe8a3260ea673c5c5ddb90",
+  "sample-06aacdbb23f806198bd0b70c",
+  "sample-5ae78b6dca4ce8a61a44d0ca",
+  "sample-057bee25fe3533856610d5c8"
+]
diff --git a/L6/full100_inputs_scored217/data/mri_samples.jsonl b/L6/full100_inputs_scored217/data/mri_samples.jsonl
new file mode 100644
index 0000000000000000000000000000000000000000..83486c9f4c2c2a4446c09b9e17c0dd5b588c6b3e
--- /dev/null
+++ b/L6/full100_inputs_scored217/data/mri_samples.jsonl
@@ -0,0 +1,100 @@
+{"sample_id": "sample-696d19bff6d991b4bc744712", "patient_id": "patient-5fa48522b2703f35ead0224b", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/f74aad52f7c880d6693aa7f28c7c568a68b81d043b6a644ab68b7040eb4c6de0.jpg", "assets/653cedfc9b826e600bbab4d09df1e5c3cd4b2dc3cb39dba9c0867067890ecc03.jpg", "assets/156671243ea7fa909883330ebb191aca8e3caff23ece30b6220c04e2d2b118d2.jpg", "assets/9c8ef004b21233f2da97d2c00c3320093eea300592f08d2bde4eaec89f794df0.jpg", "assets/4eb0fdeb9de7c9609bdccb37ecf83d83ad152b787e1003a37eddfac8a34d3406.jpg", "assets/31f639a022e9ecef7ac2e7561e4970387cdf687be4646924d75c112108e0e129.jpg", "assets/03161fedc30f7c61c1f66868a2c2a925c49bc5728ed0b8024180bbbacf3cb111.jpg", "assets/3fe92181cbd30011cccf46a421dece3ea770131993459a14c28750bf0e6ce37c.jpg", "assets/faffd63b765d633efb6e9ccd6bd7c7b1abf75513f5d0399d456eae3570e6328e.jpg", "assets/ec2e42177e09aa60f10e1874d0057a7e127fc9beed66ee6cd49123012c6d97f3.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 1, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 0, "口咽": 1, "翼突基底部": 0, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "翼内肌", "斜坡", "口咽", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-1207ed9082e2263a1d3782e0", "patient_id": "patient-5ee5dba6116030961a7a97b5", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/164f3f7c842001b08bae3d96ffe3b7b79e2cecbfe98d3d6238679573bc9842bb.jpg", "assets/ae60f499e03c677fc7d38a889c9c865e23650ece5ee78f01e0d9522b2a6bff7a.jpg", "assets/01744ed4df0ea2f908dc9cbacd8b5b79d817b3f0ce491451da3db52e316037b0.jpg", "assets/d55a420adfc518fa5cfdc904c1e6315d23179533faa381a168df4984e5c57071.jpg", "assets/20ed1443f0337b574a4947759510633dc6230e1cf05efe2b12c2feb6cbc8cdf6.jpg", "assets/e4eae3fd6ecae3dbe26ba1ddd55f09e21b75a600b7dab4af36dc7ca91ae204c9.jpg", "assets/476f9175ca20bfcf7abbeb390291f2005fa02cb1e5457062170cf8e95476c6fa.jpg", "assets/be8c6e7fe15239fae1b9032f3420bb07e7b6576878a87bc02f2a14692c017b9f.jpg", "assets/cc94dca7acdd17c17b2212e76c4678a122ff749f8c3603db12bb0b44c6b90249.jpg", "assets/66194724f4a1b0eb146f2596ce1c28f412b7eb73cb12429043b33f5721300772.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "翼突基底部", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-60fd3a65c7b9461b49e2ad79", "patient_id": "patient-867f2373fc1b04e0b8b80452", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/20616619537b796ee5b5ec7c15c2b3577697a37b8d453565345903a5bae3b627.jpg", "assets/a6e7bb6c6783df8b6b719960f47b10d8c57b786cd031743205ac4f136ea89293.jpg", "assets/bbfc8b6a24e0c464d90bbeb2f96ae4d2118967e1e359ee6a4398080d360368ea.jpg", "assets/22c91d767c942fdd758cea5b06ca77869a5fd38a5af76e63d1200810e767fbe5.jpg", "assets/07c4955e121bcd7f8774ca858bdbaccc81b9d11c275bec1595e09605ec0f567e.jpg", "assets/a39be4fe534cb6dc942c8deae89b4057b97a99c1db32f8ecda26f04146c823d4.jpg", "assets/87b251ac1d05e4f708c02f46aca0d84fdaf219438c46e607d92d2cd84fe95864.jpg", "assets/a96da581eb561ce3535a77f225ead45437fe2c8acb17518ad70ff60a4b6af167.jpg", "assets/08023e85914a3a57f5188fd82066b7fe0631523ae38d69326f93990735f62bfa.jpg", "assets/19e71b6abab24c39befc187b61e4cceed899696510f4a47f63d299820ed89a1f.jpg"], "answer": {"T_stage": "T4", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 1, "蝶窦": 1, "鼻腔": 1, "颈动脉鞘": 0, "翼外肌": 1, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 1, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "翼内肌", "蝶窦", "鼻腔", "翼外肌", "斜坡", "海绵窦", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-d181677097153837949be4d8", "patient_id": "patient-9149023ec8599161ec3e5cfd", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/6d04014a7b954c01d5980508f22f29a0170209e2ec3e53b3ef8b28f984426383.jpg", "assets/ccc81d01433e2b019071ef8464a69d8ad7b3b191ce5a0e352a6d9540cb30e029.jpg", "assets/2437a725aaf259345ae8d5e05642c553bbedff6efc1f02a5efd92a1e143c243a.jpg", "assets/296f9591995b04ed071632b0cc24ab9c989f58ab2f84e4af0de30759f2504be3.jpg", "assets/55f9b4efd80610956ed01e46e1deb0f4da2118c77bbf9533b6da41554edbd7bb.jpg", "assets/c2248ca61df301dd9ee38c6a051e4f8e61f6156d4d1b8bce93f1f614abe62e21.jpg", "assets/56f547b9240932ce1c93c8ca3f4d303a1f9c0f0ddc45962ca9afce9cc358906f.jpg", "assets/8e8c943a5eed7ac04c6c23977c15f7a8655352a55df42acefcd5d80ded7e798b.jpg", "assets/cbbf314a19e94f2ff74124b6b1e5c8c7b3501071739087775055c1e802871fa9.jpg", "assets/5c0b89f58f1dd9c2ff8e48867445ed47fa529da83765159cf9b4c5dab4e64d79.jpg"], "answer": {"T_stage": "T4", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 0, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 1, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "头长肌", "斜坡", "海绵窦", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-2e9a500ab730a8b812a30781", "patient_id": "patient-4e3ac84b9e1451cea981f98e", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/2b7b5c9f2fdbf60c39044c6fed93d5d84e55a3e20f792e66c1fa556e373a1040.jpg", "assets/6436ea318464da871651a25a0809fe419070839a3b689cbe0ef96fcaffad967c.jpg", "assets/659ef0a013eb2fbeca8e8518d0baea208dd0ba801889f9687a4f343147d78f8b.jpg", "assets/241c89b1d3115271704173c49bdd0470922ed8a6fd8a83eb33254c9e9e87fb89.jpg", "assets/ec22ecf38da03c8239cb5c54c90d0817c9a5f813fa859e0f534a2cd65ecef7ec.jpg", "assets/2db5a902c0aec8b5904dcabd87b47444e3397790bf23febe6bd7c3754654d4df.jpg", "assets/05bc772aab23b5b85e69946437ea3c17289d9f947568f00bba3094bb1a704364.jpg", "assets/890ed4dc0afadc32cd020f95451bc2a82ce23e2d0c20883eeb8f6fca8d60d69e.jpg", "assets/995eff980d45f20066a942a659eb6e9b1bee341871ba80a3b819da4f6fe109fe.jpg", "assets/b43c57705e8574c8d9f3f75708711ba4726e6fe00f300990f099711413bee93d.jpg"], "answer": {"T_stage": "T2", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 0, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 0, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "头长肌"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-ec87b3b629d494caa3b0c2f1", "patient_id": "patient-e45c55cc63c050892e6b2467", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/f9960bae334cdceb3eb93f3d8252ecfcd18afe7cb11a71dbe39e97a2ed358352.jpg", "assets/fbaf3c23d2b6a6eeb541f7dcb4055f58c861094bbdb54a54367c839276b353d4.jpg", "assets/2e4103e10e43bf317323d4b567a0795839da3d0f41cc34b16423612982e97188.jpg", "assets/a87f8194bd40c5d6d0ee9cedc7c13eb9072aeea7af26dcbb4f741c02c4c6e361.jpg", "assets/664d2867df97e0c4503ca4d0a78aeb8e514b45a792ad6c968a785c5abb1747be.jpg", "assets/598219df480a3e53c649a5fa9f087114ec4e0994335a9368d03fd7185a1f3da8.jpg", "assets/c6b6f28cc3a7989b241eb2ab566921d7b9e048eebe4ab120492bf0a8eda21079.jpg", "assets/b9169abe479ad98c9aca6cc132edab45ff9fdc2d73c5952d9c718009da2118e2.jpg", "assets/b93bcf634112dc938e9aa9d1ba076a3dc99911e2e6f50b3dbb18800dcbd8bfeb.jpg", "assets/b42628e6de1aee61c640333f5876f91eb10f239255a5d9fed67f46f303ce7ef6.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 1, "蝶窦": 1, "鼻腔": 0, "颈动脉鞘": 1, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 1, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "翼内肌", "蝶窦", "颈动脉鞘", "斜坡", "翼突基底部", "蝶骨基底部", "岩尖", "寰椎"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-69daf2c670fd11615e125384", "patient_id": "patient-a48d1d72efa6c4217cf5b79c", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/8b47be8c61a58da83628e3562a391abfa0ddb181f6cd4d4320aea39028c90654.jpg", "assets/2c31594924a13e7169573a23522df348757bcb57f989cfa2c45dbf76ee309110.jpg", "assets/cdd5e77a6b2b64e78957d5f66411b1a18b9f387db17fd385870074d1e0d6af98.jpg", "assets/8b999dd5d961821db0a5cd4cccca6dab1e561f37f8367006d4fcfe75ed2e57c5.jpg", "assets/ce29a9ee1cff9740a73d4ca0a153f6c4434f6f6a9e08a9887b7df08f117e78dd.jpg", "assets/a248d3aa8bf92698685b24b600bc7eb68d4bf8390e0670b0742a549d4c3ee13a.jpg", "assets/f8e8fbc7409ac6cd751eddc58e938f150f1e730f3dd8fecbd41d84ebe691ed71.jpg", "assets/014a7169d0c026167af61fc8d7ce16db70d1d1aa98be44af7351fdfd847cac85.jpg", "assets/e4e2b27b3ff4650ca833dca88a61570dea0e5128e485dee52b6e853d2bab4b11.jpg", "assets/9483dfc90a95ed0dd7b6c8ae40a3faf46bd321379184377b5a702e7a7ec77e12.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 1, "上颌窦": 0, "斜坡": 1, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "筛窦", "斜坡", "翼突基底部", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-4e7313af07e4b05947cdb8b4", "patient_id": "patient-e90c2443e271b2e927262653", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/2982920e907972b3d0b09ee3a704c6bc0a7c6436e503e1d05d479e1ca7711e6a.jpg", "assets/943b715c4b976a4b2b04a3e63245c73445560944502a934d10c82a4885645e7e.jpg", "assets/c18ef8d010419f57185674a60bc5d58c554ca73ec04af1849ba4316bc9d52422.jpg", "assets/31fb48125ab9af5cde20f0f089a7aadced53c87b282196813b323e532a14fc99.jpg", "assets/fde929825c6d7dd1fd399e3386b8824a28709e9927e60b865875a3a53373decb.jpg", "assets/458e414a66ca8a356f0a7a87e5b77aafcedfe72f792588256d9a9fe7dbc41c5b.jpg", "assets/4426b2403495c0919942ed0f29240e999d016458a99c34a998145698fc560097.jpg", "assets/d4428f427ebccd59ab89778226771cac989f46e03064d690f2041995c71cc463.jpg", "assets/08ed05d1ea329ab1c50bd27307c3bea4dafff802e1f7d5bb852d51b2d034b61e.jpg", "assets/f53b0ef7208fa1e17ddede451c5121e7e6970922b403da170ae32ac88a5e8983.jpg"], "answer": {"T_stage": "T4", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 0, "蝶窦": 1, "鼻腔": 0, "颈动脉鞘": 1, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 1, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "蝶窦", "颈动脉鞘", "斜坡", "海绵窦", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-a3d53ddfb29c79a21cedc3e9", "patient_id": "patient-7c0941dbdd4694260fd4de38", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/931f2174e6ca64ac79c2a0fc0144cd13abf3548840d1ea95952ff64865522557.jpg", "assets/0910a70d0fb942ab23f5d0ee8c4a5b31325f85312fa44e0058aeae7e53d1c407.jpg", "assets/3be0880a106fdc3eede19dd87f389e4d9a6312e440138eb10693ee0692c2d1ad.jpg", "assets/2552b3c58797d82a7476c2e94fb6094d967150c510041984a9fc7122f3efea32.jpg", "assets/38955c3191af348f64be6cbf2c0657bc0ca3ca3e0e5192e127521d6b044b3bb5.jpg", "assets/5b6218515b688ea959d0eaf063c73218ca99c54403eb788aad43a23d197cf339.jpg", "assets/24bc4766aacbfbfa0f8c780f07309d54f39849cd2b868708341cade82e3ebc20.jpg", "assets/e0c7db93ad86a91c9cec402ffbb5e6f0a699a850b78aaac2fef2aa9fd4112f83.jpg", "assets/506d72043ac0a4a5dbf312bd927644a7263a187a5825c896cf0d0701d9d7f81c.jpg", "assets/5dc5f040baec78775c0e3241d2b6bfb59f403bb3d8eff82675c218a51e419af6.jpg"], "answer": {"T_stage": "T2", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 1, "翼突基底部": 0, "蝶骨基底部": 0, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "口咽"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-c8f353e4bb6411158a854549", "patient_id": "patient-36d433557e63f939b878347d", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/55451eca025e5d9eb23c35363f229c2dee1e05d506e4501a9adf5aad57fa725a.jpg", "assets/412f51042f52fbc504f5118295f77c0b793426d51322a15c89bb6ea829d61722.jpg", "assets/72a209ae8d5d8595f0506ea4522fdd028444dcc07e0d7bb4c94d0104ca038de3.jpg", "assets/0a6c33db3cfdd65dcb83e3727c55760c6218bf342862bf5558e9d22b46ba3d2a.jpg", "assets/aec426628a9f91c415de4fced8da8de923900eaf753eaed43cceab5edfd100e5.jpg", "assets/da957fd6fe57014f397e0b0e7fbc0d3eaf133f4d6129a8416e49cd0abcc47ced.jpg", "assets/fef5f6d114b8fafc4707b1b5033d179b4b046fe4012d02af09d56f8918728d85.jpg", "assets/221b4cf259af4e880f58a938d3dd150fc41c8548d3c4470bc64860ae65de0b0b.jpg", "assets/d89f437727cc22522b11f051c351c539277a9260153f13296256dcddc2ac7396.jpg", "assets/34ec0a135c5b26cad43281720175f6f4105fe93068de89325fbe249e36f2ab4a.jpg"], "answer": {"T_stage": "T4", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 0, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 1, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 0, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "海绵窦", "翼突基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-ff52fcd72975621572f86d0a", "patient_id": "patient-79fa00752e4405e2980f6292", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/a2c85240f07c1a1d7ee8a01d87dfda44c4270154f71225099746ba6da2cb46f0.jpg", "assets/f285efd666cd3b7b118b4bbe28e56776abb51af814557bdc8e51d235ae3aea7a.jpg", "assets/e9c499df7d4ecd6d3b1c8780c4837f5b6976e168c02e06eaa5a40ae6bacc101c.jpg", "assets/a1e7dc2da8a8a5426b60f7863e1151ab1b7edeb9ef9083922efec17537460f75.jpg", "assets/3ffa6aeea91a4147bfe002f000e2c33026daa9f00505b3e91c7e4e8dbf00e929.jpg", "assets/afc06c6962e03b132b4254774ded3858f69b57efa7cc1cdab8c84b0e1bdbead8.jpg", "assets/20f13bfe738d1d7bef17415209095509a8e5a2f5bc27632183643b181b1c0527.jpg", "assets/5f29989419b5ebf7cbd94834571f1d781aeb23cd001f18fecf70d1de0d8785f5.jpg", "assets/6055eb946f9f9ef3cac1995c1dd6dd70b018e20b806572f01c1346b4601c4928.jpg", "assets/fc1fdc5d1228c2fdd0d9264fd3d759b79f3d89cd2a54da62d527613da50026c3.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 0, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-6936a30a34ceed215a43ffaf", "patient_id": "patient-e7eec542502a097814d58d8a", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/d22640b76c9e20b7d7f3787d4e8e804f95bef5e8db5736456a7458c54f300563.jpg", "assets/d1e766f0067e16b03e8abdef6addd6ab53fe1d30034526b89d773885c8b979aa.jpg", "assets/5bce19b9cdbbd93668261a6aec825fffd2b1a5a0dd58e147d5c26e063b53a3c5.jpg", "assets/f126c421018fd107c0cf6b1e87a2ccd1e3361af7ef6fd48cd586a2307f515e1f.jpg", "assets/2971e6ed997b08d51c0c4f24c1cd5a13e625217d3c171d55c6cc903e983fa03f.jpg", "assets/c5e646b4c2d702060446cce24360bd7d53b254f550ce908e21d687c492567f85.jpg", "assets/109a4473ca486f6cc4df06b2d5f12df7ac299c82b77a26d700122a51b8fae473.jpg", "assets/dfcf9593f5c1b9833b242e3c97dddf5ea1180ff9a77b417c2ac524c57eff4e14.jpg", "assets/6f7d1657f7d9a86df53a378f216f95a0fe45bbfc5083ba67f85bcc361345c747.jpg", "assets/8b4faa8d45be9e86a538a0a60ade4609622f3e7066ada518bd99a312dab2d4e3.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 0, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "翼突基底部", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-bf2ce212a9088377084a5aad", "patient_id": "patient-4912d2bc95150726fba7d603", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/5422f6ac38239cc1392d762becd3a3a6d1978abcc404ac26142f5584da077dd6.jpg", "assets/02d6d258208664bf2ad7224fb8d771bdaf65637cde9c2341379d48532890767e.jpg", "assets/1a5884f87e41712abdb99d2c63baa15fde3576edf1600db484c2069019c1fcb7.jpg", "assets/15f39eef3adb9fc477bf8f9433e15083cac743ffffecfc6ee9f9bb8a50acc98f.jpg", "assets/eea782568a1e60f1ecfbd2c029188900e47af800c730edddaea8247b07724550.jpg", "assets/963ac186efa2b8994a802e822afda280f72a34c49f2e92f337c2dc9c0570fc6a.jpg", "assets/c530352b76f2f63059b3bec2a3f61e7b4a9a61b304b90d737f995690d636d066.jpg", "assets/20dffecd3b0626592a9c86d43fca509c80f9e782ae819572f42d4e6a67e5127e.jpg", "assets/c9bf7603cd38583584b86f71a6689011cb6b398a4f4ea39f6ad8f1e10c24cd4f.jpg", "assets/5b980ebcc4c557fb27e6f7b6e2e916be01125bb9ec470ad716e79b30defd642c.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 0, "咽旁间隙": 0, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-6d82c1a95d7e735b5b682f87", "patient_id": "patient-658c901d241197123d75230c", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/bea9b06e69b9afb619aee57b7bb28e49c620b96fef59a4e1b5ddb5fa3718ed40.jpg", "assets/5ccdda8d98b00403e6f5a800951c28903981ddbdbe1c6d29037da5889f5ff20c.jpg", "assets/76cda12eb082ae15f1d5bb250e46d58d35cd024450b669a4163a874c4d09eaf9.jpg", "assets/2c7b5b44c93d9c4280f7bbc9741cc9cca3c083cb95cc233097b9e3f19f1abc02.jpg", "assets/5567263c1b423b5c0575e2f4c9809f9425f1b27bd54858641bacf902b2df65b5.jpg", "assets/b15f60152de1495c1acd3d2af9cb0d55abc7086f0c994c17b9af49178a99e542.jpg", "assets/6e8f21c8356c4e658f3fe7c72c1e30bd6ebb59c7dbef93d36316203a246c0a26.jpg", "assets/1275a3b06bbaeb90c99585d26ac2059a3574072a0ce770eeb957daf0103ddc36.jpg", "assets/fce1d8914eb7757ee6f797eac992ca3d974264b7c6f846bcadc7978c105887e1.jpg", "assets/9715366246e6acb5723b9785c7958dd1964af2cdcf9d34949899db0f7c3d2d13.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-60768a3b6b3b6d861cf4aec3", "patient_id": "patient-817588890ea7d1df0cf353ab", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/8248be14c977a4a1400b7f64a6ff3b652c629c03fb8fbda4ef38938e6b5fed5e.jpg", "assets/de8253a2538b0c0be3eca41b5ded0466279728417b1363013c235265a9275f02.jpg", "assets/b05575da5bda4866d86c2d16102adfa9cf14cecf703818cd20517229944ff264.jpg", "assets/a1ce9342c868a273f3c720939263e406afcff59f1f4cb0fe42f3ec4ca855fd06.jpg", "assets/cf6e26946c777b9a0e78e70d0a24a3d8adcc9fe2c1c04e8bab68976defeff098.jpg", "assets/751b519efaa3f3a6dbc9f2600f8b4cc70c647eb9b9e73f78caa990ffe97a2441.jpg", "assets/75a1d2e992d10fe89dd15c9ff46731aa381560779927ec86495d61af8c8781f4.jpg", "assets/19f0033a3aee44c0fd31dd5697543d6d2bebbf334691d24cd8af1901c8b69d9d.jpg", "assets/155e9bec31259f6efd9e6c841f732f136d8134daf9fde498b25ff68808154730.jpg", "assets/2b76828b8515487ddddf4475ee0f211c1e12a66d1193ec163e8b5a2a3cbb2fb1.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "翼突基底部", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-bae59bd979ddbf3acf974725", "patient_id": "patient-eefab65cf080ff1d932d6946", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/8b7380dc2125ea1d60a4e60fb4e97a8bd3df72390263300d048dd684346cf934.jpg", "assets/692dc7fb2154298a6cc1a46d4979c53dc3fe7f8667d8bcb0dfdeb80db1096755.jpg", "assets/a0afcc76f35256f2fa6618610246d59e608109e5827c121726ae6e16d89652a3.jpg", "assets/14e08b156e636b213a576febf5bd7541bbaaa5558892cdb361c34a7452772160.jpg", "assets/a5befc86072376dbe967672715ac5d71fe5efe855a82f941e6da10187504595a.jpg", "assets/f4cdf1d04a6ac08f6d5bd8f10b344aa9a7c19fbe98b83bb4afea63f7d3bea6e5.jpg", "assets/4e5026092097c677786988253ae7fd24c8e6d6e752f0814f3de411be73329555.jpg", "assets/dad26cfa4698c8b2aa3ce74b9edac40e8032ac2c5df7df61ab832e3a88e5f5df.jpg", "assets/1483f6ca50fa297aea4a22a95b6199ef7bf7061754ab87def4e24f67276e9621.jpg", "assets/99b0b1de1625650f727f52fab2780b8889f75a7cd4302deddd6f559548bd9cf5.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "斜坡", "翼突基底部", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-329ccf16e682fc0694b2fadc", "patient_id": "patient-f229dd9bf4b869b8294dd81a", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/b006929f58b9b5b60897bd92e20554b86de81f14234e1718bb2a19692ef7dce3.jpg", "assets/1a986109f16297075e7ad3da3d85a53c42a7d0eeaf8806feeb6eb9d0e2254835.jpg", "assets/f95d5c3a829fc53bfc7aed048785568c2f03652ba7aab75ef399cd739db950ee.jpg", "assets/148a19a05b3e68b7c442ac8b46a3a562fe65772f68e57b4b816054cabea78fe7.jpg", "assets/743c1dd90043638babe97729c134af90d71836f7f95c39ddb924c7b9cc99784d.jpg", "assets/27f093396c33e5dae9134aab13a84a4f80b30ea7e7d87d2f472f6c7d27ad3871.jpg", "assets/7c001e896eab09b34f1a3a3fe7c5ebc731d3ab0a5a41db1a90aeb50f4eba1b7e.jpg", "assets/50cbda6fe38c78a818ef079c651a95321c2ebac2641f3ecdba9445f7ae74f571.jpg", "assets/2592a7909ac24ef3c90547f18de2cd23d62fc82007c45bb670e7d47510537bdc.jpg", "assets/92241844ef456126a6abffe5361c52d1219737185f72fbd0b27f7b2ab8f379f1.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 1, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "鼻腔", "斜坡", "翼突基底部", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-9e78fd52f56647fbf59437b7", "patient_id": "patient-2904f892de88d1d694b3a4f3", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/a5958399db98bc15a90f9d13a82402e34fa37f168c1045fa84e6e77d920b2dff.jpg", "assets/0bc6fae94f86267fb83e02607059abd968880c59d74730187d37c8cc3ac77089.jpg", "assets/90013b8f0617c0b991e4ebf763a4327935af72c7628b25718a0696fa3d4cf1a6.jpg", "assets/72f8e5c3f21d8b77e4a0e8a43a999be062f9e1f84bd5190be9642bb833c3195c.jpg", "assets/f5290df91dbe24a22b4866d47e691efe0f775fdceb01629cc2aa6c73f94e00ea.jpg", "assets/0e44989538f68c1a168f8a92aceb5b0650e5d971d5cea058a4e68df2c5bdd4d5.jpg", "assets/6b3b0f0e3e256a1ec8ec7bb25d21af167b1704b760c02f9289bee249ddb6e203.jpg", "assets/400c7120f18f330f4413b0edd54b33a266a75b4868e3d4025e9cd96023f42a89.jpg", "assets/919093032f4a431e153bb3d2f0d4b2de4317c3950a6beb7cb210fed814ff501d.jpg", "assets/04ac66e877b72a2323d4780363d8deb009dff2b535ade0b54595f751485e6e68.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "斜坡", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-42d3f7b229983d8d1b8f26b3", "patient_id": "patient-9eee365a9ef54e00d4f99666", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/3f7a4fe64a40eba10705d5d8f5f84221ed1c7312def26f2948bd38d64b6eea52.jpg", "assets/372c83dfd31814fd7763afd07cdab48029241070ed6fb326f19eb9a083e3726a.jpg", "assets/a6922030333e8af49d31d1e1f24f179b6f31900b9e25f2a82134517777ac43e5.jpg", "assets/efa54cd12af26fe74fd4b2a96941577896ad44c464688386403c221273467def.jpg", "assets/89a13aa28d120d3511c5e1b6cbe0da26bfc56121d063c9dcb462cb99998cdf74.jpg", "assets/3b706792a9a04653ffa6eb7902e27e90bde211b47f249f049d1ce0e982d68016.jpg", "assets/709ccb09c359db72c044f98f2f22fce1ba3991c4896c799fc2c613f103d990c2.jpg", "assets/575953bbbe3e9934cdcc9307d6e6b552085d714618071d9ea4a0f6eb33deddfc.jpg", "assets/1fe6a6fcdaed9421234b5713997fc70a3bc07cf2934bc3024db44aba92bee0b6.jpg", "assets/c261a164368d9178fea3d58d8bfe72d3b6db83c8acfb82b636560246a5f35a15.jpg"], "answer": {"T_stage": "T1", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 0, "咽旁间隙": 0, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 0, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-9d78c7f06b9d18847a6c6042", "patient_id": "patient-2636abbed83572883f5aa8f0", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/0bfd6eb46dcac92c6f9b4f208f65365fe2b3b96f957272711e89ef0d8864fe7a.jpg", "assets/41b8eae28d4bbe9fa3405ef10276f757028834faca3253792ea5801e6e971b84.jpg", "assets/827532133b050036db68ce150c4e8fa91be0a0e2c16536f81739ed8f2e399405.jpg", "assets/10c3672067774eccaa0aac2657d2337e63bfd3f976ec0ab94dd38c3b6e333eaf.jpg", "assets/986f470f7a09e2e99b7322312a0b85de676a9e2e5aa8f2212bfc9532f2ea7f04.jpg", "assets/a6a3d27db4f55cf8d85f8dcac54429289760fdcdb07a454e8f9ce4e2754df4dd.jpg", "assets/44c1bc936745821d2917047b70a947a3a98f6831033ecac149cea48dae357275.jpg", "assets/19839c5aaeab9f8f50d587664a2df20b599906232cea1afcb0aba106de89b8bc.jpg", "assets/575f5952aaf79b38100898eff05e48d72ec89d39b069842c2f130f91ab4b2d63.jpg", "assets/ce5f521652924a7e80c4054b0c3dab6b9b52761f6d9f39cf6ec15343f1006464.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "斜坡", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-ab3b575732e80d8aef4ab9f6", "patient_id": "patient-a1f42fd798b22a2ae5c5a7bc", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/615105f751667ec87a9d921b2ee9254c2faa81644cf41e6646d117fe4475e776.jpg", "assets/4f1f66ee0419fd3191215005aaeb42e3667ae5207f46d262ed76fe946a29f9f9.jpg", "assets/fe1e3081b7f26003fefee0f3acc5fddd2e2c33850e4e5825228854c0823f35d7.jpg", "assets/7045ad26b6c59934e00691fcbe2cca5acec0b4ff57215394d803d582cae423ef.jpg", "assets/727ca332bb34ed19bea724a2fbd8dafcd203e8942e88be80d9242fc7aaaaa452.jpg", "assets/0875f635a6e4b1765adba5f2a50d7b4674513127940484c96d8202d9dd502c00.jpg", "assets/4b2de92ca914ebf10331878c86dbb126621ab7f78ae402173fbc666a73342262.jpg", "assets/4f6e028081ef31f344b2e36a69f79b6735cc037d699f904cbd3bba93731a43f7.jpg", "assets/563adf18bde55e30aa3d1740988627e0b53a34669fc17044e4eac4c5189471ee.jpg", "assets/767af46da25c2788f235c7e3f4475f39ec948d2a7889e7c988ab125863a465bd.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 1, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 0, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "鼻腔", "斜坡", "翼突基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-12c1267ec05c2c2e1941c2b8", "patient_id": "patient-722916e6f49e457dd9fb890f", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/a377d84f0000d91bd77968eb15e55b7a39f68cecacf336700eb31b31006a7545.jpg", "assets/99fbe32952d50fe8f4971fba04c2434aa88c74b56ccf05cd4ef6907a1815ca32.jpg", "assets/1cdc959ec630db654aa0222dd134b112218930f69255acf1654281895fb667df.jpg", "assets/df32c5eff4db9ae7ebc7032122e20f0a74eba522a386ff7d6f9ba9f8895fa4fc.jpg", "assets/e4a15c5b460a311df7e89c49ac65cc5be1523dad55f636d18f6a8ead1441e5f4.jpg", "assets/c0a17235f9fb8fab3d4eab4438dcd01863d4511c737f430273ab53c5472e7406.jpg", "assets/b08def03bf0c92561f5ae65ce9301b391cd1332d28f39816df777975bb0f981a.jpg", "assets/266de664963c3b4fa6568011b65eb03713fb9d802b6f910c9d518e38b78f735b.jpg", "assets/518335b5f06e17ec4638beaadd12d2e46622124f4227f263bd35892653590af9.jpg", "assets/5f2a8d22e6cb1f4a9f88b4ef8f2a5904633741f4203aff00dbaa52bf4a41c32d.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 1, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 0, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "翼内肌", "翼突基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-66571f9c2a886a2916965d62", "patient_id": "patient-28f7f3a688fe8d84fcbc1ce9", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/d1e7c7ec8975b0306e78710ea354a3917427b7b0bb29f20c55a7fb5c73e709fc.jpg", "assets/e6d492b0f2d4ffd59b5fb4ad2b8e4a5ca32701420a43e853fb47fb6fe96b7518.jpg", "assets/ebf525e05ab432cb280414346cdd2bc3890b96e6830525ce36d32f1d1dc44112.jpg", "assets/1f67278e85f62343b51bebf04e87db001b84c4fb4a3f4ec174fad8a15c55d06a.jpg", "assets/da02f95a2cd8abc63530962c121ff53f226e1dd4293f743332da01a2695b795a.jpg", "assets/3478a086c9e6c44afa41d334d5b2200b642f57cd7bc47c7af12a9c04e0e1d64f.jpg", "assets/ac42cc854a28cfb417c90183b15bfd4b2cc1fa9881de55678f3e083f542146f8.jpg", "assets/80cff6e8b77a057e0845bd0953661b1a26209baf02642fac3dea541a81af2186.jpg", "assets/2c5f3389e180c78e47dfdfaf7597c999ad13cec69ff7c52e058699fe4ddb8752.jpg", "assets/c4e51aca1193559aa7df2d9a2358d9166bb8ac24d6f76bf69a4ca834fce887c9.jpg"], "answer": {"T_stage": "T2", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 0, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-95eeb5e1223bd086a1fd0199", "patient_id": "patient-09adf80599b6978210d6c9c8", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/c0bf4d77d1b6610a727f341447d195ce7127ac920c7fa3eea83a22fde3b80049.jpg", "assets/ffd8cfa9d1e3680d6ef8f54e9a9393182caae7a56c0eec72b8243bd8303b6049.jpg", "assets/a08fc8bf479af50a0465d71e58a4e5297d46d173dcd917b9844b43202654a315.jpg", "assets/ede6b0ee92c06c6fb675e4d657761fadebcc17962c2d058a962bd026b338b917.jpg", "assets/395d9fc1e8f4635e0d01c25519d52cf48f809f780af1deb06992cd6582a906a4.jpg", "assets/56f740999b74db1804bb636ed813052d31b9d10488d3b7fd1970224867b1b0d8.jpg", "assets/8d55ac347470218c4e25774a89eafe852be54152fb2a35999bda684585fb1821.jpg", "assets/bf67b41ab75f16b675452852611c02bff4c3bafa7347159b9127d043187d7760.jpg", "assets/d571fd15898e25d45c6c4dc48740b74c8a6cb8f978176df0b568737a362da3fc.jpg", "assets/775d460b6468e632d77da27395486f8e7dae965b676bd5413f0a35452f85ae85.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 1, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 0, "口咽": 1, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "颈动脉鞘", "斜坡", "口咽", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-a4400216bd2efe27e647860f", "patient_id": "patient-11503878835da201ca5804cc", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/e5e0c54481f0dd89a68f535011b138ac3c467521d6c6ae62850824f9a5bc135e.jpg", "assets/f54145ab5d52f21bc1d072b3089c5dd36510a88bfa5bc29ad70a25023c37d63f.jpg", "assets/08b606297e56e3b4bbe66fe3263c6415965016b8a517d3f75bc97030375c41d9.jpg", "assets/0d6f253406a5f0fbcd08c1b68e963470fae119e6e4c1df4c57c888c14aa7d0e1.jpg", "assets/9ab348715bf3000ad1f29e42bf8031a2cb8413c9c90759d26c7c186a972b52a6.jpg", "assets/aea3762de274a74767daf47ad22c3fe86bf874baaf3da705b21aa30ad7ac7245.jpg", "assets/fe97474a556adc542b209cda8cf70a80f13379b8df1c97b8d40ef1f7325668cc.jpg", "assets/00421f6daeddb4fc7350f55664c673aaf87f9efd7311af41d9eba2bccc6b2557.jpg", "assets/0c51131c14f311d8db12090e1f1f1fd31319ddde32f805234aaaf1f4610e0e7d.jpg", "assets/c74959613c48fd191a2dd24d3979df6710982d4ac5fa89d6a2046659ee315936.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 1, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "鼻腔", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-fc337d4b1970e2f158281e11", "patient_id": "patient-fe3907002c96678650d6585c", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/74ce58ad9f644a99e8a12111cad9ec3975a5cc9fbfcdff715312b0cbac61497d.jpg", "assets/90cc2e4cc30b4d0081cdc764e21a4873e87c6ba4772b48db64e8049ef86d7697.jpg", "assets/f6e990b296cf9ab4ad9205fea1d3a220025e8aa27d3de23ba222b08e012d1a15.jpg", "assets/35e1c5c54c5509e025f52bfac444871fb116c9cd6bc650dc356d4447356742be.jpg", "assets/314600116c91d1339479678fe2fe65ce57887159c1e2e2652233958af8107ba1.jpg", "assets/8a49cce3b60e3ec1c06b8694d62becd466d8666f26758bac46b17bb273d430f8.jpg", "assets/d7323c503090d670d50c59fa3a6c2d0bd72bedf1200f700960dfbb3b586b54bc.jpg", "assets/3a053523f2f8ad22cabbcb2a95bb41eb35b704afaeabc355c3a04925615b6d1d.jpg", "assets/358d66c6bc358bd5b45703df8ba2f3d712a91e1dc6b724a74bd74e1962836613.jpg", "assets/916463cd5ff891b62a4b178732f16af1f714a6d4916d30e8bca399311d11f863.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "翼突基底部", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-6ce30c8ff1fa167a057151f1", "patient_id": "patient-14905446c8bcef1504c57491", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/495525ea28294393d1ed55d4cbff2056f7070307ea4e3cabea8b32ad959fd1f7.jpg", "assets/c5f122449e74637bd633a7d5ccb0bd61e45b75e7303f481edc7035ec095d9b17.jpg", "assets/401adec7425c6147d7225dfb4e4c1af61fe21cf2883e058212a3b8113cf57cd5.jpg", "assets/b71f57f9c9850c8fd913f60fe54b05abcee31de08e83b3167d01a49abfffa19f.jpg", "assets/31a64931656d992538b492520ec6b82131f48543f65a76b9d14e0cdc80c86548.jpg", "assets/310ddd70db2232ce662249aadfa12e74ceb1a400422180664997abf3ee21951a.jpg", "assets/9caa913f941daed6863171690001ea69d37985c0f6ebf2fa1c2279ddfe6b4711.jpg", "assets/a9ff8bffbc683d0d71c82ae5902e13d8e3c9003714dfe6291f7238e45f279754.jpg", "assets/732c0499f37f1c88d1954a070a1a15332e747bc7d07bebd6e4a866b32f3c8d88.jpg", "assets/71053c72d991908894b560c0b9b4786b2600fa5feef68f96e3a7b43d2acbdabb.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 0, "蝶窦": 1, "鼻腔": 1, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "蝶窦", "鼻腔", "斜坡", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-bc35f6a40967decc094b6116", "patient_id": "patient-37545afdde23568d4e27a6d4", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/207db438d6cd1f785e68f2c3a58c71a36dd4e459d34aea8ec66589c32d3564c3.jpg", "assets/c0ff5cb52d386bffd6f1ed8a3280f576138e0a999c73d734ab7b13b37981997c.jpg", "assets/57d4fc7e31ad11de7b4c88c1487b50fad2bca977439bb0981aee7bbab1f91e42.jpg", "assets/89f4e438fd56e9d421f0ad5373de40c82bffdecc7feaa7c6817d651918381baf.jpg", "assets/44a6bef155ac69077cea12bd0550823a1753a4786e7dcdfcbd1957e6ce3cedfb.jpg", "assets/e9d330ba6465749f89421d3bdddf4add53e83e6d116e08bd067b0000865a2627.jpg", "assets/3523a197cb55481f0665dcfe28349edc8564b79fe64454619946fd10de68185a.jpg", "assets/511662489c1160679c342c10cfcd33f3f2e1c57e4294cc6022655390e9444793.jpg", "assets/c2465e08137884ae3457b7c9b2e534c3fb18ada244f0560128c7447bdd494700.jpg", "assets/49c4b539e66d3ca14ab11d1f0795ae844201b3e17478b9e50175e917a84cfdb5.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "翼突基底部", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-648573dc187092af06f70a5e", "patient_id": "patient-08132992947b1cf09e7de6ed", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/e7590ba4f01c39f3280bbb8dee86c123cb94e2f02fd92c3e914f4cb80d75efcf.jpg", "assets/05671a44fefd215ec8645b795959c89525b26c86b3018b3c90d8be8cfad8207d.jpg", "assets/0162f3035277a7a174b404bfe3c2225d0da1ea972a4f9cc162a30ef4898da2b8.jpg", "assets/3bb728b380168e3ebc6708321f8a4a9b898e9dc3c276f5786fd0fc894413d645.jpg", "assets/38af55947edd00ef9bafe01a830347c5ac6d17750c67925671db374b55bbbb85.jpg", "assets/b3bfd0097e0179be2cbf9d2ab7d23261b42b3ec9689e16cc6bbb0026430ca510.jpg", "assets/98136cbd61fe37e3dafdde4e5683573ca7e4af0738004cb1f5eef7f4e2523465.jpg", "assets/b63c5a99f3c493f6b9a50b636f48100cf0a7c45802f7cfb80678ecba1cf34dc0.jpg", "assets/799628670344f6589b2c02c7275365c58c13e73ed2a9e5e00e13d828f824c739.jpg", "assets/e240c2ce2d86e639f3dbbce86183dd167f06435508b72e050b1af521cbd58e77.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 1, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 1, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "翼内肌", "颈动脉鞘", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-b154372f8a76cfae8c0c3000", "patient_id": "patient-e03e0bb9f04b511dce152fc5", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/f1094929aa66f5bca88d1b26e0fc740fe8edf7a678e531439a0904ee83111025.jpg", "assets/76475c8157e50ce226c9cd7ce5df6d56424fb0cf7fc3883b62c93459d514c34a.jpg", "assets/f028287e40832efdc51e5e2fede9c36e8d48dc8f68ff858d3609d0cf083496ce.jpg", "assets/f0a081fffd73e0a453dad8df04586253305cf69c209678e333970889ef698525.jpg", "assets/4cb0f07b0fe8b732f84fcbcb36f099386d3d52d78dcb3a748b087d2f27d14bde.jpg", "assets/b06e7cc64a9432e4ab9210ddf1a6723000ff04a322b8fc38865e93b1d86b42e5.jpg", "assets/37f37080ab36f8561141e472d729cce2f8b988733c9296002a5061461e4ce108.jpg", "assets/afaf04c3c1370d84966e50a8b9eb7e30075c39f1dc1e96c4875d4d0639f9e30e.jpg", "assets/ab75b1fdc5da285f4ad548e03d4a479adf2b2884cfa321bb99fa695f8ac43093.jpg", "assets/4fe75b6fc435cab3d0cde6159ad0857f3cc09592a4373cd6e50e8e54250775fe.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 0, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 1, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "鼻腔", "翼突基底部", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-bc9dcabd5ab7726fb3c83d63", "patient_id": "patient-5f7d232ab1dbb3e235a22839", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/65d5ec7db2f6aca8b7f614fcdfeb011aa6588b5bbc1e9b4e0c2d227ad151d99f.jpg", "assets/eb76e6f6b535f9263fc086c448bb77a2646b830c92aca7601c971fed334e3afb.jpg", "assets/fc6300c5428373084945adeb1c320648c3ad79ace2f579d91e69dd18eba2eab6.jpg", "assets/fedbd0e7af6854ebfe61fb5b0e00c7a9da40d4622573976c05db104bf691edfc.jpg", "assets/02e7485b9ebefbee9508232af4917310c78218639b32276216d4a6634e302e3e.jpg", "assets/9fe53552e9974631b4719b822df8e79b258fab6a64d91ada04744425feaf5c27.jpg", "assets/c9adb5686b78841a424a3c702883daa3f849836dcc9521d31599afd8fdf6ccd1.jpg", "assets/d27b6e2c3bd1a74d1668c92ead685cd9fcabcfeedf868e816aea7b541c9fc8a6.jpg", "assets/c6e8baad10209e57391ae573414b226cadbbe5871aa73c7a4e1f6c46e033ad6a.jpg", "assets/d9a6ac7fe225b803f339a41ee7f0034ce001a9c9d09796214577d53c7843f9b0.jpg"], "answer": {"T_stage": "T4", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 1, "蝶窦": 0, "鼻腔": 1, "颈动脉鞘": 1, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 1, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 0, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "翼内肌", "鼻腔", "颈动脉鞘", "海绵窦", "翼突基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-610ff0ce550ac525781689c2", "patient_id": "patient-8fc9073eeef1f579602c53c2", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/b28e3cd62ae9c85799144e2c5e475d18b94ee363b7d7b1852009e111a40f77c6.jpg", "assets/3a0676e596c3b0d60e4ef258b9444f05238dbdab1c130334c4ad6df6694b8193.jpg", "assets/0ea5259dbcf0cfe2c1943209184f7bbbe6135127564a053d81522194149435e6.jpg", "assets/1d7f1d4f3bce64c696c02a597c33f662a697222fe6cbb4da70890d6763def709.jpg", "assets/74a85e431550556b869084f63ee6b9d483f61b966ae87471c7173f6dbc6d6446.jpg", "assets/d93f971fd94688ce2feb56c2e3af30fb6d79a0d06b55c513fbbb2b5bf84d9452.jpg", "assets/81f1db501a4d7511c8acaa1d20cac46eed04110f54b1abf47c8f8604bb36d19a.jpg", "assets/1e9c29d75fdd4d1f7f09f46b5b1adbc9383d9d565011f6e1982a71ed3811887e.jpg", "assets/ce4c3c87c17508135bcad350d4837c4ed832992a7eeefb5656822e38c722dd12.jpg", "assets/2addfe5a2dca1e7f17e9c8e995fed82ac0aead0a09c43ae6cb1a9f446e940b25.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 0, "头长肌": 1, "翼内肌": 0, "蝶窦": 1, "鼻腔": 1, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "头长肌", "蝶窦", "鼻腔", "斜坡", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-d2ce7e932e0f462d098cd5b1", "patient_id": "patient-a8747d2f636013b6aaea5e0e", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/a98fce92ea00018ccb38357cbb128be145857164eed3e1081df905c6711084fb.jpg", "assets/09f13e45a2bcff607747cc68a6d1c763acf57763a88fd4db62ae5b35a09069dc.jpg", "assets/731648be3c0a32f3ff8d77fbc9777aaf74bc61ddb8e1b3b2e146da3cd7a39ae1.jpg", "assets/7dca60fd94b0bf784e0c29aad9e32d819203c3fa128f0f8e475f9fcad811a2f6.jpg", "assets/12b7c8b7755f5c18584a66e67d216e203f71ea848132c5fff29b377bb4d2369f.jpg", "assets/f2512d839cd36eff53034b1a94d690d793e96c9926c0c6c32ff84d254fc8620c.jpg", "assets/463860d01ec86c0ff9ad5c4bed014fc4dfc6fb7d63b131dbcec3bf0c056d493b.jpg", "assets/851ea6cc2d9f17e44b0cc6ed8cf1cadab05a3750e69ef321c13467323a36b9eb.jpg", "assets/998970ac46e705b7d4f9a2bd9664afd5a865f2f016ad9393f555a72c97d7f7ea.jpg", "assets/99b8813faa8bc4700362a7f278efac66242898ab94b4eefcb9ff3db934bb6ca3.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 1, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "翼内肌", "斜坡", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-051805e1ed2dad752bb5f780", "patient_id": "patient-8f9d5f890b71f169b48cfb7a", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/93987cfa291acdd3c9832752693c6839901a3e0d559266e3ea9917ed83869c9d.jpg", "assets/d1f985c3f33cb17e9b82477424c13f417317deb5c1fda343ab8320a1876d6e00.jpg", "assets/52723e10709f4e22d75f7eeca9c32fe6b1750cb80a2511c653b48c999787a127.jpg", "assets/d69f210df0dbf67f4629b035a00ab03f89be6277c5881078d34c19c94bf4c12f.jpg", "assets/6caea1b5e99b09fefde332a93db7ff26d17409190a6005ccbe2feb2f303f56b0.jpg", "assets/be5d7207997508996fd47788143d6860a8c98af5d3e00c2df1391db9192048a2.jpg", "assets/3ff485323114e0a8e00a8e76d4bb8a78cdc816ffd2c8382e8a7c117bb1459eca.jpg", "assets/1f8d2f9e06d04ff6a83a728f4123ff67cdeade7dc951c66cbb2957e8a78138e5.jpg", "assets/0754c7fe829246eaae2fb6ec4c62b4a0fc71b8914ee5bee6bed1232acd442338.jpg", "assets/fc755d2139a001594342313d34cfdc12ab4f9bc0510e05bc442f8d00888f3304.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 0, "蝶窦": 1, "鼻腔": 1, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "蝶窦", "鼻腔", "斜坡", "翼突基底部", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-d5883b4a5d5f7fb1d90b2f1c", "patient_id": "patient-26124904f2562282e2449ddc", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/31b684bd9c31f81b716a4eab95cf160bb6caca8aa6ee2fc2ae8fd378f9edf954.jpg", "assets/54c3ad8d166ada1c7f0ad3a4eae7fd3cb2b6053dbce2b6044e9f18f06661d7d0.jpg", "assets/60176d0fd89a79db75408a733da9d912522b69fcc96b7f530a537b3b68f97555.jpg", "assets/2de43503dfd0a24b7dde21dd9d722c9639188f654e12ee0b3289baab636c528f.jpg", "assets/f2bd174961877c99e8f2882955f3c0062cb7ededde6860761e959267affb06b2.jpg", "assets/671b39848835d16c185662e0c67be6d097d12319980afb9bad18c5be81619dba.jpg", "assets/2c6ff48c6c62e845d02e2b2bf288924a74044324550472215c08e0af83b995c7.jpg", "assets/9f01ecb3b14e992c3a380c7dda7fa693b77f5a55ffce704efd4e336de1f720b9.jpg", "assets/1d5ac166db2e0721349beea48d1db5fc0786a0834ff0af5a6a7730a60a8cd0a6.jpg", "assets/00b4ed935fc32dcd9096ffa209883b1b24b6a3a7af2faf5906b44f58db262796.jpg"], "answer": {"T_stage": "T1", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 0, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 0, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-8726f9123d46d7dcce0a997e", "patient_id": "patient-a6aa1737ddf626a453650fc7", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/332bcd74dcf0adc2061ae90bcf702d50cf503e9f4669cbf14560d82191a9cebf.jpg", "assets/2b018c7deb7ed73941c4189db6f4cc04382425c2b2dd1e8226e6f61157608a39.jpg", "assets/a02236c533fc79f0a38677dc361cf7b78a0c5b60baf0f387d1fc8698aed795c1.jpg", "assets/f825683e859810603da81206eba71345eb5d4c1d58851c30a447b560c5933f8e.jpg", "assets/1c324628505adaa9706e37860f523a1e163b426a0f53ef7f70d0b14620789263.jpg", "assets/e40c2ea3817594260ec5fda3c98f6803d925a3ec24f024bfc42fd375c1b946ba.jpg", "assets/3421b8657aa73086e8f4c91a0b2a6668feb2d3471770664b0e1305151f2384ad.jpg", "assets/b51ce70d06729fbc7c757724f1299e3fc70d5d75df4356e55b0897d3b1827ca7.jpg", "assets/b177dc0dc8a3f9fcbe7b76b2b1c3bdb9e31cdf30ad1c0c5b6bd824ed6fd82df7.jpg", "assets/67daf76d2f7caa28f3a869ff9c46123d93651ffb66840ea91177b88ecd235183.jpg"], "answer": {"T_stage": "T4", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 1, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 1, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "翼内肌", "斜坡", "海绵窦", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-d9da0492d89e27ad54874707", "patient_id": "patient-e84ab9973716353b1e20d968", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/b185b0f60c592d0578ae5d8d16c46a1c0a0d525494cb0f086da7602289a9f99a.jpg", "assets/db1d6e22a3348f073945acf4e01e44212d61dcac2ef3101c9f3966967b9f803c.jpg", "assets/9d0c7c27e60392004d53991f0ac206bfa28ca9924ad6f777d1a329e2e2341269.jpg", "assets/258f8488e4373f50854f79e08e744b69e564e7ef7bed450223c3e6bff9bc949a.jpg", "assets/5964ddded220062f02c284ab6d1f34e79dc50590dfd500d3d484915855c1b9fb.jpg", "assets/b648c676f00337ca61acee4aa1444d2ab34d6cc5e47c96d2b30de23e0c434c05.jpg", "assets/f49dc5ac5b1f33064fe205650f02ca3c4812b2a1f3ed6305a2f52e885a13cd3b.jpg", "assets/ac349eea30cecb8acec919169a943df2d3c7c06abbf8e9e352bcc017031f4c5e.jpg", "assets/57c6ba8cfd32250c8960347b4445015966cf85d821c4f60f303971277b7413f1.jpg", "assets/04284297233e4e89d7206b004250a65973ac5942b427846bd1dc299d3ece621d.jpg"], "answer": {"T_stage": "T4", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 1, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 1, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "颈动脉鞘", "斜坡", "海绵窦", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-1c27ad47144e22f4bd4e8c51", "patient_id": "patient-f509f093a998dace3479c00a", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/a5e7969751d253062f5590c32d11f7f89de8d81481475b9502bf6d8697e00c4a.jpg", "assets/e91cadb77c210dc9eb61e038ef682f3e5ba016e0427838667b2cfe50561edfdd.jpg", "assets/251163e89f8cc93ff8a0137123710ddf1a379ac99ed90d780b5e397085ff8550.jpg", "assets/d26251226136da0c0fcb6d6c713c9d685143f3faa425d7876997c4dcf54d0f33.jpg", "assets/5abefb19851bdd501c8bf67d8e7eab5ef2baef84276cf534126b641b47a94e04.jpg", "assets/3dca21a64eef49730fb3947bd6998f74a66118f0575c684439360d3df1d2e1a0.jpg", "assets/74b760903e72d2842c3c245e5175e7f8bd4e9d114678918c06b9bc94c709fe32.jpg", "assets/e0ca9b39d793eaed34c7435c57a67c866f245ca77ed88813263d21b13d4d9ce6.jpg", "assets/fa7f66e990537c23c1f68f2908d0d41e7b87a58858883187eb2a38e16fabee14.jpg", "assets/0dc6a1af2402f01204056b232fc6486b2d1491c46a796d245eddc376913513ed.jpg"], "answer": {"T_stage": "T4", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 1, "蝶窦": 0, "鼻腔": 1, "颈动脉鞘": 1, "翼外肌": 1, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 1, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "翼内肌", "鼻腔", "颈动脉鞘", "翼外肌", "斜坡", "海绵窦", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-3af98f4c6c1957eee2f4e977", "patient_id": "patient-48b354132fb0421b229210e0", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/96788bb10d181a7a071d432e23c5b65ed4404c81be8462a8b2fe9db24c8f9351.jpg", "assets/ea01bf32a9afba59b47866d9b99c72b69da7d957861f0d983d7b74a0de7ffb00.jpg", "assets/447432a13fb9d257cd19f592a648b35bf961107c4636a82a05af3a17bd5400a9.jpg", "assets/46abf3adc0af64b0c22c3fa56b35e4c519f656a69bce2a9a68ec756197f24ffa.jpg", "assets/c3e7dfd5b9b314359afc336f9b086c21bb202b5befdc8580720cc16659925707.jpg", "assets/05943eacc6e3f46ab6a3991a4d043c5ac4646e19af125abcf9f794ae3d2571c0.jpg", "assets/6a41b57386c2cb35c868b6fe94b7f330031bcfdaab197327058c26ec8a01b146.jpg", "assets/29d216d65df2011cd96a496d8aeae3d0e4bace98efd4756c812c56e7c83f9eab.jpg", "assets/4f9fdf916be867747149b6b132aceab76feec7e1bc2018a73d173abec025da1c.jpg", "assets/c14d49e85b2b46bfc1af2210e283ce28587b7536d3164906c307012248a60cfe.jpg"], "answer": {"T_stage": "T4", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 1, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 1, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "翼内肌", "斜坡", "海绵窦", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-a837b0a76ac7658c3922164d", "patient_id": "patient-641b087096be76a631a78061", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/e079e18314844f7a848c43246c4fea003be58f290942d307eeacff89afa090c8.jpg", "assets/ac46054f2c95ee6daddcd386b575e98a472bb5ca917a6701f7021744cb7670d0.jpg", "assets/19288f5db6bafa5a46badae2c202d542825eba398703481f2f73ad9d38962084.jpg", "assets/392f0f0d98e64668b6d0e6dc9ff01391b98b09f97f9c04b49cebacf3561c3b4a.jpg", "assets/55aa0733fed415bb57dfe92e76079014fd657590a52fc4dce61c55afa9e9fdb6.jpg", "assets/e54fefd0e28590ed4d6a33ce831520b52a8720afca8907dce2f336ee56874cd2.jpg", "assets/8eb579ac05fd9f7c38531db0c2d9ea5af6a92ddef08dcbb04fbd159c3578ef2d.jpg", "assets/f387c47125614bc64cc810a09111ade1ca4d66930fb705cc11854fe8fe02d2f3.jpg", "assets/4628100b8daae28893e3f03cd52122fb15307a475f2b5099a1bed440ca80c2e0.jpg", "assets/3779656b84594d02ca13bbc03f7ebafdb3230266b1b06c1781bebaf08a670496.jpg"], "answer": {"T_stage": "T1", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 0, "咽旁间隙": 0, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 0, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-8e93d0e278cd4e21cca56728", "patient_id": "patient-30c44ba207e66a3175f648ed", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/766621a97be76942fb546d18554031a96f08fa32d0d975219683e452eebdb505.jpg", "assets/1f957f4bd507c226506770594f962ea619c84d3531e0fd569033fec04b9113ce.jpg", "assets/9e725ad3b311c341cc652a8fe11203de8b7b987e448e5c440f54371e2d311d2f.jpg", "assets/7184bbd42f963d8426ce4c4e37556bd1f28766c5302681263800cfb64e412073.jpg", "assets/c8a61988edfdc592c351a6f6be807ef32b58b7273a253116e79fa18b25fb4b4f.jpg", "assets/dbae873c4afb76851c3a8f8a45942dca701eb7a629791818056b0c5db7cb61c0.jpg", "assets/4aaa21b077b37de77797a100b35fe22db3d048b43f8c8248284d0a98dc27ae37.jpg", "assets/f6006f2951e26088d5813e9c3b9d58cd92956a20b45139a3e671705ba2468c2d.jpg", "assets/b8143875ee9d903573498ce932ccd1f0badc4c289532ce11524e9aa0749a6e9f.jpg", "assets/203b04c3b76ce114de6b82daee3b6b9f03f3ef1469f5cf8aa8dcf5eea15ebe43.jpg"], "answer": {"T_stage": "T2", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 0, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-41c691d472544b2e773d4be9", "patient_id": "patient-d35b8662b9cf177265f9f63d", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/abc8fc729f0620a96d6efee1a0d6df345fda2de5930ffe346560c3f8d5b3a52e.jpg", "assets/8637dc1e6bbd61d8c0deeb95f7b2d85996b7798e76632b609cf95fc6a72e6caf.jpg", "assets/70a088e71d77ce93b80cec7b5c4511729134cd9da149103d855d8bac0c6276f6.jpg", "assets/82a90fd339de1413f52b67071055b810db340f3fa3c06e9ffa3e94759678d603.jpg", "assets/ae157c7347a48abef44b57cef617e275645fcf29c78f7d003cb9e05aa52b6991.jpg", "assets/1dfa15fa0eaee5069a315a7beeb6a58e955b27df4b60b27b3094c4abd7daf091.jpg", "assets/1906c6b19b47fbff17b50b82f87add79f1d540fa8b1635a445116c151ded8266.jpg", "assets/c1d297d5858cec142ee55aaa2441902b15f7998c1644fa9e9b5af7842db0f7e0.jpg", "assets/b394d6f8a881678e31d346e7b40aab7a460d7af567bcedfa54367775125897c8.jpg", "assets/5b0415d4854975ca918073636511031bfc05fc3df3c4d30375686de24a7dd97e.jpg"], "answer": {"T_stage": "T4", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 0, "翼内肌": 1, "蝶窦": 1, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 1, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 1, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "翼内肌", "蝶窦", "翼外肌", "斜坡", "海绵窦", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-507325988f182761f38e73c5", "patient_id": "patient-8b32cb25120a42a552884380", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/6db3fe7c907d80dbe7720ecbcf7f80e28f45afaf3482d8e92884fae975d80df9.jpg", "assets/4c3036201332d0371895a96bfb1ebb4b219404d33897b588c318fa0841f84077.jpg", "assets/c186518fb57e362a9b89ebb20bbf67900b4cb368691e6aa6141554cb5f4052ae.jpg", "assets/d0f3f3256b29552c3cd2f6a2537e22b7b47e3c5f2a81c9435aa519215c74bceb.jpg", "assets/8e06885a7188ffe9daf51ed2002f7fcc3907dcf17c05b03543da31925e63d731.jpg", "assets/f06b645ea509420e36365921548d27480ff76d5223620f2907e3225e53777981.jpg", "assets/c33646758dd0adb67fb5829de45f22c3d5974f7b54a3ded83632b3333c9e1918.jpg", "assets/fc6ba5ed7e6b655a87d73633bd911acf1236d10a530ca3e6672c8cb49714f26d.jpg", "assets/ee73af99e8e6d76371fd5017caca3a4fe9d6c988ce8ce26768f4cd72346300de.jpg", "assets/1ce9e8a95a8a5270ed942ae3bc1f5638d4899191f9c0a63249119e0181692c91.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 1, "颈动脉鞘": 1, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "鼻腔", "颈动脉鞘", "斜坡", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-d45a38b94d9bec9b6901506b", "patient_id": "patient-5990e6fe34e7e300b080c17a", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/f2dfaa6eefd6a9ceda7d2f247ac1535d5370fc1edd70b9a7f055602f7a0fbb69.jpg", "assets/302698229311fa128527555244dd9c556ac7d92e4c8c949c71049e76a1aaab30.jpg", "assets/2e892631ea4f29280b7013bd5fa8a4687de905f7326ae571a38159b5b5146c04.jpg", "assets/8fd937899a031743f3cfa3f8a281a9ed3d9747b0fb80416dd932fd8811b37120.jpg", "assets/e6009487615d06de1352a4b34dfe48c505ffcecf923023919f9c8a4ed85d9d57.jpg", "assets/a12d3ed30f072d82432a9eb9fcd65a874aef9fde01da5afbde8203c303b27b18.jpg", "assets/c1b560daafb5f8c8aea691db6317e569e982aa421e3382b2a0444a63489da414.jpg", "assets/6a79a1c055e2847f25943ad1526dc304530b6949a3c72bb1b159ee24c2249d23.jpg", "assets/c85ad72b75a72071ad59b5d837a896847caba350e0e97e00e61c1a6dc82b20b3.jpg", "assets/38ecf349881f2366bc17c89a1cdb0767a0ba70f6fc0cb444d19eb1fbc9b75972.jpg"], "answer": {"T_stage": "T2", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 0, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-23debcf6d1f4006c0b1d7976", "patient_id": "patient-5c77cf118819bdf31fcf8f42", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/c4528376e08511970742b73ba79c3c23cf2099975796367d4c6c02fa3c2f46eb.jpg", "assets/ce2fcd5ed26122f615f07603138f05e3259a1500d018366b9a0de3cdbdeff40d.jpg", "assets/8bcef54d3dec6eaadf3a1ea5508e3b8232dee8833971ae292a79077b2eec948a.jpg", "assets/8a9c7961992a9667868d5575213959d89756e928288d3119eb97e17f9a8c42ba.jpg", "assets/72895ac86c181e1c8843e4fa67937b4aa54cfeaef158bab30bc1ee04377e7a89.jpg", "assets/70f446eaada735e363dd266a2fedd259fff600e58addab9196be6bc045f992bb.jpg", "assets/57f82f6e38d22f59112140030541641ee13153f1a8811c54635203725e290fd9.jpg", "assets/d5998196886502b25b913828578d83b6b863bab3ef846d94c7062a1d682f9982.jpg", "assets/dcfd9589f14659c58d38fd62b7e9b8cf4d09f1dc823da92e09923f656c9b0d26.jpg", "assets/5076ce5ea6cb74f762793707ac0ed3a478cdd20ebfee3e8f0d29a7a6596f8354.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 1, "蝶窦": 0, "鼻腔": 1, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "翼内肌", "鼻腔", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-2adea75e88323de160c23708", "patient_id": "patient-91e3c16145c17bad01196479", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/a77e1feb1c130e60d2f473d4bdfe1fbf0ffd432d2df309024fd5606105a0538c.jpg", "assets/ed7e91b8b0745f8fbfe84dc1194b9a7ce535db346283198794022494a05830e3.jpg", "assets/ce5880626d2811f58e8455061832e88b877e1a655b74a713ec6d21892282142b.jpg", "assets/131cd8e3b20cd1501eec992a56959e6280ebdd52495c0cbb9222a5103b66bdbb.jpg", "assets/b1e6c377fa441b75afe68f7f6706833d4a3522ca25efa09ccb2ed76a25889ea9.jpg", "assets/43076114ee25be760f0502be7d582e13b22f732c53e0c2a3fc8a6a93937c1632.jpg", "assets/49af777fbbd71d589a3b492e6d365e8c043bff06c3bff5d43d72f73877aba853.jpg", "assets/f8f0748d70b109314e6b0b8ddebe0de18d1af9bd505f1ba591d0a7af02bdafac.jpg", "assets/e82ea724939b70a65d6e110717c3bc2f3c4e73f5361061961af61e6154a9d82d.jpg", "assets/f5aa0fa8a657335afad20a0bb46fc4a9d8621aed27206e6f5b2f7aec21497a27.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 0, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "斜坡", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-ace7412fef28656aaa765b1a", "patient_id": "patient-772412c07d2776f303790dfa", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/57f7650be5899387e3787dcaacca3044a8b8014a0cc15be4b44af693f1039eea.jpg", "assets/051e26ad3dc1aa4d5ad7e04d055493749c5511a71ab58456294afd86d2fdbbac.jpg", "assets/55de8a207d951578b1dae4ba3cf12870e6cb50e140d5fc13b1c8258e41efbe2b.jpg", "assets/033a4541e73a024f8f247660238b98b0c6623cb938b5c2acb0687f6d9b1c064d.jpg", "assets/3d4b7a3387b90803003e39b368753dfd6eecd105c023cc92778c0ec9bfd852a8.jpg", "assets/ffd4427348a8917dffa11d48761c4d9bec0c3c323bd794d6eb2261b3f175374e.jpg", "assets/31a02aaeeb6d01e20f94f2723fe053900c2406e54522746fb32bc120c9204795.jpg", "assets/1f9ba6e07b113845e59395d68fcde9779c13bee331edb0a11cc433b7c9ce53f6.jpg", "assets/859966eeecfa8cb4530a2f38ff58daf557d96915a920cec505d7a8f222aa088c.jpg", "assets/be228d624be8eff4f5fb748701cc474bd581d6b63fb6cb04fad7eab5f4afadcb.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 1, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "鼻腔", "翼突基底部", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-350958be7e80c5aa6926a3bf", "patient_id": "patient-8977b4b1d24f1a473b242981", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/2d4e66a18e11bf50cc4674e18804efac417cdf243749118a3288f6ab07c1ffc6.jpg", "assets/81823cd7ba0a887573fd98afb5916021a3dea3544dd0a9021ab205ad9c26978d.jpg", "assets/98272bfedd5d27dbc34aad250fc1ca0733eeaca5a57a468a09aa6f0c3bf632fa.jpg", "assets/b996904ec12d3da6cfdd6b2eeb9abb6de7e500325b5336a3e5e710389e819a0a.jpg", "assets/c492e25e57c8cda1c2b592ba3f37766905577afd57e1b6db611bac247b3b5456.jpg", "assets/afd00e53aa646e11283929cc26019d56914c2f30f5e47551bcc6f8b75072d2ee.jpg", "assets/a6b0403aca5a057b4b3bbe99f35d8afb23b14065096d54814db0ac315b9ebdf5.jpg", "assets/856ae070235de8113d7ceae5c3a4668f85e2ae0d22228b7d7dbd01f483a6461a.jpg", "assets/cad84585e51084a97d33bcd302b9f68000531af0ec635213f769545812913df9.jpg", "assets/ffa38f7aa829ba61bcfa6c02454a879cf5649e0557918d8df74959cdfc7a6ac3.jpg"], "answer": {"T_stage": "T2", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 0, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-16d89bda37dd37ed8ccc860d", "patient_id": "patient-476cb2a0d6afea80b42088a3", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/027c42acaa6d85131e55bd83f51566ccf016cc3e98796a916594b93989e7ba50.jpg", "assets/a1b259974fefad0e5f71ddb46df69350fa2b64ab87daa66240934b099f87a3f8.jpg", "assets/d284d743bedabbae5b5fcb15f2cb7db7b549b6db505f040f4c90ccd64b9e37e4.jpg", "assets/fbd7adc9df7b0bf654f143e8753a7e36028ec3c44add195c064020f083e6f48e.jpg", "assets/702b5ab6c1497e08b0d928413f398db12533036a3627da06bc712cffe1588f08.jpg", "assets/b1b1be671e40c451738d371b025722408eed5f894a0daccdc4c804bee60ea53e.jpg", "assets/a04e7766f8d75031a002435a1c17df8c094c91e1e20ff566ff7df7774d4e1b11.jpg", "assets/7062c15dbe19f4fa9021ec5c62c85a986ec8b64e3ebafedaca6ee20126476aa6.jpg", "assets/acebd351050ec880b40770c8e0d8dcab26d06052ca288747bb32179640d00667.jpg", "assets/f18ec16d8432fdc0d94832c7346ca3af9a04155efcfa397ff1b28ca8d1ea345d.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 1, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 0, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "鼻腔", "翼突基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-f4abe5c77434b64b05c33be5", "patient_id": "patient-f81cca3c5327e5165d731767", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/1a93dd0f63ef2428bee5aa72159859f4d0fd209e01706f2825a2c0a60d046925.jpg", "assets/8b87ba28905119d36cbd926458bca4e1beef51e770ead374ee045d464adba13b.jpg", "assets/e0bad654cd8818466b82a426c39ad9a8354c529160a53f537bd82ae7dc257daa.jpg", "assets/ed3fa455c8a246111d3904189bfc9e3dc0b6270fd3f9e13a42312faf419b8ab3.jpg", "assets/8c572d17d1507750a25998e6ccce8b2665ef0f4c742dac0e9f9233198244dbde.jpg", "assets/3a352015c3260e0a23320d92caf5dd7e878f6ae875299f861c355ae5c86642c2.jpg", "assets/80521cd69bd5f1122ef669cc5e3ff8c8637c10a4fcc40588c725818a4337ea46.jpg", "assets/a3a277560830caaeb45a50a3f54507247a741c4c19f142197ea0e56023005148.jpg", "assets/605e8c75bfeee24ba5dc5e9d1285f7e33d6575216738cb2cd625d2e9158d85a1.jpg", "assets/821ab0093c5097d44d6d93819b457618a12b563706f7c518dd95d257851accf3.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "翼突基底部", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-8c7b00b765d9c70ed98b27dd", "patient_id": "patient-84fa3d6098d10a1d14b6b19e", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/03527a5bed44e0e813f429fc03246f3478220398cdac19e015cc5ca7c03a5fc5.jpg", "assets/f92758edb46cb68cb5869dd4068f32ba916ea5d24631cb910ffb6b27b3145a75.jpg", "assets/53474d52fb1672365f1a97f1df842f9af0cf7595f62ba0c9fa2dded33ae34b83.jpg", "assets/466def3bdf7a9a6eafcf78bae89e2baed8b2905998bd0a6878ac7a736f572f85.jpg", "assets/9959ff3450ff0e72f9451d0c0589d83244974523753a036ee26166b48999f9c0.jpg", "assets/c0b85f0e1ce01c5566a38e9cae342e90cf4a72e635227e26bf16e182969ae43a.jpg", "assets/fb5f25085781906497101c41bfdb80020a511c7e5e1ec13bd37435728cc75667.jpg", "assets/4107cd8e14297e6ef2bbe62035e8d66b3f90f309254ff874454cac035d786174.jpg", "assets/755ca10e36c4fe8f9223b49700462edf0da2285390566aafc5ac1d23ad0b9cef.jpg", "assets/3ff5c8cbf31b19d1429ff0addf334ac94b923f689eb54f8fa7178f28b88a22cd.jpg"], "answer": {"T_stage": "T4", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 0, "翼内肌": 1, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 1, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "翼内肌", "斜坡", "海绵窦", "翼突基底部", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-1124bea189a1759a23ce2ef2", "patient_id": "patient-34616c327ce5d69194ca7f4d", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/a334349be060a5eb4b4cc599f8e5d76e6c41bace54c403be6522cce1fd2499f2.jpg", "assets/adb8f018c43422a8bb481885296b83967f4d8c008b37d4af327e752f69c165d0.jpg", "assets/5629bac1a5debdab5f6ff0b657ad0290e67137429880b4ec336fc51961b83ec7.jpg", "assets/c86748053957657533937b5bf0233f7a63e7e64204c17b98b57d9f6cfea9f6b1.jpg", "assets/770aad1f11451111fd78e4da112bdf7f661e02b397a90030627bf1fc06b29c80.jpg", "assets/b32b6bade8844559fea69316a4a244428fc07fd7f089f8fc5ebe33339d5092cb.jpg", "assets/8bb1cd79966ec19e1bd5e3c03a1158299e405f712cf9cbeb2ef52f196d2cb540.jpg", "assets/090347e8a606e38ad1c7090e385e6d8c1a08681f65925f96b328a636392f57fb.jpg", "assets/34d929647d903d5700395c4e204cbeb5106ec4f390d2cc1baed6fe973046920e.jpg", "assets/4630f3b63ba5aadcf370c782d067fe5d6c720af0411ea84d2381d6e56a4b87d1.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 0, "咽旁间隙": 0, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "翼突基底部", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-58b6ed030d470b20fbd59d48", "patient_id": "patient-9bf5c8c03860cdf61108611d", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/87445c02c46d81d8e06fd808b95207242100de96e83f2af978444aa40b32c038.jpg", "assets/a15b218012f18b485d338a4737e3ca368067eab08318df58e57dbe2aaf26386f.jpg", "assets/ead349981525fedd40e53974e4ae54e9671bacc587b21b32d626cbdc9913a39d.jpg", "assets/be163e777e9e2864d84aa68d88df4609afd8a6f44b2a86a7b7a31781dfd6ccbb.jpg", "assets/d2c21989e2dff1b1aae599fc683693d1f664bef5fb3b36cad6b1a8aa0bd849ed.jpg", "assets/76962bc4f60666b8d3eac1f6fb2332aae96c8f1582671cbe9482a11fad414c8e.jpg", "assets/dc3c4d57ec0c0473c23d84932a920dd2600c84694f25f5ff65a15cc62f87c670.jpg", "assets/99bcae65ac53c317d518e9bc9d84a64865834c005fffc331123c13728108ed14.jpg", "assets/fd6515165fe616be788211939cc33a6d50d6bfe86d4d017a80e1d52e081ede13.jpg", "assets/3cd823e500cd22530244a8f43efe3094ab245db07608b584034a425a2b84e617.jpg"], "answer": {"T_stage": "T1", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 0, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 0, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-f8a46b6b13ef0358c5d560f0", "patient_id": "patient-f402aced5926698da3194c37", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/9b4304bccdf8e43b9288ed7dcdb69037403629b86849e28bee9b36de6bfb2035.jpg", "assets/57f01c565b54d9db9bca6f065f096449560dc22f58dffad857fcebf6c9b7aa35.jpg", "assets/b9bf199748c93ff3c65404357417aaaf4fbd678f75bfcfac8db9d6268fd002a0.jpg", "assets/6e2d1bacca9028eacfe22d6b331a9a85bf7f962697b36c4346ca247ce49ac73b.jpg", "assets/2085740b3b8f42d59c67084fba622becb6480bd75911a14385575b65686c2950.jpg", "assets/160fa24472f983af04820793dfd07fad3336173a89c5ae15109160dc986d2d2e.jpg", "assets/a54bb604c744d4739ef0ba7d699b8f0a7c617aa41e15acfa4078f2e6ebe1b671.jpg", "assets/375ddcaabdf16508b0041c4e2eee31648b65e80a7753477c5381f7acf026b8be.jpg", "assets/68ba2d02eb2294dd9e75abf54d8837787818294434f035eebaa0c3f6b13b0734.jpg", "assets/d927b9f00198291f4fe1fa005a0aaded44b60b7e4587a377e682718b7053c32a.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 0, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "头长肌", "斜坡", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-c02b01cecfcf0b5cbf78aa88", "patient_id": "patient-51e6f99c527367bbd97aebd8", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/066179a6162737f04650100744d22f2e75f17ab4e6ff605a821fb1dca4a7f884.jpg", "assets/ca0f9a62284f9813525f3b411d18277e45c68e3fb58fca739f1d901c00e5b115.jpg", "assets/3ace759c05f46311968bbc1cd3115f9166a778c753a69de6430ccb5f0477b3c7.jpg", "assets/5243f27b5da026dac8c3d1ac16c7a6ff8e8841fae83dc870a34c10e5497cae38.jpg", "assets/4bba41db4155403f69539b4a037a1d585af5f391d8733d75c7bfd09aa68b2ea1.jpg", "assets/d436e88b80581384ddb21b6281592de5c2356f993a4145aa7b44b654c4b5c8c2.jpg", "assets/a812a9419c7f1cfc99058bdbf84695291badb8cc394b3611b109a58de61b122c.jpg", "assets/bb29226a694005381f49ba671ae10431ecbfafa1a82eebfe27c4e88ce7b8f05c.jpg", "assets/ba6185d6d25b024bce1960d50be8c14f1ea7e6036b4aff0ad67fa841b6953f8a.jpg", "assets/b7c24415c4c6fad4a37e694d30f441b6a7477faaab1a9fd67d8f7e28ec81c9fe.jpg"], "answer": {"T_stage": "T1", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 0, "咽旁间隙": 0, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 1, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 0, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "鼻腔"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-deb29a86d49bb3474ef49a4f", "patient_id": "patient-5731cc38ced94b2ee39c442a", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/ceadf8c8550b3db82ad5886e8311adabfc9a2c9dba0fa2a4bfe5aafe5c45d2b8.jpg", "assets/9f3a6e3f43db97517bcb67f718581ae97ad397482d2eebe0e2da6b1ce15cbad2.jpg", "assets/2234a2f763a07349891af6c7736bbb46975e8b66f9edbfbbf4b8b36b8ecf81ed.jpg", "assets/9013a6af30d7a641ee9d45601eb224fcac2437f00593c0bbd0b75d7ad77e6f83.jpg", "assets/ac9021ae6830c3867ffe4b2ffec3efab0fea2336bb21031278a38bc3ae18f497.jpg", "assets/125cc40946390943d64a76b0408c536e5b0766714ee4835d2bfd229f5d550482.jpg", "assets/b333b9a5ebf36dfd058047021acdc56de3ede47112b0ac0e65bc15f886857e8c.jpg", "assets/a29efb26b7b05f497c8e172f749b0f3705ba71004caffdd45043573e18436b2d.jpg", "assets/73dd11f6afd9a669ad18160dc4b3807d01cd98572180c7058cb23f07d4c72d9b.jpg", "assets/3f4352fef08e43d2b6a202b9edd522720787b3dbeeca502995efaec032f531b4.jpg"], "answer": {"T_stage": "T4", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 0, "翼内肌": 1, "蝶窦": 1, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 1, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "翼内肌", "蝶窦", "斜坡", "海绵窦", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-205f6b3043c596a4d6434ed6", "patient_id": "patient-e5fcd31b4b8b85194b146991", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/2f42f41b3f2dcfb71120f1db8d7dde0784565546f53c5453f8cf45b22b7b7152.jpg", "assets/301ce31335434038f308c60d14e4429b6a3c28726fad0ba96e1dfa2cf59985d8.jpg", "assets/ee40be93563e13f5f8d16f4fe6c78b692ffe237fbd9e41f41d933c80f3e66bcb.jpg", "assets/4240a32eeb26815de8b509c46180d789bc2687775637e828664b998e5633e6aa.jpg", "assets/5a6387eb70054aac1e610a5dfa8dbf677472e747fd40c07dcad8588e6285208b.jpg", "assets/4c7c436e3c49008533a909df94195255dbf8cbfb89ddbf09fd2ca4ae2bdb1449.jpg", "assets/158d403d110856575aedd50572c9e97a8eb22d63a57f6c552e2abc7494152f67.jpg", "assets/966a04db00a9f3a4b946d1d3e346622edafe6109c09cae3de7d4f067b14cd993.jpg", "assets/2038e88691281b095c3394c367d101856467d2138b83f9c773890103eadf2d01.jpg", "assets/78942c0ef564ba599893c3cd2a70fb41ea2a871a446836f1a9d004a61a416a1e.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "翼突基底部", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-c413de747f5d59b2cbc2317c", "patient_id": "patient-d6812a1c46ed21fda9ebb9f8", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/3bec4c512284a8ae6c519a893bcfb11b711112f6f9610df10ed40948dfa54338.jpg", "assets/6d826b98a58558e86e7571a89c80aae28e59d1107e0e144fe177fbbd07b5795b.jpg", "assets/6708c9e9f4330b1f1ec2463a73978ad481d942397b7c6decfa0ea50d3ad44160.jpg", "assets/70ff605c330cfd7955bade09984ad131166e54160435ff63fa12708f10f91a88.jpg", "assets/e901a84c7c2d576369fb21efa6df28bc9c6495510f6e5b8cc70df954b1244de1.jpg", "assets/71a164940ab9086ae599bb1e8454581fa6a800f55660f8cfc32aa3b19da64351.jpg", "assets/ef89adf8de0217d5e215a5111e39585d7b658833e1c808d3bb210a29f526fb16.jpg", "assets/f5a694e59f09056133306c3a7fd4d87da7b63bbcf781a5c7db1fdd84aa8da42b.jpg", "assets/4de88f3bc374d3743843cb47f3599b85e57cc2c07fe5a66b93282ea0d795b48f.jpg", "assets/2caf2cf7f9015ba6ec68cf5c0078dd7469ad4474a61679e92f1a1e730bc2923c.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 1, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "翼内肌", "翼突基底部", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-873d91c7abbe2fa373339449", "patient_id": "patient-eecadcdf172a1efe8947b052", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/3ddc9cfef371cd3260630931c1270ccee6aa0ef3eebf88b45079843c39156619.jpg", "assets/f8642fdeebfe5ff8b42985a47eb4d1609ef93b9688d171437c0898368f371afe.jpg", "assets/17ed7b40716b8d75a001c1db9cbb24b3369de06bd19e8ae2ebcd0d94133a32df.jpg", "assets/e03955e28337613a75abc78552d91fadcbdd148f5855426b56c83570877427dc.jpg", "assets/7fe0e96fa3c0a00a7fb155304ab070116f3d5c06536c27b73c25c8e0af27835d.jpg", "assets/d739c95079238cfc7f94602376234eb4345b1d5327e478679cc83ebc41bfd753.jpg", "assets/9c66c409e0854a6c87dea376e336df7e770bdfb01965b3d483a69fe4217d8450.jpg", "assets/7c7afa4f7de3f5fac06eb49bd1a27b4baa18bb5fa299b10e74cb0ee4516682fb.jpg", "assets/b259810ac9315ad3e754dc40aa119794d691249f380c4bd110982448f6a8385b.jpg", "assets/7cb924511719873570cb5d8bd87a7501c49f03f51893e3b8ef1e0c9337d2a0e4.jpg"], "answer": {"T_stage": "T4", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 0, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "头长肌", "斜坡", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-512e0976e07cf5bdef790b77", "patient_id": "patient-290a042206ccfe67e72f9a19", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/0e21b69a2a9a058277513c236a04841bc50dd5d69c20df58bfa356f0d25dc8b5.jpg", "assets/06f520afefd08392b0133b0e5507006a364a1175cab55a3c3985f1e224cdc2b8.jpg", "assets/c0ec4c05f9a6d7dbcd8f5a3659986616c3e8996c66d421153956b6c270b091f7.jpg", "assets/d2f4a6543f672625da8afc5034016d6f576888a5d6c76ed90599c82993744b97.jpg", "assets/6806b3940dac8e3a2c8b95a1a41e84531509ada8045e0cd0be1ac3b62973ea7e.jpg", "assets/6c80839a90f82b1dcd1de4488e8075e901fdb515c72392dd9c1338a8801cafe8.jpg", "assets/1da9e8d3587226b3f9ee28b9888bb90c6fa9198fec7322ae6d2a9cd0d9d2d6d4.jpg", "assets/0760dcc3a750f95e176d3c4df4adf9f01a1c86fef9f8e721f3ddaf8de0c7afc2.jpg", "assets/9a665d2981aba7b4757106f913c78ed6f0c411823bb65ba7fb34f43ea2c2a6af.jpg", "assets/451094b595c0b6c37b8195b87545b6b7a2f76904ac612d4a79ae2a9d0a14c061.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 0, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "头长肌", "斜坡", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-82bbc2aaedb84d88ceaa56ac", "patient_id": "patient-02ca51eed4fedbb13e4db76d", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/4b74e80d3e4788b71a63813b284d303d4cd5a395d3ba24ad57fbd5ca5d8284f3.jpg", "assets/62914741cc4210d1e755c2fd2812014bf717784198071d35080d91215f5209f4.jpg", "assets/16921840b70322ae2419217bfc8bf5c7540958b1f8c890032119b85f8888307e.jpg", "assets/cdc12071e5370b848569e2caedc898376cb19b38b0f50aefdae670b65735bc68.jpg", "assets/0e11822edda898a2695c0a6a82e27a029ccbbd2958f02005952cab84d525b180.jpg", "assets/9eb99125ad04c86c1d8f38da7754e967650941b8b9b6923e8c00c68858bcfc0e.jpg", "assets/fe12c5ac189ed7d511d59b28614dafa3fed7cb902a79a9af1e44fdf3a63cd06e.jpg", "assets/673888a2c3d63040c95bdc8e33112a46bad9ac5a41aa3f68fbca62035baa3749.jpg", "assets/3ad56f8a21191c2288bbfab588a0413ed2cb63b816dc9d8c9dd122a4c1b03d6a.jpg", "assets/c14379fddcf07d1ba43d1c762b5609172f68a362a51bdcb1a8b600bfb8af2f44.jpg"], "answer": {"T_stage": "T2", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 1, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 0, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "鼻腔"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-6eac8e0c62b2116853b28000", "patient_id": "patient-f25e20b1e5c6eea840d4cc21", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/9c1d219377b4ab42380522e93ae4a91670aa9c38fdacd9122e3371760e540df1.jpg", "assets/a783167276f29535306b574348d4ae11a88109c4057ca7f4fdb491426bcbc728.jpg", "assets/f63461721d78a357d02d932494b92d9f9514112d524c61aeaeb14affa969785d.jpg", "assets/e20355be1998cd599139591ab876641a292fe754e46e8b5d5bc6a0a8f686f463.jpg", "assets/bc765f61afe13994d6a6b0507f5e05d840e310eef0b0db3ac2fe74a7d2525102.jpg", "assets/730ec25c0f0b2831ad6e3837884e0e18ca506d51fd02c3eb36ccb0b5dbef658d.jpg", "assets/2179e5014c1cff46d8e194e084f3df2eb9880680f2b2476771e4a2f4afaae1f2.jpg", "assets/3f04b53dab6d8703944c059f389ededfa2eba4ca89bf061fbb84a0335e822c88.jpg", "assets/e34c75dedee71f6c9cd088403376ceaa0c83b30dec537dfea0fbbf7e78573a41.jpg", "assets/f7754768c14704ff4cba252a0ad912a94bdeecacf4adda74ec2af132c347c586.jpg"], "answer": {"T_stage": "T4", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 0, "蝶窦": 1, "鼻腔": 1, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 1, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "蝶窦", "鼻腔", "斜坡", "海绵窦", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-e4cfe8969392b8172de4cc15", "patient_id": "patient-9fcde7a95f4d57501ecbf7b2", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/b17260547813674ff18eaa0b120d450b6b6435d073659b4ca531cae33ba6c363.jpg", "assets/a37ff78889b125a7f0bb14e82e3820df030d5a01aa550b437fd87337d8062851.jpg", "assets/7902c9c9cb5eb084be027c5d243a828108885da64794a65b580a8fc8169a1c3e.jpg", "assets/e36922e8831743e23b5857348c58ee70b409e2ce701fe07e253fee953f9b9f06.jpg", "assets/7900099d8ef66e6d8a77246cf7cd241d5d122909e4cb64d5767add44ea6a05a4.jpg", "assets/b924d485b77b3599bd79d0c6d6f85f546e64275a6027abe79aebae079a8fdca9.jpg", "assets/5481de537be57cdc0c877860b435f4ca7daa5b88eb2dd237d2e00917945b0549.jpg", "assets/7e4715a85f00c55d527b411721e5e0e70b977e01951497fdcc5e99c51c8f168c.jpg", "assets/234c84b6270ead9de01943a207373d75cd2ac9b782728b759a2ba59667b30c0a.jpg", "assets/f877165022b87a7e6b5140c8904f19191967f45eb8f9fa7080a19ac9e504b534.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 0, "咽旁间隙": 1, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "咽旁间隙", "斜坡", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-251d516cf3ed760cd63a5f74", "patient_id": "patient-1189badad5e7374b82a3cc86", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/186234c35a9f84dfb63ae2b8e83ec554bd10fa5b80788627852cc846831dc77d.jpg", "assets/a5c3e966721d1e4990b6f32b1bdcb09b4edd73a01ee61883a6de3022c87f4ea1.jpg", "assets/02b956af80df858600e49687e25408858ae06e86a71288277751078284e58d40.jpg", "assets/863b6e8a3389a5b9217a3a1d305d42dea20cb05670ae0d88ddf745484cf2b215.jpg", "assets/2b97fa780f832007db1ef84f2b640f6dd58a49e90de7f2145b67133abf60b171.jpg", "assets/9da2bc1ef5a02768d9519f61c6a91c6ff5513d3701cf693b46847786bfd17049.jpg", "assets/72f0a440d608e4c9909c320614fa3662bdcbb1cd0859319c30f0a59d3fc24669.jpg", "assets/a906e325345e9a268bea4472bac2aa647f4f161e1d01c2a83232358b266e7d9e.jpg", "assets/cea6d12f08339f8095a1f4943171e3490896b7dc3ba235fca82ee85bbb675a6d.jpg", "assets/6a097867db953ae7d5ecac4261a6e02ecdbdd6e7484ded529d74abff736ff496.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 0, "翼内肌": 0, "蝶窦": 1, "鼻腔": 1, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 1, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "蝶窦", "鼻腔", "筛窦", "翼突基底部", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-6be5f76a822e2d0df7fab100", "patient_id": "patient-283ba4356f86fb9f68ac5c06", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/a37302f4f3f1ac83e95923978b54bae44d884eb88a613ba69490bfaf1fb99444.jpg", "assets/041b4cf3c492927c30462c6d22b003abb33b9f092da4a4fae95b8f4849c6d1e5.jpg", "assets/7fd1de6194fd8b3237645f8ff8479e641f983ca358525d14e0125c3b6db03e92.jpg", "assets/14094ebcef443abe6ff0275d4ab51710e001a967c0c8847004bfec192db3424c.jpg", "assets/6dd56531fe5bd3cfdd6b4645e7ad6b832f4b290f0707e80c4e7dda04a4ca6b69.jpg", "assets/a5e4a0aeda7b686feada18cb4753fee37158e0816d4a6443a0ff22c6f0ab5de2.jpg", "assets/7d2041dda7eb047b2d68f143514c3fb999337b00125c0967f5588ed2c960e64b.jpg", "assets/b1301f7119132d34070c28c018d160b76d0376d882bb153701d2eb62e912e7e8.jpg", "assets/bdda7af5651f2d8aad4e5a4769de9b770c30eae76dd77b4d6b4f7f3710209952.jpg", "assets/a31cade90cb275e25f8f97a57be36f2f62c7148680fb347f84e5bdfa6a11a3fd.jpg"], "answer": {"T_stage": "T4", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 0, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 1, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "斜坡", "海绵窦", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-3e8681d614cfeaa63a137c16", "patient_id": "patient-f89d81ee7716a74d2854d920", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/b441cb3a853b977f8058c77ef09b7a1de1ea37465c71a927b035629c1ae45043.jpg", "assets/fb49b4e5e623e42bbf487f915a46524957a915ed1490507479a275b4158a943d.jpg", "assets/7513ac108096c64ae64134f2f265be9ad4d5bc169e3c85429914b90bcff96c8d.jpg", "assets/840379d3c69ad4d19a9753705b025a193e310055af90007c556fc59f9388104c.jpg", "assets/fc77516d4213fed438eefa1811e18e720ec015f36b39ea3630c774aa5076304d.jpg", "assets/180dab461352290ef846184e78481041c5f358666af1f1880e37186273311312.jpg", "assets/065cc3f581cb44ad27600fa56e317e8b74388eaf0b6ba3268e02190f939d5087.jpg", "assets/5c8f97b99f220a2c0604a1f9caa396833ea78d787b74438840127474cb43b00c.jpg", "assets/5eaac33afcf3baee20d34fd8b6d5423fd6f89faef87c128202ab2b673660a8ed.jpg", "assets/1ba76ec2971aca5d0460b02b1faaf84a8da574bc426b846e656a809417e68a5d.jpg"], "answer": {"T_stage": "T4", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 1, "蝶窦": 1, "鼻腔": 1, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 1, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "翼内肌", "蝶窦", "鼻腔", "斜坡", "海绵窦", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-6c1680d16f1a18f09aa7be4e", "patient_id": "patient-01cb4effba96aca19ec352ef", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/4fea9d8f965dd22146969bb495a7c247ccd69b1bae86b6b339f0a85536435de3.jpg", "assets/ab1839bafe602f85dc9bd157f5313e7d476ee9d0a028e3198c60824492d3c0b4.jpg", "assets/428b98d79ce4d2c170034c49cb76d5f3ebc0adc63dc6286e9c6c18cf73ae6244.jpg", "assets/30cf6bd6a1f8368d62da81b37ffe6c0e02ef6873a14d4f5921c9c9119da9848f.jpg", "assets/863ad006bd59d96d2f4ca3cd913ee4bb78d2936ad9528cb22f56a4b6959dc328.jpg", "assets/2c00ecc25be76d93b11d06c9b3c55838415b3bd99957944451310e54a2abd2d0.jpg", "assets/128ac20fa7d3a4367f91a12c6634a10ab4c665d0ea2a70b25ed48dec842a8590.jpg", "assets/4a716d8387e81f27dee27fc79428fad419442bca72c506aa8a8fd1a966a2720f.jpg", "assets/df9d9704bc99fd2828c19d1297f582fc066389fa8fde718495de4f5094625b7f.jpg", "assets/b944a465ddbb577448a3d94404830fadca2d83f51e82a1e7d055d0bcfd1da422.jpg"], "answer": {"T_stage": "T2", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 0, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-f5cfb00949f641c11df92567", "patient_id": "patient-8e2d677e2677ad4a75d70dcb", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/5eef599a7c7a00d588688558c07f124ed5c3a0b082a6a4c100a455fc451af76b.jpg", "assets/f49695e008aba4b10704819b228ad61e9ee043e354021ff4f5e782c0b02460ae.jpg", "assets/498a6ce14be85c23b90527892dd8dc412115afe141b2725730f9cd6ef534b2e5.jpg", "assets/e8715bb6eece9401f93bc989fc5b7dcb04d2e1270cca65a68d4b237b2cc38821.jpg", "assets/37fc19f45dd34e31948856d9b0015d006727a2e939a2a62be9a4d3bc2da6de74.jpg", "assets/d79a08a54bc95095199344365e941dc52a087e702e8af65994eba9000633856b.jpg", "assets/17a0c2a60aea5861d6dfe97228b57e6b23545fb7ebcb0ff074969ebcd80e9a6c.jpg", "assets/f685cbccb6d3a3a374ef6c1fa9ade25329362f747023d78423aa35e24e5794ba.jpg", "assets/ed2d290bf14a1afe2a5ab1d79757eb162875d770cf9b81b217b40b0c8d593556.jpg", "assets/9020bcb8b29a36b73d7360e2e123aaef376fc19d077184730db95e8a8819e39e.jpg"], "answer": {"T_stage": "T4", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 0, "头长肌": 1, "翼内肌": 0, "蝶窦": 1, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 1, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 1, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "头长肌", "蝶窦", "斜坡", "海绵窦", "翼突基底部", "蝶骨基底部", "岩尖", "寰椎"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-2d307d567fa41a0d57e9c8e1", "patient_id": "patient-9eaf0b40aec7a0f326916f11", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/6e60e497e214ff813287d465c1d7f3fcd932fdb7d7293595913f0927dd05dd71.jpg", "assets/240beeb2b2800621bc4aa1493fd20c2176bc7e5d389a547540adb866e0a397ad.jpg", "assets/c61f6846f228642fc7c9a321eb8c5107483c04d2a6622d97b49107572820c1d2.jpg", "assets/9272da51a1d34e93295ddf1250fc9f6a70787ddaa7d81594b27643170a9a0056.jpg", "assets/039ca6a100162a601681de31ddafcd6aa6960840f21499ddbaf45d81c4e0fd52.jpg", "assets/b4753fb646a2eeea06e0860ee4a08d2b6efb50ffbb27cf8142a73bfe9d2d8c53.jpg", "assets/cf4400f72081b9d0fa82b309abd184f788a9150ef27e9e45361bd0f393172e9a.jpg", "assets/7d674867cd3b58483109ca1275b29d11ad62e5988f3bb493c9835a55ad09e0eb.jpg", "assets/9a6e41aa7217caa92662f9ac48919f0bf8b0ea0665b4d03af004ccf53758608c.jpg", "assets/c65bc2a2a060265c7102a45c10c7e0b628dd9bde4a8af42417959f122f481c22.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 1, "蝶窦": 0, "鼻腔": 1, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 0, "口咽": 1, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "翼内肌", "鼻腔", "斜坡", "口咽", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-b4d5db8447be6a3dc920cf36", "patient_id": "patient-c37f6b32f02ac91bd1ae7799", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/7a33b11520f2d272640be6d7a56c0aeabe401d3273e5e52ffc7ac3534311c7dd.jpg", "assets/681840e6cb1fb7d18a6af21dc1333ebdb19b4c14c0bdae734d064542390e9e9e.jpg", "assets/a09137260760b8abecc51b56093a11daa8667416303b69ddff4c9096c4366a84.jpg", "assets/c917e872795104694a9a6057925e9db9c351483c47d9ce3b92288a5f1736afaf.jpg", "assets/9d7ed35c8b6fbc2ddee0d80cd21ed97b12b408a4c5ead49342dd4b3d7560edce.jpg", "assets/96ccc05e8d48d81894e954ecec06f4999209255e98c4ba68b84c7afedf8e176a.jpg", "assets/29436805d56d28295408cc76c0156364a51ca4f4c4a985df46914790b7a8a453.jpg", "assets/78b718cccfb1e5249405e9bc5e224f79c707cb0ce462ebf7369d3e41c46b7f77.jpg", "assets/96243cddb34c98cb8c70e40bd173ab5e05370de42d85c714974e335097a56175.jpg", "assets/f149c609232f1942707ee3962f6a443316335fee3411e0c34adce4ae6e2c80a9.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-cfcdffa3528332d59b5b50d2", "patient_id": "patient-4aef168669533556a36bc39e", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/94ce13e05831ff01f3bf8be4ef3b454f06b193f8c0e38ea595e7c4714e56dfa2.jpg", "assets/9598283eae9436a51306cfb14081455046c784defdcb5797402aac4386c5aff1.jpg", "assets/0e5fdcf8b3867c8ef34b26aa1a17392b8990e60db21c9f1e106f904b0eaff625.jpg", "assets/9aa29a3a5f950717331759126c49c3ddbddc7aa10790ee719e233432325107f9.jpg", "assets/c775b826647bdca3e8c305618cc0251b015846185ba9f3ac3285be3a5a0cb0af.jpg", "assets/01136139dd8a9d5be421869ace92516343c947f30be3f2936d0f1501c44f9aaf.jpg", "assets/11985251cd651171a3e032d7a2addc6f357358e2f2281335f67c313e58e34a4c.jpg", "assets/09071f50a4c4afd3ad97625c10b3587e11b281a4409b0ca602f5917a3d34adce.jpg", "assets/5a3c5c7969dd10f1cb47ca979020d2ae2f890c1622f26055b8e8066b4a6e9446.jpg", "assets/dc8a4af88661bcae764d0036616cbe9b39bbcab7dfc9231791e193b17bf8972b.jpg"], "answer": {"T_stage": "T2", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 0, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 1, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 0, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "鼻腔"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-53d2c4abfaf8a1ec764ba5ef", "patient_id": "patient-e675eddb370b74337da96684", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/712d5816eba2ce556fda08b200212b702d924331e080f98cb228743d36ba77fa.jpg", "assets/65ba13156e48f6ba8b8944f4388ec6e31005efa166b476b9c3d2c836d2519453.jpg", "assets/3838f2b34a798e557b5ce358060b13d1eb42bf7b36ca75ceaee26baceef8cf10.jpg", "assets/8578766cb78dad2db48f8fd46eb3d99a86595844d68e2ae099ce70872ca0b8e1.jpg", "assets/62e2ed8c9799ec5a8d77fecbd4451890a2df7974e04d23f9c0a126451ad0a340.jpg", "assets/142184bbbf7e77a94793d47d9b6cb2faca977d2616b2b61dd1279445fb5c3652.jpg", "assets/c3da209cf69c5881643d7705d778cedb03b5d79c22c21c6884dd2d40e730c396.jpg", "assets/9d213be602942564e9e52004a18fd4e7ba9e7c3900b57fe4761ddcbfcb88f651.jpg", "assets/0419900b6a5e837f5800f75cae9e3fcf6bbe865fff46a7b00886df20b231d8f8.jpg", "assets/01aaf2b5185dcbc97d32425822c09b4ec9ca513c0bd4735772c9cbd4334492f6.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 1, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 1, "翼外肌": 1, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 0, "口咽": 1, "翼突基底部": 1, "蝶骨基底部": 0, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "翼内肌", "颈动脉鞘", "翼外肌", "斜坡", "口咽", "翼突基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-215f010636d995bed6596f5a", "patient_id": "patient-174236bff64528c2f91d7aa7", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/95e42ea829f5d438a879e517e7c20dea11825c48bc3103c53cffe6cfb0b920cb.jpg", "assets/1537d67fccabf3118ed8633303bc088914018c002f201ab35c8bf20780ecc8fd.jpg", "assets/c301a131cb21314ef2ca420a24c0a32424707f90d1dfdd47f9ca6645bd17f794.jpg", "assets/77578b0306d02b572fa3cf2f2f5a9da5c8b2abc0d6ea39f3a481afe393c505e3.jpg", "assets/a9a84e7ed2908053f7e5b9d1dacb3f3a4085258b73373ac7fe501b37acc7a328.jpg", "assets/5c87b6f676d661c7c5db5bd67d219d8762078a328ae6780e8b850ffab9a05100.jpg", "assets/9e20524dca3dabd9b39f4e9ccdc57ed6096fe8bbd1ff0b896e516e12b880c311.jpg", "assets/d8b1aa4e3f887b1bb8f8a6c84bd88bd4edcb7ba178db83dd56be122894af9f48.jpg", "assets/4ded6a282c63aa4bd720d9b47707bdcea02ba3520cb7a496df4a2ca7e799816a.jpg", "assets/0a76c3372c2aac7d413d2cd9829e7933218235d2c0053004a46ebbbb4db4be20.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 1, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "翼内肌", "翼突基底部", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-65d7d5bb220f36def131b282", "patient_id": "patient-b933c2f377b80fd439ace547", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/5701eb38e392795bee28b7710f42dbf20f1f35acdbc5492538ee4a29a4d90b60.jpg", "assets/9b6913bfbd7e4ec7850451059446357a0b816b43756f27a0ed9c30468e0b0709.jpg", "assets/5a4e9bb6b5306c9dc5b1db91f7c11df59bba96baac95e4365e61397318787b6a.jpg", "assets/5bec347a9d6026dc04f61d44365043ccc9ae4f5c4932b1cfc22b2fe97db66204.jpg", "assets/0054044ea73e46379af146adeaa3ba34fb1730c25da28a209db6abbd2128897b.jpg", "assets/4c16a8b2fdb34736ccc03a12d196e5d62bfccec401abfa6bbce89526b0928d9b.jpg", "assets/703e33356a1f48e9ab991208f13af43e5d80f5dc06e7128e95c5e665b9fda10c.jpg", "assets/2a11b605dfabaffedee278f8f4fcc12e2929e2e2500d3fcb4d9bc542e2543db0.jpg", "assets/ea9d04b779c3517ca73b34beb55c2c1533abb3d7aa767b2fa6a1da7fcaf1d7a7.jpg", "assets/4fdfac961855faf1f5df7cfa28450abed8f7031928bb740c096867dedf1c44e3.jpg"], "answer": {"T_stage": "T4", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 1, "蝶窦": 0, "鼻腔": 1, "颈动脉鞘": 1, "翼外肌": 1, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 1, "口咽": 1, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "翼内肌", "鼻腔", "颈动脉鞘", "翼外肌", "海绵窦", "口咽", "翼突基底部", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-6e82ffe1226119ce74609eee", "patient_id": "patient-640515b141269ff2b238a29f", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/c8ba40da18073d9dd022f5f825cfff36ce85e024ef29c1303d14fcb824aa8dbc.jpg", "assets/ddf2e3419679711c3c658d0261aa82dbf542b210def42b17713a4de592544e31.jpg", "assets/b70e0a37956aa58a5c0602250d9604df972874898395f87e3ff3187015504b44.jpg", "assets/1882053e2af3631d336686c611133cfe8dc3c5a0c82bf366bf6eb02ca4899486.jpg", "assets/d9f5c6484ac9db09f265ef3371c149a5fa03643d599ba2ed62b1ec71f5e7bedd.jpg", "assets/fcb38346888664e4f57aee5c2b6473497fa390601e4bf84db157f8e96e0d96b2.jpg", "assets/9d975a4806f9e5ab2faa67b33bc3fced6d065b35fdcb861c2b9165cc1a9f66d3.jpg", "assets/ef4955fd064307ba65788cf8a04d437c84cac8f4c6f2885d43be948615eaa8b5.jpg", "assets/b45b0a3b12d8861a0c4fb90e9ecc139f2b84c16e0fd8b1f373b50ebdb11dcbec.jpg", "assets/b469309c3ab5c9cc15d09658f238e7d431766a7489db48c0811e929ddbe4fae6.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 0, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "翼突基底部", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-d0363582f657458f4630f74b", "patient_id": "patient-b574ac1f42cd6a06d5a529d9", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/938b04dc77c936ddf5d3e960dbbbe82d775506ba428485d83fccb21b8d23e65f.jpg", "assets/785914fd7fe3755ffad176e8f797ce7f2f32b3f04fffff136785bf3496405420.jpg", "assets/1e7089dff7256d7ad9fec0b669ca2965860d96505a6432062742eafce85f5d18.jpg", "assets/a4f564e31050a616abcccb71e9c9b51d99cb9c632c335bfa2ee5506c12d192e7.jpg", "assets/bca6cdc895d07bd78fa7e64bef20271135e947d8bf531833f9ffa377422a725d.jpg", "assets/5b877ed39eda175e5bc0b386363138ed40387a49c427dbaacb54046fea19b087.jpg", "assets/0af570e06c4abbbd3b2d831f14eb4756f9ca130b77d2319119ce4e45b2ebd028.jpg", "assets/e04d734a939552fc1fdb14ff86dce0da33bf6f4fe429e68dd1b4d41d2bc720b5.jpg", "assets/335f36eccbf3d4afd99e3926206a81b4082d81d6545b3ddbc6e54cdf2d263406.jpg", "assets/04583b19b18f845868254cf01b9dcf42afeb04929b434c3f3f5c609bed0f33c0.jpg"], "answer": {"T_stage": "T4", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 1, "蝶窦": 0, "鼻腔": 1, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 1, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "翼内肌", "鼻腔", "斜坡", "海绵窦", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-049893635ccfde4dea3770e1", "patient_id": "patient-cdb749e199be2356a7040391", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/f5e0d2e4f043d27657ed1101377ecceb908d4a398a54049f7196a5545a20b0c5.jpg", "assets/516517c4770332e929d627789f72f3c78a4dc4417e435202fb217d95efa39cbd.jpg", "assets/3d0cb4c65383e4faf1159eb94d6a6c32b140ebafe8120ed8fbfc095e46eda2d6.jpg", "assets/8d032680f6af0c0eb2bf17831b7df0e7d62b3eb7de16b572d60202965b6df969.jpg", "assets/11f71fdc9870aa6d1964ec4eeec8896fed226ffe30c0ed258e797438987355fb.jpg", "assets/0f04168cd3290eccd03157dbb9b065ca19e1349139450009268ac76f381c4721.jpg", "assets/e509cec2ae5089f05d352f8c0e3f7e737954a993a152f2f42edd55e2911f287a.jpg", "assets/534a01063e6cb79913c7ff973f74d887f17f5753bdc417c5e5078efaafc5cd07.jpg", "assets/eeb7bc52cb86fb60ceeefcac384e6a1fa468dfc042e3eb828b5a8be4d327557e.jpg", "assets/4d16e7fe2fb69f7d04da58023700582b00368ea0300f1cb06623adca110fb484.jpg"], "answer": {"T_stage": "T4", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 1, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "斜坡", "海绵窦", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-1c664e71a8219910c8bd81b1", "patient_id": "patient-8711d6dac046e543146e43a2", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/eaad2abaa7576a5aed8a5ff183fdf542b839317ecdcb2bf431aa7fc698669f0f.jpg", "assets/d878cf4174311b337c1bdeec8adb605177806bb581038b3ce9bafd0163b11dea.jpg", "assets/95875d69aa6ce4e45fcdaf9bc01a73dce658b7ab6e88466c5ef0c3fb9e2200ef.jpg", "assets/586644a436088ae9f536b552777088fa69d360243c43fe33ee99927f6267690b.jpg", "assets/627723ba1d930e3249512f64917c8135aad82a10839da94a2166de1dc953349b.jpg", "assets/cd0df9777b511739edbb82de2d1780072f5dc1641c91e88567b5c5280f5e6880.jpg", "assets/3c2618bce6b2c51322d7f4b59e2fff929446ecda89f7acec52015afe5d5336ab.jpg", "assets/97f1706ce5459e53d53cd741d34e006caca355110e95ce1140494d78ce176e81.jpg", "assets/780833a092e5d609627c1325f9b83c241704a42d3581e754eea20029e6262ade.jpg", "assets/aa74c0096e7bd1a1554ae98e4509a2af44cd36306b8e84dd4eae19ddeeb65463.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 0, "口咽": 1, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 1, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "斜坡", "口咽", "翼突基底部", "蝶骨基底部", "岩尖", "寰椎"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-aaf1c899fc2e4e167ca41bfa", "patient_id": "patient-f5101794bd0a287128017a19", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/05e589246b76c61313e1c19e9199735d695fcff6a878149e9ef75367db959c7e.jpg", "assets/3f2896768e3de784acbb849684bf8a48fdc9db731591f4f785ac86f716f655b0.jpg", "assets/f29fbf3ee35b75590c1bea39e6865d29b58aa2a9edea8218cd360e4c1be4c009.jpg", "assets/ca14c69a62f668c1aa03036a50ee358ebe1bbef8f20c982c03a1a962bb0877c7.jpg", "assets/936ad69ba97815edc80faeb0204fcc607f6a65826be8c7c53d3af91284e2320f.jpg", "assets/3439a385c39a28105e9fcada843367cfe9308cdb92d63696061be993d23a07c2.jpg", "assets/97d69561fcf85fe83a7fa41482a81639d6b1a86ae744dcbe2c7a142d6e5af1ea.jpg", "assets/c13d667c931995056158655b31b88d738d8054a264c97368b419870d0b931489.jpg", "assets/557970c05449e98034579da87a452fbd1b05985bb79d96a62f8b3fecbb3df0c6.jpg", "assets/6e4a2ef0cca9bc253d09144c9174e13067c499e42c4d33f8df78fcc8e49698da.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 0, "咽旁间隙": 0, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 1, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "鼻腔", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-0a8e5d72381b30faf4203a6b", "patient_id": "patient-45e4c46d921f3565452c0d71", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/e9181b05c0cd2f49ca86012e2403b4c0986ff25516724271c433393f024c718c.jpg", "assets/38daa15d7f62f12b93d5b8194a5f2c24fff367df34af989bf12488da8ed14121.jpg", "assets/68e71cbc83af1f82c5915878eb364e2d55084abadad1d7dcaa0a40fd3ad4e07f.jpg", "assets/6b8d95b93face05f3e8710b092a40fab600340c0875449aeb13d4a9b8fa90b9c.jpg", "assets/c5bf332ca0d95ac8de2b13e940ba4aa34ba0c16bf5c4fd6b9bab292756e60899.jpg", "assets/95cc0c0a749b51892885231274b99fdb98a44737145ed1ce35d6da507a451ddc.jpg", "assets/03eed1e3fe2f081cfcafa18f4da21e59176f925586ff694917f7b8a7ac93045f.jpg", "assets/7783bd12c823da2404da6cda1d56d9d154986cd393066ad00580572653fc9c7a.jpg", "assets/38060cd96b111bc3084268c6df32de957021125a1778b08adb9adb91d97d1329.jpg", "assets/58d2600a0ae961d75e2506f1773efec994051c080450b4c72889c28500499f30.jpg"], "answer": {"T_stage": "T1", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 0, "咽旁间隙": 0, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 0, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-065e53b438bda3cb3c7406cf", "patient_id": "patient-5d0c932da06a8cecf1430be4", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/28d75c39745f840e5e4a95b9572559c811013711ec74e243eac0821ac56457aa.jpg", "assets/bf12c6b5628302271b9f798cd0c56df23b281a1abf452b11b8d2fe2e99531a6e.jpg", "assets/362f511b8d624af73a3fd6cd2f852068db05447c8216f52374aa4b8fc00662ae.jpg", "assets/1384dc6623795f9924b1c7d2aeaeff04d996d3c1d003bc7acf733a5ef5362905.jpg", "assets/80ce96945f3f690d775b5eb98452fafd1183b71e82ae00d8cb1eb32f885327fc.jpg", "assets/9dd33757d50e22a2ff81d0fd7bd8621ff603229d555760874512b67bd29ee73f.jpg", "assets/00dcbbe5aa8f89c9bdfa4891fae76f198eb00ea90b37629569a9daaebe301000.jpg", "assets/a8c7e3d56d4efb012faf02694e54a8b30ddfd82dbecebf1e955cda5a91b897ef.jpg", "assets/7707c2da14b412b5d6b308f9091f52e52327e5ba413a493afafc5532a8cb09c2.jpg", "assets/64b89f7dff3a10c984f8f1fec4ffdaa1dc28ab44c91c9a8d7e2bec88dda895ab.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 0, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 1, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "头长肌", "鼻腔", "翼突基底部", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-c70dc87fb87d24a717adc608", "patient_id": "patient-684941835dbbdf1c83ea8f14", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/70d4256efcf01576c010a81c1463a3fc6886d9cdb8231f39566b2f39fbec3679.jpg", "assets/5cb641d5678e53d509261a6f1df749d48713b586333946f31b3a0bcd62336e8a.jpg", "assets/5f0fe2042358ec1ecc02fd7342a07c8063ad9c722a1e9b280b261fd197e9dc45.jpg", "assets/a1d82801cff8a48e2670a852aae094e817797b04016392e887827ada4ab94bad.jpg", "assets/763d4bd41653fdf8a335d8904a264490388a0e32f67ee8bfd7d331d301cab768.jpg", "assets/1ba2e6a32cccb345f8dc29ae69fcd80627cbc58da6410b1213ccf4a1f3f3b0b3.jpg", "assets/17efd2775bf893f48fb85ed020d2efd0cb3242992d436052d55005fee3e797b3.jpg", "assets/df2d529007153d7ac8b5d041f801ae98e50413f87e1fe8b787c6b1f124f372ba.jpg", "assets/c11d9091e9a3135c87571aa7958e8201dbb08f817ed1e161de4a393b90293b34.jpg", "assets/17328a2fc93bc5065e5b1f299ec5ec57a8c504f87693779a45d7367b533a2a3e.jpg"], "answer": {"T_stage": "T2", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 1, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 0, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "鼻腔"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-a3480884898de1dc46893ae2", "patient_id": "patient-cd8d5017ed5c739576ddc3c8", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/1398c277867afdce82bc4e4bed8c70b3c1b34ad512cb94ae33c8a7ae49c9f60d.jpg", "assets/9137417b104359440470a06c9e90cb12be56677f8ba6c7c92bd74d63420e9bca.jpg", "assets/77fc80ff36d9f97bb14a559cb7498350d9455bac30018403c5c51cb921b367b0.jpg", "assets/ec173dad43b20e24d9b1b4fbbd4cfc25f95f655cba2b929cc04492e741d0941d.jpg", "assets/933f1a91e797e2ee90fd165c77e9256196c75c60462a8a0410dc48111392b94f.jpg", "assets/3211ad7c8ed9077667fc8d66a780ac71bc0694294d6198411b4f0c8c2a2c8b7f.jpg", "assets/e073e07263ac4fc70b2210d5ca433b5f3984c4ba187abaaa2aa5d4511bf5c199.jpg", "assets/87eff71f11373f0c4df04a53c8179a6bdf535778f7949a6821c1a275b5b3abcd.jpg", "assets/b1def53179990adf636cf4c8e7a91b2725144919301d25865d0f145b97667a63.jpg", "assets/d1a23cbdce0f753409d04a970dd5a6eebc29038b43bbdb391b32cfcd3522e123.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "翼突基底部", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-0d5abcc135f03b66de811bc1", "patient_id": "patient-ea6494e889c7facfd6a5b961", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/f7b2ecd6d9c1d82fca13c099ae7122417c93f4813ae870af22b8f91d9fc35b2d.jpg", "assets/8accf751f7ed981a4225c01fe9a8e7bef517874718b8137f4e1cb290d6939d82.jpg", "assets/50f14adf1198d222bff329084f662d2ddbe7562e6573bff689c040f76f500853.jpg", "assets/730c653c469de722355555c8d773cc166719890bf20a22a092ee619b3eb980d0.jpg", "assets/9a866af7c62d77719443ed72f1e28722b2866fcbcac97365e63595b54176e0c2.jpg", "assets/d64784d906da55d4645fb965c8ac5b2a93e016b3ad86540a2ca0ce67634f2314.jpg", "assets/c85ed5f21d7c7031282b83a675b3c54a30629437fa280431cbfc4949742aaff5.jpg", "assets/27b7f556893d5f2ccc8a0b866b2ca074f949673eba7164767924f6fd78aa73e8.jpg", "assets/44b90541ec094d613ffadfc05fbde4b60e5f60daf051c3819558b763e9433739.jpg", "assets/8063536a4ebea7030a8cd4e004533bc8075122a56aa3cafc634abbba4259ee3f.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 0, "翼内肌": 1, "蝶窦": 0, "鼻腔": 1, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "翼内肌", "鼻腔", "斜坡", "翼突基底部", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-d789c317af83e47be88922e4", "patient_id": "patient-393a69d1a905e05600212d51", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/881624b13def3bc2fd4d22f186caf15c7a3f0e93f939eb7ae0b029743954ba03.jpg", "assets/5305c3b4a50966d9e2355e95a96a9f76bb8d513aa0295ebe2b44a81022bd8bf9.jpg", "assets/739247e7c38747d2c45978aa07021d05bd4febd42445cd02109a01a7fdd644ad.jpg", "assets/7ba994848caeaec105359c4196ec2b66950f05fc7aa6c9929ad1c760bd6f91e1.jpg", "assets/43313578c68615db9d8e0f8f89923066cc2427346857dcc2c63fab2d2c9ecaba.jpg", "assets/b5458390c53300e8a85f24ec2db98e5051f2f1f3f1be42bc3778a8027d916899.jpg", "assets/e9e6aaefd5cbb5b827a20cb6b9a4343861e2ed44d6c8db821f276968d867084a.jpg", "assets/858e5ecfd0f30d7d3293a5906ef3b2bc67feb1ad000d7f668f932c2385f67b0d.jpg", "assets/7d76932bdec7b15820fe4a9e5a194aac7ff2ea2ffedbddef607b8dc5da7fd957.jpg", "assets/3d74f2b21912b19f13e780fe70b297c375bddc1677078cb3dd0c136abae5cbfd.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 1, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "翼内肌", "斜坡", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-1f5909676fa1955e44933180", "patient_id": "patient-b65cb84467c638c61d55d3fd", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/124634c80c04e32301b3860cab85ba9b4348b827bc18388b83af1577641dd886.jpg", "assets/820c3162a8a286a593ab232b23b8f446dcbbc8d8549f8b85f999ae366a79db43.jpg", "assets/bae6189cb104140afe840897bcccf1382531b684137458cdd7dc68f84409970b.jpg", "assets/9be2fbdef733651002e479525a60759d71afd553dbdf263cda42d655a94d983a.jpg", "assets/83ba2a0fbce058e49176b5a781211b3f940aa6cfcc5820d2168b1d7e483ce656.jpg", "assets/690fbf1ad1ac10deb68c61d4dfe70c0cb4f615651b84f5b5ea5b16fc5ae43bb4.jpg", "assets/9c3cac71b671df354957612906923017fa1fe4b4d17e67526caca99ee67037ef.jpg", "assets/fe9b9e57e7429c6139ce81e98ab95c848dd2d29b4c2e192680d5556a5ffa722e.jpg", "assets/3eb17c08f92d92ab9125d17ff3068f85b663db76ea3579bd889e0fc99a6ad5ba.jpg", "assets/5d1aace9fb389a2fbbaf8e6e58ce57d6f5f103b1d2b4badb10bc0c0f016f4fa4.jpg"], "answer": {"T_stage": "T2", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 0, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-8aa660dc04d081deb2f963e3", "patient_id": "patient-2cf7bbf9c878504492560fe8", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/e524c22851d71425ecfe2fc6cf89eb4e643abd29fc50c78c85dd132e7cd4d73a.jpg", "assets/47fa8c6f6b5c8b8e766bbde665b62be0fa6e58ba4697ccc395137527826d9d6e.jpg", "assets/7a7b35118b1fde431f0b7eff887827f52ee7dd04d86120a901fb2924bcad07de.jpg", "assets/7355afa29ea6dd5ac265fab376b74c1ee16e1dfe8050d7d03e4b366e6a30fc98.jpg", "assets/b6580b15dbd841094119a21ea618b9989ea8799b85071c2a385c750b22e93032.jpg", "assets/a7e96924a09c0b47c9c79569ba6bb2bf67b9ea6c84940296a8ec566de6cb82eb.jpg", "assets/52e722748940ec2863d54ea8e367b7db4ea5ecf7d47168ade595491e4895c300.jpg", "assets/328c0943f12855bfe4993d0220bf48b6bff3eadc922b906f61b82854da503b9f.jpg", "assets/70c1ddbbc5d03624945729ca9e96380d0230f9287a67720f9a517aa91148fd8a.jpg", "assets/108628e146d0c00859c257dde44b751364616f5fc1cef3524f9ca448cae5530c.jpg"], "answer": {"T_stage": "T2", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 0, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 0, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-95449aad7df78e1b50df2585", "patient_id": "patient-960f6ab1e16dbdd23090f492", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/fe3581d077a8a466dff736da957194c8a095e4eb02a8b46aec0e54650b96a2e2.jpg", "assets/fef661669464824f5ba5f6e890ab301fdd43c1e12f572f2f6d68cf304de44a6f.jpg", "assets/72d2467c2b4bc6642da6b9dd67aaab53e70a3daef4932d9a6b5e6f9cb7a64586.jpg", "assets/ce10838ac3e63d696bf654551ce11265bb8ae7e1c3342edaa023867c44c42a32.jpg", "assets/f91e3aa5932e288f97b78507e7c2a42b64658bda461b454b5a0285a72f633e74.jpg", "assets/bf13a008ad62cf7d74814659034b099124add93406f5e2d6c6b075aea1f3f3fa.jpg", "assets/08e45c5ac824049917189c3e9440200be85ce0799c632033aac67a03cfcab18b.jpg", "assets/4141d61828f38997aaa4bc03e633ac2dd1b87e0a6717a3c3e9f98c32fe4645e8.jpg", "assets/1315a0b9e9befc8d09559ade715f69da62e42c69278ec5a1e8c2e0420b3c7db9.jpg", "assets/1b3eed208ad967e0dd4c55701a4d45026b59eebb7f20d2ba83f845fc0db2e348.jpg"], "answer": {"T_stage": "T4", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 1, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 1, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "颈动脉鞘", "斜坡", "海绵窦", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-54df38ad62851e78b1834559", "patient_id": "patient-16c0f88f348c8b36a4e0ba3d", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/bd1f2a64a1482de4b5cd0d7119223f609ff3b6073e01086bc1dd13cc7196eb91.jpg", "assets/150faa2f828bcb42a888c024097f8e9898ce7bf7d8b257181f0959f751220e01.jpg", "assets/efb0b3663f3b82b042eb9e5725f40597ad1deb2091e5eb9947e24539fe60dbf6.jpg", "assets/8cc8858e2df7950ecbde8df5dfb298c6398528a7acdd1dd955a50bb33212827b.jpg", "assets/0aeea4bebc6a11323d423d2bebaff3e3865ba6fb1549596f73f136d69e0f030e.jpg", "assets/adf9fb344dbf9dc9fb3c6db14c3b777085b8cb21949609e673b4d878cd0745ed.jpg", "assets/8a610d988c932910f525639becc1adfa189987c0cb5a67f57ac856dfa8b11d76.jpg", "assets/494b239829c0e5b1db92d17a1744b3b75977c4b0425bfd744c454f83479aa4b3.jpg", "assets/a97d81391a88d2b8d4548a2ce019f72aced983a80aac441d7f4b4c9987ea9f99.jpg", "assets/03198d827dbd9ba70ade26991d6498a70503af3ab66ff6b513fc11998d24cd7c.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 1, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 0, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "鼻腔", "翼突基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-e2b177ab139df3cd74d86247", "patient_id": "patient-23d7450690ac27c41cf2d08a", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/ea50a00d9dab8724e8b437981f197927aa4a4767491e88619cf8c66c4a263a0c.jpg", "assets/55945a905e620e5b831d1364a2843cb47e27de266a378d0ea778059e61628b7d.jpg", "assets/c8ed0fd0a67417d74a95486142bf8db967b95094ceb6a10f6c5dd08852f900eb.jpg", "assets/634f1371a364e9cbf65b3b13dbbc33df7d32279b6e690d2ee835ef3496dd3625.jpg", "assets/7459a4fd9378aea8c366dd5fa264b21e9d5d9d797b5bb55fb2adc62f96d30188.jpg", "assets/6c71a6db3d6962ce59f8fbbf4b70e967db7ae16cb8e311f2df537800b030e019.jpg", "assets/41e3c631dad5341a71811e6490ca8358130d707678c826ecd182d5062d3cb237.jpg", "assets/d1a582a6d147a483f73805689ce12ec60a83ab50cf0881e22e563394a465d5b8.jpg", "assets/e3bf5169c93879e243c0d88281e007bd9b81153fae676da06ca49c900eae0a5b.jpg", "assets/c0f3631734c9dcc9fe4ffa0b74be0663476e1a47de842d5ef78c65a9dfeaf4b8.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "翼突基底部", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-67d4cc1852435095d3eadd06", "patient_id": "patient-d0d7ee4ee410114ceb96522e", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/687e2dc87957d41d1c096b2819fa49dfdd02665ead4353ab766ba7721c2ee9dd.jpg", "assets/f0584a98e1b3c837c30f493287577ac34612bab644e43e43b1bef0653127d683.jpg", "assets/064e4b5b9f80028cd5979f526471ce19361f2c711b96fb456fa31da93a845ef0.jpg", "assets/7f0466cbaad56cf4c4cabac3651bff34d6f924de3a6f19e885bb381792efb922.jpg", "assets/179c3d5a87231dac82bfd344ccb95dbdf75dfdcad41dd049b0c0018f88e30352.jpg", "assets/14775990f205b7f8922080caeb7fb102c3235f760fa4806d6126b31d180156f1.jpg", "assets/41abd63dbaa530ff5508ebeec91f69ec5f17a35d85c53b4ff1ccb68327f9eda7.jpg", "assets/4cb2c5826921875d35f84de2d6fff2c3ee6b92783163d6bee236cab503bf8315.jpg", "assets/e42c97271ef9a2050fbd5a7918c25de9b5d69d1c10aa1c325da6806c45972839.jpg", "assets/eeb2f9bc57cbc021b93271fe826db54e23cf96e3e6cb72adefbb833425d81488.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 1, "蝶窦": 1, "鼻腔": 1, "颈动脉鞘": 1, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 1, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "翼内肌", "蝶窦", "鼻腔", "颈动脉鞘", "口咽", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-fa3fd1418d9dd5360b918557", "patient_id": "patient-1f701280917a20dc32022e52", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/9e557d210e51c95d2fefd8e5ac0af43bd6469b8e07be7a250885b08b0b0c11fe.jpg", "assets/e4de7bd8247aa5a3e5dd79cb043bb55bfab3224200ed170390bf29905c4cc64c.jpg", "assets/1bf8b5e11f09afa0b0d1c818966c94ca24d5a93ada46948d4cf90e8fca17db40.jpg", "assets/0dd665901aa7f9232818cb1b6d5e7cbaf6e1bb0e853a2672b3a3a1d5bf7cf2e6.jpg", "assets/da0d5666d5b637d1e84fe0e18d9dc06f19704d0512e7c3f68d3707830665ce32.jpg", "assets/5ed8bc7513dc607d53ad979c1d0ddec2c01c5d7caae03e6d6c0f70a98ca5a56b.jpg", "assets/ef7e3c85b2de5443742aa7aa17fb87df5bb61bf03ff094ac50d40e84bd6d51cd.jpg", "assets/4f4e8064af04942f49d6ef3c732bae31e38e5dd5d9fd7d51c41a54f60b7bc0c5.jpg", "assets/d1e3015aa5b9357a70a40c900e15357ebbaf19682f7a539eb01538ee1beaeed1.jpg", "assets/0b86cf644e5763a530515e39ab15a295eab346a8e9355fd7e9a6d4576381dfcb.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-45b839d74e5b4504ce2d2598", "patient_id": "patient-49de37b11211aa728bd7cf39", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/8ad4a097aae1f19297798f97b72d5b952d2df5c0fde70e9fd25ccfa7b9a038b4.jpg", "assets/9b2766b55a7cc7bad8de27844508bb3435b02189dddedd72966c5b7cd72ea6e8.jpg", "assets/cfe4c3dbcba2f8ba5d809d8d115789fd5222423d3d901cab30f3ada56f693d7a.jpg", "assets/e21f70c789fb7c3daa09cb862fac1ff7bef2e3158a235d47bef20e7fa0082e54.jpg", "assets/adcfd5b440f250b80d73b6cd33fd905542a1f651e5ea702bf099937c6c586e55.jpg", "assets/7d57919f989ce111b677208516c1471e5274c00ef16ac712bfa44660f8081899.jpg", "assets/a7f4ccf23b3f5109f8d338485e73643e90b6cbeaf1e0bce03b75ea3dc5338173.jpg", "assets/9b95b980ce75aaa4415448e00ee6c60337a71dfa730b84bab1bfd7d01f0010cb.jpg", "assets/a9275621de3fb0b7f3eb0dfbeac85b6f1dc8af71713fa8c9c24267c18c1f9326.jpg", "assets/1780f34ffe7c08356c23908800b2a88f8bf074f5b5bf6f8834bcd2264b608aa2.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 1, "蝶窦": 1, "鼻腔": 1, "颈动脉鞘": 1, "翼外肌": 1, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "翼内肌", "蝶窦", "鼻腔", "颈动脉鞘", "翼外肌", "斜坡", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-9b283d58da6f08039e89e0e9", "patient_id": "patient-aa7bbd78f73aee5acf2a27c4", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/c2062c84e787a9ecc96f09f873738b91ba7104c74773e4456a859d656cc45370.jpg", "assets/9f4c3377f1795fc7f9bd4b6c018329fe239de2c7947a3e901b5f0d8654e9d4ec.jpg", "assets/dae4f4e79bda70e14e9da91db720b9a2e132b2b4085e1c60ae5d710d298d074f.jpg", "assets/2215cdfbc0931f82d4e1a90cb18225cf939d7e74711a53492be501cc1bdfc3ff.jpg", "assets/3b074144bb7c05087aeca14fedabc39def024de02a3c5a61325402db0f5db60f.jpg", "assets/30babe2bd7277823199759ed938c0c0767546e7e63c3348b52a575c7e829c4ca.jpg", "assets/a3cfe3e145075b7bda73a7d1def0caaf104cf44b8d1267ccb1cbe0bbedd68998.jpg", "assets/8660fe79083a2fda3fb212222a2c67dd31bdbe9bf4028753f384dfa1ea1d22cf.jpg", "assets/a486e7fab99bd338e8a267f83b15146ef641aa588721857267f5cc26aa645530.jpg", "assets/6f02f498466ebc8cde56d427af51ba7546afcff35643166b4d67310c27502355.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 0, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "斜坡", "翼突基底部", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-8159e1790fb1d175debe12c5", "patient_id": "patient-9aa3715525d6a6720ad66982", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/ad5665a714341ece513b4b960135819ae69cdeaf911a2c3f36f16da345c2e0c7.jpg", "assets/35bcba87e1086706da384452e2cb458e6de252c2d8859aab189674111aa0860c.jpg", "assets/54d4f3854bd161b51450cd918bf3f894a8e12dd7064720c7313a5e3a17986890.jpg", "assets/f068c0a1e071ea994744f559106601a04577222cbfe690a244b8f75b61e148ff.jpg", "assets/4d12dc6295ee59e9b79afd778fa7cc43867b59742cdbddb975a3c9f69e7de433.jpg", "assets/9deece9306d8fb1b4e13c43467a1bae4febe3f737d8940a542887645e50a7ad9.jpg", "assets/79d36890a3fe770c0948824125a1475fdd8ba5bfcdd7fb6be95b3e461ba6ff02.jpg", "assets/595ced86793752e368099aef036aa2d1b442a8fc53adde7eab5f09dc19aed369.jpg", "assets/7ef5562cc746c8c39b4ed1ab32b9eb16babef21b8b121516eaa5fcddad85810f.jpg", "assets/0c08b25aa8f7e308062097eb4adc70bcc73c7f012c0a4ecad6de1cb400bc47e9.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "斜坡", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-5edca731b395888f1c974eba", "patient_id": "patient-412a1cb9536aabf4688e2144", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/843abaf9d3e4871c36c489a3ad0d91ca4dc60fb869dea27d86460322f49d7f0a.jpg", "assets/17f2d977d32592e0dcc21a30d2afe0e98f59c3ab1215ba9e4d282641ab0ddb1d.jpg", "assets/2e20643f5209bce3ef331c4562ef9bead3796f5148b624900a803803c178ff2d.jpg", "assets/37fd6df3096419abade00f3e5e5fcc1a7b986a959aa5af566febe6c9492a75fa.jpg", "assets/941b5bf15e171162814b441ec30c44d04963c695356b4d56b1ff0adecfa31542.jpg", "assets/a4baef93419d01f0a1c10c87d2c4aefbc51105bdcf7431ac5802597837565a42.jpg", "assets/48089110eb538f6e7f1458875134f2a188cc3279f06270e03d879aaf039e9c9d.jpg", "assets/f80f1875cb6f5d47b328a9afa17dc3e6d34bc0438853f8da022fd72a0015a010.jpg", "assets/512ee5abcaf7bf234418c59de0c9ec8da4b06b7b09da49113f8199af6e6a1466.jpg", "assets/3f439ba38bb452cda6728b77b05f64baed6410f00301d3dfe210345c866e0129.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "斜坡", "翼突基底部", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-a926bcb19fede743a3ff33a8", "patient_id": "patient-003420d0da40426e1c7e0974", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/2dcc41101dfac600671f207085a860b20f4ae5e70c53df3c9b93f1dd0257794b.jpg", "assets/c63267d5b626cd1e44e7b44d06a8a2ee7e06d67c3e97d6adff5850fe318e4503.jpg", "assets/490ca46253a7b7ebaf040ae0d312214cdfcfe616671ce79a579a944fbe3a43b9.jpg", "assets/768b073785202e264f1f473fa7c82f0ed26417b47619a9549ba31b4084849e51.jpg", "assets/d22f0078deb161057026fbdefbf171764e53ebd9f2914fd9a23e886f5b0a9a3c.jpg", "assets/f27591c8c5db11a05fc576c97c27e4ae8a98c38770717f86b46f16efd327c9fe.jpg", "assets/bf62ec3afd3b31674685d7847cdd24d71746d6d4a0a6d52caac073bcd981a158.jpg", "assets/71fd7738c72f4be061ed33890597f44b14103decf5fcc405498f0f51851d63f5.jpg", "assets/43f26e754d29b3e83e92281d5545b59a68f02b678327f41b84540e353bb8de46.jpg", "assets/e081f87b33178fa62f2ccb9b9757bf20dcc097ed2c4069f6c49602b903f4e2e5.jpg"], "answer": {"T_stage": "T1", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 0, "咽旁间隙": 0, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 0, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-db1667d194c1789864c0cd1e", "patient_id": "patient-5800309a4e814fbcbd295754", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/61a08bb59579bfd1bc2095d01f0447fdd5e150acdb94a11208e8281ea4cf49ab.jpg", "assets/b728157bce82aa374bd1546bc3e2575be5ab682303fda9eeb3270afca8dc70ad.jpg", "assets/5299e83e7159300a4c375791cc9b656a0d0ffb881c456acca5d6707abc4a1c98.jpg", "assets/f7a3356b90e35b720b1def9e033471145c3eb87e701e736cbd3876b040474338.jpg", "assets/acaf19292fdbd6b9660100ead235395abe7c71b06c2da2ade713cfc446298744.jpg", "assets/5203fcc6f452e3466d16ad33fd298b5a903a102712a63c3f2a67ae4cbcc61489.jpg", "assets/6367dabf94a105f07e3bf051d052c19270934c2832c41788102c455a52b58247.jpg", "assets/d9e5c561726604779d41f409c5db9d9403f7a17f23493ab217a7f8bde49d0906.jpg", "assets/d241660d61ba3e5f6fba340cbd4ebcba3553bcf433f6cb82fd3cac9cbfd9352d.jpg", "assets/22a0c164a140c7d9a36eab4215d3e2d58731eaaf610ac15d11521990c25e56e7.jpg"], "answer": {"T_stage": "T4", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 1, "蝶窦": 1, "鼻腔": 0, "颈动脉鞘": 1, "翼外肌": 1, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 1, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "翼内肌", "蝶窦", "颈动脉鞘", "翼外肌", "斜坡", "海绵窦", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-21d034b231e0efc33d90aa62", "patient_id": "patient-a578b52d91765d2dc023e7ca", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/afa6f22d468a2d902634b335dd35752392cf1b00e457ba59c1ed3f32d59dc8bf.jpg", "assets/211df3ebc6bbf899035d35e0a7cdae88d733f0a04aae465aee71c4321ed4cc4c.jpg", "assets/c57da21ff8d328fa4a144fddfc72662c0287fc27483cc88becf566235c6ae52d.jpg", "assets/bf5011db9b28a5575c0461b14b04a5ff04f59214b7dbb0d0e977436d4e95a049.jpg", "assets/771335075f352765b2fe505ba80b5fe2cb88c5753caa6e6914dc0c17dc7a575b.jpg", "assets/6f01d85a192aa2d2a1325c52ecc95faec8cd9daf4a5dc78a964672ecc3c47a85.jpg", "assets/068b8d1b9f84e65e77ca2f9c202b122e981b362a0868146ac33042ebf2db76c9.jpg", "assets/4c1b24791b8ef997981e19aab6c037e59f68328d988e860e9977931fa546fc47.jpg", "assets/f75b4819fa3508dd6615608ea3b919aa8774dbd9cbe1c3721120e3af20806c63.jpg", "assets/1c744c304451c74ecf73ec8e6da79a16875fbe518326111e228db2dc65127b53.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-035ed2337a42b297993aa905", "patient_id": "patient-0adb245ab94b19ab3ec93940", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组基线MRI panel图像。\n\n任务：\n1. 逐项判断下列鼻咽外结构是否受侵犯，输出0或1。\n2. 基于结构侵犯判断AJCC第9版T分期。\n3. 给出简要影像依据。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出JSON；T_stage只能为T1、T2、T3或T4。", "images": ["assets/0b6e6d1ae6ad301b27e848a42bb89b482fa58f5221bdbc75c91875ac62aa6e41.jpg", "assets/6d12fb571bb0a9bed28934108adbeee32cbb04fc573642a592a575c71cd269a0.jpg", "assets/69fff995c8c7e2acf6db926c8be79ab948b1a6597f3b901ca718212bf8fe4691.jpg", "assets/c701d235c8a42e59f031f98a6e4548b6e1a49e860858a663539187e45dd7b242.jpg", "assets/16a0378934b7ef7c7547700226b3c22d30c5f59793fba0c2da3a7703a3cb969b.jpg", "assets/de66a544f931ef9f03548335ca5d63acbb7a553fae924e55db4527fef27e4d9e.jpg", "assets/9eb4e37acbfa83d69f821050097a4069e877cccc39a615a7526c204858072254.jpg", "assets/bb414c74f5614963d542de8a24f33b9c7be2ef33b2ad52e8dc20361753664d1c.jpg", "assets/b05e097af3eb06c51b90a87a8e9aeba6f2b713b58d5af69541a8fcd63af837d5.jpg", "assets/a9cbae7c908a3e1f5f1183f6575f336a117dc81f72a5f9e27133b76eb3726cad.jpg"], "answer": {"T_stage": "T4", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 1, "蝶窦": 0, "鼻腔": 1, "颈动脉鞘": 0, "翼外肌": 1, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 1, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "翼内肌", "鼻腔", "翼外肌", "斜坡", "海绵窦", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
diff --git a/L6/full100_inputs_scored217/data/pathology_samples.jsonl b/L6/full100_inputs_scored217/data/pathology_samples.jsonl
new file mode 100644
index 0000000000000000000000000000000000000000..7c537f2790f8754304ae7fad1ac49af022afc8c4
--- /dev/null
+++ b/L6/full100_inputs_scored217/data/pathology_samples.jsonl
@@ -0,0 +1,100 @@
+{"sample_id": "sample-e4cdc6e57d3d2abcf1f2d4b6", "patient_id": "patient-5fa48522b2703f35ead0224b", "task": "pathology_binary_npc_support", "prompt": "根据提供的病理图像，判断该病例是否支持鼻咽癌诊断。\n请仅输出 0 或 1。\n0 表示不支持鼻咽癌诊断；1 表示支持鼻咽癌诊断。", "images": ["assets/9ab8ce08101342bfbe7c4db6e9495dd9b426264e67722c569ea0914c52c25eba.jpg"], "answer": "1", "modality_source": "patient_matched"}
+{"sample_id": "sample-49e66b1ba0221a39c00aa767", "patient_id": "patient-5ee5dba6116030961a7a97b5", "task": "pathology_binary_npc_support", "prompt": "根据提供的病理图像，判断该病例是否支持鼻咽癌诊断。\n请仅输出 0 或 1。\n0 表示不支持鼻咽癌诊断；1 表示支持鼻咽癌诊断。", "images": ["assets/4c0e16e18582e977f7ef9436f51d31af22eaf2233c7cd7ab9bd3aa3248a38480.jpg"], "answer": "1", "modality_source": "patient_matched"}
+{"sample_id": "sample-c3fe2d73681610beec27dd74", "patient_id": "patient-867f2373fc1b04e0b8b80452", "task": "pathology_binary_npc_support", "prompt": "根据提供的病理图像，判断该病例是否支持鼻咽癌诊断。\n请仅输出 0 或 1。\n0 表示不支持鼻咽癌诊断；1 表示支持鼻咽癌诊断。", "images": ["assets/5d5c2f8b499a691297003604dc6e7679b4619d37b0d8c5e89d9f48d71f976c2d.jpg"], "answer": "1", "modality_source": "patient_matched"}
+{"sample_id": "sample-1bb43e39142ea1753e756ceb", "patient_id": "patient-9149023ec8599161ec3e5cfd", "task": "pathology_binary_npc_support", "prompt": "根据提供的病理图像，判断该病例是否支持鼻咽癌诊断。\n请仅输出 0 或 1。\n0 表示不支持鼻咽癌诊断；1 表示支持鼻咽癌诊断。", "images": ["assets/822181b81a298803011d41145940daefd4057805c98122a036224c49f8b010df.jpg"], "answer": "1", "modality_source": "patient_matched"}
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+{"sample_id": "sample-c287a9a97c2cff7b7171ec42", "patient_id": "patient-16c0f88f348c8b36a4e0ba3d", "task": "pathology_binary_npc_support", "prompt": "根据提供的病理图像，判断该图像是否支持鼻咽癌诊断。\n请仅输出 0 或 1。\n0 表示不支持鼻咽癌诊断；1 表示支持鼻咽癌诊断。\n说明：本图像为非患者特异的病理判别图像，不代表该患者本人的病理切片；请仅依据图像内容作答。", "images": ["assets/b59a4407beaffb6867da564ecb7092100a51dbf600d00f48c92b413b0050f5e6.jpg"], "answer": "1", "modality_source": "pathology_specimen_proxy"}
+{"sample_id": "sample-92e0b7699cbe4ae29fa6935e", "patient_id": "patient-23d7450690ac27c41cf2d08a", "task": "pathology_binary_npc_support", "prompt": "根据提供的病理图像，判断该图像是否支持鼻咽癌诊断。\n请仅输出 0 或 1。\n0 表示不支持鼻咽癌诊断；1 表示支持鼻咽癌诊断。\n说明：本图像为非患者特异的病理判别图像，不代表该患者本人的病理切片；请仅依据图像内容作答。", "images": ["assets/b43cd4568b88e1ab5b5f6f605f0f4619e543da513179cbdd0703b9d19cadb04e.jpg"], "answer": "1", "modality_source": "pathology_specimen_proxy"}
+{"sample_id": "sample-0aa5ecf5a58e921997c007a7", "patient_id": "patient-d0d7ee4ee410114ceb96522e", "task": "pathology_binary_npc_support", "prompt": "根据提供的病理图像，判断该图像是否支持鼻咽癌诊断。\n请仅输出 0 或 1。\n0 表示不支持鼻咽癌诊断；1 表示支持鼻咽癌诊断。\n说明：本图像为非患者特异的病理判别图像，不代表该患者本人的病理切片；请仅依据图像内容作答。", "images": ["assets/527e5cd50198944f7b407a5cd6867c6143ad4573708ed3f1f9bbe1d80214f956.jpg"], "answer": "1", "modality_source": "pathology_specimen_proxy"}
+{"sample_id": "sample-1823f1031d3286497784decb", "patient_id": "patient-1f701280917a20dc32022e52", "task": "pathology_binary_npc_support", "prompt": "根据提供的病理图像，判断该图像是否支持鼻咽癌诊断。\n请仅输出 0 或 1。\n0 表示不支持鼻咽癌诊断；1 表示支持鼻咽癌诊断。\n说明：本图像为非患者特异的病理判别图像，不代表该患者本人的病理切片；请仅依据图像内容作答。", "images": ["assets/af4cf2952f655c6140699d4db5c47dd7e114bf687a7dba0e76bc41fb562bc7fe.jpg"], "answer": "1", "modality_source": "pathology_specimen_proxy"}
+{"sample_id": "sample-6f08ba6dece1d8bb3759e0ac", "patient_id": "patient-49de37b11211aa728bd7cf39", "task": "pathology_binary_npc_support", "prompt": "根据提供的病理图像，判断该图像是否支持鼻咽癌诊断。\n请仅输出 0 或 1。\n0 表示不支持鼻咽癌诊断；1 表示支持鼻咽癌诊断。\n说明：本图像为非患者特异的病理判别图像，不代表该患者本人的病理切片；请仅依据图像内容作答。", "images": ["assets/a53293d4d36d8710d0afa7e305649e268543b54ac1bc9d44a4d188b213eaec4b.jpg"], "answer": "1", "modality_source": "pathology_specimen_proxy"}
+{"sample_id": "sample-3865dbbab3ecfb72316eaa79", "patient_id": "patient-aa7bbd78f73aee5acf2a27c4", "task": "pathology_binary_npc_support", "prompt": "根据提供的病理图像，判断该图像是否支持鼻咽癌诊断。\n请仅输出 0 或 1。\n0 表示不支持鼻咽癌诊断；1 表示支持鼻咽癌诊断。\n说明：本图像为非患者特异的病理判别图像，不代表该患者本人的病理切片；请仅依据图像内容作答。", "images": ["assets/3d75e932f6f20a49e2df94f7d3754ddf4766e0b027d84b0259f1e3bb760308c6.jpg"], "answer": "1", "modality_source": "pathology_specimen_proxy"}
+{"sample_id": "sample-4f7cd4952161ebbb98a7b51b", "patient_id": "patient-9aa3715525d6a6720ad66982", "task": "pathology_binary_npc_support", "prompt": "根据提供的病理图像，判断该图像是否支持鼻咽癌诊断。\n请仅输出 0 或 1。\n0 表示不支持鼻咽癌诊断；1 表示支持鼻咽癌诊断。\n说明：本图像为非患者特异的病理判别图像，不代表该患者本人的病理切片；请仅依据图像内容作答。", "images": ["assets/66d6998b345e8c1c837bef1bbb1836a04b3cb113485f797559b34fab02d1d00a.jpg"], "answer": "1", "modality_source": "pathology_specimen_proxy"}
+{"sample_id": "sample-94502e2b9a6bf109eca7bc49", "patient_id": "patient-412a1cb9536aabf4688e2144", "task": "pathology_binary_npc_support", "prompt": "根据提供的病理图像，判断该图像是否支持鼻咽癌诊断。\n请仅输出 0 或 1。\n0 表示不支持鼻咽癌诊断；1 表示支持鼻咽癌诊断。\n说明：本图像为非患者特异的病理判别图像，不代表该患者本人的病理切片；请仅依据图像内容作答。", "images": ["assets/7032422d444b62ed31ae264661e265a3c8d8f4f747dd2272450ba82689add7e9.jpg"], "answer": "1", "modality_source": "pathology_specimen_proxy"}
+{"sample_id": "sample-5b8a30336e51723d263344a7", "patient_id": "patient-003420d0da40426e1c7e0974", "task": "pathology_binary_npc_support", "prompt": "根据提供的病理图像，判断该图像是否支持鼻咽癌诊断。\n请仅输出 0 或 1。\n0 表示不支持鼻咽癌诊断；1 表示支持鼻咽癌诊断。\n说明：本图像为非患者特异的病理判别图像，不代表该患者本人的病理切片；请仅依据图像内容作答。", "images": ["assets/9ff65a0773ed0676690c76253277c442d0eba67540b8c678fb043b3c950aedec.jpg"], "answer": "1", "modality_source": "pathology_specimen_proxy"}
+{"sample_id": "sample-a4d2d1b7719bd1fb8ea89063", "patient_id": "patient-5800309a4e814fbcbd295754", "task": "pathology_binary_npc_support", "prompt": "根据提供的病理图像，判断该图像是否支持鼻咽癌诊断。\n请仅输出 0 或 1。\n0 表示不支持鼻咽癌诊断；1 表示支持鼻咽癌诊断。\n说明：本图像为非患者特异的病理判别图像，不代表该患者本人的病理切片；请仅依据图像内容作答。", "images": ["assets/3d5c498f4c14e0462e6f7c45157a58a697bac7948fd0f2622b5a80fa1d462c71.jpg"], "answer": "1", "modality_source": "pathology_specimen_proxy"}
+{"sample_id": "sample-063450cc1804626553e4d45e", "patient_id": "patient-a578b52d91765d2dc023e7ca", "task": "pathology_binary_npc_support", "prompt": "根据提供的病理图像，判断该图像是否支持鼻咽癌诊断。\n请仅输出 0 或 1。\n0 表示不支持鼻咽癌诊断；1 表示支持鼻咽癌诊断。\n说明：本图像为非患者特异的病理判别图像，不代表该患者本人的病理切片；请仅依据图像内容作答。", "images": ["assets/a400cfe7e5da75f0d42c4fb14d47de073c68969c2e58c01327bccf131beda83b.jpg"], "answer": "1", "modality_source": "pathology_specimen_proxy"}
+{"sample_id": "sample-63a8f970b69efacf1c1fe156", "patient_id": "patient-0adb245ab94b19ab3ec93940", "task": "pathology_binary_npc_support", "prompt": "根据提供的病理图像，判断该图像是否支持鼻咽癌诊断。\n请仅输出 0 或 1。\n0 表示不支持鼻咽癌诊断；1 表示支持鼻咽癌诊断。\n说明：本图像为非患者特异的病理判别图像，不代表该患者本人的病理切片；请仅依据图像内容作答。", "images": ["assets/9991e6713757453cd022cabac88d1c09028f08c43b63ab6d823b83376f3200dc.jpg"], "answer": "1", "modality_source": "pathology_specimen_proxy"}
diff --git a/L6/full100_inputs_scored217/data/patient_episodes.jsonl b/L6/full100_inputs_scored217/data/patient_episodes.jsonl
new file mode 100644
index 0000000000000000000000000000000000000000..e33f749f87c94d7459a5fb235e3445ba3ee1e9d6
--- /dev/null
+++ b/L6/full100_inputs_scored217/data/patient_episodes.jsonl
@@ -0,0 +1,100 @@
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+{"episode_id":"episode-84ee92caca381be71893520f","patient_id":"patient-5ee5dba6116030961a7a97b5","pathology_sample_id":"sample-49e66b1ba0221a39c00aa767","mri_sample_id":"sample-1207ed9082e2263a1d3782e0","oracle_tnm_context":"【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。","streaming_tnm_context_template":"【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。","ajcc_v9_gold":{"T":"T3","N":"N2","M":"M0","overall_stage":"II","overall_stage_evaluable":true},"structure_invasion_19_gold":{"鼻咽":1,"腭帆提肌":1,"咽旁间隙":1,"头长肌":0,"翼内肌":0,"蝶窦":0,"鼻腔":0,"颈动脉鞘":0,"翼外肌":0,"筛窦":0,"上颌窦":0,"斜坡":0,"海绵窦":0,"口咽":0,"翼突基底部":1,"蝶骨基底部":1,"岩尖":0,"寰椎":0,"枢椎":0},"unscored_care_turn_ids":[],"care_turns":[{"sample_id":"sample-de1b18b9f870f76853282d28","turn_id":"turn01","turn_type":"initial_workup_choice"},{"sample_id":"sample-8976031a638416cb5f037a59","turn_id":"turn04","turn_type":"initial_treatment_selection"},{"sample_id":"sample-5d943566dde88ca9f3640bc0","turn_id":"turn05","turn_type":"toxicity_or_support_decision"},{"sample_id":"sample-90c3b83f1d4c9db69ef01572","turn_id":"turn06","turn_type":"toxicity_or_support_decision"},{"sample_id":"sample-c2aa48d510cb846f4ee51384","turn_id":"turn08","turn_type":"response_assessment_decision"}]}
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new file mode 100644
index 0000000000000000000000000000000000000000..7720cbbd831e1b82c31be6ff96c9c651141ab497
--- /dev/null
+++ b/L6/full100_inputs_scored217/dataset_manifest.json
@@ -0,0 +1,13 @@
+{
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+  "scoring_contract_sha256": "68add94878b40f4d17f3dc5d412f2b55412a4df29a6083caa8f32961705a0eca"
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diff --git a/L6/full100_inputs_scored217/file_manifest.json b/L6/full100_inputs_scored217/file_manifest.json
new file mode 100644
index 0000000000000000000000000000000000000000..7ff8200da528a59c4b36c8a036113ad8facc3271
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+++ b/L6/full100_inputs_scored217/file_manifest.json
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diff --git a/L6/full100_inputs_scored217/scoring_contract.json b/L6/full100_inputs_scored217/scoring_contract.json
new file mode 100644
index 0000000000000000000000000000000000000000..d9ba7cbbb11aee0e2305e91224a2db4c64538bd5
--- /dev/null
+++ b/L6/full100_inputs_scored217/scoring_contract.json
@@ -0,0 +1,267 @@
+{
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+  "version": "full100_scored217_v1_20261026",
+  "decision_date": "2026-10-26",
+  "decision_timezone": "Asia/Shanghai",
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+    "ordered_vs_administered_unresolved": "Ordered and administered medicines were combined without establishing the same executed treatment regimen.",
+    "stopped_order_in_gold_action": "The proposed action includes a medicine associated with a stopped order in the source excerpt.",
+    "staging_source_disagreement": "The checkpoint staging condition and later source staging statement disagree and have not been adjudicated.",
+    "radiotherapy_omitted_from_gold_action": "Radiotherapy appears in the source while the generated gold action represents medicines only.",
+    "decision_time_boundary_unresolved": "The later treatment record does not establish a unique decision at the earlier checkpoint."
+  },
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+    "strict_episode": 100,
+    "pathology": 100,
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+    "hardcore_care": 93
+  },
+  "strict_episode_definition": "pathology_correct AND MRI_T_correct AND all retained scored care_turns correct",
+  "excluded_nodes_count_as": "neither_correct_nor_incorrect; absent_from_all_scoring_masks",
+  "separate_safety_endpoint_measured": false,
+  "answer_parser_status": "revision_required; membership_confirmation_does_not_validate_parser",
+  "parent_care_sha256": "1bec4c712ffa55702a6b815af6ad5cfae7da4cb75f62f86826b63c7e531cad62",
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+  "episodes_sha256": "3a970221b99ee2c252ac5ece30b8e14311e9191e9fc1c36413b26ee4ed69096f",
+  "hardcore_sha256": "c415f31808ed22b579039f6983c22671dd79e499be729d33992c50b71c62dbf8"
+}
diff --git a/L6/full100_inputs_scored217/unscored/care_pending_review.jsonl b/L6/full100_inputs_scored217/unscored/care_pending_review.jsonl
new file mode 100644
index 0000000000000000000000000000000000000000..4961c110e4f001f210dda60ee21a1fec9a549b04
--- /dev/null
+++ b/L6/full100_inputs_scored217/unscored/care_pending_review.jsonl
@@ -0,0 +1,6 @@
+{"sample_id":"sample-12f314190f742e35d1b0beb6","patient_id":"patient-30c44ba207e66a3175f648ed","episode_id":"episode-4d56ed64ec75115988b7cbac","turn_id":"P4_01","status":"unscored_pending_item_review"}
+{"sample_id":"sample-7b65ce668408f9ea66544af8","patient_id":"patient-4912d2bc95150726fba7d603","episode_id":"episode-73bafcd2d14697159b5d1b7b","turn_id":"P4_01","status":"unscored_pending_item_review"}
+{"sample_id":"sample-79529e369270dc3a5c7c0a67","patient_id":"patient-641b087096be76a631a78061","episode_id":"episode-ebfee8142953531864f40945","turn_id":"P4_01","status":"unscored_pending_item_review"}
+{"sample_id":"sample-609d2981b7532ea640d0fd4b","patient_id":"patient-16c0f88f348c8b36a4e0ba3d","episode_id":"episode-dab7f4ebfe3b20b0503fd7e4","turn_id":"P4_01","status":"unscored_pending_item_review"}
+{"sample_id":"sample-c696f0a618cfe7777e966bd2","patient_id":"patient-393a69d1a905e05600212d51","episode_id":"episode-316ca44099c55186ce6cf1ad","turn_id":"P4_01","status":"unscored_pending_item_review"}
+{"sample_id":"sample-53a6f549f066ad1e543508ec","patient_id":"patient-9aa3715525d6a6720ad66982","episode_id":"episode-7520d0606065154fbfaf68dc","turn_id":"P4_01","status":"unscored_pending_item_review"}
diff --git a/LICENSE b/LICENSE
new file mode 100644
index 0000000000000000000000000000000000000000..13ca539f377dc705af32b8d2ce89262298ea2f06
--- /dev/null
+++ b/LICENSE
@@ -0,0 +1,156 @@
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diff --git a/LICENSE-DATA.md b/LICENSE-DATA.md
new file mode 100644
index 0000000000000000000000000000000000000000..6313964729b44ff493fad6d474002e94dcee4cc9
--- /dev/null
+++ b/LICENSE-DATA.md
@@ -0,0 +1,13 @@
+# Data license
+
+The original NPCBench datasets and annotations are licensed under the
+[Creative Commons Attribution 4.0 International License](https://creativecommons.org/licenses/by/4.0/).
+Copyright (c) 2026 NPCBench contributors.
+
+This license applies to the authors' original benchmark questions, case
+representations, annotations, and authorized de-identified assets in this dataset. Cite NPCBench, retain attribution, and indicate
+modifications. The full legal terms are in `LICENSE`.
+
+Third-party source publications, guideline texts, model software/weights and
+other separately identified material retain their own terms. This grant does
+not relicense those materials. See `THIRD_PARTY_NOTICES.md`.
diff --git a/O1/README.md b/O1/README.md
new file mode 100644
index 0000000000000000000000000000000000000000..c5d3332529bf41f3bdd8155aced448d954022ba5
--- /dev/null
+++ b/O1/README.md
@@ -0,0 +1,7 @@
+# O1 · Specialist consultation
+
+O1 contains 103 questions from 42 cases. `questions.jsonl` provides case information and consultation questions; `rubrics.jsonl` provides 1,726 weighted criteria.
+
+The 1,069 positive criteria cover core conclusions, supporting evidence and conditional recommendations. The 657 negative criteria cover 337 major and 320 minor errors. A true positive criterion earns credit; a true negative criterion incurs its specified deduction.
+
+Generate one answer per question, then judge each criterion against that answer. The paper uses GPT-OSS-120B as its default judge. Scores average questions equally; case-weighted results are reported separately.
diff --git a/O1/questions.jsonl b/O1/questions.jsonl
new file mode 100644
index 0000000000000000000000000000000000000000..18f7413f7f16a686b5911b0d8aed0ae50021c98b
--- /dev/null
+++ b/O1/questions.jsonl
@@ -0,0 +1,103 @@
+{"item_id":"o1-item-bc8a8ffffdf84e723bc11793","case_id":"o1-case-96da46650d70bb7c66a94275","patient_id":"o1-patient-d3eaa78b08ec4168c5a45e0d","tag":"AE_GENERAL","question":"结合当前资料，该患者当前不良反应的类型及严重程度是什么？","case_input":"【病情摘要】\n患者女，35岁。\n2022年出现症状，病程第16天入院。\n因反复流脓涕、头晕2年就诊。\n2022年出现流脓涕，伴有头晕，无回吸性血痰，无耳鸣、听力下降，无头痛，无视物模糊、视物重影。\n某医院，行鼻窦CT：鼻咽腔狭窄，鼻咽顶后壁及左侧壁不规则增厚，性质待定。病理（病程第0天056910）：未分化型非角化性癌。某医院，鼻咽镜（病程第2天）：右侧鼻腔狭窄，鼻腔呈术后改变，鼻咽顶后壁可见新生物，双侧咽隐窝对称。病理会诊（病程第2天[记录编号已隐去]）：（鼻咽肿物）考虑为鳞状细胞癌。颈部+鼻咽MRI：鼻咽双侧壁、顶后壁增厚，左侧腭帆提肌似受累，腭帆张肌、左侧翼内板、上颌窦内侧壁受累，右侧腭帆提肌似受累，符合鼻咽癌表现。2.双侧咽后及双侧颈部淋巴结，性质待定。3.右侧鼻腔呈术后改变，右侧鼻腔局部粘连、狭窄。胸部+上腹部增强CT、ECT未见明确转移灶。EBV-DNA阴性。\n病理会诊（病程第6天[记录编号已隐去]）：考虑为未分化型非角化性癌。原单位免疫组化结果：CK-H（+），CK7（-），CK5/6（+），CK19（+），P53（部分+），LCA（-），EBV（-）。颈部+鼻咽部MR平扫+增强（病程第13天）：鼻咽腔狭窄，鼻咽双侧顶壁、双侧顶后壁、双侧后壁、双侧壁增厚，双侧咽隐窝受侵。左侧后鼻道受侵。双侧咽旁间隙受侵。双侧腭帆提肌、双侧腭帆张肌受侵。余咽旁肌未见明显异常。双侧翼突基底部受侵。左侧翼腭窝受侵。检查诊断：鼻咽病变，考虑鼻咽癌。颅底骨质破坏。双侧咽后数个肿大淋巴结，考虑转移。颈部双侧II区、双侧III区、双侧IV区、双侧V区见数个小淋巴结，可疑转移瘤。\n既往体健。\n外公患有胃癌，已故，外婆患有食管癌，已故。\n\n【本次经过】\n病程第19天患者诉皮肤瘙痒。","rubric_template_structured":{"total_score":10.0,"core_answer":["不良反应：皮肤瘙痒（pruritus）","严重程度：资料不足，仅能判为严重程度不详的皮肤不良反应"],"key_evidence":["症状证据：患者于病程第19天自诉出现皮肤瘙痒","分级证据：资料未提供瘙痒分布范围、持续时间、伴随皮疹情况","分级证据：资料未见干预措施及对睡眠或日常生活影响等CTCAE分级所需信息"],"conditional_modifiers":["资料不足时：在未补充分布、持续时间及生活影响前，应保守表述为严重程度不详","资料补充时：如提示影响睡眠或日常生活、需系统药物干预，可按CTCAE标准进一步具体分级"],"negative_list":{"major_errors":["将主要不良反应误写为非皮肤事件，或未识别皮肤瘙痒作为当前主要表现","缺乏范围、持续时间和生活影响等信息时，仍给出具体CTCAE分级结论"],"minor_errors":["笼统描述如“有不适”或“皮肤不良反应”，未明确为皮肤瘙痒","未说明资料不足，仍武断判为“轻度”或“中度”等无依据的严重程度","只写“皮肤瘙痒”但未提示资料不全或“严重程度不详”"]},"scoring_rules":{"item_scores":{"core_answer":[3.0,3.0],"key_evidence":[0.67,0.67,0.66],"conditional_modifiers":[1.0,1.0]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-52547ed4500a588e168a5790","case_id":"o1-case-96da46650d70bb7c66a94275","patient_id":"o1-patient-d3eaa78b08ec4168c5a45e0d","tag":"AE_GENERAL","question":"针对该患者当前不良反应，应采取哪些处理和监测措施？","case_input":"【病情摘要】\n患者女，35岁。\n2022年出现症状，病程第16天入院。\n因反复流脓涕、头晕2年就诊。\n2022年出现流脓涕，伴有头晕，无回吸性血痰，无耳鸣、听力下降，无头痛，无视物模糊、视物重影。\n某医院，行鼻窦CT：鼻咽腔狭窄，鼻咽顶后壁及左侧壁不规则增厚，性质待定。病理（病程第0天056910）：未分化型非角化性癌。某医院，鼻咽镜（病程第2天）：右侧鼻腔狭窄，鼻腔呈术后改变，鼻咽顶后壁可见新生物，双侧咽隐窝对称。病理会诊（病程第2天[记录编号已隐去]）：（鼻咽肿物）考虑为鳞状细胞癌。颈部+鼻咽MRI：鼻咽双侧壁、顶后壁增厚，左侧腭帆提肌似受累，腭帆张肌、左侧翼内板、上颌窦内侧壁受累，右侧腭帆提肌似受累，符合鼻咽癌表现。2.双侧咽后及双侧颈部淋巴结，性质待定。3.右侧鼻腔呈术后改变，右侧鼻腔局部粘连、狭窄。胸部+上腹部增强CT、ECT未见明确转移灶。EBV-DNA阴性。\n病理会诊（病程第6天[记录编号已隐去]）：考虑为未分化型非角化性癌。原单位免疫组化结果：CK-H（+），CK7（-），CK5/6（+），CK19（+），P53（部分+），LCA（-），EBV（-）。颈部+鼻咽部MR平扫+增强（病程第13天）：鼻咽腔狭窄，鼻咽双侧顶壁、双侧顶后壁、双侧后壁、双侧壁增厚，双侧咽隐窝受侵。左侧后鼻道受侵。双侧咽旁间隙受侵。双侧腭帆提肌、双侧腭帆张肌受侵。余咽旁肌未见明显异常。双侧翼突基底部受侵。左侧翼腭窝受侵。检查诊断：鼻咽病变，考虑鼻咽癌。颅底骨质破坏。双侧咽后数个肿大淋巴结，考虑转移。颈部双侧II区、双侧III区、双侧IV区、双侧V区见数个小淋巴结，可疑转移瘤。\n既往体健。\n外公患有胃癌，已故，外婆患有食管癌，已故。\n\n【本次经过】\n病程第19天患者诉皮肤瘙痒。","rubric_template_structured":{"total_score":10.0,"core_answer":["评估：判断瘙痒严重度、范围及皮肤黏膜体征","对症：给予合适止痒药物及皮肤护理，注意用药禁忌","病因：复盘近期用药、过敏史和基础疾病，初步排查原因","监测：动态记录瘙痒及皮损变化，关注病情进展信号","宣教：告知重症预警表现，出现危险征象及时就医"],"key_evidence":["瘙痒证据：仅记载“病程第19天患者诉皮肤瘙痒”，未描述皮疹、水疱、脱屑、紫癜或黏膜受累等客观体征，提示目前为主观瘙痒主诉","处理证据：未见明确肝肾功能异常或特定药物暴露信息，当前以对症止痒、生活护理、初步病因排查和动态监测为主，并需教育识别重症皮肤不良反应预警信号"],"conditional_modifiers":["病因补充：如发现肝肾功能异常、胆汁淤积、甲状腺或血液系统疾病，应在对症止痒基础上处理原发病","药物关联：如瘙痒前后新启或调整抗肿瘤药、抗生素、解热镇痛药或阿片类等，应结合时间关系评估药物性皮疹可能，必要时调整或暂停可疑药物并专科会诊","升级处理：如瘙痒加重明显影响生活，或出现皮疹、黏膜受累、全身症状，应尽早皮肤科/过敏专科评估并升级治疗"],"negative_list":{"major_errors":["在缺乏用药时间关系和其他证据时，将单纯瘙痒肯定归因于某一特定抗肿瘤药物并套用其毒性管理流程","无皮疹、黏膜受累或全身症状证据时，直接诊断SJS/TEN/DRESS等重症药疹并常规推荐大剂量糖皮质激素或强免疫抑制治疗","对瘙痒主诉完全不评估不处理，仅写“无需处理”或“观察即可”，无止痒、护理、病因排查或随访安排"],"minor_errors":["仅给药物止痒方案，未提基础皮肤护理与生活指导如避免搔抓、保湿等","未提动态记录瘙痒程度及对睡眠、生活影响，也未提醒观察皮疹、脱屑、黏膜受累等变化及加重时就医","病因分析过于单一，仅归因“过敏”或“皮肤干燥”，未体现结合用药史、过敏史和必要检查排查药物性反应或系统性疾病","建议停药或换药时未强调需结合用药时间关系、病情轻重及专科会诊"]},"scoring_rules":{"item_scores":{"core_answer":[1.2,1.2,1.2,1.2,1.2],"key_evidence":[1.0,1.0],"conditional_modifiers":[0.67,0.67,0.66]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-f71d3f4851aa17b53248d4de","case_id":"o1-case-96da46650d70bb7c66a94275","patient_id":"o1-patient-d3eaa78b08ec4168c5a45e0d","tag":"AE_GENERAL","question":"待该患者不良反应缓解后，后续抗肿瘤治疗应如何恢复、延期或调整？","case_input":"【病情摘要】\n患者女，35岁。\n2022年出现症状，病程第16天入院。\n因反复流脓涕、头晕2年就诊。\n2022年出现流脓涕，伴有头晕，无回吸性血痰，无耳鸣、听力下降，无头痛，无视物模糊、视物重影。\n某医院，行鼻窦CT：鼻咽腔狭窄，鼻咽顶后壁及左侧壁不规则增厚，性质待定。病理（病程第0天056910）：未分化型非角化性癌。某医院，鼻咽镜（病程第2天）：右侧鼻腔狭窄，鼻腔呈术后改变，鼻咽顶后壁可见新生物，双侧咽隐窝对称。病理会诊（病程第2天[记录编号已隐去]）：（鼻咽肿物）考虑为鳞状细胞癌。颈部+鼻咽MRI：鼻咽双侧壁、顶后壁增厚，左侧腭帆提肌似受累，腭帆张肌、左侧翼内板、上颌窦内侧壁受累，右侧腭帆提肌似受累，符合鼻咽癌表现。2.双侧咽后及双侧颈部淋巴结，性质待定。3.右侧鼻腔呈术后改变，右侧鼻腔局部粘连、狭窄。胸部+上腹部增强CT、ECT未见明确转移灶。EBV-DNA阴性。\n病理会诊（病程第6天[记录编号已隐去]）：考虑为未分化型非角化性癌。原单位免疫组化结果：CK-H（+），CK7（-），CK5/6（+），CK19（+），P53（部分+），LCA（-），EBV（-）。颈部+鼻咽部MR平扫+增强（病程第13天）：鼻咽腔狭窄，鼻咽双侧顶壁、双侧顶后壁、双侧后壁、双侧壁增厚，双侧咽隐窝受侵。左侧后鼻道受侵。双侧咽旁间隙受侵。双侧腭帆提肌、双侧腭帆张肌受侵。余咽旁肌未见明显异常。双侧翼突基底部受侵。左侧翼腭窝受侵。检查诊断：鼻咽病变，考虑鼻咽癌。颅底骨质破坏。双侧咽后数个肿大淋巴结，考虑转移。颈部双侧II区、双侧III区、双侧IV区、双侧V区见数个小淋巴结，可疑转移瘤。\n既往体健。\n外公患有胃癌，已故，外婆患有食管癌，已故。\n\n【本次经过】\n病程第19天患者诉皮肤瘙痒。","rubric_template_structured":{"total_score":10.0,"core_answer":["前提澄清：目前无任何已实施抗肿瘤治疗，不存在对既往方案的恢复或调整","总体策略：瘙痒缓解或排除禁忌后，应按原计划制定并启动鼻咽癌初始抗肿瘤治疗","启动时机：如瘙痒严重、进展或伴系统危险信号，未明原因前可暂缓开启全身抗肿瘤治疗","后续监测：正式启动抗肿瘤治疗后，以本次皮肤症状为基线动态监测皮肤毒性"],"key_evidence":["治疗记录证据：病历中无化疗、放疗、靶向或免疫等已实施治疗记录","疾病阶段证据：新诊断鼻咽癌，处于初治阶段需尽快制定放化疗等系统治疗方案"],"conditional_modifiers":["瘙痒轻微时：若仅为皮肤干燥或轻度过敏，经对症处理缓解，不应因瘙痒延迟按时启动初始抗肿瘤治疗","再发瘙痒处理：未来治疗期间如瘙痒加重或新发皮疹，应结合用药时间按药物不良反应原则重新分级，决定是否延期或调整剂量"],"negative_list":{"major_errors":["忽视尚未实施抗肿瘤治疗事实，虚构患者正接受某特定方案并提出剂量调整、停药或恢复等建议","将本次皮肤瘙痒视为抗肿瘤治疗绝对禁忌，完全否定后续治疗且未权衡肿瘤治疗获益"],"minor_errors":["未指出当前为初治阶段，泛泛套用“轻度继续、重度停药”原则","未提及开启抗肿瘤治疗后需对皮肤不良反应进行动态监测"]},"scoring_rules":{"item_scores":{"core_answer":[1.5,1.5,1.5,1.5],"key_evidence":[1.0,1.0],"conditional_modifiers":[1.0,1.0]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-8652d9f7bafcc85e75768212","case_id":"o1-case-af90006571e0f8ca062f96c1","patient_id":"o1-patient-4e48f82d28ad8114279e1188","tag":"AE_GENERAL","question":"结合当前资料，该患者当前不良反应的类型及严重程度是什么？","case_input":"【病情摘要】\n患者女，37岁。\n20年前发现左颈部肿物，病程第0天感肿物增大，病程第24天入院。\n发现左颈部淋巴结肿大20年，增大1年。\n20年前发现左颈部肿物，约1-2cm大小，无痛，逐渐加重。病程第0天突感左颈部轻微疼痛且发现肿物增大。\n病程第0天某医院，MRI检查发现鼻咽顶后壁肿物，左颈部淋巴结肿大，考虑转移。鼻咽镜见鼻咽顶后壁肿物，活检病理示鼻咽非角化性鳞状细胞癌。\n病程第18天我院电子鼻咽镜检查鼻咽右顶后壁可见肿物。病理显示（鼻咽右顶后壁）未分化型非角化性癌。免疫组化：CK(AE1/AE3)（+），EGFR（+）原位杂交：EBERs（+）。病程第23天 PET/CT全身显像：鼻咽右顶壁、顶后壁右份病灶代谢略活跃，符合鼻咽癌；左颈IIb区淋巴结代谢较活跃，考虑转移；双侧咽后淋巴结代谢略活跃，疑转移。\n既往体健。\n否认家族中有恶性肿瘤病史。\n鼻咽未分化型非角化性癌。\n\n【本次经过】\n病程第25天于我院首次行吉西他滨+顺铂化疗，点滴快结束时突发呼吸困难、双手抖动、全身不适，被迫停止输注。\n{病程第24天: 白蛋白(ALB) 38.7 g/L ↓, 丙氨酸氨基转移酶(ALT) 53.2 U/L ↑, 血红蛋白(Hb) 113.0 g/L ↓}","rubric_template_structured":{"total_score":10.0,"core_answer":["不良反应：化疗药物（吉西他滨/顺铂）相关输注/过敏反应","严重程度：至少CTCAE 2级，需中断输注或停止当次治疗"],"key_evidence":["时间证据：吉西他滨+顺铂点滴将毕突发呼吸困难、双手抖动、全身不适，与输注时间紧密相关","严重度证据：因上述急性症状被迫停止输注，达到需中断治疗级别"],"conditional_modifiers":[],"negative_list":{"major_errors":["误判为感染、心源性等化疗输注无关反应，忽略与化疗同步发生；","将严重程度定为CTCAE 1级或认为无需干预；","将贫血、轻度肝功能异常、低白蛋白血症作为当前主要不良反应，忽视急性输注相关表现。"],"minor_errors":["仅表述为“输液反应”或“一过性不适”，未点明化疗药物相关性；","未描述症状与化疗输注当日密切相关；","严重程度仅用“轻中度”模糊表述，未明确已达需中断输注或停止治疗标准"]},"scoring_rules":{"item_scores":{"core_answer":[4.0,4.0],"key_evidence":[1.0,1.0],"conditional_modifiers":[]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-7e04f1778e254f72b10cb2e7","case_id":"o1-case-af90006571e0f8ca062f96c1","patient_id":"o1-patient-4e48f82d28ad8114279e1188","tag":"AE_GENERAL","question":"针对该患者当前不良反应，应采取哪些处理和监测措施？","case_input":"【病情摘要】\n患者女，37岁。\n20年前发现左颈部肿物，病程第0天感肿物增大，病程第24天入院。\n发现左颈部淋巴结肿大20年，增大1年。\n20年前发现左颈部肿物，约1-2cm大小，无痛，逐渐加重。病程第0天突感左颈部轻微疼痛且发现肿物增大。\n病程第0天某医院，MRI检查发现鼻咽顶后壁肿物，左颈部淋巴结肿大，考虑转移。鼻咽镜见鼻咽顶后壁肿物，活检病理示鼻咽非角化性鳞状细胞癌。\n病程第18天我院电子鼻咽镜检查鼻咽右顶后壁可见肿物。病理显示（鼻咽右顶后壁）未分化型非角化性癌。免疫组化：CK(AE1/AE3)（+），EGFR（+）原位杂交：EBERs（+）。病程第23天 PET/CT全身显像：鼻咽右顶壁、顶后壁右份病灶代谢略活跃，符合鼻咽癌；左颈IIb区淋巴结代谢较活跃，考虑转移；双侧咽后淋巴结代谢略活跃，疑转移。\n既往体健。\n否认家族中有恶性肿瘤病史。\n鼻咽未分化型非角化性癌。\n\n【本次经过】\n病程第25天于我院首次行吉西他滨+顺铂化疗，点滴快结束时突发呼吸困难、双手抖动、全身不适，被迫停止输注。\n{病程第24天: 白蛋白(ALB) 38.7 g/L ↓, 丙氨酸氨基转移酶(ALT) 53.2 U/L ↑, 血红蛋白(Hb) 113.0 g/L ↓}","rubric_template_structured":{"total_score":10.0,"core_answer":["立即停止吉西他滨+顺铂等化疗，保持静脉通路，通知上级或急救团队，评估处理方案","按ABCs评估气道、呼吸、循环及意识，监测生命体征，必要时予氧疗","床旁记录不良反应发生时间、持续时间、用药种类剂量、用药时间与症状关系及伴随表现","根据症状轻重给予氧疗、支气管扩张剂、镇静/止吐、补液等支持治疗","症状缓解后继续观察，完整记录病程和处理，评估对后续化疗的影响"],"key_evidence":["37岁女性，鼻咽未分化型非角化癌，病程第25天首次行吉西他滨+顺铂化疗","病程第25天化疗点滴将结束时出现呼吸困难、双手抖动、全身不适，发生在用药当天，符合急性输注相关/过敏反应特征","病程第24天ALB 38.7 g/L、ALT 53.2 U/L、Hb 113.0 g/L，提示轻度肝功能异常及贫血，需在评估不良反应和后续治疗时考虑"],"conditional_modifiers":["如呼吸困难进行性加重、喘鸣、血压下降或意识改变，应在确保气道和氧疗基础上，立即启动急救流程，按指南给予肾上腺素等抢救及高级生命支持","如本次反应轻微、短暂且生命体征稳定，可在症状完全缓解并经专业评估后，考虑在加强预处理和减慢输注速度前提下谨慎再次应用相关化疗，并制订严密监测预案","如后续ALT升高或贫血等实验室异常持续/加重，应评估与吉西他滨/顺铂相关性，在后续化疗中考虑减量、更换方案或延迟治疗，并加强实验室监测"],"negative_list":{"major_errors":["未提出急性不良反应出现时立即停止相关化疗输注","未提出对气道、呼吸、循环及生命体征的评估和监测","症状未缓解或原因未明情况下仍继续或加快化疗输注","将急性症状仅归为慢性毒性，未识别和处理急性输注反应或过敏反应"],"minor_errors":["未提及记录不良反应发生时间、用药及症状演变以评估与化疗药物关系","未指出氧疗、支气管扩张剂、抗组胺或糖皮质激素等必要对症支持措施","未提及反应缓解后继续观察、完善检查及评估对后续治疗影响"]},"scoring_rules":{"item_scores":{"core_answer":[1.2,1.2,1.2,1.2,1.2],"key_evidence":[0.67,0.67,0.66],"conditional_modifiers":[0.67,0.67,0.66]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-f28007f34c91dec8c74a8c78","case_id":"o1-case-af90006571e0f8ca062f96c1","patient_id":"o1-patient-4e48f82d28ad8114279e1188","tag":"AE_GENERAL","question":"待该患者不良反应缓解后，后续抗肿瘤治疗应如何恢复、延期或调整？","case_input":"【病情摘要】\n患者女，37岁。\n20年前发现左颈部肿物，病程第0天感肿物增大，病程第24天入院。\n发现左颈部淋巴结肿大20年，增大1年。\n20年前发现左颈部肿物，约1-2cm大小，无痛，逐渐加重。病程第0天突感左颈部轻微疼痛且发现肿物增大。\n病程第0天某医院，MRI检查发现鼻咽顶后壁肿物，左颈部淋巴结肿大，考虑转移。鼻咽镜见鼻咽顶后壁肿物，活检病理示鼻咽非角化性鳞状细胞癌。\n病程第18天我院电子鼻咽镜检查鼻咽右顶后壁可见肿物。病理显示（鼻咽右顶后壁）未分化型非角化性癌。免疫组化：CK(AE1/AE3)（+），EGFR（+）原位杂交：EBERs（+）。病程第23天 PET/CT全身显像：鼻咽右顶壁、顶后壁右份病灶代谢略活跃，符合鼻咽癌；左颈IIb区淋巴结代谢较活跃，考虑转移；双侧咽后淋巴结代谢略活跃，疑转移。\n既往体健。\n否认家族中有恶性肿瘤病史。\n鼻咽未分化型非角化性癌。\n\n【本次经过】\n病程第25天于我院首次行吉西他滨+顺铂化疗，点滴快结束时突发呼吸困难、双手抖动、全身不适，被迫停止输注。\n{病程第24天: 白蛋白(ALB) 38.7 g/L ↓, 丙氨酸氨基转移酶(ALT) 53.2 U/L ↑, 血红蛋白(Hb) 113.0 g/L ↓}","rubric_template_structured":{"total_score":10.0,"core_answer":["输注反应定性：伴呼吸困难的即刻输注/过敏样反应，至少按中重度风险评估","恢复前评估：待症状完全缓解后，重新评估CTCAE分级、生命体征稳定性、再次暴露风险和抗肿瘤治疗获益","重度反应处理：重度/严重过敏反应（CTCAE 3–4级、呼吸/循环受累或疑似过敏性休克）原则上停用原致敏药，改用替代方案；仅无替代且获益明确时，于专科或严密监护下考虑脱敏/延长输注。","轻中度反应处理：若为轻中度输注反应且症状完全缓解、生命体征稳定，可在加强预处理、减慢输注速率并严密监测下谨慎重启，一旦复发立即停止并升级处理"],"key_evidence":["输注反应依据：病程第25天首次吉西他滨＋顺铂输注将结束时，出现呼吸困难、双手抖动及全身不适并停止后续治疗，提示即时系统性反应，需按至少中重度风险评估。","恢复治疗依据：结合反应严重度、症状是否完全缓解、生命体征稳定性、再次暴露风险及抗肿瘤治疗获益，决定是否恢复。","分级处置依据：轻中度反应缓解后可减慢滴速、加强预处理并谨慎重启；重度/严重过敏反应应避免原致敏药，仅无替代时考虑脱敏。","综合治疗证据：患者为鼻咽未分化型非角化性癌，需后续系统性抗肿瘤治疗（如放疗或同步放化疗），需在保证输注安全前提下恢复或调整方案，而非长期中断抗肿瘤治疗"],"conditional_modifiers":["脱敏边界：重度或危及生命的过敏反应，可在过敏专科评估下讨论特定致敏药物脱敏，但常规以停用致敏药物、改用替代方案或调整综合治疗路径为主","综合路径：若有既往过敏史或心肺基础病、再次输注风险高，可优先考虑放疗、同步放化疗或其他可替代系统治疗，避免因输注风险延误整体治疗","重启与预处理：轻中度输注反应症状消退后重启同类药物时，减慢输注速度，并给予抗组胺药和/或糖皮质激素预处理。","重启监护：轻中度输注反应症状消退后重启同类药物时，加强生命体征及呼吸循环监测；症状再现即停药并按急性过敏反应处理。"],"negative_list":{"major_errors":["误判伴呼吸困难的即刻输注反应为轻度不适，未充分评估和无监护下继续或尽快重启原方案","已高度怀疑或明确为重度/严重过敏反应时，无减量、无预处理、无监护地机械恢复原致敏方案，且不考虑停药或更换方案或脱敏","仅提出永久停治或放弃抗肿瘤治疗，未结合鼻咽癌合理替代治疗"],"minor_errors":["未提出需待本次不良反应完全缓解并重新评估严重程度后再恢复抗肿瘤治疗","建议重启同类药物或原方案时，未提及需减慢输注速度或加强预处理、严密监护","换药或调整方案表述笼统，未结合本病种标准治疗，缺乏具体可行的替代路径"]},"scoring_rules":{"item_scores":{"core_answer":[1.5,1.5,1.5,1.5],"key_evidence":[0.5,0.5,0.5,0.5],"conditional_modifiers":[0.5,0.5,0.5,0.5]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-5a038c2e12ed9c34decbbcab","case_id":"o1-case-45cc86cfd90d4fed550d065a","patient_id":"o1-patient-215ed92abb14a454c63f5a14","tag":"AE_GENERAL","question":"结合本次肝功能异常经过，请判断主要异常类型及发生期间的最高严重程度，并说明当前恢复趋势。","case_input":"【病情摘要】\n患者男，46岁。\n2月前出现症状，病程第26天入院。\n头痛2月，加重1月，伴重影、耳鸣、吞咽困难。\n2月前无明显诱因出现左侧颞部疼痛，可耐受。1月前疼痛加重，影响睡眠，出现左侧口咽歪斜。病程第14天出现左侧面瘫，左侧上眼睑稍下垂，左眼视物模糊、重影，左耳耳鸣、听力下降，吞咽困难，声音嘶哑。\n病程第0天某医院，诊断为周围性面神经麻痹、三叉神经痛，给予中医药治疗及止痛、营养神经等对症治疗。病程第16天某医院，住院期间给予抗病毒、护肝治疗（具体不详）。\n病程第16天头颅MRI：鼻咽左侧壁增厚并软组织肿块形成，考虑恶性占位性病变-鼻咽癌并侵犯左侧头长肌、腭帆张/提肌、左侧翼内肌；斜坡、蝶骨体部、左侧颞骨岩尖多发骨质破坏，侵犯左侧三叉神经节腔及左侧颞叶，继发左侧中耳乳突炎。病程第20天鼻咽镜及活检：病变符合为癌，部位为未分化型非角化性癌，部分为分化型非角化性癌。PET/CT全身显像：鼻咽病灶代谢活跃，考虑鼻咽癌，病灶侵犯左颞叶伴周围颞叶脑水肿；左咽后及左颈Ⅱ-Ⅲ区多个淋巴结代谢活跃/较活跃，考虑转移。\n16年前因“十二指肠穿孔”手术治疗。近1月住院期间发现“乙型病毒性肝炎”、“高血压”。\n否认家族中有恶性肿瘤病史。\n鼻咽未分化型非角化性癌 T4N3M0 IV期。\n下一步治疗。\n\n【本次经过】\n本院ALT、AST正常参考上限均为40 U/L。\n病程第26天生化检查提示白蛋白36.4g/L↓、胆碱酯酶3192U/L↓、谷丙转氨酶129.2U/L↑、谷草转氨酶126.3U/L↑、直接胆红素15.6umol/L↑、谷氨酰转肽酶145.6U/L↑、总胆汁酸36.0umol/L↑、总胆红素25.8umol/L↑、碱性磷酸酶139.6U/L↑。病程第27天复查生化提示碱性磷酸酶131.4U/L↑、谷丙转氨酶111.5U/L↑、胆碱酯酶2977U/L↓、谷氨酰转肽酶133.6U/L↑、总胆汁酸18.5umol/L↑、谷草转氨酶97.5U/L↑。病程第30天复查生化提示谷丙转氨酶71.9U/L↑、谷草转氨酶102.7U/L↑。病程第33天复查生化提示谷丙转氨酶33.1U/L、谷草转氨酶38.9U/L。\n{病程第27天: 凝血酶原时间(PT) 13.6 sec. ↑, 凝血酶时间(TT) 17.2 sec. ↑, 天门冬氨酸氨基转移酶(AST) 97.5 U/L ↑, 丙氨酸氨基转移酶(ALT) 111.5 U/L ↑; 病程第30天: 天门冬氨酸氨基转移酶(AST) 102.7 U/L ↑, 丙氨酸氨基转移酶(ALT) 71.9 U/L ↑}","rubric_template_structured":{"total_score":10.0,"core_answer":["主要异常：肝功能异常/肝损伤，伴转氨酶及胆汁淤积相关指标升高；需鉴别既往用药及基础乙肝等病因，缺少ALP正常上限及R比值时不固定判为混合型。","严重程度：ALT/AST峰值约为3.23/3.16×ULN；基线正常时按CTCAE v5.0为2级（>3–5×ULN）。基线未提供，不能无条件定级；基线异常时按相对基线倍数复核。"],"key_evidence":["峰值证据：病程第26天ALT/AST为129.2/126.3 U/L，约3.23/3.16×ULN；两者ULN均为40 U/L。","恢复证据：病程第30天ALT/AST为71.9/102.7 U/L；至病程第33天分别为33.1/38.9 U/L，两者回至参考范围。","胆红素证据：病程第26天总胆红素25.8 μmol/L↑、直接胆红素15.6 μmol/L↑","胆汁淤积证据：病程第26天GGT 145.6 U/L↑、ALP 139.6 U/L↑，总胆汁酸36.0 μmol/L↑","肝合成功能证据：病程第26天及09-30 胆碱酯酶3192 U/L、2977 U/L↓，白蛋白36.4 g/L↓","凝血功能证据：病程第27天PT 13.6 sec↑、TT 17.2 sec↑"],"conditional_modifiers":["病因鉴别：结合乙肝病史及既往用药，区分药物相关肝损伤与基础肝病所致异常。","基线判定：CTCAE v5.0对异常基线采用相对基线倍数；乙肝病史本身不能证明基线正常或异常。","分级时间点：不良反应分级应以实验室指标峰值时的异常程度为准，虽随后指标逐渐好转提示损伤可逆"],"negative_list":{"major_errors":["严重程度误判为3级及以上或重度，并建议不适当过度干预","只依据转氨酶，不提胆红素、胆碱酯酶、白蛋白和凝血功能等异常","误判为已接受抗肿瘤治疗并归因于相关药物"],"minor_errors":["仅泛称肝功能异常，未说明转氨酶、胆红素及胆汁淤积相关指标变化或病因待鉴别。","仅泛称轻中度异常，既未按正常基线口径指出峰值为CTCAE 2级，也未说明基线缺失使正式分级需复核。"]},"scoring_rules":{"item_scores":{"core_answer":[3.0,3.0],"key_evidence":[0.34,0.34,0.33,0.33,0.33,0.33],"conditional_modifiers":[0.67,0.67,0.66]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-fe4e51911275911bd8410e78","case_id":"o1-case-45cc86cfd90d4fed550d065a","patient_id":"o1-patient-215ed92abb14a454c63f5a14","tag":"AE_GENERAL","question":"针对该患者当前不良反应，应采取哪些处理和监测措施？","case_input":"【病情摘要】\n患者男，46岁。\n2月前出现症状，病程第26天入院。\n头痛2月，加重1月，伴重影、耳鸣、吞咽困难。\n2月前无明显诱因出现左侧颞部疼痛，可耐受。1月前疼痛加重，影响睡眠，出现左侧口咽歪斜。病程第14天出现左侧面瘫，左侧上眼睑稍下垂，左眼视物模糊、重影，左耳耳鸣、听力下降，吞咽困难，声音嘶哑。\n病程第0天某医院，诊断为周围性面神经麻痹、三叉神经痛，给予中医药治疗及止痛、营养神经等对症治疗。病程第16天某医院，住院期间给予抗病毒、护肝治疗（具体不详）。\n病程第16天头颅MRI：鼻咽左侧壁增厚并软组织肿块形成，考虑恶性占位性病变-鼻咽癌并侵犯左侧头长肌、腭帆张/提肌、左侧翼内肌；斜坡、蝶骨体部、左侧颞骨岩尖多发骨质破坏，侵犯左侧三叉神经节腔及左侧颞叶，继发左侧中耳乳突炎。病程第20天鼻咽镜及活检：病变符合为癌，部位为未分化型非角化性癌，部分为分化型非角化性癌。PET/CT全身显像：鼻咽病灶代谢活跃，考虑鼻咽癌，病灶侵犯左颞叶伴周围颞叶脑水肿；左咽后及左颈Ⅱ-Ⅲ区多个淋巴结代谢活跃/较活跃，考虑转移。\n16年前因“十二指肠穿孔”手术治疗。近1月住院期间发现“乙型病毒性肝炎”、“高血压”。\n否认家族中有恶性肿瘤病史。\n鼻咽未分化型非角化性癌 T4N3M0 IV期。\n下一步治疗。\n\n【本次经过】\n本院ALT、AST正常参考上限均为40 U/L。\n病程第26天生化检查提示白蛋白36.4g/L↓、胆碱酯酶3192U/L↓、谷丙转氨酶129.2U/L↑、谷草转氨酶126.3U/L↑、直接胆红素15.6umol/L↑、谷氨酰转肽酶145.6U/L↑、总胆汁酸36.0umol/L↑、总胆红素25.8umol/L↑、碱性磷酸酶139.6U/L↑。病程第27天复查生化提示碱性磷酸酶131.4U/L↑、谷丙转氨酶111.5U/L↑、胆碱酯酶2977U/L↓、谷氨酰转肽酶133.6U/L↑、总胆汁酸18.5umol/L↑、谷草转氨酶97.5U/L↑。病程第30天复查生化提示谷丙转氨酶71.9U/L↑、谷草转氨酶102.7U/L↑。病程第33天复查生化提示谷丙转氨酶33.1U/L、谷草转氨酶38.9U/L。\n{病程第27天: 凝血酶原时间(PT) 13.6 sec. ↑, 凝血酶时间(TT) 17.2 sec. ↑, 天门冬氨酸氨基转移酶(AST) 97.5 U/L ↑, 丙氨酸氨基转移酶(ALT) 111.5 U/L ↑; 病程第30天: 天门冬氨酸氨基转移酶(AST) 102.7 U/L ↑, 丙氨酸氨基转移酶(ALT) 71.9 U/L ↑}","rubric_template_structured":{"total_score":10.0,"core_answer":["总体策略：当前属肝损伤恢复期，以继续监测为主","监测：定期复查肝功能及凝血功能，关注趋势变化","危险因素：评估并控制乙肝、合并用药等肝损伤危险因素","支持治疗：给予护肝等支持治疗，避免酒精及潜在肝毒性或不安全用药","抗肿瘤治疗前：启动或调整后续治疗前需确认肝功能和凝血功能稳定"],"key_evidence":["乙肝证据：既往“乙型病毒性肝炎”病史提示基础肝病，增加药物性肝损伤及HBV再激活风险","峰值异常依据：病程第26天ALT/AST为129.2/126.3 U/L，总/直接胆红素为25.8/15.6 μmol/L，提示既往肝功能异常。","恢复期依据：病程第27天至病程第30天肝功能总体好转；病程第33天ALT/AST为33.1/38.9 U/L，均低于ULN 40 U/L，支持恢复期管理。","凝血证据：病程第27天PT 13.6 sec、TT 17.2 sec轻度升高，提示需联合监测凝血及出血风险"],"conditional_modifiers":["病情加重时：如肝酶再明显升高或出现黄疸、乏力、出血等，应急查肝功和凝血，评估分级并必要时转肝病或重症专科","乙肝活动时：如HBV-DNA阳性或活动性肝炎，应在专科指导下抗病毒治疗并全程监测HBV-DNA及肝功能","强肝毒治疗前：拟行放化疗等系统治疗前评估肝储备功能，根据肝功能决定延后、减量或调整含肝毒性方案","其他因素时：如存在酒精、中成药/保健品、感染或肝转移等，应排查记录并完善腹部影像，据此调整处理策略"],"negative_list":{"major_errors":["忽视既往乙型肝炎及本次肝功能异常，认为无需特殊处理和监测","肝功能未稳定时直接建议强肝毒性抗肿瘤治疗且未提评估或调整","臆断本例为免疫检查点抑制剂相关肝炎并错误套用ICI特异性处理（病例无ICI使用证据）","未评估HBV活动度前否认乙肝监测和抗病毒管理的必要性"],"minor_errors":["未提及需动态随访肝功能和凝血功能监测","未强调完善HBV相关检测、评估再激活风险或建议专科会诊","支持治疗缺乏避免酒精、中草药/保健品及肝毒性药物等安全要点"]},"scoring_rules":{"item_scores":{"core_answer":[1.2,1.2,1.2,1.2,1.2],"key_evidence":[0.5,0.5,0.5,0.5],"conditional_modifiers":[0.5,0.5,0.5,0.5]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-66b5946e36398fca4ebbf888","case_id":"o1-case-45cc86cfd90d4fed550d065a","patient_id":"o1-patient-215ed92abb14a454c63f5a14","tag":"AE_GENERAL","question":"结合肝功能恢复情况，该患者后续抗肿瘤治疗应如何启动、延期或调整？","case_input":"【病情摘要】\n患者男，46岁。\n2月前出现症状，病程第26天入院。\n头痛2月，加重1月，伴重影、耳鸣、吞咽困难。\n2月前无明显诱因出现左侧颞部疼痛，可耐受。1月前疼痛加重，影响睡眠，出现左侧口咽歪斜。病程第14天出现左侧面瘫，左侧上眼睑稍下垂，左眼视物模糊、重影，左耳耳鸣、听力下降，吞咽困难，声音嘶哑。\n病程第0天某医院，诊断为周围性面神经麻痹、三叉神经痛，给予中医药治疗及止痛、营养神经等对症治疗。病程第16天某医院，住院期间给予抗病毒、护肝治疗（具体不详）。\n病程第16天头颅MRI：鼻咽左侧壁增厚并软组织肿块形成，考虑恶性占位性病变-鼻咽癌并侵犯左侧头长肌、腭帆张/提肌、左侧翼内肌；斜坡、蝶骨体部、左侧颞骨岩尖多发骨质破坏，侵犯左侧三叉神经节腔及左侧颞叶，继发左侧中耳乳突炎。病程第20天鼻咽镜及活检：病变符合为癌，部位为未分化型非角化性癌，部分为分化型非角化性癌。PET/CT全身显像：鼻咽病灶代谢活跃，考虑鼻咽癌，病灶侵犯左颞叶伴周围颞叶脑水肿；左咽后及左颈Ⅱ-Ⅲ区多个淋巴结代谢活跃/较活跃，考虑转移。\n16年前因“十二指肠穿孔”手术治疗。近1月住院期间发现“乙型病毒性肝炎”、“高血压”。\n否认家族中有恶性肿瘤病史。\n鼻咽未分化型非角化性癌 T4N3M0 IV期。\n下一步治疗。\n\n【本次经过】\n本院ALT、AST正常参考上限均为40 U/L。\n病程第26天生化检查提示白蛋白36.4g/L↓、胆碱酯酶3192U/L↓、谷丙转氨酶129.2U/L↑、谷草转氨酶126.3U/L↑、直接胆红素15.6umol/L↑、谷氨酰转肽酶145.6U/L↑、总胆汁酸36.0umol/L↑、总胆红素25.8umol/L↑、碱性磷酸酶139.6U/L↑。病程第27天复查生化提示碱性磷酸酶131.4U/L↑、谷丙转氨酶111.5U/L↑、胆碱酯酶2977U/L↓、谷氨酰转肽酶133.6U/L↑、总胆汁酸18.5umol/L↑、谷草转氨酶97.5U/L↑。病程第30天复查生化提示谷丙转氨酶71.9U/L↑、谷草转氨酶102.7U/L↑。病程第33天复查生化提示谷丙转氨酶33.1U/L、谷草转氨酶38.9U/L。\n{病程第27天: 凝血酶原时间(PT) 13.6 sec. ↑, 凝血酶时间(TT) 17.2 sec. ↑, 天门冬氨酸氨基转移酶(AST) 97.5 U/L ↑, 丙氨酸氨基转移酶(ALT) 111.5 U/L ↑; 病程第30天: 天门冬氨酸氨基转移酶(AST) 102.7 U/L ↑, 丙氨酸氨基转移酶(ALT) 71.9 U/L ↑}","rubric_template_structured":{"total_score":10.0,"core_answer":["总体策略：肝功能异常缓解、ALT/AST恢复至≤1级或回到治疗基线后再启动抗肿瘤治疗","监测与调整：治疗期间定期监测肝功能，出现肝毒性时视分级决定暂停、减量、延长间隔或更换方案"],"key_evidence":["肝功能异常证据：病程第26天ALT 129.2 U/L、AST 126.3 U/L，总胆红素及胆汁淤积相关指标升高；药物、基础乙肝等病因仍需鉴别。","肝功能恢复证据：病程第33天ALT 33.1 U/L、AST 38.9 U/L均低于所给ULN（40 U/L），提示转氨酶已恢复至参考范围。"],"conditional_modifiers":["基础肝病边界：如合并乙肝等基础肝病或其他肝毒性药物，需先稳定相关因素，并在治疗期间加强肝功能监测","肝毒性再发时：后续治疗中如出现≥2级肝毒性，应暂停相关药物，并根据严重程度和获益评估减量、延长给药间隔或更换方案"],"negative_list":{"major_errors":["肝功能指标未恢复至≤1级或安全基线时，即启动明显肝毒性的抗肿瘤治疗","误判：患者本例尚未开启抗肿瘤治疗，不得建议‘恢复原方案’等措施","将本次可逆性肝损伤视为绝对禁忌，建议永久放弃鼻咽癌抗肿瘤治疗"],"minor_errors":["仅表述‘肝功能好转后开始治疗’，未明确需恢复至≤1级或治疗基线","未提及启动治疗后应定期监测肝功能"]},"scoring_rules":{"item_scores":{"core_answer":[3.0,3.0],"key_evidence":[1.0,1.0],"conditional_modifiers":[1.0,1.0]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-de93703410d04f6cc4d6a1ec","case_id":"o1-case-1781066c4a4512068015569a","patient_id":"o1-patient-78f393580a2da6571f061e30","tag":"AE_GENERAL","question":"结合当前资料，该患者当前不良反应的类型及严重程度是什么？","case_input":"【病情摘要】\n患者男，46岁。\n2017年11月确诊，病程第515天入院。\n鼻咽癌放化疗后复发伴肝、骨转移。\n目前患者无鼻塞、流涕、流鼻血等症状。\n2017年11月某医院确诊鼻咽癌-非角化型分化性癌 cT4N2M0 (IVA期)。\n病程第426天腹部MR示：肝右叶转移瘤可能。病程第430天行PET-CT示：考虑鼻咽癌局部浸润转移，肝S6-7段转移，T12、L2骨转移。\n30多年前曾患“急性黄疸型肝炎”已治愈。\n其母亲70岁患乳腺癌，已故。\n吸烟20多年，每日2-3支，目前未戒烟。\n2017年11月确诊鼻咽癌-非角化型分化性癌 cT4N2M0 (IVA期)。\n病程第0天行TP方案（紫杉醇+奈达铂）诱导化疗1程。2017年12月开始行放疗，共33次，末次放疗时间病程第77天。病程第22天、病程第46天、病程第69天行TP（紫杉醇+顺铂）方案同期化疗3程。\n病程第451天治疗前甲功检查，TSH 2.1 mIU/L、FT4 15.2 pmol/L，均在参考范围内。\n病程第452天起接受GP联合卡瑞利珠单抗治疗，卡瑞利珠单抗于病程第452天、病程第473天及病程第494天静脉给药，每次200 mg。病程第507天门诊复诊，拟继续原抗肿瘤方案，为求进一步治疗入院。\n\n【本次经过】\n病程第509天复查甲功，TSH 6.8 mIU/L、FT4 14.2 pmol/L，出现亚临床甲状腺功能减退。病程第515天入院复查，TSH 6.6 mIU/L、FT4 14.5 pmol/L。上述检验的参考范围为TSH 0.27～4.20 mIU/L、FT4 12.0～22.0 pmol/L。\n患者无乏力、畏寒、便秘，体重稳定，购物、备餐及洗漱、穿衣等日常活动均不受影响。当前无甲状腺激素替代治疗指征，予观察随访，尚未使用左甲状腺素等替代药物。","rubric_template_structured":{"total_score":10.0,"core_answer":["识别PD-1治疗期间出现的亚临床甲减，可表述为甲状腺功能减退或TSH升高，结合用药时序考虑卡瑞利珠单抗相关","严重程度为CTCAE v5.0 1级，患者无症状、日常活动正常，仅有甲功异常，当前无甲状腺激素替代治疗指征"],"key_evidence":["治疗前依据：卡瑞利珠单抗给药前TSH 2.1 mIU/L、FT4 15.2 pmol/L，均正常。","治疗后依据：卡瑞利珠单抗治疗后，病程第509天TSH 6.8 mIU/L、FT4 14.2 pmol/L，符合亚临床甲减，支持治疗相关可能。","患者无乏力、畏寒、便秘，体重稳定，工具性及自理性日常活动均不受影响","病程第515天TSH 6.6 mIU/L、FT4 14.5 pmol/L，结合无症状和日常活动正常，当前无替代治疗指征，支持1级判断"],"conditional_modifiers":[],"negative_list":{"major_errors":["将本例判为甲亢，或完全否认已出现的TSH升高及亚临床甲减","将本例无症状、FT4正常且当前无替代治疗指征的甲减判为CTCAE 2级及以上","完全遗漏甲状腺功能异常及其严重程度判断"],"minor_errors":["仅笼统写甲状腺异常，未说明甲状腺功能减退、亚临床甲减或TSH升高且FT4正常","描述不全：未标明为轻度CTCAE 1级，仅模糊说明严重程度"]},"scoring_rules":{"item_scores":{"core_answer":[4.0,4.0],"key_evidence":[0.5,0.5,0.5,0.5],"conditional_modifiers":[]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-5d376e3c6e7d7dc7d11c1abf","case_id":"o1-case-1781066c4a4512068015569a","patient_id":"o1-patient-78f393580a2da6571f061e30","tag":"AE_GENERAL","question":"针对该患者当前不良反应，应采取哪些处理和监测措施？","case_input":"【病情摘要】\n患者男，46岁。\n2017年11月确诊，病程第515天入院。\n鼻咽癌放化疗后复发伴肝、骨转移。\n目前患者无鼻塞、流涕、流鼻血等症状。\n2017年11月某医院确诊鼻咽癌-非角化型分化性癌 cT4N2M0 (IVA期)。\n病程第426天腹部MR示：肝右叶转移瘤可能。病程第430天行PET-CT示：考虑鼻咽癌局部浸润转移，肝S6-7段转移，T12、L2骨转移。\n30多年前曾患“急性黄疸型肝炎”已治愈。\n其母亲70岁患乳腺癌，已故。\n吸烟20多年，每日2-3支，目前未戒烟。\n2017年11月确诊鼻咽癌-非角化型分化性癌 cT4N2M0 (IVA期)。\n病程第0天行TP方案（紫杉醇+奈达铂）诱导化疗1程。2017年12月开始行放疗，共33次，末次放疗时间病程第77天。病程第22天、病程第46天、病程第69天行TP（紫杉醇+顺铂）方案同期化疗3程。\n病程第451天治疗前甲功检查，TSH 2.1 mIU/L、FT4 15.2 pmol/L，均在参考范围内。\n病程第452天起接受GP联合卡瑞利珠单抗治疗，卡瑞利珠单抗于病程第452天、病程第473天及病程第494天静脉给药，每次200 mg。病程第507天门诊复诊，拟继续原抗肿瘤方案，为求进一步治疗入院。\n\n【本次经过】\n病程第509天复查甲功，TSH 6.8 mIU/L、FT4 14.2 pmol/L，出现亚临床甲状腺功能减退。病程第515天入院复查，TSH 6.6 mIU/L、FT4 14.5 pmol/L。上述检验的参考范围为TSH 0.27～4.20 mIU/L、FT4 12.0～22.0 pmol/L。\n患者无乏力、畏寒、便秘，体重稳定，购物、备餐及洗漱、穿衣等日常活动均不受影响。当前无甲状腺激素替代治疗指征，予观察随访，尚未使用左甲状腺素等替代药物。","rubric_template_structured":{"total_score":10.0,"core_answer":["评估并记录TSH、FT4、甲减症状及功能影响，按CTCAE v5.0 1级管理，约4～6周复查甲功","本例无症状的1级甲减可在监测下继续原抗肿瘤治疗，包括卡瑞利珠单抗","本例当前以观察随访为主，无需启动左甲状腺素替代治疗","告知患者留意乏力、畏寒、便秘及体重变化，出现症状及时复诊","总体策略：甲减管理中兼顾肿瘤病情和全身状况，综合调整方案"],"key_evidence":["病程证据：鼻咽癌放化疗后复发并伴肝、骨转移，处于需持续系统抗肿瘤治疗和随访的晚期阶段","病程第452天开始卡瑞利珠单抗治疗，病程第509天出现TSH升高，甲功异常发生于免疫治疗之后","TSH为6.6～6.8 mIU/L，FT4正常，患者无症状且日常活动正常，支持观察监测及继续治疗"],"conditional_modifiers":["若随访出现甲减症状、FT4降低或TSH持续升高，应重新评估严重程度和替代治疗指征","若TSH持续高于10 mIU/L，间隔约4周复测仍升高，或出现与TSH升高相符的甲减症状，应评估启动左甲状腺素，必要时请内分泌科协助","若进展为临床显著甲减，应按新的严重程度评估是否暂缓免疫治疗，处理稳定后再决定恢复"],"negative_list":{"major_errors":["将当前无需替代治疗等同于无需甲功和症状随访","仅因本例TSH轻度升高即要求立即常规替代治疗或中断抗肿瘤治疗","仅提出笼统对症处理，完全遗漏甲功复查与甲减评估"],"minor_errors":["未提及根据甲功结果定期随访并动态调整","未说明本例当前观察随访与后续启动替代治疗的条件","未说明评估甲减对功能影响及健康宣教"]},"scoring_rules":{"item_scores":{"core_answer":[1.2,1.2,1.2,1.2,1.2],"key_evidence":[0.67,0.67,0.66],"conditional_modifiers":[0.67,0.67,0.66]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-b576aad9dc8796d9f73d08ae","case_id":"o1-case-1781066c4a4512068015569a","patient_id":"o1-patient-78f393580a2da6571f061e30","tag":"AE_GENERAL","question":"针对该患者当前甲减，后续抗肿瘤治疗应如何继续、延期或调整？","case_input":"【病情摘要】\n患者男，46岁。\n2017年11月确诊，病程第515天入院。\n鼻咽癌放化疗后复发伴肝、骨转移。\n目前患者无鼻塞、流涕、流鼻血等症状。\n2017年11月某医院确诊鼻咽癌-非角化型分化性癌 cT4N2M0 (IVA期)。\n病程第426天腹部MR示：肝右叶转移瘤可能。病程第430天行PET-CT示：考虑鼻咽癌局部浸润转移，肝S6-7段转移，T12、L2骨转移。\n30多年前曾患“急性黄疸型肝炎”已治愈。\n其母亲70岁患乳腺癌，已故。\n吸烟20多年，每日2-3支，目前未戒烟。\n2017年11月确诊鼻咽癌-非角化型分化性癌 cT4N2M0 (IVA期)。\n病程第0天行TP方案（紫杉醇+奈达铂）诱导化疗1程。2017年12月开始行放疗，共33次，末次放疗时间病程第77天。病程第22天、病程第46天、病程第69天行TP（紫杉醇+顺铂）方案同期化疗3程。\n病程第451天治疗前甲功检查，TSH 2.1 mIU/L、FT4 15.2 pmol/L，均在参考范围内。\n病程第452天起接受GP联合卡瑞利珠单抗治疗，卡瑞利珠单抗于病程第452天、病程第473天及病程第494天静脉给药，每次200 mg。病程第507天门诊复诊，拟继续原抗肿瘤方案，为求进一步治疗入院。\n\n【本次经过】\n病程第509天复查甲功，TSH 6.8 mIU/L、FT4 14.2 pmol/L，出现亚临床甲状腺功能减退。病程第515天入院复查，TSH 6.6 mIU/L、FT4 14.5 pmol/L。上述检验的参考范围为TSH 0.27～4.20 mIU/L、FT4 12.0～22.0 pmol/L。\n患者无乏力、畏寒、便秘，体重稳定，购物、备餐及洗漱、穿衣等日常活动均不受影响。当前无甲状腺激素替代治疗指征，予观察随访，尚未使用左甲状腺素等替代药物。","rubric_template_structured":{"total_score":10.0,"core_answer":["本例为无症状CTCAE v5.0 1级甲减，可在监测下按原方案继续抗肿瘤治疗，包括卡瑞利珠单抗","后续治疗前复核甲功、症状及功能状态，当前无需以甲功完全正常或已接受替代治疗为继续治疗的前提","治疗期间每4～6周复查TSH、FT4并评估症状，发现变化及时调整管理"],"key_evidence":["病程第452天开始卡瑞利珠单抗治疗，病程第509天出现亚临床甲减，当前问题是免疫治疗期间的后续治疗安排","病程第515天TSH 6.6 mIU/L、FT4 14.5 pmol/L，患者无甲减症状且日常活动正常，当前无替代治疗指征","无症状1级甲减可在监测下继续免疫治疗，符合本例当前情况"],"conditional_modifiers":["若后续出现甲减症状、FT4下降或TSH持续高于10 mIU/L，应重新分级、评估替代治疗及免疫治疗暂缓的必要性，临床状态稳定后再决定恢复"],"negative_list":{"major_errors":["误判：将甲减作为绝对禁忌，主张永久取消抗肿瘤治疗","仅因本例1级甲减要求停药、减量或延期，或强制等待甲功完全正常及替代治疗后才继续原方案","继续抗肿瘤治疗时完全忽视甲功及症状监测"],"minor_errors":["未明确说明本例可在监测下继续原方案","未说明后续治疗前需复核甲功、症状及功能状态","遗漏随访监测：未提需定期随访和监测甲功"]},"scoring_rules":{"item_scores":{"core_answer":[2.0,2.0,2.0],"key_evidence":[0.67,0.67,0.66],"conditional_modifiers":[2.0]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-086d5b29e69a09913f79f61a","case_id":"o1-case-8af6f8e24bc00cb42c3eeb7a","patient_id":"o1-patient-6f3399d1a44e36a8c85aebbc","tag":"AE_GENERAL","question":"结合本周期最低血象，该患者化疗相关不良反应的类型及最高严重程度是什么？","case_input":"【病情摘要】\n患者男，29岁。\n2024年3月出现症状，病程第0天入院。\n右颈肿物9月。\n2024年3月无明显诱因出现右颈部肿物，后出现涕中带血，近期诉耳痛。\n某医院检查后予观察。2025年1月超声检查提示淋巴结结构异常，某医院鼻咽镜检查提示鼻咽肿物，活检病理示鼻咽未分化型非角化性癌。\n乙肝4年，规律抗病毒中。\n否认家族中有恶性肿瘤病史。\n鼻咽未分化型非角化性癌。\n现为行下一步治疗收入我科。\n\n【本次经过】\n病程第1天开始行第一周期TPF方案诱导化疗（多西他赛102mg D1、顺铂102mg D1、氟尿嘧啶4.25g 持续静脉泵入120小时，Q3W）。病程第8天辅助检查提示白细胞计数1.88×10E9/L↓。患者化疗后出现III°白细胞下降、III°中性粒细胞下降。\n{病程第4天: 钠离子(Na+) 136.5 mmol/L ↓; 病程第5天: 总胆红素(TBIL) 29.3 umol/L ↑, 丙氨酸氨基转移酶(ALT) 51.3 U/L ↑, 间接胆红素(IBIL) 23.1 umol/L ↑, 中性粒细胞计数(Neut#) 8.62 10E9/L ↑, 肌酐(Crea) 56.2 umol/L ↓, 钠离子(Na+) 133.0 mmol/L ↓, 氯离子(Cl-) 97.1 mmol/L ↓, C-反应蛋白(CRP) 95.20 mg/L ↑, 降钙素原(PCT) 0.26 ng/ml ↑; 病程第7天: 白细胞计数(WBC#) 2.95 10E9/L ↓, 氯离子(Cl-) 98.4 mmol/L ↓, C-反应蛋白(CRP) 65.88 mg/L ↑, 钠离子(Na+) 135.1 mmol/L ↓, 白蛋白(ALB) 38.1 g/L ↓, 肌酸激酶(CK) 45 U/L ↓; 病程第8天: 中性粒细胞计数(Neut#) 0.89 10E9/L ↓, 白细胞计数(WBC#) 1.88 10E9/L ↓, 降钙素原(PCT) 0.07 ng/ml ↑; 病程第9天: 中性粒细胞计数(Neut#) 1.11 10E9/L ↓, 白细胞计数(WBC#) 2.41 10E9/L ↓; 病程第10天: 中性粒细胞计数(Neut#) 6.90 10E9/L ↑}","rubric_template_structured":{"total_score":10.0,"core_answer":["不良反应类型：化疗相关骨髓抑制，以白细胞减少和中性粒细胞减少为主","严重程度：根据最低血象，白细胞及中性粒细胞减少为CTCAE 3级"],"key_evidence":["白细胞证据：病程第8天白细胞1.88×10E9/L，落在CTCAE 3级白细胞减少（<2.0–1.0×10E9/L）区间","中性粒细胞证据：病程第8天中性粒细胞0.89×10E9/L，落在CTCAE 3级中性粒细胞减少（<1.0–0.5×10E9/L）区间"],"conditional_modifiers":["FN边界：病例未记体温，仅见CRP、PCT升高，不足以确诊发热性中性粒细胞减少；如有发热并符合标准，可再定性为FN"],"negative_list":{"major_errors":["未判为化疗相关骨髓抑制（白细胞/中性粒细胞减少）或误判为其他系统毒性","将本周期最低血象对应的CTCAE 3级白细胞或中性粒细胞减少误判为1～2级，或以病程第10天恢复值否认本周期曾达3级"],"minor_errors":["仅表述“血象异常”或“骨髓抑制”，未点明以白细胞及中性粒细胞减少为主","严重程度未明示为CTCAE 3级，仅用“重度/较重”等模糊表述"]},"scoring_rules":{"item_scores":{"core_answer":[3.0,3.0],"key_evidence":[1.0,1.0],"conditional_modifiers":[2.0]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-832954d112a7513f15c4dc4a","case_id":"o1-case-8af6f8e24bc00cb42c3eeb7a","patient_id":"o1-patient-6f3399d1a44e36a8c85aebbc","tag":"AE_GENERAL","question":"结合截至病程第10天的资料，针对该患者化疗后血象变化，应采取哪些处理和监测措施？","case_input":"【病情摘要】\n患者男，29岁。\n2024年3月出现症状，病程第0天入院。\n右颈肿物9月。\n2024年3月无明显诱因出现右颈部肿物，后出现涕中带血，近期诉耳痛。\n某医院检查后予观察。2025年1月超声检查提示淋巴结结构异常，某医院鼻咽镜检查提示鼻咽肿物，活检病理示鼻咽未分化型非角化性癌。\n乙肝4年，规律抗病毒中。\n否认家族中有恶性肿瘤病史。\n鼻咽未分化型非角化性癌。\n现为行下一步治疗收入我科。\n\n【本次经过】\n病程第1天开始行第一周期TPF方案诱导化疗（多西他赛102mg D1、顺铂102mg D1、氟尿嘧啶4.25g 持续静脉泵入120小时，Q3W）。病程第8天辅助检查提示白细胞计数1.88×10E9/L↓。患者化疗后出现III°白细胞下降、III°中性粒细胞下降。\n{病程第4天: 钠离子(Na+) 136.5 mmol/L ↓; 病程第5天: 总胆红素(TBIL) 29.3 umol/L ↑, 丙氨酸氨基转移酶(ALT) 51.3 U/L ↑, 间接胆红素(IBIL) 23.1 umol/L ↑, 中性粒细胞计数(Neut#) 8.62 10E9/L ↑, 肌酐(Crea) 56.2 umol/L ↓, 钠离子(Na+) 133.0 mmol/L ↓, 氯离子(Cl-) 97.1 mmol/L ↓, C-反应蛋白(CRP) 95.20 mg/L ↑, 降钙素原(PCT) 0.26 ng/ml ↑; 病程第7天: 白细胞计数(WBC#) 2.95 10E9/L ↓, 氯离子(Cl-) 98.4 mmol/L ↓, C-反应蛋白(CRP) 65.88 mg/L ↑, 钠离子(Na+) 135.1 mmol/L ↓, 白蛋白(ALB) 38.1 g/L ↓, 肌酸激酶(CK) 45 U/L ↓; 病程第8天: 中性粒细胞计数(Neut#) 0.89 10E9/L ↓, 白细胞计数(WBC#) 1.88 10E9/L ↓, 降钙素原(PCT) 0.07 ng/ml ↑; 病程第9天: 中性粒细胞计数(Neut#) 1.11 10E9/L ↓, 白细胞计数(WBC#) 2.41 10E9/L ↓; 病程第10天: 中性粒细胞计数(Neut#) 6.90 10E9/L ↑}","rubric_template_structured":{"total_score":10.0,"core_answer":["截至病程第10天，中性粒细胞已恢复至6.90×10^9/L，白细胞最后一次记录为病程第9天2.41×10^9/L，需复查确认当前白细胞水平","当前ANC已恢复，无需仅因病程第8天历史低谷立即新启动治疗性G-CSF，具体用药结合当前血象、既往用药及发热或感染情况评估","当前复查血常规并随访变化，若再次出现中性粒细胞减少，应提高复查频率直至恢复","继续监测体温和感染征象，出现发热或疑似感染时及时评估处理"],"key_evidence":["低谷依据：病程第8天中性粒细胞最低0.89×10^9/L、白细胞最低1.88×10^9/L，支持本周期曾达3级。","恢复依据：病程第10天中性粒细胞已恢复至6.90×10^9/L。","方案证据：TPF可导致骨髓抑制及发热性中性粒细胞减少，后续预防须结合具体方案、患者因素和本周期中性粒细胞减少经过评估。"],"conditional_modifiers":["肝功监测：乙肝史合并长期抗病毒，使用G-CSF及调整化疗时需监测肝功能，可会诊肝病/感染科评估用药安全","FN路径：中性粒细胞减少期一旦发热或有感染证据，按发热性中性粒细胞减少路径立即经验性抗感染，必要时住院或升级监护"],"negative_list":{"major_errors":["将病程第8天历史III度中性粒细胞减少当作病程第10天仍持续存在，或因当前ANC恢复而完全忽视复查及感染监测","仅据病程第8天历史低谷而忽视当前ANC已恢复，仍要求立即新启动治疗性G-CSF","后续血象仍不满足方案给药条件时仍立即原剂量化疗，或既不评估再发及FN风险，也不制定相应监测、预防或调整计划。"],"minor_errors":["未提复查血常规确认当前白细胞水平及后续中性粒细胞变化","未提体温和感染征象监测，或未说明发热需按发热性中性粒细胞减少及时处理","未评估后续周期FN及再发中性粒细胞减少风险，或未说明相应预防、监测或化疗调整计划；有依据选择监测、延期或减量者，不因未使用G-CSF扣分。"]},"scoring_rules":{"item_scores":{"core_answer":[1.5,1.5,1.5,1.5],"key_evidence":[0.67,0.67,0.66],"conditional_modifiers":[1.0,1.0]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-f97810ff76a7d6bddd9e15fe","case_id":"o1-case-8af6f8e24bc00cb42c3eeb7a","patient_id":"o1-patient-6f3399d1a44e36a8c85aebbc","tag":"AE_GENERAL","question":"结合截至病程第10天的血象恢复情况，后续抗肿瘤治疗应如何恢复、延期或调整？","case_input":"【病情摘要】\n患者男，29岁。\n2024年3月出现症状，病程第0天入院。\n右颈肿物9月。\n2024年3月无明显诱因出现右颈部肿物，后出现涕中带血，近期诉耳痛。\n某医院检查后予观察。2025年1月超声检查提示淋巴结结构异常，某医院鼻咽镜检查提示鼻咽肿物，活检病理示鼻咽未分化型非角化性癌。\n乙肝4年，规律抗病毒中。\n否认家族中有恶性肿瘤病史。\n鼻咽未分化型非角化性癌。\n现为行下一步治疗收入我科。\n\n【本次经过】\n病程第1天开始行第一周期TPF方案诱导化疗（多西他赛102mg D1、顺铂102mg D1、氟尿嘧啶4.25g 持续静脉泵入120小时，Q3W）。病程第8天辅助检查提示白细胞计数1.88×10E9/L↓。患者化疗后出现III°白细胞下降、III°中性粒细胞下降。\n{病程第4天: 钠离子(Na+) 136.5 mmol/L ↓; 病程第5天: 总胆红素(TBIL) 29.3 umol/L ↑, 丙氨酸氨基转移酶(ALT) 51.3 U/L ↑, 间接胆红素(IBIL) 23.1 umol/L ↑, 中性粒细胞计数(Neut#) 8.62 10E9/L ↑, 肌酐(Crea) 56.2 umol/L ↓, 钠离子(Na+) 133.0 mmol/L ↓, 氯离子(Cl-) 97.1 mmol/L ↓, C-反应蛋白(CRP) 95.20 mg/L ↑, 降钙素原(PCT) 0.26 ng/ml ↑; 病程第7天: 白细胞计数(WBC#) 2.95 10E9/L ↓, 氯离子(Cl-) 98.4 mmol/L ↓, C-反应蛋白(CRP) 65.88 mg/L ↑, 钠离子(Na+) 135.1 mmol/L ↓, 白蛋白(ALB) 38.1 g/L ↓, 肌酸激酶(CK) 45 U/L ↓; 病程第8天: 中性粒细胞计数(Neut#) 0.89 10E9/L ↓, 白细胞计数(WBC#) 1.88 10E9/L ↓, 降钙素原(PCT) 0.07 ng/ml ↑; 病程第9天: 中性粒细胞计数(Neut#) 1.11 10E9/L ↓, 白细胞计数(WBC#) 2.41 10E9/L ↓; 病程第10天: 中性粒细胞计数(Neut#) 6.90 10E9/L ↑}","rubric_template_structured":{"total_score":10.0,"core_answer":["中性粒细胞已恢复，后续化疗前仍需复查完整血常规并评估其他治疗条件，达到方案规定条件后安排下一周期","预防评估：结合具体TPF方案、个体FN风险及本周期并发症评估G-CSF指征；重点考虑既往中性粒细胞减少并发症及减量或延期对疗效的影响。","后续处置：符合G-CSF预防指征者给予支持；未达指征者加强监测，并按血象和耐受性决定是否延期或减量。"],"key_evidence":["首周期TPF后病程第8天中性粒细胞最低0.89×10^9/L，为CTCAE 3级，病程第10天中性粒细胞已恢复至6.90×10^9/L","方案风险证据：TPF首周期已出现3级中性粒细胞减少，提示后续周期需评估再发及FN风险；具体FN风险结合方案剂量和患者因素确定。","限制毒性证据：资料未见其他需停用或明显减量TPF的限制性毒性，主要问题为骨髓抑制"],"conditional_modifiers":["剂量调整边界：后续是否减量TPF需结合血象恢复、体力状态及是否出现发热性中性粒细胞减少综合评估","监测与用药细节：加强血常规监测；如采用预防性G-CSF，应按制剂要求与化疗时间错开，并根据后续血象及耐受性调整方案。"],"negative_list":{"major_errors":["在血象未达到给药条件时仍立即原剂量继续TPF，或明确符合G-CSF预防指征却既不安排支持也不提出合理替代措施；不因有依据未选G-CSF本身扣分。","仅因本次可恢复的骨髓抑制即建议永久停用TPF，未评估恢复后继续治疗及支持治疗或合理调整路径。","忽视：未提再发风险及缺乏方案调整路径"],"minor_errors":["未说明需在后续周期治疗前复查血象并确认达到方案要求","选用G-CSF时未说明其预防用途及选择依据；选择其他合理路径者，未说明相应风险评估和监测或调整计划。","未提需加强血象监测或耐受性评估微调"]},"scoring_rules":{"item_scores":{"core_answer":[2.0,2.0,2.0],"key_evidence":[0.67,0.67,0.66],"conditional_modifiers":[1.0,1.0]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-7dfddacb2b1e74bbf8358be8","case_id":"o1-case-68bf1e4a325a6c95f1eb6140","patient_id":"o1-patient-f4ad12cf63a206d241a44c9e","tag":"AE_GENERAL","question":"结合本周期电解质最低值及症状，请判断不良反应的类型和发生时最高严重程度，并说明病程第11天的恢复情况。","case_input":"【病情摘要】\n患者女，43岁。\n2024年8月初出现症状，病程第0天入院。\n外院确诊鼻咽癌1周。\n2024年8月初因咽痛并发现左颈部包块3天就诊，自觉双眼视力较前稍下降，无头晕、头痛、复视、耳鸣、听力下降、鼻塞、涕血、面麻等不适。\n2024年8月初就诊于外院，行左颈淋巴结穿刺活检见低分化鳞状细胞癌，行鼻咽+鼻窦+颈部增强MR见鼻咽左侧壁、顶后壁病变，考虑鼻咽癌，并颅底骨质破坏，鼻咽肿物活检示符合未分化型非角化性癌。\n13年前左肾结石病史，保守治疗后好转。13年前及8年前分别行2次剖宫产手术。\n否认家族中有恶性肿瘤病史。\n\n【本次经过】\n病程第8天予以吉西他滨+顺铂化疗。病程第10天患者出现恶心、食欲减退、乏力、手脚无力、抽搐，查血生化示钾:2.62mmol/L↓。\n{病程第10天: 氯离子(Cl-) 82.3 mmol/L ↓, 钾离子(K+) 2.62 mmol/L ↓, 白细胞计数(WBC#) 28.61 10E9/L ↑, 钠离子(Na+) 123.9 mmol/L ↓, C-反应蛋白(CRP) 15.54 mg/L ↑, 天门冬氨酸氨基转移酶(AST) 46.9 U/L ↑, 中性粒细胞计数(Neut#) 27.81 10E9/L ↑; 病程第11天: 钠离子(Na+) 136.7 mmol/L ↓, 钾离子(K+) 2.96 mmol/L ↓}","rubric_template_structured":{"total_score":10.0,"core_answer":["不良反应：电解质紊乱，包含低钾血症和低钠血症","低钾血症：CTCAE 3级","低钠峰值：08-19 Na 123.9 mmol/L符合CTCAE 3级数值范围；如抽搐构成低钠所致危及生命后果，应评估4级。","低钠现状：08-20 Na 136.7 mmol/L已恢复，不能称当前持续重度低钠。"],"key_evidence":["低钾证据：病程第10天血钾2.62 mmol/L，落在2.5–<3.0 mmol/L 3级范围","低钠证据：病程第10天血钠123.9 mmol/L，落在120–124 mmol/L 3级范围","症状证据：恶心、食欲减退、乏力、手脚无力、抽搐等中重度电解质紊乱表现"],"conditional_modifiers":[],"negative_list":{"major_errors":["未识别本例为电解质紊乱（低钾血症和低钠血症），误归为其他不良反应","忽视历史3级低钾/低钠而将发作期低估为轻度或无需干预；对抽搐等表现未评估是否危及生命。","忽视2.62 mmol/L低钾和123.9 mmol/L低钠，仅凭其它化验结果判断"],"minor_errors":["仅笼统写电解质紊乱，未明确低钾、低钠及各自分级","未结合具体数值说明3级分级，或未提及对应症状"]},"scoring_rules":{"item_scores":{"core_answer":[2.0,2.0,2.0,2.0],"key_evidence":[0.67,0.67,0.66],"conditional_modifiers":[]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-eccf5061925d63fdcf120e4a","case_id":"o1-case-68bf1e4a325a6c95f1eb6140","patient_id":"o1-patient-f4ad12cf63a206d241a44c9e","tag":"AE_GENERAL","question":"截至病程第11天，针对本次电解质紊乱应采取哪些处理和监测措施？","case_input":"【病情摘要】\n患者女，43岁。\n2024年8月初出现症状，病程第0天入院。\n外院确诊鼻咽癌1周。\n2024年8月初因咽痛并发现左颈部包块3天就诊，自觉双眼视力较前稍下降，无头晕、头痛、复视、耳鸣、听力下降、鼻塞、涕血、面麻等不适。\n2024年8月初就诊于外院，行左颈淋巴结穿刺活检见低分化鳞状细胞癌，行鼻咽+鼻窦+颈部增强MR见鼻咽左侧壁、顶后壁病变，考虑鼻咽癌，并颅底骨质破坏，鼻咽肿物活检示符合未分化型非角化性癌。\n13年前左肾结石病史，保守治疗后好转。13年前及8年前分别行2次剖宫产手术。\n否认家族中有恶性肿瘤病史。\n\n【本次经过】\n病程第8天予以吉西他滨+顺铂化疗。病程第10天患者出现恶心、食欲减退、乏力、手脚无力、抽搐，查血生化示钾:2.62mmol/L↓。\n{病程第10天: 氯离子(Cl-) 82.3 mmol/L ↓, 钾离子(K+) 2.62 mmol/L ↓, 白细胞计数(WBC#) 28.61 10E9/L ↑, 钠离子(Na+) 123.9 mmol/L ↓, C-反应蛋白(CRP) 15.54 mg/L ↑, 天门冬氨酸氨基转移酶(AST) 46.9 U/L ↑, 中性粒细胞计数(Neut#) 27.81 10E9/L ↑; 病程第11天: 钠离子(Na+) 136.7 mmol/L ↓, 钾离子(K+) 2.96 mmol/L ↓}","rubric_template_structured":{"total_score":10.0,"core_answer":["总体策略：将严重电解质紊乱作为当前主要不良反应，积极处理","补钾：08-20 K 2.96 mmol/L仍低，结合症状、心电、肾功能及口服耐受补钾。","补钠判断：08-20 Na已136.7 mmol/L，不再按持续低钠继续补钠。","复查与纠正速度：复查Na、K、Cl及必要时Mg/Ca，核对既往补钠经过和纠正速度。","监测：动态复查血电解质、肾功能及尿量，必要时监测心电和生命体征","对症和安全：对抽搐、乏力等给予对症处理并防跌倒、防误吸等安全防护","抗肿瘤治疗：在严重不良反应未稳定前暂停或推迟相关化疗，并评估后续方案","诱因管理：评估摄入/丢失因素（呕吐、腹泻、进食不足等）并针对性干预"],"key_evidence":["发作期依据：08-19 K 2.62、Na 123.9、Cl 82.3 mmol/L。","复查依据：08-20 K 2.96 mmol/L仍低，Na 136.7 mmol/L已恢复。","纠正过程依据：两次钠上升12.8 mmol/L，确切采样间隔及纠正过程尚需核对。","时间关联证据：病程第8天接受吉西他滨+顺铂化疗，病程第10天出现恶心、乏力、手脚无力、抽搐等，符合化疗后严重电解质紊乱表现"],"conditional_modifiers":["肾功能边界：既往有肾结石史，补液和补钾需评估肾功能与容量负荷，避免加重肾损伤","顺铂毒性评估：若电解质异常持续或出现肾功能损害，应评估顺铂相关肾毒性并考虑减量、更换药物或调整周期","随访监测：调整化疗方案时，应加密复查电解质和肾功能"],"negative_list":{"major_errors":["未将低钾、低钠、低氯识别为本次不良反应核心，仅归为一般化疗不适","对持续低钾不积极复查、评估和处理，或钠已恢复仍不评估就继续补钠。","在严重电解质紊乱未控制前仍建议继续化疗不调整","将乏力、抽搐等误判为其他急症而不处理电解质紊乱"],"minor_errors":["未提出按当前复查结果补钾、动态监测电解质和肾功能，并核对钠纠正经过。","未提及对抽搐、乏力等症状的安全防护或对症处理","未提及严重不良反应后评估并调整化疗方案"]},"scoring_rules":{"item_scores":{"core_answer":[0.75,0.75,0.75,0.75,0.75,0.75,0.75,0.75],"key_evidence":[0.5,0.5,0.5,0.5],"conditional_modifiers":[0.67,0.67,0.66]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-ef638a9fa177d3524fdc736f","case_id":"o1-case-68bf1e4a325a6c95f1eb6140","patient_id":"o1-patient-f4ad12cf63a206d241a44c9e","tag":"AE_GENERAL","question":"待该患者不良反应缓解后，后续抗肿瘤治疗应如何恢复、延期或调整？","case_input":"【病情摘要】\n患者女，43岁。\n2024年8月初出现症状，病程第0天入院。\n外院确诊鼻咽癌1周。\n2024年8月初因咽痛并发现左颈部包块3天就诊，自觉双眼视力较前稍下降，无头晕、头痛、复视、耳鸣、听力下降、鼻塞、涕血、面麻等不适。\n2024年8月初就诊于外院，行左颈淋巴结穿刺活检见低分化鳞状细胞癌，行鼻咽+鼻窦+颈部增强MR见鼻咽左侧壁、顶后壁病变，考虑鼻咽癌，并颅底骨质破坏，鼻咽肿物活检示符合未分化型非角化性癌。\n13年前左肾结石病史，保守治疗后好转。13年前及8年前分别行2次剖宫产手术。\n否认家族中有恶性肿瘤病史。\n\n【本次经过】\n病程第8天予以吉西他滨+顺铂化疗。病程第10天患者出现恶心、食欲减退、乏力、手脚无力、抽搐，查血生化示钾:2.62mmol/L↓。\n{病程第10天: 氯离子(Cl-) 82.3 mmol/L ↓, 钾离子(K+) 2.62 mmol/L ↓, 白细胞计数(WBC#) 28.61 10E9/L ↑, 钠离子(Na+) 123.9 mmol/L ↓, C-反应蛋白(CRP) 15.54 mg/L ↑, 天门冬氨酸氨基转移酶(AST) 46.9 U/L ↑, 中性粒细胞计数(Neut#) 27.81 10E9/L ↑; 病程第11天: 钠离子(Na+) 136.7 mmol/L ↓, 钾离子(K+) 2.96 mmol/L ↓}","rubric_template_structured":{"total_score":10.0,"core_answer":["毒性定级：本次严重电解质紊乱按≥3级处理，待缓解后再评估恢复治疗","顺铂调整：电解质纠正、症状缓解后，结合当前肾功能、异常原因和再次用药风险决定是否减量、延期或替换顺铂，并加强肾功能与电解质监测。","吉西他滨调整：严重毒性未缓解前暂缓给药；恢复后根据吉西他滨相关毒性、器官功能及具体方案要求决定是否减量或延期，不因顺铂调整而强制同步减量。","总体策略：综合肾功能、电解质和全身状况，必要时下调整体治疗强度"],"key_evidence":["时间证据：病程第8天开始吉西他滨+顺铂，08-19即出现恶心、乏力、抽搐等急性不良反应","发作期依据：08-19 K 2.62、Na 123.9、Cl 82.3 mmol/L。","恢复治疗依据：08-20 K 2.96 mmol/L仍低、Na 136.7 mmol/L已恢复；再次治疗前需复查确认电解质稳定。","肾脏背景证据：既往左肾结石史，需结合当前肾功能及尿路情况评估顺铂用药风险，不能仅凭结石史确定减量或延长间隔。"],"conditional_modifiers":["顺铂替代：若判断严重电解质紊乱与顺铂高度相关且再用风险大，可改用肾毒性更小的含铂药物或非含铂方案","可逆诱因处理：合并呕吐、腹泻或利尿剂等因素时，纠正诱因，待电解质稳定、症状缓解后，结合肾功能及再次用药风险谨慎恢复原方案并加强监测；是否减量或延长周期按评估决定。","治疗降阶：若电解质难以长期稳定或肾功能持续受损，应降低治疗强度，必要时以放疗或支持治疗为主，减少或停用含顺铂强化方案"],"negative_list":{"major_errors":["在严重电解质紊乱未纠正或症状未缓解时即按原剂量原周期恢复吉西他滨+顺铂","忽视顺铂肾毒性和电解质紊乱风险，未提出任何剂量调整、监测或替代方案","将明显低钾低钠及抽搐视为轻微不良反应，仅口服补液/补钾后继续原方案"],"minor_errors":["仅笼统写电解质纠正后继续化疗，未说明恢复前需评估肾功能和再次用药风险，或未提出恢复治疗后加强电解质及肾功能监测。","未区分顺铂与吉西他滨在肾毒性和电解质紊乱风险上的不同作用，未经评估一概照常使用，或机械要求两药同步减量。","未结合既往肾结石与本次严重电解质紊乱，对后续含顺铂治疗的谨慎和个体化调整不足"]},"scoring_rules":{"item_scores":{"core_answer":[1.5,1.5,1.5,1.5],"key_evidence":[0.5,0.5,0.5,0.5],"conditional_modifiers":[0.67,0.67,0.66]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-8b1c4e89668793d9bf3e3eb8","case_id":"o1-case-22a5c9abf3703e1e23afcbcc","patient_id":"o1-patient-a1c25f2b266a4794c7cadcde","tag":"AE_GENERAL","question":"结合当前资料，该患者当前不良反应的类型及严重程度是什么？","case_input":"【病情摘要】\n患者男，46岁。\n2024年4月左右出现症状，病程第0天入院。\n左耳闷6月余，诊断鼻咽癌1月余。\n2024年4月左右无明显诱因出现左耳闷，无回吸性血涕、面麻、复视等不适。2024年9月自觉症状再发。\n2024年9月某医院就诊，行鼻咽镜活检病理提示：（鼻咽部）非角化型鳞状细胞癌。\n既往体健。有吸烟史10余年，平均15-20支/天，已戒烟3天。\n否认家族中有恶性肿瘤病史。\n\n【本次经过】\n本院血肌酐正常参考上限为110 μmol/L。\n病程第9天开始行第1程TPF+泰欣生方案诱导化疗，具体剂量为白蛋白结合型紫杉醇410.8mg d1、顺铂33mg d1-3、5-氟尿嘧啶4.0 d1，同时行水化治疗。病程第14天复查示肌酐226.2umol/L↑。\n{病程第0天: C-反应蛋白(CRP) 3.49 mg/L ↑, 天门冬氨酸氨基转移酶(AST) 14.1 U/L ↓, 血红蛋白(Hb) 123.0 g/L ↓; 病程第14天: 白细胞计数(WBC#) 10.96 10E9/L ↑, 氯离子(Cl-) 90.9 mmol/L ↓, 尿素(Urea) 18.8 mmol/L ↑, 钠离子(Na+) 132.6 mmol/L ↓, 肌酐(Crea) 226.2 umol/L ↑, 中性粒细胞计数(Neut#) 10.51 10E9/L ↑, 血红蛋白(Hb) 120.0 g/L ↓}","rubric_template_structured":{"total_score":10.0,"core_answer":["诊断：主要为含顺铂化疗相关肾功能损伤/AKI，合并电解质紊乱（低钠血症、低氯血症）","肌酐升高分级：肌酐226.2 μmol/L为ULN 110 μmol/L的2.06倍，按CTCAE v5.0的ULN标准为2级；AKI分级须结合临床条件另评。","低钠血症程度：血钠132.6 mmol/L，为轻度低钠血症/低级别不良反应","低氯血症程度：血氯90.9 mmol/L，为轻度低氯血症/轻度实验室异常"],"key_evidence":["化疗证据：病程第9天起TPF+泰欣生方案（含顺铂），属典型肾毒性化疗，行同步水化治疗","肾损伤证据：病程第14天肌酐226.2 μmol/L（约2.06×ULN）、尿素18.8 mmol/L升高，提示明显肾功能异常。","电解质证据：同次血钠132.6 mmol/L↓、血氯90.9 mmol/L↓，为电解质紊乱","基线资料边界：血肌酐参考上限已给出，但化疗前肌酐、尿量及症状记录仍缺，不能据此确定相对基线升幅或AKI严重程度。"],"conditional_modifiers":["基线不明时：补查治疗前肌酐和尿量；本次按ULN可判“肌酐升高”2级，如补得基线后发现现值>3倍基线，应按该条目复核是否达3级。","肾损伤上调条件：如存在少尿/无尿、氮质血症症状、电解质相关神经精神症状或需肾替代治疗，应考虑更高级别","恢复期复评：若后续肌酐下降，可按复查值重新评估当前实验室异常级别；不能仅凭症状轻或基线偏高，将本次2.06×ULN的实验室异常下调为1级。","低钠分级条件：需结合头痛、恶心、意识改变、抽搐等症状，仅轻度实验室异常且无症状时按低级别不良反应处理","分级区分：肌酐升高2级不等于AKI 2级。CTCAE v5.0的AKI按肾损伤所致住院指征、危及生命后果或透析指征分级，不能因患者已住院直接上调。"],"negative_list":{"major_errors":["未识别肾功能损伤为主要不良反应，仅提实验室异常或忽略电解质紊乱","将本次肌酐226.2 μmol/L（约2.06×ULN）误判为“肌酐升高”1级，或认为肾功能异常轻微而无需评估、处理和监测。","未提及低钠血症和低氯血症，或无证据下将异常归因于肿瘤进展而非化疗不良反应","资料不全时给出与实验室数据不符的极端CTCAE分级并作为确定结论（如无重症证据却判CTCAE 4–5级或0级）"],"minor_errors":["仅写“肾功能轻度异常”而不体现肌酐226.2 umol/L、尿素18.8 mmol/L明显升高，导致严重程度表述含糊","未说明肾功能及电解质异常与含顺铂化疗的时间关联，仅罗列实验室数据而不归类为化疗相关肾毒性","将血钠132.6 mmol/L、血氯90.9 mmol/L描述为“极重度电解质紊乱”或未说明分级受症状信息缺失限制"]},"scoring_rules":{"item_scores":{"core_answer":[1.5,1.5,1.5,1.5],"key_evidence":[0.5,0.5,0.5,0.5],"conditional_modifiers":[0.4,0.4,0.4,0.4,0.4]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-4b01a65227cee3051aa12ada","case_id":"o1-case-22a5c9abf3703e1e23afcbcc","patient_id":"o1-patient-a1c25f2b266a4794c7cadcde","tag":"AE_GENERAL","question":"针对该患者当前不良反应，应采取哪些处理和监测措施？","case_input":"【病情摘要】\n患者男，46岁。\n2024年4月左右出现症状，病程第0天入院。\n左耳闷6月余，诊断鼻咽癌1月余。\n2024年4月左右无明显诱因出现左耳闷，无回吸性血涕、面麻、复视等不适。2024年9月自觉症状再发。\n2024年9月某医院就诊，行鼻咽镜活检病理提示：（鼻咽部）非角化型鳞状细胞癌。\n既往体健。有吸烟史10余年，平均15-20支/天，已戒烟3天。\n否认家族中有恶性肿瘤病史。\n\n【本次经过】\n本院血肌酐正常参考上限为110 μmol/L。\n病程第9天开始行第1程TPF+泰欣生方案诱导化疗，具体剂量为白蛋白结合型紫杉醇410.8mg d1、顺铂33mg d1-3、5-氟尿嘧啶4.0 d1，同时行水化治疗。病程第14天复查示肌酐226.2umol/L↑。\n{病程第0天: C-反应蛋白(CRP) 3.49 mg/L ↑, 天门冬氨酸氨基转移酶(AST) 14.1 U/L ↓, 血红蛋白(Hb) 123.0 g/L ↓; 病程第14天: 白细胞计数(WBC#) 10.96 10E9/L ↑, 氯离子(Cl-) 90.9 mmol/L ↓, 尿素(Urea) 18.8 mmol/L ↑, 钠离子(Na+) 132.6 mmol/L ↓, 肌酐(Crea) 226.2 umol/L ↑, 中性粒细胞计数(Neut#) 10.51 10E9/L ↑, 血红蛋白(Hb) 120.0 g/L ↓}","rubric_template_structured":{"total_score":10.0,"core_answer":["总体策略：判断为顺铂相关急性肾损伤，立即暂停含顺铂方案，待肾功能评估后决定减量、延后或改用其他方案","支持治疗：先评估容量状态、血流动力学及尿量，低容量时适量等渗液体补充，避免容量过负荷；利尿剂不常规用于治疗已发生AKI，仅在容量过负荷等适应证下使用。","监测：动态监测血肌酐、尿素氮及尿量，评估肾损伤程度与恢复趋势","电解质处理：密切监测电解质，尤其低钠血症，及时纠正并对症支持","用药管理：避免或停用其他潜在肾毒性药物，综合评估整体用药风险"],"key_evidence":["肾功能证据：病程第14天肌酐226.2 umol/L↑、尿素18.8 mmol/L↑，提示急性肾功能损伤","电解质证据：病程第14天钠离子132.6 mmol/L↓，提示低钠血症","药物背景证据：患者接受含顺铂TPF诱导化疗，顺铂有明确肾毒性，需关注肾功能及电解质变化"],"conditional_modifiers":["重症边界：如肾功能持续恶化或少尿/无尿、严重电解质紊乱或全身情况不稳，应住院加强监护，请肾内科会诊并评估血液净化等支持","再用含铂条件：如肾功能明显恢复稳定，可在严密监测下评估减量恢复含铂或改用肾毒性较低替代方案，需平衡抗肿瘤获益与肾损伤风险"],"negative_list":{"major_errors":["遗漏：对已发生急性肾功能损伤未提出任何处理或监测，认为无需干预","误判：肾功能明显异常时仍坚持原剂量顺铂或含铂方案，未提暂停或调整治疗","臆断：否认顺铂肾毒性，将肾功能异常完全归因其他因素，不做必要用药调整"],"minor_errors":["未提及需动态高频率监测肾功能及电解质变化","未提及应避免或停用其他潜在肾毒性药物","支持治疗仅泛泛表述，未体现按容量状态个体化补液及电解质处理，或无适应证常规利尿。"]},"scoring_rules":{"item_scores":{"core_answer":[1.2,1.2,1.2,1.2,1.2],"key_evidence":[0.67,0.67,0.66],"conditional_modifiers":[1.0,1.0]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-749ce6d7d3c4571eb8aea716","case_id":"o1-case-22a5c9abf3703e1e23afcbcc","patient_id":"o1-patient-a1c25f2b266a4794c7cadcde","tag":"AE_GENERAL","question":"待该患者不良反应缓解后，后续抗肿瘤治疗应如何恢复、延期或调整？","case_input":"【病情摘要】\n患者男，46岁。\n2024年4月左右出现症状，病程第0天入院。\n左耳闷6月余，诊断鼻咽癌1月余。\n2024年4月左右无明显诱因出现左耳闷，无回吸性血涕、面麻、复视等不适。2024年9月自觉症状再发。\n2024年9月某医院就诊，行鼻咽镜活检病理提示：（鼻咽部）非角化型鳞状细胞癌。\n既往体健。有吸烟史10余年，平均15-20支/天，已戒烟3天。\n否认家族中有恶性肿瘤病史。\n\n【本次经过】\n本院血肌酐正常参考上限为110 μmol/L。\n病程第9天开始行第1程TPF+泰欣生方案诱导化疗，具体剂量为白蛋白结合型紫杉醇410.8mg d1、顺铂33mg d1-3、5-氟尿嘧啶4.0 d1，同时行水化治疗。病程第14天复查示肌酐226.2umol/L↑。\n{病程第0天: C-反应蛋白(CRP) 3.49 mg/L ↑, 天门冬氨酸氨基转移酶(AST) 14.1 U/L ↓, 血红蛋白(Hb) 123.0 g/L ↓; 病程第14天: 白细胞计数(WBC#) 10.96 10E9/L ↑, 氯离子(Cl-) 90.9 mmol/L ↓, 尿素(Urea) 18.8 mmol/L ↑, 钠离子(Na+) 132.6 mmol/L ↓, 肌酐(Crea) 226.2 umol/L ↑, 中性粒细胞计数(Neut#) 10.51 10E9/L ↑, 血红蛋白(Hb) 120.0 g/L ↓}","rubric_template_structured":{"total_score":10.0,"core_answer":["恢复前提：肾损伤缓解并复查肾功能、电解质","肾功能恢复良好：在充分水化和监测下恢复或减量顺铂","肾功能部分恢复：顺铂延期/减量，或改用肾毒性较低方案","肾功能未恢复：停用顺铂，改用非顺铂抗肿瘤方案"],"key_evidence":["肾损伤证据：TPF诱导化疗后，病程第14天肌酐226.2 μmol/L、尿素18.8 mmol/L升高，提示急性肾损伤","电解质证据：同日Na+ 132.6 mmol/L、Cl- 90.9 mmol/L降低，提示需在肾毒性和电解质纠正后再评估含顺铂方案"],"conditional_modifiers":["肾功能分层：可用eGFR或CrCl等分层指导顺铂恢复或减量，结合患者整体状况综合决策","监测与支持：恢复或调整含铂治疗时需充分水化、必要利尿，并在各周期前后监测肾功能和电解质","合并用药：后续治疗中尽量避免合用其他肾毒性药物，必要时肾内科会诊，多学科讨论平衡疗效与安全"],"negative_list":{"major_errors":["肾功能未恢复仍继续原剂量原周期顺铂或原方案","未根据肾功能恢复分层调整，仅笼统建议继续原方案","以肾损伤为唯一理由直接放弃所有后续抗肿瘤治疗，未考虑减量或替代"],"minor_errors":["未提及不良反应缓解后需复查肾功能和电解质再决策","只笼统提出调整肾方案，未具体说明减量、延周期或更换低肾毒方案","恢复或后续治疗未提及加强水化、监测和避免合并肾毒性药物"]},"scoring_rules":{"item_scores":{"core_answer":[1.5,1.5,1.5,1.5],"key_evidence":[1.0,1.0],"conditional_modifiers":[0.67,0.67,0.66]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-0e621caae44e241c24b3450e","case_id":"o1-case-2469abbf87a4fa43481a71a3","patient_id":"o1-patient-73542339174e1ffe688f9a6f","tag":"AE_GENERAL","question":"结合当前资料，该患者当前不良反应的类型及严重程度是什么？","case_input":"【病情摘要】\n患者男，51岁。\n13月前出现症状，病程第0天入院。\n回吸涕中带血13个月。\n13月前无明显诱因逐渐出现每日晨起回吸涕中带血丝，无头痛、面麻，无复视、耳鸣。\n某医院诊断为\"鼻窦炎\"，予口服药（具体不详）对症治疗后无明显好转。1月某医院鼻咽MR发现\"双侧咽隐窝狭窄，左侧咽旁间隙占位\"\"双侧颈动脉鞘周围多发较小淋巴结\"，鼻咽活检病理报告\"非角化性癌\"。某医院，鼻咽喉镜检查发现\"鼻咽顶后壁、双侧咽隐窝、咽鼓管隆突见隆起新生物\"，活检病理为\"非角化型低分化鳞癌\"。\n我院行鼻咽及颈部MR示鼻咽双侧壁、顶壁、顶后壁肿物，伴颅底骨质破坏，左侧咽后淋巴结肿大。EBV-DNA 1.35×10^3copy/ml。我院PET/CT鼻咽顶壁、顶后壁、双侧壁占位SUV约17.6，左侧咽后数个淋巴结SUVmax16.3，最大1.6*2.0cm，左肾上极软组织影2.7*3.0cm，SUV 4.5，与左肾上极及左肾上腺分界不清，可疑恶性。双肾及肾上腺超声示左肾上腺区实性肿物考虑肾上腺来源，恶性待排。上腹、下腹MR示左肾上极42mm*33mm肿物，恶性肿瘤可能性大。\n吸烟8年，20支/天。饮酒30年，每月5-10kg白酒。2009年于外院行\"阑尾炎手术\"。\n否认肿瘤家族史。\n病理会诊第二军医大学鼻咽活检标本为\"未分化型非角化性癌\"。\n患者未接受治疗。\n\n【本次经过】\n病程第2天开始PF30d方案化疗，第5天诉喉咙疼痛。放疗第5次时诉口干、下颌关节疼痛，查体见口角溃疡；放疗第7次、第10次、第15次、第25次、第28次时诉口干；放疗第17次时诉喉咙疼痛、口干；放疗第21次时诉偶流鼻血、嘴角溃疡，查体口腔II度放射性黏膜炎；放疗第24次时诉口干。\n放疗第21次时口腔中度疼痛，需调整为软食，但仍可维持经口进食及饮水。\n{病程第3天: 中性粒细胞计数(Neut#) 10.7 10E9/L ↑, 总胆红素(TBIL) 4.9 umol/L ↓, 白细胞计数(WBC#) 13.46 10E9/L ↑}","rubric_template_structured":{"total_score":10.0,"core_answer":["不良反应：放射性口腔黏膜炎","分级：CTCAE v5.0口腔黏膜炎2级；口腔中度疼痛，需调整为软食，但仍可维持经口进食及饮水。"],"key_evidence":["黏膜炎证据：放疗第21次查体记录口腔II度放射性黏膜炎；同次口腔中度疼痛、需软食，但仍可维持经口进食及饮水，支持CTCAE v5.0口腔黏膜炎2级。","症状证据：化放疗中多次出现喉咙痛、口干、口角溃疡等口腔黏膜受累表现"],"conditional_modifiers":[],"negative_list":{"major_errors":["误判为其他系统不良反应","严重程度判定为CTCAE 1级或3级及以上"],"minor_errors":["未指出为放射性口腔黏膜炎","只用非标准分级（如“中度”）未给出CTCAE 2级"]},"scoring_rules":{"item_scores":{"core_answer":[4.0,4.0],"key_evidence":[1.0,1.0],"conditional_modifiers":[]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-a4b125ea068b55615b1e6d34","case_id":"o1-case-2469abbf87a4fa43481a71a3","patient_id":"o1-patient-73542339174e1ffe688f9a6f","tag":"AE_GENERAL","question":"针对该患者当前不良反应，应采取哪些处理和监测措施？","case_input":"【病情摘要】\n患者男，51岁。\n13月前出现症状，病程第0天入院。\n回吸涕中带血13个月。\n13月前无明显诱因逐渐出现每日晨起回吸涕中带血丝，无头痛、面麻，无复视、耳鸣。\n某医院诊断为\"鼻窦炎\"，予口服药（具体不详）对症治疗后无明显好转。1月某医院鼻咽MR发现\"双侧咽隐窝狭窄，左侧咽旁间隙占位\"\"双侧颈动脉鞘周围多发较小淋巴结\"，鼻咽活检病理报告\"非角化性癌\"。某医院，鼻咽喉镜检查发现\"鼻咽顶后壁、双侧咽隐窝、咽鼓管隆突见隆起新生物\"，活检病理为\"非角化型低分化鳞癌\"。\n我院行鼻咽及颈部MR示鼻咽双侧壁、顶壁、顶后壁肿物，伴颅底骨质破坏，左侧咽后淋巴结肿大。EBV-DNA 1.35×10^3copy/ml。我院PET/CT鼻咽顶壁、顶后壁、双侧壁占位SUV约17.6，左侧咽后数个淋巴结SUVmax16.3，最大1.6*2.0cm，左肾上极软组织影2.7*3.0cm，SUV 4.5，与左肾上极及左肾上腺分界不清，可疑恶性。双肾及肾上腺超声示左肾上腺区实性肿物考虑肾上腺来源，恶性待排。上腹、下腹MR示左肾上极42mm*33mm肿物，恶性肿瘤可能性大。\n吸烟8年，20支/天。饮酒30年，每月5-10kg白酒。2009年于外院行\"阑尾炎手术\"。\n否认肿瘤家族史。\n病理会诊第二军医大学鼻咽活检标本为\"未分化型非角化性癌\"。\n患者未接受治疗。\n\n【本次经过】\n病程第2天开始PF30d方案化疗，第5天诉喉咙疼痛。放疗第5次时诉口干、下颌关节疼痛，查体见口角溃疡；放疗第7次、第10次、第15次、第25次、第28次时诉口干；放疗第17次时诉喉咙疼痛、口干；放疗第21次时诉偶流鼻血、嘴角溃疡，查体口腔II度放射性黏膜炎；放疗第24次时诉口干。\n放疗第21次时口腔中度疼痛，需调整为软食，但仍可维持经口进食及饮水。\n{病程第3天: 中性粒细胞计数(Neut#) 10.7 10E9/L ↑, 总胆红素(TBIL) 4.9 umol/L ↓, 白细胞计数(WBC#) 13.46 10E9/L ↑}","rubric_template_structured":{"total_score":10.0,"core_answer":["总体目标：缓解口腔疼痛，维持口腔清洁，保证进食与水分摄入","镇痛：局部表面麻醉剂漱口配合非阿片类全身镇痛，按疼痛程度调整","口腔护理：规范基础口腔护理，生理盐水或碳酸氢钠等温和漱口，避免刺激性漱口液和机械损伤","营养支持：根据吞咽和疼痛调整为软食/半流质/流质，避免辛辣过烫，监测摄入量和体重，必要时启动营养支持","监测：动态随访症状、黏膜炎分级、疼痛和感染体征，及时评估进展"],"key_evidence":["黏膜炎分级依据：放疗第21次记录口腔II度放射性黏膜炎；中度疼痛、需软食，仍可经口进食饮水，符合CTCAE v5.0口腔黏膜炎2级。","支持处理依据：CTCAE v5.0 2级口腔黏膜炎需加强镇痛、口腔护理与摄入监测。","治疗背景证据：正在接受PF方案化疗联合放疗，放化疗叠加易诱发或加重口腔黏膜炎，需在继续抗肿瘤治疗中加强支持治疗与监测"],"conditional_modifiers":["治疗强度调整：如黏膜炎进展为重度或疼痛难控（如不能经口进食、合并明显感染或出血），考虑暂缓或调整放疗/化疗，并升级镇痛和营养支持，多学科评估","感染处理：如出现发热、脓性分泌物或其他感染证据，可启动全身抗感染；无感染证据时不常规预防性使用全身抗生素","生活方式：长期吸烟和大量饮酒者需强化戒烟限酒宣教，加强随访口腔溃疡范围、愈合及感染体征"],"negative_list":{"major_errors":["误判：将II度黏膜炎视为轻微不良反应而不安排镇痛、口腔护理、营养支持或必要监测","误判：将当前II度黏膜炎视为必须立即中断放化疗的重度毒性，主张长期停用或明显削弱抗肿瘤治疗而非以支持治疗为主","管理失当：在无感染证据时常规使用全身抗生素，或完全忽视继发感染风险和相关监测处理"],"minor_errors":["遗漏：仅笼统提出注意口腔卫生而未提具体口腔护理措施（如生理盐水或碳酸氢钠漱口）","描述不全：镇痛和营养支持方案叙述笼统，未结合疼痛程度和进食受限调整，或未提及监测体重和饮食摄入","遗漏：未提黏膜炎分级、疼痛程度、感染迹象等动态评估和随访以指导支持治疗及是否调整抗肿瘤治疗"]},"scoring_rules":{"item_scores":{"core_answer":[1.2,1.2,1.2,1.2,1.2],"key_evidence":[0.67,0.67,0.66],"conditional_modifiers":[0.67,0.67,0.66]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-6a4f62c6036b54c752c69feb","case_id":"o1-case-2469abbf87a4fa43481a71a3","patient_id":"o1-patient-73542339174e1ffe688f9a6f","tag":"AE_GENERAL","question":"待该患者不良反应缓解后，后续抗肿瘤治疗应如何恢复、延期或调整？","case_input":"【病情摘要】\n患者男，51岁。\n13月前出现症状，病程第0天入院。\n回吸涕中带血13个月。\n13月前无明显诱因逐渐出现每日晨起回吸涕中带血丝，无头痛、面麻，无复视、耳鸣。\n某医院诊断为\"鼻窦炎\"，予口服药（具体不详）对症治疗后无明显好转。1月某医院鼻咽MR发现\"双侧咽隐窝狭窄，左侧咽旁间隙占位\"\"双侧颈动脉鞘周围多发较小淋巴结\"，鼻咽活检病理报告\"非角化性癌\"。某医院，鼻咽喉镜检查发现\"鼻咽顶后壁、双侧咽隐窝、咽鼓管隆突见隆起新生物\"，活检病理为\"非角化型低分化鳞癌\"。\n我院行鼻咽及颈部MR示鼻咽双侧壁、顶壁、顶后壁肿物，伴颅底骨质破坏，左侧咽后淋巴结肿大。EBV-DNA 1.35×10^3copy/ml。我院PET/CT鼻咽顶壁、顶后壁、双侧壁占位SUV约17.6，左侧咽后数个淋巴结SUVmax16.3，最大1.6*2.0cm，左肾上极软组织影2.7*3.0cm，SUV 4.5，与左肾上极及左肾上腺分界不清，可疑恶性。双肾及肾上腺超声示左肾上腺区实性肿物考虑肾上腺来源，恶性待排。上腹、下腹MR示左肾上极42mm*33mm肿物，恶性肿瘤可能性大。\n吸烟8年，20支/天。饮酒30年，每月5-10kg白酒。2009年于外院行\"阑尾炎手术\"。\n否认肿瘤家族史。\n病理会诊第二军医大学鼻咽活检标本为\"未分化型非角化性癌\"。\n患者未接受治疗。\n\n【本次经过】\n病程第2天开始PF30d方案化疗，第5天诉喉咙疼痛。放疗第5次时诉口干、下颌关节疼痛，查体见口角溃疡；放疗第7次、第10次、第15次、第25次、第28次时诉口干；放疗第17次时诉喉咙疼痛、口干；放疗第21次时诉偶流鼻血、嘴角溃疡，查体口腔II度放射性黏膜炎；放疗第24次时诉口干。\n放疗第21次时口腔中度疼痛，需调整为软食，但仍可维持经口进食及饮水。\n{病程第3天: 中性粒细胞计数(Neut#) 10.7 10E9/L ↑, 总胆红素(TBIL) 4.9 umol/L ↓, 白细胞计数(WBC#) 13.46 10E9/L ↑}","rubric_template_structured":{"total_score":10.0,"core_answer":["总体策略：当前2级黏膜炎在加强镇痛和营养支持下，应按原计划继续同步放化疗，无需中断","延期指征：仅当黏膜炎进展至≥3级或合并严重感染等不可耐受毒性时，才考虑延迟或暂缓治疗","恢复前提：如因毒性加重而暂停治疗，待黏膜炎缓解至≤1级且进食/吞咽可耐受后再评估恢复","方案调整：如反复出现重度黏膜炎，恢复时需权衡肿瘤控制与安全性，必要时减量化疗或调整放疗计划"],"key_evidence":["分级依据：口腔中度疼痛、需软食，但仍可经口进食饮水，符合CTCAE v5.0口腔黏膜炎2级。","继续治疗依据：CTCAE v5.0口腔黏膜炎2级，可在加强镇痛、口腔护理、营养支持与监测下继续治疗，不因该级别本身强制中断。","治疗时点边界：病例未提供因黏膜炎停疗的记录；当前2级以支持治疗并继续抗肿瘤治疗为主，若后续因毒性加重暂停，再按缓解程度和进食耐受评估恢复。"],"conditional_modifiers":["资料不足时：如患者因主观拒受或合并严重全身毒性（如骨髓抑制）已暂停治疗，恢复前需确认全身情况及黏膜炎均改善","多学科配合：继续或恢复治疗时宜联合口腔科、营养科等多学科监测和干预"],"negative_list":{"major_errors":["将当前2级黏膜炎视为必须立即停药，建议停药并等待完全缓解后再恢复","因出现黏膜炎即主张永久停止或放弃后续抗肿瘤治疗","在黏膜炎进展至无法进食等重度情况下，仍坚持原剂量原强度同步放化疗，不提延期或减量"],"minor_errors":["未指出当前2级黏膜炎在支持治疗下可按原计划继续，仅笼统回答“缓解后继续”","未提及毒性加重导致停药后，在恢复时需评估是否剂量调整或方案优化"]},"scoring_rules":{"item_scores":{"core_answer":[1.5,1.5,1.5,1.5],"key_evidence":[0.67,0.67,0.66],"conditional_modifiers":[1.0,1.0]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-a1d3a4a903242d81fc3204d6","case_id":"o1-case-5bdf1872afc9f6023211307c","patient_id":"o1-patient-373534698cd38e16adf07c5a","tag":"AE_GENERAL","question":"结合当前资料，该患者当前不良反应的类型及严重程度是什么？","case_input":"【病情摘要】\n患者女，52岁。\n病程第3天就诊。\n右侧听力下降1年余。\n2023年6月前无明显诱因出现右侧听力下降伴右侧颈部无痛性肿块，逐渐加重。\n病程第0天外院鼻咽活检病理示：鼻咽癌，未行治疗。\n既往体健。\n否认家族中有恶性肿瘤病史。\n\n【本次经过】\n病程第13天行第1程顺铂+吉西他滨+特瑞普利单抗治疗。病程第14天患者化疗结束，食欲欠佳，无恶心、上腹不适、发热、腹痛、腹泻等不适。\n{病程第3天: 间接胆红素(IBIL) 16.3 umol/L ↑, D-二聚体(D-Dimer) 0.98 μg/mL ↑}","rubric_template_structured":{"total_score":10.0,"core_answer":["不良反应：食欲减退/纳差，为治疗相关胃肠道/全身状况类 AE，非感染/发热相关 AE","严重程度：轻度食欲下降，倾向 CTCAE 1级"],"key_evidence":["症状证据：化疗后病历记载“食欲欠佳”，无恶心、上腹不适等消化道症状","感染证据：明确记录无发热、无腹痛、无腹泻等感染/发热表现","支持治疗证据：未见住院支持、静脉营养、止吐/促胃动力用药或明显体重下降记录"],"conditional_modifiers":["分级边界：需结合进食量、体重、日常活动及是否需药物/营养支持综合评估，本例资料有限按轻度判断"],"negative_list":{"major_errors":["误判为感染/发热相关 AE（如感染性发热、发热性中性粒细胞减少）","将轻度食欲减退评为 CTCAE 3–4级或危及生命 AE，或称营养状况严重不良需密集干预","忽略已记录的食欲减退，判为“无不良反应”或以病历无据的AE作为主要不良反应"],"minor_errors":["未明确为食欲下降，仅表述“胃肠道反应”或“轻度不适”","仅表述为轻度，未说明约为 CTCAE 1级或同义分级，且未说明缺乏需特殊干预证据"]},"scoring_rules":{"item_scores":{"core_answer":[3.0,3.0],"key_evidence":[0.67,0.67,0.66],"conditional_modifiers":[2.0]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-f8a36dfc228cc5a75d1142a7","case_id":"o1-case-5bdf1872afc9f6023211307c","patient_id":"o1-patient-373534698cd38e16adf07c5a","tag":"AE_GENERAL","question":"针对该患者当前不良反应，应采取哪些处理和监测措施？","case_input":"【病情摘要】\n患者女，52岁。\n病程第3天就诊。\n右侧听力下降1年余。\n2023年6月前无明显诱因出现右侧听力下降伴右侧颈部无痛性肿块，逐渐加重。\n病程第0天外院鼻咽活检病理示：鼻咽癌，未行治疗。\n既往体健。\n否认家族中有恶性肿瘤病史。\n\n【本次经过】\n病程第13天行第1程顺铂+吉西他滨+特瑞普利单抗治疗。病程第14天患者化疗结束，食欲欠佳，无恶心、上腹不适、发热、腹痛、腹泻等不适。\n{病程第3天: 间接胆红素(IBIL) 16.3 umol/L ↑, D-二聚体(D-Dimer) 0.98 μg/mL ↑}","rubric_template_structured":{"total_score":10.0,"core_answer":["监测：持续观察进食量、营养状况和体重变化","饮食：指导少食多餐，选择高热量、高蛋白、易消化饮食","营养支持：当前轻度食欲减退，暂不启动管饲或静脉营养等强化支持"],"key_evidence":["症状证据：化疗结束后记录“食欲欠佳”，提示食欲轻度下降","否定证据：明确无恶心、上腹不适、发热、腹痛、腹泻等，提示无严重胃肠道或感染表现"],"conditional_modifiers":["营养升级：如食欲明显加重减退、口服摄入严重不足或体重明显下降，应行全面营养评估，考虑ONS或药物干预"],"negative_list":{"major_errors":["误判为感染/发热并开广谱抗生素或退热药","因轻度食欲减退而暂停或推迟抗肿瘤治疗","立即启动全静脉营养等强化营养支持"],"minor_errors":["未说明饮食调整策略","未提及营养、进食量或体重的持续监测"]},"scoring_rules":{"item_scores":{"core_answer":[2.0,2.0,2.0],"key_evidence":[1.0,1.0],"conditional_modifiers":[2.0]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-4afa19bd1f5a82a99ecec5c0","case_id":"o1-case-5bdf1872afc9f6023211307c","patient_id":"o1-patient-373534698cd38e16adf07c5a","tag":"AE_GENERAL","question":"待该患者不良反应缓解后，后续抗肿瘤治疗应如何恢复、延期或调整？","case_input":"【病情摘要】\n患者女，52岁。\n病程第3天就诊。\n右侧听力下降1年余。\n2023年6月前无明显诱因出现右侧听力下降伴右侧颈部无痛性肿块，逐渐加重。\n病程第0天外院鼻咽活检病理示：鼻咽癌，未行治疗。\n既往体健。\n否认家族中有恶性肿瘤病史。\n\n【本次经过】\n病程第13天行第1程顺铂+吉西他滨+特瑞普利单抗治疗。病程第14天患者化疗结束，食欲欠佳，无恶心、上腹不适、发热、腹痛、腹泻等不适。\n{病程第3天: 间接胆红素(IBIL) 16.3 umol/L ↑, D-二聚体(D-Dimer) 0.98 μg/mL ↑}","rubric_template_structured":{"total_score":10.0,"core_answer":["总体策略：当前轻度食欲减退无需延期或减量化疗/免疫治疗","方案执行：顺铂+吉西他滨+特瑞普利单抗按原剂量原周期继续","随访监测：后续周期持续监测食欲、体重及营养状态"],"key_evidence":["毒性证据：仅记录“食欲欠佳”，未达≥2级严重程度","全身状态证据：无恶心、上腹不适、发热、腹痛、腹泻等，提示症状轻微"],"conditional_modifiers":["毒性升级时：若食欲减退加重或出现显著营养不良等严重毒性，再评估安全性并考虑调整方案或剂量"],"negative_list":{"major_errors":["将轻度食欲减退误判为需永久停用、常规推迟或减量治疗的指征","凭空提出“待感染/发热控制后再评估”等本例不符的前提"],"minor_errors":["未说明可按原计划原剂量继续治疗","未提及需监测食欲和营养状态"]},"scoring_rules":{"item_scores":{"core_answer":[2.0,2.0,2.0],"key_evidence":[1.0,1.0],"conditional_modifiers":[2.0]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-feb69d3550d45259ef78d860","case_id":"o1-case-97ec3fbf8fccf53761c8915b","patient_id":"o1-patient-51114b2418d32ad341caeacd","tag":"AE_GENERAL","question":"结合当前资料，该患者当前不良反应的类型及严重程度是什么？","case_input":"【病情摘要】\n患者男，56岁。\n2019年9月发现症状，病程第899天入院。\n鼻咽癌综合治疗后复发。\n2019年9月发现左侧颈部肿物，不伴疼痛。2021年7月以来，患者诉左斜视曾出现重影，无耳鸣，无鼻塞、涕血，无头痛，无面麻。\n某医院就诊，自诉未见异常。左侧颈部肿物无明显增大，某医院住院治疗，行颈部淋巴结穿刺活检提示（左侧颈部淋巴结）转移性癌，免疫组化及原位杂交提示鼻咽来源。鼻咽镜检查提示鼻咽部左侧壁新生物，活检提示（左侧鼻咽）未角化性未分化癌。\n病程第0天我院病理会诊：（左侧鼻咽）镜检为未分化型非角化性癌。病程第1天全身骨显像：左侧乳突炎症；多个颈腰椎退行性变。病程第5天胸部+上腹部CT平扫+增强：双肺数个小类结节灶，转移待排。病程第7天颈部MR平扫+增强：鼻咽左侧壁、左侧咽隐窝软组织肿物，考虑符合鼻咽癌，侵犯左侧咽旁、左侧翼内肌，包绕左侧颈动脉鞘。颅底骨质破坏，考虑肿瘤浸润可能性大。双侧咽后、颈部左侧II区肿大淋巴结，考虑转移可能性大。病程第529天复查PET-CT提示：鼻咽左侧壁稍增厚代谢较活跃，考虑复发；左侧咽后及左颈II区数个淋巴结代谢活跃/较活跃，考虑转移。\n既往体健。\n否认家族中有恶性肿瘤病史。\n2019年诊断：鼻咽未分化性非角化型癌。2021年诊断明确为“鼻咽癌综合治疗后复发（左隐窝，左咽后，左颈部）”。\n分别于 病程第8天、 病程第29天、 病程第50天、 病程第71天予“紫杉醇脂质体+奈达铂+泰欣生”化疗4程。病程第78天至 病程第128天完成IMRT治疗（GTV 68Gy/32F，CTV1 60Gy/32F，CTV1 50Gy/32F）。病程第563天、 病程第584天、 病程第606天予以吉西他滨+DDP+泰欣生治疗3程。于 病程第567天、 病程第588天、 病程第609天、 病程第639天予以4程信迪利单抗免疫治疗。第4程信迪利单抗免疫治疗后肌钙蛋白I及BNP升高暂停免疫治疗。病程第606天开始卡培他滨（1500mg bid）口服化疗药辅助治疗至 病程第871天。\n病程第871天复查PD。\n\n【本次经过】\n病程第899天11:30空腹服用安罗替尼胶囊1粒（8mg）。服药约数小时后出现明显恶心、反复呕吐，为黄绿色胃内容物，无法进食及口服给药，无发热、无腹泻、无腹痛，生命体征平稳，查体未见明显腹部压痛或反跳痛，肠鸣音可。既往无类似严重胃肠道反应史。","rubric_template_structured":{"total_score":10.0,"core_answer":["类型：安罗替尼相关恶心/反复呕吐，属胃肠道不良反应","严重程度：CTCAE 3级/重度，因恶心呕吐致明显经口摄入不足","全身情况：未合并其他严重胃肠道或全身毒性，生命体征平稳"],"key_evidence":["AE证据：病程第899天空腹服用安罗替尼8mg后数小时出现明显恶心、反复呕吐","严重度证据：呕吐物为黄绿色胃内容物，无法进食及口服给药，生命体征平稳，无发热、腹痛、腹泻"],"conditional_modifiers":["分级上调：呕吐需管饲、TPN或住院属于CTCAE 3级条件；仅出现危及生命后果才评估4级。脱水或电解质紊乱需另按相应条目和严重程度评估，不能自动将呕吐判4级。","病因排查：如提示肠梗阻、感染或颅内病变等，应评估非药物相关原因"],"negative_list":{"major_errors":["遗漏服药后明显恶心、反复呕吐，误判为无恶心/呕吐不良反应","未识别安罗替尼应用后出现胃肠道不良反应及其时间相关性","无危及生命后果证据时，仅凭脱水、住院或管饲/TPN将呕吐判为CTCAE 4级。"],"minor_errors":["仅描述恶心呕吐，未提及无法进食及口服给药导致经口摄入不足","给出CTCAE分级但未说明3级/重度的关键依据","忽略生命体征平稳、无腹痛/发热/腹泻等缺乏其他严重毒性证据"]},"scoring_rules":{"item_scores":{"core_answer":[2.0,2.0,2.0],"key_evidence":[1.0,1.0],"conditional_modifiers":[1.0,1.0]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-a8c287dfd81da85977976c15","case_id":"o1-case-97ec3fbf8fccf53761c8915b","patient_id":"o1-patient-51114b2418d32ad341caeacd","tag":"AE_GENERAL","question":"针对该患者当前不良反应，应采取哪些处理和监测措施？","case_input":"【病情摘要】\n患者男，56岁。\n2019年9月发现症状，病程第899天入院。\n鼻咽癌综合治疗后复发。\n2019年9月发现左侧颈部肿物，不伴疼痛。2021年7月以来，患者诉左斜视曾出现重影，无耳鸣，无鼻塞、涕血，无头痛，无面麻。\n某医院就诊，自诉未见异常。左侧颈部肿物无明显增大，某医院住院治疗，行颈部淋巴结穿刺活检提示（左侧颈部淋巴结）转移性癌，免疫组化及原位杂交提示鼻咽来源。鼻咽镜检查提示鼻咽部左侧壁新生物，活检提示（左侧鼻咽）未角化性未分化癌。\n病程第0天我院病理会诊：（左侧鼻咽）镜检为未分化型非角化性癌。病程第1天全身骨显像：左侧乳突炎症；多个颈腰椎退行性变。病程第5天胸部+上腹部CT平扫+增强：双肺数个小类结节灶，转移待排。病程第7天颈部MR平扫+增强：鼻咽左侧壁、左侧咽隐窝软组织肿物，考虑符合鼻咽癌，侵犯左侧咽旁、左侧翼内肌，包绕左侧颈动脉鞘。颅底骨质破坏，考虑肿瘤浸润可能性大。双侧咽后、颈部左侧II区肿大淋巴结，考虑转移可能性大。病程第529天复查PET-CT提示：鼻咽左侧壁稍增厚代谢较活跃，考虑复发；左侧咽后及左颈II区数个淋巴结代谢活跃/较活跃，考虑转移。\n既往体健。\n否认家族中有恶性肿瘤病史。\n2019年诊断：鼻咽未分化性非角化型癌。2021年诊断明确为“鼻咽癌综合治疗后复发（左隐窝，左咽后，左颈部）”。\n分别于 病程第8天、 病程第29天、 病程第50天、 病程第71天予“紫杉醇脂质体+奈达铂+泰欣生”化疗4程。病程第78天至 病程第128天完成IMRT治疗（GTV 68Gy/32F，CTV1 60Gy/32F，CTV1 50Gy/32F）。病程第563天、 病程第584天、 病程第606天予以吉西他滨+DDP+泰欣生治疗3程。于 病程第567天、 病程第588天、 病程第609天、 病程第639天予以4程信迪利单抗免疫治疗。第4程信迪利单抗免疫治疗后肌钙蛋白I及BNP升高暂停免疫治疗。病程第606天开始卡培他滨（1500mg bid）口服化疗药辅助治疗至 病程第871天。\n病程第871天复查PD。\n\n【本次经过】\n病程第899天11:30空腹服用安罗替尼胶囊1粒（8mg）。服药约数小时后出现明显恶心、反复呕吐，为黄绿色胃内容物，无法进食及口服给药，无发热、无腹泻、无腹痛，生命体征平稳，查体未见明显腹部压痛或反跳痛，肠鸣音可。既往无类似严重胃肠道反应史。","rubric_template_structured":{"total_score":10.0,"core_answer":["总体策略：当前严重恶心呕吐且无法进食/口服时，应暂缓或中止本次安罗替尼给药","支持治疗：无法经口进食和服药时，尽快给予静脉补液维持水电解质平衡","止吐方案：在原有基础上优化止吐方案，增加或调整不同机制止吐药物","给药途径：患者不能口服时，改用静脉、肌内等非口服途径进行止吐及支持治疗","监测与评估：密切监测生命体征、尿量和呕吐情况，警惕腹痛、腹胀、发热等提示其他严重原因"],"key_evidence":["不良反应证据：病程第899天空腹口服安罗替尼8mg数小时后即出现明显恶心、反复呕吐，为黄绿色胃内容物，无法进食及口服给药","病情评估证据：当时无发热、无腹泻、无腹痛，生命体征平稳，腹部无明显压痛或反跳痛，肠鸣音可，既往无类似严重胃肠道反应史"],"conditional_modifiers":["重症边界：如持续呕吐、明显脱水、意识改变、少尿/无尿或血流动力学不稳，应完善实验室及影像学检查，必要时收入院或重症监护强化补液、电解质纠正及对症支持","再挑战策略：如评估呕吐与安罗替尼相关性较大，症状控制后结合耐受性和肿瘤控制，考虑减量、调整给药或改用其他方案，并在下一周期前强化预防性止吐","鉴别诊断：如出现腹痛、腹胀、发热或肠鸣音异常，应警惕肠梗阻、消化道穿孔或颅内病变等，及时专科会诊并进一步检查"],"negative_list":{"major_errors":["未提及无法进食/口服时需静脉补液支持，忽视脱水或电解质紊乱风险","明显持续恶心呕吐、不能经口时仍仅建议按需口服止吐药，未强调规律及非口服途径","严重恶心呕吐未控下仍继续原剂量安罗替尼，未考虑暂停及重新评估","未指出需监测生命体征和警惕其他严重原因导致呕吐"],"minor_errors":["仅写‘对症处理’，未具体说明优化止吐方案或使用不同机制止吐药","未提及不能经口时应改用静脉等替代给药途径","未提及症状缓解后需重新评估安罗替尼方案及预防性止吐"]},"scoring_rules":{"item_scores":{"core_answer":[1.2,1.2,1.2,1.2,1.2],"key_evidence":[1.0,1.0],"conditional_modifiers":[0.66,0.66,0.68]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-5a423ba9bb66ffa4a8e22dd0","case_id":"o1-case-a40c83c57da70860bb913cdd","patient_id":"o1-patient-cd39964dd5853d876bd83b5d","tag":"AE_GENERAL","question":"结合当前资料，该患者当前不良反应的类型及严重程度是什么？","case_input":"【病情摘要】\n患者男，40岁。\n病程第10天入院。\n左颈部淋巴结肿大半月余，诊断鼻咽癌10天。\n半月余前无明显诱因发现左颈部耳后区肿物，无疼痛，无鼻塞、头痛、耳鸣，无声嘶，呛咳等不适。自起病以来，食欲一般，体重下降4公斤。\n某医院鼻内镜提示：鼻咽占位，病理提示CA。\n病程第0天病理会诊意见：（鼻咽肿物）恶性肿瘤，首先考虑非角化癌（未分化型），建议完善免疫组化。\n既往体健。\n否认家族中有恶性肿瘤病史。\n为进一步治疗入院。\n\n【本次经过】\n病程第11天患者血糖28.33 mmol/L↑，尿糖4+。病程第12天血糖16.21mmol/L↑。病程第13天夜间最高血糖25.4mmol/L↑。病程第14天糖化血红蛋白A1c为13.4%↑。\n{病程第11天: 钠离子(Na+) 135.0 mmol/L ↓, C-反应蛋白(CRP) 13.72 mg/L ↑, 淀粉样蛋白A(SAA) 48.19 mg/L ↑, 氯离子(Cl-) 97.9 mmol/L ↓; 病程第13天: 钠离子(Na+) 134.0 mmol/L ↓, C-反应蛋白(CRP) 6.48 mg/L ↑, 氯离子(Cl-) 98.6 mmol/L ↓, 肌酐(Crea) 51.3 umol/L ↓}","rubric_template_structured":{"total_score":10.0,"core_answer":["主要异常：显著高血糖，需紧急评估和规范降糖；CTCAE v5.0正式分级需结合干预及临床后果，若已启动胰岛素或因高血糖有住院指征则符合3级。","伴测定血钠轻度降低；若低于当地正常下限且≥130 mmol/L，可记CTCAE 1级实验室低钠；明显高血糖时需评估校正钠及渗透压，不能据此直接判定低渗性缺钠。"],"key_evidence":["高血糖证据：病程第11天血糖28.33 mmol/L，5-29为16.21 mmol/L，5-30夜间最高25.4 mmol/L","长期控制证据：糖化血红蛋白A1c 13.4%，提示既往血糖长期控制不佳","实测钠依据：05-28 Na 135.0 mmol/L、05-30 Na 134.0 mmol/L，均≥130 mmol/L。","血钠解释：需结合当地正常下限和同时点血糖；05-30夜间血糖与电解质是否同时采样未知。","CTCAE高血糖分级证据：3级标准为已启动胰岛素治疗或有高血糖相关住院指征；现资料未记录这些条件，不能仅凭28.33 mmol/L固定分级。","CTCAE低钠分级证据：低于正常下限但≥130 mmol/L符合实验室1级范围；高血糖所致水分转移可降低测定钠，需校正后判断临床性质。"],"conditional_modifiers":[],"negative_list":{"major_errors":["未识别显著高血糖这一主要异常，或将其视为无需处理。","对显著高血糖不建议积极评估和规范干预，或否认急性代谢并发症风险。","遗漏：只强调轻微电解质异常而忽视高血糖这一主要异常"],"minor_errors":["仅笼统写血糖升高或电解质紊乱，未识别显著高血糖、测定钠降低及其分级证据的局限。","未引用关键血糖/血钠数值，且未解释严重程度及正式CTCAE分级所需条件。"]},"scoring_rules":{"item_scores":{"core_answer":[4.0,4.0],"key_evidence":[0.34,0.34,0.33,0.33,0.33,0.33],"conditional_modifiers":[]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-a7c6b85cd7736bb1216f8734","case_id":"o1-case-a40c83c57da70860bb913cdd","patient_id":"o1-patient-cd39964dd5853d876bd83b5d","tag":"AE_GENERAL","question":"针对该患者当前不良反应，应采取哪些处理和监测措施？","case_input":"【病情摘要】\n患者男，40岁。\n病程第10天入院。\n左颈部淋巴结肿大半月余，诊断鼻咽癌10天。\n半月余前无明显诱因发现左颈部耳后区肿物，无疼痛，无鼻塞、头痛、耳鸣，无声嘶，呛咳等不适。自起病以来，食欲一般，体重下降4公斤。\n某医院鼻内镜提示：鼻咽占位，病理提示CA。\n病程第0天病理会诊意见：（鼻咽肿物）恶性肿瘤，首先考虑非角化癌（未分化型），建议完善免疫组化。\n既往体健。\n否认家族中有恶性肿瘤病史。\n为进一步治疗入院。\n\n【本次经过】\n病程第11天患者血糖28.33 mmol/L↑，尿糖4+。病程第12天血糖16.21mmol/L↑。病程第13天夜间最高血糖25.4mmol/L↑。病程第14天糖化血红蛋白A1c为13.4%↑。\n{病程第11天: 钠离子(Na+) 135.0 mmol/L ↓, C-反应蛋白(CRP) 13.72 mg/L ↑, 淀粉样蛋白A(SAA) 48.19 mg/L ↑, 氯离子(Cl-) 97.9 mmol/L ↓; 病程第13天: 钠离子(Na+) 134.0 mmol/L ↓, C-反应蛋白(CRP) 6.48 mg/L ↑, 氯离子(Cl-) 98.6 mmol/L ↓, 肌酐(Crea) 51.3 umol/L ↓}","rubric_template_structured":{"total_score":10.0,"core_answer":["总体策略：将当前极高血糖视为需紧急处理的代谢异常，尽快启动胰岛素等规范降糖治疗","监测：加强血糖监测，至少覆盖空腹、餐后及睡前血糖，必要时增加指尖血糖频次以动态调药","电解质评估：复查同时点血糖、电解质（重点Na、K、Cl）、肾功能和渗透压，评估校正钠及容量状态。","补液与纠正：结合校正钠及容量评估个体化补液，纠正真实电解质异常，不因实测Na 134–135 mmol/L常规补钠。","急性并发症：主动筛查评估DKA或HHS风险和临床表现，必要时行相关检查","抗肿瘤治疗：在血糖和电解质基本控制后，再评估高血糖对鼻咽癌后续治疗安全性的影响，必要时调整或阶段性延后方案"],"key_evidence":["高血糖证据：病程第11天起多次血糖显著升高，最高28.33 mmol/L，另有16.21 mmol/L、25.4 mmol/L记录","慢性控制证据：糖化血红蛋白A1c 13.4%，提示长期血糖控制极差或未诊断糖尿病","尿糖证据：尿糖4+，与持续显著高血糖一致","电解质数值依据：实测Na 134.0–135.0 mmol/L、Cl 97.9–98.6 mmol/L，轻度降低。","解释依据：明显高血糖可影响实测钠，应复查并结合校正钠、渗透压及容量状态判断。"],"conditional_modifiers":["急性恶化时：如出现多饮多尿、恶心呕吐、腹痛、呼吸加深加快或意识改变，应警惕DKA/HHS，需血酮、血气等紧急检查并住院强化治疗","控制平稳后：如血糖基本控制、容量和电解质稳定且无DKA/HHS等急性并发症，可在专科指导下启动后续抗肿瘤治疗；不要求等待HbA1c下降或正常化。","整体状态：注意鼻咽癌、炎症、应激等可能诱发高血糖和电解质紊乱，处理同时兼顾营养与全身状况"],"negative_list":{"major_errors":["将极高血糖或疑似糖尿病仅观察或仅限饮食控制，未启动规范降糖治疗","不评估电解质、校正钠及容量状态，或仅凭轻度测定钠降低即盲目补钠。","未进行DKA或HHS等急性并发症的风险筛查与警惕，或否认其可能","血糖明显失控或存在急性代谢并发症风险时，不经评估和处理即推进抗肿瘤治疗。"],"minor_errors":["未明确提出覆盖空腹、餐后及睡前等动态血糖监测","未提出复查电解质并结合同时点血糖、校正钠及容量状态决定处理。","未说明血糖控制后如何与鼻咽癌后续抗肿瘤治疗衔接或调整"]},"scoring_rules":{"item_scores":{"core_answer":[1.0,1.0,1.0,1.0,1.0,1.0],"key_evidence":[0.4,0.4,0.4,0.4,0.4],"conditional_modifiers":[0.67,0.67,0.66]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-42061cbbfca0567d4b5f8a47","case_id":"o1-case-a40c83c57da70860bb913cdd","patient_id":"o1-patient-cd39964dd5853d876bd83b5d","tag":"AE_GENERAL","question":"血糖基本控制后，该患者后续抗肿瘤治疗应如何启动、延期或调整？","case_input":"【病情摘要】\n患者男，40岁。\n病程第10天入院。\n左颈部淋巴结肿大半月余，诊断鼻咽癌10天。\n半月余前无明显诱因发现左颈部耳后区肿物，无疼痛，无鼻塞、头痛、耳鸣，无声嘶，呛咳等不适。自起病以来，食欲一般，体重下降4公斤。\n某医院鼻内镜提示：鼻咽占位，病理提示CA。\n病程第0天病理会诊意见：（鼻咽肿物）恶性肿瘤，首先考虑非角化癌（未分化型），建议完善免疫组化。\n既往体健。\n否认家族中有恶性肿瘤病史。\n为进一步治疗入院。\n\n【本次经过】\n病程第11天患者血糖28.33 mmol/L↑，尿糖4+。病程第12天血糖16.21mmol/L↑。病程第13天夜间最高血糖25.4mmol/L↑。病程第14天糖化血红蛋白A1c为13.4%↑。\n{病程第11天: 钠离子(Na+) 135.0 mmol/L ↓, C-反应蛋白(CRP) 13.72 mg/L ↑, 淀粉样蛋白A(SAA) 48.19 mg/L ↑, 氯离子(Cl-) 97.9 mmol/L ↓; 病程第13天: 钠离子(Na+) 134.0 mmol/L ↓, C-反应蛋白(CRP) 6.48 mg/L ↑, 氯离子(Cl-) 98.6 mmol/L ↓, 肌酐(Crea) 51.3 umol/L ↓}","rubric_template_structured":{"total_score":10.0,"core_answer":["总体策略：血糖基本控制、临床状态稳定且无急性代谢并发症后，评估启动抗肿瘤治疗；不以HbA1c下降或正常化作为启动前提。","协同管理：在内分泌等专科协作下持续控制血糖，并根据实际控制情况、急性并发症及治疗耐受性评估是否调整抗肿瘤治疗节奏和强度。","随访监测：启动抗肿瘤治疗后加强血糖监测，动态调整降糖方案和治疗安排。"],"key_evidence":["糖代谢证据：随机血糖28.33 mmol/L，糖化血红蛋白A1c 13.4%，提示长期血糖控制不良或新发重度糖尿病","治疗背景证据：目前为鼻咽癌拟行进一步抗肿瘤治疗，尚未启动药物相关治疗"],"conditional_modifiers":["专科协作：启动抗肿瘤治疗前宜请内分泌/代谢专科会诊，明确糖代谢异常性质并设定个体化控制目标","治疗节奏：若血糖波动明显或存在急性代谢并发症风险，应优先稳定代谢状态并评估是否延期；是否减量或调整方案取决于具体治疗的安全性与耐受性。"],"negative_list":{"major_errors":["当前显著高血糖尚未控制或急性代谢并发症风险未处理时，仍建议立即按常规推进抗肿瘤治疗；不以HbA1c仍高单独认定不可启动。","将当前显著高血糖视为无需规范处理，或未评估其对拟行抗肿瘤治疗安全性的影响；血糖已控制且临床稳定者，不因未调整原拟方案扣分。","无严重并发症或难以控制证据时，因高血糖直接永久放弃后续抗肿瘤治疗"],"minor_errors":["未指出需在血糖基本控制、临床稳定且急性并发症风险得到处理后评估启动抗肿瘤治疗。","未提及需内分泌/代谢专科会诊或多学科协作，仅笼统说控制血糖","未强调启动抗肿瘤治疗后需加强血糖监测，或未说明根据控制情况及耐受性评估是否调整治疗安排。"]},"scoring_rules":{"item_scores":{"core_answer":[2.0,2.0,2.0],"key_evidence":[1.0,1.0],"conditional_modifiers":[1.0,1.0]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-16f74049c5d7dcbd89b44c26","case_id":"o1-case-b82dd0c9b3135f028d41fcea","patient_id":"o1-patient-9c0c54f70fd39db85bc76609","tag":"AE_GENERAL","question":"结合当前资料，该患者当前不良反应的类型及严重程度是什么？","case_input":"【病情摘要】\n患者男，53岁。\n2024年2月就诊。\n鼻咽癌外院术后化疗后7月，复视、视力下降1月。\n2024年1月自觉视物重影、右眼睑下垂、头痛。\n病程第0天于某医院行“显微镜及神经内镜下单鼻孔入炉蝶窦、鞍区及斜坡肿瘤切除术+脑脊液漏修补术”。术后病理：（鞍区病损、斜坡病损）恶性肿瘤，符合淋巴上皮瘤样癌。术后至某医院就诊，病理会诊示：非角化型未分化癌，免疫组化：EGFR(+),PDL1(CPS＝20)。病程第16天诊断为“鼻咽未分化型非角化性癌”cT4N1M0 IVA期。于病程第16天，病程第37天、病程第56天行白紫（260mg/m2）+顺铂(45mg d1-d2)+替吉奥(60mg)治疗3程，后因患者个人原因，停止治疗。改行“中药”治疗至今。病程第187天外院颅脑+鼻咽MRI检查：术区肿物较前增大。\n病程第205天 EBV-DNA:17572copy/ml。病程第207天我院病理会诊：鼻咽未分化型非角化性癌。病程第207天鼻咽部、颈部MR：鼻咽癌术后化疗后，蝶窦、斜坡、鞍区见不规则软组织影，边界欠清，范围约60mm×56mm，包绕双侧颈内动脉，双侧海绵窦受侵。颈部双侧II、III、左侧IV区见多发淋巴结，大者短径约8mm，明显强化。病程第210天全身PET/CT：未见远处转移征象。\n既往体健。有吸烟史，20支/日*20年。\n否认家族中有恶性肿瘤病史。\n鼻咽未分化型非角化性癌T4N1M0 IVa期术后化疗后进展。\n病程第16天、病程第37天、病程第56天行白紫（260mg/m2）+顺铂(45mg d1-d2)+替吉奥(60mg)治疗3程。\n\n【本次经过】\n病程第214天泰欣生输注过程中患者出现胸闷、寒战，血氧饱和度87%，血压130/70mmHg。","rubric_template_structured":{"total_score":10.0,"core_answer":["不良反应：泰欣生（尼妥珠单抗）输注相关反应/过敏或超敏反应","严重程度：至少CTCAE 3级重度输注相关/过敏反应"],"key_evidence":["时间证据：不良反应发生于泰欣生（尼妥珠单抗）输注过程中","症状证据：输注中出现胸闷、寒战等急性全身症状","低氧证据：血氧饱和度下降至87%"],"conditional_modifiers":[],"negative_list":{"major_errors":["误判为与输注/过敏无关的不良事件（如单纯感染或心脏事件）","将严重程度判为CTCAE 1–2级，未体现血氧饱和度明显下降提示的重度反应"],"minor_errors":["仅写输注反应或过敏反应，未指出重度或至少CTCAE 3级","未提及发生在输注过程中或遗漏血氧饱和度下降等严重程度要点"]},"scoring_rules":{"item_scores":{"core_answer":[4.0,4.0],"key_evidence":[0.67,0.67,0.66],"conditional_modifiers":[]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-82d99220e4968d317879a682","case_id":"o1-case-b82dd0c9b3135f028d41fcea","patient_id":"o1-patient-9c0c54f70fd39db85bc76609","tag":"AE_GENERAL","question":"针对该患者当前不良反应，应采取哪些处理和监测措施？","case_input":"【病情摘要】\n患者男，53岁。\n2024年2月就诊。\n鼻咽癌外院术后化疗后7月，复视、视力下降1月。\n2024年1月自觉视物重影、右眼睑下垂、头痛。\n病程第0天于某医院行“显微镜及神经内镜下单鼻孔入炉蝶窦、鞍区及斜坡肿瘤切除术+脑脊液漏修补术”。术后病理：（鞍区病损、斜坡病损）恶性肿瘤，符合淋巴上皮瘤样癌。术后至某医院就诊，病理会诊示：非角化型未分化癌，免疫组化：EGFR(+),PDL1(CPS＝20)。病程第16天诊断为“鼻咽未分化型非角化性癌”cT4N1M0 IVA期。于病程第16天，病程第37天、病程第56天行白紫（260mg/m2）+顺铂(45mg d1-d2)+替吉奥(60mg)治疗3程，后因患者个人原因，停止治疗。改行“中药”治疗至今。病程第187天外院颅脑+鼻咽MRI检查：术区肿物较前增大。\n病程第205天 EBV-DNA:17572copy/ml。病程第207天我院病理会诊：鼻咽未分化型非角化性癌。病程第207天鼻咽部、颈部MR：鼻咽癌术后化疗后，蝶窦、斜坡、鞍区见不规则软组织影，边界欠清，范围约60mm×56mm，包绕双侧颈内动脉，双侧海绵窦受侵。颈部双侧II、III、左侧IV区见多发淋巴结，大者短径约8mm，明显强化。病程第210天全身PET/CT：未见远处转移征象。\n既往体健。有吸烟史，20支/日*20年。\n否认家族中有恶性肿瘤病史。\n鼻咽未分化型非角化性癌T4N1M0 IVa期术后化疗后进展。\n病程第16天、病程第37天、病程第56天行白紫（260mg/m2）+顺铂(45mg d1-d2)+替吉奥(60mg)治疗3程。\n\n【本次经过】\n病程第214天泰欣生输注过程中患者出现胸闷、寒战，血氧饱和度87%，血压130/70mmHg。","rubric_template_structured":{"total_score":10.0,"core_answer":["即时处理：立即停止泰欣生输注，保持静脉通路","氧疗：立即给予吸氧，纠正血氧饱和度87%的低氧血症","急救评估：快速评估气道、呼吸、循环及意识，识别伴呼吸或循环受损的严重过敏反应，不因血压正常排除。","急救用药：如符合过敏反应并有气道、呼吸或循环受损，立即肌内注射肾上腺素（大腿外侧）；不等待低血压或休克出现。","监测：急性期持续监测生命体征和症状直至完全缓解","后续用药：本次停止泰欣生输注，重度反应缓解后通常不再使用，优先选择其他抗肿瘤方案。"],"key_evidence":["输注证据：病程第214天泰欣生输注过程中出现胸闷、寒战","低氧证据：反应发生时血氧饱和度为87%","血压证据：当时血压130/70mmHg，无明显低血压记录"],"conditional_modifiers":["严重过敏边界：有气道、呼吸或循环受损时按严重过敏反应流程及时急救；出现低血压、意识障碍或休克时加强复苏并考虑监护。","后续方案：停用泰欣生并调整为其他抗肿瘤方案可接受；仅在无可行替代方案、经专科及多学科评估后，才考虑严密监护下规范脱敏，不作常规要求。"],"negative_list":{"major_errors":["将本次为重度不良反应误判为轻度或一般，仅减慢滴速或仅对症处理而未立即停用泰欣生","低氧血症及急性全身症状时，未进行气道、呼吸、循环等急性评估与抢救","本次反应尚未控制时继续或恢复泰欣生输注，或反应缓解后未经风险评估即常规重启原药。"],"minor_errors":["未提及持续监测生命体征和症状至完全缓解","未结合血氧87%和血压130/70mmHg的表现进行相对精准分级或处理","对后续是否重启泰欣生态度含糊，未明确应按重度输注反应通常不再使用"]},"scoring_rules":{"item_scores":{"core_answer":[1.0,1.0,1.0,1.0,1.0,1.0],"key_evidence":[0.67,0.67,0.66],"conditional_modifiers":[1.0,1.0]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-f8a0d573b3fe68573699700e","case_id":"o1-case-b82dd0c9b3135f028d41fcea","patient_id":"o1-patient-9c0c54f70fd39db85bc76609","tag":"AE_GENERAL","question":"待该患者不良反应缓解后，后续抗肿瘤治疗应如何恢复、延期或调整？","case_input":"【病情摘要】\n患者男，53岁。\n2024年2月就诊。\n鼻咽癌外院术后化疗后7月，复视、视力下降1月。\n2024年1月自觉视物重影、右眼睑下垂、头痛。\n病程第0天于某医院行“显微镜及神经内镜下单鼻孔入炉蝶窦、鞍区及斜坡肿瘤切除术+脑脊液漏修补术”。术后病理：（鞍区病损、斜坡病损）恶性肿瘤，符合淋巴上皮瘤样癌。术后至某医院就诊，病理会诊示：非角化型未分化癌，免疫组化：EGFR(+),PDL1(CPS＝20)。病程第16天诊断为“鼻咽未分化型非角化性癌”cT4N1M0 IVA期。于病程第16天，病程第37天、病程第56天行白紫（260mg/m2）+顺铂(45mg d1-d2)+替吉奥(60mg)治疗3程，后因患者个人原因，停止治疗。改行“中药”治疗至今。病程第187天外院颅脑+鼻咽MRI检查：术区肿物较前增大。\n病程第205天 EBV-DNA:17572copy/ml。病程第207天我院病理会诊：鼻咽未分化型非角化性癌。病程第207天鼻咽部、颈部MR：鼻咽癌术后化疗后，蝶窦、斜坡、鞍区见不规则软组织影，边界欠清，范围约60mm×56mm，包绕双侧颈内动脉，双侧海绵窦受侵。颈部双侧II、III、左侧IV区见多发淋巴结，大者短径约8mm，明显强化。病程第210天全身PET/CT：未见远处转移征象。\n既往体健。有吸烟史，20支/日*20年。\n否认家族中有恶性肿瘤病史。\n鼻咽未分化型非角化性癌T4N1M0 IVa期术后化疗后进展。\n病程第16天、病程第37天、病程第56天行白紫（260mg/m2）+顺铂(45mg d1-d2)+替吉奥(60mg)治疗3程。\n\n【本次经过】\n病程第214天泰欣生输注过程中患者出现胸闷、寒战，血氧饱和度87%，血压130/70mmHg。","rubric_template_structured":{"total_score":10.0,"core_answer":["总体策略：严重输注反应后不常规按原方案重启泰欣生","治疗调整：通常停用泰欣生并改用其他抗肿瘤方案；或在无可行替代方案、经专科及多学科评估同意后，选择严密监护下规范脱敏的路径。符合其中一条路径即可。"],"key_evidence":["输注反应证据：泰欣生输注中出现胸闷、寒战，血氧饱和度降至87%，符合高等级输注/过敏样反应"],"conditional_modifiers":["后续治疗：通常停用泰欣生并采用替代抗肿瘤方案；如考虑脱敏，仅限无可行替代、经专科及多学科评估同意并具备严密监护条件时。"],"negative_list":{"major_errors":["严重输注反应后仍建议常规恢复或继续原泰欣生，或仅作对症/减慢滴速处理","在有可行替代方案或未经专科及多学科评估时，即主张脱敏后再用泰欣生。"],"minor_errors":["提出泰欣生脱敏再用时，未说明规范脱敏流程或严密监护要求。","未说明后续抗肿瘤治疗的具体处理方向，仅泛称“调整”或“个体化处理”。"]},"scoring_rules":{"item_scores":{"core_answer":[3.0,3.0],"key_evidence":[2.0],"conditional_modifiers":[2.0]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-38ca87cdb9ae97fd6977e0c3","case_id":"o1-case-5723e1d7811c322656be94e1","patient_id":"o1-patient-f6cd4ec7553e6e77a10e2343","tag":"ELDERLY_NPC_BUNDLE","question":"结合当前资料，请评估该患者当前是否符合标准强度综合治疗的适用情形，并说明判断依据。","case_input":"【病情摘要】\n患者女，71岁。\n病程第67天入院。\n鼻咽癌放化疗后14年，近期检查发现局部复发。\n14年前因“鼻咽肿物”就诊。\n病程第0天当地鼻咽镜下见双侧鼻咽肿物伴白色分泌物。病程第7天鼻咽镜活检病理诊断为未分化型非角化性癌，符合复发。\n2010年8月MR提示鼻咽病变，符合鼻咽癌。鼻内镜活检病理诊断:（鼻咽顶后壁）镜检为未分化型非角化性癌，遂行根治性放化疗。\n既往高血压病史，长期口服降压药物，血压控制可。\n否认家族中有恶性肿瘤病史。","rubric_template_structured":{"total_score":10.0,"core_answer":["总体判断：现有资料不足以确定标准强度治疗的适用性，应按既往放疗后复发路径评估，不能直接套用初治同步放化疗。","治疗目标：经评估具备根治性局部挽救条件者可按根治意图治疗；不具备者以控瘤和缓解症状为主，兼顾毒性与生活质量。","总体策略：在缺乏充分耐受证据前，不应将标准强度同步放化疗作为首选","总体策略：需评估可切除性、再放疗可行性及整体耐受性（尤其是高龄），再选择治疗路径。"],"key_evidence":["人群证据：患者71岁，≥70岁高龄","治疗史证据：14年前已行鼻咽癌放化疗，累积放化疗毒性风险存在","疾病证据：当前为鼻咽癌复发，距离初次治疗14年","合并症证据：长期高血压等慢性基础疾病存在"],"conditional_modifiers":["手术及再放疗边界：可切除且适合手术者考虑挽救手术；再放疗可行者经严格筛选后考虑再放疗±系统治疗。","非局部治疗路径：经评估不适合挽救手术及再放疗者，结合耐受性选择个体化系统治疗。","支持治疗边界：不适合局部挽救及系统治疗者，以最佳支持治疗为主。"],"negative_list":{"major_errors":["未经评估可切除性、再放疗可行性及整体耐受性，即直接套用初治标准强度同步放化疗。","仅凭高龄或既往放疗史，直接判定不适合根治性挽救治疗。","未做复发危险度分层即要求必须再程放疗"],"minor_errors":["未提及既往放化疗累积毒性风险","未体现对高龄及合并基础疾病等整体情况评估","治疗目标只强调积极根治，未提平衡疗效与毒性及生活质量"]},"scoring_rules":{"item_scores":{"core_answer":[1.5,1.5,1.5,1.5],"key_evidence":[0.5,0.5,0.5,0.5],"conditional_modifiers":[0.67,0.67,0.66]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-b070342ff078afa29fb140d8","case_id":"o1-case-5723e1d7811c322656be94e1","patient_id":"o1-patient-f6cd4ec7553e6e77a10e2343","tag":"ELDERLY_NPC_BUNDLE","question":"若不符合标准强度治疗的适用情形，请说明整体治疗策略应如何进行个体化调整，并注明主要依据。","case_input":"【病情摘要】\n患者女，71岁。\n病程第67天入院。\n鼻咽癌放化疗后14年，近期检查发现局部复发。\n14年前因“鼻咽肿物”就诊。\n病程第0天当地鼻咽镜下见双侧鼻咽肿物伴白色分泌物。病程第7天鼻咽镜活检病理诊断为未分化型非角化性癌，符合复发。\n2010年8月MR提示鼻咽病变，符合鼻咽癌。鼻内镜活检病理诊断:（鼻咽顶后壁）镜检为未分化型非角化性癌，遂行根治性放化疗。\n既往高血压病史，长期口服降压药物，血压控制可。\n否认家族中有恶性肿瘤病史。","rubric_template_structured":{"total_score":10.0,"core_answer":["总体策略：需评估可切除性、再放疗可行性及整体耐受性（尤其是高龄），再选择治疗路径。","非局部治疗路径：经评估不适合挽救手术及再放疗者，结合耐受性选择系统治疗或最佳支持治疗。","再放疗路径：再放疗可行者经严格筛选后，可选择再放疗±系统治疗；治疗强度按获益、风险及耐受性确定。"],"key_evidence":["年龄依据：患者71岁，需重点评估高龄相关耐受性，不能仅凭年龄认定再放疗高危或排除根治性挽救治疗。","放疗风险证据：既往已行根治性放化疗，组织累积放射损伤风险增加","合并症依据：高血压药物控制可，需纳入整体耐受性评估，不据此直接判定必须减强治疗。"],"conditional_modifiers":["手术及放疗边界：可切除且适合手术者评估挽救手术；不可切除但再放疗获益风险可接受者，个体化讨论精确再放疗。","再放疗边界：经评估确认不适合再放疗者，不采用再放疗；仍需结合手术可行性及系统治疗耐受性选择路径。","系统治疗边界：按NCCN鼻咽癌系统治疗方案，结合体能状态、器官功能及治疗目标个体化选择。"],"negative_list":{"major_errors":["误判：未经评估可切除性、再放疗可行性及整体耐受性，即直接套用初治标准强度同步放化疗。","误判：未经评估即要求所有复发患者必须接受再放疗，或必须减强再放疗。","误判：将经评估不适合再放疗者选择适宜的系统治疗或最佳支持治疗判为错误。"],"minor_errors":["遗漏：仅笼统提出个体化，未评估可切除性、再放疗可行性及整体耐受性。","遗漏：未指出高龄和既往放疗史作为决定再程放疗与强度调整的重要依据"]},"scoring_rules":{"item_scores":{"core_answer":[2.0,2.0,2.0],"key_evidence":[0.67,0.67,0.66],"conditional_modifiers":[0.67,0.67,0.66]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
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+{"item_id":"o1-item-fbe655a84f91d76c02460f10","case_id":"o1-case-01b4851b207a4e645d555858","patient_id":"o1-patient-b693d091a0bdfd054efdcbd1","tag":"PEDIATRIC_NPC_BUNDLE","question":"结合当前资料，请列出该患者治疗前还需补充的儿童/青少年特异性评估，并分别说明各项评估的目的。","case_input":"【病情摘要】\n患者男，16岁。\n2024年11月发现症状，病程第59天入院。\n鼻咽癌2程诱导化疗后3周余。\n2024年11月发现左颈部淋巴结肿大，伴持续性疼痛，自行口服非甾体类抗炎药可缓解，伴鼻塞、涕血，头晕、头痛，双侧耳鸣、听力下降。\n2024年12月至某医院拟诊为淋巴结炎，予消炎止痛治疗后疼痛缓解，左颈部肿物未见消退，完善喉镜见鼻咽肿物，未活检。病程第0天至某医院行“鼻内镜下左鼻咽肿物活检术”，术后病理考虑未分化型非角化性癌。后转至某医院进一步诊治。\nEB病毒DNA定量：1.550E+03copies/ml。病程第7天鼻咽、颈部软组织MRI平扫+增强：鼻咽部肿块：考虑鼻咽癌，累及周围软组织、颅底骨质受侵，颈部多发淋巴结增大。2025-02病理会诊报告：（左鼻咽部肿物，活检）符合非角化性鳞状细胞癌，未分化型。病程第8天PET-CT：结合病理符合鼻咽部恶性肿瘤改变，累及邻近软组织及颅底骨质及并多发淋巴结转移可能性大。病程第35天某医院复查MR提示：鼻咽部肿块伴右侧咽旁间隙受累、颅底骨质受侵、颈部多发淋巴结转移均较前进展，EB病毒DNA定量：6.635E+03copies/ml。\n慢性鼻炎。鱼鳞病。2025-03外院发现窦性心动过速。2岁时行“隐睾手术”。3岁时左臂骨折，行“固定治疗”，肌力较右臂减弱。\n有舅公患鼻咽癌，已过世。\n近2月体重减轻约7kg。\n于某医院明确诊断为鼻咽未分化型非角化性癌T3N3M0 III期（AJCC第九版）。\n\n【影像资料】\n{病程第62天电子鼻咽镜检查(表麻下)(不活检)(套): 继续综合治疗。 ;鼻咽癌3程诱导化疗后，复查： 鼻咽全腔见肿物，侵犯双侧后鼻孔，少许分泌物覆盖。, 鼻咽癌化疗后}","rubric_template_structured":{"total_score":10.0,"core_answer":["垂体及生长发育基线评估：评估生长激素/性腺轴，监测放疗对生长和青春期发育影响。","甲状腺功能与超声基线评估：监测颈部照射及化疗对甲状腺功能和结构的长期影响。","听力及中耳/咽鼓管功能基线评估：评估耳蜗和传音系统状态，监测放疗及含铂药物耳毒性。","眼科及视神经/颅神经功能基线评估：评估视力和相关颅神经功能，监测颅底照射引起的视神经及颅神经损伤。","GFR等肾功能基线评估：评估肾小球滤过率和肾储备功能，监测含铂等药物肾毒性及长期肾功能结局。","心电图及心超基线评估：结合既往窦性心动过速评价心律与心功能；如拟用心脏毒性药物，再按具体药物安排监测。"],"key_evidence":["年龄证据：男，16岁，处于青春期和生长期，需关注内分泌、生长发育及远期器官毒性。","颅底累及证据：鼻咽部肿块累及颅底骨质，邻近眼眶、视神经及颅神经，需评估相关功能基线。","耳部受累证据：双侧耳鸣、听力下降，提示耳功能受累，需治疗前听力及中耳/咽鼓管评价。","心脏病史证据：既往窦性心动过速，需完善心脏结构及心律评估。","治疗方案证据：拟行放化疗但诱导药物组成未列，需核对方案；如用铂类应监测耳/肾毒性，心脏评估有既往心动过速依据，不默认含蒽环。"],"conditional_modifiers":["含铂方案边界：若基线听力已中重度受损或有明显耳毒性，需多学科讨论调整铂剂剂量或替代方案，并强化随访听力监测。"],"negative_list":{"major_errors":["仅列出成人常规鼻咽癌检查（如鼻咽镜、常规MRI、PET-CT、血常规、肝肾功），未体现儿童/青少年生长发育和远期器官毒性相关评估。","将“需补充的评估”写成病例中已完成的检查结果或具体治疗方案，未回答需新增的评估项目及其目的。"],"minor_errors":["遗漏任一关键儿童/青少年特异性评估类别（垂体及生长发育、甲状腺、听力及中耳/咽鼓管、眼科、肾功能、心功能）。","仅列出检查名称，未说明其用于监测放疗/化疗相关短期及远期生长发育或器官功能影响的目的。","未体现“儿童/青少年”特点，仅笼统写“评估某器官功能”，未提建立基线或监测长期毒性。"]},"scoring_rules":{"item_scores":{"core_answer":[1.0,1.0,1.0,1.0,1.0,1.0],"key_evidence":[0.4,0.4,0.4,0.4,0.4],"conditional_modifiers":[2.0]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-96abe3b20ccd214aeda1f3ac","case_id":"o1-case-01b4851b207a4e645d555858","patient_id":"o1-patient-b693d091a0bdfd054efdcbd1","tag":"PEDIATRIC_NPC_BUNDLE","question":"若该患者实施放疗，请说明在治疗强度、剂量安排、靶区设计及正常组织保护方面的特殊考虑。","case_input":"【病情摘要】\n患者男，16岁。\n2024年11月发现症状，病程第59天入院。\n鼻咽癌2程诱导化疗后3周余。\n2024年11月发现左颈部淋巴结肿大，伴持续性疼痛，自行口服非甾体类抗炎药可缓解，伴鼻塞、涕血，头晕、头痛，双侧耳鸣、听力下降。\n2024年12月至某医院拟诊为淋巴结炎，予消炎止痛治疗后疼痛缓解，左颈部肿物未见消退，完善喉镜见鼻咽肿物，未活检。病程第0天至某医院行“鼻内镜下左鼻咽肿物活检术”，术后病理考虑未分化型非角化性癌。后转至某医院进一步诊治。\nEB病毒DNA定量：1.550E+03copies/ml。病程第7天鼻咽、颈部软组织MRI平扫+增强：鼻咽部肿块：考虑鼻咽癌，累及周围软组织、颅底骨质受侵，颈部多发淋巴结增大。2025-02病理会诊报告：（左鼻咽部肿物，活检）符合非角化性鳞状细胞癌，未分化型。病程第8天PET-CT：结合病理符合鼻咽部恶性肿瘤改变，累及邻近软组织及颅底骨质及并多发淋巴结转移可能性大。病程第35天某医院复查MR提示：鼻咽部肿块伴右侧咽旁间隙受累、颅底骨质受侵、颈部多发淋巴结转移均较前进展，EB病毒DNA定量：6.635E+03copies/ml。\n慢性鼻炎。鱼鳞病。2025-03外院发现窦性心动过速。2岁时行“隐睾手术”。3岁时左臂骨折，行“固定治疗”，肌力较右臂减弱。\n有舅公患鼻咽癌，已过世。\n近2月体重减轻约7kg。\n于某医院明确诊断为鼻咽未分化型非角化性癌T3N3M0 III期（AJCC第九版）。\n\n【影像资料】\n{病程第62天电子鼻咽镜检查(表麻下)(不活检)(套): 继续综合治疗。 ;鼻咽癌3程诱导化疗后，复查： 鼻咽全腔见肿物，侵犯双侧后鼻孔，少许分泌物覆盖。, 鼻咽癌化疗后}","rubric_template_structured":{"total_score":10.0,"core_answer":["总体策略：16岁局部晚期NPC采用IMRT等高精度根治放疗","剂量与分割：原发灶及阳性颈淋巴结给予足够根治剂量，采用常规/标准分割","靶区设计：按GTV/CTV分层勾画，原发灶及颈部多站淋巴结纳入高危靶区","颈部设计：N3期需覆盖所有阳性淋巴结及相邻高危引流区，并向同侧下一站区域预防性扩展","正常组织保护：重点保护垂体、颅底骨、生长相关结构及耳蜗/内耳，兼顾远期毒性和生长发育"],"key_evidence":["总体证据：16岁男性，未分化型非角化性鼻咽癌T3N3M0 III期，局部晚期需根治性放疗并追求高局控率","T证据：影像示鼻咽肿块累及颅底骨质、右侧咽旁间隙，多发颈淋巴结转移，病程第35天MR较前进展，支持原发灶及多站颈淋巴结列为高危靶区","残余病灶证据：诱导化疗3程后电子鼻咽镜仍见鼻咽全腔肿物侵犯双侧后鼻孔，提示残余明确，需据残余范围优化GTV/CTV并给予足量根治剂量","生长发育证据：患者为青少年生长期，需保护垂体、颅底骨及其他生长相关结构，降低远期生长及内分泌并发症","听力损伤证据：已有双侧耳鸣、听力下降，需保护耳蜗/内耳；诱导药物组成未列，若使用顺铂则进一步评估耳毒性风险。","黏膜皮肤证据：慢性鼻炎及鱼鳞病提示鼻黏膜和皮肤对放射性炎症反应可能更敏感，需在剂量分布设计和毒性管理中重点关注"],"conditional_modifiers":["剂量个体化：根据诱导化疗后影像学疗效调整剂量，明显缩小者可用推荐下限，残留明显或进展者在安全前提下倾向推荐上限","分割原则：采用常规/标准分割（1.8–2.0 Gy/次，每周5次），不常规使用大分割或过高单次剂量以避免青少年远期毒性显著增加","靶区勾画：在CT模拟基础上融合MRI及有条件时的PET-CT，PTV在GTV/CTV外放约3–5 mm，邻近脑干、视交叉等危及器官处适当收缩或优化","放疗技术：可采用IGRT提高摆位精度，尤其高剂量区邻近脑干、脊髓、视交叉、内耳时，以兼顾靶区覆盖和正常组织保护","黏膜管理：考虑慢性鼻炎，放疗中加强鼻咽黏膜护理，必要时调整局部剂量分布或予对症用药以减轻放射性黏膜炎和鼻部不适","摆位固定：考虑既往左臂骨折及肌力减弱，个体化设计固定与摆位方案，兼顾患肢舒适和体位可重复性，避免影响靶区定位精度"],"negative_list":{"major_errors":["未推荐以IMRT等高精度根治放疗为主，或错误首选传统二维放疗","根治放疗背景下推荐大分割或单次剂量明显高于常规分割，且忽视青少年远期毒性","靶区未覆盖鼻咽原发肿瘤、颅底侵犯或多发阳性颈淋巴结区域，N3期未分层设计颈部高/低危CTV","忽视青少年器官保护，如未考虑垂体、颅底骨、生长相关结构、耳蜗/内耳剂量控制，或对已有听力下降及可能使用铂类时的内耳保护要求重视不足"],"minor_errors":["未提及根据诱导化疗后肿瘤残留或疗效调整放疗剂量或靶区范围","未说明靶区勾画需参考化疗前后MRI/PET-CT及内镜结果，表述过于笼统","未提到脑干、脊髓、视交叉、腮腺、耳蜗/内耳等关键危及器官的剂量限制和保护策略","未提及IMRT/IGRT等先进放疗技术优化剂量分布和摆位精度，仅泛称“放疗”"]},"scoring_rules":{"item_scores":{"core_answer":[1.2,1.2,1.2,1.2,1.2],"key_evidence":[0.33,0.33,0.33,0.33,0.33,0.35],"conditional_modifiers":[0.33,0.33,0.33,0.33,0.33,0.35]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-f679193211bcdbaf99c8c5e8","case_id":"o1-case-01b4851b207a4e645d555858","patient_id":"o1-patient-b693d091a0bdfd054efdcbd1","tag":"PEDIATRIC_NPC_BUNDLE","question":"请评估其是否符合减量治疗的适用情形，并说明判断依据及需满足的前提条件。","case_input":"【病情摘要】\n患者男，16岁。\n2024年11月发现症状，病程第59天入院。\n鼻咽癌2程诱导化疗后3周余。\n2024年11月发现左颈部淋巴结肿大，伴持续性疼痛，自行口服非甾体类抗炎药可缓解，伴鼻塞、涕血，头晕、头痛，双侧耳鸣、听力下降。\n2024年12月至某医院拟诊为淋巴结炎，予消炎止痛治疗后疼痛缓解，左颈部肿物未见消退，完善喉镜见鼻咽肿物，未活检。病程第0天至某医院行“鼻内镜下左鼻咽肿物活检术”，术后病理考虑未分化型非角化性癌。后转至某医院进一步诊治。\nEB病毒DNA定量：1.550E+03copies/ml。病程第7天鼻咽、颈部软组织MRI平扫+增强：鼻咽部肿块：考虑鼻咽癌，累及周围软组织、颅底骨质受侵，颈部多发淋巴结增大。2025-02病理会诊报告：（左鼻咽部肿物，活检）符合非角化性鳞状细胞癌，未分化型。病程第8天PET-CT：结合病理符合鼻咽部恶性肿瘤改变，累及邻近软组织及颅底骨质及并多发淋巴结转移可能性大。病程第35天某医院复查MR提示：鼻咽部肿块伴右侧咽旁间隙受累、颅底骨质受侵、颈部多发淋巴结转移均较前进展，EB病毒DNA定量：6.635E+03copies/ml。\n慢性鼻炎。鱼鳞病。2025-03外院发现窦性心动过速。2岁时行“隐睾手术”。3岁时左臂骨折，行“固定治疗”，肌力较右臂减弱。\n有舅公患鼻咽癌，已过世。\n近2月体重减轻约7kg。\n于某医院明确诊断为鼻咽未分化型非角化性癌T3N3M0 III期（AJCC第九版）。\n\n【影像资料】\n{病程第62天电子鼻咽镜检查(表麻下)(不活检)(套): 继续综合治疗。 ;鼻咽癌3程诱导化疗后，复查： 鼻咽全腔见肿物，侵犯双侧后鼻孔，少许分泌物覆盖。, 鼻咽癌化疗后}","rubric_template_structured":{"total_score":10.0,"core_answer":["总体策略：本例为16岁青少年局部晚期鼻咽癌，已完成诱导化疗后进入放化疗阶段。","减量适应证：仅凭现有资料不能认定符合放疗减量条件，需在标准路径下优先保证局部控制和长期生存。","放疗减量前提：完成计划诱导化疗，复评缓解良好且EBV-DNA明显下降或转阴，方可在研究或共识框架下考虑放疗剂量或体积适度减量。","剂量依据：减量依据应为客观毒性和脏器功能，不因儿童/青少年身份主观减量。","决策程序：任何减量策略需经多学科团队讨论，并在患儿及家属充分知情同意基础上实施。"],"key_evidence":["人群证据：患者男16岁，处于生长发育期，远期听力、心血管、内分泌毒性需重点权衡。","病理及病毒学证据：鼻咽未分化型非角化性癌，血EBV-DNA阳性；未提供组织EBER结果，不能将其写为已证实阳性。","分期证据：T3N3M0 III期，原发灶累及周围软组织及颅底骨质并多发颈淋巴结转移，属局部晚期、高肿瘤负荷。","复评证据：已完成2程诱导化疗，鼻咽镜提示3程后仍见鼻咽全腔肿物侵犯双侧后鼻孔，缺乏规范CR/PR分级、体积缩小比例及EBV-DNA趋势。","毒性风险证据：既往双侧耳鸣、听力下降及2025-03外院发现窦性心动过速，提示后续含铂化疗及放疗需监测听力和心功能。"],"conditional_modifiers":["放疗减量边界：若完成计划诱导化疗后原发灶及颈淋巴结达CR或接近CR，体积明显缩小，且EBV-DNA较基线显著下降或转阴、全身状况良好，可在有循证依据或临床研究/专家共识指导下谨慎讨论放疗剂量或照射体积适度减量。","不宜减量情形：若诱导化疗后病灶退缩不佳、EBV-DNA持续阳性/上升或存在高危残留灶，则不宜降低放疗剂量或化疗强度，应按标准剂量和推荐方案优先保证肿瘤控制。","化疗个体化边界：若后续证实有中重度耳毒性、心功能受损或肾功能异常，可在保证总体疗效前提下对含铂等化疗药物剂量或方案做个体化调整。","临床研究路径：如患儿及家属高度关注远期毒性且可进入规范减量相关临床研究，可在充分知情同意下按研究方案执行减量幅度和前提。"],"negative_list":{"major_errors":["误判：仅凭T3N3M0或局部晚期分期直接判断必须或绝对不能减量，忽视诱导化疗疗效、EBV-DNA变化及毒性情况。","臆断：以儿童/青少年或减毒为主要依据提出减量方案，而未强调局部控制率和长期生存率优先。","遗漏：缺乏诱导化疗后正式疗效评估、EBV-DNA随访和毒性监测资料时，直接给出明确放疗或化疗减量方案。","混淆：将放疗减量和化疗剂量/周期调整等同对待，导致减量适应证和决策路径混乱。"],"minor_errors":["未提及需通过影像、内镜及EBV-DNA等系统复评作为是否减量的重要依据。","未覆盖本例相关的听力、心功能、肾功能等关键毒性监测点即讨论减量方案。","对减量治疗泛泛描述为减少毒性，未结合本例局部晚期、高肿瘤负荷及当前疗效信息不足具体分析。","未强调多学科团队讨论及规范证据基础上决定减量，而以个体经验随意给出建议。"]},"scoring_rules":{"item_scores":{"core_answer":[1.2,1.2,1.2,1.2,1.2],"key_evidence":[0.4,0.4,0.4,0.4,0.4],"conditional_modifiers":[0.5,0.5,0.5,0.5]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-c26206e12c081a8e1d5e7651","case_id":"o1-case-01b4851b207a4e645d555858","patient_id":"o1-patient-b693d091a0bdfd054efdcbd1","tag":"PEDIATRIC_NPC_BUNDLE","question":"请说明治疗期及随访期需重点关注的毒性、功能影响或支持治疗要点。","case_input":"【病情摘要】\n患者男，16岁。\n2024年11月发现症状，病程第59天入院。\n鼻咽癌2程诱导化疗后3周余。\n2024年11月发现左颈部淋巴结肿大，伴持续性疼痛，自行口服非甾体类抗炎药可缓解，伴鼻塞、涕血，头晕、头痛，双侧耳鸣、听力下降。\n2024年12月至某医院拟诊为淋巴结炎，予消炎止痛治疗后疼痛缓解，左颈部肿物未见消退，完善喉镜见鼻咽肿物，未活检。病程第0天至某医院行“鼻内镜下左鼻咽肿物活检术”，术后病理考虑未分化型非角化性癌。后转至某医院进一步诊治。\nEB病毒DNA定量：1.550E+03copies/ml。病程第7天鼻咽、颈部软组织MRI平扫+增强：鼻咽部肿块：考虑鼻咽癌，累及周围软组织、颅底骨质受侵，颈部多发淋巴结增大。2025-02病理会诊报告：（左鼻咽部肿物，活检）符合非角化性鳞状细胞癌，未分化型。病程第8天PET-CT：结合病理符合鼻咽部恶性肿瘤改变，累及邻近软组织及颅底骨质及并多发淋巴结转移可能性大。病程第35天某医院复查MR提示：鼻咽部肿块伴右侧咽旁间隙受累、颅底骨质受侵、颈部多发淋巴结转移均较前进展，EB病毒DNA定量：6.635E+03copies/ml。\n慢性鼻炎。鱼鳞病。2025-03外院发现窦性心动过速。2岁时行“隐睾手术”。3岁时左臂骨折，行“固定治疗”，肌力较右臂减弱。\n有舅公患鼻咽癌，已过世。\n近2月体重减轻约7kg。\n于某医院明确诊断为鼻咽未分化型非角化性癌T3N3M0 III期（AJCC第九版）。\n\n【影像资料】\n{病程第62天电子鼻咽镜检查(表麻下)(不活检)(套): 继续综合治疗。 ;鼻咽癌3程诱导化疗后，复查： 鼻咽全腔见肿物，侵犯双侧后鼻孔，少许分泌物覆盖。, 鼻咽癌化疗后}","rubric_template_structured":{"total_score":10.0,"core_answer":["毒性监测：顺铂耳毒性管理，基线及定期听力评估，必要时调整方案保护听力","毒性监测：顺铂肾毒性管理，每周期前后查肾功能，足量水化和肾保护","支持治疗：放化疗急性黏膜炎及局部损伤的营养支持和镇痛，维持进食和生活质量","骨髓抑制：监测血象，预防和处理中性粒细胞减少相关感染、贫血和出血","内分泌随访：长期监测甲状腺功能，发现甲减及时内分泌干预","生长发育：长期监测垂体轴激素、身高及性发育，防治放疗相关损伤","神经认知：长期随访中枢神经及认知功能，警惕颞叶损伤并行康复干预","复发与第二肿瘤：随访中监测肿瘤复发及继发恶性肿瘤，整合影像和EB病毒DNA评估"],"key_evidence":["听力证据：初诊双侧耳鸣和听力下降，提示基线听力受损，顺铂耳毒性风险较高","营养证据：近2月体重减轻约7kg，提示营养受损，放化疗期更需强化营养支持","放疗靶区证据：影像示颅底骨质受侵，放疗靶区涉及垂体及中枢结构，需兼顾内分泌和神经保护","复发监测证据：EB病毒DNA定量升高，可作为治疗及随访中评估复发和残留病灶的生物标志"],"conditional_modifiers":["生长期边界：患者16岁处于生长发育期，需联合儿科内分泌及营养团队随访身高、体重和性发育","鼻炎合并症：既往慢性鼻炎可加重放疗期黏膜反应，需加强鼻腔冲洗、抗炎和对症处理"],"negative_list":{"major_errors":["忽略顺铂耳毒性、肾毒性或放疗远期内分泌/认知功能影响","仅泛泛写短期对症处理，缺乏系统性随访和功能监测","完全不提生长发育或生活质量管理，忽视儿童青少年特异需求"],"minor_errors":["漏提关键监测项目，如听力、肾功能或内分泌功能随访","未体现营养、内分泌、康复或心理等支持治疗团队协作"]},"scoring_rules":{"item_scores":{"core_answer":[0.75,0.75,0.75,0.75,0.75,0.75,0.75,0.75],"key_evidence":[0.5,0.5,0.5,0.5],"conditional_modifiers":[1.0,1.0]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-834ce9b9e72e2b41ebaa3d06","case_id":"o1-case-2368f49dd842bc80e7f5ff94","patient_id":"o1-patient-b1ac6994d97c5711b4ae8eac","tag":"PEDIATRIC_NPC_BUNDLE","question":"结合当前资料，请列出该患者治疗前还需补充的儿童/青少年特异性评估，并分别说明各项评估的目的。","case_input":"【病情摘要】\n患者男，15岁。\n2月前出现症状，病程第0天外院就诊，病程第16天入院。\n右侧头痛及右侧耳鸣2月。\n2月前无明显诱因出现右侧间断性头痛及右侧耳鸣，伴饮水呛咳，头痛逐渐加重，影响夜间睡眠，体重下降10+kg。\n病程第0天外院鼻咽镜活检：右侧圆枕及鼻咽部非角化性未分化型癌。免疫组化：CK+，Ki-67+ 70%，EBER+。外院鼻咽CT：鼻咽部-右侧咽旁间隙占位性病变，考虑鼻咽癌并累及右侧咽旁间隙、颚帆张肌、颚帆提肌、翼内外肌、头长肌可能，右侧颈部II区淋巴结转移可能；右侧翼突外侧板、枕骨斜坡右侧骨皮质变薄，肿瘤累及可能性大。\n病程第11天 PET/CT全身显像：鼻咽病灶代谢活跃，考虑鼻咽癌，病灶侵犯右颈动脉鞘、右翼腭窝、右卵圆孔及颅底骨质等；双侧咽后、颈部右侧Ⅱ区淋巴结代谢活跃，考虑转移；颈部左侧Ⅱ区及右腮腺区淋巴结代谢活跃，疑转移；颈部右侧Ⅲ区小淋巴结代谢较活跃，转移待排。病程第14天 颈部磁共振：鼻咽病变，考虑鼻咽癌；右侧海绵窦受侵。颅底骨质破坏。双侧咽后数个肿大淋巴结，考虑转移。颈部双侧II区、双侧III区见多个肿大淋巴结，考虑转移。双侧腮腺结节，考虑转移淋巴结可能。\n既往体健。\n否认家族中有恶性肿瘤病史。\n鼻咽部非角化性未分化型癌。\n\n【影像资料】\n{病程第16天电子鼻咽镜检查(表麻下)(含活检)(套): 明确病理，依据病理结果决定下一步检查或治疗。 ;顶后壁黏膜增厚, 鼻咽肿物性质待查;\n病程第22天电子鼻咽镜检查(表麻下)(含活检)(套): 明确病理，依据病理结果决定下一步检查或治疗。 ;鼻咽顶后壁增厚, 鼻咽肿物性质待查}\n\n【病理资料】\n{病程第17天病理检查报告: （顶后壁）镜下：鼻咽粘膜慢性炎，伴淋巴组织增生及淋巴滤泡形成，局部见散在分布核稍增大的细胞，建议加行免疫组化及原位杂交除外肿瘤可能。;\n病程第21天病理检查报告: （顶后壁）镜下：鼻咽粘膜慢性炎，伴淋巴组织增生及淋巴滤泡形成，未见癌，请集合临床或进一步检查。  免疫组化：标本20：CK(AE1/AE3)（鼻咽粘膜+）。 原位杂交：标本20：EBERs（-）。;\n病程第24天病理检查报告: （右隐窝）镜下：鼻咽粘膜慢性炎，伴淋巴组织增生及淋巴滤泡形成，局部散在分布少量核稍增大的细胞，可见核仁，结合免疫组化及原位杂交结果，符合未分化型非角化性癌。  免疫组化：标本22：CK(AE1/AE3)（+）。 原位杂交：标本22：EBERs（+）。;\n病程第31天病理检查报告: 免疫组化：标本22：EGFR（+）。}","rubric_template_structured":{"total_score":10.0,"core_answer":["生长发育/内分泌轴基线：身高体重曲线、骨龄、垂体甲状腺相关激素，说明评估生长潜能及放疗/化疗对内分泌轴影响","生殖/性腺功能基线：Tanner分期、性腺轴激素，说明评估青春期发育状态及治疗对生育力/性腺功能影响","听力及中耳/咽鼓管功能基线：客观听力学和中耳功能检查，说明评估放疗及可能耳毒性治疗的短期和远期听力风险"],"key_evidence":["年龄证据：患者15岁男孩，处于身高及第二性征快速发育期","诊断证据：鼻咽非角化性未分化癌需行放疗联合系统治疗，为可能影响生长内分泌和听力的恶性肿瘤","放疗野证据：影像提示累及颅底及邻近结构，放疗野难以避开垂体轴及颅底周围重要器官","听力症状证据：存在右侧耳鸣主诉，提示需在治疗前获取客观听力及中耳/咽鼓管功能基线"],"conditional_modifiers":["资料不足时：如院内常规已完成部分内分泌评估，答题可不列结果，但需点明其作为儿童特异性基线及随访目的","听力评估边界：即使未使用耳毒性药物，仍应将听力评估视为儿童期重要器官功能基线，说明其与放疗相关风险"],"negative_list":{"major_errors":["仅列成人常规检查、分期或随访项目，未体现儿童/青少年特异性评估（如生长发育、内分泌或器官成熟）","将评估需求误写为具体检查结果或针对治疗方案，偏离补充儿童特异性评估本意"],"minor_errors":["遗漏生长发育/内分泌轴、青春期/性腺功能、听力及中耳咽鼓管任一核心评估项","仅罗列检查名称，未说明与儿童生长发育或放化疗短期及远期毒性的相关性","将通用肿瘤学评估混淆为儿童特异性评估"]},"scoring_rules":{"item_scores":{"core_answer":[2.0,2.0,2.0],"key_evidence":[0.5,0.5,0.5,0.5],"conditional_modifiers":[1.0,1.0]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-69c73dbec5fff6856b61cc2f","case_id":"o1-case-2368f49dd842bc80e7f5ff94","patient_id":"o1-patient-b1ac6994d97c5711b4ae8eac","tag":"PEDIATRIC_NPC_BUNDLE","question":"若该患者实施放疗，请说明在治疗强度、剂量安排、靶区设计及正常组织保护方面的特殊考虑。","case_input":"【病情摘要】\n患者男，15岁。\n2月前出现症状，病程第0天外院就诊，病程第16天入院。\n右侧头痛及右侧耳鸣2月。\n2月前无明显诱因出现右侧间断性头痛及右侧耳鸣，伴饮水呛咳，头痛逐渐加重，影响夜间睡眠，体重下降10+kg。\n病程第0天外院鼻咽镜活检：右侧圆枕及鼻咽部非角化性未分化型癌。免疫组化：CK+，Ki-67+ 70%，EBER+。外院鼻咽CT：鼻咽部-右侧咽旁间隙占位性病变，考虑鼻咽癌并累及右侧咽旁间隙、颚帆张肌、颚帆提肌、翼内外肌、头长肌可能，右侧颈部II区淋巴结转移可能；右侧翼突外侧板、枕骨斜坡右侧骨皮质变薄，肿瘤累及可能性大。\n病程第11天 PET/CT全身显像：鼻咽病灶代谢活跃，考虑鼻咽癌，病灶侵犯右颈动脉鞘、右翼腭窝、右卵圆孔及颅底骨质等；双侧咽后、颈部右侧Ⅱ区淋巴结代谢活跃，考虑转移；颈部左侧Ⅱ区及右腮腺区淋巴结代谢活跃，疑转移；颈部右侧Ⅲ区小淋巴结代谢较活跃，转移待排。病程第14天 颈部磁共振：鼻咽病变，考虑鼻咽癌；右侧海绵窦受侵。颅底骨质破坏。双侧咽后数个肿大淋巴结，考虑转移。颈部双侧II区、双侧III区见多个肿大淋巴结，考虑转移。双侧腮腺结节，考虑转移淋巴结可能。\n既往体健。\n否认家族中有恶性肿瘤病史。\n鼻咽部非角化性未分化型癌。\n\n【影像资料】\n{病程第16天电子鼻咽镜检查(表麻下)(含活检)(套): 明确病理，依据病理结果决定下一步检查或治疗。 ;顶后壁黏膜增厚, 鼻咽肿物性质待查;\n病程第22天电子鼻咽镜检查(表麻下)(含活检)(套): 明确病理，依据病理结果决定下一步检查或治疗。 ;鼻咽顶后壁增厚, 鼻咽肿物性质待查}\n\n【病理资料】\n{病程第17天病理检查报告: （顶后壁）镜下：鼻咽粘膜慢性炎，伴淋巴组织增生及淋巴滤泡形成，局部见散在分布核稍增大的细胞，建议加行免疫组化及原位杂交除外肿瘤可能。;\n病程第21天病理检查报告: （顶后壁）镜下：鼻咽粘膜慢性炎，伴淋巴组织增生及淋巴滤泡形成，未见癌，请集合临床或进一步检查。  免疫组化：标本20：CK(AE1/AE3)（鼻咽粘膜+）。 原位杂交：标本20：EBERs（-）。;\n病程第24天病理检查报告: （右隐窝）镜下：鼻咽粘膜慢性炎，伴淋巴组织增生及淋巴滤泡形成，局部散在分布少量核稍增大的细胞，可见核仁，结合免疫组化及原位杂交结果，符合未分化型非角化性癌。  免疫组化：标本22：CK(AE1/AE3)（+）。 原位杂交：标本22：EBERs（+）。;\n病程第31天病理检查报告: 免疫组化：标本22：EGFR（+）。}","rubric_template_structured":{"total_score":10.0,"core_answer":["放疗技术路径：首选IMRT等高精度放疗技术","治疗强度与剂量：采用有依据的儿童/青少年方案，通常常规分割约1.8 Gy/次；总剂量按诱导反应、残留及方案确定，62–66 Gy仅为讨论范围，并非固定处方。","基于反应的调整：仅在完成诱导后达到相应方案规定的充分缓解且有证据支持时讨论减量；60–61.2Gy须有具体方案依据，不能将任意PR作为充分条件。","正常组织保护与靶区设计：利用IMRT/VMAT/IGRT精细勾画靶区，及时改野缩野并严格危及器官剂量约束"],"key_evidence":["年龄证据：15岁男孩，处于生长发育期，远期放射后遗症风险高","病理证据：鼻咽非角化未分化癌，对放化疗敏感","范围证据：病变累及颅底及多站颈淋巴结，需精细靶区勾画","降剂量证据：基于诱导化疗消退情况降低放疗强度以保护远期生活质量"],"conditional_modifiers":["靶区随疗效调整：联合诱导化疗时，可按残余病灶范围调整GTV及放疗野","危及器官边界：脑干、视交叉、晶体、内耳、垂体等邻近区可适当缩小安全边界或加强剂量约束优化"],"negative_list":{"major_errors":["未体现IMRT或高精度放疗技术","未结合诱导反应、残留病灶、儿童方案及危及器官限制，机械套用固定剂量或仅因年龄普遍降阶。","未说明放疗剂量和分割需依据儿童方案及诱导后疗效个体化，或在仅有基线资料时直接断言符合减量条件。","靶区设计未覆盖影像学所示多区颈淋巴结或忽视调整缩野","明显忽视脑干、视交叉、内耳等危及器官剂量保护"],"minor_errors":["未提及高精度技术如IMRT/VMAT/IGRT的剂量/摆位优化","未提及依据诱导化疗疗效调整放疗剂量"]},"scoring_rules":{"item_scores":{"core_answer":[1.5,1.5,1.5,1.5],"key_evidence":[0.5,0.5,0.5,0.5],"conditional_modifiers":[1.0,1.0]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-98356ad6d226a5001d93b984","case_id":"o1-case-2368f49dd842bc80e7f5ff94","patient_id":"o1-patient-b1ac6994d97c5711b4ae8eac","tag":"PEDIATRIC_NPC_BUNDLE","question":"请评估其是否符合减量治疗的适用情形，并说明判断依据及需满足的前提条件。","case_input":"【病情摘要】\n患者男，15岁。\n2月前出现症状，病程第0天外院就诊，病程第16天入院。\n右侧头痛及右侧耳鸣2月。\n2月前无明显诱因出现右侧间断性头痛及右侧耳鸣，伴饮水呛咳，头痛逐渐加重，影响夜间睡眠，体重下降10+kg。\n病程第0天外院鼻咽镜活检：右侧圆枕及鼻咽部非角化性未分化型癌。免疫组化：CK+，Ki-67+ 70%，EBER+。外院鼻咽CT：鼻咽部-右侧咽旁间隙占位性病变，考虑鼻咽癌并累及右侧咽旁间隙、颚帆张肌、颚帆提肌、翼内外肌、头长肌可能，右侧颈部II区淋巴结转移可能；右侧翼突外侧板、枕骨斜坡右侧骨皮质变薄，肿瘤累及可能性大。\n病程第11天 PET/CT全身显像：鼻咽病灶代谢活跃，考虑鼻咽癌，病灶侵犯右颈动脉鞘、右翼腭窝、右卵圆孔及颅底骨质等；双侧咽后、颈部右侧Ⅱ区淋巴结代谢活跃，考虑转移；颈部左侧Ⅱ区及右腮腺区淋巴结代谢活跃，疑转移；颈部右侧Ⅲ区小淋巴结代谢较活跃，转移待排。病程第14天 颈部磁共振：鼻咽病变，考虑鼻咽癌；右侧海绵窦受侵。颅底骨质破坏。双侧咽后数个肿大淋巴结，考虑转移。颈部双侧II区、双侧III区见多个肿大淋巴结，考虑转移。双侧腮腺结节，考虑转移淋巴结可能。\n既往体健。\n否认家族中有恶性肿瘤病史。\n鼻咽部非角化性未分化型癌。\n\n【影像资料】\n{病程第16天电子鼻咽镜检查(表麻下)(含活检)(套): 明确病理，依据病理结果决定下一步检查或治疗。 ;顶后壁黏膜增厚, 鼻咽肿物性质待查;\n病程第22天电子鼻咽镜检查(表麻下)(含活检)(套): 明确病理，依据病理结果决定下一步检查或治疗。 ;鼻咽顶后壁增厚, 鼻咽肿物性质待查}\n\n【病理资料】\n{病程第17天病理检查报告: （顶后壁）镜下：鼻咽粘膜慢性炎，伴淋巴组织增生及淋巴滤泡形成，局部见散在分布核稍增大的细胞，建议加行免疫组化及原位杂交除外肿瘤可能。;\n病程第21天病理检查报告: （顶后壁）镜下：鼻咽粘膜慢性炎，伴淋巴组织增生及淋巴滤泡形成，未见癌，请集合临床或进一步检查。  免疫组化：标本20：CK(AE1/AE3)（鼻咽粘膜+）。 原位杂交：标本20：EBERs（-）。;\n病程第24天病理检查报告: （右隐窝）镜下：鼻咽粘膜慢性炎，伴淋巴组织增生及淋巴滤泡形成，局部散在分布少量核稍增大的细胞，可见核仁，结合免疫组化及原位杂交结果，符合未分化型非角化性癌。  免疫组化：标本22：CK(AE1/AE3)（+）。 原位杂交：标本22：EBERs（+）。;\n病程第31天病理检查报告: 免疫组化：标本22：EGFR（+）。}","rubric_template_structured":{"total_score":10.0,"core_answer":["总体策略：本例为儿童/青少年局部晚期高危鼻咽癌，目前仅基线病理和分期资料，减量放疗尚缺充分依据。","总体策略：完成计划诱导化疗并系统复评后，在放疗计划制定前判断是否符合相应方案的减量条件；不以已完成本次同步放化疗为前提。","总体策略：标准综合治疗路径优先，减量放疗仅在符合研究或共识条件时个体化慎用。"],"key_evidence":["人群证据：患者15岁男性，属儿童/青少年鼻咽癌人群，需兼顾长期毒性与肿瘤控制/生存结局。","诊断证据：鼻咽镜及病理示非角化性未分化型癌，CK阳性、Ki-67约70%、EBER阳性，为EBV相关未分化型鼻咽癌高危类型。","分期证据：影像提示原发灶侵犯周围重要结构并累及多站颈淋巴结，肿瘤负荷高，局部控制要求高。","资料证据：病历缺乏已完成诱导化疗的周期数及化疗后影像学/鼻咽镜客观疗效资料，现阶段仅可视为潜在可讨论减量人群。"],"conditional_modifiers":["前提条件：需完成足疗程诱导化疗，并通过复查MRI/CT及鼻咽镜等系统评估原发及淋巴结退缩程度，由MDT讨论减量可行性。","疗效边界：诱导化疗达完全缓解或极佳部分缓解且有指南、共识或临床研究方案支持时，可在MDT和充分知情同意基础上考虑适度放疗减量；一般部分缓解或疾病稳定时不宜减量。","综合评估：评估减量时需综合患儿年龄、生长发育、器官功能、复发风险及随访条件，在不降低治愈率和局控前提下兼顾迟发毒性。","研究框架：如实施减量放疗，应优先采用有循证依据的方案或在临床研究中进行，避免在缺乏数据时经验性大幅下调剂量或缩小靶区。"],"negative_list":{"major_errors":["在仅有初诊病理和分期资料、缺乏诱导化疗后疗效评估时，直接肯定放疗减量适用性，未强调需完整疗效评估和相应前提。","仅因患儿年轻或担忧毒性而主张普遍降低放疗强度，忽视局部晚期肿瘤负荷及局控和复发风险。","将放疗减量当作常规或默认做法，未限定于有指南/研究或充分疗效评估支撑下的个体化决策。"],"minor_errors":["未指出本例仅有基线诊断和分期、缺乏诱导化疗及完成后疗效评估这一关键背景，答案流于笼统判断。","讨论减量仅强调短期毒性、年龄或家属诉求，未明确以不降低治愈率和局部控制为前提。","“减量治疗”表达对象不清，未限定对应放疗，导致概念混用。"]},"scoring_rules":{"item_scores":{"core_answer":[2.0,2.0,2.0],"key_evidence":[0.5,0.5,0.5,0.5],"conditional_modifiers":[0.5,0.5,0.5,0.5]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-92a2adb8ec05b2b6e828ff73","case_id":"o1-case-2368f49dd842bc80e7f5ff94","patient_id":"o1-patient-b1ac6994d97c5711b4ae8eac","tag":"PEDIATRIC_NPC_BUNDLE","question":"请说明治疗期及随访期需重点关注的毒性、功能影响或支持治疗要点。","case_input":"【病情摘要】\n患者男，15岁。\n2月前出现症状，病程第0天外院就诊，病程第16天入院。\n右侧头痛及右侧耳鸣2月。\n2月前无明显诱因出现右侧间断性头痛及右侧耳鸣，伴饮水呛咳，头痛逐渐加重，影响夜间睡眠，体重下降10+kg。\n病程第0天外院鼻咽镜活检：右侧圆枕及鼻咽部非角化性未分化型癌。免疫组化：CK+，Ki-67+ 70%，EBER+。外院鼻咽CT：鼻咽部-右侧咽旁间隙占位性病变，考虑鼻咽癌并累及右侧咽旁间隙、颚帆张肌、颚帆提肌、翼内外肌、头长肌可能，右侧颈部II区淋巴结转移可能；右侧翼突外侧板、枕骨斜坡右侧骨皮质变薄，肿瘤累及可能性大。\n病程第11天 PET/CT全身显像：鼻咽病灶代谢活跃，考虑鼻咽癌，病灶侵犯右颈动脉鞘、右翼腭窝、右卵圆孔及颅底骨质等；双侧咽后、颈部右侧Ⅱ区淋巴结代谢活跃，考虑转移；颈部左侧Ⅱ区及右腮腺区淋巴结代谢活跃，疑转移；颈部右侧Ⅲ区小淋巴结代谢较活跃，转移待排。病程第14天 颈部磁共振：鼻咽病变，考虑鼻咽癌；右侧海绵窦受侵。颅底骨质破坏。双侧咽后数个肿大淋巴结，考虑转移。颈部双侧II区、双侧III区见多个肿大淋巴结，考虑转移。双侧腮腺结节，考虑转移淋巴结可能。\n既往体健。\n否认家族中有恶性肿瘤病史。\n鼻咽部非角化性未分化型癌。\n\n【影像资料】\n{病程第16天电子鼻咽镜检查(表麻下)(含活检)(套): 明确病理，依据病理结果决定下一步检查或治疗。 ;顶后壁黏膜增厚, 鼻咽肿物性质待查;\n病程第22天电子鼻咽镜检查(表麻下)(含活检)(套): 明确病理，依据病理结果决定下一步检查或治疗。 ;鼻咽顶后壁增厚, 鼻咽肿物性质待查}\n\n【病理资料】\n{病程第17天病理检查报告: （顶后壁）镜下：鼻咽粘膜慢性炎，伴淋巴组织增生及淋巴滤泡形成，局部见散在分布核稍增大的细胞，建议加行免疫组化及原位杂交除外肿瘤可能。;\n病程第21天病理检查报告: （顶后壁）镜下：鼻咽粘膜慢性炎，伴淋巴组织增生及淋巴滤泡形成，未见癌，请集合临床或进一步检查。  免疫组化：标本20：CK(AE1/AE3)（鼻咽粘膜+）。 原位杂交：标本20：EBERs（-）。;\n病程第24天病理检查报告: （右隐窝）镜下：鼻咽粘膜慢性炎，伴淋巴组织增生及淋巴滤泡形成，局部散在分布少量核稍增大的细胞，可见核仁，结合免疫组化及原位杂交结果，符合未分化型非角化性癌。  免疫组化：标本22：CK(AE1/AE3)（+）。 原位杂交：标本22：EBERs（+）。;\n病程第31天病理检查报告: 免疫组化：标本22：EGFR（+）。}","rubric_template_structured":{"total_score":10.0,"core_answer":["急性毒性：监测顺铂等铂类相关肾功能和耳毒性，并关注黏膜炎、恶心呕吐、神经症状、骨髓抑制等急性不良反应","放疗策略：优化照射野与剂量，兼顾肿瘤控制与垂体、颞叶等关键结构的功能保护","内分泌随访：长期监测垂体相关激素和甲状腺功能，及早识别并处理生长发育障碍与甲状腺功能减退","神经认知随访：长期评估颞叶等中枢神经系统放射损伤，监测认知及神经功能变化，并给予康复和教育支持","长期肿瘤管理：随访肿瘤控制情况，警惕放化疗相关继发恶性肿瘤并纳入长期管理"],"key_evidence":["生长发育证据：患者15岁男性，处于生长发育关键期，放疗野涉及鼻咽、颅底及右侧海绵窦，需重点保护垂体及颞叶功能","耳毒性证据：初诊有右侧耳鸣和明显头痛，后续含铂化疗和放疗增加耳毒性及神经毒性风险，需随访听力和神经功能","营养证据：2个月内体重下降约10kg，提示营养受损，治疗期需加强营养支持以提高耐受性并减少毒性","复发与远期事件证据：病理为非角化性未分化癌，EBER阳性，提示需长期随访肿瘤复发及EB病毒相关远期事件"],"conditional_modifiers":["方案个体化：化疗方案和剂量调整需根据肾功能、听力基础及耐受性，在多学科团队协作下优化并强化支持治疗","功能问题处理：随访中如发现生长发育迟缓、性发育异常、认知下降或情绪行为问题，应及时转介相关专科综合评估干预，将功能康复与生活质量纳入随访目标"],"negative_list":{"major_errors":["遗漏生长发育、认知、内分泌、听力等长期保护目标，或仅有短期对症处理、缺乏持续跟踪管理思路"],"minor_errors":["遗漏肾功能、听力或垂体-甲状腺轴监测，或未体现多学科毒性与康复管理协作"]},"scoring_rules":{"item_scores":{"core_answer":[1.2,1.2,1.2,1.2,1.2],"key_evidence":[0.5,0.5,0.5,0.5],"conditional_modifiers":[1.0,1.0]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-c345438e91eacb534d580bd2","case_id":"o1-case-fcb57f6712ba53279f0a5199","patient_id":"o1-patient-2e843db18ff268a16d11e7de","tag":"DIAGNOSIS_GENERAL","question":"结合当前资料，请给出该患者的最终诊断及临床 TNM 分期，并说明核心判断依据。","case_input":"- 背景摘要：患者男，44岁。2023年无明显诱因出现右耳听力下降，偶有右侧偏头痛，伴鼻塞、回吸性涕血，逐渐加重。病程第0天某医院行鼻咽活检病理示：非角化性鳞状细胞癌，未行治疗。1月前体检提示脂肪肝。奶奶患肺癌，已逝。病程第7天入院\n- 影像资料：{病程第9天PET/CT全身显像（套）: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及双侧壁粘膜增厚放射性浓聚，SUV约11.5，病灶侵犯颅底骨（蝶骨基底部、双侧翼突、右侧岩尖）及左侧腭帆提肌、右侧腭帆肌群、右侧头长肌、右侧翼内肌、右侧翼腭窝、右侧扁桃体。右侧咽隐窝消失，左侧咽隐窝变浅。口咽局部变窄；喉咽未见异常。鼻窦及右侧乳突炎症。双侧海绵窦放射性分布未见明显异常。左侧乳突结构及放射性分布未见明显异常。甲状腺结构及放射性分布未见明显异常。右侧咽后、右颈Ib-III区淋巴结放射性浓聚，SUV约20.9，大者约4.5×3.1cm；左侧咽后、左颈II区、右颈V区淋巴结放射性分布略浓密，SUV约2.5，大者约0.7×0.6cm。余双颈小淋巴结放射性分布未见异常。 所见脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 左肺斜裂实性结节放射性分布未见明显异常，大小约0.3×0.3cm。余双肺纹理未见明显异常。气管、支气管通畅。心脏及大血管未见明显异常。食管未见明显占位影及异常放射性分布。双侧胸壁未见确切病灶和异常放射性分布。纵隔及双肺门未见肿大淋巴结及异常放射性分布。双侧腋窝小淋巴结放射性未见明显异常。 肝脏密度减低放射性分布未见异常；肝门区未见占位及异常放射性分布。肝内、外胆管未见扩张。胆囊结石。胃及十二指肠放射性分布未见明显异常。胰腺、脾脏、双肾及双肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后小淋巴结放射性分布未见明显异常。 前列腺、膀胱及肠管形态、结构及放射性分布未见明显异常。双髂血管旁及双侧腹股沟未见肿大淋巴结及异常放射性分布。 胸骨柄低密度影放射性浓聚，SUV约10.3，周围见硬化边。余颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。, 鼻咽病灶代谢活跃，符合鼻咽癌，侵犯范围如上述；右侧咽后、右颈Ib-III区淋巴结代谢活跃，考虑转移；左侧咽后、左颈II区、右颈V区淋巴结代谢略活跃，转移待排。 胸骨柄低密度影代谢活跃，疑良性病变，建议随诊。 鼻窦及右侧乳突炎症。 左肺斜裂纤维增殖灶。 脂肪肝。 胆囊结石。;\n病程第13天电子鼻咽镜检查(表麻下)(不活检)(套): 按计划治疗 ;双侧鼻腔通畅，鼻中隔无偏曲 鼻咽顶后壁、右侧壁可见肿物, 鼻咽癌;\n病程第14天鼻咽部、颈部MR平扫+增强: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、右侧壁见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。肿物占据鼻咽顶壁、右侧咽隐窝，推移右侧咽旁脂肪间隙及颈动脉鞘区血管，左侧咽隐窝变浅，左侧咽旁脂肪间隙及颈动脉鞘区未见异常。 右侧腭帆提肌、腭帆张肌、头长肌受侵，不均匀强化。 双侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽右侧壁受压，双侧扁桃体稍增大，均匀强化。 右侧翼突基底部骨质信号减低，稍明显强化。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、右侧乳突黏膜增厚，可见长T1、T2异常信号影，骨壁完整。双眼球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变。 右侧咽后间隙见肿大淋巴结，大者约为28 mm ×44 mm；左侧咽后见小淋巴结，边界清，信号均匀，均匀强化，短径约4mm。右颈II、III区见肿大淋巴结，大者短径约23mm。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。, 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 右侧咽后淋巴结肿大，考虑转移。 右颈II、III区肿大淋巴结，考虑转移。 左侧咽后小淋巴结，性质待定，建议随诊。 副鼻窦炎、右侧乳突炎。}\n- 病理资料：{病程第15天病理检查报告: （右颈部Ib区淋巴）（经重切片观察）镜下为增生的纤维及横纹肌组织，局部见囊壁样结构，囊内见粘液，囊内壁披覆纤毛柱状上皮，细胞异型性不明显，病变符合为良性，不除外良性囊肿性病变，未见癌。;\n病程第17天病理检查报告: （左颈III区淋巴结）镜下：穿刺淋巴组织中见少许异型细胞巢团状排列，细胞核大、核仁明显，形态考虑为分化差的癌转移，建议加血免疫组化及原位杂交协助诊断。;\n病程第20天病理检查报告: （左颈III区淋巴结）镜下：穿刺淋巴组织中见少许异型细胞巢团状排列，细胞核大、核仁明显，结合免疫组化及原位杂交结果，符合（鼻咽）未分化型非角化性癌转移。  免疫组化：标本24：CK(AE1/AE3)（+），EGFR（+），SSTR2（95%，3+），p16（-），p53（90%强+），p40（+），NUT（-），INI-1（+；无缺失），BRG1（+；无缺失），Syn（-）。 原位杂交：标本24：EBERs（+）。;\n病程第20天免疫组织化学染色诊断(全自动单独温控法): 病程第20天补充报告： （鼻咽肿物）镜检为癌，本次送检外单位切片中大部分区域呈乳头状生长，局灶似有不典型角化，细胞核大，核仁明显，形态结合本院病理号标本23（左颈III区淋巴结）活检结果（该份本院标本明确为EBERs阳性），考虑为鼻咽癌，但目前外单位白片加行原位杂交检测结果为阴性，无法进一步分类，建议重切白片3张来我科重做原位杂交协助诊断。  免疫组化：标本73：CK(AE1/AE3)（+），p40（+），p16（-），EGFR（+）。 原位杂交：标本73：EBERs（-，建议重做）。}\n- 当前检查：{病程第9天: 淀粉样蛋白A(SAA) 10.7 mg/L ↑, C-反应蛋白(CRP) 4.48 mg/L ↑}","rubric_template_structured":{"total_score":10.0,"core_answer":["诊断：鼻咽未分化型非角化性癌","TNM分期：cT3N2M0","临床分期：II期（AJCC第9版）"],"key_evidence":["诊断证据：鼻咽活检示非角化性鳞癌，左颈III区淋巴结穿刺及EBERs阳性，符合鼻咽未分化型非角化性癌转移。","T证据：PET/CT及MRI示鼻咽顶壁、顶后壁及右侧壁肿物，侵犯蝶骨基底部、双侧翼突、右岩尖及腭帆肌群、头长肌，无海绵窦或颅内实质侵犯，符合T3。","N证据：左颈III区穿刺证实转移，右颈II/III区影像提示转移，支持双侧颈部N2；右Ib取材病理为良性，左咽后、左颈II及右颈V等可疑小淋巴结不作已确证依据。","M证据：全身PET/CT未见明确远处器官或骨转移，胸骨柄低密度影代谢偏良性，判定M0。","分期证据：综合病理与影像，按AJCC第9版鼻咽癌标准，T3N2M0归为II期。"],"conditional_modifiers":["资料不足时：如后续证实胸骨柄或其他远处病灶为转移，应改分期为M1并上调临床分期。"],"negative_list":{"major_errors":["诊断未涵盖鼻咽癌或鼻咽未分化型非角化性癌","TNM主方向错误（如T1/T2或T4，或M1但无远处转移证据）","将蝶骨基底部、翼突、岩尖骨质侵犯误记为T1/T2或T4","N分期未反映双侧多站及左颈III区阳性（如写N0/N1/N3或忽视左颈III区转移）","在未见明确远处转移的情况下判定为M1","T3依据误写为T4，或仅以可疑淋巴结判为N2及以上"],"minor_errors":["未指出颅底骨质及邻近肌肉受侵为T3依据","未强调双侧多站颈淋巴结及左颈III区病理阳性为N2依据，仅笼统写颈淋巴结肿大","未区分胸骨柄疑为良性与远处转移或未说明M0依据","未提及分期参照AJCC第9版"]},"scoring_rules":{"item_scores":{"core_answer":[2.0,2.0,2.0],"key_evidence":[0.4,0.4,0.4,0.4,0.4],"conditional_modifiers":[2.0]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-378452e97e515bcb8d3adeb4","case_id":"o1-case-54d9604a4866e73900ce4f93","patient_id":"o1-patient-09a836ea846bb6e1f0eb29cc","tag":"DIAGNOSIS_GENERAL","question":"结合当前资料，请给出该患者的最终诊断及临床 TNM 分期，并说明核心判断依据。","case_input":"- 背景摘要：患者男，56岁。2025年1月无明显诱因出现双耳闷堵感伴听力下降，伴鼻塞，偶有回吸涕带血，偶有头晕。病程第0天于某医院行鼻咽活检病理示：（鼻咽）考虑肿瘤性病变，建议进一步检查。未行治疗。高血压病史，未行药物治疗。否认家族中有恶性肿瘤病史。病程第7天入院\n- 影像资料：{病程第8天电子鼻咽镜检查(表麻下)(不活检)(套): 明确病理，依据病理结果决定下一步检查或治疗。 ;双侧鼻腔通畅，鼻中隔无偏曲 鼻咽可见肿物, 鼻咽肿物性质待查;\n病程第11天PET/CT全身显像（套）: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及双侧壁粘膜增厚放射性分布浓密，SUV约16.7，病灶侵犯双侧腭帆肌群、双侧头长肌，双侧咽隐窝消失，左侧咽旁间隙稍变窄，右侧咽旁间隙未见明显异常。颅底骨质未见明显破坏，放射性分布未见明显异常。双侧海绵窦结构及放射性分布未见明显异常。右侧咽后淋巴结放射性分布略浓密，SUV约2.6，大小约0.6×0.8cm。左侧咽后小淋巴结放射性分布未见明显异常。右颈II区淋巴结放射性分布浓密，SUV约5.4，最大者约0.7×1.4cm。左颈II区、右颈Va区淋巴结放射性分布略浓密，SUV约3.4，最大者约0.6×1.0cm。余双颈小淋巴结放射性分布未见明显异常。 双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。右侧扁桃体结石。余口咽及喉咽结构及放射性分布未见明显异常。筛窦、双侧乳突内低密度影放射性分布未见明显异常。甲状腺放射性分布未见明显异常。 右下背段点状钙化灶。余双侧肺纹理未见明显异常。气管、支气管通畅。心脏及大血管未见明显异常。食管未见明显占位影及异常放射性分布。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏形态、结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。胰腺、脾脏、双肾及双侧肾上腺形态、结构及放射性分布未见异常。腹腔未见肿大淋巴结及异常放射性分布。腹膜后小淋巴结放射性分布未见明显异常。 右下腹腔内短棒状致密影（阑尾术后改变）。前列腺钙化灶。膀胱、肠管等形态、结构及放射性分布未见明显异常。双侧髂血管旁及双侧腹股沟小淋巴结放射性分布未见明显异常。 左侧肱骨头小片状高密度影放射性分布较浓密，SUV约3.4。右侧肩锁关节、L4/5左侧关节突放射性分布浓密，SUV约6.9。L5椎体骨质增生。所见颅盖骨、其余躯干骨及四肢骨结构及放射性分布未见明显异常。, 鼻咽病灶代谢活跃，考虑鼻咽癌，侵犯范围如上所述；右侧咽后淋巴结代谢略活跃、右颈II区淋巴结代谢活跃，疑转移；左颈II区、右颈Va区淋巴结代谢略活跃，转移待排。 右侧扁桃体结石。 鼻窦炎；双侧乳突炎。 右下背段点状钙化灶。 前列腺钙化灶。 左侧肱骨头小片状高密度影代谢较活跃，疑良性病变，建议随诊；右侧肩锁关节、L4/5左侧关节突炎症；腰椎骨质增生。;\n病程第12天电子鼻咽镜检查(表麻下)(不活检)(套): 内科止血，继续完善检查。 ;见鼻咽肿物近右侧壁处少许活动性出血，予明胶海绵压迫止血后血止, 鼻咽肿物出血;\n病程第13天鼻咽部、颈部MR平扫+增强: 鼻咽腔狭窄，鼻咽双侧顶壁、双侧顶后壁、双侧后壁、双侧壁增厚，明显强化。双侧咽隐窝受侵。左侧咽旁间隙受压变窄，右侧咽旁间隙及双侧颈动脉鞘区未见明显异常。 双侧腭帆提肌受侵，余咽旁肌未见明显异常。 颅底骨质未见明显破坏。 双侧咽后见多个淋巴结，界清，大者短径5mm，明显强化。 颈部双侧II、III、Va区见数个淋巴结，界清，大者短径约7mm，强化尚均匀。 双侧上颌窦、筛窦粘膜增厚。双侧乳突见较多分泌物。 双侧腮腺、颌下腺、甲状腺、喉部、所见脑实质未见明显异常。, 鼻咽病变，考虑鼻咽癌。 颅底骨质未见明显破坏。 双侧咽后多个淋巴结，考虑转移。 颈部双侧II、III、Va区数个淋巴结，可疑转移。 副鼻窦炎；双侧乳突炎。}\n- 当前检查：{病程第8天: 促甲状腺激素(TSH) 5.000 uIU/mL ↑, 促甲状腺激素(TSH) 5.200 uIU/mL ↑}","rubric_template_structured":{"total_score":10.0,"core_answer":["诊断：鼻咽恶性肿瘤，鼻咽占位高度怀疑鼻咽癌，待病理明确具体类型及病毒学状态","TNM分期：cT2N1M0（AJCC第9版）","临床分期：IB期（AJCC第9版，cT2N1M0成立时）。"],"key_evidence":["诊断证据：局部检查示鼻咽腔占位，黏膜增厚、强化或局部出血等恶性征象，形态高度怀疑鼻咽恶性肿瘤，需活检病理明确类型","T证据：影像示病灶累及鼻咽顶部及（或）侧壁并侵犯咽旁间隙/软组织或相关肌群，未见颅底骨质破坏或颅神经受侵，符合AJCC第9版T2","淋巴结依据：咽后淋巴结考虑转移，右颈II区疑转移；左颈II、III、Va等可疑节点需复核。","N分期依据：双侧咽后淋巴结仍可属N1；双侧颈淋巴结确证转移则为N2，不能由双侧分布直接判N1。","M证据：现有资料未见远处脏器及骨骼转移灶，按M0处理，如后续发现远处转移应改为M1","分期证据：若咽旁/相关肌群侵犯为T2、咽后或单侧颈转移为N1且M0成立，则第9版cT2N1M0归IB；对侧可疑颈节点仍需评估。"],"conditional_modifiers":["病理完善时：活检及EBER/EBV结果出台后，应将最终诊断具体到病理亚型及病毒学分型，当前不得先验写成已证实事实","分期上调条件：若追加检查发现颅底骨质破坏、颅神经受侵、广泛软组织浸润或远处转移，应相应上调T/N/M及临床分期","资料不足时：如缺少颈部或全身评估，仅可就现有资料给出T分期方向，并说明N分期和M分期需进一步检查后才能最终确定"],"negative_list":{"major_errors":["将本例写成鼻咽炎、良性肿瘤或其他部位原发肿瘤，未明确鼻咽原发恶性肿瘤（高度怀疑鼻咽癌）","写T3/T4而无颅底、颅神经受侵证据，或有咽旁间隙/软组织受侵却写T1且无合理解释，与侵犯范围不符","遗漏影像提示的咽后/颈部转移线索而无解释判N0，或把双侧可疑颈节点直接当作已确证N1依据。","全身评估未见远处转移证据却判为M1，或将良性、退行性骨关节异常当作远处转移依据","无病理类型及EBER/EBV结果时，将“未分化型非角化癌”“EBV相关/EBER阳性鼻咽癌”等作为已证实的最终诊断"],"minor_errors":["分期依据未具体描述咽旁软组织/肌群侵犯范围或颅底未受侵，但T2分期方向正确","未区分咽后与颈部节点、单侧与双侧及疑似与确证，导致N1依据含糊。","cT2N1M0方向正确却未注明第9版对应IB期，或仍写成II期。","提及病理亚型或EBV相关性时，未严格区分“已证实”“待证实”，但未将其作为核心已定结论","题干未提供具体PET/CT指标却写出细化指标，但诊断方向和分期判断未明显受其影响"]},"scoring_rules":{"item_scores":{"core_answer":[2.0,2.0,2.0],"key_evidence":[0.34,0.34,0.33,0.33,0.33,0.33],"conditional_modifiers":[0.67,0.67,0.66]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-885f6d67861db4b61e254cd3","case_id":"o1-case-5faef8d937f38187f1e5abb4","patient_id":"o1-patient-612444f701f4cde3e2f92ca7","tag":"DIAGNOSIS_GENERAL","question":"结合当前资料，请给出该患者的最终诊断及临床 TNM 分期，并说明核心判断依据。","case_input":"背景摘要：患者男，44岁。2026年7月左右无明显诱因出现枕后部头痛、头晕，耳鸣、听力下降，无鼻塞、涕血，无面麻等不适，未予重视，逐渐加重。病程第0天某医院鼻咽镜示：鼻咽肿物，未行治疗。既往体健，发现丙肝4天。父亲70+岁患鼻咽恶性肿瘤，已死亡。病程第10天入院。\n\n住院经过与检查：入院后完善相关检查。鼻咽 MRI 示鼻咽顶及后壁见软组织肿块，侵犯翼突及部分颅底骨质，但未见明确颅内实质及眶内受侵征象。结合临床查体，无明确的脑神经受侵表现。颈部增强 MRI 未见明确肿大淋巴结。全身影像学检查（如胸部 CT、腹部超声等）未见远处转移证据。鼻咽活检病理提示：未分化型非角化性鼻咽癌。结合影像学表现，病变局部侵及颅底骨质及翼突、无颈淋巴结转移及远处转移征象，考虑临床分期需按 AJCC 第九版进一步综合判定。","rubric_template_structured":{"total_score":10.0,"core_answer":["诊断：鼻咽未分化型非角化性癌","TNM分期：cT3N0M0","临床分期：II期（AJCC第九版）"],"key_evidence":["诊断证据：鼻咽活检示未分化型非角化性鼻咽癌。","T证据：鼻咽MRI示病灶侵犯翼突及颅底骨质，无脑神经、颅内实质及眼眶受侵，符合AJCC第九版T3。","N证据：颈部增强MRI未见明确肿大淋巴结，支持N0。","M证据：胸部CT、腹部超声等全身检查未见远处转移，支持M0。","分期证据：按AJCC第九版，cT3N0M0归为II期。"],"conditional_modifiers":["T分期边界：如后续证实有颅内实质、眼眶或脑神经等受侵，则上调为T4，总分期上调为III期。","合并疾病：丙型肝炎影响后续系统治疗选择和耐受性，但不改变当前TNM分期。"],"negative_list":{"major_errors":["未将疾病诊断为鼻咽未分化型非角化性癌或同义诊断","T3分期下误写为T1/T2或无T4证据时误写为T4","无肿大淋巴结时将N0写为N1–N3","无远处转移证据时将M0写为M1","将假设性或待查结果当作既有事实用于分期","cT3N0M0误判为III期或其他错误期别"],"minor_errors":["未提及颅底骨质/翼突受侵或N0M0证据等关键依据","影像依据与TNM分期不一致","未注明或混淆所用AJCC版本（如写第九版却仍归为III期）"]},"scoring_rules":{"item_scores":{"core_answer":[2.0,2.0,2.0],"key_evidence":[0.4,0.4,0.4,0.4,0.4],"conditional_modifiers":[1.0,1.0]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-7894efaf4dfb937c747c0041","case_id":"o1-case-4e88ffbc89d1e4f2dc40eafb","patient_id":"o1-patient-e2670de87f52b534db9c939f","tag":"DIAGNOSIS_GENERAL","question":"结合当前资料，请给出该患者的最终诊断及临床 TNM 分期，并说明核心判断依据。","case_input":"背景摘要：患者男，60岁。2016年因“鼻咽未分化型非角化癌”于外院行根治性放化疗治疗（具体不详）。近年来复查提示鼻咽部病变复发可能，2023年外院复查评估提示局部肿瘤进展并累及区域淋巴结，无明确远处转移证据，诊断为鼻咽部复发（rT4N2M0）。既往“乙肝”病史。否认家族中有恶性肿瘤病史。病程第0天入院。\n当前检查：{病程第0天: 氯离子(Cl-) 97.1 mmol/L ↓, 尿素(Urea) 11.4 mmol/L ↑, 中性粒细胞计数(Neut#) 7.12 10E9/L ↑, 血红蛋白(Hb) 127.0 g/L ↓}","rubric_template_structured":{"total_score":10.0,"core_answer":["诊断：鼻咽癌复发","TNM分期：rT4N2M0"],"key_evidence":["诊断证据：既往鼻咽未分化型非角化癌，2016年行根治性放化疗。","复发证据：多年随访提示复发，2023年外院记录为鼻咽部复发 rT4N2M0。","M证据：影像仅示局部进展及区域淋巴结受累，无远处转移证据，判为M0。"],"conditional_modifiers":["分期边界：如后续影像或病理提示原发灶侵犯或淋巴结受累范围不同，rT或rN需相应调整，当前按2023年外院结论保守判定。"],"negative_list":{"major_errors":["未明确诊断为鼻咽癌复发或误写为其他肿瘤","将rT4N2M0误分为早期分期、M1或其他明显方向错误","无证据情况下，将可疑淋巴结当成N2或误定M1"],"minor_errors":["诊断未体现“复发”属性","rTNM分期表述不全或缺T/N/M项","分期依据未说明或与结论不对应"]},"scoring_rules":{"item_scores":{"core_answer":[3.0,3.0],"key_evidence":[0.67,0.67,0.66],"conditional_modifiers":[2.0]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-54ff793adae23ed110a85fb4","case_id":"o1-case-2ad5fa8679db23865025438b","patient_id":"o1-patient-f6dc8a4d1534e23e55cfdb20","tag":"DIAGNOSIS_GENERAL","question":"结合当前资料，请给出该患者的最终诊断及临床 TNM 分期，并说明核心判断依据。","case_input":"- 既往史：2022年确诊为鼻咽癌，已完成根治性放化疗，后定期随访。\n- 复查资料：病程第814天鼻咽部活检提示未分化型非角化性癌；鼻咽MR提示海绵窦复发。\n- 影像资料：{病程第886天电子鼻咽镜检查(表麻下)(不活检)(套): 按计划治疗。 ;双侧鼻腔通畅，鼻中隔居中。 鼻咽顶壁、左侧壁稍增厚。右侧隐窝结构存在。, 鼻咽癌}\n- 当前检查：{病程第884天: 天门冬氨酸氨基转移酶(AST) 13.8 U/L ↓; 病程第888天: 白细胞计数(WBC#) 10.15 10E9/L ↑, 尿素(Urea) 9.4 mmol/L ↑, 肌酸激酶(CK) 45 U/L ↓, 天门冬氨酸氨基转移酶(AST) 8.1 U/L ↓, 中性粒细胞计数(Neut#) 9.16 10E9/L ↑, 血红蛋白(Hb) 121.0 g/L ↓, 白蛋白(ALB) 34.0 g/L ↓}","rubric_template_structured":{"total_score":10.0,"core_answer":["诊断：鼻咽未分化型非角化性癌根治放化疗后局部复发，累及海绵窦。","TNM：鼻咽MR提示海绵窦复发，符合颅内侵犯，判为rT4；N、M分期仍需完善评估。","总体分期：因N、M分期资料不足，暂不确定总期别。"],"key_evidence":["复发证据：既往鼻咽癌根治放化疗后，病程第814天鼻咽部活检提示未分化型非角化性癌，结合鼻咽MR海绵窦复发结论，支持局部复发。","T证据：鼻咽MR提示海绵窦复发，符合颅内侵犯，支持rT4；电子鼻咽镜仅见轻度黏膜增厚不能排除该深部病变。","N/M证据：缺乏完整颈部及远处分期，不能由未描述转移推定已证实N0M0。"],"conditional_modifiers":["病理复核时：已有鼻咽部活检支持未分化型非角化性癌；如后续病理复核提供不同结论，再相应调整组织学诊断。","分期待完善时：完善颈部及远处分期评估，根据新获得的病灶范围和N/M证据更新rTNM及总期别。"],"negative_list":{"major_errors":["忽视已提供的复发活检及MRI结论，仍将当前病变仅判断为治疗后改变或良性，未识别局部复发。","分期错误：已有MRI提示海绵窦复发，仍将局部复发判为低于rT4，或给出与该影像结论矛盾的T分期。","臆断：无明确影像或病理证据时，将N分期写为N+或M1，并把可疑部位定性为转移","捏造：病例未提供的病理或影像结果被写入诊断或分期"],"minor_errors":["诊断未体现既往根治放化疗后当前局部复发的属性。","未说明N、M分期资料不足及需进一步评估，或据不完整资料直接给出完整rTNM及总期别。","表述不当：T分期未引用海绵窦复发的MRI依据，或未交代N/M分期的证据边界。","偏武断：对N/M分期给出结论却未说明证据有限或需进一步评估"]},"scoring_rules":{"item_scores":{"core_answer":[2.0,2.0,2.0],"key_evidence":[0.67,0.67,0.66],"conditional_modifiers":[1.0,1.0]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-97b75c843db434c646b43e43","case_id":"o1-case-f715ee5f43183bca7c7a74a5","patient_id":"o1-patient-88ef56c6fdf9a0e23b2aecce","tag":"DIAGNOSIS_GENERAL","question":"结合当前资料，请给出该患者的最终诊断及临床 TNM 分期，并说明核心判断依据。","case_input":"背景摘要：患者男，53岁。2020年下半年无明显诱因出现耳鸣，伴听力下降，涕中带血。2021年7月某医院，病理：左侧鼻腔非角化性分化型癌，右侧鼻腔非角化性分化型癌。某医院进一步检查，MRI提示鼻咽占位伴双侧咽后淋巴结肿大，右侧颈部II、III区淋巴结肿大，考虑转移，随后在当地行综合治疗（以放疗为主，具体方案不详）。近半年间反复出现头痛加重，右耳听力丧失，左耳听力下降，伴痰多、吞咽困难，体重进行性下降，于病程第1157天月在外院行鼻咽及颅底相关手术治疗（具体术式不详），术后症状未明显缓解。家族史：父亲、1名弟弟有鼻咽癌病史，均已去世。病程第1244天为进一步明确病情入院。\n\n影像资料：病程第1245天电子鼻咽镜检查(表麻下)(不活检)：双侧鼻腔通畅，右侧鼻腔可见坏死物痂皮附着，右侧咽隐窝深溃疡，可见坏死物痂皮附着，左侧咽隐窝结构存在。镜下所见符合鼻咽癌放疗后改变，待结合影像及病理进一步评估。\n\n住院经过：入院后予完善相关实验室及影像学检查。病程第1246天实验室检查示：血红蛋白116.0 g/L↓，白蛋白35.3 g/L↓，谷草转氨酶60.9 U/L↑，氯95.5 mmol/L↓，C-反应蛋白84.94 mg/L↑，钠136.5 mmol/L↓，尿酸204.7 μmol/L↓，纤维蛋白原5.76 g/L↑。心脏彩超示二尖瓣及三尖瓣轻度关闭不全。病程第1247天EBV-DNA定量检测171 copy/ml，EBNA1-IgA 22.35 COI↑，Zta-IgA阳性。外院既往病理会诊结果提示分化型非角化性癌，EBERs（+），支持鼻咽癌性质。为评估局部范围及远处情况，病程第1248天行PET/MR检查：示鼻咽及邻近颅底区可见术后及放疗后改变，局部不规则片状软组织影代谢增高，累及右侧头长肌、翼内肌、咽旁间隙及部分颅底结构，未见明确远处脏器代谢异常病灶；颈部未见明确增大的高代谢淋巴结影像学证据。结合病史、影像及既往病理，考虑鼻咽癌综合治疗后局部复发可能大，待进一步明确分期及后续治疗方案。住院期间对症支持治疗后一般情况尚可，计划出院后于肿瘤专科门诊进一步制定综合治疗方案。\n\n当前检查：病程第1246天：C-反应蛋白(CRP) 84.94 mg/L ↑，氯离子(Cl-) 95.5 mmol/L ↓，白蛋白(ALB) 35.3 g/L ↓，纤维蛋白原(Fbg) 5.76 g/L ↑，天门冬氨酸氨基转移酶(AST) 60.9 U/L ↑，钠离子(Na+) 136.5 mmol/L ↓，血红蛋白(Hb) 116.0 g/L ↓。\n病程第1255天：白蛋白(ALB) 36.2 g/L ↓，C-反应蛋白(CRP) 39.40 mg/L ↑，血小板计数(PLT#) 425.0×10^9/L ↑，天门冬氨酸氨基转移酶(AST) 75.3 U/L ↑，肌酸激酶(CK) 29 U/L ↓，丙氨酸氨基转移酶(ALT) 106.0 U/L ↑，血红蛋白(Hb) 112.0 g/L ↓。","rubric_template_structured":{"total_score":10.0,"core_answer":["诊断：鼻咽癌放疗+手术后局部复发可能大，病理类型为分化型非角化性癌","TNM分期：rT3N0M0（临床评估）","临床分期：AJCC第9版 II期"],"key_evidence":["诊断证据：既往病理为分化型非角化性癌、EBERs（+），已行放疗及2024年鼻咽及颅底手术，符合综合治疗后局部复发背景","T分期依据：病程第1248天PET/MR见鼻咽及颅底术后放疗区不规则软组织影代谢增高，累及颅底骨质、右头长肌、翼内肌及咽旁间隙；未见颅内、眼眶、下咽或超过翼外肌外侧缘侵犯，符合rT3。","N证据：病程第1248天PET/MR 未见颈部明确增大高代谢淋巴结，按rN0处理","M证据：病程第1248天PET/MR 未见远处脏器代谢异常灶，病历亦无远处转移记录，按M0处理","局部复发证据：病程第1245天电子鼻咽镜见右侧咽隐窝深溃疡及坏死痂皮，合并局部代谢增高及放疗/手术史，倾向鼻咽癌局部复发而非单纯放射性坏死"],"conditional_modifiers":["T分期边界：如后续证实颅内、脑神经沿程、眼眶或下咽受侵，或肿瘤超过翼外肌外侧缘，则上调为rT4并调整临床分期","N/M分期边界：如后续证实颈部或咽后区淋巴结转移或远处转移，则按rN+或M1处理并重新评估临床分期"],"negative_list":{"major_errors":["误判初治鼻咽癌、良性病变或单纯放射性坏死，未体现复发及综合治疗后背景","无证据情况下将分期写为N2/N3或M1，或仅累及颅底/咽旁即判为rT4","将影像疑似或待证实表现直接作为远处转移、N2/N3或rT4明确依据","将rT3的受侵解剖部位误写为rT4，或把可疑/待证实淋巴结当作确定N2证据","沿用被淘汰的分期版本判作III期"],"minor_errors":["未注明复发属性或综合治疗（放疗+手术）背景，仅写“鼻咽癌”","分期未结合关键受侵结构，或分期结论与解剖依据脱节","未标明分期采用的AJCC版本或版本不符现行标准"]},"scoring_rules":{"item_scores":{"core_answer":[2.0,2.0,2.0],"key_evidence":[0.4,0.4,0.4,0.4,0.4],"conditional_modifiers":[1.0,1.0]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-df6f4041cac65f820a01d3e2","case_id":"o1-case-07731ea95d45c04390eb7360","patient_id":"o1-patient-65a5dfbcc1370b3639ada8c6","tag":"DIAGNOSIS_GENERAL","question":"结合当前资料，请给出该患者的最终诊断及临床 TNM 分期，并说明核心判断依据。","case_input":"- 背景摘要：患者男，55岁。3月前无明显诱因出现左耳听力下降，无耳鸣。10天前发现左颈肿物，无头晕、头痛、复视、视力模糊、鼻塞、涕血、面麻等不适，未予重视，逐渐加重。病程第0天鼻咽镜检查示：鼻咽左侧壁肿物。既往体健。吸烟40年，每天20支。父亲患“直肠癌”。病程第0天入院\n- 影像资料：{病程第6天鼻咽部、颈部MR平扫+增强: 鼻咽腔狭窄，鼻咽顶后壁、左侧壁增厚，右侧壁稍增厚，并见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化；肿物推压左侧咽旁脂肪间隙及颈动脉鞘区血管，左侧咽隐窝闭塞；左侧腭帆提肌、腭帆张肌、头长肌、翼内肌受侵。右侧腭帆提肌、腭帆张肌、头长肌未见受侵征象。 左侧咽后见多发肿大淋巴结，短径14mm；右侧咽后见数个小淋巴结，短径约4mm。肿物向前堵塞后鼻孔。 左侧翼腭窝见少许强化软组织影；右侧翼腭窝、双侧颞下窝未见异常；口咽侧壁未见受累增厚。 斜坡、蝶骨基底部、左侧翼突基底部、左侧岩尖骨质破坏，左侧圆孔、卵圆孔、破裂孔、舌下神经管软组织影增多。左侧海绵窦增宽，见强化软组织影。 右侧海绵窦形态正常，未见增宽；右侧上颌窦、双筛窦、蝶窦粘膜增厚，左侧乳突内见长T2信号影，骨壁完整；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 左颈Ⅱ区、Ⅲ区见多枚淋巴结，大者短径约16mm，明显强化。双颈部I区、右颈II区见数个淋巴结，可见强化，大者短径约7mm。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。, 考虑鼻咽癌。 颅底骨质破坏。 左侧咽后、左颈Ⅱ区、Ⅲ区淋巴结，考虑转移瘤。 右侧咽后、右颈Ⅱ区淋巴结，可疑转移。 双颈I区小淋巴结，建议随访。  副鼻窦炎；左乳突炎。}\n- 住院经过：当前入院后已完成相关检查评估，尚未开始明确的抗肿瘤治疗方案。\n- 当前检查：{病程第1天: 天门冬氨酸氨基转移酶(AST) 13.8 U/L ↓; 病程第18天: 白蛋白(ALB) 32.7 g/L ↓, 总胆红素(TBIL) 4.9 umol/L ↓, 肌酐(Crea) 106.5 umol/L ↑; 病程第21天: 氯离子(Cl-) 89.5 mmol/L ↓, 肌酐(Crea) 97.8 umol/L ↑, 白细胞计数(WBC#) 10.45 10E9/L ↑, 肌酸激酶(CK) 31 U/L ↓, 钠离子(Na+) 135.7 mmol/L ↓, C-反应蛋白(CRP) 12.24 mg/L ↑, 中性粒细胞计数(Neut#) 7.0 10E9/L ↑, 丙氨酸氨基转移酶(ALT) 80.4 U/L ↑, 淀粉样蛋白A(SAA) 39.9 mg/L ↑}","rubric_template_structured":{"total_score":10.0,"core_answer":["诊断：影像高度怀疑鼻咽癌，需鼻咽病灶活检明确组织学诊断。","临床分期方向：影像支持cT4，左侧颈转移支持N1；若对侧颈节点确证转移则N2。M分期需完善远处评估，不能仅凭局部MRI确定M0。","总体分期：若组织确诊、T4N1/2且M0成立，则第9版III期或第8版IVA期；当前总期别需待完整评估。"],"key_evidence":["诊断证据：鼻咽影像示鼻咽顶后壁及侧壁占位，边界不清、强化明显，累及咽隐窝及周围软组织，结合症状符合鼻咽癌特征。","T证据：影像示斜坡、蝶骨基底等颅底骨质破坏，多处颅底孔道受累，左海绵窦增宽伴强化软组织影，提示颅内受侵，符合T4。","N证据：左咽后及左颈II/III区考虑转移，支持N1方向；右颈II区可疑节点若确证转移可上调N2，双侧咽后节点本身不等同双侧颈转移。","M证据：当前仅见局部MRI，未提供完整远处检查，M分期待评估；未提及转移不等于阴性远处分期。","分期证据：AJCC第9版中T4N0-3M0为III期，如按AJCC第8版，T4N0-2M0为IVA期。"],"conditional_modifiers":["N分期边界：左侧颈转移而对侧未证实时为N1方向；右侧颈节点证实转移时可N2，咽后节点单/双侧均不单独决定N2。","分期版本：若组织确诊且T4N1/2M0成立，第9版为III期、第8版为IVA期；当前M分期未完成，不能确定总期别。","分期核对：依据病例影像中的实际颅底/颅内侵犯及淋巴结分布，复核T4和N1/N2。"],"negative_list":{"major_errors":["误判为其他肿瘤或良性病变","T4已成立但仅写T1-T3","用单侧多站淋巴结转移错误定义N2","无远处分期依据即确定M0或M1","将缺乏依据的总期别作为确定结论，或所述TNM与所用版本的总期别不符；明确资料不足、暂不确定总期别不因此扣分。"],"minor_errors":["仅写“晚期鼻咽癌”而不注明详细分期和AJCC版本","描述T分期未提及颅底或海绵窦/颅内侵犯等关键点","N分期时漏写单/双侧及咽后淋巴结分布"]},"scoring_rules":{"item_scores":{"core_answer":[2.0,2.0,2.0],"key_evidence":[0.4,0.4,0.4,0.4,0.4],"conditional_modifiers":[0.67,0.67,0.66]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-0e4b0bd09765bbe5f867d145","case_id":"o1-case-b9899d9e2e42b3459a803bbe","patient_id":"o1-patient-25cd3d742f0b5069afe755b1","tag":"DIAGNOSIS_GENERAL","question":"结合当前资料，请给出该患者的最终诊断及临床 TNM 分期，并说明核心判断依据。","case_input":"主要疾病：鼻咽未分化型非角化性癌，放疗后，肝、骨转移。\n\n背景摘要：患者男，39岁。2020年12月开始出现鼻塞伴右侧耳鸣。现患者神志清，精神可，无鼻塞头痛等颅神经症状，右耳前肿物、质软，无肝区疼痛等不适。病程第552天某医院就诊，查鼻咽镜考虑鼻咽癌，未活检。病程第562天某医院某医院。病程第562天鼻咽部及颈部 MR 提示：鼻咽右侧壁、顶后壁增厚，右侧咽隐窝消失，局部肿块，2.1cm×1.9cm，侵犯右侧腭帆张肌、腭帆提肌、右侧翼内肌，右侧咽后、右侧 II 区多发淋巴结转移，最大 2.5cm×2.0cm；查 PETCT：鼻咽右侧壁、顶后壁增厚高代谢肿物，侵犯右侧椎前肌、腭帆张肌、腭帆提肌、右侧翼内肌，右侧咽后、右侧 II 区多发淋巴结转移。鼻咽镜活检提示：未分化型非角化性癌 EBER(+)。病程第0天、病程第17天在某医院分别行右肾结石取出术、右肾移植术，目前抗排斥治疗中。高血压病史 6 年，最高血压 240/150 mmHg，现口服拜新同，血压控制正常。母亲 15 年前患乳腺癌，至今存活。病程第826天入院。患者既往已接受鼻咽癌根治性放疗，2021年7月随访 MR 提示鼻咽局部肿物、颈部淋巴结基本消失；肝脏彩超提示肝内多发占位；病程第702天 PETCT：原鼻咽复查鼻咽部肿物、颈部淋巴结消失，肝内多发转移，最大位于肝 S4 段，直径约 1.7cm，左侧锁骨及右侧股骨上段示多发骨转移病灶；右侧腮腺影像考虑腮腺混合瘤。病程第705天肝内肿物穿刺活检：提示肝内病灶为鼻咽癌转移。病程第819天某医院复查肝脏 CT 提示：肝内多发转移，最大 4.7cm×6.4cm，腮腺 MR 示右侧腮腺周围肿物，不排除转移。\n\n影像资料：\n病程第828天PET/CT 全身显像：空腹 6h 以上，静脉注射 18F-FDG，静息 60 min 后行全身 PET/CT 断层显像，影像清晰。鼻咽癌治疗后：鼻咽右顶后壁及右侧壁黏膜稍增厚，放射性分布浓密，SUV 约 4.3。颅底骨质放射性分布未见明显异常，双侧破裂孔未见明显异常，双侧咽后未见肿大淋巴结及异常放射性分布，双侧海绵窦结构及放射性分布未见异常。双侧乳突、筛窦及双侧上颌窦低密度影放射性分布稀疏。口咽、喉咽未见明显异常。甲状腺放射性分布未见异常，双侧咽后小淋巴结放射性分布未见异常。右腮腺区及右颈 Ib 区数个肿大淋巴结放射性浓聚，SUV 约 16.5，最大约 1.7×2.0cm。余双颈小淋巴结放射性分布未见明显异常。右膈上前组、腹腔（胃贲门旁、胃小弯旁、肝门区）及腹膜后（胰头周围、下腔静脉旁、腹主动脉旁）多发淋巴结放射性浓聚，SUV 约 14.4，最大约 3.5×3.7cm。双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。左上肺舌段及右中肺条片影放射性分布未见异常；余双肺未见确切病灶和异常放射性分布。气管、支气管通畅。心脏及大血管放射性分布未见异常。食管放射性分布未见明显异常，双肺门、纵隔及双侧腋窝未见肿大淋巴结及异常放射性分布。肾移植术后：移植肾脏位于右髂窝，放射性分布未见明显异常，原双肾萎缩，内见数个囊肿，最大约 0.8×0.9cm，原右肾结石。肝内多发稍低密度结节、团块影放射性分布浓聚，SUV 约 14.7，最大约 5.2×5.5cm，部分内见低密度坏死区。肝内、外胆管及胆总管未见扩张。胆囊、胃及十二指肠放射性分布未见异常。脾脏、胰腺、双侧肾上腺形态、结构及放射性分布未见异常。前列腺内见钙化灶，放射性分布未见异常。膀胱、肠管等形态、结构及放射性分布未见明显异常。双侧髂血管旁及双侧腹股沟未见明显肿大淋巴结及异常放射性分布。双侧肱骨、左侧锁骨、右侧第 5 后肋、左侧第 3 前肋、多个胸腰骶椎、双侧髂骨、右侧股骨上段可见骨质破坏灶放射性浓聚，SUV 约 18.0。右侧臀小肌局部放射性分布浓密，SUV 约 5.3。影像学考虑：鼻咽癌治疗后：鼻咽右顶后壁及右侧壁黏膜稍增厚，代谢较活跃，残留待排，请结合临床；右腮腺区、右颈 Ib 区、右膈上前组、腹腔及腹膜后多发淋巴结代谢活跃，肝脏多发病灶代谢活跃，全身多发骨质破坏灶代谢活跃，考虑肿瘤转移。双侧乳突炎、鼻窦炎。双肺条片影代谢未见明显异常，考虑炎性病变/增殖灶。肾移植术后：移植肾代谢未见明显异常；原双肾萎缩；原双肾囊肿；原右肾结石。前列腺钙化灶。右侧臀小肌局部代谢较活跃，炎性病变与生理性摄取待鉴别。\n\n病理资料：\n病程第705天肝内肿物穿刺活检：提示肝内病灶为鼻咽癌转移。病程第828天EBV-DNA 定量检测：1.44E+05 copy/mL，参考值＜1000 copy/mL。\n\n住院经过：\n病程第827天检查提示：促甲状腺素 4.570 uIU/mL；血清淀粉样蛋白 189.9 mg/L、碱性磷酸酶 138.5 U/L；谷氨酰转肽酶 172.8 U/L，肌酐 103.7 umol/L；胱抑素 C 1.51 mg/L；C-反应蛋白 33.50 mg/L。查房意见：放疗后出现轻微甲状腺功能减退，可至某医院内分泌科就诊调整甲功；肝功能储备功能减弱与肝转移相关；肌酐轻度升高考虑与肾移植相关，待 PET/CT 检查结果回报后再安排下一步治疗。病程第828天，PET/CT 已完成，嘱继续观察病情变化。后续治疗方案尚待根据影像学评估结果及患者意愿综合决策。\n\n当前检查：\n病程第827天：C-反应蛋白(CRP) 33.50 mg/L ↑，淀粉样蛋白A(SAA) 189.9 mg/L ↑，肌酐(Crea) 103.7 umol/L ↑，肌酸激酶(CK) 38 U/L ↓，中性粒细胞计数(Neut#) 8.04×10^9/L ↑，促甲状腺激素(TSH) 4.570 uIU/mL ↑，D-二聚体(D-Dimer) 1.20 μg/mL ↑，纤维蛋白原(Fbg) 5.94 g/L ↑，白细胞计数(WBC#) 9.91×10^9/L ↑。\n病程第828天：白细胞介素-6(IL-6) 29.10 pg/mL ↑。","rubric_template_structured":{"total_score":10.0,"core_answer":["最终诊断：复发/转移性鼻咽未分化型非角化性癌","临床TNM分期：cT?N?M1","临床分期：IV期（依据存在远处转移，保守按晚期分层）"],"key_evidence":["诊断证据：鼻咽镜活检提示未分化型非角化性癌，EBER(+)，确立鼻咽癌病理。","缓解证据：既往行根治性放疗，2021年7月MR示鼻咽局灶及颈淋巴结基本消失，提示原发及局部缓解。","肝转移证据：病程第705天肝内肿物穿刺活检证实为鼻咽癌转移，影像示肝内多发转移灶。","肝进展证据：病程第828天PET/CT示肝内多发高代谢结节和团块，最大约5.2×5.5cm，提示肝转移进展。","骨转移证据：病程第828天PET/CT示双侧肱骨、左锁骨、胸腰骶椎、双髂骨、右股骨上段多发骨质破坏及放射性浓聚，提示骨转移。","远处淋巴结证据：病程第828天PET/CT示右膈上前组、腹腔及腹膜后多发淋巴结代谢活跃，属区域外淋巴结转移，支持M1。"],"conditional_modifiers":["T/N分期边界：原发及颈淋巴结未重新系统评估，T及N以T?、N?表示，后续如证实局部或区域进展，可调整cT/cN，但M1和IV期方向不变。"],"negative_list":{"major_errors":["将本例误判为初治或局限/局部晚期鼻咽癌，未体现复发/远处转移性质","TNM分期写成M0，否定已有的远处转移","缺乏系统重新评估时强行写具体T/N分期并据此判断为局限期"],"minor_errors":["未提及肝转移或骨转移作为判定M1和IV期的核心依据","在未说明依据不足时，随意写具体T或N分期，未用T?、N?提示需重新评估","分期依据与结论不一致，如列出多发肝、骨转移证据后仍给出M0或早期分期"]},"scoring_rules":{"item_scores":{"core_answer":[2.0,2.0,2.0],"key_evidence":[0.33,0.33,0.33,0.33,0.33,0.35],"conditional_modifiers":[2.0]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-40c1b5d10cde2137e65bff62","case_id":"o1-case-34edfd1be6b98118c4c229f9","patient_id":"o1-patient-3cb0561d021b396d53e3375e","tag":"DIAGNOSIS_GENERAL","question":"结合当前资料，请给出该患者的最终诊断及临床 TNM 分期，并说明核心判断依据。","case_input":"- 主要疾病：鼻咽未分化型非角化性癌放化疗后伴多发骨转移\n- 背景摘要：患者女，53岁。2014年5月出现左耳耳鸣、听力下降，鼻炎发作时出现左侧颞部头痛。2014年9月出现左颈包块，大小约1.5cm，逐渐增大。2016年7月出现腰痛，后出现左颈部肿物。最近三月诉腰痛，程度轻。现腰部串电样疼痛，左大腿僵硬感，活动轻度受限。2015年3月某医院，查体示鼻咽部新生物，呈分叶状，欠光滑，表面可见脓性分泌物，双颈可触及肿大淋巴结。鼻咽MR示：鼻咽部占位，以左侧壁及后壁增厚为著，咽腔形态失常、变窄，左侧咽隐窝消失，右侧咽隐窝变窄，双侧咽旁间隙、颈动脉鞘周围、双侧颈部、颏下、双侧颌下多发大小不等淋巴结，最大者3.0cm。骨扫描未见明确转移。EBV-DNA 4900 copies/mL。鼻咽部肿物活检病理：考虑鼻咽癌（未分化型非角化性癌）。2015年4月于某医院行单药顺铂化疗1程。化疗第二日患者于抽血时出现晕厥，后续拒绝化疗。2015年5月行鼻咽部及颈部引流区淋巴结放疗。放疗后MR示鼻咽部治疗后改变，咽壁稍厚。多发小淋巴结。2016年10月：某医院PET/CT示：左颈部转移。左侧肱骨头、多发椎体、骶骨、双侧坐骨、双侧股骨转移。EBV-DNA 2.27*10E3 copies/mL。病程第143天我院CT：腰1椎体右份软组织灶较前明显增大，考虑PD。病程第190天我院胸部CT：左侧肱骨头、右侧部分肋骨、多个胸腰椎椎体及腰1椎弓根病变，考虑转移瘤，部分骨质较前致密，腰1椎体右份软组织灶较前缩小。病程第237天CT：双肺下叶类结节，考虑增殖灶。左侧腋窝肿大淋巴结，考虑转移可能性大。膈脚后、腹主动脉旁、下腔静脉后方数个淋巴结，较前稍增大。左侧肱骨头、右侧部分肋骨、多个胸腰椎椎体及腰1椎弓根病变，考虑转移瘤，腰1椎体右份织灶，较前变化不明显。鼻咽部MR：鼻咽部左侧壁及顶壁粘膜增厚，大致同前，考虑治疗后改变可能大。颅底骨质破坏，范围大致同前。左颈V区多发结节及斑片灶，考虑淋巴结转移复发，范围较前稍增大。鼻炎病史20年。哥哥患“膀胱癌”。病程第291天入院\n- 住院经过：入院期间患者仍诉腰部疼痛，奥施康定控制可，服药后有便秘不适，给予对症治疗后好转。行一线GP方案4程，二线TC方案5程，本次复查CT示PD，建议行希罗达方案治疗，患者及家属签署知情同意书。排除化疗禁忌证后于病程第292天给予希罗达治疗，过程顺利，无不适，准予办理出院。\n- 当前检查：{病程第322天: 血小板计数(PLT#) 55.0 10E9/L ↓, 天门冬氨酸氨基转移酶(AST) 382.2 U/L ↑, 钠离子(Na+) 124.1 mmol/L ↓, 白蛋白(ALB) 31.7 g/L ↓, 丙氨酸氨基转移酶(ALT) 63.5 U/L ↑, 氯离子(Cl-) 89.0 mmol/L ↓, 肌酸激酶(CK) 206 U/L ↑, C-反应蛋白(CRP) 105.46 mg/L ↑, 淀粉样蛋白A(SAA) 282.9 mg/L ↑, 血红蛋白(Hb) 77.0 g/L ↓}","rubric_template_structured":{"total_score":10.0,"core_answer":["诊断：鼻咽未分化型非角化性癌，放化疗后复发/进展，伴多发骨转移","TNM：多发骨转移确立M1；当前原发区偏治疗后改变，T需复评，左颈V区考虑转移复发，N待完整评估。按第9版远处病灶>3可M1b/IVB，不强制写rT3。"],"key_evidence":["病理证据：鼻咽部肿物活检示鼻咽未分化型非角化性癌","局部证据：病程第237天MR鼻咽黏膜增厚及颅底骨破坏大致同前，影像偏治疗后改变，不能单凭骨破坏确证当前rT3；左颈V区病灶考虑淋巴结转移复发。","远处转移依据：2016年PET/CT见左肱骨头、多发椎体、骶骨、双侧坐骨及股骨等骨转移，2017年CT仍见多发病灶；远处病灶>3个，按第9版可归M1b。"],"conditional_modifiers":["T/N边界：当前原发活动性与完整节点分布不足，允许说明T/N待复评，同时明确M1；不能以治疗后骨破坏强制当前rT3。","M细分：第9版远处转移病灶≤3为M1a、>3为M1b；本例多发骨灶可M1b及IVB，须注明版次。"],"negative_list":{"major_errors":["误判为初治局限期或未提远处转移","分期写为M0或局限期（如T4M0），已存在多发骨转移证据","将治疗后稳定骨破坏直接当作活动性原发复发的确证，或忽视左颈V区疑转移复发；有依据保留T/N待评估不扣分。","将远处骨转移当作区域淋巴结转移处理"],"minor_errors":["仅写“鼻咽癌”而未注明复发/进展或多发骨转移","未区分稳定治疗后改变、颈部疑复发与已明确的多发远处骨转移。"]},"scoring_rules":{"item_scores":{"core_answer":[3.0,3.0],"key_evidence":[0.67,0.67,0.66],"conditional_modifiers":[1.0,1.0]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-bed7014d17a6bd3b084c8e6f","case_id":"o1-case-262857a92c2978a7ff496c00","patient_id":"o1-patient-c7b18e780a186bf2d56a7ea1","tag":"DIAGNOSIS_GENERAL","question":"结合当前资料，请给出该患者的最终诊断及临床 TNM 分期，并说明核心判断依据。","case_input":"- 背景摘要：患者男，66岁。2006年8月出现左颈淋巴结肿大。2020年6月出现涕血，逐渐加重。2020年6月出现涕血，未予重视。2021年2月于广医二院就诊，行鼻咽及颈部MRI检查发现可疑复发。2023年底于外院检查提示复发。病程第0天鼻咽镜下活检确诊为鼻咽未分化型非角化性癌。病程第1104天行鼻咽活检病理提示：鼻咽未分化型非角化性癌。病程第1323天行鼻咽部、颈部MR平扫+增强提示：鼻咽壁增厚，较前部分加重，并右侧顶壁/顶后壁处新见软组织肿物，突向鼻咽腔内。既往发现“高血压”12年，血压最高达200/110mmHg，口服“拜新同”等治疗。发现“冠心病”5年。否认家族中有恶性肿瘤病史。病程第1329天入院\n- 影像资料：{病程第1395天鼻咽部MR平扫+增强: 鼻咽癌复发术后复查： 鼻咽顶壁、顶后壁、双侧壁增厚，均匀明显强化，原右侧顶壁/顶后壁现未见显示。双侧咽隐窝变浅。 双侧翼腭窝、左卵圆孔少许软组织影，增强扫描轻度强化。 左侧腭帆张肌、双侧腭帆提肌、双侧头长肌、左侧翼内肌上缘信号欠均匀，增强扫描明显强化。右侧腭帆张提肌肿胀、模糊。 双侧咽后未见肿大淋巴结。双侧上颈动脉鞘结构清晰。 双侧颞下窝未见异常；口咽壁未见增厚。    斜坡、蝶骨基底部、双侧翼突基底部信号减低，明显强化。右侧颞骨鳞部见数个长T1长T2信号，增强扫描未见强化，最大者直径约10mm。 双侧海绵窦无增宽，内未见异常信号灶。  左侧上颌窦见囊性灶；双侧上颌窦、筛窦、蝶窦、双侧乳突粘膜稍厚。 扫描范围脑实质未见明显异常信号灶。, 鼻咽癌复发术后复查，对比病程第1322天MR： 鼻咽壁增厚，较前明显，考虑治疗后改变可能，原右侧顶壁/顶后壁肿物未见显示，建议随诊。 颅底骨质信号异常，强化较前明显，建议随诊。 副鼻窦炎，双侧乳突炎，较前稍明显；左侧上颌窦粘膜下囊肿。 右侧颞骨鳞部囊性灶，同前。}\n- 病理资料：{病程第1342天病理检查报告: 冰冻后石蜡1（右上缘）未见癌。 冰冻后石蜡2（右前缘）未见癌。 冰冻后石蜡3（左缘）未见癌。 1（蝶骨基底）未见癌。 2（右切缘）未见癌。 3（左切缘）未见癌。 4（下切缘）未见癌。 5（上切缘）未见癌。 6（基底）未见癌。 7（鼻咽肿瘤大体）镜下见肿瘤细胞呈片巢状排列，细胞核呈空泡状，核仁明显，结合病史及免疫组化结果，符合鼻咽未分化型非角化性癌。 8（犁骨）未见癌。  免疫组化：标本47A：CK(AE1/AE3)（+），EGFR（+）。 特殊染色：标本47A：Ag染（-）；标本47F：Ag染（-） 原位杂交：标本47A：EBERs（+）；标本47F：EBERs（+）。}\n- 当前检查：{病程第1334天: 淀粉样蛋白A(SAA) 14.2 mg/L ↑, 间接胆红素(IBIL) 17.6 umol/L ↑, 纤维蛋白原(Fbg) 4.51 g/L ↑, C-反应蛋白(CRP) 8.83 mg/L ↑; 病程第1336天: 氧合指数(OI) 183 ↓; 病程第1337天: 血红蛋白(Hb) 119.0 g/L ↓, 中性粒细胞计数(Neut#) 6.80 10E9/L ↑, D-二聚体(D-Dimer) 6.21 μg/mL ↑, 凝血酶原时间(PT) 13.6 sec. ↑, 纤维蛋白原(Fbg) 4.70 g/L ↑, 氧合指数(OI) 186 ↓, 纤维蛋白原降解产物(FDP) 12.9 μg/mL ↑, C-反应蛋白(CRP) 104.01 mg/L ↑, 丙氨酸氨基转移酶(ALT) 8.0 U/L ↓, 天门冬氨酸氨基转移酶(AST) 14.8 U/L ↓, 白蛋白(ALB) 34.1 g/L ↓}","rubric_template_structured":{"total_score":10.0,"core_answer":["诊断：复发性鼻咽未分化型非角化癌挽救切除术后；当前MRI偏治疗后改变，尚未证实活动性残留或再次复发。","TNM：不能仅由当前术后MRI固定rT3N0M0；原发活动性及T需复评，颈部未见明确转移，M需结合完整远处检查。","临床期别：当前不宜强制定为III期；若有独立证据确证活动性rT3N0M0，第8版才对应III期。"],"key_evidence":["病理证据：病程第1342天切除标本符合鼻咽未分化型非角化癌、EBERs阳性，多处送检切缘未见癌；不是仅有活检确诊而未治疗。","当前局部证据：病程第1395天MRI原右顶壁/顶后壁肿物未见显示，壁增厚考虑治疗后改变，颅底信号异常建议随诊；不能单凭强化和骨信号固定当前rT3。","N证据：病程第1395天MR未见双侧咽后及颈部淋巴结肿大，双侧上颈动脉鞘结构清晰，缺乏颈淋巴结转移影像学证据，判N0。","M证据：现资料未提供完整远处分期，不能仅因未描述转移就视为已完成M0评估。","分期证据：病理支持已切除的复发癌，当前影像未确证活动性病灶；如后续确证rT3N0M0，则第8版为III，第9版为II。"],"conditional_modifiers":["资料不足时：如补充全身PET-CT或其他系统影像发现远处转移，应改为M1并上调临床分期。","分期待完善：如后续证据提示颅神经、海绵窦或颅内侵犯超出现有MR范围，应重评T分期并调整临床分期。"],"negative_list":{"major_errors":["误判或遗漏复发性鼻咽癌的诊断，或将本例误诊为其他部位/病理类型肿瘤","把当前术后壁增厚及骨信号异常直接定为活动性rT3，或无颅内/颅神经等依据升级T4。","N分期误判：将N0情形误写为N1-3，或将仅可疑/待定淋巴结当作确定N2证据","M分期误判：无远处转移证据时写为M1，或否认已有明确远处转移证据"],"minor_errors":["未指出术后影像偏治疗后改变及当前残留/再复发待评估，或未描述颈部节点情况。","将历史复发、手术病理及当前术后影像混用，导致活动性肿瘤状态和TNM依据不一致。","讨论具体TNM对应期别时未注明分期版次或条件。"]},"scoring_rules":{"item_scores":{"core_answer":[2.0,2.0,2.0],"key_evidence":[0.4,0.4,0.4,0.4,0.4],"conditional_modifiers":[1.0,1.0]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-209dedb579d2d694ab24fb50","case_id":"o1-case-679095fbab2483271dcd4c5b","patient_id":"o1-patient-6ad41a4d807449cd2f142a37","tag":"DIAGNOSIS_GENERAL","question":"结合当前资料，请给出该患者的最终诊断及临床 TNM 分期，并说明核心判断依据。","case_input":"- 背景摘要：患者女，64岁。3月前无明显诱因出现左侧鼻塞伴耳鸣听力下降，无头晕头痛、复视、视力模糊、涕血、面麻等不适，未予重视，逐渐加重。曾至某医院就诊，未行治疗。既往体健。否认家族中有恶性肿瘤病史。病程第0天入院\n- 影像资料：{病程第2天电子鼻咽镜检查(表麻下)(含活检)(套): 治疗后复查 ;双侧鼻腔通畅，鼻中隔无偏曲 鼻咽左侧壁可见肿物, 鼻咽癌;\n病程第2天PET/CT全身显像（套）: 空腹6h以上，静脉注射18F-FDG，静息60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及双侧壁粘膜增厚放射性浓聚，SUV约33.0，病灶侵犯颅底骨（蝶骨基底部、左翼突基底部、枕骨斜坡、左岩尖）、双侧腭帆肌群及左头长肌。双侧破裂孔未见明显异常。右咽后小淋巴结放射性分布未见明显异常。双侧海绵窦结构及放射性分布未见异常。筛窦及左乳突内低密度影放射性分布未见明显异常。口咽、喉咽未见明显异常。甲状腺放射性分布未见异常。左咽后及左颈Ⅱ区淋巴结放射性分布浓密，SUV约4.5，最大约1.1×0.7cm；右颈Ⅱ区小淋巴结放射性分布略浓密，SUV约2.5，最大约0.9×0.5cm；余双颈小淋巴结放射性分布未见明显异常。 双侧脑实质平扫未见确切病灶及异常放射性分布，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 右上肺尖段小结节放射性分布未见明显异常，大小约0.7×0.5cm；余双肺斑片、条片影放射性分布未见明显异常。气管、支气管通畅。心脏及大血管放射性分布未见异常。食管放射性分布未见明显异常。双侧乳腺未见确切病灶和异常放射性分布。纵隔及双肺门小淋巴结放射性分布略浓密。双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏平扫未见确切病灶和异常放射性分布。肝内、外胆管及胆总管未见扩张。胆囊、胃及十二指肠放射性分布未见异常。双肾囊状影放射性分布未见异常，最大直径约1.2cm。脾脏、胰腺及双侧肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后小淋巴结放射性分布未见明显异常。 膀胱、肠管、子宫等形态、结构及放射性分布未见明显异常。双侧髂血管旁及双侧腹股沟未见明显肿大淋巴结及异常放射性分布。双侧臀部皮下片状影放射性分布略浓密。 多个颈胸腰椎边缘见骨赘形成，放射性分布未见明显异常；余颅骨、躯干骨、四肢骨放射性分布未见明显异常。, 鼻咽病灶代谢活跃，考虑鼻咽癌，病灶侵犯范围如上述；左咽后及左颈Ⅱ区淋巴结代谢较活跃，考虑转移。 右颈Ⅱ区小淋巴结代谢略活跃，疑炎性病变。 鼻窦炎；左乳突炎。 右上肺小结节代谢未见明显异常，疑炎性病变/增殖灶，请结合临床。 余双肺斑片、条片影代谢未见明显异常，纵隔及双肺门小淋巴结代谢略活跃，考虑炎性病变。 双肾囊肿。 双侧臀部皮下片状影代谢略活跃，疑炎性病变。 多个颈胸腰椎退行性变。;\n病程第6天鼻咽部MR平扫+增强 颈部MR平扫+增强: 鼻咽腔狭窄，鼻咽双侧顶壁、双侧顶后壁、双侧后壁、双侧壁增厚，明显强化。左侧咽隐窝受侵。 左侧腭帆提肌、左侧腭帆张肌、左侧头长肌受侵。余咽旁肌未见明显异常。 左侧翼突基底部、左侧岩尖受侵，余颅底骨质未见明显异常。 左侧咽后见1个淋巴结，大者短径5mm(0-5mm)，明显强化。 颈部双侧II区、双侧III区见数个小淋巴结，大者短径7mm(0-10mm)，明显强化。 双侧筛窦粘膜增厚。左侧乳突见分泌物。 双侧腮腺、颌下腺、甲状腺、喉部、所见脑实质未见明显异常。, 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 左侧咽后淋巴结，可疑转移。 颈部双侧II区、双侧III区小淋巴结，性质待定。 副鼻窦炎；左侧乳突炎。}\n- 病理资料：{病程第3天病理检查报告: （左侧壁）镜下：形态符合恶性肿瘤，初步考虑未分化型非角化性癌，待免疫组化及原位杂交结果补充报告进一步诊断。;\n病程第6天病理检查报告: （左侧壁）镜下：形态结果免疫组化及原位杂交结果，符合未分化型非角化性癌。  免疫组化：标本27：CK(AE1/AE3)（+），EGFR（+）。 原位杂交：标本27：EBERs（+）。}\n- 当前检查：{病程第1天: 淀粉样蛋白A(SAA) 21.0 mg/L ↑, C-反应蛋白(CRP) 16.50 mg/L ↑}","rubric_template_structured":{"total_score":10.0,"core_answer":["诊断：鼻咽未分化型非角化癌，EBV相关","TNM分期：cT3N1M0（AJCC第9版）","临床分期：AJCC第9版II期"],"key_evidence":["诊断证据：鼻咽左侧壁活检示未分化型非角化癌，CK(AE1/AE3)+、EGFR+、EBER+，支持EBV相关鼻咽未分化癌。","T证据：PET/CT及MRI示鼻咽顶/顶后壁及双侧壁病变，侵犯蝶骨基底部、翼突基底部、枕骨斜坡、左岩尖及左咽旁肌群，未见海绵窦、颅神经、颅腔内受累，符合AJCC第9版T3。","N证据：PET/CT示左咽后及左颈Ⅱ区代谢活跃淋巴结，约1.1×0.7cm，位于环状软骨尾侧缘以上；MRI示左咽后及双侧II、III区小淋巴结，无>6cm或低位结节及明显包膜外侵，符合AJCC第9版N1。","M证据：全身PET/CT未见肺、肝、骨等远处转移灶，右上肺小结节代谢不高，纵隔及肺门小淋巴结代谢略高偏炎性，整体判定为M0。","期别依据：按AJCC第9版，颅底骨质侵犯支持T3；单侧咽后/颈转移淋巴结≤6 cm且位于环状软骨尾侧缘以上支持N1；M0前提下为cT3N1M0、II期。"],"conditional_modifiers":["T分期边界：若后续证实海绵窦、颅神经或颅腔内受累，则T分期调整为T4。","N分期边界：若发现环状软骨尾侧缘以下或>6cm颈淋巴结，或右侧颈淋巴结广泛转移或严重包膜外侵，则N分期可上调（如N2/N3）。","M分期边界：若后续评估证实肺、肝、骨等远处转移，则M分期改为M1，总体分期进展为IV期（IVA或IVB）。"],"negative_list":{"major_errors":["误判为良性、炎症或其它原发肿瘤","在无颅腔内、颅神经、海绵窦受累证据时，将本例T3误写为T1/T2/T4","已有同侧咽后及颈淋巴结转移证据仍误写为N0/N2/N3","在无远处转移证据时将M0误为M1","仅因‘颅底受侵’即认定为T4","将II期误写为III期或IV期且无合理说明","将T3相关解剖依据误写为T4，或将待定义的结节定为N2"],"minor_errors":["T分期时未提及颅底骨质或咽旁肌肉受侵，仅以“局部晚期”等宽泛表述","N1未说明为同侧咽后及颈Ⅱ区转移及大小、分布","M0未结合全身PET/CT或未注明未见远处转移","未注明采用AJCC第9版但TNM分期与该版标准一致"]},"scoring_rules":{"item_scores":{"core_answer":[2.0,2.0,2.0],"key_evidence":[0.4,0.4,0.4,0.4,0.4],"conditional_modifiers":[0.67,0.67,0.66]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-f09d507def9ec1e62fe739f7","case_id":"o1-case-de7784002046d817a7e77fde","patient_id":"o1-patient-e2444465835573edb31ffe5a","tag":"WORKUP_GENERAL","question":"结合当前资料，请列出该患者当前需重点鉴别的疾病，并分别说明关键鉴别依据。","case_input":"【病情摘要】\n患者男，27岁。\n2023年10月发现右颈肿物，病程第0天就诊。\n发现右颈肿物半年余。\n2023年10月无明显诱因发现右颈肿物，2个指甲盖大小，无压痛，质地硬，活动度中，无头晕、头痛、复视、视力模糊、耳鸣、听力下降、鼻塞、涕血、面麻等不适。2023年11月右颈肿物逐渐增大至2指甲盖大小，性质同前。\n2023年10月于某医院就诊，行CT检查未见明显异常，诊断淋巴结炎，予以“头孢克洛分散片”治疗3天后右颈肿物明显减退。2024年1月于某医院就诊，予以消炎处理，肿物未见明显消退。\n2022年于某医院行左下肢血管瘤切除术。\n否认家族中有恶性肿瘤病史。\n吸烟6年，0.5包/天。","rubric_template_structured":{"total_score":10.0,"core_answer":["诊断：鼻咽部原发恶性上皮性肿瘤/鼻咽癌为首要鉴别方向","诊断：需鉴别鼻咽/咽旁及（或）颈部受累的淋巴瘤等淋巴造血系统恶性肿瘤","诊断：需鉴别其他部位原发恶性肿瘤以颈部淋巴结转移为首发表现的转移癌","诊断：需鉴别鼻咽部良性/炎性增生性病变及良性肿瘤（如腺样体增生、鼻咽纤维血管瘤）"],"key_evidence":["鼻咽恶性肿瘤证据：以鼻咽部/咽旁区肿物或颈部肿块为主要表现，需尽快行组织学检查明确肿瘤性质和分型","上皮性肿瘤证据：鼻咽癌多起源于上皮组织，需进一步行病理及免疫组化（含EB病毒相关检测）明确性质，答案不得将具体分型或EBV结果写成既定事实","淋巴瘤证据：鼻咽/咽旁部淋巴瘤起源于淋巴组织，可为黏膜下肿块并累及颈部淋巴结，需通过组织取材及T/B细胞相关免疫组化与上皮性肿瘤鉴别，仅能作为待完善检查方向","转移癌证据：颈部淋巴结肿大可为其他部位原发恶性肿瘤的首发表现，需全身查体及头颈、胸腹部影像、内镜等排查原发灶，不能虚构具体影像结论或原发部位","良性鉴别依据：腺样体增生、慢性炎症性增生或鼻咽纤维血管瘤可致鼻咽占位、鼻塞出血，病程相对缓慢且影像/组织学偏良性；依据组织形态及检查鉴别，不杜撰未提供的结果。","待完善检查证据：EB病毒相关检测、完整免疫组化谱及必要全身影像学应作为需进一步完善项目，用于明确原发灶性质及组织学类型，答案不得将其具体结果写成已确定证据"],"conditional_modifiers":[],"negative_list":{"major_errors":["误判：将需重点鉴别方向偏离为与病例线索不符的系统性疾病","臆断：将尚需完善的病理、免疫组化、EBV检测或影像结果写成已确定事实"],"minor_errors":["遗漏鼻咽部恶性上皮性肿瘤/鼻咽癌为主要鉴别方向","遗漏鼻咽淋巴瘤或其他淋巴系统恶性肿瘤的鉴别","遗漏考虑其他部位原发恶性肿瘤以转移首发的可能","遗漏鼻咽部良性/炎性增生性病变和良性肿瘤的鉴别","鉴别依据与疾病基本特征相悖，如将良性特征描述为高度恶性或反之","虚构“已明确排除某诊断”等结论，缺乏合理依据或与当前资料阶段不符"]},"scoring_rules":{"item_scores":{"core_answer":[2.0,2.0,2.0,2.0],"key_evidence":[0.33,0.33,0.33,0.33,0.33,0.35],"conditional_modifiers":[]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-d11181bc0dcee1cc96a514d2","case_id":"o1-case-de7784002046d817a7e77fde","patient_id":"o1-patient-e2444465835573edb31ffe5a","tag":"WORKUP_GENERAL","question":"为明确该患者的诊断与分期，请列出该患者还需完善的关键检查，并分别说明各项检查的目的。","case_input":"【病情摘要】\n患者男，27岁。\n2023年10月发现右颈肿物，病程第0天就诊。\n发现右颈肿物半年余。\n2023年10月无明显诱因发现右颈肿物，2个指甲盖大小，无压痛，质地硬，活动度中，无头晕、头痛、复视、视力模糊、耳鸣、听力下降、鼻塞、涕血、面麻等不适。2023年11月右颈肿物逐渐增大至2指甲盖大小，性质同前。\n2023年10月于某医院就诊，行CT检查未见明显异常，诊断淋巴结炎，予以“头孢克洛分散片”治疗3天后右颈肿物明显减退。2024年1月于某医院就诊，予以消炎处理，肿物未见明显消退。\n2022年于某医院行左下肢血管瘤切除术。\n否认家族中有恶性肿瘤病史。\n吸烟6年，0.5包/天。","rubric_template_structured":{"total_score":10.0,"core_answer":["局部影像：完善鼻咽及颈部增强 MRI，评估原发灶范围及颈部淋巴结受累","远处转移：完善全身 FDG-PET/CT（或等效全身代谢显像），评估远处转移并完成 M 分期","EBV 检测：补充血浆（或血清）EBV-DNA 定量，作为鼻咽恶性肿瘤诊断与分期的辅助手段","病理确诊：通过鼻咽镜评估并对可疑鼻咽病灶活检，必要时对颈部肿物穿刺取材，结合病理、免疫组化和EBER明确来源；已有标本时再作复核。"],"key_evidence":["局部分期证据：现有资料仅有鼻咽病变初步线索，缺乏鼻咽及颈部精细影像评估原发灶及淋巴结","远处分期证据：未见系统全身代谢或解剖学影像，需 PET/CT 等检查完成远处转移及 M 分期评估","EBV 证据：鼻咽恶性肿瘤常需血浆 EBV-DNA 等检测，辅助诊断、分期及预后判断","病理证据：需通过补充免疫组化及 EBER 原位杂交等病理检查，进一步明确肿瘤类型及 EBV 相关性"],"conditional_modifiers":["骨受侵评估：若需精细评估骨质或颅底受侵，可补充原发灶及颈部 CT 或颅底骨窗 CT","远处转移替代：如暂不能行 PET/CT，可用胸部 CT、腹部 CT 或 MRI、全身骨显像/骨 ECT 等筛查远处转移","全身评估：根据具体情况完善基础实验室及肿瘤相关标志物，评估全身状况与治疗耐受性"],"negative_list":{"major_errors":["将需完善的检查写成已完成检查并虚构具体结果","同时遗漏局部分期 MRI（或等效头颈部精细影像）和远处转移评估（如 PET/CT）两类核心检查","在病例未提供时，将病理类型或 EBV 状态写成已证实事实"],"minor_errors":["遗漏 EBV-DNA 检测或补充病理学检查等重要辅助检查","未说明各检查在诊断与分期中的具体目的或目的与检查不匹配","仅列“完善影像学检查”等笼统表述而未列出具体检查名称"]},"scoring_rules":{"item_scores":{"core_answer":[1.5,1.5,1.5,1.5],"key_evidence":[0.5,0.5,0.5,0.5],"conditional_modifiers":[0.67,0.67,0.66]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-a95546ef215b8aff69ab2fda","case_id":"o1-case-54d9604a4866e73900ce4f93","patient_id":"o1-patient-09a836ea846bb6e1f0eb29cc","tag":"TX_GENERAL","question":"根据最新 CSCO 指南，结合当前资料，请制定该患者当前阶段的标准治疗策略，并注明主要指南依据、推荐等级及证据类别。","case_input":"【病情摘要】\n患者男，56岁。\n2025年2月出现症状，病程第7天入院。\n双耳闷堵感、听力下降伴鼻塞1月余，外院见鼻咽肿物。\n2025年2月无明显诱因出现双耳闷堵感伴听力下降，伴鼻塞，偶有回吸涕带血，偶有头晕。\n病程第0天于某医院行鼻咽活检病理示：（鼻咽）非角化性癌，未分化型。未行治疗。\n高血压病史，未行药物治疗。\n否认家族中有恶性肿瘤病史。\nT分期：T2\nN分期：N1\n总分期：IB","rubric_template_structured":{"total_score":10.0,"core_answer":["TNM分期：IB期鼻咽癌（T2N1M0），当前目标为根治","总体策略：同期放化疗为首选标准方案","替代策略：无不良预后因素患者可选单纯根治性放疗","指南依据：以上方案为CSCO指南高等级推荐，单纯放疗为次一级推荐"],"key_evidence":["分期证据：T2病灶合并N1淋巴结受累、无远处转移，分期为IB期（T2N1M0）","CSCO证据：T1-2N1鼻咽癌一线治疗中，同期放化疗列为高等级推荐","放疗证据：研究显示无不良预后因素患者单纯放疗疗效不劣、毒性更低，CSCO列为次一级推荐"],"conditional_modifiers":["顺铂不耐受时：可考虑换用其他铂类药物（如奈达铂、奥沙利铂或卡铂）","放化疗不耐受时：合并症或评估为无不良预后因素时，可选择单纯根治性放疗","资料不足时：经MDT评估患者全身状况与器官功能，个体化调整治疗强度"],"negative_list":{"major_errors":["未将同期放化疗或单纯根治性放疗列为IB期（T2N1M0）主要方案","将诱导化疗或辅助化疗作为本期患者标准主路径","将本例按转移性或晚期鼻咽癌制定姑息性治疗方案"],"minor_errors":["未说明同期放化疗在CSCO指南中的优先推荐地位","未注明CSCO指南的推荐等级或证据类别","未提及化疗不耐受时的单纯放疗或个体化调整策略"]},"scoring_rules":{"item_scores":{"core_answer":[1.5,1.5,1.5,1.5],"key_evidence":[0.67,0.67,0.66],"conditional_modifiers":[0.67,0.67,0.66]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-27cf05c63e8f7012bb45d6e0","case_id":"o1-case-54d9604a4866e73900ce4f93","patient_id":"o1-patient-09a836ea846bb6e1f0eb29cc","tag":"TX_GENERAL","question":"根据最新 CSCO 指南，若按上述治疗策略进行治疗，请提供该患者的具体治疗方案及实施要点；如涉及系统治疗，请注明方案名称、药物组成、给药方式、频次及疗程；如涉及局部治疗，请注明主要干预手段。","case_input":"【病情摘要】\n患者男，56岁。\n2025年2月出现症状，病程第7天入院。\n双耳闷堵感、听力下降伴鼻塞1月余，外院见鼻咽肿物。\n2025年2月无明显诱因出现双耳闷堵感伴听力下降，伴鼻塞，偶有回吸涕带血，偶有头晕。\n病程第0天于某医院行鼻咽活检病理示：（鼻咽）非角化性癌，未分化型。未行治疗。\n高血压病史，未行药物治疗。\n否认家族中有恶性肿瘤病史。\nT分期：T2\nN分期：N1\n总分期：IB","rubric_template_structured":{"total_score":10.0,"core_answer":["局部治疗：采用鼻咽癌根治剂量IMRT，覆盖原发灶及高危区域，处方约70Gy/32~35次","系统治疗：若选同期放化疗，以顺铂为基础的含铂方案为主","给药方案：顺铂每3周100mg/m²或每周30–40mg/m²静脉给药","治疗监测：放化疗期间监测毒性，及时处理不良反应并加强支持治疗"],"key_evidence":["放疗证据：IMRT为鼻咽癌标准放疗技术，T2N1M0需给予约70Gy根治剂量","放化疗证据：CSCO指南一线推荐IMRT联合足量顺铂同期放化疗","给药证据：CSCO指南推荐顺铂三周方案100mg/m²或每周方案作为同期化疗标准"],"conditional_modifiers":["放疗边界：若选择单纯放疗，可按CSCO较低推荐等级实施，但需保证IMRT根治剂量与计划质量","含铂替代：同期放化疗时如顺铂不耐受或禁忌，可改用奈达铂、卡铂或奥沙利铂等铂类","支持治疗：放疗过程中需加强营养、水化止吐及皮肤黏膜放射损伤的监测与处理"],"negative_list":{"major_errors":["未将IMRT或同级现代精确放疗及根治剂量作为局部根治性治疗核心","同期放化疗时未使用含铂方案，而采用非CSCO标准化疗","将手术作为原发灶和区域淋巴结的主要根治性局部治疗"],"minor_errors":["未说明放疗处方剂量约70Gy及分割次数","同期化疗中未明确顺铂给药频次为每3周或每周","未提及顺铂不耐受时可用铂类替代药物，或未指出单纯放疗作为无不良预后因素时的备选方案"]},"scoring_rules":{"item_scores":{"core_answer":[1.5,1.5,1.5,1.5],"key_evidence":[0.67,0.67,0.66],"conditional_modifiers":[0.67,0.67,0.66]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
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+{"item_id":"o1-item-e6940c590cd813cf8fdbf761","case_id":"o1-case-4e88ffbc89d1e4f2dc40eafb","patient_id":"o1-patient-e2670de87f52b534db9c939f","tag":"TX_GENERAL","question":"根据最新 CSCO 指南，若按上述治疗策略进行治疗，请提供该患者的具体治疗方案及实施要点；如涉及系统治疗，请注明方案名称、药物组成、给药方式、频次及疗程；如涉及局部治疗，请注明主要干预手段。","case_input":"【病情摘要】\n患者男，60岁。\n病程第0天就诊。\n鼻咽癌治疗后多年复发。\n2016年因“鼻咽未分化型非角化癌”于外院行根治性放化疗（具体不详）。\n既往“乙肝”病史。\n否认家族中有恶性肿瘤病史。\n2025年3月外院复查鼻咽部复发（rT4N2M0）。\n今为求进一步诊治来我院。\nT分期：rT4\nN分期：rN2","rubric_template_structured":{"total_score":10.0,"core_answer":["总体策略：承接局部挽救资格分层；适宜者实施挽救手术或精确再放疗，不适宜者选择系统治疗或最佳支持治疗。","系统方案：选择系统治疗时，可用GP（吉西他滨＋顺铂）联合特瑞普利单抗、卡瑞利珠单抗或替雷利珠单抗；免疫不适宜者可用GP化疗。","实施要点：选择系统治疗时，列明所选药物的给药方式、周期及疗程，并按耐受性调整。","疗程与评估：采用GP±PD-1时常按21天周期给药，化疗约4–6周期并定期评估；仅实际联合免疫且有适应证者考虑免疫维持。","局部与支持：适宜局部根治挽救时列明手术或再放疗及风险控制；不适宜者按症状考虑局部姑息干预，配合镇痛、营养及乙肝管理。"],"key_evidence":["疾病证据：2016年根治放化疗后，2025年外院评估rT4N2M0复发；尚未提供局部挽救资格，不能仅据复发标签固定姑息目标。","系统治疗证据：若局部根治挽救不适宜且复发阶段尚未系统治疗，可按复发性鼻咽癌选择一线系统方案。","路径证据：局部复发先评估手术/再放疗；两者不适宜时以系统治疗为主，进展后再结合既往暴露及毒性选择后线方案。","安全证据：合并乙肝病史，系统治疗需监测肝功能和HBV指标，预防再激活并随毒性调整方案"],"conditional_modifiers":["剂量调整：如有明显骨髓抑制或肝肾损害，应减量、延长间隔或改用单药/支持治疗为主","局部边界：病灶局限且风险可接受时，经MDT可选择具根治意图的手术或再放疗；不具备此条件时，局部干预用于症状控制。","进展后策略：含铂+PD-1方案期间或之后进展时，可改用单药化疗、二线免疫或进入临床试验，并按不良反应调整或停药","乙肝管理：HBV复制活跃或肝功能异常时，系统治疗前完善HBV-DNA及肝功能，强化抗病毒并在肝毒性明显时调整或暂缓治疗"],"negative_list":{"major_errors":["无资格评估即固定某一路径，或选择系统治疗后使用无合理依据的非标准方案；经评估选择局部根治或非ICI方案不据此扣分。","不评估既往放疗、可切除性及危及器官风险，即把再次大剂量放疗或手术作为必选。","合并乙肝病史时完全忽视肝功能和乙肝再激活风险管理而推荐高肝毒性方案"],"minor_errors":["已选择系统治疗却未写方案组成和周期；选择局部挽救者应说明相应实施及风险控制，无须强制列系统处方。","未根据挽救资格说明根治或姑息目标，或套用初治根治流程而忽视既往治疗。","涉及局部手术/再放疗却未说明MDT及累积风险评估；不因经评估选择根治意图扣分。","提及乙肝病史但未说明需监测肝功能或乙肝再激活，仅泛泛提安全性"]},"scoring_rules":{"item_scores":{"core_answer":[1.2,1.2,1.2,1.2,1.2],"key_evidence":[0.5,0.5,0.5,0.5],"conditional_modifiers":[0.5,0.5,0.5,0.5]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-8c80bb30ddfa11b79be74b3a","case_id":"o1-case-2ad5fa8679db23865025438b","patient_id":"o1-patient-f6dc8a4d1534e23e55cfdb20","tag":"TX_GENERAL","question":"根据最新 NCCN 指南，结合当前资料，请制定该患者当前阶段的标准治疗策略，并注明主要指南依据、推荐等级及证据类别。","case_input":"【病情摘要】\n患者男，57岁。\n2022年9月就诊，病程第884天入院。\n鼻咽癌综合治疗后22月，左眼复视2个月。\n2个月前出现左眼不能外展，伴视物重影。\n2022年9月因“左侧听力下降”某医院，完善鼻咽MR提示：鼻咽癌，累及左侧腭帆张肌、腭帆提肌、翼内肌、头长肌、左侧中颅窝，左侧翼外肌可疑侵犯，颅底骨质侵犯，双侧颈部淋巴结转移。病理提示：低分化鳞癌。某医院继续GP方案化疗2程，末次治疗时间为病程第146天。病程第790天某医院鼻咽MR提示：左侧鼻咽部粘膜较前稍增厚。病程第795天PET/CT提示：鼻咽左侧壁粘膜轻度不规则增厚，SUVmax 2.0，符合鼻咽癌治疗后改变，提示肿瘤细胞处于抑制状态。左侧海绵窦区、左侧颈动脉孔增宽，SUVmax 5.3，结合MR，考虑鼻咽癌累及左侧海绵窦区。病程第814天复诊咨询检查结果及后续治疗，再次鼻咽部活检提示：未分化型非角化性癌。鼻咽MR提示：海绵窦复发。\n2022年9月鼻咽MR提示：鼻咽癌，累及左侧腭帆张肌、腭帆提肌、翼内肌、头长肌、左侧中颅窝，左侧翼外肌可疑侵犯，颅底骨质侵犯，双侧颈部淋巴结转移。病理提示：低分化鳞癌。病程第795天PET/CT提示：鼻咽左侧壁粘膜轻度不规则增厚，SUVmax 2.0；左侧海绵窦区、左侧颈动脉孔增宽，SUVmax 5.3，考虑鼻咽癌累及左侧海绵窦区。病程第814天鼻咽部活检提示：未分化型非角化性癌。鼻咽MR提示：海绵窦复发。\n既往体健。有吸烟史，20支/天，近40年吸烟史，未戒烟。\n否认家族中有恶性肿瘤病史。\n2022年9月诊断为鼻咽低分化鳞癌。病程第814天诊断为鼻咽未分化型非角化性癌（海绵窦复发）。\n病程第0天和病程第21天行GP方案化疗2次。2022年11月至2023年1月行鼻咽及颈部放疗（70.4Gy/32f），期间顺铂qw同步4次，尼妥珠qw6次。某医院继续GP方案化疗2程，末次治疗时间为病程第146天。\nT分期：T4\nN分期：N0","rubric_template_structured":{"total_score":10.0,"core_answer":["疾病阶段：既往70.4 Gy根治放化疗后≥6个月的局部复发，累及海绵窦，为不可切除病灶","总体策略：在MDT评估下，首选参加临床试验，或行再程放疗（Reirradiation）±同步系统治疗","再程放疗策略：拟行根治性再程放疗时，需经MDT严格筛选，评估能否安全追加≥60 Gy、危及器官累积剂量、整体耐受性及预期寿命；是否联合同步系统治疗另行评估。","系统治疗策略：若无放疗或手术指征，则按NCCN以系统治疗为主行全身姑息治疗（如含顺铂/吉西他滨+特瑞普利单抗的1类推荐方案）"],"key_evidence":["复发及时间证据：既往70.4Gy放疗结束于2023年1月，病程第146天为后续GP末次化疗；2024年12月海绵窦复发，距RT结束仍超过6个月。","再程放疗依据：NCCN头颈部肿瘤V1.2026对既往放疗后的不可切除局部复发列出再程放疗±系统治疗，优先考虑临床试验；未另注明者为2A类。","剂量适用依据：NCCN头颈部肿瘤V1.2026在根治意图、手术不适宜且严格筛选时提出可追加≥60 Gy；处方须结合分割及危及器官累积耐受，不作为所有再照射的剂量下限。","NCCN系统治疗证据：无再程放疗选项时，复发不可切除鼻咽癌应按NCCN首选系统治疗方案，如顺铂/吉西他滨+特瑞普利单抗（1类推荐）"],"conditional_modifiers":["放疗手段边界：若光子再程放疗难以同时满足OARs限量与肿瘤剂量覆盖，可根据NCCN考虑质子治疗","同步药物替代：若再程放疗时患者因既往毒性或合并症不能耐受同步顺铂，可用卡铂替代","纯系统治疗路径：若再程放疗风险过大改用单纯系统治疗，应结合既往GP方案反应及当前体能状态调整方案"],"negative_list":{"major_errors":["忽视既往70.4 Gy放疗史，直接按初治鼻咽癌推荐常规同步放化疗","未考虑距前次放疗时间及OARs耐受性等前置条件即推荐再程放疗","未说明海绵窦病灶不可切除与高风险，仍以手术切除为首选常规方案","推荐不符合NCCN复发后线系统治疗的药物组合"],"minor_errors":["未提及再程放疗决策需在MDT框架下进行","未说明在合适情况下应首选参加临床试验","未区分再程放疗可行与不可行时的系统治疗不同路径"]},"scoring_rules":{"item_scores":{"core_answer":[1.5,1.5,1.5,1.5],"key_evidence":[0.5,0.5,0.5,0.5],"conditional_modifiers":[0.67,0.67,0.66]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-50f8ab0ffb089e840bba8ab7","case_id":"o1-case-2ad5fa8679db23865025438b","patient_id":"o1-patient-f6dc8a4d1534e23e55cfdb20","tag":"TX_GENERAL","question":"根据最新 NCCN 指南，若按上述治疗策略进行治疗，请提供该患者的具体治疗方案及实施要点；如涉及系统治疗，请注明方案名称、药物组成、给药方式、频次及疗程；如涉及局部治疗，请注明主要干预手段。","case_input":"【病情摘要】\n患者男，57岁。\n2022年9月就诊，病程第884天入院。\n鼻咽癌综合治疗后22月，左眼复视2个月。\n2个月前出现左眼不能外展，伴视物重影。\n2022年9月因“左侧听力下降”某医院，完善鼻咽MR提示：鼻咽癌，累及左侧腭帆张肌、腭帆提肌、翼内肌、头长肌、左侧中颅窝，左侧翼外肌可疑侵犯，颅底骨质侵犯，双侧颈部淋巴结转移。病理提示：低分化鳞癌。某医院继续GP方案化疗2程，末次治疗时间为病程第146天。病程第790天某医院鼻咽MR提示：左侧鼻咽部粘膜较前稍增厚。病程第795天PET/CT提示：鼻咽左侧壁粘膜轻度不规则增厚，SUVmax 2.0，符合鼻咽癌治疗后改变，提示肿瘤细胞处于抑制状态。左侧海绵窦区、左侧颈动脉孔增宽，SUVmax 5.3，结合MR，考虑鼻咽癌累及左侧海绵窦区。病程第814天复诊咨询检查结果及后续治疗，再次鼻咽部活检提示：未分化型非角化性癌。鼻咽MR提示：海绵窦复发。\n2022年9月鼻咽MR提示：鼻咽癌，累及左侧腭帆张肌、腭帆提肌、翼内肌、头长肌、左侧中颅窝，左侧翼外肌可疑侵犯，颅底骨质侵犯，双侧颈部淋巴结转移。病理提示：低分化鳞癌。病程第795天PET/CT提示：鼻咽左侧壁粘膜轻度不规则增厚，SUVmax 2.0；左侧海绵窦区、左侧颈动脉孔增宽，SUVmax 5.3，考虑鼻咽癌累及左侧海绵窦区。病程第814天鼻咽部活检提示：未分化型非角化性癌。鼻咽MR提示：海绵窦复发。\n既往体健。有吸烟史，20支/天，近40年吸烟史，未戒烟。\n否认家族中有恶性肿瘤病史。\n2022年9月诊断为鼻咽低分化鳞癌。病程第814天诊断为鼻咽未分化型非角化性癌（海绵窦复发）。\n病程第0天和病程第21天行GP方案化疗2次。2022年11月至2023年1月行鼻咽及颈部放疗（70.4Gy/32f），期间顺铂qw同步4次，尼妥珠qw6次。某医院继续GP方案化疗2程，末次治疗时间为病程第146天。\nT分期：T4\nN分期：N0","rubric_template_structured":{"total_score":10.0,"core_answer":["局部再程放疗：采用IMRT等精确放疗技术，处方剂量及分割根据治疗目标、照射范围和危及器官累积剂量制定；光子计划不能兼顾安全性与靶区覆盖时，可考虑质子治疗。","同步系统治疗：再放疗可联合或不联合系统治疗；选择同步治疗时可用含铂方案，顺铂不宜者评估卡铂等替代，单纯再放疗亦可基于风险获益选择。","纯系统治疗：无法放疗时首选顺铂/吉西他滨+特瑞普利单抗（Category 1）或其他 NCCN 推荐 PD-1+含铂双药方案","支持与姑息：针对左眼复视及外展神经受累对症处理，并监测放化疗毒性及脑干/视路等迟发并发症"],"key_evidence":["剂量依据：NCCN头颈部肿瘤V1.2026中的追加≥60 Gy用于特定根治意图再照射筛选；剂量、分割须结合治疗目标、范围及危及器官累积剂量，不是所有方案的统一下限。","技术选择依据：光子再照射计划不能兼顾安全性与靶区覆盖时，可考虑质子治疗。","同步用药依据：NCCN鼻咽癌指南将含铂方案列为再程放疗联合同步系统治疗的用药方案。","系统治疗依据：无手术或放疗选择的不可切除或转移性复发，NCCN首选吉西他滨＋顺铂联合特瑞普利单抗，为1类推荐。"],"conditional_modifiers":["顺铂毒性边界：既往 GP 出现明显周围神经毒性或不可逆听力损伤时，应减量或改用卡铂","再照射安全边界：海绵窦病灶再照射需结合既往 RT 和 DVH 严格评估视路、脑干、颈内动脉累积剂量","疗效监测：系统治疗期间通过影像及 EBV-DNA（非角化性癌）动态评估疗效并据疗效/毒性调整方案"],"negative_list":{"major_errors":["再程放疗仍按初治常规 70 Gy 开具且未体现 OAR 累积剂量评估或质子替代思路","选择同步系统治疗时使用无合理依据的方案；经评估选择单纯再放疗不因未用铂类扣分。","无法放疗时未推荐 NCCN 认可的含铂联合免疫或其他标准一线/后线方案"],"minor_errors":["未提及 IMRT/质子等高精度放疗在颅底再照射中的必要性","涉及系统治疗却仅写化疗，未列代表性药物；合理选择单纯再放疗者不因未列药物扣分。","未提及对左眼复视/不能外展的对症处理或疗效及毒性监测"]},"scoring_rules":{"item_scores":{"core_answer":[1.5,1.5,1.5,1.5],"key_evidence":[0.5,0.5,0.5,0.5],"conditional_modifiers":[0.67,0.67,0.66]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-0d7517d83c6e589783859366","case_id":"o1-case-f715ee5f43183bca7c7a74a5","patient_id":"o1-patient-88ef56c6fdf9a0e23b2aecce","tag":"TX_GENERAL","question":"根据最新 CSCO 指南，结合当前资料，请制定该患者当前阶段的标准治疗策略，并注明主要指南依据、推荐等级及证据类别。","case_input":"【病情摘要】\n患者男，53岁。\n2020年下半年出现症状；2021年7月就诊；病程第1244天入院。\n鼻咽癌综合治疗后3年余，发现复发1月余。\n2020年下半年无明显诱因出现耳鸣，伴听力下降，涕中带血。\n2021年7月某医院，病理：左侧鼻腔非角化性分化型癌，右侧鼻腔非角化性分化型癌。某医院，MRI提示鼻咽癌，双侧咽后淋巴结肿大，右侧颈部II、III区淋巴结肿大，考虑转移。病程第1125天该院复查鼻咽+颈部MRI提示鼻咽右侧壁条状坏死伴周边组织异常强化，感染可能，予抗感染后症状持续加重。病程第1175天行颈动脉支架植入术。病程第1198天该院行“鼻内窥镜下颅底恶性肿瘤扩大切除+鼻咽坏死切除+颅底重建术+右侧下鼻甲部分切除”，术后病理提示（右侧鼻咽肿物）低分化癌。术后出现头痛加重，右耳听力丧失，左耳听力下降，伴痰多，吞咽困难，体重进行性下降。至南昌大学第一附属疼痛科就诊，完善MRI提示考虑NPC复发。\n2021年7月某医院MRI提示鼻咽癌，双侧咽后淋巴结肿大，右侧颈部II、III区淋巴结肿大，考虑转移。病程第1125天该院复查鼻咽+颈部MRI提示鼻咽右侧壁条状坏死伴周边组织异常强化，感染可能。病程第1198天术后病理提示（右侧鼻咽肿物）低分化癌。\n既往体健。\n有父亲、1弟弟有鼻咽癌病史，已去世。\n2021年7月病理诊断：左侧鼻腔非角化性分化型癌，右侧鼻腔非角化性分化型癌。病程第1198天术后病理诊断：（右侧鼻咽肿物）低分化癌。\n病程第0天至病程第46天于某医院行放疗（鼻咽癌+颈部淋巴结引流区，计划：PGTVnx70Gy，PGTVnd-right70Gy，Gtv-left66Gy，CTV160Gy，CTV254Gy，分32次完成），并予同期顺铂化疗2次，并予尼采珠单抗靶向治疗8次及甘胺双唑钠放射增敏治疗。病程第1175天行颈动脉支架植入术。病程第1198天行“鼻内窥镜下颅底恶性肿瘤扩大切除+鼻咽坏死切除+颅底重建术+右侧下鼻甲部分切除”。\nT分期：T4\nN分期：N0","rubric_template_structured":{"total_score":10.0,"core_answer":["诊断阶段：既往根治放化疗后局部/区域复发鼻咽癌，已完成挽救性鼻内镜下颅底及鼻咽坏死切除手术，现处于术后管理期","病灶复核：复核术后病理、切缘、鼻咽内镜及影像，鉴别活动性残留/复发与坏死、感染或术后改变。","后续处置：无活动性肿瘤时密切随访并支持治疗；确证残留/复发后，按局部挽救治疗资格选择处置。","放疗策略：在未证实明确残留病灶或显著高危因素时，不常规推荐再次根治性放化疗","系统治疗：确证活动性残留/复发且不适合局部根治挽救时，按复发性鼻咽癌评估含铂双药±PD-1；仅因术后高危因素不将辅助系统治疗写成必须实施的标准。","指南依据：依据CSCO鼻咽癌指南，局部复发且适宜手术者首选手术挽救，术后按风险个体化管理，对应高推荐等级和高证据类别"],"key_evidence":["疾病阶段证据：患者为鼻咽癌综合治疗后3年余局部复发，2021年完成鼻咽及颈部放疗等综合治疗，2024年影像及术后病理提示鼻咽癌局部/区域复发","既往放疗证据：2021年接受鼻咽及颈部放疗，PGTVnx等70Gy剂量水平，合并化疗及靶向治疗，提示既往已接受高剂量根治性放疗","手术及当前证据：病程第1198天已行颅底肿瘤及鼻咽坏死切除、颅底重建，病理低分化癌；术后症状加重且MRI考虑复发，尚缺切缘及当前活动性病灶的完整判定。","指南匹配证据：局部复发应评估手术及再放疗挽救机会；两者不适宜时考虑系统治疗。术后无活动性病灶可随访，不能仅凭高危因素推定必须辅助化疗。","放疗风险证据：患者既往已接受PGTVnx 70Gy根治剂量和近期颅底手术，提示再次大剂量局部放疗并发症风险显著升高"],"conditional_modifiers":["残留/复发时：结合病理及影像确认活动性病灶后，由MDT评估再次局部挽救、系统治疗或临床试验；切缘及颅底风险参与决策，不能单独替代活动性病灶和获益评估。","放疗边界：因既往高剂量放疗及近期颅底重建，再次大剂量局部放疗仅在极特殊情况下慎重考虑，一般不作为常规路径","耐受受限时：无活动性肿瘤者密切随访并支持；已确证活动性肿瘤但不耐受抗肿瘤治疗者，以症状控制和最佳支持治疗为主。","随访要求：无论是否实施术后辅助治疗，均需纳入规范随访，包括定期影像、鼻咽内镜及神经功能评估，以早期发现再次复发或严重并发症"],"negative_list":{"major_errors":["将当前阶段错误定为初治根治性同步放化疗或再次大剂量放疗，忽略已行挽救性手术和既往高剂量放疗","误按初治局部晚期鼻咽癌路径制定治疗，未识别为复发后手术切除的术后管理阶段","未提及CSCO关于局部复发适宜手术患者首选手术挽救的原则，或推荐等级与证据类别严重表述错"],"minor_errors":["未复核术后病理、切缘及当前影像，未区分无活动性病灶随访与确证残留/复发后的治疗分支。","未说明无活动性肿瘤时可随访，或未评估当前疑似复发就固定选择观察或化疗。","将术后辅助系统治疗表述为所有患者均须实施，或无依据将高危因素等同已确证复发。"]},"scoring_rules":{"item_scores":{"core_answer":[1.0,1.0,1.0,1.0,1.0,1.0],"key_evidence":[0.4,0.4,0.4,0.4,0.4],"conditional_modifiers":[0.5,0.5,0.5,0.5]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-63b3a07950d5eebef4caec42","case_id":"o1-case-f715ee5f43183bca7c7a74a5","patient_id":"o1-patient-88ef56c6fdf9a0e23b2aecce","tag":"TX_GENERAL","question":"根据最新 CSCO 指南，若按上述治疗策略进行治疗，请提供该患者的具体治疗方案及实施要点；如涉及系统治疗，请注明方案名称、药物组成、给药方式、频次及疗程；如涉及局部治疗，请注明主要干预手段。","case_input":"【病情摘要】\n患者男，53岁。\n2020年下半年出现症状；2021年7月就诊；病程第1244天入院。\n鼻咽癌综合治疗后3年余，发现复发1月余。\n2020年下半年无明显诱因出现耳鸣，伴听力下降，涕中带血。\n2021年7月某医院，病理：左侧鼻腔非角化性分化型癌，右侧鼻腔非角化性分化型癌。某医院，MRI提示鼻咽癌，双侧咽后淋巴结肿大，右侧颈部II、III区淋巴结肿大，考虑转移。病程第1125天该院复查鼻咽+颈部MRI提示鼻咽右侧壁条状坏死伴周边组织异常强化，感染可能，予抗感染后症状持续加重。病程第1175天行颈动脉支架植入术。病程第1198天该院行“鼻内窥镜下颅底恶性肿瘤扩大切除+鼻咽坏死切除+颅底重建术+右侧下鼻甲部分切除”，术后病理提示（右侧鼻咽肿物）低分化癌。术后出现头痛加重，右耳听力丧失，左耳听力下降，伴痰多，吞咽困难，体重进行性下降。至南昌大学第一附属疼痛科就诊，完善MRI提示考虑NPC复发。\n2021年7月某医院MRI提示鼻咽癌，双侧咽后淋巴结肿大，右侧颈部II、III区淋巴结肿大，考虑转移。病程第1125天该院复查鼻咽+颈部MRI提示鼻咽右侧壁条状坏死伴周边组织异常强化，感染可能。病程第1198天术后病理提示（右侧鼻咽肿物）低分化癌。\n既往体健。\n有父亲、1弟弟有鼻咽癌病史，已去世。\n2021年7月病理诊断：左侧鼻腔非角化性分化型癌，右侧鼻腔非角化性分化型癌。病程第1198天术后病理诊断：（右侧鼻咽肿物）低分化癌。\n病程第0天至病程第46天于某医院行放疗（鼻咽癌+颈部淋巴结引流区，计划：PGTVnx70Gy，PGTVnd-right70Gy，Gtv-left66Gy，CTV160Gy，CTV254Gy，分32次完成），并予同期顺铂化疗2次，并予尼采珠单抗靶向治疗8次及甘胺双唑钠放射增敏治疗。病程第1175天行颈动脉支架植入术。病程第1198天行“鼻内窥镜下颅底恶性肿瘤扩大切除+鼻咽坏死切除+颅底重建术+右侧下鼻甲部分切除”。\nT分期：T4\nN分期：N0","rubric_template_structured":{"total_score":10.0,"core_answer":["总体策略：先按病理、切缘和影像复评当前残留/复发状态；无活动性病灶时密切随访并支持，确证复发时根据局部挽救资格及耐受性选择治疗。","系统治疗：仅在确证活动性残留/复发且局部根治挽救不适宜时，考虑GP等含铂双药±PD-1；不因术后复发风险高就一概启动化疗。","分支实施：选择系统治疗时列明方案组成、给药方式及周期，并定期评估疗效和毒性；选择无病随访时说明内镜、影像及症状复查安排，无须列化疗处方。","支持与护理：重视术后创面护理、抗感染、营养支持（必要时管饲），并加强颈动脉大出血等严重并发症预防与监测"],"key_evidence":["复评依据：近期挽救手术后病理低分化癌，症状加重且MRI考虑复发，但切缘和当前病灶性质未明确；需先鉴别活动性肿瘤、术后改变、坏死或感染。","系统方案证据：GP±PD-1属于适宜系统治疗的复发/转移性鼻咽癌方案；不能直接据此认定挽救术后所有高危患者均须接受辅助系统治疗。","营养支持证据：CSCO指南建议放疗致吞咽困难或营养不良患者早期营养支持，可采用管饲等方式改善治疗耐受","出血风险证据：咽旁坏死及颅底术后患者颈内动脉大出血风险极高，既往高剂量放疗及颈动脉支架进一步增加再放疗危害，需重点监控和慎用再程放疗"],"conditional_modifiers":["化疗强度边界：如骨髓或肝肾功能及体能状态欠佳，应减量含铂化疗或改用毒性较低方案，必要时以最佳支持治疗为主","再放疗边界：因既往高剂量放疗、颈动脉支架及颅底大范围切除，再次大剂量局部放疗应极度慎重甚至避免","营养与感染前提：先评估吞咽及营养，必要时管饲；有感染时积极控制。仅在确认抗肿瘤治疗指征且全身状态允许后启动相应方案。","免疫治疗监测：启动含铂双药联合PD-1单抗时，应充分告知风险与费用，并严格监测免疫相关不良反应及骨髓抑制"],"negative_list":{"major_errors":["将再次根治性或大剂量放疗作为常规首选，未考虑前期高剂量放疗、颈动脉支架和颅底手术后出血及再放疗高风险","未评估当前活动性病灶及局部挽救资格就强制系统治疗，或在确需系统治疗时选用明显不适当药物。","仅笼统观察或轻微对症，既不复评疑似复发，也不处理营养及并发症风险。"],"minor_errors":["已选择系统治疗却仅写化疗而未明确代表性含铂双药组成；经复评选择无病随访者不因未列化疗方案扣分。","未提及吞咽困难或营养不良时的营养支持（如管饲）或颈动脉出血防范","已选择含铂±免疫系统治疗却未说明相关毒性监测；未选择系统治疗者不适用此扣分。"]},"scoring_rules":{"item_scores":{"core_answer":[1.5,1.5,1.5,1.5],"key_evidence":[0.5,0.5,0.5,0.5],"conditional_modifiers":[0.5,0.5,0.5,0.5]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-ec2c60b6a79d3959598b44bc","case_id":"o1-case-b9899d9e2e42b3459a803bbe","patient_id":"o1-patient-25cd3d742f0b5069afe755b1","tag":"TX_GENERAL","question":"根据最新 CSCO 指南，结合当前资料，请制定该患者当前阶段的标准治疗策略，并注明主要指南依据、推荐等级及证据类别。","case_input":"【病情摘要】\n患者男，39岁。\n2020年12月开始出现症状，病程第552天、病程第562天、病程第596天-病程第638天、2021年7月、病程第819天、病程第826天。\n鼻咽癌放疗后6月，肝骨转移4月。\n2020年12月开始出现鼻塞伴右侧耳鸣。现患者神志清，精神可，无鼻塞头痛等颅神经症状，右耳前肿物、质软，无肝区疼痛等不适。\n病程第552天某医院就诊，查鼻咽镜考虑鼻咽癌，未活检。病程第562天某医院某医院。病程第819天某医院复查肝脏CT提示：肝内多发转移，最大4.7cm*6.4cm，腮腺MR:右侧腮腺周围肿物，不排除转移。\n病程第562天鼻咽部及颈部MR提示：鼻咽右侧壁、顶后壁增厚，右侧咽隐窝消失，局部肿块，2.1cm*1.9cm，侵犯右侧腭帆张肌、腭帆提肌、右侧翼内肌，右侧咽后、右侧II区多发淋巴结转移，最大2.5cm*2.0cm；查PETCT：鼻咽右侧壁、顶后壁增厚高代谢肿物，侵犯右侧椎前肌、腭帆张肌、腭帆提肌、右侧翼内肌，右侧咽后、右侧II区多发淋巴结转移。鼻咽镜活检提示：未分化型非角化性癌 EBER(+)。病程第702天MR:鼻咽局部肿物、颈部淋巴结基本消失；肝脏彩超提示：肝内多发占位；病程第702天PETCT：原鼻咽复查鼻咽部肿物、颈部淋巴结消失，肝内多发转移，最大S4段，直径1.7cm，左侧所骨头、右侧股骨上段，考虑骨转移；右侧腮腺考虑腮腺混合瘤。病程第705天肝内肿物穿刺活检：肝内为鼻咽癌转移。\n病程第0天、病程第17天在某医院分别行右肾结石取出术，右肾移植术，目前抗排斥治疗中。高血压病史6年，最高血压240/150mmHg，现口服拜新同，血压控制正常。\n母亲15年前患乳腺癌，至今存活。\n鼻咽癌（未分化型非角化性癌 EBER(+)），肝转移、骨转移。\n病程第596天-病程第638天行TOMO调强放疗：GTVnx 70.4Gy/32f、GTVnd 68.8Gy/32f、CTV1 64Gy/32f、CTV2 54Gy/32f，同期泰欣生 100mg qw*6次。2021年7月后患者出院在当地中医药治疗。\n为进一步治疗收入我院。\nT分期：T2\nN分期：N2","rubric_template_structured":{"total_score":10.0,"core_answer":["诊断：根治性放疗后远处转移（M1）/转移性鼻咽癌","总体策略：当前阶段以系统性全身抗肿瘤治疗为主，非再次根治性局部治疗","系统治疗：以GP等含铂双药为可接受方案；肾移植及持续抗排斥治疗背景下不强制联合PD-1，是否使用须经移植科与肿瘤科共同评估。","个体化策略：结合移植肾功能、免疫抑制药物及高血压调整化疗；如拟用PD-1，须评估排斥和移植物丢失风险，充分知情沟通。","指南依据：一般复发/转移性鼻咽癌可用GP联合具有相应证据的PD-1；本例允许因肾移植风险选择非ICI含铂双药，不将PD-1/PD-L1全类等同或列为必选。"],"key_evidence":["原发控制证据：2021年3–5月完成鼻咽及颈部根治性放疗，同期泰欣生，复查鼻咽原发灶及颈淋巴结基本消失","转移证据：肝内多发转移，最大约4.7cm×6.4cm，且肝穿刺证实鼻咽癌转移；同时存在骨转移。","治疗背景证据：既往完成根治放疗，同期泰欣生为尼妥珠单抗抗EGFR靶向治疗；不能据此视为既往接受过免疫检查点抑制剂。","合并疾病证据：右肾移植且长期抗排斥治疗，PD-1可能导致排斥及移植物丢失；选择GP等非ICI化疗并评估肾毒性和药物相互作用是合理路径。"],"conditional_modifiers":["肾功能受限时：评估减量、调整铂类或采用毒性更可控的非ICI化疗；PD-1不能作为因肾毒性调整的自动替代，须另行评估移植排斥风险。","寡转移残留时：一线系统治疗缓解良好且残留寡转移，可经MDT讨论加用局部巩固放疗等手段","随访监测：全程加强肾功能、高血压及免疫抑制剂与抗肿瘤药物相互作用监测，按毒性和耐受性动态调整方案"],"negative_list":{"major_errors":["将再次根治性放疗或手术等局部治疗作为当前转移性阶段的首选或主要治疗","未识别已为根治性放疗后远处转移阶段，按局限期鼻咽癌制定根治性同步放化疗或单纯局部方案","推荐与转移性鼻咽癌CSCO系统治疗路径不符的根治性局部方案为一线标准，而非以一线系统治疗为核心"],"minor_errors":["仅笼统写化疗或免疫治疗，未列GP等代表性系统方案；明确因移植风险选择非ICI含铂双药不扣分。","未结合肾移植、移植肾功能、免疫抑制药物及高血压作安全性评估；拟用PD-1却未讨论排斥和移植物丢失风险。","未说明所推荐一线方案为CSCO指南中具有较高推荐等级与证据级别的一线标准"]},"scoring_rules":{"item_scores":{"core_answer":[1.2,1.2,1.2,1.2,1.2],"key_evidence":[0.5,0.5,0.5,0.5],"conditional_modifiers":[0.67,0.67,0.66]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-e96f79c1025f2cd755dc96da","case_id":"o1-case-b9899d9e2e42b3459a803bbe","patient_id":"o1-patient-25cd3d742f0b5069afe755b1","tag":"TX_GENERAL","question":"根据最新 CSCO 指南，若按上述治疗策略进行治疗，请提供该患者的具体治疗方案及实施要点；如涉及系统治疗，请注明方案名称、药物组成、给药方式、频次及疗程；如涉及局部治疗，请注明主要干预手段。","case_input":"【病情摘要】\n患者男，39岁。\n2020年12月开始出现症状，病程第552天、病程第562天、病程第596天-病程第638天、2021年7月、病程第819天、病程第826天。\n鼻咽癌放疗后6月，肝骨转移4月。\n2020年12月开始出现鼻塞伴右侧耳鸣。现患者神志清，精神可，无鼻塞头痛等颅神经症状，右耳前肿物、质软，无肝区疼痛等不适。\n病程第552天某医院就诊，查鼻咽镜考虑鼻咽癌，未活检。病程第562天某医院某医院。病程第819天某医院复查肝脏CT提示：肝内多发转移，最大4.7cm*6.4cm，腮腺MR:右侧腮腺周围肿物，不排除转移。\n病程第562天鼻咽部及颈部MR提示：鼻咽右侧壁、顶后壁增厚，右侧咽隐窝消失，局部肿块，2.1cm*1.9cm，侵犯右侧腭帆张肌、腭帆提肌、右侧翼内肌，右侧咽后、右侧II区多发淋巴结转移，最大2.5cm*2.0cm；查PETCT：鼻咽右侧壁、顶后壁增厚高代谢肿物，侵犯右侧椎前肌、腭帆张肌、腭帆提肌、右侧翼内肌，右侧咽后、右侧II区多发淋巴结转移。鼻咽镜活检提示：未分化型非角化性癌 EBER(+)。病程第702天MR:鼻咽局部肿物、颈部淋巴结基本消失；肝脏彩超提示：肝内多发占位；病程第702天PETCT：原鼻咽复查鼻咽部肿物、颈部淋巴结消失，肝内多发转移，最大S4段，直径1.7cm，左侧所骨头、右侧股骨上段，考虑骨转移；右侧腮腺考虑腮腺混合瘤。病程第705天肝内肿物穿刺活检：肝内为鼻咽癌转移。\n病程第0天、病程第17天在某医院分别行右肾结石取出术，右肾移植术，目前抗排斥治疗中。高血压病史6年，最高血压240/150mmHg，现口服拜新同，血压控制正常。\n母亲15年前患乳腺癌，至今存活。\n鼻咽癌（未分化型非角化性癌 EBER(+)），肝转移、骨转移。\n病程第596天-病程第638天行TOMO调强放疗：GTVnx 70.4Gy/32f、GTVnd 68.8Gy/32f、CTV1 64Gy/32f、CTV2 54Gy/32f，同期泰欣生 100mg qw*6次。2021年7月后患者出院在当地中医药治疗。\n为进一步治疗收入我院。\nT分期：T2\nN分期：N2","rubric_template_structured":{"total_score":10.0,"core_answer":["总体策略：复发/转移性鼻咽癌以全身系统治疗为主，局部姑息为辅","系统治疗：采用GP等含铂双药；因移植排斥风险选择不联合ICI为可接受路径。PD-1仅在移植科与肿瘤科共同评估获益风险、充分知情后个体化考虑。","实施要点：静脉给药，约21天为1周期，共4–6周期后评估疗效与毒性","安全个体化：评估移植肾功能及抗排斥药物相互作用；如拟用ICI，须另行评估排斥和移植物丢失风险，充分知情沟通。","局部/支持治疗：骨改良药物+镇痛，必要时对肝/骨转移行姑息放疗"],"key_evidence":["疾病证据：鼻咽癌根治放疗后肝内多发转移及骨转移，属复发/转移性鼻咽癌，以系统治疗为主","系统治疗证据：复发/转移性鼻咽癌一线推荐含铂双药化疗，常用吉西他滨+顺铂（GP），可联合PD-1抑制剂提高疗效","给药证据：静脉输注含铂双药，常用21天1周期，完成约4–6周期后评估疗效和毒性决定后续","个体化证据：患者有右肾移植史并长期用抗排斥药物，需重点监测肾功能及免疫相关风险","局部姑息证据：骨转移可行姑息放疗、镇痛及骨改良药物以缓解疼痛和预防骨相关事件"],"conditional_modifiers":["免疫不宜时：因肾移植/免疫抑制或其他原因不能用PD-1时，可采用GP等含铂双药化疗并加强支持治疗","肾功能受限时：肾功能减退或不能耐受标准剂量顺铂时，考虑顺铂减量或改用卡铂并动态调整强度","维持治疗：化疗联合免疫结束且疾病控制良好、耐受可时，可继续PD-1单药维持至进展或不可耐受","毒性管理：系统治疗中如出现明显肾毒性、骨髓抑制或免疫相关不良反应，应及时减量、延迟、暂停或更换方案","骨转移高危时：骨转移致明显疼痛或病理骨折/脊髓压迫高危时，调整姑息放疗剂量分割并优化镇痛及骨改良药物"],"negative_list":{"major_errors":["将肝、骨远处转移的复发/转移性鼻咽癌按局限期处理，仅针对原发灶行根治放疗而不以系统治疗为主","完全不提系统抗肿瘤治疗，或以单纯中医药/保健等非证据手段为主要治疗路径","制定方案时忽视肾移植及长期抗排斥背景，对含铂肾毒性和免疫治疗排斥风险不作评估或调整","不良基础状况下推荐高毒性强化多药或大剂量含铂方案且无安全性考量"],"minor_errors":["仅写系统治疗而未给出代表性含铂双药名称及组成；因移植风险合理选择GP等非ICI方案，不因未联合PD-1扣分。","未说明静脉给药及按周期实施（如21天1周期、多周期后评估）的实施要点","未结合肾移植史及肾功能评估含铂化疗安全性并安排毒性监测；拟用PD-1时，未说明移植排斥风险评估和相应监测；明确选择非ICI方案者，不因未调整免疫治疗扣分。","未提及针对肝、骨转移相关疼痛或高危并发症的姑息放疗、镇痛及骨保护等局部和支持治疗"]},"scoring_rules":{"item_scores":{"core_answer":[1.2,1.2,1.2,1.2,1.2],"key_evidence":[0.4,0.4,0.4,0.4,0.4],"conditional_modifiers":[0.4,0.4,0.4,0.4,0.4]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-fd9658d4556bc2bee4f16521","case_id":"o1-case-0c46b58a16fc08d667822e64","patient_id":"o1-patient-aa26c0073e0795e7da3fd35c","tag":"TX_GENERAL","question":"根据最新 NCCN 指南，结合当前资料，请制定该患者当前阶段的标准治疗策略，并注明主要指南依据、推荐等级及证据类别。","case_input":"【病情摘要】\n患者男，58岁。\n病程第37天就诊。\n涕血1月余。\n1月前无明显诱因出现涕血，伴鼻塞、耳鸣，逐渐加重。\n病程第0天外院鼻咽活检病理示：鼻咽未分化型非角化性癌，未行治疗。\n乙肝小三阳病史。吸烟40年，1包/日。\n父亲肝癌，已过世。\nT分期：T4\nN分期：N1","rubric_template_structured":{"total_score":10.0,"core_answer":["疾病阶段/路径：初诊局部晚期鼻咽癌T4N1M0，治疗目标为根治。","总体策略：首选诱导化疗序贯同期全身治疗/放疗（放化疗），或优先参加临床试验。","替代策略：可用同期全身治疗/放疗序贯辅助化疗，或单独同期全身治疗/放疗（NCCN Category 2B）。","指南依据：NCCN将T4N0-3M0的诱导化疗+同期放化疗列为首选（Preferred）、Category 1 推荐。"],"key_evidence":["分期证据：病灶T4N1M0，按NCCN归入高危局部晚期鼻咽癌。","放化疗模式证据：NCCN对T4N0-3M0首选诱导化疗+同步全身治疗/放疗，以提高局部及远期控制和生存。","EBV证据：未分化型非角化癌提示EBV相关，NCCN建议检测血清/血浆EBV DNA用于预后评估和疗效监测。","合并症证据：乙肝小三阳需按NCCN进行HBV筛查和动态监测，吸烟40年需进行戒烟咨询（smoking cessation counseling）。"],"conditional_modifiers":["顺铂不耐受时：须依据肾功能、听力等选择合适替代药物或调整强度；选择CCRT±辅助等路径时仍需解决具体药物耐受，改变顺序不能替代这一评估。","有条件时：局部晚期高危患者在完成顺铂+放疗后可考虑卡培他滨辅助治疗（Useful in Certain Circumstances）。","资料不足时：治疗前应行MDT评估，包括放疗前牙科评估、营养支持及吞咽功能评估。"],"negative_list":{"major_errors":["未提出任何合理根治放化疗路径；有依据选择同期放化疗后辅助或单纯同期放化疗者，不属于未安排诱导的错误。","将单纯手术推荐为该患者局部首选根治治疗。","将不含放化疗的单药靶向/免疫姑息治疗作为首选标准方案。","忽略乙肝病史相关的抗病毒预防与监测需求。"],"minor_errors":["涉及NCCN推荐级别时，未说明所选诱导后同期、同期后辅助或单纯同期放化疗路径的证据依据。","未提及戒烟干预或EBV DNA检测的指南建议。","未指出标准方案不耐受时的可接受替代方案。"]},"scoring_rules":{"item_scores":{"core_answer":[1.5,1.5,1.5,1.5],"key_evidence":[0.5,0.5,0.5,0.5],"conditional_modifiers":[0.67,0.67,0.66]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-faa36b40144db7c02f33ede0","case_id":"o1-case-0c46b58a16fc08d667822e64","patient_id":"o1-patient-aa26c0073e0795e7da3fd35c","tag":"TX_GENERAL","question":"根据最新 NCCN 指南，若按上述治疗策略进行治疗，请提供该患者的具体治疗方案及实施要点；如涉及系统治疗，请注明方案名称、药物组成、给药方式、频次及疗程；如涉及局部治疗，请注明主要干预手段。","case_input":"【病情摘要】\n患者男，58岁。\n病程第37天就诊。\n涕血1月余。\n1月前无明显诱因出现涕血，伴鼻塞、耳鸣，逐渐加重。\n病程第0天外院鼻咽活检病理示：鼻咽未分化型非角化性癌，未行治疗。\n乙肝小三阳病史。吸烟40年，1包/日。\n父亲肝癌，已过世。\nT分期：T4\nN分期：N1","rubric_template_structured":{"total_score":10.0,"core_answer":["总体策略：以根治性放疗联合系统治疗为核心，首选诱导后同期放化疗；可按病情及耐受选择同期放化疗后辅助或单纯同期放化疗。","系统方案：诱导后同期路径可选GP或TPF诱导，并以顺铂或卡铂单药同期治疗；采用同期放化疗后辅助或单纯同期放化疗时，列明对应药物组成。","实施要点：按所选诱导后同期、同期后辅助或单纯同期放化疗路径，说明相应系统治疗周期。","局部治疗：采用IMRT为主的根治性放疗，原发灶及高危淋巴引流区剂量约70–70.2 Gy。","支持与管理：监测肝功能和骨髓抑制，抗乙肝病毒预防，戒烟干预及口腔/牙齿和黏膜炎护理。"],"key_evidence":["诱导化疗证据：EBV相关鼻咽癌GP和TPF为NCCN Preferred、Category 1诱导方案。","同步化疗证据：诱导后同步放化疗常用顺铂或卡铂单药，全程系统治疗与放疗联合。","放疗技术证据：IMRT为NCCN标准放疗技术，可降低危及器官剂量。","放疗剂量证据：NCCN推荐原发肿瘤及高危PTV根治剂量70–70.2 Gy（1.8–2.0 Gy/次）。","支持治疗证据：既往乙肝小三阳和长期吸烟史，需抗病毒和戒烟，以减少毒性叠加和病毒再激活。"],"conditional_modifiers":["诱导方案边界：不耐受TPF等高强度方案时，可用顺铂/5-FU或多西他赛/顺铂等NCCN 2B方案替代。","顺铂不耐受时：同期放化疗阶段可卡铂替代顺铂。","营养支持边界：若出现明显体重下降或吞咽困难，可预防性或反应性置入PEG等饲管。"],"negative_list":{"major_errors":["未提出以根治性放疗联合系统治疗为核心的合理路径，如仅用单药免疫根治；有依据采用同期放化疗或同期放化疗后辅助者，不因省略诱导而构成此错误。","局部治疗以手术切除为首选根治手段。","放疗未采用根治性技术/剂量或仅给低剂量姑息放疗。","忽略乙肝状态，无肝功能监测或抗病毒管理表述。"],"minor_errors":["已选择诱导化疗，却未列GP、TPF等合理方案；选择同期放化疗后辅助或单纯同期放化疗者不适用。","未明确需IMRT等精准放疗及高危区约70 Gy根治剂量目标。","支持治疗遗漏戒烟干预、口腔/牙齿或营养相关评估与护理要点。"]},"scoring_rules":{"item_scores":{"core_answer":[1.2,1.2,1.2,1.2,1.2],"key_evidence":[0.4,0.4,0.4,0.4,0.4],"conditional_modifiers":[0.67,0.67,0.66]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-a11cdc42b8533823b7e14bdc","case_id":"o1-case-16a5bb7442be740836122060","patient_id":"o1-patient-6357125f9d5c22b86205fcd6","tag":"TX_GENERAL","question":"根据最新 NCCN 指南，结合当前资料，请制定该患者当前阶段的标准治疗策略，并注明主要指南依据、推荐等级及证据类别。","case_input":"【病情摘要】\n患者男，49岁。\n2015年4月出现症状，病程第112天入院。\n鼻咽癌骨转移4程化疗后2周余。\n2015年4月因牙痛发现右侧颈前淋巴结肿大，口服“甲硝唑”后牙痛缓解，但淋巴结肿大未消退。2015年5月，出现右侧耳鸣，并逐渐出现右耳流液，呈淡黄色液体，量不多，伴鼻塞、涕血及颈前、耳后、锁骨上淋巴结肿大、压痛。\n病程第0天就诊于“某医院”行鼻咽镜活检示：（右侧鼻咽）未分化型非角化型癌。\n鼻咽及颈部MR诊断鼻咽癌伴颅底骨质破坏，双侧咽后、右侧腮腺、左颈I~III区、右颈I~V区淋巴结转移。PET-CT示考虑鼻咽癌，双侧咽后、右腮腺区及双颈多发淋巴结转移，全身多发骨转移，右乳突病灶侵犯临近脑膜，疑累及右侧耳道。我院病理会诊为未分化型非角化性癌。\n发现糖尿病史1年，口服“格列美脲、二甲双胍”降糖治疗，血糖控制可。16岁时患“急性肝炎”已治愈。2014年8月因“肛周脓肿”行手术治疗。\n吸烟30年，10支/天，已戒烟1月。\n内科分期cT4N3M1 IV期。\n病程第28天、病程第44天、病程第52天、病程第92天予DCF方案（多西他赛+DDP+5-Fu）化疗4程。1程化疗后发热1天，Tmax38.1℃,1、2、3程化疗期间及化疗后出现Ⅰ°腹泻，Ⅰ°恶心，均自行缓解。4程化疗后未出现明显不适。2程化疗后患者鼻塞症状明显缓解，涕血症状消失，右耳鸣较前好转，右耳流液症状消失，MR疗效评价PR。4程化疗后MR及PET疗效评价PR-confirm。\n现放疗计划已制定完毕并经全科讨论通过，今患者为行同期放化疗入院。\nT分期：T4\nN分期：N3","rubric_template_structured":{"total_score":10.0,"core_answer":["阶段定位：初诊转移性鼻咽癌（cT4N3M1/IV期），一线含铂诱导化疗（DCF×4）经确认的PR后阶段","总体策略：在诱导化疗获益基础上，行原发灶及区域淋巴结的放疗或顺铂同期放化疗（Cisplatin/RT）","治疗目标：提高局部区域控制率，延长生存并改善预后","指南依据：依据 NCCN 转移性鼻咽癌章节，诱导化疗后序贯 Cisplatin/RT 或局部根治性放疗（CR/接近CR者优先），推荐级别2A"],"key_evidence":["疾病与疗效证据：cT4N3M1鼻咽癌，已完成4程DCF含铂诱导化疗，MR及PET复查评估为PR-confirm（经确认的部分缓解）","当前治疗路径证据：已制定原发及颈部放疗并拟行同期放化疗，处于诱导化疗后巩固治疗阶段","指南依据：NCCN对T1–4N0–3M1鼻咽癌，诱导化疗后可选顺铂同期放疗或原发及区域淋巴结放疗；CR或接近CR时优先根治性局部放疗，默认2A类。"],"conditional_modifiers":["骨转移处理：NCCN建议对有指征的寡转移灶行放疗，多发骨转移结合部位和症状个体化考虑姑息RT","合并症管理：合并糖尿病者放化疗期间需监测血糖、营养及支持治疗","耐受性评估：已接受4程DCF三药，如有累积毒性或骨髓抑制，应评估同步化疗耐受性并适当减量或调整方案"],"negative_list":{"major_errors":["忽视已完成4程诱导化疗并达经确认的PR，主张当前阶段首选继续或更换全身一线化疗而非局部放（化）疗巩固","将M1期一概视为局部放疗禁忌，否定原发灶和颈部淋巴结的根治性或巩固性放疗"],"minor_errors":["未说明NCCN推荐级别为2A类","未明确放疗靶区应包括原发灶及颈部/区域淋巴结","未表述治疗目标为改善局控和延长生存","未提及根据毒性评估同步化疗耐受性或未关注糖尿病等合并症管理"]},"scoring_rules":{"item_scores":{"core_answer":[1.5,1.5,1.5,1.5],"key_evidence":[0.67,0.67,0.66],"conditional_modifiers":[0.67,0.67,0.66]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-569c5e5f6d80abb046224779","case_id":"o1-case-16a5bb7442be740836122060","patient_id":"o1-patient-6357125f9d5c22b86205fcd6","tag":"TX_GENERAL","question":"根据最新 NCCN 指南，若按上述治疗策略进行治疗，请提供该患者的具体治疗方案及实施要点；如涉及系统治疗，请注明方案名称、药物组成、给药方式、频次及疗程；如涉及局部治疗，请注明主要干预手段。","case_input":"【病情摘要】\n患者男，49岁。\n2015年4月出现症状，病程第112天入院。\n鼻咽癌骨转移4程化疗后2周余。\n2015年4月因牙痛发现右侧颈前淋巴结肿大，口服“甲硝唑”后牙痛缓解，但淋巴结肿大未消退。2015年5月，出现右侧耳鸣，并逐渐出现右耳流液，呈淡黄色液体，量不多，伴鼻塞、涕血及颈前、耳后、锁骨上淋巴结肿大、压痛。\n病程第0天就诊于“某医院”行鼻咽镜活检示：（右侧鼻咽）未分化型非角化型癌。\n鼻咽及颈部MR诊断鼻咽癌伴颅底骨质破坏，双侧咽后、右侧腮腺、左颈I~III区、右颈I~V区淋巴结转移。PET-CT示考虑鼻咽癌，双侧咽后、右腮腺区及双颈多发淋巴结转移，全身多发骨转移，右乳突病灶侵犯临近脑膜，疑累及右侧耳道。我院病理会诊为未分化型非角化性癌。\n发现糖尿病史1年，口服“格列美脲、二甲双胍”降糖治疗，血糖控制可。16岁时患“急性肝炎”已治愈。2014年8月因“肛周脓肿”行手术治疗。\n吸烟30年，10支/天，已戒烟1月。\n内科分期cT4N3M1 IV期。\n病程第28天、病程第44天、病程第52天、病程第92天予DCF方案（多西他赛+DDP+5-Fu）化疗4程。1程化疗后发热1天，Tmax38.1℃,1、2、3程化疗期间及化疗后出现Ⅰ°腹泻，Ⅰ°恶心，均自行缓解。4程化疗后未出现明显不适。2程化疗后患者鼻塞症状明显缓解，涕血症状消失，右耳鸣较前好转，右耳流液症状消失，MR疗效评价PR。4程化疗后MR及PET疗效评价PR-confirm。\n现放疗计划已制定完毕并经全科讨论通过，今患者为行同期放化疗入院。\nT分期：T4\nN分期：N3","rubric_template_structured":{"total_score":10.0,"core_answer":["局部治疗：原发灶及颈部淋巴结行 IMRT 根治放疗，高危靶区总剂量约 70-70.2 Gy","同期治疗：选择同期放化疗时可用顺铂，不耐受者评估替代；诱导化疗获益后，经MDT选择单纯局部根治放疗时，应说明省略同期化疗的依据。","给药要点：实施同期化疗者注明静脉途径及每周或每3周等节律；合理选择单RT者说明无需同步给药及相应监测安排亦可。","转移灶处理：对骨转移/寡转移病灶按指征给予姑息或巩固放疗","支持治疗：合并糖尿病等时强化营养和毒性管理，监测血糖、黏膜炎及骨髓抑制"],"key_evidence":["放疗证据：NCCN 推荐原发灶及颈部采用 IMRT，原发肿瘤及受累淋巴结高危区剂量 70-70.2 Gy（1.8-2.0 Gy/次）","同期化疗依据：NCCN鼻咽癌指南注明，诱导化疗后同期放化疗常用单药顺铂或卡铂，每周给药为常用方式，非多药联合。","安全性证据：既往 4 程含铂化疗仅轻度胃肠道反应，后续放化疗易加重黏膜炎和骨髓抑制，且合并糖尿病需个体化调整给药与监测"],"conditional_modifiers":["顺铂不耐受时：如因 4 程 DCF 累积毒性或体能下降不能耐受三周大剂量顺铂，可改为每周顺铂或换用卡铂","寡转移放疗：骨转移虽经系统化疗达 PR，仍可按 NCCN“RT to oligometastases as indicated”在有症状或高风险时行放疗","毒性管理：放疗中若出现重度黏膜炎、骨髓抑制或血糖失控，可减量或暂停同期化疗，并联合营养及内分泌团队干预"],"negative_list":{"major_errors":["将多药联合姑息全身方案（如 GP+PD-1）或 PF（5-FU+顺铂）误作诱导后同步放化疗 NCCN 标准方案","未明确原发灶及颈部行 IMRT 或高危区剂量未达根治剂量水平","忽略骨转移可能放疗干预，或忽视糖尿病等基础病及放化疗期支持治疗需求"],"minor_errors":["实际采用同期化疗却未说明给药方式或频次；选择合理单RT者不适用。","拟用同期顺铂却未讨论不耐受时调整；合理单RT分支不因未列铂类替代扣分。","遗漏点：未结合糖尿病及既往化疗史提出毒性监测和营养支持要点"]},"scoring_rules":{"item_scores":{"core_answer":[1.2,1.2,1.2,1.2,1.2],"key_evidence":[0.67,0.67,0.66],"conditional_modifiers":[0.67,0.67,0.66]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-3f6de29953f304fc82527f29","case_id":"o1-case-5de091dbe71cfe6aa05d85e0","patient_id":"o1-patient-84d21f7abfd995e1371c4263","tag":"TX_GENERAL","question":"根据最新 CSCO 指南，结合当前资料，请制定该患者当前阶段的标准治疗策略，并注明主要指南依据、推荐等级及证据类别。","case_input":"【病情摘要】\n患者男，47岁。\n病程第0天就诊，病程第64天入院。\n鼻咽癌综合治疗后。\n2月余前（病程第0天）因发现双侧颈部肿物1月余就诊。\n病程第0天某医院。胸CT示：双肺及纵隔CT未见异常；所示肝内多发低密度影，囊肿？鼻咽及颈部MR示：1、鼻咽周壁不规则增厚并软组织肿块形成，鼻咽癌？淋巴瘤？病变累积范围详见上述；颅底多发骨质破坏。2、双侧咽旁间隙及双侧颈部多发淋巴结肿大、融合。鼻咽部组织活检：（鼻咽部组织）考虑非角化性未分化型癌。临床分期T3N2M0 III期。\n病程第56天复查发现弥漫性肝转移及胸腰椎多发骨转移，双侧少量胸腔积液。\n既往体健。\n否认家族中有恶性肿瘤病史。\n临床分期T3N2M0 III期。\n病程第8天、病程第29天给予TP方案（白蛋白紫杉醇400mg+奈达铂100mg）诱导化疗2程。病程第34天开始给予鼻咽部及颈部引流区域放疗，适型调强，计划52Gy/22f，未完成，末次放疗病程第55天，共计完成19f放疗。\n患者疾病进展，为进一步诊治就诊。\nT分期：T3\nN分期：N2","rubric_template_structured":{"total_score":10.0,"core_answer":["总体策略：当前为转移性/IV期（M1）鼻咽癌，目标为姑息治疗，重在延长生存和改善症状","总体策略：以系统治疗为核心的综合治疗，而非再行根治性局部放疗或手术","总体策略：病情为极短期铂耐药/含铂方案失败阶段，不再首选含铂双药方案","总体策略：首选入组临床试验，或一线未用的单药化疗，或单药PD-1抑制剂为挽救治疗"],"key_evidence":["分期证据：复查示弥漫性肝转移、胸腰椎多发骨转移及双侧少量胸腔积液，提示远处转移，属转移性/IV期（M1）鼻咽癌","病程证据：初诊T3N2M0 III期，诱导TP化疗及放疗后不到2个月即多发转移，提示含铂方案难治/极短期铂耐药","既往方案证据：已接受含铂双药诱导化疗后迅速转移，不再适合继续含铂双药联合方案，应转入二线/挽救性姑息治疗","指南证据：CSCO鼻咽癌指南对一线含铂失败的转移性病例，Ⅰ级推荐未用的单药化疗或临床试验，PD-1单药为较高推荐等级。"],"conditional_modifiers":["资料不足时：若体能状态良好，优先考虑参加设计合理的临床试验以寻求更多获益","化疗选择：采用单药化疗时，优先选择一线未用且毒性较低药物，如卡培他滨、多西他赛或吉西他滨，对应CSCO高等级推荐及中高证据级别","免疫替代：化疗不耐受或拒绝化疗时，可选PD-1单药作为挽救治疗，对应CSCO较高推荐等级","局部治疗：针对多发骨转移等症状灶，可经多学科讨论联合骨改良药物及姑息放疗以缓解症状"],"negative_list":{"major_errors":["误判：在极短期铂耐药阶段仍以含铂双药（如吉西他滨+顺铂）联合或不联合免疫作为首选","误判：将根治性同期放化疗或局部区域放疗作为本阶段主要路径，而不是以系统治疗为核心","误判：将转移灶根治性手术或大剂量根治性放疗写为首选方案，替代系统姑息治疗"],"minor_errors":["遗漏：只写“化疗”或“免疫治疗”，未具体到二线单药化疗、PD-1单药或临床试验等标准路径","遗漏：未指出极短期铂耐药特点，未明确不宜继续含铂双药方案","遗漏：未说明依据CSCO指南的二线路径、推荐等级及证据类别"]},"scoring_rules":{"item_scores":{"core_answer":[1.5,1.5,1.5,1.5],"key_evidence":[0.5,0.5,0.5,0.5],"conditional_modifiers":[0.5,0.5,0.5,0.5]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-345bbcfc750af7b646d600c5","case_id":"o1-case-5de091dbe71cfe6aa05d85e0","patient_id":"o1-patient-84d21f7abfd995e1371c4263","tag":"TX_GENERAL","question":"根据最新 CSCO 指南，若按上述治疗策略进行治疗，请提供该患者的具体治疗方案及实施要点；如涉及系统治疗，请注明方案名称、药物组成、给药方式、频次及疗程；如涉及局部治疗，请注明主要干预手段。","case_input":"【病情摘要】\n患者男，47岁。\n病程第0天就诊，病程第64天入院。\n鼻咽癌综合治疗后。\n2月余前（病程第0天）因发现双侧颈部肿物1月余就诊。\n病程第0天某医院。胸CT示：双肺及纵隔CT未见异常；所示肝内多发低密度影，囊肿？鼻咽及颈部MR示：1、鼻咽周壁不规则增厚并软组织肿块形成，鼻咽癌？淋巴瘤？病变累积范围详见上述；颅底多发骨质破坏。2、双侧咽旁间隙及双侧颈部多发淋巴结肿大、融合。鼻咽部组织活检：（鼻咽部组织）考虑非角化性未分化型癌。临床分期T3N2M0 III期。\n病程第56天复查发现弥漫性肝转移及胸腰椎多发骨转移，双侧少量胸腔积液。\n既往体健。\n否认家族中有恶性肿瘤病史。\n临床分期T3N2M0 III期。\n病程第8天、病程第29天给予TP方案（白蛋白紫杉醇400mg+奈达铂100mg）诱导化疗2程。病程第34天开始给予鼻咽部及颈部引流区域放疗，适型调强，计划52Gy/22f，未完成，末次放疗病程第55天，共计完成19f放疗。\n患者疾病进展，为进一步诊治就诊。\nT分期：T3\nN分期：N2","rubric_template_structured":{"total_score":10.0,"core_answer":["总体策略：一线含铂失败后行二线/挽救性系统治疗，优先单药化疗或PD-1抑制剂单药/联合抗血管靶向药，鼓励进入临床试验","系统方案：可选卡培他滨/多西他赛/吉西他滨单药，或特瑞普利单抗/卡瑞利珠单抗等单药PD-1，或卡瑞利珠单抗+阿帕替尼等靶免联合","给药与疗程：按各药常规剂量和周期口服或静脉给药，治疗至疾病进展或出现不可耐受毒性","局部与支持治疗：对胸腰椎骨转移行骨改良药物和镇痛，对症时加用骨转移灶姑息放疗"],"key_evidence":["病程证据：诱导TP及鼻咽放疗后不到2个月出现弥漫肝转移及胸腰椎多发骨转移，属复发/转移性且铂耐药","指南证据：一线含铂失败的复发/转移性鼻咽癌，CSCO指南不推荐继续含铂双药，推荐未用过的单药化疗或PD-1抑制剂单药/联合抗血管靶向药","监测证据：二线单药化疗或靶免联合时需监测血常规、肝肾功能及免疫/靶向相关不良反应，定期评估疗效与毒性调整方案","骨转移证据：胸腰椎多发骨转移需评估骨相关事件风险，在系统治疗基础上应用骨改良药物，必要时局部姑息放疗"],"conditional_modifiers":["临床试验：无公认优选挽救方案且体能良好者，建议进入设计良好的临床试验","靶免风险：选择免疫联合抗血管生成药物时，需警惕既往放疗史相关的鼻咽坏死和出血等叠加风险","耐受性边界：既往治疗耐受差者，可优先选择毒性较低的口服氟尿嘧啶类（如卡培他滨）或PD-1单药","骨病灶处理边界：有骨痛或脊髓压迫风险时加强姑息放疗及骨保护，如无明显症状可系统治疗和骨改良药物为主"],"negative_list":{"major_errors":["误判：将再次根治性局部放疗或转移灶手术切除作为主导，而不以系统姑息治疗为主","误判：忽视铂难治特征，继续推荐含铂双药方案（如GP或重复TP）作为当前首选或主导系统方案","违指南原则：系统治疗推荐明显违背CSCO指南的一线含铂失败后二线原则，例如随意组合多药化疗"],"minor_errors":["表述不明：仅写“化疗”或“免疫治疗”，未点明二线单药化疗种类或具体PD-1单药/靶免联合方案","表述不全：未说明疗程规划，如未提及应持续至疾病进展或不可耐受毒性","遗漏：未提及对胸腰椎多发骨转移使用骨改良药物及必要的局部姑息治疗"]},"scoring_rules":{"item_scores":{"core_answer":[1.5,1.5,1.5,1.5],"key_evidence":[0.5,0.5,0.5,0.5],"conditional_modifiers":[0.5,0.5,0.5,0.5]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-21ef1232f4a6b7f2576fd1d3","case_id":"o1-case-34edfd1be6b98118c4c229f9","patient_id":"o1-patient-3cb0561d021b396d53e3375e","tag":"TX_GENERAL","question":"根据最新 CSCO 指南，结合当前资料，请制定该患者当前阶段的标准治疗策略，并注明主要指南依据、推荐等级及证据类别。","case_input":"【病情摘要】\n患者女，53岁。\n2014年5月出现症状，病程第291天入院。\n鼻咽癌放化疗后多发骨转移。\n2014年5月出现左耳耳鸣、听力下降，鼻炎发作时出现左侧颞部头痛。2014年9月出现左颈包块，大小约1.5cm，逐渐增大。2016年7月出现腰痛，后出现左颈部肿物。最近三月诉腰痛，程度轻。现腰部串电样疼痛，左大腿僵硬感，活动轻度受限。\n2015年3月某医院，查体示鼻咽部新生物，呈分叶状，欠光滑，表面可见脓性分泌物，双颈可触及肿大淋巴结。鼻咽MR示：鼻咽部占位，以左侧壁及后壁增厚为著，咽腔形态失常、变窄，左侧咽隐窝消失，右侧咽隐窝变窄，双侧咽旁间隙、颈动脉鞘周围、双侧颈部、颏下、双侧颌下多发大小不等淋巴结，最大者3.0cm。骨扫描未见明确转移。EBV-DNA 4900 copies/mL。鼻咽部肿物活检病理：考虑鼻咽癌（未分化型非角化性癌）。诊断为：鼻咽未分化型非角化性癌 cT2N2M0 III期。2015年4月于某医院行单药顺铂化疗1程。化疗第二日患者于抽血时出现晕厥，后续拒绝化疗。2015年5月行鼻咽部及颈部引流区淋巴结放疗。放疗后MR示鼻咽部治疗后改变，咽壁稍厚。多发小淋巴结。2016年10月：某医院PET/CT示：左颈部转移。左侧肱骨头、多发椎体、骶骨、双侧坐骨、双侧股骨转移。EBV-DNA 2.27*10E3 copies/mL。\n病程第143天我院CT：腰1椎体右份软组织灶较前明显增大，考虑PD。病程第190天我院胸部CT：左侧肱骨头、右侧部分肋骨、多个胸腰椎椎体及腰1椎弓根病变，考虑转移瘤，部分骨质较前致密，腰1椎体右份软组织灶较前缩小。病程第237天CT：双肺下叶类结节，考虑增殖灶。左侧腋窝肿大淋巴结，考虑转移可能性大。膈脚后、腹主动脉旁、下腔静脉后方数个淋巴结，较前稍增大。左侧肱骨头、右侧部分肋骨、多个胸腰椎椎体及腰1椎弓根病变，考虑转移瘤，腰1椎体右份织灶，较前变化不明显。鼻咽部MR：鼻咽部左侧壁及顶壁粘膜增厚，大致同前，考虑治疗后改变可能大。颅底骨质破坏，范围大致同前。左颈V区多发结节及斑片灶，考虑淋巴结转移复发，范围较前稍增大。\n鼻炎病史20年。\n哥哥患“膀胱癌”。\n鼻咽未分化型非角化性癌 cT2N2M0 III期。后出现多发骨转移。\n病程第0天、病程第21天、病程第43天、病程第62天给予4程GP方案化疗（吉西他滨+顺铂），并给予唑来膦酸治疗（末次病程第148天）。病程第149天、病程第173天、病程第195天、病程第217天、病程第244天行TC（紫杉醇+卡铂）化疗5程。\n为下一步治疗入院。\nT分期：T2\nN分期：N2","rubric_template_structured":{"total_score":10.0,"core_answer":["总体策略：患者为复发/转移性鼻咽癌，两线含铂化疗进展，进入三线及以上姑息系统治疗阶段","总体策略：以全身系统抗肿瘤治疗为主的姑息/综合治疗，不再以根治性再次放疗或大范围手术为主","系统治疗：三线及以上优选 PD-1 抑制剂单药作为标准后线免疫方案","系统治疗：可选前线未用过的卡培他滨、多西他赛等化疗单药作为后线备选方案；具体药物须核对既往暴露，已用GP中的吉西他滨不属于本例未用药物。"],"key_evidence":["病例证据：发生多发骨转移，先后接受 GP 与 TC 两线含铂化疗后影像学评估为 PD，进入三线及以上阶段","指南证据：CSCO 鼻咽癌指南将多线化疗后进展的复发/转移性患者纳入三线及以上系统治疗范畴","免疫证据：CSCO 指南指出 RM-NPC 三线及以上、既往未用免疫者，优选 PD-1 抑制剂单药","后线方案依据：CSCO指南将前线未用的卡培他滨、多西他赛单药列为三线及以上推荐，并建议适合者参加临床试验。","既往暴露依据：须核对既往用药；本例已用GP，吉西他滨不属于前线未用药物。"],"conditional_modifiers":["个体化调整：需结合全身状况、器官功能及不良反应调整药物种类和剂量，必要时减量或改用毒性更低单药，无法耐受时以最佳支持治疗为主","骨转移管理：如有骨痛或骨相关症状，应持续骨改良治疗（如双膦酸盐或地舒单抗），并评估姑息放疗缓解症状和预防骨相关事件","临床试验：在标准后线方案有限或疗效欠佳时，应评估条件并积极争取进入合适临床试验","局部治疗边界：如系统治疗后仍有局限性症状性病灶，可经 MDT 讨论选择局部姑息放疗等以进一步改善生活质量"],"negative_list":{"major_errors":["误判：未识别已为两线化疗后进展阶段，将一线或二线局限期治疗（如根治性放化疗）作为主要推荐","误判：错误地推荐已使用过的 GP、TC 等含铂联合化疗为当前首选或主要方案","误判：将根治性再次放疗或手术作为当前首选主要治疗，而忽视姑息系统治疗地位","遗漏：完全不提及三线及以上后线系统治疗或 PD-1 抑制剂单药路径"],"minor_errors":["表述笼统，如仅写“化疗”或“免疫治疗”，未具体说明优选 PD-1 抑制剂或前线未用的单药化疗","遗漏临床试验、骨改良治疗或最佳支持治疗等综合管理内容","未提当前阶段的主要目标为姑息和疾病控制，或未体现依据 CSCO 指南原则"]},"scoring_rules":{"item_scores":{"core_answer":[1.5,1.5,1.5,1.5],"key_evidence":[0.4,0.4,0.4,0.4,0.4],"conditional_modifiers":[0.5,0.5,0.5,0.5]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-96036b8392e2a2d6d5a01ecc","case_id":"o1-case-34edfd1be6b98118c4c229f9","patient_id":"o1-patient-3cb0561d021b396d53e3375e","tag":"TX_GENERAL","question":"根据最新 CSCO 指南，若按上述治疗策略进行治疗，请提供该患者的具体治疗方案及实施要点；如涉及系统治疗，请注明方案名称、药物组成、给药方式、频次及疗程；如涉及局部治疗，请注明主要干预手段。","case_input":"【病情摘要】\n患者女，53岁。\n2014年5月出现症状，病程第291天入院。\n鼻咽癌放化疗后多发骨转移。\n2014年5月出现左耳耳鸣、听力下降，鼻炎发作时出现左侧颞部头痛。2014年9月出现左颈包块，大小约1.5cm，逐渐增大。2016年7月出现腰痛，后出现左颈部肿物。最近三月诉腰痛，程度轻。现腰部串电样疼痛，左大腿僵硬感，活动轻度受限。\n2015年3月某医院，查体示鼻咽部新生物，呈分叶状，欠光滑，表面可见脓性分泌物，双颈可触及肿大淋巴结。鼻咽MR示：鼻咽部占位，以左侧壁及后壁增厚为著，咽腔形态失常、变窄，左侧咽隐窝消失，右侧咽隐窝变窄，双侧咽旁间隙、颈动脉鞘周围、双侧颈部、颏下、双侧颌下多发大小不等淋巴结，最大者3.0cm。骨扫描未见明确转移。EBV-DNA 4900 copies/mL。鼻咽部肿物活检病理：考虑鼻咽癌（未分化型非角化性癌）。诊断为：鼻咽未分化型非角化性癌 cT2N2M0 III期。2015年4月于某医院行单药顺铂化疗1程。化疗第二日患者于抽血时出现晕厥，后续拒绝化疗。2015年5月行鼻咽部及颈部引流区淋巴结放疗。放疗后MR示鼻咽部治疗后改变，咽壁稍厚。多发小淋巴结。2016年10月：某医院PET/CT示：左颈部转移。左侧肱骨头、多发椎体、骶骨、双侧坐骨、双侧股骨转移。EBV-DNA 2.27*10E3 copies/mL。\n病程第143天我院CT：腰1椎体右份软组织灶较前明显增大，考虑PD。病程第190天我院胸部CT：左侧肱骨头、右侧部分肋骨、多个胸腰椎椎体及腰1椎弓根病变，考虑转移瘤，部分骨质较前致密，腰1椎体右份软组织灶较前缩小。病程第237天CT：双肺下叶类结节，考虑增殖灶。左侧腋窝肿大淋巴结，考虑转移可能性大。膈脚后、腹主动脉旁、下腔静脉后方数个淋巴结，较前稍增大。左侧肱骨头、右侧部分肋骨、多个胸腰椎椎体及腰1椎弓根病变，考虑转移瘤，腰1椎体右份织灶，较前变化不明显。鼻咽部MR：鼻咽部左侧壁及顶壁粘膜增厚，大致同前，考虑治疗后改变可能大。颅底骨质破坏，范围大致同前。左颈V区多发结节及斑片灶，考虑淋巴结转移复发，范围较前稍增大。\n鼻炎病史20年。\n哥哥患“膀胱癌”。\n鼻咽未分化型非角化性癌 cT2N2M0 III期。后出现多发骨转移。\n病程第0天、病程第21天、病程第43天、病程第62天给予4程GP方案化疗（吉西他滨+顺铂），并给予唑来膦酸治疗（末次病程第148天）。病程第149天、病程第173天、病程第195天、病程第217天、病程第244天行TC（紫杉醇+卡铂）化疗5程。\n为下一步治疗入院。\nT分期：T2\nN分期：N2","rubric_template_structured":{"total_score":10.0,"core_answer":["总体策略：进入三线及以上姑息系统治疗阶段，以系统治疗为主","系统治疗：优选PD-1单抗单药方案，备选前线未用的化疗单药（如卡培他滨、多西他赛）；具体药物须核对既往暴露，已用GP中的吉西他滨不属于本例未用药物。","给药实施：按所选单药标准剂量和周期规律给药，静脉或口服，周期性重复","疗程原则：在疗效与耐受允许时持续用药，直至疾病进展或出现不可接受毒性","骨病管理：常规使用骨改良药物和镇痛，必要时对症或高危骨转移灶行局部姑息放疗"],"key_evidence":["阶段证据：先出现多发骨转移，后接受GP及TC两线含铂化疗；其后影像进展，进入多线失败后的治疗阶段。","免疫证据：CSCO鼻咽癌指南推荐RM-NPC三线及以上且未用免疫者，优选PD-1单抗单药作为后线方案","化疗证据：CSCO指南将前线未使用的卡培他滨、多西他赛单药列为三线及以上备选系统治疗；具体药物须核对既往暴露，已用GP中的吉西他滨不属于本例未用药物。","骨转移证据：多发骨转移伴疼痛等症状时，应在系统治疗基础上联合骨改良药物和姑息放疗以改善生活质量"],"conditional_modifiers":["体能边界：体能差或重要脏器功能受限者，可减量或延长给药间隔，必要时以最佳支持治疗为主","疗程延续：若疗效稳定且耐受良好，应维持原PD-1单药或化疗单药至进展或不可耐受","方案调整：若疗效欠佳或毒性大，应更换其他单药方案、考虑临床试验或转为最佳支持治疗","放疗边界：骨痛明显、活动受限或有病理骨折、脊髓压迫高危时，姑息放疗为必需措施；症状轻微时为可选","临床试验：多线治疗失败患者宜积极参加后线新药临床试验以争取额外获益"],"negative_list":{"major_errors":["误判治疗阶段为一线/二线，或再次推荐已耐药的含铂双药化疗为首选","将给药和疗程描述为短期固定疗程后停药，未体现持续至进展或不可耐受的原则","列举根治性同步放化疗或大范围手术为首选而否认姑息性系统治疗为主","忽略骨改良药物、镇痛或姑息放疗等重要骨转移症状控制措施"],"minor_errors":["仅泛写“后线化疗”或“免疫治疗”，未明确列出代表性PD-1单抗或具体化疗单药名称","未说明给药途径和周期，仅笼统表述系统用药，无静脉/口服及间隔信息","未提及根据体能状态和既往耐受性调整剂量或疗程的个体化原则","未明确骨改良药物的持续使用，或未说明姑息放疗在骨转移管理中的应用"]},"scoring_rules":{"item_scores":{"core_answer":[1.2,1.2,1.2,1.2,1.2],"key_evidence":[0.5,0.5,0.5,0.5],"conditional_modifiers":[0.4,0.4,0.4,0.4,0.4]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-9a90b57c045d4d5f1ff3dd9b","case_id":"o1-case-0c8821380907d3df3b2b7b65","patient_id":"o1-patient-ff75099558763d882fdc28a8","tag":"TX_GENERAL","question":"根据最新 NCCN 指南，结合当前资料，请制定该患者当前阶段的标准治疗策略，并注明主要指南依据、推荐等级及证据类别。","case_input":"【病情摘要】\n患者男，60岁。\n2011年5月诊断，病程第2388天入院。\n鼻咽癌综合治疗后进展。\n近3月仍诉手足麻木轻度，听力下降及偶有鼻塞浓涕。\n2011年5月诊断鼻咽癌低分化鳞癌T4N3M0 IVA期（2008中国分期）。病程第1675天复查胸部+腹部CT：右肺中叶病灶，考虑鼻咽癌肺转移瘤可能性大；双肺多发类结节灶，纵隔及右侧肺门肿大淋巴结，考虑转移瘤；肝S3/4、6低密度灶，考虑转移瘤。病程第1675天鼻咽+颈部MRI：鼻咽腔未见明确肿物。病程第1688天PET/CT：T7及胸骨柄骨质致密代谢活跃，考虑转移。病程第1694天肝穿刺活检病理：肝穿刺组织中见恶性肿瘤，考虑为分化差的癌。病程第1702天查EBV-DNA：2.52×105copy/mL。\n既往体健。\n否认家族中有恶性肿瘤病史。\n2011年5月诊断鼻咽癌低分化鳞癌T4N3M0 IVA期（2008中国分期）。2016年考虑鼻咽癌综合治疗后肝、肺、骨转移。\n病程第0天行TP方案化疗1程。病程第10天开始放疗，鼻咽68GY/30F，颈部淋巴结66GY/30F，同期DDP100mg/m2化疗2程。一线治疗于病程第1704天、4-16、5-17、06-09、07-01、7-23行GP（吉西他滨+顺铂）方案化疗6程。二线治疗于病程第1933天、病程第1947天、病程第1961天、病程第1975天、病程第1990天、病程第2003天、病程第2030天给予Nivolumab 240mg/次方案治疗7程。三线治疗于病程第2044天、病程第2064天、病程第2093天、病程第2119天行多西他赛4程化疗。于病程第2212天给予PI3K-AKT靶向药物ACC006 0.2g治疗1程。于病程第2308天、12-07、病程第2352天分别行3程吉西他滨单药化疗，末次化疗时间病程第2359天。\nT分期：T4\nN分期：N3","rubric_template_structured":{"total_score":10.0,"core_answer":["总体策略：多线系统治疗失败的复发/转移性鼻咽癌，以延缓进展、缓解症状和改善生活质量为目标","系统治疗：评估是否有合适的临床试验；是否继续抗肿瘤治疗，应结合既往治疗、体能状态及耐受性决定，也可选择最佳支持治疗。","支持与局治：全程实施最佳支持治疗，按症状及临床指征对骨转移等病灶考虑姑息放疗。","指南依据：依据 NCCN 复发/转移性鼻咽癌“Clinical trial preferred”及最佳支持治疗/姑息放疗推荐，多为 Category 2A"],"key_evidence":["疾病证据：鼻咽癌复发并累及肝、肺、骨等多器官远处转移，为极晚期复发/转移性阶段","治疗史证据：既往含铂双药、PD-1单抗、紫杉类、吉西他滨等≥5线系统治疗失败，多线难治","临床试验适用：可评估合适的临床研究，但不得据现有治疗史推定已入组或必然符合某项研究。","姑息放疗证据：存在明确骨转移灶，NCCN 建议按临床指征考虑姑息放疗并实施最佳支持治疗"],"conditional_modifiers":["试验边界：临床试验需在知情同意、符合入组标准且体能状态允许前提下，严格按方案执行","后线选择：依据体能、器官功能、既往用药和毒性，可评估未使用的后线单药（如卡培他滨）或以最佳支持治疗为主。","最佳支持：需系统实施镇痛、营养等最佳支持治疗，不因入组新药试验而弱化其地位"],"negative_list":{"major_errors":["忽视多线失败史，继续推荐一线含铂双药联合免疫等前线方案","未结合既往治疗及耐受性说明后线治疗、合适临床试验评估或支持治疗的选择依据；不因未指定某项试验或未承诺入组扣分。","将大范围根治性手术或根治性放疗作为主要治疗路径"],"minor_errors":["仅笼统写全身系统治疗，未说明多线治疗后的处理方向及评估依据；不因未选择临床试验扣分。","未提最佳支持治疗或骨转移姑息放疗作为整体策略的重要组成部分"]},"scoring_rules":{"item_scores":{"core_answer":[1.5,1.5,1.5,1.5],"key_evidence":[0.5,0.5,0.5,0.5],"conditional_modifiers":[0.67,0.67,0.66]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-753701764cbc2f1842cd9ce9","case_id":"o1-case-0c8821380907d3df3b2b7b65","patient_id":"o1-patient-ff75099558763d882fdc28a8","tag":"TX_GENERAL","question":"根据最新 NCCN 指南，若按上述治疗策略进行治疗，请提供该患者的具体治疗方案及实施要点；如涉及系统治疗，请注明方案名称、药物组成、给药方式、频次及疗程；如涉及局部治疗，请注明主要干预手段。","case_input":"【病情摘要】\n患者男，60岁。\n2011年5月诊断，病程第2388天入院。\n鼻咽癌综合治疗后进展。\n近3月仍诉手足麻木轻度，听力下降及偶有鼻塞浓涕。\n2011年5月诊断鼻咽癌低分化鳞癌T4N3M0 IVA期（2008中国分期）。病程第1675天复查胸部+腹部CT：右肺中叶病灶，考虑鼻咽癌肺转移瘤可能性大；双肺多发类结节灶，纵隔及右侧肺门肿大淋巴结，考虑转移瘤；肝S3/4、6低密度灶，考虑转移瘤。病程第1675天鼻咽+颈部MRI：鼻咽腔未见明确肿物。病程第1688天PET/CT：T7及胸骨柄骨质致密代谢活跃，考虑转移。病程第1694天肝穿刺活检病理：肝穿刺组织中见恶性肿瘤，考虑为分化差的癌。病程第1702天查EBV-DNA：2.52×105copy/mL。\n既往体健。\n否认家族中有恶性肿瘤病史。\n2011年5月诊断鼻咽癌低分化鳞癌T4N3M0 IVA期（2008中国分期）。2016年考虑鼻咽癌综合治疗后肝、肺、骨转移。\n病程第0天行TP方案化疗1程。病程第10天开始放疗，鼻咽68GY/30F，颈部淋巴结66GY/30F，同期DDP100mg/m2化疗2程。一线治疗于病程第1704天、4-16、5-17、06-09、07-01、7-23行GP（吉西他滨+顺铂）方案化疗6程。二线治疗于病程第1933天、病程第1947天、病程第1961天、病程第1975天、病程第1990天、病程第2003天、病程第2030天给予Nivolumab 240mg/次方案治疗7程。三线治疗于病程第2044天、病程第2064天、病程第2093天、病程第2119天行多西他赛4程化疗。于病程第2212天给予PI3K-AKT靶向药物ACC006 0.2g治疗1程。于病程第2308天、12-07、病程第2352天分别行3程吉西他滨单药化疗，末次化疗时间病程第2359天。\nT分期：T4\nN分期：N3","rubric_template_structured":{"total_score":10.0,"core_answer":["总体策略：结合多线治疗史、体能及耐受性，评估合适临床试验、未使用的后线治疗或最佳支持治疗，并按症状决定是否需要局部姑息干预。","系统治疗实施：如选择后线单药，列明与既往用药及耐受性相匹配的药物、给药方式、频次及疗程，卡培他滨可作为未用药物的评估选项；选择最佳支持治疗时不强制系统处方，临床试验仅作可评估选择，不要求未知研究用药方案。","局部治疗：对T7及胸骨柄等骨转移病灶按需给予姑息性放疗以控制疼痛等局部症状","支持治疗：全程实施最佳支持治疗，包括骨改良药物、规范镇痛及营养管理"],"key_evidence":["决策依据：既往多线治疗及现有毒性提示后续应评估体能、器官功能、治疗目标和未用药物选择，不能直接套用某个试验方案。","指南证据：NCCN 指南对多线治疗后伴远处转移患者标注“Clinical trial preferred”作为首选路径","放疗证据：NCCN 指南对伴骨转移等症状性病灶建议“Consider palliative RT as clinically indicated”","支持证据：NCCN 指南指出极晚期多线难治头颈/鼻咽肿瘤全程需配合最佳支持治疗（Best supportive care）"],"conditional_modifiers":["路径边界：评估临床试验仅表示可考虑该方向，不预设已经入组或可直接使用某项研究药物；后线治疗应与既往治疗和耐受性相匹配。","毒性处理：如后续系统治疗出现不可耐受不良反应，应按所选药物及严重程度调整、延迟或停用，并监测疗效和毒性。","后线与支持：结合体能状态、器官功能、既往毒性及患者意愿，选择未用单药或最佳支持治疗，并按指征考虑姑息放疗；未提供PS评估时，不将体能状态当作已知。","放疗边界：姑息放疗前需结合既往多靶区放疗史，评估OARs累积剂量与耐受限值"],"negative_list":{"major_errors":["将根治性放疗或手术作为多器官远处转移患者的首要或主导治疗而非系统治疗为主","再次推荐已在前线或二线失败的含铂化疗或纳武利尤单抗等标准方案作为当前主要系统治疗","无相应指南依据或适应证，即把研究性药物作为本例必须采用的常规治疗，或将未提供的试验用药方案写成已知。"],"minor_errors":["选择系统治疗后未说明给药安排及疗效、毒性监测；不因未列某项试验药物的剂量、周期或选择最佳支持治疗扣分。","未提到对骨转移等症状性病灶考虑姑息性放疗","未提到镇痛、骨保护等最佳支持治疗措施"]},"scoring_rules":{"item_scores":{"core_answer":[1.5,1.5,1.5,1.5],"key_evidence":[0.5,0.5,0.5,0.5],"conditional_modifiers":[0.5,0.5,0.5,0.5]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-62d62e376e33f567361112ac","case_id":"o1-case-181c390f3d772a33d2340565","patient_id":"o1-patient-74d8d4e43565d0415e807e44","tag":"TX_GENERAL","question":"根据最新 CSCO 指南，结合当前资料，请制定该患者当前阶段的标准治疗策略，并注明主要指南依据、推荐等级及证据类别。","case_input":"【病情摘要】\n患者女，21岁。\n2021年11月起出现症状，病程第479天入院。\n鼻咽癌综合治疗1年余，复发4月余。\n2021年11月起无明显诱因出现间歇性鼻血伴头痛，左侧耳听力下降。2023年3月起出现持续左耳耳鸣。自起病以来，患者诉持续左耳耳鸣，左耳闷塞感，无听力下降。\n2023年3月某医院，提示鼻咽占位病变。某医院行鼻咽活检，病理示鼻咽未分化非角化性癌。某医院，确诊为鼻咽未分化非角化性癌T4N2M0，IVa期。2024年3月某医院，病程第373天于全麻下行“机器人腔镜辅助下经口左侧咽后颅底肿物切除术”，术后病理未见。\n病程第347天MRI复查发现左侧咽后淋巴结较前增大，考虑咽后淋巴结复发。病程第437天鼻咽及颈部MR：鼻咽壁稍增厚，考虑治疗后改变可能；左侧咽旁、咽后软组织灶，考虑活性灶可能，与咽后淋巴结分界不清。颅底骨质破坏。\n既往体健。\n祖父曾患食管癌，已去世。\n2023年3月确诊为鼻咽未分化非角化性癌T4N2M0，IVa期。\n病程第0天、病程第21天予以吉西他滨+顺铂诱导化疗2程。病程第41天开始行IMRT放疗，鼻咽原发病灶+咽后淋巴结70Gy/35次，颈部转移淋巴结66Gy/35次，鼻咽亚临床病灶及上颈部淋巴引流区60Gy/35次，下颈部淋巴结引流区54Gy/35次。放疗期间分别于病程第40天、病程第70天予以顺铂41mg，D1-D3天同步化疗2程。放化疗结束后，于病程第123天至病程第276天予卡培他滨口服化疗维持治疗，因手足综合征停药。\n为进一步诊治就诊我院。\nT分期：T4\nN分期：N2","rubric_template_structured":{"total_score":10.0,"core_answer":["疾病阶段：根治放化疗后局部/区域疑复发；先复评活动性病灶及挽救资格，具备条件者以局部根治挽救为目标。","总体策略：适宜局部根治挽救者优先讨论手术或再放疗；不具备条件者转系统治疗及支持治疗。","指南依据：CSCO 鼻咽癌复发章节，推荐具局部治疗条件者行根治性局部挽救治疗，并注明对应推荐等级及证据类别。"],"key_evidence":["既往治疗依据：既往T4N2M0 IVA期鼻咽未分化非角化癌，已行诱导化疗、同期放化疗及口服化疗维持。","当前病灶依据：约4个月后MRI见左咽旁、咽后软组织灶及颅底骨质破坏；现有材料无远处转移证据。","复发部位证据：病灶位于咽旁/咽后及颅底区域，与咽后淋巴结分界不清，符合局部/区域复发特征，未见远处器官转移描述。","既往治疗背景证据：原发及咽后淋巴结曾接受约70 Gy 根治剂量放疗并同步化疗，需在高剂量放疗基础上评估再程放疗及外科切除可行性。","局部挽救依据：CSCO指南建议，无远处转移且具备局部治疗条件的局部/区域复发鼻咽癌，优先挽救手术或再程放疗；不具备局部挽救条件时，以姑息性系统治疗为主。"],"conditional_modifiers":["手术/再放疗边界：病灶局限、解剖位置允许且全身状况良好时，可优先考虑挽救性手术或再程放疗，并在随访中根据疗效和毒性个体化考虑巩固/辅助治疗。","局部挽救不适宜时：病变广泛、与颅底重要结构关系密切、既往放疗限制或手术风险高，或全身状况及意愿不允许时，可选择姑息性系统治疗（化疗±免疫）及最佳支持治疗。","挽救风险评估：综合既往放疗剂量分布、颅底骨破坏、病灶与重要血管神经关系、年龄及器官功能制定方案。","局部方案评估：必要时经MDT评估手术路径或IMRT、质子、立体定向再照射等技术，平衡疗效与毒性。"],"negative_list":{"major_errors":["将当前局部/区域复发阶段误按远处转移或初治局部晚期路径处理，未识别为根治放化疗后复发。","不评估当前病灶及局部挽救机会就一概选择姑息治疗；经评估不适宜局部挽救者可接受系统或支持治疗。","提出缺乏权威指南支撑的探索性或单纯姑息方案作为标准策略，未依据 CSCO 复发部分推荐。"],"minor_errors":["未明确提出挽救性手术或再程放疗为局部挽救治疗主要方式，仅笼统表述“进一步治疗”或“综合治疗”。","未指出不适合局部挽救时应转为以姑息性系统治疗为主，导致治疗路径不完整。","未注明参考 CSCO 鼻咽癌复发章节的推荐等级及证据类别，仅给出经验性建议。"]},"scoring_rules":{"item_scores":{"core_answer":[2.0,2.0,2.0],"key_evidence":[0.4,0.4,0.4,0.4,0.4],"conditional_modifiers":[0.5,0.5,0.5,0.5]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-354283b6aeff48299dbb2264","case_id":"o1-case-181c390f3d772a33d2340565","patient_id":"o1-patient-74d8d4e43565d0415e807e44","tag":"TX_GENERAL","question":"根据最新 CSCO 指南，若按上述治疗策略进行治疗，请提供该患者的具体治疗方案及实施要点；如涉及系统治疗，请注明方案名称、药物组成、给药方式、频次及疗程；如涉及局部治疗，请注明主要干预手段。","case_input":"【病情摘要】\n患者女，21岁。\n2021年11月起出现症状，病程第479天入院。\n鼻咽癌综合治疗1年余，复发4月余。\n2021年11月起无明显诱因出现间歇性鼻血伴头痛，左侧耳听力下降。2023年3月起出现持续左耳耳鸣。自起病以来，患者诉持续左耳耳鸣，左耳闷塞感，无听力下降。\n2023年3月某医院，提示鼻咽占位病变。某医院行鼻咽活检，病理示鼻咽未分化非角化性癌。某医院，确诊为鼻咽未分化非角化性癌T4N2M0，IVa期。2024年3月某医院，病程第373天于全麻下行“机器人腔镜辅助下经口左侧咽后颅底肿物切除术”，术后病理未见。\n病程第347天MRI复查发现左侧咽后淋巴结较前增大，考虑咽后淋巴结复发。病程第437天鼻咽及颈部MR：鼻咽壁稍增厚，考虑治疗后改变可能；左侧咽旁、咽后软组织灶，考虑活性灶可能，与咽后淋巴结分界不清。颅底骨质破坏。\n既往体健。\n祖父曾患食管癌，已去世。\n2023年3月确诊为鼻咽未分化非角化性癌T4N2M0，IVa期。\n病程第0天、病程第21天予以吉西他滨+顺铂诱导化疗2程。病程第41天开始行IMRT放疗，鼻咽原发病灶+咽后淋巴结70Gy/35次，颈部转移淋巴结66Gy/35次，鼻咽亚临床病灶及上颈部淋巴引流区60Gy/35次，下颈部淋巴结引流区54Gy/35次。放疗期间分别于病程第40天、病程第70天予以顺铂41mg，D1-D3天同步化疗2程。放化疗结束后，于病程第123天至病程第276天予卡培他滨口服化疗维持治疗，因手足综合征停药。\n为进一步诊治就诊我院。\nT分期：T4\nN分期：N2","rubric_template_structured":{"total_score":10.0,"core_answer":["总体策略：先复评活动性病灶及手术、再放疗挽救资格；适宜局部根治挽救者可优先局部治疗，不适宜者以系统治疗及支持治疗为主。","具体方案：不适宜局部根治、需系统治疗且既往疗效、毒性及当前耐受允许时，可用GP（吉西他滨＋顺铂）联合特瑞普利单抗、卡瑞利珠单抗或替雷利珠单抗；免疫不宜者可选GP。采用局部挽救时，列明手术或精确再放疗。","实施要点：选择系统治疗时说明给药方式、周期及疗程；选择局部挽救时说明该方案的风险控制，不要求系统治疗处方。","后续管理：实际联合免疫且疾病控制、耐受允许者，可按相应方案考虑免疫维持；采用局部挽救或非ICI路径者，安排对应随访及疗效评估。","局部及支持：具备条件时优先实施局部挽救；先行系统治疗者可于疗效评估后再讨论局部整合，均需营养、镇痛及并发症管理。"],"key_evidence":["既往治疗依据：鼻咽未分化非角化癌T4N2M0 IVA期，已行GP诱导、根治放疗、同期化疗及卡培他滨维持。","当前病灶依据：MRI见左咽旁、咽后疑活性灶及颅底骨破坏；活动性残留或复发需复评，不能仅据骨破坏确证活动性颅底复发。","推荐依据：CSCO鼻咽癌指南2026版将GP联合特瑞普利单抗、卡瑞利珠单抗或替雷利珠单抗，以及GP化疗，列为复发/转移鼻咽癌一线Ⅰ级推荐、1A类证据。","适用性依据：不适宜局部根治且具备给药条件者可选系统治疗；适合局部根治挽救者，不因存在系统治疗推荐而排除局部治疗。","疗程证据：免疫联合含铂化疗常规给4–6周期，治疗中需定期评估疗效与毒性，继续后续方案","局部证据：既往高剂量放疗及颅底病灶提示再治疗风险，须MDT评估手术及再放疗；风险需个体化，不能由此直接推定仅可系统治疗。","支持治疗证据：复发伴随症状时，同步提供止痛、营养、感染防治等支持措施，提高耐受和生活质量"],"conditional_modifiers":["免疫禁忌时：如因自身免疫病、严重的不良反应或经济因素不能用免疫药物时，可采用含铂双药化疗4–6周期，并加强支持治疗和随访","化疗方案调整：若既往吉西他滨顺铂方案累积毒性较大或疑吉西他滨耐药，可调整为其他含铂双药，条件允许时仍优先联合免疫药物","手术评估：活动性病灶及可切除性确认后，可直接选择挽救手术；如先系统治疗后缩小，也可重新评估，不固定为仅减瘤或姑息。","再程放疗原则：如考虑再程放疗，需回顾以往放疗剂量并评估危及器官耐受，采用IMRT/VMAT/质子等高精度技术，严格控制累积剂量和分割强度","免疫维持调整：如实际使用PD-1，按具体药物说明书和irAE级别决定暂缓或停用，不按细胞毒化疗方式常规减量。"],"negative_list":{"major_errors":["选定系统治疗却无视既往GP暴露、疗效、毒性及免疫适用性而机械重复；合理局部挽救或免疫不宜的非ICI方案不据此扣分。","选择周期性系统治疗时仅给单次或明显不完整疗程且无合理解释；局部挽救分支不适用此扣分。","未经MDT、既往剂量及危及器官评估直接开再放疗；经评估可行的局部挽救不因先于系统治疗扣分。"],"minor_errors":["选择系统治疗，却未列药物组成和疗程；采用局部挽救路径时，此系统用药要求不适用。","未提及高剂量放疗后再程放疗需严格风险控制，将其视为与初次放疗相同的常规处置","未说明所选路径的疗程和疗效/毒性评估；未实际使用免疫者不要求免疫维持。"]},"scoring_rules":{"item_scores":{"core_answer":[1.2,1.2,1.2,1.2,1.2],"key_evidence":[0.29,0.29,0.29,0.29,0.28,0.28,0.28],"conditional_modifiers":[0.4,0.4,0.4,0.4,0.4]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-dadf84d8b6d6aa78459ba052","case_id":"o1-case-b852c4d7b2034f4dffc0a35f","patient_id":"o1-patient-e4ac6ecd2c67aed4fc68e718","tag":"TX_GENERAL","question":"根据最新 CSCO 指南，结合当前资料，请制定该患者当前阶段的标准治疗策略，并注明主要指南依据、推荐等级及证据类别。","case_input":"【病情摘要】\n患者男，48岁。\n病程第34天入院。\n鼻咽癌外院放疗后70个月，鼻咽复发7月。\n目前诉有右耳闷，偶有左侧前胸壁疼痛，精神佳，睡眠不佳，食欲可，大小便正常，体重无减轻。\n2018年10月某医院确诊为鼻咽低分化鳞癌伴左颈多发淋巴结转移，行放疗及TP化疗多疗程，放疗结束时间2019年1月，末次化疗时间2019年5月。 2019年11月发现右颈淋巴结复发行切除活检术，术后行化疗6周期（具体方案不详）。 2024年3月全身PET-CT显示鼻咽顶壁不规则增厚考虑为复发，伴纵隔淋巴结转移可能，其后行化疗联合免疫治疗4周期（GP+卡瑞利珠单抗），后因肌钙蛋白（0.089ng/ml）升高停药免疫治疗，后继续2程化疗（GP）。 病程第0天在某医院行介入治疗，具体为左侧上颌动脉栓塞术、双侧支气管动脉造影+灌注术。\n2024年3月全身PET-CT显示鼻咽顶壁不规则增厚考虑为复发，伴纵隔淋巴结转移可能。\n既往体健。\n父亲73岁患肺癌，死亡。\n吸烟史26年，每天7-12支，未戒烟。 饮酒20余年，每天半斤，已戒1年。\n2018年10月确诊为鼻咽低分化鳞癌伴左颈多发淋巴结转移。\n2018年10月后行放疗及TP化疗多疗程，放疗结束时间2019年1月，末次化疗时间2019年5月。 2019年11月术后行化疗6周期（具体方案不详）。 2024年3月后行化疗联合免疫治疗4周期（GP+卡瑞利珠单抗），后继续2程化疗（GP）。 病程第0天行介入治疗（左侧上颌动脉栓塞术、双侧支气管动脉造影+灌注术）。\n今为行进一步治疗入我科。\nT分期：T3\nN分期：N0","rubric_template_structured":{"total_score":10.0,"core_answer":["疾病阶段：鼻咽癌多次治疗后局部疑复发，需复查当前病灶、疗效及纵隔疑转移；未提供GP+免疫后明确进展证据，不能自动认定该方案失败。","局部治疗：评估当前病灶、可切除性及再放疗风险；rT3不自动等同某一手术分期，也不足以单独排除手术或认定再放疗为唯一根治方式。","系统治疗：先复核既往反应及当前进展状态；如证实含铂方案失败，再结合既往暴露选择后线化疗或临床试验。","免疫用药：既往肌钙蛋白升高的病因及心肌炎风险未明确前，不直接恢复或更换PD-1；先行心脏专科评估，若确诊2–4级免疫相关心肌炎，应永久停用免疫治疗。"],"key_evidence":["既往经过：4周期GP+卡瑞利珠单抗后因肌钙蛋白升高停免疫，后续2周期GP及介入；未列明确疗效PD记录，须复核而非直接认定一线失败。","局部依据：现仅列T3N0，缺手术解剖分层及完整影像评估，不能由该代码推出手术绝对不适宜或再放疗唯一。","系统治疗证据：CSCO指南建议一线含铂失败后，选用未用过的单药化疗（卡培他滨、多西他赛等）及鼓励临床试验","免疫不良反应证据：2024年卡瑞利珠单抗治疗后肌钙蛋白升高至0.089ng/ml被迫停药，提示免疫相关心肌损伤风险"],"conditional_modifiers":["再程放疗边界：需评估年龄、KPS、GTV体积、复发间隔及既往毒性，低危可行再程放疗，高危不推荐","再程放疗禁忌时：如再程放疗风险过高或靶区无法安全覆盖，则以全身后线治疗或最佳支持治疗为主","免疫再用边界：先由心脏肿瘤及肿瘤专科明确肌钙蛋白升高病因、是否免疫心肌炎及严重度；不能默认换另一PD-1即可安全再用，具体再挑战须另行裁定。","临床试验：多线失败且缺乏优选方案时，应优先考虑参加适合的临床试验（在知情同意前提下）"],"negative_list":{"major_errors":["未经可切除性及既往治疗风险评估就固定手术或排除手术。","未复核既往疗效和当前进展状态即断定GP耐药，或忽略已确证耐药仍机械重复；不因缺PD证据时保留疗效复评而扣分。","误判：未评估既往肌钙蛋白升高病因及心肌炎风险，即直接继续或更换PD-1；或在确诊2–4级免疫相关心肌炎后仍建议再挑战。","误判：按初治鼻咽癌根治放化疗路径制定当前方案而忽视复发转移状态"],"minor_errors":["未提出复核既往疗效、当前病灶及据此选择后续系统方案或试验。","未评估局部挽救资格和再放疗风险；不强制写成再放疗唯一根治。","遗漏：未将肌钙蛋白升高与PD-1调整及心脏监测建立明确关联","仅固定局部或系统方案，未结合当前疗效、局部挽救资格及心脏安全作整体评估。"]},"scoring_rules":{"item_scores":{"core_answer":[1.5,1.5,1.5,1.5],"key_evidence":[0.5,0.5,0.5,0.5],"conditional_modifiers":[0.5,0.5,0.5,0.5]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-63a690ef8195b3bbe5a89e53","case_id":"o1-case-26a7e6547428f8bab254d2cb","patient_id":"o1-patient-6da261fc67e21ea159f11d40","tag":"TX_GENERAL","question":"根据最新 NCCN 指南，结合当前资料，请制定该患者当前阶段的标准治疗策略，并注明主要指南依据、推荐等级及证据类别。","case_input":"【病情摘要】\n患者男，47岁。\n2017年4月出现症状，病程第0天入院。\n鼻咽癌4年，肝转移2年，鼻咽复发1月余。\n2017年4月无明显诱因出现回缩性涕血，逐渐加重。\n2017年5月某医院诊断为鼻咽非角化型未分化癌T2N2M0 III期（AJCC第8版）。2019年7月复查腹部CT发现S8段结节，肝穿刺活检病理示转移性鳞状细胞癌。2021年4月复查发现鼻咽复发。\n2019年7月腹部CT发现S8段结节，肝穿刺活检病理示转移性鳞状细胞癌。\n既往体健。\n否认家族中有恶性肿瘤病史。\n2017年5月诊断为鼻咽非角化型未分化癌T2N2M0 III期（AJCC第8版）。2019年7月诊断肝转移性鳞状细胞癌。\n2017年行鼻咽及颈部放疗70Gy/33F，放疗后行PF方案化疗（具体疗程不详）。2019年7月后行GP方案化疗1程，行肝转移灶60Gy/25F放疗，放疗结束后再行GP方案化疗1程。\nT分期：T2\nN分期：N1","rubric_template_structured":{"total_score":10.0,"core_answer":["疾病阶段：已属复发/转移性鼻咽癌，本阶段以全身系统治疗为主。","总体策略：一线首选含铂双药化疗联合PD-1抑制剂。","指南依据：参考最新NCCN鼻咽癌指南，顺铂/吉西他滨+特瑞普利单抗为Preferred一线方案，Category 1。"],"key_evidence":["分期证据：2017年T2N2M0，2019年肝转移，2021年鼻咽复发，符合复发/转移性阶段。","既往治疗证据：鼻咽及颈部放疗70Gy、肝转移灶放疗60Gy，无明确挽救性手术或再次放疗指征时以系统治疗为主。","方案证据：NCCN鼻咽癌指南对复发、不可切除、寡转移或转移性疾病，推荐顺铂/吉西他滨+特瑞普利单抗为Preferred First-Line。","推荐等级证据：NCCN中顺铂/吉西他滨+特瑞普利单抗及免疫禁忌时的单纯顺铂/吉西他滨，均为Category 1。"],"conditional_modifiers":["局部治疗：若MDT评估病灶局限、可切除或距前次放疗>6个月且正常组织可耐受，可考虑挽救性手术或再次放疗。","既往GP考量：2019年用过GP且间隔较长无进展，可再挑战含铂双药；若评估为耐药，可改为单药免疫作为后续。","替代方案：顺铂不耐受时可改卡铂；免疫禁忌时使用单纯含铂双药化疗（Category 1）。","评估要求：系统治疗前应完善影像分期与肿瘤负荷评估，以判断局部干预可行性。"],"negative_list":{"major_errors":["在已有转移及高剂量放疗史下，将根治性再次放疗或手术作为无条件首选，忽视系统治疗为主。","未识别复发/转移性阶段，仍按局限期初治鼻咽癌制定根治放化疗策略。","首选方案缺乏NCCN依据，如把单药化疗或非适应症靶向药作为一线标准。"],"minor_errors":["未明确含铂双药+PD-1（如特瑞普利单抗）为一线首选，仅笼统称化疗。","未说明参考NCCN鼻咽癌指南或未体现Category 1推荐。","未提到免疫禁忌时可用单纯含铂双药化疗作为一线替代。","未指出需经MDT评估后再决定挽救性手术或再次放疗整合。"]},"scoring_rules":{"item_scores":{"core_answer":[2.0,2.0,2.0],"key_evidence":[0.5,0.5,0.5,0.5],"conditional_modifiers":[0.5,0.5,0.5,0.5]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-37029f6ed1b71a4c819d7879","case_id":"o1-case-26a7e6547428f8bab254d2cb","patient_id":"o1-patient-6da261fc67e21ea159f11d40","tag":"TX_GENERAL","question":"根据最新 NCCN 指南，若按上述治疗策略进行治疗，请提供该患者的具体治疗方案及实施要点；如涉及系统治疗，请注明方案名称、药物组成、给药方式、频次及疗程；如涉及局部治疗，请注明主要干预手段。","case_input":"【病情摘要】\n患者男，47岁。\n2017年4月出现症状，病程第0天入院。\n鼻咽癌4年，肝转移2年，鼻咽复发1月余。\n2017年4月无明显诱因出现回缩性涕血，逐渐加重。\n2017年5月某医院诊断为鼻咽非角化型未分化癌T2N2M0 III期（AJCC第8版）。2019年7月复查腹部CT发现S8段结节，肝穿刺活检病理示转移性鳞状细胞癌。2021年4月复查发现鼻咽复发。\n2019年7月腹部CT发现S8段结节，肝穿刺活检病理示转移性鳞状细胞癌。\n既往体健。\n否认家族中有恶性肿瘤病史。\n2017年5月诊断为鼻咽非角化型未分化癌T2N2M0 III期（AJCC第8版）。2019年7月诊断肝转移性鳞状细胞癌。\n2017年行鼻咽及颈部放疗70Gy/33F，放疗后行PF方案化疗（具体疗程不详）。2019年7月后行GP方案化疗1程，行肝转移灶60Gy/25F放疗，放疗结束后再行GP方案化疗1程。\nT分期：T2\nN分期：N1","rubric_template_structured":{"total_score":10.0,"core_answer":["系统治疗方案：一线首选顺铂/吉西他滨+PD-1抑制剂（Preferred，推荐特瑞普利单抗）","给药实施：静脉给药，按约3周/周期规律连续实施","疗程与评估：按方案周期给药，定期影像评估疗效并监测血常规及肝肾功能毒性","局部及支持治疗：在MDT下严格选择再程放疗或手术，贯穿营养、镇痛等最佳支持治疗"],"key_evidence":["一线证据：NCCN复发/转移性鼻咽癌将顺铂/吉西他滨+特瑞普利单抗列为Preferred First-Line方案","方案成分证据：姑息系统治疗应含铂类（顺铂/卡铂）、吉西他滨及免疫检查点抑制剂","再程放疗证据：既往鼻咽70Gy、肝60Gy根治放疗后，再次放疗须间隔≥6个月并充分评估危及器官，仅限高度选择患者","生存与生活质量证据：复发/晚期治疗需兼顾生存与生活质量，局部姑息和Best supportive care同等重要"],"conditional_modifiers":["免疫禁忌时：可用顺铂/吉西他滨双药化疗；顺铂不耐受时改用卡铂/吉西他滨，均可视情况联用或不联用PD-1","局部干预边界：系统治疗控制良好或局限复发，且距上次放疗>6个月并评估耐受后，可个体化再程放疗或外科切除","后线用药调整：进展或铂耐药时，后线可改为单药免疫（如特瑞普利单抗、帕博利珠单抗）或其他二线化疗方案","毒性与支持：贯穿营养、镇痛和毒性监测；化疗可按毒性减量或延期，PD-1按具体说明书及irAE级别暂缓或停用，不常规减量。"],"negative_list":{"major_errors":["忽视既往高剂量放疗，将根治性再程放疗或手术作为首选，未提及前置系统治疗或严格选择条件","推荐明显不符NCCN鼻咽癌的一线或姑息系统方案（如无依据的非常规靶向组合）","沿用初治局限期鼻咽癌根治放化疗框架，忽略复发/转移期以姑息系统治疗为主的策略"],"minor_errors":["未明确提及顺铂/吉西他滨+特瑞普利单抗或等价PD-1联合方案","未说明静脉周期性规律给药等基本实施要点","未提及系统治疗期间的影像学疗效评估和毒性监测","未体现MDT下整合局部干预，对最佳支持治疗强调不足"]},"scoring_rules":{"item_scores":{"core_answer":[1.5,1.5,1.5,1.5],"key_evidence":[0.5,0.5,0.5,0.5],"conditional_modifiers":[0.5,0.5,0.5,0.5]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-303998aaab5e4e4271e4d826","case_id":"o1-case-262857a92c2978a7ff496c00","patient_id":"o1-patient-c7b18e780a186bf2d56a7ea1","tag":"TX_GENERAL","question":"根据最新 NCCN 指南，结合当前资料，请制定该患者当前阶段的标准治疗策略，并注明主要指南依据、推荐等级及证据类别。","case_input":"【病情摘要】\n患者男，66岁。\n2006年8月出现症状，病程第1329天入院。\n鼻咽癌18年，复发化疗后进展。\n2006年8月出现左颈淋巴结肿大。2020年6月出现涕血，逐渐加重。\n2020年6月出现涕血，未予重视。2021年2月于广医二院就诊，行鼻咽及颈部MRI检查发现可疑复发。2023年底于外院检查提示复发。\n病程第0天鼻咽镜下活检确诊为鼻咽未分化型非角化性癌。病程第1104天行鼻咽活检病理提示：鼻咽未分化型非角化性癌。病程第1323天行鼻咽部、颈部MR平扫+增强提示：鼻咽壁增厚，较前部分加重，并右侧顶壁/顶后壁处新见软组织肿物，突向鼻咽腔内。\n既往发现“高血压”12年，血压最高达200/110mmHg，口服“拜新同”等治疗。发现“冠心病”5年。\n否认家族中有恶性肿瘤病史。\n鼻咽未分化型非角化性癌。\n2006年行单纯放疗。病程第27天、病程第48天予以2程“卡瑞利珠单抗+阿帕替尼”治疗。病程第89天起于门诊予以“卡瑞利珠单抗”治疗18程，末次免疫时间为病程第628天。病程第1110天、病程第1125天、病程第1153天、病程第1174天、病程第1202天、病程第1223天、病程第1258天予以7程“卡瑞利珠单抗”治疗。\n为接受进一步治疗收住我院。\nT分期：T3\nN分期：N0","rubric_template_structured":{"total_score":10.0,"core_answer":["疾病阶段：放疗后局部复发鼻咽癌，现资料列rT3N0；需完善当前范围、可切除性及再放疗耐受评估。","总体策略：具备局部根治挽救条件者讨论手术/再放疗；不具备者以系统治疗及症状控制为主。","指南依据：NCCN推荐既往放疗后局部复发可切除者首选手术，不可切除者再程放疗±系统治疗、单纯系统治疗或最佳支持治疗（多为2A类）。","再照射定位：既往放疗、高血压及冠心病提示风险，需复核既往剂量、靶区、心血管控制及OAR耐受；不能仅凭rT3及病史断言绝对不宜。","推荐路径：MDT完成局部挽救及全身耐受评估后选定方案；确不适宜局部治疗时考虑化疗、临床试验或最佳支持。"],"key_evidence":["复发证据：既往根治性放疗多年后局部复发，影像评估为rT3N0。","合并症证据：高龄，严重高血压和冠心病，心血管风险高。","NCCN证据：既往放疗后局部复发，手术可切除时为首选；不可切除时可选再程放疗、系统治疗或最佳支持治疗，属于2A类推荐。","再照射谨慎证据：NCCN强调再程放疗仅限高度选择人群，需能耐受严重并发症。","系统治疗既往史：长期卡瑞利珠单抗后进展，提示对既往PD-1方案耐药。"],"conditional_modifiers":["再照射边界：仅在经验中心完成病灶、累积剂量和心血管风险评估，预期获益大于风险时个体化考虑。","系统治疗调整：系统治疗方案需考虑既往PD-1失败，避免简单重复单药PD-1，优先化疗或临床试验。","决策流程：最终方案应经MDT讨论后确定，动态评估风险与获益。"],"negative_list":{"major_errors":["将本例按初治或未放疗局晚期鼻咽癌制定根治策略。","忽略既往放疗和心血管风险，不经MDT及剂量评估即推荐高强度局部治疗；合理评估后选择挽救者不据此扣分。","错误标注NCCN推荐等级，将本情形描述为1类或高于实际证据级别。"],"minor_errors":["未说明再放疗需严格选择及心血管评估，或无评估即宣称本例绝对禁忌。","未提及需MDT多学科综合评估后再定策略。","未体现需结合既往免疫治疗耐药史调整全身治疗。"]},"scoring_rules":{"item_scores":{"core_answer":[1.2,1.2,1.2,1.2,1.2],"key_evidence":[0.4,0.4,0.4,0.4,0.4],"conditional_modifiers":[0.67,0.67,0.66]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-abaa2ade4eff917bc9fbca5b","case_id":"o1-case-262857a92c2978a7ff496c00","patient_id":"o1-patient-c7b18e780a186bf2d56a7ea1","tag":"TX_GENERAL","question":"根据最新 NCCN 指南，若按上述治疗策略进行治疗，请提供该患者的具体治疗方案及实施要点；如涉及系统治疗，请注明方案名称、药物组成、给药方式、频次及疗程；如涉及局部治疗，请注明主要干预手段。","case_input":"【病情摘要】\n患者男，66岁。\n2006年8月出现症状，病程第1329天入院。\n鼻咽癌18年，复发化疗后进展。\n2006年8月出现左颈淋巴结肿大。2020年6月出现涕血，逐渐加重。\n2020年6月出现涕血，未予重视。2021年2月于广医二院就诊，行鼻咽及颈部MRI检查发现可疑复发。2023年底于外院检查提示复发。\n病程第0天鼻咽镜下活检确诊为鼻咽未分化型非角化性癌。病程第1104天行鼻咽活检病理提示：鼻咽未分化型非角化性癌。病程第1323天行鼻咽部、颈部MR平扫+增强提示：鼻咽壁增厚，较前部分加重，并右侧顶壁/顶后壁处新见软组织肿物，突向鼻咽腔内。\n既往发现“高血压”12年，血压最高达200/110mmHg，口服“拜新同”等治疗。发现“冠心病”5年。\n否认家族中有恶性肿瘤病史。\n鼻咽未分化型非角化性癌。\n2006年行单纯放疗。病程第27天、病程第48天予以2程“卡瑞利珠单抗+阿帕替尼”治疗。病程第89天起于门诊予以“卡瑞利珠单抗”治疗18程，末次免疫时间为病程第628天。病程第1110天、病程第1125天、病程第1153天、病程第1174天、病程第1202天、病程第1223天、病程第1258天予以7程“卡瑞利珠单抗”治疗。\n为接受进一步治疗收住我院。\nT分期：T3\nN分期：N0","rubric_template_structured":{"total_score":10.0,"core_answer":["总体策略：先评估手术及再放疗挽救资格；不适宜局部根治者，按既往PD-1进展及心血管风险选择系统治疗、试验或最佳支持治疗。","系统治疗：如不适宜局部根治且需系统治疗，结合既往PD-1进展及铂暴露选择含铂双药等化疗，具体依心血管及脏器耐受。","化疗实施：静脉给药，每3周一周期，按PS及肝肾等脏器功能动态调整疗程与剂量。","并发症管理：合并重度高血压和冠心病，需心内科协作严控血压、监测心功能，使用顺铂时注意水化量防心衰。"],"key_evidence":["局部证据：MRI提示鼻咽壁加重及新软组织肿物，需复评局部复发范围；既往放疗和合并症提示风险，但未提供已判定不可切除或再放疗禁忌的依据。","免疫耐药证据：卡瑞利珠单抗用至2024年8月，10月影像评估进展，提示PD-1单药免疫已耐药。","NCCN依据：复发/转移性鼻咽癌一线优先含铂双药化疗（如吉西他滨+顺铂），本例复发阶段未用过铂类方案。","心血管风险证据：长期高血压控制差，血压峰值约200/110，合并冠心病，限制高强度治疗及顺铂给药方式。","个体化强度证据：NCCN强调依合并症和PS调整系统治疗强度及药物选择。"],"conditional_modifiers":["顺铂不耐受时：心功能差或一般状态差可改用卡铂，或降级为单药化疗（如吉西他滨、多西他赛、卡培他滨等）。","局部症状时：系统治疗期间如出现大出血、气道受压等严重局部症状，可加用姑息性局部放疗缓解。","治疗转向：应充分告知风险和预后，随病情与意愿在抗肿瘤治疗和最佳支持治疗间调整，可随时转为BSC。","临床试验：具备条件且患者同意时，优先推荐进入针对免疫耐药复发鼻咽癌的新药临床试验。"],"negative_list":{"major_errors":["未评估局部挽救资格及心血管风险即固定根治性局部治疗，或未经评估直接排除所有局部挽救。","已确认卡瑞利珠单抗长期使用后进展，仍继续推荐原PD-1方案或仅更换PD-1单药作为主要方案。","推荐含铂化疗时完全未提血压与心功能评估和监测，忽视严重心血管并发症风险。"],"minor_errors":["未说明局部挽救可行性和系统/支持治疗的适用分支，仅笼统写化疗。","提及系统治疗仅写“化疗”，未给出代表性含铂方案名及基本周期安排。","未体现针对高血压、冠心病的用药调整思路，如未提顺铂与卡铂取舍。","未说明系统治疗与局部姑息放疗等干预的配合方式。"]},"scoring_rules":{"item_scores":{"core_answer":[1.5,1.5,1.5,1.5],"key_evidence":[0.4,0.4,0.4,0.4,0.4],"conditional_modifiers":[0.5,0.5,0.5,0.5]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-67872b2453b1c48aedf6391a","case_id":"o1-case-825c78f4cb35e8440676c19c","patient_id":"o1-patient-660d2938d435fdd66d018186","tag":"TX_GENERAL","question":"根据最新 CSCO 指南，结合当前资料，请制定该患者当前阶段的标准治疗策略，并注明主要指南依据、推荐等级及证据类别。","case_input":"【病情摘要】\n患者男，44岁。\n1年前出现症状，病程第8天入院。\n右颈部疼痛伴肿物1年，外院颈部术后考虑鼻咽癌1周。\n1年前无明显诱因出现右颈部疼痛伴肿物，伴咽痛，偶有回吸涕带血，无头晕、头痛、复视、视力模糊、耳鸣、听力下降、面麻等不适，逐渐加重。\n病程第0天于某医院全麻下行“右腮腺病损切除术+右侧腮腺部分切除术+颌面局部皮瓣转移术”，术中冰冻病理回报：颈部转移癌及另见囊性组织为淋巴上皮囊肿，考虑原发灶为鼻咽。病程第1天行鼻咽活检病理示：鼻咽未分化型非角化性癌，建议行放化综合治疗。\n20余年前因疝气外院行手术治疗。\n母亲肺癌已故。\nT分期：T2\nN分期：N1\n总分期：IB","rubric_template_structured":{"total_score":10.0,"core_answer":["疾病阶段及目标：初治局限期/局部进展期鼻咽癌，当前以根治/治愈为目标","总体策略：以根治IMRT为核心，通常首选含铂同期放化疗；经评估符合低危T1–2N1M0的循证条件时可考虑单纯IMRT，并说明风险评估。","系统治疗取舍：选择CCRT时优先顺铂等含铂方案；合理低危单RT者说明省略化疗的依据和评估亦可。","指南依据：遵循CSCO指南，将同期放化疗作为本阶段高证据等级推荐的标准路径"],"key_evidence":["诊断证据：鼻咽活检示未分化型非角化性癌，右颈部转移癌考虑原发灶为鼻咽，属初治鼻咽癌伴同侧颈部淋巴结转移","分期证据：现有资料仅见鼻咽原发及右侧颈部转移淋巴结，无远处转移、无明确颅神经受累或颅内、眼眶侵犯，符合局限期/局部进展期","既往治疗证据：仅行右腮腺病损切除及局部皮瓣术，未行放疗或系统化疗，44岁，无严重合并症或器官功能不全，适合根治意图同期放化疗","指南证据：CSCO指南中，初治局部进展期鼻咽癌（原发局限鼻咽伴同侧颈淋巴结、无远处转移及明显T4特征）推荐根治性放疗联合同步含铂化疗，属高证据等级推荐"],"conditional_modifiers":["顺铂不耐受时：体能、肾功能、听力等不耐受标准剂量顺铂者，可在CSCO指南允许范围内改用卡铂等含铂药物或减量/调整给药，作为标准同步放化疗路径下的个体化调整","严重合并症调整：严重内科疾病或重要器官功能损害导致同期化疗不适宜时，经说明原因和沟通，可用以根治放疗为主的减强方案，并加强随访及支持治疗；此为非首选折中路径。","随访与局部残留时：完成根治性同期放化疗后应规范随访，根据影像和鼻咽镜评估，如有局部残留或复发，再评估追加局部或系统治疗","远处转移出现时：随访影像如发现疑似远处转移或病灶明显进展，应调整为以全身系统治疗为主，并经MDT综合决策","单纯放疗条件：T1–2N1M0、全部淋巴结<3 cm、无IV/Vb区受累、无结外侵犯且治疗前血浆EBV-DNA<4000拷贝/mL时，可依据低危研究考虑单纯IMRT。","本例适用性：现有材料不足以确认单纯放疗所需低危条件，不能仅凭T2N1认定可采用单纯放疗。"],"negative_list":{"major_errors":["将单纯诱导化疗、单纯辅助化疗或单纯手术作为首选根治性标准方案，未突出含放疗（以同步放化疗为主）的核心路径","无病例依据将本例视为远处转移或高危T4/N2-3，统一推荐强化诱导化疗等非常规方案为首选标准，而未说明为个体化或需进一步证据","忽视含铂同步化疗的地位，仅推荐免疫、靶向或其他实验性治疗作为主要根治性治疗，与CSCO指南推荐路径明显不符","将同期放化疗描述为低证据、非优先或不推荐方案，从而弱化或否定其首选根治性路径地位"],"minor_errors":["未写明当前治疗目标为根治/治愈，仅含糊为控制病情","未写清根治放疗及所选同步治疗或单RT路径；不因合理低危单RT缺同期化疗扣分。","已选择同期化疗却未列含铂代表方案；合理低危单RT者不适用。","未提及任何CSCO指南依据或推荐等级/证据类别，导致治疗策略缺乏循证指向","未对顺铂不耐受或严重基础疾病时的替代方案设定前提和优先级，简单罗列多种方案","未评估低危条件、缺乏循证依据或耐受理由就一概选择单RT；有依据选择低危单RT路径不扣分。"]},"scoring_rules":{"item_scores":{"core_answer":[1.5,1.5,1.5,1.5],"key_evidence":[0.5,0.5,0.5,0.5],"conditional_modifiers":[0.34,0.34,0.33,0.33,0.33,0.33]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-bbb02e8f87564cc3bc44402f","case_id":"o1-case-825c78f4cb35e8440676c19c","patient_id":"o1-patient-660d2938d435fdd66d018186","tag":"TX_GENERAL","question":"根据最新 CSCO 指南，若按上述治疗策略进行治疗，请提供该患者的具体治疗方案及实施要点；如涉及系统治疗，请注明方案名称、药物组成、给药方式、频次及疗程；如涉及局部治疗，请注明主要干预手段。","case_input":"【病情摘要】\n患者男，44岁。\n1年前出现症状，病程第8天入院。\n右颈部疼痛伴肿物1年，外院颈部术后考虑鼻咽癌1周。\n1年前无明显诱因出现右颈部疼痛伴肿物，伴咽痛，偶有回吸涕带血，无头晕、头痛、复视、视力模糊、耳鸣、听力下降、面麻等不适，逐渐加重。\n病程第0天于某医院全麻下行“右腮腺病损切除术+右侧腮腺部分切除术+颌面局部皮瓣转移术”，术中冰冻病理回报：颈部转移癌及另见囊性组织为淋巴上皮囊肿，考虑原发灶为鼻咽。病程第1天行鼻咽活检病理示：鼻咽未分化型非角化性癌，建议行放化综合治疗。\n20余年前因疝气外院行手术治疗。\n母亲肺癌已故。\nT分期：T2\nN分期：N1\n总分期：IB","rubric_template_structured":{"total_score":10.0,"core_answer":["总体策略：以根治IMRT为核心，优先含铂同期放化疗；T1–2N1M0且全部淋巴结<3 cm、无IV/Vb区淋巴结受累、无结外侵犯、治疗前血浆EBV-DNA<4000拷贝/mL，经评估符合低危条件时可考虑单纯IMRT；不能耐受同期化疗者说明原因后亦可选择单纯放疗。","系统治疗：采用CCRT时列顺铂等具体同期方案；合理单RT者说明省略同期化疗的风险评估及依据亦可。","治疗节律：采用CCRT者说明化疗与RT同步及毒性评估；单RT者说明放疗节律、疗效与毒性随访亦可。","局部治疗：调强放疗/IMRT根治放疗，覆盖原发灶及颈部高危区"],"key_evidence":["诊断证据：中年男性，鼻咽未分化型非角化癌，伴颈部淋巴结转移，属初诊T1-2N1（IB期）鼻咽癌","指南证据：CSCO指南推荐T1-2N1（IB期）鼻咽癌首选调强放疗/IMRT根治放疗联合含铂同步放化疗"],"conditional_modifiers":["顺铂不耐受时：可用每周小剂量顺铂或卡铂同步化疗，并据毒性调整剂量或延迟给药","高危时强化：肿瘤负荷大或EBV-DNA显著升高且全身状况良好时，可在多学科讨论后考虑诱导化疗联合同步放化疗，但同步放化疗仍为主干"],"negative_list":{"major_errors":["未安排根治性放疗，或缺乏低危/耐受依据就省略系统治疗；合理低危单RT不据此扣分。","仅给诱导或辅助化疗而缺少根治性放疗，或治疗顺序无依据；不因合理单RT未安排同步而扣分。","推荐明显不符合鼻咽癌标准的放化疗方案（如单药紫杉醇替代含铂同步化疗，或放疗剂量明显低于根治剂量）作为主要路径"],"minor_errors":["仅笼统写治疗而未说明IMRT根治照射及所选路径；合理单RT者不要求写含铂同期。","已选择同期化疗却未说明途径、节律和周期；合理单RT者不适用。","涉及顺铂却未评估耐受及必要替代；合理单RT者不因未列替代药扣分。"]},"scoring_rules":{"item_scores":{"core_answer":[1.5,1.5,1.5,1.5],"key_evidence":[1.0,1.0],"conditional_modifiers":[1.0,1.0]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-66a828525bcbbf5d34f41644","case_id":"o1-case-90c5de5e973845274b8ed5ad","patient_id":"o1-patient-3d415268227d5f16db1e73c5","tag":"TX_GENERAL","question":"根据最新 NCCN 指南，结合当前资料，请制定该患者当前阶段的标准治疗策略，并注明主要指南依据、推荐等级及证据类别。","case_input":"【病情摘要】\n患者男，33岁。\n2024年8月出现症状，病程第12天入院。\n确诊鼻咽癌5天。\n2024年8月无明显诱因出现左耳耳闷，伴耳鸣，听力下降。病程第0天左颈出现肿大淋巴结。自起病以来，精神、睡眠可，食欲如常，小便正常，稀烂便，2-3次/天，体重无下降。\n于某医院诊断为“中耳炎”，予赛洛唑琳治疗，自觉症状无好转。病程第0天行鼻咽镜检查示：左侧鼻咽后壁肿物。活检病理：（左侧鼻咽后壁）非角化性癌。\n病程第8天鼻咽颅底MR平扫+增强：左侧鼻咽侧后壁增厚，广泛软组织浸润并超过翼外肌外侧缘。上颈部见稍大淋巴结。左侧颌下见一大小约2.8cm×2.6cm×4.7cm团块影，增强呈中度强化，边界清晰。颅底骨质未见明显异常。影像诊断：1、左侧鼻咽癌，广泛软组织浸润并超过翼外肌外侧缘，伴左侧颈部淋巴结转移。左侧中耳乳突炎，提示咽鼓管侵犯。\n既往体健。否认肝炎、结核等传染病史。否认心脏病、高血压、糖尿病史。否认手术史。否认重大外伤史和输血史。\n父亲55岁患肝癌，至今存活。\nT分期：T4\nN分期：N1","rubric_template_structured":{"total_score":10.0,"core_answer":["疾病阶段：已确诊鼻咽癌，按T4N1M0局部晚期制定根治性治疗策略。","治疗目标：根治性放化疗为主的根治治疗","总体策略：放疗为基础的综合治疗（放化疗综合治疗）","首选路径：优先临床试验，或诱导化疗后同步放化疗（首选），或同步放化疗后辅助化疗"],"key_evidence":["分期依据：活检非角化性癌，软组织浸润超过翼外肌外侧缘支持T4，单侧颈淋巴结转移支持N1；治疗路径按T4N1M0制定。","全身状况证据：33岁，既往体健无基础病，仍需PS及器官功能评估后判断能否耐受标准强度全身化疗及根治性放疗","NCCN路径证据：NCCN鼻咽癌指南T4N1M0推荐临床试验、诱导化疗序贯同步放化疗或同步放化疗后辅助化疗，单纯同步放化疗为2B推荐","证据级别证据：NCCN载明EBV相关患者诱导化疗为Category 1（非EBV相关为2A），本例非角化性癌应补充EBV检测以明确证据级别"],"conditional_modifiers":["化疗耐受边界：器官功能受限或不耐受标准诱导化疗时，可用单纯同步放化疗（NCCN 2B）或减量/调整药物","EBV阳性补充：如证实EBV相关，可在同步放化疗后考虑加用卡培他滨辅助治疗","支持治疗：治疗中应完善营养、胃管评估、牙科及内分泌等支持性诊疗"],"negative_list":{"major_errors":["以单纯手术或单纯化疗作为根治性首选方案","忽略放化疗综合治疗核心地位，仅给出姑息治疗方案","将免疫单药等非NCCN首选的初治局部晚期方案列为首选标准路径"],"minor_errors":["仅泛称放化疗，未说明具体采用诱导化疗后同步放化疗、同步放化疗后辅助化疗，或耐受受限时采用同步放化疗的治疗路径及顺序。","未提及NCCN指南依据或未区分Category/证据等级","未提出诱导或同步化疗不耐受时的替代或减量个体化策略"]},"scoring_rules":{"item_scores":{"core_answer":[1.5,1.5,1.5,1.5],"key_evidence":[0.5,0.5,0.5,0.5],"conditional_modifiers":[0.67,0.67,0.66]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-23740299b15dcc641bab6661","case_id":"o1-case-90c5de5e973845274b8ed5ad","patient_id":"o1-patient-3d415268227d5f16db1e73c5","tag":"TX_GENERAL","question":"根据最新 NCCN 指南，若按上述治疗策略进行治疗，请提供该患者的具体治疗方案及实施要点；如涉及系统治疗，请注明方案名称、药物组成、给药方式、频次及疗程；如涉及局部治疗，请注明主要干预手段。","case_input":"【病情摘要】\n患者男，33岁。\n2024年8月出现症状，病程第12天入院。\n确诊鼻咽癌5天。\n2024年8月无明显诱因出现左耳耳闷，伴耳鸣，听力下降。病程第0天左颈出现肿大淋巴结。自起病以来，精神、睡眠可，食欲如常，小便正常，稀烂便，2-3次/天，体重无下降。\n于某医院诊断为“中耳炎”，予赛洛唑琳治疗，自觉症状无好转。病程第0天行鼻咽镜检查示：左侧鼻咽后壁肿物。活检病理：（左侧鼻咽后壁）非角化性癌。\n病程第8天鼻咽颅底MR平扫+增强：左侧鼻咽侧后壁增厚，广泛软组织浸润并超过翼外肌外侧缘。上颈部见稍大淋巴结。左侧颌下见一大小约2.8cm×2.6cm×4.7cm团块影，增强呈中度强化，边界清晰。颅底骨质未见明显异常。影像诊断：1、左侧鼻咽癌，广泛软组织浸润并超过翼外肌外侧缘，伴左侧颈部淋巴结转移。左侧中耳乳突炎，提示咽鼓管侵犯。\n既往体健。否认肝炎、结核等传染病史。否认心脏病、高血压、糖尿病史。否认手术史。否认重大外伤史和输血史。\n父亲55岁患肝癌，至今存活。\nT分期：T4\nN分期：N1","rubric_template_structured":{"total_score":10.0,"core_answer":["方案选择：T4N1M0局部晚期鼻咽癌，可用GP（吉西他滨＋顺铂）或TPF（多西他赛＋顺铂＋氟尿嘧啶）诱导后同期放化疗，或同期放化疗后辅助；器官功能受限或不耐受诱导时，可个体化采用同期放化疗。","同步放化疗：放疗同期以顺铂为主，可用卡铂替代","局部放疗技术：采用IMRT等图像引导调强放疗","放疗剂量：高危靶区约70-70.2 Gy，常规分割照射"],"key_evidence":["诱导化疗证据：NCCN指南推荐GP、TPF为初治局部晚期鼻咽癌Category 1或Preferred方案","同步化疗证据：NCCN推荐顺铂单药（每周或每3周一次）为同步放化疗标准用药","放疗技术证据：NCCN明确IMRT为局部晚期鼻咽癌标准放疗技术，以减低重要器官毒性","放疗剂量证据：NCCN要求T4N1等高危区累计剂量70-70.2 Gy，低中危区约44-63 Gy"],"conditional_modifiers":["顺铂不耐受时：如肾功能受损或听力风险高，可个体化改用卡铂同步化疗","放疗技术边界：常规光子IMRT难以满足OAR限制且影响靶区覆盖时，可考虑质子治疗","辅助治疗：如病理为EBV相关肿瘤，诱导及同步放化疗后可个体化考虑卡培他滨维持"],"negative_list":{"major_errors":["仅采用单纯化疗或无合理适应证的单纯放疗，未安排根治性放化疗综合治疗。","诱导化疗选用明显偏离NCCN且非含铂经验方案，且无合理依据","放疗技术仍推荐二维或三维常规放疗，未提IMRT等调强放疗","未给出根治剂量放疗，高危区剂量远低于70 Gy或仅给出姑息剂量"],"minor_errors":["采用GP或TPF诱导化疗却未列明药物组成；采用同步放化疗后辅助化疗却未说明辅助药物及实施顺序；采用同步放化疗却未说明同步用药。","未说明同步放化疗阶段以顺铂（或其等效替代）为主要用药","写了放疗但未说明高危靶区约70 Gy及分次等关键实施要点"]},"scoring_rules":{"item_scores":{"core_answer":[1.5,1.5,1.5,1.5],"key_evidence":[0.5,0.5,0.5,0.5],"conditional_modifiers":[0.67,0.67,0.66]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-b6b35f893e6d015f10d03024","case_id":"o1-case-f5cc6a3189c3cab741177c47","patient_id":"o1-patient-60ae255b1815d435b04fec64","tag":"TX_GENERAL","question":"根据最新 NCCN 指南，结合当前资料，请制定该患者当前阶段的标准治疗策略，并注明主要指南依据、推荐等级及证据类别。","case_input":"【病情摘要】\n患者男，40岁。\n2025年2月发现左颈肿物，病程第2天就诊。\n左颈肿物1月余。\n2025年2月发现左颈淋巴结肿大，大小约5*6cm，无鼻塞、涕血，无头晕、头痛，无耳鸣、听力下降。\n病程第0天某医院左颈淋巴结穿刺活检：淋巴结转移癌，鼻咽来源可能，未行免疫组化。\n母亲患胃癌。\nT分期：T2\nN分期：N2\n总分期：II","rubric_template_structured":{"total_score":10.0,"core_answer":["诊断/阶段：颈部淋巴结转移癌，鼻咽来源待确认；现有资料不足以确定TNM分期及总期别，应完善病理来源确认和分期评估，再制定治疗策略。","总体策略：先完善病理及免疫组化、鼻咽原发评估和局部/远处分期，再依据确诊来源、分期及耐受性选择治疗。","治疗决策：当前不固定根治或姑息目标，也不指定诱导、同步或辅助治疗；说明需待诊断分期完善后再确定路径即可。","指南依据：采用NCCN诊断与分期检查路径并注明版次；如头颈部肿瘤V1.2026未另标类别者为2A类。本例不套用尚未确定治疗的推荐等级。"],"key_evidence":["病理依据：颈部穿刺已证实转移癌，但仅提示鼻咽来源可能且未行免疫组化，尚不能直接确定鼻咽原发。","原发评估依据：需结合病理补充检查及鼻咽镜、必要时原发活检等确认来源；颈部肿物不能代替原发病灶证据。","分期依据：缺少支持完整局部及远处分期的检查资料，不能直接确定TNM或总期别，也不能据此指定某一分期对应的治疗组合。","耐受性依据：年龄及未记载严重合并症不足以证明可耐受标准强度治疗，后续治疗需结合整体状况及器官功能评估。"],"conditional_modifiers":["结果适配：后续按确认的原发来源、病理、实际分期及耐受性选择治疗；当前说明需据结果再定即可，不要求预设任何系统药物或局部处方。","条件性建议：如讨论后续治疗或临床试验，须明确以确诊、分期和相应资格评估为前提；明确目前资料不足、暂不指定方案或试验亦可。"],"negative_list":{"major_errors":["在来源和分期未明确时，将某一固定抗肿瘤方案作为本例已确定的标准治疗；仅说明需先完善诊断分期、不列具体方案不扣分。","无相应依据即确定具体TNM、总期别或根治/姑息目标，并据此制定治疗。"],"minor_errors":["未说明当前治疗目标与路径需待诊断分期明确后确定；不因未写“根治性治疗”扣分。","未说明当前诊断与分期检查的NCCN依据；不因未给尚未确定治疗方案的推荐等级或证据类别扣分。","仅笼统写“放化疗”，未回应当前需先确认病理来源和完善分期；不因未列诱导/同步/辅助的顺序或组成扣分。"]},"scoring_rules":{"item_scores":{"core_answer":[1.5,1.5,1.5,1.5],"key_evidence":[0.5,0.5,0.5,0.5],"conditional_modifiers":[1.0,1.0]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-e45598c54ee8bf1d98d0a986","case_id":"o1-case-f5cc6a3189c3cab741177c47","patient_id":"o1-patient-60ae255b1815d435b04fec64","tag":"TX_GENERAL","question":"根据最新 NCCN 指南，若按上述治疗策略进行治疗，请提供该患者的具体治疗方案及实施要点；如涉及系统治疗，请注明方案名称、药物组成、给药方式、频次及疗程；如涉及局部治疗，请注明主要干预手段。","case_input":"【病情摘要】\n患者男，40岁。\n2025年2月发现左颈肿物，病程第2天就诊。\n左颈肿物1月余。\n2025年2月发现左颈淋巴结肿大，大小约5*6cm，无鼻塞、涕血，无头晕、头痛，无耳鸣、听力下降。\n病程第0天某医院左颈淋巴结穿刺活检：淋巴结转移癌，鼻咽来源可能，未行免疫组化。\n母亲患胃癌。\nT分期：T2\nN分期：N2\n总分期：II","rubric_template_structured":{"total_score":10.0,"core_answer":["总体策略：当前先完成病理来源确认及分期评估，治疗方案待诊断、分期和耐受性明确后制定；不预设具体TNM、诱导化疗或根治放化疗路径。","病理实施：复核颈部穿刺病理并完善来源鉴别所需的免疫组化等检查；结合鼻咽镜及必要的活检确认鼻咽是否为原发。","分期实施：完善鼻咽及颈部影像、远处转移评估后再确定分期；现有资料不足时不指定TNM或总期别。","治疗实施边界：诊断分期明确前，不确定系统治疗药物、周期或根治放疗处方；说明待结果明确后按治疗适应证制定具体方案即可。"],"key_evidence":["病理依据：现有穿刺仅能支持颈部转移癌、鼻咽来源可能，原发归属仍需确认。","局部分期依据：颈部肿物大小不能替代鼻咽原发及完整淋巴结影像评估，不能据此确定完整局部分期。","远处分期依据：尚缺远处评估资料，不能默认无远处转移或已存在远处转移。","方案选择依据：确定局部或系统治疗前，需明确来源、分期、治疗适应证和耐受性；仅凭年龄或未描述合并症不预设治疗资格。"],"conditional_modifiers":["指南适用：可依据NCCN鼻咽癌指南安排病理来源及局部/远处分期检查；未确诊鼻咽来源前，不将某分期的用药或推荐等级直接套用于本例。","耐受性评估：在确定需系统或局部治疗后再评估相应器官功能及整体耐受性；现阶段说明需评估即可，不强制具体药物选择。","后续方案边界：待诊断分期结果明确后再决定是否需要系统或局部治疗；暂不列诱导、同期、辅助方案及根治剂量不扣分。"],"negative_list":{"major_errors":["未确认来源及分期即将含铂治疗联合根治性IMRT作为本例已确定的方案；说明资料不足并先完善诊断分期不扣分。","未确认原发来源及相应适应证，即将手术或放疗作为本例已确定的主要根治手段。","无证据即确定具体TNM或总期别，并据此直接指定诱导、同步或辅助治疗。"],"minor_errors":["未说明需要确认病理来源；不因未列具体系统药物方案扣分。","未说明具体治疗选择需待诊断分期及适应证明确；不因未列同期药物扣分。","未说明当前不能确定局部根治治疗及其处方；不因未列放疗技术或根治剂量扣分。","仅列药物或放疗处方，未交代先完成病理来源确认及分期评估的实施步骤；不因未列给药方式、频次、疗程或放疗分割扣分。"]},"scoring_rules":{"item_scores":{"core_answer":[1.5,1.5,1.5,1.5],"key_evidence":[0.5,0.5,0.5,0.5],"conditional_modifiers":[0.67,0.67,0.66]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-65f6b2c64c276a20ae30a360","case_id":"o1-case-a1c38d07c108f3e8b14754fa","patient_id":"o1-patient-eacb04773f2a5ed9dbae662d","tag":"TX_GENERAL","question":"根据最新 CSCO 指南，结合当前资料，请制定该患者当前阶段的标准治疗策略，并注明主要指南依据、推荐等级及证据类别。","case_input":"【病情摘要】\n患者男，51岁。\n2024年4月底出现症状，病程第0天入院。\n耳鸣伴头痛3周余。\n2024年4月底无意中出现耳鸣，头疼，无发热，无听力下降，无鼻塞、回吸性涕血，无面麻。\n某医院考虑“中耳炎”，行消炎治疗后耳鸣症状可缓解，但仍持续头疼。某医院行头颈部CT未见明显异常。某医院行颅脑CT示：左侧后鼻孔及鼻咽部软组织病变，肿瘤可疑。鼻咽镜结果示：鼻炎隆起待查，左中鼻甲病变待查。病理结果示：未分化型非角化性癌。\n颅脑CT示：左侧后鼻孔及鼻咽部软组织病变，肿瘤可疑。鼻咽镜结果示：鼻炎隆起待查，左中鼻甲病变待查。\n既往体健。有吸烟史3年余，约20支/周。有饮酒史20余年，饮白酒1斤/天。\n否认家族中有恶性肿瘤病史。\nT分期：T3\nN分期：N0\n总分期：II","rubric_template_structured":{"total_score":10.0,"core_answer":["诊断/阶段：病理提示未分化型非角化性癌；现有资料不足以核定TNM及总期别，应完善原发评估与局部、远处分期，再制定治疗策略。","总体策略：先完善原发与颈部评估及远处分期，依据实际诊断、分期和耐受性再确定治疗目标及方案。","治疗选择：当前资料不足以判定低危或确定同期放化疗、单纯放疗等固定路径；说明暂不指定具体抗肿瘤方案、待分期完成后再定即可。","指南依据：围绕CSCO的诊断与分期评估要求说明当前应完善的检查，并注明所用版次；未确定治疗路径时，不强制列某一治疗方案的推荐等级或证据类别。"],"key_evidence":["病理依据：已有未分化型非角化性癌病理结果，可作为诊断依据；该病理类型本身不能确定肿瘤侵犯范围、淋巴结状态或远处转移。","分期依据：现有CT及鼻咽镜描述未充分交代局部侵犯范围，也缺少完整颈部及远处评估，不能据此核定TNM及总期别。","风险与指南适用：是否属于低危、是否适合放化疗或单纯放疗，需在分期完善后结合实际风险及耐受性评估；不能用缺失的EBV-DNA或肿瘤负荷数据认定低危。"],"conditional_modifiers":["风险分层：完善分期后再按实际疾病范围、EBV-DNA等资料判断风险及治疗适应证；当前指出低危证据不足、暂不作降阶决定即可。","后续评估：先完成本次分期及治疗决策；明确后续随访需按最终诊断与实际治疗制定即可，不预设本例已经放疗结束、复发或需挽救治疗。","耐受性：后续治疗需结合整体状况、器官功能及耐受性评估；当前说明需评估即可，不根据年龄或既往体健直接确定化疗资格或减强方案。"],"negative_list":{"major_errors":["诊断分期未完善，即将某一固定抗肿瘤方案作为本例已确定的标准治疗；先完善原发评估与分期、不列具体处方不扣分。","无相应证据即确定具体TNM或总期别，并据此选择或排除治疗路径。","未评估分期及风险即认定本例低危，直接确定单纯放疗或减强治疗；明确待分期及风险评估后再定不扣分。"],"minor_errors":["仅写“综合治疗”，未说明需先完善原发及分期评估；不因未将根治性放疗写作主导治疗扣分。","未指出当前分期或风险资料不足；不因未给低危阈值、单纯放疗条件或具体化疗方案扣分。","未说明原发及分期评估的CSCO依据；不因未给尚未确定治疗方案的具体推荐等级或证据类别扣分。"]},"scoring_rules":{"item_scores":{"core_answer":[1.5,1.5,1.5,1.5],"key_evidence":[0.67,0.67,0.66],"conditional_modifiers":[0.67,0.67,0.66]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-c644cf2def93750fa69a15c0","case_id":"o1-case-a1c38d07c108f3e8b14754fa","patient_id":"o1-patient-eacb04773f2a5ed9dbae662d","tag":"TX_GENERAL","question":"根据最新 CSCO 指南，若按上述治疗策略进行治疗，请提供该患者的具体治疗方案及实施要点；如涉及系统治疗，请注明方案名称、药物组成、给药方式、频次及疗程；如涉及局部治疗，请注明主要干预手段。","case_input":"【病情摘要】\n患者男，51岁。\n2024年4月底出现症状，病程第0天入院。\n耳鸣伴头痛3周余。\n2024年4月底无意中出现耳鸣，头疼，无发热，无听力下降，无鼻塞、回吸性涕血，无面麻。\n某医院考虑“中耳炎”，行消炎治疗后耳鸣症状可缓解，但仍持续头疼。某医院行头颈部CT未见明显异常。某医院行颅脑CT示：左侧后鼻孔及鼻咽部软组织病变，肿瘤可疑。鼻咽镜结果示：鼻炎隆起待查，左中鼻甲病变待查。病理结果示：未分化型非角化性癌。\n颅脑CT示：左侧后鼻孔及鼻咽部软组织病变，肿瘤可疑。鼻咽镜结果示：鼻炎隆起待查，左中鼻甲病变待查。\n既往体健。有吸烟史3年余，约20支/周。有饮酒史20余年，饮白酒1斤/天。\n否认家族中有恶性肿瘤病史。\nT分期：T3\nN分期：N0\n总分期：II","rubric_template_structured":{"total_score":10.0,"core_answer":["总体策略：先完善原发评估与局部、远处分期，再根据实际诊断、分期及耐受性确定治疗；当前不固定同期放化疗或低危单纯放疗路径。","原发与局部评估：结合已有病理、鼻咽镜及鼻咽/颈部影像，明确原发病灶及局部、区域淋巴结范围；不凭病理类型或症状直接定分期。","远处分期实施：补全远处转移评估后再确定转移状态及总期别；目前不默认无远处转移或已有转移。","治疗实施边界：待原发评估、分期和适应证明确后再确定系统治疗与局部治疗的必要性及具体处方；当前暂不列药物、剂量、周期或根治放疗处方亦可。"],"key_evidence":["现有证据：已有未分化型非角化性癌病理；现有资料不能完整核定TNM、总期别或治疗目标。","指南适用：CSCO的分期治疗路径需与实际疾病范围及风险对应，当前应先完善分期，不把某一分组的同步放化疗推荐直接套用于本例。","局部治疗依据：放疗适应证、治疗目标及处方须结合原发与分期结果确定，不能因未列根治剂量或放疗技术而否定当前先完善分期的方案。","系统治疗依据：是否需化疗、同期药物及给药强度，取决于实际诊断分期、风险和耐受性；当前不强制某种铂类或累积剂量。"],"conditional_modifiers":["耐受性评估：确定系统治疗适应证后再评估器官功能和整体耐受性；现阶段说明需评估即可，不强制给出顺铂替代药物或调整处方。","单纯放疗边界：是否可采用单纯放疗，需在实际分期、风险及耐受评估后决定；当前指出资料不足、暂不判断单纯放疗适用性即可。","后续治疗：辅助或巩固治疗需根据最终分期、已实施治疗及后续评估决定；当前可明确待分期及初始治疗策略确定后再议，不预设必须安排。","支持与个体化：按后续实际治疗及整体状况安排营养、毒性与器官功能监测；当前提出评估及支持原则即可，不强制化疗特定支持处方。"],"negative_list":{"major_errors":["诊断分期未完善即将根治放疗联合系统治疗作为本例已确定方案；先完善评估、暂不列固定治疗不扣分。","未明确实际分期及适应证即把某一系统药物或固定组合定为本例标准方案；明确前提的后续治疗讨论不因此扣分。","无依据即确定具体TNM、总期别或根治/姑息目标，并据此直接制定治疗。"],"minor_errors":["所述当前策略及评估步骤不清；不因未列顺铂或其他具体系统方案扣分。","未说明需完善局部及颈部分期；不因未列IMRT、根治剂量或分割方式扣分。","未说明需完善远处分期；不因未列化疗途径、剂量或节律扣分。","未说明治疗适应证及耐受性仍需评估；不因未列顺铂累积剂量或其专门监测处方扣分。","未说明当前具体方案需待分期结果再定；不因未讨论放化疗后的辅助或巩固安排扣分。"]},"scoring_rules":{"item_scores":{"core_answer":[1.5,1.5,1.5,1.5],"key_evidence":[0.5,0.5,0.5,0.5],"conditional_modifiers":[0.5,0.5,0.5,0.5]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-c92ee86a5c6a23bf51ece1bd","case_id":"o1-case-b05a2d4a9c045d5437025b27","patient_id":"o1-patient-9fa1b46cba77ff44282e9d09","tag":"TX_GENERAL","question":"根据最新 NCCN 指南，结合当前资料，请制定该患者当前阶段的标准治疗策略，并注明主要指南依据、推荐等级及证据类别。","case_input":"【病情摘要】\n患者男，46岁。\n2023年底出现症状，病程第4天就诊。\n回吸性涕血6月。\n2023年底无明显诱因出现回吸性涕血，无头晕、头痛，无复视、视力模糊，无耳鸣、听力下降，无鼻塞、涕血，无面麻等不适，未予重视，逐渐加重。\n病程第0天某医院鼻咽镜：鼻咽肿物。未行治疗。\n治疗前鼻咽肿物活检：非角化性癌，EBER阳性。\n鼻咽及颈部MRI：病灶累及鼻咽及颅底骨质，其余邻近结构未见受侵；咽后及双侧颈部未见转移性淋巴结。\n全身PET/CT：未见远处转移。\n既往体健。\n有舅舅曾患鼻咽癌，至今死亡。\nT分期：T3\nN分期：N0\nM分期：M0\n总分期：II（AJCC第9版）","rubric_template_structured":{"total_score":10.0,"core_answer":["诊断/阶段：鼻咽非角化性癌，EBER阳性，治疗前分期为T3N0M0（AJCC第9版II期），按根治性治疗路径评估方案。","总体策略：根治性放疗联合同期系统治疗；治疗前评估PS、器官功能及整体耐受性。","强化治疗选择：有肿瘤负荷大、血EBV-DNA高等高危因素时考虑增加诱导或辅助化疗；本例未提供这些指标，不强制诱导或辅助。","指南依据：NCCN头颈部肿瘤V1.2026将T3N0M0的同期系统治疗/放疗列为2A类；有高危因素时考虑诱导或辅助，不套用其他分组的诱导首选1类或单纯同期放化疗2B类。"],"key_evidence":["诊断分期证据：鼻咽活检非角化性癌、EBER阳性；MRI示颅底骨侵犯，其余邻近结构未见受侵，咽后及双侧颈部无转移性淋巴结；全身PET/CT无远处转移，支持T3N0M0及AJCC第9版II期。","全身状况证据：46岁且既往体健，未提供正式PS、器官功能和治疗耐受评估，需治疗前完善。","指南证据：NCCN对T3N0M0采用同期系统治疗/放疗；增加诱导或辅助化疗需结合肿瘤负荷、血EBV-DNA等高危因素，不以EBER阳性本身替代高危评估。"],"conditional_modifiers":["不耐受顺铂时：如肾功能不全或听力受损，可多学科评估改用卡铂等或必要时仅行放疗。","个体化选择：评估肿瘤负荷、血EBV-DNA等高危因素及整体耐受性后，决定是否增加诱导或辅助化疗；现有年龄及既往体健不能替代顺铂资格评估。"],"negative_list":{"major_errors":["经评估适合联合系统治疗时，将单纯放疗列为T3N0M0的首选标准治疗；确有系统治疗不适用依据而评估单独放疗不因此扣分。","主路径为姑息为主、单药靶向/免疫且不联合放疗，或以根治性外科切除原发灶为主要治疗。","无视已明确的M0，将本例当作广泛转移性疾病制定全身姑息方案，忽略根治治疗目标。"],"minor_errors":["未说明同期放化疗主路径及选择依据；不因未增加诱导或辅助化疗扣分，选择强化治疗时需说明高危因素及耐受性评估依据。","未说明关键指南依据及NCCN类别/推荐等级。"]},"scoring_rules":{"item_scores":{"core_answer":[1.5,1.5,1.5,1.5],"key_evidence":[0.67,0.67,0.66],"conditional_modifiers":[1.0,1.0]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-42086b7cc2cd8f238aa4fd73","case_id":"o1-case-b05a2d4a9c045d5437025b27","patient_id":"o1-patient-9fa1b46cba77ff44282e9d09","tag":"TX_GENERAL","question":"根据最新 NCCN 指南，若按上述治疗策略进行治疗，请提供该患者的具体治疗方案及实施要点；如涉及系统治疗，请注明方案名称、药物组成、给药方式、频次及疗程；如涉及局部治疗，请注明主要干预手段。","case_input":"【病情摘要】\n患者男，46岁。\n2023年底出现症状，病程第4天就诊。\n回吸性涕血6月。\n2023年底无明显诱因出现回吸性涕血，无头晕、头痛，无复视、视力模糊，无耳鸣、听力下降，无鼻塞、涕血，无面麻等不适，未予重视，逐渐加重。\n病程第0天某医院鼻咽镜：鼻咽肿物。未行治疗。\n治疗前鼻咽肿物活检：非角化性癌，EBER阳性。\n鼻咽及颈部MRI：病灶累及鼻咽及颅底骨质，其余邻近结构未见受侵；咽后及双侧颈部未见转移性淋巴结。\n全身PET/CT：未见远处转移。\n既往体健。\n有舅舅曾患鼻咽癌，至今死亡。\nT分期：T3\nN分期：N0\nM分期：M0\n总分期：II（AJCC第9版）","rubric_template_structured":{"total_score":10.0,"core_answer":["总体策略：以根治性放疗联合同期系统治疗为对应分期的标准路径，实施前评估器官功能及耐受性；是否增加诱导或辅助化疗，应结合肿瘤负荷、血EBV-DNA等高危因素决定。","系统方案：以顺铂同期方案为主；高危因素评估支持且选择诱导时，可用GP（吉西他滨＋顺铂）或剂量调整TPF（多西他赛＋顺铂＋5-FU）；选择辅助时可用顺铂＋5-FU，不强制诱导或辅助。","实施要点：按所选同期治疗及有指征时增加的诱导或辅助方案，说明给药方式、频次、疗程及与放疗的先后顺序。","同步化疗：放疗同期静脉顺铂单药，可每3周大剂量或每周小剂量方案。","局部治疗：采用调强适形放疗（IMRT）根治照射，常规70–70.2 Gy照射高危靶区。"],"key_evidence":["系统治疗依据：T3N0M0的同期系统治疗/放疗路径为Category 2A，有高危因素时考虑诱导或辅助。GP及剂量调整TPF在EBV相关疾病的诱导药物方案中为Category 1，不等于本例必须诱导，治疗路径等级仍按对应分组判定。","同步化疗证据：NCCN推荐根治放疗应同步以顺铂为基础的系统治疗，可采用每3周或每周方案。","局部放疗证据：NCCN推荐IMRT作为鼻咽癌标准放疗技术，高危靶区处方剂量70–70.2 Gy为根治剂量。","治疗监测证据：放化疗期间应监测血常规、肝肾功能及黏膜炎等放射毒性，并给予营养与支持治疗。"],"conditional_modifiers":["顺铂不适用或不耐受时：经器官功能及整体耐受评估，可采用卡铂同期放疗；若选择辅助，可接卡铂＋5-FU；无法耐受系统治疗时可评估单独放疗。","毒性管理：如化疗毒副反应显著，可减量或延长给药间期，但需保证根治性IMRT放疗完整按期完成。"],"negative_list":{"major_errors":["将免疫或靶向治疗作为本期别首选一线系统治疗，违背NCCN推荐。","忽略根治性IMRT，改以姑息放疗、单纯化疗或首选外科手术作为主要治疗。","经评估适合联合系统治疗时，仅推荐单纯放疗而不说明同期系统治疗；不能仅凭既往体健认定顺铂资格，有明确系统治疗不适用依据时不因此扣分。"],"minor_errors":["采用同期化疗时未说明具体药物或未结合顺铂适用性说明药物选择；有依据采用卡铂替代不扣分。","未明确局部治疗为IMRT或未提及70–70.2 Gy级别根治剂量。","选择诱导时未说明具体药物组成及周期；采用GP或剂量调整TPF时应准确列明组成，未选择诱导不扣分。"]},"scoring_rules":{"item_scores":{"core_answer":[1.2,1.2,1.2,1.2,1.2],"key_evidence":[0.5,0.5,0.5,0.5],"conditional_modifiers":[1.0,1.0]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-4c38ab4d2c24fabc1cb3c9eb","case_id":"o1-case-679095fbab2483271dcd4c5b","patient_id":"o1-patient-6ad41a4d807449cd2f142a37","tag":"TX_GENERAL","question":"根据最新 NCCN 指南，结合当前资料，请制定该患者当前阶段的标准治疗策略，并注明主要指南依据、推荐等级及证据类别。","case_input":"【病情摘要】\n患者女，64岁。\n病程第0天就诊。\n左侧鼻塞伴耳鸣听力下降3月。\n3月前无明显诱因出现左侧鼻塞伴耳鸣听力下降，无头晕头痛、复视、视力模糊、涕血、面麻等不适，未予重视，逐渐加重。\n曾至某医院就诊，未行治疗。\n既往体健。\n否认家族中有恶性肿瘤病史。\nT分期：T3\nN分期：N1\n总分期：II","rubric_template_structured":{"total_score":10.0,"core_answer":["TNM分期：T3N1M0局部区域进展期鼻咽癌，无远处转移，以根治为目标","总体策略：首选进入临床试验或根治性放化疗为主的综合治疗","一线首选：诱导化疗序贯同步放化疗，为NCCN Category 1、Preferred路径","可选方案：同步放化疗序贯辅助化疗（Category 2A），或单纯同步放化疗（Category 2B）"],"key_evidence":["分期证据：女性64岁，临床分期T3N1M0，无远处转移，符合NCCN局部区域进展期（T3, N1-3, M0）根治路径","首选路径证据：NCCN推荐T3N1鼻咽癌首选“临床试验”或“诱导化疗+同步放化疗”为Preferred方案","指南依据：2025年NCCN将诱导后同期放化疗列为1类推荐；同期放化疗后辅助为2A类，单纯同期放化疗为2B类替代方案。"],"conditional_modifiers":["耐受性边界：体能差或肾功能等受限时，可在NCCN框架内减量或用卡铂等替代顺铂，调整诱导及同步放化疗方案","检测补充：治疗前可行EBV/DNA，条件允许时行NGS及CPS/TMB等检测，以规划后续系统治疗","随访要求：完成根治性治疗后，按NCCN进行规范随访，包括头颈查体、PET/CT或MRI及甲状腺等内分泌功能监测"],"negative_list":{"major_errors":["将单纯放疗、单纯化疗、单纯免疫/靶向或单纯手术作为本例首选标准方案","将本例误判为转移性或姑息阶段，未以根治为治疗目标","未提供合理的根治放化疗或临床试验路径，或严重误述证据等级；采用有依据的同期放化疗后辅助或单纯同期放化疗者，不因省略诱导而构成此错误。"],"minor_errors":["未明确本例治疗目标为根治性/治愈性","涉及诱导方案推荐级别时，未说明EBV状态及依据；选择同期放化疗后辅助或单纯同期放化疗时，不要求讨论未采用的诱导方案。","遗漏同步放化疗+辅助化疗与单纯同步放化疗等指南认可替代方案","未考虑放化疗耐受性对药物选择及剂量调整的条件性影响"]},"scoring_rules":{"item_scores":{"core_answer":[1.5,1.5,1.5,1.5],"key_evidence":[0.67,0.67,0.66],"conditional_modifiers":[0.67,0.67,0.66]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-6d01516a3aa6a05f4f25082d","case_id":"o1-case-679095fbab2483271dcd4c5b","patient_id":"o1-patient-6ad41a4d807449cd2f142a37","tag":"TX_GENERAL","question":"根据最新 NCCN 指南，若按上述治疗策略进行治疗，请提供该患者的具体治疗方案及实施要点；如涉及系统治疗，请注明方案名称、药物组成、给药方式、频次及疗程；如涉及局部治疗，请注明主要干预手段。","case_input":"【病情摘要】\n患者女，64岁。\n病程第0天就诊。\n左侧鼻塞伴耳鸣听力下降3月。\n3月前无明显诱因出现左侧鼻塞伴耳鸣听力下降，无头晕头痛、复视、视力模糊、涕血、面麻等不适，未予重视，逐渐加重。\n曾至某医院就诊，未行治疗。\n既往体健。\n否认家族中有恶性肿瘤病史。\nT分期：T3\nN分期：N1\n总分期：II","rubric_template_structured":{"total_score":10.0,"core_answer":["总体策略：以根治性放疗联合系统治疗为核心，首选诱导后同期放化疗；亦可依据病情和耐受选择同期放化疗后辅助，或单纯同期放化疗。","系统方案：选择诱导时首选GP（吉西他滨＋顺铂）或TPF（多西他赛＋顺铂＋氟尿嘧啶），NCCN对EBV相关病例为1类、非EBV相关为2A类；选择同期放化疗后辅助或单纯同期放化疗时，列明对应系统用药组成。","实施要点：采用诱导后同期路径时说明静脉给药和周期；采用同期放化疗后辅助或单纯同期放化疗时，说明对应系统治疗周期。","局部放疗：采用IMRT根治放疗，高危原发灶及受累淋巴结（高危PTV）处方总剂量70–70.2 Gy，1.8–2.0 Gy/次","同期系统治疗：放疗同期联合含铂化疗，推荐顺铂或卡铂，可按每周给药方案实施"],"key_evidence":["系统治疗证据：NCCN Nasopharynx 2025建议局部晚期首选含铂双药或三药诱导化疗（GP或TPF），序贯同期放化疗以提高局部及远处控制","放疗依据：NCCN放疗原则推荐IMRT保护危及器官，局部晚期高危靶区应给予70–70.2 Gy根治剂量。","同步化疗证据：诱导化疗后，同期系统治疗多采用单药顺铂或卡铂以起放疗增敏作用"],"conditional_modifiers":["顺铂不耐受时：因年龄、合并症或肾功能/听力受损不能用顺铂者，可在诱导或同步阶段改用卡铂并加强支持治疗","支持评估：放化疗前应行口腔/牙科评估、营养及吞咽功能评估，必要时预防性置管保障营养","EBV状态：根据EBV阳性与否评估诱导方案推荐级别，治疗中需监测血常规、肝肾功能和电解质"],"negative_list":{"major_errors":["未提出以根治性放疗联合系统治疗为核心的合理路径，如仅用单药免疫根治；有依据采用同期放化疗或同期放化疗后辅助者，不因省略诱导而构成此错误。","局部治疗路径错误，如将原发灶外科切除作为替代放疗的首选根治手段","放疗剂量明显低于根治剂量，仅给出姑息性低剂量放疗"],"minor_errors":["遗漏要点：未说明应采用IMRT，或未给出高危靶区70–70.2 Gy剂量范围","已选择诱导化疗，却未列GP、TPF等合理方案；选择同期放化疗后辅助或单纯同期放化疗者不适用。","遗漏要点：未指出放疗同期需联合铂类（顺铂或卡铂）系统治疗","遗漏要点：未提及放疗前口腔/牙科或营养支持相关评估"]},"scoring_rules":{"item_scores":{"core_answer":[1.2,1.2,1.2,1.2,1.2],"key_evidence":[0.67,0.67,0.66],"conditional_modifiers":[0.67,0.67,0.66]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-534caa03e307f0ac61263dd1","case_id":"o1-case-73b58ed147b8401f7d92952f","patient_id":"o1-patient-960b4a4e75fa19fd763ec6c9","tag":"TX_GENERAL","question":"根据最新 CSCO 指南，结合当前资料，请制定该患者当前阶段的标准治疗策略，并注明主要指南依据、推荐等级及证据类别。","case_input":"【病情摘要】\n患者女，52岁。\n1年余前出现症状，病程第0天外院就诊，病程第8天入院。\n右耳听力下降1年余。\n1年余前无明显诱因出现右耳听力下降、右耳鸣，1年以来逐渐出现左耳听力下降、晨起回吸性血涕，偶有头痛、颈部疼痛。\n病程第0天至某医院，行鼻咽镜检查示：鼻咽肿物。予行鼻咽肿物活检，病理报告示：（鼻咽肿物）异型上皮样细胞片状分布，伴大量急慢性炎细胞浸润至坏死，符合恶性肿瘤，考虑非角化性癌，建议免疫组化。CT：右侧咽隐窝变浅，可见肥大软组织影，右侧咽旁间隙变窄，右侧颈动脉鞘区可见多发明显肿大淋巴结影，骨窗示颅底骨质破坏。\n既往体健。\n否认家族中有恶性肿瘤病史。\nT分期：T3\nN分期：N1\n总分期：II","rubric_template_structured":{"total_score":10.0,"core_answer":["诊断/阶段：鼻咽活检符合恶性肿瘤，考虑非角化性癌，需免疫组化确认；CT有颅底骨质破坏及右颈淋巴结肿大，需完善分期后确定治疗。","总体策略：先补全病理类型确认、鼻咽及颈部评估与远处分期，再依据实际疾病范围和耐受性制定治疗；当前暂不指定诱导、同期或辅助组合即可。","指南依据：围绕CSCO诊断及分期评估原则说明当前应完善的检查，并注明所用版次；不以笼统的推荐等级或未经核实的治疗等级代替适用性判断，不强制为尚未确定的治疗路径列等级。"],"key_evidence":["病理依据：鼻咽活检已有恶性肿瘤证据，考虑非角化性癌且建议免疫组化；需补全病理类型确认，不能将已有恶性肿瘤证据写成完全缺失。","分期依据：颅底骨质破坏提示局部骨侵犯，右颈肿大淋巴结需结合完整影像进一步评估；缺少完整局部、颈部及远处分期资料，不能核定完整TNM及总期别。","指南适用：后续治疗路径需与确认的病理类型、实际分期及耐受性对应；现阶段先完善评估，不将某分期的强化放化疗推荐直接作为本例既定要求。"],"conditional_modifiers":["结果适配：待病理类型和分期明确后，再决定是否需要系统治疗及其顺序；当前暂不列具体药物、周期或给药强度亦可。","局部治疗：依据实际分期及适应证确定局部治疗目标和实施方式；当前先完善评估，不强制根治性放疗、同步化疗或具体放疗技术。","耐受性：既有听力下降应纳入药物选择和整体耐受评估；不能仅凭既往体健认定可耐受顺铂，当前不强制列替代药物。"],"negative_list":{"major_errors":["病理类型及完整分期未明确，即将某一固定抗肿瘤组合或根治方案作为本例已确定的标准治疗；先完善评估、暂不处方不扣分。","无相应证据即确定具体TNM、总期别或根治/姑息目标，并据此选择或排除治疗路径。","忽略已有恶性肿瘤病理，或将仍待确认的具体病理类型作为已确定事实。"],"minor_errors":["仅笼统写综合治疗，未说明需先完成病理类型确认及分期；不因未列诱导、同期或辅助阶段的顺序扣分。","未说明当前诊断分期评估的CSCO依据；不因未给尚未确定治疗路径的具体推荐等级或证据类别扣分。","未说明治疗适应证及耐受性仍需评估，或未结合已有听力下降；不因未列顺铂首选及替代方案扣分。"]},"scoring_rules":{"item_scores":{"core_answer":[2.0,2.0,2.0],"key_evidence":[0.67,0.67,0.66],"conditional_modifiers":[0.67,0.67,0.66]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-76b79c4d613a4fdecafa127a","case_id":"o1-case-73b58ed147b8401f7d92952f","patient_id":"o1-patient-960b4a4e75fa19fd763ec6c9","tag":"TX_GENERAL","question":"根据最新 CSCO 指南，若按上述治疗策略进行治疗，请提供该患者的具体治疗方案及实施要点；如涉及系统治疗，请注明方案名称、药物组成、给药方式、频次及疗程；如涉及局部治疗，请注明主要干预手段。","case_input":"【病情摘要】\n患者女，52岁。\n1年余前出现症状，病程第0天外院就诊，病程第8天入院。\n右耳听力下降1年余。\n1年余前无明显诱因出现右耳听力下降、右耳鸣，1年以来逐渐出现左耳听力下降、晨起回吸性血涕，偶有头痛、颈部疼痛。\n病程第0天至某医院，行鼻咽镜检查示：鼻咽肿物。予行鼻咽肿物活检，病理报告示：（鼻咽肿物）异型上皮样细胞片状分布，伴大量急慢性炎细胞浸润至坏死，符合恶性肿瘤，考虑非角化性癌，建议免疫组化。CT：右侧咽隐窝变浅，可见肥大软组织影，右侧咽旁间隙变窄，右侧颈动脉鞘区可见多发明显肿大淋巴结影，骨窗示颅底骨质破坏。\n既往体健。\n否认家族中有恶性肿瘤病史。\nT分期：T3\nN分期：N1\n总分期：II","rubric_template_structured":{"total_score":10.0,"core_answer":["总体策略：先完成病理类型确认、分期及耐受性评估，再确定治疗方案；当前不固定诱导、同期或辅助治疗路径。","病理实施：复核鼻咽活检并按病理建议完善免疫组化等类型确认检查；保留现有恶性肿瘤证据，不直接将考虑中的类型写成最终结论。","分期实施：完善鼻咽及颈部影像和远处转移评估，结合已有颅底骨质破坏与右颈肿大淋巴结，明确实际疾病范围后再定完整分期。","治疗实施边界：待病理类型、分期和适应证明确后，再确定系统治疗组成、顺序及局部治疗处方；当前暂不列药物、频次、疗程或根治放疗处方亦可。"],"key_evidence":["现有证据：鼻咽活检符合恶性肿瘤并考虑非角化性癌，影像已有颅底及右颈淋巴结异常；这些资料尚不能替代病理类型确认及完整分期。","指南依据：CSCO治疗推荐需匹配实际诊断及分期，当前先落实诊断分期评估；不以未经核实的强化治疗等级作为本例既定路径依据。","系统治疗依据：是否需要化疗、药物及强度需结合病理类型、分期与耐受性，已有听力下降应纳入评估；不预设顺铂资格或具体替代药物。","局部治疗依据：局部治疗目标、技术及处方需待分期与适应证明确后制定；当前不因未列调强技术、根治剂量或分割方式而否定先完善评估的方案。"],"conditional_modifiers":["方案前评估：根据后续实际治疗需要评估整体状况、骨髓及器官功能；当前说明需评估即可，不预设进入诱导化疗或确定剂量。","评估时点：后续疗效及毒性评估应随实际实施的治疗安排；当前先完成本次确诊分型与分期，不强制安排诱导后的评估节点。","听力与耐受：结合已有听力下降评估后续系统治疗可行性，必要时再按实际适应证调整药物；当前不强制列含铂替代方案。","放疗可行性：后续如需放疗，应评估局部治疗可行性并在计划中保护危及器官；当前说明待分期及适应证明确后再定即可，不强制处方剂量或分割。"],"negative_list":{"major_errors":["病理类型及完整分期未明确，即将根治放化疗或某一固定序贯组合确定为本例方案；先完成评估、暂不处方不扣分。","未确认实际诊断、分期及适应证，即将具体系统药物或固定组合定为本例标准治疗；明确实际适用前提的后续讨论不因此扣分。","无依据确定具体TNM、总期别或根治/姑息目标，并据此直接制定治疗。","忽略已有听力下降及必要耐受评估，直接认定本例可接受固定强度顺铂等治疗。"],"minor_errors":["当前评估及治疗决策步骤不清；不因未列诱导、同期或辅助阶段的顺序和实施参数扣分。","未说明需要完成病理类型确认；不因未列IMRT或根治剂量扣分。","未说明需要完善局部、颈部及远处分期；不因未列系统治疗周期、频次及疗程扣分。","未说明整体耐受及已有听力下降需评估；不因未列顺铂替代药物扣分。"]},"scoring_rules":{"item_scores":{"core_answer":[1.5,1.5,1.5,1.5],"key_evidence":[0.5,0.5,0.5,0.5],"conditional_modifiers":[0.5,0.5,0.5,0.5]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-bbd65c47e5a029ae54a42dad","case_id":"o1-case-69e9eb5e4bc33fcce7da0db6","patient_id":"o1-patient-f78784f2749c6bd6a67be60d","tag":"TX_GENERAL","question":"根据最新 NCCN 指南，结合当前资料，请制定该患者当前阶段的标准治疗策略，并注明主要指南依据、推荐等级及证据类别。","case_input":"【病情摘要】\n患者女，51岁。\n2019年1月出现症状，病程第1764天就诊。\n鼻咽癌5年余，治疗后复发2月。\n2019年1月患者无明显诱因出现喉咙疼痛。\n2019年1月某医院，确诊为鼻咽癌T2N1M0。于病程第0天、病程第21天予以2程多西他赛+卡铂化疗。于2020-4开始予以根治性放疗，2020年5月治疗结束。2024年8月于某医院复查，怀疑复发。\n活检病理示：鼻咽未分化型非角化性癌。\n高血压10年余。乙肝大三阳5年。\n否认家族中有恶性肿瘤病史。\n鼻咽癌T2N1M0。\n病程第0天、病程第21天予以2程多西他赛+卡铂化疗。于2020-4开始予以根治性放疗，2020年5月治疗结束。\nT分期：T1\nN分期：N0","rubric_template_structured":{"total_score":10.0,"core_answer":["总体策略：先行全面影像再分期（含PET/CT与头颈MRI），区分局限复发与远处转移","局部复发可切除：按NCCN鼻咽癌复发治疗路径，优先挽救性手术；必要时考虑术后再程放疗和/或全身治疗。","局部/区域复发不可切除：距首次放疗≥6个月时，可在有经验中心考虑再程放疗±全身治疗，参照NCCN建议","远处转移或不适合局部治疗：首选含铂为基础的全身系统治疗（含铂化疗±免疫治疗）或最佳支持治疗，按NCCN复发/转移一线策略","决策方式：所有方案基于MDT讨论，结合既往毒性及患者意愿个体化调整"],"key_evidence":["再分期证据：既往根治性放化疗后4年疑似复发，符合NCCN对复发/转移鼻咽癌需PET/CT、MRI等全面影像分期的要求","手术优先依据：NCCN建议，既往放疗后的局部/区域复发且病灶可切除时，首选挽救性手术。","再程放疗证据：患者距首次放疗>6个月，符合NCCN对再程放疗“首次放疗后≥6个月”时间门槛，可在有经验中心实施","全身治疗证据：NCCN对远处转移或不可局控者推荐含铂双药联合免疫治疗（如GP+特瑞普利单抗）作为Category 1/2A一线方案"],"conditional_modifiers":["资料不足时：未完成全面再分期前不应启动不可逆局部治疗，以免漏诊M1错失系统治疗时机","治疗前评估：结合病情评估EBV-DNA。","生物标志物评估：需指导治疗时，PD-L1及CPS采用免疫组化；TMB及其他基因改变可按需采用NGS等检测，不能将CPS写成NGS结果。","乙肝边界：乙肝大三阳患者使用免疫治疗或强免疫抑制方案前，应监测HBV DNA并预防性抗病毒","再程放疗边界：再程放疗须评估既往剂量与OAR耐受性，并充分告知严重晚期并发症风险，由经验丰富中心实施"],"negative_list":{"major_errors":["按初治局部晚期鼻咽癌路径制定方案而未识别复发/放疗后阶段","未要求再分期即直接判定仅可姑息全身治疗，放弃挽救性局部治疗机会","未评估可切除性，一概推荐单一固定治疗（仅手术、仅放疗或仅系统治疗）为标准路径","以未经验证靶向单药或非NCCN首选方案替代手术、再程放疗或含铂联合免疫系统治疗"],"minor_errors":["未提及需PET/CT或MRI等影像学检查进行再分期","提及再程放疗但未说明需结合既往放疗史及≥6个月时间间隔","未强调治疗决策需经MDT讨论","未提及乙肝大三阳对系统治疗选择及监测的影响"]},"scoring_rules":{"item_scores":{"core_answer":[1.2,1.2,1.2,1.2,1.2],"key_evidence":[0.5,0.5,0.5,0.5],"conditional_modifiers":[0.4,0.4,0.4,0.4,0.4]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
+{"item_id":"o1-item-c49ba0ecdf9ea9a6688d5dc8","case_id":"o1-case-69e9eb5e4bc33fcce7da0db6","patient_id":"o1-patient-f78784f2749c6bd6a67be60d","tag":"TX_GENERAL","question":"根据最新 NCCN 指南，若按上述治疗策略进行治疗，请提供该患者的具体治疗方案及实施要点；如涉及系统治疗，请注明方案名称、药物组成、给药方式、频次及疗程；如涉及局部治疗，请注明主要干预手段。","case_input":"【病情摘要】\n患者女，51岁。\n2019年1月出现症状，病程第1764天就诊。\n鼻咽癌5年余，治疗后复发2月。\n2019年1月患者无明显诱因出现喉咙疼痛。\n2019年1月某医院，确诊为鼻咽癌T2N1M0。于病程第0天、病程第21天予以2程多西他赛+卡铂化疗。于2020-4开始予以根治性放疗，2020年5月治疗结束。2024年8月于某医院复查，怀疑复发。\n活检病理示：鼻咽未分化型非角化性癌。\n高血压10年余。乙肝大三阳5年。\n否认家族中有恶性肿瘤病史。\n鼻咽癌T2N1M0。\n病程第0天、病程第21天予以2程多西他赛+卡铂化疗。于2020-4开始予以根治性放疗，2020年5月治疗结束。\nT分期：T1\nN分期：N0","rubric_template_structured":{"total_score":10.0,"core_answer":["局部手术：局限且可切除复发病灶行挽救性切除（如经鼻内镜鼻咽切除或颈淋巴结清扫）","局部放疗：不可切除但适合放疗时采用IMRT或质子高精度再程放疗","系统治疗：一线优选顺铂/吉西他滨 + 特瑞普利单抗，或含铂双药联合其他PD-1抑制剂","支持治疗：按周期给药并监测HBV-DNA和肝功能，加强营养与疼痛管理"],"key_evidence":["手术依据：NCCN头颈部肿瘤指南建议，既往放疗后复发且解剖可切除时，优先挽救手术以优化局部控制。","再程放疗依据：NCCN要求采用IMRT或质子治疗等高精度技术，兼顾治疗剂量与危及器官保护。","系统治疗依据：NCCN鼻咽癌指南将吉西他滨＋顺铂联合特瑞普利单抗列为无手术或放疗指征的复发/转移鼻咽癌一线首选，为1类推荐。","支持治疗证据：患者乙肝大三阳及高强度化疗/免疫背景下，NCCN免疫毒性与支持治疗指南强调需评估并监测肝功和HBV以防再激活"],"conditional_modifiers":["药物替代：顺铂不耐受或禁忌时，可在含铂双药方案中改用卡铂","免疫毒性：联合PD-1治疗时需全程警惕irAEs，乙肝大三阳患者要重点监测免疫相关肝损伤","体能差异：PS 3–4等不耐受联合强化治疗时，可改为单药化疗、姑息放疗或最佳支持治疗","放疗取舍：再程放疗存在黏膜坏死和大出血等高风险时，应权衡获益，必要时优先选择全身系统治疗"],"negative_list":{"major_errors":["局限可切除复发未提手术挽救而仅给不可逆单纯系统治疗","再程放疗推荐常规二维或低精度照射而不提IMRT/质子等高精度技术","将单药免疫或无NCCN推荐级别的探索性靶向组合列为一线首选并弱化含铂双药+PD-1地位","无视乙肝大三阳直接给高强度免疫联合化疗且未提示肝毒性与HBV再激活监测预防"],"minor_errors":["仅笼统写“化疗+免疫”未说明NCCN推荐基础组合如GP+PD-1","描述再程放疗时未提需控制正常组织和危及器官累积剂量","未提系统治疗给药周期及疗效/毒性评估安排","未提系统治疗或局部治疗同期的营养、疼痛等支持治疗"]},"scoring_rules":{"item_scores":{"core_answer":[1.5,1.5,1.5,1.5],"key_evidence":[0.5,0.5,0.5,0.5],"conditional_modifiers":[0.5,0.5,0.5,0.5]}},"formal_scorer_policy":"positive_minus_2major_1minor_no_minor_cap","scoring_rule":"final_score=max(0, positive_score - 2*major_error_hits - 1*minor_error_hits)"}}
diff --git a/O1/rubrics.jsonl b/O1/rubrics.jsonl
new file mode 100644
index 0000000000000000000000000000000000000000..915f77d9d16a7cb1daeb8513b09198c4abd13d75
--- /dev/null
+++ b/O1/rubrics.jsonl
@@ -0,0 +1,1726 @@
+{"rubric_id":"o1-item-bc8a8ffffdf84e723bc11793::core_answer::0","item_id":"o1-item-bc8a8ffffdf84e723bc11793","case_id":"o1-case-96da46650d70bb7c66a94275","patient_id":"o1-patient-d3eaa78b08ec4168c5a45e0d","tag":"AE_GENERAL","section":"core_answer","index":0,"criterion":"不良反应：皮肤瘙痒（pruritus）","points":3.0,"penalty":0.0,"scoring_effect":"positive","acceptable":[],"unacceptable":[]}
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+{"rubric_id":"o1-item-bc8a8ffffdf84e723bc11793::key_evidence::1","item_id":"o1-item-bc8a8ffffdf84e723bc11793","case_id":"o1-case-96da46650d70bb7c66a94275","patient_id":"o1-patient-d3eaa78b08ec4168c5a45e0d","tag":"AE_GENERAL","section":"key_evidence","index":1,"criterion":"分级证据：资料未提供瘙痒分布范围、持续时间、伴随皮疹情况","points":0.67,"penalty":0.0,"scoring_effect":"positive","acceptable":[],"unacceptable":[]}
+{"rubric_id":"o1-item-bc8a8ffffdf84e723bc11793::key_evidence::2","item_id":"o1-item-bc8a8ffffdf84e723bc11793","case_id":"o1-case-96da46650d70bb7c66a94275","patient_id":"o1-patient-d3eaa78b08ec4168c5a45e0d","tag":"AE_GENERAL","section":"key_evidence","index":2,"criterion":"分级证据：资料未见干预措施及对睡眠或日常生活影响等CTCAE分级所需信息","points":0.66,"penalty":0.0,"scoring_effect":"positive","acceptable":[],"unacceptable":[]}
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+{"rubric_id":"o1-item-c49ba0ecdf9ea9a6688d5dc8::key_evidence::2","item_id":"o1-item-c49ba0ecdf9ea9a6688d5dc8","case_id":"o1-case-69e9eb5e4bc33fcce7da0db6","patient_id":"o1-patient-f78784f2749c6bd6a67be60d","tag":"TX_GENERAL","section":"key_evidence","index":2,"criterion":"系统治疗依据：NCCN鼻咽癌指南将吉西他滨＋顺铂联合特瑞普利单抗列为无手术或放疗指征的复发/转移鼻咽癌一线首选，为1类推荐。","points":0.5,"penalty":0.0,"scoring_effect":"positive","acceptable":[],"unacceptable":[]}
+{"rubric_id":"o1-item-c49ba0ecdf9ea9a6688d5dc8::key_evidence::3","item_id":"o1-item-c49ba0ecdf9ea9a6688d5dc8","case_id":"o1-case-69e9eb5e4bc33fcce7da0db6","patient_id":"o1-patient-f78784f2749c6bd6a67be60d","tag":"TX_GENERAL","section":"key_evidence","index":3,"criterion":"支持治疗证据：患者乙肝大三阳及高强度化疗/免疫背景下，NCCN免疫毒性与支持治疗指南强调需评估并监测肝功和HBV以防再激活","points":0.5,"penalty":0.0,"scoring_effect":"positive","acceptable":[],"unacceptable":[]}
+{"rubric_id":"o1-item-c49ba0ecdf9ea9a6688d5dc8::conditional_modifiers::0","item_id":"o1-item-c49ba0ecdf9ea9a6688d5dc8","case_id":"o1-case-69e9eb5e4bc33fcce7da0db6","patient_id":"o1-patient-f78784f2749c6bd6a67be60d","tag":"TX_GENERAL","section":"conditional_modifiers","index":0,"criterion":"药物替代：顺铂不耐受或禁忌时，可在含铂双药方案中改用卡铂","points":0.5,"penalty":0.0,"scoring_effect":"positive","acceptable":[],"unacceptable":[]}
+{"rubric_id":"o1-item-c49ba0ecdf9ea9a6688d5dc8::conditional_modifiers::1","item_id":"o1-item-c49ba0ecdf9ea9a6688d5dc8","case_id":"o1-case-69e9eb5e4bc33fcce7da0db6","patient_id":"o1-patient-f78784f2749c6bd6a67be60d","tag":"TX_GENERAL","section":"conditional_modifiers","index":1,"criterion":"免疫毒性：联合PD-1治疗时需全程警惕irAEs，乙肝大三阳患者要重点监测免疫相关肝损伤","points":0.5,"penalty":0.0,"scoring_effect":"positive","acceptable":[],"unacceptable":[]}
+{"rubric_id":"o1-item-c49ba0ecdf9ea9a6688d5dc8::conditional_modifiers::2","item_id":"o1-item-c49ba0ecdf9ea9a6688d5dc8","case_id":"o1-case-69e9eb5e4bc33fcce7da0db6","patient_id":"o1-patient-f78784f2749c6bd6a67be60d","tag":"TX_GENERAL","section":"conditional_modifiers","index":2,"criterion":"体能差异：PS 3–4等不耐受联合强化治疗时，可改为单药化疗、姑息放疗或最佳支持治疗","points":0.5,"penalty":0.0,"scoring_effect":"positive","acceptable":[],"unacceptable":[]}
+{"rubric_id":"o1-item-c49ba0ecdf9ea9a6688d5dc8::conditional_modifiers::3","item_id":"o1-item-c49ba0ecdf9ea9a6688d5dc8","case_id":"o1-case-69e9eb5e4bc33fcce7da0db6","patient_id":"o1-patient-f78784f2749c6bd6a67be60d","tag":"TX_GENERAL","section":"conditional_modifiers","index":3,"criterion":"放疗取舍：再程放疗存在黏膜坏死和大出血等高风险时，应权衡获益，必要时优先选择全身系统治疗","points":0.5,"penalty":0.0,"scoring_effect":"positive","acceptable":[],"unacceptable":[]}
+{"rubric_id":"o1-item-c49ba0ecdf9ea9a6688d5dc8::major_errors::0","item_id":"o1-item-c49ba0ecdf9ea9a6688d5dc8","case_id":"o1-case-69e9eb5e4bc33fcce7da0db6","patient_id":"o1-patient-f78784f2749c6bd6a67be60d","tag":"TX_GENERAL","section":"major_errors","index":0,"criterion":"局限可切除复发未提手术挽救而仅给不可逆单纯系统治疗","points":0.0,"penalty":2.0,"scoring_effect":"major_penalty","acceptable":[],"unacceptable":[]}
+{"rubric_id":"o1-item-c49ba0ecdf9ea9a6688d5dc8::major_errors::1","item_id":"o1-item-c49ba0ecdf9ea9a6688d5dc8","case_id":"o1-case-69e9eb5e4bc33fcce7da0db6","patient_id":"o1-patient-f78784f2749c6bd6a67be60d","tag":"TX_GENERAL","section":"major_errors","index":1,"criterion":"再程放疗推荐常规二维或低精度照射而不提IMRT/质子等高精度技术","points":0.0,"penalty":2.0,"scoring_effect":"major_penalty","acceptable":[],"unacceptable":[]}
+{"rubric_id":"o1-item-c49ba0ecdf9ea9a6688d5dc8::major_errors::2","item_id":"o1-item-c49ba0ecdf9ea9a6688d5dc8","case_id":"o1-case-69e9eb5e4bc33fcce7da0db6","patient_id":"o1-patient-f78784f2749c6bd6a67be60d","tag":"TX_GENERAL","section":"major_errors","index":2,"criterion":"将单药免疫或无NCCN推荐级别的探索性靶向组合列为一线首选并弱化含铂双药+PD-1地位","points":0.0,"penalty":2.0,"scoring_effect":"major_penalty","acceptable":[],"unacceptable":[]}
+{"rubric_id":"o1-item-c49ba0ecdf9ea9a6688d5dc8::major_errors::3","item_id":"o1-item-c49ba0ecdf9ea9a6688d5dc8","case_id":"o1-case-69e9eb5e4bc33fcce7da0db6","patient_id":"o1-patient-f78784f2749c6bd6a67be60d","tag":"TX_GENERAL","section":"major_errors","index":3,"criterion":"无视乙肝大三阳直接给高强度免疫联合化疗且未提示肝毒性与HBV再激活监测预防","points":0.0,"penalty":2.0,"scoring_effect":"major_penalty","acceptable":[],"unacceptable":[]}
+{"rubric_id":"o1-item-c49ba0ecdf9ea9a6688d5dc8::minor_errors::0","item_id":"o1-item-c49ba0ecdf9ea9a6688d5dc8","case_id":"o1-case-69e9eb5e4bc33fcce7da0db6","patient_id":"o1-patient-f78784f2749c6bd6a67be60d","tag":"TX_GENERAL","section":"minor_errors","index":0,"criterion":"仅笼统写“化疗+免疫”未说明NCCN推荐基础组合如GP+PD-1","points":0.0,"penalty":1.0,"scoring_effect":"minor_penalty","acceptable":[],"unacceptable":[]}
+{"rubric_id":"o1-item-c49ba0ecdf9ea9a6688d5dc8::minor_errors::1","item_id":"o1-item-c49ba0ecdf9ea9a6688d5dc8","case_id":"o1-case-69e9eb5e4bc33fcce7da0db6","patient_id":"o1-patient-f78784f2749c6bd6a67be60d","tag":"TX_GENERAL","section":"minor_errors","index":1,"criterion":"描述再程放疗时未提需控制正常组织和危及器官累积剂量","points":0.0,"penalty":1.0,"scoring_effect":"minor_penalty","acceptable":[],"unacceptable":[]}
+{"rubric_id":"o1-item-c49ba0ecdf9ea9a6688d5dc8::minor_errors::2","item_id":"o1-item-c49ba0ecdf9ea9a6688d5dc8","case_id":"o1-case-69e9eb5e4bc33fcce7da0db6","patient_id":"o1-patient-f78784f2749c6bd6a67be60d","tag":"TX_GENERAL","section":"minor_errors","index":2,"criterion":"未提系统治疗给药周期及疗效/毒性评估安排","points":0.0,"penalty":1.0,"scoring_effect":"minor_penalty","acceptable":[],"unacceptable":[]}
+{"rubric_id":"o1-item-c49ba0ecdf9ea9a6688d5dc8::minor_errors::3","item_id":"o1-item-c49ba0ecdf9ea9a6688d5dc8","case_id":"o1-case-69e9eb5e4bc33fcce7da0db6","patient_id":"o1-patient-f78784f2749c6bd6a67be60d","tag":"TX_GENERAL","section":"minor_errors","index":3,"criterion":"未提系统治疗或局部治疗同期的营养、疼痛等支持治疗","points":0.0,"penalty":1.0,"scoring_effect":"minor_penalty","acceptable":[],"unacceptable":[]}
diff --git a/README.md b/README.md
new file mode 100644
index 0000000000000000000000000000000000000000..93b8587e20329409893f0207a19f4526ba0560f3
--- /dev/null
+++ b/README.md
@@ -0,0 +1,92 @@
+---
+pretty_name: NPCBench
+license: cc-by-4.0
+configs:
+- config_name: L1
+  data_files:
+  - split: test
+    path: L1/questions.jsonl
+- config_name: L2
+  data_files:
+  - split: test
+    path: L2/questions.jsonl
+- config_name: L3-Path
+  data_files:
+  - split: test
+    path: L3/Path.jsonl
+- config_name: L3-Seq
+  data_files:
+  - split: test
+    path: L3/Seq.jsonl
+- config_name: L3-Struct
+  data_files:
+  - split: test
+    path: L3/Struct.jsonl
+- config_name: L4
+  data_files:
+  - split: test
+    path: L4/questions.jsonl
+- config_name: L5
+  data_files:
+  - split: test
+    path: L5/questions.jsonl
+- config_name: O1
+  data_files:
+  - split: test
+    path: O1/questions.jsonl
+- config_name: L3-T400
+  data_files:
+  - split: test
+    path: L3/T400.jsonl
+- config_name: L3-N400
+  data_files:
+  - split: test
+    path: L3/N400.jsonl
+language:
+- en
+- zh
+tags:
+- medical
+- benchmark
+- multimodal
+- nasopharyngeal-carcinoma
+---
+# NPCBench
+
+NPCBench evaluates guideline knowledge, image interpretation, care decisions,
+and specialist consultation in nasopharyngeal carcinoma.
+
+[Paper](https://openreview.net/forum?id=AVTJEREEah) · [Evaluation code](https://github.com/pidneuralode/NPCBench)
+
+## Tasks
+
+- **L1 and L2** contain 250 guideline questions and 185 application questions.
+- **L3** contains pathology, MRI sequence recognition, structure assessment, and T400/N400 staging. T400 uses structure cards for 100 patients and sequence groups for 300. N400 uses sequence groups from a disjoint cohort.
+- **L4 and L5** contain 165 planning questions and 305 longitudinal decisions, respectively.
+- **L6** covers 100 patients and 417 scored tasks (100 pathology assessments, 100 MRI T assessments, and 217 care decisions). The archive records six excluded treatment questions and their reasons.
+- **O1** contains 103 consultations from 42 cases and 1,726 scoring criteria.
+
+## Download
+
+```sh
+hf download pengkaiScience/NPCBench L2/questions.jsonl --repo-type dataset --local-dir data
+```
+
+For image tasks, see the [L3 data guide](L3/README.md) and the
+[CarePath guide](L6/full100_inputs_scored217/README.md). They give archive paths
+and the information needed to match images, prompts, and labels.
+[Supplementary data](supplementary/README.md) cover input controls, external MRI,
+cine, and physician calibration.
+
+## Use
+
+The release uses de-identified clinical inputs. L4 retains dates needed to apply
+the relevant guideline edition. Longitudinal tasks use patient-relative days
+where applicable. Ethics approval is documented under IRB B2026-465-01.
+NPCBench is intended for research evaluation. Retrospective, disease-specific
+sampling and differences in image formats affect how scores should be interpreted.
+
+Original data and annotations use [CC BY 4.0](LICENSE-DATA.md). Third-party
+materials retain their terms. Please cite the paper when using the dataset.
+
+Only fields used to present, group, or score questions are included. Clinical timelines and staging editions are part of the questions. The scoring code is available in the linked GitHub repository.
diff --git a/THIRD_PARTY_NOTICES.md b/THIRD_PARTY_NOTICES.md
new file mode 100644
index 0000000000000000000000000000000000000000..813b061a32a1dfb00cba69ac4a91caf14d7b4719
--- /dev/null
+++ b/THIRD_PARTY_NOTICES.md
@@ -0,0 +1,12 @@
+# Third-party sources
+
+NPCBench's original questions, annotations and authorized de-identified clinical
+derivatives are licensed under CC BY 4.0.
+
+CSCO, NCCN, AJCC/UICC and cited publications informed the benchmark questions and
+reference reasoning. Their original publications retain their own copyright and
+license terms. NPCBench does not distribute or relicense complete guideline books.
+Available source attribution is retained in the question records.
+
+The evaluation software and its third-party software notices are provided in the
+[code repository](https://github.com/pidneuralode/NPCBench).
diff --git a/supplementary/README.md b/supplementary/README.md
new file mode 100644
index 0000000000000000000000000000000000000000..c3c957b61ee86537aaa51ae5195756a58384523d
--- /dev/null
+++ b/supplementary/README.md
@@ -0,0 +1,9 @@
+# Supplementary data
+
+- `option_free/` holds 71 matched guideline questions with and without options.
+- `l5_history/` holds history and interaction controls for longitudinal decisions.
+- `carepath25/` and `carepath_history/` hold evidence and history controls. The paired evidence analysis uses 146 care questions from 25 patients in the CarePath cohort.
+- `full100_schema/` holds the CarePath MRI response-format control.
+- `external_mri/` holds the independent 53-case T-stage panel.
+- `mri_cine/` holds cine inputs and frame correspondence.
+- `physician_calibration/` holds specialist and judge labels on consultation criteria.
diff --git a/supplementary/carepath25/canonical_packed.jsonl b/supplementary/carepath25/canonical_packed.jsonl
new file mode 100644
index 0000000000000000000000000000000000000000..f76260b444064a7316a075e1d8b3a5d26daada19
--- /dev/null
+++ b/supplementary/carepath25/canonical_packed.jsonl
@@ -0,0 +1,146 @@
+{"sample_id":"sample-c56105087904f0da386b7001","patient_id":"patient-5fa48522b2703f35ead0224b","turn_id":"turn02","turn_position":1,"turn_type":"imaging_release_workup","gold_letter":"J","gold_action":"行颈部淋巴结穿刺活检或鼻咽镜活检以明确病理诊断，并完善全身分期检查（如胸腹部CT、骨扫描或PET-CT）。","options":[{"letter":"A","text":"完善血浆EBV-DNA检测，若结果阳性则临床确诊鼻咽癌并启动根治性放疗","is_gold":false},{"letter":"B","text":"行鼻咽肿物开放性切除活检以明确病理诊断，并完善胸腹部CT及骨扫描","is_gold":false},{"letter":"C","text":"行颈部淋巴结切除活检以明确病理诊断，暂缓全身远处转移排查","is_gold":false},{"letter":"D","text":"行颈部淋巴结细针穿刺细胞学检查（FNAC）作为最终确诊依据，并完善全身分期检查","is_gold":false},{"letter":"E","text":"行鼻咽镜下活检以明确病理诊断，无需常规进行胸腹部影像学分期","is_gold":false},{"letter":"F","text":"优先行全身PET-CT检查，若无远处转移则直接开始诱导化疗","is_gold":false},{"letter":"G","text":"行双侧颈部淋巴结清扫术并送常规病理，确诊后安排术后放疗","is_gold":false},{"letter":"H","text":"行鼻咽镜下活检以明确病理诊断，并仅行头颈部增强CT以补充评估颅底骨质破坏","is_gold":false},{"letter":"I","text":"行鼻咽镜下活检以明确病理诊断，并直接安排诱导化疗，化疗后补充全身分期检查","is_gold":false},{"letter":"J","text":"行颈部淋巴结穿刺活检或鼻咽镜活检以明确病理诊断，并完善全身分期检查","is_gold":true},{"letter":"K","text":"密切观察鼻咽部病灶及颈部淋巴结变化，1个月后复查头颈部MRI决定是否活检","is_gold":false},{"letter":"L","text":"行颈部淋巴结穿刺活检，确诊后直接启动根治性放疗，无需全身分期检查","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、斜坡、口咽、蝶骨基底部、岩尖。\n文本分期信息：N2，Mx 左侧腋窝淋巴结可疑转移。\n综合TNM状态：T3N2Mx 左侧腋窝淋巴结可疑转移。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 正常范围心电图\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽左顶壁、左顶后壁、左侧壁增厚，并见团块状软组织信号影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，鼻咽右侧壁粘膜未见增厚，左侧咽隐窝闭塞，右侧咽隐窝存在，左侧咽旁脂肪间隙狭窄。左侧腭帆提肌、腭帆张肌、头长肌、翼内肌受侵犯，余咽旁诸肌未见异常； 左侧咽后见肿大的淋巴结，短径22mm，右侧咽后见小淋巴结，短径5mm。 病灶向前堵塞左侧后鼻孔，口咽左侧壁受侵增厚。 左侧翼腭窝软组织影稍增多，右侧翼腭窝、双侧颞下窝未见异常。 蝶骨基底部、斜坡左侧份、左侧岩尖骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、上颌窦粘膜增厚；蝶窦、双侧乳突气化良好，未见异常信号影；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。 双颈II区、左颈III区见多个淋巴结，较大者短径24mm，信号欠均匀，增强扫描不均匀强化。；检查结论: 鼻咽左顶后壁、左侧壁病灶，考虑鼻咽癌，侵犯左侧咽旁、口咽左侧壁。 颅底骨质破坏。 双侧咽后、双颈II区、左颈III区淋巴结，考虑转移瘤。 副鼻窦炎。\n- [全程D5] 检验组合: 红细胞比容(Hct)-静脉血: 38.9%；血红蛋白(Hb)-静脉血: 131.6g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.5mmolL；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；总蛋白(TP)-静脉血: 69.64g/L；总钙(Ca)-静脉血: 2.26mmol/L；白蛋白(ALB)-静脉血: 43.1g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.42mmol/L；磷(P)-静脉血: 1.22mmol/L；凝血酶时间(TT)-静脉血: 17.3sec.；淋巴细胞百分比(Lymph%)-静脉血: 0.325；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；钠离子(Na+)-静脉血: 140.5mmol/L；单核细胞百分比(Mono%)-静脉血: 0.0954；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；载脂蛋白AI(apoAI)-静脉血: 1.38g/L；丙氨酸氨基转移酶(ALT)-静脉血: 21.7U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；氯离子(Cl-)-静脉血: 103.9mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；血小板计数(PLT#)-静脉血: 270.910E9/L；总胆固醇(TC)-静脉血: 5.3mmol/L；C-反应蛋白(CRP)-静脉血: 0.37mg/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.69mmol/L；甘油三酯(TG)-静脉血: 0.78mmol/L；淋巴细胞计数(Lymph#)-静脉血: 210E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.568；凝血酶原时间活动度(PTA)-静脉血: 94%；活化部分凝血活酶时间(APTT)-静脉血: 25.3sec.；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；平均红细胞血红蛋白含量(MCH)-静脉血: 30.2pg；凝血酶原时间(PT)-静脉血: 11.4sec.；纤维蛋白原(Fbg)-静脉血: 2.62g/L；天门冬氨酸氨基转移酶/丙氨酸氨……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善血浆EBV-DNA检测，若结果阳性则临床确诊鼻咽癌并启动根治性放疗\nB. 行鼻咽肿物开放性切除活检以明确病理诊断，并完善胸腹部CT及骨扫描\nC. 行颈部淋巴结切除活检以明确病理诊断，暂缓全身远处转移排查\nD. 行颈部淋巴结细针穿刺细胞学检查（FNAC）作为最终确诊依据，并完善全身分期检查\nE. 行鼻咽镜下活检以明确病理诊断，无需常规进行胸腹部影像学分期\nF. 优先行全身PET-CT检查，若无远处转移则直接开始诱导化疗\nG. 行双侧颈部淋巴结清扫术并送常规病理，确诊后安排术后放疗\nH. 行鼻咽镜下活检以明确病理诊断，并仅行头颈部增强CT以补充评估颅底骨质破坏\nI. 行鼻咽镜下活检以明确病理诊断，并直接安排诱导化疗，化疗后补充全身分期检查\nJ. 行颈部淋巴结穿刺活检或鼻咽镜活检以明确病理诊断，并完善全身分期检查\nK. 密切观察鼻咽部病灶及颈部淋巴结变化，1个月后复查头颈部MRI决定是否活检\nL. 行颈部淋巴结穿刺活检，确诊后直接启动根治性放疗，无需全身分期检查\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、斜坡、口咽、蝶骨基底部、岩尖。\n文本分期信息：N2，Mx 左侧腋窝淋巴结可疑转移。\n综合TNM状态：T3N2Mx 左侧腋窝淋巴结可疑转移。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 正常范围心电图\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽左顶壁、左顶后壁、左侧壁增厚，并见团块状软组织信号影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，鼻咽右侧壁粘膜未见增厚，左侧咽隐窝闭塞，右侧咽隐窝存在，左侧咽旁脂肪间隙狭窄。左侧腭帆提肌、腭帆张肌、头长肌、翼内肌受侵犯，余咽旁诸肌未见异常； 左侧咽后见肿大的淋巴结，短径22mm，右侧咽后见小淋巴结，短径5mm。 病灶向前堵塞左侧后鼻孔，口咽左侧壁受侵增厚。 左侧翼腭窝软组织影稍增多，右侧翼腭窝、双侧颞下窝未见异常。 蝶骨基底部、斜坡左侧份、左侧岩尖骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、上颌窦粘膜增厚；蝶窦、双侧乳突气化良好，未见异常信号影；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。 双颈II区、左颈III区见多个淋巴结，较大者短径24mm，信号欠均匀，增强扫描不均匀强化。；检查结论: 鼻咽左顶后壁、左侧壁病灶，考虑鼻咽癌，侵犯左侧咽旁、口咽左侧壁。 颅底骨质破坏。 双侧咽后、双颈II区、左颈III区淋巴结，考虑转移瘤。 副鼻窦炎。\n- [全程D5] 检验组合: 红细胞比容(Hct)-静脉血: 38.9%；血红蛋白(Hb)-静脉血: 131.6g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.5mmolL；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；总蛋白(TP)-静脉血: 69.64g/L；总钙(Ca)-静脉血: 2.26mmol/L；白蛋白(ALB)-静脉血: 43.1g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.42mmol/L；磷(P)-静脉血: 1.22mmol/L；凝血酶时间(TT)-静脉血: 17.3sec.；淋巴细胞百分比(Lymph%)-静脉血: 0.325；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；钠离子(Na+)-静脉血: 140.5mmol/L；单核细胞百分比(Mono%)-静脉血: 0.0954；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；载脂蛋白AI(apoAI)-静脉血: 1.38g/L；丙氨酸氨基转移酶(ALT)-静脉血: 21.7U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；氯离子(Cl-)-静脉血: 103.9mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；血小板计数(PLT#)-静脉血: 270.910E9/L；总胆固醇(TC)-静脉血: 5.3mmol/L；C-反应蛋白(CRP)-静脉血: 0.37mg/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.69mmol/L；甘油三酯(TG)-静脉血: 0.78mmol/L；淋巴细胞计数(Lymph#)-静脉血: 210E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.568；凝血酶原时间活动度(PTA)-静脉血: 94%；活化部分凝血活酶时间(APTT)-静脉血: 25.3sec.；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；平均红细胞血红蛋白含量(MCH)-静脉血: 30.2pg；凝血酶原时间(PT)-静脉血: 11.4sec.；纤维蛋白原(Fbg)-静脉血: 2.62g/L；天门冬氨酸氨基转移酶/丙氨酸氨……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善血浆EBV-DNA检测，若结果阳性则临床确诊鼻咽癌并启动根治性放疗\nB. 行鼻咽肿物开放性切除活检以明确病理诊断，并完善胸腹部CT及骨扫描\nC. 行颈部淋巴结切除活检以明确病理诊断，暂缓全身远处转移排查\nD. 行颈部淋巴结细针穿刺细胞学检查（FNAC）作为最终确诊依据，并完善全身分期检查\nE. 行鼻咽镜下活检以明确病理诊断，无需常规进行胸腹部影像学分期\nF. 优先行全身PET-CT检查，若无远处转移则直接开始诱导化疗\nG. 行双侧颈部淋巴结清扫术并送常规病理，确诊后安排术后放疗\nH. 行鼻咽镜下活检以明确病理诊断，并仅行头颈部增强CT以补充评估颅底骨质破坏\nI. 行鼻咽镜下活检以明确病理诊断，并直接安排诱导化疗，化疗后补充全身分期检查\nJ. 行颈部淋巴结穿刺活检或鼻咽镜活检以明确病理诊断，并完善全身分期检查\nK. 密切观察鼻咽部病灶及颈部淋巴结变化，1个月后复查头颈部MRI决定是否活检\nL. 行颈部淋巴结穿刺活检，确诊后直接启动根治性放疗，无需全身分期检查\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-9b76347b9a2749777a06cd80","patient_id":"patient-5fa48522b2703f35ead0224b","turn_id":"turn04","turn_position":2,"turn_type":"initial_treatment_selection","gold_letter":"L","gold_action":"诱导化疗（顺铂+氟尿嘧啶方案）","options":[{"letter":"A","text":"同步放化疗（顺铂单药方案）","is_gold":false},{"letter":"B","text":"诱导化疗（吉西他滨+顺铂方案）联合PD-1抑制剂","is_gold":false},{"letter":"C","text":"根治性放疗联合辅助化疗（顺铂+氟尿嘧啶方案）","is_gold":false},{"letter":"D","text":"诱导化疗（紫杉醇+卡铂方案）","is_gold":false},{"letter":"E","text":"诱导化疗（多西他赛+顺铂+氟尿嘧啶方案）联合西妥昔单抗","is_gold":false},{"letter":"F","text":"根治性放疗（单纯放疗）","is_gold":false},{"letter":"G","text":"诱导化疗（卡培他滨单药方案）","is_gold":false},{"letter":"H","text":"靶向治疗（尼妥珠单抗）联合同步放化疗","is_gold":false},{"letter":"I","text":"诱导化疗（依托泊苷+顺铂方案）","is_gold":false},{"letter":"J","text":"姑息性化疗（顺铂+氟尿嘧啶方案）","is_gold":false},{"letter":"K","text":"诱导化疗（顺铂单药方案）","is_gold":false},{"letter":"L","text":"诱导化疗（顺铂+氟尿嘧啶方案）","is_gold":true}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、斜坡、口咽、蝶骨基底部、岩尖。\n文本分期信息：N2，Mx 左侧腋窝淋巴结可疑转移。\n综合TNM状态：T3N2Mx 左侧腋窝淋巴结可疑转移。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 正常范围心电图\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽左顶壁、左顶后壁、左侧壁增厚，并见团块状软组织信号影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，鼻咽右侧壁粘膜未见增厚，左侧咽隐窝闭塞，右侧咽隐窝存在，左侧咽旁脂肪间隙狭窄。左侧腭帆提肌、腭帆张肌、头长肌、翼内肌受侵犯，余咽旁诸肌未见异常； 左侧咽后见肿大的淋巴结，短径22mm，右侧咽后见小淋巴结，短径5mm。 病灶向前堵塞左侧后鼻孔，口咽左侧壁受侵增厚。 左侧翼腭窝软组织影稍增多，右侧翼腭窝、双侧颞下窝未见异常。 蝶骨基底部、斜坡左侧份、左侧岩尖骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、上颌窦粘膜增厚；蝶窦、双侧乳突气化良好，未见异常信号影；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。 双颈II区、左颈III区见多个淋巴结，较大者短径24mm，信号欠均匀，增强扫描不均匀强化。；检查结论: 鼻咽左顶后壁、左侧壁病灶，考虑鼻咽癌，侵犯左侧咽旁、口咽左侧壁。 颅底骨质破坏。 双侧咽后、双颈II区、左颈III区淋巴结，考虑转移瘤。 副鼻窦炎。\n- [全程D5] 检验组合: 红细胞比容(Hct)-静脉血: 38.9%；血红蛋白(Hb)-静脉血: 131.6g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.5mmolL；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；总蛋白(TP)-静脉血: 69.64g/L；总钙(Ca)-静脉血: 2.26mmol/L；白蛋白(ALB)-静脉血: 43.1g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.42mmol/L；磷(P)-静脉血: 1.22mmol/L；凝血酶时间(TT)-静脉血: 17.3sec.；淋巴细胞百分比(Lymph%)-静脉血: 0.325；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；钠离子(Na+)-静脉血: 140.5mmol/L；单核细胞百分比(Mono%)-静脉血: 0.0954；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；载脂蛋白AI(apoAI)-静脉血: 1.38g/L；丙氨酸氨基转移酶(ALT)-静脉血: 21.7U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；氯离子(Cl-)-静脉血: 103.9mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；血小板计数(PLT#)-静脉血: 270.910E9/L；总胆固醇(TC)-静脉血: 5.3mmol/L；C-反应蛋白(CRP)-静脉血: 0.37mg/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.69mmol/L；甘油三酯(TG)-静脉血: 0.78mmol/L；淋巴细胞计数(Lymph#)-静脉血: 210E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.568；凝血酶原时间活动度(PTA)-静脉血: 94%；活化部分凝血活酶时间(APTT)-静脉血: 25.3sec.；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；平均红细胞血红蛋白含量(MCH)-静脉血: 30.2pg；凝血酶原时间(PT)-静脉血: 11.4sec.；纤维蛋白原(Fbg)-静脉血: 2.62g/L；天门冬氨酸氨基转移酶/丙氨酸氨……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D8] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见:；检查结论:\n- [全程D14] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；透明质酸(HA)-静脉血: 76.89ng/ml；III型前胶原氨基端肽(PIIINP)-静脉血: 28.08ng/ml；葡萄糖(Glu)-尿液: -（参考: 阴性）；降钙素(CT)-静脉血: 22.05pg/ml；总蛋白(TP)-尿液: -（参考: 阴性）；IV型胶原(C-IV)-静脉血: 28.93ng/ml；比重(SG)-尿液: 1.008；颜色-尿液: 无色；酸碱度(pH)-尿液: 6.5；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；层粘连蛋白(LN)-静脉血: 35.29ng/ml；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮\n- [全程D15] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T6水平，估计导管末端位于上腔静脉内。；检查结论: PICC管末端位置如上述。\n- [全程D15] 检验组合: 骨钙素N端中分子片段(N-MID)-静脉血: 11.9ng/ml；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.318ng/ml\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 同步放化疗（顺铂单药方案）\nB. 诱导化疗（吉西他滨+顺铂方案）联合PD-1抑制剂\nC. 根治性放疗联合辅助化疗（顺铂+氟尿嘧啶方案）\nD. 诱导化疗（紫杉醇+卡铂方案）\nE. 诱导化疗（多西他赛+顺铂+氟尿嘧啶方案）联合西妥昔单抗\nF. 根治性放疗（单纯放疗）\nG. 诱导化疗（卡培他滨单药方案）\nH. 靶向治疗（尼妥珠单抗）联合同步放化疗\nI. 诱导化疗（依托泊苷+顺铂方案）\nJ. 姑息性化疗（顺铂+氟尿嘧啶方案）\nK. 诱导化疗（顺铂单药方案）\nL. 诱导化疗（顺铂+氟尿嘧啶方案）\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、斜坡、口咽、蝶骨基底部、岩尖。\n文本分期信息：N2，Mx 左侧腋窝淋巴结可疑转移。\n综合TNM状态：T3N2Mx 左侧腋窝淋巴结可疑转移。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 正常范围心电图\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽左顶壁、左顶后壁、左侧壁增厚，并见团块状软组织信号影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，鼻咽右侧壁粘膜未见增厚，左侧咽隐窝闭塞，右侧咽隐窝存在，左侧咽旁脂肪间隙狭窄。左侧腭帆提肌、腭帆张肌、头长肌、翼内肌受侵犯，余咽旁诸肌未见异常； 左侧咽后见肿大的淋巴结，短径22mm，右侧咽后见小淋巴结，短径5mm。 病灶向前堵塞左侧后鼻孔，口咽左侧壁受侵增厚。 左侧翼腭窝软组织影稍增多，右侧翼腭窝、双侧颞下窝未见异常。 蝶骨基底部、斜坡左侧份、左侧岩尖骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、上颌窦粘膜增厚；蝶窦、双侧乳突气化良好，未见异常信号影；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。 双颈II区、左颈III区见多个淋巴结，较大者短径24mm，信号欠均匀，增强扫描不均匀强化。；检查结论: 鼻咽左顶后壁、左侧壁病灶，考虑鼻咽癌，侵犯左侧咽旁、口咽左侧壁。 颅底骨质破坏。 双侧咽后、双颈II区、左颈III区淋巴结，考虑转移瘤。 副鼻窦炎。\n- [全程D5] 检验组合: 红细胞比容(Hct)-静脉血: 38.9%；血红蛋白(Hb)-静脉血: 131.6g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.5mmolL；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；总蛋白(TP)-静脉血: 69.64g/L；总钙(Ca)-静脉血: 2.26mmol/L；白蛋白(ALB)-静脉血: 43.1g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.42mmol/L；磷(P)-静脉血: 1.22mmol/L；凝血酶时间(TT)-静脉血: 17.3sec.；淋巴细胞百分比(Lymph%)-静脉血: 0.325；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；钠离子(Na+)-静脉血: 140.5mmol/L；单核细胞百分比(Mono%)-静脉血: 0.0954；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；载脂蛋白AI(apoAI)-静脉血: 1.38g/L；丙氨酸氨基转移酶(ALT)-静脉血: 21.7U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；氯离子(Cl-)-静脉血: 103.9mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；血小板计数(PLT#)-静脉血: 270.910E9/L；总胆固醇(TC)-静脉血: 5.3mmol/L；C-反应蛋白(CRP)-静脉血: 0.37mg/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.69mmol/L；甘油三酯(TG)-静脉血: 0.78mmol/L；淋巴细胞计数(Lymph#)-静脉血: 210E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.568；凝血酶原时间活动度(PTA)-静脉血: 94%；活化部分凝血活酶时间(APTT)-静脉血: 25.3sec.；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；平均红细胞血红蛋白含量(MCH)-静脉血: 30.2pg；凝血酶原时间(PT)-静脉血: 11.4sec.；纤维蛋白原(Fbg)-静脉血: 2.62g/L；天门冬氨酸氨基转移酶/丙氨酸氨……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D8] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见:；检查结论:\n- [全程D14] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；透明质酸(HA)-静脉血: 76.89ng/ml；III型前胶原氨基端肽(PIIINP)-静脉血: 28.08ng/ml；葡萄糖(Glu)-尿液: -（参考: 阴性）；降钙素(CT)-静脉血: 22.05pg/ml；总蛋白(TP)-尿液: -（参考: 阴性）；IV型胶原(C-IV)-静脉血: 28.93ng/ml；比重(SG)-尿液: 1.008；颜色-尿液: 无色；酸碱度(pH)-尿液: 6.5；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；层粘连蛋白(LN)-静脉血: 35.29ng/ml；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮\n- [全程D15] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T6水平，估计导管末端位于上腔静脉内。；检查结论: PICC管末端位置如上述。\n- [全程D15] 检验组合: 骨钙素N端中分子片段(N-MID)-静脉血: 11.9ng/ml；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.318ng/ml\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 同步放化疗（顺铂单药方案）\nB. 诱导化疗（吉西他滨+顺铂方案）联合PD-1抑制剂\nC. 根治性放疗联合辅助化疗（顺铂+氟尿嘧啶方案）\nD. 诱导化疗（紫杉醇+卡铂方案）\nE. 诱导化疗（多西他赛+顺铂+氟尿嘧啶方案）联合西妥昔单抗\nF. 根治性放疗（单纯放疗）\nG. 诱导化疗（卡培他滨单药方案）\nH. 靶向治疗（尼妥珠单抗）联合同步放化疗\nI. 诱导化疗（依托泊苷+顺铂方案）\nJ. 姑息性化疗（顺铂+氟尿嘧啶方案）\nK. 诱导化疗（顺铂单药方案）\nL. 诱导化疗（顺铂+氟尿嘧啶方案）\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-ad9c851cda35b0e3c9061982","patient_id":"patient-5fa48522b2703f35ead0224b","turn_id":"turn05","turn_position":3,"turn_type":"toxicity_or_support_decision","gold_letter":"A","gold_action":"办理出院，予以胸腺五肽皮下注射支持治疗，嘱每周复查血常规及生化，按期返院行第2程诱导化疗。","options":[{"letter":"A","text":"办理出院，予以胸腺五肽皮下注射支持治疗，嘱每周复查血常规及生化，按期返院行第2程诱导化疗。","is_gold":true},{"letter":"B","text":"暂缓出院，继续静脉给予5-HT3受体拮抗剂及补液支持，待恶心呕吐完全缓解后出院。","is_gold":false},{"letter":"C","text":"办理出院，嘱每周复查血常规及生化，第2程诱导化疗将顺铂剂量下调20%。","is_gold":false},{"letter":"D","text":"办理出院，嘱每周复查血常规及生化，第2程诱导化疗更改为吉西他滨+顺铂（GP）方案。","is_gold":false},{"letter":"E","text":"办理出院，予以重组人粒细胞集落刺激因子（G-CSF）皮下注射，按期返院行第2程诱导化疗。","is_gold":false},{"letter":"F","text":"办理出院，予以重组人促红素（EPO）皮下注射，按期返院行第2程诱导化疗。","is_gold":false},{"letter":"G","text":"办理出院，予以胸腺五肽皮下注射支持治疗，并安排左侧腋窝淋巴结穿刺活检。","is_gold":false},{"letter":"H","text":"办理出院，予以胸腺五肽皮下注射支持治疗，嘱返院直接开始根治性放疗及同步化疗。","is_gold":false},{"letter":"I","text":"办理出院，予以口服阿瑞匹坦带药，嘱第2程诱导化疗推迟1周进行。","is_gold":false},{"letter":"J","text":"办理出院，予以重组人血小板生成素（rhTPO）皮下注射，按期返院行第2程诱导化疗。","is_gold":false},{"letter":"K","text":"暂缓出院，复查鼻咽及颈部MRI评估近期疗效，结果决定第2程化疗方案。","is_gold":false},{"letter":"L","text":"办理出院，予以胸腺五肽皮下注射支持治疗，嘱第2程诱导化疗加用尼妥珠单抗。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、斜坡、口咽、蝶骨基底部、岩尖。\n文本分期信息：N2，Mx 左侧腋窝淋巴结可疑转移。\n综合TNM状态：T3N2Mx 左侧腋窝淋巴结可疑转移。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 正常范围心电图\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽左顶壁、左顶后壁、左侧壁增厚，并见团块状软组织信号影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，鼻咽右侧壁粘膜未见增厚，左侧咽隐窝闭塞，右侧咽隐窝存在，左侧咽旁脂肪间隙狭窄。左侧腭帆提肌、腭帆张肌、头长肌、翼内肌受侵犯，余咽旁诸肌未见异常； 左侧咽后见肿大的淋巴结，短径22mm，右侧咽后见小淋巴结，短径5mm。 病灶向前堵塞左侧后鼻孔，口咽左侧壁受侵增厚。 左侧翼腭窝软组织影稍增多，右侧翼腭窝、双侧颞下窝未见异常。 蝶骨基底部、斜坡左侧份、左侧岩尖骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、上颌窦粘膜增厚；蝶窦、双侧乳突气化良好，未见异常信号影；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。 双颈II区、左颈III区见多个淋巴结，较大者短径24mm，信号欠均匀，增强扫描不均匀强化。；检查结论: 鼻咽左顶后壁、左侧壁病灶，考虑鼻咽癌，侵犯左侧咽旁、口咽左侧壁。 颅底骨质破坏。 双侧咽后、双颈II区、左颈III区淋巴结，考虑转移瘤。 副鼻窦炎。\n- [全程D5] 检验组合: 红细胞比容(Hct)-静脉血: 38.9%；血红蛋白(Hb)-静脉血: 131.6g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.5mmolL；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；总蛋白(TP)-静脉血: 69.64g/L；总钙(Ca)-静脉血: 2.26mmol/L；白蛋白(ALB)-静脉血: 43.1g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.42mmol/L；磷(P)-静脉血: 1.22mmol/L；凝血酶时间(TT)-静脉血: 17.3sec.；淋巴细胞百分比(Lymph%)-静脉血: 0.325；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；钠离子(Na+)-静脉血: 140.5mmol/L；单核细胞百分比(Mono%)-静脉血: 0.0954；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；载脂蛋白AI(apoAI)-静脉血: 1.38g/L；丙氨酸氨基转移酶(ALT)-静脉血: 21.7U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；氯离子(Cl-)-静脉血: 103.9mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；血小板计数(PLT#)-静脉血: 270.910E9/L；总胆固醇(TC)-静脉血: 5.3mmol/L；C-反应蛋白(CRP)-静脉血: 0.37mg/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.69mmol/L；甘油三酯(TG)-静脉血: 0.78mmol/L；淋巴细胞计数(Lymph#)-静脉血: 210E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.568；凝血酶原时间活动度(PTA)-静脉血: 94%；活化部分凝血活酶时间(APTT)-静脉血: 25.3sec.；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；平均红细胞血红蛋白含量(MCH)-静脉血: 30.2pg；凝血酶原时间(PT)-静脉血: 11.4sec.；纤维蛋白原(Fbg)-静脉血: 2.62g/L；天门冬氨酸氨基转移酶/丙氨酸氨……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D8] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见:；检查结论:\n- [全程D14] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；透明质酸(HA)-静脉血: 76.89ng/ml；III型前胶原氨基端肽(PIIINP)-静脉血: 28.08ng/ml；葡萄糖(Glu)-尿液: -（参考: 阴性）；降钙素(CT)-静脉血: 22.05pg/ml；总蛋白(TP)-尿液: -（参考: 阴性）；IV型胶原(C-IV)-静脉血: 28.93ng/ml；比重(SG)-尿液: 1.008；颜色-尿液: 无色；酸碱度(pH)-尿液: 6.5；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；层粘连蛋白(LN)-静脉血: 35.29ng/ml；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮\n- [全程D15] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T6水平，估计导管末端位于上腔静脉内。；检查结论: PICC管末端位置如上述。\n- [全程D15] 检验组合: 骨钙素N端中分子片段(N-MID)-静脉血: 11.9ng/ml；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.318ng/ml\n- [全程D16] 检验组合: 浊度(TRUB)-尿液: 清亮；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: +-（参考: 阴性）；酸碱度(pH)-尿液: 7；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.016；葡萄糖(Glu)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 3/μL\n- [全程D17] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 31/μL；颜色-尿液: Yellow；鳞状上皮细胞计数(SQEP#)-尿液: 7/μL；白细胞计数(WBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.021；浊度(TRUB)-尿液: 清亮；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D19] 检验组合: 总钙(Ca)-静脉血: 2.15mmol/L；钠离子(Na+)-静脉血: 138.8mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.2mmol/L；钾离子(K+)-静脉血: 3.08mmol/L；氯离子(Cl-)-静脉血: 102.2mmol/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；磷(P)-静脉血: 1.19mmol/L；阴离子间隙(AG)-静脉血: 15.4\n- [全程D20] 超声；双侧腋窝淋巴结彩超(套): 检查类型: 超声；检查名称: 双侧腋窝淋巴结彩超(套)；检查部位:；检查所见: 左侧腋窝腋下组可见1个淋巴结回声，大小约16x4mm，椭圆形，边界清，皮髓质分界清，淋巴门结构可探及。腋上组及腋中组未见明显异常淋巴结回声。 CDFI：上述淋巴结内可见门型血流信号。；检查结论: 左侧腋窝腋下组淋巴结，符合良性淋巴结声像。\n- [全程D20] 检验组合: 血小板计数(PLT#)-静脉血: 250.210E9/L；肌酐(Crea)-静脉血: 54umol/L；总胆红素(TBIL)-静脉血: 13.7umol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；阴离子间隙(AG)-静脉血: 12.4；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；碱性磷酸酶(ALP)-静脉血: 59.5U/L；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；球蛋白(GLO)-静脉血: 25.26g/L；葡萄糖(Glu)-静脉血: 4.81mmol/L；白蛋白(ALB)-静脉血: 40.9g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；尿素氮(BUN)-静脉血: 3.9mmol/L；血小板分布宽度(PDW)-静脉血: 15.8%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.38mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.05mmolL；乳酸脱氢酶(LDH)-静脉血: 275.2U/L；单核细胞百分比(Mono%)-静脉血: 0.0621；中性粒细胞计数(Neut#)-静脉血: 4.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.711；γ-谷氨酰基转移酶(GGT)-静脉血: 19.5U/L；甘油三酯(TG)-静脉血: 1.23mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.5pg；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.0032；磷(P)-静脉血: 1.37mmol/L；总钙(Ca)-静脉血: 2.23mmol/L；间接胆红素(IBIL)-静脉血: 9umolL；血小板比容-静脉血: 20.8%；C-反应蛋白(CRP)-静脉血: 0.65mg/L；载脂蛋白AI(apoAI)-静脉血: 1.12g/L；总蛋白(TP)-静脉血: 66.16g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.62；单核细胞计数(Mono#)-静脉血: 0.410E9/L；钠离子(Na+)-静脉血: 137.8mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 27.7U/L；丙氨酸氨基转移酶(ALT)-静脉……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D15] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D20] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗结束，诉呕吐 次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程5-FU+顺铂方案诱导化疗结束，无诉特殊不适，可予出院，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 办理出院，予以胸腺五肽皮下注射支持治疗，嘱每周复查血常规及生化，按期返院行第2程诱导化疗。\nB. 暂缓出院，继续静脉给予5-HT3受体拮抗剂及补液支持，待恶心呕吐完全缓解后出院。\nC. 办理出院，嘱每周复查血常规及生化，第2程诱导化疗将顺铂剂量下调20%。\nD. 办理出院，嘱每周复查血常规及生化，第2程诱导化疗更改为吉西他滨+顺铂（GP）方案。\nE. 办理出院，予以重组人粒细胞集落刺激因子（G-CSF）皮下注射，按期返院行第2程诱导化疗。\nF. 办理出院，予以重组人促红素（EPO）皮下注射，按期返院行第2程诱导化疗。\nG. 办理出院，予以胸腺五肽皮下注射支持治疗，并安排左侧腋窝淋巴结穿刺活检。\nH. 办理出院，予以胸腺五肽皮下注射支持治疗，嘱返院直接开始根治性放疗及同步化疗。\nI. 办理出院，予以口服阿瑞匹坦带药，嘱第2程诱导化疗推迟1周进行。\nJ. 办理出院，予以重组人血小板生成素（rhTPO）皮下注射，按期返院行第2程诱导化疗。\nK. 暂缓出院，复查鼻咽及颈部MRI评估近期疗效，结果决定第2程化疗方案。\nL. 办理出院，予以胸腺五肽皮下注射支持治疗，嘱第2程诱导化疗加用尼妥珠单抗。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、斜坡、口咽、蝶骨基底部、岩尖。\n文本分期信息：N2，Mx 左侧腋窝淋巴结可疑转移。\n综合TNM状态：T3N2Mx 左侧腋窝淋巴结可疑转移。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 正常范围心电图\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽左顶壁、左顶后壁、左侧壁增厚，并见团块状软组织信号影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，鼻咽右侧壁粘膜未见增厚，左侧咽隐窝闭塞，右侧咽隐窝存在，左侧咽旁脂肪间隙狭窄。左侧腭帆提肌、腭帆张肌、头长肌、翼内肌受侵犯，余咽旁诸肌未见异常； 左侧咽后见肿大的淋巴结，短径22mm，右侧咽后见小淋巴结，短径5mm。 病灶向前堵塞左侧后鼻孔，口咽左侧壁受侵增厚。 左侧翼腭窝软组织影稍增多，右侧翼腭窝、双侧颞下窝未见异常。 蝶骨基底部、斜坡左侧份、左侧岩尖骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、上颌窦粘膜增厚；蝶窦、双侧乳突气化良好，未见异常信号影；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。 双颈II区、左颈III区见多个淋巴结，较大者短径24mm，信号欠均匀，增强扫描不均匀强化。；检查结论: 鼻咽左顶后壁、左侧壁病灶，考虑鼻咽癌，侵犯左侧咽旁、口咽左侧壁。 颅底骨质破坏。 双侧咽后、双颈II区、左颈III区淋巴结，考虑转移瘤。 副鼻窦炎。\n- [全程D5] 检验组合: 红细胞比容(Hct)-静脉血: 38.9%；血红蛋白(Hb)-静脉血: 131.6g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.5mmolL；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；总蛋白(TP)-静脉血: 69.64g/L；总钙(Ca)-静脉血: 2.26mmol/L；白蛋白(ALB)-静脉血: 43.1g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.42mmol/L；磷(P)-静脉血: 1.22mmol/L；凝血酶时间(TT)-静脉血: 17.3sec.；淋巴细胞百分比(Lymph%)-静脉血: 0.325；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；钠离子(Na+)-静脉血: 140.5mmol/L；单核细胞百分比(Mono%)-静脉血: 0.0954；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；载脂蛋白AI(apoAI)-静脉血: 1.38g/L；丙氨酸氨基转移酶(ALT)-静脉血: 21.7U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；氯离子(Cl-)-静脉血: 103.9mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；血小板计数(PLT#)-静脉血: 270.910E9/L；总胆固醇(TC)-静脉血: 5.3mmol/L；C-反应蛋白(CRP)-静脉血: 0.37mg/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.69mmol/L；甘油三酯(TG)-静脉血: 0.78mmol/L；淋巴细胞计数(Lymph#)-静脉血: 210E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.568；凝血酶原时间活动度(PTA)-静脉血: 94%；活化部分凝血活酶时间(APTT)-静脉血: 25.3sec.；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；平均红细胞血红蛋白含量(MCH)-静脉血: 30.2pg；凝血酶原时间(PT)-静脉血: 11.4sec.；纤维蛋白原(Fbg)-静脉血: 2.62g/L；天门冬氨酸氨基转移酶/丙氨酸氨……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D8] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见:；检查结论:\n- [全程D14] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；透明质酸(HA)-静脉血: 76.89ng/ml；III型前胶原氨基端肽(PIIINP)-静脉血: 28.08ng/ml；葡萄糖(Glu)-尿液: -（参考: 阴性）；降钙素(CT)-静脉血: 22.05pg/ml；总蛋白(TP)-尿液: -（参考: 阴性）；IV型胶原(C-IV)-静脉血: 28.93ng/ml；比重(SG)-尿液: 1.008；颜色-尿液: 无色；酸碱度(pH)-尿液: 6.5；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；层粘连蛋白(LN)-静脉血: 35.29ng/ml；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮\n- [全程D15] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T6水平，估计导管末端位于上腔静脉内。；检查结论: PICC管末端位置如上述。\n- [全程D15] 检验组合: 骨钙素N端中分子片段(N-MID)-静脉血: 11.9ng/ml；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.318ng/ml\n- [全程D16] 检验组合: 浊度(TRUB)-尿液: 清亮；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: +-（参考: 阴性）；酸碱度(pH)-尿液: 7；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.016；葡萄糖(Glu)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 3/μL\n- [全程D17] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 31/μL；颜色-尿液: Yellow；鳞状上皮细胞计数(SQEP#)-尿液: 7/μL；白细胞计数(WBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.021；浊度(TRUB)-尿液: 清亮；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D19] 检验组合: 总钙(Ca)-静脉血: 2.15mmol/L；钠离子(Na+)-静脉血: 138.8mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.2mmol/L；钾离子(K+)-静脉血: 3.08mmol/L；氯离子(Cl-)-静脉血: 102.2mmol/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；磷(P)-静脉血: 1.19mmol/L；阴离子间隙(AG)-静脉血: 15.4\n- [全程D20] 超声；双侧腋窝淋巴结彩超(套): 检查类型: 超声；检查名称: 双侧腋窝淋巴结彩超(套)；检查部位:；检查所见: 左侧腋窝腋下组可见1个淋巴结回声，大小约16x4mm，椭圆形，边界清，皮髓质分界清，淋巴门结构可探及。腋上组及腋中组未见明显异常淋巴结回声。 CDFI：上述淋巴结内可见门型血流信号。；检查结论: 左侧腋窝腋下组淋巴结，符合良性淋巴结声像。\n- [全程D20] 检验组合: 血小板计数(PLT#)-静脉血: 250.210E9/L；肌酐(Crea)-静脉血: 54umol/L；总胆红素(TBIL)-静脉血: 13.7umol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；阴离子间隙(AG)-静脉血: 12.4；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；碱性磷酸酶(ALP)-静脉血: 59.5U/L；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；球蛋白(GLO)-静脉血: 25.26g/L；葡萄糖(Glu)-静脉血: 4.81mmol/L；白蛋白(ALB)-静脉血: 40.9g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；尿素氮(BUN)-静脉血: 3.9mmol/L；血小板分布宽度(PDW)-静脉血: 15.8%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.38mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.05mmolL；乳酸脱氢酶(LDH)-静脉血: 275.2U/L；单核细胞百分比(Mono%)-静脉血: 0.0621；中性粒细胞计数(Neut#)-静脉血: 4.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.711；γ-谷氨酰基转移酶(GGT)-静脉血: 19.5U/L；甘油三酯(TG)-静脉血: 1.23mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.5pg；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.0032；磷(P)-静脉血: 1.37mmol/L；总钙(Ca)-静脉血: 2.23mmol/L；间接胆红素(IBIL)-静脉血: 9umolL；血小板比容-静脉血: 20.8%；C-反应蛋白(CRP)-静脉血: 0.65mg/L；载脂蛋白AI(apoAI)-静脉血: 1.12g/L；总蛋白(TP)-静脉血: 66.16g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.62；单核细胞计数(Mono#)-静脉血: 0.410E9/L；钠离子(Na+)-静脉血: 137.8mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 27.7U/L；丙氨酸氨基转移酶(ALT)-静脉……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D15] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D20] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗结束，诉呕吐 次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程5-FU+顺铂方案诱导化疗结束，无诉特殊不适，可予出院，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 办理出院，予以胸腺五肽皮下注射支持治疗，嘱每周复查血常规及生化，按期返院行第2程诱导化疗。\nB. 暂缓出院，继续静脉给予5-HT3受体拮抗剂及补液支持，待恶心呕吐完全缓解后出院。\nC. 办理出院，嘱每周复查血常规及生化，第2程诱导化疗将顺铂剂量下调20%。\nD. 办理出院，嘱每周复查血常规及生化，第2程诱导化疗更改为吉西他滨+顺铂（GP）方案。\nE. 办理出院，予以重组人粒细胞集落刺激因子（G-CSF）皮下注射，按期返院行第2程诱导化疗。\nF. 办理出院，予以重组人促红素（EPO）皮下注射，按期返院行第2程诱导化疗。\nG. 办理出院，予以胸腺五肽皮下注射支持治疗，并安排左侧腋窝淋巴结穿刺活检。\nH. 办理出院，予以胸腺五肽皮下注射支持治疗，嘱返院直接开始根治性放疗及同步化疗。\nI. 办理出院，予以口服阿瑞匹坦带药，嘱第2程诱导化疗推迟1周进行。\nJ. 办理出院，予以重组人血小板生成素（rhTPO）皮下注射，按期返院行第2程诱导化疗。\nK. 暂缓出院，复查鼻咽及颈部MRI评估近期疗效，结果决定第2程化疗方案。\nL. 办理出院，予以胸腺五肽皮下注射支持治疗，嘱第2程诱导化疗加用尼妥珠单抗。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-9acca1b0c829ebdd4e952950","patient_id":"patient-5fa48522b2703f35ead0224b","turn_id":"turn06","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"B","gold_action":"开始适形调强放射治疗（IMRT），并予以雾化吸入、鼻腔冲洗、皮肤及黏膜保护剂等放疗支持处理。","options":[{"letter":"A","text":"予以第3程5-FU+顺铂方案诱导化疗，并继续予以护胃、止呕、补液等常规对症支持治疗。","is_gold":false},{"letter":"B","text":"开始适形调强放射治疗（IMRT），并予以雾化吸入、鼻腔冲洗、皮肤及黏膜保护剂等放疗支持处理。","is_gold":true},{"letter":"C","text":"开始适形调强放射治疗（IMRT），待出现III度以上放射性皮炎或黏膜炎时再启动局部保护剂及雾化治疗。","is_gold":false},{"letter":"D","text":"予以第3程5-FU+顺铂方案诱导化疗，并预防性使用长效重组人粒细胞集落刺激因子。","is_gold":false},{"letter":"E","text":"开始适形调强放射治疗（IMRT），并常规预防性静脉滴注头孢类广谱抗生素及抗真菌药物。","is_gold":false},{"letter":"F","text":"暂缓抗肿瘤治疗，继续予以升白细胞及营养支持治疗，观察1-2周后再复查各项生化指标。","is_gold":false},{"letter":"G","text":"开始适形调强放射治疗（IMRT），并常规预防性静脉滴注大剂量糖皮质激素及甘露醇脱水。","is_gold":false},{"letter":"H","text":"开始适形调强放射治疗（IMRT），并预防性给予全胃肠外营养（TPN）及静脉高营养支持。","is_gold":false},{"letter":"I","text":"予以单药顺铂同期化疗，并常规予以水化、利尿及止吐等支持治疗，暂缓启动放射治疗。","is_gold":false},{"letter":"J","text":"开始适形调强放射治疗（IMRT），并常规预防性口服非甾体抗炎药及阿片类镇痛药物。","is_gold":false},{"letter":"K","text":"开始适形调强放射治疗（IMRT），并予以预防性低分子肝素抗凝及深静脉置管常规护理。","is_gold":false},{"letter":"L","text":"予以靶向治疗联合适形调强放射治疗（IMRT），并常规予以抗过敏及皮疹预防对症处理。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、斜坡、口咽、蝶骨基底部、岩尖。\n文本分期信息：N2，Mx 左侧腋窝淋巴结可疑转移。\n综合TNM状态：T3N2Mx 左侧腋窝淋巴结可疑转移。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 正常范围心电图\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽左顶壁、左顶后壁、左侧壁增厚，并见团块状软组织信号影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，鼻咽右侧壁粘膜未见增厚，左侧咽隐窝闭塞，右侧咽隐窝存在，左侧咽旁脂肪间隙狭窄。左侧腭帆提肌、腭帆张肌、头长肌、翼内肌受侵犯，余咽旁诸肌未见异常； 左侧咽后见肿大的淋巴结，短径22mm，右侧咽后见小淋巴结，短径5mm。 病灶向前堵塞左侧后鼻孔，口咽左侧壁受侵增厚。 左侧翼腭窝软组织影稍增多，右侧翼腭窝、双侧颞下窝未见异常。 蝶骨基底部、斜坡左侧份、左侧岩尖骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、上颌窦粘膜增厚；蝶窦、双侧乳突气化良好，未见异常信号影；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。 双颈II区、左颈III区见多个淋巴结，较大者短径24mm，信号欠均匀，增强扫描不均匀强化。；检查结论: 鼻咽左顶后壁、左侧壁病灶，考虑鼻咽癌，侵犯左侧咽旁、口咽左侧壁。 颅底骨质破坏。 双侧咽后、双颈II区、左颈III区淋巴结，考虑转移瘤。 副鼻窦炎。\n- [全程D5] 检验组合: 红细胞比容(Hct)-静脉血: 38.9%；血红蛋白(Hb)-静脉血: 131.6g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.5mmolL；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；总蛋白(TP)-静脉血: 69.64g/L；总钙(Ca)-静脉血: 2.26mmol/L；白蛋白(ALB)-静脉血: 43.1g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.42mmol/L；磷(P)-静脉血: 1.22mmol/L；凝血酶时间(TT)-静脉血: 17.3sec.；淋巴细胞百分比(Lymph%)-静脉血: 0.325；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；钠离子(Na+)-静脉血: 140.5mmol/L；单核细胞百分比(Mono%)-静脉血: 0.0954；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；载脂蛋白AI(apoAI)-静脉血: 1.38g/L；丙氨酸氨基转移酶(ALT)-静脉血: 21.7U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；氯离子(Cl-)-静脉血: 103.9mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；血小板计数(PLT#)-静脉血: 270.910E9/L；总胆固醇(TC)-静脉血: 5.3mmol/L；C-反应蛋白(CRP)-静脉血: 0.37mg/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.69mmol/L；甘油三酯(TG)-静脉血: 0.78mmol/L；淋巴细胞计数(Lymph#)-静脉血: 210E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.568；凝血酶原时间活动度(PTA)-静脉血: 94%；活化部分凝血活酶时间(APTT)-静脉血: 25.3sec.；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；平均红细胞血红蛋白含量(MCH)-静脉血: 30.2pg；凝血酶原时间(PT)-静脉血: 11.4sec.；纤维蛋白原(Fbg)-静脉血: 2.62g/L；天门冬氨酸氨基转移酶/丙氨酸氨……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D8] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见:；检查结论:\n- [全程D14] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；透明质酸(HA)-静脉血: 76.89ng/ml；III型前胶原氨基端肽(PIIINP)-静脉血: 28.08ng/ml；葡萄糖(Glu)-尿液: -（参考: 阴性）；降钙素(CT)-静脉血: 22.05pg/ml；总蛋白(TP)-尿液: -（参考: 阴性）；IV型胶原(C-IV)-静脉血: 28.93ng/ml；比重(SG)-尿液: 1.008；颜色-尿液: 无色；酸碱度(pH)-尿液: 6.5；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；层粘连蛋白(LN)-静脉血: 35.29ng/ml；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮\n- [全程D15] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T6水平，估计导管末端位于上腔静脉内。；检查结论: PICC管末端位置如上述。\n- [全程D15] 检验组合: 骨钙素N端中分子片段(N-MID)-静脉血: 11.9ng/ml；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.318ng/ml\n- [全程D16] 检验组合: 浊度(TRUB)-尿液: 清亮；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: +-（参考: 阴性）；酸碱度(pH)-尿液: 7；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.016；葡萄糖(Glu)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 3/μL\n- [全程D17] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 31/μL；颜色-尿液: Yellow；鳞状上皮细胞计数(SQEP#)-尿液: 7/μL；白细胞计数(WBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.021；浊度(TRUB)-尿液: 清亮；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D19] 检验组合: 总钙(Ca)-静脉血: 2.15mmol/L；钠离子(Na+)-静脉血: 138.8mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.2mmol/L；钾离子(K+)-静脉血: 3.08mmol/L；氯离子(Cl-)-静脉血: 102.2mmol/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；磷(P)-静脉血: 1.19mmol/L；阴离子间隙(AG)-静脉血: 15.4\n- [全程D20] 超声；双侧腋窝淋巴结彩超(套): 检查类型: 超声；检查名称: 双侧腋窝淋巴结彩超(套)；检查部位:；检查所见: 左侧腋窝腋下组可见1个淋巴结回声，大小约16x4mm，椭圆形，边界清，皮髓质分界清，淋巴门结构可探及。腋上组及腋中组未见明显异常淋巴结回声。 CDFI：上述淋巴结内可见门型血流信号。；检查结论: 左侧腋窝腋下组淋巴结，符合良性淋巴结声像。\n- [全程D20] 检验组合: 血小板计数(PLT#)-静脉血: 250.210E9/L；肌酐(Crea)-静脉血: 54umol/L；总胆红素(TBIL)-静脉血: 13.7umol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；阴离子间隙(AG)-静脉血: 12.4；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；碱性磷酸酶(ALP)-静脉血: 59.5U/L；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；球蛋白(GLO)-静脉血: 25.26g/L；葡萄糖(Glu)-静脉血: 4.81mmol/L；白蛋白(ALB)-静脉血: 40.9g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；尿素氮(BUN)-静脉血: 3.9mmol/L；血小板分布宽度(PDW)-静脉血: 15.8%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.38mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.05mmolL；乳酸脱氢酶(LDH)-静脉血: 275.2U/L；单核细胞百分比(Mono%)-静脉血: 0.0621；中性粒细胞计数(Neut#)-静脉血: 4.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.711；γ-谷氨酰基转移酶(GGT)-静脉血: 19.5U/L；甘油三酯(TG)-静脉血: 1.23mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.5pg；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.0032；磷(P)-静脉血: 1.37mmol/L；总钙(Ca)-静脉血: 2.23mmol/L；间接胆红素(IBIL)-静脉血: 9umolL；血小板比容-静脉血: 20.8%；C-反应蛋白(CRP)-静脉血: 0.65mg/L；载脂蛋白AI(apoAI)-静脉血: 1.12g/L；总蛋白(TP)-静脉血: 66.16g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.62；单核细胞计数(Mono#)-静脉血: 0.410E9/L；钠离子(Na+)-静脉血: 137.8mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 27.7U/L；丙氨酸氨基转移酶(ALT)-静脉……\n- [全程D37] 检验组合: 嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.4；红细胞比容(Hct)-静脉血: 35.6%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞体积(MCV)-静脉血: 89.9fL；单核细胞百分比(Mono%)-静脉血: 0.046；血小板计数(PLT#)-静脉血: 21310E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.8pg；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.9；平均血小板体积(MPV)-静脉血: 9.2fL；单核细胞计数(Mono#)-静脉血: 0.410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；中性粒细胞百分比(Neut%)-静脉血: 0.79；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；血小板比容-静脉血: 20%；血红蛋白(Hb)-静脉血: 118g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.009；淋巴细胞百分比(Lymph%)-静脉血: 0.147；红细胞计数(RBC#)-静脉血: 3.9610E12/L；血小板分布宽度(PDW)-静脉血: 9.9%；大血小板百分比(P-LCR%)-静脉血: 18.7%；中性粒细胞计数(Neut#)-静脉血: 7.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；白细胞计数(WBC#)-静脉血: 910E9/L\n- [全程D40] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.018；草酸钙结晶计数(CAOX#)-尿液: 10/μL；红细胞计数(RBC#)-尿液: 4/μL；总蛋白(TP)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: 无色；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D41] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；红细胞计数(RBC#)-尿液: 4/μL；白细胞(LEU)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；酮体(KET)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 1/μL；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.024；颜色-尿液: Light-Yellow\n- [全程D42] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 6/μL；隐血(OB)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 4/μL；总蛋白(TP)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7；颜色-尿液: Light-Yellow；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.023；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）；细菌计数(BACT#)-尿液: 8/μL\n- [全程D47] 超声；双侧腋窝淋巴结彩超(套): 检查类型: 超声；检查名称: 双侧腋窝淋巴结彩超(套)；检查部位:；检查所见: 双侧侧腋窝腋下组可见多个淋巴结回声，最大约12x6mm，椭圆形，边界清，皮髓质分界清，淋巴门结构可探及。腋上组及腋中组未见明显异常淋巴结回声。 CDFI：上述淋巴结内可见门型血流信号。；检查结论: 左侧腋窝腋下组淋巴结，符合良性淋巴结声像。\n- [全程D47] 检验组合: 有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 89.5fL；钠离子(Na+)-静脉血: 135.9mmol/L；尿酸(UA)-静脉血: 277.5umol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.0062；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；血红蛋白(Hb)-静脉血: 115.6g/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 332.5g/L；碱性磷酸酶(ALP)-静脉血: 63.1U/L；白蛋白(ALB)-静脉血: 39.9g/L；单核细胞百分比(Mono%)-静脉血: 0.056；α-L-岩藻糖苷酶(AFU)-静脉血: 42.7U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.315；尿素氮(BUN)-静脉血: 5.4mmol/L；白细胞计数(WBC#)-静脉血: 4.0510E9/L；总胆固醇(TC)-静脉血: 4.12mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24U/L；氯离子(Cl-)-静脉血: 99.2mmol/L；载脂蛋白B(apoB)-静脉血: 0.78g/L；丙氨酸氨基转移酶(ALT)-静脉血: 41.3U/L；总胆汁酸(TBA)-静脉血: 0.5umol/L；血小板计数(PLT#)-静脉血: 196.310E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.5%；葡萄糖(Glu)-静脉血: 4.67mmol/L；球蛋白(GLO)-静脉血: 23.82g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.3mmol/L；间接胆红素(IBIL)-静脉血: 7umolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.0051；镁离子(Mg2+)-静脉血: 0.69mmol/L；磷(P)-静脉血: 1.4mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 3.7umol/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；总钙(Ca)-静脉血: 2.27mmol/L；胱抑素(Cys-C)-静脉血: 0.95mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.68；中性粒细胞百分比(……\n- [全程D49] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后： 鼻咽腔轻度狭窄，鼻咽左顶壁、左顶后壁、左侧壁增厚，并见团块状软组织信号影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。鼻咽右侧壁粘膜未见增厚，左侧咽隐窝闭塞，右侧咽隐窝存在，左侧咽旁脂肪间隙狭窄。左侧腭帆提肌、腭帆张肌、头长肌受侵犯，余咽旁诸肌未见异常。 鼻腔未见肿物，口咽左侧壁受侵稍增厚。 双侧翼腭窝、双侧颞下窝未见异常。 蝶骨基底部、斜坡左侧份、左侧岩尖、左侧翼突基底部、左侧翼突内侧板骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、上颌窦、蝶窦、双侧乳突气化良好，未见异常信号影。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。蝶鞍形态正常，其内未见占位性病变。 左侧咽后见肿大的淋巴结，短径17mm，右侧咽后见小淋巴结，短径5mm。左颈II、III区见多个肿大淋巴结，较大者短径13mm，信号欠均匀，增强扫描不均匀强化。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。 扫描所见脑组织未见明确异常。；检查结论: 鼻咽癌化疗后，对比某次就诊时间日片： 鼻咽肿物，较前明显缩小。 颅底骨质破坏，基本同前。 左侧咽后淋巴结、左颈II、III区淋巴结，考虑转移瘤，较前明显缩小。右侧咽后小淋巴结，较前变化不大。\n- [全程D50] 检验组合: 总胆红素(TBIL)-静脉血: 8.1umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 20710E9/L；磷(P)-静脉血: 1.19mmol/L；中性粒细胞计数(Neut#)-静脉血: 2.810E9/L；葡萄糖(Glu)-静脉血: 5.75mmol/L；血红蛋白(Hb)-静脉血: 118g/L；尿酸(UA)-静脉血: 347.3umol/L；平均红细胞体积(MCV)-静脉血: 85.6fL；胱抑素(Cys-C)-静脉血: 1.01mg/L；红细胞比容(Hct)-静脉血: 34%；C-反应蛋白(CRP)-静脉血: 0.45mg/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；白蛋白(ALB)-静脉血: 44.1g/L；肌酐(Crea)-静脉血: 93.9umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 44.6U/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；总钙(Ca)-静脉血: 2.32mmol/L；红细胞计数(RBC#)-静脉血: 3.9710E12/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.1；球蛋白(GLO)-静脉血: 26.11g/L；尿素氮(BUN)-静脉血: 7.9mmol/L；钾离子(K+)-静脉血: 3.55mmol/L；载脂蛋白B(apoB)-静脉血: 0.88g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.72mmol/L；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.592；载脂蛋白AI(apoAI)-静脉血: 1.31g/L；乳酸脱氢酶(LDH)-静脉血: 232.4U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；总胆汁酸(TBA)-静脉血: 2.1umol/L；氯离子(Cl-)-静脉血: 102mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 23.5U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.33mmolL；总蛋白(TP)-静脉血: 70.21g/L；阴离子间隙(AG)-静脉血: 12.8；α-L-岩藻糖苷酶(AFU)-静脉血: 40.7U/L；总胆固醇(TC)-静脉血: 4.57mmol/L；白细胞计数(W……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D15] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D20] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗结束，诉呕吐 次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程5-FU+顺铂方案诱导化疗结束，无诉特殊不适，可予出院，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n- [全程D36] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者复查血常规：中性粒细胞1.2×109/L。郭医生信息已隐藏：暂停化疗，予以患者升中西粒细胞处理。\n- [全程D37] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 患者入院第三天，继续升白细胞处理，今日复查血常规，白细胞已经恢复正常，郭医生信息已隐藏：下周一予以患者第二程化疗。\n- [全程D40] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，可于今日执行第2程5-FU+顺铂方案诱导化疗，注意化疗不良反应。\n- [全程D43] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D47] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+顺铂方案诱导化疗结束，诉恶心、食欲下降，无发热、呕吐、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第2程5-FU+顺铂方案诱导化疗结束，无诉特殊不适，嘱其完成鼻咽、颈MRI复查，以及放疗定位扫描，定期返院治疗。遵嘱。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 予以第3程5-FU+顺铂方案诱导化疗，并继续予以护胃、止呕、补液等常规对症支持治疗。\nB. 开始适形调强放射治疗（IMRT），并予以雾化吸入、鼻腔冲洗、皮肤及黏膜保护剂等放疗支持处理。\nC. 开始适形调强放射治疗（IMRT），待出现III度以上放射性皮炎或黏膜炎时再启动局部保护剂及雾化治疗。\nD. 予以第3程5-FU+顺铂方案诱导化疗，并预防性使用长效重组人粒细胞集落刺激因子。\nE. 开始适形调强放射治疗（IMRT），并常规预防性静脉滴注头孢类广谱抗生素及抗真菌药物。\nF. 暂缓抗肿瘤治疗，继续予以升白细胞及营养支持治疗，观察1-2周后再复查各项生化指标。\nG. 开始适形调强放射治疗（IMRT），并常规预防性静脉滴注大剂量糖皮质激素及甘露醇脱水。\nH. 开始适形调强放射治疗（IMRT），并预防性给予全胃肠外营养（TPN）及静脉高营养支持。\nI. 予以单药顺铂同期化疗，并常规予以水化、利尿及止吐等支持治疗，暂缓启动放射治疗。\nJ. 开始适形调强放射治疗（IMRT），并常规预防性口服非甾体抗炎药及阿片类镇痛药物。\nK. 开始适形调强放射治疗（IMRT），并予以预防性低分子肝素抗凝及深静脉置管常规护理。\nL. 予以靶向治疗联合适形调强放射治疗（IMRT），并常规予以抗过敏及皮疹预防对症处理。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、斜坡、口咽、蝶骨基底部、岩尖。\n文本分期信息：N2，Mx 左侧腋窝淋巴结可疑转移。\n综合TNM状态：T3N2Mx 左侧腋窝淋巴结可疑转移。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 正常范围心电图\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽左顶壁、左顶后壁、左侧壁增厚，并见团块状软组织信号影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，鼻咽右侧壁粘膜未见增厚，左侧咽隐窝闭塞，右侧咽隐窝存在，左侧咽旁脂肪间隙狭窄。左侧腭帆提肌、腭帆张肌、头长肌、翼内肌受侵犯，余咽旁诸肌未见异常； 左侧咽后见肿大的淋巴结，短径22mm，右侧咽后见小淋巴结，短径5mm。 病灶向前堵塞左侧后鼻孔，口咽左侧壁受侵增厚。 左侧翼腭窝软组织影稍增多，右侧翼腭窝、双侧颞下窝未见异常。 蝶骨基底部、斜坡左侧份、左侧岩尖骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、上颌窦粘膜增厚；蝶窦、双侧乳突气化良好，未见异常信号影；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。 双颈II区、左颈III区见多个淋巴结，较大者短径24mm，信号欠均匀，增强扫描不均匀强化。；检查结论: 鼻咽左顶后壁、左侧壁病灶，考虑鼻咽癌，侵犯左侧咽旁、口咽左侧壁。 颅底骨质破坏。 双侧咽后、双颈II区、左颈III区淋巴结，考虑转移瘤。 副鼻窦炎。\n- [全程D5] 检验组合: 红细胞比容(Hct)-静脉血: 38.9%；血红蛋白(Hb)-静脉血: 131.6g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.5mmolL；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；总蛋白(TP)-静脉血: 69.64g/L；总钙(Ca)-静脉血: 2.26mmol/L；白蛋白(ALB)-静脉血: 43.1g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.42mmol/L；磷(P)-静脉血: 1.22mmol/L；凝血酶时间(TT)-静脉血: 17.3sec.；淋巴细胞百分比(Lymph%)-静脉血: 0.325；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；钠离子(Na+)-静脉血: 140.5mmol/L；单核细胞百分比(Mono%)-静脉血: 0.0954；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；载脂蛋白AI(apoAI)-静脉血: 1.38g/L；丙氨酸氨基转移酶(ALT)-静脉血: 21.7U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；氯离子(Cl-)-静脉血: 103.9mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；血小板计数(PLT#)-静脉血: 270.910E9/L；总胆固醇(TC)-静脉血: 5.3mmol/L；C-反应蛋白(CRP)-静脉血: 0.37mg/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.69mmol/L；甘油三酯(TG)-静脉血: 0.78mmol/L；淋巴细胞计数(Lymph#)-静脉血: 210E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.568；凝血酶原时间活动度(PTA)-静脉血: 94%；活化部分凝血活酶时间(APTT)-静脉血: 25.3sec.；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；平均红细胞血红蛋白含量(MCH)-静脉血: 30.2pg；凝血酶原时间(PT)-静脉血: 11.4sec.；纤维蛋白原(Fbg)-静脉血: 2.62g/L；天门冬氨酸氨基转移酶/丙氨酸氨……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D8] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见:；检查结论:\n- [全程D14] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；透明质酸(HA)-静脉血: 76.89ng/ml；III型前胶原氨基端肽(PIIINP)-静脉血: 28.08ng/ml；葡萄糖(Glu)-尿液: -（参考: 阴性）；降钙素(CT)-静脉血: 22.05pg/ml；总蛋白(TP)-尿液: -（参考: 阴性）；IV型胶原(C-IV)-静脉血: 28.93ng/ml；比重(SG)-尿液: 1.008；颜色-尿液: 无色；酸碱度(pH)-尿液: 6.5；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；层粘连蛋白(LN)-静脉血: 35.29ng/ml；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮\n- [全程D15] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T6水平，估计导管末端位于上腔静脉内。；检查结论: PICC管末端位置如上述。\n- [全程D15] 检验组合: 骨钙素N端中分子片段(N-MID)-静脉血: 11.9ng/ml；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.318ng/ml\n- [全程D16] 检验组合: 浊度(TRUB)-尿液: 清亮；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: +-（参考: 阴性）；酸碱度(pH)-尿液: 7；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.016；葡萄糖(Glu)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 3/μL\n- [全程D17] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 31/μL；颜色-尿液: Yellow；鳞状上皮细胞计数(SQEP#)-尿液: 7/μL；白细胞计数(WBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.021；浊度(TRUB)-尿液: 清亮；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D19] 检验组合: 总钙(Ca)-静脉血: 2.15mmol/L；钠离子(Na+)-静脉血: 138.8mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.2mmol/L；钾离子(K+)-静脉血: 3.08mmol/L；氯离子(Cl-)-静脉血: 102.2mmol/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；磷(P)-静脉血: 1.19mmol/L；阴离子间隙(AG)-静脉血: 15.4\n- [全程D20] 超声；双侧腋窝淋巴结彩超(套): 检查类型: 超声；检查名称: 双侧腋窝淋巴结彩超(套)；检查部位:；检查所见: 左侧腋窝腋下组可见1个淋巴结回声，大小约16x4mm，椭圆形，边界清，皮髓质分界清，淋巴门结构可探及。腋上组及腋中组未见明显异常淋巴结回声。 CDFI：上述淋巴结内可见门型血流信号。；检查结论: 左侧腋窝腋下组淋巴结，符合良性淋巴结声像。\n- [全程D20] 检验组合: 血小板计数(PLT#)-静脉血: 250.210E9/L；肌酐(Crea)-静脉血: 54umol/L；总胆红素(TBIL)-静脉血: 13.7umol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；阴离子间隙(AG)-静脉血: 12.4；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；碱性磷酸酶(ALP)-静脉血: 59.5U/L；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；球蛋白(GLO)-静脉血: 25.26g/L；葡萄糖(Glu)-静脉血: 4.81mmol/L；白蛋白(ALB)-静脉血: 40.9g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；尿素氮(BUN)-静脉血: 3.9mmol/L；血小板分布宽度(PDW)-静脉血: 15.8%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.38mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.05mmolL；乳酸脱氢酶(LDH)-静脉血: 275.2U/L；单核细胞百分比(Mono%)-静脉血: 0.0621；中性粒细胞计数(Neut#)-静脉血: 4.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.711；γ-谷氨酰基转移酶(GGT)-静脉血: 19.5U/L；甘油三酯(TG)-静脉血: 1.23mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.5pg；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.0032；磷(P)-静脉血: 1.37mmol/L；总钙(Ca)-静脉血: 2.23mmol/L；间接胆红素(IBIL)-静脉血: 9umolL；血小板比容-静脉血: 20.8%；C-反应蛋白(CRP)-静脉血: 0.65mg/L；载脂蛋白AI(apoAI)-静脉血: 1.12g/L；总蛋白(TP)-静脉血: 66.16g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.62；单核细胞计数(Mono#)-静脉血: 0.410E9/L；钠离子(Na+)-静脉血: 137.8mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 27.7U/L；丙氨酸氨基转移酶(ALT)-静脉……\n- [全程D37] 检验组合: 嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.4；红细胞比容(Hct)-静脉血: 35.6%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞体积(MCV)-静脉血: 89.9fL；单核细胞百分比(Mono%)-静脉血: 0.046；血小板计数(PLT#)-静脉血: 21310E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.8pg；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.9；平均血小板体积(MPV)-静脉血: 9.2fL；单核细胞计数(Mono#)-静脉血: 0.410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；中性粒细胞百分比(Neut%)-静脉血: 0.79；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；血小板比容-静脉血: 20%；血红蛋白(Hb)-静脉血: 118g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.009；淋巴细胞百分比(Lymph%)-静脉血: 0.147；红细胞计数(RBC#)-静脉血: 3.9610E12/L；血小板分布宽度(PDW)-静脉血: 9.9%；大血小板百分比(P-LCR%)-静脉血: 18.7%；中性粒细胞计数(Neut#)-静脉血: 7.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；白细胞计数(WBC#)-静脉血: 910E9/L\n- [全程D40] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.018；草酸钙结晶计数(CAOX#)-尿液: 10/μL；红细胞计数(RBC#)-尿液: 4/μL；总蛋白(TP)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: 无色；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D41] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；红细胞计数(RBC#)-尿液: 4/μL；白细胞(LEU)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；酮体(KET)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 1/μL；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.024；颜色-尿液: Light-Yellow\n- [全程D42] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 6/μL；隐血(OB)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 4/μL；总蛋白(TP)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7；颜色-尿液: Light-Yellow；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.023；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）；细菌计数(BACT#)-尿液: 8/μL\n- [全程D47] 超声；双侧腋窝淋巴结彩超(套): 检查类型: 超声；检查名称: 双侧腋窝淋巴结彩超(套)；检查部位:；检查所见: 双侧侧腋窝腋下组可见多个淋巴结回声，最大约12x6mm，椭圆形，边界清，皮髓质分界清，淋巴门结构可探及。腋上组及腋中组未见明显异常淋巴结回声。 CDFI：上述淋巴结内可见门型血流信号。；检查结论: 左侧腋窝腋下组淋巴结，符合良性淋巴结声像。\n- [全程D47] 检验组合: 有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 89.5fL；钠离子(Na+)-静脉血: 135.9mmol/L；尿酸(UA)-静脉血: 277.5umol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.0062；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；血红蛋白(Hb)-静脉血: 115.6g/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 332.5g/L；碱性磷酸酶(ALP)-静脉血: 63.1U/L；白蛋白(ALB)-静脉血: 39.9g/L；单核细胞百分比(Mono%)-静脉血: 0.056；α-L-岩藻糖苷酶(AFU)-静脉血: 42.7U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.315；尿素氮(BUN)-静脉血: 5.4mmol/L；白细胞计数(WBC#)-静脉血: 4.0510E9/L；总胆固醇(TC)-静脉血: 4.12mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24U/L；氯离子(Cl-)-静脉血: 99.2mmol/L；载脂蛋白B(apoB)-静脉血: 0.78g/L；丙氨酸氨基转移酶(ALT)-静脉血: 41.3U/L；总胆汁酸(TBA)-静脉血: 0.5umol/L；血小板计数(PLT#)-静脉血: 196.310E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.5%；葡萄糖(Glu)-静脉血: 4.67mmol/L；球蛋白(GLO)-静脉血: 23.82g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.3mmol/L；间接胆红素(IBIL)-静脉血: 7umolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.0051；镁离子(Mg2+)-静脉血: 0.69mmol/L；磷(P)-静脉血: 1.4mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 3.7umol/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；总钙(Ca)-静脉血: 2.27mmol/L；胱抑素(Cys-C)-静脉血: 0.95mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.68；中性粒细胞百分比(……\n- [全程D49] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后： 鼻咽腔轻度狭窄，鼻咽左顶壁、左顶后壁、左侧壁增厚，并见团块状软组织信号影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。鼻咽右侧壁粘膜未见增厚，左侧咽隐窝闭塞，右侧咽隐窝存在，左侧咽旁脂肪间隙狭窄。左侧腭帆提肌、腭帆张肌、头长肌受侵犯，余咽旁诸肌未见异常。 鼻腔未见肿物，口咽左侧壁受侵稍增厚。 双侧翼腭窝、双侧颞下窝未见异常。 蝶骨基底部、斜坡左侧份、左侧岩尖、左侧翼突基底部、左侧翼突内侧板骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、上颌窦、蝶窦、双侧乳突气化良好，未见异常信号影。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。蝶鞍形态正常，其内未见占位性病变。 左侧咽后见肿大的淋巴结，短径17mm，右侧咽后见小淋巴结，短径5mm。左颈II、III区见多个肿大淋巴结，较大者短径13mm，信号欠均匀，增强扫描不均匀强化。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。 扫描所见脑组织未见明确异常。；检查结论: 鼻咽癌化疗后，对比某次就诊时间日片： 鼻咽肿物，较前明显缩小。 颅底骨质破坏，基本同前。 左侧咽后淋巴结、左颈II、III区淋巴结，考虑转移瘤，较前明显缩小。右侧咽后小淋巴结，较前变化不大。\n- [全程D50] 检验组合: 总胆红素(TBIL)-静脉血: 8.1umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 20710E9/L；磷(P)-静脉血: 1.19mmol/L；中性粒细胞计数(Neut#)-静脉血: 2.810E9/L；葡萄糖(Glu)-静脉血: 5.75mmol/L；血红蛋白(Hb)-静脉血: 118g/L；尿酸(UA)-静脉血: 347.3umol/L；平均红细胞体积(MCV)-静脉血: 85.6fL；胱抑素(Cys-C)-静脉血: 1.01mg/L；红细胞比容(Hct)-静脉血: 34%；C-反应蛋白(CRP)-静脉血: 0.45mg/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；白蛋白(ALB)-静脉血: 44.1g/L；肌酐(Crea)-静脉血: 93.9umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 44.6U/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；总钙(Ca)-静脉血: 2.32mmol/L；红细胞计数(RBC#)-静脉血: 3.9710E12/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.1；球蛋白(GLO)-静脉血: 26.11g/L；尿素氮(BUN)-静脉血: 7.9mmol/L；钾离子(K+)-静脉血: 3.55mmol/L；载脂蛋白B(apoB)-静脉血: 0.88g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.72mmol/L；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.592；载脂蛋白AI(apoAI)-静脉血: 1.31g/L；乳酸脱氢酶(LDH)-静脉血: 232.4U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；总胆汁酸(TBA)-静脉血: 2.1umol/L；氯离子(Cl-)-静脉血: 102mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 23.5U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.33mmolL；总蛋白(TP)-静脉血: 70.21g/L；阴离子间隙(AG)-静脉血: 12.8；α-L-岩藻糖苷酶(AFU)-静脉血: 40.7U/L；总胆固醇(TC)-静脉血: 4.57mmol/L；白细胞计数(W……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D15] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D20] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗结束，诉呕吐 次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程5-FU+顺铂方案诱导化疗结束，无诉特殊不适，可予出院，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n- [全程D36] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者复查血常规：中性粒细胞1.2×109/L。郭医生信息已隐藏：暂停化疗，予以患者升中西粒细胞处理。\n- [全程D37] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 患者入院第三天，继续升白细胞处理，今日复查血常规，白细胞已经恢复正常，郭医生信息已隐藏：下周一予以患者第二程化疗。\n- [全程D40] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，可于今日执行第2程5-FU+顺铂方案诱导化疗，注意化疗不良反应。\n- [全程D43] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D47] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+顺铂方案诱导化疗结束，诉恶心、食欲下降，无发热、呕吐、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第2程5-FU+顺铂方案诱导化疗结束，无诉特殊不适，嘱其完成鼻咽、颈MRI复查，以及放疗定位扫描，定期返院治疗。遵嘱。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 予以第3程5-FU+顺铂方案诱导化疗，并继续予以护胃、止呕、补液等常规对症支持治疗。\nB. 开始适形调强放射治疗（IMRT），并予以雾化吸入、鼻腔冲洗、皮肤及黏膜保护剂等放疗支持处理。\nC. 开始适形调强放射治疗（IMRT），待出现III度以上放射性皮炎或黏膜炎时再启动局部保护剂及雾化治疗。\nD. 予以第3程5-FU+顺铂方案诱导化疗，并预防性使用长效重组人粒细胞集落刺激因子。\nE. 开始适形调强放射治疗（IMRT），并常规预防性静脉滴注头孢类广谱抗生素及抗真菌药物。\nF. 暂缓抗肿瘤治疗，继续予以升白细胞及营养支持治疗，观察1-2周后再复查各项生化指标。\nG. 开始适形调强放射治疗（IMRT），并常规预防性静脉滴注大剂量糖皮质激素及甘露醇脱水。\nH. 开始适形调强放射治疗（IMRT），并预防性给予全胃肠外营养（TPN）及静脉高营养支持。\nI. 予以单药顺铂同期化疗，并常规予以水化、利尿及止吐等支持治疗，暂缓启动放射治疗。\nJ. 开始适形调强放射治疗（IMRT），并常规预防性口服非甾体抗炎药及阿片类镇痛药物。\nK. 开始适形调强放射治疗（IMRT），并予以预防性低分子肝素抗凝及深静脉置管常规护理。\nL. 予以靶向治疗联合适形调强放射治疗（IMRT），并常规予以抗过敏及皮疹预防对症处理。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-ba3079ee7b3ef01162117027","patient_id":"patient-5fa48522b2703f35ead0224b","turn_id":"turn07","turn_position":5,"turn_type":"recurrence_or_salvage_decision","gold_letter":"C","gold_action":"暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，动态监测血常规，待中性粒细胞计数恢复后再行下一程化疗。","options":[{"letter":"A","text":"立即按原剂量启动第二程5-FU+顺铂方案化疗，并预防性给予长效重组人粒细胞刺激因子皮下注射","is_gold":false},{"letter":"B","text":"立即按原剂量启动第二程5-FU+顺铂方案化疗，化疗期间同步给予短效重组人粒细胞刺激因子皮下注射","is_gold":false},{"letter":"C","text":"暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，动态监测血常规，待中性粒细胞计数恢复后再行下一程化疗","is_gold":true},{"letter":"D","text":"暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射及广谱抗菌药物静脉滴注，待中性粒细胞计数恢复后再行化疗","is_gold":false},{"letter":"E","text":"终止诱导化疗，直接进入根治性放疗阶段，并给予重组人粒细胞刺激因子皮下注射","is_gold":false},{"letter":"F","text":"暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，待中性粒细胞恢复后调整下一程化疗方案为单药顺铂","is_gold":false},{"letter":"G","text":"暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，待中性粒细胞恢复后将5-FU与顺铂剂量均减低20%行下一程化疗","is_gold":false},{"letter":"H","text":"暂缓本周期化疗，仅予密切观察和口服升白药物，待中性粒细胞计数自然恢复后再行化疗","is_gold":false},{"letter":"I","text":"暂缓本周期化疗，行左侧腋窝淋巴结穿刺活检，同时给予重组人粒细胞刺激因子皮下注射","is_gold":false},{"letter":"J","text":"立即按原剂量启动第二程5-FU+顺铂方案化疗，化疗结束后48小时给予重组人粒细胞刺激因子皮下注射","is_gold":false},{"letter":"K","text":"暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，并安排全身PET-CT重新评估肿瘤范围","is_gold":false},{"letter":"L","text":"终止诱导化疗，改为靶向治疗联合重组人粒细胞刺激因子皮下注射，动态监测血常规","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、斜坡、口咽、蝶骨基底部、岩尖。\n文本分期信息：N2，Mx 左侧腋窝淋巴结可疑转移。\n综合TNM状态：T3N2Mx 左侧腋窝淋巴结可疑转移。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 正常范围心电图\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽左顶壁、左顶后壁、左侧壁增厚，并见团块状软组织信号影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，鼻咽右侧壁粘膜未见增厚，左侧咽隐窝闭塞，右侧咽隐窝存在，左侧咽旁脂肪间隙狭窄。左侧腭帆提肌、腭帆张肌、头长肌、翼内肌受侵犯，余咽旁诸肌未见异常； 左侧咽后见肿大的淋巴结，短径22mm，右侧咽后见小淋巴结，短径5mm。 病灶向前堵塞左侧后鼻孔，口咽左侧壁受侵增厚。 左侧翼腭窝软组织影稍增多，右侧翼腭窝、双侧颞下窝未见异常。 蝶骨基底部、斜坡左侧份、左侧岩尖骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、上颌窦粘膜增厚；蝶窦、双侧乳突气化良好，未见异常信号影；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。 双颈II区、左颈III区见多个淋巴结，较大者短径24mm，信号欠均匀，增强扫描不均匀强化。；检查结论: 鼻咽左顶后壁、左侧壁病灶，考虑鼻咽癌，侵犯左侧咽旁、口咽左侧壁。 颅底骨质破坏。 双侧咽后、双颈II区、左颈III区淋巴结，考虑转移瘤。 副鼻窦炎。\n- [全程D5] 检验组合: 红细胞比容(Hct)-静脉血: 38.9%；血红蛋白(Hb)-静脉血: 131.6g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.5mmolL；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；总蛋白(TP)-静脉血: 69.64g/L；总钙(Ca)-静脉血: 2.26mmol/L；白蛋白(ALB)-静脉血: 43.1g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.42mmol/L；磷(P)-静脉血: 1.22mmol/L；凝血酶时间(TT)-静脉血: 17.3sec.；淋巴细胞百分比(Lymph%)-静脉血: 0.325；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；钠离子(Na+)-静脉血: 140.5mmol/L；单核细胞百分比(Mono%)-静脉血: 0.0954；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；载脂蛋白AI(apoAI)-静脉血: 1.38g/L；丙氨酸氨基转移酶(ALT)-静脉血: 21.7U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；氯离子(Cl-)-静脉血: 103.9mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；血小板计数(PLT#)-静脉血: 270.910E9/L；总胆固醇(TC)-静脉血: 5.3mmol/L；C-反应蛋白(CRP)-静脉血: 0.37mg/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.69mmol/L；甘油三酯(TG)-静脉血: 0.78mmol/L；淋巴细胞计数(Lymph#)-静脉血: 210E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.568；凝血酶原时间活动度(PTA)-静脉血: 94%；活化部分凝血活酶时间(APTT)-静脉血: 25.3sec.；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；平均红细胞血红蛋白含量(MCH)-静脉血: 30.2pg；凝血酶原时间(PT)-静脉血: 11.4sec.；纤维蛋白原(Fbg)-静脉血: 2.62g/L；天门冬氨酸氨基转移酶/丙氨酸氨……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D8] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见:；检查结论:\n- [全程D14] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；透明质酸(HA)-静脉血: 76.89ng/ml；III型前胶原氨基端肽(PIIINP)-静脉血: 28.08ng/ml；葡萄糖(Glu)-尿液: -（参考: 阴性）；降钙素(CT)-静脉血: 22.05pg/ml；总蛋白(TP)-尿液: -（参考: 阴性）；IV型胶原(C-IV)-静脉血: 28.93ng/ml；比重(SG)-尿液: 1.008；颜色-尿液: 无色；酸碱度(pH)-尿液: 6.5；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；层粘连蛋白(LN)-静脉血: 35.29ng/ml；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮\n- [全程D15] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T6水平，估计导管末端位于上腔静脉内。；检查结论: PICC管末端位置如上述。\n- [全程D15] 检验组合: 骨钙素N端中分子片段(N-MID)-静脉血: 11.9ng/ml；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.318ng/ml\n- [全程D16] 检验组合: 浊度(TRUB)-尿液: 清亮；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: +-（参考: 阴性）；酸碱度(pH)-尿液: 7；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.016；葡萄糖(Glu)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 3/μL\n- [全程D17] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 31/μL；颜色-尿液: Yellow；鳞状上皮细胞计数(SQEP#)-尿液: 7/μL；白细胞计数(WBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.021；浊度(TRUB)-尿液: 清亮；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D19] 检验组合: 总钙(Ca)-静脉血: 2.15mmol/L；钠离子(Na+)-静脉血: 138.8mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.2mmol/L；钾离子(K+)-静脉血: 3.08mmol/L；氯离子(Cl-)-静脉血: 102.2mmol/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；磷(P)-静脉血: 1.19mmol/L；阴离子间隙(AG)-静脉血: 15.4\n- [全程D20] 超声；双侧腋窝淋巴结彩超(套): 检查类型: 超声；检查名称: 双侧腋窝淋巴结彩超(套)；检查部位:；检查所见: 左侧腋窝腋下组可见1个淋巴结回声，大小约16x4mm，椭圆形，边界清，皮髓质分界清，淋巴门结构可探及。腋上组及腋中组未见明显异常淋巴结回声。 CDFI：上述淋巴结内可见门型血流信号。；检查结论: 左侧腋窝腋下组淋巴结，符合良性淋巴结声像。\n- [全程D20] 检验组合: 血小板计数(PLT#)-静脉血: 250.210E9/L；肌酐(Crea)-静脉血: 54umol/L；总胆红素(TBIL)-静脉血: 13.7umol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；阴离子间隙(AG)-静脉血: 12.4；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；碱性磷酸酶(ALP)-静脉血: 59.5U/L；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；球蛋白(GLO)-静脉血: 25.26g/L；葡萄糖(Glu)-静脉血: 4.81mmol/L；白蛋白(ALB)-静脉血: 40.9g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；尿素氮(BUN)-静脉血: 3.9mmol/L；血小板分布宽度(PDW)-静脉血: 15.8%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.38mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.05mmolL；乳酸脱氢酶(LDH)-静脉血: 275.2U/L；单核细胞百分比(Mono%)-静脉血: 0.0621；中性粒细胞计数(Neut#)-静脉血: 4.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.711；γ-谷氨酰基转移酶(GGT)-静脉血: 19.5U/L；甘油三酯(TG)-静脉血: 1.23mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.5pg；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.0032；磷(P)-静脉血: 1.37mmol/L；总钙(Ca)-静脉血: 2.23mmol/L；间接胆红素(IBIL)-静脉血: 9umolL；血小板比容-静脉血: 20.8%；C-反应蛋白(CRP)-静脉血: 0.65mg/L；载脂蛋白AI(apoAI)-静脉血: 1.12g/L；总蛋白(TP)-静脉血: 66.16g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.62；单核细胞计数(Mono#)-静脉血: 0.410E9/L；钠离子(Na+)-静脉血: 137.8mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 27.7U/L；丙氨酸氨基转移酶(ALT)-静脉……\n- [全程D37] 检验组合: 嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.4；红细胞比容(Hct)-静脉血: 35.6%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞体积(MCV)-静脉血: 89.9fL；单核细胞百分比(Mono%)-静脉血: 0.046；血小板计数(PLT#)-静脉血: 21310E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.8pg；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.9；平均血小板体积(MPV)-静脉血: 9.2fL；单核细胞计数(Mono#)-静脉血: 0.410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；中性粒细胞百分比(Neut%)-静脉血: 0.79；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；血小板比容-静脉血: 20%；血红蛋白(Hb)-静脉血: 118g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.009；淋巴细胞百分比(Lymph%)-静脉血: 0.147；红细胞计数(RBC#)-静脉血: 3.9610E12/L；血小板分布宽度(PDW)-静脉血: 9.9%；大血小板百分比(P-LCR%)-静脉血: 18.7%；中性粒细胞计数(Neut#)-静脉血: 7.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；白细胞计数(WBC#)-静脉血: 910E9/L\n- [全程D40] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.018；草酸钙结晶计数(CAOX#)-尿液: 10/μL；红细胞计数(RBC#)-尿液: 4/μL；总蛋白(TP)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: 无色；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D41] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；红细胞计数(RBC#)-尿液: 4/μL；白细胞(LEU)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；酮体(KET)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 1/μL；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.024；颜色-尿液: Light-Yellow\n- [全程D42] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 6/μL；隐血(OB)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 4/μL；总蛋白(TP)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7；颜色-尿液: Light-Yellow；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.023；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）；细菌计数(BACT#)-尿液: 8/μL\n- [全程D47] 超声；双侧腋窝淋巴结彩超(套): 检查类型: 超声；检查名称: 双侧腋窝淋巴结彩超(套)；检查部位:；检查所见: 双侧侧腋窝腋下组可见多个淋巴结回声，最大约12x6mm，椭圆形，边界清，皮髓质分界清，淋巴门结构可探及。腋上组及腋中组未见明显异常淋巴结回声。 CDFI：上述淋巴结内可见门型血流信号。；检查结论: 左侧腋窝腋下组淋巴结，符合良性淋巴结声像。\n- [全程D47] 检验组合: 有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 89.5fL；钠离子(Na+)-静脉血: 135.9mmol/L；尿酸(UA)-静脉血: 277.5umol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.0062；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；血红蛋白(Hb)-静脉血: 115.6g/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 332.5g/L；碱性磷酸酶(ALP)-静脉血: 63.1U/L；白蛋白(ALB)-静脉血: 39.9g/L；单核细胞百分比(Mono%)-静脉血: 0.056；α-L-岩藻糖苷酶(AFU)-静脉血: 42.7U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.315；尿素氮(BUN)-静脉血: 5.4mmol/L；白细胞计数(WBC#)-静脉血: 4.0510E9/L；总胆固醇(TC)-静脉血: 4.12mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24U/L；氯离子(Cl-)-静脉血: 99.2mmol/L；载脂蛋白B(apoB)-静脉血: 0.78g/L；丙氨酸氨基转移酶(ALT)-静脉血: 41.3U/L；总胆汁酸(TBA)-静脉血: 0.5umol/L；血小板计数(PLT#)-静脉血: 196.310E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.5%；葡萄糖(Glu)-静脉血: 4.67mmol/L；球蛋白(GLO)-静脉血: 23.82g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.3mmol/L；间接胆红素(IBIL)-静脉血: 7umolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.0051；镁离子(Mg2+)-静脉血: 0.69mmol/L；磷(P)-静脉血: 1.4mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 3.7umol/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；总钙(Ca)-静脉血: 2.27mmol/L；胱抑素(Cys-C)-静脉血: 0.95mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.68；中性粒细胞百分比(……\n- [全程D49] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后： 鼻咽腔轻度狭窄，鼻咽左顶壁、左顶后壁、左侧壁增厚，并见团块状软组织信号影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。鼻咽右侧壁粘膜未见增厚，左侧咽隐窝闭塞，右侧咽隐窝存在，左侧咽旁脂肪间隙狭窄。左侧腭帆提肌、腭帆张肌、头长肌受侵犯，余咽旁诸肌未见异常。 鼻腔未见肿物，口咽左侧壁受侵稍增厚。 双侧翼腭窝、双侧颞下窝未见异常。 蝶骨基底部、斜坡左侧份、左侧岩尖、左侧翼突基底部、左侧翼突内侧板骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、上颌窦、蝶窦、双侧乳突气化良好，未见异常信号影。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。蝶鞍形态正常，其内未见占位性病变。 左侧咽后见肿大的淋巴结，短径17mm，右侧咽后见小淋巴结，短径5mm。左颈II、III区见多个肿大淋巴结，较大者短径13mm，信号欠均匀，增强扫描不均匀强化。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。 扫描所见脑组织未见明确异常。；检查结论: 鼻咽癌化疗后，对比某次就诊时间日片： 鼻咽肿物，较前明显缩小。 颅底骨质破坏，基本同前。 左侧咽后淋巴结、左颈II、III区淋巴结，考虑转移瘤，较前明显缩小。右侧咽后小淋巴结，较前变化不大。\n- [全程D50] 检验组合: 总胆红素(TBIL)-静脉血: 8.1umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 20710E9/L；磷(P)-静脉血: 1.19mmol/L；中性粒细胞计数(Neut#)-静脉血: 2.810E9/L；葡萄糖(Glu)-静脉血: 5.75mmol/L；血红蛋白(Hb)-静脉血: 118g/L；尿酸(UA)-静脉血: 347.3umol/L；平均红细胞体积(MCV)-静脉血: 85.6fL；胱抑素(Cys-C)-静脉血: 1.01mg/L；红细胞比容(Hct)-静脉血: 34%；C-反应蛋白(CRP)-静脉血: 0.45mg/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；白蛋白(ALB)-静脉血: 44.1g/L；肌酐(Crea)-静脉血: 93.9umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 44.6U/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；总钙(Ca)-静脉血: 2.32mmol/L；红细胞计数(RBC#)-静脉血: 3.9710E12/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.1；球蛋白(GLO)-静脉血: 26.11g/L；尿素氮(BUN)-静脉血: 7.9mmol/L；钾离子(K+)-静脉血: 3.55mmol/L；载脂蛋白B(apoB)-静脉血: 0.88g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.72mmol/L；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.592；载脂蛋白AI(apoAI)-静脉血: 1.31g/L；乳酸脱氢酶(LDH)-静脉血: 232.4U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；总胆汁酸(TBA)-静脉血: 2.1umol/L；氯离子(Cl-)-静脉血: 102mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 23.5U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.33mmolL；总蛋白(TP)-静脉血: 70.21g/L；阴离子间隙(AG)-静脉血: 12.8；α-L-岩藻糖苷酶(AFU)-静脉血: 40.7U/L；总胆固醇(TC)-静脉血: 4.57mmol/L；白细胞计数(W……\n- [全程D34] 检验组合: 中性粒细胞百分比(Neut%)-静脉血: 0.356；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329.8g/L；中性粒细胞计数(Neut#)-静脉血: 1.210E9/L；载脂蛋白AI(apoAI)-静脉血: 1.23g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 1.9umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.3；平均红细胞体积(MCV)-静脉血: 89.7fL；钾离子(K+)-静脉血: 3.9mmol/L；总蛋白(TP)-静脉血: 68.46g/L；球蛋白(GLO)-静脉血: 29.66g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.5%；血小板分布宽度(PDW)-静脉血: 16%；白细胞计数(WBC#)-静脉血: 3.2410E9/L；磷(P)-静脉血: 1.24mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.0079；间接胆红素(IBIL)-静脉血: 2.8umolL；镁离子(Mg2+)-静脉血: 0.89mmol/L；碱性磷酸酶(ALP)-静脉血: 66.5U/L；红细胞比容(Hct)-静脉血: 36.1%；丙氨酸氨基转移酶(ALT)-静脉血: 18.5U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.51；单核细胞百分比(Mono%)-静脉血: 0.1112；尿素氮(BUN)-静脉血: 5.39mmol/L；红细胞计数(RBC#)-静脉血: 4.0210E12/L；血小板计数(PLT#)-静脉血: 240.610E9/L；胱抑素(Cys-C)-静脉血: 0.87mg/L；天门冬氨酸氨基转移酶(AST)-静脉血: 22.2U/L；C-反应蛋白(CRP)-静脉血: 0.37mg/L；阴离子间隙(AG)-静脉血: 13；总胆汁酸(TBA)-静脉血: 0.8umol/L；葡萄糖(Glu)-静脉血: 4.81mmol/L；总钙(Ca)-静脉血: 2.31mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；总胆红素(TBIL)-静脉血: 4.7umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.2；平均血小板体积(MPV)-静脉血……\n- [全程D35] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁、后壁及左侧壁增厚放射性浓聚，SUV约22.8，病灶向下侵犯软腭及口咽左侧壁；病灶侵犯左头长肌、左侧腭帆提张肌及左咽旁间隙，左侧咽隐窝消失，左侧咽旁间隙消失。左咽后肿大淋巴结放射性浓聚，SUV约19.2，与鼻咽病灶分界不清。喉咽结构及放射性分布未见明显异常。额窦、蝶窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。左颈II、III区数个淋巴结放射性浓聚，SUV约20.2，最大约1.8×3.3cm；右颈II、Va区数个小淋巴结部分放射性分布略浓密，SUV约3.3，最大约0.6×1.1cm；余双颈小淋巴结放射性分布未见异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。心脏及纵隔大血管未见明显异常。左腋窝淋巴结放射性分布浓密，SUV约9.0，大小约0.9×1.5cm；纵隔、双肺门及右侧腋窝未见肿大淋巴结及异常放射性分布。双侧乳腺放射性分布未见明显异常。 肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 子宫体积增大，外形呈波浪状，放射性分布未见异常；子宫旁见高密度节育器影；膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，病灶侵犯软腭、口咽左侧壁及左咽旁间隙；左咽后及左颈II、III区淋巴结代谢活跃，考虑转移；左腋窝淋巴结代谢活跃，不排除转移。 右颈II、Va区小淋巴结部分代谢略活跃，疑炎性病变，请结合临床。 疑子宫肌瘤。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D15] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D20] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗结束，诉呕吐 次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程5-FU+顺铂方案诱导化疗结束，无诉特殊不适，可予出院，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n- [全程D36] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者复查血常规：中性粒细胞1.2×109/L。郭医生信息已隐藏：暂停化疗，予以患者升中西粒细胞处理。\n- [全程D37] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 患者入院第三天，继续升白细胞处理，今日复查血常规，白细胞已经恢复正常，郭医生信息已隐藏：下周一予以患者第二程化疗。\n- [全程D40] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，可于今日执行第2程5-FU+顺铂方案诱导化疗，注意化疗不良反应。\n- [全程D43] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D47] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+顺铂方案诱导化疗结束，诉恶心、食欲下降，无发热、呕吐、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第2程5-FU+顺铂方案诱导化疗结束，无诉特殊不适，嘱其完成鼻咽、颈MRI复查，以及放疗定位扫描，定期返院治疗。遵嘱。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即按原剂量启动第二程5-FU+顺铂方案化疗，并预防性给予长效重组人粒细胞刺激因子皮下注射\nB. 立即按原剂量启动第二程5-FU+顺铂方案化疗，化疗期间同步给予短效重组人粒细胞刺激因子皮下注射\nC. 暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，动态监测血常规，待中性粒细胞计数恢复后再行下一程化疗\nD. 暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射及广谱抗菌药物静脉滴注，待中性粒细胞计数恢复后再行化疗\nE. 终止诱导化疗，直接进入根治性放疗阶段，并给予重组人粒细胞刺激因子皮下注射\nF. 暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，待中性粒细胞恢复后调整下一程化疗方案为单药顺铂\nG. 暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，待中性粒细胞恢复后将5-FU与顺铂剂量均减低20%行下一程化疗\nH. 暂缓本周期化疗，仅予密切观察和口服升白药物，待中性粒细胞计数自然恢复后再行化疗\nI. 暂缓本周期化疗，行左侧腋窝淋巴结穿刺活检，同时给予重组人粒细胞刺激因子皮下注射\nJ. 立即按原剂量启动第二程5-FU+顺铂方案化疗，化疗结束后48小时给予重组人粒细胞刺激因子皮下注射\nK. 暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，并安排全身PET-CT重新评估肿瘤范围\nL. 终止诱导化疗，改为靶向治疗联合重组人粒细胞刺激因子皮下注射，动态监测血常规\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、斜坡、口咽、蝶骨基底部、岩尖。\n文本分期信息：N2，Mx 左侧腋窝淋巴结可疑转移。\n综合TNM状态：T3N2Mx 左侧腋窝淋巴结可疑转移。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 正常范围心电图\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽左顶壁、左顶后壁、左侧壁增厚，并见团块状软组织信号影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，鼻咽右侧壁粘膜未见增厚，左侧咽隐窝闭塞，右侧咽隐窝存在，左侧咽旁脂肪间隙狭窄。左侧腭帆提肌、腭帆张肌、头长肌、翼内肌受侵犯，余咽旁诸肌未见异常； 左侧咽后见肿大的淋巴结，短径22mm，右侧咽后见小淋巴结，短径5mm。 病灶向前堵塞左侧后鼻孔，口咽左侧壁受侵增厚。 左侧翼腭窝软组织影稍增多，右侧翼腭窝、双侧颞下窝未见异常。 蝶骨基底部、斜坡左侧份、左侧岩尖骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、上颌窦粘膜增厚；蝶窦、双侧乳突气化良好，未见异常信号影；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。 双颈II区、左颈III区见多个淋巴结，较大者短径24mm，信号欠均匀，增强扫描不均匀强化。；检查结论: 鼻咽左顶后壁、左侧壁病灶，考虑鼻咽癌，侵犯左侧咽旁、口咽左侧壁。 颅底骨质破坏。 双侧咽后、双颈II区、左颈III区淋巴结，考虑转移瘤。 副鼻窦炎。\n- [全程D5] 检验组合: 红细胞比容(Hct)-静脉血: 38.9%；血红蛋白(Hb)-静脉血: 131.6g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.5mmolL；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；总蛋白(TP)-静脉血: 69.64g/L；总钙(Ca)-静脉血: 2.26mmol/L；白蛋白(ALB)-静脉血: 43.1g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.42mmol/L；磷(P)-静脉血: 1.22mmol/L；凝血酶时间(TT)-静脉血: 17.3sec.；淋巴细胞百分比(Lymph%)-静脉血: 0.325；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；钠离子(Na+)-静脉血: 140.5mmol/L；单核细胞百分比(Mono%)-静脉血: 0.0954；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；载脂蛋白AI(apoAI)-静脉血: 1.38g/L；丙氨酸氨基转移酶(ALT)-静脉血: 21.7U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；氯离子(Cl-)-静脉血: 103.9mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；血小板计数(PLT#)-静脉血: 270.910E9/L；总胆固醇(TC)-静脉血: 5.3mmol/L；C-反应蛋白(CRP)-静脉血: 0.37mg/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.69mmol/L；甘油三酯(TG)-静脉血: 0.78mmol/L；淋巴细胞计数(Lymph#)-静脉血: 210E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.568；凝血酶原时间活动度(PTA)-静脉血: 94%；活化部分凝血活酶时间(APTT)-静脉血: 25.3sec.；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；平均红细胞血红蛋白含量(MCH)-静脉血: 30.2pg；凝血酶原时间(PT)-静脉血: 11.4sec.；纤维蛋白原(Fbg)-静脉血: 2.62g/L；天门冬氨酸氨基转移酶/丙氨酸氨……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D8] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见:；检查结论:\n- [全程D14] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；透明质酸(HA)-静脉血: 76.89ng/ml；III型前胶原氨基端肽(PIIINP)-静脉血: 28.08ng/ml；葡萄糖(Glu)-尿液: -（参考: 阴性）；降钙素(CT)-静脉血: 22.05pg/ml；总蛋白(TP)-尿液: -（参考: 阴性）；IV型胶原(C-IV)-静脉血: 28.93ng/ml；比重(SG)-尿液: 1.008；颜色-尿液: 无色；酸碱度(pH)-尿液: 6.5；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；层粘连蛋白(LN)-静脉血: 35.29ng/ml；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮\n- [全程D15] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T6水平，估计导管末端位于上腔静脉内。；检查结论: PICC管末端位置如上述。\n- [全程D15] 检验组合: 骨钙素N端中分子片段(N-MID)-静脉血: 11.9ng/ml；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.318ng/ml\n- [全程D16] 检验组合: 浊度(TRUB)-尿液: 清亮；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: +-（参考: 阴性）；酸碱度(pH)-尿液: 7；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.016；葡萄糖(Glu)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 3/μL\n- [全程D17] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 31/μL；颜色-尿液: Yellow；鳞状上皮细胞计数(SQEP#)-尿液: 7/μL；白细胞计数(WBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.021；浊度(TRUB)-尿液: 清亮；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D19] 检验组合: 总钙(Ca)-静脉血: 2.15mmol/L；钠离子(Na+)-静脉血: 138.8mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.2mmol/L；钾离子(K+)-静脉血: 3.08mmol/L；氯离子(Cl-)-静脉血: 102.2mmol/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；磷(P)-静脉血: 1.19mmol/L；阴离子间隙(AG)-静脉血: 15.4\n- [全程D20] 超声；双侧腋窝淋巴结彩超(套): 检查类型: 超声；检查名称: 双侧腋窝淋巴结彩超(套)；检查部位:；检查所见: 左侧腋窝腋下组可见1个淋巴结回声，大小约16x4mm，椭圆形，边界清，皮髓质分界清，淋巴门结构可探及。腋上组及腋中组未见明显异常淋巴结回声。 CDFI：上述淋巴结内可见门型血流信号。；检查结论: 左侧腋窝腋下组淋巴结，符合良性淋巴结声像。\n- [全程D20] 检验组合: 血小板计数(PLT#)-静脉血: 250.210E9/L；肌酐(Crea)-静脉血: 54umol/L；总胆红素(TBIL)-静脉血: 13.7umol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；阴离子间隙(AG)-静脉血: 12.4；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；碱性磷酸酶(ALP)-静脉血: 59.5U/L；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；球蛋白(GLO)-静脉血: 25.26g/L；葡萄糖(Glu)-静脉血: 4.81mmol/L；白蛋白(ALB)-静脉血: 40.9g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；尿素氮(BUN)-静脉血: 3.9mmol/L；血小板分布宽度(PDW)-静脉血: 15.8%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.38mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.05mmolL；乳酸脱氢酶(LDH)-静脉血: 275.2U/L；单核细胞百分比(Mono%)-静脉血: 0.0621；中性粒细胞计数(Neut#)-静脉血: 4.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.711；γ-谷氨酰基转移酶(GGT)-静脉血: 19.5U/L；甘油三酯(TG)-静脉血: 1.23mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.5pg；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.0032；磷(P)-静脉血: 1.37mmol/L；总钙(Ca)-静脉血: 2.23mmol/L；间接胆红素(IBIL)-静脉血: 9umolL；血小板比容-静脉血: 20.8%；C-反应蛋白(CRP)-静脉血: 0.65mg/L；载脂蛋白AI(apoAI)-静脉血: 1.12g/L；总蛋白(TP)-静脉血: 66.16g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.62；单核细胞计数(Mono#)-静脉血: 0.410E9/L；钠离子(Na+)-静脉血: 137.8mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 27.7U/L；丙氨酸氨基转移酶(ALT)-静脉……\n- [全程D37] 检验组合: 嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.4；红细胞比容(Hct)-静脉血: 35.6%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞体积(MCV)-静脉血: 89.9fL；单核细胞百分比(Mono%)-静脉血: 0.046；血小板计数(PLT#)-静脉血: 21310E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.8pg；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.9；平均血小板体积(MPV)-静脉血: 9.2fL；单核细胞计数(Mono#)-静脉血: 0.410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；中性粒细胞百分比(Neut%)-静脉血: 0.79；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；血小板比容-静脉血: 20%；血红蛋白(Hb)-静脉血: 118g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.009；淋巴细胞百分比(Lymph%)-静脉血: 0.147；红细胞计数(RBC#)-静脉血: 3.9610E12/L；血小板分布宽度(PDW)-静脉血: 9.9%；大血小板百分比(P-LCR%)-静脉血: 18.7%；中性粒细胞计数(Neut#)-静脉血: 7.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；白细胞计数(WBC#)-静脉血: 910E9/L\n- [全程D40] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.018；草酸钙结晶计数(CAOX#)-尿液: 10/μL；红细胞计数(RBC#)-尿液: 4/μL；总蛋白(TP)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: 无色；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D41] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；红细胞计数(RBC#)-尿液: 4/μL；白细胞(LEU)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；酮体(KET)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 1/μL；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.024；颜色-尿液: Light-Yellow\n- [全程D42] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 6/μL；隐血(OB)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 4/μL；总蛋白(TP)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7；颜色-尿液: Light-Yellow；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.023；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）；细菌计数(BACT#)-尿液: 8/μL\n- [全程D47] 超声；双侧腋窝淋巴结彩超(套): 检查类型: 超声；检查名称: 双侧腋窝淋巴结彩超(套)；检查部位:；检查所见: 双侧侧腋窝腋下组可见多个淋巴结回声，最大约12x6mm，椭圆形，边界清，皮髓质分界清，淋巴门结构可探及。腋上组及腋中组未见明显异常淋巴结回声。 CDFI：上述淋巴结内可见门型血流信号。；检查结论: 左侧腋窝腋下组淋巴结，符合良性淋巴结声像。\n- [全程D47] 检验组合: 有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 89.5fL；钠离子(Na+)-静脉血: 135.9mmol/L；尿酸(UA)-静脉血: 277.5umol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.0062；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；血红蛋白(Hb)-静脉血: 115.6g/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 332.5g/L；碱性磷酸酶(ALP)-静脉血: 63.1U/L；白蛋白(ALB)-静脉血: 39.9g/L；单核细胞百分比(Mono%)-静脉血: 0.056；α-L-岩藻糖苷酶(AFU)-静脉血: 42.7U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.315；尿素氮(BUN)-静脉血: 5.4mmol/L；白细胞计数(WBC#)-静脉血: 4.0510E9/L；总胆固醇(TC)-静脉血: 4.12mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24U/L；氯离子(Cl-)-静脉血: 99.2mmol/L；载脂蛋白B(apoB)-静脉血: 0.78g/L；丙氨酸氨基转移酶(ALT)-静脉血: 41.3U/L；总胆汁酸(TBA)-静脉血: 0.5umol/L；血小板计数(PLT#)-静脉血: 196.310E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.5%；葡萄糖(Glu)-静脉血: 4.67mmol/L；球蛋白(GLO)-静脉血: 23.82g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.3mmol/L；间接胆红素(IBIL)-静脉血: 7umolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.0051；镁离子(Mg2+)-静脉血: 0.69mmol/L；磷(P)-静脉血: 1.4mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 3.7umol/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；总钙(Ca)-静脉血: 2.27mmol/L；胱抑素(Cys-C)-静脉血: 0.95mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.68；中性粒细胞百分比(……\n- [全程D49] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后： 鼻咽腔轻度狭窄，鼻咽左顶壁、左顶后壁、左侧壁增厚，并见团块状软组织信号影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。鼻咽右侧壁粘膜未见增厚，左侧咽隐窝闭塞，右侧咽隐窝存在，左侧咽旁脂肪间隙狭窄。左侧腭帆提肌、腭帆张肌、头长肌受侵犯，余咽旁诸肌未见异常。 鼻腔未见肿物，口咽左侧壁受侵稍增厚。 双侧翼腭窝、双侧颞下窝未见异常。 蝶骨基底部、斜坡左侧份、左侧岩尖、左侧翼突基底部、左侧翼突内侧板骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、上颌窦、蝶窦、双侧乳突气化良好，未见异常信号影。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。蝶鞍形态正常，其内未见占位性病变。 左侧咽后见肿大的淋巴结，短径17mm，右侧咽后见小淋巴结，短径5mm。左颈II、III区见多个肿大淋巴结，较大者短径13mm，信号欠均匀，增强扫描不均匀强化。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。 扫描所见脑组织未见明确异常。；检查结论: 鼻咽癌化疗后，对比某次就诊时间日片： 鼻咽肿物，较前明显缩小。 颅底骨质破坏，基本同前。 左侧咽后淋巴结、左颈II、III区淋巴结，考虑转移瘤，较前明显缩小。右侧咽后小淋巴结，较前变化不大。\n- [全程D50] 检验组合: 总胆红素(TBIL)-静脉血: 8.1umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 20710E9/L；磷(P)-静脉血: 1.19mmol/L；中性粒细胞计数(Neut#)-静脉血: 2.810E9/L；葡萄糖(Glu)-静脉血: 5.75mmol/L；血红蛋白(Hb)-静脉血: 118g/L；尿酸(UA)-静脉血: 347.3umol/L；平均红细胞体积(MCV)-静脉血: 85.6fL；胱抑素(Cys-C)-静脉血: 1.01mg/L；红细胞比容(Hct)-静脉血: 34%；C-反应蛋白(CRP)-静脉血: 0.45mg/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；白蛋白(ALB)-静脉血: 44.1g/L；肌酐(Crea)-静脉血: 93.9umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 44.6U/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；总钙(Ca)-静脉血: 2.32mmol/L；红细胞计数(RBC#)-静脉血: 3.9710E12/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.1；球蛋白(GLO)-静脉血: 26.11g/L；尿素氮(BUN)-静脉血: 7.9mmol/L；钾离子(K+)-静脉血: 3.55mmol/L；载脂蛋白B(apoB)-静脉血: 0.88g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.72mmol/L；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.592；载脂蛋白AI(apoAI)-静脉血: 1.31g/L；乳酸脱氢酶(LDH)-静脉血: 232.4U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；总胆汁酸(TBA)-静脉血: 2.1umol/L；氯离子(Cl-)-静脉血: 102mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 23.5U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.33mmolL；总蛋白(TP)-静脉血: 70.21g/L；阴离子间隙(AG)-静脉血: 12.8；α-L-岩藻糖苷酶(AFU)-静脉血: 40.7U/L；总胆固醇(TC)-静脉血: 4.57mmol/L；白细胞计数(W……\n- [全程D34] 检验组合: 中性粒细胞百分比(Neut%)-静脉血: 0.356；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329.8g/L；中性粒细胞计数(Neut#)-静脉血: 1.210E9/L；载脂蛋白AI(apoAI)-静脉血: 1.23g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 1.9umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.3；平均红细胞体积(MCV)-静脉血: 89.7fL；钾离子(K+)-静脉血: 3.9mmol/L；总蛋白(TP)-静脉血: 68.46g/L；球蛋白(GLO)-静脉血: 29.66g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.5%；血小板分布宽度(PDW)-静脉血: 16%；白细胞计数(WBC#)-静脉血: 3.2410E9/L；磷(P)-静脉血: 1.24mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.0079；间接胆红素(IBIL)-静脉血: 2.8umolL；镁离子(Mg2+)-静脉血: 0.89mmol/L；碱性磷酸酶(ALP)-静脉血: 66.5U/L；红细胞比容(Hct)-静脉血: 36.1%；丙氨酸氨基转移酶(ALT)-静脉血: 18.5U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.51；单核细胞百分比(Mono%)-静脉血: 0.1112；尿素氮(BUN)-静脉血: 5.39mmol/L；红细胞计数(RBC#)-静脉血: 4.0210E12/L；血小板计数(PLT#)-静脉血: 240.610E9/L；胱抑素(Cys-C)-静脉血: 0.87mg/L；天门冬氨酸氨基转移酶(AST)-静脉血: 22.2U/L；C-反应蛋白(CRP)-静脉血: 0.37mg/L；阴离子间隙(AG)-静脉血: 13；总胆汁酸(TBA)-静脉血: 0.8umol/L；葡萄糖(Glu)-静脉血: 4.81mmol/L；总钙(Ca)-静脉血: 2.31mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；总胆红素(TBIL)-静脉血: 4.7umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.2；平均血小板体积(MPV)-静脉血……\n- [全程D35] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁、后壁及左侧壁增厚放射性浓聚，SUV约22.8，病灶向下侵犯软腭及口咽左侧壁；病灶侵犯左头长肌、左侧腭帆提张肌及左咽旁间隙，左侧咽隐窝消失，左侧咽旁间隙消失。左咽后肿大淋巴结放射性浓聚，SUV约19.2，与鼻咽病灶分界不清。喉咽结构及放射性分布未见明显异常。额窦、蝶窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。左颈II、III区数个淋巴结放射性浓聚，SUV约20.2，最大约1.8×3.3cm；右颈II、Va区数个小淋巴结部分放射性分布略浓密，SUV约3.3，最大约0.6×1.1cm；余双颈小淋巴结放射性分布未见异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。心脏及纵隔大血管未见明显异常。左腋窝淋巴结放射性分布浓密，SUV约9.0，大小约0.9×1.5cm；纵隔、双肺门及右侧腋窝未见肿大淋巴结及异常放射性分布。双侧乳腺放射性分布未见明显异常。 肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 子宫体积增大，外形呈波浪状，放射性分布未见异常；子宫旁见高密度节育器影；膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，病灶侵犯软腭、口咽左侧壁及左咽旁间隙；左咽后及左颈II、III区淋巴结代谢活跃，考虑转移；左腋窝淋巴结代谢活跃，不排除转移。 右颈II、Va区小淋巴结部分代谢略活跃，疑炎性病变，请结合临床。 疑子宫肌瘤。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D15] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D20] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗结束，诉呕吐 次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程5-FU+顺铂方案诱导化疗结束，无诉特殊不适，可予出院，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n- [全程D36] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者复查血常规：中性粒细胞1.2×109/L。郭医生信息已隐藏：暂停化疗，予以患者升中西粒细胞处理。\n- [全程D37] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 患者入院第三天，继续升白细胞处理，今日复查血常规，白细胞已经恢复正常，郭医生信息已隐藏：下周一予以患者第二程化疗。\n- [全程D40] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，可于今日执行第2程5-FU+顺铂方案诱导化疗，注意化疗不良反应。\n- [全程D43] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D47] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+顺铂方案诱导化疗结束，诉恶心、食欲下降，无发热、呕吐、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第2程5-FU+顺铂方案诱导化疗结束，无诉特殊不适，嘱其完成鼻咽、颈MRI复查，以及放疗定位扫描，定期返院治疗。遵嘱。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即按原剂量启动第二程5-FU+顺铂方案化疗，并预防性给予长效重组人粒细胞刺激因子皮下注射\nB. 立即按原剂量启动第二程5-FU+顺铂方案化疗，化疗期间同步给予短效重组人粒细胞刺激因子皮下注射\nC. 暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，动态监测血常规，待中性粒细胞计数恢复后再行下一程化疗\nD. 暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射及广谱抗菌药物静脉滴注，待中性粒细胞计数恢复后再行化疗\nE. 终止诱导化疗，直接进入根治性放疗阶段，并给予重组人粒细胞刺激因子皮下注射\nF. 暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，待中性粒细胞恢复后调整下一程化疗方案为单药顺铂\nG. 暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，待中性粒细胞恢复后将5-FU与顺铂剂量均减低20%行下一程化疗\nH. 暂缓本周期化疗，仅予密切观察和口服升白药物，待中性粒细胞计数自然恢复后再行化疗\nI. 暂缓本周期化疗，行左侧腋窝淋巴结穿刺活检，同时给予重组人粒细胞刺激因子皮下注射\nJ. 立即按原剂量启动第二程5-FU+顺铂方案化疗，化疗结束后48小时给予重组人粒细胞刺激因子皮下注射\nK. 暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，并安排全身PET-CT重新评估肿瘤范围\nL. 终止诱导化疗，改为靶向治疗联合重组人粒细胞刺激因子皮下注射，动态监测血常规\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-800192dfaf82bbe4edb2533a","patient_id":"patient-5fa48522b2703f35ead0224b","turn_id":"turn08","turn_position":6,"turn_type":"response_assessment_decision","gold_letter":"A","gold_action":"完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动顺铂同期化放疗","options":[{"letter":"A","text":"完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动顺铂同期化放疗","is_gold":true},{"letter":"B","text":"完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动第3程5-FU+顺铂诱导化疗","is_gold":false},{"letter":"C","text":"完善左侧腋窝淋巴结穿刺活检，行放疗定位扫描，并启动顺铂同期化放疗","is_gold":false},{"letter":"D","text":"完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动尼妥珠单抗联合根治性放疗","is_gold":false},{"letter":"E","text":"完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动单纯根治性放疗","is_gold":false},{"letter":"F","text":"完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动信迪利单抗联合根治性放疗","is_gold":false},{"letter":"G","text":"完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动尼妥珠单抗联合顺铂同期化放疗","is_gold":false},{"letter":"H","text":"完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动卡培他滨同期化放疗","is_gold":false},{"letter":"I","text":"完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动西妥昔单抗联合根治性放疗","is_gold":false},{"letter":"J","text":"完善全身PET-CT复查，行放疗定位扫描，并启动尼妥珠单抗联合根治性放疗","is_gold":false},{"letter":"K","text":"完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动吉西他滨联合顺铂同期化放疗","is_gold":false},{"letter":"L","text":"完善鼻咽及颈部MRI复查，暂缓放疗定位，启动第3程5-FU+顺铂诱导化疗","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、斜坡、口咽、蝶骨基底部、岩尖。\n文本分期信息：N2，Mx 左侧腋窝淋巴结可疑转移。\n综合TNM状态：T3N2Mx 左侧腋窝淋巴结可疑转移。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 正常范围心电图\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽左顶壁、左顶后壁、左侧壁增厚，并见团块状软组织信号影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，鼻咽右侧壁粘膜未见增厚，左侧咽隐窝闭塞，右侧咽隐窝存在，左侧咽旁脂肪间隙狭窄。左侧腭帆提肌、腭帆张肌、头长肌、翼内肌受侵犯，余咽旁诸肌未见异常； 左侧咽后见肿大的淋巴结，短径22mm，右侧咽后见小淋巴结，短径5mm。 病灶向前堵塞左侧后鼻孔，口咽左侧壁受侵增厚。 左侧翼腭窝软组织影稍增多，右侧翼腭窝、双侧颞下窝未见异常。 蝶骨基底部、斜坡左侧份、左侧岩尖骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、上颌窦粘膜增厚；蝶窦、双侧乳突气化良好，未见异常信号影；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。 双颈II区、左颈III区见多个淋巴结，较大者短径24mm，信号欠均匀，增强扫描不均匀强化。；检查结论: 鼻咽左顶后壁、左侧壁病灶，考虑鼻咽癌，侵犯左侧咽旁、口咽左侧壁。 颅底骨质破坏。 双侧咽后、双颈II区、左颈III区淋巴结，考虑转移瘤。 副鼻窦炎。\n- [全程D5] 检验组合: 红细胞比容(Hct)-静脉血: 38.9%；血红蛋白(Hb)-静脉血: 131.6g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.5mmolL；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；总蛋白(TP)-静脉血: 69.64g/L；总钙(Ca)-静脉血: 2.26mmol/L；白蛋白(ALB)-静脉血: 43.1g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.42mmol/L；磷(P)-静脉血: 1.22mmol/L；凝血酶时间(TT)-静脉血: 17.3sec.；淋巴细胞百分比(Lymph%)-静脉血: 0.325；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；钠离子(Na+)-静脉血: 140.5mmol/L；单核细胞百分比(Mono%)-静脉血: 0.0954；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；载脂蛋白AI(apoAI)-静脉血: 1.38g/L；丙氨酸氨基转移酶(ALT)-静脉血: 21.7U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；氯离子(Cl-)-静脉血: 103.9mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；血小板计数(PLT#)-静脉血: 270.910E9/L；总胆固醇(TC)-静脉血: 5.3mmol/L；C-反应蛋白(CRP)-静脉血: 0.37mg/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.69mmol/L；甘油三酯(TG)-静脉血: 0.78mmol/L；淋巴细胞计数(Lymph#)-静脉血: 210E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.568；凝血酶原时间活动度(PTA)-静脉血: 94%；活化部分凝血活酶时间(APTT)-静脉血: 25.3sec.；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；平均红细胞血红蛋白含量(MCH)-静脉血: 30.2pg；凝血酶原时间(PT)-静脉血: 11.4sec.；纤维蛋白原(Fbg)-静脉血: 2.62g/L；天门冬氨酸氨基转移酶/丙氨酸氨……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D8] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见:；检查结论:\n- [全程D14] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；透明质酸(HA)-静脉血: 76.89ng/ml；III型前胶原氨基端肽(PIIINP)-静脉血: 28.08ng/ml；葡萄糖(Glu)-尿液: -（参考: 阴性）；降钙素(CT)-静脉血: 22.05pg/ml；总蛋白(TP)-尿液: -（参考: 阴性）；IV型胶原(C-IV)-静脉血: 28.93ng/ml；比重(SG)-尿液: 1.008；颜色-尿液: 无色；酸碱度(pH)-尿液: 6.5；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；层粘连蛋白(LN)-静脉血: 35.29ng/ml；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮\n- [全程D15] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T6水平，估计导管末端位于上腔静脉内。；检查结论: PICC管末端位置如上述。\n- [全程D15] 检验组合: 骨钙素N端中分子片段(N-MID)-静脉血: 11.9ng/ml；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.318ng/ml\n- [全程D16] 检验组合: 浊度(TRUB)-尿液: 清亮；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: +-（参考: 阴性）；酸碱度(pH)-尿液: 7；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.016；葡萄糖(Glu)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 3/μL\n- [全程D17] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 31/μL；颜色-尿液: Yellow；鳞状上皮细胞计数(SQEP#)-尿液: 7/μL；白细胞计数(WBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.021；浊度(TRUB)-尿液: 清亮；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D19] 检验组合: 总钙(Ca)-静脉血: 2.15mmol/L；钠离子(Na+)-静脉血: 138.8mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.2mmol/L；钾离子(K+)-静脉血: 3.08mmol/L；氯离子(Cl-)-静脉血: 102.2mmol/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；磷(P)-静脉血: 1.19mmol/L；阴离子间隙(AG)-静脉血: 15.4\n- [全程D20] 超声；双侧腋窝淋巴结彩超(套): 检查类型: 超声；检查名称: 双侧腋窝淋巴结彩超(套)；检查部位:；检查所见: 左侧腋窝腋下组可见1个淋巴结回声，大小约16x4mm，椭圆形，边界清，皮髓质分界清，淋巴门结构可探及。腋上组及腋中组未见明显异常淋巴结回声。 CDFI：上述淋巴结内可见门型血流信号。；检查结论: 左侧腋窝腋下组淋巴结，符合良性淋巴结声像。\n- [全程D20] 检验组合: 血小板计数(PLT#)-静脉血: 250.210E9/L；肌酐(Crea)-静脉血: 54umol/L；总胆红素(TBIL)-静脉血: 13.7umol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；阴离子间隙(AG)-静脉血: 12.4；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；碱性磷酸酶(ALP)-静脉血: 59.5U/L；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；球蛋白(GLO)-静脉血: 25.26g/L；葡萄糖(Glu)-静脉血: 4.81mmol/L；白蛋白(ALB)-静脉血: 40.9g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；尿素氮(BUN)-静脉血: 3.9mmol/L；血小板分布宽度(PDW)-静脉血: 15.8%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.38mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.05mmolL；乳酸脱氢酶(LDH)-静脉血: 275.2U/L；单核细胞百分比(Mono%)-静脉血: 0.0621；中性粒细胞计数(Neut#)-静脉血: 4.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.711；γ-谷氨酰基转移酶(GGT)-静脉血: 19.5U/L；甘油三酯(TG)-静脉血: 1.23mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.5pg；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.0032；磷(P)-静脉血: 1.37mmol/L；总钙(Ca)-静脉血: 2.23mmol/L；间接胆红素(IBIL)-静脉血: 9umolL；血小板比容-静脉血: 20.8%；C-反应蛋白(CRP)-静脉血: 0.65mg/L；载脂蛋白AI(apoAI)-静脉血: 1.12g/L；总蛋白(TP)-静脉血: 66.16g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.62；单核细胞计数(Mono#)-静脉血: 0.410E9/L；钠离子(Na+)-静脉血: 137.8mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 27.7U/L；丙氨酸氨基转移酶(ALT)-静脉……\n- [全程D37] 检验组合: 嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.4；红细胞比容(Hct)-静脉血: 35.6%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞体积(MCV)-静脉血: 89.9fL；单核细胞百分比(Mono%)-静脉血: 0.046；血小板计数(PLT#)-静脉血: 21310E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.8pg；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.9；平均血小板体积(MPV)-静脉血: 9.2fL；单核细胞计数(Mono#)-静脉血: 0.410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；中性粒细胞百分比(Neut%)-静脉血: 0.79；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；血小板比容-静脉血: 20%；血红蛋白(Hb)-静脉血: 118g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.009；淋巴细胞百分比(Lymph%)-静脉血: 0.147；红细胞计数(RBC#)-静脉血: 3.9610E12/L；血小板分布宽度(PDW)-静脉血: 9.9%；大血小板百分比(P-LCR%)-静脉血: 18.7%；中性粒细胞计数(Neut#)-静脉血: 7.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；白细胞计数(WBC#)-静脉血: 910E9/L\n- [全程D40] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.018；草酸钙结晶计数(CAOX#)-尿液: 10/μL；红细胞计数(RBC#)-尿液: 4/μL；总蛋白(TP)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: 无色；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D41] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；红细胞计数(RBC#)-尿液: 4/μL；白细胞(LEU)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；酮体(KET)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 1/μL；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.024；颜色-尿液: Light-Yellow\n- [全程D42] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 6/μL；隐血(OB)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 4/μL；总蛋白(TP)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7；颜色-尿液: Light-Yellow；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.023；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）；细菌计数(BACT#)-尿液: 8/μL\n- [全程D47] 超声；双侧腋窝淋巴结彩超(套): 检查类型: 超声；检查名称: 双侧腋窝淋巴结彩超(套)；检查部位:；检查所见: 双侧侧腋窝腋下组可见多个淋巴结回声，最大约12x6mm，椭圆形，边界清，皮髓质分界清，淋巴门结构可探及。腋上组及腋中组未见明显异常淋巴结回声。 CDFI：上述淋巴结内可见门型血流信号。；检查结论: 左侧腋窝腋下组淋巴结，符合良性淋巴结声像。\n- [全程D47] 检验组合: 有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 89.5fL；钠离子(Na+)-静脉血: 135.9mmol/L；尿酸(UA)-静脉血: 277.5umol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.0062；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；血红蛋白(Hb)-静脉血: 115.6g/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 332.5g/L；碱性磷酸酶(ALP)-静脉血: 63.1U/L；白蛋白(ALB)-静脉血: 39.9g/L；单核细胞百分比(Mono%)-静脉血: 0.056；α-L-岩藻糖苷酶(AFU)-静脉血: 42.7U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.315；尿素氮(BUN)-静脉血: 5.4mmol/L；白细胞计数(WBC#)-静脉血: 4.0510E9/L；总胆固醇(TC)-静脉血: 4.12mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24U/L；氯离子(Cl-)-静脉血: 99.2mmol/L；载脂蛋白B(apoB)-静脉血: 0.78g/L；丙氨酸氨基转移酶(ALT)-静脉血: 41.3U/L；总胆汁酸(TBA)-静脉血: 0.5umol/L；血小板计数(PLT#)-静脉血: 196.310E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.5%；葡萄糖(Glu)-静脉血: 4.67mmol/L；球蛋白(GLO)-静脉血: 23.82g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.3mmol/L；间接胆红素(IBIL)-静脉血: 7umolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.0051；镁离子(Mg2+)-静脉血: 0.69mmol/L；磷(P)-静脉血: 1.4mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 3.7umol/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；总钙(Ca)-静脉血: 2.27mmol/L；胱抑素(Cys-C)-静脉血: 0.95mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.68；中性粒细胞百分比(……\n- [全程D49] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后： 鼻咽腔轻度狭窄，鼻咽左顶壁、左顶后壁、左侧壁增厚，并见团块状软组织信号影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。鼻咽右侧壁粘膜未见增厚，左侧咽隐窝闭塞，右侧咽隐窝存在，左侧咽旁脂肪间隙狭窄。左侧腭帆提肌、腭帆张肌、头长肌受侵犯，余咽旁诸肌未见异常。 鼻腔未见肿物，口咽左侧壁受侵稍增厚。 双侧翼腭窝、双侧颞下窝未见异常。 蝶骨基底部、斜坡左侧份、左侧岩尖、左侧翼突基底部、左侧翼突内侧板骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、上颌窦、蝶窦、双侧乳突气化良好，未见异常信号影。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。蝶鞍形态正常，其内未见占位性病变。 左侧咽后见肿大的淋巴结，短径17mm，右侧咽后见小淋巴结，短径5mm。左颈II、III区见多个肿大淋巴结，较大者短径13mm，信号欠均匀，增强扫描不均匀强化。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。 扫描所见脑组织未见明确异常。；检查结论: 鼻咽癌化疗后，对比某次就诊时间日片： 鼻咽肿物，较前明显缩小。 颅底骨质破坏，基本同前。 左侧咽后淋巴结、左颈II、III区淋巴结，考虑转移瘤，较前明显缩小。右侧咽后小淋巴结，较前变化不大。\n- [全程D50] 检验组合: 总胆红素(TBIL)-静脉血: 8.1umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 20710E9/L；磷(P)-静脉血: 1.19mmol/L；中性粒细胞计数(Neut#)-静脉血: 2.810E9/L；葡萄糖(Glu)-静脉血: 5.75mmol/L；血红蛋白(Hb)-静脉血: 118g/L；尿酸(UA)-静脉血: 347.3umol/L；平均红细胞体积(MCV)-静脉血: 85.6fL；胱抑素(Cys-C)-静脉血: 1.01mg/L；红细胞比容(Hct)-静脉血: 34%；C-反应蛋白(CRP)-静脉血: 0.45mg/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；白蛋白(ALB)-静脉血: 44.1g/L；肌酐(Crea)-静脉血: 93.9umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 44.6U/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；总钙(Ca)-静脉血: 2.32mmol/L；红细胞计数(RBC#)-静脉血: 3.9710E12/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.1；球蛋白(GLO)-静脉血: 26.11g/L；尿素氮(BUN)-静脉血: 7.9mmol/L；钾离子(K+)-静脉血: 3.55mmol/L；载脂蛋白B(apoB)-静脉血: 0.88g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.72mmol/L；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.592；载脂蛋白AI(apoAI)-静脉血: 1.31g/L；乳酸脱氢酶(LDH)-静脉血: 232.4U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；总胆汁酸(TBA)-静脉血: 2.1umol/L；氯离子(Cl-)-静脉血: 102mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 23.5U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.33mmolL；总蛋白(TP)-静脉血: 70.21g/L；阴离子间隙(AG)-静脉血: 12.8；α-L-岩藻糖苷酶(AFU)-静脉血: 40.7U/L；总胆固醇(TC)-静脉血: 4.57mmol/L；白细胞计数(W……\n- [全程D34] 检验组合: 中性粒细胞百分比(Neut%)-静脉血: 0.356；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329.8g/L；中性粒细胞计数(Neut#)-静脉血: 1.210E9/L；载脂蛋白AI(apoAI)-静脉血: 1.23g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 1.9umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.3；平均红细胞体积(MCV)-静脉血: 89.7fL；钾离子(K+)-静脉血: 3.9mmol/L；总蛋白(TP)-静脉血: 68.46g/L；球蛋白(GLO)-静脉血: 29.66g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.5%；血小板分布宽度(PDW)-静脉血: 16%；白细胞计数(WBC#)-静脉血: 3.2410E9/L；磷(P)-静脉血: 1.24mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.0079；间接胆红素(IBIL)-静脉血: 2.8umolL；镁离子(Mg2+)-静脉血: 0.89mmol/L；碱性磷酸酶(ALP)-静脉血: 66.5U/L；红细胞比容(Hct)-静脉血: 36.1%；丙氨酸氨基转移酶(ALT)-静脉血: 18.5U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.51；单核细胞百分比(Mono%)-静脉血: 0.1112；尿素氮(BUN)-静脉血: 5.39mmol/L；红细胞计数(RBC#)-静脉血: 4.0210E12/L；血小板计数(PLT#)-静脉血: 240.610E9/L；胱抑素(Cys-C)-静脉血: 0.87mg/L；天门冬氨酸氨基转移酶(AST)-静脉血: 22.2U/L；C-反应蛋白(CRP)-静脉血: 0.37mg/L；阴离子间隙(AG)-静脉血: 13；总胆汁酸(TBA)-静脉血: 0.8umol/L；葡萄糖(Glu)-静脉血: 4.81mmol/L；总钙(Ca)-静脉血: 2.31mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；总胆红素(TBIL)-静脉血: 4.7umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.2；平均血小板体积(MPV)-静脉血……\n- [全程D35] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁、后壁及左侧壁增厚放射性浓聚，SUV约22.8，病灶向下侵犯软腭及口咽左侧壁；病灶侵犯左头长肌、左侧腭帆提张肌及左咽旁间隙，左侧咽隐窝消失，左侧咽旁间隙消失。左咽后肿大淋巴结放射性浓聚，SUV约19.2，与鼻咽病灶分界不清。喉咽结构及放射性分布未见明显异常。额窦、蝶窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。左颈II、III区数个淋巴结放射性浓聚，SUV约20.2，最大约1.8×3.3cm；右颈II、Va区数个小淋巴结部分放射性分布略浓密，SUV约3.3，最大约0.6×1.1cm；余双颈小淋巴结放射性分布未见异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。心脏及纵隔大血管未见明显异常。左腋窝淋巴结放射性分布浓密，SUV约9.0，大小约0.9×1.5cm；纵隔、双肺门及右侧腋窝未见肿大淋巴结及异常放射性分布。双侧乳腺放射性分布未见明显异常。 肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 子宫体积增大，外形呈波浪状，放射性分布未见异常；子宫旁见高密度节育器影；膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，病灶侵犯软腭、口咽左侧壁及左咽旁间隙；左咽后及左颈II、III区淋巴结代谢活跃，考虑转移；左腋窝淋巴结代谢活跃，不排除转移。 右颈II、Va区小淋巴结部分代谢略活跃，疑炎性病变，请结合临床。 疑子宫肌瘤。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D15] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D20] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗结束，诉呕吐 次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程5-FU+顺铂方案诱导化疗结束，无诉特殊不适，可予出院，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n- [全程D36] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者复查血常规：中性粒细胞1.2×109/L。郭医生信息已隐藏：暂停化疗，予以患者升中西粒细胞处理。\n- [全程D37] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 患者入院第三天，继续升白细胞处理，今日复查血常规，白细胞已经恢复正常，郭医生信息已隐藏：下周一予以患者第二程化疗。\n- [全程D40] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，可于今日执行第2程5-FU+顺铂方案诱导化疗，注意化疗不良反应。\n- [全程D43] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D47] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+顺铂方案诱导化疗结束，诉恶心、食欲下降，无发热、呕吐、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第2程5-FU+顺铂方案诱导化疗结束，无诉特殊不适，嘱其完成鼻咽、颈MRI复查，以及放疗定位扫描，定期返院治疗。遵嘱。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动顺铂同期化放疗\nB. 完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动第3程5-FU+顺铂诱导化疗\nC. 完善左侧腋窝淋巴结穿刺活检，行放疗定位扫描，并启动顺铂同期化放疗\nD. 完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动尼妥珠单抗联合根治性放疗\nE. 完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动单纯根治性放疗\nF. 完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动信迪利单抗联合根治性放疗\nG. 完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动尼妥珠单抗联合顺铂同期化放疗\nH. 完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动卡培他滨同期化放疗\nI. 完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动西妥昔单抗联合根治性放疗\nJ. 完善全身PET-CT复查，行放疗定位扫描，并启动尼妥珠单抗联合根治性放疗\nK. 完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动吉西他滨联合顺铂同期化放疗\nL. 完善鼻咽及颈部MRI复查，暂缓放疗定位，启动第3程5-FU+顺铂诱导化疗\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、斜坡、口咽、蝶骨基底部、岩尖。\n文本分期信息：N2，Mx 左侧腋窝淋巴结可疑转移。\n综合TNM状态：T3N2Mx 左侧腋窝淋巴结可疑转移。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 正常范围心电图\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽左顶壁、左顶后壁、左侧壁增厚，并见团块状软组织信号影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，鼻咽右侧壁粘膜未见增厚，左侧咽隐窝闭塞，右侧咽隐窝存在，左侧咽旁脂肪间隙狭窄。左侧腭帆提肌、腭帆张肌、头长肌、翼内肌受侵犯，余咽旁诸肌未见异常； 左侧咽后见肿大的淋巴结，短径22mm，右侧咽后见小淋巴结，短径5mm。 病灶向前堵塞左侧后鼻孔，口咽左侧壁受侵增厚。 左侧翼腭窝软组织影稍增多，右侧翼腭窝、双侧颞下窝未见异常。 蝶骨基底部、斜坡左侧份、左侧岩尖骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、上颌窦粘膜增厚；蝶窦、双侧乳突气化良好，未见异常信号影；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。 双颈II区、左颈III区见多个淋巴结，较大者短径24mm，信号欠均匀，增强扫描不均匀强化。；检查结论: 鼻咽左顶后壁、左侧壁病灶，考虑鼻咽癌，侵犯左侧咽旁、口咽左侧壁。 颅底骨质破坏。 双侧咽后、双颈II区、左颈III区淋巴结，考虑转移瘤。 副鼻窦炎。\n- [全程D5] 检验组合: 红细胞比容(Hct)-静脉血: 38.9%；血红蛋白(Hb)-静脉血: 131.6g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.5mmolL；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；总蛋白(TP)-静脉血: 69.64g/L；总钙(Ca)-静脉血: 2.26mmol/L；白蛋白(ALB)-静脉血: 43.1g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.42mmol/L；磷(P)-静脉血: 1.22mmol/L；凝血酶时间(TT)-静脉血: 17.3sec.；淋巴细胞百分比(Lymph%)-静脉血: 0.325；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；钠离子(Na+)-静脉血: 140.5mmol/L；单核细胞百分比(Mono%)-静脉血: 0.0954；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；载脂蛋白AI(apoAI)-静脉血: 1.38g/L；丙氨酸氨基转移酶(ALT)-静脉血: 21.7U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；氯离子(Cl-)-静脉血: 103.9mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；血小板计数(PLT#)-静脉血: 270.910E9/L；总胆固醇(TC)-静脉血: 5.3mmol/L；C-反应蛋白(CRP)-静脉血: 0.37mg/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.69mmol/L；甘油三酯(TG)-静脉血: 0.78mmol/L；淋巴细胞计数(Lymph#)-静脉血: 210E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.568；凝血酶原时间活动度(PTA)-静脉血: 94%；活化部分凝血活酶时间(APTT)-静脉血: 25.3sec.；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；平均红细胞血红蛋白含量(MCH)-静脉血: 30.2pg；凝血酶原时间(PT)-静脉血: 11.4sec.；纤维蛋白原(Fbg)-静脉血: 2.62g/L；天门冬氨酸氨基转移酶/丙氨酸氨……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D8] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见:；检查结论:\n- [全程D14] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；透明质酸(HA)-静脉血: 76.89ng/ml；III型前胶原氨基端肽(PIIINP)-静脉血: 28.08ng/ml；葡萄糖(Glu)-尿液: -（参考: 阴性）；降钙素(CT)-静脉血: 22.05pg/ml；总蛋白(TP)-尿液: -（参考: 阴性）；IV型胶原(C-IV)-静脉血: 28.93ng/ml；比重(SG)-尿液: 1.008；颜色-尿液: 无色；酸碱度(pH)-尿液: 6.5；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；层粘连蛋白(LN)-静脉血: 35.29ng/ml；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮\n- [全程D15] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T6水平，估计导管末端位于上腔静脉内。；检查结论: PICC管末端位置如上述。\n- [全程D15] 检验组合: 骨钙素N端中分子片段(N-MID)-静脉血: 11.9ng/ml；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.318ng/ml\n- [全程D16] 检验组合: 浊度(TRUB)-尿液: 清亮；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: +-（参考: 阴性）；酸碱度(pH)-尿液: 7；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.016；葡萄糖(Glu)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 3/μL\n- [全程D17] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 31/μL；颜色-尿液: Yellow；鳞状上皮细胞计数(SQEP#)-尿液: 7/μL；白细胞计数(WBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.021；浊度(TRUB)-尿液: 清亮；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D19] 检验组合: 总钙(Ca)-静脉血: 2.15mmol/L；钠离子(Na+)-静脉血: 138.8mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.2mmol/L；钾离子(K+)-静脉血: 3.08mmol/L；氯离子(Cl-)-静脉血: 102.2mmol/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；磷(P)-静脉血: 1.19mmol/L；阴离子间隙(AG)-静脉血: 15.4\n- [全程D20] 超声；双侧腋窝淋巴结彩超(套): 检查类型: 超声；检查名称: 双侧腋窝淋巴结彩超(套)；检查部位:；检查所见: 左侧腋窝腋下组可见1个淋巴结回声，大小约16x4mm，椭圆形，边界清，皮髓质分界清，淋巴门结构可探及。腋上组及腋中组未见明显异常淋巴结回声。 CDFI：上述淋巴结内可见门型血流信号。；检查结论: 左侧腋窝腋下组淋巴结，符合良性淋巴结声像。\n- [全程D20] 检验组合: 血小板计数(PLT#)-静脉血: 250.210E9/L；肌酐(Crea)-静脉血: 54umol/L；总胆红素(TBIL)-静脉血: 13.7umol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；阴离子间隙(AG)-静脉血: 12.4；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；碱性磷酸酶(ALP)-静脉血: 59.5U/L；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；球蛋白(GLO)-静脉血: 25.26g/L；葡萄糖(Glu)-静脉血: 4.81mmol/L；白蛋白(ALB)-静脉血: 40.9g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；尿素氮(BUN)-静脉血: 3.9mmol/L；血小板分布宽度(PDW)-静脉血: 15.8%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.38mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.05mmolL；乳酸脱氢酶(LDH)-静脉血: 275.2U/L；单核细胞百分比(Mono%)-静脉血: 0.0621；中性粒细胞计数(Neut#)-静脉血: 4.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.711；γ-谷氨酰基转移酶(GGT)-静脉血: 19.5U/L；甘油三酯(TG)-静脉血: 1.23mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.5pg；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.0032；磷(P)-静脉血: 1.37mmol/L；总钙(Ca)-静脉血: 2.23mmol/L；间接胆红素(IBIL)-静脉血: 9umolL；血小板比容-静脉血: 20.8%；C-反应蛋白(CRP)-静脉血: 0.65mg/L；载脂蛋白AI(apoAI)-静脉血: 1.12g/L；总蛋白(TP)-静脉血: 66.16g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.62；单核细胞计数(Mono#)-静脉血: 0.410E9/L；钠离子(Na+)-静脉血: 137.8mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 27.7U/L；丙氨酸氨基转移酶(ALT)-静脉……\n- [全程D37] 检验组合: 嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.4；红细胞比容(Hct)-静脉血: 35.6%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞体积(MCV)-静脉血: 89.9fL；单核细胞百分比(Mono%)-静脉血: 0.046；血小板计数(PLT#)-静脉血: 21310E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.8pg；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.9；平均血小板体积(MPV)-静脉血: 9.2fL；单核细胞计数(Mono#)-静脉血: 0.410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；中性粒细胞百分比(Neut%)-静脉血: 0.79；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；血小板比容-静脉血: 20%；血红蛋白(Hb)-静脉血: 118g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.009；淋巴细胞百分比(Lymph%)-静脉血: 0.147；红细胞计数(RBC#)-静脉血: 3.9610E12/L；血小板分布宽度(PDW)-静脉血: 9.9%；大血小板百分比(P-LCR%)-静脉血: 18.7%；中性粒细胞计数(Neut#)-静脉血: 7.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；白细胞计数(WBC#)-静脉血: 910E9/L\n- [全程D40] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.018；草酸钙结晶计数(CAOX#)-尿液: 10/μL；红细胞计数(RBC#)-尿液: 4/μL；总蛋白(TP)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: 无色；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D41] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；红细胞计数(RBC#)-尿液: 4/μL；白细胞(LEU)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；酮体(KET)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 1/μL；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.024；颜色-尿液: Light-Yellow\n- [全程D42] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 6/μL；隐血(OB)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 4/μL；总蛋白(TP)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7；颜色-尿液: Light-Yellow；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.023；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）；细菌计数(BACT#)-尿液: 8/μL\n- [全程D47] 超声；双侧腋窝淋巴结彩超(套): 检查类型: 超声；检查名称: 双侧腋窝淋巴结彩超(套)；检查部位:；检查所见: 双侧侧腋窝腋下组可见多个淋巴结回声，最大约12x6mm，椭圆形，边界清，皮髓质分界清，淋巴门结构可探及。腋上组及腋中组未见明显异常淋巴结回声。 CDFI：上述淋巴结内可见门型血流信号。；检查结论: 左侧腋窝腋下组淋巴结，符合良性淋巴结声像。\n- [全程D47] 检验组合: 有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 89.5fL；钠离子(Na+)-静脉血: 135.9mmol/L；尿酸(UA)-静脉血: 277.5umol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.0062；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；血红蛋白(Hb)-静脉血: 115.6g/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 332.5g/L；碱性磷酸酶(ALP)-静脉血: 63.1U/L；白蛋白(ALB)-静脉血: 39.9g/L；单核细胞百分比(Mono%)-静脉血: 0.056；α-L-岩藻糖苷酶(AFU)-静脉血: 42.7U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.315；尿素氮(BUN)-静脉血: 5.4mmol/L；白细胞计数(WBC#)-静脉血: 4.0510E9/L；总胆固醇(TC)-静脉血: 4.12mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24U/L；氯离子(Cl-)-静脉血: 99.2mmol/L；载脂蛋白B(apoB)-静脉血: 0.78g/L；丙氨酸氨基转移酶(ALT)-静脉血: 41.3U/L；总胆汁酸(TBA)-静脉血: 0.5umol/L；血小板计数(PLT#)-静脉血: 196.310E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.5%；葡萄糖(Glu)-静脉血: 4.67mmol/L；球蛋白(GLO)-静脉血: 23.82g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.3mmol/L；间接胆红素(IBIL)-静脉血: 7umolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.0051；镁离子(Mg2+)-静脉血: 0.69mmol/L；磷(P)-静脉血: 1.4mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 3.7umol/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；总钙(Ca)-静脉血: 2.27mmol/L；胱抑素(Cys-C)-静脉血: 0.95mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.68；中性粒细胞百分比(……\n- [全程D49] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后： 鼻咽腔轻度狭窄，鼻咽左顶壁、左顶后壁、左侧壁增厚，并见团块状软组织信号影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。鼻咽右侧壁粘膜未见增厚，左侧咽隐窝闭塞，右侧咽隐窝存在，左侧咽旁脂肪间隙狭窄。左侧腭帆提肌、腭帆张肌、头长肌受侵犯，余咽旁诸肌未见异常。 鼻腔未见肿物，口咽左侧壁受侵稍增厚。 双侧翼腭窝、双侧颞下窝未见异常。 蝶骨基底部、斜坡左侧份、左侧岩尖、左侧翼突基底部、左侧翼突内侧板骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、上颌窦、蝶窦、双侧乳突气化良好，未见异常信号影。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。蝶鞍形态正常，其内未见占位性病变。 左侧咽后见肿大的淋巴结，短径17mm，右侧咽后见小淋巴结，短径5mm。左颈II、III区见多个肿大淋巴结，较大者短径13mm，信号欠均匀，增强扫描不均匀强化。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。 扫描所见脑组织未见明确异常。；检查结论: 鼻咽癌化疗后，对比某次就诊时间日片： 鼻咽肿物，较前明显缩小。 颅底骨质破坏，基本同前。 左侧咽后淋巴结、左颈II、III区淋巴结，考虑转移瘤，较前明显缩小。右侧咽后小淋巴结，较前变化不大。\n- [全程D50] 检验组合: 总胆红素(TBIL)-静脉血: 8.1umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 20710E9/L；磷(P)-静脉血: 1.19mmol/L；中性粒细胞计数(Neut#)-静脉血: 2.810E9/L；葡萄糖(Glu)-静脉血: 5.75mmol/L；血红蛋白(Hb)-静脉血: 118g/L；尿酸(UA)-静脉血: 347.3umol/L；平均红细胞体积(MCV)-静脉血: 85.6fL；胱抑素(Cys-C)-静脉血: 1.01mg/L；红细胞比容(Hct)-静脉血: 34%；C-反应蛋白(CRP)-静脉血: 0.45mg/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；白蛋白(ALB)-静脉血: 44.1g/L；肌酐(Crea)-静脉血: 93.9umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 44.6U/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；总钙(Ca)-静脉血: 2.32mmol/L；红细胞计数(RBC#)-静脉血: 3.9710E12/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.1；球蛋白(GLO)-静脉血: 26.11g/L；尿素氮(BUN)-静脉血: 7.9mmol/L；钾离子(K+)-静脉血: 3.55mmol/L；载脂蛋白B(apoB)-静脉血: 0.88g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.72mmol/L；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.592；载脂蛋白AI(apoAI)-静脉血: 1.31g/L；乳酸脱氢酶(LDH)-静脉血: 232.4U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；总胆汁酸(TBA)-静脉血: 2.1umol/L；氯离子(Cl-)-静脉血: 102mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 23.5U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.33mmolL；总蛋白(TP)-静脉血: 70.21g/L；阴离子间隙(AG)-静脉血: 12.8；α-L-岩藻糖苷酶(AFU)-静脉血: 40.7U/L；总胆固醇(TC)-静脉血: 4.57mmol/L；白细胞计数(W……\n- [全程D34] 检验组合: 中性粒细胞百分比(Neut%)-静脉血: 0.356；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329.8g/L；中性粒细胞计数(Neut#)-静脉血: 1.210E9/L；载脂蛋白AI(apoAI)-静脉血: 1.23g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 1.9umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.3；平均红细胞体积(MCV)-静脉血: 89.7fL；钾离子(K+)-静脉血: 3.9mmol/L；总蛋白(TP)-静脉血: 68.46g/L；球蛋白(GLO)-静脉血: 29.66g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.5%；血小板分布宽度(PDW)-静脉血: 16%；白细胞计数(WBC#)-静脉血: 3.2410E9/L；磷(P)-静脉血: 1.24mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.0079；间接胆红素(IBIL)-静脉血: 2.8umolL；镁离子(Mg2+)-静脉血: 0.89mmol/L；碱性磷酸酶(ALP)-静脉血: 66.5U/L；红细胞比容(Hct)-静脉血: 36.1%；丙氨酸氨基转移酶(ALT)-静脉血: 18.5U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.51；单核细胞百分比(Mono%)-静脉血: 0.1112；尿素氮(BUN)-静脉血: 5.39mmol/L；红细胞计数(RBC#)-静脉血: 4.0210E12/L；血小板计数(PLT#)-静脉血: 240.610E9/L；胱抑素(Cys-C)-静脉血: 0.87mg/L；天门冬氨酸氨基转移酶(AST)-静脉血: 22.2U/L；C-反应蛋白(CRP)-静脉血: 0.37mg/L；阴离子间隙(AG)-静脉血: 13；总胆汁酸(TBA)-静脉血: 0.8umol/L；葡萄糖(Glu)-静脉血: 4.81mmol/L；总钙(Ca)-静脉血: 2.31mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；总胆红素(TBIL)-静脉血: 4.7umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.2；平均血小板体积(MPV)-静脉血……\n- [全程D35] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁、后壁及左侧壁增厚放射性浓聚，SUV约22.8，病灶向下侵犯软腭及口咽左侧壁；病灶侵犯左头长肌、左侧腭帆提张肌及左咽旁间隙，左侧咽隐窝消失，左侧咽旁间隙消失。左咽后肿大淋巴结放射性浓聚，SUV约19.2，与鼻咽病灶分界不清。喉咽结构及放射性分布未见明显异常。额窦、蝶窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。左颈II、III区数个淋巴结放射性浓聚，SUV约20.2，最大约1.8×3.3cm；右颈II、Va区数个小淋巴结部分放射性分布略浓密，SUV约3.3，最大约0.6×1.1cm；余双颈小淋巴结放射性分布未见异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。心脏及纵隔大血管未见明显异常。左腋窝淋巴结放射性分布浓密，SUV约9.0，大小约0.9×1.5cm；纵隔、双肺门及右侧腋窝未见肿大淋巴结及异常放射性分布。双侧乳腺放射性分布未见明显异常。 肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 子宫体积增大，外形呈波浪状，放射性分布未见异常；子宫旁见高密度节育器影；膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，病灶侵犯软腭、口咽左侧壁及左咽旁间隙；左咽后及左颈II、III区淋巴结代谢活跃，考虑转移；左腋窝淋巴结代谢活跃，不排除转移。 右颈II、Va区小淋巴结部分代谢略活跃，疑炎性病变，请结合临床。 疑子宫肌瘤。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D15] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D20] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗结束，诉呕吐 次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程5-FU+顺铂方案诱导化疗结束，无诉特殊不适，可予出院，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n- [全程D36] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者复查血常规：中性粒细胞1.2×109/L。郭医生信息已隐藏：暂停化疗，予以患者升中西粒细胞处理。\n- [全程D37] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 患者入院第三天，继续升白细胞处理，今日复查血常规，白细胞已经恢复正常，郭医生信息已隐藏：下周一予以患者第二程化疗。\n- [全程D40] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，可于今日执行第2程5-FU+顺铂方案诱导化疗，注意化疗不良反应。\n- [全程D43] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D47] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+顺铂方案诱导化疗结束，诉恶心、食欲下降，无发热、呕吐、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第2程5-FU+顺铂方案诱导化疗结束，无诉特殊不适，嘱其完成鼻咽、颈MRI复查，以及放疗定位扫描，定期返院治疗。遵嘱。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动顺铂同期化放疗\nB. 完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动第3程5-FU+顺铂诱导化疗\nC. 完善左侧腋窝淋巴结穿刺活检，行放疗定位扫描，并启动顺铂同期化放疗\nD. 完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动尼妥珠单抗联合根治性放疗\nE. 完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动单纯根治性放疗\nF. 完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动信迪利单抗联合根治性放疗\nG. 完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动尼妥珠单抗联合顺铂同期化放疗\nH. 完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动卡培他滨同期化放疗\nI. 完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动西妥昔单抗联合根治性放疗\nJ. 完善全身PET-CT复查，行放疗定位扫描，并启动尼妥珠单抗联合根治性放疗\nK. 完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动吉西他滨联合顺铂同期化放疗\nL. 完善鼻咽及颈部MRI复查，暂缓放疗定位，启动第3程5-FU+顺铂诱导化疗\n\n请仅输出一个选项字母（A-L）。"}]}
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张口门齿距4.5cm；鼻咽双侧壁、顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善基线血液学检查，包含血常规、生化常规及凝血功能，暂缓检测EB病毒DNA及骨代谢标志物。\nB. 完善基线血液学检查，包含生化常规、凝血功能及传染病筛查，并安排全身PET-CT替代常规影像学分期。\nC. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能及传染病筛查，暂缓检测骨代谢标志物。\nD. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查，并安排颈部淋巴结穿刺活检明确病理。\nE. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查，并安排头颅增强MRI评估颅内侵犯。\nF. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测。\nG. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并安排全身PET-CT替代所有常规分期检查。\nH. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并安排鼻咽部平扫MRI。\nI. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并安排颈部超声指导淋巴结清扫。\nJ. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并安排鼻咽镜评估治疗疗效。\nK. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并首选胸部X线片排除肺转移。\nL. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并常规安排骨髓穿刺排除骨髓转移。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、斜坡、海绵窦、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左耳听力下降1年余；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右耳鸣；既往史: 某次就诊时间患“结核性胸膜炎”已治愈，某次就诊时间患“急性胰腺炎”已治愈。否认\"肝炎、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟史30年，1包每天，常饮酒，两天/次，每次500ml。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：120/80mmHg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 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完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并安排鼻咽部平扫MRI。\nI. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并安排颈部超声指导淋巴结清扫。\nJ. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并安排鼻咽镜评估治疗疗效。\nK. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并首选胸部X线片排除肺转移。\nL. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并常规安排骨髓穿刺排除骨髓转移。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-474b60646fc04122e2c1c7ce","patient_id":"patient-84fa3d6098d10a1d14b6b19e","turn_id":"turn04","turn_position":3,"turn_type":"initial_treatment_selection","gold_letter":"H","gold_action":"顺铂+氟尿嘧啶（PF方案）诱导化疗","options":[{"letter":"A","text":"顺铂单药同期放化疗","is_gold":false},{"letter":"B","text":"多西他赛+顺铂（TP方案）姑息化疗","is_gold":false},{"letter":"C","text":"鼻咽及颈部根治性放射治疗","is_gold":false},{"letter":"D","text":"顺铂+多西他赛（TP方案）同期放化疗","is_gold":false},{"letter":"E","text":"依托泊苷+顺铂（EP方案）诱导化疗","is_gold":false},{"letter":"F","text":"顺铂+氟尿嘧啶（PF方案）姑息化疗","is_gold":false},{"letter":"G","text":"西妥昔单抗联合根治性放疗","is_gold":false},{"letter":"H","text":"顺铂+氟尿嘧啶（PF方案）诱导化疗","is_gold":true},{"letter":"I","text":"氟尿嘧啶单药诱导化疗","is_gold":false},{"letter":"J","text":"吉西他滨+顺铂（GP方案）姑息化疗","is_gold":false},{"letter":"K","text":"顺铂单药诱导化疗","is_gold":false},{"letter":"L","text":"卡瑞利珠单抗联合PF方案姑息化疗","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、斜坡、海绵窦、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左耳听力下降1年余；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右耳鸣；既往史: 某次就诊时间患“结核性胸膜炎”已治愈，某次就诊时间患“急性胰腺炎”已治愈。否认\"肝炎、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟史30年，1包每天，常饮酒，两天/次，每次500ml。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：120/80mmHg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧壁、顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D3] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D3] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 38mm AO 26mm MV E 0.79m/s EF 75% LV 50mm IVS 11mm A 0.67m/s FS 45% RA 33mm LVPW 8mm RV 20mm PA 19mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 左房稍大，余各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 左房稍大 各房室腔及大血管未探及异常血流信号 心功能正常\n- [全程D3] 检验组合: 丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D4] CT；胸部CT平扫＋增强: 检查类型: CT；检查名称: 胸部CT平扫＋增强；检查部位:；检查所见: 右中肺及双下肺见数个类结节影，最大者直径约 5 mm，病灶边界清楚而不规则，密度较高而不均匀；气管及支气管分枝通畅，未见明显软组织肿物或受压变窄；双侧肺门及纵隔未见明确肿大淋巴结；双侧胸腔未见积液；胸膜未见增厚；扫描范围内胸椎、胸壁骨未见骨质破坏征象。；检查结论: 双肺类结节影，转移瘤可能性大。\n- [全程D4] 检验组合: 酮体(KET)-尿液: +-（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；尿胆原(URO)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 4/μL；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；白细胞计数(WBC#)-尿液: 26/μL；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；酸碱度(pH)-尿液: 6；总蛋白(TP)-尿液: -（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性（参考: 阴性）；颜色-尿液: Light-Yellow；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；非鳞状上皮细胞计数-尿液: 2/μL；比重(SG)-尿液: 1.032；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.05；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 顺铂单药同期放化疗\nB. 多西他赛+顺铂（TP方案）姑息化疗\nC. 鼻咽及颈部根治性放射治疗\nD. 顺铂+多西他赛（TP方案）同期放化疗\nE. 依托泊苷+顺铂（EP方案）诱导化疗\nF. 顺铂+氟尿嘧啶（PF方案）姑息化疗\nG. 西妥昔单抗联合根治性放疗\nH. 顺铂+氟尿嘧啶（PF方案）诱导化疗\nI. 氟尿嘧啶单药诱导化疗\nJ. 吉西他滨+顺铂（GP方案）姑息化疗\nK. 顺铂单药诱导化疗\nL. 卡瑞利珠单抗联合PF方案姑息化疗\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、斜坡、海绵窦、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左耳听力下降1年余；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右耳鸣；既往史: 某次就诊时间患“结核性胸膜炎”已治愈，某次就诊时间患“急性胰腺炎”已治愈。否认\"肝炎、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟史30年，1包每天，常饮酒，两天/次，每次500ml。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：120/80mmHg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧壁、顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D3] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D3] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 38mm AO 26mm MV E 0.79m/s EF 75% LV 50mm IVS 11mm A 0.67m/s FS 45% RA 33mm LVPW 8mm RV 20mm PA 19mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 左房稍大，余各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 左房稍大 各房室腔及大血管未探及异常血流信号 心功能正常\n- [全程D3] 检验组合: 丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D4] CT；胸部CT平扫＋增强: 检查类型: CT；检查名称: 胸部CT平扫＋增强；检查部位:；检查所见: 右中肺及双下肺见数个类结节影，最大者直径约 5 mm，病灶边界清楚而不规则，密度较高而不均匀；气管及支气管分枝通畅，未见明显软组织肿物或受压变窄；双侧肺门及纵隔未见明确肿大淋巴结；双侧胸腔未见积液；胸膜未见增厚；扫描范围内胸椎、胸壁骨未见骨质破坏征象。；检查结论: 双肺类结节影，转移瘤可能性大。\n- [全程D4] 检验组合: 酮体(KET)-尿液: +-（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；尿胆原(URO)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 4/μL；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；白细胞计数(WBC#)-尿液: 26/μL；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；酸碱度(pH)-尿液: 6；总蛋白(TP)-尿液: -（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性（参考: 阴性）；颜色-尿液: Light-Yellow；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；非鳞状上皮细胞计数-尿液: 2/μL；比重(SG)-尿液: 1.032；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.05；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 顺铂单药同期放化疗\nB. 多西他赛+顺铂（TP方案）姑息化疗\nC. 鼻咽及颈部根治性放射治疗\nD. 顺铂+多西他赛（TP方案）同期放化疗\nE. 依托泊苷+顺铂（EP方案）诱导化疗\nF. 顺铂+氟尿嘧啶（PF方案）姑息化疗\nG. 西妥昔单抗联合根治性放疗\nH. 顺铂+氟尿嘧啶（PF方案）诱导化疗\nI. 氟尿嘧啶单药诱导化疗\nJ. 吉西他滨+顺铂（GP方案）姑息化疗\nK. 顺铂单药诱导化疗\nL. 卡瑞利珠单抗联合PF方案姑息化疗\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-654cb1177e5cb9c5732eccb0","patient_id":"patient-84fa3d6098d10a1d14b6b19e","turn_id":"turn05","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"I","gold_action":"继续当前化疗及对症支持治疗，执行动静脉置管常规护理，并常规监测血常规与生化指标。","options":[{"letter":"A","text":"暂停化疗，静脉滴注还原型谷胱甘肽进行保肝治疗，待肝功能恢复正常后重启化疗。","is_gold":false},{"letter":"B","text":"暂停化疗，静脉滴注头孢类抗生素进行经验性抗感染治疗，待白细胞计数恢复正常后重启化疗。","is_gold":false},{"letter":"C","text":"继续化疗，皮下注射重组人粒细胞集落刺激因子预防中性粒细胞缺乏。","is_gold":false},{"letter":"D","text":"终止诱导化疗，提前进入根治性放疗阶段，并静脉滴注保肝药物。","is_gold":false},{"letter":"E","text":"继续化疗，静脉滴注异甘草酸镁注射液进行保肝治疗，并每日复查肝功能。","is_gold":false},{"letter":"F","text":"暂停化疗，行腹部CT增强扫描以排除肝脏转移或化疗引起的急性肝损伤。","is_gold":false},{"letter":"G","text":"继续化疗，停用所有止吐及护胃药物以减轻肝脏代谢负担。","is_gold":false},{"letter":"H","text":"暂停化疗，静脉推注地塞米松及异丙嗪进行抗过敏治疗。","is_gold":false},{"letter":"I","text":"继续化疗及对症支持治疗，执行动静脉置管常规护理，并常规监测血常规与生化指标。","is_gold":true},{"letter":"J","text":"继续化疗，拔除动静脉置管以预防导管相关性血流感染，改用外周静脉穿刺。","is_gold":false},{"letter":"K","text":"暂停化疗，静脉滴注氯化钾进行补钾治疗，待血钾明显上升后继续化疗。","is_gold":false},{"letter":"L","text":"继续化疗，静脉推注呋塞米促进顺铂排泄，预防急性肾功能损伤。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、斜坡、海绵窦、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左耳听力下降1年余；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右耳鸣；既往史: 某次就诊时间患“结核性胸膜炎”已治愈，某次就诊时间患“急性胰腺炎”已治愈。否认\"肝炎、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟史30年，1包每天，常饮酒，两天/次，每次500ml。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：120/80mmHg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧壁、顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D3] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D3] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 38mm AO 26mm MV E 0.79m/s EF 75% LV 50mm IVS 11mm A 0.67m/s FS 45% RA 33mm LVPW 8mm RV 20mm PA 19mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 左房稍大，余各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 左房稍大 各房室腔及大血管未探及异常血流信号 心功能正常\n- [全程D3] 检验组合: 丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D4] CT；胸部CT平扫＋增强: 检查类型: CT；检查名称: 胸部CT平扫＋增强；检查部位:；检查所见: 右中肺及双下肺见数个类结节影，最大者直径约 5 mm，病灶边界清楚而不规则，密度较高而不均匀；气管及支气管分枝通畅，未见明显软组织肿物或受压变窄；双侧肺门及纵隔未见明确肿大淋巴结；双侧胸腔未见积液；胸膜未见增厚；扫描范围内胸椎、胸壁骨未见骨质破坏征象。；检查结论: 双肺类结节影，转移瘤可能性大。\n- [全程D4] 检验组合: 酮体(KET)-尿液: +-（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；尿胆原(URO)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 4/μL；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；白细胞计数(WBC#)-尿液: 26/μL；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；酸碱度(pH)-尿液: 6；总蛋白(TP)-尿液: -（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性（参考: 阴性）；颜色-尿液: Light-Yellow；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；非鳞状上皮细胞计数-尿液: 2/μL；比重(SG)-尿液: 1.032；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.05；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL\n- [全程D2] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: 右臂静脉插管,导管末端位于T 6右旁，估计位于上腔静脉中段。；检查结论: 导管末端位置如上述。\n- [全程D2] 检验组合: 血小板分布宽度(PDW)-静脉血: 13.8%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；淋巴细胞百分比(Lymph%)-静脉血: 0.262；单核细胞计数(Mono#)-静脉血: 0.510E9/L；胱抑素(Cys-C)-静脉血: 1.01mg/L；总蛋白(TP)-静脉血: 68.46g/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.16COI；透明质酸(HA)-静脉血: 61.97ng/ml；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；大血小板百分比(P-LCR%)-静脉血: 32.4%；白蛋白(ALB)-静脉血: 43.7g/L；总胆固醇(TC)-静脉血: 5.59mmol/L；总胆红素(TBIL)-静脉血: 14.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.84；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.009；丙氨酸氨基转移酶(ALT)-静脉血: 27U/L；氯离子(Cl-)-静脉血: 103.1mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；淋巴细胞计数(Lymph#)-静脉血: 2.510E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.63mmol/L；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.06S/CO；血小板比容-静脉血: 21%；载脂蛋白B(apoB)-静脉血: 1.22g/L；C-反应蛋白(CRP)-静脉血: 4.05mg/L；ABO血型-静脉血: A；载脂蛋白AI(apoAI)-静脉血: 1.2g/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；单核细胞百分比(Mono%)-静脉血: 0.049；钠离子(Na+)-静脉血: 139.6mmol/L；凝血酶原时间(PT)-静脉血: 10.3sec.；球蛋白(GLO)-静脉血: 24.76g/L；纤维蛋白原(Fbg)-静脉血: 2.49g/L；凝血酶时间(TT)-静脉血: 20sec.；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44.6；Rh血型-静脉血: 阳性；平均红细胞体积(MCV)-静脉血: 85.8fL；直接胆红素(DBIL)-静脉血: 3.3umol/L；凝血酶原时间活动度(PTA)-静脉血: 113.8……\n- [全程D5] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: 3+500Leu（参考: 阴性）；白细胞计数(WBC#)-尿液: 18/μL；鳞状上皮细胞计数(SQEP#)-尿液: 5/μL；比重(SG)-尿液: 1.02；总蛋白(TP)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: Turbid；隐血(OB)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；未分类结晶计数(UNCX#)-尿液: 25/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；非鳞状上皮细胞计数-尿液: 5/μL\n- [全程D9] 检验组合: 钾离子(K+)-静脉血: 3.73mmol/L；红细胞比容(Hct)-静脉血: 48.1%；血小板比容-静脉血: 19%；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.94mmolL；尿素氮(BUN)-静脉血: 9.5mmol/L；钠离子(Na+)-静脉血: 137.8mmol/L；血红蛋白(Hb)-静脉血: 159g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.095；总钙(Ca)-静脉血: 1.93mmol/L；血小板分布宽度(PDW)-静脉血: 13.3%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；丙氨酸氨基转移酶(ALT)-静脉血: 94.9U/L；载脂蛋白B(apoB)-静脉血: 1.06g/L；白蛋白(ALB)-静脉血: 40.3g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.46；白细胞计数(WBC#)-静脉血: 14.910E9/L；胱抑素(Cys-C)-静脉血: 1.26mg/L；平均血小板体积(MPV)-静脉血: 10.4fL；中性粒细胞百分比(Neut%)-静脉血: 0.837；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.45mmol/L；血小板计数(PLT#)-静脉血: 17910E9/L；总胆固醇(TC)-静脉血: 5.1mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.4；球蛋白(GLO)-静脉血: 23.17g/L；磷(P)-静脉血: 1.26mmol/L；间接胆红素(IBIL)-静脉血: 13.1umolL；红细胞计数(RBC#)-静脉血: 5.5910E12/L；直接胆红素(DBIL)-静脉血: 5.4umol/L；总胆汁酸(TBA)-静脉血: 0.1umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；单核细胞百分比(Mono%)-静脉血: 0.06；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 42.8U/L；肌酐(Crea)-静脉血: 101.5umol/L；载脂蛋白AI(apoAI)-静脉血: 0.99g/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.4mmol/L；单核细胞计……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者无诉特殊不适，完善各项检查中，体查同入院时，[姓名已隐去]主任查房指示，待各项检查完成明确分期后，再决定下一步治疗。\n- [全程D8] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停化疗，静脉滴注还原型谷胱甘肽进行保肝治疗，待肝功能恢复正常后重启化疗。\nB. 暂停化疗，静脉滴注头孢类抗生素进行经验性抗感染治疗，待白细胞计数恢复正常后重启化疗。\nC. 继续化疗，皮下注射重组人粒细胞集落刺激因子预防中性粒细胞缺乏。\nD. 终止诱导化疗，提前进入根治性放疗阶段，并静脉滴注保肝药物。\nE. 继续化疗，静脉滴注异甘草酸镁注射液进行保肝治疗，并每日复查肝功能。\nF. 暂停化疗，行腹部CT增强扫描以排除肝脏转移或化疗引起的急性肝损伤。\nG. 继续化疗，停用所有止吐及护胃药物以减轻肝脏代谢负担。\nH. 暂停化疗，静脉推注地塞米松及异丙嗪进行抗过敏治疗。\nI. 继续化疗及对症支持治疗，执行动静脉置管常规护理，并常规监测血常规与生化指标。\nJ. 继续化疗，拔除动静脉置管以预防导管相关性血流感染，改用外周静脉穿刺。\nK. 暂停化疗，静脉滴注氯化钾进行补钾治疗，待血钾明显上升后继续化疗。\nL. 继续化疗，静脉推注呋塞米促进顺铂排泄，预防急性肾功能损伤。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、斜坡、海绵窦、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左耳听力下降1年余；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右耳鸣；既往史: 某次就诊时间患“结核性胸膜炎”已治愈，某次就诊时间患“急性胰腺炎”已治愈。否认\"肝炎、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟史30年，1包每天，常饮酒，两天/次，每次500ml。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：120/80mmHg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧壁、顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D3] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D3] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 38mm AO 26mm MV E 0.79m/s EF 75% LV 50mm IVS 11mm A 0.67m/s FS 45% RA 33mm LVPW 8mm RV 20mm PA 19mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 左房稍大，余各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 左房稍大 各房室腔及大血管未探及异常血流信号 心功能正常\n- [全程D3] 检验组合: 丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D4] CT；胸部CT平扫＋增强: 检查类型: CT；检查名称: 胸部CT平扫＋增强；检查部位:；检查所见: 右中肺及双下肺见数个类结节影，最大者直径约 5 mm，病灶边界清楚而不规则，密度较高而不均匀；气管及支气管分枝通畅，未见明显软组织肿物或受压变窄；双侧肺门及纵隔未见明确肿大淋巴结；双侧胸腔未见积液；胸膜未见增厚；扫描范围内胸椎、胸壁骨未见骨质破坏征象。；检查结论: 双肺类结节影，转移瘤可能性大。\n- [全程D4] 检验组合: 酮体(KET)-尿液: +-（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；尿胆原(URO)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 4/μL；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；白细胞计数(WBC#)-尿液: 26/μL；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；酸碱度(pH)-尿液: 6；总蛋白(TP)-尿液: -（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性（参考: 阴性）；颜色-尿液: Light-Yellow；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；非鳞状上皮细胞计数-尿液: 2/μL；比重(SG)-尿液: 1.032；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.05；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL\n- [全程D2] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: 右臂静脉插管,导管末端位于T 6右旁，估计位于上腔静脉中段。；检查结论: 导管末端位置如上述。\n- [全程D2] 检验组合: 血小板分布宽度(PDW)-静脉血: 13.8%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；淋巴细胞百分比(Lymph%)-静脉血: 0.262；单核细胞计数(Mono#)-静脉血: 0.510E9/L；胱抑素(Cys-C)-静脉血: 1.01mg/L；总蛋白(TP)-静脉血: 68.46g/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.16COI；透明质酸(HA)-静脉血: 61.97ng/ml；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；大血小板百分比(P-LCR%)-静脉血: 32.4%；白蛋白(ALB)-静脉血: 43.7g/L；总胆固醇(TC)-静脉血: 5.59mmol/L；总胆红素(TBIL)-静脉血: 14.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.84；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.009；丙氨酸氨基转移酶(ALT)-静脉血: 27U/L；氯离子(Cl-)-静脉血: 103.1mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；淋巴细胞计数(Lymph#)-静脉血: 2.510E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.63mmol/L；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.06S/CO；血小板比容-静脉血: 21%；载脂蛋白B(apoB)-静脉血: 1.22g/L；C-反应蛋白(CRP)-静脉血: 4.05mg/L；ABO血型-静脉血: A；载脂蛋白AI(apoAI)-静脉血: 1.2g/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；单核细胞百分比(Mono%)-静脉血: 0.049；钠离子(Na+)-静脉血: 139.6mmol/L；凝血酶原时间(PT)-静脉血: 10.3sec.；球蛋白(GLO)-静脉血: 24.76g/L；纤维蛋白原(Fbg)-静脉血: 2.49g/L；凝血酶时间(TT)-静脉血: 20sec.；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44.6；Rh血型-静脉血: 阳性；平均红细胞体积(MCV)-静脉血: 85.8fL；直接胆红素(DBIL)-静脉血: 3.3umol/L；凝血酶原时间活动度(PTA)-静脉血: 113.8……\n- [全程D5] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: 3+500Leu（参考: 阴性）；白细胞计数(WBC#)-尿液: 18/μL；鳞状上皮细胞计数(SQEP#)-尿液: 5/μL；比重(SG)-尿液: 1.02；总蛋白(TP)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: Turbid；隐血(OB)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；未分类结晶计数(UNCX#)-尿液: 25/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；非鳞状上皮细胞计数-尿液: 5/μL\n- [全程D9] 检验组合: 钾离子(K+)-静脉血: 3.73mmol/L；红细胞比容(Hct)-静脉血: 48.1%；血小板比容-静脉血: 19%；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.94mmolL；尿素氮(BUN)-静脉血: 9.5mmol/L；钠离子(Na+)-静脉血: 137.8mmol/L；血红蛋白(Hb)-静脉血: 159g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.095；总钙(Ca)-静脉血: 1.93mmol/L；血小板分布宽度(PDW)-静脉血: 13.3%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；丙氨酸氨基转移酶(ALT)-静脉血: 94.9U/L；载脂蛋白B(apoB)-静脉血: 1.06g/L；白蛋白(ALB)-静脉血: 40.3g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.46；白细胞计数(WBC#)-静脉血: 14.910E9/L；胱抑素(Cys-C)-静脉血: 1.26mg/L；平均血小板体积(MPV)-静脉血: 10.4fL；中性粒细胞百分比(Neut%)-静脉血: 0.837；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.45mmol/L；血小板计数(PLT#)-静脉血: 17910E9/L；总胆固醇(TC)-静脉血: 5.1mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.4；球蛋白(GLO)-静脉血: 23.17g/L；磷(P)-静脉血: 1.26mmol/L；间接胆红素(IBIL)-静脉血: 13.1umolL；红细胞计数(RBC#)-静脉血: 5.5910E12/L；直接胆红素(DBIL)-静脉血: 5.4umol/L；总胆汁酸(TBA)-静脉血: 0.1umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；单核细胞百分比(Mono%)-静脉血: 0.06；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 42.8U/L；肌酐(Crea)-静脉血: 101.5umol/L；载脂蛋白AI(apoAI)-静脉血: 0.99g/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.4mmol/L；单核细胞计……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者无诉特殊不适，完善各项检查中，体查同入院时，[姓名已隐去]主任查房指示，待各项检查完成明确分期后，再决定下一步治疗。\n- [全程D8] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停化疗，静脉滴注还原型谷胱甘肽进行保肝治疗，待肝功能恢复正常后重启化疗。\nB. 暂停化疗，静脉滴注头孢类抗生素进行经验性抗感染治疗，待白细胞计数恢复正常后重启化疗。\nC. 继续化疗，皮下注射重组人粒细胞集落刺激因子预防中性粒细胞缺乏。\nD. 终止诱导化疗，提前进入根治性放疗阶段，并静脉滴注保肝药物。\nE. 继续化疗，静脉滴注异甘草酸镁注射液进行保肝治疗，并每日复查肝功能。\nF. 暂停化疗，行腹部CT增强扫描以排除肝脏转移或化疗引起的急性肝损伤。\nG. 继续化疗，停用所有止吐及护胃药物以减轻肝脏代谢负担。\nH. 暂停化疗，静脉推注地塞米松及异丙嗪进行抗过敏治疗。\nI. 继续化疗及对症支持治疗，执行动静脉置管常规护理，并常规监测血常规与生化指标。\nJ. 继续化疗，拔除动静脉置管以预防导管相关性血流感染，改用外周静脉穿刺。\nK. 暂停化疗，静脉滴注氯化钾进行补钾治疗，待血钾明显上升后继续化疗。\nL. 继续化疗，静脉推注呋塞米促进顺铂排泄，预防急性肾功能损伤。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-b094635ac349a10618a48030","patient_id":"patient-84fa3d6098d10a1d14b6b19e","turn_id":"turn06","turn_position":5,"turn_type":"toxicity_or_support_decision","gold_letter":"J","gold_action":"予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，并监测24小时尿量，准备行下一程化疗。","options":[{"letter":"A","text":"予以口服升白细胞药物，静脉水化及补充电解质，皮下注射胸腺法新，并监测24小时尿量，准备行下一程化疗。","is_gold":false},{"letter":"B","text":"予以静脉滴注保肝药物，静脉水化及补充电解质，皮下注射胸腺法新，暂缓化疗待复查指标正常后继续。","is_gold":false},{"letter":"C","text":"予以静脉输注碳酸氢钠碱化尿液及利尿处理，静脉水化及补充电解质，将下一程化疗方案中的顺铂替换为卡铂。","is_gold":false},{"letter":"D","text":"予以静脉营养支持，静脉水化及补充电解质，皮下注射胸腺法新，下一程化疗顺铂剂量下调20%。","is_gold":false},{"letter":"E","text":"予以静脉水化、补充电解质及维生素，预防性皮下注射重组人粒细胞刺激因子，口服止咳药物，准备行下一程化疗。","is_gold":false},{"letter":"F","text":"予以静脉水化、补充电解质及维生素，预防性皮下注射重组人血小板生成素，口服止咳药物，准备行下一程化疗。","is_gold":false},{"letter":"G","text":"予以静脉水化、补充电解质及维生素，口服止咳药物，加用异烟肼预防性抗结核治疗，准备行下一程化疗。","is_gold":false},{"letter":"H","text":"予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，无需监测尿量，准备行下一程化疗。","is_gold":false},{"letter":"I","text":"予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，并监测24小时尿量，准备行单纯放射治疗。","is_gold":false},{"letter":"J","text":"予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，并监测24小时尿量，准备行下一程化疗。","is_gold":true},{"letter":"K","text":"予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，并监测24小时尿量，将下一程化疗方案更改为吉西他滨加顺铂。","is_gold":false},{"letter":"L","text":"予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，并监测24小时尿量，将下一程化疗方案更改为紫杉醇加顺铂。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、斜坡、海绵窦、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左耳听力下降1年余；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右耳鸣；既往史: 某次就诊时间患“结核性胸膜炎”已治愈，某次就诊时间患“急性胰腺炎”已治愈。否认\"肝炎、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟史30年，1包每天，常饮酒，两天/次，每次500ml。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：120/80mmHg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧壁、顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D3] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D3] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 38mm AO 26mm MV E 0.79m/s EF 75% LV 50mm IVS 11mm A 0.67m/s FS 45% RA 33mm LVPW 8mm RV 20mm PA 19mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 左房稍大，余各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 左房稍大 各房室腔及大血管未探及异常血流信号 心功能正常\n- [全程D3] 检验组合: 丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D4] CT；胸部CT平扫＋增强: 检查类型: CT；检查名称: 胸部CT平扫＋增强；检查部位:；检查所见: 右中肺及双下肺见数个类结节影，最大者直径约 5 mm，病灶边界清楚而不规则，密度较高而不均匀；气管及支气管分枝通畅，未见明显软组织肿物或受压变窄；双侧肺门及纵隔未见明确肿大淋巴结；双侧胸腔未见积液；胸膜未见增厚；扫描范围内胸椎、胸壁骨未见骨质破坏征象。；检查结论: 双肺类结节影，转移瘤可能性大。\n- [全程D4] 检验组合: 酮体(KET)-尿液: +-（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；尿胆原(URO)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 4/μL；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；白细胞计数(WBC#)-尿液: 26/μL；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；酸碱度(pH)-尿液: 6；总蛋白(TP)-尿液: -（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性（参考: 阴性）；颜色-尿液: Light-Yellow；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；非鳞状上皮细胞计数-尿液: 2/μL；比重(SG)-尿液: 1.032；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.05；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL\n- [全程D2] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: 右臂静脉插管,导管末端位于T 6右旁，估计位于上腔静脉中段。；检查结论: 导管末端位置如上述。\n- [全程D2] 检验组合: 血小板分布宽度(PDW)-静脉血: 13.8%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；淋巴细胞百分比(Lymph%)-静脉血: 0.262；单核细胞计数(Mono#)-静脉血: 0.510E9/L；胱抑素(Cys-C)-静脉血: 1.01mg/L；总蛋白(TP)-静脉血: 68.46g/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.16COI；透明质酸(HA)-静脉血: 61.97ng/ml；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；大血小板百分比(P-LCR%)-静脉血: 32.4%；白蛋白(ALB)-静脉血: 43.7g/L；总胆固醇(TC)-静脉血: 5.59mmol/L；总胆红素(TBIL)-静脉血: 14.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.84；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.009；丙氨酸氨基转移酶(ALT)-静脉血: 27U/L；氯离子(Cl-)-静脉血: 103.1mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；淋巴细胞计数(Lymph#)-静脉血: 2.510E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.63mmol/L；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.06S/CO；血小板比容-静脉血: 21%；载脂蛋白B(apoB)-静脉血: 1.22g/L；C-反应蛋白(CRP)-静脉血: 4.05mg/L；ABO血型-静脉血: A；载脂蛋白AI(apoAI)-静脉血: 1.2g/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；单核细胞百分比(Mono%)-静脉血: 0.049；钠离子(Na+)-静脉血: 139.6mmol/L；凝血酶原时间(PT)-静脉血: 10.3sec.；球蛋白(GLO)-静脉血: 24.76g/L；纤维蛋白原(Fbg)-静脉血: 2.49g/L；凝血酶时间(TT)-静脉血: 20sec.；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44.6；Rh血型-静脉血: 阳性；平均红细胞体积(MCV)-静脉血: 85.8fL；直接胆红素(DBIL)-静脉血: 3.3umol/L；凝血酶原时间活动度(PTA)-静脉血: 113.8……\n- [全程D5] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: 3+500Leu（参考: 阴性）；白细胞计数(WBC#)-尿液: 18/μL；鳞状上皮细胞计数(SQEP#)-尿液: 5/μL；比重(SG)-尿液: 1.02；总蛋白(TP)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: Turbid；隐血(OB)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；未分类结晶计数(UNCX#)-尿液: 25/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；非鳞状上皮细胞计数-尿液: 5/μL\n- [全程D9] 检验组合: 钾离子(K+)-静脉血: 3.73mmol/L；红细胞比容(Hct)-静脉血: 48.1%；血小板比容-静脉血: 19%；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.94mmolL；尿素氮(BUN)-静脉血: 9.5mmol/L；钠离子(Na+)-静脉血: 137.8mmol/L；血红蛋白(Hb)-静脉血: 159g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.095；总钙(Ca)-静脉血: 1.93mmol/L；血小板分布宽度(PDW)-静脉血: 13.3%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；丙氨酸氨基转移酶(ALT)-静脉血: 94.9U/L；载脂蛋白B(apoB)-静脉血: 1.06g/L；白蛋白(ALB)-静脉血: 40.3g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.46；白细胞计数(WBC#)-静脉血: 14.910E9/L；胱抑素(Cys-C)-静脉血: 1.26mg/L；平均血小板体积(MPV)-静脉血: 10.4fL；中性粒细胞百分比(Neut%)-静脉血: 0.837；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.45mmol/L；血小板计数(PLT#)-静脉血: 17910E9/L；总胆固醇(TC)-静脉血: 5.1mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.4；球蛋白(GLO)-静脉血: 23.17g/L；磷(P)-静脉血: 1.26mmol/L；间接胆红素(IBIL)-静脉血: 13.1umolL；红细胞计数(RBC#)-静脉血: 5.5910E12/L；直接胆红素(DBIL)-静脉血: 5.4umol/L；总胆汁酸(TBA)-静脉血: 0.1umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；单核细胞百分比(Mono%)-静脉血: 0.06；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 42.8U/L；肌酐(Crea)-静脉血: 101.5umol/L；载脂蛋白AI(apoAI)-静脉血: 0.99g/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.4mmol/L；单核细胞计……\n- [全程D16] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及双侧壁增厚放射性浓聚，SUV约11.9，双侧咽隐窝消失；病灶侵犯双侧腭帆提肌、左侧腭帆张肌、左翼内肌，左咽旁间隙及左咽后间隙消失；病灶向上侵犯蝶骨基底部、左翼突区、左蝶骨大翼、左卵圆孔及左海绵窦；向前侵犯左翼腭窝、左上颌后脂肪间隙、左眶尖及左眶内后份，左框内病灶与视神经分界不清。右咽后小淋巴结放射性分布未见明显异常。双侧扁桃体放射性浓聚，SUV约9.4；喉咽结构及放射性分布未见明显异常。双侧上颌窦低密度影放射性分布未见异常；额窦、蝶窦、筛窦结构及放射性分布未见明显异常。甲状腺双叶密度减低，放射性分布未见异常。双颈多个小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺散在多发结节影放射性分布未见明显异常，最大约0.6×0.8cm；左上肺舌段条索影放射性分布未见异常；气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。心脏及纵隔大血管未见明显异常。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏弥漫性密度减低，CT值约36Hu（脾脏CT值约51Hu），放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾门区结节影放射性分布未见异常，大小约1.1×1.4cm（副脾）；脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 双侧乳突气房内低密度影放射性分布未见异常；余颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌病灶，侵犯左咽后及左咽旁间隙、颅底骨骼、左卵圆孔、左海绵窦、左翼腭窝、左上颌后脂肪间隙、左眶尖及左眶内后份，累及左视神经。 双肺多发小结节影代谢未见异常，疑增殖灶。 双侧上颌窦炎症；双侧乳突炎症。 双侧扁桃体代谢活跃，考虑炎性病变。 脂肪肝。\n- [全程D24] 检验组合: 红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.4%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.71mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.0123；平均血小板体积(MPV)-静脉血: 8.22fL；载脂蛋白B(apoB)-静脉血: 1.13g/L；总胆固醇(TC)-静脉血: 5.18mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.281；有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞血红蛋白浓度(MCHC)-静脉血: 325.6g/L；磷(P)-静脉血: 1.14mmol/L；胱抑素(Cys-C)-静脉血: 1.19mg/L；尿素氮(BUN)-静脉血: 7.71mmol/L；血小板分布宽度(PDW)-静脉血: 16.4%；丙氨酸氨基转移酶(ALT)-静脉血: 28.8U/L；直接胆红素(DBIL)-静脉血: 2.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.8；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.14mmolL；氯离子(Cl-)-静脉血: 105.9mmol/L；血小板计数(PLT#)-静脉血: 18310E9/L；中性粒细胞计数(Neut#)-静脉血: 510E9/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；乳酸脱氢酶(LDH)-静脉血: 159U/L；平均红细胞体积(MCV)-静脉血: 84.3fL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；红细胞计数(RBC#)-静脉血: 5.2310E12/L；球蛋白(GLO)-静脉血: 27.58g/L；葡萄糖(Glu)-静脉血: 4.55mmol/L；肌酐(Crea)-静脉血: 91.9umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；血小板比容-静脉血: 15%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 50.8U/L；白细胞计数(WBC#)-静脉血: 7.810E9/L；单核细胞百分比(Mono%)-静脉血: 0.0665；淋巴细胞计数(Lymph#)-静脉血: 2.210E9/L；C-反应蛋白(CRP)-静脉血: 4.59mg/L；红细胞比容(Hct)-静脉血:……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者无诉特殊不适，完善各项检查中，体查同入院时，[姓名已隐去]主任查房指示，待各项检查完成明确分期后，再决定下一步治疗。\n- [全程D8] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D10] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗结束，诉呕吐2次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程5-FU+顺铂方案诱导化疗结束，无诉特殊不适，可予请假至6月13日，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n- [全程D15] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者请假至.吕星\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 予以口服升白细胞药物，静脉水化及补充电解质，皮下注射胸腺法新，并监测24小时尿量，准备行下一程化疗。\nB. 予以静脉滴注保肝药物，静脉水化及补充电解质，皮下注射胸腺法新，暂缓化疗待复查指标正常后继续。\nC. 予以静脉输注碳酸氢钠碱化尿液及利尿处理，静脉水化及补充电解质，将下一程化疗方案中的顺铂替换为卡铂。\nD. 予以静脉营养支持，静脉水化及补充电解质，皮下注射胸腺法新，下一程化疗顺铂剂量下调20%。\nE. 予以静脉水化、补充电解质及维生素，预防性皮下注射重组人粒细胞刺激因子，口服止咳药物，准备行下一程化疗。\nF. 予以静脉水化、补充电解质及维生素，预防性皮下注射重组人血小板生成素，口服止咳药物，准备行下一程化疗。\nG. 予以静脉水化、补充电解质及维生素，口服止咳药物，加用异烟肼预防性抗结核治疗，准备行下一程化疗。\nH. 予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，无需监测尿量，准备行下一程化疗。\nI. 予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，并监测24小时尿量，准备行单纯放射治疗。\nJ. 予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，并监测24小时尿量，准备行下一程化疗。\nK. 予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，并监测24小时尿量，将下一程化疗方案更改为吉西他滨加顺铂。\nL. 予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，并监测24小时尿量，将下一程化疗方案更改为紫杉醇加顺铂。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、斜坡、海绵窦、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左耳听力下降1年余；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右耳鸣；既往史: 某次就诊时间患“结核性胸膜炎”已治愈，某次就诊时间患“急性胰腺炎”已治愈。否认\"肝炎、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟史30年，1包每天，常饮酒，两天/次，每次500ml。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：120/80mmHg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧壁、顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D3] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D3] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 38mm AO 26mm MV E 0.79m/s EF 75% LV 50mm IVS 11mm A 0.67m/s FS 45% RA 33mm LVPW 8mm RV 20mm PA 19mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 左房稍大，余各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 左房稍大 各房室腔及大血管未探及异常血流信号 心功能正常\n- [全程D3] 检验组合: 丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D4] CT；胸部CT平扫＋增强: 检查类型: CT；检查名称: 胸部CT平扫＋增强；检查部位:；检查所见: 右中肺及双下肺见数个类结节影，最大者直径约 5 mm，病灶边界清楚而不规则，密度较高而不均匀；气管及支气管分枝通畅，未见明显软组织肿物或受压变窄；双侧肺门及纵隔未见明确肿大淋巴结；双侧胸腔未见积液；胸膜未见增厚；扫描范围内胸椎、胸壁骨未见骨质破坏征象。；检查结论: 双肺类结节影，转移瘤可能性大。\n- [全程D4] 检验组合: 酮体(KET)-尿液: +-（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；尿胆原(URO)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 4/μL；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；白细胞计数(WBC#)-尿液: 26/μL；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；酸碱度(pH)-尿液: 6；总蛋白(TP)-尿液: -（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性（参考: 阴性）；颜色-尿液: Light-Yellow；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；非鳞状上皮细胞计数-尿液: 2/μL；比重(SG)-尿液: 1.032；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.05；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL\n- [全程D2] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: 右臂静脉插管,导管末端位于T 6右旁，估计位于上腔静脉中段。；检查结论: 导管末端位置如上述。\n- [全程D2] 检验组合: 血小板分布宽度(PDW)-静脉血: 13.8%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；淋巴细胞百分比(Lymph%)-静脉血: 0.262；单核细胞计数(Mono#)-静脉血: 0.510E9/L；胱抑素(Cys-C)-静脉血: 1.01mg/L；总蛋白(TP)-静脉血: 68.46g/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.16COI；透明质酸(HA)-静脉血: 61.97ng/ml；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；大血小板百分比(P-LCR%)-静脉血: 32.4%；白蛋白(ALB)-静脉血: 43.7g/L；总胆固醇(TC)-静脉血: 5.59mmol/L；总胆红素(TBIL)-静脉血: 14.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.84；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.009；丙氨酸氨基转移酶(ALT)-静脉血: 27U/L；氯离子(Cl-)-静脉血: 103.1mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；淋巴细胞计数(Lymph#)-静脉血: 2.510E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.63mmol/L；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.06S/CO；血小板比容-静脉血: 21%；载脂蛋白B(apoB)-静脉血: 1.22g/L；C-反应蛋白(CRP)-静脉血: 4.05mg/L；ABO血型-静脉血: A；载脂蛋白AI(apoAI)-静脉血: 1.2g/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；单核细胞百分比(Mono%)-静脉血: 0.049；钠离子(Na+)-静脉血: 139.6mmol/L；凝血酶原时间(PT)-静脉血: 10.3sec.；球蛋白(GLO)-静脉血: 24.76g/L；纤维蛋白原(Fbg)-静脉血: 2.49g/L；凝血酶时间(TT)-静脉血: 20sec.；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44.6；Rh血型-静脉血: 阳性；平均红细胞体积(MCV)-静脉血: 85.8fL；直接胆红素(DBIL)-静脉血: 3.3umol/L；凝血酶原时间活动度(PTA)-静脉血: 113.8……\n- [全程D5] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: 3+500Leu（参考: 阴性）；白细胞计数(WBC#)-尿液: 18/μL；鳞状上皮细胞计数(SQEP#)-尿液: 5/μL；比重(SG)-尿液: 1.02；总蛋白(TP)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: Turbid；隐血(OB)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；未分类结晶计数(UNCX#)-尿液: 25/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；非鳞状上皮细胞计数-尿液: 5/μL\n- [全程D9] 检验组合: 钾离子(K+)-静脉血: 3.73mmol/L；红细胞比容(Hct)-静脉血: 48.1%；血小板比容-静脉血: 19%；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.94mmolL；尿素氮(BUN)-静脉血: 9.5mmol/L；钠离子(Na+)-静脉血: 137.8mmol/L；血红蛋白(Hb)-静脉血: 159g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.095；总钙(Ca)-静脉血: 1.93mmol/L；血小板分布宽度(PDW)-静脉血: 13.3%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；丙氨酸氨基转移酶(ALT)-静脉血: 94.9U/L；载脂蛋白B(apoB)-静脉血: 1.06g/L；白蛋白(ALB)-静脉血: 40.3g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.46；白细胞计数(WBC#)-静脉血: 14.910E9/L；胱抑素(Cys-C)-静脉血: 1.26mg/L；平均血小板体积(MPV)-静脉血: 10.4fL；中性粒细胞百分比(Neut%)-静脉血: 0.837；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.45mmol/L；血小板计数(PLT#)-静脉血: 17910E9/L；总胆固醇(TC)-静脉血: 5.1mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.4；球蛋白(GLO)-静脉血: 23.17g/L；磷(P)-静脉血: 1.26mmol/L；间接胆红素(IBIL)-静脉血: 13.1umolL；红细胞计数(RBC#)-静脉血: 5.5910E12/L；直接胆红素(DBIL)-静脉血: 5.4umol/L；总胆汁酸(TBA)-静脉血: 0.1umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；单核细胞百分比(Mono%)-静脉血: 0.06；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 42.8U/L；肌酐(Crea)-静脉血: 101.5umol/L；载脂蛋白AI(apoAI)-静脉血: 0.99g/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.4mmol/L；单核细胞计……\n- [全程D16] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及双侧壁增厚放射性浓聚，SUV约11.9，双侧咽隐窝消失；病灶侵犯双侧腭帆提肌、左侧腭帆张肌、左翼内肌，左咽旁间隙及左咽后间隙消失；病灶向上侵犯蝶骨基底部、左翼突区、左蝶骨大翼、左卵圆孔及左海绵窦；向前侵犯左翼腭窝、左上颌后脂肪间隙、左眶尖及左眶内后份，左框内病灶与视神经分界不清。右咽后小淋巴结放射性分布未见明显异常。双侧扁桃体放射性浓聚，SUV约9.4；喉咽结构及放射性分布未见明显异常。双侧上颌窦低密度影放射性分布未见异常；额窦、蝶窦、筛窦结构及放射性分布未见明显异常。甲状腺双叶密度减低，放射性分布未见异常。双颈多个小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺散在多发结节影放射性分布未见明显异常，最大约0.6×0.8cm；左上肺舌段条索影放射性分布未见异常；气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。心脏及纵隔大血管未见明显异常。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏弥漫性密度减低，CT值约36Hu（脾脏CT值约51Hu），放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾门区结节影放射性分布未见异常，大小约1.1×1.4cm（副脾）；脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 双侧乳突气房内低密度影放射性分布未见异常；余颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌病灶，侵犯左咽后及左咽旁间隙、颅底骨骼、左卵圆孔、左海绵窦、左翼腭窝、左上颌后脂肪间隙、左眶尖及左眶内后份，累及左视神经。 双肺多发小结节影代谢未见异常，疑增殖灶。 双侧上颌窦炎症；双侧乳突炎症。 双侧扁桃体代谢活跃，考虑炎性病变。 脂肪肝。\n- [全程D24] 检验组合: 红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.4%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.71mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.0123；平均血小板体积(MPV)-静脉血: 8.22fL；载脂蛋白B(apoB)-静脉血: 1.13g/L；总胆固醇(TC)-静脉血: 5.18mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.281；有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞血红蛋白浓度(MCHC)-静脉血: 325.6g/L；磷(P)-静脉血: 1.14mmol/L；胱抑素(Cys-C)-静脉血: 1.19mg/L；尿素氮(BUN)-静脉血: 7.71mmol/L；血小板分布宽度(PDW)-静脉血: 16.4%；丙氨酸氨基转移酶(ALT)-静脉血: 28.8U/L；直接胆红素(DBIL)-静脉血: 2.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.8；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.14mmolL；氯离子(Cl-)-静脉血: 105.9mmol/L；血小板计数(PLT#)-静脉血: 18310E9/L；中性粒细胞计数(Neut#)-静脉血: 510E9/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；乳酸脱氢酶(LDH)-静脉血: 159U/L；平均红细胞体积(MCV)-静脉血: 84.3fL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；红细胞计数(RBC#)-静脉血: 5.2310E12/L；球蛋白(GLO)-静脉血: 27.58g/L；葡萄糖(Glu)-静脉血: 4.55mmol/L；肌酐(Crea)-静脉血: 91.9umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；血小板比容-静脉血: 15%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 50.8U/L；白细胞计数(WBC#)-静脉血: 7.810E9/L；单核细胞百分比(Mono%)-静脉血: 0.0665；淋巴细胞计数(Lymph#)-静脉血: 2.210E9/L；C-反应蛋白(CRP)-静脉血: 4.59mg/L；红细胞比容(Hct)-静脉血:……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者无诉特殊不适，完善各项检查中，体查同入院时，[姓名已隐去]主任查房指示，待各项检查完成明确分期后，再决定下一步治疗。\n- [全程D8] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D10] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗结束，诉呕吐2次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程5-FU+顺铂方案诱导化疗结束，无诉特殊不适，可予请假至6月13日，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n- [全程D15] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者请假至.吕星\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 予以口服升白细胞药物，静脉水化及补充电解质，皮下注射胸腺法新，并监测24小时尿量，准备行下一程化疗。\nB. 予以静脉滴注保肝药物，静脉水化及补充电解质，皮下注射胸腺法新，暂缓化疗待复查指标正常后继续。\nC. 予以静脉输注碳酸氢钠碱化尿液及利尿处理，静脉水化及补充电解质，将下一程化疗方案中的顺铂替换为卡铂。\nD. 予以静脉营养支持，静脉水化及补充电解质，皮下注射胸腺法新，下一程化疗顺铂剂量下调20%。\nE. 予以静脉水化、补充电解质及维生素，预防性皮下注射重组人粒细胞刺激因子，口服止咳药物，准备行下一程化疗。\nF. 予以静脉水化、补充电解质及维生素，预防性皮下注射重组人血小板生成素，口服止咳药物，准备行下一程化疗。\nG. 予以静脉水化、补充电解质及维生素，口服止咳药物，加用异烟肼预防性抗结核治疗，准备行下一程化疗。\nH. 予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，无需监测尿量，准备行下一程化疗。\nI. 予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，并监测24小时尿量，准备行单纯放射治疗。\nJ. 予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，并监测24小时尿量，准备行下一程化疗。\nK. 予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，并监测24小时尿量，将下一程化疗方案更改为吉西他滨加顺铂。\nL. 予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，并监测24小时尿量，将下一程化疗方案更改为紫杉醇加顺铂。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-237ee315803b648b5eb4c67f","patient_id":"patient-84fa3d6098d10a1d14b6b19e","turn_id":"turn07","turn_position":6,"turn_type":"response_assessment_decision","gold_letter":"K","gold_action":"评估PET/CT证实双肺结节无代谢活性（排除M1），维持局部晚期诊断；行静脉置管护理与通畅性维护，复查生化常规后，继续行第2程PF方案诱导化疗。","options":[{"letter":"A","text":"评估PET/CT双侧扁桃体代谢活跃为淋巴结转移，双肺结节无代谢活性；调整为GP方案（吉西他滨+顺铂）行第2程诱导化疗，并加强静脉导管护理。","is_gold":false},{"letter":"B","text":"评估PET/CT证实双肺结节无代谢活性（排除M1）；已完成1程诱导化疗，直接进入根治性放疗阶段，并辅以同期顺铂化疗，定期复查生化常规。","is_gold":false},{"letter":"C","text":"评估PET/CT见双肺多发结节伴鼻咽病灶广泛侵犯，考虑为IVB期（M1）；调整为姑息性化疗，采用TP方案联合PD-1抑制剂，并维持静脉通路。","is_gold":false},{"letter":"D","text":"评估PET/CT证实双肺结节无代谢活性；病灶侵犯视神经及海绵窦，第2程诱导化疗需升级为TPF方案（多西他赛+顺铂+5-FU），并复查生化。","is_gold":false},{"letter":"E","text":"评估PET/CT证实双肺结节无代谢活性；拔除原有静脉置管以防血栓，复查生化常规后，继续行第2程PF方案（5-FU+顺铂）诱导化疗。","is_gold":false},{"letter":"F","text":"评估PET/CT证实双肺结节无代谢活性；局部病灶侵犯广泛，暂停化疗，优先行局部病灶减瘤术以解除视神经压迫，术后继续PF方案化疗。","is_gold":false},{"letter":"G","text":"评估PET/CT证实双肺结节无代谢活性；为加强局部控制，第2程诱导化疗在PF方案基础上加用西妥昔单抗靶向治疗，并常规维护静脉导管。","is_gold":false},{"letter":"H","text":"评估PET/CT证实双肺结节无代谢活性；第1程化疗后出现胃肠道反应，第2程化疗将顺铂替换为卡铂，行5-FU+卡铂方案，复查生化常规。","is_gold":false},{"letter":"I","text":"评估PET/CT证实双肺结节无代谢活性；行静脉置管护理，复查生化常规后，提前终止诱导化疗，开始单纯根治性放疗，密切监测不良反应。","is_gold":false},{"letter":"J","text":"评估PET/CT证实双肺结节无代谢活性，鼻咽病灶SUV值偏高说明原方案疗效欠佳；换用吉西他滨+顺铂方案行第2程诱导化疗，并复查生化。","is_gold":false},{"letter":"K","text":"评估PET/CT证实双肺结节无代谢活性（排除M1），维持局部晚期诊断；行静脉置管护理与通畅性维护，复查生化常规后，继续行第2程PF方案诱导化疗。","is_gold":true},{"letter":"L","text":"评估PET/CT证实双肺结节无代谢活性；病灶累及颅底及海绵窦，行第2程PF方案诱导化疗的同时，加用局部姑息性放疗，并维护静脉导管。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、斜坡、海绵窦、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左耳听力下降1年余；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右耳鸣；既往史: 某次就诊时间患“结核性胸膜炎”已治愈，某次就诊时间患“急性胰腺炎”已治愈。否认\"肝炎、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟史30年，1包每天，常饮酒，两天/次，每次500ml。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：120/80mmHg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧壁、顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D3] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D3] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 38mm AO 26mm MV E 0.79m/s EF 75% LV 50mm IVS 11mm A 0.67m/s FS 45% RA 33mm LVPW 8mm RV 20mm PA 19mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 左房稍大，余各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 左房稍大 各房室腔及大血管未探及异常血流信号 心功能正常\n- [全程D3] 检验组合: 丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D4] CT；胸部CT平扫＋增强: 检查类型: CT；检查名称: 胸部CT平扫＋增强；检查部位:；检查所见: 右中肺及双下肺见数个类结节影，最大者直径约 5 mm，病灶边界清楚而不规则，密度较高而不均匀；气管及支气管分枝通畅，未见明显软组织肿物或受压变窄；双侧肺门及纵隔未见明确肿大淋巴结；双侧胸腔未见积液；胸膜未见增厚；扫描范围内胸椎、胸壁骨未见骨质破坏征象。；检查结论: 双肺类结节影，转移瘤可能性大。\n- [全程D4] 检验组合: 酮体(KET)-尿液: +-（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；尿胆原(URO)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 4/μL；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；白细胞计数(WBC#)-尿液: 26/μL；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；酸碱度(pH)-尿液: 6；总蛋白(TP)-尿液: -（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性（参考: 阴性）；颜色-尿液: Light-Yellow；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；非鳞状上皮细胞计数-尿液: 2/μL；比重(SG)-尿液: 1.032；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.05；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL\n- [全程D2] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: 右臂静脉插管,导管末端位于T 6右旁，估计位于上腔静脉中段。；检查结论: 导管末端位置如上述。\n- [全程D2] 检验组合: 血小板分布宽度(PDW)-静脉血: 13.8%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；淋巴细胞百分比(Lymph%)-静脉血: 0.262；单核细胞计数(Mono#)-静脉血: 0.510E9/L；胱抑素(Cys-C)-静脉血: 1.01mg/L；总蛋白(TP)-静脉血: 68.46g/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.16COI；透明质酸(HA)-静脉血: 61.97ng/ml；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；大血小板百分比(P-LCR%)-静脉血: 32.4%；白蛋白(ALB)-静脉血: 43.7g/L；总胆固醇(TC)-静脉血: 5.59mmol/L；总胆红素(TBIL)-静脉血: 14.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.84；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.009；丙氨酸氨基转移酶(ALT)-静脉血: 27U/L；氯离子(Cl-)-静脉血: 103.1mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；淋巴细胞计数(Lymph#)-静脉血: 2.510E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.63mmol/L；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.06S/CO；血小板比容-静脉血: 21%；载脂蛋白B(apoB)-静脉血: 1.22g/L；C-反应蛋白(CRP)-静脉血: 4.05mg/L；ABO血型-静脉血: A；载脂蛋白AI(apoAI)-静脉血: 1.2g/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；单核细胞百分比(Mono%)-静脉血: 0.049；钠离子(Na+)-静脉血: 139.6mmol/L；凝血酶原时间(PT)-静脉血: 10.3sec.；球蛋白(GLO)-静脉血: 24.76g/L；纤维蛋白原(Fbg)-静脉血: 2.49g/L；凝血酶时间(TT)-静脉血: 20sec.；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44.6；Rh血型-静脉血: 阳性；平均红细胞体积(MCV)-静脉血: 85.8fL；直接胆红素(DBIL)-静脉血: 3.3umol/L；凝血酶原时间活动度(PTA)-静脉血: 113.8……\n- [全程D5] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: 3+500Leu（参考: 阴性）；白细胞计数(WBC#)-尿液: 18/μL；鳞状上皮细胞计数(SQEP#)-尿液: 5/μL；比重(SG)-尿液: 1.02；总蛋白(TP)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: Turbid；隐血(OB)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；未分类结晶计数(UNCX#)-尿液: 25/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；非鳞状上皮细胞计数-尿液: 5/μL\n- [全程D9] 检验组合: 钾离子(K+)-静脉血: 3.73mmol/L；红细胞比容(Hct)-静脉血: 48.1%；血小板比容-静脉血: 19%；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.94mmolL；尿素氮(BUN)-静脉血: 9.5mmol/L；钠离子(Na+)-静脉血: 137.8mmol/L；血红蛋白(Hb)-静脉血: 159g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.095；总钙(Ca)-静脉血: 1.93mmol/L；血小板分布宽度(PDW)-静脉血: 13.3%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；丙氨酸氨基转移酶(ALT)-静脉血: 94.9U/L；载脂蛋白B(apoB)-静脉血: 1.06g/L；白蛋白(ALB)-静脉血: 40.3g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.46；白细胞计数(WBC#)-静脉血: 14.910E9/L；胱抑素(Cys-C)-静脉血: 1.26mg/L；平均血小板体积(MPV)-静脉血: 10.4fL；中性粒细胞百分比(Neut%)-静脉血: 0.837；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.45mmol/L；血小板计数(PLT#)-静脉血: 17910E9/L；总胆固醇(TC)-静脉血: 5.1mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.4；球蛋白(GLO)-静脉血: 23.17g/L；磷(P)-静脉血: 1.26mmol/L；间接胆红素(IBIL)-静脉血: 13.1umolL；红细胞计数(RBC#)-静脉血: 5.5910E12/L；直接胆红素(DBIL)-静脉血: 5.4umol/L；总胆汁酸(TBA)-静脉血: 0.1umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；单核细胞百分比(Mono%)-静脉血: 0.06；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 42.8U/L；肌酐(Crea)-静脉血: 101.5umol/L；载脂蛋白AI(apoAI)-静脉血: 0.99g/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.4mmol/L；单核细胞计……\n- [全程D16] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及双侧壁增厚放射性浓聚，SUV约11.9，双侧咽隐窝消失；病灶侵犯双侧腭帆提肌、左侧腭帆张肌、左翼内肌，左咽旁间隙及左咽后间隙消失；病灶向上侵犯蝶骨基底部、左翼突区、左蝶骨大翼、左卵圆孔及左海绵窦；向前侵犯左翼腭窝、左上颌后脂肪间隙、左眶尖及左眶内后份，左框内病灶与视神经分界不清。右咽后小淋巴结放射性分布未见明显异常。双侧扁桃体放射性浓聚，SUV约9.4；喉咽结构及放射性分布未见明显异常。双侧上颌窦低密度影放射性分布未见异常；额窦、蝶窦、筛窦结构及放射性分布未见明显异常。甲状腺双叶密度减低，放射性分布未见异常。双颈多个小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺散在多发结节影放射性分布未见明显异常，最大约0.6×0.8cm；左上肺舌段条索影放射性分布未见异常；气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。心脏及纵隔大血管未见明显异常。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏弥漫性密度减低，CT值约36Hu（脾脏CT值约51Hu），放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾门区结节影放射性分布未见异常，大小约1.1×1.4cm（副脾）；脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 双侧乳突气房内低密度影放射性分布未见异常；余颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌病灶，侵犯左咽后及左咽旁间隙、颅底骨骼、左卵圆孔、左海绵窦、左翼腭窝、左上颌后脂肪间隙、左眶尖及左眶内后份，累及左视神经。 双肺多发小结节影代谢未见异常，疑增殖灶。 双侧上颌窦炎症；双侧乳突炎症。 双侧扁桃体代谢活跃，考虑炎性病变。 脂肪肝。\n- [全程D24] 检验组合: 红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.4%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.71mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.0123；平均血小板体积(MPV)-静脉血: 8.22fL；载脂蛋白B(apoB)-静脉血: 1.13g/L；总胆固醇(TC)-静脉血: 5.18mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.281；有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞血红蛋白浓度(MCHC)-静脉血: 325.6g/L；磷(P)-静脉血: 1.14mmol/L；胱抑素(Cys-C)-静脉血: 1.19mg/L；尿素氮(BUN)-静脉血: 7.71mmol/L；血小板分布宽度(PDW)-静脉血: 16.4%；丙氨酸氨基转移酶(ALT)-静脉血: 28.8U/L；直接胆红素(DBIL)-静脉血: 2.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.8；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.14mmolL；氯离子(Cl-)-静脉血: 105.9mmol/L；血小板计数(PLT#)-静脉血: 18310E9/L；中性粒细胞计数(Neut#)-静脉血: 510E9/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；乳酸脱氢酶(LDH)-静脉血: 159U/L；平均红细胞体积(MCV)-静脉血: 84.3fL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；红细胞计数(RBC#)-静脉血: 5.2310E12/L；球蛋白(GLO)-静脉血: 27.58g/L；葡萄糖(Glu)-静脉血: 4.55mmol/L；肌酐(Crea)-静脉血: 91.9umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；血小板比容-静脉血: 15%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 50.8U/L；白细胞计数(WBC#)-静脉血: 7.810E9/L；单核细胞百分比(Mono%)-静脉血: 0.0665；淋巴细胞计数(Lymph#)-静脉血: 2.210E9/L；C-反应蛋白(CRP)-静脉血: 4.59mg/L；红细胞比容(Hct)-静脉血:……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者无诉特殊不适，完善各项检查中，体查同入院时，[姓名已隐去]主任查房指示，待各项检查完成明确分期后，再决定下一步治疗。\n- [全程D8] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D10] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗结束，诉呕吐2次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程5-FU+顺铂方案诱导化疗结束，无诉特殊不适，可予请假至6月13日，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n- [全程D15] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者请假至.吕星\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估PET/CT双侧扁桃体代谢活跃为淋巴结转移，双肺结节无代谢活性；调整为GP方案（吉西他滨+顺铂）行第2程诱导化疗，并加强静脉导管护理。\nB. 评估PET/CT证实双肺结节无代谢活性（排除M1）；已完成1程诱导化疗，直接进入根治性放疗阶段，并辅以同期顺铂化疗，定期复查生化常规。\nC. 评估PET/CT见双肺多发结节伴鼻咽病灶广泛侵犯，考虑为IVB期（M1）；调整为姑息性化疗，采用TP方案联合PD-1抑制剂，并维持静脉通路。\nD. 评估PET/CT证实双肺结节无代谢活性；病灶侵犯视神经及海绵窦，第2程诱导化疗需升级为TPF方案（多西他赛+顺铂+5-FU），并复查生化。\nE. 评估PET/CT证实双肺结节无代谢活性；拔除原有静脉置管以防血栓，复查生化常规后，继续行第2程PF方案（5-FU+顺铂）诱导化疗。\nF. 评估PET/CT证实双肺结节无代谢活性；局部病灶侵犯广泛，暂停化疗，优先行局部病灶减瘤术以解除视神经压迫，术后继续PF方案化疗。\nG. 评估PET/CT证实双肺结节无代谢活性；为加强局部控制，第2程诱导化疗在PF方案基础上加用西妥昔单抗靶向治疗，并常规维护静脉导管。\nH. 评估PET/CT证实双肺结节无代谢活性；第1程化疗后出现胃肠道反应，第2程化疗将顺铂替换为卡铂，行5-FU+卡铂方案，复查生化常规。\nI. 评估PET/CT证实双肺结节无代谢活性；行静脉置管护理，复查生化常规后，提前终止诱导化疗，开始单纯根治性放疗，密切监测不良反应。\nJ. 评估PET/CT证实双肺结节无代谢活性，鼻咽病灶SUV值偏高说明原方案疗效欠佳；换用吉西他滨+顺铂方案行第2程诱导化疗，并复查生化。\nK. 评估PET/CT证实双肺结节无代谢活性（排除M1），维持局部晚期诊断；行静脉置管护理与通畅性维护，复查生化常规后，继续行第2程PF方案诱导化疗。\nL. 评估PET/CT证实双肺结节无代谢活性；病灶累及颅底及海绵窦，行第2程PF方案诱导化疗的同时，加用局部姑息性放疗，并维护静脉导管。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、斜坡、海绵窦、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左耳听力下降1年余；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右耳鸣；既往史: 某次就诊时间患“结核性胸膜炎”已治愈，某次就诊时间患“急性胰腺炎”已治愈。否认\"肝炎、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟史30年，1包每天，常饮酒，两天/次，每次500ml。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：120/80mmHg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧壁、顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D3] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D3] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 38mm AO 26mm MV E 0.79m/s EF 75% LV 50mm IVS 11mm A 0.67m/s FS 45% RA 33mm LVPW 8mm RV 20mm PA 19mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 左房稍大，余各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 左房稍大 各房室腔及大血管未探及异常血流信号 心功能正常\n- [全程D3] 检验组合: 丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D4] CT；胸部CT平扫＋增强: 检查类型: CT；检查名称: 胸部CT平扫＋增强；检查部位:；检查所见: 右中肺及双下肺见数个类结节影，最大者直径约 5 mm，病灶边界清楚而不规则，密度较高而不均匀；气管及支气管分枝通畅，未见明显软组织肿物或受压变窄；双侧肺门及纵隔未见明确肿大淋巴结；双侧胸腔未见积液；胸膜未见增厚；扫描范围内胸椎、胸壁骨未见骨质破坏征象。；检查结论: 双肺类结节影，转移瘤可能性大。\n- [全程D4] 检验组合: 酮体(KET)-尿液: +-（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；尿胆原(URO)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 4/μL；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；白细胞计数(WBC#)-尿液: 26/μL；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；酸碱度(pH)-尿液: 6；总蛋白(TP)-尿液: -（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性（参考: 阴性）；颜色-尿液: Light-Yellow；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；非鳞状上皮细胞计数-尿液: 2/μL；比重(SG)-尿液: 1.032；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.05；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL\n- [全程D2] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: 右臂静脉插管,导管末端位于T 6右旁，估计位于上腔静脉中段。；检查结论: 导管末端位置如上述。\n- [全程D2] 检验组合: 血小板分布宽度(PDW)-静脉血: 13.8%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；淋巴细胞百分比(Lymph%)-静脉血: 0.262；单核细胞计数(Mono#)-静脉血: 0.510E9/L；胱抑素(Cys-C)-静脉血: 1.01mg/L；总蛋白(TP)-静脉血: 68.46g/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.16COI；透明质酸(HA)-静脉血: 61.97ng/ml；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；大血小板百分比(P-LCR%)-静脉血: 32.4%；白蛋白(ALB)-静脉血: 43.7g/L；总胆固醇(TC)-静脉血: 5.59mmol/L；总胆红素(TBIL)-静脉血: 14.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.84；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.009；丙氨酸氨基转移酶(ALT)-静脉血: 27U/L；氯离子(Cl-)-静脉血: 103.1mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；淋巴细胞计数(Lymph#)-静脉血: 2.510E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.63mmol/L；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.06S/CO；血小板比容-静脉血: 21%；载脂蛋白B(apoB)-静脉血: 1.22g/L；C-反应蛋白(CRP)-静脉血: 4.05mg/L；ABO血型-静脉血: A；载脂蛋白AI(apoAI)-静脉血: 1.2g/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；单核细胞百分比(Mono%)-静脉血: 0.049；钠离子(Na+)-静脉血: 139.6mmol/L；凝血酶原时间(PT)-静脉血: 10.3sec.；球蛋白(GLO)-静脉血: 24.76g/L；纤维蛋白原(Fbg)-静脉血: 2.49g/L；凝血酶时间(TT)-静脉血: 20sec.；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44.6；Rh血型-静脉血: 阳性；平均红细胞体积(MCV)-静脉血: 85.8fL；直接胆红素(DBIL)-静脉血: 3.3umol/L；凝血酶原时间活动度(PTA)-静脉血: 113.8……\n- [全程D5] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: 3+500Leu（参考: 阴性）；白细胞计数(WBC#)-尿液: 18/μL；鳞状上皮细胞计数(SQEP#)-尿液: 5/μL；比重(SG)-尿液: 1.02；总蛋白(TP)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: Turbid；隐血(OB)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；未分类结晶计数(UNCX#)-尿液: 25/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；非鳞状上皮细胞计数-尿液: 5/μL\n- [全程D9] 检验组合: 钾离子(K+)-静脉血: 3.73mmol/L；红细胞比容(Hct)-静脉血: 48.1%；血小板比容-静脉血: 19%；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.94mmolL；尿素氮(BUN)-静脉血: 9.5mmol/L；钠离子(Na+)-静脉血: 137.8mmol/L；血红蛋白(Hb)-静脉血: 159g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.095；总钙(Ca)-静脉血: 1.93mmol/L；血小板分布宽度(PDW)-静脉血: 13.3%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；丙氨酸氨基转移酶(ALT)-静脉血: 94.9U/L；载脂蛋白B(apoB)-静脉血: 1.06g/L；白蛋白(ALB)-静脉血: 40.3g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.46；白细胞计数(WBC#)-静脉血: 14.910E9/L；胱抑素(Cys-C)-静脉血: 1.26mg/L；平均血小板体积(MPV)-静脉血: 10.4fL；中性粒细胞百分比(Neut%)-静脉血: 0.837；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.45mmol/L；血小板计数(PLT#)-静脉血: 17910E9/L；总胆固醇(TC)-静脉血: 5.1mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.4；球蛋白(GLO)-静脉血: 23.17g/L；磷(P)-静脉血: 1.26mmol/L；间接胆红素(IBIL)-静脉血: 13.1umolL；红细胞计数(RBC#)-静脉血: 5.5910E12/L；直接胆红素(DBIL)-静脉血: 5.4umol/L；总胆汁酸(TBA)-静脉血: 0.1umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；单核细胞百分比(Mono%)-静脉血: 0.06；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 42.8U/L；肌酐(Crea)-静脉血: 101.5umol/L；载脂蛋白AI(apoAI)-静脉血: 0.99g/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.4mmol/L；单核细胞计……\n- [全程D16] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及双侧壁增厚放射性浓聚，SUV约11.9，双侧咽隐窝消失；病灶侵犯双侧腭帆提肌、左侧腭帆张肌、左翼内肌，左咽旁间隙及左咽后间隙消失；病灶向上侵犯蝶骨基底部、左翼突区、左蝶骨大翼、左卵圆孔及左海绵窦；向前侵犯左翼腭窝、左上颌后脂肪间隙、左眶尖及左眶内后份，左框内病灶与视神经分界不清。右咽后小淋巴结放射性分布未见明显异常。双侧扁桃体放射性浓聚，SUV约9.4；喉咽结构及放射性分布未见明显异常。双侧上颌窦低密度影放射性分布未见异常；额窦、蝶窦、筛窦结构及放射性分布未见明显异常。甲状腺双叶密度减低，放射性分布未见异常。双颈多个小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺散在多发结节影放射性分布未见明显异常，最大约0.6×0.8cm；左上肺舌段条索影放射性分布未见异常；气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。心脏及纵隔大血管未见明显异常。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏弥漫性密度减低，CT值约36Hu（脾脏CT值约51Hu），放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾门区结节影放射性分布未见异常，大小约1.1×1.4cm（副脾）；脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 双侧乳突气房内低密度影放射性分布未见异常；余颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌病灶，侵犯左咽后及左咽旁间隙、颅底骨骼、左卵圆孔、左海绵窦、左翼腭窝、左上颌后脂肪间隙、左眶尖及左眶内后份，累及左视神经。 双肺多发小结节影代谢未见异常，疑增殖灶。 双侧上颌窦炎症；双侧乳突炎症。 双侧扁桃体代谢活跃，考虑炎性病变。 脂肪肝。\n- [全程D24] 检验组合: 红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.4%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.71mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.0123；平均血小板体积(MPV)-静脉血: 8.22fL；载脂蛋白B(apoB)-静脉血: 1.13g/L；总胆固醇(TC)-静脉血: 5.18mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.281；有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞血红蛋白浓度(MCHC)-静脉血: 325.6g/L；磷(P)-静脉血: 1.14mmol/L；胱抑素(Cys-C)-静脉血: 1.19mg/L；尿素氮(BUN)-静脉血: 7.71mmol/L；血小板分布宽度(PDW)-静脉血: 16.4%；丙氨酸氨基转移酶(ALT)-静脉血: 28.8U/L；直接胆红素(DBIL)-静脉血: 2.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.8；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.14mmolL；氯离子(Cl-)-静脉血: 105.9mmol/L；血小板计数(PLT#)-静脉血: 18310E9/L；中性粒细胞计数(Neut#)-静脉血: 510E9/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；乳酸脱氢酶(LDH)-静脉血: 159U/L；平均红细胞体积(MCV)-静脉血: 84.3fL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；红细胞计数(RBC#)-静脉血: 5.2310E12/L；球蛋白(GLO)-静脉血: 27.58g/L；葡萄糖(Glu)-静脉血: 4.55mmol/L；肌酐(Crea)-静脉血: 91.9umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；血小板比容-静脉血: 15%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 50.8U/L；白细胞计数(WBC#)-静脉血: 7.810E9/L；单核细胞百分比(Mono%)-静脉血: 0.0665；淋巴细胞计数(Lymph#)-静脉血: 2.210E9/L；C-反应蛋白(CRP)-静脉血: 4.59mg/L；红细胞比容(Hct)-静脉血:……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者无诉特殊不适，完善各项检查中，体查同入院时，[姓名已隐去]主任查房指示，待各项检查完成明确分期后，再决定下一步治疗。\n- [全程D8] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D10] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗结束，诉呕吐2次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程5-FU+顺铂方案诱导化疗结束，无诉特殊不适，可予请假至6月13日，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n- [全程D15] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者请假至.吕星\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估PET/CT双侧扁桃体代谢活跃为淋巴结转移，双肺结节无代谢活性；调整为GP方案（吉西他滨+顺铂）行第2程诱导化疗，并加强静脉导管护理。\nB. 评估PET/CT证实双肺结节无代谢活性（排除M1）；已完成1程诱导化疗，直接进入根治性放疗阶段，并辅以同期顺铂化疗，定期复查生化常规。\nC. 评估PET/CT见双肺多发结节伴鼻咽病灶广泛侵犯，考虑为IVB期（M1）；调整为姑息性化疗，采用TP方案联合PD-1抑制剂，并维持静脉通路。\nD. 评估PET/CT证实双肺结节无代谢活性；病灶侵犯视神经及海绵窦，第2程诱导化疗需升级为TPF方案（多西他赛+顺铂+5-FU），并复查生化。\nE. 评估PET/CT证实双肺结节无代谢活性；拔除原有静脉置管以防血栓，复查生化常规后，继续行第2程PF方案（5-FU+顺铂）诱导化疗。\nF. 评估PET/CT证实双肺结节无代谢活性；局部病灶侵犯广泛，暂停化疗，优先行局部病灶减瘤术以解除视神经压迫，术后继续PF方案化疗。\nG. 评估PET/CT证实双肺结节无代谢活性；为加强局部控制，第2程诱导化疗在PF方案基础上加用西妥昔单抗靶向治疗，并常规维护静脉导管。\nH. 评估PET/CT证实双肺结节无代谢活性；第1程化疗后出现胃肠道反应，第2程化疗将顺铂替换为卡铂，行5-FU+卡铂方案，复查生化常规。\nI. 评估PET/CT证实双肺结节无代谢活性；行静脉置管护理，复查生化常规后，提前终止诱导化疗，开始单纯根治性放疗，密切监测不良反应。\nJ. 评估PET/CT证实双肺结节无代谢活性，鼻咽病灶SUV值偏高说明原方案疗效欠佳；换用吉西他滨+顺铂方案行第2程诱导化疗，并复查生化。\nK. 评估PET/CT证实双肺结节无代谢活性（排除M1），维持局部晚期诊断；行静脉置管护理与通畅性维护，复查生化常规后，继续行第2程PF方案诱导化疗。\nL. 评估PET/CT证实双肺结节无代谢活性；病灶累及颅底及海绵窦，行第2程PF方案诱导化疗的同时，加用局部姑息性放疗，并维护静脉导管。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-c9510f9db8861176764ecc37","patient_id":"patient-84fa3d6098d10a1d14b6b19e","turn_id":"turn08","turn_position":7,"turn_type":"recurrence_or_salvage_decision","gold_letter":"L","gold_action":"行电子鼻咽镜检查（不活检）进一步评估鼻咽局部疗效，复查血常规与生化常规，并予动静脉置管护理。","options":[{"letter":"A","text":"立即启动根治性调强放射治疗及同步化疗，暂不安排其他局部影像或内镜检查。","is_gold":false},{"letter":"B","text":"行电子鼻咽镜检查并对残留病灶取活检以明确病理状态，复查血常规与生化常规。","is_gold":false},{"letter":"C","text":"继续予以第3程5-FU+顺铂方案诱导化疗，待化疗结束后再行鼻咽镜评估。","is_gold":false},{"letter":"D","text":"安排全身PET/CT复查以评估全身肿瘤代谢活性变化，随后制定放疗计划。","is_gold":false},{"letter":"E","text":"更改为紫杉醇+顺铂方案行第3程诱导化疗，并予动静脉置管常规护理。","is_gold":false},{"letter":"F","text":"安排鼻咽及颈部CT平扫+增强进一步评估颅底骨质破坏情况，复查血常规。","is_gold":false},{"letter":"G","text":"择期行双侧颈部淋巴结清扫术，术后启动鼻咽局部及颈部放射治疗。","is_gold":false},{"letter":"H","text":"行电子鼻咽镜检查（不活检）评估局部疗效，并拔除动静脉置管准备单纯放疗。","is_gold":false},{"letter":"I","text":"更改为吉西他滨+顺铂方案行第3程诱导化疗，复查血常规与生化常规。","is_gold":false},{"letter":"J","text":"行电子鼻咽镜检查（不活检），若无明显外生型肿物则暂缓放疗并定期随访。","is_gold":false},{"letter":"K","text":"立即启动单纯根治性放射治疗，并予动静脉置管常规护理。","is_gold":false},{"letter":"L","text":"行电子鼻咽镜检查（不活检）进一步评估鼻咽局部疗效，复查血常规与生化常规，并予动静脉置管护理。","is_gold":true}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、斜坡、海绵窦、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左耳听力下降1年余；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右耳鸣；既往史: 某次就诊时间患“结核性胸膜炎”已治愈，某次就诊时间患“急性胰腺炎”已治愈。否认\"肝炎、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟史30年，1包每天，常饮酒，两天/次，每次500ml。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：120/80mmHg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧壁、顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D3] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D3] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 38mm AO 26mm MV E 0.79m/s EF 75% LV 50mm IVS 11mm A 0.67m/s FS 45% RA 33mm LVPW 8mm RV 20mm PA 19mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 左房稍大，余各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 左房稍大 各房室腔及大血管未探及异常血流信号 心功能正常\n- [全程D3] 检验组合: 丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D4] CT；胸部CT平扫＋增强: 检查类型: CT；检查名称: 胸部CT平扫＋增强；检查部位:；检查所见: 右中肺及双下肺见数个类结节影，最大者直径约 5 mm，病灶边界清楚而不规则，密度较高而不均匀；气管及支气管分枝通畅，未见明显软组织肿物或受压变窄；双侧肺门及纵隔未见明确肿大淋巴结；双侧胸腔未见积液；胸膜未见增厚；扫描范围内胸椎、胸壁骨未见骨质破坏征象。；检查结论: 双肺类结节影，转移瘤可能性大。\n- [全程D4] 检验组合: 酮体(KET)-尿液: +-（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；尿胆原(URO)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 4/μL；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；白细胞计数(WBC#)-尿液: 26/μL；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；酸碱度(pH)-尿液: 6；总蛋白(TP)-尿液: -（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性（参考: 阴性）；颜色-尿液: Light-Yellow；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；非鳞状上皮细胞计数-尿液: 2/μL；比重(SG)-尿液: 1.032；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.05；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL\n- [全程D2] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: 右臂静脉插管,导管末端位于T 6右旁，估计位于上腔静脉中段。；检查结论: 导管末端位置如上述。\n- [全程D2] 检验组合: 血小板分布宽度(PDW)-静脉血: 13.8%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；淋巴细胞百分比(Lymph%)-静脉血: 0.262；单核细胞计数(Mono#)-静脉血: 0.510E9/L；胱抑素(Cys-C)-静脉血: 1.01mg/L；总蛋白(TP)-静脉血: 68.46g/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.16COI；透明质酸(HA)-静脉血: 61.97ng/ml；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；大血小板百分比(P-LCR%)-静脉血: 32.4%；白蛋白(ALB)-静脉血: 43.7g/L；总胆固醇(TC)-静脉血: 5.59mmol/L；总胆红素(TBIL)-静脉血: 14.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.84；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.009；丙氨酸氨基转移酶(ALT)-静脉血: 27U/L；氯离子(Cl-)-静脉血: 103.1mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；淋巴细胞计数(Lymph#)-静脉血: 2.510E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.63mmol/L；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.06S/CO；血小板比容-静脉血: 21%；载脂蛋白B(apoB)-静脉血: 1.22g/L；C-反应蛋白(CRP)-静脉血: 4.05mg/L；ABO血型-静脉血: A；载脂蛋白AI(apoAI)-静脉血: 1.2g/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；单核细胞百分比(Mono%)-静脉血: 0.049；钠离子(Na+)-静脉血: 139.6mmol/L；凝血酶原时间(PT)-静脉血: 10.3sec.；球蛋白(GLO)-静脉血: 24.76g/L；纤维蛋白原(Fbg)-静脉血: 2.49g/L；凝血酶时间(TT)-静脉血: 20sec.；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44.6；Rh血型-静脉血: 阳性；平均红细胞体积(MCV)-静脉血: 85.8fL；直接胆红素(DBIL)-静脉血: 3.3umol/L；凝血酶原时间活动度(PTA)-静脉血: 113.8……\n- [全程D5] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: 3+500Leu（参考: 阴性）；白细胞计数(WBC#)-尿液: 18/μL；鳞状上皮细胞计数(SQEP#)-尿液: 5/μL；比重(SG)-尿液: 1.02；总蛋白(TP)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: Turbid；隐血(OB)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；未分类结晶计数(UNCX#)-尿液: 25/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；非鳞状上皮细胞计数-尿液: 5/μL\n- [全程D9] 检验组合: 钾离子(K+)-静脉血: 3.73mmol/L；红细胞比容(Hct)-静脉血: 48.1%；血小板比容-静脉血: 19%；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.94mmolL；尿素氮(BUN)-静脉血: 9.5mmol/L；钠离子(Na+)-静脉血: 137.8mmol/L；血红蛋白(Hb)-静脉血: 159g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.095；总钙(Ca)-静脉血: 1.93mmol/L；血小板分布宽度(PDW)-静脉血: 13.3%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；丙氨酸氨基转移酶(ALT)-静脉血: 94.9U/L；载脂蛋白B(apoB)-静脉血: 1.06g/L；白蛋白(ALB)-静脉血: 40.3g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.46；白细胞计数(WBC#)-静脉血: 14.910E9/L；胱抑素(Cys-C)-静脉血: 1.26mg/L；平均血小板体积(MPV)-静脉血: 10.4fL；中性粒细胞百分比(Neut%)-静脉血: 0.837；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.45mmol/L；血小板计数(PLT#)-静脉血: 17910E9/L；总胆固醇(TC)-静脉血: 5.1mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.4；球蛋白(GLO)-静脉血: 23.17g/L；磷(P)-静脉血: 1.26mmol/L；间接胆红素(IBIL)-静脉血: 13.1umolL；红细胞计数(RBC#)-静脉血: 5.5910E12/L；直接胆红素(DBIL)-静脉血: 5.4umol/L；总胆汁酸(TBA)-静脉血: 0.1umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；单核细胞百分比(Mono%)-静脉血: 0.06；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 42.8U/L；肌酐(Crea)-静脉血: 101.5umol/L；载脂蛋白AI(apoAI)-静脉血: 0.99g/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.4mmol/L；单核细胞计……\n- [全程D16] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及双侧壁增厚放射性浓聚，SUV约11.9，双侧咽隐窝消失；病灶侵犯双侧腭帆提肌、左侧腭帆张肌、左翼内肌，左咽旁间隙及左咽后间隙消失；病灶向上侵犯蝶骨基底部、左翼突区、左蝶骨大翼、左卵圆孔及左海绵窦；向前侵犯左翼腭窝、左上颌后脂肪间隙、左眶尖及左眶内后份，左框内病灶与视神经分界不清。右咽后小淋巴结放射性分布未见明显异常。双侧扁桃体放射性浓聚，SUV约9.4；喉咽结构及放射性分布未见明显异常。双侧上颌窦低密度影放射性分布未见异常；额窦、蝶窦、筛窦结构及放射性分布未见明显异常。甲状腺双叶密度减低，放射性分布未见异常。双颈多个小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺散在多发结节影放射性分布未见明显异常，最大约0.6×0.8cm；左上肺舌段条索影放射性分布未见异常；气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。心脏及纵隔大血管未见明显异常。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏弥漫性密度减低，CT值约36Hu（脾脏CT值约51Hu），放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾门区结节影放射性分布未见异常，大小约1.1×1.4cm（副脾）；脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 双侧乳突气房内低密度影放射性分布未见异常；余颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌病灶，侵犯左咽后及左咽旁间隙、颅底骨骼、左卵圆孔、左海绵窦、左翼腭窝、左上颌后脂肪间隙、左眶尖及左眶内后份，累及左视神经。 双肺多发小结节影代谢未见异常，疑增殖灶。 双侧上颌窦炎症；双侧乳突炎症。 双侧扁桃体代谢活跃，考虑炎性病变。 脂肪肝。\n- [全程D24] 检验组合: 红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.4%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.71mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.0123；平均血小板体积(MPV)-静脉血: 8.22fL；载脂蛋白B(apoB)-静脉血: 1.13g/L；总胆固醇(TC)-静脉血: 5.18mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.281；有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞血红蛋白浓度(MCHC)-静脉血: 325.6g/L；磷(P)-静脉血: 1.14mmol/L；胱抑素(Cys-C)-静脉血: 1.19mg/L；尿素氮(BUN)-静脉血: 7.71mmol/L；血小板分布宽度(PDW)-静脉血: 16.4%；丙氨酸氨基转移酶(ALT)-静脉血: 28.8U/L；直接胆红素(DBIL)-静脉血: 2.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.8；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.14mmolL；氯离子(Cl-)-静脉血: 105.9mmol/L；血小板计数(PLT#)-静脉血: 18310E9/L；中性粒细胞计数(Neut#)-静脉血: 510E9/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；乳酸脱氢酶(LDH)-静脉血: 159U/L；平均红细胞体积(MCV)-静脉血: 84.3fL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；红细胞计数(RBC#)-静脉血: 5.2310E12/L；球蛋白(GLO)-静脉血: 27.58g/L；葡萄糖(Glu)-静脉血: 4.55mmol/L；肌酐(Crea)-静脉血: 91.9umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；血小板比容-静脉血: 15%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 50.8U/L；白细胞计数(WBC#)-静脉血: 7.810E9/L；单核细胞百分比(Mono%)-静脉血: 0.0665；淋巴细胞计数(Lymph#)-静脉血: 2.210E9/L；C-反应蛋白(CRP)-静脉血: 4.59mg/L；红细胞比容(Hct)-静脉血:……\n- [全程D25] 检验组合: 浊度(TRUB)-尿液: 清亮；白细胞计数(WBC#)-尿液: 100/μL；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；红细胞计数(RBC#)-尿液: 4/μL；比重(SG)-尿液: 1.028；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -+25Leu（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow\n- [全程D26] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.027；颜色-尿液: Light-Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；葡萄糖(Glu)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）\n- [全程D27] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 9/μL；酮体(KET)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.026；酸碱度(pH)-尿液: 6.5；颜色-尿液: Light-Yellow；浊度(TRUB)-尿液: 清亮；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）\n- [全程D31] 检验组合: 钠离子(Na+)-静脉血: 137.1mmol/L；直接胆红素(DBIL)-静脉血: 5.1umol/L；磷(P)-静脉血: 1.46mmol/L；红细胞计数(RBC#)-静脉血: 5.0710E12/L；镁离子(Mg2+)-静脉血: 0.64mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.7mmol/L；血小板计数(PLT#)-静脉血: 11810E9/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；胱抑素(Cys-C)-静脉血: 1.51mg/L；间接胆红素(IBIL)-静脉血: 9umolL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.9；中性粒细胞百分比(Neut%)-静脉血: 0.581；甘油三酯(TG)-静脉血: 1.92mmol/L；血小板分布宽度(PDW)-静脉血: 11.5%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.006；氯离子(Cl-)-静脉血: 98.9mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.94mmolL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；总蛋白(TP)-静脉血: 63.22g/L；尿素氮(BUN)-静脉血: 10.16mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 27.6pg；总胆汁酸(TBA)-静脉血: 0.3umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.710E9/L；葡萄糖(Glu)-静脉血: 5.19mmol/L；血红蛋白(Hb)-静脉血: 140g/L；载脂蛋白AI(apoAI)-静脉血: 1.13g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 41.9U/L；总胆固醇(TC)-静脉血: 5.12mmol/L；肌酐(Crea)-静脉血: 132.7umol/L；总钙(Ca)-静脉血: 1.91mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 44U/L；球蛋白(GLO)-静脉血: 24.42g/L；白蛋白(ALB)-静脉血: 38.8g/L；平均红细胞体积(MCV)-静脉血: 83.8fL；乳酸脱氢酶(LDH)-静脉血: 199.2U/L；总胆红素(TBIL)-静脉血: 14.1umol/L；钾离子(K+)……\n- [全程D32] 检验组合: 肌酐(Crea)-静脉血: 122.2umol/L；磷(P)-静脉血: 1.38mmol/L；尿素氮(BUN)-静脉血: 9.9mmol/L；总胆红素(TBIL)-静脉血: 14.5umol/L；尿酸(UA)-静脉血: 496.4umol/L；镁离子(Mg2+)-静脉血: 0.57mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.76；总钙(Ca)-静脉血: 1.79mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.5mmol/L；球蛋白(GLO)-静脉血: 23.74g/L；氯离子(Cl-)-静脉血: 97.6mmol/L；钠离子(Na+)-静脉血: 136.5mmol/L；阴离子间隙(AG)-静脉血: 16.4；间接胆红素(IBIL)-静脉血: 10.3umolL；直接胆红素(DBIL)-静脉血: 4.2umol/L；白蛋白(ALB)-静脉血: 41.9g/L；总蛋白(TP)-静脉血: 65.64g/L；钾离子(K+)-静脉血: 3.56mmol/L\n- [全程D35] 检验组合: 磷(P)-静脉血: 1.32mmol/L；镁离子(Mg2+)-静脉血: 0.53mmol/L；阴离子间隙(AG)-静脉血: 14.8；球蛋白(GLO)-静脉血: 21.96g/L；总钙(Ca)-静脉血: 1.51mmol/L；总胆红素(TBIL)-静脉血: 7.6umol/L；总蛋白(TP)-静脉血: 60.56g/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.2mmol/L；间接胆红素(IBIL)-静脉血: 5umolL；尿素氮(BUN)-静脉血: 11.2mmol/L；钾离子(K+)-静脉血: 3.94mmol/L；白蛋白(ALB)-静脉血: 38.6g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.76；尿酸(UA)-静脉血: 490.1umol/L；肌酐(Crea)-静脉血: 116.6umol/L；直接胆红素(DBIL)-静脉血: 2.6umol/L；氯离子(Cl-)-静脉血: 104.1mmol/L；钠离子(Na+)-静脉血: 140.1mmol/L\n- [全程D36] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌两程诱导化疗后复查：对比某次就诊时间MRI， 鼻咽顶壁、顶后壁、后壁及双侧壁稍增厚，形成软组织肿物向腔内突出，T1WI呈等信号，T2WI呈高信号，增强后明显强化。肿物占据双侧咽隐窝，侵犯双侧腭帆张、提肌及左侧翼内肌。右侧翼外肌未见明显异常。双侧咽旁间隙清晰。 口咽未见明确病变。 蝶骨基底部、左侧岩尖骨质信号减低 ，增强后明显强化。 双侧海绵窦形态正常，未见增宽。 双侧蝶窦、筛窦、额窦粘膜增厚，呈长分期信息见历史辅助诊断节点长分期信息见历史辅助诊断节点信号，增强后边缘轻度强化，双侧乳突内见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点信号分泌物，骨壁完好。 双侧眼球大小、形态、位置均属正常，信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变。 双侧咽后各见一淋巴结，大小分别约为6mm×6mm（左）、7mm×4mm（右），边界清，信号均，增强后可见强化。 双颈II区见数个稍大淋巴结，边缘清，信号欠均，增强后明显强化，孤立散在，未见明显坏死，最大者位于右颈II区，大小约13mm×9mm。 双颈II~IV区可见小淋巴结，边缘清，信号尚均，增强后可见强化。 喉咽腔形态正常，未见占位性病变。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽占位，对比某次就诊时间MRI所见病变明显缩小好转。 颅底骨质破坏。 双颈II区稍大淋巴结，不除外转移。 鼻窦炎、乳突炎。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者无诉特殊不适，完善各项检查中，体查同入院时，[姓名已隐去]主任查房指示，待各项检查完成明确分期后，再决定下一步治疗。\n- [全程D8] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D10] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗结束，诉呕吐2次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程5-FU+顺铂方案诱导化疗结束，无诉特殊不适，可予请假至6月13日，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n- [全程D15] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者请假至.吕星\n- [全程D25] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者安返病房，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，可于今日执行第2程5-FU+顺铂方案诱导化疗，注意化疗不良反应。\n- [全程D27] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D36] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者请假至.\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即启动根治性调强放射治疗及同步化疗，暂不安排其他局部影像或内镜检查。\nB. 行电子鼻咽镜检查并对残留病灶取活检以明确病理状态，复查血常规与生化常规。\nC. 继续予以第3程5-FU+顺铂方案诱导化疗，待化疗结束后再行鼻咽镜评估。\nD. 安排全身PET/CT复查以评估全身肿瘤代谢活性变化，随后制定放疗计划。\nE. 更改为紫杉醇+顺铂方案行第3程诱导化疗，并予动静脉置管常规护理。\nF. 安排鼻咽及颈部CT平扫+增强进一步评估颅底骨质破坏情况，复查血常规。\nG. 择期行双侧颈部淋巴结清扫术，术后启动鼻咽局部及颈部放射治疗。\nH. 行电子鼻咽镜检查（不活检）评估局部疗效，并拔除动静脉置管准备单纯放疗。\nI. 更改为吉西他滨+顺铂方案行第3程诱导化疗，复查血常规与生化常规。\nJ. 行电子鼻咽镜检查（不活检），若无明显外生型肿物则暂缓放疗并定期随访。\nK. 立即启动单纯根治性放射治疗，并予动静脉置管常规护理。\nL. 行电子鼻咽镜检查（不活检）进一步评估鼻咽局部疗效，复查血常规与生化常规，并予动静脉置管护理。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、斜坡、海绵窦、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左耳听力下降1年余；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右耳鸣；既往史: 某次就诊时间患“结核性胸膜炎”已治愈，某次就诊时间患“急性胰腺炎”已治愈。否认\"肝炎、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟史30年，1包每天，常饮酒，两天/次，每次500ml。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：120/80mmHg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧壁、顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D3] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D3] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 38mm AO 26mm MV E 0.79m/s EF 75% LV 50mm IVS 11mm A 0.67m/s FS 45% RA 33mm LVPW 8mm RV 20mm PA 19mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 左房稍大，余各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 左房稍大 各房室腔及大血管未探及异常血流信号 心功能正常\n- [全程D3] 检验组合: 丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D4] CT；胸部CT平扫＋增强: 检查类型: CT；检查名称: 胸部CT平扫＋增强；检查部位:；检查所见: 右中肺及双下肺见数个类结节影，最大者直径约 5 mm，病灶边界清楚而不规则，密度较高而不均匀；气管及支气管分枝通畅，未见明显软组织肿物或受压变窄；双侧肺门及纵隔未见明确肿大淋巴结；双侧胸腔未见积液；胸膜未见增厚；扫描范围内胸椎、胸壁骨未见骨质破坏征象。；检查结论: 双肺类结节影，转移瘤可能性大。\n- [全程D4] 检验组合: 酮体(KET)-尿液: +-（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；尿胆原(URO)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 4/μL；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；白细胞计数(WBC#)-尿液: 26/μL；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；酸碱度(pH)-尿液: 6；总蛋白(TP)-尿液: -（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性（参考: 阴性）；颜色-尿液: Light-Yellow；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；非鳞状上皮细胞计数-尿液: 2/μL；比重(SG)-尿液: 1.032；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.05；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL\n- [全程D2] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: 右臂静脉插管,导管末端位于T 6右旁，估计位于上腔静脉中段。；检查结论: 导管末端位置如上述。\n- [全程D2] 检验组合: 血小板分布宽度(PDW)-静脉血: 13.8%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；淋巴细胞百分比(Lymph%)-静脉血: 0.262；单核细胞计数(Mono#)-静脉血: 0.510E9/L；胱抑素(Cys-C)-静脉血: 1.01mg/L；总蛋白(TP)-静脉血: 68.46g/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.16COI；透明质酸(HA)-静脉血: 61.97ng/ml；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；大血小板百分比(P-LCR%)-静脉血: 32.4%；白蛋白(ALB)-静脉血: 43.7g/L；总胆固醇(TC)-静脉血: 5.59mmol/L；总胆红素(TBIL)-静脉血: 14.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.84；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.009；丙氨酸氨基转移酶(ALT)-静脉血: 27U/L；氯离子(Cl-)-静脉血: 103.1mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；淋巴细胞计数(Lymph#)-静脉血: 2.510E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.63mmol/L；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.06S/CO；血小板比容-静脉血: 21%；载脂蛋白B(apoB)-静脉血: 1.22g/L；C-反应蛋白(CRP)-静脉血: 4.05mg/L；ABO血型-静脉血: A；载脂蛋白AI(apoAI)-静脉血: 1.2g/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；单核细胞百分比(Mono%)-静脉血: 0.049；钠离子(Na+)-静脉血: 139.6mmol/L；凝血酶原时间(PT)-静脉血: 10.3sec.；球蛋白(GLO)-静脉血: 24.76g/L；纤维蛋白原(Fbg)-静脉血: 2.49g/L；凝血酶时间(TT)-静脉血: 20sec.；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44.6；Rh血型-静脉血: 阳性；平均红细胞体积(MCV)-静脉血: 85.8fL；直接胆红素(DBIL)-静脉血: 3.3umol/L；凝血酶原时间活动度(PTA)-静脉血: 113.8……\n- [全程D5] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: 3+500Leu（参考: 阴性）；白细胞计数(WBC#)-尿液: 18/μL；鳞状上皮细胞计数(SQEP#)-尿液: 5/μL；比重(SG)-尿液: 1.02；总蛋白(TP)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: Turbid；隐血(OB)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；未分类结晶计数(UNCX#)-尿液: 25/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；非鳞状上皮细胞计数-尿液: 5/μL\n- [全程D9] 检验组合: 钾离子(K+)-静脉血: 3.73mmol/L；红细胞比容(Hct)-静脉血: 48.1%；血小板比容-静脉血: 19%；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.94mmolL；尿素氮(BUN)-静脉血: 9.5mmol/L；钠离子(Na+)-静脉血: 137.8mmol/L；血红蛋白(Hb)-静脉血: 159g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.095；总钙(Ca)-静脉血: 1.93mmol/L；血小板分布宽度(PDW)-静脉血: 13.3%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；丙氨酸氨基转移酶(ALT)-静脉血: 94.9U/L；载脂蛋白B(apoB)-静脉血: 1.06g/L；白蛋白(ALB)-静脉血: 40.3g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.46；白细胞计数(WBC#)-静脉血: 14.910E9/L；胱抑素(Cys-C)-静脉血: 1.26mg/L；平均血小板体积(MPV)-静脉血: 10.4fL；中性粒细胞百分比(Neut%)-静脉血: 0.837；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.45mmol/L；血小板计数(PLT#)-静脉血: 17910E9/L；总胆固醇(TC)-静脉血: 5.1mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.4；球蛋白(GLO)-静脉血: 23.17g/L；磷(P)-静脉血: 1.26mmol/L；间接胆红素(IBIL)-静脉血: 13.1umolL；红细胞计数(RBC#)-静脉血: 5.5910E12/L；直接胆红素(DBIL)-静脉血: 5.4umol/L；总胆汁酸(TBA)-静脉血: 0.1umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；单核细胞百分比(Mono%)-静脉血: 0.06；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 42.8U/L；肌酐(Crea)-静脉血: 101.5umol/L；载脂蛋白AI(apoAI)-静脉血: 0.99g/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.4mmol/L；单核细胞计……\n- [全程D16] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及双侧壁增厚放射性浓聚，SUV约11.9，双侧咽隐窝消失；病灶侵犯双侧腭帆提肌、左侧腭帆张肌、左翼内肌，左咽旁间隙及左咽后间隙消失；病灶向上侵犯蝶骨基底部、左翼突区、左蝶骨大翼、左卵圆孔及左海绵窦；向前侵犯左翼腭窝、左上颌后脂肪间隙、左眶尖及左眶内后份，左框内病灶与视神经分界不清。右咽后小淋巴结放射性分布未见明显异常。双侧扁桃体放射性浓聚，SUV约9.4；喉咽结构及放射性分布未见明显异常。双侧上颌窦低密度影放射性分布未见异常；额窦、蝶窦、筛窦结构及放射性分布未见明显异常。甲状腺双叶密度减低，放射性分布未见异常。双颈多个小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺散在多发结节影放射性分布未见明显异常，最大约0.6×0.8cm；左上肺舌段条索影放射性分布未见异常；气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。心脏及纵隔大血管未见明显异常。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏弥漫性密度减低，CT值约36Hu（脾脏CT值约51Hu），放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾门区结节影放射性分布未见异常，大小约1.1×1.4cm（副脾）；脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 双侧乳突气房内低密度影放射性分布未见异常；余颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌病灶，侵犯左咽后及左咽旁间隙、颅底骨骼、左卵圆孔、左海绵窦、左翼腭窝、左上颌后脂肪间隙、左眶尖及左眶内后份，累及左视神经。 双肺多发小结节影代谢未见异常，疑增殖灶。 双侧上颌窦炎症；双侧乳突炎症。 双侧扁桃体代谢活跃，考虑炎性病变。 脂肪肝。\n- [全程D24] 检验组合: 红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.4%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.71mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.0123；平均血小板体积(MPV)-静脉血: 8.22fL；载脂蛋白B(apoB)-静脉血: 1.13g/L；总胆固醇(TC)-静脉血: 5.18mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.281；有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞血红蛋白浓度(MCHC)-静脉血: 325.6g/L；磷(P)-静脉血: 1.14mmol/L；胱抑素(Cys-C)-静脉血: 1.19mg/L；尿素氮(BUN)-静脉血: 7.71mmol/L；血小板分布宽度(PDW)-静脉血: 16.4%；丙氨酸氨基转移酶(ALT)-静脉血: 28.8U/L；直接胆红素(DBIL)-静脉血: 2.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.8；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.14mmolL；氯离子(Cl-)-静脉血: 105.9mmol/L；血小板计数(PLT#)-静脉血: 18310E9/L；中性粒细胞计数(Neut#)-静脉血: 510E9/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；乳酸脱氢酶(LDH)-静脉血: 159U/L；平均红细胞体积(MCV)-静脉血: 84.3fL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；红细胞计数(RBC#)-静脉血: 5.2310E12/L；球蛋白(GLO)-静脉血: 27.58g/L；葡萄糖(Glu)-静脉血: 4.55mmol/L；肌酐(Crea)-静脉血: 91.9umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；血小板比容-静脉血: 15%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 50.8U/L；白细胞计数(WBC#)-静脉血: 7.810E9/L；单核细胞百分比(Mono%)-静脉血: 0.0665；淋巴细胞计数(Lymph#)-静脉血: 2.210E9/L；C-反应蛋白(CRP)-静脉血: 4.59mg/L；红细胞比容(Hct)-静脉血:……\n- [全程D25] 检验组合: 浊度(TRUB)-尿液: 清亮；白细胞计数(WBC#)-尿液: 100/μL；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；红细胞计数(RBC#)-尿液: 4/μL；比重(SG)-尿液: 1.028；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -+25Leu（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow\n- [全程D26] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.027；颜色-尿液: Light-Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；葡萄糖(Glu)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）\n- [全程D27] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 9/μL；酮体(KET)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.026；酸碱度(pH)-尿液: 6.5；颜色-尿液: Light-Yellow；浊度(TRUB)-尿液: 清亮；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）\n- [全程D31] 检验组合: 钠离子(Na+)-静脉血: 137.1mmol/L；直接胆红素(DBIL)-静脉血: 5.1umol/L；磷(P)-静脉血: 1.46mmol/L；红细胞计数(RBC#)-静脉血: 5.0710E12/L；镁离子(Mg2+)-静脉血: 0.64mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.7mmol/L；血小板计数(PLT#)-静脉血: 11810E9/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；胱抑素(Cys-C)-静脉血: 1.51mg/L；间接胆红素(IBIL)-静脉血: 9umolL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.9；中性粒细胞百分比(Neut%)-静脉血: 0.581；甘油三酯(TG)-静脉血: 1.92mmol/L；血小板分布宽度(PDW)-静脉血: 11.5%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.006；氯离子(Cl-)-静脉血: 98.9mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.94mmolL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；总蛋白(TP)-静脉血: 63.22g/L；尿素氮(BUN)-静脉血: 10.16mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 27.6pg；总胆汁酸(TBA)-静脉血: 0.3umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.710E9/L；葡萄糖(Glu)-静脉血: 5.19mmol/L；血红蛋白(Hb)-静脉血: 140g/L；载脂蛋白AI(apoAI)-静脉血: 1.13g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 41.9U/L；总胆固醇(TC)-静脉血: 5.12mmol/L；肌酐(Crea)-静脉血: 132.7umol/L；总钙(Ca)-静脉血: 1.91mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 44U/L；球蛋白(GLO)-静脉血: 24.42g/L；白蛋白(ALB)-静脉血: 38.8g/L；平均红细胞体积(MCV)-静脉血: 83.8fL；乳酸脱氢酶(LDH)-静脉血: 199.2U/L；总胆红素(TBIL)-静脉血: 14.1umol/L；钾离子(K+)……\n- [全程D32] 检验组合: 肌酐(Crea)-静脉血: 122.2umol/L；磷(P)-静脉血: 1.38mmol/L；尿素氮(BUN)-静脉血: 9.9mmol/L；总胆红素(TBIL)-静脉血: 14.5umol/L；尿酸(UA)-静脉血: 496.4umol/L；镁离子(Mg2+)-静脉血: 0.57mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.76；总钙(Ca)-静脉血: 1.79mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.5mmol/L；球蛋白(GLO)-静脉血: 23.74g/L；氯离子(Cl-)-静脉血: 97.6mmol/L；钠离子(Na+)-静脉血: 136.5mmol/L；阴离子间隙(AG)-静脉血: 16.4；间接胆红素(IBIL)-静脉血: 10.3umolL；直接胆红素(DBIL)-静脉血: 4.2umol/L；白蛋白(ALB)-静脉血: 41.9g/L；总蛋白(TP)-静脉血: 65.64g/L；钾离子(K+)-静脉血: 3.56mmol/L\n- [全程D35] 检验组合: 磷(P)-静脉血: 1.32mmol/L；镁离子(Mg2+)-静脉血: 0.53mmol/L；阴离子间隙(AG)-静脉血: 14.8；球蛋白(GLO)-静脉血: 21.96g/L；总钙(Ca)-静脉血: 1.51mmol/L；总胆红素(TBIL)-静脉血: 7.6umol/L；总蛋白(TP)-静脉血: 60.56g/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.2mmol/L；间接胆红素(IBIL)-静脉血: 5umolL；尿素氮(BUN)-静脉血: 11.2mmol/L；钾离子(K+)-静脉血: 3.94mmol/L；白蛋白(ALB)-静脉血: 38.6g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.76；尿酸(UA)-静脉血: 490.1umol/L；肌酐(Crea)-静脉血: 116.6umol/L；直接胆红素(DBIL)-静脉血: 2.6umol/L；氯离子(Cl-)-静脉血: 104.1mmol/L；钠离子(Na+)-静脉血: 140.1mmol/L\n- [全程D36] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌两程诱导化疗后复查：对比某次就诊时间MRI， 鼻咽顶壁、顶后壁、后壁及双侧壁稍增厚，形成软组织肿物向腔内突出，T1WI呈等信号，T2WI呈高信号，增强后明显强化。肿物占据双侧咽隐窝，侵犯双侧腭帆张、提肌及左侧翼内肌。右侧翼外肌未见明显异常。双侧咽旁间隙清晰。 口咽未见明确病变。 蝶骨基底部、左侧岩尖骨质信号减低 ，增强后明显强化。 双侧海绵窦形态正常，未见增宽。 双侧蝶窦、筛窦、额窦粘膜增厚，呈长分期信息见历史辅助诊断节点长分期信息见历史辅助诊断节点信号，增强后边缘轻度强化，双侧乳突内见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点信号分泌物，骨壁完好。 双侧眼球大小、形态、位置均属正常，信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变。 双侧咽后各见一淋巴结，大小分别约为6mm×6mm（左）、7mm×4mm（右），边界清，信号均，增强后可见强化。 双颈II区见数个稍大淋巴结，边缘清，信号欠均，增强后明显强化，孤立散在，未见明显坏死，最大者位于右颈II区，大小约13mm×9mm。 双颈II~IV区可见小淋巴结，边缘清，信号尚均，增强后可见强化。 喉咽腔形态正常，未见占位性病变。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽占位，对比某次就诊时间MRI所见病变明显缩小好转。 颅底骨质破坏。 双颈II区稍大淋巴结，不除外转移。 鼻窦炎、乳突炎。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者无诉特殊不适，完善各项检查中，体查同入院时，[姓名已隐去]主任查房指示，待各项检查完成明确分期后，再决定下一步治疗。\n- [全程D8] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D10] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗结束，诉呕吐2次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程5-FU+顺铂方案诱导化疗结束，无诉特殊不适，可予请假至6月13日，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n- [全程D15] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者请假至.吕星\n- [全程D25] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者安返病房，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，可于今日执行第2程5-FU+顺铂方案诱导化疗，注意化疗不良反应。\n- [全程D27] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D36] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者请假至.\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即启动根治性调强放射治疗及同步化疗，暂不安排其他局部影像或内镜检查。\nB. 行电子鼻咽镜检查并对残留病灶取活检以明确病理状态，复查血常规与生化常规。\nC. 继续予以第3程5-FU+顺铂方案诱导化疗，待化疗结束后再行鼻咽镜评估。\nD. 安排全身PET/CT复查以评估全身肿瘤代谢活性变化，随后制定放疗计划。\nE. 更改为紫杉醇+顺铂方案行第3程诱导化疗，并予动静脉置管常规护理。\nF. 安排鼻咽及颈部CT平扫+增强进一步评估颅底骨质破坏情况，复查血常规。\nG. 择期行双侧颈部淋巴结清扫术，术后启动鼻咽局部及颈部放射治疗。\nH. 行电子鼻咽镜检查（不活检）评估局部疗效，并拔除动静脉置管准备单纯放疗。\nI. 更改为吉西他滨+顺铂方案行第3程诱导化疗，复查血常规与生化常规。\nJ. 行电子鼻咽镜检查（不活检），若无明显外生型肿物则暂缓放疗并定期随访。\nK. 立即启动单纯根治性放射治疗，并予动静脉置管常规护理。\nL. 行电子鼻咽镜检查（不活检）进一步评估鼻咽局部疗效，复查血常规与生化常规，并予动静脉置管护理。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-eb32294d1506d6b48368496f","patient_id":"patient-34616c327ce5d69194ca7f4d","turn_id":"turn01","turn_position":1,"turn_type":"initial_workup_choice","gold_letter":"A","gold_action":"完善鼻咽镜检查及活检，检测EBV DNA定量、常规血液学指标，并进行胸部DR与腹盆腔彩超检查。","options":[{"letter":"A","text":"完善鼻咽镜检查及活检，检测EBV DNA定量、常规血液学指标，并进行胸部DR与腹盆腔彩超检查","is_gold":true},{"letter":"B","text":"完善鼻咽镜检查及活检，检测EBV DNA定量，并进行全身PET-CT检查，暂缓常规血液学指标检测","is_gold":false},{"letter":"C","text":"完善鼻咽镜检查及活检，检测EBV DNA定量，并进行胸腹部增强CT检查，暂缓常规血液学指标检测","is_gold":false},{"letter":"D","text":"行头颈部MRI及颅底薄层CT检查，待影像学显示异常后再行鼻咽镜活检及EBV DNA检测","is_gold":false},{"letter":"E","text":"检测EBV DNA定量及常规血液学指标，待EBV DNA结果阳性后再行鼻咽镜活检及影像学检查","is_gold":false},{"letter":"F","text":"完善鼻咽镜检查及活检，检测常规血液学指标，并进行胸部DR与腹盆腔彩超检查，暂不检测EBV DNA","is_gold":false},{"letter":"G","text":"完善鼻咽镜检查（暂不活检），检测EBV DNA定量、常规血液学指标，并进行胸部DR与腹盆腔彩超检查","is_gold":false},{"letter":"H","text":"行全身骨扫描及头颅增强MRI检查，暂缓鼻咽镜活检及EBV DNA定量检测","is_gold":false},{"letter":"I","text":"完善鼻咽镜检查及活检，检测EBV DNA定量，并进行全身骨扫描，暂缓胸部及腹盆腔影像学检查","is_gold":false},{"letter":"J","text":"完善鼻咽镜检查及活检，检测EBV DNA定量、常规血液学指标，仅行胸部CT检查，暂不进行腹盆腔影像学评估","is_gold":false},{"letter":"K","text":"行常规血液学指标检测及基础影像学检查（胸部DR、腹盆腔彩超），暂缓鼻咽镜活检及EBV DNA检测","is_gold":false},{"letter":"L","text":"完善鼻咽镜检查及活检，检测常规血液学指标，行头颈部PET-CT检查，暂不检测EBV DNA定量","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D3189] 门急诊记录: 主诉: 鼻咽癌治疗后8年；患者家属自述行放疗（具体方案不详）。患者家属来诊，诉近来头后部疼痛，持续二月余，逐渐加重，无其他明显，来诊咨询诊疗意见。；既往史: 是否有过敏史无过敏史。是否有吸烟史吸烟史详情；个人史:；家族史:；体格检查:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善鼻咽镜检查及活检，检测EBV DNA定量、常规血液学指标，并进行胸部DR与腹盆腔彩超检查\nB. 完善鼻咽镜检查及活检，检测EBV DNA定量，并进行全身PET-CT检查，暂缓常规血液学指标检测\nC. 完善鼻咽镜检查及活检，检测EBV DNA定量，并进行胸腹部增强CT检查，暂缓常规血液学指标检测\nD. 行头颈部MRI及颅底薄层CT检查，待影像学显示异常后再行鼻咽镜活检及EBV DNA检测\nE. 检测EBV DNA定量及常规血液学指标，待EBV DNA结果阳性后再行鼻咽镜活检及影像学检查\nF. 完善鼻咽镜检查及活检，检测常规血液学指标，并进行胸部DR与腹盆腔彩超检查，暂不检测EBV DNA\nG. 完善鼻咽镜检查（暂不活检），检测EBV DNA定量、常规血液学指标，并进行胸部DR与腹盆腔彩超检查\nH. 行全身骨扫描及头颅增强MRI检查，暂缓鼻咽镜活检及EBV DNA定量检测\nI. 完善鼻咽镜检查及活检，检测EBV DNA定量，并进行全身骨扫描，暂缓胸部及腹盆腔影像学检查\nJ. 完善鼻咽镜检查及活检，检测EBV DNA定量、常规血液学指标，仅行胸部CT检查，暂不进行腹盆腔影像学评估\nK. 行常规血液学指标检测及基础影像学检查（胸部DR、腹盆腔彩超），暂缓鼻咽镜活检及EBV DNA检测\nL. 完善鼻咽镜检查及活检，检测常规血液学指标，行头颈部PET-CT检查，暂不检测EBV DNA定量\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D3189] 门急诊记录: 主诉: 鼻咽癌治疗后8年；患者家属自述行放疗（具体方案不详）。患者家属来诊，诉近来头后部疼痛，持续二月余，逐渐加重，无其他明显，来诊咨询诊疗意见。；既往史: 是否有过敏史无过敏史。是否有吸烟史吸烟史详情；个人史:；家族史:；体格检查:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善鼻咽镜检查及活检，检测EBV DNA定量、常规血液学指标，并进行胸部DR与腹盆腔彩超检查\nB. 完善鼻咽镜检查及活检，检测EBV DNA定量，并进行全身PET-CT检查，暂缓常规血液学指标检测\nC. 完善鼻咽镜检查及活检，检测EBV DNA定量，并进行胸腹部增强CT检查，暂缓常规血液学指标检测\nD. 行头颈部MRI及颅底薄层CT检查，待影像学显示异常后再行鼻咽镜活检及EBV DNA检测\nE. 检测EBV DNA定量及常规血液学指标，待EBV DNA结果阳性后再行鼻咽镜活检及影像学检查\nF. 完善鼻咽镜检查及活检，检测常规血液学指标，并进行胸部DR与腹盆腔彩超检查，暂不检测EBV DNA\nG. 完善鼻咽镜检查（暂不活检），检测EBV DNA定量、常规血液学指标，并进行胸部DR与腹盆腔彩超检查\nH. 行全身骨扫描及头颅增强MRI检查，暂缓鼻咽镜活检及EBV DNA定量检测\nI. 完善鼻咽镜检查及活检，检测EBV DNA定量，并进行全身骨扫描，暂缓胸部及腹盆腔影像学检查\nJ. 完善鼻咽镜检查及活检，检测EBV DNA定量、常规血液学指标，仅行胸部CT检查，暂不进行腹盆腔影像学评估\nK. 行常规血液学指标检测及基础影像学检查（胸部DR、腹盆腔彩超），暂缓鼻咽镜活检及EBV DNA检测\nL. 完善鼻咽镜检查及活检，检测常规血液学指标，行头颈部PET-CT检查，暂不检测EBV DNA定量\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-f19200235c8a99467249ed0c","patient_id":"patient-34616c327ce5d69194ca7f4d","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"B","gold_action":"评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查","options":[{"letter":"A","text":"评估影像分期为 cT3N1M0（AJCC 第9版 II期），直接安排诱导化疗联合同期放化疗，并补充生化常规检查","is_gold":false},{"letter":"B","text":"评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查","is_gold":true},{"letter":"C","text":"评估影像分期为 cT4N1M0（AJCC 第9版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查","is_gold":false},{"letter":"D","text":"评估影像分期为 cT3N2M0（AJCC 第9版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查","is_gold":false},{"letter":"E","text":"评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽镜及活检以获取病理确诊，并补充全身PET-CT检查","is_gold":false},{"letter":"F","text":"评估影像分期为 cT2N1M0（AJCC 第9版 I期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查","is_gold":false},{"letter":"G","text":"评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽镜及活检以获取病理确诊，并补充头颅增强MRI检查","is_gold":false},{"letter":"H","text":"评估影像分期为 cT3N1M1（AJCC 第9版 IVB期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查","is_gold":false},{"letter":"I","text":"评估影像分期为 cT3N1M0（AJCC 第8版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查","is_gold":false},{"letter":"J","text":"评估影像分期为 cT4N2M0（AJCC 第9版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查","is_gold":false},{"letter":"K","text":"评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽肿物切除活检以获取病理确诊，并补充生化常规检查","is_gold":false},{"letter":"L","text":"评估影像分期为 cT3N1M0（AJCC 第9版 II期），行右颈部淋巴结穿刺活检以获取病理确诊，并补充生化常规检查","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D3189] 门急诊记录: 主诉: 鼻咽癌治疗后8年；患者家属自述行放疗（具体方案不详）。患者家属来诊，诉近来头后部疼痛，持续二月余，逐渐加重，无其他明显，来诊咨询诊疗意见。；既往史: 是否有过敏史无过敏史。是否有吸烟史吸烟史详情；个人史:；家族史:；体格检查:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 检验组合: 嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；凝血酶原时间活动度(PTA)-静脉血: 89%；平均血小板体积(MPV)-静脉血: 9.4fL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 334g/L；D-二聚体(D-Dimer)-静脉血: 0.29ug/ml；凝血酶原国际标准化比值(PT-INR)-静脉血: 1.02；纤维蛋白原(Fbg)-静脉血: 3.21g/L；红细胞比容(Hct)-静脉血: 48.2%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；平均红细胞血红蛋白含量(MCH)-静脉血: 32pg；红细胞计数(RBC#)-静脉血: 5.0310E12/L；淋巴细胞百分比(Lymph%)-静脉血: 0.271；中性粒细胞计数(Neut#)-静脉血: 5.910E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.65；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.8；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；大血小板百分比(P-LCR%)-静脉血: 20.8%；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；血小板比容-静脉血: 27%；平均红细胞体积(MCV)-静脉血: 95.8fL；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.06S/CO；血小板分布宽度(PDW)-静脉血: 10.8%；单核细胞计数(Mono#)-静脉血: 0.510E9/L；活化部分凝血活酶时间(APTT)-静脉血: 29.2sec.；凝血酶原时间(PT)-静脉血: 11.4sec.；纤维蛋白原降解产物(FDP)-静脉血: 2.8ug/ml；淋巴细胞计数(Lymph#)-静脉血: 2.510E9/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.01IU/mL；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.13COI；凝血酶时间(TT)-静脉血: 20sec.；血小板计数(PLT#)-静脉血: 28910E9/L；Rh血型-静脉血: 阳性；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.06S/CO；血红蛋白(Hb)-静脉血: 161g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；白细胞计数(WBC……\n- [全程D14] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 左前分支阻滞\n- [全程D14] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理稍增粗，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见重要病变。\n- [全程D15] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 右侧乳突可见片状放射性浓集灶。胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 右侧乳突炎症。 余全身骨骼未见明显异常。\n- [全程D16] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，肝S7可见一强回声斑，直径约5mm，后方伴声影。血管走行清晰、自然，肝内胆管不扩张，门静脉内径14mm。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约21cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约36×26×23mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝S7强回声斑，考虑肝内胆管结石。 胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估影像分期为 cT3N1M0（AJCC 第9版 II期），直接安排诱导化疗联合同期放化疗，并补充生化常规检查\nB. 评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nC. 评估影像分期为 cT4N1M0（AJCC 第9版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nD. 评估影像分期为 cT3N2M0（AJCC 第9版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nE. 评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽镜及活检以获取病理确诊，并补充全身PET-CT检查\nF. 评估影像分期为 cT2N1M0（AJCC 第9版 I期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nG. 评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽镜及活检以获取病理确诊，并补充头颅增强MRI检查\nH. 评估影像分期为 cT3N1M1（AJCC 第9版 IVB期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nI. 评估影像分期为 cT3N1M0（AJCC 第8版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nJ. 评估影像分期为 cT4N2M0（AJCC 第9版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nK. 评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽肿物切除活检以获取病理确诊，并补充生化常规检查\nL. 评估影像分期为 cT3N1M0（AJCC 第9版 II期），行右颈部淋巴结穿刺活检以获取病理确诊，并补充生化常规检查\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D3189] 门急诊记录: 主诉: 鼻咽癌治疗后8年；患者家属自述行放疗（具体方案不详）。患者家属来诊，诉近来头后部疼痛，持续二月余，逐渐加重，无其他明显，来诊咨询诊疗意见。；既往史: 是否有过敏史无过敏史。是否有吸烟史吸烟史详情；个人史:；家族史:；体格检查:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 检验组合: 嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；凝血酶原时间活动度(PTA)-静脉血: 89%；平均血小板体积(MPV)-静脉血: 9.4fL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 334g/L；D-二聚体(D-Dimer)-静脉血: 0.29ug/ml；凝血酶原国际标准化比值(PT-INR)-静脉血: 1.02；纤维蛋白原(Fbg)-静脉血: 3.21g/L；红细胞比容(Hct)-静脉血: 48.2%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；平均红细胞血红蛋白含量(MCH)-静脉血: 32pg；红细胞计数(RBC#)-静脉血: 5.0310E12/L；淋巴细胞百分比(Lymph%)-静脉血: 0.271；中性粒细胞计数(Neut#)-静脉血: 5.910E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.65；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.8；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；大血小板百分比(P-LCR%)-静脉血: 20.8%；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；血小板比容-静脉血: 27%；平均红细胞体积(MCV)-静脉血: 95.8fL；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.06S/CO；血小板分布宽度(PDW)-静脉血: 10.8%；单核细胞计数(Mono#)-静脉血: 0.510E9/L；活化部分凝血活酶时间(APTT)-静脉血: 29.2sec.；凝血酶原时间(PT)-静脉血: 11.4sec.；纤维蛋白原降解产物(FDP)-静脉血: 2.8ug/ml；淋巴细胞计数(Lymph#)-静脉血: 2.510E9/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.01IU/mL；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.13COI；凝血酶时间(TT)-静脉血: 20sec.；血小板计数(PLT#)-静脉血: 28910E9/L；Rh血型-静脉血: 阳性；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.06S/CO；血红蛋白(Hb)-静脉血: 161g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；白细胞计数(WBC……\n- [全程D14] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 左前分支阻滞\n- [全程D14] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理稍增粗，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见重要病变。\n- [全程D15] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 右侧乳突可见片状放射性浓集灶。胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 右侧乳突炎症。 余全身骨骼未见明显异常。\n- [全程D16] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，肝S7可见一强回声斑，直径约5mm，后方伴声影。血管走行清晰、自然，肝内胆管不扩张，门静脉内径14mm。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约21cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约36×26×23mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝S7强回声斑，考虑肝内胆管结石。 胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估影像分期为 cT3N1M0（AJCC 第9版 II期），直接安排诱导化疗联合同期放化疗，并补充生化常规检查\nB. 评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nC. 评估影像分期为 cT4N1M0（AJCC 第9版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nD. 评估影像分期为 cT3N2M0（AJCC 第9版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nE. 评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽镜及活检以获取病理确诊，并补充全身PET-CT检查\nF. 评估影像分期为 cT2N1M0（AJCC 第9版 I期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nG. 评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽镜及活检以获取病理确诊，并补充头颅增强MRI检查\nH. 评估影像分期为 cT3N1M1（AJCC 第9版 IVB期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nI. 评估影像分期为 cT3N1M0（AJCC 第8版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nJ. 评估影像分期为 cT4N2M0（AJCC 第9版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nK. 评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽肿物切除活检以获取病理确诊，并补充生化常规检查\nL. 评估影像分期为 cT3N1M0（AJCC 第9版 II期），行右颈部淋巴结穿刺活检以获取病理确诊，并补充生化常规检查\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-2288420a623ad83bf0b0a558","patient_id":"patient-34616c327ce5d69194ca7f4d","turn_id":"turn04","turn_position":3,"turn_type":"initial_treatment_selection","gold_letter":"D","gold_action":"含铂方案诱导化疗序贯根治性放化疗，或根治性放疗联合含铂方案同步化疗","options":[{"letter":"A","text":"单纯根治性调强放射治疗","is_gold":false},{"letter":"B","text":"含铂双药方案诱导化疗序贯单纯根治性放疗","is_gold":false},{"letter":"C","text":"根治性放疗联合含铂方案同步化疗，序贯含铂双药辅助化疗","is_gold":false},{"letter":"D","text":"含铂方案诱导化疗序贯根治性放化疗，或根治性放疗联合含铂方案同步化疗","is_gold":true},{"letter":"E","text":"根治性放疗联合西妥昔单抗等EGFR靶向治疗","is_gold":false},{"letter":"F","text":"根治性放疗联合PD-1抑制剂同步免疫治疗","is_gold":false},{"letter":"G","text":"姑息性全身化疗联合局部病灶姑息性放疗","is_gold":false},{"letter":"H","text":"含铂双药方案诱导化疗序贯鼻咽原发灶切除及颈部淋巴结清扫术","is_gold":false},{"letter":"I","text":"根治性放疗联合大分子抗血管生成靶向治疗","is_gold":false},{"letter":"J","text":"单纯含铂双药方案全身化疗4-6个周期","is_gold":false},{"letter":"K","text":"鼻咽原发灶切除及颈部淋巴结清扫术序贯术后辅助放化疗","is_gold":false},{"letter":"L","text":"含铂双药方案诱导化疗序贯根治性放疗及PD-1抑制剂维持治疗","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D3189] 门急诊记录: 主诉: 鼻咽癌治疗后8年；患者家属自述行放疗（具体方案不详）。患者家属来诊，诉近来头后部疼痛，持续二月余，逐渐加重，无其他明显，来诊咨询诊疗意见。；既往史: 是否有过敏史无过敏史。是否有吸烟史吸烟史详情；个人史:；家族史:；体格检查:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 检验组合: 嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；凝血酶原时间活动度(PTA)-静脉血: 89%；平均血小板体积(MPV)-静脉血: 9.4fL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 334g/L；D-二聚体(D-Dimer)-静脉血: 0.29ug/ml；凝血酶原国际标准化比值(PT-INR)-静脉血: 1.02；纤维蛋白原(Fbg)-静脉血: 3.21g/L；红细胞比容(Hct)-静脉血: 48.2%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；平均红细胞血红蛋白含量(MCH)-静脉血: 32pg；红细胞计数(RBC#)-静脉血: 5.0310E12/L；淋巴细胞百分比(Lymph%)-静脉血: 0.271；中性粒细胞计数(Neut#)-静脉血: 5.910E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.65；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.8；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；大血小板百分比(P-LCR%)-静脉血: 20.8%；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；血小板比容-静脉血: 27%；平均红细胞体积(MCV)-静脉血: 95.8fL；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.06S/CO；血小板分布宽度(PDW)-静脉血: 10.8%；单核细胞计数(Mono#)-静脉血: 0.510E9/L；活化部分凝血活酶时间(APTT)-静脉血: 29.2sec.；凝血酶原时间(PT)-静脉血: 11.4sec.；纤维蛋白原降解产物(FDP)-静脉血: 2.8ug/ml；淋巴细胞计数(Lymph#)-静脉血: 2.510E9/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.01IU/mL；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.13COI；凝血酶时间(TT)-静脉血: 20sec.；血小板计数(PLT#)-静脉血: 28910E9/L；Rh血型-静脉血: 阳性；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.06S/CO；血红蛋白(Hb)-静脉血: 161g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；白细胞计数(WBC……\n- [全程D14] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 左前分支阻滞\n- [全程D14] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理稍增粗，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见重要病变。\n- [全程D15] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 右侧乳突可见片状放射性浓集灶。胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 右侧乳突炎症。 余全身骨骼未见明显异常。\n- [全程D16] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，肝S7可见一强回声斑，直径约5mm，后方伴声影。血管走行清晰、自然，肝内胆管不扩张，门静脉内径14mm。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约21cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约36×26×23mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝S7强回声斑，考虑肝内胆管结石。 胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D22] 检验组合: 钾离子(K+)-静脉血: 4.18mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 46.8U/L；氯离子(Cl-)-静脉血: 101.7mmol/L；直接胆红素(DBIL)-静脉血: 2.5umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；乳酸脱氢酶(LDH)-静脉血: 172.2U/L；尿酸(UA)-静脉血: 299umol/L；碱性磷酸酶(ALP)-静脉血: 35.4U/L；载脂蛋白B(apoB)-静脉血: 0.71g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.09mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.82；γ-谷氨酰基转移酶(GGT)-静脉血: 23.1U/L；总钙(Ca)-静脉血: 2.31mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.1U/L；间接胆红素(IBIL)-静脉血: 4.8umolL；血液二氧化碳含量ctCO2(B)-静脉血: 22.5mmol/L；总蛋白(TP)-静脉血: 76.15g/L；阴离子间隙(AG)-静脉血: 16.8；总胆固醇(TC)-静脉血: 4.05mmol/L；总胆汁酸(TBA)-静脉血: 3.1umol/L；总胆红素(TBIL)-静脉血: 7.3umol/L；肌酐(Crea)-静脉血: 58.1umol/L；载脂蛋白AI(apoAI)-静脉血: 1.48g/L；球蛋白(GLO)-静脉血: 30.25g/L；C-反应蛋白(CRP)-静脉血: 3.66mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.33mmolL；镁离子(Mg2+)-静脉血: 0.86mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.3U/L；胱抑素(Cys-C)-静脉血: 0.88mg/L；尿素氮(BUN)-静脉血: 3.4mmol/L；葡萄糖(Glu)-静脉血: 5.59mmol/L；甘油三酯(TG)-静脉血: 2.5mmol/L；磷(P)-静脉血: 1.15mmol/L；白蛋白(ALB)-静脉血: 45.9g/L；钠离子(Na+)-静脉血: 141mmol/L\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 单纯根治性调强放射治疗\nB. 含铂双药方案诱导化疗序贯单纯根治性放疗\nC. 根治性放疗联合含铂方案同步化疗，序贯含铂双药辅助化疗\nD. 含铂方案诱导化疗序贯根治性放化疗，或根治性放疗联合含铂方案同步化疗\nE. 根治性放疗联合西妥昔单抗等EGFR靶向治疗\nF. 根治性放疗联合PD-1抑制剂同步免疫治疗\nG. 姑息性全身化疗联合局部病灶姑息性放疗\nH. 含铂双药方案诱导化疗序贯鼻咽原发灶切除及颈部淋巴结清扫术\nI. 根治性放疗联合大分子抗血管生成靶向治疗\nJ. 单纯含铂双药方案全身化疗4-6个周期\nK. 鼻咽原发灶切除及颈部淋巴结清扫术序贯术后辅助放化疗\nL. 含铂双药方案诱导化疗序贯根治性放疗及PD-1抑制剂维持治疗\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D3189] 门急诊记录: 主诉: 鼻咽癌治疗后8年；患者家属自述行放疗（具体方案不详）。患者家属来诊，诉近来头后部疼痛，持续二月余，逐渐加重，无其他明显，来诊咨询诊疗意见。；既往史: 是否有过敏史无过敏史。是否有吸烟史吸烟史详情；个人史:；家族史:；体格检查:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 检验组合: 嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；凝血酶原时间活动度(PTA)-静脉血: 89%；平均血小板体积(MPV)-静脉血: 9.4fL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 334g/L；D-二聚体(D-Dimer)-静脉血: 0.29ug/ml；凝血酶原国际标准化比值(PT-INR)-静脉血: 1.02；纤维蛋白原(Fbg)-静脉血: 3.21g/L；红细胞比容(Hct)-静脉血: 48.2%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；平均红细胞血红蛋白含量(MCH)-静脉血: 32pg；红细胞计数(RBC#)-静脉血: 5.0310E12/L；淋巴细胞百分比(Lymph%)-静脉血: 0.271；中性粒细胞计数(Neut#)-静脉血: 5.910E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.65；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.8；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；大血小板百分比(P-LCR%)-静脉血: 20.8%；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；血小板比容-静脉血: 27%；平均红细胞体积(MCV)-静脉血: 95.8fL；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.06S/CO；血小板分布宽度(PDW)-静脉血: 10.8%；单核细胞计数(Mono#)-静脉血: 0.510E9/L；活化部分凝血活酶时间(APTT)-静脉血: 29.2sec.；凝血酶原时间(PT)-静脉血: 11.4sec.；纤维蛋白原降解产物(FDP)-静脉血: 2.8ug/ml；淋巴细胞计数(Lymph#)-静脉血: 2.510E9/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.01IU/mL；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.13COI；凝血酶时间(TT)-静脉血: 20sec.；血小板计数(PLT#)-静脉血: 28910E9/L；Rh血型-静脉血: 阳性；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.06S/CO；血红蛋白(Hb)-静脉血: 161g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；白细胞计数(WBC……\n- [全程D14] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 左前分支阻滞\n- [全程D14] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理稍增粗，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见重要病变。\n- [全程D15] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 右侧乳突可见片状放射性浓集灶。胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 右侧乳突炎症。 余全身骨骼未见明显异常。\n- [全程D16] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，肝S7可见一强回声斑，直径约5mm，后方伴声影。血管走行清晰、自然，肝内胆管不扩张，门静脉内径14mm。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约21cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约36×26×23mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝S7强回声斑，考虑肝内胆管结石。 胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D22] 检验组合: 钾离子(K+)-静脉血: 4.18mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 46.8U/L；氯离子(Cl-)-静脉血: 101.7mmol/L；直接胆红素(DBIL)-静脉血: 2.5umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；乳酸脱氢酶(LDH)-静脉血: 172.2U/L；尿酸(UA)-静脉血: 299umol/L；碱性磷酸酶(ALP)-静脉血: 35.4U/L；载脂蛋白B(apoB)-静脉血: 0.71g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.09mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.82；γ-谷氨酰基转移酶(GGT)-静脉血: 23.1U/L；总钙(Ca)-静脉血: 2.31mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.1U/L；间接胆红素(IBIL)-静脉血: 4.8umolL；血液二氧化碳含量ctCO2(B)-静脉血: 22.5mmol/L；总蛋白(TP)-静脉血: 76.15g/L；阴离子间隙(AG)-静脉血: 16.8；总胆固醇(TC)-静脉血: 4.05mmol/L；总胆汁酸(TBA)-静脉血: 3.1umol/L；总胆红素(TBIL)-静脉血: 7.3umol/L；肌酐(Crea)-静脉血: 58.1umol/L；载脂蛋白AI(apoAI)-静脉血: 1.48g/L；球蛋白(GLO)-静脉血: 30.25g/L；C-反应蛋白(CRP)-静脉血: 3.66mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.33mmolL；镁离子(Mg2+)-静脉血: 0.86mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.3U/L；胱抑素(Cys-C)-静脉血: 0.88mg/L；尿素氮(BUN)-静脉血: 3.4mmol/L；葡萄糖(Glu)-静脉血: 5.59mmol/L；甘油三酯(TG)-静脉血: 2.5mmol/L；磷(P)-静脉血: 1.15mmol/L；白蛋白(ALB)-静脉血: 45.9g/L；钠离子(Na+)-静脉血: 141mmol/L\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 单纯根治性调强放射治疗\nB. 含铂双药方案诱导化疗序贯单纯根治性放疗\nC. 根治性放疗联合含铂方案同步化疗，序贯含铂双药辅助化疗\nD. 含铂方案诱导化疗序贯根治性放化疗，或根治性放疗联合含铂方案同步化疗\nE. 根治性放疗联合西妥昔单抗等EGFR靶向治疗\nF. 根治性放疗联合PD-1抑制剂同步免疫治疗\nG. 姑息性全身化疗联合局部病灶姑息性放疗\nH. 含铂双药方案诱导化疗序贯鼻咽原发灶切除及颈部淋巴结清扫术\nI. 根治性放疗联合大分子抗血管生成靶向治疗\nJ. 单纯含铂双药方案全身化疗4-6个周期\nK. 鼻咽原发灶切除及颈部淋巴结清扫术序贯术后辅助放化疗\nL. 含铂双药方案诱导化疗序贯根治性放疗及PD-1抑制剂维持治疗\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-258f93513eac99791d84464c","patient_id":"patient-34616c327ce5d69194ca7f4d","turn_id":"turn05","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"E","gold_action":"继续当前放化疗方案，定期复查血常规及生化指标。","options":[{"letter":"A","text":"暂停同期化疗，继续单纯放疗，并加用保肝药物","is_gold":false},{"letter":"B","text":"暂停放化疗，给予重组人粒细胞刺激因子支持治疗","is_gold":false},{"letter":"C","text":"继续放疗，将同期化疗剂量减低20%","is_gold":false},{"letter":"D","text":"继续放化疗方案，给予重组人血小板生成素","is_gold":false},{"letter":"E","text":"继续放化疗方案，定期复查血常规及生化指标","is_gold":true},{"letter":"F","text":"暂停放化疗，给予还原型谷胱甘肽保肝治疗","is_gold":false},{"letter":"G","text":"继续放化疗方案，加用双环醇保肝治疗","is_gold":false},{"letter":"H","text":"继续放化疗方案，给予重组人粒细胞刺激因子","is_gold":false},{"letter":"I","text":"暂停同期化疗，给予静脉补液及利尿处理","is_gold":false},{"letter":"J","text":"继续放疗，取消同期化疗，改为西妥昔单抗治疗","is_gold":false},{"letter":"K","text":"暂停放疗，继续同期化疗，给予促红细胞生成素治疗","is_gold":false},{"letter":"L","text":"继续放化疗方案，输注单采血小板","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D3189] 门急诊记录: 主诉: 鼻咽癌治疗后8年；患者家属自述行放疗（具体方案不详）。患者家属来诊，诉近来头后部疼痛，持续二月余，逐渐加重，无其他明显，来诊咨询诊疗意见。；既往史: 是否有过敏史无过敏史。是否有吸烟史吸烟史详情；个人史:；家族史:；体格检查:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 检验组合: 嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；凝血酶原时间活动度(PTA)-静脉血: 89%；平均血小板体积(MPV)-静脉血: 9.4fL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 334g/L；D-二聚体(D-Dimer)-静脉血: 0.29ug/ml；凝血酶原国际标准化比值(PT-INR)-静脉血: 1.02；纤维蛋白原(Fbg)-静脉血: 3.21g/L；红细胞比容(Hct)-静脉血: 48.2%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；平均红细胞血红蛋白含量(MCH)-静脉血: 32pg；红细胞计数(RBC#)-静脉血: 5.0310E12/L；淋巴细胞百分比(Lymph%)-静脉血: 0.271；中性粒细胞计数(Neut#)-静脉血: 5.910E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.65；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.8；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；大血小板百分比(P-LCR%)-静脉血: 20.8%；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；血小板比容-静脉血: 27%；平均红细胞体积(MCV)-静脉血: 95.8fL；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.06S/CO；血小板分布宽度(PDW)-静脉血: 10.8%；单核细胞计数(Mono#)-静脉血: 0.510E9/L；活化部分凝血活酶时间(APTT)-静脉血: 29.2sec.；凝血酶原时间(PT)-静脉血: 11.4sec.；纤维蛋白原降解产物(FDP)-静脉血: 2.8ug/ml；淋巴细胞计数(Lymph#)-静脉血: 2.510E9/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.01IU/mL；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.13COI；凝血酶时间(TT)-静脉血: 20sec.；血小板计数(PLT#)-静脉血: 28910E9/L；Rh血型-静脉血: 阳性；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.06S/CO；血红蛋白(Hb)-静脉血: 161g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；白细胞计数(WBC……\n- [全程D14] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 左前分支阻滞\n- [全程D14] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理稍增粗，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见重要病变。\n- [全程D15] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 右侧乳突可见片状放射性浓集灶。胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 右侧乳突炎症。 余全身骨骼未见明显异常。\n- [全程D16] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，肝S7可见一强回声斑，直径约5mm，后方伴声影。血管走行清晰、自然，肝内胆管不扩张，门静脉内径14mm。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约21cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约36×26×23mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝S7强回声斑，考虑肝内胆管结石。 胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D22] 检验组合: 钾离子(K+)-静脉血: 4.18mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 46.8U/L；氯离子(Cl-)-静脉血: 101.7mmol/L；直接胆红素(DBIL)-静脉血: 2.5umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；乳酸脱氢酶(LDH)-静脉血: 172.2U/L；尿酸(UA)-静脉血: 299umol/L；碱性磷酸酶(ALP)-静脉血: 35.4U/L；载脂蛋白B(apoB)-静脉血: 0.71g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.09mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.82；γ-谷氨酰基转移酶(GGT)-静脉血: 23.1U/L；总钙(Ca)-静脉血: 2.31mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.1U/L；间接胆红素(IBIL)-静脉血: 4.8umolL；血液二氧化碳含量ctCO2(B)-静脉血: 22.5mmol/L；总蛋白(TP)-静脉血: 76.15g/L；阴离子间隙(AG)-静脉血: 16.8；总胆固醇(TC)-静脉血: 4.05mmol/L；总胆汁酸(TBA)-静脉血: 3.1umol/L；总胆红素(TBIL)-静脉血: 7.3umol/L；肌酐(Crea)-静脉血: 58.1umol/L；载脂蛋白AI(apoAI)-静脉血: 1.48g/L；球蛋白(GLO)-静脉血: 30.25g/L；C-反应蛋白(CRP)-静脉血: 3.66mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.33mmolL；镁离子(Mg2+)-静脉血: 0.86mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.3U/L；胱抑素(Cys-C)-静脉血: 0.88mg/L；尿素氮(BUN)-静脉血: 3.4mmol/L；葡萄糖(Glu)-静脉血: 5.59mmol/L；甘油三酯(TG)-静脉血: 2.5mmol/L；磷(P)-静脉血: 1.15mmol/L；白蛋白(ALB)-静脉血: 45.9g/L；钠离子(Na+)-静脉血: 141mmol/L\n- [全程D70] 检验组合: 低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.66mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.6；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32pg；白细胞计数(WBC#)-静脉血: 7.7410E9/L；血红蛋白(Hb)-静脉血: 164g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 27.3U/L；磷(P)-静脉血: 1.31mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 20.8mmol/L；尿酸(UA)-静脉血: 323.7umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 44.8U/L；C-反应蛋白(CRP)-静脉血: 1.33mg/L；血小板比容-静脉血: 22%；血小板计数(PLT#)-静脉血: 23710E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.35mmolL；总胆红素(TBIL)-静脉血: 10.7umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 36.6U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.75；平均红细胞血红蛋白浓度(MCHC)-静脉血: 342g/L；肌酐(Crea)-静脉血: 62.3umol/L；总蛋白(TP)-静脉血: 75.99g/L；单核细胞百分比(Mono%)-静脉血: 0.056；平均红细胞血红蛋白浓度(MCHC)-静脉血: 337g/L；平均血小板体积(MPV)-静脉血: 9.5fL；血小板计数(PLT#)-静脉血: 24810E9/L；甘油三酯(TG)-静脉血: 1.02mmol/L；单核细胞百分比(Mono%)-静脉血: 0.081；球蛋白(GLO)-静脉血: 29.79g/L；平均红细胞体积(MCV)-静脉血: 95.1fL；总钙(Ca)-静脉血: 2.3mmol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；直接胆红素(DBIL)-静脉血: 3.9umol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；载脂蛋白AI(apoAI)-静脉血: 1.36g/L；大血小板百分比(P-LCR%)-静脉血: 17.2%；血红蛋白(Hb)-静脉血: 158g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32pg……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D64] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者近日精神好，胃纳尚可，暂无特殊不适。体查大致同入院。患者目前无放疗禁忌症，开始予以行鼻咽癌放疗。靶区剂量为：GTV70Gy/31F。放疗期间予同期化疗，并予加强对症、支持治疗。注意观察放疗不良反应表现。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停同期化疗，继续单纯放疗，并加用保肝药物\nB. 暂停放化疗，给予重组人粒细胞刺激因子支持治疗\nC. 继续放疗，将同期化疗剂量减低20%\nD. 继续放化疗方案，给予重组人血小板生成素\nE. 继续放化疗方案，定期复查血常规及生化指标\nF. 暂停放化疗，给予还原型谷胱甘肽保肝治疗\nG. 继续放化疗方案，加用双环醇保肝治疗\nH. 继续放化疗方案，给予重组人粒细胞刺激因子\nI. 暂停同期化疗，给予静脉补液及利尿处理\nJ. 继续放疗，取消同期化疗，改为西妥昔单抗治疗\nK. 暂停放疗，继续同期化疗，给予促红细胞生成素治疗\nL. 继续放化疗方案，输注单采血小板\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D3189] 门急诊记录: 主诉: 鼻咽癌治疗后8年；患者家属自述行放疗（具体方案不详）。患者家属来诊，诉近来头后部疼痛，持续二月余，逐渐加重，无其他明显，来诊咨询诊疗意见。；既往史: 是否有过敏史无过敏史。是否有吸烟史吸烟史详情；个人史:；家族史:；体格检查:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 检验组合: 嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；凝血酶原时间活动度(PTA)-静脉血: 89%；平均血小板体积(MPV)-静脉血: 9.4fL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 334g/L；D-二聚体(D-Dimer)-静脉血: 0.29ug/ml；凝血酶原国际标准化比值(PT-INR)-静脉血: 1.02；纤维蛋白原(Fbg)-静脉血: 3.21g/L；红细胞比容(Hct)-静脉血: 48.2%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；平均红细胞血红蛋白含量(MCH)-静脉血: 32pg；红细胞计数(RBC#)-静脉血: 5.0310E12/L；淋巴细胞百分比(Lymph%)-静脉血: 0.271；中性粒细胞计数(Neut#)-静脉血: 5.910E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.65；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.8；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；大血小板百分比(P-LCR%)-静脉血: 20.8%；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；血小板比容-静脉血: 27%；平均红细胞体积(MCV)-静脉血: 95.8fL；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.06S/CO；血小板分布宽度(PDW)-静脉血: 10.8%；单核细胞计数(Mono#)-静脉血: 0.510E9/L；活化部分凝血活酶时间(APTT)-静脉血: 29.2sec.；凝血酶原时间(PT)-静脉血: 11.4sec.；纤维蛋白原降解产物(FDP)-静脉血: 2.8ug/ml；淋巴细胞计数(Lymph#)-静脉血: 2.510E9/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.01IU/mL；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.13COI；凝血酶时间(TT)-静脉血: 20sec.；血小板计数(PLT#)-静脉血: 28910E9/L；Rh血型-静脉血: 阳性；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.06S/CO；血红蛋白(Hb)-静脉血: 161g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；白细胞计数(WBC……\n- [全程D14] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 左前分支阻滞\n- [全程D14] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理稍增粗，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见重要病变。\n- [全程D15] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 右侧乳突可见片状放射性浓集灶。胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 右侧乳突炎症。 余全身骨骼未见明显异常。\n- [全程D16] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，肝S7可见一强回声斑，直径约5mm，后方伴声影。血管走行清晰、自然，肝内胆管不扩张，门静脉内径14mm。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约21cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约36×26×23mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝S7强回声斑，考虑肝内胆管结石。 胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D22] 检验组合: 钾离子(K+)-静脉血: 4.18mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 46.8U/L；氯离子(Cl-)-静脉血: 101.7mmol/L；直接胆红素(DBIL)-静脉血: 2.5umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；乳酸脱氢酶(LDH)-静脉血: 172.2U/L；尿酸(UA)-静脉血: 299umol/L；碱性磷酸酶(ALP)-静脉血: 35.4U/L；载脂蛋白B(apoB)-静脉血: 0.71g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.09mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.82；γ-谷氨酰基转移酶(GGT)-静脉血: 23.1U/L；总钙(Ca)-静脉血: 2.31mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.1U/L；间接胆红素(IBIL)-静脉血: 4.8umolL；血液二氧化碳含量ctCO2(B)-静脉血: 22.5mmol/L；总蛋白(TP)-静脉血: 76.15g/L；阴离子间隙(AG)-静脉血: 16.8；总胆固醇(TC)-静脉血: 4.05mmol/L；总胆汁酸(TBA)-静脉血: 3.1umol/L；总胆红素(TBIL)-静脉血: 7.3umol/L；肌酐(Crea)-静脉血: 58.1umol/L；载脂蛋白AI(apoAI)-静脉血: 1.48g/L；球蛋白(GLO)-静脉血: 30.25g/L；C-反应蛋白(CRP)-静脉血: 3.66mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.33mmolL；镁离子(Mg2+)-静脉血: 0.86mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.3U/L；胱抑素(Cys-C)-静脉血: 0.88mg/L；尿素氮(BUN)-静脉血: 3.4mmol/L；葡萄糖(Glu)-静脉血: 5.59mmol/L；甘油三酯(TG)-静脉血: 2.5mmol/L；磷(P)-静脉血: 1.15mmol/L；白蛋白(ALB)-静脉血: 45.9g/L；钠离子(Na+)-静脉血: 141mmol/L\n- [全程D70] 检验组合: 低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.66mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.6；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32pg；白细胞计数(WBC#)-静脉血: 7.7410E9/L；血红蛋白(Hb)-静脉血: 164g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 27.3U/L；磷(P)-静脉血: 1.31mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 20.8mmol/L；尿酸(UA)-静脉血: 323.7umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 44.8U/L；C-反应蛋白(CRP)-静脉血: 1.33mg/L；血小板比容-静脉血: 22%；血小板计数(PLT#)-静脉血: 23710E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.35mmolL；总胆红素(TBIL)-静脉血: 10.7umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 36.6U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.75；平均红细胞血红蛋白浓度(MCHC)-静脉血: 342g/L；肌酐(Crea)-静脉血: 62.3umol/L；总蛋白(TP)-静脉血: 75.99g/L；单核细胞百分比(Mono%)-静脉血: 0.056；平均红细胞血红蛋白浓度(MCHC)-静脉血: 337g/L；平均血小板体积(MPV)-静脉血: 9.5fL；血小板计数(PLT#)-静脉血: 24810E9/L；甘油三酯(TG)-静脉血: 1.02mmol/L；单核细胞百分比(Mono%)-静脉血: 0.081；球蛋白(GLO)-静脉血: 29.79g/L；平均红细胞体积(MCV)-静脉血: 95.1fL；总钙(Ca)-静脉血: 2.3mmol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；直接胆红素(DBIL)-静脉血: 3.9umol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；载脂蛋白AI(apoAI)-静脉血: 1.36g/L；大血小板百分比(P-LCR%)-静脉血: 17.2%；血红蛋白(Hb)-静脉血: 158g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32pg……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D64] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者近日精神好，胃纳尚可，暂无特殊不适。体查大致同入院。患者目前无放疗禁忌症，开始予以行鼻咽癌放疗。靶区剂量为：GTV70Gy/31F。放疗期间予同期化疗，并予加强对症、支持治疗。注意观察放疗不良反应表现。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停同期化疗，继续单纯放疗，并加用保肝药物\nB. 暂停放化疗，给予重组人粒细胞刺激因子支持治疗\nC. 继续放疗，将同期化疗剂量减低20%\nD. 继续放化疗方案，给予重组人血小板生成素\nE. 继续放化疗方案，定期复查血常规及生化指标\nF. 暂停放化疗，给予还原型谷胱甘肽保肝治疗\nG. 继续放化疗方案，加用双环醇保肝治疗\nH. 继续放化疗方案，给予重组人粒细胞刺激因子\nI. 暂停同期化疗，给予静脉补液及利尿处理\nJ. 继续放疗，取消同期化疗，改为西妥昔单抗治疗\nK. 暂停放疗，继续同期化疗，给予促红细胞生成素治疗\nL. 继续放化疗方案，输注单采血小板\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-5a0d01adf33246131a9f67e1","patient_id":"patient-34616c327ce5d69194ca7f4d","turn_id":"turn06","turn_position":5,"turn_type":"toxicity_or_support_decision","gold_letter":"F","gold_action":"继续按计划完成根治性放疗，并维持当前口腔含漱等常规对症支持治疗。","options":[{"letter":"A","text":"暂停放疗，给予静脉营养支持及广谱抗生素，待黏膜反应恢复后恢复放疗。","is_gold":false},{"letter":"B","text":"暂停放疗，复查鼻咽颈部MRI评估疗效，若肿瘤完全消退则提前终止放疗。","is_gold":false},{"letter":"C","text":"继续放疗，给予重组人粒细胞集落刺激因子皮下注射以纠正淋巴细胞减少。","is_gold":false},{"letter":"D","text":"继续放疗，加用大剂量糖皮质激素静脉滴注以减轻放射性口腔黏膜炎。","is_gold":false},{"letter":"E","text":"暂停放疗，行经皮内镜下胃造瘘术以保障后续营养摄入及防止体重下降。","is_gold":false},{"letter":"F","text":"继续按计划完成根治性放疗，并维持口腔含漱等常规对症支持治疗。","is_gold":true},{"letter":"G","text":"继续放疗，加用氟康唑口服以预防放疗后期可能出现的真菌性口腔炎。","is_gold":false},{"letter":"H","text":"暂停放疗，给予局部放射性保护剂及高压氧治疗，待口干症状缓解后继续。","is_gold":false},{"letter":"I","text":"继续放疗，降低单次放疗剂量以减少对双侧腮腺及颌下腺的进一步损伤。","is_gold":false},{"letter":"J","text":"提前结束放疗，转为单药辅助化学治疗以控制微小转移灶并减轻局部毒性。","is_gold":false},{"letter":"K","text":"继续放疗，预防性留置鼻胃管以应对放疗末期可能加重的吞咽困难。","is_gold":false},{"letter":"L","text":"暂停放疗，行全身PET-CT排除远处转移后再决定是否完成剩余放疗。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D3189] 门急诊记录: 主诉: 鼻咽癌治疗后8年；患者家属自述行放疗（具体方案不详）。患者家属来诊，诉近来头后部疼痛，持续二月余，逐渐加重，无其他明显，来诊咨询诊疗意见。；既往史: 是否有过敏史无过敏史。是否有吸烟史吸烟史详情；个人史:；家族史:；体格检查:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 检验组合: 嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；凝血酶原时间活动度(PTA)-静脉血: 89%；平均血小板体积(MPV)-静脉血: 9.4fL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 334g/L；D-二聚体(D-Dimer)-静脉血: 0.29ug/ml；凝血酶原国际标准化比值(PT-INR)-静脉血: 1.02；纤维蛋白原(Fbg)-静脉血: 3.21g/L；红细胞比容(Hct)-静脉血: 48.2%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；平均红细胞血红蛋白含量(MCH)-静脉血: 32pg；红细胞计数(RBC#)-静脉血: 5.0310E12/L；淋巴细胞百分比(Lymph%)-静脉血: 0.271；中性粒细胞计数(Neut#)-静脉血: 5.910E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.65；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.8；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；大血小板百分比(P-LCR%)-静脉血: 20.8%；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；血小板比容-静脉血: 27%；平均红细胞体积(MCV)-静脉血: 95.8fL；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.06S/CO；血小板分布宽度(PDW)-静脉血: 10.8%；单核细胞计数(Mono#)-静脉血: 0.510E9/L；活化部分凝血活酶时间(APTT)-静脉血: 29.2sec.；凝血酶原时间(PT)-静脉血: 11.4sec.；纤维蛋白原降解产物(FDP)-静脉血: 2.8ug/ml；淋巴细胞计数(Lymph#)-静脉血: 2.510E9/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.01IU/mL；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.13COI；凝血酶时间(TT)-静脉血: 20sec.；血小板计数(PLT#)-静脉血: 28910E9/L；Rh血型-静脉血: 阳性；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.06S/CO；血红蛋白(Hb)-静脉血: 161g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；白细胞计数(WBC……\n- [全程D14] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 左前分支阻滞\n- [全程D14] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理稍增粗，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见重要病变。\n- [全程D15] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 右侧乳突可见片状放射性浓集灶。胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 右侧乳突炎症。 余全身骨骼未见明显异常。\n- [全程D16] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，肝S7可见一强回声斑，直径约5mm，后方伴声影。血管走行清晰、自然，肝内胆管不扩张，门静脉内径14mm。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约21cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约36×26×23mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝S7强回声斑，考虑肝内胆管结石。 胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D22] 检验组合: 钾离子(K+)-静脉血: 4.18mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 46.8U/L；氯离子(Cl-)-静脉血: 101.7mmol/L；直接胆红素(DBIL)-静脉血: 2.5umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；乳酸脱氢酶(LDH)-静脉血: 172.2U/L；尿酸(UA)-静脉血: 299umol/L；碱性磷酸酶(ALP)-静脉血: 35.4U/L；载脂蛋白B(apoB)-静脉血: 0.71g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.09mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.82；γ-谷氨酰基转移酶(GGT)-静脉血: 23.1U/L；总钙(Ca)-静脉血: 2.31mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.1U/L；间接胆红素(IBIL)-静脉血: 4.8umolL；血液二氧化碳含量ctCO2(B)-静脉血: 22.5mmol/L；总蛋白(TP)-静脉血: 76.15g/L；阴离子间隙(AG)-静脉血: 16.8；总胆固醇(TC)-静脉血: 4.05mmol/L；总胆汁酸(TBA)-静脉血: 3.1umol/L；总胆红素(TBIL)-静脉血: 7.3umol/L；肌酐(Crea)-静脉血: 58.1umol/L；载脂蛋白AI(apoAI)-静脉血: 1.48g/L；球蛋白(GLO)-静脉血: 30.25g/L；C-反应蛋白(CRP)-静脉血: 3.66mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.33mmolL；镁离子(Mg2+)-静脉血: 0.86mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.3U/L；胱抑素(Cys-C)-静脉血: 0.88mg/L；尿素氮(BUN)-静脉血: 3.4mmol/L；葡萄糖(Glu)-静脉血: 5.59mmol/L；甘油三酯(TG)-静脉血: 2.5mmol/L；磷(P)-静脉血: 1.15mmol/L；白蛋白(ALB)-静脉血: 45.9g/L；钠离子(Na+)-静脉血: 141mmol/L\n- [全程D70] 检验组合: 低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.66mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.6；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32pg；白细胞计数(WBC#)-静脉血: 7.7410E9/L；血红蛋白(Hb)-静脉血: 164g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 27.3U/L；磷(P)-静脉血: 1.31mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 20.8mmol/L；尿酸(UA)-静脉血: 323.7umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 44.8U/L；C-反应蛋白(CRP)-静脉血: 1.33mg/L；血小板比容-静脉血: 22%；血小板计数(PLT#)-静脉血: 23710E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.35mmolL；总胆红素(TBIL)-静脉血: 10.7umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 36.6U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.75；平均红细胞血红蛋白浓度(MCHC)-静脉血: 342g/L；肌酐(Crea)-静脉血: 62.3umol/L；总蛋白(TP)-静脉血: 75.99g/L；单核细胞百分比(Mono%)-静脉血: 0.056；平均红细胞血红蛋白浓度(MCHC)-静脉血: 337g/L；平均血小板体积(MPV)-静脉血: 9.5fL；血小板计数(PLT#)-静脉血: 24810E9/L；甘油三酯(TG)-静脉血: 1.02mmol/L；单核细胞百分比(Mono%)-静脉血: 0.081；球蛋白(GLO)-静脉血: 29.79g/L；平均红细胞体积(MCV)-静脉血: 95.1fL；总钙(Ca)-静脉血: 2.3mmol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；直接胆红素(DBIL)-静脉血: 3.9umol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；载脂蛋白AI(apoAI)-静脉血: 1.36g/L；大血小板百分比(P-LCR%)-静脉血: 17.2%；血红蛋白(Hb)-静脉血: 158g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32pg……\n- [全程D83] 检验组合: 平均红细胞血红蛋白含量(MCH)-静脉血: 32.2pg；乳酸脱氢酶(LDH)-静脉血: 190.8U/L；直接胆红素(DBIL)-静脉血: 5.3umol/L；血小板计数(PLT#)-静脉血: 22010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.8；中性粒细胞计数(Neut#)-静脉血: 6.310E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.5；白蛋白(ALB)-静脉血: 45.7g/L；大血小板百分比(P-LCR%)-静脉血: 18.3%；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.81；球蛋白(GLO)-静脉血: 30.11g/L；血小板比容-静脉血: 20%；间接胆红素(IBIL)-静脉血: 8.8umolL；淋巴细胞百分比(Lymph%)-静脉血: 0.068；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 27.5U/L；总胆红素(TBIL)-静脉血: 14.1umol/L；单核细胞百分比(Mono%)-静脉血: 0.075；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；碱性磷酸酶(ALP)-静脉血: 31.2U/L；肌酐(Crea)-静脉血: 68.3umol/L；白细胞计数(WBC#)-静脉血: 7.610E9/L；总蛋白(TP)-静脉血: 75.81g/L；尿素氮(BUN)-静脉血: 4.4mmol/L；总胆汁酸(TBA)-静脉血: 1.8umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 343g/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；红细胞计数(RBC#)-静脉血: 4.910E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；红细胞比容(Hct)-静脉血: 46.1%；平均血小板体积(MPV)-静脉血: 9.3fL；平均红细胞体积(MCV)-静脉血: 94.1fL；尿酸(UA)-静脉血: 343.1umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 39U/L；中……\n- [全程D97] 检验组合: 磷(P)-静脉血: 1.26mmol/L；阴离子间隙(AG)-静脉血: 17.4；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；间接胆红素(IBIL)-静脉血: 5.9umolL；白蛋白(ALB)-静脉血: 45.2g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14；镁离子(Mg2+)-静脉血: 0.87mmol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；葡萄糖(Glu)-静脉血: 4.31mmol/L；尿酸(UA)-静脉血: 265.3umol/L；尿素氮(BUN)-静脉血: 3.1mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.6mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；单核细胞百分比(Mono%)-静脉血: 0.093；总胆汁酸(TBA)-静脉血: 0.9umol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；胱抑素(Cys-C)-静脉血: 0.73mg/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20.7U/L；钾离子(K+)-静脉血: 3.7mmol/L；总胆红素(TBIL)-静脉血: 11.1umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.98；载脂蛋白AI(apoAI)-静脉血: 1.29g/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；红细胞计数(RBC#)-静脉血: 4.5510E12/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336g/L；红细胞比容(Hct)-静脉血: 43.4%；球蛋白(GLO)-静脉血: 29.28g/L；肌酐(Crea)-静脉血: 63.8umol/L；中性粒细胞计数(Neut#)-静脉血: 4.910E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.8；大血小板百分比(P-LCR%)-静脉血: 16.8%；血红蛋白(Hb)-静脉血: 146g/L；直接胆红素(DBIL)-静脉血: 5.2umol/L；总胆固醇(TC)-静脉血: 3.12mmol/L；血小板分布宽度(PDW)-静脉血: 9.8%；总钙(Ca)-静脉血: 2.2mmol/L；血小板比容-静脉血: 13%；丙氨酸氨基转移酶(ALT)-静脉血: 21.2U/L……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D64] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者近日精神好，胃纳尚可，暂无特殊不适。体查大致同入院。患者目前无放疗禁忌症，开始予以行鼻咽癌放疗。靶区剂量为：GTV70Gy/31F。放疗期间予同期化疗，并予加强对症、支持治疗。注意观察放疗不良反应表现。\n- [全程D71] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者近1周放疗期间一般情况好，精神好，胃纳佳，无耳鸣、无涕血、无鼻塞，无头痛、面麻，无视物模糊、复视，无声嘶、饮水呛咳、无发热，二便正常。体查大致同前。至今天，患者共完成放疗11F，暂无特殊不良反应表现。继续予以目前放疗及对症治疗。\n- [全程D78] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者至今天已行放疗16F，过程顺利。今患者精神好，胃纳尚可，诉口干、味觉改变，无咽痛，无耳鸣、无涕血、无鼻塞，无头痛、面麻，无视物模糊、复视，无声嘶、饮水呛咳、无发热，二便正常。体查：鼻咽顶后壁及右侧壁结节状肿物，肿物较放疗前稍有缩小，双颈未及明显肿大淋巴结，颅神经（－）。患者放疗期间出现口干、味觉改变，考虑为放疗副作用所致，嘱患者勤含漱，余继续予以放疗对症治疗。\n- [全程D85] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 今患者精神好，胃纳尚可，诉口干、味觉改变，轻微咽痛，无耳鸣、无涕血、无鼻塞，无头痛、面麻，无视物模糊、复视，无声嘶、饮水呛咳、无发热，二便正常。患者至今天已行放疗18F。体查：口咽黏膜充血，无明显破溃，鼻咽顶后壁及右侧壁结节状肿物，肿物较放疗前继续有缩小，双颈未及明显肿大淋巴结，颅神经（－）。患者放疗期间出现轻微咽痛，考虑为放疗所致口咽黏膜反应，予以继续加强含漱对症治疗，余继续予以放疗对症治疗。\n- [全程D92] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者近1周放疗期间一般情况好，精神好，胃纳佳，诉咽痛症状较前好转，仍有口干、味觉改变，无头痛，无发热，二便正常。体查大致同前。至今天，患者共完成放疗22F，继续予以目前放疗及对症治疗。\n- [全程D97] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者近1周放疗期间一般情况好，精神好，胃纳佳，诉咽痛症状较前好转，仍有口干、味觉改变，无头痛，无发热，二便正常。体查大致同前。至今天，患者共完成放疗27F，继续予以目前放疗及对症治疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，给予静脉营养支持及广谱抗生素，待黏膜反应恢复后恢复放疗。\nB. 暂停放疗，复查鼻咽颈部MRI评估疗效，若肿瘤完全消退则提前终止放疗。\nC. 继续放疗，给予重组人粒细胞集落刺激因子皮下注射以纠正淋巴细胞减少。\nD. 继续放疗，加用大剂量糖皮质激素静脉滴注以减轻放射性口腔黏膜炎。\nE. 暂停放疗，行经皮内镜下胃造瘘术以保障后续营养摄入及防止体重下降。\nF. 继续按计划完成根治性放疗，并维持口腔含漱等常规对症支持治疗。\nG. 继续放疗，加用氟康唑口服以预防放疗后期可能出现的真菌性口腔炎。\nH. 暂停放疗，给予局部放射性保护剂及高压氧治疗，待口干症状缓解后继续。\nI. 继续放疗，降低单次放疗剂量以减少对双侧腮腺及颌下腺的进一步损伤。\nJ. 提前结束放疗，转为单药辅助化学治疗以控制微小转移灶并减轻局部毒性。\nK. 继续放疗，预防性留置鼻胃管以应对放疗末期可能加重的吞咽困难。\nL. 暂停放疗，行全身PET-CT排除远处转移后再决定是否完成剩余放疗。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D3189] 门急诊记录: 主诉: 鼻咽癌治疗后8年；患者家属自述行放疗（具体方案不详）。患者家属来诊，诉近来头后部疼痛，持续二月余，逐渐加重，无其他明显，来诊咨询诊疗意见。；既往史: 是否有过敏史无过敏史。是否有吸烟史吸烟史详情；个人史:；家族史:；体格检查:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 检验组合: 嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；凝血酶原时间活动度(PTA)-静脉血: 89%；平均血小板体积(MPV)-静脉血: 9.4fL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 334g/L；D-二聚体(D-Dimer)-静脉血: 0.29ug/ml；凝血酶原国际标准化比值(PT-INR)-静脉血: 1.02；纤维蛋白原(Fbg)-静脉血: 3.21g/L；红细胞比容(Hct)-静脉血: 48.2%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；平均红细胞血红蛋白含量(MCH)-静脉血: 32pg；红细胞计数(RBC#)-静脉血: 5.0310E12/L；淋巴细胞百分比(Lymph%)-静脉血: 0.271；中性粒细胞计数(Neut#)-静脉血: 5.910E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.65；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.8；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；大血小板百分比(P-LCR%)-静脉血: 20.8%；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；血小板比容-静脉血: 27%；平均红细胞体积(MCV)-静脉血: 95.8fL；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.06S/CO；血小板分布宽度(PDW)-静脉血: 10.8%；单核细胞计数(Mono#)-静脉血: 0.510E9/L；活化部分凝血活酶时间(APTT)-静脉血: 29.2sec.；凝血酶原时间(PT)-静脉血: 11.4sec.；纤维蛋白原降解产物(FDP)-静脉血: 2.8ug/ml；淋巴细胞计数(Lymph#)-静脉血: 2.510E9/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.01IU/mL；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.13COI；凝血酶时间(TT)-静脉血: 20sec.；血小板计数(PLT#)-静脉血: 28910E9/L；Rh血型-静脉血: 阳性；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.06S/CO；血红蛋白(Hb)-静脉血: 161g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；白细胞计数(WBC……\n- [全程D14] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 左前分支阻滞\n- [全程D14] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理稍增粗，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见重要病变。\n- [全程D15] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 右侧乳突可见片状放射性浓集灶。胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 右侧乳突炎症。 余全身骨骼未见明显异常。\n- [全程D16] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，肝S7可见一强回声斑，直径约5mm，后方伴声影。血管走行清晰、自然，肝内胆管不扩张，门静脉内径14mm。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约21cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约36×26×23mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝S7强回声斑，考虑肝内胆管结石。 胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D22] 检验组合: 钾离子(K+)-静脉血: 4.18mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 46.8U/L；氯离子(Cl-)-静脉血: 101.7mmol/L；直接胆红素(DBIL)-静脉血: 2.5umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；乳酸脱氢酶(LDH)-静脉血: 172.2U/L；尿酸(UA)-静脉血: 299umol/L；碱性磷酸酶(ALP)-静脉血: 35.4U/L；载脂蛋白B(apoB)-静脉血: 0.71g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.09mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.82；γ-谷氨酰基转移酶(GGT)-静脉血: 23.1U/L；总钙(Ca)-静脉血: 2.31mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.1U/L；间接胆红素(IBIL)-静脉血: 4.8umolL；血液二氧化碳含量ctCO2(B)-静脉血: 22.5mmol/L；总蛋白(TP)-静脉血: 76.15g/L；阴离子间隙(AG)-静脉血: 16.8；总胆固醇(TC)-静脉血: 4.05mmol/L；总胆汁酸(TBA)-静脉血: 3.1umol/L；总胆红素(TBIL)-静脉血: 7.3umol/L；肌酐(Crea)-静脉血: 58.1umol/L；载脂蛋白AI(apoAI)-静脉血: 1.48g/L；球蛋白(GLO)-静脉血: 30.25g/L；C-反应蛋白(CRP)-静脉血: 3.66mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.33mmolL；镁离子(Mg2+)-静脉血: 0.86mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.3U/L；胱抑素(Cys-C)-静脉血: 0.88mg/L；尿素氮(BUN)-静脉血: 3.4mmol/L；葡萄糖(Glu)-静脉血: 5.59mmol/L；甘油三酯(TG)-静脉血: 2.5mmol/L；磷(P)-静脉血: 1.15mmol/L；白蛋白(ALB)-静脉血: 45.9g/L；钠离子(Na+)-静脉血: 141mmol/L\n- [全程D70] 检验组合: 低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.66mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.6；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32pg；白细胞计数(WBC#)-静脉血: 7.7410E9/L；血红蛋白(Hb)-静脉血: 164g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 27.3U/L；磷(P)-静脉血: 1.31mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 20.8mmol/L；尿酸(UA)-静脉血: 323.7umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 44.8U/L；C-反应蛋白(CRP)-静脉血: 1.33mg/L；血小板比容-静脉血: 22%；血小板计数(PLT#)-静脉血: 23710E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.35mmolL；总胆红素(TBIL)-静脉血: 10.7umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 36.6U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.75；平均红细胞血红蛋白浓度(MCHC)-静脉血: 342g/L；肌酐(Crea)-静脉血: 62.3umol/L；总蛋白(TP)-静脉血: 75.99g/L；单核细胞百分比(Mono%)-静脉血: 0.056；平均红细胞血红蛋白浓度(MCHC)-静脉血: 337g/L；平均血小板体积(MPV)-静脉血: 9.5fL；血小板计数(PLT#)-静脉血: 24810E9/L；甘油三酯(TG)-静脉血: 1.02mmol/L；单核细胞百分比(Mono%)-静脉血: 0.081；球蛋白(GLO)-静脉血: 29.79g/L；平均红细胞体积(MCV)-静脉血: 95.1fL；总钙(Ca)-静脉血: 2.3mmol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；直接胆红素(DBIL)-静脉血: 3.9umol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；载脂蛋白AI(apoAI)-静脉血: 1.36g/L；大血小板百分比(P-LCR%)-静脉血: 17.2%；血红蛋白(Hb)-静脉血: 158g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32pg……\n- [全程D83] 检验组合: 平均红细胞血红蛋白含量(MCH)-静脉血: 32.2pg；乳酸脱氢酶(LDH)-静脉血: 190.8U/L；直接胆红素(DBIL)-静脉血: 5.3umol/L；血小板计数(PLT#)-静脉血: 22010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.8；中性粒细胞计数(Neut#)-静脉血: 6.310E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.5；白蛋白(ALB)-静脉血: 45.7g/L；大血小板百分比(P-LCR%)-静脉血: 18.3%；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.81；球蛋白(GLO)-静脉血: 30.11g/L；血小板比容-静脉血: 20%；间接胆红素(IBIL)-静脉血: 8.8umolL；淋巴细胞百分比(Lymph%)-静脉血: 0.068；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 27.5U/L；总胆红素(TBIL)-静脉血: 14.1umol/L；单核细胞百分比(Mono%)-静脉血: 0.075；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；碱性磷酸酶(ALP)-静脉血: 31.2U/L；肌酐(Crea)-静脉血: 68.3umol/L；白细胞计数(WBC#)-静脉血: 7.610E9/L；总蛋白(TP)-静脉血: 75.81g/L；尿素氮(BUN)-静脉血: 4.4mmol/L；总胆汁酸(TBA)-静脉血: 1.8umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 343g/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；红细胞计数(RBC#)-静脉血: 4.910E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；红细胞比容(Hct)-静脉血: 46.1%；平均血小板体积(MPV)-静脉血: 9.3fL；平均红细胞体积(MCV)-静脉血: 94.1fL；尿酸(UA)-静脉血: 343.1umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 39U/L；中……\n- [全程D97] 检验组合: 磷(P)-静脉血: 1.26mmol/L；阴离子间隙(AG)-静脉血: 17.4；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；间接胆红素(IBIL)-静脉血: 5.9umolL；白蛋白(ALB)-静脉血: 45.2g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14；镁离子(Mg2+)-静脉血: 0.87mmol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；葡萄糖(Glu)-静脉血: 4.31mmol/L；尿酸(UA)-静脉血: 265.3umol/L；尿素氮(BUN)-静脉血: 3.1mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.6mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；单核细胞百分比(Mono%)-静脉血: 0.093；总胆汁酸(TBA)-静脉血: 0.9umol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；胱抑素(Cys-C)-静脉血: 0.73mg/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20.7U/L；钾离子(K+)-静脉血: 3.7mmol/L；总胆红素(TBIL)-静脉血: 11.1umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.98；载脂蛋白AI(apoAI)-静脉血: 1.29g/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；红细胞计数(RBC#)-静脉血: 4.5510E12/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336g/L；红细胞比容(Hct)-静脉血: 43.4%；球蛋白(GLO)-静脉血: 29.28g/L；肌酐(Crea)-静脉血: 63.8umol/L；中性粒细胞计数(Neut#)-静脉血: 4.910E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.8；大血小板百分比(P-LCR%)-静脉血: 16.8%；血红蛋白(Hb)-静脉血: 146g/L；直接胆红素(DBIL)-静脉血: 5.2umol/L；总胆固醇(TC)-静脉血: 3.12mmol/L；血小板分布宽度(PDW)-静脉血: 9.8%；总钙(Ca)-静脉血: 2.2mmol/L；血小板比容-静脉血: 13%；丙氨酸氨基转移酶(ALT)-静脉血: 21.2U/L……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D64] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者近日精神好，胃纳尚可，暂无特殊不适。体查大致同入院。患者目前无放疗禁忌症，开始予以行鼻咽癌放疗。靶区剂量为：GTV70Gy/31F。放疗期间予同期化疗，并予加强对症、支持治疗。注意观察放疗不良反应表现。\n- [全程D71] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者近1周放疗期间一般情况好，精神好，胃纳佳，无耳鸣、无涕血、无鼻塞，无头痛、面麻，无视物模糊、复视，无声嘶、饮水呛咳、无发热，二便正常。体查大致同前。至今天，患者共完成放疗11F，暂无特殊不良反应表现。继续予以目前放疗及对症治疗。\n- [全程D78] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者至今天已行放疗16F，过程顺利。今患者精神好，胃纳尚可，诉口干、味觉改变，无咽痛，无耳鸣、无涕血、无鼻塞，无头痛、面麻，无视物模糊、复视，无声嘶、饮水呛咳、无发热，二便正常。体查：鼻咽顶后壁及右侧壁结节状肿物，肿物较放疗前稍有缩小，双颈未及明显肿大淋巴结，颅神经（－）。患者放疗期间出现口干、味觉改变，考虑为放疗副作用所致，嘱患者勤含漱，余继续予以放疗对症治疗。\n- [全程D85] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 今患者精神好，胃纳尚可，诉口干、味觉改变，轻微咽痛，无耳鸣、无涕血、无鼻塞，无头痛、面麻，无视物模糊、复视，无声嘶、饮水呛咳、无发热，二便正常。患者至今天已行放疗18F。体查：口咽黏膜充血，无明显破溃，鼻咽顶后壁及右侧壁结节状肿物，肿物较放疗前继续有缩小，双颈未及明显肿大淋巴结，颅神经（－）。患者放疗期间出现轻微咽痛，考虑为放疗所致口咽黏膜反应，予以继续加强含漱对症治疗，余继续予以放疗对症治疗。\n- [全程D92] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者近1周放疗期间一般情况好，精神好，胃纳佳，诉咽痛症状较前好转，仍有口干、味觉改变，无头痛，无发热，二便正常。体查大致同前。至今天，患者共完成放疗22F，继续予以目前放疗及对症治疗。\n- [全程D97] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者近1周放疗期间一般情况好，精神好，胃纳佳，诉咽痛症状较前好转，仍有口干、味觉改变，无头痛，无发热，二便正常。体查大致同前。至今天，患者共完成放疗27F，继续予以目前放疗及对症治疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，给予静脉营养支持及广谱抗生素，待黏膜反应恢复后恢复放疗。\nB. 暂停放疗，复查鼻咽颈部MRI评估疗效，若肿瘤完全消退则提前终止放疗。\nC. 继续放疗，给予重组人粒细胞集落刺激因子皮下注射以纠正淋巴细胞减少。\nD. 继续放疗，加用大剂量糖皮质激素静脉滴注以减轻放射性口腔黏膜炎。\nE. 暂停放疗，行经皮内镜下胃造瘘术以保障后续营养摄入及防止体重下降。\nF. 继续按计划完成根治性放疗，并维持口腔含漱等常规对症支持治疗。\nG. 继续放疗，加用氟康唑口服以预防放疗后期可能出现的真菌性口腔炎。\nH. 暂停放疗，给予局部放射性保护剂及高压氧治疗，待口干症状缓解后继续。\nI. 继续放疗，降低单次放疗剂量以减少对双侧腮腺及颌下腺的进一步损伤。\nJ. 提前结束放疗，转为单药辅助化学治疗以控制微小转移灶并减轻局部毒性。\nK. 继续放疗，预防性留置鼻胃管以应对放疗末期可能加重的吞咽困难。\nL. 暂停放疗，行全身PET-CT排除远处转移后再决定是否完成剩余放疗。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-a4894f941ebb70f32d9155cc","patient_id":"patient-9bf5c8c03860cdf61108611d","turn_id":"turn01","turn_position":1,"turn_type":"initial_workup_choice","gold_letter":"G","gold_action":"电子鼻咽镜检查及活检，鼻咽及颈部增强MRI，胸部X线、腹部彩超、全身骨显像，以及EBV抗体检测。","options":[{"letter":"A","text":"电子鼻咽镜检查及活检，鼻咽及颈部平扫CT，胸部X线、腹部彩超，暂缓全身骨显像及EBV检测","is_gold":false},{"letter":"B","text":"左颈部淋巴结切除活检，鼻咽及颈部增强MRI，胸部X线、腹部彩超、全身骨显像及EBV检测","is_gold":false},{"letter":"C","text":"电子鼻咽镜检查及活检，鼻咽及颈部增强CT，胸部X线、腹部彩超、全身骨显像，暂缓EBV检测","is_gold":false},{"letter":"D","text":"电子鼻咽镜检查（暂不活检），鼻咽及颈部增强MRI，全身PET-CT，以及EBV抗体检测","is_gold":false},{"letter":"E","text":"左颈部淋巴结细针穿刺活检，鼻咽及颈部平扫MRI，胸部X线、腹部彩超、全身骨显像","is_gold":false},{"letter":"F","text":"电子鼻咽镜检查及活检，鼻咽及颈部增强MRI，仅行胸部X线及腹部彩超，无需全身骨显像","is_gold":false},{"letter":"G","text":"电子鼻咽镜检查及活检，鼻咽及颈部增强MRI，胸部X线、腹部彩超、全身骨显像，以及EBV抗体检测","is_gold":true},{"letter":"H","text":"电子鼻咽镜检查及活检，鼻咽及颈部增强MRI，头颅增强MRI，全身骨髓穿刺活检及EBV检测","is_gold":false},{"letter":"I","text":"电子鼻咽镜检查及活检，鼻咽及颈部增强MRI，胸部X线、腹部彩超、全身骨显像，并预防性气管切开","is_gold":false},{"letter":"J","text":"电子鼻咽镜检查及活检，鼻咽及颈部平扫MRI，胸部X线、腹部彩超、全身骨显像，以及EBV抗体检测","is_gold":false},{"letter":"K","text":"鼻咽及颈部增强MRI，胸部X线、腹部彩超、全身骨显像，待影像学出具恶性报告后再行鼻咽镜活检","is_gold":false},{"letter":"L","text":"电子鼻咽镜检查及活检，鼻咽及颈部增强MRI，直接行全身骨显像及头颅CT，免除胸腹部影像学检查","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：腭帆提肌。\n文本分期信息：N2，M0。\n综合TNM状态：T1N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 听力下降8月，发现左颈部包块1月余；现病史: 患者于某次就诊时间初开始无明显诱因出现听力下降，以右侧为著，未予重视。某次就诊时间7月初患者无意中发现左颈部包块，大小约4×4cm，无疼痛，无表面皮肤发红，未就诊，肿物进行性增大。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,左颈部包块,颈部肿物；既往史: 发现血糖升高一年余，未行药物治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟：30－40支/天×30余。否认饮酒史。否认不洁性生活史。；家族史: 两个舅舅分别患有肝癌及骨肿瘤。；体格检查: T：36.4℃，P：83次/分，R：20次/分，BP：100/65mmHg,Ht：164cm，Wt：87kg，BSA：1.93m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左侧颈部IIa区可扪及1个淋巴结，最大径7×3cm，无融合，质地硬，边界清，活动度差，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 电子鼻咽镜检查及活检，鼻咽及颈部平扫CT，胸部X线、腹部彩超，暂缓全身骨显像及EBV检测\nB. 左颈部淋巴结切除活检，鼻咽及颈部增强MRI，胸部X线、腹部彩超、全身骨显像及EBV检测\nC. 电子鼻咽镜检查及活检，鼻咽及颈部增强CT，胸部X线、腹部彩超、全身骨显像，暂缓EBV检测\nD. 电子鼻咽镜检查（暂不活检），鼻咽及颈部增强MRI，全身PET-CT，以及EBV抗体检测\nE. 左颈部淋巴结细针穿刺活检，鼻咽及颈部平扫MRI，胸部X线、腹部彩超、全身骨显像\nF. 电子鼻咽镜检查及活检，鼻咽及颈部增强MRI，仅行胸部X线及腹部彩超，无需全身骨显像\nG. 电子鼻咽镜检查及活检，鼻咽及颈部增强MRI，胸部X线、腹部彩超、全身骨显像，以及EBV抗体检测\nH. 电子鼻咽镜检查及活检，鼻咽及颈部增强MRI，头颅增强MRI，全身骨髓穿刺活检及EBV检测\nI. 电子鼻咽镜检查及活检，鼻咽及颈部增强MRI，胸部X线、腹部彩超、全身骨显像，并预防性气管切开\nJ. 电子鼻咽镜检查及活检，鼻咽及颈部平扫MRI，胸部X线、腹部彩超、全身骨显像，以及EBV抗体检测\nK. 鼻咽及颈部增强MRI，胸部X线、腹部彩超、全身骨显像，待影像学出具恶性报告后再行鼻咽镜活检\nL. 电子鼻咽镜检查及活检，鼻咽及颈部增强MRI，直接行全身骨显像及头颅CT，免除胸腹部影像学检查\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：腭帆提肌。\n文本分期信息：N2，M0。\n综合TNM状态：T1N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 听力下降8月，发现左颈部包块1月余；现病史: 患者于某次就诊时间初开始无明显诱因出现听力下降，以右侧为著，未予重视。某次就诊时间7月初患者无意中发现左颈部包块，大小约4×4cm，无疼痛，无表面皮肤发红，未就诊，肿物进行性增大。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,左颈部包块,颈部肿物；既往史: 发现血糖升高一年余，未行药物治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟：30－40支/天×30余。否认饮酒史。否认不洁性生活史。；家族史: 两个舅舅分别患有肝癌及骨肿瘤。；体格检查: 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full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：腭帆提肌。\n文本分期信息：N2，M0。\n综合TNM状态：T1N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 听力下降8月，发现左颈部包块1月余；现病史: 患者于某次就诊时间初开始无明显诱因出现听力下降，以右侧为著，未予重视。某次就诊时间7月初患者无意中发现左颈部包块，大小约4×4cm，无疼痛，无表面皮肤发红，未就诊，肿物进行性增大。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,左颈部包块,颈部肿物；既往史: 发现血糖升高一年余，未行药物治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟：30－40支/天×30余。否认饮酒史。否认不洁性生活史。；家族史: 两个舅舅分别患有肝癌及骨肿瘤。；体格检查: T：36.4℃，P：83次/分，R：20次/分，BP：100/65mmHg,Ht：164cm，Wt：87kg，BSA：1.93m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左侧颈部IIa区可扪及1个淋巴结，最大径7×3cm，无融合，质地硬，边界清，活动度差，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D0] 检验组合: 隐血(OB)-粪便: 阴性（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-粪便: 棕色；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；比重(SG)-尿液: 1.021；浊度(TRUB)-尿液: 清亮；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 5.5；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；白细胞计数(WBC#)-尿液: 3/μL；虫卵-粪便: 未见虫卵（参考: 未见虫卵）\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理增多增粗，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，右肋膈角锐利，左肋膈角模糊。；检查结论: 考虑双肺慢性支气管炎X线改变。 左侧胸膜稍增厚。\n- [全程D1] 检验组合: 人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；载脂蛋白B(apoB)-静脉血: 1.08g/L；间接胆红素(IBIL)-静脉血: 5.9umolL；钾离子(K+)-静脉血: 4.1mmol/L；阴离子间隙(AG)-静脉血: 17.5；血红蛋白(Hb)-静脉血: 151g/L；凝血酶原时间活动度(PTA)-静脉血: 113.8%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；单核细胞计数(Mono#)-静脉血: 0.610E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.99mmol/L；ABO血型-静脉血: O；中性粒细胞百分比(Neut%)-静脉血: 0.578；血小板比容-静脉血: 24%；Rh血型-静脉血: 阳性；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 5.12mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；梅毒非特异性抗体甲苯胺红不加热血清试验(TRUST)-静脉血: 阴性(-)（参考: 阴性）；淋巴细胞百分比(Lymph%)-静脉血: 0.307；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.9；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 7.9umol/L；白细胞计数(WBC#)-静脉血: 7.610E9/L；直接胆红素(DBIL)-静脉血: 2umol/L；红细胞计数(RBC#)-静脉血: 5.2510E12/L；白蛋白(ALB)-静脉血: 42.2g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；红细胞比容(Hct)-静脉血: 44.7%；糖化血红蛋白A1c(HbA1c)-静脉血: 7.2%；总蛋白(TP)-静脉血: 76.24g/L；凝血酶时间(TT)-静脉血: 18.9sec.；纤维蛋白原(Fbg)-静脉血: 2.44g/L；钠离子(Na+)-静脉血……\n- [全程D4] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔变窄，鼻咽各壁粘膜明显增厚，见结节状肿物向鼻咽腔内突出，T1WI呈等信号，T2WI呈稍高信号，增强扫描轻度不均匀强化，双侧咽隐窝见肿物填塞。口咽双侧壁未见受累增厚，病变未累及双侧后鼻孔。 双侧腭帆提肌受侵，双侧腭帆张肌及头长肌、双侧翼内外肌未见受侵征象。 双侧翼腭窝、双侧上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 颅底骨质未见破坏。 双侧海绵窦形态未见异常。 双侧筛窦、双侧上颌窦粘膜增厚，增强扫描呈轻度强化。双侧乳突未见分泌物。 双眼未见异常，球后未见占位性病变。蝶鞍形态未见异常，其内未见占位性病变。 双侧咽后见淋巴结，大小约7mm×9mm，增强扫描明显强化。 双颈II区、左颈III区见多个肿大淋巴结，最大约33mm×27mm，边界欠清，增强扫描呈明显强化。 右颈III区、双颈I区见数个小淋巴结，最大约5mm×11mm，边界清楚，孤立散在。 甲状腺双叶及峡部形态未见异常，信号均匀，未见占位性病变。喉咽腔形态未见异常，未见占位性病变。双侧颌下腺、腮腺大小、形态未见异常，信号均匀，未见占位性病变。 扫描所见脑组织未见明确异常。；检查结论: 鼻咽肿物，考虑鼻咽癌。 颅底骨质未见破坏。 双侧咽后、双颈II区、左颈III区肿大淋巴结，考虑转移。 鼻窦炎。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善颈部淋巴结细针穿刺活检作为首选病理确诊手段。\nB. 完善全身PET-CT检查，若无远处转移则直接开始根治性放疗。\nC. 完善电子鼻咽镜检查评估局部侵犯范围，暂不取活检以防大出血。\nD. 完善鼻咽镜检查并取活检，同时行颈部淋巴结切除活检以明确分期。\nE. 完善鼻咽部刷片细胞学检查明确病理诊断。\nF. 完善鼻内镜下鼻咽肿物切除术，术后送常规病理。\nG. 完善电子鼻咽镜检查并取活检，若首次活检阴性则按临床诊断开始化疗。\nH. 完善电子鼻咽镜检查并取活检明确病理诊断。\nI. 完善颈部淋巴结切除活检作为首选病理确诊手段。\nJ. 完善电子鼻咽镜检查并取活检，同时行预防性气管切开。\nK. 完善鼻咽镜检查并取活检，同时行扁桃体切除活检排除隐匿原发灶。\nL. 完善全身骨扫描及腹部超声，待全身分期明确后再行鼻咽活检。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：腭帆提肌。\n文本分期信息：N2，M0。\n综合TNM状态：T1N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 听力下降8月，发现左颈部包块1月余；现病史: 患者于某次就诊时间初开始无明显诱因出现听力下降，以右侧为著，未予重视。某次就诊时间7月初患者无意中发现左颈部包块，大小约4×4cm，无疼痛，无表面皮肤发红，未就诊，肿物进行性增大。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,左颈部包块,颈部肿物；既往史: 发现血糖升高一年余，未行药物治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟：30－40支/天×30余。否认饮酒史。否认不洁性生活史。；家族史: 两个舅舅分别患有肝癌及骨肿瘤。；体格检查: T：36.4℃，P：83次/分，R：20次/分，BP：100/65mmHg,Ht：164cm，Wt：87kg，BSA：1.93m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左侧颈部IIa区可扪及1个淋巴结，最大径7×3cm，无融合，质地硬，边界清，活动度差，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D0] 检验组合: 隐血(OB)-粪便: 阴性（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-粪便: 棕色；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；比重(SG)-尿液: 1.021；浊度(TRUB)-尿液: 清亮；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 5.5；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；白细胞计数(WBC#)-尿液: 3/μL；虫卵-粪便: 未见虫卵（参考: 未见虫卵）\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理增多增粗，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，右肋膈角锐利，左肋膈角模糊。；检查结论: 考虑双肺慢性支气管炎X线改变。 左侧胸膜稍增厚。\n- [全程D1] 检验组合: 人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；载脂蛋白B(apoB)-静脉血: 1.08g/L；间接胆红素(IBIL)-静脉血: 5.9umolL；钾离子(K+)-静脉血: 4.1mmol/L；阴离子间隙(AG)-静脉血: 17.5；血红蛋白(Hb)-静脉血: 151g/L；凝血酶原时间活动度(PTA)-静脉血: 113.8%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；单核细胞计数(Mono#)-静脉血: 0.610E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.99mmol/L；ABO血型-静脉血: O；中性粒细胞百分比(Neut%)-静脉血: 0.578；血小板比容-静脉血: 24%；Rh血型-静脉血: 阳性；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 5.12mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；梅毒非特异性抗体甲苯胺红不加热血清试验(TRUST)-静脉血: 阴性(-)（参考: 阴性）；淋巴细胞百分比(Lymph%)-静脉血: 0.307；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.9；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 7.9umol/L；白细胞计数(WBC#)-静脉血: 7.610E9/L；直接胆红素(DBIL)-静脉血: 2umol/L；红细胞计数(RBC#)-静脉血: 5.2510E12/L；白蛋白(ALB)-静脉血: 42.2g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；红细胞比容(Hct)-静脉血: 44.7%；糖化血红蛋白A1c(HbA1c)-静脉血: 7.2%；总蛋白(TP)-静脉血: 76.24g/L；凝血酶时间(TT)-静脉血: 18.9sec.；纤维蛋白原(Fbg)-静脉血: 2.44g/L；钠离子(Na+)-静脉血……\n- [全程D4] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔变窄，鼻咽各壁粘膜明显增厚，见结节状肿物向鼻咽腔内突出，T1WI呈等信号，T2WI呈稍高信号，增强扫描轻度不均匀强化，双侧咽隐窝见肿物填塞。口咽双侧壁未见受累增厚，病变未累及双侧后鼻孔。 双侧腭帆提肌受侵，双侧腭帆张肌及头长肌、双侧翼内外肌未见受侵征象。 双侧翼腭窝、双侧上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 颅底骨质未见破坏。 双侧海绵窦形态未见异常。 双侧筛窦、双侧上颌窦粘膜增厚，增强扫描呈轻度强化。双侧乳突未见分泌物。 双眼未见异常，球后未见占位性病变。蝶鞍形态未见异常，其内未见占位性病变。 双侧咽后见淋巴结，大小约7mm×9mm，增强扫描明显强化。 双颈II区、左颈III区见多个肿大淋巴结，最大约33mm×27mm，边界欠清，增强扫描呈明显强化。 右颈III区、双颈I区见数个小淋巴结，最大约5mm×11mm，边界清楚，孤立散在。 甲状腺双叶及峡部形态未见异常，信号均匀，未见占位性病变。喉咽腔形态未见异常，未见占位性病变。双侧颌下腺、腮腺大小、形态未见异常，信号均匀，未见占位性病变。 扫描所见脑组织未见明确异常。；检查结论: 鼻咽肿物，考虑鼻咽癌。 颅底骨质未见破坏。 双侧咽后、双颈II区、左颈III区肿大淋巴结，考虑转移。 鼻窦炎。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善颈部淋巴结细针穿刺活检作为首选病理确诊手段。\nB. 完善全身PET-CT检查，若无远处转移则直接开始根治性放疗。\nC. 完善电子鼻咽镜检查评估局部侵犯范围，暂不取活检以防大出血。\nD. 完善鼻咽镜检查并取活检，同时行颈部淋巴结切除活检以明确分期。\nE. 完善鼻咽部刷片细胞学检查明确病理诊断。\nF. 完善鼻内镜下鼻咽肿物切除术，术后送常规病理。\nG. 完善电子鼻咽镜检查并取活检，若首次活检阴性则按临床诊断开始化疗。\nH. 完善电子鼻咽镜检查并取活检明确病理诊断。\nI. 完善颈部淋巴结切除活检作为首选病理确诊手段。\nJ. 完善电子鼻咽镜检查并取活检，同时行预防性气管切开。\nK. 完善鼻咽镜检查并取活检，同时行扁桃体切除活检排除隐匿原发灶。\nL. 完善全身骨扫描及腹部超声，待全身分期明确后再行鼻咽活检。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-7ff1cd1ea3ebf1a9891b521d","patient_id":"patient-9bf5c8c03860cdf61108611d","turn_id":"turn05","turn_position":3,"turn_type":"toxicity_or_support_decision","gold_letter":"K","gold_action":"按原剂量行第二程GP（吉西他滨+顺铂）诱导化疗，并辅以常规止吐、护胃及水化利尿等支持治疗。","options":[{"letter":"A","text":"暂缓化疗，给予重组人血小板生成素升血小板治疗，待血小板恢复至正常范围后原剂量行第二程GP诱导化疗。","is_gold":false},{"letter":"B","text":"行第二程GP诱导化疗，吉西他滨剂量下调25%，顺铂维持原剂量，辅以常规止吐及水化利尿等支持治疗。","is_gold":false},{"letter":"C","text":"停用GP诱导化疗方案，直接转入根治性单纯放疗阶段，并安排心血管专科随访与干预。","is_gold":false},{"letter":"D","text":"更改诱导化疗方案，将第二程方案由GP（吉西他滨+顺铂）调整为TP（多西他赛+顺铂）方案并按原剂量给药。","is_gold":false},{"letter":"E","text":"按原剂量行第二程GP诱导化疗，并于化疗结束后预防性给予聚乙二醇化重组人粒细胞刺激因子支持。","is_gold":false},{"letter":"F","text":"暂缓化疗，请心血管内科会诊并完善超声心动图等检查，待心血管专科评估通过后再行第二程GP化疗。","is_gold":false},{"letter":"G","text":"按原剂量行第二程GP诱导化疗，并同步皮下注射重组人促红细胞生成素以提升血红蛋白水平。","is_gold":false},{"letter":"H","text":"行第二程GP诱导化疗，顺铂剂量下调25%，吉西他滨维持原剂量，辅以常规止吐及水化利尿等支持治疗。","is_gold":false},{"letter":"I","text":"终止诱导化疗，直接进入根治性同步放化疗阶段，同步化疗采用单药顺铂标准剂量方案。","is_gold":false},{"letter":"J","text":"按原剂量行第二程GP诱导化疗，化疗前预防性输注单采血小板1个治疗量以降低出血风险。","is_gold":false},{"letter":"K","text":"按原剂量行第二程GP诱导化疗，并辅以常规止吐、护胃及水化利尿等支持治疗。","is_gold":true},{"letter":"L","text":"按原剂量行第二程GP诱导化疗，并预防性加用异甘草酸镁等保肝药物以防止化疗相关肝损伤。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：腭帆提肌。\n文本分期信息：N2，M0。\n综合TNM状态：T1N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 听力下降8月，发现左颈部包块1月余；现病史: 患者于某次就诊时间初开始无明显诱因出现听力下降，以右侧为著，未予重视。某次就诊时间7月初患者无意中发现左颈部包块，大小约4×4cm，无疼痛，无表面皮肤发红，未就诊，肿物进行性增大。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,左颈部包块,颈部肿物；既往史: 发现血糖升高一年余，未行药物治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟：30－40支/天×30余。否认饮酒史。否认不洁性生活史。；家族史: 两个舅舅分别患有肝癌及骨肿瘤。；体格检查: T：36.4℃，P：83次/分，R：20次/分，BP：100/65mmHg,Ht：164cm，Wt：87kg，BSA：1.93m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左侧颈部IIa区可扪及1个淋巴结，最大径7×3cm，无融合，质地硬，边界清，活动度差，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D8] 入院记录: 主诉: 听力下降8月，发现左颈部包块1月余；现病史: 简要入院病史:患者于某次就诊时间初开始无明显诱因出现听力下降，以右侧为著，未予重视。某次就诊时间7月初患者无意中发现左颈部包块，大小约4×4cm，无疼痛，无表面皮肤发红，未就诊，肿物进行性增大。8月初肿物增大至鸡蛋大小，就诊地域信息已隐藏，行颈部肿块穿刺，病理回报：转移癌可能性大。8－11行鼻咽＋颈部MRI提示：鼻咽双侧壁及顶后壁软组织增厚，考虑鼻咽癌并双侧咽后、双颈部多发淋巴结肿大。胸部MRI检查未见异常。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,左颈部包块,颈部肿物；既往史: 发现血糖升高一年余，未行药物治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、肾病”病史；否认手术、外伤、输血史及献血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D0] 检验组合: 隐血(OB)-粪便: 阴性（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-粪便: 棕色；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；比重(SG)-尿液: 1.021；浊度(TRUB)-尿液: 清亮；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 5.5；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；白细胞计数(WBC#)-尿液: 3/μL；虫卵-粪便: 未见虫卵（参考: 未见虫卵）\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理增多增粗，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，右肋膈角锐利，左肋膈角模糊。；检查结论: 考虑双肺慢性支气管炎X线改变。 左侧胸膜稍增厚。\n- [全程D1] 检验组合: 人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；载脂蛋白B(apoB)-静脉血: 1.08g/L；间接胆红素(IBIL)-静脉血: 5.9umolL；钾离子(K+)-静脉血: 4.1mmol/L；阴离子间隙(AG)-静脉血: 17.5；血红蛋白(Hb)-静脉血: 151g/L；凝血酶原时间活动度(PTA)-静脉血: 113.8%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；单核细胞计数(Mono#)-静脉血: 0.610E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.99mmol/L；ABO血型-静脉血: O；中性粒细胞百分比(Neut%)-静脉血: 0.578；血小板比容-静脉血: 24%；Rh血型-静脉血: 阳性；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 5.12mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；梅毒非特异性抗体甲苯胺红不加热血清试验(TRUST)-静脉血: 阴性(-)（参考: 阴性）；淋巴细胞百分比(Lymph%)-静脉血: 0.307；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.9；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 7.9umol/L；白细胞计数(WBC#)-静脉血: 7.610E9/L；直接胆红素(DBIL)-静脉血: 2umol/L；红细胞计数(RBC#)-静脉血: 5.2510E12/L；白蛋白(ALB)-静脉血: 42.2g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；红细胞比容(Hct)-静脉血: 44.7%；糖化血红蛋白A1c(HbA1c)-静脉血: 7.2%；总蛋白(TP)-静脉血: 76.24g/L；凝血酶时间(TT)-静脉血: 18.9sec.；纤维蛋白原(Fbg)-静脉血: 2.44g/L；钠离子(Na+)-静脉血……\n- [全程D4] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔变窄，鼻咽各壁粘膜明显增厚，见结节状肿物向鼻咽腔内突出，T1WI呈等信号，T2WI呈稍高信号，增强扫描轻度不均匀强化，双侧咽隐窝见肿物填塞。口咽双侧壁未见受累增厚，病变未累及双侧后鼻孔。 双侧腭帆提肌受侵，双侧腭帆张肌及头长肌、双侧翼内外肌未见受侵征象。 双侧翼腭窝、双侧上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 颅底骨质未见破坏。 双侧海绵窦形态未见异常。 双侧筛窦、双侧上颌窦粘膜增厚，增强扫描呈轻度强化。双侧乳突未见分泌物。 双眼未见异常，球后未见占位性病变。蝶鞍形态未见异常，其内未见占位性病变。 双侧咽后见淋巴结，大小约7mm×9mm，增强扫描明显强化。 双颈II区、左颈III区见多个肿大淋巴结，最大约33mm×27mm，边界欠清，增强扫描呈明显强化。 右颈III区、双颈I区见数个小淋巴结，最大约5mm×11mm，边界清楚，孤立散在。 甲状腺双叶及峡部形态未见异常，信号均匀，未见占位性病变。喉咽腔形态未见异常，未见占位性病变。双侧颌下腺、腮腺大小、形态未见异常，信号均匀，未见占位性病变。 扫描所见脑组织未见明确异常。；检查结论: 鼻咽肿物，考虑鼻咽癌。 颅底骨质未见破坏。 双侧咽后、双颈II区、左颈III区肿大淋巴结，考虑转移。 鼻窦炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D5] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约15cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D7] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 双上颌骨可见片状放射性浓集灶。胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 双上颌骨炎症。 余全身骨骼未见明显异常。\n- [全程D12] 检验组合: 平均红细胞血红蛋白浓度(MCHC)-静脉血: 340g/L；血小板比容-静脉血: 24%；单核细胞计数(Mono#)-静脉血: 0.110E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；红细胞比容(Hct)-静脉血: 41.8%；平均红细胞血红蛋白含量(MCH)-静脉血: 29pg；单核细胞百分比(Mono%)-静脉血: 0.016；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.1；平均血小板体积(MPV)-静脉血: 10.3fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.007；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；红细胞计数(RBC#)-静脉血: 4.8910E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；大血小板百分比(P-LCR%)-静脉血: 27%；淋巴细胞百分比(Lymph%)-静脉血: 0.422；血小板计数(PLT#)-静脉血: 23710E9/L；平均红细胞体积(MCV)-静脉血: 85.5fL；淋巴细胞计数(Lymph#)-静脉血: 310E9/L；白细胞计数(WBC#)-静脉血: 710E9/L；血小板分布宽度(PDW)-静脉血: 11.6%；血红蛋白(Hb)-静脉血: 142g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；中性粒细胞百分比(Neut%)-静脉血: 0.552\n- [全程D15] 检验组合: 单核细胞计数(Mono#)-静脉血: 0.310E9/L；血小板计数(PLT#)-静脉血: 19810E9/L；红细胞比容(Hct)-静脉血: 44.3%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13；大血小板百分比(P-LCR%)-静脉血: 22.1%；红细胞计数(RBC#)-静脉血: 5.2510E12/L；淋巴细胞百分比(Lymph%)-静脉血: 0.443；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；血小板比容-静脉血: 19%；血红蛋白(Hb)-静脉血: 151g/L；血小板分布宽度(PDW)-静脉血: 11.5%；平均红细胞体积(MCV)-静脉血: 84.4fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.033；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；单核细胞百分比(Mono%)-静脉血: 0.059；平均血小板体积(MPV)-静脉血: 9.5fL；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.46；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；白细胞计数(WBC#)-静脉血: 5.7610E9/L；淋巴细胞计数(Lymph#)-静脉血: 2.610E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.8\n- [全程D19] 检验组合: 中性粒细胞计数(Neut#)-静脉血: 5.210E9/L；单核细胞计数(Mono#)-静脉血: 0.110E9/L；血红蛋白(Hb)-静脉血: 131g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.231；红细胞计数(RBC#)-静脉血: 4.510E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.742；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；大血小板百分比(P-LCR%)-静脉血: 21.7%；血小板计数(PLT#)-静脉血: 14310E9/L；血小板分布宽度(PDW)-静脉血: 10.7%；平均红细胞体积(MCV)-静脉血: 88.9fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.6；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；血小板比容-静脉血: 14%；白细胞计数(WBC#)-静脉血: 710E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.3；单核细胞百分比(Mono%)-静脉血: 0.01；平均血小板体积(MPV)-静脉血: 9.5fL；红细胞比容(Hct)-静脉血: 40%；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L\n- [全程D27] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 拟不完全性右束支传导阻滞\n- [全程D27] 检验组合: 镁离子(Mg2+)-静脉血: 0.82mmol/L；氯离子(Cl-)-静脉血: 103.6mmol/L；总胆固醇(TC)-静脉血: 5.1mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.25mmol/L；总胆汁酸(TBA)-静脉血: 4.1umol/L；肌酐(Crea)-静脉血: 76.9umol/L；直接胆红素(DBIL)-静脉血: 1.6umol/L；总钙(Ca)-静脉血: 2.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 19.8U/L；总蛋白(TP)-静脉血: 75.08g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.29；尿酸(UA)-静脉血: 440.4umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 19.1mmol/L；磷(P)-静脉血: 1.09mmol/L；胱抑素(Cys-C)-静脉血: 1.21mg/L；C-反应蛋白(CRP)-静脉血: 4.53mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.06mmolL；碱性磷酸酶(ALP)-静脉血: 84.7U/L；白蛋白(ALB)-静脉血: 42.3g/L；载脂蛋白B(apoB)-静脉血: 1.13g/L；球蛋白(GLO)-静脉血: 32.78g/L；尿素氮(BUN)-静脉血: 7.3mmol/L；钠离子(Na+)-静脉血: 138.8mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 47.8U/L；甘油三酯(TG)-静脉血: 2.38mmol/L；乳酸脱氢酶(LDH)-静脉血: 183.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 54U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.2U/L；葡萄糖(Glu)-静脉血: 7.26mmol/L；总胆红素(TBIL)-静脉血: 5.3umol/L；载脂蛋白AI(apoAI)-静脉血: 1.29g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.92；钾离子(K+)-静脉血: 4.48mmol/L；间接胆红素(IBIL)-静脉血: 3.7umolL；阴离子间隙(AG)-静脉血: 16.1\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂缓化疗，给予重组人血小板生成素升血小板治疗，待血小板恢复至正常范围后原剂量行第二程GP诱导化疗。\nB. 行第二程GP诱导化疗，吉西他滨剂量下调25%，顺铂维持原剂量，辅以常规止吐及水化利尿等支持治疗。\nC. 停用GP诱导化疗方案，直接转入根治性单纯放疗阶段，并安排心血管专科随访与干预。\nD. 更改诱导化疗方案，将第二程方案由GP（吉西他滨+顺铂）调整为TP（多西他赛+顺铂）方案并按原剂量给药。\nE. 按原剂量行第二程GP诱导化疗，并于化疗结束后预防性给予聚乙二醇化重组人粒细胞刺激因子支持。\nF. 暂缓化疗，请心血管内科会诊并完善超声心动图等检查，待心血管专科评估通过后再行第二程GP化疗。\nG. 按原剂量行第二程GP诱导化疗，并同步皮下注射重组人促红细胞生成素以提升血红蛋白水平。\nH. 行第二程GP诱导化疗，顺铂剂量下调25%，吉西他滨维持原剂量，辅以常规止吐及水化利尿等支持治疗。\nI. 终止诱导化疗，直接进入根治性同步放化疗阶段，同步化疗采用单药顺铂标准剂量方案。\nJ. 按原剂量行第二程GP诱导化疗，化疗前预防性输注单采血小板1个治疗量以降低出血风险。\nK. 按原剂量行第二程GP诱导化疗，并辅以常规止吐、护胃及水化利尿等支持治疗。\nL. 按原剂量行第二程GP诱导化疗，并预防性加用异甘草酸镁等保肝药物以防止化疗相关肝损伤。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：腭帆提肌。\n文本分期信息：N2，M0。\n综合TNM状态：T1N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 听力下降8月，发现左颈部包块1月余；现病史: 患者于某次就诊时间初开始无明显诱因出现听力下降，以右侧为著，未予重视。某次就诊时间7月初患者无意中发现左颈部包块，大小约4×4cm，无疼痛，无表面皮肤发红，未就诊，肿物进行性增大。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,左颈部包块,颈部肿物；既往史: 发现血糖升高一年余，未行药物治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟：30－40支/天×30余。否认饮酒史。否认不洁性生活史。；家族史: 两个舅舅分别患有肝癌及骨肿瘤。；体格检查: T：36.4℃，P：83次/分，R：20次/分，BP：100/65mmHg,Ht：164cm，Wt：87kg，BSA：1.93m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左侧颈部IIa区可扪及1个淋巴结，最大径7×3cm，无融合，质地硬，边界清，活动度差，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D8] 入院记录: 主诉: 听力下降8月，发现左颈部包块1月余；现病史: 简要入院病史:患者于某次就诊时间初开始无明显诱因出现听力下降，以右侧为著，未予重视。某次就诊时间7月初患者无意中发现左颈部包块，大小约4×4cm，无疼痛，无表面皮肤发红，未就诊，肿物进行性增大。8月初肿物增大至鸡蛋大小，就诊地域信息已隐藏，行颈部肿块穿刺，病理回报：转移癌可能性大。8－11行鼻咽＋颈部MRI提示：鼻咽双侧壁及顶后壁软组织增厚，考虑鼻咽癌并双侧咽后、双颈部多发淋巴结肿大。胸部MRI检查未见异常。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,左颈部包块,颈部肿物；既往史: 发现血糖升高一年余，未行药物治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、肾病”病史；否认手术、外伤、输血史及献血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D0] 检验组合: 隐血(OB)-粪便: 阴性（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-粪便: 棕色；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；比重(SG)-尿液: 1.021；浊度(TRUB)-尿液: 清亮；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 5.5；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；白细胞计数(WBC#)-尿液: 3/μL；虫卵-粪便: 未见虫卵（参考: 未见虫卵）\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理增多增粗，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，右肋膈角锐利，左肋膈角模糊。；检查结论: 考虑双肺慢性支气管炎X线改变。 左侧胸膜稍增厚。\n- [全程D1] 检验组合: 人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；载脂蛋白B(apoB)-静脉血: 1.08g/L；间接胆红素(IBIL)-静脉血: 5.9umolL；钾离子(K+)-静脉血: 4.1mmol/L；阴离子间隙(AG)-静脉血: 17.5；血红蛋白(Hb)-静脉血: 151g/L；凝血酶原时间活动度(PTA)-静脉血: 113.8%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；单核细胞计数(Mono#)-静脉血: 0.610E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.99mmol/L；ABO血型-静脉血: O；中性粒细胞百分比(Neut%)-静脉血: 0.578；血小板比容-静脉血: 24%；Rh血型-静脉血: 阳性；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 5.12mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；梅毒非特异性抗体甲苯胺红不加热血清试验(TRUST)-静脉血: 阴性(-)（参考: 阴性）；淋巴细胞百分比(Lymph%)-静脉血: 0.307；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.9；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 7.9umol/L；白细胞计数(WBC#)-静脉血: 7.610E9/L；直接胆红素(DBIL)-静脉血: 2umol/L；红细胞计数(RBC#)-静脉血: 5.2510E12/L；白蛋白(ALB)-静脉血: 42.2g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；红细胞比容(Hct)-静脉血: 44.7%；糖化血红蛋白A1c(HbA1c)-静脉血: 7.2%；总蛋白(TP)-静脉血: 76.24g/L；凝血酶时间(TT)-静脉血: 18.9sec.；纤维蛋白原(Fbg)-静脉血: 2.44g/L；钠离子(Na+)-静脉血……\n- [全程D4] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔变窄，鼻咽各壁粘膜明显增厚，见结节状肿物向鼻咽腔内突出，T1WI呈等信号，T2WI呈稍高信号，增强扫描轻度不均匀强化，双侧咽隐窝见肿物填塞。口咽双侧壁未见受累增厚，病变未累及双侧后鼻孔。 双侧腭帆提肌受侵，双侧腭帆张肌及头长肌、双侧翼内外肌未见受侵征象。 双侧翼腭窝、双侧上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 颅底骨质未见破坏。 双侧海绵窦形态未见异常。 双侧筛窦、双侧上颌窦粘膜增厚，增强扫描呈轻度强化。双侧乳突未见分泌物。 双眼未见异常，球后未见占位性病变。蝶鞍形态未见异常，其内未见占位性病变。 双侧咽后见淋巴结，大小约7mm×9mm，增强扫描明显强化。 双颈II区、左颈III区见多个肿大淋巴结，最大约33mm×27mm，边界欠清，增强扫描呈明显强化。 右颈III区、双颈I区见数个小淋巴结，最大约5mm×11mm，边界清楚，孤立散在。 甲状腺双叶及峡部形态未见异常，信号均匀，未见占位性病变。喉咽腔形态未见异常，未见占位性病变。双侧颌下腺、腮腺大小、形态未见异常，信号均匀，未见占位性病变。 扫描所见脑组织未见明确异常。；检查结论: 鼻咽肿物，考虑鼻咽癌。 颅底骨质未见破坏。 双侧咽后、双颈II区、左颈III区肿大淋巴结，考虑转移。 鼻窦炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D5] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约15cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D7] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 双上颌骨可见片状放射性浓集灶。胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 双上颌骨炎症。 余全身骨骼未见明显异常。\n- [全程D12] 检验组合: 平均红细胞血红蛋白浓度(MCHC)-静脉血: 340g/L；血小板比容-静脉血: 24%；单核细胞计数(Mono#)-静脉血: 0.110E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；红细胞比容(Hct)-静脉血: 41.8%；平均红细胞血红蛋白含量(MCH)-静脉血: 29pg；单核细胞百分比(Mono%)-静脉血: 0.016；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.1；平均血小板体积(MPV)-静脉血: 10.3fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.007；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；红细胞计数(RBC#)-静脉血: 4.8910E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；大血小板百分比(P-LCR%)-静脉血: 27%；淋巴细胞百分比(Lymph%)-静脉血: 0.422；血小板计数(PLT#)-静脉血: 23710E9/L；平均红细胞体积(MCV)-静脉血: 85.5fL；淋巴细胞计数(Lymph#)-静脉血: 310E9/L；白细胞计数(WBC#)-静脉血: 710E9/L；血小板分布宽度(PDW)-静脉血: 11.6%；血红蛋白(Hb)-静脉血: 142g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；中性粒细胞百分比(Neut%)-静脉血: 0.552\n- [全程D15] 检验组合: 单核细胞计数(Mono#)-静脉血: 0.310E9/L；血小板计数(PLT#)-静脉血: 19810E9/L；红细胞比容(Hct)-静脉血: 44.3%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13；大血小板百分比(P-LCR%)-静脉血: 22.1%；红细胞计数(RBC#)-静脉血: 5.2510E12/L；淋巴细胞百分比(Lymph%)-静脉血: 0.443；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；血小板比容-静脉血: 19%；血红蛋白(Hb)-静脉血: 151g/L；血小板分布宽度(PDW)-静脉血: 11.5%；平均红细胞体积(MCV)-静脉血: 84.4fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.033；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；单核细胞百分比(Mono%)-静脉血: 0.059；平均血小板体积(MPV)-静脉血: 9.5fL；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.46；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；白细胞计数(WBC#)-静脉血: 5.7610E9/L；淋巴细胞计数(Lymph#)-静脉血: 2.610E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.8\n- [全程D19] 检验组合: 中性粒细胞计数(Neut#)-静脉血: 5.210E9/L；单核细胞计数(Mono#)-静脉血: 0.110E9/L；血红蛋白(Hb)-静脉血: 131g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.231；红细胞计数(RBC#)-静脉血: 4.510E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.742；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；大血小板百分比(P-LCR%)-静脉血: 21.7%；血小板计数(PLT#)-静脉血: 14310E9/L；血小板分布宽度(PDW)-静脉血: 10.7%；平均红细胞体积(MCV)-静脉血: 88.9fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.6；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；血小板比容-静脉血: 14%；白细胞计数(WBC#)-静脉血: 710E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.3；单核细胞百分比(Mono%)-静脉血: 0.01；平均血小板体积(MPV)-静脉血: 9.5fL；红细胞比容(Hct)-静脉血: 40%；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L\n- [全程D27] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 拟不完全性右束支传导阻滞\n- [全程D27] 检验组合: 镁离子(Mg2+)-静脉血: 0.82mmol/L；氯离子(Cl-)-静脉血: 103.6mmol/L；总胆固醇(TC)-静脉血: 5.1mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.25mmol/L；总胆汁酸(TBA)-静脉血: 4.1umol/L；肌酐(Crea)-静脉血: 76.9umol/L；直接胆红素(DBIL)-静脉血: 1.6umol/L；总钙(Ca)-静脉血: 2.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 19.8U/L；总蛋白(TP)-静脉血: 75.08g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.29；尿酸(UA)-静脉血: 440.4umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 19.1mmol/L；磷(P)-静脉血: 1.09mmol/L；胱抑素(Cys-C)-静脉血: 1.21mg/L；C-反应蛋白(CRP)-静脉血: 4.53mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.06mmolL；碱性磷酸酶(ALP)-静脉血: 84.7U/L；白蛋白(ALB)-静脉血: 42.3g/L；载脂蛋白B(apoB)-静脉血: 1.13g/L；球蛋白(GLO)-静脉血: 32.78g/L；尿素氮(BUN)-静脉血: 7.3mmol/L；钠离子(Na+)-静脉血: 138.8mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 47.8U/L；甘油三酯(TG)-静脉血: 2.38mmol/L；乳酸脱氢酶(LDH)-静脉血: 183.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 54U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.2U/L；葡萄糖(Glu)-静脉血: 7.26mmol/L；总胆红素(TBIL)-静脉血: 5.3umol/L；载脂蛋白AI(apoAI)-静脉血: 1.29g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.92；钾离子(K+)-静脉血: 4.48mmol/L；间接胆红素(IBIL)-静脉血: 3.7umolL；阴离子间隙(AG)-静脉血: 16.1\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂缓化疗，给予重组人血小板生成素升血小板治疗，待血小板恢复至正常范围后原剂量行第二程GP诱导化疗。\nB. 行第二程GP诱导化疗，吉西他滨剂量下调25%，顺铂维持原剂量，辅以常规止吐及水化利尿等支持治疗。\nC. 停用GP诱导化疗方案，直接转入根治性单纯放疗阶段，并安排心血管专科随访与干预。\nD. 更改诱导化疗方案，将第二程方案由GP（吉西他滨+顺铂）调整为TP（多西他赛+顺铂）方案并按原剂量给药。\nE. 按原剂量行第二程GP诱导化疗，并于化疗结束后预防性给予聚乙二醇化重组人粒细胞刺激因子支持。\nF. 暂缓化疗，请心血管内科会诊并完善超声心动图等检查，待心血管专科评估通过后再行第二程GP化疗。\nG. 按原剂量行第二程GP诱导化疗，并同步皮下注射重组人促红细胞生成素以提升血红蛋白水平。\nH. 行第二程GP诱导化疗，顺铂剂量下调25%，吉西他滨维持原剂量，辅以常规止吐及水化利尿等支持治疗。\nI. 终止诱导化疗，直接进入根治性同步放化疗阶段，同步化疗采用单药顺铂标准剂量方案。\nJ. 按原剂量行第二程GP诱导化疗，化疗前预防性输注单采血小板1个治疗量以降低出血风险。\nK. 按原剂量行第二程GP诱导化疗，并辅以常规止吐、护胃及水化利尿等支持治疗。\nL. 按原剂量行第二程GP诱导化疗，并预防性加用异甘草酸镁等保肝药物以防止化疗相关肝损伤。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-9fc5959f48286f0a038d3acb","patient_id":"patient-9bf5c8c03860cdf61108611d","turn_id":"turn07","turn_position":4,"turn_type":"response_assessment_decision","gold_letter":"A","gold_action":"完善鼻咽及颈部MRI评估疗效；取消同期顺铂化疗，予以纠正贫血并单纯根治性调强放疗（或联合靶向治疗）。","options":[{"letter":"A","text":"完善鼻咽及颈部MRI评估疗效；取消同期顺铂化疗，予以纠正贫血并单纯根治性调强放疗（或联合靶向治疗）。","is_gold":true},{"letter":"B","text":"完善鼻咽及颈部MRI评估疗效；按原计划行同期顺铂化疗联合根治性调强放疗。","is_gold":false},{"letter":"C","text":"完善鼻咽及颈部MRI评估疗效；将同期顺铂减量至40mg/m2周疗，联合根治性调强放疗。","is_gold":false},{"letter":"D","text":"完善鼻咽及颈部MRI评估疗效；将同期化疗方案更换为卡铂，联合根治性调强放疗。","is_gold":false},{"letter":"E","text":"完善鼻咽及颈部MRI评估疗效；暂停抗肿瘤治疗，待血红蛋白恢复至100g/L以上后再行同期放化疗。","is_gold":false},{"letter":"F","text":"完善鼻咽及颈部MRI评估疗效；予以输血支持，待贫血纠正后按原计划行同期顺铂化疗联合调强放疗。","is_gold":false},{"letter":"G","text":"完善鼻咽及颈部MRI评估疗效；取消同期顺铂化疗，直接行根治性调强放疗，暂不予纠正贫血。","is_gold":false},{"letter":"H","text":"完善鼻咽及颈部MRI评估疗效；将同期化疗方案更换为氟尿嘧啶单药，联合根治性调强放疗。","is_gold":false},{"letter":"I","text":"完善鼻咽及颈部MRI评估疗效；取消同期顺铂化疗，予以纠正贫血并联合PD-1抑制剂及调强放疗。","is_gold":false},{"letter":"J","text":"完善鼻咽及颈部MRI评估疗效；将同期化疗方案更换为吉西他滨单药，联合根治性调强放疗。","is_gold":false},{"letter":"K","text":"完善鼻咽及颈部MRI评估疗效；取消放疗，继续行非铂类方案（如紫杉醇单药）化疗。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：腭帆提肌。\n文本分期信息：N2，M0。\n综合TNM状态：T1N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 听力下降8月，发现左颈部包块1月余；现病史: 患者于某次就诊时间初开始无明显诱因出现听力下降，以右侧为著，未予重视。某次就诊时间7月初患者无意中发现左颈部包块，大小约4×4cm，无疼痛，无表面皮肤发红，未就诊，肿物进行性增大。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,左颈部包块,颈部肿物；既往史: 发现血糖升高一年余，未行药物治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟：30－40支/天×30余。否认饮酒史。否认不洁性生活史。；家族史: 两个舅舅分别患有肝癌及骨肿瘤。；体格检查: T：36.4℃，P：83次/分，R：20次/分，BP：100/65mmHg,Ht：164cm，Wt：87kg，BSA：1.93m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左侧颈部IIa区可扪及1个淋巴结，最大径7×3cm，无融合，质地硬，边界清，活动度差，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D8] 入院记录: 主诉: 听力下降8月，发现左颈部包块1月余；现病史: 简要入院病史:患者于某次就诊时间初开始无明显诱因出现听力下降，以右侧为著，未予重视。某次就诊时间7月初患者无意中发现左颈部包块，大小约4×4cm，无疼痛，无表面皮肤发红，未就诊，肿物进行性增大。8月初肿物增大至鸡蛋大小，就诊地域信息已隐藏，行颈部肿块穿刺，病理回报：转移癌可能性大。8－11行鼻咽＋颈部MRI提示：鼻咽双侧壁及顶后壁软组织增厚，考虑鼻咽癌并双侧咽后、双颈部多发淋巴结肿大。胸部MRI检查未见异常。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,左颈部包块,颈部肿物；既往史: 发现血糖升高一年余，未行药物治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、肾病”病史；否认手术、外伤、输血史及献血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n- [全程D69] 入院记录: 主诉: 鼻咽癌3程诱导化疗后2周；现病史: 患者于某次就诊时间初开始无明显诱因出现听力下降，以右侧为著，未予重视。某次就诊时间7月初患者无意中发现左颈部包块，大小约4×4cm，无疼痛，无表面皮肤发红，未就诊，肿物进行性增大。8月初肿物增大至鸡蛋大小，就诊地域信息已隐藏，行颈部肿块穿刺，病理回报：转移癌可能性大。8－11行鼻咽＋颈部MRI提示：鼻咽双侧壁及顶后壁软组织增厚，考虑鼻咽癌并双侧咽后、双颈部多发淋巴结肿大。胸部MRI检查未见异常。于某次就诊时间、某次就诊时间、某次就诊时间我院各行一程GP诱导化疗，（剂量：吉西他滨：1g/m^2,d1,d8;顺铂：80mg/m^2,d1），现为同期放化疗入院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,左颈部包块,颈部肿物；既往史: 发现血糖升高一年余，未行药物治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、肾病”病史；否认手术、外伤、输血史及献血史。；个人史: 长期居于原籍，无疫区居住史。吸烟：30－40支/天×30余。否认饮酒史。否认不洁性生活史。；家族史: 两个舅舅分别患有肝癌及骨肿瘤。；体格检查:；专科检查:；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D0] 检验组合: 隐血(OB)-粪便: 阴性（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-粪便: 棕色；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；比重(SG)-尿液: 1.021；浊度(TRUB)-尿液: 清亮；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 5.5；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；白细胞计数(WBC#)-尿液: 3/μL；虫卵-粪便: 未见虫卵（参考: 未见虫卵）\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理增多增粗，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，右肋膈角锐利，左肋膈角模糊。；检查结论: 考虑双肺慢性支气管炎X线改变。 左侧胸膜稍增厚。\n- [全程D1] 检验组合: 人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；载脂蛋白B(apoB)-静脉血: 1.08g/L；间接胆红素(IBIL)-静脉血: 5.9umolL；钾离子(K+)-静脉血: 4.1mmol/L；阴离子间隙(AG)-静脉血: 17.5；血红蛋白(Hb)-静脉血: 151g/L；凝血酶原时间活动度(PTA)-静脉血: 113.8%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；单核细胞计数(Mono#)-静脉血: 0.610E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.99mmol/L；ABO血型-静脉血: O；中性粒细胞百分比(Neut%)-静脉血: 0.578；血小板比容-静脉血: 24%；Rh血型-静脉血: 阳性；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 5.12mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；梅毒非特异性抗体甲苯胺红不加热血清试验(TRUST)-静脉血: 阴性(-)（参考: 阴性）；淋巴细胞百分比(Lymph%)-静脉血: 0.307；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.9；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 7.9umol/L；白细胞计数(WBC#)-静脉血: 7.610E9/L；直接胆红素(DBIL)-静脉血: 2umol/L；红细胞计数(RBC#)-静脉血: 5.2510E12/L；白蛋白(ALB)-静脉血: 42.2g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；红细胞比容(Hct)-静脉血: 44.7%；糖化血红蛋白A1c(HbA1c)-静脉血: 7.2%；总蛋白(TP)-静脉血: 76.24g/L；凝血酶时间(TT)-静脉血: 18.9sec.；纤维蛋白原(Fbg)-静脉血: 2.44g/L；钠离子(Na+)-静脉血……\n- [全程D4] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔变窄，鼻咽各壁粘膜明显增厚，见结节状肿物向鼻咽腔内突出，T1WI呈等信号，T2WI呈稍高信号，增强扫描轻度不均匀强化，双侧咽隐窝见肿物填塞。口咽双侧壁未见受累增厚，病变未累及双侧后鼻孔。 双侧腭帆提肌受侵，双侧腭帆张肌及头长肌、双侧翼内外肌未见受侵征象。 双侧翼腭窝、双侧上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 颅底骨质未见破坏。 双侧海绵窦形态未见异常。 双侧筛窦、双侧上颌窦粘膜增厚，增强扫描呈轻度强化。双侧乳突未见分泌物。 双眼未见异常，球后未见占位性病变。蝶鞍形态未见异常，其内未见占位性病变。 双侧咽后见淋巴结，大小约7mm×9mm，增强扫描明显强化。 双颈II区、左颈III区见多个肿大淋巴结，最大约33mm×27mm，边界欠清，增强扫描呈明显强化。 右颈III区、双颈I区见数个小淋巴结，最大约5mm×11mm，边界清楚，孤立散在。 甲状腺双叶及峡部形态未见异常，信号均匀，未见占位性病变。喉咽腔形态未见异常，未见占位性病变。双侧颌下腺、腮腺大小、形态未见异常，信号均匀，未见占位性病变。 扫描所见脑组织未见明确异常。；检查结论: 鼻咽肿物，考虑鼻咽癌。 颅底骨质未见破坏。 双侧咽后、双颈II区、左颈III区肿大淋巴结，考虑转移。 鼻窦炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D5] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约15cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D7] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 双上颌骨可见片状放射性浓集灶。胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 双上颌骨炎症。 余全身骨骼未见明显异常。\n- [全程D12] 检验组合: 平均红细胞血红蛋白浓度(MCHC)-静脉血: 340g/L；血小板比容-静脉血: 24%；单核细胞计数(Mono#)-静脉血: 0.110E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；红细胞比容(Hct)-静脉血: 41.8%；平均红细胞血红蛋白含量(MCH)-静脉血: 29pg；单核细胞百分比(Mono%)-静脉血: 0.016；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.1；平均血小板体积(MPV)-静脉血: 10.3fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.007；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；红细胞计数(RBC#)-静脉血: 4.8910E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；大血小板百分比(P-LCR%)-静脉血: 27%；淋巴细胞百分比(Lymph%)-静脉血: 0.422；血小板计数(PLT#)-静脉血: 23710E9/L；平均红细胞体积(MCV)-静脉血: 85.5fL；淋巴细胞计数(Lymph#)-静脉血: 310E9/L；白细胞计数(WBC#)-静脉血: 710E9/L；血小板分布宽度(PDW)-静脉血: 11.6%；血红蛋白(Hb)-静脉血: 142g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；中性粒细胞百分比(Neut%)-静脉血: 0.552\n- [全程D15] 检验组合: 单核细胞计数(Mono#)-静脉血: 0.310E9/L；血小板计数(PLT#)-静脉血: 19810E9/L；红细胞比容(Hct)-静脉血: 44.3%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13；大血小板百分比(P-LCR%)-静脉血: 22.1%；红细胞计数(RBC#)-静脉血: 5.2510E12/L；淋巴细胞百分比(Lymph%)-静脉血: 0.443；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；血小板比容-静脉血: 19%；血红蛋白(Hb)-静脉血: 151g/L；血小板分布宽度(PDW)-静脉血: 11.5%；平均红细胞体积(MCV)-静脉血: 84.4fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.033；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；单核细胞百分比(Mono%)-静脉血: 0.059；平均血小板体积(MPV)-静脉血: 9.5fL；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.46；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；白细胞计数(WBC#)-静脉血: 5.7610E9/L；淋巴细胞计数(Lymph#)-静脉血: 2.610E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.8\n- [全程D19] 检验组合: 中性粒细胞计数(Neut#)-静脉血: 5.210E9/L；单核细胞计数(Mono#)-静脉血: 0.110E9/L；血红蛋白(Hb)-静脉血: 131g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.231；红细胞计数(RBC#)-静脉血: 4.510E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.742；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；大血小板百分比(P-LCR%)-静脉血: 21.7%；血小板计数(PLT#)-静脉血: 14310E9/L；血小板分布宽度(PDW)-静脉血: 10.7%；平均红细胞体积(MCV)-静脉血: 88.9fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.6；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；血小板比容-静脉血: 14%；白细胞计数(WBC#)-静脉血: 710E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.3；单核细胞百分比(Mono%)-静脉血: 0.01；平均血小板体积(MPV)-静脉血: 9.5fL；红细胞比容(Hct)-静脉血: 40%；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L\n- [全程D27] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 拟不完全性右束支传导阻滞\n- [全程D27] 检验组合: 镁离子(Mg2+)-静脉血: 0.82mmol/L；氯离子(Cl-)-静脉血: 103.6mmol/L；总胆固醇(TC)-静脉血: 5.1mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.25mmol/L；总胆汁酸(TBA)-静脉血: 4.1umol/L；肌酐(Crea)-静脉血: 76.9umol/L；直接胆红素(DBIL)-静脉血: 1.6umol/L；总钙(Ca)-静脉血: 2.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 19.8U/L；总蛋白(TP)-静脉血: 75.08g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.29；尿酸(UA)-静脉血: 440.4umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 19.1mmol/L；磷(P)-静脉血: 1.09mmol/L；胱抑素(Cys-C)-静脉血: 1.21mg/L；C-反应蛋白(CRP)-静脉血: 4.53mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.06mmolL；碱性磷酸酶(ALP)-静脉血: 84.7U/L；白蛋白(ALB)-静脉血: 42.3g/L；载脂蛋白B(apoB)-静脉血: 1.13g/L；球蛋白(GLO)-静脉血: 32.78g/L；尿素氮(BUN)-静脉血: 7.3mmol/L；钠离子(Na+)-静脉血: 138.8mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 47.8U/L；甘油三酯(TG)-静脉血: 2.38mmol/L；乳酸脱氢酶(LDH)-静脉血: 183.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 54U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.2U/L；葡萄糖(Glu)-静脉血: 7.26mmol/L；总胆红素(TBIL)-静脉血: 5.3umol/L；载脂蛋白AI(apoAI)-静脉血: 1.29g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.92；钾离子(K+)-静脉血: 4.48mmol/L；间接胆红素(IBIL)-静脉血: 3.7umolL；阴离子间隙(AG)-静脉血: 16.1\n- [全程D64] 检验组合: 肌酐(Crea)-静脉血: 160.7umol/L；葡萄糖(Glu)-静脉血: 8.34mmol/L；碱性磷酸酶(ALP)-静脉血: 72.1U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 55U/L；C-反应蛋白(CRP)-静脉血: 2.43mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.94mmol/L；总胆固醇(TC)-静脉血: 4.9mmol/L；镁离子(Mg2+)-静脉血: 0.61mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；总钙(Ca)-静脉血: 2.32mmol/L；氯离子(Cl-)-静脉血: 96.3mmol/L；甘油三酯(TG)-静脉血: 2.49mmol/L；尿素氮(BUN)-静脉血: 9.9mmol/L；直接胆红素(DBIL)-静脉血: 2.6umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.2mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 23.9U/L；载脂蛋白B(apoB)-静脉血: 1.05g/L；乳酸脱氢酶(LDH)-静脉血: 221.5U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.43；间接胆红素(IBIL)-静脉血: 5.8umolL；尿酸(UA)-静脉血: 602.1umol/L；球蛋白(GLO)-静脉血: 30.83g/L；胱抑素(Cys-C)-静脉血: 1.84mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.13mmolL；γ-谷氨酰基转移酶(GGT)-静脉血: 54.4U/L；总胆红素(TBIL)-静脉血: 8.4umol/L；钾离子(K+)-静脉血: 3.86mmol/L；白蛋白(ALB)-静脉血: 44g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.97；丙氨酸氨基转移酶(ALT)-静脉血: 24.7U/L；磷(P)-静脉血: 1.33mmol/L；总胆汁酸(TBA)-静脉血: 2.2umol/L；钠离子(Na+)-静脉血: 136.5mmol/L；阴离子间隙(AG)-静脉血: 15；总蛋白(TP)-静脉血: 74.83g/L\n- [全程D71] 检验组合: 平均红细胞体积(MCV)-静脉血: 86.5fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.015；中性粒细胞计数(Neut#)-静脉血: 2.210E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.8；血红蛋白(Hb)-静脉血: 111g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.011；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.36；平均红细胞血红蛋白浓度(MCHC)-静脉血: 352g/L；红细胞计数(RBC#)-静脉血: 3.6410E12/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.482；大血小板百分比(P-LCR%)-静脉血: 19.1%；血小板比容-静脉血: 10%；平均血小板体积(MPV)-静脉血: 9.3fL；红细胞比容(Hct)-静脉血: 31.5%；单核细胞百分比(Mono%)-静脉血: 0.132；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；血小板分布宽度(PDW)-静脉血: 9.1%；血小板计数(PLT#)-静脉血: 10910E9/L；白细胞计数(WBC#)-静脉血: 4.610E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.1\n- [全程D78] 检验组合: 嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；红细胞比容(Hct)-静脉血: 31.2%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；血小板计数(PLT#)-静脉血: 22110E9/L；血小板比容-静脉血: 20%；大血小板百分比(P-LCR%)-静脉血: 19.1%；单核细胞百分比(Mono%)-静脉血: 0.108；血红蛋白(Hb)-静脉血: 108g/L；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；血小板分布宽度(PDW)-静脉血: 10%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.02；白细胞计数(WBC#)-静脉血: 4.510E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.653；平均红细胞体积(MCV)-静脉血: 86.9fL；平均血小板体积(MPV)-静脉血: 9.2fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.9；中性粒细胞计数(Neut#)-静脉血: 310E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.215；平均红细胞血红蛋白浓度(MCHC)-静脉血: 346g/L；红细胞计数(RBC#)-静脉血: 3.5910E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；单核细胞计数(Mono#)-静脉血: 0.510E9/L\n- [全程D85] 检验组合: 平均血小板体积(MPV)-静脉血: 9fL；血小板计数(PLT#)-静脉血: 26310E9/L；血小板分布宽度(PDW)-静脉血: 9.9%；淋巴细胞计数(Lymph#)-静脉血: 1.210E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.9；血红蛋白(Hb)-静脉血: 103g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；平均红细胞体积(MCV)-静脉血: 88.5fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.7；白细胞计数(WBC#)-静脉血: 4.2910E9/L；大血小板百分比(P-LCR%)-静脉血: 17.7%；单核细胞百分比(Mono%)-静脉血: 0.191；平均红细胞血红蛋白含量(MCH)-静脉血: 30.3pg；血小板比容-静脉血: 24%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 342g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞计数(RBC#)-静脉血: 3.410E12/L；红细胞比容(Hct)-静脉血: 30.1%；淋巴细胞百分比(Lymph%)-静脉血: 0.27；中性粒细胞百分比(Neut%)-静脉血: 0.513；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.021；单核细胞计数(Mono#)-静脉血: 0.810E9/L；中性粒细胞计数(Neut#)-静脉血: 2.210E9/L\n- [全程D85] 检验组合: 总胆固醇(TC)-静脉血: 5mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 41U/L；球蛋白(GLO)-静脉血: 29.79g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.3；血液二氧化碳含量ctCO2(B)-静脉血: 20.9mmol/L；钠离子(Na+)-静脉血: 137.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.12g/L；载脂蛋白B(apoB)-静脉血: 1.02g/L；丙氨酸氨基转移酶(ALT)-静脉血: 15.3U/L；阴离子间隙(AG)-静脉血: 16；氯离子(Cl-)-静脉血: 100.4mmol/L；磷(P)-静脉血: 1.27mmol/L；总钙(Ca)-静脉血: 2.29mmol/L；总胆红素(TBIL)-静脉血: 10.7umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 32.1U/L；尿酸(UA)-静脉血: 642.2umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.2mmol/L；钾离子(K+)-静脉血: 4.6mmol/L；镁离子(Mg2+)-静脉血: 0.56mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20.5U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；间接胆红素(IBIL)-静脉血: 6.8umolL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；胱抑素(Cys-C)-静脉血: 1.89mg/L；肌酐(Crea)-静脉血: 171.5umol/L；碱性磷酸酶(ALP)-静脉血: 55.8U/L；乳酸脱氢酶(LDH)-静脉血: 182U/L；总胆汁酸(TBA)-静脉血: 1.2umol/L；总蛋白(TP)-静脉血: 72.99g/L；直接胆红素(DBIL)-静脉血: 3.9umol/L；C-反应蛋白(CRP)-静脉血: 2.96mg/L；甘油三酯(TG)-静脉血: 2.22mmol/L；葡萄糖(Glu)-静脉血: 6.63mmol/L；尿素氮(BUN)-静脉血: 10.78mmol/L；白蛋白(ALB)-静脉血: 43.2g/L\n- [全程D92] 检验组合: 嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；单核细胞百分比(Mono%)-静脉血: 0.13；中性粒细胞计数(Neut#)-静脉血: 5.310E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.7pg；血小板比容-静脉血: 24%；红细胞计数(RBC#)-静脉血: 3.3610E12/L；平均红细胞体积(MCV)-静脉血: 89.9fL；血红蛋白(Hb)-静脉血: 103g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.9；单核细胞计数(Mono#)-静脉血: 0.910E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；血小板计数(PLT#)-静脉血: 26210E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；大血小板百分比(P-LCR%)-静脉血: 17.3%；白细胞计数(WBC#)-静脉血: 710E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.103；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.8；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；中性粒细胞百分比(Neut%)-静脉血: 0.757；红细胞比容(Hct)-静脉血: 30.2%；血小板分布宽度(PDW)-静脉血: 9.9%；平均血小板体积(MPV)-静脉血: 9.1fL\n- [全程D99] 检验组合: 球蛋白(GLO)-静脉血: 25.82g/L；血小板比容-静脉血: 12%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 4.5umol/L；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 14.7mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.104；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；总胆红素(TBIL)-静脉血: 11.3umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 33.1U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.1；总钙(Ca)-静脉血: 1.94mmol/L；间接胆红素(IBIL)-静脉血: 6.8umolL；血红蛋白(Hb)-静脉血: 92g/L；肌酐(Crea)-静脉血: 230.6umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.53；单核细胞计数(Mono#)-静脉血: 0.710E9/L；磷(P)-静脉血: 1.43mmol/L；尿素氮(BUN)-静脉血: 14.3mmol/L；尿酸(UA)-静脉血: 664.3umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.5；氯离子(Cl-)-静脉血: 101.4mmol/L；镁离子(Mg2+)-静脉血: 0.39mmol/L；载脂蛋白AI(apoAI)-静脉血: 0.93g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；红细胞比容(Hct)-静脉血: 27.4%；γ-谷氨酰基转移酶(GGT)-静脉血: 32.2U/L；阴离子间隙(AG)-静脉血: 22；血小板分布宽度(PDW)-静脉血: 10.5%；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.41；总蛋白(TP)-静脉血: 65.22g/L；单核细胞百分比(Mono%)-静脉血: 0.138；白蛋白(ALB)-静脉血: 39.4g/L；乳酸脱氢酶(LDH)-静脉血: 174.3U/L；C-反应蛋白(CRP)-静脉血: 5.63mg/L；血小板计数(PLT#)-静脉血: 13410E9/L；总胆汁酸(TBA)-静脉血: 1.9um……\n- [全程D103] 检验组合: 白蛋白(ALB)-静脉血: 38.8g/L；肌酐(Crea)-静脉血: 213.9umol/L；球蛋白(GLO)-静脉血: 26.15g/L；间接胆红素(IBIL)-静脉血: 6.6umolL；总胆红素(TBIL)-静脉血: 10.9umol/L；总蛋白(TP)-静脉血: 64.95g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.48；直接胆红素(DBIL)-静脉血: 4.3umol/L；尿素氮(BUN)-静脉血: 14.5mmol/L；尿酸(UA)-静脉血: 660.5umol/L\n- [全程D106] 检验组合: 平均血小板体积(MPV)-静脉血: 9.5fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44.6；血小板计数(PLT#)-静脉血: 7110E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；血红蛋白(Hb)-静脉血: 75g/L；红细胞比容(Hct)-静脉血: 21.6%；白细胞计数(WBC#)-静脉血: 3.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.089；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；单核细胞计数(Mono#)-静脉血: 0.310E9/L；血小板分布宽度(PDW)-静脉血: 9.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 31.9pg；中性粒细胞百分比(Neut%)-静脉血: 0.784；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；大血小板百分比(P-LCR%)-静脉血: 20.6%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.098；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板比容-静脉血: 6%；红细胞计数(RBC#)-静脉血: 2.3510E12/L；平均红细胞体积(MCV)-静脉血: 91.9fL\n- [全程D109] 检验组合: 红细胞比容(Hct)-静脉血: 21.5%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.7；白细胞计数(WBC#)-静脉血: 4.210E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.4pg；单核细胞百分比(Mono%)-静脉血: 0.057；平均红细胞血红蛋白浓度(MCHC)-静脉血: 335g/L；血红蛋白(Hb)-静脉血: 72g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；红细胞计数(RBC#)-静脉血: 2.2910E12/L；血小板计数(PLT#)-静脉血: 6210E9/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.041；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；大血小板百分比(P-LCR%)-静脉血: 21.1%；平均血小板体积(MPV)-静脉血: 9.4fL；平均红细胞体积(MCV)-静脉血: 93.9fL；血小板比容-静脉血: 6%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；血小板分布宽度(PDW)-静脉血: 10.3%；中性粒细胞百分比(Neut%)-静脉血: 0.847；淋巴细胞百分比(Lymph%)-静脉血: 0.05；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L\n- [全程D113] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.082；血小板分布宽度(PDW)-静脉血: 10.8%；淋巴细胞百分比(Lymph%)-静脉血: 0.114；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；红细胞比容(Hct)-静脉血: 22.8%；平均血小板体积(MPV)-静脉血: 9.8fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 48.1；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；中性粒细胞计数(Neut#)-静脉血: 1.610E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1；白细胞计数(WBC#)-静脉血: 2.210E9/L；血小板计数(PLT#)-静脉血: 11810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.722；大血小板百分比(P-LCR%)-静脉血: 24.7%；单核细胞计数(Mono#)-静脉血: 0.210E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 320g/L；红细胞计数(RBC#)-静脉血: 2.2910E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.9pg；血小板比容-静脉血: 12%；血红蛋白(Hb)-静脉血: 73g/L；平均红细胞体积(MCV)-静脉血: 99.6fL；单核细胞百分比(Mono%)-静脉血: 0.077；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L\n- [全程D117] 检验组合: 天门冬氨酸氨基转移酶(AST)-静脉血: 14.1U/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；镁离子(Mg2+)-静脉血: 0.67mmol/L；血小板计数(PLT#)-静脉血: 23410E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.72mmolL；中性粒细胞计数(Neut#)-静脉血: 2.410E9/L；胱抑素(Cys-C)-静脉血: 2.73mg/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；血小板分布宽度(PDW)-静脉血: 10.4%；总蛋白(TP)-静脉血: 69.47g/L；大血小板百分比(P-LCR%)-静脉血: 22%；球蛋白(GLO)-静脉血: 32.07g/L；氯离子(Cl-)-静脉血: 102.3mmol/L；尿素氮(BUN)-静脉血: 14.7mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.136；丙氨酸氨基转移酶(ALT)-静脉血: 11.2U/L；葡萄糖(Glu)-静脉血: 7.22mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 19.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 0.81g/L；总胆固醇(TC)-静脉血: 4.12mmol/L；血小板比容-静脉血: 22%；C-反应蛋白(CRP)-静脉血: 15.19mg/L；总胆汁酸(TBA)-静脉血: 2.1umol/L；直接胆红素(DBIL)-静脉血: 2.3umol/L；尿酸(UA)-静脉血: 692umol/L；白细胞计数(WBC#)-静脉血: 3.710E9/L；乳酸脱氢酶(LDH)-静脉血: 178.2U/L；中性粒细胞百分比(Neut%)-静脉血: 0.651；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；肌酐(Crea)-静脉血: 220.1umol/L；红细胞计数(RBC#)-静脉血: 2.3510E12/L；钠离子(Na+)-静脉血: 138.8mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.26；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.6mmol/L；红细胞比容(Hct)-静脉血: 23.1%；钾离子(K+)-静脉血: 4.79mmol/L……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 完善鼻咽及颈部MRI评估疗效；取消同期顺铂化疗，予以纠正贫血并单纯根治性调强放疗（或联合靶向治疗）。\nB. 完善鼻咽及颈部MRI评估疗效；按原计划行同期顺铂化疗联合根治性调强放疗。\nC. 完善鼻咽及颈部MRI评估疗效；将同期顺铂减量至40mg/m2周疗，联合根治性调强放疗。\nD. 完善鼻咽及颈部MRI评估疗效；将同期化疗方案更换为卡铂，联合根治性调强放疗。\nE. 完善鼻咽及颈部MRI评估疗效；暂停抗肿瘤治疗，待血红蛋白恢复至100g/L以上后再行同期放化疗。\nF. 完善鼻咽及颈部MRI评估疗效；予以输血支持，待贫血纠正后按原计划行同期顺铂化疗联合调强放疗。\nG. 完善鼻咽及颈部MRI评估疗效；取消同期顺铂化疗，直接行根治性调强放疗，暂不予纠正贫血。\nH. 完善鼻咽及颈部MRI评估疗效；将同期化疗方案更换为氟尿嘧啶单药，联合根治性调强放疗。\nI. 完善鼻咽及颈部MRI评估疗效；取消同期顺铂化疗，予以纠正贫血并联合PD-1抑制剂及调强放疗。\nJ. 完善鼻咽及颈部MRI评估疗效；将同期化疗方案更换为吉西他滨单药，联合根治性调强放疗。\nK. 完善鼻咽及颈部MRI评估疗效；取消放疗，继续行非铂类方案（如紫杉醇单药）化疗。\n\n请仅输出一个选项字母（A-K）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：腭帆提肌。\n文本分期信息：N2，M0。\n综合TNM状态：T1N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 听力下降8月，发现左颈部包块1月余；现病史: 患者于某次就诊时间初开始无明显诱因出现听力下降，以右侧为著，未予重视。某次就诊时间7月初患者无意中发现左颈部包块，大小约4×4cm，无疼痛，无表面皮肤发红，未就诊，肿物进行性增大。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,左颈部包块,颈部肿物；既往史: 发现血糖升高一年余，未行药物治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟：30－40支/天×30余。否认饮酒史。否认不洁性生活史。；家族史: 两个舅舅分别患有肝癌及骨肿瘤。；体格检查: T：36.4℃，P：83次/分，R：20次/分，BP：100/65mmHg,Ht：164cm，Wt：87kg，BSA：1.93m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左侧颈部IIa区可扪及1个淋巴结，最大径7×3cm，无融合，质地硬，边界清，活动度差，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D8] 入院记录: 主诉: 听力下降8月，发现左颈部包块1月余；现病史: 简要入院病史:患者于某次就诊时间初开始无明显诱因出现听力下降，以右侧为著，未予重视。某次就诊时间7月初患者无意中发现左颈部包块，大小约4×4cm，无疼痛，无表面皮肤发红，未就诊，肿物进行性增大。8月初肿物增大至鸡蛋大小，就诊地域信息已隐藏，行颈部肿块穿刺，病理回报：转移癌可能性大。8－11行鼻咽＋颈部MRI提示：鼻咽双侧壁及顶后壁软组织增厚，考虑鼻咽癌并双侧咽后、双颈部多发淋巴结肿大。胸部MRI检查未见异常。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,左颈部包块,颈部肿物；既往史: 发现血糖升高一年余，未行药物治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、肾病”病史；否认手术、外伤、输血史及献血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n- [全程D69] 入院记录: 主诉: 鼻咽癌3程诱导化疗后2周；现病史: 患者于某次就诊时间初开始无明显诱因出现听力下降，以右侧为著，未予重视。某次就诊时间7月初患者无意中发现左颈部包块，大小约4×4cm，无疼痛，无表面皮肤发红，未就诊，肿物进行性增大。8月初肿物增大至鸡蛋大小，就诊地域信息已隐藏，行颈部肿块穿刺，病理回报：转移癌可能性大。8－11行鼻咽＋颈部MRI提示：鼻咽双侧壁及顶后壁软组织增厚，考虑鼻咽癌并双侧咽后、双颈部多发淋巴结肿大。胸部MRI检查未见异常。于某次就诊时间、某次就诊时间、某次就诊时间我院各行一程GP诱导化疗，（剂量：吉西他滨：1g/m^2,d1,d8;顺铂：80mg/m^2,d1），现为同期放化疗入院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,左颈部包块,颈部肿物；既往史: 发现血糖升高一年余，未行药物治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、肾病”病史；否认手术、外伤、输血史及献血史。；个人史: 长期居于原籍，无疫区居住史。吸烟：30－40支/天×30余。否认饮酒史。否认不洁性生活史。；家族史: 两个舅舅分别患有肝癌及骨肿瘤。；体格检查:；专科检查:；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D0] 检验组合: 隐血(OB)-粪便: 阴性（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-粪便: 棕色；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；比重(SG)-尿液: 1.021；浊度(TRUB)-尿液: 清亮；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 5.5；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；白细胞计数(WBC#)-尿液: 3/μL；虫卵-粪便: 未见虫卵（参考: 未见虫卵）\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理增多增粗，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，右肋膈角锐利，左肋膈角模糊。；检查结论: 考虑双肺慢性支气管炎X线改变。 左侧胸膜稍增厚。\n- [全程D1] 检验组合: 人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；载脂蛋白B(apoB)-静脉血: 1.08g/L；间接胆红素(IBIL)-静脉血: 5.9umolL；钾离子(K+)-静脉血: 4.1mmol/L；阴离子间隙(AG)-静脉血: 17.5；血红蛋白(Hb)-静脉血: 151g/L；凝血酶原时间活动度(PTA)-静脉血: 113.8%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；单核细胞计数(Mono#)-静脉血: 0.610E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.99mmol/L；ABO血型-静脉血: O；中性粒细胞百分比(Neut%)-静脉血: 0.578；血小板比容-静脉血: 24%；Rh血型-静脉血: 阳性；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 5.12mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；梅毒非特异性抗体甲苯胺红不加热血清试验(TRUST)-静脉血: 阴性(-)（参考: 阴性）；淋巴细胞百分比(Lymph%)-静脉血: 0.307；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.9；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 7.9umol/L；白细胞计数(WBC#)-静脉血: 7.610E9/L；直接胆红素(DBIL)-静脉血: 2umol/L；红细胞计数(RBC#)-静脉血: 5.2510E12/L；白蛋白(ALB)-静脉血: 42.2g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；红细胞比容(Hct)-静脉血: 44.7%；糖化血红蛋白A1c(HbA1c)-静脉血: 7.2%；总蛋白(TP)-静脉血: 76.24g/L；凝血酶时间(TT)-静脉血: 18.9sec.；纤维蛋白原(Fbg)-静脉血: 2.44g/L；钠离子(Na+)-静脉血……\n- [全程D4] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔变窄，鼻咽各壁粘膜明显增厚，见结节状肿物向鼻咽腔内突出，T1WI呈等信号，T2WI呈稍高信号，增强扫描轻度不均匀强化，双侧咽隐窝见肿物填塞。口咽双侧壁未见受累增厚，病变未累及双侧后鼻孔。 双侧腭帆提肌受侵，双侧腭帆张肌及头长肌、双侧翼内外肌未见受侵征象。 双侧翼腭窝、双侧上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 颅底骨质未见破坏。 双侧海绵窦形态未见异常。 双侧筛窦、双侧上颌窦粘膜增厚，增强扫描呈轻度强化。双侧乳突未见分泌物。 双眼未见异常，球后未见占位性病变。蝶鞍形态未见异常，其内未见占位性病变。 双侧咽后见淋巴结，大小约7mm×9mm，增强扫描明显强化。 双颈II区、左颈III区见多个肿大淋巴结，最大约33mm×27mm，边界欠清，增强扫描呈明显强化。 右颈III区、双颈I区见数个小淋巴结，最大约5mm×11mm，边界清楚，孤立散在。 甲状腺双叶及峡部形态未见异常，信号均匀，未见占位性病变。喉咽腔形态未见异常，未见占位性病变。双侧颌下腺、腮腺大小、形态未见异常，信号均匀，未见占位性病变。 扫描所见脑组织未见明确异常。；检查结论: 鼻咽肿物，考虑鼻咽癌。 颅底骨质未见破坏。 双侧咽后、双颈II区、左颈III区肿大淋巴结，考虑转移。 鼻窦炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D5] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约15cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D7] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 双上颌骨可见片状放射性浓集灶。胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 双上颌骨炎症。 余全身骨骼未见明显异常。\n- [全程D12] 检验组合: 平均红细胞血红蛋白浓度(MCHC)-静脉血: 340g/L；血小板比容-静脉血: 24%；单核细胞计数(Mono#)-静脉血: 0.110E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；红细胞比容(Hct)-静脉血: 41.8%；平均红细胞血红蛋白含量(MCH)-静脉血: 29pg；单核细胞百分比(Mono%)-静脉血: 0.016；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.1；平均血小板体积(MPV)-静脉血: 10.3fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.007；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；红细胞计数(RBC#)-静脉血: 4.8910E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；大血小板百分比(P-LCR%)-静脉血: 27%；淋巴细胞百分比(Lymph%)-静脉血: 0.422；血小板计数(PLT#)-静脉血: 23710E9/L；平均红细胞体积(MCV)-静脉血: 85.5fL；淋巴细胞计数(Lymph#)-静脉血: 310E9/L；白细胞计数(WBC#)-静脉血: 710E9/L；血小板分布宽度(PDW)-静脉血: 11.6%；血红蛋白(Hb)-静脉血: 142g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；中性粒细胞百分比(Neut%)-静脉血: 0.552\n- [全程D15] 检验组合: 单核细胞计数(Mono#)-静脉血: 0.310E9/L；血小板计数(PLT#)-静脉血: 19810E9/L；红细胞比容(Hct)-静脉血: 44.3%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13；大血小板百分比(P-LCR%)-静脉血: 22.1%；红细胞计数(RBC#)-静脉血: 5.2510E12/L；淋巴细胞百分比(Lymph%)-静脉血: 0.443；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；血小板比容-静脉血: 19%；血红蛋白(Hb)-静脉血: 151g/L；血小板分布宽度(PDW)-静脉血: 11.5%；平均红细胞体积(MCV)-静脉血: 84.4fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.033；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；单核细胞百分比(Mono%)-静脉血: 0.059；平均血小板体积(MPV)-静脉血: 9.5fL；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.46；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；白细胞计数(WBC#)-静脉血: 5.7610E9/L；淋巴细胞计数(Lymph#)-静脉血: 2.610E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.8\n- [全程D19] 检验组合: 中性粒细胞计数(Neut#)-静脉血: 5.210E9/L；单核细胞计数(Mono#)-静脉血: 0.110E9/L；血红蛋白(Hb)-静脉血: 131g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.231；红细胞计数(RBC#)-静脉血: 4.510E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.742；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；大血小板百分比(P-LCR%)-静脉血: 21.7%；血小板计数(PLT#)-静脉血: 14310E9/L；血小板分布宽度(PDW)-静脉血: 10.7%；平均红细胞体积(MCV)-静脉血: 88.9fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.6；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；血小板比容-静脉血: 14%；白细胞计数(WBC#)-静脉血: 710E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.3；单核细胞百分比(Mono%)-静脉血: 0.01；平均血小板体积(MPV)-静脉血: 9.5fL；红细胞比容(Hct)-静脉血: 40%；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L\n- [全程D27] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 拟不完全性右束支传导阻滞\n- [全程D27] 检验组合: 镁离子(Mg2+)-静脉血: 0.82mmol/L；氯离子(Cl-)-静脉血: 103.6mmol/L；总胆固醇(TC)-静脉血: 5.1mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.25mmol/L；总胆汁酸(TBA)-静脉血: 4.1umol/L；肌酐(Crea)-静脉血: 76.9umol/L；直接胆红素(DBIL)-静脉血: 1.6umol/L；总钙(Ca)-静脉血: 2.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 19.8U/L；总蛋白(TP)-静脉血: 75.08g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.29；尿酸(UA)-静脉血: 440.4umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 19.1mmol/L；磷(P)-静脉血: 1.09mmol/L；胱抑素(Cys-C)-静脉血: 1.21mg/L；C-反应蛋白(CRP)-静脉血: 4.53mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.06mmolL；碱性磷酸酶(ALP)-静脉血: 84.7U/L；白蛋白(ALB)-静脉血: 42.3g/L；载脂蛋白B(apoB)-静脉血: 1.13g/L；球蛋白(GLO)-静脉血: 32.78g/L；尿素氮(BUN)-静脉血: 7.3mmol/L；钠离子(Na+)-静脉血: 138.8mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 47.8U/L；甘油三酯(TG)-静脉血: 2.38mmol/L；乳酸脱氢酶(LDH)-静脉血: 183.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 54U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.2U/L；葡萄糖(Glu)-静脉血: 7.26mmol/L；总胆红素(TBIL)-静脉血: 5.3umol/L；载脂蛋白AI(apoAI)-静脉血: 1.29g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.92；钾离子(K+)-静脉血: 4.48mmol/L；间接胆红素(IBIL)-静脉血: 3.7umolL；阴离子间隙(AG)-静脉血: 16.1\n- [全程D64] 检验组合: 肌酐(Crea)-静脉血: 160.7umol/L；葡萄糖(Glu)-静脉血: 8.34mmol/L；碱性磷酸酶(ALP)-静脉血: 72.1U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 55U/L；C-反应蛋白(CRP)-静脉血: 2.43mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.94mmol/L；总胆固醇(TC)-静脉血: 4.9mmol/L；镁离子(Mg2+)-静脉血: 0.61mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；总钙(Ca)-静脉血: 2.32mmol/L；氯离子(Cl-)-静脉血: 96.3mmol/L；甘油三酯(TG)-静脉血: 2.49mmol/L；尿素氮(BUN)-静脉血: 9.9mmol/L；直接胆红素(DBIL)-静脉血: 2.6umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.2mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 23.9U/L；载脂蛋白B(apoB)-静脉血: 1.05g/L；乳酸脱氢酶(LDH)-静脉血: 221.5U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.43；间接胆红素(IBIL)-静脉血: 5.8umolL；尿酸(UA)-静脉血: 602.1umol/L；球蛋白(GLO)-静脉血: 30.83g/L；胱抑素(Cys-C)-静脉血: 1.84mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.13mmolL；γ-谷氨酰基转移酶(GGT)-静脉血: 54.4U/L；总胆红素(TBIL)-静脉血: 8.4umol/L；钾离子(K+)-静脉血: 3.86mmol/L；白蛋白(ALB)-静脉血: 44g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.97；丙氨酸氨基转移酶(ALT)-静脉血: 24.7U/L；磷(P)-静脉血: 1.33mmol/L；总胆汁酸(TBA)-静脉血: 2.2umol/L；钠离子(Na+)-静脉血: 136.5mmol/L；阴离子间隙(AG)-静脉血: 15；总蛋白(TP)-静脉血: 74.83g/L\n- [全程D71] 检验组合: 平均红细胞体积(MCV)-静脉血: 86.5fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.015；中性粒细胞计数(Neut#)-静脉血: 2.210E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.8；血红蛋白(Hb)-静脉血: 111g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.011；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.36；平均红细胞血红蛋白浓度(MCHC)-静脉血: 352g/L；红细胞计数(RBC#)-静脉血: 3.6410E12/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.482；大血小板百分比(P-LCR%)-静脉血: 19.1%；血小板比容-静脉血: 10%；平均血小板体积(MPV)-静脉血: 9.3fL；红细胞比容(Hct)-静脉血: 31.5%；单核细胞百分比(Mono%)-静脉血: 0.132；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；血小板分布宽度(PDW)-静脉血: 9.1%；血小板计数(PLT#)-静脉血: 10910E9/L；白细胞计数(WBC#)-静脉血: 4.610E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.1\n- [全程D78] 检验组合: 嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；红细胞比容(Hct)-静脉血: 31.2%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；血小板计数(PLT#)-静脉血: 22110E9/L；血小板比容-静脉血: 20%；大血小板百分比(P-LCR%)-静脉血: 19.1%；单核细胞百分比(Mono%)-静脉血: 0.108；血红蛋白(Hb)-静脉血: 108g/L；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；血小板分布宽度(PDW)-静脉血: 10%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.02；白细胞计数(WBC#)-静脉血: 4.510E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.653；平均红细胞体积(MCV)-静脉血: 86.9fL；平均血小板体积(MPV)-静脉血: 9.2fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.9；中性粒细胞计数(Neut#)-静脉血: 310E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.215；平均红细胞血红蛋白浓度(MCHC)-静脉血: 346g/L；红细胞计数(RBC#)-静脉血: 3.5910E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；单核细胞计数(Mono#)-静脉血: 0.510E9/L\n- [全程D85] 检验组合: 平均血小板体积(MPV)-静脉血: 9fL；血小板计数(PLT#)-静脉血: 26310E9/L；血小板分布宽度(PDW)-静脉血: 9.9%；淋巴细胞计数(Lymph#)-静脉血: 1.210E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.9；血红蛋白(Hb)-静脉血: 103g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；平均红细胞体积(MCV)-静脉血: 88.5fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.7；白细胞计数(WBC#)-静脉血: 4.2910E9/L；大血小板百分比(P-LCR%)-静脉血: 17.7%；单核细胞百分比(Mono%)-静脉血: 0.191；平均红细胞血红蛋白含量(MCH)-静脉血: 30.3pg；血小板比容-静脉血: 24%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 342g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞计数(RBC#)-静脉血: 3.410E12/L；红细胞比容(Hct)-静脉血: 30.1%；淋巴细胞百分比(Lymph%)-静脉血: 0.27；中性粒细胞百分比(Neut%)-静脉血: 0.513；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.021；单核细胞计数(Mono#)-静脉血: 0.810E9/L；中性粒细胞计数(Neut#)-静脉血: 2.210E9/L\n- [全程D85] 检验组合: 总胆固醇(TC)-静脉血: 5mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 41U/L；球蛋白(GLO)-静脉血: 29.79g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.3；血液二氧化碳含量ctCO2(B)-静脉血: 20.9mmol/L；钠离子(Na+)-静脉血: 137.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.12g/L；载脂蛋白B(apoB)-静脉血: 1.02g/L；丙氨酸氨基转移酶(ALT)-静脉血: 15.3U/L；阴离子间隙(AG)-静脉血: 16；氯离子(Cl-)-静脉血: 100.4mmol/L；磷(P)-静脉血: 1.27mmol/L；总钙(Ca)-静脉血: 2.29mmol/L；总胆红素(TBIL)-静脉血: 10.7umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 32.1U/L；尿酸(UA)-静脉血: 642.2umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.2mmol/L；钾离子(K+)-静脉血: 4.6mmol/L；镁离子(Mg2+)-静脉血: 0.56mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20.5U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；间接胆红素(IBIL)-静脉血: 6.8umolL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；胱抑素(Cys-C)-静脉血: 1.89mg/L；肌酐(Crea)-静脉血: 171.5umol/L；碱性磷酸酶(ALP)-静脉血: 55.8U/L；乳酸脱氢酶(LDH)-静脉血: 182U/L；总胆汁酸(TBA)-静脉血: 1.2umol/L；总蛋白(TP)-静脉血: 72.99g/L；直接胆红素(DBIL)-静脉血: 3.9umol/L；C-反应蛋白(CRP)-静脉血: 2.96mg/L；甘油三酯(TG)-静脉血: 2.22mmol/L；葡萄糖(Glu)-静脉血: 6.63mmol/L；尿素氮(BUN)-静脉血: 10.78mmol/L；白蛋白(ALB)-静脉血: 43.2g/L\n- [全程D92] 检验组合: 嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；单核细胞百分比(Mono%)-静脉血: 0.13；中性粒细胞计数(Neut#)-静脉血: 5.310E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.7pg；血小板比容-静脉血: 24%；红细胞计数(RBC#)-静脉血: 3.3610E12/L；平均红细胞体积(MCV)-静脉血: 89.9fL；血红蛋白(Hb)-静脉血: 103g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.9；单核细胞计数(Mono#)-静脉血: 0.910E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；血小板计数(PLT#)-静脉血: 26210E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；大血小板百分比(P-LCR%)-静脉血: 17.3%；白细胞计数(WBC#)-静脉血: 710E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.103；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.8；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；中性粒细胞百分比(Neut%)-静脉血: 0.757；红细胞比容(Hct)-静脉血: 30.2%；血小板分布宽度(PDW)-静脉血: 9.9%；平均血小板体积(MPV)-静脉血: 9.1fL\n- [全程D99] 检验组合: 球蛋白(GLO)-静脉血: 25.82g/L；血小板比容-静脉血: 12%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 4.5umol/L；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 14.7mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.104；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；总胆红素(TBIL)-静脉血: 11.3umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 33.1U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.1；总钙(Ca)-静脉血: 1.94mmol/L；间接胆红素(IBIL)-静脉血: 6.8umolL；血红蛋白(Hb)-静脉血: 92g/L；肌酐(Crea)-静脉血: 230.6umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.53；单核细胞计数(Mono#)-静脉血: 0.710E9/L；磷(P)-静脉血: 1.43mmol/L；尿素氮(BUN)-静脉血: 14.3mmol/L；尿酸(UA)-静脉血: 664.3umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.5；氯离子(Cl-)-静脉血: 101.4mmol/L；镁离子(Mg2+)-静脉血: 0.39mmol/L；载脂蛋白AI(apoAI)-静脉血: 0.93g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；红细胞比容(Hct)-静脉血: 27.4%；γ-谷氨酰基转移酶(GGT)-静脉血: 32.2U/L；阴离子间隙(AG)-静脉血: 22；血小板分布宽度(PDW)-静脉血: 10.5%；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.41；总蛋白(TP)-静脉血: 65.22g/L；单核细胞百分比(Mono%)-静脉血: 0.138；白蛋白(ALB)-静脉血: 39.4g/L；乳酸脱氢酶(LDH)-静脉血: 174.3U/L；C-反应蛋白(CRP)-静脉血: 5.63mg/L；血小板计数(PLT#)-静脉血: 13410E9/L；总胆汁酸(TBA)-静脉血: 1.9um……\n- [全程D103] 检验组合: 白蛋白(ALB)-静脉血: 38.8g/L；肌酐(Crea)-静脉血: 213.9umol/L；球蛋白(GLO)-静脉血: 26.15g/L；间接胆红素(IBIL)-静脉血: 6.6umolL；总胆红素(TBIL)-静脉血: 10.9umol/L；总蛋白(TP)-静脉血: 64.95g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.48；直接胆红素(DBIL)-静脉血: 4.3umol/L；尿素氮(BUN)-静脉血: 14.5mmol/L；尿酸(UA)-静脉血: 660.5umol/L\n- [全程D106] 检验组合: 平均血小板体积(MPV)-静脉血: 9.5fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44.6；血小板计数(PLT#)-静脉血: 7110E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；血红蛋白(Hb)-静脉血: 75g/L；红细胞比容(Hct)-静脉血: 21.6%；白细胞计数(WBC#)-静脉血: 3.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.089；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；单核细胞计数(Mono#)-静脉血: 0.310E9/L；血小板分布宽度(PDW)-静脉血: 9.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 31.9pg；中性粒细胞百分比(Neut%)-静脉血: 0.784；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；大血小板百分比(P-LCR%)-静脉血: 20.6%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.098；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板比容-静脉血: 6%；红细胞计数(RBC#)-静脉血: 2.3510E12/L；平均红细胞体积(MCV)-静脉血: 91.9fL\n- [全程D109] 检验组合: 红细胞比容(Hct)-静脉血: 21.5%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.7；白细胞计数(WBC#)-静脉血: 4.210E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.4pg；单核细胞百分比(Mono%)-静脉血: 0.057；平均红细胞血红蛋白浓度(MCHC)-静脉血: 335g/L；血红蛋白(Hb)-静脉血: 72g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；红细胞计数(RBC#)-静脉血: 2.2910E12/L；血小板计数(PLT#)-静脉血: 6210E9/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.041；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；大血小板百分比(P-LCR%)-静脉血: 21.1%；平均血小板体积(MPV)-静脉血: 9.4fL；平均红细胞体积(MCV)-静脉血: 93.9fL；血小板比容-静脉血: 6%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；血小板分布宽度(PDW)-静脉血: 10.3%；中性粒细胞百分比(Neut%)-静脉血: 0.847；淋巴细胞百分比(Lymph%)-静脉血: 0.05；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L\n- [全程D113] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.082；血小板分布宽度(PDW)-静脉血: 10.8%；淋巴细胞百分比(Lymph%)-静脉血: 0.114；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；红细胞比容(Hct)-静脉血: 22.8%；平均血小板体积(MPV)-静脉血: 9.8fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 48.1；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；中性粒细胞计数(Neut#)-静脉血: 1.610E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1；白细胞计数(WBC#)-静脉血: 2.210E9/L；血小板计数(PLT#)-静脉血: 11810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.722；大血小板百分比(P-LCR%)-静脉血: 24.7%；单核细胞计数(Mono#)-静脉血: 0.210E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 320g/L；红细胞计数(RBC#)-静脉血: 2.2910E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.9pg；血小板比容-静脉血: 12%；血红蛋白(Hb)-静脉血: 73g/L；平均红细胞体积(MCV)-静脉血: 99.6fL；单核细胞百分比(Mono%)-静脉血: 0.077；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L\n- [全程D117] 检验组合: 天门冬氨酸氨基转移酶(AST)-静脉血: 14.1U/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；镁离子(Mg2+)-静脉血: 0.67mmol/L；血小板计数(PLT#)-静脉血: 23410E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.72mmolL；中性粒细胞计数(Neut#)-静脉血: 2.410E9/L；胱抑素(Cys-C)-静脉血: 2.73mg/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；血小板分布宽度(PDW)-静脉血: 10.4%；总蛋白(TP)-静脉血: 69.47g/L；大血小板百分比(P-LCR%)-静脉血: 22%；球蛋白(GLO)-静脉血: 32.07g/L；氯离子(Cl-)-静脉血: 102.3mmol/L；尿素氮(BUN)-静脉血: 14.7mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.136；丙氨酸氨基转移酶(ALT)-静脉血: 11.2U/L；葡萄糖(Glu)-静脉血: 7.22mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 19.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 0.81g/L；总胆固醇(TC)-静脉血: 4.12mmol/L；血小板比容-静脉血: 22%；C-反应蛋白(CRP)-静脉血: 15.19mg/L；总胆汁酸(TBA)-静脉血: 2.1umol/L；直接胆红素(DBIL)-静脉血: 2.3umol/L；尿酸(UA)-静脉血: 692umol/L；白细胞计数(WBC#)-静脉血: 3.710E9/L；乳酸脱氢酶(LDH)-静脉血: 178.2U/L；中性粒细胞百分比(Neut%)-静脉血: 0.651；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；肌酐(Crea)-静脉血: 220.1umol/L；红细胞计数(RBC#)-静脉血: 2.3510E12/L；钠离子(Na+)-静脉血: 138.8mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.26；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.6mmol/L；红细胞比容(Hct)-静脉血: 23.1%；钾离子(K+)-静脉血: 4.79mmol/L……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 完善鼻咽及颈部MRI评估疗效；取消同期顺铂化疗，予以纠正贫血并单纯根治性调强放疗（或联合靶向治疗）。\nB. 完善鼻咽及颈部MRI评估疗效；按原计划行同期顺铂化疗联合根治性调强放疗。\nC. 完善鼻咽及颈部MRI评估疗效；将同期顺铂减量至40mg/m2周疗，联合根治性调强放疗。\nD. 完善鼻咽及颈部MRI评估疗效；将同期化疗方案更换为卡铂，联合根治性调强放疗。\nE. 完善鼻咽及颈部MRI评估疗效；暂停抗肿瘤治疗，待血红蛋白恢复至100g/L以上后再行同期放化疗。\nF. 完善鼻咽及颈部MRI评估疗效；予以输血支持，待贫血纠正后按原计划行同期顺铂化疗联合调强放疗。\nG. 完善鼻咽及颈部MRI评估疗效；取消同期顺铂化疗，直接行根治性调强放疗，暂不予纠正贫血。\nH. 完善鼻咽及颈部MRI评估疗效；将同期化疗方案更换为氟尿嘧啶单药，联合根治性调强放疗。\nI. 完善鼻咽及颈部MRI评估疗效；取消同期顺铂化疗，予以纠正贫血并联合PD-1抑制剂及调强放疗。\nJ. 完善鼻咽及颈部MRI评估疗效；将同期化疗方案更换为吉西他滨单药，联合根治性调强放疗。\nK. 完善鼻咽及颈部MRI评估疗效；取消放疗，继续行非铂类方案（如紫杉醇单药）化疗。\n\n请仅输出一个选项字母（A-K）。"}]}
+{"sample_id":"sample-340a8b44018e54c31bcf1d9c","patient_id":"patient-9bf5c8c03860cdf61108611d","turn_id":"turn08","turn_position":5,"turn_type":"response_assessment_decision","gold_letter":"B","gold_action":"判定为放疗后改变或临床完全缓解，进入定期随访观察","options":[{"letter":"A","text":"判定为局部残留，行鼻咽及颈部挽救性手术","is_gold":false},{"letter":"B","text":"判定为放疗后改变或临床完全缓解，进入定期随访观察","is_gold":true},{"letter":"C","text":"判定为局部残留，行鼻咽及颈部局部追加放疗","is_gold":false},{"letter":"D","text":"判定为疾病稳定，启动卡培他滨维持化疗","is_gold":false},{"letter":"E","text":"判定为疾病进展，启动含铂双药联合免疫全身治疗","is_gold":false},{"letter":"F","text":"判定为放疗后改变，启动尼妥珠单抗靶向维持治疗","is_gold":false},{"letter":"G","text":"判定为颈部淋巴结残留，行双侧颈淋巴结清扫术","is_gold":false},{"letter":"H","text":"判定为颅底骨质受侵进展，行颅底病灶切除术","is_gold":false},{"letter":"I","text":"判定为疗效不确定，行全身PET-CT检查明确病灶活性","is_gold":false},{"letter":"J","text":"判定为放疗后改变，行鼻咽黏膜活检排除微小残留","is_gold":false},{"letter":"K","text":"判定为临床完全缓解，启动PD-1抑制剂维持治疗","is_gold":false},{"letter":"L","text":"判定为局部残留，行原全身化疗方案追加2个周期","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：腭帆提肌。\n文本分期信息：N2，M0。\n综合TNM状态：T1N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 听力下降8月，发现左颈部包块1月余；现病史: 患者于某次就诊时间初开始无明显诱因出现听力下降，以右侧为著，未予重视。某次就诊时间7月初患者无意中发现左颈部包块，大小约4×4cm，无疼痛，无表面皮肤发红，未就诊，肿物进行性增大。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,左颈部包块,颈部肿物；既往史: 发现血糖升高一年余，未行药物治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟：30－40支/天×30余。否认饮酒史。否认不洁性生活史。；家族史: 两个舅舅分别患有肝癌及骨肿瘤。；体格检查: T：36.4℃，P：83次/分，R：20次/分，BP：100/65mmHg,Ht：164cm，Wt：87kg，BSA：1.93m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左侧颈部IIa区可扪及1个淋巴结，最大径7×3cm，无融合，质地硬，边界清，活动度差，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D8] 入院记录: 主诉: 听力下降8月，发现左颈部包块1月余；现病史: 简要入院病史:患者于某次就诊时间初开始无明显诱因出现听力下降，以右侧为著，未予重视。某次就诊时间7月初患者无意中发现左颈部包块，大小约4×4cm，无疼痛，无表面皮肤发红，未就诊，肿物进行性增大。8月初肿物增大至鸡蛋大小，就诊地域信息已隐藏，行颈部肿块穿刺，病理回报：转移癌可能性大。8－11行鼻咽＋颈部MRI提示：鼻咽双侧壁及顶后壁软组织增厚，考虑鼻咽癌并双侧咽后、双颈部多发淋巴结肿大。胸部MRI检查未见异常。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,左颈部包块,颈部肿物；既往史: 发现血糖升高一年余，未行药物治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、肾病”病史；否认手术、外伤、输血史及献血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n- [全程D69] 入院记录: 主诉: 鼻咽癌3程诱导化疗后2周；现病史: 患者于某次就诊时间初开始无明显诱因出现听力下降，以右侧为著，未予重视。某次就诊时间7月初患者无意中发现左颈部包块，大小约4×4cm，无疼痛，无表面皮肤发红，未就诊，肿物进行性增大。8月初肿物增大至鸡蛋大小，就诊地域信息已隐藏，行颈部肿块穿刺，病理回报：转移癌可能性大。8－11行鼻咽＋颈部MRI提示：鼻咽双侧壁及顶后壁软组织增厚，考虑鼻咽癌并双侧咽后、双颈部多发淋巴结肿大。胸部MRI检查未见异常。于某次就诊时间、某次就诊时间、某次就诊时间我院各行一程GP诱导化疗，（剂量：吉西他滨：1g/m^2,d1,d8;顺铂：80mg/m^2,d1），现为同期放化疗入院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,左颈部包块,颈部肿物；既往史: 发现血糖升高一年余，未行药物治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、肾病”病史；否认手术、外伤、输血史及献血史。；个人史: 长期居于原籍，无疫区居住史。吸烟：30－40支/天×30余。否认饮酒史。否认不洁性生活史。；家族史: 两个舅舅分别患有肝癌及骨肿瘤。；体格检查:；专科检查:；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D0] 检验组合: 隐血(OB)-粪便: 阴性（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-粪便: 棕色；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；比重(SG)-尿液: 1.021；浊度(TRUB)-尿液: 清亮；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 5.5；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；白细胞计数(WBC#)-尿液: 3/μL；虫卵-粪便: 未见虫卵（参考: 未见虫卵）\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理增多增粗，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，右肋膈角锐利，左肋膈角模糊。；检查结论: 考虑双肺慢性支气管炎X线改变。 左侧胸膜稍增厚。\n- [全程D1] 检验组合: 人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；载脂蛋白B(apoB)-静脉血: 1.08g/L；间接胆红素(IBIL)-静脉血: 5.9umolL；钾离子(K+)-静脉血: 4.1mmol/L；阴离子间隙(AG)-静脉血: 17.5；血红蛋白(Hb)-静脉血: 151g/L；凝血酶原时间活动度(PTA)-静脉血: 113.8%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；单核细胞计数(Mono#)-静脉血: 0.610E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.99mmol/L；ABO血型-静脉血: O；中性粒细胞百分比(Neut%)-静脉血: 0.578；血小板比容-静脉血: 24%；Rh血型-静脉血: 阳性；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 5.12mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；梅毒非特异性抗体甲苯胺红不加热血清试验(TRUST)-静脉血: 阴性(-)（参考: 阴性）；淋巴细胞百分比(Lymph%)-静脉血: 0.307；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.9；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 7.9umol/L；白细胞计数(WBC#)-静脉血: 7.610E9/L；直接胆红素(DBIL)-静脉血: 2umol/L；红细胞计数(RBC#)-静脉血: 5.2510E12/L；白蛋白(ALB)-静脉血: 42.2g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；红细胞比容(Hct)-静脉血: 44.7%；糖化血红蛋白A1c(HbA1c)-静脉血: 7.2%；总蛋白(TP)-静脉血: 76.24g/L；凝血酶时间(TT)-静脉血: 18.9sec.；纤维蛋白原(Fbg)-静脉血: 2.44g/L；钠离子(Na+)-静脉血……\n- [全程D4] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔变窄，鼻咽各壁粘膜明显增厚，见结节状肿物向鼻咽腔内突出，T1WI呈等信号，T2WI呈稍高信号，增强扫描轻度不均匀强化，双侧咽隐窝见肿物填塞。口咽双侧壁未见受累增厚，病变未累及双侧后鼻孔。 双侧腭帆提肌受侵，双侧腭帆张肌及头长肌、双侧翼内外肌未见受侵征象。 双侧翼腭窝、双侧上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 颅底骨质未见破坏。 双侧海绵窦形态未见异常。 双侧筛窦、双侧上颌窦粘膜增厚，增强扫描呈轻度强化。双侧乳突未见分泌物。 双眼未见异常，球后未见占位性病变。蝶鞍形态未见异常，其内未见占位性病变。 双侧咽后见淋巴结，大小约7mm×9mm，增强扫描明显强化。 双颈II区、左颈III区见多个肿大淋巴结，最大约33mm×27mm，边界欠清，增强扫描呈明显强化。 右颈III区、双颈I区见数个小淋巴结，最大约5mm×11mm，边界清楚，孤立散在。 甲状腺双叶及峡部形态未见异常，信号均匀，未见占位性病变。喉咽腔形态未见异常，未见占位性病变。双侧颌下腺、腮腺大小、形态未见异常，信号均匀，未见占位性病变。 扫描所见脑组织未见明确异常。；检查结论: 鼻咽肿物，考虑鼻咽癌。 颅底骨质未见破坏。 双侧咽后、双颈II区、左颈III区肿大淋巴结，考虑转移。 鼻窦炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D5] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约15cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D7] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 双上颌骨可见片状放射性浓集灶。胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 双上颌骨炎症。 余全身骨骼未见明显异常。\n- [全程D12] 检验组合: 平均红细胞血红蛋白浓度(MCHC)-静脉血: 340g/L；血小板比容-静脉血: 24%；单核细胞计数(Mono#)-静脉血: 0.110E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；红细胞比容(Hct)-静脉血: 41.8%；平均红细胞血红蛋白含量(MCH)-静脉血: 29pg；单核细胞百分比(Mono%)-静脉血: 0.016；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.1；平均血小板体积(MPV)-静脉血: 10.3fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.007；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；红细胞计数(RBC#)-静脉血: 4.8910E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；大血小板百分比(P-LCR%)-静脉血: 27%；淋巴细胞百分比(Lymph%)-静脉血: 0.422；血小板计数(PLT#)-静脉血: 23710E9/L；平均红细胞体积(MCV)-静脉血: 85.5fL；淋巴细胞计数(Lymph#)-静脉血: 310E9/L；白细胞计数(WBC#)-静脉血: 710E9/L；血小板分布宽度(PDW)-静脉血: 11.6%；血红蛋白(Hb)-静脉血: 142g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；中性粒细胞百分比(Neut%)-静脉血: 0.552\n- [全程D15] 检验组合: 单核细胞计数(Mono#)-静脉血: 0.310E9/L；血小板计数(PLT#)-静脉血: 19810E9/L；红细胞比容(Hct)-静脉血: 44.3%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13；大血小板百分比(P-LCR%)-静脉血: 22.1%；红细胞计数(RBC#)-静脉血: 5.2510E12/L；淋巴细胞百分比(Lymph%)-静脉血: 0.443；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；血小板比容-静脉血: 19%；血红蛋白(Hb)-静脉血: 151g/L；血小板分布宽度(PDW)-静脉血: 11.5%；平均红细胞体积(MCV)-静脉血: 84.4fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.033；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；单核细胞百分比(Mono%)-静脉血: 0.059；平均血小板体积(MPV)-静脉血: 9.5fL；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.46；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；白细胞计数(WBC#)-静脉血: 5.7610E9/L；淋巴细胞计数(Lymph#)-静脉血: 2.610E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.8\n- [全程D19] 检验组合: 中性粒细胞计数(Neut#)-静脉血: 5.210E9/L；单核细胞计数(Mono#)-静脉血: 0.110E9/L；血红蛋白(Hb)-静脉血: 131g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.231；红细胞计数(RBC#)-静脉血: 4.510E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.742；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；大血小板百分比(P-LCR%)-静脉血: 21.7%；血小板计数(PLT#)-静脉血: 14310E9/L；血小板分布宽度(PDW)-静脉血: 10.7%；平均红细胞体积(MCV)-静脉血: 88.9fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.6；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；血小板比容-静脉血: 14%；白细胞计数(WBC#)-静脉血: 710E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.3；单核细胞百分比(Mono%)-静脉血: 0.01；平均血小板体积(MPV)-静脉血: 9.5fL；红细胞比容(Hct)-静脉血: 40%；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L\n- [全程D27] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 拟不完全性右束支传导阻滞\n- [全程D27] 检验组合: 镁离子(Mg2+)-静脉血: 0.82mmol/L；氯离子(Cl-)-静脉血: 103.6mmol/L；总胆固醇(TC)-静脉血: 5.1mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.25mmol/L；总胆汁酸(TBA)-静脉血: 4.1umol/L；肌酐(Crea)-静脉血: 76.9umol/L；直接胆红素(DBIL)-静脉血: 1.6umol/L；总钙(Ca)-静脉血: 2.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 19.8U/L；总蛋白(TP)-静脉血: 75.08g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.29；尿酸(UA)-静脉血: 440.4umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 19.1mmol/L；磷(P)-静脉血: 1.09mmol/L；胱抑素(Cys-C)-静脉血: 1.21mg/L；C-反应蛋白(CRP)-静脉血: 4.53mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.06mmolL；碱性磷酸酶(ALP)-静脉血: 84.7U/L；白蛋白(ALB)-静脉血: 42.3g/L；载脂蛋白B(apoB)-静脉血: 1.13g/L；球蛋白(GLO)-静脉血: 32.78g/L；尿素氮(BUN)-静脉血: 7.3mmol/L；钠离子(Na+)-静脉血: 138.8mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 47.8U/L；甘油三酯(TG)-静脉血: 2.38mmol/L；乳酸脱氢酶(LDH)-静脉血: 183.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 54U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.2U/L；葡萄糖(Glu)-静脉血: 7.26mmol/L；总胆红素(TBIL)-静脉血: 5.3umol/L；载脂蛋白AI(apoAI)-静脉血: 1.29g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.92；钾离子(K+)-静脉血: 4.48mmol/L；间接胆红素(IBIL)-静脉血: 3.7umolL；阴离子间隙(AG)-静脉血: 16.1\n- [全程D64] 检验组合: 肌酐(Crea)-静脉血: 160.7umol/L；葡萄糖(Glu)-静脉血: 8.34mmol/L；碱性磷酸酶(ALP)-静脉血: 72.1U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 55U/L；C-反应蛋白(CRP)-静脉血: 2.43mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.94mmol/L；总胆固醇(TC)-静脉血: 4.9mmol/L；镁离子(Mg2+)-静脉血: 0.61mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；总钙(Ca)-静脉血: 2.32mmol/L；氯离子(Cl-)-静脉血: 96.3mmol/L；甘油三酯(TG)-静脉血: 2.49mmol/L；尿素氮(BUN)-静脉血: 9.9mmol/L；直接胆红素(DBIL)-静脉血: 2.6umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.2mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 23.9U/L；载脂蛋白B(apoB)-静脉血: 1.05g/L；乳酸脱氢酶(LDH)-静脉血: 221.5U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.43；间接胆红素(IBIL)-静脉血: 5.8umolL；尿酸(UA)-静脉血: 602.1umol/L；球蛋白(GLO)-静脉血: 30.83g/L；胱抑素(Cys-C)-静脉血: 1.84mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.13mmolL；γ-谷氨酰基转移酶(GGT)-静脉血: 54.4U/L；总胆红素(TBIL)-静脉血: 8.4umol/L；钾离子(K+)-静脉血: 3.86mmol/L；白蛋白(ALB)-静脉血: 44g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.97；丙氨酸氨基转移酶(ALT)-静脉血: 24.7U/L；磷(P)-静脉血: 1.33mmol/L；总胆汁酸(TBA)-静脉血: 2.2umol/L；钠离子(Na+)-静脉血: 136.5mmol/L；阴离子间隙(AG)-静脉血: 15；总蛋白(TP)-静脉血: 74.83g/L\n- [全程D71] 检验组合: 平均红细胞体积(MCV)-静脉血: 86.5fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.015；中性粒细胞计数(Neut#)-静脉血: 2.210E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.8；血红蛋白(Hb)-静脉血: 111g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.011；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.36；平均红细胞血红蛋白浓度(MCHC)-静脉血: 352g/L；红细胞计数(RBC#)-静脉血: 3.6410E12/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.482；大血小板百分比(P-LCR%)-静脉血: 19.1%；血小板比容-静脉血: 10%；平均血小板体积(MPV)-静脉血: 9.3fL；红细胞比容(Hct)-静脉血: 31.5%；单核细胞百分比(Mono%)-静脉血: 0.132；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；血小板分布宽度(PDW)-静脉血: 9.1%；血小板计数(PLT#)-静脉血: 10910E9/L；白细胞计数(WBC#)-静脉血: 4.610E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.1\n- [全程D78] 检验组合: 嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；红细胞比容(Hct)-静脉血: 31.2%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；血小板计数(PLT#)-静脉血: 22110E9/L；血小板比容-静脉血: 20%；大血小板百分比(P-LCR%)-静脉血: 19.1%；单核细胞百分比(Mono%)-静脉血: 0.108；血红蛋白(Hb)-静脉血: 108g/L；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；血小板分布宽度(PDW)-静脉血: 10%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.02；白细胞计数(WBC#)-静脉血: 4.510E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.653；平均红细胞体积(MCV)-静脉血: 86.9fL；平均血小板体积(MPV)-静脉血: 9.2fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.9；中性粒细胞计数(Neut#)-静脉血: 310E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.215；平均红细胞血红蛋白浓度(MCHC)-静脉血: 346g/L；红细胞计数(RBC#)-静脉血: 3.5910E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；单核细胞计数(Mono#)-静脉血: 0.510E9/L\n- [全程D85] 检验组合: 平均血小板体积(MPV)-静脉血: 9fL；血小板计数(PLT#)-静脉血: 26310E9/L；血小板分布宽度(PDW)-静脉血: 9.9%；淋巴细胞计数(Lymph#)-静脉血: 1.210E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.9；血红蛋白(Hb)-静脉血: 103g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；平均红细胞体积(MCV)-静脉血: 88.5fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.7；白细胞计数(WBC#)-静脉血: 4.2910E9/L；大血小板百分比(P-LCR%)-静脉血: 17.7%；单核细胞百分比(Mono%)-静脉血: 0.191；平均红细胞血红蛋白含量(MCH)-静脉血: 30.3pg；血小板比容-静脉血: 24%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 342g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞计数(RBC#)-静脉血: 3.410E12/L；红细胞比容(Hct)-静脉血: 30.1%；淋巴细胞百分比(Lymph%)-静脉血: 0.27；中性粒细胞百分比(Neut%)-静脉血: 0.513；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.021；单核细胞计数(Mono#)-静脉血: 0.810E9/L；中性粒细胞计数(Neut#)-静脉血: 2.210E9/L\n- [全程D85] 检验组合: 总胆固醇(TC)-静脉血: 5mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 41U/L；球蛋白(GLO)-静脉血: 29.79g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.3；血液二氧化碳含量ctCO2(B)-静脉血: 20.9mmol/L；钠离子(Na+)-静脉血: 137.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.12g/L；载脂蛋白B(apoB)-静脉血: 1.02g/L；丙氨酸氨基转移酶(ALT)-静脉血: 15.3U/L；阴离子间隙(AG)-静脉血: 16；氯离子(Cl-)-静脉血: 100.4mmol/L；磷(P)-静脉血: 1.27mmol/L；总钙(Ca)-静脉血: 2.29mmol/L；总胆红素(TBIL)-静脉血: 10.7umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 32.1U/L；尿酸(UA)-静脉血: 642.2umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.2mmol/L；钾离子(K+)-静脉血: 4.6mmol/L；镁离子(Mg2+)-静脉血: 0.56mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20.5U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；间接胆红素(IBIL)-静脉血: 6.8umolL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；胱抑素(Cys-C)-静脉血: 1.89mg/L；肌酐(Crea)-静脉血: 171.5umol/L；碱性磷酸酶(ALP)-静脉血: 55.8U/L；乳酸脱氢酶(LDH)-静脉血: 182U/L；总胆汁酸(TBA)-静脉血: 1.2umol/L；总蛋白(TP)-静脉血: 72.99g/L；直接胆红素(DBIL)-静脉血: 3.9umol/L；C-反应蛋白(CRP)-静脉血: 2.96mg/L；甘油三酯(TG)-静脉血: 2.22mmol/L；葡萄糖(Glu)-静脉血: 6.63mmol/L；尿素氮(BUN)-静脉血: 10.78mmol/L；白蛋白(ALB)-静脉血: 43.2g/L\n- [全程D92] 检验组合: 嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；单核细胞百分比(Mono%)-静脉血: 0.13；中性粒细胞计数(Neut#)-静脉血: 5.310E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.7pg；血小板比容-静脉血: 24%；红细胞计数(RBC#)-静脉血: 3.3610E12/L；平均红细胞体积(MCV)-静脉血: 89.9fL；血红蛋白(Hb)-静脉血: 103g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.9；单核细胞计数(Mono#)-静脉血: 0.910E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；血小板计数(PLT#)-静脉血: 26210E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；大血小板百分比(P-LCR%)-静脉血: 17.3%；白细胞计数(WBC#)-静脉血: 710E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.103；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.8；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；中性粒细胞百分比(Neut%)-静脉血: 0.757；红细胞比容(Hct)-静脉血: 30.2%；血小板分布宽度(PDW)-静脉血: 9.9%；平均血小板体积(MPV)-静脉血: 9.1fL\n- [全程D99] 检验组合: 球蛋白(GLO)-静脉血: 25.82g/L；血小板比容-静脉血: 12%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 4.5umol/L；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 14.7mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.104；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；总胆红素(TBIL)-静脉血: 11.3umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 33.1U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.1；总钙(Ca)-静脉血: 1.94mmol/L；间接胆红素(IBIL)-静脉血: 6.8umolL；血红蛋白(Hb)-静脉血: 92g/L；肌酐(Crea)-静脉血: 230.6umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.53；单核细胞计数(Mono#)-静脉血: 0.710E9/L；磷(P)-静脉血: 1.43mmol/L；尿素氮(BUN)-静脉血: 14.3mmol/L；尿酸(UA)-静脉血: 664.3umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.5；氯离子(Cl-)-静脉血: 101.4mmol/L；镁离子(Mg2+)-静脉血: 0.39mmol/L；载脂蛋白AI(apoAI)-静脉血: 0.93g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；红细胞比容(Hct)-静脉血: 27.4%；γ-谷氨酰基转移酶(GGT)-静脉血: 32.2U/L；阴离子间隙(AG)-静脉血: 22；血小板分布宽度(PDW)-静脉血: 10.5%；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.41；总蛋白(TP)-静脉血: 65.22g/L；单核细胞百分比(Mono%)-静脉血: 0.138；白蛋白(ALB)-静脉血: 39.4g/L；乳酸脱氢酶(LDH)-静脉血: 174.3U/L；C-反应蛋白(CRP)-静脉血: 5.63mg/L；血小板计数(PLT#)-静脉血: 13410E9/L；总胆汁酸(TBA)-静脉血: 1.9um……\n- [全程D103] 检验组合: 白蛋白(ALB)-静脉血: 38.8g/L；肌酐(Crea)-静脉血: 213.9umol/L；球蛋白(GLO)-静脉血: 26.15g/L；间接胆红素(IBIL)-静脉血: 6.6umolL；总胆红素(TBIL)-静脉血: 10.9umol/L；总蛋白(TP)-静脉血: 64.95g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.48；直接胆红素(DBIL)-静脉血: 4.3umol/L；尿素氮(BUN)-静脉血: 14.5mmol/L；尿酸(UA)-静脉血: 660.5umol/L\n- [全程D106] 检验组合: 平均血小板体积(MPV)-静脉血: 9.5fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44.6；血小板计数(PLT#)-静脉血: 7110E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；血红蛋白(Hb)-静脉血: 75g/L；红细胞比容(Hct)-静脉血: 21.6%；白细胞计数(WBC#)-静脉血: 3.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.089；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；单核细胞计数(Mono#)-静脉血: 0.310E9/L；血小板分布宽度(PDW)-静脉血: 9.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 31.9pg；中性粒细胞百分比(Neut%)-静脉血: 0.784；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；大血小板百分比(P-LCR%)-静脉血: 20.6%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.098；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板比容-静脉血: 6%；红细胞计数(RBC#)-静脉血: 2.3510E12/L；平均红细胞体积(MCV)-静脉血: 91.9fL\n- [全程D109] 检验组合: 红细胞比容(Hct)-静脉血: 21.5%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.7；白细胞计数(WBC#)-静脉血: 4.210E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.4pg；单核细胞百分比(Mono%)-静脉血: 0.057；平均红细胞血红蛋白浓度(MCHC)-静脉血: 335g/L；血红蛋白(Hb)-静脉血: 72g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；红细胞计数(RBC#)-静脉血: 2.2910E12/L；血小板计数(PLT#)-静脉血: 6210E9/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.041；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；大血小板百分比(P-LCR%)-静脉血: 21.1%；平均血小板体积(MPV)-静脉血: 9.4fL；平均红细胞体积(MCV)-静脉血: 93.9fL；血小板比容-静脉血: 6%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；血小板分布宽度(PDW)-静脉血: 10.3%；中性粒细胞百分比(Neut%)-静脉血: 0.847；淋巴细胞百分比(Lymph%)-静脉血: 0.05；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L\n- [全程D113] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.082；血小板分布宽度(PDW)-静脉血: 10.8%；淋巴细胞百分比(Lymph%)-静脉血: 0.114；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；红细胞比容(Hct)-静脉血: 22.8%；平均血小板体积(MPV)-静脉血: 9.8fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 48.1；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；中性粒细胞计数(Neut#)-静脉血: 1.610E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1；白细胞计数(WBC#)-静脉血: 2.210E9/L；血小板计数(PLT#)-静脉血: 11810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.722；大血小板百分比(P-LCR%)-静脉血: 24.7%；单核细胞计数(Mono#)-静脉血: 0.210E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 320g/L；红细胞计数(RBC#)-静脉血: 2.2910E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.9pg；血小板比容-静脉血: 12%；血红蛋白(Hb)-静脉血: 73g/L；平均红细胞体积(MCV)-静脉血: 99.6fL；单核细胞百分比(Mono%)-静脉血: 0.077；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L\n- [全程D117] 检验组合: 天门冬氨酸氨基转移酶(AST)-静脉血: 14.1U/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；镁离子(Mg2+)-静脉血: 0.67mmol/L；血小板计数(PLT#)-静脉血: 23410E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.72mmolL；中性粒细胞计数(Neut#)-静脉血: 2.410E9/L；胱抑素(Cys-C)-静脉血: 2.73mg/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；血小板分布宽度(PDW)-静脉血: 10.4%；总蛋白(TP)-静脉血: 69.47g/L；大血小板百分比(P-LCR%)-静脉血: 22%；球蛋白(GLO)-静脉血: 32.07g/L；氯离子(Cl-)-静脉血: 102.3mmol/L；尿素氮(BUN)-静脉血: 14.7mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.136；丙氨酸氨基转移酶(ALT)-静脉血: 11.2U/L；葡萄糖(Glu)-静脉血: 7.22mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 19.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 0.81g/L；总胆固醇(TC)-静脉血: 4.12mmol/L；血小板比容-静脉血: 22%；C-反应蛋白(CRP)-静脉血: 15.19mg/L；总胆汁酸(TBA)-静脉血: 2.1umol/L；直接胆红素(DBIL)-静脉血: 2.3umol/L；尿酸(UA)-静脉血: 692umol/L；白细胞计数(WBC#)-静脉血: 3.710E9/L；乳酸脱氢酶(LDH)-静脉血: 178.2U/L；中性粒细胞百分比(Neut%)-静脉血: 0.651；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；肌酐(Crea)-静脉血: 220.1umol/L；红细胞计数(RBC#)-静脉血: 2.3510E12/L；钠离子(Na+)-静脉血: 138.8mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.26；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.6mmol/L；红细胞比容(Hct)-静脉血: 23.1%；钾离子(K+)-静脉血: 4.79mmol/L……\n- [全程D209] CT；胸、上腹CT平扫+增强: 检查类型: CT；检查名称: 胸、上腹CT平扫+增强；检查部位:；检查所见: 双肺纹理清晰，未见结节影；气管及支气管分枝通畅，未见明显软组织肿物或受压变窄；双锁上、双腋窝、双肺门及纵隔未见明显肿大淋巴结；双侧胸腔未见积液；胸膜未见增厚。 肝脏形态正常，比例正常，外形轮廓光整，密度均匀，快速注射造影剂后，动脉期未见明确异常强化灶，门脉期及平衡期未见明确低密度区，肝内见数个（约3个）囊肿影，大小约为 4 × 3 mm至 12 × 10 mm，边界清楚，密度均匀，未见强化；肝内胆管未见扩张，胆囊大小正常，内未见结石影，胆总管未见扩张；肝门区未见肿大淋巴结；门静脉未见充盈缺损；脾大小正常，密度均匀；胰腺大小、形态正常，密度均匀；双肾大小、形态正常，排泌功能正常，双肾见多个囊肿影，大小约为 3 × 3 mm 至 60 × 40 mm；双侧肾上腺大小、形态、密度正常；膈脚后、腹主动脉旁未见肿大淋巴结。 扫描范围内胸椎、腰椎、肋骨未见明确骨质破坏征象。；检查结论: 胸部、腹部未见明显占位性病变， 肝、肾囊肿。\n- [全程D210] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌放疗后复查： 鼻咽腔变窄，鼻咽各壁粘膜增厚，T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化，双侧咽隐窝变浅。口咽双侧壁未见受累增厚，病变未累及双侧后鼻孔。 双侧腭帆提肌结构欠清晰，双侧腭帆张肌及头长肌、双侧翼内外肌未见受侵征象。 双侧翼腭窝、双侧上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 双侧翼突基底部及内板骨质信号减低，增强扫描可见轻度强化。 双侧海绵窦形态未见异常。 双侧筛窦、双侧上颌窦粘膜增厚，增强扫描呈轻度强化。双侧乳突内见分泌物。 双眼未见异常，球后未见占位性病变。蝶鞍形态未见异常，其内未见占位性病变。 双侧咽后未见肿大淋巴结。 双颈II区、III区见多个小淋巴结，最大约6mm×13mm，部分边界欠，呈明显强化。 甲状腺双叶及峡部形态未见异常，信号均匀，未见占位性病变。 喉咽腔形态未见异常，未见占位性病变。 双侧颌下腺、腮腺大小、形态未见异常，信号均匀，未见占位性病变。 扫描所见脑组织未见明确异常。；检查结论: 鼻咽癌放疗后复查，与某次就诊时间片比较： 鼻咽肿物已不明显，现鼻咽粘膜增厚，考虑放疗后改变可能，建议随诊。 颅底骨质异常信号，放疗后改变？建议随诊。 双侧咽后未见肿大淋巴结。 双颈II、III区小淋巴结，较前明显缩小。 鼻窦炎；双侧乳突炎。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 判定为局部残留，行鼻咽及颈部挽救性手术\nB. 判定为放疗后改变或临床完全缓解，进入定期随访观察\nC. 判定为局部残留，行鼻咽及颈部局部追加放疗\nD. 判定为疾病稳定，启动卡培他滨维持化疗\nE. 判定为疾病进展，启动含铂双药联合免疫全身治疗\nF. 判定为放疗后改变，启动尼妥珠单抗靶向维持治疗\nG. 判定为颈部淋巴结残留，行双侧颈淋巴结清扫术\nH. 判定为颅底骨质受侵进展，行颅底病灶切除术\nI. 判定为疗效不确定，行全身PET-CT检查明确病灶活性\nJ. 判定为放疗后改变，行鼻咽黏膜活检排除微小残留\nK. 判定为临床完全缓解，启动PD-1抑制剂维持治疗\nL. 判定为局部残留，行原全身化疗方案追加2个周期\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：腭帆提肌。\n文本分期信息：N2，M0。\n综合TNM状态：T1N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 听力下降8月，发现左颈部包块1月余；现病史: 患者于某次就诊时间初开始无明显诱因出现听力下降，以右侧为著，未予重视。某次就诊时间7月初患者无意中发现左颈部包块，大小约4×4cm，无疼痛，无表面皮肤发红，未就诊，肿物进行性增大。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,左颈部包块,颈部肿物；既往史: 发现血糖升高一年余，未行药物治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟：30－40支/天×30余。否认饮酒史。否认不洁性生活史。；家族史: 两个舅舅分别患有肝癌及骨肿瘤。；体格检查: T：36.4℃，P：83次/分，R：20次/分，BP：100/65mmHg,Ht：164cm，Wt：87kg，BSA：1.93m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左侧颈部IIa区可扪及1个淋巴结，最大径7×3cm，无融合，质地硬，边界清，活动度差，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D8] 入院记录: 主诉: 听力下降8月，发现左颈部包块1月余；现病史: 简要入院病史:患者于某次就诊时间初开始无明显诱因出现听力下降，以右侧为著，未予重视。某次就诊时间7月初患者无意中发现左颈部包块，大小约4×4cm，无疼痛，无表面皮肤发红，未就诊，肿物进行性增大。8月初肿物增大至鸡蛋大小，就诊地域信息已隐藏，行颈部肿块穿刺，病理回报：转移癌可能性大。8－11行鼻咽＋颈部MRI提示：鼻咽双侧壁及顶后壁软组织增厚，考虑鼻咽癌并双侧咽后、双颈部多发淋巴结肿大。胸部MRI检查未见异常。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,左颈部包块,颈部肿物；既往史: 发现血糖升高一年余，未行药物治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、肾病”病史；否认手术、外伤、输血史及献血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n- [全程D69] 入院记录: 主诉: 鼻咽癌3程诱导化疗后2周；现病史: 患者于某次就诊时间初开始无明显诱因出现听力下降，以右侧为著，未予重视。某次就诊时间7月初患者无意中发现左颈部包块，大小约4×4cm，无疼痛，无表面皮肤发红，未就诊，肿物进行性增大。8月初肿物增大至鸡蛋大小，就诊地域信息已隐藏，行颈部肿块穿刺，病理回报：转移癌可能性大。8－11行鼻咽＋颈部MRI提示：鼻咽双侧壁及顶后壁软组织增厚，考虑鼻咽癌并双侧咽后、双颈部多发淋巴结肿大。胸部MRI检查未见异常。于某次就诊时间、某次就诊时间、某次就诊时间我院各行一程GP诱导化疗，（剂量：吉西他滨：1g/m^2,d1,d8;顺铂：80mg/m^2,d1），现为同期放化疗入院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,左颈部包块,颈部肿物；既往史: 发现血糖升高一年余，未行药物治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、肾病”病史；否认手术、外伤、输血史及献血史。；个人史: 长期居于原籍，无疫区居住史。吸烟：30－40支/天×30余。否认饮酒史。否认不洁性生活史。；家族史: 两个舅舅分别患有肝癌及骨肿瘤。；体格检查:；专科检查:；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D0] 检验组合: 隐血(OB)-粪便: 阴性（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-粪便: 棕色；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；比重(SG)-尿液: 1.021；浊度(TRUB)-尿液: 清亮；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 5.5；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；白细胞计数(WBC#)-尿液: 3/μL；虫卵-粪便: 未见虫卵（参考: 未见虫卵）\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理增多增粗，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，右肋膈角锐利，左肋膈角模糊。；检查结论: 考虑双肺慢性支气管炎X线改变。 左侧胸膜稍增厚。\n- [全程D1] 检验组合: 人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；载脂蛋白B(apoB)-静脉血: 1.08g/L；间接胆红素(IBIL)-静脉血: 5.9umolL；钾离子(K+)-静脉血: 4.1mmol/L；阴离子间隙(AG)-静脉血: 17.5；血红蛋白(Hb)-静脉血: 151g/L；凝血酶原时间活动度(PTA)-静脉血: 113.8%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；单核细胞计数(Mono#)-静脉血: 0.610E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.99mmol/L；ABO血型-静脉血: O；中性粒细胞百分比(Neut%)-静脉血: 0.578；血小板比容-静脉血: 24%；Rh血型-静脉血: 阳性；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 5.12mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；梅毒非特异性抗体甲苯胺红不加热血清试验(TRUST)-静脉血: 阴性(-)（参考: 阴性）；淋巴细胞百分比(Lymph%)-静脉血: 0.307；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.9；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 7.9umol/L；白细胞计数(WBC#)-静脉血: 7.610E9/L；直接胆红素(DBIL)-静脉血: 2umol/L；红细胞计数(RBC#)-静脉血: 5.2510E12/L；白蛋白(ALB)-静脉血: 42.2g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；红细胞比容(Hct)-静脉血: 44.7%；糖化血红蛋白A1c(HbA1c)-静脉血: 7.2%；总蛋白(TP)-静脉血: 76.24g/L；凝血酶时间(TT)-静脉血: 18.9sec.；纤维蛋白原(Fbg)-静脉血: 2.44g/L；钠离子(Na+)-静脉血……\n- [全程D4] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔变窄，鼻咽各壁粘膜明显增厚，见结节状肿物向鼻咽腔内突出，T1WI呈等信号，T2WI呈稍高信号，增强扫描轻度不均匀强化，双侧咽隐窝见肿物填塞。口咽双侧壁未见受累增厚，病变未累及双侧后鼻孔。 双侧腭帆提肌受侵，双侧腭帆张肌及头长肌、双侧翼内外肌未见受侵征象。 双侧翼腭窝、双侧上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 颅底骨质未见破坏。 双侧海绵窦形态未见异常。 双侧筛窦、双侧上颌窦粘膜增厚，增强扫描呈轻度强化。双侧乳突未见分泌物。 双眼未见异常，球后未见占位性病变。蝶鞍形态未见异常，其内未见占位性病变。 双侧咽后见淋巴结，大小约7mm×9mm，增强扫描明显强化。 双颈II区、左颈III区见多个肿大淋巴结，最大约33mm×27mm，边界欠清，增强扫描呈明显强化。 右颈III区、双颈I区见数个小淋巴结，最大约5mm×11mm，边界清楚，孤立散在。 甲状腺双叶及峡部形态未见异常，信号均匀，未见占位性病变。喉咽腔形态未见异常，未见占位性病变。双侧颌下腺、腮腺大小、形态未见异常，信号均匀，未见占位性病变。 扫描所见脑组织未见明确异常。；检查结论: 鼻咽肿物，考虑鼻咽癌。 颅底骨质未见破坏。 双侧咽后、双颈II区、左颈III区肿大淋巴结，考虑转移。 鼻窦炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D5] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约15cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D7] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 双上颌骨可见片状放射性浓集灶。胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 双上颌骨炎症。 余全身骨骼未见明显异常。\n- [全程D12] 检验组合: 平均红细胞血红蛋白浓度(MCHC)-静脉血: 340g/L；血小板比容-静脉血: 24%；单核细胞计数(Mono#)-静脉血: 0.110E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；红细胞比容(Hct)-静脉血: 41.8%；平均红细胞血红蛋白含量(MCH)-静脉血: 29pg；单核细胞百分比(Mono%)-静脉血: 0.016；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.1；平均血小板体积(MPV)-静脉血: 10.3fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.007；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；红细胞计数(RBC#)-静脉血: 4.8910E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；大血小板百分比(P-LCR%)-静脉血: 27%；淋巴细胞百分比(Lymph%)-静脉血: 0.422；血小板计数(PLT#)-静脉血: 23710E9/L；平均红细胞体积(MCV)-静脉血: 85.5fL；淋巴细胞计数(Lymph#)-静脉血: 310E9/L；白细胞计数(WBC#)-静脉血: 710E9/L；血小板分布宽度(PDW)-静脉血: 11.6%；血红蛋白(Hb)-静脉血: 142g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；中性粒细胞百分比(Neut%)-静脉血: 0.552\n- [全程D15] 检验组合: 单核细胞计数(Mono#)-静脉血: 0.310E9/L；血小板计数(PLT#)-静脉血: 19810E9/L；红细胞比容(Hct)-静脉血: 44.3%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13；大血小板百分比(P-LCR%)-静脉血: 22.1%；红细胞计数(RBC#)-静脉血: 5.2510E12/L；淋巴细胞百分比(Lymph%)-静脉血: 0.443；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；血小板比容-静脉血: 19%；血红蛋白(Hb)-静脉血: 151g/L；血小板分布宽度(PDW)-静脉血: 11.5%；平均红细胞体积(MCV)-静脉血: 84.4fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.033；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；单核细胞百分比(Mono%)-静脉血: 0.059；平均血小板体积(MPV)-静脉血: 9.5fL；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.46；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；白细胞计数(WBC#)-静脉血: 5.7610E9/L；淋巴细胞计数(Lymph#)-静脉血: 2.610E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.8\n- [全程D19] 检验组合: 中性粒细胞计数(Neut#)-静脉血: 5.210E9/L；单核细胞计数(Mono#)-静脉血: 0.110E9/L；血红蛋白(Hb)-静脉血: 131g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.231；红细胞计数(RBC#)-静脉血: 4.510E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.742；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；大血小板百分比(P-LCR%)-静脉血: 21.7%；血小板计数(PLT#)-静脉血: 14310E9/L；血小板分布宽度(PDW)-静脉血: 10.7%；平均红细胞体积(MCV)-静脉血: 88.9fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.6；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；血小板比容-静脉血: 14%；白细胞计数(WBC#)-静脉血: 710E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.3；单核细胞百分比(Mono%)-静脉血: 0.01；平均血小板体积(MPV)-静脉血: 9.5fL；红细胞比容(Hct)-静脉血: 40%；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L\n- [全程D27] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 拟不完全性右束支传导阻滞\n- [全程D27] 检验组合: 镁离子(Mg2+)-静脉血: 0.82mmol/L；氯离子(Cl-)-静脉血: 103.6mmol/L；总胆固醇(TC)-静脉血: 5.1mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.25mmol/L；总胆汁酸(TBA)-静脉血: 4.1umol/L；肌酐(Crea)-静脉血: 76.9umol/L；直接胆红素(DBIL)-静脉血: 1.6umol/L；总钙(Ca)-静脉血: 2.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 19.8U/L；总蛋白(TP)-静脉血: 75.08g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.29；尿酸(UA)-静脉血: 440.4umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 19.1mmol/L；磷(P)-静脉血: 1.09mmol/L；胱抑素(Cys-C)-静脉血: 1.21mg/L；C-反应蛋白(CRP)-静脉血: 4.53mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.06mmolL；碱性磷酸酶(ALP)-静脉血: 84.7U/L；白蛋白(ALB)-静脉血: 42.3g/L；载脂蛋白B(apoB)-静脉血: 1.13g/L；球蛋白(GLO)-静脉血: 32.78g/L；尿素氮(BUN)-静脉血: 7.3mmol/L；钠离子(Na+)-静脉血: 138.8mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 47.8U/L；甘油三酯(TG)-静脉血: 2.38mmol/L；乳酸脱氢酶(LDH)-静脉血: 183.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 54U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.2U/L；葡萄糖(Glu)-静脉血: 7.26mmol/L；总胆红素(TBIL)-静脉血: 5.3umol/L；载脂蛋白AI(apoAI)-静脉血: 1.29g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.92；钾离子(K+)-静脉血: 4.48mmol/L；间接胆红素(IBIL)-静脉血: 3.7umolL；阴离子间隙(AG)-静脉血: 16.1\n- [全程D64] 检验组合: 肌酐(Crea)-静脉血: 160.7umol/L；葡萄糖(Glu)-静脉血: 8.34mmol/L；碱性磷酸酶(ALP)-静脉血: 72.1U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 55U/L；C-反应蛋白(CRP)-静脉血: 2.43mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.94mmol/L；总胆固醇(TC)-静脉血: 4.9mmol/L；镁离子(Mg2+)-静脉血: 0.61mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；总钙(Ca)-静脉血: 2.32mmol/L；氯离子(Cl-)-静脉血: 96.3mmol/L；甘油三酯(TG)-静脉血: 2.49mmol/L；尿素氮(BUN)-静脉血: 9.9mmol/L；直接胆红素(DBIL)-静脉血: 2.6umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.2mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 23.9U/L；载脂蛋白B(apoB)-静脉血: 1.05g/L；乳酸脱氢酶(LDH)-静脉血: 221.5U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.43；间接胆红素(IBIL)-静脉血: 5.8umolL；尿酸(UA)-静脉血: 602.1umol/L；球蛋白(GLO)-静脉血: 30.83g/L；胱抑素(Cys-C)-静脉血: 1.84mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.13mmolL；γ-谷氨酰基转移酶(GGT)-静脉血: 54.4U/L；总胆红素(TBIL)-静脉血: 8.4umol/L；钾离子(K+)-静脉血: 3.86mmol/L；白蛋白(ALB)-静脉血: 44g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.97；丙氨酸氨基转移酶(ALT)-静脉血: 24.7U/L；磷(P)-静脉血: 1.33mmol/L；总胆汁酸(TBA)-静脉血: 2.2umol/L；钠离子(Na+)-静脉血: 136.5mmol/L；阴离子间隙(AG)-静脉血: 15；总蛋白(TP)-静脉血: 74.83g/L\n- [全程D71] 检验组合: 平均红细胞体积(MCV)-静脉血: 86.5fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.015；中性粒细胞计数(Neut#)-静脉血: 2.210E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.8；血红蛋白(Hb)-静脉血: 111g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.011；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.36；平均红细胞血红蛋白浓度(MCHC)-静脉血: 352g/L；红细胞计数(RBC#)-静脉血: 3.6410E12/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.482；大血小板百分比(P-LCR%)-静脉血: 19.1%；血小板比容-静脉血: 10%；平均血小板体积(MPV)-静脉血: 9.3fL；红细胞比容(Hct)-静脉血: 31.5%；单核细胞百分比(Mono%)-静脉血: 0.132；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；血小板分布宽度(PDW)-静脉血: 9.1%；血小板计数(PLT#)-静脉血: 10910E9/L；白细胞计数(WBC#)-静脉血: 4.610E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.1\n- [全程D78] 检验组合: 嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；红细胞比容(Hct)-静脉血: 31.2%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；血小板计数(PLT#)-静脉血: 22110E9/L；血小板比容-静脉血: 20%；大血小板百分比(P-LCR%)-静脉血: 19.1%；单核细胞百分比(Mono%)-静脉血: 0.108；血红蛋白(Hb)-静脉血: 108g/L；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；血小板分布宽度(PDW)-静脉血: 10%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.02；白细胞计数(WBC#)-静脉血: 4.510E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.653；平均红细胞体积(MCV)-静脉血: 86.9fL；平均血小板体积(MPV)-静脉血: 9.2fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.9；中性粒细胞计数(Neut#)-静脉血: 310E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.215；平均红细胞血红蛋白浓度(MCHC)-静脉血: 346g/L；红细胞计数(RBC#)-静脉血: 3.5910E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；单核细胞计数(Mono#)-静脉血: 0.510E9/L\n- [全程D85] 检验组合: 平均血小板体积(MPV)-静脉血: 9fL；血小板计数(PLT#)-静脉血: 26310E9/L；血小板分布宽度(PDW)-静脉血: 9.9%；淋巴细胞计数(Lymph#)-静脉血: 1.210E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.9；血红蛋白(Hb)-静脉血: 103g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；平均红细胞体积(MCV)-静脉血: 88.5fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.7；白细胞计数(WBC#)-静脉血: 4.2910E9/L；大血小板百分比(P-LCR%)-静脉血: 17.7%；单核细胞百分比(Mono%)-静脉血: 0.191；平均红细胞血红蛋白含量(MCH)-静脉血: 30.3pg；血小板比容-静脉血: 24%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 342g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞计数(RBC#)-静脉血: 3.410E12/L；红细胞比容(Hct)-静脉血: 30.1%；淋巴细胞百分比(Lymph%)-静脉血: 0.27；中性粒细胞百分比(Neut%)-静脉血: 0.513；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.021；单核细胞计数(Mono#)-静脉血: 0.810E9/L；中性粒细胞计数(Neut#)-静脉血: 2.210E9/L\n- [全程D85] 检验组合: 总胆固醇(TC)-静脉血: 5mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 41U/L；球蛋白(GLO)-静脉血: 29.79g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.3；血液二氧化碳含量ctCO2(B)-静脉血: 20.9mmol/L；钠离子(Na+)-静脉血: 137.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.12g/L；载脂蛋白B(apoB)-静脉血: 1.02g/L；丙氨酸氨基转移酶(ALT)-静脉血: 15.3U/L；阴离子间隙(AG)-静脉血: 16；氯离子(Cl-)-静脉血: 100.4mmol/L；磷(P)-静脉血: 1.27mmol/L；总钙(Ca)-静脉血: 2.29mmol/L；总胆红素(TBIL)-静脉血: 10.7umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 32.1U/L；尿酸(UA)-静脉血: 642.2umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.2mmol/L；钾离子(K+)-静脉血: 4.6mmol/L；镁离子(Mg2+)-静脉血: 0.56mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20.5U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；间接胆红素(IBIL)-静脉血: 6.8umolL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；胱抑素(Cys-C)-静脉血: 1.89mg/L；肌酐(Crea)-静脉血: 171.5umol/L；碱性磷酸酶(ALP)-静脉血: 55.8U/L；乳酸脱氢酶(LDH)-静脉血: 182U/L；总胆汁酸(TBA)-静脉血: 1.2umol/L；总蛋白(TP)-静脉血: 72.99g/L；直接胆红素(DBIL)-静脉血: 3.9umol/L；C-反应蛋白(CRP)-静脉血: 2.96mg/L；甘油三酯(TG)-静脉血: 2.22mmol/L；葡萄糖(Glu)-静脉血: 6.63mmol/L；尿素氮(BUN)-静脉血: 10.78mmol/L；白蛋白(ALB)-静脉血: 43.2g/L\n- [全程D92] 检验组合: 嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；单核细胞百分比(Mono%)-静脉血: 0.13；中性粒细胞计数(Neut#)-静脉血: 5.310E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.7pg；血小板比容-静脉血: 24%；红细胞计数(RBC#)-静脉血: 3.3610E12/L；平均红细胞体积(MCV)-静脉血: 89.9fL；血红蛋白(Hb)-静脉血: 103g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.9；单核细胞计数(Mono#)-静脉血: 0.910E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；血小板计数(PLT#)-静脉血: 26210E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；大血小板百分比(P-LCR%)-静脉血: 17.3%；白细胞计数(WBC#)-静脉血: 710E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.103；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.8；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；中性粒细胞百分比(Neut%)-静脉血: 0.757；红细胞比容(Hct)-静脉血: 30.2%；血小板分布宽度(PDW)-静脉血: 9.9%；平均血小板体积(MPV)-静脉血: 9.1fL\n- [全程D99] 检验组合: 球蛋白(GLO)-静脉血: 25.82g/L；血小板比容-静脉血: 12%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 4.5umol/L；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 14.7mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.104；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；总胆红素(TBIL)-静脉血: 11.3umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 33.1U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.1；总钙(Ca)-静脉血: 1.94mmol/L；间接胆红素(IBIL)-静脉血: 6.8umolL；血红蛋白(Hb)-静脉血: 92g/L；肌酐(Crea)-静脉血: 230.6umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.53；单核细胞计数(Mono#)-静脉血: 0.710E9/L；磷(P)-静脉血: 1.43mmol/L；尿素氮(BUN)-静脉血: 14.3mmol/L；尿酸(UA)-静脉血: 664.3umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.5；氯离子(Cl-)-静脉血: 101.4mmol/L；镁离子(Mg2+)-静脉血: 0.39mmol/L；载脂蛋白AI(apoAI)-静脉血: 0.93g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；红细胞比容(Hct)-静脉血: 27.4%；γ-谷氨酰基转移酶(GGT)-静脉血: 32.2U/L；阴离子间隙(AG)-静脉血: 22；血小板分布宽度(PDW)-静脉血: 10.5%；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.41；总蛋白(TP)-静脉血: 65.22g/L；单核细胞百分比(Mono%)-静脉血: 0.138；白蛋白(ALB)-静脉血: 39.4g/L；乳酸脱氢酶(LDH)-静脉血: 174.3U/L；C-反应蛋白(CRP)-静脉血: 5.63mg/L；血小板计数(PLT#)-静脉血: 13410E9/L；总胆汁酸(TBA)-静脉血: 1.9um……\n- [全程D103] 检验组合: 白蛋白(ALB)-静脉血: 38.8g/L；肌酐(Crea)-静脉血: 213.9umol/L；球蛋白(GLO)-静脉血: 26.15g/L；间接胆红素(IBIL)-静脉血: 6.6umolL；总胆红素(TBIL)-静脉血: 10.9umol/L；总蛋白(TP)-静脉血: 64.95g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.48；直接胆红素(DBIL)-静脉血: 4.3umol/L；尿素氮(BUN)-静脉血: 14.5mmol/L；尿酸(UA)-静脉血: 660.5umol/L\n- [全程D106] 检验组合: 平均血小板体积(MPV)-静脉血: 9.5fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44.6；血小板计数(PLT#)-静脉血: 7110E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；血红蛋白(Hb)-静脉血: 75g/L；红细胞比容(Hct)-静脉血: 21.6%；白细胞计数(WBC#)-静脉血: 3.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.089；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；单核细胞计数(Mono#)-静脉血: 0.310E9/L；血小板分布宽度(PDW)-静脉血: 9.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 31.9pg；中性粒细胞百分比(Neut%)-静脉血: 0.784；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；大血小板百分比(P-LCR%)-静脉血: 20.6%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.098；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板比容-静脉血: 6%；红细胞计数(RBC#)-静脉血: 2.3510E12/L；平均红细胞体积(MCV)-静脉血: 91.9fL\n- [全程D109] 检验组合: 红细胞比容(Hct)-静脉血: 21.5%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.7；白细胞计数(WBC#)-静脉血: 4.210E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.4pg；单核细胞百分比(Mono%)-静脉血: 0.057；平均红细胞血红蛋白浓度(MCHC)-静脉血: 335g/L；血红蛋白(Hb)-静脉血: 72g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；红细胞计数(RBC#)-静脉血: 2.2910E12/L；血小板计数(PLT#)-静脉血: 6210E9/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.041；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；大血小板百分比(P-LCR%)-静脉血: 21.1%；平均血小板体积(MPV)-静脉血: 9.4fL；平均红细胞体积(MCV)-静脉血: 93.9fL；血小板比容-静脉血: 6%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；血小板分布宽度(PDW)-静脉血: 10.3%；中性粒细胞百分比(Neut%)-静脉血: 0.847；淋巴细胞百分比(Lymph%)-静脉血: 0.05；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L\n- [全程D113] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.082；血小板分布宽度(PDW)-静脉血: 10.8%；淋巴细胞百分比(Lymph%)-静脉血: 0.114；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；红细胞比容(Hct)-静脉血: 22.8%；平均血小板体积(MPV)-静脉血: 9.8fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 48.1；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；中性粒细胞计数(Neut#)-静脉血: 1.610E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1；白细胞计数(WBC#)-静脉血: 2.210E9/L；血小板计数(PLT#)-静脉血: 11810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.722；大血小板百分比(P-LCR%)-静脉血: 24.7%；单核细胞计数(Mono#)-静脉血: 0.210E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 320g/L；红细胞计数(RBC#)-静脉血: 2.2910E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.9pg；血小板比容-静脉血: 12%；血红蛋白(Hb)-静脉血: 73g/L；平均红细胞体积(MCV)-静脉血: 99.6fL；单核细胞百分比(Mono%)-静脉血: 0.077；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L\n- [全程D117] 检验组合: 天门冬氨酸氨基转移酶(AST)-静脉血: 14.1U/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；镁离子(Mg2+)-静脉血: 0.67mmol/L；血小板计数(PLT#)-静脉血: 23410E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.72mmolL；中性粒细胞计数(Neut#)-静脉血: 2.410E9/L；胱抑素(Cys-C)-静脉血: 2.73mg/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；血小板分布宽度(PDW)-静脉血: 10.4%；总蛋白(TP)-静脉血: 69.47g/L；大血小板百分比(P-LCR%)-静脉血: 22%；球蛋白(GLO)-静脉血: 32.07g/L；氯离子(Cl-)-静脉血: 102.3mmol/L；尿素氮(BUN)-静脉血: 14.7mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.136；丙氨酸氨基转移酶(ALT)-静脉血: 11.2U/L；葡萄糖(Glu)-静脉血: 7.22mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 19.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 0.81g/L；总胆固醇(TC)-静脉血: 4.12mmol/L；血小板比容-静脉血: 22%；C-反应蛋白(CRP)-静脉血: 15.19mg/L；总胆汁酸(TBA)-静脉血: 2.1umol/L；直接胆红素(DBIL)-静脉血: 2.3umol/L；尿酸(UA)-静脉血: 692umol/L；白细胞计数(WBC#)-静脉血: 3.710E9/L；乳酸脱氢酶(LDH)-静脉血: 178.2U/L；中性粒细胞百分比(Neut%)-静脉血: 0.651；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；肌酐(Crea)-静脉血: 220.1umol/L；红细胞计数(RBC#)-静脉血: 2.3510E12/L；钠离子(Na+)-静脉血: 138.8mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.26；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.6mmol/L；红细胞比容(Hct)-静脉血: 23.1%；钾离子(K+)-静脉血: 4.79mmol/L……\n- [全程D209] CT；胸、上腹CT平扫+增强: 检查类型: CT；检查名称: 胸、上腹CT平扫+增强；检查部位:；检查所见: 双肺纹理清晰，未见结节影；气管及支气管分枝通畅，未见明显软组织肿物或受压变窄；双锁上、双腋窝、双肺门及纵隔未见明显肿大淋巴结；双侧胸腔未见积液；胸膜未见增厚。 肝脏形态正常，比例正常，外形轮廓光整，密度均匀，快速注射造影剂后，动脉期未见明确异常强化灶，门脉期及平衡期未见明确低密度区，肝内见数个（约3个）囊肿影，大小约为 4 × 3 mm至 12 × 10 mm，边界清楚，密度均匀，未见强化；肝内胆管未见扩张，胆囊大小正常，内未见结石影，胆总管未见扩张；肝门区未见肿大淋巴结；门静脉未见充盈缺损；脾大小正常，密度均匀；胰腺大小、形态正常，密度均匀；双肾大小、形态正常，排泌功能正常，双肾见多个囊肿影，大小约为 3 × 3 mm 至 60 × 40 mm；双侧肾上腺大小、形态、密度正常；膈脚后、腹主动脉旁未见肿大淋巴结。 扫描范围内胸椎、腰椎、肋骨未见明确骨质破坏征象。；检查结论: 胸部、腹部未见明显占位性病变， 肝、肾囊肿。\n- [全程D210] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌放疗后复查： 鼻咽腔变窄，鼻咽各壁粘膜增厚，T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化，双侧咽隐窝变浅。口咽双侧壁未见受累增厚，病变未累及双侧后鼻孔。 双侧腭帆提肌结构欠清晰，双侧腭帆张肌及头长肌、双侧翼内外肌未见受侵征象。 双侧翼腭窝、双侧上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 双侧翼突基底部及内板骨质信号减低，增强扫描可见轻度强化。 双侧海绵窦形态未见异常。 双侧筛窦、双侧上颌窦粘膜增厚，增强扫描呈轻度强化。双侧乳突内见分泌物。 双眼未见异常，球后未见占位性病变。蝶鞍形态未见异常，其内未见占位性病变。 双侧咽后未见肿大淋巴结。 双颈II区、III区见多个小淋巴结，最大约6mm×13mm，部分边界欠，呈明显强化。 甲状腺双叶及峡部形态未见异常，信号均匀，未见占位性病变。 喉咽腔形态未见异常，未见占位性病变。 双侧颌下腺、腮腺大小、形态未见异常，信号均匀，未见占位性病变。 扫描所见脑组织未见明确异常。；检查结论: 鼻咽癌放疗后复查，与某次就诊时间片比较： 鼻咽肿物已不明显，现鼻咽粘膜增厚，考虑放疗后改变可能，建议随诊。 颅底骨质异常信号，放疗后改变？建议随诊。 双侧咽后未见肿大淋巴结。 双颈II、III区小淋巴结，较前明显缩小。 鼻窦炎；双侧乳突炎。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 判定为局部残留，行鼻咽及颈部挽救性手术\nB. 判定为放疗后改变或临床完全缓解，进入定期随访观察\nC. 判定为局部残留，行鼻咽及颈部局部追加放疗\nD. 判定为疾病稳定，启动卡培他滨维持化疗\nE. 判定为疾病进展，启动含铂双药联合免疫全身治疗\nF. 判定为放疗后改变，启动尼妥珠单抗靶向维持治疗\nG. 判定为颈部淋巴结残留，行双侧颈淋巴结清扫术\nH. 判定为颅底骨质受侵进展，行颅底病灶切除术\nI. 判定为疗效不确定，行全身PET-CT检查明确病灶活性\nJ. 判定为放疗后改变，行鼻咽黏膜活检排除微小残留\nK. 判定为临床完全缓解，启动PD-1抑制剂维持治疗\nL. 判定为局部残留，行原全身化疗方案追加2个周期\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-de1b18b9f870f76853282d28","patient_id":"patient-5ee5dba6116030961a7a97b5","turn_id":"turn01","turn_position":1,"turn_type":"initial_workup_choice","gold_letter":"K","gold_action":"鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查及活检、PET/CT全身显像、EB病毒DNA定量及常规血液生化检查","options":[{"letter":"A","text":"鼻咽及颈部CT平扫+增强、间接鼻咽镜检查及活检、PET/CT全身显像、EB病毒DNA定量及常规血液生化检查","is_gold":false},{"letter":"B","text":"鼻咽及颈部MRI平扫、间接鼻咽镜检查及活检、PET/CT全身显像、EB病毒DNA定量及常规血液生化检查","is_gold":false},{"letter":"C","text":"鼻咽MRI平扫+增强、间接鼻咽镜检查及活检、PET/CT全身显像、EB病毒DNA定量及常规血液生化检查","is_gold":false},{"letter":"D","text":"鼻咽及颈部MRI平扫+增强、右颈部肿物穿刺活检、PET/CT全身显像、EB病毒DNA定量及常规血液生化检查","is_gold":false},{"letter":"E","text":"鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查及活检、胸部X线及腹部B超、EB病毒DNA定量及常规血液生化检查","is_gold":false},{"letter":"F","text":"鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查及活检、PET/CT全身显像、常规血液生化检查","is_gold":false},{"letter":"G","text":"鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查及活检、头颅MRI平扫+增强、EB病毒DNA定量及常规血液生化检查","is_gold":false},{"letter":"H","text":"鼻咽及颈部CT平扫、间接鼻咽镜检查及活检、PET/CT全身显像、EB病毒DNA定量及常规血液生化检查","is_gold":false},{"letter":"I","text":"鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查及活检、PET/CT全身显像、EB病毒VCA-IgA检测及常规血液生化检查","is_gold":false},{"letter":"J","text":"鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查及活检、全身骨扫描、EB病毒DNA定量及常规血液生化检查","is_gold":false},{"letter":"K","text":"鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查及活检、PET/CT全身显像、EB病毒DNA定量及常规血液生化检查","is_gold":true},{"letter":"L","text":"鼻咽及颈部MRI平扫+增强、PET/CT全身显像、EB病毒DNA定量及常规血液生化检查、直接行诱导化疗","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 涕血半年伴右颈肿物2周；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 鼻咽及颈部CT平扫+增强、间接鼻咽镜检查及活检、PET/CT全身显像、EB病毒DNA定量及常规血液生化检查\nB. 鼻咽及颈部MRI平扫、间接鼻咽镜检查及活检、PET/CT全身显像、EB病毒DNA定量及常规血液生化检查\nC. 鼻咽MRI平扫+增强、间接鼻咽镜检查及活检、PET/CT全身显像、EB病毒DNA定量及常规血液生化检查\nD. 鼻咽及颈部MRI平扫+增强、右颈部肿物穿刺活检、PET/CT全身显像、EB病毒DNA定量及常规血液生化检查\nE. 鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查及活检、胸部X线及腹部B超、EB病毒DNA定量及常规血液生化检查\nF. 鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查及活检、PET/CT全身显像、常规血液生化检查\nG. 鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查及活检、头颅MRI平扫+增强、EB病毒DNA定量及常规血液生化检查\nH. 鼻咽及颈部CT平扫、间接鼻咽镜检查及活检、PET/CT全身显像、EB病毒DNA定量及常规血液生化检查\nI. 鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查及活检、PET/CT全身显像、EB病毒VCA-IgA检测及常规血液生化检查\nJ. 鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查及活检、全身骨扫描、EB病毒DNA定量及常规血液生化检查\nK. 鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查及活检、PET/CT全身显像、EB病毒DNA定量及常规血液生化检查\nL. 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+{"sample_id":"sample-2c772b6972f0c7fdbd562b73","patient_id":"patient-5ee5dba6116030961a7a97b5","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"L","gold_action":"在尚未完成病理确诊和EB病毒DNA定量检测的前提下，下一步应行电子鼻咽镜检查及活检明确病理诊断，并补充EB病毒DNA荧光定量PCR检测","options":[{"letter":"A","text":"安排颈部淋巴结细针穿刺活检明确病理，并补充全身PET-CT检查","is_gold":false},{"letter":"B","text":"安排右侧颈部肿大淋巴结切除活检，并补充EB病毒DNA荧光定量PCR检测","is_gold":false},{"letter":"C","text":"直接基于MRI及EBV抗体阳性结果启动根治性放化疗","is_gold":false},{"letter":"D","text":"行电子鼻咽镜检查观察肿瘤范围，并补充全身骨扫描及胸腹部CT","is_gold":false},{"letter":"E","text":"行电子鼻咽镜检查及活检明确病理诊断，但不安排任何与EB病毒相关的检查","is_gold":false},{"letter":"F","text":"安排鼻内镜下鼻咽肿物切除术，并补充EB病毒DNA荧光定量PCR检测","is_gold":false},{"letter":"G","text":"安排颈部淋巴结细针穿刺活检，并补充EB病毒DNA荧光定量PCR检测","is_gold":false},{"letter":"H","text":"行电子鼻咽镜检查及活检明确病理诊断，并立即行右颈部淋巴结切除活检","is_gold":false},{"letter":"I","text":"补充EB病毒DNA荧光定量PCR检测，待结果回报后再决定是否行鼻咽活检","is_gold":false},{"letter":"J","text":"行电子鼻咽镜检查及活检明确病理诊断，并预防性行右颈淋巴结清扫术","is_gold":false},{"letter":"K","text":"安排颈部淋巴结穿刺活检及鼻咽镜下活检，并直接启动诱导化疗","is_gold":false},{"letter":"L","text":"行电子鼻咽镜检查及活检明确病理诊断，并补充EB病毒DNA荧光定量PCR检测","is_gold":true}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 涕血半年伴右颈肿物2周；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D3] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁增厚，可见软组织肿块形成，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。双侧咽隐窝见软组织占据，双侧咽旁脂肪间隙受压变窄，病灶侵犯双侧腭帆提肌。双侧腭帆张肌、头长肌未见受侵。 双侧翼腭窝、颞下窝未见异常；口咽双侧壁未见受累增厚，病变未累及后鼻孔。 双侧翼突基底内份、蝶骨基底部右份骨髓信号减低，增强可见轻度强化。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 双侧咽后间隙见肿大淋巴结，右侧大小约为7mm ×8 mm，左侧大小约3mm×4mm。双颈II区、III区见数个淋巴结，最大位于右颈II区，大小约为15mm×27mm。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽肿块，考虑鼻咽癌。 颅底骨质破坏。 右侧咽后及右颈淋巴结肿大，考虑转移瘤。 左侧咽后及左颈小淋巴结。 鼻窦炎、右乳突炎。\n- [全程D3] 检验组合: 平均红细胞体积(MCV)-静脉血: 93.7fL；凝血酶原时间活动度(PTA)-静脉血: 97%；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；中性粒细胞计数(Neut#)-静脉血: 3.610E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.7sec.；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；尿酸(UA)-静脉血: 413.6umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；血小板分布宽度(PDW)-静脉血: 14.7%；间接胆红素(IBIL)-静脉血: 9.7umolL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；丙氨酸氨基转移酶(ALT)-静脉血: 24U/L；碱性磷酸酶(ALP)-静脉血: 84.3U/L；总胆汁酸(TBA)-静脉血: 2.2umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.3mmol/L；葡萄糖(Glu)-静脉血: 4.51mmol/L；磷(P)-静脉血: 1.39mmol/L；C-反应蛋白(CRP)-静脉血: 4.68mg/L；血小板比容-静脉血: 25%；大血小板百分比(P-LCR%)-静脉血: 35.8%；血小板计数(PLT#)-静脉血: 21810E9/L；红细胞计数(RBC#)-静脉血: 4.5910E12/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；阴离子间隙(AG)-静脉血: 18；凝血酶时间(TT)-静脉血: 21.4sec.；红细胞比容(Hct)-静脉血: 43%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 344g/L；纤维蛋白原(Fbg)-静脉血: 3.09g/L；乳酸脱氢酶(LDH)-静脉血: 116.6U/L；总蛋白(TP)-静脉血: 69.58g/L；总钙(Ca)-静脉血: 2.31mmol/L；总胆固醇(TC)-静脉血: 5.94mmol/L；甘油三酯(TG)-静脉血: 1.79mmol/L；总胆红素(TBIL)-静脉血: 13.9umol/L；尿素氮(BUN……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 安排颈部淋巴结细针穿刺活检明确病理，并补充全身PET-CT检查\nB. 安排右侧颈部肿大淋巴结切除活检，并补充EB病毒DNA荧光定量PCR检测\nC. 直接基于MRI及EBV抗体阳性结果启动根治性放化疗\nD. 行电子鼻咽镜检查观察肿瘤范围，并补充全身骨扫描及胸腹部CT\nE. 行电子鼻咽镜检查及活检明确病理诊断，但不安排任何与EB病毒相关的检查\nF. 安排鼻内镜下鼻咽肿物切除术，并补充EB病毒DNA荧光定量PCR检测\nG. 安排颈部淋巴结细针穿刺活检，并补充EB病毒DNA荧光定量PCR检测\nH. 行电子鼻咽镜检查及活检明确病理诊断，并立即行右颈部淋巴结切除活检\nI. 补充EB病毒DNA荧光定量PCR检测，待结果回报后再决定是否行鼻咽活检\nJ. 行电子鼻咽镜检查及活检明确病理诊断，并预防性行右颈淋巴结清扫术\nK. 安排颈部淋巴结穿刺活检及鼻咽镜下活检，并直接启动诱导化疗\nL. 行电子鼻咽镜检查及活检明确病理诊断，并补充EB病毒DNA荧光定量PCR检测\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 涕血半年伴右颈肿物2周；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D3] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁增厚，可见软组织肿块形成，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。双侧咽隐窝见软组织占据，双侧咽旁脂肪间隙受压变窄，病灶侵犯双侧腭帆提肌。双侧腭帆张肌、头长肌未见受侵。 双侧翼腭窝、颞下窝未见异常；口咽双侧壁未见受累增厚，病变未累及后鼻孔。 双侧翼突基底内份、蝶骨基底部右份骨髓信号减低，增强可见轻度强化。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 双侧咽后间隙见肿大淋巴结，右侧大小约为7mm ×8 mm，左侧大小约3mm×4mm。双颈II区、III区见数个淋巴结，最大位于右颈II区，大小约为15mm×27mm。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽肿块，考虑鼻咽癌。 颅底骨质破坏。 右侧咽后及右颈淋巴结肿大，考虑转移瘤。 左侧咽后及左颈小淋巴结。 鼻窦炎、右乳突炎。\n- [全程D3] 检验组合: 平均红细胞体积(MCV)-静脉血: 93.7fL；凝血酶原时间活动度(PTA)-静脉血: 97%；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；中性粒细胞计数(Neut#)-静脉血: 3.610E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.7sec.；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；尿酸(UA)-静脉血: 413.6umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；血小板分布宽度(PDW)-静脉血: 14.7%；间接胆红素(IBIL)-静脉血: 9.7umolL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；丙氨酸氨基转移酶(ALT)-静脉血: 24U/L；碱性磷酸酶(ALP)-静脉血: 84.3U/L；总胆汁酸(TBA)-静脉血: 2.2umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.3mmol/L；葡萄糖(Glu)-静脉血: 4.51mmol/L；磷(P)-静脉血: 1.39mmol/L；C-反应蛋白(CRP)-静脉血: 4.68mg/L；血小板比容-静脉血: 25%；大血小板百分比(P-LCR%)-静脉血: 35.8%；血小板计数(PLT#)-静脉血: 21810E9/L；红细胞计数(RBC#)-静脉血: 4.5910E12/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；阴离子间隙(AG)-静脉血: 18；凝血酶时间(TT)-静脉血: 21.4sec.；红细胞比容(Hct)-静脉血: 43%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 344g/L；纤维蛋白原(Fbg)-静脉血: 3.09g/L；乳酸脱氢酶(LDH)-静脉血: 116.6U/L；总蛋白(TP)-静脉血: 69.58g/L；总钙(Ca)-静脉血: 2.31mmol/L；总胆固醇(TC)-静脉血: 5.94mmol/L；甘油三酯(TG)-静脉血: 1.79mmol/L；总胆红素(TBIL)-静脉血: 13.9umol/L；尿素氮(BUN……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 安排颈部淋巴结细针穿刺活检明确病理，并补充全身PET-CT检查\nB. 安排右侧颈部肿大淋巴结切除活检，并补充EB病毒DNA荧光定量PCR检测\nC. 直接基于MRI及EBV抗体阳性结果启动根治性放化疗\nD. 行电子鼻咽镜检查观察肿瘤范围，并补充全身骨扫描及胸腹部CT\nE. 行电子鼻咽镜检查及活检明确病理诊断，但不安排任何与EB病毒相关的检查\nF. 安排鼻内镜下鼻咽肿物切除术，并补充EB病毒DNA荧光定量PCR检测\nG. 安排颈部淋巴结细针穿刺活检，并补充EB病毒DNA荧光定量PCR检测\nH. 行电子鼻咽镜检查及活检明确病理诊断，并立即行右颈部淋巴结切除活检\nI. 补充EB病毒DNA荧光定量PCR检测，待结果回报后再决定是否行鼻咽活检\nJ. 行电子鼻咽镜检查及活检明确病理诊断，并预防性行右颈淋巴结清扫术\nK. 安排颈部淋巴结穿刺活检及鼻咽镜下活检，并直接启动诱导化疗\nL. 行电子鼻咽镜检查及活检明确病理诊断，并补充EB病毒DNA荧光定量PCR检测\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-8976031a638416cb5f037a59","patient_id":"patient-5ee5dba6116030961a7a97b5","turn_id":"turn04","turn_position":3,"turn_type":"initial_treatment_selection","gold_letter":"A","gold_action":"行吉西他滨+顺铂方案诱导化疗联合PD-1抑制剂","options":[{"letter":"A","text":"行吉西他滨+顺铂方案诱导化疗联合PD-1抑制剂","is_gold":true},{"letter":"B","text":"行单纯根治性放射治疗","is_gold":false},{"letter":"C","text":"行紫杉醇+顺铂+氟尿嘧啶方案诱导化疗联合西妥昔单抗","is_gold":false},{"letter":"D","text":"行鼻咽原发灶及颈部淋巴结根治性切除术","is_gold":false},{"letter":"E","text":"行洛铂+氟尿嘧啶方案姑息性化疗","is_gold":false},{"letter":"F","text":"行卡培他滨单药节拍化疗","is_gold":false},{"letter":"G","text":"行洛铂+氟尿嘧啶方案诱导化疗后序贯颈部淋巴结清扫术","is_gold":false},{"letter":"H","text":"行多西他赛+顺铂方案同期放化疗","is_gold":false},{"letter":"I","text":"行吉西他滨单药诱导化疗","is_gold":false},{"letter":"J","text":"行依托泊苷+顺铂方案诱导化疗","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 涕血半年伴右颈肿物2周；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 涕血半年伴右颈肿物2周；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D10] 入院记录: 主诉: 涕血半年伴右颈肿物2周.；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D3] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁增厚，可见软组织肿块形成，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。双侧咽隐窝见软组织占据，双侧咽旁脂肪间隙受压变窄，病灶侵犯双侧腭帆提肌。双侧腭帆张肌、头长肌未见受侵。 双侧翼腭窝、颞下窝未见异常；口咽双侧壁未见受累增厚，病变未累及后鼻孔。 双侧翼突基底内份、蝶骨基底部右份骨髓信号减低，增强可见轻度强化。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 双侧咽后间隙见肿大淋巴结，右侧大小约为7mm ×8 mm，左侧大小约3mm×4mm。双颈II区、III区见数个淋巴结，最大位于右颈II区，大小约为15mm×27mm。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽肿块，考虑鼻咽癌。 颅底骨质破坏。 右侧咽后及右颈淋巴结肿大，考虑转移瘤。 左侧咽后及左颈小淋巴结。 鼻窦炎、右乳突炎。\n- [全程D3] 检验组合: 平均红细胞体积(MCV)-静脉血: 93.7fL；凝血酶原时间活动度(PTA)-静脉血: 97%；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；中性粒细胞计数(Neut#)-静脉血: 3.610E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.7sec.；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；尿酸(UA)-静脉血: 413.6umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；血小板分布宽度(PDW)-静脉血: 14.7%；间接胆红素(IBIL)-静脉血: 9.7umolL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；丙氨酸氨基转移酶(ALT)-静脉血: 24U/L；碱性磷酸酶(ALP)-静脉血: 84.3U/L；总胆汁酸(TBA)-静脉血: 2.2umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.3mmol/L；葡萄糖(Glu)-静脉血: 4.51mmol/L；磷(P)-静脉血: 1.39mmol/L；C-反应蛋白(CRP)-静脉血: 4.68mg/L；血小板比容-静脉血: 25%；大血小板百分比(P-LCR%)-静脉血: 35.8%；血小板计数(PLT#)-静脉血: 21810E9/L；红细胞计数(RBC#)-静脉血: 4.5910E12/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；阴离子间隙(AG)-静脉血: 18；凝血酶时间(TT)-静脉血: 21.4sec.；红细胞比容(Hct)-静脉血: 43%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 344g/L；纤维蛋白原(Fbg)-静脉血: 3.09g/L；乳酸脱氢酶(LDH)-静脉血: 116.6U/L；总蛋白(TP)-静脉血: 69.58g/L；总钙(Ca)-静脉血: 2.31mmol/L；总胆固醇(TC)-静脉血: 5.94mmol/L；甘油三酯(TG)-静脉血: 1.79mmol/L；总胆红素(TBIL)-静脉血: 13.9umol/L；尿素氮(BUN……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D4] 检验组合: 乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D5] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶后壁及双侧壁粘膜增厚放射性浓聚，SUV约23.1；病灶填塞双侧鼻后孔，向上侵犯蝶骨基底部、双翼突基底部、犁骨及枕骨斜坡，局部骨质稍模糊放射性分布浓密。双侧破裂孔未见明显异常。双侧咽隐窝变浅。双侧咽旁间隙结构尚清。右侧咽后淋巴结放射性浓聚，SUV约11.4，大小约0.7×1.0cm；左侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见异常。筛窦、右上颌窦及右乳突稍低密度影放射性分布未见异常；额窦、蝶窦、左侧上颌窦及左乳突结构及放射性分布未见明显异常。口咽、喉咽未见明显异常。甲状腺放射性分布未见异常。双颈Ⅱ区肿大淋巴结放射性浓聚，SUV约10.2，最大约1.6×2.6cm；余双侧颈部未见肿大淋巴结及异常放射性分布。 双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺纹理清晰，双侧肺野未见确切病灶和异常放射性分布。气管、支气管通畅。心脏及大血管放射性分布未见异常。胸壁未见确切病灶和异常放射性分布。双肺门、纵隔及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏密度不均匀降低，放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管及胆总管未见扩张。胆囊、胃及十二指肠放射性分布未见异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、肠管等形态、结构及放射性分布未见明显异常。前列腺点状高密度影放射性分布未见异常。双侧髂血管旁及腹股沟未见明显肿大淋巴结及异常放射性分布。 余所见颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，病灶侵犯颅底骨；右咽后及双颈Ⅱ区淋巴结代谢较活跃，考虑转移。 鼻窦炎；右乳突炎。 脂肪肝。 前列腺钙化灶。\n- [全程D10] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: 右臂静脉插管, 导管末端位于胸椎右旁T 7上缘水平，估计位于上腔静脉下段。；检查结论: 导管末端位置如上述。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-J 选项中选择唯一最合适的答案。\nA. 行吉西他滨+顺铂方案诱导化疗联合PD-1抑制剂\nB. 行单纯根治性放射治疗\nC. 行紫杉醇+顺铂+氟尿嘧啶方案诱导化疗联合西妥昔单抗\nD. 行鼻咽原发灶及颈部淋巴结根治性切除术\nE. 行洛铂+氟尿嘧啶方案姑息性化疗\nF. 行卡培他滨单药节拍化疗\nG. 行洛铂+氟尿嘧啶方案诱导化疗后序贯颈部淋巴结清扫术\nH. 行多西他赛+顺铂方案同期放化疗\nI. 行吉西他滨单药诱导化疗\nJ. 行依托泊苷+顺铂方案诱导化疗\n\n请仅输出一个选项字母（A-J）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 涕血半年伴右颈肿物2周；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 涕血半年伴右颈肿物2周；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D10] 入院记录: 主诉: 涕血半年伴右颈肿物2周.；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D3] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁增厚，可见软组织肿块形成，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。双侧咽隐窝见软组织占据，双侧咽旁脂肪间隙受压变窄，病灶侵犯双侧腭帆提肌。双侧腭帆张肌、头长肌未见受侵。 双侧翼腭窝、颞下窝未见异常；口咽双侧壁未见受累增厚，病变未累及后鼻孔。 双侧翼突基底内份、蝶骨基底部右份骨髓信号减低，增强可见轻度强化。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 双侧咽后间隙见肿大淋巴结，右侧大小约为7mm ×8 mm，左侧大小约3mm×4mm。双颈II区、III区见数个淋巴结，最大位于右颈II区，大小约为15mm×27mm。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽肿块，考虑鼻咽癌。 颅底骨质破坏。 右侧咽后及右颈淋巴结肿大，考虑转移瘤。 左侧咽后及左颈小淋巴结。 鼻窦炎、右乳突炎。\n- [全程D3] 检验组合: 平均红细胞体积(MCV)-静脉血: 93.7fL；凝血酶原时间活动度(PTA)-静脉血: 97%；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；中性粒细胞计数(Neut#)-静脉血: 3.610E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.7sec.；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；尿酸(UA)-静脉血: 413.6umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；血小板分布宽度(PDW)-静脉血: 14.7%；间接胆红素(IBIL)-静脉血: 9.7umolL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；丙氨酸氨基转移酶(ALT)-静脉血: 24U/L；碱性磷酸酶(ALP)-静脉血: 84.3U/L；总胆汁酸(TBA)-静脉血: 2.2umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.3mmol/L；葡萄糖(Glu)-静脉血: 4.51mmol/L；磷(P)-静脉血: 1.39mmol/L；C-反应蛋白(CRP)-静脉血: 4.68mg/L；血小板比容-静脉血: 25%；大血小板百分比(P-LCR%)-静脉血: 35.8%；血小板计数(PLT#)-静脉血: 21810E9/L；红细胞计数(RBC#)-静脉血: 4.5910E12/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；阴离子间隙(AG)-静脉血: 18；凝血酶时间(TT)-静脉血: 21.4sec.；红细胞比容(Hct)-静脉血: 43%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 344g/L；纤维蛋白原(Fbg)-静脉血: 3.09g/L；乳酸脱氢酶(LDH)-静脉血: 116.6U/L；总蛋白(TP)-静脉血: 69.58g/L；总钙(Ca)-静脉血: 2.31mmol/L；总胆固醇(TC)-静脉血: 5.94mmol/L；甘油三酯(TG)-静脉血: 1.79mmol/L；总胆红素(TBIL)-静脉血: 13.9umol/L；尿素氮(BUN……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D4] 检验组合: 乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D5] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶后壁及双侧壁粘膜增厚放射性浓聚，SUV约23.1；病灶填塞双侧鼻后孔，向上侵犯蝶骨基底部、双翼突基底部、犁骨及枕骨斜坡，局部骨质稍模糊放射性分布浓密。双侧破裂孔未见明显异常。双侧咽隐窝变浅。双侧咽旁间隙结构尚清。右侧咽后淋巴结放射性浓聚，SUV约11.4，大小约0.7×1.0cm；左侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见异常。筛窦、右上颌窦及右乳突稍低密度影放射性分布未见异常；额窦、蝶窦、左侧上颌窦及左乳突结构及放射性分布未见明显异常。口咽、喉咽未见明显异常。甲状腺放射性分布未见异常。双颈Ⅱ区肿大淋巴结放射性浓聚，SUV约10.2，最大约1.6×2.6cm；余双侧颈部未见肿大淋巴结及异常放射性分布。 双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺纹理清晰，双侧肺野未见确切病灶和异常放射性分布。气管、支气管通畅。心脏及大血管放射性分布未见异常。胸壁未见确切病灶和异常放射性分布。双肺门、纵隔及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏密度不均匀降低，放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管及胆总管未见扩张。胆囊、胃及十二指肠放射性分布未见异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、肠管等形态、结构及放射性分布未见明显异常。前列腺点状高密度影放射性分布未见异常。双侧髂血管旁及腹股沟未见明显肿大淋巴结及异常放射性分布。 余所见颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，病灶侵犯颅底骨；右咽后及双颈Ⅱ区淋巴结代谢较活跃，考虑转移。 鼻窦炎；右乳突炎。 脂肪肝。 前列腺钙化灶。\n- [全程D10] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: 右臂静脉插管, 导管末端位于胸椎右旁T 7上缘水平，估计位于上腔静脉下段。；检查结论: 导管末端位置如上述。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-J 选项中选择唯一最合适的答案。\nA. 行吉西他滨+顺铂方案诱导化疗联合PD-1抑制剂\nB. 行单纯根治性放射治疗\nC. 行紫杉醇+顺铂+氟尿嘧啶方案诱导化疗联合西妥昔单抗\nD. 行鼻咽原发灶及颈部淋巴结根治性切除术\nE. 行洛铂+氟尿嘧啶方案姑息性化疗\nF. 行卡培他滨单药节拍化疗\nG. 行洛铂+氟尿嘧啶方案诱导化疗后序贯颈部淋巴结清扫术\nH. 行多西他赛+顺铂方案同期放化疗\nI. 行吉西他滨单药诱导化疗\nJ. 行依托泊苷+顺铂方案诱导化疗\n\n请仅输出一个选项字母（A-J）。"}]}
+{"sample_id":"sample-5d943566dde88ca9f3640bc0","patient_id":"patient-5ee5dba6116030961a7a97b5","turn_id":"turn05","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"C","gold_action":"办理出院，嘱每周复查血常规及肝肾功能，2周后返院继续下一阶段治疗。","options":[{"letter":"A","text":"办理出院，嘱每3天复查血常规及肝肾功能，1周后返院继续下一阶段治疗","is_gold":false},{"letter":"B","text":"予以重组人粒细胞刺激因子皮下注射后办理出院，嘱每周复查血常规，2周后返院","is_gold":false},{"letter":"C","text":"办理出院，嘱每周复查血常规及肝肾功能，2周后返院继续下一阶段治疗","is_gold":true},{"letter":"D","text":"办理出院，嘱每2周复查血常规及肝肾功能，3周后返院继续下一阶段治疗","is_gold":false},{"letter":"E","text":"暂缓出院，继续住院观察并每日复查血常规，待血液学指标进一步稳定后出院","is_gold":false},{"letter":"F","text":"办理出院，嘱每月复查血常规及肝肾功能，4周后返院评估疗效并决定后续治疗","is_gold":false},{"letter":"G","text":"予以静脉滴注保肝药物治疗，待复查肝功能指标完全正常后办理出院","is_gold":false},{"letter":"H","text":"办理出院，处方口服升血小板药物，嘱每周复查血常规，2周后返院","is_gold":false},{"letter":"I","text":"办理出院，处方口服卡培他滨单药维持，嘱每周复查血常规，3周后返院","is_gold":false},{"letter":"J","text":"办理出院，嘱每周复查血常规及肝肾功能，4周后返院行MRI复查评估疗效","is_gold":false},{"letter":"K","text":"予以口服氯化钾缓释片补钾治疗，每日监测电解质，待血钾水平上升后办理出院","is_gold":false},{"letter":"L","text":"办理出院，无需定期复查化验指标，嘱出现发热或出血症状时急诊就诊，3周后返院","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 涕血半年伴右颈肿物2周；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 涕血半年伴右颈肿物2周；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D10] 入院记录: 主诉: 涕血半年伴右颈肿物2周.；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D3] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁增厚，可见软组织肿块形成，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。双侧咽隐窝见软组织占据，双侧咽旁脂肪间隙受压变窄，病灶侵犯双侧腭帆提肌。双侧腭帆张肌、头长肌未见受侵。 双侧翼腭窝、颞下窝未见异常；口咽双侧壁未见受累增厚，病变未累及后鼻孔。 双侧翼突基底内份、蝶骨基底部右份骨髓信号减低，增强可见轻度强化。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 双侧咽后间隙见肿大淋巴结，右侧大小约为7mm ×8 mm，左侧大小约3mm×4mm。双颈II区、III区见数个淋巴结，最大位于右颈II区，大小约为15mm×27mm。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽肿块，考虑鼻咽癌。 颅底骨质破坏。 右侧咽后及右颈淋巴结肿大，考虑转移瘤。 左侧咽后及左颈小淋巴结。 鼻窦炎、右乳突炎。\n- [全程D3] 检验组合: 平均红细胞体积(MCV)-静脉血: 93.7fL；凝血酶原时间活动度(PTA)-静脉血: 97%；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；中性粒细胞计数(Neut#)-静脉血: 3.610E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.7sec.；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；尿酸(UA)-静脉血: 413.6umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；血小板分布宽度(PDW)-静脉血: 14.7%；间接胆红素(IBIL)-静脉血: 9.7umolL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；丙氨酸氨基转移酶(ALT)-静脉血: 24U/L；碱性磷酸酶(ALP)-静脉血: 84.3U/L；总胆汁酸(TBA)-静脉血: 2.2umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.3mmol/L；葡萄糖(Glu)-静脉血: 4.51mmol/L；磷(P)-静脉血: 1.39mmol/L；C-反应蛋白(CRP)-静脉血: 4.68mg/L；血小板比容-静脉血: 25%；大血小板百分比(P-LCR%)-静脉血: 35.8%；血小板计数(PLT#)-静脉血: 21810E9/L；红细胞计数(RBC#)-静脉血: 4.5910E12/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；阴离子间隙(AG)-静脉血: 18；凝血酶时间(TT)-静脉血: 21.4sec.；红细胞比容(Hct)-静脉血: 43%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 344g/L；纤维蛋白原(Fbg)-静脉血: 3.09g/L；乳酸脱氢酶(LDH)-静脉血: 116.6U/L；总蛋白(TP)-静脉血: 69.58g/L；总钙(Ca)-静脉血: 2.31mmol/L；总胆固醇(TC)-静脉血: 5.94mmol/L；甘油三酯(TG)-静脉血: 1.79mmol/L；总胆红素(TBIL)-静脉血: 13.9umol/L；尿素氮(BUN……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D4] 检验组合: 乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D5] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶后壁及双侧壁粘膜增厚放射性浓聚，SUV约23.1；病灶填塞双侧鼻后孔，向上侵犯蝶骨基底部、双翼突基底部、犁骨及枕骨斜坡，局部骨质稍模糊放射性分布浓密。双侧破裂孔未见明显异常。双侧咽隐窝变浅。双侧咽旁间隙结构尚清。右侧咽后淋巴结放射性浓聚，SUV约11.4，大小约0.7×1.0cm；左侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见异常。筛窦、右上颌窦及右乳突稍低密度影放射性分布未见异常；额窦、蝶窦、左侧上颌窦及左乳突结构及放射性分布未见明显异常。口咽、喉咽未见明显异常。甲状腺放射性分布未见异常。双颈Ⅱ区肿大淋巴结放射性浓聚，SUV约10.2，最大约1.6×2.6cm；余双侧颈部未见肿大淋巴结及异常放射性分布。 双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺纹理清晰，双侧肺野未见确切病灶和异常放射性分布。气管、支气管通畅。心脏及大血管放射性分布未见异常。胸壁未见确切病灶和异常放射性分布。双肺门、纵隔及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏密度不均匀降低，放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管及胆总管未见扩张。胆囊、胃及十二指肠放射性分布未见异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、肠管等形态、结构及放射性分布未见明显异常。前列腺点状高密度影放射性分布未见异常。双侧髂血管旁及腹股沟未见明显肿大淋巴结及异常放射性分布。 余所见颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，病灶侵犯颅底骨；右咽后及双颈Ⅱ区淋巴结代谢较活跃，考虑转移。 鼻窦炎；右乳突炎。 脂肪肝。 前列腺钙化灶。\n- [全程D10] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: 右臂静脉插管, 导管末端位于胸椎右旁T 7上缘水平，估计位于上腔静脉下段。；检查结论: 导管末端位置如上述。\n- [全程D39] 检验组合: 胱抑素(Cys-C)-静脉血: 0.78mg/L；血小板比容-静脉血: 14.8%；中性粒细胞百分比(Neut%)-静脉血: 0.61；γ-谷氨酰基转移酶(GGT)-静脉血: 57.8U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；总蛋白(TP)-静脉血: 67.84g/L；平均红细胞体积(MCV)-静脉血: 96.4fL；镁离子(Mg2+)-静脉血: 0.92mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.05mmolL；钠离子(Na+)-静脉血: 139.4mmol/L；磷(P)-静脉血: 1.36mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.302；氯离子(Cl-)-静脉血: 103.4mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.54；平均红细胞血红蛋白含量(MCH)-静脉血: 32.7pg；平均血小板体积(MPV)-静脉血: 8.84fL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.59；钾离子(K+)-静脉血: 3.79mmol/L；单核细胞百分比(Mono%)-静脉血: 0.06；白细胞计数(WBC#)-静脉血: 5.4510E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；α-L-岩藻糖苷酶(AFU)-静脉血: 35.8U/L；血小板分布宽度(PDW)-静脉血: 16.9%；红细胞比容(Hct)-静脉血: 40.3%；乳酸脱氢酶(LDH)-静脉血: 149.5U/L；红细胞计数(RBC#)-静脉血: 4.1810E12/L；C-反应蛋白(CRP)-静脉血: 2.31mg/L；总钙(Ca)-静脉血: 2.19mmol/L；尿素氮(BUN)-静脉血: 3.8mmol/L；尿酸(UA)-静脉血: 285umol/L；阴离子间隙(AG)-静脉血: 11.3；葡萄糖(Glu)-静脉血: 4.38mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339.2g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 32.4U/L；甘油三酯(TG)-静脉血: 2.32mmol/L；白蛋白(ALB)-静脉血: 41.6g/L；血小板计数(PLT#)-静脉血: 167.……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D34] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者今日洛铂+5-FU化疗第2天，诉食欲较差，无恶心、呕吐等不适，精神、睡眠尚可，大小便正常。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者化疗第2日，一般情况可，嘱患者注意饮食，加强营养，续行化疗。密切观察化疗反应，必要时加强处理。现已按查房指示执行。\n- [全程D35] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者今日洛铂+5-FU化疗第3天，诉食欲较差，无恶心、呕吐等不适，精神、睡眠尚可，大小便正常。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者化疗第3日，一般情况可，密切观察化疗反应，必要时加强处理。现已按查房指示执行。\n- [全程D39] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者计划于今日完成第2程洛铂+5-FU方案诱导化疗，未诉特殊不适。[姓名已隐去]主诊医生信息已隐藏：患者现完成第2程洛铂+5-FU方案诱导化疗，一般情况可，予今日出院。嘱患者出院后定期每周复查血常规、肝肾功能，2周后返院续治。现已按查房指示执行。\n- [时间未明] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 现已按查房指示执行。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 办理出院，嘱每3天复查血常规及肝肾功能，1周后返院继续下一阶段治疗\nB. 予以重组人粒细胞刺激因子皮下注射后办理出院，嘱每周复查血常规，2周后返院\nC. 办理出院，嘱每周复查血常规及肝肾功能，2周后返院继续下一阶段治疗\nD. 办理出院，嘱每2周复查血常规及肝肾功能，3周后返院继续下一阶段治疗\nE. 暂缓出院，继续住院观察并每日复查血常规，待血液学指标进一步稳定后出院\nF. 办理出院，嘱每月复查血常规及肝肾功能，4周后返院评估疗效并决定后续治疗\nG. 予以静脉滴注保肝药物治疗，待复查肝功能指标完全正常后办理出院\nH. 办理出院，处方口服升血小板药物，嘱每周复查血常规，2周后返院\nI. 办理出院，处方口服卡培他滨单药维持，嘱每周复查血常规，3周后返院\nJ. 办理出院，嘱每周复查血常规及肝肾功能，4周后返院行MRI复查评估疗效\nK. 予以口服氯化钾缓释片补钾治疗，每日监测电解质，待血钾水平上升后办理出院\nL. 办理出院，无需定期复查化验指标，嘱出现发热或出血症状时急诊就诊，3周后返院\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 涕血半年伴右颈肿物2周；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 涕血半年伴右颈肿物2周；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D10] 入院记录: 主诉: 涕血半年伴右颈肿物2周.；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D3] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁增厚，可见软组织肿块形成，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。双侧咽隐窝见软组织占据，双侧咽旁脂肪间隙受压变窄，病灶侵犯双侧腭帆提肌。双侧腭帆张肌、头长肌未见受侵。 双侧翼腭窝、颞下窝未见异常；口咽双侧壁未见受累增厚，病变未累及后鼻孔。 双侧翼突基底内份、蝶骨基底部右份骨髓信号减低，增强可见轻度强化。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 双侧咽后间隙见肿大淋巴结，右侧大小约为7mm ×8 mm，左侧大小约3mm×4mm。双颈II区、III区见数个淋巴结，最大位于右颈II区，大小约为15mm×27mm。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽肿块，考虑鼻咽癌。 颅底骨质破坏。 右侧咽后及右颈淋巴结肿大，考虑转移瘤。 左侧咽后及左颈小淋巴结。 鼻窦炎、右乳突炎。\n- [全程D3] 检验组合: 平均红细胞体积(MCV)-静脉血: 93.7fL；凝血酶原时间活动度(PTA)-静脉血: 97%；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；中性粒细胞计数(Neut#)-静脉血: 3.610E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.7sec.；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；尿酸(UA)-静脉血: 413.6umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；血小板分布宽度(PDW)-静脉血: 14.7%；间接胆红素(IBIL)-静脉血: 9.7umolL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；丙氨酸氨基转移酶(ALT)-静脉血: 24U/L；碱性磷酸酶(ALP)-静脉血: 84.3U/L；总胆汁酸(TBA)-静脉血: 2.2umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.3mmol/L；葡萄糖(Glu)-静脉血: 4.51mmol/L；磷(P)-静脉血: 1.39mmol/L；C-反应蛋白(CRP)-静脉血: 4.68mg/L；血小板比容-静脉血: 25%；大血小板百分比(P-LCR%)-静脉血: 35.8%；血小板计数(PLT#)-静脉血: 21810E9/L；红细胞计数(RBC#)-静脉血: 4.5910E12/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；阴离子间隙(AG)-静脉血: 18；凝血酶时间(TT)-静脉血: 21.4sec.；红细胞比容(Hct)-静脉血: 43%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 344g/L；纤维蛋白原(Fbg)-静脉血: 3.09g/L；乳酸脱氢酶(LDH)-静脉血: 116.6U/L；总蛋白(TP)-静脉血: 69.58g/L；总钙(Ca)-静脉血: 2.31mmol/L；总胆固醇(TC)-静脉血: 5.94mmol/L；甘油三酯(TG)-静脉血: 1.79mmol/L；总胆红素(TBIL)-静脉血: 13.9umol/L；尿素氮(BUN……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D4] 检验组合: 乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D5] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶后壁及双侧壁粘膜增厚放射性浓聚，SUV约23.1；病灶填塞双侧鼻后孔，向上侵犯蝶骨基底部、双翼突基底部、犁骨及枕骨斜坡，局部骨质稍模糊放射性分布浓密。双侧破裂孔未见明显异常。双侧咽隐窝变浅。双侧咽旁间隙结构尚清。右侧咽后淋巴结放射性浓聚，SUV约11.4，大小约0.7×1.0cm；左侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见异常。筛窦、右上颌窦及右乳突稍低密度影放射性分布未见异常；额窦、蝶窦、左侧上颌窦及左乳突结构及放射性分布未见明显异常。口咽、喉咽未见明显异常。甲状腺放射性分布未见异常。双颈Ⅱ区肿大淋巴结放射性浓聚，SUV约10.2，最大约1.6×2.6cm；余双侧颈部未见肿大淋巴结及异常放射性分布。 双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺纹理清晰，双侧肺野未见确切病灶和异常放射性分布。气管、支气管通畅。心脏及大血管放射性分布未见异常。胸壁未见确切病灶和异常放射性分布。双肺门、纵隔及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏密度不均匀降低，放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管及胆总管未见扩张。胆囊、胃及十二指肠放射性分布未见异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、肠管等形态、结构及放射性分布未见明显异常。前列腺点状高密度影放射性分布未见异常。双侧髂血管旁及腹股沟未见明显肿大淋巴结及异常放射性分布。 余所见颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，病灶侵犯颅底骨；右咽后及双颈Ⅱ区淋巴结代谢较活跃，考虑转移。 鼻窦炎；右乳突炎。 脂肪肝。 前列腺钙化灶。\n- [全程D10] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: 右臂静脉插管, 导管末端位于胸椎右旁T 7上缘水平，估计位于上腔静脉下段。；检查结论: 导管末端位置如上述。\n- [全程D39] 检验组合: 胱抑素(Cys-C)-静脉血: 0.78mg/L；血小板比容-静脉血: 14.8%；中性粒细胞百分比(Neut%)-静脉血: 0.61；γ-谷氨酰基转移酶(GGT)-静脉血: 57.8U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；总蛋白(TP)-静脉血: 67.84g/L；平均红细胞体积(MCV)-静脉血: 96.4fL；镁离子(Mg2+)-静脉血: 0.92mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.05mmolL；钠离子(Na+)-静脉血: 139.4mmol/L；磷(P)-静脉血: 1.36mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.302；氯离子(Cl-)-静脉血: 103.4mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.54；平均红细胞血红蛋白含量(MCH)-静脉血: 32.7pg；平均血小板体积(MPV)-静脉血: 8.84fL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.59；钾离子(K+)-静脉血: 3.79mmol/L；单核细胞百分比(Mono%)-静脉血: 0.06；白细胞计数(WBC#)-静脉血: 5.4510E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；α-L-岩藻糖苷酶(AFU)-静脉血: 35.8U/L；血小板分布宽度(PDW)-静脉血: 16.9%；红细胞比容(Hct)-静脉血: 40.3%；乳酸脱氢酶(LDH)-静脉血: 149.5U/L；红细胞计数(RBC#)-静脉血: 4.1810E12/L；C-反应蛋白(CRP)-静脉血: 2.31mg/L；总钙(Ca)-静脉血: 2.19mmol/L；尿素氮(BUN)-静脉血: 3.8mmol/L；尿酸(UA)-静脉血: 285umol/L；阴离子间隙(AG)-静脉血: 11.3；葡萄糖(Glu)-静脉血: 4.38mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339.2g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 32.4U/L；甘油三酯(TG)-静脉血: 2.32mmol/L；白蛋白(ALB)-静脉血: 41.6g/L；血小板计数(PLT#)-静脉血: 167.……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D34] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者今日洛铂+5-FU化疗第2天，诉食欲较差，无恶心、呕吐等不适，精神、睡眠尚可，大小便正常。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者化疗第2日，一般情况可，嘱患者注意饮食，加强营养，续行化疗。密切观察化疗反应，必要时加强处理。现已按查房指示执行。\n- [全程D35] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者今日洛铂+5-FU化疗第3天，诉食欲较差，无恶心、呕吐等不适，精神、睡眠尚可，大小便正常。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者化疗第3日，一般情况可，密切观察化疗反应，必要时加强处理。现已按查房指示执行。\n- [全程D39] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者计划于今日完成第2程洛铂+5-FU方案诱导化疗，未诉特殊不适。[姓名已隐去]主诊医生信息已隐藏：患者现完成第2程洛铂+5-FU方案诱导化疗，一般情况可，予今日出院。嘱患者出院后定期每周复查血常规、肝肾功能，2周后返院续治。现已按查房指示执行。\n- [时间未明] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 现已按查房指示执行。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 办理出院，嘱每3天复查血常规及肝肾功能，1周后返院继续下一阶段治疗\nB. 予以重组人粒细胞刺激因子皮下注射后办理出院，嘱每周复查血常规，2周后返院\nC. 办理出院，嘱每周复查血常规及肝肾功能，2周后返院继续下一阶段治疗\nD. 办理出院，嘱每2周复查血常规及肝肾功能，3周后返院继续下一阶段治疗\nE. 暂缓出院，继续住院观察并每日复查血常规，待血液学指标进一步稳定后出院\nF. 办理出院，嘱每月复查血常规及肝肾功能，4周后返院评估疗效并决定后续治疗\nG. 予以静脉滴注保肝药物治疗，待复查肝功能指标完全正常后办理出院\nH. 办理出院，处方口服升血小板药物，嘱每周复查血常规，2周后返院\nI. 办理出院，处方口服卡培他滨单药维持，嘱每周复查血常规，3周后返院\nJ. 办理出院，嘱每周复查血常规及肝肾功能，4周后返院行MRI复查评估疗效\nK. 予以口服氯化钾缓释片补钾治疗，每日监测电解质，待血钾水平上升后办理出院\nL. 办理出院，无需定期复查化验指标，嘱出现发热或出血症状时急诊就诊，3周后返院\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-90c3b83f1d4c9db69ef01572","patient_id":"patient-5ee5dba6116030961a7a97b5","turn_id":"turn06","turn_position":5,"turn_type":"toxicity_or_support_decision","gold_letter":"K","gold_action":"继续同期放化疗，予以甲氧氯普胺口服止吐，暂不予静脉营养及免疫调节支持。","options":[{"letter":"A","text":"继续同期放化疗，予以重组人粒细胞刺激因子皮下注射及甲氧氯普胺口服止吐。","is_gold":false},{"letter":"B","text":"继续同期放化疗，予以重组人血小板生成素皮下注射及脂肪乳氨基酸葡萄糖静脉营养。","is_gold":false},{"letter":"C","text":"继续同期放化疗，予以多烯磷脂酰胆碱静脉滴注保肝及甲氧氯普胺口服止吐。","is_gold":false},{"letter":"D","text":"继续同期放化疗，予以甲氧氯普胺口服止吐，加用脂肪乳氨基酸葡萄糖静脉营养及胸腺五肽支持治疗。","is_gold":false},{"letter":"E","text":"暂停同期化疗，仅行单纯放疗，予以甲氧氯普胺口服止吐及脂肪乳氨基酸葡萄糖静脉营养。","is_gold":false},{"letter":"F","text":"继续同期放化疗，予以促红细胞生成素皮下注射及胸腺五肽支持治疗。","is_gold":false},{"letter":"G","text":"暂停放化疗，予以静脉输注红细胞悬液及脂肪乳氨基酸葡萄糖静脉营养。","is_gold":false},{"letter":"H","text":"继续同期放化疗，予以5-HT3受体拮抗剂静脉推注强化止吐，暂不予静脉营养支持。","is_gold":false},{"letter":"I","text":"继续同期放化疗，予以水化碱化尿液及甲氧氯普胺口服止吐。","is_gold":false},{"letter":"J","text":"暂停放化疗，予以广谱抗生素静脉滴注抗感染及胸腺五肽支持治疗。","is_gold":false},{"letter":"K","text":"继续同期放化疗，予以甲氧氯普胺口服止吐，暂不予静脉营养及免疫调节支持。","is_gold":true},{"letter":"L","text":"继续同期放化疗，予以重组人粒细胞刺激因子及促红细胞生成素双重支持。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 涕血半年伴右颈肿物2周；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 涕血半年伴右颈肿物2周；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D10] 入院记录: 主诉: 涕血半年伴右颈肿物2周.；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D3] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁增厚，可见软组织肿块形成，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。双侧咽隐窝见软组织占据，双侧咽旁脂肪间隙受压变窄，病灶侵犯双侧腭帆提肌。双侧腭帆张肌、头长肌未见受侵。 双侧翼腭窝、颞下窝未见异常；口咽双侧壁未见受累增厚，病变未累及后鼻孔。 双侧翼突基底内份、蝶骨基底部右份骨髓信号减低，增强可见轻度强化。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 双侧咽后间隙见肿大淋巴结，右侧大小约为7mm ×8 mm，左侧大小约3mm×4mm。双颈II区、III区见数个淋巴结，最大位于右颈II区，大小约为15mm×27mm。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽肿块，考虑鼻咽癌。 颅底骨质破坏。 右侧咽后及右颈淋巴结肿大，考虑转移瘤。 左侧咽后及左颈小淋巴结。 鼻窦炎、右乳突炎。\n- [全程D3] 检验组合: 平均红细胞体积(MCV)-静脉血: 93.7fL；凝血酶原时间活动度(PTA)-静脉血: 97%；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；中性粒细胞计数(Neut#)-静脉血: 3.610E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.7sec.；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；尿酸(UA)-静脉血: 413.6umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；血小板分布宽度(PDW)-静脉血: 14.7%；间接胆红素(IBIL)-静脉血: 9.7umolL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；丙氨酸氨基转移酶(ALT)-静脉血: 24U/L；碱性磷酸酶(ALP)-静脉血: 84.3U/L；总胆汁酸(TBA)-静脉血: 2.2umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.3mmol/L；葡萄糖(Glu)-静脉血: 4.51mmol/L；磷(P)-静脉血: 1.39mmol/L；C-反应蛋白(CRP)-静脉血: 4.68mg/L；血小板比容-静脉血: 25%；大血小板百分比(P-LCR%)-静脉血: 35.8%；血小板计数(PLT#)-静脉血: 21810E9/L；红细胞计数(RBC#)-静脉血: 4.5910E12/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；阴离子间隙(AG)-静脉血: 18；凝血酶时间(TT)-静脉血: 21.4sec.；红细胞比容(Hct)-静脉血: 43%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 344g/L；纤维蛋白原(Fbg)-静脉血: 3.09g/L；乳酸脱氢酶(LDH)-静脉血: 116.6U/L；总蛋白(TP)-静脉血: 69.58g/L；总钙(Ca)-静脉血: 2.31mmol/L；总胆固醇(TC)-静脉血: 5.94mmol/L；甘油三酯(TG)-静脉血: 1.79mmol/L；总胆红素(TBIL)-静脉血: 13.9umol/L；尿素氮(BUN……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D4] 检验组合: 乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D5] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶后壁及双侧壁粘膜增厚放射性浓聚，SUV约23.1；病灶填塞双侧鼻后孔，向上侵犯蝶骨基底部、双翼突基底部、犁骨及枕骨斜坡，局部骨质稍模糊放射性分布浓密。双侧破裂孔未见明显异常。双侧咽隐窝变浅。双侧咽旁间隙结构尚清。右侧咽后淋巴结放射性浓聚，SUV约11.4，大小约0.7×1.0cm；左侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见异常。筛窦、右上颌窦及右乳突稍低密度影放射性分布未见异常；额窦、蝶窦、左侧上颌窦及左乳突结构及放射性分布未见明显异常。口咽、喉咽未见明显异常。甲状腺放射性分布未见异常。双颈Ⅱ区肿大淋巴结放射性浓聚，SUV约10.2，最大约1.6×2.6cm；余双侧颈部未见肿大淋巴结及异常放射性分布。 双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺纹理清晰，双侧肺野未见确切病灶和异常放射性分布。气管、支气管通畅。心脏及大血管放射性分布未见异常。胸壁未见确切病灶和异常放射性分布。双肺门、纵隔及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏密度不均匀降低，放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管及胆总管未见扩张。胆囊、胃及十二指肠放射性分布未见异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、肠管等形态、结构及放射性分布未见明显异常。前列腺点状高密度影放射性分布未见异常。双侧髂血管旁及腹股沟未见明显肿大淋巴结及异常放射性分布。 余所见颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，病灶侵犯颅底骨；右咽后及双颈Ⅱ区淋巴结代谢较活跃，考虑转移。 鼻窦炎；右乳突炎。 脂肪肝。 前列腺钙化灶。\n- [全程D10] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: 右臂静脉插管, 导管末端位于胸椎右旁T 7上缘水平，估计位于上腔静脉下段。；检查结论: 导管末端位置如上述。\n- [全程D39] 检验组合: 胱抑素(Cys-C)-静脉血: 0.78mg/L；血小板比容-静脉血: 14.8%；中性粒细胞百分比(Neut%)-静脉血: 0.61；γ-谷氨酰基转移酶(GGT)-静脉血: 57.8U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；总蛋白(TP)-静脉血: 67.84g/L；平均红细胞体积(MCV)-静脉血: 96.4fL；镁离子(Mg2+)-静脉血: 0.92mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.05mmolL；钠离子(Na+)-静脉血: 139.4mmol/L；磷(P)-静脉血: 1.36mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.302；氯离子(Cl-)-静脉血: 103.4mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.54；平均红细胞血红蛋白含量(MCH)-静脉血: 32.7pg；平均血小板体积(MPV)-静脉血: 8.84fL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.59；钾离子(K+)-静脉血: 3.79mmol/L；单核细胞百分比(Mono%)-静脉血: 0.06；白细胞计数(WBC#)-静脉血: 5.4510E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；α-L-岩藻糖苷酶(AFU)-静脉血: 35.8U/L；血小板分布宽度(PDW)-静脉血: 16.9%；红细胞比容(Hct)-静脉血: 40.3%；乳酸脱氢酶(LDH)-静脉血: 149.5U/L；红细胞计数(RBC#)-静脉血: 4.1810E12/L；C-反应蛋白(CRP)-静脉血: 2.31mg/L；总钙(Ca)-静脉血: 2.19mmol/L；尿素氮(BUN)-静脉血: 3.8mmol/L；尿酸(UA)-静脉血: 285umol/L；阴离子间隙(AG)-静脉血: 11.3；葡萄糖(Glu)-静脉血: 4.38mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339.2g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 32.4U/L；甘油三酯(TG)-静脉血: 2.32mmol/L；白蛋白(ALB)-静脉血: 41.6g/L；血小板计数(PLT#)-静脉血: 167.……\n- [全程D45] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌2程化疗后，与某次就诊时间片对比： 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁增厚，可见软组织肿块形成，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，对比前片，较前明显缩小。双侧咽隐窝见软组织占据，双侧咽旁脂肪间隙受压变窄，病灶侵犯双侧腭帆提肌，范围较前稍缩小。双侧腭帆张肌、头长肌未见受侵。 双侧翼腭窝、颞下窝未见异常；口咽双侧壁未见受累增厚，病变未累及后鼻孔。 双侧翼突基底内份、蝶骨基底部右份骨髓信号减低，增强可见轻度强化。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 双侧咽后间隙见肿大淋巴结，右侧大小约为6mm ×7 mm，左侧大小约4mm×6mm。双颈II区、III区见数个淋巴结，最大位于右颈II区，大小约为11mm×24mm，较前明显缩小。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌2程化疗后： 鼻咽病灶较前明显缩小。 颅底骨质破坏。 双侧咽后及颈部淋巴结，较前明显缩小。 鼻窦炎、右乳突炎。\n- [全程D60] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 28.3U/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.1g/L；平均红细胞体积(MCV)-静脉血: 97.9fL；血液二氧化碳含量ctCO2(B)-静脉血: 22.6mmol/L；血小板计数(PLT#)-静脉血: 152.910E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；钾离子(K+)-静脉血: 4.2mmol/L；碱性磷酸酶(ALP)-静脉血: 76.4U/L；单核细胞百分比(Mono%)-静脉血: 0.073；γ-谷氨酰基转移酶(GGT)-静脉血: 46.4U/L；血红蛋白(Hb)-静脉血: 145.2g/L；胱抑素(Cys-C)-静脉血: 0.82mg/L；阴离子间隙(AG)-静脉血: 18；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；甘油三酯(TG)-静脉血: 1.57mmol/L；直接胆红素(DBIL)-静脉血: 6.7umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 345.2g/L；间接胆红素(IBIL)-静脉血: 17.9umolL；中性粒细胞百分比(Neut%)-静脉血: 0.676；乳酸脱氢酶(LDH)-静脉血: 132.5U/L；总蛋白(TP)-静脉血: 71.34g/L；总胆固醇(TC)-静脉血: 6.52mmol/L；总钙(Ca)-静脉血: 2.33mmol/L；血小板分布宽度(PDW)-静脉血: 16.9%；血小板比容-静脉血: 13%；尿酸(UA)-静脉血: 305.5umol/L；平均血小板体积(MPV)-静脉血: 8.53fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1%；淋巴细胞百分比(Lymph%)-静脉血: 0.221；钠离子(Na+)-静脉血: 139.5mmol/L；载脂蛋白B(apoB)-静脉血: 1.31g/L；有核红细胞百分比(NRBC%)-静脉血: 0；总胆汁酸(TBA)-静脉血: 3.6umol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总胆红素(TBIL)-静脉血: 24.6umol/L……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D34] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者今日洛铂+5-FU化疗第2天，诉食欲较差，无恶心、呕吐等不适，精神、睡眠尚可，大小便正常。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者化疗第2日，一般情况可，嘱患者注意饮食，加强营养，续行化疗。密切观察化疗反应，必要时加强处理。现已按查房指示执行。\n- [全程D35] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者今日洛铂+5-FU化疗第3天，诉食欲较差，无恶心、呕吐等不适，精神、睡眠尚可，大小便正常。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者化疗第3日，一般情况可，密切观察化疗反应，必要时加强处理。现已按查房指示执行。\n- [全程D39] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者计划于今日完成第2程洛铂+5-FU方案诱导化疗，未诉特殊不适。[姓名已隐去]主诊医生信息已隐藏：患者现完成第2程洛铂+5-FU方案诱导化疗，一般情况可，予今日出院。嘱患者出院后定期每周复查血常规、肝肾功能，2周后返院续治。现已按查房指示执行。\n- [时间未明] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 现已按查房指示执行。\n- [全程D55] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者未诉特殊不适，饮食、睡眠、精神尚可，大小便正常。查体：基本同前。[姓名已隐去]主诊医生信息已隐藏：患者诊断明确，已完成患者靶区设计，并通过全科会诊，剂量分布均匀，予GTVnx:70Gy/30F,GTVnd(L):66Gy/30F,GTVnd(R):66Gy/30F。考虑联合洛铂同期放化疗，告知患者放疗及化疗的可能获益及相关风险，患者表示已知情并同意。续观。现已按查房指示执行。\n- [全程D56] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现放疗1F，未诉特殊不适。生命体征平稳。查体情况大致同前。[姓名已隐去]主诊医生信息已隐藏：考虑患者一般情况可，继续放疗，密切关注放疗副反应，必要时加强处理。现已按查房指示执行。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 继续同期放化疗，予以重组人粒细胞刺激因子皮下注射及甲氧氯普胺口服止吐。\nB. 继续同期放化疗，予以重组人血小板生成素皮下注射及脂肪乳氨基酸葡萄糖静脉营养。\nC. 继续同期放化疗，予以多烯磷脂酰胆碱静脉滴注保肝及甲氧氯普胺口服止吐。\nD. 继续同期放化疗，予以甲氧氯普胺口服止吐，加用脂肪乳氨基酸葡萄糖静脉营养及胸腺五肽支持治疗。\nE. 暂停同期化疗，仅行单纯放疗，予以甲氧氯普胺口服止吐及脂肪乳氨基酸葡萄糖静脉营养。\nF. 继续同期放化疗，予以促红细胞生成素皮下注射及胸腺五肽支持治疗。\nG. 暂停放化疗，予以静脉输注红细胞悬液及脂肪乳氨基酸葡萄糖静脉营养。\nH. 继续同期放化疗，予以5-HT3受体拮抗剂静脉推注强化止吐，暂不予静脉营养支持。\nI. 继续同期放化疗，予以水化碱化尿液及甲氧氯普胺口服止吐。\nJ. 暂停放化疗，予以广谱抗生素静脉滴注抗感染及胸腺五肽支持治疗。\nK. 继续同期放化疗，予以甲氧氯普胺口服止吐，暂不予静脉营养及免疫调节支持。\nL. 继续同期放化疗，予以重组人粒细胞刺激因子及促红细胞生成素双重支持。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 涕血半年伴右颈肿物2周；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 涕血半年伴右颈肿物2周；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D10] 入院记录: 主诉: 涕血半年伴右颈肿物2周.；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D3] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁增厚，可见软组织肿块形成，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。双侧咽隐窝见软组织占据，双侧咽旁脂肪间隙受压变窄，病灶侵犯双侧腭帆提肌。双侧腭帆张肌、头长肌未见受侵。 双侧翼腭窝、颞下窝未见异常；口咽双侧壁未见受累增厚，病变未累及后鼻孔。 双侧翼突基底内份、蝶骨基底部右份骨髓信号减低，增强可见轻度强化。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 双侧咽后间隙见肿大淋巴结，右侧大小约为7mm ×8 mm，左侧大小约3mm×4mm。双颈II区、III区见数个淋巴结，最大位于右颈II区，大小约为15mm×27mm。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽肿块，考虑鼻咽癌。 颅底骨质破坏。 右侧咽后及右颈淋巴结肿大，考虑转移瘤。 左侧咽后及左颈小淋巴结。 鼻窦炎、右乳突炎。\n- [全程D3] 检验组合: 平均红细胞体积(MCV)-静脉血: 93.7fL；凝血酶原时间活动度(PTA)-静脉血: 97%；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；中性粒细胞计数(Neut#)-静脉血: 3.610E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.7sec.；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；尿酸(UA)-静脉血: 413.6umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；血小板分布宽度(PDW)-静脉血: 14.7%；间接胆红素(IBIL)-静脉血: 9.7umolL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；丙氨酸氨基转移酶(ALT)-静脉血: 24U/L；碱性磷酸酶(ALP)-静脉血: 84.3U/L；总胆汁酸(TBA)-静脉血: 2.2umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.3mmol/L；葡萄糖(Glu)-静脉血: 4.51mmol/L；磷(P)-静脉血: 1.39mmol/L；C-反应蛋白(CRP)-静脉血: 4.68mg/L；血小板比容-静脉血: 25%；大血小板百分比(P-LCR%)-静脉血: 35.8%；血小板计数(PLT#)-静脉血: 21810E9/L；红细胞计数(RBC#)-静脉血: 4.5910E12/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；阴离子间隙(AG)-静脉血: 18；凝血酶时间(TT)-静脉血: 21.4sec.；红细胞比容(Hct)-静脉血: 43%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 344g/L；纤维蛋白原(Fbg)-静脉血: 3.09g/L；乳酸脱氢酶(LDH)-静脉血: 116.6U/L；总蛋白(TP)-静脉血: 69.58g/L；总钙(Ca)-静脉血: 2.31mmol/L；总胆固醇(TC)-静脉血: 5.94mmol/L；甘油三酯(TG)-静脉血: 1.79mmol/L；总胆红素(TBIL)-静脉血: 13.9umol/L；尿素氮(BUN……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D4] 检验组合: 乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D5] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶后壁及双侧壁粘膜增厚放射性浓聚，SUV约23.1；病灶填塞双侧鼻后孔，向上侵犯蝶骨基底部、双翼突基底部、犁骨及枕骨斜坡，局部骨质稍模糊放射性分布浓密。双侧破裂孔未见明显异常。双侧咽隐窝变浅。双侧咽旁间隙结构尚清。右侧咽后淋巴结放射性浓聚，SUV约11.4，大小约0.7×1.0cm；左侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见异常。筛窦、右上颌窦及右乳突稍低密度影放射性分布未见异常；额窦、蝶窦、左侧上颌窦及左乳突结构及放射性分布未见明显异常。口咽、喉咽未见明显异常。甲状腺放射性分布未见异常。双颈Ⅱ区肿大淋巴结放射性浓聚，SUV约10.2，最大约1.6×2.6cm；余双侧颈部未见肿大淋巴结及异常放射性分布。 双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺纹理清晰，双侧肺野未见确切病灶和异常放射性分布。气管、支气管通畅。心脏及大血管放射性分布未见异常。胸壁未见确切病灶和异常放射性分布。双肺门、纵隔及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏密度不均匀降低，放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管及胆总管未见扩张。胆囊、胃及十二指肠放射性分布未见异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、肠管等形态、结构及放射性分布未见明显异常。前列腺点状高密度影放射性分布未见异常。双侧髂血管旁及腹股沟未见明显肿大淋巴结及异常放射性分布。 余所见颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，病灶侵犯颅底骨；右咽后及双颈Ⅱ区淋巴结代谢较活跃，考虑转移。 鼻窦炎；右乳突炎。 脂肪肝。 前列腺钙化灶。\n- [全程D10] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: 右臂静脉插管, 导管末端位于胸椎右旁T 7上缘水平，估计位于上腔静脉下段。；检查结论: 导管末端位置如上述。\n- [全程D39] 检验组合: 胱抑素(Cys-C)-静脉血: 0.78mg/L；血小板比容-静脉血: 14.8%；中性粒细胞百分比(Neut%)-静脉血: 0.61；γ-谷氨酰基转移酶(GGT)-静脉血: 57.8U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；总蛋白(TP)-静脉血: 67.84g/L；平均红细胞体积(MCV)-静脉血: 96.4fL；镁离子(Mg2+)-静脉血: 0.92mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.05mmolL；钠离子(Na+)-静脉血: 139.4mmol/L；磷(P)-静脉血: 1.36mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.302；氯离子(Cl-)-静脉血: 103.4mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.54；平均红细胞血红蛋白含量(MCH)-静脉血: 32.7pg；平均血小板体积(MPV)-静脉血: 8.84fL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.59；钾离子(K+)-静脉血: 3.79mmol/L；单核细胞百分比(Mono%)-静脉血: 0.06；白细胞计数(WBC#)-静脉血: 5.4510E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；α-L-岩藻糖苷酶(AFU)-静脉血: 35.8U/L；血小板分布宽度(PDW)-静脉血: 16.9%；红细胞比容(Hct)-静脉血: 40.3%；乳酸脱氢酶(LDH)-静脉血: 149.5U/L；红细胞计数(RBC#)-静脉血: 4.1810E12/L；C-反应蛋白(CRP)-静脉血: 2.31mg/L；总钙(Ca)-静脉血: 2.19mmol/L；尿素氮(BUN)-静脉血: 3.8mmol/L；尿酸(UA)-静脉血: 285umol/L；阴离子间隙(AG)-静脉血: 11.3；葡萄糖(Glu)-静脉血: 4.38mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339.2g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 32.4U/L；甘油三酯(TG)-静脉血: 2.32mmol/L；白蛋白(ALB)-静脉血: 41.6g/L；血小板计数(PLT#)-静脉血: 167.……\n- [全程D45] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌2程化疗后，与某次就诊时间片对比： 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁增厚，可见软组织肿块形成，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，对比前片，较前明显缩小。双侧咽隐窝见软组织占据，双侧咽旁脂肪间隙受压变窄，病灶侵犯双侧腭帆提肌，范围较前稍缩小。双侧腭帆张肌、头长肌未见受侵。 双侧翼腭窝、颞下窝未见异常；口咽双侧壁未见受累增厚，病变未累及后鼻孔。 双侧翼突基底内份、蝶骨基底部右份骨髓信号减低，增强可见轻度强化。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 双侧咽后间隙见肿大淋巴结，右侧大小约为6mm ×7 mm，左侧大小约4mm×6mm。双颈II区、III区见数个淋巴结，最大位于右颈II区，大小约为11mm×24mm，较前明显缩小。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌2程化疗后： 鼻咽病灶较前明显缩小。 颅底骨质破坏。 双侧咽后及颈部淋巴结，较前明显缩小。 鼻窦炎、右乳突炎。\n- [全程D60] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 28.3U/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.1g/L；平均红细胞体积(MCV)-静脉血: 97.9fL；血液二氧化碳含量ctCO2(B)-静脉血: 22.6mmol/L；血小板计数(PLT#)-静脉血: 152.910E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；钾离子(K+)-静脉血: 4.2mmol/L；碱性磷酸酶(ALP)-静脉血: 76.4U/L；单核细胞百分比(Mono%)-静脉血: 0.073；γ-谷氨酰基转移酶(GGT)-静脉血: 46.4U/L；血红蛋白(Hb)-静脉血: 145.2g/L；胱抑素(Cys-C)-静脉血: 0.82mg/L；阴离子间隙(AG)-静脉血: 18；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；甘油三酯(TG)-静脉血: 1.57mmol/L；直接胆红素(DBIL)-静脉血: 6.7umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 345.2g/L；间接胆红素(IBIL)-静脉血: 17.9umolL；中性粒细胞百分比(Neut%)-静脉血: 0.676；乳酸脱氢酶(LDH)-静脉血: 132.5U/L；总蛋白(TP)-静脉血: 71.34g/L；总胆固醇(TC)-静脉血: 6.52mmol/L；总钙(Ca)-静脉血: 2.33mmol/L；血小板分布宽度(PDW)-静脉血: 16.9%；血小板比容-静脉血: 13%；尿酸(UA)-静脉血: 305.5umol/L；平均血小板体积(MPV)-静脉血: 8.53fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1%；淋巴细胞百分比(Lymph%)-静脉血: 0.221；钠离子(Na+)-静脉血: 139.5mmol/L；载脂蛋白B(apoB)-静脉血: 1.31g/L；有核红细胞百分比(NRBC%)-静脉血: 0；总胆汁酸(TBA)-静脉血: 3.6umol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总胆红素(TBIL)-静脉血: 24.6umol/L……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D34] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者今日洛铂+5-FU化疗第2天，诉食欲较差，无恶心、呕吐等不适，精神、睡眠尚可，大小便正常。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者化疗第2日，一般情况可，嘱患者注意饮食，加强营养，续行化疗。密切观察化疗反应，必要时加强处理。现已按查房指示执行。\n- [全程D35] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者今日洛铂+5-FU化疗第3天，诉食欲较差，无恶心、呕吐等不适，精神、睡眠尚可，大小便正常。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者化疗第3日，一般情况可，密切观察化疗反应，必要时加强处理。现已按查房指示执行。\n- [全程D39] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者计划于今日完成第2程洛铂+5-FU方案诱导化疗，未诉特殊不适。[姓名已隐去]主诊医生信息已隐藏：患者现完成第2程洛铂+5-FU方案诱导化疗，一般情况可，予今日出院。嘱患者出院后定期每周复查血常规、肝肾功能，2周后返院续治。现已按查房指示执行。\n- [时间未明] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 现已按查房指示执行。\n- [全程D55] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者未诉特殊不适，饮食、睡眠、精神尚可，大小便正常。查体：基本同前。[姓名已隐去]主诊医生信息已隐藏：患者诊断明确，已完成患者靶区设计，并通过全科会诊，剂量分布均匀，予GTVnx:70Gy/30F,GTVnd(L):66Gy/30F,GTVnd(R):66Gy/30F。考虑联合洛铂同期放化疗，告知患者放疗及化疗的可能获益及相关风险，患者表示已知情并同意。续观。现已按查房指示执行。\n- [全程D56] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现放疗1F，未诉特殊不适。生命体征平稳。查体情况大致同前。[姓名已隐去]主诊医生信息已隐藏：考虑患者一般情况可，继续放疗，密切关注放疗副反应，必要时加强处理。现已按查房指示执行。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 继续同期放化疗，予以重组人粒细胞刺激因子皮下注射及甲氧氯普胺口服止吐。\nB. 继续同期放化疗，予以重组人血小板生成素皮下注射及脂肪乳氨基酸葡萄糖静脉营养。\nC. 继续同期放化疗，予以多烯磷脂酰胆碱静脉滴注保肝及甲氧氯普胺口服止吐。\nD. 继续同期放化疗，予以甲氧氯普胺口服止吐，加用脂肪乳氨基酸葡萄糖静脉营养及胸腺五肽支持治疗。\nE. 暂停同期化疗，仅行单纯放疗，予以甲氧氯普胺口服止吐及脂肪乳氨基酸葡萄糖静脉营养。\nF. 继续同期放化疗，予以促红细胞生成素皮下注射及胸腺五肽支持治疗。\nG. 暂停放化疗，予以静脉输注红细胞悬液及脂肪乳氨基酸葡萄糖静脉营养。\nH. 继续同期放化疗，予以5-HT3受体拮抗剂静脉推注强化止吐，暂不予静脉营养支持。\nI. 继续同期放化疗，予以水化碱化尿液及甲氧氯普胺口服止吐。\nJ. 暂停放化疗，予以广谱抗生素静脉滴注抗感染及胸腺五肽支持治疗。\nK. 继续同期放化疗，予以甲氧氯普胺口服止吐，暂不予静脉营养及免疫调节支持。\nL. 继续同期放化疗，予以重组人粒细胞刺激因子及促红细胞生成素双重支持。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-d1b602a57ed6c599e7f441cc","patient_id":"patient-5ee5dba6116030961a7a97b5","turn_id":"turn07","turn_position":6,"turn_type":"response_assessment_decision","gold_letter":"E","gold_action":"评估为诱导化疗部分缓解（PR），完善放疗前常规血液学检查，启动根治性调强放射治疗（IMRT）及放疗相关支持治疗。","options":[{"letter":"A","text":"评估为诱导化疗疾病稳定（SD），原方案（洛铂+5-FU）继续第3程诱导化疗，随后再评估放疗指征。","is_gold":false},{"letter":"B","text":"评估为诱导化疗部分缓解（PR），原方案（洛铂+5-FU）继续第3程诱导化疗，以期达到完全缓解后放疗。","is_gold":false},{"letter":"C","text":"评估为诱导化疗部分缓解（PR），行鼻咽及颈部病灶根治性手术切除，术后辅助调强放射治疗。","is_gold":false},{"letter":"D","text":"评估为诱导化疗完全缓解（CR），暂缓放射治疗，进入定期随访观察阶段。","is_gold":false},{"letter":"E","text":"评估为诱导化疗部分缓解（PR），完善放疗前常规血液学检查，启动根治性调强放射治疗（IMRT）及放疗相关支持治疗。","is_gold":true},{"letter":"F","text":"评估为诱导化疗部分缓解（PR），启动根治性三维适形放射治疗（3D-CRT）及放疗相关支持治疗。","is_gold":false},{"letter":"G","text":"评估为诱导化疗疾病进展（PD），更改诱导化疗方案为吉西他滨+顺铂（GP），2程后再次评估。","is_gold":false},{"letter":"H","text":"评估为诱导化疗部分缓解（PR），行颈部淋巴结清扫术，术后行鼻咽局部调强放射治疗。","is_gold":false},{"letter":"I","text":"评估为诱导化疗部分缓解（PR），启动姑息性减症放射治疗，剂量控制在40Gy左右。","is_gold":false},{"letter":"J","text":"评估为诱导化疗疾病稳定（SD），加用免疫检查点抑制剂联合原方案化疗。","is_gold":false},{"letter":"K","text":"评估为诱导化疗部分缓解（PR），等待4周后复查PET-CT，视代谢活性决定是否启动放射治疗。","is_gold":false},{"letter":"L","text":"评估为诱导化疗部分缓解（PR），停用化疗，单用靶向药物维持治疗。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 涕血半年伴右颈肿物2周；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 涕血半年伴右颈肿物2周；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D10] 入院记录: 主诉: 涕血半年伴右颈肿物2周.；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D3] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁增厚，可见软组织肿块形成，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。双侧咽隐窝见软组织占据，双侧咽旁脂肪间隙受压变窄，病灶侵犯双侧腭帆提肌。双侧腭帆张肌、头长肌未见受侵。 双侧翼腭窝、颞下窝未见异常；口咽双侧壁未见受累增厚，病变未累及后鼻孔。 双侧翼突基底内份、蝶骨基底部右份骨髓信号减低，增强可见轻度强化。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 双侧咽后间隙见肿大淋巴结，右侧大小约为7mm ×8 mm，左侧大小约3mm×4mm。双颈II区、III区见数个淋巴结，最大位于右颈II区，大小约为15mm×27mm。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽肿块，考虑鼻咽癌。 颅底骨质破坏。 右侧咽后及右颈淋巴结肿大，考虑转移瘤。 左侧咽后及左颈小淋巴结。 鼻窦炎、右乳突炎。\n- [全程D3] 检验组合: 平均红细胞体积(MCV)-静脉血: 93.7fL；凝血酶原时间活动度(PTA)-静脉血: 97%；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；中性粒细胞计数(Neut#)-静脉血: 3.610E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.7sec.；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；尿酸(UA)-静脉血: 413.6umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；血小板分布宽度(PDW)-静脉血: 14.7%；间接胆红素(IBIL)-静脉血: 9.7umolL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；丙氨酸氨基转移酶(ALT)-静脉血: 24U/L；碱性磷酸酶(ALP)-静脉血: 84.3U/L；总胆汁酸(TBA)-静脉血: 2.2umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.3mmol/L；葡萄糖(Glu)-静脉血: 4.51mmol/L；磷(P)-静脉血: 1.39mmol/L；C-反应蛋白(CRP)-静脉血: 4.68mg/L；血小板比容-静脉血: 25%；大血小板百分比(P-LCR%)-静脉血: 35.8%；血小板计数(PLT#)-静脉血: 21810E9/L；红细胞计数(RBC#)-静脉血: 4.5910E12/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；阴离子间隙(AG)-静脉血: 18；凝血酶时间(TT)-静脉血: 21.4sec.；红细胞比容(Hct)-静脉血: 43%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 344g/L；纤维蛋白原(Fbg)-静脉血: 3.09g/L；乳酸脱氢酶(LDH)-静脉血: 116.6U/L；总蛋白(TP)-静脉血: 69.58g/L；总钙(Ca)-静脉血: 2.31mmol/L；总胆固醇(TC)-静脉血: 5.94mmol/L；甘油三酯(TG)-静脉血: 1.79mmol/L；总胆红素(TBIL)-静脉血: 13.9umol/L；尿素氮(BUN……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D4] 检验组合: 乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D5] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶后壁及双侧壁粘膜增厚放射性浓聚，SUV约23.1；病灶填塞双侧鼻后孔，向上侵犯蝶骨基底部、双翼突基底部、犁骨及枕骨斜坡，局部骨质稍模糊放射性分布浓密。双侧破裂孔未见明显异常。双侧咽隐窝变浅。双侧咽旁间隙结构尚清。右侧咽后淋巴结放射性浓聚，SUV约11.4，大小约0.7×1.0cm；左侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见异常。筛窦、右上颌窦及右乳突稍低密度影放射性分布未见异常；额窦、蝶窦、左侧上颌窦及左乳突结构及放射性分布未见明显异常。口咽、喉咽未见明显异常。甲状腺放射性分布未见异常。双颈Ⅱ区肿大淋巴结放射性浓聚，SUV约10.2，最大约1.6×2.6cm；余双侧颈部未见肿大淋巴结及异常放射性分布。 双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺纹理清晰，双侧肺野未见确切病灶和异常放射性分布。气管、支气管通畅。心脏及大血管放射性分布未见异常。胸壁未见确切病灶和异常放射性分布。双肺门、纵隔及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏密度不均匀降低，放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管及胆总管未见扩张。胆囊、胃及十二指肠放射性分布未见异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、肠管等形态、结构及放射性分布未见明显异常。前列腺点状高密度影放射性分布未见异常。双侧髂血管旁及腹股沟未见明显肿大淋巴结及异常放射性分布。 余所见颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，病灶侵犯颅底骨；右咽后及双颈Ⅱ区淋巴结代谢较活跃，考虑转移。 鼻窦炎；右乳突炎。 脂肪肝。 前列腺钙化灶。\n- [全程D10] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: 右臂静脉插管, 导管末端位于胸椎右旁T 7上缘水平，估计位于上腔静脉下段。；检查结论: 导管末端位置如上述。\n- [全程D39] 检验组合: 胱抑素(Cys-C)-静脉血: 0.78mg/L；血小板比容-静脉血: 14.8%；中性粒细胞百分比(Neut%)-静脉血: 0.61；γ-谷氨酰基转移酶(GGT)-静脉血: 57.8U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；总蛋白(TP)-静脉血: 67.84g/L；平均红细胞体积(MCV)-静脉血: 96.4fL；镁离子(Mg2+)-静脉血: 0.92mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.05mmolL；钠离子(Na+)-静脉血: 139.4mmol/L；磷(P)-静脉血: 1.36mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.302；氯离子(Cl-)-静脉血: 103.4mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.54；平均红细胞血红蛋白含量(MCH)-静脉血: 32.7pg；平均血小板体积(MPV)-静脉血: 8.84fL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.59；钾离子(K+)-静脉血: 3.79mmol/L；单核细胞百分比(Mono%)-静脉血: 0.06；白细胞计数(WBC#)-静脉血: 5.4510E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；α-L-岩藻糖苷酶(AFU)-静脉血: 35.8U/L；血小板分布宽度(PDW)-静脉血: 16.9%；红细胞比容(Hct)-静脉血: 40.3%；乳酸脱氢酶(LDH)-静脉血: 149.5U/L；红细胞计数(RBC#)-静脉血: 4.1810E12/L；C-反应蛋白(CRP)-静脉血: 2.31mg/L；总钙(Ca)-静脉血: 2.19mmol/L；尿素氮(BUN)-静脉血: 3.8mmol/L；尿酸(UA)-静脉血: 285umol/L；阴离子间隙(AG)-静脉血: 11.3；葡萄糖(Glu)-静脉血: 4.38mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339.2g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 32.4U/L；甘油三酯(TG)-静脉血: 2.32mmol/L；白蛋白(ALB)-静脉血: 41.6g/L；血小板计数(PLT#)-静脉血: 167.……\n- [全程D45] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌2程化疗后，与某次就诊时间片对比： 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁增厚，可见软组织肿块形成，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，对比前片，较前明显缩小。双侧咽隐窝见软组织占据，双侧咽旁脂肪间隙受压变窄，病灶侵犯双侧腭帆提肌，范围较前稍缩小。双侧腭帆张肌、头长肌未见受侵。 双侧翼腭窝、颞下窝未见异常；口咽双侧壁未见受累增厚，病变未累及后鼻孔。 双侧翼突基底内份、蝶骨基底部右份骨髓信号减低，增强可见轻度强化。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 双侧咽后间隙见肿大淋巴结，右侧大小约为6mm ×7 mm，左侧大小约4mm×6mm。双颈II区、III区见数个淋巴结，最大位于右颈II区，大小约为11mm×24mm，较前明显缩小。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌2程化疗后： 鼻咽病灶较前明显缩小。 颅底骨质破坏。 双侧咽后及颈部淋巴结，较前明显缩小。 鼻窦炎、右乳突炎。\n- [全程D60] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 28.3U/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.1g/L；平均红细胞体积(MCV)-静脉血: 97.9fL；血液二氧化碳含量ctCO2(B)-静脉血: 22.6mmol/L；血小板计数(PLT#)-静脉血: 152.910E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；钾离子(K+)-静脉血: 4.2mmol/L；碱性磷酸酶(ALP)-静脉血: 76.4U/L；单核细胞百分比(Mono%)-静脉血: 0.073；γ-谷氨酰基转移酶(GGT)-静脉血: 46.4U/L；血红蛋白(Hb)-静脉血: 145.2g/L；胱抑素(Cys-C)-静脉血: 0.82mg/L；阴离子间隙(AG)-静脉血: 18；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；甘油三酯(TG)-静脉血: 1.57mmol/L；直接胆红素(DBIL)-静脉血: 6.7umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 345.2g/L；间接胆红素(IBIL)-静脉血: 17.9umolL；中性粒细胞百分比(Neut%)-静脉血: 0.676；乳酸脱氢酶(LDH)-静脉血: 132.5U/L；总蛋白(TP)-静脉血: 71.34g/L；总胆固醇(TC)-静脉血: 6.52mmol/L；总钙(Ca)-静脉血: 2.33mmol/L；血小板分布宽度(PDW)-静脉血: 16.9%；血小板比容-静脉血: 13%；尿酸(UA)-静脉血: 305.5umol/L；平均血小板体积(MPV)-静脉血: 8.53fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1%；淋巴细胞百分比(Lymph%)-静脉血: 0.221；钠离子(Na+)-静脉血: 139.5mmol/L；载脂蛋白B(apoB)-静脉血: 1.31g/L；有核红细胞百分比(NRBC%)-静脉血: 0；总胆汁酸(TBA)-静脉血: 3.6umol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总胆红素(TBIL)-静脉血: 24.6umol/L……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D34] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者今日洛铂+5-FU化疗第2天，诉食欲较差，无恶心、呕吐等不适，精神、睡眠尚可，大小便正常。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者化疗第2日，一般情况可，嘱患者注意饮食，加强营养，续行化疗。密切观察化疗反应，必要时加强处理。现已按查房指示执行。\n- [全程D35] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者今日洛铂+5-FU化疗第3天，诉食欲较差，无恶心、呕吐等不适，精神、睡眠尚可，大小便正常。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者化疗第3日，一般情况可，密切观察化疗反应，必要时加强处理。现已按查房指示执行。\n- [全程D39] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者计划于今日完成第2程洛铂+5-FU方案诱导化疗，未诉特殊不适。[姓名已隐去]主诊医生信息已隐藏：患者现完成第2程洛铂+5-FU方案诱导化疗，一般情况可，予今日出院。嘱患者出院后定期每周复查血常规、肝肾功能，2周后返院续治。现已按查房指示执行。\n- [时间未明] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 现已按查房指示执行。\n- [全程D55] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者未诉特殊不适，饮食、睡眠、精神尚可，大小便正常。查体：基本同前。[姓名已隐去]主诊医生信息已隐藏：患者诊断明确，已完成患者靶区设计，并通过全科会诊，剂量分布均匀，予GTVnx:70Gy/30F,GTVnd(L):66Gy/30F,GTVnd(R):66Gy/30F。考虑联合洛铂同期放化疗，告知患者放疗及化疗的可能获益及相关风险，患者表示已知情并同意。续观。现已按查房指示执行。\n- [全程D56] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现放疗1F，未诉特殊不适。生命体征平稳。查体情况大致同前。[姓名已隐去]主诊医生信息已隐藏：考虑患者一般情况可，继续放疗，密切关注放疗副反应，必要时加强处理。现已按查房指示执行。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估为诱导化疗疾病稳定（SD），原方案（洛铂+5-FU）继续第3程诱导化疗，随后再评估放疗指征。\nB. 评估为诱导化疗部分缓解（PR），原方案（洛铂+5-FU）继续第3程诱导化疗，以期达到完全缓解后放疗。\nC. 评估为诱导化疗部分缓解（PR），行鼻咽及颈部病灶根治性手术切除，术后辅助调强放射治疗。\nD. 评估为诱导化疗完全缓解（CR），暂缓放射治疗，进入定期随访观察阶段。\nE. 评估为诱导化疗部分缓解（PR），完善放疗前常规血液学检查，启动根治性调强放射治疗（IMRT）及放疗相关支持治疗。\nF. 评估为诱导化疗部分缓解（PR），启动根治性三维适形放射治疗（3D-CRT）及放疗相关支持治疗。\nG. 评估为诱导化疗疾病进展（PD），更改诱导化疗方案为吉西他滨+顺铂（GP），2程后再次评估。\nH. 评估为诱导化疗部分缓解（PR），行颈部淋巴结清扫术，术后行鼻咽局部调强放射治疗。\nI. 评估为诱导化疗部分缓解（PR），启动姑息性减症放射治疗，剂量控制在40Gy左右。\nJ. 评估为诱导化疗疾病稳定（SD），加用免疫检查点抑制剂联合原方案化疗。\nK. 评估为诱导化疗部分缓解（PR），等待4周后复查PET-CT，视代谢活性决定是否启动放射治疗。\nL. 评估为诱导化疗部分缓解（PR），停用化疗，单用靶向药物维持治疗。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 涕血半年伴右颈肿物2周；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 涕血半年伴右颈肿物2周；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D10] 入院记录: 主诉: 涕血半年伴右颈肿物2周.；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D3] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁增厚，可见软组织肿块形成，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。双侧咽隐窝见软组织占据，双侧咽旁脂肪间隙受压变窄，病灶侵犯双侧腭帆提肌。双侧腭帆张肌、头长肌未见受侵。 双侧翼腭窝、颞下窝未见异常；口咽双侧壁未见受累增厚，病变未累及后鼻孔。 双侧翼突基底内份、蝶骨基底部右份骨髓信号减低，增强可见轻度强化。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 双侧咽后间隙见肿大淋巴结，右侧大小约为7mm ×8 mm，左侧大小约3mm×4mm。双颈II区、III区见数个淋巴结，最大位于右颈II区，大小约为15mm×27mm。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽肿块，考虑鼻咽癌。 颅底骨质破坏。 右侧咽后及右颈淋巴结肿大，考虑转移瘤。 左侧咽后及左颈小淋巴结。 鼻窦炎、右乳突炎。\n- [全程D3] 检验组合: 平均红细胞体积(MCV)-静脉血: 93.7fL；凝血酶原时间活动度(PTA)-静脉血: 97%；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；中性粒细胞计数(Neut#)-静脉血: 3.610E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.7sec.；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；尿酸(UA)-静脉血: 413.6umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；血小板分布宽度(PDW)-静脉血: 14.7%；间接胆红素(IBIL)-静脉血: 9.7umolL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；丙氨酸氨基转移酶(ALT)-静脉血: 24U/L；碱性磷酸酶(ALP)-静脉血: 84.3U/L；总胆汁酸(TBA)-静脉血: 2.2umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.3mmol/L；葡萄糖(Glu)-静脉血: 4.51mmol/L；磷(P)-静脉血: 1.39mmol/L；C-反应蛋白(CRP)-静脉血: 4.68mg/L；血小板比容-静脉血: 25%；大血小板百分比(P-LCR%)-静脉血: 35.8%；血小板计数(PLT#)-静脉血: 21810E9/L；红细胞计数(RBC#)-静脉血: 4.5910E12/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；阴离子间隙(AG)-静脉血: 18；凝血酶时间(TT)-静脉血: 21.4sec.；红细胞比容(Hct)-静脉血: 43%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 344g/L；纤维蛋白原(Fbg)-静脉血: 3.09g/L；乳酸脱氢酶(LDH)-静脉血: 116.6U/L；总蛋白(TP)-静脉血: 69.58g/L；总钙(Ca)-静脉血: 2.31mmol/L；总胆固醇(TC)-静脉血: 5.94mmol/L；甘油三酯(TG)-静脉血: 1.79mmol/L；总胆红素(TBIL)-静脉血: 13.9umol/L；尿素氮(BUN……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D4] 检验组合: 乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D5] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶后壁及双侧壁粘膜增厚放射性浓聚，SUV约23.1；病灶填塞双侧鼻后孔，向上侵犯蝶骨基底部、双翼突基底部、犁骨及枕骨斜坡，局部骨质稍模糊放射性分布浓密。双侧破裂孔未见明显异常。双侧咽隐窝变浅。双侧咽旁间隙结构尚清。右侧咽后淋巴结放射性浓聚，SUV约11.4，大小约0.7×1.0cm；左侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见异常。筛窦、右上颌窦及右乳突稍低密度影放射性分布未见异常；额窦、蝶窦、左侧上颌窦及左乳突结构及放射性分布未见明显异常。口咽、喉咽未见明显异常。甲状腺放射性分布未见异常。双颈Ⅱ区肿大淋巴结放射性浓聚，SUV约10.2，最大约1.6×2.6cm；余双侧颈部未见肿大淋巴结及异常放射性分布。 双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺纹理清晰，双侧肺野未见确切病灶和异常放射性分布。气管、支气管通畅。心脏及大血管放射性分布未见异常。胸壁未见确切病灶和异常放射性分布。双肺门、纵隔及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏密度不均匀降低，放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管及胆总管未见扩张。胆囊、胃及十二指肠放射性分布未见异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、肠管等形态、结构及放射性分布未见明显异常。前列腺点状高密度影放射性分布未见异常。双侧髂血管旁及腹股沟未见明显肿大淋巴结及异常放射性分布。 余所见颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，病灶侵犯颅底骨；右咽后及双颈Ⅱ区淋巴结代谢较活跃，考虑转移。 鼻窦炎；右乳突炎。 脂肪肝。 前列腺钙化灶。\n- [全程D10] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: 右臂静脉插管, 导管末端位于胸椎右旁T 7上缘水平，估计位于上腔静脉下段。；检查结论: 导管末端位置如上述。\n- [全程D39] 检验组合: 胱抑素(Cys-C)-静脉血: 0.78mg/L；血小板比容-静脉血: 14.8%；中性粒细胞百分比(Neut%)-静脉血: 0.61；γ-谷氨酰基转移酶(GGT)-静脉血: 57.8U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；总蛋白(TP)-静脉血: 67.84g/L；平均红细胞体积(MCV)-静脉血: 96.4fL；镁离子(Mg2+)-静脉血: 0.92mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.05mmolL；钠离子(Na+)-静脉血: 139.4mmol/L；磷(P)-静脉血: 1.36mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.302；氯离子(Cl-)-静脉血: 103.4mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.54；平均红细胞血红蛋白含量(MCH)-静脉血: 32.7pg；平均血小板体积(MPV)-静脉血: 8.84fL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.59；钾离子(K+)-静脉血: 3.79mmol/L；单核细胞百分比(Mono%)-静脉血: 0.06；白细胞计数(WBC#)-静脉血: 5.4510E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；α-L-岩藻糖苷酶(AFU)-静脉血: 35.8U/L；血小板分布宽度(PDW)-静脉血: 16.9%；红细胞比容(Hct)-静脉血: 40.3%；乳酸脱氢酶(LDH)-静脉血: 149.5U/L；红细胞计数(RBC#)-静脉血: 4.1810E12/L；C-反应蛋白(CRP)-静脉血: 2.31mg/L；总钙(Ca)-静脉血: 2.19mmol/L；尿素氮(BUN)-静脉血: 3.8mmol/L；尿酸(UA)-静脉血: 285umol/L；阴离子间隙(AG)-静脉血: 11.3；葡萄糖(Glu)-静脉血: 4.38mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339.2g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 32.4U/L；甘油三酯(TG)-静脉血: 2.32mmol/L；白蛋白(ALB)-静脉血: 41.6g/L；血小板计数(PLT#)-静脉血: 167.……\n- [全程D45] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌2程化疗后，与某次就诊时间片对比： 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁增厚，可见软组织肿块形成，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，对比前片，较前明显缩小。双侧咽隐窝见软组织占据，双侧咽旁脂肪间隙受压变窄，病灶侵犯双侧腭帆提肌，范围较前稍缩小。双侧腭帆张肌、头长肌未见受侵。 双侧翼腭窝、颞下窝未见异常；口咽双侧壁未见受累增厚，病变未累及后鼻孔。 双侧翼突基底内份、蝶骨基底部右份骨髓信号减低，增强可见轻度强化。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 双侧咽后间隙见肿大淋巴结，右侧大小约为6mm ×7 mm，左侧大小约4mm×6mm。双颈II区、III区见数个淋巴结，最大位于右颈II区，大小约为11mm×24mm，较前明显缩小。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌2程化疗后： 鼻咽病灶较前明显缩小。 颅底骨质破坏。 双侧咽后及颈部淋巴结，较前明显缩小。 鼻窦炎、右乳突炎。\n- [全程D60] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 28.3U/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.1g/L；平均红细胞体积(MCV)-静脉血: 97.9fL；血液二氧化碳含量ctCO2(B)-静脉血: 22.6mmol/L；血小板计数(PLT#)-静脉血: 152.910E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；钾离子(K+)-静脉血: 4.2mmol/L；碱性磷酸酶(ALP)-静脉血: 76.4U/L；单核细胞百分比(Mono%)-静脉血: 0.073；γ-谷氨酰基转移酶(GGT)-静脉血: 46.4U/L；血红蛋白(Hb)-静脉血: 145.2g/L；胱抑素(Cys-C)-静脉血: 0.82mg/L；阴离子间隙(AG)-静脉血: 18；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；甘油三酯(TG)-静脉血: 1.57mmol/L；直接胆红素(DBIL)-静脉血: 6.7umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 345.2g/L；间接胆红素(IBIL)-静脉血: 17.9umolL；中性粒细胞百分比(Neut%)-静脉血: 0.676；乳酸脱氢酶(LDH)-静脉血: 132.5U/L；总蛋白(TP)-静脉血: 71.34g/L；总胆固醇(TC)-静脉血: 6.52mmol/L；总钙(Ca)-静脉血: 2.33mmol/L；血小板分布宽度(PDW)-静脉血: 16.9%；血小板比容-静脉血: 13%；尿酸(UA)-静脉血: 305.5umol/L；平均血小板体积(MPV)-静脉血: 8.53fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1%；淋巴细胞百分比(Lymph%)-静脉血: 0.221；钠离子(Na+)-静脉血: 139.5mmol/L；载脂蛋白B(apoB)-静脉血: 1.31g/L；有核红细胞百分比(NRBC%)-静脉血: 0；总胆汁酸(TBA)-静脉血: 3.6umol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总胆红素(TBIL)-静脉血: 24.6umol/L……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D34] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者今日洛铂+5-FU化疗第2天，诉食欲较差，无恶心、呕吐等不适，精神、睡眠尚可，大小便正常。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者化疗第2日，一般情况可，嘱患者注意饮食，加强营养，续行化疗。密切观察化疗反应，必要时加强处理。现已按查房指示执行。\n- [全程D35] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者今日洛铂+5-FU化疗第3天，诉食欲较差，无恶心、呕吐等不适，精神、睡眠尚可，大小便正常。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者化疗第3日，一般情况可，密切观察化疗反应，必要时加强处理。现已按查房指示执行。\n- [全程D39] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者计划于今日完成第2程洛铂+5-FU方案诱导化疗，未诉特殊不适。[姓名已隐去]主诊医生信息已隐藏：患者现完成第2程洛铂+5-FU方案诱导化疗，一般情况可，予今日出院。嘱患者出院后定期每周复查血常规、肝肾功能，2周后返院续治。现已按查房指示执行。\n- [时间未明] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 现已按查房指示执行。\n- [全程D55] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者未诉特殊不适，饮食、睡眠、精神尚可，大小便正常。查体：基本同前。[姓名已隐去]主诊医生信息已隐藏：患者诊断明确，已完成患者靶区设计，并通过全科会诊，剂量分布均匀，予GTVnx:70Gy/30F,GTVnd(L):66Gy/30F,GTVnd(R):66Gy/30F。考虑联合洛铂同期放化疗，告知患者放疗及化疗的可能获益及相关风险，患者表示已知情并同意。续观。现已按查房指示执行。\n- [全程D56] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现放疗1F，未诉特殊不适。生命体征平稳。查体情况大致同前。[姓名已隐去]主诊医生信息已隐藏：考虑患者一般情况可，继续放疗，密切关注放疗副反应，必要时加强处理。现已按查房指示执行。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估为诱导化疗疾病稳定（SD），原方案（洛铂+5-FU）继续第3程诱导化疗，随后再评估放疗指征。\nB. 评估为诱导化疗部分缓解（PR），原方案（洛铂+5-FU）继续第3程诱导化疗，以期达到完全缓解后放疗。\nC. 评估为诱导化疗部分缓解（PR），行鼻咽及颈部病灶根治性手术切除，术后辅助调强放射治疗。\nD. 评估为诱导化疗完全缓解（CR），暂缓放射治疗，进入定期随访观察阶段。\nE. 评估为诱导化疗部分缓解（PR），完善放疗前常规血液学检查，启动根治性调强放射治疗（IMRT）及放疗相关支持治疗。\nF. 评估为诱导化疗部分缓解（PR），启动根治性三维适形放射治疗（3D-CRT）及放疗相关支持治疗。\nG. 评估为诱导化疗疾病进展（PD），更改诱导化疗方案为吉西他滨+顺铂（GP），2程后再次评估。\nH. 评估为诱导化疗部分缓解（PR），行颈部淋巴结清扫术，术后行鼻咽局部调强放射治疗。\nI. 评估为诱导化疗部分缓解（PR），启动姑息性减症放射治疗，剂量控制在40Gy左右。\nJ. 评估为诱导化疗疾病稳定（SD），加用免疫检查点抑制剂联合原方案化疗。\nK. 评估为诱导化疗部分缓解（PR），等待4周后复查PET-CT，视代谢活性决定是否启动放射治疗。\nL. 评估为诱导化疗部分缓解（PR），停用化疗，单用靶向药物维持治疗。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-c2aa48d510cb846f4ee51384","patient_id":"patient-5ee5dba6116030961a7a97b5","turn_id":"turn08","turn_position":7,"turn_type":"response_assessment_decision","gold_letter":"F","gold_action":"行电子鼻咽镜检查（不活检）评估局部情况，安排出院并予以镇痛、黏膜保护及雾化等对症药物。","options":[{"letter":"A","text":"行鼻咽部MRI及全身PET-CT全面评估疗效，若疑有残留即刻行局部挽救性手术。","is_gold":false},{"letter":"B","text":"行电子鼻咽镜检查并对原发灶区域行多点活检，明确病理缓解情况后决定是否追加化疗。","is_gold":false},{"letter":"C","text":"暂缓局部内镜检查，继续原方案洛铂单药辅助化疗2个周期后再行全面评估。","is_gold":false},{"letter":"D","text":"行电子鼻咽镜检查评估局部疗效，并继续住院行第3周期洛铂同期化疗。","is_gold":false},{"letter":"E","text":"直接安排出院，嘱3个月后返院行鼻咽镜及MRI检查，期间停用所有处方药物。","is_gold":false},{"letter":"F","text":"行电子鼻咽镜检查（不活检）评估局部情况，安排出院并予以镇痛、黏膜保护及雾化等对症药物。","is_gold":true},{"letter":"G","text":"行鼻咽部及颈部增强CT评估病灶退缩情况，若有残留予以局部追加放疗推量。","is_gold":false},{"letter":"H","text":"行电子鼻咽镜检查评估局部疗效，安排出院并立即开始PD-1抑制剂维持治疗半年。","is_gold":false},{"letter":"I","text":"行全身骨扫描及腹部超声评估远处转移情况，若阴性则安排出院并定期随访。","is_gold":false},{"letter":"J","text":"行电子鼻咽镜检查（不活检）评估局部情况，并转入头颈外科行右颈淋巴结清扫术。","is_gold":false},{"letter":"K","text":"安排出院并予以镇痛药物，1个月后返院行鼻咽镜下活检以明确是否达到病理完全缓解。","is_gold":false},{"letter":"L","text":"行鼻咽部MRI评估局部疗效，若达到完全缓解则安排出院并逐步停用所有镇痛药物。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 涕血半年伴右颈肿物2周；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 涕血半年伴右颈肿物2周；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D10] 入院记录: 主诉: 涕血半年伴右颈肿物2周.；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D3] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁增厚，可见软组织肿块形成，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。双侧咽隐窝见软组织占据，双侧咽旁脂肪间隙受压变窄，病灶侵犯双侧腭帆提肌。双侧腭帆张肌、头长肌未见受侵。 双侧翼腭窝、颞下窝未见异常；口咽双侧壁未见受累增厚，病变未累及后鼻孔。 双侧翼突基底内份、蝶骨基底部右份骨髓信号减低，增强可见轻度强化。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 双侧咽后间隙见肿大淋巴结，右侧大小约为7mm ×8 mm，左侧大小约3mm×4mm。双颈II区、III区见数个淋巴结，最大位于右颈II区，大小约为15mm×27mm。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽肿块，考虑鼻咽癌。 颅底骨质破坏。 右侧咽后及右颈淋巴结肿大，考虑转移瘤。 左侧咽后及左颈小淋巴结。 鼻窦炎、右乳突炎。\n- [全程D3] 检验组合: 平均红细胞体积(MCV)-静脉血: 93.7fL；凝血酶原时间活动度(PTA)-静脉血: 97%；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；中性粒细胞计数(Neut#)-静脉血: 3.610E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.7sec.；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；尿酸(UA)-静脉血: 413.6umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；血小板分布宽度(PDW)-静脉血: 14.7%；间接胆红素(IBIL)-静脉血: 9.7umolL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；丙氨酸氨基转移酶(ALT)-静脉血: 24U/L；碱性磷酸酶(ALP)-静脉血: 84.3U/L；总胆汁酸(TBA)-静脉血: 2.2umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.3mmol/L；葡萄糖(Glu)-静脉血: 4.51mmol/L；磷(P)-静脉血: 1.39mmol/L；C-反应蛋白(CRP)-静脉血: 4.68mg/L；血小板比容-静脉血: 25%；大血小板百分比(P-LCR%)-静脉血: 35.8%；血小板计数(PLT#)-静脉血: 21810E9/L；红细胞计数(RBC#)-静脉血: 4.5910E12/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；阴离子间隙(AG)-静脉血: 18；凝血酶时间(TT)-静脉血: 21.4sec.；红细胞比容(Hct)-静脉血: 43%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 344g/L；纤维蛋白原(Fbg)-静脉血: 3.09g/L；乳酸脱氢酶(LDH)-静脉血: 116.6U/L；总蛋白(TP)-静脉血: 69.58g/L；总钙(Ca)-静脉血: 2.31mmol/L；总胆固醇(TC)-静脉血: 5.94mmol/L；甘油三酯(TG)-静脉血: 1.79mmol/L；总胆红素(TBIL)-静脉血: 13.9umol/L；尿素氮(BUN……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D4] 检验组合: 乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D5] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶后壁及双侧壁粘膜增厚放射性浓聚，SUV约23.1；病灶填塞双侧鼻后孔，向上侵犯蝶骨基底部、双翼突基底部、犁骨及枕骨斜坡，局部骨质稍模糊放射性分布浓密。双侧破裂孔未见明显异常。双侧咽隐窝变浅。双侧咽旁间隙结构尚清。右侧咽后淋巴结放射性浓聚，SUV约11.4，大小约0.7×1.0cm；左侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见异常。筛窦、右上颌窦及右乳突稍低密度影放射性分布未见异常；额窦、蝶窦、左侧上颌窦及左乳突结构及放射性分布未见明显异常。口咽、喉咽未见明显异常。甲状腺放射性分布未见异常。双颈Ⅱ区肿大淋巴结放射性浓聚，SUV约10.2，最大约1.6×2.6cm；余双侧颈部未见肿大淋巴结及异常放射性分布。 双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺纹理清晰，双侧肺野未见确切病灶和异常放射性分布。气管、支气管通畅。心脏及大血管放射性分布未见异常。胸壁未见确切病灶和异常放射性分布。双肺门、纵隔及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏密度不均匀降低，放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管及胆总管未见扩张。胆囊、胃及十二指肠放射性分布未见异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、肠管等形态、结构及放射性分布未见明显异常。前列腺点状高密度影放射性分布未见异常。双侧髂血管旁及腹股沟未见明显肿大淋巴结及异常放射性分布。 余所见颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，病灶侵犯颅底骨；右咽后及双颈Ⅱ区淋巴结代谢较活跃，考虑转移。 鼻窦炎；右乳突炎。 脂肪肝。 前列腺钙化灶。\n- [全程D10] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: 右臂静脉插管, 导管末端位于胸椎右旁T 7上缘水平，估计位于上腔静脉下段。；检查结论: 导管末端位置如上述。\n- [全程D39] 检验组合: 胱抑素(Cys-C)-静脉血: 0.78mg/L；血小板比容-静脉血: 14.8%；中性粒细胞百分比(Neut%)-静脉血: 0.61；γ-谷氨酰基转移酶(GGT)-静脉血: 57.8U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；总蛋白(TP)-静脉血: 67.84g/L；平均红细胞体积(MCV)-静脉血: 96.4fL；镁离子(Mg2+)-静脉血: 0.92mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.05mmolL；钠离子(Na+)-静脉血: 139.4mmol/L；磷(P)-静脉血: 1.36mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.302；氯离子(Cl-)-静脉血: 103.4mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.54；平均红细胞血红蛋白含量(MCH)-静脉血: 32.7pg；平均血小板体积(MPV)-静脉血: 8.84fL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.59；钾离子(K+)-静脉血: 3.79mmol/L；单核细胞百分比(Mono%)-静脉血: 0.06；白细胞计数(WBC#)-静脉血: 5.4510E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；α-L-岩藻糖苷酶(AFU)-静脉血: 35.8U/L；血小板分布宽度(PDW)-静脉血: 16.9%；红细胞比容(Hct)-静脉血: 40.3%；乳酸脱氢酶(LDH)-静脉血: 149.5U/L；红细胞计数(RBC#)-静脉血: 4.1810E12/L；C-反应蛋白(CRP)-静脉血: 2.31mg/L；总钙(Ca)-静脉血: 2.19mmol/L；尿素氮(BUN)-静脉血: 3.8mmol/L；尿酸(UA)-静脉血: 285umol/L；阴离子间隙(AG)-静脉血: 11.3；葡萄糖(Glu)-静脉血: 4.38mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339.2g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 32.4U/L；甘油三酯(TG)-静脉血: 2.32mmol/L；白蛋白(ALB)-静脉血: 41.6g/L；血小板计数(PLT#)-静脉血: 167.……\n- [全程D45] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌2程化疗后，与某次就诊时间片对比： 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁增厚，可见软组织肿块形成，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，对比前片，较前明显缩小。双侧咽隐窝见软组织占据，双侧咽旁脂肪间隙受压变窄，病灶侵犯双侧腭帆提肌，范围较前稍缩小。双侧腭帆张肌、头长肌未见受侵。 双侧翼腭窝、颞下窝未见异常；口咽双侧壁未见受累增厚，病变未累及后鼻孔。 双侧翼突基底内份、蝶骨基底部右份骨髓信号减低，增强可见轻度强化。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 双侧咽后间隙见肿大淋巴结，右侧大小约为6mm ×7 mm，左侧大小约4mm×6mm。双颈II区、III区见数个淋巴结，最大位于右颈II区，大小约为11mm×24mm，较前明显缩小。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌2程化疗后： 鼻咽病灶较前明显缩小。 颅底骨质破坏。 双侧咽后及颈部淋巴结，较前明显缩小。 鼻窦炎、右乳突炎。\n- [全程D60] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 28.3U/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.1g/L；平均红细胞体积(MCV)-静脉血: 97.9fL；血液二氧化碳含量ctCO2(B)-静脉血: 22.6mmol/L；血小板计数(PLT#)-静脉血: 152.910E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；钾离子(K+)-静脉血: 4.2mmol/L；碱性磷酸酶(ALP)-静脉血: 76.4U/L；单核细胞百分比(Mono%)-静脉血: 0.073；γ-谷氨酰基转移酶(GGT)-静脉血: 46.4U/L；血红蛋白(Hb)-静脉血: 145.2g/L；胱抑素(Cys-C)-静脉血: 0.82mg/L；阴离子间隙(AG)-静脉血: 18；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；甘油三酯(TG)-静脉血: 1.57mmol/L；直接胆红素(DBIL)-静脉血: 6.7umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 345.2g/L；间接胆红素(IBIL)-静脉血: 17.9umolL；中性粒细胞百分比(Neut%)-静脉血: 0.676；乳酸脱氢酶(LDH)-静脉血: 132.5U/L；总蛋白(TP)-静脉血: 71.34g/L；总胆固醇(TC)-静脉血: 6.52mmol/L；总钙(Ca)-静脉血: 2.33mmol/L；血小板分布宽度(PDW)-静脉血: 16.9%；血小板比容-静脉血: 13%；尿酸(UA)-静脉血: 305.5umol/L；平均血小板体积(MPV)-静脉血: 8.53fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1%；淋巴细胞百分比(Lymph%)-静脉血: 0.221；钠离子(Na+)-静脉血: 139.5mmol/L；载脂蛋白B(apoB)-静脉血: 1.31g/L；有核红细胞百分比(NRBC%)-静脉血: 0；总胆汁酸(TBA)-静脉血: 3.6umol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总胆红素(TBIL)-静脉血: 24.6umol/L……\n- [全程D67] 检验组合: 平均红细胞血红蛋白浓度(MCHC)-静脉血: 349g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.5；血小板比容-静脉血: 12%；总蛋白(TP)-静脉血: 64.55g/L；镁离子(Mg2+)-静脉血: 0.9mmol/L；乳酸脱氢酶(LDH)-静脉血: 113.1U/L；总胆固醇(TC)-静脉血: 5.45mmol/L；葡萄糖(Glu)-静脉血: 4.72mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.5；钠离子(Na+)-静脉血: 142.5mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 33.4pg；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.022；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；总胆汁酸(TBA)-静脉血: 2.5umol/L；阴离子间隙(AG)-静脉血: 10；胱抑素(Cys-C)-静脉血: 0.75mg/L；间接胆红素(IBIL)-静脉血: 8.9umolL；钾离子(K+)-静脉血: 3.8mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 36.7U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；红细胞比容(Hct)-静脉血: 39%；血小板分布宽度(PDW)-静脉血: 12.4%；中性粒细胞百分比(Neut%)-静脉血: 0.753；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；球蛋白(GLO)-静脉血: 26.65g/L；甘油三酯(TG)-静脉血: 1.38mmol/L；碱性磷酸酶(ALP)-静脉血: 67.5U/L；白细胞计数(WBC#)-静脉血: 5.0810E9/L；总胆红素(TBIL)-静脉血: 13.1umol/L；单核细胞百分比(Mono%)-静脉血: 0.089；α-L-岩藻糖苷酶(AFU)-静脉血: 26U/L；尿酸(UA)-静脉血: 318.1umol/L；尿素氮(BUN)-静脉血: 3.21mmol/L；平均血小板体积(MPV)-静脉血: 10.4fL；载脂蛋白B(apoB)-静脉血: 1.08g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；血红蛋白(Hb)-静脉血: 136g/L；氯离子(Cl-)-静……\n- [全程D74] 检验组合: 有核红细胞计数(NRBC#)-静脉血: 010E9/L；乳酸脱氢酶(LDH)-静脉血: 120.6U/L；磷(P)-静脉血: 1.42mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.111；天门冬氨酸氨基转移酶(AST)-静脉血: 20.1U/L；直接胆红素(DBIL)-静脉血: 5.8umol/L；胱抑素(Cys-C)-静脉血: 0.73mg/L；血小板比容-静脉血: 12.1%；载脂蛋白AI(apoAI)-静脉血: 1.03g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；C-反应蛋白(CRP)-静脉血: 12.33mg/L；血红蛋白(Hb)-静脉血: 131.8g/L；尿素氮(BUN)-静脉血: 4.01mmol/L；载脂蛋白B(apoB)-静脉血: 1.28g/L；甘油三酯(TG)-静脉血: 1.16mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 34pg；单核细胞百分比(Mono%)-静脉血: 0.103；总钙(Ca)-静脉血: 2.21mmol/L；红细胞计数(RBC#)-静脉血: 3.8710E12/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；尿酸(UA)-静脉血: 319.8umol/L；总胆红素(TBIL)-静脉血: 18.5umol/L；钠离子(Na+)-静脉血: 140.1mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.11mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347.8g/L；中性粒细胞百分比(Neut%)-静脉血: 0.746；红细胞比容(Hct)-静脉血: 37.8%；血小板分布宽度(PDW)-静脉血: 16.7%；球蛋白(GLO)-静脉血: 21.96g/L；肌酐(Crea)-静脉血: 61.6umol/L；总胆汁酸(TBA)-静脉血: 3.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 34.1U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.01mmolL；碱性磷酸酶(ALP)-静脉血: 65.6U/L；葡萄糖(Glu)-静脉血: 5.14mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.036；嗜碱性粒细胞计数(B……\n- [全程D81] 检验组合: 红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.6；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.77；平均红细胞体积(MCV)-静脉血: 95.3fL；直接胆红素(DBIL)-静脉血: 6.5umol/L；平均血小板体积(MPV)-静脉血: 10fL；大血小板百分比(P-LCR%)-静脉血: 25.7%；白蛋白(ALB)-静脉血: 41.6g/L；肌酐(Crea)-静脉血: 53.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.75；钠离子(Na+)-静脉血: 137.9mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.7U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7；间接胆红素(IBIL)-静脉血: 17.4umolL；球蛋白(GLO)-静脉血: 23.48g/L；总胆固醇(TC)-静脉血: 5.17mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.833；胱抑素(Cys-C)-静脉血: 0.67mg/L；乳酸脱氢酶(LDH)-静脉血: 137.4U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.51mmol/L；血小板分布宽度(PDW)-静脉血: 11.9%；白细胞计数(WBC#)-静脉血: 3.7810E9/L；载脂蛋白B(apoB)-静脉血: 1.17g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 38.7U/L；中性粒细胞计数(Neut#)-静脉血: 3.210E9/L；总胆红素(TBIL)-静脉血: 23.9umol/L；阴离子间隙(AG)-静脉血: 11.3；α-L-岩藻糖苷酶(AFU)-静脉血: 30.5U/L；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；血小板比容-静脉血: 15%；C-反应蛋白(CRP)-静脉血: 15.45mg/L；氯离子(Cl-)-静脉血: 100.4mmol/L；总胆汁酸(TBA)-静脉血: 1.2umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.024；尿素氮(BUN)-静脉血: 4.4mmol/L；血红蛋白(Hb)-静脉血: 134g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.8U/L；单核细胞计数(……\n- [全程D88] 检验组合: C-反应蛋白(CRP)-静脉血: 7.88mg/L；甘油三酯(TG)-静脉血: 1.18mmol/L；平均红细胞体积(MCV)-静脉血: 96.4fL；载脂蛋白B(apoB)-静脉血: 1.03g/L；血小板计数(PLT#)-静脉血: 92.910E9/L；总胆红素(TBIL)-静脉血: 29umol/L；中性粒细胞计数(Neut#)-静脉血: 2.810E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 30.3U/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；葡萄糖(Glu)-静脉血: 4.55mmol/L；总胆汁酸(TBA)-静脉血: 2.3umol/L；血小板比容-静脉血: 7.5%；红细胞比容(Hct)-静脉血: 32.9%；中性粒细胞百分比(Neut%)-静脉血: 0.784；载脂蛋白AI(apoAI)-静脉血: 0.93g/L；血红蛋白(Hb)-静脉血: 117.2g/L；间接胆红素(IBIL)-静脉血: 20.4umolL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；白细胞计数(WBC#)-静脉血: 3.5310E9/L；总胆固醇(TC)-静脉血: 4.84mmol/L；总钙(Ca)-静脉血: 2.27mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；平均红细胞血红蛋白含量(MCH)-静脉血: 34.2pg；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总蛋白(TP)-静脉血: 62g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.86mmolL；单核细胞计数(Mono#)-静脉血: 0.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.108；直接胆红素(DBIL)-静脉血: 8.6umol/L；钠离子(Na+)-静脉血: 141mmol/L；镁离子(Mg2+)-静脉血: 0.94mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.088；钾离子(K+)-静脉血: 4.2mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 48.3U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；尿酸(UA)-静脉血: 281.5umol/L；白蛋白(ALB)-静……\n- [全程D94] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理清晰，走行自然，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影形态、大小未见异常。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见异常。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D34] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者今日洛铂+5-FU化疗第2天，诉食欲较差，无恶心、呕吐等不适，精神、睡眠尚可，大小便正常。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者化疗第2日，一般情况可，嘱患者注意饮食，加强营养，续行化疗。密切观察化疗反应，必要时加强处理。现已按查房指示执行。\n- [全程D35] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者今日洛铂+5-FU化疗第3天，诉食欲较差，无恶心、呕吐等不适，精神、睡眠尚可，大小便正常。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者化疗第3日，一般情况可，密切观察化疗反应，必要时加强处理。现已按查房指示执行。\n- [全程D39] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者计划于今日完成第2程洛铂+5-FU方案诱导化疗，未诉特殊不适。[姓名已隐去]主诊医生信息已隐藏：患者现完成第2程洛铂+5-FU方案诱导化疗，一般情况可，予今日出院。嘱患者出院后定期每周复查血常规、肝肾功能，2周后返院续治。现已按查房指示执行。\n- [时间未明] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 现已按查房指示执行。\n- [全程D55] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者未诉特殊不适，饮食、睡眠、精神尚可，大小便正常。查体：基本同前。[姓名已隐去]主诊医生信息已隐藏：患者诊断明确，已完成患者靶区设计，并通过全科会诊，剂量分布均匀，予GTVnx:70Gy/30F,GTVnd(L):66Gy/30F,GTVnd(R):66Gy/30F。考虑联合洛铂同期放化疗，告知患者放疗及化疗的可能获益及相关风险，患者表示已知情并同意。续观。现已按查房指示执行。\n- [全程D56] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现放疗1F，未诉特殊不适。生命体征平稳。查体情况大致同前。[姓名已隐去]主诊医生信息已隐藏：考虑患者一般情况可，继续放疗，密切关注放疗副反应，必要时加强处理。现已按查房指示执行。\n- [全程D71] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现放疗13F，诉口干，轻微咽痛，偶有咳嗽，食欲欠佳，无恶心、呕吐等不适，精神、睡眠欠佳，大小便正常。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者放疗初期出现口腔粘膜反应，予止咳、止痛等对症处理，继续放疗，密切关注放疗副反应，定期复查血常规，必要时加强处理。现已按查房指示执行。\n- [全程D76] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现放疗16F，DDP同期化疗第1日，诉咽痛较前加重，偶有咳嗽，食欲欠佳，无恶心、呕吐等不适，精神、睡眠欠佳，大小便正常。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者咽痛较前加重，予加强止痛。患者今日洛铂同期化疗第1日，密切观察化疗反应，加强止呕处理，注意放化疗叠加副反应，继续喷喉、洗鼻等对症处理，续行放疗。现已按查房指示执行。\n- [全程D91] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现放疗26F，诉口干，咽痛较前明显，食欲较前变差，余无不适，精神、睡眠一般。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者现于同时期放化疗中，放射性口腔粘膜反应1度，予止痛、静脉营养支持等加强处理，继续予喷喉、洗鼻等对症处理，定期复查血常规，续行放疗。现已按查房指示执行。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行鼻咽部MRI及全身PET-CT全面评估疗效，若疑有残留即刻行局部挽救性手术。\nB. 行电子鼻咽镜检查并对原发灶区域行多点活检，明确病理缓解情况后决定是否追加化疗。\nC. 暂缓局部内镜检查，继续原方案洛铂单药辅助化疗2个周期后再行全面评估。\nD. 行电子鼻咽镜检查评估局部疗效，并继续住院行第3周期洛铂同期化疗。\nE. 直接安排出院，嘱3个月后返院行鼻咽镜及MRI检查，期间停用所有处方药物。\nF. 行电子鼻咽镜检查（不活检）评估局部情况，安排出院并予以镇痛、黏膜保护及雾化等对症药物。\nG. 行鼻咽部及颈部增强CT评估病灶退缩情况，若有残留予以局部追加放疗推量。\nH. 行电子鼻咽镜检查评估局部疗效，安排出院并立即开始PD-1抑制剂维持治疗半年。\nI. 行全身骨扫描及腹部超声评估远处转移情况，若阴性则安排出院并定期随访。\nJ. 行电子鼻咽镜检查（不活检）评估局部情况，并转入头颈外科行右颈淋巴结清扫术。\nK. 安排出院并予以镇痛药物，1个月后返院行鼻咽镜下活检以明确是否达到病理完全缓解。\nL. 行鼻咽部MRI评估局部疗效，若达到完全缓解则安排出院并逐步停用所有镇痛药物。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 涕血半年伴右颈肿物2周；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 涕血半年伴右颈肿物2周；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D10] 入院记录: 主诉: 涕血半年伴右颈肿物2周.；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D3] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁增厚，可见软组织肿块形成，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。双侧咽隐窝见软组织占据，双侧咽旁脂肪间隙受压变窄，病灶侵犯双侧腭帆提肌。双侧腭帆张肌、头长肌未见受侵。 双侧翼腭窝、颞下窝未见异常；口咽双侧壁未见受累增厚，病变未累及后鼻孔。 双侧翼突基底内份、蝶骨基底部右份骨髓信号减低，增强可见轻度强化。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 双侧咽后间隙见肿大淋巴结，右侧大小约为7mm ×8 mm，左侧大小约3mm×4mm。双颈II区、III区见数个淋巴结，最大位于右颈II区，大小约为15mm×27mm。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽肿块，考虑鼻咽癌。 颅底骨质破坏。 右侧咽后及右颈淋巴结肿大，考虑转移瘤。 左侧咽后及左颈小淋巴结。 鼻窦炎、右乳突炎。\n- [全程D3] 检验组合: 平均红细胞体积(MCV)-静脉血: 93.7fL；凝血酶原时间活动度(PTA)-静脉血: 97%；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；中性粒细胞计数(Neut#)-静脉血: 3.610E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.7sec.；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；尿酸(UA)-静脉血: 413.6umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；血小板分布宽度(PDW)-静脉血: 14.7%；间接胆红素(IBIL)-静脉血: 9.7umolL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；丙氨酸氨基转移酶(ALT)-静脉血: 24U/L；碱性磷酸酶(ALP)-静脉血: 84.3U/L；总胆汁酸(TBA)-静脉血: 2.2umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.3mmol/L；葡萄糖(Glu)-静脉血: 4.51mmol/L；磷(P)-静脉血: 1.39mmol/L；C-反应蛋白(CRP)-静脉血: 4.68mg/L；血小板比容-静脉血: 25%；大血小板百分比(P-LCR%)-静脉血: 35.8%；血小板计数(PLT#)-静脉血: 21810E9/L；红细胞计数(RBC#)-静脉血: 4.5910E12/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；阴离子间隙(AG)-静脉血: 18；凝血酶时间(TT)-静脉血: 21.4sec.；红细胞比容(Hct)-静脉血: 43%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 344g/L；纤维蛋白原(Fbg)-静脉血: 3.09g/L；乳酸脱氢酶(LDH)-静脉血: 116.6U/L；总蛋白(TP)-静脉血: 69.58g/L；总钙(Ca)-静脉血: 2.31mmol/L；总胆固醇(TC)-静脉血: 5.94mmol/L；甘油三酯(TG)-静脉血: 1.79mmol/L；总胆红素(TBIL)-静脉血: 13.9umol/L；尿素氮(BUN……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D4] 检验组合: 乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D5] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶后壁及双侧壁粘膜增厚放射性浓聚，SUV约23.1；病灶填塞双侧鼻后孔，向上侵犯蝶骨基底部、双翼突基底部、犁骨及枕骨斜坡，局部骨质稍模糊放射性分布浓密。双侧破裂孔未见明显异常。双侧咽隐窝变浅。双侧咽旁间隙结构尚清。右侧咽后淋巴结放射性浓聚，SUV约11.4，大小约0.7×1.0cm；左侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见异常。筛窦、右上颌窦及右乳突稍低密度影放射性分布未见异常；额窦、蝶窦、左侧上颌窦及左乳突结构及放射性分布未见明显异常。口咽、喉咽未见明显异常。甲状腺放射性分布未见异常。双颈Ⅱ区肿大淋巴结放射性浓聚，SUV约10.2，最大约1.6×2.6cm；余双侧颈部未见肿大淋巴结及异常放射性分布。 双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺纹理清晰，双侧肺野未见确切病灶和异常放射性分布。气管、支气管通畅。心脏及大血管放射性分布未见异常。胸壁未见确切病灶和异常放射性分布。双肺门、纵隔及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏密度不均匀降低，放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管及胆总管未见扩张。胆囊、胃及十二指肠放射性分布未见异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、肠管等形态、结构及放射性分布未见明显异常。前列腺点状高密度影放射性分布未见异常。双侧髂血管旁及腹股沟未见明显肿大淋巴结及异常放射性分布。 余所见颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，病灶侵犯颅底骨；右咽后及双颈Ⅱ区淋巴结代谢较活跃，考虑转移。 鼻窦炎；右乳突炎。 脂肪肝。 前列腺钙化灶。\n- [全程D10] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: 右臂静脉插管, 导管末端位于胸椎右旁T 7上缘水平，估计位于上腔静脉下段。；检查结论: 导管末端位置如上述。\n- [全程D39] 检验组合: 胱抑素(Cys-C)-静脉血: 0.78mg/L；血小板比容-静脉血: 14.8%；中性粒细胞百分比(Neut%)-静脉血: 0.61；γ-谷氨酰基转移酶(GGT)-静脉血: 57.8U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；总蛋白(TP)-静脉血: 67.84g/L；平均红细胞体积(MCV)-静脉血: 96.4fL；镁离子(Mg2+)-静脉血: 0.92mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.05mmolL；钠离子(Na+)-静脉血: 139.4mmol/L；磷(P)-静脉血: 1.36mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.302；氯离子(Cl-)-静脉血: 103.4mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.54；平均红细胞血红蛋白含量(MCH)-静脉血: 32.7pg；平均血小板体积(MPV)-静脉血: 8.84fL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.59；钾离子(K+)-静脉血: 3.79mmol/L；单核细胞百分比(Mono%)-静脉血: 0.06；白细胞计数(WBC#)-静脉血: 5.4510E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；α-L-岩藻糖苷酶(AFU)-静脉血: 35.8U/L；血小板分布宽度(PDW)-静脉血: 16.9%；红细胞比容(Hct)-静脉血: 40.3%；乳酸脱氢酶(LDH)-静脉血: 149.5U/L；红细胞计数(RBC#)-静脉血: 4.1810E12/L；C-反应蛋白(CRP)-静脉血: 2.31mg/L；总钙(Ca)-静脉血: 2.19mmol/L；尿素氮(BUN)-静脉血: 3.8mmol/L；尿酸(UA)-静脉血: 285umol/L；阴离子间隙(AG)-静脉血: 11.3；葡萄糖(Glu)-静脉血: 4.38mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339.2g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 32.4U/L；甘油三酯(TG)-静脉血: 2.32mmol/L；白蛋白(ALB)-静脉血: 41.6g/L；血小板计数(PLT#)-静脉血: 167.……\n- [全程D45] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌2程化疗后，与某次就诊时间片对比： 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁增厚，可见软组织肿块形成，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，对比前片，较前明显缩小。双侧咽隐窝见软组织占据，双侧咽旁脂肪间隙受压变窄，病灶侵犯双侧腭帆提肌，范围较前稍缩小。双侧腭帆张肌、头长肌未见受侵。 双侧翼腭窝、颞下窝未见异常；口咽双侧壁未见受累增厚，病变未累及后鼻孔。 双侧翼突基底内份、蝶骨基底部右份骨髓信号减低，增强可见轻度强化。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 双侧咽后间隙见肿大淋巴结，右侧大小约为6mm ×7 mm，左侧大小约4mm×6mm。双颈II区、III区见数个淋巴结，最大位于右颈II区，大小约为11mm×24mm，较前明显缩小。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌2程化疗后： 鼻咽病灶较前明显缩小。 颅底骨质破坏。 双侧咽后及颈部淋巴结，较前明显缩小。 鼻窦炎、右乳突炎。\n- [全程D60] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 28.3U/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.1g/L；平均红细胞体积(MCV)-静脉血: 97.9fL；血液二氧化碳含量ctCO2(B)-静脉血: 22.6mmol/L；血小板计数(PLT#)-静脉血: 152.910E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；钾离子(K+)-静脉血: 4.2mmol/L；碱性磷酸酶(ALP)-静脉血: 76.4U/L；单核细胞百分比(Mono%)-静脉血: 0.073；γ-谷氨酰基转移酶(GGT)-静脉血: 46.4U/L；血红蛋白(Hb)-静脉血: 145.2g/L；胱抑素(Cys-C)-静脉血: 0.82mg/L；阴离子间隙(AG)-静脉血: 18；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；甘油三酯(TG)-静脉血: 1.57mmol/L；直接胆红素(DBIL)-静脉血: 6.7umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 345.2g/L；间接胆红素(IBIL)-静脉血: 17.9umolL；中性粒细胞百分比(Neut%)-静脉血: 0.676；乳酸脱氢酶(LDH)-静脉血: 132.5U/L；总蛋白(TP)-静脉血: 71.34g/L；总胆固醇(TC)-静脉血: 6.52mmol/L；总钙(Ca)-静脉血: 2.33mmol/L；血小板分布宽度(PDW)-静脉血: 16.9%；血小板比容-静脉血: 13%；尿酸(UA)-静脉血: 305.5umol/L；平均血小板体积(MPV)-静脉血: 8.53fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1%；淋巴细胞百分比(Lymph%)-静脉血: 0.221；钠离子(Na+)-静脉血: 139.5mmol/L；载脂蛋白B(apoB)-静脉血: 1.31g/L；有核红细胞百分比(NRBC%)-静脉血: 0；总胆汁酸(TBA)-静脉血: 3.6umol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总胆红素(TBIL)-静脉血: 24.6umol/L……\n- [全程D67] 检验组合: 平均红细胞血红蛋白浓度(MCHC)-静脉血: 349g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.5；血小板比容-静脉血: 12%；总蛋白(TP)-静脉血: 64.55g/L；镁离子(Mg2+)-静脉血: 0.9mmol/L；乳酸脱氢酶(LDH)-静脉血: 113.1U/L；总胆固醇(TC)-静脉血: 5.45mmol/L；葡萄糖(Glu)-静脉血: 4.72mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.5；钠离子(Na+)-静脉血: 142.5mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 33.4pg；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.022；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；总胆汁酸(TBA)-静脉血: 2.5umol/L；阴离子间隙(AG)-静脉血: 10；胱抑素(Cys-C)-静脉血: 0.75mg/L；间接胆红素(IBIL)-静脉血: 8.9umolL；钾离子(K+)-静脉血: 3.8mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 36.7U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；红细胞比容(Hct)-静脉血: 39%；血小板分布宽度(PDW)-静脉血: 12.4%；中性粒细胞百分比(Neut%)-静脉血: 0.753；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；球蛋白(GLO)-静脉血: 26.65g/L；甘油三酯(TG)-静脉血: 1.38mmol/L；碱性磷酸酶(ALP)-静脉血: 67.5U/L；白细胞计数(WBC#)-静脉血: 5.0810E9/L；总胆红素(TBIL)-静脉血: 13.1umol/L；单核细胞百分比(Mono%)-静脉血: 0.089；α-L-岩藻糖苷酶(AFU)-静脉血: 26U/L；尿酸(UA)-静脉血: 318.1umol/L；尿素氮(BUN)-静脉血: 3.21mmol/L；平均血小板体积(MPV)-静脉血: 10.4fL；载脂蛋白B(apoB)-静脉血: 1.08g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；血红蛋白(Hb)-静脉血: 136g/L；氯离子(Cl-)-静……\n- [全程D74] 检验组合: 有核红细胞计数(NRBC#)-静脉血: 010E9/L；乳酸脱氢酶(LDH)-静脉血: 120.6U/L；磷(P)-静脉血: 1.42mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.111；天门冬氨酸氨基转移酶(AST)-静脉血: 20.1U/L；直接胆红素(DBIL)-静脉血: 5.8umol/L；胱抑素(Cys-C)-静脉血: 0.73mg/L；血小板比容-静脉血: 12.1%；载脂蛋白AI(apoAI)-静脉血: 1.03g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；C-反应蛋白(CRP)-静脉血: 12.33mg/L；血红蛋白(Hb)-静脉血: 131.8g/L；尿素氮(BUN)-静脉血: 4.01mmol/L；载脂蛋白B(apoB)-静脉血: 1.28g/L；甘油三酯(TG)-静脉血: 1.16mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 34pg；单核细胞百分比(Mono%)-静脉血: 0.103；总钙(Ca)-静脉血: 2.21mmol/L；红细胞计数(RBC#)-静脉血: 3.8710E12/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；尿酸(UA)-静脉血: 319.8umol/L；总胆红素(TBIL)-静脉血: 18.5umol/L；钠离子(Na+)-静脉血: 140.1mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.11mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347.8g/L；中性粒细胞百分比(Neut%)-静脉血: 0.746；红细胞比容(Hct)-静脉血: 37.8%；血小板分布宽度(PDW)-静脉血: 16.7%；球蛋白(GLO)-静脉血: 21.96g/L；肌酐(Crea)-静脉血: 61.6umol/L；总胆汁酸(TBA)-静脉血: 3.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 34.1U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.01mmolL；碱性磷酸酶(ALP)-静脉血: 65.6U/L；葡萄糖(Glu)-静脉血: 5.14mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.036；嗜碱性粒细胞计数(B……\n- [全程D81] 检验组合: 红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.6；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.77；平均红细胞体积(MCV)-静脉血: 95.3fL；直接胆红素(DBIL)-静脉血: 6.5umol/L；平均血小板体积(MPV)-静脉血: 10fL；大血小板百分比(P-LCR%)-静脉血: 25.7%；白蛋白(ALB)-静脉血: 41.6g/L；肌酐(Crea)-静脉血: 53.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.75；钠离子(Na+)-静脉血: 137.9mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.7U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7；间接胆红素(IBIL)-静脉血: 17.4umolL；球蛋白(GLO)-静脉血: 23.48g/L；总胆固醇(TC)-静脉血: 5.17mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.833；胱抑素(Cys-C)-静脉血: 0.67mg/L；乳酸脱氢酶(LDH)-静脉血: 137.4U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.51mmol/L；血小板分布宽度(PDW)-静脉血: 11.9%；白细胞计数(WBC#)-静脉血: 3.7810E9/L；载脂蛋白B(apoB)-静脉血: 1.17g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 38.7U/L；中性粒细胞计数(Neut#)-静脉血: 3.210E9/L；总胆红素(TBIL)-静脉血: 23.9umol/L；阴离子间隙(AG)-静脉血: 11.3；α-L-岩藻糖苷酶(AFU)-静脉血: 30.5U/L；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；血小板比容-静脉血: 15%；C-反应蛋白(CRP)-静脉血: 15.45mg/L；氯离子(Cl-)-静脉血: 100.4mmol/L；总胆汁酸(TBA)-静脉血: 1.2umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.024；尿素氮(BUN)-静脉血: 4.4mmol/L；血红蛋白(Hb)-静脉血: 134g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.8U/L；单核细胞计数(……\n- [全程D88] 检验组合: C-反应蛋白(CRP)-静脉血: 7.88mg/L；甘油三酯(TG)-静脉血: 1.18mmol/L；平均红细胞体积(MCV)-静脉血: 96.4fL；载脂蛋白B(apoB)-静脉血: 1.03g/L；血小板计数(PLT#)-静脉血: 92.910E9/L；总胆红素(TBIL)-静脉血: 29umol/L；中性粒细胞计数(Neut#)-静脉血: 2.810E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 30.3U/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；葡萄糖(Glu)-静脉血: 4.55mmol/L；总胆汁酸(TBA)-静脉血: 2.3umol/L；血小板比容-静脉血: 7.5%；红细胞比容(Hct)-静脉血: 32.9%；中性粒细胞百分比(Neut%)-静脉血: 0.784；载脂蛋白AI(apoAI)-静脉血: 0.93g/L；血红蛋白(Hb)-静脉血: 117.2g/L；间接胆红素(IBIL)-静脉血: 20.4umolL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；白细胞计数(WBC#)-静脉血: 3.5310E9/L；总胆固醇(TC)-静脉血: 4.84mmol/L；总钙(Ca)-静脉血: 2.27mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；平均红细胞血红蛋白含量(MCH)-静脉血: 34.2pg；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总蛋白(TP)-静脉血: 62g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.86mmolL；单核细胞计数(Mono#)-静脉血: 0.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.108；直接胆红素(DBIL)-静脉血: 8.6umol/L；钠离子(Na+)-静脉血: 141mmol/L；镁离子(Mg2+)-静脉血: 0.94mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.088；钾离子(K+)-静脉血: 4.2mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 48.3U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；尿酸(UA)-静脉血: 281.5umol/L；白蛋白(ALB)-静……\n- [全程D94] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理清晰，走行自然，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影形态、大小未见异常。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见异常。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D34] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者今日洛铂+5-FU化疗第2天，诉食欲较差，无恶心、呕吐等不适，精神、睡眠尚可，大小便正常。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者化疗第2日，一般情况可，嘱患者注意饮食，加强营养，续行化疗。密切观察化疗反应，必要时加强处理。现已按查房指示执行。\n- [全程D35] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者今日洛铂+5-FU化疗第3天，诉食欲较差，无恶心、呕吐等不适，精神、睡眠尚可，大小便正常。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者化疗第3日，一般情况可，密切观察化疗反应，必要时加强处理。现已按查房指示执行。\n- [全程D39] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者计划于今日完成第2程洛铂+5-FU方案诱导化疗，未诉特殊不适。[姓名已隐去]主诊医生信息已隐藏：患者现完成第2程洛铂+5-FU方案诱导化疗，一般情况可，予今日出院。嘱患者出院后定期每周复查血常规、肝肾功能，2周后返院续治。现已按查房指示执行。\n- [时间未明] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 现已按查房指示执行。\n- [全程D55] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者未诉特殊不适，饮食、睡眠、精神尚可，大小便正常。查体：基本同前。[姓名已隐去]主诊医生信息已隐藏：患者诊断明确，已完成患者靶区设计，并通过全科会诊，剂量分布均匀，予GTVnx:70Gy/30F,GTVnd(L):66Gy/30F,GTVnd(R):66Gy/30F。考虑联合洛铂同期放化疗，告知患者放疗及化疗的可能获益及相关风险，患者表示已知情并同意。续观。现已按查房指示执行。\n- [全程D56] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现放疗1F，未诉特殊不适。生命体征平稳。查体情况大致同前。[姓名已隐去]主诊医生信息已隐藏：考虑患者一般情况可，继续放疗，密切关注放疗副反应，必要时加强处理。现已按查房指示执行。\n- [全程D71] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现放疗13F，诉口干，轻微咽痛，偶有咳嗽，食欲欠佳，无恶心、呕吐等不适，精神、睡眠欠佳，大小便正常。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者放疗初期出现口腔粘膜反应，予止咳、止痛等对症处理，继续放疗，密切关注放疗副反应，定期复查血常规，必要时加强处理。现已按查房指示执行。\n- [全程D76] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现放疗16F，DDP同期化疗第1日，诉咽痛较前加重，偶有咳嗽，食欲欠佳，无恶心、呕吐等不适，精神、睡眠欠佳，大小便正常。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者咽痛较前加重，予加强止痛。患者今日洛铂同期化疗第1日，密切观察化疗反应，加强止呕处理，注意放化疗叠加副反应，继续喷喉、洗鼻等对症处理，续行放疗。现已按查房指示执行。\n- [全程D91] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现放疗26F，诉口干，咽痛较前明显，食欲较前变差，余无不适，精神、睡眠一般。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者现于同时期放化疗中，放射性口腔粘膜反应1度，予止痛、静脉营养支持等加强处理，继续予喷喉、洗鼻等对症处理，定期复查血常规，续行放疗。现已按查房指示执行。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行鼻咽部MRI及全身PET-CT全面评估疗效，若疑有残留即刻行局部挽救性手术。\nB. 行电子鼻咽镜检查并对原发灶区域行多点活检，明确病理缓解情况后决定是否追加化疗。\nC. 暂缓局部内镜检查，继续原方案洛铂单药辅助化疗2个周期后再行全面评估。\nD. 行电子鼻咽镜检查评估局部疗效，并继续住院行第3周期洛铂同期化疗。\nE. 直接安排出院，嘱3个月后返院行鼻咽镜及MRI检查，期间停用所有处方药物。\nF. 行电子鼻咽镜检查（不活检）评估局部情况，安排出院并予以镇痛、黏膜保护及雾化等对症药物。\nG. 行鼻咽部及颈部增强CT评估病灶退缩情况，若有残留予以局部追加放疗推量。\nH. 行电子鼻咽镜检查评估局部疗效，安排出院并立即开始PD-1抑制剂维持治疗半年。\nI. 行全身骨扫描及腹部超声评估远处转移情况，若阴性则安排出院并定期随访。\nJ. 行电子鼻咽镜检查（不活检）评估局部情况，并转入头颈外科行右颈淋巴结清扫术。\nK. 安排出院并予以镇痛药物，1个月后返院行鼻咽镜下活检以明确是否达到病理完全缓解。\nL. 行鼻咽部MRI评估局部疗效，若达到完全缓解则安排出院并逐步停用所有镇痛药物。\n\n请仅输出一个选项字母（A-L）。"}]}
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full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左颈肿物20余天；现病史: 20余天前患者无明显诱因自觉左颈肿物，无发热、疼痛，伴涕血、左耳堵塞感。无头痛、面麻、鼻塞、复视、张口困难等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左耳闷胀感,涕血,左颈肿物；既往史: 高血压10余年，规律服药，血压控制在130/80mmHg左右。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:穿山甲壳、蜂蛹、伟哥过敏。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 大儿子患“脑胶质瘤”，已病逝。；体格检查: T：36.4℃，P：66次/分，R：20次/分，BP：134/81mmHg,Ht：175cm，Wt：84kg，BSA：2.0m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽顶后壁、左侧壁结节状肿物；双侧颈部II区可扪及1个淋巴结，最大径6×5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 电子鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸部及腹部CT平扫，常规血液学检查。\nB. 颈部淋巴结切除活检，鼻咽及颈部MRI平扫+增强，全身PET/CT显像，常规血液学检查。\nC. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，颈部超声，暂缓全身影像学分期。\nD. 鼻咽及颈部MRI平扫+增强，全身PET/CT显像，先行诱导化疗待肿瘤缩小后行鼻咽活检。\nE. 电子鼻咽镜检查及活检，鼻咽MRI平扫+增强，胸部X线，腹部超声，全身骨显像。\nF. 颈部淋巴结细针穿刺活检，鼻咽及颈部CT平扫+增强，全身PET/CT显像，常规血液学检查。\nG. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT显像，常规血液学、心电图与心脏彩超检查。\nH. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸腹部CT平扫+增强，免除全身骨显像。\nI. 电子鼻咽镜检查及活检，头颅MRI平扫+增强，颈部超声，全身PET/CT显像，常规血液学检查。\nJ. 鼻咽刷片细胞学检查，鼻咽及颈部MRI平扫+增强，全身PET/CT显像，常规血液学检查。\nK. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫，全身PET/CT显像，常规血液学检查。\nL. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT显像，同步安排根治性放疗定位。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左颈肿物20余天；现病史: 20余天前患者无明显诱因自觉左颈肿物，无发热、疼痛，伴涕血、左耳堵塞感。无头痛、面麻、鼻塞、复视、张口困难等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左耳闷胀感,涕血,左颈肿物；既往史: 高血压10余年，规律服药，血压控制在130/80mmHg左右。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:穿山甲壳、蜂蛹、伟哥过敏。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 大儿子患“脑胶质瘤”，已病逝。；体格检查: T：36.4℃，P：66次/分，R：20次/分，BP：134/81mmHg,Ht：175cm，Wt：84kg，BSA：2.0m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽顶后壁、左侧壁结节状肿物；双侧颈部II区可扪及1个淋巴结，最大径6×5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 电子鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸部及腹部CT平扫，常规血液学检查。\nB. 颈部淋巴结切除活检，鼻咽及颈部MRI平扫+增强，全身PET/CT显像，常规血液学检查。\nC. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，颈部超声，暂缓全身影像学分期。\nD. 鼻咽及颈部MRI平扫+增强，全身PET/CT显像，先行诱导化疗待肿瘤缩小后行鼻咽活检。\nE. 电子鼻咽镜检查及活检，鼻咽MRI平扫+增强，胸部X线，腹部超声，全身骨显像。\nF. 颈部淋巴结细针穿刺活检，鼻咽及颈部CT平扫+增强，全身PET/CT显像，常规血液学检查。\nG. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT显像，常规血液学、心电图与心脏彩超检查。\nH. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸腹部CT平扫+增强，免除全身骨显像。\nI. 电子鼻咽镜检查及活检，头颅MRI平扫+增强，颈部超声，全身PET/CT显像，常规血液学检查。\nJ. 鼻咽刷片细胞学检查，鼻咽及颈部MRI平扫+增强，全身PET/CT显像，常规血液学检查。\nK. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫，全身PET/CT显像，常规血液学检查。\nL. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT显像，同步安排根治性放疗定位。\n\n请仅输出一个选项字母（A-L）。"}]}
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full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左颈肿物20余天；现病史: 20余天前患者无明显诱因自觉左颈肿物，无发热、疼痛，伴涕血、左耳堵塞感。无头痛、面麻、鼻塞、复视、张口困难等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左耳闷胀感,涕血,左颈肿物；既往史: 高血压10余年，规律服药，血压控制在130/80mmHg左右。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:穿山甲壳、蜂蛹、伟哥过敏。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 大儿子患“脑胶质瘤”，已病逝。；体格检查: T：36.4℃，P：66次/分，R：20次/分，BP：134/81mmHg,Ht：175cm，Wt：84kg，BSA：2.0m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽顶后壁、左侧壁结节状肿物；双侧颈部II区可扪及1个淋巴结，最大径6×5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 ST-T轻度改变\n- [全程D1] 检验组合: 梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；有核红细胞计数(NRBC#)-静脉血: 010E9/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；单核细胞计数(Mono#)-静脉血: 0.510E9/L；胱抑素(Cys-C)-静脉血: 0.76mg/L；磷(P)-静脉血: 1.12mmol/L；纤维蛋白原(Fbg)-静脉血: 3.32g/L；Rh血型-静脉血: 阳性；血红蛋白(Hb)-静脉血: 136.2g/L；ABO血型-静脉血: O；骨钙素N端中分子片段(N-MID)-静脉血: 14.08ng/ml；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；直接胆红素(DBIL)-静脉血: 3.1umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 28.5U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；中性粒细胞百分比(Neut%)-静脉血: 0.617；镁离子(Mg2+)-静脉血: 0.88mmol/L；白细胞计数(WBC#)-静脉血: 7.0810E9/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 26.4U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.295ng/ml（参考: <0.704）；凝血酶原时间活动度(PTA)-静脉血: 120%；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.9mmol/L；血小板比容-静脉血: 18.3%；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.05S/CO；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.23mmolL；平均红细胞血红蛋白含量(MCH)-静脉血: 30pg；单核细胞百分比(Mono%)-静脉血: 0.072；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；总蛋白(TP)-静脉血: 71.09g/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40……\n- [全程D3] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及左侧壁粘膜增厚放射性浓聚，SUV约14.5，病灶累及蝶骨基底部、枕骨斜坡、左侧翼突、左岩尖、左侧破裂孔及左侧鼻后孔。双侧咽隐窝消失。双侧咽后未见明显肿大淋巴结及异常放射性分布。口咽及喉咽结构及放射性分布未见明显异常。左侧上颌窦及蝶窦内见低密度影放射性分布未见明显异常，额窦、筛窦及右侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双颈Ⅱ区多发肿大淋巴结放射性浓聚，SUV约14.2，最大约2.2×2.6cm。 双侧苍白球钙化放射性分布缺损，余所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。左肾盂小结石放射性分布缺损。脾脏、胰腺、右肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺小点状钙化灶。余盆腔放射性分布均匀，膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 所见颅盖骨、余躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽顶壁、顶后壁及左侧壁粘膜增厚代谢活跃，考虑鼻咽癌，病灶累及颅底骨、左侧破裂孔及左侧鼻后孔；双颈Ⅱ区多发肿大淋巴结代谢活跃，考虑转移。 左侧上颌窦及蝶窦炎症。 左肾盂小结石。 前列腺钙化。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行颈部淋巴结细针穿刺活检，完善鼻咽及颈部CT平扫+增强，查乙肝病毒DNA定量\nB. 行鼻咽内镜组织活检，完善鼻咽及颈部CT平扫+增强，查乙肝病毒DNA定量\nC. 行鼻咽内镜组织活检，完善鼻咽及颈部MRI平扫+增强，暂不查乙肝病毒DNA定量\nD. 行颈部淋巴结切除活检，完善鼻咽及颈部MRI平扫+增强，查乙肝病毒DNA定量\nE. 行鼻咽内镜组织活检，完善鼻咽及颈部CT平扫+增强，查丙肝病毒RNA定量\nF. 行鼻咽内镜组织活检，完善头颅MRI平扫+增强，查乙肝病毒DNA定量\nG. 行颈部淋巴结细针穿刺活检，完善鼻咽及颈部MRI平扫+增强，暂不查乙肝病毒DNA定量\nH. 行鼻咽内镜组织活检，完善鼻咽及颈部MRI平扫+增强，查乙肝病毒DNA定量\nI. 行鼻咽内镜组织活检及颈部淋巴结穿刺活检，完善鼻咽及颈部MRI平扫+增强\nJ. 行鼻咽内镜组织活检，完善鼻咽及颈部MRI平扫+增强，查丙肝病毒RNA定量\nK. 行鼻咽内镜组织活检，完善颈部超声造影，查乙肝病毒DNA定量\nL. 行鼻咽内镜组织活检，完善全身骨扫描，查乙肝病毒DNA定量\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左颈肿物20余天；现病史: 20余天前患者无明显诱因自觉左颈肿物，无发热、疼痛，伴涕血、左耳堵塞感。无头痛、面麻、鼻塞、复视、张口困难等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左耳闷胀感,涕血,左颈肿物；既往史: 高血压10余年，规律服药，血压控制在130/80mmHg左右。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:穿山甲壳、蜂蛹、伟哥过敏。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 大儿子患“脑胶质瘤”，已病逝。；体格检查: T：36.4℃，P：66次/分，R：20次/分，BP：134/81mmHg,Ht：175cm，Wt：84kg，BSA：2.0m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽顶后壁、左侧壁结节状肿物；双侧颈部II区可扪及1个淋巴结，最大径6×5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 ST-T轻度改变\n- [全程D1] 检验组合: 梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；有核红细胞计数(NRBC#)-静脉血: 010E9/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；单核细胞计数(Mono#)-静脉血: 0.510E9/L；胱抑素(Cys-C)-静脉血: 0.76mg/L；磷(P)-静脉血: 1.12mmol/L；纤维蛋白原(Fbg)-静脉血: 3.32g/L；Rh血型-静脉血: 阳性；血红蛋白(Hb)-静脉血: 136.2g/L；ABO血型-静脉血: O；骨钙素N端中分子片段(N-MID)-静脉血: 14.08ng/ml；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；直接胆红素(DBIL)-静脉血: 3.1umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 28.5U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；中性粒细胞百分比(Neut%)-静脉血: 0.617；镁离子(Mg2+)-静脉血: 0.88mmol/L；白细胞计数(WBC#)-静脉血: 7.0810E9/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 26.4U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.295ng/ml（参考: <0.704）；凝血酶原时间活动度(PTA)-静脉血: 120%；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.9mmol/L；血小板比容-静脉血: 18.3%；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.05S/CO；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.23mmolL；平均红细胞血红蛋白含量(MCH)-静脉血: 30pg；单核细胞百分比(Mono%)-静脉血: 0.072；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；总蛋白(TP)-静脉血: 71.09g/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40……\n- [全程D3] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及左侧壁粘膜增厚放射性浓聚，SUV约14.5，病灶累及蝶骨基底部、枕骨斜坡、左侧翼突、左岩尖、左侧破裂孔及左侧鼻后孔。双侧咽隐窝消失。双侧咽后未见明显肿大淋巴结及异常放射性分布。口咽及喉咽结构及放射性分布未见明显异常。左侧上颌窦及蝶窦内见低密度影放射性分布未见明显异常，额窦、筛窦及右侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双颈Ⅱ区多发肿大淋巴结放射性浓聚，SUV约14.2，最大约2.2×2.6cm。 双侧苍白球钙化放射性分布缺损，余所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。左肾盂小结石放射性分布缺损。脾脏、胰腺、右肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺小点状钙化灶。余盆腔放射性分布均匀，膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 所见颅盖骨、余躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽顶壁、顶后壁及左侧壁粘膜增厚代谢活跃，考虑鼻咽癌，病灶累及颅底骨、左侧破裂孔及左侧鼻后孔；双颈Ⅱ区多发肿大淋巴结代谢活跃，考虑转移。 左侧上颌窦及蝶窦炎症。 左肾盂小结石。 前列腺钙化。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行颈部淋巴结细针穿刺活检，完善鼻咽及颈部CT平扫+增强，查乙肝病毒DNA定量\nB. 行鼻咽内镜组织活检，完善鼻咽及颈部CT平扫+增强，查乙肝病毒DNA定量\nC. 行鼻咽内镜组织活检，完善鼻咽及颈部MRI平扫+增强，暂不查乙肝病毒DNA定量\nD. 行颈部淋巴结切除活检，完善鼻咽及颈部MRI平扫+增强，查乙肝病毒DNA定量\nE. 行鼻咽内镜组织活检，完善鼻咽及颈部CT平扫+增强，查丙肝病毒RNA定量\nF. 行鼻咽内镜组织活检，完善头颅MRI平扫+增强，查乙肝病毒DNA定量\nG. 行颈部淋巴结细针穿刺活检，完善鼻咽及颈部MRI平扫+增强，暂不查乙肝病毒DNA定量\nH. 行鼻咽内镜组织活检，完善鼻咽及颈部MRI平扫+增强，查乙肝病毒DNA定量\nI. 行鼻咽内镜组织活检及颈部淋巴结穿刺活检，完善鼻咽及颈部MRI平扫+增强\nJ. 行鼻咽内镜组织活检，完善鼻咽及颈部MRI平扫+增强，查丙肝病毒RNA定量\nK. 行鼻咽内镜组织活检，完善颈部超声造影，查乙肝病毒DNA定量\nL. 行鼻咽内镜组织活检，完善全身骨扫描，查乙肝病毒DNA定量\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-9fa3bde2f5d0ac4e910cb3cb","patient_id":"patient-f402aced5926698da3194c37","turn_id":"turn05","turn_position":3,"turn_type":"toxicity_or_support_decision","gold_letter":"K","gold_action":"按原剂量执行第2程洛铂+5-FU诱导化疗，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗","options":[{"letter":"A","text":"将第2程洛铂+5-FU诱导化疗减量20%，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗","is_gold":false},{"letter":"B","text":"暂停第2程诱导化疗，仅给予肠内营养及护胃支持，待胃肠道症状完全缓解后再评估化疗指征","is_gold":false},{"letter":"C","text":"按原剂量执行第2程洛铂+5-FU诱导化疗，并预防性给予重组人粒细胞集落刺激因子及止吐护胃支持治疗","is_gold":false},{"letter":"D","text":"按原剂量执行第2程洛铂+5-FU诱导化疗，并预防性给予重组人血小板生成素及止吐护胃支持治疗","is_gold":false},{"letter":"E","text":"将第2程诱导化疗方案更改为吉西他滨+顺铂，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗","is_gold":false},{"letter":"F","text":"将第2程诱导化疗方案更改为多西他赛+顺铂，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗","is_gold":false},{"letter":"G","text":"终止诱导化疗直接进入根治性放疗及同期化疗，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗","is_gold":false},{"letter":"H","text":"延迟第2程诱导化疗1周，期间给予护胃及止吐支持，待胃肠道症状完全缓解后再按原剂量化疗","is_gold":false},{"letter":"I","text":"按原剂量执行第2程洛铂+5-FU诱导化疗，取消常规止吐及护胃支持，仅在出现严重呕吐时给予解救治疗","is_gold":false},{"letter":"J","text":"将第2程洛铂+5-FU诱导化疗减量25%，并预防性给予重组人粒细胞集落刺激因子及止吐护胃支持治疗","is_gold":false},{"letter":"K","text":"按原剂量执行第2程洛铂+5-FU诱导化疗，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗","is_gold":true},{"letter":"L","text":"停用静脉化疗，改为口服卡培他滨单药化疗，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左颈肿物20余天；现病史: 20余天前患者无明显诱因自觉左颈肿物，无发热、疼痛，伴涕血、左耳堵塞感。无头痛、面麻、鼻塞、复视、张口困难等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左耳闷胀感,涕血,左颈肿物；既往史: 高血压10余年，规律服药，血压控制在130/80mmHg左右。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:穿山甲壳、蜂蛹、伟哥过敏。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 大儿子患“脑胶质瘤”，已病逝。；体格检查: T：36.4℃，P：66次/分，R：20次/分，BP：134/81mmHg,Ht：175cm，Wt：84kg，BSA：2.0m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽顶后壁、左侧壁结节状肿物；双侧颈部II区可扪及1个淋巴结，最大径6×5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 ST-T轻度改变\n- [全程D1] 检验组合: 梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；有核红细胞计数(NRBC#)-静脉血: 010E9/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；单核细胞计数(Mono#)-静脉血: 0.510E9/L；胱抑素(Cys-C)-静脉血: 0.76mg/L；磷(P)-静脉血: 1.12mmol/L；纤维蛋白原(Fbg)-静脉血: 3.32g/L；Rh血型-静脉血: 阳性；血红蛋白(Hb)-静脉血: 136.2g/L；ABO血型-静脉血: O；骨钙素N端中分子片段(N-MID)-静脉血: 14.08ng/ml；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；直接胆红素(DBIL)-静脉血: 3.1umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 28.5U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；中性粒细胞百分比(Neut%)-静脉血: 0.617；镁离子(Mg2+)-静脉血: 0.88mmol/L；白细胞计数(WBC#)-静脉血: 7.0810E9/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 26.4U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.295ng/ml（参考: <0.704）；凝血酶原时间活动度(PTA)-静脉血: 120%；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.9mmol/L；血小板比容-静脉血: 18.3%；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.05S/CO；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.23mmolL；平均红细胞血红蛋白含量(MCH)-静脉血: 30pg；单核细胞百分比(Mono%)-静脉血: 0.072；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；总蛋白(TP)-静脉血: 71.09g/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40……\n- [全程D3] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及左侧壁粘膜增厚放射性浓聚，SUV约14.5，病灶累及蝶骨基底部、枕骨斜坡、左侧翼突、左岩尖、左侧破裂孔及左侧鼻后孔。双侧咽隐窝消失。双侧咽后未见明显肿大淋巴结及异常放射性分布。口咽及喉咽结构及放射性分布未见明显异常。左侧上颌窦及蝶窦内见低密度影放射性分布未见明显异常，额窦、筛窦及右侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双颈Ⅱ区多发肿大淋巴结放射性浓聚，SUV约14.2，最大约2.2×2.6cm。 双侧苍白球钙化放射性分布缺损，余所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。左肾盂小结石放射性分布缺损。脾脏、胰腺、右肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺小点状钙化灶。余盆腔放射性分布均匀，膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 所见颅盖骨、余躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽顶壁、顶后壁及左侧壁粘膜增厚代谢活跃，考虑鼻咽癌，病灶累及颅底骨、左侧破裂孔及左侧鼻后孔；双颈Ⅱ区多发肿大淋巴结代谢活跃，考虑转移。 左侧上颌窦及蝶窦炎症。 左肾盂小结石。 前列腺钙化。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D6] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽左侧壁、顶壁及后壁增厚，见软组织灶形成，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，病灶占据左侧咽隐窝，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，右侧咽隐窝稍变浅，右侧咽旁脂肪间隙及颈动脉鞘区未见异常； 左侧腭帆提肌、双侧头长肌直接受侵；病灶累及左侧破裂孔、左侧后鼻孔； 双侧侧翼腭窝、颞下窝未见异常；口咽各壁无受累增厚。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部骨质破坏。 双侧海绵窦形态正常，未见增宽。 左侧上颌窦、蝶窦、左侧乳突粘膜稍增厚，双侧筛窦、右侧乳突气化好，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 左侧咽后间隙见小淋巴结，短径约4mm；双颈II区见肿大淋巴结，较大者短径约25mm；左颈III、V区见多发淋巴结，边界清，信号均匀，较大者短径约7mm。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 考虑鼻咽癌可能性大。 颅底骨质破坏。 左侧咽后小淋巴结。 双颈II区淋巴结肿大。\n- [全程D6] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T7上缘水平，估计导管末端位于上腔静脉下段内。；检查结论: PICC管末端位置如上述。\n- [全程D6] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 28mm AO 29mm MV E 0.51m/s EF 73% LV 49mm IVS 9mm A 0.73m/s FS 42% RA 28mm LVPW 10mm RV 18mm PA 20mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 心脏结构及运动未见异常 各房室腔及大血管未探及异常血流信号 左室舒张功能减低，收缩功能正常\n- [全程D13] 检验组合: 镁离子(Mg2+)-静脉血: 0.89mmol/L；总胆红素(TBIL)-静脉血: 13.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 23.7U/L；丙氨酸氨基转移酶(ALT)-静脉血: 21.4U/L；总钙(Ca)-静脉血: 2.2mmol/L；氯离子(Cl-)-静脉血: 104mmol/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；直接胆红素(DBIL)-静脉血: 5umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6；红细胞比容(Hct)-静脉血: 38.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.358；间接胆红素(IBIL)-静脉血: 8.3umolL；平均红细胞体积(MCV)-静脉血: 87.1fL；载脂蛋白AI(apoAI)-静脉血: 1.11g/L；球蛋白(GLO)-静脉血: 29.01g/L；C-反应蛋白(CRP)-静脉血: 13.69mg/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；白细胞计数(WBC#)-静脉血: 4.8310E9/L；碱性磷酸酶(ALP)-静脉血: 70.4U/L；血小板比容-静脉血: 18%；载脂蛋白B(apoB)-静脉血: 0.67g/L；中性粒细胞百分比(Neut%)-静脉血: 0.566；淋巴细胞计数(Lymph#)-静脉血: 1.710E9/L；钾离子(K+)-静脉血: 4.1mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；乳酸脱氢酶(LDH)-静脉血: 203.5U/L；阴离子间隙(AG)-静脉血: 14；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；甘油三酯(TG)-静脉血: 1.28mmol/L；红细胞计数(RBC#)-静脉血: 4.4310E12/L；血小板分布宽度(PDW)-静脉血: 8.5%；单核细胞百分比(Mono%)-静脉血: 0.058；大血小板百分比(P-LCR%)-静脉血: 11.6%；血液二氧化碳含量ctCO2(B)-静脉血: 25.1mmol/L；白蛋白(ALB)-静脉血: 40.2g/L；尿素氮(BUN)-静脉血: 5.8mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.3U/L；尿酸(UA)-静脉血: 378.8umol/L；总胆固醇(TC)-……\n- [全程D21] 检验组合: 单核细胞百分比(Mono%)-静脉血: 0.062；中性粒细胞百分比(Neut%)-静脉血: 0.67；白细胞计数(WBC#)-静脉血: 5.9710E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.9；平均红细胞血红蛋白含量(MCH)-静脉血: 29.3pg；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 134g/L；红细胞比容(Hct)-静脉血: 41.3%；血小板比容-静脉血: 13%；平均红细胞体积(MCV)-静脉血: 90.4fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；平均血小板体积(MPV)-静脉血: 9.4fL；血小板计数(PLT#)-静脉血: 13810E9/L；中性粒细胞计数(Neut#)-静脉血: 410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 324g/L；血小板分布宽度(PDW)-静脉血: 9.9%；大血小板百分比(P-LCR%)-静脉血: 21.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.255；单核细胞计数(Mono#)-静脉血: 0.410E9/L；红细胞计数(RBC#)-静脉血: 4.5710E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.2\n- [全程D27] 检验组合: 红细胞计数(RBC#)-静脉血: 4.3410E12/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.85mmol/L；血小板计数(PLT#)-静脉血: 255.510E9/L；白细胞计数(WBC#)-静脉血: 6.210E9/L；氯离子(Cl-)-静脉血: 104.9mmol/L；总胆汁酸(TBA)-静脉血: 1umol/L；肌酐(Crea)-静脉血: 96.8umol/L；钾离子(K+)-静脉血: 4.5mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.386；乳酸脱氢酶(LDH)-静脉血: 212.1U/L；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.33mmolL；淋巴细胞计数(Lymph#)-静脉血: 2.410E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21U/L；平均红细胞体积(MCV)-静脉血: 90.1fL；总蛋白(TP)-静脉血: 70.21g/L；丙氨酸氨基转移酶(ALT)-静脉血: 19.6U/L；间接胆红素(IBIL)-静脉血: 4.6umolL；尿酸(UA)-静脉血: 469.1umol/L；血小板比容-静脉血: 15.3%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；甘油三酯(TG)-静脉血: 1.12mmol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白B(apoB)-静脉血: 0.9g/L；平均血小板体积(MPV)-静脉血: 6.02fL；总钙(Ca)-静脉血: 2.25mmol/L；单核细胞百分比(Mono%)-静脉血: 0.066；红细胞比容(Hct)-静脉血: 39.1%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；γ-谷氨酰基转移酶(GGT)-静脉血: 25.5U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.7pg；尿素氮(BUN)-静脉血: 4.22mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341.2g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；中性粒细胞计数(Neut#)-静脉血: 3.310E9/L；有核红细胞计数(NRBC#)-静脉血: 010E……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+洛铂方案诱导化疗结束，诉呕吐1次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程5-FU+洛铂方案诱导化疗结束，无诉特殊不适，可予出院，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 将第2程洛铂+5-FU诱导化疗减量20%，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nB. 暂停第2程诱导化疗，仅给予肠内营养及护胃支持，待胃肠道症状完全缓解后再评估化疗指征\nC. 按原剂量执行第2程洛铂+5-FU诱导化疗，并预防性给予重组人粒细胞集落刺激因子及止吐护胃支持治疗\nD. 按原剂量执行第2程洛铂+5-FU诱导化疗，并预防性给予重组人血小板生成素及止吐护胃支持治疗\nE. 将第2程诱导化疗方案更改为吉西他滨+顺铂，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nF. 将第2程诱导化疗方案更改为多西他赛+顺铂，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nG. 终止诱导化疗直接进入根治性放疗及同期化疗，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nH. 延迟第2程诱导化疗1周，期间给予护胃及止吐支持，待胃肠道症状完全缓解后再按原剂量化疗\nI. 按原剂量执行第2程洛铂+5-FU诱导化疗，取消常规止吐及护胃支持，仅在出现严重呕吐时给予解救治疗\nJ. 将第2程洛铂+5-FU诱导化疗减量25%，并预防性给予重组人粒细胞集落刺激因子及止吐护胃支持治疗\nK. 按原剂量执行第2程洛铂+5-FU诱导化疗，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nL. 停用静脉化疗，改为口服卡培他滨单药化疗，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左颈肿物20余天；现病史: 20余天前患者无明显诱因自觉左颈肿物，无发热、疼痛，伴涕血、左耳堵塞感。无头痛、面麻、鼻塞、复视、张口困难等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左耳闷胀感,涕血,左颈肿物；既往史: 高血压10余年，规律服药，血压控制在130/80mmHg左右。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:穿山甲壳、蜂蛹、伟哥过敏。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 大儿子患“脑胶质瘤”，已病逝。；体格检查: T：36.4℃，P：66次/分，R：20次/分，BP：134/81mmHg,Ht：175cm，Wt：84kg，BSA：2.0m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽顶后壁、左侧壁结节状肿物；双侧颈部II区可扪及1个淋巴结，最大径6×5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 ST-T轻度改变\n- [全程D1] 检验组合: 梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；有核红细胞计数(NRBC#)-静脉血: 010E9/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；单核细胞计数(Mono#)-静脉血: 0.510E9/L；胱抑素(Cys-C)-静脉血: 0.76mg/L；磷(P)-静脉血: 1.12mmol/L；纤维蛋白原(Fbg)-静脉血: 3.32g/L；Rh血型-静脉血: 阳性；血红蛋白(Hb)-静脉血: 136.2g/L；ABO血型-静脉血: O；骨钙素N端中分子片段(N-MID)-静脉血: 14.08ng/ml；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；直接胆红素(DBIL)-静脉血: 3.1umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 28.5U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；中性粒细胞百分比(Neut%)-静脉血: 0.617；镁离子(Mg2+)-静脉血: 0.88mmol/L；白细胞计数(WBC#)-静脉血: 7.0810E9/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 26.4U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.295ng/ml（参考: <0.704）；凝血酶原时间活动度(PTA)-静脉血: 120%；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.9mmol/L；血小板比容-静脉血: 18.3%；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.05S/CO；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.23mmolL；平均红细胞血红蛋白含量(MCH)-静脉血: 30pg；单核细胞百分比(Mono%)-静脉血: 0.072；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；总蛋白(TP)-静脉血: 71.09g/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40……\n- [全程D3] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及左侧壁粘膜增厚放射性浓聚，SUV约14.5，病灶累及蝶骨基底部、枕骨斜坡、左侧翼突、左岩尖、左侧破裂孔及左侧鼻后孔。双侧咽隐窝消失。双侧咽后未见明显肿大淋巴结及异常放射性分布。口咽及喉咽结构及放射性分布未见明显异常。左侧上颌窦及蝶窦内见低密度影放射性分布未见明显异常，额窦、筛窦及右侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双颈Ⅱ区多发肿大淋巴结放射性浓聚，SUV约14.2，最大约2.2×2.6cm。 双侧苍白球钙化放射性分布缺损，余所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。左肾盂小结石放射性分布缺损。脾脏、胰腺、右肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺小点状钙化灶。余盆腔放射性分布均匀，膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 所见颅盖骨、余躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽顶壁、顶后壁及左侧壁粘膜增厚代谢活跃，考虑鼻咽癌，病灶累及颅底骨、左侧破裂孔及左侧鼻后孔；双颈Ⅱ区多发肿大淋巴结代谢活跃，考虑转移。 左侧上颌窦及蝶窦炎症。 左肾盂小结石。 前列腺钙化。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D6] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽左侧壁、顶壁及后壁增厚，见软组织灶形成，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，病灶占据左侧咽隐窝，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，右侧咽隐窝稍变浅，右侧咽旁脂肪间隙及颈动脉鞘区未见异常； 左侧腭帆提肌、双侧头长肌直接受侵；病灶累及左侧破裂孔、左侧后鼻孔； 双侧侧翼腭窝、颞下窝未见异常；口咽各壁无受累增厚。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部骨质破坏。 双侧海绵窦形态正常，未见增宽。 左侧上颌窦、蝶窦、左侧乳突粘膜稍增厚，双侧筛窦、右侧乳突气化好，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 左侧咽后间隙见小淋巴结，短径约4mm；双颈II区见肿大淋巴结，较大者短径约25mm；左颈III、V区见多发淋巴结，边界清，信号均匀，较大者短径约7mm。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 考虑鼻咽癌可能性大。 颅底骨质破坏。 左侧咽后小淋巴结。 双颈II区淋巴结肿大。\n- [全程D6] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T7上缘水平，估计导管末端位于上腔静脉下段内。；检查结论: PICC管末端位置如上述。\n- [全程D6] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 28mm AO 29mm MV E 0.51m/s EF 73% LV 49mm IVS 9mm A 0.73m/s FS 42% RA 28mm LVPW 10mm RV 18mm PA 20mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 心脏结构及运动未见异常 各房室腔及大血管未探及异常血流信号 左室舒张功能减低，收缩功能正常\n- [全程D13] 检验组合: 镁离子(Mg2+)-静脉血: 0.89mmol/L；总胆红素(TBIL)-静脉血: 13.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 23.7U/L；丙氨酸氨基转移酶(ALT)-静脉血: 21.4U/L；总钙(Ca)-静脉血: 2.2mmol/L；氯离子(Cl-)-静脉血: 104mmol/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；直接胆红素(DBIL)-静脉血: 5umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6；红细胞比容(Hct)-静脉血: 38.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.358；间接胆红素(IBIL)-静脉血: 8.3umolL；平均红细胞体积(MCV)-静脉血: 87.1fL；载脂蛋白AI(apoAI)-静脉血: 1.11g/L；球蛋白(GLO)-静脉血: 29.01g/L；C-反应蛋白(CRP)-静脉血: 13.69mg/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；白细胞计数(WBC#)-静脉血: 4.8310E9/L；碱性磷酸酶(ALP)-静脉血: 70.4U/L；血小板比容-静脉血: 18%；载脂蛋白B(apoB)-静脉血: 0.67g/L；中性粒细胞百分比(Neut%)-静脉血: 0.566；淋巴细胞计数(Lymph#)-静脉血: 1.710E9/L；钾离子(K+)-静脉血: 4.1mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；乳酸脱氢酶(LDH)-静脉血: 203.5U/L；阴离子间隙(AG)-静脉血: 14；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；甘油三酯(TG)-静脉血: 1.28mmol/L；红细胞计数(RBC#)-静脉血: 4.4310E12/L；血小板分布宽度(PDW)-静脉血: 8.5%；单核细胞百分比(Mono%)-静脉血: 0.058；大血小板百分比(P-LCR%)-静脉血: 11.6%；血液二氧化碳含量ctCO2(B)-静脉血: 25.1mmol/L；白蛋白(ALB)-静脉血: 40.2g/L；尿素氮(BUN)-静脉血: 5.8mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.3U/L；尿酸(UA)-静脉血: 378.8umol/L；总胆固醇(TC)-……\n- [全程D21] 检验组合: 单核细胞百分比(Mono%)-静脉血: 0.062；中性粒细胞百分比(Neut%)-静脉血: 0.67；白细胞计数(WBC#)-静脉血: 5.9710E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.9；平均红细胞血红蛋白含量(MCH)-静脉血: 29.3pg；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 134g/L；红细胞比容(Hct)-静脉血: 41.3%；血小板比容-静脉血: 13%；平均红细胞体积(MCV)-静脉血: 90.4fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；平均血小板体积(MPV)-静脉血: 9.4fL；血小板计数(PLT#)-静脉血: 13810E9/L；中性粒细胞计数(Neut#)-静脉血: 410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 324g/L；血小板分布宽度(PDW)-静脉血: 9.9%；大血小板百分比(P-LCR%)-静脉血: 21.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.255；单核细胞计数(Mono#)-静脉血: 0.410E9/L；红细胞计数(RBC#)-静脉血: 4.5710E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.2\n- [全程D27] 检验组合: 红细胞计数(RBC#)-静脉血: 4.3410E12/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.85mmol/L；血小板计数(PLT#)-静脉血: 255.510E9/L；白细胞计数(WBC#)-静脉血: 6.210E9/L；氯离子(Cl-)-静脉血: 104.9mmol/L；总胆汁酸(TBA)-静脉血: 1umol/L；肌酐(Crea)-静脉血: 96.8umol/L；钾离子(K+)-静脉血: 4.5mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.386；乳酸脱氢酶(LDH)-静脉血: 212.1U/L；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.33mmolL；淋巴细胞计数(Lymph#)-静脉血: 2.410E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21U/L；平均红细胞体积(MCV)-静脉血: 90.1fL；总蛋白(TP)-静脉血: 70.21g/L；丙氨酸氨基转移酶(ALT)-静脉血: 19.6U/L；间接胆红素(IBIL)-静脉血: 4.6umolL；尿酸(UA)-静脉血: 469.1umol/L；血小板比容-静脉血: 15.3%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；甘油三酯(TG)-静脉血: 1.12mmol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白B(apoB)-静脉血: 0.9g/L；平均血小板体积(MPV)-静脉血: 6.02fL；总钙(Ca)-静脉血: 2.25mmol/L；单核细胞百分比(Mono%)-静脉血: 0.066；红细胞比容(Hct)-静脉血: 39.1%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；γ-谷氨酰基转移酶(GGT)-静脉血: 25.5U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.7pg；尿素氮(BUN)-静脉血: 4.22mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341.2g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；中性粒细胞计数(Neut#)-静脉血: 3.310E9/L；有核红细胞计数(NRBC#)-静脉血: 010E……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+洛铂方案诱导化疗结束，诉呕吐1次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程5-FU+洛铂方案诱导化疗结束，无诉特殊不适，可予出院，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 将第2程洛铂+5-FU诱导化疗减量20%，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nB. 暂停第2程诱导化疗，仅给予肠内营养及护胃支持，待胃肠道症状完全缓解后再评估化疗指征\nC. 按原剂量执行第2程洛铂+5-FU诱导化疗，并预防性给予重组人粒细胞集落刺激因子及止吐护胃支持治疗\nD. 按原剂量执行第2程洛铂+5-FU诱导化疗，并预防性给予重组人血小板生成素及止吐护胃支持治疗\nE. 将第2程诱导化疗方案更改为吉西他滨+顺铂，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nF. 将第2程诱导化疗方案更改为多西他赛+顺铂，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nG. 终止诱导化疗直接进入根治性放疗及同期化疗，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nH. 延迟第2程诱导化疗1周，期间给予护胃及止吐支持，待胃肠道症状完全缓解后再按原剂量化疗\nI. 按原剂量执行第2程洛铂+5-FU诱导化疗，取消常规止吐及护胃支持，仅在出现严重呕吐时给予解救治疗\nJ. 将第2程洛铂+5-FU诱导化疗减量25%，并预防性给予重组人粒细胞集落刺激因子及止吐护胃支持治疗\nK. 按原剂量执行第2程洛铂+5-FU诱导化疗，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nL. 停用静脉化疗，改为口服卡培他滨单药化疗，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-cc3b58d3bf4229805e8c7b84","patient_id":"patient-f402aced5926698da3194c37","turn_id":"turn06","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"D","gold_action":"暂不予特殊药物支持治疗，仅常规监测血常规、生化常规","options":[{"letter":"A","text":"予以静脉输注红细胞悬液，并常规监测血常规、生化常规","is_gold":false},{"letter":"B","text":"予以重组人促红素（EPO）皮下注射，并常规监测血常规、生化常规","is_gold":false},{"letter":"C","text":"予以静脉滴注蔗糖铁注射液，并常规监测血常规、生化常规","is_gold":false},{"letter":"D","text":"暂不予特殊药物支持治疗，仅常规监测血常规、生化常规","is_gold":true},{"letter":"E","text":"予以粒细胞集落刺激因子（G-CSF）皮下注射，并常规监测血常规、生化常规","is_gold":false},{"letter":"F","text":"予以重组人血小板生成素（rhTPO）皮下注射，并常规监测血常规、生化常规","is_gold":false},{"letter":"G","text":"予以静脉滴注人血白蛋白，并常规监测血常规、生化常规","is_gold":false},{"letter":"H","text":"予以口服叶酸及维生素B12片，并常规监测血常规、生化常规","is_gold":false},{"letter":"I","text":"予以口服利血生及鲨肝醇片，并常规监测血常规、生化常规","is_gold":false},{"letter":"J","text":"予以静脉滴注右旋糖酐铁注射液，并常规监测血常规、生化常规","is_gold":false},{"letter":"K","text":"予以静脉滴注地塞米松及托烷司琼，并常规监测血常规、生化常规","is_gold":false},{"letter":"L","text":"予以口服多糖铁复合物胶囊，并常规监测血常规、生化常规","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左颈肿物20余天；现病史: 20余天前患者无明显诱因自觉左颈肿物，无发热、疼痛，伴涕血、左耳堵塞感。无头痛、面麻、鼻塞、复视、张口困难等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左耳闷胀感,涕血,左颈肿物；既往史: 高血压10余年，规律服药，血压控制在130/80mmHg左右。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:穿山甲壳、蜂蛹、伟哥过敏。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 大儿子患“脑胶质瘤”，已病逝。；体格检查: T：36.4℃，P：66次/分，R：20次/分，BP：134/81mmHg,Ht：175cm，Wt：84kg，BSA：2.0m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽顶后壁、左侧壁结节状肿物；双侧颈部II区可扪及1个淋巴结，最大径6×5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 ST-T轻度改变\n- [全程D1] 检验组合: 梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；有核红细胞计数(NRBC#)-静脉血: 010E9/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；单核细胞计数(Mono#)-静脉血: 0.510E9/L；胱抑素(Cys-C)-静脉血: 0.76mg/L；磷(P)-静脉血: 1.12mmol/L；纤维蛋白原(Fbg)-静脉血: 3.32g/L；Rh血型-静脉血: 阳性；血红蛋白(Hb)-静脉血: 136.2g/L；ABO血型-静脉血: O；骨钙素N端中分子片段(N-MID)-静脉血: 14.08ng/ml；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；直接胆红素(DBIL)-静脉血: 3.1umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 28.5U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；中性粒细胞百分比(Neut%)-静脉血: 0.617；镁离子(Mg2+)-静脉血: 0.88mmol/L；白细胞计数(WBC#)-静脉血: 7.0810E9/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 26.4U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.295ng/ml（参考: <0.704）；凝血酶原时间活动度(PTA)-静脉血: 120%；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.9mmol/L；血小板比容-静脉血: 18.3%；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.05S/CO；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.23mmolL；平均红细胞血红蛋白含量(MCH)-静脉血: 30pg；单核细胞百分比(Mono%)-静脉血: 0.072；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；总蛋白(TP)-静脉血: 71.09g/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40……\n- [全程D3] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及左侧壁粘膜增厚放射性浓聚，SUV约14.5，病灶累及蝶骨基底部、枕骨斜坡、左侧翼突、左岩尖、左侧破裂孔及左侧鼻后孔。双侧咽隐窝消失。双侧咽后未见明显肿大淋巴结及异常放射性分布。口咽及喉咽结构及放射性分布未见明显异常。左侧上颌窦及蝶窦内见低密度影放射性分布未见明显异常，额窦、筛窦及右侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双颈Ⅱ区多发肿大淋巴结放射性浓聚，SUV约14.2，最大约2.2×2.6cm。 双侧苍白球钙化放射性分布缺损，余所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。左肾盂小结石放射性分布缺损。脾脏、胰腺、右肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺小点状钙化灶。余盆腔放射性分布均匀，膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 所见颅盖骨、余躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽顶壁、顶后壁及左侧壁粘膜增厚代谢活跃，考虑鼻咽癌，病灶累及颅底骨、左侧破裂孔及左侧鼻后孔；双颈Ⅱ区多发肿大淋巴结代谢活跃，考虑转移。 左侧上颌窦及蝶窦炎症。 左肾盂小结石。 前列腺钙化。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D6] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽左侧壁、顶壁及后壁增厚，见软组织灶形成，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，病灶占据左侧咽隐窝，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，右侧咽隐窝稍变浅，右侧咽旁脂肪间隙及颈动脉鞘区未见异常； 左侧腭帆提肌、双侧头长肌直接受侵；病灶累及左侧破裂孔、左侧后鼻孔； 双侧侧翼腭窝、颞下窝未见异常；口咽各壁无受累增厚。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部骨质破坏。 双侧海绵窦形态正常，未见增宽。 左侧上颌窦、蝶窦、左侧乳突粘膜稍增厚，双侧筛窦、右侧乳突气化好，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 左侧咽后间隙见小淋巴结，短径约4mm；双颈II区见肿大淋巴结，较大者短径约25mm；左颈III、V区见多发淋巴结，边界清，信号均匀，较大者短径约7mm。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 考虑鼻咽癌可能性大。 颅底骨质破坏。 左侧咽后小淋巴结。 双颈II区淋巴结肿大。\n- [全程D6] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T7上缘水平，估计导管末端位于上腔静脉下段内。；检查结论: PICC管末端位置如上述。\n- [全程D6] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 28mm AO 29mm MV E 0.51m/s EF 73% LV 49mm IVS 9mm A 0.73m/s FS 42% RA 28mm LVPW 10mm RV 18mm PA 20mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 心脏结构及运动未见异常 各房室腔及大血管未探及异常血流信号 左室舒张功能减低，收缩功能正常\n- [全程D13] 检验组合: 镁离子(Mg2+)-静脉血: 0.89mmol/L；总胆红素(TBIL)-静脉血: 13.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 23.7U/L；丙氨酸氨基转移酶(ALT)-静脉血: 21.4U/L；总钙(Ca)-静脉血: 2.2mmol/L；氯离子(Cl-)-静脉血: 104mmol/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；直接胆红素(DBIL)-静脉血: 5umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6；红细胞比容(Hct)-静脉血: 38.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.358；间接胆红素(IBIL)-静脉血: 8.3umolL；平均红细胞体积(MCV)-静脉血: 87.1fL；载脂蛋白AI(apoAI)-静脉血: 1.11g/L；球蛋白(GLO)-静脉血: 29.01g/L；C-反应蛋白(CRP)-静脉血: 13.69mg/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；白细胞计数(WBC#)-静脉血: 4.8310E9/L；碱性磷酸酶(ALP)-静脉血: 70.4U/L；血小板比容-静脉血: 18%；载脂蛋白B(apoB)-静脉血: 0.67g/L；中性粒细胞百分比(Neut%)-静脉血: 0.566；淋巴细胞计数(Lymph#)-静脉血: 1.710E9/L；钾离子(K+)-静脉血: 4.1mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；乳酸脱氢酶(LDH)-静脉血: 203.5U/L；阴离子间隙(AG)-静脉血: 14；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；甘油三酯(TG)-静脉血: 1.28mmol/L；红细胞计数(RBC#)-静脉血: 4.4310E12/L；血小板分布宽度(PDW)-静脉血: 8.5%；单核细胞百分比(Mono%)-静脉血: 0.058；大血小板百分比(P-LCR%)-静脉血: 11.6%；血液二氧化碳含量ctCO2(B)-静脉血: 25.1mmol/L；白蛋白(ALB)-静脉血: 40.2g/L；尿素氮(BUN)-静脉血: 5.8mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.3U/L；尿酸(UA)-静脉血: 378.8umol/L；总胆固醇(TC)-……\n- [全程D21] 检验组合: 单核细胞百分比(Mono%)-静脉血: 0.062；中性粒细胞百分比(Neut%)-静脉血: 0.67；白细胞计数(WBC#)-静脉血: 5.9710E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.9；平均红细胞血红蛋白含量(MCH)-静脉血: 29.3pg；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 134g/L；红细胞比容(Hct)-静脉血: 41.3%；血小板比容-静脉血: 13%；平均红细胞体积(MCV)-静脉血: 90.4fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；平均血小板体积(MPV)-静脉血: 9.4fL；血小板计数(PLT#)-静脉血: 13810E9/L；中性粒细胞计数(Neut#)-静脉血: 410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 324g/L；血小板分布宽度(PDW)-静脉血: 9.9%；大血小板百分比(P-LCR%)-静脉血: 21.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.255；单核细胞计数(Mono#)-静脉血: 0.410E9/L；红细胞计数(RBC#)-静脉血: 4.5710E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.2\n- [全程D27] 检验组合: 红细胞计数(RBC#)-静脉血: 4.3410E12/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.85mmol/L；血小板计数(PLT#)-静脉血: 255.510E9/L；白细胞计数(WBC#)-静脉血: 6.210E9/L；氯离子(Cl-)-静脉血: 104.9mmol/L；总胆汁酸(TBA)-静脉血: 1umol/L；肌酐(Crea)-静脉血: 96.8umol/L；钾离子(K+)-静脉血: 4.5mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.386；乳酸脱氢酶(LDH)-静脉血: 212.1U/L；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.33mmolL；淋巴细胞计数(Lymph#)-静脉血: 2.410E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21U/L；平均红细胞体积(MCV)-静脉血: 90.1fL；总蛋白(TP)-静脉血: 70.21g/L；丙氨酸氨基转移酶(ALT)-静脉血: 19.6U/L；间接胆红素(IBIL)-静脉血: 4.6umolL；尿酸(UA)-静脉血: 469.1umol/L；血小板比容-静脉血: 15.3%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；甘油三酯(TG)-静脉血: 1.12mmol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白B(apoB)-静脉血: 0.9g/L；平均血小板体积(MPV)-静脉血: 6.02fL；总钙(Ca)-静脉血: 2.25mmol/L；单核细胞百分比(Mono%)-静脉血: 0.066；红细胞比容(Hct)-静脉血: 39.1%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；γ-谷氨酰基转移酶(GGT)-静脉血: 25.5U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.7pg；尿素氮(BUN)-静脉血: 4.22mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341.2g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；中性粒细胞计数(Neut#)-静脉血: 3.310E9/L；有核红细胞计数(NRBC#)-静脉血: 010E……\n- [全程D33] 检验组合: 尿素氮(BUN)-静脉血: 3.5mmol/L；直接胆红素(DBIL)-静脉血: 9umol/L；红细胞计数(RBC#)-静脉血: 3.8710E12/L；球蛋白(GLO)-静脉血: 27.06g/L；总胆红素(TBIL)-静脉血: 28.4umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.08mmolL；钾离子(K+)-静脉血: 3.68mmol/L；钠离子(Na+)-静脉血: 140.7mmol/L；肌酐(Crea)-静脉血: 71.4umol/L；红细胞比容(Hct)-静脉血: 34.5%；血小板比容-静脉血: 13.9%；总胆固醇(TC)-静脉血: 3.79mmol/L；磷(P)-静脉血: 1.21mmol/L；阴离子间隙(AG)-静脉血: 14.8；C-反应蛋白(CRP)-静脉血: 15.32mg/L；有核红细胞百分比(NRBC%)-静脉血: 0；乳酸脱氢酶(LDH)-静脉血: 214.8U/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15.3U/L；间接胆红素(IBIL)-静脉血: 19.4umolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.21mmol/L；白蛋白(ALB)-静脉血: 36.4g/L；总钙(Ca)-静脉血: 2.01mmol/L；载脂蛋白B(apoB)-静脉血: 0.79g/L；中性粒细胞计数(Neut#)-静脉血: 3.210E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.308；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.02；平均红细胞血红蛋白含量(MCH)-静脉血: 30.6pg；载脂蛋白AI(apoAI)-静脉血: 1.04g/L；尿酸(UA)-静脉血: 290.1umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.35；平均红细胞体积(MCV)-静脉血: 89.1fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；碱性磷酸酶(ALP)-静脉血: 60.5U/L；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；血小板计数(PLT#)-静脉血: 230.610E9/L；γ-谷氨酰基转移酶(GGT)-静……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+洛铂方案诱导化疗结束，诉呕吐1次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程5-FU+洛铂方案诱导化疗结束，无诉特殊不适，可予出院，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n- [全程D28] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，可于今日执行第2程5-FU+洛铂方案诱导化疗，注意化疗不良反应。\n- [全程D29] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+洛铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 予以静脉输注红细胞悬液，并常规监测血常规、生化常规\nB. 予以重组人促红素（EPO）皮下注射，并常规监测血常规、生化常规\nC. 予以静脉滴注蔗糖铁注射液，并常规监测血常规、生化常规\nD. 暂不予特殊药物支持治疗，仅常规监测血常规、生化常规\nE. 予以粒细胞集落刺激因子（G-CSF）皮下注射，并常规监测血常规、生化常规\nF. 予以重组人血小板生成素（rhTPO）皮下注射，并常规监测血常规、生化常规\nG. 予以静脉滴注人血白蛋白，并常规监测血常规、生化常规\nH. 予以口服叶酸及维生素B12片，并常规监测血常规、生化常规\nI. 予以口服利血生及鲨肝醇片，并常规监测血常规、生化常规\nJ. 予以静脉滴注右旋糖酐铁注射液，并常规监测血常规、生化常规\nK. 予以静脉滴注地塞米松及托烷司琼，并常规监测血常规、生化常规\nL. 予以口服多糖铁复合物胶囊，并常规监测血常规、生化常规\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左颈肿物20余天；现病史: 20余天前患者无明显诱因自觉左颈肿物，无发热、疼痛，伴涕血、左耳堵塞感。无头痛、面麻、鼻塞、复视、张口困难等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左耳闷胀感,涕血,左颈肿物；既往史: 高血压10余年，规律服药，血压控制在130/80mmHg左右。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:穿山甲壳、蜂蛹、伟哥过敏。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 大儿子患“脑胶质瘤”，已病逝。；体格检查: T：36.4℃，P：66次/分，R：20次/分，BP：134/81mmHg,Ht：175cm，Wt：84kg，BSA：2.0m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽顶后壁、左侧壁结节状肿物；双侧颈部II区可扪及1个淋巴结，最大径6×5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 ST-T轻度改变\n- [全程D1] 检验组合: 梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；有核红细胞计数(NRBC#)-静脉血: 010E9/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；单核细胞计数(Mono#)-静脉血: 0.510E9/L；胱抑素(Cys-C)-静脉血: 0.76mg/L；磷(P)-静脉血: 1.12mmol/L；纤维蛋白原(Fbg)-静脉血: 3.32g/L；Rh血型-静脉血: 阳性；血红蛋白(Hb)-静脉血: 136.2g/L；ABO血型-静脉血: O；骨钙素N端中分子片段(N-MID)-静脉血: 14.08ng/ml；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；直接胆红素(DBIL)-静脉血: 3.1umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 28.5U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；中性粒细胞百分比(Neut%)-静脉血: 0.617；镁离子(Mg2+)-静脉血: 0.88mmol/L；白细胞计数(WBC#)-静脉血: 7.0810E9/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 26.4U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.295ng/ml（参考: <0.704）；凝血酶原时间活动度(PTA)-静脉血: 120%；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.9mmol/L；血小板比容-静脉血: 18.3%；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.05S/CO；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.23mmolL；平均红细胞血红蛋白含量(MCH)-静脉血: 30pg；单核细胞百分比(Mono%)-静脉血: 0.072；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；总蛋白(TP)-静脉血: 71.09g/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40……\n- [全程D3] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及左侧壁粘膜增厚放射性浓聚，SUV约14.5，病灶累及蝶骨基底部、枕骨斜坡、左侧翼突、左岩尖、左侧破裂孔及左侧鼻后孔。双侧咽隐窝消失。双侧咽后未见明显肿大淋巴结及异常放射性分布。口咽及喉咽结构及放射性分布未见明显异常。左侧上颌窦及蝶窦内见低密度影放射性分布未见明显异常，额窦、筛窦及右侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双颈Ⅱ区多发肿大淋巴结放射性浓聚，SUV约14.2，最大约2.2×2.6cm。 双侧苍白球钙化放射性分布缺损，余所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。左肾盂小结石放射性分布缺损。脾脏、胰腺、右肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺小点状钙化灶。余盆腔放射性分布均匀，膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 所见颅盖骨、余躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽顶壁、顶后壁及左侧壁粘膜增厚代谢活跃，考虑鼻咽癌，病灶累及颅底骨、左侧破裂孔及左侧鼻后孔；双颈Ⅱ区多发肿大淋巴结代谢活跃，考虑转移。 左侧上颌窦及蝶窦炎症。 左肾盂小结石。 前列腺钙化。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D6] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽左侧壁、顶壁及后壁增厚，见软组织灶形成，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，病灶占据左侧咽隐窝，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，右侧咽隐窝稍变浅，右侧咽旁脂肪间隙及颈动脉鞘区未见异常； 左侧腭帆提肌、双侧头长肌直接受侵；病灶累及左侧破裂孔、左侧后鼻孔； 双侧侧翼腭窝、颞下窝未见异常；口咽各壁无受累增厚。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部骨质破坏。 双侧海绵窦形态正常，未见增宽。 左侧上颌窦、蝶窦、左侧乳突粘膜稍增厚，双侧筛窦、右侧乳突气化好，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 左侧咽后间隙见小淋巴结，短径约4mm；双颈II区见肿大淋巴结，较大者短径约25mm；左颈III、V区见多发淋巴结，边界清，信号均匀，较大者短径约7mm。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 考虑鼻咽癌可能性大。 颅底骨质破坏。 左侧咽后小淋巴结。 双颈II区淋巴结肿大。\n- [全程D6] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T7上缘水平，估计导管末端位于上腔静脉下段内。；检查结论: PICC管末端位置如上述。\n- [全程D6] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 28mm AO 29mm MV E 0.51m/s EF 73% LV 49mm IVS 9mm A 0.73m/s FS 42% RA 28mm LVPW 10mm RV 18mm PA 20mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 心脏结构及运动未见异常 各房室腔及大血管未探及异常血流信号 左室舒张功能减低，收缩功能正常\n- [全程D13] 检验组合: 镁离子(Mg2+)-静脉血: 0.89mmol/L；总胆红素(TBIL)-静脉血: 13.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 23.7U/L；丙氨酸氨基转移酶(ALT)-静脉血: 21.4U/L；总钙(Ca)-静脉血: 2.2mmol/L；氯离子(Cl-)-静脉血: 104mmol/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；直接胆红素(DBIL)-静脉血: 5umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6；红细胞比容(Hct)-静脉血: 38.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.358；间接胆红素(IBIL)-静脉血: 8.3umolL；平均红细胞体积(MCV)-静脉血: 87.1fL；载脂蛋白AI(apoAI)-静脉血: 1.11g/L；球蛋白(GLO)-静脉血: 29.01g/L；C-反应蛋白(CRP)-静脉血: 13.69mg/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；白细胞计数(WBC#)-静脉血: 4.8310E9/L；碱性磷酸酶(ALP)-静脉血: 70.4U/L；血小板比容-静脉血: 18%；载脂蛋白B(apoB)-静脉血: 0.67g/L；中性粒细胞百分比(Neut%)-静脉血: 0.566；淋巴细胞计数(Lymph#)-静脉血: 1.710E9/L；钾离子(K+)-静脉血: 4.1mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；乳酸脱氢酶(LDH)-静脉血: 203.5U/L；阴离子间隙(AG)-静脉血: 14；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；甘油三酯(TG)-静脉血: 1.28mmol/L；红细胞计数(RBC#)-静脉血: 4.4310E12/L；血小板分布宽度(PDW)-静脉血: 8.5%；单核细胞百分比(Mono%)-静脉血: 0.058；大血小板百分比(P-LCR%)-静脉血: 11.6%；血液二氧化碳含量ctCO2(B)-静脉血: 25.1mmol/L；白蛋白(ALB)-静脉血: 40.2g/L；尿素氮(BUN)-静脉血: 5.8mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.3U/L；尿酸(UA)-静脉血: 378.8umol/L；总胆固醇(TC)-……\n- [全程D21] 检验组合: 单核细胞百分比(Mono%)-静脉血: 0.062；中性粒细胞百分比(Neut%)-静脉血: 0.67；白细胞计数(WBC#)-静脉血: 5.9710E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.9；平均红细胞血红蛋白含量(MCH)-静脉血: 29.3pg；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 134g/L；红细胞比容(Hct)-静脉血: 41.3%；血小板比容-静脉血: 13%；平均红细胞体积(MCV)-静脉血: 90.4fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；平均血小板体积(MPV)-静脉血: 9.4fL；血小板计数(PLT#)-静脉血: 13810E9/L；中性粒细胞计数(Neut#)-静脉血: 410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 324g/L；血小板分布宽度(PDW)-静脉血: 9.9%；大血小板百分比(P-LCR%)-静脉血: 21.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.255；单核细胞计数(Mono#)-静脉血: 0.410E9/L；红细胞计数(RBC#)-静脉血: 4.5710E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.2\n- [全程D27] 检验组合: 红细胞计数(RBC#)-静脉血: 4.3410E12/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.85mmol/L；血小板计数(PLT#)-静脉血: 255.510E9/L；白细胞计数(WBC#)-静脉血: 6.210E9/L；氯离子(Cl-)-静脉血: 104.9mmol/L；总胆汁酸(TBA)-静脉血: 1umol/L；肌酐(Crea)-静脉血: 96.8umol/L；钾离子(K+)-静脉血: 4.5mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.386；乳酸脱氢酶(LDH)-静脉血: 212.1U/L；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.33mmolL；淋巴细胞计数(Lymph#)-静脉血: 2.410E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21U/L；平均红细胞体积(MCV)-静脉血: 90.1fL；总蛋白(TP)-静脉血: 70.21g/L；丙氨酸氨基转移酶(ALT)-静脉血: 19.6U/L；间接胆红素(IBIL)-静脉血: 4.6umolL；尿酸(UA)-静脉血: 469.1umol/L；血小板比容-静脉血: 15.3%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；甘油三酯(TG)-静脉血: 1.12mmol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白B(apoB)-静脉血: 0.9g/L；平均血小板体积(MPV)-静脉血: 6.02fL；总钙(Ca)-静脉血: 2.25mmol/L；单核细胞百分比(Mono%)-静脉血: 0.066；红细胞比容(Hct)-静脉血: 39.1%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；γ-谷氨酰基转移酶(GGT)-静脉血: 25.5U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.7pg；尿素氮(BUN)-静脉血: 4.22mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341.2g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；中性粒细胞计数(Neut#)-静脉血: 3.310E9/L；有核红细胞计数(NRBC#)-静脉血: 010E……\n- [全程D33] 检验组合: 尿素氮(BUN)-静脉血: 3.5mmol/L；直接胆红素(DBIL)-静脉血: 9umol/L；红细胞计数(RBC#)-静脉血: 3.8710E12/L；球蛋白(GLO)-静脉血: 27.06g/L；总胆红素(TBIL)-静脉血: 28.4umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.08mmolL；钾离子(K+)-静脉血: 3.68mmol/L；钠离子(Na+)-静脉血: 140.7mmol/L；肌酐(Crea)-静脉血: 71.4umol/L；红细胞比容(Hct)-静脉血: 34.5%；血小板比容-静脉血: 13.9%；总胆固醇(TC)-静脉血: 3.79mmol/L；磷(P)-静脉血: 1.21mmol/L；阴离子间隙(AG)-静脉血: 14.8；C-反应蛋白(CRP)-静脉血: 15.32mg/L；有核红细胞百分比(NRBC%)-静脉血: 0；乳酸脱氢酶(LDH)-静脉血: 214.8U/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15.3U/L；间接胆红素(IBIL)-静脉血: 19.4umolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.21mmol/L；白蛋白(ALB)-静脉血: 36.4g/L；总钙(Ca)-静脉血: 2.01mmol/L；载脂蛋白B(apoB)-静脉血: 0.79g/L；中性粒细胞计数(Neut#)-静脉血: 3.210E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.308；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.02；平均红细胞血红蛋白含量(MCH)-静脉血: 30.6pg；载脂蛋白AI(apoAI)-静脉血: 1.04g/L；尿酸(UA)-静脉血: 290.1umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.35；平均红细胞体积(MCV)-静脉血: 89.1fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；碱性磷酸酶(ALP)-静脉血: 60.5U/L；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；血小板计数(PLT#)-静脉血: 230.610E9/L；γ-谷氨酰基转移酶(GGT)-静……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+洛铂方案诱导化疗结束，诉呕吐1次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程5-FU+洛铂方案诱导化疗结束，无诉特殊不适，可予出院，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n- [全程D28] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，可于今日执行第2程5-FU+洛铂方案诱导化疗，注意化疗不良反应。\n- [全程D29] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+洛铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 予以静脉输注红细胞悬液，并常规监测血常规、生化常规\nB. 予以重组人促红素（EPO）皮下注射，并常规监测血常规、生化常规\nC. 予以静脉滴注蔗糖铁注射液，并常规监测血常规、生化常规\nD. 暂不予特殊药物支持治疗，仅常规监测血常规、生化常规\nE. 予以粒细胞集落刺激因子（G-CSF）皮下注射，并常规监测血常规、生化常规\nF. 予以重组人血小板生成素（rhTPO）皮下注射，并常规监测血常规、生化常规\nG. 予以静脉滴注人血白蛋白，并常规监测血常规、生化常规\nH. 予以口服叶酸及维生素B12片，并常规监测血常规、生化常规\nI. 予以口服利血生及鲨肝醇片，并常规监测血常规、生化常规\nJ. 予以静脉滴注右旋糖酐铁注射液，并常规监测血常规、生化常规\nK. 予以静脉滴注地塞米松及托烷司琼，并常规监测血常规、生化常规\nL. 予以口服多糖铁复合物胶囊，并常规监测血常规、生化常规\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-80438584d0b66a199c599a7d","patient_id":"patient-f402aced5926698da3194c37","turn_id":"turn07","turn_position":5,"turn_type":"response_assessment_decision","gold_letter":"A","gold_action":"疗效评估为部分缓解（PR），启动靶向治疗（西妥昔单抗）联合同期放化疗。","options":[{"letter":"A","text":"疗效评估为部分缓解（PR），启动靶向治疗（西妥昔单抗）联合同期放化疗","is_gold":true},{"letter":"B","text":"疗效评估为部分缓解（PR），启动靶向治疗（尼妥珠单抗）联合同期放化疗","is_gold":false},{"letter":"C","text":"疗效评估为部分缓解（PR），继续原方案（洛铂+5-FU）第3程诱导化疗","is_gold":false},{"letter":"D","text":"疗效评估为部分缓解（PR），启动同期放化疗，暂不联合靶向治疗","is_gold":false},{"letter":"E","text":"疗效评估为疾病稳定（SD），启动免疫治疗（卡瑞利珠单抗）联合同期放化疗","is_gold":false},{"letter":"F","text":"疗效评估为疾病进展（PD），更改化疗方案为吉西他滨+顺铂诱导化疗","is_gold":false},{"letter":"G","text":"疗效评估为部分缓解（PR），行鼻咽及颈部根治性放疗，不联合全身治疗","is_gold":false},{"letter":"H","text":"疗效评估为部分缓解（PR），暂停抗肿瘤治疗，单纯行纠正贫血支持治疗","is_gold":false},{"letter":"I","text":"疗效评估为部分缓解（PR），行双侧颈部淋巴结清扫术，术后辅助放疗","is_gold":false},{"letter":"J","text":"疗效评估为完全缓解（CR），启动靶向治疗（西妥昔单抗）联合同期放化疗","is_gold":false},{"letter":"K","text":"疗效评估为部分缓解（PR），启动靶向治疗（贝伐珠单抗）联合同期放化疗","is_gold":false},{"letter":"L","text":"疗效评估为部分缓解（PR），启动免疫治疗（帕博利珠单抗）联合同期放化疗","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左颈肿物20余天；现病史: 20余天前患者无明显诱因自觉左颈肿物，无发热、疼痛，伴涕血、左耳堵塞感。无头痛、面麻、鼻塞、复视、张口困难等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左耳闷胀感,涕血,左颈肿物；既往史: 高血压10余年，规律服药，血压控制在130/80mmHg左右。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:穿山甲壳、蜂蛹、伟哥过敏。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 大儿子患“脑胶质瘤”，已病逝。；体格检查: T：36.4℃，P：66次/分，R：20次/分，BP：134/81mmHg,Ht：175cm，Wt：84kg，BSA：2.0m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽顶后壁、左侧壁结节状肿物；双侧颈部II区可扪及1个淋巴结，最大径6×5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 ST-T轻度改变\n- [全程D1] 检验组合: 梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；有核红细胞计数(NRBC#)-静脉血: 010E9/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；单核细胞计数(Mono#)-静脉血: 0.510E9/L；胱抑素(Cys-C)-静脉血: 0.76mg/L；磷(P)-静脉血: 1.12mmol/L；纤维蛋白原(Fbg)-静脉血: 3.32g/L；Rh血型-静脉血: 阳性；血红蛋白(Hb)-静脉血: 136.2g/L；ABO血型-静脉血: O；骨钙素N端中分子片段(N-MID)-静脉血: 14.08ng/ml；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；直接胆红素(DBIL)-静脉血: 3.1umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 28.5U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；中性粒细胞百分比(Neut%)-静脉血: 0.617；镁离子(Mg2+)-静脉血: 0.88mmol/L；白细胞计数(WBC#)-静脉血: 7.0810E9/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 26.4U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.295ng/ml（参考: <0.704）；凝血酶原时间活动度(PTA)-静脉血: 120%；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.9mmol/L；血小板比容-静脉血: 18.3%；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.05S/CO；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.23mmolL；平均红细胞血红蛋白含量(MCH)-静脉血: 30pg；单核细胞百分比(Mono%)-静脉血: 0.072；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；总蛋白(TP)-静脉血: 71.09g/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40……\n- [全程D3] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及左侧壁粘膜增厚放射性浓聚，SUV约14.5，病灶累及蝶骨基底部、枕骨斜坡、左侧翼突、左岩尖、左侧破裂孔及左侧鼻后孔。双侧咽隐窝消失。双侧咽后未见明显肿大淋巴结及异常放射性分布。口咽及喉咽结构及放射性分布未见明显异常。左侧上颌窦及蝶窦内见低密度影放射性分布未见明显异常，额窦、筛窦及右侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双颈Ⅱ区多发肿大淋巴结放射性浓聚，SUV约14.2，最大约2.2×2.6cm。 双侧苍白球钙化放射性分布缺损，余所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。左肾盂小结石放射性分布缺损。脾脏、胰腺、右肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺小点状钙化灶。余盆腔放射性分布均匀，膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 所见颅盖骨、余躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽顶壁、顶后壁及左侧壁粘膜增厚代谢活跃，考虑鼻咽癌，病灶累及颅底骨、左侧破裂孔及左侧鼻后孔；双颈Ⅱ区多发肿大淋巴结代谢活跃，考虑转移。 左侧上颌窦及蝶窦炎症。 左肾盂小结石。 前列腺钙化。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D6] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽左侧壁、顶壁及后壁增厚，见软组织灶形成，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，病灶占据左侧咽隐窝，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，右侧咽隐窝稍变浅，右侧咽旁脂肪间隙及颈动脉鞘区未见异常； 左侧腭帆提肌、双侧头长肌直接受侵；病灶累及左侧破裂孔、左侧后鼻孔； 双侧侧翼腭窝、颞下窝未见异常；口咽各壁无受累增厚。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部骨质破坏。 双侧海绵窦形态正常，未见增宽。 左侧上颌窦、蝶窦、左侧乳突粘膜稍增厚，双侧筛窦、右侧乳突气化好，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 左侧咽后间隙见小淋巴结，短径约4mm；双颈II区见肿大淋巴结，较大者短径约25mm；左颈III、V区见多发淋巴结，边界清，信号均匀，较大者短径约7mm。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 考虑鼻咽癌可能性大。 颅底骨质破坏。 左侧咽后小淋巴结。 双颈II区淋巴结肿大。\n- [全程D6] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T7上缘水平，估计导管末端位于上腔静脉下段内。；检查结论: PICC管末端位置如上述。\n- [全程D6] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 28mm AO 29mm MV E 0.51m/s EF 73% LV 49mm IVS 9mm A 0.73m/s FS 42% RA 28mm LVPW 10mm RV 18mm PA 20mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 心脏结构及运动未见异常 各房室腔及大血管未探及异常血流信号 左室舒张功能减低，收缩功能正常\n- [全程D13] 检验组合: 镁离子(Mg2+)-静脉血: 0.89mmol/L；总胆红素(TBIL)-静脉血: 13.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 23.7U/L；丙氨酸氨基转移酶(ALT)-静脉血: 21.4U/L；总钙(Ca)-静脉血: 2.2mmol/L；氯离子(Cl-)-静脉血: 104mmol/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；直接胆红素(DBIL)-静脉血: 5umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6；红细胞比容(Hct)-静脉血: 38.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.358；间接胆红素(IBIL)-静脉血: 8.3umolL；平均红细胞体积(MCV)-静脉血: 87.1fL；载脂蛋白AI(apoAI)-静脉血: 1.11g/L；球蛋白(GLO)-静脉血: 29.01g/L；C-反应蛋白(CRP)-静脉血: 13.69mg/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；白细胞计数(WBC#)-静脉血: 4.8310E9/L；碱性磷酸酶(ALP)-静脉血: 70.4U/L；血小板比容-静脉血: 18%；载脂蛋白B(apoB)-静脉血: 0.67g/L；中性粒细胞百分比(Neut%)-静脉血: 0.566；淋巴细胞计数(Lymph#)-静脉血: 1.710E9/L；钾离子(K+)-静脉血: 4.1mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；乳酸脱氢酶(LDH)-静脉血: 203.5U/L；阴离子间隙(AG)-静脉血: 14；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；甘油三酯(TG)-静脉血: 1.28mmol/L；红细胞计数(RBC#)-静脉血: 4.4310E12/L；血小板分布宽度(PDW)-静脉血: 8.5%；单核细胞百分比(Mono%)-静脉血: 0.058；大血小板百分比(P-LCR%)-静脉血: 11.6%；血液二氧化碳含量ctCO2(B)-静脉血: 25.1mmol/L；白蛋白(ALB)-静脉血: 40.2g/L；尿素氮(BUN)-静脉血: 5.8mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.3U/L；尿酸(UA)-静脉血: 378.8umol/L；总胆固醇(TC)-……\n- [全程D21] 检验组合: 单核细胞百分比(Mono%)-静脉血: 0.062；中性粒细胞百分比(Neut%)-静脉血: 0.67；白细胞计数(WBC#)-静脉血: 5.9710E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.9；平均红细胞血红蛋白含量(MCH)-静脉血: 29.3pg；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 134g/L；红细胞比容(Hct)-静脉血: 41.3%；血小板比容-静脉血: 13%；平均红细胞体积(MCV)-静脉血: 90.4fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；平均血小板体积(MPV)-静脉血: 9.4fL；血小板计数(PLT#)-静脉血: 13810E9/L；中性粒细胞计数(Neut#)-静脉血: 410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 324g/L；血小板分布宽度(PDW)-静脉血: 9.9%；大血小板百分比(P-LCR%)-静脉血: 21.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.255；单核细胞计数(Mono#)-静脉血: 0.410E9/L；红细胞计数(RBC#)-静脉血: 4.5710E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.2\n- [全程D27] 检验组合: 红细胞计数(RBC#)-静脉血: 4.3410E12/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.85mmol/L；血小板计数(PLT#)-静脉血: 255.510E9/L；白细胞计数(WBC#)-静脉血: 6.210E9/L；氯离子(Cl-)-静脉血: 104.9mmol/L；总胆汁酸(TBA)-静脉血: 1umol/L；肌酐(Crea)-静脉血: 96.8umol/L；钾离子(K+)-静脉血: 4.5mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.386；乳酸脱氢酶(LDH)-静脉血: 212.1U/L；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.33mmolL；淋巴细胞计数(Lymph#)-静脉血: 2.410E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21U/L；平均红细胞体积(MCV)-静脉血: 90.1fL；总蛋白(TP)-静脉血: 70.21g/L；丙氨酸氨基转移酶(ALT)-静脉血: 19.6U/L；间接胆红素(IBIL)-静脉血: 4.6umolL；尿酸(UA)-静脉血: 469.1umol/L；血小板比容-静脉血: 15.3%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；甘油三酯(TG)-静脉血: 1.12mmol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白B(apoB)-静脉血: 0.9g/L；平均血小板体积(MPV)-静脉血: 6.02fL；总钙(Ca)-静脉血: 2.25mmol/L；单核细胞百分比(Mono%)-静脉血: 0.066；红细胞比容(Hct)-静脉血: 39.1%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；γ-谷氨酰基转移酶(GGT)-静脉血: 25.5U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.7pg；尿素氮(BUN)-静脉血: 4.22mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341.2g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；中性粒细胞计数(Neut#)-静脉血: 3.310E9/L；有核红细胞计数(NRBC#)-静脉血: 010E……\n- [全程D33] 检验组合: 尿素氮(BUN)-静脉血: 3.5mmol/L；直接胆红素(DBIL)-静脉血: 9umol/L；红细胞计数(RBC#)-静脉血: 3.8710E12/L；球蛋白(GLO)-静脉血: 27.06g/L；总胆红素(TBIL)-静脉血: 28.4umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.08mmolL；钾离子(K+)-静脉血: 3.68mmol/L；钠离子(Na+)-静脉血: 140.7mmol/L；肌酐(Crea)-静脉血: 71.4umol/L；红细胞比容(Hct)-静脉血: 34.5%；血小板比容-静脉血: 13.9%；总胆固醇(TC)-静脉血: 3.79mmol/L；磷(P)-静脉血: 1.21mmol/L；阴离子间隙(AG)-静脉血: 14.8；C-反应蛋白(CRP)-静脉血: 15.32mg/L；有核红细胞百分比(NRBC%)-静脉血: 0；乳酸脱氢酶(LDH)-静脉血: 214.8U/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15.3U/L；间接胆红素(IBIL)-静脉血: 19.4umolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.21mmol/L；白蛋白(ALB)-静脉血: 36.4g/L；总钙(Ca)-静脉血: 2.01mmol/L；载脂蛋白B(apoB)-静脉血: 0.79g/L；中性粒细胞计数(Neut#)-静脉血: 3.210E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.308；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.02；平均红细胞血红蛋白含量(MCH)-静脉血: 30.6pg；载脂蛋白AI(apoAI)-静脉血: 1.04g/L；尿酸(UA)-静脉血: 290.1umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.35；平均红细胞体积(MCV)-静脉血: 89.1fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；碱性磷酸酶(ALP)-静脉血: 60.5U/L；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；血小板计数(PLT#)-静脉血: 230.610E9/L；γ-谷氨酰基转移酶(GGT)-静……\n- [全程D36] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后，与某次就诊时间片对比， 鼻咽腔狭窄，鼻咽左侧壁、顶壁及后壁增厚，见软组织灶形成，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，病灶占据左侧咽隐窝，向前堵塞左侧后鼻孔，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，右侧咽隐窝稍变浅，范围较前缩小，右侧咽旁脂肪间隙及颈动脉鞘区未见异常。 左侧腭帆提肌、双侧头长肌受侵。 双侧翼腭窝、咀嚼肌间隙未见明显异常；口咽各壁无受累增厚。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部骨质破坏。双侧海绵窦形态正常，未见增宽。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。蝶鞍形态正常，其内未见占位性病变。 双侧上颌窦、蝶窦、筛窦、左侧乳突粘膜增厚，见不等量分泌物，右侧乳突气化好，骨壁完整。 左侧咽后间隙见小淋巴结，短径约4mm，较前未见明显变化。 双颈II区见肿大淋巴结，较大者短径约22mm，较前稍缩小。 左颈III、V区见多发小淋巴结，边界清，信号均匀，较大者短径约7mm，较前未见明显变化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。 喉咽腔形态正常，未见占位性病变。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗后，鼻咽肿物较前缩小。 颅底骨质破坏。 左侧咽后小淋巴结，较前未见明显变化。 双颈II区淋巴结肿大，较前稍缩小。 左颈III、V区多发小淋巴结，较前未见明显变化。 副鼻窦炎、左侧乳突炎。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+洛铂方案诱导化疗结束，诉呕吐1次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程5-FU+洛铂方案诱导化疗结束，无诉特殊不适，可予出院，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n- [全程D28] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，可于今日执行第2程5-FU+洛铂方案诱导化疗，注意化疗不良反应。\n- [全程D29] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+洛铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D34] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+洛铂方案诱导化疗结束，诉恶心、食欲下降，无发热、呕吐、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规示轻度贫血，肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第2程5-FU+洛铂方案诱导化疗结束，无诉特殊不适，血象提示轻度贫血，予铁剂口服等纠正贫血治疗，下周及时监测血常规、肝肾功能，备行同时期放化疗+靶向治疗。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 疗效评估为部分缓解（PR），启动靶向治疗（西妥昔单抗）联合同期放化疗\nB. 疗效评估为部分缓解（PR），启动靶向治疗（尼妥珠单抗）联合同期放化疗\nC. 疗效评估为部分缓解（PR），继续原方案（洛铂+5-FU）第3程诱导化疗\nD. 疗效评估为部分缓解（PR），启动同期放化疗，暂不联合靶向治疗\nE. 疗效评估为疾病稳定（SD），启动免疫治疗（卡瑞利珠单抗）联合同期放化疗\nF. 疗效评估为疾病进展（PD），更改化疗方案为吉西他滨+顺铂诱导化疗\nG. 疗效评估为部分缓解（PR），行鼻咽及颈部根治性放疗，不联合全身治疗\nH. 疗效评估为部分缓解（PR），暂停抗肿瘤治疗，单纯行纠正贫血支持治疗\nI. 疗效评估为部分缓解（PR），行双侧颈部淋巴结清扫术，术后辅助放疗\nJ. 疗效评估为完全缓解（CR），启动靶向治疗（西妥昔单抗）联合同期放化疗\nK. 疗效评估为部分缓解（PR），启动靶向治疗（贝伐珠单抗）联合同期放化疗\nL. 疗效评估为部分缓解（PR），启动免疫治疗（帕博利珠单抗）联合同期放化疗\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左颈肿物20余天；现病史: 20余天前患者无明显诱因自觉左颈肿物，无发热、疼痛，伴涕血、左耳堵塞感。无头痛、面麻、鼻塞、复视、张口困难等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左耳闷胀感,涕血,左颈肿物；既往史: 高血压10余年，规律服药，血压控制在130/80mmHg左右。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:穿山甲壳、蜂蛹、伟哥过敏。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 大儿子患“脑胶质瘤”，已病逝。；体格检查: T：36.4℃，P：66次/分，R：20次/分，BP：134/81mmHg,Ht：175cm，Wt：84kg，BSA：2.0m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽顶后壁、左侧壁结节状肿物；双侧颈部II区可扪及1个淋巴结，最大径6×5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 ST-T轻度改变\n- [全程D1] 检验组合: 梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；有核红细胞计数(NRBC#)-静脉血: 010E9/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；单核细胞计数(Mono#)-静脉血: 0.510E9/L；胱抑素(Cys-C)-静脉血: 0.76mg/L；磷(P)-静脉血: 1.12mmol/L；纤维蛋白原(Fbg)-静脉血: 3.32g/L；Rh血型-静脉血: 阳性；血红蛋白(Hb)-静脉血: 136.2g/L；ABO血型-静脉血: O；骨钙素N端中分子片段(N-MID)-静脉血: 14.08ng/ml；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；直接胆红素(DBIL)-静脉血: 3.1umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 28.5U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；中性粒细胞百分比(Neut%)-静脉血: 0.617；镁离子(Mg2+)-静脉血: 0.88mmol/L；白细胞计数(WBC#)-静脉血: 7.0810E9/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 26.4U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.295ng/ml（参考: <0.704）；凝血酶原时间活动度(PTA)-静脉血: 120%；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.9mmol/L；血小板比容-静脉血: 18.3%；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.05S/CO；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.23mmolL；平均红细胞血红蛋白含量(MCH)-静脉血: 30pg；单核细胞百分比(Mono%)-静脉血: 0.072；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；总蛋白(TP)-静脉血: 71.09g/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40……\n- [全程D3] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及左侧壁粘膜增厚放射性浓聚，SUV约14.5，病灶累及蝶骨基底部、枕骨斜坡、左侧翼突、左岩尖、左侧破裂孔及左侧鼻后孔。双侧咽隐窝消失。双侧咽后未见明显肿大淋巴结及异常放射性分布。口咽及喉咽结构及放射性分布未见明显异常。左侧上颌窦及蝶窦内见低密度影放射性分布未见明显异常，额窦、筛窦及右侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双颈Ⅱ区多发肿大淋巴结放射性浓聚，SUV约14.2，最大约2.2×2.6cm。 双侧苍白球钙化放射性分布缺损，余所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。左肾盂小结石放射性分布缺损。脾脏、胰腺、右肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺小点状钙化灶。余盆腔放射性分布均匀，膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 所见颅盖骨、余躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽顶壁、顶后壁及左侧壁粘膜增厚代谢活跃，考虑鼻咽癌，病灶累及颅底骨、左侧破裂孔及左侧鼻后孔；双颈Ⅱ区多发肿大淋巴结代谢活跃，考虑转移。 左侧上颌窦及蝶窦炎症。 左肾盂小结石。 前列腺钙化。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D6] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽左侧壁、顶壁及后壁增厚，见软组织灶形成，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，病灶占据左侧咽隐窝，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，右侧咽隐窝稍变浅，右侧咽旁脂肪间隙及颈动脉鞘区未见异常； 左侧腭帆提肌、双侧头长肌直接受侵；病灶累及左侧破裂孔、左侧后鼻孔； 双侧侧翼腭窝、颞下窝未见异常；口咽各壁无受累增厚。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部骨质破坏。 双侧海绵窦形态正常，未见增宽。 左侧上颌窦、蝶窦、左侧乳突粘膜稍增厚，双侧筛窦、右侧乳突气化好，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 左侧咽后间隙见小淋巴结，短径约4mm；双颈II区见肿大淋巴结，较大者短径约25mm；左颈III、V区见多发淋巴结，边界清，信号均匀，较大者短径约7mm。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 考虑鼻咽癌可能性大。 颅底骨质破坏。 左侧咽后小淋巴结。 双颈II区淋巴结肿大。\n- [全程D6] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T7上缘水平，估计导管末端位于上腔静脉下段内。；检查结论: PICC管末端位置如上述。\n- [全程D6] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 28mm AO 29mm MV E 0.51m/s EF 73% LV 49mm IVS 9mm A 0.73m/s FS 42% RA 28mm LVPW 10mm RV 18mm PA 20mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 心脏结构及运动未见异常 各房室腔及大血管未探及异常血流信号 左室舒张功能减低，收缩功能正常\n- [全程D13] 检验组合: 镁离子(Mg2+)-静脉血: 0.89mmol/L；总胆红素(TBIL)-静脉血: 13.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 23.7U/L；丙氨酸氨基转移酶(ALT)-静脉血: 21.4U/L；总钙(Ca)-静脉血: 2.2mmol/L；氯离子(Cl-)-静脉血: 104mmol/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；直接胆红素(DBIL)-静脉血: 5umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6；红细胞比容(Hct)-静脉血: 38.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.358；间接胆红素(IBIL)-静脉血: 8.3umolL；平均红细胞体积(MCV)-静脉血: 87.1fL；载脂蛋白AI(apoAI)-静脉血: 1.11g/L；球蛋白(GLO)-静脉血: 29.01g/L；C-反应蛋白(CRP)-静脉血: 13.69mg/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；白细胞计数(WBC#)-静脉血: 4.8310E9/L；碱性磷酸酶(ALP)-静脉血: 70.4U/L；血小板比容-静脉血: 18%；载脂蛋白B(apoB)-静脉血: 0.67g/L；中性粒细胞百分比(Neut%)-静脉血: 0.566；淋巴细胞计数(Lymph#)-静脉血: 1.710E9/L；钾离子(K+)-静脉血: 4.1mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；乳酸脱氢酶(LDH)-静脉血: 203.5U/L；阴离子间隙(AG)-静脉血: 14；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；甘油三酯(TG)-静脉血: 1.28mmol/L；红细胞计数(RBC#)-静脉血: 4.4310E12/L；血小板分布宽度(PDW)-静脉血: 8.5%；单核细胞百分比(Mono%)-静脉血: 0.058；大血小板百分比(P-LCR%)-静脉血: 11.6%；血液二氧化碳含量ctCO2(B)-静脉血: 25.1mmol/L；白蛋白(ALB)-静脉血: 40.2g/L；尿素氮(BUN)-静脉血: 5.8mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.3U/L；尿酸(UA)-静脉血: 378.8umol/L；总胆固醇(TC)-……\n- [全程D21] 检验组合: 单核细胞百分比(Mono%)-静脉血: 0.062；中性粒细胞百分比(Neut%)-静脉血: 0.67；白细胞计数(WBC#)-静脉血: 5.9710E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.9；平均红细胞血红蛋白含量(MCH)-静脉血: 29.3pg；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 134g/L；红细胞比容(Hct)-静脉血: 41.3%；血小板比容-静脉血: 13%；平均红细胞体积(MCV)-静脉血: 90.4fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；平均血小板体积(MPV)-静脉血: 9.4fL；血小板计数(PLT#)-静脉血: 13810E9/L；中性粒细胞计数(Neut#)-静脉血: 410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 324g/L；血小板分布宽度(PDW)-静脉血: 9.9%；大血小板百分比(P-LCR%)-静脉血: 21.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.255；单核细胞计数(Mono#)-静脉血: 0.410E9/L；红细胞计数(RBC#)-静脉血: 4.5710E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.2\n- [全程D27] 检验组合: 红细胞计数(RBC#)-静脉血: 4.3410E12/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.85mmol/L；血小板计数(PLT#)-静脉血: 255.510E9/L；白细胞计数(WBC#)-静脉血: 6.210E9/L；氯离子(Cl-)-静脉血: 104.9mmol/L；总胆汁酸(TBA)-静脉血: 1umol/L；肌酐(Crea)-静脉血: 96.8umol/L；钾离子(K+)-静脉血: 4.5mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.386；乳酸脱氢酶(LDH)-静脉血: 212.1U/L；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.33mmolL；淋巴细胞计数(Lymph#)-静脉血: 2.410E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21U/L；平均红细胞体积(MCV)-静脉血: 90.1fL；总蛋白(TP)-静脉血: 70.21g/L；丙氨酸氨基转移酶(ALT)-静脉血: 19.6U/L；间接胆红素(IBIL)-静脉血: 4.6umolL；尿酸(UA)-静脉血: 469.1umol/L；血小板比容-静脉血: 15.3%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；甘油三酯(TG)-静脉血: 1.12mmol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白B(apoB)-静脉血: 0.9g/L；平均血小板体积(MPV)-静脉血: 6.02fL；总钙(Ca)-静脉血: 2.25mmol/L；单核细胞百分比(Mono%)-静脉血: 0.066；红细胞比容(Hct)-静脉血: 39.1%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；γ-谷氨酰基转移酶(GGT)-静脉血: 25.5U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.7pg；尿素氮(BUN)-静脉血: 4.22mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341.2g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；中性粒细胞计数(Neut#)-静脉血: 3.310E9/L；有核红细胞计数(NRBC#)-静脉血: 010E……\n- [全程D33] 检验组合: 尿素氮(BUN)-静脉血: 3.5mmol/L；直接胆红素(DBIL)-静脉血: 9umol/L；红细胞计数(RBC#)-静脉血: 3.8710E12/L；球蛋白(GLO)-静脉血: 27.06g/L；总胆红素(TBIL)-静脉血: 28.4umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.08mmolL；钾离子(K+)-静脉血: 3.68mmol/L；钠离子(Na+)-静脉血: 140.7mmol/L；肌酐(Crea)-静脉血: 71.4umol/L；红细胞比容(Hct)-静脉血: 34.5%；血小板比容-静脉血: 13.9%；总胆固醇(TC)-静脉血: 3.79mmol/L；磷(P)-静脉血: 1.21mmol/L；阴离子间隙(AG)-静脉血: 14.8；C-反应蛋白(CRP)-静脉血: 15.32mg/L；有核红细胞百分比(NRBC%)-静脉血: 0；乳酸脱氢酶(LDH)-静脉血: 214.8U/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15.3U/L；间接胆红素(IBIL)-静脉血: 19.4umolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.21mmol/L；白蛋白(ALB)-静脉血: 36.4g/L；总钙(Ca)-静脉血: 2.01mmol/L；载脂蛋白B(apoB)-静脉血: 0.79g/L；中性粒细胞计数(Neut#)-静脉血: 3.210E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.308；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.02；平均红细胞血红蛋白含量(MCH)-静脉血: 30.6pg；载脂蛋白AI(apoAI)-静脉血: 1.04g/L；尿酸(UA)-静脉血: 290.1umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.35；平均红细胞体积(MCV)-静脉血: 89.1fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；碱性磷酸酶(ALP)-静脉血: 60.5U/L；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；血小板计数(PLT#)-静脉血: 230.610E9/L；γ-谷氨酰基转移酶(GGT)-静……\n- [全程D36] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后，与某次就诊时间片对比， 鼻咽腔狭窄，鼻咽左侧壁、顶壁及后壁增厚，见软组织灶形成，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，病灶占据左侧咽隐窝，向前堵塞左侧后鼻孔，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，右侧咽隐窝稍变浅，范围较前缩小，右侧咽旁脂肪间隙及颈动脉鞘区未见异常。 左侧腭帆提肌、双侧头长肌受侵。 双侧翼腭窝、咀嚼肌间隙未见明显异常；口咽各壁无受累增厚。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部骨质破坏。双侧海绵窦形态正常，未见增宽。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。蝶鞍形态正常，其内未见占位性病变。 双侧上颌窦、蝶窦、筛窦、左侧乳突粘膜增厚，见不等量分泌物，右侧乳突气化好，骨壁完整。 左侧咽后间隙见小淋巴结，短径约4mm，较前未见明显变化。 双颈II区见肿大淋巴结，较大者短径约22mm，较前稍缩小。 左颈III、V区见多发小淋巴结，边界清，信号均匀，较大者短径约7mm，较前未见明显变化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。 喉咽腔形态正常，未见占位性病变。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗后，鼻咽肿物较前缩小。 颅底骨质破坏。 左侧咽后小淋巴结，较前未见明显变化。 双颈II区淋巴结肿大，较前稍缩小。 左颈III、V区多发小淋巴结，较前未见明显变化。 副鼻窦炎、左侧乳突炎。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+洛铂方案诱导化疗结束，诉呕吐1次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程5-FU+洛铂方案诱导化疗结束，无诉特殊不适，可予出院，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n- [全程D28] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，可于今日执行第2程5-FU+洛铂方案诱导化疗，注意化疗不良反应。\n- [全程D29] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+洛铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D34] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+洛铂方案诱导化疗结束，诉恶心、食欲下降，无发热、呕吐、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规示轻度贫血，肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第2程5-FU+洛铂方案诱导化疗结束，无诉特殊不适，血象提示轻度贫血，予铁剂口服等纠正贫血治疗，下周及时监测血常规、肝肾功能，备行同时期放化疗+靶向治疗。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 疗效评估为部分缓解（PR），启动靶向治疗（西妥昔单抗）联合同期放化疗\nB. 疗效评估为部分缓解（PR），启动靶向治疗（尼妥珠单抗）联合同期放化疗\nC. 疗效评估为部分缓解（PR），继续原方案（洛铂+5-FU）第3程诱导化疗\nD. 疗效评估为部分缓解（PR），启动同期放化疗，暂不联合靶向治疗\nE. 疗效评估为疾病稳定（SD），启动免疫治疗（卡瑞利珠单抗）联合同期放化疗\nF. 疗效评估为疾病进展（PD），更改化疗方案为吉西他滨+顺铂诱导化疗\nG. 疗效评估为部分缓解（PR），行鼻咽及颈部根治性放疗，不联合全身治疗\nH. 疗效评估为部分缓解（PR），暂停抗肿瘤治疗，单纯行纠正贫血支持治疗\nI. 疗效评估为部分缓解（PR），行双侧颈部淋巴结清扫术，术后辅助放疗\nJ. 疗效评估为完全缓解（CR），启动靶向治疗（西妥昔单抗）联合同期放化疗\nK. 疗效评估为部分缓解（PR），启动靶向治疗（贝伐珠单抗）联合同期放化疗\nL. 疗效评估为部分缓解（PR），启动免疫治疗（帕博利珠单抗）联合同期放化疗\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-8b39359cc6c7b630fd005591","patient_id":"patient-f402aced5926698da3194c37","turn_id":"turn08","turn_position":6,"turn_type":"response_assessment_decision","gold_letter":"B","gold_action":"确认腹部彩超无转移，继续门诊放疗，左肾结石暂予观察，并予乳果糖口服液。","options":[{"letter":"A","text":"确认腹部彩超无转移，暂停放疗，请泌尿外科会诊行左肾结石碎石治疗，并予乳果糖口服液。","is_gold":false},{"letter":"B","text":"确认腹部彩超无转移，继续门诊放疗，左肾结石暂予观察，并予乳果糖口服液。","is_gold":true},{"letter":"C","text":"确认腹部彩超无转移，继续门诊放疗，左肾结石暂予观察，并加用洛铂行第3程同期化疗。","is_gold":false},{"letter":"D","text":"确认腹部彩超无转移，暂停门诊放疗，复查鼻咽及颈部MRI评估局部疗效，并予乳果糖口服液。","is_gold":false},{"letter":"E","text":"确认腹部彩超无转移，继续门诊放疗，对左肾结石予排石颗粒，并加用西妥昔单抗靶向治疗。","is_gold":false},{"letter":"F","text":"确认腹部彩超无转移，终止放疗，左肾结石暂予观察，转入康复科行便秘治疗。","is_gold":false},{"letter":"G","text":"确认腹部彩超无转移，继续门诊放疗，对左肾结石予留置双J管，并予乳果糖口服液。","is_gold":false},{"letter":"H","text":"确认腹部彩超无转移，暂停门诊放疗，予温肥皂水灌肠处理便秘，左肾结石暂予观察。","is_gold":false},{"letter":"I","text":"确认腹部彩超无转移，继续门诊放疗，左肾结石暂予观察，并予洛哌丁胺口服。","is_gold":false},{"letter":"J","text":"确认腹部彩超无转移，继续门诊放疗，左肾结石暂予观察，并予开塞露联合新斯的明肌注。","is_gold":false},{"letter":"K","text":"确认腹部彩超无转移，暂停门诊放疗，行全身PET-CT评估疗效，左肾结石暂予观察。","is_gold":false},{"letter":"L","text":"确认腹部彩超无转移，继续门诊放疗，行体外冲击波碎石，处理左肾结石，并予乳果糖口服液。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左颈肿物20余天；现病史: 20余天前患者无明显诱因自觉左颈肿物，无发热、疼痛，伴涕血、左耳堵塞感。无头痛、面麻、鼻塞、复视、张口困难等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左耳闷胀感,涕血,左颈肿物；既往史: 高血压10余年，规律服药，血压控制在130/80mmHg左右。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:穿山甲壳、蜂蛹、伟哥过敏。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 大儿子患“脑胶质瘤”，已病逝。；体格检查: T：36.4℃，P：66次/分，R：20次/分，BP：134/81mmHg,Ht：175cm，Wt：84kg，BSA：2.0m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽顶后壁、左侧壁结节状肿物；双侧颈部II区可扪及1个淋巴结，最大径6×5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 ST-T轻度改变\n- [全程D1] 检验组合: 梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；有核红细胞计数(NRBC#)-静脉血: 010E9/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；单核细胞计数(Mono#)-静脉血: 0.510E9/L；胱抑素(Cys-C)-静脉血: 0.76mg/L；磷(P)-静脉血: 1.12mmol/L；纤维蛋白原(Fbg)-静脉血: 3.32g/L；Rh血型-静脉血: 阳性；血红蛋白(Hb)-静脉血: 136.2g/L；ABO血型-静脉血: O；骨钙素N端中分子片段(N-MID)-静脉血: 14.08ng/ml；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；直接胆红素(DBIL)-静脉血: 3.1umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 28.5U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；中性粒细胞百分比(Neut%)-静脉血: 0.617；镁离子(Mg2+)-静脉血: 0.88mmol/L；白细胞计数(WBC#)-静脉血: 7.0810E9/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 26.4U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.295ng/ml（参考: <0.704）；凝血酶原时间活动度(PTA)-静脉血: 120%；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.9mmol/L；血小板比容-静脉血: 18.3%；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.05S/CO；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.23mmolL；平均红细胞血红蛋白含量(MCH)-静脉血: 30pg；单核细胞百分比(Mono%)-静脉血: 0.072；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；总蛋白(TP)-静脉血: 71.09g/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40……\n- [全程D3] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及左侧壁粘膜增厚放射性浓聚，SUV约14.5，病灶累及蝶骨基底部、枕骨斜坡、左侧翼突、左岩尖、左侧破裂孔及左侧鼻后孔。双侧咽隐窝消失。双侧咽后未见明显肿大淋巴结及异常放射性分布。口咽及喉咽结构及放射性分布未见明显异常。左侧上颌窦及蝶窦内见低密度影放射性分布未见明显异常，额窦、筛窦及右侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双颈Ⅱ区多发肿大淋巴结放射性浓聚，SUV约14.2，最大约2.2×2.6cm。 双侧苍白球钙化放射性分布缺损，余所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。左肾盂小结石放射性分布缺损。脾脏、胰腺、右肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺小点状钙化灶。余盆腔放射性分布均匀，膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 所见颅盖骨、余躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽顶壁、顶后壁及左侧壁粘膜增厚代谢活跃，考虑鼻咽癌，病灶累及颅底骨、左侧破裂孔及左侧鼻后孔；双颈Ⅱ区多发肿大淋巴结代谢活跃，考虑转移。 左侧上颌窦及蝶窦炎症。 左肾盂小结石。 前列腺钙化。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D6] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽左侧壁、顶壁及后壁增厚，见软组织灶形成，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，病灶占据左侧咽隐窝，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，右侧咽隐窝稍变浅，右侧咽旁脂肪间隙及颈动脉鞘区未见异常； 左侧腭帆提肌、双侧头长肌直接受侵；病灶累及左侧破裂孔、左侧后鼻孔； 双侧侧翼腭窝、颞下窝未见异常；口咽各壁无受累增厚。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部骨质破坏。 双侧海绵窦形态正常，未见增宽。 左侧上颌窦、蝶窦、左侧乳突粘膜稍增厚，双侧筛窦、右侧乳突气化好，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 左侧咽后间隙见小淋巴结，短径约4mm；双颈II区见肿大淋巴结，较大者短径约25mm；左颈III、V区见多发淋巴结，边界清，信号均匀，较大者短径约7mm。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 考虑鼻咽癌可能性大。 颅底骨质破坏。 左侧咽后小淋巴结。 双颈II区淋巴结肿大。\n- [全程D6] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T7上缘水平，估计导管末端位于上腔静脉下段内。；检查结论: PICC管末端位置如上述。\n- [全程D6] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 28mm AO 29mm MV E 0.51m/s EF 73% LV 49mm IVS 9mm A 0.73m/s FS 42% RA 28mm LVPW 10mm RV 18mm PA 20mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 心脏结构及运动未见异常 各房室腔及大血管未探及异常血流信号 左室舒张功能减低，收缩功能正常\n- [全程D13] 检验组合: 镁离子(Mg2+)-静脉血: 0.89mmol/L；总胆红素(TBIL)-静脉血: 13.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 23.7U/L；丙氨酸氨基转移酶(ALT)-静脉血: 21.4U/L；总钙(Ca)-静脉血: 2.2mmol/L；氯离子(Cl-)-静脉血: 104mmol/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；直接胆红素(DBIL)-静脉血: 5umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6；红细胞比容(Hct)-静脉血: 38.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.358；间接胆红素(IBIL)-静脉血: 8.3umolL；平均红细胞体积(MCV)-静脉血: 87.1fL；载脂蛋白AI(apoAI)-静脉血: 1.11g/L；球蛋白(GLO)-静脉血: 29.01g/L；C-反应蛋白(CRP)-静脉血: 13.69mg/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；白细胞计数(WBC#)-静脉血: 4.8310E9/L；碱性磷酸酶(ALP)-静脉血: 70.4U/L；血小板比容-静脉血: 18%；载脂蛋白B(apoB)-静脉血: 0.67g/L；中性粒细胞百分比(Neut%)-静脉血: 0.566；淋巴细胞计数(Lymph#)-静脉血: 1.710E9/L；钾离子(K+)-静脉血: 4.1mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；乳酸脱氢酶(LDH)-静脉血: 203.5U/L；阴离子间隙(AG)-静脉血: 14；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；甘油三酯(TG)-静脉血: 1.28mmol/L；红细胞计数(RBC#)-静脉血: 4.4310E12/L；血小板分布宽度(PDW)-静脉血: 8.5%；单核细胞百分比(Mono%)-静脉血: 0.058；大血小板百分比(P-LCR%)-静脉血: 11.6%；血液二氧化碳含量ctCO2(B)-静脉血: 25.1mmol/L；白蛋白(ALB)-静脉血: 40.2g/L；尿素氮(BUN)-静脉血: 5.8mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.3U/L；尿酸(UA)-静脉血: 378.8umol/L；总胆固醇(TC)-……\n- [全程D21] 检验组合: 单核细胞百分比(Mono%)-静脉血: 0.062；中性粒细胞百分比(Neut%)-静脉血: 0.67；白细胞计数(WBC#)-静脉血: 5.9710E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.9；平均红细胞血红蛋白含量(MCH)-静脉血: 29.3pg；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 134g/L；红细胞比容(Hct)-静脉血: 41.3%；血小板比容-静脉血: 13%；平均红细胞体积(MCV)-静脉血: 90.4fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；平均血小板体积(MPV)-静脉血: 9.4fL；血小板计数(PLT#)-静脉血: 13810E9/L；中性粒细胞计数(Neut#)-静脉血: 410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 324g/L；血小板分布宽度(PDW)-静脉血: 9.9%；大血小板百分比(P-LCR%)-静脉血: 21.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.255；单核细胞计数(Mono#)-静脉血: 0.410E9/L；红细胞计数(RBC#)-静脉血: 4.5710E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.2\n- [全程D27] 检验组合: 红细胞计数(RBC#)-静脉血: 4.3410E12/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.85mmol/L；血小板计数(PLT#)-静脉血: 255.510E9/L；白细胞计数(WBC#)-静脉血: 6.210E9/L；氯离子(Cl-)-静脉血: 104.9mmol/L；总胆汁酸(TBA)-静脉血: 1umol/L；肌酐(Crea)-静脉血: 96.8umol/L；钾离子(K+)-静脉血: 4.5mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.386；乳酸脱氢酶(LDH)-静脉血: 212.1U/L；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.33mmolL；淋巴细胞计数(Lymph#)-静脉血: 2.410E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21U/L；平均红细胞体积(MCV)-静脉血: 90.1fL；总蛋白(TP)-静脉血: 70.21g/L；丙氨酸氨基转移酶(ALT)-静脉血: 19.6U/L；间接胆红素(IBIL)-静脉血: 4.6umolL；尿酸(UA)-静脉血: 469.1umol/L；血小板比容-静脉血: 15.3%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；甘油三酯(TG)-静脉血: 1.12mmol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白B(apoB)-静脉血: 0.9g/L；平均血小板体积(MPV)-静脉血: 6.02fL；总钙(Ca)-静脉血: 2.25mmol/L；单核细胞百分比(Mono%)-静脉血: 0.066；红细胞比容(Hct)-静脉血: 39.1%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；γ-谷氨酰基转移酶(GGT)-静脉血: 25.5U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.7pg；尿素氮(BUN)-静脉血: 4.22mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341.2g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；中性粒细胞计数(Neut#)-静脉血: 3.310E9/L；有核红细胞计数(NRBC#)-静脉血: 010E……\n- [全程D33] 检验组合: 尿素氮(BUN)-静脉血: 3.5mmol/L；直接胆红素(DBIL)-静脉血: 9umol/L；红细胞计数(RBC#)-静脉血: 3.8710E12/L；球蛋白(GLO)-静脉血: 27.06g/L；总胆红素(TBIL)-静脉血: 28.4umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.08mmolL；钾离子(K+)-静脉血: 3.68mmol/L；钠离子(Na+)-静脉血: 140.7mmol/L；肌酐(Crea)-静脉血: 71.4umol/L；红细胞比容(Hct)-静脉血: 34.5%；血小板比容-静脉血: 13.9%；总胆固醇(TC)-静脉血: 3.79mmol/L；磷(P)-静脉血: 1.21mmol/L；阴离子间隙(AG)-静脉血: 14.8；C-反应蛋白(CRP)-静脉血: 15.32mg/L；有核红细胞百分比(NRBC%)-静脉血: 0；乳酸脱氢酶(LDH)-静脉血: 214.8U/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15.3U/L；间接胆红素(IBIL)-静脉血: 19.4umolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.21mmol/L；白蛋白(ALB)-静脉血: 36.4g/L；总钙(Ca)-静脉血: 2.01mmol/L；载脂蛋白B(apoB)-静脉血: 0.79g/L；中性粒细胞计数(Neut#)-静脉血: 3.210E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.308；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.02；平均红细胞血红蛋白含量(MCH)-静脉血: 30.6pg；载脂蛋白AI(apoAI)-静脉血: 1.04g/L；尿酸(UA)-静脉血: 290.1umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.35；平均红细胞体积(MCV)-静脉血: 89.1fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；碱性磷酸酶(ALP)-静脉血: 60.5U/L；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；血小板计数(PLT#)-静脉血: 230.610E9/L；γ-谷氨酰基转移酶(GGT)-静……\n- [全程D36] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后，与某次就诊时间片对比， 鼻咽腔狭窄，鼻咽左侧壁、顶壁及后壁增厚，见软组织灶形成，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，病灶占据左侧咽隐窝，向前堵塞左侧后鼻孔，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，右侧咽隐窝稍变浅，范围较前缩小，右侧咽旁脂肪间隙及颈动脉鞘区未见异常。 左侧腭帆提肌、双侧头长肌受侵。 双侧翼腭窝、咀嚼肌间隙未见明显异常；口咽各壁无受累增厚。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部骨质破坏。双侧海绵窦形态正常，未见增宽。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。蝶鞍形态正常，其内未见占位性病变。 双侧上颌窦、蝶窦、筛窦、左侧乳突粘膜增厚，见不等量分泌物，右侧乳突气化好，骨壁完整。 左侧咽后间隙见小淋巴结，短径约4mm，较前未见明显变化。 双颈II区见肿大淋巴结，较大者短径约22mm，较前稍缩小。 左颈III、V区见多发小淋巴结，边界清，信号均匀，较大者短径约7mm，较前未见明显变化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。 喉咽腔形态正常，未见占位性病变。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗后，鼻咽肿物较前缩小。 颅底骨质破坏。 左侧咽后小淋巴结，较前未见明显变化。 双颈II区淋巴结肿大，较前稍缩小。 左颈III、V区多发小淋巴结，较前未见明显变化。 副鼻窦炎、左侧乳突炎。\n- [全程D58] 检验组合: 红细胞比容(Hct)-静脉血: 34.3%；载脂蛋白B(apoB)-静脉血: 0.73g/L；碱性磷酸酶(ALP)-静脉血: 76U/L；肌酐(Crea)-静脉血: 67.8umol/L；胱抑素(Cys-C)-静脉血: 0.64mg/L；中性粒细胞百分比(Neut%)-静脉血: 0.768；血红蛋白(Hb)-静脉血: 116g/L；平均血小板体积(MPV)-静脉血: 8.4fL；总胆红素(TBIL)-静脉血: 15.8umol/L；尿素氮(BUN)-静脉血: 3.79mmol/L；镁离子(Mg2+)-静脉血: 0.9mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 22.5U/L；钾离子(K+)-静脉血: 3.6mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 16U/L；直接胆红素(DBIL)-静脉血: 6.5umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.5mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.5；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.7；白蛋白(ALB)-静脉血: 35.4g/L；钠离子(Na+)-静脉血: 138.1mmol/L；总钙(Ca)-静脉血: 2.12mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.08mmolL；磷(P)-静脉血: 1.18mmol/L；C-反应蛋白(CRP)-静脉血: 30.45mg/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.005；总胆汁酸(TBA)-静脉血: 1.6umol/L；乳酸脱氢酶(LDH)-静脉血: 175.3U/L；甘油三酯(TG)-静脉血: 0.98mmol/L；红细胞计数(RBC#)-静脉血: 3.8810E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血小板比容-静脉血: 13%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.28mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.04g/L；间接胆红素(IBIL)-静脉血: 9.3umolL；平均红细胞血红蛋白含量(MCH)-静脉血: 29.9pg；氯离子(Cl-)-静脉血: 102.7mmol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L……\n- [全程D65] 检验组合: 钾离子(K+)-静脉血: 3.65mmol/L；总胆固醇(TC)-静脉血: 3.47mmol/L；阴离子间隙(AG)-静脉血: 9.1；磷(P)-静脉血: 1.16mmol/L；间接胆红素(IBIL)-静脉血: 7.2umolL；总蛋白(TP)-静脉血: 66.88g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 14.2U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.07mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；红细胞比容(Hct)-静脉血: 35.8%；淋巴细胞百分比(Lymph%)-静脉血: 0.077；红细胞体积分布宽度CV(RDW-CV)-静脉血: 15.7%；丙氨酸氨基转移酶(ALT)-静脉血: 15.7U/L；钠离子(Na+)-静脉血: 141.1mmol/L；乳酸脱氢酶(LDH)-静脉血: 147.8U/L；C-反应蛋白(CRP)-静脉血: 23.42mg/L；甘油三酯(TG)-静脉血: 1.16mmol/L；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；血小板分布宽度(PDW)-静脉血: 17.3%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；肌酐(Crea)-静脉血: 62.8umol/L；镁离子(Mg2+)-静脉血: 0.8mmol/L；总胆红素(TBIL)-静脉血: 12.5umol/L；淋巴细胞计数(Lymph#)-静脉血: 0.410E9/L；直接胆红素(DBIL)-静脉血: 5.3umol/L；球蛋白(GLO)-静脉血: 30.38g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；尿素氮(BUN)-静脉血: 3.1mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 35.9U/L；载脂蛋白AI(apoAI)-静脉血: 0.9g/L；白蛋白(ALB)-静脉血: 36.5g/L；血红蛋白(Hb)-静脉血: 118.5g/L；载脂蛋白B(apoB)-静脉血: 0.74g/L；白细胞计数(WBC#)-静脉血: 4.5110E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 18.3U/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血……\n- [全程D72] 检验组合: 磷(P)-静脉血: 1.31mmol/L；总钙(Ca)-静脉血: 2.11mmol/L；总胆红素(TBIL)-静脉血: 12umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.745；镁离子(Mg2+)-静脉血: 0.8mmol/L；总蛋白(TP)-静脉血: 65.97g/L；单核细胞百分比(Mono%)-静脉血: 0.132；血小板计数(PLT#)-静脉血: 17910E9/L；球蛋白(GLO)-静脉血: 33.37g/L；尿素氮(BUN)-静脉血: 3.82mmol/L；尿酸(UA)-静脉血: 232.9umol/L；间接胆红素(IBIL)-静脉血: 6.9umolL；中性粒细胞计数(Neut#)-静脉血: 2.510E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.9；氯离子(Cl-)-静脉血: 105mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.6；血小板比容-静脉血: 15%；平均红细胞血红蛋白含量(MCH)-静脉血: 29.2pg；总胆固醇(TC)-静脉血: 3.73mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；载脂蛋白AI(apoAI)-静脉血: 0.88g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 36.1U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.026；胱抑素(Cys-C)-静脉血: 0.62mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.91mmolL；乳酸脱氢酶(LDH)-静脉血: 137U/L；肌酐(Crea)-静脉血: 68.5umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 87.7fL；血小板分布宽度(PDW)-静脉血: 7.4%；白蛋白(ALB)-静脉血: 32.6g/L；甘油三酯(TG)-静脉血: 0.96mmol/L；大血小板百分比(P-LCR%)-静脉血: 11.2%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15.9U/L；丙氨酸氨基转移酶(ALT)-静脉血: 17.3U/L；钠离子(Na+)-静脉血: 141.2mmol……\n- [全程D75] 检验组合: 白细胞计数(WBC#)-静脉血: 3.3210E9/L；血小板分布宽度(PDW)-静脉血: 7.9%；钾离子(K+)-静脉血: 3.4mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 18.6U/L；C-反应蛋白(CRP)-静脉血: 56.54mg/L；红细胞比容(Hct)-静脉血: 33.5%；单核细胞百分比(Mono%)-静脉血: 0.117；肌酐(Crea)-静脉血: 63.4umol/L；尿酸(UA)-静脉血: 304umol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；血小板比容-静脉血: 18%；α-L-岩藻糖苷酶(AFU)-静脉血: 22U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.72mmol/L；血小板计数(PLT#)-静脉血: 21110E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.9；中性粒细胞百分比(Neut%)-静脉血: 0.772；淋巴细胞百分比(Lymph%)-静脉血: 0.072；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；总钙(Ca)-静脉血: 2.12mmol/L；药物曲线下面积(AUC)-静脉血: 1；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；总胆固醇(TC)-静脉血: 4.15mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.88mmolL；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 16.7U/L；白蛋白(ALB)-静脉血: 33g/L；平均血小板体积(MPV)-静脉血: 8.3fL；总胆红素(TBIL)-静脉血: 13.6umol/L；磷(P)-静脉血: 1.15mmol/L；球蛋白(GLO)-静脉血: 33.66g/L；阴离子间隙(AG)-静脉血: 14；葡萄糖(Glu)-静脉血: 5.63mmol/L；载脂蛋白AI(apoAI)-静脉血: 0.81g/L；总胆汁酸(TBA)-静脉血: 1.4umol/L；间接胆红素(IBIL)-静脉血: 7.9umolL；尿素氮(BUN)-静脉血: 5.04mmol/L；胱抑素(Cys-C)-静脉血: 0.65mg/L；红细胞计数(RBC#)-静脉血: 3.8110E12/L；红细胞体积分布宽度……\n- [全程D86] 检验组合: 总胆汁酸(TBA)-静脉血: 1.6umol/L；直接胆红素(DBIL)-静脉血: 2.4umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 16U/L；C-反应蛋白(CRP)-静脉血: 15.4mg/L；淋巴细胞百分比(Lymph%)-静脉血: 0.142；总钙(Ca)-静脉血: 2.08mmol/L；阴离子间隙(AG)-静脉血: 10；丙氨酸氨基转移酶(ALT)-静脉血: 27.7U/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；白蛋白(ALB)-静脉血: 30.3g/L；钾离子(K+)-静脉血: 3.2mmol/L；葡萄糖(Glu)-静脉血: 5.56mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.27mmol/L；总胆固醇(TC)-静脉血: 3.75mmol/L；平均红细胞体积(MCV)-静脉血: 89.4fL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.83mmolL；肌酐(Crea)-静脉血: 72.9umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 53U/L；尿酸(UA)-静脉血: 338.6umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.9mmol/L；白细胞计数(WBC#)-静脉血: 2.610E9/L；钠离子(Na+)-静脉血: 140.5mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.4pg；单核细胞百分比(Mono%)-静脉血: 0.281；大血小板百分比(P-LCR%)-静脉血: 12.6%；载脂蛋白B(apoB)-静脉血: 0.76g/L；载脂蛋白AI(apoAI)-静脉血: 0.84g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.6U/L；间接胆红素(IBIL)-静脉血: 3umolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.7；甘油三酯(TG)-静脉血: 1.42mmol/L；磷(P)-静脉血: 1.4mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.8；碱性磷酸酶(ALP)-静脉血: 70.5U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；尿素氮……\n- [全程D88] 检验组合: 血红蛋白(Hb)-静脉血: 118g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.26；平均血小板体积(MPV)-静脉血: 8.5fL；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；红细胞比容(Hct)-静脉血: 35.8%；血小板比容-静脉血: 14%；血小板分布宽度(PDW)-静脉血: 7.6%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.7；平均红细胞体积(MCV)-静脉血: 90.4fL；血小板计数(PLT#)-静脉血: 16910E9/L；红细胞计数(RBC#)-静脉血: 3.9610E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.028；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；单核细胞百分比(Mono%)-静脉血: 0.097；大血小板百分比(P-LCR%)-静脉血: 14.3%；白细胞计数(WBC#)-静脉血: 2.8810E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.8pg；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.5；中性粒细胞计数(Neut#)-静脉血: 1.810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.612\n- [全程D93] 检验组合: 低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.82mmol/L；白蛋白(ALB)-静脉血: 37.8g/L；总胆红素(TBIL)-静脉血: 9.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 39.6U/L；胱抑素(Cys-C)-静脉血: 0.78mg/L；淋巴细胞百分比(Lymph%)-静脉血: 0.15；天门冬氨酸氨基转移酶(AST)-静脉血: 21.3U/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；尿酸(UA)-静脉血: 295.9umol/L；血小板比容-静脉血: 12.1%；中性粒细胞计数(Neut#)-静脉血: 2.410E9/L；氯离子(Cl-)-静脉血: 102mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.7mmol/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；阴离子间隙(AG)-静脉血: 13.1；钠离子(Na+)-静脉血: 142.8mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 16.1%；血小板分布宽度(PDW)-静脉血: 15.9%；红细胞比容(Hct)-静脉血: 36.4%；磷(P)-静脉血: 1.26mmol/L；直接胆红素(DBIL)-静脉血: 3.4umol/L；总蛋白(TP)-静脉血: 70.94g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；葡萄糖(Glu)-静脉血: 6.22mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.019；间接胆红素(IBIL)-静脉血: 5.9umolL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；载脂蛋白B(apoB)-静脉血: 0.94g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.11mmolL；总胆固醇(TC)-静脉血: 4.28mmol/L；碱性磷酸酶(ALP)-静脉血: 88.1U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.5pg；血小板计数(PLT#)-静脉血: 215.910E9/L；钾离子(K+)-静脉血: 3.96mmol/L；单核细胞百分比(Mono%)-静脉血: 0.146；平均血小板体积(MPV)-静脉血: 5.62fL；有核红细胞百分比(NRBC%)-静脉血:……\n- [全程D94] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约28cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，右肾实质回声均匀，未见明显异常回声。左肾下盏可见一强回声团，直径约6mm，边界清。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约28×25×25mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 左肾结石。 肝脏、胆囊、脾脏、胰腺、右肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+洛铂方案诱导化疗结束，诉呕吐1次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程5-FU+洛铂方案诱导化疗结束，无诉特殊不适，可予出院，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n- [全程D28] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，可于今日执行第2程5-FU+洛铂方案诱导化疗，注意化疗不良反应。\n- [全程D29] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+洛铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D34] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+洛铂方案诱导化疗结束，诉恶心、食欲下降，无发热、呕吐、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规示轻度贫血，肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第2程5-FU+洛铂方案诱导化疗结束，无诉特殊不适，血象提示轻度贫血，予铁剂口服等纠正贫血治疗，下周及时监测血常规、肝肾功能，备行同时期放化疗+靶向治疗。\n- [全程D64] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者放疗中，第4程爱必妥靶向治疗后3天，诉口感、咽痛、纳差。查体同前。[姓名已隐去]医生信息已隐藏：予喷喉、洗鼻、保护皮肤处理，加强营养，继续放疗。\n- [全程D69] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者放疗中，今日第5程爱必妥靶向治疗，诉头面部皮疹，口感、咽痛，余无明显不适。查体：头面部散在红疹，无脱皮、水泡，余同前。[姓名已隐去]医生信息已隐藏：予红外线治疗，喷喉、洗鼻、保护皮肤处理，加强营养，继续放疗。\n- [全程D74] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者放疗中，第2程洛铂方案同时期化疗结束，诉恶心、食欲下降，呕吐1次，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规示轻度贫血，肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第2程洛铂方案同时期化疗结束，诉恶心、呕吐，予止呕护胃处理，继续放疗。\n- [全程D78] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者2月18日至2月26日春节请假中。\n- [全程D88] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者放疗中，第6程爱必妥靶向治疗结束，诉头面部皮疹，口感、咽痛，余无明显不适。查体：头面部散在红疹，无脱皮、水泡，余同前。复查血常规、生化插管基本正常。[姓名已隐去]医生信息已隐藏：予喷喉、洗鼻、保护皮肤处理，加强营养，今日可办理出院，继续门诊放疗，按时间行复查。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 确认腹部彩超无转移，暂停放疗，请泌尿外科会诊行左肾结石碎石治疗，并予乳果糖口服液。\nB. 确认腹部彩超无转移，继续门诊放疗，左肾结石暂予观察，并予乳果糖口服液。\nC. 确认腹部彩超无转移，继续门诊放疗，左肾结石暂予观察，并加用洛铂行第3程同期化疗。\nD. 确认腹部彩超无转移，暂停门诊放疗，复查鼻咽及颈部MRI评估局部疗效，并予乳果糖口服液。\nE. 确认腹部彩超无转移，继续门诊放疗，对左肾结石予排石颗粒，并加用西妥昔单抗靶向治疗。\nF. 确认腹部彩超无转移，终止放疗，左肾结石暂予观察，转入康复科行便秘治疗。\nG. 确认腹部彩超无转移，继续门诊放疗，对左肾结石予留置双J管，并予乳果糖口服液。\nH. 确认腹部彩超无转移，暂停门诊放疗，予温肥皂水灌肠处理便秘，左肾结石暂予观察。\nI. 确认腹部彩超无转移，继续门诊放疗，左肾结石暂予观察，并予洛哌丁胺口服。\nJ. 确认腹部彩超无转移，继续门诊放疗，左肾结石暂予观察，并予开塞露联合新斯的明肌注。\nK. 确认腹部彩超无转移，暂停门诊放疗，行全身PET-CT评估疗效，左肾结石暂予观察。\nL. 确认腹部彩超无转移，继续门诊放疗，行体外冲击波碎石，处理左肾结石，并予乳果糖口服液。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左颈肿物20余天；现病史: 20余天前患者无明显诱因自觉左颈肿物，无发热、疼痛，伴涕血、左耳堵塞感。无头痛、面麻、鼻塞、复视、张口困难等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左耳闷胀感,涕血,左颈肿物；既往史: 高血压10余年，规律服药，血压控制在130/80mmHg左右。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:穿山甲壳、蜂蛹、伟哥过敏。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 大儿子患“脑胶质瘤”，已病逝。；体格检查: T：36.4℃，P：66次/分，R：20次/分，BP：134/81mmHg,Ht：175cm，Wt：84kg，BSA：2.0m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽顶后壁、左侧壁结节状肿物；双侧颈部II区可扪及1个淋巴结，最大径6×5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 ST-T轻度改变\n- [全程D1] 检验组合: 梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；有核红细胞计数(NRBC#)-静脉血: 010E9/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；单核细胞计数(Mono#)-静脉血: 0.510E9/L；胱抑素(Cys-C)-静脉血: 0.76mg/L；磷(P)-静脉血: 1.12mmol/L；纤维蛋白原(Fbg)-静脉血: 3.32g/L；Rh血型-静脉血: 阳性；血红蛋白(Hb)-静脉血: 136.2g/L；ABO血型-静脉血: O；骨钙素N端中分子片段(N-MID)-静脉血: 14.08ng/ml；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；直接胆红素(DBIL)-静脉血: 3.1umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 28.5U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；中性粒细胞百分比(Neut%)-静脉血: 0.617；镁离子(Mg2+)-静脉血: 0.88mmol/L；白细胞计数(WBC#)-静脉血: 7.0810E9/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 26.4U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.295ng/ml（参考: <0.704）；凝血酶原时间活动度(PTA)-静脉血: 120%；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.9mmol/L；血小板比容-静脉血: 18.3%；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.05S/CO；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.23mmolL；平均红细胞血红蛋白含量(MCH)-静脉血: 30pg；单核细胞百分比(Mono%)-静脉血: 0.072；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；总蛋白(TP)-静脉血: 71.09g/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40……\n- [全程D3] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及左侧壁粘膜增厚放射性浓聚，SUV约14.5，病灶累及蝶骨基底部、枕骨斜坡、左侧翼突、左岩尖、左侧破裂孔及左侧鼻后孔。双侧咽隐窝消失。双侧咽后未见明显肿大淋巴结及异常放射性分布。口咽及喉咽结构及放射性分布未见明显异常。左侧上颌窦及蝶窦内见低密度影放射性分布未见明显异常，额窦、筛窦及右侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双颈Ⅱ区多发肿大淋巴结放射性浓聚，SUV约14.2，最大约2.2×2.6cm。 双侧苍白球钙化放射性分布缺损，余所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。左肾盂小结石放射性分布缺损。脾脏、胰腺、右肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺小点状钙化灶。余盆腔放射性分布均匀，膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 所见颅盖骨、余躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽顶壁、顶后壁及左侧壁粘膜增厚代谢活跃，考虑鼻咽癌，病灶累及颅底骨、左侧破裂孔及左侧鼻后孔；双颈Ⅱ区多发肿大淋巴结代谢活跃，考虑转移。 左侧上颌窦及蝶窦炎症。 左肾盂小结石。 前列腺钙化。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D6] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽左侧壁、顶壁及后壁增厚，见软组织灶形成，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，病灶占据左侧咽隐窝，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，右侧咽隐窝稍变浅，右侧咽旁脂肪间隙及颈动脉鞘区未见异常； 左侧腭帆提肌、双侧头长肌直接受侵；病灶累及左侧破裂孔、左侧后鼻孔； 双侧侧翼腭窝、颞下窝未见异常；口咽各壁无受累增厚。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部骨质破坏。 双侧海绵窦形态正常，未见增宽。 左侧上颌窦、蝶窦、左侧乳突粘膜稍增厚，双侧筛窦、右侧乳突气化好，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 左侧咽后间隙见小淋巴结，短径约4mm；双颈II区见肿大淋巴结，较大者短径约25mm；左颈III、V区见多发淋巴结，边界清，信号均匀，较大者短径约7mm。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 考虑鼻咽癌可能性大。 颅底骨质破坏。 左侧咽后小淋巴结。 双颈II区淋巴结肿大。\n- [全程D6] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T7上缘水平，估计导管末端位于上腔静脉下段内。；检查结论: PICC管末端位置如上述。\n- [全程D6] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 28mm AO 29mm MV E 0.51m/s EF 73% LV 49mm IVS 9mm A 0.73m/s FS 42% RA 28mm LVPW 10mm RV 18mm PA 20mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 心脏结构及运动未见异常 各房室腔及大血管未探及异常血流信号 左室舒张功能减低，收缩功能正常\n- [全程D13] 检验组合: 镁离子(Mg2+)-静脉血: 0.89mmol/L；总胆红素(TBIL)-静脉血: 13.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 23.7U/L；丙氨酸氨基转移酶(ALT)-静脉血: 21.4U/L；总钙(Ca)-静脉血: 2.2mmol/L；氯离子(Cl-)-静脉血: 104mmol/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；直接胆红素(DBIL)-静脉血: 5umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6；红细胞比容(Hct)-静脉血: 38.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.358；间接胆红素(IBIL)-静脉血: 8.3umolL；平均红细胞体积(MCV)-静脉血: 87.1fL；载脂蛋白AI(apoAI)-静脉血: 1.11g/L；球蛋白(GLO)-静脉血: 29.01g/L；C-反应蛋白(CRP)-静脉血: 13.69mg/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；白细胞计数(WBC#)-静脉血: 4.8310E9/L；碱性磷酸酶(ALP)-静脉血: 70.4U/L；血小板比容-静脉血: 18%；载脂蛋白B(apoB)-静脉血: 0.67g/L；中性粒细胞百分比(Neut%)-静脉血: 0.566；淋巴细胞计数(Lymph#)-静脉血: 1.710E9/L；钾离子(K+)-静脉血: 4.1mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；乳酸脱氢酶(LDH)-静脉血: 203.5U/L；阴离子间隙(AG)-静脉血: 14；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；甘油三酯(TG)-静脉血: 1.28mmol/L；红细胞计数(RBC#)-静脉血: 4.4310E12/L；血小板分布宽度(PDW)-静脉血: 8.5%；单核细胞百分比(Mono%)-静脉血: 0.058；大血小板百分比(P-LCR%)-静脉血: 11.6%；血液二氧化碳含量ctCO2(B)-静脉血: 25.1mmol/L；白蛋白(ALB)-静脉血: 40.2g/L；尿素氮(BUN)-静脉血: 5.8mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.3U/L；尿酸(UA)-静脉血: 378.8umol/L；总胆固醇(TC)-……\n- [全程D21] 检验组合: 单核细胞百分比(Mono%)-静脉血: 0.062；中性粒细胞百分比(Neut%)-静脉血: 0.67；白细胞计数(WBC#)-静脉血: 5.9710E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.9；平均红细胞血红蛋白含量(MCH)-静脉血: 29.3pg；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 134g/L；红细胞比容(Hct)-静脉血: 41.3%；血小板比容-静脉血: 13%；平均红细胞体积(MCV)-静脉血: 90.4fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；平均血小板体积(MPV)-静脉血: 9.4fL；血小板计数(PLT#)-静脉血: 13810E9/L；中性粒细胞计数(Neut#)-静脉血: 410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 324g/L；血小板分布宽度(PDW)-静脉血: 9.9%；大血小板百分比(P-LCR%)-静脉血: 21.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.255；单核细胞计数(Mono#)-静脉血: 0.410E9/L；红细胞计数(RBC#)-静脉血: 4.5710E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.2\n- [全程D27] 检验组合: 红细胞计数(RBC#)-静脉血: 4.3410E12/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.85mmol/L；血小板计数(PLT#)-静脉血: 255.510E9/L；白细胞计数(WBC#)-静脉血: 6.210E9/L；氯离子(Cl-)-静脉血: 104.9mmol/L；总胆汁酸(TBA)-静脉血: 1umol/L；肌酐(Crea)-静脉血: 96.8umol/L；钾离子(K+)-静脉血: 4.5mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.386；乳酸脱氢酶(LDH)-静脉血: 212.1U/L；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.33mmolL；淋巴细胞计数(Lymph#)-静脉血: 2.410E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21U/L；平均红细胞体积(MCV)-静脉血: 90.1fL；总蛋白(TP)-静脉血: 70.21g/L；丙氨酸氨基转移酶(ALT)-静脉血: 19.6U/L；间接胆红素(IBIL)-静脉血: 4.6umolL；尿酸(UA)-静脉血: 469.1umol/L；血小板比容-静脉血: 15.3%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；甘油三酯(TG)-静脉血: 1.12mmol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白B(apoB)-静脉血: 0.9g/L；平均血小板体积(MPV)-静脉血: 6.02fL；总钙(Ca)-静脉血: 2.25mmol/L；单核细胞百分比(Mono%)-静脉血: 0.066；红细胞比容(Hct)-静脉血: 39.1%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；γ-谷氨酰基转移酶(GGT)-静脉血: 25.5U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.7pg；尿素氮(BUN)-静脉血: 4.22mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341.2g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；中性粒细胞计数(Neut#)-静脉血: 3.310E9/L；有核红细胞计数(NRBC#)-静脉血: 010E……\n- [全程D33] 检验组合: 尿素氮(BUN)-静脉血: 3.5mmol/L；直接胆红素(DBIL)-静脉血: 9umol/L；红细胞计数(RBC#)-静脉血: 3.8710E12/L；球蛋白(GLO)-静脉血: 27.06g/L；总胆红素(TBIL)-静脉血: 28.4umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.08mmolL；钾离子(K+)-静脉血: 3.68mmol/L；钠离子(Na+)-静脉血: 140.7mmol/L；肌酐(Crea)-静脉血: 71.4umol/L；红细胞比容(Hct)-静脉血: 34.5%；血小板比容-静脉血: 13.9%；总胆固醇(TC)-静脉血: 3.79mmol/L；磷(P)-静脉血: 1.21mmol/L；阴离子间隙(AG)-静脉血: 14.8；C-反应蛋白(CRP)-静脉血: 15.32mg/L；有核红细胞百分比(NRBC%)-静脉血: 0；乳酸脱氢酶(LDH)-静脉血: 214.8U/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15.3U/L；间接胆红素(IBIL)-静脉血: 19.4umolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.21mmol/L；白蛋白(ALB)-静脉血: 36.4g/L；总钙(Ca)-静脉血: 2.01mmol/L；载脂蛋白B(apoB)-静脉血: 0.79g/L；中性粒细胞计数(Neut#)-静脉血: 3.210E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.308；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.02；平均红细胞血红蛋白含量(MCH)-静脉血: 30.6pg；载脂蛋白AI(apoAI)-静脉血: 1.04g/L；尿酸(UA)-静脉血: 290.1umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.35；平均红细胞体积(MCV)-静脉血: 89.1fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；碱性磷酸酶(ALP)-静脉血: 60.5U/L；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；血小板计数(PLT#)-静脉血: 230.610E9/L；γ-谷氨酰基转移酶(GGT)-静……\n- [全程D36] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后，与某次就诊时间片对比， 鼻咽腔狭窄，鼻咽左侧壁、顶壁及后壁增厚，见软组织灶形成，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，病灶占据左侧咽隐窝，向前堵塞左侧后鼻孔，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，右侧咽隐窝稍变浅，范围较前缩小，右侧咽旁脂肪间隙及颈动脉鞘区未见异常。 左侧腭帆提肌、双侧头长肌受侵。 双侧翼腭窝、咀嚼肌间隙未见明显异常；口咽各壁无受累增厚。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部骨质破坏。双侧海绵窦形态正常，未见增宽。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。蝶鞍形态正常，其内未见占位性病变。 双侧上颌窦、蝶窦、筛窦、左侧乳突粘膜增厚，见不等量分泌物，右侧乳突气化好，骨壁完整。 左侧咽后间隙见小淋巴结，短径约4mm，较前未见明显变化。 双颈II区见肿大淋巴结，较大者短径约22mm，较前稍缩小。 左颈III、V区见多发小淋巴结，边界清，信号均匀，较大者短径约7mm，较前未见明显变化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。 喉咽腔形态正常，未见占位性病变。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗后，鼻咽肿物较前缩小。 颅底骨质破坏。 左侧咽后小淋巴结，较前未见明显变化。 双颈II区淋巴结肿大，较前稍缩小。 左颈III、V区多发小淋巴结，较前未见明显变化。 副鼻窦炎、左侧乳突炎。\n- [全程D58] 检验组合: 红细胞比容(Hct)-静脉血: 34.3%；载脂蛋白B(apoB)-静脉血: 0.73g/L；碱性磷酸酶(ALP)-静脉血: 76U/L；肌酐(Crea)-静脉血: 67.8umol/L；胱抑素(Cys-C)-静脉血: 0.64mg/L；中性粒细胞百分比(Neut%)-静脉血: 0.768；血红蛋白(Hb)-静脉血: 116g/L；平均血小板体积(MPV)-静脉血: 8.4fL；总胆红素(TBIL)-静脉血: 15.8umol/L；尿素氮(BUN)-静脉血: 3.79mmol/L；镁离子(Mg2+)-静脉血: 0.9mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 22.5U/L；钾离子(K+)-静脉血: 3.6mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 16U/L；直接胆红素(DBIL)-静脉血: 6.5umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.5mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.5；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.7；白蛋白(ALB)-静脉血: 35.4g/L；钠离子(Na+)-静脉血: 138.1mmol/L；总钙(Ca)-静脉血: 2.12mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.08mmolL；磷(P)-静脉血: 1.18mmol/L；C-反应蛋白(CRP)-静脉血: 30.45mg/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.005；总胆汁酸(TBA)-静脉血: 1.6umol/L；乳酸脱氢酶(LDH)-静脉血: 175.3U/L；甘油三酯(TG)-静脉血: 0.98mmol/L；红细胞计数(RBC#)-静脉血: 3.8810E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血小板比容-静脉血: 13%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.28mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.04g/L；间接胆红素(IBIL)-静脉血: 9.3umolL；平均红细胞血红蛋白含量(MCH)-静脉血: 29.9pg；氯离子(Cl-)-静脉血: 102.7mmol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L……\n- [全程D65] 检验组合: 钾离子(K+)-静脉血: 3.65mmol/L；总胆固醇(TC)-静脉血: 3.47mmol/L；阴离子间隙(AG)-静脉血: 9.1；磷(P)-静脉血: 1.16mmol/L；间接胆红素(IBIL)-静脉血: 7.2umolL；总蛋白(TP)-静脉血: 66.88g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 14.2U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.07mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；红细胞比容(Hct)-静脉血: 35.8%；淋巴细胞百分比(Lymph%)-静脉血: 0.077；红细胞体积分布宽度CV(RDW-CV)-静脉血: 15.7%；丙氨酸氨基转移酶(ALT)-静脉血: 15.7U/L；钠离子(Na+)-静脉血: 141.1mmol/L；乳酸脱氢酶(LDH)-静脉血: 147.8U/L；C-反应蛋白(CRP)-静脉血: 23.42mg/L；甘油三酯(TG)-静脉血: 1.16mmol/L；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；血小板分布宽度(PDW)-静脉血: 17.3%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；肌酐(Crea)-静脉血: 62.8umol/L；镁离子(Mg2+)-静脉血: 0.8mmol/L；总胆红素(TBIL)-静脉血: 12.5umol/L；淋巴细胞计数(Lymph#)-静脉血: 0.410E9/L；直接胆红素(DBIL)-静脉血: 5.3umol/L；球蛋白(GLO)-静脉血: 30.38g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；尿素氮(BUN)-静脉血: 3.1mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 35.9U/L；载脂蛋白AI(apoAI)-静脉血: 0.9g/L；白蛋白(ALB)-静脉血: 36.5g/L；血红蛋白(Hb)-静脉血: 118.5g/L；载脂蛋白B(apoB)-静脉血: 0.74g/L；白细胞计数(WBC#)-静脉血: 4.5110E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 18.3U/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血……\n- [全程D72] 检验组合: 磷(P)-静脉血: 1.31mmol/L；总钙(Ca)-静脉血: 2.11mmol/L；总胆红素(TBIL)-静脉血: 12umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.745；镁离子(Mg2+)-静脉血: 0.8mmol/L；总蛋白(TP)-静脉血: 65.97g/L；单核细胞百分比(Mono%)-静脉血: 0.132；血小板计数(PLT#)-静脉血: 17910E9/L；球蛋白(GLO)-静脉血: 33.37g/L；尿素氮(BUN)-静脉血: 3.82mmol/L；尿酸(UA)-静脉血: 232.9umol/L；间接胆红素(IBIL)-静脉血: 6.9umolL；中性粒细胞计数(Neut#)-静脉血: 2.510E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.9；氯离子(Cl-)-静脉血: 105mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.6；血小板比容-静脉血: 15%；平均红细胞血红蛋白含量(MCH)-静脉血: 29.2pg；总胆固醇(TC)-静脉血: 3.73mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；载脂蛋白AI(apoAI)-静脉血: 0.88g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 36.1U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.026；胱抑素(Cys-C)-静脉血: 0.62mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.91mmolL；乳酸脱氢酶(LDH)-静脉血: 137U/L；肌酐(Crea)-静脉血: 68.5umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 87.7fL；血小板分布宽度(PDW)-静脉血: 7.4%；白蛋白(ALB)-静脉血: 32.6g/L；甘油三酯(TG)-静脉血: 0.96mmol/L；大血小板百分比(P-LCR%)-静脉血: 11.2%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15.9U/L；丙氨酸氨基转移酶(ALT)-静脉血: 17.3U/L；钠离子(Na+)-静脉血: 141.2mmol……\n- [全程D75] 检验组合: 白细胞计数(WBC#)-静脉血: 3.3210E9/L；血小板分布宽度(PDW)-静脉血: 7.9%；钾离子(K+)-静脉血: 3.4mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 18.6U/L；C-反应蛋白(CRP)-静脉血: 56.54mg/L；红细胞比容(Hct)-静脉血: 33.5%；单核细胞百分比(Mono%)-静脉血: 0.117；肌酐(Crea)-静脉血: 63.4umol/L；尿酸(UA)-静脉血: 304umol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；血小板比容-静脉血: 18%；α-L-岩藻糖苷酶(AFU)-静脉血: 22U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.72mmol/L；血小板计数(PLT#)-静脉血: 21110E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.9；中性粒细胞百分比(Neut%)-静脉血: 0.772；淋巴细胞百分比(Lymph%)-静脉血: 0.072；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；总钙(Ca)-静脉血: 2.12mmol/L；药物曲线下面积(AUC)-静脉血: 1；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；总胆固醇(TC)-静脉血: 4.15mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.88mmolL；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 16.7U/L；白蛋白(ALB)-静脉血: 33g/L；平均血小板体积(MPV)-静脉血: 8.3fL；总胆红素(TBIL)-静脉血: 13.6umol/L；磷(P)-静脉血: 1.15mmol/L；球蛋白(GLO)-静脉血: 33.66g/L；阴离子间隙(AG)-静脉血: 14；葡萄糖(Glu)-静脉血: 5.63mmol/L；载脂蛋白AI(apoAI)-静脉血: 0.81g/L；总胆汁酸(TBA)-静脉血: 1.4umol/L；间接胆红素(IBIL)-静脉血: 7.9umolL；尿素氮(BUN)-静脉血: 5.04mmol/L；胱抑素(Cys-C)-静脉血: 0.65mg/L；红细胞计数(RBC#)-静脉血: 3.8110E12/L；红细胞体积分布宽度……\n- [全程D86] 检验组合: 总胆汁酸(TBA)-静脉血: 1.6umol/L；直接胆红素(DBIL)-静脉血: 2.4umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 16U/L；C-反应蛋白(CRP)-静脉血: 15.4mg/L；淋巴细胞百分比(Lymph%)-静脉血: 0.142；总钙(Ca)-静脉血: 2.08mmol/L；阴离子间隙(AG)-静脉血: 10；丙氨酸氨基转移酶(ALT)-静脉血: 27.7U/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；白蛋白(ALB)-静脉血: 30.3g/L；钾离子(K+)-静脉血: 3.2mmol/L；葡萄糖(Glu)-静脉血: 5.56mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.27mmol/L；总胆固醇(TC)-静脉血: 3.75mmol/L；平均红细胞体积(MCV)-静脉血: 89.4fL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.83mmolL；肌酐(Crea)-静脉血: 72.9umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 53U/L；尿酸(UA)-静脉血: 338.6umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.9mmol/L；白细胞计数(WBC#)-静脉血: 2.610E9/L；钠离子(Na+)-静脉血: 140.5mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.4pg；单核细胞百分比(Mono%)-静脉血: 0.281；大血小板百分比(P-LCR%)-静脉血: 12.6%；载脂蛋白B(apoB)-静脉血: 0.76g/L；载脂蛋白AI(apoAI)-静脉血: 0.84g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.6U/L；间接胆红素(IBIL)-静脉血: 3umolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.7；甘油三酯(TG)-静脉血: 1.42mmol/L；磷(P)-静脉血: 1.4mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.8；碱性磷酸酶(ALP)-静脉血: 70.5U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；尿素氮……\n- [全程D88] 检验组合: 血红蛋白(Hb)-静脉血: 118g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.26；平均血小板体积(MPV)-静脉血: 8.5fL；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；红细胞比容(Hct)-静脉血: 35.8%；血小板比容-静脉血: 14%；血小板分布宽度(PDW)-静脉血: 7.6%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.7；平均红细胞体积(MCV)-静脉血: 90.4fL；血小板计数(PLT#)-静脉血: 16910E9/L；红细胞计数(RBC#)-静脉血: 3.9610E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.028；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；单核细胞百分比(Mono%)-静脉血: 0.097；大血小板百分比(P-LCR%)-静脉血: 14.3%；白细胞计数(WBC#)-静脉血: 2.8810E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.8pg；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.5；中性粒细胞计数(Neut#)-静脉血: 1.810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.612\n- [全程D93] 检验组合: 低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.82mmol/L；白蛋白(ALB)-静脉血: 37.8g/L；总胆红素(TBIL)-静脉血: 9.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 39.6U/L；胱抑素(Cys-C)-静脉血: 0.78mg/L；淋巴细胞百分比(Lymph%)-静脉血: 0.15；天门冬氨酸氨基转移酶(AST)-静脉血: 21.3U/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；尿酸(UA)-静脉血: 295.9umol/L；血小板比容-静脉血: 12.1%；中性粒细胞计数(Neut#)-静脉血: 2.410E9/L；氯离子(Cl-)-静脉血: 102mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.7mmol/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；阴离子间隙(AG)-静脉血: 13.1；钠离子(Na+)-静脉血: 142.8mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 16.1%；血小板分布宽度(PDW)-静脉血: 15.9%；红细胞比容(Hct)-静脉血: 36.4%；磷(P)-静脉血: 1.26mmol/L；直接胆红素(DBIL)-静脉血: 3.4umol/L；总蛋白(TP)-静脉血: 70.94g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；葡萄糖(Glu)-静脉血: 6.22mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.019；间接胆红素(IBIL)-静脉血: 5.9umolL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；载脂蛋白B(apoB)-静脉血: 0.94g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.11mmolL；总胆固醇(TC)-静脉血: 4.28mmol/L；碱性磷酸酶(ALP)-静脉血: 88.1U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.5pg；血小板计数(PLT#)-静脉血: 215.910E9/L；钾离子(K+)-静脉血: 3.96mmol/L；单核细胞百分比(Mono%)-静脉血: 0.146；平均血小板体积(MPV)-静脉血: 5.62fL；有核红细胞百分比(NRBC%)-静脉血:……\n- [全程D94] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约28cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，右肾实质回声均匀，未见明显异常回声。左肾下盏可见一强回声团，直径约6mm，边界清。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约28×25×25mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 左肾结石。 肝脏、胆囊、脾脏、胰腺、右肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+洛铂方案诱导化疗结束，诉呕吐1次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程5-FU+洛铂方案诱导化疗结束，无诉特殊不适，可予出院，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n- [全程D28] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，可于今日执行第2程5-FU+洛铂方案诱导化疗，注意化疗不良反应。\n- [全程D29] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+洛铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D34] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+洛铂方案诱导化疗结束，诉恶心、食欲下降，无发热、呕吐、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规示轻度贫血，肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第2程5-FU+洛铂方案诱导化疗结束，无诉特殊不适，血象提示轻度贫血，予铁剂口服等纠正贫血治疗，下周及时监测血常规、肝肾功能，备行同时期放化疗+靶向治疗。\n- [全程D64] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者放疗中，第4程爱必妥靶向治疗后3天，诉口感、咽痛、纳差。查体同前。[姓名已隐去]医生信息已隐藏：予喷喉、洗鼻、保护皮肤处理，加强营养，继续放疗。\n- [全程D69] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者放疗中，今日第5程爱必妥靶向治疗，诉头面部皮疹，口感、咽痛，余无明显不适。查体：头面部散在红疹，无脱皮、水泡，余同前。[姓名已隐去]医生信息已隐藏：予红外线治疗，喷喉、洗鼻、保护皮肤处理，加强营养，继续放疗。\n- [全程D74] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者放疗中，第2程洛铂方案同时期化疗结束，诉恶心、食欲下降，呕吐1次，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规示轻度贫血，肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第2程洛铂方案同时期化疗结束，诉恶心、呕吐，予止呕护胃处理，继续放疗。\n- [全程D78] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者2月18日至2月26日春节请假中。\n- [全程D88] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者放疗中，第6程爱必妥靶向治疗结束，诉头面部皮疹，口感、咽痛，余无明显不适。查体：头面部散在红疹，无脱皮、水泡，余同前。复查血常规、生化插管基本正常。[姓名已隐去]医生信息已隐藏：予喷喉、洗鼻、保护皮肤处理，加强营养，今日可办理出院，继续门诊放疗，按时间行复查。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 确认腹部彩超无转移，暂停放疗，请泌尿外科会诊行左肾结石碎石治疗，并予乳果糖口服液。\nB. 确认腹部彩超无转移，继续门诊放疗，左肾结石暂予观察，并予乳果糖口服液。\nC. 确认腹部彩超无转移，继续门诊放疗，左肾结石暂予观察，并加用洛铂行第3程同期化疗。\nD. 确认腹部彩超无转移，暂停门诊放疗，复查鼻咽及颈部MRI评估局部疗效，并予乳果糖口服液。\nE. 确认腹部彩超无转移，继续门诊放疗，对左肾结石予排石颗粒，并加用西妥昔单抗靶向治疗。\nF. 确认腹部彩超无转移，终止放疗，左肾结石暂予观察，转入康复科行便秘治疗。\nG. 确认腹部彩超无转移，继续门诊放疗，对左肾结石予留置双J管，并予乳果糖口服液。\nH. 确认腹部彩超无转移，暂停门诊放疗，予温肥皂水灌肠处理便秘，左肾结石暂予观察。\nI. 确认腹部彩超无转移，继续门诊放疗，左肾结石暂予观察，并予洛哌丁胺口服。\nJ. 确认腹部彩超无转移，继续门诊放疗，左肾结石暂予观察，并予开塞露联合新斯的明肌注。\nK. 确认腹部彩超无转移，暂停门诊放疗，行全身PET-CT评估疗效，左肾结石暂予观察。\nL. 确认腹部彩超无转移，继续门诊放疗，行体外冲击波碎石，处理左肾结石，并予乳果糖口服液。\n\n请仅输出一个选项字母（A-L）。"}]}
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+{"sample_id":"sample-78b27b455a910a93bd013384","patient_id":"patient-51e6f99c527367bbd97aebd8","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"D","gold_action":"明确鼻咽癌临床分期为 cT1N0M0，IA期（肿瘤累及鼻咽及左侧后鼻孔，无颈部淋巴结转移）","options":[{"letter":"A","text":"明确鼻咽癌临床分期为 cT2N0M0，II期（肿瘤累及左侧后鼻孔，无颈部淋巴结转移）","is_gold":false},{"letter":"B","text":"明确鼻咽癌临床分期为 cT1N1M0，II期（肿瘤局限于鼻咽，伴单侧咽后淋巴结转移）","is_gold":false},{"letter":"C","text":"明确鼻咽癌临床分期为 cT2N1M0，II期（肿瘤累及左侧后鼻孔及咽旁间隙，伴单侧颈部淋巴结转移）","is_gold":false},{"letter":"D","text":"明确鼻咽癌临床分期为 cT1N0M0，IA期（肿瘤累及鼻咽及左侧后鼻孔，无颈部淋巴结转移）","is_gold":true},{"letter":"E","text":"明确鼻咽癌临床分期为 cT3N0M0，III期（肿瘤累及颅底骨质，无颈部淋巴结转移）","is_gold":false},{"letter":"F","text":"明确鼻咽癌临床分期为 cT1N0M0，IA期（肿瘤局限于鼻咽，未累及鼻腔及口咽等邻近结构）","is_gold":false},{"letter":"G","text":"明确鼻咽癌临床分期为 cT2N0M0，II期（肿瘤累及鼻咽及口咽，无颈部淋巴结转移）","is_gold":false},{"letter":"H","text":"明确鼻咽癌临床分期为 cT1N2M0，III期（肿瘤累及左侧后鼻孔，伴双侧颈部淋巴结转移）","is_gold":false},{"letter":"I","text":"明确鼻咽癌临床分期为 cT3N1M0，III期（肿瘤累及翼内肌，伴单侧颈部淋巴结转移）","is_gold":false},{"letter":"J","text":"明确鼻咽癌临床分期为 cT4N0M0，IVA期（肿瘤累及海绵窦，无颈部淋巴结转移）","is_gold":false},{"letter":"K","text":"明确鼻咽癌临床分期为 cT1N0M1，IVB期（肿瘤累及左侧后鼻孔，伴远处器官转移）","is_gold":false},{"letter":"L","text":"明确鼻咽癌临床分期为 cT2N2M0，III期（肿瘤累及咽旁间隙，伴双侧颈部淋巴结转移）","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：鼻腔。\n文本分期信息：N0，M0。\n综合TNM状态：T1N0M0。\n综合分期：IA。\n\n【已知病史与当前主诉】\n- [全程D6] 入院记录: 主诉: 涕血2月；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血；既往史: “胃溃疡”病史22年，于某次就诊时间、某次就诊时间发生2次“胃出血”，经“输血”、“药物”治疗后好转，具体不详。某次就诊时间发现“胃底息肉”，行“内镜下胃底息肉切除术”。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：114/69mmHg,Ht：157cm，Wt：53kg，BSA：1.52m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽左侧壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D7] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- [全程D7] 检验组合: 平均红细胞体积(MCV)-静脉血: 91.1fL；总钙(Ca)-静脉血: 2.21mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24.2U/L；碱性磷酸酶(ALP)-静脉血: 74.3U/L；IV型胶原(C-IV)-静脉血: 12.97ng/ml；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 35.9U/L；钾离子(K+)-静脉血: 3.76mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；D-二聚体(D-Dimer)-静脉血: 0.07ug/ml；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；淀粉样蛋白A(SAA)-静脉血: 2.44mg/L；C-反应蛋白(CRP)-静脉血: 1.92mg/L；凝血酶原时间活动度(PTA)-静脉血: 120%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.67；载脂蛋白B(apoB)-静脉血: 1.07g/L；球蛋白(GLO)-静脉血: 26.18g/L；磷(P)-静脉血: 1.03mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；胱抑素(Cys-C)-静脉血: 0.79mg/L；红细胞计数(RBC#)-静脉血: 5.2710E12/L；单核细胞计数(Mono#)-静脉血: 110E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.6sec.；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.87；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.411ng/ml（参考: <0.584）；尿素氮(BUN)-静脉血: 4.7mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；血小板计数(PLT#)-静脉血: 21810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.578；凝血酶原时间(PT)-静脉血: 10.1sec.；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.05mmol/L；尿酸(UA)-静脉血: 331.5umol/L；阴离子间隙(AG)-静脉血: 15.7；层粘……\n- [全程D10] 内镜；胃镜: 检查类型: 内镜；检查名称: 胃镜；检查部位:；检查所见: 插镜情况：顺利 送达部位：十二指肠降部。 食 管：粘膜光滑, 舒缩好。 贲 门：开闭好, E-G线清楚。 胃 底：粘液湖清亮，粘膜光滑，无静脉曲张。 胃 体：花斑样充血，未见溃疡肿物。 胃 角：弧形， 光滑。 胃 窦：蠕动好，粘膜呈花斑样充血，未见溃疡肿物。 幽 门：圆， 开闭好。 球 部：球腔变形，后壁可见霜斑样溃疡，表面附着白苔。 降 部：十二指肠乳头及降部粘膜未见异常。 请4个工作日后到病理科（5楼）取活检结果。；检查结论: 十二指肠球部霜斑样溃疡 慢性浅表性胃炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 明确鼻咽癌临床分期为 cT2N0M0，II期（肿瘤累及左侧后鼻孔，无颈部淋巴结转移）\nB. 明确鼻咽癌临床分期为 cT1N1M0，II期（肿瘤局限于鼻咽，伴单侧咽后淋巴结转移）\nC. 明确鼻咽癌临床分期为 cT2N1M0，II期（肿瘤累及左侧后鼻孔及咽旁间隙，伴单侧颈部淋巴结转移）\nD. 明确鼻咽癌临床分期为 cT1N0M0，IA期（肿瘤累及鼻咽及左侧后鼻孔，无颈部淋巴结转移）\nE. 明确鼻咽癌临床分期为 cT3N0M0，III期（肿瘤累及颅底骨质，无颈部淋巴结转移）\nF. 明确鼻咽癌临床分期为 cT1N0M0，IA期（肿瘤局限于鼻咽，未累及鼻腔及口咽等邻近结构）\nG. 明确鼻咽癌临床分期为 cT2N0M0，II期（肿瘤累及鼻咽及口咽，无颈部淋巴结转移）\nH. 明确鼻咽癌临床分期为 cT1N2M0，III期（肿瘤累及左侧后鼻孔，伴双侧颈部淋巴结转移）\nI. 明确鼻咽癌临床分期为 cT3N1M0，III期（肿瘤累及翼内肌，伴单侧颈部淋巴结转移）\nJ. 明确鼻咽癌临床分期为 cT4N0M0，IVA期（肿瘤累及海绵窦，无颈部淋巴结转移）\nK. 明确鼻咽癌临床分期为 cT1N0M1，IVB期（肿瘤累及左侧后鼻孔，伴远处器官转移）\nL. 明确鼻咽癌临床分期为 cT2N2M0，III期（肿瘤累及咽旁间隙，伴双侧颈部淋巴结转移）\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：鼻腔。\n文本分期信息：N0，M0。\n综合TNM状态：T1N0M0。\n综合分期：IA。\n\n【已知病史与当前主诉】\n- [全程D6] 入院记录: 主诉: 涕血2月；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血；既往史: “胃溃疡”病史22年，于某次就诊时间、某次就诊时间发生2次“胃出血”，经“输血”、“药物”治疗后好转，具体不详。某次就诊时间发现“胃底息肉”，行“内镜下胃底息肉切除术”。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：114/69mmHg,Ht：157cm，Wt：53kg，BSA：1.52m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽左侧壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D7] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- [全程D7] 检验组合: 平均红细胞体积(MCV)-静脉血: 91.1fL；总钙(Ca)-静脉血: 2.21mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24.2U/L；碱性磷酸酶(ALP)-静脉血: 74.3U/L；IV型胶原(C-IV)-静脉血: 12.97ng/ml；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 35.9U/L；钾离子(K+)-静脉血: 3.76mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；D-二聚体(D-Dimer)-静脉血: 0.07ug/ml；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；淀粉样蛋白A(SAA)-静脉血: 2.44mg/L；C-反应蛋白(CRP)-静脉血: 1.92mg/L；凝血酶原时间活动度(PTA)-静脉血: 120%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.67；载脂蛋白B(apoB)-静脉血: 1.07g/L；球蛋白(GLO)-静脉血: 26.18g/L；磷(P)-静脉血: 1.03mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；胱抑素(Cys-C)-静脉血: 0.79mg/L；红细胞计数(RBC#)-静脉血: 5.2710E12/L；单核细胞计数(Mono#)-静脉血: 110E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.6sec.；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.87；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.411ng/ml（参考: <0.584）；尿素氮(BUN)-静脉血: 4.7mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；血小板计数(PLT#)-静脉血: 21810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.578；凝血酶原时间(PT)-静脉血: 10.1sec.；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.05mmol/L；尿酸(UA)-静脉血: 331.5umol/L；阴离子间隙(AG)-静脉血: 15.7；层粘……\n- [全程D10] 内镜；胃镜: 检查类型: 内镜；检查名称: 胃镜；检查部位:；检查所见: 插镜情况：顺利 送达部位：十二指肠降部。 食 管：粘膜光滑, 舒缩好。 贲 门：开闭好, E-G线清楚。 胃 底：粘液湖清亮，粘膜光滑，无静脉曲张。 胃 体：花斑样充血，未见溃疡肿物。 胃 角：弧形， 光滑。 胃 窦：蠕动好，粘膜呈花斑样充血，未见溃疡肿物。 幽 门：圆， 开闭好。 球 部：球腔变形，后壁可见霜斑样溃疡，表面附着白苔。 降 部：十二指肠乳头及降部粘膜未见异常。 请4个工作日后到病理科（5楼）取活检结果。；检查结论: 十二指肠球部霜斑样溃疡 慢性浅表性胃炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 明确鼻咽癌临床分期为 cT2N0M0，II期（肿瘤累及左侧后鼻孔，无颈部淋巴结转移）\nB. 明确鼻咽癌临床分期为 cT1N1M0，II期（肿瘤局限于鼻咽，伴单侧咽后淋巴结转移）\nC. 明确鼻咽癌临床分期为 cT2N1M0，II期（肿瘤累及左侧后鼻孔及咽旁间隙，伴单侧颈部淋巴结转移）\nD. 明确鼻咽癌临床分期为 cT1N0M0，IA期（肿瘤累及鼻咽及左侧后鼻孔，无颈部淋巴结转移）\nE. 明确鼻咽癌临床分期为 cT3N0M0，III期（肿瘤累及颅底骨质，无颈部淋巴结转移）\nF. 明确鼻咽癌临床分期为 cT1N0M0，IA期（肿瘤局限于鼻咽，未累及鼻腔及口咽等邻近结构）\nG. 明确鼻咽癌临床分期为 cT2N0M0，II期（肿瘤累及鼻咽及口咽，无颈部淋巴结转移）\nH. 明确鼻咽癌临床分期为 cT1N2M0，III期（肿瘤累及左侧后鼻孔，伴双侧颈部淋巴结转移）\nI. 明确鼻咽癌临床分期为 cT3N1M0，III期（肿瘤累及翼内肌，伴单侧颈部淋巴结转移）\nJ. 明确鼻咽癌临床分期为 cT4N0M0，IVA期（肿瘤累及海绵窦，无颈部淋巴结转移）\nK. 明确鼻咽癌临床分期为 cT1N0M1，IVB期（肿瘤累及左侧后鼻孔，伴远处器官转移）\nL. 明确鼻咽癌临床分期为 cT2N2M0，III期（肿瘤累及咽旁间隙，伴双侧颈部淋巴结转移）\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-db8d6d3eabcfcb123b0c3cb1","patient_id":"patient-51e6f99c527367bbd97aebd8","turn_id":"turn05","turn_position":3,"turn_type":"toxicity_or_support_decision","gold_letter":"F","gold_action":"暂停顺铂化疗，继续单纯放疗，给予静脉保肝治疗，待肝功能恢复后补足化疗周期。","options":[{"letter":"A","text":"暂停放化疗，给予多烯磷脂酰胆碱、还原型谷胱甘肽等静脉保肝治疗，待肝功能恢复正常后恢复放化疗。","is_gold":false},{"letter":"B","text":"继续放化疗，仅密切监测肝功能变化，暂不给予静脉保肝药物干预。","is_gold":false},{"letter":"C","text":"继续放化疗，给予广谱抗生素静脉滴注预防感染，并辅以雾化吸入及止吐等对症支持处理。","is_gold":false},{"letter":"D","text":"将顺铂方案调整为卡铂方案同时期化疗，并给予静脉保肝治疗及止吐等对症支持处理。","is_gold":false},{"letter":"E","text":"顺铂剂量减低25%继续同时期化疗，给予静脉保肝治疗，辅以雾化吸入及止吐等对症支持处理。","is_gold":false},{"letter":"F","text":"暂停顺铂化疗，继续单纯放疗，给予静脉保肝治疗，待肝功能恢复后补足化疗周期。","is_gold":true},{"letter":"G","text":"给予多烯磷脂酰胆碱、还原型谷胱甘肽、复方甘草酸苷等静脉保肝治疗，辅以雾化吸入及止吐等对症支持处理。","is_gold":false},{"letter":"H","text":"给予大剂量质子泵抑制剂静脉滴注预防消化道出血，暂缓保肝治疗，继续放化疗。","is_gold":false},{"letter":"I","text":"暂停放疗，继续顺铂化疗，给予静脉保肝治疗及止吐等对症支持处理。","is_gold":false},{"letter":"J","text":"给予静脉保肝治疗，行骨髓穿刺检查排除血液系统异常，继续放化疗。","is_gold":false},{"letter":"K","text":"终止临床试验，转为常规单药顺铂同时期放化疗，并给予静脉保肝治疗。","is_gold":false},{"letter":"L","text":"给予口服保肝药物治疗，辅以雾化吸入及止吐等对症支持处理，继续放化疗。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：鼻腔。\n文本分期信息：N0，M0。\n综合TNM状态：T1N0M0。\n综合分期：IA。\n\n【已知病史与当前主诉】\n- [全程D6] 入院记录: 主诉: 涕血2月；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血；既往史: “胃溃疡”病史22年，于某次就诊时间、某次就诊时间发生2次“胃出血”，经“输血”、“药物”治疗后好转，具体不详。某次就诊时间发现“胃底息肉”，行“内镜下胃底息肉切除术”。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：114/69mmHg,Ht：157cm，Wt：53kg，BSA：1.52m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽左侧壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D7] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- [全程D7] 检验组合: 平均红细胞体积(MCV)-静脉血: 91.1fL；总钙(Ca)-静脉血: 2.21mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24.2U/L；碱性磷酸酶(ALP)-静脉血: 74.3U/L；IV型胶原(C-IV)-静脉血: 12.97ng/ml；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 35.9U/L；钾离子(K+)-静脉血: 3.76mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；D-二聚体(D-Dimer)-静脉血: 0.07ug/ml；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；淀粉样蛋白A(SAA)-静脉血: 2.44mg/L；C-反应蛋白(CRP)-静脉血: 1.92mg/L；凝血酶原时间活动度(PTA)-静脉血: 120%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.67；载脂蛋白B(apoB)-静脉血: 1.07g/L；球蛋白(GLO)-静脉血: 26.18g/L；磷(P)-静脉血: 1.03mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；胱抑素(Cys-C)-静脉血: 0.79mg/L；红细胞计数(RBC#)-静脉血: 5.2710E12/L；单核细胞计数(Mono#)-静脉血: 110E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.6sec.；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.87；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.411ng/ml（参考: <0.584）；尿素氮(BUN)-静脉血: 4.7mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；血小板计数(PLT#)-静脉血: 21810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.578；凝血酶原时间(PT)-静脉血: 10.1sec.；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.05mmol/L；尿酸(UA)-静脉血: 331.5umol/L；阴离子间隙(AG)-静脉血: 15.7；层粘……\n- [全程D10] 内镜；胃镜: 检查类型: 内镜；检查名称: 胃镜；检查部位:；检查所见: 插镜情况：顺利 送达部位：十二指肠降部。 食 管：粘膜光滑, 舒缩好。 贲 门：开闭好, E-G线清楚。 胃 底：粘液湖清亮，粘膜光滑，无静脉曲张。 胃 体：花斑样充血，未见溃疡肿物。 胃 角：弧形， 光滑。 胃 窦：蠕动好，粘膜呈花斑样充血，未见溃疡肿物。 幽 门：圆， 开闭好。 球 部：球腔变形，后壁可见霜斑样溃疡，表面附着白苔。 降 部：十二指肠乳头及降部粘膜未见异常。 请4个工作日后到病理科（5楼）取活检结果。；检查结论: 十二指肠球部霜斑样溃疡 慢性浅表性胃炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D24] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽左侧顶后壁及左侧壁局部粘膜增厚形成软组织影放射性浓聚，SUV约21.0，堵塞左侧鼻后孔，鼻咽腔变窄，累及左侧翼突基底部及犁骨。左侧咽隐窝变，右侧咽隐窝未见明显异常，双侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。口咽及喉咽结构及放射性分布未见明显异常。额窦、蝶窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双上颈小淋巴结放射性分布未见明显异常。 双上肺尖、右中肺内侧段及左下肺后基底段少许条索影放射性分布未见明显异常；其余双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏S4低密度影放射性分布未见明显异常，大小约0.6×0.6cm，边界尚清，密度欠均匀，CT值约26Hu；其余肝脏密度减低，CT值约50Hu，结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。盆腔盆底静脉内多发点状/小结节状高密度影放射性缺损。 所见颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，侵犯左侧鼻后孔，累及颅底骨。 肝S4低密度影代谢未见明显异常，建议随诊。 脂肪肝。\n- [全程D29] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.013；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 6.5\n- [全程D30] 检验组合: 浊度(TRUB)-尿液: 清亮；白细胞计数(WBC#)-尿液: 3/μL；白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.023；酮体(KET)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 13/μL；颜色-尿液: Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；隐血(OB)-尿液: 1+ 0.6mg（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D31] 检验组合: 红细胞计数(RBC#)-静脉血: 4.6210E12/L；血小板计数(PLT#)-静脉血: 22810E9/L；大血小板百分比(P-LCR%)-静脉血: 21.2%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.61mmol/L；白蛋白(ALB)-静脉血: 38.5g/L；间接胆红素(IBIL)-静脉血: 8.4umolL；球蛋白(GLO)-静脉血: 25.82g/L；单核细胞百分比(Mono%)-静脉血: 0.093；血小板分布宽度(PDW)-静脉血: 10.8%；红细胞比容(Hct)-静脉血: 41.4%；总蛋白(TP)-静脉血: 64.32g/L；单核细胞计数(Mono#)-静脉血: 1.510E9/L；葡萄糖(Glu)-静脉血: 5.98mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.6；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；总胆红素(TBIL)-静脉血: 12.9umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 176.9U/L；甘油三酯(TG)-静脉血: 1.4mmol/L；乳酸脱氢酶(LDH)-静脉血: 239U/L；总胆汁酸(TBA)-静脉血: 3umol/L；直接胆红素(DBIL)-静脉血: 4.5umol/L；肌酐(Crea)-静脉血: 70umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.7；尿素氮(BUN)-静脉血: 6.02mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 136.5U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；天门冬氨酸氨基转移酶(AST)-静脉血: 104.5U/L；磷(P)-静脉血: 1.34mmol/L；钠离子(Na+)-静脉血: 138.8mmol/L；平均红细胞体积(MCV)-静脉血: 89.6fL；白细胞计数(WBC#)-静脉血: 15.9910E9/L；载脂蛋白AI(apoAI)-静脉血: 1.29g/L；阴离子间隙(AG)-静脉血: 14；C-反应蛋白(CRP)-静脉血: 1.98mg/L；钾离子(K+)-静脉血: 3.5mmol/L；碱性磷酸酶(ALP)-静脉血:……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D8] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者相关检查完善中，请假未回病房。\n- [全程D13] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者相关检查完善中，请假未回病房。\n- [全程D19] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者元旦假期请假中。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D29] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者无明显不适主诉，查体情况：一般情况可，余同入院。放疗计划已完善。[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，向患者及其家属交代病情及化疗风险，表示理解并已签署知情同意书，同意入组三周/单周DDP同时期化疗临床试验，抽签入三周组，可于今日执行第1程顺铂方案同时期化疗，注意化疗不良反应，开始放疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放化疗，给予多烯磷脂酰胆碱、还原型谷胱甘肽等静脉保肝治疗，待肝功能恢复正常后恢复放化疗。\nB. 继续放化疗，仅密切监测肝功能变化，暂不给予静脉保肝药物干预。\nC. 继续放化疗，给予广谱抗生素静脉滴注预防感染，并辅以雾化吸入及止吐等对症支持处理。\nD. 将顺铂方案调整为卡铂方案同时期化疗，并给予静脉保肝治疗及止吐等对症支持处理。\nE. 顺铂剂量减低25%继续同时期化疗，给予静脉保肝治疗，辅以雾化吸入及止吐等对症支持处理。\nF. 暂停顺铂化疗，继续单纯放疗，给予静脉保肝治疗，待肝功能恢复后补足化疗周期。\nG. 给予多烯磷脂酰胆碱、还原型谷胱甘肽、复方甘草酸苷等静脉保肝治疗，辅以雾化吸入及止吐等对症支持处理。\nH. 给予大剂量质子泵抑制剂静脉滴注预防消化道出血，暂缓保肝治疗，继续放化疗。\nI. 暂停放疗，继续顺铂化疗，给予静脉保肝治疗及止吐等对症支持处理。\nJ. 给予静脉保肝治疗，行骨髓穿刺检查排除血液系统异常，继续放化疗。\nK. 终止临床试验，转为常规单药顺铂同时期放化疗，并给予静脉保肝治疗。\nL. 给予口服保肝药物治疗，辅以雾化吸入及止吐等对症支持处理，继续放化疗。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：鼻腔。\n文本分期信息：N0，M0。\n综合TNM状态：T1N0M0。\n综合分期：IA。\n\n【已知病史与当前主诉】\n- [全程D6] 入院记录: 主诉: 涕血2月；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血；既往史: “胃溃疡”病史22年，于某次就诊时间、某次就诊时间发生2次“胃出血”，经“输血”、“药物”治疗后好转，具体不详。某次就诊时间发现“胃底息肉”，行“内镜下胃底息肉切除术”。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：114/69mmHg,Ht：157cm，Wt：53kg，BSA：1.52m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽左侧壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D7] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- [全程D7] 检验组合: 平均红细胞体积(MCV)-静脉血: 91.1fL；总钙(Ca)-静脉血: 2.21mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24.2U/L；碱性磷酸酶(ALP)-静脉血: 74.3U/L；IV型胶原(C-IV)-静脉血: 12.97ng/ml；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 35.9U/L；钾离子(K+)-静脉血: 3.76mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；D-二聚体(D-Dimer)-静脉血: 0.07ug/ml；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；淀粉样蛋白A(SAA)-静脉血: 2.44mg/L；C-反应蛋白(CRP)-静脉血: 1.92mg/L；凝血酶原时间活动度(PTA)-静脉血: 120%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.67；载脂蛋白B(apoB)-静脉血: 1.07g/L；球蛋白(GLO)-静脉血: 26.18g/L；磷(P)-静脉血: 1.03mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；胱抑素(Cys-C)-静脉血: 0.79mg/L；红细胞计数(RBC#)-静脉血: 5.2710E12/L；单核细胞计数(Mono#)-静脉血: 110E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.6sec.；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.87；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.411ng/ml（参考: <0.584）；尿素氮(BUN)-静脉血: 4.7mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；血小板计数(PLT#)-静脉血: 21810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.578；凝血酶原时间(PT)-静脉血: 10.1sec.；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.05mmol/L；尿酸(UA)-静脉血: 331.5umol/L；阴离子间隙(AG)-静脉血: 15.7；层粘……\n- [全程D10] 内镜；胃镜: 检查类型: 内镜；检查名称: 胃镜；检查部位:；检查所见: 插镜情况：顺利 送达部位：十二指肠降部。 食 管：粘膜光滑, 舒缩好。 贲 门：开闭好, E-G线清楚。 胃 底：粘液湖清亮，粘膜光滑，无静脉曲张。 胃 体：花斑样充血，未见溃疡肿物。 胃 角：弧形， 光滑。 胃 窦：蠕动好，粘膜呈花斑样充血，未见溃疡肿物。 幽 门：圆， 开闭好。 球 部：球腔变形，后壁可见霜斑样溃疡，表面附着白苔。 降 部：十二指肠乳头及降部粘膜未见异常。 请4个工作日后到病理科（5楼）取活检结果。；检查结论: 十二指肠球部霜斑样溃疡 慢性浅表性胃炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D24] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽左侧顶后壁及左侧壁局部粘膜增厚形成软组织影放射性浓聚，SUV约21.0，堵塞左侧鼻后孔，鼻咽腔变窄，累及左侧翼突基底部及犁骨。左侧咽隐窝变，右侧咽隐窝未见明显异常，双侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。口咽及喉咽结构及放射性分布未见明显异常。额窦、蝶窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双上颈小淋巴结放射性分布未见明显异常。 双上肺尖、右中肺内侧段及左下肺后基底段少许条索影放射性分布未见明显异常；其余双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏S4低密度影放射性分布未见明显异常，大小约0.6×0.6cm，边界尚清，密度欠均匀，CT值约26Hu；其余肝脏密度减低，CT值约50Hu，结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。盆腔盆底静脉内多发点状/小结节状高密度影放射性缺损。 所见颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，侵犯左侧鼻后孔，累及颅底骨。 肝S4低密度影代谢未见明显异常，建议随诊。 脂肪肝。\n- [全程D29] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.013；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 6.5\n- [全程D30] 检验组合: 浊度(TRUB)-尿液: 清亮；白细胞计数(WBC#)-尿液: 3/μL；白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.023；酮体(KET)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 13/μL；颜色-尿液: Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；隐血(OB)-尿液: 1+ 0.6mg（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D31] 检验组合: 红细胞计数(RBC#)-静脉血: 4.6210E12/L；血小板计数(PLT#)-静脉血: 22810E9/L；大血小板百分比(P-LCR%)-静脉血: 21.2%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.61mmol/L；白蛋白(ALB)-静脉血: 38.5g/L；间接胆红素(IBIL)-静脉血: 8.4umolL；球蛋白(GLO)-静脉血: 25.82g/L；单核细胞百分比(Mono%)-静脉血: 0.093；血小板分布宽度(PDW)-静脉血: 10.8%；红细胞比容(Hct)-静脉血: 41.4%；总蛋白(TP)-静脉血: 64.32g/L；单核细胞计数(Mono#)-静脉血: 1.510E9/L；葡萄糖(Glu)-静脉血: 5.98mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.6；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；总胆红素(TBIL)-静脉血: 12.9umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 176.9U/L；甘油三酯(TG)-静脉血: 1.4mmol/L；乳酸脱氢酶(LDH)-静脉血: 239U/L；总胆汁酸(TBA)-静脉血: 3umol/L；直接胆红素(DBIL)-静脉血: 4.5umol/L；肌酐(Crea)-静脉血: 70umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.7；尿素氮(BUN)-静脉血: 6.02mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 136.5U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；天门冬氨酸氨基转移酶(AST)-静脉血: 104.5U/L；磷(P)-静脉血: 1.34mmol/L；钠离子(Na+)-静脉血: 138.8mmol/L；平均红细胞体积(MCV)-静脉血: 89.6fL；白细胞计数(WBC#)-静脉血: 15.9910E9/L；载脂蛋白AI(apoAI)-静脉血: 1.29g/L；阴离子间隙(AG)-静脉血: 14；C-反应蛋白(CRP)-静脉血: 1.98mg/L；钾离子(K+)-静脉血: 3.5mmol/L；碱性磷酸酶(ALP)-静脉血:……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D8] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者相关检查完善中，请假未回病房。\n- [全程D13] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者相关检查完善中，请假未回病房。\n- [全程D19] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者元旦假期请假中。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D29] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者无明显不适主诉，查体情况：一般情况可，余同入院。放疗计划已完善。[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，向患者及其家属交代病情及化疗风险，表示理解并已签署知情同意书，同意入组三周/单周DDP同时期化疗临床试验，抽签入三周组，可于今日执行第1程顺铂方案同时期化疗，注意化疗不良反应，开始放疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放化疗，给予多烯磷脂酰胆碱、还原型谷胱甘肽等静脉保肝治疗，待肝功能恢复正常后恢复放化疗。\nB. 继续放化疗，仅密切监测肝功能变化，暂不给予静脉保肝药物干预。\nC. 继续放化疗，给予广谱抗生素静脉滴注预防感染，并辅以雾化吸入及止吐等对症支持处理。\nD. 将顺铂方案调整为卡铂方案同时期化疗，并给予静脉保肝治疗及止吐等对症支持处理。\nE. 顺铂剂量减低25%继续同时期化疗，给予静脉保肝治疗，辅以雾化吸入及止吐等对症支持处理。\nF. 暂停顺铂化疗，继续单纯放疗，给予静脉保肝治疗，待肝功能恢复后补足化疗周期。\nG. 给予多烯磷脂酰胆碱、还原型谷胱甘肽、复方甘草酸苷等静脉保肝治疗，辅以雾化吸入及止吐等对症支持处理。\nH. 给予大剂量质子泵抑制剂静脉滴注预防消化道出血，暂缓保肝治疗，继续放化疗。\nI. 暂停放疗，继续顺铂化疗，给予静脉保肝治疗及止吐等对症支持处理。\nJ. 给予静脉保肝治疗，行骨髓穿刺检查排除血液系统异常，继续放化疗。\nK. 终止临床试验，转为常规单药顺铂同时期放化疗，并给予静脉保肝治疗。\nL. 给予口服保肝药物治疗，辅以雾化吸入及止吐等对症支持处理，继续放化疗。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-1d71f20ed555c71c5a4de4ee","patient_id":"patient-51e6f99c527367bbd97aebd8","turn_id":"turn06","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"H","gold_action":"给予联苯双酯等保肝降酶药物，辅以静脉营养支持，并密切复查肝功能。","options":[{"letter":"A","text":"暂停放疗与化疗，给予异甘草酸镁静脉滴注，待转氨酶降至正常水平后重启治疗。","is_gold":false},{"letter":"B","text":"终止顺铂化疗，后续疗程替换为卡铂，并加用甲泼尼龙静脉滴注。","is_gold":false},{"letter":"C","text":"暂停放疗，继续按计划执行化疗，给予联苯双酯口服及静脉营养支持。","is_gold":false},{"letter":"D","text":"维持治疗节奏，暂不加用保肝药物，1周后常规复查肝肾功能。","is_gold":false},{"letter":"E","text":"加用恩替卡韦口服抗病毒治疗，并维持放化疗方案不变。","is_gold":false},{"letter":"F","text":"安排肝脏病灶穿刺活检，明确病理性质前暂停所有抗肿瘤治疗。","is_gold":false},{"letter":"G","text":"给予重组人粒细胞集落刺激因子皮下注射，辅以静脉营养支持。","is_gold":false},{"letter":"H","text":"给予联苯双酯等保肝降酶药物，辅以静脉营养支持，并密切复查肝功能。","is_gold":true},{"letter":"I","text":"给予重组人血小板生成素皮下注射，并推迟下一疗程化疗。","is_gold":false},{"letter":"J","text":"给予头孢哌酮舒巴坦静脉滴注抗感染，并密切复查肝功能。","is_gold":false},{"letter":"K","text":"给予保肝降酶药物治疗，并按比例降低后续颈部放疗靶区处方剂量。","is_gold":false},{"letter":"L","text":"立即行血浆置换治疗，暂停放疗及化疗。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：鼻腔。\n文本分期信息：N0，M0。\n综合TNM状态：T1N0M0。\n综合分期：IA。\n\n【已知病史与当前主诉】\n- [全程D6] 入院记录: 主诉: 涕血2月；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血；既往史: “胃溃疡”病史22年，于某次就诊时间、某次就诊时间发生2次“胃出血”，经“输血”、“药物”治疗后好转，具体不详。某次就诊时间发现“胃底息肉”，行“内镜下胃底息肉切除术”。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：114/69mmHg,Ht：157cm，Wt：53kg，BSA：1.52m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽左侧壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D7] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- [全程D7] 检验组合: 平均红细胞体积(MCV)-静脉血: 91.1fL；总钙(Ca)-静脉血: 2.21mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24.2U/L；碱性磷酸酶(ALP)-静脉血: 74.3U/L；IV型胶原(C-IV)-静脉血: 12.97ng/ml；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 35.9U/L；钾离子(K+)-静脉血: 3.76mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；D-二聚体(D-Dimer)-静脉血: 0.07ug/ml；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；淀粉样蛋白A(SAA)-静脉血: 2.44mg/L；C-反应蛋白(CRP)-静脉血: 1.92mg/L；凝血酶原时间活动度(PTA)-静脉血: 120%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.67；载脂蛋白B(apoB)-静脉血: 1.07g/L；球蛋白(GLO)-静脉血: 26.18g/L；磷(P)-静脉血: 1.03mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；胱抑素(Cys-C)-静脉血: 0.79mg/L；红细胞计数(RBC#)-静脉血: 5.2710E12/L；单核细胞计数(Mono#)-静脉血: 110E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.6sec.；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.87；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.411ng/ml（参考: <0.584）；尿素氮(BUN)-静脉血: 4.7mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；血小板计数(PLT#)-静脉血: 21810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.578；凝血酶原时间(PT)-静脉血: 10.1sec.；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.05mmol/L；尿酸(UA)-静脉血: 331.5umol/L；阴离子间隙(AG)-静脉血: 15.7；层粘……\n- [全程D10] 内镜；胃镜: 检查类型: 内镜；检查名称: 胃镜；检查部位:；检查所见: 插镜情况：顺利 送达部位：十二指肠降部。 食 管：粘膜光滑, 舒缩好。 贲 门：开闭好, E-G线清楚。 胃 底：粘液湖清亮，粘膜光滑，无静脉曲张。 胃 体：花斑样充血，未见溃疡肿物。 胃 角：弧形， 光滑。 胃 窦：蠕动好，粘膜呈花斑样充血，未见溃疡肿物。 幽 门：圆， 开闭好。 球 部：球腔变形，后壁可见霜斑样溃疡，表面附着白苔。 降 部：十二指肠乳头及降部粘膜未见异常。 请4个工作日后到病理科（5楼）取活检结果。；检查结论: 十二指肠球部霜斑样溃疡 慢性浅表性胃炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D24] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽左侧顶后壁及左侧壁局部粘膜增厚形成软组织影放射性浓聚，SUV约21.0，堵塞左侧鼻后孔，鼻咽腔变窄，累及左侧翼突基底部及犁骨。左侧咽隐窝变，右侧咽隐窝未见明显异常，双侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。口咽及喉咽结构及放射性分布未见明显异常。额窦、蝶窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双上颈小淋巴结放射性分布未见明显异常。 双上肺尖、右中肺内侧段及左下肺后基底段少许条索影放射性分布未见明显异常；其余双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏S4低密度影放射性分布未见明显异常，大小约0.6×0.6cm，边界尚清，密度欠均匀，CT值约26Hu；其余肝脏密度减低，CT值约50Hu，结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。盆腔盆底静脉内多发点状/小结节状高密度影放射性缺损。 所见颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，侵犯左侧鼻后孔，累及颅底骨。 肝S4低密度影代谢未见明显异常，建议随诊。 脂肪肝。\n- [全程D29] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.013；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 6.5\n- [全程D30] 检验组合: 浊度(TRUB)-尿液: 清亮；白细胞计数(WBC#)-尿液: 3/μL；白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.023；酮体(KET)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 13/μL；颜色-尿液: Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；隐血(OB)-尿液: 1+ 0.6mg（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D31] 检验组合: 红细胞计数(RBC#)-静脉血: 4.6210E12/L；血小板计数(PLT#)-静脉血: 22810E9/L；大血小板百分比(P-LCR%)-静脉血: 21.2%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.61mmol/L；白蛋白(ALB)-静脉血: 38.5g/L；间接胆红素(IBIL)-静脉血: 8.4umolL；球蛋白(GLO)-静脉血: 25.82g/L；单核细胞百分比(Mono%)-静脉血: 0.093；血小板分布宽度(PDW)-静脉血: 10.8%；红细胞比容(Hct)-静脉血: 41.4%；总蛋白(TP)-静脉血: 64.32g/L；单核细胞计数(Mono#)-静脉血: 1.510E9/L；葡萄糖(Glu)-静脉血: 5.98mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.6；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；总胆红素(TBIL)-静脉血: 12.9umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 176.9U/L；甘油三酯(TG)-静脉血: 1.4mmol/L；乳酸脱氢酶(LDH)-静脉血: 239U/L；总胆汁酸(TBA)-静脉血: 3umol/L；直接胆红素(DBIL)-静脉血: 4.5umol/L；肌酐(Crea)-静脉血: 70umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.7；尿素氮(BUN)-静脉血: 6.02mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 136.5U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；天门冬氨酸氨基转移酶(AST)-静脉血: 104.5U/L；磷(P)-静脉血: 1.34mmol/L；钠离子(Na+)-静脉血: 138.8mmol/L；平均红细胞体积(MCV)-静脉血: 89.6fL；白细胞计数(WBC#)-静脉血: 15.9910E9/L；载脂蛋白AI(apoAI)-静脉血: 1.29g/L；阴离子间隙(AG)-静脉血: 14；C-反应蛋白(CRP)-静脉血: 1.98mg/L；钾离子(K+)-静脉血: 3.5mmol/L；碱性磷酸酶(ALP)-静脉血:……\n- [全程D32] 检验组合: 胱抑素(Cys-C)-静脉血: 0.73mg/L；乳酸脱氢酶(LDH)-静脉血: 162.4U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.51mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；淋巴细胞百分比(Lymph%)-静脉血: 0.05；平均红细胞血红蛋白含量(MCH)-静脉血: 29.9pg；血红蛋白(Hb)-静脉血: 137.4g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 5.43mmol/L；白蛋白(ALB)-静脉血: 43.2g/L；肌酐(Crea)-静脉血: 86.7umol/L；氯离子(Cl-)-静脉血: 97.6mmol/L；C-反应蛋白(CRP)-静脉血: 6.52mg/L；钾离子(K+)-静脉血: 4.2mmol/L；尿酸(UA)-静脉血: 298.5umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.15mmolL；载脂蛋白B(apoB)-静脉血: 1.3g/L；血小板比容-静脉血: 14.7%；血小板分布宽度(PDW)-静脉血: 8.7%；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.41mmolL；有核红细胞百分比(NRBC%)-静脉血: 0；血小板比容-静脉血: 14%；总胆固醇(TC)-静脉血: 7.5mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；甘油三酯(TG)-静脉血: 1.38mmol/L；平均血小板体积(MPV)-静脉血: 8.9fL；平均红细胞体积(MCV)-静脉血: 90.2fL；γ-谷氨酰基转移酶(GGT)-静脉血: 97.8U/L；阴离子间隙(AG)-静脉血: 17；胱抑素(Cys-C)-静脉血: 1.03mg/L；氯离子(Cl-)-静脉血: 96.7mmol/L；血小板分布宽度(PDW)-静脉血: 16.1%；平均血小板体积(MPV)-静脉血: 6.78fL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；球蛋白(GLO)-静脉血: 35.61g/L；镁离子(Mg2+)-静脉血: 0.66mmol/L；间接胆红素(IBIL)-静脉血: 6.3umolL；γ-谷氨酰基转移酶(GGT)-静脉血: 151U/L；阴离子间隙(AG)-静脉血: 17；单核细胞计数(Mono#)-……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D8] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者相关检查完善中，请假未回病房。\n- [全程D13] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者相关检查完善中，请假未回病房。\n- [全程D19] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者元旦假期请假中。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D29] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者无明显不适主诉，查体情况：一般情况可，余同入院。放疗计划已完善。[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，向患者及其家属交代病情及化疗风险，表示理解并已签署知情同意书，同意入组三周/单周DDP同时期化疗临床试验，抽签入三周组，可于今日执行第1程顺铂方案同时期化疗，注意化疗不良反应，开始放疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗与化疗，给予异甘草酸镁静脉滴注，待转氨酶降至正常水平后重启治疗。\nB. 终止顺铂化疗，后续疗程替换为卡铂，并加用甲泼尼龙静脉滴注。\nC. 暂停放疗，继续按计划执行化疗，给予联苯双酯口服及静脉营养支持。\nD. 维持治疗节奏，暂不加用保肝药物，1周后常规复查肝肾功能。\nE. 加用恩替卡韦口服抗病毒治疗，并维持放化疗方案不变。\nF. 安排肝脏病灶穿刺活检，明确病理性质前暂停所有抗肿瘤治疗。\nG. 给予重组人粒细胞集落刺激因子皮下注射，辅以静脉营养支持。\nH. 给予联苯双酯等保肝降酶药物，辅以静脉营养支持，并密切复查肝功能。\nI. 给予重组人血小板生成素皮下注射，并推迟下一疗程化疗。\nJ. 给予头孢哌酮舒巴坦静脉滴注抗感染，并密切复查肝功能。\nK. 给予保肝降酶药物治疗，并按比例降低后续颈部放疗靶区处方剂量。\nL. 立即行血浆置换治疗，暂停放疗及化疗。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：鼻腔。\n文本分期信息：N0，M0。\n综合TNM状态：T1N0M0。\n综合分期：IA。\n\n【已知病史与当前主诉】\n- [全程D6] 入院记录: 主诉: 涕血2月；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血；既往史: “胃溃疡”病史22年，于某次就诊时间、某次就诊时间发生2次“胃出血”，经“输血”、“药物”治疗后好转，具体不详。某次就诊时间发现“胃底息肉”，行“内镜下胃底息肉切除术”。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：114/69mmHg,Ht：157cm，Wt：53kg，BSA：1.52m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽左侧壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D7] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- [全程D7] 检验组合: 平均红细胞体积(MCV)-静脉血: 91.1fL；总钙(Ca)-静脉血: 2.21mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24.2U/L；碱性磷酸酶(ALP)-静脉血: 74.3U/L；IV型胶原(C-IV)-静脉血: 12.97ng/ml；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 35.9U/L；钾离子(K+)-静脉血: 3.76mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；D-二聚体(D-Dimer)-静脉血: 0.07ug/ml；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；淀粉样蛋白A(SAA)-静脉血: 2.44mg/L；C-反应蛋白(CRP)-静脉血: 1.92mg/L；凝血酶原时间活动度(PTA)-静脉血: 120%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.67；载脂蛋白B(apoB)-静脉血: 1.07g/L；球蛋白(GLO)-静脉血: 26.18g/L；磷(P)-静脉血: 1.03mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；胱抑素(Cys-C)-静脉血: 0.79mg/L；红细胞计数(RBC#)-静脉血: 5.2710E12/L；单核细胞计数(Mono#)-静脉血: 110E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.6sec.；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.87；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.411ng/ml（参考: <0.584）；尿素氮(BUN)-静脉血: 4.7mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；血小板计数(PLT#)-静脉血: 21810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.578；凝血酶原时间(PT)-静脉血: 10.1sec.；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.05mmol/L；尿酸(UA)-静脉血: 331.5umol/L；阴离子间隙(AG)-静脉血: 15.7；层粘……\n- [全程D10] 内镜；胃镜: 检查类型: 内镜；检查名称: 胃镜；检查部位:；检查所见: 插镜情况：顺利 送达部位：十二指肠降部。 食 管：粘膜光滑, 舒缩好。 贲 门：开闭好, E-G线清楚。 胃 底：粘液湖清亮，粘膜光滑，无静脉曲张。 胃 体：花斑样充血，未见溃疡肿物。 胃 角：弧形， 光滑。 胃 窦：蠕动好，粘膜呈花斑样充血，未见溃疡肿物。 幽 门：圆， 开闭好。 球 部：球腔变形，后壁可见霜斑样溃疡，表面附着白苔。 降 部：十二指肠乳头及降部粘膜未见异常。 请4个工作日后到病理科（5楼）取活检结果。；检查结论: 十二指肠球部霜斑样溃疡 慢性浅表性胃炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D24] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽左侧顶后壁及左侧壁局部粘膜增厚形成软组织影放射性浓聚，SUV约21.0，堵塞左侧鼻后孔，鼻咽腔变窄，累及左侧翼突基底部及犁骨。左侧咽隐窝变，右侧咽隐窝未见明显异常，双侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。口咽及喉咽结构及放射性分布未见明显异常。额窦、蝶窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双上颈小淋巴结放射性分布未见明显异常。 双上肺尖、右中肺内侧段及左下肺后基底段少许条索影放射性分布未见明显异常；其余双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏S4低密度影放射性分布未见明显异常，大小约0.6×0.6cm，边界尚清，密度欠均匀，CT值约26Hu；其余肝脏密度减低，CT值约50Hu，结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。盆腔盆底静脉内多发点状/小结节状高密度影放射性缺损。 所见颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，侵犯左侧鼻后孔，累及颅底骨。 肝S4低密度影代谢未见明显异常，建议随诊。 脂肪肝。\n- [全程D29] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.013；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 6.5\n- [全程D30] 检验组合: 浊度(TRUB)-尿液: 清亮；白细胞计数(WBC#)-尿液: 3/μL；白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.023；酮体(KET)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 13/μL；颜色-尿液: Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；隐血(OB)-尿液: 1+ 0.6mg（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D31] 检验组合: 红细胞计数(RBC#)-静脉血: 4.6210E12/L；血小板计数(PLT#)-静脉血: 22810E9/L；大血小板百分比(P-LCR%)-静脉血: 21.2%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.61mmol/L；白蛋白(ALB)-静脉血: 38.5g/L；间接胆红素(IBIL)-静脉血: 8.4umolL；球蛋白(GLO)-静脉血: 25.82g/L；单核细胞百分比(Mono%)-静脉血: 0.093；血小板分布宽度(PDW)-静脉血: 10.8%；红细胞比容(Hct)-静脉血: 41.4%；总蛋白(TP)-静脉血: 64.32g/L；单核细胞计数(Mono#)-静脉血: 1.510E9/L；葡萄糖(Glu)-静脉血: 5.98mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.6；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；总胆红素(TBIL)-静脉血: 12.9umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 176.9U/L；甘油三酯(TG)-静脉血: 1.4mmol/L；乳酸脱氢酶(LDH)-静脉血: 239U/L；总胆汁酸(TBA)-静脉血: 3umol/L；直接胆红素(DBIL)-静脉血: 4.5umol/L；肌酐(Crea)-静脉血: 70umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.7；尿素氮(BUN)-静脉血: 6.02mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 136.5U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；天门冬氨酸氨基转移酶(AST)-静脉血: 104.5U/L；磷(P)-静脉血: 1.34mmol/L；钠离子(Na+)-静脉血: 138.8mmol/L；平均红细胞体积(MCV)-静脉血: 89.6fL；白细胞计数(WBC#)-静脉血: 15.9910E9/L；载脂蛋白AI(apoAI)-静脉血: 1.29g/L；阴离子间隙(AG)-静脉血: 14；C-反应蛋白(CRP)-静脉血: 1.98mg/L；钾离子(K+)-静脉血: 3.5mmol/L；碱性磷酸酶(ALP)-静脉血:……\n- [全程D32] 检验组合: 胱抑素(Cys-C)-静脉血: 0.73mg/L；乳酸脱氢酶(LDH)-静脉血: 162.4U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.51mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；淋巴细胞百分比(Lymph%)-静脉血: 0.05；平均红细胞血红蛋白含量(MCH)-静脉血: 29.9pg；血红蛋白(Hb)-静脉血: 137.4g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 5.43mmol/L；白蛋白(ALB)-静脉血: 43.2g/L；肌酐(Crea)-静脉血: 86.7umol/L；氯离子(Cl-)-静脉血: 97.6mmol/L；C-反应蛋白(CRP)-静脉血: 6.52mg/L；钾离子(K+)-静脉血: 4.2mmol/L；尿酸(UA)-静脉血: 298.5umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.15mmolL；载脂蛋白B(apoB)-静脉血: 1.3g/L；血小板比容-静脉血: 14.7%；血小板分布宽度(PDW)-静脉血: 8.7%；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.41mmolL；有核红细胞百分比(NRBC%)-静脉血: 0；血小板比容-静脉血: 14%；总胆固醇(TC)-静脉血: 7.5mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；甘油三酯(TG)-静脉血: 1.38mmol/L；平均血小板体积(MPV)-静脉血: 8.9fL；平均红细胞体积(MCV)-静脉血: 90.2fL；γ-谷氨酰基转移酶(GGT)-静脉血: 97.8U/L；阴离子间隙(AG)-静脉血: 17；胱抑素(Cys-C)-静脉血: 1.03mg/L；氯离子(Cl-)-静脉血: 96.7mmol/L；血小板分布宽度(PDW)-静脉血: 16.1%；平均血小板体积(MPV)-静脉血: 6.78fL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；球蛋白(GLO)-静脉血: 35.61g/L；镁离子(Mg2+)-静脉血: 0.66mmol/L；间接胆红素(IBIL)-静脉血: 6.3umolL；γ-谷氨酰基转移酶(GGT)-静脉血: 151U/L；阴离子间隙(AG)-静脉血: 17；单核细胞计数(Mono#)-……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D8] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者相关检查完善中，请假未回病房。\n- [全程D13] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者相关检查完善中，请假未回病房。\n- [全程D19] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者元旦假期请假中。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D29] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者无明显不适主诉，查体情况：一般情况可，余同入院。放疗计划已完善。[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，向患者及其家属交代病情及化疗风险，表示理解并已签署知情同意书，同意入组三周/单周DDP同时期化疗临床试验，抽签入三周组，可于今日执行第1程顺铂方案同时期化疗，注意化疗不良反应，开始放疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗与化疗，给予异甘草酸镁静脉滴注，待转氨酶降至正常水平后重启治疗。\nB. 终止顺铂化疗，后续疗程替换为卡铂，并加用甲泼尼龙静脉滴注。\nC. 暂停放疗，继续按计划执行化疗，给予联苯双酯口服及静脉营养支持。\nD. 维持治疗节奏，暂不加用保肝药物，1周后常规复查肝肾功能。\nE. 加用恩替卡韦口服抗病毒治疗，并维持放化疗方案不变。\nF. 安排肝脏病灶穿刺活检，明确病理性质前暂停所有抗肿瘤治疗。\nG. 给予重组人粒细胞集落刺激因子皮下注射，辅以静脉营养支持。\nH. 给予联苯双酯等保肝降酶药物，辅以静脉营养支持，并密切复查肝功能。\nI. 给予重组人血小板生成素皮下注射，并推迟下一疗程化疗。\nJ. 给予头孢哌酮舒巴坦静脉滴注抗感染，并密切复查肝功能。\nK. 给予保肝降酶药物治疗，并按比例降低后续颈部放疗靶区处方剂量。\nL. 立即行血浆置换治疗，暂停放疗及化疗。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-5eba0030ab5d024288a0d69d","patient_id":"patient-51e6f99c527367bbd97aebd8","turn_id":"turn07","turn_position":5,"turn_type":"response_assessment_decision","gold_letter":"I","gold_action":"继续根治性放疗，给予雾化吸入氨溴索与地塞米松，并局部外用三乙醇胺乳膏。","options":[{"letter":"A","text":"暂停放疗，给予静脉滴注广谱抗菌药物及大剂量糖皮质激素。","is_gold":false},{"letter":"B","text":"暂停放疗，行肝脏穿刺活检明确肝脏病灶性质后调整全身系统性化疗方案。","is_gold":false},{"letter":"C","text":"继续根治性放疗，给予重组人粒细胞集落刺激因子（G-CSF）皮下注射。","is_gold":false},{"letter":"D","text":"继续根治性放疗，加用第3程顺铂同期化疗，并给予静脉保肝药物。","is_gold":false},{"letter":"E","text":"终止放疗，转为TPF方案全身系统性化疗。","is_gold":false},{"letter":"F","text":"继续根治性放疗，局部外用强效糖皮质激素软膏，并口服非甾体抗炎药。","is_gold":false},{"letter":"G","text":"暂停放疗，复查鼻咽及颈部MRI以决定是否降低后续放疗靶区剂量。","is_gold":false},{"letter":"H","text":"继续根治性放疗，给予静脉异甘草酸镁及还原型谷胱甘肽保肝治疗。","is_gold":false},{"letter":"I","text":"继续根治性放疗，给予雾化吸入氨溴索与地塞米松，并局部外用三乙醇胺乳膏。","is_gold":true},{"letter":"J","text":"继续根治性放疗，联合靶向药物尼妥珠单抗及PD-1抑制剂治疗。","is_gold":false},{"letter":"K","text":"继续根治性放疗，给予静脉滴注地塞米松，并局部外用莫匹罗星软膏。","is_gold":false},{"letter":"L","text":"结束放化疗综合治疗，进入随访观察期，定期复查鼻咽MRI及颈部超声。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：鼻腔。\n文本分期信息：N0，M0。\n综合TNM状态：T1N0M0。\n综合分期：IA。\n\n【已知病史与当前主诉】\n- [全程D6] 入院记录: 主诉: 涕血2月；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血；既往史: “胃溃疡”病史22年，于某次就诊时间、某次就诊时间发生2次“胃出血”，经“输血”、“药物”治疗后好转，具体不详。某次就诊时间发现“胃底息肉”，行“内镜下胃底息肉切除术”。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：114/69mmHg,Ht：157cm，Wt：53kg，BSA：1.52m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽左侧壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D7] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- [全程D7] 检验组合: 平均红细胞体积(MCV)-静脉血: 91.1fL；总钙(Ca)-静脉血: 2.21mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24.2U/L；碱性磷酸酶(ALP)-静脉血: 74.3U/L；IV型胶原(C-IV)-静脉血: 12.97ng/ml；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 35.9U/L；钾离子(K+)-静脉血: 3.76mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；D-二聚体(D-Dimer)-静脉血: 0.07ug/ml；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；淀粉样蛋白A(SAA)-静脉血: 2.44mg/L；C-反应蛋白(CRP)-静脉血: 1.92mg/L；凝血酶原时间活动度(PTA)-静脉血: 120%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.67；载脂蛋白B(apoB)-静脉血: 1.07g/L；球蛋白(GLO)-静脉血: 26.18g/L；磷(P)-静脉血: 1.03mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；胱抑素(Cys-C)-静脉血: 0.79mg/L；红细胞计数(RBC#)-静脉血: 5.2710E12/L；单核细胞计数(Mono#)-静脉血: 110E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.6sec.；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.87；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.411ng/ml（参考: <0.584）；尿素氮(BUN)-静脉血: 4.7mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；血小板计数(PLT#)-静脉血: 21810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.578；凝血酶原时间(PT)-静脉血: 10.1sec.；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.05mmol/L；尿酸(UA)-静脉血: 331.5umol/L；阴离子间隙(AG)-静脉血: 15.7；层粘……\n- [全程D10] 内镜；胃镜: 检查类型: 内镜；检查名称: 胃镜；检查部位:；检查所见: 插镜情况：顺利 送达部位：十二指肠降部。 食 管：粘膜光滑, 舒缩好。 贲 门：开闭好, E-G线清楚。 胃 底：粘液湖清亮，粘膜光滑，无静脉曲张。 胃 体：花斑样充血，未见溃疡肿物。 胃 角：弧形， 光滑。 胃 窦：蠕动好，粘膜呈花斑样充血，未见溃疡肿物。 幽 门：圆， 开闭好。 球 部：球腔变形，后壁可见霜斑样溃疡，表面附着白苔。 降 部：十二指肠乳头及降部粘膜未见异常。 请4个工作日后到病理科（5楼）取活检结果。；检查结论: 十二指肠球部霜斑样溃疡 慢性浅表性胃炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D24] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽左侧顶后壁及左侧壁局部粘膜增厚形成软组织影放射性浓聚，SUV约21.0，堵塞左侧鼻后孔，鼻咽腔变窄，累及左侧翼突基底部及犁骨。左侧咽隐窝变，右侧咽隐窝未见明显异常，双侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。口咽及喉咽结构及放射性分布未见明显异常。额窦、蝶窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双上颈小淋巴结放射性分布未见明显异常。 双上肺尖、右中肺内侧段及左下肺后基底段少许条索影放射性分布未见明显异常；其余双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏S4低密度影放射性分布未见明显异常，大小约0.6×0.6cm，边界尚清，密度欠均匀，CT值约26Hu；其余肝脏密度减低，CT值约50Hu，结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。盆腔盆底静脉内多发点状/小结节状高密度影放射性缺损。 所见颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，侵犯左侧鼻后孔，累及颅底骨。 肝S4低密度影代谢未见明显异常，建议随诊。 脂肪肝。\n- [全程D29] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.013；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 6.5\n- [全程D30] 检验组合: 浊度(TRUB)-尿液: 清亮；白细胞计数(WBC#)-尿液: 3/μL；白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.023；酮体(KET)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 13/μL；颜色-尿液: Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；隐血(OB)-尿液: 1+ 0.6mg（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D31] 检验组合: 红细胞计数(RBC#)-静脉血: 4.6210E12/L；血小板计数(PLT#)-静脉血: 22810E9/L；大血小板百分比(P-LCR%)-静脉血: 21.2%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.61mmol/L；白蛋白(ALB)-静脉血: 38.5g/L；间接胆红素(IBIL)-静脉血: 8.4umolL；球蛋白(GLO)-静脉血: 25.82g/L；单核细胞百分比(Mono%)-静脉血: 0.093；血小板分布宽度(PDW)-静脉血: 10.8%；红细胞比容(Hct)-静脉血: 41.4%；总蛋白(TP)-静脉血: 64.32g/L；单核细胞计数(Mono#)-静脉血: 1.510E9/L；葡萄糖(Glu)-静脉血: 5.98mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.6；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；总胆红素(TBIL)-静脉血: 12.9umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 176.9U/L；甘油三酯(TG)-静脉血: 1.4mmol/L；乳酸脱氢酶(LDH)-静脉血: 239U/L；总胆汁酸(TBA)-静脉血: 3umol/L；直接胆红素(DBIL)-静脉血: 4.5umol/L；肌酐(Crea)-静脉血: 70umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.7；尿素氮(BUN)-静脉血: 6.02mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 136.5U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；天门冬氨酸氨基转移酶(AST)-静脉血: 104.5U/L；磷(P)-静脉血: 1.34mmol/L；钠离子(Na+)-静脉血: 138.8mmol/L；平均红细胞体积(MCV)-静脉血: 89.6fL；白细胞计数(WBC#)-静脉血: 15.9910E9/L；载脂蛋白AI(apoAI)-静脉血: 1.29g/L；阴离子间隙(AG)-静脉血: 14；C-反应蛋白(CRP)-静脉血: 1.98mg/L；钾离子(K+)-静脉血: 3.5mmol/L；碱性磷酸酶(ALP)-静脉血:……\n- [全程D32] 检验组合: 胱抑素(Cys-C)-静脉血: 0.73mg/L；乳酸脱氢酶(LDH)-静脉血: 162.4U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.51mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；淋巴细胞百分比(Lymph%)-静脉血: 0.05；平均红细胞血红蛋白含量(MCH)-静脉血: 29.9pg；血红蛋白(Hb)-静脉血: 137.4g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 5.43mmol/L；白蛋白(ALB)-静脉血: 43.2g/L；肌酐(Crea)-静脉血: 86.7umol/L；氯离子(Cl-)-静脉血: 97.6mmol/L；C-反应蛋白(CRP)-静脉血: 6.52mg/L；钾离子(K+)-静脉血: 4.2mmol/L；尿酸(UA)-静脉血: 298.5umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.15mmolL；载脂蛋白B(apoB)-静脉血: 1.3g/L；血小板比容-静脉血: 14.7%；血小板分布宽度(PDW)-静脉血: 8.7%；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.41mmolL；有核红细胞百分比(NRBC%)-静脉血: 0；血小板比容-静脉血: 14%；总胆固醇(TC)-静脉血: 7.5mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；甘油三酯(TG)-静脉血: 1.38mmol/L；平均血小板体积(MPV)-静脉血: 8.9fL；平均红细胞体积(MCV)-静脉血: 90.2fL；γ-谷氨酰基转移酶(GGT)-静脉血: 97.8U/L；阴离子间隙(AG)-静脉血: 17；胱抑素(Cys-C)-静脉血: 1.03mg/L；氯离子(Cl-)-静脉血: 96.7mmol/L；血小板分布宽度(PDW)-静脉血: 16.1%；平均血小板体积(MPV)-静脉血: 6.78fL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；球蛋白(GLO)-静脉血: 35.61g/L；镁离子(Mg2+)-静脉血: 0.66mmol/L；间接胆红素(IBIL)-静脉血: 6.3umolL；γ-谷氨酰基转移酶(GGT)-静脉血: 151U/L；阴离子间隙(AG)-静脉血: 17；单核细胞计数(Mono#)-……\n- [全程D41] 检验组合: 中性粒细胞计数(Neut#)-静脉血: 6.110E9/L；钠离子(Na+)-静脉血: 139.4mmol/L；尿素氮(BUN)-静脉血: 7.2mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.53；淋巴细胞计数(Lymph#)-静脉血: 0.910E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 42.7U/L；丙氨酸氨基转移酶(ALT)-静脉血: 35.4U/L；甘油三酯(TG)-静脉血: 1.71mmol/L；白细胞计数(WBC#)-静脉血: 7.7810E9/L；总蛋白(TP)-静脉血: 62.51g/L；血红蛋白(Hb)-静脉血: 131g/L；总钙(Ca)-静脉血: 2.05mmol/L；肌酐(Crea)-静脉血: 81.5umol/L；载脂蛋白B(apoB)-静脉血: 1.23g/L；白蛋白(ALB)-静脉血: 36.6g/L；中性粒细胞百分比(Neut%)-静脉血: 0.79；红细胞比容(Hct)-静脉血: 38.9%；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.6；淋巴细胞百分比(Lymph%)-静脉血: 0.113；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.006；大血小板百分比(P-LCR%)-静脉血: 15.3%；乳酸脱氢酶(LDH)-静脉血: 185.9U/L；间接胆红素(IBIL)-静脉血: 6.7umolL；氯离子(Cl-)-静脉血: 100.4mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.8U/L；血小板计数(PLT#)-静脉血: 15410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.3g/L；平均血小板体积(MPV)-静脉血: 8.9fL；胱抑素(Cys-C)-静脉血: 0.86mg/L；γ-谷氨酰基转移酶(GGT)-静脉血: 268.3U/L；总胆红素(TBIL)-静脉血: 8umol/L；葡萄糖(Glu)-静脉血: 5.28mmol/L；红细胞计数(RBC#)-静脉血: 4.3510E12/L；总胆汁酸(TBA)-静脉血: 2.7umol/L；血小板分……\n- [全程D49] 检验组合: 红细胞计数(RBC#)-尿液: 6/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；白细胞计数(WBC#)-尿液: 1/μL；比重(SG)-尿液: 1.009；胆红素(BIL)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: 无色；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮\n- [全程D50] 检验组合: 浊度(TRUB)-尿液: clear；酮体(KET)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 13/μL；比重(SG)-尿液: 1.017；白细胞计数(WBC#)-尿液: 10/μL；隐血(OB)-尿液: 1+0.6mg（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；总蛋白(TP)-尿液: -（参考: 阴性）；非鳞状上皮细胞计数-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 3/μL；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow\n- [全程D51] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；比重(SG)-尿液: 1.013；白细胞计数(WBC#)-尿液: 13/μL；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 8/μL；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；白细胞(LEU)-尿液: -（参考: 阴性）\n- [全程D52] 检验组合: 淋巴细胞百分比(Lymph%)-静脉血: 0.1；镁离子(Mg2+)-静脉血: 0.52mmol/L；尿素氮(BUN)-静脉血: 6.1mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.14mmolL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；总蛋白(TP)-静脉血: 64.42g/L；磷(P)-静脉血: 1.33mmol/L；总胆红素(TBIL)-静脉血: 6umol/L；氯离子(Cl-)-静脉血: 99.5mmol/L；红细胞比容(Hct)-静脉血: 36.9%；平均红细胞体积(MCV)-静脉血: 89.1fL；红细胞计数(RBC#)-静脉血: 4.1410E12/L；C-反应蛋白(CRP)-静脉血: 4.91mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；白细胞计数(WBC#)-静脉血: 3.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.253；血小板比容-静脉血: 20%；丙氨酸氨基转移酶(ALT)-静脉血: 42.9U/L；血液二氧化碳含量ctCO2(B)-静脉血: 26.2mmol/L；胱抑素(Cys-C)-静脉血: 1.28mg/L；球蛋白(GLO)-静脉血: 29.62g/L；甘油三酯(TG)-静脉血: 1.61mmol/L；尿酸(UA)-静脉血: 292.8umol/L；血小板分布宽度(PDW)-静脉血: 8.6%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.8；单核细胞计数(Mono#)-静脉血: 0.910E9/L；肌酐(Crea)-静脉血: 109.5umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.015；总胆固醇(TC)-静脉血: 5.96mmol/L；阴离子间隙(AG)-静脉血: 12；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 47U/L；平均血小板体积(MPV)-静脉血: 8.8fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.4；中性粒细胞百分比(Neut%)-静脉血: 0.626；总钙(Ca)-静脉血: 1.94mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.……\n- [全程D61] 超声；肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声不均匀，肝S5可见2个无回声灶，直径约3-4mm，边界清,内透声可，后方回声增强。血管走行清晰、自然，肝内胆管不扩张，门静脉内径约7mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约28cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约43×27×32mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝S5囊性灶，考虑肝囊肿可能性大。 胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D61] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，走行自然，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D8] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者相关检查完善中，请假未回病房。\n- [全程D13] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者相关检查完善中，请假未回病房。\n- [全程D19] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者元旦假期请假中。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D29] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者无明显不适主诉，查体情况：一般情况可，余同入院。放疗计划已完善。[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，向患者及其家属交代病情及化疗风险，表示理解并已签署知情同意书，同意入组三周/单周DDP同时期化疗临床试验，抽签入三周组，可于今日执行第1程顺铂方案同时期化疗，注意化疗不良反应，开始放疗。\n- [全程D41] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者放疗中，诉口感、咽痛，余无不适。查体同前。复查血常规：基本正常，生化常规：正常。[姓名已隐去]医生信息已隐藏：患者DDP化疗后出现肝酶升高，考虑为药物性肝损害，经多种滑竿药物治疗后肝功能恢复正常，今日可办理出院，继续门诊放疗。\n- [全程D50] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，向患者及其家属交代病情及化疗风险，表示理解并已签署知情同意书，可于今日水化，明日执行第2程DDP方案同时期化疗，注意化疗不良反应。\n- [全程D51] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程DDP方案同时期化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D52] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第二程DDP单药同期化疗结束，诉咽痛、恶心、食欲下降，呕吐1次，伴头晕，无腹痛、腹泻等不适。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者同时期化疗结束，一般情况可，可以今日结账出院，门诊继续放疗。嘱定期复查血常规及肝肾功能，行放疗结束前常规检查。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，给予静脉滴注广谱抗菌药物及大剂量糖皮质激素。\nB. 暂停放疗，行肝脏穿刺活检明确肝脏病灶性质后调整全身系统性化疗方案。\nC. 继续根治性放疗，给予重组人粒细胞集落刺激因子（G-CSF）皮下注射。\nD. 继续根治性放疗，加用第3程顺铂同期化疗，并给予静脉保肝药物。\nE. 终止放疗，转为TPF方案全身系统性化疗。\nF. 继续根治性放疗，局部外用强效糖皮质激素软膏，并口服非甾体抗炎药。\nG. 暂停放疗，复查鼻咽及颈部MRI以决定是否降低后续放疗靶区剂量。\nH. 继续根治性放疗，给予静脉异甘草酸镁及还原型谷胱甘肽保肝治疗。\nI. 继续根治性放疗，给予雾化吸入氨溴索与地塞米松，并局部外用三乙醇胺乳膏。\nJ. 继续根治性放疗，联合靶向药物尼妥珠单抗及PD-1抑制剂治疗。\nK. 继续根治性放疗，给予静脉滴注地塞米松，并局部外用莫匹罗星软膏。\nL. 结束放化疗综合治疗，进入随访观察期，定期复查鼻咽MRI及颈部超声。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：鼻腔。\n文本分期信息：N0，M0。\n综合TNM状态：T1N0M0。\n综合分期：IA。\n\n【已知病史与当前主诉】\n- [全程D6] 入院记录: 主诉: 涕血2月；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血；既往史: “胃溃疡”病史22年，于某次就诊时间、某次就诊时间发生2次“胃出血”，经“输血”、“药物”治疗后好转，具体不详。某次就诊时间发现“胃底息肉”，行“内镜下胃底息肉切除术”。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：114/69mmHg,Ht：157cm，Wt：53kg，BSA：1.52m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽左侧壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D7] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- [全程D7] 检验组合: 平均红细胞体积(MCV)-静脉血: 91.1fL；总钙(Ca)-静脉血: 2.21mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24.2U/L；碱性磷酸酶(ALP)-静脉血: 74.3U/L；IV型胶原(C-IV)-静脉血: 12.97ng/ml；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 35.9U/L；钾离子(K+)-静脉血: 3.76mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；D-二聚体(D-Dimer)-静脉血: 0.07ug/ml；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；淀粉样蛋白A(SAA)-静脉血: 2.44mg/L；C-反应蛋白(CRP)-静脉血: 1.92mg/L；凝血酶原时间活动度(PTA)-静脉血: 120%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.67；载脂蛋白B(apoB)-静脉血: 1.07g/L；球蛋白(GLO)-静脉血: 26.18g/L；磷(P)-静脉血: 1.03mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；胱抑素(Cys-C)-静脉血: 0.79mg/L；红细胞计数(RBC#)-静脉血: 5.2710E12/L；单核细胞计数(Mono#)-静脉血: 110E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.6sec.；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.87；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.411ng/ml（参考: <0.584）；尿素氮(BUN)-静脉血: 4.7mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；血小板计数(PLT#)-静脉血: 21810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.578；凝血酶原时间(PT)-静脉血: 10.1sec.；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.05mmol/L；尿酸(UA)-静脉血: 331.5umol/L；阴离子间隙(AG)-静脉血: 15.7；层粘……\n- [全程D10] 内镜；胃镜: 检查类型: 内镜；检查名称: 胃镜；检查部位:；检查所见: 插镜情况：顺利 送达部位：十二指肠降部。 食 管：粘膜光滑, 舒缩好。 贲 门：开闭好, E-G线清楚。 胃 底：粘液湖清亮，粘膜光滑，无静脉曲张。 胃 体：花斑样充血，未见溃疡肿物。 胃 角：弧形， 光滑。 胃 窦：蠕动好，粘膜呈花斑样充血，未见溃疡肿物。 幽 门：圆， 开闭好。 球 部：球腔变形，后壁可见霜斑样溃疡，表面附着白苔。 降 部：十二指肠乳头及降部粘膜未见异常。 请4个工作日后到病理科（5楼）取活检结果。；检查结论: 十二指肠球部霜斑样溃疡 慢性浅表性胃炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D24] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽左侧顶后壁及左侧壁局部粘膜增厚形成软组织影放射性浓聚，SUV约21.0，堵塞左侧鼻后孔，鼻咽腔变窄，累及左侧翼突基底部及犁骨。左侧咽隐窝变，右侧咽隐窝未见明显异常，双侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。口咽及喉咽结构及放射性分布未见明显异常。额窦、蝶窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双上颈小淋巴结放射性分布未见明显异常。 双上肺尖、右中肺内侧段及左下肺后基底段少许条索影放射性分布未见明显异常；其余双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏S4低密度影放射性分布未见明显异常，大小约0.6×0.6cm，边界尚清，密度欠均匀，CT值约26Hu；其余肝脏密度减低，CT值约50Hu，结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。盆腔盆底静脉内多发点状/小结节状高密度影放射性缺损。 所见颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，侵犯左侧鼻后孔，累及颅底骨。 肝S4低密度影代谢未见明显异常，建议随诊。 脂肪肝。\n- [全程D29] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.013；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 6.5\n- [全程D30] 检验组合: 浊度(TRUB)-尿液: 清亮；白细胞计数(WBC#)-尿液: 3/μL；白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.023；酮体(KET)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 13/μL；颜色-尿液: Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；隐血(OB)-尿液: 1+ 0.6mg（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D31] 检验组合: 红细胞计数(RBC#)-静脉血: 4.6210E12/L；血小板计数(PLT#)-静脉血: 22810E9/L；大血小板百分比(P-LCR%)-静脉血: 21.2%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.61mmol/L；白蛋白(ALB)-静脉血: 38.5g/L；间接胆红素(IBIL)-静脉血: 8.4umolL；球蛋白(GLO)-静脉血: 25.82g/L；单核细胞百分比(Mono%)-静脉血: 0.093；血小板分布宽度(PDW)-静脉血: 10.8%；红细胞比容(Hct)-静脉血: 41.4%；总蛋白(TP)-静脉血: 64.32g/L；单核细胞计数(Mono#)-静脉血: 1.510E9/L；葡萄糖(Glu)-静脉血: 5.98mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.6；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；总胆红素(TBIL)-静脉血: 12.9umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 176.9U/L；甘油三酯(TG)-静脉血: 1.4mmol/L；乳酸脱氢酶(LDH)-静脉血: 239U/L；总胆汁酸(TBA)-静脉血: 3umol/L；直接胆红素(DBIL)-静脉血: 4.5umol/L；肌酐(Crea)-静脉血: 70umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.7；尿素氮(BUN)-静脉血: 6.02mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 136.5U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；天门冬氨酸氨基转移酶(AST)-静脉血: 104.5U/L；磷(P)-静脉血: 1.34mmol/L；钠离子(Na+)-静脉血: 138.8mmol/L；平均红细胞体积(MCV)-静脉血: 89.6fL；白细胞计数(WBC#)-静脉血: 15.9910E9/L；载脂蛋白AI(apoAI)-静脉血: 1.29g/L；阴离子间隙(AG)-静脉血: 14；C-反应蛋白(CRP)-静脉血: 1.98mg/L；钾离子(K+)-静脉血: 3.5mmol/L；碱性磷酸酶(ALP)-静脉血:……\n- [全程D32] 检验组合: 胱抑素(Cys-C)-静脉血: 0.73mg/L；乳酸脱氢酶(LDH)-静脉血: 162.4U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.51mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；淋巴细胞百分比(Lymph%)-静脉血: 0.05；平均红细胞血红蛋白含量(MCH)-静脉血: 29.9pg；血红蛋白(Hb)-静脉血: 137.4g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 5.43mmol/L；白蛋白(ALB)-静脉血: 43.2g/L；肌酐(Crea)-静脉血: 86.7umol/L；氯离子(Cl-)-静脉血: 97.6mmol/L；C-反应蛋白(CRP)-静脉血: 6.52mg/L；钾离子(K+)-静脉血: 4.2mmol/L；尿酸(UA)-静脉血: 298.5umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.15mmolL；载脂蛋白B(apoB)-静脉血: 1.3g/L；血小板比容-静脉血: 14.7%；血小板分布宽度(PDW)-静脉血: 8.7%；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.41mmolL；有核红细胞百分比(NRBC%)-静脉血: 0；血小板比容-静脉血: 14%；总胆固醇(TC)-静脉血: 7.5mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；甘油三酯(TG)-静脉血: 1.38mmol/L；平均血小板体积(MPV)-静脉血: 8.9fL；平均红细胞体积(MCV)-静脉血: 90.2fL；γ-谷氨酰基转移酶(GGT)-静脉血: 97.8U/L；阴离子间隙(AG)-静脉血: 17；胱抑素(Cys-C)-静脉血: 1.03mg/L；氯离子(Cl-)-静脉血: 96.7mmol/L；血小板分布宽度(PDW)-静脉血: 16.1%；平均血小板体积(MPV)-静脉血: 6.78fL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；球蛋白(GLO)-静脉血: 35.61g/L；镁离子(Mg2+)-静脉血: 0.66mmol/L；间接胆红素(IBIL)-静脉血: 6.3umolL；γ-谷氨酰基转移酶(GGT)-静脉血: 151U/L；阴离子间隙(AG)-静脉血: 17；单核细胞计数(Mono#)-……\n- [全程D41] 检验组合: 中性粒细胞计数(Neut#)-静脉血: 6.110E9/L；钠离子(Na+)-静脉血: 139.4mmol/L；尿素氮(BUN)-静脉血: 7.2mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.53；淋巴细胞计数(Lymph#)-静脉血: 0.910E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 42.7U/L；丙氨酸氨基转移酶(ALT)-静脉血: 35.4U/L；甘油三酯(TG)-静脉血: 1.71mmol/L；白细胞计数(WBC#)-静脉血: 7.7810E9/L；总蛋白(TP)-静脉血: 62.51g/L；血红蛋白(Hb)-静脉血: 131g/L；总钙(Ca)-静脉血: 2.05mmol/L；肌酐(Crea)-静脉血: 81.5umol/L；载脂蛋白B(apoB)-静脉血: 1.23g/L；白蛋白(ALB)-静脉血: 36.6g/L；中性粒细胞百分比(Neut%)-静脉血: 0.79；红细胞比容(Hct)-静脉血: 38.9%；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.6；淋巴细胞百分比(Lymph%)-静脉血: 0.113；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.006；大血小板百分比(P-LCR%)-静脉血: 15.3%；乳酸脱氢酶(LDH)-静脉血: 185.9U/L；间接胆红素(IBIL)-静脉血: 6.7umolL；氯离子(Cl-)-静脉血: 100.4mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.8U/L；血小板计数(PLT#)-静脉血: 15410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.3g/L；平均血小板体积(MPV)-静脉血: 8.9fL；胱抑素(Cys-C)-静脉血: 0.86mg/L；γ-谷氨酰基转移酶(GGT)-静脉血: 268.3U/L；总胆红素(TBIL)-静脉血: 8umol/L；葡萄糖(Glu)-静脉血: 5.28mmol/L；红细胞计数(RBC#)-静脉血: 4.3510E12/L；总胆汁酸(TBA)-静脉血: 2.7umol/L；血小板分……\n- [全程D49] 检验组合: 红细胞计数(RBC#)-尿液: 6/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；白细胞计数(WBC#)-尿液: 1/μL；比重(SG)-尿液: 1.009；胆红素(BIL)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: 无色；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮\n- [全程D50] 检验组合: 浊度(TRUB)-尿液: clear；酮体(KET)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 13/μL；比重(SG)-尿液: 1.017；白细胞计数(WBC#)-尿液: 10/μL；隐血(OB)-尿液: 1+0.6mg（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；总蛋白(TP)-尿液: -（参考: 阴性）；非鳞状上皮细胞计数-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 3/μL；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow\n- [全程D51] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；比重(SG)-尿液: 1.013；白细胞计数(WBC#)-尿液: 13/μL；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 8/μL；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；白细胞(LEU)-尿液: -（参考: 阴性）\n- [全程D52] 检验组合: 淋巴细胞百分比(Lymph%)-静脉血: 0.1；镁离子(Mg2+)-静脉血: 0.52mmol/L；尿素氮(BUN)-静脉血: 6.1mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.14mmolL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；总蛋白(TP)-静脉血: 64.42g/L；磷(P)-静脉血: 1.33mmol/L；总胆红素(TBIL)-静脉血: 6umol/L；氯离子(Cl-)-静脉血: 99.5mmol/L；红细胞比容(Hct)-静脉血: 36.9%；平均红细胞体积(MCV)-静脉血: 89.1fL；红细胞计数(RBC#)-静脉血: 4.1410E12/L；C-反应蛋白(CRP)-静脉血: 4.91mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；白细胞计数(WBC#)-静脉血: 3.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.253；血小板比容-静脉血: 20%；丙氨酸氨基转移酶(ALT)-静脉血: 42.9U/L；血液二氧化碳含量ctCO2(B)-静脉血: 26.2mmol/L；胱抑素(Cys-C)-静脉血: 1.28mg/L；球蛋白(GLO)-静脉血: 29.62g/L；甘油三酯(TG)-静脉血: 1.61mmol/L；尿酸(UA)-静脉血: 292.8umol/L；血小板分布宽度(PDW)-静脉血: 8.6%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.8；单核细胞计数(Mono#)-静脉血: 0.910E9/L；肌酐(Crea)-静脉血: 109.5umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.015；总胆固醇(TC)-静脉血: 5.96mmol/L；阴离子间隙(AG)-静脉血: 12；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 47U/L；平均血小板体积(MPV)-静脉血: 8.8fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.4；中性粒细胞百分比(Neut%)-静脉血: 0.626；总钙(Ca)-静脉血: 1.94mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.……\n- [全程D61] 超声；肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声不均匀，肝S5可见2个无回声灶，直径约3-4mm，边界清,内透声可，后方回声增强。血管走行清晰、自然，肝内胆管不扩张，门静脉内径约7mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约28cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约43×27×32mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝S5囊性灶，考虑肝囊肿可能性大。 胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D61] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，走行自然，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D8] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者相关检查完善中，请假未回病房。\n- [全程D13] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者相关检查完善中，请假未回病房。\n- [全程D19] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者元旦假期请假中。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D29] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者无明显不适主诉，查体情况：一般情况可，余同入院。放疗计划已完善。[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，向患者及其家属交代病情及化疗风险，表示理解并已签署知情同意书，同意入组三周/单周DDP同时期化疗临床试验，抽签入三周组，可于今日执行第1程顺铂方案同时期化疗，注意化疗不良反应，开始放疗。\n- [全程D41] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者放疗中，诉口感、咽痛，余无不适。查体同前。复查血常规：基本正常，生化常规：正常。[姓名已隐去]医生信息已隐藏：患者DDP化疗后出现肝酶升高，考虑为药物性肝损害，经多种滑竿药物治疗后肝功能恢复正常，今日可办理出院，继续门诊放疗。\n- [全程D50] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，向患者及其家属交代病情及化疗风险，表示理解并已签署知情同意书，可于今日水化，明日执行第2程DDP方案同时期化疗，注意化疗不良反应。\n- [全程D51] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程DDP方案同时期化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D52] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第二程DDP单药同期化疗结束，诉咽痛、恶心、食欲下降，呕吐1次，伴头晕，无腹痛、腹泻等不适。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者同时期化疗结束，一般情况可，可以今日结账出院，门诊继续放疗。嘱定期复查血常规及肝肾功能，行放疗结束前常规检查。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，给予静脉滴注广谱抗菌药物及大剂量糖皮质激素。\nB. 暂停放疗，行肝脏穿刺活检明确肝脏病灶性质后调整全身系统性化疗方案。\nC. 继续根治性放疗，给予重组人粒细胞集落刺激因子（G-CSF）皮下注射。\nD. 继续根治性放疗，加用第3程顺铂同期化疗，并给予静脉保肝药物。\nE. 终止放疗，转为TPF方案全身系统性化疗。\nF. 继续根治性放疗，局部外用强效糖皮质激素软膏，并口服非甾体抗炎药。\nG. 暂停放疗，复查鼻咽及颈部MRI以决定是否降低后续放疗靶区剂量。\nH. 继续根治性放疗，给予静脉异甘草酸镁及还原型谷胱甘肽保肝治疗。\nI. 继续根治性放疗，给予雾化吸入氨溴索与地塞米松，并局部外用三乙醇胺乳膏。\nJ. 继续根治性放疗，联合靶向药物尼妥珠单抗及PD-1抑制剂治疗。\nK. 继续根治性放疗，给予静脉滴注地塞米松，并局部外用莫匹罗星软膏。\nL. 结束放化疗综合治疗，进入随访观察期，定期复查鼻咽MRI及颈部超声。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-24c04c80074ea3aab5465600","patient_id":"patient-51e6f99c527367bbd97aebd8","turn_id":"turn08","turn_position":6,"turn_type":"response_assessment_decision","gold_letter":"J","gold_action":"继续根治性放疗，给予雾化吸入（氨溴索、地塞米松）及局部外用药（三乙醇胺乳膏）处理急性放射性黏膜炎和皮炎。","options":[{"letter":"A","text":"暂停放疗，行腹部增强MRI或穿刺活检明确肝脏囊性病灶性质，待明确性质后再决定后续治疗方案。","is_gold":false},{"letter":"B","text":"继续根治性放疗，启动第三程顺铂单药同期化疗，并给予保肝、止吐及水化等预防性对症支持治疗。","is_gold":false},{"letter":"C","text":"继续根治性放疗，加用卡培他滨口服节拍化疗，并给予雾化吸入及局部外用药处理放疗反应。","is_gold":false},{"letter":"D","text":"提前结束放疗，给予静脉滴注大剂量糖皮质激素及广谱抗生素处理放射性黏膜炎和皮炎。","is_gold":false},{"letter":"E","text":"继续根治性放疗，给予静脉高营养支持处理急性放射性黏膜炎，并预防性使用重组人粒细胞刺激因子。","is_gold":false},{"letter":"F","text":"暂停放疗，复查鼻咽及颈部MRI，重新定位并缩减原发灶及颈部放疗靶区。","is_gold":false},{"letter":"G","text":"继续根治性放疗，行肝脏囊性灶局部射频消融治疗，并给予雾化吸入及局部外用药处理放疗反应。","is_gold":false},{"letter":"H","text":"继续根治性放疗，继续给予静脉双环醇等保肝药物强化治疗，并给予局部外用药处理放疗反应。","is_gold":false},{"letter":"I","text":"暂停放疗，给予局部清创换药，待皮肤及黏膜反应恢复至1级以下再恢复根治性放疗。","is_gold":false},{"letter":"J","text":"继续根治性放疗，给予雾化吸入（氨溴索、地塞米松）及局部外用药（三乙醇胺乳膏）处理急性放射性黏膜炎和皮炎。","is_gold":true},{"letter":"K","text":"继续根治性放疗，给予口服非甾体抗炎药缓解黏膜疼痛，并在局部皮炎处预防性涂抹抗生素软膏。","is_gold":false},{"letter":"L","text":"结束根治性放疗，进入定期随访阶段，给予雾化吸入及局部外用药处理急性放射性黏膜炎和皮炎。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：鼻腔。\n文本分期信息：N0，M0。\n综合TNM状态：T1N0M0。\n综合分期：IA。\n\n【已知病史与当前主诉】\n- [全程D6] 入院记录: 主诉: 涕血2月；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血；既往史: “胃溃疡”病史22年，于某次就诊时间、某次就诊时间发生2次“胃出血”，经“输血”、“药物”治疗后好转，具体不详。某次就诊时间发现“胃底息肉”，行“内镜下胃底息肉切除术”。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：114/69mmHg,Ht：157cm，Wt：53kg，BSA：1.52m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽左侧壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D7] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- [全程D7] 检验组合: 平均红细胞体积(MCV)-静脉血: 91.1fL；总钙(Ca)-静脉血: 2.21mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24.2U/L；碱性磷酸酶(ALP)-静脉血: 74.3U/L；IV型胶原(C-IV)-静脉血: 12.97ng/ml；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 35.9U/L；钾离子(K+)-静脉血: 3.76mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；D-二聚体(D-Dimer)-静脉血: 0.07ug/ml；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；淀粉样蛋白A(SAA)-静脉血: 2.44mg/L；C-反应蛋白(CRP)-静脉血: 1.92mg/L；凝血酶原时间活动度(PTA)-静脉血: 120%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.67；载脂蛋白B(apoB)-静脉血: 1.07g/L；球蛋白(GLO)-静脉血: 26.18g/L；磷(P)-静脉血: 1.03mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；胱抑素(Cys-C)-静脉血: 0.79mg/L；红细胞计数(RBC#)-静脉血: 5.2710E12/L；单核细胞计数(Mono#)-静脉血: 110E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.6sec.；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.87；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.411ng/ml（参考: <0.584）；尿素氮(BUN)-静脉血: 4.7mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；血小板计数(PLT#)-静脉血: 21810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.578；凝血酶原时间(PT)-静脉血: 10.1sec.；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.05mmol/L；尿酸(UA)-静脉血: 331.5umol/L；阴离子间隙(AG)-静脉血: 15.7；层粘……\n- [全程D10] 内镜；胃镜: 检查类型: 内镜；检查名称: 胃镜；检查部位:；检查所见: 插镜情况：顺利 送达部位：十二指肠降部。 食 管：粘膜光滑, 舒缩好。 贲 门：开闭好, E-G线清楚。 胃 底：粘液湖清亮，粘膜光滑，无静脉曲张。 胃 体：花斑样充血，未见溃疡肿物。 胃 角：弧形， 光滑。 胃 窦：蠕动好，粘膜呈花斑样充血，未见溃疡肿物。 幽 门：圆， 开闭好。 球 部：球腔变形，后壁可见霜斑样溃疡，表面附着白苔。 降 部：十二指肠乳头及降部粘膜未见异常。 请4个工作日后到病理科（5楼）取活检结果。；检查结论: 十二指肠球部霜斑样溃疡 慢性浅表性胃炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D24] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽左侧顶后壁及左侧壁局部粘膜增厚形成软组织影放射性浓聚，SUV约21.0，堵塞左侧鼻后孔，鼻咽腔变窄，累及左侧翼突基底部及犁骨。左侧咽隐窝变，右侧咽隐窝未见明显异常，双侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。口咽及喉咽结构及放射性分布未见明显异常。额窦、蝶窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双上颈小淋巴结放射性分布未见明显异常。 双上肺尖、右中肺内侧段及左下肺后基底段少许条索影放射性分布未见明显异常；其余双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏S4低密度影放射性分布未见明显异常，大小约0.6×0.6cm，边界尚清，密度欠均匀，CT值约26Hu；其余肝脏密度减低，CT值约50Hu，结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。盆腔盆底静脉内多发点状/小结节状高密度影放射性缺损。 所见颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，侵犯左侧鼻后孔，累及颅底骨。 肝S4低密度影代谢未见明显异常，建议随诊。 脂肪肝。\n- [全程D29] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.013；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 6.5\n- [全程D30] 检验组合: 浊度(TRUB)-尿液: 清亮；白细胞计数(WBC#)-尿液: 3/μL；白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.023；酮体(KET)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 13/μL；颜色-尿液: Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；隐血(OB)-尿液: 1+ 0.6mg（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D31] 检验组合: 红细胞计数(RBC#)-静脉血: 4.6210E12/L；血小板计数(PLT#)-静脉血: 22810E9/L；大血小板百分比(P-LCR%)-静脉血: 21.2%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.61mmol/L；白蛋白(ALB)-静脉血: 38.5g/L；间接胆红素(IBIL)-静脉血: 8.4umolL；球蛋白(GLO)-静脉血: 25.82g/L；单核细胞百分比(Mono%)-静脉血: 0.093；血小板分布宽度(PDW)-静脉血: 10.8%；红细胞比容(Hct)-静脉血: 41.4%；总蛋白(TP)-静脉血: 64.32g/L；单核细胞计数(Mono#)-静脉血: 1.510E9/L；葡萄糖(Glu)-静脉血: 5.98mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.6；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；总胆红素(TBIL)-静脉血: 12.9umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 176.9U/L；甘油三酯(TG)-静脉血: 1.4mmol/L；乳酸脱氢酶(LDH)-静脉血: 239U/L；总胆汁酸(TBA)-静脉血: 3umol/L；直接胆红素(DBIL)-静脉血: 4.5umol/L；肌酐(Crea)-静脉血: 70umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.7；尿素氮(BUN)-静脉血: 6.02mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 136.5U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；天门冬氨酸氨基转移酶(AST)-静脉血: 104.5U/L；磷(P)-静脉血: 1.34mmol/L；钠离子(Na+)-静脉血: 138.8mmol/L；平均红细胞体积(MCV)-静脉血: 89.6fL；白细胞计数(WBC#)-静脉血: 15.9910E9/L；载脂蛋白AI(apoAI)-静脉血: 1.29g/L；阴离子间隙(AG)-静脉血: 14；C-反应蛋白(CRP)-静脉血: 1.98mg/L；钾离子(K+)-静脉血: 3.5mmol/L；碱性磷酸酶(ALP)-静脉血:……\n- [全程D32] 检验组合: 胱抑素(Cys-C)-静脉血: 0.73mg/L；乳酸脱氢酶(LDH)-静脉血: 162.4U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.51mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；淋巴细胞百分比(Lymph%)-静脉血: 0.05；平均红细胞血红蛋白含量(MCH)-静脉血: 29.9pg；血红蛋白(Hb)-静脉血: 137.4g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 5.43mmol/L；白蛋白(ALB)-静脉血: 43.2g/L；肌酐(Crea)-静脉血: 86.7umol/L；氯离子(Cl-)-静脉血: 97.6mmol/L；C-反应蛋白(CRP)-静脉血: 6.52mg/L；钾离子(K+)-静脉血: 4.2mmol/L；尿酸(UA)-静脉血: 298.5umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.15mmolL；载脂蛋白B(apoB)-静脉血: 1.3g/L；血小板比容-静脉血: 14.7%；血小板分布宽度(PDW)-静脉血: 8.7%；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.41mmolL；有核红细胞百分比(NRBC%)-静脉血: 0；血小板比容-静脉血: 14%；总胆固醇(TC)-静脉血: 7.5mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；甘油三酯(TG)-静脉血: 1.38mmol/L；平均血小板体积(MPV)-静脉血: 8.9fL；平均红细胞体积(MCV)-静脉血: 90.2fL；γ-谷氨酰基转移酶(GGT)-静脉血: 97.8U/L；阴离子间隙(AG)-静脉血: 17；胱抑素(Cys-C)-静脉血: 1.03mg/L；氯离子(Cl-)-静脉血: 96.7mmol/L；血小板分布宽度(PDW)-静脉血: 16.1%；平均血小板体积(MPV)-静脉血: 6.78fL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；球蛋白(GLO)-静脉血: 35.61g/L；镁离子(Mg2+)-静脉血: 0.66mmol/L；间接胆红素(IBIL)-静脉血: 6.3umolL；γ-谷氨酰基转移酶(GGT)-静脉血: 151U/L；阴离子间隙(AG)-静脉血: 17；单核细胞计数(Mono#)-……\n- [全程D41] 检验组合: 中性粒细胞计数(Neut#)-静脉血: 6.110E9/L；钠离子(Na+)-静脉血: 139.4mmol/L；尿素氮(BUN)-静脉血: 7.2mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.53；淋巴细胞计数(Lymph#)-静脉血: 0.910E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 42.7U/L；丙氨酸氨基转移酶(ALT)-静脉血: 35.4U/L；甘油三酯(TG)-静脉血: 1.71mmol/L；白细胞计数(WBC#)-静脉血: 7.7810E9/L；总蛋白(TP)-静脉血: 62.51g/L；血红蛋白(Hb)-静脉血: 131g/L；总钙(Ca)-静脉血: 2.05mmol/L；肌酐(Crea)-静脉血: 81.5umol/L；载脂蛋白B(apoB)-静脉血: 1.23g/L；白蛋白(ALB)-静脉血: 36.6g/L；中性粒细胞百分比(Neut%)-静脉血: 0.79；红细胞比容(Hct)-静脉血: 38.9%；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.6；淋巴细胞百分比(Lymph%)-静脉血: 0.113；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.006；大血小板百分比(P-LCR%)-静脉血: 15.3%；乳酸脱氢酶(LDH)-静脉血: 185.9U/L；间接胆红素(IBIL)-静脉血: 6.7umolL；氯离子(Cl-)-静脉血: 100.4mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.8U/L；血小板计数(PLT#)-静脉血: 15410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.3g/L；平均血小板体积(MPV)-静脉血: 8.9fL；胱抑素(Cys-C)-静脉血: 0.86mg/L；γ-谷氨酰基转移酶(GGT)-静脉血: 268.3U/L；总胆红素(TBIL)-静脉血: 8umol/L；葡萄糖(Glu)-静脉血: 5.28mmol/L；红细胞计数(RBC#)-静脉血: 4.3510E12/L；总胆汁酸(TBA)-静脉血: 2.7umol/L；血小板分……\n- [全程D49] 检验组合: 红细胞计数(RBC#)-尿液: 6/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；白细胞计数(WBC#)-尿液: 1/μL；比重(SG)-尿液: 1.009；胆红素(BIL)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: 无色；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮\n- [全程D50] 检验组合: 浊度(TRUB)-尿液: clear；酮体(KET)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 13/μL；比重(SG)-尿液: 1.017；白细胞计数(WBC#)-尿液: 10/μL；隐血(OB)-尿液: 1+0.6mg（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；总蛋白(TP)-尿液: -（参考: 阴性）；非鳞状上皮细胞计数-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 3/μL；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow\n- [全程D51] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；比重(SG)-尿液: 1.013；白细胞计数(WBC#)-尿液: 13/μL；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 8/μL；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；白细胞(LEU)-尿液: -（参考: 阴性）\n- [全程D52] 检验组合: 淋巴细胞百分比(Lymph%)-静脉血: 0.1；镁离子(Mg2+)-静脉血: 0.52mmol/L；尿素氮(BUN)-静脉血: 6.1mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.14mmolL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；总蛋白(TP)-静脉血: 64.42g/L；磷(P)-静脉血: 1.33mmol/L；总胆红素(TBIL)-静脉血: 6umol/L；氯离子(Cl-)-静脉血: 99.5mmol/L；红细胞比容(Hct)-静脉血: 36.9%；平均红细胞体积(MCV)-静脉血: 89.1fL；红细胞计数(RBC#)-静脉血: 4.1410E12/L；C-反应蛋白(CRP)-静脉血: 4.91mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；白细胞计数(WBC#)-静脉血: 3.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.253；血小板比容-静脉血: 20%；丙氨酸氨基转移酶(ALT)-静脉血: 42.9U/L；血液二氧化碳含量ctCO2(B)-静脉血: 26.2mmol/L；胱抑素(Cys-C)-静脉血: 1.28mg/L；球蛋白(GLO)-静脉血: 29.62g/L；甘油三酯(TG)-静脉血: 1.61mmol/L；尿酸(UA)-静脉血: 292.8umol/L；血小板分布宽度(PDW)-静脉血: 8.6%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.8；单核细胞计数(Mono#)-静脉血: 0.910E9/L；肌酐(Crea)-静脉血: 109.5umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.015；总胆固醇(TC)-静脉血: 5.96mmol/L；阴离子间隙(AG)-静脉血: 12；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 47U/L；平均血小板体积(MPV)-静脉血: 8.8fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.4；中性粒细胞百分比(Neut%)-静脉血: 0.626；总钙(Ca)-静脉血: 1.94mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.……\n- [全程D61] 超声；肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声不均匀，肝S5可见2个无回声灶，直径约3-4mm，边界清,内透声可，后方回声增强。血管走行清晰、自然，肝内胆管不扩张，门静脉内径约7mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约28cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约43×27×32mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝S5囊性灶，考虑肝囊肿可能性大。 胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D61] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，走行自然，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D8] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者相关检查完善中，请假未回病房。\n- [全程D13] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者相关检查完善中，请假未回病房。\n- [全程D19] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者元旦假期请假中。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D29] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者无明显不适主诉，查体情况：一般情况可，余同入院。放疗计划已完善。[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，向患者及其家属交代病情及化疗风险，表示理解并已签署知情同意书，同意入组三周/单周DDP同时期化疗临床试验，抽签入三周组，可于今日执行第1程顺铂方案同时期化疗，注意化疗不良反应，开始放疗。\n- [全程D41] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者放疗中，诉口感、咽痛，余无不适。查体同前。复查血常规：基本正常，生化常规：正常。[姓名已隐去]医生信息已隐藏：患者DDP化疗后出现肝酶升高，考虑为药物性肝损害，经多种滑竿药物治疗后肝功能恢复正常，今日可办理出院，继续门诊放疗。\n- [全程D50] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，向患者及其家属交代病情及化疗风险，表示理解并已签署知情同意书，可于今日水化，明日执行第2程DDP方案同时期化疗，注意化疗不良反应。\n- [全程D51] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程DDP方案同时期化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D52] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第二程DDP单药同期化疗结束，诉咽痛、恶心、食欲下降，呕吐1次，伴头晕，无腹痛、腹泻等不适。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者同时期化疗结束，一般情况可，可以今日结账出院，门诊继续放疗。嘱定期复查血常规及肝肾功能，行放疗结束前常规检查。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，行腹部增强MRI或穿刺活检明确肝脏囊性病灶性质，待明确性质后再决定后续治疗方案。\nB. 继续根治性放疗，启动第三程顺铂单药同期化疗，并给予保肝、止吐及水化等预防性对症支持治疗。\nC. 继续根治性放疗，加用卡培他滨口服节拍化疗，并给予雾化吸入及局部外用药处理放疗反应。\nD. 提前结束放疗，给予静脉滴注大剂量糖皮质激素及广谱抗生素处理放射性黏膜炎和皮炎。\nE. 继续根治性放疗，给予静脉高营养支持处理急性放射性黏膜炎，并预防性使用重组人粒细胞刺激因子。\nF. 暂停放疗，复查鼻咽及颈部MRI，重新定位并缩减原发灶及颈部放疗靶区。\nG. 继续根治性放疗，行肝脏囊性灶局部射频消融治疗，并给予雾化吸入及局部外用药处理放疗反应。\nH. 继续根治性放疗，继续给予静脉双环醇等保肝药物强化治疗，并给予局部外用药处理放疗反应。\nI. 暂停放疗，给予局部清创换药，待皮肤及黏膜反应恢复至1级以下再恢复根治性放疗。\nJ. 继续根治性放疗，给予雾化吸入（氨溴索、地塞米松）及局部外用药（三乙醇胺乳膏）处理急性放射性黏膜炎和皮炎。\nK. 继续根治性放疗，给予口服非甾体抗炎药缓解黏膜疼痛，并在局部皮炎处预防性涂抹抗生素软膏。\nL. 结束根治性放疗，进入定期随访阶段，给予雾化吸入及局部外用药处理急性放射性黏膜炎和皮炎。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：鼻腔。\n文本分期信息：N0，M0。\n综合TNM状态：T1N0M0。\n综合分期：IA。\n\n【已知病史与当前主诉】\n- [全程D6] 入院记录: 主诉: 涕血2月；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血；既往史: “胃溃疡”病史22年，于某次就诊时间、某次就诊时间发生2次“胃出血”，经“输血”、“药物”治疗后好转，具体不详。某次就诊时间发现“胃底息肉”，行“内镜下胃底息肉切除术”。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：114/69mmHg,Ht：157cm，Wt：53kg，BSA：1.52m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽左侧壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D7] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- [全程D7] 检验组合: 平均红细胞体积(MCV)-静脉血: 91.1fL；总钙(Ca)-静脉血: 2.21mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24.2U/L；碱性磷酸酶(ALP)-静脉血: 74.3U/L；IV型胶原(C-IV)-静脉血: 12.97ng/ml；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 35.9U/L；钾离子(K+)-静脉血: 3.76mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；D-二聚体(D-Dimer)-静脉血: 0.07ug/ml；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；淀粉样蛋白A(SAA)-静脉血: 2.44mg/L；C-反应蛋白(CRP)-静脉血: 1.92mg/L；凝血酶原时间活动度(PTA)-静脉血: 120%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.67；载脂蛋白B(apoB)-静脉血: 1.07g/L；球蛋白(GLO)-静脉血: 26.18g/L；磷(P)-静脉血: 1.03mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；胱抑素(Cys-C)-静脉血: 0.79mg/L；红细胞计数(RBC#)-静脉血: 5.2710E12/L；单核细胞计数(Mono#)-静脉血: 110E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.6sec.；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.87；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.411ng/ml（参考: <0.584）；尿素氮(BUN)-静脉血: 4.7mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；血小板计数(PLT#)-静脉血: 21810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.578；凝血酶原时间(PT)-静脉血: 10.1sec.；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.05mmol/L；尿酸(UA)-静脉血: 331.5umol/L；阴离子间隙(AG)-静脉血: 15.7；层粘……\n- [全程D10] 内镜；胃镜: 检查类型: 内镜；检查名称: 胃镜；检查部位:；检查所见: 插镜情况：顺利 送达部位：十二指肠降部。 食 管：粘膜光滑, 舒缩好。 贲 门：开闭好, E-G线清楚。 胃 底：粘液湖清亮，粘膜光滑，无静脉曲张。 胃 体：花斑样充血，未见溃疡肿物。 胃 角：弧形， 光滑。 胃 窦：蠕动好，粘膜呈花斑样充血，未见溃疡肿物。 幽 门：圆， 开闭好。 球 部：球腔变形，后壁可见霜斑样溃疡，表面附着白苔。 降 部：十二指肠乳头及降部粘膜未见异常。 请4个工作日后到病理科（5楼）取活检结果。；检查结论: 十二指肠球部霜斑样溃疡 慢性浅表性胃炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D24] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽左侧顶后壁及左侧壁局部粘膜增厚形成软组织影放射性浓聚，SUV约21.0，堵塞左侧鼻后孔，鼻咽腔变窄，累及左侧翼突基底部及犁骨。左侧咽隐窝变，右侧咽隐窝未见明显异常，双侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。口咽及喉咽结构及放射性分布未见明显异常。额窦、蝶窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双上颈小淋巴结放射性分布未见明显异常。 双上肺尖、右中肺内侧段及左下肺后基底段少许条索影放射性分布未见明显异常；其余双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏S4低密度影放射性分布未见明显异常，大小约0.6×0.6cm，边界尚清，密度欠均匀，CT值约26Hu；其余肝脏密度减低，CT值约50Hu，结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。盆腔盆底静脉内多发点状/小结节状高密度影放射性缺损。 所见颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，侵犯左侧鼻后孔，累及颅底骨。 肝S4低密度影代谢未见明显异常，建议随诊。 脂肪肝。\n- [全程D29] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.013；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 6.5\n- [全程D30] 检验组合: 浊度(TRUB)-尿液: 清亮；白细胞计数(WBC#)-尿液: 3/μL；白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.023；酮体(KET)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 13/μL；颜色-尿液: Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；隐血(OB)-尿液: 1+ 0.6mg（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D31] 检验组合: 红细胞计数(RBC#)-静脉血: 4.6210E12/L；血小板计数(PLT#)-静脉血: 22810E9/L；大血小板百分比(P-LCR%)-静脉血: 21.2%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.61mmol/L；白蛋白(ALB)-静脉血: 38.5g/L；间接胆红素(IBIL)-静脉血: 8.4umolL；球蛋白(GLO)-静脉血: 25.82g/L；单核细胞百分比(Mono%)-静脉血: 0.093；血小板分布宽度(PDW)-静脉血: 10.8%；红细胞比容(Hct)-静脉血: 41.4%；总蛋白(TP)-静脉血: 64.32g/L；单核细胞计数(Mono#)-静脉血: 1.510E9/L；葡萄糖(Glu)-静脉血: 5.98mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.6；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；总胆红素(TBIL)-静脉血: 12.9umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 176.9U/L；甘油三酯(TG)-静脉血: 1.4mmol/L；乳酸脱氢酶(LDH)-静脉血: 239U/L；总胆汁酸(TBA)-静脉血: 3umol/L；直接胆红素(DBIL)-静脉血: 4.5umol/L；肌酐(Crea)-静脉血: 70umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.7；尿素氮(BUN)-静脉血: 6.02mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 136.5U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；天门冬氨酸氨基转移酶(AST)-静脉血: 104.5U/L；磷(P)-静脉血: 1.34mmol/L；钠离子(Na+)-静脉血: 138.8mmol/L；平均红细胞体积(MCV)-静脉血: 89.6fL；白细胞计数(WBC#)-静脉血: 15.9910E9/L；载脂蛋白AI(apoAI)-静脉血: 1.29g/L；阴离子间隙(AG)-静脉血: 14；C-反应蛋白(CRP)-静脉血: 1.98mg/L；钾离子(K+)-静脉血: 3.5mmol/L；碱性磷酸酶(ALP)-静脉血:……\n- [全程D32] 检验组合: 胱抑素(Cys-C)-静脉血: 0.73mg/L；乳酸脱氢酶(LDH)-静脉血: 162.4U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.51mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；淋巴细胞百分比(Lymph%)-静脉血: 0.05；平均红细胞血红蛋白含量(MCH)-静脉血: 29.9pg；血红蛋白(Hb)-静脉血: 137.4g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 5.43mmol/L；白蛋白(ALB)-静脉血: 43.2g/L；肌酐(Crea)-静脉血: 86.7umol/L；氯离子(Cl-)-静脉血: 97.6mmol/L；C-反应蛋白(CRP)-静脉血: 6.52mg/L；钾离子(K+)-静脉血: 4.2mmol/L；尿酸(UA)-静脉血: 298.5umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.15mmolL；载脂蛋白B(apoB)-静脉血: 1.3g/L；血小板比容-静脉血: 14.7%；血小板分布宽度(PDW)-静脉血: 8.7%；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.41mmolL；有核红细胞百分比(NRBC%)-静脉血: 0；血小板比容-静脉血: 14%；总胆固醇(TC)-静脉血: 7.5mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；甘油三酯(TG)-静脉血: 1.38mmol/L；平均血小板体积(MPV)-静脉血: 8.9fL；平均红细胞体积(MCV)-静脉血: 90.2fL；γ-谷氨酰基转移酶(GGT)-静脉血: 97.8U/L；阴离子间隙(AG)-静脉血: 17；胱抑素(Cys-C)-静脉血: 1.03mg/L；氯离子(Cl-)-静脉血: 96.7mmol/L；血小板分布宽度(PDW)-静脉血: 16.1%；平均血小板体积(MPV)-静脉血: 6.78fL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；球蛋白(GLO)-静脉血: 35.61g/L；镁离子(Mg2+)-静脉血: 0.66mmol/L；间接胆红素(IBIL)-静脉血: 6.3umolL；γ-谷氨酰基转移酶(GGT)-静脉血: 151U/L；阴离子间隙(AG)-静脉血: 17；单核细胞计数(Mono#)-……\n- [全程D41] 检验组合: 中性粒细胞计数(Neut#)-静脉血: 6.110E9/L；钠离子(Na+)-静脉血: 139.4mmol/L；尿素氮(BUN)-静脉血: 7.2mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.53；淋巴细胞计数(Lymph#)-静脉血: 0.910E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 42.7U/L；丙氨酸氨基转移酶(ALT)-静脉血: 35.4U/L；甘油三酯(TG)-静脉血: 1.71mmol/L；白细胞计数(WBC#)-静脉血: 7.7810E9/L；总蛋白(TP)-静脉血: 62.51g/L；血红蛋白(Hb)-静脉血: 131g/L；总钙(Ca)-静脉血: 2.05mmol/L；肌酐(Crea)-静脉血: 81.5umol/L；载脂蛋白B(apoB)-静脉血: 1.23g/L；白蛋白(ALB)-静脉血: 36.6g/L；中性粒细胞百分比(Neut%)-静脉血: 0.79；红细胞比容(Hct)-静脉血: 38.9%；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.6；淋巴细胞百分比(Lymph%)-静脉血: 0.113；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.006；大血小板百分比(P-LCR%)-静脉血: 15.3%；乳酸脱氢酶(LDH)-静脉血: 185.9U/L；间接胆红素(IBIL)-静脉血: 6.7umolL；氯离子(Cl-)-静脉血: 100.4mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.8U/L；血小板计数(PLT#)-静脉血: 15410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.3g/L；平均血小板体积(MPV)-静脉血: 8.9fL；胱抑素(Cys-C)-静脉血: 0.86mg/L；γ-谷氨酰基转移酶(GGT)-静脉血: 268.3U/L；总胆红素(TBIL)-静脉血: 8umol/L；葡萄糖(Glu)-静脉血: 5.28mmol/L；红细胞计数(RBC#)-静脉血: 4.3510E12/L；总胆汁酸(TBA)-静脉血: 2.7umol/L；血小板分……\n- [全程D49] 检验组合: 红细胞计数(RBC#)-尿液: 6/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；白细胞计数(WBC#)-尿液: 1/μL；比重(SG)-尿液: 1.009；胆红素(BIL)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: 无色；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮\n- [全程D50] 检验组合: 浊度(TRUB)-尿液: clear；酮体(KET)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 13/μL；比重(SG)-尿液: 1.017；白细胞计数(WBC#)-尿液: 10/μL；隐血(OB)-尿液: 1+0.6mg（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；总蛋白(TP)-尿液: -（参考: 阴性）；非鳞状上皮细胞计数-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 3/μL；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow\n- [全程D51] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；比重(SG)-尿液: 1.013；白细胞计数(WBC#)-尿液: 13/μL；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 8/μL；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；白细胞(LEU)-尿液: -（参考: 阴性）\n- [全程D52] 检验组合: 淋巴细胞百分比(Lymph%)-静脉血: 0.1；镁离子(Mg2+)-静脉血: 0.52mmol/L；尿素氮(BUN)-静脉血: 6.1mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.14mmolL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；总蛋白(TP)-静脉血: 64.42g/L；磷(P)-静脉血: 1.33mmol/L；总胆红素(TBIL)-静脉血: 6umol/L；氯离子(Cl-)-静脉血: 99.5mmol/L；红细胞比容(Hct)-静脉血: 36.9%；平均红细胞体积(MCV)-静脉血: 89.1fL；红细胞计数(RBC#)-静脉血: 4.1410E12/L；C-反应蛋白(CRP)-静脉血: 4.91mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；白细胞计数(WBC#)-静脉血: 3.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.253；血小板比容-静脉血: 20%；丙氨酸氨基转移酶(ALT)-静脉血: 42.9U/L；血液二氧化碳含量ctCO2(B)-静脉血: 26.2mmol/L；胱抑素(Cys-C)-静脉血: 1.28mg/L；球蛋白(GLO)-静脉血: 29.62g/L；甘油三酯(TG)-静脉血: 1.61mmol/L；尿酸(UA)-静脉血: 292.8umol/L；血小板分布宽度(PDW)-静脉血: 8.6%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.8；单核细胞计数(Mono#)-静脉血: 0.910E9/L；肌酐(Crea)-静脉血: 109.5umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.015；总胆固醇(TC)-静脉血: 5.96mmol/L；阴离子间隙(AG)-静脉血: 12；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 47U/L；平均血小板体积(MPV)-静脉血: 8.8fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.4；中性粒细胞百分比(Neut%)-静脉血: 0.626；总钙(Ca)-静脉血: 1.94mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.……\n- [全程D61] 超声；肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声不均匀，肝S5可见2个无回声灶，直径约3-4mm，边界清,内透声可，后方回声增强。血管走行清晰、自然，肝内胆管不扩张，门静脉内径约7mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约28cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约43×27×32mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝S5囊性灶，考虑肝囊肿可能性大。 胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D61] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，走行自然，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D8] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者相关检查完善中，请假未回病房。\n- [全程D13] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者相关检查完善中，请假未回病房。\n- [全程D19] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者元旦假期请假中。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D29] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者无明显不适主诉，查体情况：一般情况可，余同入院。放疗计划已完善。[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，向患者及其家属交代病情及化疗风险，表示理解并已签署知情同意书，同意入组三周/单周DDP同时期化疗临床试验，抽签入三周组，可于今日执行第1程顺铂方案同时期化疗，注意化疗不良反应，开始放疗。\n- [全程D41] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者放疗中，诉口感、咽痛，余无不适。查体同前。复查血常规：基本正常，生化常规：正常。[姓名已隐去]医生信息已隐藏：患者DDP化疗后出现肝酶升高，考虑为药物性肝损害，经多种滑竿药物治疗后肝功能恢复正常，今日可办理出院，继续门诊放疗。\n- [全程D50] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，向患者及其家属交代病情及化疗风险，表示理解并已签署知情同意书，可于今日水化，明日执行第2程DDP方案同时期化疗，注意化疗不良反应。\n- [全程D51] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程DDP方案同时期化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D52] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第二程DDP单药同期化疗结束，诉咽痛、恶心、食欲下降，呕吐1次，伴头晕，无腹痛、腹泻等不适。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者同时期化疗结束，一般情况可，可以今日结账出院，门诊继续放疗。嘱定期复查血常规及肝肾功能，行放疗结束前常规检查。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，行腹部增强MRI或穿刺活检明确肝脏囊性病灶性质，待明确性质后再决定后续治疗方案。\nB. 继续根治性放疗，启动第三程顺铂单药同期化疗，并给予保肝、止吐及水化等预防性对症支持治疗。\nC. 继续根治性放疗，加用卡培他滨口服节拍化疗，并给予雾化吸入及局部外用药处理放疗反应。\nD. 提前结束放疗，给予静脉滴注大剂量糖皮质激素及广谱抗生素处理放射性黏膜炎和皮炎。\nE. 继续根治性放疗，给予静脉高营养支持处理急性放射性黏膜炎，并预防性使用重组人粒细胞刺激因子。\nF. 暂停放疗，复查鼻咽及颈部MRI，重新定位并缩减原发灶及颈部放疗靶区。\nG. 继续根治性放疗，行肝脏囊性灶局部射频消融治疗，并给予雾化吸入及局部外用药处理放疗反应。\nH. 继续根治性放疗，继续给予静脉双环醇等保肝药物强化治疗，并给予局部外用药处理放疗反应。\nI. 暂停放疗，给予局部清创换药，待皮肤及黏膜反应恢复至1级以下再恢复根治性放疗。\nJ. 继续根治性放疗，给予雾化吸入（氨溴索、地塞米松）及局部外用药（三乙醇胺乳膏）处理急性放射性黏膜炎和皮炎。\nK. 继续根治性放疗，给予口服非甾体抗炎药缓解黏膜疼痛，并在局部皮炎处预防性涂抹抗生素软膏。\nL. 结束根治性放疗，进入定期随访阶段，给予雾化吸入及局部外用药处理急性放射性黏膜炎和皮炎。\n\n请仅输出一个选项字母（A-L）。"}]}
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+{"sample_id":"sample-31a839b9f99ab6bf0a218575","patient_id":"patient-867f2373fc1b04e0b8b80452","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"L","gold_action":"完善全身远处转移排查（如PET-CT或胸腹部CT联合骨扫描）及血浆EBV-DNA检测，并行超声引导下中心静脉穿刺置管及X线定位，为全身化疗做准备。","options":[{"letter":"A","text":"完善全身远处转移排查及血浆EBV-DNA检测，并直接安排单纯根治性放射治疗定位。","is_gold":false},{"letter":"B","text":"完善全身远处转移排查及血浆EBV-DNA检测，并请头颈外科会诊评估鼻咽及颈部病灶根治性切除可能。","is_gold":false},{"letter":"C","text":"完善胸部X线、腹部超声及血浆EBV-DNA检测进行分期，并行超声引导下中心静脉穿刺置管及X线定位，为全身化疗做准备。","is_gold":false},{"letter":"D","text":"完善全身远处转移排查及血浆EBV-DNA检测，并预防性行经皮内镜下胃造瘘术（PEG）以保障放化疗期间营养。","is_gold":false},{"letter":"E","text":"安排鼻咽镜下再次活检以明确组织学亚型，暂缓全身远处转移排查及静脉置管，待病理亚型确诊后再行后续安排。","is_gold":false},{"letter":"F","text":"完善全身远处转移排查及血浆EBV-DNA检测，并直接通过外周静脉留置针（PIV）启动全身化疗。","is_gold":false},{"letter":"G","text":"完善全身骨扫描及血浆EBV-DNA检测，并行超声引导下中心静脉穿刺置管及X线定位，为全身化疗做准备。","is_gold":false},{"letter":"H","text":"完善全身远处转移排查及血浆EBV-DNA检测，并先行双侧颈部淋巴结清扫术，术后行全身化疗。","is_gold":false},{"letter":"I","text":"完善全身远处转移排查及血浆EBV-DNA检测，并安排单药免疫治疗作为诱导治疗，无需中心静脉置管。","is_gold":false},{"letter":"J","text":"完善全身远处转移排查及血浆EBV-DNA检测，并安排超声引导下颈部淋巴结穿刺活检以病理确诊N分期。","is_gold":false},{"letter":"K","text":"完善全身远处转移排查及血浆EBV-DNA检测，并常规安排腰椎穿刺脑脊液检查以排除脑膜转移。","is_gold":false},{"letter":"L","text":"完善全身远处转移排查（如PET-CT或胸腹部CT联合骨扫描）及血浆EBV-DNA检测，并行超声引导下中心静脉穿刺置管及X线定位，为全身化疗做准备。","is_gold":true}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、鼻腔、翼外肌、斜坡、海绵窦、翼突基底部等。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1750] 入院记录: 主诉: 间断性涕血3月，面麻、复视1月，耳鸣20天；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 复视,涕血,双面麻；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟1包，30年，不嗜酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：88次/分，R：20次/分，BP：114/69mmHg,Ht：170cm，Wt：62kg，BSA：1.71m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1751] 检验组合: 阴离子间隙(AG)-静脉血: 18.2；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；平均血小板体积(MPV)-静脉血: 9.8fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.8；白细胞计数(WBC#)-静脉血: 6.2310E9/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 64.8umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阳性(+)（参考: 阴性）；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.92mmol/L；透明质酸(HA)-静脉血: 91.434ng/ml；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.4U/L；氯离子(Cl-)-静脉血: 101.8mmol/L；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 1.43ng/ml（参考: <0.704）；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；血小板比容-静脉血: 20%；活化部分凝血活酶时间(APTT)-静脉血: 27.5sec.；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.62；梅毒非特异性抗体甲苯胺红不加热血清试验(TRUST)-静脉血: 阴性(-)（参考: 阴性）；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；总钙(Ca)-静脉血: 2.27mmol/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.43；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；凝血酶时间(TT)-静脉血: 17.6sec.；间接胆红素(IBIL)-静脉血: 6.6umolL；凝血酶原时间活动度(PTA)-静脉血: 97.9%；降钙素(CT)-静脉血: 25.774pg/ml；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 44.9U/L……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善全身远处转移排查及血浆EBV-DNA检测，并直接安排单纯根治性放射治疗定位。\nB. 完善全身远处转移排查及血浆EBV-DNA检测，并请头颈外科会诊评估鼻咽及颈部病灶根治性切除可能。\nC. 完善胸部X线、腹部超声及血浆EBV-DNA检测进行分期，并行超声引导下中心静脉穿刺置管及X线定位，为全身化疗做准备。\nD. 完善全身远处转移排查及血浆EBV-DNA检测，并预防性行经皮内镜下胃造瘘术（PEG）以保障放化疗期间营养。\nE. 安排鼻咽镜下再次活检以明确组织学亚型，暂缓全身远处转移排查及静脉置管，待病理亚型确诊后再行后续安排。\nF. 完善全身远处转移排查及血浆EBV-DNA检测，并直接通过外周静脉留置针（PIV）启动全身化疗。\nG. 完善全身骨扫描及血浆EBV-DNA检测，并行超声引导下中心静脉穿刺置管及X线定位，为全身化疗做准备。\nH. 完善全身远处转移排查及血浆EBV-DNA检测，并先行双侧颈部淋巴结清扫术，术后行全身化疗。\nI. 完善全身远处转移排查及血浆EBV-DNA检测，并安排单药免疫治疗作为诱导治疗，无需中心静脉置管。\nJ. 完善全身远处转移排查及血浆EBV-DNA检测，并安排超声引导下颈部淋巴结穿刺活检以病理确诊N分期。\nK. 完善全身远处转移排查及血浆EBV-DNA检测，并常规安排腰椎穿刺脑脊液检查以排除脑膜转移。\nL. 完善全身远处转移排查（如PET-CT或胸腹部CT联合骨扫描）及血浆EBV-DNA检测，并行超声引导下中心静脉穿刺置管及X线定位，为全身化疗做准备。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、鼻腔、翼外肌、斜坡、海绵窦、翼突基底部等。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1750] 入院记录: 主诉: 间断性涕血3月，面麻、复视1月，耳鸣20天；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 复视,涕血,双面麻；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟1包，30年，不嗜酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：88次/分，R：20次/分，BP：114/69mmHg,Ht：170cm，Wt：62kg，BSA：1.71m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1751] 检验组合: 阴离子间隙(AG)-静脉血: 18.2；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；平均血小板体积(MPV)-静脉血: 9.8fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.8；白细胞计数(WBC#)-静脉血: 6.2310E9/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 64.8umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阳性(+)（参考: 阴性）；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.92mmol/L；透明质酸(HA)-静脉血: 91.434ng/ml；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.4U/L；氯离子(Cl-)-静脉血: 101.8mmol/L；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 1.43ng/ml（参考: <0.704）；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；血小板比容-静脉血: 20%；活化部分凝血活酶时间(APTT)-静脉血: 27.5sec.；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.62；梅毒非特异性抗体甲苯胺红不加热血清试验(TRUST)-静脉血: 阴性(-)（参考: 阴性）；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；总钙(Ca)-静脉血: 2.27mmol/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.43；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；凝血酶时间(TT)-静脉血: 17.6sec.；间接胆红素(IBIL)-静脉血: 6.6umolL；凝血酶原时间活动度(PTA)-静脉血: 97.9%；降钙素(CT)-静脉血: 25.774pg/ml；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 44.9U/L……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善全身远处转移排查及血浆EBV-DNA检测，并直接安排单纯根治性放射治疗定位。\nB. 完善全身远处转移排查及血浆EBV-DNA检测，并请头颈外科会诊评估鼻咽及颈部病灶根治性切除可能。\nC. 完善胸部X线、腹部超声及血浆EBV-DNA检测进行分期，并行超声引导下中心静脉穿刺置管及X线定位，为全身化疗做准备。\nD. 完善全身远处转移排查及血浆EBV-DNA检测，并预防性行经皮内镜下胃造瘘术（PEG）以保障放化疗期间营养。\nE. 安排鼻咽镜下再次活检以明确组织学亚型，暂缓全身远处转移排查及静脉置管，待病理亚型确诊后再行后续安排。\nF. 完善全身远处转移排查及血浆EBV-DNA检测，并直接通过外周静脉留置针（PIV）启动全身化疗。\nG. 完善全身骨扫描及血浆EBV-DNA检测，并行超声引导下中心静脉穿刺置管及X线定位，为全身化疗做准备。\nH. 完善全身远处转移排查及血浆EBV-DNA检测，并先行双侧颈部淋巴结清扫术，术后行全身化疗。\nI. 完善全身远处转移排查及血浆EBV-DNA检测，并安排单药免疫治疗作为诱导治疗，无需中心静脉置管。\nJ. 完善全身远处转移排查及血浆EBV-DNA检测，并安排超声引导下颈部淋巴结穿刺活检以病理确诊N分期。\nK. 完善全身远处转移排查及血浆EBV-DNA检测，并常规安排腰椎穿刺脑脊液检查以排除脑膜转移。\nL. 完善全身远处转移排查（如PET-CT或胸腹部CT联合骨扫描）及血浆EBV-DNA检测，并行超声引导下中心静脉穿刺置管及X线定位，为全身化疗做准备。\n\n请仅输出一个选项字母（A-L）。"}]}
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full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、鼻腔、翼外肌、斜坡、海绵窦、翼突基底部等。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1750] 入院记录: 主诉: 间断性涕血3月，面麻、复视1月，耳鸣20天；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 复视,涕血,双面麻；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟1包，30年，不嗜酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：88次/分，R：20次/分，BP：114/69mmHg,Ht：170cm，Wt：62kg，BSA：1.71m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。；KPS: 90；ECOG:\n- [全程D1750] 入院记录: 主诉: 间断性涕血3月，面麻、复视1月，耳鸣20天；现病史: 缘于3月余前患者无明显诱因出现间断性回吸性涕血，未予重视，一月前患者出现双侧面麻、复视，无鼻塞、头痛、视力下降等不适，遂就诊当地医院行鼻咽活检病理确诊鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 复视,涕血,双面麻；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟1包，30年，不嗜酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：88次/分，R：20次/分，BP：114/69mmHg,Ht：170cm，Wt：62kg，BSA：1.71m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率88次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1751] 检验组合: 阴离子间隙(AG)-静脉血: 18.2；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；平均血小板体积(MPV)-静脉血: 9.8fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.8；白细胞计数(WBC#)-静脉血: 6.2310E9/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 64.8umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阳性(+)（参考: 阴性）；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.92mmol/L；透明质酸(HA)-静脉血: 91.434ng/ml；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.4U/L；氯离子(Cl-)-静脉血: 101.8mmol/L；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 1.43ng/ml（参考: <0.704）；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；血小板比容-静脉血: 20%；活化部分凝血活酶时间(APTT)-静脉血: 27.5sec.；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.62；梅毒非特异性抗体甲苯胺红不加热血清试验(TRUST)-静脉血: 阴性(-)（参考: 阴性）；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；总钙(Ca)-静脉血: 2.27mmol/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.43；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；凝血酶时间(TT)-静脉血: 17.6sec.；间接胆红素(IBIL)-静脉血: 6.6umolL；凝血酶原时间活动度(PTA)-静脉血: 97.9%；降钙素(CT)-静脉血: 25.774pg/ml；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 44.9U/L……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 诱导化疗（吉西他滨+顺铂）序贯单纯根治性放疗\nB. 诱导化疗（洛铂+氟尿嘧啶）序贯同期放化疗\nC. 同期放化疗（顺铂单药）序贯辅助化疗\nD. 诱导化疗（多西他赛+顺铂+氟尿嘧啶）序贯单纯根治性放疗\nE. 诱导化疗（紫杉醇+卡铂）序贯同期放化疗\nF. 靶向治疗（西妥昔单抗）联合根治性放疗\nG. 诱导化疗（洛铂+氟尿嘧啶）联合特瑞普利单抗序贯同期放化疗\nH. 诱导化疗（依托泊苷+顺铂）序贯同期放化疗\nI. 单纯根治性放疗序贯辅助化疗\nJ. 诱导化疗（顺铂+氟尿嘧啶）序贯单纯根治性放疗\nK. 诱导化疗（吉西他滨+卡培他滨）序贯同期放化疗\nL. 姑息性化疗（洛铂+氟尿嘧啶）序贯姑息性放疗\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、鼻腔、翼外肌、斜坡、海绵窦、翼突基底部等。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1750] 入院记录: 主诉: 间断性涕血3月，面麻、复视1月，耳鸣20天；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 复视,涕血,双面麻；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟1包，30年，不嗜酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：88次/分，R：20次/分，BP：114/69mmHg,Ht：170cm，Wt：62kg，BSA：1.71m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。；KPS: 90；ECOG:\n- [全程D1750] 入院记录: 主诉: 间断性涕血3月，面麻、复视1月，耳鸣20天；现病史: 缘于3月余前患者无明显诱因出现间断性回吸性涕血，未予重视，一月前患者出现双侧面麻、复视，无鼻塞、头痛、视力下降等不适，遂就诊当地医院行鼻咽活检病理确诊鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 复视,涕血,双面麻；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟1包，30年，不嗜酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：88次/分，R：20次/分，BP：114/69mmHg,Ht：170cm，Wt：62kg，BSA：1.71m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率88次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1751] 检验组合: 阴离子间隙(AG)-静脉血: 18.2；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；平均血小板体积(MPV)-静脉血: 9.8fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.8；白细胞计数(WBC#)-静脉血: 6.2310E9/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 64.8umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阳性(+)（参考: 阴性）；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.92mmol/L；透明质酸(HA)-静脉血: 91.434ng/ml；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.4U/L；氯离子(Cl-)-静脉血: 101.8mmol/L；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 1.43ng/ml（参考: <0.704）；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；血小板比容-静脉血: 20%；活化部分凝血活酶时间(APTT)-静脉血: 27.5sec.；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.62；梅毒非特异性抗体甲苯胺红不加热血清试验(TRUST)-静脉血: 阴性(-)（参考: 阴性）；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；总钙(Ca)-静脉血: 2.27mmol/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.43；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；凝血酶时间(TT)-静脉血: 17.6sec.；间接胆红素(IBIL)-静脉血: 6.6umolL；凝血酶原时间活动度(PTA)-静脉血: 97.9%；降钙素(CT)-静脉血: 25.774pg/ml；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 44.9U/L……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 诱导化疗（吉西他滨+顺铂）序贯单纯根治性放疗\nB. 诱导化疗（洛铂+氟尿嘧啶）序贯同期放化疗\nC. 同期放化疗（顺铂单药）序贯辅助化疗\nD. 诱导化疗（多西他赛+顺铂+氟尿嘧啶）序贯单纯根治性放疗\nE. 诱导化疗（紫杉醇+卡铂）序贯同期放化疗\nF. 靶向治疗（西妥昔单抗）联合根治性放疗\nG. 诱导化疗（洛铂+氟尿嘧啶）联合特瑞普利单抗序贯同期放化疗\nH. 诱导化疗（依托泊苷+顺铂）序贯同期放化疗\nI. 单纯根治性放疗序贯辅助化疗\nJ. 诱导化疗（顺铂+氟尿嘧啶）序贯单纯根治性放疗\nK. 诱导化疗（吉西他滨+卡培他滨）序贯同期放化疗\nL. 姑息性化疗（洛铂+氟尿嘧啶）序贯姑息性放疗\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-5d0eff95cd33597017422fc5","patient_id":"patient-867f2373fc1b04e0b8b80452","turn_id":"turn05","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"C","gold_action":"予以止呕、护胃等对症支持，办理出院；嘱院外每周复查血常规及肝肾功能，定期进行PICC导管维护，按期返院行下一程治疗。","options":[{"letter":"A","text":"予以止呕、护胃等对症支持，继续住院观察至消化道反应完全缓解后再予出院，出院后按期返院行下一程治疗。","is_gold":false},{"letter":"B","text":"予以止呕、护胃等对症支持，办理出院；下一程化疗将洛铂及5-FU剂量下调20%，嘱院外每周复查血常规及肝肾功能。","is_gold":false},{"letter":"C","text":"予以止呕、护胃等对症支持，办理出院；嘱院外每周复查血常规及肝肾功能，定期进行PICC导管维护，按期返院行下一程治疗。","is_gold":true},{"letter":"D","text":"予以止呕、护胃等对症支持，办理出院；嘱院外预防性皮下注射重组人粒细胞刺激因子（G-CSF），每周复查血常规。","is_gold":false},{"letter":"E","text":"予以止呕、护胃等对症支持，办理出院；下一程化疗方案更改为吉西他滨+顺铂（GP方案），嘱院外每周复查血常规。","is_gold":false},{"letter":"F","text":"予以止呕、护胃等对症支持，办理出院；嘱院外每周复查血常规及肝肾功能，并拔除PICC导管以防感染。","is_gold":false},{"letter":"G","text":"予以止呕、护胃等对症支持，办理出院；嘱院外每月复查一次血常规及肝肾功能，按期返院行下一程治疗。","is_gold":false},{"letter":"H","text":"予以止呕、护胃等对症支持，办理出院；上报严重不良事件（SAE）并暂停临床试验入组治疗，转为常规放化疗。","is_gold":false},{"letter":"I","text":"予以止呕、护胃等对症支持，办理出院；嘱院外口服卡培他滨维持治疗，按期返院行下一程静脉化疗。","is_gold":false},{"letter":"J","text":"予以止呕、护胃等对症支持，办理出院；嘱院外每周复查血常规及肝肾功能，并于院外立即开始同步放射治疗。","is_gold":false},{"letter":"K","text":"予以止呕、护胃等对症支持，常规留取大便隐血及行腹部CT检查排除消化道并发症后，再办理出院。","is_gold":false},{"letter":"L","text":"予以止呕、护胃等对症支持，办理出院；嘱院外每周复查血常规及肝肾功能，若出现发热则自行口服抗生素观察。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、鼻腔、翼外肌、斜坡、海绵窦、翼突基底部等。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1750] 入院记录: 主诉: 间断性涕血3月，面麻、复视1月，耳鸣20天；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 复视,涕血,双面麻；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟1包，30年，不嗜酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：88次/分，R：20次/分，BP：114/69mmHg,Ht：170cm，Wt：62kg，BSA：1.71m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。；KPS: 90；ECOG:\n- [全程D1750] 入院记录: 主诉: 间断性涕血3月，面麻、复视1月，耳鸣20天；现病史: 缘于3月余前患者无明显诱因出现间断性回吸性涕血，未予重视，一月前患者出现双侧面麻、复视，无鼻塞、头痛、视力下降等不适，遂就诊当地医院行鼻咽活检病理确诊鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 复视,涕血,双面麻；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟1包，30年，不嗜酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：88次/分，R：20次/分，BP：114/69mmHg,Ht：170cm，Wt：62kg，BSA：1.71m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率88次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1751] 检验组合: 阴离子间隙(AG)-静脉血: 18.2；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；平均血小板体积(MPV)-静脉血: 9.8fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.8；白细胞计数(WBC#)-静脉血: 6.2310E9/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 64.8umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阳性(+)（参考: 阴性）；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.92mmol/L；透明质酸(HA)-静脉血: 91.434ng/ml；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.4U/L；氯离子(Cl-)-静脉血: 101.8mmol/L；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 1.43ng/ml（参考: <0.704）；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；血小板比容-静脉血: 20%；活化部分凝血活酶时间(APTT)-静脉血: 27.5sec.；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.62；梅毒非特异性抗体甲苯胺红不加热血清试验(TRUST)-静脉血: 阴性(-)（参考: 阴性）；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；总钙(Ca)-静脉血: 2.27mmol/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.43；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；凝血酶时间(TT)-静脉血: 17.6sec.；间接胆红素(IBIL)-静脉血: 6.6umolL；凝血酶原时间活动度(PTA)-静脉血: 97.9%；降钙素(CT)-静脉血: 25.774pg/ml；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 44.9U/L……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1754] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右旁T7椎体上缘水平，估计位于上腔静脉内。；检查结论: PICC管位置如上所述。\n- [全程D1758] 检验组合: 红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.410E9/L；总胆红素(TBIL)-静脉血: 15.3umol/L；葡萄糖(Glu)-静脉血: 4.9mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.6pg；间接胆红素(IBIL)-静脉血: 10.2umolL；肌酐(Crea)-静脉血: 67.1umol/L；血小板计数(PLT#)-静脉血: 159.110E9/L；中性粒细胞计数(Neut#)-静脉血: 5.210E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；血小板比容-静脉血: 13.7%；氯离子(Cl-)-静脉血: 100.4mmol/L；尿素氮(BUN)-静脉血: 5.1mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；平均血小板体积(MPV)-静脉血: 8.66fL；白蛋白(ALB)-静脉血: 36.6g/L；载脂蛋白B(apoB)-静脉血: 0.97g/L；C-反应蛋白(CRP)-静脉血: 17.22mg/L；乳酸脱氢酶(LDH)-静脉血: 196.7U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.69mmol/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；尿酸(UA)-静脉血: 195.2umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.759；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.37；总胆固醇(TC)-静脉血: 4.18mmol/L；钾离子(K+)-静脉血: 4.29mmol/L；单核细胞百分比(Mono%)-静脉血: 0.062；α-L-岩藻糖苷酶(AFU)-静脉血: 34.2U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.97；直接胆红素(DBIL)-静脉血: 5.1umol/L；碱性磷酸酶(ALP)-静脉血: 54.4U/L；有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞体积(MCV)-静脉血: 90.4fL；白细胞计数(WBC#)-静脉血: 6.810E9/L；总蛋白(TP)-静脉血: 63.4g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15U/L；甘油三酯(TG)-静脉血: 0.61mmol/L；球蛋白(……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1751] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者入院第二天，无特殊不适主诉，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。复查血常规、生化常规结果无异常。[姓名已隐去]副医生信息已隐藏：现等待患者鼻咽颈部影像学检查结果，明确分期后再行进一步诊治，病情继观。\n- [全程D1752] 上级查房记录；[姓名已隐去]医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医师查房记录；病程内容: 患者入院第三天，无诉，体查情况基本同前，[姓名已隐去]医师查房后示：等待患者影像学检查结果，明确分期后再行进一步诊治，余治疗同前，继观。\n- [全程D1758] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者处于一程洛铂+5FU方案诱导化疗中，诉恶心、呕吐，一般情况可，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。复查血常规、生化常规结果基本正常，[姓名已隐去]副医生信息已隐藏：现患者已完成一程诱导化疗，情况尚可，予以止呕、护胃等对症支持，嘱今日可予以出院，按期返院，不适随诊。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 予以止呕、护胃等对症支持，继续住院观察至消化道反应完全缓解后再予出院，出院后按期返院行下一程治疗。\nB. 予以止呕、护胃等对症支持，办理出院；下一程化疗将洛铂及5-FU剂量下调20%，嘱院外每周复查血常规及肝肾功能。\nC. 予以止呕、护胃等对症支持，办理出院；嘱院外每周复查血常规及肝肾功能，定期进行PICC导管维护，按期返院行下一程治疗。\nD. 予以止呕、护胃等对症支持，办理出院；嘱院外预防性皮下注射重组人粒细胞刺激因子（G-CSF），每周复查血常规。\nE. 予以止呕、护胃等对症支持，办理出院；下一程化疗方案更改为吉西他滨+顺铂（GP方案），嘱院外每周复查血常规。\nF. 予以止呕、护胃等对症支持，办理出院；嘱院外每周复查血常规及肝肾功能，并拔除PICC导管以防感染。\nG. 予以止呕、护胃等对症支持，办理出院；嘱院外每月复查一次血常规及肝肾功能，按期返院行下一程治疗。\nH. 予以止呕、护胃等对症支持，办理出院；上报严重不良事件（SAE）并暂停临床试验入组治疗，转为常规放化疗。\nI. 予以止呕、护胃等对症支持，办理出院；嘱院外口服卡培他滨维持治疗，按期返院行下一程静脉化疗。\nJ. 予以止呕、护胃等对症支持，办理出院；嘱院外每周复查血常规及肝肾功能，并于院外立即开始同步放射治疗。\nK. 予以止呕、护胃等对症支持，常规留取大便隐血及行腹部CT检查排除消化道并发症后，再办理出院。\nL. 予以止呕、护胃等对症支持，办理出院；嘱院外每周复查血常规及肝肾功能，若出现发热则自行口服抗生素观察。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、鼻腔、翼外肌、斜坡、海绵窦、翼突基底部等。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1750] 入院记录: 主诉: 间断性涕血3月，面麻、复视1月，耳鸣20天；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 复视,涕血,双面麻；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟1包，30年，不嗜酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：88次/分，R：20次/分，BP：114/69mmHg,Ht：170cm，Wt：62kg，BSA：1.71m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。；KPS: 90；ECOG:\n- [全程D1750] 入院记录: 主诉: 间断性涕血3月，面麻、复视1月，耳鸣20天；现病史: 缘于3月余前患者无明显诱因出现间断性回吸性涕血，未予重视，一月前患者出现双侧面麻、复视，无鼻塞、头痛、视力下降等不适，遂就诊当地医院行鼻咽活检病理确诊鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 复视,涕血,双面麻；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟1包，30年，不嗜酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：88次/分，R：20次/分，BP：114/69mmHg,Ht：170cm，Wt：62kg，BSA：1.71m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率88次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1751] 检验组合: 阴离子间隙(AG)-静脉血: 18.2；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；平均血小板体积(MPV)-静脉血: 9.8fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.8；白细胞计数(WBC#)-静脉血: 6.2310E9/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 64.8umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阳性(+)（参考: 阴性）；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.92mmol/L；透明质酸(HA)-静脉血: 91.434ng/ml；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.4U/L；氯离子(Cl-)-静脉血: 101.8mmol/L；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 1.43ng/ml（参考: <0.704）；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；血小板比容-静脉血: 20%；活化部分凝血活酶时间(APTT)-静脉血: 27.5sec.；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.62；梅毒非特异性抗体甲苯胺红不加热血清试验(TRUST)-静脉血: 阴性(-)（参考: 阴性）；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；总钙(Ca)-静脉血: 2.27mmol/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.43；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；凝血酶时间(TT)-静脉血: 17.6sec.；间接胆红素(IBIL)-静脉血: 6.6umolL；凝血酶原时间活动度(PTA)-静脉血: 97.9%；降钙素(CT)-静脉血: 25.774pg/ml；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 44.9U/L……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1754] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右旁T7椎体上缘水平，估计位于上腔静脉内。；检查结论: PICC管位置如上所述。\n- [全程D1758] 检验组合: 红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.410E9/L；总胆红素(TBIL)-静脉血: 15.3umol/L；葡萄糖(Glu)-静脉血: 4.9mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.6pg；间接胆红素(IBIL)-静脉血: 10.2umolL；肌酐(Crea)-静脉血: 67.1umol/L；血小板计数(PLT#)-静脉血: 159.110E9/L；中性粒细胞计数(Neut#)-静脉血: 5.210E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；血小板比容-静脉血: 13.7%；氯离子(Cl-)-静脉血: 100.4mmol/L；尿素氮(BUN)-静脉血: 5.1mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；平均血小板体积(MPV)-静脉血: 8.66fL；白蛋白(ALB)-静脉血: 36.6g/L；载脂蛋白B(apoB)-静脉血: 0.97g/L；C-反应蛋白(CRP)-静脉血: 17.22mg/L；乳酸脱氢酶(LDH)-静脉血: 196.7U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.69mmol/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；尿酸(UA)-静脉血: 195.2umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.759；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.37；总胆固醇(TC)-静脉血: 4.18mmol/L；钾离子(K+)-静脉血: 4.29mmol/L；单核细胞百分比(Mono%)-静脉血: 0.062；α-L-岩藻糖苷酶(AFU)-静脉血: 34.2U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.97；直接胆红素(DBIL)-静脉血: 5.1umol/L；碱性磷酸酶(ALP)-静脉血: 54.4U/L；有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞体积(MCV)-静脉血: 90.4fL；白细胞计数(WBC#)-静脉血: 6.810E9/L；总蛋白(TP)-静脉血: 63.4g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15U/L；甘油三酯(TG)-静脉血: 0.61mmol/L；球蛋白(……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1751] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者入院第二天，无特殊不适主诉，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。复查血常规、生化常规结果无异常。[姓名已隐去]副医生信息已隐藏：现等待患者鼻咽颈部影像学检查结果，明确分期后再行进一步诊治，病情继观。\n- [全程D1752] 上级查房记录；[姓名已隐去]医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医师查房记录；病程内容: 患者入院第三天，无诉，体查情况基本同前，[姓名已隐去]医师查房后示：等待患者影像学检查结果，明确分期后再行进一步诊治，余治疗同前，继观。\n- [全程D1758] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者处于一程洛铂+5FU方案诱导化疗中，诉恶心、呕吐，一般情况可，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。复查血常规、生化常规结果基本正常，[姓名已隐去]副医生信息已隐藏：现患者已完成一程诱导化疗，情况尚可，予以止呕、护胃等对症支持，嘱今日可予以出院，按期返院，不适随诊。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 予以止呕、护胃等对症支持，继续住院观察至消化道反应完全缓解后再予出院，出院后按期返院行下一程治疗。\nB. 予以止呕、护胃等对症支持，办理出院；下一程化疗将洛铂及5-FU剂量下调20%，嘱院外每周复查血常规及肝肾功能。\nC. 予以止呕、护胃等对症支持，办理出院；嘱院外每周复查血常规及肝肾功能，定期进行PICC导管维护，按期返院行下一程治疗。\nD. 予以止呕、护胃等对症支持，办理出院；嘱院外预防性皮下注射重组人粒细胞刺激因子（G-CSF），每周复查血常规。\nE. 予以止呕、护胃等对症支持，办理出院；下一程化疗方案更改为吉西他滨+顺铂（GP方案），嘱院外每周复查血常规。\nF. 予以止呕、护胃等对症支持，办理出院；嘱院外每周复查血常规及肝肾功能，并拔除PICC导管以防感染。\nG. 予以止呕、护胃等对症支持，办理出院；嘱院外每月复查一次血常规及肝肾功能，按期返院行下一程治疗。\nH. 予以止呕、护胃等对症支持，办理出院；上报严重不良事件（SAE）并暂停临床试验入组治疗，转为常规放化疗。\nI. 予以止呕、护胃等对症支持，办理出院；嘱院外口服卡培他滨维持治疗，按期返院行下一程静脉化疗。\nJ. 予以止呕、护胃等对症支持，办理出院；嘱院外每周复查血常规及肝肾功能，并于院外立即开始同步放射治疗。\nK. 予以止呕、护胃等对症支持，常规留取大便隐血及行腹部CT检查排除消化道并发症后，再办理出院。\nL. 予以止呕、护胃等对症支持，办理出院；嘱院外每周复查血常规及肝肾功能，若出现发热则自行口服抗生素观察。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-be610c2d167fae3585440ece","patient_id":"patient-867f2373fc1b04e0b8b80452","turn_id":"turn06","turn_position":5,"turn_type":"toxicity_or_support_decision","gold_letter":"D","gold_action":"按计划开展第二周期洛铂+5-FU诱导化疗，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗","options":[{"letter":"A","text":"暂缓化疗，予以重组人粒细胞集落刺激因子升白治疗，待中性粒细胞绝对值恢复至2.0×10^9/L以上再行第二周期化疗","is_gold":false},{"letter":"B","text":"开展第二周期洛铂+5-FU诱导化疗，将洛铂剂量下调20%，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃","is_gold":false},{"letter":"C","text":"终止诱导化疗，直接进入同期放化疗阶段，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗","is_gold":false},{"letter":"D","text":"按计划开展第二周期洛铂+5-FU诱导化疗，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗","is_gold":true},{"letter":"E","text":"开展第二周期洛铂+5-FU诱导化疗，暂不予以预防性止吐，待出现恶心呕吐症状时再予以甲氧氯普胺解痉止吐","is_gold":false},{"letter":"F","text":"更改化疗方案为紫杉醇+顺铂方案进行第二周期诱导化疗，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃","is_gold":false},{"letter":"G","text":"开展第二周期洛铂+5-FU诱导化疗，并预防性予以阿瑞匹坦、地塞米松联合5-HT3受体拮抗剂三联强效止吐","is_gold":false},{"letter":"H","text":"暂缓化疗，复查鼻咽颈部MRI评估一程化疗疗效，若肿瘤缩小则继续原方案，否则更改为紫杉醇+顺铂方案","is_gold":false},{"letter":"I","text":"开展第二周期洛铂+5-FU诱导化疗，将5-FU剂量下调25%，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃","is_gold":false},{"letter":"J","text":"暂缓化疗，予以静脉高营养支持及补液治疗，待消化道症状完全缓解、体重增加后再行第二周期诱导化疗","is_gold":false},{"letter":"K","text":"退出临床试验，更改为顺铂+5-FU方案进行第二周期诱导化疗，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃","is_gold":false},{"letter":"L","text":"开展第二周期洛铂+5-FU诱导化疗，并预防性予以奥氮平联合地塞米松双联止吐及质子泵抑制剂护胃支持治疗","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、鼻腔、翼外肌、斜坡、海绵窦、翼突基底部等。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1750] 入院记录: 主诉: 间断性涕血3月，面麻、复视1月，耳鸣20天；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 复视,涕血,双面麻；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟1包，30年，不嗜酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：88次/分，R：20次/分，BP：114/69mmHg,Ht：170cm，Wt：62kg，BSA：1.71m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。；KPS: 90；ECOG:\n- [全程D1750] 入院记录: 主诉: 间断性涕血3月，面麻、复视1月，耳鸣20天；现病史: 缘于3月余前患者无明显诱因出现间断性回吸性涕血，未予重视，一月前患者出现双侧面麻、复视，无鼻塞、头痛、视力下降等不适，遂就诊当地医院行鼻咽活检病理确诊鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 复视,涕血,双面麻；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟1包，30年，不嗜酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：88次/分，R：20次/分，BP：114/69mmHg,Ht：170cm，Wt：62kg，BSA：1.71m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率88次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1751] 检验组合: 阴离子间隙(AG)-静脉血: 18.2；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；平均血小板体积(MPV)-静脉血: 9.8fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.8；白细胞计数(WBC#)-静脉血: 6.2310E9/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 64.8umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阳性(+)（参考: 阴性）；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.92mmol/L；透明质酸(HA)-静脉血: 91.434ng/ml；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.4U/L；氯离子(Cl-)-静脉血: 101.8mmol/L；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 1.43ng/ml（参考: <0.704）；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；血小板比容-静脉血: 20%；活化部分凝血活酶时间(APTT)-静脉血: 27.5sec.；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.62；梅毒非特异性抗体甲苯胺红不加热血清试验(TRUST)-静脉血: 阴性(-)（参考: 阴性）；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；总钙(Ca)-静脉血: 2.27mmol/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.43；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；凝血酶时间(TT)-静脉血: 17.6sec.；间接胆红素(IBIL)-静脉血: 6.6umolL；凝血酶原时间活动度(PTA)-静脉血: 97.9%；降钙素(CT)-静脉血: 25.774pg/ml；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 44.9U/L……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1754] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右旁T7椎体上缘水平，估计位于上腔静脉内。；检查结论: PICC管位置如上所述。\n- [全程D1758] 检验组合: 红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.410E9/L；总胆红素(TBIL)-静脉血: 15.3umol/L；葡萄糖(Glu)-静脉血: 4.9mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.6pg；间接胆红素(IBIL)-静脉血: 10.2umolL；肌酐(Crea)-静脉血: 67.1umol/L；血小板计数(PLT#)-静脉血: 159.110E9/L；中性粒细胞计数(Neut#)-静脉血: 5.210E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；血小板比容-静脉血: 13.7%；氯离子(Cl-)-静脉血: 100.4mmol/L；尿素氮(BUN)-静脉血: 5.1mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；平均血小板体积(MPV)-静脉血: 8.66fL；白蛋白(ALB)-静脉血: 36.6g/L；载脂蛋白B(apoB)-静脉血: 0.97g/L；C-反应蛋白(CRP)-静脉血: 17.22mg/L；乳酸脱氢酶(LDH)-静脉血: 196.7U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.69mmol/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；尿酸(UA)-静脉血: 195.2umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.759；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.37；总胆固醇(TC)-静脉血: 4.18mmol/L；钾离子(K+)-静脉血: 4.29mmol/L；单核细胞百分比(Mono%)-静脉血: 0.062；α-L-岩藻糖苷酶(AFU)-静脉血: 34.2U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.97；直接胆红素(DBIL)-静脉血: 5.1umol/L；碱性磷酸酶(ALP)-静脉血: 54.4U/L；有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞体积(MCV)-静脉血: 90.4fL；白细胞计数(WBC#)-静脉血: 6.810E9/L；总蛋白(TP)-静脉血: 63.4g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15U/L；甘油三酯(TG)-静脉血: 0.61mmol/L；球蛋白(……\n- [全程D1772] 检验组合: 总胆红素(TBIL)-静脉血: 7.6umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.472；红细胞计数(RBC#)-静脉血: 4.2810E12/L；直接胆红素(DBIL)-静脉血: 1.4umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.281；中性粒细胞计数(Neut#)-静脉血: 1.810E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.07；载脂蛋白B(apoB)-静脉血: 1.11g/L；血小板比容-静脉血: 18%；磷(P)-静脉血: 1.23mmol/L；总蛋白(TP)-静脉血: 70.84g/L；平均红细胞体积(MCV)-静脉血: 93.5fL；间接胆红素(IBIL)-静脉血: 6.2umolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.78；丙氨酸氨基转移酶(ALT)-静脉血: 20.8U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.6pg；乳酸脱氢酶(LDH)-静脉血: 173.8U/L；白蛋白(ALB)-静脉血: 41.6g/L；钾离子(K+)-静脉血: 4.12mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 20.8mmol/L；钠离子(Na+)-静脉血: 140.8mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.55mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.33g/L；尿素氮(BUN)-静脉血: 5.1mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.42；甘油三酯(TG)-静脉血: 0.99mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.2；碱性磷酸酶(ALP)-静脉血: 67.2U/L；肌酐(Crea)-静脉血: 68.4umol/L；C-反应蛋白(CRP)-静脉血: 1.24mg/L；血小板计数(PLT#)-静脉血: 18110E9/L；红细胞比容(Hct)-静脉血: 40%；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 30.4U/L；血红蛋白(Hb)-静脉血: 131g/L；镁离子(Mg2+)-静脉血: 0.92mmol/L；平均红细胞血红蛋白……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1751] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者入院第二天，无特殊不适主诉，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。复查血常规、生化常规结果无异常。[姓名已隐去]副医生信息已隐藏：现等待患者鼻咽颈部影像学检查结果，明确分期后再行进一步诊治，病情继观。\n- [全程D1752] 上级查房记录；[姓名已隐去]医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医师查房记录；病程内容: 患者入院第三天，无诉，体查情况基本同前，[姓名已隐去]医师查房后示：等待患者影像学检查结果，明确分期后再行进一步诊治，余治疗同前，继观。\n- [全程D1758] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者处于一程洛铂+5FU方案诱导化疗中，诉恶心、呕吐，一般情况可，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。复查血常规、生化常规结果基本正常，[姓名已隐去]副医生信息已隐藏：现患者已完成一程诱导化疗，情况尚可，予以止呕、护胃等对症支持，嘱今日可予以出院，按期返院，不适随诊。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂缓化疗，予以重组人粒细胞集落刺激因子升白治疗，待中性粒细胞绝对值恢复至2.0×10^9/L以上再行第二周期化疗\nB. 开展第二周期洛铂+5-FU诱导化疗，将洛铂剂量下调20%，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃\nC. 终止诱导化疗，直接进入同期放化疗阶段，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nD. 按计划开展第二周期洛铂+5-FU诱导化疗，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nE. 开展第二周期洛铂+5-FU诱导化疗，暂不予以预防性止吐，待出现恶心呕吐症状时再予以甲氧氯普胺解痉止吐\nF. 更改化疗方案为紫杉醇+顺铂方案进行第二周期诱导化疗，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃\nG. 开展第二周期洛铂+5-FU诱导化疗，并预防性予以阿瑞匹坦、地塞米松联合5-HT3受体拮抗剂三联强效止吐\nH. 暂缓化疗，复查鼻咽颈部MRI评估一程化疗疗效，若肿瘤缩小则继续原方案，否则更改为紫杉醇+顺铂方案\nI. 开展第二周期洛铂+5-FU诱导化疗，将5-FU剂量下调25%，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃\nJ. 暂缓化疗，予以静脉高营养支持及补液治疗，待消化道症状完全缓解、体重增加后再行第二周期诱导化疗\nK. 退出临床试验，更改为顺铂+5-FU方案进行第二周期诱导化疗，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃\nL. 开展第二周期洛铂+5-FU诱导化疗，并预防性予以奥氮平联合地塞米松双联止吐及质子泵抑制剂护胃支持治疗\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、鼻腔、翼外肌、斜坡、海绵窦、翼突基底部等。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1750] 入院记录: 主诉: 间断性涕血3月，面麻、复视1月，耳鸣20天；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 复视,涕血,双面麻；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟1包，30年，不嗜酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：88次/分，R：20次/分，BP：114/69mmHg,Ht：170cm，Wt：62kg，BSA：1.71m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。；KPS: 90；ECOG:\n- [全程D1750] 入院记录: 主诉: 间断性涕血3月，面麻、复视1月，耳鸣20天；现病史: 缘于3月余前患者无明显诱因出现间断性回吸性涕血，未予重视，一月前患者出现双侧面麻、复视，无鼻塞、头痛、视力下降等不适，遂就诊当地医院行鼻咽活检病理确诊鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 复视,涕血,双面麻；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟1包，30年，不嗜酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：88次/分，R：20次/分，BP：114/69mmHg,Ht：170cm，Wt：62kg，BSA：1.71m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率88次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1751] 检验组合: 阴离子间隙(AG)-静脉血: 18.2；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；平均血小板体积(MPV)-静脉血: 9.8fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.8；白细胞计数(WBC#)-静脉血: 6.2310E9/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 64.8umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阳性(+)（参考: 阴性）；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.92mmol/L；透明质酸(HA)-静脉血: 91.434ng/ml；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.4U/L；氯离子(Cl-)-静脉血: 101.8mmol/L；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 1.43ng/ml（参考: <0.704）；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；血小板比容-静脉血: 20%；活化部分凝血活酶时间(APTT)-静脉血: 27.5sec.；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.62；梅毒非特异性抗体甲苯胺红不加热血清试验(TRUST)-静脉血: 阴性(-)（参考: 阴性）；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；总钙(Ca)-静脉血: 2.27mmol/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.43；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；凝血酶时间(TT)-静脉血: 17.6sec.；间接胆红素(IBIL)-静脉血: 6.6umolL；凝血酶原时间活动度(PTA)-静脉血: 97.9%；降钙素(CT)-静脉血: 25.774pg/ml；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 44.9U/L……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1754] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右旁T7椎体上缘水平，估计位于上腔静脉内。；检查结论: PICC管位置如上所述。\n- [全程D1758] 检验组合: 红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.410E9/L；总胆红素(TBIL)-静脉血: 15.3umol/L；葡萄糖(Glu)-静脉血: 4.9mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.6pg；间接胆红素(IBIL)-静脉血: 10.2umolL；肌酐(Crea)-静脉血: 67.1umol/L；血小板计数(PLT#)-静脉血: 159.110E9/L；中性粒细胞计数(Neut#)-静脉血: 5.210E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；血小板比容-静脉血: 13.7%；氯离子(Cl-)-静脉血: 100.4mmol/L；尿素氮(BUN)-静脉血: 5.1mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；平均血小板体积(MPV)-静脉血: 8.66fL；白蛋白(ALB)-静脉血: 36.6g/L；载脂蛋白B(apoB)-静脉血: 0.97g/L；C-反应蛋白(CRP)-静脉血: 17.22mg/L；乳酸脱氢酶(LDH)-静脉血: 196.7U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.69mmol/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；尿酸(UA)-静脉血: 195.2umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.759；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.37；总胆固醇(TC)-静脉血: 4.18mmol/L；钾离子(K+)-静脉血: 4.29mmol/L；单核细胞百分比(Mono%)-静脉血: 0.062；α-L-岩藻糖苷酶(AFU)-静脉血: 34.2U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.97；直接胆红素(DBIL)-静脉血: 5.1umol/L；碱性磷酸酶(ALP)-静脉血: 54.4U/L；有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞体积(MCV)-静脉血: 90.4fL；白细胞计数(WBC#)-静脉血: 6.810E9/L；总蛋白(TP)-静脉血: 63.4g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15U/L；甘油三酯(TG)-静脉血: 0.61mmol/L；球蛋白(……\n- [全程D1772] 检验组合: 总胆红素(TBIL)-静脉血: 7.6umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.472；红细胞计数(RBC#)-静脉血: 4.2810E12/L；直接胆红素(DBIL)-静脉血: 1.4umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.281；中性粒细胞计数(Neut#)-静脉血: 1.810E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.07；载脂蛋白B(apoB)-静脉血: 1.11g/L；血小板比容-静脉血: 18%；磷(P)-静脉血: 1.23mmol/L；总蛋白(TP)-静脉血: 70.84g/L；平均红细胞体积(MCV)-静脉血: 93.5fL；间接胆红素(IBIL)-静脉血: 6.2umolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.78；丙氨酸氨基转移酶(ALT)-静脉血: 20.8U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.6pg；乳酸脱氢酶(LDH)-静脉血: 173.8U/L；白蛋白(ALB)-静脉血: 41.6g/L；钾离子(K+)-静脉血: 4.12mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 20.8mmol/L；钠离子(Na+)-静脉血: 140.8mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.55mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.33g/L；尿素氮(BUN)-静脉血: 5.1mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.42；甘油三酯(TG)-静脉血: 0.99mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.2；碱性磷酸酶(ALP)-静脉血: 67.2U/L；肌酐(Crea)-静脉血: 68.4umol/L；C-反应蛋白(CRP)-静脉血: 1.24mg/L；血小板计数(PLT#)-静脉血: 18110E9/L；红细胞比容(Hct)-静脉血: 40%；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 30.4U/L；血红蛋白(Hb)-静脉血: 131g/L；镁离子(Mg2+)-静脉血: 0.92mmol/L；平均红细胞血红蛋白……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1751] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者入院第二天，无特殊不适主诉，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。复查血常规、生化常规结果无异常。[姓名已隐去]副医生信息已隐藏：现等待患者鼻咽颈部影像学检查结果，明确分期后再行进一步诊治，病情继观。\n- [全程D1752] 上级查房记录；[姓名已隐去]医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医师查房记录；病程内容: 患者入院第三天，无诉，体查情况基本同前，[姓名已隐去]医师查房后示：等待患者影像学检查结果，明确分期后再行进一步诊治，余治疗同前，继观。\n- [全程D1758] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者处于一程洛铂+5FU方案诱导化疗中，诉恶心、呕吐，一般情况可，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。复查血常规、生化常规结果基本正常，[姓名已隐去]副医生信息已隐藏：现患者已完成一程诱导化疗，情况尚可，予以止呕、护胃等对症支持，嘱今日可予以出院，按期返院，不适随诊。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂缓化疗，予以重组人粒细胞集落刺激因子升白治疗，待中性粒细胞绝对值恢复至2.0×10^9/L以上再行第二周期化疗\nB. 开展第二周期洛铂+5-FU诱导化疗，将洛铂剂量下调20%，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃\nC. 终止诱导化疗，直接进入同期放化疗阶段，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nD. 按计划开展第二周期洛铂+5-FU诱导化疗，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nE. 开展第二周期洛铂+5-FU诱导化疗，暂不予以预防性止吐，待出现恶心呕吐症状时再予以甲氧氯普胺解痉止吐\nF. 更改化疗方案为紫杉醇+顺铂方案进行第二周期诱导化疗，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃\nG. 开展第二周期洛铂+5-FU诱导化疗，并预防性予以阿瑞匹坦、地塞米松联合5-HT3受体拮抗剂三联强效止吐\nH. 暂缓化疗，复查鼻咽颈部MRI评估一程化疗疗效，若肿瘤缩小则继续原方案，否则更改为紫杉醇+顺铂方案\nI. 开展第二周期洛铂+5-FU诱导化疗，将5-FU剂量下调25%，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃\nJ. 暂缓化疗，予以静脉高营养支持及补液治疗，待消化道症状完全缓解、体重增加后再行第二周期诱导化疗\nK. 退出临床试验，更改为顺铂+5-FU方案进行第二周期诱导化疗，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃\nL. 开展第二周期洛铂+5-FU诱导化疗，并预防性予以奥氮平联合地塞米松双联止吐及质子泵抑制剂护胃支持治疗\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-08c11518d363599b5511b9c9","patient_id":"patient-867f2373fc1b04e0b8b80452","turn_id":"turn07","turn_position":6,"turn_type":"recurrence_or_salvage_decision","gold_letter":"B","gold_action":"启动根治性放疗及同步化疗，每周复查血常规，暂不予以重组人白介素-11及粒细胞刺激因子。","options":[{"letter":"A","text":"继续行洛铂联合5-FU方案第3程诱导化疗，予以重组人粒细胞刺激因子支持治疗，暂缓放疗。","is_gold":false},{"letter":"B","text":"启动根治性放疗及同步化疗，每周复查血常规，暂不予以重组人白介素-11及粒细胞刺激因子。","is_gold":true},{"letter":"C","text":"准备行根治性放疗及同步化疗，予以重组人促红素及重组人粒细胞刺激因子支持治疗，动态复查血常规。","is_gold":false},{"letter":"D","text":"更改化疗方案为吉西他滨联合顺铂诱导化疗，予以重组人白介素-11支持治疗，暂缓放疗。","is_gold":false},{"letter":"E","text":"准备行根治性放疗及同步化疗，予以输注单采血小板及红细胞悬液支持治疗，动态复查血常规。","is_gold":false},{"letter":"F","text":"准备行根治性放疗及同步化疗，因骨髓抑制降低同步化疗药物剂量，予以重组人粒细胞刺激因子支持治疗。","is_gold":false},{"letter":"G","text":"继续行洛铂联合5-FU方案第3程诱导化疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗。","is_gold":false},{"letter":"H","text":"准备行单纯根治性放疗，取消同步化疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗。","is_gold":false},{"letter":"I","text":"转为姑息性放疗及最佳支持治疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗。","is_gold":false},{"letter":"J","text":"准备行根治性放疗及同步化疗，予以重组人血小板生成素支持治疗，暂不使用粒细胞刺激因子。","is_gold":false},{"letter":"K","text":"暂停抗肿瘤治疗，待血象自然恢复后，再行第3程洛铂联合5-FU方案诱导化疗，暂缓放疗。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、鼻腔、翼外肌、斜坡、海绵窦、翼突基底部等。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1750] 入院记录: 主诉: 间断性涕血3月，面麻、复视1月，耳鸣20天；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 复视,涕血,双面麻；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟1包，30年，不嗜酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：88次/分，R：20次/分，BP：114/69mmHg,Ht：170cm，Wt：62kg，BSA：1.71m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。；KPS: 90；ECOG:\n- [全程D1750] 入院记录: 主诉: 间断性涕血3月，面麻、复视1月，耳鸣20天；现病史: 缘于3月余前患者无明显诱因出现间断性回吸性涕血，未予重视，一月前患者出现双侧面麻、复视，无鼻塞、头痛、视力下降等不适，遂就诊当地医院行鼻咽活检病理确诊鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 复视,涕血,双面麻；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟1包，30年，不嗜酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：88次/分，R：20次/分，BP：114/69mmHg,Ht：170cm，Wt：62kg，BSA：1.71m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率88次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1751] 检验组合: 阴离子间隙(AG)-静脉血: 18.2；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；平均血小板体积(MPV)-静脉血: 9.8fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.8；白细胞计数(WBC#)-静脉血: 6.2310E9/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 64.8umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阳性(+)（参考: 阴性）；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.92mmol/L；透明质酸(HA)-静脉血: 91.434ng/ml；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.4U/L；氯离子(Cl-)-静脉血: 101.8mmol/L；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 1.43ng/ml（参考: <0.704）；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；血小板比容-静脉血: 20%；活化部分凝血活酶时间(APTT)-静脉血: 27.5sec.；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.62；梅毒非特异性抗体甲苯胺红不加热血清试验(TRUST)-静脉血: 阴性(-)（参考: 阴性）；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；总钙(Ca)-静脉血: 2.27mmol/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.43；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；凝血酶时间(TT)-静脉血: 17.6sec.；间接胆红素(IBIL)-静脉血: 6.6umolL；凝血酶原时间活动度(PTA)-静脉血: 97.9%；降钙素(CT)-静脉血: 25.774pg/ml；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 44.9U/L……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1754] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右旁T7椎体上缘水平，估计位于上腔静脉内。；检查结论: PICC管位置如上所述。\n- [全程D1758] 检验组合: 红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.410E9/L；总胆红素(TBIL)-静脉血: 15.3umol/L；葡萄糖(Glu)-静脉血: 4.9mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.6pg；间接胆红素(IBIL)-静脉血: 10.2umolL；肌酐(Crea)-静脉血: 67.1umol/L；血小板计数(PLT#)-静脉血: 159.110E9/L；中性粒细胞计数(Neut#)-静脉血: 5.210E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；血小板比容-静脉血: 13.7%；氯离子(Cl-)-静脉血: 100.4mmol/L；尿素氮(BUN)-静脉血: 5.1mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；平均血小板体积(MPV)-静脉血: 8.66fL；白蛋白(ALB)-静脉血: 36.6g/L；载脂蛋白B(apoB)-静脉血: 0.97g/L；C-反应蛋白(CRP)-静脉血: 17.22mg/L；乳酸脱氢酶(LDH)-静脉血: 196.7U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.69mmol/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；尿酸(UA)-静脉血: 195.2umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.759；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.37；总胆固醇(TC)-静脉血: 4.18mmol/L；钾离子(K+)-静脉血: 4.29mmol/L；单核细胞百分比(Mono%)-静脉血: 0.062；α-L-岩藻糖苷酶(AFU)-静脉血: 34.2U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.97；直接胆红素(DBIL)-静脉血: 5.1umol/L；碱性磷酸酶(ALP)-静脉血: 54.4U/L；有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞体积(MCV)-静脉血: 90.4fL；白细胞计数(WBC#)-静脉血: 6.810E9/L；总蛋白(TP)-静脉血: 63.4g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15U/L；甘油三酯(TG)-静脉血: 0.61mmol/L；球蛋白(……\n- [全程D1772] 检验组合: 总胆红素(TBIL)-静脉血: 7.6umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.472；红细胞计数(RBC#)-静脉血: 4.2810E12/L；直接胆红素(DBIL)-静脉血: 1.4umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.281；中性粒细胞计数(Neut#)-静脉血: 1.810E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.07；载脂蛋白B(apoB)-静脉血: 1.11g/L；血小板比容-静脉血: 18%；磷(P)-静脉血: 1.23mmol/L；总蛋白(TP)-静脉血: 70.84g/L；平均红细胞体积(MCV)-静脉血: 93.5fL；间接胆红素(IBIL)-静脉血: 6.2umolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.78；丙氨酸氨基转移酶(ALT)-静脉血: 20.8U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.6pg；乳酸脱氢酶(LDH)-静脉血: 173.8U/L；白蛋白(ALB)-静脉血: 41.6g/L；钾离子(K+)-静脉血: 4.12mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 20.8mmol/L；钠离子(Na+)-静脉血: 140.8mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.55mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.33g/L；尿素氮(BUN)-静脉血: 5.1mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.42；甘油三酯(TG)-静脉血: 0.99mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.2；碱性磷酸酶(ALP)-静脉血: 67.2U/L；肌酐(Crea)-静脉血: 68.4umol/L；C-反应蛋白(CRP)-静脉血: 1.24mg/L；血小板计数(PLT#)-静脉血: 18110E9/L；红细胞比容(Hct)-静脉血: 40%；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 30.4U/L；血红蛋白(Hb)-静脉血: 131g/L；镁离子(Mg2+)-静脉血: 0.92mmol/L；平均红细胞血红蛋白……\n- [全程D1777] 检验组合: 低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.92mmol/L；尿素氮(BUN)-静脉血: 5.65mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；载脂蛋白B(apoB)-静脉血: 1.12g/L；平均红细胞体积(MCV)-静脉血: 91.7fL；中性粒细胞计数(Neut#)-静脉血: 3.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.108；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336.6g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.8；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.23mmolL；血小板比容-静脉血: 11.1%；血红蛋白(Hb)-静脉血: 131.2g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.6mmol/L；甘油三酯(TG)-静脉血: 0.96mmol/L；镁离子(Mg2+)-静脉血: 1.02mmol/L；总胆固醇(TC)-静脉血: 5.75mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.510E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；直接胆红素(DBIL)-静脉血: 5.7umol/L；总蛋白(TP)-静脉血: 68.83g/L；白蛋白(ALB)-静脉血: 37.6g/L；钾离子(K+)-静脉血: 4.1mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；尿酸(UA)-静脉血: 299.7umol/L；碱性磷酸酶(ALP)-静脉血: 64.4U/L；阴离子间隙(AG)-静脉血: 13；氯离子(Cl-)-静脉血: 101.5mmol/L；球蛋白(GLO)-静脉血: 31.23g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1%；血小板分布宽度(PDW)-静脉血: 17.9%；间接胆红素(IBIL)-静脉血: 12.7umolL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；丙氨酸氨基转移酶(ALT)-静脉血: 23.7U/L；C-反……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1751] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者入院第二天，无特殊不适主诉，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。复查血常规、生化常规结果无异常。[姓名已隐去]副医生信息已隐藏：现等待患者鼻咽颈部影像学检查结果，明确分期后再行进一步诊治，病情继观。\n- [全程D1752] 上级查房记录；[姓名已隐去]医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医师查房记录；病程内容: 患者入院第三天，无诉，体查情况基本同前，[姓名已隐去]医师查房后示：等待患者影像学检查结果，明确分期后再行进一步诊治，余治疗同前，继观。\n- [全程D1758] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者处于一程洛铂+5FU方案诱导化疗中，诉恶心、呕吐，一般情况可，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。复查血常规、生化常规结果基本正常，[姓名已隐去]副医生信息已隐藏：现患者已完成一程诱导化疗，情况尚可，予以止呕、护胃等对症支持，嘱今日可予以出院，按期返院，不适随诊。\n- [全程D1774] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者入院第二天，诉复视、面麻未见好转，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经（-）。复查血常规、生化常规结果无异常。[姓名已隐去]副医生信息已隐藏：现患者入院行第一程洛铂+5FU方案诱导化疗中，目前患者情况尚可，继续予以止呕、护胃、加强营养等对症支持治疗，病情继观。\n- [全程D1775] 上级查房记录；[姓名已隐去]医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医师查房记录；病程内容: 患者入院第三天，无诉，体查情况基本同前，[姓名已隐去]医师查房后示：现患者第一程洛铂+5FU方案诱导化疗中，目前患者情况尚可，继续予以对症支持治疗，病情继观。\n- [全程D1779] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现基本完成一程诱导化疗，诉恶心，一般情况尚可，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经（-）。复查血常规、生化常规结果基本正常，[姓名已隐去]副医生信息已隐藏：现患者情况尚可，嘱今日可予以出院，按期返院，不适随诊。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 继续行洛铂联合5-FU方案第3程诱导化疗，予以重组人粒细胞刺激因子支持治疗，暂缓放疗。\nB. 启动根治性放疗及同步化疗，每周复查血常规，暂不予以重组人白介素-11及粒细胞刺激因子。\nC. 准备行根治性放疗及同步化疗，予以重组人促红素及重组人粒细胞刺激因子支持治疗，动态复查血常规。\nD. 更改化疗方案为吉西他滨联合顺铂诱导化疗，予以重组人白介素-11支持治疗，暂缓放疗。\nE. 准备行根治性放疗及同步化疗，予以输注单采血小板及红细胞悬液支持治疗，动态复查血常规。\nF. 准备行根治性放疗及同步化疗，因骨髓抑制降低同步化疗药物剂量，予以重组人粒细胞刺激因子支持治疗。\nG. 继续行洛铂联合5-FU方案第3程诱导化疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗。\nH. 准备行单纯根治性放疗，取消同步化疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗。\nI. 转为姑息性放疗及最佳支持治疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗。\nJ. 准备行根治性放疗及同步化疗，予以重组人血小板生成素支持治疗，暂不使用粒细胞刺激因子。\nK. 暂停抗肿瘤治疗，待血象自然恢复后，再行第3程洛铂联合5-FU方案诱导化疗，暂缓放疗。\n\n请仅输出一个选项字母（A-K）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、鼻腔、翼外肌、斜坡、海绵窦、翼突基底部等。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1750] 入院记录: 主诉: 间断性涕血3月，面麻、复视1月，耳鸣20天；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 复视,涕血,双面麻；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟1包，30年，不嗜酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：88次/分，R：20次/分，BP：114/69mmHg,Ht：170cm，Wt：62kg，BSA：1.71m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。；KPS: 90；ECOG:\n- [全程D1750] 入院记录: 主诉: 间断性涕血3月，面麻、复视1月，耳鸣20天；现病史: 缘于3月余前患者无明显诱因出现间断性回吸性涕血，未予重视，一月前患者出现双侧面麻、复视，无鼻塞、头痛、视力下降等不适，遂就诊当地医院行鼻咽活检病理确诊鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 复视,涕血,双面麻；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟1包，30年，不嗜酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：88次/分，R：20次/分，BP：114/69mmHg,Ht：170cm，Wt：62kg，BSA：1.71m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率88次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1751] 检验组合: 阴离子间隙(AG)-静脉血: 18.2；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；平均血小板体积(MPV)-静脉血: 9.8fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.8；白细胞计数(WBC#)-静脉血: 6.2310E9/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 64.8umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阳性(+)（参考: 阴性）；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.92mmol/L；透明质酸(HA)-静脉血: 91.434ng/ml；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.4U/L；氯离子(Cl-)-静脉血: 101.8mmol/L；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 1.43ng/ml（参考: <0.704）；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；血小板比容-静脉血: 20%；活化部分凝血活酶时间(APTT)-静脉血: 27.5sec.；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.62；梅毒非特异性抗体甲苯胺红不加热血清试验(TRUST)-静脉血: 阴性(-)（参考: 阴性）；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；总钙(Ca)-静脉血: 2.27mmol/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.43；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；凝血酶时间(TT)-静脉血: 17.6sec.；间接胆红素(IBIL)-静脉血: 6.6umolL；凝血酶原时间活动度(PTA)-静脉血: 97.9%；降钙素(CT)-静脉血: 25.774pg/ml；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 44.9U/L……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1754] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右旁T7椎体上缘水平，估计位于上腔静脉内。；检查结论: PICC管位置如上所述。\n- [全程D1758] 检验组合: 红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.410E9/L；总胆红素(TBIL)-静脉血: 15.3umol/L；葡萄糖(Glu)-静脉血: 4.9mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.6pg；间接胆红素(IBIL)-静脉血: 10.2umolL；肌酐(Crea)-静脉血: 67.1umol/L；血小板计数(PLT#)-静脉血: 159.110E9/L；中性粒细胞计数(Neut#)-静脉血: 5.210E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；血小板比容-静脉血: 13.7%；氯离子(Cl-)-静脉血: 100.4mmol/L；尿素氮(BUN)-静脉血: 5.1mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；平均血小板体积(MPV)-静脉血: 8.66fL；白蛋白(ALB)-静脉血: 36.6g/L；载脂蛋白B(apoB)-静脉血: 0.97g/L；C-反应蛋白(CRP)-静脉血: 17.22mg/L；乳酸脱氢酶(LDH)-静脉血: 196.7U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.69mmol/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；尿酸(UA)-静脉血: 195.2umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.759；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.37；总胆固醇(TC)-静脉血: 4.18mmol/L；钾离子(K+)-静脉血: 4.29mmol/L；单核细胞百分比(Mono%)-静脉血: 0.062；α-L-岩藻糖苷酶(AFU)-静脉血: 34.2U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.97；直接胆红素(DBIL)-静脉血: 5.1umol/L；碱性磷酸酶(ALP)-静脉血: 54.4U/L；有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞体积(MCV)-静脉血: 90.4fL；白细胞计数(WBC#)-静脉血: 6.810E9/L；总蛋白(TP)-静脉血: 63.4g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15U/L；甘油三酯(TG)-静脉血: 0.61mmol/L；球蛋白(……\n- [全程D1772] 检验组合: 总胆红素(TBIL)-静脉血: 7.6umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.472；红细胞计数(RBC#)-静脉血: 4.2810E12/L；直接胆红素(DBIL)-静脉血: 1.4umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.281；中性粒细胞计数(Neut#)-静脉血: 1.810E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.07；载脂蛋白B(apoB)-静脉血: 1.11g/L；血小板比容-静脉血: 18%；磷(P)-静脉血: 1.23mmol/L；总蛋白(TP)-静脉血: 70.84g/L；平均红细胞体积(MCV)-静脉血: 93.5fL；间接胆红素(IBIL)-静脉血: 6.2umolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.78；丙氨酸氨基转移酶(ALT)-静脉血: 20.8U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.6pg；乳酸脱氢酶(LDH)-静脉血: 173.8U/L；白蛋白(ALB)-静脉血: 41.6g/L；钾离子(K+)-静脉血: 4.12mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 20.8mmol/L；钠离子(Na+)-静脉血: 140.8mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.55mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.33g/L；尿素氮(BUN)-静脉血: 5.1mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.42；甘油三酯(TG)-静脉血: 0.99mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.2；碱性磷酸酶(ALP)-静脉血: 67.2U/L；肌酐(Crea)-静脉血: 68.4umol/L；C-反应蛋白(CRP)-静脉血: 1.24mg/L；血小板计数(PLT#)-静脉血: 18110E9/L；红细胞比容(Hct)-静脉血: 40%；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 30.4U/L；血红蛋白(Hb)-静脉血: 131g/L；镁离子(Mg2+)-静脉血: 0.92mmol/L；平均红细胞血红蛋白……\n- [全程D1777] 检验组合: 低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.92mmol/L；尿素氮(BUN)-静脉血: 5.65mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；载脂蛋白B(apoB)-静脉血: 1.12g/L；平均红细胞体积(MCV)-静脉血: 91.7fL；中性粒细胞计数(Neut#)-静脉血: 3.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.108；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336.6g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.8；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.23mmolL；血小板比容-静脉血: 11.1%；血红蛋白(Hb)-静脉血: 131.2g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.6mmol/L；甘油三酯(TG)-静脉血: 0.96mmol/L；镁离子(Mg2+)-静脉血: 1.02mmol/L；总胆固醇(TC)-静脉血: 5.75mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.510E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；直接胆红素(DBIL)-静脉血: 5.7umol/L；总蛋白(TP)-静脉血: 68.83g/L；白蛋白(ALB)-静脉血: 37.6g/L；钾离子(K+)-静脉血: 4.1mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；尿酸(UA)-静脉血: 299.7umol/L；碱性磷酸酶(ALP)-静脉血: 64.4U/L；阴离子间隙(AG)-静脉血: 13；氯离子(Cl-)-静脉血: 101.5mmol/L；球蛋白(GLO)-静脉血: 31.23g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1%；血小板分布宽度(PDW)-静脉血: 17.9%；间接胆红素(IBIL)-静脉血: 12.7umolL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；丙氨酸氨基转移酶(ALT)-静脉血: 23.7U/L；C-反……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1751] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者入院第二天，无特殊不适主诉，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。复查血常规、生化常规结果无异常。[姓名已隐去]副医生信息已隐藏：现等待患者鼻咽颈部影像学检查结果，明确分期后再行进一步诊治，病情继观。\n- [全程D1752] 上级查房记录；[姓名已隐去]医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医师查房记录；病程内容: 患者入院第三天，无诉，体查情况基本同前，[姓名已隐去]医师查房后示：等待患者影像学检查结果，明确分期后再行进一步诊治，余治疗同前，继观。\n- [全程D1758] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者处于一程洛铂+5FU方案诱导化疗中，诉恶心、呕吐，一般情况可，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。复查血常规、生化常规结果基本正常，[姓名已隐去]副医生信息已隐藏：现患者已完成一程诱导化疗，情况尚可，予以止呕、护胃等对症支持，嘱今日可予以出院，按期返院，不适随诊。\n- [全程D1774] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者入院第二天，诉复视、面麻未见好转，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经（-）。复查血常规、生化常规结果无异常。[姓名已隐去]副医生信息已隐藏：现患者入院行第一程洛铂+5FU方案诱导化疗中，目前患者情况尚可，继续予以止呕、护胃、加强营养等对症支持治疗，病情继观。\n- [全程D1775] 上级查房记录；[姓名已隐去]医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医师查房记录；病程内容: 患者入院第三天，无诉，体查情况基本同前，[姓名已隐去]医师查房后示：现患者第一程洛铂+5FU方案诱导化疗中，目前患者情况尚可，继续予以对症支持治疗，病情继观。\n- [全程D1779] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现基本完成一程诱导化疗，诉恶心，一般情况尚可，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经（-）。复查血常规、生化常规结果基本正常，[姓名已隐去]副医生信息已隐藏：现患者情况尚可，嘱今日可予以出院，按期返院，不适随诊。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 继续行洛铂联合5-FU方案第3程诱导化疗，予以重组人粒细胞刺激因子支持治疗，暂缓放疗。\nB. 启动根治性放疗及同步化疗，每周复查血常规，暂不予以重组人白介素-11及粒细胞刺激因子。\nC. 准备行根治性放疗及同步化疗，予以重组人促红素及重组人粒细胞刺激因子支持治疗，动态复查血常规。\nD. 更改化疗方案为吉西他滨联合顺铂诱导化疗，予以重组人白介素-11支持治疗，暂缓放疗。\nE. 准备行根治性放疗及同步化疗，予以输注单采血小板及红细胞悬液支持治疗，动态复查血常规。\nF. 准备行根治性放疗及同步化疗，因骨髓抑制降低同步化疗药物剂量，予以重组人粒细胞刺激因子支持治疗。\nG. 继续行洛铂联合5-FU方案第3程诱导化疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗。\nH. 准备行单纯根治性放疗，取消同步化疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗。\nI. 转为姑息性放疗及最佳支持治疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗。\nJ. 准备行根治性放疗及同步化疗，予以重组人血小板生成素支持治疗，暂不使用粒细胞刺激因子。\nK. 暂停抗肿瘤治疗，待血象自然恢复后，再行第3程洛铂联合5-FU方案诱导化疗，暂缓放疗。\n\n请仅输出一个选项字母（A-K）。"}]}
+{"sample_id":"sample-070df43e0c39a4c5f77b459e","patient_id":"patient-867f2373fc1b04e0b8b80452","turn_id":"turn08","turn_position":7,"turn_type":"recurrence_or_salvage_decision","gold_letter":"D","gold_action":"立即开展根治性放疗及洛铂同步化疗，期间定期监测血常规，暂不予造血生长因子干预。","options":[{"letter":"A","text":"立即开展根治性放疗及顺铂同步化疗，期间定期监测血常规，暂不予造血生长因子干预。","is_gold":false},{"letter":"B","text":"予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及顺铂同步化疗。","is_gold":false},{"letter":"C","text":"仅予以重组人白介素-11升血小板治疗，动态复查血常规，并序贯开展根治性放疗及顺铂同步化疗。","is_gold":false},{"letter":"D","text":"立即开展根治性放疗及洛铂同步化疗，期间定期监测血常规，暂不予造血生长因子干预。","is_gold":true},{"letter":"E","text":"仅予以重组人粒细胞刺激因子升白细胞治疗，动态复查血常规，并序贯开展根治性放疗及洛铂同步化疗。","is_gold":false},{"letter":"F","text":"予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及洛铂同步化疗。","is_gold":false},{"letter":"G","text":"予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并转为洛铂单药姑息性化疗。","is_gold":false},{"letter":"H","text":"予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展开放性手术切除原发灶及颈部淋巴结。","is_gold":false},{"letter":"I","text":"予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及西妥昔单抗靶向治疗。","is_gold":false},{"letter":"J","text":"予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及PD-1抑制剂免疫治疗。","is_gold":false},{"letter":"K","text":"暂暂停抗肿瘤治疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，待血象恢复后继续行第三程洛铂+5FU诱导化疗。","is_gold":false},{"letter":"L","text":"予以输注单采血小板及洗涤红细胞支持治疗，动态复查血常规，并序贯开展根治性放疗及洛铂同步化疗。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、鼻腔、翼外肌、斜坡、海绵窦、翼突基底部等。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1750] 入院记录: 主诉: 间断性涕血3月，面麻、复视1月，耳鸣20天；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 复视,涕血,双面麻；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟1包，30年，不嗜酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：88次/分，R：20次/分，BP：114/69mmHg,Ht：170cm，Wt：62kg，BSA：1.71m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。；KPS: 90；ECOG:\n- [全程D1750] 入院记录: 主诉: 间断性涕血3月，面麻、复视1月，耳鸣20天；现病史: 缘于3月余前患者无明显诱因出现间断性回吸性涕血，未予重视，一月前患者出现双侧面麻、复视，无鼻塞、头痛、视力下降等不适，遂就诊当地医院行鼻咽活检病理确诊鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 复视,涕血,双面麻；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟1包，30年，不嗜酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：88次/分，R：20次/分，BP：114/69mmHg,Ht：170cm，Wt：62kg，BSA：1.71m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率88次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1751] 检验组合: 阴离子间隙(AG)-静脉血: 18.2；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；平均血小板体积(MPV)-静脉血: 9.8fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.8；白细胞计数(WBC#)-静脉血: 6.2310E9/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 64.8umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阳性(+)（参考: 阴性）；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.92mmol/L；透明质酸(HA)-静脉血: 91.434ng/ml；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.4U/L；氯离子(Cl-)-静脉血: 101.8mmol/L；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 1.43ng/ml（参考: <0.704）；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；血小板比容-静脉血: 20%；活化部分凝血活酶时间(APTT)-静脉血: 27.5sec.；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.62；梅毒非特异性抗体甲苯胺红不加热血清试验(TRUST)-静脉血: 阴性(-)（参考: 阴性）；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；总钙(Ca)-静脉血: 2.27mmol/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.43；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；凝血酶时间(TT)-静脉血: 17.6sec.；间接胆红素(IBIL)-静脉血: 6.6umolL；凝血酶原时间活动度(PTA)-静脉血: 97.9%；降钙素(CT)-静脉血: 25.774pg/ml；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 44.9U/L……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1754] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右旁T7椎体上缘水平，估计位于上腔静脉内。；检查结论: PICC管位置如上所述。\n- [全程D1758] 检验组合: 红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.410E9/L；总胆红素(TBIL)-静脉血: 15.3umol/L；葡萄糖(Glu)-静脉血: 4.9mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.6pg；间接胆红素(IBIL)-静脉血: 10.2umolL；肌酐(Crea)-静脉血: 67.1umol/L；血小板计数(PLT#)-静脉血: 159.110E9/L；中性粒细胞计数(Neut#)-静脉血: 5.210E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；血小板比容-静脉血: 13.7%；氯离子(Cl-)-静脉血: 100.4mmol/L；尿素氮(BUN)-静脉血: 5.1mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；平均血小板体积(MPV)-静脉血: 8.66fL；白蛋白(ALB)-静脉血: 36.6g/L；载脂蛋白B(apoB)-静脉血: 0.97g/L；C-反应蛋白(CRP)-静脉血: 17.22mg/L；乳酸脱氢酶(LDH)-静脉血: 196.7U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.69mmol/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；尿酸(UA)-静脉血: 195.2umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.759；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.37；总胆固醇(TC)-静脉血: 4.18mmol/L；钾离子(K+)-静脉血: 4.29mmol/L；单核细胞百分比(Mono%)-静脉血: 0.062；α-L-岩藻糖苷酶(AFU)-静脉血: 34.2U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.97；直接胆红素(DBIL)-静脉血: 5.1umol/L；碱性磷酸酶(ALP)-静脉血: 54.4U/L；有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞体积(MCV)-静脉血: 90.4fL；白细胞计数(WBC#)-静脉血: 6.810E9/L；总蛋白(TP)-静脉血: 63.4g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15U/L；甘油三酯(TG)-静脉血: 0.61mmol/L；球蛋白(……\n- [全程D1772] 检验组合: 总胆红素(TBIL)-静脉血: 7.6umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.472；红细胞计数(RBC#)-静脉血: 4.2810E12/L；直接胆红素(DBIL)-静脉血: 1.4umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.281；中性粒细胞计数(Neut#)-静脉血: 1.810E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.07；载脂蛋白B(apoB)-静脉血: 1.11g/L；血小板比容-静脉血: 18%；磷(P)-静脉血: 1.23mmol/L；总蛋白(TP)-静脉血: 70.84g/L；平均红细胞体积(MCV)-静脉血: 93.5fL；间接胆红素(IBIL)-静脉血: 6.2umolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.78；丙氨酸氨基转移酶(ALT)-静脉血: 20.8U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.6pg；乳酸脱氢酶(LDH)-静脉血: 173.8U/L；白蛋白(ALB)-静脉血: 41.6g/L；钾离子(K+)-静脉血: 4.12mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 20.8mmol/L；钠离子(Na+)-静脉血: 140.8mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.55mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.33g/L；尿素氮(BUN)-静脉血: 5.1mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.42；甘油三酯(TG)-静脉血: 0.99mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.2；碱性磷酸酶(ALP)-静脉血: 67.2U/L；肌酐(Crea)-静脉血: 68.4umol/L；C-反应蛋白(CRP)-静脉血: 1.24mg/L；血小板计数(PLT#)-静脉血: 18110E9/L；红细胞比容(Hct)-静脉血: 40%；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 30.4U/L；血红蛋白(Hb)-静脉血: 131g/L；镁离子(Mg2+)-静脉血: 0.92mmol/L；平均红细胞血红蛋白……\n- [全程D1777] 检验组合: 低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.92mmol/L；尿素氮(BUN)-静脉血: 5.65mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；载脂蛋白B(apoB)-静脉血: 1.12g/L；平均红细胞体积(MCV)-静脉血: 91.7fL；中性粒细胞计数(Neut#)-静脉血: 3.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.108；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336.6g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.8；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.23mmolL；血小板比容-静脉血: 11.1%；血红蛋白(Hb)-静脉血: 131.2g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.6mmol/L；甘油三酯(TG)-静脉血: 0.96mmol/L；镁离子(Mg2+)-静脉血: 1.02mmol/L；总胆固醇(TC)-静脉血: 5.75mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.510E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；直接胆红素(DBIL)-静脉血: 5.7umol/L；总蛋白(TP)-静脉血: 68.83g/L；白蛋白(ALB)-静脉血: 37.6g/L；钾离子(K+)-静脉血: 4.1mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；尿酸(UA)-静脉血: 299.7umol/L；碱性磷酸酶(ALP)-静脉血: 64.4U/L；阴离子间隙(AG)-静脉血: 13；氯离子(Cl-)-静脉血: 101.5mmol/L；球蛋白(GLO)-静脉血: 31.23g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1%；血小板分布宽度(PDW)-静脉血: 17.9%；间接胆红素(IBIL)-静脉血: 12.7umolL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；丙氨酸氨基转移酶(ALT)-静脉血: 23.7U/L；C-反……\n- [全程D1782] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及双侧壁粘膜增厚形成软组织影放射性浓聚，SUV约15.6，病灶侵犯蝶窦、蝶骨体、右侧蝶骨翼、蝶骨基底部、枕骨基底部、枕骨斜坡、右侧颈动脉孔、右侧破裂孔、右侧岩枕裂、右侧桥小脑角、右侧颞骨岩尖、双侧翼突基底部、右翼突内/外板、双侧鼻后孔、右翼腭窝、鼻中隔后份、双侧中鼻甲后份、左侧下鼻甲后份、右侧咽旁/咽后间隙、右侧头长肌、右侧腭帆张/提肌及右翼内肌，累及左侧翼腭窝，堵塞鼻咽腔。双侧咽隐窝消失。双侧咽后小淋巴结放射性较浓密，SUV约4.1，大者约0.8×0.9cm。口咽、喉咽未见异常。蝶窦、筛窦、双侧上颌窦及双侧乳突内低密度影放射性分布未见明显异常。双侧海绵窦放射性分布未见明显异常。甲状腺放射性分布未见明显异常。左颈II区数个淋巴结放射性浓聚，SUV约21.9，大者约1.1×1.5cm；右颈II区数个小淋巴结放射性较浓密，SUV约2.7，大者约0.6×0.7cm；余双颈未见肿大淋巴结及异常放射性分布。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺多发条片影放射性分布未见明显异常；余双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔右下气管旁及右肺门数个小淋巴结放射性略浓密。左肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏形态、结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺、膀胱、肠管等形态、结构及放射性分布未见明显异常。双侧髂血管旁及双侧腹股沟未见肿大淋巴结及异常放射性分布。 L5棘突局部放射性略浓密（良性病变）。左髂骨小片状低密度影放射性稀疏（良性病变）。所见颅盖骨、余躯干骨及四肢骨结构及放射性分布未见明显异常。 鼻咽局部代谢较活跃，双侧扁桃体代谢较活跃，双颈II区小淋巴结代谢稍活跃，考虑炎性病变。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，侵犯范围如上述；双侧咽后小淋巴结代谢较活跃，左颈II区数个淋巴结……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1751] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者入院第二天，无特殊不适主诉，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。复查血常规、生化常规结果无异常。[姓名已隐去]副医生信息已隐藏：现等待患者鼻咽颈部影像学检查结果，明确分期后再行进一步诊治，病情继观。\n- [全程D1752] 上级查房记录；[姓名已隐去]医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医师查房记录；病程内容: 患者入院第三天，无诉，体查情况基本同前，[姓名已隐去]医师查房后示：等待患者影像学检查结果，明确分期后再行进一步诊治，余治疗同前，继观。\n- [全程D1758] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者处于一程洛铂+5FU方案诱导化疗中，诉恶心、呕吐，一般情况可，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。复查血常规、生化常规结果基本正常，[姓名已隐去]副医生信息已隐藏：现患者已完成一程诱导化疗，情况尚可，予以止呕、护胃等对症支持，嘱今日可予以出院，按期返院，不适随诊。\n- [全程D1774] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者入院第二天，诉复视、面麻未见好转，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经（-）。复查血常规、生化常规结果无异常。[姓名已隐去]副医生信息已隐藏：现患者入院行第一程洛铂+5FU方案诱导化疗中，目前患者情况尚可，继续予以止呕、护胃、加强营养等对症支持治疗，病情继观。\n- [全程D1775] 上级查房记录；[姓名已隐去]医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医师查房记录；病程内容: 患者入院第三天，无诉，体查情况基本同前，[姓名已隐去]医师查房后示：现患者第一程洛铂+5FU方案诱导化疗中，目前患者情况尚可，继续予以对症支持治疗，病情继观。\n- [全程D1779] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现基本完成一程诱导化疗，诉恶心，一般情况尚可，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经（-）。复查血常规、生化常规结果基本正常，[姓名已隐去]副医生信息已隐藏：现患者情况尚可，嘱今日可予以出院，按期返院，不适随诊。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即开展根治性放疗及顺铂同步化疗，期间定期监测血常规，暂不予造血生长因子干预。\nB. 予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及顺铂同步化疗。\nC. 仅予以重组人白介素-11升血小板治疗，动态复查血常规，并序贯开展根治性放疗及顺铂同步化疗。\nD. 立即开展根治性放疗及洛铂同步化疗，期间定期监测血常规，暂不予造血生长因子干预。\nE. 仅予以重组人粒细胞刺激因子升白细胞治疗，动态复查血常规，并序贯开展根治性放疗及洛铂同步化疗。\nF. 予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及洛铂同步化疗。\nG. 予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并转为洛铂单药姑息性化疗。\nH. 予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展开放性手术切除原发灶及颈部淋巴结。\nI. 予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及西妥昔单抗靶向治疗。\nJ. 予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及PD-1抑制剂免疫治疗。\nK. 暂暂停抗肿瘤治疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，待血象恢复后继续行第三程洛铂+5FU诱导化疗。\nL. 予以输注单采血小板及洗涤红细胞支持治疗，动态复查血常规，并序贯开展根治性放疗及洛铂同步化疗。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、鼻腔、翼外肌、斜坡、海绵窦、翼突基底部等。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1750] 入院记录: 主诉: 间断性涕血3月，面麻、复视1月，耳鸣20天；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 复视,涕血,双面麻；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟1包，30年，不嗜酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：88次/分，R：20次/分，BP：114/69mmHg,Ht：170cm，Wt：62kg，BSA：1.71m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。；KPS: 90；ECOG:\n- [全程D1750] 入院记录: 主诉: 间断性涕血3月，面麻、复视1月，耳鸣20天；现病史: 缘于3月余前患者无明显诱因出现间断性回吸性涕血，未予重视，一月前患者出现双侧面麻、复视，无鼻塞、头痛、视力下降等不适，遂就诊当地医院行鼻咽活检病理确诊鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 复视,涕血,双面麻；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟1包，30年，不嗜酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：88次/分，R：20次/分，BP：114/69mmHg,Ht：170cm，Wt：62kg，BSA：1.71m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率88次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1751] 检验组合: 阴离子间隙(AG)-静脉血: 18.2；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；平均血小板体积(MPV)-静脉血: 9.8fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.8；白细胞计数(WBC#)-静脉血: 6.2310E9/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 64.8umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阳性(+)（参考: 阴性）；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.92mmol/L；透明质酸(HA)-静脉血: 91.434ng/ml；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.4U/L；氯离子(Cl-)-静脉血: 101.8mmol/L；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 1.43ng/ml（参考: <0.704）；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；血小板比容-静脉血: 20%；活化部分凝血活酶时间(APTT)-静脉血: 27.5sec.；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.62；梅毒非特异性抗体甲苯胺红不加热血清试验(TRUST)-静脉血: 阴性(-)（参考: 阴性）；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；总钙(Ca)-静脉血: 2.27mmol/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.43；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；凝血酶时间(TT)-静脉血: 17.6sec.；间接胆红素(IBIL)-静脉血: 6.6umolL；凝血酶原时间活动度(PTA)-静脉血: 97.9%；降钙素(CT)-静脉血: 25.774pg/ml；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 44.9U/L……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1754] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右旁T7椎体上缘水平，估计位于上腔静脉内。；检查结论: PICC管位置如上所述。\n- [全程D1758] 检验组合: 红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.410E9/L；总胆红素(TBIL)-静脉血: 15.3umol/L；葡萄糖(Glu)-静脉血: 4.9mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.6pg；间接胆红素(IBIL)-静脉血: 10.2umolL；肌酐(Crea)-静脉血: 67.1umol/L；血小板计数(PLT#)-静脉血: 159.110E9/L；中性粒细胞计数(Neut#)-静脉血: 5.210E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；血小板比容-静脉血: 13.7%；氯离子(Cl-)-静脉血: 100.4mmol/L；尿素氮(BUN)-静脉血: 5.1mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；平均血小板体积(MPV)-静脉血: 8.66fL；白蛋白(ALB)-静脉血: 36.6g/L；载脂蛋白B(apoB)-静脉血: 0.97g/L；C-反应蛋白(CRP)-静脉血: 17.22mg/L；乳酸脱氢酶(LDH)-静脉血: 196.7U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.69mmol/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；尿酸(UA)-静脉血: 195.2umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.759；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.37；总胆固醇(TC)-静脉血: 4.18mmol/L；钾离子(K+)-静脉血: 4.29mmol/L；单核细胞百分比(Mono%)-静脉血: 0.062；α-L-岩藻糖苷酶(AFU)-静脉血: 34.2U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.97；直接胆红素(DBIL)-静脉血: 5.1umol/L；碱性磷酸酶(ALP)-静脉血: 54.4U/L；有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞体积(MCV)-静脉血: 90.4fL；白细胞计数(WBC#)-静脉血: 6.810E9/L；总蛋白(TP)-静脉血: 63.4g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15U/L；甘油三酯(TG)-静脉血: 0.61mmol/L；球蛋白(……\n- [全程D1772] 检验组合: 总胆红素(TBIL)-静脉血: 7.6umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.472；红细胞计数(RBC#)-静脉血: 4.2810E12/L；直接胆红素(DBIL)-静脉血: 1.4umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.281；中性粒细胞计数(Neut#)-静脉血: 1.810E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.07；载脂蛋白B(apoB)-静脉血: 1.11g/L；血小板比容-静脉血: 18%；磷(P)-静脉血: 1.23mmol/L；总蛋白(TP)-静脉血: 70.84g/L；平均红细胞体积(MCV)-静脉血: 93.5fL；间接胆红素(IBIL)-静脉血: 6.2umolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.78；丙氨酸氨基转移酶(ALT)-静脉血: 20.8U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.6pg；乳酸脱氢酶(LDH)-静脉血: 173.8U/L；白蛋白(ALB)-静脉血: 41.6g/L；钾离子(K+)-静脉血: 4.12mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 20.8mmol/L；钠离子(Na+)-静脉血: 140.8mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.55mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.33g/L；尿素氮(BUN)-静脉血: 5.1mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.42；甘油三酯(TG)-静脉血: 0.99mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.2；碱性磷酸酶(ALP)-静脉血: 67.2U/L；肌酐(Crea)-静脉血: 68.4umol/L；C-反应蛋白(CRP)-静脉血: 1.24mg/L；血小板计数(PLT#)-静脉血: 18110E9/L；红细胞比容(Hct)-静脉血: 40%；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 30.4U/L；血红蛋白(Hb)-静脉血: 131g/L；镁离子(Mg2+)-静脉血: 0.92mmol/L；平均红细胞血红蛋白……\n- [全程D1777] 检验组合: 低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.92mmol/L；尿素氮(BUN)-静脉血: 5.65mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；载脂蛋白B(apoB)-静脉血: 1.12g/L；平均红细胞体积(MCV)-静脉血: 91.7fL；中性粒细胞计数(Neut#)-静脉血: 3.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.108；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336.6g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.8；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.23mmolL；血小板比容-静脉血: 11.1%；血红蛋白(Hb)-静脉血: 131.2g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.6mmol/L；甘油三酯(TG)-静脉血: 0.96mmol/L；镁离子(Mg2+)-静脉血: 1.02mmol/L；总胆固醇(TC)-静脉血: 5.75mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.510E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；直接胆红素(DBIL)-静脉血: 5.7umol/L；总蛋白(TP)-静脉血: 68.83g/L；白蛋白(ALB)-静脉血: 37.6g/L；钾离子(K+)-静脉血: 4.1mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；尿酸(UA)-静脉血: 299.7umol/L；碱性磷酸酶(ALP)-静脉血: 64.4U/L；阴离子间隙(AG)-静脉血: 13；氯离子(Cl-)-静脉血: 101.5mmol/L；球蛋白(GLO)-静脉血: 31.23g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1%；血小板分布宽度(PDW)-静脉血: 17.9%；间接胆红素(IBIL)-静脉血: 12.7umolL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；丙氨酸氨基转移酶(ALT)-静脉血: 23.7U/L；C-反……\n- [全程D1782] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及双侧壁粘膜增厚形成软组织影放射性浓聚，SUV约15.6，病灶侵犯蝶窦、蝶骨体、右侧蝶骨翼、蝶骨基底部、枕骨基底部、枕骨斜坡、右侧颈动脉孔、右侧破裂孔、右侧岩枕裂、右侧桥小脑角、右侧颞骨岩尖、双侧翼突基底部、右翼突内/外板、双侧鼻后孔、右翼腭窝、鼻中隔后份、双侧中鼻甲后份、左侧下鼻甲后份、右侧咽旁/咽后间隙、右侧头长肌、右侧腭帆张/提肌及右翼内肌，累及左侧翼腭窝，堵塞鼻咽腔。双侧咽隐窝消失。双侧咽后小淋巴结放射性较浓密，SUV约4.1，大者约0.8×0.9cm。口咽、喉咽未见异常。蝶窦、筛窦、双侧上颌窦及双侧乳突内低密度影放射性分布未见明显异常。双侧海绵窦放射性分布未见明显异常。甲状腺放射性分布未见明显异常。左颈II区数个淋巴结放射性浓聚，SUV约21.9，大者约1.1×1.5cm；右颈II区数个小淋巴结放射性较浓密，SUV约2.7，大者约0.6×0.7cm；余双颈未见肿大淋巴结及异常放射性分布。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺多发条片影放射性分布未见明显异常；余双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔右下气管旁及右肺门数个小淋巴结放射性略浓密。左肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏形态、结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺、膀胱、肠管等形态、结构及放射性分布未见明显异常。双侧髂血管旁及双侧腹股沟未见肿大淋巴结及异常放射性分布。 L5棘突局部放射性略浓密（良性病变）。左髂骨小片状低密度影放射性稀疏（良性病变）。所见颅盖骨、余躯干骨及四肢骨结构及放射性分布未见明显异常。 鼻咽局部代谢较活跃，双侧扁桃体代谢较活跃，双颈II区小淋巴结代谢稍活跃，考虑炎性病变。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，侵犯范围如上述；双侧咽后小淋巴结代谢较活跃，左颈II区数个淋巴结……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1751] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者入院第二天，无特殊不适主诉，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。复查血常规、生化常规结果无异常。[姓名已隐去]副医生信息已隐藏：现等待患者鼻咽颈部影像学检查结果，明确分期后再行进一步诊治，病情继观。\n- [全程D1752] 上级查房记录；[姓名已隐去]医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医师查房记录；病程内容: 患者入院第三天，无诉，体查情况基本同前，[姓名已隐去]医师查房后示：等待患者影像学检查结果，明确分期后再行进一步诊治，余治疗同前，继观。\n- [全程D1758] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者处于一程洛铂+5FU方案诱导化疗中，诉恶心、呕吐，一般情况可，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。复查血常规、生化常规结果基本正常，[姓名已隐去]副医生信息已隐藏：现患者已完成一程诱导化疗，情况尚可，予以止呕、护胃等对症支持，嘱今日可予以出院，按期返院，不适随诊。\n- [全程D1774] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者入院第二天，诉复视、面麻未见好转，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经（-）。复查血常规、生化常规结果无异常。[姓名已隐去]副医生信息已隐藏：现患者入院行第一程洛铂+5FU方案诱导化疗中，目前患者情况尚可，继续予以止呕、护胃、加强营养等对症支持治疗，病情继观。\n- [全程D1775] 上级查房记录；[姓名已隐去]医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医师查房记录；病程内容: 患者入院第三天，无诉，体查情况基本同前，[姓名已隐去]医师查房后示：现患者第一程洛铂+5FU方案诱导化疗中，目前患者情况尚可，继续予以对症支持治疗，病情继观。\n- [全程D1779] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现基本完成一程诱导化疗，诉恶心，一般情况尚可，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经（-）。复查血常规、生化常规结果基本正常，[姓名已隐去]副医生信息已隐藏：现患者情况尚可，嘱今日可予以出院，按期返院，不适随诊。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即开展根治性放疗及顺铂同步化疗，期间定期监测血常规，暂不予造血生长因子干预。\nB. 予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及顺铂同步化疗。\nC. 仅予以重组人白介素-11升血小板治疗，动态复查血常规，并序贯开展根治性放疗及顺铂同步化疗。\nD. 立即开展根治性放疗及洛铂同步化疗，期间定期监测血常规，暂不予造血生长因子干预。\nE. 仅予以重组人粒细胞刺激因子升白细胞治疗，动态复查血常规，并序贯开展根治性放疗及洛铂同步化疗。\nF. 予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及洛铂同步化疗。\nG. 予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并转为洛铂单药姑息性化疗。\nH. 予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展开放性手术切除原发灶及颈部淋巴结。\nI. 予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及西妥昔单抗靶向治疗。\nJ. 予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及PD-1抑制剂免疫治疗。\nK. 暂暂停抗肿瘤治疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，待血象恢复后继续行第三程洛铂+5FU诱导化疗。\nL. 予以输注单采血小板及洗涤红细胞支持治疗，动态复查血常规，并序贯开展根治性放疗及洛铂同步化疗。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-ce0b8b89ec8b1d9a2405353d","patient_id":"patient-5731cc38ced94b2ee39c442a","turn_id":"turn01","turn_position":1,"turn_type":"initial_workup_choice","gold_letter":"G","gold_action":"完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描（或PET-CT），EBV-DNA及抗体检测，常规血液学检查。","options":[{"letter":"A","text":"完善鼻咽+颈部增强CT，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查，择期行颈部淋巴结穿刺活检。","is_gold":false},{"letter":"B","text":"完善鼻咽镜及活检，鼻咽+颈部增强CT，胸腹部超声及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。","is_gold":false},{"letter":"C","text":"完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，常规血液学检查，暂缓EBV相关检测。","is_gold":false},{"letter":"D","text":"完善鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查，若影像典型直接开始放化疗。","is_gold":false},{"letter":"E","text":"完善鼻咽镜及活检，头颅增强MRI，颈部超声，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。","is_gold":false},{"letter":"F","text":"完善鼻咽镜及活检，鼻咽+颈部平扫MRI，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。","is_gold":false},{"letter":"G","text":"完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描（或PET-CT），EBV-DNA及抗体检测，常规血液学检查。","is_gold":true},{"letter":"H","text":"完善鼻咽镜及活检，鼻咽+颈部增强MRI，EBV-DNA及抗体检测，常规血液学检查，待局部放疗结束后再行全身转移排查。","is_gold":false},{"letter":"I","text":"完善颈部淋巴结切除活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。","is_gold":false},{"letter":"J","text":"完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，常规血液学检查，并立即行诱导化疗。","is_gold":false},{"letter":"K","text":"完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸部X线，腹部超声，全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。","is_gold":false},{"letter":"L","text":"完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查，并预防性行气管切开。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 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阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶壁、顶后壁、双侧壁结节状肿物；左侧颈部II区可扪及1个淋巴结，最大径2cm×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善鼻咽+颈部增强CT，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查，择期行颈部淋巴结穿刺活检。\nB. 完善鼻咽镜及活检，鼻咽+颈部增强CT，胸腹部超声及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。\nC. 完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，常规血液学检查，暂缓EBV相关检测。\nD. 完善鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查，若影像典型直接开始放化疗。\nE. 完善鼻咽镜及活检，头颅增强MRI，颈部超声，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。\nF. 完善鼻咽镜及活检，鼻咽+颈部平扫MRI，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。\nG. 完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描（或PET-CT），EBV-DNA及抗体检测，常规血液学检查。\nH. 完善鼻咽镜及活检，鼻咽+颈部增强MRI，EBV-DNA及抗体检测，常规血液学检查，待局部放疗结束后再行全身转移排查。\nI. 完善颈部淋巴结切除活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。\nJ. 完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，常规血液学检查，并立即行诱导化疗。\nK. 完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸部X线，腹部超声，全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。\nL. 完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查，并预防性行气管切开。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、蝶窦、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 左耳闷涉不适1年，涕血2月。；某次就诊时间特来我院门诊进一步诊治，完善相关检查，诊断明确后，今日入院系统治疗。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,左耳闷胀感,涕血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。有吸烟史1年，日7支；少量饮酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：90次/分，R：20次/分，BP：131/86mmHg,Ht：171cm，Wt：76.5kg，BSA1.89m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶壁、顶后壁、双侧壁结节状肿物；左侧颈部II区可扪及1个淋巴结，最大径2cm×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善鼻咽+颈部增强CT，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查，择期行颈部淋巴结穿刺活检。\nB. 完善鼻咽镜及活检，鼻咽+颈部增强CT，胸腹部超声及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。\nC. 完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，常规血液学检查，暂缓EBV相关检测。\nD. 完善鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查，若影像典型直接开始放化疗。\nE. 完善鼻咽镜及活检，头颅增强MRI，颈部超声，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。\nF. 完善鼻咽镜及活检，鼻咽+颈部平扫MRI，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。\nG. 完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描（或PET-CT），EBV-DNA及抗体检测，常规血液学检查。\nH. 完善鼻咽镜及活检，鼻咽+颈部增强MRI，EBV-DNA及抗体检测，常规血液学检查，待局部放疗结束后再行全身转移排查。\nI. 完善颈部淋巴结切除活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。\nJ. 完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，常规血液学检查，并立即行诱导化疗。\nK. 完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸部X线，腹部超声，全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。\nL. 完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查，并预防性行气管切开。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-e3ed1270448c84eefbda9f61","patient_id":"patient-5731cc38ced94b2ee39c442a","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"H","gold_action":"完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充血浆EBV DNA定量检测","options":[{"letter":"A","text":"完善胸部CT、腹部CT及全身骨扫描，并补充颈部淋巴结切除活检","is_gold":false},{"letter":"B","text":"完善全身PET-CT检查，并补充颈部淋巴结穿刺活检","is_gold":false},{"letter":"C","text":"完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充头颈部CTA检查","is_gold":false},{"letter":"D","text":"完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充颈部淋巴结穿刺活检","is_gold":false},{"letter":"E","text":"完善胸部CT、腹部CT，并补充脑部MRI平扫及增强","is_gold":false},{"letter":"F","text":"完善全身骨扫描及脑部MRI增强，并补充血浆EBV DNA定量检测","is_gold":false},{"letter":"G","text":"完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充鼻咽脱落细胞学检查","is_gold":false},{"letter":"H","text":"完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充血浆EBV DNA定量检测","is_gold":true},{"letter":"I","text":"完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充骨髓穿刺活检","is_gold":false},{"letter":"J","text":"完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充EBV抗体滴度复查","is_gold":false},{"letter":"K","text":"完善胸部CT、腹部CT及全身骨扫描，并补充头颅PET-MR检查","is_gold":false},{"letter":"L","text":"完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并立即开始诱导化疗","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、蝶窦、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 左耳闷涉不适1年，涕血2月。；某次就诊时间特来我院门诊进一步诊治，完善相关检查，诊断明确后，今日入院系统治疗。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,左耳闷胀感,涕血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。有吸烟史1年，日7支；少量饮酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：90次/分，R：20次/分，BP：131/86mmHg,Ht：171cm，Wt：76.5kg，BSA1.89m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶壁、顶后壁、双侧壁结节状肿物；左侧颈部II区可扪及1个淋巴结，最大径2cm×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.51；平均红细胞血红蛋白含量(MCH)-静脉血: 27.4pg；磷(P)-静脉血: 0.9mmol/L；直接胆红素(DBIL)-静脉血: 4.7umol/L；凝血酶时间(TT)-静脉血: 22.7sec.；D-二聚体(D-Dimer)-静脉血: 0.29ug/ml；活化部分凝血活酶时间(APTT)-静脉血: 38.5sec.；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.04S/CO；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.82mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.6；单核细胞百分比(Mono%)-静脉血: 0.047；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；间接胆红素(IBIL)-静脉血: 10.5umolL；白蛋白(ALB)-静脉血: 48g/L；氯离子(Cl-)-静脉血: 101.7mmol/L；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.718；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.1COI；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；白细胞计数(WBC#)-静脉血: 6.9510E9/L；红细胞比容(Hct)-静脉血: 46.8%；尿酸(UA)-静脉血: 431.8umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 81.8umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 26mmol/L；血小板分布宽度(PDW)-静脉血: 11.2%；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.04S/CO；平均血小板体积(MPV)-静脉血: 9.7fL；中性粒细胞计数(Neut#)-静脉血: 510E9/L；载脂蛋白B(apoB)-静脉血: 0.96g/L；凝血酶原时间(PT)-静脉血: 11.8sec.；钠离子(Na+)-静脉血: 138.7mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；甘油三酯(TG)-静脉血: 2.2mmol/L；总胆红素(TBIL)-……\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 Ⅱ、Ⅲ、aVF、V5、V6导联T波低平\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、后壁及双侧壁增厚，见软组织肿物向鼻咽腔内突出，在T1WI上呈等信号，在T2WI上呈稍高信号，增强扫描明显强化。双侧咽隐窝变浅，见软组织肿物填充。病灶侵犯左侧后鼻孔，侵犯左侧腭帆张提肌、左侧翼内肌头部、左侧咽旁脂肪间隙，侵犯蝶窦左侧份及左侧翼腭窝，侵犯左侧破裂孔、左侧海绵窦。 右侧咽旁间隙及双侧颈动脉鞘区血管未见明显异常。右侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常。口咽双侧壁未见增厚。 斜坡、左侧岩尖、蝶骨基底部、左侧翼突区骨质信号减低，增强扫描明显强化。 右侧海绵窦形态正常，未见增宽。 双侧筛窦、左侧上颌窦、蝶窦及右侧乳突粘膜增厚，左侧乳突内见大量长分期信息见历史辅助诊断节点长分期信息见历史辅助诊断节点信号分泌物。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变。 左侧咽后可见数个小淋巴结，较大短径约4mm；右侧咽后可见小淋巴结，短径约2mm。左颈II、III区可见数个淋巴结，最大约21mm×15mm，部分呈相互融合改变，边界欠清，增强扫描可见明显强化。右颈II、III区可见数个淋巴结，最大约12mm×7mm，边界清。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 左颈II、III区淋巴结肿大，考虑转移。 左侧咽后、右颈II、III区淋巴结，不排除转移。 右侧咽后小淋巴结。 鼻窦炎。双侧乳突炎。\n- [全程D5] 检验组合: EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；Rh血型-静脉血: 阳性；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；ABO血型-静脉血: O\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善胸部CT、腹部CT及全身骨扫描，并补充颈部淋巴结切除活检\nB. 完善全身PET-CT检查，并补充颈部淋巴结穿刺活检\nC. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充头颈部CTA检查\nD. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充颈部淋巴结穿刺活检\nE. 完善胸部CT、腹部CT，并补充脑部MRI平扫及增强\nF. 完善全身骨扫描及脑部MRI增强，并补充血浆EBV DNA定量检测\nG. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充鼻咽脱落细胞学检查\nH. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充血浆EBV DNA定量检测\nI. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充骨髓穿刺活检\nJ. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充EBV抗体滴度复查\nK. 完善胸部CT、腹部CT及全身骨扫描，并补充头颅PET-MR检查\nL. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并立即开始诱导化疗\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、蝶窦、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 左耳闷涉不适1年，涕血2月。；某次就诊时间特来我院门诊进一步诊治，完善相关检查，诊断明确后，今日入院系统治疗。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,左耳闷胀感,涕血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。有吸烟史1年，日7支；少量饮酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：90次/分，R：20次/分，BP：131/86mmHg,Ht：171cm，Wt：76.5kg，BSA1.89m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶壁、顶后壁、双侧壁结节状肿物；左侧颈部II区可扪及1个淋巴结，最大径2cm×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.51；平均红细胞血红蛋白含量(MCH)-静脉血: 27.4pg；磷(P)-静脉血: 0.9mmol/L；直接胆红素(DBIL)-静脉血: 4.7umol/L；凝血酶时间(TT)-静脉血: 22.7sec.；D-二聚体(D-Dimer)-静脉血: 0.29ug/ml；活化部分凝血活酶时间(APTT)-静脉血: 38.5sec.；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.04S/CO；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.82mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.6；单核细胞百分比(Mono%)-静脉血: 0.047；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；间接胆红素(IBIL)-静脉血: 10.5umolL；白蛋白(ALB)-静脉血: 48g/L；氯离子(Cl-)-静脉血: 101.7mmol/L；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.718；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.1COI；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；白细胞计数(WBC#)-静脉血: 6.9510E9/L；红细胞比容(Hct)-静脉血: 46.8%；尿酸(UA)-静脉血: 431.8umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 81.8umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 26mmol/L；血小板分布宽度(PDW)-静脉血: 11.2%；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.04S/CO；平均血小板体积(MPV)-静脉血: 9.7fL；中性粒细胞计数(Neut#)-静脉血: 510E9/L；载脂蛋白B(apoB)-静脉血: 0.96g/L；凝血酶原时间(PT)-静脉血: 11.8sec.；钠离子(Na+)-静脉血: 138.7mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；甘油三酯(TG)-静脉血: 2.2mmol/L；总胆红素(TBIL)-……\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 Ⅱ、Ⅲ、aVF、V5、V6导联T波低平\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、后壁及双侧壁增厚，见软组织肿物向鼻咽腔内突出，在T1WI上呈等信号，在T2WI上呈稍高信号，增强扫描明显强化。双侧咽隐窝变浅，见软组织肿物填充。病灶侵犯左侧后鼻孔，侵犯左侧腭帆张提肌、左侧翼内肌头部、左侧咽旁脂肪间隙，侵犯蝶窦左侧份及左侧翼腭窝，侵犯左侧破裂孔、左侧海绵窦。 右侧咽旁间隙及双侧颈动脉鞘区血管未见明显异常。右侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常。口咽双侧壁未见增厚。 斜坡、左侧岩尖、蝶骨基底部、左侧翼突区骨质信号减低，增强扫描明显强化。 右侧海绵窦形态正常，未见增宽。 双侧筛窦、左侧上颌窦、蝶窦及右侧乳突粘膜增厚，左侧乳突内见大量长分期信息见历史辅助诊断节点长分期信息见历史辅助诊断节点信号分泌物。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变。 左侧咽后可见数个小淋巴结，较大短径约4mm；右侧咽后可见小淋巴结，短径约2mm。左颈II、III区可见数个淋巴结，最大约21mm×15mm，部分呈相互融合改变，边界欠清，增强扫描可见明显强化。右颈II、III区可见数个淋巴结，最大约12mm×7mm，边界清。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 左颈II、III区淋巴结肿大，考虑转移。 左侧咽后、右颈II、III区淋巴结，不排除转移。 右侧咽后小淋巴结。 鼻窦炎。双侧乳突炎。\n- [全程D5] 检验组合: EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；Rh血型-静脉血: 阳性；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；ABO血型-静脉血: O\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善胸部CT、腹部CT及全身骨扫描，并补充颈部淋巴结切除活检\nB. 完善全身PET-CT检查，并补充颈部淋巴结穿刺活检\nC. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充头颈部CTA检查\nD. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充颈部淋巴结穿刺活检\nE. 完善胸部CT、腹部CT，并补充脑部MRI平扫及增强\nF. 完善全身骨扫描及脑部MRI增强，并补充血浆EBV DNA定量检测\nG. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充鼻咽脱落细胞学检查\nH. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充血浆EBV DNA定量检测\nI. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充骨髓穿刺活检\nJ. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充EBV抗体滴度复查\nK. 完善胸部CT、腹部CT及全身骨扫描，并补充头颅PET-MR检查\nL. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并立即开始诱导化疗\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-cd1385d4e13dda199ba81658","patient_id":"patient-5731cc38ced94b2ee39c442a","turn_id":"turn05","turn_position":3,"turn_type":"toxicity_or_support_decision","gold_letter":"K","gold_action":"办理出院，开具口服保肝药物（如多烯磷脂酰胆碱等），嘱每周复查血常规和生化，按期返院行下一程诱导化疗。","options":[{"letter":"A","text":"办理出院，暂不予保肝药物干预，嘱每周复查血常规和生化，按期返院行下一程诱导化疗。","is_gold":false},{"letter":"B","text":"暂缓出院，予静脉滴注保肝降酶药物，待转氨酶及胆红素完全恢复正常后出院，按期行下一程诱导化疗。","is_gold":false},{"letter":"C","text":"办理出院，开具口服保肝药物，终止后续诱导化疗计划，择期直接开始根治性同期放化疗。","is_gold":false},{"letter":"D","text":"办理出院，开具口服保肝药物，下一程诱导化疗直接将多西他赛及顺铂剂量下调20%。","is_gold":false},{"letter":"E","text":"办理出院，开具口服保肝药物，下一程诱导化疗方案更改为吉西他滨联合顺铂（GP方案）。","is_gold":false},{"letter":"F","text":"暂缓出院，请感染内科会诊排除乙肝病毒再激活，待专科意见明确后再决定后续抗肿瘤治疗计划。","is_gold":false},{"letter":"G","text":"办理出院，开具口服保肝药物，嘱每周复查血常规和生化，将下一程诱导化疗推迟1至2周进行。","is_gold":false},{"letter":"H","text":"办理出院，开具口服保肝药物，并预防性给予长效G-CSF支持，按期返院行下一程诱导化疗。","is_gold":false},{"letter":"I","text":"暂缓出院，按重度药物性肝损伤启动多学科联合诊疗，待肝功能好转后，按期行下一程诱导化疗。","is_gold":false},{"letter":"J","text":"办理出院，开具口服保肝药物，下一程治疗停用尼妥珠单抗，仅行TPF方案诱导化疗。","is_gold":false},{"letter":"K","text":"办理出院，开具口服保肝药物（如多烯磷脂酰胆碱等），嘱每周复查血常规和生化，按期返院行下一程诱导化疗。","is_gold":true},{"letter":"L","text":"办理出院，开具口服保肝药物，下一程诱导化疗剔除氟尿嘧啶，改为多西他赛联合顺铂双药方案。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、蝶窦、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 左耳闷涉不适1年，涕血2月。；某次就诊时间特来我院门诊进一步诊治，完善相关检查，诊断明确后，今日入院系统治疗。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,左耳闷胀感,涕血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。有吸烟史1年，日7支；少量饮酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：90次/分，R：20次/分，BP：131/86mmHg,Ht：171cm，Wt：76.5kg，BSA1.89m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶壁、顶后壁、双侧壁结节状肿物；左侧颈部II区可扪及1个淋巴结，最大径2cm×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.51；平均红细胞血红蛋白含量(MCH)-静脉血: 27.4pg；磷(P)-静脉血: 0.9mmol/L；直接胆红素(DBIL)-静脉血: 4.7umol/L；凝血酶时间(TT)-静脉血: 22.7sec.；D-二聚体(D-Dimer)-静脉血: 0.29ug/ml；活化部分凝血活酶时间(APTT)-静脉血: 38.5sec.；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.04S/CO；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.82mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.6；单核细胞百分比(Mono%)-静脉血: 0.047；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；间接胆红素(IBIL)-静脉血: 10.5umolL；白蛋白(ALB)-静脉血: 48g/L；氯离子(Cl-)-静脉血: 101.7mmol/L；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.718；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.1COI；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；白细胞计数(WBC#)-静脉血: 6.9510E9/L；红细胞比容(Hct)-静脉血: 46.8%；尿酸(UA)-静脉血: 431.8umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 81.8umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 26mmol/L；血小板分布宽度(PDW)-静脉血: 11.2%；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.04S/CO；平均血小板体积(MPV)-静脉血: 9.7fL；中性粒细胞计数(Neut#)-静脉血: 510E9/L；载脂蛋白B(apoB)-静脉血: 0.96g/L；凝血酶原时间(PT)-静脉血: 11.8sec.；钠离子(Na+)-静脉血: 138.7mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；甘油三酯(TG)-静脉血: 2.2mmol/L；总胆红素(TBIL)-……\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 Ⅱ、Ⅲ、aVF、V5、V6导联T波低平\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、后壁及双侧壁增厚，见软组织肿物向鼻咽腔内突出，在T1WI上呈等信号，在T2WI上呈稍高信号，增强扫描明显强化。双侧咽隐窝变浅，见软组织肿物填充。病灶侵犯左侧后鼻孔，侵犯左侧腭帆张提肌、左侧翼内肌头部、左侧咽旁脂肪间隙，侵犯蝶窦左侧份及左侧翼腭窝，侵犯左侧破裂孔、左侧海绵窦。 右侧咽旁间隙及双侧颈动脉鞘区血管未见明显异常。右侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常。口咽双侧壁未见增厚。 斜坡、左侧岩尖、蝶骨基底部、左侧翼突区骨质信号减低，增强扫描明显强化。 右侧海绵窦形态正常，未见增宽。 双侧筛窦、左侧上颌窦、蝶窦及右侧乳突粘膜增厚，左侧乳突内见大量长分期信息见历史辅助诊断节点长分期信息见历史辅助诊断节点信号分泌物。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变。 左侧咽后可见数个小淋巴结，较大短径约4mm；右侧咽后可见小淋巴结，短径约2mm。左颈II、III区可见数个淋巴结，最大约21mm×15mm，部分呈相互融合改变，边界欠清，增强扫描可见明显强化。右颈II、III区可见数个淋巴结，最大约12mm×7mm，边界清。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 左颈II、III区淋巴结肿大，考虑转移。 左侧咽后、右颈II、III区淋巴结，不排除转移。 右侧咽后小淋巴结。 鼻窦炎。双侧乳突炎。\n- [全程D5] 检验组合: EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；Rh血型-静脉血: 阳性；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；ABO血型-静脉血: O\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D24] 检验组合: 天门冬氨酸氨基转移酶(AST)-静脉血: 20.1U/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；血小板分布宽度(PDW)-静脉血: 11.9%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.1；尿素氮(BUN)-静脉血: 3.6mmol/L；磷(P)-静脉血: 0.97mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21.8U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.55；丙氨酸氨基转移酶(ALT)-静脉血: 41U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.19mmol/L；葡萄糖(Glu)-静脉血: 5.41mmol/L；白蛋白(ALB)-静脉血: 46.9g/L；白细胞计数(WBC#)-静脉血: 5.2810E9/L；红细胞计数(RBC#)-静脉血: 5.3910E12/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.6；尿酸(UA)-静脉血: 386.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 27U/L；C-反应蛋白(CRP)-静脉血: 4.25mg/L；钾离子(K+)-静脉血: 4.08mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.051；载脂蛋白B(apoB)-静脉血: 1.1g/L；球蛋白(GLO)-静脉血: 30.3g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；平均血小板体积(MPV)-静脉血: 10.3fL；总胆汁酸(TBA)-静脉血: 1.8umol/L；总蛋白(TP)-静脉血: 77.2g/L；间接胆红素(IBIL)-静脉血: 11.1umolL；甘油三酯(TG)-静脉血: 1.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.08g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.310E9/L；氯离子(Cl-)-静脉血: 102.2mmol/L；单核细胞百分比(Mono%)-静脉血: 0.072；碱性磷酸酶(ALP)-静脉血: 82.4U/L；总胆红素(TBIL)-静脉血: 15.1umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.49；总胆固醇(TC)-静脉血: 4.74mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.237；血小板比容……\n- [全程D25] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右侧约平T6椎体下缘水平，估计导管末端位于上腔静脉下段内。；检查结论: PICC管位置如上所述。\n- [全程D25] 检验组合: 浊度(TRUB)-尿液: clear；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 5.5；葡萄糖(Glu)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；虫卵-粪便: 未见虫卵（参考: 未见虫卵）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 30/μL；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；隐血(OB)-粪便: 阴性（参考: 阴性）；比重(SG)-尿液: 1.021；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-粪便: 棕色；酮体(KET)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D29] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；磷(P)-静脉血: 1.54mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.4U/L；总胆固醇(TC)-静脉血: 6.28mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.3pg；镁离子(Mg2+)-静脉血: 1.06mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=2.00)（参考: 阴性）；肌酐(Crea)-静脉血: 76.5umol/L；球蛋白(GLO)-静脉血: 31.62g/L；白蛋白(ALB)-静脉血: 48.1g/L；白细胞计数(WBC#)-静脉血: 5.310E9/L；血小板分布宽度(PDW)-静脉血: 14.3%；单核细胞百分比(Mono%)-静脉血: 0.011；淋巴细胞百分比(Lymph%)-静脉血: 0.128；血小板计数(PLT#)-静脉血: 18310E9/L；甘油三酯(TG)-静脉血: 1.83mmol/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；碱性磷酸酶(ALP)-静脉血: 76.4U/L；总胆汁酸(TBA)-静脉血: 14.5umol/L；总蛋白(TP)-静脉血: 79.72g/L；有核红细胞百分比(NRBC%)-静脉血: 0；红细胞比容(Hct)-静脉血: 44.3%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.7；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.42mmolL；胱抑素(Cys-C)-静脉血: 1.15mg/L；尿酸(UA)-静脉血: 254.8umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；间接胆红素(IBIL)-静脉血: 27.2umolL；钾离子(K+)-静脉血: 4.43mmol/L；乳酸脱氢酶(LDH)-静脉血: 200.6U/L；C-反应蛋白(CRP)-静脉血: 1.97mg/L；浊度(TRUB)-尿液: clear；酸碱度(pH)-尿液: 5.5；平均红细胞体积(MCV……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D26] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 化疗第2天，患者一般情况可，未诉特殊不适。查体：左侧颈部II区可扪及1个淋巴结，最大径2cm×2.5cm2，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]医生信息已隐藏示：目前暂未出现明显副反应，继续行化疗，密切观察病情。\n- [全程D29] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 化疗第5天，患者一般情况可。体查：KPS90分，张口门齿距4.5cm。鼻咽顶壁、顶后壁、双侧壁结节状肿物；左侧颈部II区可扪及1个淋巴结，最大径2cm×2cm2，无融合，质中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。复查血常规无明显异常。生化示：ALT 77.8U/L↑、IBIL27.20 umolL↑、TBIL35.1umol/L↑。[姓名已隐去]医生信息已隐藏示:第1程化疗结束，病情稳定，今日予办理出院。嘱其注意休息及营养支持，保持口腔清洁；出院后每周复查血常规2次，生化1次常规；按时[计划性表述已隐藏]下一程诱导化疗；若有不适，及时就诊。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 办理出院，暂不予保肝药物干预，嘱每周复查血常规和生化，按期返院行下一程诱导化疗。\nB. 暂缓出院，予静脉滴注保肝降酶药物，待转氨酶及胆红素完全恢复正常后出院，按期行下一程诱导化疗。\nC. 办理出院，开具口服保肝药物，终止后续诱导化疗计划，择期直接开始根治性同期放化疗。\nD. 办理出院，开具口服保肝药物，下一程诱导化疗直接将多西他赛及顺铂剂量下调20%。\nE. 办理出院，开具口服保肝药物，下一程诱导化疗方案更改为吉西他滨联合顺铂（GP方案）。\nF. 暂缓出院，请感染内科会诊排除乙肝病毒再激活，待专科意见明确后再决定后续抗肿瘤治疗计划。\nG. 办理出院，开具口服保肝药物，嘱每周复查血常规和生化，将下一程诱导化疗推迟1至2周进行。\nH. 办理出院，开具口服保肝药物，并预防性给予长效G-CSF支持，按期返院行下一程诱导化疗。\nI. 暂缓出院，按重度药物性肝损伤启动多学科联合诊疗，待肝功能好转后，按期行下一程诱导化疗。\nJ. 办理出院，开具口服保肝药物，下一程治疗停用尼妥珠单抗，仅行TPF方案诱导化疗。\nK. 办理出院，开具口服保肝药物（如多烯磷脂酰胆碱等），嘱每周复查血常规和生化，按期返院行下一程诱导化疗。\nL. 办理出院，开具口服保肝药物，下一程诱导化疗剔除氟尿嘧啶，改为多西他赛联合顺铂双药方案。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、蝶窦、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 左耳闷涉不适1年，涕血2月。；某次就诊时间特来我院门诊进一步诊治，完善相关检查，诊断明确后，今日入院系统治疗。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,左耳闷胀感,涕血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。有吸烟史1年，日7支；少量饮酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：90次/分，R：20次/分，BP：131/86mmHg,Ht：171cm，Wt：76.5kg，BSA1.89m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶壁、顶后壁、双侧壁结节状肿物；左侧颈部II区可扪及1个淋巴结，最大径2cm×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.51；平均红细胞血红蛋白含量(MCH)-静脉血: 27.4pg；磷(P)-静脉血: 0.9mmol/L；直接胆红素(DBIL)-静脉血: 4.7umol/L；凝血酶时间(TT)-静脉血: 22.7sec.；D-二聚体(D-Dimer)-静脉血: 0.29ug/ml；活化部分凝血活酶时间(APTT)-静脉血: 38.5sec.；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.04S/CO；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.82mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.6；单核细胞百分比(Mono%)-静脉血: 0.047；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；间接胆红素(IBIL)-静脉血: 10.5umolL；白蛋白(ALB)-静脉血: 48g/L；氯离子(Cl-)-静脉血: 101.7mmol/L；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.718；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.1COI；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；白细胞计数(WBC#)-静脉血: 6.9510E9/L；红细胞比容(Hct)-静脉血: 46.8%；尿酸(UA)-静脉血: 431.8umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 81.8umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 26mmol/L；血小板分布宽度(PDW)-静脉血: 11.2%；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.04S/CO；平均血小板体积(MPV)-静脉血: 9.7fL；中性粒细胞计数(Neut#)-静脉血: 510E9/L；载脂蛋白B(apoB)-静脉血: 0.96g/L；凝血酶原时间(PT)-静脉血: 11.8sec.；钠离子(Na+)-静脉血: 138.7mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；甘油三酯(TG)-静脉血: 2.2mmol/L；总胆红素(TBIL)-……\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 Ⅱ、Ⅲ、aVF、V5、V6导联T波低平\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、后壁及双侧壁增厚，见软组织肿物向鼻咽腔内突出，在T1WI上呈等信号，在T2WI上呈稍高信号，增强扫描明显强化。双侧咽隐窝变浅，见软组织肿物填充。病灶侵犯左侧后鼻孔，侵犯左侧腭帆张提肌、左侧翼内肌头部、左侧咽旁脂肪间隙，侵犯蝶窦左侧份及左侧翼腭窝，侵犯左侧破裂孔、左侧海绵窦。 右侧咽旁间隙及双侧颈动脉鞘区血管未见明显异常。右侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常。口咽双侧壁未见增厚。 斜坡、左侧岩尖、蝶骨基底部、左侧翼突区骨质信号减低，增强扫描明显强化。 右侧海绵窦形态正常，未见增宽。 双侧筛窦、左侧上颌窦、蝶窦及右侧乳突粘膜增厚，左侧乳突内见大量长分期信息见历史辅助诊断节点长分期信息见历史辅助诊断节点信号分泌物。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变。 左侧咽后可见数个小淋巴结，较大短径约4mm；右侧咽后可见小淋巴结，短径约2mm。左颈II、III区可见数个淋巴结，最大约21mm×15mm，部分呈相互融合改变，边界欠清，增强扫描可见明显强化。右颈II、III区可见数个淋巴结，最大约12mm×7mm，边界清。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 左颈II、III区淋巴结肿大，考虑转移。 左侧咽后、右颈II、III区淋巴结，不排除转移。 右侧咽后小淋巴结。 鼻窦炎。双侧乳突炎。\n- [全程D5] 检验组合: EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；Rh血型-静脉血: 阳性；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；ABO血型-静脉血: O\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D24] 检验组合: 天门冬氨酸氨基转移酶(AST)-静脉血: 20.1U/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；血小板分布宽度(PDW)-静脉血: 11.9%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.1；尿素氮(BUN)-静脉血: 3.6mmol/L；磷(P)-静脉血: 0.97mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21.8U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.55；丙氨酸氨基转移酶(ALT)-静脉血: 41U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.19mmol/L；葡萄糖(Glu)-静脉血: 5.41mmol/L；白蛋白(ALB)-静脉血: 46.9g/L；白细胞计数(WBC#)-静脉血: 5.2810E9/L；红细胞计数(RBC#)-静脉血: 5.3910E12/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.6；尿酸(UA)-静脉血: 386.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 27U/L；C-反应蛋白(CRP)-静脉血: 4.25mg/L；钾离子(K+)-静脉血: 4.08mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.051；载脂蛋白B(apoB)-静脉血: 1.1g/L；球蛋白(GLO)-静脉血: 30.3g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；平均血小板体积(MPV)-静脉血: 10.3fL；总胆汁酸(TBA)-静脉血: 1.8umol/L；总蛋白(TP)-静脉血: 77.2g/L；间接胆红素(IBIL)-静脉血: 11.1umolL；甘油三酯(TG)-静脉血: 1.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.08g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.310E9/L；氯离子(Cl-)-静脉血: 102.2mmol/L；单核细胞百分比(Mono%)-静脉血: 0.072；碱性磷酸酶(ALP)-静脉血: 82.4U/L；总胆红素(TBIL)-静脉血: 15.1umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.49；总胆固醇(TC)-静脉血: 4.74mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.237；血小板比容……\n- [全程D25] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右侧约平T6椎体下缘水平，估计导管末端位于上腔静脉下段内。；检查结论: PICC管位置如上所述。\n- [全程D25] 检验组合: 浊度(TRUB)-尿液: clear；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 5.5；葡萄糖(Glu)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；虫卵-粪便: 未见虫卵（参考: 未见虫卵）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 30/μL；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；隐血(OB)-粪便: 阴性（参考: 阴性）；比重(SG)-尿液: 1.021；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-粪便: 棕色；酮体(KET)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D29] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；磷(P)-静脉血: 1.54mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.4U/L；总胆固醇(TC)-静脉血: 6.28mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.3pg；镁离子(Mg2+)-静脉血: 1.06mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=2.00)（参考: 阴性）；肌酐(Crea)-静脉血: 76.5umol/L；球蛋白(GLO)-静脉血: 31.62g/L；白蛋白(ALB)-静脉血: 48.1g/L；白细胞计数(WBC#)-静脉血: 5.310E9/L；血小板分布宽度(PDW)-静脉血: 14.3%；单核细胞百分比(Mono%)-静脉血: 0.011；淋巴细胞百分比(Lymph%)-静脉血: 0.128；血小板计数(PLT#)-静脉血: 18310E9/L；甘油三酯(TG)-静脉血: 1.83mmol/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；碱性磷酸酶(ALP)-静脉血: 76.4U/L；总胆汁酸(TBA)-静脉血: 14.5umol/L；总蛋白(TP)-静脉血: 79.72g/L；有核红细胞百分比(NRBC%)-静脉血: 0；红细胞比容(Hct)-静脉血: 44.3%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.7；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.42mmolL；胱抑素(Cys-C)-静脉血: 1.15mg/L；尿酸(UA)-静脉血: 254.8umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；间接胆红素(IBIL)-静脉血: 27.2umolL；钾离子(K+)-静脉血: 4.43mmol/L；乳酸脱氢酶(LDH)-静脉血: 200.6U/L；C-反应蛋白(CRP)-静脉血: 1.97mg/L；浊度(TRUB)-尿液: clear；酸碱度(pH)-尿液: 5.5；平均红细胞体积(MCV……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D26] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 化疗第2天，患者一般情况可，未诉特殊不适。查体：左侧颈部II区可扪及1个淋巴结，最大径2cm×2.5cm2，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]医生信息已隐藏示：目前暂未出现明显副反应，继续行化疗，密切观察病情。\n- [全程D29] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 化疗第5天，患者一般情况可。体查：KPS90分，张口门齿距4.5cm。鼻咽顶壁、顶后壁、双侧壁结节状肿物；左侧颈部II区可扪及1个淋巴结，最大径2cm×2cm2，无融合，质中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。复查血常规无明显异常。生化示：ALT 77.8U/L↑、IBIL27.20 umolL↑、TBIL35.1umol/L↑。[姓名已隐去]医生信息已隐藏示:第1程化疗结束，病情稳定，今日予办理出院。嘱其注意休息及营养支持，保持口腔清洁；出院后每周复查血常规2次，生化1次常规；按时[计划性表述已隐藏]下一程诱导化疗；若有不适，及时就诊。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 办理出院，暂不予保肝药物干预，嘱每周复查血常规和生化，按期返院行下一程诱导化疗。\nB. 暂缓出院，予静脉滴注保肝降酶药物，待转氨酶及胆红素完全恢复正常后出院，按期行下一程诱导化疗。\nC. 办理出院，开具口服保肝药物，终止后续诱导化疗计划，择期直接开始根治性同期放化疗。\nD. 办理出院，开具口服保肝药物，下一程诱导化疗直接将多西他赛及顺铂剂量下调20%。\nE. 办理出院，开具口服保肝药物，下一程诱导化疗方案更改为吉西他滨联合顺铂（GP方案）。\nF. 暂缓出院，请感染内科会诊排除乙肝病毒再激活，待专科意见明确后再决定后续抗肿瘤治疗计划。\nG. 办理出院，开具口服保肝药物，嘱每周复查血常规和生化，将下一程诱导化疗推迟1至2周进行。\nH. 办理出院，开具口服保肝药物，并预防性给予长效G-CSF支持，按期返院行下一程诱导化疗。\nI. 暂缓出院，按重度药物性肝损伤启动多学科联合诊疗，待肝功能好转后，按期行下一程诱导化疗。\nJ. 办理出院，开具口服保肝药物，下一程治疗停用尼妥珠单抗，仅行TPF方案诱导化疗。\nK. 办理出院，开具口服保肝药物（如多烯磷脂酰胆碱等），嘱每周复查血常规和生化，按期返院行下一程诱导化疗。\nL. 办理出院，开具口服保肝药物，下一程诱导化疗剔除氟尿嘧啶，改为多西他赛联合顺铂双药方案。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-ad5a1060b6801c87debff9d0","patient_id":"patient-5731cc38ced94b2ee39c442a","turn_id":"turn06","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"L","gold_action":"开具口服升白细胞药物（如咖啡酸片）、保肝药物（如复方甘草酸苷）及抑酸护胃、促动力药物进行对症支持。","options":[{"letter":"A","text":"予以皮下注射重组人粒细胞集落刺激因子（G-CSF），并静脉滴注异甘草酸镁进行保肝治疗。","is_gold":false},{"letter":"B","text":"嘱多饮水及注意休息，暂不予药物干预，定期门诊复查血常规及肝肾功能以评估毒性。","is_gold":false},{"letter":"C","text":"开具口服升白细胞药物（如咖啡酸片）及保肝药物（如复方甘草酸苷），暂不使用护胃止吐药物。","is_gold":false},{"letter":"D","text":"立即收治入院，予以静脉滴注质子泵抑制剂、止吐药及保肝药物，并密切监测血常规变化。","is_gold":false},{"letter":"E","text":"开具口服抑酸护胃及促胃动力药物（如艾司奥美拉唑、多潘立酮），暂不处理白细胞及肝功能异常。","is_gold":false},{"letter":"F","text":"提前开始第二周期TPF诱导化疗，并预防性给予长效G-CSF及静脉保肝药物支持治疗。","is_gold":false},{"letter":"G","text":"开具口服保肝药物（如复方甘草酸苷）及护胃止吐药物，暂不予口服升白细胞药物进行干预。","is_gold":false},{"letter":"H","text":"予以皮下注射重组人促红素（EPO），并开具口服保肝、护胃及促动力药物进行对症支持。","is_gold":false},{"letter":"I","text":"开具口服升白细胞药物（如咖啡酸片）、抑酸护胃及促胃动力药物，暂不予保肝药物治疗。","is_gold":false},{"letter":"J","text":"安排骨髓穿刺检查以明确白细胞减少原因，同时开具口服保肝及护胃药物进行对症支持。","is_gold":false},{"letter":"K","text":"门诊静脉推注地塞米松及昂丹司琼强化止吐，并开具口服保肝及升白药物进行对症支持。","is_gold":false},{"letter":"L","text":"开具口服升白细胞药物（如咖啡酸片）、保肝药物（如复方甘草酸苷）及抑酸护胃、促动力药物进行对症支持。","is_gold":true}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、蝶窦、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 左耳闷涉不适1年，涕血2月。；某次就诊时间特来我院门诊进一步诊治，完善相关检查，诊断明确后，今日入院系统治疗。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,左耳闷胀感,涕血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。有吸烟史1年，日7支；少量饮酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：90次/分，R：20次/分，BP：131/86mmHg,Ht：171cm，Wt：76.5kg，BSA1.89m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶壁、顶后壁、双侧壁结节状肿物；左侧颈部II区可扪及1个淋巴结，最大径2cm×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.51；平均红细胞血红蛋白含量(MCH)-静脉血: 27.4pg；磷(P)-静脉血: 0.9mmol/L；直接胆红素(DBIL)-静脉血: 4.7umol/L；凝血酶时间(TT)-静脉血: 22.7sec.；D-二聚体(D-Dimer)-静脉血: 0.29ug/ml；活化部分凝血活酶时间(APTT)-静脉血: 38.5sec.；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.04S/CO；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.82mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.6；单核细胞百分比(Mono%)-静脉血: 0.047；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；间接胆红素(IBIL)-静脉血: 10.5umolL；白蛋白(ALB)-静脉血: 48g/L；氯离子(Cl-)-静脉血: 101.7mmol/L；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.718；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.1COI；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；白细胞计数(WBC#)-静脉血: 6.9510E9/L；红细胞比容(Hct)-静脉血: 46.8%；尿酸(UA)-静脉血: 431.8umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 81.8umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 26mmol/L；血小板分布宽度(PDW)-静脉血: 11.2%；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.04S/CO；平均血小板体积(MPV)-静脉血: 9.7fL；中性粒细胞计数(Neut#)-静脉血: 510E9/L；载脂蛋白B(apoB)-静脉血: 0.96g/L；凝血酶原时间(PT)-静脉血: 11.8sec.；钠离子(Na+)-静脉血: 138.7mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；甘油三酯(TG)-静脉血: 2.2mmol/L；总胆红素(TBIL)-……\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 Ⅱ、Ⅲ、aVF、V5、V6导联T波低平\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、后壁及双侧壁增厚，见软组织肿物向鼻咽腔内突出，在T1WI上呈等信号，在T2WI上呈稍高信号，增强扫描明显强化。双侧咽隐窝变浅，见软组织肿物填充。病灶侵犯左侧后鼻孔，侵犯左侧腭帆张提肌、左侧翼内肌头部、左侧咽旁脂肪间隙，侵犯蝶窦左侧份及左侧翼腭窝，侵犯左侧破裂孔、左侧海绵窦。 右侧咽旁间隙及双侧颈动脉鞘区血管未见明显异常。右侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常。口咽双侧壁未见增厚。 斜坡、左侧岩尖、蝶骨基底部、左侧翼突区骨质信号减低，增强扫描明显强化。 右侧海绵窦形态正常，未见增宽。 双侧筛窦、左侧上颌窦、蝶窦及右侧乳突粘膜增厚，左侧乳突内见大量长分期信息见历史辅助诊断节点长分期信息见历史辅助诊断节点信号分泌物。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变。 左侧咽后可见数个小淋巴结，较大短径约4mm；右侧咽后可见小淋巴结，短径约2mm。左颈II、III区可见数个淋巴结，最大约21mm×15mm，部分呈相互融合改变，边界欠清，增强扫描可见明显强化。右颈II、III区可见数个淋巴结，最大约12mm×7mm，边界清。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 左颈II、III区淋巴结肿大，考虑转移。 左侧咽后、右颈II、III区淋巴结，不排除转移。 右侧咽后小淋巴结。 鼻窦炎。双侧乳突炎。\n- [全程D5] 检验组合: EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；Rh血型-静脉血: 阳性；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；ABO血型-静脉血: O\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D24] 检验组合: 天门冬氨酸氨基转移酶(AST)-静脉血: 20.1U/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；血小板分布宽度(PDW)-静脉血: 11.9%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.1；尿素氮(BUN)-静脉血: 3.6mmol/L；磷(P)-静脉血: 0.97mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21.8U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.55；丙氨酸氨基转移酶(ALT)-静脉血: 41U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.19mmol/L；葡萄糖(Glu)-静脉血: 5.41mmol/L；白蛋白(ALB)-静脉血: 46.9g/L；白细胞计数(WBC#)-静脉血: 5.2810E9/L；红细胞计数(RBC#)-静脉血: 5.3910E12/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.6；尿酸(UA)-静脉血: 386.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 27U/L；C-反应蛋白(CRP)-静脉血: 4.25mg/L；钾离子(K+)-静脉血: 4.08mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.051；载脂蛋白B(apoB)-静脉血: 1.1g/L；球蛋白(GLO)-静脉血: 30.3g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；平均血小板体积(MPV)-静脉血: 10.3fL；总胆汁酸(TBA)-静脉血: 1.8umol/L；总蛋白(TP)-静脉血: 77.2g/L；间接胆红素(IBIL)-静脉血: 11.1umolL；甘油三酯(TG)-静脉血: 1.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.08g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.310E9/L；氯离子(Cl-)-静脉血: 102.2mmol/L；单核细胞百分比(Mono%)-静脉血: 0.072；碱性磷酸酶(ALP)-静脉血: 82.4U/L；总胆红素(TBIL)-静脉血: 15.1umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.49；总胆固醇(TC)-静脉血: 4.74mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.237；血小板比容……\n- [全程D25] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右侧约平T6椎体下缘水平，估计导管末端位于上腔静脉下段内。；检查结论: PICC管位置如上所述。\n- [全程D25] 检验组合: 浊度(TRUB)-尿液: clear；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 5.5；葡萄糖(Glu)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；虫卵-粪便: 未见虫卵（参考: 未见虫卵）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 30/μL；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；隐血(OB)-粪便: 阴性（参考: 阴性）；比重(SG)-尿液: 1.021；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-粪便: 棕色；酮体(KET)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D29] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；磷(P)-静脉血: 1.54mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.4U/L；总胆固醇(TC)-静脉血: 6.28mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.3pg；镁离子(Mg2+)-静脉血: 1.06mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=2.00)（参考: 阴性）；肌酐(Crea)-静脉血: 76.5umol/L；球蛋白(GLO)-静脉血: 31.62g/L；白蛋白(ALB)-静脉血: 48.1g/L；白细胞计数(WBC#)-静脉血: 5.310E9/L；血小板分布宽度(PDW)-静脉血: 14.3%；单核细胞百分比(Mono%)-静脉血: 0.011；淋巴细胞百分比(Lymph%)-静脉血: 0.128；血小板计数(PLT#)-静脉血: 18310E9/L；甘油三酯(TG)-静脉血: 1.83mmol/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；碱性磷酸酶(ALP)-静脉血: 76.4U/L；总胆汁酸(TBA)-静脉血: 14.5umol/L；总蛋白(TP)-静脉血: 79.72g/L；有核红细胞百分比(NRBC%)-静脉血: 0；红细胞比容(Hct)-静脉血: 44.3%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.7；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.42mmolL；胱抑素(Cys-C)-静脉血: 1.15mg/L；尿酸(UA)-静脉血: 254.8umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；间接胆红素(IBIL)-静脉血: 27.2umolL；钾离子(K+)-静脉血: 4.43mmol/L；乳酸脱氢酶(LDH)-静脉血: 200.6U/L；C-反应蛋白(CRP)-静脉血: 1.97mg/L；浊度(TRUB)-尿液: clear；酸碱度(pH)-尿液: 5.5；平均红细胞体积(MCV……\n- [全程D32] 检验组合: 间接胆红素(IBIL)-静脉血: 13.9umolL；肌酐(Crea)-静脉血: 83.3umol/L；碱性磷酸酶(ALP)-静脉血: 80.7U/L；镁离子(Mg2+)-静脉血: 1.02mmol/L；总胆红素(TBIL)-静脉血: 19.3umol/L；胱抑素(Cys-C)-静脉血: 0.87mg/L；尿素氮(BUN)-静脉血: 4.5mmol/L；载脂蛋白B(apoB)-静脉血: 1.13g/L；白细胞计数(WBC#)-静脉血: 3.0510E9/L；总胆汁酸(TBA)-静脉血: 1.7umol/L；血小板分布宽度(PDW)-静脉血: 12.5%；血小板比容-静脉血: 17%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.01；单核细胞百分比(Mono%)-静脉血: 0.013；平均血小板体积(MPV)-静脉血: 10.9fL；乳酸脱氢酶(LDH)-静脉血: 186U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.36；平均红细胞血红蛋白含量(MCH)-静脉血: 27.7pg；平均红细胞体积(MCV)-静脉血: 81.7fL；单核细胞计数(Mono#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 15410E9/L；氯离子(Cl-)-静脉血: 96.9mmol/L；钾离子(K+)-静脉血: 3.58mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.4mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 28U/L；甘油三酯(TG)-静脉血: 1.46mmol/L；红细胞比容(Hct)-静脉血: 44.3%；中性粒细胞百分比(Neut%)-静脉血: 0.748；总钙(Ca)-静脉血: 2.27mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 34.1；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 25.5U/L；葡萄糖(Glu)-静脉血: 5.55mmol/L；尿酸(UA)-静脉血: 325.7umol/L；直接胆红素(DBIL)-静脉血: 5.4umol/L；钠离子(Na+)-静脉血: 133.9mmol/L；大血小板百分比(P-LCR%)-静脉血: 31.7%；红细胞体积分布宽度CV(RDW-CV)-静……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D26] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 化疗第2天，患者一般情况可，未诉特殊不适。查体：左侧颈部II区可扪及1个淋巴结，最大径2cm×2.5cm2，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]医生信息已隐藏示：目前暂未出现明显副反应，继续行化疗，密切观察病情。\n- [全程D29] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 化疗第5天，患者一般情况可。体查：KPS90分，张口门齿距4.5cm。鼻咽顶壁、顶后壁、双侧壁结节状肿物；左侧颈部II区可扪及1个淋巴结，最大径2cm×2cm2，无融合，质中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。复查血常规无明显异常。生化示：ALT 77.8U/L↑、IBIL27.20 umolL↑、TBIL35.1umol/L↑。[姓名已隐去]医生信息已隐藏示:第1程化疗结束，病情稳定，今日予办理出院。嘱其注意休息及营养支持，保持口腔清洁；出院后每周复查血常规2次，生化1次常规；按时[计划性表述已隐藏]下一程诱导化疗；若有不适，及时就诊。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 予以皮下注射重组人粒细胞集落刺激因子（G-CSF），并静脉滴注异甘草酸镁进行保肝治疗。\nB. 嘱多饮水及注意休息，暂不予药物干预，定期门诊复查血常规及肝肾功能以评估毒性。\nC. 开具口服升白细胞药物（如咖啡酸片）及保肝药物（如复方甘草酸苷），暂不使用护胃止吐药物。\nD. 立即收治入院，予以静脉滴注质子泵抑制剂、止吐药及保肝药物，并密切监测血常规变化。\nE. 开具口服抑酸护胃及促胃动力药物（如艾司奥美拉唑、多潘立酮），暂不处理白细胞及肝功能异常。\nF. 提前开始第二周期TPF诱导化疗，并预防性给予长效G-CSF及静脉保肝药物支持治疗。\nG. 开具口服保肝药物（如复方甘草酸苷）及护胃止吐药物，暂不予口服升白细胞药物进行干预。\nH. 予以皮下注射重组人促红素（EPO），并开具口服保肝、护胃及促动力药物进行对症支持。\nI. 开具口服升白细胞药物（如咖啡酸片）、抑酸护胃及促胃动力药物，暂不予保肝药物治疗。\nJ. 安排骨髓穿刺检查以明确白细胞减少原因，同时开具口服保肝及护胃药物进行对症支持。\nK. 门诊静脉推注地塞米松及昂丹司琼强化止吐，并开具口服保肝及升白药物进行对症支持。\nL. 开具口服升白细胞药物（如咖啡酸片）、保肝药物（如复方甘草酸苷）及抑酸护胃、促动力药物进行对症支持。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、蝶窦、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 左耳闷涉不适1年，涕血2月。；某次就诊时间特来我院门诊进一步诊治，完善相关检查，诊断明确后，今日入院系统治疗。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,左耳闷胀感,涕血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。有吸烟史1年，日7支；少量饮酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：90次/分，R：20次/分，BP：131/86mmHg,Ht：171cm，Wt：76.5kg，BSA1.89m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶壁、顶后壁、双侧壁结节状肿物；左侧颈部II区可扪及1个淋巴结，最大径2cm×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.51；平均红细胞血红蛋白含量(MCH)-静脉血: 27.4pg；磷(P)-静脉血: 0.9mmol/L；直接胆红素(DBIL)-静脉血: 4.7umol/L；凝血酶时间(TT)-静脉血: 22.7sec.；D-二聚体(D-Dimer)-静脉血: 0.29ug/ml；活化部分凝血活酶时间(APTT)-静脉血: 38.5sec.；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.04S/CO；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.82mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.6；单核细胞百分比(Mono%)-静脉血: 0.047；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；间接胆红素(IBIL)-静脉血: 10.5umolL；白蛋白(ALB)-静脉血: 48g/L；氯离子(Cl-)-静脉血: 101.7mmol/L；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.718；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.1COI；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；白细胞计数(WBC#)-静脉血: 6.9510E9/L；红细胞比容(Hct)-静脉血: 46.8%；尿酸(UA)-静脉血: 431.8umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 81.8umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 26mmol/L；血小板分布宽度(PDW)-静脉血: 11.2%；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.04S/CO；平均血小板体积(MPV)-静脉血: 9.7fL；中性粒细胞计数(Neut#)-静脉血: 510E9/L；载脂蛋白B(apoB)-静脉血: 0.96g/L；凝血酶原时间(PT)-静脉血: 11.8sec.；钠离子(Na+)-静脉血: 138.7mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；甘油三酯(TG)-静脉血: 2.2mmol/L；总胆红素(TBIL)-……\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 Ⅱ、Ⅲ、aVF、V5、V6导联T波低平\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、后壁及双侧壁增厚，见软组织肿物向鼻咽腔内突出，在T1WI上呈等信号，在T2WI上呈稍高信号，增强扫描明显强化。双侧咽隐窝变浅，见软组织肿物填充。病灶侵犯左侧后鼻孔，侵犯左侧腭帆张提肌、左侧翼内肌头部、左侧咽旁脂肪间隙，侵犯蝶窦左侧份及左侧翼腭窝，侵犯左侧破裂孔、左侧海绵窦。 右侧咽旁间隙及双侧颈动脉鞘区血管未见明显异常。右侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常。口咽双侧壁未见增厚。 斜坡、左侧岩尖、蝶骨基底部、左侧翼突区骨质信号减低，增强扫描明显强化。 右侧海绵窦形态正常，未见增宽。 双侧筛窦、左侧上颌窦、蝶窦及右侧乳突粘膜增厚，左侧乳突内见大量长分期信息见历史辅助诊断节点长分期信息见历史辅助诊断节点信号分泌物。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变。 左侧咽后可见数个小淋巴结，较大短径约4mm；右侧咽后可见小淋巴结，短径约2mm。左颈II、III区可见数个淋巴结，最大约21mm×15mm，部分呈相互融合改变，边界欠清，增强扫描可见明显强化。右颈II、III区可见数个淋巴结，最大约12mm×7mm，边界清。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 左颈II、III区淋巴结肿大，考虑转移。 左侧咽后、右颈II、III区淋巴结，不排除转移。 右侧咽后小淋巴结。 鼻窦炎。双侧乳突炎。\n- [全程D5] 检验组合: EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；Rh血型-静脉血: 阳性；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；ABO血型-静脉血: O\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D24] 检验组合: 天门冬氨酸氨基转移酶(AST)-静脉血: 20.1U/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；血小板分布宽度(PDW)-静脉血: 11.9%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.1；尿素氮(BUN)-静脉血: 3.6mmol/L；磷(P)-静脉血: 0.97mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21.8U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.55；丙氨酸氨基转移酶(ALT)-静脉血: 41U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.19mmol/L；葡萄糖(Glu)-静脉血: 5.41mmol/L；白蛋白(ALB)-静脉血: 46.9g/L；白细胞计数(WBC#)-静脉血: 5.2810E9/L；红细胞计数(RBC#)-静脉血: 5.3910E12/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.6；尿酸(UA)-静脉血: 386.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 27U/L；C-反应蛋白(CRP)-静脉血: 4.25mg/L；钾离子(K+)-静脉血: 4.08mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.051；载脂蛋白B(apoB)-静脉血: 1.1g/L；球蛋白(GLO)-静脉血: 30.3g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；平均血小板体积(MPV)-静脉血: 10.3fL；总胆汁酸(TBA)-静脉血: 1.8umol/L；总蛋白(TP)-静脉血: 77.2g/L；间接胆红素(IBIL)-静脉血: 11.1umolL；甘油三酯(TG)-静脉血: 1.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.08g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.310E9/L；氯离子(Cl-)-静脉血: 102.2mmol/L；单核细胞百分比(Mono%)-静脉血: 0.072；碱性磷酸酶(ALP)-静脉血: 82.4U/L；总胆红素(TBIL)-静脉血: 15.1umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.49；总胆固醇(TC)-静脉血: 4.74mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.237；血小板比容……\n- [全程D25] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右侧约平T6椎体下缘水平，估计导管末端位于上腔静脉下段内。；检查结论: PICC管位置如上所述。\n- [全程D25] 检验组合: 浊度(TRUB)-尿液: clear；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 5.5；葡萄糖(Glu)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；虫卵-粪便: 未见虫卵（参考: 未见虫卵）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 30/μL；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；隐血(OB)-粪便: 阴性（参考: 阴性）；比重(SG)-尿液: 1.021；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-粪便: 棕色；酮体(KET)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D29] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；磷(P)-静脉血: 1.54mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.4U/L；总胆固醇(TC)-静脉血: 6.28mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.3pg；镁离子(Mg2+)-静脉血: 1.06mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=2.00)（参考: 阴性）；肌酐(Crea)-静脉血: 76.5umol/L；球蛋白(GLO)-静脉血: 31.62g/L；白蛋白(ALB)-静脉血: 48.1g/L；白细胞计数(WBC#)-静脉血: 5.310E9/L；血小板分布宽度(PDW)-静脉血: 14.3%；单核细胞百分比(Mono%)-静脉血: 0.011；淋巴细胞百分比(Lymph%)-静脉血: 0.128；血小板计数(PLT#)-静脉血: 18310E9/L；甘油三酯(TG)-静脉血: 1.83mmol/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；碱性磷酸酶(ALP)-静脉血: 76.4U/L；总胆汁酸(TBA)-静脉血: 14.5umol/L；总蛋白(TP)-静脉血: 79.72g/L；有核红细胞百分比(NRBC%)-静脉血: 0；红细胞比容(Hct)-静脉血: 44.3%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.7；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.42mmolL；胱抑素(Cys-C)-静脉血: 1.15mg/L；尿酸(UA)-静脉血: 254.8umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；间接胆红素(IBIL)-静脉血: 27.2umolL；钾离子(K+)-静脉血: 4.43mmol/L；乳酸脱氢酶(LDH)-静脉血: 200.6U/L；C-反应蛋白(CRP)-静脉血: 1.97mg/L；浊度(TRUB)-尿液: clear；酸碱度(pH)-尿液: 5.5；平均红细胞体积(MCV……\n- [全程D32] 检验组合: 间接胆红素(IBIL)-静脉血: 13.9umolL；肌酐(Crea)-静脉血: 83.3umol/L；碱性磷酸酶(ALP)-静脉血: 80.7U/L；镁离子(Mg2+)-静脉血: 1.02mmol/L；总胆红素(TBIL)-静脉血: 19.3umol/L；胱抑素(Cys-C)-静脉血: 0.87mg/L；尿素氮(BUN)-静脉血: 4.5mmol/L；载脂蛋白B(apoB)-静脉血: 1.13g/L；白细胞计数(WBC#)-静脉血: 3.0510E9/L；总胆汁酸(TBA)-静脉血: 1.7umol/L；血小板分布宽度(PDW)-静脉血: 12.5%；血小板比容-静脉血: 17%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.01；单核细胞百分比(Mono%)-静脉血: 0.013；平均血小板体积(MPV)-静脉血: 10.9fL；乳酸脱氢酶(LDH)-静脉血: 186U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.36；平均红细胞血红蛋白含量(MCH)-静脉血: 27.7pg；平均红细胞体积(MCV)-静脉血: 81.7fL；单核细胞计数(Mono#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 15410E9/L；氯离子(Cl-)-静脉血: 96.9mmol/L；钾离子(K+)-静脉血: 3.58mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.4mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 28U/L；甘油三酯(TG)-静脉血: 1.46mmol/L；红细胞比容(Hct)-静脉血: 44.3%；中性粒细胞百分比(Neut%)-静脉血: 0.748；总钙(Ca)-静脉血: 2.27mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 34.1；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 25.5U/L；葡萄糖(Glu)-静脉血: 5.55mmol/L；尿酸(UA)-静脉血: 325.7umol/L；直接胆红素(DBIL)-静脉血: 5.4umol/L；钠离子(Na+)-静脉血: 133.9mmol/L；大血小板百分比(P-LCR%)-静脉血: 31.7%；红细胞体积分布宽度CV(RDW-CV)-静……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D26] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 化疗第2天，患者一般情况可，未诉特殊不适。查体：左侧颈部II区可扪及1个淋巴结，最大径2cm×2.5cm2，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]医生信息已隐藏示：目前暂未出现明显副反应，继续行化疗，密切观察病情。\n- [全程D29] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 化疗第5天，患者一般情况可。体查：KPS90分，张口门齿距4.5cm。鼻咽顶壁、顶后壁、双侧壁结节状肿物；左侧颈部II区可扪及1个淋巴结，最大径2cm×2cm2，无融合，质中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。复查血常规无明显异常。生化示：ALT 77.8U/L↑、IBIL27.20 umolL↑、TBIL35.1umol/L↑。[姓名已隐去]医生信息已隐藏示:第1程化疗结束，病情稳定，今日予办理出院。嘱其注意休息及营养支持，保持口腔清洁；出院后每周复查血常规2次，生化1次常规；按时[计划性表述已隐藏]下一程诱导化疗；若有不适，及时就诊。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 予以皮下注射重组人粒细胞集落刺激因子（G-CSF），并静脉滴注异甘草酸镁进行保肝治疗。\nB. 嘱多饮水及注意休息，暂不予药物干预，定期门诊复查血常规及肝肾功能以评估毒性。\nC. 开具口服升白细胞药物（如咖啡酸片）及保肝药物（如复方甘草酸苷），暂不使用护胃止吐药物。\nD. 立即收治入院，予以静脉滴注质子泵抑制剂、止吐药及保肝药物，并密切监测血常规变化。\nE. 开具口服抑酸护胃及促胃动力药物（如艾司奥美拉唑、多潘立酮），暂不处理白细胞及肝功能异常。\nF. 提前开始第二周期TPF诱导化疗，并预防性给予长效G-CSF及静脉保肝药物支持治疗。\nG. 开具口服保肝药物（如复方甘草酸苷）及护胃止吐药物，暂不予口服升白细胞药物进行干预。\nH. 予以皮下注射重组人促红素（EPO），并开具口服保肝、护胃及促动力药物进行对症支持。\nI. 开具口服升白细胞药物（如咖啡酸片）、抑酸护胃及促胃动力药物，暂不予保肝药物治疗。\nJ. 安排骨髓穿刺检查以明确白细胞减少原因，同时开具口服保肝及护胃药物进行对症支持。\nK. 门诊静脉推注地塞米松及昂丹司琼强化止吐，并开具口服保肝及升白药物进行对症支持。\nL. 开具口服升白细胞药物（如咖啡酸片）、保肝药物（如复方甘草酸苷）及抑酸护胃、促动力药物进行对症支持。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-b10ed2b10a17f1626353b252","patient_id":"patient-5731cc38ced94b2ee39c442a","turn_id":"turn07","turn_position":5,"turn_type":"recurrence_or_salvage_decision","gold_letter":"A","gold_action":"结束诱导化疗，序贯开展根治性放射治疗。","options":[{"letter":"A","text":"结束诱导化疗，序贯开展根治性放射治疗","is_gold":true},{"letter":"B","text":"继续原方案（TPF联合尼妥珠单抗）诱导化疗至第6周期后再行放射治疗","is_gold":false},{"letter":"C","text":"更换为GP方案（吉西他滨联合顺铂）继续诱导化疗2个周期","is_gold":false},{"letter":"D","text":"行鼻咽原发灶及双侧颈部淋巴结根治性切除术","is_gold":false},{"letter":"E","text":"行双侧颈部淋巴结清扫术，术后序贯鼻咽局部放射治疗","is_gold":false},{"letter":"F","text":"加用PD-1抑制剂联合原方案继续诱导化疗2个周期","is_gold":false},{"letter":"G","text":"暂停抗肿瘤治疗，进入定期随访观察阶段","is_gold":false},{"letter":"H","text":"完善全身PET-CT重新分期后再决定后续局部治疗方案","is_gold":false},{"letter":"I","text":"仅行根治性放射治疗，处理鼻咽原发灶，颈部病灶继续随访观察","is_gold":false},{"letter":"J","text":"结束诱导化疗，序贯开展尼妥珠单抗单药靶向维持治疗","is_gold":false},{"letter":"K","text":"行放射性粒子植入术，处理鼻咽及颈部残留病灶直接","is_gold":false},{"letter":"L","text":"采用卡培他滨单药维持化疗，推迟局部放射治疗","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、蝶窦、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 左耳闷涉不适1年，涕血2月。；某次就诊时间特来我院门诊进一步诊治，完善相关检查，诊断明确后，今日入院系统治疗。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,左耳闷胀感,涕血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。有吸烟史1年，日7支；少量饮酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：90次/分，R：20次/分，BP：131/86mmHg,Ht：171cm，Wt：76.5kg，BSA1.89m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶壁、顶后壁、双侧壁结节状肿物；左侧颈部II区可扪及1个淋巴结，最大径2cm×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.51；平均红细胞血红蛋白含量(MCH)-静脉血: 27.4pg；磷(P)-静脉血: 0.9mmol/L；直接胆红素(DBIL)-静脉血: 4.7umol/L；凝血酶时间(TT)-静脉血: 22.7sec.；D-二聚体(D-Dimer)-静脉血: 0.29ug/ml；活化部分凝血活酶时间(APTT)-静脉血: 38.5sec.；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.04S/CO；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.82mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.6；单核细胞百分比(Mono%)-静脉血: 0.047；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；间接胆红素(IBIL)-静脉血: 10.5umolL；白蛋白(ALB)-静脉血: 48g/L；氯离子(Cl-)-静脉血: 101.7mmol/L；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.718；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.1COI；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；白细胞计数(WBC#)-静脉血: 6.9510E9/L；红细胞比容(Hct)-静脉血: 46.8%；尿酸(UA)-静脉血: 431.8umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 81.8umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 26mmol/L；血小板分布宽度(PDW)-静脉血: 11.2%；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.04S/CO；平均血小板体积(MPV)-静脉血: 9.7fL；中性粒细胞计数(Neut#)-静脉血: 510E9/L；载脂蛋白B(apoB)-静脉血: 0.96g/L；凝血酶原时间(PT)-静脉血: 11.8sec.；钠离子(Na+)-静脉血: 138.7mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；甘油三酯(TG)-静脉血: 2.2mmol/L；总胆红素(TBIL)-……\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 Ⅱ、Ⅲ、aVF、V5、V6导联T波低平\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、后壁及双侧壁增厚，见软组织肿物向鼻咽腔内突出，在T1WI上呈等信号，在T2WI上呈稍高信号，增强扫描明显强化。双侧咽隐窝变浅，见软组织肿物填充。病灶侵犯左侧后鼻孔，侵犯左侧腭帆张提肌、左侧翼内肌头部、左侧咽旁脂肪间隙，侵犯蝶窦左侧份及左侧翼腭窝，侵犯左侧破裂孔、左侧海绵窦。 右侧咽旁间隙及双侧颈动脉鞘区血管未见明显异常。右侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常。口咽双侧壁未见增厚。 斜坡、左侧岩尖、蝶骨基底部、左侧翼突区骨质信号减低，增强扫描明显强化。 右侧海绵窦形态正常，未见增宽。 双侧筛窦、左侧上颌窦、蝶窦及右侧乳突粘膜增厚，左侧乳突内见大量长分期信息见历史辅助诊断节点长分期信息见历史辅助诊断节点信号分泌物。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变。 左侧咽后可见数个小淋巴结，较大短径约4mm；右侧咽后可见小淋巴结，短径约2mm。左颈II、III区可见数个淋巴结，最大约21mm×15mm，部分呈相互融合改变，边界欠清，增强扫描可见明显强化。右颈II、III区可见数个淋巴结，最大约12mm×7mm，边界清。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 左颈II、III区淋巴结肿大，考虑转移。 左侧咽后、右颈II、III区淋巴结，不排除转移。 右侧咽后小淋巴结。 鼻窦炎。双侧乳突炎。\n- [全程D5] 检验组合: EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；Rh血型-静脉血: 阳性；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；ABO血型-静脉血: O\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D24] 检验组合: 天门冬氨酸氨基转移酶(AST)-静脉血: 20.1U/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；血小板分布宽度(PDW)-静脉血: 11.9%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.1；尿素氮(BUN)-静脉血: 3.6mmol/L；磷(P)-静脉血: 0.97mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21.8U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.55；丙氨酸氨基转移酶(ALT)-静脉血: 41U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.19mmol/L；葡萄糖(Glu)-静脉血: 5.41mmol/L；白蛋白(ALB)-静脉血: 46.9g/L；白细胞计数(WBC#)-静脉血: 5.2810E9/L；红细胞计数(RBC#)-静脉血: 5.3910E12/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.6；尿酸(UA)-静脉血: 386.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 27U/L；C-反应蛋白(CRP)-静脉血: 4.25mg/L；钾离子(K+)-静脉血: 4.08mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.051；载脂蛋白B(apoB)-静脉血: 1.1g/L；球蛋白(GLO)-静脉血: 30.3g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；平均血小板体积(MPV)-静脉血: 10.3fL；总胆汁酸(TBA)-静脉血: 1.8umol/L；总蛋白(TP)-静脉血: 77.2g/L；间接胆红素(IBIL)-静脉血: 11.1umolL；甘油三酯(TG)-静脉血: 1.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.08g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.310E9/L；氯离子(Cl-)-静脉血: 102.2mmol/L；单核细胞百分比(Mono%)-静脉血: 0.072；碱性磷酸酶(ALP)-静脉血: 82.4U/L；总胆红素(TBIL)-静脉血: 15.1umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.49；总胆固醇(TC)-静脉血: 4.74mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.237；血小板比容……\n- [全程D25] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右侧约平T6椎体下缘水平，估计导管末端位于上腔静脉下段内。；检查结论: PICC管位置如上所述。\n- [全程D25] 检验组合: 浊度(TRUB)-尿液: clear；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 5.5；葡萄糖(Glu)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；虫卵-粪便: 未见虫卵（参考: 未见虫卵）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 30/μL；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；隐血(OB)-粪便: 阴性（参考: 阴性）；比重(SG)-尿液: 1.021；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-粪便: 棕色；酮体(KET)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D29] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；磷(P)-静脉血: 1.54mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.4U/L；总胆固醇(TC)-静脉血: 6.28mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.3pg；镁离子(Mg2+)-静脉血: 1.06mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=2.00)（参考: 阴性）；肌酐(Crea)-静脉血: 76.5umol/L；球蛋白(GLO)-静脉血: 31.62g/L；白蛋白(ALB)-静脉血: 48.1g/L；白细胞计数(WBC#)-静脉血: 5.310E9/L；血小板分布宽度(PDW)-静脉血: 14.3%；单核细胞百分比(Mono%)-静脉血: 0.011；淋巴细胞百分比(Lymph%)-静脉血: 0.128；血小板计数(PLT#)-静脉血: 18310E9/L；甘油三酯(TG)-静脉血: 1.83mmol/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；碱性磷酸酶(ALP)-静脉血: 76.4U/L；总胆汁酸(TBA)-静脉血: 14.5umol/L；总蛋白(TP)-静脉血: 79.72g/L；有核红细胞百分比(NRBC%)-静脉血: 0；红细胞比容(Hct)-静脉血: 44.3%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.7；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.42mmolL；胱抑素(Cys-C)-静脉血: 1.15mg/L；尿酸(UA)-静脉血: 254.8umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；间接胆红素(IBIL)-静脉血: 27.2umolL；钾离子(K+)-静脉血: 4.43mmol/L；乳酸脱氢酶(LDH)-静脉血: 200.6U/L；C-反应蛋白(CRP)-静脉血: 1.97mg/L；浊度(TRUB)-尿液: clear；酸碱度(pH)-尿液: 5.5；平均红细胞体积(MCV……\n- [全程D32] 检验组合: 间接胆红素(IBIL)-静脉血: 13.9umolL；肌酐(Crea)-静脉血: 83.3umol/L；碱性磷酸酶(ALP)-静脉血: 80.7U/L；镁离子(Mg2+)-静脉血: 1.02mmol/L；总胆红素(TBIL)-静脉血: 19.3umol/L；胱抑素(Cys-C)-静脉血: 0.87mg/L；尿素氮(BUN)-静脉血: 4.5mmol/L；载脂蛋白B(apoB)-静脉血: 1.13g/L；白细胞计数(WBC#)-静脉血: 3.0510E9/L；总胆汁酸(TBA)-静脉血: 1.7umol/L；血小板分布宽度(PDW)-静脉血: 12.5%；血小板比容-静脉血: 17%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.01；单核细胞百分比(Mono%)-静脉血: 0.013；平均血小板体积(MPV)-静脉血: 10.9fL；乳酸脱氢酶(LDH)-静脉血: 186U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.36；平均红细胞血红蛋白含量(MCH)-静脉血: 27.7pg；平均红细胞体积(MCV)-静脉血: 81.7fL；单核细胞计数(Mono#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 15410E9/L；氯离子(Cl-)-静脉血: 96.9mmol/L；钾离子(K+)-静脉血: 3.58mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.4mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 28U/L；甘油三酯(TG)-静脉血: 1.46mmol/L；红细胞比容(Hct)-静脉血: 44.3%；中性粒细胞百分比(Neut%)-静脉血: 0.748；总钙(Ca)-静脉血: 2.27mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 34.1；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 25.5U/L；葡萄糖(Glu)-静脉血: 5.55mmol/L；尿酸(UA)-静脉血: 325.7umol/L；直接胆红素(DBIL)-静脉血: 5.4umol/L；钠离子(Na+)-静脉血: 133.9mmol/L；大血小板百分比(P-LCR%)-静脉血: 31.7%；红细胞体积分布宽度CV(RDW-CV)-静……\n- [全程D50] 检验组合: 碱性磷酸酶(ALP)-静脉血: 79.1U/L；总胆红素(TBIL)-静脉血: 18.4umol/L；血小板比容-静脉血: 24%；磷(P)-静脉血: 1.77mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=4.50)（参考: 阴性）；白蛋白(ALB)-静脉血: 44g/L；C-反应蛋白(CRP)-静脉血: 2.48mg/L；球蛋白(GLO)-静脉血: 30.07g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 5.18mmol/L；总胆汁酸(TBA)-静脉血: 3umol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.9；平均红细胞血红蛋白浓度(MCHC)-静脉血: 332g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0；淋巴细胞百分比(Lymph%)-静脉血: 0.212；胱抑素(Cys-C)-静脉血: 1.1mg/L；乳酸脱氢酶(LDH)-静脉血: 209.6U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 51.1U/L；氯离子(Cl-)-静脉血: 99.5mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 45.8U/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.7mmol/L；载脂蛋白B(apoB)-静脉血: 1.54g/L；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.726；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.18mmolL；镁离子(Mg2+)-静脉血: 0.94mmol/L；钾离子(K+)-静脉血: 4.21mmol/L；阴离子间隙(AG)-静脉血: 15；单核细胞百分比(Mono%)-静脉血: 0.06；直接胆红素(DBIL)-静脉血: 3.3umol/L；总蛋白(TP)-静脉血: 74.07g/L；红细胞比容(Hct)-静脉血: 41.9%；血小板计数(PLT#)-静脉血: 24410E9/L；EB病毒Zta蛋白抗体IgA(EBV-Zta-IgA)-静脉血: 阳性(SCO=5.00)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 32.5U/L；载脂蛋白AI(ap……\n- [全程D53] 检验组合: 单核细胞计数(Mono#)-静脉血: 0.210E9/L；平均血小板体积(MPV)-静脉血: 10.1fL；平均红细胞血红蛋白含量(MCH)-静脉血: 27.5pg；氯离子(Cl-)-静脉血: 102.2mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；血小板分布宽度(PDW)-静脉血: 11.6%；钾离子(K+)-静脉血: 4.44mmol/L；血红蛋白(Hb)-静脉血: 146g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.4U/L；血小板比容-静脉血: 24%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 23610E9/L；肌酐(Crea)-静脉血: 78umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.97mmolL；直接胆红素(DBIL)-静脉血: 2.9umol/L；镁离子(Mg2+)-静脉血: 0.89mmol/L；白细胞计数(WBC#)-静脉血: 4.8410E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.9；有核红细胞计数(NRBC#)-静脉血: 010E9/L；尿酸(UA)-静脉血: 396.5umol/L；白蛋白(ALB)-静脉血: 43.6g/L；有核红细胞百分比(NRBC%)-静脉血: 0；单核细胞百分比(Mono%)-静脉血: 0.041；甘油三酯(TG)-静脉血: 1.5mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.5；总胆汁酸(TBA)-静脉血: 3.2umol/L；总钙(Ca)-静脉血: 2.29mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 29.4U/L；碱性磷酸酶(ALP)-静脉血: 88.9U/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.5mmol/L；平均红细胞体积(MCV)-静脉血: 84fL；丙氨酸氨基转移酶(ALT)-静脉血: 34.7U/L；红细胞比容(Hct)-静脉血: 44.5%；尿素氮(BUN)-静脉血: 6.4mmol/L；胱抑素(Cys-C)-……\n- [全程D64] 检验组合: 磷(P)-静脉血: 1.1mmol/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；平均红细胞血红蛋白含量(MCH)-静脉血: 27.3pg；平均血小板体积(MPV)-静脉血: 9.4fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.4；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；总钙(Ca)-静脉血: 2.24mmol/L；总蛋白(TP)-静脉血: 73.3g/L；氯离子(Cl-)-静脉血: 104.7mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 46.1U/L；单核细胞百分比(Mono%)-静脉血: 0.094；α-L-岩藻糖苷酶(AFU)-静脉血: 31.3U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.93mmol/L；尿素氮(BUN)-静脉血: 6.4mmol/L；总胆固醇(TC)-静脉血: 5.7mmol/L；血小板计数(PLT#)-静脉血: 15510E9/L；球蛋白(GLO)-静脉血: 28g/L；直接胆红素(DBIL)-静脉血: 2.3umol/L；总胆汁酸(TBA)-静脉血: 1.8umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.09mmolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.74；载脂蛋白B(apoB)-静脉血: 1.34g/L；钠离子(Na+)-静脉血: 141.6mmol/L；C-反应蛋白(CRP)-静脉血: 4.1mg/L；血小板比容-静脉血: 15%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；葡萄糖(Glu)-静脉血: 5.4mmol/L；白蛋白(ALB)-静脉血: 45.3g/L；有核红细胞计数(NRBC#)-静脉血: 0.0110E9/L；尿酸(UA)-静脉血: 511.6umol/L；甘油三酯(TG)-静脉血: 1.82mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.5mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 26.8U/L；大血小板百分比(P-LCR%)-静脉血: 19.5%；中性粒细胞计数(Neut#)-静脉血: 3.110E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 319g/L；乳酸脱氢酶(……\n- [全程D71] 检验组合: γ-谷氨酰基转移酶(GGT)-静脉血: 47U/L；尿酸(UA)-静脉血: 339.1umol/L；阴离子间隙(AG)-静脉血: 16.7；白细胞计数(WBC#)-静脉血: 5.8510E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 27.4pg；有核红细胞计数(NRBC#)-静脉血: 010E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.156；EB病毒Zta蛋白抗体IgA(EBV-Zta-IgA)-静脉血: 阳性(SCO=4.00)（参考: 阴性）；磷(P)-静脉血: 1.25mmol/L；肌酐(Crea)-静脉血: 80.9umol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:20（参考: 阴性）；单核细胞百分比(Mono%)-静脉血: 0.029；中性粒细胞计数(Neut#)-静脉血: 4.810E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.7mmol/L；红细胞比容(Hct)-静脉血: 43.3%；总胆红素(TBIL)-静脉血: 18.3umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 6.04mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；平均血小板体积(MPV)-静脉血: 10.9fL；碱性磷酸酶(ALP)-静脉血: 81.8U/L；葡萄糖(Glu)-静脉血: 5.79mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.6；间接胆红素(IBIL)-静脉血: 15umolL；α-L-岩藻糖苷酶(AFU)-静脉血: 41.6U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.48mmolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.3；载脂蛋白AI(apoAI)-静脉血: 1.28g/L；甘油三酯(TG)-静脉血: 2.29mmol/L；平均红细胞体积(MCV)-静脉血: 83.1fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板比容-静脉血: 17%；球蛋白(GLO)-静脉血: 29.1g/L；载脂蛋白B(apoB)-静脉血: 1.64g/L；乳酸脱氢酶(LDH)-静脉血: 229.2U/L；镁离子(Mg2+)-静脉血: 0.76mmol……\n- [全程D75] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后，对比某次就诊时间片： 鼻咽腔稍狭窄，鼻咽左顶壁及左侧壁增厚，在T1WI上呈等信号，在T2WI上呈稍高信号，增强扫描明显强化，较前明显缩小，左侧破裂孔、海绵窦、翼腭窝及蝶窦左份仍可见软组织灶，边界欠清，明显强化。右侧咽隐窝存在，左侧咽隐窝变浅 左侧腭帆张提肌、左侧翼内肌上缘信号不均匀，可见强化。 左侧咽旁间隙变窄，右侧咽旁间隙及双侧颈动脉鞘区血管未见明显异常。 右侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常。口咽双侧壁未见增厚。 斜坡、左侧岩尖、蝶骨基底部、左侧翼突区骨质信号减低，增强扫描明显强化。 右侧海绵窦形态正常，未见增宽。 双侧筛窦、左侧上颌窦、蝶窦粘膜增厚，左侧乳突内见少量信号分泌物。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变。 双侧咽后未见明确肿大淋巴结。 双颈II区及左颈III区可见数个淋巴结，最大约14mm×5mm，边界欠清，增强扫描可见明显强化。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。 所示脑实质未见明确异常。；检查结论: 鼻咽癌化疗后，范围较前明显缩小。 颅底骨质破坏。 双颈淋巴结，考虑转移，较前缩小、减少。 双侧咽后未见肿大淋巴结。 鼻窦炎。 左侧乳突炎。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D26] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 化疗第2天，患者一般情况可，未诉特殊不适。查体：左侧颈部II区可扪及1个淋巴结，最大径2cm×2.5cm2，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]医生信息已隐藏示：目前暂未出现明显副反应，继续行化疗，密切观察病情。\n- [全程D29] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 化疗第5天，患者一般情况可。体查：KPS90分，张口门齿距4.5cm。鼻咽顶壁、顶后壁、双侧壁结节状肿物；左侧颈部II区可扪及1个淋巴结，最大径2cm×2cm2，无融合，质中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。复查血常规无明显异常。生化示：ALT 77.8U/L↑、IBIL27.20 umolL↑、TBIL35.1umol/L↑。[姓名已隐去]医生信息已隐藏示:第1程化疗结束，病情稳定，今日予办理出院。嘱其注意休息及营养支持，保持口腔清洁；出院后每周复查血常规2次，生化1次常规；按时[计划性表述已隐藏]下一程诱导化疗；若有不适，及时就诊。\n- [全程D65] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日患者症状体征基本同前，无诉其余特殊不适。[姓名已隐去]医生信息已隐藏示：患者诊断明确，复查血常规、生化常规无明显化疗禁忌症，拟按期于某次就诊时间开始行TPF诱导化疗， 具体用药：DOC60mg/㎡d1+DDP60mg/㎡ d2+5-FU2.5g/㎡civ48hQ3w，并指示化疗期间给予护肝、护胃、止吐及营养支持治疗，昨日已行泰欣生靶向治疗，密切观察患者病情变化。\n- [全程D66] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，未诉恶心、呕吐、腹痛、腹泻等不适，大小便正常。[姓名已隐去]医生信息已隐藏出，患者目前一般情况可，予明日按TPF方案行第3周期化疗，注意化疗结束后复查血、生化常规，及时对症处理。\n- [全程D69] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日为化疗第3天，诉间有恶心，无呕吐，无咳嗽、咳痰，无头痛、头晕，大小便正常。[姓名已隐去]医生信息已隐藏出，患者化疗后出现胃肠道反应I度，予继续对症处理，减轻化疗后反应。\n- [全程D71] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日患者症状体征基本同前，无诉其余特殊不适。今日复查血常规及生化常规未见明显异常。[姓名已隐去]医生信息已隐藏示：患者病情平稳，一般情况良好，目前予完善相关放疗前准备，今日予办理出院。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 结束诱导化疗，序贯开展根治性放射治疗\nB. 继续原方案（TPF联合尼妥珠单抗）诱导化疗至第6周期后再行放射治疗\nC. 更换为GP方案（吉西他滨联合顺铂）继续诱导化疗2个周期\nD. 行鼻咽原发灶及双侧颈部淋巴结根治性切除术\nE. 行双侧颈部淋巴结清扫术，术后序贯鼻咽局部放射治疗\nF. 加用PD-1抑制剂联合原方案继续诱导化疗2个周期\nG. 暂停抗肿瘤治疗，进入定期随访观察阶段\nH. 完善全身PET-CT重新分期后再决定后续局部治疗方案\nI. 仅行根治性放射治疗，处理鼻咽原发灶，颈部病灶继续随访观察\nJ. 结束诱导化疗，序贯开展尼妥珠单抗单药靶向维持治疗\nK. 行放射性粒子植入术，处理鼻咽及颈部残留病灶直接\nL. 采用卡培他滨单药维持化疗，推迟局部放射治疗\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、蝶窦、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 左耳闷涉不适1年，涕血2月。；某次就诊时间特来我院门诊进一步诊治，完善相关检查，诊断明确后，今日入院系统治疗。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,左耳闷胀感,涕血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。有吸烟史1年，日7支；少量饮酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：90次/分，R：20次/分，BP：131/86mmHg,Ht：171cm，Wt：76.5kg，BSA1.89m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶壁、顶后壁、双侧壁结节状肿物；左侧颈部II区可扪及1个淋巴结，最大径2cm×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.51；平均红细胞血红蛋白含量(MCH)-静脉血: 27.4pg；磷(P)-静脉血: 0.9mmol/L；直接胆红素(DBIL)-静脉血: 4.7umol/L；凝血酶时间(TT)-静脉血: 22.7sec.；D-二聚体(D-Dimer)-静脉血: 0.29ug/ml；活化部分凝血活酶时间(APTT)-静脉血: 38.5sec.；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.04S/CO；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.82mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.6；单核细胞百分比(Mono%)-静脉血: 0.047；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；间接胆红素(IBIL)-静脉血: 10.5umolL；白蛋白(ALB)-静脉血: 48g/L；氯离子(Cl-)-静脉血: 101.7mmol/L；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.718；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.1COI；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；白细胞计数(WBC#)-静脉血: 6.9510E9/L；红细胞比容(Hct)-静脉血: 46.8%；尿酸(UA)-静脉血: 431.8umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 81.8umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 26mmol/L；血小板分布宽度(PDW)-静脉血: 11.2%；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.04S/CO；平均血小板体积(MPV)-静脉血: 9.7fL；中性粒细胞计数(Neut#)-静脉血: 510E9/L；载脂蛋白B(apoB)-静脉血: 0.96g/L；凝血酶原时间(PT)-静脉血: 11.8sec.；钠离子(Na+)-静脉血: 138.7mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；甘油三酯(TG)-静脉血: 2.2mmol/L；总胆红素(TBIL)-……\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 Ⅱ、Ⅲ、aVF、V5、V6导联T波低平\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、后壁及双侧壁增厚，见软组织肿物向鼻咽腔内突出，在T1WI上呈等信号，在T2WI上呈稍高信号，增强扫描明显强化。双侧咽隐窝变浅，见软组织肿物填充。病灶侵犯左侧后鼻孔，侵犯左侧腭帆张提肌、左侧翼内肌头部、左侧咽旁脂肪间隙，侵犯蝶窦左侧份及左侧翼腭窝，侵犯左侧破裂孔、左侧海绵窦。 右侧咽旁间隙及双侧颈动脉鞘区血管未见明显异常。右侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常。口咽双侧壁未见增厚。 斜坡、左侧岩尖、蝶骨基底部、左侧翼突区骨质信号减低，增强扫描明显强化。 右侧海绵窦形态正常，未见增宽。 双侧筛窦、左侧上颌窦、蝶窦及右侧乳突粘膜增厚，左侧乳突内见大量长分期信息见历史辅助诊断节点长分期信息见历史辅助诊断节点信号分泌物。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变。 左侧咽后可见数个小淋巴结，较大短径约4mm；右侧咽后可见小淋巴结，短径约2mm。左颈II、III区可见数个淋巴结，最大约21mm×15mm，部分呈相互融合改变，边界欠清，增强扫描可见明显强化。右颈II、III区可见数个淋巴结，最大约12mm×7mm，边界清。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 左颈II、III区淋巴结肿大，考虑转移。 左侧咽后、右颈II、III区淋巴结，不排除转移。 右侧咽后小淋巴结。 鼻窦炎。双侧乳突炎。\n- [全程D5] 检验组合: EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；Rh血型-静脉血: 阳性；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；ABO血型-静脉血: O\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D24] 检验组合: 天门冬氨酸氨基转移酶(AST)-静脉血: 20.1U/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；血小板分布宽度(PDW)-静脉血: 11.9%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.1；尿素氮(BUN)-静脉血: 3.6mmol/L；磷(P)-静脉血: 0.97mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21.8U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.55；丙氨酸氨基转移酶(ALT)-静脉血: 41U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.19mmol/L；葡萄糖(Glu)-静脉血: 5.41mmol/L；白蛋白(ALB)-静脉血: 46.9g/L；白细胞计数(WBC#)-静脉血: 5.2810E9/L；红细胞计数(RBC#)-静脉血: 5.3910E12/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.6；尿酸(UA)-静脉血: 386.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 27U/L；C-反应蛋白(CRP)-静脉血: 4.25mg/L；钾离子(K+)-静脉血: 4.08mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.051；载脂蛋白B(apoB)-静脉血: 1.1g/L；球蛋白(GLO)-静脉血: 30.3g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；平均血小板体积(MPV)-静脉血: 10.3fL；总胆汁酸(TBA)-静脉血: 1.8umol/L；总蛋白(TP)-静脉血: 77.2g/L；间接胆红素(IBIL)-静脉血: 11.1umolL；甘油三酯(TG)-静脉血: 1.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.08g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.310E9/L；氯离子(Cl-)-静脉血: 102.2mmol/L；单核细胞百分比(Mono%)-静脉血: 0.072；碱性磷酸酶(ALP)-静脉血: 82.4U/L；总胆红素(TBIL)-静脉血: 15.1umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.49；总胆固醇(TC)-静脉血: 4.74mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.237；血小板比容……\n- [全程D25] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右侧约平T6椎体下缘水平，估计导管末端位于上腔静脉下段内。；检查结论: PICC管位置如上所述。\n- [全程D25] 检验组合: 浊度(TRUB)-尿液: clear；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 5.5；葡萄糖(Glu)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；虫卵-粪便: 未见虫卵（参考: 未见虫卵）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 30/μL；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；隐血(OB)-粪便: 阴性（参考: 阴性）；比重(SG)-尿液: 1.021；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-粪便: 棕色；酮体(KET)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D29] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；磷(P)-静脉血: 1.54mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.4U/L；总胆固醇(TC)-静脉血: 6.28mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.3pg；镁离子(Mg2+)-静脉血: 1.06mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=2.00)（参考: 阴性）；肌酐(Crea)-静脉血: 76.5umol/L；球蛋白(GLO)-静脉血: 31.62g/L；白蛋白(ALB)-静脉血: 48.1g/L；白细胞计数(WBC#)-静脉血: 5.310E9/L；血小板分布宽度(PDW)-静脉血: 14.3%；单核细胞百分比(Mono%)-静脉血: 0.011；淋巴细胞百分比(Lymph%)-静脉血: 0.128；血小板计数(PLT#)-静脉血: 18310E9/L；甘油三酯(TG)-静脉血: 1.83mmol/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；碱性磷酸酶(ALP)-静脉血: 76.4U/L；总胆汁酸(TBA)-静脉血: 14.5umol/L；总蛋白(TP)-静脉血: 79.72g/L；有核红细胞百分比(NRBC%)-静脉血: 0；红细胞比容(Hct)-静脉血: 44.3%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.7；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.42mmolL；胱抑素(Cys-C)-静脉血: 1.15mg/L；尿酸(UA)-静脉血: 254.8umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；间接胆红素(IBIL)-静脉血: 27.2umolL；钾离子(K+)-静脉血: 4.43mmol/L；乳酸脱氢酶(LDH)-静脉血: 200.6U/L；C-反应蛋白(CRP)-静脉血: 1.97mg/L；浊度(TRUB)-尿液: clear；酸碱度(pH)-尿液: 5.5；平均红细胞体积(MCV……\n- [全程D32] 检验组合: 间接胆红素(IBIL)-静脉血: 13.9umolL；肌酐(Crea)-静脉血: 83.3umol/L；碱性磷酸酶(ALP)-静脉血: 80.7U/L；镁离子(Mg2+)-静脉血: 1.02mmol/L；总胆红素(TBIL)-静脉血: 19.3umol/L；胱抑素(Cys-C)-静脉血: 0.87mg/L；尿素氮(BUN)-静脉血: 4.5mmol/L；载脂蛋白B(apoB)-静脉血: 1.13g/L；白细胞计数(WBC#)-静脉血: 3.0510E9/L；总胆汁酸(TBA)-静脉血: 1.7umol/L；血小板分布宽度(PDW)-静脉血: 12.5%；血小板比容-静脉血: 17%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.01；单核细胞百分比(Mono%)-静脉血: 0.013；平均血小板体积(MPV)-静脉血: 10.9fL；乳酸脱氢酶(LDH)-静脉血: 186U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.36；平均红细胞血红蛋白含量(MCH)-静脉血: 27.7pg；平均红细胞体积(MCV)-静脉血: 81.7fL；单核细胞计数(Mono#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 15410E9/L；氯离子(Cl-)-静脉血: 96.9mmol/L；钾离子(K+)-静脉血: 3.58mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.4mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 28U/L；甘油三酯(TG)-静脉血: 1.46mmol/L；红细胞比容(Hct)-静脉血: 44.3%；中性粒细胞百分比(Neut%)-静脉血: 0.748；总钙(Ca)-静脉血: 2.27mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 34.1；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 25.5U/L；葡萄糖(Glu)-静脉血: 5.55mmol/L；尿酸(UA)-静脉血: 325.7umol/L；直接胆红素(DBIL)-静脉血: 5.4umol/L；钠离子(Na+)-静脉血: 133.9mmol/L；大血小板百分比(P-LCR%)-静脉血: 31.7%；红细胞体积分布宽度CV(RDW-CV)-静……\n- [全程D50] 检验组合: 碱性磷酸酶(ALP)-静脉血: 79.1U/L；总胆红素(TBIL)-静脉血: 18.4umol/L；血小板比容-静脉血: 24%；磷(P)-静脉血: 1.77mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=4.50)（参考: 阴性）；白蛋白(ALB)-静脉血: 44g/L；C-反应蛋白(CRP)-静脉血: 2.48mg/L；球蛋白(GLO)-静脉血: 30.07g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 5.18mmol/L；总胆汁酸(TBA)-静脉血: 3umol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.9；平均红细胞血红蛋白浓度(MCHC)-静脉血: 332g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0；淋巴细胞百分比(Lymph%)-静脉血: 0.212；胱抑素(Cys-C)-静脉血: 1.1mg/L；乳酸脱氢酶(LDH)-静脉血: 209.6U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 51.1U/L；氯离子(Cl-)-静脉血: 99.5mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 45.8U/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.7mmol/L；载脂蛋白B(apoB)-静脉血: 1.54g/L；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.726；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.18mmolL；镁离子(Mg2+)-静脉血: 0.94mmol/L；钾离子(K+)-静脉血: 4.21mmol/L；阴离子间隙(AG)-静脉血: 15；单核细胞百分比(Mono%)-静脉血: 0.06；直接胆红素(DBIL)-静脉血: 3.3umol/L；总蛋白(TP)-静脉血: 74.07g/L；红细胞比容(Hct)-静脉血: 41.9%；血小板计数(PLT#)-静脉血: 24410E9/L；EB病毒Zta蛋白抗体IgA(EBV-Zta-IgA)-静脉血: 阳性(SCO=5.00)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 32.5U/L；载脂蛋白AI(ap……\n- [全程D53] 检验组合: 单核细胞计数(Mono#)-静脉血: 0.210E9/L；平均血小板体积(MPV)-静脉血: 10.1fL；平均红细胞血红蛋白含量(MCH)-静脉血: 27.5pg；氯离子(Cl-)-静脉血: 102.2mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；血小板分布宽度(PDW)-静脉血: 11.6%；钾离子(K+)-静脉血: 4.44mmol/L；血红蛋白(Hb)-静脉血: 146g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.4U/L；血小板比容-静脉血: 24%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 23610E9/L；肌酐(Crea)-静脉血: 78umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.97mmolL；直接胆红素(DBIL)-静脉血: 2.9umol/L；镁离子(Mg2+)-静脉血: 0.89mmol/L；白细胞计数(WBC#)-静脉血: 4.8410E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.9；有核红细胞计数(NRBC#)-静脉血: 010E9/L；尿酸(UA)-静脉血: 396.5umol/L；白蛋白(ALB)-静脉血: 43.6g/L；有核红细胞百分比(NRBC%)-静脉血: 0；单核细胞百分比(Mono%)-静脉血: 0.041；甘油三酯(TG)-静脉血: 1.5mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.5；总胆汁酸(TBA)-静脉血: 3.2umol/L；总钙(Ca)-静脉血: 2.29mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 29.4U/L；碱性磷酸酶(ALP)-静脉血: 88.9U/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.5mmol/L；平均红细胞体积(MCV)-静脉血: 84fL；丙氨酸氨基转移酶(ALT)-静脉血: 34.7U/L；红细胞比容(Hct)-静脉血: 44.5%；尿素氮(BUN)-静脉血: 6.4mmol/L；胱抑素(Cys-C)-……\n- [全程D64] 检验组合: 磷(P)-静脉血: 1.1mmol/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；平均红细胞血红蛋白含量(MCH)-静脉血: 27.3pg；平均血小板体积(MPV)-静脉血: 9.4fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.4；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；总钙(Ca)-静脉血: 2.24mmol/L；总蛋白(TP)-静脉血: 73.3g/L；氯离子(Cl-)-静脉血: 104.7mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 46.1U/L；单核细胞百分比(Mono%)-静脉血: 0.094；α-L-岩藻糖苷酶(AFU)-静脉血: 31.3U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.93mmol/L；尿素氮(BUN)-静脉血: 6.4mmol/L；总胆固醇(TC)-静脉血: 5.7mmol/L；血小板计数(PLT#)-静脉血: 15510E9/L；球蛋白(GLO)-静脉血: 28g/L；直接胆红素(DBIL)-静脉血: 2.3umol/L；总胆汁酸(TBA)-静脉血: 1.8umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.09mmolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.74；载脂蛋白B(apoB)-静脉血: 1.34g/L；钠离子(Na+)-静脉血: 141.6mmol/L；C-反应蛋白(CRP)-静脉血: 4.1mg/L；血小板比容-静脉血: 15%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；葡萄糖(Glu)-静脉血: 5.4mmol/L；白蛋白(ALB)-静脉血: 45.3g/L；有核红细胞计数(NRBC#)-静脉血: 0.0110E9/L；尿酸(UA)-静脉血: 511.6umol/L；甘油三酯(TG)-静脉血: 1.82mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.5mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 26.8U/L；大血小板百分比(P-LCR%)-静脉血: 19.5%；中性粒细胞计数(Neut#)-静脉血: 3.110E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 319g/L；乳酸脱氢酶(……\n- [全程D71] 检验组合: γ-谷氨酰基转移酶(GGT)-静脉血: 47U/L；尿酸(UA)-静脉血: 339.1umol/L；阴离子间隙(AG)-静脉血: 16.7；白细胞计数(WBC#)-静脉血: 5.8510E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 27.4pg；有核红细胞计数(NRBC#)-静脉血: 010E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.156；EB病毒Zta蛋白抗体IgA(EBV-Zta-IgA)-静脉血: 阳性(SCO=4.00)（参考: 阴性）；磷(P)-静脉血: 1.25mmol/L；肌酐(Crea)-静脉血: 80.9umol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:20（参考: 阴性）；单核细胞百分比(Mono%)-静脉血: 0.029；中性粒细胞计数(Neut#)-静脉血: 4.810E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.7mmol/L；红细胞比容(Hct)-静脉血: 43.3%；总胆红素(TBIL)-静脉血: 18.3umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 6.04mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；平均血小板体积(MPV)-静脉血: 10.9fL；碱性磷酸酶(ALP)-静脉血: 81.8U/L；葡萄糖(Glu)-静脉血: 5.79mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.6；间接胆红素(IBIL)-静脉血: 15umolL；α-L-岩藻糖苷酶(AFU)-静脉血: 41.6U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.48mmolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.3；载脂蛋白AI(apoAI)-静脉血: 1.28g/L；甘油三酯(TG)-静脉血: 2.29mmol/L；平均红细胞体积(MCV)-静脉血: 83.1fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板比容-静脉血: 17%；球蛋白(GLO)-静脉血: 29.1g/L；载脂蛋白B(apoB)-静脉血: 1.64g/L；乳酸脱氢酶(LDH)-静脉血: 229.2U/L；镁离子(Mg2+)-静脉血: 0.76mmol……\n- [全程D75] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后，对比某次就诊时间片： 鼻咽腔稍狭窄，鼻咽左顶壁及左侧壁增厚，在T1WI上呈等信号，在T2WI上呈稍高信号，增强扫描明显强化，较前明显缩小，左侧破裂孔、海绵窦、翼腭窝及蝶窦左份仍可见软组织灶，边界欠清，明显强化。右侧咽隐窝存在，左侧咽隐窝变浅 左侧腭帆张提肌、左侧翼内肌上缘信号不均匀，可见强化。 左侧咽旁间隙变窄，右侧咽旁间隙及双侧颈动脉鞘区血管未见明显异常。 右侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常。口咽双侧壁未见增厚。 斜坡、左侧岩尖、蝶骨基底部、左侧翼突区骨质信号减低，增强扫描明显强化。 右侧海绵窦形态正常，未见增宽。 双侧筛窦、左侧上颌窦、蝶窦粘膜增厚，左侧乳突内见少量信号分泌物。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变。 双侧咽后未见明确肿大淋巴结。 双颈II区及左颈III区可见数个淋巴结，最大约14mm×5mm，边界欠清，增强扫描可见明显强化。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。 所示脑实质未见明确异常。；检查结论: 鼻咽癌化疗后，范围较前明显缩小。 颅底骨质破坏。 双颈淋巴结，考虑转移，较前缩小、减少。 双侧咽后未见肿大淋巴结。 鼻窦炎。 左侧乳突炎。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D26] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 化疗第2天，患者一般情况可，未诉特殊不适。查体：左侧颈部II区可扪及1个淋巴结，最大径2cm×2.5cm2，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]医生信息已隐藏示：目前暂未出现明显副反应，继续行化疗，密切观察病情。\n- [全程D29] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 化疗第5天，患者一般情况可。体查：KPS90分，张口门齿距4.5cm。鼻咽顶壁、顶后壁、双侧壁结节状肿物；左侧颈部II区可扪及1个淋巴结，最大径2cm×2cm2，无融合，质中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。复查血常规无明显异常。生化示：ALT 77.8U/L↑、IBIL27.20 umolL↑、TBIL35.1umol/L↑。[姓名已隐去]医生信息已隐藏示:第1程化疗结束，病情稳定，今日予办理出院。嘱其注意休息及营养支持，保持口腔清洁；出院后每周复查血常规2次，生化1次常规；按时[计划性表述已隐藏]下一程诱导化疗；若有不适，及时就诊。\n- [全程D65] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日患者症状体征基本同前，无诉其余特殊不适。[姓名已隐去]医生信息已隐藏示：患者诊断明确，复查血常规、生化常规无明显化疗禁忌症，拟按期于某次就诊时间开始行TPF诱导化疗， 具体用药：DOC60mg/㎡d1+DDP60mg/㎡ d2+5-FU2.5g/㎡civ48hQ3w，并指示化疗期间给予护肝、护胃、止吐及营养支持治疗，昨日已行泰欣生靶向治疗，密切观察患者病情变化。\n- [全程D66] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，未诉恶心、呕吐、腹痛、腹泻等不适，大小便正常。[姓名已隐去]医生信息已隐藏出，患者目前一般情况可，予明日按TPF方案行第3周期化疗，注意化疗结束后复查血、生化常规，及时对症处理。\n- [全程D69] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日为化疗第3天，诉间有恶心，无呕吐，无咳嗽、咳痰，无头痛、头晕，大小便正常。[姓名已隐去]医生信息已隐藏出，患者化疗后出现胃肠道反应I度，予继续对症处理，减轻化疗后反应。\n- [全程D71] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日患者症状体征基本同前，无诉其余特殊不适。今日复查血常规及生化常规未见明显异常。[姓名已隐去]医生信息已隐藏示：患者病情平稳，一般情况良好，目前予完善相关放疗前准备，今日予办理出院。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 结束诱导化疗，序贯开展根治性放射治疗\nB. 继续原方案（TPF联合尼妥珠单抗）诱导化疗至第6周期后再行放射治疗\nC. 更换为GP方案（吉西他滨联合顺铂）继续诱导化疗2个周期\nD. 行鼻咽原发灶及双侧颈部淋巴结根治性切除术\nE. 行双侧颈部淋巴结清扫术，术后序贯鼻咽局部放射治疗\nF. 加用PD-1抑制剂联合原方案继续诱导化疗2个周期\nG. 暂停抗肿瘤治疗，进入定期随访观察阶段\nH. 完善全身PET-CT重新分期后再决定后续局部治疗方案\nI. 仅行根治性放射治疗，处理鼻咽原发灶，颈部病灶继续随访观察\nJ. 结束诱导化疗，序贯开展尼妥珠单抗单药靶向维持治疗\nK. 行放射性粒子植入术，处理鼻咽及颈部残留病灶直接\nL. 采用卡培他滨单药维持化疗，推迟局部放射治疗\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-95ccde5ff1e164e8d7edc6f5","patient_id":"patient-5731cc38ced94b2ee39c442a","turn_id":"turn08","turn_position":6,"turn_type":"recurrence_or_salvage_decision","gold_letter":"B","gold_action":"行鼻咽及颈部MRI增强扫描评估近期疗效，继续定期随访","options":[{"letter":"A","text":"行全身PET-CT扫描评估全身肿瘤负荷及近期疗效","is_gold":false},{"letter":"B","text":"行鼻咽及颈部MRI增强扫描评估近期疗效，继续定期随访","is_gold":true},{"letter":"C","text":"行鼻咽镜检查并对原发灶区域进行常规多点活检排除残留","is_gold":false},{"letter":"D","text":"启动卡培他滨节拍性维持化疗降低远处转移风险","is_gold":false},{"letter":"E","text":"启动PD-1抑制剂维持治疗巩固靶向联合放疗的近期疗效","is_gold":false},{"letter":"F","text":"仅定期复查血常规、生化及EBV-DNA，暂不复查局部影像学","is_gold":false},{"letter":"G","text":"直接安排鼻咽原发灶内镜下挽救性切除手术","is_gold":false},{"letter":"H","text":"直接安排鼻咽原发灶挽救性立体定向放疗","is_gold":false},{"letter":"I","text":"行胸部及全腹部增强CT扫描，暂缓头颈部局部影像学复查","is_gold":false},{"letter":"J","text":"行全身骨扫描及头颅MRI排除无症状的远处器官转移风险","is_gold":false},{"letter":"K","text":"启动吉西他滨联合顺铂方案全身化疗清除潜在微小转移灶","is_gold":false},{"letter":"L","text":"继续使用尼妥珠单抗单药维持治疗至满一年巩固局部疗效","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、蝶窦、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 左耳闷涉不适1年，涕血2月。；某次就诊时间特来我院门诊进一步诊治，完善相关检查，诊断明确后，今日入院系统治疗。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,左耳闷胀感,涕血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。有吸烟史1年，日7支；少量饮酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：90次/分，R：20次/分，BP：131/86mmHg,Ht：171cm，Wt：76.5kg，BSA1.89m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶壁、顶后壁、双侧壁结节状肿物；左侧颈部II区可扪及1个淋巴结，最大径2cm×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.51；平均红细胞血红蛋白含量(MCH)-静脉血: 27.4pg；磷(P)-静脉血: 0.9mmol/L；直接胆红素(DBIL)-静脉血: 4.7umol/L；凝血酶时间(TT)-静脉血: 22.7sec.；D-二聚体(D-Dimer)-静脉血: 0.29ug/ml；活化部分凝血活酶时间(APTT)-静脉血: 38.5sec.；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.04S/CO；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.82mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.6；单核细胞百分比(Mono%)-静脉血: 0.047；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；间接胆红素(IBIL)-静脉血: 10.5umolL；白蛋白(ALB)-静脉血: 48g/L；氯离子(Cl-)-静脉血: 101.7mmol/L；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.718；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.1COI；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；白细胞计数(WBC#)-静脉血: 6.9510E9/L；红细胞比容(Hct)-静脉血: 46.8%；尿酸(UA)-静脉血: 431.8umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 81.8umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 26mmol/L；血小板分布宽度(PDW)-静脉血: 11.2%；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.04S/CO；平均血小板体积(MPV)-静脉血: 9.7fL；中性粒细胞计数(Neut#)-静脉血: 510E9/L；载脂蛋白B(apoB)-静脉血: 0.96g/L；凝血酶原时间(PT)-静脉血: 11.8sec.；钠离子(Na+)-静脉血: 138.7mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；甘油三酯(TG)-静脉血: 2.2mmol/L；总胆红素(TBIL)-……\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 Ⅱ、Ⅲ、aVF、V5、V6导联T波低平\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、后壁及双侧壁增厚，见软组织肿物向鼻咽腔内突出，在T1WI上呈等信号，在T2WI上呈稍高信号，增强扫描明显强化。双侧咽隐窝变浅，见软组织肿物填充。病灶侵犯左侧后鼻孔，侵犯左侧腭帆张提肌、左侧翼内肌头部、左侧咽旁脂肪间隙，侵犯蝶窦左侧份及左侧翼腭窝，侵犯左侧破裂孔、左侧海绵窦。 右侧咽旁间隙及双侧颈动脉鞘区血管未见明显异常。右侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常。口咽双侧壁未见增厚。 斜坡、左侧岩尖、蝶骨基底部、左侧翼突区骨质信号减低，增强扫描明显强化。 右侧海绵窦形态正常，未见增宽。 双侧筛窦、左侧上颌窦、蝶窦及右侧乳突粘膜增厚，左侧乳突内见大量长分期信息见历史辅助诊断节点长分期信息见历史辅助诊断节点信号分泌物。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变。 左侧咽后可见数个小淋巴结，较大短径约4mm；右侧咽后可见小淋巴结，短径约2mm。左颈II、III区可见数个淋巴结，最大约21mm×15mm，部分呈相互融合改变，边界欠清，增强扫描可见明显强化。右颈II、III区可见数个淋巴结，最大约12mm×7mm，边界清。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 左颈II、III区淋巴结肿大，考虑转移。 左侧咽后、右颈II、III区淋巴结，不排除转移。 右侧咽后小淋巴结。 鼻窦炎。双侧乳突炎。\n- [全程D5] 检验组合: EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；Rh血型-静脉血: 阳性；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；ABO血型-静脉血: O\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D24] 检验组合: 天门冬氨酸氨基转移酶(AST)-静脉血: 20.1U/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；血小板分布宽度(PDW)-静脉血: 11.9%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.1；尿素氮(BUN)-静脉血: 3.6mmol/L；磷(P)-静脉血: 0.97mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21.8U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.55；丙氨酸氨基转移酶(ALT)-静脉血: 41U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.19mmol/L；葡萄糖(Glu)-静脉血: 5.41mmol/L；白蛋白(ALB)-静脉血: 46.9g/L；白细胞计数(WBC#)-静脉血: 5.2810E9/L；红细胞计数(RBC#)-静脉血: 5.3910E12/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.6；尿酸(UA)-静脉血: 386.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 27U/L；C-反应蛋白(CRP)-静脉血: 4.25mg/L；钾离子(K+)-静脉血: 4.08mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.051；载脂蛋白B(apoB)-静脉血: 1.1g/L；球蛋白(GLO)-静脉血: 30.3g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；平均血小板体积(MPV)-静脉血: 10.3fL；总胆汁酸(TBA)-静脉血: 1.8umol/L；总蛋白(TP)-静脉血: 77.2g/L；间接胆红素(IBIL)-静脉血: 11.1umolL；甘油三酯(TG)-静脉血: 1.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.08g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.310E9/L；氯离子(Cl-)-静脉血: 102.2mmol/L；单核细胞百分比(Mono%)-静脉血: 0.072；碱性磷酸酶(ALP)-静脉血: 82.4U/L；总胆红素(TBIL)-静脉血: 15.1umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.49；总胆固醇(TC)-静脉血: 4.74mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.237；血小板比容……\n- [全程D25] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右侧约平T6椎体下缘水平，估计导管末端位于上腔静脉下段内。；检查结论: PICC管位置如上所述。\n- [全程D25] 检验组合: 浊度(TRUB)-尿液: clear；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 5.5；葡萄糖(Glu)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；虫卵-粪便: 未见虫卵（参考: 未见虫卵）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 30/μL；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；隐血(OB)-粪便: 阴性（参考: 阴性）；比重(SG)-尿液: 1.021；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-粪便: 棕色；酮体(KET)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D29] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；磷(P)-静脉血: 1.54mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.4U/L；总胆固醇(TC)-静脉血: 6.28mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.3pg；镁离子(Mg2+)-静脉血: 1.06mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=2.00)（参考: 阴性）；肌酐(Crea)-静脉血: 76.5umol/L；球蛋白(GLO)-静脉血: 31.62g/L；白蛋白(ALB)-静脉血: 48.1g/L；白细胞计数(WBC#)-静脉血: 5.310E9/L；血小板分布宽度(PDW)-静脉血: 14.3%；单核细胞百分比(Mono%)-静脉血: 0.011；淋巴细胞百分比(Lymph%)-静脉血: 0.128；血小板计数(PLT#)-静脉血: 18310E9/L；甘油三酯(TG)-静脉血: 1.83mmol/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；碱性磷酸酶(ALP)-静脉血: 76.4U/L；总胆汁酸(TBA)-静脉血: 14.5umol/L；总蛋白(TP)-静脉血: 79.72g/L；有核红细胞百分比(NRBC%)-静脉血: 0；红细胞比容(Hct)-静脉血: 44.3%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.7；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.42mmolL；胱抑素(Cys-C)-静脉血: 1.15mg/L；尿酸(UA)-静脉血: 254.8umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；间接胆红素(IBIL)-静脉血: 27.2umolL；钾离子(K+)-静脉血: 4.43mmol/L；乳酸脱氢酶(LDH)-静脉血: 200.6U/L；C-反应蛋白(CRP)-静脉血: 1.97mg/L；浊度(TRUB)-尿液: clear；酸碱度(pH)-尿液: 5.5；平均红细胞体积(MCV……\n- [全程D32] 检验组合: 间接胆红素(IBIL)-静脉血: 13.9umolL；肌酐(Crea)-静脉血: 83.3umol/L；碱性磷酸酶(ALP)-静脉血: 80.7U/L；镁离子(Mg2+)-静脉血: 1.02mmol/L；总胆红素(TBIL)-静脉血: 19.3umol/L；胱抑素(Cys-C)-静脉血: 0.87mg/L；尿素氮(BUN)-静脉血: 4.5mmol/L；载脂蛋白B(apoB)-静脉血: 1.13g/L；白细胞计数(WBC#)-静脉血: 3.0510E9/L；总胆汁酸(TBA)-静脉血: 1.7umol/L；血小板分布宽度(PDW)-静脉血: 12.5%；血小板比容-静脉血: 17%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.01；单核细胞百分比(Mono%)-静脉血: 0.013；平均血小板体积(MPV)-静脉血: 10.9fL；乳酸脱氢酶(LDH)-静脉血: 186U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.36；平均红细胞血红蛋白含量(MCH)-静脉血: 27.7pg；平均红细胞体积(MCV)-静脉血: 81.7fL；单核细胞计数(Mono#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 15410E9/L；氯离子(Cl-)-静脉血: 96.9mmol/L；钾离子(K+)-静脉血: 3.58mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.4mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 28U/L；甘油三酯(TG)-静脉血: 1.46mmol/L；红细胞比容(Hct)-静脉血: 44.3%；中性粒细胞百分比(Neut%)-静脉血: 0.748；总钙(Ca)-静脉血: 2.27mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 34.1；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 25.5U/L；葡萄糖(Glu)-静脉血: 5.55mmol/L；尿酸(UA)-静脉血: 325.7umol/L；直接胆红素(DBIL)-静脉血: 5.4umol/L；钠离子(Na+)-静脉血: 133.9mmol/L；大血小板百分比(P-LCR%)-静脉血: 31.7%；红细胞体积分布宽度CV(RDW-CV)-静……\n- [全程D50] 检验组合: 碱性磷酸酶(ALP)-静脉血: 79.1U/L；总胆红素(TBIL)-静脉血: 18.4umol/L；血小板比容-静脉血: 24%；磷(P)-静脉血: 1.77mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=4.50)（参考: 阴性）；白蛋白(ALB)-静脉血: 44g/L；C-反应蛋白(CRP)-静脉血: 2.48mg/L；球蛋白(GLO)-静脉血: 30.07g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 5.18mmol/L；总胆汁酸(TBA)-静脉血: 3umol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.9；平均红细胞血红蛋白浓度(MCHC)-静脉血: 332g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0；淋巴细胞百分比(Lymph%)-静脉血: 0.212；胱抑素(Cys-C)-静脉血: 1.1mg/L；乳酸脱氢酶(LDH)-静脉血: 209.6U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 51.1U/L；氯离子(Cl-)-静脉血: 99.5mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 45.8U/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.7mmol/L；载脂蛋白B(apoB)-静脉血: 1.54g/L；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.726；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.18mmolL；镁离子(Mg2+)-静脉血: 0.94mmol/L；钾离子(K+)-静脉血: 4.21mmol/L；阴离子间隙(AG)-静脉血: 15；单核细胞百分比(Mono%)-静脉血: 0.06；直接胆红素(DBIL)-静脉血: 3.3umol/L；总蛋白(TP)-静脉血: 74.07g/L；红细胞比容(Hct)-静脉血: 41.9%；血小板计数(PLT#)-静脉血: 24410E9/L；EB病毒Zta蛋白抗体IgA(EBV-Zta-IgA)-静脉血: 阳性(SCO=5.00)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 32.5U/L；载脂蛋白AI(ap……\n- [全程D53] 检验组合: 单核细胞计数(Mono#)-静脉血: 0.210E9/L；平均血小板体积(MPV)-静脉血: 10.1fL；平均红细胞血红蛋白含量(MCH)-静脉血: 27.5pg；氯离子(Cl-)-静脉血: 102.2mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；血小板分布宽度(PDW)-静脉血: 11.6%；钾离子(K+)-静脉血: 4.44mmol/L；血红蛋白(Hb)-静脉血: 146g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.4U/L；血小板比容-静脉血: 24%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 23610E9/L；肌酐(Crea)-静脉血: 78umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.97mmolL；直接胆红素(DBIL)-静脉血: 2.9umol/L；镁离子(Mg2+)-静脉血: 0.89mmol/L；白细胞计数(WBC#)-静脉血: 4.8410E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.9；有核红细胞计数(NRBC#)-静脉血: 010E9/L；尿酸(UA)-静脉血: 396.5umol/L；白蛋白(ALB)-静脉血: 43.6g/L；有核红细胞百分比(NRBC%)-静脉血: 0；单核细胞百分比(Mono%)-静脉血: 0.041；甘油三酯(TG)-静脉血: 1.5mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.5；总胆汁酸(TBA)-静脉血: 3.2umol/L；总钙(Ca)-静脉血: 2.29mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 29.4U/L；碱性磷酸酶(ALP)-静脉血: 88.9U/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.5mmol/L；平均红细胞体积(MCV)-静脉血: 84fL；丙氨酸氨基转移酶(ALT)-静脉血: 34.7U/L；红细胞比容(Hct)-静脉血: 44.5%；尿素氮(BUN)-静脉血: 6.4mmol/L；胱抑素(Cys-C)-……\n- [全程D64] 检验组合: 磷(P)-静脉血: 1.1mmol/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；平均红细胞血红蛋白含量(MCH)-静脉血: 27.3pg；平均血小板体积(MPV)-静脉血: 9.4fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.4；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；总钙(Ca)-静脉血: 2.24mmol/L；总蛋白(TP)-静脉血: 73.3g/L；氯离子(Cl-)-静脉血: 104.7mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 46.1U/L；单核细胞百分比(Mono%)-静脉血: 0.094；α-L-岩藻糖苷酶(AFU)-静脉血: 31.3U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.93mmol/L；尿素氮(BUN)-静脉血: 6.4mmol/L；总胆固醇(TC)-静脉血: 5.7mmol/L；血小板计数(PLT#)-静脉血: 15510E9/L；球蛋白(GLO)-静脉血: 28g/L；直接胆红素(DBIL)-静脉血: 2.3umol/L；总胆汁酸(TBA)-静脉血: 1.8umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.09mmolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.74；载脂蛋白B(apoB)-静脉血: 1.34g/L；钠离子(Na+)-静脉血: 141.6mmol/L；C-反应蛋白(CRP)-静脉血: 4.1mg/L；血小板比容-静脉血: 15%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；葡萄糖(Glu)-静脉血: 5.4mmol/L；白蛋白(ALB)-静脉血: 45.3g/L；有核红细胞计数(NRBC#)-静脉血: 0.0110E9/L；尿酸(UA)-静脉血: 511.6umol/L；甘油三酯(TG)-静脉血: 1.82mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.5mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 26.8U/L；大血小板百分比(P-LCR%)-静脉血: 19.5%；中性粒细胞计数(Neut#)-静脉血: 3.110E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 319g/L；乳酸脱氢酶(……\n- [全程D71] 检验组合: γ-谷氨酰基转移酶(GGT)-静脉血: 47U/L；尿酸(UA)-静脉血: 339.1umol/L；阴离子间隙(AG)-静脉血: 16.7；白细胞计数(WBC#)-静脉血: 5.8510E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 27.4pg；有核红细胞计数(NRBC#)-静脉血: 010E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.156；EB病毒Zta蛋白抗体IgA(EBV-Zta-IgA)-静脉血: 阳性(SCO=4.00)（参考: 阴性）；磷(P)-静脉血: 1.25mmol/L；肌酐(Crea)-静脉血: 80.9umol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:20（参考: 阴性）；单核细胞百分比(Mono%)-静脉血: 0.029；中性粒细胞计数(Neut#)-静脉血: 4.810E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.7mmol/L；红细胞比容(Hct)-静脉血: 43.3%；总胆红素(TBIL)-静脉血: 18.3umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 6.04mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；平均血小板体积(MPV)-静脉血: 10.9fL；碱性磷酸酶(ALP)-静脉血: 81.8U/L；葡萄糖(Glu)-静脉血: 5.79mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.6；间接胆红素(IBIL)-静脉血: 15umolL；α-L-岩藻糖苷酶(AFU)-静脉血: 41.6U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.48mmolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.3；载脂蛋白AI(apoAI)-静脉血: 1.28g/L；甘油三酯(TG)-静脉血: 2.29mmol/L；平均红细胞体积(MCV)-静脉血: 83.1fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板比容-静脉血: 17%；球蛋白(GLO)-静脉血: 29.1g/L；载脂蛋白B(apoB)-静脉血: 1.64g/L；乳酸脱氢酶(LDH)-静脉血: 229.2U/L；镁离子(Mg2+)-静脉血: 0.76mmol……\n- [全程D75] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后，对比某次就诊时间片： 鼻咽腔稍狭窄，鼻咽左顶壁及左侧壁增厚，在T1WI上呈等信号，在T2WI上呈稍高信号，增强扫描明显强化，较前明显缩小，左侧破裂孔、海绵窦、翼腭窝及蝶窦左份仍可见软组织灶，边界欠清，明显强化。右侧咽隐窝存在，左侧咽隐窝变浅 左侧腭帆张提肌、左侧翼内肌上缘信号不均匀，可见强化。 左侧咽旁间隙变窄，右侧咽旁间隙及双侧颈动脉鞘区血管未见明显异常。 右侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常。口咽双侧壁未见增厚。 斜坡、左侧岩尖、蝶骨基底部、左侧翼突区骨质信号减低，增强扫描明显强化。 右侧海绵窦形态正常，未见增宽。 双侧筛窦、左侧上颌窦、蝶窦粘膜增厚，左侧乳突内见少量信号分泌物。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变。 双侧咽后未见明确肿大淋巴结。 双颈II区及左颈III区可见数个淋巴结，最大约14mm×5mm，边界欠清，增强扫描可见明显强化。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。 所示脑实质未见明确异常。；检查结论: 鼻咽癌化疗后，范围较前明显缩小。 颅底骨质破坏。 双颈淋巴结，考虑转移，较前缩小、减少。 双侧咽后未见肿大淋巴结。 鼻窦炎。 左侧乳突炎。\n- [全程D120] 检验组合: 尿酸(UA)-静脉血: 409.8umol/L；球蛋白(GLO)-静脉血: 27.4g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.63；总钙(Ca)-静脉血: 2.24mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 25U/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；γ-谷氨酰基转移酶(GGT)-静脉血: 55.3U/L；中性粒细胞百分比(Neut%)-静脉血: 0.859；白细胞计数(WBC#)-静脉血: 5.710E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.058；间接胆红素(IBIL)-静脉血: 6.28umolL；C-反应蛋白(CRP)-静脉血: 88.14mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 48；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；碱性磷酸酶(ALP)-静脉血: 82.1U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15.7U/L；磷(P)-静脉血: 1.36mmol/L；白蛋白(ALB)-静脉血: 41.7g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.78mmolL；镁离子(Mg2+)-静脉血: 0.9mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.79mmol/L；钠离子(Na+)-静脉血: 139.5mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 15.1；中性粒细胞计数(Neut#)-静脉血: 4.910E9/L；血红蛋白(Hb)-静脉血: 113g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.3fL；氯离子(Cl-)-静脉血: 101.6mmol/L；红细胞比容(Hct)-静脉血: 34.4%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；乳酸脱氢酶(LDH)-静脉血: 163.4U/L；总胆汁酸(TBA)-静脉血: 5.6umol/L；尿素氮(BUN)-静脉血: 6mmol/L；血小板比容-静脉血: 10%；大血小板百分比(P-LCR%)-静脉血: 25%；葡萄糖(Glu)-静脉……\n- [全程D127] 检验组合: 红细胞比容(Hct)-静脉血: 27.7%；血红蛋白(Hb)-静脉血: 88g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.005；尿酸(UA)-静脉血: 268.3umol/L；直接胆红素(DBIL)-静脉血: 2.1umol/L；乳酸脱氢酶(LDH)-静脉血: 105.9U/L；碱性磷酸酶(ALP)-静脉血: 82.3U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.72；中性粒细胞百分比(Neut%)-静脉血: 0.798；尿素氮(BUN)-静脉血: 4.9mmol/L；载脂蛋白B(apoB)-静脉血: 1.41g/L；C-反应蛋白(CRP)-静脉血: 198.52mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.26；总胆汁酸(TBA)-静脉血: 1.1umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 9.6U/L；球蛋白(GLO)-静脉血: 27.52g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.03；总钙(Ca)-静脉血: 2.35mmol/L；甘油三酯(TG)-静脉血: 2.27mmol/L；氯离子(Cl-)-静脉血: 102.6mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28pg；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.74mmolL；白蛋白(ALB)-静脉血: 34.8g/L；载脂蛋白AI(apoAI)-静脉血: 0.71g/L；单核细胞百分比(Mono%)-静脉血: 0.167；淋巴细胞计数(Lymph#)-静脉血: 0.110E9/L；血小板比容-静脉血: 11%；肌酐(Crea)-静脉血: 68.7umol/L；总胆固醇(TC)-静脉血: 5.14mmol/L；胱抑素(Cys-C)-静脉血: 0.91mg/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 60.6U/L；镁离子(Mg2+)-静脉血: 0.81mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 12610E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.2mmol/L；大血小板百分比(P-LCR%)-静脉血: 16.5%；丙氨酸氨基转移酶(ALT)-静脉血:……\n- [全程D132] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）\n- [全程D167] 检验组合: EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:80（参考: 阴性）\n- [全程D222] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:80（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）\n- [全程D222] 检验组合: 氯离子(Cl-)-静脉血: 103.6mmol/L；血小板分布宽度(PDW)-静脉血: 10.7%；C-反应蛋白(CRP)-静脉血: 1.07mg/L；甘油三酯(TG)-静脉血: 1.41mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.89；白蛋白(ALB)-静脉血: 46.7g/L；葡萄糖(Glu)-静脉血: 5.1mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.68；血小板比容-静脉血: 17%；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L；直接胆红素(DBIL)-静脉血: 2.1umol/L；磷(P)-静脉血: 1.27mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 317g/L；大血小板百分比(P-LCR%)-静脉血: 24.8%；丙氨酸氨基转移酶(ALT)-静脉血: 19.3U/L；总蛋白(TP)-静脉血: 74.5g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 18.4U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.2U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.63mmol/L；总胆固醇(TC)-静脉血: 5.21mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 15.7U/L；乳酸脱氢酶(LDH)-静脉血: 168.2U/L；间接胆红素(IBIL)-静脉血: 6.8umolL；平均红细胞体积(MCV)-静脉血: 87.3fL；红细胞比容(Hct)-静脉血: 39.7%；中性粒细胞百分比(Neut%)-静脉血: 0.657；钠离子(Na+)-静脉血: 139.4mmol/L；碱性磷酸酶(ALP)-静脉血: 72U/L；单核细胞百分比(Mono%)-静脉血: 0.101；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.05；阴离子间隙(AG)-静脉血: 13.3；总胆汁酸(TBA)-静脉血: 2.7umol/L；镁离子(Mg2+)-静脉血: 0.92mmol/L；总胆红素(TBIL)-静脉血: 8.9umol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 42.4；肌酐(Crea)-静脉血: 74.3um……\n- [全程D223] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理清晰，未见明确实质性病变。双侧肺门未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D26] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 化疗第2天，患者一般情况可，未诉特殊不适。查体：左侧颈部II区可扪及1个淋巴结，最大径2cm×2.5cm2，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]医生信息已隐藏示：目前暂未出现明显副反应，继续行化疗，密切观察病情。\n- [全程D29] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 化疗第5天，患者一般情况可。体查：KPS90分，张口门齿距4.5cm。鼻咽顶壁、顶后壁、双侧壁结节状肿物；左侧颈部II区可扪及1个淋巴结，最大径2cm×2cm2，无融合，质中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。复查血常规无明显异常。生化示：ALT 77.8U/L↑、IBIL27.20 umolL↑、TBIL35.1umol/L↑。[姓名已隐去]医生信息已隐藏示:第1程化疗结束，病情稳定，今日予办理出院。嘱其注意休息及营养支持，保持口腔清洁；出院后每周复查血常规2次，生化1次常规；按时[计划性表述已隐藏]下一程诱导化疗；若有不适，及时就诊。\n- [全程D65] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日患者症状体征基本同前，无诉其余特殊不适。[姓名已隐去]医生信息已隐藏示：患者诊断明确，复查血常规、生化常规无明显化疗禁忌症，拟按期于某次就诊时间开始行TPF诱导化疗， 具体用药：DOC60mg/㎡d1+DDP60mg/㎡ d2+5-FU2.5g/㎡civ48hQ3w，并指示化疗期间给予护肝、护胃、止吐及营养支持治疗，昨日已行泰欣生靶向治疗，密切观察患者病情变化。\n- [全程D66] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，未诉恶心、呕吐、腹痛、腹泻等不适，大小便正常。[姓名已隐去]医生信息已隐藏出，患者目前一般情况可，予明日按TPF方案行第3周期化疗，注意化疗结束后复查血、生化常规，及时对症处理。\n- [全程D69] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日为化疗第3天，诉间有恶心，无呕吐，无咳嗽、咳痰，无头痛、头晕，大小便正常。[姓名已隐去]医生信息已隐藏出，患者化疗后出现胃肠道反应I度，予继续对症处理，减轻化疗后反应。\n- [全程D71] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日患者症状体征基本同前，无诉其余特殊不适。今日复查血常规及生化常规未见明显异常。[姓名已隐去]医生信息已隐藏示：患者病情平稳，一般情况良好，目前予完善相关放疗前准备，今日予办理出院。\n- [全程D121] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今天完成放疗24次，仍有轻度口干，口咽疼痛NRS1分，无恶心、呕吐，无头晕、头痛。查体：口咽部放射性粘膜炎Ⅱ°，颈部放射性皮炎Ⅰ°。某次就诊时间血常规HGB113g/L，生化大致正常。[姓名已隐去]医生信息已隐藏：继续予加强止痛、营养、改善贫血等对症支持治疗，密切观察病情变化。\n- [全程D124] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者昨天行第6次泰欣生分子靶向治疗，今天完成放疗26次，仍有轻度口干，口咽疼痛NRS1分，无恶心、呕吐，无发热、畏寒，查体：口咽部放射性粘膜炎Ⅱ°，颈部放射性皮炎Ⅰ°。[姓名已隐去]医生信息已隐藏示：患者放射性口咽炎仍明显，需加强局部冲洗、止痛等支持治疗，继续予按计划放疗。\n- [全程D127] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今天完成放疗29次，仍有轻度口干，口咽疼痛NRS1分，无发热、畏寒，无恶心、呕吐，查体：口咽部放射性粘膜炎Ⅰ°，颈部放射性皮炎Ⅰ°。某次就诊时间血常规示WBC3.6510E9/L， NE#2.9*10E9/L， HGB88.0g/L，PLT126.0*10E9/L，[姓名已隐去]医生信息已隐藏：患者白细胞稍低，但血红蛋白较前下降，考虑营养摄入不足和放化疗后骨髓抑制所致，予口服升白、改善贫血药治疗，加强口腔局部冲洗，密切观察病情变化。\n- [全程D130] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今天完成放疗30次，仍有轻度口干，口咽疼痛NRS2分，无发热、畏寒，无恶心、呕吐，查体：口咽部放射性粘膜炎Ⅱ°，颈部放射性皮炎Ⅰ°。[姓名已隐去]医生信息已隐藏：患者今天予第7次泰欣生分子靶向治疗。患者口咽痛反复，继续加强止痛治疗，辅以局部冲洗等护理，观察病情变化。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行全身PET-CT扫描评估全身肿瘤负荷及近期疗效\nB. 行鼻咽及颈部MRI增强扫描评估近期疗效，继续定期随访\nC. 行鼻咽镜检查并对原发灶区域进行常规多点活检排除残留\nD. 启动卡培他滨节拍性维持化疗降低远处转移风险\nE. 启动PD-1抑制剂维持治疗巩固靶向联合放疗的近期疗效\nF. 仅定期复查血常规、生化及EBV-DNA，暂不复查局部影像学\nG. 直接安排鼻咽原发灶内镜下挽救性切除手术\nH. 直接安排鼻咽原发灶挽救性立体定向放疗\nI. 行胸部及全腹部增强CT扫描，暂缓头颈部局部影像学复查\nJ. 行全身骨扫描及头颅MRI排除无症状的远处器官转移风险\nK. 启动吉西他滨联合顺铂方案全身化疗清除潜在微小转移灶\nL. 继续使用尼妥珠单抗单药维持治疗至满一年巩固局部疗效\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、蝶窦、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 左耳闷涉不适1年，涕血2月。；某次就诊时间特来我院门诊进一步诊治，完善相关检查，诊断明确后，今日入院系统治疗。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,左耳闷胀感,涕血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。有吸烟史1年，日7支；少量饮酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：90次/分，R：20次/分，BP：131/86mmHg,Ht：171cm，Wt：76.5kg，BSA1.89m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶壁、顶后壁、双侧壁结节状肿物；左侧颈部II区可扪及1个淋巴结，最大径2cm×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.51；平均红细胞血红蛋白含量(MCH)-静脉血: 27.4pg；磷(P)-静脉血: 0.9mmol/L；直接胆红素(DBIL)-静脉血: 4.7umol/L；凝血酶时间(TT)-静脉血: 22.7sec.；D-二聚体(D-Dimer)-静脉血: 0.29ug/ml；活化部分凝血活酶时间(APTT)-静脉血: 38.5sec.；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.04S/CO；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.82mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.6；单核细胞百分比(Mono%)-静脉血: 0.047；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；间接胆红素(IBIL)-静脉血: 10.5umolL；白蛋白(ALB)-静脉血: 48g/L；氯离子(Cl-)-静脉血: 101.7mmol/L；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.718；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.1COI；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；白细胞计数(WBC#)-静脉血: 6.9510E9/L；红细胞比容(Hct)-静脉血: 46.8%；尿酸(UA)-静脉血: 431.8umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 81.8umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 26mmol/L；血小板分布宽度(PDW)-静脉血: 11.2%；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.04S/CO；平均血小板体积(MPV)-静脉血: 9.7fL；中性粒细胞计数(Neut#)-静脉血: 510E9/L；载脂蛋白B(apoB)-静脉血: 0.96g/L；凝血酶原时间(PT)-静脉血: 11.8sec.；钠离子(Na+)-静脉血: 138.7mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；甘油三酯(TG)-静脉血: 2.2mmol/L；总胆红素(TBIL)-……\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 Ⅱ、Ⅲ、aVF、V5、V6导联T波低平\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、后壁及双侧壁增厚，见软组织肿物向鼻咽腔内突出，在T1WI上呈等信号，在T2WI上呈稍高信号，增强扫描明显强化。双侧咽隐窝变浅，见软组织肿物填充。病灶侵犯左侧后鼻孔，侵犯左侧腭帆张提肌、左侧翼内肌头部、左侧咽旁脂肪间隙，侵犯蝶窦左侧份及左侧翼腭窝，侵犯左侧破裂孔、左侧海绵窦。 右侧咽旁间隙及双侧颈动脉鞘区血管未见明显异常。右侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常。口咽双侧壁未见增厚。 斜坡、左侧岩尖、蝶骨基底部、左侧翼突区骨质信号减低，增强扫描明显强化。 右侧海绵窦形态正常，未见增宽。 双侧筛窦、左侧上颌窦、蝶窦及右侧乳突粘膜增厚，左侧乳突内见大量长分期信息见历史辅助诊断节点长分期信息见历史辅助诊断节点信号分泌物。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变。 左侧咽后可见数个小淋巴结，较大短径约4mm；右侧咽后可见小淋巴结，短径约2mm。左颈II、III区可见数个淋巴结，最大约21mm×15mm，部分呈相互融合改变，边界欠清，增强扫描可见明显强化。右颈II、III区可见数个淋巴结，最大约12mm×7mm，边界清。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 左颈II、III区淋巴结肿大，考虑转移。 左侧咽后、右颈II、III区淋巴结，不排除转移。 右侧咽后小淋巴结。 鼻窦炎。双侧乳突炎。\n- [全程D5] 检验组合: EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；Rh血型-静脉血: 阳性；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；ABO血型-静脉血: O\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D24] 检验组合: 天门冬氨酸氨基转移酶(AST)-静脉血: 20.1U/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；血小板分布宽度(PDW)-静脉血: 11.9%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.1；尿素氮(BUN)-静脉血: 3.6mmol/L；磷(P)-静脉血: 0.97mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21.8U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.55；丙氨酸氨基转移酶(ALT)-静脉血: 41U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.19mmol/L；葡萄糖(Glu)-静脉血: 5.41mmol/L；白蛋白(ALB)-静脉血: 46.9g/L；白细胞计数(WBC#)-静脉血: 5.2810E9/L；红细胞计数(RBC#)-静脉血: 5.3910E12/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.6；尿酸(UA)-静脉血: 386.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 27U/L；C-反应蛋白(CRP)-静脉血: 4.25mg/L；钾离子(K+)-静脉血: 4.08mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.051；载脂蛋白B(apoB)-静脉血: 1.1g/L；球蛋白(GLO)-静脉血: 30.3g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；平均血小板体积(MPV)-静脉血: 10.3fL；总胆汁酸(TBA)-静脉血: 1.8umol/L；总蛋白(TP)-静脉血: 77.2g/L；间接胆红素(IBIL)-静脉血: 11.1umolL；甘油三酯(TG)-静脉血: 1.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.08g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.310E9/L；氯离子(Cl-)-静脉血: 102.2mmol/L；单核细胞百分比(Mono%)-静脉血: 0.072；碱性磷酸酶(ALP)-静脉血: 82.4U/L；总胆红素(TBIL)-静脉血: 15.1umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.49；总胆固醇(TC)-静脉血: 4.74mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.237；血小板比容……\n- [全程D25] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右侧约平T6椎体下缘水平，估计导管末端位于上腔静脉下段内。；检查结论: PICC管位置如上所述。\n- [全程D25] 检验组合: 浊度(TRUB)-尿液: clear；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 5.5；葡萄糖(Glu)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；虫卵-粪便: 未见虫卵（参考: 未见虫卵）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 30/μL；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；隐血(OB)-粪便: 阴性（参考: 阴性）；比重(SG)-尿液: 1.021；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-粪便: 棕色；酮体(KET)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D29] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；磷(P)-静脉血: 1.54mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.4U/L；总胆固醇(TC)-静脉血: 6.28mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.3pg；镁离子(Mg2+)-静脉血: 1.06mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=2.00)（参考: 阴性）；肌酐(Crea)-静脉血: 76.5umol/L；球蛋白(GLO)-静脉血: 31.62g/L；白蛋白(ALB)-静脉血: 48.1g/L；白细胞计数(WBC#)-静脉血: 5.310E9/L；血小板分布宽度(PDW)-静脉血: 14.3%；单核细胞百分比(Mono%)-静脉血: 0.011；淋巴细胞百分比(Lymph%)-静脉血: 0.128；血小板计数(PLT#)-静脉血: 18310E9/L；甘油三酯(TG)-静脉血: 1.83mmol/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；碱性磷酸酶(ALP)-静脉血: 76.4U/L；总胆汁酸(TBA)-静脉血: 14.5umol/L；总蛋白(TP)-静脉血: 79.72g/L；有核红细胞百分比(NRBC%)-静脉血: 0；红细胞比容(Hct)-静脉血: 44.3%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.7；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.42mmolL；胱抑素(Cys-C)-静脉血: 1.15mg/L；尿酸(UA)-静脉血: 254.8umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；间接胆红素(IBIL)-静脉血: 27.2umolL；钾离子(K+)-静脉血: 4.43mmol/L；乳酸脱氢酶(LDH)-静脉血: 200.6U/L；C-反应蛋白(CRP)-静脉血: 1.97mg/L；浊度(TRUB)-尿液: clear；酸碱度(pH)-尿液: 5.5；平均红细胞体积(MCV……\n- [全程D32] 检验组合: 间接胆红素(IBIL)-静脉血: 13.9umolL；肌酐(Crea)-静脉血: 83.3umol/L；碱性磷酸酶(ALP)-静脉血: 80.7U/L；镁离子(Mg2+)-静脉血: 1.02mmol/L；总胆红素(TBIL)-静脉血: 19.3umol/L；胱抑素(Cys-C)-静脉血: 0.87mg/L；尿素氮(BUN)-静脉血: 4.5mmol/L；载脂蛋白B(apoB)-静脉血: 1.13g/L；白细胞计数(WBC#)-静脉血: 3.0510E9/L；总胆汁酸(TBA)-静脉血: 1.7umol/L；血小板分布宽度(PDW)-静脉血: 12.5%；血小板比容-静脉血: 17%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.01；单核细胞百分比(Mono%)-静脉血: 0.013；平均血小板体积(MPV)-静脉血: 10.9fL；乳酸脱氢酶(LDH)-静脉血: 186U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.36；平均红细胞血红蛋白含量(MCH)-静脉血: 27.7pg；平均红细胞体积(MCV)-静脉血: 81.7fL；单核细胞计数(Mono#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 15410E9/L；氯离子(Cl-)-静脉血: 96.9mmol/L；钾离子(K+)-静脉血: 3.58mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.4mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 28U/L；甘油三酯(TG)-静脉血: 1.46mmol/L；红细胞比容(Hct)-静脉血: 44.3%；中性粒细胞百分比(Neut%)-静脉血: 0.748；总钙(Ca)-静脉血: 2.27mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 34.1；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 25.5U/L；葡萄糖(Glu)-静脉血: 5.55mmol/L；尿酸(UA)-静脉血: 325.7umol/L；直接胆红素(DBIL)-静脉血: 5.4umol/L；钠离子(Na+)-静脉血: 133.9mmol/L；大血小板百分比(P-LCR%)-静脉血: 31.7%；红细胞体积分布宽度CV(RDW-CV)-静……\n- [全程D50] 检验组合: 碱性磷酸酶(ALP)-静脉血: 79.1U/L；总胆红素(TBIL)-静脉血: 18.4umol/L；血小板比容-静脉血: 24%；磷(P)-静脉血: 1.77mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=4.50)（参考: 阴性）；白蛋白(ALB)-静脉血: 44g/L；C-反应蛋白(CRP)-静脉血: 2.48mg/L；球蛋白(GLO)-静脉血: 30.07g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 5.18mmol/L；总胆汁酸(TBA)-静脉血: 3umol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.9；平均红细胞血红蛋白浓度(MCHC)-静脉血: 332g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0；淋巴细胞百分比(Lymph%)-静脉血: 0.212；胱抑素(Cys-C)-静脉血: 1.1mg/L；乳酸脱氢酶(LDH)-静脉血: 209.6U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 51.1U/L；氯离子(Cl-)-静脉血: 99.5mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 45.8U/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.7mmol/L；载脂蛋白B(apoB)-静脉血: 1.54g/L；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.726；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.18mmolL；镁离子(Mg2+)-静脉血: 0.94mmol/L；钾离子(K+)-静脉血: 4.21mmol/L；阴离子间隙(AG)-静脉血: 15；单核细胞百分比(Mono%)-静脉血: 0.06；直接胆红素(DBIL)-静脉血: 3.3umol/L；总蛋白(TP)-静脉血: 74.07g/L；红细胞比容(Hct)-静脉血: 41.9%；血小板计数(PLT#)-静脉血: 24410E9/L；EB病毒Zta蛋白抗体IgA(EBV-Zta-IgA)-静脉血: 阳性(SCO=5.00)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 32.5U/L；载脂蛋白AI(ap……\n- [全程D53] 检验组合: 单核细胞计数(Mono#)-静脉血: 0.210E9/L；平均血小板体积(MPV)-静脉血: 10.1fL；平均红细胞血红蛋白含量(MCH)-静脉血: 27.5pg；氯离子(Cl-)-静脉血: 102.2mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；血小板分布宽度(PDW)-静脉血: 11.6%；钾离子(K+)-静脉血: 4.44mmol/L；血红蛋白(Hb)-静脉血: 146g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.4U/L；血小板比容-静脉血: 24%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 23610E9/L；肌酐(Crea)-静脉血: 78umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.97mmolL；直接胆红素(DBIL)-静脉血: 2.9umol/L；镁离子(Mg2+)-静脉血: 0.89mmol/L；白细胞计数(WBC#)-静脉血: 4.8410E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.9；有核红细胞计数(NRBC#)-静脉血: 010E9/L；尿酸(UA)-静脉血: 396.5umol/L；白蛋白(ALB)-静脉血: 43.6g/L；有核红细胞百分比(NRBC%)-静脉血: 0；单核细胞百分比(Mono%)-静脉血: 0.041；甘油三酯(TG)-静脉血: 1.5mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.5；总胆汁酸(TBA)-静脉血: 3.2umol/L；总钙(Ca)-静脉血: 2.29mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 29.4U/L；碱性磷酸酶(ALP)-静脉血: 88.9U/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.5mmol/L；平均红细胞体积(MCV)-静脉血: 84fL；丙氨酸氨基转移酶(ALT)-静脉血: 34.7U/L；红细胞比容(Hct)-静脉血: 44.5%；尿素氮(BUN)-静脉血: 6.4mmol/L；胱抑素(Cys-C)-……\n- [全程D64] 检验组合: 磷(P)-静脉血: 1.1mmol/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；平均红细胞血红蛋白含量(MCH)-静脉血: 27.3pg；平均血小板体积(MPV)-静脉血: 9.4fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.4；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；总钙(Ca)-静脉血: 2.24mmol/L；总蛋白(TP)-静脉血: 73.3g/L；氯离子(Cl-)-静脉血: 104.7mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 46.1U/L；单核细胞百分比(Mono%)-静脉血: 0.094；α-L-岩藻糖苷酶(AFU)-静脉血: 31.3U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.93mmol/L；尿素氮(BUN)-静脉血: 6.4mmol/L；总胆固醇(TC)-静脉血: 5.7mmol/L；血小板计数(PLT#)-静脉血: 15510E9/L；球蛋白(GLO)-静脉血: 28g/L；直接胆红素(DBIL)-静脉血: 2.3umol/L；总胆汁酸(TBA)-静脉血: 1.8umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.09mmolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.74；载脂蛋白B(apoB)-静脉血: 1.34g/L；钠离子(Na+)-静脉血: 141.6mmol/L；C-反应蛋白(CRP)-静脉血: 4.1mg/L；血小板比容-静脉血: 15%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；葡萄糖(Glu)-静脉血: 5.4mmol/L；白蛋白(ALB)-静脉血: 45.3g/L；有核红细胞计数(NRBC#)-静脉血: 0.0110E9/L；尿酸(UA)-静脉血: 511.6umol/L；甘油三酯(TG)-静脉血: 1.82mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.5mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 26.8U/L；大血小板百分比(P-LCR%)-静脉血: 19.5%；中性粒细胞计数(Neut#)-静脉血: 3.110E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 319g/L；乳酸脱氢酶(……\n- [全程D71] 检验组合: γ-谷氨酰基转移酶(GGT)-静脉血: 47U/L；尿酸(UA)-静脉血: 339.1umol/L；阴离子间隙(AG)-静脉血: 16.7；白细胞计数(WBC#)-静脉血: 5.8510E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 27.4pg；有核红细胞计数(NRBC#)-静脉血: 010E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.156；EB病毒Zta蛋白抗体IgA(EBV-Zta-IgA)-静脉血: 阳性(SCO=4.00)（参考: 阴性）；磷(P)-静脉血: 1.25mmol/L；肌酐(Crea)-静脉血: 80.9umol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:20（参考: 阴性）；单核细胞百分比(Mono%)-静脉血: 0.029；中性粒细胞计数(Neut#)-静脉血: 4.810E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.7mmol/L；红细胞比容(Hct)-静脉血: 43.3%；总胆红素(TBIL)-静脉血: 18.3umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 6.04mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；平均血小板体积(MPV)-静脉血: 10.9fL；碱性磷酸酶(ALP)-静脉血: 81.8U/L；葡萄糖(Glu)-静脉血: 5.79mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.6；间接胆红素(IBIL)-静脉血: 15umolL；α-L-岩藻糖苷酶(AFU)-静脉血: 41.6U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.48mmolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.3；载脂蛋白AI(apoAI)-静脉血: 1.28g/L；甘油三酯(TG)-静脉血: 2.29mmol/L；平均红细胞体积(MCV)-静脉血: 83.1fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板比容-静脉血: 17%；球蛋白(GLO)-静脉血: 29.1g/L；载脂蛋白B(apoB)-静脉血: 1.64g/L；乳酸脱氢酶(LDH)-静脉血: 229.2U/L；镁离子(Mg2+)-静脉血: 0.76mmol……\n- [全程D75] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后，对比某次就诊时间片： 鼻咽腔稍狭窄，鼻咽左顶壁及左侧壁增厚，在T1WI上呈等信号，在T2WI上呈稍高信号，增强扫描明显强化，较前明显缩小，左侧破裂孔、海绵窦、翼腭窝及蝶窦左份仍可见软组织灶，边界欠清，明显强化。右侧咽隐窝存在，左侧咽隐窝变浅 左侧腭帆张提肌、左侧翼内肌上缘信号不均匀，可见强化。 左侧咽旁间隙变窄，右侧咽旁间隙及双侧颈动脉鞘区血管未见明显异常。 右侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常。口咽双侧壁未见增厚。 斜坡、左侧岩尖、蝶骨基底部、左侧翼突区骨质信号减低，增强扫描明显强化。 右侧海绵窦形态正常，未见增宽。 双侧筛窦、左侧上颌窦、蝶窦粘膜增厚，左侧乳突内见少量信号分泌物。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变。 双侧咽后未见明确肿大淋巴结。 双颈II区及左颈III区可见数个淋巴结，最大约14mm×5mm，边界欠清，增强扫描可见明显强化。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。 所示脑实质未见明确异常。；检查结论: 鼻咽癌化疗后，范围较前明显缩小。 颅底骨质破坏。 双颈淋巴结，考虑转移，较前缩小、减少。 双侧咽后未见肿大淋巴结。 鼻窦炎。 左侧乳突炎。\n- [全程D120] 检验组合: 尿酸(UA)-静脉血: 409.8umol/L；球蛋白(GLO)-静脉血: 27.4g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.63；总钙(Ca)-静脉血: 2.24mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 25U/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；γ-谷氨酰基转移酶(GGT)-静脉血: 55.3U/L；中性粒细胞百分比(Neut%)-静脉血: 0.859；白细胞计数(WBC#)-静脉血: 5.710E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.058；间接胆红素(IBIL)-静脉血: 6.28umolL；C-反应蛋白(CRP)-静脉血: 88.14mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 48；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；碱性磷酸酶(ALP)-静脉血: 82.1U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15.7U/L；磷(P)-静脉血: 1.36mmol/L；白蛋白(ALB)-静脉血: 41.7g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.78mmolL；镁离子(Mg2+)-静脉血: 0.9mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.79mmol/L；钠离子(Na+)-静脉血: 139.5mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 15.1；中性粒细胞计数(Neut#)-静脉血: 4.910E9/L；血红蛋白(Hb)-静脉血: 113g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.3fL；氯离子(Cl-)-静脉血: 101.6mmol/L；红细胞比容(Hct)-静脉血: 34.4%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；乳酸脱氢酶(LDH)-静脉血: 163.4U/L；总胆汁酸(TBA)-静脉血: 5.6umol/L；尿素氮(BUN)-静脉血: 6mmol/L；血小板比容-静脉血: 10%；大血小板百分比(P-LCR%)-静脉血: 25%；葡萄糖(Glu)-静脉……\n- [全程D127] 检验组合: 红细胞比容(Hct)-静脉血: 27.7%；血红蛋白(Hb)-静脉血: 88g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.005；尿酸(UA)-静脉血: 268.3umol/L；直接胆红素(DBIL)-静脉血: 2.1umol/L；乳酸脱氢酶(LDH)-静脉血: 105.9U/L；碱性磷酸酶(ALP)-静脉血: 82.3U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.72；中性粒细胞百分比(Neut%)-静脉血: 0.798；尿素氮(BUN)-静脉血: 4.9mmol/L；载脂蛋白B(apoB)-静脉血: 1.41g/L；C-反应蛋白(CRP)-静脉血: 198.52mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.26；总胆汁酸(TBA)-静脉血: 1.1umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 9.6U/L；球蛋白(GLO)-静脉血: 27.52g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.03；总钙(Ca)-静脉血: 2.35mmol/L；甘油三酯(TG)-静脉血: 2.27mmol/L；氯离子(Cl-)-静脉血: 102.6mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28pg；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.74mmolL；白蛋白(ALB)-静脉血: 34.8g/L；载脂蛋白AI(apoAI)-静脉血: 0.71g/L；单核细胞百分比(Mono%)-静脉血: 0.167；淋巴细胞计数(Lymph#)-静脉血: 0.110E9/L；血小板比容-静脉血: 11%；肌酐(Crea)-静脉血: 68.7umol/L；总胆固醇(TC)-静脉血: 5.14mmol/L；胱抑素(Cys-C)-静脉血: 0.91mg/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 60.6U/L；镁离子(Mg2+)-静脉血: 0.81mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 12610E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.2mmol/L；大血小板百分比(P-LCR%)-静脉血: 16.5%；丙氨酸氨基转移酶(ALT)-静脉血:……\n- [全程D132] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）\n- [全程D167] 检验组合: EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:80（参考: 阴性）\n- [全程D222] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:80（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）\n- [全程D222] 检验组合: 氯离子(Cl-)-静脉血: 103.6mmol/L；血小板分布宽度(PDW)-静脉血: 10.7%；C-反应蛋白(CRP)-静脉血: 1.07mg/L；甘油三酯(TG)-静脉血: 1.41mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.89；白蛋白(ALB)-静脉血: 46.7g/L；葡萄糖(Glu)-静脉血: 5.1mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.68；血小板比容-静脉血: 17%；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L；直接胆红素(DBIL)-静脉血: 2.1umol/L；磷(P)-静脉血: 1.27mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 317g/L；大血小板百分比(P-LCR%)-静脉血: 24.8%；丙氨酸氨基转移酶(ALT)-静脉血: 19.3U/L；总蛋白(TP)-静脉血: 74.5g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 18.4U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.2U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.63mmol/L；总胆固醇(TC)-静脉血: 5.21mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 15.7U/L；乳酸脱氢酶(LDH)-静脉血: 168.2U/L；间接胆红素(IBIL)-静脉血: 6.8umolL；平均红细胞体积(MCV)-静脉血: 87.3fL；红细胞比容(Hct)-静脉血: 39.7%；中性粒细胞百分比(Neut%)-静脉血: 0.657；钠离子(Na+)-静脉血: 139.4mmol/L；碱性磷酸酶(ALP)-静脉血: 72U/L；单核细胞百分比(Mono%)-静脉血: 0.101；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.05；阴离子间隙(AG)-静脉血: 13.3；总胆汁酸(TBA)-静脉血: 2.7umol/L；镁离子(Mg2+)-静脉血: 0.92mmol/L；总胆红素(TBIL)-静脉血: 8.9umol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 42.4；肌酐(Crea)-静脉血: 74.3um……\n- [全程D223] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理清晰，未见明确实质性病变。双侧肺门未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D26] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 化疗第2天，患者一般情况可，未诉特殊不适。查体：左侧颈部II区可扪及1个淋巴结，最大径2cm×2.5cm2，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]医生信息已隐藏示：目前暂未出现明显副反应，继续行化疗，密切观察病情。\n- [全程D29] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 化疗第5天，患者一般情况可。体查：KPS90分，张口门齿距4.5cm。鼻咽顶壁、顶后壁、双侧壁结节状肿物；左侧颈部II区可扪及1个淋巴结，最大径2cm×2cm2，无融合，质中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。复查血常规无明显异常。生化示：ALT 77.8U/L↑、IBIL27.20 umolL↑、TBIL35.1umol/L↑。[姓名已隐去]医生信息已隐藏示:第1程化疗结束，病情稳定，今日予办理出院。嘱其注意休息及营养支持，保持口腔清洁；出院后每周复查血常规2次，生化1次常规；按时[计划性表述已隐藏]下一程诱导化疗；若有不适，及时就诊。\n- [全程D65] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日患者症状体征基本同前，无诉其余特殊不适。[姓名已隐去]医生信息已隐藏示：患者诊断明确，复查血常规、生化常规无明显化疗禁忌症，拟按期于某次就诊时间开始行TPF诱导化疗， 具体用药：DOC60mg/㎡d1+DDP60mg/㎡ d2+5-FU2.5g/㎡civ48hQ3w，并指示化疗期间给予护肝、护胃、止吐及营养支持治疗，昨日已行泰欣生靶向治疗，密切观察患者病情变化。\n- [全程D66] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，未诉恶心、呕吐、腹痛、腹泻等不适，大小便正常。[姓名已隐去]医生信息已隐藏出，患者目前一般情况可，予明日按TPF方案行第3周期化疗，注意化疗结束后复查血、生化常规，及时对症处理。\n- [全程D69] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日为化疗第3天，诉间有恶心，无呕吐，无咳嗽、咳痰，无头痛、头晕，大小便正常。[姓名已隐去]医生信息已隐藏出，患者化疗后出现胃肠道反应I度，予继续对症处理，减轻化疗后反应。\n- [全程D71] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日患者症状体征基本同前，无诉其余特殊不适。今日复查血常规及生化常规未见明显异常。[姓名已隐去]医生信息已隐藏示：患者病情平稳，一般情况良好，目前予完善相关放疗前准备，今日予办理出院。\n- [全程D121] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今天完成放疗24次，仍有轻度口干，口咽疼痛NRS1分，无恶心、呕吐，无头晕、头痛。查体：口咽部放射性粘膜炎Ⅱ°，颈部放射性皮炎Ⅰ°。某次就诊时间血常规HGB113g/L，生化大致正常。[姓名已隐去]医生信息已隐藏：继续予加强止痛、营养、改善贫血等对症支持治疗，密切观察病情变化。\n- [全程D124] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者昨天行第6次泰欣生分子靶向治疗，今天完成放疗26次，仍有轻度口干，口咽疼痛NRS1分，无恶心、呕吐，无发热、畏寒，查体：口咽部放射性粘膜炎Ⅱ°，颈部放射性皮炎Ⅰ°。[姓名已隐去]医生信息已隐藏示：患者放射性口咽炎仍明显，需加强局部冲洗、止痛等支持治疗，继续予按计划放疗。\n- [全程D127] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今天完成放疗29次，仍有轻度口干，口咽疼痛NRS1分，无发热、畏寒，无恶心、呕吐，查体：口咽部放射性粘膜炎Ⅰ°，颈部放射性皮炎Ⅰ°。某次就诊时间血常规示WBC3.6510E9/L， NE#2.9*10E9/L， HGB88.0g/L，PLT126.0*10E9/L，[姓名已隐去]医生信息已隐藏：患者白细胞稍低，但血红蛋白较前下降，考虑营养摄入不足和放化疗后骨髓抑制所致，予口服升白、改善贫血药治疗，加强口腔局部冲洗，密切观察病情变化。\n- [全程D130] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今天完成放疗30次，仍有轻度口干，口咽疼痛NRS2分，无发热、畏寒，无恶心、呕吐，查体：口咽部放射性粘膜炎Ⅱ°，颈部放射性皮炎Ⅰ°。[姓名已隐去]医生信息已隐藏：患者今天予第7次泰欣生分子靶向治疗。患者口咽痛反复，继续加强止痛治疗，辅以局部冲洗等护理，观察病情变化。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行全身PET-CT扫描评估全身肿瘤负荷及近期疗效\nB. 行鼻咽及颈部MRI增强扫描评估近期疗效，继续定期随访\nC. 行鼻咽镜检查并对原发灶区域进行常规多点活检排除残留\nD. 启动卡培他滨节拍性维持化疗降低远处转移风险\nE. 启动PD-1抑制剂维持治疗巩固靶向联合放疗的近期疗效\nF. 仅定期复查血常规、生化及EBV-DNA，暂不复查局部影像学\nG. 直接安排鼻咽原发灶内镜下挽救性切除手术\nH. 直接安排鼻咽原发灶挽救性立体定向放疗\nI. 行胸部及全腹部增强CT扫描，暂缓头颈部局部影像学复查\nJ. 行全身骨扫描及头颅MRI排除无症状的远处器官转移风险\nK. 启动吉西他滨联合顺铂方案全身化疗清除潜在微小转移灶\nL. 继续使用尼妥珠单抗单药维持治疗至满一年巩固局部疗效\n\n请仅输出一个选项字母（A-L）。"}]}
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full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现双颈肿物半年余；现病史: 者半年余前无明显诱因出现左侧颈部肿物，无疼痛，逐渐增大，伴有鼻塞、流涕，至当地医院予抗炎对症治疗后，肿物能减小；2月前患者始出现右侧颈部肿物，逐渐增大，伴有鼻塞、流涕，间中有涕血，无发热、畏寒，无头晕、头痛，无周身骨痛等，于当地医院检查ＣＴ示：鼻咽肿物，遂转至我院进一步诊治。门诊拟诊“鼻咽肿物”收入我科进一步治疗。患者起病以来精神、睡眠欠佳，胃纳尚可，二便正常，体重无明显下降。；阳性症状体征: 鼻塞,睡眠欠佳,鼻咽肿物,涕血,右颈部肿物,左颈部肿物,流涕；既往史: 体健，无高血压、心脏病等慢性病，无糖尿病、肾病等全身性疾病，无乙肝、结核等传染病，无外伤史。；个人史: 生于原籍，有吸烟史30年,无饮酒，无其他嗜好，否认冶游史。；家族史: 家族中无类似患者，无家族性遗传病患者，无重大精神病患者。；体格检查:；专科检查:；KPS:；ECOG:\n- [时间未明] 门急诊记录: 主诉:；现病史: 者半年余前无明显诱因出现左侧颈部肿物，无疼痛，逐渐增大，伴有鼻塞、流涕，至当地医院予抗炎对症治疗后，肿物能减小；2月前患者始出现右侧颈部肿物，逐渐增大，伴有鼻塞、流涕，间中有涕血，无发热、畏寒，无头晕、头痛，无周身骨痛等，于当地医院检查ＣＴ示：鼻咽肿物，遂转至我院进一步诊治。门诊拟诊“鼻咽肿物”收入我科进一步治疗。患者起病以来精神、睡眠欠佳，胃纳尚可，二便正常，体重无明显下降。；既往史: 否认高血压、糖尿病及心脏病史，否认结核等传染病史、否认手术、外伤及输血史。；个人史:；家族史: 家族中无类似患者，无家族性遗传病患者，无重大精神病患者。；体格检查: KPS90，一般状况可，鼻咽左侧壁、顶后壁肿物，双颈扪及肿大淋巴结，右颈多枚肿大淋巴结，较大者约6*4及2*2cm,质硬，活动差，左上颈可及一淋巴结，约3*3cm，质中，活动度可，无融合，无皮肤浸润等，左中颈可及一大小约1*1cm质硬淋巴结；张口门齿距约4cm，颅神经征阴性。。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D0] 检验组合: 磷(P)-静脉血: 1.15mmol/L；平均红细胞体积(MCV)-静脉血: 87fL；肌酐(Crea)-静脉血: 58.2umol/L；C-反应蛋白(CRP)-静脉血: 1.11mg/L；尿酸(UA)-静脉血: 148.1umol/L；葡萄糖(Glu)-静脉血: 5.38mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.29；总胆红素(TBIL)-静脉血: 7.6umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.39mmolL；凝血酶时间(TT)-静脉血: 19.1sec.；钾离子(K+)-静脉血: 4.25mmol/L；阴离子间隙(AG)-静脉血: 10.3；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；白细胞计数(WBC#)-静脉血: 710E9/L；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阳性(169.39U/mL)（参考: 阴性）；载脂蛋白AI(apoAI)-静脉血: 1.57g/L；纤维蛋白原(Fbg)-静脉血: 3.35g/L；中性粒细胞计数(Neut#)-静脉血: 4.210E9/L；平均血小板体积(MPV)-静脉血: 9.6fL；有核红细胞百分比(NRBC%)-静脉血: 0；血小板比容-静脉血: 29%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 27mmol/L；凝血酶原时间活动度(PTA)-静脉血: 85.4%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；ABO血型-静脉血: O；甘油三酯(TG)-静脉血: 1.43mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.04S/CO；球蛋白(GLO)-静脉血: 33.45g/L；总钙(Ca)-静脉血: 2.26mmol/L；血小板分布宽度(PDW)-静脉血: 9.7%；间接胆红素(IBIL)-静脉血: 5.8umolL；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0IU/mL；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 安排根治性放化疗并完善胸腹部及骨骼等远处转移排查\nB. 行颈部淋巴结切除活检明确病理并完善胸腹部及骨骼等远处转移排查\nC. 行鼻咽镜下活检明确病理并暂缓远处转移排查直至病理确诊\nD. 行鼻咽镜下活检明确病理并完善胸腹部及骨骼等远处转移排查\nE. 行鼻咽镜下活检明确病理并安排诱导化疗联合同步放化疗\nF. 完善全身PET-CT检查排查远处转移并安排根治性放疗\nG. 行鼻咽镜下活检明确病理并完善头颅CT进一步评估颅底骨质破坏\nH. 行鼻咽镜下活检明确病理并完善EBV-DNA定量检测暂缓影像学排查\nI. 行颈部淋巴结穿刺活检明确病理并完善胸腹部及骨骼等远处转移排查\nJ. 完善胸部CT和腹部超声排查远处转移并暂缓鼻咽原发灶活检\nK. 行鼻咽镜下活检明确病理并完善全身骨扫描暂缓胸腹部影像学检查\nL. 安排鼻咽部肿物切除术明确病理并完善胸腹部及骨骼等远处转移排查\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现双颈肿物半年余；现病史: 者半年余前无明显诱因出现左侧颈部肿物，无疼痛，逐渐增大，伴有鼻塞、流涕，至当地医院予抗炎对症治疗后，肿物能减小；2月前患者始出现右侧颈部肿物，逐渐增大，伴有鼻塞、流涕，间中有涕血，无发热、畏寒，无头晕、头痛，无周身骨痛等，于当地医院检查ＣＴ示：鼻咽肿物，遂转至我院进一步诊治。门诊拟诊“鼻咽肿物”收入我科进一步治疗。患者起病以来精神、睡眠欠佳，胃纳尚可，二便正常，体重无明显下降。；阳性症状体征: 鼻塞,睡眠欠佳,鼻咽肿物,涕血,右颈部肿物,左颈部肿物,流涕；既往史: 体健，无高血压、心脏病等慢性病，无糖尿病、肾病等全身性疾病，无乙肝、结核等传染病，无外伤史。；个人史: 生于原籍，有吸烟史30年,无饮酒，无其他嗜好，否认冶游史。；家族史: 家族中无类似患者，无家族性遗传病患者，无重大精神病患者。；体格检查:；专科检查:；KPS:；ECOG:\n- [时间未明] 门急诊记录: 主诉:；现病史: 者半年余前无明显诱因出现左侧颈部肿物，无疼痛，逐渐增大，伴有鼻塞、流涕，至当地医院予抗炎对症治疗后，肿物能减小；2月前患者始出现右侧颈部肿物，逐渐增大，伴有鼻塞、流涕，间中有涕血，无发热、畏寒，无头晕、头痛，无周身骨痛等，于当地医院检查ＣＴ示：鼻咽肿物，遂转至我院进一步诊治。门诊拟诊“鼻咽肿物”收入我科进一步治疗。患者起病以来精神、睡眠欠佳，胃纳尚可，二便正常，体重无明显下降。；既往史: 否认高血压、糖尿病及心脏病史，否认结核等传染病史、否认手术、外伤及输血史。；个人史:；家族史: 家族中无类似患者，无家族性遗传病患者，无重大精神病患者。；体格检查: KPS90，一般状况可，鼻咽左侧壁、顶后壁肿物，双颈扪及肿大淋巴结，右颈多枚肿大淋巴结，较大者约6*4及2*2cm,质硬，活动差，左上颈可及一淋巴结，约3*3cm，质中，活动度可，无融合，无皮肤浸润等，左中颈可及一大小约1*1cm质硬淋巴结；张口门齿距约4cm，颅神经征阴性。。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D0] 检验组合: 磷(P)-静脉血: 1.15mmol/L；平均红细胞体积(MCV)-静脉血: 87fL；肌酐(Crea)-静脉血: 58.2umol/L；C-反应蛋白(CRP)-静脉血: 1.11mg/L；尿酸(UA)-静脉血: 148.1umol/L；葡萄糖(Glu)-静脉血: 5.38mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.29；总胆红素(TBIL)-静脉血: 7.6umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.39mmolL；凝血酶时间(TT)-静脉血: 19.1sec.；钾离子(K+)-静脉血: 4.25mmol/L；阴离子间隙(AG)-静脉血: 10.3；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；白细胞计数(WBC#)-静脉血: 710E9/L；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阳性(169.39U/mL)（参考: 阴性）；载脂蛋白AI(apoAI)-静脉血: 1.57g/L；纤维蛋白原(Fbg)-静脉血: 3.35g/L；中性粒细胞计数(Neut#)-静脉血: 4.210E9/L；平均血小板体积(MPV)-静脉血: 9.6fL；有核红细胞百分比(NRBC%)-静脉血: 0；血小板比容-静脉血: 29%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 27mmol/L；凝血酶原时间活动度(PTA)-静脉血: 85.4%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；ABO血型-静脉血: O；甘油三酯(TG)-静脉血: 1.43mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.04S/CO；球蛋白(GLO)-静脉血: 33.45g/L；总钙(Ca)-静脉血: 2.26mmol/L；血小板分布宽度(PDW)-静脉血: 9.7%；间接胆红素(IBIL)-静脉血: 5.8umolL；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0IU/mL；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 安排根治性放化疗并完善胸腹部及骨骼等远处转移排查\nB. 行颈部淋巴结切除活检明确病理并完善胸腹部及骨骼等远处转移排查\nC. 行鼻咽镜下活检明确病理并暂缓远处转移排查直至病理确诊\nD. 行鼻咽镜下活检明确病理并完善胸腹部及骨骼等远处转移排查\nE. 行鼻咽镜下活检明确病理并安排诱导化疗联合同步放化疗\nF. 完善全身PET-CT检查排查远处转移并安排根治性放疗\nG. 行鼻咽镜下活检明确病理并完善头颅CT进一步评估颅底骨质破坏\nH. 行鼻咽镜下活检明确病理并完善EBV-DNA定量检测暂缓影像学排查\nI. 行颈部淋巴结穿刺活检明确病理并完善胸腹部及骨骼等远处转移排查\nJ. 完善胸部CT和腹部超声排查远处转移并暂缓鼻咽原发灶活检\nK. 行鼻咽镜下活检明确病理并完善全身骨扫描暂缓胸腹部影像学检查\nL. 安排鼻咽部肿物切除术明确病理并完善胸腹部及骨骼等远处转移排查\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-220f428c46f369e75a66e1ab","patient_id":"patient-9149023ec8599161ec3e5cfd","turn_id":"turn04","turn_position":3,"turn_type":"initial_treatment_selection","gold_letter":"F","gold_action":"诱导化疗序贯同步放化疗","options":[{"letter":"A","text":"单纯根治性放疗","is_gold":false},{"letter":"B","text":"同步放化疗","is_gold":false},{"letter":"C","text":"诱导化疗序贯单纯根治性放疗","is_gold":false},{"letter":"D","text":"同步放化疗序贯辅助化疗","is_gold":false},{"letter":"E","text":"诱导化疗联合靶向治疗序贯放疗","is_gold":false},{"letter":"F","text":"诱导化疗序贯同步放化疗","is_gold":true},{"letter":"G","text":"根治性放疗序贯辅助化疗","is_gold":false},{"letter":"H","text":"诱导化疗序贯免疫联合同步放化疗","is_gold":false},{"letter":"I","text":"姑息性化疗联合免疫治疗","is_gold":false},{"letter":"J","text":"鼻咽放疗联合颈部淋巴结清扫术","is_gold":false},{"letter":"K","text":"靶向治疗联合同步放化疗","is_gold":false},{"letter":"L","text":"诱导化疗序贯颈部淋巴结清扫术","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现双颈肿物半年余；现病史: 者半年余前无明显诱因出现左侧颈部肿物，无疼痛，逐渐增大，伴有鼻塞、流涕，至当地医院予抗炎对症治疗后，肿物能减小；2月前患者始出现右侧颈部肿物，逐渐增大，伴有鼻塞、流涕，间中有涕血，无发热、畏寒，无头晕、头痛，无周身骨痛等，于当地医院检查ＣＴ示：鼻咽肿物，遂转至我院进一步诊治。门诊拟诊“鼻咽肿物”收入我科进一步治疗。患者起病以来精神、睡眠欠佳，胃纳尚可，二便正常，体重无明显下降。；阳性症状体征: 鼻塞,睡眠欠佳,鼻咽肿物,涕血,右颈部肿物,左颈部肿物,流涕；既往史: 体健，无高血压、心脏病等慢性病，无糖尿病、肾病等全身性疾病，无乙肝、结核等传染病，无外伤史。；个人史: 生于原籍，有吸烟史30年,无饮酒，无其他嗜好，否认冶游史。；家族史: 家族中无类似患者，无家族性遗传病患者，无重大精神病患者。；体格检查:；专科检查:；KPS:；ECOG:\n- [时间未明] 门急诊记录: 主诉:；现病史: 者半年余前无明显诱因出现左侧颈部肿物，无疼痛，逐渐增大，伴有鼻塞、流涕，至当地医院予抗炎对症治疗后，肿物能减小；2月前患者始出现右侧颈部肿物，逐渐增大，伴有鼻塞、流涕，间中有涕血，无发热、畏寒，无头晕、头痛，无周身骨痛等，于当地医院检查ＣＴ示：鼻咽肿物，遂转至我院进一步诊治。门诊拟诊“鼻咽肿物”收入我科进一步治疗。患者起病以来精神、睡眠欠佳，胃纳尚可，二便正常，体重无明显下降。；既往史: 否认高血压、糖尿病及心脏病史，否认结核等传染病史、否认手术、外伤及输血史。；个人史:；家族史: 家族中无类似患者，无家族性遗传病患者，无重大精神病患者。；体格检查: KPS90，一般状况可，鼻咽左侧壁、顶后壁肿物，双颈扪及肿大淋巴结，右颈多枚肿大淋巴结，较大者约6*4及2*2cm,质硬，活动差，左上颈可及一淋巴结，约3*3cm，质中，活动度可，无融合，无皮肤浸润等，左中颈可及一大小约1*1cm质硬淋巴结；张口门齿距约4cm，颅神经征阴性。。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D0] 检验组合: 磷(P)-静脉血: 1.15mmol/L；平均红细胞体积(MCV)-静脉血: 87fL；肌酐(Crea)-静脉血: 58.2umol/L；C-反应蛋白(CRP)-静脉血: 1.11mg/L；尿酸(UA)-静脉血: 148.1umol/L；葡萄糖(Glu)-静脉血: 5.38mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.29；总胆红素(TBIL)-静脉血: 7.6umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.39mmolL；凝血酶时间(TT)-静脉血: 19.1sec.；钾离子(K+)-静脉血: 4.25mmol/L；阴离子间隙(AG)-静脉血: 10.3；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；白细胞计数(WBC#)-静脉血: 710E9/L；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阳性(169.39U/mL)（参考: 阴性）；载脂蛋白AI(apoAI)-静脉血: 1.57g/L；纤维蛋白原(Fbg)-静脉血: 3.35g/L；中性粒细胞计数(Neut#)-静脉血: 4.210E9/L；平均血小板体积(MPV)-静脉血: 9.6fL；有核红细胞百分比(NRBC%)-静脉血: 0；血小板比容-静脉血: 29%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 27mmol/L；凝血酶原时间活动度(PTA)-静脉血: 85.4%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；ABO血型-静脉血: O；甘油三酯(TG)-静脉血: 1.43mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.04S/CO；球蛋白(GLO)-静脉血: 33.45g/L；总钙(Ca)-静脉血: 2.26mmol/L；血小板分布宽度(PDW)-静脉血: 9.7%；间接胆红素(IBIL)-静脉血: 5.8umolL；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0IU/mL；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)……\n- [全程D1] CT；胸、上腹CT平扫+增强: 检查类型: CT；检查名称: 胸、上腹CT平扫+增强；检查部位:；检查所见: 双肺纹理清晰，左肺下叶外基底段见条索状高密度影，边界清；余双肺内未见明显实质性病变。 气管及支气管分支通畅。 双肺门及纵隔未见明显肿大淋巴结。 双侧胸腔未见积液。双侧胸膜未见增厚、粘连。 肝脏形态未见异常，轮廓光整，各叶比例在正常范围以内，密度均匀。 肝内胆管未见明显异常。胆囊不大、壁不厚，其内未见结石。胆总管未见扩张，其内未见结石。 肝门区结构清晰。门静脉未见明显异常。 脾脏大小、形态未见明显异常，密度均匀。 胰腺大小、形态未见明显异常，密度均匀。 所示双肾及双侧肾上腺大小、形态未见明显异常，密度均匀。 膈脚后、肝门区、腹主动脉旁、腹腔干周围未见明显肿大淋巴结。 扫描层面内未见明显骨质破坏。；检查结论: 左肺下叶外基底段条索影，考虑纤维灶。 上腹部未见明显异常。\n- [全程D2] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 鼻咽部见片状放射性浓密影。胸骨、锁骨、肩胛骨、肋骨、颈椎、胸椎、腰椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 鼻咽部代谢活跃，考虑鼻咽癌所致。 余全身骨骼未见明显异常。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 单纯根治性放疗\nB. 同步放化疗\nC. 诱导化疗序贯单纯根治性放疗\nD. 同步放化疗序贯辅助化疗\nE. 诱导化疗联合靶向治疗序贯放疗\nF. 诱导化疗序贯同步放化疗\nG. 根治性放疗序贯辅助化疗\nH. 诱导化疗序贯免疫联合同步放化疗\nI. 姑息性化疗联合免疫治疗\nJ. 鼻咽放疗联合颈部淋巴结清扫术\nK. 靶向治疗联合同步放化疗\nL. 诱导化疗序贯颈部淋巴结清扫术\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现双颈肿物半年余；现病史: 者半年余前无明显诱因出现左侧颈部肿物，无疼痛，逐渐增大，伴有鼻塞、流涕，至当地医院予抗炎对症治疗后，肿物能减小；2月前患者始出现右侧颈部肿物，逐渐增大，伴有鼻塞、流涕，间中有涕血，无发热、畏寒，无头晕、头痛，无周身骨痛等，于当地医院检查ＣＴ示：鼻咽肿物，遂转至我院进一步诊治。门诊拟诊“鼻咽肿物”收入我科进一步治疗。患者起病以来精神、睡眠欠佳，胃纳尚可，二便正常，体重无明显下降。；阳性症状体征: 鼻塞,睡眠欠佳,鼻咽肿物,涕血,右颈部肿物,左颈部肿物,流涕；既往史: 体健，无高血压、心脏病等慢性病，无糖尿病、肾病等全身性疾病，无乙肝、结核等传染病，无外伤史。；个人史: 生于原籍，有吸烟史30年,无饮酒，无其他嗜好，否认冶游史。；家族史: 家族中无类似患者，无家族性遗传病患者，无重大精神病患者。；体格检查:；专科检查:；KPS:；ECOG:\n- [时间未明] 门急诊记录: 主诉:；现病史: 者半年余前无明显诱因出现左侧颈部肿物，无疼痛，逐渐增大，伴有鼻塞、流涕，至当地医院予抗炎对症治疗后，肿物能减小；2月前患者始出现右侧颈部肿物，逐渐增大，伴有鼻塞、流涕，间中有涕血，无发热、畏寒，无头晕、头痛，无周身骨痛等，于当地医院检查ＣＴ示：鼻咽肿物，遂转至我院进一步诊治。门诊拟诊“鼻咽肿物”收入我科进一步治疗。患者起病以来精神、睡眠欠佳，胃纳尚可，二便正常，体重无明显下降。；既往史: 否认高血压、糖尿病及心脏病史，否认结核等传染病史、否认手术、外伤及输血史。；个人史:；家族史: 家族中无类似患者，无家族性遗传病患者，无重大精神病患者。；体格检查: KPS90，一般状况可，鼻咽左侧壁、顶后壁肿物，双颈扪及肿大淋巴结，右颈多枚肿大淋巴结，较大者约6*4及2*2cm,质硬，活动差，左上颈可及一淋巴结，约3*3cm，质中，活动度可，无融合，无皮肤浸润等，左中颈可及一大小约1*1cm质硬淋巴结；张口门齿距约4cm，颅神经征阴性。。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D0] 检验组合: 磷(P)-静脉血: 1.15mmol/L；平均红细胞体积(MCV)-静脉血: 87fL；肌酐(Crea)-静脉血: 58.2umol/L；C-反应蛋白(CRP)-静脉血: 1.11mg/L；尿酸(UA)-静脉血: 148.1umol/L；葡萄糖(Glu)-静脉血: 5.38mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.29；总胆红素(TBIL)-静脉血: 7.6umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.39mmolL；凝血酶时间(TT)-静脉血: 19.1sec.；钾离子(K+)-静脉血: 4.25mmol/L；阴离子间隙(AG)-静脉血: 10.3；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；白细胞计数(WBC#)-静脉血: 710E9/L；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阳性(169.39U/mL)（参考: 阴性）；载脂蛋白AI(apoAI)-静脉血: 1.57g/L；纤维蛋白原(Fbg)-静脉血: 3.35g/L；中性粒细胞计数(Neut#)-静脉血: 4.210E9/L；平均血小板体积(MPV)-静脉血: 9.6fL；有核红细胞百分比(NRBC%)-静脉血: 0；血小板比容-静脉血: 29%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 27mmol/L；凝血酶原时间活动度(PTA)-静脉血: 85.4%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；ABO血型-静脉血: O；甘油三酯(TG)-静脉血: 1.43mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.04S/CO；球蛋白(GLO)-静脉血: 33.45g/L；总钙(Ca)-静脉血: 2.26mmol/L；血小板分布宽度(PDW)-静脉血: 9.7%；间接胆红素(IBIL)-静脉血: 5.8umolL；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0IU/mL；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)……\n- [全程D1] CT；胸、上腹CT平扫+增强: 检查类型: CT；检查名称: 胸、上腹CT平扫+增强；检查部位:；检查所见: 双肺纹理清晰，左肺下叶外基底段见条索状高密度影，边界清；余双肺内未见明显实质性病变。 气管及支气管分支通畅。 双肺门及纵隔未见明显肿大淋巴结。 双侧胸腔未见积液。双侧胸膜未见增厚、粘连。 肝脏形态未见异常，轮廓光整，各叶比例在正常范围以内，密度均匀。 肝内胆管未见明显异常。胆囊不大、壁不厚，其内未见结石。胆总管未见扩张，其内未见结石。 肝门区结构清晰。门静脉未见明显异常。 脾脏大小、形态未见明显异常，密度均匀。 胰腺大小、形态未见明显异常，密度均匀。 所示双肾及双侧肾上腺大小、形态未见明显异常，密度均匀。 膈脚后、肝门区、腹主动脉旁、腹腔干周围未见明显肿大淋巴结。 扫描层面内未见明显骨质破坏。；检查结论: 左肺下叶外基底段条索影，考虑纤维灶。 上腹部未见明显异常。\n- [全程D2] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 鼻咽部见片状放射性浓密影。胸骨、锁骨、肩胛骨、肋骨、颈椎、胸椎、腰椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 鼻咽部代谢活跃，考虑鼻咽癌所致。 余全身骨骼未见明显异常。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 单纯根治性放疗\nB. 同步放化疗\nC. 诱导化疗序贯单纯根治性放疗\nD. 同步放化疗序贯辅助化疗\nE. 诱导化疗联合靶向治疗序贯放疗\nF. 诱导化疗序贯同步放化疗\nG. 根治性放疗序贯辅助化疗\nH. 诱导化疗序贯免疫联合同步放化疗\nI. 姑息性化疗联合免疫治疗\nJ. 鼻咽放疗联合颈部淋巴结清扫术\nK. 靶向治疗联合同步放化疗\nL. 诱导化疗序贯颈部淋巴结清扫术\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-ed1b449691d94cea18e7b28b","patient_id":"patient-9149023ec8599161ec3e5cfd","turn_id":"turn05","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"K","gold_action":"安排鼻咽及颈部MRI平扫+增强、头颅MRI平扫+增强，暂缓胸部X线及腹部彩超检查，作为当前时点针对左侧颞叶新发病灶的重点影像随访；常规胸片、腹部彩超、EBV-DNA及甲功等全身随访可在下一随访窗口期再行安排。","options":[{"letter":"A","text":"给予大剂量糖皮质激素冲击治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超","is_gold":false},{"letter":"B","text":"给予贝伐珠单抗靶向治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项","is_gold":false},{"letter":"C","text":"安排头颅PET-CT检查鉴别左侧颞叶病变性质，并安排胸部X线、腹部彩超、甲功五项","is_gold":false},{"letter":"D","text":"安排立体定向脑活检明确左侧颞叶病变性质，并安排胸部X线、腹部彩超、甲功五项","is_gold":false},{"letter":"E","text":"给予高压氧治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项","is_gold":false},{"letter":"F","text":"给予甘露醇静脉滴注脱水降颅压，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超","is_gold":false},{"letter":"G","text":"安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项及EBV-DNA定量检测","is_gold":false},{"letter":"H","text":"给予神经营养药物治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项","is_gold":false},{"letter":"I","text":"安排鼻咽及颈部CT平扫+增强、胸部CT平扫、腹部CT平扫、甲功五项及EBV-DNA定量检测","is_gold":false},{"letter":"J","text":"安排立体定向放射外科治疗左侧颞叶病变，并安排胸部X线、腹部彩超、甲功五项","is_gold":false},{"letter":"K","text":"安排鼻咽及颈部MRI平扫+增强、头颅MRI平扫+增强，暂缓胸部X线及腹部彩超检查","is_gold":true},{"letter":"L","text":"给予抗癫痫药物预防性治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现双颈肿物半年余；现病史: 者半年余前无明显诱因出现左侧颈部肿物，无疼痛，逐渐增大，伴有鼻塞、流涕，至当地医院予抗炎对症治疗后，肿物能减小；2月前患者始出现右侧颈部肿物，逐渐增大，伴有鼻塞、流涕，间中有涕血，无发热、畏寒，无头晕、头痛，无周身骨痛等，于当地医院检查ＣＴ示：鼻咽肿物，遂转至我院进一步诊治。门诊拟诊“鼻咽肿物”收入我科进一步治疗。患者起病以来精神、睡眠欠佳，胃纳尚可，二便正常，体重无明显下降。；阳性症状体征: 鼻塞,睡眠欠佳,鼻咽肿物,涕血,右颈部肿物,左颈部肿物,流涕；既往史: 体健，无高血压、心脏病等慢性病，无糖尿病、肾病等全身性疾病，无乙肝、结核等传染病，无外伤史。；个人史: 生于原籍，有吸烟史30年,无饮酒，无其他嗜好，否认冶游史。；家族史: 家族中无类似患者，无家族性遗传病患者，无重大精神病患者。；体格检查:；专科检查:；KPS:；ECOG:\n- [时间未明] 门急诊记录: 主诉:；现病史: 者半年余前无明显诱因出现左侧颈部肿物，无疼痛，逐渐增大，伴有鼻塞、流涕，至当地医院予抗炎对症治疗后，肿物能减小；2月前患者始出现右侧颈部肿物，逐渐增大，伴有鼻塞、流涕，间中有涕血，无发热、畏寒，无头晕、头痛，无周身骨痛等，于当地医院检查ＣＴ示：鼻咽肿物，遂转至我院进一步诊治。门诊拟诊“鼻咽肿物”收入我科进一步治疗。患者起病以来精神、睡眠欠佳，胃纳尚可，二便正常，体重无明显下降。；既往史: 否认高血压、糖尿病及心脏病史，否认结核等传染病史、否认手术、外伤及输血史。；个人史:；家族史: 家族中无类似患者，无家族性遗传病患者，无重大精神病患者。；体格检查: KPS90，一般状况可，鼻咽左侧壁、顶后壁肿物，双颈扪及肿大淋巴结，右颈多枚肿大淋巴结，较大者约6*4及2*2cm,质硬，活动差，左上颈可及一淋巴结，约3*3cm，质中，活动度可，无融合，无皮肤浸润等，左中颈可及一大小约1*1cm质硬淋巴结；张口门齿距约4cm，颅神经征阴性。。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D986] 门急诊记录: 主诉: 鼻咽癌放化疗结束2年，诉轻度口干，听力视力正常，无头晕、头痛。体查：鼻咽未见明确肿物，双颈未扪及明显肿大淋巴结，颅神经（-）甲功五项示正常。鼻咽MRI未见明确复发，腹部B超、胸片未见明确转移。EBV-DNA:0；现病史:；既往史:；个人史:；家族史:；体格检查:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D0] 检验组合: 磷(P)-静脉血: 1.15mmol/L；平均红细胞体积(MCV)-静脉血: 87fL；肌酐(Crea)-静脉血: 58.2umol/L；C-反应蛋白(CRP)-静脉血: 1.11mg/L；尿酸(UA)-静脉血: 148.1umol/L；葡萄糖(Glu)-静脉血: 5.38mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.29；总胆红素(TBIL)-静脉血: 7.6umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.39mmolL；凝血酶时间(TT)-静脉血: 19.1sec.；钾离子(K+)-静脉血: 4.25mmol/L；阴离子间隙(AG)-静脉血: 10.3；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；白细胞计数(WBC#)-静脉血: 710E9/L；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阳性(169.39U/mL)（参考: 阴性）；载脂蛋白AI(apoAI)-静脉血: 1.57g/L；纤维蛋白原(Fbg)-静脉血: 3.35g/L；中性粒细胞计数(Neut#)-静脉血: 4.210E9/L；平均血小板体积(MPV)-静脉血: 9.6fL；有核红细胞百分比(NRBC%)-静脉血: 0；血小板比容-静脉血: 29%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 27mmol/L；凝血酶原时间活动度(PTA)-静脉血: 85.4%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；ABO血型-静脉血: O；甘油三酯(TG)-静脉血: 1.43mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.04S/CO；球蛋白(GLO)-静脉血: 33.45g/L；总钙(Ca)-静脉血: 2.26mmol/L；血小板分布宽度(PDW)-静脉血: 9.7%；间接胆红素(IBIL)-静脉血: 5.8umolL；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0IU/mL；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)……\n- [全程D1] CT；胸、上腹CT平扫+增强: 检查类型: CT；检查名称: 胸、上腹CT平扫+增强；检查部位:；检查所见: 双肺纹理清晰，左肺下叶外基底段见条索状高密度影，边界清；余双肺内未见明显实质性病变。 气管及支气管分支通畅。 双肺门及纵隔未见明显肿大淋巴结。 双侧胸腔未见积液。双侧胸膜未见增厚、粘连。 肝脏形态未见异常，轮廓光整，各叶比例在正常范围以内，密度均匀。 肝内胆管未见明显异常。胆囊不大、壁不厚，其内未见结石。胆总管未见扩张，其内未见结石。 肝门区结构清晰。门静脉未见明显异常。 脾脏大小、形态未见明显异常，密度均匀。 胰腺大小、形态未见明显异常，密度均匀。 所示双肾及双侧肾上腺大小、形态未见明显异常，密度均匀。 膈脚后、肝门区、腹主动脉旁、腹腔干周围未见明显肿大淋巴结。 扫描层面内未见明显骨质破坏。；检查结论: 左肺下叶外基底段条索影，考虑纤维灶。 上腹部未见明显异常。\n- [全程D2] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 鼻咽部见片状放射性浓密影。胸骨、锁骨、肩胛骨、肋骨、颈椎、胸椎、腰椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 鼻咽部代谢活跃，考虑鼻咽癌所致。 余全身骨骼未见明显异常。\n- [全程D985] MRI；鼻咽部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部MR平扫+增强；检查部位:；检查所见: 鼻咽癌放疗后复查，对比某次就诊时间片： 鼻咽腔未见狭窄，鼻咽顶壁、顶后壁、右侧壁轻度增厚，均匀强化，右侧咽隐窝变浅，考虑放疗后改变，较前相仿。 蝶骨基底部、左侧枕骨基底部、左侧岩尖、左侧翼突基底部骨质信号下降，增强扫描轻度不均匀强化，较前相仿。 左侧破裂孔见少许软组织影，增强扫描轻度强化，较前相仿。 双侧咽后间隙见小淋巴结，大者短径约3mm，较前相仿。 右颈II区见多个淋巴结，最大短径约为5mm，部分边界欠清，增强扫描不均匀强化，较前稍缩小。 双侧上颌窦、筛窦、额窦粘膜增厚，考虑副鼻窦炎，较前相仿。 扫描所见颅脑未见明确异常。；检查结论:\n- [全程D985] MRI；颈部MR平扫+增强: 检查类型: MRI；检查名称: 颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌放疗后复查，对比某次就诊时间片： 鼻咽腔未见狭窄，鼻咽顶壁、顶后壁、右侧壁轻度增厚，均匀强化，右侧咽隐窝变浅，考虑放疗后改变，较前相仿。 蝶骨基底部、左侧枕骨基底部、左侧岩尖、左侧翼突基底部骨质信号下降，增强扫描轻度不均匀强化，较前相仿。 左侧破裂孔见少许软组织影，增强扫描轻度强化，较前相仿。 双侧咽后间隙见小淋巴结，大者短径约3mm，较前相仿。 右颈II区见多个淋巴结，最大短径约为5mm，部分边界欠清，增强扫描不均匀强化，较前稍缩小。 双侧上颌窦、筛窦、额窦粘膜增厚，考虑副鼻窦炎，较前相仿。 扫描所见颅脑未见明确异常。；检查结论:\n- [全程D1168] 检验组合: 游离甲状腺素(FT4)-静脉血: 14.91pmol/L；甲状腺过氧化物酶抗体(TPO-Ab)-静脉血: 12.55U/ml；游离三碘甲状腺原氨酸(FT3)-静脉血: 4.97pmol/L；甲状腺球蛋白(TG)-静脉血: 1.12ng/ml；促甲状腺激素(TSH)-静脉血: 1.59uIU/ml\n- [全程D1169] 超声；肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径不宽，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。\n- [全程D1170] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，走行自然，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n- [全程D1380] 检验组合: 游离三碘甲状腺原氨酸(FT3)-静脉血: 5.27pmol/L；游离甲状腺素(FT4)-静脉血: 13.84pmol/L；胆碱酯酶(ChE)-静脉血: 10374U/L；总钙(Ca)-静脉血: 2.33mmol/L；中性粒细胞百分比(Neut%)-静脉血: 56.6%；γ-谷氨酰基转移酶(GGT)-静脉血: 25.6U/L；肌酸激酶(CK)-静脉血: 80U/L；肌酐(Crea)-静脉血: 59.7umol/L；总蛋白(TP)-静脉血: 72.07g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 27.9pg；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.29mmol/L；淋巴细胞计数(Lymph#)-静脉血: 2.110E9/L；镁离子(Mg2+)-静脉血: 1.02mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.3mmol/L；碱性磷酸酶(ALP)-静脉血: 75.5U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.2510E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.2%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.1fL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；大血小板百分比(P-LCR%)-静脉血: 21.4%；白蛋白(ALB)-静脉血: 43.8g/L；载脂蛋白AI(apoAI)-静脉血: 1.52g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.55；总胆固醇(TC)-静脉血: 6.32mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.7U/L；阴离子间隙(AG)-静脉血: 18.4；血红蛋白(Hb)-静脉血: 131g/L；甲状腺球蛋白(TG)-静脉血: 1.4ng/ml；平均红细胞血红蛋白浓度(MCHC)-静脉血: 300g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.34mmolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 2.4；钾离子(K+)-静脉血: 3.9mmol/L；红细胞比容(Hct)-静脉血: 43.7%；未成熟粒细胞百分比(IG%)-静脉血: 0.5%；磷(P)-静脉血: 1.39mmol/L；钠离子(Na+)-静脉血: 141.4mmol/L；间接胆红素(IBIL)-静脉血:……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D986] 门急诊记录: 主诉: 鼻咽癌放化疗结束2年，诉轻度口干，听力视力正常，无头晕、头痛。体查：鼻咽未见明确肿物，双颈未扪及明显肿大淋巴结，颅神经（-）甲功五项示正常。鼻咽MRI未见明确复发，腹部B超、胸片未见明确转移。EBV-DNA:0；现病史:；既往史:；个人史:；家族史:；体格检查:\n- [全程D1174] 门急诊记录: 主诉: 鼻咽癌放化疗结束2年，诉轻度口干，听力视力正常，无头晕、头痛。体查：鼻咽未见明确肿物，双颈未扪及明显肿大淋巴结，颅神经（-）甲功五项示正常。鼻咽MRI未见明确复发，腹部B超、胸片未见明确转移。EBV-DNA:0；现病史:；既往史:；个人史:；家族史:；体格检查:\n- [时间未明] 门急诊记录: 主诉:；现病史: 者半年余前无明显诱因出现左侧颈部肿物，无疼痛，逐渐增大，伴有鼻塞、流涕，至当地医院予抗炎对症治疗后，肿物能减小；2月前患者始出现右侧颈部肿物，逐渐增大，伴有鼻塞、流涕，间中有涕血，无发热、畏寒，无头晕、头痛，无周身骨痛等，于当地医院检查ＣＴ示：鼻咽肿物，遂转至我院进一步诊治。门诊拟诊“鼻咽肿物”收入我科进一步治疗。患者起病以来精神、睡眠欠佳，胃纳尚可，二便正常，体重无明显下降。；既往史: 否认高血压、糖尿病及心脏病史，否认结核等传染病史、否认手术、外伤及输血史。；个人史:；家族史: 家族中无类似患者，无家族性遗传病患者，无重大精神病患者。；体格检查: KPS90，一般状况可，鼻咽左侧壁、顶后壁肿物，双颈扪及肿大淋巴结，右颈多枚肿大淋巴结，较大者约6*4及2*2cm,质硬，活动差，左上颈可及一淋巴结，约3*3cm，质中，活动度可，无融合，无皮肤浸润等，左中颈可及一大小约1*1cm质硬淋巴结；张口门齿距约4cm，颅神经征阴性。。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 给予大剂量糖皮质激素冲击治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超\nB. 给予贝伐珠单抗靶向治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项\nC. 安排头颅PET-CT检查鉴别左侧颞叶病变性质，并安排胸部X线、腹部彩超、甲功五项\nD. 安排立体定向脑活检明确左侧颞叶病变性质，并安排胸部X线、腹部彩超、甲功五项\nE. 给予高压氧治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项\nF. 给予甘露醇静脉滴注脱水降颅压，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超\nG. 安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项及EBV-DNA定量检测\nH. 给予神经营养药物治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项\nI. 安排鼻咽及颈部CT平扫+增强、胸部CT平扫、腹部CT平扫、甲功五项及EBV-DNA定量检测\nJ. 安排立体定向放射外科治疗左侧颞叶病变，并安排胸部X线、腹部彩超、甲功五项\nK. 安排鼻咽及颈部MRI平扫+增强、头颅MRI平扫+增强，暂缓胸部X线及腹部彩超检查\nL. 给予抗癫痫药物预防性治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现双颈肿物半年余；现病史: 者半年余前无明显诱因出现左侧颈部肿物，无疼痛，逐渐增大，伴有鼻塞、流涕，至当地医院予抗炎对症治疗后，肿物能减小；2月前患者始出现右侧颈部肿物，逐渐增大，伴有鼻塞、流涕，间中有涕血，无发热、畏寒，无头晕、头痛，无周身骨痛等，于当地医院检查ＣＴ示：鼻咽肿物，遂转至我院进一步诊治。门诊拟诊“鼻咽肿物”收入我科进一步治疗。患者起病以来精神、睡眠欠佳，胃纳尚可，二便正常，体重无明显下降。；阳性症状体征: 鼻塞,睡眠欠佳,鼻咽肿物,涕血,右颈部肿物,左颈部肿物,流涕；既往史: 体健，无高血压、心脏病等慢性病，无糖尿病、肾病等全身性疾病，无乙肝、结核等传染病，无外伤史。；个人史: 生于原籍，有吸烟史30年,无饮酒，无其他嗜好，否认冶游史。；家族史: 家族中无类似患者，无家族性遗传病患者，无重大精神病患者。；体格检查:；专科检查:；KPS:；ECOG:\n- [时间未明] 门急诊记录: 主诉:；现病史: 者半年余前无明显诱因出现左侧颈部肿物，无疼痛，逐渐增大，伴有鼻塞、流涕，至当地医院予抗炎对症治疗后，肿物能减小；2月前患者始出现右侧颈部肿物，逐渐增大，伴有鼻塞、流涕，间中有涕血，无发热、畏寒，无头晕、头痛，无周身骨痛等，于当地医院检查ＣＴ示：鼻咽肿物，遂转至我院进一步诊治。门诊拟诊“鼻咽肿物”收入我科进一步治疗。患者起病以来精神、睡眠欠佳，胃纳尚可，二便正常，体重无明显下降。；既往史: 否认高血压、糖尿病及心脏病史，否认结核等传染病史、否认手术、外伤及输血史。；个人史:；家族史: 家族中无类似患者，无家族性遗传病患者，无重大精神病患者。；体格检查: KPS90，一般状况可，鼻咽左侧壁、顶后壁肿物，双颈扪及肿大淋巴结，右颈多枚肿大淋巴结，较大者约6*4及2*2cm,质硬，活动差，左上颈可及一淋巴结，约3*3cm，质中，活动度可，无融合，无皮肤浸润等，左中颈可及一大小约1*1cm质硬淋巴结；张口门齿距约4cm，颅神经征阴性。。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D986] 门急诊记录: 主诉: 鼻咽癌放化疗结束2年，诉轻度口干，听力视力正常，无头晕、头痛。体查：鼻咽未见明确肿物，双颈未扪及明显肿大淋巴结，颅神经（-）甲功五项示正常。鼻咽MRI未见明确复发，腹部B超、胸片未见明确转移。EBV-DNA:0；现病史:；既往史:；个人史:；家族史:；体格检查:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D0] 检验组合: 磷(P)-静脉血: 1.15mmol/L；平均红细胞体积(MCV)-静脉血: 87fL；肌酐(Crea)-静脉血: 58.2umol/L；C-反应蛋白(CRP)-静脉血: 1.11mg/L；尿酸(UA)-静脉血: 148.1umol/L；葡萄糖(Glu)-静脉血: 5.38mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.29；总胆红素(TBIL)-静脉血: 7.6umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.39mmolL；凝血酶时间(TT)-静脉血: 19.1sec.；钾离子(K+)-静脉血: 4.25mmol/L；阴离子间隙(AG)-静脉血: 10.3；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；白细胞计数(WBC#)-静脉血: 710E9/L；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阳性(169.39U/mL)（参考: 阴性）；载脂蛋白AI(apoAI)-静脉血: 1.57g/L；纤维蛋白原(Fbg)-静脉血: 3.35g/L；中性粒细胞计数(Neut#)-静脉血: 4.210E9/L；平均血小板体积(MPV)-静脉血: 9.6fL；有核红细胞百分比(NRBC%)-静脉血: 0；血小板比容-静脉血: 29%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 27mmol/L；凝血酶原时间活动度(PTA)-静脉血: 85.4%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；ABO血型-静脉血: O；甘油三酯(TG)-静脉血: 1.43mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.04S/CO；球蛋白(GLO)-静脉血: 33.45g/L；总钙(Ca)-静脉血: 2.26mmol/L；血小板分布宽度(PDW)-静脉血: 9.7%；间接胆红素(IBIL)-静脉血: 5.8umolL；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0IU/mL；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)……\n- [全程D1] CT；胸、上腹CT平扫+增强: 检查类型: CT；检查名称: 胸、上腹CT平扫+增强；检查部位:；检查所见: 双肺纹理清晰，左肺下叶外基底段见条索状高密度影，边界清；余双肺内未见明显实质性病变。 气管及支气管分支通畅。 双肺门及纵隔未见明显肿大淋巴结。 双侧胸腔未见积液。双侧胸膜未见增厚、粘连。 肝脏形态未见异常，轮廓光整，各叶比例在正常范围以内，密度均匀。 肝内胆管未见明显异常。胆囊不大、壁不厚，其内未见结石。胆总管未见扩张，其内未见结石。 肝门区结构清晰。门静脉未见明显异常。 脾脏大小、形态未见明显异常，密度均匀。 胰腺大小、形态未见明显异常，密度均匀。 所示双肾及双侧肾上腺大小、形态未见明显异常，密度均匀。 膈脚后、肝门区、腹主动脉旁、腹腔干周围未见明显肿大淋巴结。 扫描层面内未见明显骨质破坏。；检查结论: 左肺下叶外基底段条索影，考虑纤维灶。 上腹部未见明显异常。\n- [全程D2] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 鼻咽部见片状放射性浓密影。胸骨、锁骨、肩胛骨、肋骨、颈椎、胸椎、腰椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 鼻咽部代谢活跃，考虑鼻咽癌所致。 余全身骨骼未见明显异常。\n- [全程D985] MRI；鼻咽部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部MR平扫+增强；检查部位:；检查所见: 鼻咽癌放疗后复查，对比某次就诊时间片： 鼻咽腔未见狭窄，鼻咽顶壁、顶后壁、右侧壁轻度增厚，均匀强化，右侧咽隐窝变浅，考虑放疗后改变，较前相仿。 蝶骨基底部、左侧枕骨基底部、左侧岩尖、左侧翼突基底部骨质信号下降，增强扫描轻度不均匀强化，较前相仿。 左侧破裂孔见少许软组织影，增强扫描轻度强化，较前相仿。 双侧咽后间隙见小淋巴结，大者短径约3mm，较前相仿。 右颈II区见多个淋巴结，最大短径约为5mm，部分边界欠清，增强扫描不均匀强化，较前稍缩小。 双侧上颌窦、筛窦、额窦粘膜增厚，考虑副鼻窦炎，较前相仿。 扫描所见颅脑未见明确异常。；检查结论:\n- [全程D985] MRI；颈部MR平扫+增强: 检查类型: MRI；检查名称: 颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌放疗后复查，对比某次就诊时间片： 鼻咽腔未见狭窄，鼻咽顶壁、顶后壁、右侧壁轻度增厚，均匀强化，右侧咽隐窝变浅，考虑放疗后改变，较前相仿。 蝶骨基底部、左侧枕骨基底部、左侧岩尖、左侧翼突基底部骨质信号下降，增强扫描轻度不均匀强化，较前相仿。 左侧破裂孔见少许软组织影，增强扫描轻度强化，较前相仿。 双侧咽后间隙见小淋巴结，大者短径约3mm，较前相仿。 右颈II区见多个淋巴结，最大短径约为5mm，部分边界欠清，增强扫描不均匀强化，较前稍缩小。 双侧上颌窦、筛窦、额窦粘膜增厚，考虑副鼻窦炎，较前相仿。 扫描所见颅脑未见明确异常。；检查结论:\n- [全程D1168] 检验组合: 游离甲状腺素(FT4)-静脉血: 14.91pmol/L；甲状腺过氧化物酶抗体(TPO-Ab)-静脉血: 12.55U/ml；游离三碘甲状腺原氨酸(FT3)-静脉血: 4.97pmol/L；甲状腺球蛋白(TG)-静脉血: 1.12ng/ml；促甲状腺激素(TSH)-静脉血: 1.59uIU/ml\n- [全程D1169] 超声；肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径不宽，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。\n- [全程D1170] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，走行自然，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n- [全程D1380] 检验组合: 游离三碘甲状腺原氨酸(FT3)-静脉血: 5.27pmol/L；游离甲状腺素(FT4)-静脉血: 13.84pmol/L；胆碱酯酶(ChE)-静脉血: 10374U/L；总钙(Ca)-静脉血: 2.33mmol/L；中性粒细胞百分比(Neut%)-静脉血: 56.6%；γ-谷氨酰基转移酶(GGT)-静脉血: 25.6U/L；肌酸激酶(CK)-静脉血: 80U/L；肌酐(Crea)-静脉血: 59.7umol/L；总蛋白(TP)-静脉血: 72.07g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 27.9pg；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.29mmol/L；淋巴细胞计数(Lymph#)-静脉血: 2.110E9/L；镁离子(Mg2+)-静脉血: 1.02mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.3mmol/L；碱性磷酸酶(ALP)-静脉血: 75.5U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.2510E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.2%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.1fL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；大血小板百分比(P-LCR%)-静脉血: 21.4%；白蛋白(ALB)-静脉血: 43.8g/L；载脂蛋白AI(apoAI)-静脉血: 1.52g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.55；总胆固醇(TC)-静脉血: 6.32mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.7U/L；阴离子间隙(AG)-静脉血: 18.4；血红蛋白(Hb)-静脉血: 131g/L；甲状腺球蛋白(TG)-静脉血: 1.4ng/ml；平均红细胞血红蛋白浓度(MCHC)-静脉血: 300g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.34mmolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 2.4；钾离子(K+)-静脉血: 3.9mmol/L；红细胞比容(Hct)-静脉血: 43.7%；未成熟粒细胞百分比(IG%)-静脉血: 0.5%；磷(P)-静脉血: 1.39mmol/L；钠离子(Na+)-静脉血: 141.4mmol/L；间接胆红素(IBIL)-静脉血:……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D986] 门急诊记录: 主诉: 鼻咽癌放化疗结束2年，诉轻度口干，听力视力正常，无头晕、头痛。体查：鼻咽未见明确肿物，双颈未扪及明显肿大淋巴结，颅神经（-）甲功五项示正常。鼻咽MRI未见明确复发，腹部B超、胸片未见明确转移。EBV-DNA:0；现病史:；既往史:；个人史:；家族史:；体格检查:\n- [全程D1174] 门急诊记录: 主诉: 鼻咽癌放化疗结束2年，诉轻度口干，听力视力正常，无头晕、头痛。体查：鼻咽未见明确肿物，双颈未扪及明显肿大淋巴结，颅神经（-）甲功五项示正常。鼻咽MRI未见明确复发，腹部B超、胸片未见明确转移。EBV-DNA:0；现病史:；既往史:；个人史:；家族史:；体格检查:\n- [时间未明] 门急诊记录: 主诉:；现病史: 者半年余前无明显诱因出现左侧颈部肿物，无疼痛，逐渐增大，伴有鼻塞、流涕，至当地医院予抗炎对症治疗后，肿物能减小；2月前患者始出现右侧颈部肿物，逐渐增大，伴有鼻塞、流涕，间中有涕血，无发热、畏寒，无头晕、头痛，无周身骨痛等，于当地医院检查ＣＴ示：鼻咽肿物，遂转至我院进一步诊治。门诊拟诊“鼻咽肿物”收入我科进一步治疗。患者起病以来精神、睡眠欠佳，胃纳尚可，二便正常，体重无明显下降。；既往史: 否认高血压、糖尿病及心脏病史，否认结核等传染病史、否认手术、外伤及输血史。；个人史:；家族史: 家族中无类似患者，无家族性遗传病患者，无重大精神病患者。；体格检查: KPS90，一般状况可，鼻咽左侧壁、顶后壁肿物，双颈扪及肿大淋巴结，右颈多枚肿大淋巴结，较大者约6*4及2*2cm,质硬，活动差，左上颈可及一淋巴结，约3*3cm，质中，活动度可，无融合，无皮肤浸润等，左中颈可及一大小约1*1cm质硬淋巴结；张口门齿距约4cm，颅神经征阴性。。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 给予大剂量糖皮质激素冲击治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超\nB. 给予贝伐珠单抗靶向治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项\nC. 安排头颅PET-CT检查鉴别左侧颞叶病变性质，并安排胸部X线、腹部彩超、甲功五项\nD. 安排立体定向脑活检明确左侧颞叶病变性质，并安排胸部X线、腹部彩超、甲功五项\nE. 给予高压氧治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项\nF. 给予甘露醇静脉滴注脱水降颅压，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超\nG. 安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项及EBV-DNA定量检测\nH. 给予神经营养药物治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项\nI. 安排鼻咽及颈部CT平扫+增强、胸部CT平扫、腹部CT平扫、甲功五项及EBV-DNA定量检测\nJ. 安排立体定向放射外科治疗左侧颞叶病变，并安排胸部X线、腹部彩超、甲功五项\nK. 安排鼻咽及颈部MRI平扫+增强、头颅MRI平扫+增强，暂缓胸部X线及腹部彩超检查\nL. 给予抗癫痫药物预防性治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-2fc2bca32acf3eb67f65396b","patient_id":"patient-9149023ec8599161ec3e5cfd","turn_id":"turn07","turn_position":5,"turn_type":"recurrence_or_salvage_decision","gold_letter":"I","gold_action":"继续行第3周期GP方案第8天化疗（吉西他滨），辅以肠内营养支持，并安排出院。","options":[{"letter":"A","text":"提前终止第3周期诱导化疗，直接进入根治性同步放化疗阶段。","is_gold":false},{"letter":"B","text":"暂停第8天化疗，予重组人粒细胞集落刺激因子升白治疗后复查血常规。","is_gold":false},{"letter":"C","text":"更改诱导化疗方案为TP（多西他赛+顺铂）进行第4周期治疗。","is_gold":false},{"letter":"D","text":"继续行第3周期GP方案第8天化疗（吉西他滨联合顺铂），并安排出院。","is_gold":false},{"letter":"E","text":"计划在第3周期结束后，继续行第4周期GP方案诱导化疗。","is_gold":false},{"letter":"F","text":"暂停化疗，行双侧颈部淋巴结清扫术及鼻咽原发灶切除术。","is_gold":false},{"letter":"G","text":"终止后续放疗计划，按完全缓解（CR）状态进入定期随访观察。","is_gold":false},{"letter":"H","text":"将第8天吉西他滨剂量下调25%后给药，并密切监测血常规。","is_gold":false},{"letter":"I","text":"继续行第3周期GP方案第8天化疗（吉西他滨），辅以肠内营养支持，并安排出院。","is_gold":true},{"letter":"J","text":"暂停治疗，行全身PET-CT检查以重新评估全身肿瘤负荷。","is_gold":false},{"letter":"K","text":"在第8天化疗基础上加用PD-1抑制剂（如特瑞普利单抗）进行联合治疗。","is_gold":false},{"letter":"L","text":"立即启动根治性调强放疗，并同步给予吉西他滨单药化疗。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现双颈肿物半年余；现病史: 者半年余前无明显诱因出现左侧颈部肿物，无疼痛，逐渐增大，伴有鼻塞、流涕，至当地医院予抗炎对症治疗后，肿物能减小；2月前患者始出现右侧颈部肿物，逐渐增大，伴有鼻塞、流涕，间中有涕血，无发热、畏寒，无头晕、头痛，无周身骨痛等，于当地医院检查ＣＴ示：鼻咽肿物，遂转至我院进一步诊治。门诊拟诊“鼻咽肿物”收入我科进一步治疗。患者起病以来精神、睡眠欠佳，胃纳尚可，二便正常，体重无明显下降。；阳性症状体征: 鼻塞,睡眠欠佳,鼻咽肿物,涕血,右颈部肿物,左颈部肿物,流涕；既往史: 体健，无高血压、心脏病等慢性病，无糖尿病、肾病等全身性疾病，无乙肝、结核等传染病，无外伤史。；个人史: 生于原籍，有吸烟史30年,无饮酒，无其他嗜好，否认冶游史。；家族史: 家族中无类似患者，无家族性遗传病患者，无重大精神病患者。；体格检查:；专科检查:；KPS:；ECOG:\n- [时间未明] 门急诊记录: 主诉:；现病史: 者半年余前无明显诱因出现左侧颈部肿物，无疼痛，逐渐增大，伴有鼻塞、流涕，至当地医院予抗炎对症治疗后，肿物能减小；2月前患者始出现右侧颈部肿物，逐渐增大，伴有鼻塞、流涕，间中有涕血，无发热、畏寒，无头晕、头痛，无周身骨痛等，于当地医院检查ＣＴ示：鼻咽肿物，遂转至我院进一步诊治。门诊拟诊“鼻咽肿物”收入我科进一步治疗。患者起病以来精神、睡眠欠佳，胃纳尚可，二便正常，体重无明显下降。；既往史: 否认高血压、糖尿病及心脏病史，否认结核等传染病史、否认手术、外伤及输血史。；个人史:；家族史: 家族中无类似患者，无家族性遗传病患者，无重大精神病患者。；体格检查: KPS90，一般状况可，鼻咽左侧壁、顶后壁肿物，双颈扪及肿大淋巴结，右颈多枚肿大淋巴结，较大者约6*4及2*2cm,质硬，活动差，左上颈可及一淋巴结，约3*3cm，质中，活动度可，无融合，无皮肤浸润等，左中颈可及一大小约1*1cm质硬淋巴结；张口门齿距约4cm，颅神经征阴性。。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D986] 门急诊记录: 主诉: 鼻咽癌放化疗结束2年，诉轻度口干，听力视力正常，无头晕、头痛。体查：鼻咽未见明确肿物，双颈未扪及明显肿大淋巴结，颅神经（-）甲功五项示正常。鼻咽MRI未见明确复发，腹部B超、胸片未见明确转移。EBV-DNA:0；现病史:；既往史:；个人史:；家族史:；体格检查:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D0] 检验组合: 磷(P)-静脉血: 1.15mmol/L；平均红细胞体积(MCV)-静脉血: 87fL；肌酐(Crea)-静脉血: 58.2umol/L；C-反应蛋白(CRP)-静脉血: 1.11mg/L；尿酸(UA)-静脉血: 148.1umol/L；葡萄糖(Glu)-静脉血: 5.38mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.29；总胆红素(TBIL)-静脉血: 7.6umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.39mmolL；凝血酶时间(TT)-静脉血: 19.1sec.；钾离子(K+)-静脉血: 4.25mmol/L；阴离子间隙(AG)-静脉血: 10.3；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；白细胞计数(WBC#)-静脉血: 710E9/L；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阳性(169.39U/mL)（参考: 阴性）；载脂蛋白AI(apoAI)-静脉血: 1.57g/L；纤维蛋白原(Fbg)-静脉血: 3.35g/L；中性粒细胞计数(Neut#)-静脉血: 4.210E9/L；平均血小板体积(MPV)-静脉血: 9.6fL；有核红细胞百分比(NRBC%)-静脉血: 0；血小板比容-静脉血: 29%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 27mmol/L；凝血酶原时间活动度(PTA)-静脉血: 85.4%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；ABO血型-静脉血: O；甘油三酯(TG)-静脉血: 1.43mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.04S/CO；球蛋白(GLO)-静脉血: 33.45g/L；总钙(Ca)-静脉血: 2.26mmol/L；血小板分布宽度(PDW)-静脉血: 9.7%；间接胆红素(IBIL)-静脉血: 5.8umolL；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0IU/mL；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)……\n- [全程D1] CT；胸、上腹CT平扫+增强: 检查类型: CT；检查名称: 胸、上腹CT平扫+增强；检查部位:；检查所见: 双肺纹理清晰，左肺下叶外基底段见条索状高密度影，边界清；余双肺内未见明显实质性病变。 气管及支气管分支通畅。 双肺门及纵隔未见明显肿大淋巴结。 双侧胸腔未见积液。双侧胸膜未见增厚、粘连。 肝脏形态未见异常，轮廓光整，各叶比例在正常范围以内，密度均匀。 肝内胆管未见明显异常。胆囊不大、壁不厚，其内未见结石。胆总管未见扩张，其内未见结石。 肝门区结构清晰。门静脉未见明显异常。 脾脏大小、形态未见明显异常，密度均匀。 胰腺大小、形态未见明显异常，密度均匀。 所示双肾及双侧肾上腺大小、形态未见明显异常，密度均匀。 膈脚后、肝门区、腹主动脉旁、腹腔干周围未见明显肿大淋巴结。 扫描层面内未见明显骨质破坏。；检查结论: 左肺下叶外基底段条索影，考虑纤维灶。 上腹部未见明显异常。\n- [全程D2] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 鼻咽部见片状放射性浓密影。胸骨、锁骨、肩胛骨、肋骨、颈椎、胸椎、腰椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 鼻咽部代谢活跃，考虑鼻咽癌所致。 余全身骨骼未见明显异常。\n- [全程D985] MRI；鼻咽部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部MR平扫+增强；检查部位:；检查所见: 鼻咽癌放疗后复查，对比某次就诊时间片： 鼻咽腔未见狭窄，鼻咽顶壁、顶后壁、右侧壁轻度增厚，均匀强化，右侧咽隐窝变浅，考虑放疗后改变，较前相仿。 蝶骨基底部、左侧枕骨基底部、左侧岩尖、左侧翼突基底部骨质信号下降，增强扫描轻度不均匀强化，较前相仿。 左侧破裂孔见少许软组织影，增强扫描轻度强化，较前相仿。 双侧咽后间隙见小淋巴结，大者短径约3mm，较前相仿。 右颈II区见多个淋巴结，最大短径约为5mm，部分边界欠清，增强扫描不均匀强化，较前稍缩小。 双侧上颌窦、筛窦、额窦粘膜增厚，考虑副鼻窦炎，较前相仿。 扫描所见颅脑未见明确异常。；检查结论:\n- [全程D985] MRI；颈部MR平扫+增强: 检查类型: MRI；检查名称: 颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌放疗后复查，对比某次就诊时间片： 鼻咽腔未见狭窄，鼻咽顶壁、顶后壁、右侧壁轻度增厚，均匀强化，右侧咽隐窝变浅，考虑放疗后改变，较前相仿。 蝶骨基底部、左侧枕骨基底部、左侧岩尖、左侧翼突基底部骨质信号下降，增强扫描轻度不均匀强化，较前相仿。 左侧破裂孔见少许软组织影，增强扫描轻度强化，较前相仿。 双侧咽后间隙见小淋巴结，大者短径约3mm，较前相仿。 右颈II区见多个淋巴结，最大短径约为5mm，部分边界欠清，增强扫描不均匀强化，较前稍缩小。 双侧上颌窦、筛窦、额窦粘膜增厚，考虑副鼻窦炎，较前相仿。 扫描所见颅脑未见明确异常。；检查结论:\n- [全程D1168] 检验组合: 游离甲状腺素(FT4)-静脉血: 14.91pmol/L；甲状腺过氧化物酶抗体(TPO-Ab)-静脉血: 12.55U/ml；游离三碘甲状腺原氨酸(FT3)-静脉血: 4.97pmol/L；甲状腺球蛋白(TG)-静脉血: 1.12ng/ml；促甲状腺激素(TSH)-静脉血: 1.59uIU/ml\n- [全程D1169] 超声；肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径不宽，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。\n- [全程D1170] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，走行自然，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n- [全程D1380] 检验组合: 游离三碘甲状腺原氨酸(FT3)-静脉血: 5.27pmol/L；游离甲状腺素(FT4)-静脉血: 13.84pmol/L；胆碱酯酶(ChE)-静脉血: 10374U/L；总钙(Ca)-静脉血: 2.33mmol/L；中性粒细胞百分比(Neut%)-静脉血: 56.6%；γ-谷氨酰基转移酶(GGT)-静脉血: 25.6U/L；肌酸激酶(CK)-静脉血: 80U/L；肌酐(Crea)-静脉血: 59.7umol/L；总蛋白(TP)-静脉血: 72.07g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 27.9pg；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.29mmol/L；淋巴细胞计数(Lymph#)-静脉血: 2.110E9/L；镁离子(Mg2+)-静脉血: 1.02mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.3mmol/L；碱性磷酸酶(ALP)-静脉血: 75.5U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.2510E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.2%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.1fL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；大血小板百分比(P-LCR%)-静脉血: 21.4%；白蛋白(ALB)-静脉血: 43.8g/L；载脂蛋白AI(apoAI)-静脉血: 1.52g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.55；总胆固醇(TC)-静脉血: 6.32mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.7U/L；阴离子间隙(AG)-静脉血: 18.4；血红蛋白(Hb)-静脉血: 131g/L；甲状腺球蛋白(TG)-静脉血: 1.4ng/ml；平均红细胞血红蛋白浓度(MCHC)-静脉血: 300g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.34mmolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 2.4；钾离子(K+)-静脉血: 3.9mmol/L；红细胞比容(Hct)-静脉血: 43.7%；未成熟粒细胞百分比(IG%)-静脉血: 0.5%；磷(P)-静脉血: 1.39mmol/L；钠离子(Na+)-静脉血: 141.4mmol/L；间接胆红素(IBIL)-静脉血:……\n- [全程D46] 检验组合: 中性粒细胞百分比(Neut%)-静脉血: 0.568；血液二氧化碳含量ctCO2(B)-静脉血: 23mmol/L；钾离子(K+)-静脉血: 3.97mmol/L；镁离子(Mg2+)-静脉血: 0.79mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.383；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.55；钠离子(Na+)-静脉血: 130mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；平均红细胞体积(MCV)-静脉血: 82.6fL；单核细胞百分比(Mono%)-静脉血: 0.042；肌酐(Crea)-静脉血: 46.6umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 44U/L；血红蛋白(Hb)-静脉血: 118g/L；磷(P)-静脉血: 1.18mmol/L；总胆红素(TBIL)-静脉血: 7.2umol/L；平均血小板体积(MPV)-静脉血: 9fL；总蛋白(TP)-静脉血: 67.1g/L；乳酸脱氢酶(LDH)-静脉血: 137.5U/L；间接胆红素(IBIL)-静脉血: 5.3umolL；球蛋白(GLO)-静脉血: 28.1g/L；尿酸(UA)-静脉血: 102.4umol/L；白蛋白(ALB)-静脉血: 39g/L；有核红细胞百分比(NRBC%)-静脉血: 0；单核细胞计数(Mono#)-静脉血: 0.210E9/L；红细胞比容(Hct)-静脉血: 36%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血小板分布宽度(PDW)-静脉血: 9%；阴离子间隙(AG)-静脉血: 14.1；直接胆红素(DBIL)-静脉血: 1.9umol/L；总胆汁酸(TBA)-静脉血: 1.5umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.4；有核红细胞计数(NRBC#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.710E9/L；大血小板百分比(P-LCR%)-静脉血: 16.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 27.1pg；γ-谷氨酰基转移酶(GGT)-静脉血: 62.8U/L；尿素氮(BUN)-静脉血: 3.4mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.39；红细胞计数(RBC#……\n- [全程D55] 检验组合: 平均红细胞血红蛋白含量(MCH)-静脉血: 27.3pg；天门冬氨酸氨基转移酶(AST)-静脉血: 14.5U/L；碱性磷酸酶(ALP)-静脉血: 103.1U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；淋巴细胞计数(Lymph#)-静脉血: 2.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.145；红细胞计数(RBC#)-静脉血: 3.7410E12/L；有核红细胞百分比(NRBC%)-静脉血: 0；大血小板百分比(P-LCR%)-静脉血: 18.5%；红细胞比容(Hct)-静脉血: 32.5%；淋巴细胞百分比(Lymph%)-静脉血: 0.531；丙氨酸氨基转移酶(ALT)-静脉血: 7.8U/L；氯离子(Cl-)-静脉血: 102mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；间接胆红素(IBIL)-静脉血: 1.7umolL；平均血小板体积(MPV)-静脉血: 9.3fL；总钙(Ca)-静脉血: 2.22mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；总蛋白(TP)-静脉血: 64.51g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.6mmol/L；血红蛋白(Hb)-静脉血: 102g/L；血小板比容-静脉血: 15%；中性粒细胞计数(Neut#)-静脉血: 1.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.318；白细胞计数(WBC#)-静脉血: 4.4810E9/L；镁离子(Mg2+)-静脉血: 0.78mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 35.3U/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 314g/L；乳酸脱氢酶(LDH)-静脉血: 139.5U/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；钠离子(Na+)-静脉血: 137.5mmol/L；总胆红素(TBIL)-静脉血: 2.4umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.86；尿素氮(BUN)-静脉血: 3.4mmol/L；肌酐(Crea)-静脉血: 64.6umol/L；总胆汁酸(TBA)-静脉血: 3.8umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 55.2U/L；单核细……\n- [全程D61] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- [全程D61] 检验组合: 碱性磷酸酶(ALP)-静脉血: 108.3U/L；丙氨酸氨基转移酶(ALT)-静脉血: 14.3U/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；直接胆红素(DBIL)-静脉血: 0.6umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24U/L；中性粒细胞百分比(Neut%)-静脉血: 0.512；α-L-岩藻糖苷酶(AFU)-静脉血: 44.3U/L；钾离子(K+)-静脉血: 4.3mmol/L；平均红细胞体积(MCV)-静脉血: 87.2fL；白细胞计数(WBC#)-静脉血: 7.6610E9/L；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；血小板比容-静脉血: 24%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；平均红细胞血红蛋白含量(MCH)-静脉血: 27.2pg；乳酸脱氢酶(LDH)-静脉血: 151.5U/L；阴离子间隙(AG)-静脉血: 16.2；肌酐(Crea)-静脉血: 58.2umol/L；总胆汁酸(TBA)-静脉血: 12.2umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.9mmol/L；球蛋白(GLO)-静脉血: 28.8g/L；淋巴细胞计数(Lymph#)-静脉血: 2.710E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 312g/L；氯离子(Cl-)-静脉血: 100.7mmol/L；尿酸(UA)-静脉血: 217.3umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.47；总钙(Ca)-静脉血: 2.18mmol/L；白蛋白(ALB)-静脉血: 42.2g/L；大血小板百分比(P-LCR%)-静脉血: 17.6%；γ-谷氨酰基转移酶(GGT)-静脉血: 62.4U/L；平均血小板体积(MPV)-静脉血: 9.1fL；磷(P)-静脉血: 1.45mmol/L；间接胆红素(IBIL)-静脉血: 2.4umolL；血小板计数(PLT#)-静脉血: 26810E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；血小板分布宽度(PDW)-静脉血: 9.4%；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.68；总胆红素(TBIL)-静脉血: 3umol/L；单核细胞百分比(Mono%)-静脉血:……\n- [全程D68] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后，对比某次就诊时间片： 鼻咽腔狭窄，鼻咽顶壁、顶后壁、左侧壁见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强后明显强化，肿物占据左侧咽隐窝，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，向前累及双侧后鼻孔，范围较前缩小，右侧咽隐窝变浅，右侧咽旁脂肪间隙及颈动脉鞘区未见异常。 左侧腭帆张提肌、左侧翼内肌上缘及双侧头长肌受侵，右侧腭帆提肌、腭帆张肌未见受侵征象。左侧翼腭窝可见软组织稍增厚，大致同前，右侧翼腭窝、右侧颞下窝未见异常；口咽双侧壁未见增厚。 斜坡、蝶骨基底部、左侧枕骨基底部、左侧岩尖、左侧翼突基底部、左侧翼突内外板、左侧蝶骨大翼骨质破坏，增强扫描后明显强化，大致同前。 左侧破裂孔及左侧海绵窦下份见少许软组织影，增强扫描后明显强化，较前变化不大，右侧海绵窦形态正常。 左侧上颌窦、筛窦、蝶窦、双侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 双侧咽后间隙见小淋巴结，最大短径约3mm，较前稍缩小；双颈II区见肿大淋巴结，最大约为20mm×30mm，边界清楚，信号不均匀，部分见囊变坏死，增强后不均匀强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗后，对比某次就诊时间片： 鼻咽病灶较前范围稍缩小。 颅底骨质破坏，大致同前。 双侧咽后淋巴结小淋巴结，较前稍缩小；双颈II区淋巴结肿大，考虑转移，部分较前缩小。 鼻窦炎、双侧乳突炎。\n- [全程D68] 检验组合: 阴离子间隙(AG)-静脉血: 14.8；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.75；白蛋白(ALB)-静脉血: 42.2g/L；间接胆红素(IBIL)-静脉血: 6.1umolL；总胆红素(TBIL)-静脉血: 8umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.6；血小板分布宽度(PDW)-静脉血: 8.4%；平均红细胞血红蛋白含量(MCH)-静脉血: 27.1pg；钠离子(Na+)-静脉血: 132.5mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 323g/L；直接胆红素(DBIL)-静脉血: 1.9umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 65.5U/L；钾离子(K+)-静脉血: 4.64mmol/L；碱性磷酸酶(ALP)-静脉血: 83.1U/L；白细胞计数(WBC#)-静脉血: 3.3810E9/L；血红蛋白(Hb)-静脉血: 107g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞比容(Hct)-静脉血: 33.1%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44.7；α-L-岩藻糖苷酶(AFU)-静脉血: 49.8U/L；中性粒细胞百分比(Neut%)-静脉血: 0.558；乳酸脱氢酶(LDH)-静脉血: 136.8U/L；尿素氮(BUN)-静脉血: 2.6mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.3mmol/L；单核细胞计数(Mono#)-静脉血: 0.110E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.033；氯离子(Cl-)-静脉血: 94.4mmol/L；肌酐(Crea)-静脉血: 53.8umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.9U/L；球蛋白(GLO)-静脉血: 28.48g/L；平均血小板体积(MPV)-静脉血: 8.3fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；中性粒细胞计数(Neut#)-静脉血: 1.910E9/L；总胆汁酸(TBA)-静脉血: 2.7umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.373；血小板比容-静脉血: 31%；总蛋白(TP)-静脉……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D986] 门急诊记录: 主诉: 鼻咽癌放化疗结束2年，诉轻度口干，听力视力正常，无头晕、头痛。体查：鼻咽未见明确肿物，双颈未扪及明显肿大淋巴结，颅神经（-）甲功五项示正常。鼻咽MRI未见明确复发，腹部B超、胸片未见明确转移。EBV-DNA:0；现病史:；既往史:；个人史:；家族史:；体格检查:\n- [全程D1174] 门急诊记录: 主诉: 鼻咽癌放化疗结束2年，诉轻度口干，听力视力正常，无头晕、头痛。体查：鼻咽未见明确肿物，双颈未扪及明显肿大淋巴结，颅神经（-）甲功五项示正常。鼻咽MRI未见明确复发，腹部B超、胸片未见明确转移。EBV-DNA:0；现病史:；既往史:；个人史:；家族史:；体格检查:\n- [时间未明] 门急诊记录: 主诉:；现病史: 者半年余前无明显诱因出现左侧颈部肿物，无疼痛，逐渐增大，伴有鼻塞、流涕，至当地医院予抗炎对症治疗后，肿物能减小；2月前患者始出现右侧颈部肿物，逐渐增大，伴有鼻塞、流涕，间中有涕血，无发热、畏寒，无头晕、头痛，无周身骨痛等，于当地医院检查ＣＴ示：鼻咽肿物，遂转至我院进一步诊治。门诊拟诊“鼻咽肿物”收入我科进一步治疗。患者起病以来精神、睡眠欠佳，胃纳尚可，二便正常，体重无明显下降。；既往史: 否认高血压、糖尿病及心脏病史，否认结核等传染病史、否认手术、外伤及输血史。；个人史:；家族史: 家族中无类似患者，无家族性遗传病患者，无重大精神病患者。；体格检查: KPS90，一般状况可，鼻咽左侧壁、顶后壁肿物，双颈扪及肿大淋巴结，右颈多枚肿大淋巴结，较大者约6*4及2*2cm,质硬，活动差，左上颈可及一淋巴结，约3*3cm，质中，活动度可，无融合，无皮肤浸润等，左中颈可及一大小约1*1cm质硬淋巴结；张口门齿距约4cm，颅神经征阴性。。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D62] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日查房时自述精神食欲可，睡眠休息好。查体：KPS 90，一般状况可，鼻咽左侧壁、顶后壁肿物，双颈扪及肿大淋巴结，右颈多枚肿大淋巴结，较大者约6*4及2*2cm,质硬，活动差，左上颈可及一淋巴结，约3*3cm，质中，活动度可，无融合，无皮肤浸润等，左中颈可及一大小约1*1cm质硬淋巴结；张口门齿距约4cm，颅神经征阴性。[姓名已隐去]医生信息已隐藏：该病人为鼻咽癌，已接受GP方案诱导化疗2周期。目前排除化疗禁忌症，今日水化，明日再予GP方案行第三周期化疗，遵执。\n- [全程D63] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日查房时无特殊不适主诉，精神食欲可，昨日水化顺利。查体大致同前。[姓名已隐去]医生信息已隐藏：该病人继续按原方案（吉西他滨 1g/m2d1、d8+顺铂 80mg/m2d1）化疗，注意护胃、止吐等对症支持处理，遵执。\n- [全程D66] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 患者化疗输液顺利完成。今日查房时自诉精神食欲可，二便通畅。今继续对症支持治疗，择期复查血常规及血生化。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 提前终止第3周期诱导化疗，直接进入根治性同步放化疗阶段。\nB. 暂停第8天化疗，予重组人粒细胞集落刺激因子升白治疗后复查血常规。\nC. 更改诱导化疗方案为TP（多西他赛+顺铂）进行第4周期治疗。\nD. 继续行第3周期GP方案第8天化疗（吉西他滨联合顺铂），并安排出院。\nE. 计划在第3周期结束后，继续行第4周期GP方案诱导化疗。\nF. 暂停化疗，行双侧颈部淋巴结清扫术及鼻咽原发灶切除术。\nG. 终止后续放疗计划，按完全缓解（CR）状态进入定期随访观察。\nH. 将第8天吉西他滨剂量下调25%后给药，并密切监测血常规。\nI. 继续行第3周期GP方案第8天化疗（吉西他滨），辅以肠内营养支持，并安排出院。\nJ. 暂停治疗，行全身PET-CT检查以重新评估全身肿瘤负荷。\nK. 在第8天化疗基础上加用PD-1抑制剂（如特瑞普利单抗）进行联合治疗。\nL. 立即启动根治性调强放疗，并同步给予吉西他滨单药化疗。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现双颈肿物半年余；现病史: 者半年余前无明显诱因出现左侧颈部肿物，无疼痛，逐渐增大，伴有鼻塞、流涕，至当地医院予抗炎对症治疗后，肿物能减小；2月前患者始出现右侧颈部肿物，逐渐增大，伴有鼻塞、流涕，间中有涕血，无发热、畏寒，无头晕、头痛，无周身骨痛等，于当地医院检查ＣＴ示：鼻咽肿物，遂转至我院进一步诊治。门诊拟诊“鼻咽肿物”收入我科进一步治疗。患者起病以来精神、睡眠欠佳，胃纳尚可，二便正常，体重无明显下降。；阳性症状体征: 鼻塞,睡眠欠佳,鼻咽肿物,涕血,右颈部肿物,左颈部肿物,流涕；既往史: 体健，无高血压、心脏病等慢性病，无糖尿病、肾病等全身性疾病，无乙肝、结核等传染病，无外伤史。；个人史: 生于原籍，有吸烟史30年,无饮酒，无其他嗜好，否认冶游史。；家族史: 家族中无类似患者，无家族性遗传病患者，无重大精神病患者。；体格检查:；专科检查:；KPS:；ECOG:\n- [时间未明] 门急诊记录: 主诉:；现病史: 者半年余前无明显诱因出现左侧颈部肿物，无疼痛，逐渐增大，伴有鼻塞、流涕，至当地医院予抗炎对症治疗后，肿物能减小；2月前患者始出现右侧颈部肿物，逐渐增大，伴有鼻塞、流涕，间中有涕血，无发热、畏寒，无头晕、头痛，无周身骨痛等，于当地医院检查ＣＴ示：鼻咽肿物，遂转至我院进一步诊治。门诊拟诊“鼻咽肿物”收入我科进一步治疗。患者起病以来精神、睡眠欠佳，胃纳尚可，二便正常，体重无明显下降。；既往史: 否认高血压、糖尿病及心脏病史，否认结核等传染病史、否认手术、外伤及输血史。；个人史:；家族史: 家族中无类似患者，无家族性遗传病患者，无重大精神病患者。；体格检查: KPS90，一般状况可，鼻咽左侧壁、顶后壁肿物，双颈扪及肿大淋巴结，右颈多枚肿大淋巴结，较大者约6*4及2*2cm,质硬，活动差，左上颈可及一淋巴结，约3*3cm，质中，活动度可，无融合，无皮肤浸润等，左中颈可及一大小约1*1cm质硬淋巴结；张口门齿距约4cm，颅神经征阴性。。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D986] 门急诊记录: 主诉: 鼻咽癌放化疗结束2年，诉轻度口干，听力视力正常，无头晕、头痛。体查：鼻咽未见明确肿物，双颈未扪及明显肿大淋巴结，颅神经（-）甲功五项示正常。鼻咽MRI未见明确复发，腹部B超、胸片未见明确转移。EBV-DNA:0；现病史:；既往史:；个人史:；家族史:；体格检查:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D0] 检验组合: 磷(P)-静脉血: 1.15mmol/L；平均红细胞体积(MCV)-静脉血: 87fL；肌酐(Crea)-静脉血: 58.2umol/L；C-反应蛋白(CRP)-静脉血: 1.11mg/L；尿酸(UA)-静脉血: 148.1umol/L；葡萄糖(Glu)-静脉血: 5.38mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.29；总胆红素(TBIL)-静脉血: 7.6umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.39mmolL；凝血酶时间(TT)-静脉血: 19.1sec.；钾离子(K+)-静脉血: 4.25mmol/L；阴离子间隙(AG)-静脉血: 10.3；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；白细胞计数(WBC#)-静脉血: 710E9/L；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阳性(169.39U/mL)（参考: 阴性）；载脂蛋白AI(apoAI)-静脉血: 1.57g/L；纤维蛋白原(Fbg)-静脉血: 3.35g/L；中性粒细胞计数(Neut#)-静脉血: 4.210E9/L；平均血小板体积(MPV)-静脉血: 9.6fL；有核红细胞百分比(NRBC%)-静脉血: 0；血小板比容-静脉血: 29%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 27mmol/L；凝血酶原时间活动度(PTA)-静脉血: 85.4%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；ABO血型-静脉血: O；甘油三酯(TG)-静脉血: 1.43mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.04S/CO；球蛋白(GLO)-静脉血: 33.45g/L；总钙(Ca)-静脉血: 2.26mmol/L；血小板分布宽度(PDW)-静脉血: 9.7%；间接胆红素(IBIL)-静脉血: 5.8umolL；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0IU/mL；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)……\n- [全程D1] CT；胸、上腹CT平扫+增强: 检查类型: CT；检查名称: 胸、上腹CT平扫+增强；检查部位:；检查所见: 双肺纹理清晰，左肺下叶外基底段见条索状高密度影，边界清；余双肺内未见明显实质性病变。 气管及支气管分支通畅。 双肺门及纵隔未见明显肿大淋巴结。 双侧胸腔未见积液。双侧胸膜未见增厚、粘连。 肝脏形态未见异常，轮廓光整，各叶比例在正常范围以内，密度均匀。 肝内胆管未见明显异常。胆囊不大、壁不厚，其内未见结石。胆总管未见扩张，其内未见结石。 肝门区结构清晰。门静脉未见明显异常。 脾脏大小、形态未见明显异常，密度均匀。 胰腺大小、形态未见明显异常，密度均匀。 所示双肾及双侧肾上腺大小、形态未见明显异常，密度均匀。 膈脚后、肝门区、腹主动脉旁、腹腔干周围未见明显肿大淋巴结。 扫描层面内未见明显骨质破坏。；检查结论: 左肺下叶外基底段条索影，考虑纤维灶。 上腹部未见明显异常。\n- [全程D2] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 鼻咽部见片状放射性浓密影。胸骨、锁骨、肩胛骨、肋骨、颈椎、胸椎、腰椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 鼻咽部代谢活跃，考虑鼻咽癌所致。 余全身骨骼未见明显异常。\n- [全程D985] MRI；鼻咽部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部MR平扫+增强；检查部位:；检查所见: 鼻咽癌放疗后复查，对比某次就诊时间片： 鼻咽腔未见狭窄，鼻咽顶壁、顶后壁、右侧壁轻度增厚，均匀强化，右侧咽隐窝变浅，考虑放疗后改变，较前相仿。 蝶骨基底部、左侧枕骨基底部、左侧岩尖、左侧翼突基底部骨质信号下降，增强扫描轻度不均匀强化，较前相仿。 左侧破裂孔见少许软组织影，增强扫描轻度强化，较前相仿。 双侧咽后间隙见小淋巴结，大者短径约3mm，较前相仿。 右颈II区见多个淋巴结，最大短径约为5mm，部分边界欠清，增强扫描不均匀强化，较前稍缩小。 双侧上颌窦、筛窦、额窦粘膜增厚，考虑副鼻窦炎，较前相仿。 扫描所见颅脑未见明确异常。；检查结论:\n- [全程D985] MRI；颈部MR平扫+增强: 检查类型: MRI；检查名称: 颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌放疗后复查，对比某次就诊时间片： 鼻咽腔未见狭窄，鼻咽顶壁、顶后壁、右侧壁轻度增厚，均匀强化，右侧咽隐窝变浅，考虑放疗后改变，较前相仿。 蝶骨基底部、左侧枕骨基底部、左侧岩尖、左侧翼突基底部骨质信号下降，增强扫描轻度不均匀强化，较前相仿。 左侧破裂孔见少许软组织影，增强扫描轻度强化，较前相仿。 双侧咽后间隙见小淋巴结，大者短径约3mm，较前相仿。 右颈II区见多个淋巴结，最大短径约为5mm，部分边界欠清，增强扫描不均匀强化，较前稍缩小。 双侧上颌窦、筛窦、额窦粘膜增厚，考虑副鼻窦炎，较前相仿。 扫描所见颅脑未见明确异常。；检查结论:\n- [全程D1168] 检验组合: 游离甲状腺素(FT4)-静脉血: 14.91pmol/L；甲状腺过氧化物酶抗体(TPO-Ab)-静脉血: 12.55U/ml；游离三碘甲状腺原氨酸(FT3)-静脉血: 4.97pmol/L；甲状腺球蛋白(TG)-静脉血: 1.12ng/ml；促甲状腺激素(TSH)-静脉血: 1.59uIU/ml\n- [全程D1169] 超声；肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径不宽，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。\n- [全程D1170] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，走行自然，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n- [全程D1380] 检验组合: 游离三碘甲状腺原氨酸(FT3)-静脉血: 5.27pmol/L；游离甲状腺素(FT4)-静脉血: 13.84pmol/L；胆碱酯酶(ChE)-静脉血: 10374U/L；总钙(Ca)-静脉血: 2.33mmol/L；中性粒细胞百分比(Neut%)-静脉血: 56.6%；γ-谷氨酰基转移酶(GGT)-静脉血: 25.6U/L；肌酸激酶(CK)-静脉血: 80U/L；肌酐(Crea)-静脉血: 59.7umol/L；总蛋白(TP)-静脉血: 72.07g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 27.9pg；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.29mmol/L；淋巴细胞计数(Lymph#)-静脉血: 2.110E9/L；镁离子(Mg2+)-静脉血: 1.02mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.3mmol/L；碱性磷酸酶(ALP)-静脉血: 75.5U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.2510E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.2%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.1fL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；大血小板百分比(P-LCR%)-静脉血: 21.4%；白蛋白(ALB)-静脉血: 43.8g/L；载脂蛋白AI(apoAI)-静脉血: 1.52g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.55；总胆固醇(TC)-静脉血: 6.32mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.7U/L；阴离子间隙(AG)-静脉血: 18.4；血红蛋白(Hb)-静脉血: 131g/L；甲状腺球蛋白(TG)-静脉血: 1.4ng/ml；平均红细胞血红蛋白浓度(MCHC)-静脉血: 300g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.34mmolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 2.4；钾离子(K+)-静脉血: 3.9mmol/L；红细胞比容(Hct)-静脉血: 43.7%；未成熟粒细胞百分比(IG%)-静脉血: 0.5%；磷(P)-静脉血: 1.39mmol/L；钠离子(Na+)-静脉血: 141.4mmol/L；间接胆红素(IBIL)-静脉血:……\n- [全程D46] 检验组合: 中性粒细胞百分比(Neut%)-静脉血: 0.568；血液二氧化碳含量ctCO2(B)-静脉血: 23mmol/L；钾离子(K+)-静脉血: 3.97mmol/L；镁离子(Mg2+)-静脉血: 0.79mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.383；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.55；钠离子(Na+)-静脉血: 130mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；平均红细胞体积(MCV)-静脉血: 82.6fL；单核细胞百分比(Mono%)-静脉血: 0.042；肌酐(Crea)-静脉血: 46.6umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 44U/L；血红蛋白(Hb)-静脉血: 118g/L；磷(P)-静脉血: 1.18mmol/L；总胆红素(TBIL)-静脉血: 7.2umol/L；平均血小板体积(MPV)-静脉血: 9fL；总蛋白(TP)-静脉血: 67.1g/L；乳酸脱氢酶(LDH)-静脉血: 137.5U/L；间接胆红素(IBIL)-静脉血: 5.3umolL；球蛋白(GLO)-静脉血: 28.1g/L；尿酸(UA)-静脉血: 102.4umol/L；白蛋白(ALB)-静脉血: 39g/L；有核红细胞百分比(NRBC%)-静脉血: 0；单核细胞计数(Mono#)-静脉血: 0.210E9/L；红细胞比容(Hct)-静脉血: 36%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血小板分布宽度(PDW)-静脉血: 9%；阴离子间隙(AG)-静脉血: 14.1；直接胆红素(DBIL)-静脉血: 1.9umol/L；总胆汁酸(TBA)-静脉血: 1.5umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.4；有核红细胞计数(NRBC#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.710E9/L；大血小板百分比(P-LCR%)-静脉血: 16.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 27.1pg；γ-谷氨酰基转移酶(GGT)-静脉血: 62.8U/L；尿素氮(BUN)-静脉血: 3.4mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.39；红细胞计数(RBC#……\n- [全程D55] 检验组合: 平均红细胞血红蛋白含量(MCH)-静脉血: 27.3pg；天门冬氨酸氨基转移酶(AST)-静脉血: 14.5U/L；碱性磷酸酶(ALP)-静脉血: 103.1U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；淋巴细胞计数(Lymph#)-静脉血: 2.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.145；红细胞计数(RBC#)-静脉血: 3.7410E12/L；有核红细胞百分比(NRBC%)-静脉血: 0；大血小板百分比(P-LCR%)-静脉血: 18.5%；红细胞比容(Hct)-静脉血: 32.5%；淋巴细胞百分比(Lymph%)-静脉血: 0.531；丙氨酸氨基转移酶(ALT)-静脉血: 7.8U/L；氯离子(Cl-)-静脉血: 102mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；间接胆红素(IBIL)-静脉血: 1.7umolL；平均血小板体积(MPV)-静脉血: 9.3fL；总钙(Ca)-静脉血: 2.22mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；总蛋白(TP)-静脉血: 64.51g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.6mmol/L；血红蛋白(Hb)-静脉血: 102g/L；血小板比容-静脉血: 15%；中性粒细胞计数(Neut#)-静脉血: 1.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.318；白细胞计数(WBC#)-静脉血: 4.4810E9/L；镁离子(Mg2+)-静脉血: 0.78mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 35.3U/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 314g/L；乳酸脱氢酶(LDH)-静脉血: 139.5U/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；钠离子(Na+)-静脉血: 137.5mmol/L；总胆红素(TBIL)-静脉血: 2.4umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.86；尿素氮(BUN)-静脉血: 3.4mmol/L；肌酐(Crea)-静脉血: 64.6umol/L；总胆汁酸(TBA)-静脉血: 3.8umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 55.2U/L；单核细……\n- [全程D61] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- [全程D61] 检验组合: 碱性磷酸酶(ALP)-静脉血: 108.3U/L；丙氨酸氨基转移酶(ALT)-静脉血: 14.3U/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；直接胆红素(DBIL)-静脉血: 0.6umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24U/L；中性粒细胞百分比(Neut%)-静脉血: 0.512；α-L-岩藻糖苷酶(AFU)-静脉血: 44.3U/L；钾离子(K+)-静脉血: 4.3mmol/L；平均红细胞体积(MCV)-静脉血: 87.2fL；白细胞计数(WBC#)-静脉血: 7.6610E9/L；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；血小板比容-静脉血: 24%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；平均红细胞血红蛋白含量(MCH)-静脉血: 27.2pg；乳酸脱氢酶(LDH)-静脉血: 151.5U/L；阴离子间隙(AG)-静脉血: 16.2；肌酐(Crea)-静脉血: 58.2umol/L；总胆汁酸(TBA)-静脉血: 12.2umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.9mmol/L；球蛋白(GLO)-静脉血: 28.8g/L；淋巴细胞计数(Lymph#)-静脉血: 2.710E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 312g/L；氯离子(Cl-)-静脉血: 100.7mmol/L；尿酸(UA)-静脉血: 217.3umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.47；总钙(Ca)-静脉血: 2.18mmol/L；白蛋白(ALB)-静脉血: 42.2g/L；大血小板百分比(P-LCR%)-静脉血: 17.6%；γ-谷氨酰基转移酶(GGT)-静脉血: 62.4U/L；平均血小板体积(MPV)-静脉血: 9.1fL；磷(P)-静脉血: 1.45mmol/L；间接胆红素(IBIL)-静脉血: 2.4umolL；血小板计数(PLT#)-静脉血: 26810E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；血小板分布宽度(PDW)-静脉血: 9.4%；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.68；总胆红素(TBIL)-静脉血: 3umol/L；单核细胞百分比(Mono%)-静脉血:……\n- [全程D68] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后，对比某次就诊时间片： 鼻咽腔狭窄，鼻咽顶壁、顶后壁、左侧壁见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强后明显强化，肿物占据左侧咽隐窝，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，向前累及双侧后鼻孔，范围较前缩小，右侧咽隐窝变浅，右侧咽旁脂肪间隙及颈动脉鞘区未见异常。 左侧腭帆张提肌、左侧翼内肌上缘及双侧头长肌受侵，右侧腭帆提肌、腭帆张肌未见受侵征象。左侧翼腭窝可见软组织稍增厚，大致同前，右侧翼腭窝、右侧颞下窝未见异常；口咽双侧壁未见增厚。 斜坡、蝶骨基底部、左侧枕骨基底部、左侧岩尖、左侧翼突基底部、左侧翼突内外板、左侧蝶骨大翼骨质破坏，增强扫描后明显强化，大致同前。 左侧破裂孔及左侧海绵窦下份见少许软组织影，增强扫描后明显强化，较前变化不大，右侧海绵窦形态正常。 左侧上颌窦、筛窦、蝶窦、双侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 双侧咽后间隙见小淋巴结，最大短径约3mm，较前稍缩小；双颈II区见肿大淋巴结，最大约为20mm×30mm，边界清楚，信号不均匀，部分见囊变坏死，增强后不均匀强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗后，对比某次就诊时间片： 鼻咽病灶较前范围稍缩小。 颅底骨质破坏，大致同前。 双侧咽后淋巴结小淋巴结，较前稍缩小；双颈II区淋巴结肿大，考虑转移，部分较前缩小。 鼻窦炎、双侧乳突炎。\n- [全程D68] 检验组合: 阴离子间隙(AG)-静脉血: 14.8；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.75；白蛋白(ALB)-静脉血: 42.2g/L；间接胆红素(IBIL)-静脉血: 6.1umolL；总胆红素(TBIL)-静脉血: 8umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.6；血小板分布宽度(PDW)-静脉血: 8.4%；平均红细胞血红蛋白含量(MCH)-静脉血: 27.1pg；钠离子(Na+)-静脉血: 132.5mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 323g/L；直接胆红素(DBIL)-静脉血: 1.9umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 65.5U/L；钾离子(K+)-静脉血: 4.64mmol/L；碱性磷酸酶(ALP)-静脉血: 83.1U/L；白细胞计数(WBC#)-静脉血: 3.3810E9/L；血红蛋白(Hb)-静脉血: 107g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞比容(Hct)-静脉血: 33.1%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44.7；α-L-岩藻糖苷酶(AFU)-静脉血: 49.8U/L；中性粒细胞百分比(Neut%)-静脉血: 0.558；乳酸脱氢酶(LDH)-静脉血: 136.8U/L；尿素氮(BUN)-静脉血: 2.6mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.3mmol/L；单核细胞计数(Mono#)-静脉血: 0.110E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.033；氯离子(Cl-)-静脉血: 94.4mmol/L；肌酐(Crea)-静脉血: 53.8umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.9U/L；球蛋白(GLO)-静脉血: 28.48g/L；平均血小板体积(MPV)-静脉血: 8.3fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；中性粒细胞计数(Neut#)-静脉血: 1.910E9/L；总胆汁酸(TBA)-静脉血: 2.7umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.373；血小板比容-静脉血: 31%；总蛋白(TP)-静脉……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D986] 门急诊记录: 主诉: 鼻咽癌放化疗结束2年，诉轻度口干，听力视力正常，无头晕、头痛。体查：鼻咽未见明确肿物，双颈未扪及明显肿大淋巴结，颅神经（-）甲功五项示正常。鼻咽MRI未见明确复发，腹部B超、胸片未见明确转移。EBV-DNA:0；现病史:；既往史:；个人史:；家族史:；体格检查:\n- [全程D1174] 门急诊记录: 主诉: 鼻咽癌放化疗结束2年，诉轻度口干，听力视力正常，无头晕、头痛。体查：鼻咽未见明确肿物，双颈未扪及明显肿大淋巴结，颅神经（-）甲功五项示正常。鼻咽MRI未见明确复发，腹部B超、胸片未见明确转移。EBV-DNA:0；现病史:；既往史:；个人史:；家族史:；体格检查:\n- [时间未明] 门急诊记录: 主诉:；现病史: 者半年余前无明显诱因出现左侧颈部肿物，无疼痛，逐渐增大，伴有鼻塞、流涕，至当地医院予抗炎对症治疗后，肿物能减小；2月前患者始出现右侧颈部肿物，逐渐增大，伴有鼻塞、流涕，间中有涕血，无发热、畏寒，无头晕、头痛，无周身骨痛等，于当地医院检查ＣＴ示：鼻咽肿物，遂转至我院进一步诊治。门诊拟诊“鼻咽肿物”收入我科进一步治疗。患者起病以来精神、睡眠欠佳，胃纳尚可，二便正常，体重无明显下降。；既往史: 否认高血压、糖尿病及心脏病史，否认结核等传染病史、否认手术、外伤及输血史。；个人史:；家族史: 家族中无类似患者，无家族性遗传病患者，无重大精神病患者。；体格检查: KPS90，一般状况可，鼻咽左侧壁、顶后壁肿物，双颈扪及肿大淋巴结，右颈多枚肿大淋巴结，较大者约6*4及2*2cm,质硬，活动差，左上颈可及一淋巴结，约3*3cm，质中，活动度可，无融合，无皮肤浸润等，左中颈可及一大小约1*1cm质硬淋巴结；张口门齿距约4cm，颅神经征阴性。。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D62] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日查房时自述精神食欲可，睡眠休息好。查体：KPS 90，一般状况可，鼻咽左侧壁、顶后壁肿物，双颈扪及肿大淋巴结，右颈多枚肿大淋巴结，较大者约6*4及2*2cm,质硬，活动差，左上颈可及一淋巴结，约3*3cm，质中，活动度可，无融合，无皮肤浸润等，左中颈可及一大小约1*1cm质硬淋巴结；张口门齿距约4cm，颅神经征阴性。[姓名已隐去]医生信息已隐藏：该病人为鼻咽癌，已接受GP方案诱导化疗2周期。目前排除化疗禁忌症，今日水化，明日再予GP方案行第三周期化疗，遵执。\n- [全程D63] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日查房时无特殊不适主诉，精神食欲可，昨日水化顺利。查体大致同前。[姓名已隐去]医生信息已隐藏：该病人继续按原方案（吉西他滨 1g/m2d1、d8+顺铂 80mg/m2d1）化疗，注意护胃、止吐等对症支持处理，遵执。\n- [全程D66] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 患者化疗输液顺利完成。今日查房时自诉精神食欲可，二便通畅。今继续对症支持治疗，择期复查血常规及血生化。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 提前终止第3周期诱导化疗，直接进入根治性同步放化疗阶段。\nB. 暂停第8天化疗，予重组人粒细胞集落刺激因子升白治疗后复查血常规。\nC. 更改诱导化疗方案为TP（多西他赛+顺铂）进行第4周期治疗。\nD. 继续行第3周期GP方案第8天化疗（吉西他滨联合顺铂），并安排出院。\nE. 计划在第3周期结束后，继续行第4周期GP方案诱导化疗。\nF. 暂停化疗，行双侧颈部淋巴结清扫术及鼻咽原发灶切除术。\nG. 终止后续放疗计划，按完全缓解（CR）状态进入定期随访观察。\nH. 将第8天吉西他滨剂量下调25%后给药，并密切监测血常规。\nI. 继续行第3周期GP方案第8天化疗（吉西他滨），辅以肠内营养支持，并安排出院。\nJ. 暂停治疗，行全身PET-CT检查以重新评估全身肿瘤负荷。\nK. 在第8天化疗基础上加用PD-1抑制剂（如特瑞普利单抗）进行联合治疗。\nL. 立即启动根治性调强放疗，并同步给予吉西他滨单药化疗。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-655ad2033595c09c6c4ce571","patient_id":"patient-4e3ac84b9e1451cea981f98e","turn_id":"turn01","turn_position":1,"turn_type":"initial_workup_choice","gold_letter":"B","gold_action":"完善血常规、肝肾功能、凝血功能，并安排鼻咽部活检。","options":[{"letter":"A","text":"完善血常规、肝肾功能、EBV-DNA检测，并安排全身PET-CT。","is_gold":false},{"letter":"B","text":"完善血常规、肝肾功能、凝血功能，并安排鼻咽部活检。","is_gold":true},{"letter":"C","text":"完善血常规、肝功能、EBV-DNA检测，并直接开始诱导化疗。","is_gold":false},{"letter":"D","text":"完善血常规、肝功能、甲状腺功能检测，并安排胸部CT和腹部增强CT。","is_gold":false},{"letter":"E","text":"完善血常规、肝功能、肾功能及心电图检查，暂不检测内分泌功能。","is_gold":false},{"letter":"F","text":"完善血常规、肝功能、脑垂体激素五项检测，暂不检测甲状腺功能。","is_gold":false},{"letter":"G","text":"完善血常规、肝功能、甲状腺功能及性激素六项检测。","is_gold":false},{"letter":"H","text":"完善血常规、肝功能检测，并安排骨扫描。","is_gold":false},{"letter":"I","text":"完善血常规、肝功能、甲状腺功能及肾上腺皮质激素检测。","is_gold":false},{"letter":"J","text":"完善血常规、肝功能、甲状腺功能及脑垂体激素五项检测。","is_gold":false},{"letter":"K","text":"完善血常规、肝功能、甲状腺功能及脑垂体激素五项检测，并立即行胸椎穿刺活检。","is_gold":false},{"letter":"L","text":"完善血常规、肝功能检测，并安排全身骨髓穿刺。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、头长肌。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D37] 入院记录: 主诉: 回吸性涕血3月；现病史: 患者于某次就诊时间无明显诱因出现涕中带血，量少，色鲜红，呈间歇性，未引起重视。近2个月间歇性出现耳鸣，伴左颈肿物，遂就诊我院。患者无头痛、面麻、复视、听力下降等症状。左侧腭帆提肌、头长肌受侵，右侧腭帆提肌、双侧腭帆张肌及右侧头长肌未见受侵征象。颅底骨质未见破坏征象。右侧咽后淋巴结、左颈II区淋巴肿大。第3、7胸椎局部代谢活跃，建议随诊。胸部平片、腹部彩超未见明显异常。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,涕中带血,左颈肿物,淋巴肿大；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.8℃，P：18次/分，R: 76次/分，BP：116/68mmHg,Ht：165cm，Wt：56.5kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；双侧顶后壁，左侧隐窝可见结节状肿物，左颈II区可扪及肿大淋巴结，大小约10*15mm,质韧，无压痛，活动度可，与周围组织分界清楚。颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善血常规、肝肾功能、EBV-DNA检测，并安排全身PET-CT。\nB. 完善血常规、肝肾功能、凝血功能，并安排鼻咽部活检。\nC. 完善血常规、肝功能、EBV-DNA检测，并直接开始诱导化疗。\nD. 完善血常规、肝功能、甲状腺功能检测，并安排胸部CT和腹部增强CT。\nE. 完善血常规、肝功能、肾功能及心电图检查，暂不检测内分泌功能。\nF. 完善血常规、肝功能、脑垂体激素五项检测，暂不检测甲状腺功能。\nG. 完善血常规、肝功能、甲状腺功能及性激素六项检测。\nH. 完善血常规、肝功能检测，并安排骨扫描。\nI. 完善血常规、肝功能、甲状腺功能及肾上腺皮质激素检测。\nJ. 完善血常规、肝功能、甲状腺功能及脑垂体激素五项检测。\nK. 完善血常规、肝功能、甲状腺功能及脑垂体激素五项检测，并立即行胸椎穿刺活检。\nL. 完善血常规、肝功能检测，并安排全身骨髓穿刺。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、头长肌。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D37] 入院记录: 主诉: 回吸性涕血3月；现病史: 患者于某次就诊时间无明显诱因出现涕中带血，量少，色鲜红，呈间歇性，未引起重视。近2个月间歇性出现耳鸣，伴左颈肿物，遂就诊我院。患者无头痛、面麻、复视、听力下降等症状。左侧腭帆提肌、头长肌受侵，右侧腭帆提肌、双侧腭帆张肌及右侧头长肌未见受侵征象。颅底骨质未见破坏征象。右侧咽后淋巴结、左颈II区淋巴肿大。第3、7胸椎局部代谢活跃，建议随诊。胸部平片、腹部彩超未见明显异常。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,涕中带血,左颈肿物,淋巴肿大；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.8℃，P：18次/分，R: 76次/分，BP：116/68mmHg,Ht：165cm，Wt：56.5kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；双侧顶后壁，左侧隐窝可见结节状肿物，左颈II区可扪及肿大淋巴结，大小约10*15mm,质韧，无压痛，活动度可，与周围组织分界清楚。颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善血常规、肝肾功能、EBV-DNA检测，并安排全身PET-CT。\nB. 完善血常规、肝肾功能、凝血功能，并安排鼻咽部活检。\nC. 完善血常规、肝功能、EBV-DNA检测，并直接开始诱导化疗。\nD. 完善血常规、肝功能、甲状腺功能检测，并安排胸部CT和腹部增强CT。\nE. 完善血常规、肝功能、肾功能及心电图检查，暂不检测内分泌功能。\nF. 完善血常规、肝功能、脑垂体激素五项检测，暂不检测甲状腺功能。\nG. 完善血常规、肝功能、甲状腺功能及性激素六项检测。\nH. 完善血常规、肝功能检测，并安排骨扫描。\nI. 完善血常规、肝功能、甲状腺功能及肾上腺皮质激素检测。\nJ. 完善血常规、肝功能、甲状腺功能及脑垂体激素五项检测。\nK. 完善血常规、肝功能、甲状腺功能及脑垂体激素五项检测，并立即行胸椎穿刺活检。\nL. 完善血常规、肝功能检测，并安排全身骨髓穿刺。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-49bfe4582a9d9a75f21d4be4","patient_id":"patient-4e3ac84b9e1451cea981f98e","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"K","gold_action":"临床分期为 cT2N1M0（AJCC v9 IB期），头长肌受侵定为T2，双侧咽后及单侧颈部淋巴结转移定为N1，骨显像异常考虑良性暂定M0。","options":[{"letter":"A","text":"临床分期为 cT1N1M0（AJCC v9 IB期），病变局限于鼻咽腔及咽隐窝，未见明确周围软组织受侵，骨显像异常考虑良性。","is_gold":false},{"letter":"B","text":"临床分期为 cT2N2M0（AJCC v9 II期），双侧咽后淋巴结受累按分期规则应评为N2，骨显像异常考虑良性。","is_gold":false},{"letter":"C","text":"临床分期为 cT2N1M1（AJCC v9 IVB期），骨显像胸椎及股骨代谢活跃表现已达到多发骨转移诊断标准。","is_gold":false},{"letter":"D","text":"临床分期为 cT3N1M0（AJCC v9 II期），病灶堵塞后鼻孔已构成鼻腔侵犯，按分期规则应评为T3。","is_gold":false},{"letter":"E","text":"临床分期为 cT2N1M0（AJCC v9 II期），头长肌受侵定为T2，单侧颈部淋巴结转移定为N1，综合评为II期。","is_gold":false},{"letter":"F","text":"临床分期暂定 cT2N1Mx，骨显像异常代谢灶性质未明，需常规补充全身PET-CT或骨活检明确M分期。","is_gold":false},{"letter":"G","text":"临床分期为 cT1N2M0（AJCC v9 II期），左侧咽后及左颈II区淋巴结转移评为N2，未见明确T2结构受侵。","is_gold":false},{"letter":"H","text":"临床分期为 cT3N1M0（AJCC v9 II期），腭帆提肌受侵代表侵犯咽旁间隙以外结构，按分期规则应评为T3。","is_gold":false},{"letter":"I","text":"临床分期为 cT2N0M0（AJCC v9 IB期），咽后及颈部淋巴结短径均小于15mm，未达转移诊断标准，应评为N0。","is_gold":false},{"letter":"J","text":"临床分期为 cT4N1M0（AJCC v9 III期），病变侵犯头长肌属于广泛软组织受侵，按分期规则应评为T4。","is_gold":false},{"letter":"K","text":"临床分期为 cT2N1M0（AJCC v9 IB期），头长肌受侵定为T2，双侧咽后及单侧颈部淋巴结转移定为N1，骨显像异常考虑良性暂定M0。","is_gold":true},{"letter":"L","text":"临床分期为 cT2N1M0（AJCC v9 IB期），腭帆提肌受侵定为T2，建议加做全身PET-CT以排除隐匿性转移。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、头长肌。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D37] 入院记录: 主诉: 回吸性涕血3月；现病史: 患者于某次就诊时间无明显诱因出现涕中带血，量少，色鲜红，呈间歇性，未引起重视。近2个月间歇性出现耳鸣，伴左颈肿物，遂就诊我院。患者无头痛、面麻、复视、听力下降等症状。左侧腭帆提肌、头长肌受侵，右侧腭帆提肌、双侧腭帆张肌及右侧头长肌未见受侵征象。颅底骨质未见破坏征象。右侧咽后淋巴结、左颈II区淋巴肿大。第3、7胸椎局部代谢活跃，建议随诊。胸部平片、腹部彩超未见明显异常。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,涕中带血,左颈肿物,淋巴肿大；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.8℃，P：18次/分，R: 76次/分，BP：116/68mmHg,Ht：165cm，Wt：56.5kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；双侧顶后壁，左侧隐窝可见结节状肿物，左颈II区可扪及肿大淋巴结，大小约10*15mm,质韧，无压痛，活动度可，与周围组织分界清楚。颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] 检验组合: 尿酸(UA)-静脉血: 316.2umol/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 5.28mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 7.2umol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；球蛋白(GLO)-静脉血: 32.53g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.54mmol/L；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；磷(P)-静脉血: 1.06mmol/L；总胆汁酸(TBA)-静脉血: 2.6umol/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；Rh血型-静脉血: 阳性；血红蛋白(Hb)-静脉血: 153g/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.94；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.93mg/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；血小板分布宽度(PDW)-静脉血: 11.2%；血小板计数(PLT#)-静脉血: 29810E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；白蛋白(ALB)-静脉血: 48g/L；直接胆红素(DBIL)-静脉血: 1.8umol/L；活化部分凝血活酶时间(APTT)-静脉血: 24.9sec.；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；钠离子(Na+)-静脉血: 139.1mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.39；尿素氮(BUN)-静脉血: 5.9mmol/L；钾离子(K+)-静脉血: 4.04mmol/L；C-反应蛋白(CRP)-静脉血: 9.58mg/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22.5U/L；纤维蛋白原(Fbg)-静脉血: 4.77g/L；凝血酶原时间活动度(PTA)-静脉血: 125.5%；淋巴细胞……\n- [全程D18] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- [全程D18] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约25cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约45×26×26mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D19] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显斑片或结节影。双侧肺门影未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见病变。\n- [全程D20] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 第3、7胸椎及右股骨上段见片状放射性浓聚影。颅骨、胸骨、锁骨、肩胛骨、肋骨、颈椎、腰椎、骶尾骨、髋骨及上肢骨骼放射性分布未见明显异常。；检查结论: 右股骨上段局部代谢活跃，疑良性病变，缺血性坏死待排。 第3、7胸椎局部代谢活跃，建议随诊。\n- [全程D20] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁及左侧壁明显增厚，见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。左侧咽隐窝见肿物占据，右侧咽隐窝存在。左侧腭帆提肌、头长肌受侵，右侧腭帆提肌、双侧腭帆张肌及右侧头长肌未见受侵征象。病灶堵塞左侧后鼻孔。 双侧翼腭窝、双侧颞下窝未见异常；口咽未见异常。 颅底骨质未见破坏征象。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦粘膜未见增厚，双侧乳突充气良好，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 左侧咽后间隙见肿大淋巴结，大小约11mm×14mm；右侧咽后间隙见淋巴结，边界欠清，较大者短径约5mm。 左颈II区见数个淋巴结，部分信号不均匀，较大者大小约10mm×13mm，不均匀强化。颈部双侧Ⅰ、ⅡI区见小淋巴结，边界清，较大者短径约5mm，孤立散在。 甲状腺未见异常信号灶。喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 扫描范围颈椎未见明确骨质破坏。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质未见破坏征象。 左侧咽后淋巴结，考虑转移。右侧咽后淋巴结，考虑转移可能性大。 左颈II区淋巴结，考虑转移可能性大。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 临床分期为 cT1N1M0（AJCC v9 IB期），病变局限于鼻咽腔及咽隐窝，未见明确周围软组织受侵，骨显像异常考虑良性。\nB. 临床分期为 cT2N2M0（AJCC v9 II期），双侧咽后淋巴结受累按分期规则应评为N2，骨显像异常考虑良性。\nC. 临床分期为 cT2N1M1（AJCC v9 IVB期），骨显像胸椎及股骨代谢活跃表现已达到多发骨转移诊断标准。\nD. 临床分期为 cT3N1M0（AJCC v9 II期），病灶堵塞后鼻孔已构成鼻腔侵犯，按分期规则应评为T3。\nE. 临床分期为 cT2N1M0（AJCC v9 II期），头长肌受侵定为T2，单侧颈部淋巴结转移定为N1，综合评为II期。\nF. 临床分期暂定 cT2N1Mx，骨显像异常代谢灶性质未明，需常规补充全身PET-CT或骨活检明确M分期。\nG. 临床分期为 cT1N2M0（AJCC v9 II期），左侧咽后及左颈II区淋巴结转移评为N2，未见明确T2结构受侵。\nH. 临床分期为 cT3N1M0（AJCC v9 II期），腭帆提肌受侵代表侵犯咽旁间隙以外结构，按分期规则应评为T3。\nI. 临床分期为 cT2N0M0（AJCC v9 IB期），咽后及颈部淋巴结短径均小于15mm，未达转移诊断标准，应评为N0。\nJ. 临床分期为 cT4N1M0（AJCC v9 III期），病变侵犯头长肌属于广泛软组织受侵，按分期规则应评为T4。\nK. 临床分期为 cT2N1M0（AJCC v9 IB期），头长肌受侵定为T2，双侧咽后及单侧颈部淋巴结转移定为N1，骨显像异常考虑良性暂定M0。\nL. 临床分期为 cT2N1M0（AJCC v9 IB期），腭帆提肌受侵定为T2，建议加做全身PET-CT以排除隐匿性转移。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、头长肌。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D37] 入院记录: 主诉: 回吸性涕血3月；现病史: 患者于某次就诊时间无明显诱因出现涕中带血，量少，色鲜红，呈间歇性，未引起重视。近2个月间歇性出现耳鸣，伴左颈肿物，遂就诊我院。患者无头痛、面麻、复视、听力下降等症状。左侧腭帆提肌、头长肌受侵，右侧腭帆提肌、双侧腭帆张肌及右侧头长肌未见受侵征象。颅底骨质未见破坏征象。右侧咽后淋巴结、左颈II区淋巴肿大。第3、7胸椎局部代谢活跃，建议随诊。胸部平片、腹部彩超未见明显异常。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,涕中带血,左颈肿物,淋巴肿大；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.8℃，P：18次/分，R: 76次/分，BP：116/68mmHg,Ht：165cm，Wt：56.5kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；双侧顶后壁，左侧隐窝可见结节状肿物，左颈II区可扪及肿大淋巴结，大小约10*15mm,质韧，无压痛，活动度可，与周围组织分界清楚。颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] 检验组合: 尿酸(UA)-静脉血: 316.2umol/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 5.28mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 7.2umol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；球蛋白(GLO)-静脉血: 32.53g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.54mmol/L；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；磷(P)-静脉血: 1.06mmol/L；总胆汁酸(TBA)-静脉血: 2.6umol/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；Rh血型-静脉血: 阳性；血红蛋白(Hb)-静脉血: 153g/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.94；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.93mg/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；血小板分布宽度(PDW)-静脉血: 11.2%；血小板计数(PLT#)-静脉血: 29810E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；白蛋白(ALB)-静脉血: 48g/L；直接胆红素(DBIL)-静脉血: 1.8umol/L；活化部分凝血活酶时间(APTT)-静脉血: 24.9sec.；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；钠离子(Na+)-静脉血: 139.1mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.39；尿素氮(BUN)-静脉血: 5.9mmol/L；钾离子(K+)-静脉血: 4.04mmol/L；C-反应蛋白(CRP)-静脉血: 9.58mg/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22.5U/L；纤维蛋白原(Fbg)-静脉血: 4.77g/L；凝血酶原时间活动度(PTA)-静脉血: 125.5%；淋巴细胞……\n- [全程D18] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- [全程D18] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约25cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约45×26×26mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D19] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显斑片或结节影。双侧肺门影未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见病变。\n- [全程D20] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 第3、7胸椎及右股骨上段见片状放射性浓聚影。颅骨、胸骨、锁骨、肩胛骨、肋骨、颈椎、腰椎、骶尾骨、髋骨及上肢骨骼放射性分布未见明显异常。；检查结论: 右股骨上段局部代谢活跃，疑良性病变，缺血性坏死待排。 第3、7胸椎局部代谢活跃，建议随诊。\n- [全程D20] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁及左侧壁明显增厚，见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。左侧咽隐窝见肿物占据，右侧咽隐窝存在。左侧腭帆提肌、头长肌受侵，右侧腭帆提肌、双侧腭帆张肌及右侧头长肌未见受侵征象。病灶堵塞左侧后鼻孔。 双侧翼腭窝、双侧颞下窝未见异常；口咽未见异常。 颅底骨质未见破坏征象。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦粘膜未见增厚，双侧乳突充气良好，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 左侧咽后间隙见肿大淋巴结，大小约11mm×14mm；右侧咽后间隙见淋巴结，边界欠清，较大者短径约5mm。 左颈II区见数个淋巴结，部分信号不均匀，较大者大小约10mm×13mm，不均匀强化。颈部双侧Ⅰ、ⅡI区见小淋巴结，边界清，较大者短径约5mm，孤立散在。 甲状腺未见异常信号灶。喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 扫描范围颈椎未见明确骨质破坏。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质未见破坏征象。 左侧咽后淋巴结，考虑转移。右侧咽后淋巴结，考虑转移可能性大。 左颈II区淋巴结，考虑转移可能性大。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 临床分期为 cT1N1M0（AJCC v9 IB期），病变局限于鼻咽腔及咽隐窝，未见明确周围软组织受侵，骨显像异常考虑良性。\nB. 临床分期为 cT2N2M0（AJCC v9 II期），双侧咽后淋巴结受累按分期规则应评为N2，骨显像异常考虑良性。\nC. 临床分期为 cT2N1M1（AJCC v9 IVB期），骨显像胸椎及股骨代谢活跃表现已达到多发骨转移诊断标准。\nD. 临床分期为 cT3N1M0（AJCC v9 II期），病灶堵塞后鼻孔已构成鼻腔侵犯，按分期规则应评为T3。\nE. 临床分期为 cT2N1M0（AJCC v9 II期），头长肌受侵定为T2，单侧颈部淋巴结转移定为N1，综合评为II期。\nF. 临床分期暂定 cT2N1Mx，骨显像异常代谢灶性质未明，需常规补充全身PET-CT或骨活检明确M分期。\nG. 临床分期为 cT1N2M0（AJCC v9 II期），左侧咽后及左颈II区淋巴结转移评为N2，未见明确T2结构受侵。\nH. 临床分期为 cT3N1M0（AJCC v9 II期），腭帆提肌受侵代表侵犯咽旁间隙以外结构，按分期规则应评为T3。\nI. 临床分期为 cT2N0M0（AJCC v9 IB期），咽后及颈部淋巴结短径均小于15mm，未达转移诊断标准，应评为N0。\nJ. 临床分期为 cT4N1M0（AJCC v9 III期），病变侵犯头长肌属于广泛软组织受侵，按分期规则应评为T4。\nK. 临床分期为 cT2N1M0（AJCC v9 IB期），头长肌受侵定为T2，双侧咽后及单侧颈部淋巴结转移定为N1，骨显像异常考虑良性暂定M0。\nL. 临床分期为 cT2N1M0（AJCC v9 IB期），腭帆提肌受侵定为T2，建议加做全身PET-CT以排除隐匿性转移。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-04c8674f03cec4de991fcf32","patient_id":"patient-4e3ac84b9e1451cea981f98e","turn_id":"turn04","turn_position":3,"turn_type":"initial_treatment_selection","gold_letter":"A","gold_action":"单纯根治性放射治疗或根治性放化疗","options":[{"letter":"A","text":"单纯根治性放射治疗或根治性放化疗","is_gold":true},{"letter":"B","text":"诱导化疗后序贯单纯根治性放射治疗","is_gold":false},{"letter":"C","text":"诱导化疗后序贯根治性放化疗","is_gold":false},{"letter":"D","text":"单纯根治性放射治疗后序贯辅助化疗","is_gold":false},{"letter":"E","text":"根治性放化疗后序贯辅助化疗","is_gold":false},{"letter":"F","text":"诱导化疗后序贯根治性放化疗及辅助化疗","is_gold":false},{"letter":"G","text":"姑息性放射治疗联合全身系统性化疗","is_gold":false},{"letter":"H","text":"单纯根治性放射治疗联合EGFR靶向治疗","is_gold":false},{"letter":"I","text":"诱导化疗联合EGFR靶向治疗后序贯放疗","is_gold":false},{"letter":"J","text":"根治性放化疗联合PD-1抑制剂治疗","is_gold":false},{"letter":"K","text":"诱导化疗联合PD-1抑制剂后序贯放化疗","is_gold":false},{"letter":"L","text":"单纯全身系统性化疗","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、头长肌。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D37] 入院记录: 主诉: 回吸性涕血3月；现病史: 患者于某次就诊时间无明显诱因出现涕中带血，量少，色鲜红，呈间歇性，未引起重视。近2个月间歇性出现耳鸣，伴左颈肿物，遂就诊我院。患者无头痛、面麻、复视、听力下降等症状。左侧腭帆提肌、头长肌受侵，右侧腭帆提肌、双侧腭帆张肌及右侧头长肌未见受侵征象。颅底骨质未见破坏征象。右侧咽后淋巴结、左颈II区淋巴肿大。第3、7胸椎局部代谢活跃，建议随诊。胸部平片、腹部彩超未见明显异常。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,涕中带血,左颈肿物,淋巴肿大；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.8℃，P：18次/分，R: 76次/分，BP：116/68mmHg,Ht：165cm，Wt：56.5kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；双侧顶后壁，左侧隐窝可见结节状肿物，左颈II区可扪及肿大淋巴结，大小约10*15mm,质韧，无压痛，活动度可，与周围组织分界清楚。颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] 检验组合: 尿酸(UA)-静脉血: 316.2umol/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 5.28mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 7.2umol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；球蛋白(GLO)-静脉血: 32.53g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.54mmol/L；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；磷(P)-静脉血: 1.06mmol/L；总胆汁酸(TBA)-静脉血: 2.6umol/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；Rh血型-静脉血: 阳性；血红蛋白(Hb)-静脉血: 153g/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.94；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.93mg/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；血小板分布宽度(PDW)-静脉血: 11.2%；血小板计数(PLT#)-静脉血: 29810E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；白蛋白(ALB)-静脉血: 48g/L；直接胆红素(DBIL)-静脉血: 1.8umol/L；活化部分凝血活酶时间(APTT)-静脉血: 24.9sec.；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；钠离子(Na+)-静脉血: 139.1mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.39；尿素氮(BUN)-静脉血: 5.9mmol/L；钾离子(K+)-静脉血: 4.04mmol/L；C-反应蛋白(CRP)-静脉血: 9.58mg/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22.5U/L；纤维蛋白原(Fbg)-静脉血: 4.77g/L；凝血酶原时间活动度(PTA)-静脉血: 125.5%；淋巴细胞……\n- [全程D18] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- [全程D18] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约25cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约45×26×26mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D19] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显斑片或结节影。双侧肺门影未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见病变。\n- [全程D20] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 第3、7胸椎及右股骨上段见片状放射性浓聚影。颅骨、胸骨、锁骨、肩胛骨、肋骨、颈椎、腰椎、骶尾骨、髋骨及上肢骨骼放射性分布未见明显异常。；检查结论: 右股骨上段局部代谢活跃，疑良性病变，缺血性坏死待排。 第3、7胸椎局部代谢活跃，建议随诊。\n- [全程D20] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁及左侧壁明显增厚，见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。左侧咽隐窝见肿物占据，右侧咽隐窝存在。左侧腭帆提肌、头长肌受侵，右侧腭帆提肌、双侧腭帆张肌及右侧头长肌未见受侵征象。病灶堵塞左侧后鼻孔。 双侧翼腭窝、双侧颞下窝未见异常；口咽未见异常。 颅底骨质未见破坏征象。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦粘膜未见增厚，双侧乳突充气良好，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 左侧咽后间隙见肿大淋巴结，大小约11mm×14mm；右侧咽后间隙见淋巴结，边界欠清，较大者短径约5mm。 左颈II区见数个淋巴结，部分信号不均匀，较大者大小约10mm×13mm，不均匀强化。颈部双侧Ⅰ、ⅡI区见小淋巴结，边界清，较大者短径约5mm，孤立散在。 甲状腺未见异常信号灶。喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 扫描范围颈椎未见明确骨质破坏。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质未见破坏征象。 左侧咽后淋巴结，考虑转移。右侧咽后淋巴结，考虑转移可能性大。 左颈II区淋巴结，考虑转移可能性大。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D23] 检验组合: 天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.75；乳酸脱氢酶(LDH)-静脉血: 285.9U/L；总胆汁酸(TBA)-静脉血: 12.7umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 220U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 20.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 249.9U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 165.4U/L；碱性磷酸酶(ALP)-静脉血: 161.1U/L\n- [全程D37] 检验组合: 甲状腺球蛋白(TG)-静脉血: 13.08ng/ml；平均血小板体积(MPV)-静脉血: 9.9fL；α-L-岩藻糖苷酶(AFU)-静脉血: 21.1U/L；促卵泡刺激素(FSH)-静脉血: 6.26mIU/ml；血小板比容-静脉血: 29%；血小板分布宽度(PDW)-静脉血: 11.3%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.2；催乳素(PRL)-静脉血: 277.6uIU/ml；大血小板百分比(P-LCR%)-静脉血: 23.9%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；促黄体生成素(LH)-静脉血: 9.22mIU/ml；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；血小板计数(PLT#)-静脉血: 29710E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.262；γ-谷氨酰基转移酶(GGT)-静脉血: 227.5U/L；生长激素(GH)-静脉血: 0.54ng/ml；碱性磷酸酶(ALP)-静脉血: 164.9U/L；乳酸脱氢酶(LDH)-静脉血: 170.2U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 38.5；平均红细胞体积(MCV)-静脉血: 94fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；血红蛋白(Hb)-静脉血: 140g/L；中性粒细胞计数(Neut#)-静脉血: 4.410E9/L；促甲状腺激素(TSH)-静脉血: 4.45uIU/ml；有核红细胞计数(NRBC#)-静脉血: 010E9/L；单核细胞百分比(Mono%)-静脉血: 0.105；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.619；红细胞计数(RBC#)-静脉血: 4.5110E12/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；红细胞比容(Hct)-静脉血: 42.4%；总胆汁酸(TBA)-静脉血: 2umol/L；甲状腺过氧化物酶抗体(TPO-Ab)-静脉血: 14.45U/ml；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.58；丙氨酸氨基转移酶(ALT)-静脉血:……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 单纯根治性放射治疗或根治性放化疗\nB. 诱导化疗后序贯单纯根治性放射治疗\nC. 诱导化疗后序贯根治性放化疗\nD. 单纯根治性放射治疗后序贯辅助化疗\nE. 根治性放化疗后序贯辅助化疗\nF. 诱导化疗后序贯根治性放化疗及辅助化疗\nG. 姑息性放射治疗联合全身系统性化疗\nH. 单纯根治性放射治疗联合EGFR靶向治疗\nI. 诱导化疗联合EGFR靶向治疗后序贯放疗\nJ. 根治性放化疗联合PD-1抑制剂治疗\nK. 诱导化疗联合PD-1抑制剂后序贯放化疗\nL. 单纯全身系统性化疗\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、头长肌。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D37] 入院记录: 主诉: 回吸性涕血3月；现病史: 患者于某次就诊时间无明显诱因出现涕中带血，量少，色鲜红，呈间歇性，未引起重视。近2个月间歇性出现耳鸣，伴左颈肿物，遂就诊我院。患者无头痛、面麻、复视、听力下降等症状。左侧腭帆提肌、头长肌受侵，右侧腭帆提肌、双侧腭帆张肌及右侧头长肌未见受侵征象。颅底骨质未见破坏征象。右侧咽后淋巴结、左颈II区淋巴肿大。第3、7胸椎局部代谢活跃，建议随诊。胸部平片、腹部彩超未见明显异常。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,涕中带血,左颈肿物,淋巴肿大；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.8℃，P：18次/分，R: 76次/分，BP：116/68mmHg,Ht：165cm，Wt：56.5kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；双侧顶后壁，左侧隐窝可见结节状肿物，左颈II区可扪及肿大淋巴结，大小约10*15mm,质韧，无压痛，活动度可，与周围组织分界清楚。颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] 检验组合: 尿酸(UA)-静脉血: 316.2umol/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 5.28mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 7.2umol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；球蛋白(GLO)-静脉血: 32.53g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.54mmol/L；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；磷(P)-静脉血: 1.06mmol/L；总胆汁酸(TBA)-静脉血: 2.6umol/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；Rh血型-静脉血: 阳性；血红蛋白(Hb)-静脉血: 153g/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.94；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.93mg/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；血小板分布宽度(PDW)-静脉血: 11.2%；血小板计数(PLT#)-静脉血: 29810E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；白蛋白(ALB)-静脉血: 48g/L；直接胆红素(DBIL)-静脉血: 1.8umol/L；活化部分凝血活酶时间(APTT)-静脉血: 24.9sec.；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；钠离子(Na+)-静脉血: 139.1mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.39；尿素氮(BUN)-静脉血: 5.9mmol/L；钾离子(K+)-静脉血: 4.04mmol/L；C-反应蛋白(CRP)-静脉血: 9.58mg/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22.5U/L；纤维蛋白原(Fbg)-静脉血: 4.77g/L；凝血酶原时间活动度(PTA)-静脉血: 125.5%；淋巴细胞……\n- [全程D18] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- [全程D18] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约25cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约45×26×26mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D19] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显斑片或结节影。双侧肺门影未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见病变。\n- [全程D20] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 第3、7胸椎及右股骨上段见片状放射性浓聚影。颅骨、胸骨、锁骨、肩胛骨、肋骨、颈椎、腰椎、骶尾骨、髋骨及上肢骨骼放射性分布未见明显异常。；检查结论: 右股骨上段局部代谢活跃，疑良性病变，缺血性坏死待排。 第3、7胸椎局部代谢活跃，建议随诊。\n- [全程D20] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁及左侧壁明显增厚，见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。左侧咽隐窝见肿物占据，右侧咽隐窝存在。左侧腭帆提肌、头长肌受侵，右侧腭帆提肌、双侧腭帆张肌及右侧头长肌未见受侵征象。病灶堵塞左侧后鼻孔。 双侧翼腭窝、双侧颞下窝未见异常；口咽未见异常。 颅底骨质未见破坏征象。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦粘膜未见增厚，双侧乳突充气良好，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 左侧咽后间隙见肿大淋巴结，大小约11mm×14mm；右侧咽后间隙见淋巴结，边界欠清，较大者短径约5mm。 左颈II区见数个淋巴结，部分信号不均匀，较大者大小约10mm×13mm，不均匀强化。颈部双侧Ⅰ、ⅡI区见小淋巴结，边界清，较大者短径约5mm，孤立散在。 甲状腺未见异常信号灶。喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 扫描范围颈椎未见明确骨质破坏。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质未见破坏征象。 左侧咽后淋巴结，考虑转移。右侧咽后淋巴结，考虑转移可能性大。 左颈II区淋巴结，考虑转移可能性大。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D23] 检验组合: 天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.75；乳酸脱氢酶(LDH)-静脉血: 285.9U/L；总胆汁酸(TBA)-静脉血: 12.7umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 220U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 20.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 249.9U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 165.4U/L；碱性磷酸酶(ALP)-静脉血: 161.1U/L\n- [全程D37] 检验组合: 甲状腺球蛋白(TG)-静脉血: 13.08ng/ml；平均血小板体积(MPV)-静脉血: 9.9fL；α-L-岩藻糖苷酶(AFU)-静脉血: 21.1U/L；促卵泡刺激素(FSH)-静脉血: 6.26mIU/ml；血小板比容-静脉血: 29%；血小板分布宽度(PDW)-静脉血: 11.3%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.2；催乳素(PRL)-静脉血: 277.6uIU/ml；大血小板百分比(P-LCR%)-静脉血: 23.9%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；促黄体生成素(LH)-静脉血: 9.22mIU/ml；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；血小板计数(PLT#)-静脉血: 29710E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.262；γ-谷氨酰基转移酶(GGT)-静脉血: 227.5U/L；生长激素(GH)-静脉血: 0.54ng/ml；碱性磷酸酶(ALP)-静脉血: 164.9U/L；乳酸脱氢酶(LDH)-静脉血: 170.2U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 38.5；平均红细胞体积(MCV)-静脉血: 94fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；血红蛋白(Hb)-静脉血: 140g/L；中性粒细胞计数(Neut#)-静脉血: 4.410E9/L；促甲状腺激素(TSH)-静脉血: 4.45uIU/ml；有核红细胞计数(NRBC#)-静脉血: 010E9/L；单核细胞百分比(Mono%)-静脉血: 0.105；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.619；红细胞计数(RBC#)-静脉血: 4.5110E12/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；红细胞比容(Hct)-静脉血: 42.4%；总胆汁酸(TBA)-静脉血: 2umol/L；甲状腺过氧化物酶抗体(TPO-Ab)-静脉血: 14.45U/ml；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.58；丙氨酸氨基转移酶(ALT)-静脉血:……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 单纯根治性放射治疗或根治性放化疗\nB. 诱导化疗后序贯单纯根治性放射治疗\nC. 诱导化疗后序贯根治性放化疗\nD. 单纯根治性放射治疗后序贯辅助化疗\nE. 根治性放化疗后序贯辅助化疗\nF. 诱导化疗后序贯根治性放化疗及辅助化疗\nG. 姑息性放射治疗联合全身系统性化疗\nH. 单纯根治性放射治疗联合EGFR靶向治疗\nI. 诱导化疗联合EGFR靶向治疗后序贯放疗\nJ. 根治性放化疗联合PD-1抑制剂治疗\nK. 诱导化疗联合PD-1抑制剂后序贯放化疗\nL. 单纯全身系统性化疗\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-453547f6b6c780c6834cd926","patient_id":"patient-4e3ac84b9e1451cea981f98e","turn_id":"turn05","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"B","gold_action":"继续当前调强放疗，定期监测血常规及肝肾功能，暂不予特殊药物干预。","options":[{"letter":"A","text":"暂停放疗，给予静脉保肝降酶药物，待转氨酶正常后重启放疗","is_gold":false},{"letter":"B","text":"继续调强放疗，定期监测血常规及肝肾功能，暂不予特殊药物干预","is_gold":true},{"letter":"C","text":"暂停放疗，经验性静脉滴注广谱抗生素，待中性粒细胞正常后重启放疗","is_gold":false},{"letter":"D","text":"继续调强放疗，皮下注射重组人粒细胞集落刺激因子","is_gold":false},{"letter":"E","text":"暂停放疗，给予大剂量静脉水化及利尿治疗","is_gold":false},{"letter":"F","text":"继续调强放疗，计划在下一周期将顺铂剂量下调20%","is_gold":false},{"letter":"G","text":"暂停放疗，完善血培养及降钙素原检查","is_gold":false},{"letter":"H","text":"继续调强放疗，静脉滴注大剂量糖皮质激素","is_gold":false},{"letter":"I","text":"暂停放疗，给予静脉输注人血白蛋白及肠外营养支持","is_gold":false},{"letter":"J","text":"继续调强放疗，计划将下一周期同期化疗药物替换为卡铂","is_gold":false},{"letter":"K","text":"暂停放疗，复查鼻咽及颈部增强MRI","is_gold":false},{"letter":"L","text":"继续调强放疗，取消后续同期化疗周期","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、头长肌。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D37] 入院记录: 主诉: 回吸性涕血3月；现病史: 患者于某次就诊时间无明显诱因出现涕中带血，量少，色鲜红，呈间歇性，未引起重视。近2个月间歇性出现耳鸣，伴左颈肿物，遂就诊我院。患者无头痛、面麻、复视、听力下降等症状。左侧腭帆提肌、头长肌受侵，右侧腭帆提肌、双侧腭帆张肌及右侧头长肌未见受侵征象。颅底骨质未见破坏征象。右侧咽后淋巴结、左颈II区淋巴肿大。第3、7胸椎局部代谢活跃，建议随诊。胸部平片、腹部彩超未见明显异常。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,涕中带血,左颈肿物,淋巴肿大；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.8℃，P：18次/分，R: 76次/分，BP：116/68mmHg,Ht：165cm，Wt：56.5kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；双侧顶后壁，左侧隐窝可见结节状肿物，左颈II区可扪及肿大淋巴结，大小约10*15mm,质韧，无压痛，活动度可，与周围组织分界清楚。颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] 检验组合: 尿酸(UA)-静脉血: 316.2umol/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 5.28mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 7.2umol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；球蛋白(GLO)-静脉血: 32.53g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.54mmol/L；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；磷(P)-静脉血: 1.06mmol/L；总胆汁酸(TBA)-静脉血: 2.6umol/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；Rh血型-静脉血: 阳性；血红蛋白(Hb)-静脉血: 153g/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.94；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.93mg/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；血小板分布宽度(PDW)-静脉血: 11.2%；血小板计数(PLT#)-静脉血: 29810E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；白蛋白(ALB)-静脉血: 48g/L；直接胆红素(DBIL)-静脉血: 1.8umol/L；活化部分凝血活酶时间(APTT)-静脉血: 24.9sec.；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；钠离子(Na+)-静脉血: 139.1mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.39；尿素氮(BUN)-静脉血: 5.9mmol/L；钾离子(K+)-静脉血: 4.04mmol/L；C-反应蛋白(CRP)-静脉血: 9.58mg/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22.5U/L；纤维蛋白原(Fbg)-静脉血: 4.77g/L；凝血酶原时间活动度(PTA)-静脉血: 125.5%；淋巴细胞……\n- [全程D18] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- [全程D18] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约25cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约45×26×26mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D19] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显斑片或结节影。双侧肺门影未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见病变。\n- [全程D20] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 第3、7胸椎及右股骨上段见片状放射性浓聚影。颅骨、胸骨、锁骨、肩胛骨、肋骨、颈椎、腰椎、骶尾骨、髋骨及上肢骨骼放射性分布未见明显异常。；检查结论: 右股骨上段局部代谢活跃，疑良性病变，缺血性坏死待排。 第3、7胸椎局部代谢活跃，建议随诊。\n- [全程D20] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁及左侧壁明显增厚，见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。左侧咽隐窝见肿物占据，右侧咽隐窝存在。左侧腭帆提肌、头长肌受侵，右侧腭帆提肌、双侧腭帆张肌及右侧头长肌未见受侵征象。病灶堵塞左侧后鼻孔。 双侧翼腭窝、双侧颞下窝未见异常；口咽未见异常。 颅底骨质未见破坏征象。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦粘膜未见增厚，双侧乳突充气良好，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 左侧咽后间隙见肿大淋巴结，大小约11mm×14mm；右侧咽后间隙见淋巴结，边界欠清，较大者短径约5mm。 左颈II区见数个淋巴结，部分信号不均匀，较大者大小约10mm×13mm，不均匀强化。颈部双侧Ⅰ、ⅡI区见小淋巴结，边界清，较大者短径约5mm，孤立散在。 甲状腺未见异常信号灶。喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 扫描范围颈椎未见明确骨质破坏。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质未见破坏征象。 左侧咽后淋巴结，考虑转移。右侧咽后淋巴结，考虑转移可能性大。 左颈II区淋巴结，考虑转移可能性大。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D23] 检验组合: 天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.75；乳酸脱氢酶(LDH)-静脉血: 285.9U/L；总胆汁酸(TBA)-静脉血: 12.7umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 220U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 20.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 249.9U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 165.4U/L；碱性磷酸酶(ALP)-静脉血: 161.1U/L\n- [全程D37] 检验组合: 甲状腺球蛋白(TG)-静脉血: 13.08ng/ml；平均血小板体积(MPV)-静脉血: 9.9fL；α-L-岩藻糖苷酶(AFU)-静脉血: 21.1U/L；促卵泡刺激素(FSH)-静脉血: 6.26mIU/ml；血小板比容-静脉血: 29%；血小板分布宽度(PDW)-静脉血: 11.3%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.2；催乳素(PRL)-静脉血: 277.6uIU/ml；大血小板百分比(P-LCR%)-静脉血: 23.9%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；促黄体生成素(LH)-静脉血: 9.22mIU/ml；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；血小板计数(PLT#)-静脉血: 29710E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.262；γ-谷氨酰基转移酶(GGT)-静脉血: 227.5U/L；生长激素(GH)-静脉血: 0.54ng/ml；碱性磷酸酶(ALP)-静脉血: 164.9U/L；乳酸脱氢酶(LDH)-静脉血: 170.2U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 38.5；平均红细胞体积(MCV)-静脉血: 94fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；血红蛋白(Hb)-静脉血: 140g/L；中性粒细胞计数(Neut#)-静脉血: 4.410E9/L；促甲状腺激素(TSH)-静脉血: 4.45uIU/ml；有核红细胞计数(NRBC#)-静脉血: 010E9/L；单核细胞百分比(Mono%)-静脉血: 0.105；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.619；红细胞计数(RBC#)-静脉血: 4.5110E12/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；红细胞比容(Hct)-静脉血: 42.4%；总胆汁酸(TBA)-静脉血: 2umol/L；甲状腺过氧化物酶抗体(TPO-Ab)-静脉血: 14.45U/ml；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.58；丙氨酸氨基转移酶(ALT)-静脉血:……\n- [全程D44] 检验组合: 平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；单核细胞百分比(Mono%)-静脉血: 0.084；载脂蛋白B(apoB)-静脉血: 1.02g/L；磷(P)-静脉血: 1.54mmol/L；钠离子(Na+)-静脉血: 137mmol/L；白蛋白(ALB)-静脉血: 41.2g/L；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 38.1U/L；总胆固醇(TC)-静脉血: 5.9mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；中性粒细胞百分比(Neut%)-静脉血: 0.789；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.65mmol/L；间接胆红素(IBIL)-静脉血: 5.6umolL；尿素氮(BUN)-静脉血: 7.73mmol/L；总胆红素(TBIL)-静脉血: 7.4umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.4mmol/L；C-反应蛋白(CRP)-静脉血: 9.62mg/L；血小板比容-静脉血: 27%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；大血小板百分比(P-LCR%)-静脉血: 26.8%；α-L-岩藻糖苷酶(AFU)-静脉血: 35U/L；钾离子(K+)-静脉血: 4.2mmol/L；直接胆红素(DBIL)-静脉血: 1.8umol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.6；尿酸(UA)-静脉血: 288.4umol/L；碱性磷酸酶(ALP)-静脉血: 138.4U/L；中性粒细胞计数(Neut#)-静脉血: 11.910E9/L；总钙(Ca)-静脉血: 2.25mmol/L；肌酐(Crea)-静脉血: 84umol/L；总胆汁酸(TBA)-静脉血: 4.1umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.24；球蛋白(GLO)-静脉血: 33.12g/L；氯离子(Cl-)-静脉血: 97.5mmol/L；甘油三酯(TG)-静脉血: 2.9mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；丙氨酸氨基转移酶(ALT)-静脉血:……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D39] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者一般情况可，未诉特殊不适。按[计划性表述已隐藏]同期放化疗，放疗技术采用调强放疗9野，处方剂量：PTVp 7029cGy/33F， PTVn_L 6600cGy/33F,PTVn_R 6000cGy/33F,PTV1 6000cGy/33F,PTV2 5400cGy/33F。目前放疗计划已完善，予以今日复位验证后执行放疗。\n- [全程D40] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者精神食欲可，放疗2次，无特殊不适，查体无特殊。今日按[计划性表述已隐藏]第一程DDP同期化疗（顺铂 80mg/m2），若无特殊不适，今日化疗结束后予以出院。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，给予静脉保肝降酶药物，待转氨酶正常后重启放疗\nB. 继续调强放疗，定期监测血常规及肝肾功能，暂不予特殊药物干预\nC. 暂停放疗，经验性静脉滴注广谱抗生素，待中性粒细胞正常后重启放疗\nD. 继续调强放疗，皮下注射重组人粒细胞集落刺激因子\nE. 暂停放疗，给予大剂量静脉水化及利尿治疗\nF. 继续调强放疗，计划在下一周期将顺铂剂量下调20%\nG. 暂停放疗，完善血培养及降钙素原检查\nH. 继续调强放疗，静脉滴注大剂量糖皮质激素\nI. 暂停放疗，给予静脉输注人血白蛋白及肠外营养支持\nJ. 继续调强放疗，计划将下一周期同期化疗药物替换为卡铂\nK. 暂停放疗，复查鼻咽及颈部增强MRI\nL. 继续调强放疗，取消后续同期化疗周期\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、头长肌。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D37] 入院记录: 主诉: 回吸性涕血3月；现病史: 患者于某次就诊时间无明显诱因出现涕中带血，量少，色鲜红，呈间歇性，未引起重视。近2个月间歇性出现耳鸣，伴左颈肿物，遂就诊我院。患者无头痛、面麻、复视、听力下降等症状。左侧腭帆提肌、头长肌受侵，右侧腭帆提肌、双侧腭帆张肌及右侧头长肌未见受侵征象。颅底骨质未见破坏征象。右侧咽后淋巴结、左颈II区淋巴肿大。第3、7胸椎局部代谢活跃，建议随诊。胸部平片、腹部彩超未见明显异常。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,涕中带血,左颈肿物,淋巴肿大；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.8℃，P：18次/分，R: 76次/分，BP：116/68mmHg,Ht：165cm，Wt：56.5kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；双侧顶后壁，左侧隐窝可见结节状肿物，左颈II区可扪及肿大淋巴结，大小约10*15mm,质韧，无压痛，活动度可，与周围组织分界清楚。颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] 检验组合: 尿酸(UA)-静脉血: 316.2umol/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 5.28mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 7.2umol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；球蛋白(GLO)-静脉血: 32.53g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.54mmol/L；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；磷(P)-静脉血: 1.06mmol/L；总胆汁酸(TBA)-静脉血: 2.6umol/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；Rh血型-静脉血: 阳性；血红蛋白(Hb)-静脉血: 153g/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.94；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.93mg/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；血小板分布宽度(PDW)-静脉血: 11.2%；血小板计数(PLT#)-静脉血: 29810E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；白蛋白(ALB)-静脉血: 48g/L；直接胆红素(DBIL)-静脉血: 1.8umol/L；活化部分凝血活酶时间(APTT)-静脉血: 24.9sec.；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；钠离子(Na+)-静脉血: 139.1mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.39；尿素氮(BUN)-静脉血: 5.9mmol/L；钾离子(K+)-静脉血: 4.04mmol/L；C-反应蛋白(CRP)-静脉血: 9.58mg/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22.5U/L；纤维蛋白原(Fbg)-静脉血: 4.77g/L；凝血酶原时间活动度(PTA)-静脉血: 125.5%；淋巴细胞……\n- [全程D18] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- [全程D18] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约25cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约45×26×26mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D19] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显斑片或结节影。双侧肺门影未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见病变。\n- [全程D20] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 第3、7胸椎及右股骨上段见片状放射性浓聚影。颅骨、胸骨、锁骨、肩胛骨、肋骨、颈椎、腰椎、骶尾骨、髋骨及上肢骨骼放射性分布未见明显异常。；检查结论: 右股骨上段局部代谢活跃，疑良性病变，缺血性坏死待排。 第3、7胸椎局部代谢活跃，建议随诊。\n- [全程D20] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁及左侧壁明显增厚，见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。左侧咽隐窝见肿物占据，右侧咽隐窝存在。左侧腭帆提肌、头长肌受侵，右侧腭帆提肌、双侧腭帆张肌及右侧头长肌未见受侵征象。病灶堵塞左侧后鼻孔。 双侧翼腭窝、双侧颞下窝未见异常；口咽未见异常。 颅底骨质未见破坏征象。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦粘膜未见增厚，双侧乳突充气良好，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 左侧咽后间隙见肿大淋巴结，大小约11mm×14mm；右侧咽后间隙见淋巴结，边界欠清，较大者短径约5mm。 左颈II区见数个淋巴结，部分信号不均匀，较大者大小约10mm×13mm，不均匀强化。颈部双侧Ⅰ、ⅡI区见小淋巴结，边界清，较大者短径约5mm，孤立散在。 甲状腺未见异常信号灶。喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 扫描范围颈椎未见明确骨质破坏。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质未见破坏征象。 左侧咽后淋巴结，考虑转移。右侧咽后淋巴结，考虑转移可能性大。 左颈II区淋巴结，考虑转移可能性大。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D23] 检验组合: 天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.75；乳酸脱氢酶(LDH)-静脉血: 285.9U/L；总胆汁酸(TBA)-静脉血: 12.7umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 220U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 20.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 249.9U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 165.4U/L；碱性磷酸酶(ALP)-静脉血: 161.1U/L\n- [全程D37] 检验组合: 甲状腺球蛋白(TG)-静脉血: 13.08ng/ml；平均血小板体积(MPV)-静脉血: 9.9fL；α-L-岩藻糖苷酶(AFU)-静脉血: 21.1U/L；促卵泡刺激素(FSH)-静脉血: 6.26mIU/ml；血小板比容-静脉血: 29%；血小板分布宽度(PDW)-静脉血: 11.3%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.2；催乳素(PRL)-静脉血: 277.6uIU/ml；大血小板百分比(P-LCR%)-静脉血: 23.9%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；促黄体生成素(LH)-静脉血: 9.22mIU/ml；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；血小板计数(PLT#)-静脉血: 29710E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.262；γ-谷氨酰基转移酶(GGT)-静脉血: 227.5U/L；生长激素(GH)-静脉血: 0.54ng/ml；碱性磷酸酶(ALP)-静脉血: 164.9U/L；乳酸脱氢酶(LDH)-静脉血: 170.2U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 38.5；平均红细胞体积(MCV)-静脉血: 94fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；血红蛋白(Hb)-静脉血: 140g/L；中性粒细胞计数(Neut#)-静脉血: 4.410E9/L；促甲状腺激素(TSH)-静脉血: 4.45uIU/ml；有核红细胞计数(NRBC#)-静脉血: 010E9/L；单核细胞百分比(Mono%)-静脉血: 0.105；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.619；红细胞计数(RBC#)-静脉血: 4.5110E12/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；红细胞比容(Hct)-静脉血: 42.4%；总胆汁酸(TBA)-静脉血: 2umol/L；甲状腺过氧化物酶抗体(TPO-Ab)-静脉血: 14.45U/ml；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.58；丙氨酸氨基转移酶(ALT)-静脉血:……\n- [全程D44] 检验组合: 平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；单核细胞百分比(Mono%)-静脉血: 0.084；载脂蛋白B(apoB)-静脉血: 1.02g/L；磷(P)-静脉血: 1.54mmol/L；钠离子(Na+)-静脉血: 137mmol/L；白蛋白(ALB)-静脉血: 41.2g/L；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 38.1U/L；总胆固醇(TC)-静脉血: 5.9mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；中性粒细胞百分比(Neut%)-静脉血: 0.789；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.65mmol/L；间接胆红素(IBIL)-静脉血: 5.6umolL；尿素氮(BUN)-静脉血: 7.73mmol/L；总胆红素(TBIL)-静脉血: 7.4umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.4mmol/L；C-反应蛋白(CRP)-静脉血: 9.62mg/L；血小板比容-静脉血: 27%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；大血小板百分比(P-LCR%)-静脉血: 26.8%；α-L-岩藻糖苷酶(AFU)-静脉血: 35U/L；钾离子(K+)-静脉血: 4.2mmol/L；直接胆红素(DBIL)-静脉血: 1.8umol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.6；尿酸(UA)-静脉血: 288.4umol/L；碱性磷酸酶(ALP)-静脉血: 138.4U/L；中性粒细胞计数(Neut#)-静脉血: 11.910E9/L；总钙(Ca)-静脉血: 2.25mmol/L；肌酐(Crea)-静脉血: 84umol/L；总胆汁酸(TBA)-静脉血: 4.1umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.24；球蛋白(GLO)-静脉血: 33.12g/L；氯离子(Cl-)-静脉血: 97.5mmol/L；甘油三酯(TG)-静脉血: 2.9mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；丙氨酸氨基转移酶(ALT)-静脉血:……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D39] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者一般情况可，未诉特殊不适。按[计划性表述已隐藏]同期放化疗，放疗技术采用调强放疗9野，处方剂量：PTVp 7029cGy/33F， PTVn_L 6600cGy/33F,PTVn_R 6000cGy/33F,PTV1 6000cGy/33F,PTV2 5400cGy/33F。目前放疗计划已完善，予以今日复位验证后执行放疗。\n- [全程D40] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者精神食欲可，放疗2次，无特殊不适，查体无特殊。今日按[计划性表述已隐藏]第一程DDP同期化疗（顺铂 80mg/m2），若无特殊不适，今日化疗结束后予以出院。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，给予静脉保肝降酶药物，待转氨酶正常后重启放疗\nB. 继续调强放疗，定期监测血常规及肝肾功能，暂不予特殊药物干预\nC. 暂停放疗，经验性静脉滴注广谱抗生素，待中性粒细胞正常后重启放疗\nD. 继续调强放疗，皮下注射重组人粒细胞集落刺激因子\nE. 暂停放疗，给予大剂量静脉水化及利尿治疗\nF. 继续调强放疗，计划在下一周期将顺铂剂量下调20%\nG. 暂停放疗，完善血培养及降钙素原检查\nH. 继续调强放疗，静脉滴注大剂量糖皮质激素\nI. 暂停放疗，给予静脉输注人血白蛋白及肠外营养支持\nJ. 继续调强放疗，计划将下一周期同期化疗药物替换为卡铂\nK. 暂停放疗，复查鼻咽及颈部增强MRI\nL. 继续调强放疗，取消后续同期化疗周期\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-192932039e740110f5fb9ae6","patient_id":"patient-4e3ac84b9e1451cea981f98e","turn_id":"turn06","turn_position":5,"turn_type":"toxicity_or_support_decision","gold_letter":"C","gold_action":"继续按计划执行调强放疗，定期复查血常规及肝肾功能","options":[{"letter":"A","text":"暂停放疗，给予重组人粒细胞刺激因子皮下注射","is_gold":false},{"letter":"B","text":"继续放疗，给予重组人血小板生成素皮下注射","is_gold":false},{"letter":"C","text":"继续按计划执行调强放疗，定期复查血常规及肝肾功能","is_gold":true},{"letter":"D","text":"暂停放疗，给予静脉保肝降酶治疗并密切监测","is_gold":false},{"letter":"E","text":"继续放疗，立即启动第二周期顺铂同期化疗","is_gold":false},{"letter":"F","text":"继续放疗，将第二周期顺铂同期化疗剂量下调20%","is_gold":false},{"letter":"G","text":"继续放疗，将第二周期同期化疗药物更换为卡铂","is_gold":false},{"letter":"H","text":"暂停放疗，完善鼻咽及颈部MRI评估近期疗效","is_gold":false},{"letter":"I","text":"继续放疗，给予大剂量静脉水化及利尿促排治疗","is_gold":false},{"letter":"J","text":"继续放疗，联合尼妥珠单抗靶向治疗以增强疗效","is_gold":false},{"letter":"K","text":"继续放疗，给予促红细胞生成素皮下注射纠正贫血","is_gold":false},{"letter":"L","text":"终止放疗，转为全身静脉化疗并评估后续方案","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、头长肌。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D37] 入院记录: 主诉: 回吸性涕血3月；现病史: 患者于某次就诊时间无明显诱因出现涕中带血，量少，色鲜红，呈间歇性，未引起重视。近2个月间歇性出现耳鸣，伴左颈肿物，遂就诊我院。患者无头痛、面麻、复视、听力下降等症状。左侧腭帆提肌、头长肌受侵，右侧腭帆提肌、双侧腭帆张肌及右侧头长肌未见受侵征象。颅底骨质未见破坏征象。右侧咽后淋巴结、左颈II区淋巴肿大。第3、7胸椎局部代谢活跃，建议随诊。胸部平片、腹部彩超未见明显异常。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,涕中带血,左颈肿物,淋巴肿大；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.8℃，P：18次/分，R: 76次/分，BP：116/68mmHg,Ht：165cm，Wt：56.5kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；双侧顶后壁，左侧隐窝可见结节状肿物，左颈II区可扪及肿大淋巴结，大小约10*15mm,质韧，无压痛，活动度可，与周围组织分界清楚。颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] 检验组合: 尿酸(UA)-静脉血: 316.2umol/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 5.28mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 7.2umol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；球蛋白(GLO)-静脉血: 32.53g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.54mmol/L；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；磷(P)-静脉血: 1.06mmol/L；总胆汁酸(TBA)-静脉血: 2.6umol/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；Rh血型-静脉血: 阳性；血红蛋白(Hb)-静脉血: 153g/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.94；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.93mg/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；血小板分布宽度(PDW)-静脉血: 11.2%；血小板计数(PLT#)-静脉血: 29810E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；白蛋白(ALB)-静脉血: 48g/L；直接胆红素(DBIL)-静脉血: 1.8umol/L；活化部分凝血活酶时间(APTT)-静脉血: 24.9sec.；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；钠离子(Na+)-静脉血: 139.1mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.39；尿素氮(BUN)-静脉血: 5.9mmol/L；钾离子(K+)-静脉血: 4.04mmol/L；C-反应蛋白(CRP)-静脉血: 9.58mg/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22.5U/L；纤维蛋白原(Fbg)-静脉血: 4.77g/L；凝血酶原时间活动度(PTA)-静脉血: 125.5%；淋巴细胞……\n- [全程D18] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- [全程D18] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约25cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约45×26×26mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D19] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显斑片或结节影。双侧肺门影未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见病变。\n- [全程D20] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 第3、7胸椎及右股骨上段见片状放射性浓聚影。颅骨、胸骨、锁骨、肩胛骨、肋骨、颈椎、腰椎、骶尾骨、髋骨及上肢骨骼放射性分布未见明显异常。；检查结论: 右股骨上段局部代谢活跃，疑良性病变，缺血性坏死待排。 第3、7胸椎局部代谢活跃，建议随诊。\n- [全程D20] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁及左侧壁明显增厚，见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。左侧咽隐窝见肿物占据，右侧咽隐窝存在。左侧腭帆提肌、头长肌受侵，右侧腭帆提肌、双侧腭帆张肌及右侧头长肌未见受侵征象。病灶堵塞左侧后鼻孔。 双侧翼腭窝、双侧颞下窝未见异常；口咽未见异常。 颅底骨质未见破坏征象。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦粘膜未见增厚，双侧乳突充气良好，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 左侧咽后间隙见肿大淋巴结，大小约11mm×14mm；右侧咽后间隙见淋巴结，边界欠清，较大者短径约5mm。 左颈II区见数个淋巴结，部分信号不均匀，较大者大小约10mm×13mm，不均匀强化。颈部双侧Ⅰ、ⅡI区见小淋巴结，边界清，较大者短径约5mm，孤立散在。 甲状腺未见异常信号灶。喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 扫描范围颈椎未见明确骨质破坏。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质未见破坏征象。 左侧咽后淋巴结，考虑转移。右侧咽后淋巴结，考虑转移可能性大。 左颈II区淋巴结，考虑转移可能性大。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D23] 检验组合: 天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.75；乳酸脱氢酶(LDH)-静脉血: 285.9U/L；总胆汁酸(TBA)-静脉血: 12.7umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 220U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 20.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 249.9U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 165.4U/L；碱性磷酸酶(ALP)-静脉血: 161.1U/L\n- [全程D37] 检验组合: 甲状腺球蛋白(TG)-静脉血: 13.08ng/ml；平均血小板体积(MPV)-静脉血: 9.9fL；α-L-岩藻糖苷酶(AFU)-静脉血: 21.1U/L；促卵泡刺激素(FSH)-静脉血: 6.26mIU/ml；血小板比容-静脉血: 29%；血小板分布宽度(PDW)-静脉血: 11.3%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.2；催乳素(PRL)-静脉血: 277.6uIU/ml；大血小板百分比(P-LCR%)-静脉血: 23.9%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；促黄体生成素(LH)-静脉血: 9.22mIU/ml；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；血小板计数(PLT#)-静脉血: 29710E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.262；γ-谷氨酰基转移酶(GGT)-静脉血: 227.5U/L；生长激素(GH)-静脉血: 0.54ng/ml；碱性磷酸酶(ALP)-静脉血: 164.9U/L；乳酸脱氢酶(LDH)-静脉血: 170.2U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 38.5；平均红细胞体积(MCV)-静脉血: 94fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；血红蛋白(Hb)-静脉血: 140g/L；中性粒细胞计数(Neut#)-静脉血: 4.410E9/L；促甲状腺激素(TSH)-静脉血: 4.45uIU/ml；有核红细胞计数(NRBC#)-静脉血: 010E9/L；单核细胞百分比(Mono%)-静脉血: 0.105；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.619；红细胞计数(RBC#)-静脉血: 4.5110E12/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；红细胞比容(Hct)-静脉血: 42.4%；总胆汁酸(TBA)-静脉血: 2umol/L；甲状腺过氧化物酶抗体(TPO-Ab)-静脉血: 14.45U/ml；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.58；丙氨酸氨基转移酶(ALT)-静脉血:……\n- [全程D44] 检验组合: 平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；单核细胞百分比(Mono%)-静脉血: 0.084；载脂蛋白B(apoB)-静脉血: 1.02g/L；磷(P)-静脉血: 1.54mmol/L；钠离子(Na+)-静脉血: 137mmol/L；白蛋白(ALB)-静脉血: 41.2g/L；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 38.1U/L；总胆固醇(TC)-静脉血: 5.9mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；中性粒细胞百分比(Neut%)-静脉血: 0.789；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.65mmol/L；间接胆红素(IBIL)-静脉血: 5.6umolL；尿素氮(BUN)-静脉血: 7.73mmol/L；总胆红素(TBIL)-静脉血: 7.4umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.4mmol/L；C-反应蛋白(CRP)-静脉血: 9.62mg/L；血小板比容-静脉血: 27%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；大血小板百分比(P-LCR%)-静脉血: 26.8%；α-L-岩藻糖苷酶(AFU)-静脉血: 35U/L；钾离子(K+)-静脉血: 4.2mmol/L；直接胆红素(DBIL)-静脉血: 1.8umol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.6；尿酸(UA)-静脉血: 288.4umol/L；碱性磷酸酶(ALP)-静脉血: 138.4U/L；中性粒细胞计数(Neut#)-静脉血: 11.910E9/L；总钙(Ca)-静脉血: 2.25mmol/L；肌酐(Crea)-静脉血: 84umol/L；总胆汁酸(TBA)-静脉血: 4.1umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.24；球蛋白(GLO)-静脉血: 33.12g/L；氯离子(Cl-)-静脉血: 97.5mmol/L；甘油三酯(TG)-静脉血: 2.9mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；丙氨酸氨基转移酶(ALT)-静脉血:……\n- [全程D47] 检验组合: 血小板分布宽度(PDW)-静脉血: 13.9%；白细胞计数(WBC#)-静脉血: 6.3810E9/L；单核细胞计数(Mono#)-静脉血: 1.410E9/L；红细胞比容(Hct)-静脉血: 43.9%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 38.1；平均红细胞血红蛋白浓度(MCHC)-静脉血: 333g/L；血小板计数(PLT#)-静脉血: 26510E9/L；平均红细胞体积(MCV)-静脉血: 93.6fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；大血小板百分比(P-LCR%)-静脉血: 34.5%；血小板比容-静脉血: 30%；平均血小板体积(MPV)-静脉血: 11.2fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 146g/L；中性粒细胞百分比(Neut%)-静脉血: 0.569；单核细胞百分比(Mono%)-静脉血: 0.216；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；红细胞计数(RBC#)-静脉血: 4.6910E12/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；中性粒细胞计数(Neut#)-静脉血: 3.610E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.205；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.5；平均红细胞血红蛋白含量(MCH)-静脉血: 31.1pg\n- [全程D54] 检验组合: 直接胆红素(DBIL)-静脉血: 1.3umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 337g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.173；血小板计数(PLT#)-静脉血: 14810E9/L；碱性磷酸酶(ALP)-静脉血: 120.1U/L；氯离子(Cl-)-静脉血: 101.8mmol/L；总胆固醇(TC)-静脉血: 5.93mmol/L；钾离子(K+)-静脉血: 3.93mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 127.6U/L；有核红细胞百分比(NRBC%)-静脉血: 0；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.51；甘油三酯(TG)-静脉血: 2.02mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 38.4；单核细胞计数(Mono#)-静脉血: 0.710E9/L；平均血小板体积(MPV)-静脉血: 10.1fL；白细胞计数(WBC#)-静脉血: 5.910E9/L；钠离子(Na+)-静脉血: 140.2mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；中性粒细胞计数(Neut#)-静脉血: 4.110E9/L；红细胞比容(Hct)-静脉血: 40.7%；尿素氮(BUN)-静脉血: 3.9mmol/L；平均红细胞体积(MCV)-静脉血: 91.3fL；总胆红素(TBIL)-静脉血: 9.5umol/L；总胆汁酸(TBA)-静脉血: 6.5umol/L；C-反应蛋白(CRP)-静脉血: 5.08mg/L；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.7pg；总蛋白(TP)-静脉血: 72.34g/L；总钙(Ca)-静脉血: 2.35mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.6mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.2mmolL；载脂蛋白AI(apoAI)-静脉血: 1.36g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 36.9U/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.9；红细胞计数(RBC#)-静脉血: 4.4610E12/L；嗜碱性粒细胞百分比(Baso%)-静脉血……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D39] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者一般情况可，未诉特殊不适。按[计划性表述已隐藏]同期放化疗，放疗技术采用调强放疗9野，处方剂量：PTVp 7029cGy/33F， PTVn_L 6600cGy/33F,PTVn_R 6000cGy/33F,PTV1 6000cGy/33F,PTV2 5400cGy/33F。目前放疗计划已完善，予以今日复位验证后执行放疗。\n- [全程D40] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者精神食欲可，放疗2次，无特殊不适，查体无特殊。今日按[计划性表述已隐藏]第一程DDP同期化疗（顺铂 80mg/m2），若无特殊不适，今日化疗结束后予以出院。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，给予重组人粒细胞刺激因子皮下注射\nB. 继续放疗，给予重组人血小板生成素皮下注射\nC. 继续按计划执行调强放疗，定期复查血常规及肝肾功能\nD. 暂停放疗，给予静脉保肝降酶治疗并密切监测\nE. 继续放疗，立即启动第二周期顺铂同期化疗\nF. 继续放疗，将第二周期顺铂同期化疗剂量下调20%\nG. 继续放疗，将第二周期同期化疗药物更换为卡铂\nH. 暂停放疗，完善鼻咽及颈部MRI评估近期疗效\nI. 继续放疗，给予大剂量静脉水化及利尿促排治疗\nJ. 继续放疗，联合尼妥珠单抗靶向治疗以增强疗效\nK. 继续放疗，给予促红细胞生成素皮下注射纠正贫血\nL. 终止放疗，转为全身静脉化疗并评估后续方案\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、头长肌。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D37] 入院记录: 主诉: 回吸性涕血3月；现病史: 患者于某次就诊时间无明显诱因出现涕中带血，量少，色鲜红，呈间歇性，未引起重视。近2个月间歇性出现耳鸣，伴左颈肿物，遂就诊我院。患者无头痛、面麻、复视、听力下降等症状。左侧腭帆提肌、头长肌受侵，右侧腭帆提肌、双侧腭帆张肌及右侧头长肌未见受侵征象。颅底骨质未见破坏征象。右侧咽后淋巴结、左颈II区淋巴肿大。第3、7胸椎局部代谢活跃，建议随诊。胸部平片、腹部彩超未见明显异常。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,涕中带血,左颈肿物,淋巴肿大；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.8℃，P：18次/分，R: 76次/分，BP：116/68mmHg,Ht：165cm，Wt：56.5kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；双侧顶后壁，左侧隐窝可见结节状肿物，左颈II区可扪及肿大淋巴结，大小约10*15mm,质韧，无压痛，活动度可，与周围组织分界清楚。颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] 检验组合: 尿酸(UA)-静脉血: 316.2umol/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 5.28mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 7.2umol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；球蛋白(GLO)-静脉血: 32.53g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.54mmol/L；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；磷(P)-静脉血: 1.06mmol/L；总胆汁酸(TBA)-静脉血: 2.6umol/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；Rh血型-静脉血: 阳性；血红蛋白(Hb)-静脉血: 153g/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.94；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.93mg/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；血小板分布宽度(PDW)-静脉血: 11.2%；血小板计数(PLT#)-静脉血: 29810E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；白蛋白(ALB)-静脉血: 48g/L；直接胆红素(DBIL)-静脉血: 1.8umol/L；活化部分凝血活酶时间(APTT)-静脉血: 24.9sec.；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；钠离子(Na+)-静脉血: 139.1mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.39；尿素氮(BUN)-静脉血: 5.9mmol/L；钾离子(K+)-静脉血: 4.04mmol/L；C-反应蛋白(CRP)-静脉血: 9.58mg/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22.5U/L；纤维蛋白原(Fbg)-静脉血: 4.77g/L；凝血酶原时间活动度(PTA)-静脉血: 125.5%；淋巴细胞……\n- [全程D18] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- [全程D18] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约25cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约45×26×26mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D19] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显斑片或结节影。双侧肺门影未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见病变。\n- [全程D20] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 第3、7胸椎及右股骨上段见片状放射性浓聚影。颅骨、胸骨、锁骨、肩胛骨、肋骨、颈椎、腰椎、骶尾骨、髋骨及上肢骨骼放射性分布未见明显异常。；检查结论: 右股骨上段局部代谢活跃，疑良性病变，缺血性坏死待排。 第3、7胸椎局部代谢活跃，建议随诊。\n- [全程D20] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁及左侧壁明显增厚，见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。左侧咽隐窝见肿物占据，右侧咽隐窝存在。左侧腭帆提肌、头长肌受侵，右侧腭帆提肌、双侧腭帆张肌及右侧头长肌未见受侵征象。病灶堵塞左侧后鼻孔。 双侧翼腭窝、双侧颞下窝未见异常；口咽未见异常。 颅底骨质未见破坏征象。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦粘膜未见增厚，双侧乳突充气良好，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 左侧咽后间隙见肿大淋巴结，大小约11mm×14mm；右侧咽后间隙见淋巴结，边界欠清，较大者短径约5mm。 左颈II区见数个淋巴结，部分信号不均匀，较大者大小约10mm×13mm，不均匀强化。颈部双侧Ⅰ、ⅡI区见小淋巴结，边界清，较大者短径约5mm，孤立散在。 甲状腺未见异常信号灶。喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 扫描范围颈椎未见明确骨质破坏。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质未见破坏征象。 左侧咽后淋巴结，考虑转移。右侧咽后淋巴结，考虑转移可能性大。 左颈II区淋巴结，考虑转移可能性大。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D23] 检验组合: 天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.75；乳酸脱氢酶(LDH)-静脉血: 285.9U/L；总胆汁酸(TBA)-静脉血: 12.7umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 220U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 20.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 249.9U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 165.4U/L；碱性磷酸酶(ALP)-静脉血: 161.1U/L\n- [全程D37] 检验组合: 甲状腺球蛋白(TG)-静脉血: 13.08ng/ml；平均血小板体积(MPV)-静脉血: 9.9fL；α-L-岩藻糖苷酶(AFU)-静脉血: 21.1U/L；促卵泡刺激素(FSH)-静脉血: 6.26mIU/ml；血小板比容-静脉血: 29%；血小板分布宽度(PDW)-静脉血: 11.3%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.2；催乳素(PRL)-静脉血: 277.6uIU/ml；大血小板百分比(P-LCR%)-静脉血: 23.9%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；促黄体生成素(LH)-静脉血: 9.22mIU/ml；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；血小板计数(PLT#)-静脉血: 29710E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.262；γ-谷氨酰基转移酶(GGT)-静脉血: 227.5U/L；生长激素(GH)-静脉血: 0.54ng/ml；碱性磷酸酶(ALP)-静脉血: 164.9U/L；乳酸脱氢酶(LDH)-静脉血: 170.2U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 38.5；平均红细胞体积(MCV)-静脉血: 94fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；血红蛋白(Hb)-静脉血: 140g/L；中性粒细胞计数(Neut#)-静脉血: 4.410E9/L；促甲状腺激素(TSH)-静脉血: 4.45uIU/ml；有核红细胞计数(NRBC#)-静脉血: 010E9/L；单核细胞百分比(Mono%)-静脉血: 0.105；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.619；红细胞计数(RBC#)-静脉血: 4.5110E12/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；红细胞比容(Hct)-静脉血: 42.4%；总胆汁酸(TBA)-静脉血: 2umol/L；甲状腺过氧化物酶抗体(TPO-Ab)-静脉血: 14.45U/ml；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.58；丙氨酸氨基转移酶(ALT)-静脉血:……\n- [全程D44] 检验组合: 平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；单核细胞百分比(Mono%)-静脉血: 0.084；载脂蛋白B(apoB)-静脉血: 1.02g/L；磷(P)-静脉血: 1.54mmol/L；钠离子(Na+)-静脉血: 137mmol/L；白蛋白(ALB)-静脉血: 41.2g/L；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 38.1U/L；总胆固醇(TC)-静脉血: 5.9mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；中性粒细胞百分比(Neut%)-静脉血: 0.789；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.65mmol/L；间接胆红素(IBIL)-静脉血: 5.6umolL；尿素氮(BUN)-静脉血: 7.73mmol/L；总胆红素(TBIL)-静脉血: 7.4umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.4mmol/L；C-反应蛋白(CRP)-静脉血: 9.62mg/L；血小板比容-静脉血: 27%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；大血小板百分比(P-LCR%)-静脉血: 26.8%；α-L-岩藻糖苷酶(AFU)-静脉血: 35U/L；钾离子(K+)-静脉血: 4.2mmol/L；直接胆红素(DBIL)-静脉血: 1.8umol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.6；尿酸(UA)-静脉血: 288.4umol/L；碱性磷酸酶(ALP)-静脉血: 138.4U/L；中性粒细胞计数(Neut#)-静脉血: 11.910E9/L；总钙(Ca)-静脉血: 2.25mmol/L；肌酐(Crea)-静脉血: 84umol/L；总胆汁酸(TBA)-静脉血: 4.1umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.24；球蛋白(GLO)-静脉血: 33.12g/L；氯离子(Cl-)-静脉血: 97.5mmol/L；甘油三酯(TG)-静脉血: 2.9mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；丙氨酸氨基转移酶(ALT)-静脉血:……\n- [全程D47] 检验组合: 血小板分布宽度(PDW)-静脉血: 13.9%；白细胞计数(WBC#)-静脉血: 6.3810E9/L；单核细胞计数(Mono#)-静脉血: 1.410E9/L；红细胞比容(Hct)-静脉血: 43.9%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 38.1；平均红细胞血红蛋白浓度(MCHC)-静脉血: 333g/L；血小板计数(PLT#)-静脉血: 26510E9/L；平均红细胞体积(MCV)-静脉血: 93.6fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；大血小板百分比(P-LCR%)-静脉血: 34.5%；血小板比容-静脉血: 30%；平均血小板体积(MPV)-静脉血: 11.2fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 146g/L；中性粒细胞百分比(Neut%)-静脉血: 0.569；单核细胞百分比(Mono%)-静脉血: 0.216；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；红细胞计数(RBC#)-静脉血: 4.6910E12/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；中性粒细胞计数(Neut#)-静脉血: 3.610E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.205；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.5；平均红细胞血红蛋白含量(MCH)-静脉血: 31.1pg\n- [全程D54] 检验组合: 直接胆红素(DBIL)-静脉血: 1.3umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 337g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.173；血小板计数(PLT#)-静脉血: 14810E9/L；碱性磷酸酶(ALP)-静脉血: 120.1U/L；氯离子(Cl-)-静脉血: 101.8mmol/L；总胆固醇(TC)-静脉血: 5.93mmol/L；钾离子(K+)-静脉血: 3.93mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 127.6U/L；有核红细胞百分比(NRBC%)-静脉血: 0；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.51；甘油三酯(TG)-静脉血: 2.02mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 38.4；单核细胞计数(Mono#)-静脉血: 0.710E9/L；平均血小板体积(MPV)-静脉血: 10.1fL；白细胞计数(WBC#)-静脉血: 5.910E9/L；钠离子(Na+)-静脉血: 140.2mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；中性粒细胞计数(Neut#)-静脉血: 4.110E9/L；红细胞比容(Hct)-静脉血: 40.7%；尿素氮(BUN)-静脉血: 3.9mmol/L；平均红细胞体积(MCV)-静脉血: 91.3fL；总胆红素(TBIL)-静脉血: 9.5umol/L；总胆汁酸(TBA)-静脉血: 6.5umol/L；C-反应蛋白(CRP)-静脉血: 5.08mg/L；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.7pg；总蛋白(TP)-静脉血: 72.34g/L；总钙(Ca)-静脉血: 2.35mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.6mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.2mmolL；载脂蛋白AI(apoAI)-静脉血: 1.36g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 36.9U/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.9；红细胞计数(RBC#)-静脉血: 4.4610E12/L；嗜碱性粒细胞百分比(Baso%)-静脉血……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D39] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者一般情况可，未诉特殊不适。按[计划性表述已隐藏]同期放化疗，放疗技术采用调强放疗9野，处方剂量：PTVp 7029cGy/33F， PTVn_L 6600cGy/33F,PTVn_R 6000cGy/33F,PTV1 6000cGy/33F,PTV2 5400cGy/33F。目前放疗计划已完善，予以今日复位验证后执行放疗。\n- [全程D40] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者精神食欲可，放疗2次，无特殊不适，查体无特殊。今日按[计划性表述已隐藏]第一程DDP同期化疗（顺铂 80mg/m2），若无特殊不适，今日化疗结束后予以出院。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，给予重组人粒细胞刺激因子皮下注射\nB. 继续放疗，给予重组人血小板生成素皮下注射\nC. 继续按计划执行调强放疗，定期复查血常规及肝肾功能\nD. 暂停放疗，给予静脉保肝降酶治疗并密切监测\nE. 继续放疗，立即启动第二周期顺铂同期化疗\nF. 继续放疗，将第二周期顺铂同期化疗剂量下调20%\nG. 继续放疗，将第二周期同期化疗药物更换为卡铂\nH. 暂停放疗，完善鼻咽及颈部MRI评估近期疗效\nI. 继续放疗，给予大剂量静脉水化及利尿促排治疗\nJ. 继续放疗，联合尼妥珠单抗靶向治疗以增强疗效\nK. 继续放疗，给予促红细胞生成素皮下注射纠正贫血\nL. 终止放疗，转为全身静脉化疗并评估后续方案\n\n请仅输出一个选项字母（A-L）。"}]}
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+{"sample_id":"sample-bc7a956bb6d6b0bc48992292","patient_id":"patient-e5fcd31b4b8b85194b146991","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"E","gold_action":"安排电子鼻咽镜及鼻咽肿物活检，并完善胸腹部CT及骨扫描（或PET-CT）","options":[{"letter":"A","text":"安排颈部淋巴结切除活检，并完善全身PET-CT检查","is_gold":false},{"letter":"B","text":"安排鼻咽镜下活检，并完善头颅CT检查","is_gold":false},{"letter":"C","text":"安排颈部淋巴结细针穿刺活检，并完善胸腹部CT及骨扫描","is_gold":false},{"letter":"D","text":"安排鼻咽镜下活检，并完善EBV-DNA定量检测，暂缓全身影像学检查","is_gold":false},{"letter":"E","text":"安排电子鼻咽镜及鼻咽肿物活检，并完善胸腹部CT及骨扫描（或PET-CT）","is_gold":true},{"letter":"F","text":"安排鼻咽肿物及颈部淋巴结双重活检，并完善胸腹部MRI检查","is_gold":false},{"letter":"G","text":"安排鼻咽镜下活检，并完善颈部超声检查","is_gold":false},{"letter":"H","text":"安排全身PET-CT检查，并直接开始根治性放化疗","is_gold":false},{"letter":"I","text":"安排电子鼻咽镜检查，并直接进入放疗定位阶段","is_gold":false},{"letter":"J","text":"安排鼻咽镜下活检，并直接开始根治性放疗","is_gold":false},{"letter":"K","text":"安排鼻咽肿物活检，并直接进入诱导化疗阶段","is_gold":false},{"letter":"L","text":"安排鼻咽镜下活检，并完善全身骨髓穿刺检查","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 回吸性涕血1月余。；现病史: 缘于1月前患者无意中出现抽吸性血涕，痰中带血；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻咽角化,涕血,痰中带血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：78次/分，R：20次/分，BP：125/80mmHg,Ht：162cm，Wt：61kg，BSA：1.6483m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 胱抑素(Cys-C)-静脉血: 0.77mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.69mmol/L；阴离子间隙(AG)-静脉血: 13；磷(P)-静脉血: 0.92mmol/L；总胆红素(TBIL)-静脉血: 12.4umol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；肌酐(Crea)-静脉血: 80.5umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.58；Rh血型-静脉血: 阳性；总钙(Ca)-静脉血: 2.44mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；血小板计数(PLT#)-静脉血: 21910E9/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 4.81mmol/L；直接胆红素(DBIL)-静脉血: 4.2umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.64mmolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.013；载脂蛋白B(apoB)-静脉血: 0.73g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.3pg；α-L-岩藻糖苷酶(AFU)-静脉血: 24U/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 8.2umolL；白蛋白(ALB)-静脉血: 45.8g/L；血小板比容-静脉血: 21%；ABO血型-静脉血: O；尿素氮(BUN)-静脉血: 3.6mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；凝血酶时间(TT)-静脉血: 20.2sec.；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；载脂蛋白AI(apoAI)-静脉血: 1.33g/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；C-反应蛋白(CRP)-静脉血: 0.36mg/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血:……\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔稍狭窄，鼻咽左侧壁明显增厚，左侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。肿物侵犯左侧腭帆张提肌，左侧咽旁脂肪间隙变窄。鼻咽顶后壁稍增厚，右侧壁未见明显增厚，右侧咽隐窝清晰。 右侧腭帆张提肌、双侧头长肌、翼内外肌未见明显异常。 双侧翼腭窝、上颌后脂肪间隙、咀嚼肌间隙未见异常。 口咽各壁未见增厚。鼻腔内未见肿物。 蝶骨基底部、左侧翼突基底部及内侧板骨质信号降低，增强扫描可见强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦粘膜稍增厚，双侧乳突未见明显异常。 左侧咽后见几个淋巴结，最大者约8mm×5mm，边界欠清，明显强化。双颈II区见多个淋巴结，最大者约16mm×8mm，边界尚清，较均匀明显强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽左侧壁增厚，左侧咽隐窝肿物，考虑鼻咽癌。 颅底骨质破坏。 左侧咽后、双颈II区淋巴结，可疑转移。 轻度鼻窦炎。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 安排颈部淋巴结切除活检，并完善全身PET-CT检查\nB. 安排鼻咽镜下活检，并完善头颅CT检查\nC. 安排颈部淋巴结细针穿刺活检，并完善胸腹部CT及骨扫描\nD. 安排鼻咽镜下活检，并完善EBV-DNA定量检测，暂缓全身影像学检查\nE. 安排电子鼻咽镜及鼻咽肿物活检，并完善胸腹部CT及骨扫描（或PET-CT）\nF. 安排鼻咽肿物及颈部淋巴结双重活检，并完善胸腹部MRI检查\nG. 安排鼻咽镜下活检，并完善颈部超声检查\nH. 安排全身PET-CT检查，并直接开始根治性放化疗\nI. 安排电子鼻咽镜检查，并直接进入放疗定位阶段\nJ. 安排鼻咽镜下活检，并直接开始根治性放疗\nK. 安排鼻咽肿物活检，并直接进入诱导化疗阶段\nL. 安排鼻咽镜下活检，并完善全身骨髓穿刺检查\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 回吸性涕血1月余。；现病史: 缘于1月前患者无意中出现抽吸性血涕，痰中带血；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻咽角化,涕血,痰中带血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：78次/分，R：20次/分，BP：125/80mmHg,Ht：162cm，Wt：61kg，BSA：1.6483m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 胱抑素(Cys-C)-静脉血: 0.77mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.69mmol/L；阴离子间隙(AG)-静脉血: 13；磷(P)-静脉血: 0.92mmol/L；总胆红素(TBIL)-静脉血: 12.4umol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；肌酐(Crea)-静脉血: 80.5umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.58；Rh血型-静脉血: 阳性；总钙(Ca)-静脉血: 2.44mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；血小板计数(PLT#)-静脉血: 21910E9/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 4.81mmol/L；直接胆红素(DBIL)-静脉血: 4.2umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.64mmolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.013；载脂蛋白B(apoB)-静脉血: 0.73g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.3pg；α-L-岩藻糖苷酶(AFU)-静脉血: 24U/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 8.2umolL；白蛋白(ALB)-静脉血: 45.8g/L；血小板比容-静脉血: 21%；ABO血型-静脉血: O；尿素氮(BUN)-静脉血: 3.6mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；凝血酶时间(TT)-静脉血: 20.2sec.；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；载脂蛋白AI(apoAI)-静脉血: 1.33g/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；C-反应蛋白(CRP)-静脉血: 0.36mg/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血:……\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔稍狭窄，鼻咽左侧壁明显增厚，左侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。肿物侵犯左侧腭帆张提肌，左侧咽旁脂肪间隙变窄。鼻咽顶后壁稍增厚，右侧壁未见明显增厚，右侧咽隐窝清晰。 右侧腭帆张提肌、双侧头长肌、翼内外肌未见明显异常。 双侧翼腭窝、上颌后脂肪间隙、咀嚼肌间隙未见异常。 口咽各壁未见增厚。鼻腔内未见肿物。 蝶骨基底部、左侧翼突基底部及内侧板骨质信号降低，增强扫描可见强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦粘膜稍增厚，双侧乳突未见明显异常。 左侧咽后见几个淋巴结，最大者约8mm×5mm，边界欠清，明显强化。双颈II区见多个淋巴结，最大者约16mm×8mm，边界尚清，较均匀明显强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽左侧壁增厚，左侧咽隐窝肿物，考虑鼻咽癌。 颅底骨质破坏。 左侧咽后、双颈II区淋巴结，可疑转移。 轻度鼻窦炎。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 安排颈部淋巴结切除活检，并完善全身PET-CT检查\nB. 安排鼻咽镜下活检，并完善头颅CT检查\nC. 安排颈部淋巴结细针穿刺活检，并完善胸腹部CT及骨扫描\nD. 安排鼻咽镜下活检，并完善EBV-DNA定量检测，暂缓全身影像学检查\nE. 安排电子鼻咽镜及鼻咽肿物活检，并完善胸腹部CT及骨扫描（或PET-CT）\nF. 安排鼻咽肿物及颈部淋巴结双重活检，并完善胸腹部MRI检查\nG. 安排鼻咽镜下活检，并完善颈部超声检查\nH. 安排全身PET-CT检查，并直接开始根治性放化疗\nI. 安排电子鼻咽镜检查，并直接进入放疗定位阶段\nJ. 安排鼻咽镜下活检，并直接开始根治性放疗\nK. 安排鼻咽肿物活检，并直接进入诱导化疗阶段\nL. 安排鼻咽镜下活检，并完善全身骨髓穿刺检查\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-49519c2b08d621c382f2a093","patient_id":"patient-e5fcd31b4b8b85194b146991","turn_id":"turn04","turn_position":3,"turn_type":"initial_treatment_selection","gold_letter":"G","gold_action":"诱导化疗（顺铂+氟尿嘧啶，PF方案）","options":[{"letter":"A","text":"根治性单纯放疗","is_gold":false},{"letter":"B","text":"诱导化疗（紫杉醇+卡铂）","is_gold":false},{"letter":"C","text":"诱导化疗（吉西他滨+奥沙利铂）","is_gold":false},{"letter":"D","text":"同期放化疗（顺铂）","is_gold":false},{"letter":"E","text":"诱导化疗（依托泊苷+顺铂）","is_gold":false},{"letter":"F","text":"诱导化疗（长春瑞滨+顺铂）","is_gold":false},{"letter":"G","text":"诱导化疗（顺铂+氟尿嘧啶）","is_gold":true},{"letter":"H","text":"靶向单药治疗（西妥昔单抗）","is_gold":false},{"letter":"I","text":"诱导化疗（多柔比星+环磷酰胺）","is_gold":false},{"letter":"J","text":"姑息性单药化疗（卡培他滨）","is_gold":false},{"letter":"K","text":"免疫单药治疗（帕博利珠单抗）","is_gold":false},{"letter":"L","text":"鼻咽及颈部淋巴结根治性切除术","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 回吸性涕血1月余。；现病史: 缘于1月前患者无意中出现抽吸性血涕，痰中带血；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻咽角化,涕血,痰中带血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：78次/分，R：20次/分，BP：125/80mmHg,Ht：162cm，Wt：61kg，BSA：1.6483m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 回吸性涕血1月余。；现病史: 缘于1月前患者无意中出现抽吸性血涕，痰中带血；无头痛、面麻，无视力下降、复视，无听力下降、耳鸣等不适，于当地乡镇医院予滴鼻治疗，具体药物不详，未见好转，遂于某次就诊时间往[地点已隐去]人民医院检查，某次就诊时间病理活检示：鼻咽未分化型角化性癌。某次就诊时间鼻咽MRI示：左侧鼻咽部占位病变，考虑鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻咽角化,涕血,痰中带血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：78次/分，R：20次/分，BP：125/80mmHg,Ht：162cm，Wt：61kg，BSA：1.6483m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率100次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 胱抑素(Cys-C)-静脉血: 0.77mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.69mmol/L；阴离子间隙(AG)-静脉血: 13；磷(P)-静脉血: 0.92mmol/L；总胆红素(TBIL)-静脉血: 12.4umol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；肌酐(Crea)-静脉血: 80.5umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.58；Rh血型-静脉血: 阳性；总钙(Ca)-静脉血: 2.44mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；血小板计数(PLT#)-静脉血: 21910E9/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 4.81mmol/L；直接胆红素(DBIL)-静脉血: 4.2umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.64mmolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.013；载脂蛋白B(apoB)-静脉血: 0.73g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.3pg；α-L-岩藻糖苷酶(AFU)-静脉血: 24U/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 8.2umolL；白蛋白(ALB)-静脉血: 45.8g/L；血小板比容-静脉血: 21%；ABO血型-静脉血: O；尿素氮(BUN)-静脉血: 3.6mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；凝血酶时间(TT)-静脉血: 20.2sec.；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；载脂蛋白AI(apoAI)-静脉血: 1.33g/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；C-反应蛋白(CRP)-静脉血: 0.36mg/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血:……\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔稍狭窄，鼻咽左侧壁明显增厚，左侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。肿物侵犯左侧腭帆张提肌，左侧咽旁脂肪间隙变窄。鼻咽顶后壁稍增厚，右侧壁未见明显增厚，右侧咽隐窝清晰。 右侧腭帆张提肌、双侧头长肌、翼内外肌未见明显异常。 双侧翼腭窝、上颌后脂肪间隙、咀嚼肌间隙未见异常。 口咽各壁未见增厚。鼻腔内未见肿物。 蝶骨基底部、左侧翼突基底部及内侧板骨质信号降低，增强扫描可见强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦粘膜稍增厚，双侧乳突未见明显异常。 左侧咽后见几个淋巴结，最大者约8mm×5mm，边界欠清，明显强化。双颈II区见多个淋巴结，最大者约16mm×8mm，边界尚清，较均匀明显强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽左侧壁增厚，左侧咽隐窝肿物，考虑鼻咽癌。 颅底骨质破坏。 左侧咽后、双颈II区淋巴结，可疑转移。 轻度鼻窦炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右侧约平T6椎体水平，估计导管末端位于上腔静脉上段内。；检查结论: PICC管位置如上所述。\n- [全程D13] 检验组合: 酸碱度(pH)-尿液: 5.5；粘液丝计数(MUCS#)-尿液: 11/μL；酮体(KET)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 1/μL；红细胞计数(RBC#)-尿液: 3/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: colorless；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；比重(SG)-尿液: 1.008\n- [全程D14] 检验组合: 总蛋白(TP)-尿液: +- 0.2g（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；红细胞计数(RBC#)-尿液: 1/μL；葡萄糖(Glu)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.02；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；粘液丝计数(MUCS#)-尿液: 4/μL；白细胞(LEU)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；胆红素(BIL)-尿液: -（参考: 阴性）\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 根治性单纯放疗\nB. 诱导化疗（紫杉醇+卡铂）\nC. 诱导化疗（吉西他滨+奥沙利铂）\nD. 同期放化疗（顺铂）\nE. 诱导化疗（依托泊苷+顺铂）\nF. 诱导化疗（长春瑞滨+顺铂）\nG. 诱导化疗（顺铂+氟尿嘧啶）\nH. 靶向单药治疗（西妥昔单抗）\nI. 诱导化疗（多柔比星+环磷酰胺）\nJ. 姑息性单药化疗（卡培他滨）\nK. 免疫单药治疗（帕博利珠单抗）\nL. 鼻咽及颈部淋巴结根治性切除术\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 回吸性涕血1月余。；现病史: 缘于1月前患者无意中出现抽吸性血涕，痰中带血；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻咽角化,涕血,痰中带血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：78次/分，R：20次/分，BP：125/80mmHg,Ht：162cm，Wt：61kg，BSA：1.6483m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 回吸性涕血1月余。；现病史: 缘于1月前患者无意中出现抽吸性血涕，痰中带血；无头痛、面麻，无视力下降、复视，无听力下降、耳鸣等不适，于当地乡镇医院予滴鼻治疗，具体药物不详，未见好转，遂于某次就诊时间往[地点已隐去]人民医院检查，某次就诊时间病理活检示：鼻咽未分化型角化性癌。某次就诊时间鼻咽MRI示：左侧鼻咽部占位病变，考虑鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻咽角化,涕血,痰中带血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：78次/分，R：20次/分，BP：125/80mmHg,Ht：162cm，Wt：61kg，BSA：1.6483m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率100次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 胱抑素(Cys-C)-静脉血: 0.77mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.69mmol/L；阴离子间隙(AG)-静脉血: 13；磷(P)-静脉血: 0.92mmol/L；总胆红素(TBIL)-静脉血: 12.4umol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；肌酐(Crea)-静脉血: 80.5umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.58；Rh血型-静脉血: 阳性；总钙(Ca)-静脉血: 2.44mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；血小板计数(PLT#)-静脉血: 21910E9/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 4.81mmol/L；直接胆红素(DBIL)-静脉血: 4.2umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.64mmolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.013；载脂蛋白B(apoB)-静脉血: 0.73g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.3pg；α-L-岩藻糖苷酶(AFU)-静脉血: 24U/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 8.2umolL；白蛋白(ALB)-静脉血: 45.8g/L；血小板比容-静脉血: 21%；ABO血型-静脉血: O；尿素氮(BUN)-静脉血: 3.6mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；凝血酶时间(TT)-静脉血: 20.2sec.；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；载脂蛋白AI(apoAI)-静脉血: 1.33g/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；C-反应蛋白(CRP)-静脉血: 0.36mg/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血:……\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔稍狭窄，鼻咽左侧壁明显增厚，左侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。肿物侵犯左侧腭帆张提肌，左侧咽旁脂肪间隙变窄。鼻咽顶后壁稍增厚，右侧壁未见明显增厚，右侧咽隐窝清晰。 右侧腭帆张提肌、双侧头长肌、翼内外肌未见明显异常。 双侧翼腭窝、上颌后脂肪间隙、咀嚼肌间隙未见异常。 口咽各壁未见增厚。鼻腔内未见肿物。 蝶骨基底部、左侧翼突基底部及内侧板骨质信号降低，增强扫描可见强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦粘膜稍增厚，双侧乳突未见明显异常。 左侧咽后见几个淋巴结，最大者约8mm×5mm，边界欠清，明显强化。双颈II区见多个淋巴结，最大者约16mm×8mm，边界尚清，较均匀明显强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽左侧壁增厚，左侧咽隐窝肿物，考虑鼻咽癌。 颅底骨质破坏。 左侧咽后、双颈II区淋巴结，可疑转移。 轻度鼻窦炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右侧约平T6椎体水平，估计导管末端位于上腔静脉上段内。；检查结论: PICC管位置如上所述。\n- [全程D13] 检验组合: 酸碱度(pH)-尿液: 5.5；粘液丝计数(MUCS#)-尿液: 11/μL；酮体(KET)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 1/μL；红细胞计数(RBC#)-尿液: 3/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: colorless；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；比重(SG)-尿液: 1.008\n- [全程D14] 检验组合: 总蛋白(TP)-尿液: +- 0.2g（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；红细胞计数(RBC#)-尿液: 1/μL；葡萄糖(Glu)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.02；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；粘液丝计数(MUCS#)-尿液: 4/μL；白细胞(LEU)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；胆红素(BIL)-尿液: -（参考: 阴性）\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 根治性单纯放疗\nB. 诱导化疗（紫杉醇+卡铂）\nC. 诱导化疗（吉西他滨+奥沙利铂）\nD. 同期放化疗（顺铂）\nE. 诱导化疗（依托泊苷+顺铂）\nF. 诱导化疗（长春瑞滨+顺铂）\nG. 诱导化疗（顺铂+氟尿嘧啶）\nH. 靶向单药治疗（西妥昔单抗）\nI. 诱导化疗（多柔比星+环磷酰胺）\nJ. 姑息性单药化疗（卡培他滨）\nK. 免疫单药治疗（帕博利珠单抗）\nL. 鼻咽及颈部淋巴结根治性切除术\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-ba0bc8aff143756f9ee645b5","patient_id":"patient-e5fcd31b4b8b85194b146991","turn_id":"turn05","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"H","gold_action":"办理出院，予以帕洛诺司琼等止吐处理，嘱出院后每周复查血常规及肝肾功能，按计划返院行下一程化疗。","options":[{"letter":"A","text":"办理出院，无需特殊用药，嘱出院后每2周复查血常规及肝肾功能，按计划返院行下一程诱导化疗。","is_gold":false},{"letter":"B","text":"暂缓出院，予以静脉营养支持及强效止吐治疗，待恶心症状完全缓解后出院，按计划返院行下一程化疗。","is_gold":false},{"letter":"C","text":"办理出院，予以止吐处理并预防性给予长效G-CSF支持，嘱出院后每周复查血常规，按计划返院行下一程化疗。","is_gold":false},{"letter":"D","text":"办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，下一程化疗方案需减量20%并延迟1周进行。","is_gold":false},{"letter":"E","text":"暂缓出院，予以保肝降酶及护胃治疗，待复查肝功能及消化道症状好转后出院，按计划返院行下一程化疗。","is_gold":false},{"letter":"F","text":"办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，下一阶段直接转入同期放化疗。","is_gold":false},{"letter":"G","text":"办理出院，予以止吐处理，嘱出院后每3天复查肾功能及电解质，按计划返院行下一程诱导化疗。","is_gold":false},{"letter":"H","text":"办理出院，予以帕洛诺司琼等止吐处理，嘱出院后每周复查血常规及肝肾功能，按计划返院行下一程化疗。","is_gold":true},{"letter":"I","text":"暂缓出院，予以静脉补液及纠正电解质紊乱治疗，复查生化指标正常后出院，按计划返院行下一程化疗。","is_gold":false},{"letter":"J","text":"办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，下一程化疗更改为单药方案以减轻反应。","is_gold":false},{"letter":"K","text":"办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，按计划返院行靶向治疗联合放疗。","is_gold":false},{"letter":"L","text":"暂缓出院，予以质子泵抑制剂静脉滴注预防应激性溃疡，观察3天后出院，按计划返院行下一程化疗。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 回吸性涕血1月余。；现病史: 缘于1月前患者无意中出现抽吸性血涕，痰中带血；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻咽角化,涕血,痰中带血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：78次/分，R：20次/分，BP：125/80mmHg,Ht：162cm，Wt：61kg，BSA：1.6483m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 回吸性涕血1月余。；现病史: 缘于1月前患者无意中出现抽吸性血涕，痰中带血；无头痛、面麻，无视力下降、复视，无听力下降、耳鸣等不适，于当地乡镇医院予滴鼻治疗，具体药物不详，未见好转，遂于某次就诊时间往[地点已隐去]人民医院检查，某次就诊时间病理活检示：鼻咽未分化型角化性癌。某次就诊时间鼻咽MRI示：左侧鼻咽部占位病变，考虑鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻咽角化,涕血,痰中带血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：78次/分，R：20次/分，BP：125/80mmHg,Ht：162cm，Wt：61kg，BSA：1.6483m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率100次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 胱抑素(Cys-C)-静脉血: 0.77mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.69mmol/L；阴离子间隙(AG)-静脉血: 13；磷(P)-静脉血: 0.92mmol/L；总胆红素(TBIL)-静脉血: 12.4umol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；肌酐(Crea)-静脉血: 80.5umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.58；Rh血型-静脉血: 阳性；总钙(Ca)-静脉血: 2.44mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；血小板计数(PLT#)-静脉血: 21910E9/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 4.81mmol/L；直接胆红素(DBIL)-静脉血: 4.2umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.64mmolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.013；载脂蛋白B(apoB)-静脉血: 0.73g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.3pg；α-L-岩藻糖苷酶(AFU)-静脉血: 24U/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 8.2umolL；白蛋白(ALB)-静脉血: 45.8g/L；血小板比容-静脉血: 21%；ABO血型-静脉血: O；尿素氮(BUN)-静脉血: 3.6mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；凝血酶时间(TT)-静脉血: 20.2sec.；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；载脂蛋白AI(apoAI)-静脉血: 1.33g/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；C-反应蛋白(CRP)-静脉血: 0.36mg/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血:……\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔稍狭窄，鼻咽左侧壁明显增厚，左侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。肿物侵犯左侧腭帆张提肌，左侧咽旁脂肪间隙变窄。鼻咽顶后壁稍增厚，右侧壁未见明显增厚，右侧咽隐窝清晰。 右侧腭帆张提肌、双侧头长肌、翼内外肌未见明显异常。 双侧翼腭窝、上颌后脂肪间隙、咀嚼肌间隙未见异常。 口咽各壁未见增厚。鼻腔内未见肿物。 蝶骨基底部、左侧翼突基底部及内侧板骨质信号降低，增强扫描可见强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦粘膜稍增厚，双侧乳突未见明显异常。 左侧咽后见几个淋巴结，最大者约8mm×5mm，边界欠清，明显强化。双颈II区见多个淋巴结，最大者约16mm×8mm，边界尚清，较均匀明显强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽左侧壁增厚，左侧咽隐窝肿物，考虑鼻咽癌。 颅底骨质破坏。 左侧咽后、双颈II区淋巴结，可疑转移。 轻度鼻窦炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右侧约平T6椎体水平，估计导管末端位于上腔静脉上段内。；检查结论: PICC管位置如上所述。\n- [全程D13] 检验组合: 酸碱度(pH)-尿液: 5.5；粘液丝计数(MUCS#)-尿液: 11/μL；酮体(KET)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 1/μL；红细胞计数(RBC#)-尿液: 3/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: colorless；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；比重(SG)-尿液: 1.008\n- [全程D14] 检验组合: 总蛋白(TP)-尿液: +- 0.2g（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；红细胞计数(RBC#)-尿液: 1/μL；葡萄糖(Glu)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.02；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；粘液丝计数(MUCS#)-尿液: 4/μL；白细胞(LEU)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D15] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 11/μL；酮体(KET)-尿液: -（参考: 阴性）；酵母菌(YEAST)-尿液: 1/μL；白细胞(LEU)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 1/μL；比重(SG)-尿液: 1.019；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 7/μL；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；酸碱度(pH)-尿液: 6.5；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D19] 检验组合: 氯离子(Cl-)-静脉血: 96.7mmol/L；总蛋白(TP)-静脉血: 73.8g/L；甘油三酯(TG)-静脉血: 1mmol/L；血小板计数(PLT#)-静脉血: 18410E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.2；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.27；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.44mmolL；球蛋白(GLO)-静脉血: 27.4g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；丙氨酸氨基转移酶(ALT)-静脉血: 16.1U/L；总钙(Ca)-静脉血: 2.31mmol/L；血小板比容-静脉血: 18%；血红蛋白(Hb)-静脉血: 144g/L；血液二氧化碳含量ctCO2(B)-静脉血: 26.5mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 356g/L；胱抑素(Cys-C)-静脉血: 0.75mg/L；γ-谷氨酰基转移酶(GGT)-静脉血: 18.1U/L；红细胞计数(RBC#)-静脉血: 4.5310E12/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.1；淋巴细胞百分比(Lymph%)-静脉血: 0.277；平均红细胞血红蛋白含量(MCH)-静脉血: 31.8pg；尿酸(UA)-静脉血: 231.9umol/L；乳酸脱氢酶(LDH)-静脉血: 158.8U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；载脂蛋白B(apoB)-静脉血: 0.78g/L；中性粒细胞百分比(Neut%)-静脉血: 0.597；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；血小板分布宽度(PDW)-静脉血: 10.5%；间接胆红素(IBIL)-静脉血: 11.1umolL；单核细胞百分比(Mono%)-静脉血: 0.101；天门冬氨酸氨基转移酶(AST)-静脉血: 20.5U/L；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L；白细胞计数(WBC#)-静脉血: 4.8310E9/L；镁离子(Mg2+)-静脉血: 0.93mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.36g/L；总胆红素(TBIL)-静脉血: 16.1umol/……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D17] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者第一程诱导化疗后，诉轻度恶心呕吐，精神睡眠尚可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。钱医生信息已隐藏：患者03-02开始予5-Fu6.6g,DDP130mg化疗，患者未诉特殊不适，注意观察不良反应。\n- [全程D19] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者化疗后，诉轻度恶心，精神睡眠尚可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。医生信息已隐藏：患者第一程诱导化疗顺利，一般情况可，予出院。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 办理出院，无需特殊用药，嘱出院后每2周复查血常规及肝肾功能，按计划返院行下一程诱导化疗。\nB. 暂缓出院，予以静脉营养支持及强效止吐治疗，待恶心症状完全缓解后出院，按计划返院行下一程化疗。\nC. 办理出院，予以止吐处理并预防性给予长效G-CSF支持，嘱出院后每周复查血常规，按计划返院行下一程化疗。\nD. 办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，下一程化疗方案需减量20%并延迟1周进行。\nE. 暂缓出院，予以保肝降酶及护胃治疗，待复查肝功能及消化道症状好转后出院，按计划返院行下一程化疗。\nF. 办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，下一阶段直接转入同期放化疗。\nG. 办理出院，予以止吐处理，嘱出院后每3天复查肾功能及电解质，按计划返院行下一程诱导化疗。\nH. 办理出院，予以帕洛诺司琼等止吐处理，嘱出院后每周复查血常规及肝肾功能，按计划返院行下一程化疗。\nI. 暂缓出院，予以静脉补液及纠正电解质紊乱治疗，复查生化指标正常后出院，按计划返院行下一程化疗。\nJ. 办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，下一程化疗更改为单药方案以减轻反应。\nK. 办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，按计划返院行靶向治疗联合放疗。\nL. 暂缓出院，予以质子泵抑制剂静脉滴注预防应激性溃疡，观察3天后出院，按计划返院行下一程化疗。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 回吸性涕血1月余。；现病史: 缘于1月前患者无意中出现抽吸性血涕，痰中带血；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻咽角化,涕血,痰中带血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：78次/分，R：20次/分，BP：125/80mmHg,Ht：162cm，Wt：61kg，BSA：1.6483m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 回吸性涕血1月余。；现病史: 缘于1月前患者无意中出现抽吸性血涕，痰中带血；无头痛、面麻，无视力下降、复视，无听力下降、耳鸣等不适，于当地乡镇医院予滴鼻治疗，具体药物不详，未见好转，遂于某次就诊时间往[地点已隐去]人民医院检查，某次就诊时间病理活检示：鼻咽未分化型角化性癌。某次就诊时间鼻咽MRI示：左侧鼻咽部占位病变，考虑鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻咽角化,涕血,痰中带血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：78次/分，R：20次/分，BP：125/80mmHg,Ht：162cm，Wt：61kg，BSA：1.6483m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率100次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 胱抑素(Cys-C)-静脉血: 0.77mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.69mmol/L；阴离子间隙(AG)-静脉血: 13；磷(P)-静脉血: 0.92mmol/L；总胆红素(TBIL)-静脉血: 12.4umol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；肌酐(Crea)-静脉血: 80.5umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.58；Rh血型-静脉血: 阳性；总钙(Ca)-静脉血: 2.44mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；血小板计数(PLT#)-静脉血: 21910E9/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 4.81mmol/L；直接胆红素(DBIL)-静脉血: 4.2umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.64mmolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.013；载脂蛋白B(apoB)-静脉血: 0.73g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.3pg；α-L-岩藻糖苷酶(AFU)-静脉血: 24U/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 8.2umolL；白蛋白(ALB)-静脉血: 45.8g/L；血小板比容-静脉血: 21%；ABO血型-静脉血: O；尿素氮(BUN)-静脉血: 3.6mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；凝血酶时间(TT)-静脉血: 20.2sec.；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；载脂蛋白AI(apoAI)-静脉血: 1.33g/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；C-反应蛋白(CRP)-静脉血: 0.36mg/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血:……\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔稍狭窄，鼻咽左侧壁明显增厚，左侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。肿物侵犯左侧腭帆张提肌，左侧咽旁脂肪间隙变窄。鼻咽顶后壁稍增厚，右侧壁未见明显增厚，右侧咽隐窝清晰。 右侧腭帆张提肌、双侧头长肌、翼内外肌未见明显异常。 双侧翼腭窝、上颌后脂肪间隙、咀嚼肌间隙未见异常。 口咽各壁未见增厚。鼻腔内未见肿物。 蝶骨基底部、左侧翼突基底部及内侧板骨质信号降低，增强扫描可见强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦粘膜稍增厚，双侧乳突未见明显异常。 左侧咽后见几个淋巴结，最大者约8mm×5mm，边界欠清，明显强化。双颈II区见多个淋巴结，最大者约16mm×8mm，边界尚清，较均匀明显强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽左侧壁增厚，左侧咽隐窝肿物，考虑鼻咽癌。 颅底骨质破坏。 左侧咽后、双颈II区淋巴结，可疑转移。 轻度鼻窦炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右侧约平T6椎体水平，估计导管末端位于上腔静脉上段内。；检查结论: PICC管位置如上所述。\n- [全程D13] 检验组合: 酸碱度(pH)-尿液: 5.5；粘液丝计数(MUCS#)-尿液: 11/μL；酮体(KET)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 1/μL；红细胞计数(RBC#)-尿液: 3/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: colorless；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；比重(SG)-尿液: 1.008\n- [全程D14] 检验组合: 总蛋白(TP)-尿液: +- 0.2g（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；红细胞计数(RBC#)-尿液: 1/μL；葡萄糖(Glu)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.02；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；粘液丝计数(MUCS#)-尿液: 4/μL；白细胞(LEU)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D15] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 11/μL；酮体(KET)-尿液: -（参考: 阴性）；酵母菌(YEAST)-尿液: 1/μL；白细胞(LEU)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 1/μL；比重(SG)-尿液: 1.019；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 7/μL；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；酸碱度(pH)-尿液: 6.5；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D19] 检验组合: 氯离子(Cl-)-静脉血: 96.7mmol/L；总蛋白(TP)-静脉血: 73.8g/L；甘油三酯(TG)-静脉血: 1mmol/L；血小板计数(PLT#)-静脉血: 18410E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.2；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.27；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.44mmolL；球蛋白(GLO)-静脉血: 27.4g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；丙氨酸氨基转移酶(ALT)-静脉血: 16.1U/L；总钙(Ca)-静脉血: 2.31mmol/L；血小板比容-静脉血: 18%；血红蛋白(Hb)-静脉血: 144g/L；血液二氧化碳含量ctCO2(B)-静脉血: 26.5mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 356g/L；胱抑素(Cys-C)-静脉血: 0.75mg/L；γ-谷氨酰基转移酶(GGT)-静脉血: 18.1U/L；红细胞计数(RBC#)-静脉血: 4.5310E12/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.1；淋巴细胞百分比(Lymph%)-静脉血: 0.277；平均红细胞血红蛋白含量(MCH)-静脉血: 31.8pg；尿酸(UA)-静脉血: 231.9umol/L；乳酸脱氢酶(LDH)-静脉血: 158.8U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；载脂蛋白B(apoB)-静脉血: 0.78g/L；中性粒细胞百分比(Neut%)-静脉血: 0.597；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；血小板分布宽度(PDW)-静脉血: 10.5%；间接胆红素(IBIL)-静脉血: 11.1umolL；单核细胞百分比(Mono%)-静脉血: 0.101；天门冬氨酸氨基转移酶(AST)-静脉血: 20.5U/L；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L；白细胞计数(WBC#)-静脉血: 4.8310E9/L；镁离子(Mg2+)-静脉血: 0.93mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.36g/L；总胆红素(TBIL)-静脉血: 16.1umol/……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D17] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者第一程诱导化疗后，诉轻度恶心呕吐，精神睡眠尚可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。钱医生信息已隐藏：患者03-02开始予5-Fu6.6g,DDP130mg化疗，患者未诉特殊不适，注意观察不良反应。\n- [全程D19] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者化疗后，诉轻度恶心，精神睡眠尚可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。医生信息已隐藏：患者第一程诱导化疗顺利，一般情况可，予出院。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 办理出院，无需特殊用药，嘱出院后每2周复查血常规及肝肾功能，按计划返院行下一程诱导化疗。\nB. 暂缓出院，予以静脉营养支持及强效止吐治疗，待恶心症状完全缓解后出院，按计划返院行下一程化疗。\nC. 办理出院，予以止吐处理并预防性给予长效G-CSF支持，嘱出院后每周复查血常规，按计划返院行下一程化疗。\nD. 办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，下一程化疗方案需减量20%并延迟1周进行。\nE. 暂缓出院，予以保肝降酶及护胃治疗，待复查肝功能及消化道症状好转后出院，按计划返院行下一程化疗。\nF. 办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，下一阶段直接转入同期放化疗。\nG. 办理出院，予以止吐处理，嘱出院后每3天复查肾功能及电解质，按计划返院行下一程诱导化疗。\nH. 办理出院，予以帕洛诺司琼等止吐处理，嘱出院后每周复查血常规及肝肾功能，按计划返院行下一程化疗。\nI. 暂缓出院，予以静脉补液及纠正电解质紊乱治疗，复查生化指标正常后出院，按计划返院行下一程化疗。\nJ. 办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，下一程化疗更改为单药方案以减轻反应。\nK. 办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，按计划返院行靶向治疗联合放疗。\nL. 暂缓出院，予以质子泵抑制剂静脉滴注预防应激性溃疡，观察3天后出院，按计划返院行下一程化疗。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-f5ab8fe6b2ae40df32eed56b","patient_id":"patient-e5fcd31b4b8b85194b146991","turn_id":"turn06","turn_position":5,"turn_type":"toxicity_or_support_decision","gold_letter":"I","gold_action":"行PICC导管常规维护（更换敷料与正压接头），并完善间接鼻咽镜检查准备下一周期治疗。","options":[{"letter":"A","text":"拔除PICC导管改行外周静脉穿刺，并完善间接鼻咽镜检查准备下一周期治疗。","is_gold":false},{"letter":"B","text":"予重组人粒细胞刺激因子皮下注射，并行动静脉置管常规护理准备下一周期治疗。","is_gold":false},{"letter":"C","text":"予静脉补钾、补镁及水化利尿治疗，并行动静脉置管常规护理准备下一周期治疗。","is_gold":false},{"letter":"D","text":"予静脉输注红细胞悬液，并行动静脉置管常规护理准备下一周期治疗。","is_gold":false},{"letter":"E","text":"予静脉滴注广谱抗菌药物，并完善间接鼻咽镜检查准备下一周期治疗。","is_gold":false},{"letter":"F","text":"拔除PICC导管更换为锁骨下静脉置管，并完善间接鼻咽镜检查准备下一周期治疗。","is_gold":false},{"letter":"G","text":"予静脉滴注5-HT3受体拮抗剂，并行动静脉置管常规护理准备下一周期治疗。","is_gold":false},{"letter":"H","text":"予静脉输注肠外营养液，并完善间接鼻咽镜检查准备下一周期治疗。","is_gold":false},{"letter":"I","text":"行PICC导管常规维护（更换敷料与正压接头），并完善间接鼻咽镜检查准备下一周期治疗。","is_gold":true},{"letter":"J","text":"行鼻咽内镜下组织活检，并行动静脉置管常规护理准备下一周期治疗。","is_gold":false},{"letter":"K","text":"予静脉输注人血白蛋白，并行动静脉置管常规护理准备下一周期治疗。","is_gold":false},{"letter":"L","text":"予口服保肝药物，并完善间接鼻咽镜检查准备下一周期治疗。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 回吸性涕血1月余。；现病史: 缘于1月前患者无意中出现抽吸性血涕，痰中带血；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻咽角化,涕血,痰中带血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：78次/分，R：20次/分，BP：125/80mmHg,Ht：162cm，Wt：61kg，BSA：1.6483m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 回吸性涕血1月余。；现病史: 缘于1月前患者无意中出现抽吸性血涕，痰中带血；无头痛、面麻，无视力下降、复视，无听力下降、耳鸣等不适，于当地乡镇医院予滴鼻治疗，具体药物不详，未见好转，遂于某次就诊时间往[地点已隐去]人民医院检查，某次就诊时间病理活检示：鼻咽未分化型角化性癌。某次就诊时间鼻咽MRI示：左侧鼻咽部占位病变，考虑鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻咽角化,涕血,痰中带血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：78次/分，R：20次/分，BP：125/80mmHg,Ht：162cm，Wt：61kg，BSA：1.6483m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率100次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 胱抑素(Cys-C)-静脉血: 0.77mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.69mmol/L；阴离子间隙(AG)-静脉血: 13；磷(P)-静脉血: 0.92mmol/L；总胆红素(TBIL)-静脉血: 12.4umol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；肌酐(Crea)-静脉血: 80.5umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.58；Rh血型-静脉血: 阳性；总钙(Ca)-静脉血: 2.44mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；血小板计数(PLT#)-静脉血: 21910E9/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 4.81mmol/L；直接胆红素(DBIL)-静脉血: 4.2umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.64mmolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.013；载脂蛋白B(apoB)-静脉血: 0.73g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.3pg；α-L-岩藻糖苷酶(AFU)-静脉血: 24U/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 8.2umolL；白蛋白(ALB)-静脉血: 45.8g/L；血小板比容-静脉血: 21%；ABO血型-静脉血: O；尿素氮(BUN)-静脉血: 3.6mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；凝血酶时间(TT)-静脉血: 20.2sec.；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；载脂蛋白AI(apoAI)-静脉血: 1.33g/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；C-反应蛋白(CRP)-静脉血: 0.36mg/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血:……\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔稍狭窄，鼻咽左侧壁明显增厚，左侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。肿物侵犯左侧腭帆张提肌，左侧咽旁脂肪间隙变窄。鼻咽顶后壁稍增厚，右侧壁未见明显增厚，右侧咽隐窝清晰。 右侧腭帆张提肌、双侧头长肌、翼内外肌未见明显异常。 双侧翼腭窝、上颌后脂肪间隙、咀嚼肌间隙未见异常。 口咽各壁未见增厚。鼻腔内未见肿物。 蝶骨基底部、左侧翼突基底部及内侧板骨质信号降低，增强扫描可见强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦粘膜稍增厚，双侧乳突未见明显异常。 左侧咽后见几个淋巴结，最大者约8mm×5mm，边界欠清，明显强化。双颈II区见多个淋巴结，最大者约16mm×8mm，边界尚清，较均匀明显强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽左侧壁增厚，左侧咽隐窝肿物，考虑鼻咽癌。 颅底骨质破坏。 左侧咽后、双颈II区淋巴结，可疑转移。 轻度鼻窦炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右侧约平T6椎体水平，估计导管末端位于上腔静脉上段内。；检查结论: PICC管位置如上所述。\n- [全程D13] 检验组合: 酸碱度(pH)-尿液: 5.5；粘液丝计数(MUCS#)-尿液: 11/μL；酮体(KET)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 1/μL；红细胞计数(RBC#)-尿液: 3/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: colorless；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；比重(SG)-尿液: 1.008\n- [全程D14] 检验组合: 总蛋白(TP)-尿液: +- 0.2g（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；红细胞计数(RBC#)-尿液: 1/μL；葡萄糖(Glu)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.02；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；粘液丝计数(MUCS#)-尿液: 4/μL；白细胞(LEU)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D15] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 11/μL；酮体(KET)-尿液: -（参考: 阴性）；酵母菌(YEAST)-尿液: 1/μL；白细胞(LEU)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 1/μL；比重(SG)-尿液: 1.019；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 7/μL；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；酸碱度(pH)-尿液: 6.5；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D19] 检验组合: 氯离子(Cl-)-静脉血: 96.7mmol/L；总蛋白(TP)-静脉血: 73.8g/L；甘油三酯(TG)-静脉血: 1mmol/L；血小板计数(PLT#)-静脉血: 18410E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.2；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.27；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.44mmolL；球蛋白(GLO)-静脉血: 27.4g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；丙氨酸氨基转移酶(ALT)-静脉血: 16.1U/L；总钙(Ca)-静脉血: 2.31mmol/L；血小板比容-静脉血: 18%；血红蛋白(Hb)-静脉血: 144g/L；血液二氧化碳含量ctCO2(B)-静脉血: 26.5mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 356g/L；胱抑素(Cys-C)-静脉血: 0.75mg/L；γ-谷氨酰基转移酶(GGT)-静脉血: 18.1U/L；红细胞计数(RBC#)-静脉血: 4.5310E12/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.1；淋巴细胞百分比(Lymph%)-静脉血: 0.277；平均红细胞血红蛋白含量(MCH)-静脉血: 31.8pg；尿酸(UA)-静脉血: 231.9umol/L；乳酸脱氢酶(LDH)-静脉血: 158.8U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；载脂蛋白B(apoB)-静脉血: 0.78g/L；中性粒细胞百分比(Neut%)-静脉血: 0.597；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；血小板分布宽度(PDW)-静脉血: 10.5%；间接胆红素(IBIL)-静脉血: 11.1umolL；单核细胞百分比(Mono%)-静脉血: 0.101；天门冬氨酸氨基转移酶(AST)-静脉血: 20.5U/L；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L；白细胞计数(WBC#)-静脉血: 4.8310E9/L；镁离子(Mg2+)-静脉血: 0.93mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.36g/L；总胆红素(TBIL)-静脉血: 16.1umol/……\n- [全程D34] 检验组合: 阴离子间隙(AG)-静脉血: 10.5；乳酸脱氢酶(LDH)-静脉血: 175.1U/L；肌酐(Crea)-静脉血: 86umol/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；钾离子(K+)-静脉血: 3.9mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.43；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.18；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；甘油三酯(TG)-静脉血: 0.79mmol/L；总蛋白(TP)-静脉血: 76.5g/L；大血小板百分比(P-LCR%)-静脉血: 15.9%；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.537；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；总钙(Ca)-静脉血: 2.39mmol/L；尿酸(UA)-静脉血: 334.3umol/L；钠离子(Na+)-静脉血: 142.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.53g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；单核细胞百分比(Mono%)-静脉血: 0.102；有核红细胞百分比(NRBC%)-静脉血: 0；单核细胞计数(Mono#)-静脉血: 0.510E9/L；碱性磷酸酶(ALP)-静脉血: 63.6U/L；间接胆红素(IBIL)-静脉血: 6.8umolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.028；平均红细胞体积(MCV)-静脉血: 90.7fL；淋巴细胞百分比(Lymph%)-静脉血: 0.325；血液二氧化碳含量ctCO2(B)-静脉血: 29.6mmol/L；血小板分布宽度(PDW)-静脉血: 8.8%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.3；平均血小板体积(MPV)-静脉血: 8.9fL；球蛋白(GLO)-静脉血: 31.5g/L；血红蛋白(Hb)-静脉血: 130g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 29U/L；白蛋白(ALB)-静脉血: 45g/L；总胆汁酸(TBA)-静脉血: 5.6umol/L；总胆固醇(TC)-静脉血: 5.01mmol/L……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D17] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者第一程诱导化疗后，诉轻度恶心呕吐，精神睡眠尚可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。钱医生信息已隐藏：患者03-02开始予5-Fu6.6g,DDP130mg化疗，患者未诉特殊不适，注意观察不良反应。\n- [全程D19] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者化疗后，诉轻度恶心，精神睡眠尚可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。医生信息已隐藏：患者第一程诱导化疗顺利，一般情况可，予出院。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 拔除PICC导管改行外周静脉穿刺，并完善间接鼻咽镜检查准备下一周期治疗。\nB. 予重组人粒细胞刺激因子皮下注射，并行动静脉置管常规护理准备下一周期治疗。\nC. 予静脉补钾、补镁及水化利尿治疗，并行动静脉置管常规护理准备下一周期治疗。\nD. 予静脉输注红细胞悬液，并行动静脉置管常规护理准备下一周期治疗。\nE. 予静脉滴注广谱抗菌药物，并完善间接鼻咽镜检查准备下一周期治疗。\nF. 拔除PICC导管更换为锁骨下静脉置管，并完善间接鼻咽镜检查准备下一周期治疗。\nG. 予静脉滴注5-HT3受体拮抗剂，并行动静脉置管常规护理准备下一周期治疗。\nH. 予静脉输注肠外营养液，并完善间接鼻咽镜检查准备下一周期治疗。\nI. 行PICC导管常规维护（更换敷料与正压接头），并完善间接鼻咽镜检查准备下一周期治疗。\nJ. 行鼻咽内镜下组织活检，并行动静脉置管常规护理准备下一周期治疗。\nK. 予静脉输注人血白蛋白，并行动静脉置管常规护理准备下一周期治疗。\nL. 予口服保肝药物，并完善间接鼻咽镜检查准备下一周期治疗。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 回吸性涕血1月余。；现病史: 缘于1月前患者无意中出现抽吸性血涕，痰中带血；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻咽角化,涕血,痰中带血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：78次/分，R：20次/分，BP：125/80mmHg,Ht：162cm，Wt：61kg，BSA：1.6483m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 回吸性涕血1月余。；现病史: 缘于1月前患者无意中出现抽吸性血涕，痰中带血；无头痛、面麻，无视力下降、复视，无听力下降、耳鸣等不适，于当地乡镇医院予滴鼻治疗，具体药物不详，未见好转，遂于某次就诊时间往[地点已隐去]人民医院检查，某次就诊时间病理活检示：鼻咽未分化型角化性癌。某次就诊时间鼻咽MRI示：左侧鼻咽部占位病变，考虑鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻咽角化,涕血,痰中带血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：78次/分，R：20次/分，BP：125/80mmHg,Ht：162cm，Wt：61kg，BSA：1.6483m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率100次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 胱抑素(Cys-C)-静脉血: 0.77mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.69mmol/L；阴离子间隙(AG)-静脉血: 13；磷(P)-静脉血: 0.92mmol/L；总胆红素(TBIL)-静脉血: 12.4umol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；肌酐(Crea)-静脉血: 80.5umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.58；Rh血型-静脉血: 阳性；总钙(Ca)-静脉血: 2.44mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；血小板计数(PLT#)-静脉血: 21910E9/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 4.81mmol/L；直接胆红素(DBIL)-静脉血: 4.2umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.64mmolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.013；载脂蛋白B(apoB)-静脉血: 0.73g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.3pg；α-L-岩藻糖苷酶(AFU)-静脉血: 24U/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 8.2umolL；白蛋白(ALB)-静脉血: 45.8g/L；血小板比容-静脉血: 21%；ABO血型-静脉血: O；尿素氮(BUN)-静脉血: 3.6mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；凝血酶时间(TT)-静脉血: 20.2sec.；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；载脂蛋白AI(apoAI)-静脉血: 1.33g/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；C-反应蛋白(CRP)-静脉血: 0.36mg/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血:……\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔稍狭窄，鼻咽左侧壁明显增厚，左侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。肿物侵犯左侧腭帆张提肌，左侧咽旁脂肪间隙变窄。鼻咽顶后壁稍增厚，右侧壁未见明显增厚，右侧咽隐窝清晰。 右侧腭帆张提肌、双侧头长肌、翼内外肌未见明显异常。 双侧翼腭窝、上颌后脂肪间隙、咀嚼肌间隙未见异常。 口咽各壁未见增厚。鼻腔内未见肿物。 蝶骨基底部、左侧翼突基底部及内侧板骨质信号降低，增强扫描可见强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦粘膜稍增厚，双侧乳突未见明显异常。 左侧咽后见几个淋巴结，最大者约8mm×5mm，边界欠清，明显强化。双颈II区见多个淋巴结，最大者约16mm×8mm，边界尚清，较均匀明显强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽左侧壁增厚，左侧咽隐窝肿物，考虑鼻咽癌。 颅底骨质破坏。 左侧咽后、双颈II区淋巴结，可疑转移。 轻度鼻窦炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右侧约平T6椎体水平，估计导管末端位于上腔静脉上段内。；检查结论: PICC管位置如上所述。\n- [全程D13] 检验组合: 酸碱度(pH)-尿液: 5.5；粘液丝计数(MUCS#)-尿液: 11/μL；酮体(KET)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 1/μL；红细胞计数(RBC#)-尿液: 3/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: colorless；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；比重(SG)-尿液: 1.008\n- [全程D14] 检验组合: 总蛋白(TP)-尿液: +- 0.2g（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；红细胞计数(RBC#)-尿液: 1/μL；葡萄糖(Glu)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.02；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；粘液丝计数(MUCS#)-尿液: 4/μL；白细胞(LEU)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D15] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 11/μL；酮体(KET)-尿液: -（参考: 阴性）；酵母菌(YEAST)-尿液: 1/μL；白细胞(LEU)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 1/μL；比重(SG)-尿液: 1.019；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 7/μL；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；酸碱度(pH)-尿液: 6.5；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D19] 检验组合: 氯离子(Cl-)-静脉血: 96.7mmol/L；总蛋白(TP)-静脉血: 73.8g/L；甘油三酯(TG)-静脉血: 1mmol/L；血小板计数(PLT#)-静脉血: 18410E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.2；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.27；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.44mmolL；球蛋白(GLO)-静脉血: 27.4g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；丙氨酸氨基转移酶(ALT)-静脉血: 16.1U/L；总钙(Ca)-静脉血: 2.31mmol/L；血小板比容-静脉血: 18%；血红蛋白(Hb)-静脉血: 144g/L；血液二氧化碳含量ctCO2(B)-静脉血: 26.5mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 356g/L；胱抑素(Cys-C)-静脉血: 0.75mg/L；γ-谷氨酰基转移酶(GGT)-静脉血: 18.1U/L；红细胞计数(RBC#)-静脉血: 4.5310E12/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.1；淋巴细胞百分比(Lymph%)-静脉血: 0.277；平均红细胞血红蛋白含量(MCH)-静脉血: 31.8pg；尿酸(UA)-静脉血: 231.9umol/L；乳酸脱氢酶(LDH)-静脉血: 158.8U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；载脂蛋白B(apoB)-静脉血: 0.78g/L；中性粒细胞百分比(Neut%)-静脉血: 0.597；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；血小板分布宽度(PDW)-静脉血: 10.5%；间接胆红素(IBIL)-静脉血: 11.1umolL；单核细胞百分比(Mono%)-静脉血: 0.101；天门冬氨酸氨基转移酶(AST)-静脉血: 20.5U/L；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L；白细胞计数(WBC#)-静脉血: 4.8310E9/L；镁离子(Mg2+)-静脉血: 0.93mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.36g/L；总胆红素(TBIL)-静脉血: 16.1umol/……\n- [全程D34] 检验组合: 阴离子间隙(AG)-静脉血: 10.5；乳酸脱氢酶(LDH)-静脉血: 175.1U/L；肌酐(Crea)-静脉血: 86umol/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；钾离子(K+)-静脉血: 3.9mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.43；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.18；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；甘油三酯(TG)-静脉血: 0.79mmol/L；总蛋白(TP)-静脉血: 76.5g/L；大血小板百分比(P-LCR%)-静脉血: 15.9%；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.537；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；总钙(Ca)-静脉血: 2.39mmol/L；尿酸(UA)-静脉血: 334.3umol/L；钠离子(Na+)-静脉血: 142.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.53g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；单核细胞百分比(Mono%)-静脉血: 0.102；有核红细胞百分比(NRBC%)-静脉血: 0；单核细胞计数(Mono#)-静脉血: 0.510E9/L；碱性磷酸酶(ALP)-静脉血: 63.6U/L；间接胆红素(IBIL)-静脉血: 6.8umolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.028；平均红细胞体积(MCV)-静脉血: 90.7fL；淋巴细胞百分比(Lymph%)-静脉血: 0.325；血液二氧化碳含量ctCO2(B)-静脉血: 29.6mmol/L；血小板分布宽度(PDW)-静脉血: 8.8%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.3；平均血小板体积(MPV)-静脉血: 8.9fL；球蛋白(GLO)-静脉血: 31.5g/L；血红蛋白(Hb)-静脉血: 130g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 29U/L；白蛋白(ALB)-静脉血: 45g/L；总胆汁酸(TBA)-静脉血: 5.6umol/L；总胆固醇(TC)-静脉血: 5.01mmol/L……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D17] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者第一程诱导化疗后，诉轻度恶心呕吐，精神睡眠尚可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。钱医生信息已隐藏：患者03-02开始予5-Fu6.6g,DDP130mg化疗，患者未诉特殊不适，注意观察不良反应。\n- [全程D19] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者化疗后，诉轻度恶心，精神睡眠尚可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。医生信息已隐藏：患者第一程诱导化疗顺利，一般情况可，予出院。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 拔除PICC导管改行外周静脉穿刺，并完善间接鼻咽镜检查准备下一周期治疗。\nB. 予重组人粒细胞刺激因子皮下注射，并行动静脉置管常规护理准备下一周期治疗。\nC. 予静脉补钾、补镁及水化利尿治疗，并行动静脉置管常规护理准备下一周期治疗。\nD. 予静脉输注红细胞悬液，并行动静脉置管常规护理准备下一周期治疗。\nE. 予静脉滴注广谱抗菌药物，并完善间接鼻咽镜检查准备下一周期治疗。\nF. 拔除PICC导管更换为锁骨下静脉置管，并完善间接鼻咽镜检查准备下一周期治疗。\nG. 予静脉滴注5-HT3受体拮抗剂，并行动静脉置管常规护理准备下一周期治疗。\nH. 予静脉输注肠外营养液，并完善间接鼻咽镜检查准备下一周期治疗。\nI. 行PICC导管常规维护（更换敷料与正压接头），并完善间接鼻咽镜检查准备下一周期治疗。\nJ. 行鼻咽内镜下组织活检，并行动静脉置管常规护理准备下一周期治疗。\nK. 予静脉输注人血白蛋白，并行动静脉置管常规护理准备下一周期治疗。\nL. 予口服保肝药物，并完善间接鼻咽镜检查准备下一周期治疗。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-dd7067359645093ab08b6c16","patient_id":"patient-e5fcd31b4b8b85194b146991","turn_id":"turn07","turn_position":6,"turn_type":"recurrence_or_salvage_decision","gold_letter":"J","gold_action":"出院休养并对症处理化疗副反应，定期复查血常规及肝肾功能，按计划返院行根治性放射治疗。","options":[{"letter":"A","text":"立即启动第三程PF方案诱导化疗，随后再行根治性放射治疗。","is_gold":false},{"letter":"B","text":"更改化疗方案为TP或GP方案继续诱导化疗，随后再行根治性放射治疗。","is_gold":false},{"letter":"C","text":"立即行鼻咽及颈部根治性手术切除，术后辅以根治性放射治疗。","is_gold":false},{"letter":"D","text":"出院休养，待化疗副反应恢复后，行右颈部淋巴结清扫术，再行根治性放疗。","is_gold":false},{"letter":"E","text":"立即予以全量根治性放射治疗，并联合靶向药物如西妥昔单抗。","is_gold":false},{"letter":"F","text":"出院休养，行颈部淋巴结穿刺活检明确病理，再决定后续放疗方案。","is_gold":false},{"letter":"G","text":"立即启动根治性放射治疗，暂缓处理骨髓抑制及胃肠道反应。","is_gold":false},{"letter":"H","text":"出院休养，待化疗副反应恢复后，行姑息性放射治疗联合免疫治疗。","is_gold":false},{"letter":"I","text":"行全身PET-CT重新评估远处转移情况，再决定是否启动根治性放疗。","is_gold":false},{"letter":"J","text":"出院休养并对症处理化疗副反应，定期复查血常规及肝肾功能，按计划返院行根治性放射治疗。","is_gold":true},{"letter":"K","text":"出院休养，定期复查血常规及肝肾功能，待恢复后返院行第三程PF方案诱导化疗。","is_gold":false},{"letter":"L","text":"立即予以同期放化疗，并对右颈淋巴结局部推量加量放疗。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 回吸性涕血1月余。；现病史: 缘于1月前患者无意中出现抽吸性血涕，痰中带血；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻咽角化,涕血,痰中带血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：78次/分，R：20次/分，BP：125/80mmHg,Ht：162cm，Wt：61kg，BSA：1.6483m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 回吸性涕血1月余。；现病史: 缘于1月前患者无意中出现抽吸性血涕，痰中带血；无头痛、面麻，无视力下降、复视，无听力下降、耳鸣等不适，于当地乡镇医院予滴鼻治疗，具体药物不详，未见好转，遂于某次就诊时间往[地点已隐去]人民医院检查，某次就诊时间病理活检示：鼻咽未分化型角化性癌。某次就诊时间鼻咽MRI示：左侧鼻咽部占位病变，考虑鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻咽角化,涕血,痰中带血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：78次/分，R：20次/分，BP：125/80mmHg,Ht：162cm，Wt：61kg，BSA：1.6483m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率100次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 胱抑素(Cys-C)-静脉血: 0.77mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.69mmol/L；阴离子间隙(AG)-静脉血: 13；磷(P)-静脉血: 0.92mmol/L；总胆红素(TBIL)-静脉血: 12.4umol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；肌酐(Crea)-静脉血: 80.5umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.58；Rh血型-静脉血: 阳性；总钙(Ca)-静脉血: 2.44mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；血小板计数(PLT#)-静脉血: 21910E9/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 4.81mmol/L；直接胆红素(DBIL)-静脉血: 4.2umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.64mmolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.013；载脂蛋白B(apoB)-静脉血: 0.73g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.3pg；α-L-岩藻糖苷酶(AFU)-静脉血: 24U/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 8.2umolL；白蛋白(ALB)-静脉血: 45.8g/L；血小板比容-静脉血: 21%；ABO血型-静脉血: O；尿素氮(BUN)-静脉血: 3.6mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；凝血酶时间(TT)-静脉血: 20.2sec.；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；载脂蛋白AI(apoAI)-静脉血: 1.33g/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；C-反应蛋白(CRP)-静脉血: 0.36mg/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血:……\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔稍狭窄，鼻咽左侧壁明显增厚，左侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。肿物侵犯左侧腭帆张提肌，左侧咽旁脂肪间隙变窄。鼻咽顶后壁稍增厚，右侧壁未见明显增厚，右侧咽隐窝清晰。 右侧腭帆张提肌、双侧头长肌、翼内外肌未见明显异常。 双侧翼腭窝、上颌后脂肪间隙、咀嚼肌间隙未见异常。 口咽各壁未见增厚。鼻腔内未见肿物。 蝶骨基底部、左侧翼突基底部及内侧板骨质信号降低，增强扫描可见强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦粘膜稍增厚，双侧乳突未见明显异常。 左侧咽后见几个淋巴结，最大者约8mm×5mm，边界欠清，明显强化。双颈II区见多个淋巴结，最大者约16mm×8mm，边界尚清，较均匀明显强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽左侧壁增厚，左侧咽隐窝肿物，考虑鼻咽癌。 颅底骨质破坏。 左侧咽后、双颈II区淋巴结，可疑转移。 轻度鼻窦炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右侧约平T6椎体水平，估计导管末端位于上腔静脉上段内。；检查结论: PICC管位置如上所述。\n- [全程D13] 检验组合: 酸碱度(pH)-尿液: 5.5；粘液丝计数(MUCS#)-尿液: 11/μL；酮体(KET)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 1/μL；红细胞计数(RBC#)-尿液: 3/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: colorless；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；比重(SG)-尿液: 1.008\n- [全程D14] 检验组合: 总蛋白(TP)-尿液: +- 0.2g（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；红细胞计数(RBC#)-尿液: 1/μL；葡萄糖(Glu)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.02；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；粘液丝计数(MUCS#)-尿液: 4/μL；白细胞(LEU)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D15] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 11/μL；酮体(KET)-尿液: -（参考: 阴性）；酵母菌(YEAST)-尿液: 1/μL；白细胞(LEU)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 1/μL；比重(SG)-尿液: 1.019；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 7/μL；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；酸碱度(pH)-尿液: 6.5；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D19] 检验组合: 氯离子(Cl-)-静脉血: 96.7mmol/L；总蛋白(TP)-静脉血: 73.8g/L；甘油三酯(TG)-静脉血: 1mmol/L；血小板计数(PLT#)-静脉血: 18410E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.2；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.27；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.44mmolL；球蛋白(GLO)-静脉血: 27.4g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；丙氨酸氨基转移酶(ALT)-静脉血: 16.1U/L；总钙(Ca)-静脉血: 2.31mmol/L；血小板比容-静脉血: 18%；血红蛋白(Hb)-静脉血: 144g/L；血液二氧化碳含量ctCO2(B)-静脉血: 26.5mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 356g/L；胱抑素(Cys-C)-静脉血: 0.75mg/L；γ-谷氨酰基转移酶(GGT)-静脉血: 18.1U/L；红细胞计数(RBC#)-静脉血: 4.5310E12/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.1；淋巴细胞百分比(Lymph%)-静脉血: 0.277；平均红细胞血红蛋白含量(MCH)-静脉血: 31.8pg；尿酸(UA)-静脉血: 231.9umol/L；乳酸脱氢酶(LDH)-静脉血: 158.8U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；载脂蛋白B(apoB)-静脉血: 0.78g/L；中性粒细胞百分比(Neut%)-静脉血: 0.597；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；血小板分布宽度(PDW)-静脉血: 10.5%；间接胆红素(IBIL)-静脉血: 11.1umolL；单核细胞百分比(Mono%)-静脉血: 0.101；天门冬氨酸氨基转移酶(AST)-静脉血: 20.5U/L；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L；白细胞计数(WBC#)-静脉血: 4.8310E9/L；镁离子(Mg2+)-静脉血: 0.93mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.36g/L；总胆红素(TBIL)-静脉血: 16.1umol/……\n- [全程D34] 检验组合: 阴离子间隙(AG)-静脉血: 10.5；乳酸脱氢酶(LDH)-静脉血: 175.1U/L；肌酐(Crea)-静脉血: 86umol/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；钾离子(K+)-静脉血: 3.9mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.43；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.18；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；甘油三酯(TG)-静脉血: 0.79mmol/L；总蛋白(TP)-静脉血: 76.5g/L；大血小板百分比(P-LCR%)-静脉血: 15.9%；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.537；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；总钙(Ca)-静脉血: 2.39mmol/L；尿酸(UA)-静脉血: 334.3umol/L；钠离子(Na+)-静脉血: 142.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.53g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；单核细胞百分比(Mono%)-静脉血: 0.102；有核红细胞百分比(NRBC%)-静脉血: 0；单核细胞计数(Mono#)-静脉血: 0.510E9/L；碱性磷酸酶(ALP)-静脉血: 63.6U/L；间接胆红素(IBIL)-静脉血: 6.8umolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.028；平均红细胞体积(MCV)-静脉血: 90.7fL；淋巴细胞百分比(Lymph%)-静脉血: 0.325；血液二氧化碳含量ctCO2(B)-静脉血: 29.6mmol/L；血小板分布宽度(PDW)-静脉血: 8.8%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.3；平均血小板体积(MPV)-静脉血: 8.9fL；球蛋白(GLO)-静脉血: 31.5g/L；血红蛋白(Hb)-静脉血: 130g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 29U/L；白蛋白(ALB)-静脉血: 45g/L；总胆汁酸(TBA)-静脉血: 5.6umol/L；总胆固醇(TC)-静脉血: 5.01mmol/L……\n- [全程D35] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；比重(SG)-尿液: 1.015；白细胞计数(WBC#)-尿液: 2/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 6.5；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）\n- [全程D36] 检验组合: 浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 7.5；隐血(OB)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；胆红素(BIL)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.022；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）\n- [全程D37] 检验组合: 颜色-尿液: Yellow；葡萄糖(Glu)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.018；隐血(OB)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 3/μL；酸碱度(pH)-尿液: 7；酮体(KET)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D41] 检验组合: 总胆固醇(TC)-静脉血: 4.84mmol/L；红细胞计数(RBC#)-静脉血: 4.2110E12/L；红细胞比容(Hct)-静脉血: 36.6%；血小板分布宽度(PDW)-静脉血: 7.9%；白蛋白(ALB)-静脉血: 42.1g/L；尿素氮(BUN)-静脉血: 4.8mmol/L；总钙(Ca)-静脉血: 2.25mmol/L；乳酸脱氢酶(LDH)-静脉血: 148.6U/L；钾离子(K+)-静脉血: 3.3mmol/L；阴离子间隙(AG)-静脉血: 14.2；血液二氧化碳含量ctCO2(B)-静脉血: 25mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；胱抑素(Cys-C)-静脉血: 0.8mg/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 350g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.4pg；平均红细胞体积(MCV)-静脉血: 86.9fL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；氯离子(Cl-)-静脉血: 97.5mmol/L；葡萄糖(Glu)-静脉血: 5.35mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.89；镁离子(Mg2+)-静脉血: 0.78mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.34mmolL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；中性粒细胞计数(Neut#)-静脉血: 1.710E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.13mmol/L；直接胆红素(DBIL)-静脉血: 2.5umol/L；磷(P)-静脉血: 1.18mmol/L；球蛋白(GLO)-静脉血: 28.13g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.01；白细胞计数(WBC#)-静脉血: 3.0210E9/L；平均血小板体积(MPV)-静脉血: 8.8fL；总胆红素(TBIL)-静脉血: 9.3umol/L；碱性磷酸酶(ALP)-静脉血: 57.9U/L；中性粒细胞百分比(Neut%)-静脉血: 0.55；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；血小板计数(PLT#)-静脉血: 13810E9/L；肌酐(Crea)-静脉血: 90.1umol/L；血红蛋白(Hb)-静……\n- [全程D42] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后复查： 鼻咽腔稍狭窄，鼻咽双侧壁、顶后壁增厚，左侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。右侧咽隐窝变窄。肿物侵犯左侧腭帆张提肌，右侧腭帆提肌结构稍模糊，右侧腭帆张提肌间隙稍模糊。 双侧头长肌、翼内外肌未见明显异常。 双侧翼腭窝、上颌后脂肪间隙、咀嚼肌间隙未见异常。 口咽各壁未见增厚。鼻腔内未见肿物。 蝶骨基底部、左侧翼突基底部及内侧板骨质信号降低，增强扫描可见强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦粘膜稍增厚，双侧乳突未见明显异常。 左侧咽后见几个淋巴结，最大者约8mm×5mm，边界欠清，明显强化。双颈II区见多个淋巴结，最大者约15mm×12mm，边界尚清，较均匀明显强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗后复查，对比某次就诊时间片： 鼻咽部肿物，较前明显缩小。 颅底骨质破坏，较前未见明显变化。 左侧咽后、双颈II区淋巴结，可疑转移，其中右颈IIa区淋巴结较前增大，余较前未见明显变化。 轻度鼻窦炎。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D17] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者第一程诱导化疗后，诉轻度恶心呕吐，精神睡眠尚可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。钱医生信息已隐藏：患者03-02开始予5-Fu6.6g,DDP130mg化疗，患者未诉特殊不适，注意观察不良反应。\n- [全程D19] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者化疗后，诉轻度恶心，精神睡眠尚可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。医生信息已隐藏：患者第一程诱导化疗顺利，一般情况可，予出院。\n- [全程D35] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者未诉特殊不适，精神睡眠可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。03-22血生化常规未见异常。[姓名已隐去]医生信息已隐藏：患者1程PF方案诱导化疗后，一般情况可，已排除化疗禁忌症，今日水化，明日开始化疗（DDP 130mg d1 ; 5-Fu6.5g civ）。并予对症支持治疗。\n- [全程D36] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉稍恶心呕吐，无头痛、头晕，精神睡眠可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]副医生信息已隐藏：加强对症治疗，患者一般情况可，继续完成化疗，注意休息，加强营养。\n- [全程D37] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉稍恶心，无明显呕吐，无头痛、头晕，精神睡眠可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]副医生信息已隐藏：患者一般情况可继续完成化疗，\n- [全程D41] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者诉恶心呕吐，盗汗，头晕鼻塞，精神睡眠可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。03-29血常规示：WBC3.0*109/L NE1.7*109/L 生化示：血钾 3.3mmol/L[姓名已隐去]医生信息已隐藏：患者第二程诱导化疗，出现I度骨髓抑制，予香伏益血。胃肠道反应相比上次稍重，嘱少食多餐，加强营养。今日化疗结束，嘱明日出院。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即启动第三程PF方案诱导化疗，随后再行根治性放射治疗。\nB. 更改化疗方案为TP或GP方案继续诱导化疗，随后再行根治性放射治疗。\nC. 立即行鼻咽及颈部根治性手术切除，术后辅以根治性放射治疗。\nD. 出院休养，待化疗副反应恢复后，行右颈部淋巴结清扫术，再行根治性放疗。\nE. 立即予以全量根治性放射治疗，并联合靶向药物如西妥昔单抗。\nF. 出院休养，行颈部淋巴结穿刺活检明确病理，再决定后续放疗方案。\nG. 立即启动根治性放射治疗，暂缓处理骨髓抑制及胃肠道反应。\nH. 出院休养，待化疗副反应恢复后，行姑息性放射治疗联合免疫治疗。\nI. 行全身PET-CT重新评估远处转移情况，再决定是否启动根治性放疗。\nJ. 出院休养并对症处理化疗副反应，定期复查血常规及肝肾功能，按计划返院行根治性放射治疗。\nK. 出院休养，定期复查血常规及肝肾功能，待恢复后返院行第三程PF方案诱导化疗。\nL. 立即予以同期放化疗，并对右颈淋巴结局部推量加量放疗。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 回吸性涕血1月余。；现病史: 缘于1月前患者无意中出现抽吸性血涕，痰中带血；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻咽角化,涕血,痰中带血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：78次/分，R：20次/分，BP：125/80mmHg,Ht：162cm，Wt：61kg，BSA：1.6483m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 回吸性涕血1月余。；现病史: 缘于1月前患者无意中出现抽吸性血涕，痰中带血；无头痛、面麻，无视力下降、复视，无听力下降、耳鸣等不适，于当地乡镇医院予滴鼻治疗，具体药物不详，未见好转，遂于某次就诊时间往[地点已隐去]人民医院检查，某次就诊时间病理活检示：鼻咽未分化型角化性癌。某次就诊时间鼻咽MRI示：左侧鼻咽部占位病变，考虑鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻咽角化,涕血,痰中带血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：78次/分，R：20次/分，BP：125/80mmHg,Ht：162cm，Wt：61kg，BSA：1.6483m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率100次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 胱抑素(Cys-C)-静脉血: 0.77mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.69mmol/L；阴离子间隙(AG)-静脉血: 13；磷(P)-静脉血: 0.92mmol/L；总胆红素(TBIL)-静脉血: 12.4umol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；肌酐(Crea)-静脉血: 80.5umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.58；Rh血型-静脉血: 阳性；总钙(Ca)-静脉血: 2.44mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；血小板计数(PLT#)-静脉血: 21910E9/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 4.81mmol/L；直接胆红素(DBIL)-静脉血: 4.2umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.64mmolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.013；载脂蛋白B(apoB)-静脉血: 0.73g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.3pg；α-L-岩藻糖苷酶(AFU)-静脉血: 24U/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 8.2umolL；白蛋白(ALB)-静脉血: 45.8g/L；血小板比容-静脉血: 21%；ABO血型-静脉血: O；尿素氮(BUN)-静脉血: 3.6mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；凝血酶时间(TT)-静脉血: 20.2sec.；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；载脂蛋白AI(apoAI)-静脉血: 1.33g/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；C-反应蛋白(CRP)-静脉血: 0.36mg/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血:……\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔稍狭窄，鼻咽左侧壁明显增厚，左侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。肿物侵犯左侧腭帆张提肌，左侧咽旁脂肪间隙变窄。鼻咽顶后壁稍增厚，右侧壁未见明显增厚，右侧咽隐窝清晰。 右侧腭帆张提肌、双侧头长肌、翼内外肌未见明显异常。 双侧翼腭窝、上颌后脂肪间隙、咀嚼肌间隙未见异常。 口咽各壁未见增厚。鼻腔内未见肿物。 蝶骨基底部、左侧翼突基底部及内侧板骨质信号降低，增强扫描可见强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦粘膜稍增厚，双侧乳突未见明显异常。 左侧咽后见几个淋巴结，最大者约8mm×5mm，边界欠清，明显强化。双颈II区见多个淋巴结，最大者约16mm×8mm，边界尚清，较均匀明显强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽左侧壁增厚，左侧咽隐窝肿物，考虑鼻咽癌。 颅底骨质破坏。 左侧咽后、双颈II区淋巴结，可疑转移。 轻度鼻窦炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右侧约平T6椎体水平，估计导管末端位于上腔静脉上段内。；检查结论: PICC管位置如上所述。\n- [全程D13] 检验组合: 酸碱度(pH)-尿液: 5.5；粘液丝计数(MUCS#)-尿液: 11/μL；酮体(KET)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 1/μL；红细胞计数(RBC#)-尿液: 3/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: colorless；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；比重(SG)-尿液: 1.008\n- [全程D14] 检验组合: 总蛋白(TP)-尿液: +- 0.2g（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；红细胞计数(RBC#)-尿液: 1/μL；葡萄糖(Glu)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.02；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；粘液丝计数(MUCS#)-尿液: 4/μL；白细胞(LEU)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D15] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 11/μL；酮体(KET)-尿液: -（参考: 阴性）；酵母菌(YEAST)-尿液: 1/μL；白细胞(LEU)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 1/μL；比重(SG)-尿液: 1.019；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 7/μL；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；酸碱度(pH)-尿液: 6.5；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D19] 检验组合: 氯离子(Cl-)-静脉血: 96.7mmol/L；总蛋白(TP)-静脉血: 73.8g/L；甘油三酯(TG)-静脉血: 1mmol/L；血小板计数(PLT#)-静脉血: 18410E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.2；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.27；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.44mmolL；球蛋白(GLO)-静脉血: 27.4g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；丙氨酸氨基转移酶(ALT)-静脉血: 16.1U/L；总钙(Ca)-静脉血: 2.31mmol/L；血小板比容-静脉血: 18%；血红蛋白(Hb)-静脉血: 144g/L；血液二氧化碳含量ctCO2(B)-静脉血: 26.5mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 356g/L；胱抑素(Cys-C)-静脉血: 0.75mg/L；γ-谷氨酰基转移酶(GGT)-静脉血: 18.1U/L；红细胞计数(RBC#)-静脉血: 4.5310E12/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.1；淋巴细胞百分比(Lymph%)-静脉血: 0.277；平均红细胞血红蛋白含量(MCH)-静脉血: 31.8pg；尿酸(UA)-静脉血: 231.9umol/L；乳酸脱氢酶(LDH)-静脉血: 158.8U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；载脂蛋白B(apoB)-静脉血: 0.78g/L；中性粒细胞百分比(Neut%)-静脉血: 0.597；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；血小板分布宽度(PDW)-静脉血: 10.5%；间接胆红素(IBIL)-静脉血: 11.1umolL；单核细胞百分比(Mono%)-静脉血: 0.101；天门冬氨酸氨基转移酶(AST)-静脉血: 20.5U/L；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L；白细胞计数(WBC#)-静脉血: 4.8310E9/L；镁离子(Mg2+)-静脉血: 0.93mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.36g/L；总胆红素(TBIL)-静脉血: 16.1umol/……\n- [全程D34] 检验组合: 阴离子间隙(AG)-静脉血: 10.5；乳酸脱氢酶(LDH)-静脉血: 175.1U/L；肌酐(Crea)-静脉血: 86umol/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；钾离子(K+)-静脉血: 3.9mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.43；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.18；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；甘油三酯(TG)-静脉血: 0.79mmol/L；总蛋白(TP)-静脉血: 76.5g/L；大血小板百分比(P-LCR%)-静脉血: 15.9%；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.537；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；总钙(Ca)-静脉血: 2.39mmol/L；尿酸(UA)-静脉血: 334.3umol/L；钠离子(Na+)-静脉血: 142.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.53g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；单核细胞百分比(Mono%)-静脉血: 0.102；有核红细胞百分比(NRBC%)-静脉血: 0；单核细胞计数(Mono#)-静脉血: 0.510E9/L；碱性磷酸酶(ALP)-静脉血: 63.6U/L；间接胆红素(IBIL)-静脉血: 6.8umolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.028；平均红细胞体积(MCV)-静脉血: 90.7fL；淋巴细胞百分比(Lymph%)-静脉血: 0.325；血液二氧化碳含量ctCO2(B)-静脉血: 29.6mmol/L；血小板分布宽度(PDW)-静脉血: 8.8%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.3；平均血小板体积(MPV)-静脉血: 8.9fL；球蛋白(GLO)-静脉血: 31.5g/L；血红蛋白(Hb)-静脉血: 130g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 29U/L；白蛋白(ALB)-静脉血: 45g/L；总胆汁酸(TBA)-静脉血: 5.6umol/L；总胆固醇(TC)-静脉血: 5.01mmol/L……\n- [全程D35] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；比重(SG)-尿液: 1.015；白细胞计数(WBC#)-尿液: 2/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 6.5；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）\n- [全程D36] 检验组合: 浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 7.5；隐血(OB)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；胆红素(BIL)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.022；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）\n- [全程D37] 检验组合: 颜色-尿液: Yellow；葡萄糖(Glu)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.018；隐血(OB)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 3/μL；酸碱度(pH)-尿液: 7；酮体(KET)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D41] 检验组合: 总胆固醇(TC)-静脉血: 4.84mmol/L；红细胞计数(RBC#)-静脉血: 4.2110E12/L；红细胞比容(Hct)-静脉血: 36.6%；血小板分布宽度(PDW)-静脉血: 7.9%；白蛋白(ALB)-静脉血: 42.1g/L；尿素氮(BUN)-静脉血: 4.8mmol/L；总钙(Ca)-静脉血: 2.25mmol/L；乳酸脱氢酶(LDH)-静脉血: 148.6U/L；钾离子(K+)-静脉血: 3.3mmol/L；阴离子间隙(AG)-静脉血: 14.2；血液二氧化碳含量ctCO2(B)-静脉血: 25mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；胱抑素(Cys-C)-静脉血: 0.8mg/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 350g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.4pg；平均红细胞体积(MCV)-静脉血: 86.9fL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；氯离子(Cl-)-静脉血: 97.5mmol/L；葡萄糖(Glu)-静脉血: 5.35mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.89；镁离子(Mg2+)-静脉血: 0.78mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.34mmolL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；中性粒细胞计数(Neut#)-静脉血: 1.710E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.13mmol/L；直接胆红素(DBIL)-静脉血: 2.5umol/L；磷(P)-静脉血: 1.18mmol/L；球蛋白(GLO)-静脉血: 28.13g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.01；白细胞计数(WBC#)-静脉血: 3.0210E9/L；平均血小板体积(MPV)-静脉血: 8.8fL；总胆红素(TBIL)-静脉血: 9.3umol/L；碱性磷酸酶(ALP)-静脉血: 57.9U/L；中性粒细胞百分比(Neut%)-静脉血: 0.55；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；血小板计数(PLT#)-静脉血: 13810E9/L；肌酐(Crea)-静脉血: 90.1umol/L；血红蛋白(Hb)-静……\n- [全程D42] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后复查： 鼻咽腔稍狭窄，鼻咽双侧壁、顶后壁增厚，左侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。右侧咽隐窝变窄。肿物侵犯左侧腭帆张提肌，右侧腭帆提肌结构稍模糊，右侧腭帆张提肌间隙稍模糊。 双侧头长肌、翼内外肌未见明显异常。 双侧翼腭窝、上颌后脂肪间隙、咀嚼肌间隙未见异常。 口咽各壁未见增厚。鼻腔内未见肿物。 蝶骨基底部、左侧翼突基底部及内侧板骨质信号降低，增强扫描可见强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦粘膜稍增厚，双侧乳突未见明显异常。 左侧咽后见几个淋巴结，最大者约8mm×5mm，边界欠清，明显强化。双颈II区见多个淋巴结，最大者约15mm×12mm，边界尚清，较均匀明显强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗后复查，对比某次就诊时间片： 鼻咽部肿物，较前明显缩小。 颅底骨质破坏，较前未见明显变化。 左侧咽后、双颈II区淋巴结，可疑转移，其中右颈IIa区淋巴结较前增大，余较前未见明显变化。 轻度鼻窦炎。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D17] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者第一程诱导化疗后，诉轻度恶心呕吐，精神睡眠尚可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。钱医生信息已隐藏：患者03-02开始予5-Fu6.6g,DDP130mg化疗，患者未诉特殊不适，注意观察不良反应。\n- [全程D19] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者化疗后，诉轻度恶心，精神睡眠尚可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。医生信息已隐藏：患者第一程诱导化疗顺利，一般情况可，予出院。\n- [全程D35] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者未诉特殊不适，精神睡眠可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。03-22血生化常规未见异常。[姓名已隐去]医生信息已隐藏：患者1程PF方案诱导化疗后，一般情况可，已排除化疗禁忌症，今日水化，明日开始化疗（DDP 130mg d1 ; 5-Fu6.5g civ）。并予对症支持治疗。\n- [全程D36] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉稍恶心呕吐，无头痛、头晕，精神睡眠可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]副医生信息已隐藏：加强对症治疗，患者一般情况可，继续完成化疗，注意休息，加强营养。\n- [全程D37] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉稍恶心，无明显呕吐，无头痛、头晕，精神睡眠可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]副医生信息已隐藏：患者一般情况可继续完成化疗，\n- [全程D41] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者诉恶心呕吐，盗汗，头晕鼻塞，精神睡眠可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。03-29血常规示：WBC3.0*109/L NE1.7*109/L 生化示：血钾 3.3mmol/L[姓名已隐去]医生信息已隐藏：患者第二程诱导化疗，出现I度骨髓抑制，予香伏益血。胃肠道反应相比上次稍重，嘱少食多餐，加强营养。今日化疗结束，嘱明日出院。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即启动第三程PF方案诱导化疗，随后再行根治性放射治疗。\nB. 更改化疗方案为TP或GP方案继续诱导化疗，随后再行根治性放射治疗。\nC. 立即行鼻咽及颈部根治性手术切除，术后辅以根治性放射治疗。\nD. 出院休养，待化疗副反应恢复后，行右颈部淋巴结清扫术，再行根治性放疗。\nE. 立即予以全量根治性放射治疗，并联合靶向药物如西妥昔单抗。\nF. 出院休养，行颈部淋巴结穿刺活检明确病理，再决定后续放疗方案。\nG. 立即启动根治性放射治疗，暂缓处理骨髓抑制及胃肠道反应。\nH. 出院休养，待化疗副反应恢复后，行姑息性放射治疗联合免疫治疗。\nI. 行全身PET-CT重新评估远处转移情况，再决定是否启动根治性放疗。\nJ. 出院休养并对症处理化疗副反应，定期复查血常规及肝肾功能，按计划返院行根治性放射治疗。\nK. 出院休养，定期复查血常规及肝肾功能，待恢复后返院行第三程PF方案诱导化疗。\nL. 立即予以同期放化疗，并对右颈淋巴结局部推量加量放疗。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-9cd68a6b9c75f1d90e6a9dbe","patient_id":"patient-e5fcd31b4b8b85194b146991","turn_id":"turn08","turn_position":7,"turn_type":"response_assessment_decision","gold_letter":"K","gold_action":"评估为放化疗后临床缓解，按计划结疗出院，嘱鼻腔冲洗、张口及颈部功能锻炼，定期随访复查。","options":[{"letter":"A","text":"评估为原发灶缓解但颈部淋巴结残留，行双侧颈部淋巴结清扫术，术后定期随访复查。","is_gold":false},{"letter":"B","text":"评估为颅底骨质破坏未缓解，局部追加立体定向放射治疗推量，并定期随访复查。","is_gold":false},{"letter":"C","text":"评估为放化疗后部分缓解，继续原方案辅助化疗2个周期以巩固疗效。","is_gold":false},{"letter":"D","text":"评估为放化疗后临床缓解，按计划结疗出院，序贯PD-1抑制剂维持治疗1年。","is_gold":false},{"letter":"E","text":"评估为原发灶残留，行鼻咽内镜下挽救性切除术，术后配合张口及颈部功能锻炼。","is_gold":false},{"letter":"F","text":"评估为放化疗后临床缓解，按计划结疗出院，3个月后行PET-CT评估，期间无需特殊干预。","is_gold":false},{"letter":"G","text":"评估为放化疗后病情稳定，更改化疗方案为吉西他滨联合顺铂进行二线化疗。","is_gold":false},{"letter":"H","text":"评估为放化疗后临床缓解，按计划结疗出院，预防性给予全脑放射治疗。","is_gold":false},{"letter":"I","text":"评估为颈部淋巴结残留，局部追加电子线放射治疗推量，并加强营养支持。","is_gold":false},{"letter":"J","text":"评估为放化疗后临床缓解，按计划结疗出院，序贯口服卡培他滨节拍维持治疗1年。","is_gold":false},{"letter":"K","text":"评估为放化疗后临床缓解，按计划结疗出院，嘱鼻腔冲洗、张口及颈部功能锻炼，定期随访复查。","is_gold":true},{"letter":"L","text":"评估为颅底病灶残留，转诊行质子重离子放射治疗以提高局部控制率。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 回吸性涕血1月余。；现病史: 缘于1月前患者无意中出现抽吸性血涕，痰中带血；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻咽角化,涕血,痰中带血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：78次/分，R：20次/分，BP：125/80mmHg,Ht：162cm，Wt：61kg，BSA：1.6483m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 回吸性涕血1月余。；现病史: 缘于1月前患者无意中出现抽吸性血涕，痰中带血；无头痛、面麻，无视力下降、复视，无听力下降、耳鸣等不适，于当地乡镇医院予滴鼻治疗，具体药物不详，未见好转，遂于某次就诊时间往[地点已隐去]人民医院检查，某次就诊时间病理活检示：鼻咽未分化型角化性癌。某次就诊时间鼻咽MRI示：左侧鼻咽部占位病变，考虑鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻咽角化,涕血,痰中带血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：78次/分，R：20次/分，BP：125/80mmHg,Ht：162cm，Wt：61kg，BSA：1.6483m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率100次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 胱抑素(Cys-C)-静脉血: 0.77mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.69mmol/L；阴离子间隙(AG)-静脉血: 13；磷(P)-静脉血: 0.92mmol/L；总胆红素(TBIL)-静脉血: 12.4umol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；肌酐(Crea)-静脉血: 80.5umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.58；Rh血型-静脉血: 阳性；总钙(Ca)-静脉血: 2.44mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；血小板计数(PLT#)-静脉血: 21910E9/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 4.81mmol/L；直接胆红素(DBIL)-静脉血: 4.2umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.64mmolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.013；载脂蛋白B(apoB)-静脉血: 0.73g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.3pg；α-L-岩藻糖苷酶(AFU)-静脉血: 24U/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 8.2umolL；白蛋白(ALB)-静脉血: 45.8g/L；血小板比容-静脉血: 21%；ABO血型-静脉血: O；尿素氮(BUN)-静脉血: 3.6mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；凝血酶时间(TT)-静脉血: 20.2sec.；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；载脂蛋白AI(apoAI)-静脉血: 1.33g/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；C-反应蛋白(CRP)-静脉血: 0.36mg/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血:……\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔稍狭窄，鼻咽左侧壁明显增厚，左侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。肿物侵犯左侧腭帆张提肌，左侧咽旁脂肪间隙变窄。鼻咽顶后壁稍增厚，右侧壁未见明显增厚，右侧咽隐窝清晰。 右侧腭帆张提肌、双侧头长肌、翼内外肌未见明显异常。 双侧翼腭窝、上颌后脂肪间隙、咀嚼肌间隙未见异常。 口咽各壁未见增厚。鼻腔内未见肿物。 蝶骨基底部、左侧翼突基底部及内侧板骨质信号降低，增强扫描可见强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦粘膜稍增厚，双侧乳突未见明显异常。 左侧咽后见几个淋巴结，最大者约8mm×5mm，边界欠清，明显强化。双颈II区见多个淋巴结，最大者约16mm×8mm，边界尚清，较均匀明显强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽左侧壁增厚，左侧咽隐窝肿物，考虑鼻咽癌。 颅底骨质破坏。 左侧咽后、双颈II区淋巴结，可疑转移。 轻度鼻窦炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右侧约平T6椎体水平，估计导管末端位于上腔静脉上段内。；检查结论: PICC管位置如上所述。\n- [全程D13] 检验组合: 酸碱度(pH)-尿液: 5.5；粘液丝计数(MUCS#)-尿液: 11/μL；酮体(KET)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 1/μL；红细胞计数(RBC#)-尿液: 3/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: colorless；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；比重(SG)-尿液: 1.008\n- [全程D14] 检验组合: 总蛋白(TP)-尿液: +- 0.2g（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；红细胞计数(RBC#)-尿液: 1/μL；葡萄糖(Glu)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.02；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；粘液丝计数(MUCS#)-尿液: 4/μL；白细胞(LEU)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D15] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 11/μL；酮体(KET)-尿液: -（参考: 阴性）；酵母菌(YEAST)-尿液: 1/μL；白细胞(LEU)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 1/μL；比重(SG)-尿液: 1.019；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 7/μL；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；酸碱度(pH)-尿液: 6.5；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D19] 检验组合: 氯离子(Cl-)-静脉血: 96.7mmol/L；总蛋白(TP)-静脉血: 73.8g/L；甘油三酯(TG)-静脉血: 1mmol/L；血小板计数(PLT#)-静脉血: 18410E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.2；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.27；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.44mmolL；球蛋白(GLO)-静脉血: 27.4g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；丙氨酸氨基转移酶(ALT)-静脉血: 16.1U/L；总钙(Ca)-静脉血: 2.31mmol/L；血小板比容-静脉血: 18%；血红蛋白(Hb)-静脉血: 144g/L；血液二氧化碳含量ctCO2(B)-静脉血: 26.5mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 356g/L；胱抑素(Cys-C)-静脉血: 0.75mg/L；γ-谷氨酰基转移酶(GGT)-静脉血: 18.1U/L；红细胞计数(RBC#)-静脉血: 4.5310E12/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.1；淋巴细胞百分比(Lymph%)-静脉血: 0.277；平均红细胞血红蛋白含量(MCH)-静脉血: 31.8pg；尿酸(UA)-静脉血: 231.9umol/L；乳酸脱氢酶(LDH)-静脉血: 158.8U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；载脂蛋白B(apoB)-静脉血: 0.78g/L；中性粒细胞百分比(Neut%)-静脉血: 0.597；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；血小板分布宽度(PDW)-静脉血: 10.5%；间接胆红素(IBIL)-静脉血: 11.1umolL；单核细胞百分比(Mono%)-静脉血: 0.101；天门冬氨酸氨基转移酶(AST)-静脉血: 20.5U/L；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L；白细胞计数(WBC#)-静脉血: 4.8310E9/L；镁离子(Mg2+)-静脉血: 0.93mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.36g/L；总胆红素(TBIL)-静脉血: 16.1umol/……\n- [全程D34] 检验组合: 阴离子间隙(AG)-静脉血: 10.5；乳酸脱氢酶(LDH)-静脉血: 175.1U/L；肌酐(Crea)-静脉血: 86umol/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；钾离子(K+)-静脉血: 3.9mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.43；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.18；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；甘油三酯(TG)-静脉血: 0.79mmol/L；总蛋白(TP)-静脉血: 76.5g/L；大血小板百分比(P-LCR%)-静脉血: 15.9%；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.537；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；总钙(Ca)-静脉血: 2.39mmol/L；尿酸(UA)-静脉血: 334.3umol/L；钠离子(Na+)-静脉血: 142.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.53g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；单核细胞百分比(Mono%)-静脉血: 0.102；有核红细胞百分比(NRBC%)-静脉血: 0；单核细胞计数(Mono#)-静脉血: 0.510E9/L；碱性磷酸酶(ALP)-静脉血: 63.6U/L；间接胆红素(IBIL)-静脉血: 6.8umolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.028；平均红细胞体积(MCV)-静脉血: 90.7fL；淋巴细胞百分比(Lymph%)-静脉血: 0.325；血液二氧化碳含量ctCO2(B)-静脉血: 29.6mmol/L；血小板分布宽度(PDW)-静脉血: 8.8%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.3；平均血小板体积(MPV)-静脉血: 8.9fL；球蛋白(GLO)-静脉血: 31.5g/L；血红蛋白(Hb)-静脉血: 130g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 29U/L；白蛋白(ALB)-静脉血: 45g/L；总胆汁酸(TBA)-静脉血: 5.6umol/L；总胆固醇(TC)-静脉血: 5.01mmol/L……\n- [全程D35] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；比重(SG)-尿液: 1.015；白细胞计数(WBC#)-尿液: 2/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 6.5；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）\n- [全程D36] 检验组合: 浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 7.5；隐血(OB)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；胆红素(BIL)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.022；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）\n- [全程D37] 检验组合: 颜色-尿液: Yellow；葡萄糖(Glu)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.018；隐血(OB)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 3/μL；酸碱度(pH)-尿液: 7；酮体(KET)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D41] 检验组合: 总胆固醇(TC)-静脉血: 4.84mmol/L；红细胞计数(RBC#)-静脉血: 4.2110E12/L；红细胞比容(Hct)-静脉血: 36.6%；血小板分布宽度(PDW)-静脉血: 7.9%；白蛋白(ALB)-静脉血: 42.1g/L；尿素氮(BUN)-静脉血: 4.8mmol/L；总钙(Ca)-静脉血: 2.25mmol/L；乳酸脱氢酶(LDH)-静脉血: 148.6U/L；钾离子(K+)-静脉血: 3.3mmol/L；阴离子间隙(AG)-静脉血: 14.2；血液二氧化碳含量ctCO2(B)-静脉血: 25mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；胱抑素(Cys-C)-静脉血: 0.8mg/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 350g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.4pg；平均红细胞体积(MCV)-静脉血: 86.9fL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；氯离子(Cl-)-静脉血: 97.5mmol/L；葡萄糖(Glu)-静脉血: 5.35mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.89；镁离子(Mg2+)-静脉血: 0.78mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.34mmolL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；中性粒细胞计数(Neut#)-静脉血: 1.710E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.13mmol/L；直接胆红素(DBIL)-静脉血: 2.5umol/L；磷(P)-静脉血: 1.18mmol/L；球蛋白(GLO)-静脉血: 28.13g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.01；白细胞计数(WBC#)-静脉血: 3.0210E9/L；平均血小板体积(MPV)-静脉血: 8.8fL；总胆红素(TBIL)-静脉血: 9.3umol/L；碱性磷酸酶(ALP)-静脉血: 57.9U/L；中性粒细胞百分比(Neut%)-静脉血: 0.55；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；血小板计数(PLT#)-静脉血: 13810E9/L；肌酐(Crea)-静脉血: 90.1umol/L；血红蛋白(Hb)-静……\n- [全程D42] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后复查： 鼻咽腔稍狭窄，鼻咽双侧壁、顶后壁增厚，左侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。右侧咽隐窝变窄。肿物侵犯左侧腭帆张提肌，右侧腭帆提肌结构稍模糊，右侧腭帆张提肌间隙稍模糊。 双侧头长肌、翼内外肌未见明显异常。 双侧翼腭窝、上颌后脂肪间隙、咀嚼肌间隙未见异常。 口咽各壁未见增厚。鼻腔内未见肿物。 蝶骨基底部、左侧翼突基底部及内侧板骨质信号降低，增强扫描可见强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦粘膜稍增厚，双侧乳突未见明显异常。 左侧咽后见几个淋巴结，最大者约8mm×5mm，边界欠清，明显强化。双颈II区见多个淋巴结，最大者约15mm×12mm，边界尚清，较均匀明显强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗后复查，对比某次就诊时间片： 鼻咽部肿物，较前明显缩小。 颅底骨质破坏，较前未见明显变化。 左侧咽后、双颈II区淋巴结，可疑转移，其中右颈IIa区淋巴结较前增大，余较前未见明显变化。 轻度鼻窦炎。\n- [全程D76] 检验组合: 钠离子(Na+)-静脉血: 138.3mmol/L；球蛋白(GLO)-静脉血: 27.6g/L；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 14.1U/L；碱性磷酸酶(ALP)-静脉血: 64.9U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 26.4U/L；平均血小板体积(MPV)-静脉血: 9fL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；红细胞比容(Hct)-静脉血: 29.5%；白蛋白(ALB)-静脉血: 44.6g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.62；α-L-岩藻糖苷酶(AFU)-静脉血: 24U/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；尿酸(UA)-静脉血: 284.2umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 8.7U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.73mmol/L；平均红细胞体积(MCV)-静脉血: 87.5fL；血小板比容-静脉血: 14%；单核细胞百分比(Mono%)-静脉血: 0.136；间接胆红素(IBIL)-静脉血: 7.16umolL；血液二氧化碳含量ctCO2(B)-静脉血: 23.6mmol/L；尿素氮(BUN)-静脉血: 5.4mmol/L；乳酸脱氢酶(LDH)-静脉血: 140.2U/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 104g/L；直接胆红素(DBIL)-静脉血: 3.72umol/L；载脂蛋白B(apoB)-静脉血: 0.86g/L；钾离子(K+)-静脉血: 4.1mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.129；中性粒细胞百分比(Neut%)-静脉血: 0.713；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.2；平均红细胞血红蛋白浓度(MCHC)-静脉血: 353g/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L；红细胞计数(RBC#)-静脉血: 3.3710E12/L；C-反应蛋白(CRP)-静脉……\n- [全程D83] 检验组合: 碱性磷酸酶(ALP)-静脉血: 52.7U/L；血红蛋白(Hb)-静脉血: 96g/L；总胆汁酸(TBA)-静脉血: 2.4umol/L；磷(P)-静脉血: 1.26mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.41mmol/L；尿酸(UA)-静脉血: 329.6umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.76；血小板比容-静脉血: 11%；淋巴细胞计数(Lymph#)-静脉血: 0.410E9/L；红细胞计数(RBC#)-静脉血: 3.0610E12/L；间接胆红素(IBIL)-静脉血: 6.3umolL；血液二氧化碳含量ctCO2(B)-静脉血: 24.5mmol/L；钾离子(K+)-静脉血: 3.83mmol/L；葡萄糖(Glu)-静脉血: 4.88mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 356g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.56；氯离子(Cl-)-静脉血: 102.9mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总胆固醇(TC)-静脉血: 3.96mmol/L；平均红细胞体积(MCV)-静脉血: 88.2fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.9；中性粒细胞计数(Neut#)-静脉血: 1.310E9/L；阴离子间隙(AG)-静脉血: 12.6；尿素氮(BUN)-静脉血: 5.9mmol/L；肌酐(Crea)-静脉血: 89.8umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 20.3U/L；球蛋白(GLO)-静脉血: 25.51g/L；镁离子(Mg2+)-静脉血: 0.77mmol/L；乳酸脱氢酶(LDH)-静脉血: 128.5U/L；C-反应蛋白(CRP)-静脉血: 0.49mg/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.4pg；总蛋白(TP)-静脉血: 65.31g/L；红细胞比容(Hct)-静脉血: 27%；单核细胞计数(Mono#)-静脉血: 0.310E9/L；血小板分布宽度(PDW)-静脉血: 8.1%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.009；单核细胞百分比(Mono%)-静脉血: 0.156；嗜碱性粒细胞计数(Baso#)-静脉血:……\n- [全程D90] 检验组合: 尿素氮(BUN)-静脉血: 5.1mmol/L；总胆汁酸(TBA)-静脉血: 3.6umol/L；总钙(Ca)-静脉血: 2.27mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 21.5U/L；总胆红素(TBIL)-静脉血: 11.71umol/L；载脂蛋白AI(apoAI)-静脉血: 1.59g/L；载脂蛋白B(apoB)-静脉血: 0.85g/L；氯离子(Cl-)-静脉血: 99.7mmol/L；白蛋白(ALB)-静脉血: 46.3g/L；有核红细胞百分比(NRBC%)-静脉血: 0；血小板计数(PLT#)-静脉血: 14210E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；血小板比容-静脉血: 13%；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.58；嗜酸性粒细胞计数(Eos#)-静脉血: 0.410E9/L；血小板分布宽度(PDW)-静脉血: 9%；磷(P)-静脉血: 1.33mmol/L；尿酸(UA)-静脉血: 467.8umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.78；甘油三酯(TG)-静脉血: 0.58mmol/L；C-反应蛋白(CRP)-静脉血: 0.4mg/L；平均红细胞体积(MCV)-静脉血: 91.4fL；α-L-岩藻糖苷酶(AFU)-静脉血: 22.5U/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1；中性粒细胞计数(Neut#)-静脉血: 2.210E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 346g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；白细胞计数(WBC#)-静脉血: 3.4910E9/L；钾离子(K+)-静脉血: 3.89mmol/L；血红蛋白(Hb)-静脉血: 118g/L；平均血小板体积(MPV)-静脉血: 9fL；中性粒细胞百分比(Neut%)-静脉血: 0.636；红细胞计数(RBC#)-静脉血: 3.7310E12/L；肌酐(Crea)-静脉血: 91.5umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.132；总胆固醇(TC)-静脉血: 4.55mmol/L；阴离子间隙(AG)-静脉血: 14.7……\n- [全程D91] 检验组合: 比重(SG)-尿液: 1.011；酮体(KET)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5；隐血(OB)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；总蛋白(TP)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；白细胞计数(WBC#)-尿液: 3/μL\n- [全程D92] 检验组合: 亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；隐血(OB)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 2/μL；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；比重(SG)-尿液: 1.018；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）\n- [全程D94] 检验组合: 亚硝酸盐(NIT)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 11/μL；颜色-尿液: Yellow；白细胞计数(WBC#)-尿液: 5/μL；酮体(KET)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 28/μL；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.014；酸碱度(pH)-尿液: 6\n- [全程D97] 检验组合: 低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.8mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；平均红细胞体积(MCV)-静脉血: 86.8fL；载脂蛋白AI(apoAI)-静脉血: 1.3g/L；甘油三酯(TG)-静脉血: 0.75mmol/L；钠离子(Na+)-静脉血: 139mmol/L；总钙(Ca)-静脉血: 2.24mmol/L；氯离子(Cl-)-静脉血: 98.2mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 13.3U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.65；α-L-岩藻糖苷酶(AFU)-静脉血: 24.8U/L；碱性磷酸酶(ALP)-静脉血: 57U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 21.5U/L；血小板比容-静脉血: 12%；直接胆红素(DBIL)-静脉血: 4.61umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.642；白细胞计数(WBC#)-静脉血: 2.0410E9/L；大血小板百分比(P-LCR%)-静脉血: 11.5%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.127；血液二氧化碳含量ctCO2(B)-静脉血: 27.4mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 357g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.5；总蛋白(TP)-静脉血: 67.8g/L；血红蛋白(Hb)-静脉血: 96g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.310E9/L；尿酸(UA)-静脉血: 356.9umol/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；血小板计数(PLT#)-静脉血: 14210E9/L；钾离子(K+)-静脉血: 3.77mmol/L；载脂蛋白B(apoB)-静脉血: 0.86g/L；单核细胞百分比(Mono%)-静脉血: 0.083；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.37；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.02；胱抑素(Cys-C)-静脉血: 0.71mg/L；白蛋白(ALB)-静脉血: 42.2g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞计数(Neut#)-静脉血: 1.310E9/L……\n- [全程D98] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗放疗后复查： 鼻咽腔无狭窄，鼻咽壁无增厚，粘膜规整无增厚，双侧咽隐窝、咽旁脂肪间隙未见异常。双侧腭帆张、提肌、双侧头长肌、翼内外肌未见明显异常。 双侧翼腭窝、上颌后脂肪间隙、咀嚼肌间隙未见异常。 口咽各壁未见增厚。鼻腔内未见肿物。 蝶骨基底部左份、左侧翼突基底部及内侧骨质信号降低，增强扫描可见强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦粘膜稍增厚，骨壁完整。左乳头见少许渗出影。 双侧咽后未见肿大淋巴结。双颈II区见多个淋巴结，最大者约8mm×5mm，边界尚清，较均匀明显强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗放疗后复查，对比某次就诊时间片： 鼻咽未见明显病灶。 颅底骨质破坏，较前未见明显变化。 左侧咽后淋巴结消失，双颈II区淋巴结缩小。 鼻窦炎，左乳突炎。\n- [全程D98] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称。双肺纹理清晰；双肺野未见明显实质性病变；双侧肺门无增大。纵隔未见增宽。心影大小、形态正常。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D17] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者第一程诱导化疗后，诉轻度恶心呕吐，精神睡眠尚可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。钱医生信息已隐藏：患者03-02开始予5-Fu6.6g,DDP130mg化疗，患者未诉特殊不适，注意观察不良反应。\n- [全程D19] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者化疗后，诉轻度恶心，精神睡眠尚可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。医生信息已隐藏：患者第一程诱导化疗顺利，一般情况可，予出院。\n- [全程D35] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者未诉特殊不适，精神睡眠可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。03-22血生化常规未见异常。[姓名已隐去]医生信息已隐藏：患者1程PF方案诱导化疗后，一般情况可，已排除化疗禁忌症，今日水化，明日开始化疗（DDP 130mg d1 ; 5-Fu6.5g civ）。并予对症支持治疗。\n- [全程D36] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉稍恶心呕吐，无头痛、头晕，精神睡眠可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]副医生信息已隐藏：加强对症治疗，患者一般情况可，继续完成化疗，注意休息，加强营养。\n- [全程D37] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉稍恶心，无明显呕吐，无头痛、头晕，精神睡眠可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]副医生信息已隐藏：患者一般情况可继续完成化疗，\n- [全程D41] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者诉恶心呕吐，盗汗，头晕鼻塞，精神睡眠可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。03-29血常规示：WBC3.0*109/L NE1.7*109/L 生化示：血钾 3.3mmol/L[姓名已隐去]医生信息已隐藏：患者第二程诱导化疗，出现I度骨髓抑制，予香伏益血。胃肠道反应相比上次稍重，嘱少食多餐，加强营养。今日化疗结束，嘱明日出院。\n- [全程D77] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 今行放疗第15次，患者口干咽痛，稍恶心、呕吐，食纳、睡眠欠佳。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。某次就诊时间日查血常规、肝肾功能电解质无明显异常。[姓名已隐去]副医生信息已隐藏：予口腔粘膜保护等对症治疗，加强营养支持治疗，继续完成放疗。\n- [全程D82] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今行放疗第18次，患者口干咽痛，稍恶心、呕吐，食纳、睡眠欠佳。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物，较前缩小；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]医生信息已隐藏：予口腔粘膜保护等对症治疗，加强营养支持治疗，明日复查血常规、肝肾功能，继续完成放疗。\n- [全程D91] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今行放疗第25次，患者口干咽痛，稍恶心、呕吐，食纳、睡眠欠佳。查体：张口门齿距4.5cm；鼻咽肿物不明显；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。昨日查血常规、肝肾功能未见明显异常。[姓名已隐去]医生信息已隐藏：予口腔粘膜保护等对症治疗，加强营养支持治疗，明日予同期DDP化疗，密切观察放化疗反应，继续完成放疗。\n- [全程D96] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 今行放疗第28次，患者口干咽痛，稍恶心、呕吐，食纳、睡眠欠佳。查体：张口门齿距4.5cm；鼻咽肿物不明显；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]医生信息已隐藏：予口腔粘膜保护等对症治疗，加强营养支持治疗，明日复查血常规、肝肾功能，继续完成放疗。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估为原发灶缓解但颈部淋巴结残留，行双侧颈部淋巴结清扫术，术后定期随访复查。\nB. 评估为颅底骨质破坏未缓解，局部追加立体定向放射治疗推量，并定期随访复查。\nC. 评估为放化疗后部分缓解，继续原方案辅助化疗2个周期以巩固疗效。\nD. 评估为放化疗后临床缓解，按计划结疗出院，序贯PD-1抑制剂维持治疗1年。\nE. 评估为原发灶残留，行鼻咽内镜下挽救性切除术，术后配合张口及颈部功能锻炼。\nF. 评估为放化疗后临床缓解，按计划结疗出院，3个月后行PET-CT评估，期间无需特殊干预。\nG. 评估为放化疗后病情稳定，更改化疗方案为吉西他滨联合顺铂进行二线化疗。\nH. 评估为放化疗后临床缓解，按计划结疗出院，预防性给予全脑放射治疗。\nI. 评估为颈部淋巴结残留，局部追加电子线放射治疗推量，并加强营养支持。\nJ. 评估为放化疗后临床缓解，按计划结疗出院，序贯口服卡培他滨节拍维持治疗1年。\nK. 评估为放化疗后临床缓解，按计划结疗出院，嘱鼻腔冲洗、张口及颈部功能锻炼，定期随访复查。\nL. 评估为颅底病灶残留，转诊行质子重离子放射治疗以提高局部控制率。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 回吸性涕血1月余。；现病史: 缘于1月前患者无意中出现抽吸性血涕，痰中带血；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻咽角化,涕血,痰中带血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：78次/分，R：20次/分，BP：125/80mmHg,Ht：162cm，Wt：61kg，BSA：1.6483m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 回吸性涕血1月余。；现病史: 缘于1月前患者无意中出现抽吸性血涕，痰中带血；无头痛、面麻，无视力下降、复视，无听力下降、耳鸣等不适，于当地乡镇医院予滴鼻治疗，具体药物不详，未见好转，遂于某次就诊时间往[地点已隐去]人民医院检查，某次就诊时间病理活检示：鼻咽未分化型角化性癌。某次就诊时间鼻咽MRI示：左侧鼻咽部占位病变，考虑鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻咽角化,涕血,痰中带血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：78次/分，R：20次/分，BP：125/80mmHg,Ht：162cm，Wt：61kg，BSA：1.6483m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率100次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 胱抑素(Cys-C)-静脉血: 0.77mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.69mmol/L；阴离子间隙(AG)-静脉血: 13；磷(P)-静脉血: 0.92mmol/L；总胆红素(TBIL)-静脉血: 12.4umol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；肌酐(Crea)-静脉血: 80.5umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.58；Rh血型-静脉血: 阳性；总钙(Ca)-静脉血: 2.44mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；血小板计数(PLT#)-静脉血: 21910E9/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 4.81mmol/L；直接胆红素(DBIL)-静脉血: 4.2umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.64mmolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.013；载脂蛋白B(apoB)-静脉血: 0.73g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.3pg；α-L-岩藻糖苷酶(AFU)-静脉血: 24U/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 8.2umolL；白蛋白(ALB)-静脉血: 45.8g/L；血小板比容-静脉血: 21%；ABO血型-静脉血: O；尿素氮(BUN)-静脉血: 3.6mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；凝血酶时间(TT)-静脉血: 20.2sec.；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；载脂蛋白AI(apoAI)-静脉血: 1.33g/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；C-反应蛋白(CRP)-静脉血: 0.36mg/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血:……\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔稍狭窄，鼻咽左侧壁明显增厚，左侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。肿物侵犯左侧腭帆张提肌，左侧咽旁脂肪间隙变窄。鼻咽顶后壁稍增厚，右侧壁未见明显增厚，右侧咽隐窝清晰。 右侧腭帆张提肌、双侧头长肌、翼内外肌未见明显异常。 双侧翼腭窝、上颌后脂肪间隙、咀嚼肌间隙未见异常。 口咽各壁未见增厚。鼻腔内未见肿物。 蝶骨基底部、左侧翼突基底部及内侧板骨质信号降低，增强扫描可见强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦粘膜稍增厚，双侧乳突未见明显异常。 左侧咽后见几个淋巴结，最大者约8mm×5mm，边界欠清，明显强化。双颈II区见多个淋巴结，最大者约16mm×8mm，边界尚清，较均匀明显强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽左侧壁增厚，左侧咽隐窝肿物，考虑鼻咽癌。 颅底骨质破坏。 左侧咽后、双颈II区淋巴结，可疑转移。 轻度鼻窦炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右侧约平T6椎体水平，估计导管末端位于上腔静脉上段内。；检查结论: PICC管位置如上所述。\n- [全程D13] 检验组合: 酸碱度(pH)-尿液: 5.5；粘液丝计数(MUCS#)-尿液: 11/μL；酮体(KET)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 1/μL；红细胞计数(RBC#)-尿液: 3/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: colorless；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；比重(SG)-尿液: 1.008\n- [全程D14] 检验组合: 总蛋白(TP)-尿液: +- 0.2g（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；红细胞计数(RBC#)-尿液: 1/μL；葡萄糖(Glu)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.02；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；粘液丝计数(MUCS#)-尿液: 4/μL；白细胞(LEU)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D15] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 11/μL；酮体(KET)-尿液: -（参考: 阴性）；酵母菌(YEAST)-尿液: 1/μL；白细胞(LEU)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 1/μL；比重(SG)-尿液: 1.019；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 7/μL；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；酸碱度(pH)-尿液: 6.5；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D19] 检验组合: 氯离子(Cl-)-静脉血: 96.7mmol/L；总蛋白(TP)-静脉血: 73.8g/L；甘油三酯(TG)-静脉血: 1mmol/L；血小板计数(PLT#)-静脉血: 18410E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.2；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.27；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.44mmolL；球蛋白(GLO)-静脉血: 27.4g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；丙氨酸氨基转移酶(ALT)-静脉血: 16.1U/L；总钙(Ca)-静脉血: 2.31mmol/L；血小板比容-静脉血: 18%；血红蛋白(Hb)-静脉血: 144g/L；血液二氧化碳含量ctCO2(B)-静脉血: 26.5mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 356g/L；胱抑素(Cys-C)-静脉血: 0.75mg/L；γ-谷氨酰基转移酶(GGT)-静脉血: 18.1U/L；红细胞计数(RBC#)-静脉血: 4.5310E12/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.1；淋巴细胞百分比(Lymph%)-静脉血: 0.277；平均红细胞血红蛋白含量(MCH)-静脉血: 31.8pg；尿酸(UA)-静脉血: 231.9umol/L；乳酸脱氢酶(LDH)-静脉血: 158.8U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；载脂蛋白B(apoB)-静脉血: 0.78g/L；中性粒细胞百分比(Neut%)-静脉血: 0.597；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；血小板分布宽度(PDW)-静脉血: 10.5%；间接胆红素(IBIL)-静脉血: 11.1umolL；单核细胞百分比(Mono%)-静脉血: 0.101；天门冬氨酸氨基转移酶(AST)-静脉血: 20.5U/L；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L；白细胞计数(WBC#)-静脉血: 4.8310E9/L；镁离子(Mg2+)-静脉血: 0.93mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.36g/L；总胆红素(TBIL)-静脉血: 16.1umol/……\n- [全程D34] 检验组合: 阴离子间隙(AG)-静脉血: 10.5；乳酸脱氢酶(LDH)-静脉血: 175.1U/L；肌酐(Crea)-静脉血: 86umol/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；钾离子(K+)-静脉血: 3.9mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.43；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.18；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；甘油三酯(TG)-静脉血: 0.79mmol/L；总蛋白(TP)-静脉血: 76.5g/L；大血小板百分比(P-LCR%)-静脉血: 15.9%；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.537；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；总钙(Ca)-静脉血: 2.39mmol/L；尿酸(UA)-静脉血: 334.3umol/L；钠离子(Na+)-静脉血: 142.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.53g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；单核细胞百分比(Mono%)-静脉血: 0.102；有核红细胞百分比(NRBC%)-静脉血: 0；单核细胞计数(Mono#)-静脉血: 0.510E9/L；碱性磷酸酶(ALP)-静脉血: 63.6U/L；间接胆红素(IBIL)-静脉血: 6.8umolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.028；平均红细胞体积(MCV)-静脉血: 90.7fL；淋巴细胞百分比(Lymph%)-静脉血: 0.325；血液二氧化碳含量ctCO2(B)-静脉血: 29.6mmol/L；血小板分布宽度(PDW)-静脉血: 8.8%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.3；平均血小板体积(MPV)-静脉血: 8.9fL；球蛋白(GLO)-静脉血: 31.5g/L；血红蛋白(Hb)-静脉血: 130g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 29U/L；白蛋白(ALB)-静脉血: 45g/L；总胆汁酸(TBA)-静脉血: 5.6umol/L；总胆固醇(TC)-静脉血: 5.01mmol/L……\n- [全程D35] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；比重(SG)-尿液: 1.015；白细胞计数(WBC#)-尿液: 2/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 6.5；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）\n- [全程D36] 检验组合: 浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 7.5；隐血(OB)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；胆红素(BIL)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.022；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）\n- [全程D37] 检验组合: 颜色-尿液: Yellow；葡萄糖(Glu)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.018；隐血(OB)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 3/μL；酸碱度(pH)-尿液: 7；酮体(KET)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D41] 检验组合: 总胆固醇(TC)-静脉血: 4.84mmol/L；红细胞计数(RBC#)-静脉血: 4.2110E12/L；红细胞比容(Hct)-静脉血: 36.6%；血小板分布宽度(PDW)-静脉血: 7.9%；白蛋白(ALB)-静脉血: 42.1g/L；尿素氮(BUN)-静脉血: 4.8mmol/L；总钙(Ca)-静脉血: 2.25mmol/L；乳酸脱氢酶(LDH)-静脉血: 148.6U/L；钾离子(K+)-静脉血: 3.3mmol/L；阴离子间隙(AG)-静脉血: 14.2；血液二氧化碳含量ctCO2(B)-静脉血: 25mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；胱抑素(Cys-C)-静脉血: 0.8mg/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 350g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.4pg；平均红细胞体积(MCV)-静脉血: 86.9fL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；氯离子(Cl-)-静脉血: 97.5mmol/L；葡萄糖(Glu)-静脉血: 5.35mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.89；镁离子(Mg2+)-静脉血: 0.78mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.34mmolL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；中性粒细胞计数(Neut#)-静脉血: 1.710E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.13mmol/L；直接胆红素(DBIL)-静脉血: 2.5umol/L；磷(P)-静脉血: 1.18mmol/L；球蛋白(GLO)-静脉血: 28.13g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.01；白细胞计数(WBC#)-静脉血: 3.0210E9/L；平均血小板体积(MPV)-静脉血: 8.8fL；总胆红素(TBIL)-静脉血: 9.3umol/L；碱性磷酸酶(ALP)-静脉血: 57.9U/L；中性粒细胞百分比(Neut%)-静脉血: 0.55；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；血小板计数(PLT#)-静脉血: 13810E9/L；肌酐(Crea)-静脉血: 90.1umol/L；血红蛋白(Hb)-静……\n- [全程D42] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后复查： 鼻咽腔稍狭窄，鼻咽双侧壁、顶后壁增厚，左侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。右侧咽隐窝变窄。肿物侵犯左侧腭帆张提肌，右侧腭帆提肌结构稍模糊，右侧腭帆张提肌间隙稍模糊。 双侧头长肌、翼内外肌未见明显异常。 双侧翼腭窝、上颌后脂肪间隙、咀嚼肌间隙未见异常。 口咽各壁未见增厚。鼻腔内未见肿物。 蝶骨基底部、左侧翼突基底部及内侧板骨质信号降低，增强扫描可见强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦粘膜稍增厚，双侧乳突未见明显异常。 左侧咽后见几个淋巴结，最大者约8mm×5mm，边界欠清，明显强化。双颈II区见多个淋巴结，最大者约15mm×12mm，边界尚清，较均匀明显强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗后复查，对比某次就诊时间片： 鼻咽部肿物，较前明显缩小。 颅底骨质破坏，较前未见明显变化。 左侧咽后、双颈II区淋巴结，可疑转移，其中右颈IIa区淋巴结较前增大，余较前未见明显变化。 轻度鼻窦炎。\n- [全程D76] 检验组合: 钠离子(Na+)-静脉血: 138.3mmol/L；球蛋白(GLO)-静脉血: 27.6g/L；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 14.1U/L；碱性磷酸酶(ALP)-静脉血: 64.9U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 26.4U/L；平均血小板体积(MPV)-静脉血: 9fL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；红细胞比容(Hct)-静脉血: 29.5%；白蛋白(ALB)-静脉血: 44.6g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.62；α-L-岩藻糖苷酶(AFU)-静脉血: 24U/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；尿酸(UA)-静脉血: 284.2umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 8.7U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.73mmol/L；平均红细胞体积(MCV)-静脉血: 87.5fL；血小板比容-静脉血: 14%；单核细胞百分比(Mono%)-静脉血: 0.136；间接胆红素(IBIL)-静脉血: 7.16umolL；血液二氧化碳含量ctCO2(B)-静脉血: 23.6mmol/L；尿素氮(BUN)-静脉血: 5.4mmol/L；乳酸脱氢酶(LDH)-静脉血: 140.2U/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 104g/L；直接胆红素(DBIL)-静脉血: 3.72umol/L；载脂蛋白B(apoB)-静脉血: 0.86g/L；钾离子(K+)-静脉血: 4.1mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.129；中性粒细胞百分比(Neut%)-静脉血: 0.713；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.2；平均红细胞血红蛋白浓度(MCHC)-静脉血: 353g/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L；红细胞计数(RBC#)-静脉血: 3.3710E12/L；C-反应蛋白(CRP)-静脉……\n- [全程D83] 检验组合: 碱性磷酸酶(ALP)-静脉血: 52.7U/L；血红蛋白(Hb)-静脉血: 96g/L；总胆汁酸(TBA)-静脉血: 2.4umol/L；磷(P)-静脉血: 1.26mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.41mmol/L；尿酸(UA)-静脉血: 329.6umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.76；血小板比容-静脉血: 11%；淋巴细胞计数(Lymph#)-静脉血: 0.410E9/L；红细胞计数(RBC#)-静脉血: 3.0610E12/L；间接胆红素(IBIL)-静脉血: 6.3umolL；血液二氧化碳含量ctCO2(B)-静脉血: 24.5mmol/L；钾离子(K+)-静脉血: 3.83mmol/L；葡萄糖(Glu)-静脉血: 4.88mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 356g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.56；氯离子(Cl-)-静脉血: 102.9mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总胆固醇(TC)-静脉血: 3.96mmol/L；平均红细胞体积(MCV)-静脉血: 88.2fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.9；中性粒细胞计数(Neut#)-静脉血: 1.310E9/L；阴离子间隙(AG)-静脉血: 12.6；尿素氮(BUN)-静脉血: 5.9mmol/L；肌酐(Crea)-静脉血: 89.8umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 20.3U/L；球蛋白(GLO)-静脉血: 25.51g/L；镁离子(Mg2+)-静脉血: 0.77mmol/L；乳酸脱氢酶(LDH)-静脉血: 128.5U/L；C-反应蛋白(CRP)-静脉血: 0.49mg/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.4pg；总蛋白(TP)-静脉血: 65.31g/L；红细胞比容(Hct)-静脉血: 27%；单核细胞计数(Mono#)-静脉血: 0.310E9/L；血小板分布宽度(PDW)-静脉血: 8.1%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.009；单核细胞百分比(Mono%)-静脉血: 0.156；嗜碱性粒细胞计数(Baso#)-静脉血:……\n- [全程D90] 检验组合: 尿素氮(BUN)-静脉血: 5.1mmol/L；总胆汁酸(TBA)-静脉血: 3.6umol/L；总钙(Ca)-静脉血: 2.27mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 21.5U/L；总胆红素(TBIL)-静脉血: 11.71umol/L；载脂蛋白AI(apoAI)-静脉血: 1.59g/L；载脂蛋白B(apoB)-静脉血: 0.85g/L；氯离子(Cl-)-静脉血: 99.7mmol/L；白蛋白(ALB)-静脉血: 46.3g/L；有核红细胞百分比(NRBC%)-静脉血: 0；血小板计数(PLT#)-静脉血: 14210E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；血小板比容-静脉血: 13%；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.58；嗜酸性粒细胞计数(Eos#)-静脉血: 0.410E9/L；血小板分布宽度(PDW)-静脉血: 9%；磷(P)-静脉血: 1.33mmol/L；尿酸(UA)-静脉血: 467.8umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.78；甘油三酯(TG)-静脉血: 0.58mmol/L；C-反应蛋白(CRP)-静脉血: 0.4mg/L；平均红细胞体积(MCV)-静脉血: 91.4fL；α-L-岩藻糖苷酶(AFU)-静脉血: 22.5U/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1；中性粒细胞计数(Neut#)-静脉血: 2.210E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 346g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；白细胞计数(WBC#)-静脉血: 3.4910E9/L；钾离子(K+)-静脉血: 3.89mmol/L；血红蛋白(Hb)-静脉血: 118g/L；平均血小板体积(MPV)-静脉血: 9fL；中性粒细胞百分比(Neut%)-静脉血: 0.636；红细胞计数(RBC#)-静脉血: 3.7310E12/L；肌酐(Crea)-静脉血: 91.5umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.132；总胆固醇(TC)-静脉血: 4.55mmol/L；阴离子间隙(AG)-静脉血: 14.7……\n- [全程D91] 检验组合: 比重(SG)-尿液: 1.011；酮体(KET)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5；隐血(OB)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；总蛋白(TP)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；白细胞计数(WBC#)-尿液: 3/μL\n- [全程D92] 检验组合: 亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；隐血(OB)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 2/μL；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；比重(SG)-尿液: 1.018；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）\n- [全程D94] 检验组合: 亚硝酸盐(NIT)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 11/μL；颜色-尿液: Yellow；白细胞计数(WBC#)-尿液: 5/μL；酮体(KET)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 28/μL；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.014；酸碱度(pH)-尿液: 6\n- [全程D97] 检验组合: 低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.8mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；平均红细胞体积(MCV)-静脉血: 86.8fL；载脂蛋白AI(apoAI)-静脉血: 1.3g/L；甘油三酯(TG)-静脉血: 0.75mmol/L；钠离子(Na+)-静脉血: 139mmol/L；总钙(Ca)-静脉血: 2.24mmol/L；氯离子(Cl-)-静脉血: 98.2mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 13.3U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.65；α-L-岩藻糖苷酶(AFU)-静脉血: 24.8U/L；碱性磷酸酶(ALP)-静脉血: 57U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 21.5U/L；血小板比容-静脉血: 12%；直接胆红素(DBIL)-静脉血: 4.61umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.642；白细胞计数(WBC#)-静脉血: 2.0410E9/L；大血小板百分比(P-LCR%)-静脉血: 11.5%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.127；血液二氧化碳含量ctCO2(B)-静脉血: 27.4mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 357g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.5；总蛋白(TP)-静脉血: 67.8g/L；血红蛋白(Hb)-静脉血: 96g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.310E9/L；尿酸(UA)-静脉血: 356.9umol/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；血小板计数(PLT#)-静脉血: 14210E9/L；钾离子(K+)-静脉血: 3.77mmol/L；载脂蛋白B(apoB)-静脉血: 0.86g/L；单核细胞百分比(Mono%)-静脉血: 0.083；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.37；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.02；胱抑素(Cys-C)-静脉血: 0.71mg/L；白蛋白(ALB)-静脉血: 42.2g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞计数(Neut#)-静脉血: 1.310E9/L……\n- [全程D98] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗放疗后复查： 鼻咽腔无狭窄，鼻咽壁无增厚，粘膜规整无增厚，双侧咽隐窝、咽旁脂肪间隙未见异常。双侧腭帆张、提肌、双侧头长肌、翼内外肌未见明显异常。 双侧翼腭窝、上颌后脂肪间隙、咀嚼肌间隙未见异常。 口咽各壁未见增厚。鼻腔内未见肿物。 蝶骨基底部左份、左侧翼突基底部及内侧骨质信号降低，增强扫描可见强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦粘膜稍增厚，骨壁完整。左乳头见少许渗出影。 双侧咽后未见肿大淋巴结。双颈II区见多个淋巴结，最大者约8mm×5mm，边界尚清，较均匀明显强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗放疗后复查，对比某次就诊时间片： 鼻咽未见明显病灶。 颅底骨质破坏，较前未见明显变化。 左侧咽后淋巴结消失，双颈II区淋巴结缩小。 鼻窦炎，左乳突炎。\n- [全程D98] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称。双肺纹理清晰；双肺野未见明显实质性病变；双侧肺门无增大。纵隔未见增宽。心影大小、形态正常。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D17] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者第一程诱导化疗后，诉轻度恶心呕吐，精神睡眠尚可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。钱医生信息已隐藏：患者03-02开始予5-Fu6.6g,DDP130mg化疗，患者未诉特殊不适，注意观察不良反应。\n- [全程D19] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者化疗后，诉轻度恶心，精神睡眠尚可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。医生信息已隐藏：患者第一程诱导化疗顺利，一般情况可，予出院。\n- [全程D35] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者未诉特殊不适，精神睡眠可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。03-22血生化常规未见异常。[姓名已隐去]医生信息已隐藏：患者1程PF方案诱导化疗后，一般情况可，已排除化疗禁忌症，今日水化，明日开始化疗（DDP 130mg d1 ; 5-Fu6.5g civ）。并予对症支持治疗。\n- [全程D36] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉稍恶心呕吐，无头痛、头晕，精神睡眠可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]副医生信息已隐藏：加强对症治疗，患者一般情况可，继续完成化疗，注意休息，加强营养。\n- [全程D37] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉稍恶心，无明显呕吐，无头痛、头晕，精神睡眠可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]副医生信息已隐藏：患者一般情况可继续完成化疗，\n- [全程D41] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者诉恶心呕吐，盗汗，头晕鼻塞，精神睡眠可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。03-29血常规示：WBC3.0*109/L NE1.7*109/L 生化示：血钾 3.3mmol/L[姓名已隐去]医生信息已隐藏：患者第二程诱导化疗，出现I度骨髓抑制，予香伏益血。胃肠道反应相比上次稍重，嘱少食多餐，加强营养。今日化疗结束，嘱明日出院。\n- [全程D77] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 今行放疗第15次，患者口干咽痛，稍恶心、呕吐，食纳、睡眠欠佳。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。某次就诊时间日查血常规、肝肾功能电解质无明显异常。[姓名已隐去]副医生信息已隐藏：予口腔粘膜保护等对症治疗，加强营养支持治疗，继续完成放疗。\n- [全程D82] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今行放疗第18次，患者口干咽痛，稍恶心、呕吐，食纳、睡眠欠佳。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物，较前缩小；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]医生信息已隐藏：予口腔粘膜保护等对症治疗，加强营养支持治疗，明日复查血常规、肝肾功能，继续完成放疗。\n- [全程D91] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今行放疗第25次，患者口干咽痛，稍恶心、呕吐，食纳、睡眠欠佳。查体：张口门齿距4.5cm；鼻咽肿物不明显；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。昨日查血常规、肝肾功能未见明显异常。[姓名已隐去]医生信息已隐藏：予口腔粘膜保护等对症治疗，加强营养支持治疗，明日予同期DDP化疗，密切观察放化疗反应，继续完成放疗。\n- [全程D96] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 今行放疗第28次，患者口干咽痛，稍恶心、呕吐，食纳、睡眠欠佳。查体：张口门齿距4.5cm；鼻咽肿物不明显；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]医生信息已隐藏：予口腔粘膜保护等对症治疗，加强营养支持治疗，明日复查血常规、肝肾功能，继续完成放疗。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估为原发灶缓解但颈部淋巴结残留，行双侧颈部淋巴结清扫术，术后定期随访复查。\nB. 评估为颅底骨质破坏未缓解，局部追加立体定向放射治疗推量，并定期随访复查。\nC. 评估为放化疗后部分缓解，继续原方案辅助化疗2个周期以巩固疗效。\nD. 评估为放化疗后临床缓解，按计划结疗出院，序贯PD-1抑制剂维持治疗1年。\nE. 评估为原发灶残留，行鼻咽内镜下挽救性切除术，术后配合张口及颈部功能锻炼。\nF. 评估为放化疗后临床缓解，按计划结疗出院，3个月后行PET-CT评估，期间无需特殊干预。\nG. 评估为放化疗后病情稳定，更改化疗方案为吉西他滨联合顺铂进行二线化疗。\nH. 评估为放化疗后临床缓解，按计划结疗出院，预防性给予全脑放射治疗。\nI. 评估为颈部淋巴结残留，局部追加电子线放射治疗推量，并加强营养支持。\nJ. 评估为放化疗后临床缓解，按计划结疗出院，序贯口服卡培他滨节拍维持治疗1年。\nK. 评估为放化疗后临床缓解，按计划结疗出院，嘱鼻腔冲洗、张口及颈部功能锻炼，定期随访复查。\nL. 评估为颅底病灶残留，转诊行质子重离子放射治疗以提高局部控制率。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-deb84ffb5f7c209f58040b0d","patient_id":"patient-d6812a1c46ed21fda9ebb9f8","turn_id":"turn01","turn_position":1,"turn_type":"initial_workup_choice","gold_letter":"D","gold_action":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部X线，腹部彩超及心电图","options":[{"letter":"A","text":"鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸部X线，腹部彩超","is_gold":false},{"letter":"B","text":"鼻咽及颈部MRI平扫+增强，全身PET-CT检查，暂缓鼻咽活检","is_gold":false},{"letter":"C","text":"鼻咽镜检查及活检，仅行鼻咽MRI平扫+增强，胸部CT，腹部彩超","is_gold":false},{"letter":"D","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部X线，腹部彩超及心电图","is_gold":true},{"letter":"E","text":"鼻咽镜检查及活检，全身PET-CT检查，头颅MRI平扫+增强","is_gold":false},{"letter":"F","text":"鼻咽及颈部根治性放疗，同步行胸部及腹部影像学检查","is_gold":false},{"letter":"G","text":"鼻咽肿物切除活检，鼻咽及颈部MRI平扫+增强，胸部X线，腹部彩超","is_gold":false},{"letter":"H","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，暂不进行胸腹部影像学检查","is_gold":false},{"letter":"I","text":"鼻咽镜检查及活检，鼻咽CT平扫+增强，颈部超声，胸部X线，腹部彩超","is_gold":false},{"letter":"J","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身骨扫描，头颅CT","is_gold":false},{"letter":"K","text":"鼻咽脱落细胞学检查，鼻咽及颈部MRI平扫+增强，胸部CT，腹部彩超","is_gold":false},{"letter":"L","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，预防性颈部淋巴结清扫术","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 右侧耳鸣、鼻塞3月余，加重1周。；现病史: 缘于某次就诊时间11月下旬患者无意中出现右侧耳鸣、鼻塞，伴有右耳听力下降、头痛症状，无鼻出血，无面麻，无视物模糊、复视，无呛咳等症状；未予重视，逐渐加重，于某次就诊时间在[机构已隐去]就诊；建议患者住院治疗，患者及家属不同意。近1周来，耳鸣、鼻塞及头痛症状加重，今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,听力下降,右耳鸣,头痛；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：75次/分，R：20次/分，BP：110/65mmHg,Ht：150cm，Wt：41kg，BSA：1.316m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶壁、顶后壁、右侧壁明显增厚，左侧壁稍增厚，并见结节状肿物突出；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸部X线，腹部彩超\nB. 鼻咽及颈部MRI平扫+增强，全身PET-CT检查，暂缓鼻咽活检\nC. 鼻咽镜检查及活检，仅行鼻咽MRI平扫+增强，胸部CT，腹部彩超\nD. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部X线，腹部彩超及心电图\nE. 鼻咽镜检查及活检，全身PET-CT检查，头颅MRI平扫+增强\nF. 鼻咽及颈部根治性放疗，同步行胸部及腹部影像学检查\nG. 鼻咽肿物切除活检，鼻咽及颈部MRI平扫+增强，胸部X线，腹部彩超\nH. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，暂不进行胸腹部影像学检查\nI. 鼻咽镜检查及活检，鼻咽CT平扫+增强，颈部超声，胸部X线，腹部彩超\nJ. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身骨扫描，头颅CT\nK. 鼻咽脱落细胞学检查，鼻咽及颈部MRI平扫+增强，胸部CT，腹部彩超\nL. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，预防性颈部淋巴结清扫术\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 右侧耳鸣、鼻塞3月余，加重1周。；现病史: 缘于某次就诊时间11月下旬患者无意中出现右侧耳鸣、鼻塞，伴有右耳听力下降、头痛症状，无鼻出血，无面麻，无视物模糊、复视，无呛咳等症状；未予重视，逐渐加重，于某次就诊时间在[机构已隐去]就诊；建议患者住院治疗，患者及家属不同意。近1周来，耳鸣、鼻塞及头痛症状加重，今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,听力下降,右耳鸣,头痛；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：75次/分，R：20次/分，BP：110/65mmHg,Ht：150cm，Wt：41kg，BSA：1.316m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶壁、顶后壁、右侧壁明显增厚，左侧壁稍增厚，并见结节状肿物突出；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸部X线，腹部彩超\nB. 鼻咽及颈部MRI平扫+增强，全身PET-CT检查，暂缓鼻咽活检\nC. 鼻咽镜检查及活检，仅行鼻咽MRI平扫+增强，胸部CT，腹部彩超\nD. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部X线，腹部彩超及心电图\nE. 鼻咽镜检查及活检，全身PET-CT检查，头颅MRI平扫+增强\nF. 鼻咽及颈部根治性放疗，同步行胸部及腹部影像学检查\nG. 鼻咽肿物切除活检，鼻咽及颈部MRI平扫+增强，胸部X线，腹部彩超\nH. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，暂不进行胸腹部影像学检查\nI. 鼻咽镜检查及活检，鼻咽CT平扫+增强，颈部超声，胸部X线，腹部彩超\nJ. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身骨扫描，头颅CT\nK. 鼻咽脱落细胞学检查，鼻咽及颈部MRI平扫+增强，胸部CT，腹部彩超\nL. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，预防性颈部淋巴结清扫术\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-76e183c8ae4202bcecbc9d87","patient_id":"patient-d6812a1c46ed21fda9ebb9f8","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"E","gold_action":"行鼻咽肿物活检明确病理诊断，并安排甲状腺超声检查。","options":[{"letter":"A","text":"行鼻咽肿物活检明确病理诊断，并安排全身PET-CT检查","is_gold":false},{"letter":"B","text":"行鼻咽肿物活检明确病理诊断，并安排全身骨扫描检查","is_gold":false},{"letter":"C","text":"行颈部淋巴结细针穿刺活检明确病理诊断，并安排甲状腺超声检查","is_gold":false},{"letter":"D","text":"行鼻咽肿物活检明确病理诊断，并直接安排甲状腺结节细针穿刺活检","is_gold":false},{"letter":"E","text":"行鼻咽肿物活检明确病理诊断，并安排甲状腺超声检查","is_gold":true},{"letter":"F","text":"行鼻咽肿物活检明确病理诊断，并安排胸部增强CT检查","is_gold":false},{"letter":"G","text":"行鼻咽肿物活检明确病理诊断，并安排头颅增强MRI检查","is_gold":false},{"letter":"H","text":"行鼻咽肿物活检明确病理诊断，并安排甲状腺功能生化检查","is_gold":false},{"letter":"I","text":"行鼻咽肿物活检明确病理诊断，并安排颈部超声检查","is_gold":false},{"letter":"J","text":"行鼻咽肿物活检明确病理诊断，并安排肝脏增强MRI检查","is_gold":false},{"letter":"K","text":"行鼻咽肿物活检明确病理诊断，并安排甲状腺核素扫描检查","is_gold":false},{"letter":"L","text":"暂缓活检操作，先行诊断性抗炎治疗两周后复查鼻咽部MRI","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 右侧耳鸣、鼻塞3月余，加重1周。；现病史: 缘于某次就诊时间11月下旬患者无意中出现右侧耳鸣、鼻塞，伴有右耳听力下降、头痛症状，无鼻出血，无面麻，无视物模糊、复视，无呛咳等症状；未予重视，逐渐加重，于某次就诊时间在[机构已隐去]就诊；建议患者住院治疗，患者及家属不同意。近1周来，耳鸣、鼻塞及头痛症状加重，今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,听力下降,右耳鸣,头痛；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：75次/分，R：20次/分，BP：110/65mmHg,Ht：150cm，Wt：41kg，BSA：1.316m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶壁、顶后壁、右侧壁明显增厚，左侧壁稍增厚，并见结节状肿物突出；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见: 轻度ST段下移；检查结论: 窦性心律 轻度ST段下移\n- [全程D1] 检验组合: 淋巴细胞百分比(Lymph%)-静脉血: 0.35；平均红细胞血红蛋白含量(MCH)-静脉血: 28.7pg；总钙(Ca)-静脉血: 2.32mmol/L；凝血酶时间(TT)-静脉血: 19.8sec.；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阳性(+)（参考: 阴性）；总胆汁酸(TBA)-静脉血: 4.1umol/L；钾离子(K+)-静脉血: 3.82mmol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；红细胞计数(RBC#)-静脉血: 5.0210E12/L；钠离子(Na+)-静脉血: 142.9mmol/L；尿素氮(BUN)-静脉血: 4.2mmol/L；葡萄糖(Glu)-静脉血: 5.36mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.66mmolL；球蛋白(GLO)-静脉血: 25.7g/L；尿酸(UA)-静脉血: 214.3umol/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；ABO血型-静脉血: O；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.98mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.76；中性粒细胞百分比(Neut%)-静脉血: 0.579；阴离子间隙(AG)-静脉血: 11.5；γ-谷氨酰基转移酶(GGT)-静脉血: 12.3U/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 23.4U/L；载脂蛋白B(apoB)-静脉血: 0.98g/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 6.4umolL；中性粒细胞计数(Neut#)-静脉血: 3.710E9/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；载脂蛋白AI(apoAI)-静脉血: 1.79g/L；肌酐(Crea)-静脉血: 50.2umol/L；总蛋白(TP)-静脉血: 70.9g/L；总胆固醇(TC)-静脉血: 5.02mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)……\n- [全程D2] 超声；双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声欠均匀，肝内可见多个无回声灶，较大者约43×29mm，椭圆形，边界清，内透声好，部分可见高回声分隔，后方回声增强。血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：上述病灶内未见明确血流信号。肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声欠均匀，右肾多个无回声灶，较大者约15×13mm，类圆形，边界清，内透声好，后方回声增强。左肾未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确肿物回声。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。；检查结论: 肝多发囊肿。 右肾多发囊肿。 胆囊、脾脏、胰腺、左肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D2] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对侧，双肺野纹理稍增多、增粗，未见明显实质性病变。双侧肺门不大，纵隔不宽，心影形态、大小、位置未见异常。双膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明确病变。\n- [全程D7] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、右侧壁明显增厚，左侧壁稍增厚，并见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号增强扫描明显强化，肿物占据右侧咽隐窝。双侧鼻腔及口咽各壁未见异常。 右侧腭帆张提肌、右侧头长肌及右侧翼内肌受侵，病变包绕右侧颈内动静脉。 右侧腭帆提肌、腭帆张肌、双侧头长肌受侵；左侧腭帆提肌、腭帆张肌未见受侵征象。 双侧翼腭窝、颞下窝未见异常；口咽侧壁未见受累增厚。 蝶骨基底部右份及右侧翼突基底部内侧、右侧翼突内板骨质信号减低，增强扫描不均匀强化。余颅底骨质未见明确异常。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、右侧乳突粘膜增厚，双侧上颌窦、蝶窦、左侧乳突充气良好，骨壁完整；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 右侧咽后见多个肿大淋巴结，最大者短径13mm，增强后明显强化，融合。左侧咽后及双颈II区见多发小淋巴结，最大者短径约7mm，未见坏死及包膜外侵。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺左叶见一结节，大小约11mm×11mm，边界尚清， T1WI及T2WI均呈混杂高信号，增强扫描部分区域强化较明显。甲状腺右叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。；检查结论: 鼻咽病变侵犯右侧咽旁间隙、椎前间隙右份及右侧翼内肌，考虑鼻咽癌可能性大。 蝶骨基底部右份、右侧翼突基底部内侧及右侧翼突内板骨质信号异常，考虑肿瘤浸润可能性大。 右侧咽后肿大淋巴结，考虑转移瘤。 左侧咽后及双颈II区小淋巴结，未排除转移可能。 鼻窦炎；右侧乳突炎。 甲状腺左叶结节灶，建议超声检查。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行鼻咽肿物活检明确病理诊断，并安排全身PET-CT检查\nB. 行鼻咽肿物活检明确病理诊断，并安排全身骨扫描检查\nC. 行颈部淋巴结细针穿刺活检明确病理诊断，并安排甲状腺超声检查\nD. 行鼻咽肿物活检明确病理诊断，并直接安排甲状腺结节细针穿刺活检\nE. 行鼻咽肿物活检明确病理诊断，并安排甲状腺超声检查\nF. 行鼻咽肿物活检明确病理诊断，并安排胸部增强CT检查\nG. 行鼻咽肿物活检明确病理诊断，并安排头颅增强MRI检查\nH. 行鼻咽肿物活检明确病理诊断，并安排甲状腺功能生化检查\nI. 行鼻咽肿物活检明确病理诊断，并安排颈部超声检查\nJ. 行鼻咽肿物活检明确病理诊断，并安排肝脏增强MRI检查\nK. 行鼻咽肿物活检明确病理诊断，并安排甲状腺核素扫描检查\nL. 暂缓活检操作，先行诊断性抗炎治疗两周后复查鼻咽部MRI\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 右侧耳鸣、鼻塞3月余，加重1周。；现病史: 缘于某次就诊时间11月下旬患者无意中出现右侧耳鸣、鼻塞，伴有右耳听力下降、头痛症状，无鼻出血，无面麻，无视物模糊、复视，无呛咳等症状；未予重视，逐渐加重，于某次就诊时间在[机构已隐去]就诊；建议患者住院治疗，患者及家属不同意。近1周来，耳鸣、鼻塞及头痛症状加重，今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,听力下降,右耳鸣,头痛；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：75次/分，R：20次/分，BP：110/65mmHg,Ht：150cm，Wt：41kg，BSA：1.316m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶壁、顶后壁、右侧壁明显增厚，左侧壁稍增厚，并见结节状肿物突出；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见: 轻度ST段下移；检查结论: 窦性心律 轻度ST段下移\n- [全程D1] 检验组合: 淋巴细胞百分比(Lymph%)-静脉血: 0.35；平均红细胞血红蛋白含量(MCH)-静脉血: 28.7pg；总钙(Ca)-静脉血: 2.32mmol/L；凝血酶时间(TT)-静脉血: 19.8sec.；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阳性(+)（参考: 阴性）；总胆汁酸(TBA)-静脉血: 4.1umol/L；钾离子(K+)-静脉血: 3.82mmol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；红细胞计数(RBC#)-静脉血: 5.0210E12/L；钠离子(Na+)-静脉血: 142.9mmol/L；尿素氮(BUN)-静脉血: 4.2mmol/L；葡萄糖(Glu)-静脉血: 5.36mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.66mmolL；球蛋白(GLO)-静脉血: 25.7g/L；尿酸(UA)-静脉血: 214.3umol/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；ABO血型-静脉血: O；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.98mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.76；中性粒细胞百分比(Neut%)-静脉血: 0.579；阴离子间隙(AG)-静脉血: 11.5；γ-谷氨酰基转移酶(GGT)-静脉血: 12.3U/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 23.4U/L；载脂蛋白B(apoB)-静脉血: 0.98g/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 6.4umolL；中性粒细胞计数(Neut#)-静脉血: 3.710E9/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；载脂蛋白AI(apoAI)-静脉血: 1.79g/L；肌酐(Crea)-静脉血: 50.2umol/L；总蛋白(TP)-静脉血: 70.9g/L；总胆固醇(TC)-静脉血: 5.02mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)……\n- [全程D2] 超声；双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声欠均匀，肝内可见多个无回声灶，较大者约43×29mm，椭圆形，边界清，内透声好，部分可见高回声分隔，后方回声增强。血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：上述病灶内未见明确血流信号。肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声欠均匀，右肾多个无回声灶，较大者约15×13mm，类圆形，边界清，内透声好，后方回声增强。左肾未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确肿物回声。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。；检查结论: 肝多发囊肿。 右肾多发囊肿。 胆囊、脾脏、胰腺、左肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D2] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对侧，双肺野纹理稍增多、增粗，未见明显实质性病变。双侧肺门不大，纵隔不宽，心影形态、大小、位置未见异常。双膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明确病变。\n- [全程D7] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、右侧壁明显增厚，左侧壁稍增厚，并见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号增强扫描明显强化，肿物占据右侧咽隐窝。双侧鼻腔及口咽各壁未见异常。 右侧腭帆张提肌、右侧头长肌及右侧翼内肌受侵，病变包绕右侧颈内动静脉。 右侧腭帆提肌、腭帆张肌、双侧头长肌受侵；左侧腭帆提肌、腭帆张肌未见受侵征象。 双侧翼腭窝、颞下窝未见异常；口咽侧壁未见受累增厚。 蝶骨基底部右份及右侧翼突基底部内侧、右侧翼突内板骨质信号减低，增强扫描不均匀强化。余颅底骨质未见明确异常。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、右侧乳突粘膜增厚，双侧上颌窦、蝶窦、左侧乳突充气良好，骨壁完整；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 右侧咽后见多个肿大淋巴结，最大者短径13mm，增强后明显强化，融合。左侧咽后及双颈II区见多发小淋巴结，最大者短径约7mm，未见坏死及包膜外侵。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺左叶见一结节，大小约11mm×11mm，边界尚清， T1WI及T2WI均呈混杂高信号，增强扫描部分区域强化较明显。甲状腺右叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。；检查结论: 鼻咽病变侵犯右侧咽旁间隙、椎前间隙右份及右侧翼内肌，考虑鼻咽癌可能性大。 蝶骨基底部右份、右侧翼突基底部内侧及右侧翼突内板骨质信号异常，考虑肿瘤浸润可能性大。 右侧咽后肿大淋巴结，考虑转移瘤。 左侧咽后及双颈II区小淋巴结，未排除转移可能。 鼻窦炎；右侧乳突炎。 甲状腺左叶结节灶，建议超声检查。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行鼻咽肿物活检明确病理诊断，并安排全身PET-CT检查\nB. 行鼻咽肿物活检明确病理诊断，并安排全身骨扫描检查\nC. 行颈部淋巴结细针穿刺活检明确病理诊断，并安排甲状腺超声检查\nD. 行鼻咽肿物活检明确病理诊断，并直接安排甲状腺结节细针穿刺活检\nE. 行鼻咽肿物活检明确病理诊断，并安排甲状腺超声检查\nF. 行鼻咽肿物活检明确病理诊断，并安排胸部增强CT检查\nG. 行鼻咽肿物活检明确病理诊断，并安排头颅增强MRI检查\nH. 行鼻咽肿物活检明确病理诊断，并安排甲状腺功能生化检查\nI. 行鼻咽肿物活检明确病理诊断，并安排颈部超声检查\nJ. 行鼻咽肿物活检明确病理诊断，并安排肝脏增强MRI检查\nK. 行鼻咽肿物活检明确病理诊断，并安排甲状腺核素扫描检查\nL. 暂缓活检操作，先行诊断性抗炎治疗两周后复查鼻咽部MRI\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-bf94c856279752df44d2b5a5","patient_id":"patient-d6812a1c46ed21fda9ebb9f8","turn_id":"turn05","turn_position":3,"turn_type":"toxicity_or_support_decision","gold_letter":"H","gold_action":"停止静脉输液，予以口服氯化钾缓释片维持补钾，行PICC导管常规护理，安排出院休养。","options":[{"letter":"A","text":"继续静脉滴注氯化钾及氯化钠注射液，暂缓出院继续住院观察。","is_gold":false},{"letter":"B","text":"停止静脉输液，停用所有补钾药物，拔除PICC导管，安排出院休养。","is_gold":false},{"letter":"C","text":"停止静脉输液，予以口服氯化钾缓释片，拔除PICC导管，安排出院休养。","is_gold":false},{"letter":"D","text":"继续静脉滴注氯化钾，行PICC导管常规护理，暂缓出院继续住院观察。","is_gold":false},{"letter":"E","text":"停止静脉输液，停用所有补钾药物，行PICC导管常规护理，安排出院休养。","is_gold":false},{"letter":"F","text":"予以静脉推注氯化钾注射液，行PICC导管常规护理，暂缓出院继续住院观察。","is_gold":false},{"letter":"G","text":"停止静脉输液，予以口服氯化钾缓释片及螺内酯，行PICC导管常规护理，安排出院休养。","is_gold":false},{"letter":"H","text":"停止静脉输液，予以口服氯化钾缓释片，行PICC导管常规护理，安排出院休养。","is_gold":true},{"letter":"I","text":"继续静脉滴注氯化钠注射液，予以口服氯化钾缓释片，行PICC导管常规护理，暂缓出院。","is_gold":false},{"letter":"J","text":"停止静脉输液，予以口服聚苯乙烯磺酸钙散，行PICC导管常规护理，安排出院休养。","is_gold":false},{"letter":"K","text":"停止静脉输液，予以静脉泵入氯化钾注射液，行PICC导管常规护理，暂缓出院。","is_gold":false},{"letter":"L","text":"继续静脉滴注氯化钾及氯化钠注射液，行PICC导管常规护理，带静脉输液装置出院。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 右侧耳鸣、鼻塞3月余，加重1周。；现病史: 缘于某次就诊时间11月下旬患者无意中出现右侧耳鸣、鼻塞，伴有右耳听力下降、头痛症状，无鼻出血，无面麻，无视物模糊、复视，无呛咳等症状；未予重视，逐渐加重，于某次就诊时间在[机构已隐去]就诊；建议患者住院治疗，患者及家属不同意。近1周来，耳鸣、鼻塞及头痛症状加重，今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,听力下降,右耳鸣,头痛；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：75次/分，R：20次/分，BP：110/65mmHg,Ht：150cm，Wt：41kg，BSA：1.316m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶壁、顶后壁、右侧壁明显增厚，左侧壁稍增厚，并见结节状肿物突出；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见: 轻度ST段下移；检查结论: 窦性心律 轻度ST段下移\n- [全程D1] 检验组合: 淋巴细胞百分比(Lymph%)-静脉血: 0.35；平均红细胞血红蛋白含量(MCH)-静脉血: 28.7pg；总钙(Ca)-静脉血: 2.32mmol/L；凝血酶时间(TT)-静脉血: 19.8sec.；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阳性(+)（参考: 阴性）；总胆汁酸(TBA)-静脉血: 4.1umol/L；钾离子(K+)-静脉血: 3.82mmol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；红细胞计数(RBC#)-静脉血: 5.0210E12/L；钠离子(Na+)-静脉血: 142.9mmol/L；尿素氮(BUN)-静脉血: 4.2mmol/L；葡萄糖(Glu)-静脉血: 5.36mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.66mmolL；球蛋白(GLO)-静脉血: 25.7g/L；尿酸(UA)-静脉血: 214.3umol/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；ABO血型-静脉血: O；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.98mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.76；中性粒细胞百分比(Neut%)-静脉血: 0.579；阴离子间隙(AG)-静脉血: 11.5；γ-谷氨酰基转移酶(GGT)-静脉血: 12.3U/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 23.4U/L；载脂蛋白B(apoB)-静脉血: 0.98g/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 6.4umolL；中性粒细胞计数(Neut#)-静脉血: 3.710E9/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；载脂蛋白AI(apoAI)-静脉血: 1.79g/L；肌酐(Crea)-静脉血: 50.2umol/L；总蛋白(TP)-静脉血: 70.9g/L；总胆固醇(TC)-静脉血: 5.02mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)……\n- [全程D2] 超声；双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声欠均匀，肝内可见多个无回声灶，较大者约43×29mm，椭圆形，边界清，内透声好，部分可见高回声分隔，后方回声增强。血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：上述病灶内未见明确血流信号。肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声欠均匀，右肾多个无回声灶，较大者约15×13mm，类圆形，边界清，内透声好，后方回声增强。左肾未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确肿物回声。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。；检查结论: 肝多发囊肿。 右肾多发囊肿。 胆囊、脾脏、胰腺、左肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D2] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对侧，双肺野纹理稍增多、增粗，未见明显实质性病变。双侧肺门不大，纵隔不宽，心影形态、大小、位置未见异常。双膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明确病变。\n- [全程D7] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、右侧壁明显增厚，左侧壁稍增厚，并见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号增强扫描明显强化，肿物占据右侧咽隐窝。双侧鼻腔及口咽各壁未见异常。 右侧腭帆张提肌、右侧头长肌及右侧翼内肌受侵，病变包绕右侧颈内动静脉。 右侧腭帆提肌、腭帆张肌、双侧头长肌受侵；左侧腭帆提肌、腭帆张肌未见受侵征象。 双侧翼腭窝、颞下窝未见异常；口咽侧壁未见受累增厚。 蝶骨基底部右份及右侧翼突基底部内侧、右侧翼突内板骨质信号减低，增强扫描不均匀强化。余颅底骨质未见明确异常。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、右侧乳突粘膜增厚，双侧上颌窦、蝶窦、左侧乳突充气良好，骨壁完整；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 右侧咽后见多个肿大淋巴结，最大者短径13mm，增强后明显强化，融合。左侧咽后及双颈II区见多发小淋巴结，最大者短径约7mm，未见坏死及包膜外侵。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺左叶见一结节，大小约11mm×11mm，边界尚清， T1WI及T2WI均呈混杂高信号，增强扫描部分区域强化较明显。甲状腺右叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。；检查结论: 鼻咽病变侵犯右侧咽旁间隙、椎前间隙右份及右侧翼内肌，考虑鼻咽癌可能性大。 蝶骨基底部右份、右侧翼突基底部内侧及右侧翼突内板骨质信号异常，考虑肿瘤浸润可能性大。 右侧咽后肿大淋巴结，考虑转移瘤。 左侧咽后及双颈II区小淋巴结，未排除转移可能。 鼻窦炎；右侧乳突炎。 甲状腺左叶结节灶，建议超声检查。\n- [全程D42] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位置位于第5胸椎体下缘，估计位于上腔静脉上段。；检查结论: PICC管末端位置如上所述。\n- [全程D42] 检验组合: 阴离子间隙(AG)-静脉血: 11；丙氨酸氨基转移酶(ALT)-静脉血: 12.8U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；钠离子(Na+)-静脉血: 143.3mmol/L；总钙(Ca)-静脉血: 2.2mmol/L；总胆红素(TBIL)-静脉血: 8.4umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.3U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.86；C-反应蛋白(CRP)-静脉血: 0.85mg/L；胱抑素(Cys-C)-静脉血: 0.61mg/L；磷(P)-静脉血: 1.14mmol/L；总胆固醇(TC)-静脉血: 4.61mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.292；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；载脂蛋白B(apoB)-静脉血: 0.93g/L；间接胆红素(IBIL)-静脉血: 6.4umolL；甘油三酯(TG)-静脉血: 0.64mmol/L；碱性磷酸酶(ALP)-静脉血: 87.2U/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 2umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；尿酸(UA)-静脉血: 194.8umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.02mmol/L；总胆汁酸(TBA)-静脉血: 2.1umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.96；钾离子(K+)-静脉血: 3.83mmol/L；红细胞比容(Hct)-静脉血: 40.7%；氯离子(Cl-)-静脉血: 107.6mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；肌酐(Crea)-静脉血: 46.2umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.810E9/L；血小板分布宽度(PDW)-静脉血: 10.6%；平均血小板体积(MPV)-静脉血: 9.5fL；白蛋白(ALB)-静脉血: 43.5g/L；尿素氮(BUN)-静脉血: 3.6mmol/L；白细胞计数(WBC#)-静脉血: 6.3110……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D43] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.016；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: 1+ 0.6mg（参考: 阴性）；浊度(TRUB)-尿液: 清亮；葡萄糖(Glu)-尿液: +- 1.7mmol（参考: 阴性）；酸碱度(pH)-尿液: 6.5；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；红细胞计数(RBC#)-尿液: 8/μL；酮体(KET)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 7/μL；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D44] 检验组合: 白蛋白(ALB)-静脉血: 37.7g/L；总胆红素(TBIL)-静脉血: 9umol/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；钠离子(Na+)-静脉血: 133.7mmol/L；直接胆红素(DBIL)-静脉血: 2.1umol/L；总胆汁酸(TBA)-静脉血: 1.4umol/L；尿酸(UA)-静脉血: 164.1umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.6U/L；总蛋白(TP)-静脉血: 58.49g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 23.7U/L；碱性磷酸酶(ALP)-静脉血: 72.8U/L；肌酐(Crea)-静脉血: 44.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.95；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.81；尿素氮(BUN)-静脉血: 4.4mmol/L；磷(P)-静脉血: 0.93mmol/L；总钙(Ca)-静脉血: 2.02mmol/L；乳酸脱氢酶(LDH)-静脉血: 210.9U/L；氯离子(Cl-)-静脉血: 100.2mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 12.3U/L；间接胆红素(IBIL)-静脉血: 6.9umolL；钾离子(K+)-静脉血: 2.94mmol/L；阴离子间隙(AG)-静脉血: 12.1；血液二氧化碳含量ctCO2(B)-静脉血: 21.4mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.3U/L；球蛋白(GLO)-静脉血: 20.79g/L\n- [全程D45] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 1/μL；钠离子(Na+)-静脉血: 131.1mmol/L；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；阴离子间隙(AG)-静脉血: 14.5；浊度(TRUB)-尿液: clear；胆红素(BIL)-尿液: -（参考: 阴性）；镁离子(Mg2+)-静脉血: 0.79mmol/L；钾离子(K+)-静脉血: 3.17mmol/L；红细胞计数(RBC#)-尿液: 17/μL；磷(P)-静脉血: 0.95mmol/L；氯离子(Cl-)-静脉血: 96.2mmol/L；白细胞计数(WBC#)-尿液: 5/μL；总钙(Ca)-静脉血: 1.92mmol/L；颜色-尿液: Light-Yellow；比重(SG)-尿液: 1.011；葡萄糖(Glu)-尿液: 1+ 5.6mmol（参考: 阴性）；隐血(OB)-尿液: +-0.3mg（参考: 阴性）；未分类结晶计数(UNCX#)-尿液: 5/μL；血液二氧化碳含量ctCO2(B)-静脉血: 20.4mmol/L；酸碱度(pH)-尿液: 6.5；尿胆原(URO)-尿液: -（参考: 阴性）\n- [全程D46] 检验组合: 阴离子间隙(AG)-静脉血: 17.7；血液二氧化碳含量ctCO2(B)-静脉血: 19.3mmol/L；氯离子(Cl-)-静脉血: 85.6mmol/L；总钙(Ca)-静脉血: 2.04mmol/L；钠离子(Na+)-静脉血: 122.6mmol/L；钾离子(K+)-静脉血: 3.26mmol/L；镁离子(Mg2+)-静脉血: 0.77mmol/L；磷(P)-静脉血: 0.51mmol/L\n- [全程D47] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 20.9mmol/L；总钙(Ca)-静脉血: 2.12mmol/L；阴离子间隙(AG)-静脉血: 14.5；磷(P)-静脉血: 0.67mmol/L；钾离子(K+)-静脉血: 4.06mmol/L；氯离子(Cl-)-静脉血: 89.8mmol/L；钠离子(Na+)-静脉血: 125.2mmol/L；镁离子(Mg2+)-静脉血: 0.93mmol/L\n- [全程D49] 检验组合: 镁离子(Mg2+)-静脉血: 0.89mmol/L；血小板分布宽度(PDW)-静脉血: 11.2%；有核红细胞百分比(NRBC%)-静脉血: 0；白蛋白(ALB)-静脉血: 44.2g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 33.1U/L；丙氨酸氨基转移酶(ALT)-静脉血: 22.6U/L；葡萄糖(Glu)-静脉血: 5.17mmol/L；间接胆红素(IBIL)-静脉血: 8.9umolL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.09mmolL；载脂蛋白B(apoB)-静脉血: 0.78g/L；总胆汁酸(TBA)-静脉血: 7.4umol/L；磷(P)-静脉血: 0.8mmol/L；肌酐(Crea)-静脉血: 38.9umol/L；甘油三酯(TG)-静脉血: 1.35mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29pg；平均红细胞体积(MCV)-静脉血: 83.3fL；单核细胞计数(Mono#)-静脉血: 0.710E9/L；总胆固醇(TC)-静脉血: 3.61mmol/L；总蛋白(TP)-静脉血: 67.8g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.003；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；总胆红素(TBIL)-静脉血: 12.8umol/L；血小板计数(PLT#)-静脉血: 19410E9/L；血小板比容-静脉血: 20%；天门冬氨酸氨基转移酶(AST)-静脉血: 12.9U/L；阴离子间隙(AG)-静脉血: 14.6；直接胆红素(DBIL)-静脉血: 3.9umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.05mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.2mmol/L；大血小板百分比(P-LCR%)-静脉血: 25.6%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 35.8；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.87；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；C-反应蛋白(CRP)-静脉血: 0.28mg/L；尿酸(UA)-静脉血: 110.7umol/L；单核细胞百分比(Mono%)-静脉血: 0……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D11] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者检查完善，已完成放疗预约，嘱今日出院，按期行放疗前准备及放疗前口腔检查。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 继续静脉滴注氯化钾及氯化钠注射液，暂缓出院继续住院观察。\nB. 停止静脉输液，停用所有补钾药物，拔除PICC导管，安排出院休养。\nC. 停止静脉输液，予以口服氯化钾缓释片，拔除PICC导管，安排出院休养。\nD. 继续静脉滴注氯化钾，行PICC导管常规护理，暂缓出院继续住院观察。\nE. 停止静脉输液，停用所有补钾药物，行PICC导管常规护理，安排出院休养。\nF. 予以静脉推注氯化钾注射液，行PICC导管常规护理，暂缓出院继续住院观察。\nG. 停止静脉输液，予以口服氯化钾缓释片及螺内酯，行PICC导管常规护理，安排出院休养。\nH. 停止静脉输液，予以口服氯化钾缓释片，行PICC导管常规护理，安排出院休养。\nI. 继续静脉滴注氯化钠注射液，予以口服氯化钾缓释片，行PICC导管常规护理，暂缓出院。\nJ. 停止静脉输液，予以口服聚苯乙烯磺酸钙散，行PICC导管常规护理，安排出院休养。\nK. 停止静脉输液，予以静脉泵入氯化钾注射液，行PICC导管常规护理，暂缓出院。\nL. 继续静脉滴注氯化钾及氯化钠注射液，行PICC导管常规护理，带静脉输液装置出院。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 右侧耳鸣、鼻塞3月余，加重1周。；现病史: 缘于某次就诊时间11月下旬患者无意中出现右侧耳鸣、鼻塞，伴有右耳听力下降、头痛症状，无鼻出血，无面麻，无视物模糊、复视，无呛咳等症状；未予重视，逐渐加重，于某次就诊时间在[机构已隐去]就诊；建议患者住院治疗，患者及家属不同意。近1周来，耳鸣、鼻塞及头痛症状加重，今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,听力下降,右耳鸣,头痛；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：75次/分，R：20次/分，BP：110/65mmHg,Ht：150cm，Wt：41kg，BSA：1.316m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶壁、顶后壁、右侧壁明显增厚，左侧壁稍增厚，并见结节状肿物突出；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见: 轻度ST段下移；检查结论: 窦性心律 轻度ST段下移\n- [全程D1] 检验组合: 淋巴细胞百分比(Lymph%)-静脉血: 0.35；平均红细胞血红蛋白含量(MCH)-静脉血: 28.7pg；总钙(Ca)-静脉血: 2.32mmol/L；凝血酶时间(TT)-静脉血: 19.8sec.；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阳性(+)（参考: 阴性）；总胆汁酸(TBA)-静脉血: 4.1umol/L；钾离子(K+)-静脉血: 3.82mmol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；红细胞计数(RBC#)-静脉血: 5.0210E12/L；钠离子(Na+)-静脉血: 142.9mmol/L；尿素氮(BUN)-静脉血: 4.2mmol/L；葡萄糖(Glu)-静脉血: 5.36mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.66mmolL；球蛋白(GLO)-静脉血: 25.7g/L；尿酸(UA)-静脉血: 214.3umol/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；ABO血型-静脉血: O；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.98mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.76；中性粒细胞百分比(Neut%)-静脉血: 0.579；阴离子间隙(AG)-静脉血: 11.5；γ-谷氨酰基转移酶(GGT)-静脉血: 12.3U/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 23.4U/L；载脂蛋白B(apoB)-静脉血: 0.98g/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 6.4umolL；中性粒细胞计数(Neut#)-静脉血: 3.710E9/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；载脂蛋白AI(apoAI)-静脉血: 1.79g/L；肌酐(Crea)-静脉血: 50.2umol/L；总蛋白(TP)-静脉血: 70.9g/L；总胆固醇(TC)-静脉血: 5.02mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)……\n- [全程D2] 超声；双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声欠均匀，肝内可见多个无回声灶，较大者约43×29mm，椭圆形，边界清，内透声好，部分可见高回声分隔，后方回声增强。血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：上述病灶内未见明确血流信号。肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声欠均匀，右肾多个无回声灶，较大者约15×13mm，类圆形，边界清，内透声好，后方回声增强。左肾未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确肿物回声。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。；检查结论: 肝多发囊肿。 右肾多发囊肿。 胆囊、脾脏、胰腺、左肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D2] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对侧，双肺野纹理稍增多、增粗，未见明显实质性病变。双侧肺门不大，纵隔不宽，心影形态、大小、位置未见异常。双膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明确病变。\n- [全程D7] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、右侧壁明显增厚，左侧壁稍增厚，并见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号增强扫描明显强化，肿物占据右侧咽隐窝。双侧鼻腔及口咽各壁未见异常。 右侧腭帆张提肌、右侧头长肌及右侧翼内肌受侵，病变包绕右侧颈内动静脉。 右侧腭帆提肌、腭帆张肌、双侧头长肌受侵；左侧腭帆提肌、腭帆张肌未见受侵征象。 双侧翼腭窝、颞下窝未见异常；口咽侧壁未见受累增厚。 蝶骨基底部右份及右侧翼突基底部内侧、右侧翼突内板骨质信号减低，增强扫描不均匀强化。余颅底骨质未见明确异常。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、右侧乳突粘膜增厚，双侧上颌窦、蝶窦、左侧乳突充气良好，骨壁完整；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 右侧咽后见多个肿大淋巴结，最大者短径13mm，增强后明显强化，融合。左侧咽后及双颈II区见多发小淋巴结，最大者短径约7mm，未见坏死及包膜外侵。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺左叶见一结节，大小约11mm×11mm，边界尚清， T1WI及T2WI均呈混杂高信号，增强扫描部分区域强化较明显。甲状腺右叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。；检查结论: 鼻咽病变侵犯右侧咽旁间隙、椎前间隙右份及右侧翼内肌，考虑鼻咽癌可能性大。 蝶骨基底部右份、右侧翼突基底部内侧及右侧翼突内板骨质信号异常，考虑肿瘤浸润可能性大。 右侧咽后肿大淋巴结，考虑转移瘤。 左侧咽后及双颈II区小淋巴结，未排除转移可能。 鼻窦炎；右侧乳突炎。 甲状腺左叶结节灶，建议超声检查。\n- [全程D42] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位置位于第5胸椎体下缘，估计位于上腔静脉上段。；检查结论: PICC管末端位置如上所述。\n- [全程D42] 检验组合: 阴离子间隙(AG)-静脉血: 11；丙氨酸氨基转移酶(ALT)-静脉血: 12.8U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；钠离子(Na+)-静脉血: 143.3mmol/L；总钙(Ca)-静脉血: 2.2mmol/L；总胆红素(TBIL)-静脉血: 8.4umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.3U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.86；C-反应蛋白(CRP)-静脉血: 0.85mg/L；胱抑素(Cys-C)-静脉血: 0.61mg/L；磷(P)-静脉血: 1.14mmol/L；总胆固醇(TC)-静脉血: 4.61mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.292；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；载脂蛋白B(apoB)-静脉血: 0.93g/L；间接胆红素(IBIL)-静脉血: 6.4umolL；甘油三酯(TG)-静脉血: 0.64mmol/L；碱性磷酸酶(ALP)-静脉血: 87.2U/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 2umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；尿酸(UA)-静脉血: 194.8umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.02mmol/L；总胆汁酸(TBA)-静脉血: 2.1umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.96；钾离子(K+)-静脉血: 3.83mmol/L；红细胞比容(Hct)-静脉血: 40.7%；氯离子(Cl-)-静脉血: 107.6mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；肌酐(Crea)-静脉血: 46.2umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.810E9/L；血小板分布宽度(PDW)-静脉血: 10.6%；平均血小板体积(MPV)-静脉血: 9.5fL；白蛋白(ALB)-静脉血: 43.5g/L；尿素氮(BUN)-静脉血: 3.6mmol/L；白细胞计数(WBC#)-静脉血: 6.3110……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D43] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.016；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: 1+ 0.6mg（参考: 阴性）；浊度(TRUB)-尿液: 清亮；葡萄糖(Glu)-尿液: +- 1.7mmol（参考: 阴性）；酸碱度(pH)-尿液: 6.5；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；红细胞计数(RBC#)-尿液: 8/μL；酮体(KET)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 7/μL；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D44] 检验组合: 白蛋白(ALB)-静脉血: 37.7g/L；总胆红素(TBIL)-静脉血: 9umol/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；钠离子(Na+)-静脉血: 133.7mmol/L；直接胆红素(DBIL)-静脉血: 2.1umol/L；总胆汁酸(TBA)-静脉血: 1.4umol/L；尿酸(UA)-静脉血: 164.1umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.6U/L；总蛋白(TP)-静脉血: 58.49g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 23.7U/L；碱性磷酸酶(ALP)-静脉血: 72.8U/L；肌酐(Crea)-静脉血: 44.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.95；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.81；尿素氮(BUN)-静脉血: 4.4mmol/L；磷(P)-静脉血: 0.93mmol/L；总钙(Ca)-静脉血: 2.02mmol/L；乳酸脱氢酶(LDH)-静脉血: 210.9U/L；氯离子(Cl-)-静脉血: 100.2mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 12.3U/L；间接胆红素(IBIL)-静脉血: 6.9umolL；钾离子(K+)-静脉血: 2.94mmol/L；阴离子间隙(AG)-静脉血: 12.1；血液二氧化碳含量ctCO2(B)-静脉血: 21.4mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.3U/L；球蛋白(GLO)-静脉血: 20.79g/L\n- [全程D45] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 1/μL；钠离子(Na+)-静脉血: 131.1mmol/L；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；阴离子间隙(AG)-静脉血: 14.5；浊度(TRUB)-尿液: clear；胆红素(BIL)-尿液: -（参考: 阴性）；镁离子(Mg2+)-静脉血: 0.79mmol/L；钾离子(K+)-静脉血: 3.17mmol/L；红细胞计数(RBC#)-尿液: 17/μL；磷(P)-静脉血: 0.95mmol/L；氯离子(Cl-)-静脉血: 96.2mmol/L；白细胞计数(WBC#)-尿液: 5/μL；总钙(Ca)-静脉血: 1.92mmol/L；颜色-尿液: Light-Yellow；比重(SG)-尿液: 1.011；葡萄糖(Glu)-尿液: 1+ 5.6mmol（参考: 阴性）；隐血(OB)-尿液: +-0.3mg（参考: 阴性）；未分类结晶计数(UNCX#)-尿液: 5/μL；血液二氧化碳含量ctCO2(B)-静脉血: 20.4mmol/L；酸碱度(pH)-尿液: 6.5；尿胆原(URO)-尿液: -（参考: 阴性）\n- [全程D46] 检验组合: 阴离子间隙(AG)-静脉血: 17.7；血液二氧化碳含量ctCO2(B)-静脉血: 19.3mmol/L；氯离子(Cl-)-静脉血: 85.6mmol/L；总钙(Ca)-静脉血: 2.04mmol/L；钠离子(Na+)-静脉血: 122.6mmol/L；钾离子(K+)-静脉血: 3.26mmol/L；镁离子(Mg2+)-静脉血: 0.77mmol/L；磷(P)-静脉血: 0.51mmol/L\n- [全程D47] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 20.9mmol/L；总钙(Ca)-静脉血: 2.12mmol/L；阴离子间隙(AG)-静脉血: 14.5；磷(P)-静脉血: 0.67mmol/L；钾离子(K+)-静脉血: 4.06mmol/L；氯离子(Cl-)-静脉血: 89.8mmol/L；钠离子(Na+)-静脉血: 125.2mmol/L；镁离子(Mg2+)-静脉血: 0.93mmol/L\n- [全程D49] 检验组合: 镁离子(Mg2+)-静脉血: 0.89mmol/L；血小板分布宽度(PDW)-静脉血: 11.2%；有核红细胞百分比(NRBC%)-静脉血: 0；白蛋白(ALB)-静脉血: 44.2g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 33.1U/L；丙氨酸氨基转移酶(ALT)-静脉血: 22.6U/L；葡萄糖(Glu)-静脉血: 5.17mmol/L；间接胆红素(IBIL)-静脉血: 8.9umolL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.09mmolL；载脂蛋白B(apoB)-静脉血: 0.78g/L；总胆汁酸(TBA)-静脉血: 7.4umol/L；磷(P)-静脉血: 0.8mmol/L；肌酐(Crea)-静脉血: 38.9umol/L；甘油三酯(TG)-静脉血: 1.35mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29pg；平均红细胞体积(MCV)-静脉血: 83.3fL；单核细胞计数(Mono#)-静脉血: 0.710E9/L；总胆固醇(TC)-静脉血: 3.61mmol/L；总蛋白(TP)-静脉血: 67.8g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.003；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；总胆红素(TBIL)-静脉血: 12.8umol/L；血小板计数(PLT#)-静脉血: 19410E9/L；血小板比容-静脉血: 20%；天门冬氨酸氨基转移酶(AST)-静脉血: 12.9U/L；阴离子间隙(AG)-静脉血: 14.6；直接胆红素(DBIL)-静脉血: 3.9umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.05mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.2mmol/L；大血小板百分比(P-LCR%)-静脉血: 25.6%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 35.8；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.87；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；C-反应蛋白(CRP)-静脉血: 0.28mg/L；尿酸(UA)-静脉血: 110.7umol/L；单核细胞百分比(Mono%)-静脉血: 0……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D11] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者检查完善，已完成放疗预约，嘱今日出院，按期行放疗前准备及放疗前口腔检查。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 继续静脉滴注氯化钾及氯化钠注射液，暂缓出院继续住院观察。\nB. 停止静脉输液，停用所有补钾药物，拔除PICC导管，安排出院休养。\nC. 停止静脉输液，予以口服氯化钾缓释片，拔除PICC导管，安排出院休养。\nD. 继续静脉滴注氯化钾，行PICC导管常规护理，暂缓出院继续住院观察。\nE. 停止静脉输液，停用所有补钾药物，行PICC导管常规护理，安排出院休养。\nF. 予以静脉推注氯化钾注射液，行PICC导管常规护理，暂缓出院继续住院观察。\nG. 停止静脉输液，予以口服氯化钾缓释片及螺内酯，行PICC导管常规护理，安排出院休养。\nH. 停止静脉输液，予以口服氯化钾缓释片，行PICC导管常规护理，安排出院休养。\nI. 继续静脉滴注氯化钠注射液，予以口服氯化钾缓释片，行PICC导管常规护理，暂缓出院。\nJ. 停止静脉输液，予以口服聚苯乙烯磺酸钙散，行PICC导管常规护理，安排出院休养。\nK. 停止静脉输液，予以静脉泵入氯化钾注射液，行PICC导管常规护理，暂缓出院。\nL. 继续静脉滴注氯化钾及氯化钠注射液，行PICC导管常规护理，带静脉输液装置出院。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-9549c3c98f10ace802cbb08b","patient_id":"patient-d6812a1c46ed21fda9ebb9f8","turn_id":"turn06","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"I","gold_action":"继续顺铂单药化疗，并给予地塞米松、甲氧氯普胺、奥美拉唑止吐，辅以静脉水化及补钾支持治疗。","options":[{"letter":"A","text":"暂停化疗，给予重组人粒细胞集落刺激因子升白细胞治疗，待白细胞恢复后继续顺铂化疗。","is_gold":false},{"letter":"B","text":"暂停化疗，给予3%氯化钠注射液强化纠正低钠血症，待血钠持续稳定正常后再考虑恢复顺铂化疗。","is_gold":false},{"letter":"C","text":"将化疗方案调整为卡铂单药，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化支持治疗。","is_gold":false},{"letter":"D","text":"继续顺铂化疗，并给予地塞米松、甲氧氯普胺、奥美拉唑止吐，无需常规静脉水化及补钾。","is_gold":false},{"letter":"E","text":"继续顺铂化疗，并给予昂丹司琼单药止吐，辅以静脉水化及补钾支持治疗。","is_gold":false},{"letter":"F","text":"继续顺铂联合5-氟尿嘧啶化疗，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化支持治疗。","is_gold":false},{"letter":"G","text":"继续顺铂化疗，并给予地塞米松、甲氧氯普胺、奥美拉唑止吐，同时预防性使用重组人粒细胞集落刺激因子。","is_gold":false},{"letter":"H","text":"终止化疗，仅行单纯放射治疗，并给予静脉水化及营养支持。","is_gold":false},{"letter":"I","text":"继续顺铂化疗，并给予地塞米松、甲氧氯普胺、奥美拉唑止吐，辅以静脉水化及补钾支持治疗。","is_gold":true},{"letter":"J","text":"继续顺铂化疗，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化，同时加用呋塞米强迫利尿且不补钾。","is_gold":false},{"letter":"K","text":"暂停化疗，给予保肝降酶治疗，待肝功能恢复后继续顺铂化疗。","is_gold":false},{"letter":"L","text":"将化疗方案调整为紫杉醇单药，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化支持治疗。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 右侧耳鸣、鼻塞3月余，加重1周。；现病史: 缘于某次就诊时间11月下旬患者无意中出现右侧耳鸣、鼻塞，伴有右耳听力下降、头痛症状，无鼻出血，无面麻，无视物模糊、复视，无呛咳等症状；未予重视，逐渐加重，于某次就诊时间在[机构已隐去]就诊；建议患者住院治疗，患者及家属不同意。近1周来，耳鸣、鼻塞及头痛症状加重，今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,听力下降,右耳鸣,头痛；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：75次/分，R：20次/分，BP：110/65mmHg,Ht：150cm，Wt：41kg，BSA：1.316m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶壁、顶后壁、右侧壁明显增厚，左侧壁稍增厚，并见结节状肿物突出；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见: 轻度ST段下移；检查结论: 窦性心律 轻度ST段下移\n- [全程D1] 检验组合: 淋巴细胞百分比(Lymph%)-静脉血: 0.35；平均红细胞血红蛋白含量(MCH)-静脉血: 28.7pg；总钙(Ca)-静脉血: 2.32mmol/L；凝血酶时间(TT)-静脉血: 19.8sec.；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阳性(+)（参考: 阴性）；总胆汁酸(TBA)-静脉血: 4.1umol/L；钾离子(K+)-静脉血: 3.82mmol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；红细胞计数(RBC#)-静脉血: 5.0210E12/L；钠离子(Na+)-静脉血: 142.9mmol/L；尿素氮(BUN)-静脉血: 4.2mmol/L；葡萄糖(Glu)-静脉血: 5.36mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.66mmolL；球蛋白(GLO)-静脉血: 25.7g/L；尿酸(UA)-静脉血: 214.3umol/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；ABO血型-静脉血: O；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.98mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.76；中性粒细胞百分比(Neut%)-静脉血: 0.579；阴离子间隙(AG)-静脉血: 11.5；γ-谷氨酰基转移酶(GGT)-静脉血: 12.3U/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 23.4U/L；载脂蛋白B(apoB)-静脉血: 0.98g/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 6.4umolL；中性粒细胞计数(Neut#)-静脉血: 3.710E9/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；载脂蛋白AI(apoAI)-静脉血: 1.79g/L；肌酐(Crea)-静脉血: 50.2umol/L；总蛋白(TP)-静脉血: 70.9g/L；总胆固醇(TC)-静脉血: 5.02mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)……\n- [全程D2] 超声；双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声欠均匀，肝内可见多个无回声灶，较大者约43×29mm，椭圆形，边界清，内透声好，部分可见高回声分隔，后方回声增强。血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：上述病灶内未见明确血流信号。肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声欠均匀，右肾多个无回声灶，较大者约15×13mm，类圆形，边界清，内透声好，后方回声增强。左肾未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确肿物回声。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。；检查结论: 肝多发囊肿。 右肾多发囊肿。 胆囊、脾脏、胰腺、左肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D2] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对侧，双肺野纹理稍增多、增粗，未见明显实质性病变。双侧肺门不大，纵隔不宽，心影形态、大小、位置未见异常。双膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明确病变。\n- [全程D7] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、右侧壁明显增厚，左侧壁稍增厚，并见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号增强扫描明显强化，肿物占据右侧咽隐窝。双侧鼻腔及口咽各壁未见异常。 右侧腭帆张提肌、右侧头长肌及右侧翼内肌受侵，病变包绕右侧颈内动静脉。 右侧腭帆提肌、腭帆张肌、双侧头长肌受侵；左侧腭帆提肌、腭帆张肌未见受侵征象。 双侧翼腭窝、颞下窝未见异常；口咽侧壁未见受累增厚。 蝶骨基底部右份及右侧翼突基底部内侧、右侧翼突内板骨质信号减低，增强扫描不均匀强化。余颅底骨质未见明确异常。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、右侧乳突粘膜增厚，双侧上颌窦、蝶窦、左侧乳突充气良好，骨壁完整；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 右侧咽后见多个肿大淋巴结，最大者短径13mm，增强后明显强化，融合。左侧咽后及双颈II区见多发小淋巴结，最大者短径约7mm，未见坏死及包膜外侵。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺左叶见一结节，大小约11mm×11mm，边界尚清， T1WI及T2WI均呈混杂高信号，增强扫描部分区域强化较明显。甲状腺右叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。；检查结论: 鼻咽病变侵犯右侧咽旁间隙、椎前间隙右份及右侧翼内肌，考虑鼻咽癌可能性大。 蝶骨基底部右份、右侧翼突基底部内侧及右侧翼突内板骨质信号异常，考虑肿瘤浸润可能性大。 右侧咽后肿大淋巴结，考虑转移瘤。 左侧咽后及双颈II区小淋巴结，未排除转移可能。 鼻窦炎；右侧乳突炎。 甲状腺左叶结节灶，建议超声检查。\n- [全程D42] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位置位于第5胸椎体下缘，估计位于上腔静脉上段。；检查结论: PICC管末端位置如上所述。\n- [全程D42] 检验组合: 阴离子间隙(AG)-静脉血: 11；丙氨酸氨基转移酶(ALT)-静脉血: 12.8U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；钠离子(Na+)-静脉血: 143.3mmol/L；总钙(Ca)-静脉血: 2.2mmol/L；总胆红素(TBIL)-静脉血: 8.4umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.3U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.86；C-反应蛋白(CRP)-静脉血: 0.85mg/L；胱抑素(Cys-C)-静脉血: 0.61mg/L；磷(P)-静脉血: 1.14mmol/L；总胆固醇(TC)-静脉血: 4.61mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.292；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；载脂蛋白B(apoB)-静脉血: 0.93g/L；间接胆红素(IBIL)-静脉血: 6.4umolL；甘油三酯(TG)-静脉血: 0.64mmol/L；碱性磷酸酶(ALP)-静脉血: 87.2U/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 2umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；尿酸(UA)-静脉血: 194.8umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.02mmol/L；总胆汁酸(TBA)-静脉血: 2.1umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.96；钾离子(K+)-静脉血: 3.83mmol/L；红细胞比容(Hct)-静脉血: 40.7%；氯离子(Cl-)-静脉血: 107.6mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；肌酐(Crea)-静脉血: 46.2umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.810E9/L；血小板分布宽度(PDW)-静脉血: 10.6%；平均血小板体积(MPV)-静脉血: 9.5fL；白蛋白(ALB)-静脉血: 43.5g/L；尿素氮(BUN)-静脉血: 3.6mmol/L；白细胞计数(WBC#)-静脉血: 6.3110……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D43] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.016；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: 1+ 0.6mg（参考: 阴性）；浊度(TRUB)-尿液: 清亮；葡萄糖(Glu)-尿液: +- 1.7mmol（参考: 阴性）；酸碱度(pH)-尿液: 6.5；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；红细胞计数(RBC#)-尿液: 8/μL；酮体(KET)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 7/μL；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D44] 检验组合: 白蛋白(ALB)-静脉血: 37.7g/L；总胆红素(TBIL)-静脉血: 9umol/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；钠离子(Na+)-静脉血: 133.7mmol/L；直接胆红素(DBIL)-静脉血: 2.1umol/L；总胆汁酸(TBA)-静脉血: 1.4umol/L；尿酸(UA)-静脉血: 164.1umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.6U/L；总蛋白(TP)-静脉血: 58.49g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 23.7U/L；碱性磷酸酶(ALP)-静脉血: 72.8U/L；肌酐(Crea)-静脉血: 44.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.95；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.81；尿素氮(BUN)-静脉血: 4.4mmol/L；磷(P)-静脉血: 0.93mmol/L；总钙(Ca)-静脉血: 2.02mmol/L；乳酸脱氢酶(LDH)-静脉血: 210.9U/L；氯离子(Cl-)-静脉血: 100.2mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 12.3U/L；间接胆红素(IBIL)-静脉血: 6.9umolL；钾离子(K+)-静脉血: 2.94mmol/L；阴离子间隙(AG)-静脉血: 12.1；血液二氧化碳含量ctCO2(B)-静脉血: 21.4mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.3U/L；球蛋白(GLO)-静脉血: 20.79g/L\n- [全程D45] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 1/μL；钠离子(Na+)-静脉血: 131.1mmol/L；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；阴离子间隙(AG)-静脉血: 14.5；浊度(TRUB)-尿液: clear；胆红素(BIL)-尿液: -（参考: 阴性）；镁离子(Mg2+)-静脉血: 0.79mmol/L；钾离子(K+)-静脉血: 3.17mmol/L；红细胞计数(RBC#)-尿液: 17/μL；磷(P)-静脉血: 0.95mmol/L；氯离子(Cl-)-静脉血: 96.2mmol/L；白细胞计数(WBC#)-尿液: 5/μL；总钙(Ca)-静脉血: 1.92mmol/L；颜色-尿液: Light-Yellow；比重(SG)-尿液: 1.011；葡萄糖(Glu)-尿液: 1+ 5.6mmol（参考: 阴性）；隐血(OB)-尿液: +-0.3mg（参考: 阴性）；未分类结晶计数(UNCX#)-尿液: 5/μL；血液二氧化碳含量ctCO2(B)-静脉血: 20.4mmol/L；酸碱度(pH)-尿液: 6.5；尿胆原(URO)-尿液: -（参考: 阴性）\n- [全程D46] 检验组合: 阴离子间隙(AG)-静脉血: 17.7；血液二氧化碳含量ctCO2(B)-静脉血: 19.3mmol/L；氯离子(Cl-)-静脉血: 85.6mmol/L；总钙(Ca)-静脉血: 2.04mmol/L；钠离子(Na+)-静脉血: 122.6mmol/L；钾离子(K+)-静脉血: 3.26mmol/L；镁离子(Mg2+)-静脉血: 0.77mmol/L；磷(P)-静脉血: 0.51mmol/L\n- [全程D47] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 20.9mmol/L；总钙(Ca)-静脉血: 2.12mmol/L；阴离子间隙(AG)-静脉血: 14.5；磷(P)-静脉血: 0.67mmol/L；钾离子(K+)-静脉血: 4.06mmol/L；氯离子(Cl-)-静脉血: 89.8mmol/L；钠离子(Na+)-静脉血: 125.2mmol/L；镁离子(Mg2+)-静脉血: 0.93mmol/L\n- [全程D49] 检验组合: 镁离子(Mg2+)-静脉血: 0.89mmol/L；血小板分布宽度(PDW)-静脉血: 11.2%；有核红细胞百分比(NRBC%)-静脉血: 0；白蛋白(ALB)-静脉血: 44.2g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 33.1U/L；丙氨酸氨基转移酶(ALT)-静脉血: 22.6U/L；葡萄糖(Glu)-静脉血: 5.17mmol/L；间接胆红素(IBIL)-静脉血: 8.9umolL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.09mmolL；载脂蛋白B(apoB)-静脉血: 0.78g/L；总胆汁酸(TBA)-静脉血: 7.4umol/L；磷(P)-静脉血: 0.8mmol/L；肌酐(Crea)-静脉血: 38.9umol/L；甘油三酯(TG)-静脉血: 1.35mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29pg；平均红细胞体积(MCV)-静脉血: 83.3fL；单核细胞计数(Mono#)-静脉血: 0.710E9/L；总胆固醇(TC)-静脉血: 3.61mmol/L；总蛋白(TP)-静脉血: 67.8g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.003；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；总胆红素(TBIL)-静脉血: 12.8umol/L；血小板计数(PLT#)-静脉血: 19410E9/L；血小板比容-静脉血: 20%；天门冬氨酸氨基转移酶(AST)-静脉血: 12.9U/L；阴离子间隙(AG)-静脉血: 14.6；直接胆红素(DBIL)-静脉血: 3.9umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.05mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.2mmol/L；大血小板百分比(P-LCR%)-静脉血: 25.6%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 35.8；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.87；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；C-反应蛋白(CRP)-静脉血: 0.28mg/L；尿酸(UA)-静脉血: 110.7umol/L；单核细胞百分比(Mono%)-静脉血: 0……\n- [全程D60] 检验组合: α-L-岩藻糖苷酶(AFU)-静脉血: 20.3U/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；总胆固醇(TC)-静脉血: 3.99mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.68；天门冬氨酸氨基转移酶(AST)-静脉血: 11.8U/L；总钙(Ca)-静脉血: 2.22mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.05；有核红细胞计数(NRBC#)-静脉血: 010E9/L；白细胞计数(WBC#)-静脉血: 3.5710E9/L；钾离子(K+)-静脉血: 3.88mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.14；碱性磷酸酶(ALP)-静脉血: 52.6U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.62mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.89mmolL；氯离子(Cl-)-静脉血: 103mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；阴离子间隙(AG)-静脉血: 11；球蛋白(GLO)-静脉血: 22.9g/L；总胆汁酸(TBA)-静脉血: 0.9umol/L；镁离子(Mg2+)-静脉血: 0.9mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336g/L；血红蛋白(Hb)-静脉血: 115g/L；红细胞计数(RBC#)-静脉血: 3.910E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；甘油三酯(TG)-静脉血: 0.63mmol/L；磷(P)-静脉血: 1.02mmol/L；直接胆红素(DBIL)-静脉血: 2.86umol/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；单核细胞百分比(Mono%)-静脉血: 0.101；红细胞比容(Hct)-静脉血: 34.2%；血小板比容-静脉血: 17%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.5pg；平均血小板体积(MPV)-静脉血: 9.5fL；尿酸(UA)-静脉血: 152.4umol/L；肌酐(Crea)-静脉血: 43umol/L；丙氨酸氨基转移酶(ALT……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D11] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者检查完善，已完成放疗预约，嘱今日出院，按期行放疗前准备及放疗前口腔检查。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停化疗，给予重组人粒细胞集落刺激因子升白细胞治疗，待白细胞恢复后继续顺铂化疗。\nB. 暂停化疗，给予3%氯化钠注射液强化纠正低钠血症，待血钠持续稳定正常后再考虑恢复顺铂化疗。\nC. 将化疗方案调整为卡铂单药，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化支持治疗。\nD. 继续顺铂化疗，并给予地塞米松、甲氧氯普胺、奥美拉唑止吐，无需常规静脉水化及补钾。\nE. 继续顺铂化疗，并给予昂丹司琼单药止吐，辅以静脉水化及补钾支持治疗。\nF. 继续顺铂联合5-氟尿嘧啶化疗，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化支持治疗。\nG. 继续顺铂化疗，并给予地塞米松、甲氧氯普胺、奥美拉唑止吐，同时预防性使用重组人粒细胞集落刺激因子。\nH. 终止化疗，仅行单纯放射治疗，并给予静脉水化及营养支持。\nI. 继续顺铂化疗，并给予地塞米松、甲氧氯普胺、奥美拉唑止吐，辅以静脉水化及补钾支持治疗。\nJ. 继续顺铂化疗，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化，同时加用呋塞米强迫利尿且不补钾。\nK. 暂停化疗，给予保肝降酶治疗，待肝功能恢复后继续顺铂化疗。\nL. 将化疗方案调整为紫杉醇单药，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化支持治疗。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 右侧耳鸣、鼻塞3月余，加重1周。；现病史: 缘于某次就诊时间11月下旬患者无意中出现右侧耳鸣、鼻塞，伴有右耳听力下降、头痛症状，无鼻出血，无面麻，无视物模糊、复视，无呛咳等症状；未予重视，逐渐加重，于某次就诊时间在[机构已隐去]就诊；建议患者住院治疗，患者及家属不同意。近1周来，耳鸣、鼻塞及头痛症状加重，今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,听力下降,右耳鸣,头痛；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：75次/分，R：20次/分，BP：110/65mmHg,Ht：150cm，Wt：41kg，BSA：1.316m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶壁、顶后壁、右侧壁明显增厚，左侧壁稍增厚，并见结节状肿物突出；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见: 轻度ST段下移；检查结论: 窦性心律 轻度ST段下移\n- [全程D1] 检验组合: 淋巴细胞百分比(Lymph%)-静脉血: 0.35；平均红细胞血红蛋白含量(MCH)-静脉血: 28.7pg；总钙(Ca)-静脉血: 2.32mmol/L；凝血酶时间(TT)-静脉血: 19.8sec.；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阳性(+)（参考: 阴性）；总胆汁酸(TBA)-静脉血: 4.1umol/L；钾离子(K+)-静脉血: 3.82mmol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；红细胞计数(RBC#)-静脉血: 5.0210E12/L；钠离子(Na+)-静脉血: 142.9mmol/L；尿素氮(BUN)-静脉血: 4.2mmol/L；葡萄糖(Glu)-静脉血: 5.36mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.66mmolL；球蛋白(GLO)-静脉血: 25.7g/L；尿酸(UA)-静脉血: 214.3umol/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；ABO血型-静脉血: O；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.98mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.76；中性粒细胞百分比(Neut%)-静脉血: 0.579；阴离子间隙(AG)-静脉血: 11.5；γ-谷氨酰基转移酶(GGT)-静脉血: 12.3U/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 23.4U/L；载脂蛋白B(apoB)-静脉血: 0.98g/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 6.4umolL；中性粒细胞计数(Neut#)-静脉血: 3.710E9/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；载脂蛋白AI(apoAI)-静脉血: 1.79g/L；肌酐(Crea)-静脉血: 50.2umol/L；总蛋白(TP)-静脉血: 70.9g/L；总胆固醇(TC)-静脉血: 5.02mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)……\n- [全程D2] 超声；双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声欠均匀，肝内可见多个无回声灶，较大者约43×29mm，椭圆形，边界清，内透声好，部分可见高回声分隔，后方回声增强。血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：上述病灶内未见明确血流信号。肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声欠均匀，右肾多个无回声灶，较大者约15×13mm，类圆形，边界清，内透声好，后方回声增强。左肾未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确肿物回声。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。；检查结论: 肝多发囊肿。 右肾多发囊肿。 胆囊、脾脏、胰腺、左肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D2] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对侧，双肺野纹理稍增多、增粗，未见明显实质性病变。双侧肺门不大，纵隔不宽，心影形态、大小、位置未见异常。双膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明确病变。\n- [全程D7] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、右侧壁明显增厚，左侧壁稍增厚，并见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号增强扫描明显强化，肿物占据右侧咽隐窝。双侧鼻腔及口咽各壁未见异常。 右侧腭帆张提肌、右侧头长肌及右侧翼内肌受侵，病变包绕右侧颈内动静脉。 右侧腭帆提肌、腭帆张肌、双侧头长肌受侵；左侧腭帆提肌、腭帆张肌未见受侵征象。 双侧翼腭窝、颞下窝未见异常；口咽侧壁未见受累增厚。 蝶骨基底部右份及右侧翼突基底部内侧、右侧翼突内板骨质信号减低，增强扫描不均匀强化。余颅底骨质未见明确异常。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、右侧乳突粘膜增厚，双侧上颌窦、蝶窦、左侧乳突充气良好，骨壁完整；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 右侧咽后见多个肿大淋巴结，最大者短径13mm，增强后明显强化，融合。左侧咽后及双颈II区见多发小淋巴结，最大者短径约7mm，未见坏死及包膜外侵。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺左叶见一结节，大小约11mm×11mm，边界尚清， T1WI及T2WI均呈混杂高信号，增强扫描部分区域强化较明显。甲状腺右叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。；检查结论: 鼻咽病变侵犯右侧咽旁间隙、椎前间隙右份及右侧翼内肌，考虑鼻咽癌可能性大。 蝶骨基底部右份、右侧翼突基底部内侧及右侧翼突内板骨质信号异常，考虑肿瘤浸润可能性大。 右侧咽后肿大淋巴结，考虑转移瘤。 左侧咽后及双颈II区小淋巴结，未排除转移可能。 鼻窦炎；右侧乳突炎。 甲状腺左叶结节灶，建议超声检查。\n- [全程D42] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位置位于第5胸椎体下缘，估计位于上腔静脉上段。；检查结论: PICC管末端位置如上所述。\n- [全程D42] 检验组合: 阴离子间隙(AG)-静脉血: 11；丙氨酸氨基转移酶(ALT)-静脉血: 12.8U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；钠离子(Na+)-静脉血: 143.3mmol/L；总钙(Ca)-静脉血: 2.2mmol/L；总胆红素(TBIL)-静脉血: 8.4umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.3U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.86；C-反应蛋白(CRP)-静脉血: 0.85mg/L；胱抑素(Cys-C)-静脉血: 0.61mg/L；磷(P)-静脉血: 1.14mmol/L；总胆固醇(TC)-静脉血: 4.61mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.292；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；载脂蛋白B(apoB)-静脉血: 0.93g/L；间接胆红素(IBIL)-静脉血: 6.4umolL；甘油三酯(TG)-静脉血: 0.64mmol/L；碱性磷酸酶(ALP)-静脉血: 87.2U/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 2umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；尿酸(UA)-静脉血: 194.8umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.02mmol/L；总胆汁酸(TBA)-静脉血: 2.1umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.96；钾离子(K+)-静脉血: 3.83mmol/L；红细胞比容(Hct)-静脉血: 40.7%；氯离子(Cl-)-静脉血: 107.6mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；肌酐(Crea)-静脉血: 46.2umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.810E9/L；血小板分布宽度(PDW)-静脉血: 10.6%；平均血小板体积(MPV)-静脉血: 9.5fL；白蛋白(ALB)-静脉血: 43.5g/L；尿素氮(BUN)-静脉血: 3.6mmol/L；白细胞计数(WBC#)-静脉血: 6.3110……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D43] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.016；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: 1+ 0.6mg（参考: 阴性）；浊度(TRUB)-尿液: 清亮；葡萄糖(Glu)-尿液: +- 1.7mmol（参考: 阴性）；酸碱度(pH)-尿液: 6.5；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；红细胞计数(RBC#)-尿液: 8/μL；酮体(KET)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 7/μL；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D44] 检验组合: 白蛋白(ALB)-静脉血: 37.7g/L；总胆红素(TBIL)-静脉血: 9umol/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；钠离子(Na+)-静脉血: 133.7mmol/L；直接胆红素(DBIL)-静脉血: 2.1umol/L；总胆汁酸(TBA)-静脉血: 1.4umol/L；尿酸(UA)-静脉血: 164.1umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.6U/L；总蛋白(TP)-静脉血: 58.49g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 23.7U/L；碱性磷酸酶(ALP)-静脉血: 72.8U/L；肌酐(Crea)-静脉血: 44.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.95；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.81；尿素氮(BUN)-静脉血: 4.4mmol/L；磷(P)-静脉血: 0.93mmol/L；总钙(Ca)-静脉血: 2.02mmol/L；乳酸脱氢酶(LDH)-静脉血: 210.9U/L；氯离子(Cl-)-静脉血: 100.2mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 12.3U/L；间接胆红素(IBIL)-静脉血: 6.9umolL；钾离子(K+)-静脉血: 2.94mmol/L；阴离子间隙(AG)-静脉血: 12.1；血液二氧化碳含量ctCO2(B)-静脉血: 21.4mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.3U/L；球蛋白(GLO)-静脉血: 20.79g/L\n- [全程D45] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 1/μL；钠离子(Na+)-静脉血: 131.1mmol/L；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；阴离子间隙(AG)-静脉血: 14.5；浊度(TRUB)-尿液: clear；胆红素(BIL)-尿液: -（参考: 阴性）；镁离子(Mg2+)-静脉血: 0.79mmol/L；钾离子(K+)-静脉血: 3.17mmol/L；红细胞计数(RBC#)-尿液: 17/μL；磷(P)-静脉血: 0.95mmol/L；氯离子(Cl-)-静脉血: 96.2mmol/L；白细胞计数(WBC#)-尿液: 5/μL；总钙(Ca)-静脉血: 1.92mmol/L；颜色-尿液: Light-Yellow；比重(SG)-尿液: 1.011；葡萄糖(Glu)-尿液: 1+ 5.6mmol（参考: 阴性）；隐血(OB)-尿液: +-0.3mg（参考: 阴性）；未分类结晶计数(UNCX#)-尿液: 5/μL；血液二氧化碳含量ctCO2(B)-静脉血: 20.4mmol/L；酸碱度(pH)-尿液: 6.5；尿胆原(URO)-尿液: -（参考: 阴性）\n- [全程D46] 检验组合: 阴离子间隙(AG)-静脉血: 17.7；血液二氧化碳含量ctCO2(B)-静脉血: 19.3mmol/L；氯离子(Cl-)-静脉血: 85.6mmol/L；总钙(Ca)-静脉血: 2.04mmol/L；钠离子(Na+)-静脉血: 122.6mmol/L；钾离子(K+)-静脉血: 3.26mmol/L；镁离子(Mg2+)-静脉血: 0.77mmol/L；磷(P)-静脉血: 0.51mmol/L\n- [全程D47] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 20.9mmol/L；总钙(Ca)-静脉血: 2.12mmol/L；阴离子间隙(AG)-静脉血: 14.5；磷(P)-静脉血: 0.67mmol/L；钾离子(K+)-静脉血: 4.06mmol/L；氯离子(Cl-)-静脉血: 89.8mmol/L；钠离子(Na+)-静脉血: 125.2mmol/L；镁离子(Mg2+)-静脉血: 0.93mmol/L\n- [全程D49] 检验组合: 镁离子(Mg2+)-静脉血: 0.89mmol/L；血小板分布宽度(PDW)-静脉血: 11.2%；有核红细胞百分比(NRBC%)-静脉血: 0；白蛋白(ALB)-静脉血: 44.2g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 33.1U/L；丙氨酸氨基转移酶(ALT)-静脉血: 22.6U/L；葡萄糖(Glu)-静脉血: 5.17mmol/L；间接胆红素(IBIL)-静脉血: 8.9umolL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.09mmolL；载脂蛋白B(apoB)-静脉血: 0.78g/L；总胆汁酸(TBA)-静脉血: 7.4umol/L；磷(P)-静脉血: 0.8mmol/L；肌酐(Crea)-静脉血: 38.9umol/L；甘油三酯(TG)-静脉血: 1.35mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29pg；平均红细胞体积(MCV)-静脉血: 83.3fL；单核细胞计数(Mono#)-静脉血: 0.710E9/L；总胆固醇(TC)-静脉血: 3.61mmol/L；总蛋白(TP)-静脉血: 67.8g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.003；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；总胆红素(TBIL)-静脉血: 12.8umol/L；血小板计数(PLT#)-静脉血: 19410E9/L；血小板比容-静脉血: 20%；天门冬氨酸氨基转移酶(AST)-静脉血: 12.9U/L；阴离子间隙(AG)-静脉血: 14.6；直接胆红素(DBIL)-静脉血: 3.9umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.05mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.2mmol/L；大血小板百分比(P-LCR%)-静脉血: 25.6%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 35.8；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.87；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；C-反应蛋白(CRP)-静脉血: 0.28mg/L；尿酸(UA)-静脉血: 110.7umol/L；单核细胞百分比(Mono%)-静脉血: 0……\n- [全程D60] 检验组合: α-L-岩藻糖苷酶(AFU)-静脉血: 20.3U/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；总胆固醇(TC)-静脉血: 3.99mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.68；天门冬氨酸氨基转移酶(AST)-静脉血: 11.8U/L；总钙(Ca)-静脉血: 2.22mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.05；有核红细胞计数(NRBC#)-静脉血: 010E9/L；白细胞计数(WBC#)-静脉血: 3.5710E9/L；钾离子(K+)-静脉血: 3.88mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.14；碱性磷酸酶(ALP)-静脉血: 52.6U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.62mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.89mmolL；氯离子(Cl-)-静脉血: 103mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；阴离子间隙(AG)-静脉血: 11；球蛋白(GLO)-静脉血: 22.9g/L；总胆汁酸(TBA)-静脉血: 0.9umol/L；镁离子(Mg2+)-静脉血: 0.9mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336g/L；血红蛋白(Hb)-静脉血: 115g/L；红细胞计数(RBC#)-静脉血: 3.910E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；甘油三酯(TG)-静脉血: 0.63mmol/L；磷(P)-静脉血: 1.02mmol/L；直接胆红素(DBIL)-静脉血: 2.86umol/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；单核细胞百分比(Mono%)-静脉血: 0.101；红细胞比容(Hct)-静脉血: 34.2%；血小板比容-静脉血: 17%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.5pg；平均血小板体积(MPV)-静脉血: 9.5fL；尿酸(UA)-静脉血: 152.4umol/L；肌酐(Crea)-静脉血: 43umol/L；丙氨酸氨基转移酶(ALT……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D11] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者检查完善，已完成放疗预约，嘱今日出院，按期行放疗前准备及放疗前口腔检查。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停化疗，给予重组人粒细胞集落刺激因子升白细胞治疗，待白细胞恢复后继续顺铂化疗。\nB. 暂停化疗，给予3%氯化钠注射液强化纠正低钠血症，待血钠持续稳定正常后再考虑恢复顺铂化疗。\nC. 将化疗方案调整为卡铂单药，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化支持治疗。\nD. 继续顺铂化疗，并给予地塞米松、甲氧氯普胺、奥美拉唑止吐，无需常规静脉水化及补钾。\nE. 继续顺铂化疗，并给予昂丹司琼单药止吐，辅以静脉水化及补钾支持治疗。\nF. 继续顺铂联合5-氟尿嘧啶化疗，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化支持治疗。\nG. 继续顺铂化疗，并给予地塞米松、甲氧氯普胺、奥美拉唑止吐，同时预防性使用重组人粒细胞集落刺激因子。\nH. 终止化疗，仅行单纯放射治疗，并给予静脉水化及营养支持。\nI. 继续顺铂化疗，并给予地塞米松、甲氧氯普胺、奥美拉唑止吐，辅以静脉水化及补钾支持治疗。\nJ. 继续顺铂化疗，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化，同时加用呋塞米强迫利尿且不补钾。\nK. 暂停化疗，给予保肝降酶治疗，待肝功能恢复后继续顺铂化疗。\nL. 将化疗方案调整为紫杉醇单药，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化支持治疗。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-5acaafa7f13a3c4be08160aa","patient_id":"patient-d6812a1c46ed21fda9ebb9f8","turn_id":"turn07","turn_position":5,"turn_type":"response_assessment_decision","gold_letter":"J","gold_action":"疗效评估为放化疗有效，针对进食差及低钾血症予以静脉营养支持及补钾，继续根治性放疗并按期行第三程同期化疗。","options":[{"letter":"A","text":"疗效评估为疾病进展，存在低钾血症，暂停放疗，改为单药靶向治疗并静脉补钾。","is_gold":false},{"letter":"B","text":"疗效评估为放化疗有效，存在低钾血症及进食差，终止同期化疗，仅继续单纯放疗及口服补钾。","is_gold":false},{"letter":"C","text":"疗效评估为放化疗有效，存在低钾血症，暂停放疗及化疗，待血钾恢复正常后再恢复原方案。","is_gold":false},{"letter":"D","text":"疗效评估为疾病稳定，存在骨髓抑制，给予重组人血小板生成素并推迟后续化疗。","is_gold":false},{"letter":"E","text":"疗效评估为放化疗有效，右肾多发囊肿，请泌尿外科急会诊行囊肿穿刺引流，暂缓化疗。","is_gold":false},{"letter":"F","text":"疗效评估为疾病进展，复查鼻咽 MRI 及全身 PET-CT，更改化疗方案为吉西他滨联合顺铂。","is_gold":false},{"letter":"G","text":"疗效评估为放化疗有效，进食差，行经皮胃造瘘术进行肠内营养，继续放化疗。","is_gold":false},{"letter":"H","text":"疗效评估为放化疗有效，存在低钾血症，门诊口服氯化钾缓释片，继续放疗，取消第三程化疗。","is_gold":false},{"letter":"I","text":"疗效评估为放化疗有效，存在肝功能损害，停用顺铂，改为西妥昔单抗靶向治疗并保肝处理。","is_gold":false},{"letter":"J","text":"疗效评估为放化疗有效，予以静脉营养支持及补钾，处理进食差及低钾血症，继续根治性放疗并按期行第三程同期化疗。","is_gold":true},{"letter":"K","text":"疗效评估为放化疗有效，予以静脉补钾，处理低钾血症，结束同期化疗阶段，后续仅需完成单纯放疗。","is_gold":false},{"letter":"L","text":"疗效评估为疾病稳定，存在恶心呕吐，预防性给予三联止吐方案，提前结束放疗并转为辅助化疗。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 右侧耳鸣、鼻塞3月余，加重1周。；现病史: 缘于某次就诊时间11月下旬患者无意中出现右侧耳鸣、鼻塞，伴有右耳听力下降、头痛症状，无鼻出血，无面麻，无视物模糊、复视，无呛咳等症状；未予重视，逐渐加重，于某次就诊时间在[机构已隐去]就诊；建议患者住院治疗，患者及家属不同意。近1周来，耳鸣、鼻塞及头痛症状加重，今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,听力下降,右耳鸣,头痛；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：75次/分，R：20次/分，BP：110/65mmHg,Ht：150cm，Wt：41kg，BSA：1.316m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶壁、顶后壁、右侧壁明显增厚，左侧壁稍增厚，并见结节状肿物突出；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见: 轻度ST段下移；检查结论: 窦性心律 轻度ST段下移\n- [全程D1] 检验组合: 淋巴细胞百分比(Lymph%)-静脉血: 0.35；平均红细胞血红蛋白含量(MCH)-静脉血: 28.7pg；总钙(Ca)-静脉血: 2.32mmol/L；凝血酶时间(TT)-静脉血: 19.8sec.；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阳性(+)（参考: 阴性）；总胆汁酸(TBA)-静脉血: 4.1umol/L；钾离子(K+)-静脉血: 3.82mmol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；红细胞计数(RBC#)-静脉血: 5.0210E12/L；钠离子(Na+)-静脉血: 142.9mmol/L；尿素氮(BUN)-静脉血: 4.2mmol/L；葡萄糖(Glu)-静脉血: 5.36mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.66mmolL；球蛋白(GLO)-静脉血: 25.7g/L；尿酸(UA)-静脉血: 214.3umol/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；ABO血型-静脉血: O；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.98mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.76；中性粒细胞百分比(Neut%)-静脉血: 0.579；阴离子间隙(AG)-静脉血: 11.5；γ-谷氨酰基转移酶(GGT)-静脉血: 12.3U/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 23.4U/L；载脂蛋白B(apoB)-静脉血: 0.98g/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 6.4umolL；中性粒细胞计数(Neut#)-静脉血: 3.710E9/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；载脂蛋白AI(apoAI)-静脉血: 1.79g/L；肌酐(Crea)-静脉血: 50.2umol/L；总蛋白(TP)-静脉血: 70.9g/L；总胆固醇(TC)-静脉血: 5.02mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)……\n- [全程D2] 超声；双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声欠均匀，肝内可见多个无回声灶，较大者约43×29mm，椭圆形，边界清，内透声好，部分可见高回声分隔，后方回声增强。血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：上述病灶内未见明确血流信号。肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声欠均匀，右肾多个无回声灶，较大者约15×13mm，类圆形，边界清，内透声好，后方回声增强。左肾未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确肿物回声。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。；检查结论: 肝多发囊肿。 右肾多发囊肿。 胆囊、脾脏、胰腺、左肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D2] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对侧，双肺野纹理稍增多、增粗，未见明显实质性病变。双侧肺门不大，纵隔不宽，心影形态、大小、位置未见异常。双膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明确病变。\n- [全程D7] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、右侧壁明显增厚，左侧壁稍增厚，并见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号增强扫描明显强化，肿物占据右侧咽隐窝。双侧鼻腔及口咽各壁未见异常。 右侧腭帆张提肌、右侧头长肌及右侧翼内肌受侵，病变包绕右侧颈内动静脉。 右侧腭帆提肌、腭帆张肌、双侧头长肌受侵；左侧腭帆提肌、腭帆张肌未见受侵征象。 双侧翼腭窝、颞下窝未见异常；口咽侧壁未见受累增厚。 蝶骨基底部右份及右侧翼突基底部内侧、右侧翼突内板骨质信号减低，增强扫描不均匀强化。余颅底骨质未见明确异常。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、右侧乳突粘膜增厚，双侧上颌窦、蝶窦、左侧乳突充气良好，骨壁完整；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 右侧咽后见多个肿大淋巴结，最大者短径13mm，增强后明显强化，融合。左侧咽后及双颈II区见多发小淋巴结，最大者短径约7mm，未见坏死及包膜外侵。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺左叶见一结节，大小约11mm×11mm，边界尚清， T1WI及T2WI均呈混杂高信号，增强扫描部分区域强化较明显。甲状腺右叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。；检查结论: 鼻咽病变侵犯右侧咽旁间隙、椎前间隙右份及右侧翼内肌，考虑鼻咽癌可能性大。 蝶骨基底部右份、右侧翼突基底部内侧及右侧翼突内板骨质信号异常，考虑肿瘤浸润可能性大。 右侧咽后肿大淋巴结，考虑转移瘤。 左侧咽后及双颈II区小淋巴结，未排除转移可能。 鼻窦炎；右侧乳突炎。 甲状腺左叶结节灶，建议超声检查。\n- [全程D42] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位置位于第5胸椎体下缘，估计位于上腔静脉上段。；检查结论: PICC管末端位置如上所述。\n- [全程D42] 检验组合: 阴离子间隙(AG)-静脉血: 11；丙氨酸氨基转移酶(ALT)-静脉血: 12.8U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；钠离子(Na+)-静脉血: 143.3mmol/L；总钙(Ca)-静脉血: 2.2mmol/L；总胆红素(TBIL)-静脉血: 8.4umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.3U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.86；C-反应蛋白(CRP)-静脉血: 0.85mg/L；胱抑素(Cys-C)-静脉血: 0.61mg/L；磷(P)-静脉血: 1.14mmol/L；总胆固醇(TC)-静脉血: 4.61mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.292；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；载脂蛋白B(apoB)-静脉血: 0.93g/L；间接胆红素(IBIL)-静脉血: 6.4umolL；甘油三酯(TG)-静脉血: 0.64mmol/L；碱性磷酸酶(ALP)-静脉血: 87.2U/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 2umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；尿酸(UA)-静脉血: 194.8umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.02mmol/L；总胆汁酸(TBA)-静脉血: 2.1umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.96；钾离子(K+)-静脉血: 3.83mmol/L；红细胞比容(Hct)-静脉血: 40.7%；氯离子(Cl-)-静脉血: 107.6mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；肌酐(Crea)-静脉血: 46.2umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.810E9/L；血小板分布宽度(PDW)-静脉血: 10.6%；平均血小板体积(MPV)-静脉血: 9.5fL；白蛋白(ALB)-静脉血: 43.5g/L；尿素氮(BUN)-静脉血: 3.6mmol/L；白细胞计数(WBC#)-静脉血: 6.3110……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D43] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.016；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: 1+ 0.6mg（参考: 阴性）；浊度(TRUB)-尿液: 清亮；葡萄糖(Glu)-尿液: +- 1.7mmol（参考: 阴性）；酸碱度(pH)-尿液: 6.5；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；红细胞计数(RBC#)-尿液: 8/μL；酮体(KET)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 7/μL；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D44] 检验组合: 白蛋白(ALB)-静脉血: 37.7g/L；总胆红素(TBIL)-静脉血: 9umol/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；钠离子(Na+)-静脉血: 133.7mmol/L；直接胆红素(DBIL)-静脉血: 2.1umol/L；总胆汁酸(TBA)-静脉血: 1.4umol/L；尿酸(UA)-静脉血: 164.1umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.6U/L；总蛋白(TP)-静脉血: 58.49g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 23.7U/L；碱性磷酸酶(ALP)-静脉血: 72.8U/L；肌酐(Crea)-静脉血: 44.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.95；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.81；尿素氮(BUN)-静脉血: 4.4mmol/L；磷(P)-静脉血: 0.93mmol/L；总钙(Ca)-静脉血: 2.02mmol/L；乳酸脱氢酶(LDH)-静脉血: 210.9U/L；氯离子(Cl-)-静脉血: 100.2mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 12.3U/L；间接胆红素(IBIL)-静脉血: 6.9umolL；钾离子(K+)-静脉血: 2.94mmol/L；阴离子间隙(AG)-静脉血: 12.1；血液二氧化碳含量ctCO2(B)-静脉血: 21.4mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.3U/L；球蛋白(GLO)-静脉血: 20.79g/L\n- [全程D45] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 1/μL；钠离子(Na+)-静脉血: 131.1mmol/L；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；阴离子间隙(AG)-静脉血: 14.5；浊度(TRUB)-尿液: clear；胆红素(BIL)-尿液: -（参考: 阴性）；镁离子(Mg2+)-静脉血: 0.79mmol/L；钾离子(K+)-静脉血: 3.17mmol/L；红细胞计数(RBC#)-尿液: 17/μL；磷(P)-静脉血: 0.95mmol/L；氯离子(Cl-)-静脉血: 96.2mmol/L；白细胞计数(WBC#)-尿液: 5/μL；总钙(Ca)-静脉血: 1.92mmol/L；颜色-尿液: Light-Yellow；比重(SG)-尿液: 1.011；葡萄糖(Glu)-尿液: 1+ 5.6mmol（参考: 阴性）；隐血(OB)-尿液: +-0.3mg（参考: 阴性）；未分类结晶计数(UNCX#)-尿液: 5/μL；血液二氧化碳含量ctCO2(B)-静脉血: 20.4mmol/L；酸碱度(pH)-尿液: 6.5；尿胆原(URO)-尿液: -（参考: 阴性）\n- [全程D46] 检验组合: 阴离子间隙(AG)-静脉血: 17.7；血液二氧化碳含量ctCO2(B)-静脉血: 19.3mmol/L；氯离子(Cl-)-静脉血: 85.6mmol/L；总钙(Ca)-静脉血: 2.04mmol/L；钠离子(Na+)-静脉血: 122.6mmol/L；钾离子(K+)-静脉血: 3.26mmol/L；镁离子(Mg2+)-静脉血: 0.77mmol/L；磷(P)-静脉血: 0.51mmol/L\n- [全程D47] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 20.9mmol/L；总钙(Ca)-静脉血: 2.12mmol/L；阴离子间隙(AG)-静脉血: 14.5；磷(P)-静脉血: 0.67mmol/L；钾离子(K+)-静脉血: 4.06mmol/L；氯离子(Cl-)-静脉血: 89.8mmol/L；钠离子(Na+)-静脉血: 125.2mmol/L；镁离子(Mg2+)-静脉血: 0.93mmol/L\n- [全程D49] 检验组合: 镁离子(Mg2+)-静脉血: 0.89mmol/L；血小板分布宽度(PDW)-静脉血: 11.2%；有核红细胞百分比(NRBC%)-静脉血: 0；白蛋白(ALB)-静脉血: 44.2g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 33.1U/L；丙氨酸氨基转移酶(ALT)-静脉血: 22.6U/L；葡萄糖(Glu)-静脉血: 5.17mmol/L；间接胆红素(IBIL)-静脉血: 8.9umolL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.09mmolL；载脂蛋白B(apoB)-静脉血: 0.78g/L；总胆汁酸(TBA)-静脉血: 7.4umol/L；磷(P)-静脉血: 0.8mmol/L；肌酐(Crea)-静脉血: 38.9umol/L；甘油三酯(TG)-静脉血: 1.35mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29pg；平均红细胞体积(MCV)-静脉血: 83.3fL；单核细胞计数(Mono#)-静脉血: 0.710E9/L；总胆固醇(TC)-静脉血: 3.61mmol/L；总蛋白(TP)-静脉血: 67.8g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.003；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；总胆红素(TBIL)-静脉血: 12.8umol/L；血小板计数(PLT#)-静脉血: 19410E9/L；血小板比容-静脉血: 20%；天门冬氨酸氨基转移酶(AST)-静脉血: 12.9U/L；阴离子间隙(AG)-静脉血: 14.6；直接胆红素(DBIL)-静脉血: 3.9umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.05mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.2mmol/L；大血小板百分比(P-LCR%)-静脉血: 25.6%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 35.8；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.87；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；C-反应蛋白(CRP)-静脉血: 0.28mg/L；尿酸(UA)-静脉血: 110.7umol/L；单核细胞百分比(Mono%)-静脉血: 0……\n- [全程D60] 检验组合: α-L-岩藻糖苷酶(AFU)-静脉血: 20.3U/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；总胆固醇(TC)-静脉血: 3.99mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.68；天门冬氨酸氨基转移酶(AST)-静脉血: 11.8U/L；总钙(Ca)-静脉血: 2.22mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.05；有核红细胞计数(NRBC#)-静脉血: 010E9/L；白细胞计数(WBC#)-静脉血: 3.5710E9/L；钾离子(K+)-静脉血: 3.88mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.14；碱性磷酸酶(ALP)-静脉血: 52.6U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.62mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.89mmolL；氯离子(Cl-)-静脉血: 103mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；阴离子间隙(AG)-静脉血: 11；球蛋白(GLO)-静脉血: 22.9g/L；总胆汁酸(TBA)-静脉血: 0.9umol/L；镁离子(Mg2+)-静脉血: 0.9mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336g/L；血红蛋白(Hb)-静脉血: 115g/L；红细胞计数(RBC#)-静脉血: 3.910E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；甘油三酯(TG)-静脉血: 0.63mmol/L；磷(P)-静脉血: 1.02mmol/L；直接胆红素(DBIL)-静脉血: 2.86umol/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；单核细胞百分比(Mono%)-静脉血: 0.101；红细胞比容(Hct)-静脉血: 34.2%；血小板比容-静脉血: 17%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.5pg；平均血小板体积(MPV)-静脉血: 9.5fL；尿酸(UA)-静脉血: 152.4umol/L；肌酐(Crea)-静脉血: 43umol/L；丙氨酸氨基转移酶(ALT……\n- [全程D68] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0；有核红细胞计数(NRBC#)-静脉血: 010E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0；大血小板百分比(P-LCR%)-静脉血: 20.1%；尿酸(UA)-静脉血: 120.2umol/L；总胆固醇(TC)-静脉血: 4.11mmol/L；总钙(Ca)-静脉血: 2.22mmol/L；平均红细胞体积(MCV)-静脉血: 84.4fL；单核细胞百分比(Mono%)-静脉血: 0.155；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；淋巴细胞百分比(Lymph%)-静脉血: 0.088；总胆汁酸(TBA)-静脉血: 2.6umol/L；白蛋白(ALB)-静脉血: 40.1g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.22mmolL；总蛋白(TP)-静脉血: 62.7g/L；载脂蛋白AI(apoAI)-静脉血: 1.32g/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.5U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.77；中性粒细胞百分比(Neut%)-静脉血: 0.757；α-L-岩藻糖苷酶(AFU)-静脉血: 42.2U/L；C-反应蛋白(CRP)-静脉血: 0.25mg/L；阴离子间隙(AG)-静脉血: 13.4；肌酐(Crea)-静脉血: 43.4umol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.7；中性粒细胞计数(Neut#)-静脉血: 4.210E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.9U/L；钠离子(Na+)-静脉血: 134mmol/L；单核细胞计数(Mono#)-静脉血: 0.910E9/L；血小板分布宽度(PDW)-静脉血: 10.6%；镁离子(Mg2+)-静脉血: 0.72mmol/L；血小板比容-静脉血: 19%；白细胞计数(WBC#)-静脉血: 5.4810E9/L；胱抑素(Cys-C)-静脉血: 0.92mg/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.3；葡萄糖(Glu)-静脉血: 4.71mmol/L；直接胆红素(DBIL)-静脉血: 2.12umol/L；血红蛋白(Hb)-静脉血: 123g/L；碱性磷酸酶(……\n- [全程D70] 检验组合: 淋巴细胞百分比(Lymph%)-静脉血: 0.097；血小板分布宽度(PDW)-静脉血: 10.4%；白细胞计数(WBC#)-静脉血: 5.3710E9/L；平均血小板体积(MPV)-静脉血: 9.5fL；乳酸脱氢酶(LDH)-静脉血: 191.8U/L；直接胆红素(DBIL)-静脉血: 2.52umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20.6U/L；氯离子(Cl-)-静脉血: 92.5mmol/L；尿素氮(BUN)-静脉血: 5mmol/L；血小板比容-静脉血: 21%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总钙(Ca)-静脉血: 2.25mmol/L；尿酸(UA)-静脉血: 198umol/L；总胆红素(TBIL)-静脉血: 9.15umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 37.3U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.006；中性粒细胞计数(Neut#)-静脉血: 4.110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.77；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；间接胆红素(IBIL)-静脉血: 6.63umolL；碱性磷酸酶(ALP)-静脉血: 58U/L；单核细胞百分比(Mono%)-静脉血: 0.125；载脂蛋白B(apoB)-静脉血: 1.02g/L；C-反应蛋白(CRP)-静脉血: 1.01mg/L；γ-谷氨酰基转移酶(GGT)-静脉血: 27.6U/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.3mmol/L；甘油三酯(TG)-静脉血: 1.4mmol/L；总胆汁酸(TBA)-静脉血: 3.6umol/L；球蛋白(GLO)-静脉血: 24.2g/L；白蛋白(ALB)-静脉血: 41.8g/L；葡萄糖(Glu)-静脉血: 5.35mmol/L；平均红细胞体积(MCV)-静脉血: 83.5fL；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 348g/L；胱抑素(Cys-C)-静脉血: 0.79mg/L；丙氨酸氨基转移酶(ALT)-静脉血: 24U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.88mmol/L；红细……\n- [全程D77] 检验组合: 总胆红素(TBIL)-静脉血: 9.1umol/L；血小板分布宽度(PDW)-静脉血: 10.7%；乳酸脱氢酶(LDH)-静脉血: 184.4U/L；直接胆红素(DBIL)-静脉血: 2.92umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.9mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 24U/L；总胆固醇(TC)-静脉血: 4.36mmol/L；平均血小板体积(MPV)-静脉血: 9.7fL；白细胞计数(WBC#)-静脉血: 6.0610E9/L；氯离子(Cl-)-静脉血: 97.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 9.2U/L；阴离子间隙(AG)-静脉血: 15.2；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞计数(RBC#)-静脉血: 4.0510E12/L；总胆汁酸(TBA)-静脉血: 1.1umol/L；C-反应蛋白(CRP)-静脉血: 6.66mg/L；磷(P)-静脉血: 1.11mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.012；中性粒细胞百分比(Neut%)-静脉血: 0.799；淋巴细胞计数(Lymph#)-静脉血: 0.410E9/L；总钙(Ca)-静脉血: 2.14mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.03mmol/L；球蛋白(GLO)-静脉血: 22g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.99mmolL；淋巴细胞百分比(Lymph%)-静脉血: 0.064；血小板计数(PLT#)-静脉血: 12010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.2；钾离子(K+)-静脉血: 3.15mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.09；碱性磷酸酶(ALP)-静脉血: 49.9U/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 44.5umol/L；中性粒细胞计数(Neut#)-静脉血: 4.810E9/L；间接胆红素(IBIL)-静脉血: 6.18umolL；尿素氮(BUN)-静脉血: 5.3mmol/L；红细胞体积分布宽度CV(RDW-CV)-……\n- [全程D79] 超声；双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 双肾大小形态正常，右肾探及几个无回声灶，大者约16×13mm，边界清，内透声可，后方回声增强。左肾实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确肿物回声。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。；检查结论: 右肾多发囊性灶，考虑肾囊肿。 左肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位性病变。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D11] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者检查完善，已完成放疗预约，嘱今日出院，按期行放疗前准备及放疗前口腔检查。\n- [全程D66] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者诉恶心，食欲差，于未诉特殊不适，查体基本同前。患者第二程DDP同时期化疗。予加强止呕及营养支持治疗，防治放化毒副反应。续观。\n- [全程D70] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者诉恶心，进食差，余未诉特殊不适，查体基本同前。今日[姓名已隐去]医生信息已隐藏后示：患者已完成第二程DDP同时期化疗，予加强营养支持治疗。一般情况平稳，嘱今日补液结束后出院，于门诊继续放疗。按期返院继续治疗。遵嘱。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 疗效评估为疾病进展，存在低钾血症，暂停放疗，改为单药靶向治疗并静脉补钾。\nB. 疗效评估为放化疗有效，存在低钾血症及进食差，终止同期化疗，仅继续单纯放疗及口服补钾。\nC. 疗效评估为放化疗有效，存在低钾血症，暂停放疗及化疗，待血钾恢复正常后再恢复原方案。\nD. 疗效评估为疾病稳定，存在骨髓抑制，给予重组人血小板生成素并推迟后续化疗。\nE. 疗效评估为放化疗有效，右肾多发囊肿，请泌尿外科急会诊行囊肿穿刺引流，暂缓化疗。\nF. 疗效评估为疾病进展，复查鼻咽 MRI 及全身 PET-CT，更改化疗方案为吉西他滨联合顺铂。\nG. 疗效评估为放化疗有效，进食差，行经皮胃造瘘术进行肠内营养，继续放化疗。\nH. 疗效评估为放化疗有效，存在低钾血症，门诊口服氯化钾缓释片，继续放疗，取消第三程化疗。\nI. 疗效评估为放化疗有效，存在肝功能损害，停用顺铂，改为西妥昔单抗靶向治疗并保肝处理。\nJ. 疗效评估为放化疗有效，予以静脉营养支持及补钾，处理进食差及低钾血症，继续根治性放疗并按期行第三程同期化疗。\nK. 疗效评估为放化疗有效，予以静脉补钾，处理低钾血症，结束同期化疗阶段，后续仅需完成单纯放疗。\nL. 疗效评估为疾病稳定，存在恶心呕吐，预防性给予三联止吐方案，提前结束放疗并转为辅助化疗。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 右侧耳鸣、鼻塞3月余，加重1周。；现病史: 缘于某次就诊时间11月下旬患者无意中出现右侧耳鸣、鼻塞，伴有右耳听力下降、头痛症状，无鼻出血，无面麻，无视物模糊、复视，无呛咳等症状；未予重视，逐渐加重，于某次就诊时间在[机构已隐去]就诊；建议患者住院治疗，患者及家属不同意。近1周来，耳鸣、鼻塞及头痛症状加重，今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,听力下降,右耳鸣,头痛；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：75次/分，R：20次/分，BP：110/65mmHg,Ht：150cm，Wt：41kg，BSA：1.316m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶壁、顶后壁、右侧壁明显增厚，左侧壁稍增厚，并见结节状肿物突出；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见: 轻度ST段下移；检查结论: 窦性心律 轻度ST段下移\n- [全程D1] 检验组合: 淋巴细胞百分比(Lymph%)-静脉血: 0.35；平均红细胞血红蛋白含量(MCH)-静脉血: 28.7pg；总钙(Ca)-静脉血: 2.32mmol/L；凝血酶时间(TT)-静脉血: 19.8sec.；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阳性(+)（参考: 阴性）；总胆汁酸(TBA)-静脉血: 4.1umol/L；钾离子(K+)-静脉血: 3.82mmol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；红细胞计数(RBC#)-静脉血: 5.0210E12/L；钠离子(Na+)-静脉血: 142.9mmol/L；尿素氮(BUN)-静脉血: 4.2mmol/L；葡萄糖(Glu)-静脉血: 5.36mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.66mmolL；球蛋白(GLO)-静脉血: 25.7g/L；尿酸(UA)-静脉血: 214.3umol/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；ABO血型-静脉血: O；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.98mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.76；中性粒细胞百分比(Neut%)-静脉血: 0.579；阴离子间隙(AG)-静脉血: 11.5；γ-谷氨酰基转移酶(GGT)-静脉血: 12.3U/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 23.4U/L；载脂蛋白B(apoB)-静脉血: 0.98g/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 6.4umolL；中性粒细胞计数(Neut#)-静脉血: 3.710E9/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；载脂蛋白AI(apoAI)-静脉血: 1.79g/L；肌酐(Crea)-静脉血: 50.2umol/L；总蛋白(TP)-静脉血: 70.9g/L；总胆固醇(TC)-静脉血: 5.02mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)……\n- [全程D2] 超声；双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声欠均匀，肝内可见多个无回声灶，较大者约43×29mm，椭圆形，边界清，内透声好，部分可见高回声分隔，后方回声增强。血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：上述病灶内未见明确血流信号。肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声欠均匀，右肾多个无回声灶，较大者约15×13mm，类圆形，边界清，内透声好，后方回声增强。左肾未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确肿物回声。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。；检查结论: 肝多发囊肿。 右肾多发囊肿。 胆囊、脾脏、胰腺、左肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D2] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对侧，双肺野纹理稍增多、增粗，未见明显实质性病变。双侧肺门不大，纵隔不宽，心影形态、大小、位置未见异常。双膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明确病变。\n- [全程D7] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、右侧壁明显增厚，左侧壁稍增厚，并见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号增强扫描明显强化，肿物占据右侧咽隐窝。双侧鼻腔及口咽各壁未见异常。 右侧腭帆张提肌、右侧头长肌及右侧翼内肌受侵，病变包绕右侧颈内动静脉。 右侧腭帆提肌、腭帆张肌、双侧头长肌受侵；左侧腭帆提肌、腭帆张肌未见受侵征象。 双侧翼腭窝、颞下窝未见异常；口咽侧壁未见受累增厚。 蝶骨基底部右份及右侧翼突基底部内侧、右侧翼突内板骨质信号减低，增强扫描不均匀强化。余颅底骨质未见明确异常。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、右侧乳突粘膜增厚，双侧上颌窦、蝶窦、左侧乳突充气良好，骨壁完整；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 右侧咽后见多个肿大淋巴结，最大者短径13mm，增强后明显强化，融合。左侧咽后及双颈II区见多发小淋巴结，最大者短径约7mm，未见坏死及包膜外侵。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺左叶见一结节，大小约11mm×11mm，边界尚清， T1WI及T2WI均呈混杂高信号，增强扫描部分区域强化较明显。甲状腺右叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。；检查结论: 鼻咽病变侵犯右侧咽旁间隙、椎前间隙右份及右侧翼内肌，考虑鼻咽癌可能性大。 蝶骨基底部右份、右侧翼突基底部内侧及右侧翼突内板骨质信号异常，考虑肿瘤浸润可能性大。 右侧咽后肿大淋巴结，考虑转移瘤。 左侧咽后及双颈II区小淋巴结，未排除转移可能。 鼻窦炎；右侧乳突炎。 甲状腺左叶结节灶，建议超声检查。\n- [全程D42] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位置位于第5胸椎体下缘，估计位于上腔静脉上段。；检查结论: PICC管末端位置如上所述。\n- [全程D42] 检验组合: 阴离子间隙(AG)-静脉血: 11；丙氨酸氨基转移酶(ALT)-静脉血: 12.8U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；钠离子(Na+)-静脉血: 143.3mmol/L；总钙(Ca)-静脉血: 2.2mmol/L；总胆红素(TBIL)-静脉血: 8.4umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.3U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.86；C-反应蛋白(CRP)-静脉血: 0.85mg/L；胱抑素(Cys-C)-静脉血: 0.61mg/L；磷(P)-静脉血: 1.14mmol/L；总胆固醇(TC)-静脉血: 4.61mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.292；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；载脂蛋白B(apoB)-静脉血: 0.93g/L；间接胆红素(IBIL)-静脉血: 6.4umolL；甘油三酯(TG)-静脉血: 0.64mmol/L；碱性磷酸酶(ALP)-静脉血: 87.2U/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 2umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；尿酸(UA)-静脉血: 194.8umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.02mmol/L；总胆汁酸(TBA)-静脉血: 2.1umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.96；钾离子(K+)-静脉血: 3.83mmol/L；红细胞比容(Hct)-静脉血: 40.7%；氯离子(Cl-)-静脉血: 107.6mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；肌酐(Crea)-静脉血: 46.2umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.810E9/L；血小板分布宽度(PDW)-静脉血: 10.6%；平均血小板体积(MPV)-静脉血: 9.5fL；白蛋白(ALB)-静脉血: 43.5g/L；尿素氮(BUN)-静脉血: 3.6mmol/L；白细胞计数(WBC#)-静脉血: 6.3110……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D43] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.016；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: 1+ 0.6mg（参考: 阴性）；浊度(TRUB)-尿液: 清亮；葡萄糖(Glu)-尿液: +- 1.7mmol（参考: 阴性）；酸碱度(pH)-尿液: 6.5；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；红细胞计数(RBC#)-尿液: 8/μL；酮体(KET)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 7/μL；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D44] 检验组合: 白蛋白(ALB)-静脉血: 37.7g/L；总胆红素(TBIL)-静脉血: 9umol/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；钠离子(Na+)-静脉血: 133.7mmol/L；直接胆红素(DBIL)-静脉血: 2.1umol/L；总胆汁酸(TBA)-静脉血: 1.4umol/L；尿酸(UA)-静脉血: 164.1umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.6U/L；总蛋白(TP)-静脉血: 58.49g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 23.7U/L；碱性磷酸酶(ALP)-静脉血: 72.8U/L；肌酐(Crea)-静脉血: 44.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.95；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.81；尿素氮(BUN)-静脉血: 4.4mmol/L；磷(P)-静脉血: 0.93mmol/L；总钙(Ca)-静脉血: 2.02mmol/L；乳酸脱氢酶(LDH)-静脉血: 210.9U/L；氯离子(Cl-)-静脉血: 100.2mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 12.3U/L；间接胆红素(IBIL)-静脉血: 6.9umolL；钾离子(K+)-静脉血: 2.94mmol/L；阴离子间隙(AG)-静脉血: 12.1；血液二氧化碳含量ctCO2(B)-静脉血: 21.4mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.3U/L；球蛋白(GLO)-静脉血: 20.79g/L\n- [全程D45] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 1/μL；钠离子(Na+)-静脉血: 131.1mmol/L；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；阴离子间隙(AG)-静脉血: 14.5；浊度(TRUB)-尿液: clear；胆红素(BIL)-尿液: -（参考: 阴性）；镁离子(Mg2+)-静脉血: 0.79mmol/L；钾离子(K+)-静脉血: 3.17mmol/L；红细胞计数(RBC#)-尿液: 17/μL；磷(P)-静脉血: 0.95mmol/L；氯离子(Cl-)-静脉血: 96.2mmol/L；白细胞计数(WBC#)-尿液: 5/μL；总钙(Ca)-静脉血: 1.92mmol/L；颜色-尿液: Light-Yellow；比重(SG)-尿液: 1.011；葡萄糖(Glu)-尿液: 1+ 5.6mmol（参考: 阴性）；隐血(OB)-尿液: +-0.3mg（参考: 阴性）；未分类结晶计数(UNCX#)-尿液: 5/μL；血液二氧化碳含量ctCO2(B)-静脉血: 20.4mmol/L；酸碱度(pH)-尿液: 6.5；尿胆原(URO)-尿液: -（参考: 阴性）\n- [全程D46] 检验组合: 阴离子间隙(AG)-静脉血: 17.7；血液二氧化碳含量ctCO2(B)-静脉血: 19.3mmol/L；氯离子(Cl-)-静脉血: 85.6mmol/L；总钙(Ca)-静脉血: 2.04mmol/L；钠离子(Na+)-静脉血: 122.6mmol/L；钾离子(K+)-静脉血: 3.26mmol/L；镁离子(Mg2+)-静脉血: 0.77mmol/L；磷(P)-静脉血: 0.51mmol/L\n- [全程D47] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 20.9mmol/L；总钙(Ca)-静脉血: 2.12mmol/L；阴离子间隙(AG)-静脉血: 14.5；磷(P)-静脉血: 0.67mmol/L；钾离子(K+)-静脉血: 4.06mmol/L；氯离子(Cl-)-静脉血: 89.8mmol/L；钠离子(Na+)-静脉血: 125.2mmol/L；镁离子(Mg2+)-静脉血: 0.93mmol/L\n- [全程D49] 检验组合: 镁离子(Mg2+)-静脉血: 0.89mmol/L；血小板分布宽度(PDW)-静脉血: 11.2%；有核红细胞百分比(NRBC%)-静脉血: 0；白蛋白(ALB)-静脉血: 44.2g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 33.1U/L；丙氨酸氨基转移酶(ALT)-静脉血: 22.6U/L；葡萄糖(Glu)-静脉血: 5.17mmol/L；间接胆红素(IBIL)-静脉血: 8.9umolL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.09mmolL；载脂蛋白B(apoB)-静脉血: 0.78g/L；总胆汁酸(TBA)-静脉血: 7.4umol/L；磷(P)-静脉血: 0.8mmol/L；肌酐(Crea)-静脉血: 38.9umol/L；甘油三酯(TG)-静脉血: 1.35mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29pg；平均红细胞体积(MCV)-静脉血: 83.3fL；单核细胞计数(Mono#)-静脉血: 0.710E9/L；总胆固醇(TC)-静脉血: 3.61mmol/L；总蛋白(TP)-静脉血: 67.8g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.003；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；总胆红素(TBIL)-静脉血: 12.8umol/L；血小板计数(PLT#)-静脉血: 19410E9/L；血小板比容-静脉血: 20%；天门冬氨酸氨基转移酶(AST)-静脉血: 12.9U/L；阴离子间隙(AG)-静脉血: 14.6；直接胆红素(DBIL)-静脉血: 3.9umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.05mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.2mmol/L；大血小板百分比(P-LCR%)-静脉血: 25.6%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 35.8；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.87；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；C-反应蛋白(CRP)-静脉血: 0.28mg/L；尿酸(UA)-静脉血: 110.7umol/L；单核细胞百分比(Mono%)-静脉血: 0……\n- [全程D60] 检验组合: α-L-岩藻糖苷酶(AFU)-静脉血: 20.3U/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；总胆固醇(TC)-静脉血: 3.99mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.68；天门冬氨酸氨基转移酶(AST)-静脉血: 11.8U/L；总钙(Ca)-静脉血: 2.22mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.05；有核红细胞计数(NRBC#)-静脉血: 010E9/L；白细胞计数(WBC#)-静脉血: 3.5710E9/L；钾离子(K+)-静脉血: 3.88mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.14；碱性磷酸酶(ALP)-静脉血: 52.6U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.62mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.89mmolL；氯离子(Cl-)-静脉血: 103mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；阴离子间隙(AG)-静脉血: 11；球蛋白(GLO)-静脉血: 22.9g/L；总胆汁酸(TBA)-静脉血: 0.9umol/L；镁离子(Mg2+)-静脉血: 0.9mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336g/L；血红蛋白(Hb)-静脉血: 115g/L；红细胞计数(RBC#)-静脉血: 3.910E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；甘油三酯(TG)-静脉血: 0.63mmol/L；磷(P)-静脉血: 1.02mmol/L；直接胆红素(DBIL)-静脉血: 2.86umol/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；单核细胞百分比(Mono%)-静脉血: 0.101；红细胞比容(Hct)-静脉血: 34.2%；血小板比容-静脉血: 17%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.5pg；平均血小板体积(MPV)-静脉血: 9.5fL；尿酸(UA)-静脉血: 152.4umol/L；肌酐(Crea)-静脉血: 43umol/L；丙氨酸氨基转移酶(ALT……\n- [全程D68] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0；有核红细胞计数(NRBC#)-静脉血: 010E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0；大血小板百分比(P-LCR%)-静脉血: 20.1%；尿酸(UA)-静脉血: 120.2umol/L；总胆固醇(TC)-静脉血: 4.11mmol/L；总钙(Ca)-静脉血: 2.22mmol/L；平均红细胞体积(MCV)-静脉血: 84.4fL；单核细胞百分比(Mono%)-静脉血: 0.155；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；淋巴细胞百分比(Lymph%)-静脉血: 0.088；总胆汁酸(TBA)-静脉血: 2.6umol/L；白蛋白(ALB)-静脉血: 40.1g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.22mmolL；总蛋白(TP)-静脉血: 62.7g/L；载脂蛋白AI(apoAI)-静脉血: 1.32g/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.5U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.77；中性粒细胞百分比(Neut%)-静脉血: 0.757；α-L-岩藻糖苷酶(AFU)-静脉血: 42.2U/L；C-反应蛋白(CRP)-静脉血: 0.25mg/L；阴离子间隙(AG)-静脉血: 13.4；肌酐(Crea)-静脉血: 43.4umol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.7；中性粒细胞计数(Neut#)-静脉血: 4.210E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.9U/L；钠离子(Na+)-静脉血: 134mmol/L；单核细胞计数(Mono#)-静脉血: 0.910E9/L；血小板分布宽度(PDW)-静脉血: 10.6%；镁离子(Mg2+)-静脉血: 0.72mmol/L；血小板比容-静脉血: 19%；白细胞计数(WBC#)-静脉血: 5.4810E9/L；胱抑素(Cys-C)-静脉血: 0.92mg/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.3；葡萄糖(Glu)-静脉血: 4.71mmol/L；直接胆红素(DBIL)-静脉血: 2.12umol/L；血红蛋白(Hb)-静脉血: 123g/L；碱性磷酸酶(……\n- [全程D70] 检验组合: 淋巴细胞百分比(Lymph%)-静脉血: 0.097；血小板分布宽度(PDW)-静脉血: 10.4%；白细胞计数(WBC#)-静脉血: 5.3710E9/L；平均血小板体积(MPV)-静脉血: 9.5fL；乳酸脱氢酶(LDH)-静脉血: 191.8U/L；直接胆红素(DBIL)-静脉血: 2.52umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20.6U/L；氯离子(Cl-)-静脉血: 92.5mmol/L；尿素氮(BUN)-静脉血: 5mmol/L；血小板比容-静脉血: 21%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总钙(Ca)-静脉血: 2.25mmol/L；尿酸(UA)-静脉血: 198umol/L；总胆红素(TBIL)-静脉血: 9.15umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 37.3U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.006；中性粒细胞计数(Neut#)-静脉血: 4.110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.77；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；间接胆红素(IBIL)-静脉血: 6.63umolL；碱性磷酸酶(ALP)-静脉血: 58U/L；单核细胞百分比(Mono%)-静脉血: 0.125；载脂蛋白B(apoB)-静脉血: 1.02g/L；C-反应蛋白(CRP)-静脉血: 1.01mg/L；γ-谷氨酰基转移酶(GGT)-静脉血: 27.6U/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.3mmol/L；甘油三酯(TG)-静脉血: 1.4mmol/L；总胆汁酸(TBA)-静脉血: 3.6umol/L；球蛋白(GLO)-静脉血: 24.2g/L；白蛋白(ALB)-静脉血: 41.8g/L；葡萄糖(Glu)-静脉血: 5.35mmol/L；平均红细胞体积(MCV)-静脉血: 83.5fL；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 348g/L；胱抑素(Cys-C)-静脉血: 0.79mg/L；丙氨酸氨基转移酶(ALT)-静脉血: 24U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.88mmol/L；红细……\n- [全程D77] 检验组合: 总胆红素(TBIL)-静脉血: 9.1umol/L；血小板分布宽度(PDW)-静脉血: 10.7%；乳酸脱氢酶(LDH)-静脉血: 184.4U/L；直接胆红素(DBIL)-静脉血: 2.92umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.9mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 24U/L；总胆固醇(TC)-静脉血: 4.36mmol/L；平均血小板体积(MPV)-静脉血: 9.7fL；白细胞计数(WBC#)-静脉血: 6.0610E9/L；氯离子(Cl-)-静脉血: 97.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 9.2U/L；阴离子间隙(AG)-静脉血: 15.2；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞计数(RBC#)-静脉血: 4.0510E12/L；总胆汁酸(TBA)-静脉血: 1.1umol/L；C-反应蛋白(CRP)-静脉血: 6.66mg/L；磷(P)-静脉血: 1.11mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.012；中性粒细胞百分比(Neut%)-静脉血: 0.799；淋巴细胞计数(Lymph#)-静脉血: 0.410E9/L；总钙(Ca)-静脉血: 2.14mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.03mmol/L；球蛋白(GLO)-静脉血: 22g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.99mmolL；淋巴细胞百分比(Lymph%)-静脉血: 0.064；血小板计数(PLT#)-静脉血: 12010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.2；钾离子(K+)-静脉血: 3.15mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.09；碱性磷酸酶(ALP)-静脉血: 49.9U/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 44.5umol/L；中性粒细胞计数(Neut#)-静脉血: 4.810E9/L；间接胆红素(IBIL)-静脉血: 6.18umolL；尿素氮(BUN)-静脉血: 5.3mmol/L；红细胞体积分布宽度CV(RDW-CV)-……\n- [全程D79] 超声；双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 双肾大小形态正常，右肾探及几个无回声灶，大者约16×13mm，边界清，内透声可，后方回声增强。左肾实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确肿物回声。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。；检查结论: 右肾多发囊性灶，考虑肾囊肿。 左肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位性病变。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D11] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者检查完善，已完成放疗预约，嘱今日出院，按期行放疗前准备及放疗前口腔检查。\n- [全程D66] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者诉恶心，食欲差，于未诉特殊不适，查体基本同前。患者第二程DDP同时期化疗。予加强止呕及营养支持治疗，防治放化毒副反应。续观。\n- [全程D70] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者诉恶心，进食差，余未诉特殊不适，查体基本同前。今日[姓名已隐去]医生信息已隐藏后示：患者已完成第二程DDP同时期化疗，予加强营养支持治疗。一般情况平稳，嘱今日补液结束后出院，于门诊继续放疗。按期返院继续治疗。遵嘱。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 疗效评估为疾病进展，存在低钾血症，暂停放疗，改为单药靶向治疗并静脉补钾。\nB. 疗效评估为放化疗有效，存在低钾血症及进食差，终止同期化疗，仅继续单纯放疗及口服补钾。\nC. 疗效评估为放化疗有效，存在低钾血症，暂停放疗及化疗，待血钾恢复正常后再恢复原方案。\nD. 疗效评估为疾病稳定，存在骨髓抑制，给予重组人血小板生成素并推迟后续化疗。\nE. 疗效评估为放化疗有效，右肾多发囊肿，请泌尿外科急会诊行囊肿穿刺引流，暂缓化疗。\nF. 疗效评估为疾病进展，复查鼻咽 MRI 及全身 PET-CT，更改化疗方案为吉西他滨联合顺铂。\nG. 疗效评估为放化疗有效，进食差，行经皮胃造瘘术进行肠内营养，继续放化疗。\nH. 疗效评估为放化疗有效，存在低钾血症，门诊口服氯化钾缓释片，继续放疗，取消第三程化疗。\nI. 疗效评估为放化疗有效，存在肝功能损害，停用顺铂，改为西妥昔单抗靶向治疗并保肝处理。\nJ. 疗效评估为放化疗有效，予以静脉营养支持及补钾，处理进食差及低钾血症，继续根治性放疗并按期行第三程同期化疗。\nK. 疗效评估为放化疗有效，予以静脉补钾，处理低钾血症，结束同期化疗阶段，后续仅需完成单纯放疗。\nL. 疗效评估为疾病稳定，存在恶心呕吐，预防性给予三联止吐方案，提前结束放疗并转为辅助化疗。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-47e9b2e315a805773d669325","patient_id":"patient-d6812a1c46ed21fda9ebb9f8","turn_id":"turn08","turn_position":6,"turn_type":"response_assessment_decision","gold_letter":"K","gold_action":"疗效评估为部分缓解（PR），继续完成根治性放疗及既定化疗计划，并加强静脉营养支持与补钾等对症处理。","options":[{"letter":"A","text":"疗效评估为疾病进展（PD），终止放化疗计划，改行鼻咽及颈部挽救性手术切除。","is_gold":false},{"letter":"B","text":"疗效评估为疾病进展（PD），停用顺铂，更改化疗方案为吉西他滨联合氟尿嘧啶并继续放疗。","is_gold":false},{"letter":"C","text":"疗效评估为部分缓解（PR），继续完成根治性放疗，对鼻咽及颈部残留病灶局部加量至76Gy。","is_gold":false},{"letter":"D","text":"疗效评估为部分缓解（PR），继续完成根治性放疗，取消后续化疗计划，仅予口服补钾与营养支持。","is_gold":false},{"letter":"E","text":"疗效评估为部分缓解（PR），继续完成根治性放疗及既定化疗计划，并加用尼妥珠单抗靶向治疗。","is_gold":false},{"letter":"F","text":"疗效评估为完全缓解（CR），提前终止放疗与化疗，拔除静脉通道，转入定期门诊随访观察阶段。","is_gold":false},{"letter":"G","text":"疗效评估为部分缓解（PR），继续完成根治性放疗，并行局部清扫术，处理右侧咽旁及咽后残留病灶。","is_gold":false},{"letter":"H","text":"疗效评估为疾病稳定（SD），继续放疗，并联合PD-1抑制剂以增强局部控制与全身抗肿瘤反应。","is_gold":false},{"letter":"I","text":"疗效评估为部分缓解（PR），暂停放疗优先纠正低钾血症与营养不良，待电解质完全恢复后重启放疗。","is_gold":false},{"letter":"J","text":"疗效评估为部分缓解（PR），继续完成根治性放疗及既定化疗计划，无需特殊支持治疗，定期复查即可。","is_gold":false},{"letter":"K","text":"疗效评估为部分缓解（PR），继续完成根治性放疗及既定化疗计划，并加强静脉营养支持与补钾等对症处理。","is_gold":true},{"letter":"L","text":"疗效评估为疾病稳定（SD），继续完成根治性放疗，将后续化疗方案调整为紫杉醇联合卡铂以克服耐药。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 右侧耳鸣、鼻塞3月余，加重1周。；现病史: 缘于某次就诊时间11月下旬患者无意中出现右侧耳鸣、鼻塞，伴有右耳听力下降、头痛症状，无鼻出血，无面麻，无视物模糊、复视，无呛咳等症状；未予重视，逐渐加重，于某次就诊时间在[机构已隐去]就诊；建议患者住院治疗，患者及家属不同意。近1周来，耳鸣、鼻塞及头痛症状加重，今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,听力下降,右耳鸣,头痛；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：75次/分，R：20次/分，BP：110/65mmHg,Ht：150cm，Wt：41kg，BSA：1.316m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶壁、顶后壁、右侧壁明显增厚，左侧壁稍增厚，并见结节状肿物突出；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见: 轻度ST段下移；检查结论: 窦性心律 轻度ST段下移\n- [全程D1] 检验组合: 淋巴细胞百分比(Lymph%)-静脉血: 0.35；平均红细胞血红蛋白含量(MCH)-静脉血: 28.7pg；总钙(Ca)-静脉血: 2.32mmol/L；凝血酶时间(TT)-静脉血: 19.8sec.；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阳性(+)（参考: 阴性）；总胆汁酸(TBA)-静脉血: 4.1umol/L；钾离子(K+)-静脉血: 3.82mmol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；红细胞计数(RBC#)-静脉血: 5.0210E12/L；钠离子(Na+)-静脉血: 142.9mmol/L；尿素氮(BUN)-静脉血: 4.2mmol/L；葡萄糖(Glu)-静脉血: 5.36mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.66mmolL；球蛋白(GLO)-静脉血: 25.7g/L；尿酸(UA)-静脉血: 214.3umol/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；ABO血型-静脉血: O；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.98mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.76；中性粒细胞百分比(Neut%)-静脉血: 0.579；阴离子间隙(AG)-静脉血: 11.5；γ-谷氨酰基转移酶(GGT)-静脉血: 12.3U/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 23.4U/L；载脂蛋白B(apoB)-静脉血: 0.98g/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 6.4umolL；中性粒细胞计数(Neut#)-静脉血: 3.710E9/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；载脂蛋白AI(apoAI)-静脉血: 1.79g/L；肌酐(Crea)-静脉血: 50.2umol/L；总蛋白(TP)-静脉血: 70.9g/L；总胆固醇(TC)-静脉血: 5.02mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)……\n- [全程D2] 超声；双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声欠均匀，肝内可见多个无回声灶，较大者约43×29mm，椭圆形，边界清，内透声好，部分可见高回声分隔，后方回声增强。血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：上述病灶内未见明确血流信号。肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声欠均匀，右肾多个无回声灶，较大者约15×13mm，类圆形，边界清，内透声好，后方回声增强。左肾未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确肿物回声。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。；检查结论: 肝多发囊肿。 右肾多发囊肿。 胆囊、脾脏、胰腺、左肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D2] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对侧，双肺野纹理稍增多、增粗，未见明显实质性病变。双侧肺门不大，纵隔不宽，心影形态、大小、位置未见异常。双膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明确病变。\n- [全程D7] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、右侧壁明显增厚，左侧壁稍增厚，并见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号增强扫描明显强化，肿物占据右侧咽隐窝。双侧鼻腔及口咽各壁未见异常。 右侧腭帆张提肌、右侧头长肌及右侧翼内肌受侵，病变包绕右侧颈内动静脉。 右侧腭帆提肌、腭帆张肌、双侧头长肌受侵；左侧腭帆提肌、腭帆张肌未见受侵征象。 双侧翼腭窝、颞下窝未见异常；口咽侧壁未见受累增厚。 蝶骨基底部右份及右侧翼突基底部内侧、右侧翼突内板骨质信号减低，增强扫描不均匀强化。余颅底骨质未见明确异常。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、右侧乳突粘膜增厚，双侧上颌窦、蝶窦、左侧乳突充气良好，骨壁完整；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 右侧咽后见多个肿大淋巴结，最大者短径13mm，增强后明显强化，融合。左侧咽后及双颈II区见多发小淋巴结，最大者短径约7mm，未见坏死及包膜外侵。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺左叶见一结节，大小约11mm×11mm，边界尚清， T1WI及T2WI均呈混杂高信号，增强扫描部分区域强化较明显。甲状腺右叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。；检查结论: 鼻咽病变侵犯右侧咽旁间隙、椎前间隙右份及右侧翼内肌，考虑鼻咽癌可能性大。 蝶骨基底部右份、右侧翼突基底部内侧及右侧翼突内板骨质信号异常，考虑肿瘤浸润可能性大。 右侧咽后肿大淋巴结，考虑转移瘤。 左侧咽后及双颈II区小淋巴结，未排除转移可能。 鼻窦炎；右侧乳突炎。 甲状腺左叶结节灶，建议超声检查。\n- [全程D42] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位置位于第5胸椎体下缘，估计位于上腔静脉上段。；检查结论: PICC管末端位置如上所述。\n- [全程D42] 检验组合: 阴离子间隙(AG)-静脉血: 11；丙氨酸氨基转移酶(ALT)-静脉血: 12.8U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；钠离子(Na+)-静脉血: 143.3mmol/L；总钙(Ca)-静脉血: 2.2mmol/L；总胆红素(TBIL)-静脉血: 8.4umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.3U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.86；C-反应蛋白(CRP)-静脉血: 0.85mg/L；胱抑素(Cys-C)-静脉血: 0.61mg/L；磷(P)-静脉血: 1.14mmol/L；总胆固醇(TC)-静脉血: 4.61mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.292；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；载脂蛋白B(apoB)-静脉血: 0.93g/L；间接胆红素(IBIL)-静脉血: 6.4umolL；甘油三酯(TG)-静脉血: 0.64mmol/L；碱性磷酸酶(ALP)-静脉血: 87.2U/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 2umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；尿酸(UA)-静脉血: 194.8umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.02mmol/L；总胆汁酸(TBA)-静脉血: 2.1umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.96；钾离子(K+)-静脉血: 3.83mmol/L；红细胞比容(Hct)-静脉血: 40.7%；氯离子(Cl-)-静脉血: 107.6mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；肌酐(Crea)-静脉血: 46.2umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.810E9/L；血小板分布宽度(PDW)-静脉血: 10.6%；平均血小板体积(MPV)-静脉血: 9.5fL；白蛋白(ALB)-静脉血: 43.5g/L；尿素氮(BUN)-静脉血: 3.6mmol/L；白细胞计数(WBC#)-静脉血: 6.3110……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D43] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.016；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: 1+ 0.6mg（参考: 阴性）；浊度(TRUB)-尿液: 清亮；葡萄糖(Glu)-尿液: +- 1.7mmol（参考: 阴性）；酸碱度(pH)-尿液: 6.5；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；红细胞计数(RBC#)-尿液: 8/μL；酮体(KET)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 7/μL；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D44] 检验组合: 白蛋白(ALB)-静脉血: 37.7g/L；总胆红素(TBIL)-静脉血: 9umol/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；钠离子(Na+)-静脉血: 133.7mmol/L；直接胆红素(DBIL)-静脉血: 2.1umol/L；总胆汁酸(TBA)-静脉血: 1.4umol/L；尿酸(UA)-静脉血: 164.1umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.6U/L；总蛋白(TP)-静脉血: 58.49g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 23.7U/L；碱性磷酸酶(ALP)-静脉血: 72.8U/L；肌酐(Crea)-静脉血: 44.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.95；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.81；尿素氮(BUN)-静脉血: 4.4mmol/L；磷(P)-静脉血: 0.93mmol/L；总钙(Ca)-静脉血: 2.02mmol/L；乳酸脱氢酶(LDH)-静脉血: 210.9U/L；氯离子(Cl-)-静脉血: 100.2mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 12.3U/L；间接胆红素(IBIL)-静脉血: 6.9umolL；钾离子(K+)-静脉血: 2.94mmol/L；阴离子间隙(AG)-静脉血: 12.1；血液二氧化碳含量ctCO2(B)-静脉血: 21.4mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.3U/L；球蛋白(GLO)-静脉血: 20.79g/L\n- [全程D45] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 1/μL；钠离子(Na+)-静脉血: 131.1mmol/L；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；阴离子间隙(AG)-静脉血: 14.5；浊度(TRUB)-尿液: clear；胆红素(BIL)-尿液: -（参考: 阴性）；镁离子(Mg2+)-静脉血: 0.79mmol/L；钾离子(K+)-静脉血: 3.17mmol/L；红细胞计数(RBC#)-尿液: 17/μL；磷(P)-静脉血: 0.95mmol/L；氯离子(Cl-)-静脉血: 96.2mmol/L；白细胞计数(WBC#)-尿液: 5/μL；总钙(Ca)-静脉血: 1.92mmol/L；颜色-尿液: Light-Yellow；比重(SG)-尿液: 1.011；葡萄糖(Glu)-尿液: 1+ 5.6mmol（参考: 阴性）；隐血(OB)-尿液: +-0.3mg（参考: 阴性）；未分类结晶计数(UNCX#)-尿液: 5/μL；血液二氧化碳含量ctCO2(B)-静脉血: 20.4mmol/L；酸碱度(pH)-尿液: 6.5；尿胆原(URO)-尿液: -（参考: 阴性）\n- [全程D46] 检验组合: 阴离子间隙(AG)-静脉血: 17.7；血液二氧化碳含量ctCO2(B)-静脉血: 19.3mmol/L；氯离子(Cl-)-静脉血: 85.6mmol/L；总钙(Ca)-静脉血: 2.04mmol/L；钠离子(Na+)-静脉血: 122.6mmol/L；钾离子(K+)-静脉血: 3.26mmol/L；镁离子(Mg2+)-静脉血: 0.77mmol/L；磷(P)-静脉血: 0.51mmol/L\n- [全程D47] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 20.9mmol/L；总钙(Ca)-静脉血: 2.12mmol/L；阴离子间隙(AG)-静脉血: 14.5；磷(P)-静脉血: 0.67mmol/L；钾离子(K+)-静脉血: 4.06mmol/L；氯离子(Cl-)-静脉血: 89.8mmol/L；钠离子(Na+)-静脉血: 125.2mmol/L；镁离子(Mg2+)-静脉血: 0.93mmol/L\n- [全程D49] 检验组合: 镁离子(Mg2+)-静脉血: 0.89mmol/L；血小板分布宽度(PDW)-静脉血: 11.2%；有核红细胞百分比(NRBC%)-静脉血: 0；白蛋白(ALB)-静脉血: 44.2g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 33.1U/L；丙氨酸氨基转移酶(ALT)-静脉血: 22.6U/L；葡萄糖(Glu)-静脉血: 5.17mmol/L；间接胆红素(IBIL)-静脉血: 8.9umolL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.09mmolL；载脂蛋白B(apoB)-静脉血: 0.78g/L；总胆汁酸(TBA)-静脉血: 7.4umol/L；磷(P)-静脉血: 0.8mmol/L；肌酐(Crea)-静脉血: 38.9umol/L；甘油三酯(TG)-静脉血: 1.35mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29pg；平均红细胞体积(MCV)-静脉血: 83.3fL；单核细胞计数(Mono#)-静脉血: 0.710E9/L；总胆固醇(TC)-静脉血: 3.61mmol/L；总蛋白(TP)-静脉血: 67.8g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.003；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；总胆红素(TBIL)-静脉血: 12.8umol/L；血小板计数(PLT#)-静脉血: 19410E9/L；血小板比容-静脉血: 20%；天门冬氨酸氨基转移酶(AST)-静脉血: 12.9U/L；阴离子间隙(AG)-静脉血: 14.6；直接胆红素(DBIL)-静脉血: 3.9umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.05mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.2mmol/L；大血小板百分比(P-LCR%)-静脉血: 25.6%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 35.8；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.87；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；C-反应蛋白(CRP)-静脉血: 0.28mg/L；尿酸(UA)-静脉血: 110.7umol/L；单核细胞百分比(Mono%)-静脉血: 0……\n- [全程D60] 检验组合: α-L-岩藻糖苷酶(AFU)-静脉血: 20.3U/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；总胆固醇(TC)-静脉血: 3.99mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.68；天门冬氨酸氨基转移酶(AST)-静脉血: 11.8U/L；总钙(Ca)-静脉血: 2.22mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.05；有核红细胞计数(NRBC#)-静脉血: 010E9/L；白细胞计数(WBC#)-静脉血: 3.5710E9/L；钾离子(K+)-静脉血: 3.88mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.14；碱性磷酸酶(ALP)-静脉血: 52.6U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.62mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.89mmolL；氯离子(Cl-)-静脉血: 103mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；阴离子间隙(AG)-静脉血: 11；球蛋白(GLO)-静脉血: 22.9g/L；总胆汁酸(TBA)-静脉血: 0.9umol/L；镁离子(Mg2+)-静脉血: 0.9mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336g/L；血红蛋白(Hb)-静脉血: 115g/L；红细胞计数(RBC#)-静脉血: 3.910E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；甘油三酯(TG)-静脉血: 0.63mmol/L；磷(P)-静脉血: 1.02mmol/L；直接胆红素(DBIL)-静脉血: 2.86umol/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；单核细胞百分比(Mono%)-静脉血: 0.101；红细胞比容(Hct)-静脉血: 34.2%；血小板比容-静脉血: 17%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.5pg；平均血小板体积(MPV)-静脉血: 9.5fL；尿酸(UA)-静脉血: 152.4umol/L；肌酐(Crea)-静脉血: 43umol/L；丙氨酸氨基转移酶(ALT……\n- [全程D68] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0；有核红细胞计数(NRBC#)-静脉血: 010E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0；大血小板百分比(P-LCR%)-静脉血: 20.1%；尿酸(UA)-静脉血: 120.2umol/L；总胆固醇(TC)-静脉血: 4.11mmol/L；总钙(Ca)-静脉血: 2.22mmol/L；平均红细胞体积(MCV)-静脉血: 84.4fL；单核细胞百分比(Mono%)-静脉血: 0.155；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；淋巴细胞百分比(Lymph%)-静脉血: 0.088；总胆汁酸(TBA)-静脉血: 2.6umol/L；白蛋白(ALB)-静脉血: 40.1g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.22mmolL；总蛋白(TP)-静脉血: 62.7g/L；载脂蛋白AI(apoAI)-静脉血: 1.32g/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.5U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.77；中性粒细胞百分比(Neut%)-静脉血: 0.757；α-L-岩藻糖苷酶(AFU)-静脉血: 42.2U/L；C-反应蛋白(CRP)-静脉血: 0.25mg/L；阴离子间隙(AG)-静脉血: 13.4；肌酐(Crea)-静脉血: 43.4umol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.7；中性粒细胞计数(Neut#)-静脉血: 4.210E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.9U/L；钠离子(Na+)-静脉血: 134mmol/L；单核细胞计数(Mono#)-静脉血: 0.910E9/L；血小板分布宽度(PDW)-静脉血: 10.6%；镁离子(Mg2+)-静脉血: 0.72mmol/L；血小板比容-静脉血: 19%；白细胞计数(WBC#)-静脉血: 5.4810E9/L；胱抑素(Cys-C)-静脉血: 0.92mg/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.3；葡萄糖(Glu)-静脉血: 4.71mmol/L；直接胆红素(DBIL)-静脉血: 2.12umol/L；血红蛋白(Hb)-静脉血: 123g/L；碱性磷酸酶(……\n- [全程D70] 检验组合: 淋巴细胞百分比(Lymph%)-静脉血: 0.097；血小板分布宽度(PDW)-静脉血: 10.4%；白细胞计数(WBC#)-静脉血: 5.3710E9/L；平均血小板体积(MPV)-静脉血: 9.5fL；乳酸脱氢酶(LDH)-静脉血: 191.8U/L；直接胆红素(DBIL)-静脉血: 2.52umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20.6U/L；氯离子(Cl-)-静脉血: 92.5mmol/L；尿素氮(BUN)-静脉血: 5mmol/L；血小板比容-静脉血: 21%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总钙(Ca)-静脉血: 2.25mmol/L；尿酸(UA)-静脉血: 198umol/L；总胆红素(TBIL)-静脉血: 9.15umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 37.3U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.006；中性粒细胞计数(Neut#)-静脉血: 4.110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.77；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；间接胆红素(IBIL)-静脉血: 6.63umolL；碱性磷酸酶(ALP)-静脉血: 58U/L；单核细胞百分比(Mono%)-静脉血: 0.125；载脂蛋白B(apoB)-静脉血: 1.02g/L；C-反应蛋白(CRP)-静脉血: 1.01mg/L；γ-谷氨酰基转移酶(GGT)-静脉血: 27.6U/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.3mmol/L；甘油三酯(TG)-静脉血: 1.4mmol/L；总胆汁酸(TBA)-静脉血: 3.6umol/L；球蛋白(GLO)-静脉血: 24.2g/L；白蛋白(ALB)-静脉血: 41.8g/L；葡萄糖(Glu)-静脉血: 5.35mmol/L；平均红细胞体积(MCV)-静脉血: 83.5fL；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 348g/L；胱抑素(Cys-C)-静脉血: 0.79mg/L；丙氨酸氨基转移酶(ALT)-静脉血: 24U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.88mmol/L；红细……\n- [全程D77] 检验组合: 总胆红素(TBIL)-静脉血: 9.1umol/L；血小板分布宽度(PDW)-静脉血: 10.7%；乳酸脱氢酶(LDH)-静脉血: 184.4U/L；直接胆红素(DBIL)-静脉血: 2.92umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.9mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 24U/L；总胆固醇(TC)-静脉血: 4.36mmol/L；平均血小板体积(MPV)-静脉血: 9.7fL；白细胞计数(WBC#)-静脉血: 6.0610E9/L；氯离子(Cl-)-静脉血: 97.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 9.2U/L；阴离子间隙(AG)-静脉血: 15.2；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞计数(RBC#)-静脉血: 4.0510E12/L；总胆汁酸(TBA)-静脉血: 1.1umol/L；C-反应蛋白(CRP)-静脉血: 6.66mg/L；磷(P)-静脉血: 1.11mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.012；中性粒细胞百分比(Neut%)-静脉血: 0.799；淋巴细胞计数(Lymph#)-静脉血: 0.410E9/L；总钙(Ca)-静脉血: 2.14mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.03mmol/L；球蛋白(GLO)-静脉血: 22g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.99mmolL；淋巴细胞百分比(Lymph%)-静脉血: 0.064；血小板计数(PLT#)-静脉血: 12010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.2；钾离子(K+)-静脉血: 3.15mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.09；碱性磷酸酶(ALP)-静脉血: 49.9U/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 44.5umol/L；中性粒细胞计数(Neut#)-静脉血: 4.810E9/L；间接胆红素(IBIL)-静脉血: 6.18umolL；尿素氮(BUN)-静脉血: 5.3mmol/L；红细胞体积分布宽度CV(RDW-CV)-……\n- [全程D79] 超声；双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 双肾大小形态正常，右肾探及几个无回声灶，大者约16×13mm，边界清，内透声可，后方回声增强。左肾实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确肿物回声。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。；检查结论: 右肾多发囊性灶，考虑肾囊肿。 左肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位性病变。\n- [全程D80] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌放疗后，对比某次就诊时间日MR： 鼻咽腔狭窄，鼻咽顶壁、顶后壁、右侧壁明显增厚，并见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化，肿物占据右侧咽隐窝。鼻咽左侧壁未见增厚，左侧咽隐窝正常，左侧咽旁及颈动脉鞘区未见异常。双侧鼻腔及口咽各壁未见异常。 右侧腭帆张提肌、右侧头长肌及右侧翼内肌受侵，病变包绕右侧颈内动静脉。 左侧腭帆提肌、腭帆张肌、头长肌未见受侵征象。 双侧翼腭窝、颞下窝未见异常；口咽侧壁未见增厚。 蝶骨基底部右份及右侧翼突基底部内侧、右侧翼突内板骨质信号减低，增强扫描不均匀强化。余颅底骨质未见明确异常。双侧海绵窦形态正常，未见增宽。 双侧筛窦、上颌窦、蝶窦及双侧乳突粘膜增厚，可见大量分泌物，骨壁完整；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 右侧咽后见多个肿大淋巴结，最大者短径9mm，增强后明显强化，融合。左侧咽后及双颈II区见多发小淋巴结，最大者短径约7mm，未见坏死及包膜外侵。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺左叶见一结节，大小约11mm×11mm，边界尚清， T1WI及T2WI均呈混杂高信号，增强扫描部分区域强化较明显。甲状腺右叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。；检查结论: 鼻咽癌放疗后，右侧咽旁见肿瘤残留，病变范围较前缩小。 颅底骨质破坏，范围大致同前。 右侧咽后肿大淋巴结，考虑转移，较前缩小。 左侧咽后及双颈II区小淋巴结，较前未见明显变化。 鼻窦炎；乳突炎，较前明显。 甲状腺左叶结节灶，大致同前。\n- [全程D80] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理稍粗，走行自然，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显病变。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D11] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者检查完善，已完成放疗预约，嘱今日出院，按期行放疗前准备及放疗前口腔检查。\n- [全程D66] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者诉恶心，食欲差，于未诉特殊不适，查体基本同前。患者第二程DDP同时期化疗。予加强止呕及营养支持治疗，防治放化毒副反应。续观。\n- [全程D70] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者诉恶心，进食差，余未诉特殊不适，查体基本同前。今日[姓名已隐去]医生信息已隐藏后示：患者已完成第二程DDP同时期化疗，予加强营养支持治疗。一般情况平稳，嘱今日补液结束后出院，于门诊继续放疗。按期返院继续治疗。遵嘱。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 疗效评估为疾病进展（PD），终止放化疗计划，改行鼻咽及颈部挽救性手术切除。\nB. 疗效评估为疾病进展（PD），停用顺铂，更改化疗方案为吉西他滨联合氟尿嘧啶并继续放疗。\nC. 疗效评估为部分缓解（PR），继续完成根治性放疗，对鼻咽及颈部残留病灶局部加量至76Gy。\nD. 疗效评估为部分缓解（PR），继续完成根治性放疗，取消后续化疗计划，仅予口服补钾与营养支持。\nE. 疗效评估为部分缓解（PR），继续完成根治性放疗及既定化疗计划，并加用尼妥珠单抗靶向治疗。\nF. 疗效评估为完全缓解（CR），提前终止放疗与化疗，拔除静脉通道，转入定期门诊随访观察阶段。\nG. 疗效评估为部分缓解（PR），继续完成根治性放疗，并行局部清扫术，处理右侧咽旁及咽后残留病灶。\nH. 疗效评估为疾病稳定（SD），继续放疗，并联合PD-1抑制剂以增强局部控制与全身抗肿瘤反应。\nI. 疗效评估为部分缓解（PR），暂停放疗优先纠正低钾血症与营养不良，待电解质完全恢复后重启放疗。\nJ. 疗效评估为部分缓解（PR），继续完成根治性放疗及既定化疗计划，无需特殊支持治疗，定期复查即可。\nK. 疗效评估为部分缓解（PR），继续完成根治性放疗及既定化疗计划，并加强静脉营养支持与补钾等对症处理。\nL. 疗效评估为疾病稳定（SD），继续完成根治性放疗，将后续化疗方案调整为紫杉醇联合卡铂以克服耐药。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 右侧耳鸣、鼻塞3月余，加重1周。；现病史: 缘于某次就诊时间11月下旬患者无意中出现右侧耳鸣、鼻塞，伴有右耳听力下降、头痛症状，无鼻出血，无面麻，无视物模糊、复视，无呛咳等症状；未予重视，逐渐加重，于某次就诊时间在[机构已隐去]就诊；建议患者住院治疗，患者及家属不同意。近1周来，耳鸣、鼻塞及头痛症状加重，今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,听力下降,右耳鸣,头痛；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：75次/分，R：20次/分，BP：110/65mmHg,Ht：150cm，Wt：41kg，BSA：1.316m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶壁、顶后壁、右侧壁明显增厚，左侧壁稍增厚，并见结节状肿物突出；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见: 轻度ST段下移；检查结论: 窦性心律 轻度ST段下移\n- [全程D1] 检验组合: 淋巴细胞百分比(Lymph%)-静脉血: 0.35；平均红细胞血红蛋白含量(MCH)-静脉血: 28.7pg；总钙(Ca)-静脉血: 2.32mmol/L；凝血酶时间(TT)-静脉血: 19.8sec.；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阳性(+)（参考: 阴性）；总胆汁酸(TBA)-静脉血: 4.1umol/L；钾离子(K+)-静脉血: 3.82mmol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；红细胞计数(RBC#)-静脉血: 5.0210E12/L；钠离子(Na+)-静脉血: 142.9mmol/L；尿素氮(BUN)-静脉血: 4.2mmol/L；葡萄糖(Glu)-静脉血: 5.36mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.66mmolL；球蛋白(GLO)-静脉血: 25.7g/L；尿酸(UA)-静脉血: 214.3umol/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；ABO血型-静脉血: O；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.98mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.76；中性粒细胞百分比(Neut%)-静脉血: 0.579；阴离子间隙(AG)-静脉血: 11.5；γ-谷氨酰基转移酶(GGT)-静脉血: 12.3U/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 23.4U/L；载脂蛋白B(apoB)-静脉血: 0.98g/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 6.4umolL；中性粒细胞计数(Neut#)-静脉血: 3.710E9/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；载脂蛋白AI(apoAI)-静脉血: 1.79g/L；肌酐(Crea)-静脉血: 50.2umol/L；总蛋白(TP)-静脉血: 70.9g/L；总胆固醇(TC)-静脉血: 5.02mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)……\n- [全程D2] 超声；双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声欠均匀，肝内可见多个无回声灶，较大者约43×29mm，椭圆形，边界清，内透声好，部分可见高回声分隔，后方回声增强。血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：上述病灶内未见明确血流信号。肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声欠均匀，右肾多个无回声灶，较大者约15×13mm，类圆形，边界清，内透声好，后方回声增强。左肾未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确肿物回声。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。；检查结论: 肝多发囊肿。 右肾多发囊肿。 胆囊、脾脏、胰腺、左肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D2] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对侧，双肺野纹理稍增多、增粗，未见明显实质性病变。双侧肺门不大，纵隔不宽，心影形态、大小、位置未见异常。双膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明确病变。\n- [全程D7] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、右侧壁明显增厚，左侧壁稍增厚，并见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号增强扫描明显强化，肿物占据右侧咽隐窝。双侧鼻腔及口咽各壁未见异常。 右侧腭帆张提肌、右侧头长肌及右侧翼内肌受侵，病变包绕右侧颈内动静脉。 右侧腭帆提肌、腭帆张肌、双侧头长肌受侵；左侧腭帆提肌、腭帆张肌未见受侵征象。 双侧翼腭窝、颞下窝未见异常；口咽侧壁未见受累增厚。 蝶骨基底部右份及右侧翼突基底部内侧、右侧翼突内板骨质信号减低，增强扫描不均匀强化。余颅底骨质未见明确异常。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、右侧乳突粘膜增厚，双侧上颌窦、蝶窦、左侧乳突充气良好，骨壁完整；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 右侧咽后见多个肿大淋巴结，最大者短径13mm，增强后明显强化，融合。左侧咽后及双颈II区见多发小淋巴结，最大者短径约7mm，未见坏死及包膜外侵。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺左叶见一结节，大小约11mm×11mm，边界尚清， T1WI及T2WI均呈混杂高信号，增强扫描部分区域强化较明显。甲状腺右叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。；检查结论: 鼻咽病变侵犯右侧咽旁间隙、椎前间隙右份及右侧翼内肌，考虑鼻咽癌可能性大。 蝶骨基底部右份、右侧翼突基底部内侧及右侧翼突内板骨质信号异常，考虑肿瘤浸润可能性大。 右侧咽后肿大淋巴结，考虑转移瘤。 左侧咽后及双颈II区小淋巴结，未排除转移可能。 鼻窦炎；右侧乳突炎。 甲状腺左叶结节灶，建议超声检查。\n- [全程D42] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位置位于第5胸椎体下缘，估计位于上腔静脉上段。；检查结论: PICC管末端位置如上所述。\n- [全程D42] 检验组合: 阴离子间隙(AG)-静脉血: 11；丙氨酸氨基转移酶(ALT)-静脉血: 12.8U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；钠离子(Na+)-静脉血: 143.3mmol/L；总钙(Ca)-静脉血: 2.2mmol/L；总胆红素(TBIL)-静脉血: 8.4umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.3U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.86；C-反应蛋白(CRP)-静脉血: 0.85mg/L；胱抑素(Cys-C)-静脉血: 0.61mg/L；磷(P)-静脉血: 1.14mmol/L；总胆固醇(TC)-静脉血: 4.61mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.292；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；载脂蛋白B(apoB)-静脉血: 0.93g/L；间接胆红素(IBIL)-静脉血: 6.4umolL；甘油三酯(TG)-静脉血: 0.64mmol/L；碱性磷酸酶(ALP)-静脉血: 87.2U/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 2umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；尿酸(UA)-静脉血: 194.8umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.02mmol/L；总胆汁酸(TBA)-静脉血: 2.1umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.96；钾离子(K+)-静脉血: 3.83mmol/L；红细胞比容(Hct)-静脉血: 40.7%；氯离子(Cl-)-静脉血: 107.6mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；肌酐(Crea)-静脉血: 46.2umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.810E9/L；血小板分布宽度(PDW)-静脉血: 10.6%；平均血小板体积(MPV)-静脉血: 9.5fL；白蛋白(ALB)-静脉血: 43.5g/L；尿素氮(BUN)-静脉血: 3.6mmol/L；白细胞计数(WBC#)-静脉血: 6.3110……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D43] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.016；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: 1+ 0.6mg（参考: 阴性）；浊度(TRUB)-尿液: 清亮；葡萄糖(Glu)-尿液: +- 1.7mmol（参考: 阴性）；酸碱度(pH)-尿液: 6.5；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；红细胞计数(RBC#)-尿液: 8/μL；酮体(KET)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 7/μL；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D44] 检验组合: 白蛋白(ALB)-静脉血: 37.7g/L；总胆红素(TBIL)-静脉血: 9umol/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；钠离子(Na+)-静脉血: 133.7mmol/L；直接胆红素(DBIL)-静脉血: 2.1umol/L；总胆汁酸(TBA)-静脉血: 1.4umol/L；尿酸(UA)-静脉血: 164.1umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.6U/L；总蛋白(TP)-静脉血: 58.49g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 23.7U/L；碱性磷酸酶(ALP)-静脉血: 72.8U/L；肌酐(Crea)-静脉血: 44.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.95；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.81；尿素氮(BUN)-静脉血: 4.4mmol/L；磷(P)-静脉血: 0.93mmol/L；总钙(Ca)-静脉血: 2.02mmol/L；乳酸脱氢酶(LDH)-静脉血: 210.9U/L；氯离子(Cl-)-静脉血: 100.2mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 12.3U/L；间接胆红素(IBIL)-静脉血: 6.9umolL；钾离子(K+)-静脉血: 2.94mmol/L；阴离子间隙(AG)-静脉血: 12.1；血液二氧化碳含量ctCO2(B)-静脉血: 21.4mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.3U/L；球蛋白(GLO)-静脉血: 20.79g/L\n- [全程D45] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 1/μL；钠离子(Na+)-静脉血: 131.1mmol/L；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；阴离子间隙(AG)-静脉血: 14.5；浊度(TRUB)-尿液: clear；胆红素(BIL)-尿液: -（参考: 阴性）；镁离子(Mg2+)-静脉血: 0.79mmol/L；钾离子(K+)-静脉血: 3.17mmol/L；红细胞计数(RBC#)-尿液: 17/μL；磷(P)-静脉血: 0.95mmol/L；氯离子(Cl-)-静脉血: 96.2mmol/L；白细胞计数(WBC#)-尿液: 5/μL；总钙(Ca)-静脉血: 1.92mmol/L；颜色-尿液: Light-Yellow；比重(SG)-尿液: 1.011；葡萄糖(Glu)-尿液: 1+ 5.6mmol（参考: 阴性）；隐血(OB)-尿液: +-0.3mg（参考: 阴性）；未分类结晶计数(UNCX#)-尿液: 5/μL；血液二氧化碳含量ctCO2(B)-静脉血: 20.4mmol/L；酸碱度(pH)-尿液: 6.5；尿胆原(URO)-尿液: -（参考: 阴性）\n- [全程D46] 检验组合: 阴离子间隙(AG)-静脉血: 17.7；血液二氧化碳含量ctCO2(B)-静脉血: 19.3mmol/L；氯离子(Cl-)-静脉血: 85.6mmol/L；总钙(Ca)-静脉血: 2.04mmol/L；钠离子(Na+)-静脉血: 122.6mmol/L；钾离子(K+)-静脉血: 3.26mmol/L；镁离子(Mg2+)-静脉血: 0.77mmol/L；磷(P)-静脉血: 0.51mmol/L\n- [全程D47] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 20.9mmol/L；总钙(Ca)-静脉血: 2.12mmol/L；阴离子间隙(AG)-静脉血: 14.5；磷(P)-静脉血: 0.67mmol/L；钾离子(K+)-静脉血: 4.06mmol/L；氯离子(Cl-)-静脉血: 89.8mmol/L；钠离子(Na+)-静脉血: 125.2mmol/L；镁离子(Mg2+)-静脉血: 0.93mmol/L\n- [全程D49] 检验组合: 镁离子(Mg2+)-静脉血: 0.89mmol/L；血小板分布宽度(PDW)-静脉血: 11.2%；有核红细胞百分比(NRBC%)-静脉血: 0；白蛋白(ALB)-静脉血: 44.2g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 33.1U/L；丙氨酸氨基转移酶(ALT)-静脉血: 22.6U/L；葡萄糖(Glu)-静脉血: 5.17mmol/L；间接胆红素(IBIL)-静脉血: 8.9umolL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.09mmolL；载脂蛋白B(apoB)-静脉血: 0.78g/L；总胆汁酸(TBA)-静脉血: 7.4umol/L；磷(P)-静脉血: 0.8mmol/L；肌酐(Crea)-静脉血: 38.9umol/L；甘油三酯(TG)-静脉血: 1.35mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29pg；平均红细胞体积(MCV)-静脉血: 83.3fL；单核细胞计数(Mono#)-静脉血: 0.710E9/L；总胆固醇(TC)-静脉血: 3.61mmol/L；总蛋白(TP)-静脉血: 67.8g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.003；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；总胆红素(TBIL)-静脉血: 12.8umol/L；血小板计数(PLT#)-静脉血: 19410E9/L；血小板比容-静脉血: 20%；天门冬氨酸氨基转移酶(AST)-静脉血: 12.9U/L；阴离子间隙(AG)-静脉血: 14.6；直接胆红素(DBIL)-静脉血: 3.9umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.05mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.2mmol/L；大血小板百分比(P-LCR%)-静脉血: 25.6%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 35.8；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.87；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；C-反应蛋白(CRP)-静脉血: 0.28mg/L；尿酸(UA)-静脉血: 110.7umol/L；单核细胞百分比(Mono%)-静脉血: 0……\n- [全程D60] 检验组合: α-L-岩藻糖苷酶(AFU)-静脉血: 20.3U/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；总胆固醇(TC)-静脉血: 3.99mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.68；天门冬氨酸氨基转移酶(AST)-静脉血: 11.8U/L；总钙(Ca)-静脉血: 2.22mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.05；有核红细胞计数(NRBC#)-静脉血: 010E9/L；白细胞计数(WBC#)-静脉血: 3.5710E9/L；钾离子(K+)-静脉血: 3.88mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.14；碱性磷酸酶(ALP)-静脉血: 52.6U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.62mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.89mmolL；氯离子(Cl-)-静脉血: 103mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；阴离子间隙(AG)-静脉血: 11；球蛋白(GLO)-静脉血: 22.9g/L；总胆汁酸(TBA)-静脉血: 0.9umol/L；镁离子(Mg2+)-静脉血: 0.9mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336g/L；血红蛋白(Hb)-静脉血: 115g/L；红细胞计数(RBC#)-静脉血: 3.910E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；甘油三酯(TG)-静脉血: 0.63mmol/L；磷(P)-静脉血: 1.02mmol/L；直接胆红素(DBIL)-静脉血: 2.86umol/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；单核细胞百分比(Mono%)-静脉血: 0.101；红细胞比容(Hct)-静脉血: 34.2%；血小板比容-静脉血: 17%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.5pg；平均血小板体积(MPV)-静脉血: 9.5fL；尿酸(UA)-静脉血: 152.4umol/L；肌酐(Crea)-静脉血: 43umol/L；丙氨酸氨基转移酶(ALT……\n- [全程D68] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0；有核红细胞计数(NRBC#)-静脉血: 010E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0；大血小板百分比(P-LCR%)-静脉血: 20.1%；尿酸(UA)-静脉血: 120.2umol/L；总胆固醇(TC)-静脉血: 4.11mmol/L；总钙(Ca)-静脉血: 2.22mmol/L；平均红细胞体积(MCV)-静脉血: 84.4fL；单核细胞百分比(Mono%)-静脉血: 0.155；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；淋巴细胞百分比(Lymph%)-静脉血: 0.088；总胆汁酸(TBA)-静脉血: 2.6umol/L；白蛋白(ALB)-静脉血: 40.1g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.22mmolL；总蛋白(TP)-静脉血: 62.7g/L；载脂蛋白AI(apoAI)-静脉血: 1.32g/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.5U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.77；中性粒细胞百分比(Neut%)-静脉血: 0.757；α-L-岩藻糖苷酶(AFU)-静脉血: 42.2U/L；C-反应蛋白(CRP)-静脉血: 0.25mg/L；阴离子间隙(AG)-静脉血: 13.4；肌酐(Crea)-静脉血: 43.4umol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.7；中性粒细胞计数(Neut#)-静脉血: 4.210E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.9U/L；钠离子(Na+)-静脉血: 134mmol/L；单核细胞计数(Mono#)-静脉血: 0.910E9/L；血小板分布宽度(PDW)-静脉血: 10.6%；镁离子(Mg2+)-静脉血: 0.72mmol/L；血小板比容-静脉血: 19%；白细胞计数(WBC#)-静脉血: 5.4810E9/L；胱抑素(Cys-C)-静脉血: 0.92mg/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.3；葡萄糖(Glu)-静脉血: 4.71mmol/L；直接胆红素(DBIL)-静脉血: 2.12umol/L；血红蛋白(Hb)-静脉血: 123g/L；碱性磷酸酶(……\n- [全程D70] 检验组合: 淋巴细胞百分比(Lymph%)-静脉血: 0.097；血小板分布宽度(PDW)-静脉血: 10.4%；白细胞计数(WBC#)-静脉血: 5.3710E9/L；平均血小板体积(MPV)-静脉血: 9.5fL；乳酸脱氢酶(LDH)-静脉血: 191.8U/L；直接胆红素(DBIL)-静脉血: 2.52umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20.6U/L；氯离子(Cl-)-静脉血: 92.5mmol/L；尿素氮(BUN)-静脉血: 5mmol/L；血小板比容-静脉血: 21%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总钙(Ca)-静脉血: 2.25mmol/L；尿酸(UA)-静脉血: 198umol/L；总胆红素(TBIL)-静脉血: 9.15umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 37.3U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.006；中性粒细胞计数(Neut#)-静脉血: 4.110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.77；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；间接胆红素(IBIL)-静脉血: 6.63umolL；碱性磷酸酶(ALP)-静脉血: 58U/L；单核细胞百分比(Mono%)-静脉血: 0.125；载脂蛋白B(apoB)-静脉血: 1.02g/L；C-反应蛋白(CRP)-静脉血: 1.01mg/L；γ-谷氨酰基转移酶(GGT)-静脉血: 27.6U/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.3mmol/L；甘油三酯(TG)-静脉血: 1.4mmol/L；总胆汁酸(TBA)-静脉血: 3.6umol/L；球蛋白(GLO)-静脉血: 24.2g/L；白蛋白(ALB)-静脉血: 41.8g/L；葡萄糖(Glu)-静脉血: 5.35mmol/L；平均红细胞体积(MCV)-静脉血: 83.5fL；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 348g/L；胱抑素(Cys-C)-静脉血: 0.79mg/L；丙氨酸氨基转移酶(ALT)-静脉血: 24U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.88mmol/L；红细……\n- [全程D77] 检验组合: 总胆红素(TBIL)-静脉血: 9.1umol/L；血小板分布宽度(PDW)-静脉血: 10.7%；乳酸脱氢酶(LDH)-静脉血: 184.4U/L；直接胆红素(DBIL)-静脉血: 2.92umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.9mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 24U/L；总胆固醇(TC)-静脉血: 4.36mmol/L；平均血小板体积(MPV)-静脉血: 9.7fL；白细胞计数(WBC#)-静脉血: 6.0610E9/L；氯离子(Cl-)-静脉血: 97.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 9.2U/L；阴离子间隙(AG)-静脉血: 15.2；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞计数(RBC#)-静脉血: 4.0510E12/L；总胆汁酸(TBA)-静脉血: 1.1umol/L；C-反应蛋白(CRP)-静脉血: 6.66mg/L；磷(P)-静脉血: 1.11mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.012；中性粒细胞百分比(Neut%)-静脉血: 0.799；淋巴细胞计数(Lymph#)-静脉血: 0.410E9/L；总钙(Ca)-静脉血: 2.14mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.03mmol/L；球蛋白(GLO)-静脉血: 22g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.99mmolL；淋巴细胞百分比(Lymph%)-静脉血: 0.064；血小板计数(PLT#)-静脉血: 12010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.2；钾离子(K+)-静脉血: 3.15mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.09；碱性磷酸酶(ALP)-静脉血: 49.9U/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 44.5umol/L；中性粒细胞计数(Neut#)-静脉血: 4.810E9/L；间接胆红素(IBIL)-静脉血: 6.18umolL；尿素氮(BUN)-静脉血: 5.3mmol/L；红细胞体积分布宽度CV(RDW-CV)-……\n- [全程D79] 超声；双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 双肾大小形态正常，右肾探及几个无回声灶，大者约16×13mm，边界清，内透声可，后方回声增强。左肾实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确肿物回声。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。；检查结论: 右肾多发囊性灶，考虑肾囊肿。 左肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位性病变。\n- [全程D80] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌放疗后，对比某次就诊时间日MR： 鼻咽腔狭窄，鼻咽顶壁、顶后壁、右侧壁明显增厚，并见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化，肿物占据右侧咽隐窝。鼻咽左侧壁未见增厚，左侧咽隐窝正常，左侧咽旁及颈动脉鞘区未见异常。双侧鼻腔及口咽各壁未见异常。 右侧腭帆张提肌、右侧头长肌及右侧翼内肌受侵，病变包绕右侧颈内动静脉。 左侧腭帆提肌、腭帆张肌、头长肌未见受侵征象。 双侧翼腭窝、颞下窝未见异常；口咽侧壁未见增厚。 蝶骨基底部右份及右侧翼突基底部内侧、右侧翼突内板骨质信号减低，增强扫描不均匀强化。余颅底骨质未见明确异常。双侧海绵窦形态正常，未见增宽。 双侧筛窦、上颌窦、蝶窦及双侧乳突粘膜增厚，可见大量分泌物，骨壁完整；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 右侧咽后见多个肿大淋巴结，最大者短径9mm，增强后明显强化，融合。左侧咽后及双颈II区见多发小淋巴结，最大者短径约7mm，未见坏死及包膜外侵。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺左叶见一结节，大小约11mm×11mm，边界尚清， T1WI及T2WI均呈混杂高信号，增强扫描部分区域强化较明显。甲状腺右叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。；检查结论: 鼻咽癌放疗后，右侧咽旁见肿瘤残留，病变范围较前缩小。 颅底骨质破坏，范围大致同前。 右侧咽后肿大淋巴结，考虑转移，较前缩小。 左侧咽后及双颈II区小淋巴结，较前未见明显变化。 鼻窦炎；乳突炎，较前明显。 甲状腺左叶结节灶，大致同前。\n- [全程D80] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理稍粗，走行自然，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显病变。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D11] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者检查完善，已完成放疗预约，嘱今日出院，按期行放疗前准备及放疗前口腔检查。\n- [全程D66] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者诉恶心，食欲差，于未诉特殊不适，查体基本同前。患者第二程DDP同时期化疗。予加强止呕及营养支持治疗，防治放化毒副反应。续观。\n- [全程D70] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者诉恶心，进食差，余未诉特殊不适，查体基本同前。今日[姓名已隐去]医生信息已隐藏后示：患者已完成第二程DDP同时期化疗，予加强营养支持治疗。一般情况平稳，嘱今日补液结束后出院，于门诊继续放疗。按期返院继续治疗。遵嘱。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 疗效评估为疾病进展（PD），终止放化疗计划，改行鼻咽及颈部挽救性手术切除。\nB. 疗效评估为疾病进展（PD），停用顺铂，更改化疗方案为吉西他滨联合氟尿嘧啶并继续放疗。\nC. 疗效评估为部分缓解（PR），继续完成根治性放疗，对鼻咽及颈部残留病灶局部加量至76Gy。\nD. 疗效评估为部分缓解（PR），继续完成根治性放疗，取消后续化疗计划，仅予口服补钾与营养支持。\nE. 疗效评估为部分缓解（PR），继续完成根治性放疗及既定化疗计划，并加用尼妥珠单抗靶向治疗。\nF. 疗效评估为完全缓解（CR），提前终止放疗与化疗，拔除静脉通道，转入定期门诊随访观察阶段。\nG. 疗效评估为部分缓解（PR），继续完成根治性放疗，并行局部清扫术，处理右侧咽旁及咽后残留病灶。\nH. 疗效评估为疾病稳定（SD），继续放疗，并联合PD-1抑制剂以增强局部控制与全身抗肿瘤反应。\nI. 疗效评估为部分缓解（PR），暂停放疗优先纠正低钾血症与营养不良，待电解质完全恢复后重启放疗。\nJ. 疗效评估为部分缓解（PR），继续完成根治性放疗及既定化疗计划，无需特殊支持治疗，定期复查即可。\nK. 疗效评估为部分缓解（PR），继续完成根治性放疗及既定化疗计划，并加强静脉营养支持与补钾等对症处理。\nL. 疗效评估为疾病稳定（SD），继续完成根治性放疗，将后续化疗方案调整为紫杉醇联合卡铂以克服耐药。\n\n请仅输出一个选项字母（A-L）。"}]}
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+{"sample_id":"sample-fd63f0707132f4eb9174ab3e","patient_id":"patient-eecadcdf172a1efe8947b052","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"I","gold_action":"明确临床分期为T4N1M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。","options":[{"letter":"A","text":"明确临床分期为T3N1M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。","is_gold":false},{"letter":"B","text":"明确临床分期为T4N2M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。","is_gold":false},{"letter":"C","text":"明确临床分期为T4N1M0，并直接安排鼻咽及颈部根治性放疗，暂不留置静脉导管。","is_gold":false},{"letter":"D","text":"明确临床分期为T4N1M0，并安排全身PET-CT以进一步明确双颈部淋巴结性质。","is_gold":false},{"letter":"E","text":"明确临床分期为T4N0M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。","is_gold":false},{"letter":"F","text":"明确临床分期为T3N2M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。","is_gold":false},{"letter":"G","text":"明确临床分期为T4N1M0，并安排垂体MRI动态增强扫描以明确垂体受累情况。","is_gold":false},{"letter":"H","text":"明确临床分期为T4N1M0，并安排颈部淋巴结穿刺活检以明确N分期。","is_gold":false},{"letter":"I","text":"明确临床分期为T4N1M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。","is_gold":true},{"letter":"J","text":"明确临床分期为T4N1M0，并安排骨扫描及头颅CT以排除远处转移。","is_gold":false},{"letter":"K","text":"明确临床分期为T4N1M0，并安排鼻咽肿物再次活检以进行EBV相关基因检测。","is_gold":false},{"letter":"L","text":"明确临床分期为T4N1M0，并留置CVC导管及行胸部CT确认管端位置，为后续静脉给药做准备。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N1，M0。\n综合TNM状态：T4N1M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D7] 入院记录: 主诉: 头痛伴耳鸣、听力下降3月余。；颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。今患者为进一步诊治，予收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,双咽后淋巴结肿大,头痛；既往史: 否认\"乙肝、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认饮酒史。否认不洁性生活史。；家族史: 患者叔叔因肺癌死亡。；体格检查: T：36.2℃，P：82次/分，R：20次/分，BP：128/74mmHg,Ht：172cm，Wt：80kg，BSA：1.92m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无叩痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约1cm*0.8cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 早期复极改变\n- [全程D0] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.6；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:20（参考: 阴性）；活化部分凝血活酶时间(APTT)-静脉血: 23.1sec.；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；血红蛋白(Hb)-静脉血: 158g/L；血小板比容-静脉血: 26%；氯离子(Cl-)-静脉血: 105.3mmol/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 1.04；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；尿酸(UA)-静脉血: 341umol/L；甘油三酯(TG)-静脉血: 1.27mmol/L；总蛋白(TP)-静脉血: 73.53g/L；尿素氮(BUN)-静脉血: 6.35mmol/L；C-反应蛋白(CRP)-静脉血: 1.45mg/L；载脂蛋白B(apoB)-静脉血: 0.8g/L；总胆汁酸(TBA)-静脉血: 4.7umol/L；葡萄糖(Glu)-静脉血: 4.78mmol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；乳酸脱氢酶(LDH)-静脉血: 160.3U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；大血小板百分比(P-LCR%)-静脉血: 30.4%；中性粒细胞计数(Neut#)-静脉血: 6.410E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；丙氨酸氨基转移酶(ALT)-静脉血: 12.1U/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；ABO血型-静脉血: B；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.7fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；球蛋白(GLO)-静脉血: 28.23g/L；凝血酶时间(TT)-静脉血: 17.5sec.；红细胞计数(RBC#)-静脉血: 5.3710E12/L；平均红细胞体积(MCV)-静脉血: 87fL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.17mmolL；磷(P)-静脉血: 1.03mmol/L；总钙(Ca)-……\n- [全程D3] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理稍粗，未见明确实质性病变。双侧肺门不大，纵隔居中、无增宽。双膈形态正常。双侧肋膈角锐利。心影形态、大小、位置未见异常。；检查结论: 心肺未见明显异常。\n- [全程D3] 超声；双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约11cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约37×31×26mm，包膜光滑，实质回声不均匀，可见强回声斑。 腹主动脉旁未见明确肿物回声。；检查结论: 前列腺钙化。 肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、左侧壁见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强后明显强化，肿物占据鼻咽顶壁、左侧咽隐窝、左侧咽后间隙，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，右侧咽隐窝变浅，右侧咽旁脂肪间隙及颈动脉鞘区未见异常。 左侧腭帆张提肌及左侧头长肌受侵，右侧腭帆提肌、腭帆张肌、头长肌未见受侵征象。 双侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽双侧壁未见增厚。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部、翼突内外板、左侧枕骨基底部及左侧枕骨髁骨质信号减低，增强扫描后明显强化，斜坡局部见不规则软组织肿物影累及斜坡后份脑膜及蝶鞍后份，部分层面与垂体后叶分界欠清。双侧海绵窦形态正常，未见增宽。筛窦、蝶窦、左侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 左侧咽后间隙见肿大淋巴结，大小约为11mm ×9 mm，右侧咽后见肿大淋巴结，短径约6mm，均匀强化。 双颈I、II区见多个淋巴结，边界清，信号均匀，最大短径约8mm，均匀强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。 颅底骨质破坏。 双侧咽后淋巴结肿大，考虑转移。 双颈Ib、II区小淋巴结，性质待定。 副鼻窦炎、左侧乳突炎。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 明确临床分期为T3N1M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。\nB. 明确临床分期为T4N2M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。\nC. 明确临床分期为T4N1M0，并直接安排鼻咽及颈部根治性放疗，暂不留置静脉导管。\nD. 明确临床分期为T4N1M0，并安排全身PET-CT以进一步明确双颈部淋巴结性质。\nE. 明确临床分期为T4N0M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。\nF. 明确临床分期为T3N2M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。\nG. 明确临床分期为T4N1M0，并安排垂体MRI动态增强扫描以明确垂体受累情况。\nH. 明确临床分期为T4N1M0，并安排颈部淋巴结穿刺活检以明确N分期。\nI. 明确临床分期为T4N1M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。\nJ. 明确临床分期为T4N1M0，并安排骨扫描及头颅CT以排除远处转移。\nK. 明确临床分期为T4N1M0，并安排鼻咽肿物再次活检以进行EBV相关基因检测。\nL. 明确临床分期为T4N1M0，并留置CVC导管及行胸部CT确认管端位置，为后续静脉给药做准备。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N1，M0。\n综合TNM状态：T4N1M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D7] 入院记录: 主诉: 头痛伴耳鸣、听力下降3月余。；颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。今患者为进一步诊治，予收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,双咽后淋巴结肿大,头痛；既往史: 否认\"乙肝、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认饮酒史。否认不洁性生活史。；家族史: 患者叔叔因肺癌死亡。；体格检查: T：36.2℃，P：82次/分，R：20次/分，BP：128/74mmHg,Ht：172cm，Wt：80kg，BSA：1.92m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无叩痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约1cm*0.8cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 早期复极改变\n- [全程D0] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.6；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:20（参考: 阴性）；活化部分凝血活酶时间(APTT)-静脉血: 23.1sec.；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；血红蛋白(Hb)-静脉血: 158g/L；血小板比容-静脉血: 26%；氯离子(Cl-)-静脉血: 105.3mmol/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 1.04；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；尿酸(UA)-静脉血: 341umol/L；甘油三酯(TG)-静脉血: 1.27mmol/L；总蛋白(TP)-静脉血: 73.53g/L；尿素氮(BUN)-静脉血: 6.35mmol/L；C-反应蛋白(CRP)-静脉血: 1.45mg/L；载脂蛋白B(apoB)-静脉血: 0.8g/L；总胆汁酸(TBA)-静脉血: 4.7umol/L；葡萄糖(Glu)-静脉血: 4.78mmol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；乳酸脱氢酶(LDH)-静脉血: 160.3U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；大血小板百分比(P-LCR%)-静脉血: 30.4%；中性粒细胞计数(Neut#)-静脉血: 6.410E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；丙氨酸氨基转移酶(ALT)-静脉血: 12.1U/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；ABO血型-静脉血: B；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.7fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；球蛋白(GLO)-静脉血: 28.23g/L；凝血酶时间(TT)-静脉血: 17.5sec.；红细胞计数(RBC#)-静脉血: 5.3710E12/L；平均红细胞体积(MCV)-静脉血: 87fL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.17mmolL；磷(P)-静脉血: 1.03mmol/L；总钙(Ca)-……\n- [全程D3] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理稍粗，未见明确实质性病变。双侧肺门不大，纵隔居中、无增宽。双膈形态正常。双侧肋膈角锐利。心影形态、大小、位置未见异常。；检查结论: 心肺未见明显异常。\n- [全程D3] 超声；双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约11cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约37×31×26mm，包膜光滑，实质回声不均匀，可见强回声斑。 腹主动脉旁未见明确肿物回声。；检查结论: 前列腺钙化。 肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、左侧壁见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强后明显强化，肿物占据鼻咽顶壁、左侧咽隐窝、左侧咽后间隙，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，右侧咽隐窝变浅，右侧咽旁脂肪间隙及颈动脉鞘区未见异常。 左侧腭帆张提肌及左侧头长肌受侵，右侧腭帆提肌、腭帆张肌、头长肌未见受侵征象。 双侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽双侧壁未见增厚。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部、翼突内外板、左侧枕骨基底部及左侧枕骨髁骨质信号减低，增强扫描后明显强化，斜坡局部见不规则软组织肿物影累及斜坡后份脑膜及蝶鞍后份，部分层面与垂体后叶分界欠清。双侧海绵窦形态正常，未见增宽。筛窦、蝶窦、左侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 左侧咽后间隙见肿大淋巴结，大小约为11mm ×9 mm，右侧咽后见肿大淋巴结，短径约6mm，均匀强化。 双颈I、II区见多个淋巴结，边界清，信号均匀，最大短径约8mm，均匀强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。 颅底骨质破坏。 双侧咽后淋巴结肿大，考虑转移。 双颈Ib、II区小淋巴结，性质待定。 副鼻窦炎、左侧乳突炎。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 明确临床分期为T3N1M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。\nB. 明确临床分期为T4N2M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。\nC. 明确临床分期为T4N1M0，并直接安排鼻咽及颈部根治性放疗，暂不留置静脉导管。\nD. 明确临床分期为T4N1M0，并安排全身PET-CT以进一步明确双颈部淋巴结性质。\nE. 明确临床分期为T4N0M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。\nF. 明确临床分期为T3N2M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。\nG. 明确临床分期为T4N1M0，并安排垂体MRI动态增强扫描以明确垂体受累情况。\nH. 明确临床分期为T4N1M0，并安排颈部淋巴结穿刺活检以明确N分期。\nI. 明确临床分期为T4N1M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。\nJ. 明确临床分期为T4N1M0，并安排骨扫描及头颅CT以排除远处转移。\nK. 明确临床分期为T4N1M0，并安排鼻咽肿物再次活检以进行EBV相关基因检测。\nL. 明确临床分期为T4N1M0，并留置CVC导管及行胸部CT确认管端位置，为后续静脉给药做准备。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-1a0c7a960fe6a9b60533da3d","patient_id":"patient-eecadcdf172a1efe8947b052","turn_id":"turn05","turn_position":3,"turn_type":"toxicity_or_support_decision","gold_letter":"L","gold_action":"继续本周期化疗，给予止吐、护肝及静脉营养等支持治疗，并完善脑垂体激素五项检查。","options":[{"letter":"A","text":"停止本周期化疗，给予粒细胞集落刺激因子及抗感染支持治疗，并完善脑垂体激素五项检查。","is_gold":false},{"letter":"B","text":"继续本周期化疗，给予止吐、护肝及静脉营养等支持治疗，并完善甲状腺功能及皮质醇检查。","is_gold":false},{"letter":"C","text":"停止本周期化疗，给予大剂量水化、碱化尿液及利尿处理，并完善脑垂体激素五项检查。","is_gold":false},{"letter":"D","text":"继续本周期化疗，给予止吐、护胃及静脉营养支持治疗，暂不进行内分泌功能相关检查。","is_gold":false},{"letter":"E","text":"提前结束本周期化疗，给予全静脉营养支持及强效止吐治疗，并完善脑垂体激素五项检查。","is_gold":false},{"letter":"F","text":"继续本周期化疗，给予止吐、护肝及静脉营养支持治疗，同时行腰椎穿刺脑脊液常规及生化检查。","is_gold":false},{"letter":"G","text":"结束本周期化疗，给予预防性抗感染及护肝支持治疗，并完善脑垂体激素五项检查。","is_gold":false},{"letter":"H","text":"继续本周期化疗，给予止吐及肠内营养支持治疗，避免静脉营养，并复查鼻咽及垂体增强MRI。","is_gold":false},{"letter":"I","text":"暂停氟尿嘧啶持续静脉滴注，给予口腔局部镇痛及促进黏膜愈合处理，并完善脑垂体激素五项检查。","is_gold":false},{"letter":"J","text":"继续本周期化疗，给予止吐、护肝支持治疗，暂不予静脉营养，并请内分泌科急会诊。","is_gold":false},{"letter":"K","text":"结束本周期化疗，给予止吐、护肝及静脉营养支持治疗，并于次日开始局部区域调强放疗。","is_gold":false},{"letter":"L","text":"继续本周期化疗，给予止吐、护肝及静脉营养等支持治疗，并完善脑垂体激素五项检查。","is_gold":true}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N1，M0。\n综合TNM状态：T4N1M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D7] 入院记录: 主诉: 头痛伴耳鸣、听力下降3月余。；颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。今患者为进一步诊治，予收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,双咽后淋巴结肿大,头痛；既往史: 否认\"乙肝、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认饮酒史。否认不洁性生活史。；家族史: 患者叔叔因肺癌死亡。；体格检查: T：36.2℃，P：82次/分，R：20次/分，BP：128/74mmHg,Ht：172cm，Wt：80kg，BSA：1.92m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无叩痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约1cm*0.8cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）；KPS: 90；ECOG:\n- [全程D7] 入院记录: 主诉: 头痛伴耳鸣、听力下降3月余。；现病史: 患者于某次就诊时间1月无明显诱因下出现头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，患者于至[机构已隐去]就诊，行鼻咽活检病理，并送我院病理会诊示鼻咽分化型非角化性癌。某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。今患者为进一步诊治，予收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,双咽后淋巴结肿大,头痛；既往史: 否认\"乙肝、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认饮酒史。否认不洁性生活史。；家族史: 患者叔叔因肺癌死亡。；体格检查: T：36.2℃，P：82次/分，R：20次/分，BP：128/74mmHg,Ht：172cm，Wt：80kg，BSA：1.92m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率82次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无叩痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约1cm*0.8cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 早期复极改变\n- [全程D0] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.6；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:20（参考: 阴性）；活化部分凝血活酶时间(APTT)-静脉血: 23.1sec.；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；血红蛋白(Hb)-静脉血: 158g/L；血小板比容-静脉血: 26%；氯离子(Cl-)-静脉血: 105.3mmol/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 1.04；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；尿酸(UA)-静脉血: 341umol/L；甘油三酯(TG)-静脉血: 1.27mmol/L；总蛋白(TP)-静脉血: 73.53g/L；尿素氮(BUN)-静脉血: 6.35mmol/L；C-反应蛋白(CRP)-静脉血: 1.45mg/L；载脂蛋白B(apoB)-静脉血: 0.8g/L；总胆汁酸(TBA)-静脉血: 4.7umol/L；葡萄糖(Glu)-静脉血: 4.78mmol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；乳酸脱氢酶(LDH)-静脉血: 160.3U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；大血小板百分比(P-LCR%)-静脉血: 30.4%；中性粒细胞计数(Neut#)-静脉血: 6.410E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；丙氨酸氨基转移酶(ALT)-静脉血: 12.1U/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；ABO血型-静脉血: B；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.7fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；球蛋白(GLO)-静脉血: 28.23g/L；凝血酶时间(TT)-静脉血: 17.5sec.；红细胞计数(RBC#)-静脉血: 5.3710E12/L；平均红细胞体积(MCV)-静脉血: 87fL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.17mmolL；磷(P)-静脉血: 1.03mmol/L；总钙(Ca)-……\n- [全程D3] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理稍粗，未见明确实质性病变。双侧肺门不大，纵隔居中、无增宽。双膈形态正常。双侧肋膈角锐利。心影形态、大小、位置未见异常。；检查结论: 心肺未见明显异常。\n- [全程D3] 超声；双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约11cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约37×31×26mm，包膜光滑，实质回声不均匀，可见强回声斑。 腹主动脉旁未见明确肿物回声。；检查结论: 前列腺钙化。 肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、左侧壁见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强后明显强化，肿物占据鼻咽顶壁、左侧咽隐窝、左侧咽后间隙，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，右侧咽隐窝变浅，右侧咽旁脂肪间隙及颈动脉鞘区未见异常。 左侧腭帆张提肌及左侧头长肌受侵，右侧腭帆提肌、腭帆张肌、头长肌未见受侵征象。 双侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽双侧壁未见增厚。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部、翼突内外板、左侧枕骨基底部及左侧枕骨髁骨质信号减低，增强扫描后明显强化，斜坡局部见不规则软组织肿物影累及斜坡后份脑膜及蝶鞍后份，部分层面与垂体后叶分界欠清。双侧海绵窦形态正常，未见增宽。筛窦、蝶窦、左侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 左侧咽后间隙见肿大淋巴结，大小约为11mm ×9 mm，右侧咽后见肿大淋巴结，短径约6mm，均匀强化。 双颈I、II区见多个淋巴结，边界清，信号均匀，最大短径约8mm，均匀强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。 颅底骨质破坏。 双侧咽后淋巴结肿大，考虑转移。 双颈Ib、II区小淋巴结，性质待定。 副鼻窦炎、左侧乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D7] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；载脂蛋白AI(apoAI)-静脉血: 1.41g/L；总蛋白(TP)-静脉血: 72.8g/L；肌酐(Crea)-静脉血: 96.4umol/L；总胆红素(TBIL)-静脉血: 10.3umol/L；血小板比容-静脉血: 26%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；尿素氮(BUN)-静脉血: 5.6mmol/L；白细胞计数(WBC#)-尿液: 1/μL；钠离子(Na+)-静脉血: 140.2mmol/L；颜色-尿液: Light-Yellow；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.2mmolL；C-反应蛋白(CRP)-静脉血: 1.6mg/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；乳酸脱氢酶(LDH)-静脉血: 148.2U/L；总胆固醇(TC)-静脉血: 4.78mmol/L；总蛋白(TP)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 5/μL；平均血小板体积(MPV)-静脉血: 10.8fL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 345g/L；总钙(Ca)-静脉血: 2.34mmol/L；甘油三酯(TG)-静脉血: 1.84mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.34；胱抑素(Cys-C)-静脉血: 0.97mg/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.8U/L；红细胞计数(RBC#)-静脉血: 5.3810E12/L；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；单核细胞百分比(Mono%)-静脉血: 0.065；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.76；血液二氧化碳含量ctCO2(B)-静脉血: 24.3mmol/L；红细胞计数(RBC#)-尿液: 4/μL；间接胆红素(IBIL)-静脉血: 7umolL；浊度(TRUB)-尿液: clear；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.026；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；血小板计数(PLT#)-静脉血: 24610E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；颜色-粪便: 棕色；载脂蛋白……\n- [全程D11] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于第7胸椎椎体右侧水平，估计导管末端位于上腔静脉中-下段交界处。；检查结论: 导管末端位置如上述。\n- [全程D14] 检验组合: α-L-岩藻糖苷酶(AFU)-静脉血: 38.9U/L；载脂蛋白AI(apoAI)-静脉血: 1.64g/L；血红蛋白(Hb)-静脉血: 158g/L；有核红细胞百分比(NRBC%)-静脉血: 0；促黄体生成素(LH)-静脉血: 6.12mIU/ml；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.87mmol/L；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 弱阳性(±)（参考: 阴性）；天门冬氨酸氨基转移酶(AST)-静脉血: 17.6U/L；总胆汁酸(TBA)-静脉血: 1umol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.4pg；大血小板百分比(P-LCR%)-静脉血: 35.7%；胱抑素(Cys-C)-静脉血: 1.56mg/L；白蛋白(ALB)-静脉血: 45.2g/L；甘油三酯(TG)-静脉血: 1.3mmol/L；白细胞计数(WBC#)-静脉血: 9.310E9/L；红细胞计数(RBC#)-静脉血: 5.3710E12/L；单核细胞百分比(Mono%)-静脉血: 0.008；中性粒细胞计数(Neut#)-静脉血: 8.710E9/L；乳酸脱氢酶(LDH)-静脉血: 181.6U/L；总蛋白(TP)-静脉血: 70.8g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.9mmolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.02；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；催乳素(PRL)-静脉血: 308.5uIU/ml；中性粒细胞百分比(Neut%)-静脉血: 0.939；有核红细胞计数(NRBC#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 33.6；促卵泡刺激素(FSH)-静脉血: 9.93mIU/ml；钾离子(K+)-静脉血: 4.53mmol/L；镁离子(Mg2+)-静脉血: 0.89mmol/L；平均血小板体积(MPV)-静脉血: 11.3fL；碱性磷酸酶(ALP)-静脉血: 87.4U/L；总胆红素(TBIL)-静脉血: 22.5umol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=1.50)（参考: 阴性）；尿酸(UA)-静脉血: 385.9umol/L；EB……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D7] 首次病程记录；首次病程记录: 病程类型: 首次病程记录；病程主题: 首次病程记录；病程内容: 病历特点：1、患者中年男性。2、患者于某次就诊时间1月无明显诱因下出现头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，患者于至[机构已隐去]就诊，行鼻咽活检病理，并送我院病理会诊示鼻咽分化型非角化性癌。某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。现患者为进一步诊治，予收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。3、体查：张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约1cm*0.8cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）示图：4、辅助检查：（1） 某次就诊时间在我医院（病理号：[记录编号已隐去]）鼻咽活检病理示：（鼻咽肿物）镜检为分化型非角化性癌（2） 某次就诊时间在我院胸片检查：心肺未见异常。（3） 某次就诊时间在我院腹部B超检查：肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。（4） 某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。副鼻窦炎、左侧乳突炎。（6）某次就诊时间我院：VCA-IgA 1:160 EA-IgA 1:20EBV-DNA定性检测：2.14E102copy/ml。 诊断依据： 初步诊断： 鉴别诊断：患者诊断明确，无需鉴别诊断。 诊疗计划：1、完善相关检查如全身骨扫描、血常规、生化等。2、诱导化疗及同期化放疗。\n- [全程D8] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者诉间有头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，无面麻、声嘶。[姓名已隐去]医生信息已隐藏示：嘱患者今日完善全身骨扫描检查，排除骨转移征象，治疗上暂给予对症处理，继续观察病情。\n- [全程D9] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日患者症状体征基本同前，无诉其余特殊不适。[姓名已隐去]医生信息已隐藏后指示：某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，最大短径约8mm，均匀强化。骨ECT示鼻咽部、颅底骨代谢较活跃，考虑NPC所致。胸片、腹部B超排除远处转移。故目前临床诊断明确为“鼻咽分化型非角化性癌[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)，治疗方案定为TPF（多西紫杉醇 60mg/m2 + 顺铂 60mg/m2 + 5-FU 2.5g/m2， q21d）诱导化疗3程后再行同期放化疗，放疗采用IMRT技术，同期化疗采用顺铂 60mg/m2（q21d）2程。并指示化疗期间给予护肝、护胃、止吐及营养支持治疗。已向患者及家属交代病情及治疗相关不良反应后，其表示理解，并同意上述治疗方案。拟明日开始行多西紫杉醇化疗，密切观察患者病情变化。\n- [全程D12] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 患者今日TPF方案化疗第3天，现一般情况可，未诉恶心、呕吐、腹痛、腹泻等不适，大小便正常。[姓名已隐去]医生信息已隐藏出，患者目前一般情况可，可继续化疗。注意化疗结束后复查血、生化常规，及时对症处理。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 停止本周期化疗，给予粒细胞集落刺激因子及抗感染支持治疗，并完善脑垂体激素五项检查。\nB. 继续本周期化疗，给予止吐、护肝及静脉营养等支持治疗，并完善甲状腺功能及皮质醇检查。\nC. 停止本周期化疗，给予大剂量水化、碱化尿液及利尿处理，并完善脑垂体激素五项检查。\nD. 继续本周期化疗，给予止吐、护胃及静脉营养支持治疗，暂不进行内分泌功能相关检查。\nE. 提前结束本周期化疗，给予全静脉营养支持及强效止吐治疗，并完善脑垂体激素五项检查。\nF. 继续本周期化疗，给予止吐、护肝及静脉营养支持治疗，同时行腰椎穿刺脑脊液常规及生化检查。\nG. 结束本周期化疗，给予预防性抗感染及护肝支持治疗，并完善脑垂体激素五项检查。\nH. 继续本周期化疗，给予止吐及肠内营养支持治疗，避免静脉营养，并复查鼻咽及垂体增强MRI。\nI. 暂停氟尿嘧啶持续静脉滴注，给予口腔局部镇痛及促进黏膜愈合处理，并完善脑垂体激素五项检查。\nJ. 继续本周期化疗，给予止吐、护肝支持治疗，暂不予静脉营养，并请内分泌科急会诊。\nK. 结束本周期化疗，给予止吐、护肝及静脉营养支持治疗，并于次日开始局部区域调强放疗。\nL. 继续本周期化疗，给予止吐、护肝及静脉营养等支持治疗，并完善脑垂体激素五项检查。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N1，M0。\n综合TNM状态：T4N1M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D7] 入院记录: 主诉: 头痛伴耳鸣、听力下降3月余。；颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。今患者为进一步诊治，予收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,双咽后淋巴结肿大,头痛；既往史: 否认\"乙肝、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认饮酒史。否认不洁性生活史。；家族史: 患者叔叔因肺癌死亡。；体格检查: T：36.2℃，P：82次/分，R：20次/分，BP：128/74mmHg,Ht：172cm，Wt：80kg，BSA：1.92m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无叩痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约1cm*0.8cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）；KPS: 90；ECOG:\n- [全程D7] 入院记录: 主诉: 头痛伴耳鸣、听力下降3月余。；现病史: 患者于某次就诊时间1月无明显诱因下出现头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，患者于至[机构已隐去]就诊，行鼻咽活检病理，并送我院病理会诊示鼻咽分化型非角化性癌。某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。今患者为进一步诊治，予收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,双咽后淋巴结肿大,头痛；既往史: 否认\"乙肝、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认饮酒史。否认不洁性生活史。；家族史: 患者叔叔因肺癌死亡。；体格检查: T：36.2℃，P：82次/分，R：20次/分，BP：128/74mmHg,Ht：172cm，Wt：80kg，BSA：1.92m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率82次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无叩痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约1cm*0.8cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 早期复极改变\n- [全程D0] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.6；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:20（参考: 阴性）；活化部分凝血活酶时间(APTT)-静脉血: 23.1sec.；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；血红蛋白(Hb)-静脉血: 158g/L；血小板比容-静脉血: 26%；氯离子(Cl-)-静脉血: 105.3mmol/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 1.04；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；尿酸(UA)-静脉血: 341umol/L；甘油三酯(TG)-静脉血: 1.27mmol/L；总蛋白(TP)-静脉血: 73.53g/L；尿素氮(BUN)-静脉血: 6.35mmol/L；C-反应蛋白(CRP)-静脉血: 1.45mg/L；载脂蛋白B(apoB)-静脉血: 0.8g/L；总胆汁酸(TBA)-静脉血: 4.7umol/L；葡萄糖(Glu)-静脉血: 4.78mmol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；乳酸脱氢酶(LDH)-静脉血: 160.3U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；大血小板百分比(P-LCR%)-静脉血: 30.4%；中性粒细胞计数(Neut#)-静脉血: 6.410E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；丙氨酸氨基转移酶(ALT)-静脉血: 12.1U/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；ABO血型-静脉血: B；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.7fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；球蛋白(GLO)-静脉血: 28.23g/L；凝血酶时间(TT)-静脉血: 17.5sec.；红细胞计数(RBC#)-静脉血: 5.3710E12/L；平均红细胞体积(MCV)-静脉血: 87fL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.17mmolL；磷(P)-静脉血: 1.03mmol/L；总钙(Ca)-……\n- [全程D3] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理稍粗，未见明确实质性病变。双侧肺门不大，纵隔居中、无增宽。双膈形态正常。双侧肋膈角锐利。心影形态、大小、位置未见异常。；检查结论: 心肺未见明显异常。\n- [全程D3] 超声；双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约11cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约37×31×26mm，包膜光滑，实质回声不均匀，可见强回声斑。 腹主动脉旁未见明确肿物回声。；检查结论: 前列腺钙化。 肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、左侧壁见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强后明显强化，肿物占据鼻咽顶壁、左侧咽隐窝、左侧咽后间隙，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，右侧咽隐窝变浅，右侧咽旁脂肪间隙及颈动脉鞘区未见异常。 左侧腭帆张提肌及左侧头长肌受侵，右侧腭帆提肌、腭帆张肌、头长肌未见受侵征象。 双侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽双侧壁未见增厚。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部、翼突内外板、左侧枕骨基底部及左侧枕骨髁骨质信号减低，增强扫描后明显强化，斜坡局部见不规则软组织肿物影累及斜坡后份脑膜及蝶鞍后份，部分层面与垂体后叶分界欠清。双侧海绵窦形态正常，未见增宽。筛窦、蝶窦、左侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 左侧咽后间隙见肿大淋巴结，大小约为11mm ×9 mm，右侧咽后见肿大淋巴结，短径约6mm，均匀强化。 双颈I、II区见多个淋巴结，边界清，信号均匀，最大短径约8mm，均匀强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。 颅底骨质破坏。 双侧咽后淋巴结肿大，考虑转移。 双颈Ib、II区小淋巴结，性质待定。 副鼻窦炎、左侧乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D7] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；载脂蛋白AI(apoAI)-静脉血: 1.41g/L；总蛋白(TP)-静脉血: 72.8g/L；肌酐(Crea)-静脉血: 96.4umol/L；总胆红素(TBIL)-静脉血: 10.3umol/L；血小板比容-静脉血: 26%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；尿素氮(BUN)-静脉血: 5.6mmol/L；白细胞计数(WBC#)-尿液: 1/μL；钠离子(Na+)-静脉血: 140.2mmol/L；颜色-尿液: Light-Yellow；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.2mmolL；C-反应蛋白(CRP)-静脉血: 1.6mg/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；乳酸脱氢酶(LDH)-静脉血: 148.2U/L；总胆固醇(TC)-静脉血: 4.78mmol/L；总蛋白(TP)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 5/μL；平均血小板体积(MPV)-静脉血: 10.8fL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 345g/L；总钙(Ca)-静脉血: 2.34mmol/L；甘油三酯(TG)-静脉血: 1.84mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.34；胱抑素(Cys-C)-静脉血: 0.97mg/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.8U/L；红细胞计数(RBC#)-静脉血: 5.3810E12/L；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；单核细胞百分比(Mono%)-静脉血: 0.065；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.76；血液二氧化碳含量ctCO2(B)-静脉血: 24.3mmol/L；红细胞计数(RBC#)-尿液: 4/μL；间接胆红素(IBIL)-静脉血: 7umolL；浊度(TRUB)-尿液: clear；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.026；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；血小板计数(PLT#)-静脉血: 24610E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；颜色-粪便: 棕色；载脂蛋白……\n- [全程D11] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于第7胸椎椎体右侧水平，估计导管末端位于上腔静脉中-下段交界处。；检查结论: 导管末端位置如上述。\n- [全程D14] 检验组合: α-L-岩藻糖苷酶(AFU)-静脉血: 38.9U/L；载脂蛋白AI(apoAI)-静脉血: 1.64g/L；血红蛋白(Hb)-静脉血: 158g/L；有核红细胞百分比(NRBC%)-静脉血: 0；促黄体生成素(LH)-静脉血: 6.12mIU/ml；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.87mmol/L；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 弱阳性(±)（参考: 阴性）；天门冬氨酸氨基转移酶(AST)-静脉血: 17.6U/L；总胆汁酸(TBA)-静脉血: 1umol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.4pg；大血小板百分比(P-LCR%)-静脉血: 35.7%；胱抑素(Cys-C)-静脉血: 1.56mg/L；白蛋白(ALB)-静脉血: 45.2g/L；甘油三酯(TG)-静脉血: 1.3mmol/L；白细胞计数(WBC#)-静脉血: 9.310E9/L；红细胞计数(RBC#)-静脉血: 5.3710E12/L；单核细胞百分比(Mono%)-静脉血: 0.008；中性粒细胞计数(Neut#)-静脉血: 8.710E9/L；乳酸脱氢酶(LDH)-静脉血: 181.6U/L；总蛋白(TP)-静脉血: 70.8g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.9mmolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.02；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；催乳素(PRL)-静脉血: 308.5uIU/ml；中性粒细胞百分比(Neut%)-静脉血: 0.939；有核红细胞计数(NRBC#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 33.6；促卵泡刺激素(FSH)-静脉血: 9.93mIU/ml；钾离子(K+)-静脉血: 4.53mmol/L；镁离子(Mg2+)-静脉血: 0.89mmol/L；平均血小板体积(MPV)-静脉血: 11.3fL；碱性磷酸酶(ALP)-静脉血: 87.4U/L；总胆红素(TBIL)-静脉血: 22.5umol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=1.50)（参考: 阴性）；尿酸(UA)-静脉血: 385.9umol/L；EB……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D7] 首次病程记录；首次病程记录: 病程类型: 首次病程记录；病程主题: 首次病程记录；病程内容: 病历特点：1、患者中年男性。2、患者于某次就诊时间1月无明显诱因下出现头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，患者于至[机构已隐去]就诊，行鼻咽活检病理，并送我院病理会诊示鼻咽分化型非角化性癌。某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。现患者为进一步诊治，予收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。3、体查：张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约1cm*0.8cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）示图：4、辅助检查：（1） 某次就诊时间在我医院（病理号：[记录编号已隐去]）鼻咽活检病理示：（鼻咽肿物）镜检为分化型非角化性癌（2） 某次就诊时间在我院胸片检查：心肺未见异常。（3） 某次就诊时间在我院腹部B超检查：肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。（4） 某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。副鼻窦炎、左侧乳突炎。（6）某次就诊时间我院：VCA-IgA 1:160 EA-IgA 1:20EBV-DNA定性检测：2.14E102copy/ml。 诊断依据： 初步诊断： 鉴别诊断：患者诊断明确，无需鉴别诊断。 诊疗计划：1、完善相关检查如全身骨扫描、血常规、生化等。2、诱导化疗及同期化放疗。\n- [全程D8] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者诉间有头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，无面麻、声嘶。[姓名已隐去]医生信息已隐藏示：嘱患者今日完善全身骨扫描检查，排除骨转移征象，治疗上暂给予对症处理，继续观察病情。\n- [全程D9] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日患者症状体征基本同前，无诉其余特殊不适。[姓名已隐去]医生信息已隐藏后指示：某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，最大短径约8mm，均匀强化。骨ECT示鼻咽部、颅底骨代谢较活跃，考虑NPC所致。胸片、腹部B超排除远处转移。故目前临床诊断明确为“鼻咽分化型非角化性癌[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)，治疗方案定为TPF（多西紫杉醇 60mg/m2 + 顺铂 60mg/m2 + 5-FU 2.5g/m2， q21d）诱导化疗3程后再行同期放化疗，放疗采用IMRT技术，同期化疗采用顺铂 60mg/m2（q21d）2程。并指示化疗期间给予护肝、护胃、止吐及营养支持治疗。已向患者及家属交代病情及治疗相关不良反应后，其表示理解，并同意上述治疗方案。拟明日开始行多西紫杉醇化疗，密切观察患者病情变化。\n- [全程D12] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 患者今日TPF方案化疗第3天，现一般情况可，未诉恶心、呕吐、腹痛、腹泻等不适，大小便正常。[姓名已隐去]医生信息已隐藏出，患者目前一般情况可，可继续化疗。注意化疗结束后复查血、生化常规，及时对症处理。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 停止本周期化疗，给予粒细胞集落刺激因子及抗感染支持治疗，并完善脑垂体激素五项检查。\nB. 继续本周期化疗，给予止吐、护肝及静脉营养等支持治疗，并完善甲状腺功能及皮质醇检查。\nC. 停止本周期化疗，给予大剂量水化、碱化尿液及利尿处理，并完善脑垂体激素五项检查。\nD. 继续本周期化疗，给予止吐、护胃及静脉营养支持治疗，暂不进行内分泌功能相关检查。\nE. 提前结束本周期化疗，给予全静脉营养支持及强效止吐治疗，并完善脑垂体激素五项检查。\nF. 继续本周期化疗，给予止吐、护肝及静脉营养支持治疗，同时行腰椎穿刺脑脊液常规及生化检查。\nG. 结束本周期化疗，给予预防性抗感染及护肝支持治疗，并完善脑垂体激素五项检查。\nH. 继续本周期化疗，给予止吐及肠内营养支持治疗，避免静脉营养，并复查鼻咽及垂体增强MRI。\nI. 暂停氟尿嘧啶持续静脉滴注，给予口腔局部镇痛及促进黏膜愈合处理，并完善脑垂体激素五项检查。\nJ. 继续本周期化疗，给予止吐、护肝支持治疗，暂不予静脉营养，并请内分泌科急会诊。\nK. 结束本周期化疗，给予止吐、护肝及静脉营养支持治疗，并于次日开始局部区域调强放疗。\nL. 继续本周期化疗，给予止吐、护肝及静脉营养等支持治疗，并完善脑垂体激素五项检查。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-efbe1e2a6ec0abf3be38883f","patient_id":"patient-eecadcdf172a1efe8947b052","turn_id":"turn07","turn_position":4,"turn_type":"response_assessment_decision","gold_letter":"B","gold_action":"评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行根治性同期放化疗。","options":[{"letter":"A","text":"评估诱导化疗疗效为疾病稳定，继续原方案第4程诱导化疗，并予以静脉补钾、补钠及护肾治疗后出院。","is_gold":false},{"letter":"B","text":"评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行根治性同期放化疗。","is_gold":true},{"letter":"C","text":"评估诱导化疗疗效为完全缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行单纯根治性放疗。","is_gold":false},{"letter":"D","text":"评估诱导化疗疗效为部分缓解，予以静脉补钾、补钠及护肾治疗，待电解质及肾功能恢复正常后立即开始第4程诱导化疗。","is_gold":false},{"letter":"E","text":"评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行单纯根治性放疗。","is_gold":false},{"letter":"F","text":"评估诱导化疗疗效为疾病进展，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院更改为GP方案化疗。","is_gold":false},{"letter":"G","text":"评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行根治性放疗联合靶向治疗。","is_gold":false},{"letter":"H","text":"评估诱导化疗疗效为部分缓解，因出现肾功能损害，予以护肾治疗后出院，并安排按期返院行单纯根治性放疗，取消同期化疗。","is_gold":false},{"letter":"I","text":"评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行姑息性放化疗。","is_gold":false},{"letter":"J","text":"评估诱导化疗疗效为部分缓解，予以静脉补钾、补钠及护肾治疗，住院期间直接开始根治性同期放化疗。","is_gold":false},{"letter":"K","text":"评估诱导化疗疗效为疾病稳定，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行根治性同期放化疗。","is_gold":false},{"letter":"L","text":"评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行鼻咽及颈部淋巴结清扫术。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N1，M0。\n综合TNM状态：T4N1M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D7] 入院记录: 主诉: 头痛伴耳鸣、听力下降3月余。；颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。今患者为进一步诊治，予收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,双咽后淋巴结肿大,头痛；既往史: 否认\"乙肝、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认饮酒史。否认不洁性生活史。；家族史: 患者叔叔因肺癌死亡。；体格检查: T：36.2℃，P：82次/分，R：20次/分，BP：128/74mmHg,Ht：172cm，Wt：80kg，BSA：1.92m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无叩痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约1cm*0.8cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）；KPS: 90；ECOG:\n- [全程D7] 入院记录: 主诉: 头痛伴耳鸣、听力下降3月余。；现病史: 患者于某次就诊时间1月无明显诱因下出现头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，患者于至[机构已隐去]就诊，行鼻咽活检病理，并送我院病理会诊示鼻咽分化型非角化性癌。某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。今患者为进一步诊治，予收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,双咽后淋巴结肿大,头痛；既往史: 否认\"乙肝、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认饮酒史。否认不洁性生活史。；家族史: 患者叔叔因肺癌死亡。；体格检查: T：36.2℃，P：82次/分，R：20次/分，BP：128/74mmHg,Ht：172cm，Wt：80kg，BSA：1.92m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率82次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无叩痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约1cm*0.8cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）；KPS: 90；ECOG:\n- [全程D53] 入院记录: 主诉: 鼻咽癌2程诱导化疗后20天。；现病史: 患者于某次就诊时间1月无明显诱因下出现头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，患者于至[机构已隐去]就诊，行鼻咽活检，并送我院病理会诊示鼻咽分化型非角化性癌。某次就诊时间在我院行鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶；颅底骨质破坏；双侧咽后淋巴结肿大，考虑转移；双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。明确诊断为鼻咽分化型非角化性癌，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)。于某次就诊时间、某次就诊时间行TPF化疗（DOC 60mg/m2+DDP 60mg/m2+5-FU 2.5g/m2civ48h）2程诱导化疗，化疗过程顺利。今患者为行第3程诱导化疗收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,双咽后淋巴结肿大,头痛；既往史: 否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认饮酒史。否认不洁性生活史。；家族史: 患者叔叔因肺癌死亡。；体格检查: T：36.5℃，P：88次/分，R：20次/分，BP：134/63mmHg,Ht：172cm，Wt：76kg，BSA：1.88m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率88次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无叩痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射……\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 早期复极改变\n- [全程D0] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.6；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:20（参考: 阴性）；活化部分凝血活酶时间(APTT)-静脉血: 23.1sec.；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；血红蛋白(Hb)-静脉血: 158g/L；血小板比容-静脉血: 26%；氯离子(Cl-)-静脉血: 105.3mmol/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 1.04；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；尿酸(UA)-静脉血: 341umol/L；甘油三酯(TG)-静脉血: 1.27mmol/L；总蛋白(TP)-静脉血: 73.53g/L；尿素氮(BUN)-静脉血: 6.35mmol/L；C-反应蛋白(CRP)-静脉血: 1.45mg/L；载脂蛋白B(apoB)-静脉血: 0.8g/L；总胆汁酸(TBA)-静脉血: 4.7umol/L；葡萄糖(Glu)-静脉血: 4.78mmol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；乳酸脱氢酶(LDH)-静脉血: 160.3U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；大血小板百分比(P-LCR%)-静脉血: 30.4%；中性粒细胞计数(Neut#)-静脉血: 6.410E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；丙氨酸氨基转移酶(ALT)-静脉血: 12.1U/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；ABO血型-静脉血: B；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.7fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；球蛋白(GLO)-静脉血: 28.23g/L；凝血酶时间(TT)-静脉血: 17.5sec.；红细胞计数(RBC#)-静脉血: 5.3710E12/L；平均红细胞体积(MCV)-静脉血: 87fL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.17mmolL；磷(P)-静脉血: 1.03mmol/L；总钙(Ca)-……\n- [全程D3] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理稍粗，未见明确实质性病变。双侧肺门不大，纵隔居中、无增宽。双膈形态正常。双侧肋膈角锐利。心影形态、大小、位置未见异常。；检查结论: 心肺未见明显异常。\n- [全程D3] 超声；双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约11cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约37×31×26mm，包膜光滑，实质回声不均匀，可见强回声斑。 腹主动脉旁未见明确肿物回声。；检查结论: 前列腺钙化。 肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、左侧壁见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强后明显强化，肿物占据鼻咽顶壁、左侧咽隐窝、左侧咽后间隙，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，右侧咽隐窝变浅，右侧咽旁脂肪间隙及颈动脉鞘区未见异常。 左侧腭帆张提肌及左侧头长肌受侵，右侧腭帆提肌、腭帆张肌、头长肌未见受侵征象。 双侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽双侧壁未见增厚。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部、翼突内外板、左侧枕骨基底部及左侧枕骨髁骨质信号减低，增强扫描后明显强化，斜坡局部见不规则软组织肿物影累及斜坡后份脑膜及蝶鞍后份，部分层面与垂体后叶分界欠清。双侧海绵窦形态正常，未见增宽。筛窦、蝶窦、左侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 左侧咽后间隙见肿大淋巴结，大小约为11mm ×9 mm，右侧咽后见肿大淋巴结，短径约6mm，均匀强化。 双颈I、II区见多个淋巴结，边界清，信号均匀，最大短径约8mm，均匀强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。 颅底骨质破坏。 双侧咽后淋巴结肿大，考虑转移。 双颈Ib、II区小淋巴结，性质待定。 副鼻窦炎、左侧乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D7] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；载脂蛋白AI(apoAI)-静脉血: 1.41g/L；总蛋白(TP)-静脉血: 72.8g/L；肌酐(Crea)-静脉血: 96.4umol/L；总胆红素(TBIL)-静脉血: 10.3umol/L；血小板比容-静脉血: 26%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；尿素氮(BUN)-静脉血: 5.6mmol/L；白细胞计数(WBC#)-尿液: 1/μL；钠离子(Na+)-静脉血: 140.2mmol/L；颜色-尿液: Light-Yellow；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.2mmolL；C-反应蛋白(CRP)-静脉血: 1.6mg/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；乳酸脱氢酶(LDH)-静脉血: 148.2U/L；总胆固醇(TC)-静脉血: 4.78mmol/L；总蛋白(TP)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 5/μL；平均血小板体积(MPV)-静脉血: 10.8fL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 345g/L；总钙(Ca)-静脉血: 2.34mmol/L；甘油三酯(TG)-静脉血: 1.84mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.34；胱抑素(Cys-C)-静脉血: 0.97mg/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.8U/L；红细胞计数(RBC#)-静脉血: 5.3810E12/L；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；单核细胞百分比(Mono%)-静脉血: 0.065；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.76；血液二氧化碳含量ctCO2(B)-静脉血: 24.3mmol/L；红细胞计数(RBC#)-尿液: 4/μL；间接胆红素(IBIL)-静脉血: 7umolL；浊度(TRUB)-尿液: clear；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.026；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；血小板计数(PLT#)-静脉血: 24610E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；颜色-粪便: 棕色；载脂蛋白……\n- [全程D11] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于第7胸椎椎体右侧水平，估计导管末端位于上腔静脉中-下段交界处。；检查结论: 导管末端位置如上述。\n- [全程D14] 检验组合: α-L-岩藻糖苷酶(AFU)-静脉血: 38.9U/L；载脂蛋白AI(apoAI)-静脉血: 1.64g/L；血红蛋白(Hb)-静脉血: 158g/L；有核红细胞百分比(NRBC%)-静脉血: 0；促黄体生成素(LH)-静脉血: 6.12mIU/ml；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.87mmol/L；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 弱阳性(±)（参考: 阴性）；天门冬氨酸氨基转移酶(AST)-静脉血: 17.6U/L；总胆汁酸(TBA)-静脉血: 1umol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.4pg；大血小板百分比(P-LCR%)-静脉血: 35.7%；胱抑素(Cys-C)-静脉血: 1.56mg/L；白蛋白(ALB)-静脉血: 45.2g/L；甘油三酯(TG)-静脉血: 1.3mmol/L；白细胞计数(WBC#)-静脉血: 9.310E9/L；红细胞计数(RBC#)-静脉血: 5.3710E12/L；单核细胞百分比(Mono%)-静脉血: 0.008；中性粒细胞计数(Neut#)-静脉血: 8.710E9/L；乳酸脱氢酶(LDH)-静脉血: 181.6U/L；总蛋白(TP)-静脉血: 70.8g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.9mmolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.02；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；催乳素(PRL)-静脉血: 308.5uIU/ml；中性粒细胞百分比(Neut%)-静脉血: 0.939；有核红细胞计数(NRBC#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 33.6；促卵泡刺激素(FSH)-静脉血: 9.93mIU/ml；钾离子(K+)-静脉血: 4.53mmol/L；镁离子(Mg2+)-静脉血: 0.89mmol/L；平均血小板体积(MPV)-静脉血: 11.3fL；碱性磷酸酶(ALP)-静脉血: 87.4U/L；总胆红素(TBIL)-静脉血: 22.5umol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=1.50)（参考: 阴性）；尿酸(UA)-静脉血: 385.9umol/L；EB……\n- [全程D38] 检验组合: α-L-岩藻糖苷酶(AFU)-静脉血: 31.3U/L；氯离子(Cl-)-静脉血: 90.1mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.85mmol/L；胱抑素(Cys-C)-静脉血: 1.22mg/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.8mmol/L；钾离子(K+)-静脉血: 3.66mmol/L；总胆汁酸(TBA)-静脉血: 2.2umol/L；甘油三酯(TG)-静脉血: 2.25mmol/L；肌酐(Crea)-静脉血: 108.2umol/L；总钙(Ca)-静脉血: 2.23mmol/L；C-反应蛋白(CRP)-静脉血: 0.28mg/L；钠离子(Na+)-静脉血: 129.2mmol/L；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阴性(-)（参考: 阴性）；球蛋白(GLO)-静脉血: 21.3g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.69mmolL；间接胆红素(IBIL)-静脉血: 16umolL；总胆固醇(TC)-静脉血: 6.95mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 27.8U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.73；白蛋白(ALB)-静脉血: 40.8g/L；总蛋白(TP)-静脉血: 62.1g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.92；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；尿素氮(BUN)-静脉血: 11.7mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=1.25)（参考: 阴性）；尿酸(UA)-静脉血: 368.1umol/L；总胆红素(TBIL)-静脉血: 20.1umol/L；乳酸脱氢酶(LDH)-静脉血: 167U/L；阴离子间隙(AG)-静脉血: 16.3；载脂蛋白B(apoB)-静脉血: 1.3g/L；EB病毒Zta蛋白抗体IgA(EBV-Zta-IgA)-静脉血: 阴性(-)（参考: 阴性）；葡萄糖(Glu)-静脉血: 4.91mmol/L；磷(P)-静脉血: 1.13mmol/L；直接胆……\n- [全程D53] 检验组合: 钠离子(Na+)-静脉血: 142.5mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 29.9U/L；乳酸脱氢酶(LDH)-静脉血: 207.9U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.6；血小板分布宽度(PDW)-静脉血: 10.8%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.035；间接胆红素(IBIL)-静脉血: 5.54umolL；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；天门冬氨酸氨基转移酶(AST)-静脉血: 18.5U/L；磷(P)-静脉血: 0.96mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.04；肌酐(Crea)-静脉血: 102umol/L；甘油三酯(TG)-静脉血: 1.26mmol/L；单核细胞百分比(Mono%)-静脉血: 0.09；大血小板百分比(P-LCR%)-静脉血: 22.6%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；C-反应蛋白(CRP)-静脉血: 0.69mg/L；血红蛋白(Hb)-静脉血: 134g/L；平均红细胞体积(MCV)-静脉血: 86.7fL；平均血小板体积(MPV)-静脉血: 9.7fL；单核细胞计数(Mono#)-静脉血: 0.610E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.009；有核红细胞计数(NRBC#)-静脉血: 010E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.13mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.22；葡萄糖(Glu)-静脉血: 4.43mmol/L；载脂蛋白B(apoB)-静脉血: 1.26g/L；载脂蛋白AI(apoAI)-静脉血: 1.74g/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 332g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.3mmol/L；氯离子(Cl-)-静脉血: 99.6mmol/L；尿酸(UA)-静脉血: 362.4umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.53mmolL；直接胆红素(DBIL)-静脉血: 1.88umol/L；红细胞比容(Hct)-静脉血: 40.4%；总胆固醇(TC)-静脉血: 6.07mmol/L；总钙(Ca)-静脉血:……\n- [全程D59] 检验组合: 平均红细胞体积(MCV)-静脉血: 82fL；大血小板百分比(P-LCR%)-静脉血: 36.3%；有核红细胞百分比(NRBC%)-静脉血: 0；血小板分布宽度(PDW)-静脉血: 15.9%；血小板比容-静脉血: 15%；白细胞计数(WBC#)-静脉血: 4.2710E9/L；血小板计数(PLT#)-静脉血: 13510E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.351；红细胞比容(Hct)-静脉血: 37.9%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.002；有核红细胞计数(NRBC#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 133g/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.631；单核细胞计数(Mono#)-静脉血: 0.110E9/L；红细胞计数(RBC#)-静脉血: 4.6210E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；平均红细胞血红蛋白浓度(MCHC)-静脉血: 351g/L；平均血小板体积(MPV)-静脉血: 11.4fL；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.7；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；单核细胞百分比(Mono%)-静脉血: 0.014；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L\n- [全程D60] 检验组合: 阴离子间隙(AG)-静脉血: 17.3；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=1.25)（参考: 阴性）；胱抑素(Cys-C)-静脉血: 1.21mg/L；氯离子(Cl-)-静脉血: 90.7mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 35.4U/L；载脂蛋白AI(apoAI)-静脉血: 1.83g/L；钠离子(Na+)-静脉血: 130.8mmol/L；总胆红素(TBIL)-静脉血: 20.2umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.8mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；球蛋白(GLO)-静脉血: 22.01g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.03；丙氨酸氨基转移酶(ALT)-静脉血: 24.3U/L；白蛋白(ALB)-静脉血: 44.6g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.5U/L；载脂蛋白B(apoB)-静脉血: 1.33g/L；碱性磷酸酶(ALP)-静脉血: 78.3U/L；葡萄糖(Glu)-静脉血: 5.06mmol/L；磷(P)-静脉血: 1mmol/L；总钙(Ca)-静脉血: 2.29mmol/L；尿酸(UA)-静脉血: 326.1umol/L；总胆汁酸(TBA)-静脉血: 2.7umol/L；总胆固醇(TC)-静脉血: 7.06mmol/L；C-反应蛋白(CRP)-静脉血: 0.2mg/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.72；直接胆红素(DBIL)-静脉血: 4.4umol/L；镁离子(Mg2+)-静脉血: 0.72mmol/L；EB病毒Zta蛋白抗体IgA(EBV-Zta-IgA)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.71mmolL；总蛋白(TP)-静脉血: 66.61g/L；甘油三酯(TG)-静脉血: 2.92mmol/L；肌酐(Crea)-静脉血: 112.8umol/L；尿素氮(BUN)-静脉血: 10.2mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.……\n- [全程D61] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后复查，较某次就诊时间片对比： 鼻咽腔未见明显狭窄，鼻咽左侧壁粘膜稍增厚，T1WI呈等信号，T2WI呈稍高信号，增强后明显强化，左侧咽隐窝变浅，右侧咽隐窝清晰，双侧咽旁脂肪间隙及颈动脉鞘区未见异常。鼻咽肿物较前明显缩小好转。 左侧腭帆张提肌及左侧头长肌稍肿胀，右侧腭帆提肌、腭帆张肌、头长肌未见受侵征象。 双侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽双侧壁未见增厚，双侧后鼻孔未见肿物。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部、翼突内外板、左侧枕骨基底部及左侧枕骨髁骨质信号减低，增强扫描后明显强化。双侧海绵窦形态正常，未见增宽。左侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧咽后见小淋巴结，最大短径约5 mm。 双颈I、II区见多个淋巴结，边界清，信号均匀，最大短径约7mm，均匀强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗后复查，较某次就诊时间片对比： 鼻咽肿物较前明显缩小好转，累及范围较前缩小。 颅底骨质破坏同前。 双侧咽后淋巴结较前缩小。 双颈I、II区小淋巴结，较前稍缩小。 左侧乳突炎。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D7] 首次病程记录；首次病程记录: 病程类型: 首次病程记录；病程主题: 首次病程记录；病程内容: 病历特点：1、患者中年男性。2、患者于某次就诊时间1月无明显诱因下出现头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，患者于至[机构已隐去]就诊，行鼻咽活检病理，并送我院病理会诊示鼻咽分化型非角化性癌。某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。现患者为进一步诊治，予收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。3、体查：张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约1cm*0.8cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）示图：4、辅助检查：（1） 某次就诊时间在我医院（病理号：[记录编号已隐去]）鼻咽活检病理示：（鼻咽肿物）镜检为分化型非角化性癌（2） 某次就诊时间在我院胸片检查：心肺未见异常。（3） 某次就诊时间在我院腹部B超检查：肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。（4） 某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。副鼻窦炎、左侧乳突炎。（6）某次就诊时间我院：VCA-IgA 1:160 EA-IgA 1:20EBV-DNA定性检测：2.14E102copy/ml。 诊断依据： 初步诊断： 鉴别诊断：患者诊断明确，无需鉴别诊断。 诊疗计划：1、完善相关检查如全身骨扫描、血常规、生化等。2、诱导化疗及同期化放疗。\n- [全程D8] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者诉间有头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，无面麻、声嘶。[姓名已隐去]医生信息已隐藏示：嘱患者今日完善全身骨扫描检查，排除骨转移征象，治疗上暂给予对症处理，继续观察病情。\n- [全程D9] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日患者症状体征基本同前，无诉其余特殊不适。[姓名已隐去]医生信息已隐藏后指示：某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，最大短径约8mm，均匀强化。骨ECT示鼻咽部、颅底骨代谢较活跃，考虑NPC所致。胸片、腹部B超排除远处转移。故目前临床诊断明确为“鼻咽分化型非角化性癌[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)，治疗方案定为TPF（多西紫杉醇 60mg/m2 + 顺铂 60mg/m2 + 5-FU 2.5g/m2， q21d）诱导化疗3程后再行同期放化疗，放疗采用IMRT技术，同期化疗采用顺铂 60mg/m2（q21d）2程。并指示化疗期间给予护肝、护胃、止吐及营养支持治疗。已向患者及家属交代病情及治疗相关不良反应后，其表示理解，并同意上述治疗方案。拟明日开始行多西紫杉醇化疗，密切观察患者病情变化。\n- [全程D12] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 患者今日TPF方案化疗第3天，现一般情况可，未诉恶心、呕吐、腹痛、腹泻等不适，大小便正常。[姓名已隐去]医生信息已隐藏出，患者目前一般情况可，可继续化疗。注意化疗结束后复查血、生化常规，及时对症处理。\n- [全程D53] 首次病程记录；首次病程记录: 病程类型: 首次病程记录；病程主题: 首次病程记录；病程内容: 病历特点：1、患者中年男性。2、患者于某次就诊时间1月无明显诱因下出现头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，患者于至[机构已隐去]就诊，行鼻咽活检，并送我院病理会诊示鼻咽分化型非角化性癌。某次就诊时间在我院行鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶；颅底骨质破坏；双侧咽后淋巴结肿大，考虑转移；双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。明确诊断为鼻咽分化型非角化性癌，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)。于某次就诊时间、某次就诊时间行TPF化疗（DOC 60mg/m2+DDP 60mg/m2+5-FU 2.5g/m2civ48h）2程诱导化疗，化疗过程顺利。今患者为行第3程诱导化疗收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。3、体查：张口门齿距5cm；鼻咽肿物较前明显消退；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约0.8cm*0.5cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）。4、辅助检查：（1） 某次就诊时间在我医院（病理号：[记录编号已隐去]）鼻咽活检病理示：（鼻咽肿物）镜检为分化型非角化性癌（2） 某次就诊时间在我院胸片检查：心肺未见异常。（3） 某次就诊时间在我院腹部B超检查：肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。（4） 某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。副鼻窦炎、左侧乳突炎。（6） 某次就诊时间我院：VCA-IgA 1:160 EA-IgA 1:20 EBV-DNA定性检测：2.14E102copy/ml 诊断依据： 初步诊断： 鉴别诊断：诊断明确，暂无需鉴别。 诊疗计划：1、完善相关检查如三大常规、电子鼻咽镜等。2、综合治疗。\n- [全程D54] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日随[姓名已隐去]医生信息已隐藏，详细询问病史并查体后，分析病情如下：1、患者中年男性，因“鼻咽癌2程诱导化疗后20天”入院。2、查体：张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约0.8cm*0.5cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）。3、辅助检查：某次就诊时间在我医院（病理号：[记录编号已隐去]）鼻咽活检病理示：（鼻咽肿物）镜检为分化型非角化性癌。某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。副鼻窦炎、左侧乳突炎。综上述，患者诊断鼻咽分化型非角化性癌，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)。[姓名已隐去]医生信息已隐藏，患者现一般情况可。昨日复查血常规及生化常规未见明显异常，拟今日开始行第3程诱导化疗，注意防治化疗相关毒副反应。\n- [全程D55] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日随[姓名已隐去]医生信息已隐藏，详细询问病史并查体后，分析病情如下：1、患者中年男性，因“鼻咽癌2程诱导化疗后20天”入院。2、查体：张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约0.8cm*0.5cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）。3、辅助检查：某次就诊时间在我医院（病理号：[记录编号已隐去]）鼻咽活检病理示：（鼻咽肿物）镜检为分化型非角化性癌。某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。副鼻窦炎、左侧乳突炎。综上述，患者诊断鼻咽分化型非角化性癌，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)。[姓名已隐去]医生信息已隐藏，患者现一般情况可。化疗前复查血常规及生化常规未见明显异常，于昨日开始行第3程诱导化疗，注意水化、护胃止呕、营养补液等对症支持治疗。\n- [全程D58] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日TPF方案化疗第5天，现一般情况可，未诉恶心、呕吐、腹痛、腹泻等不适，大小便正常。[姓名已隐去]主治医师，患者目前一般情况可，可继续化疗。注意化疗结束后复查血、生化常规，及时对症处理。\n- [全程D60] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日已完成第3程TPF方案（多西紫杉醇 60mg/m2 + DDP 60mg/m2 + 5-Fu 2.5g/m2）诱导化疗，未诉特殊不适。2/5复查血常规结果基本正常，今日复查血生化结果示：K+ 3.13↓ mmol/L，Na+ 130.8↓ mmol/L，IBIL 15.80 ↑ umolL，CRE 112.8↑ umol/L。[姓名已隐去]医生信息已隐藏示：患者现已完成化疗，今日可带口服补钾、护肝及护肾药物出院。嘱患者注意休息，加强营养，口服补钠，每周复查血常规、肝肾功能。按期返院开始同期放化疗，不适时随诊。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估诱导化疗疗效为疾病稳定，继续原方案第4程诱导化疗，并予以静脉补钾、补钠及护肾治疗后出院。\nB. 评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行根治性同期放化疗。\nC. 评估诱导化疗疗效为完全缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行单纯根治性放疗。\nD. 评估诱导化疗疗效为部分缓解，予以静脉补钾、补钠及护肾治疗，待电解质及肾功能恢复正常后立即开始第4程诱导化疗。\nE. 评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行单纯根治性放疗。\nF. 评估诱导化疗疗效为疾病进展，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院更改为GP方案化疗。\nG. 评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行根治性放疗联合靶向治疗。\nH. 评估诱导化疗疗效为部分缓解，因出现肾功能损害，予以护肾治疗后出院，并安排按期返院行单纯根治性放疗，取消同期化疗。\nI. 评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行姑息性放化疗。\nJ. 评估诱导化疗疗效为部分缓解，予以静脉补钾、补钠及护肾治疗，住院期间直接开始根治性同期放化疗。\nK. 评估诱导化疗疗效为疾病稳定，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行根治性同期放化疗。\nL. 评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行鼻咽及颈部淋巴结清扫术。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N1，M0。\n综合TNM状态：T4N1M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D7] 入院记录: 主诉: 头痛伴耳鸣、听力下降3月余。；颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。今患者为进一步诊治，予收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,双咽后淋巴结肿大,头痛；既往史: 否认\"乙肝、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认饮酒史。否认不洁性生活史。；家族史: 患者叔叔因肺癌死亡。；体格检查: T：36.2℃，P：82次/分，R：20次/分，BP：128/74mmHg,Ht：172cm，Wt：80kg，BSA：1.92m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无叩痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约1cm*0.8cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）；KPS: 90；ECOG:\n- [全程D7] 入院记录: 主诉: 头痛伴耳鸣、听力下降3月余。；现病史: 患者于某次就诊时间1月无明显诱因下出现头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，患者于至[机构已隐去]就诊，行鼻咽活检病理，并送我院病理会诊示鼻咽分化型非角化性癌。某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。今患者为进一步诊治，予收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,双咽后淋巴结肿大,头痛；既往史: 否认\"乙肝、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认饮酒史。否认不洁性生活史。；家族史: 患者叔叔因肺癌死亡。；体格检查: T：36.2℃，P：82次/分，R：20次/分，BP：128/74mmHg,Ht：172cm，Wt：80kg，BSA：1.92m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率82次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无叩痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约1cm*0.8cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）；KPS: 90；ECOG:\n- [全程D53] 入院记录: 主诉: 鼻咽癌2程诱导化疗后20天。；现病史: 患者于某次就诊时间1月无明显诱因下出现头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，患者于至[机构已隐去]就诊，行鼻咽活检，并送我院病理会诊示鼻咽分化型非角化性癌。某次就诊时间在我院行鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶；颅底骨质破坏；双侧咽后淋巴结肿大，考虑转移；双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。明确诊断为鼻咽分化型非角化性癌，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)。于某次就诊时间、某次就诊时间行TPF化疗（DOC 60mg/m2+DDP 60mg/m2+5-FU 2.5g/m2civ48h）2程诱导化疗，化疗过程顺利。今患者为行第3程诱导化疗收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,双咽后淋巴结肿大,头痛；既往史: 否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认饮酒史。否认不洁性生活史。；家族史: 患者叔叔因肺癌死亡。；体格检查: T：36.5℃，P：88次/分，R：20次/分，BP：134/63mmHg,Ht：172cm，Wt：76kg，BSA：1.88m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率88次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无叩痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射……\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 早期复极改变\n- [全程D0] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.6；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:20（参考: 阴性）；活化部分凝血活酶时间(APTT)-静脉血: 23.1sec.；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；血红蛋白(Hb)-静脉血: 158g/L；血小板比容-静脉血: 26%；氯离子(Cl-)-静脉血: 105.3mmol/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 1.04；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；尿酸(UA)-静脉血: 341umol/L；甘油三酯(TG)-静脉血: 1.27mmol/L；总蛋白(TP)-静脉血: 73.53g/L；尿素氮(BUN)-静脉血: 6.35mmol/L；C-反应蛋白(CRP)-静脉血: 1.45mg/L；载脂蛋白B(apoB)-静脉血: 0.8g/L；总胆汁酸(TBA)-静脉血: 4.7umol/L；葡萄糖(Glu)-静脉血: 4.78mmol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；乳酸脱氢酶(LDH)-静脉血: 160.3U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；大血小板百分比(P-LCR%)-静脉血: 30.4%；中性粒细胞计数(Neut#)-静脉血: 6.410E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；丙氨酸氨基转移酶(ALT)-静脉血: 12.1U/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；ABO血型-静脉血: B；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.7fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；球蛋白(GLO)-静脉血: 28.23g/L；凝血酶时间(TT)-静脉血: 17.5sec.；红细胞计数(RBC#)-静脉血: 5.3710E12/L；平均红细胞体积(MCV)-静脉血: 87fL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.17mmolL；磷(P)-静脉血: 1.03mmol/L；总钙(Ca)-……\n- [全程D3] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理稍粗，未见明确实质性病变。双侧肺门不大，纵隔居中、无增宽。双膈形态正常。双侧肋膈角锐利。心影形态、大小、位置未见异常。；检查结论: 心肺未见明显异常。\n- [全程D3] 超声；双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约11cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约37×31×26mm，包膜光滑，实质回声不均匀，可见强回声斑。 腹主动脉旁未见明确肿物回声。；检查结论: 前列腺钙化。 肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、左侧壁见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强后明显强化，肿物占据鼻咽顶壁、左侧咽隐窝、左侧咽后间隙，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，右侧咽隐窝变浅，右侧咽旁脂肪间隙及颈动脉鞘区未见异常。 左侧腭帆张提肌及左侧头长肌受侵，右侧腭帆提肌、腭帆张肌、头长肌未见受侵征象。 双侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽双侧壁未见增厚。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部、翼突内外板、左侧枕骨基底部及左侧枕骨髁骨质信号减低，增强扫描后明显强化，斜坡局部见不规则软组织肿物影累及斜坡后份脑膜及蝶鞍后份，部分层面与垂体后叶分界欠清。双侧海绵窦形态正常，未见增宽。筛窦、蝶窦、左侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 左侧咽后间隙见肿大淋巴结，大小约为11mm ×9 mm，右侧咽后见肿大淋巴结，短径约6mm，均匀强化。 双颈I、II区见多个淋巴结，边界清，信号均匀，最大短径约8mm，均匀强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。 颅底骨质破坏。 双侧咽后淋巴结肿大，考虑转移。 双颈Ib、II区小淋巴结，性质待定。 副鼻窦炎、左侧乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D7] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；载脂蛋白AI(apoAI)-静脉血: 1.41g/L；总蛋白(TP)-静脉血: 72.8g/L；肌酐(Crea)-静脉血: 96.4umol/L；总胆红素(TBIL)-静脉血: 10.3umol/L；血小板比容-静脉血: 26%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；尿素氮(BUN)-静脉血: 5.6mmol/L；白细胞计数(WBC#)-尿液: 1/μL；钠离子(Na+)-静脉血: 140.2mmol/L；颜色-尿液: Light-Yellow；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.2mmolL；C-反应蛋白(CRP)-静脉血: 1.6mg/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；乳酸脱氢酶(LDH)-静脉血: 148.2U/L；总胆固醇(TC)-静脉血: 4.78mmol/L；总蛋白(TP)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 5/μL；平均血小板体积(MPV)-静脉血: 10.8fL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 345g/L；总钙(Ca)-静脉血: 2.34mmol/L；甘油三酯(TG)-静脉血: 1.84mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.34；胱抑素(Cys-C)-静脉血: 0.97mg/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.8U/L；红细胞计数(RBC#)-静脉血: 5.3810E12/L；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；单核细胞百分比(Mono%)-静脉血: 0.065；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.76；血液二氧化碳含量ctCO2(B)-静脉血: 24.3mmol/L；红细胞计数(RBC#)-尿液: 4/μL；间接胆红素(IBIL)-静脉血: 7umolL；浊度(TRUB)-尿液: clear；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.026；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；血小板计数(PLT#)-静脉血: 24610E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；颜色-粪便: 棕色；载脂蛋白……\n- [全程D11] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于第7胸椎椎体右侧水平，估计导管末端位于上腔静脉中-下段交界处。；检查结论: 导管末端位置如上述。\n- [全程D14] 检验组合: α-L-岩藻糖苷酶(AFU)-静脉血: 38.9U/L；载脂蛋白AI(apoAI)-静脉血: 1.64g/L；血红蛋白(Hb)-静脉血: 158g/L；有核红细胞百分比(NRBC%)-静脉血: 0；促黄体生成素(LH)-静脉血: 6.12mIU/ml；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.87mmol/L；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 弱阳性(±)（参考: 阴性）；天门冬氨酸氨基转移酶(AST)-静脉血: 17.6U/L；总胆汁酸(TBA)-静脉血: 1umol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.4pg；大血小板百分比(P-LCR%)-静脉血: 35.7%；胱抑素(Cys-C)-静脉血: 1.56mg/L；白蛋白(ALB)-静脉血: 45.2g/L；甘油三酯(TG)-静脉血: 1.3mmol/L；白细胞计数(WBC#)-静脉血: 9.310E9/L；红细胞计数(RBC#)-静脉血: 5.3710E12/L；单核细胞百分比(Mono%)-静脉血: 0.008；中性粒细胞计数(Neut#)-静脉血: 8.710E9/L；乳酸脱氢酶(LDH)-静脉血: 181.6U/L；总蛋白(TP)-静脉血: 70.8g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.9mmolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.02；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；催乳素(PRL)-静脉血: 308.5uIU/ml；中性粒细胞百分比(Neut%)-静脉血: 0.939；有核红细胞计数(NRBC#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 33.6；促卵泡刺激素(FSH)-静脉血: 9.93mIU/ml；钾离子(K+)-静脉血: 4.53mmol/L；镁离子(Mg2+)-静脉血: 0.89mmol/L；平均血小板体积(MPV)-静脉血: 11.3fL；碱性磷酸酶(ALP)-静脉血: 87.4U/L；总胆红素(TBIL)-静脉血: 22.5umol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=1.50)（参考: 阴性）；尿酸(UA)-静脉血: 385.9umol/L；EB……\n- [全程D38] 检验组合: α-L-岩藻糖苷酶(AFU)-静脉血: 31.3U/L；氯离子(Cl-)-静脉血: 90.1mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.85mmol/L；胱抑素(Cys-C)-静脉血: 1.22mg/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.8mmol/L；钾离子(K+)-静脉血: 3.66mmol/L；总胆汁酸(TBA)-静脉血: 2.2umol/L；甘油三酯(TG)-静脉血: 2.25mmol/L；肌酐(Crea)-静脉血: 108.2umol/L；总钙(Ca)-静脉血: 2.23mmol/L；C-反应蛋白(CRP)-静脉血: 0.28mg/L；钠离子(Na+)-静脉血: 129.2mmol/L；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阴性(-)（参考: 阴性）；球蛋白(GLO)-静脉血: 21.3g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.69mmolL；间接胆红素(IBIL)-静脉血: 16umolL；总胆固醇(TC)-静脉血: 6.95mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 27.8U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.73；白蛋白(ALB)-静脉血: 40.8g/L；总蛋白(TP)-静脉血: 62.1g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.92；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；尿素氮(BUN)-静脉血: 11.7mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=1.25)（参考: 阴性）；尿酸(UA)-静脉血: 368.1umol/L；总胆红素(TBIL)-静脉血: 20.1umol/L；乳酸脱氢酶(LDH)-静脉血: 167U/L；阴离子间隙(AG)-静脉血: 16.3；载脂蛋白B(apoB)-静脉血: 1.3g/L；EB病毒Zta蛋白抗体IgA(EBV-Zta-IgA)-静脉血: 阴性(-)（参考: 阴性）；葡萄糖(Glu)-静脉血: 4.91mmol/L；磷(P)-静脉血: 1.13mmol/L；直接胆……\n- [全程D53] 检验组合: 钠离子(Na+)-静脉血: 142.5mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 29.9U/L；乳酸脱氢酶(LDH)-静脉血: 207.9U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.6；血小板分布宽度(PDW)-静脉血: 10.8%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.035；间接胆红素(IBIL)-静脉血: 5.54umolL；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；天门冬氨酸氨基转移酶(AST)-静脉血: 18.5U/L；磷(P)-静脉血: 0.96mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.04；肌酐(Crea)-静脉血: 102umol/L；甘油三酯(TG)-静脉血: 1.26mmol/L；单核细胞百分比(Mono%)-静脉血: 0.09；大血小板百分比(P-LCR%)-静脉血: 22.6%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；C-反应蛋白(CRP)-静脉血: 0.69mg/L；血红蛋白(Hb)-静脉血: 134g/L；平均红细胞体积(MCV)-静脉血: 86.7fL；平均血小板体积(MPV)-静脉血: 9.7fL；单核细胞计数(Mono#)-静脉血: 0.610E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.009；有核红细胞计数(NRBC#)-静脉血: 010E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.13mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.22；葡萄糖(Glu)-静脉血: 4.43mmol/L；载脂蛋白B(apoB)-静脉血: 1.26g/L；载脂蛋白AI(apoAI)-静脉血: 1.74g/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 332g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.3mmol/L；氯离子(Cl-)-静脉血: 99.6mmol/L；尿酸(UA)-静脉血: 362.4umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.53mmolL；直接胆红素(DBIL)-静脉血: 1.88umol/L；红细胞比容(Hct)-静脉血: 40.4%；总胆固醇(TC)-静脉血: 6.07mmol/L；总钙(Ca)-静脉血:……\n- [全程D59] 检验组合: 平均红细胞体积(MCV)-静脉血: 82fL；大血小板百分比(P-LCR%)-静脉血: 36.3%；有核红细胞百分比(NRBC%)-静脉血: 0；血小板分布宽度(PDW)-静脉血: 15.9%；血小板比容-静脉血: 15%；白细胞计数(WBC#)-静脉血: 4.2710E9/L；血小板计数(PLT#)-静脉血: 13510E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.351；红细胞比容(Hct)-静脉血: 37.9%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.002；有核红细胞计数(NRBC#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 133g/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.631；单核细胞计数(Mono#)-静脉血: 0.110E9/L；红细胞计数(RBC#)-静脉血: 4.6210E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；平均红细胞血红蛋白浓度(MCHC)-静脉血: 351g/L；平均血小板体积(MPV)-静脉血: 11.4fL；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.7；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；单核细胞百分比(Mono%)-静脉血: 0.014；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L\n- [全程D60] 检验组合: 阴离子间隙(AG)-静脉血: 17.3；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=1.25)（参考: 阴性）；胱抑素(Cys-C)-静脉血: 1.21mg/L；氯离子(Cl-)-静脉血: 90.7mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 35.4U/L；载脂蛋白AI(apoAI)-静脉血: 1.83g/L；钠离子(Na+)-静脉血: 130.8mmol/L；总胆红素(TBIL)-静脉血: 20.2umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.8mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；球蛋白(GLO)-静脉血: 22.01g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.03；丙氨酸氨基转移酶(ALT)-静脉血: 24.3U/L；白蛋白(ALB)-静脉血: 44.6g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.5U/L；载脂蛋白B(apoB)-静脉血: 1.33g/L；碱性磷酸酶(ALP)-静脉血: 78.3U/L；葡萄糖(Glu)-静脉血: 5.06mmol/L；磷(P)-静脉血: 1mmol/L；总钙(Ca)-静脉血: 2.29mmol/L；尿酸(UA)-静脉血: 326.1umol/L；总胆汁酸(TBA)-静脉血: 2.7umol/L；总胆固醇(TC)-静脉血: 7.06mmol/L；C-反应蛋白(CRP)-静脉血: 0.2mg/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.72；直接胆红素(DBIL)-静脉血: 4.4umol/L；镁离子(Mg2+)-静脉血: 0.72mmol/L；EB病毒Zta蛋白抗体IgA(EBV-Zta-IgA)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.71mmolL；总蛋白(TP)-静脉血: 66.61g/L；甘油三酯(TG)-静脉血: 2.92mmol/L；肌酐(Crea)-静脉血: 112.8umol/L；尿素氮(BUN)-静脉血: 10.2mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.……\n- [全程D61] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后复查，较某次就诊时间片对比： 鼻咽腔未见明显狭窄，鼻咽左侧壁粘膜稍增厚，T1WI呈等信号，T2WI呈稍高信号，增强后明显强化，左侧咽隐窝变浅，右侧咽隐窝清晰，双侧咽旁脂肪间隙及颈动脉鞘区未见异常。鼻咽肿物较前明显缩小好转。 左侧腭帆张提肌及左侧头长肌稍肿胀，右侧腭帆提肌、腭帆张肌、头长肌未见受侵征象。 双侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽双侧壁未见增厚，双侧后鼻孔未见肿物。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部、翼突内外板、左侧枕骨基底部及左侧枕骨髁骨质信号减低，增强扫描后明显强化。双侧海绵窦形态正常，未见增宽。左侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧咽后见小淋巴结，最大短径约5 mm。 双颈I、II区见多个淋巴结，边界清，信号均匀，最大短径约7mm，均匀强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗后复查，较某次就诊时间片对比： 鼻咽肿物较前明显缩小好转，累及范围较前缩小。 颅底骨质破坏同前。 双侧咽后淋巴结较前缩小。 双颈I、II区小淋巴结，较前稍缩小。 左侧乳突炎。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D7] 首次病程记录；首次病程记录: 病程类型: 首次病程记录；病程主题: 首次病程记录；病程内容: 病历特点：1、患者中年男性。2、患者于某次就诊时间1月无明显诱因下出现头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，患者于至[机构已隐去]就诊，行鼻咽活检病理，并送我院病理会诊示鼻咽分化型非角化性癌。某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。现患者为进一步诊治，予收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。3、体查：张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约1cm*0.8cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）示图：4、辅助检查：（1） 某次就诊时间在我医院（病理号：[记录编号已隐去]）鼻咽活检病理示：（鼻咽肿物）镜检为分化型非角化性癌（2） 某次就诊时间在我院胸片检查：心肺未见异常。（3） 某次就诊时间在我院腹部B超检查：肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。（4） 某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。副鼻窦炎、左侧乳突炎。（6）某次就诊时间我院：VCA-IgA 1:160 EA-IgA 1:20EBV-DNA定性检测：2.14E102copy/ml。 诊断依据： 初步诊断： 鉴别诊断：患者诊断明确，无需鉴别诊断。 诊疗计划：1、完善相关检查如全身骨扫描、血常规、生化等。2、诱导化疗及同期化放疗。\n- [全程D8] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者诉间有头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，无面麻、声嘶。[姓名已隐去]医生信息已隐藏示：嘱患者今日完善全身骨扫描检查，排除骨转移征象，治疗上暂给予对症处理，继续观察病情。\n- [全程D9] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日患者症状体征基本同前，无诉其余特殊不适。[姓名已隐去]医生信息已隐藏后指示：某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，最大短径约8mm，均匀强化。骨ECT示鼻咽部、颅底骨代谢较活跃，考虑NPC所致。胸片、腹部B超排除远处转移。故目前临床诊断明确为“鼻咽分化型非角化性癌[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)，治疗方案定为TPF（多西紫杉醇 60mg/m2 + 顺铂 60mg/m2 + 5-FU 2.5g/m2， q21d）诱导化疗3程后再行同期放化疗，放疗采用IMRT技术，同期化疗采用顺铂 60mg/m2（q21d）2程。并指示化疗期间给予护肝、护胃、止吐及营养支持治疗。已向患者及家属交代病情及治疗相关不良反应后，其表示理解，并同意上述治疗方案。拟明日开始行多西紫杉醇化疗，密切观察患者病情变化。\n- [全程D12] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 患者今日TPF方案化疗第3天，现一般情况可，未诉恶心、呕吐、腹痛、腹泻等不适，大小便正常。[姓名已隐去]医生信息已隐藏出，患者目前一般情况可，可继续化疗。注意化疗结束后复查血、生化常规，及时对症处理。\n- [全程D53] 首次病程记录；首次病程记录: 病程类型: 首次病程记录；病程主题: 首次病程记录；病程内容: 病历特点：1、患者中年男性。2、患者于某次就诊时间1月无明显诱因下出现头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，患者于至[机构已隐去]就诊，行鼻咽活检，并送我院病理会诊示鼻咽分化型非角化性癌。某次就诊时间在我院行鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶；颅底骨质破坏；双侧咽后淋巴结肿大，考虑转移；双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。明确诊断为鼻咽分化型非角化性癌，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)。于某次就诊时间、某次就诊时间行TPF化疗（DOC 60mg/m2+DDP 60mg/m2+5-FU 2.5g/m2civ48h）2程诱导化疗，化疗过程顺利。今患者为行第3程诱导化疗收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。3、体查：张口门齿距5cm；鼻咽肿物较前明显消退；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约0.8cm*0.5cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）。4、辅助检查：（1） 某次就诊时间在我医院（病理号：[记录编号已隐去]）鼻咽活检病理示：（鼻咽肿物）镜检为分化型非角化性癌（2） 某次就诊时间在我院胸片检查：心肺未见异常。（3） 某次就诊时间在我院腹部B超检查：肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。（4） 某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。副鼻窦炎、左侧乳突炎。（6） 某次就诊时间我院：VCA-IgA 1:160 EA-IgA 1:20 EBV-DNA定性检测：2.14E102copy/ml 诊断依据： 初步诊断： 鉴别诊断：诊断明确，暂无需鉴别。 诊疗计划：1、完善相关检查如三大常规、电子鼻咽镜等。2、综合治疗。\n- [全程D54] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日随[姓名已隐去]医生信息已隐藏，详细询问病史并查体后，分析病情如下：1、患者中年男性，因“鼻咽癌2程诱导化疗后20天”入院。2、查体：张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约0.8cm*0.5cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）。3、辅助检查：某次就诊时间在我医院（病理号：[记录编号已隐去]）鼻咽活检病理示：（鼻咽肿物）镜检为分化型非角化性癌。某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。副鼻窦炎、左侧乳突炎。综上述，患者诊断鼻咽分化型非角化性癌，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)。[姓名已隐去]医生信息已隐藏，患者现一般情况可。昨日复查血常规及生化常规未见明显异常，拟今日开始行第3程诱导化疗，注意防治化疗相关毒副反应。\n- [全程D55] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日随[姓名已隐去]医生信息已隐藏，详细询问病史并查体后，分析病情如下：1、患者中年男性，因“鼻咽癌2程诱导化疗后20天”入院。2、查体：张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约0.8cm*0.5cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）。3、辅助检查：某次就诊时间在我医院（病理号：[记录编号已隐去]）鼻咽活检病理示：（鼻咽肿物）镜检为分化型非角化性癌。某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。副鼻窦炎、左侧乳突炎。综上述，患者诊断鼻咽分化型非角化性癌，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)。[姓名已隐去]医生信息已隐藏，患者现一般情况可。化疗前复查血常规及生化常规未见明显异常，于昨日开始行第3程诱导化疗，注意水化、护胃止呕、营养补液等对症支持治疗。\n- [全程D58] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日TPF方案化疗第5天，现一般情况可，未诉恶心、呕吐、腹痛、腹泻等不适，大小便正常。[姓名已隐去]主治医师，患者目前一般情况可，可继续化疗。注意化疗结束后复查血、生化常规，及时对症处理。\n- [全程D60] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日已完成第3程TPF方案（多西紫杉醇 60mg/m2 + DDP 60mg/m2 + 5-Fu 2.5g/m2）诱导化疗，未诉特殊不适。2/5复查血常规结果基本正常，今日复查血生化结果示：K+ 3.13↓ mmol/L，Na+ 130.8↓ mmol/L，IBIL 15.80 ↑ umolL，CRE 112.8↑ umol/L。[姓名已隐去]医生信息已隐藏示：患者现已完成化疗，今日可带口服补钾、护肝及护肾药物出院。嘱患者注意休息，加强营养，口服补钠，每周复查血常规、肝肾功能。按期返院开始同期放化疗，不适时随诊。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估诱导化疗疗效为疾病稳定，继续原方案第4程诱导化疗，并予以静脉补钾、补钠及护肾治疗后出院。\nB. 评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行根治性同期放化疗。\nC. 评估诱导化疗疗效为完全缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行单纯根治性放疗。\nD. 评估诱导化疗疗效为部分缓解，予以静脉补钾、补钠及护肾治疗，待电解质及肾功能恢复正常后立即开始第4程诱导化疗。\nE. 评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行单纯根治性放疗。\nF. 评估诱导化疗疗效为疾病进展，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院更改为GP方案化疗。\nG. 评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行根治性放疗联合靶向治疗。\nH. 评估诱导化疗疗效为部分缓解，因出现肾功能损害，予以护肾治疗后出院，并安排按期返院行单纯根治性放疗，取消同期化疗。\nI. 评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行姑息性放化疗。\nJ. 评估诱导化疗疗效为部分缓解，予以静脉补钾、补钠及护肾治疗，住院期间直接开始根治性同期放化疗。\nK. 评估诱导化疗疗效为疾病稳定，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行根治性同期放化疗。\nL. 评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行鼻咽及颈部淋巴结清扫术。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-a1bcb1dd845b682149871b63","patient_id":"patient-eecadcdf172a1efe8947b052","turn_id":"turn08","turn_position":5,"turn_type":"response_assessment_decision","gold_letter":"C","gold_action":"完善EB病毒DNA定量及EBV抗体（VCA-IgA、EA-IgA）检测，继续定期随访观察。","options":[{"letter":"A","text":"完善鼻咽及颈部MRI检查，暂缓EB病毒DNA及抗体检测。","is_gold":false},{"letter":"B","text":"安排全身PET-CT检查，替代常规影像学及EB病毒相关指标随访。","is_gold":false},{"letter":"C","text":"完善EB病毒DNA定量及EBV抗体（VCA-IgA、EA-IgA）检测，继续定期随访观察。","is_gold":true},{"letter":"D","text":"完善胸部增强CT及全身骨扫描，暂缓EB病毒DNA定量检测。","is_gold":false},{"letter":"E","text":"延长随访间隔至每半年一次，仅复查腹部彩超及血常规。","is_gold":false},{"letter":"F","text":"安排鼻内镜检查并常规行鼻咽部组织活检，复查EB病毒DNA。","is_gold":false},{"letter":"G","text":"给予抗病毒药物治疗以降低EBV-VCA-IgA滴度，继续随访观察。","is_gold":false},{"letter":"H","text":"启动卡培他滨节拍维持治疗，并每半年复查EB病毒DNA定量。","is_gold":false},{"letter":"I","text":"完善鼻咽及颈部CT平扫，替代MRI及EB病毒DNA定量检测。","is_gold":false},{"letter":"J","text":"安排双侧颈部淋巴结彩超检查，暂缓EB病毒相关指标检测。","is_gold":false},{"letter":"K","text":"启动PD-1抑制剂免疫维持治疗，并定期复查EB病毒DNA定量。","is_gold":false},{"letter":"L","text":"完善头颅增强MRI检查，暂缓鼻咽部及颈部影像学评估。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N1，M0。\n综合TNM状态：T4N1M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D7] 入院记录: 主诉: 头痛伴耳鸣、听力下降3月余。；颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。今患者为进一步诊治，予收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,双咽后淋巴结肿大,头痛；既往史: 否认\"乙肝、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认饮酒史。否认不洁性生活史。；家族史: 患者叔叔因肺癌死亡。；体格检查: T：36.2℃，P：82次/分，R：20次/分，BP：128/74mmHg,Ht：172cm，Wt：80kg，BSA：1.92m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无叩痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约1cm*0.8cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）；KPS: 90；ECOG:\n- [全程D7] 入院记录: 主诉: 头痛伴耳鸣、听力下降3月余。；现病史: 患者于某次就诊时间1月无明显诱因下出现头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，患者于至[机构已隐去]就诊，行鼻咽活检病理，并送我院病理会诊示鼻咽分化型非角化性癌。某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。今患者为进一步诊治，予收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,双咽后淋巴结肿大,头痛；既往史: 否认\"乙肝、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认饮酒史。否认不洁性生活史。；家族史: 患者叔叔因肺癌死亡。；体格检查: T：36.2℃，P：82次/分，R：20次/分，BP：128/74mmHg,Ht：172cm，Wt：80kg，BSA：1.92m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率82次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无叩痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约1cm*0.8cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）；KPS: 90；ECOG:\n- [全程D53] 入院记录: 主诉: 鼻咽癌2程诱导化疗后20天。；现病史: 患者于某次就诊时间1月无明显诱因下出现头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，患者于至[机构已隐去]就诊，行鼻咽活检，并送我院病理会诊示鼻咽分化型非角化性癌。某次就诊时间在我院行鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶；颅底骨质破坏；双侧咽后淋巴结肿大，考虑转移；双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。明确诊断为鼻咽分化型非角化性癌，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)。于某次就诊时间、某次就诊时间行TPF化疗（DOC 60mg/m2+DDP 60mg/m2+5-FU 2.5g/m2civ48h）2程诱导化疗，化疗过程顺利。今患者为行第3程诱导化疗收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,双咽后淋巴结肿大,头痛；既往史: 否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认饮酒史。否认不洁性生活史。；家族史: 患者叔叔因肺癌死亡。；体格检查: T：36.5℃，P：88次/分，R：20次/分，BP：134/63mmHg,Ht：172cm，Wt：76kg，BSA：1.88m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率88次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无叩痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射……\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 早期复极改变\n- [全程D0] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.6；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:20（参考: 阴性）；活化部分凝血活酶时间(APTT)-静脉血: 23.1sec.；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；血红蛋白(Hb)-静脉血: 158g/L；血小板比容-静脉血: 26%；氯离子(Cl-)-静脉血: 105.3mmol/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 1.04；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；尿酸(UA)-静脉血: 341umol/L；甘油三酯(TG)-静脉血: 1.27mmol/L；总蛋白(TP)-静脉血: 73.53g/L；尿素氮(BUN)-静脉血: 6.35mmol/L；C-反应蛋白(CRP)-静脉血: 1.45mg/L；载脂蛋白B(apoB)-静脉血: 0.8g/L；总胆汁酸(TBA)-静脉血: 4.7umol/L；葡萄糖(Glu)-静脉血: 4.78mmol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；乳酸脱氢酶(LDH)-静脉血: 160.3U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；大血小板百分比(P-LCR%)-静脉血: 30.4%；中性粒细胞计数(Neut#)-静脉血: 6.410E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；丙氨酸氨基转移酶(ALT)-静脉血: 12.1U/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；ABO血型-静脉血: B；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.7fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；球蛋白(GLO)-静脉血: 28.23g/L；凝血酶时间(TT)-静脉血: 17.5sec.；红细胞计数(RBC#)-静脉血: 5.3710E12/L；平均红细胞体积(MCV)-静脉血: 87fL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.17mmolL；磷(P)-静脉血: 1.03mmol/L；总钙(Ca)-……\n- [全程D3] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理稍粗，未见明确实质性病变。双侧肺门不大，纵隔居中、无增宽。双膈形态正常。双侧肋膈角锐利。心影形态、大小、位置未见异常。；检查结论: 心肺未见明显异常。\n- [全程D3] 超声；双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约11cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约37×31×26mm，包膜光滑，实质回声不均匀，可见强回声斑。 腹主动脉旁未见明确肿物回声。；检查结论: 前列腺钙化。 肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、左侧壁见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强后明显强化，肿物占据鼻咽顶壁、左侧咽隐窝、左侧咽后间隙，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，右侧咽隐窝变浅，右侧咽旁脂肪间隙及颈动脉鞘区未见异常。 左侧腭帆张提肌及左侧头长肌受侵，右侧腭帆提肌、腭帆张肌、头长肌未见受侵征象。 双侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽双侧壁未见增厚。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部、翼突内外板、左侧枕骨基底部及左侧枕骨髁骨质信号减低，增强扫描后明显强化，斜坡局部见不规则软组织肿物影累及斜坡后份脑膜及蝶鞍后份，部分层面与垂体后叶分界欠清。双侧海绵窦形态正常，未见增宽。筛窦、蝶窦、左侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 左侧咽后间隙见肿大淋巴结，大小约为11mm ×9 mm，右侧咽后见肿大淋巴结，短径约6mm，均匀强化。 双颈I、II区见多个淋巴结，边界清，信号均匀，最大短径约8mm，均匀强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。 颅底骨质破坏。 双侧咽后淋巴结肿大，考虑转移。 双颈Ib、II区小淋巴结，性质待定。 副鼻窦炎、左侧乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D7] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；载脂蛋白AI(apoAI)-静脉血: 1.41g/L；总蛋白(TP)-静脉血: 72.8g/L；肌酐(Crea)-静脉血: 96.4umol/L；总胆红素(TBIL)-静脉血: 10.3umol/L；血小板比容-静脉血: 26%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；尿素氮(BUN)-静脉血: 5.6mmol/L；白细胞计数(WBC#)-尿液: 1/μL；钠离子(Na+)-静脉血: 140.2mmol/L；颜色-尿液: Light-Yellow；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.2mmolL；C-反应蛋白(CRP)-静脉血: 1.6mg/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；乳酸脱氢酶(LDH)-静脉血: 148.2U/L；总胆固醇(TC)-静脉血: 4.78mmol/L；总蛋白(TP)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 5/μL；平均血小板体积(MPV)-静脉血: 10.8fL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 345g/L；总钙(Ca)-静脉血: 2.34mmol/L；甘油三酯(TG)-静脉血: 1.84mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.34；胱抑素(Cys-C)-静脉血: 0.97mg/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.8U/L；红细胞计数(RBC#)-静脉血: 5.3810E12/L；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；单核细胞百分比(Mono%)-静脉血: 0.065；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.76；血液二氧化碳含量ctCO2(B)-静脉血: 24.3mmol/L；红细胞计数(RBC#)-尿液: 4/μL；间接胆红素(IBIL)-静脉血: 7umolL；浊度(TRUB)-尿液: clear；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.026；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；血小板计数(PLT#)-静脉血: 24610E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；颜色-粪便: 棕色；载脂蛋白……\n- [全程D11] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于第7胸椎椎体右侧水平，估计导管末端位于上腔静脉中-下段交界处。；检查结论: 导管末端位置如上述。\n- [全程D14] 检验组合: α-L-岩藻糖苷酶(AFU)-静脉血: 38.9U/L；载脂蛋白AI(apoAI)-静脉血: 1.64g/L；血红蛋白(Hb)-静脉血: 158g/L；有核红细胞百分比(NRBC%)-静脉血: 0；促黄体生成素(LH)-静脉血: 6.12mIU/ml；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.87mmol/L；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 弱阳性(±)（参考: 阴性）；天门冬氨酸氨基转移酶(AST)-静脉血: 17.6U/L；总胆汁酸(TBA)-静脉血: 1umol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.4pg；大血小板百分比(P-LCR%)-静脉血: 35.7%；胱抑素(Cys-C)-静脉血: 1.56mg/L；白蛋白(ALB)-静脉血: 45.2g/L；甘油三酯(TG)-静脉血: 1.3mmol/L；白细胞计数(WBC#)-静脉血: 9.310E9/L；红细胞计数(RBC#)-静脉血: 5.3710E12/L；单核细胞百分比(Mono%)-静脉血: 0.008；中性粒细胞计数(Neut#)-静脉血: 8.710E9/L；乳酸脱氢酶(LDH)-静脉血: 181.6U/L；总蛋白(TP)-静脉血: 70.8g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.9mmolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.02；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；催乳素(PRL)-静脉血: 308.5uIU/ml；中性粒细胞百分比(Neut%)-静脉血: 0.939；有核红细胞计数(NRBC#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 33.6；促卵泡刺激素(FSH)-静脉血: 9.93mIU/ml；钾离子(K+)-静脉血: 4.53mmol/L；镁离子(Mg2+)-静脉血: 0.89mmol/L；平均血小板体积(MPV)-静脉血: 11.3fL；碱性磷酸酶(ALP)-静脉血: 87.4U/L；总胆红素(TBIL)-静脉血: 22.5umol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=1.50)（参考: 阴性）；尿酸(UA)-静脉血: 385.9umol/L；EB……\n- [全程D38] 检验组合: α-L-岩藻糖苷酶(AFU)-静脉血: 31.3U/L；氯离子(Cl-)-静脉血: 90.1mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.85mmol/L；胱抑素(Cys-C)-静脉血: 1.22mg/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.8mmol/L；钾离子(K+)-静脉血: 3.66mmol/L；总胆汁酸(TBA)-静脉血: 2.2umol/L；甘油三酯(TG)-静脉血: 2.25mmol/L；肌酐(Crea)-静脉血: 108.2umol/L；总钙(Ca)-静脉血: 2.23mmol/L；C-反应蛋白(CRP)-静脉血: 0.28mg/L；钠离子(Na+)-静脉血: 129.2mmol/L；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阴性(-)（参考: 阴性）；球蛋白(GLO)-静脉血: 21.3g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.69mmolL；间接胆红素(IBIL)-静脉血: 16umolL；总胆固醇(TC)-静脉血: 6.95mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 27.8U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.73；白蛋白(ALB)-静脉血: 40.8g/L；总蛋白(TP)-静脉血: 62.1g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.92；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；尿素氮(BUN)-静脉血: 11.7mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=1.25)（参考: 阴性）；尿酸(UA)-静脉血: 368.1umol/L；总胆红素(TBIL)-静脉血: 20.1umol/L；乳酸脱氢酶(LDH)-静脉血: 167U/L；阴离子间隙(AG)-静脉血: 16.3；载脂蛋白B(apoB)-静脉血: 1.3g/L；EB病毒Zta蛋白抗体IgA(EBV-Zta-IgA)-静脉血: 阴性(-)（参考: 阴性）；葡萄糖(Glu)-静脉血: 4.91mmol/L；磷(P)-静脉血: 1.13mmol/L；直接胆……\n- [全程D53] 检验组合: 钠离子(Na+)-静脉血: 142.5mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 29.9U/L；乳酸脱氢酶(LDH)-静脉血: 207.9U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.6；血小板分布宽度(PDW)-静脉血: 10.8%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.035；间接胆红素(IBIL)-静脉血: 5.54umolL；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；天门冬氨酸氨基转移酶(AST)-静脉血: 18.5U/L；磷(P)-静脉血: 0.96mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.04；肌酐(Crea)-静脉血: 102umol/L；甘油三酯(TG)-静脉血: 1.26mmol/L；单核细胞百分比(Mono%)-静脉血: 0.09；大血小板百分比(P-LCR%)-静脉血: 22.6%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；C-反应蛋白(CRP)-静脉血: 0.69mg/L；血红蛋白(Hb)-静脉血: 134g/L；平均红细胞体积(MCV)-静脉血: 86.7fL；平均血小板体积(MPV)-静脉血: 9.7fL；单核细胞计数(Mono#)-静脉血: 0.610E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.009；有核红细胞计数(NRBC#)-静脉血: 010E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.13mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.22；葡萄糖(Glu)-静脉血: 4.43mmol/L；载脂蛋白B(apoB)-静脉血: 1.26g/L；载脂蛋白AI(apoAI)-静脉血: 1.74g/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 332g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.3mmol/L；氯离子(Cl-)-静脉血: 99.6mmol/L；尿酸(UA)-静脉血: 362.4umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.53mmolL；直接胆红素(DBIL)-静脉血: 1.88umol/L；红细胞比容(Hct)-静脉血: 40.4%；总胆固醇(TC)-静脉血: 6.07mmol/L；总钙(Ca)-静脉血:……\n- [全程D59] 检验组合: 平均红细胞体积(MCV)-静脉血: 82fL；大血小板百分比(P-LCR%)-静脉血: 36.3%；有核红细胞百分比(NRBC%)-静脉血: 0；血小板分布宽度(PDW)-静脉血: 15.9%；血小板比容-静脉血: 15%；白细胞计数(WBC#)-静脉血: 4.2710E9/L；血小板计数(PLT#)-静脉血: 13510E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.351；红细胞比容(Hct)-静脉血: 37.9%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.002；有核红细胞计数(NRBC#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 133g/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.631；单核细胞计数(Mono#)-静脉血: 0.110E9/L；红细胞计数(RBC#)-静脉血: 4.6210E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；平均红细胞血红蛋白浓度(MCHC)-静脉血: 351g/L；平均血小板体积(MPV)-静脉血: 11.4fL；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.7；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；单核细胞百分比(Mono%)-静脉血: 0.014；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L\n- [全程D60] 检验组合: 阴离子间隙(AG)-静脉血: 17.3；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=1.25)（参考: 阴性）；胱抑素(Cys-C)-静脉血: 1.21mg/L；氯离子(Cl-)-静脉血: 90.7mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 35.4U/L；载脂蛋白AI(apoAI)-静脉血: 1.83g/L；钠离子(Na+)-静脉血: 130.8mmol/L；总胆红素(TBIL)-静脉血: 20.2umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.8mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；球蛋白(GLO)-静脉血: 22.01g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.03；丙氨酸氨基转移酶(ALT)-静脉血: 24.3U/L；白蛋白(ALB)-静脉血: 44.6g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.5U/L；载脂蛋白B(apoB)-静脉血: 1.33g/L；碱性磷酸酶(ALP)-静脉血: 78.3U/L；葡萄糖(Glu)-静脉血: 5.06mmol/L；磷(P)-静脉血: 1mmol/L；总钙(Ca)-静脉血: 2.29mmol/L；尿酸(UA)-静脉血: 326.1umol/L；总胆汁酸(TBA)-静脉血: 2.7umol/L；总胆固醇(TC)-静脉血: 7.06mmol/L；C-反应蛋白(CRP)-静脉血: 0.2mg/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.72；直接胆红素(DBIL)-静脉血: 4.4umol/L；镁离子(Mg2+)-静脉血: 0.72mmol/L；EB病毒Zta蛋白抗体IgA(EBV-Zta-IgA)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.71mmolL；总蛋白(TP)-静脉血: 66.61g/L；甘油三酯(TG)-静脉血: 2.92mmol/L；肌酐(Crea)-静脉血: 112.8umol/L；尿素氮(BUN)-静脉血: 10.2mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.……\n- [全程D61] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后复查，较某次就诊时间片对比： 鼻咽腔未见明显狭窄，鼻咽左侧壁粘膜稍增厚，T1WI呈等信号，T2WI呈稍高信号，增强后明显强化，左侧咽隐窝变浅，右侧咽隐窝清晰，双侧咽旁脂肪间隙及颈动脉鞘区未见异常。鼻咽肿物较前明显缩小好转。 左侧腭帆张提肌及左侧头长肌稍肿胀，右侧腭帆提肌、腭帆张肌、头长肌未见受侵征象。 双侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽双侧壁未见增厚，双侧后鼻孔未见肿物。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部、翼突内外板、左侧枕骨基底部及左侧枕骨髁骨质信号减低，增强扫描后明显强化。双侧海绵窦形态正常，未见增宽。左侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧咽后见小淋巴结，最大短径约5 mm。 双颈I、II区见多个淋巴结，边界清，信号均匀，最大短径约7mm，均匀强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗后复查，较某次就诊时间片对比： 鼻咽肿物较前明显缩小好转，累及范围较前缩小。 颅底骨质破坏同前。 双侧咽后淋巴结较前缩小。 双颈I、II区小淋巴结，较前稍缩小。 左侧乳突炎。\n- [全程D99] 检验组合: 单核细胞计数(Mono#)-静脉血: 1.710E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；血小板分布宽度(PDW)-静脉血: 11.4%；大血小板百分比(P-LCR%)-静脉血: 29.1%；单核细胞百分比(Mono%)-静脉血: 0.093；平均红细胞体积(MCV)-静脉血: 88.1fL；红细胞比容(Hct)-静脉血: 29%；有核红细胞百分比(NRBC%)-静脉血: 0.1；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.9；嗜酸性粒细胞计数(Eos#)-静脉血: 0.410E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.022；白细胞计数(WBC#)-静脉血: 18.7210E9/L；红细胞计数(RBC#)-静脉血: 3.2910E12/L；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；血小板比容-静脉血: 12%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 48；血小板计数(PLT#)-静脉血: 11710E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 345g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.034；平均红细胞血红蛋白含量(MCH)-静脉血: 30.4pg；中性粒细胞计数(Neut#)-静脉血: 15.910E9/L；血红蛋白(Hb)-静脉血: 100g/L；中性粒细胞百分比(Neut%)-静脉血: 0.848；平均血小板体积(MPV)-静脉血: 10.7fL；有核红细胞计数(NRBC#)-静脉血: 0.0210E9/L\n- [全程D104] 检验组合: 钠离子(Na+)-静脉血: 136.2mmol/L；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；血小板分布宽度(PDW)-静脉血: 11.8%；葡萄糖(Glu)-静脉血: 6mmol/L；碱性磷酸酶(ALP)-静脉血: 59.8U/L；尿酸(UA)-静脉血: 486.4umol/L；尿素氮(BUN)-静脉血: 15mmol/L；直接胆红素(DBIL)-静脉血: 2.5umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；间接胆红素(IBIL)-静脉血: 7.3umolL；镁离子(Mg2+)-静脉血: 0.75mmol/L；血小板计数(PLT#)-静脉血: 15910E9/L；单核细胞百分比(Mono%)-静脉血: 0.081；平均血小板体积(MPV)-静脉血: 10.5fL；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.08mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.6；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；总胆固醇(TC)-静脉血: 6.02mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.899；血红蛋白(Hb)-静脉血: 107g/L；红细胞计数(RBC#)-静脉血: 3.5110E12/L；球蛋白(GLO)-静脉血: 20.38g/L；甘油三酯(TG)-静脉血: 1.26mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；大血小板百分比(P-LCR%)-静脉血: 29.3%；总钙(Ca)-静脉血: 2.37mmol/L；总胆汁酸(TBA)-静脉血: 0.8umol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.1；胱抑素(Cys-C)-静脉血: 1.67mg/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 358g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.01；α-L-岩藻糖苷酶(AFU)-静脉血: 31.2U/L；钾离子(K+)-静脉血: 3.53mmol/L；总蛋白(TP)-静脉血: 61.28g/L；天门冬氨酸氨基转移酶(AST)-静……\n- [全程D108] 检验组合: 总胆红素(TBIL)-静脉血: 13.8umol/L；总蛋白(TP)-静脉血: 57.11g/L；单核细胞百分比(Mono%)-静脉血: 0.048；球蛋白(GLO)-静脉血: 18.41g/L；尿素氮(BUN)-静脉血: 9.7mmol/L；间接胆红素(IBIL)-静脉血: 10.2umolL；碱性磷酸酶(ALP)-静脉血: 52.2U/L；胱抑素(Cys-C)-静脉血: 1.26mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.2mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1；肌酐(Crea)-静脉血: 85umol/L；尿酸(UA)-静脉血: 283umol/L；乳酸脱氢酶(LDH)-静脉血: 131.8U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 9.3U/L；红细胞计数(RBC#)-静脉血: 3.4610E12/L；C-反应蛋白(CRP)-静脉血: 1.53mg/L；阴离子间隙(AG)-静脉血: 15.1；平均血小板体积(MPV)-静脉血: 9.8fL；淋巴细胞百分比(Lymph%)-静脉血: 0.039；γ-谷氨酰基转移酶(GGT)-静脉血: 27.7U/L；镁离子(Mg2+)-静脉血: 0.65mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 367g/L；大血小板百分比(P-LCR%)-静脉血: 24.8%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 42.5；载脂蛋白AI(apoAI)-静脉血: 1.09g/L；白蛋白(ALB)-静脉血: 38.7g/L；总胆汁酸(TBA)-静脉血: 1.5umol/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；白细胞计数(WBC#)-静脉血: 8.2710E9/L；总胆固醇(TC)-静脉血: 6.03mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.21；氯离子(Cl-)-静脉血: 90.9mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 7.7U/L；血小板分布宽度(PDW)-静脉血: 11.2%；血液二氧化碳含量ctCO2(B)-静脉血: 21.1mmol/L；红细胞比容(Hct)-静脉血: 28.3%；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；中性粒细胞百……\n- [全程D116] 检验组合: 大血小板百分比(P-LCR%)-静脉血: 28.7%；载脂蛋白B(apoB)-静脉血: 1.55g/L；钠离子(Na+)-静脉血: 133.3mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 32.4U/L；胱抑素(Cys-C)-静脉血: 0.84mg/L；直接胆红素(DBIL)-静脉血: 3.2umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 348g/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；血小板比容-静脉血: 13%；平均红细胞体积(MCV)-静脉血: 86.3fL；尿素氮(BUN)-静脉血: 6.6mmol/L；磷(P)-静脉血: 1.15mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.4mmolL；有核红细胞百分比(NRBC%)-静脉血: 0；有核红细胞计数(NRBC#)-静脉血: 010E9/L；载脂蛋白AI(apoAI)-静脉血: 1.2g/L；总胆固醇(TC)-静脉血: 7.16mmol/L；甘油三酯(TG)-静脉血: 1.74mmol/L；总钙(Ca)-静脉血: 2.28mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 76.6umol/L；钾离子(K+)-静脉血: 3.01mmol/L；间接胆红素(IBIL)-静脉血: 10.4umolL；尿酸(UA)-静脉血: 216umol/L；镁离子(Mg2+)-静脉血: 0.56mmol/L；单核细胞百分比(Mono%)-静脉血: 0.065；红细胞计数(RBC#)-静脉血: 3.3610E12/L；天门冬氨酸氨基转移酶(AST)-静脉血: 9.4U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.053；血小板计数(PLT#)-静脉血: 12210E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.6；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；乳酸脱氢酶(LDH)-静脉血: 130.3U/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；中性粒细胞计数(Neut#)-静脉血: 4.410E9/L；C-反应蛋白(CRP)-静脉血: 6.72mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 5.32mmol/L；丙氨酸氨基转移酶(ALT)……\n- [全程D152] 检验组合: EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）\n- [全程D222] 超声；腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约21cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D222] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:80（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D7] 首次病程记录；首次病程记录: 病程类型: 首次病程记录；病程主题: 首次病程记录；病程内容: 病历特点：1、患者中年男性。2、患者于某次就诊时间1月无明显诱因下出现头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，患者于至[机构已隐去]就诊，行鼻咽活检病理，并送我院病理会诊示鼻咽分化型非角化性癌。某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。现患者为进一步诊治，予收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。3、体查：张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约1cm*0.8cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）示图：4、辅助检查：（1） 某次就诊时间在我医院（病理号：[记录编号已隐去]）鼻咽活检病理示：（鼻咽肿物）镜检为分化型非角化性癌（2） 某次就诊时间在我院胸片检查：心肺未见异常。（3） 某次就诊时间在我院腹部B超检查：肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。（4） 某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。副鼻窦炎、左侧乳突炎。（6）某次就诊时间我院：VCA-IgA 1:160 EA-IgA 1:20EBV-DNA定性检测：2.14E102copy/ml。 诊断依据： 初步诊断： 鉴别诊断：患者诊断明确，无需鉴别诊断。 诊疗计划：1、完善相关检查如全身骨扫描、血常规、生化等。2、诱导化疗及同期化放疗。\n- [全程D8] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者诉间有头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，无面麻、声嘶。[姓名已隐去]医生信息已隐藏示：嘱患者今日完善全身骨扫描检查，排除骨转移征象，治疗上暂给予对症处理，继续观察病情。\n- [全程D9] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日患者症状体征基本同前，无诉其余特殊不适。[姓名已隐去]医生信息已隐藏后指示：某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，最大短径约8mm，均匀强化。骨ECT示鼻咽部、颅底骨代谢较活跃，考虑NPC所致。胸片、腹部B超排除远处转移。故目前临床诊断明确为“鼻咽分化型非角化性癌[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)，治疗方案定为TPF（多西紫杉醇 60mg/m2 + 顺铂 60mg/m2 + 5-FU 2.5g/m2， q21d）诱导化疗3程后再行同期放化疗，放疗采用IMRT技术，同期化疗采用顺铂 60mg/m2（q21d）2程。并指示化疗期间给予护肝、护胃、止吐及营养支持治疗。已向患者及家属交代病情及治疗相关不良反应后，其表示理解，并同意上述治疗方案。拟明日开始行多西紫杉醇化疗，密切观察患者病情变化。\n- [全程D12] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 患者今日TPF方案化疗第3天，现一般情况可，未诉恶心、呕吐、腹痛、腹泻等不适，大小便正常。[姓名已隐去]医生信息已隐藏出，患者目前一般情况可，可继续化疗。注意化疗结束后复查血、生化常规，及时对症处理。\n- [全程D53] 首次病程记录；首次病程记录: 病程类型: 首次病程记录；病程主题: 首次病程记录；病程内容: 病历特点：1、患者中年男性。2、患者于某次就诊时间1月无明显诱因下出现头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，患者于至[机构已隐去]就诊，行鼻咽活检，并送我院病理会诊示鼻咽分化型非角化性癌。某次就诊时间在我院行鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶；颅底骨质破坏；双侧咽后淋巴结肿大，考虑转移；双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。明确诊断为鼻咽分化型非角化性癌，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)。于某次就诊时间、某次就诊时间行TPF化疗（DOC 60mg/m2+DDP 60mg/m2+5-FU 2.5g/m2civ48h）2程诱导化疗，化疗过程顺利。今患者为行第3程诱导化疗收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。3、体查：张口门齿距5cm；鼻咽肿物较前明显消退；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约0.8cm*0.5cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）。4、辅助检查：（1） 某次就诊时间在我医院（病理号：[记录编号已隐去]）鼻咽活检病理示：（鼻咽肿物）镜检为分化型非角化性癌（2） 某次就诊时间在我院胸片检查：心肺未见异常。（3） 某次就诊时间在我院腹部B超检查：肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。（4） 某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。副鼻窦炎、左侧乳突炎。（6） 某次就诊时间我院：VCA-IgA 1:160 EA-IgA 1:20 EBV-DNA定性检测：2.14E102copy/ml 诊断依据： 初步诊断： 鉴别诊断：诊断明确，暂无需鉴别。 诊疗计划：1、完善相关检查如三大常规、电子鼻咽镜等。2、综合治疗。\n- [全程D54] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日随[姓名已隐去]医生信息已隐藏，详细询问病史并查体后，分析病情如下：1、患者中年男性，因“鼻咽癌2程诱导化疗后20天”入院。2、查体：张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约0.8cm*0.5cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）。3、辅助检查：某次就诊时间在我医院（病理号：[记录编号已隐去]）鼻咽活检病理示：（鼻咽肿物）镜检为分化型非角化性癌。某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。副鼻窦炎、左侧乳突炎。综上述，患者诊断鼻咽分化型非角化性癌，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)。[姓名已隐去]医生信息已隐藏，患者现一般情况可。昨日复查血常规及生化常规未见明显异常，拟今日开始行第3程诱导化疗，注意防治化疗相关毒副反应。\n- [全程D55] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日随[姓名已隐去]医生信息已隐藏，详细询问病史并查体后，分析病情如下：1、患者中年男性，因“鼻咽癌2程诱导化疗后20天”入院。2、查体：张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约0.8cm*0.5cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）。3、辅助检查：某次就诊时间在我医院（病理号：[记录编号已隐去]）鼻咽活检病理示：（鼻咽肿物）镜检为分化型非角化性癌。某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。副鼻窦炎、左侧乳突炎。综上述，患者诊断鼻咽分化型非角化性癌，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)。[姓名已隐去]医生信息已隐藏，患者现一般情况可。化疗前复查血常规及生化常规未见明显异常，于昨日开始行第3程诱导化疗，注意水化、护胃止呕、营养补液等对症支持治疗。\n- [全程D58] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日TPF方案化疗第5天，现一般情况可，未诉恶心、呕吐、腹痛、腹泻等不适，大小便正常。[姓名已隐去]主治医师，患者目前一般情况可，可继续化疗。注意化疗结束后复查血、生化常规，及时对症处理。\n- [全程D60] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日已完成第3程TPF方案（多西紫杉醇 60mg/m2 + DDP 60mg/m2 + 5-Fu 2.5g/m2）诱导化疗，未诉特殊不适。2/5复查血常规结果基本正常，今日复查血生化结果示：K+ 3.13↓ mmol/L，Na+ 130.8↓ mmol/L，IBIL 15.80 ↑ umolL，CRE 112.8↑ umol/L。[姓名已隐去]医生信息已隐藏示：患者现已完成化疗，今日可带口服补钾、护肝及护肾药物出院。嘱患者注意休息，加强营养，口服补钠，每周复查血常规、肝肾功能。按期返院开始同期放化疗，不适时随诊。\n- [全程D104] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者放疗22次，诉中度咽痛，有干咳，感恶心，无呕吐，无畏寒、发热。查体大致同前。今日查血常规生化未见异常。[姓名已隐去]医生信息已隐藏，患者放化疗顺利，现继续予以加强护胃、护肝等营养支持对症治疗，定期复查血生化常规，严密观察病情变化。\n- [全程D108] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者诉乏力，无恶心、呕吐，仍有便秘。查体大致同前。今日查血生化提示：血钾3.06mmol/L，血钠127.1mmol/L。血常规提示血红蛋白稍低。[姓名已隐去]医生信息已隐藏后指示：患者放疗过程中，现血钾、血钠低，可予以加强补钾、补钠治疗，现继续放疗，加强支持对症治疗，严密观察病情变化。\n- [全程D111] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者放疗27次，诉有咳嗽、咳痰，大便未解。查体大致同前。[姓名已隐去]医生信息已隐藏，患者放疗进行中，现有咳嗽，予以加强祛痰处理，大便未解加强通便治疗。继续加强支持对症治疗，严密观察病情变化。\n- [全程D116] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者放疗30次，患者诉感乏力，咳嗽、咳痰症状较前改善，无畏寒、发热。查体大致同前。今日查血常规大致正常。生化提示血钠低、血钾低、血镁低。[姓名已隐去]医生信息已隐藏，患者生化提示血钾、血钠、血镁低，加强支持对症治疗，严密观察病情变化。\n- [全程D118] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日完成放疗。今日[姓名已隐去]医生信息已隐藏者诉轻度咽痛，胃纳一般，无恶心、呕吐，无发热、咳嗽、咳痰等，精神、睡眠一般，大小便正常。体查：张口门齿距4.5cm；鼻咽顶壁见肿物，较前明显消退；浅表淋巴结未及肿大，颅神经检查：（-）。口腔黏膜反应Ⅱ度，皮肤反应Ⅰ度。[姓名已隐去]医生信息已隐藏示：患者已结束放疗及同期化疗，过程顺利，现病情平稳，可予以出院，嘱患者注意休息，加强营养，出院后一个月内每周复查血常规、肝肾功能，出院后一个月返院复查，不适时随诊。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善鼻咽及颈部MRI检查，暂缓EB病毒DNA及抗体检测。\nB. 安排全身PET-CT检查，替代常规影像学及EB病毒相关指标随访。\nC. 完善EB病毒DNA定量及EBV抗体（VCA-IgA、EA-IgA）检测，继续定期随访观察。\nD. 完善胸部增强CT及全身骨扫描，暂缓EB病毒DNA定量检测。\nE. 延长随访间隔至每半年一次，仅复查腹部彩超及血常规。\nF. 安排鼻内镜检查并常规行鼻咽部组织活检，复查EB病毒DNA。\nG. 给予抗病毒药物治疗以降低EBV-VCA-IgA滴度，继续随访观察。\nH. 启动卡培他滨节拍维持治疗，并每半年复查EB病毒DNA定量。\nI. 完善鼻咽及颈部CT平扫，替代MRI及EB病毒DNA定量检测。\nJ. 安排双侧颈部淋巴结彩超检查，暂缓EB病毒相关指标检测。\nK. 启动PD-1抑制剂免疫维持治疗，并定期复查EB病毒DNA定量。\nL. 完善头颅增强MRI检查，暂缓鼻咽部及颈部影像学评估。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N1，M0。\n综合TNM状态：T4N1M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D7] 入院记录: 主诉: 头痛伴耳鸣、听力下降3月余。；颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。今患者为进一步诊治，予收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,双咽后淋巴结肿大,头痛；既往史: 否认\"乙肝、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认饮酒史。否认不洁性生活史。；家族史: 患者叔叔因肺癌死亡。；体格检查: T：36.2℃，P：82次/分，R：20次/分，BP：128/74mmHg,Ht：172cm，Wt：80kg，BSA：1.92m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无叩痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约1cm*0.8cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）；KPS: 90；ECOG:\n- [全程D7] 入院记录: 主诉: 头痛伴耳鸣、听力下降3月余。；现病史: 患者于某次就诊时间1月无明显诱因下出现头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，患者于至[机构已隐去]就诊，行鼻咽活检病理，并送我院病理会诊示鼻咽分化型非角化性癌。某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。今患者为进一步诊治，予收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,双咽后淋巴结肿大,头痛；既往史: 否认\"乙肝、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认饮酒史。否认不洁性生活史。；家族史: 患者叔叔因肺癌死亡。；体格检查: T：36.2℃，P：82次/分，R：20次/分，BP：128/74mmHg,Ht：172cm，Wt：80kg，BSA：1.92m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率82次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无叩痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约1cm*0.8cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）；KPS: 90；ECOG:\n- [全程D53] 入院记录: 主诉: 鼻咽癌2程诱导化疗后20天。；现病史: 患者于某次就诊时间1月无明显诱因下出现头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，患者于至[机构已隐去]就诊，行鼻咽活检，并送我院病理会诊示鼻咽分化型非角化性癌。某次就诊时间在我院行鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶；颅底骨质破坏；双侧咽后淋巴结肿大，考虑转移；双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。明确诊断为鼻咽分化型非角化性癌，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)。于某次就诊时间、某次就诊时间行TPF化疗（DOC 60mg/m2+DDP 60mg/m2+5-FU 2.5g/m2civ48h）2程诱导化疗，化疗过程顺利。今患者为行第3程诱导化疗收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,双咽后淋巴结肿大,头痛；既往史: 否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认饮酒史。否认不洁性生活史。；家族史: 患者叔叔因肺癌死亡。；体格检查: T：36.5℃，P：88次/分，R：20次/分，BP：134/63mmHg,Ht：172cm，Wt：76kg，BSA：1.88m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率88次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无叩痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射……\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 早期复极改变\n- [全程D0] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.6；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:20（参考: 阴性）；活化部分凝血活酶时间(APTT)-静脉血: 23.1sec.；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；血红蛋白(Hb)-静脉血: 158g/L；血小板比容-静脉血: 26%；氯离子(Cl-)-静脉血: 105.3mmol/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 1.04；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；尿酸(UA)-静脉血: 341umol/L；甘油三酯(TG)-静脉血: 1.27mmol/L；总蛋白(TP)-静脉血: 73.53g/L；尿素氮(BUN)-静脉血: 6.35mmol/L；C-反应蛋白(CRP)-静脉血: 1.45mg/L；载脂蛋白B(apoB)-静脉血: 0.8g/L；总胆汁酸(TBA)-静脉血: 4.7umol/L；葡萄糖(Glu)-静脉血: 4.78mmol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；乳酸脱氢酶(LDH)-静脉血: 160.3U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；大血小板百分比(P-LCR%)-静脉血: 30.4%；中性粒细胞计数(Neut#)-静脉血: 6.410E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；丙氨酸氨基转移酶(ALT)-静脉血: 12.1U/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；ABO血型-静脉血: B；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.7fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；球蛋白(GLO)-静脉血: 28.23g/L；凝血酶时间(TT)-静脉血: 17.5sec.；红细胞计数(RBC#)-静脉血: 5.3710E12/L；平均红细胞体积(MCV)-静脉血: 87fL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.17mmolL；磷(P)-静脉血: 1.03mmol/L；总钙(Ca)-……\n- [全程D3] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理稍粗，未见明确实质性病变。双侧肺门不大，纵隔居中、无增宽。双膈形态正常。双侧肋膈角锐利。心影形态、大小、位置未见异常。；检查结论: 心肺未见明显异常。\n- [全程D3] 超声；双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约11cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约37×31×26mm，包膜光滑，实质回声不均匀，可见强回声斑。 腹主动脉旁未见明确肿物回声。；检查结论: 前列腺钙化。 肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、左侧壁见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强后明显强化，肿物占据鼻咽顶壁、左侧咽隐窝、左侧咽后间隙，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，右侧咽隐窝变浅，右侧咽旁脂肪间隙及颈动脉鞘区未见异常。 左侧腭帆张提肌及左侧头长肌受侵，右侧腭帆提肌、腭帆张肌、头长肌未见受侵征象。 双侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽双侧壁未见增厚。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部、翼突内外板、左侧枕骨基底部及左侧枕骨髁骨质信号减低，增强扫描后明显强化，斜坡局部见不规则软组织肿物影累及斜坡后份脑膜及蝶鞍后份，部分层面与垂体后叶分界欠清。双侧海绵窦形态正常，未见增宽。筛窦、蝶窦、左侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 左侧咽后间隙见肿大淋巴结，大小约为11mm ×9 mm，右侧咽后见肿大淋巴结，短径约6mm，均匀强化。 双颈I、II区见多个淋巴结，边界清，信号均匀，最大短径约8mm，均匀强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。 颅底骨质破坏。 双侧咽后淋巴结肿大，考虑转移。 双颈Ib、II区小淋巴结，性质待定。 副鼻窦炎、左侧乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D7] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；载脂蛋白AI(apoAI)-静脉血: 1.41g/L；总蛋白(TP)-静脉血: 72.8g/L；肌酐(Crea)-静脉血: 96.4umol/L；总胆红素(TBIL)-静脉血: 10.3umol/L；血小板比容-静脉血: 26%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；尿素氮(BUN)-静脉血: 5.6mmol/L；白细胞计数(WBC#)-尿液: 1/μL；钠离子(Na+)-静脉血: 140.2mmol/L；颜色-尿液: Light-Yellow；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.2mmolL；C-反应蛋白(CRP)-静脉血: 1.6mg/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；乳酸脱氢酶(LDH)-静脉血: 148.2U/L；总胆固醇(TC)-静脉血: 4.78mmol/L；总蛋白(TP)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 5/μL；平均血小板体积(MPV)-静脉血: 10.8fL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 345g/L；总钙(Ca)-静脉血: 2.34mmol/L；甘油三酯(TG)-静脉血: 1.84mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.34；胱抑素(Cys-C)-静脉血: 0.97mg/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.8U/L；红细胞计数(RBC#)-静脉血: 5.3810E12/L；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；单核细胞百分比(Mono%)-静脉血: 0.065；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.76；血液二氧化碳含量ctCO2(B)-静脉血: 24.3mmol/L；红细胞计数(RBC#)-尿液: 4/μL；间接胆红素(IBIL)-静脉血: 7umolL；浊度(TRUB)-尿液: clear；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.026；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；血小板计数(PLT#)-静脉血: 24610E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；颜色-粪便: 棕色；载脂蛋白……\n- [全程D11] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于第7胸椎椎体右侧水平，估计导管末端位于上腔静脉中-下段交界处。；检查结论: 导管末端位置如上述。\n- [全程D14] 检验组合: α-L-岩藻糖苷酶(AFU)-静脉血: 38.9U/L；载脂蛋白AI(apoAI)-静脉血: 1.64g/L；血红蛋白(Hb)-静脉血: 158g/L；有核红细胞百分比(NRBC%)-静脉血: 0；促黄体生成素(LH)-静脉血: 6.12mIU/ml；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.87mmol/L；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 弱阳性(±)（参考: 阴性）；天门冬氨酸氨基转移酶(AST)-静脉血: 17.6U/L；总胆汁酸(TBA)-静脉血: 1umol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.4pg；大血小板百分比(P-LCR%)-静脉血: 35.7%；胱抑素(Cys-C)-静脉血: 1.56mg/L；白蛋白(ALB)-静脉血: 45.2g/L；甘油三酯(TG)-静脉血: 1.3mmol/L；白细胞计数(WBC#)-静脉血: 9.310E9/L；红细胞计数(RBC#)-静脉血: 5.3710E12/L；单核细胞百分比(Mono%)-静脉血: 0.008；中性粒细胞计数(Neut#)-静脉血: 8.710E9/L；乳酸脱氢酶(LDH)-静脉血: 181.6U/L；总蛋白(TP)-静脉血: 70.8g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.9mmolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.02；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；催乳素(PRL)-静脉血: 308.5uIU/ml；中性粒细胞百分比(Neut%)-静脉血: 0.939；有核红细胞计数(NRBC#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 33.6；促卵泡刺激素(FSH)-静脉血: 9.93mIU/ml；钾离子(K+)-静脉血: 4.53mmol/L；镁离子(Mg2+)-静脉血: 0.89mmol/L；平均血小板体积(MPV)-静脉血: 11.3fL；碱性磷酸酶(ALP)-静脉血: 87.4U/L；总胆红素(TBIL)-静脉血: 22.5umol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=1.50)（参考: 阴性）；尿酸(UA)-静脉血: 385.9umol/L；EB……\n- [全程D38] 检验组合: α-L-岩藻糖苷酶(AFU)-静脉血: 31.3U/L；氯离子(Cl-)-静脉血: 90.1mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.85mmol/L；胱抑素(Cys-C)-静脉血: 1.22mg/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.8mmol/L；钾离子(K+)-静脉血: 3.66mmol/L；总胆汁酸(TBA)-静脉血: 2.2umol/L；甘油三酯(TG)-静脉血: 2.25mmol/L；肌酐(Crea)-静脉血: 108.2umol/L；总钙(Ca)-静脉血: 2.23mmol/L；C-反应蛋白(CRP)-静脉血: 0.28mg/L；钠离子(Na+)-静脉血: 129.2mmol/L；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阴性(-)（参考: 阴性）；球蛋白(GLO)-静脉血: 21.3g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.69mmolL；间接胆红素(IBIL)-静脉血: 16umolL；总胆固醇(TC)-静脉血: 6.95mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 27.8U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.73；白蛋白(ALB)-静脉血: 40.8g/L；总蛋白(TP)-静脉血: 62.1g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.92；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；尿素氮(BUN)-静脉血: 11.7mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=1.25)（参考: 阴性）；尿酸(UA)-静脉血: 368.1umol/L；总胆红素(TBIL)-静脉血: 20.1umol/L；乳酸脱氢酶(LDH)-静脉血: 167U/L；阴离子间隙(AG)-静脉血: 16.3；载脂蛋白B(apoB)-静脉血: 1.3g/L；EB病毒Zta蛋白抗体IgA(EBV-Zta-IgA)-静脉血: 阴性(-)（参考: 阴性）；葡萄糖(Glu)-静脉血: 4.91mmol/L；磷(P)-静脉血: 1.13mmol/L；直接胆……\n- [全程D53] 检验组合: 钠离子(Na+)-静脉血: 142.5mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 29.9U/L；乳酸脱氢酶(LDH)-静脉血: 207.9U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.6；血小板分布宽度(PDW)-静脉血: 10.8%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.035；间接胆红素(IBIL)-静脉血: 5.54umolL；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；天门冬氨酸氨基转移酶(AST)-静脉血: 18.5U/L；磷(P)-静脉血: 0.96mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.04；肌酐(Crea)-静脉血: 102umol/L；甘油三酯(TG)-静脉血: 1.26mmol/L；单核细胞百分比(Mono%)-静脉血: 0.09；大血小板百分比(P-LCR%)-静脉血: 22.6%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；C-反应蛋白(CRP)-静脉血: 0.69mg/L；血红蛋白(Hb)-静脉血: 134g/L；平均红细胞体积(MCV)-静脉血: 86.7fL；平均血小板体积(MPV)-静脉血: 9.7fL；单核细胞计数(Mono#)-静脉血: 0.610E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.009；有核红细胞计数(NRBC#)-静脉血: 010E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.13mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.22；葡萄糖(Glu)-静脉血: 4.43mmol/L；载脂蛋白B(apoB)-静脉血: 1.26g/L；载脂蛋白AI(apoAI)-静脉血: 1.74g/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 332g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.3mmol/L；氯离子(Cl-)-静脉血: 99.6mmol/L；尿酸(UA)-静脉血: 362.4umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.53mmolL；直接胆红素(DBIL)-静脉血: 1.88umol/L；红细胞比容(Hct)-静脉血: 40.4%；总胆固醇(TC)-静脉血: 6.07mmol/L；总钙(Ca)-静脉血:……\n- [全程D59] 检验组合: 平均红细胞体积(MCV)-静脉血: 82fL；大血小板百分比(P-LCR%)-静脉血: 36.3%；有核红细胞百分比(NRBC%)-静脉血: 0；血小板分布宽度(PDW)-静脉血: 15.9%；血小板比容-静脉血: 15%；白细胞计数(WBC#)-静脉血: 4.2710E9/L；血小板计数(PLT#)-静脉血: 13510E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.351；红细胞比容(Hct)-静脉血: 37.9%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.002；有核红细胞计数(NRBC#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 133g/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.631；单核细胞计数(Mono#)-静脉血: 0.110E9/L；红细胞计数(RBC#)-静脉血: 4.6210E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；平均红细胞血红蛋白浓度(MCHC)-静脉血: 351g/L；平均血小板体积(MPV)-静脉血: 11.4fL；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.7；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；单核细胞百分比(Mono%)-静脉血: 0.014；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L\n- [全程D60] 检验组合: 阴离子间隙(AG)-静脉血: 17.3；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=1.25)（参考: 阴性）；胱抑素(Cys-C)-静脉血: 1.21mg/L；氯离子(Cl-)-静脉血: 90.7mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 35.4U/L；载脂蛋白AI(apoAI)-静脉血: 1.83g/L；钠离子(Na+)-静脉血: 130.8mmol/L；总胆红素(TBIL)-静脉血: 20.2umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.8mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；球蛋白(GLO)-静脉血: 22.01g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.03；丙氨酸氨基转移酶(ALT)-静脉血: 24.3U/L；白蛋白(ALB)-静脉血: 44.6g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.5U/L；载脂蛋白B(apoB)-静脉血: 1.33g/L；碱性磷酸酶(ALP)-静脉血: 78.3U/L；葡萄糖(Glu)-静脉血: 5.06mmol/L；磷(P)-静脉血: 1mmol/L；总钙(Ca)-静脉血: 2.29mmol/L；尿酸(UA)-静脉血: 326.1umol/L；总胆汁酸(TBA)-静脉血: 2.7umol/L；总胆固醇(TC)-静脉血: 7.06mmol/L；C-反应蛋白(CRP)-静脉血: 0.2mg/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.72；直接胆红素(DBIL)-静脉血: 4.4umol/L；镁离子(Mg2+)-静脉血: 0.72mmol/L；EB病毒Zta蛋白抗体IgA(EBV-Zta-IgA)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.71mmolL；总蛋白(TP)-静脉血: 66.61g/L；甘油三酯(TG)-静脉血: 2.92mmol/L；肌酐(Crea)-静脉血: 112.8umol/L；尿素氮(BUN)-静脉血: 10.2mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.……\n- [全程D61] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后复查，较某次就诊时间片对比： 鼻咽腔未见明显狭窄，鼻咽左侧壁粘膜稍增厚，T1WI呈等信号，T2WI呈稍高信号，增强后明显强化，左侧咽隐窝变浅，右侧咽隐窝清晰，双侧咽旁脂肪间隙及颈动脉鞘区未见异常。鼻咽肿物较前明显缩小好转。 左侧腭帆张提肌及左侧头长肌稍肿胀，右侧腭帆提肌、腭帆张肌、头长肌未见受侵征象。 双侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽双侧壁未见增厚，双侧后鼻孔未见肿物。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部、翼突内外板、左侧枕骨基底部及左侧枕骨髁骨质信号减低，增强扫描后明显强化。双侧海绵窦形态正常，未见增宽。左侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧咽后见小淋巴结，最大短径约5 mm。 双颈I、II区见多个淋巴结，边界清，信号均匀，最大短径约7mm，均匀强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗后复查，较某次就诊时间片对比： 鼻咽肿物较前明显缩小好转，累及范围较前缩小。 颅底骨质破坏同前。 双侧咽后淋巴结较前缩小。 双颈I、II区小淋巴结，较前稍缩小。 左侧乳突炎。\n- [全程D99] 检验组合: 单核细胞计数(Mono#)-静脉血: 1.710E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；血小板分布宽度(PDW)-静脉血: 11.4%；大血小板百分比(P-LCR%)-静脉血: 29.1%；单核细胞百分比(Mono%)-静脉血: 0.093；平均红细胞体积(MCV)-静脉血: 88.1fL；红细胞比容(Hct)-静脉血: 29%；有核红细胞百分比(NRBC%)-静脉血: 0.1；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.9；嗜酸性粒细胞计数(Eos#)-静脉血: 0.410E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.022；白细胞计数(WBC#)-静脉血: 18.7210E9/L；红细胞计数(RBC#)-静脉血: 3.2910E12/L；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；血小板比容-静脉血: 12%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 48；血小板计数(PLT#)-静脉血: 11710E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 345g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.034；平均红细胞血红蛋白含量(MCH)-静脉血: 30.4pg；中性粒细胞计数(Neut#)-静脉血: 15.910E9/L；血红蛋白(Hb)-静脉血: 100g/L；中性粒细胞百分比(Neut%)-静脉血: 0.848；平均血小板体积(MPV)-静脉血: 10.7fL；有核红细胞计数(NRBC#)-静脉血: 0.0210E9/L\n- [全程D104] 检验组合: 钠离子(Na+)-静脉血: 136.2mmol/L；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；血小板分布宽度(PDW)-静脉血: 11.8%；葡萄糖(Glu)-静脉血: 6mmol/L；碱性磷酸酶(ALP)-静脉血: 59.8U/L；尿酸(UA)-静脉血: 486.4umol/L；尿素氮(BUN)-静脉血: 15mmol/L；直接胆红素(DBIL)-静脉血: 2.5umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；间接胆红素(IBIL)-静脉血: 7.3umolL；镁离子(Mg2+)-静脉血: 0.75mmol/L；血小板计数(PLT#)-静脉血: 15910E9/L；单核细胞百分比(Mono%)-静脉血: 0.081；平均血小板体积(MPV)-静脉血: 10.5fL；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.08mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.6；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；总胆固醇(TC)-静脉血: 6.02mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.899；血红蛋白(Hb)-静脉血: 107g/L；红细胞计数(RBC#)-静脉血: 3.5110E12/L；球蛋白(GLO)-静脉血: 20.38g/L；甘油三酯(TG)-静脉血: 1.26mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；大血小板百分比(P-LCR%)-静脉血: 29.3%；总钙(Ca)-静脉血: 2.37mmol/L；总胆汁酸(TBA)-静脉血: 0.8umol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.1；胱抑素(Cys-C)-静脉血: 1.67mg/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 358g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.01；α-L-岩藻糖苷酶(AFU)-静脉血: 31.2U/L；钾离子(K+)-静脉血: 3.53mmol/L；总蛋白(TP)-静脉血: 61.28g/L；天门冬氨酸氨基转移酶(AST)-静……\n- [全程D108] 检验组合: 总胆红素(TBIL)-静脉血: 13.8umol/L；总蛋白(TP)-静脉血: 57.11g/L；单核细胞百分比(Mono%)-静脉血: 0.048；球蛋白(GLO)-静脉血: 18.41g/L；尿素氮(BUN)-静脉血: 9.7mmol/L；间接胆红素(IBIL)-静脉血: 10.2umolL；碱性磷酸酶(ALP)-静脉血: 52.2U/L；胱抑素(Cys-C)-静脉血: 1.26mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.2mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1；肌酐(Crea)-静脉血: 85umol/L；尿酸(UA)-静脉血: 283umol/L；乳酸脱氢酶(LDH)-静脉血: 131.8U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 9.3U/L；红细胞计数(RBC#)-静脉血: 3.4610E12/L；C-反应蛋白(CRP)-静脉血: 1.53mg/L；阴离子间隙(AG)-静脉血: 15.1；平均血小板体积(MPV)-静脉血: 9.8fL；淋巴细胞百分比(Lymph%)-静脉血: 0.039；γ-谷氨酰基转移酶(GGT)-静脉血: 27.7U/L；镁离子(Mg2+)-静脉血: 0.65mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 367g/L；大血小板百分比(P-LCR%)-静脉血: 24.8%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 42.5；载脂蛋白AI(apoAI)-静脉血: 1.09g/L；白蛋白(ALB)-静脉血: 38.7g/L；总胆汁酸(TBA)-静脉血: 1.5umol/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；白细胞计数(WBC#)-静脉血: 8.2710E9/L；总胆固醇(TC)-静脉血: 6.03mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.21；氯离子(Cl-)-静脉血: 90.9mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 7.7U/L；血小板分布宽度(PDW)-静脉血: 11.2%；血液二氧化碳含量ctCO2(B)-静脉血: 21.1mmol/L；红细胞比容(Hct)-静脉血: 28.3%；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；中性粒细胞百……\n- [全程D116] 检验组合: 大血小板百分比(P-LCR%)-静脉血: 28.7%；载脂蛋白B(apoB)-静脉血: 1.55g/L；钠离子(Na+)-静脉血: 133.3mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 32.4U/L；胱抑素(Cys-C)-静脉血: 0.84mg/L；直接胆红素(DBIL)-静脉血: 3.2umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 348g/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；血小板比容-静脉血: 13%；平均红细胞体积(MCV)-静脉血: 86.3fL；尿素氮(BUN)-静脉血: 6.6mmol/L；磷(P)-静脉血: 1.15mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.4mmolL；有核红细胞百分比(NRBC%)-静脉血: 0；有核红细胞计数(NRBC#)-静脉血: 010E9/L；载脂蛋白AI(apoAI)-静脉血: 1.2g/L；总胆固醇(TC)-静脉血: 7.16mmol/L；甘油三酯(TG)-静脉血: 1.74mmol/L；总钙(Ca)-静脉血: 2.28mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 76.6umol/L；钾离子(K+)-静脉血: 3.01mmol/L；间接胆红素(IBIL)-静脉血: 10.4umolL；尿酸(UA)-静脉血: 216umol/L；镁离子(Mg2+)-静脉血: 0.56mmol/L；单核细胞百分比(Mono%)-静脉血: 0.065；红细胞计数(RBC#)-静脉血: 3.3610E12/L；天门冬氨酸氨基转移酶(AST)-静脉血: 9.4U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.053；血小板计数(PLT#)-静脉血: 12210E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.6；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；乳酸脱氢酶(LDH)-静脉血: 130.3U/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；中性粒细胞计数(Neut#)-静脉血: 4.410E9/L；C-反应蛋白(CRP)-静脉血: 6.72mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 5.32mmol/L；丙氨酸氨基转移酶(ALT)……\n- [全程D152] 检验组合: EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）\n- [全程D222] 超声；腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约21cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D222] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:80（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D7] 首次病程记录；首次病程记录: 病程类型: 首次病程记录；病程主题: 首次病程记录；病程内容: 病历特点：1、患者中年男性。2、患者于某次就诊时间1月无明显诱因下出现头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，患者于至[机构已隐去]就诊，行鼻咽活检病理，并送我院病理会诊示鼻咽分化型非角化性癌。某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。现患者为进一步诊治，予收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。3、体查：张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约1cm*0.8cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）示图：4、辅助检查：（1） 某次就诊时间在我医院（病理号：[记录编号已隐去]）鼻咽活检病理示：（鼻咽肿物）镜检为分化型非角化性癌（2） 某次就诊时间在我院胸片检查：心肺未见异常。（3） 某次就诊时间在我院腹部B超检查：肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。（4） 某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。副鼻窦炎、左侧乳突炎。（6）某次就诊时间我院：VCA-IgA 1:160 EA-IgA 1:20EBV-DNA定性检测：2.14E102copy/ml。 诊断依据： 初步诊断： 鉴别诊断：患者诊断明确，无需鉴别诊断。 诊疗计划：1、完善相关检查如全身骨扫描、血常规、生化等。2、诱导化疗及同期化放疗。\n- [全程D8] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者诉间有头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，无面麻、声嘶。[姓名已隐去]医生信息已隐藏示：嘱患者今日完善全身骨扫描检查，排除骨转移征象，治疗上暂给予对症处理，继续观察病情。\n- [全程D9] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日患者症状体征基本同前，无诉其余特殊不适。[姓名已隐去]医生信息已隐藏后指示：某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，最大短径约8mm，均匀强化。骨ECT示鼻咽部、颅底骨代谢较活跃，考虑NPC所致。胸片、腹部B超排除远处转移。故目前临床诊断明确为“鼻咽分化型非角化性癌[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)，治疗方案定为TPF（多西紫杉醇 60mg/m2 + 顺铂 60mg/m2 + 5-FU 2.5g/m2， q21d）诱导化疗3程后再行同期放化疗，放疗采用IMRT技术，同期化疗采用顺铂 60mg/m2（q21d）2程。并指示化疗期间给予护肝、护胃、止吐及营养支持治疗。已向患者及家属交代病情及治疗相关不良反应后，其表示理解，并同意上述治疗方案。拟明日开始行多西紫杉醇化疗，密切观察患者病情变化。\n- [全程D12] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 患者今日TPF方案化疗第3天，现一般情况可，未诉恶心、呕吐、腹痛、腹泻等不适，大小便正常。[姓名已隐去]医生信息已隐藏出，患者目前一般情况可，可继续化疗。注意化疗结束后复查血、生化常规，及时对症处理。\n- [全程D53] 首次病程记录；首次病程记录: 病程类型: 首次病程记录；病程主题: 首次病程记录；病程内容: 病历特点：1、患者中年男性。2、患者于某次就诊时间1月无明显诱因下出现头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，患者于至[机构已隐去]就诊，行鼻咽活检，并送我院病理会诊示鼻咽分化型非角化性癌。某次就诊时间在我院行鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶；颅底骨质破坏；双侧咽后淋巴结肿大，考虑转移；双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。明确诊断为鼻咽分化型非角化性癌，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)。于某次就诊时间、某次就诊时间行TPF化疗（DOC 60mg/m2+DDP 60mg/m2+5-FU 2.5g/m2civ48h）2程诱导化疗，化疗过程顺利。今患者为行第3程诱导化疗收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。3、体查：张口门齿距5cm；鼻咽肿物较前明显消退；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约0.8cm*0.5cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）。4、辅助检查：（1） 某次就诊时间在我医院（病理号：[记录编号已隐去]）鼻咽活检病理示：（鼻咽肿物）镜检为分化型非角化性癌（2） 某次就诊时间在我院胸片检查：心肺未见异常。（3） 某次就诊时间在我院腹部B超检查：肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。（4） 某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。副鼻窦炎、左侧乳突炎。（6） 某次就诊时间我院：VCA-IgA 1:160 EA-IgA 1:20 EBV-DNA定性检测：2.14E102copy/ml 诊断依据： 初步诊断： 鉴别诊断：诊断明确，暂无需鉴别。 诊疗计划：1、完善相关检查如三大常规、电子鼻咽镜等。2、综合治疗。\n- [全程D54] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日随[姓名已隐去]医生信息已隐藏，详细询问病史并查体后，分析病情如下：1、患者中年男性，因“鼻咽癌2程诱导化疗后20天”入院。2、查体：张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约0.8cm*0.5cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）。3、辅助检查：某次就诊时间在我医院（病理号：[记录编号已隐去]）鼻咽活检病理示：（鼻咽肿物）镜检为分化型非角化性癌。某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。副鼻窦炎、左侧乳突炎。综上述，患者诊断鼻咽分化型非角化性癌，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)。[姓名已隐去]医生信息已隐藏，患者现一般情况可。昨日复查血常规及生化常规未见明显异常，拟今日开始行第3程诱导化疗，注意防治化疗相关毒副反应。\n- [全程D55] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日随[姓名已隐去]医生信息已隐藏，详细询问病史并查体后，分析病情如下：1、患者中年男性，因“鼻咽癌2程诱导化疗后20天”入院。2、查体：张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约0.8cm*0.5cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）。3、辅助检查：某次就诊时间在我医院（病理号：[记录编号已隐去]）鼻咽活检病理示：（鼻咽肿物）镜检为分化型非角化性癌。某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。副鼻窦炎、左侧乳突炎。综上述，患者诊断鼻咽分化型非角化性癌，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)。[姓名已隐去]医生信息已隐藏，患者现一般情况可。化疗前复查血常规及生化常规未见明显异常，于昨日开始行第3程诱导化疗，注意水化、护胃止呕、营养补液等对症支持治疗。\n- [全程D58] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日TPF方案化疗第5天，现一般情况可，未诉恶心、呕吐、腹痛、腹泻等不适，大小便正常。[姓名已隐去]主治医师，患者目前一般情况可，可继续化疗。注意化疗结束后复查血、生化常规，及时对症处理。\n- [全程D60] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日已完成第3程TPF方案（多西紫杉醇 60mg/m2 + DDP 60mg/m2 + 5-Fu 2.5g/m2）诱导化疗，未诉特殊不适。2/5复查血常规结果基本正常，今日复查血生化结果示：K+ 3.13↓ mmol/L，Na+ 130.8↓ mmol/L，IBIL 15.80 ↑ umolL，CRE 112.8↑ umol/L。[姓名已隐去]医生信息已隐藏示：患者现已完成化疗，今日可带口服补钾、护肝及护肾药物出院。嘱患者注意休息，加强营养，口服补钠，每周复查血常规、肝肾功能。按期返院开始同期放化疗，不适时随诊。\n- [全程D104] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者放疗22次，诉中度咽痛，有干咳，感恶心，无呕吐，无畏寒、发热。查体大致同前。今日查血常规生化未见异常。[姓名已隐去]医生信息已隐藏，患者放化疗顺利，现继续予以加强护胃、护肝等营养支持对症治疗，定期复查血生化常规，严密观察病情变化。\n- [全程D108] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者诉乏力，无恶心、呕吐，仍有便秘。查体大致同前。今日查血生化提示：血钾3.06mmol/L，血钠127.1mmol/L。血常规提示血红蛋白稍低。[姓名已隐去]医生信息已隐藏后指示：患者放疗过程中，现血钾、血钠低，可予以加强补钾、补钠治疗，现继续放疗，加强支持对症治疗，严密观察病情变化。\n- [全程D111] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者放疗27次，诉有咳嗽、咳痰，大便未解。查体大致同前。[姓名已隐去]医生信息已隐藏，患者放疗进行中，现有咳嗽，予以加强祛痰处理，大便未解加强通便治疗。继续加强支持对症治疗，严密观察病情变化。\n- [全程D116] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者放疗30次，患者诉感乏力，咳嗽、咳痰症状较前改善，无畏寒、发热。查体大致同前。今日查血常规大致正常。生化提示血钠低、血钾低、血镁低。[姓名已隐去]医生信息已隐藏，患者生化提示血钾、血钠、血镁低，加强支持对症治疗，严密观察病情变化。\n- [全程D118] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日完成放疗。今日[姓名已隐去]医生信息已隐藏者诉轻度咽痛，胃纳一般，无恶心、呕吐，无发热、咳嗽、咳痰等，精神、睡眠一般，大小便正常。体查：张口门齿距4.5cm；鼻咽顶壁见肿物，较前明显消退；浅表淋巴结未及肿大，颅神经检查：（-）。口腔黏膜反应Ⅱ度，皮肤反应Ⅰ度。[姓名已隐去]医生信息已隐藏示：患者已结束放疗及同期化疗，过程顺利，现病情平稳，可予以出院，嘱患者注意休息，加强营养，出院后一个月内每周复查血常规、肝肾功能，出院后一个月返院复查，不适时随诊。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善鼻咽及颈部MRI检查，暂缓EB病毒DNA及抗体检测。\nB. 安排全身PET-CT检查，替代常规影像学及EB病毒相关指标随访。\nC. 完善EB病毒DNA定量及EBV抗体（VCA-IgA、EA-IgA）检测，继续定期随访观察。\nD. 完善胸部增强CT及全身骨扫描，暂缓EB病毒DNA定量检测。\nE. 延长随访间隔至每半年一次，仅复查腹部彩超及血常规。\nF. 安排鼻内镜检查并常规行鼻咽部组织活检，复查EB病毒DNA。\nG. 给予抗病毒药物治疗以降低EBV-VCA-IgA滴度，继续随访观察。\nH. 启动卡培他滨节拍维持治疗，并每半年复查EB病毒DNA定量。\nI. 完善鼻咽及颈部CT平扫，替代MRI及EB病毒DNA定量检测。\nJ. 安排双侧颈部淋巴结彩超检查，暂缓EB病毒相关指标检测。\nK. 启动PD-1抑制剂免疫维持治疗，并定期复查EB病毒DNA定量。\nL. 完善头颅增强MRI检查，暂缓鼻咽部及颈部影像学评估。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-32fca5d8e1da4de5e54c5c0b","patient_id":"patient-290a042206ccfe67e72f9a19","turn_id":"turn01","turn_position":1,"turn_type":"initial_workup_choice","gold_letter":"D","gold_action":"行电子鼻咽镜检查及活检，并完善鼻咽及颈部MRI平扫+增强，常规心电图检查","options":[{"letter":"A","text":"行电子鼻咽镜检查（不活检），并完善鼻咽及颈部CT平扫+增强，常规心电图检查","is_gold":false},{"letter":"B","text":"行颈部淋巴结切除活检，并完善鼻咽及颈部MRI平扫+增强，常规心电图检查","is_gold":false},{"letter":"C","text":"行电子鼻咽镜检查及活检，并完善鼻咽及颈部MRI平扫（不增强），常规心电图检查","is_gold":false},{"letter":"D","text":"行电子鼻咽镜检查及活检，并完善鼻咽及颈部MRI平扫+增强，常规心电图检查","is_gold":true},{"letter":"E","text":"行电子鼻咽镜检查及活检，并完善鼻咽MRI平扫+增强，暂缓颈部影像学检查","is_gold":false},{"letter":"F","text":"直接行全身PET-CT检查，暂缓电子鼻咽镜及活检与局部MRI","is_gold":false},{"letter":"G","text":"行电子鼻咽镜检查及活检，并完善胸部及腹部CT平扫+增强，暂缓头颈部MRI","is_gold":false},{"letter":"H","text":"行鼻咽及颈部MRI平扫+增强，常规心电图检查，暂缓鼻咽镜检查及活检","is_gold":false},{"letter":"I","text":"行电子鼻咽镜检查及活检，并完善鼻咽及颈部CT平扫，常规心电图检查","is_gold":false},{"letter":"J","text":"行颈部淋巴结穿刺活检，并完善鼻咽及颈部MRI平扫+增强，常规心电图检查","is_gold":false},{"letter":"K","text":"行电子鼻咽镜检查（不活检），并完善全身PET-CT检查，常规心电图检查","is_gold":false},{"letter":"L","text":"行电子鼻咽镜检查及活检，并完善鼻咽及颈部超声检查，常规心电图检查","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现颈部肿物1月余；当地诊断：鼻咽癌。于某次就诊时间在[机构已隐去]行力扑素270mgd1+奈达铂120mgd1+泰欣生200mgd1化疗一程，化疗后出现四度中性粒细胞减少，无发热、腹泻、寒战等，予升白处理后中性粒细胞恢复。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物,中性粒细胞减少,颈部肿物；既往史: 颈椎病史10年，既往有慢性肠炎病史。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：362.℃，P：100次/分，R：20次/分，BP：126/74mmHg,Ht：168cm，Wt：63kg，BSA：1.72m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；双侧颈部IIa区各可扪及1个淋巴结，左颈2×3cm，右颈2×2cm,无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行电子鼻咽镜检查（不活检），并完善鼻咽及颈部CT平扫+增强，常规心电图检查\nB. 行颈部淋巴结切除活检，并完善鼻咽及颈部MRI平扫+增强，常规心电图检查\nC. 行电子鼻咽镜检查及活检，并完善鼻咽及颈部MRI平扫（不增强），常规心电图检查\nD. 行电子鼻咽镜检查及活检，并完善鼻咽及颈部MRI平扫+增强，常规心电图检查\nE. 行电子鼻咽镜检查及活检，并完善鼻咽MRI平扫+增强，暂缓颈部影像学检查\nF. 直接行全身PET-CT检查，暂缓电子鼻咽镜及活检与局部MRI\nG. 行电子鼻咽镜检查及活检，并完善胸部及腹部CT平扫+增强，暂缓头颈部MRI\nH. 行鼻咽及颈部MRI平扫+增强，常规心电图检查，暂缓鼻咽镜检查及活检\nI. 行电子鼻咽镜检查及活检，并完善鼻咽及颈部CT平扫，常规心电图检查\nJ. 行颈部淋巴结穿刺活检，并完善鼻咽及颈部MRI平扫+增强，常规心电图检查\nK. 行电子鼻咽镜检查（不活检），并完善全身PET-CT检查，常规心电图检查\nL. 行电子鼻咽镜检查及活检，并完善鼻咽及颈部超声检查，常规心电图检查\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现颈部肿物1月余；当地诊断：鼻咽癌。于某次就诊时间在[机构已隐去]行力扑素270mgd1+奈达铂120mgd1+泰欣生200mgd1化疗一程，化疗后出现四度中性粒细胞减少，无发热、腹泻、寒战等，予升白处理后中性粒细胞恢复。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物,中性粒细胞减少,颈部肿物；既往史: 颈椎病史10年，既往有慢性肠炎病史。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：362.℃，P：100次/分，R：20次/分，BP：126/74mmHg,Ht：168cm，Wt：63kg，BSA：1.72m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；双侧颈部IIa区各可扪及1个淋巴结，左颈2×3cm，右颈2×2cm,无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行电子鼻咽镜检查（不活检），并完善鼻咽及颈部CT平扫+增强，常规心电图检查\nB. 行颈部淋巴结切除活检，并完善鼻咽及颈部MRI平扫+增强，常规心电图检查\nC. 行电子鼻咽镜检查及活检，并完善鼻咽及颈部MRI平扫（不增强），常规心电图检查\nD. 行电子鼻咽镜检查及活检，并完善鼻咽及颈部MRI平扫+增强，常规心电图检查\nE. 行电子鼻咽镜检查及活检，并完善鼻咽MRI平扫+增强，暂缓颈部影像学检查\nF. 直接行全身PET-CT检查，暂缓电子鼻咽镜及活检与局部MRI\nG. 行电子鼻咽镜检查及活检，并完善胸部及腹部CT平扫+增强，暂缓头颈部MRI\nH. 行鼻咽及颈部MRI平扫+增强，常规心电图检查，暂缓鼻咽镜检查及活检\nI. 行电子鼻咽镜检查及活检，并完善鼻咽及颈部CT平扫，常规心电图检查\nJ. 行颈部淋巴结穿刺活检，并完善鼻咽及颈部MRI平扫+增强，常规心电图检查\nK. 行电子鼻咽镜检查（不活检），并完善全身PET-CT检查，常规心电图检查\nL. 行电子鼻咽镜检查及活检，并完善鼻咽及颈部超声检查，常规心电图检查\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-95b51d663e429afb86c572e7","patient_id":"patient-290a042206ccfe67e72f9a19","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"E","gold_action":"行外院疑难病理会诊，完善PET/CT全身显像及血浆EBV DNA检测","options":[{"letter":"A","text":"行鼻咽镜下重新活检，完善胸部CT、腹部超声及全身骨扫描，检测血浆EBV DNA","is_gold":false},{"letter":"B","text":"行外院疑难病理会诊，完善胸部CT、腹部超声，暂缓全身骨扫描，检测血浆EBV DNA","is_gold":false},{"letter":"C","text":"沿用外院病理诊断，完善PET/CT全身显像及血浆EBV DNA检测","is_gold":false},{"letter":"D","text":"行外院疑难病理会诊，完善胸部增强CT及腹部增强CT，暂缓全身骨扫描","is_gold":false},{"letter":"E","text":"行外院疑难病理会诊，完善PET/CT全身显像及血浆EBV DNA检测","is_gold":true},{"letter":"F","text":"行鼻咽镜下重新活检，完善PET/CT全身显像及血浆EBV DNA检测","is_gold":false},{"letter":"G","text":"行外院疑难病理会诊，完善PET/CT全身显像，暂缓血浆EBV DNA检测","is_gold":false},{"letter":"H","text":"行外院疑难病理会诊，完善胸部CT及腹部CT，暂缓全身骨扫描及血浆EBV DNA检测","is_gold":false},{"letter":"I","text":"沿用外院病理诊断，完善PET/CT全身显像，暂缓血浆EBV DNA检测","is_gold":false},{"letter":"J","text":"行外院疑难病理会诊，完善头颈部局部PET/CT及血浆EBV DNA检测","is_gold":false},{"letter":"K","text":"行鼻咽镜下重新活检，完善胸部CT及腹部CT，暂缓血浆EBV DNA检测","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现颈部肿物1月余；当地诊断：鼻咽癌。于某次就诊时间在[机构已隐去]行力扑素270mgd1+奈达铂120mgd1+泰欣生200mgd1化疗一程，化疗后出现四度中性粒细胞减少，无发热、腹泻、寒战等，予升白处理后中性粒细胞恢复。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物,中性粒细胞减少,颈部肿物；既往史: 颈椎病史10年，既往有慢性肠炎病史。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：362.℃，P：100次/分，R：20次/分，BP：126/74mmHg,Ht：168cm，Wt：63kg，BSA：1.72m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；双侧颈部IIa区各可扪及1个淋巴结，左颈2×3cm，右颈2×2cm,无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 电轴左偏(轻度) 心电图大致正常\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1] 检验组合: 纤维蛋白原降解产物(FDP)-静脉血: 2ug/ml；平均红细胞体积(MCV)-静脉血: 93.5fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6；甘油三酯(TG)-静脉血: 2.17mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 51.4U/L；胱抑素(Cys-C)-静脉血: 0.91mg/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.08COI；总钙(Ca)-静脉血: 2.24mmol/L；淋巴细胞计数(Lymph#)-静脉血: 2.610E9/L；葡萄糖(Glu)-静脉血: 5.18mmol/L；球蛋白(GLO)-静脉血: 26.59g/L；有核红细胞计数(NRBC#)-静脉血: 0.0410E9/L；平均血小板体积(MPV)-静脉血: 9.5fL；大血小板百分比(P-LCR%)-静脉血: 20.5%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.003；红细胞计数(RBC#)-静脉血: 4.1410E12/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.07S/CO；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.55mmol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0IU/mL；血小板分布宽度(PDW)-静脉血: 9.8%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.014；载脂蛋白B(apoB)-静脉血: 0.91g/L；C-反应蛋白(CRP)-静脉血: 2.8mg/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；镁离子(Mg2+)-静脉血: 0.83mmol/L；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；肌酐(Crea)-静脉血: 77umol/L；钾离子(K+)-静脉血: 4mmol/L；白蛋白(ALB)-静脉血: 40.9g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；凝血酶原时间活动度(PTA)-静脉血: 90.4%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.54；阴离子间隙(AG)-静脉血: 12……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 行鼻咽镜下重新活检，完善胸部CT、腹部超声及全身骨扫描，检测血浆EBV DNA\nB. 行外院疑难病理会诊，完善胸部CT、腹部超声，暂缓全身骨扫描，检测血浆EBV DNA\nC. 沿用外院病理诊断，完善PET/CT全身显像及血浆EBV DNA检测\nD. 行外院疑难病理会诊，完善胸部增强CT及腹部增强CT，暂缓全身骨扫描\nE. 行外院疑难病理会诊，完善PET/CT全身显像及血浆EBV DNA检测\nF. 行鼻咽镜下重新活检，完善PET/CT全身显像及血浆EBV DNA检测\nG. 行外院疑难病理会诊，完善PET/CT全身显像，暂缓血浆EBV DNA检测\nH. 行外院疑难病理会诊，完善胸部CT及腹部CT，暂缓全身骨扫描及血浆EBV DNA检测\nI. 沿用外院病理诊断，完善PET/CT全身显像，暂缓血浆EBV DNA检测\nJ. 行外院疑难病理会诊，完善头颈部局部PET/CT及血浆EBV DNA检测\nK. 行鼻咽镜下重新活检，完善胸部CT及腹部CT，暂缓血浆EBV DNA检测\n\n请仅输出一个选项字母（A-K）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现颈部肿物1月余；当地诊断：鼻咽癌。于某次就诊时间在[机构已隐去]行力扑素270mgd1+奈达铂120mgd1+泰欣生200mgd1化疗一程，化疗后出现四度中性粒细胞减少，无发热、腹泻、寒战等，予升白处理后中性粒细胞恢复。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物,中性粒细胞减少,颈部肿物；既往史: 颈椎病史10年，既往有慢性肠炎病史。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：362.℃，P：100次/分，R：20次/分，BP：126/74mmHg,Ht：168cm，Wt：63kg，BSA：1.72m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；双侧颈部IIa区各可扪及1个淋巴结，左颈2×3cm，右颈2×2cm,无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 电轴左偏(轻度) 心电图大致正常\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1] 检验组合: 纤维蛋白原降解产物(FDP)-静脉血: 2ug/ml；平均红细胞体积(MCV)-静脉血: 93.5fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6；甘油三酯(TG)-静脉血: 2.17mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 51.4U/L；胱抑素(Cys-C)-静脉血: 0.91mg/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.08COI；总钙(Ca)-静脉血: 2.24mmol/L；淋巴细胞计数(Lymph#)-静脉血: 2.610E9/L；葡萄糖(Glu)-静脉血: 5.18mmol/L；球蛋白(GLO)-静脉血: 26.59g/L；有核红细胞计数(NRBC#)-静脉血: 0.0410E9/L；平均血小板体积(MPV)-静脉血: 9.5fL；大血小板百分比(P-LCR%)-静脉血: 20.5%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.003；红细胞计数(RBC#)-静脉血: 4.1410E12/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.07S/CO；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.55mmol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0IU/mL；血小板分布宽度(PDW)-静脉血: 9.8%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.014；载脂蛋白B(apoB)-静脉血: 0.91g/L；C-反应蛋白(CRP)-静脉血: 2.8mg/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；镁离子(Mg2+)-静脉血: 0.83mmol/L；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；肌酐(Crea)-静脉血: 77umol/L；钾离子(K+)-静脉血: 4mmol/L；白蛋白(ALB)-静脉血: 40.9g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；凝血酶原时间活动度(PTA)-静脉血: 90.4%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.54；阴离子间隙(AG)-静脉血: 12……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 行鼻咽镜下重新活检，完善胸部CT、腹部超声及全身骨扫描，检测血浆EBV DNA\nB. 行外院疑难病理会诊，完善胸部CT、腹部超声，暂缓全身骨扫描，检测血浆EBV DNA\nC. 沿用外院病理诊断，完善PET/CT全身显像及血浆EBV DNA检测\nD. 行外院疑难病理会诊，完善胸部增强CT及腹部增强CT，暂缓全身骨扫描\nE. 行外院疑难病理会诊，完善PET/CT全身显像及血浆EBV DNA检测\nF. 行鼻咽镜下重新活检，完善PET/CT全身显像及血浆EBV DNA检测\nG. 行外院疑难病理会诊，完善PET/CT全身显像，暂缓血浆EBV DNA检测\nH. 行外院疑难病理会诊，完善胸部CT及腹部CT，暂缓全身骨扫描及血浆EBV DNA检测\nI. 沿用外院病理诊断，完善PET/CT全身显像，暂缓血浆EBV DNA检测\nJ. 行外院疑难病理会诊，完善头颈部局部PET/CT及血浆EBV DNA检测\nK. 行鼻咽镜下重新活检，完善胸部CT及腹部CT，暂缓血浆EBV DNA检测\n\n请仅输出一个选项字母（A-K）。"}]}
+{"sample_id":"sample-ac55ce5273aeb2587f3051e7","patient_id":"patient-290a042206ccfe67e72f9a19","turn_id":"turn05","turn_position":3,"turn_type":"toxicity_or_support_decision","gold_letter":"I","gold_action":"予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，暂不予口服保肝药物治疗，并复查血常规及生化后安排出院。","options":[{"letter":"A","text":"予以短效重组人粒细胞刺激因子（rhG-CSF）皮下注射，暂不予口服保肝药物治疗，并复查血常规及生化后继续住院观察。","is_gold":false},{"letter":"B","text":"暂不予粒细胞集落刺激因子预防，仅口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。","is_gold":false},{"letter":"C","text":"予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，静脉滴注头孢菌素预防感染，并复查血常规及生化后安排出院。","is_gold":false},{"letter":"D","text":"予以短效重组人粒细胞刺激因子（rhG-CSF）皮下注射，静脉滴注异甘草酸镁强效保肝，并复查血常规及生化后继续住院观察。","is_gold":false},{"letter":"E","text":"暂不予粒细胞集落刺激因子预防，暂不予口服保肝药物治疗，直接安排出院并嘱院外定期复查血常规及生化。","is_gold":false},{"letter":"F","text":"予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，口服恩替卡韦抗病毒治疗，并复查血常规及生化后安排出院。","is_gold":false},{"letter":"G","text":"予以短效重组人粒细胞刺激因子（rhG-CSF）皮下注射，口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。","is_gold":false},{"letter":"H","text":"予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。","is_gold":false},{"letter":"I","text":"予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，暂不予口服保肝药物治疗，并复查血常规及生化后安排出院。","is_gold":true},{"letter":"J","text":"予以重组人促血小板生成素（rhTPO）皮下注射，口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。","is_gold":false},{"letter":"K","text":"予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，静脉滴注还原型谷胱甘肽保肝，并复查血常规及生化后继续住院观察。","is_gold":false},{"letter":"L","text":"暂不予任何药物处理，直接安排出院，嘱院外定期复查血常规及生化，若出现发热再返院使用粒细胞集落刺激因子。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现颈部肿物1月余；当地诊断：鼻咽癌。于某次就诊时间在[机构已隐去]行力扑素270mgd1+奈达铂120mgd1+泰欣生200mgd1化疗一程，化疗后出现四度中性粒细胞减少，无发热、腹泻、寒战等，予升白处理后中性粒细胞恢复。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物,中性粒细胞减少,颈部肿物；既往史: 颈椎病史10年，既往有慢性肠炎病史。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：362.℃，P：100次/分，R：20次/分，BP：126/74mmHg,Ht：168cm，Wt：63kg，BSA：1.72m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；双侧颈部IIa区各可扪及1个淋巴结，左颈2×3cm，右颈2×2cm,无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 电轴左偏(轻度) 心电图大致正常\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1] 检验组合: 纤维蛋白原降解产物(FDP)-静脉血: 2ug/ml；平均红细胞体积(MCV)-静脉血: 93.5fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6；甘油三酯(TG)-静脉血: 2.17mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 51.4U/L；胱抑素(Cys-C)-静脉血: 0.91mg/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.08COI；总钙(Ca)-静脉血: 2.24mmol/L；淋巴细胞计数(Lymph#)-静脉血: 2.610E9/L；葡萄糖(Glu)-静脉血: 5.18mmol/L；球蛋白(GLO)-静脉血: 26.59g/L；有核红细胞计数(NRBC#)-静脉血: 0.0410E9/L；平均血小板体积(MPV)-静脉血: 9.5fL；大血小板百分比(P-LCR%)-静脉血: 20.5%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.003；红细胞计数(RBC#)-静脉血: 4.1410E12/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.07S/CO；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.55mmol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0IU/mL；血小板分布宽度(PDW)-静脉血: 9.8%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.014；载脂蛋白B(apoB)-静脉血: 0.91g/L；C-反应蛋白(CRP)-静脉血: 2.8mg/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；镁离子(Mg2+)-静脉血: 0.83mmol/L；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；肌酐(Crea)-静脉血: 77umol/L；钾离子(K+)-静脉血: 4mmol/L；白蛋白(ALB)-静脉血: 40.9g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；凝血酶原时间活动度(PTA)-静脉血: 90.4%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.54；阴离子间隙(AG)-静脉血: 12……\n- [全程D8] 检验组合: 单核细胞百分比(Mono%)-静脉血: 0.065；血红蛋白(Hb)-静脉血: 129g/L；淋巴细胞计数(Lymph#)-静脉血: 2.110E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；大血小板百分比(P-LCR%)-静脉血: 22%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.013；平均红细胞体积(MCV)-静脉血: 93.8fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.2；红细胞比容(Hct)-静脉血: 39.2%；中性粒细胞百分比(Neut%)-静脉血: 0.53；单核细胞计数(Mono#)-静脉血: 0.410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；白细胞计数(WBC#)-静脉血: 5.3910E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血小板分布宽度(PDW)-静脉血: 10.3%；平均红细胞血红蛋白含量(MCH)-静脉血: 30.9pg；血小板计数(PLT#)-静脉血: 14810E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.8；淋巴细胞百分比(Lymph%)-静脉血: 0.39；有核红细胞计数(NRBC#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.002；血小板比容-静脉血: 14%；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；红细胞计数(RBC#)-静脉血: 4.1810E12/L；平均血小板体积(MPV)-静脉血: 9.7fL；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L\n- [全程D9] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: 输液港走行于右锁骨下静脉，导管末端位于脊柱右旁T6椎体下缘水平，估计位于上腔静脉上段。；检查结论: 导管末端位置如上述。\n- [全程D9] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；非鳞状上皮细胞计数-尿液: 1/μL；颜色-尿液: Light-Yellow；粘液丝计数(MUCS#)-尿液: 5/μL；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-尿液: colorless；比重(SG)-尿液: 1.013；白细胞(LEU)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；白细胞(LEU)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 1/μL；酸碱度(pH)-尿液: 6.5；浊度(TRUB)-尿液: clear；比重(SG)-尿液: 1.016；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D10] 检验组合: 红细胞计数(RBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 6；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 7/μL；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.017；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 1/μL；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow\n- [全程D14] 检验组合: 总胆固醇(TC)-静脉血: 5.88mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜碱性粒细胞百分比(Baso%)-静脉血: 0；单核细胞百分比(Mono%)-静脉血: 0.008；丙氨酸氨基转移酶(ALT)-静脉血: 65.5U/L；血小板分布宽度(PDW)-静脉血: 13.8%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.9；白蛋白(ALB)-静脉血: 42.5g/L；球蛋白(GLO)-静脉血: 26g/L；胱抑素(Cys-C)-静脉血: 1.11mg/L；总蛋白(TP)-静脉血: 68.5g/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.7mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞计数(RBC#)-静脉血: 4.4510E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；总胆红素(TBIL)-静脉血: 15.4umol/L；钾离子(K+)-静脉血: 4.03mmol/L；葡萄糖(Glu)-静脉血: 5.74mmol/L；乳酸脱氢酶(LDH)-静脉血: 175U/L；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；肌酐(Crea)-静脉血: 80umol/L；总钙(Ca)-静脉血: 2.18mmol/L；钠离子(Na+)-静脉血: 132.2mmol/L；大血小板百分比(P-LCR%)-静脉血: 34.4%；红细胞比容(Hct)-静脉血: 39.3%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；阴离子间隙(AG)-静脉血: 17.8；γ-谷氨酰基转移酶(GGT)-静脉血: 26.8U/L；白细胞计数(WBC#)-静脉血: 5.2310E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.83mmol/L；平均血小板体积(MPV)-静脉血: 11.2fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.01；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.51mmolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.35；碱性磷酸酶(ALP)-静脉血: 57.4U/L；直接胆红素(DBIL)-静脉血: 4.1umol/L；镁离子(Mg2+)-静脉血: 0.93mmol/L；血红蛋白(Hb)-静脉血: 1……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者各项检查继续完善中。\n- [全程D10] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程多西紫杉醇＋DDP+5-FU方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 予以短效重组人粒细胞刺激因子（rhG-CSF）皮下注射，暂不予口服保肝药物治疗，并复查血常规及生化后继续住院观察。\nB. 暂不予粒细胞集落刺激因子预防，仅口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。\nC. 予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，静脉滴注头孢菌素预防感染，并复查血常规及生化后安排出院。\nD. 予以短效重组人粒细胞刺激因子（rhG-CSF）皮下注射，静脉滴注异甘草酸镁强效保肝，并复查血常规及生化后继续住院观察。\nE. 暂不予粒细胞集落刺激因子预防，暂不予口服保肝药物治疗，直接安排出院并嘱院外定期复查血常规及生化。\nF. 予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，口服恩替卡韦抗病毒治疗，并复查血常规及生化后安排出院。\nG. 予以短效重组人粒细胞刺激因子（rhG-CSF）皮下注射，口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。\nH. 予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。\nI. 予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，暂不予口服保肝药物治疗，并复查血常规及生化后安排出院。\nJ. 予以重组人促血小板生成素（rhTPO）皮下注射，口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。\nK. 予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，静脉滴注还原型谷胱甘肽保肝，并复查血常规及生化后继续住院观察。\nL. 暂不予任何药物处理，直接安排出院，嘱院外定期复查血常规及生化，若出现发热再返院使用粒细胞集落刺激因子。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现颈部肿物1月余；当地诊断：鼻咽癌。于某次就诊时间在[机构已隐去]行力扑素270mgd1+奈达铂120mgd1+泰欣生200mgd1化疗一程，化疗后出现四度中性粒细胞减少，无发热、腹泻、寒战等，予升白处理后中性粒细胞恢复。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物,中性粒细胞减少,颈部肿物；既往史: 颈椎病史10年，既往有慢性肠炎病史。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：362.℃，P：100次/分，R：20次/分，BP：126/74mmHg,Ht：168cm，Wt：63kg，BSA：1.72m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；双侧颈部IIa区各可扪及1个淋巴结，左颈2×3cm，右颈2×2cm,无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 电轴左偏(轻度) 心电图大致正常\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1] 检验组合: 纤维蛋白原降解产物(FDP)-静脉血: 2ug/ml；平均红细胞体积(MCV)-静脉血: 93.5fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6；甘油三酯(TG)-静脉血: 2.17mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 51.4U/L；胱抑素(Cys-C)-静脉血: 0.91mg/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.08COI；总钙(Ca)-静脉血: 2.24mmol/L；淋巴细胞计数(Lymph#)-静脉血: 2.610E9/L；葡萄糖(Glu)-静脉血: 5.18mmol/L；球蛋白(GLO)-静脉血: 26.59g/L；有核红细胞计数(NRBC#)-静脉血: 0.0410E9/L；平均血小板体积(MPV)-静脉血: 9.5fL；大血小板百分比(P-LCR%)-静脉血: 20.5%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.003；红细胞计数(RBC#)-静脉血: 4.1410E12/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.07S/CO；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.55mmol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0IU/mL；血小板分布宽度(PDW)-静脉血: 9.8%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.014；载脂蛋白B(apoB)-静脉血: 0.91g/L；C-反应蛋白(CRP)-静脉血: 2.8mg/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；镁离子(Mg2+)-静脉血: 0.83mmol/L；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；肌酐(Crea)-静脉血: 77umol/L；钾离子(K+)-静脉血: 4mmol/L；白蛋白(ALB)-静脉血: 40.9g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；凝血酶原时间活动度(PTA)-静脉血: 90.4%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.54；阴离子间隙(AG)-静脉血: 12……\n- [全程D8] 检验组合: 单核细胞百分比(Mono%)-静脉血: 0.065；血红蛋白(Hb)-静脉血: 129g/L；淋巴细胞计数(Lymph#)-静脉血: 2.110E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；大血小板百分比(P-LCR%)-静脉血: 22%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.013；平均红细胞体积(MCV)-静脉血: 93.8fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.2；红细胞比容(Hct)-静脉血: 39.2%；中性粒细胞百分比(Neut%)-静脉血: 0.53；单核细胞计数(Mono#)-静脉血: 0.410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；白细胞计数(WBC#)-静脉血: 5.3910E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血小板分布宽度(PDW)-静脉血: 10.3%；平均红细胞血红蛋白含量(MCH)-静脉血: 30.9pg；血小板计数(PLT#)-静脉血: 14810E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.8；淋巴细胞百分比(Lymph%)-静脉血: 0.39；有核红细胞计数(NRBC#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.002；血小板比容-静脉血: 14%；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；红细胞计数(RBC#)-静脉血: 4.1810E12/L；平均血小板体积(MPV)-静脉血: 9.7fL；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L\n- [全程D9] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: 输液港走行于右锁骨下静脉，导管末端位于脊柱右旁T6椎体下缘水平，估计位于上腔静脉上段。；检查结论: 导管末端位置如上述。\n- [全程D9] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；非鳞状上皮细胞计数-尿液: 1/μL；颜色-尿液: Light-Yellow；粘液丝计数(MUCS#)-尿液: 5/μL；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-尿液: colorless；比重(SG)-尿液: 1.013；白细胞(LEU)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；白细胞(LEU)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 1/μL；酸碱度(pH)-尿液: 6.5；浊度(TRUB)-尿液: clear；比重(SG)-尿液: 1.016；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D10] 检验组合: 红细胞计数(RBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 6；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 7/μL；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.017；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 1/μL；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow\n- [全程D14] 检验组合: 总胆固醇(TC)-静脉血: 5.88mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜碱性粒细胞百分比(Baso%)-静脉血: 0；单核细胞百分比(Mono%)-静脉血: 0.008；丙氨酸氨基转移酶(ALT)-静脉血: 65.5U/L；血小板分布宽度(PDW)-静脉血: 13.8%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.9；白蛋白(ALB)-静脉血: 42.5g/L；球蛋白(GLO)-静脉血: 26g/L；胱抑素(Cys-C)-静脉血: 1.11mg/L；总蛋白(TP)-静脉血: 68.5g/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.7mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞计数(RBC#)-静脉血: 4.4510E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；总胆红素(TBIL)-静脉血: 15.4umol/L；钾离子(K+)-静脉血: 4.03mmol/L；葡萄糖(Glu)-静脉血: 5.74mmol/L；乳酸脱氢酶(LDH)-静脉血: 175U/L；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；肌酐(Crea)-静脉血: 80umol/L；总钙(Ca)-静脉血: 2.18mmol/L；钠离子(Na+)-静脉血: 132.2mmol/L；大血小板百分比(P-LCR%)-静脉血: 34.4%；红细胞比容(Hct)-静脉血: 39.3%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；阴离子间隙(AG)-静脉血: 17.8；γ-谷氨酰基转移酶(GGT)-静脉血: 26.8U/L；白细胞计数(WBC#)-静脉血: 5.2310E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.83mmol/L；平均血小板体积(MPV)-静脉血: 11.2fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.01；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.51mmolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.35；碱性磷酸酶(ALP)-静脉血: 57.4U/L；直接胆红素(DBIL)-静脉血: 4.1umol/L；镁离子(Mg2+)-静脉血: 0.93mmol/L；血红蛋白(Hb)-静脉血: 1……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者各项检查继续完善中。\n- [全程D10] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程多西紫杉醇＋DDP+5-FU方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 予以短效重组人粒细胞刺激因子（rhG-CSF）皮下注射，暂不予口服保肝药物治疗，并复查血常规及生化后继续住院观察。\nB. 暂不予粒细胞集落刺激因子预防，仅口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。\nC. 予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，静脉滴注头孢菌素预防感染，并复查血常规及生化后安排出院。\nD. 予以短效重组人粒细胞刺激因子（rhG-CSF）皮下注射，静脉滴注异甘草酸镁强效保肝，并复查血常规及生化后继续住院观察。\nE. 暂不予粒细胞集落刺激因子预防，暂不予口服保肝药物治疗，直接安排出院并嘱院外定期复查血常规及生化。\nF. 予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，口服恩替卡韦抗病毒治疗，并复查血常规及生化后安排出院。\nG. 予以短效重组人粒细胞刺激因子（rhG-CSF）皮下注射，口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。\nH. 予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。\nI. 予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，暂不予口服保肝药物治疗，并复查血常规及生化后安排出院。\nJ. 予以重组人促血小板生成素（rhTPO）皮下注射，口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。\nK. 予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，静脉滴注还原型谷胱甘肽保肝，并复查血常规及生化后继续住院观察。\nL. 暂不予任何药物处理，直接安排出院，嘱院外定期复查血常规及生化，若出现发热再返院使用粒细胞集落刺激因子。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-6d1ca43d48e1d74031505487","patient_id":"patient-290a042206ccfe67e72f9a19","turn_id":"turn07","turn_position":4,"turn_type":"recurrence_or_salvage_decision","gold_letter":"J","gold_action":"继续予以抑酸护胃及静脉高营养等对症支持治疗，待体能恢复后序贯开展根治性放疗或同步放化疗。","options":[{"letter":"A","text":"立即启动根治性调强放疗联合同步顺铂化疗，停止静脉高营养以避免导管相关感染。","is_gold":false},{"letter":"B","text":"更换为吉西他滨联合顺铂方案进行第四周期诱导化疗，并继续抑酸护胃治疗。","is_gold":false},{"letter":"C","text":"安排鼻咽原发灶及双侧颈部淋巴结根治性切除术，术后辅以静脉营养支持。","is_gold":false},{"letter":"D","text":"维持静脉营养支持，并立即启动根治性放疗联合PD-1抑制剂及靶向治疗。","is_gold":false},{"letter":"E","text":"继续原方案（多西紫杉醇+顺铂+5-FU）进行第四周期诱导化疗，并辅以抑酸护胃治疗。","is_gold":false},{"letter":"F","text":"暂停所有抗肿瘤治疗，仅维持静脉营养支持及抑酸治疗，1个月后复查MRI决定后续方案。","is_gold":false},{"letter":"G","text":"安排全身PET-CT检查评估全身情况，若无远处转移则继续原方案诱导化疗两周期。","is_gold":false},{"letter":"H","text":"行局部清扫术，处理颈部残留淋巴结，术后序贯鼻咽部根治性放疗及静脉营养支持。","is_gold":false},{"letter":"I","text":"调整为卡培他滨节拍化疗联合静脉营养支持，待消化道反应完全缓解后启动放疗。","is_gold":false},{"letter":"J","text":"继续予以抑酸护胃及静脉高营养等对症支持治疗，待体能恢复后序贯开展根治性放疗或同步放化疗。","is_gold":true},{"letter":"K","text":"启动姑息性放疗控制局部及颈部病灶，并联合阿帕替尼等抗血管生成药物治疗。","is_gold":false},{"letter":"L","text":"维持静脉营养支持，并安排鼻咽镜下局部病灶再次活检以病理确认肿瘤退缩程度。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现颈部肿物1月余；当地诊断：鼻咽癌。于某次就诊时间在[机构已隐去]行力扑素270mgd1+奈达铂120mgd1+泰欣生200mgd1化疗一程，化疗后出现四度中性粒细胞减少，无发热、腹泻、寒战等，予升白处理后中性粒细胞恢复。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物,中性粒细胞减少,颈部肿物；既往史: 颈椎病史10年，既往有慢性肠炎病史。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：362.℃，P：100次/分，R：20次/分，BP：126/74mmHg,Ht：168cm，Wt：63kg，BSA：1.72m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；双侧颈部IIa区各可扪及1个淋巴结，左颈2×3cm，右颈2×2cm,无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 电轴左偏(轻度) 心电图大致正常\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1] 检验组合: 纤维蛋白原降解产物(FDP)-静脉血: 2ug/ml；平均红细胞体积(MCV)-静脉血: 93.5fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6；甘油三酯(TG)-静脉血: 2.17mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 51.4U/L；胱抑素(Cys-C)-静脉血: 0.91mg/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.08COI；总钙(Ca)-静脉血: 2.24mmol/L；淋巴细胞计数(Lymph#)-静脉血: 2.610E9/L；葡萄糖(Glu)-静脉血: 5.18mmol/L；球蛋白(GLO)-静脉血: 26.59g/L；有核红细胞计数(NRBC#)-静脉血: 0.0410E9/L；平均血小板体积(MPV)-静脉血: 9.5fL；大血小板百分比(P-LCR%)-静脉血: 20.5%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.003；红细胞计数(RBC#)-静脉血: 4.1410E12/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.07S/CO；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.55mmol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0IU/mL；血小板分布宽度(PDW)-静脉血: 9.8%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.014；载脂蛋白B(apoB)-静脉血: 0.91g/L；C-反应蛋白(CRP)-静脉血: 2.8mg/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；镁离子(Mg2+)-静脉血: 0.83mmol/L；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；肌酐(Crea)-静脉血: 77umol/L；钾离子(K+)-静脉血: 4mmol/L；白蛋白(ALB)-静脉血: 40.9g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；凝血酶原时间活动度(PTA)-静脉血: 90.4%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.54；阴离子间隙(AG)-静脉血: 12……\n- [全程D8] 检验组合: 单核细胞百分比(Mono%)-静脉血: 0.065；血红蛋白(Hb)-静脉血: 129g/L；淋巴细胞计数(Lymph#)-静脉血: 2.110E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；大血小板百分比(P-LCR%)-静脉血: 22%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.013；平均红细胞体积(MCV)-静脉血: 93.8fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.2；红细胞比容(Hct)-静脉血: 39.2%；中性粒细胞百分比(Neut%)-静脉血: 0.53；单核细胞计数(Mono#)-静脉血: 0.410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；白细胞计数(WBC#)-静脉血: 5.3910E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血小板分布宽度(PDW)-静脉血: 10.3%；平均红细胞血红蛋白含量(MCH)-静脉血: 30.9pg；血小板计数(PLT#)-静脉血: 14810E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.8；淋巴细胞百分比(Lymph%)-静脉血: 0.39；有核红细胞计数(NRBC#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.002；血小板比容-静脉血: 14%；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；红细胞计数(RBC#)-静脉血: 4.1810E12/L；平均血小板体积(MPV)-静脉血: 9.7fL；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L\n- [全程D9] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: 输液港走行于右锁骨下静脉，导管末端位于脊柱右旁T6椎体下缘水平，估计位于上腔静脉上段。；检查结论: 导管末端位置如上述。\n- [全程D9] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；非鳞状上皮细胞计数-尿液: 1/μL；颜色-尿液: Light-Yellow；粘液丝计数(MUCS#)-尿液: 5/μL；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-尿液: colorless；比重(SG)-尿液: 1.013；白细胞(LEU)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；白细胞(LEU)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 1/μL；酸碱度(pH)-尿液: 6.5；浊度(TRUB)-尿液: clear；比重(SG)-尿液: 1.016；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D10] 检验组合: 红细胞计数(RBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 6；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 7/μL；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.017；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 1/μL；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow\n- [全程D14] 检验组合: 总胆固醇(TC)-静脉血: 5.88mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜碱性粒细胞百分比(Baso%)-静脉血: 0；单核细胞百分比(Mono%)-静脉血: 0.008；丙氨酸氨基转移酶(ALT)-静脉血: 65.5U/L；血小板分布宽度(PDW)-静脉血: 13.8%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.9；白蛋白(ALB)-静脉血: 42.5g/L；球蛋白(GLO)-静脉血: 26g/L；胱抑素(Cys-C)-静脉血: 1.11mg/L；总蛋白(TP)-静脉血: 68.5g/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.7mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞计数(RBC#)-静脉血: 4.4510E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；总胆红素(TBIL)-静脉血: 15.4umol/L；钾离子(K+)-静脉血: 4.03mmol/L；葡萄糖(Glu)-静脉血: 5.74mmol/L；乳酸脱氢酶(LDH)-静脉血: 175U/L；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；肌酐(Crea)-静脉血: 80umol/L；总钙(Ca)-静脉血: 2.18mmol/L；钠离子(Na+)-静脉血: 132.2mmol/L；大血小板百分比(P-LCR%)-静脉血: 34.4%；红细胞比容(Hct)-静脉血: 39.3%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；阴离子间隙(AG)-静脉血: 17.8；γ-谷氨酰基转移酶(GGT)-静脉血: 26.8U/L；白细胞计数(WBC#)-静脉血: 5.2310E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.83mmol/L；平均血小板体积(MPV)-静脉血: 11.2fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.01；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.51mmolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.35；碱性磷酸酶(ALP)-静脉血: 57.4U/L；直接胆红素(DBIL)-静脉血: 4.1umol/L；镁离子(Mg2+)-静脉血: 0.93mmol/L；血红蛋白(Hb)-静脉血: 1……\n- [全程D29] 检验组合: γ-谷氨酰基转移酶(GGT)-静脉血: 24.3U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.69；中性粒细胞计数(Neut#)-静脉血: 5.710E9/L；载脂蛋白AI(apoAI)-静脉血: 1.44g/L；血红蛋白(Hb)-静脉血: 117g/L；总胆固醇(TC)-静脉血: 5.21mmol/L；血小板分布宽度(PDW)-静脉血: 9.2%；乳酸脱氢酶(LDH)-静脉血: 181.3U/L；总胆汁酸(TBA)-静脉血: 3.1umol/L；直接胆红素(DBIL)-静脉血: 2umol/L；白蛋白(ALB)-静脉血: 39.2g/L；总胆红素(TBIL)-静脉血: 7.9umol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；平均红细胞体积(MCV)-静脉血: 92.9fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.647；C-反应蛋白(CRP)-静脉血: 1.01mg/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.3；红细胞计数(RBC#)-静脉血: 3.9410E12/L；白细胞计数(WBC#)-静脉血: 8.7310E9/L；肌酐(Crea)-静脉血: 102.7umol/L；钠离子(Na+)-静脉血: 141.8mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.56；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.32mmolL；总钙(Ca)-静脉血: 2.29mmol/L；胱抑素(Cys-C)-静脉血: 1.08mg/L；血液二氧化碳含量ctCO2(B)-静脉血: 26.3mmol/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；碱性磷酸酶(ALP)-静脉血: 61.9U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.5U/L；甘油三酯(TG)-静脉血: 1.82mmol/L；氯离子(Cl-)-静脉血: 103.6mmol/L；间接胆红素(IBIL)-静脉血: 5.9umolL；大血小板百分比(P-LCR%)-静脉血: 13.5%；淋巴细胞百分比(Lymph%)-静脉血: 0.282；葡萄糖(Glu)-静脉血: 5.18mmol/L；尿素氮(BUN)-静脉血: 6.……\n- [全程D31] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 2/μL；胆红素(BIL)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.011；比重(SG)-尿液: 1.017；隐血(OB)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 1/μL；胆红素(BIL)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 10/μL；白细胞(LEU)-尿液: -（参考: 阴性）；颜色-尿液: 无色；浊度(TRUB)-尿液: clear；总蛋白(TP)-尿液: -（参考: 阴性）\n- [全程D33] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.016；浊度(TRUB)-尿液: 清亮；总蛋白(TP)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；隐血(OB)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7；白细胞计数(WBC#)-尿液: 1/μL；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）\n- [全程D34] 检验组合: 隐血(OB)-粪便: 阴性（参考: 阴性）；阴离子间隙(AG)-静脉血: 10.6；颜色-粪便: 棕色；钠离子(Na+)-静脉血: 136.7mmol/L；虫卵-粪便: 未见虫卵（参考: 未见虫卵）；血液二氧化碳含量ctCO2(B)-静脉血: 26.2mmol/L；氯离子(Cl-)-静脉血: 99.9mmol/L；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；磷(P)-静脉血: 1.16mmol/L；总钙(Ca)-静脉血: 1.98mmol/L；镁离子(Mg2+)-静脉血: 0.59mmol/L；钾离子(K+)-静脉血: 3.49mmol/L；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）\n- [全程D36] 检验组合: 钾离子(K+)-静脉血: 4.1mmol/L；碱性磷酸酶(ALP)-静脉血: 51.9U/L；球蛋白(GLO)-静脉血: 20.23g/L；钠离子(Na+)-静脉血: 136.6mmol/L；阴离子间隙(AG)-静脉血: 13；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.82mmol/L；总胆红素(TBIL)-静脉血: 15.3umol/L；镁离子(Mg2+)-静脉血: 0.51mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.14g/L；氯离子(Cl-)-静脉血: 99mmol/L；单核细胞计数(Mono#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.3；乳酸脱氢酶(LDH)-静脉血: 169.8U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15.6U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.78；磷(P)-静脉血: 1.11mmol/L；葡萄糖(Glu)-静脉血: 5.25mmol/L；总钙(Ca)-静脉血: 2.08mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 27.3U/L；血小板计数(PLT#)-静脉血: 10410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 327g/L；单核细胞百分比(Mono%)-静脉血: 0.005；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；总胆固醇(TC)-静脉血: 5.03mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 28U/L；平均红细胞体积(MCV)-静脉血: 90.6fL；血红蛋白(Hb)-静脉血: 110g/L；血小板分布宽度(PDW)-静脉血: 11.8%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.6pg；白蛋白(ALB)-静脉血: 36g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1；血液二氧化碳含量ctCO2(B)-静脉血: 24.8mmol/L；总蛋白(TP)-静脉血: 56.23g/L；间接胆红素(IBIL)-静脉血: 10umolL；总胆汁酸(TBA)-静脉血: 4.4umol/L；载脂蛋白B(apoB)-静脉血: 0.9g/L；C-反应蛋白(CRP)-静脉血: 1.75mg/L；嗜酸性粒细胞百分……\n- [全程D37] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后复查，与某次就诊时间对比： 鼻咽腔稍狭窄，鼻咽顶壁、顶后壁、后壁及双侧壁稍增厚，T1WI呈等信号，T2WI呈稍高信号，增强扫描强化明显，粘膜表面不光整。双侧咽隐窝变浅。双侧咽旁间隙未见明显狭窄。双侧腭帆张提肌、头长肌信号不均匀，增强后不均匀强化。双侧翼内外肌未见受侵。 口咽双侧壁未见增厚，左侧鼻甲明显肿大，气道狭窄。双侧鼻腔未见肿物。 双侧翼腭窝、上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 斜坡、枕骨基底部、蝶骨基底部、双侧翼突基底、翼内板、右侧岩尖骨质信号降低，增强扫描强化明显。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶窦、筛窦及右侧乳突气房内见积液，双侧上颌窦及左侧乳突充气良好，骨壁完整。 左侧咽后见淋巴结，大小约4mm×7mm，较前缩小；右侧咽后见小淋巴结，大小约3mm×4mm，较前缩小。双颈II、III区见数个淋巴结，大者大小约8mm×14mm，边界欠清，信号不均匀，增强扫描不均匀明显强化，较前缩小。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗后复查，与某次就诊时间对比： 鼻咽病变，较前明显好转。 颅底骨质破坏，较前好转。 双侧咽后淋巴结，较前缩小。 双颈II、III区淋巴结，考虑转移，较前缩小。 鼻窦炎，右侧乳突炎。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者各项检查继续完善中。\n- [全程D10] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程多西紫杉醇＋DDP+5-FU方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D15] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程TPF方案诱导化疗结束，诉呕吐1次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部IIa区各可扪及1个淋巴结，左颈2×2cm，右颈1.5×1.5cm,无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程TPF方案诱导化疗结束，无诉特殊不适，可予出院，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n- [全程D30] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，可于今日水化，明日执行第2程多西紫杉醇＋DDP+5-FU方案诱导化疗，注意化疗不良反应。\n- [全程D31] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程多西紫杉醇＋DDP+5-FU方案诱导化疗第一天，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D35] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程多西紫杉醇＋DDP+5-FU方案诱导化疗结束，诉反酸、恶心，无发热、腹痛、腹泻，无关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第2程多西紫杉醇＋DDP+5-FU方案诱导化疗结束后出现反酸、恶心现象，予抑酸护胃、补液等对症处理，继观。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即启动根治性调强放疗联合同步顺铂化疗，停止静脉高营养以避免导管相关感染。\nB. 更换为吉西他滨联合顺铂方案进行第四周期诱导化疗，并继续抑酸护胃治疗。\nC. 安排鼻咽原发灶及双侧颈部淋巴结根治性切除术，术后辅以静脉营养支持。\nD. 维持静脉营养支持，并立即启动根治性放疗联合PD-1抑制剂及靶向治疗。\nE. 继续原方案（多西紫杉醇+顺铂+5-FU）进行第四周期诱导化疗，并辅以抑酸护胃治疗。\nF. 暂停所有抗肿瘤治疗，仅维持静脉营养支持及抑酸治疗，1个月后复查MRI决定后续方案。\nG. 安排全身PET-CT检查评估全身情况，若无远处转移则继续原方案诱导化疗两周期。\nH. 行局部清扫术，处理颈部残留淋巴结，术后序贯鼻咽部根治性放疗及静脉营养支持。\nI. 调整为卡培他滨节拍化疗联合静脉营养支持，待消化道反应完全缓解后启动放疗。\nJ. 继续予以抑酸护胃及静脉高营养等对症支持治疗，待体能恢复后序贯开展根治性放疗或同步放化疗。\nK. 启动姑息性放疗控制局部及颈部病灶，并联合阿帕替尼等抗血管生成药物治疗。\nL. 维持静脉营养支持，并安排鼻咽镜下局部病灶再次活检以病理确认肿瘤退缩程度。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现颈部肿物1月余；当地诊断：鼻咽癌。于某次就诊时间在[机构已隐去]行力扑素270mgd1+奈达铂120mgd1+泰欣生200mgd1化疗一程，化疗后出现四度中性粒细胞减少，无发热、腹泻、寒战等，予升白处理后中性粒细胞恢复。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物,中性粒细胞减少,颈部肿物；既往史: 颈椎病史10年，既往有慢性肠炎病史。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：362.℃，P：100次/分，R：20次/分，BP：126/74mmHg,Ht：168cm，Wt：63kg，BSA：1.72m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；双侧颈部IIa区各可扪及1个淋巴结，左颈2×3cm，右颈2×2cm,无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 电轴左偏(轻度) 心电图大致正常\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1] 检验组合: 纤维蛋白原降解产物(FDP)-静脉血: 2ug/ml；平均红细胞体积(MCV)-静脉血: 93.5fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6；甘油三酯(TG)-静脉血: 2.17mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 51.4U/L；胱抑素(Cys-C)-静脉血: 0.91mg/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.08COI；总钙(Ca)-静脉血: 2.24mmol/L；淋巴细胞计数(Lymph#)-静脉血: 2.610E9/L；葡萄糖(Glu)-静脉血: 5.18mmol/L；球蛋白(GLO)-静脉血: 26.59g/L；有核红细胞计数(NRBC#)-静脉血: 0.0410E9/L；平均血小板体积(MPV)-静脉血: 9.5fL；大血小板百分比(P-LCR%)-静脉血: 20.5%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.003；红细胞计数(RBC#)-静脉血: 4.1410E12/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.07S/CO；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.55mmol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0IU/mL；血小板分布宽度(PDW)-静脉血: 9.8%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.014；载脂蛋白B(apoB)-静脉血: 0.91g/L；C-反应蛋白(CRP)-静脉血: 2.8mg/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；镁离子(Mg2+)-静脉血: 0.83mmol/L；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；肌酐(Crea)-静脉血: 77umol/L；钾离子(K+)-静脉血: 4mmol/L；白蛋白(ALB)-静脉血: 40.9g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；凝血酶原时间活动度(PTA)-静脉血: 90.4%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.54；阴离子间隙(AG)-静脉血: 12……\n- [全程D8] 检验组合: 单核细胞百分比(Mono%)-静脉血: 0.065；血红蛋白(Hb)-静脉血: 129g/L；淋巴细胞计数(Lymph#)-静脉血: 2.110E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；大血小板百分比(P-LCR%)-静脉血: 22%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.013；平均红细胞体积(MCV)-静脉血: 93.8fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.2；红细胞比容(Hct)-静脉血: 39.2%；中性粒细胞百分比(Neut%)-静脉血: 0.53；单核细胞计数(Mono#)-静脉血: 0.410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；白细胞计数(WBC#)-静脉血: 5.3910E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血小板分布宽度(PDW)-静脉血: 10.3%；平均红细胞血红蛋白含量(MCH)-静脉血: 30.9pg；血小板计数(PLT#)-静脉血: 14810E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.8；淋巴细胞百分比(Lymph%)-静脉血: 0.39；有核红细胞计数(NRBC#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.002；血小板比容-静脉血: 14%；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；红细胞计数(RBC#)-静脉血: 4.1810E12/L；平均血小板体积(MPV)-静脉血: 9.7fL；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L\n- [全程D9] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: 输液港走行于右锁骨下静脉，导管末端位于脊柱右旁T6椎体下缘水平，估计位于上腔静脉上段。；检查结论: 导管末端位置如上述。\n- [全程D9] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；非鳞状上皮细胞计数-尿液: 1/μL；颜色-尿液: Light-Yellow；粘液丝计数(MUCS#)-尿液: 5/μL；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-尿液: colorless；比重(SG)-尿液: 1.013；白细胞(LEU)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；白细胞(LEU)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 1/μL；酸碱度(pH)-尿液: 6.5；浊度(TRUB)-尿液: clear；比重(SG)-尿液: 1.016；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D10] 检验组合: 红细胞计数(RBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 6；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 7/μL；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.017；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 1/μL；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow\n- [全程D14] 检验组合: 总胆固醇(TC)-静脉血: 5.88mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜碱性粒细胞百分比(Baso%)-静脉血: 0；单核细胞百分比(Mono%)-静脉血: 0.008；丙氨酸氨基转移酶(ALT)-静脉血: 65.5U/L；血小板分布宽度(PDW)-静脉血: 13.8%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.9；白蛋白(ALB)-静脉血: 42.5g/L；球蛋白(GLO)-静脉血: 26g/L；胱抑素(Cys-C)-静脉血: 1.11mg/L；总蛋白(TP)-静脉血: 68.5g/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.7mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞计数(RBC#)-静脉血: 4.4510E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；总胆红素(TBIL)-静脉血: 15.4umol/L；钾离子(K+)-静脉血: 4.03mmol/L；葡萄糖(Glu)-静脉血: 5.74mmol/L；乳酸脱氢酶(LDH)-静脉血: 175U/L；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；肌酐(Crea)-静脉血: 80umol/L；总钙(Ca)-静脉血: 2.18mmol/L；钠离子(Na+)-静脉血: 132.2mmol/L；大血小板百分比(P-LCR%)-静脉血: 34.4%；红细胞比容(Hct)-静脉血: 39.3%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；阴离子间隙(AG)-静脉血: 17.8；γ-谷氨酰基转移酶(GGT)-静脉血: 26.8U/L；白细胞计数(WBC#)-静脉血: 5.2310E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.83mmol/L；平均血小板体积(MPV)-静脉血: 11.2fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.01；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.51mmolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.35；碱性磷酸酶(ALP)-静脉血: 57.4U/L；直接胆红素(DBIL)-静脉血: 4.1umol/L；镁离子(Mg2+)-静脉血: 0.93mmol/L；血红蛋白(Hb)-静脉血: 1……\n- [全程D29] 检验组合: γ-谷氨酰基转移酶(GGT)-静脉血: 24.3U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.69；中性粒细胞计数(Neut#)-静脉血: 5.710E9/L；载脂蛋白AI(apoAI)-静脉血: 1.44g/L；血红蛋白(Hb)-静脉血: 117g/L；总胆固醇(TC)-静脉血: 5.21mmol/L；血小板分布宽度(PDW)-静脉血: 9.2%；乳酸脱氢酶(LDH)-静脉血: 181.3U/L；总胆汁酸(TBA)-静脉血: 3.1umol/L；直接胆红素(DBIL)-静脉血: 2umol/L；白蛋白(ALB)-静脉血: 39.2g/L；总胆红素(TBIL)-静脉血: 7.9umol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；平均红细胞体积(MCV)-静脉血: 92.9fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.647；C-反应蛋白(CRP)-静脉血: 1.01mg/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.3；红细胞计数(RBC#)-静脉血: 3.9410E12/L；白细胞计数(WBC#)-静脉血: 8.7310E9/L；肌酐(Crea)-静脉血: 102.7umol/L；钠离子(Na+)-静脉血: 141.8mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.56；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.32mmolL；总钙(Ca)-静脉血: 2.29mmol/L；胱抑素(Cys-C)-静脉血: 1.08mg/L；血液二氧化碳含量ctCO2(B)-静脉血: 26.3mmol/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；碱性磷酸酶(ALP)-静脉血: 61.9U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.5U/L；甘油三酯(TG)-静脉血: 1.82mmol/L；氯离子(Cl-)-静脉血: 103.6mmol/L；间接胆红素(IBIL)-静脉血: 5.9umolL；大血小板百分比(P-LCR%)-静脉血: 13.5%；淋巴细胞百分比(Lymph%)-静脉血: 0.282；葡萄糖(Glu)-静脉血: 5.18mmol/L；尿素氮(BUN)-静脉血: 6.……\n- [全程D31] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 2/μL；胆红素(BIL)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.011；比重(SG)-尿液: 1.017；隐血(OB)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 1/μL；胆红素(BIL)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 10/μL；白细胞(LEU)-尿液: -（参考: 阴性）；颜色-尿液: 无色；浊度(TRUB)-尿液: clear；总蛋白(TP)-尿液: -（参考: 阴性）\n- [全程D33] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.016；浊度(TRUB)-尿液: 清亮；总蛋白(TP)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；隐血(OB)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7；白细胞计数(WBC#)-尿液: 1/μL；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）\n- [全程D34] 检验组合: 隐血(OB)-粪便: 阴性（参考: 阴性）；阴离子间隙(AG)-静脉血: 10.6；颜色-粪便: 棕色；钠离子(Na+)-静脉血: 136.7mmol/L；虫卵-粪便: 未见虫卵（参考: 未见虫卵）；血液二氧化碳含量ctCO2(B)-静脉血: 26.2mmol/L；氯离子(Cl-)-静脉血: 99.9mmol/L；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；磷(P)-静脉血: 1.16mmol/L；总钙(Ca)-静脉血: 1.98mmol/L；镁离子(Mg2+)-静脉血: 0.59mmol/L；钾离子(K+)-静脉血: 3.49mmol/L；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）\n- [全程D36] 检验组合: 钾离子(K+)-静脉血: 4.1mmol/L；碱性磷酸酶(ALP)-静脉血: 51.9U/L；球蛋白(GLO)-静脉血: 20.23g/L；钠离子(Na+)-静脉血: 136.6mmol/L；阴离子间隙(AG)-静脉血: 13；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.82mmol/L；总胆红素(TBIL)-静脉血: 15.3umol/L；镁离子(Mg2+)-静脉血: 0.51mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.14g/L；氯离子(Cl-)-静脉血: 99mmol/L；单核细胞计数(Mono#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.3；乳酸脱氢酶(LDH)-静脉血: 169.8U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15.6U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.78；磷(P)-静脉血: 1.11mmol/L；葡萄糖(Glu)-静脉血: 5.25mmol/L；总钙(Ca)-静脉血: 2.08mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 27.3U/L；血小板计数(PLT#)-静脉血: 10410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 327g/L；单核细胞百分比(Mono%)-静脉血: 0.005；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；总胆固醇(TC)-静脉血: 5.03mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 28U/L；平均红细胞体积(MCV)-静脉血: 90.6fL；血红蛋白(Hb)-静脉血: 110g/L；血小板分布宽度(PDW)-静脉血: 11.8%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.6pg；白蛋白(ALB)-静脉血: 36g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1；血液二氧化碳含量ctCO2(B)-静脉血: 24.8mmol/L；总蛋白(TP)-静脉血: 56.23g/L；间接胆红素(IBIL)-静脉血: 10umolL；总胆汁酸(TBA)-静脉血: 4.4umol/L；载脂蛋白B(apoB)-静脉血: 0.9g/L；C-反应蛋白(CRP)-静脉血: 1.75mg/L；嗜酸性粒细胞百分……\n- [全程D37] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后复查，与某次就诊时间对比： 鼻咽腔稍狭窄，鼻咽顶壁、顶后壁、后壁及双侧壁稍增厚，T1WI呈等信号，T2WI呈稍高信号，增强扫描强化明显，粘膜表面不光整。双侧咽隐窝变浅。双侧咽旁间隙未见明显狭窄。双侧腭帆张提肌、头长肌信号不均匀，增强后不均匀强化。双侧翼内外肌未见受侵。 口咽双侧壁未见增厚，左侧鼻甲明显肿大，气道狭窄。双侧鼻腔未见肿物。 双侧翼腭窝、上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 斜坡、枕骨基底部、蝶骨基底部、双侧翼突基底、翼内板、右侧岩尖骨质信号降低，增强扫描强化明显。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶窦、筛窦及右侧乳突气房内见积液，双侧上颌窦及左侧乳突充气良好，骨壁完整。 左侧咽后见淋巴结，大小约4mm×7mm，较前缩小；右侧咽后见小淋巴结，大小约3mm×4mm，较前缩小。双颈II、III区见数个淋巴结，大者大小约8mm×14mm，边界欠清，信号不均匀，增强扫描不均匀明显强化，较前缩小。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗后复查，与某次就诊时间对比： 鼻咽病变，较前明显好转。 颅底骨质破坏，较前好转。 双侧咽后淋巴结，较前缩小。 双颈II、III区淋巴结，考虑转移，较前缩小。 鼻窦炎，右侧乳突炎。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者各项检查继续完善中。\n- [全程D10] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程多西紫杉醇＋DDP+5-FU方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D15] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程TPF方案诱导化疗结束，诉呕吐1次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部IIa区各可扪及1个淋巴结，左颈2×2cm，右颈1.5×1.5cm,无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程TPF方案诱导化疗结束，无诉特殊不适，可予出院，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n- [全程D30] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，可于今日水化，明日执行第2程多西紫杉醇＋DDP+5-FU方案诱导化疗，注意化疗不良反应。\n- [全程D31] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程多西紫杉醇＋DDP+5-FU方案诱导化疗第一天，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D35] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程多西紫杉醇＋DDP+5-FU方案诱导化疗结束，诉反酸、恶心，无发热、腹痛、腹泻，无关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第2程多西紫杉醇＋DDP+5-FU方案诱导化疗结束后出现反酸、恶心现象，予抑酸护胃、补液等对症处理，继观。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即启动根治性调强放疗联合同步顺铂化疗，停止静脉高营养以避免导管相关感染。\nB. 更换为吉西他滨联合顺铂方案进行第四周期诱导化疗，并继续抑酸护胃治疗。\nC. 安排鼻咽原发灶及双侧颈部淋巴结根治性切除术，术后辅以静脉营养支持。\nD. 维持静脉营养支持，并立即启动根治性放疗联合PD-1抑制剂及靶向治疗。\nE. 继续原方案（多西紫杉醇+顺铂+5-FU）进行第四周期诱导化疗，并辅以抑酸护胃治疗。\nF. 暂停所有抗肿瘤治疗，仅维持静脉营养支持及抑酸治疗，1个月后复查MRI决定后续方案。\nG. 安排全身PET-CT检查评估全身情况，若无远处转移则继续原方案诱导化疗两周期。\nH. 行局部清扫术，处理颈部残留淋巴结，术后序贯鼻咽部根治性放疗及静脉营养支持。\nI. 调整为卡培他滨节拍化疗联合静脉营养支持，待消化道反应完全缓解后启动放疗。\nJ. 继续予以抑酸护胃及静脉高营养等对症支持治疗，待体能恢复后序贯开展根治性放疗或同步放化疗。\nK. 启动姑息性放疗控制局部及颈部病灶，并联合阿帕替尼等抗血管生成药物治疗。\nL. 维持静脉营养支持，并安排鼻咽镜下局部病灶再次活检以病理确认肿瘤退缩程度。\n\n请仅输出一个选项字母（A-L）。"}]}
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full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：不支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、颈动脉鞘、斜坡、翼突基底部、蝶骨基底部、岩尖等。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D2] 入院记录: 主诉: 发现右颈部肿物5月余；现病史: 患者于入院前5月前（某次就诊时间10月）高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；阳性症状体征: 体重下降,疼痛,高热,右颈部肿物,颈部酸痛；既往史: 既往有“肾病综合征”病史，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。；家族史: 否认肿瘤家族史。；体格检查: T：36℃，P：68次/分，R：20次/分，BP：91/58mmHg,Ht：144cm，Wt：31kg，BSA：1.135m2，KPS：KPS 90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，暂缓全身影像学分期检查。\nB. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，PET-CT全身显像。\nC. 右颈部肿物切除活检，鼻咽及颈部MRI平扫+增强，全身骨显像，腹部彩超。\nD. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫，全身骨显像，腹部彩超，心电图。\nE. 鼻咽镜检查及活检，头颅MRI平扫+增强，颈部彩超，全身骨显像，腹部彩超。\nF. 鼻咽刷片细胞学检查，鼻咽及颈部MRI平扫+增强，全身骨显像，腹部彩超。\nG. 鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，全身骨显像，腹部彩超，心电图。\nH. 右颈部肿物细针穿刺活检，鼻咽及颈部MRI平扫+增强，全身骨显像，腹部彩超。\nI. 鼻咽镜检查及活检，鼻咽MRI平扫+增强，全身骨显像，腹部彩超，心电图。\nJ. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，骨髓穿刺活检，腹部彩超。\nK. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部及腹部MRI平扫+增强。\nL. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身骨显像、腹部彩超及心电图等基线检查。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：不支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、颈动脉鞘、斜坡、翼突基底部、蝶骨基底部、岩尖等。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D2] 入院记录: 主诉: 发现右颈部肿物5月余；现病史: 患者于入院前5月前（某次就诊时间10月）高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；阳性症状体征: 体重下降,疼痛,高热,右颈部肿物,颈部酸痛；既往史: 既往有“肾病综合征”病史，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。；家族史: 否认肿瘤家族史。；体格检查: T：36℃，P：68次/分，R：20次/分，BP：91/58mmHg,Ht：144cm，Wt：31kg，BSA：1.135m2，KPS：KPS 90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，暂缓全身影像学分期检查。\nB. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，PET-CT全身显像。\nC. 右颈部肿物切除活检，鼻咽及颈部MRI平扫+增强，全身骨显像，腹部彩超。\nD. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫，全身骨显像，腹部彩超，心电图。\nE. 鼻咽镜检查及活检，头颅MRI平扫+增强，颈部彩超，全身骨显像，腹部彩超。\nF. 鼻咽刷片细胞学检查，鼻咽及颈部MRI平扫+增强，全身骨显像，腹部彩超。\nG. 鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，全身骨显像，腹部彩超，心电图。\nH. 右颈部肿物细针穿刺活检，鼻咽及颈部MRI平扫+增强，全身骨显像，腹部彩超。\nI. 鼻咽镜检查及活检，鼻咽MRI平扫+增强，全身骨显像，腹部彩超，心电图。\nJ. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，骨髓穿刺活检，腹部彩超。\nK. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部及腹部MRI平扫+增强。\nL. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身骨显像、腹部彩超及心电图等基线检查。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-6cb68b4fe11abd5f5e27ea88","patient_id":"patient-e45c55cc63c050892e6b2467","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"A","gold_action":"行鼻咽镜检查及活检，并完善胸片或胸部CT检查。","options":[{"letter":"A","text":"行鼻咽镜检查及活检，并完善胸片或胸部CT检查。","is_gold":true},{"letter":"B","text":"行右颈部肿大淋巴结切除活检，并完善胸片或胸部CT检查。","is_gold":false},{"letter":"C","text":"行鼻咽镜检查及活检，并完善头颅增强MRI检查。","is_gold":false},{"letter":"D","text":"行右颈部肿大淋巴结细针穿刺活检，并完善全身骨扫描。","is_gold":false},{"letter":"E","text":"行全身PET-CT检查，暂缓鼻咽及颈部活检。","is_gold":false},{"letter":"F","text":"行鼻咽镜检查及活检，暂不安排其他部位影像学检查。","is_gold":false},{"letter":"G","text":"完善胸部及全腹部增强CT检查，待结果回报后再行活检。","is_gold":false},{"letter":"H","text":"行鼻咽镜检查及活检，并复查颈部彩超评估淋巴结。","is_gold":false},{"letter":"I","text":"安排鼻咽及颈部根治性放疗，同步完善胸片或胸部CT检查。","is_gold":false},{"letter":"J","text":"行鼻咽镜检查及活检，并完善全身骨扫描检查。","is_gold":false},{"letter":"K","text":"给予抗炎治疗2周后复查鼻咽MRI，再决定是否行鼻咽活检。","is_gold":false},{"letter":"L","text":"行鼻咽镜检查及活检，并完善血浆EBV-DNA检测，暂缓胸部影像学检查。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：不支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、颈动脉鞘、斜坡、翼突基底部、蝶骨基底部、岩尖等。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D2] 入院记录: 主诉: 发现右颈部肿物5月余；现病史: 患者于入院前5月前（某次就诊时间10月）高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；阳性症状体征: 体重下降,疼痛,高热,右颈部肿物,颈部酸痛；既往史: 既往有“肾病综合征”病史，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。；家族史: 否认肿瘤家族史。；体格检查: T：36℃，P：68次/分，R：20次/分，BP：91/58mmHg,Ht：144cm，Wt：31kg，BSA：1.135m2，KPS：KPS 90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。；KPS: 90；ECOG:\n- [全程D1] 门急诊记录: 主诉: 右颈部肿物6月余；现病史: 患者某次就诊时间10月份高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；既往史: 肾病综合征。否认高血压、糖尿病、冠心病、肾病等慢性病史，否认乙肝、结核等传染病史，否认重大外伤史，否认献血输血及使用血制品史，否认食物药物过敏史。；个人史: 原籍出生长大，否认疫区疫水接触史，否认化学毒性及放射性物质接触史。；家族史: 否认家族类似病史及肿瘤病史。；体格检查: KPS90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D3] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见: 心电图大致正常；检查结论: 窦性心律不齐 心电图大致正常\n- [全程D3] 检验组合: 乳酸脱氢酶(LDH)-静脉血: 198.2U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 10.4U/L；总胆红素(TBIL)-静脉血: 4.2umol/L；葡萄糖(Glu)-静脉血: 4.55mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.495COI；α-L-岩藻糖苷酶(AFU)-静脉血: 35U/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；铁蛋白(Ferr)-静脉血: 91.44ng/ml；磷(P)-静脉血: 1.76mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阴性(-)（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.21ug/ml；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阳性(129.78U/mL)（参考: 阴性）；淋巴细胞百分比(Lymph%)-静脉血: 0.426；碱性磷酸酶(ALP)-静脉血: 130.2U/L；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；纤维蛋白原(Fbg)-静脉血: 2.78g/L；钾离子(K+)-静脉血: 3.5mmol/L；免疫球蛋白游离λ轻链(F-Lambda)-静脉血: 阴性(-)（参考: 阴性(-)）；平均血小板体积(MPV)-静脉血: 8.8fL；尿酸(UA)-静脉血: 200umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.24mmolL；天门冬氨酸氨基转移酶(AST)-静脉血: 18.5U/L；尿素氮(BUN)-静脉血: 3.59mmol/L；总胆固醇(TC)-静脉血: 3.29mmol/L；直接胆红素(DBIL)-静脉血: 1.6umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 11.9U/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.98；中性粒细胞百分比(Neut%)-静脉血: 0.516；肌酐(Crea)-静脉血: 35.7umol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞体积(MCV)-静脉血……\n- [全程D4] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约24cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行鼻咽镜检查及活检，并完善胸片或胸部CT检查。\nB. 行右颈部肿大淋巴结切除活检，并完善胸片或胸部CT检查。\nC. 行鼻咽镜检查及活检，并完善头颅增强MRI检查。\nD. 行右颈部肿大淋巴结细针穿刺活检，并完善全身骨扫描。\nE. 行全身PET-CT检查，暂缓鼻咽及颈部活检。\nF. 行鼻咽镜检查及活检，暂不安排其他部位影像学检查。\nG. 完善胸部及全腹部增强CT检查，待结果回报后再行活检。\nH. 行鼻咽镜检查及活检，并复查颈部彩超评估淋巴结。\nI. 安排鼻咽及颈部根治性放疗，同步完善胸片或胸部CT检查。\nJ. 行鼻咽镜检查及活检，并完善全身骨扫描检查。\nK. 给予抗炎治疗2周后复查鼻咽MRI，再决定是否行鼻咽活检。\nL. 行鼻咽镜检查及活检，并完善血浆EBV-DNA检测，暂缓胸部影像学检查。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：不支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、颈动脉鞘、斜坡、翼突基底部、蝶骨基底部、岩尖等。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D2] 入院记录: 主诉: 发现右颈部肿物5月余；现病史: 患者于入院前5月前（某次就诊时间10月）高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；阳性症状体征: 体重下降,疼痛,高热,右颈部肿物,颈部酸痛；既往史: 既往有“肾病综合征”病史，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。；家族史: 否认肿瘤家族史。；体格检查: T：36℃，P：68次/分，R：20次/分，BP：91/58mmHg,Ht：144cm，Wt：31kg，BSA：1.135m2，KPS：KPS 90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。；KPS: 90；ECOG:\n- [全程D1] 门急诊记录: 主诉: 右颈部肿物6月余；现病史: 患者某次就诊时间10月份高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；既往史: 肾病综合征。否认高血压、糖尿病、冠心病、肾病等慢性病史，否认乙肝、结核等传染病史，否认重大外伤史，否认献血输血及使用血制品史，否认食物药物过敏史。；个人史: 原籍出生长大，否认疫区疫水接触史，否认化学毒性及放射性物质接触史。；家族史: 否认家族类似病史及肿瘤病史。；体格检查: KPS90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D3] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见: 心电图大致正常；检查结论: 窦性心律不齐 心电图大致正常\n- [全程D3] 检验组合: 乳酸脱氢酶(LDH)-静脉血: 198.2U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 10.4U/L；总胆红素(TBIL)-静脉血: 4.2umol/L；葡萄糖(Glu)-静脉血: 4.55mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.495COI；α-L-岩藻糖苷酶(AFU)-静脉血: 35U/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；铁蛋白(Ferr)-静脉血: 91.44ng/ml；磷(P)-静脉血: 1.76mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阴性(-)（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.21ug/ml；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阳性(129.78U/mL)（参考: 阴性）；淋巴细胞百分比(Lymph%)-静脉血: 0.426；碱性磷酸酶(ALP)-静脉血: 130.2U/L；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；纤维蛋白原(Fbg)-静脉血: 2.78g/L；钾离子(K+)-静脉血: 3.5mmol/L；免疫球蛋白游离λ轻链(F-Lambda)-静脉血: 阴性(-)（参考: 阴性(-)）；平均血小板体积(MPV)-静脉血: 8.8fL；尿酸(UA)-静脉血: 200umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.24mmolL；天门冬氨酸氨基转移酶(AST)-静脉血: 18.5U/L；尿素氮(BUN)-静脉血: 3.59mmol/L；总胆固醇(TC)-静脉血: 3.29mmol/L；直接胆红素(DBIL)-静脉血: 1.6umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 11.9U/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.98；中性粒细胞百分比(Neut%)-静脉血: 0.516；肌酐(Crea)-静脉血: 35.7umol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞体积(MCV)-静脉血……\n- [全程D4] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约24cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行鼻咽镜检查及活检，并完善胸片或胸部CT检查。\nB. 行右颈部肿大淋巴结切除活检，并完善胸片或胸部CT检查。\nC. 行鼻咽镜检查及活检，并完善头颅增强MRI检查。\nD. 行右颈部肿大淋巴结细针穿刺活检，并完善全身骨扫描。\nE. 行全身PET-CT检查，暂缓鼻咽及颈部活检。\nF. 行鼻咽镜检查及活检，暂不安排其他部位影像学检查。\nG. 完善胸部及全腹部增强CT检查，待结果回报后再行活检。\nH. 行鼻咽镜检查及活检，并复查颈部彩超评估淋巴结。\nI. 安排鼻咽及颈部根治性放疗，同步完善胸片或胸部CT检查。\nJ. 行鼻咽镜检查及活检，并完善全身骨扫描检查。\nK. 给予抗炎治疗2周后复查鼻咽MRI，再决定是否行鼻咽活检。\nL. 行鼻咽镜检查及活检，并完善血浆EBV-DNA检测，暂缓胸部影像学检查。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-51ced222567a8eb77bc8161d","patient_id":"patient-e45c55cc63c050892e6b2467","turn_id":"turn04","turn_position":3,"turn_type":"initial_treatment_selection","gold_letter":"B","gold_action":"予以诱导化疗序贯同期放化疗","options":[{"letter":"A","text":"予以根治性单纯放疗","is_gold":false},{"letter":"B","text":"予以诱导化疗序贯同期放化疗","is_gold":true},{"letter":"C","text":"予以诱导化疗序贯单纯放疗","is_gold":false},{"letter":"D","text":"予以同期放化疗序贯辅助化疗","is_gold":false},{"letter":"E","text":"予以靶向治疗联合同期放化疗","is_gold":false},{"letter":"F","text":"予以免疫治疗联合同期放化疗","is_gold":false},{"letter":"G","text":"予以诱导化疗序贯靶向治疗联合放疗","is_gold":false},{"letter":"H","text":"行颈部淋巴结清扫术序贯根治性放疗","is_gold":false},{"letter":"I","text":"行鼻咽原发灶切除联合颈部淋巴结清扫术","is_gold":false},{"letter":"J","text":"予以姑息性化疗联合局部姑息性放疗","is_gold":false},{"letter":"K","text":"予以诱导化疗序贯根治性手术切除","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：不支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、颈动脉鞘、斜坡、翼突基底部、蝶骨基底部、岩尖等。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D2] 入院记录: 主诉: 发现右颈部肿物5月余；现病史: 患者于入院前5月前（某次就诊时间10月）高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；阳性症状体征: 体重下降,疼痛,高热,右颈部肿物,颈部酸痛；既往史: 既往有“肾病综合征”病史，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。；家族史: 否认肿瘤家族史。；体格检查: T：36℃，P：68次/分，R：20次/分，BP：91/58mmHg,Ht：144cm，Wt：31kg，BSA：1.135m2，KPS：KPS 90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。；KPS: 90；ECOG:\n- [全程D1] 门急诊记录: 主诉: 右颈部肿物6月余；现病史: 患者某次就诊时间10月份高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；既往史: 肾病综合征。否认高血压、糖尿病、冠心病、肾病等慢性病史，否认乙肝、结核等传染病史，否认重大外伤史，否认献血输血及使用血制品史，否认食物药物过敏史。；个人史: 原籍出生长大，否认疫区疫水接触史，否认化学毒性及放射性物质接触史。；家族史: 否认家族类似病史及肿瘤病史。；体格检查: KPS90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 入院记录: 主诉: 发现右颈部肿物5月余；现病史: 患者于入院前5月前（某次就诊时间10月）高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。行右颈部肿物活检病理回报：提示鼻咽部鳞癌转移。鼻咽部MR示：鼻咽顶后壁及两侧壁粘膜增厚，右侧翼内肌、咽鼓管、头长肌受侵，右侧斜坡，颞骨岩部，寰椎前弓骨质破坏。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；阳性症状体征: 体重下降,疼痛,高热,右颈部肿物,颈部酸痛；既往史: 既往有“肾病综合征”病史，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。；家族史: 否认肿瘤家族史。；体格检查: T：36℃，P：68次/分，R：20次/分，BP：91/58mmHg,Ht：144cm，Wt：31kg，BSA：1.135m2，KPS：KPS 90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率{数值}次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。右颈扪及肿物，约4*3cm,无压痛，质硬，活动差，边界尚清，未扪及明显融合，活检伤口愈合良好。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D3] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见: 心电图大致正常；检查结论: 窦性心律不齐 心电图大致正常\n- [全程D3] 检验组合: 乳酸脱氢酶(LDH)-静脉血: 198.2U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 10.4U/L；总胆红素(TBIL)-静脉血: 4.2umol/L；葡萄糖(Glu)-静脉血: 4.55mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.495COI；α-L-岩藻糖苷酶(AFU)-静脉血: 35U/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；铁蛋白(Ferr)-静脉血: 91.44ng/ml；磷(P)-静脉血: 1.76mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阴性(-)（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.21ug/ml；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阳性(129.78U/mL)（参考: 阴性）；淋巴细胞百分比(Lymph%)-静脉血: 0.426；碱性磷酸酶(ALP)-静脉血: 130.2U/L；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；纤维蛋白原(Fbg)-静脉血: 2.78g/L；钾离子(K+)-静脉血: 3.5mmol/L；免疫球蛋白游离λ轻链(F-Lambda)-静脉血: 阴性(-)（参考: 阴性(-)）；平均血小板体积(MPV)-静脉血: 8.8fL；尿酸(UA)-静脉血: 200umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.24mmolL；天门冬氨酸氨基转移酶(AST)-静脉血: 18.5U/L；尿素氮(BUN)-静脉血: 3.59mmol/L；总胆固醇(TC)-静脉血: 3.29mmol/L；直接胆红素(DBIL)-静脉血: 1.6umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 11.9U/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.98；中性粒细胞百分比(Neut%)-静脉血: 0.516；肌酐(Crea)-静脉血: 35.7umol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞体积(MCV)-静脉血……\n- [全程D4] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约24cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 予以根治性单纯放疗\nB. 予以诱导化疗序贯同期放化疗\nC. 予以诱导化疗序贯单纯放疗\nD. 予以同期放化疗序贯辅助化疗\nE. 予以靶向治疗联合同期放化疗\nF. 予以免疫治疗联合同期放化疗\nG. 予以诱导化疗序贯靶向治疗联合放疗\nH. 行颈部淋巴结清扫术序贯根治性放疗\nI. 行鼻咽原发灶切除联合颈部淋巴结清扫术\nJ. 予以姑息性化疗联合局部姑息性放疗\nK. 予以诱导化疗序贯根治性手术切除\n\n请仅输出一个选项字母（A-K）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：不支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、颈动脉鞘、斜坡、翼突基底部、蝶骨基底部、岩尖等。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D2] 入院记录: 主诉: 发现右颈部肿物5月余；现病史: 患者于入院前5月前（某次就诊时间10月）高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；阳性症状体征: 体重下降,疼痛,高热,右颈部肿物,颈部酸痛；既往史: 既往有“肾病综合征”病史，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。；家族史: 否认肿瘤家族史。；体格检查: T：36℃，P：68次/分，R：20次/分，BP：91/58mmHg,Ht：144cm，Wt：31kg，BSA：1.135m2，KPS：KPS 90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。；KPS: 90；ECOG:\n- [全程D1] 门急诊记录: 主诉: 右颈部肿物6月余；现病史: 患者某次就诊时间10月份高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；既往史: 肾病综合征。否认高血压、糖尿病、冠心病、肾病等慢性病史，否认乙肝、结核等传染病史，否认重大外伤史，否认献血输血及使用血制品史，否认食物药物过敏史。；个人史: 原籍出生长大，否认疫区疫水接触史，否认化学毒性及放射性物质接触史。；家族史: 否认家族类似病史及肿瘤病史。；体格检查: KPS90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 入院记录: 主诉: 发现右颈部肿物5月余；现病史: 患者于入院前5月前（某次就诊时间10月）高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。行右颈部肿物活检病理回报：提示鼻咽部鳞癌转移。鼻咽部MR示：鼻咽顶后壁及两侧壁粘膜增厚，右侧翼内肌、咽鼓管、头长肌受侵，右侧斜坡，颞骨岩部，寰椎前弓骨质破坏。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；阳性症状体征: 体重下降,疼痛,高热,右颈部肿物,颈部酸痛；既往史: 既往有“肾病综合征”病史，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。；家族史: 否认肿瘤家族史。；体格检查: T：36℃，P：68次/分，R：20次/分，BP：91/58mmHg,Ht：144cm，Wt：31kg，BSA：1.135m2，KPS：KPS 90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率{数值}次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。右颈扪及肿物，约4*3cm,无压痛，质硬，活动差，边界尚清，未扪及明显融合，活检伤口愈合良好。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D3] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见: 心电图大致正常；检查结论: 窦性心律不齐 心电图大致正常\n- [全程D3] 检验组合: 乳酸脱氢酶(LDH)-静脉血: 198.2U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 10.4U/L；总胆红素(TBIL)-静脉血: 4.2umol/L；葡萄糖(Glu)-静脉血: 4.55mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.495COI；α-L-岩藻糖苷酶(AFU)-静脉血: 35U/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；铁蛋白(Ferr)-静脉血: 91.44ng/ml；磷(P)-静脉血: 1.76mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阴性(-)（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.21ug/ml；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阳性(129.78U/mL)（参考: 阴性）；淋巴细胞百分比(Lymph%)-静脉血: 0.426；碱性磷酸酶(ALP)-静脉血: 130.2U/L；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；纤维蛋白原(Fbg)-静脉血: 2.78g/L；钾离子(K+)-静脉血: 3.5mmol/L；免疫球蛋白游离λ轻链(F-Lambda)-静脉血: 阴性(-)（参考: 阴性(-)）；平均血小板体积(MPV)-静脉血: 8.8fL；尿酸(UA)-静脉血: 200umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.24mmolL；天门冬氨酸氨基转移酶(AST)-静脉血: 18.5U/L；尿素氮(BUN)-静脉血: 3.59mmol/L；总胆固醇(TC)-静脉血: 3.29mmol/L；直接胆红素(DBIL)-静脉血: 1.6umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 11.9U/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.98；中性粒细胞百分比(Neut%)-静脉血: 0.516；肌酐(Crea)-静脉血: 35.7umol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞体积(MCV)-静脉血……\n- [全程D4] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约24cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 予以根治性单纯放疗\nB. 予以诱导化疗序贯同期放化疗\nC. 予以诱导化疗序贯单纯放疗\nD. 予以同期放化疗序贯辅助化疗\nE. 予以靶向治疗联合同期放化疗\nF. 予以免疫治疗联合同期放化疗\nG. 予以诱导化疗序贯靶向治疗联合放疗\nH. 行颈部淋巴结清扫术序贯根治性放疗\nI. 行鼻咽原发灶切除联合颈部淋巴结清扫术\nJ. 予以姑息性化疗联合局部姑息性放疗\nK. 予以诱导化疗序贯根治性手术切除\n\n请仅输出一个选项字母（A-K）。"}]}
+{"sample_id":"sample-31164fa636b978a86d54f0c9","patient_id":"patient-e45c55cc63c050892e6b2467","turn_id":"turn05","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"D","gold_action":"完善全麻下鼻咽及颈部肿物活检术前准备，予以配血备用及口服地西泮镇静。","options":[{"letter":"A","text":"完善局麻下鼻咽及颈部肿物活检术前准备，予以口服地西泮镇静及配血备用。","is_gold":false},{"letter":"B","text":"完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注头孢类抗生素预防感染。","is_gold":false},{"letter":"C","text":"完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注氨甲环酸预防术中出血。","is_gold":false},{"letter":"D","text":"完善全麻下鼻咽及颈部肿物活检术前准备，予以配血备用及口服地西泮镇静。","is_gold":true},{"letter":"E","text":"完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注人血白蛋白及复方氨基酸。","is_gold":false},{"letter":"F","text":"完善全麻下鼻咽及颈部肿物活检术前准备，予以皮下注射低分子肝素及下肢气压治疗。","is_gold":false},{"letter":"G","text":"完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉滴注地塞米松及雾化吸入。","is_gold":false},{"letter":"H","text":"完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉补充氯化钾及晶体液扩容。","is_gold":false},{"letter":"I","text":"暂缓活检手术，予以静脉输注广谱抗生素及补液支持治疗。","is_gold":false},{"letter":"J","text":"暂缓活检手术，予以口服非甾体类抗炎药及局部热敷理疗。","is_gold":false},{"letter":"K","text":"完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注单采血小板及冷沉淀。","is_gold":false},{"letter":"L","text":"完善全麻下鼻咽及颈部肿物活检术前准备，予以口服氯雷他定及局部涂抹糖皮质激素。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：不支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、颈动脉鞘、斜坡、翼突基底部、蝶骨基底部、岩尖等。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D2] 入院记录: 主诉: 发现右颈部肿物5月余；现病史: 患者于入院前5月前（某次就诊时间10月）高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；阳性症状体征: 体重下降,疼痛,高热,右颈部肿物,颈部酸痛；既往史: 既往有“肾病综合征”病史，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。；家族史: 否认肿瘤家族史。；体格检查: T：36℃，P：68次/分，R：20次/分，BP：91/58mmHg,Ht：144cm，Wt：31kg，BSA：1.135m2，KPS：KPS 90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。；KPS: 90；ECOG:\n- [全程D1] 门急诊记录: 主诉: 右颈部肿物6月余；现病史: 患者某次就诊时间10月份高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；既往史: 肾病综合征。否认高血压、糖尿病、冠心病、肾病等慢性病史，否认乙肝、结核等传染病史，否认重大外伤史，否认献血输血及使用血制品史，否认食物药物过敏史。；个人史: 原籍出生长大，否认疫区疫水接触史，否认化学毒性及放射性物质接触史。；家族史: 否认家族类似病史及肿瘤病史。；体格检查: KPS90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 入院记录: 主诉: 发现右颈部肿物5月余；现病史: 患者于入院前5月前（某次就诊时间10月）高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。行右颈部肿物活检病理回报：提示鼻咽部鳞癌转移。鼻咽部MR示：鼻咽顶后壁及两侧壁粘膜增厚，右侧翼内肌、咽鼓管、头长肌受侵，右侧斜坡，颞骨岩部，寰椎前弓骨质破坏。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；阳性症状体征: 体重下降,疼痛,高热,右颈部肿物,颈部酸痛；既往史: 既往有“肾病综合征”病史，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。；家族史: 否认肿瘤家族史。；体格检查: T：36℃，P：68次/分，R：20次/分，BP：91/58mmHg,Ht：144cm，Wt：31kg，BSA：1.135m2，KPS：KPS 90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率{数值}次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。右颈扪及肿物，约4*3cm,无压痛，质硬，活动差，边界尚清，未扪及明显融合，活检伤口愈合良好。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D3] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见: 心电图大致正常；检查结论: 窦性心律不齐 心电图大致正常\n- [全程D3] 检验组合: 乳酸脱氢酶(LDH)-静脉血: 198.2U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 10.4U/L；总胆红素(TBIL)-静脉血: 4.2umol/L；葡萄糖(Glu)-静脉血: 4.55mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.495COI；α-L-岩藻糖苷酶(AFU)-静脉血: 35U/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；铁蛋白(Ferr)-静脉血: 91.44ng/ml；磷(P)-静脉血: 1.76mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阴性(-)（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.21ug/ml；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阳性(129.78U/mL)（参考: 阴性）；淋巴细胞百分比(Lymph%)-静脉血: 0.426；碱性磷酸酶(ALP)-静脉血: 130.2U/L；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；纤维蛋白原(Fbg)-静脉血: 2.78g/L；钾离子(K+)-静脉血: 3.5mmol/L；免疫球蛋白游离λ轻链(F-Lambda)-静脉血: 阴性(-)（参考: 阴性(-)）；平均血小板体积(MPV)-静脉血: 8.8fL；尿酸(UA)-静脉血: 200umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.24mmolL；天门冬氨酸氨基转移酶(AST)-静脉血: 18.5U/L；尿素氮(BUN)-静脉血: 3.59mmol/L；总胆固醇(TC)-静脉血: 3.29mmol/L；直接胆红素(DBIL)-静脉血: 1.6umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 11.9U/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.98；中性粒细胞百分比(Neut%)-静脉血: 0.516；肌酐(Crea)-静脉血: 35.7umol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞体积(MCV)-静脉血……\n- [全程D4] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约24cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D21] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显占位病变，肺门纵隔未见明显增宽，心影无增大，双侧肋膈角锐利。；检查结论: 心肺未见病变。\n- [全程D21] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 23mmol/L；总胆红素(TBIL)-静脉血: 7.6umol/L；C-反应蛋白(CRP)-静脉血: 4.9mg/L；总胆固醇(TC)-静脉血: 4.18mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.5mmolL；总胆汁酸(TBA)-静脉血: 2.5umol/L；血型抗体筛查-静脉血: 阴性；ABO血型-静脉血: B；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；大血小板百分比(P-LCR%)-静脉血: 24.7%；血小板比容-静脉血: 32%；血小板分布宽度(PDW)-静脉血: 11.1%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；总蛋白(TP)-静脉血: 74.14g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.011；平均红细胞血红蛋白含量(MCH)-静脉血: 28.1pg；白蛋白(ALB)-静脉血: 38.9g/L；甘油三酯(TG)-静脉血: 0.81mmol/L；磷(P)-静脉血: 1.55mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.1；直接胆红素(DBIL)-静脉血: 2.5umol/L；平均红细胞体积(MCV)-静脉血: 84.5fL；平均血小板体积(MPV)-静脉血: 10.1fL；钠离子(Na+)-静脉血: 136.6mmol/L；氯离子(Cl-)-静脉血: 101.1mmol/L；镁离子(Mg2+)-静脉血: 0.72mmol/L；肌酐(Crea)-静脉血: 33.8umol/L；Rh血型-静脉血: 阳性；载脂蛋白AI(apoAI)-静脉血: 1.34g/L；尿素氮(BUN)-静脉血: 5.75mmol/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；淋巴细胞计数(Lymph#)-静脉血: 2.810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.591；白细胞计数(WBC#)-静脉血: 8.5610E9/L；钾离子(K+)-静脉血: 4.3mmol/L；总钙(Ca)-静脉血: 2.26mmol/L；尿酸(UA)-静脉血: 204.9umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24.5U/L；有核红细胞计数(NRBC……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D3] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日随夏医生信息已隐藏，患者颈背部酸痛较前有好转，无发热畏寒，无恶心呕吐，无胸闷心悸，胃纳睡眠尚可，二便未见明显异常，体查：KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。右颈扪及肿物，约4*3cm,无压痛，质硬，活动差，边界尚清，未扪及明显融合，活检伤口愈合良好。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。右颈部肿物活检病理回报：提示鼻咽部鳞癌转移。鼻咽部MR示：鼻咽顶后壁及两侧壁粘膜增厚，右侧翼内肌、咽鼓管、头长肌受侵，右侧斜坡，颞骨岩部，寰椎前弓骨质破坏。目前患者诊断：鼻咽癌，患者病理活检部位为右颈部肿物，提示转移性鳞癌，建议其行鼻咽部肿物病理活检，患者家属不同意，有放疗适应症，无相对放疗禁忌症，告知患者放疗风险及副反应，患者家属表示理解病情，现治疗后患者要求出院，予以办理，嘱注意休息合理饮食，定期复诊，不适随诊。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D19] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。凝血、乙肝两对半、肝炎四项、HIV/梅毒等检验结果无明显异常。[姓名已隐去]主任查房后，患者因年龄较小，完成活检等操作不配合，家属要求全麻下行活检明确病理，完善相关检查后择期手术，遵嘱执行。\n- [全程D20] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。[姓名已隐去]主任查房后示，完善术前相关检验检查，做好术前准备，遵嘱执行。\n- [全程D21] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。血常规、生化常规回报无明显异常。输血三项回报：B型、RH阳性、抗体筛选阴性。[姓名已隐去]主任查房后示，结合患者各项检查，未见明显手术禁忌，拟明日在气管内吸入全麻下经鼻内镜行鼻咽肿物活检+颈部肿物活检术，做好术前准备，遵嘱执行。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善局麻下鼻咽及颈部肿物活检术前准备，予以口服地西泮镇静及配血备用。\nB. 完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注头孢类抗生素预防感染。\nC. 完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注氨甲环酸预防术中出血。\nD. 完善全麻下鼻咽及颈部肿物活检术前准备，予以配血备用及口服地西泮镇静。\nE. 完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注人血白蛋白及复方氨基酸。\nF. 完善全麻下鼻咽及颈部肿物活检术前准备，予以皮下注射低分子肝素及下肢气压治疗。\nG. 完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉滴注地塞米松及雾化吸入。\nH. 完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉补充氯化钾及晶体液扩容。\nI. 暂缓活检手术，予以静脉输注广谱抗生素及补液支持治疗。\nJ. 暂缓活检手术，予以口服非甾体类抗炎药及局部热敷理疗。\nK. 完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注单采血小板及冷沉淀。\nL. 完善全麻下鼻咽及颈部肿物活检术前准备，予以口服氯雷他定及局部涂抹糖皮质激素。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：不支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、颈动脉鞘、斜坡、翼突基底部、蝶骨基底部、岩尖等。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D2] 入院记录: 主诉: 发现右颈部肿物5月余；现病史: 患者于入院前5月前（某次就诊时间10月）高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；阳性症状体征: 体重下降,疼痛,高热,右颈部肿物,颈部酸痛；既往史: 既往有“肾病综合征”病史，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。；家族史: 否认肿瘤家族史。；体格检查: T：36℃，P：68次/分，R：20次/分，BP：91/58mmHg,Ht：144cm，Wt：31kg，BSA：1.135m2，KPS：KPS 90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。；KPS: 90；ECOG:\n- [全程D1] 门急诊记录: 主诉: 右颈部肿物6月余；现病史: 患者某次就诊时间10月份高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；既往史: 肾病综合征。否认高血压、糖尿病、冠心病、肾病等慢性病史，否认乙肝、结核等传染病史，否认重大外伤史，否认献血输血及使用血制品史，否认食物药物过敏史。；个人史: 原籍出生长大，否认疫区疫水接触史，否认化学毒性及放射性物质接触史。；家族史: 否认家族类似病史及肿瘤病史。；体格检查: KPS90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 入院记录: 主诉: 发现右颈部肿物5月余；现病史: 患者于入院前5月前（某次就诊时间10月）高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。行右颈部肿物活检病理回报：提示鼻咽部鳞癌转移。鼻咽部MR示：鼻咽顶后壁及两侧壁粘膜增厚，右侧翼内肌、咽鼓管、头长肌受侵，右侧斜坡，颞骨岩部，寰椎前弓骨质破坏。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；阳性症状体征: 体重下降,疼痛,高热,右颈部肿物,颈部酸痛；既往史: 既往有“肾病综合征”病史，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。；家族史: 否认肿瘤家族史。；体格检查: T：36℃，P：68次/分，R：20次/分，BP：91/58mmHg,Ht：144cm，Wt：31kg，BSA：1.135m2，KPS：KPS 90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率{数值}次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。右颈扪及肿物，约4*3cm,无压痛，质硬，活动差，边界尚清，未扪及明显融合，活检伤口愈合良好。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D3] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见: 心电图大致正常；检查结论: 窦性心律不齐 心电图大致正常\n- [全程D3] 检验组合: 乳酸脱氢酶(LDH)-静脉血: 198.2U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 10.4U/L；总胆红素(TBIL)-静脉血: 4.2umol/L；葡萄糖(Glu)-静脉血: 4.55mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.495COI；α-L-岩藻糖苷酶(AFU)-静脉血: 35U/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；铁蛋白(Ferr)-静脉血: 91.44ng/ml；磷(P)-静脉血: 1.76mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阴性(-)（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.21ug/ml；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阳性(129.78U/mL)（参考: 阴性）；淋巴细胞百分比(Lymph%)-静脉血: 0.426；碱性磷酸酶(ALP)-静脉血: 130.2U/L；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；纤维蛋白原(Fbg)-静脉血: 2.78g/L；钾离子(K+)-静脉血: 3.5mmol/L；免疫球蛋白游离λ轻链(F-Lambda)-静脉血: 阴性(-)（参考: 阴性(-)）；平均血小板体积(MPV)-静脉血: 8.8fL；尿酸(UA)-静脉血: 200umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.24mmolL；天门冬氨酸氨基转移酶(AST)-静脉血: 18.5U/L；尿素氮(BUN)-静脉血: 3.59mmol/L；总胆固醇(TC)-静脉血: 3.29mmol/L；直接胆红素(DBIL)-静脉血: 1.6umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 11.9U/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.98；中性粒细胞百分比(Neut%)-静脉血: 0.516；肌酐(Crea)-静脉血: 35.7umol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞体积(MCV)-静脉血……\n- [全程D4] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约24cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D21] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显占位病变，肺门纵隔未见明显增宽，心影无增大，双侧肋膈角锐利。；检查结论: 心肺未见病变。\n- [全程D21] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 23mmol/L；总胆红素(TBIL)-静脉血: 7.6umol/L；C-反应蛋白(CRP)-静脉血: 4.9mg/L；总胆固醇(TC)-静脉血: 4.18mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.5mmolL；总胆汁酸(TBA)-静脉血: 2.5umol/L；血型抗体筛查-静脉血: 阴性；ABO血型-静脉血: B；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；大血小板百分比(P-LCR%)-静脉血: 24.7%；血小板比容-静脉血: 32%；血小板分布宽度(PDW)-静脉血: 11.1%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；总蛋白(TP)-静脉血: 74.14g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.011；平均红细胞血红蛋白含量(MCH)-静脉血: 28.1pg；白蛋白(ALB)-静脉血: 38.9g/L；甘油三酯(TG)-静脉血: 0.81mmol/L；磷(P)-静脉血: 1.55mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.1；直接胆红素(DBIL)-静脉血: 2.5umol/L；平均红细胞体积(MCV)-静脉血: 84.5fL；平均血小板体积(MPV)-静脉血: 10.1fL；钠离子(Na+)-静脉血: 136.6mmol/L；氯离子(Cl-)-静脉血: 101.1mmol/L；镁离子(Mg2+)-静脉血: 0.72mmol/L；肌酐(Crea)-静脉血: 33.8umol/L；Rh血型-静脉血: 阳性；载脂蛋白AI(apoAI)-静脉血: 1.34g/L；尿素氮(BUN)-静脉血: 5.75mmol/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；淋巴细胞计数(Lymph#)-静脉血: 2.810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.591；白细胞计数(WBC#)-静脉血: 8.5610E9/L；钾离子(K+)-静脉血: 4.3mmol/L；总钙(Ca)-静脉血: 2.26mmol/L；尿酸(UA)-静脉血: 204.9umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24.5U/L；有核红细胞计数(NRBC……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D3] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日随夏医生信息已隐藏，患者颈背部酸痛较前有好转，无发热畏寒，无恶心呕吐，无胸闷心悸，胃纳睡眠尚可，二便未见明显异常，体查：KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。右颈扪及肿物，约4*3cm,无压痛，质硬，活动差，边界尚清，未扪及明显融合，活检伤口愈合良好。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。右颈部肿物活检病理回报：提示鼻咽部鳞癌转移。鼻咽部MR示：鼻咽顶后壁及两侧壁粘膜增厚，右侧翼内肌、咽鼓管、头长肌受侵，右侧斜坡，颞骨岩部，寰椎前弓骨质破坏。目前患者诊断：鼻咽癌，患者病理活检部位为右颈部肿物，提示转移性鳞癌，建议其行鼻咽部肿物病理活检，患者家属不同意，有放疗适应症，无相对放疗禁忌症，告知患者放疗风险及副反应，患者家属表示理解病情，现治疗后患者要求出院，予以办理，嘱注意休息合理饮食，定期复诊，不适随诊。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D19] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。凝血、乙肝两对半、肝炎四项、HIV/梅毒等检验结果无明显异常。[姓名已隐去]主任查房后，患者因年龄较小，完成活检等操作不配合，家属要求全麻下行活检明确病理，完善相关检查后择期手术，遵嘱执行。\n- [全程D20] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。[姓名已隐去]主任查房后示，完善术前相关检验检查，做好术前准备，遵嘱执行。\n- [全程D21] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。血常规、生化常规回报无明显异常。输血三项回报：B型、RH阳性、抗体筛选阴性。[姓名已隐去]主任查房后示，结合患者各项检查，未见明显手术禁忌，拟明日在气管内吸入全麻下经鼻内镜行鼻咽肿物活检+颈部肿物活检术，做好术前准备，遵嘱执行。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善局麻下鼻咽及颈部肿物活检术前准备，予以口服地西泮镇静及配血备用。\nB. 完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注头孢类抗生素预防感染。\nC. 完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注氨甲环酸预防术中出血。\nD. 完善全麻下鼻咽及颈部肿物活检术前准备，予以配血备用及口服地西泮镇静。\nE. 完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注人血白蛋白及复方氨基酸。\nF. 完善全麻下鼻咽及颈部肿物活检术前准备，予以皮下注射低分子肝素及下肢气压治疗。\nG. 完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉滴注地塞米松及雾化吸入。\nH. 完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉补充氯化钾及晶体液扩容。\nI. 暂缓活检手术，予以静脉输注广谱抗生素及补液支持治疗。\nJ. 暂缓活检手术，予以口服非甾体类抗炎药及局部热敷理疗。\nK. 完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注单采血小板及冷沉淀。\nL. 完善全麻下鼻咽及颈部肿物活检术前准备，予以口服氯雷他定及局部涂抹糖皮质激素。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-e79a5ee2227343d5e15dc4d1","patient_id":"patient-e45c55cc63c050892e6b2467","turn_id":"turn06","turn_position":5,"turn_type":"toxicity_or_support_decision","gold_letter":"E","gold_action":"继续抗炎及支持治疗，完善血常规、尿常规及生化常规检查。","options":[{"letter":"A","text":"立即启动含铂双药诱导化疗，并完善心电图及超声心动图检查。","is_gold":false},{"letter":"B","text":"予以静脉输注氨甲环酸，并完善凝血常规及D-二聚体检查。","is_gold":false},{"letter":"C","text":"安排右颈部淋巴结清扫术，并静脉使用广谱抗生素抗感染。","is_gold":false},{"letter":"D","text":"予以阿片类药物滴定止痛，并完善全身骨扫描检查。","is_gold":false},{"letter":"E","text":"继续抗炎及支持治疗，完善血常规、尿常规及生化常规检查。","is_gold":true},{"letter":"F","text":"启动根治性调强放射治疗，并复查鼻咽及颈部增强MRI。","is_gold":false},{"letter":"G","text":"予以静脉高营养支持治疗，并复查血浆EBV-DNA定量。","is_gold":false},{"letter":"H","text":"预防性皮下注射低分子肝素，并完善双下肢深静脉彩超。","is_gold":false},{"letter":"I","text":"予以静脉滴注地塞米松，并复查头颈部增强CT。","is_gold":false},{"letter":"J","text":"拔除静脉留置针，仅予以口服非甾体抗炎药，并继续留院观察。","is_gold":false},{"letter":"K","text":"停止静脉用药，改为口服头孢类抗生素，并立即办理出院。","is_gold":false},{"letter":"L","text":"予以颈部局部姑息性放疗，并完善甲状腺功能检查。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：不支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、颈动脉鞘、斜坡、翼突基底部、蝶骨基底部、岩尖等。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D2] 入院记录: 主诉: 发现右颈部肿物5月余；现病史: 患者于入院前5月前（某次就诊时间10月）高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；阳性症状体征: 体重下降,疼痛,高热,右颈部肿物,颈部酸痛；既往史: 既往有“肾病综合征”病史，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。；家族史: 否认肿瘤家族史。；体格检查: T：36℃，P：68次/分，R：20次/分，BP：91/58mmHg,Ht：144cm，Wt：31kg，BSA：1.135m2，KPS：KPS 90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。；KPS: 90；ECOG:\n- [全程D1] 门急诊记录: 主诉: 右颈部肿物6月余；现病史: 患者某次就诊时间10月份高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；既往史: 肾病综合征。否认高血压、糖尿病、冠心病、肾病等慢性病史，否认乙肝、结核等传染病史，否认重大外伤史，否认献血输血及使用血制品史，否认食物药物过敏史。；个人史: 原籍出生长大，否认疫区疫水接触史，否认化学毒性及放射性物质接触史。；家族史: 否认家族类似病史及肿瘤病史。；体格检查: KPS90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 入院记录: 主诉: 发现右颈部肿物5月余；现病史: 患者于入院前5月前（某次就诊时间10月）高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。行右颈部肿物活检病理回报：提示鼻咽部鳞癌转移。鼻咽部MR示：鼻咽顶后壁及两侧壁粘膜增厚，右侧翼内肌、咽鼓管、头长肌受侵，右侧斜坡，颞骨岩部，寰椎前弓骨质破坏。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；阳性症状体征: 体重下降,疼痛,高热,右颈部肿物,颈部酸痛；既往史: 既往有“肾病综合征”病史，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。；家族史: 否认肿瘤家族史。；体格检查: T：36℃，P：68次/分，R：20次/分，BP：91/58mmHg,Ht：144cm，Wt：31kg，BSA：1.135m2，KPS：KPS 90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率{数值}次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。右颈扪及肿物，约4*3cm,无压痛，质硬，活动差，边界尚清，未扪及明显融合，活检伤口愈合良好。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D3] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见: 心电图大致正常；检查结论: 窦性心律不齐 心电图大致正常\n- [全程D3] 检验组合: 乳酸脱氢酶(LDH)-静脉血: 198.2U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 10.4U/L；总胆红素(TBIL)-静脉血: 4.2umol/L；葡萄糖(Glu)-静脉血: 4.55mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.495COI；α-L-岩藻糖苷酶(AFU)-静脉血: 35U/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；铁蛋白(Ferr)-静脉血: 91.44ng/ml；磷(P)-静脉血: 1.76mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阴性(-)（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.21ug/ml；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阳性(129.78U/mL)（参考: 阴性）；淋巴细胞百分比(Lymph%)-静脉血: 0.426；碱性磷酸酶(ALP)-静脉血: 130.2U/L；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；纤维蛋白原(Fbg)-静脉血: 2.78g/L；钾离子(K+)-静脉血: 3.5mmol/L；免疫球蛋白游离λ轻链(F-Lambda)-静脉血: 阴性(-)（参考: 阴性(-)）；平均血小板体积(MPV)-静脉血: 8.8fL；尿酸(UA)-静脉血: 200umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.24mmolL；天门冬氨酸氨基转移酶(AST)-静脉血: 18.5U/L；尿素氮(BUN)-静脉血: 3.59mmol/L；总胆固醇(TC)-静脉血: 3.29mmol/L；直接胆红素(DBIL)-静脉血: 1.6umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 11.9U/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.98；中性粒细胞百分比(Neut%)-静脉血: 0.516；肌酐(Crea)-静脉血: 35.7umol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞体积(MCV)-静脉血……\n- [全程D4] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约24cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D21] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显占位病变，肺门纵隔未见明显增宽，心影无增大，双侧肋膈角锐利。；检查结论: 心肺未见病变。\n- [全程D21] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 23mmol/L；总胆红素(TBIL)-静脉血: 7.6umol/L；C-反应蛋白(CRP)-静脉血: 4.9mg/L；总胆固醇(TC)-静脉血: 4.18mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.5mmolL；总胆汁酸(TBA)-静脉血: 2.5umol/L；血型抗体筛查-静脉血: 阴性；ABO血型-静脉血: B；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；大血小板百分比(P-LCR%)-静脉血: 24.7%；血小板比容-静脉血: 32%；血小板分布宽度(PDW)-静脉血: 11.1%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；总蛋白(TP)-静脉血: 74.14g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.011；平均红细胞血红蛋白含量(MCH)-静脉血: 28.1pg；白蛋白(ALB)-静脉血: 38.9g/L；甘油三酯(TG)-静脉血: 0.81mmol/L；磷(P)-静脉血: 1.55mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.1；直接胆红素(DBIL)-静脉血: 2.5umol/L；平均红细胞体积(MCV)-静脉血: 84.5fL；平均血小板体积(MPV)-静脉血: 10.1fL；钠离子(Na+)-静脉血: 136.6mmol/L；氯离子(Cl-)-静脉血: 101.1mmol/L；镁离子(Mg2+)-静脉血: 0.72mmol/L；肌酐(Crea)-静脉血: 33.8umol/L；Rh血型-静脉血: 阳性；载脂蛋白AI(apoAI)-静脉血: 1.34g/L；尿素氮(BUN)-静脉血: 5.75mmol/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；淋巴细胞计数(Lymph#)-静脉血: 2.810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.591；白细胞计数(WBC#)-静脉血: 8.5610E9/L；钾离子(K+)-静脉血: 4.3mmol/L；总钙(Ca)-静脉血: 2.26mmol/L；尿酸(UA)-静脉血: 204.9umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24.5U/L；有核红细胞计数(NRBC……\n- [全程D22] 检验组合: 乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D25] 检验组合: 血小板分布宽度(PDW)-静脉血: 10.3%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；比重(SG)-尿液: 1.028；甘油三酯(TG)-静脉血: 1.05mmol/L；红细胞计数(RBC#)-静脉血: 3.4910E12/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.86mmolL；平均红细胞体积(MCV)-静脉血: 84.8fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 42.4；丙氨酸氨基转移酶(ALT)-静脉血: 14.8U/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.001；尿酸(UA)-静脉血: 132.3umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.910E9/L；大血小板百分比(P-LCR%)-静脉血: 21.8%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；粘液丝计数(MUCS#)-尿液: 28/μL；红细胞计数(RBC#)-尿液: 1/μL；浊度(TRUB)-尿液: 清亮；血小板计数(PLT#)-静脉血: 31810E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.218；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7；天门冬氨酸氨基转移酶(AST)-静脉血: 11.2U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.1；载脂蛋白AI(apoAI)-静脉血: 1.14g/L；单核细胞百分比(Mono%)-静脉血: 0.084；总钙(Ca)-静脉血: 2.2mmol/L；总胆汁酸(TBA)-静脉血: 4.4umol/L；白蛋白(ALB)-静脉血: 35.7g/L；红细胞比容(Hct)-静脉血: 29.6%；单核细胞计数(Mono#)-静脉血: 0.710E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 10.9U/L；平均血小板体积(MPV)-静脉血: 9.7fL；中性粒细胞计数(Neut#)-静脉血: 6.110E9/L；胆红素(BIL)-尿液: -（参考: 阴性）；血红蛋白(Hb)-静脉血: 100g/L；C-反应蛋白(CRP)-静脉血: 66.11mg/L；葡萄糖(Glu)-静脉血: 4.89mmol/L；磷(P)-静脉血: 1.26mmol/L；直接胆红素(DBIL……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D3] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日随夏医生信息已隐藏，患者颈背部酸痛较前有好转，无发热畏寒，无恶心呕吐，无胸闷心悸，胃纳睡眠尚可，二便未见明显异常，体查：KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。右颈扪及肿物，约4*3cm,无压痛，质硬，活动差，边界尚清，未扪及明显融合，活检伤口愈合良好。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。右颈部肿物活检病理回报：提示鼻咽部鳞癌转移。鼻咽部MR示：鼻咽顶后壁及两侧壁粘膜增厚，右侧翼内肌、咽鼓管、头长肌受侵，右侧斜坡，颞骨岩部，寰椎前弓骨质破坏。目前患者诊断：鼻咽癌，患者病理活检部位为右颈部肿物，提示转移性鳞癌，建议其行鼻咽部肿物病理活检，患者家属不同意，有放疗适应症，无相对放疗禁忌症，告知患者放疗风险及副反应，患者家属表示理解病情，现治疗后患者要求出院，予以办理，嘱注意休息合理饮食，定期复诊，不适随诊。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D19] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。凝血、乙肝两对半、肝炎四项、HIV/梅毒等检验结果无明显异常。[姓名已隐去]主任查房后，患者因年龄较小，完成活检等操作不配合，家属要求全麻下行活检明确病理，完善相关检查后择期手术，遵嘱执行。\n- [全程D20] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。[姓名已隐去]主任查房后示，完善术前相关检验检查，做好术前准备，遵嘱执行。\n- [全程D21] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。血常规、生化常规回报无明显异常。输血三项回报：B型、RH阳性、抗体筛选阴性。[姓名已隐去]主任查房后示，结合患者各项检查，未见明显手术禁忌，拟明日在气管内吸入全麻下经鼻内镜行鼻咽肿物活检+颈部肿物活检术，做好术前准备，遵嘱执行。\n- [全程D22] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日在气管内全麻下行左颈淋巴结切除活检+经鼻内镜鼻咽肿物切开活检术。术程顺利，术后麻醉复苏顺利，安返病房，生命体征平稳，未见口鼻活动性出血。[姓名已隐去]主任查房后，指示予抗炎、止血和支持对症治疗，并注意：1、呼吸情况；2、出血情况，遵嘱执行。\n- [全程D23] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者昨日在气管内全麻下行左颈淋巴结切除活检+经鼻内镜鼻咽肿物切开活检术，目前生命体征平稳，未见口鼻活动性出血，颈部伤口少许渗出，引流条固定在位，诉头痛、颈部肿物痛、鼻部不适。[姓名已隐去]主任查房后，指示继续抗炎、支持治疗，遵嘱执行。\n- [全程D24] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者前日在气管内全麻下行左颈淋巴结切除活检+经鼻内镜鼻咽肿物切开活检术，目前生命体征平稳，未见口鼻活动性出血，颈部伤口已无明显渗出，诉头痛、颈部肿物痛。[姓名已隐去]主任查房后，拔出引流条，指示继续抗炎、止痛、支持治疗，遵嘱执行。\n- [全程D25] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者前3日在气管内全麻下行左颈淋巴结切除活检+经鼻内镜鼻咽肿物切开活检术，目前生命体征平稳，未见口鼻活动性出血，诉头痛、颈部肿物痛。[姓名已隐去]主任查房后，指示继续抗炎、支持治疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即启动含铂双药诱导化疗，并完善心电图及超声心动图检查。\nB. 予以静脉输注氨甲环酸，并完善凝血常规及D-二聚体检查。\nC. 安排右颈部淋巴结清扫术，并静脉使用广谱抗生素抗感染。\nD. 予以阿片类药物滴定止痛，并完善全身骨扫描检查。\nE. 继续抗炎及支持治疗，完善血常规、尿常规及生化常规检查。\nF. 启动根治性调强放射治疗，并复查鼻咽及颈部增强MRI。\nG. 予以静脉高营养支持治疗，并复查血浆EBV-DNA定量。\nH. 预防性皮下注射低分子肝素，并完善双下肢深静脉彩超。\nI. 予以静脉滴注地塞米松，并复查头颈部增强CT。\nJ. 拔除静脉留置针，仅予以口服非甾体抗炎药，并继续留院观察。\nK. 停止静脉用药，改为口服头孢类抗生素，并立即办理出院。\nL. 予以颈部局部姑息性放疗，并完善甲状腺功能检查。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：不支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、颈动脉鞘、斜坡、翼突基底部、蝶骨基底部、岩尖等。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D2] 入院记录: 主诉: 发现右颈部肿物5月余；现病史: 患者于入院前5月前（某次就诊时间10月）高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；阳性症状体征: 体重下降,疼痛,高热,右颈部肿物,颈部酸痛；既往史: 既往有“肾病综合征”病史，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。；家族史: 否认肿瘤家族史。；体格检查: T：36℃，P：68次/分，R：20次/分，BP：91/58mmHg,Ht：144cm，Wt：31kg，BSA：1.135m2，KPS：KPS 90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。；KPS: 90；ECOG:\n- [全程D1] 门急诊记录: 主诉: 右颈部肿物6月余；现病史: 患者某次就诊时间10月份高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；既往史: 肾病综合征。否认高血压、糖尿病、冠心病、肾病等慢性病史，否认乙肝、结核等传染病史，否认重大外伤史，否认献血输血及使用血制品史，否认食物药物过敏史。；个人史: 原籍出生长大，否认疫区疫水接触史，否认化学毒性及放射性物质接触史。；家族史: 否认家族类似病史及肿瘤病史。；体格检查: KPS90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 入院记录: 主诉: 发现右颈部肿物5月余；现病史: 患者于入院前5月前（某次就诊时间10月）高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。行右颈部肿物活检病理回报：提示鼻咽部鳞癌转移。鼻咽部MR示：鼻咽顶后壁及两侧壁粘膜增厚，右侧翼内肌、咽鼓管、头长肌受侵，右侧斜坡，颞骨岩部，寰椎前弓骨质破坏。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；阳性症状体征: 体重下降,疼痛,高热,右颈部肿物,颈部酸痛；既往史: 既往有“肾病综合征”病史，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。；家族史: 否认肿瘤家族史。；体格检查: T：36℃，P：68次/分，R：20次/分，BP：91/58mmHg,Ht：144cm，Wt：31kg，BSA：1.135m2，KPS：KPS 90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率{数值}次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。右颈扪及肿物，约4*3cm,无压痛，质硬，活动差，边界尚清，未扪及明显融合，活检伤口愈合良好。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D3] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见: 心电图大致正常；检查结论: 窦性心律不齐 心电图大致正常\n- [全程D3] 检验组合: 乳酸脱氢酶(LDH)-静脉血: 198.2U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 10.4U/L；总胆红素(TBIL)-静脉血: 4.2umol/L；葡萄糖(Glu)-静脉血: 4.55mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.495COI；α-L-岩藻糖苷酶(AFU)-静脉血: 35U/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；铁蛋白(Ferr)-静脉血: 91.44ng/ml；磷(P)-静脉血: 1.76mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阴性(-)（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.21ug/ml；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阳性(129.78U/mL)（参考: 阴性）；淋巴细胞百分比(Lymph%)-静脉血: 0.426；碱性磷酸酶(ALP)-静脉血: 130.2U/L；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；纤维蛋白原(Fbg)-静脉血: 2.78g/L；钾离子(K+)-静脉血: 3.5mmol/L；免疫球蛋白游离λ轻链(F-Lambda)-静脉血: 阴性(-)（参考: 阴性(-)）；平均血小板体积(MPV)-静脉血: 8.8fL；尿酸(UA)-静脉血: 200umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.24mmolL；天门冬氨酸氨基转移酶(AST)-静脉血: 18.5U/L；尿素氮(BUN)-静脉血: 3.59mmol/L；总胆固醇(TC)-静脉血: 3.29mmol/L；直接胆红素(DBIL)-静脉血: 1.6umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 11.9U/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.98；中性粒细胞百分比(Neut%)-静脉血: 0.516；肌酐(Crea)-静脉血: 35.7umol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞体积(MCV)-静脉血……\n- [全程D4] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约24cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D21] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显占位病变，肺门纵隔未见明显增宽，心影无增大，双侧肋膈角锐利。；检查结论: 心肺未见病变。\n- [全程D21] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 23mmol/L；总胆红素(TBIL)-静脉血: 7.6umol/L；C-反应蛋白(CRP)-静脉血: 4.9mg/L；总胆固醇(TC)-静脉血: 4.18mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.5mmolL；总胆汁酸(TBA)-静脉血: 2.5umol/L；血型抗体筛查-静脉血: 阴性；ABO血型-静脉血: B；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；大血小板百分比(P-LCR%)-静脉血: 24.7%；血小板比容-静脉血: 32%；血小板分布宽度(PDW)-静脉血: 11.1%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；总蛋白(TP)-静脉血: 74.14g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.011；平均红细胞血红蛋白含量(MCH)-静脉血: 28.1pg；白蛋白(ALB)-静脉血: 38.9g/L；甘油三酯(TG)-静脉血: 0.81mmol/L；磷(P)-静脉血: 1.55mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.1；直接胆红素(DBIL)-静脉血: 2.5umol/L；平均红细胞体积(MCV)-静脉血: 84.5fL；平均血小板体积(MPV)-静脉血: 10.1fL；钠离子(Na+)-静脉血: 136.6mmol/L；氯离子(Cl-)-静脉血: 101.1mmol/L；镁离子(Mg2+)-静脉血: 0.72mmol/L；肌酐(Crea)-静脉血: 33.8umol/L；Rh血型-静脉血: 阳性；载脂蛋白AI(apoAI)-静脉血: 1.34g/L；尿素氮(BUN)-静脉血: 5.75mmol/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；淋巴细胞计数(Lymph#)-静脉血: 2.810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.591；白细胞计数(WBC#)-静脉血: 8.5610E9/L；钾离子(K+)-静脉血: 4.3mmol/L；总钙(Ca)-静脉血: 2.26mmol/L；尿酸(UA)-静脉血: 204.9umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24.5U/L；有核红细胞计数(NRBC……\n- [全程D22] 检验组合: 乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D25] 检验组合: 血小板分布宽度(PDW)-静脉血: 10.3%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；比重(SG)-尿液: 1.028；甘油三酯(TG)-静脉血: 1.05mmol/L；红细胞计数(RBC#)-静脉血: 3.4910E12/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.86mmolL；平均红细胞体积(MCV)-静脉血: 84.8fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 42.4；丙氨酸氨基转移酶(ALT)-静脉血: 14.8U/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.001；尿酸(UA)-静脉血: 132.3umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.910E9/L；大血小板百分比(P-LCR%)-静脉血: 21.8%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；粘液丝计数(MUCS#)-尿液: 28/μL；红细胞计数(RBC#)-尿液: 1/μL；浊度(TRUB)-尿液: 清亮；血小板计数(PLT#)-静脉血: 31810E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.218；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7；天门冬氨酸氨基转移酶(AST)-静脉血: 11.2U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.1；载脂蛋白AI(apoAI)-静脉血: 1.14g/L；单核细胞百分比(Mono%)-静脉血: 0.084；总钙(Ca)-静脉血: 2.2mmol/L；总胆汁酸(TBA)-静脉血: 4.4umol/L；白蛋白(ALB)-静脉血: 35.7g/L；红细胞比容(Hct)-静脉血: 29.6%；单核细胞计数(Mono#)-静脉血: 0.710E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 10.9U/L；平均血小板体积(MPV)-静脉血: 9.7fL；中性粒细胞计数(Neut#)-静脉血: 6.110E9/L；胆红素(BIL)-尿液: -（参考: 阴性）；血红蛋白(Hb)-静脉血: 100g/L；C-反应蛋白(CRP)-静脉血: 66.11mg/L；葡萄糖(Glu)-静脉血: 4.89mmol/L；磷(P)-静脉血: 1.26mmol/L；直接胆红素(DBIL……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D3] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日随夏医生信息已隐藏，患者颈背部酸痛较前有好转，无发热畏寒，无恶心呕吐，无胸闷心悸，胃纳睡眠尚可，二便未见明显异常，体查：KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。右颈扪及肿物，约4*3cm,无压痛，质硬，活动差，边界尚清，未扪及明显融合，活检伤口愈合良好。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。右颈部肿物活检病理回报：提示鼻咽部鳞癌转移。鼻咽部MR示：鼻咽顶后壁及两侧壁粘膜增厚，右侧翼内肌、咽鼓管、头长肌受侵，右侧斜坡，颞骨岩部，寰椎前弓骨质破坏。目前患者诊断：鼻咽癌，患者病理活检部位为右颈部肿物，提示转移性鳞癌，建议其行鼻咽部肿物病理活检，患者家属不同意，有放疗适应症，无相对放疗禁忌症，告知患者放疗风险及副反应，患者家属表示理解病情，现治疗后患者要求出院，予以办理，嘱注意休息合理饮食，定期复诊，不适随诊。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D19] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。凝血、乙肝两对半、肝炎四项、HIV/梅毒等检验结果无明显异常。[姓名已隐去]主任查房后，患者因年龄较小，完成活检等操作不配合，家属要求全麻下行活检明确病理，完善相关检查后择期手术，遵嘱执行。\n- [全程D20] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。[姓名已隐去]主任查房后示，完善术前相关检验检查，做好术前准备，遵嘱执行。\n- [全程D21] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。血常规、生化常规回报无明显异常。输血三项回报：B型、RH阳性、抗体筛选阴性。[姓名已隐去]主任查房后示，结合患者各项检查，未见明显手术禁忌，拟明日在气管内吸入全麻下经鼻内镜行鼻咽肿物活检+颈部肿物活检术，做好术前准备，遵嘱执行。\n- [全程D22] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日在气管内全麻下行左颈淋巴结切除活检+经鼻内镜鼻咽肿物切开活检术。术程顺利，术后麻醉复苏顺利，安返病房，生命体征平稳，未见口鼻活动性出血。[姓名已隐去]主任查房后，指示予抗炎、止血和支持对症治疗，并注意：1、呼吸情况；2、出血情况，遵嘱执行。\n- [全程D23] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者昨日在气管内全麻下行左颈淋巴结切除活检+经鼻内镜鼻咽肿物切开活检术，目前生命体征平稳，未见口鼻活动性出血，颈部伤口少许渗出，引流条固定在位，诉头痛、颈部肿物痛、鼻部不适。[姓名已隐去]主任查房后，指示继续抗炎、支持治疗，遵嘱执行。\n- [全程D24] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者前日在气管内全麻下行左颈淋巴结切除活检+经鼻内镜鼻咽肿物切开活检术，目前生命体征平稳，未见口鼻活动性出血，颈部伤口已无明显渗出，诉头痛、颈部肿物痛。[姓名已隐去]主任查房后，拔出引流条，指示继续抗炎、止痛、支持治疗，遵嘱执行。\n- [全程D25] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者前3日在气管内全麻下行左颈淋巴结切除活检+经鼻内镜鼻咽肿物切开活检术，目前生命体征平稳，未见口鼻活动性出血，诉头痛、颈部肿物痛。[姓名已隐去]主任查房后，指示继续抗炎、支持治疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即启动含铂双药诱导化疗，并完善心电图及超声心动图检查。\nB. 予以静脉输注氨甲环酸，并完善凝血常规及D-二聚体检查。\nC. 安排右颈部淋巴结清扫术，并静脉使用广谱抗生素抗感染。\nD. 予以阿片类药物滴定止痛，并完善全身骨扫描检查。\nE. 继续抗炎及支持治疗，完善血常规、尿常规及生化常规检查。\nF. 启动根治性调强放射治疗，并复查鼻咽及颈部增强MRI。\nG. 予以静脉高营养支持治疗，并复查血浆EBV-DNA定量。\nH. 预防性皮下注射低分子肝素，并完善双下肢深静脉彩超。\nI. 予以静脉滴注地塞米松，并复查头颈部增强CT。\nJ. 拔除静脉留置针，仅予以口服非甾体抗炎药，并继续留院观察。\nK. 停止静脉用药，改为口服头孢类抗生素，并立即办理出院。\nL. 予以颈部局部姑息性放疗，并完善甲状腺功能检查。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-3246297632d882a392dfe20a","patient_id":"patient-e45c55cc63c050892e6b2467","turn_id":"turn07","turn_position":6,"turn_type":"recurrence_or_salvage_decision","gold_letter":"F","gold_action":"完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检及颈部肿物活检术。","options":[{"letter":"A","text":"完善术前准备，在局麻下行经鼻内镜鼻咽肿物活检及颈部肿物活检术。","is_gold":false},{"letter":"B","text":"直接以颈部淋巴结转移性鳞癌及影像学表现为依据，开始诱导化疗。","is_gold":false},{"letter":"C","text":"完善术前准备，在全麻下仅行经鼻内镜鼻咽肿物活检术。","is_gold":false},{"letter":"D","text":"完善术前准备，在全麻下仅行颈部肿物切除活检术。","is_gold":false},{"letter":"E","text":"完善术前准备，在全麻下行鼻咽肿物活检术，并预防性切除双侧扁桃体。","is_gold":false},{"letter":"F","text":"完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检及颈部肿物活检术。","is_gold":true},{"letter":"G","text":"完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检，若为阴性则行颈部淋巴结清扫术。","is_gold":false},{"letter":"H","text":"暂缓活检，先行EBV-DNA及鼻咽部PET-CT检查，结果决定是否再次活检。","is_gold":false},{"letter":"I","text":"完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检及颈部肿物细针穿刺活检术。","is_gold":false},{"letter":"J","text":"完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检，并同期行鼻咽部及颈部放疗定位。","is_gold":false},{"letter":"K","text":"完善术前准备，在局麻下行颈部肿物切除活检，待病理确诊后再行鼻咽活检。","is_gold":false},{"letter":"L","text":"完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检及右侧颈部淋巴结清扫术。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：不支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、颈动脉鞘、斜坡、翼突基底部、蝶骨基底部、岩尖等。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D2] 入院记录: 主诉: 发现右颈部肿物5月余；现病史: 患者于入院前5月前（某次就诊时间10月）高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；阳性症状体征: 体重下降,疼痛,高热,右颈部肿物,颈部酸痛；既往史: 既往有“肾病综合征”病史，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。；家族史: 否认肿瘤家族史。；体格检查: T：36℃，P：68次/分，R：20次/分，BP：91/58mmHg,Ht：144cm，Wt：31kg，BSA：1.135m2，KPS：KPS 90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。；KPS: 90；ECOG:\n- [全程D1] 门急诊记录: 主诉: 右颈部肿物6月余；现病史: 患者某次就诊时间10月份高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；既往史: 肾病综合征。否认高血压、糖尿病、冠心病、肾病等慢性病史，否认乙肝、结核等传染病史，否认重大外伤史，否认献血输血及使用血制品史，否认食物药物过敏史。；个人史: 原籍出生长大，否认疫区疫水接触史，否认化学毒性及放射性物质接触史。；家族史: 否认家族类似病史及肿瘤病史。；体格检查: KPS90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 入院记录: 主诉: 发现右颈部肿物5月余；现病史: 患者于入院前5月前（某次就诊时间10月）高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。行右颈部肿物活检病理回报：提示鼻咽部鳞癌转移。鼻咽部MR示：鼻咽顶后壁及两侧壁粘膜增厚，右侧翼内肌、咽鼓管、头长肌受侵，右侧斜坡，颞骨岩部，寰椎前弓骨质破坏。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；阳性症状体征: 体重下降,疼痛,高热,右颈部肿物,颈部酸痛；既往史: 既往有“肾病综合征”病史，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。；家族史: 否认肿瘤家族史。；体格检查: T：36℃，P：68次/分，R：20次/分，BP：91/58mmHg,Ht：144cm，Wt：31kg，BSA：1.135m2，KPS：KPS 90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率{数值}次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。右颈扪及肿物，约4*3cm,无压痛，质硬，活动差，边界尚清，未扪及明显融合，活检伤口愈合良好。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D3] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见: 心电图大致正常；检查结论: 窦性心律不齐 心电图大致正常\n- [全程D3] 检验组合: 乳酸脱氢酶(LDH)-静脉血: 198.2U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 10.4U/L；总胆红素(TBIL)-静脉血: 4.2umol/L；葡萄糖(Glu)-静脉血: 4.55mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.495COI；α-L-岩藻糖苷酶(AFU)-静脉血: 35U/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；铁蛋白(Ferr)-静脉血: 91.44ng/ml；磷(P)-静脉血: 1.76mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阴性(-)（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.21ug/ml；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阳性(129.78U/mL)（参考: 阴性）；淋巴细胞百分比(Lymph%)-静脉血: 0.426；碱性磷酸酶(ALP)-静脉血: 130.2U/L；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；纤维蛋白原(Fbg)-静脉血: 2.78g/L；钾离子(K+)-静脉血: 3.5mmol/L；免疫球蛋白游离λ轻链(F-Lambda)-静脉血: 阴性(-)（参考: 阴性(-)）；平均血小板体积(MPV)-静脉血: 8.8fL；尿酸(UA)-静脉血: 200umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.24mmolL；天门冬氨酸氨基转移酶(AST)-静脉血: 18.5U/L；尿素氮(BUN)-静脉血: 3.59mmol/L；总胆固醇(TC)-静脉血: 3.29mmol/L；直接胆红素(DBIL)-静脉血: 1.6umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 11.9U/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.98；中性粒细胞百分比(Neut%)-静脉血: 0.516；肌酐(Crea)-静脉血: 35.7umol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞体积(MCV)-静脉血……\n- [全程D4] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约24cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D21] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显占位病变，肺门纵隔未见明显增宽，心影无增大，双侧肋膈角锐利。；检查结论: 心肺未见病变。\n- [全程D21] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 23mmol/L；总胆红素(TBIL)-静脉血: 7.6umol/L；C-反应蛋白(CRP)-静脉血: 4.9mg/L；总胆固醇(TC)-静脉血: 4.18mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.5mmolL；总胆汁酸(TBA)-静脉血: 2.5umol/L；血型抗体筛查-静脉血: 阴性；ABO血型-静脉血: B；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；大血小板百分比(P-LCR%)-静脉血: 24.7%；血小板比容-静脉血: 32%；血小板分布宽度(PDW)-静脉血: 11.1%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；总蛋白(TP)-静脉血: 74.14g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.011；平均红细胞血红蛋白含量(MCH)-静脉血: 28.1pg；白蛋白(ALB)-静脉血: 38.9g/L；甘油三酯(TG)-静脉血: 0.81mmol/L；磷(P)-静脉血: 1.55mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.1；直接胆红素(DBIL)-静脉血: 2.5umol/L；平均红细胞体积(MCV)-静脉血: 84.5fL；平均血小板体积(MPV)-静脉血: 10.1fL；钠离子(Na+)-静脉血: 136.6mmol/L；氯离子(Cl-)-静脉血: 101.1mmol/L；镁离子(Mg2+)-静脉血: 0.72mmol/L；肌酐(Crea)-静脉血: 33.8umol/L；Rh血型-静脉血: 阳性；载脂蛋白AI(apoAI)-静脉血: 1.34g/L；尿素氮(BUN)-静脉血: 5.75mmol/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；淋巴细胞计数(Lymph#)-静脉血: 2.810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.591；白细胞计数(WBC#)-静脉血: 8.5610E9/L；钾离子(K+)-静脉血: 4.3mmol/L；总钙(Ca)-静脉血: 2.26mmol/L；尿酸(UA)-静脉血: 204.9umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24.5U/L；有核红细胞计数(NRBC……\n- [全程D22] 检验组合: 乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D25] 检验组合: 血小板分布宽度(PDW)-静脉血: 10.3%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；比重(SG)-尿液: 1.028；甘油三酯(TG)-静脉血: 1.05mmol/L；红细胞计数(RBC#)-静脉血: 3.4910E12/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.86mmolL；平均红细胞体积(MCV)-静脉血: 84.8fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 42.4；丙氨酸氨基转移酶(ALT)-静脉血: 14.8U/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.001；尿酸(UA)-静脉血: 132.3umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.910E9/L；大血小板百分比(P-LCR%)-静脉血: 21.8%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；粘液丝计数(MUCS#)-尿液: 28/μL；红细胞计数(RBC#)-尿液: 1/μL；浊度(TRUB)-尿液: 清亮；血小板计数(PLT#)-静脉血: 31810E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.218；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7；天门冬氨酸氨基转移酶(AST)-静脉血: 11.2U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.1；载脂蛋白AI(apoAI)-静脉血: 1.14g/L；单核细胞百分比(Mono%)-静脉血: 0.084；总钙(Ca)-静脉血: 2.2mmol/L；总胆汁酸(TBA)-静脉血: 4.4umol/L；白蛋白(ALB)-静脉血: 35.7g/L；红细胞比容(Hct)-静脉血: 29.6%；单核细胞计数(Mono#)-静脉血: 0.710E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 10.9U/L；平均血小板体积(MPV)-静脉血: 9.7fL；中性粒细胞计数(Neut#)-静脉血: 6.110E9/L；胆红素(BIL)-尿液: -（参考: 阴性）；血红蛋白(Hb)-静脉血: 100g/L；C-反应蛋白(CRP)-静脉血: 66.11mg/L；葡萄糖(Glu)-静脉血: 4.89mmol/L；磷(P)-静脉血: 1.26mmol/L；直接胆红素(DBIL……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D3] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日随夏医生信息已隐藏，患者颈背部酸痛较前有好转，无发热畏寒，无恶心呕吐，无胸闷心悸，胃纳睡眠尚可，二便未见明显异常，体查：KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。右颈扪及肿物，约4*3cm,无压痛，质硬，活动差，边界尚清，未扪及明显融合，活检伤口愈合良好。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。右颈部肿物活检病理回报：提示鼻咽部鳞癌转移。鼻咽部MR示：鼻咽顶后壁及两侧壁粘膜增厚，右侧翼内肌、咽鼓管、头长肌受侵，右侧斜坡，颞骨岩部，寰椎前弓骨质破坏。目前患者诊断：鼻咽癌，患者病理活检部位为右颈部肿物，提示转移性鳞癌，建议其行鼻咽部肿物病理活检，患者家属不同意，有放疗适应症，无相对放疗禁忌症，告知患者放疗风险及副反应，患者家属表示理解病情，现治疗后患者要求出院，予以办理，嘱注意休息合理饮食，定期复诊，不适随诊。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D19] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。凝血、乙肝两对半、肝炎四项、HIV/梅毒等检验结果无明显异常。[姓名已隐去]主任查房后，患者因年龄较小，完成活检等操作不配合，家属要求全麻下行活检明确病理，完善相关检查后择期手术，遵嘱执行。\n- [全程D20] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。[姓名已隐去]主任查房后示，完善术前相关检验检查，做好术前准备，遵嘱执行。\n- [全程D21] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。血常规、生化常规回报无明显异常。输血三项回报：B型、RH阳性、抗体筛选阴性。[姓名已隐去]主任查房后示，结合患者各项检查，未见明显手术禁忌，拟明日在气管内吸入全麻下经鼻内镜行鼻咽肿物活检+颈部肿物活检术，做好术前准备，遵嘱执行。\n- [全程D22] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日在气管内全麻下行左颈淋巴结切除活检+经鼻内镜鼻咽肿物切开活检术。术程顺利，术后麻醉复苏顺利，安返病房，生命体征平稳，未见口鼻活动性出血。[姓名已隐去]主任查房后，指示予抗炎、止血和支持对症治疗，并注意：1、呼吸情况；2、出血情况，遵嘱执行。\n- [全程D23] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者昨日在气管内全麻下行左颈淋巴结切除活检+经鼻内镜鼻咽肿物切开活检术，目前生命体征平稳，未见口鼻活动性出血，颈部伤口少许渗出，引流条固定在位，诉头痛、颈部肿物痛、鼻部不适。[姓名已隐去]主任查房后，指示继续抗炎、支持治疗，遵嘱执行。\n- [全程D24] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者前日在气管内全麻下行左颈淋巴结切除活检+经鼻内镜鼻咽肿物切开活检术，目前生命体征平稳，未见口鼻活动性出血，颈部伤口已无明显渗出，诉头痛、颈部肿物痛。[姓名已隐去]主任查房后，拔出引流条，指示继续抗炎、止痛、支持治疗，遵嘱执行。\n- [全程D25] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者前3日在气管内全麻下行左颈淋巴结切除活检+经鼻内镜鼻咽肿物切开活检术，目前生命体征平稳，未见口鼻活动性出血，诉头痛、颈部肿物痛。[姓名已隐去]主任查房后，指示继续抗炎、支持治疗。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善术前准备，在局麻下行经鼻内镜鼻咽肿物活检及颈部肿物活检术。\nB. 直接以颈部淋巴结转移性鳞癌及影像学表现为依据，开始诱导化疗。\nC. 完善术前准备，在全麻下仅行经鼻内镜鼻咽肿物活检术。\nD. 完善术前准备，在全麻下仅行颈部肿物切除活检术。\nE. 完善术前准备，在全麻下行鼻咽肿物活检术，并预防性切除双侧扁桃体。\nF. 完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检及颈部肿物活检术。\nG. 完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检，若为阴性则行颈部淋巴结清扫术。\nH. 暂缓活检，先行EBV-DNA及鼻咽部PET-CT检查，结果决定是否再次活检。\nI. 完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检及颈部肿物细针穿刺活检术。\nJ. 完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检，并同期行鼻咽部及颈部放疗定位。\nK. 完善术前准备，在局麻下行颈部肿物切除活检，待病理确诊后再行鼻咽活检。\nL. 完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检及右侧颈部淋巴结清扫术。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：不支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、颈动脉鞘、斜坡、翼突基底部、蝶骨基底部、岩尖等。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D2] 入院记录: 主诉: 发现右颈部肿物5月余；现病史: 患者于入院前5月前（某次就诊时间10月）高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；阳性症状体征: 体重下降,疼痛,高热,右颈部肿物,颈部酸痛；既往史: 既往有“肾病综合征”病史，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。；家族史: 否认肿瘤家族史。；体格检查: T：36℃，P：68次/分，R：20次/分，BP：91/58mmHg,Ht：144cm，Wt：31kg，BSA：1.135m2，KPS：KPS 90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。；KPS: 90；ECOG:\n- [全程D1] 门急诊记录: 主诉: 右颈部肿物6月余；现病史: 患者某次就诊时间10月份高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；既往史: 肾病综合征。否认高血压、糖尿病、冠心病、肾病等慢性病史，否认乙肝、结核等传染病史，否认重大外伤史，否认献血输血及使用血制品史，否认食物药物过敏史。；个人史: 原籍出生长大，否认疫区疫水接触史，否认化学毒性及放射性物质接触史。；家族史: 否认家族类似病史及肿瘤病史。；体格检查: KPS90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 入院记录: 主诉: 发现右颈部肿物5月余；现病史: 患者于入院前5月前（某次就诊时间10月）高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。行右颈部肿物活检病理回报：提示鼻咽部鳞癌转移。鼻咽部MR示：鼻咽顶后壁及两侧壁粘膜增厚，右侧翼内肌、咽鼓管、头长肌受侵，右侧斜坡，颞骨岩部，寰椎前弓骨质破坏。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；阳性症状体征: 体重下降,疼痛,高热,右颈部肿物,颈部酸痛；既往史: 既往有“肾病综合征”病史，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。；家族史: 否认肿瘤家族史。；体格检查: T：36℃，P：68次/分，R：20次/分，BP：91/58mmHg,Ht：144cm，Wt：31kg，BSA：1.135m2，KPS：KPS 90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率{数值}次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。右颈扪及肿物，约4*3cm,无压痛，质硬，活动差，边界尚清，未扪及明显融合，活检伤口愈合良好。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D3] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见: 心电图大致正常；检查结论: 窦性心律不齐 心电图大致正常\n- [全程D3] 检验组合: 乳酸脱氢酶(LDH)-静脉血: 198.2U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 10.4U/L；总胆红素(TBIL)-静脉血: 4.2umol/L；葡萄糖(Glu)-静脉血: 4.55mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.495COI；α-L-岩藻糖苷酶(AFU)-静脉血: 35U/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；铁蛋白(Ferr)-静脉血: 91.44ng/ml；磷(P)-静脉血: 1.76mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阴性(-)（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.21ug/ml；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阳性(129.78U/mL)（参考: 阴性）；淋巴细胞百分比(Lymph%)-静脉血: 0.426；碱性磷酸酶(ALP)-静脉血: 130.2U/L；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；纤维蛋白原(Fbg)-静脉血: 2.78g/L；钾离子(K+)-静脉血: 3.5mmol/L；免疫球蛋白游离λ轻链(F-Lambda)-静脉血: 阴性(-)（参考: 阴性(-)）；平均血小板体积(MPV)-静脉血: 8.8fL；尿酸(UA)-静脉血: 200umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.24mmolL；天门冬氨酸氨基转移酶(AST)-静脉血: 18.5U/L；尿素氮(BUN)-静脉血: 3.59mmol/L；总胆固醇(TC)-静脉血: 3.29mmol/L；直接胆红素(DBIL)-静脉血: 1.6umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 11.9U/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.98；中性粒细胞百分比(Neut%)-静脉血: 0.516；肌酐(Crea)-静脉血: 35.7umol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞体积(MCV)-静脉血……\n- [全程D4] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约24cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D21] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显占位病变，肺门纵隔未见明显增宽，心影无增大，双侧肋膈角锐利。；检查结论: 心肺未见病变。\n- [全程D21] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 23mmol/L；总胆红素(TBIL)-静脉血: 7.6umol/L；C-反应蛋白(CRP)-静脉血: 4.9mg/L；总胆固醇(TC)-静脉血: 4.18mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.5mmolL；总胆汁酸(TBA)-静脉血: 2.5umol/L；血型抗体筛查-静脉血: 阴性；ABO血型-静脉血: B；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；大血小板百分比(P-LCR%)-静脉血: 24.7%；血小板比容-静脉血: 32%；血小板分布宽度(PDW)-静脉血: 11.1%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；总蛋白(TP)-静脉血: 74.14g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.011；平均红细胞血红蛋白含量(MCH)-静脉血: 28.1pg；白蛋白(ALB)-静脉血: 38.9g/L；甘油三酯(TG)-静脉血: 0.81mmol/L；磷(P)-静脉血: 1.55mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.1；直接胆红素(DBIL)-静脉血: 2.5umol/L；平均红细胞体积(MCV)-静脉血: 84.5fL；平均血小板体积(MPV)-静脉血: 10.1fL；钠离子(Na+)-静脉血: 136.6mmol/L；氯离子(Cl-)-静脉血: 101.1mmol/L；镁离子(Mg2+)-静脉血: 0.72mmol/L；肌酐(Crea)-静脉血: 33.8umol/L；Rh血型-静脉血: 阳性；载脂蛋白AI(apoAI)-静脉血: 1.34g/L；尿素氮(BUN)-静脉血: 5.75mmol/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；淋巴细胞计数(Lymph#)-静脉血: 2.810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.591；白细胞计数(WBC#)-静脉血: 8.5610E9/L；钾离子(K+)-静脉血: 4.3mmol/L；总钙(Ca)-静脉血: 2.26mmol/L；尿酸(UA)-静脉血: 204.9umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24.5U/L；有核红细胞计数(NRBC……\n- [全程D22] 检验组合: 乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D25] 检验组合: 血小板分布宽度(PDW)-静脉血: 10.3%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；比重(SG)-尿液: 1.028；甘油三酯(TG)-静脉血: 1.05mmol/L；红细胞计数(RBC#)-静脉血: 3.4910E12/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.86mmolL；平均红细胞体积(MCV)-静脉血: 84.8fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 42.4；丙氨酸氨基转移酶(ALT)-静脉血: 14.8U/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.001；尿酸(UA)-静脉血: 132.3umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.910E9/L；大血小板百分比(P-LCR%)-静脉血: 21.8%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；粘液丝计数(MUCS#)-尿液: 28/μL；红细胞计数(RBC#)-尿液: 1/μL；浊度(TRUB)-尿液: 清亮；血小板计数(PLT#)-静脉血: 31810E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.218；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7；天门冬氨酸氨基转移酶(AST)-静脉血: 11.2U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.1；载脂蛋白AI(apoAI)-静脉血: 1.14g/L；单核细胞百分比(Mono%)-静脉血: 0.084；总钙(Ca)-静脉血: 2.2mmol/L；总胆汁酸(TBA)-静脉血: 4.4umol/L；白蛋白(ALB)-静脉血: 35.7g/L；红细胞比容(Hct)-静脉血: 29.6%；单核细胞计数(Mono#)-静脉血: 0.710E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 10.9U/L；平均血小板体积(MPV)-静脉血: 9.7fL；中性粒细胞计数(Neut#)-静脉血: 6.110E9/L；胆红素(BIL)-尿液: -（参考: 阴性）；血红蛋白(Hb)-静脉血: 100g/L；C-反应蛋白(CRP)-静脉血: 66.11mg/L；葡萄糖(Glu)-静脉血: 4.89mmol/L；磷(P)-静脉血: 1.26mmol/L；直接胆红素(DBIL……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D3] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日随夏医生信息已隐藏，患者颈背部酸痛较前有好转，无发热畏寒，无恶心呕吐，无胸闷心悸，胃纳睡眠尚可，二便未见明显异常，体查：KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。右颈扪及肿物，约4*3cm,无压痛，质硬，活动差，边界尚清，未扪及明显融合，活检伤口愈合良好。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。右颈部肿物活检病理回报：提示鼻咽部鳞癌转移。鼻咽部MR示：鼻咽顶后壁及两侧壁粘膜增厚，右侧翼内肌、咽鼓管、头长肌受侵，右侧斜坡，颞骨岩部，寰椎前弓骨质破坏。目前患者诊断：鼻咽癌，患者病理活检部位为右颈部肿物，提示转移性鳞癌，建议其行鼻咽部肿物病理活检，患者家属不同意，有放疗适应症，无相对放疗禁忌症，告知患者放疗风险及副反应，患者家属表示理解病情，现治疗后患者要求出院，予以办理，嘱注意休息合理饮食，定期复诊，不适随诊。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D19] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。凝血、乙肝两对半、肝炎四项、HIV/梅毒等检验结果无明显异常。[姓名已隐去]主任查房后，患者因年龄较小，完成活检等操作不配合，家属要求全麻下行活检明确病理，完善相关检查后择期手术，遵嘱执行。\n- [全程D20] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。[姓名已隐去]主任查房后示，完善术前相关检验检查，做好术前准备，遵嘱执行。\n- [全程D21] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。血常规、生化常规回报无明显异常。输血三项回报：B型、RH阳性、抗体筛选阴性。[姓名已隐去]主任查房后示，结合患者各项检查，未见明显手术禁忌，拟明日在气管内吸入全麻下经鼻内镜行鼻咽肿物活检+颈部肿物活检术，做好术前准备，遵嘱执行。\n- [全程D22] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日在气管内全麻下行左颈淋巴结切除活检+经鼻内镜鼻咽肿物切开活检术。术程顺利，术后麻醉复苏顺利，安返病房，生命体征平稳，未见口鼻活动性出血。[姓名已隐去]主任查房后，指示予抗炎、止血和支持对症治疗，并注意：1、呼吸情况；2、出血情况，遵嘱执行。\n- [全程D23] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者昨日在气管内全麻下行左颈淋巴结切除活检+经鼻内镜鼻咽肿物切开活检术，目前生命体征平稳，未见口鼻活动性出血，颈部伤口少许渗出，引流条固定在位，诉头痛、颈部肿物痛、鼻部不适。[姓名已隐去]主任查房后，指示继续抗炎、支持治疗，遵嘱执行。\n- [全程D24] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者前日在气管内全麻下行左颈淋巴结切除活检+经鼻内镜鼻咽肿物切开活检术，目前生命体征平稳，未见口鼻活动性出血，颈部伤口已无明显渗出，诉头痛、颈部肿物痛。[姓名已隐去]主任查房后，拔出引流条，指示继续抗炎、止痛、支持治疗，遵嘱执行。\n- [全程D25] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者前3日在气管内全麻下行左颈淋巴结切除活检+经鼻内镜鼻咽肿物切开活检术，目前生命体征平稳，未见口鼻活动性出血，诉头痛、颈部肿物痛。[姓名已隐去]主任查房后，指示继续抗炎、支持治疗。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善术前准备，在局麻下行经鼻内镜鼻咽肿物活检及颈部肿物活检术。\nB. 直接以颈部淋巴结转移性鳞癌及影像学表现为依据，开始诱导化疗。\nC. 完善术前准备，在全麻下仅行经鼻内镜鼻咽肿物活检术。\nD. 完善术前准备，在全麻下仅行颈部肿物切除活检术。\nE. 完善术前准备，在全麻下行鼻咽肿物活检术，并预防性切除双侧扁桃体。\nF. 完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检及颈部肿物活检术。\nG. 完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检，若为阴性则行颈部淋巴结清扫术。\nH. 暂缓活检，先行EBV-DNA及鼻咽部PET-CT检查，结果决定是否再次活检。\nI. 完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检及颈部肿物细针穿刺活检术。\nJ. 完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检，并同期行鼻咽部及颈部放疗定位。\nK. 完善术前准备，在局麻下行颈部肿物切除活检，待病理确诊后再行鼻咽活检。\nL. 完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检及右侧颈部淋巴结清扫术。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-da812d38ab5771a5dbc8fc87","patient_id":"patient-e45c55cc63c050892e6b2467","turn_id":"turn08","turn_position":7,"turn_type":"recurrence_or_salvage_decision","gold_letter":"G","gold_action":"继续根治性放疗，完善电子鼻咽镜检查，并予以肠内营养支持及定期复查血常规。","options":[{"letter":"A","text":"终止放化疗，转为手术切除鼻咽原发灶及颈部残留淋巴结。","is_gold":false},{"letter":"B","text":"暂停放疗，予以静脉抗感染治疗，2周后恢复放疗。","is_gold":false},{"letter":"C","text":"重新定位并修改放疗计划，缩减原发灶及颈部淋巴结的照射靶区，继续放疗。","is_gold":false},{"letter":"D","text":"提前结束放疗，改为单药靶向治疗或PD-1抑制剂维持治疗。","is_gold":false},{"letter":"E","text":"继续根治性放疗，停用原化疗方案，改用吉西他滨联合顺铂方案化疗。","is_gold":false},{"letter":"F","text":"暂停治疗，完善全身PET-CT检查评估远处转移情况，再决定后续方案。","is_gold":false},{"letter":"G","text":"继续根治性放疗，完善电子鼻咽镜检查，并予以肠内营养支持及定期复查血常规。","is_gold":true},{"letter":"H","text":"终止放化疗，转为定期随访观察，3个月后复查鼻咽及颈部MRI。","is_gold":false},{"letter":"I","text":"继续根治性放疗，常规加用大剂量地塞米松以减轻局部黏膜炎症反应。","is_gold":false},{"letter":"J","text":"暂停放疗，行右颈部残留淋巴结穿刺活检明确病理，再制定后续治疗计划。","is_gold":false},{"letter":"K","text":"继续根治性放疗，并择期行右侧颈部淋巴结清扫术。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：不支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、颈动脉鞘、斜坡、翼突基底部、蝶骨基底部、岩尖等。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D2] 入院记录: 主诉: 发现右颈部肿物5月余；现病史: 患者于入院前5月前（某次就诊时间10月）高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；阳性症状体征: 体重下降,疼痛,高热,右颈部肿物,颈部酸痛；既往史: 既往有“肾病综合征”病史，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。；家族史: 否认肿瘤家族史。；体格检查: T：36℃，P：68次/分，R：20次/分，BP：91/58mmHg,Ht：144cm，Wt：31kg，BSA：1.135m2，KPS：KPS 90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。；KPS: 90；ECOG:\n- [全程D1] 门急诊记录: 主诉: 右颈部肿物6月余；现病史: 患者某次就诊时间10月份高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；既往史: 肾病综合征。否认高血压、糖尿病、冠心病、肾病等慢性病史，否认乙肝、结核等传染病史，否认重大外伤史，否认献血输血及使用血制品史，否认食物药物过敏史。；个人史: 原籍出生长大，否认疫区疫水接触史，否认化学毒性及放射性物质接触史。；家族史: 否认家族类似病史及肿瘤病史。；体格检查: KPS90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 入院记录: 主诉: 发现右颈部肿物5月余；现病史: 患者于入院前5月前（某次就诊时间10月）高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。行右颈部肿物活检病理回报：提示鼻咽部鳞癌转移。鼻咽部MR示：鼻咽顶后壁及两侧壁粘膜增厚，右侧翼内肌、咽鼓管、头长肌受侵，右侧斜坡，颞骨岩部，寰椎前弓骨质破坏。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；阳性症状体征: 体重下降,疼痛,高热,右颈部肿物,颈部酸痛；既往史: 既往有“肾病综合征”病史，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。；家族史: 否认肿瘤家族史。；体格检查: T：36℃，P：68次/分，R：20次/分，BP：91/58mmHg,Ht：144cm，Wt：31kg，BSA：1.135m2，KPS：KPS 90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率{数值}次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。右颈扪及肿物，约4*3cm,无压痛，质硬，活动差，边界尚清，未扪及明显融合，活检伤口愈合良好。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D3] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见: 心电图大致正常；检查结论: 窦性心律不齐 心电图大致正常\n- [全程D3] 检验组合: 乳酸脱氢酶(LDH)-静脉血: 198.2U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 10.4U/L；总胆红素(TBIL)-静脉血: 4.2umol/L；葡萄糖(Glu)-静脉血: 4.55mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.495COI；α-L-岩藻糖苷酶(AFU)-静脉血: 35U/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；铁蛋白(Ferr)-静脉血: 91.44ng/ml；磷(P)-静脉血: 1.76mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阴性(-)（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.21ug/ml；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阳性(129.78U/mL)（参考: 阴性）；淋巴细胞百分比(Lymph%)-静脉血: 0.426；碱性磷酸酶(ALP)-静脉血: 130.2U/L；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；纤维蛋白原(Fbg)-静脉血: 2.78g/L；钾离子(K+)-静脉血: 3.5mmol/L；免疫球蛋白游离λ轻链(F-Lambda)-静脉血: 阴性(-)（参考: 阴性(-)）；平均血小板体积(MPV)-静脉血: 8.8fL；尿酸(UA)-静脉血: 200umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.24mmolL；天门冬氨酸氨基转移酶(AST)-静脉血: 18.5U/L；尿素氮(BUN)-静脉血: 3.59mmol/L；总胆固醇(TC)-静脉血: 3.29mmol/L；直接胆红素(DBIL)-静脉血: 1.6umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 11.9U/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.98；中性粒细胞百分比(Neut%)-静脉血: 0.516；肌酐(Crea)-静脉血: 35.7umol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞体积(MCV)-静脉血……\n- [全程D4] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约24cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D21] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显占位病变，肺门纵隔未见明显增宽，心影无增大，双侧肋膈角锐利。；检查结论: 心肺未见病变。\n- [全程D21] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 23mmol/L；总胆红素(TBIL)-静脉血: 7.6umol/L；C-反应蛋白(CRP)-静脉血: 4.9mg/L；总胆固醇(TC)-静脉血: 4.18mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.5mmolL；总胆汁酸(TBA)-静脉血: 2.5umol/L；血型抗体筛查-静脉血: 阴性；ABO血型-静脉血: B；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；大血小板百分比(P-LCR%)-静脉血: 24.7%；血小板比容-静脉血: 32%；血小板分布宽度(PDW)-静脉血: 11.1%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；总蛋白(TP)-静脉血: 74.14g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.011；平均红细胞血红蛋白含量(MCH)-静脉血: 28.1pg；白蛋白(ALB)-静脉血: 38.9g/L；甘油三酯(TG)-静脉血: 0.81mmol/L；磷(P)-静脉血: 1.55mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.1；直接胆红素(DBIL)-静脉血: 2.5umol/L；平均红细胞体积(MCV)-静脉血: 84.5fL；平均血小板体积(MPV)-静脉血: 10.1fL；钠离子(Na+)-静脉血: 136.6mmol/L；氯离子(Cl-)-静脉血: 101.1mmol/L；镁离子(Mg2+)-静脉血: 0.72mmol/L；肌酐(Crea)-静脉血: 33.8umol/L；Rh血型-静脉血: 阳性；载脂蛋白AI(apoAI)-静脉血: 1.34g/L；尿素氮(BUN)-静脉血: 5.75mmol/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；淋巴细胞计数(Lymph#)-静脉血: 2.810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.591；白细胞计数(WBC#)-静脉血: 8.5610E9/L；钾离子(K+)-静脉血: 4.3mmol/L；总钙(Ca)-静脉血: 2.26mmol/L；尿酸(UA)-静脉血: 204.9umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24.5U/L；有核红细胞计数(NRBC……\n- [全程D22] 检验组合: 乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D25] 检验组合: 血小板分布宽度(PDW)-静脉血: 10.3%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；比重(SG)-尿液: 1.028；甘油三酯(TG)-静脉血: 1.05mmol/L；红细胞计数(RBC#)-静脉血: 3.4910E12/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.86mmolL；平均红细胞体积(MCV)-静脉血: 84.8fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 42.4；丙氨酸氨基转移酶(ALT)-静脉血: 14.8U/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.001；尿酸(UA)-静脉血: 132.3umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.910E9/L；大血小板百分比(P-LCR%)-静脉血: 21.8%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；粘液丝计数(MUCS#)-尿液: 28/μL；红细胞计数(RBC#)-尿液: 1/μL；浊度(TRUB)-尿液: 清亮；血小板计数(PLT#)-静脉血: 31810E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.218；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7；天门冬氨酸氨基转移酶(AST)-静脉血: 11.2U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.1；载脂蛋白AI(apoAI)-静脉血: 1.14g/L；单核细胞百分比(Mono%)-静脉血: 0.084；总钙(Ca)-静脉血: 2.2mmol/L；总胆汁酸(TBA)-静脉血: 4.4umol/L；白蛋白(ALB)-静脉血: 35.7g/L；红细胞比容(Hct)-静脉血: 29.6%；单核细胞计数(Mono#)-静脉血: 0.710E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 10.9U/L；平均血小板体积(MPV)-静脉血: 9.7fL；中性粒细胞计数(Neut#)-静脉血: 6.110E9/L；胆红素(BIL)-尿液: -（参考: 阴性）；血红蛋白(Hb)-静脉血: 100g/L；C-反应蛋白(CRP)-静脉血: 66.11mg/L；葡萄糖(Glu)-静脉血: 4.89mmol/L；磷(P)-静脉血: 1.26mmol/L；直接胆红素(DBIL……\n- [全程D45] 检验组合: 红细胞计数(RBC#)-静脉血: 4.0510E12/L；淋巴细胞百分比(Lymph%)-静脉血: 0.347；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.42mmolL；磷(P)-静脉血: 1.77mmol/L；肌酐(Crea)-静脉血: 30.1umol/L；总胆红素(TBIL)-静脉血: 3.5umol/L；白蛋白(ALB)-静脉血: 41.3g/L；钾离子(K+)-静脉血: 4.49mmol/L；总胆固醇(TC)-静脉血: 4.9mmol/L；直接胆红素(DBIL)-静脉血: 1.1umol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；碱性磷酸酶(ALP)-静脉血: 147.1U/L；镁离子(Mg2+)-静脉血: 0.84mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 16.5U/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.1mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 15；淋巴细胞计数(Lymph#)-静脉血: 2.210E9/L；球蛋白(GLO)-静脉血: 35g/L；血红蛋白(Hb)-静脉血: 115g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.4pg；总蛋白(TP)-静脉血: 76.3g/L；H2U:U-静脉血: 2.1；尿酸(UA)-静脉血: 236.8umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.18；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.36；白细胞计数(WBC#)-静脉血: 6.4610E9/L；血小板分布宽度(PDW)-静脉血: 8.7%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；乳酸脱氢酶(LDH)-静脉血: 195.6U/L；间接胆红素(IBIL)-静脉血: 2.4umolL；葡萄糖(Glu)-静脉血: 4.66mmol/L；总胆汁酸(TBA)-静脉血: 6.1umol/L；阴离子间隙(AG)-静脉血: 14.5；总钙(Ca)-静脉血: 2.36mmol/L；平均红细胞体积(MCV)-静脉血: 85.9fL；α-L-岩藻糖苷酶(AFU)-静脉血: 35.1U/L；甘油三酯(TG)-静脉血: 1.29mmol/L；大血小板百分比(P-LCR%)-静脉血: 14.3%；嗜碱性……\n- [全程D52] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 25mmol/L；总胆红素(TBIL)-静脉血: 7.6umol/L；磷(P)-静脉血: 1.66mmol/L；阴离子间隙(AG)-静脉血: 13.5；肌酐(Crea)-静脉血: 31.2umol/L；载脂蛋白B(apoB)-静脉血: 0.98g/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞计数(Neut#)-静脉血: 210E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 16.5U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.048；单核细胞百分比(Mono%)-静脉血: 0.082；总蛋白(TP)-静脉血: 76.7g/L；甘油三酯(TG)-静脉血: 0.86mmol/L；直接胆红素(DBIL)-静脉血: 2.21umol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；钾离子(K+)-静脉血: 4.11mmol/L；红细胞比容(Hct)-静脉血: 35.1%；葡萄糖(Glu)-静脉血: 4.64mmol/L；血红蛋白(Hb)-静脉血: 117g/L；乳酸脱氢酶(LDH)-静脉血: 217.1U/L；总胆固醇(TC)-静脉血: 5.39mmol/L；白蛋白(ALB)-静脉血: 42.7g/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；钠离子(Na+)-静脉血: 138.9mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 43.6U/L；淋巴细胞计数(Lymph#)-静脉血: 1.210E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.7pg；血小板计数(PLT#)-静脉血: 19610E9/L；白细胞计数(WBC#)-静脉血: 3.7710E9/L；平均血小板体积(MPV)-静脉血: 9.2fL；中性粒细胞百分比(Neut%)-静脉血: 0.536；H2U:U-静脉血: 1.99；间接胆红素(IBIL)-静脉血: 5.39umolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 15.7；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.6mmolL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 49.1；平均……\n- [全程D58] 检验组合: 总钙(Ca)-静脉血: 2.42mmol/L；乳酸脱氢酶(LDH)-静脉血: 177.8U/L；总蛋白(TP)-静脉血: 73.37g/L；C-反应蛋白(CRP)-静脉血: 0.68mg/L；血红蛋白(Hb)-静脉血: 111g/L；尿素氮(BUN)-静脉血: 3.6mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.38mmol/L；总胆固醇(TC)-静脉血: 5.13mmol/L；总胆汁酸(TBA)-静脉血: 5.2umol/L；直接胆红素(DBIL)-静脉血: 0.2umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.323；大血小板百分比(P-LCR%)-静脉血: 15.4%；载脂蛋白AI(apoAI)-静脉血: 1.42g/L；白蛋白(ALB)-静脉血: 42.1g/L；磷(P)-静脉血: 1.65mmol/L；淋巴细胞计数(Lymph#)-静脉血: 0.910E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.16；钠离子(Na+)-静脉血: 140.4mmol/L；血小板分布宽度(PDW)-静脉血: 9.2%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；中性粒细胞百分比(Neut%)-静脉血: 0.516；单核细胞计数(Mono#)-静脉血: 0.310E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 22.6U/L；丙氨酸氨基转移酶(ALT)-静脉血: 19.4U/L；红细胞计数(RBC#)-静脉血: 3.7910E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 15.6；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.069；血小板比容-静脉血: 16%；钾离子(K+)-静脉血: 4.5mmol/L；阴离子间隙(AG)-静脉血: 13.5；肌酐(Crea)-静脉血: 35.9umol/L；球蛋白(GLO)-静脉血: 31.27g/L；氯离子(Cl-)-静脉血: 103.5mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；间接胆红素(IBIL)-静脉血: 5umolL；白细胞计数(WBC#)-静脉血: 2.9110E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.35mmolL；α-L-岩藻糖苷酶(AFU)-静脉血: 30……\n- [全程D60] 检验组合: H2U:U-静脉血: 2.1；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.011；淋巴细胞百分比(Lymph%)-静脉血: 0.214；单核细胞计数(Mono#)-静脉血: 0.510E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 50；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 333g/L；红细胞计数(RBC#)-静脉血: 3.4910E12/L；血小板比容-静脉血: 17%；白细胞计数(WBC#)-静脉血: 3.610E9/L；血小板分布宽度(PDW)-静脉血: 9.6%；单核细胞百分比(Mono%)-静脉血: 0.136；血小板计数(PLT#)-静脉血: 18110E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；红细胞比容(Hct)-静脉血: 30.9%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 15.8；平均红细胞血红蛋白含量(MCH)-静脉血: 29.5pg；平均血小板体积(MPV)-静脉血: 9.3fL；大血小板百分比(P-LCR%)-静脉血: 18.6%；中性粒细胞计数(Neut#)-静脉血: 2.310E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；血红蛋白(Hb)-静脉血: 103g/L；平均红细胞体积(MCV)-静脉血: 88.5fL；中性粒细胞百分比(Neut%)-静脉血: 0.636\n- [全程D62] 检验组合: 血红蛋白(Hb)-静脉血: 113g/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；白细胞计数(WBC#)-静脉血: 1.910E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.032；中性粒细胞百分比(Neut%)-静脉血: 0.532；血小板计数(PLT#)-静脉血: 21510E9/L；红细胞计数(RBC#)-静脉血: 3.7810E12/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 49.3；平均红细胞血红蛋白含量(MCH)-静脉血: 29.9pg；淋巴细胞百分比(Lymph%)-静脉血: 0.284；有核红细胞计数(NRBC#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 15.4；中性粒细胞计数(Neut#)-静脉血: 110E9/L；血小板比容-静脉血: 20%；大血小板百分比(P-LCR%)-静脉血: 17.6%；单核细胞百分比(Mono%)-静脉血: 0.147；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；红细胞比容(Hct)-静脉血: 33.1%；血小板分布宽度(PDW)-静脉血: 9.4%；平均红细胞体积(MCV)-静脉血: 87.6fL；平均血小板体积(MPV)-静脉血: 9.1fL\n- [全程D65] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔稍狭窄，原鼻咽肿物现明显缩小，病变累及右侧咽隐窝，侵犯右侧咽旁脂肪间隙、右颈动脉鞘区、右侧咽后脂肪间隙及椎前间隙。右侧腭帆提肌、头长肌、颈长肌、右侧腭帆张肌及右侧翼内肌。 双侧翼腭窝、咀嚼肌间隙未见异常。口咽双侧壁未见受累增厚，双侧后鼻孔未见受累。双侧扁桃体未见明显异常。 右侧破裂孔、卵圆孔、舌下神经管内见少许软组织影，增强扫描明显强化。斜坡后缘脑膜增厚，增强扫描明显强化。双侧海绵窦未见增宽。 斜坡、蝶骨基底部、枕骨基底部、蝶骨基底部、右侧蝶骨大翼、寰椎右侧侧块、右侧枕骨髁、右侧翼突、右侧岩尖骨髓信号减低，增强扫描明显强化。 双侧筛窦、蝶窦及双侧乳突粘膜增厚。双侧乳突可见分泌物。双侧上颌窦充气良好。 双眼大小、形态、位置及信号未见异常，球后未见占位性病变。蝶鞍形态未见异常，其内未见占位性病变。 左侧咽后可见小淋巴结，短径约4mm，边界较清，增强扫描明显强化。右侧咽后可见肿大淋巴结，与鼻咽病变分界不清，增强扫描明显强化。颈右侧II、III区可见多个淋巴结，部分融合，较大范围约14mm×17mm，增强扫描明显强化。颈左侧II区、双侧Ⅲ、Ⅳ区可见多发小淋巴结，增强扫描轻度强化。 甲状腺双叶及峡部形态未见异常，信号均匀，未见占位性病变。喉咽腔形态未见异常，未见占位性病变。双侧颌下腺、腮腺大小、形态未见异常，信号均匀，未见占位性病变。 所见脑内未见明显异常。；检查结论: 鼻咽癌放疗后，与某次就诊时间MR相比： 鼻咽肿物较前明显缩小。 颅底骨质破坏，大致同前。 右侧咽后、颈右侧II、III区多个肿大淋巴结，考虑转移，较前缩小。 左侧咽后、颈左侧II区、双侧III、IV区小淋巴结，较前缩小。 双侧筛窦、蝶窦及双侧乳突炎。\n- [全程D65] 检验组合: 平均红细胞血红蛋白浓度(MCHC)-静脉血: 337g/L；大血小板百分比(P-LCR%)-静脉血: 18.8%；单核细胞计数(Mono#)-静脉血: 1.410E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；平均红细胞血红蛋白含量(MCH)-静脉血: 29.8pg；血小板计数(PLT#)-静脉血: 19110E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 16.2；红细胞比容(Hct)-静脉血: 33.8%；中性粒细胞计数(Neut#)-静脉血: 10.510E9/L；白细胞计数(WBC#)-静脉血: 13.2210E9/L；血红蛋白(Hb)-静脉血: 114g/L；红细胞计数(RBC#)-静脉血: 3.8210E12/L；血小板分布宽度(PDW)-静脉血: 10.3%；淋巴细胞百分比(Lymph%)-静脉血: 0.091；中性粒细胞百分比(Neut%)-静脉血: 0.796；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.007；红细胞体积分布宽度SD(RDW-SD)-静脉血: 49.5；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.210E9/L；平均红细胞体积(MCV)-静脉血: 88.5fL；血小板比容-静脉血: 18%；单核细胞百分比(Mono%)-静脉血: 0.104；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均血小板体积(MPV)-静脉血: 9.2fL\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D3] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日随夏医生信息已隐藏，患者颈背部酸痛较前有好转，无发热畏寒，无恶心呕吐，无胸闷心悸，胃纳睡眠尚可，二便未见明显异常，体查：KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。右颈扪及肿物，约4*3cm,无压痛，质硬，活动差，边界尚清，未扪及明显融合，活检伤口愈合良好。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。右颈部肿物活检病理回报：提示鼻咽部鳞癌转移。鼻咽部MR示：鼻咽顶后壁及两侧壁粘膜增厚，右侧翼内肌、咽鼓管、头长肌受侵，右侧斜坡，颞骨岩部，寰椎前弓骨质破坏。目前患者诊断：鼻咽癌，患者病理活检部位为右颈部肿物，提示转移性鳞癌，建议其行鼻咽部肿物病理活检，患者家属不同意，有放疗适应症，无相对放疗禁忌症，告知患者放疗风险及副反应，患者家属表示理解病情，现治疗后患者要求出院，予以办理，嘱注意休息合理饮食，定期复诊，不适随诊。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D19] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。凝血、乙肝两对半、肝炎四项、HIV/梅毒等检验结果无明显异常。[姓名已隐去]主任查房后，患者因年龄较小，完成活检等操作不配合，家属要求全麻下行活检明确病理，完善相关检查后择期手术，遵嘱执行。\n- [全程D20] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。[姓名已隐去]主任查房后示，完善术前相关检验检查，做好术前准备，遵嘱执行。\n- [全程D21] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。血常规、生化常规回报无明显异常。输血三项回报：B型、RH阳性、抗体筛选阴性。[姓名已隐去]主任查房后示，结合患者各项检查，未见明显手术禁忌，拟明日在气管内吸入全麻下经鼻内镜行鼻咽肿物活检+颈部肿物活检术，做好术前准备，遵嘱执行。\n- [全程D22] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日在气管内全麻下行左颈淋巴结切除活检+经鼻内镜鼻咽肿物切开活检术。术程顺利，术后麻醉复苏顺利，安返病房，生命体征平稳，未见口鼻活动性出血。[姓名已隐去]主任查房后，指示予抗炎、止血和支持对症治疗，并注意：1、呼吸情况；2、出血情况，遵嘱执行。\n- [全程D23] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者昨日在气管内全麻下行左颈淋巴结切除活检+经鼻内镜鼻咽肿物切开活检术，目前生命体征平稳，未见口鼻活动性出血，颈部伤口少许渗出，引流条固定在位，诉头痛、颈部肿物痛、鼻部不适。[姓名已隐去]主任查房后，指示继续抗炎、支持治疗，遵嘱执行。\n- [全程D24] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者前日在气管内全麻下行左颈淋巴结切除活检+经鼻内镜鼻咽肿物切开活检术，目前生命体征平稳，未见口鼻活动性出血，颈部伤口已无明显渗出，诉头痛、颈部肿物痛。[姓名已隐去]主任查房后，拔出引流条，指示继续抗炎、止痛、支持治疗，遵嘱执行。\n- [全程D25] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者前3日在气管内全麻下行左颈淋巴结切除活检+经鼻内镜鼻咽肿物切开活检术，目前生命体征平稳，未见口鼻活动性出血，诉头痛、颈部肿物痛。[姓名已隐去]主任查房后，指示继续抗炎、支持治疗。\n- [全程D52] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 现患者局部放疗3次，同期PF30d 化疗第19日，无特殊不适主诉。查体大致同前。复查生化常规未见异常，血常规示白细胞I度降低。[姓名已隐去]医生信息已隐藏示，患者一般状况好，继续放化疗。\n- [全程D55] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 现患者局部放疗4次，同期PF30d 化疗第22日，无特殊不适主诉。查体见颈部淋巴结较前缩小。血常规、生化未见异常。继续放化疗。\n- [全程D58] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 现患者局部放疗6次，同期PF30d 化疗第25日，无特殊不适主诉。查体见颈部淋巴结较前缩小。血常规示：白细胞计数(白细胞计数(WBC)) 2.91 10E9/L；[姓名已隐去]医生信息已隐藏示：予纠正白细胞治疗，继续放化疗。\n- [全程D64] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 现患者局部放疗10次，无特殊不适主诉。查体见颈部淋巴结较前缩小。血常规示：白细胞计数(白细胞计数(WBC)) 1.90 10E9/L；予升白细胞治疗，继续放疗。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 终止放化疗，转为手术切除鼻咽原发灶及颈部残留淋巴结。\nB. 暂停放疗，予以静脉抗感染治疗，2周后恢复放疗。\nC. 重新定位并修改放疗计划，缩减原发灶及颈部淋巴结的照射靶区，继续放疗。\nD. 提前结束放疗，改为单药靶向治疗或PD-1抑制剂维持治疗。\nE. 继续根治性放疗，停用原化疗方案，改用吉西他滨联合顺铂方案化疗。\nF. 暂停治疗，完善全身PET-CT检查评估远处转移情况，再决定后续方案。\nG. 继续根治性放疗，完善电子鼻咽镜检查，并予以肠内营养支持及定期复查血常规。\nH. 终止放化疗，转为定期随访观察，3个月后复查鼻咽及颈部MRI。\nI. 继续根治性放疗，常规加用大剂量地塞米松以减轻局部黏膜炎症反应。\nJ. 暂停放疗，行右颈部残留淋巴结穿刺活检明确病理，再制定后续治疗计划。\nK. 继续根治性放疗，并择期行右侧颈部淋巴结清扫术。\n\n请仅输出一个选项字母（A-K）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：不支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、颈动脉鞘、斜坡、翼突基底部、蝶骨基底部、岩尖等。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D2] 入院记录: 主诉: 发现右颈部肿物5月余；现病史: 患者于入院前5月前（某次就诊时间10月）高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；阳性症状体征: 体重下降,疼痛,高热,右颈部肿物,颈部酸痛；既往史: 既往有“肾病综合征”病史，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。；家族史: 否认肿瘤家族史。；体格检查: T：36℃，P：68次/分，R：20次/分，BP：91/58mmHg,Ht：144cm，Wt：31kg，BSA：1.135m2，KPS：KPS 90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。；KPS: 90；ECOG:\n- [全程D1] 门急诊记录: 主诉: 右颈部肿物6月余；现病史: 患者某次就诊时间10月份高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；既往史: 肾病综合征。否认高血压、糖尿病、冠心病、肾病等慢性病史，否认乙肝、结核等传染病史，否认重大外伤史，否认献血输血及使用血制品史，否认食物药物过敏史。；个人史: 原籍出生长大，否认疫区疫水接触史，否认化学毒性及放射性物质接触史。；家族史: 否认家族类似病史及肿瘤病史。；体格检查: KPS90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 入院记录: 主诉: 发现右颈部肿物5月余；现病史: 患者于入院前5月前（某次就诊时间10月）高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。行右颈部肿物活检病理回报：提示鼻咽部鳞癌转移。鼻咽部MR示：鼻咽顶后壁及两侧壁粘膜增厚，右侧翼内肌、咽鼓管、头长肌受侵，右侧斜坡，颞骨岩部，寰椎前弓骨质破坏。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；阳性症状体征: 体重下降,疼痛,高热,右颈部肿物,颈部酸痛；既往史: 既往有“肾病综合征”病史，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。；家族史: 否认肿瘤家族史。；体格检查: T：36℃，P：68次/分，R：20次/分，BP：91/58mmHg,Ht：144cm，Wt：31kg，BSA：1.135m2，KPS：KPS 90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率{数值}次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。右颈扪及肿物，约4*3cm,无压痛，质硬，活动差，边界尚清，未扪及明显融合，活检伤口愈合良好。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D3] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见: 心电图大致正常；检查结论: 窦性心律不齐 心电图大致正常\n- [全程D3] 检验组合: 乳酸脱氢酶(LDH)-静脉血: 198.2U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 10.4U/L；总胆红素(TBIL)-静脉血: 4.2umol/L；葡萄糖(Glu)-静脉血: 4.55mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.495COI；α-L-岩藻糖苷酶(AFU)-静脉血: 35U/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；铁蛋白(Ferr)-静脉血: 91.44ng/ml；磷(P)-静脉血: 1.76mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阴性(-)（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.21ug/ml；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阳性(129.78U/mL)（参考: 阴性）；淋巴细胞百分比(Lymph%)-静脉血: 0.426；碱性磷酸酶(ALP)-静脉血: 130.2U/L；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；纤维蛋白原(Fbg)-静脉血: 2.78g/L；钾离子(K+)-静脉血: 3.5mmol/L；免疫球蛋白游离λ轻链(F-Lambda)-静脉血: 阴性(-)（参考: 阴性(-)）；平均血小板体积(MPV)-静脉血: 8.8fL；尿酸(UA)-静脉血: 200umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.24mmolL；天门冬氨酸氨基转移酶(AST)-静脉血: 18.5U/L；尿素氮(BUN)-静脉血: 3.59mmol/L；总胆固醇(TC)-静脉血: 3.29mmol/L；直接胆红素(DBIL)-静脉血: 1.6umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 11.9U/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.98；中性粒细胞百分比(Neut%)-静脉血: 0.516；肌酐(Crea)-静脉血: 35.7umol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞体积(MCV)-静脉血……\n- [全程D4] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约24cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D21] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显占位病变，肺门纵隔未见明显增宽，心影无增大，双侧肋膈角锐利。；检查结论: 心肺未见病变。\n- [全程D21] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 23mmol/L；总胆红素(TBIL)-静脉血: 7.6umol/L；C-反应蛋白(CRP)-静脉血: 4.9mg/L；总胆固醇(TC)-静脉血: 4.18mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.5mmolL；总胆汁酸(TBA)-静脉血: 2.5umol/L；血型抗体筛查-静脉血: 阴性；ABO血型-静脉血: B；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；大血小板百分比(P-LCR%)-静脉血: 24.7%；血小板比容-静脉血: 32%；血小板分布宽度(PDW)-静脉血: 11.1%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；总蛋白(TP)-静脉血: 74.14g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.011；平均红细胞血红蛋白含量(MCH)-静脉血: 28.1pg；白蛋白(ALB)-静脉血: 38.9g/L；甘油三酯(TG)-静脉血: 0.81mmol/L；磷(P)-静脉血: 1.55mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.1；直接胆红素(DBIL)-静脉血: 2.5umol/L；平均红细胞体积(MCV)-静脉血: 84.5fL；平均血小板体积(MPV)-静脉血: 10.1fL；钠离子(Na+)-静脉血: 136.6mmol/L；氯离子(Cl-)-静脉血: 101.1mmol/L；镁离子(Mg2+)-静脉血: 0.72mmol/L；肌酐(Crea)-静脉血: 33.8umol/L；Rh血型-静脉血: 阳性；载脂蛋白AI(apoAI)-静脉血: 1.34g/L；尿素氮(BUN)-静脉血: 5.75mmol/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；淋巴细胞计数(Lymph#)-静脉血: 2.810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.591；白细胞计数(WBC#)-静脉血: 8.5610E9/L；钾离子(K+)-静脉血: 4.3mmol/L；总钙(Ca)-静脉血: 2.26mmol/L；尿酸(UA)-静脉血: 204.9umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24.5U/L；有核红细胞计数(NRBC……\n- [全程D22] 检验组合: 乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D25] 检验组合: 血小板分布宽度(PDW)-静脉血: 10.3%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；比重(SG)-尿液: 1.028；甘油三酯(TG)-静脉血: 1.05mmol/L；红细胞计数(RBC#)-静脉血: 3.4910E12/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.86mmolL；平均红细胞体积(MCV)-静脉血: 84.8fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 42.4；丙氨酸氨基转移酶(ALT)-静脉血: 14.8U/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.001；尿酸(UA)-静脉血: 132.3umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.910E9/L；大血小板百分比(P-LCR%)-静脉血: 21.8%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；粘液丝计数(MUCS#)-尿液: 28/μL；红细胞计数(RBC#)-尿液: 1/μL；浊度(TRUB)-尿液: 清亮；血小板计数(PLT#)-静脉血: 31810E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.218；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7；天门冬氨酸氨基转移酶(AST)-静脉血: 11.2U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.1；载脂蛋白AI(apoAI)-静脉血: 1.14g/L；单核细胞百分比(Mono%)-静脉血: 0.084；总钙(Ca)-静脉血: 2.2mmol/L；总胆汁酸(TBA)-静脉血: 4.4umol/L；白蛋白(ALB)-静脉血: 35.7g/L；红细胞比容(Hct)-静脉血: 29.6%；单核细胞计数(Mono#)-静脉血: 0.710E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 10.9U/L；平均血小板体积(MPV)-静脉血: 9.7fL；中性粒细胞计数(Neut#)-静脉血: 6.110E9/L；胆红素(BIL)-尿液: -（参考: 阴性）；血红蛋白(Hb)-静脉血: 100g/L；C-反应蛋白(CRP)-静脉血: 66.11mg/L；葡萄糖(Glu)-静脉血: 4.89mmol/L；磷(P)-静脉血: 1.26mmol/L；直接胆红素(DBIL……\n- [全程D45] 检验组合: 红细胞计数(RBC#)-静脉血: 4.0510E12/L；淋巴细胞百分比(Lymph%)-静脉血: 0.347；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.42mmolL；磷(P)-静脉血: 1.77mmol/L；肌酐(Crea)-静脉血: 30.1umol/L；总胆红素(TBIL)-静脉血: 3.5umol/L；白蛋白(ALB)-静脉血: 41.3g/L；钾离子(K+)-静脉血: 4.49mmol/L；总胆固醇(TC)-静脉血: 4.9mmol/L；直接胆红素(DBIL)-静脉血: 1.1umol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；碱性磷酸酶(ALP)-静脉血: 147.1U/L；镁离子(Mg2+)-静脉血: 0.84mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 16.5U/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.1mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 15；淋巴细胞计数(Lymph#)-静脉血: 2.210E9/L；球蛋白(GLO)-静脉血: 35g/L；血红蛋白(Hb)-静脉血: 115g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.4pg；总蛋白(TP)-静脉血: 76.3g/L；H2U:U-静脉血: 2.1；尿酸(UA)-静脉血: 236.8umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.18；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.36；白细胞计数(WBC#)-静脉血: 6.4610E9/L；血小板分布宽度(PDW)-静脉血: 8.7%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；乳酸脱氢酶(LDH)-静脉血: 195.6U/L；间接胆红素(IBIL)-静脉血: 2.4umolL；葡萄糖(Glu)-静脉血: 4.66mmol/L；总胆汁酸(TBA)-静脉血: 6.1umol/L；阴离子间隙(AG)-静脉血: 14.5；总钙(Ca)-静脉血: 2.36mmol/L；平均红细胞体积(MCV)-静脉血: 85.9fL；α-L-岩藻糖苷酶(AFU)-静脉血: 35.1U/L；甘油三酯(TG)-静脉血: 1.29mmol/L；大血小板百分比(P-LCR%)-静脉血: 14.3%；嗜碱性……\n- [全程D52] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 25mmol/L；总胆红素(TBIL)-静脉血: 7.6umol/L；磷(P)-静脉血: 1.66mmol/L；阴离子间隙(AG)-静脉血: 13.5；肌酐(Crea)-静脉血: 31.2umol/L；载脂蛋白B(apoB)-静脉血: 0.98g/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞计数(Neut#)-静脉血: 210E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 16.5U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.048；单核细胞百分比(Mono%)-静脉血: 0.082；总蛋白(TP)-静脉血: 76.7g/L；甘油三酯(TG)-静脉血: 0.86mmol/L；直接胆红素(DBIL)-静脉血: 2.21umol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；钾离子(K+)-静脉血: 4.11mmol/L；红细胞比容(Hct)-静脉血: 35.1%；葡萄糖(Glu)-静脉血: 4.64mmol/L；血红蛋白(Hb)-静脉血: 117g/L；乳酸脱氢酶(LDH)-静脉血: 217.1U/L；总胆固醇(TC)-静脉血: 5.39mmol/L；白蛋白(ALB)-静脉血: 42.7g/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；钠离子(Na+)-静脉血: 138.9mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 43.6U/L；淋巴细胞计数(Lymph#)-静脉血: 1.210E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.7pg；血小板计数(PLT#)-静脉血: 19610E9/L；白细胞计数(WBC#)-静脉血: 3.7710E9/L；平均血小板体积(MPV)-静脉血: 9.2fL；中性粒细胞百分比(Neut%)-静脉血: 0.536；H2U:U-静脉血: 1.99；间接胆红素(IBIL)-静脉血: 5.39umolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 15.7；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.6mmolL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 49.1；平均……\n- [全程D58] 检验组合: 总钙(Ca)-静脉血: 2.42mmol/L；乳酸脱氢酶(LDH)-静脉血: 177.8U/L；总蛋白(TP)-静脉血: 73.37g/L；C-反应蛋白(CRP)-静脉血: 0.68mg/L；血红蛋白(Hb)-静脉血: 111g/L；尿素氮(BUN)-静脉血: 3.6mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.38mmol/L；总胆固醇(TC)-静脉血: 5.13mmol/L；总胆汁酸(TBA)-静脉血: 5.2umol/L；直接胆红素(DBIL)-静脉血: 0.2umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.323；大血小板百分比(P-LCR%)-静脉血: 15.4%；载脂蛋白AI(apoAI)-静脉血: 1.42g/L；白蛋白(ALB)-静脉血: 42.1g/L；磷(P)-静脉血: 1.65mmol/L；淋巴细胞计数(Lymph#)-静脉血: 0.910E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.16；钠离子(Na+)-静脉血: 140.4mmol/L；血小板分布宽度(PDW)-静脉血: 9.2%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；中性粒细胞百分比(Neut%)-静脉血: 0.516；单核细胞计数(Mono#)-静脉血: 0.310E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 22.6U/L；丙氨酸氨基转移酶(ALT)-静脉血: 19.4U/L；红细胞计数(RBC#)-静脉血: 3.7910E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 15.6；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.069；血小板比容-静脉血: 16%；钾离子(K+)-静脉血: 4.5mmol/L；阴离子间隙(AG)-静脉血: 13.5；肌酐(Crea)-静脉血: 35.9umol/L；球蛋白(GLO)-静脉血: 31.27g/L；氯离子(Cl-)-静脉血: 103.5mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；间接胆红素(IBIL)-静脉血: 5umolL；白细胞计数(WBC#)-静脉血: 2.9110E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.35mmolL；α-L-岩藻糖苷酶(AFU)-静脉血: 30……\n- [全程D60] 检验组合: H2U:U-静脉血: 2.1；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.011；淋巴细胞百分比(Lymph%)-静脉血: 0.214；单核细胞计数(Mono#)-静脉血: 0.510E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 50；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 333g/L；红细胞计数(RBC#)-静脉血: 3.4910E12/L；血小板比容-静脉血: 17%；白细胞计数(WBC#)-静脉血: 3.610E9/L；血小板分布宽度(PDW)-静脉血: 9.6%；单核细胞百分比(Mono%)-静脉血: 0.136；血小板计数(PLT#)-静脉血: 18110E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；红细胞比容(Hct)-静脉血: 30.9%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 15.8；平均红细胞血红蛋白含量(MCH)-静脉血: 29.5pg；平均血小板体积(MPV)-静脉血: 9.3fL；大血小板百分比(P-LCR%)-静脉血: 18.6%；中性粒细胞计数(Neut#)-静脉血: 2.310E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；血红蛋白(Hb)-静脉血: 103g/L；平均红细胞体积(MCV)-静脉血: 88.5fL；中性粒细胞百分比(Neut%)-静脉血: 0.636\n- [全程D62] 检验组合: 血红蛋白(Hb)-静脉血: 113g/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；白细胞计数(WBC#)-静脉血: 1.910E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.032；中性粒细胞百分比(Neut%)-静脉血: 0.532；血小板计数(PLT#)-静脉血: 21510E9/L；红细胞计数(RBC#)-静脉血: 3.7810E12/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 49.3；平均红细胞血红蛋白含量(MCH)-静脉血: 29.9pg；淋巴细胞百分比(Lymph%)-静脉血: 0.284；有核红细胞计数(NRBC#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 15.4；中性粒细胞计数(Neut#)-静脉血: 110E9/L；血小板比容-静脉血: 20%；大血小板百分比(P-LCR%)-静脉血: 17.6%；单核细胞百分比(Mono%)-静脉血: 0.147；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；红细胞比容(Hct)-静脉血: 33.1%；血小板分布宽度(PDW)-静脉血: 9.4%；平均红细胞体积(MCV)-静脉血: 87.6fL；平均血小板体积(MPV)-静脉血: 9.1fL\n- [全程D65] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔稍狭窄，原鼻咽肿物现明显缩小，病变累及右侧咽隐窝，侵犯右侧咽旁脂肪间隙、右颈动脉鞘区、右侧咽后脂肪间隙及椎前间隙。右侧腭帆提肌、头长肌、颈长肌、右侧腭帆张肌及右侧翼内肌。 双侧翼腭窝、咀嚼肌间隙未见异常。口咽双侧壁未见受累增厚，双侧后鼻孔未见受累。双侧扁桃体未见明显异常。 右侧破裂孔、卵圆孔、舌下神经管内见少许软组织影，增强扫描明显强化。斜坡后缘脑膜增厚，增强扫描明显强化。双侧海绵窦未见增宽。 斜坡、蝶骨基底部、枕骨基底部、蝶骨基底部、右侧蝶骨大翼、寰椎右侧侧块、右侧枕骨髁、右侧翼突、右侧岩尖骨髓信号减低，增强扫描明显强化。 双侧筛窦、蝶窦及双侧乳突粘膜增厚。双侧乳突可见分泌物。双侧上颌窦充气良好。 双眼大小、形态、位置及信号未见异常，球后未见占位性病变。蝶鞍形态未见异常，其内未见占位性病变。 左侧咽后可见小淋巴结，短径约4mm，边界较清，增强扫描明显强化。右侧咽后可见肿大淋巴结，与鼻咽病变分界不清，增强扫描明显强化。颈右侧II、III区可见多个淋巴结，部分融合，较大范围约14mm×17mm，增强扫描明显强化。颈左侧II区、双侧Ⅲ、Ⅳ区可见多发小淋巴结，增强扫描轻度强化。 甲状腺双叶及峡部形态未见异常，信号均匀，未见占位性病变。喉咽腔形态未见异常，未见占位性病变。双侧颌下腺、腮腺大小、形态未见异常，信号均匀，未见占位性病变。 所见脑内未见明显异常。；检查结论: 鼻咽癌放疗后，与某次就诊时间MR相比： 鼻咽肿物较前明显缩小。 颅底骨质破坏，大致同前。 右侧咽后、颈右侧II、III区多个肿大淋巴结，考虑转移，较前缩小。 左侧咽后、颈左侧II区、双侧III、IV区小淋巴结，较前缩小。 双侧筛窦、蝶窦及双侧乳突炎。\n- [全程D65] 检验组合: 平均红细胞血红蛋白浓度(MCHC)-静脉血: 337g/L；大血小板百分比(P-LCR%)-静脉血: 18.8%；单核细胞计数(Mono#)-静脉血: 1.410E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；平均红细胞血红蛋白含量(MCH)-静脉血: 29.8pg；血小板计数(PLT#)-静脉血: 19110E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 16.2；红细胞比容(Hct)-静脉血: 33.8%；中性粒细胞计数(Neut#)-静脉血: 10.510E9/L；白细胞计数(WBC#)-静脉血: 13.2210E9/L；血红蛋白(Hb)-静脉血: 114g/L；红细胞计数(RBC#)-静脉血: 3.8210E12/L；血小板分布宽度(PDW)-静脉血: 10.3%；淋巴细胞百分比(Lymph%)-静脉血: 0.091；中性粒细胞百分比(Neut%)-静脉血: 0.796；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.007；红细胞体积分布宽度SD(RDW-SD)-静脉血: 49.5；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.210E9/L；平均红细胞体积(MCV)-静脉血: 88.5fL；血小板比容-静脉血: 18%；单核细胞百分比(Mono%)-静脉血: 0.104；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均血小板体积(MPV)-静脉血: 9.2fL\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D3] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日随夏医生信息已隐藏，患者颈背部酸痛较前有好转，无发热畏寒，无恶心呕吐，无胸闷心悸，胃纳睡眠尚可，二便未见明显异常，体查：KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。右颈扪及肿物，约4*3cm,无压痛，质硬，活动差，边界尚清，未扪及明显融合，活检伤口愈合良好。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。右颈部肿物活检病理回报：提示鼻咽部鳞癌转移。鼻咽部MR示：鼻咽顶后壁及两侧壁粘膜增厚，右侧翼内肌、咽鼓管、头长肌受侵，右侧斜坡，颞骨岩部，寰椎前弓骨质破坏。目前患者诊断：鼻咽癌，患者病理活检部位为右颈部肿物，提示转移性鳞癌，建议其行鼻咽部肿物病理活检，患者家属不同意，有放疗适应症，无相对放疗禁忌症，告知患者放疗风险及副反应，患者家属表示理解病情，现治疗后患者要求出院，予以办理，嘱注意休息合理饮食，定期复诊，不适随诊。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D19] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。凝血、乙肝两对半、肝炎四项、HIV/梅毒等检验结果无明显异常。[姓名已隐去]主任查房后，患者因年龄较小，完成活检等操作不配合，家属要求全麻下行活检明确病理，完善相关检查后择期手术，遵嘱执行。\n- [全程D20] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。[姓名已隐去]主任查房后示，完善术前相关检验检查，做好术前准备，遵嘱执行。\n- [全程D21] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。血常规、生化常规回报无明显异常。输血三项回报：B型、RH阳性、抗体筛选阴性。[姓名已隐去]主任查房后示，结合患者各项检查，未见明显手术禁忌，拟明日在气管内吸入全麻下经鼻内镜行鼻咽肿物活检+颈部肿物活检术，做好术前准备，遵嘱执行。\n- [全程D22] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日在气管内全麻下行左颈淋巴结切除活检+经鼻内镜鼻咽肿物切开活检术。术程顺利，术后麻醉复苏顺利，安返病房，生命体征平稳，未见口鼻活动性出血。[姓名已隐去]主任查房后，指示予抗炎、止血和支持对症治疗，并注意：1、呼吸情况；2、出血情况，遵嘱执行。\n- [全程D23] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者昨日在气管内全麻下行左颈淋巴结切除活检+经鼻内镜鼻咽肿物切开活检术，目前生命体征平稳，未见口鼻活动性出血，颈部伤口少许渗出，引流条固定在位，诉头痛、颈部肿物痛、鼻部不适。[姓名已隐去]主任查房后，指示继续抗炎、支持治疗，遵嘱执行。\n- [全程D24] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者前日在气管内全麻下行左颈淋巴结切除活检+经鼻内镜鼻咽肿物切开活检术，目前生命体征平稳，未见口鼻活动性出血，颈部伤口已无明显渗出，诉头痛、颈部肿物痛。[姓名已隐去]主任查房后，拔出引流条，指示继续抗炎、止痛、支持治疗，遵嘱执行。\n- [全程D25] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者前3日在气管内全麻下行左颈淋巴结切除活检+经鼻内镜鼻咽肿物切开活检术，目前生命体征平稳，未见口鼻活动性出血，诉头痛、颈部肿物痛。[姓名已隐去]主任查房后，指示继续抗炎、支持治疗。\n- [全程D52] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 现患者局部放疗3次，同期PF30d 化疗第19日，无特殊不适主诉。查体大致同前。复查生化常规未见异常，血常规示白细胞I度降低。[姓名已隐去]医生信息已隐藏示，患者一般状况好，继续放化疗。\n- [全程D55] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 现患者局部放疗4次，同期PF30d 化疗第22日，无特殊不适主诉。查体见颈部淋巴结较前缩小。血常规、生化未见异常。继续放化疗。\n- [全程D58] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 现患者局部放疗6次，同期PF30d 化疗第25日，无特殊不适主诉。查体见颈部淋巴结较前缩小。血常规示：白细胞计数(白细胞计数(WBC)) 2.91 10E9/L；[姓名已隐去]医生信息已隐藏示：予纠正白细胞治疗，继续放化疗。\n- [全程D64] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 现患者局部放疗10次，无特殊不适主诉。查体见颈部淋巴结较前缩小。血常规示：白细胞计数(白细胞计数(WBC)) 1.90 10E9/L；予升白细胞治疗，继续放疗。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 终止放化疗，转为手术切除鼻咽原发灶及颈部残留淋巴结。\nB. 暂停放疗，予以静脉抗感染治疗，2周后恢复放疗。\nC. 重新定位并修改放疗计划，缩减原发灶及颈部淋巴结的照射靶区，继续放疗。\nD. 提前结束放疗，改为单药靶向治疗或PD-1抑制剂维持治疗。\nE. 继续根治性放疗，停用原化疗方案，改用吉西他滨联合顺铂方案化疗。\nF. 暂停治疗，完善全身PET-CT检查评估远处转移情况，再决定后续方案。\nG. 继续根治性放疗，完善电子鼻咽镜检查，并予以肠内营养支持及定期复查血常规。\nH. 终止放化疗，转为定期随访观察，3个月后复查鼻咽及颈部MRI。\nI. 继续根治性放疗，常规加用大剂量地塞米松以减轻局部黏膜炎症反应。\nJ. 暂停放疗，行右颈部残留淋巴结穿刺活检明确病理，再制定后续治疗计划。\nK. 继续根治性放疗，并择期行右侧颈部淋巴结清扫术。\n\n请仅输出一个选项字母（A-K）。"}]}
+{"sample_id":"sample-6d0ec36f585feac9ee8c0aa5","patient_id":"patient-a48d1d72efa6c4217cf5b79c","turn_id":"turn01","turn_position":1,"turn_type":"initial_workup_choice","gold_letter":"H","gold_action":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT检查","options":[{"letter":"A","text":"鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸腹部CT平扫","is_gold":false},{"letter":"B","text":"颈部淋巴结切除活检，鼻咽及颈部MRI平扫+增强，全身PET/CT检查","is_gold":false},{"letter":"C","text":"鼻咽镜检查及活检，鼻咽部MRI平扫+增强，胸部X线，腹部B超","is_gold":false},{"letter":"D","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，暂不进行全身分期检查","is_gold":false},{"letter":"E","text":"颈部淋巴结细针穿刺活检，鼻咽及颈部CT平扫+增强，全身骨扫描","is_gold":false},{"letter":"F","text":"鼻咽镜检查及活检，鼻咽部MRI平扫+增强，全身PET/CT检查","is_gold":false},{"letter":"G","text":"鼻咽及颈部MRI平扫+增强，全身PET/CT检查，直接安排根治性放疗","is_gold":false},{"letter":"H","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT检查","is_gold":true},{"letter":"I","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫，胸腹部CT平扫+增强，全身骨扫描","is_gold":false},{"letter":"J","text":"鼻咽脱落细胞学涂片，鼻咽及颈部MRI平扫+增强，全身PET/CT检查","is_gold":false},{"letter":"K","text":"鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，全身PET/CT检查","is_gold":false},{"letter":"L","text":"鼻咽及颈部MRI平扫+增强，EBV-DNA检测，胸腹部CT平扫+增强","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、筛窦、斜坡、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现颈部肿物伴涕血、鼻塞2月；患者未予相关诊治，转至我院就诊。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,涕血,颈部肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。偶伴吸烟、饮酒15年，3两/天，。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：90次/分，R：20次/分，BP：120/70mmHg,Ht：172cm，Wt：73kg，BSA：1.85m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.0cm；鼻咽双侧顶后壁结节状肿物；双侧颈部IIa区可扪及1个淋巴结，最大径2×2cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸腹部CT平扫\nB. 颈部淋巴结切除活检，鼻咽及颈部MRI平扫+增强，全身PET/CT检查\nC. 鼻咽镜检查及活检，鼻咽部MRI平扫+增强，胸部X线，腹部B超\nD. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，暂不进行全身分期检查\nE. 颈部淋巴结细针穿刺活检，鼻咽及颈部CT平扫+增强，全身骨扫描\nF. 鼻咽镜检查及活检，鼻咽部MRI平扫+增强，全身PET/CT检查\nG. 鼻咽及颈部MRI平扫+增强，全身PET/CT检查，直接安排根治性放疗\nH. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT检查\nI. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫，胸腹部CT平扫+增强，全身骨扫描\nJ. 鼻咽脱落细胞学涂片，鼻咽及颈部MRI平扫+增强，全身PET/CT检查\nK. 鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，全身PET/CT检查\nL. 鼻咽及颈部MRI平扫+增强，EBV-DNA检测，胸腹部CT平扫+增强\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、筛窦、斜坡、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现颈部肿物伴涕血、鼻塞2月；患者未予相关诊治，转至我院就诊。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,涕血,颈部肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。偶伴吸烟、饮酒15年，3两/天，。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：90次/分，R：20次/分，BP：120/70mmHg,Ht：172cm，Wt：73kg，BSA：1.85m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.0cm；鼻咽双侧顶后壁结节状肿物；双侧颈部IIa区可扪及1个淋巴结，最大径2×2cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸腹部CT平扫\nB. 颈部淋巴结切除活检，鼻咽及颈部MRI平扫+增强，全身PET/CT检查\nC. 鼻咽镜检查及活检，鼻咽部MRI平扫+增强，胸部X线，腹部B超\nD. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，暂不进行全身分期检查\nE. 颈部淋巴结细针穿刺活检，鼻咽及颈部CT平扫+增强，全身骨扫描\nF. 鼻咽镜检查及活检，鼻咽部MRI平扫+增强，全身PET/CT检查\nG. 鼻咽及颈部MRI平扫+增强，全身PET/CT检查，直接安排根治性放疗\nH. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT检查\nI. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫，胸腹部CT平扫+增强，全身骨扫描\nJ. 鼻咽脱落细胞学涂片，鼻咽及颈部MRI平扫+增强，全身PET/CT检查\nK. 鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，全身PET/CT检查\nL. 鼻咽及颈部MRI平扫+增强，EBV-DNA检测，胸腹部CT平扫+增强\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-11ca3bd9dd2a5877fa6a6b49","patient_id":"patient-a48d1d72efa6c4217cf5b79c","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"I","gold_action":"影像评估为 cT3N2，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期","options":[{"letter":"A","text":"影像评估为 cT4N2，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期","is_gold":false},{"letter":"B","text":"影像评估为 cT3N1，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期","is_gold":false},{"letter":"C","text":"影像评估为 cT3N2，需完善鼻咽镜及活检明确病理，无需常规进行胸腹部及骨骼的远处转移筛查","is_gold":false},{"letter":"D","text":"影像评估为 cT4N3，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期","is_gold":false},{"letter":"E","text":"影像评估为 cT2N2，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期","is_gold":false},{"letter":"F","text":"影像评估为 cT3N2，需完善颈部淋巴结穿刺活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期","is_gold":false},{"letter":"G","text":"影像评估为 cT3N2，已具备影像学确诊条件，直接安排诱导化疗及后续根治性放疗","is_gold":false},{"letter":"H","text":"影像评估为 cT4N2，需完善颈部淋巴结穿刺活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期","is_gold":false},{"letter":"I","text":"影像评估为 cT3N2，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期","is_gold":true},{"letter":"J","text":"影像评估为 cT3N3，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期","is_gold":false},{"letter":"K","text":"影像评估为 cT2N1，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期","is_gold":false},{"letter":"L","text":"影像评估为 cT3N2，需完善鼻咽镜及活检明确病理，并完善头颅MRI及脑脊液检查以排除中枢神经系统转移","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、筛窦、斜坡、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现颈部肿物伴涕血、鼻塞2月；患者未予相关诊治，转至我院就诊。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,涕血,颈部肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。偶伴吸烟、饮酒15年，3两/天，。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：90次/分，R：20次/分，BP：120/70mmHg,Ht：172cm，Wt：73kg，BSA：1.85m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.0cm；鼻咽双侧顶后壁结节状肿物；双侧颈部IIa区可扪及1个淋巴结，最大径2×2cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 甘油三酯(TG)-静脉血: 1.1mmol/L；透明质酸(HA)-静脉血: 34.26ng/ml；中性粒细胞计数(Neut#)-静脉血: 3.710E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；层粘连蛋白(LN)-静脉血: 11.97ng/ml；凝血酶原时间活动度(PTA)-静脉血: 125.5%；总胆固醇(TC)-静脉血: 4.12mmol/L；凝血酶原时间(PT)-静脉血: 10.8sec.；碱性磷酸酶(ALP)-静脉血: 83.4U/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；ABO血型-静脉血: O；镁离子(Mg2+)-静脉血: 0.88mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.005；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 65.2umol/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；尿素氮(BUN)-静脉血: 5.1mmol/L；总蛋白(TP)-静脉血: 75.4g/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 22.8U/L；钾离子(K+)-静脉血: 3.71mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 17.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 18.1U/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；乳酸脱氢酶(LDH)-静脉血: 142.3U/L；III型前胶原氨基端肽(PIIINP)-静脉血: 17.25ng/ml；尿酸(UA)-静脉血: 293.9umol/L；血小板计数(PLT#)-静脉血: 18910E9/L；Rh血型-静脉血: 阳性；总胆汁酸(TBA)-静脉血: 2.8umol/L；IV型胶原(C-IV)-静脉血: 21.48ng/ml；天门冬氨酸氨基转移酶(AST)-静脉血: 15.4U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；氯离子(Cl-)-静脉血: 103.6mmol/L；磷(P)-静脉血: 0.78m……\n- [全程D2] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D8] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、右侧壁见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。肿物占据双侧咽隐窝，向后外推移右侧咽旁脂肪间隙，前方浸润右侧筛窦及上鼻道，左侧咽旁脂肪间隙及左侧颈动脉鞘区未见异常。 右侧腭帆提肌、腭帆张肌受侵；左侧腭帆提肌、腭帆张肌、头长肌未见受累征象。 右侧翼腭窝及右侧上颌后脂肪间隙稍变窄；左侧翼腭窝、左上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽未见明显异常。 斜坡、蝶骨基底部、右侧翼突基底部及右侧蝶骨大翼信号降低，增强后强化。 双侧海绵窦未见明显异常。 双侧上颌窦、筛窦、右侧蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，无强化，骨壁完整。双眼大小、形态、位置均属正常、信号均匀。蝶鞍形态正常，其内未见占位性病变。 右侧咽后间隙见淋巴结，较大者约11mm×10mm；左侧咽后间隙未见肿大淋巴结。双颈Ⅱ区、右颈Ⅲ区见多个淋巴结，部分融合，边界清，不均匀明显强化，较大者约大小约24mm×13mm。 所见甲状腺双叶形态正常、喉咽腔、双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 符合鼻咽癌。 颅底骨质破坏。 左侧咽后、双颈Ⅱ区及右颈Ⅲ区肿大淋巴结，考虑转移。 副鼻窦炎、乳突炎。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 影像评估为 cT4N2，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nB. 影像评估为 cT3N1，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nC. 影像评估为 cT3N2，需完善鼻咽镜及活检明确病理，无需常规进行胸腹部及骨骼的远处转移筛查\nD. 影像评估为 cT4N3，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nE. 影像评估为 cT2N2，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nF. 影像评估为 cT3N2，需完善颈部淋巴结穿刺活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nG. 影像评估为 cT3N2，已具备影像学确诊条件，直接安排诱导化疗及后续根治性放疗\nH. 影像评估为 cT4N2，需完善颈部淋巴结穿刺活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nI. 影像评估为 cT3N2，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nJ. 影像评估为 cT3N3，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nK. 影像评估为 cT2N1，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nL. 影像评估为 cT3N2，需完善鼻咽镜及活检明确病理，并完善头颅MRI及脑脊液检查以排除中枢神经系统转移\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、筛窦、斜坡、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现颈部肿物伴涕血、鼻塞2月；患者未予相关诊治，转至我院就诊。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,涕血,颈部肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。偶伴吸烟、饮酒15年，3两/天，。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：90次/分，R：20次/分，BP：120/70mmHg,Ht：172cm，Wt：73kg，BSA：1.85m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.0cm；鼻咽双侧顶后壁结节状肿物；双侧颈部IIa区可扪及1个淋巴结，最大径2×2cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 甘油三酯(TG)-静脉血: 1.1mmol/L；透明质酸(HA)-静脉血: 34.26ng/ml；中性粒细胞计数(Neut#)-静脉血: 3.710E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；层粘连蛋白(LN)-静脉血: 11.97ng/ml；凝血酶原时间活动度(PTA)-静脉血: 125.5%；总胆固醇(TC)-静脉血: 4.12mmol/L；凝血酶原时间(PT)-静脉血: 10.8sec.；碱性磷酸酶(ALP)-静脉血: 83.4U/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；ABO血型-静脉血: O；镁离子(Mg2+)-静脉血: 0.88mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.005；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 65.2umol/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；尿素氮(BUN)-静脉血: 5.1mmol/L；总蛋白(TP)-静脉血: 75.4g/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 22.8U/L；钾离子(K+)-静脉血: 3.71mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 17.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 18.1U/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；乳酸脱氢酶(LDH)-静脉血: 142.3U/L；III型前胶原氨基端肽(PIIINP)-静脉血: 17.25ng/ml；尿酸(UA)-静脉血: 293.9umol/L；血小板计数(PLT#)-静脉血: 18910E9/L；Rh血型-静脉血: 阳性；总胆汁酸(TBA)-静脉血: 2.8umol/L；IV型胶原(C-IV)-静脉血: 21.48ng/ml；天门冬氨酸氨基转移酶(AST)-静脉血: 15.4U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；氯离子(Cl-)-静脉血: 103.6mmol/L；磷(P)-静脉血: 0.78m……\n- [全程D2] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D8] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、右侧壁见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。肿物占据双侧咽隐窝，向后外推移右侧咽旁脂肪间隙，前方浸润右侧筛窦及上鼻道，左侧咽旁脂肪间隙及左侧颈动脉鞘区未见异常。 右侧腭帆提肌、腭帆张肌受侵；左侧腭帆提肌、腭帆张肌、头长肌未见受累征象。 右侧翼腭窝及右侧上颌后脂肪间隙稍变窄；左侧翼腭窝、左上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽未见明显异常。 斜坡、蝶骨基底部、右侧翼突基底部及右侧蝶骨大翼信号降低，增强后强化。 双侧海绵窦未见明显异常。 双侧上颌窦、筛窦、右侧蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，无强化，骨壁完整。双眼大小、形态、位置均属正常、信号均匀。蝶鞍形态正常，其内未见占位性病变。 右侧咽后间隙见淋巴结，较大者约11mm×10mm；左侧咽后间隙未见肿大淋巴结。双颈Ⅱ区、右颈Ⅲ区见多个淋巴结，部分融合，边界清，不均匀明显强化，较大者约大小约24mm×13mm。 所见甲状腺双叶形态正常、喉咽腔、双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 符合鼻咽癌。 颅底骨质破坏。 左侧咽后、双颈Ⅱ区及右颈Ⅲ区肿大淋巴结，考虑转移。 副鼻窦炎、乳突炎。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 影像评估为 cT4N2，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nB. 影像评估为 cT3N1，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nC. 影像评估为 cT3N2，需完善鼻咽镜及活检明确病理，无需常规进行胸腹部及骨骼的远处转移筛查\nD. 影像评估为 cT4N3，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nE. 影像评估为 cT2N2，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nF. 影像评估为 cT3N2，需完善颈部淋巴结穿刺活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nG. 影像评估为 cT3N2，已具备影像学确诊条件，直接安排诱导化疗及后续根治性放疗\nH. 影像评估为 cT4N2，需完善颈部淋巴结穿刺活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nI. 影像评估为 cT3N2，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nJ. 影像评估为 cT3N3，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nK. 影像评估为 cT2N1，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nL. 影像评估为 cT3N2，需完善鼻咽镜及活检明确病理，并完善头颅MRI及脑脊液检查以排除中枢神经系统转移\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-b061f796c98789c2958f0baf","patient_id":"patient-a48d1d72efa6c4217cf5b79c","turn_id":"turn04","turn_position":3,"turn_type":"initial_treatment_selection","gold_letter":"K","gold_action":"启动首周期诱导化疗（辅以水化、止吐预处理），计划序贯根治性同步放化疗","options":[{"letter":"A","text":"启动首周期同步放化疗（辅以水化、止吐预处理），不考虑诱导化疗","is_gold":false},{"letter":"B","text":"启动首周期诱导化疗，计划序贯根治性单纯放疗","is_gold":false},{"letter":"C","text":"启动首周期诱导化疗联合PD-1抑制剂，计划序贯根治性同步放化疗","is_gold":false},{"letter":"D","text":"启动首周期诱导化疗，计划序贯手术切除原发灶及颈部淋巴结","is_gold":false},{"letter":"E","text":"启动根治性单纯放疗，计划放疗结束后行多周期辅助化疗","is_gold":false},{"letter":"F","text":"启动根治性放疗联合EGFR靶向治疗，免除全身静脉化疗","is_gold":false},{"letter":"G","text":"优先行双侧颈部淋巴结清扫术，术后行根治性同步放化疗","is_gold":false},{"letter":"H","text":"优先行鼻咽原发灶内镜下切除术，术后行根治性同步放化疗","is_gold":false},{"letter":"I","text":"启动首周期姑息性化疗，计划化疗后行局部姑息性放疗","is_gold":false},{"letter":"J","text":"启动首周期诱导化疗，若疗效达完全缓解（CR）则免除后续放疗","is_gold":false},{"letter":"K","text":"启动首周期诱导化疗（辅以水化、止吐预处理），计划序贯根治性同步放化疗","is_gold":true},{"letter":"L","text":"启动首周期同步放化疗，计划放疗结束后行多周期辅助化疗","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、筛窦、斜坡、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现颈部肿物伴涕血、鼻塞2月；患者未予相关诊治，转至我院就诊。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,涕血,颈部肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。偶伴吸烟、饮酒15年，3两/天，。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：90次/分，R：20次/分，BP：120/70mmHg,Ht：172cm，Wt：73kg，BSA：1.85m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.0cm；鼻咽双侧顶后壁结节状肿物；双侧颈部IIa区可扪及1个淋巴结，最大径2×2cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 发现颈部肿物伴涕血、鼻塞2月；现病史: 患者2月前无明显诱因出现颈部肿物，拇指大小，偶伴涕血、鼻塞，右侧明显，无面麻、复视等其他不适，未予重视，逐渐加重，患者遂于某次就诊时间行颈部彩超示：右侧颈部低回声，行鼻咽镜示：鼻咽肿物，建议活检。患者未予相关诊治，转至我院就诊。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,涕血,颈部肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。偶伴吸烟、饮酒15年，3两/天，。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：90次/分，R：20次/分，BP：120/70mmHg,Ht：172cm，Wt：73kg，BSA：1.85m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率90次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.0cm；鼻咽双侧顶后壁结节状肿物；双侧颈部IIa区可扪及1个淋巴结，最大径2×2cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 甘油三酯(TG)-静脉血: 1.1mmol/L；透明质酸(HA)-静脉血: 34.26ng/ml；中性粒细胞计数(Neut#)-静脉血: 3.710E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；层粘连蛋白(LN)-静脉血: 11.97ng/ml；凝血酶原时间活动度(PTA)-静脉血: 125.5%；总胆固醇(TC)-静脉血: 4.12mmol/L；凝血酶原时间(PT)-静脉血: 10.8sec.；碱性磷酸酶(ALP)-静脉血: 83.4U/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；ABO血型-静脉血: O；镁离子(Mg2+)-静脉血: 0.88mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.005；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 65.2umol/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；尿素氮(BUN)-静脉血: 5.1mmol/L；总蛋白(TP)-静脉血: 75.4g/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 22.8U/L；钾离子(K+)-静脉血: 3.71mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 17.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 18.1U/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；乳酸脱氢酶(LDH)-静脉血: 142.3U/L；III型前胶原氨基端肽(PIIINP)-静脉血: 17.25ng/ml；尿酸(UA)-静脉血: 293.9umol/L；血小板计数(PLT#)-静脉血: 18910E9/L；Rh血型-静脉血: 阳性；总胆汁酸(TBA)-静脉血: 2.8umol/L；IV型胶原(C-IV)-静脉血: 21.48ng/ml；天门冬氨酸氨基转移酶(AST)-静脉血: 15.4U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；氯离子(Cl-)-静脉血: 103.6mmol/L；磷(P)-静脉血: 0.78m……\n- [全程D2] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D8] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、右侧壁见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。肿物占据双侧咽隐窝，向后外推移右侧咽旁脂肪间隙，前方浸润右侧筛窦及上鼻道，左侧咽旁脂肪间隙及左侧颈动脉鞘区未见异常。 右侧腭帆提肌、腭帆张肌受侵；左侧腭帆提肌、腭帆张肌、头长肌未见受累征象。 右侧翼腭窝及右侧上颌后脂肪间隙稍变窄；左侧翼腭窝、左上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽未见明显异常。 斜坡、蝶骨基底部、右侧翼突基底部及右侧蝶骨大翼信号降低，增强后强化。 双侧海绵窦未见明显异常。 双侧上颌窦、筛窦、右侧蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，无强化，骨壁完整。双眼大小、形态、位置均属正常、信号均匀。蝶鞍形态正常，其内未见占位性病变。 右侧咽后间隙见淋巴结，较大者约11mm×10mm；左侧咽后间隙未见肿大淋巴结。双颈Ⅱ区、右颈Ⅲ区见多个淋巴结，部分融合，边界清，不均匀明显强化，较大者约大小约24mm×13mm。 所见甲状腺双叶形态正常、喉咽腔、双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 符合鼻咽癌。 颅底骨质破坏。 左侧咽后、双颈Ⅱ区及右颈Ⅲ区肿大淋巴结，考虑转移。 副鼻窦炎、乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 启动首周期同步放化疗（辅以水化、止吐预处理），不考虑诱导化疗\nB. 启动首周期诱导化疗，计划序贯根治性单纯放疗\nC. 启动首周期诱导化疗联合PD-1抑制剂，计划序贯根治性同步放化疗\nD. 启动首周期诱导化疗，计划序贯手术切除原发灶及颈部淋巴结\nE. 启动根治性单纯放疗，计划放疗结束后行多周期辅助化疗\nF. 启动根治性放疗联合EGFR靶向治疗，免除全身静脉化疗\nG. 优先行双侧颈部淋巴结清扫术，术后行根治性同步放化疗\nH. 优先行鼻咽原发灶内镜下切除术，术后行根治性同步放化疗\nI. 启动首周期姑息性化疗，计划化疗后行局部姑息性放疗\nJ. 启动首周期诱导化疗，若疗效达完全缓解（CR）则免除后续放疗\nK. 启动首周期诱导化疗（辅以水化、止吐预处理），计划序贯根治性同步放化疗\nL. 启动首周期同步放化疗，计划放疗结束后行多周期辅助化疗\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、筛窦、斜坡、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现颈部肿物伴涕血、鼻塞2月；患者未予相关诊治，转至我院就诊。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,涕血,颈部肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。偶伴吸烟、饮酒15年，3两/天，。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：90次/分，R：20次/分，BP：120/70mmHg,Ht：172cm，Wt：73kg，BSA：1.85m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.0cm；鼻咽双侧顶后壁结节状肿物；双侧颈部IIa区可扪及1个淋巴结，最大径2×2cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 发现颈部肿物伴涕血、鼻塞2月；现病史: 患者2月前无明显诱因出现颈部肿物，拇指大小，偶伴涕血、鼻塞，右侧明显，无面麻、复视等其他不适，未予重视，逐渐加重，患者遂于某次就诊时间行颈部彩超示：右侧颈部低回声，行鼻咽镜示：鼻咽肿物，建议活检。患者未予相关诊治，转至我院就诊。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,涕血,颈部肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。偶伴吸烟、饮酒15年，3两/天，。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：90次/分，R：20次/分，BP：120/70mmHg,Ht：172cm，Wt：73kg，BSA：1.85m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率90次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.0cm；鼻咽双侧顶后壁结节状肿物；双侧颈部IIa区可扪及1个淋巴结，最大径2×2cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 甘油三酯(TG)-静脉血: 1.1mmol/L；透明质酸(HA)-静脉血: 34.26ng/ml；中性粒细胞计数(Neut#)-静脉血: 3.710E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；层粘连蛋白(LN)-静脉血: 11.97ng/ml；凝血酶原时间活动度(PTA)-静脉血: 125.5%；总胆固醇(TC)-静脉血: 4.12mmol/L；凝血酶原时间(PT)-静脉血: 10.8sec.；碱性磷酸酶(ALP)-静脉血: 83.4U/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；ABO血型-静脉血: O；镁离子(Mg2+)-静脉血: 0.88mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.005；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 65.2umol/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；尿素氮(BUN)-静脉血: 5.1mmol/L；总蛋白(TP)-静脉血: 75.4g/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 22.8U/L；钾离子(K+)-静脉血: 3.71mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 17.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 18.1U/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；乳酸脱氢酶(LDH)-静脉血: 142.3U/L；III型前胶原氨基端肽(PIIINP)-静脉血: 17.25ng/ml；尿酸(UA)-静脉血: 293.9umol/L；血小板计数(PLT#)-静脉血: 18910E9/L；Rh血型-静脉血: 阳性；总胆汁酸(TBA)-静脉血: 2.8umol/L；IV型胶原(C-IV)-静脉血: 21.48ng/ml；天门冬氨酸氨基转移酶(AST)-静脉血: 15.4U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；氯离子(Cl-)-静脉血: 103.6mmol/L；磷(P)-静脉血: 0.78m……\n- [全程D2] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D8] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、右侧壁见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。肿物占据双侧咽隐窝，向后外推移右侧咽旁脂肪间隙，前方浸润右侧筛窦及上鼻道，左侧咽旁脂肪间隙及左侧颈动脉鞘区未见异常。 右侧腭帆提肌、腭帆张肌受侵；左侧腭帆提肌、腭帆张肌、头长肌未见受累征象。 右侧翼腭窝及右侧上颌后脂肪间隙稍变窄；左侧翼腭窝、左上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽未见明显异常。 斜坡、蝶骨基底部、右侧翼突基底部及右侧蝶骨大翼信号降低，增强后强化。 双侧海绵窦未见明显异常。 双侧上颌窦、筛窦、右侧蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，无强化，骨壁完整。双眼大小、形态、位置均属正常、信号均匀。蝶鞍形态正常，其内未见占位性病变。 右侧咽后间隙见淋巴结，较大者约11mm×10mm；左侧咽后间隙未见肿大淋巴结。双颈Ⅱ区、右颈Ⅲ区见多个淋巴结，部分融合，边界清，不均匀明显强化，较大者约大小约24mm×13mm。 所见甲状腺双叶形态正常、喉咽腔、双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 符合鼻咽癌。 颅底骨质破坏。 左侧咽后、双颈Ⅱ区及右颈Ⅲ区肿大淋巴结，考虑转移。 副鼻窦炎、乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 启动首周期同步放化疗（辅以水化、止吐预处理），不考虑诱导化疗\nB. 启动首周期诱导化疗，计划序贯根治性单纯放疗\nC. 启动首周期诱导化疗联合PD-1抑制剂，计划序贯根治性同步放化疗\nD. 启动首周期诱导化疗，计划序贯手术切除原发灶及颈部淋巴结\nE. 启动根治性单纯放疗，计划放疗结束后行多周期辅助化疗\nF. 启动根治性放疗联合EGFR靶向治疗，免除全身静脉化疗\nG. 优先行双侧颈部淋巴结清扫术，术后行根治性同步放化疗\nH. 优先行鼻咽原发灶内镜下切除术，术后行根治性同步放化疗\nI. 启动首周期姑息性化疗，计划化疗后行局部姑息性放疗\nJ. 启动首周期诱导化疗，若疗效达完全缓解（CR）则免除后续放疗\nK. 启动首周期诱导化疗（辅以水化、止吐预处理），计划序贯根治性同步放化疗\nL. 启动首周期同步放化疗，计划放疗结束后行多周期辅助化疗\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-b024e6abb04a58aab366631a","patient_id":"patient-a48d1d72efa6c4217cf5b79c","turn_id":"turn07","turn_position":4,"turn_type":"response_assessment_decision","gold_letter":"B","gold_action":"继续完成既定根治性放疗计划；加用重组人表皮生长因子、GM-CSF含漱液局部治疗，并予以静脉营养支持及抗感染治疗。","options":[{"letter":"A","text":"提前终止放疗；给予重组人表皮生长因子、GM-CSF含漱液局部促修复及静脉营养支持治疗。","is_gold":false},{"letter":"B","text":"继续完成既定根治性放疗计划；加用重组人表皮生长因子、GM-CSF含漱液局部治疗，并予以静脉营养支持及抗感染治疗。","is_gold":true},{"letter":"C","text":"暂停放疗及靶向治疗直至黏膜炎好转；给予重组人表皮生长因子、GM-CSF含漱液局部治疗及静脉营养支持。","is_gold":false},{"letter":"D","text":"继续完成既定根治性放疗计划；仅给予氯化钠含漱液及常规饮食指导，避免使用生长因子类药物及静脉营养。","is_gold":false},{"letter":"E","text":"继续完成既定根治性放疗计划；加用氟康唑等广谱抗真菌药物静脉滴注，并予以静脉营养支持治疗。","is_gold":false},{"letter":"F","text":"继续完成既定根治性放疗计划并立即安排鼻咽部局部加量放疗；给予重组人表皮生长因子含漱液及静脉营养支持。","is_gold":false},{"letter":"G","text":"继续完成既定根治性放疗计划；行预防性经皮内镜下胃造瘘术（PEG）替代静脉营养支持。","is_gold":false},{"letter":"H","text":"暂停放疗计划；复查鼻咽及颈部MRI以明确肿瘤退缩情况，再决定后续放疗靶区及剂量。","is_gold":false},{"letter":"I","text":"继续完成既定根治性放疗计划；给予大剂量静脉糖皮质激素冲击治疗，暂缓静脉营养支持。","is_gold":false},{"letter":"J","text":"继续完成既定根治性放疗计划；立即给予聚乙二醇化重组人粒细胞刺激因子皮下注射及静脉营养支持。","is_gold":false},{"letter":"K","text":"提前结束放疗，转为维持性靶向治疗及免疫治疗；给予重组人表皮生长因子及静脉营养支持。","is_gold":false},{"letter":"L","text":"继续完成既定根治性放疗计划；行预防性气管切开术，并予以静脉营养支持及抗感染治疗。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、筛窦、斜坡、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现颈部肿物伴涕血、鼻塞2月；患者未予相关诊治，转至我院就诊。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,涕血,颈部肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。偶伴吸烟、饮酒15年，3两/天，。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：90次/分，R：20次/分，BP：120/70mmHg,Ht：172cm，Wt：73kg，BSA：1.85m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.0cm；鼻咽双侧顶后壁结节状肿物；双侧颈部IIa区可扪及1个淋巴结，最大径2×2cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 发现颈部肿物伴涕血、鼻塞2月；现病史: 患者2月前无明显诱因出现颈部肿物，拇指大小，偶伴涕血、鼻塞，右侧明显，无面麻、复视等其他不适，未予重视，逐渐加重，患者遂于某次就诊时间行颈部彩超示：右侧颈部低回声，行鼻咽镜示：鼻咽肿物，建议活检。患者未予相关诊治，转至我院就诊。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,涕血,颈部肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。偶伴吸烟、饮酒15年，3两/天，。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：90次/分，R：20次/分，BP：120/70mmHg,Ht：172cm，Wt：73kg，BSA：1.85m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率90次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.0cm；鼻咽双侧顶后壁结节状肿物；双侧颈部IIa区可扪及1个淋巴结，最大径2×2cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 甘油三酯(TG)-静脉血: 1.1mmol/L；透明质酸(HA)-静脉血: 34.26ng/ml；中性粒细胞计数(Neut#)-静脉血: 3.710E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；层粘连蛋白(LN)-静脉血: 11.97ng/ml；凝血酶原时间活动度(PTA)-静脉血: 125.5%；总胆固醇(TC)-静脉血: 4.12mmol/L；凝血酶原时间(PT)-静脉血: 10.8sec.；碱性磷酸酶(ALP)-静脉血: 83.4U/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；ABO血型-静脉血: O；镁离子(Mg2+)-静脉血: 0.88mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.005；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 65.2umol/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；尿素氮(BUN)-静脉血: 5.1mmol/L；总蛋白(TP)-静脉血: 75.4g/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 22.8U/L；钾离子(K+)-静脉血: 3.71mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 17.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 18.1U/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；乳酸脱氢酶(LDH)-静脉血: 142.3U/L；III型前胶原氨基端肽(PIIINP)-静脉血: 17.25ng/ml；尿酸(UA)-静脉血: 293.9umol/L；血小板计数(PLT#)-静脉血: 18910E9/L；Rh血型-静脉血: 阳性；总胆汁酸(TBA)-静脉血: 2.8umol/L；IV型胶原(C-IV)-静脉血: 21.48ng/ml；天门冬氨酸氨基转移酶(AST)-静脉血: 15.4U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；氯离子(Cl-)-静脉血: 103.6mmol/L；磷(P)-静脉血: 0.78m……\n- [全程D2] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D8] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、右侧壁见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。肿物占据双侧咽隐窝，向后外推移右侧咽旁脂肪间隙，前方浸润右侧筛窦及上鼻道，左侧咽旁脂肪间隙及左侧颈动脉鞘区未见异常。 右侧腭帆提肌、腭帆张肌受侵；左侧腭帆提肌、腭帆张肌、头长肌未见受累征象。 右侧翼腭窝及右侧上颌后脂肪间隙稍变窄；左侧翼腭窝、左上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽未见明显异常。 斜坡、蝶骨基底部、右侧翼突基底部及右侧蝶骨大翼信号降低，增强后强化。 双侧海绵窦未见明显异常。 双侧上颌窦、筛窦、右侧蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，无强化，骨壁完整。双眼大小、形态、位置均属正常、信号均匀。蝶鞍形态正常，其内未见占位性病变。 右侧咽后间隙见淋巴结，较大者约11mm×10mm；左侧咽后间隙未见肿大淋巴结。双颈Ⅱ区、右颈Ⅲ区见多个淋巴结，部分融合，边界清，不均匀明显强化，较大者约大小约24mm×13mm。 所见甲状腺双叶形态正常、喉咽腔、双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 符合鼻咽癌。 颅底骨质破坏。 左侧咽后、双颈Ⅱ区及右颈Ⅲ区肿大淋巴结，考虑转移。 副鼻窦炎、乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D25] 检验组合: 间接胆红素(IBIL)-静脉血: 4.41umolL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.41；肌酐(Crea)-静脉血: 102.2umol/L；尿酸(UA)-静脉血: 315.6umol/L；总蛋白(TP)-静脉血: 63.4g/L；直接胆红素(DBIL)-静脉血: 2.3umol/L；白蛋白(ALB)-静脉血: 37.1g/L；总胆红素(TBIL)-静脉血: 6.71umol/L；尿素氮(BUN)-静脉血: 7.1mmol/L；球蛋白(GLO)-静脉血: 26.3g/L\n- [全程D29] 检验组合: 碱性磷酸酶(ALP)-静脉血: 72.7U/L；钠离子(Na+)-静脉血: 140.9mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0.3；大血小板百分比(P-LCR%)-静脉血: 28.3%；葡萄糖(Glu)-静脉血: 4.98mmol/L；载脂蛋白B(apoB)-静脉血: 0.9g/L；磷(P)-静脉血: 0.95mmol/L；球蛋白(GLO)-静脉血: 26.2g/L；氯离子(Cl-)-静脉血: 102.9mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.9U/L；镁离子(Mg2+)-静脉血: 0.81mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.67mmol/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；红细胞计数(RBC#)-静脉血: 4.2510E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.9；总蛋白(TP)-静脉血: 63.5g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 88.7fL；红细胞比容(Hct)-静脉血: 37.7%；总胆固醇(TC)-静脉血: 3.9mmol/L；乳酸脱氢酶(LDH)-静脉血: 144.8U/L；载脂蛋白AI(apoAI)-静脉血: 1.05g/L；丙氨酸氨基转移酶(ALT)-静脉血: 18.8U/L；甘油三酯(TG)-静脉血: 1mmol/L；尿酸(UA)-静脉血: 351.4umol/L；尿素氮(BUN)-静脉血: 6mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；单核细胞百分比(Mono%)-静脉血: 0.077；胱抑素(Cys-C)-静脉血: 0.99mg/L；血小板分布宽度(PDW)-静脉血: 11.5%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；有核红细胞计数(NRBC#)-静脉血: 0.0110E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 38；白细胞计数(WBC#)-静脉血: 3.6610E9/L；平均血小板体积(MPV)-静脉血: 10.5fL；血小板比容-静脉血: 20%；单核细胞计数(Mono#)-静脉血: 0.310E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；总胆汁酸……\n- [全程D36] 检验组合: 酸碱度(pH)-尿液: 6.5；丙氨酸氨基转移酶(ALT)-静脉血: 18.7U/L；阴离子间隙(AG)-静脉血: 12.9；钾离子(K+)-静脉血: 3.75mmol/L；磷(P)-静脉血: 0.98mmol/L；球蛋白(GLO)-静脉血: 29.5g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；酮体(KET)-尿液: -（参考: 阴性）；总胆固醇(TC)-静脉血: 4.56mmol/L；尿素氮(BUN)-静脉血: 4.6mmol/L；红细胞计数(RBC#)-静脉血: 4.4810E12/L；比重(SG)-尿液: 1.008；γ-谷氨酰基转移酶(GGT)-静脉血: 28U/L；红细胞比容(Hct)-静脉血: 39.4%；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.755；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.4；总胆红素(TBIL)-静脉血: 9.28umol/L；葡萄糖(Glu)-静脉血: 5.08mmol/L；钠离子(Na+)-静脉血: 141.1mmol/L；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 25.4mmol/L；颜色-尿液: colorless；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.046；乳酸脱氢酶(LDH)-静脉血: 144U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22.6U/L；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.37；C-反应蛋白(CRP)-静脉血: 7.02mg/L；间接胆红素(IBIL)-静脉血: 6.27umolL；血红蛋白(Hb)-静脉血: 135g/L；单核细胞百分比(Mono%)-静脉血: 0.08；淋巴细胞百分比(Lymph%)-静脉血: 0.113；总钙(Ca)-静脉血: 2.18mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.68；平均血小板体积(MPV)-静脉血: 10fL；淋巴细胞计数(Lymph#……\n- [全程D37] 检验组合: 亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 1/μL；酸碱度(pH)-尿液: 6.5；白细胞计数(WBC#)-尿液: 8/μL；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 1/μL；颜色-尿液: colorless；尿胆原(URO)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；胆红素(BIL)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.006；酮体(KET)-尿液: -（参考: 阴性）\n- [全程D38] 检验组合: 白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.006；尿胆原(URO)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；细菌计数(BACT#)-尿液: 2/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 1/μL；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；颜色-尿液: colorless；浊度(TRUB)-尿液: clear；隐血(OB)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 6.5\n- [全程D43] 检验组合: 尿素氮(BUN)-静脉血: 7.4mmol/L；直接胆红素(DBIL)-静脉血: 3.4umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.3mmol/L；白蛋白(ALB)-静脉血: 41.2g/L；磷(P)-静脉血: 1.12mmol/L；氯离子(Cl-)-静脉血: 97.6mmol/L；总蛋白(TP)-静脉血: 72.16g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 45.7U/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；血小板分布宽度(PDW)-静脉血: 11.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；碱性磷酸酶(ALP)-静脉血: 88.2U/L；C-反应蛋白(CRP)-静脉血: 1.75mg/L；红细胞计数(RBC#)-静脉血: 4.4910E12/L；白细胞计数(WBC#)-静脉血: 3.910E9/L；血小板比容-静脉血: 15%；淋巴细胞百分比(Lymph%)-静脉血: 0.062；总胆固醇(TC)-静脉血: 4.41mmol/L；球蛋白(GLO)-静脉血: 30.96g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.55；α-L-岩藻糖苷酶(AFU)-静脉血: 38.6U/L；钠离子(Na+)-静脉血: 138mmol/L；总胆红素(TBIL)-静脉血: 10.5umol/L；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；血小板计数(PLT#)-静脉血: 15010E9/L；平均血小板体积(MPV)-静脉血: 10.3fL；葡萄糖(Glu)-静脉血: 5.12mmol/L；载脂蛋白B(apoB)-静脉血: 0.95g/L；甘油三酯(TG)-静脉血: 1.59mmol/L；血红蛋白(Hb)-静脉血: 139g/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；胱抑素(Cys-C)-静脉血: 1.23mg/L；载脂蛋白AI(apoAI)-静脉血: 1.33g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.07mmolL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.33；乳酸脱氢酶(LDH)-静脉血: 158.1U/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜酸性粒细胞计数(Eos#)-静脉血: 0.1……\n- [全程D50] 检验组合: 乳酸脱氢酶(LDH)-静脉血: 164U/L；葡萄糖(Glu)-静脉血: 5.3mmol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；肌酐(Crea)-静脉血: 108.9umol/L；平均红细胞体积(MCV)-静脉血: 85.7fL；间接胆红素(IBIL)-静脉血: 7.8umolL；磷(P)-静脉血: 1.01mmol/L；球蛋白(GLO)-静脉血: 29.5g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；总胆固醇(TC)-静脉血: 4.57mmol/L；总蛋白(TP)-静脉血: 69g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15.2U/L；大血小板百分比(P-LCR%)-静脉血: 20.1%；钾离子(K+)-静脉血: 3.73mmol/L；碱性磷酸酶(ALP)-静脉血: 81.5U/L；阴离子间隙(AG)-静脉血: 16.9；胱抑素(Cys-C)-静脉血: 1.07mg/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；直接胆红素(DBIL)-静脉血: 3.9umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；血小板计数(PLT#)-静脉血: 18610E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 25.2U/L；细菌名称-咽拭子: 细菌涂片3；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.03；平均红细胞血红蛋白含量(MCH)-静脉血: 29.8pg；白细胞计数(WBC#)-静脉血: 3.6610E9/L；尿素氮(BUN)-静脉血: 4.8mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 24U/L；氯离子(Cl-)-静脉血: 97.1mmol/L；血小板分布宽度(PDW)-静脉血: 10.4%；淋巴细胞百分比(Lymph%)-静脉血: 0.085；血液二氧化碳含量ctCO2(B)-静脉血: 23.3mmol/L；钠离子(Na+)-静脉血: 137.3mmol/L；总胆红素(TBIL)-静脉血: 11.7umol/L；C-反应蛋白(CRP)-静脉血: 11.52mg/L；总胆汁酸(TBA)-静脉血: 1.4umol/L；中性粒细胞计……\n- [全程D55] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约12mm，肝S5可见一无回声灶，大小约11×9mm,椭圆形，边界清，内透声可，后方回声增强。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约19cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱不充盈。 前列腺大小形态正常，大小约38×30×37mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝囊肿。 胆囊、脾脏、胰腺、双肾、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D32] 阶段小结；阶段小结: 病程类型: 阶段小结；病程主题: 阶段小结；病程内容: 患者[姓名已隐去]，男，51岁，因“颈部肿物，偶伴涕血、鼻塞2月”于某次就诊时间入院。征求患者同意并签字入住顺铂三周/单周方案联合IMRT治疗局部中晚期鼻咽癌三期临床试验，抽签入三周顺铂100mg/m2组。目前放疗14次，同时期化疗1次。3次靶向治疗，继续原方案治疗，并予患者营养支持治疗。\n- [全程D37] 上级查房记录；[姓名已隐去]主任医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者诉咽喉疼痛，目前放疗17次，今日行第2次顺铂同时期化疗，查体：患者鼻咽壁肿物明显缩小，双颈未扪及淋巴结，面部、双颈部皮肤色素沉着。[姓名已隐去]医生信息已隐藏：密切关注患者放化疗副反应，遵嘱执行。\n- [全程D42] 上级查房记录；[姓名已隐去]主任医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者诉咽喉疼痛，目前放疗20次，已行2次顺铂同时期化疗，4次靶向治疗，诉食欲不佳，查体：患者鼻咽顶后壁肿物明显缩小，双颈未扪及淋巴结，面部、双颈部皮肤色素沉着。[姓名已隐去]医生信息已隐藏：嘱患者加强营养及日常休息。密切关注患者放化疗副反应。 遵嘱。\n- [全程D47] 上级查房记录；[姓名已隐去]主任医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者目前放疗24次，已行2次顺铂同时期化疗，5次靶向治疗，诉咽喉疼痛，纳差，乏力。查体：患者鼻咽顶后壁稍增厚，双颈未扪及淋巴结，面部、双颈部皮肤色素沉着。[姓名已隐去]医生信息已隐藏：予以抗炎对症处理，并予患者行营养支持治疗，并密切关注患者血象变化。\n- [全程D52] 上级查房记录；[姓名已隐去]主任医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者目前放疗27次，已行2次顺铂同时期化疗，6次靶向治疗，诉咽喉疼痛，纳差，乏力。查体：患者鼻咽右侧壁肿物已基本消退，双颈未扪及淋巴结，面部、双颈部皮肤色素沉着。[姓名已隐去]医生信息已隐藏：予患者行营养支持治疗，并密切关注患者血象变化。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 提前终止放疗；给予重组人表皮生长因子、GM-CSF含漱液局部促修复及静脉营养支持治疗。\nB. 继续完成既定根治性放疗计划；加用重组人表皮生长因子、GM-CSF含漱液局部治疗，并予以静脉营养支持及抗感染治疗。\nC. 暂停放疗及靶向治疗直至黏膜炎好转；给予重组人表皮生长因子、GM-CSF含漱液局部治疗及静脉营养支持。\nD. 继续完成既定根治性放疗计划；仅给予氯化钠含漱液及常规饮食指导，避免使用生长因子类药物及静脉营养。\nE. 继续完成既定根治性放疗计划；加用氟康唑等广谱抗真菌药物静脉滴注，并予以静脉营养支持治疗。\nF. 继续完成既定根治性放疗计划并立即安排鼻咽部局部加量放疗；给予重组人表皮生长因子含漱液及静脉营养支持。\nG. 继续完成既定根治性放疗计划；行预防性经皮内镜下胃造瘘术（PEG）替代静脉营养支持。\nH. 暂停放疗计划；复查鼻咽及颈部MRI以明确肿瘤退缩情况，再决定后续放疗靶区及剂量。\nI. 继续完成既定根治性放疗计划；给予大剂量静脉糖皮质激素冲击治疗，暂缓静脉营养支持。\nJ. 继续完成既定根治性放疗计划；立即给予聚乙二醇化重组人粒细胞刺激因子皮下注射及静脉营养支持。\nK. 提前结束放疗，转为维持性靶向治疗及免疫治疗；给予重组人表皮生长因子及静脉营养支持。\nL. 继续完成既定根治性放疗计划；行预防性气管切开术，并予以静脉营养支持及抗感染治疗。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、筛窦、斜坡、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现颈部肿物伴涕血、鼻塞2月；患者未予相关诊治，转至我院就诊。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,涕血,颈部肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。偶伴吸烟、饮酒15年，3两/天，。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：90次/分，R：20次/分，BP：120/70mmHg,Ht：172cm，Wt：73kg，BSA：1.85m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.0cm；鼻咽双侧顶后壁结节状肿物；双侧颈部IIa区可扪及1个淋巴结，最大径2×2cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 发现颈部肿物伴涕血、鼻塞2月；现病史: 患者2月前无明显诱因出现颈部肿物，拇指大小，偶伴涕血、鼻塞，右侧明显，无面麻、复视等其他不适，未予重视，逐渐加重，患者遂于某次就诊时间行颈部彩超示：右侧颈部低回声，行鼻咽镜示：鼻咽肿物，建议活检。患者未予相关诊治，转至我院就诊。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,涕血,颈部肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。偶伴吸烟、饮酒15年，3两/天，。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：90次/分，R：20次/分，BP：120/70mmHg,Ht：172cm，Wt：73kg，BSA：1.85m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率90次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.0cm；鼻咽双侧顶后壁结节状肿物；双侧颈部IIa区可扪及1个淋巴结，最大径2×2cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 甘油三酯(TG)-静脉血: 1.1mmol/L；透明质酸(HA)-静脉血: 34.26ng/ml；中性粒细胞计数(Neut#)-静脉血: 3.710E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；层粘连蛋白(LN)-静脉血: 11.97ng/ml；凝血酶原时间活动度(PTA)-静脉血: 125.5%；总胆固醇(TC)-静脉血: 4.12mmol/L；凝血酶原时间(PT)-静脉血: 10.8sec.；碱性磷酸酶(ALP)-静脉血: 83.4U/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；ABO血型-静脉血: O；镁离子(Mg2+)-静脉血: 0.88mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.005；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 65.2umol/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；尿素氮(BUN)-静脉血: 5.1mmol/L；总蛋白(TP)-静脉血: 75.4g/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 22.8U/L；钾离子(K+)-静脉血: 3.71mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 17.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 18.1U/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；乳酸脱氢酶(LDH)-静脉血: 142.3U/L；III型前胶原氨基端肽(PIIINP)-静脉血: 17.25ng/ml；尿酸(UA)-静脉血: 293.9umol/L；血小板计数(PLT#)-静脉血: 18910E9/L；Rh血型-静脉血: 阳性；总胆汁酸(TBA)-静脉血: 2.8umol/L；IV型胶原(C-IV)-静脉血: 21.48ng/ml；天门冬氨酸氨基转移酶(AST)-静脉血: 15.4U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；氯离子(Cl-)-静脉血: 103.6mmol/L；磷(P)-静脉血: 0.78m……\n- [全程D2] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D8] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、右侧壁见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。肿物占据双侧咽隐窝，向后外推移右侧咽旁脂肪间隙，前方浸润右侧筛窦及上鼻道，左侧咽旁脂肪间隙及左侧颈动脉鞘区未见异常。 右侧腭帆提肌、腭帆张肌受侵；左侧腭帆提肌、腭帆张肌、头长肌未见受累征象。 右侧翼腭窝及右侧上颌后脂肪间隙稍变窄；左侧翼腭窝、左上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽未见明显异常。 斜坡、蝶骨基底部、右侧翼突基底部及右侧蝶骨大翼信号降低，增强后强化。 双侧海绵窦未见明显异常。 双侧上颌窦、筛窦、右侧蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，无强化，骨壁完整。双眼大小、形态、位置均属正常、信号均匀。蝶鞍形态正常，其内未见占位性病变。 右侧咽后间隙见淋巴结，较大者约11mm×10mm；左侧咽后间隙未见肿大淋巴结。双颈Ⅱ区、右颈Ⅲ区见多个淋巴结，部分融合，边界清，不均匀明显强化，较大者约大小约24mm×13mm。 所见甲状腺双叶形态正常、喉咽腔、双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 符合鼻咽癌。 颅底骨质破坏。 左侧咽后、双颈Ⅱ区及右颈Ⅲ区肿大淋巴结，考虑转移。 副鼻窦炎、乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D25] 检验组合: 间接胆红素(IBIL)-静脉血: 4.41umolL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.41；肌酐(Crea)-静脉血: 102.2umol/L；尿酸(UA)-静脉血: 315.6umol/L；总蛋白(TP)-静脉血: 63.4g/L；直接胆红素(DBIL)-静脉血: 2.3umol/L；白蛋白(ALB)-静脉血: 37.1g/L；总胆红素(TBIL)-静脉血: 6.71umol/L；尿素氮(BUN)-静脉血: 7.1mmol/L；球蛋白(GLO)-静脉血: 26.3g/L\n- [全程D29] 检验组合: 碱性磷酸酶(ALP)-静脉血: 72.7U/L；钠离子(Na+)-静脉血: 140.9mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0.3；大血小板百分比(P-LCR%)-静脉血: 28.3%；葡萄糖(Glu)-静脉血: 4.98mmol/L；载脂蛋白B(apoB)-静脉血: 0.9g/L；磷(P)-静脉血: 0.95mmol/L；球蛋白(GLO)-静脉血: 26.2g/L；氯离子(Cl-)-静脉血: 102.9mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.9U/L；镁离子(Mg2+)-静脉血: 0.81mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.67mmol/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；红细胞计数(RBC#)-静脉血: 4.2510E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.9；总蛋白(TP)-静脉血: 63.5g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 88.7fL；红细胞比容(Hct)-静脉血: 37.7%；总胆固醇(TC)-静脉血: 3.9mmol/L；乳酸脱氢酶(LDH)-静脉血: 144.8U/L；载脂蛋白AI(apoAI)-静脉血: 1.05g/L；丙氨酸氨基转移酶(ALT)-静脉血: 18.8U/L；甘油三酯(TG)-静脉血: 1mmol/L；尿酸(UA)-静脉血: 351.4umol/L；尿素氮(BUN)-静脉血: 6mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；单核细胞百分比(Mono%)-静脉血: 0.077；胱抑素(Cys-C)-静脉血: 0.99mg/L；血小板分布宽度(PDW)-静脉血: 11.5%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；有核红细胞计数(NRBC#)-静脉血: 0.0110E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 38；白细胞计数(WBC#)-静脉血: 3.6610E9/L；平均血小板体积(MPV)-静脉血: 10.5fL；血小板比容-静脉血: 20%；单核细胞计数(Mono#)-静脉血: 0.310E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；总胆汁酸……\n- [全程D36] 检验组合: 酸碱度(pH)-尿液: 6.5；丙氨酸氨基转移酶(ALT)-静脉血: 18.7U/L；阴离子间隙(AG)-静脉血: 12.9；钾离子(K+)-静脉血: 3.75mmol/L；磷(P)-静脉血: 0.98mmol/L；球蛋白(GLO)-静脉血: 29.5g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；酮体(KET)-尿液: -（参考: 阴性）；总胆固醇(TC)-静脉血: 4.56mmol/L；尿素氮(BUN)-静脉血: 4.6mmol/L；红细胞计数(RBC#)-静脉血: 4.4810E12/L；比重(SG)-尿液: 1.008；γ-谷氨酰基转移酶(GGT)-静脉血: 28U/L；红细胞比容(Hct)-静脉血: 39.4%；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.755；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.4；总胆红素(TBIL)-静脉血: 9.28umol/L；葡萄糖(Glu)-静脉血: 5.08mmol/L；钠离子(Na+)-静脉血: 141.1mmol/L；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 25.4mmol/L；颜色-尿液: colorless；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.046；乳酸脱氢酶(LDH)-静脉血: 144U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22.6U/L；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.37；C-反应蛋白(CRP)-静脉血: 7.02mg/L；间接胆红素(IBIL)-静脉血: 6.27umolL；血红蛋白(Hb)-静脉血: 135g/L；单核细胞百分比(Mono%)-静脉血: 0.08；淋巴细胞百分比(Lymph%)-静脉血: 0.113；总钙(Ca)-静脉血: 2.18mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.68；平均血小板体积(MPV)-静脉血: 10fL；淋巴细胞计数(Lymph#……\n- [全程D37] 检验组合: 亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 1/μL；酸碱度(pH)-尿液: 6.5；白细胞计数(WBC#)-尿液: 8/μL；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 1/μL；颜色-尿液: colorless；尿胆原(URO)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；胆红素(BIL)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.006；酮体(KET)-尿液: -（参考: 阴性）\n- [全程D38] 检验组合: 白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.006；尿胆原(URO)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；细菌计数(BACT#)-尿液: 2/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 1/μL；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；颜色-尿液: colorless；浊度(TRUB)-尿液: clear；隐血(OB)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 6.5\n- [全程D43] 检验组合: 尿素氮(BUN)-静脉血: 7.4mmol/L；直接胆红素(DBIL)-静脉血: 3.4umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.3mmol/L；白蛋白(ALB)-静脉血: 41.2g/L；磷(P)-静脉血: 1.12mmol/L；氯离子(Cl-)-静脉血: 97.6mmol/L；总蛋白(TP)-静脉血: 72.16g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 45.7U/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；血小板分布宽度(PDW)-静脉血: 11.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；碱性磷酸酶(ALP)-静脉血: 88.2U/L；C-反应蛋白(CRP)-静脉血: 1.75mg/L；红细胞计数(RBC#)-静脉血: 4.4910E12/L；白细胞计数(WBC#)-静脉血: 3.910E9/L；血小板比容-静脉血: 15%；淋巴细胞百分比(Lymph%)-静脉血: 0.062；总胆固醇(TC)-静脉血: 4.41mmol/L；球蛋白(GLO)-静脉血: 30.96g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.55；α-L-岩藻糖苷酶(AFU)-静脉血: 38.6U/L；钠离子(Na+)-静脉血: 138mmol/L；总胆红素(TBIL)-静脉血: 10.5umol/L；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；血小板计数(PLT#)-静脉血: 15010E9/L；平均血小板体积(MPV)-静脉血: 10.3fL；葡萄糖(Glu)-静脉血: 5.12mmol/L；载脂蛋白B(apoB)-静脉血: 0.95g/L；甘油三酯(TG)-静脉血: 1.59mmol/L；血红蛋白(Hb)-静脉血: 139g/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；胱抑素(Cys-C)-静脉血: 1.23mg/L；载脂蛋白AI(apoAI)-静脉血: 1.33g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.07mmolL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.33；乳酸脱氢酶(LDH)-静脉血: 158.1U/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜酸性粒细胞计数(Eos#)-静脉血: 0.1……\n- [全程D50] 检验组合: 乳酸脱氢酶(LDH)-静脉血: 164U/L；葡萄糖(Glu)-静脉血: 5.3mmol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；肌酐(Crea)-静脉血: 108.9umol/L；平均红细胞体积(MCV)-静脉血: 85.7fL；间接胆红素(IBIL)-静脉血: 7.8umolL；磷(P)-静脉血: 1.01mmol/L；球蛋白(GLO)-静脉血: 29.5g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；总胆固醇(TC)-静脉血: 4.57mmol/L；总蛋白(TP)-静脉血: 69g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15.2U/L；大血小板百分比(P-LCR%)-静脉血: 20.1%；钾离子(K+)-静脉血: 3.73mmol/L；碱性磷酸酶(ALP)-静脉血: 81.5U/L；阴离子间隙(AG)-静脉血: 16.9；胱抑素(Cys-C)-静脉血: 1.07mg/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；直接胆红素(DBIL)-静脉血: 3.9umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；血小板计数(PLT#)-静脉血: 18610E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 25.2U/L；细菌名称-咽拭子: 细菌涂片3；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.03；平均红细胞血红蛋白含量(MCH)-静脉血: 29.8pg；白细胞计数(WBC#)-静脉血: 3.6610E9/L；尿素氮(BUN)-静脉血: 4.8mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 24U/L；氯离子(Cl-)-静脉血: 97.1mmol/L；血小板分布宽度(PDW)-静脉血: 10.4%；淋巴细胞百分比(Lymph%)-静脉血: 0.085；血液二氧化碳含量ctCO2(B)-静脉血: 23.3mmol/L；钠离子(Na+)-静脉血: 137.3mmol/L；总胆红素(TBIL)-静脉血: 11.7umol/L；C-反应蛋白(CRP)-静脉血: 11.52mg/L；总胆汁酸(TBA)-静脉血: 1.4umol/L；中性粒细胞计……\n- [全程D55] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约12mm，肝S5可见一无回声灶，大小约11×9mm,椭圆形，边界清，内透声可，后方回声增强。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约19cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱不充盈。 前列腺大小形态正常，大小约38×30×37mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝囊肿。 胆囊、脾脏、胰腺、双肾、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D32] 阶段小结；阶段小结: 病程类型: 阶段小结；病程主题: 阶段小结；病程内容: 患者[姓名已隐去]，男，51岁，因“颈部肿物，偶伴涕血、鼻塞2月”于某次就诊时间入院。征求患者同意并签字入住顺铂三周/单周方案联合IMRT治疗局部中晚期鼻咽癌三期临床试验，抽签入三周顺铂100mg/m2组。目前放疗14次，同时期化疗1次。3次靶向治疗，继续原方案治疗，并予患者营养支持治疗。\n- [全程D37] 上级查房记录；[姓名已隐去]主任医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者诉咽喉疼痛，目前放疗17次，今日行第2次顺铂同时期化疗，查体：患者鼻咽壁肿物明显缩小，双颈未扪及淋巴结，面部、双颈部皮肤色素沉着。[姓名已隐去]医生信息已隐藏：密切关注患者放化疗副反应，遵嘱执行。\n- [全程D42] 上级查房记录；[姓名已隐去]主任医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者诉咽喉疼痛，目前放疗20次，已行2次顺铂同时期化疗，4次靶向治疗，诉食欲不佳，查体：患者鼻咽顶后壁肿物明显缩小，双颈未扪及淋巴结，面部、双颈部皮肤色素沉着。[姓名已隐去]医生信息已隐藏：嘱患者加强营养及日常休息。密切关注患者放化疗副反应。 遵嘱。\n- [全程D47] 上级查房记录；[姓名已隐去]主任医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者目前放疗24次，已行2次顺铂同时期化疗，5次靶向治疗，诉咽喉疼痛，纳差，乏力。查体：患者鼻咽顶后壁稍增厚，双颈未扪及淋巴结，面部、双颈部皮肤色素沉着。[姓名已隐去]医生信息已隐藏：予以抗炎对症处理，并予患者行营养支持治疗，并密切关注患者血象变化。\n- [全程D52] 上级查房记录；[姓名已隐去]主任医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者目前放疗27次，已行2次顺铂同时期化疗，6次靶向治疗，诉咽喉疼痛，纳差，乏力。查体：患者鼻咽右侧壁肿物已基本消退，双颈未扪及淋巴结，面部、双颈部皮肤色素沉着。[姓名已隐去]医生信息已隐藏：予患者行营养支持治疗，并密切关注患者血象变化。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 提前终止放疗；给予重组人表皮生长因子、GM-CSF含漱液局部促修复及静脉营养支持治疗。\nB. 继续完成既定根治性放疗计划；加用重组人表皮生长因子、GM-CSF含漱液局部治疗，并予以静脉营养支持及抗感染治疗。\nC. 暂停放疗及靶向治疗直至黏膜炎好转；给予重组人表皮生长因子、GM-CSF含漱液局部治疗及静脉营养支持。\nD. 继续完成既定根治性放疗计划；仅给予氯化钠含漱液及常规饮食指导，避免使用生长因子类药物及静脉营养。\nE. 继续完成既定根治性放疗计划；加用氟康唑等广谱抗真菌药物静脉滴注，并予以静脉营养支持治疗。\nF. 继续完成既定根治性放疗计划并立即安排鼻咽部局部加量放疗；给予重组人表皮生长因子含漱液及静脉营养支持。\nG. 继续完成既定根治性放疗计划；行预防性经皮内镜下胃造瘘术（PEG）替代静脉营养支持。\nH. 暂停放疗计划；复查鼻咽及颈部MRI以明确肿瘤退缩情况，再决定后续放疗靶区及剂量。\nI. 继续完成既定根治性放疗计划；给予大剂量静脉糖皮质激素冲击治疗，暂缓静脉营养支持。\nJ. 继续完成既定根治性放疗计划；立即给予聚乙二醇化重组人粒细胞刺激因子皮下注射及静脉营养支持。\nK. 提前结束放疗，转为维持性靶向治疗及免疫治疗；给予重组人表皮生长因子及静脉营养支持。\nL. 继续完成既定根治性放疗计划；行预防性气管切开术，并予以静脉营养支持及抗感染治疗。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-c54efc446616b72b81ae7555","patient_id":"patient-a48d1d72efa6c4217cf5b79c","turn_id":"turn08","turn_position":5,"turn_type":"recurrence_or_salvage_decision","gold_letter":"C","gold_action":"行电子鼻咽镜检查评估局部肿瘤退缩情况，并继续使用重组人表皮生长因子、重组人粒细胞巨噬细胞刺激因子等含漱药物促进粘膜修复。","options":[{"letter":"A","text":"行电子鼻咽镜检查并在可疑残留区域取活检，继续静脉滴注莫西沙星及地塞米松预防感染与水肿，暂不予抗肿瘤治疗。","is_gold":false},{"letter":"B","text":"安排全身PET-CT检查评估放化疗后全身代谢缓解情况，并继续静脉滴注脂肪乳及氨基酸等营养支持治疗。","is_gold":false},{"letter":"C","text":"行电子鼻咽镜检查评估局部肿瘤退缩情况，并继续使用重组人表皮生长因子、重组人粒细胞巨噬细胞刺激因子等含漱药物促进粘膜修复。","is_gold":true},{"letter":"D","text":"对右侧咽后及颈部残留淋巴结行局部追加放疗推量，并继续使用重组人表皮生长因子等含漱药物促进粘膜修复。","is_gold":false},{"letter":"E","text":"行电子鼻咽镜检查评估局部疗效，并启动吉西他滨联合顺铂方案进行2至3个周期的辅助化疗以巩固全身疗效。","is_gold":false},{"letter":"F","text":"行右侧颈部淋巴结清扫术处理残留淋巴结，术后继续使用重组人表皮生长因子外用溶液促进局部创面愈合。","is_gold":false},{"letter":"G","text":"行鼻咽及颈部超声检查评估淋巴结结构，并加用卡培他滨口服进行为期1年的节拍化疗作为维持治疗。","is_gold":false},{"letter":"H","text":"暂不进行鼻咽镜检查，直接出院，嘱1个月后返院行鼻咽部活检及MRI复查，期间继续静脉营养支持。","is_gold":false},{"letter":"I","text":"行电子鼻咽镜检查评估局部疗效，并继续静脉滴注脂肪乳、氨基酸及复方氯化钠注射液加强全身营养支持。","is_gold":false},{"letter":"J","text":"安排头颅增强MRI及全身骨扫描排除远处转移，并继续原方案靶向治疗至满1年，辅以局部含漱药物治疗。","is_gold":false},{"letter":"K","text":"行电子鼻咽镜检查评估局部疗效，若发现粘膜坏死则立即行内镜下清创术，并静脉滴注大剂量抗生素抗感染。","is_gold":false},{"letter":"L","text":"继续静脉滴注莫西沙星及地塞米松抗炎治疗2周以控制鼻窦炎及乳突炎，并定期复查鼻窦CT评估炎症吸收情况。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、筛窦、斜坡、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现颈部肿物伴涕血、鼻塞2月；患者未予相关诊治，转至我院就诊。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,涕血,颈部肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。偶伴吸烟、饮酒15年，3两/天，。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：90次/分，R：20次/分，BP：120/70mmHg,Ht：172cm，Wt：73kg，BSA：1.85m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.0cm；鼻咽双侧顶后壁结节状肿物；双侧颈部IIa区可扪及1个淋巴结，最大径2×2cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 发现颈部肿物伴涕血、鼻塞2月；现病史: 患者2月前无明显诱因出现颈部肿物，拇指大小，偶伴涕血、鼻塞，右侧明显，无面麻、复视等其他不适，未予重视，逐渐加重，患者遂于某次就诊时间行颈部彩超示：右侧颈部低回声，行鼻咽镜示：鼻咽肿物，建议活检。患者未予相关诊治，转至我院就诊。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,涕血,颈部肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。偶伴吸烟、饮酒15年，3两/天，。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：90次/分，R：20次/分，BP：120/70mmHg,Ht：172cm，Wt：73kg，BSA：1.85m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率90次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.0cm；鼻咽双侧顶后壁结节状肿物；双侧颈部IIa区可扪及1个淋巴结，最大径2×2cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 甘油三酯(TG)-静脉血: 1.1mmol/L；透明质酸(HA)-静脉血: 34.26ng/ml；中性粒细胞计数(Neut#)-静脉血: 3.710E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；层粘连蛋白(LN)-静脉血: 11.97ng/ml；凝血酶原时间活动度(PTA)-静脉血: 125.5%；总胆固醇(TC)-静脉血: 4.12mmol/L；凝血酶原时间(PT)-静脉血: 10.8sec.；碱性磷酸酶(ALP)-静脉血: 83.4U/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；ABO血型-静脉血: O；镁离子(Mg2+)-静脉血: 0.88mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.005；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 65.2umol/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；尿素氮(BUN)-静脉血: 5.1mmol/L；总蛋白(TP)-静脉血: 75.4g/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 22.8U/L；钾离子(K+)-静脉血: 3.71mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 17.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 18.1U/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；乳酸脱氢酶(LDH)-静脉血: 142.3U/L；III型前胶原氨基端肽(PIIINP)-静脉血: 17.25ng/ml；尿酸(UA)-静脉血: 293.9umol/L；血小板计数(PLT#)-静脉血: 18910E9/L；Rh血型-静脉血: 阳性；总胆汁酸(TBA)-静脉血: 2.8umol/L；IV型胶原(C-IV)-静脉血: 21.48ng/ml；天门冬氨酸氨基转移酶(AST)-静脉血: 15.4U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；氯离子(Cl-)-静脉血: 103.6mmol/L；磷(P)-静脉血: 0.78m……\n- [全程D2] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D8] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、右侧壁见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。肿物占据双侧咽隐窝，向后外推移右侧咽旁脂肪间隙，前方浸润右侧筛窦及上鼻道，左侧咽旁脂肪间隙及左侧颈动脉鞘区未见异常。 右侧腭帆提肌、腭帆张肌受侵；左侧腭帆提肌、腭帆张肌、头长肌未见受累征象。 右侧翼腭窝及右侧上颌后脂肪间隙稍变窄；左侧翼腭窝、左上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽未见明显异常。 斜坡、蝶骨基底部、右侧翼突基底部及右侧蝶骨大翼信号降低，增强后强化。 双侧海绵窦未见明显异常。 双侧上颌窦、筛窦、右侧蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，无强化，骨壁完整。双眼大小、形态、位置均属正常、信号均匀。蝶鞍形态正常，其内未见占位性病变。 右侧咽后间隙见淋巴结，较大者约11mm×10mm；左侧咽后间隙未见肿大淋巴结。双颈Ⅱ区、右颈Ⅲ区见多个淋巴结，部分融合，边界清，不均匀明显强化，较大者约大小约24mm×13mm。 所见甲状腺双叶形态正常、喉咽腔、双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 符合鼻咽癌。 颅底骨质破坏。 左侧咽后、双颈Ⅱ区及右颈Ⅲ区肿大淋巴结，考虑转移。 副鼻窦炎、乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D25] 检验组合: 间接胆红素(IBIL)-静脉血: 4.41umolL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.41；肌酐(Crea)-静脉血: 102.2umol/L；尿酸(UA)-静脉血: 315.6umol/L；总蛋白(TP)-静脉血: 63.4g/L；直接胆红素(DBIL)-静脉血: 2.3umol/L；白蛋白(ALB)-静脉血: 37.1g/L；总胆红素(TBIL)-静脉血: 6.71umol/L；尿素氮(BUN)-静脉血: 7.1mmol/L；球蛋白(GLO)-静脉血: 26.3g/L\n- [全程D29] 检验组合: 碱性磷酸酶(ALP)-静脉血: 72.7U/L；钠离子(Na+)-静脉血: 140.9mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0.3；大血小板百分比(P-LCR%)-静脉血: 28.3%；葡萄糖(Glu)-静脉血: 4.98mmol/L；载脂蛋白B(apoB)-静脉血: 0.9g/L；磷(P)-静脉血: 0.95mmol/L；球蛋白(GLO)-静脉血: 26.2g/L；氯离子(Cl-)-静脉血: 102.9mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.9U/L；镁离子(Mg2+)-静脉血: 0.81mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.67mmol/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；红细胞计数(RBC#)-静脉血: 4.2510E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.9；总蛋白(TP)-静脉血: 63.5g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 88.7fL；红细胞比容(Hct)-静脉血: 37.7%；总胆固醇(TC)-静脉血: 3.9mmol/L；乳酸脱氢酶(LDH)-静脉血: 144.8U/L；载脂蛋白AI(apoAI)-静脉血: 1.05g/L；丙氨酸氨基转移酶(ALT)-静脉血: 18.8U/L；甘油三酯(TG)-静脉血: 1mmol/L；尿酸(UA)-静脉血: 351.4umol/L；尿素氮(BUN)-静脉血: 6mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；单核细胞百分比(Mono%)-静脉血: 0.077；胱抑素(Cys-C)-静脉血: 0.99mg/L；血小板分布宽度(PDW)-静脉血: 11.5%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；有核红细胞计数(NRBC#)-静脉血: 0.0110E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 38；白细胞计数(WBC#)-静脉血: 3.6610E9/L；平均血小板体积(MPV)-静脉血: 10.5fL；血小板比容-静脉血: 20%；单核细胞计数(Mono#)-静脉血: 0.310E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；总胆汁酸……\n- [全程D36] 检验组合: 酸碱度(pH)-尿液: 6.5；丙氨酸氨基转移酶(ALT)-静脉血: 18.7U/L；阴离子间隙(AG)-静脉血: 12.9；钾离子(K+)-静脉血: 3.75mmol/L；磷(P)-静脉血: 0.98mmol/L；球蛋白(GLO)-静脉血: 29.5g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；酮体(KET)-尿液: -（参考: 阴性）；总胆固醇(TC)-静脉血: 4.56mmol/L；尿素氮(BUN)-静脉血: 4.6mmol/L；红细胞计数(RBC#)-静脉血: 4.4810E12/L；比重(SG)-尿液: 1.008；γ-谷氨酰基转移酶(GGT)-静脉血: 28U/L；红细胞比容(Hct)-静脉血: 39.4%；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.755；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.4；总胆红素(TBIL)-静脉血: 9.28umol/L；葡萄糖(Glu)-静脉血: 5.08mmol/L；钠离子(Na+)-静脉血: 141.1mmol/L；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 25.4mmol/L；颜色-尿液: colorless；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.046；乳酸脱氢酶(LDH)-静脉血: 144U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22.6U/L；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.37；C-反应蛋白(CRP)-静脉血: 7.02mg/L；间接胆红素(IBIL)-静脉血: 6.27umolL；血红蛋白(Hb)-静脉血: 135g/L；单核细胞百分比(Mono%)-静脉血: 0.08；淋巴细胞百分比(Lymph%)-静脉血: 0.113；总钙(Ca)-静脉血: 2.18mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.68；平均血小板体积(MPV)-静脉血: 10fL；淋巴细胞计数(Lymph#……\n- [全程D37] 检验组合: 亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 1/μL；酸碱度(pH)-尿液: 6.5；白细胞计数(WBC#)-尿液: 8/μL；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 1/μL；颜色-尿液: colorless；尿胆原(URO)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；胆红素(BIL)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.006；酮体(KET)-尿液: -（参考: 阴性）\n- [全程D38] 检验组合: 白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.006；尿胆原(URO)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；细菌计数(BACT#)-尿液: 2/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 1/μL；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；颜色-尿液: colorless；浊度(TRUB)-尿液: clear；隐血(OB)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 6.5\n- [全程D43] 检验组合: 尿素氮(BUN)-静脉血: 7.4mmol/L；直接胆红素(DBIL)-静脉血: 3.4umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.3mmol/L；白蛋白(ALB)-静脉血: 41.2g/L；磷(P)-静脉血: 1.12mmol/L；氯离子(Cl-)-静脉血: 97.6mmol/L；总蛋白(TP)-静脉血: 72.16g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 45.7U/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；血小板分布宽度(PDW)-静脉血: 11.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；碱性磷酸酶(ALP)-静脉血: 88.2U/L；C-反应蛋白(CRP)-静脉血: 1.75mg/L；红细胞计数(RBC#)-静脉血: 4.4910E12/L；白细胞计数(WBC#)-静脉血: 3.910E9/L；血小板比容-静脉血: 15%；淋巴细胞百分比(Lymph%)-静脉血: 0.062；总胆固醇(TC)-静脉血: 4.41mmol/L；球蛋白(GLO)-静脉血: 30.96g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.55；α-L-岩藻糖苷酶(AFU)-静脉血: 38.6U/L；钠离子(Na+)-静脉血: 138mmol/L；总胆红素(TBIL)-静脉血: 10.5umol/L；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；血小板计数(PLT#)-静脉血: 15010E9/L；平均血小板体积(MPV)-静脉血: 10.3fL；葡萄糖(Glu)-静脉血: 5.12mmol/L；载脂蛋白B(apoB)-静脉血: 0.95g/L；甘油三酯(TG)-静脉血: 1.59mmol/L；血红蛋白(Hb)-静脉血: 139g/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；胱抑素(Cys-C)-静脉血: 1.23mg/L；载脂蛋白AI(apoAI)-静脉血: 1.33g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.07mmolL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.33；乳酸脱氢酶(LDH)-静脉血: 158.1U/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜酸性粒细胞计数(Eos#)-静脉血: 0.1……\n- [全程D50] 检验组合: 乳酸脱氢酶(LDH)-静脉血: 164U/L；葡萄糖(Glu)-静脉血: 5.3mmol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；肌酐(Crea)-静脉血: 108.9umol/L；平均红细胞体积(MCV)-静脉血: 85.7fL；间接胆红素(IBIL)-静脉血: 7.8umolL；磷(P)-静脉血: 1.01mmol/L；球蛋白(GLO)-静脉血: 29.5g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；总胆固醇(TC)-静脉血: 4.57mmol/L；总蛋白(TP)-静脉血: 69g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15.2U/L；大血小板百分比(P-LCR%)-静脉血: 20.1%；钾离子(K+)-静脉血: 3.73mmol/L；碱性磷酸酶(ALP)-静脉血: 81.5U/L；阴离子间隙(AG)-静脉血: 16.9；胱抑素(Cys-C)-静脉血: 1.07mg/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；直接胆红素(DBIL)-静脉血: 3.9umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；血小板计数(PLT#)-静脉血: 18610E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 25.2U/L；细菌名称-咽拭子: 细菌涂片3；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.03；平均红细胞血红蛋白含量(MCH)-静脉血: 29.8pg；白细胞计数(WBC#)-静脉血: 3.6610E9/L；尿素氮(BUN)-静脉血: 4.8mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 24U/L；氯离子(Cl-)-静脉血: 97.1mmol/L；血小板分布宽度(PDW)-静脉血: 10.4%；淋巴细胞百分比(Lymph%)-静脉血: 0.085；血液二氧化碳含量ctCO2(B)-静脉血: 23.3mmol/L；钠离子(Na+)-静脉血: 137.3mmol/L；总胆红素(TBIL)-静脉血: 11.7umol/L；C-反应蛋白(CRP)-静脉血: 11.52mg/L；总胆汁酸(TBA)-静脉血: 1.4umol/L；中性粒细胞计……\n- [全程D55] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约12mm，肝S5可见一无回声灶，大小约11×9mm,椭圆形，边界清，内透声可，后方回声增强。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约19cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱不充盈。 前列腺大小形态正常，大小约38×30×37mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝囊肿。 胆囊、脾脏、胰腺、双肾、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D56] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理清晰，双肺野内未见明显实质性病变。双侧肺门未见增大，纵隔未见增宽，心影形态、大小未见异常。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见异常。\n- [全程D56] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌治疗后，对比某次就诊时间片： 鼻咽腔狭窄，鼻咽顶壁、顶后壁、右侧壁稍增厚，粘膜表面欠光滑，增强后较明显强化，较前明显缩小，双侧咽隐窝稍变浅，鼻中隔后缘见少许软组织，增强后较明显强化，右侧咽旁间隙稍变窄，左侧咽旁脂肪间隙及左侧颈动脉鞘区未见异常。 右侧腭帆提肌稍模糊；左侧腭帆提肌、腭帆张肌、头长肌未见受累征象。 左侧中下鼻甲明显肥厚。 双侧翼腭窝、双上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽未见明显异常。 斜坡、蝶骨基底部、右侧翼突基底部信号降低，增强后强化，较前范围稍缩小。 双侧海绵窦未见明显异常。 双侧上颌窦、筛窦、右侧蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，无强化，骨壁完整。双眼大小、形态、位置均属正常、信号均匀。蝶鞍形态正常，其内未见占位性病变。 右侧咽后间隙见淋巴结，较大者约7mm×6mm，信号欠均匀，增强后明显强化，较前缩小；左侧咽后间隙未见肿大淋巴结。双颈Ⅱ区、右颈Ⅲ区见多个淋巴结，边界欠清，最大约10mm×7mm，增强后不均匀强化，较前缩小、数目减少。 所见甲状腺双叶形态正常、喉咽腔、双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌治疗后，对比某次就诊时间片： 鼻咽病灶较前明显缩小。 颅底骨质破坏，较前修复。 右侧咽后淋巴结肿大，较前明显缩小。 双颈II区、右颈III区小淋巴结，较前明显缩小、数目减少。 鼻窦炎及右侧乳突炎。 左侧中下鼻甲肥厚。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D32] 阶段小结；阶段小结: 病程类型: 阶段小结；病程主题: 阶段小结；病程内容: 患者[姓名已隐去]，男，51岁，因“颈部肿物，偶伴涕血、鼻塞2月”于某次就诊时间入院。征求患者同意并签字入住顺铂三周/单周方案联合IMRT治疗局部中晚期鼻咽癌三期临床试验，抽签入三周顺铂100mg/m2组。目前放疗14次，同时期化疗1次。3次靶向治疗，继续原方案治疗，并予患者营养支持治疗。\n- [全程D37] 上级查房记录；[姓名已隐去]主任医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者诉咽喉疼痛，目前放疗17次，今日行第2次顺铂同时期化疗，查体：患者鼻咽壁肿物明显缩小，双颈未扪及淋巴结，面部、双颈部皮肤色素沉着。[姓名已隐去]医生信息已隐藏：密切关注患者放化疗副反应，遵嘱执行。\n- [全程D42] 上级查房记录；[姓名已隐去]主任医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者诉咽喉疼痛，目前放疗20次，已行2次顺铂同时期化疗，4次靶向治疗，诉食欲不佳，查体：患者鼻咽顶后壁肿物明显缩小，双颈未扪及淋巴结，面部、双颈部皮肤色素沉着。[姓名已隐去]医生信息已隐藏：嘱患者加强营养及日常休息。密切关注患者放化疗副反应。 遵嘱。\n- [全程D47] 上级查房记录；[姓名已隐去]主任医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者目前放疗24次，已行2次顺铂同时期化疗，5次靶向治疗，诉咽喉疼痛，纳差，乏力。查体：患者鼻咽顶后壁稍增厚，双颈未扪及淋巴结，面部、双颈部皮肤色素沉着。[姓名已隐去]医生信息已隐藏：予以抗炎对症处理，并予患者行营养支持治疗，并密切关注患者血象变化。\n- [全程D52] 上级查房记录；[姓名已隐去]主任医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者目前放疗27次，已行2次顺铂同时期化疗，6次靶向治疗，诉咽喉疼痛，纳差，乏力。查体：患者鼻咽右侧壁肿物已基本消退，双颈未扪及淋巴结，面部、双颈部皮肤色素沉着。[姓名已隐去]医生信息已隐藏：予患者行营养支持治疗，并密切关注患者血象变化。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行电子鼻咽镜检查并在可疑残留区域取活检，继续静脉滴注莫西沙星及地塞米松预防感染与水肿，暂不予抗肿瘤治疗。\nB. 安排全身PET-CT检查评估放化疗后全身代谢缓解情况，并继续静脉滴注脂肪乳及氨基酸等营养支持治疗。\nC. 行电子鼻咽镜检查评估局部肿瘤退缩情况，并继续使用重组人表皮生长因子、重组人粒细胞巨噬细胞刺激因子等含漱药物促进粘膜修复。\nD. 对右侧咽后及颈部残留淋巴结行局部追加放疗推量，并继续使用重组人表皮生长因子等含漱药物促进粘膜修复。\nE. 行电子鼻咽镜检查评估局部疗效，并启动吉西他滨联合顺铂方案进行2至3个周期的辅助化疗以巩固全身疗效。\nF. 行右侧颈部淋巴结清扫术处理残留淋巴结，术后继续使用重组人表皮生长因子外用溶液促进局部创面愈合。\nG. 行鼻咽及颈部超声检查评估淋巴结结构，并加用卡培他滨口服进行为期1年的节拍化疗作为维持治疗。\nH. 暂不进行鼻咽镜检查，直接出院，嘱1个月后返院行鼻咽部活检及MRI复查，期间继续静脉营养支持。\nI. 行电子鼻咽镜检查评估局部疗效，并继续静脉滴注脂肪乳、氨基酸及复方氯化钠注射液加强全身营养支持。\nJ. 安排头颅增强MRI及全身骨扫描排除远处转移，并继续原方案靶向治疗至满1年，辅以局部含漱药物治疗。\nK. 行电子鼻咽镜检查评估局部疗效，若发现粘膜坏死则立即行内镜下清创术，并静脉滴注大剂量抗生素抗感染。\nL. 继续静脉滴注莫西沙星及地塞米松抗炎治疗2周以控制鼻窦炎及乳突炎，并定期复查鼻窦CT评估炎症吸收情况。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、筛窦、斜坡、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现颈部肿物伴涕血、鼻塞2月；患者未予相关诊治，转至我院就诊。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,涕血,颈部肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。偶伴吸烟、饮酒15年，3两/天，。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：90次/分，R：20次/分，BP：120/70mmHg,Ht：172cm，Wt：73kg，BSA：1.85m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.0cm；鼻咽双侧顶后壁结节状肿物；双侧颈部IIa区可扪及1个淋巴结，最大径2×2cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 发现颈部肿物伴涕血、鼻塞2月；现病史: 患者2月前无明显诱因出现颈部肿物，拇指大小，偶伴涕血、鼻塞，右侧明显，无面麻、复视等其他不适，未予重视，逐渐加重，患者遂于某次就诊时间行颈部彩超示：右侧颈部低回声，行鼻咽镜示：鼻咽肿物，建议活检。患者未予相关诊治，转至我院就诊。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,涕血,颈部肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。偶伴吸烟、饮酒15年，3两/天，。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：90次/分，R：20次/分，BP：120/70mmHg,Ht：172cm，Wt：73kg，BSA：1.85m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率90次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.0cm；鼻咽双侧顶后壁结节状肿物；双侧颈部IIa区可扪及1个淋巴结，最大径2×2cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 甘油三酯(TG)-静脉血: 1.1mmol/L；透明质酸(HA)-静脉血: 34.26ng/ml；中性粒细胞计数(Neut#)-静脉血: 3.710E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；层粘连蛋白(LN)-静脉血: 11.97ng/ml；凝血酶原时间活动度(PTA)-静脉血: 125.5%；总胆固醇(TC)-静脉血: 4.12mmol/L；凝血酶原时间(PT)-静脉血: 10.8sec.；碱性磷酸酶(ALP)-静脉血: 83.4U/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；ABO血型-静脉血: O；镁离子(Mg2+)-静脉血: 0.88mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.005；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 65.2umol/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；尿素氮(BUN)-静脉血: 5.1mmol/L；总蛋白(TP)-静脉血: 75.4g/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 22.8U/L；钾离子(K+)-静脉血: 3.71mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 17.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 18.1U/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；乳酸脱氢酶(LDH)-静脉血: 142.3U/L；III型前胶原氨基端肽(PIIINP)-静脉血: 17.25ng/ml；尿酸(UA)-静脉血: 293.9umol/L；血小板计数(PLT#)-静脉血: 18910E9/L；Rh血型-静脉血: 阳性；总胆汁酸(TBA)-静脉血: 2.8umol/L；IV型胶原(C-IV)-静脉血: 21.48ng/ml；天门冬氨酸氨基转移酶(AST)-静脉血: 15.4U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；氯离子(Cl-)-静脉血: 103.6mmol/L；磷(P)-静脉血: 0.78m……\n- [全程D2] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D8] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、右侧壁见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。肿物占据双侧咽隐窝，向后外推移右侧咽旁脂肪间隙，前方浸润右侧筛窦及上鼻道，左侧咽旁脂肪间隙及左侧颈动脉鞘区未见异常。 右侧腭帆提肌、腭帆张肌受侵；左侧腭帆提肌、腭帆张肌、头长肌未见受累征象。 右侧翼腭窝及右侧上颌后脂肪间隙稍变窄；左侧翼腭窝、左上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽未见明显异常。 斜坡、蝶骨基底部、右侧翼突基底部及右侧蝶骨大翼信号降低，增强后强化。 双侧海绵窦未见明显异常。 双侧上颌窦、筛窦、右侧蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，无强化，骨壁完整。双眼大小、形态、位置均属正常、信号均匀。蝶鞍形态正常，其内未见占位性病变。 右侧咽后间隙见淋巴结，较大者约11mm×10mm；左侧咽后间隙未见肿大淋巴结。双颈Ⅱ区、右颈Ⅲ区见多个淋巴结，部分融合，边界清，不均匀明显强化，较大者约大小约24mm×13mm。 所见甲状腺双叶形态正常、喉咽腔、双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 符合鼻咽癌。 颅底骨质破坏。 左侧咽后、双颈Ⅱ区及右颈Ⅲ区肿大淋巴结，考虑转移。 副鼻窦炎、乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D25] 检验组合: 间接胆红素(IBIL)-静脉血: 4.41umolL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.41；肌酐(Crea)-静脉血: 102.2umol/L；尿酸(UA)-静脉血: 315.6umol/L；总蛋白(TP)-静脉血: 63.4g/L；直接胆红素(DBIL)-静脉血: 2.3umol/L；白蛋白(ALB)-静脉血: 37.1g/L；总胆红素(TBIL)-静脉血: 6.71umol/L；尿素氮(BUN)-静脉血: 7.1mmol/L；球蛋白(GLO)-静脉血: 26.3g/L\n- [全程D29] 检验组合: 碱性磷酸酶(ALP)-静脉血: 72.7U/L；钠离子(Na+)-静脉血: 140.9mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0.3；大血小板百分比(P-LCR%)-静脉血: 28.3%；葡萄糖(Glu)-静脉血: 4.98mmol/L；载脂蛋白B(apoB)-静脉血: 0.9g/L；磷(P)-静脉血: 0.95mmol/L；球蛋白(GLO)-静脉血: 26.2g/L；氯离子(Cl-)-静脉血: 102.9mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.9U/L；镁离子(Mg2+)-静脉血: 0.81mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.67mmol/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；红细胞计数(RBC#)-静脉血: 4.2510E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.9；总蛋白(TP)-静脉血: 63.5g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 88.7fL；红细胞比容(Hct)-静脉血: 37.7%；总胆固醇(TC)-静脉血: 3.9mmol/L；乳酸脱氢酶(LDH)-静脉血: 144.8U/L；载脂蛋白AI(apoAI)-静脉血: 1.05g/L；丙氨酸氨基转移酶(ALT)-静脉血: 18.8U/L；甘油三酯(TG)-静脉血: 1mmol/L；尿酸(UA)-静脉血: 351.4umol/L；尿素氮(BUN)-静脉血: 6mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；单核细胞百分比(Mono%)-静脉血: 0.077；胱抑素(Cys-C)-静脉血: 0.99mg/L；血小板分布宽度(PDW)-静脉血: 11.5%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；有核红细胞计数(NRBC#)-静脉血: 0.0110E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 38；白细胞计数(WBC#)-静脉血: 3.6610E9/L；平均血小板体积(MPV)-静脉血: 10.5fL；血小板比容-静脉血: 20%；单核细胞计数(Mono#)-静脉血: 0.310E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；总胆汁酸……\n- [全程D36] 检验组合: 酸碱度(pH)-尿液: 6.5；丙氨酸氨基转移酶(ALT)-静脉血: 18.7U/L；阴离子间隙(AG)-静脉血: 12.9；钾离子(K+)-静脉血: 3.75mmol/L；磷(P)-静脉血: 0.98mmol/L；球蛋白(GLO)-静脉血: 29.5g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；酮体(KET)-尿液: -（参考: 阴性）；总胆固醇(TC)-静脉血: 4.56mmol/L；尿素氮(BUN)-静脉血: 4.6mmol/L；红细胞计数(RBC#)-静脉血: 4.4810E12/L；比重(SG)-尿液: 1.008；γ-谷氨酰基转移酶(GGT)-静脉血: 28U/L；红细胞比容(Hct)-静脉血: 39.4%；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.755；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.4；总胆红素(TBIL)-静脉血: 9.28umol/L；葡萄糖(Glu)-静脉血: 5.08mmol/L；钠离子(Na+)-静脉血: 141.1mmol/L；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 25.4mmol/L；颜色-尿液: colorless；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.046；乳酸脱氢酶(LDH)-静脉血: 144U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22.6U/L；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.37；C-反应蛋白(CRP)-静脉血: 7.02mg/L；间接胆红素(IBIL)-静脉血: 6.27umolL；血红蛋白(Hb)-静脉血: 135g/L；单核细胞百分比(Mono%)-静脉血: 0.08；淋巴细胞百分比(Lymph%)-静脉血: 0.113；总钙(Ca)-静脉血: 2.18mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.68；平均血小板体积(MPV)-静脉血: 10fL；淋巴细胞计数(Lymph#……\n- [全程D37] 检验组合: 亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 1/μL；酸碱度(pH)-尿液: 6.5；白细胞计数(WBC#)-尿液: 8/μL；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 1/μL；颜色-尿液: colorless；尿胆原(URO)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；胆红素(BIL)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.006；酮体(KET)-尿液: -（参考: 阴性）\n- [全程D38] 检验组合: 白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.006；尿胆原(URO)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；细菌计数(BACT#)-尿液: 2/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 1/μL；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；颜色-尿液: colorless；浊度(TRUB)-尿液: clear；隐血(OB)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 6.5\n- [全程D43] 检验组合: 尿素氮(BUN)-静脉血: 7.4mmol/L；直接胆红素(DBIL)-静脉血: 3.4umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.3mmol/L；白蛋白(ALB)-静脉血: 41.2g/L；磷(P)-静脉血: 1.12mmol/L；氯离子(Cl-)-静脉血: 97.6mmol/L；总蛋白(TP)-静脉血: 72.16g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 45.7U/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；血小板分布宽度(PDW)-静脉血: 11.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；碱性磷酸酶(ALP)-静脉血: 88.2U/L；C-反应蛋白(CRP)-静脉血: 1.75mg/L；红细胞计数(RBC#)-静脉血: 4.4910E12/L；白细胞计数(WBC#)-静脉血: 3.910E9/L；血小板比容-静脉血: 15%；淋巴细胞百分比(Lymph%)-静脉血: 0.062；总胆固醇(TC)-静脉血: 4.41mmol/L；球蛋白(GLO)-静脉血: 30.96g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.55；α-L-岩藻糖苷酶(AFU)-静脉血: 38.6U/L；钠离子(Na+)-静脉血: 138mmol/L；总胆红素(TBIL)-静脉血: 10.5umol/L；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；血小板计数(PLT#)-静脉血: 15010E9/L；平均血小板体积(MPV)-静脉血: 10.3fL；葡萄糖(Glu)-静脉血: 5.12mmol/L；载脂蛋白B(apoB)-静脉血: 0.95g/L；甘油三酯(TG)-静脉血: 1.59mmol/L；血红蛋白(Hb)-静脉血: 139g/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；胱抑素(Cys-C)-静脉血: 1.23mg/L；载脂蛋白AI(apoAI)-静脉血: 1.33g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.07mmolL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.33；乳酸脱氢酶(LDH)-静脉血: 158.1U/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜酸性粒细胞计数(Eos#)-静脉血: 0.1……\n- [全程D50] 检验组合: 乳酸脱氢酶(LDH)-静脉血: 164U/L；葡萄糖(Glu)-静脉血: 5.3mmol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；肌酐(Crea)-静脉血: 108.9umol/L；平均红细胞体积(MCV)-静脉血: 85.7fL；间接胆红素(IBIL)-静脉血: 7.8umolL；磷(P)-静脉血: 1.01mmol/L；球蛋白(GLO)-静脉血: 29.5g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；总胆固醇(TC)-静脉血: 4.57mmol/L；总蛋白(TP)-静脉血: 69g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15.2U/L；大血小板百分比(P-LCR%)-静脉血: 20.1%；钾离子(K+)-静脉血: 3.73mmol/L；碱性磷酸酶(ALP)-静脉血: 81.5U/L；阴离子间隙(AG)-静脉血: 16.9；胱抑素(Cys-C)-静脉血: 1.07mg/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；直接胆红素(DBIL)-静脉血: 3.9umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；血小板计数(PLT#)-静脉血: 18610E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 25.2U/L；细菌名称-咽拭子: 细菌涂片3；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.03；平均红细胞血红蛋白含量(MCH)-静脉血: 29.8pg；白细胞计数(WBC#)-静脉血: 3.6610E9/L；尿素氮(BUN)-静脉血: 4.8mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 24U/L；氯离子(Cl-)-静脉血: 97.1mmol/L；血小板分布宽度(PDW)-静脉血: 10.4%；淋巴细胞百分比(Lymph%)-静脉血: 0.085；血液二氧化碳含量ctCO2(B)-静脉血: 23.3mmol/L；钠离子(Na+)-静脉血: 137.3mmol/L；总胆红素(TBIL)-静脉血: 11.7umol/L；C-反应蛋白(CRP)-静脉血: 11.52mg/L；总胆汁酸(TBA)-静脉血: 1.4umol/L；中性粒细胞计……\n- [全程D55] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约12mm，肝S5可见一无回声灶，大小约11×9mm,椭圆形，边界清，内透声可，后方回声增强。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约19cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱不充盈。 前列腺大小形态正常，大小约38×30×37mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝囊肿。 胆囊、脾脏、胰腺、双肾、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D56] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理清晰，双肺野内未见明显实质性病变。双侧肺门未见增大，纵隔未见增宽，心影形态、大小未见异常。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见异常。\n- [全程D56] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌治疗后，对比某次就诊时间片： 鼻咽腔狭窄，鼻咽顶壁、顶后壁、右侧壁稍增厚，粘膜表面欠光滑，增强后较明显强化，较前明显缩小，双侧咽隐窝稍变浅，鼻中隔后缘见少许软组织，增强后较明显强化，右侧咽旁间隙稍变窄，左侧咽旁脂肪间隙及左侧颈动脉鞘区未见异常。 右侧腭帆提肌稍模糊；左侧腭帆提肌、腭帆张肌、头长肌未见受累征象。 左侧中下鼻甲明显肥厚。 双侧翼腭窝、双上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽未见明显异常。 斜坡、蝶骨基底部、右侧翼突基底部信号降低，增强后强化，较前范围稍缩小。 双侧海绵窦未见明显异常。 双侧上颌窦、筛窦、右侧蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，无强化，骨壁完整。双眼大小、形态、位置均属正常、信号均匀。蝶鞍形态正常，其内未见占位性病变。 右侧咽后间隙见淋巴结，较大者约7mm×6mm，信号欠均匀，增强后明显强化，较前缩小；左侧咽后间隙未见肿大淋巴结。双颈Ⅱ区、右颈Ⅲ区见多个淋巴结，边界欠清，最大约10mm×7mm，增强后不均匀强化，较前缩小、数目减少。 所见甲状腺双叶形态正常、喉咽腔、双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌治疗后，对比某次就诊时间片： 鼻咽病灶较前明显缩小。 颅底骨质破坏，较前修复。 右侧咽后淋巴结肿大，较前明显缩小。 双颈II区、右颈III区小淋巴结，较前明显缩小、数目减少。 鼻窦炎及右侧乳突炎。 左侧中下鼻甲肥厚。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D32] 阶段小结；阶段小结: 病程类型: 阶段小结；病程主题: 阶段小结；病程内容: 患者[姓名已隐去]，男，51岁，因“颈部肿物，偶伴涕血、鼻塞2月”于某次就诊时间入院。征求患者同意并签字入住顺铂三周/单周方案联合IMRT治疗局部中晚期鼻咽癌三期临床试验，抽签入三周顺铂100mg/m2组。目前放疗14次，同时期化疗1次。3次靶向治疗，继续原方案治疗，并予患者营养支持治疗。\n- [全程D37] 上级查房记录；[姓名已隐去]主任医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者诉咽喉疼痛，目前放疗17次，今日行第2次顺铂同时期化疗，查体：患者鼻咽壁肿物明显缩小，双颈未扪及淋巴结，面部、双颈部皮肤色素沉着。[姓名已隐去]医生信息已隐藏：密切关注患者放化疗副反应，遵嘱执行。\n- [全程D42] 上级查房记录；[姓名已隐去]主任医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者诉咽喉疼痛，目前放疗20次，已行2次顺铂同时期化疗，4次靶向治疗，诉食欲不佳，查体：患者鼻咽顶后壁肿物明显缩小，双颈未扪及淋巴结，面部、双颈部皮肤色素沉着。[姓名已隐去]医生信息已隐藏：嘱患者加强营养及日常休息。密切关注患者放化疗副反应。 遵嘱。\n- [全程D47] 上级查房记录；[姓名已隐去]主任医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者目前放疗24次，已行2次顺铂同时期化疗，5次靶向治疗，诉咽喉疼痛，纳差，乏力。查体：患者鼻咽顶后壁稍增厚，双颈未扪及淋巴结，面部、双颈部皮肤色素沉着。[姓名已隐去]医生信息已隐藏：予以抗炎对症处理，并予患者行营养支持治疗，并密切关注患者血象变化。\n- [全程D52] 上级查房记录；[姓名已隐去]主任医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者目前放疗27次，已行2次顺铂同时期化疗，6次靶向治疗，诉咽喉疼痛，纳差，乏力。查体：患者鼻咽右侧壁肿物已基本消退，双颈未扪及淋巴结，面部、双颈部皮肤色素沉着。[姓名已隐去]医生信息已隐藏：予患者行营养支持治疗，并密切关注患者血象变化。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行电子鼻咽镜检查并在可疑残留区域取活检，继续静脉滴注莫西沙星及地塞米松预防感染与水肿，暂不予抗肿瘤治疗。\nB. 安排全身PET-CT检查评估放化疗后全身代谢缓解情况，并继续静脉滴注脂肪乳及氨基酸等营养支持治疗。\nC. 行电子鼻咽镜检查评估局部肿瘤退缩情况，并继续使用重组人表皮生长因子、重组人粒细胞巨噬细胞刺激因子等含漱药物促进粘膜修复。\nD. 对右侧咽后及颈部残留淋巴结行局部追加放疗推量，并继续使用重组人表皮生长因子等含漱药物促进粘膜修复。\nE. 行电子鼻咽镜检查评估局部疗效，并启动吉西他滨联合顺铂方案进行2至3个周期的辅助化疗以巩固全身疗效。\nF. 行右侧颈部淋巴结清扫术处理残留淋巴结，术后继续使用重组人表皮生长因子外用溶液促进局部创面愈合。\nG. 行鼻咽及颈部超声检查评估淋巴结结构，并加用卡培他滨口服进行为期1年的节拍化疗作为维持治疗。\nH. 暂不进行鼻咽镜检查，直接出院，嘱1个月后返院行鼻咽部活检及MRI复查，期间继续静脉营养支持。\nI. 行电子鼻咽镜检查评估局部疗效，并继续静脉滴注脂肪乳、氨基酸及复方氯化钠注射液加强全身营养支持。\nJ. 安排头颅增强MRI及全身骨扫描排除远处转移，并继续原方案靶向治疗至满1年，辅以局部含漱药物治疗。\nK. 行电子鼻咽镜检查评估局部疗效，若发现粘膜坏死则立即行内镜下清创术，并静脉滴注大剂量抗生素抗感染。\nL. 继续静脉滴注莫西沙星及地塞米松抗炎治疗2周以控制鼻窦炎及乳突炎，并定期复查鼻窦CT评估炎症吸收情况。\n\n请仅输出一个选项字母（A-L）。"}]}
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full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、颈动脉鞘、斜坡、海绵窦、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 间断性回吸性涕血1年余。；现病史: 患者近一年以来无明显原因出现回吸性涕血、近一个月左侧鼻塞明显，间断鼻衄。双侧耳鸣伴左耳听力下降，左侧头痛，双颈肿块。无面麻、张口困难、软腭麻痹，无咳嗽咳痰、呼吸困难。伴双侧咽后、颈部淋巴结转移。现为进一步诊治入院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重下降1Kg。；阳性症状体征: 体重下降,听力下降,双颈肿物,双耳鸣,涕血,鼻衄,左鼻塞,左侧头痛；既往史: 既往体健。4年前妊娠期间高血糖。3年前剖宫产。否认肝炎、结核等传染病史。否认心脏病、高血压史。预防接种史不详。过敏史:无药物及食物过敏史。；个人史: 出生于原籍，无烟酒药物等嗜好，无疫水接触史，否认不洁性生活史。无工业毒物，粉尘，放射性物质接触史。；家族史: 否认家族其他成员中有类似病患者或肿瘤患者。；体格检查: T36.5℃P78次/分R19次/分BP115/70mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。无鼻翼扇动、鼻衄。牙龈无肿胀、出血。气管居中，甲状腺不大。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率70bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。；专科检查: KPS 90。双颈II区触及多枚肿大淋巴结，直径约1.0cm，质韧、固定、相互融合。颅神经（-）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 正常范围心电图\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理清晰，走行自然，双肺野内未见明确实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。双上胸膜略厚。；检查结论: 心肺未见明显病变。\n- [全程D1] 检验组合: 胱抑素(Cys-C)-静脉血: 0.8mg/L；钾离子(K+)-静脉血: 4.14mmol/L；肌酐(Crea)-静脉血: 65umol/L；葡萄糖(Glu)-静脉血: 5.25mmol/L；载脂蛋白B(apoB)-静脉血: 0.81g/L；碱性磷酸酶(ALP)-静脉血: 47U/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:20（参考: 阴性）；乳酸脱氢酶(LDH)-静脉血: 210.4U/L；纤维蛋白原(Fbg)-静脉血: 2.89g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.62；天门冬氨酸氨基转移酶(AST)-静脉血: 19.6U/L；阴离子间隙(AG)-静脉血: 14.7；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.376COI；总胆固醇(TC)-静脉血: 4.58mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.7mmolL；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.56g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.5mmol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 1.79COI；总胆汁酸(TBA)-静脉血: 2umol/L；平均血小板体积(MPV)-静脉血: 10.5fL；磷(P)-静脉血: 1.23mmol/L；单核细胞百分比(Mono%)-静脉血: 0.042；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 0.009COI；甘油三酯(TG)-静脉血: 0.86mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.1mmol/L；平均红细胞体积(MCV)-静脉血: 96.1fL；丙氨酸氨基转移酶(ALT)-静脉血: 15U/L；血小板分布宽度(PDW)-静脉血: 12.1%；C-反应蛋白(CRP)-静脉血: 0.28mg/L；α-L-岩藻糖苷酶(AFU)-静脉血: 33.2U/L；尿素氮(BUN)-静脉血: 4.7mmol/L；球蛋白(GLO)-静脉血: 28.21g/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 0.109……\n- [全程D2] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁 、顶后壁、左侧壁增厚，见软组织肿物影。左侧咽隐窝消失，右侧咽隐窝变浅；病灶呈稍长分期信息见历史辅助诊断节点稍长分期信息见历史辅助诊断节点信号，增强扫描强化明显。 口咽双侧壁未见增厚。鼻腔未见肿物影。 左侧咽旁脂肪间隙变窄，左侧颈动脉鞘区见肿物占据。左侧腭帆张提肌及左侧头长肌受侵。 左侧翼腭窝见软组织影；右侧翼腭窝、双侧颞下窝未见异常。 斜坡、左侧岩尖、左侧破裂孔，左侧蝶骨大翼、左侧翼突、左侧翼管、左侧圆孔、蝶骨基底部骨质破坏。 蝶窦见软组织肿物；右侧乳突、双侧上颌窦充气良好；蝶窦、筛窦及左侧乳突见分泌物。 双眼未见异常。 左侧海绵窦见可疑肿物侵犯。 双侧咽后淋巴结肿大，左侧短径大小约为15mm，见包膜外侵；右侧短径大小约为11mm。双侧II区见多个肿大淋巴结，相互融合，最大短径大小约为18mm。 右侧腮腺见小淋巴结，短径约为7mm。 双侧腮腺。颌下腺、甲状腺未见异常。；检查结论: 考虑鼻咽癌，左侧咽旁间隙、颅底骨质； 可疑左侧海绵窦受侵。 双侧咽后淋巴结，双侧II区淋巴结肿大，考虑转移。 右侧腮腺小淋巴结，性质待定。 副鼻窦炎症。 左侧乳突炎症。\n- [全程D2] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，肝内血管走行自然，门静脉内径约10mm，未见明确肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约26cm/s。 胆囊大小正常，壁不厚，光滑，其内未见异常回声。 脾脏大小正常，包膜光滑，实质回声均匀。 胰腺大小正常，包膜光滑，实质回声均匀，胰管无扩张。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位性病变。 腹主动脉旁未见明确占位病变。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善颈部淋巴结细针穿刺活检及全身骨扫描\nB. 完善颈部淋巴结切除活检及全身PET-CT\nC. 完善电子鼻咽镜检查及鼻咽脱落细胞学检查\nD. 完善鼻咽肿物切除活检及全身骨扫描检查\nE. 完善电子鼻咽镜检查及鼻咽肿物活检\nF. 完善全身骨扫描检查并直接启动根治性放疗\nG. 完善鼻内镜下鼻咽肿物扩大切除及组织活检\nH. 完善颈部淋巴结切除活检及EB病毒DNA检测\nI. 完善电子鼻咽镜检查及鼻咽部多点盲取活检\nJ. 完善电子鼻咽镜检查及鼻咽肿物细针穿刺活检\nK. 完善脑部增强MRI检查及颈部淋巴结穿刺活检\nL. 完善电子鼻咽镜检查及活检并立即启动化疗\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、颈动脉鞘、斜坡、海绵窦、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 间断性回吸性涕血1年余。；现病史: 患者近一年以来无明显原因出现回吸性涕血、近一个月左侧鼻塞明显，间断鼻衄。双侧耳鸣伴左耳听力下降，左侧头痛，双颈肿块。无面麻、张口困难、软腭麻痹，无咳嗽咳痰、呼吸困难。伴双侧咽后、颈部淋巴结转移。现为进一步诊治入院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重下降1Kg。；阳性症状体征: 体重下降,听力下降,双颈肿物,双耳鸣,涕血,鼻衄,左鼻塞,左侧头痛；既往史: 既往体健。4年前妊娠期间高血糖。3年前剖宫产。否认肝炎、结核等传染病史。否认心脏病、高血压史。预防接种史不详。过敏史:无药物及食物过敏史。；个人史: 出生于原籍，无烟酒药物等嗜好，无疫水接触史，否认不洁性生活史。无工业毒物，粉尘，放射性物质接触史。；家族史: 否认家族其他成员中有类似病患者或肿瘤患者。；体格检查: T36.5℃P78次/分R19次/分BP115/70mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。无鼻翼扇动、鼻衄。牙龈无肿胀、出血。气管居中，甲状腺不大。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率70bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。；专科检查: KPS 90。双颈II区触及多枚肿大淋巴结，直径约1.0cm，质韧、固定、相互融合。颅神经（-）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 正常范围心电图\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理清晰，走行自然，双肺野内未见明确实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。双上胸膜略厚。；检查结论: 心肺未见明显病变。\n- [全程D1] 检验组合: 胱抑素(Cys-C)-静脉血: 0.8mg/L；钾离子(K+)-静脉血: 4.14mmol/L；肌酐(Crea)-静脉血: 65umol/L；葡萄糖(Glu)-静脉血: 5.25mmol/L；载脂蛋白B(apoB)-静脉血: 0.81g/L；碱性磷酸酶(ALP)-静脉血: 47U/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:20（参考: 阴性）；乳酸脱氢酶(LDH)-静脉血: 210.4U/L；纤维蛋白原(Fbg)-静脉血: 2.89g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.62；天门冬氨酸氨基转移酶(AST)-静脉血: 19.6U/L；阴离子间隙(AG)-静脉血: 14.7；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.376COI；总胆固醇(TC)-静脉血: 4.58mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.7mmolL；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.56g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.5mmol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 1.79COI；总胆汁酸(TBA)-静脉血: 2umol/L；平均血小板体积(MPV)-静脉血: 10.5fL；磷(P)-静脉血: 1.23mmol/L；单核细胞百分比(Mono%)-静脉血: 0.042；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 0.009COI；甘油三酯(TG)-静脉血: 0.86mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.1mmol/L；平均红细胞体积(MCV)-静脉血: 96.1fL；丙氨酸氨基转移酶(ALT)-静脉血: 15U/L；血小板分布宽度(PDW)-静脉血: 12.1%；C-反应蛋白(CRP)-静脉血: 0.28mg/L；α-L-岩藻糖苷酶(AFU)-静脉血: 33.2U/L；尿素氮(BUN)-静脉血: 4.7mmol/L；球蛋白(GLO)-静脉血: 28.21g/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 0.109……\n- [全程D2] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁 、顶后壁、左侧壁增厚，见软组织肿物影。左侧咽隐窝消失，右侧咽隐窝变浅；病灶呈稍长分期信息见历史辅助诊断节点稍长分期信息见历史辅助诊断节点信号，增强扫描强化明显。 口咽双侧壁未见增厚。鼻腔未见肿物影。 左侧咽旁脂肪间隙变窄，左侧颈动脉鞘区见肿物占据。左侧腭帆张提肌及左侧头长肌受侵。 左侧翼腭窝见软组织影；右侧翼腭窝、双侧颞下窝未见异常。 斜坡、左侧岩尖、左侧破裂孔，左侧蝶骨大翼、左侧翼突、左侧翼管、左侧圆孔、蝶骨基底部骨质破坏。 蝶窦见软组织肿物；右侧乳突、双侧上颌窦充气良好；蝶窦、筛窦及左侧乳突见分泌物。 双眼未见异常。 左侧海绵窦见可疑肿物侵犯。 双侧咽后淋巴结肿大，左侧短径大小约为15mm，见包膜外侵；右侧短径大小约为11mm。双侧II区见多个肿大淋巴结，相互融合，最大短径大小约为18mm。 右侧腮腺见小淋巴结，短径约为7mm。 双侧腮腺。颌下腺、甲状腺未见异常。；检查结论: 考虑鼻咽癌，左侧咽旁间隙、颅底骨质； 可疑左侧海绵窦受侵。 双侧咽后淋巴结，双侧II区淋巴结肿大，考虑转移。 右侧腮腺小淋巴结，性质待定。 副鼻窦炎症。 左侧乳突炎症。\n- [全程D2] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，肝内血管走行自然，门静脉内径约10mm，未见明确肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约26cm/s。 胆囊大小正常，壁不厚，光滑，其内未见异常回声。 脾脏大小正常，包膜光滑，实质回声均匀。 胰腺大小正常，包膜光滑，实质回声均匀，胰管无扩张。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位性病变。 腹主动脉旁未见明确占位病变。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善颈部淋巴结细针穿刺活检及全身骨扫描\nB. 完善颈部淋巴结切除活检及全身PET-CT\nC. 完善电子鼻咽镜检查及鼻咽脱落细胞学检查\nD. 完善鼻咽肿物切除活检及全身骨扫描检查\nE. 完善电子鼻咽镜检查及鼻咽肿物活检\nF. 完善全身骨扫描检查并直接启动根治性放疗\nG. 完善鼻内镜下鼻咽肿物扩大切除及组织活检\nH. 完善颈部淋巴结切除活检及EB病毒DNA检测\nI. 完善电子鼻咽镜检查及鼻咽部多点盲取活检\nJ. 完善电子鼻咽镜检查及鼻咽肿物细针穿刺活检\nK. 完善脑部增强MRI检查及颈部淋巴结穿刺活检\nL. 完善电子鼻咽镜检查及活检并立即启动化疗\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-4caf9a9989bff46283725cce","patient_id":"patient-e90c2443e271b2e927262653","turn_id":"turn04","turn_position":3,"turn_type":"initial_treatment_selection","gold_letter":"G","gold_action":"诱导化疗序贯同步放化疗","options":[{"letter":"A","text":"单纯根治性放疗","is_gold":false},{"letter":"B","text":"同步放化疗序贯辅助化疗","is_gold":false},{"letter":"C","text":"诱导化疗序贯单纯根治性放疗","is_gold":false},{"letter":"D","text":"根治性手术切除序贯术后放化疗","is_gold":false},{"letter":"E","text":"诱导化疗序贯靶向治疗联合放疗","is_gold":false},{"letter":"F","text":"姑息性化疗联合免疫治疗","is_gold":false},{"letter":"G","text":"诱导化疗序贯同步放化疗","is_gold":true},{"letter":"H","text":"同步放化疗联合靶向治疗","is_gold":false},{"letter":"I","text":"诱导化疗序贯根治性颈清扫术","is_gold":false},{"letter":"J","text":"单纯同步放化疗","is_gold":false},{"letter":"K","text":"靶向治疗联合同步放化疗","is_gold":false},{"letter":"L","text":"诱导化疗联合免疫治疗序贯单纯放疗","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、颈动脉鞘、斜坡、海绵窦、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 间断性回吸性涕血1年余。；现病史: 患者近一年以来无明显原因出现回吸性涕血、近一个月左侧鼻塞明显，间断鼻衄。双侧耳鸣伴左耳听力下降，左侧头痛，双颈肿块。无面麻、张口困难、软腭麻痹，无咳嗽咳痰、呼吸困难。伴双侧咽后、颈部淋巴结转移。现为进一步诊治入院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重下降1Kg。；阳性症状体征: 体重下降,听力下降,双颈肿物,双耳鸣,涕血,鼻衄,左鼻塞,左侧头痛；既往史: 既往体健。4年前妊娠期间高血糖。3年前剖宫产。否认肝炎、结核等传染病史。否认心脏病、高血压史。预防接种史不详。过敏史:无药物及食物过敏史。；个人史: 出生于原籍，无烟酒药物等嗜好，无疫水接触史，否认不洁性生活史。无工业毒物，粉尘，放射性物质接触史。；家族史: 否认家族其他成员中有类似病患者或肿瘤患者。；体格检查: T36.5℃P78次/分R19次/分BP115/70mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。无鼻翼扇动、鼻衄。牙龈无肿胀、出血。气管居中，甲状腺不大。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率70bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。；专科检查: KPS 90。双颈II区触及多枚肿大淋巴结，直径约1.0cm，质韧、固定、相互融合。颅神经（-）。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 间断性回吸性涕血1年余。；现病史: 患者近一年以来无明显原因出现回吸性涕血、近一个月左侧鼻塞明显，间断鼻衄。双侧耳鸣伴左耳听力下降，左侧头痛，双颈肿块。无面麻、张口困难、软腭麻痹，无咳嗽咳痰、呼吸困难。当地医院CT提示：鼻咽癌侵犯枕斜坡双侧蝶窦。伴双侧咽后、颈部淋巴结转移。现为进一步诊治入院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重下降1Kg。；阳性症状体征: 体重下降,听力下降,双颈肿物,双耳鸣,涕血,鼻衄,左鼻塞,左侧头痛；既往史: 既往体健。4年前妊娠期间高血糖。3年前剖宫产。否认肝炎、结核等传染病史。否认心脏病、高血压史。预防接种史不详。过敏史:无药物及食物过敏史。；个人史: 出生于原籍，无烟酒药物等嗜好，无疫水接触史，否认不洁性生活史。无工业毒物，粉尘，放射性物质接触史。；家族史: 否认家族其他成员中有类似病患者或肿瘤患者。；体格检查: T36.5℃P78次/分R19次/分BP115/70mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。无鼻翼扇动、鼻衄。牙龈无肿胀、出血。气管居中，甲状腺不大。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率70bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。肛门外生殖器未见异常，生理反射存在，病理反射未引出。；专科检查: KPS 90。张口门齿距4.5cm，间接鼻咽镜：见鼻咽左侧壁肿物肿物；双颈II区触及多枚肿大淋巴结，直径约1.0cm，质韧、固定、相互融合。颅神经（-）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 正常范围心电图\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理清晰，走行自然，双肺野内未见明确实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。双上胸膜略厚。；检查结论: 心肺未见明显病变。\n- [全程D1] 检验组合: 胱抑素(Cys-C)-静脉血: 0.8mg/L；钾离子(K+)-静脉血: 4.14mmol/L；肌酐(Crea)-静脉血: 65umol/L；葡萄糖(Glu)-静脉血: 5.25mmol/L；载脂蛋白B(apoB)-静脉血: 0.81g/L；碱性磷酸酶(ALP)-静脉血: 47U/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:20（参考: 阴性）；乳酸脱氢酶(LDH)-静脉血: 210.4U/L；纤维蛋白原(Fbg)-静脉血: 2.89g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.62；天门冬氨酸氨基转移酶(AST)-静脉血: 19.6U/L；阴离子间隙(AG)-静脉血: 14.7；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.376COI；总胆固醇(TC)-静脉血: 4.58mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.7mmolL；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.56g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.5mmol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 1.79COI；总胆汁酸(TBA)-静脉血: 2umol/L；平均血小板体积(MPV)-静脉血: 10.5fL；磷(P)-静脉血: 1.23mmol/L；单核细胞百分比(Mono%)-静脉血: 0.042；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 0.009COI；甘油三酯(TG)-静脉血: 0.86mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.1mmol/L；平均红细胞体积(MCV)-静脉血: 96.1fL；丙氨酸氨基转移酶(ALT)-静脉血: 15U/L；血小板分布宽度(PDW)-静脉血: 12.1%；C-反应蛋白(CRP)-静脉血: 0.28mg/L；α-L-岩藻糖苷酶(AFU)-静脉血: 33.2U/L；尿素氮(BUN)-静脉血: 4.7mmol/L；球蛋白(GLO)-静脉血: 28.21g/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 0.109……\n- [全程D2] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁 、顶后壁、左侧壁增厚，见软组织肿物影。左侧咽隐窝消失，右侧咽隐窝变浅；病灶呈稍长分期信息见历史辅助诊断节点稍长分期信息见历史辅助诊断节点信号，增强扫描强化明显。 口咽双侧壁未见增厚。鼻腔未见肿物影。 左侧咽旁脂肪间隙变窄，左侧颈动脉鞘区见肿物占据。左侧腭帆张提肌及左侧头长肌受侵。 左侧翼腭窝见软组织影；右侧翼腭窝、双侧颞下窝未见异常。 斜坡、左侧岩尖、左侧破裂孔，左侧蝶骨大翼、左侧翼突、左侧翼管、左侧圆孔、蝶骨基底部骨质破坏。 蝶窦见软组织肿物；右侧乳突、双侧上颌窦充气良好；蝶窦、筛窦及左侧乳突见分泌物。 双眼未见异常。 左侧海绵窦见可疑肿物侵犯。 双侧咽后淋巴结肿大，左侧短径大小约为15mm，见包膜外侵；右侧短径大小约为11mm。双侧II区见多个肿大淋巴结，相互融合，最大短径大小约为18mm。 右侧腮腺见小淋巴结，短径约为7mm。 双侧腮腺。颌下腺、甲状腺未见异常。；检查结论: 考虑鼻咽癌，左侧咽旁间隙、颅底骨质； 可疑左侧海绵窦受侵。 双侧咽后淋巴结，双侧II区淋巴结肿大，考虑转移。 右侧腮腺小淋巴结，性质待定。 副鼻窦炎症。 左侧乳突炎症。\n- [全程D2] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，肝内血管走行自然，门静脉内径约10mm，未见明确肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约26cm/s。 胆囊大小正常，壁不厚，光滑，其内未见异常回声。 脾脏大小正常，包膜光滑，实质回声均匀。 胰腺大小正常，包膜光滑，实质回声均匀，胰管无扩张。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位性病变。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 单纯根治性放疗\nB. 同步放化疗序贯辅助化疗\nC. 诱导化疗序贯单纯根治性放疗\nD. 根治性手术切除序贯术后放化疗\nE. 诱导化疗序贯靶向治疗联合放疗\nF. 姑息性化疗联合免疫治疗\nG. 诱导化疗序贯同步放化疗\nH. 同步放化疗联合靶向治疗\nI. 诱导化疗序贯根治性颈清扫术\nJ. 单纯同步放化疗\nK. 靶向治疗联合同步放化疗\nL. 诱导化疗联合免疫治疗序贯单纯放疗\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、颈动脉鞘、斜坡、海绵窦、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 间断性回吸性涕血1年余。；现病史: 患者近一年以来无明显原因出现回吸性涕血、近一个月左侧鼻塞明显，间断鼻衄。双侧耳鸣伴左耳听力下降，左侧头痛，双颈肿块。无面麻、张口困难、软腭麻痹，无咳嗽咳痰、呼吸困难。伴双侧咽后、颈部淋巴结转移。现为进一步诊治入院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重下降1Kg。；阳性症状体征: 体重下降,听力下降,双颈肿物,双耳鸣,涕血,鼻衄,左鼻塞,左侧头痛；既往史: 既往体健。4年前妊娠期间高血糖。3年前剖宫产。否认肝炎、结核等传染病史。否认心脏病、高血压史。预防接种史不详。过敏史:无药物及食物过敏史。；个人史: 出生于原籍，无烟酒药物等嗜好，无疫水接触史，否认不洁性生活史。无工业毒物，粉尘，放射性物质接触史。；家族史: 否认家族其他成员中有类似病患者或肿瘤患者。；体格检查: T36.5℃P78次/分R19次/分BP115/70mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。无鼻翼扇动、鼻衄。牙龈无肿胀、出血。气管居中，甲状腺不大。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率70bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。；专科检查: KPS 90。双颈II区触及多枚肿大淋巴结，直径约1.0cm，质韧、固定、相互融合。颅神经（-）。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 间断性回吸性涕血1年余。；现病史: 患者近一年以来无明显原因出现回吸性涕血、近一个月左侧鼻塞明显，间断鼻衄。双侧耳鸣伴左耳听力下降，左侧头痛，双颈肿块。无面麻、张口困难、软腭麻痹，无咳嗽咳痰、呼吸困难。当地医院CT提示：鼻咽癌侵犯枕斜坡双侧蝶窦。伴双侧咽后、颈部淋巴结转移。现为进一步诊治入院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重下降1Kg。；阳性症状体征: 体重下降,听力下降,双颈肿物,双耳鸣,涕血,鼻衄,左鼻塞,左侧头痛；既往史: 既往体健。4年前妊娠期间高血糖。3年前剖宫产。否认肝炎、结核等传染病史。否认心脏病、高血压史。预防接种史不详。过敏史:无药物及食物过敏史。；个人史: 出生于原籍，无烟酒药物等嗜好，无疫水接触史，否认不洁性生活史。无工业毒物，粉尘，放射性物质接触史。；家族史: 否认家族其他成员中有类似病患者或肿瘤患者。；体格检查: T36.5℃P78次/分R19次/分BP115/70mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。无鼻翼扇动、鼻衄。牙龈无肿胀、出血。气管居中，甲状腺不大。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率70bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。肛门外生殖器未见异常，生理反射存在，病理反射未引出。；专科检查: KPS 90。张口门齿距4.5cm，间接鼻咽镜：见鼻咽左侧壁肿物肿物；双颈II区触及多枚肿大淋巴结，直径约1.0cm，质韧、固定、相互融合。颅神经（-）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 正常范围心电图\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理清晰，走行自然，双肺野内未见明确实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。双上胸膜略厚。；检查结论: 心肺未见明显病变。\n- [全程D1] 检验组合: 胱抑素(Cys-C)-静脉血: 0.8mg/L；钾离子(K+)-静脉血: 4.14mmol/L；肌酐(Crea)-静脉血: 65umol/L；葡萄糖(Glu)-静脉血: 5.25mmol/L；载脂蛋白B(apoB)-静脉血: 0.81g/L；碱性磷酸酶(ALP)-静脉血: 47U/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:20（参考: 阴性）；乳酸脱氢酶(LDH)-静脉血: 210.4U/L；纤维蛋白原(Fbg)-静脉血: 2.89g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.62；天门冬氨酸氨基转移酶(AST)-静脉血: 19.6U/L；阴离子间隙(AG)-静脉血: 14.7；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.376COI；总胆固醇(TC)-静脉血: 4.58mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.7mmolL；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.56g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.5mmol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 1.79COI；总胆汁酸(TBA)-静脉血: 2umol/L；平均血小板体积(MPV)-静脉血: 10.5fL；磷(P)-静脉血: 1.23mmol/L；单核细胞百分比(Mono%)-静脉血: 0.042；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 0.009COI；甘油三酯(TG)-静脉血: 0.86mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.1mmol/L；平均红细胞体积(MCV)-静脉血: 96.1fL；丙氨酸氨基转移酶(ALT)-静脉血: 15U/L；血小板分布宽度(PDW)-静脉血: 12.1%；C-反应蛋白(CRP)-静脉血: 0.28mg/L；α-L-岩藻糖苷酶(AFU)-静脉血: 33.2U/L；尿素氮(BUN)-静脉血: 4.7mmol/L；球蛋白(GLO)-静脉血: 28.21g/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 0.109……\n- [全程D2] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁 、顶后壁、左侧壁增厚，见软组织肿物影。左侧咽隐窝消失，右侧咽隐窝变浅；病灶呈稍长分期信息见历史辅助诊断节点稍长分期信息见历史辅助诊断节点信号，增强扫描强化明显。 口咽双侧壁未见增厚。鼻腔未见肿物影。 左侧咽旁脂肪间隙变窄，左侧颈动脉鞘区见肿物占据。左侧腭帆张提肌及左侧头长肌受侵。 左侧翼腭窝见软组织影；右侧翼腭窝、双侧颞下窝未见异常。 斜坡、左侧岩尖、左侧破裂孔，左侧蝶骨大翼、左侧翼突、左侧翼管、左侧圆孔、蝶骨基底部骨质破坏。 蝶窦见软组织肿物；右侧乳突、双侧上颌窦充气良好；蝶窦、筛窦及左侧乳突见分泌物。 双眼未见异常。 左侧海绵窦见可疑肿物侵犯。 双侧咽后淋巴结肿大，左侧短径大小约为15mm，见包膜外侵；右侧短径大小约为11mm。双侧II区见多个肿大淋巴结，相互融合，最大短径大小约为18mm。 右侧腮腺见小淋巴结，短径约为7mm。 双侧腮腺。颌下腺、甲状腺未见异常。；检查结论: 考虑鼻咽癌，左侧咽旁间隙、颅底骨质； 可疑左侧海绵窦受侵。 双侧咽后淋巴结，双侧II区淋巴结肿大，考虑转移。 右侧腮腺小淋巴结，性质待定。 副鼻窦炎症。 左侧乳突炎症。\n- [全程D2] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，肝内血管走行自然，门静脉内径约10mm，未见明确肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约26cm/s。 胆囊大小正常，壁不厚，光滑，其内未见异常回声。 脾脏大小正常，包膜光滑，实质回声均匀。 胰腺大小正常，包膜光滑，实质回声均匀，胰管无扩张。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位性病变。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 单纯根治性放疗\nB. 同步放化疗序贯辅助化疗\nC. 诱导化疗序贯单纯根治性放疗\nD. 根治性手术切除序贯术后放化疗\nE. 诱导化疗序贯靶向治疗联合放疗\nF. 姑息性化疗联合免疫治疗\nG. 诱导化疗序贯同步放化疗\nH. 同步放化疗联合靶向治疗\nI. 诱导化疗序贯根治性颈清扫术\nJ. 单纯同步放化疗\nK. 靶向治疗联合同步放化疗\nL. 诱导化疗联合免疫治疗序贯单纯放疗\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-9253a0b82814c8e2231522e6","patient_id":"patient-e90c2443e271b2e927262653","turn_id":"turn05","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"H","gold_action":"不额外给予预防性升白、保肝或抗凝等支持治疗，继续完善乙肝定量、凝血功能、HIV/梅毒筛查及其他治疗前基线血液学和感染学检查。","options":[{"letter":"A","text":"给予重组人粒细胞集落刺激因子（rhG-CSF）皮下注射，并完善基线心电图及超声心动图检查。","is_gold":false},{"letter":"B","text":"给予地塞米松及20%甘露醇注射液静脉滴注，并紧急行头颅CT平扫。","is_gold":false},{"letter":"C","text":"给予异甘草酸镁注射液静脉滴注进行预防性保肝治疗。","is_gold":false},{"letter":"D","text":"给予唑来膦酸静脉滴注，并完善全身骨骼核素扫描（ECT）。","is_gold":false},{"letter":"E","text":"给予肠内营养粉剂口服进行营养支持，并留置鼻胃管。","is_gold":false},{"letter":"F","text":"给予静脉铁剂及重组人促红素（rhEPO）皮下注射，并复查血常规及网织红细胞。","is_gold":false},{"letter":"G","text":"给予头孢曲松钠静脉滴注进行预防性抗感染治疗，并完善血培养及药敏试验。","is_gold":false},{"letter":"H","text":"不额外给予预防性升白、保肝或抗凝等支持治疗，继续完善乙肝定量、凝血功能及其他治疗前基线血液学和感染学筛查。","is_gold":true},{"letter":"I","text":"给予塞来昔布胶囊常规口服进行镇痛治疗，并局部外用氟比洛芬凝胶贴膏。","is_gold":false},{"letter":"J","text":"给予低分子量肝素钙皮下注射进行抗凝治疗，并完善双下肢深静脉彩超。","is_gold":false},{"letter":"K","text":"给予奥美拉唑肠溶胶囊口服进行抑酸护胃治疗，并完善胃镜检查。","is_gold":false},{"letter":"L","text":"给予安替可及硒酵母口服进行辅助治疗，并暂缓乙肝及梅毒等传染病筛查。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、颈动脉鞘、斜坡、海绵窦、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 间断性回吸性涕血1年余。；现病史: 患者近一年以来无明显原因出现回吸性涕血、近一个月左侧鼻塞明显，间断鼻衄。双侧耳鸣伴左耳听力下降，左侧头痛，双颈肿块。无面麻、张口困难、软腭麻痹，无咳嗽咳痰、呼吸困难。伴双侧咽后、颈部淋巴结转移。现为进一步诊治入院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重下降1Kg。；阳性症状体征: 体重下降,听力下降,双颈肿物,双耳鸣,涕血,鼻衄,左鼻塞,左侧头痛；既往史: 既往体健。4年前妊娠期间高血糖。3年前剖宫产。否认肝炎、结核等传染病史。否认心脏病、高血压史。预防接种史不详。过敏史:无药物及食物过敏史。；个人史: 出生于原籍，无烟酒药物等嗜好，无疫水接触史，否认不洁性生活史。无工业毒物，粉尘，放射性物质接触史。；家族史: 否认家族其他成员中有类似病患者或肿瘤患者。；体格检查: T36.5℃P78次/分R19次/分BP115/70mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。无鼻翼扇动、鼻衄。牙龈无肿胀、出血。气管居中，甲状腺不大。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率70bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。；专科检查: KPS 90。双颈II区触及多枚肿大淋巴结，直径约1.0cm，质韧、固定、相互融合。颅神经（-）。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 间断性回吸性涕血1年余。；现病史: 患者近一年以来无明显原因出现回吸性涕血、近一个月左侧鼻塞明显，间断鼻衄。双侧耳鸣伴左耳听力下降，左侧头痛，双颈肿块。无面麻、张口困难、软腭麻痹，无咳嗽咳痰、呼吸困难。当地医院CT提示：鼻咽癌侵犯枕斜坡双侧蝶窦。伴双侧咽后、颈部淋巴结转移。现为进一步诊治入院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重下降1Kg。；阳性症状体征: 体重下降,听力下降,双颈肿物,双耳鸣,涕血,鼻衄,左鼻塞,左侧头痛；既往史: 既往体健。4年前妊娠期间高血糖。3年前剖宫产。否认肝炎、结核等传染病史。否认心脏病、高血压史。预防接种史不详。过敏史:无药物及食物过敏史。；个人史: 出生于原籍，无烟酒药物等嗜好，无疫水接触史，否认不洁性生活史。无工业毒物，粉尘，放射性物质接触史。；家族史: 否认家族其他成员中有类似病患者或肿瘤患者。；体格检查: T36.5℃P78次/分R19次/分BP115/70mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。无鼻翼扇动、鼻衄。牙龈无肿胀、出血。气管居中，甲状腺不大。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率70bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。肛门外生殖器未见异常，生理反射存在，病理反射未引出。；专科检查: KPS 90。张口门齿距4.5cm，间接鼻咽镜：见鼻咽左侧壁肿物肿物；双颈II区触及多枚肿大淋巴结，直径约1.0cm，质韧、固定、相互融合。颅神经（-）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 正常范围心电图\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理清晰，走行自然，双肺野内未见明确实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。双上胸膜略厚。；检查结论: 心肺未见明显病变。\n- [全程D1] 检验组合: 胱抑素(Cys-C)-静脉血: 0.8mg/L；钾离子(K+)-静脉血: 4.14mmol/L；肌酐(Crea)-静脉血: 65umol/L；葡萄糖(Glu)-静脉血: 5.25mmol/L；载脂蛋白B(apoB)-静脉血: 0.81g/L；碱性磷酸酶(ALP)-静脉血: 47U/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:20（参考: 阴性）；乳酸脱氢酶(LDH)-静脉血: 210.4U/L；纤维蛋白原(Fbg)-静脉血: 2.89g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.62；天门冬氨酸氨基转移酶(AST)-静脉血: 19.6U/L；阴离子间隙(AG)-静脉血: 14.7；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.376COI；总胆固醇(TC)-静脉血: 4.58mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.7mmolL；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.56g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.5mmol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 1.79COI；总胆汁酸(TBA)-静脉血: 2umol/L；平均血小板体积(MPV)-静脉血: 10.5fL；磷(P)-静脉血: 1.23mmol/L；单核细胞百分比(Mono%)-静脉血: 0.042；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 0.009COI；甘油三酯(TG)-静脉血: 0.86mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.1mmol/L；平均红细胞体积(MCV)-静脉血: 96.1fL；丙氨酸氨基转移酶(ALT)-静脉血: 15U/L；血小板分布宽度(PDW)-静脉血: 12.1%；C-反应蛋白(CRP)-静脉血: 0.28mg/L；α-L-岩藻糖苷酶(AFU)-静脉血: 33.2U/L；尿素氮(BUN)-静脉血: 4.7mmol/L；球蛋白(GLO)-静脉血: 28.21g/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 0.109……\n- [全程D2] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁 、顶后壁、左侧壁增厚，见软组织肿物影。左侧咽隐窝消失，右侧咽隐窝变浅；病灶呈稍长分期信息见历史辅助诊断节点稍长分期信息见历史辅助诊断节点信号，增强扫描强化明显。 口咽双侧壁未见增厚。鼻腔未见肿物影。 左侧咽旁脂肪间隙变窄，左侧颈动脉鞘区见肿物占据。左侧腭帆张提肌及左侧头长肌受侵。 左侧翼腭窝见软组织影；右侧翼腭窝、双侧颞下窝未见异常。 斜坡、左侧岩尖、左侧破裂孔，左侧蝶骨大翼、左侧翼突、左侧翼管、左侧圆孔、蝶骨基底部骨质破坏。 蝶窦见软组织肿物；右侧乳突、双侧上颌窦充气良好；蝶窦、筛窦及左侧乳突见分泌物。 双眼未见异常。 左侧海绵窦见可疑肿物侵犯。 双侧咽后淋巴结肿大，左侧短径大小约为15mm，见包膜外侵；右侧短径大小约为11mm。双侧II区见多个肿大淋巴结，相互融合，最大短径大小约为18mm。 右侧腮腺见小淋巴结，短径约为7mm。 双侧腮腺。颌下腺、甲状腺未见异常。；检查结论: 考虑鼻咽癌，左侧咽旁间隙、颅底骨质； 可疑左侧海绵窦受侵。 双侧咽后淋巴结，双侧II区淋巴结肿大，考虑转移。 右侧腮腺小淋巴结，性质待定。 副鼻窦炎症。 左侧乳突炎症。\n- [全程D2] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，肝内血管走行自然，门静脉内径约10mm，未见明确肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约26cm/s。 胆囊大小正常，壁不厚，光滑，其内未见异常回声。 脾脏大小正常，包膜光滑，实质回声均匀。 胰腺大小正常，包膜光滑，实质回声均匀，胰管无扩张。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位性病变。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者入院第2天，一般情况可，今日[姓名已隐去]医生信息已隐藏，详细听取病情汇报、检查患者后指示：尽快完善各项治疗前检查，明确诊断及分期，并了解有无合并其他基础疾病，待分期明确后再定治疗方案。遵嘱执行。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 给予重组人粒细胞集落刺激因子（rhG-CSF）皮下注射，并完善基线心电图及超声心动图检查。\nB. 给予地塞米松及20%甘露醇注射液静脉滴注，并紧急行头颅CT平扫。\nC. 给予异甘草酸镁注射液静脉滴注进行预防性保肝治疗。\nD. 给予唑来膦酸静脉滴注，并完善全身骨骼核素扫描（ECT）。\nE. 给予肠内营养粉剂口服进行营养支持，并留置鼻胃管。\nF. 给予静脉铁剂及重组人促红素（rhEPO）皮下注射，并复查血常规及网织红细胞。\nG. 给予头孢曲松钠静脉滴注进行预防性抗感染治疗，并完善血培养及药敏试验。\nH. 不额外给予预防性升白、保肝或抗凝等支持治疗，继续完善乙肝定量、凝血功能及其他治疗前基线血液学和感染学筛查。\nI. 给予塞来昔布胶囊常规口服进行镇痛治疗，并局部外用氟比洛芬凝胶贴膏。\nJ. 给予低分子量肝素钙皮下注射进行抗凝治疗，并完善双下肢深静脉彩超。\nK. 给予奥美拉唑肠溶胶囊口服进行抑酸护胃治疗，并完善胃镜检查。\nL. 给予安替可及硒酵母口服进行辅助治疗，并暂缓乙肝及梅毒等传染病筛查。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、颈动脉鞘、斜坡、海绵窦、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 间断性回吸性涕血1年余。；现病史: 患者近一年以来无明显原因出现回吸性涕血、近一个月左侧鼻塞明显，间断鼻衄。双侧耳鸣伴左耳听力下降，左侧头痛，双颈肿块。无面麻、张口困难、软腭麻痹，无咳嗽咳痰、呼吸困难。伴双侧咽后、颈部淋巴结转移。现为进一步诊治入院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重下降1Kg。；阳性症状体征: 体重下降,听力下降,双颈肿物,双耳鸣,涕血,鼻衄,左鼻塞,左侧头痛；既往史: 既往体健。4年前妊娠期间高血糖。3年前剖宫产。否认肝炎、结核等传染病史。否认心脏病、高血压史。预防接种史不详。过敏史:无药物及食物过敏史。；个人史: 出生于原籍，无烟酒药物等嗜好，无疫水接触史，否认不洁性生活史。无工业毒物，粉尘，放射性物质接触史。；家族史: 否认家族其他成员中有类似病患者或肿瘤患者。；体格检查: T36.5℃P78次/分R19次/分BP115/70mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。无鼻翼扇动、鼻衄。牙龈无肿胀、出血。气管居中，甲状腺不大。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率70bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。；专科检查: KPS 90。双颈II区触及多枚肿大淋巴结，直径约1.0cm，质韧、固定、相互融合。颅神经（-）。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 间断性回吸性涕血1年余。；现病史: 患者近一年以来无明显原因出现回吸性涕血、近一个月左侧鼻塞明显，间断鼻衄。双侧耳鸣伴左耳听力下降，左侧头痛，双颈肿块。无面麻、张口困难、软腭麻痹，无咳嗽咳痰、呼吸困难。当地医院CT提示：鼻咽癌侵犯枕斜坡双侧蝶窦。伴双侧咽后、颈部淋巴结转移。现为进一步诊治入院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重下降1Kg。；阳性症状体征: 体重下降,听力下降,双颈肿物,双耳鸣,涕血,鼻衄,左鼻塞,左侧头痛；既往史: 既往体健。4年前妊娠期间高血糖。3年前剖宫产。否认肝炎、结核等传染病史。否认心脏病、高血压史。预防接种史不详。过敏史:无药物及食物过敏史。；个人史: 出生于原籍，无烟酒药物等嗜好，无疫水接触史，否认不洁性生活史。无工业毒物，粉尘，放射性物质接触史。；家族史: 否认家族其他成员中有类似病患者或肿瘤患者。；体格检查: T36.5℃P78次/分R19次/分BP115/70mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。无鼻翼扇动、鼻衄。牙龈无肿胀、出血。气管居中，甲状腺不大。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率70bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。肛门外生殖器未见异常，生理反射存在，病理反射未引出。；专科检查: KPS 90。张口门齿距4.5cm，间接鼻咽镜：见鼻咽左侧壁肿物肿物；双颈II区触及多枚肿大淋巴结，直径约1.0cm，质韧、固定、相互融合。颅神经（-）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 正常范围心电图\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理清晰，走行自然，双肺野内未见明确实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。双上胸膜略厚。；检查结论: 心肺未见明显病变。\n- [全程D1] 检验组合: 胱抑素(Cys-C)-静脉血: 0.8mg/L；钾离子(K+)-静脉血: 4.14mmol/L；肌酐(Crea)-静脉血: 65umol/L；葡萄糖(Glu)-静脉血: 5.25mmol/L；载脂蛋白B(apoB)-静脉血: 0.81g/L；碱性磷酸酶(ALP)-静脉血: 47U/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:20（参考: 阴性）；乳酸脱氢酶(LDH)-静脉血: 210.4U/L；纤维蛋白原(Fbg)-静脉血: 2.89g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.62；天门冬氨酸氨基转移酶(AST)-静脉血: 19.6U/L；阴离子间隙(AG)-静脉血: 14.7；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.376COI；总胆固醇(TC)-静脉血: 4.58mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.7mmolL；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.56g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.5mmol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 1.79COI；总胆汁酸(TBA)-静脉血: 2umol/L；平均血小板体积(MPV)-静脉血: 10.5fL；磷(P)-静脉血: 1.23mmol/L；单核细胞百分比(Mono%)-静脉血: 0.042；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 0.009COI；甘油三酯(TG)-静脉血: 0.86mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.1mmol/L；平均红细胞体积(MCV)-静脉血: 96.1fL；丙氨酸氨基转移酶(ALT)-静脉血: 15U/L；血小板分布宽度(PDW)-静脉血: 12.1%；C-反应蛋白(CRP)-静脉血: 0.28mg/L；α-L-岩藻糖苷酶(AFU)-静脉血: 33.2U/L；尿素氮(BUN)-静脉血: 4.7mmol/L；球蛋白(GLO)-静脉血: 28.21g/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 0.109……\n- [全程D2] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁 、顶后壁、左侧壁增厚，见软组织肿物影。左侧咽隐窝消失，右侧咽隐窝变浅；病灶呈稍长分期信息见历史辅助诊断节点稍长分期信息见历史辅助诊断节点信号，增强扫描强化明显。 口咽双侧壁未见增厚。鼻腔未见肿物影。 左侧咽旁脂肪间隙变窄，左侧颈动脉鞘区见肿物占据。左侧腭帆张提肌及左侧头长肌受侵。 左侧翼腭窝见软组织影；右侧翼腭窝、双侧颞下窝未见异常。 斜坡、左侧岩尖、左侧破裂孔，左侧蝶骨大翼、左侧翼突、左侧翼管、左侧圆孔、蝶骨基底部骨质破坏。 蝶窦见软组织肿物；右侧乳突、双侧上颌窦充气良好；蝶窦、筛窦及左侧乳突见分泌物。 双眼未见异常。 左侧海绵窦见可疑肿物侵犯。 双侧咽后淋巴结肿大，左侧短径大小约为15mm，见包膜外侵；右侧短径大小约为11mm。双侧II区见多个肿大淋巴结，相互融合，最大短径大小约为18mm。 右侧腮腺见小淋巴结，短径约为7mm。 双侧腮腺。颌下腺、甲状腺未见异常。；检查结论: 考虑鼻咽癌，左侧咽旁间隙、颅底骨质； 可疑左侧海绵窦受侵。 双侧咽后淋巴结，双侧II区淋巴结肿大，考虑转移。 右侧腮腺小淋巴结，性质待定。 副鼻窦炎症。 左侧乳突炎症。\n- [全程D2] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，肝内血管走行自然，门静脉内径约10mm，未见明确肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约26cm/s。 胆囊大小正常，壁不厚，光滑，其内未见异常回声。 脾脏大小正常，包膜光滑，实质回声均匀。 胰腺大小正常，包膜光滑，实质回声均匀，胰管无扩张。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位性病变。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者入院第2天，一般情况可，今日[姓名已隐去]医生信息已隐藏，详细听取病情汇报、检查患者后指示：尽快完善各项治疗前检查，明确诊断及分期，并了解有无合并其他基础疾病，待分期明确后再定治疗方案。遵嘱执行。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 给予重组人粒细胞集落刺激因子（rhG-CSF）皮下注射，并完善基线心电图及超声心动图检查。\nB. 给予地塞米松及20%甘露醇注射液静脉滴注，并紧急行头颅CT平扫。\nC. 给予异甘草酸镁注射液静脉滴注进行预防性保肝治疗。\nD. 给予唑来膦酸静脉滴注，并完善全身骨骼核素扫描（ECT）。\nE. 给予肠内营养粉剂口服进行营养支持，并留置鼻胃管。\nF. 给予静脉铁剂及重组人促红素（rhEPO）皮下注射，并复查血常规及网织红细胞。\nG. 给予头孢曲松钠静脉滴注进行预防性抗感染治疗，并完善血培养及药敏试验。\nH. 不额外给予预防性升白、保肝或抗凝等支持治疗，继续完善乙肝定量、凝血功能及其他治疗前基线血液学和感染学筛查。\nI. 给予塞来昔布胶囊常规口服进行镇痛治疗，并局部外用氟比洛芬凝胶贴膏。\nJ. 给予低分子量肝素钙皮下注射进行抗凝治疗，并完善双下肢深静脉彩超。\nK. 给予奥美拉唑肠溶胶囊口服进行抑酸护胃治疗，并完善胃镜检查。\nL. 给予安替可及硒酵母口服进行辅助治疗，并暂缓乙肝及梅毒等传染病筛查。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-3b37bb5b3505f87a241c1a6f","patient_id":"patient-e90c2443e271b2e927262653","turn_id":"turn06","turn_position":5,"turn_type":"toxicity_or_support_decision","gold_letter":"I","gold_action":"暂不需集落刺激因子支持，予以复方氨基酸及转化糖电解质静脉营养支持，并进行动静脉置管护理。","options":[{"letter":"A","text":"预防性给予重组人粒细胞集落刺激因子（G-CSF）皮下注射，并推迟后续抗肿瘤治疗。","is_gold":false},{"letter":"B","text":"立即输注红细胞悬液2U，并皮下注射促红细胞生成素（EPO）纠正贫血。","is_gold":false},{"letter":"C","text":"启动异甘草酸镁及多烯磷脂酰胆碱静脉滴注，进行双靶点强化保肝治疗。","is_gold":false},{"letter":"D","text":"建立中心静脉通道，给予10%氯化钾注射液微量泵持续静脉泵入补钾。","is_gold":false},{"letter":"E","text":"留取血培养后，经验性静脉滴注头孢哌酮舒巴坦等广谱抗菌药物抗感染。","is_gold":false},{"letter":"F","text":"每日静脉输注人血白蛋白10g，并配合静脉推注呋塞米进行利尿消肿。","is_gold":false},{"letter":"G","text":"给予碳酸氢钠静脉滴注碱化尿液，并进行每日3000ml以上大剂量水化。","is_gold":false},{"letter":"H","text":"启动胰岛素泵持续皮下泵入强化降糖治疗，并严格限制碳水化合物摄入。","is_gold":false},{"letter":"I","text":"暂不需集落刺激因子支持，予以复方氨基酸及转化糖电解质静脉营养支持，并进行动静脉置管护理。","is_gold":true},{"letter":"J","text":"持续静脉泵入质子泵抑制剂及5-HT3受体拮抗剂，进行强化抑酸止吐。","is_gold":false},{"letter":"K","text":"预防性输注单采血小板1个治疗量，并皮下注射重组人血小板生成素。","is_gold":false},{"letter":"L","text":"给予拉布立酶静脉滴注，并配合大剂量静脉水化预防肿瘤溶解综合征。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、颈动脉鞘、斜坡、海绵窦、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 间断性回吸性涕血1年余。；现病史: 患者近一年以来无明显原因出现回吸性涕血、近一个月左侧鼻塞明显，间断鼻衄。双侧耳鸣伴左耳听力下降，左侧头痛，双颈肿块。无面麻、张口困难、软腭麻痹，无咳嗽咳痰、呼吸困难。伴双侧咽后、颈部淋巴结转移。现为进一步诊治入院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重下降1Kg。；阳性症状体征: 体重下降,听力下降,双颈肿物,双耳鸣,涕血,鼻衄,左鼻塞,左侧头痛；既往史: 既往体健。4年前妊娠期间高血糖。3年前剖宫产。否认肝炎、结核等传染病史。否认心脏病、高血压史。预防接种史不详。过敏史:无药物及食物过敏史。；个人史: 出生于原籍，无烟酒药物等嗜好，无疫水接触史，否认不洁性生活史。无工业毒物，粉尘，放射性物质接触史。；家族史: 否认家族其他成员中有类似病患者或肿瘤患者。；体格检查: T36.5℃P78次/分R19次/分BP115/70mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。无鼻翼扇动、鼻衄。牙龈无肿胀、出血。气管居中，甲状腺不大。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率70bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。；专科检查: KPS 90。双颈II区触及多枚肿大淋巴结，直径约1.0cm，质韧、固定、相互融合。颅神经（-）。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 间断性回吸性涕血1年余。；现病史: 患者近一年以来无明显原因出现回吸性涕血、近一个月左侧鼻塞明显，间断鼻衄。双侧耳鸣伴左耳听力下降，左侧头痛，双颈肿块。无面麻、张口困难、软腭麻痹，无咳嗽咳痰、呼吸困难。当地医院CT提示：鼻咽癌侵犯枕斜坡双侧蝶窦。伴双侧咽后、颈部淋巴结转移。现为进一步诊治入院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重下降1Kg。；阳性症状体征: 体重下降,听力下降,双颈肿物,双耳鸣,涕血,鼻衄,左鼻塞,左侧头痛；既往史: 既往体健。4年前妊娠期间高血糖。3年前剖宫产。否认肝炎、结核等传染病史。否认心脏病、高血压史。预防接种史不详。过敏史:无药物及食物过敏史。；个人史: 出生于原籍，无烟酒药物等嗜好，无疫水接触史，否认不洁性生活史。无工业毒物，粉尘，放射性物质接触史。；家族史: 否认家族其他成员中有类似病患者或肿瘤患者。；体格检查: T36.5℃P78次/分R19次/分BP115/70mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。无鼻翼扇动、鼻衄。牙龈无肿胀、出血。气管居中，甲状腺不大。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率70bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。肛门外生殖器未见异常，生理反射存在，病理反射未引出。；专科检查: KPS 90。张口门齿距4.5cm，间接鼻咽镜：见鼻咽左侧壁肿物肿物；双颈II区触及多枚肿大淋巴结，直径约1.0cm，质韧、固定、相互融合。颅神经（-）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 正常范围心电图\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理清晰，走行自然，双肺野内未见明确实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。双上胸膜略厚。；检查结论: 心肺未见明显病变。\n- [全程D1] 检验组合: 胱抑素(Cys-C)-静脉血: 0.8mg/L；钾离子(K+)-静脉血: 4.14mmol/L；肌酐(Crea)-静脉血: 65umol/L；葡萄糖(Glu)-静脉血: 5.25mmol/L；载脂蛋白B(apoB)-静脉血: 0.81g/L；碱性磷酸酶(ALP)-静脉血: 47U/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:20（参考: 阴性）；乳酸脱氢酶(LDH)-静脉血: 210.4U/L；纤维蛋白原(Fbg)-静脉血: 2.89g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.62；天门冬氨酸氨基转移酶(AST)-静脉血: 19.6U/L；阴离子间隙(AG)-静脉血: 14.7；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.376COI；总胆固醇(TC)-静脉血: 4.58mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.7mmolL；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.56g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.5mmol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 1.79COI；总胆汁酸(TBA)-静脉血: 2umol/L；平均血小板体积(MPV)-静脉血: 10.5fL；磷(P)-静脉血: 1.23mmol/L；单核细胞百分比(Mono%)-静脉血: 0.042；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 0.009COI；甘油三酯(TG)-静脉血: 0.86mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.1mmol/L；平均红细胞体积(MCV)-静脉血: 96.1fL；丙氨酸氨基转移酶(ALT)-静脉血: 15U/L；血小板分布宽度(PDW)-静脉血: 12.1%；C-反应蛋白(CRP)-静脉血: 0.28mg/L；α-L-岩藻糖苷酶(AFU)-静脉血: 33.2U/L；尿素氮(BUN)-静脉血: 4.7mmol/L；球蛋白(GLO)-静脉血: 28.21g/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 0.109……\n- [全程D2] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁 、顶后壁、左侧壁增厚，见软组织肿物影。左侧咽隐窝消失，右侧咽隐窝变浅；病灶呈稍长分期信息见历史辅助诊断节点稍长分期信息见历史辅助诊断节点信号，增强扫描强化明显。 口咽双侧壁未见增厚。鼻腔未见肿物影。 左侧咽旁脂肪间隙变窄，左侧颈动脉鞘区见肿物占据。左侧腭帆张提肌及左侧头长肌受侵。 左侧翼腭窝见软组织影；右侧翼腭窝、双侧颞下窝未见异常。 斜坡、左侧岩尖、左侧破裂孔，左侧蝶骨大翼、左侧翼突、左侧翼管、左侧圆孔、蝶骨基底部骨质破坏。 蝶窦见软组织肿物；右侧乳突、双侧上颌窦充气良好；蝶窦、筛窦及左侧乳突见分泌物。 双眼未见异常。 左侧海绵窦见可疑肿物侵犯。 双侧咽后淋巴结肿大，左侧短径大小约为15mm，见包膜外侵；右侧短径大小约为11mm。双侧II区见多个肿大淋巴结，相互融合，最大短径大小约为18mm。 右侧腮腺见小淋巴结，短径约为7mm。 双侧腮腺。颌下腺、甲状腺未见异常。；检查结论: 考虑鼻咽癌，左侧咽旁间隙、颅底骨质； 可疑左侧海绵窦受侵。 双侧咽后淋巴结，双侧II区淋巴结肿大，考虑转移。 右侧腮腺小淋巴结，性质待定。 副鼻窦炎症。 左侧乳突炎症。\n- [全程D2] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，肝内血管走行自然，门静脉内径约10mm，未见明确肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约26cm/s。 胆囊大小正常，壁不厚，光滑，其内未见异常回声。 脾脏大小正常，包膜光滑，实质回声均匀。 胰腺大小正常，包膜光滑，实质回声均匀，胰管无扩张。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位性病变。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D9] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；白细胞计数(WBC#)-静脉血: 9.210E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.812；单核细胞百分比(Mono%)-静脉血: 0.005；平均血小板体积(MPV)-静脉血: 11.2fL；平均红细胞体积(MCV)-静脉血: 95.5fL；血小板比容-静脉血: 21%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.1；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339g/L；大血小板百分比(P-LCR%)-静脉血: 36.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.178；平均红细胞血红蛋白含量(MCH)-静脉血: 32.4pg；单核细胞计数(Mono#)-静脉血: 0.110E9/L；红细胞计数(RBC#)-静脉血: 3.5210E12/L；血小板分布宽度(PDW)-静脉血: 13.8%；血小板计数(PLT#)-静脉血: 19010E9/L；红细胞比容(Hct)-静脉血: 33.6%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 114g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.4；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；中性粒细胞计数(Neut#)-静脉血: 7.410E9/L\n- [全程D13] 检验组合: 嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；大血小板百分比(P-LCR%)-静脉血: 33.8%；淋巴细胞百分比(Lymph%)-静脉血: 0.645；平均红细胞血红蛋白含量(MCH)-静脉血: 32.1pg；血红蛋白(Hb)-静脉血: 130g/L；白细胞计数(WBC#)-静脉血: 1.710E9/L；平均红细胞体积(MCV)-静脉血: 92.6fL；红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；单核细胞百分比(Mono%)-静脉血: 0.114；血小板分布宽度(PDW)-静脉血: 13%；中性粒细胞百分比(Neut%)-静脉血: 0.229；红细胞比容(Hct)-静脉血: 37.5%；单核细胞计数(Mono#)-静脉血: 0.210E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 35.6；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；血小板比容-静脉血: 27%；中性粒细胞计数(Neut#)-静脉血: 0.410E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.006；血小板计数(PLT#)-静脉血: 24210E9/L；平均血小板体积(MPV)-静脉血: 11fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 10.6；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L\n- [全程D14] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；淋巴细胞百分比(Lymph%)-静脉血: 0.51；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板比容-静脉血: 23%；红细胞计数(RBC#)-静脉血: 3.8110E12/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.8pg；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.8；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；白细胞计数(WBC#)-静脉血: 2.510E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.151；大血小板百分比(P-LCR%)-静脉血: 28.8%；红细胞比容(Hct)-静脉血: 34.9%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 121g/L；平均红细胞体积(MCV)-静脉血: 91.6fL；血小板分布宽度(PDW)-静脉血: 12.4%；单核细胞百分比(Mono%)-静脉血: 0.291；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；中性粒细胞计数(Neut#)-静脉血: 0.410E9/L；平均血小板体积(MPV)-静脉血: 10.4fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.3；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；血小板计数(PLT#)-静脉血: 22010E9/L\n- [全程D15] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；红细胞计数(RBC#)-静脉血: 3.8910E12/L；血小板分布宽度(PDW)-静脉血: 12.8%；平均红细胞体积(MCV)-静脉血: 94.6fL；中性粒细胞计数(Neut#)-静脉血: 2.610E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 35.8；平均血小板体积(MPV)-静脉血: 10.4fL；中性粒细胞百分比(Neut%)-静脉血: 0.496；淋巴细胞百分比(Lymph%)-静脉血: 0.292；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 334g/L；血红蛋白(Hb)-静脉血: 123g/L；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.202；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 10.8；白细胞计数(WBC#)-静脉血: 5.210E9/L；血小板计数(PLT#)-静脉血: 25410E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.6pg；血小板比容-静脉血: 26%；大血小板百分比(P-LCR%)-静脉血: 29%；红细胞比容(Hct)-静脉血: 36.8%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；单核细胞计数(Mono#)-静脉血: 1.110E9/L\n- [全程D16] 检验组合: 红细胞体积分布宽度SD(RDW-SD)-静脉血: 37；大血小板百分比(P-LCR%)-静脉血: 29.9%；红细胞比容(Hct)-静脉血: 34.2%；血小板计数(PLT#)-静脉血: 26510E9/L；单核细胞计数(Mono#)-静脉血: 1.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.128；血小板比容-静脉血: 28%；白细胞计数(WBC#)-静脉血: 11.810E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；血红蛋白(Hb)-静脉血: 113g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.8pg；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11；中性粒细胞计数(Neut#)-静脉血: 7.910E9/L；血小板分布宽度(PDW)-静脉血: 12.3%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；红细胞计数(RBC#)-静脉血: 3.5510E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.667；平均血小板体积(MPV)-静脉血: 10.5fL；淋巴细胞计数(Lymph#)-静脉血: 2.310E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.197；平均红细胞体积(MCV)-静脉血: 96.3fL\n- [全程D26] 检验组合: 直接胆红素(DBIL)-静脉血: 1.5umol/L；C-反应蛋白(CRP)-静脉血: 6.47mg/L；红细胞比容(Hct)-静脉血: 35.4%；阴离子间隙(AG)-静脉血: 8；血小板分布宽度(PDW)-静脉血: 10.3%；总钙(Ca)-静脉血: 2.27mmol/L；甘油三酯(TG)-静脉血: 0.74mmol/L；尿素氮(BUN)-静脉血: 4.68mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 32.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 32.4U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；葡萄糖(Glu)-静脉血: 5.39mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；白细胞计数(WBC#)-静脉血: 410E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 34U/L；磷(P)-静脉血: 1.35mmol/L；乳酸脱氢酶(LDH)-静脉血: 198.6U/L；血小板计数(PLT#)-静脉血: 25510E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.4；碱性磷酸酶(ALP)-静脉血: 92.4U/L；钾离子(K+)-静脉血: 3.9mmol/L；总蛋白(TP)-静脉血: 64.1g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.435；钠离子(Na+)-静脉血: 140.2mmol/L；胱抑素(Cys-C)-静脉血: 0.82mg/L；大血小板百分比(P-LCR%)-静脉血: 19.1%；间接胆红素(IBIL)-静脉血: 3.9umolL；红细胞计数(RBC#)-静脉血: 3.710E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.6pg；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；平均血小板体积(MPV)-静脉血: 9.3fL；氯离子(Cl-)-静脉血: 100.2mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.23g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.9；淋巴细胞百分比(Lymph%)-静脉血: 0.481；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.9；中性粒细胞计数(Neut#)-静脉……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者入院第2天，一般情况可，今日[姓名已隐去]医生信息已隐藏，详细听取病情汇报、检查患者后指示：尽快完善各项治疗前检查，明确诊断及分期，并了解有无合并其他基础疾病，待分期明确后再定治疗方案。遵嘱执行。\n- [全程D13] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。胡医生信息已隐藏：患者予复查血象变化，密切观察患者病情变化。遵嘱。\n- [全程D16] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。检查回报：白细胞 2.5×109/L 。胡医生信息已隐藏：患者出现II度骨髓抑制，考虑化疗引起的副反应，予升白等对症处理，密切观察患者病情变化。遵嘱。\n- [全程D19] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。检查结果回报：白细胞 11.8×109/L。胡医生信息已隐藏：患者血象已恢复正常，密切观察患者病情变化。遵嘱。\n- [全程D22] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。胡医生信息已隐藏：患者予对症处理，密切观察患者病情变化。遵嘱。\n- [全程D25] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。胡医生信息已隐藏：患者予对症处理，密切观察患者病情变化。遵嘱。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 预防性给予重组人粒细胞集落刺激因子（G-CSF）皮下注射，并推迟后续抗肿瘤治疗。\nB. 立即输注红细胞悬液2U，并皮下注射促红细胞生成素（EPO）纠正贫血。\nC. 启动异甘草酸镁及多烯磷脂酰胆碱静脉滴注，进行双靶点强化保肝治疗。\nD. 建立中心静脉通道，给予10%氯化钾注射液微量泵持续静脉泵入补钾。\nE. 留取血培养后，经验性静脉滴注头孢哌酮舒巴坦等广谱抗菌药物抗感染。\nF. 每日静脉输注人血白蛋白10g，并配合静脉推注呋塞米进行利尿消肿。\nG. 给予碳酸氢钠静脉滴注碱化尿液，并进行每日3000ml以上大剂量水化。\nH. 启动胰岛素泵持续皮下泵入强化降糖治疗，并严格限制碳水化合物摄入。\nI. 暂不需集落刺激因子支持，予以复方氨基酸及转化糖电解质静脉营养支持，并进行动静脉置管护理。\nJ. 持续静脉泵入质子泵抑制剂及5-HT3受体拮抗剂，进行强化抑酸止吐。\nK. 预防性输注单采血小板1个治疗量，并皮下注射重组人血小板生成素。\nL. 给予拉布立酶静脉滴注，并配合大剂量静脉水化预防肿瘤溶解综合征。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、颈动脉鞘、斜坡、海绵窦、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 间断性回吸性涕血1年余。；现病史: 患者近一年以来无明显原因出现回吸性涕血、近一个月左侧鼻塞明显，间断鼻衄。双侧耳鸣伴左耳听力下降，左侧头痛，双颈肿块。无面麻、张口困难、软腭麻痹，无咳嗽咳痰、呼吸困难。伴双侧咽后、颈部淋巴结转移。现为进一步诊治入院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重下降1Kg。；阳性症状体征: 体重下降,听力下降,双颈肿物,双耳鸣,涕血,鼻衄,左鼻塞,左侧头痛；既往史: 既往体健。4年前妊娠期间高血糖。3年前剖宫产。否认肝炎、结核等传染病史。否认心脏病、高血压史。预防接种史不详。过敏史:无药物及食物过敏史。；个人史: 出生于原籍，无烟酒药物等嗜好，无疫水接触史，否认不洁性生活史。无工业毒物，粉尘，放射性物质接触史。；家族史: 否认家族其他成员中有类似病患者或肿瘤患者。；体格检查: T36.5℃P78次/分R19次/分BP115/70mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。无鼻翼扇动、鼻衄。牙龈无肿胀、出血。气管居中，甲状腺不大。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率70bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。；专科检查: KPS 90。双颈II区触及多枚肿大淋巴结，直径约1.0cm，质韧、固定、相互融合。颅神经（-）。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 间断性回吸性涕血1年余。；现病史: 患者近一年以来无明显原因出现回吸性涕血、近一个月左侧鼻塞明显，间断鼻衄。双侧耳鸣伴左耳听力下降，左侧头痛，双颈肿块。无面麻、张口困难、软腭麻痹，无咳嗽咳痰、呼吸困难。当地医院CT提示：鼻咽癌侵犯枕斜坡双侧蝶窦。伴双侧咽后、颈部淋巴结转移。现为进一步诊治入院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重下降1Kg。；阳性症状体征: 体重下降,听力下降,双颈肿物,双耳鸣,涕血,鼻衄,左鼻塞,左侧头痛；既往史: 既往体健。4年前妊娠期间高血糖。3年前剖宫产。否认肝炎、结核等传染病史。否认心脏病、高血压史。预防接种史不详。过敏史:无药物及食物过敏史。；个人史: 出生于原籍，无烟酒药物等嗜好，无疫水接触史，否认不洁性生活史。无工业毒物，粉尘，放射性物质接触史。；家族史: 否认家族其他成员中有类似病患者或肿瘤患者。；体格检查: T36.5℃P78次/分R19次/分BP115/70mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。无鼻翼扇动、鼻衄。牙龈无肿胀、出血。气管居中，甲状腺不大。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率70bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。肛门外生殖器未见异常，生理反射存在，病理反射未引出。；专科检查: KPS 90。张口门齿距4.5cm，间接鼻咽镜：见鼻咽左侧壁肿物肿物；双颈II区触及多枚肿大淋巴结，直径约1.0cm，质韧、固定、相互融合。颅神经（-）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 正常范围心电图\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理清晰，走行自然，双肺野内未见明确实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。双上胸膜略厚。；检查结论: 心肺未见明显病变。\n- [全程D1] 检验组合: 胱抑素(Cys-C)-静脉血: 0.8mg/L；钾离子(K+)-静脉血: 4.14mmol/L；肌酐(Crea)-静脉血: 65umol/L；葡萄糖(Glu)-静脉血: 5.25mmol/L；载脂蛋白B(apoB)-静脉血: 0.81g/L；碱性磷酸酶(ALP)-静脉血: 47U/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:20（参考: 阴性）；乳酸脱氢酶(LDH)-静脉血: 210.4U/L；纤维蛋白原(Fbg)-静脉血: 2.89g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.62；天门冬氨酸氨基转移酶(AST)-静脉血: 19.6U/L；阴离子间隙(AG)-静脉血: 14.7；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.376COI；总胆固醇(TC)-静脉血: 4.58mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.7mmolL；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.56g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.5mmol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 1.79COI；总胆汁酸(TBA)-静脉血: 2umol/L；平均血小板体积(MPV)-静脉血: 10.5fL；磷(P)-静脉血: 1.23mmol/L；单核细胞百分比(Mono%)-静脉血: 0.042；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 0.009COI；甘油三酯(TG)-静脉血: 0.86mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.1mmol/L；平均红细胞体积(MCV)-静脉血: 96.1fL；丙氨酸氨基转移酶(ALT)-静脉血: 15U/L；血小板分布宽度(PDW)-静脉血: 12.1%；C-反应蛋白(CRP)-静脉血: 0.28mg/L；α-L-岩藻糖苷酶(AFU)-静脉血: 33.2U/L；尿素氮(BUN)-静脉血: 4.7mmol/L；球蛋白(GLO)-静脉血: 28.21g/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 0.109……\n- [全程D2] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁 、顶后壁、左侧壁增厚，见软组织肿物影。左侧咽隐窝消失，右侧咽隐窝变浅；病灶呈稍长分期信息见历史辅助诊断节点稍长分期信息见历史辅助诊断节点信号，增强扫描强化明显。 口咽双侧壁未见增厚。鼻腔未见肿物影。 左侧咽旁脂肪间隙变窄，左侧颈动脉鞘区见肿物占据。左侧腭帆张提肌及左侧头长肌受侵。 左侧翼腭窝见软组织影；右侧翼腭窝、双侧颞下窝未见异常。 斜坡、左侧岩尖、左侧破裂孔，左侧蝶骨大翼、左侧翼突、左侧翼管、左侧圆孔、蝶骨基底部骨质破坏。 蝶窦见软组织肿物；右侧乳突、双侧上颌窦充气良好；蝶窦、筛窦及左侧乳突见分泌物。 双眼未见异常。 左侧海绵窦见可疑肿物侵犯。 双侧咽后淋巴结肿大，左侧短径大小约为15mm，见包膜外侵；右侧短径大小约为11mm。双侧II区见多个肿大淋巴结，相互融合，最大短径大小约为18mm。 右侧腮腺见小淋巴结，短径约为7mm。 双侧腮腺。颌下腺、甲状腺未见异常。；检查结论: 考虑鼻咽癌，左侧咽旁间隙、颅底骨质； 可疑左侧海绵窦受侵。 双侧咽后淋巴结，双侧II区淋巴结肿大，考虑转移。 右侧腮腺小淋巴结，性质待定。 副鼻窦炎症。 左侧乳突炎症。\n- [全程D2] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，肝内血管走行自然，门静脉内径约10mm，未见明确肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约26cm/s。 胆囊大小正常，壁不厚，光滑，其内未见异常回声。 脾脏大小正常，包膜光滑，实质回声均匀。 胰腺大小正常，包膜光滑，实质回声均匀，胰管无扩张。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位性病变。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D9] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；白细胞计数(WBC#)-静脉血: 9.210E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.812；单核细胞百分比(Mono%)-静脉血: 0.005；平均血小板体积(MPV)-静脉血: 11.2fL；平均红细胞体积(MCV)-静脉血: 95.5fL；血小板比容-静脉血: 21%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.1；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339g/L；大血小板百分比(P-LCR%)-静脉血: 36.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.178；平均红细胞血红蛋白含量(MCH)-静脉血: 32.4pg；单核细胞计数(Mono#)-静脉血: 0.110E9/L；红细胞计数(RBC#)-静脉血: 3.5210E12/L；血小板分布宽度(PDW)-静脉血: 13.8%；血小板计数(PLT#)-静脉血: 19010E9/L；红细胞比容(Hct)-静脉血: 33.6%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 114g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.4；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；中性粒细胞计数(Neut#)-静脉血: 7.410E9/L\n- [全程D13] 检验组合: 嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；大血小板百分比(P-LCR%)-静脉血: 33.8%；淋巴细胞百分比(Lymph%)-静脉血: 0.645；平均红细胞血红蛋白含量(MCH)-静脉血: 32.1pg；血红蛋白(Hb)-静脉血: 130g/L；白细胞计数(WBC#)-静脉血: 1.710E9/L；平均红细胞体积(MCV)-静脉血: 92.6fL；红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；单核细胞百分比(Mono%)-静脉血: 0.114；血小板分布宽度(PDW)-静脉血: 13%；中性粒细胞百分比(Neut%)-静脉血: 0.229；红细胞比容(Hct)-静脉血: 37.5%；单核细胞计数(Mono#)-静脉血: 0.210E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 35.6；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；血小板比容-静脉血: 27%；中性粒细胞计数(Neut#)-静脉血: 0.410E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.006；血小板计数(PLT#)-静脉血: 24210E9/L；平均血小板体积(MPV)-静脉血: 11fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 10.6；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L\n- [全程D14] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；淋巴细胞百分比(Lymph%)-静脉血: 0.51；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板比容-静脉血: 23%；红细胞计数(RBC#)-静脉血: 3.8110E12/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.8pg；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.8；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；白细胞计数(WBC#)-静脉血: 2.510E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.151；大血小板百分比(P-LCR%)-静脉血: 28.8%；红细胞比容(Hct)-静脉血: 34.9%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 121g/L；平均红细胞体积(MCV)-静脉血: 91.6fL；血小板分布宽度(PDW)-静脉血: 12.4%；单核细胞百分比(Mono%)-静脉血: 0.291；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；中性粒细胞计数(Neut#)-静脉血: 0.410E9/L；平均血小板体积(MPV)-静脉血: 10.4fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.3；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；血小板计数(PLT#)-静脉血: 22010E9/L\n- [全程D15] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；红细胞计数(RBC#)-静脉血: 3.8910E12/L；血小板分布宽度(PDW)-静脉血: 12.8%；平均红细胞体积(MCV)-静脉血: 94.6fL；中性粒细胞计数(Neut#)-静脉血: 2.610E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 35.8；平均血小板体积(MPV)-静脉血: 10.4fL；中性粒细胞百分比(Neut%)-静脉血: 0.496；淋巴细胞百分比(Lymph%)-静脉血: 0.292；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 334g/L；血红蛋白(Hb)-静脉血: 123g/L；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.202；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 10.8；白细胞计数(WBC#)-静脉血: 5.210E9/L；血小板计数(PLT#)-静脉血: 25410E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.6pg；血小板比容-静脉血: 26%；大血小板百分比(P-LCR%)-静脉血: 29%；红细胞比容(Hct)-静脉血: 36.8%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；单核细胞计数(Mono#)-静脉血: 1.110E9/L\n- [全程D16] 检验组合: 红细胞体积分布宽度SD(RDW-SD)-静脉血: 37；大血小板百分比(P-LCR%)-静脉血: 29.9%；红细胞比容(Hct)-静脉血: 34.2%；血小板计数(PLT#)-静脉血: 26510E9/L；单核细胞计数(Mono#)-静脉血: 1.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.128；血小板比容-静脉血: 28%；白细胞计数(WBC#)-静脉血: 11.810E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；血红蛋白(Hb)-静脉血: 113g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.8pg；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11；中性粒细胞计数(Neut#)-静脉血: 7.910E9/L；血小板分布宽度(PDW)-静脉血: 12.3%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；红细胞计数(RBC#)-静脉血: 3.5510E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.667；平均血小板体积(MPV)-静脉血: 10.5fL；淋巴细胞计数(Lymph#)-静脉血: 2.310E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.197；平均红细胞体积(MCV)-静脉血: 96.3fL\n- [全程D26] 检验组合: 直接胆红素(DBIL)-静脉血: 1.5umol/L；C-反应蛋白(CRP)-静脉血: 6.47mg/L；红细胞比容(Hct)-静脉血: 35.4%；阴离子间隙(AG)-静脉血: 8；血小板分布宽度(PDW)-静脉血: 10.3%；总钙(Ca)-静脉血: 2.27mmol/L；甘油三酯(TG)-静脉血: 0.74mmol/L；尿素氮(BUN)-静脉血: 4.68mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 32.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 32.4U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；葡萄糖(Glu)-静脉血: 5.39mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；白细胞计数(WBC#)-静脉血: 410E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 34U/L；磷(P)-静脉血: 1.35mmol/L；乳酸脱氢酶(LDH)-静脉血: 198.6U/L；血小板计数(PLT#)-静脉血: 25510E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.4；碱性磷酸酶(ALP)-静脉血: 92.4U/L；钾离子(K+)-静脉血: 3.9mmol/L；总蛋白(TP)-静脉血: 64.1g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.435；钠离子(Na+)-静脉血: 140.2mmol/L；胱抑素(Cys-C)-静脉血: 0.82mg/L；大血小板百分比(P-LCR%)-静脉血: 19.1%；间接胆红素(IBIL)-静脉血: 3.9umolL；红细胞计数(RBC#)-静脉血: 3.710E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.6pg；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；平均血小板体积(MPV)-静脉血: 9.3fL；氯离子(Cl-)-静脉血: 100.2mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.23g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.9；淋巴细胞百分比(Lymph%)-静脉血: 0.481；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.9；中性粒细胞计数(Neut#)-静脉……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者入院第2天，一般情况可，今日[姓名已隐去]医生信息已隐藏，详细听取病情汇报、检查患者后指示：尽快完善各项治疗前检查，明确诊断及分期，并了解有无合并其他基础疾病，待分期明确后再定治疗方案。遵嘱执行。\n- [全程D13] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。胡医生信息已隐藏：患者予复查血象变化，密切观察患者病情变化。遵嘱。\n- [全程D16] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。检查回报：白细胞 2.5×109/L 。胡医生信息已隐藏：患者出现II度骨髓抑制，考虑化疗引起的副反应，予升白等对症处理，密切观察患者病情变化。遵嘱。\n- [全程D19] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。检查结果回报：白细胞 11.8×109/L。胡医生信息已隐藏：患者血象已恢复正常，密切观察患者病情变化。遵嘱。\n- [全程D22] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。胡医生信息已隐藏：患者予对症处理，密切观察患者病情变化。遵嘱。\n- [全程D25] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。胡医生信息已隐藏：患者予对症处理，密切观察患者病情变化。遵嘱。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 预防性给予重组人粒细胞集落刺激因子（G-CSF）皮下注射，并推迟后续抗肿瘤治疗。\nB. 立即输注红细胞悬液2U，并皮下注射促红细胞生成素（EPO）纠正贫血。\nC. 启动异甘草酸镁及多烯磷脂酰胆碱静脉滴注，进行双靶点强化保肝治疗。\nD. 建立中心静脉通道，给予10%氯化钾注射液微量泵持续静脉泵入补钾。\nE. 留取血培养后，经验性静脉滴注头孢哌酮舒巴坦等广谱抗菌药物抗感染。\nF. 每日静脉输注人血白蛋白10g，并配合静脉推注呋塞米进行利尿消肿。\nG. 给予碳酸氢钠静脉滴注碱化尿液，并进行每日3000ml以上大剂量水化。\nH. 启动胰岛素泵持续皮下泵入强化降糖治疗，并严格限制碳水化合物摄入。\nI. 暂不需集落刺激因子支持，予以复方氨基酸及转化糖电解质静脉营养支持，并进行动静脉置管护理。\nJ. 持续静脉泵入质子泵抑制剂及5-HT3受体拮抗剂，进行强化抑酸止吐。\nK. 预防性输注单采血小板1个治疗量，并皮下注射重组人血小板生成素。\nL. 给予拉布立酶静脉滴注，并配合大剂量静脉水化预防肿瘤溶解综合征。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-00fdb85efc65b944f8959fc3","patient_id":"patient-e90c2443e271b2e927262653","turn_id":"turn07","turn_position":6,"turn_type":"response_assessment_decision","gold_letter":"J","gold_action":"评估为部分缓解（PR），结束诱导化疗，出院休养并定期监测血象，择期行根治性放疗及同期化疗。","options":[{"letter":"A","text":"评估为完全缓解（CR），结束诱导化疗，直接进入随访观察阶段，定期复查鼻咽及颈部MRI。","is_gold":false},{"letter":"B","text":"评估为疾病稳定（SD），更换为吉西他滨联合顺铂方案继续化疗2周期。","is_gold":false},{"letter":"C","text":"评估为疾病进展（PD），转为姑息性放疗及靶向治疗。","is_gold":false},{"letter":"D","text":"评估为部分缓解（PR），继续原方案（多西他赛联合顺铂）诱导化疗第4-6周期。","is_gold":false},{"letter":"E","text":"评估为部分缓解（PR），先行双侧颈部淋巴结清扫术，术后行根治性放疗。","is_gold":false},{"letter":"F","text":"评估为部分缓解（PR），结束诱导化疗，择期行单纯根治性放疗。","is_gold":false},{"letter":"G","text":"评估为部分缓解（PR），行鼻咽内镜下颅底肿瘤切除术联合术后放疗。","is_gold":false},{"letter":"H","text":"评估为部分缓解（PR），结束诱导化疗，择期行根治性放疗及同期靶向治疗。","is_gold":false},{"letter":"I","text":"评估为疾病稳定（SD），提前终止化疗，立即开始根治性放疗及同期化疗。","is_gold":false},{"letter":"J","text":"评估为部分缓解（PR），结束诱导化疗，出院休养并定期监测血象，择期行根治性放疗及同期化疗。","is_gold":true},{"letter":"K","text":"评估为部分缓解（PR），结束诱导化疗，行全身PET-CT检查排除远处转移后再决定后续治疗。","is_gold":false},{"letter":"L","text":"评估为完全缓解（CR），结束诱导化疗，择期行预防性低剂量放疗。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、颈动脉鞘、斜坡、海绵窦、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 间断性回吸性涕血1年余。；现病史: 患者近一年以来无明显原因出现回吸性涕血、近一个月左侧鼻塞明显，间断鼻衄。双侧耳鸣伴左耳听力下降，左侧头痛，双颈肿块。无面麻、张口困难、软腭麻痹，无咳嗽咳痰、呼吸困难。伴双侧咽后、颈部淋巴结转移。现为进一步诊治入院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重下降1Kg。；阳性症状体征: 体重下降,听力下降,双颈肿物,双耳鸣,涕血,鼻衄,左鼻塞,左侧头痛；既往史: 既往体健。4年前妊娠期间高血糖。3年前剖宫产。否认肝炎、结核等传染病史。否认心脏病、高血压史。预防接种史不详。过敏史:无药物及食物过敏史。；个人史: 出生于原籍，无烟酒药物等嗜好，无疫水接触史，否认不洁性生活史。无工业毒物，粉尘，放射性物质接触史。；家族史: 否认家族其他成员中有类似病患者或肿瘤患者。；体格检查: T36.5℃P78次/分R19次/分BP115/70mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。无鼻翼扇动、鼻衄。牙龈无肿胀、出血。气管居中，甲状腺不大。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率70bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。；专科检查: KPS 90。双颈II区触及多枚肿大淋巴结，直径约1.0cm，质韧、固定、相互融合。颅神经（-）。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 间断性回吸性涕血1年余。；现病史: 患者近一年以来无明显原因出现回吸性涕血、近一个月左侧鼻塞明显，间断鼻衄。双侧耳鸣伴左耳听力下降，左侧头痛，双颈肿块。无面麻、张口困难、软腭麻痹，无咳嗽咳痰、呼吸困难。当地医院CT提示：鼻咽癌侵犯枕斜坡双侧蝶窦。伴双侧咽后、颈部淋巴结转移。现为进一步诊治入院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重下降1Kg。；阳性症状体征: 体重下降,听力下降,双颈肿物,双耳鸣,涕血,鼻衄,左鼻塞,左侧头痛；既往史: 既往体健。4年前妊娠期间高血糖。3年前剖宫产。否认肝炎、结核等传染病史。否认心脏病、高血压史。预防接种史不详。过敏史:无药物及食物过敏史。；个人史: 出生于原籍，无烟酒药物等嗜好，无疫水接触史，否认不洁性生活史。无工业毒物，粉尘，放射性物质接触史。；家族史: 否认家族其他成员中有类似病患者或肿瘤患者。；体格检查: T36.5℃P78次/分R19次/分BP115/70mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。无鼻翼扇动、鼻衄。牙龈无肿胀、出血。气管居中，甲状腺不大。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率70bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。肛门外生殖器未见异常，生理反射存在，病理反射未引出。；专科检查: KPS 90。张口门齿距4.5cm，间接鼻咽镜：见鼻咽左侧壁肿物肿物；双颈II区触及多枚肿大淋巴结，直径约1.0cm，质韧、固定、相互融合。颅神经（-）。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 正常范围心电图\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理清晰，走行自然，双肺野内未见明确实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。双上胸膜略厚。；检查结论: 心肺未见明显病变。\n- [全程D1] 检验组合: 胱抑素(Cys-C)-静脉血: 0.8mg/L；钾离子(K+)-静脉血: 4.14mmol/L；肌酐(Crea)-静脉血: 65umol/L；葡萄糖(Glu)-静脉血: 5.25mmol/L；载脂蛋白B(apoB)-静脉血: 0.81g/L；碱性磷酸酶(ALP)-静脉血: 47U/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:20（参考: 阴性）；乳酸脱氢酶(LDH)-静脉血: 210.4U/L；纤维蛋白原(Fbg)-静脉血: 2.89g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.62；天门冬氨酸氨基转移酶(AST)-静脉血: 19.6U/L；阴离子间隙(AG)-静脉血: 14.7；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.376COI；总胆固醇(TC)-静脉血: 4.58mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.7mmolL；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.56g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.5mmol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 1.79COI；总胆汁酸(TBA)-静脉血: 2umol/L；平均血小板体积(MPV)-静脉血: 10.5fL；磷(P)-静脉血: 1.23mmol/L；单核细胞百分比(Mono%)-静脉血: 0.042；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 0.009COI；甘油三酯(TG)-静脉血: 0.86mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.1mmol/L；平均红细胞体积(MCV)-静脉血: 96.1fL；丙氨酸氨基转移酶(ALT)-静脉血: 15U/L；血小板分布宽度(PDW)-静脉血: 12.1%；C-反应蛋白(CRP)-静脉血: 0.28mg/L；α-L-岩藻糖苷酶(AFU)-静脉血: 33.2U/L；尿素氮(BUN)-静脉血: 4.7mmol/L；球蛋白(GLO)-静脉血: 28.21g/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 0.109……\n- [全程D2] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁 、顶后壁、左侧壁增厚，见软组织肿物影。左侧咽隐窝消失，右侧咽隐窝变浅；病灶呈稍长分期信息见历史辅助诊断节点稍长分期信息见历史辅助诊断节点信号，增强扫描强化明显。 口咽双侧壁未见增厚。鼻腔未见肿物影。 左侧咽旁脂肪间隙变窄，左侧颈动脉鞘区见肿物占据。左侧腭帆张提肌及左侧头长肌受侵。 左侧翼腭窝见软组织影；右侧翼腭窝、双侧颞下窝未见异常。 斜坡、左侧岩尖、左侧破裂孔，左侧蝶骨大翼、左侧翼突、左侧翼管、左侧圆孔、蝶骨基底部骨质破坏。 蝶窦见软组织肿物；右侧乳突、双侧上颌窦充气良好；蝶窦、筛窦及左侧乳突见分泌物。 双眼未见异常。 左侧海绵窦见可疑肿物侵犯。 双侧咽后淋巴结肿大，左侧短径大小约为15mm，见包膜外侵；右侧短径大小约为11mm。双侧II区见多个肿大淋巴结，相互融合，最大短径大小约为18mm。 右侧腮腺见小淋巴结，短径约为7mm。 双侧腮腺。颌下腺、甲状腺未见异常。；检查结论: 考虑鼻咽癌，左侧咽旁间隙、颅底骨质； 可疑左侧海绵窦受侵。 双侧咽后淋巴结，双侧II区淋巴结肿大，考虑转移。 右侧腮腺小淋巴结，性质待定。 副鼻窦炎症。 左侧乳突炎症。\n- [全程D2] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，肝内血管走行自然，门静脉内径约10mm，未见明确肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约26cm/s。 胆囊大小正常，壁不厚，光滑，其内未见异常回声。 脾脏大小正常，包膜光滑，实质回声均匀。 胰腺大小正常，包膜光滑，实质回声均匀，胰管无扩张。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位性病变。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D9] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；白细胞计数(WBC#)-静脉血: 9.210E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.812；单核细胞百分比(Mono%)-静脉血: 0.005；平均血小板体积(MPV)-静脉血: 11.2fL；平均红细胞体积(MCV)-静脉血: 95.5fL；血小板比容-静脉血: 21%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.1；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339g/L；大血小板百分比(P-LCR%)-静脉血: 36.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.178；平均红细胞血红蛋白含量(MCH)-静脉血: 32.4pg；单核细胞计数(Mono#)-静脉血: 0.110E9/L；红细胞计数(RBC#)-静脉血: 3.5210E12/L；血小板分布宽度(PDW)-静脉血: 13.8%；血小板计数(PLT#)-静脉血: 19010E9/L；红细胞比容(Hct)-静脉血: 33.6%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 114g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.4；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；中性粒细胞计数(Neut#)-静脉血: 7.410E9/L\n- [全程D13] 检验组合: 嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；大血小板百分比(P-LCR%)-静脉血: 33.8%；淋巴细胞百分比(Lymph%)-静脉血: 0.645；平均红细胞血红蛋白含量(MCH)-静脉血: 32.1pg；血红蛋白(Hb)-静脉血: 130g/L；白细胞计数(WBC#)-静脉血: 1.710E9/L；平均红细胞体积(MCV)-静脉血: 92.6fL；红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；单核细胞百分比(Mono%)-静脉血: 0.114；血小板分布宽度(PDW)-静脉血: 13%；中性粒细胞百分比(Neut%)-静脉血: 0.229；红细胞比容(Hct)-静脉血: 37.5%；单核细胞计数(Mono#)-静脉血: 0.210E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 35.6；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；血小板比容-静脉血: 27%；中性粒细胞计数(Neut#)-静脉血: 0.410E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.006；血小板计数(PLT#)-静脉血: 24210E9/L；平均血小板体积(MPV)-静脉血: 11fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 10.6；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L\n- [全程D14] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；淋巴细胞百分比(Lymph%)-静脉血: 0.51；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板比容-静脉血: 23%；红细胞计数(RBC#)-静脉血: 3.8110E12/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.8pg；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.8；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；白细胞计数(WBC#)-静脉血: 2.510E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.151；大血小板百分比(P-LCR%)-静脉血: 28.8%；红细胞比容(Hct)-静脉血: 34.9%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 121g/L；平均红细胞体积(MCV)-静脉血: 91.6fL；血小板分布宽度(PDW)-静脉血: 12.4%；单核细胞百分比(Mono%)-静脉血: 0.291；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；中性粒细胞计数(Neut#)-静脉血: 0.410E9/L；平均血小板体积(MPV)-静脉血: 10.4fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.3；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；血小板计数(PLT#)-静脉血: 22010E9/L\n- [全程D15] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；红细胞计数(RBC#)-静脉血: 3.8910E12/L；血小板分布宽度(PDW)-静脉血: 12.8%；平均红细胞体积(MCV)-静脉血: 94.6fL；中性粒细胞计数(Neut#)-静脉血: 2.610E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 35.8；平均血小板体积(MPV)-静脉血: 10.4fL；中性粒细胞百分比(Neut%)-静脉血: 0.496；淋巴细胞百分比(Lymph%)-静脉血: 0.292；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 334g/L；血红蛋白(Hb)-静脉血: 123g/L；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.202；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 10.8；白细胞计数(WBC#)-静脉血: 5.210E9/L；血小板计数(PLT#)-静脉血: 25410E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.6pg；血小板比容-静脉血: 26%；大血小板百分比(P-LCR%)-静脉血: 29%；红细胞比容(Hct)-静脉血: 36.8%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；单核细胞计数(Mono#)-静脉血: 1.110E9/L\n- [全程D16] 检验组合: 红细胞体积分布宽度SD(RDW-SD)-静脉血: 37；大血小板百分比(P-LCR%)-静脉血: 29.9%；红细胞比容(Hct)-静脉血: 34.2%；血小板计数(PLT#)-静脉血: 26510E9/L；单核细胞计数(Mono#)-静脉血: 1.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.128；血小板比容-静脉血: 28%；白细胞计数(WBC#)-静脉血: 11.810E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；血红蛋白(Hb)-静脉血: 113g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.8pg；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11；中性粒细胞计数(Neut#)-静脉血: 7.910E9/L；血小板分布宽度(PDW)-静脉血: 12.3%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；红细胞计数(RBC#)-静脉血: 3.5510E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.667；平均血小板体积(MPV)-静脉血: 10.5fL；淋巴细胞计数(Lymph#)-静脉血: 2.310E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.197；平均红细胞体积(MCV)-静脉血: 96.3fL\n- [全程D26] 检验组合: 直接胆红素(DBIL)-静脉血: 1.5umol/L；C-反应蛋白(CRP)-静脉血: 6.47mg/L；红细胞比容(Hct)-静脉血: 35.4%；阴离子间隙(AG)-静脉血: 8；血小板分布宽度(PDW)-静脉血: 10.3%；总钙(Ca)-静脉血: 2.27mmol/L；甘油三酯(TG)-静脉血: 0.74mmol/L；尿素氮(BUN)-静脉血: 4.68mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 32.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 32.4U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；葡萄糖(Glu)-静脉血: 5.39mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；白细胞计数(WBC#)-静脉血: 410E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 34U/L；磷(P)-静脉血: 1.35mmol/L；乳酸脱氢酶(LDH)-静脉血: 198.6U/L；血小板计数(PLT#)-静脉血: 25510E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.4；碱性磷酸酶(ALP)-静脉血: 92.4U/L；钾离子(K+)-静脉血: 3.9mmol/L；总蛋白(TP)-静脉血: 64.1g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.435；钠离子(Na+)-静脉血: 140.2mmol/L；胱抑素(Cys-C)-静脉血: 0.82mg/L；大血小板百分比(P-LCR%)-静脉血: 19.1%；间接胆红素(IBIL)-静脉血: 3.9umolL；红细胞计数(RBC#)-静脉血: 3.710E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.6pg；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；平均血小板体积(MPV)-静脉血: 9.3fL；氯离子(Cl-)-静脉血: 100.2mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.23g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.9；淋巴细胞百分比(Lymph%)-静脉血: 0.481；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.9；中性粒细胞计数(Neut#)-静脉……\n- [全程D36] 检验组合: 总胆固醇(TC)-静脉血: 4.01mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.55；γ-谷氨酰基转移酶(GGT)-静脉血: 22.5U/L；平均血小板体积(MPV)-静脉血: 10.1fL；淋巴细胞计数(Lymph#)-静脉血: 0.910E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.04；丙氨酸氨基转移酶(ALT)-静脉血: 42.3U/L；尿素氮(BUN)-静脉血: 6.2mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 26.3U/L；总胆红素(TBIL)-静脉血: 14.1umol/L；钠离子(Na+)-静脉血: 136mmol/L；碱性磷酸酶(ALP)-静脉血: 68U/L；白细胞计数(WBC#)-静脉血: 4.310E9/L；直接胆红素(DBIL)-静脉血: 4.6umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；单核细胞计数(Mono#)-静脉血: 0.110E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；磷(P)-静脉血: 0.99mmol/L；血红蛋白(Hb)-静脉血: 122g/L；氯离子(Cl-)-静脉血: 95mmol/L；血小板分布宽度(PDW)-静脉血: 12.3%；平均红细胞体积(MCV)-静脉血: 93.9fL；α-L-岩藻糖苷酶(AFU)-静脉血: 48.7U/L；阴离子间隙(AG)-静脉血: 14.1；钾离子(K+)-静脉血: 4.06mmol/L；红细胞比容(Hct)-静脉血: 35.7%；血小板比容-静脉血: 23%；白蛋白(ALB)-静脉血: 40.7g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；C-反应蛋白(CRP)-静脉血: 3.19mg/L；球蛋白(GLO)-静脉血: 26.19g/L；胱抑素(Cys-C)-静脉血: 0.64mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.04mmol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；载脂蛋白B(apoB)-静脉血: 0.72g/L；间接胆红素(IBIL)-静脉血: 9.5umolL；中性粒细胞百分比(Neut%)-静脉血: 0.729；尿酸(UA)-静脉血: 258.1umol/L；单核细胞百分比(Mono%)-静脉血: 0……\n- [全程D49] 检验组合: 单核细胞百分比(Mono%)-静脉血: 0.066；C-反应蛋白(CRP)-静脉血: 0.26mg/L；乳酸脱氢酶(LDH)-静脉血: 257.7U/L；氯离子(Cl-)-静脉血: 105.6mmol/L；总蛋白(TP)-静脉血: 65.51g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.002；甘油三酯(TG)-静脉血: 0.97mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.25mmolL；红细胞比容(Hct)-静脉血: 34.7%；间接胆红素(IBIL)-静脉血: 5.5umolL；单核细胞计数(Mono#)-静脉血: 0.310E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.5U/L；红细胞计数(RBC#)-静脉血: 3.5110E12/L；总钙(Ca)-静脉血: 2.08mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.94；葡萄糖(Glu)-静脉血: 4.89mmol/L；直接胆红素(DBIL)-静脉血: 2.4umol/L；镁离子(Mg2+)-静脉血: 1.09mmol/L；胱抑素(Cys-C)-静脉血: 0.69mg/L；总胆汁酸(TBA)-静脉血: 1.9umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 35.4U/L；肌酐(Crea)-静脉血: 52.4umol/L；载脂蛋白B(apoB)-静脉血: 0.81g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 48.8；平均红细胞血红蛋白含量(MCH)-静脉血: 32.5pg；钠离子(Na+)-静脉血: 141.4mmol/L；白蛋白(ALB)-静脉血: 40.9g/L；血小板分布宽度(PDW)-静脉血: 11%；血小板计数(PLT#)-静脉血: 19910E9/L；磷(P)-静脉血: 1.21mmol/L；钾离子(K+)-静脉血: 3.94mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.66；总胆固醇(TC)-静脉血: 4.19mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.55mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.465……\n- [全程D57] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后复查，对比某次就诊时间片： 鼻咽腔稍狭窄，鼻咽肿物较前明显缩小，鼻咽顶壁及双侧壁粘膜欠光滑，双侧咽隐窝变浅，鼻咽未见明显肿物，左侧腭帆提肌张肌及头长肌轮廓不清，其内及左侧咽后区见异常信号灶，增强扫描轻度强化，病灶范围较前明显缩小，强化程度较前降低。 左侧咽旁脂肪间隙变窄，左侧颈动脉鞘区见肿物占据，范围较前缩小，强化程度较前降低。左侧腭帆张提肌及左侧头长肌受侵。 口咽双侧壁未见增厚。鼻腔未见肿物。 左侧翼腭窝见少许软组织影，大致同前。右侧翼腭窝、双侧颞下窝未见异常。 斜坡、左侧岩尖、左侧破裂孔，左侧蝶骨大翼、左侧翼突、左侧翼管、左侧圆孔、蝶骨基底部骨质破坏，大致同前。 蝶窦见软组织肿物，较前明显缩小。 双侧上颌窦、蝶窦、筛窦粘膜增厚，左侧乳突少量分泌物。 双侧眼眶未见异常。左侧海绵窦未见明显右侧。 左侧咽后淋巴结肿大，短径约10mm，较前稍缩小。右侧咽后见小淋巴结，短径约4mm，较前明显缩小。双侧II区见多个淋巴结，相互融合，边界不清，较前明显缩小。右侧腮腺见小淋巴结，短径约为4mm。明显强化 左侧腮腺及双侧颌下腺未见异常。所示甲状腺未见异常。 所示脑实质常规MR及DTI未见明显异常信号灶。；检查结论: 鼻咽癌化疗后，鼻咽未见明显肿物，左侧咽旁、蝶窦肿物较前明显缩小。 颅底骨质破坏，大致同前。 双侧咽后及双颈II区淋巴结，较前缩小。 右侧腮腺小淋巴结。 鼻窦炎，左侧乳突炎症。\n- [全程D57] MRI；脑功能成像、DTI: 检查类型: MRI；检查名称: 脑功能成像、DTI；检查部位:；检查所见: 鼻咽癌化疗后复查，对比某次就诊时间片： 鼻咽腔稍狭窄，鼻咽肿物较前明显缩小，鼻咽顶壁及双侧壁粘膜欠光滑，双侧咽隐窝变浅，鼻咽未见明显肿物，左侧腭帆提肌张肌及头长肌轮廓不清，其内及左侧咽后区见异常信号灶，增强扫描轻度强化，病灶范围较前明显缩小，强化程度较前降低。 左侧咽旁脂肪间隙变窄，左侧颈动脉鞘区见肿物占据，范围较前缩小，强化程度较前降低。左侧腭帆张提肌及左侧头长肌受侵。 口咽双侧壁未见增厚。鼻腔未见肿物。 左侧翼腭窝见少许软组织影，大致同前。右侧翼腭窝、双侧颞下窝未见异常。 斜坡、左侧岩尖、左侧破裂孔，左侧蝶骨大翼、左侧翼突、左侧翼管、左侧圆孔、蝶骨基底部骨质破坏，大致同前。 蝶窦见软组织肿物，较前明显缩小。 双侧上颌窦、蝶窦、筛窦粘膜增厚，左侧乳突少量分泌物。 双侧眼眶未见异常。左侧海绵窦未见明显右侧。 左侧咽后淋巴结肿大，短径约10mm，较前稍缩小。右侧咽后见小淋巴结，短径约4mm，较前明显缩小。双侧II区见多个淋巴结，相互融合，边界不清，较前明显缩小。右侧腮腺见小淋巴结，短径约为4mm。明显强化 左侧腮腺及双侧颌下腺未见异常。所示甲状腺未见异常。 所示脑实质常规MR及DTI未见明显异常信号灶。；检查结论: 鼻咽癌化疗后，鼻咽未见明显肿物，左侧咽旁、蝶窦肿物较前明显缩小。 颅底骨质破坏，大致同前。 双侧咽后及双颈II区淋巴结，较前缩小。 右侧腮腺小淋巴结。 鼻窦炎，左侧乳突炎症。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者入院第2天，一般情况可，今日[姓名已隐去]医生信息已隐藏，详细听取病情汇报、检查患者后指示：尽快完善各项治疗前检查，明确诊断及分期，并了解有无合并其他基础疾病，待分期明确后再定治疗方案。遵嘱执行。\n- [全程D13] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。胡医生信息已隐藏：患者予复查血象变化，密切观察患者病情变化。遵嘱。\n- [全程D16] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。检查回报：白细胞 2.5×109/L 。胡医生信息已隐藏：患者出现II度骨髓抑制，考虑化疗引起的副反应，予升白等对症处理，密切观察患者病情变化。遵嘱。\n- [全程D19] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。检查结果回报：白细胞 11.8×109/L。胡医生信息已隐藏：患者血象已恢复正常，密切观察患者病情变化。遵嘱。\n- [全程D22] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。胡医生信息已隐藏：患者予对症处理，密切观察患者病情变化。遵嘱。\n- [全程D25] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。胡医生信息已隐藏：患者予对症处理，密切观察患者病情变化。遵嘱。\n- [全程D51] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者入院第2天，一般情况可，血常规、生化检查无明显异常。[姓名已隐去]医生信息已隐藏示：目前患者诊断明确，今日水化，明日开始第三程诱导化疗。\n- [全程D52] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，血常规、生化检查无明显异常。今日开始予多西他赛90mg/d1+PDD35mg/d1-3方案化疗。[姓名已隐去]医生信息已隐藏示：目前患者诊断明确，今日开始化疗，密切观察病情变化。\n- [全程D55] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，未诉特殊不适。[姓名已隐去]医生信息已隐藏示：目前患者今日化疗结束，密切观病情变化，如有不适，及时对症处理。\n- [全程D57] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，未诉特殊不适。[姓名已隐去]医生信息已隐藏示：目前患者化疗结束，病情稳定，可予出院。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估为完全缓解（CR），结束诱导化疗，直接进入随访观察阶段，定期复查鼻咽及颈部MRI。\nB. 评估为疾病稳定（SD），更换为吉西他滨联合顺铂方案继续化疗2周期。\nC. 评估为疾病进展（PD），转为姑息性放疗及靶向治疗。\nD. 评估为部分缓解（PR），继续原方案（多西他赛联合顺铂）诱导化疗第4-6周期。\nE. 评估为部分缓解（PR），先行双侧颈部淋巴结清扫术，术后行根治性放疗。\nF. 评估为部分缓解（PR），结束诱导化疗，择期行单纯根治性放疗。\nG. 评估为部分缓解（PR），行鼻咽内镜下颅底肿瘤切除术联合术后放疗。\nH. 评估为部分缓解（PR），结束诱导化疗，择期行根治性放疗及同期靶向治疗。\nI. 评估为疾病稳定（SD），提前终止化疗，立即开始根治性放疗及同期化疗。\nJ. 评估为部分缓解（PR），结束诱导化疗，出院休养并定期监测血象，择期行根治性放疗及同期化疗。\nK. 评估为部分缓解（PR），结束诱导化疗，行全身PET-CT检查排除远处转移后再决定后续治疗。\nL. 评估为完全缓解（CR），结束诱导化疗，择期行预防性低剂量放疗。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、颈动脉鞘、斜坡、海绵窦、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 间断性回吸性涕血1年余。；现病史: 患者近一年以来无明显原因出现回吸性涕血、近一个月左侧鼻塞明显，间断鼻衄。双侧耳鸣伴左耳听力下降，左侧头痛，双颈肿块。无面麻、张口困难、软腭麻痹，无咳嗽咳痰、呼吸困难。伴双侧咽后、颈部淋巴结转移。现为进一步诊治入院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重下降1Kg。；阳性症状体征: 体重下降,听力下降,双颈肿物,双耳鸣,涕血,鼻衄,左鼻塞,左侧头痛；既往史: 既往体健。4年前妊娠期间高血糖。3年前剖宫产。否认肝炎、结核等传染病史。否认心脏病、高血压史。预防接种史不详。过敏史:无药物及食物过敏史。；个人史: 出生于原籍，无烟酒药物等嗜好，无疫水接触史，否认不洁性生活史。无工业毒物，粉尘，放射性物质接触史。；家族史: 否认家族其他成员中有类似病患者或肿瘤患者。；体格检查: T36.5℃P78次/分R19次/分BP115/70mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。无鼻翼扇动、鼻衄。牙龈无肿胀、出血。气管居中，甲状腺不大。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率70bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。；专科检查: KPS 90。双颈II区触及多枚肿大淋巴结，直径约1.0cm，质韧、固定、相互融合。颅神经（-）。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 间断性回吸性涕血1年余。；现病史: 患者近一年以来无明显原因出现回吸性涕血、近一个月左侧鼻塞明显，间断鼻衄。双侧耳鸣伴左耳听力下降，左侧头痛，双颈肿块。无面麻、张口困难、软腭麻痹，无咳嗽咳痰、呼吸困难。当地医院CT提示：鼻咽癌侵犯枕斜坡双侧蝶窦。伴双侧咽后、颈部淋巴结转移。现为进一步诊治入院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重下降1Kg。；阳性症状体征: 体重下降,听力下降,双颈肿物,双耳鸣,涕血,鼻衄,左鼻塞,左侧头痛；既往史: 既往体健。4年前妊娠期间高血糖。3年前剖宫产。否认肝炎、结核等传染病史。否认心脏病、高血压史。预防接种史不详。过敏史:无药物及食物过敏史。；个人史: 出生于原籍，无烟酒药物等嗜好，无疫水接触史，否认不洁性生活史。无工业毒物，粉尘，放射性物质接触史。；家族史: 否认家族其他成员中有类似病患者或肿瘤患者。；体格检查: T36.5℃P78次/分R19次/分BP115/70mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。无鼻翼扇动、鼻衄。牙龈无肿胀、出血。气管居中，甲状腺不大。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率70bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。肛门外生殖器未见异常，生理反射存在，病理反射未引出。；专科检查: KPS 90。张口门齿距4.5cm，间接鼻咽镜：见鼻咽左侧壁肿物肿物；双颈II区触及多枚肿大淋巴结，直径约1.0cm，质韧、固定、相互融合。颅神经（-）。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 正常范围心电图\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理清晰，走行自然，双肺野内未见明确实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。双上胸膜略厚。；检查结论: 心肺未见明显病变。\n- [全程D1] 检验组合: 胱抑素(Cys-C)-静脉血: 0.8mg/L；钾离子(K+)-静脉血: 4.14mmol/L；肌酐(Crea)-静脉血: 65umol/L；葡萄糖(Glu)-静脉血: 5.25mmol/L；载脂蛋白B(apoB)-静脉血: 0.81g/L；碱性磷酸酶(ALP)-静脉血: 47U/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:20（参考: 阴性）；乳酸脱氢酶(LDH)-静脉血: 210.4U/L；纤维蛋白原(Fbg)-静脉血: 2.89g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.62；天门冬氨酸氨基转移酶(AST)-静脉血: 19.6U/L；阴离子间隙(AG)-静脉血: 14.7；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.376COI；总胆固醇(TC)-静脉血: 4.58mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.7mmolL；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.56g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.5mmol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 1.79COI；总胆汁酸(TBA)-静脉血: 2umol/L；平均血小板体积(MPV)-静脉血: 10.5fL；磷(P)-静脉血: 1.23mmol/L；单核细胞百分比(Mono%)-静脉血: 0.042；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 0.009COI；甘油三酯(TG)-静脉血: 0.86mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.1mmol/L；平均红细胞体积(MCV)-静脉血: 96.1fL；丙氨酸氨基转移酶(ALT)-静脉血: 15U/L；血小板分布宽度(PDW)-静脉血: 12.1%；C-反应蛋白(CRP)-静脉血: 0.28mg/L；α-L-岩藻糖苷酶(AFU)-静脉血: 33.2U/L；尿素氮(BUN)-静脉血: 4.7mmol/L；球蛋白(GLO)-静脉血: 28.21g/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 0.109……\n- [全程D2] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁 、顶后壁、左侧壁增厚，见软组织肿物影。左侧咽隐窝消失，右侧咽隐窝变浅；病灶呈稍长分期信息见历史辅助诊断节点稍长分期信息见历史辅助诊断节点信号，增强扫描强化明显。 口咽双侧壁未见增厚。鼻腔未见肿物影。 左侧咽旁脂肪间隙变窄，左侧颈动脉鞘区见肿物占据。左侧腭帆张提肌及左侧头长肌受侵。 左侧翼腭窝见软组织影；右侧翼腭窝、双侧颞下窝未见异常。 斜坡、左侧岩尖、左侧破裂孔，左侧蝶骨大翼、左侧翼突、左侧翼管、左侧圆孔、蝶骨基底部骨质破坏。 蝶窦见软组织肿物；右侧乳突、双侧上颌窦充气良好；蝶窦、筛窦及左侧乳突见分泌物。 双眼未见异常。 左侧海绵窦见可疑肿物侵犯。 双侧咽后淋巴结肿大，左侧短径大小约为15mm，见包膜外侵；右侧短径大小约为11mm。双侧II区见多个肿大淋巴结，相互融合，最大短径大小约为18mm。 右侧腮腺见小淋巴结，短径约为7mm。 双侧腮腺。颌下腺、甲状腺未见异常。；检查结论: 考虑鼻咽癌，左侧咽旁间隙、颅底骨质； 可疑左侧海绵窦受侵。 双侧咽后淋巴结，双侧II区淋巴结肿大，考虑转移。 右侧腮腺小淋巴结，性质待定。 副鼻窦炎症。 左侧乳突炎症。\n- [全程D2] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，肝内血管走行自然，门静脉内径约10mm，未见明确肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约26cm/s。 胆囊大小正常，壁不厚，光滑，其内未见异常回声。 脾脏大小正常，包膜光滑，实质回声均匀。 胰腺大小正常，包膜光滑，实质回声均匀，胰管无扩张。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位性病变。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D9] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；白细胞计数(WBC#)-静脉血: 9.210E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.812；单核细胞百分比(Mono%)-静脉血: 0.005；平均血小板体积(MPV)-静脉血: 11.2fL；平均红细胞体积(MCV)-静脉血: 95.5fL；血小板比容-静脉血: 21%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.1；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339g/L；大血小板百分比(P-LCR%)-静脉血: 36.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.178；平均红细胞血红蛋白含量(MCH)-静脉血: 32.4pg；单核细胞计数(Mono#)-静脉血: 0.110E9/L；红细胞计数(RBC#)-静脉血: 3.5210E12/L；血小板分布宽度(PDW)-静脉血: 13.8%；血小板计数(PLT#)-静脉血: 19010E9/L；红细胞比容(Hct)-静脉血: 33.6%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 114g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.4；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；中性粒细胞计数(Neut#)-静脉血: 7.410E9/L\n- [全程D13] 检验组合: 嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；大血小板百分比(P-LCR%)-静脉血: 33.8%；淋巴细胞百分比(Lymph%)-静脉血: 0.645；平均红细胞血红蛋白含量(MCH)-静脉血: 32.1pg；血红蛋白(Hb)-静脉血: 130g/L；白细胞计数(WBC#)-静脉血: 1.710E9/L；平均红细胞体积(MCV)-静脉血: 92.6fL；红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；单核细胞百分比(Mono%)-静脉血: 0.114；血小板分布宽度(PDW)-静脉血: 13%；中性粒细胞百分比(Neut%)-静脉血: 0.229；红细胞比容(Hct)-静脉血: 37.5%；单核细胞计数(Mono#)-静脉血: 0.210E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 35.6；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；血小板比容-静脉血: 27%；中性粒细胞计数(Neut#)-静脉血: 0.410E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.006；血小板计数(PLT#)-静脉血: 24210E9/L；平均血小板体积(MPV)-静脉血: 11fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 10.6；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L\n- [全程D14] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；淋巴细胞百分比(Lymph%)-静脉血: 0.51；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板比容-静脉血: 23%；红细胞计数(RBC#)-静脉血: 3.8110E12/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.8pg；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.8；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；白细胞计数(WBC#)-静脉血: 2.510E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.151；大血小板百分比(P-LCR%)-静脉血: 28.8%；红细胞比容(Hct)-静脉血: 34.9%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 121g/L；平均红细胞体积(MCV)-静脉血: 91.6fL；血小板分布宽度(PDW)-静脉血: 12.4%；单核细胞百分比(Mono%)-静脉血: 0.291；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；中性粒细胞计数(Neut#)-静脉血: 0.410E9/L；平均血小板体积(MPV)-静脉血: 10.4fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.3；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；血小板计数(PLT#)-静脉血: 22010E9/L\n- [全程D15] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；红细胞计数(RBC#)-静脉血: 3.8910E12/L；血小板分布宽度(PDW)-静脉血: 12.8%；平均红细胞体积(MCV)-静脉血: 94.6fL；中性粒细胞计数(Neut#)-静脉血: 2.610E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 35.8；平均血小板体积(MPV)-静脉血: 10.4fL；中性粒细胞百分比(Neut%)-静脉血: 0.496；淋巴细胞百分比(Lymph%)-静脉血: 0.292；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 334g/L；血红蛋白(Hb)-静脉血: 123g/L；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.202；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 10.8；白细胞计数(WBC#)-静脉血: 5.210E9/L；血小板计数(PLT#)-静脉血: 25410E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.6pg；血小板比容-静脉血: 26%；大血小板百分比(P-LCR%)-静脉血: 29%；红细胞比容(Hct)-静脉血: 36.8%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；单核细胞计数(Mono#)-静脉血: 1.110E9/L\n- [全程D16] 检验组合: 红细胞体积分布宽度SD(RDW-SD)-静脉血: 37；大血小板百分比(P-LCR%)-静脉血: 29.9%；红细胞比容(Hct)-静脉血: 34.2%；血小板计数(PLT#)-静脉血: 26510E9/L；单核细胞计数(Mono#)-静脉血: 1.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.128；血小板比容-静脉血: 28%；白细胞计数(WBC#)-静脉血: 11.810E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；血红蛋白(Hb)-静脉血: 113g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.8pg；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11；中性粒细胞计数(Neut#)-静脉血: 7.910E9/L；血小板分布宽度(PDW)-静脉血: 12.3%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；红细胞计数(RBC#)-静脉血: 3.5510E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.667；平均血小板体积(MPV)-静脉血: 10.5fL；淋巴细胞计数(Lymph#)-静脉血: 2.310E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.197；平均红细胞体积(MCV)-静脉血: 96.3fL\n- [全程D26] 检验组合: 直接胆红素(DBIL)-静脉血: 1.5umol/L；C-反应蛋白(CRP)-静脉血: 6.47mg/L；红细胞比容(Hct)-静脉血: 35.4%；阴离子间隙(AG)-静脉血: 8；血小板分布宽度(PDW)-静脉血: 10.3%；总钙(Ca)-静脉血: 2.27mmol/L；甘油三酯(TG)-静脉血: 0.74mmol/L；尿素氮(BUN)-静脉血: 4.68mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 32.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 32.4U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；葡萄糖(Glu)-静脉血: 5.39mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；白细胞计数(WBC#)-静脉血: 410E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 34U/L；磷(P)-静脉血: 1.35mmol/L；乳酸脱氢酶(LDH)-静脉血: 198.6U/L；血小板计数(PLT#)-静脉血: 25510E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.4；碱性磷酸酶(ALP)-静脉血: 92.4U/L；钾离子(K+)-静脉血: 3.9mmol/L；总蛋白(TP)-静脉血: 64.1g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.435；钠离子(Na+)-静脉血: 140.2mmol/L；胱抑素(Cys-C)-静脉血: 0.82mg/L；大血小板百分比(P-LCR%)-静脉血: 19.1%；间接胆红素(IBIL)-静脉血: 3.9umolL；红细胞计数(RBC#)-静脉血: 3.710E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.6pg；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；平均血小板体积(MPV)-静脉血: 9.3fL；氯离子(Cl-)-静脉血: 100.2mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.23g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.9；淋巴细胞百分比(Lymph%)-静脉血: 0.481；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.9；中性粒细胞计数(Neut#)-静脉……\n- [全程D36] 检验组合: 总胆固醇(TC)-静脉血: 4.01mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.55；γ-谷氨酰基转移酶(GGT)-静脉血: 22.5U/L；平均血小板体积(MPV)-静脉血: 10.1fL；淋巴细胞计数(Lymph#)-静脉血: 0.910E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.04；丙氨酸氨基转移酶(ALT)-静脉血: 42.3U/L；尿素氮(BUN)-静脉血: 6.2mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 26.3U/L；总胆红素(TBIL)-静脉血: 14.1umol/L；钠离子(Na+)-静脉血: 136mmol/L；碱性磷酸酶(ALP)-静脉血: 68U/L；白细胞计数(WBC#)-静脉血: 4.310E9/L；直接胆红素(DBIL)-静脉血: 4.6umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；单核细胞计数(Mono#)-静脉血: 0.110E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；磷(P)-静脉血: 0.99mmol/L；血红蛋白(Hb)-静脉血: 122g/L；氯离子(Cl-)-静脉血: 95mmol/L；血小板分布宽度(PDW)-静脉血: 12.3%；平均红细胞体积(MCV)-静脉血: 93.9fL；α-L-岩藻糖苷酶(AFU)-静脉血: 48.7U/L；阴离子间隙(AG)-静脉血: 14.1；钾离子(K+)-静脉血: 4.06mmol/L；红细胞比容(Hct)-静脉血: 35.7%；血小板比容-静脉血: 23%；白蛋白(ALB)-静脉血: 40.7g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；C-反应蛋白(CRP)-静脉血: 3.19mg/L；球蛋白(GLO)-静脉血: 26.19g/L；胱抑素(Cys-C)-静脉血: 0.64mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.04mmol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；载脂蛋白B(apoB)-静脉血: 0.72g/L；间接胆红素(IBIL)-静脉血: 9.5umolL；中性粒细胞百分比(Neut%)-静脉血: 0.729；尿酸(UA)-静脉血: 258.1umol/L；单核细胞百分比(Mono%)-静脉血: 0……\n- [全程D49] 检验组合: 单核细胞百分比(Mono%)-静脉血: 0.066；C-反应蛋白(CRP)-静脉血: 0.26mg/L；乳酸脱氢酶(LDH)-静脉血: 257.7U/L；氯离子(Cl-)-静脉血: 105.6mmol/L；总蛋白(TP)-静脉血: 65.51g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.002；甘油三酯(TG)-静脉血: 0.97mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.25mmolL；红细胞比容(Hct)-静脉血: 34.7%；间接胆红素(IBIL)-静脉血: 5.5umolL；单核细胞计数(Mono#)-静脉血: 0.310E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.5U/L；红细胞计数(RBC#)-静脉血: 3.5110E12/L；总钙(Ca)-静脉血: 2.08mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.94；葡萄糖(Glu)-静脉血: 4.89mmol/L；直接胆红素(DBIL)-静脉血: 2.4umol/L；镁离子(Mg2+)-静脉血: 1.09mmol/L；胱抑素(Cys-C)-静脉血: 0.69mg/L；总胆汁酸(TBA)-静脉血: 1.9umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 35.4U/L；肌酐(Crea)-静脉血: 52.4umol/L；载脂蛋白B(apoB)-静脉血: 0.81g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 48.8；平均红细胞血红蛋白含量(MCH)-静脉血: 32.5pg；钠离子(Na+)-静脉血: 141.4mmol/L；白蛋白(ALB)-静脉血: 40.9g/L；血小板分布宽度(PDW)-静脉血: 11%；血小板计数(PLT#)-静脉血: 19910E9/L；磷(P)-静脉血: 1.21mmol/L；钾离子(K+)-静脉血: 3.94mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.66；总胆固醇(TC)-静脉血: 4.19mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.55mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.465……\n- [全程D57] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后复查，对比某次就诊时间片： 鼻咽腔稍狭窄，鼻咽肿物较前明显缩小，鼻咽顶壁及双侧壁粘膜欠光滑，双侧咽隐窝变浅，鼻咽未见明显肿物，左侧腭帆提肌张肌及头长肌轮廓不清，其内及左侧咽后区见异常信号灶，增强扫描轻度强化，病灶范围较前明显缩小，强化程度较前降低。 左侧咽旁脂肪间隙变窄，左侧颈动脉鞘区见肿物占据，范围较前缩小，强化程度较前降低。左侧腭帆张提肌及左侧头长肌受侵。 口咽双侧壁未见增厚。鼻腔未见肿物。 左侧翼腭窝见少许软组织影，大致同前。右侧翼腭窝、双侧颞下窝未见异常。 斜坡、左侧岩尖、左侧破裂孔，左侧蝶骨大翼、左侧翼突、左侧翼管、左侧圆孔、蝶骨基底部骨质破坏，大致同前。 蝶窦见软组织肿物，较前明显缩小。 双侧上颌窦、蝶窦、筛窦粘膜增厚，左侧乳突少量分泌物。 双侧眼眶未见异常。左侧海绵窦未见明显右侧。 左侧咽后淋巴结肿大，短径约10mm，较前稍缩小。右侧咽后见小淋巴结，短径约4mm，较前明显缩小。双侧II区见多个淋巴结，相互融合，边界不清，较前明显缩小。右侧腮腺见小淋巴结，短径约为4mm。明显强化 左侧腮腺及双侧颌下腺未见异常。所示甲状腺未见异常。 所示脑实质常规MR及DTI未见明显异常信号灶。；检查结论: 鼻咽癌化疗后，鼻咽未见明显肿物，左侧咽旁、蝶窦肿物较前明显缩小。 颅底骨质破坏，大致同前。 双侧咽后及双颈II区淋巴结，较前缩小。 右侧腮腺小淋巴结。 鼻窦炎，左侧乳突炎症。\n- [全程D57] MRI；脑功能成像、DTI: 检查类型: MRI；检查名称: 脑功能成像、DTI；检查部位:；检查所见: 鼻咽癌化疗后复查，对比某次就诊时间片： 鼻咽腔稍狭窄，鼻咽肿物较前明显缩小，鼻咽顶壁及双侧壁粘膜欠光滑，双侧咽隐窝变浅，鼻咽未见明显肿物，左侧腭帆提肌张肌及头长肌轮廓不清，其内及左侧咽后区见异常信号灶，增强扫描轻度强化，病灶范围较前明显缩小，强化程度较前降低。 左侧咽旁脂肪间隙变窄，左侧颈动脉鞘区见肿物占据，范围较前缩小，强化程度较前降低。左侧腭帆张提肌及左侧头长肌受侵。 口咽双侧壁未见增厚。鼻腔未见肿物。 左侧翼腭窝见少许软组织影，大致同前。右侧翼腭窝、双侧颞下窝未见异常。 斜坡、左侧岩尖、左侧破裂孔，左侧蝶骨大翼、左侧翼突、左侧翼管、左侧圆孔、蝶骨基底部骨质破坏，大致同前。 蝶窦见软组织肿物，较前明显缩小。 双侧上颌窦、蝶窦、筛窦粘膜增厚，左侧乳突少量分泌物。 双侧眼眶未见异常。左侧海绵窦未见明显右侧。 左侧咽后淋巴结肿大，短径约10mm，较前稍缩小。右侧咽后见小淋巴结，短径约4mm，较前明显缩小。双侧II区见多个淋巴结，相互融合，边界不清，较前明显缩小。右侧腮腺见小淋巴结，短径约为4mm。明显强化 左侧腮腺及双侧颌下腺未见异常。所示甲状腺未见异常。 所示脑实质常规MR及DTI未见明显异常信号灶。；检查结论: 鼻咽癌化疗后，鼻咽未见明显肿物，左侧咽旁、蝶窦肿物较前明显缩小。 颅底骨质破坏，大致同前。 双侧咽后及双颈II区淋巴结，较前缩小。 右侧腮腺小淋巴结。 鼻窦炎，左侧乳突炎症。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者入院第2天，一般情况可，今日[姓名已隐去]医生信息已隐藏，详细听取病情汇报、检查患者后指示：尽快完善各项治疗前检查，明确诊断及分期，并了解有无合并其他基础疾病，待分期明确后再定治疗方案。遵嘱执行。\n- [全程D13] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。胡医生信息已隐藏：患者予复查血象变化，密切观察患者病情变化。遵嘱。\n- [全程D16] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。检查回报：白细胞 2.5×109/L 。胡医生信息已隐藏：患者出现II度骨髓抑制，考虑化疗引起的副反应，予升白等对症处理，密切观察患者病情变化。遵嘱。\n- [全程D19] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。检查结果回报：白细胞 11.8×109/L。胡医生信息已隐藏：患者血象已恢复正常，密切观察患者病情变化。遵嘱。\n- [全程D22] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。胡医生信息已隐藏：患者予对症处理，密切观察患者病情变化。遵嘱。\n- [全程D25] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。胡医生信息已隐藏：患者予对症处理，密切观察患者病情变化。遵嘱。\n- [全程D51] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者入院第2天，一般情况可，血常规、生化检查无明显异常。[姓名已隐去]医生信息已隐藏示：目前患者诊断明确，今日水化，明日开始第三程诱导化疗。\n- [全程D52] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，血常规、生化检查无明显异常。今日开始予多西他赛90mg/d1+PDD35mg/d1-3方案化疗。[姓名已隐去]医生信息已隐藏示：目前患者诊断明确，今日开始化疗，密切观察病情变化。\n- [全程D55] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，未诉特殊不适。[姓名已隐去]医生信息已隐藏示：目前患者今日化疗结束，密切观病情变化，如有不适，及时对症处理。\n- [全程D57] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，未诉特殊不适。[姓名已隐去]医生信息已隐藏示：目前患者化疗结束，病情稳定，可予出院。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估为完全缓解（CR），结束诱导化疗，直接进入随访观察阶段，定期复查鼻咽及颈部MRI。\nB. 评估为疾病稳定（SD），更换为吉西他滨联合顺铂方案继续化疗2周期。\nC. 评估为疾病进展（PD），转为姑息性放疗及靶向治疗。\nD. 评估为部分缓解（PR），继续原方案（多西他赛联合顺铂）诱导化疗第4-6周期。\nE. 评估为部分缓解（PR），先行双侧颈部淋巴结清扫术，术后行根治性放疗。\nF. 评估为部分缓解（PR），结束诱导化疗，择期行单纯根治性放疗。\nG. 评估为部分缓解（PR），行鼻咽内镜下颅底肿瘤切除术联合术后放疗。\nH. 评估为部分缓解（PR），结束诱导化疗，择期行根治性放疗及同期靶向治疗。\nI. 评估为疾病稳定（SD），提前终止化疗，立即开始根治性放疗及同期化疗。\nJ. 评估为部分缓解（PR），结束诱导化疗，出院休养并定期监测血象，择期行根治性放疗及同期化疗。\nK. 评估为部分缓解（PR），结束诱导化疗，行全身PET-CT检查排除远处转移后再决定后续治疗。\nL. 评估为完全缓解（CR），结束诱导化疗，择期行预防性低剂量放疗。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-c754017abe0842c4e67e064f","patient_id":"patient-e90c2443e271b2e927262653","turn_id":"turn08","turn_position":7,"turn_type":"response_assessment_decision","gold_letter":"K","gold_action":"评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排根治性放疗及同期化疗。","options":[{"letter":"A","text":"评估为诱导化疗后完全缓解（CR），予以出院并定期随访观察，暂缓后续放化疗。","is_gold":false},{"letter":"B","text":"评估为诱导化疗后部分缓解（PR），继续原方案（多西他赛+顺铂）行第4周期诱导化疗。","is_gold":false},{"letter":"C","text":"评估为诱导化疗后疾病稳定（SD），更改化疗方案为吉西他滨+顺铂继续诱导化疗。","is_gold":false},{"letter":"D","text":"评估为诱导化疗后疾病进展（PD），建议行姑息性放疗及靶向治疗。","is_gold":false},{"letter":"E","text":"评估为诱导化疗后部分缓解（PR），立即行双侧颈部淋巴结清扫术及鼻咽原发灶切除术。","is_gold":false},{"letter":"F","text":"评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排单纯根治性放疗。","is_gold":false},{"letter":"G","text":"评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排根治性放疗及靶向治疗。","is_gold":false},{"letter":"H","text":"评估为诱导化疗后完全缓解（CR），予以出院及对症支持治疗，并择期安排根治性放疗及同期化疗。","is_gold":false},{"letter":"I","text":"评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排根治性放疗及免疫治疗。","is_gold":false},{"letter":"J","text":"评估为诱导化疗后部分缓解（PR），继续住院观察，待血象恢复后立即行第4周期诱导化疗。","is_gold":false},{"letter":"K","text":"评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排根治性放疗及同期化疗。","is_gold":true},{"letter":"L","text":"评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排姑息性放疗。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、颈动脉鞘、斜坡、海绵窦、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 间断性回吸性涕血1年余。；现病史: 患者近一年以来无明显原因出现回吸性涕血、近一个月左侧鼻塞明显，间断鼻衄。双侧耳鸣伴左耳听力下降，左侧头痛，双颈肿块。无面麻、张口困难、软腭麻痹，无咳嗽咳痰、呼吸困难。伴双侧咽后、颈部淋巴结转移。现为进一步诊治入院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重下降1Kg。；阳性症状体征: 体重下降,听力下降,双颈肿物,双耳鸣,涕血,鼻衄,左鼻塞,左侧头痛；既往史: 既往体健。4年前妊娠期间高血糖。3年前剖宫产。否认肝炎、结核等传染病史。否认心脏病、高血压史。预防接种史不详。过敏史:无药物及食物过敏史。；个人史: 出生于原籍，无烟酒药物等嗜好，无疫水接触史，否认不洁性生活史。无工业毒物，粉尘，放射性物质接触史。；家族史: 否认家族其他成员中有类似病患者或肿瘤患者。；体格检查: T36.5℃P78次/分R19次/分BP115/70mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。无鼻翼扇动、鼻衄。牙龈无肿胀、出血。气管居中，甲状腺不大。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率70bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。；专科检查: KPS 90。双颈II区触及多枚肿大淋巴结，直径约1.0cm，质韧、固定、相互融合。颅神经（-）。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 间断性回吸性涕血1年余。；现病史: 患者近一年以来无明显原因出现回吸性涕血、近一个月左侧鼻塞明显，间断鼻衄。双侧耳鸣伴左耳听力下降，左侧头痛，双颈肿块。无面麻、张口困难、软腭麻痹，无咳嗽咳痰、呼吸困难。当地医院CT提示：鼻咽癌侵犯枕斜坡双侧蝶窦。伴双侧咽后、颈部淋巴结转移。现为进一步诊治入院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重下降1Kg。；阳性症状体征: 体重下降,听力下降,双颈肿物,双耳鸣,涕血,鼻衄,左鼻塞,左侧头痛；既往史: 既往体健。4年前妊娠期间高血糖。3年前剖宫产。否认肝炎、结核等传染病史。否认心脏病、高血压史。预防接种史不详。过敏史:无药物及食物过敏史。；个人史: 出生于原籍，无烟酒药物等嗜好，无疫水接触史，否认不洁性生活史。无工业毒物，粉尘，放射性物质接触史。；家族史: 否认家族其他成员中有类似病患者或肿瘤患者。；体格检查: T36.5℃P78次/分R19次/分BP115/70mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。无鼻翼扇动、鼻衄。牙龈无肿胀、出血。气管居中，甲状腺不大。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率70bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。肛门外生殖器未见异常，生理反射存在，病理反射未引出。；专科检查: KPS 90。张口门齿距4.5cm，间接鼻咽镜：见鼻咽左侧壁肿物肿物；双颈II区触及多枚肿大淋巴结，直径约1.0cm，质韧、固定、相互融合。颅神经（-）。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 正常范围心电图\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理清晰，走行自然，双肺野内未见明确实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。双上胸膜略厚。；检查结论: 心肺未见明显病变。\n- [全程D1] 检验组合: 胱抑素(Cys-C)-静脉血: 0.8mg/L；钾离子(K+)-静脉血: 4.14mmol/L；肌酐(Crea)-静脉血: 65umol/L；葡萄糖(Glu)-静脉血: 5.25mmol/L；载脂蛋白B(apoB)-静脉血: 0.81g/L；碱性磷酸酶(ALP)-静脉血: 47U/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:20（参考: 阴性）；乳酸脱氢酶(LDH)-静脉血: 210.4U/L；纤维蛋白原(Fbg)-静脉血: 2.89g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.62；天门冬氨酸氨基转移酶(AST)-静脉血: 19.6U/L；阴离子间隙(AG)-静脉血: 14.7；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.376COI；总胆固醇(TC)-静脉血: 4.58mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.7mmolL；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.56g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.5mmol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 1.79COI；总胆汁酸(TBA)-静脉血: 2umol/L；平均血小板体积(MPV)-静脉血: 10.5fL；磷(P)-静脉血: 1.23mmol/L；单核细胞百分比(Mono%)-静脉血: 0.042；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 0.009COI；甘油三酯(TG)-静脉血: 0.86mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.1mmol/L；平均红细胞体积(MCV)-静脉血: 96.1fL；丙氨酸氨基转移酶(ALT)-静脉血: 15U/L；血小板分布宽度(PDW)-静脉血: 12.1%；C-反应蛋白(CRP)-静脉血: 0.28mg/L；α-L-岩藻糖苷酶(AFU)-静脉血: 33.2U/L；尿素氮(BUN)-静脉血: 4.7mmol/L；球蛋白(GLO)-静脉血: 28.21g/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 0.109……\n- [全程D2] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁 、顶后壁、左侧壁增厚，见软组织肿物影。左侧咽隐窝消失，右侧咽隐窝变浅；病灶呈稍长分期信息见历史辅助诊断节点稍长分期信息见历史辅助诊断节点信号，增强扫描强化明显。 口咽双侧壁未见增厚。鼻腔未见肿物影。 左侧咽旁脂肪间隙变窄，左侧颈动脉鞘区见肿物占据。左侧腭帆张提肌及左侧头长肌受侵。 左侧翼腭窝见软组织影；右侧翼腭窝、双侧颞下窝未见异常。 斜坡、左侧岩尖、左侧破裂孔，左侧蝶骨大翼、左侧翼突、左侧翼管、左侧圆孔、蝶骨基底部骨质破坏。 蝶窦见软组织肿物；右侧乳突、双侧上颌窦充气良好；蝶窦、筛窦及左侧乳突见分泌物。 双眼未见异常。 左侧海绵窦见可疑肿物侵犯。 双侧咽后淋巴结肿大，左侧短径大小约为15mm，见包膜外侵；右侧短径大小约为11mm。双侧II区见多个肿大淋巴结，相互融合，最大短径大小约为18mm。 右侧腮腺见小淋巴结，短径约为7mm。 双侧腮腺。颌下腺、甲状腺未见异常。；检查结论: 考虑鼻咽癌，左侧咽旁间隙、颅底骨质； 可疑左侧海绵窦受侵。 双侧咽后淋巴结，双侧II区淋巴结肿大，考虑转移。 右侧腮腺小淋巴结，性质待定。 副鼻窦炎症。 左侧乳突炎症。\n- [全程D2] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，肝内血管走行自然，门静脉内径约10mm，未见明确肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约26cm/s。 胆囊大小正常，壁不厚，光滑，其内未见异常回声。 脾脏大小正常，包膜光滑，实质回声均匀。 胰腺大小正常，包膜光滑，实质回声均匀，胰管无扩张。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位性病变。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D9] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；白细胞计数(WBC#)-静脉血: 9.210E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.812；单核细胞百分比(Mono%)-静脉血: 0.005；平均血小板体积(MPV)-静脉血: 11.2fL；平均红细胞体积(MCV)-静脉血: 95.5fL；血小板比容-静脉血: 21%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.1；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339g/L；大血小板百分比(P-LCR%)-静脉血: 36.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.178；平均红细胞血红蛋白含量(MCH)-静脉血: 32.4pg；单核细胞计数(Mono#)-静脉血: 0.110E9/L；红细胞计数(RBC#)-静脉血: 3.5210E12/L；血小板分布宽度(PDW)-静脉血: 13.8%；血小板计数(PLT#)-静脉血: 19010E9/L；红细胞比容(Hct)-静脉血: 33.6%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 114g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.4；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；中性粒细胞计数(Neut#)-静脉血: 7.410E9/L\n- [全程D13] 检验组合: 嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；大血小板百分比(P-LCR%)-静脉血: 33.8%；淋巴细胞百分比(Lymph%)-静脉血: 0.645；平均红细胞血红蛋白含量(MCH)-静脉血: 32.1pg；血红蛋白(Hb)-静脉血: 130g/L；白细胞计数(WBC#)-静脉血: 1.710E9/L；平均红细胞体积(MCV)-静脉血: 92.6fL；红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；单核细胞百分比(Mono%)-静脉血: 0.114；血小板分布宽度(PDW)-静脉血: 13%；中性粒细胞百分比(Neut%)-静脉血: 0.229；红细胞比容(Hct)-静脉血: 37.5%；单核细胞计数(Mono#)-静脉血: 0.210E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 35.6；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；血小板比容-静脉血: 27%；中性粒细胞计数(Neut#)-静脉血: 0.410E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.006；血小板计数(PLT#)-静脉血: 24210E9/L；平均血小板体积(MPV)-静脉血: 11fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 10.6；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L\n- [全程D14] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；淋巴细胞百分比(Lymph%)-静脉血: 0.51；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板比容-静脉血: 23%；红细胞计数(RBC#)-静脉血: 3.8110E12/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.8pg；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.8；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；白细胞计数(WBC#)-静脉血: 2.510E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.151；大血小板百分比(P-LCR%)-静脉血: 28.8%；红细胞比容(Hct)-静脉血: 34.9%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 121g/L；平均红细胞体积(MCV)-静脉血: 91.6fL；血小板分布宽度(PDW)-静脉血: 12.4%；单核细胞百分比(Mono%)-静脉血: 0.291；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；中性粒细胞计数(Neut#)-静脉血: 0.410E9/L；平均血小板体积(MPV)-静脉血: 10.4fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.3；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；血小板计数(PLT#)-静脉血: 22010E9/L\n- [全程D15] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；红细胞计数(RBC#)-静脉血: 3.8910E12/L；血小板分布宽度(PDW)-静脉血: 12.8%；平均红细胞体积(MCV)-静脉血: 94.6fL；中性粒细胞计数(Neut#)-静脉血: 2.610E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 35.8；平均血小板体积(MPV)-静脉血: 10.4fL；中性粒细胞百分比(Neut%)-静脉血: 0.496；淋巴细胞百分比(Lymph%)-静脉血: 0.292；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 334g/L；血红蛋白(Hb)-静脉血: 123g/L；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.202；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 10.8；白细胞计数(WBC#)-静脉血: 5.210E9/L；血小板计数(PLT#)-静脉血: 25410E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.6pg；血小板比容-静脉血: 26%；大血小板百分比(P-LCR%)-静脉血: 29%；红细胞比容(Hct)-静脉血: 36.8%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；单核细胞计数(Mono#)-静脉血: 1.110E9/L\n- [全程D16] 检验组合: 红细胞体积分布宽度SD(RDW-SD)-静脉血: 37；大血小板百分比(P-LCR%)-静脉血: 29.9%；红细胞比容(Hct)-静脉血: 34.2%；血小板计数(PLT#)-静脉血: 26510E9/L；单核细胞计数(Mono#)-静脉血: 1.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.128；血小板比容-静脉血: 28%；白细胞计数(WBC#)-静脉血: 11.810E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；血红蛋白(Hb)-静脉血: 113g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.8pg；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11；中性粒细胞计数(Neut#)-静脉血: 7.910E9/L；血小板分布宽度(PDW)-静脉血: 12.3%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；红细胞计数(RBC#)-静脉血: 3.5510E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.667；平均血小板体积(MPV)-静脉血: 10.5fL；淋巴细胞计数(Lymph#)-静脉血: 2.310E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.197；平均红细胞体积(MCV)-静脉血: 96.3fL\n- [全程D26] 检验组合: 直接胆红素(DBIL)-静脉血: 1.5umol/L；C-反应蛋白(CRP)-静脉血: 6.47mg/L；红细胞比容(Hct)-静脉血: 35.4%；阴离子间隙(AG)-静脉血: 8；血小板分布宽度(PDW)-静脉血: 10.3%；总钙(Ca)-静脉血: 2.27mmol/L；甘油三酯(TG)-静脉血: 0.74mmol/L；尿素氮(BUN)-静脉血: 4.68mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 32.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 32.4U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；葡萄糖(Glu)-静脉血: 5.39mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；白细胞计数(WBC#)-静脉血: 410E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 34U/L；磷(P)-静脉血: 1.35mmol/L；乳酸脱氢酶(LDH)-静脉血: 198.6U/L；血小板计数(PLT#)-静脉血: 25510E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.4；碱性磷酸酶(ALP)-静脉血: 92.4U/L；钾离子(K+)-静脉血: 3.9mmol/L；总蛋白(TP)-静脉血: 64.1g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.435；钠离子(Na+)-静脉血: 140.2mmol/L；胱抑素(Cys-C)-静脉血: 0.82mg/L；大血小板百分比(P-LCR%)-静脉血: 19.1%；间接胆红素(IBIL)-静脉血: 3.9umolL；红细胞计数(RBC#)-静脉血: 3.710E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.6pg；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；平均血小板体积(MPV)-静脉血: 9.3fL；氯离子(Cl-)-静脉血: 100.2mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.23g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.9；淋巴细胞百分比(Lymph%)-静脉血: 0.481；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.9；中性粒细胞计数(Neut#)-静脉……\n- [全程D36] 检验组合: 总胆固醇(TC)-静脉血: 4.01mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.55；γ-谷氨酰基转移酶(GGT)-静脉血: 22.5U/L；平均血小板体积(MPV)-静脉血: 10.1fL；淋巴细胞计数(Lymph#)-静脉血: 0.910E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.04；丙氨酸氨基转移酶(ALT)-静脉血: 42.3U/L；尿素氮(BUN)-静脉血: 6.2mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 26.3U/L；总胆红素(TBIL)-静脉血: 14.1umol/L；钠离子(Na+)-静脉血: 136mmol/L；碱性磷酸酶(ALP)-静脉血: 68U/L；白细胞计数(WBC#)-静脉血: 4.310E9/L；直接胆红素(DBIL)-静脉血: 4.6umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；单核细胞计数(Mono#)-静脉血: 0.110E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；磷(P)-静脉血: 0.99mmol/L；血红蛋白(Hb)-静脉血: 122g/L；氯离子(Cl-)-静脉血: 95mmol/L；血小板分布宽度(PDW)-静脉血: 12.3%；平均红细胞体积(MCV)-静脉血: 93.9fL；α-L-岩藻糖苷酶(AFU)-静脉血: 48.7U/L；阴离子间隙(AG)-静脉血: 14.1；钾离子(K+)-静脉血: 4.06mmol/L；红细胞比容(Hct)-静脉血: 35.7%；血小板比容-静脉血: 23%；白蛋白(ALB)-静脉血: 40.7g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；C-反应蛋白(CRP)-静脉血: 3.19mg/L；球蛋白(GLO)-静脉血: 26.19g/L；胱抑素(Cys-C)-静脉血: 0.64mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.04mmol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；载脂蛋白B(apoB)-静脉血: 0.72g/L；间接胆红素(IBIL)-静脉血: 9.5umolL；中性粒细胞百分比(Neut%)-静脉血: 0.729；尿酸(UA)-静脉血: 258.1umol/L；单核细胞百分比(Mono%)-静脉血: 0……\n- [全程D49] 检验组合: 单核细胞百分比(Mono%)-静脉血: 0.066；C-反应蛋白(CRP)-静脉血: 0.26mg/L；乳酸脱氢酶(LDH)-静脉血: 257.7U/L；氯离子(Cl-)-静脉血: 105.6mmol/L；总蛋白(TP)-静脉血: 65.51g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.002；甘油三酯(TG)-静脉血: 0.97mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.25mmolL；红细胞比容(Hct)-静脉血: 34.7%；间接胆红素(IBIL)-静脉血: 5.5umolL；单核细胞计数(Mono#)-静脉血: 0.310E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.5U/L；红细胞计数(RBC#)-静脉血: 3.5110E12/L；总钙(Ca)-静脉血: 2.08mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.94；葡萄糖(Glu)-静脉血: 4.89mmol/L；直接胆红素(DBIL)-静脉血: 2.4umol/L；镁离子(Mg2+)-静脉血: 1.09mmol/L；胱抑素(Cys-C)-静脉血: 0.69mg/L；总胆汁酸(TBA)-静脉血: 1.9umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 35.4U/L；肌酐(Crea)-静脉血: 52.4umol/L；载脂蛋白B(apoB)-静脉血: 0.81g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 48.8；平均红细胞血红蛋白含量(MCH)-静脉血: 32.5pg；钠离子(Na+)-静脉血: 141.4mmol/L；白蛋白(ALB)-静脉血: 40.9g/L；血小板分布宽度(PDW)-静脉血: 11%；血小板计数(PLT#)-静脉血: 19910E9/L；磷(P)-静脉血: 1.21mmol/L；钾离子(K+)-静脉血: 3.94mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.66；总胆固醇(TC)-静脉血: 4.19mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.55mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.465……\n- [全程D57] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后复查，对比某次就诊时间片： 鼻咽腔稍狭窄，鼻咽肿物较前明显缩小，鼻咽顶壁及双侧壁粘膜欠光滑，双侧咽隐窝变浅，鼻咽未见明显肿物，左侧腭帆提肌张肌及头长肌轮廓不清，其内及左侧咽后区见异常信号灶，增强扫描轻度强化，病灶范围较前明显缩小，强化程度较前降低。 左侧咽旁脂肪间隙变窄，左侧颈动脉鞘区见肿物占据，范围较前缩小，强化程度较前降低。左侧腭帆张提肌及左侧头长肌受侵。 口咽双侧壁未见增厚。鼻腔未见肿物。 左侧翼腭窝见少许软组织影，大致同前。右侧翼腭窝、双侧颞下窝未见异常。 斜坡、左侧岩尖、左侧破裂孔，左侧蝶骨大翼、左侧翼突、左侧翼管、左侧圆孔、蝶骨基底部骨质破坏，大致同前。 蝶窦见软组织肿物，较前明显缩小。 双侧上颌窦、蝶窦、筛窦粘膜增厚，左侧乳突少量分泌物。 双侧眼眶未见异常。左侧海绵窦未见明显右侧。 左侧咽后淋巴结肿大，短径约10mm，较前稍缩小。右侧咽后见小淋巴结，短径约4mm，较前明显缩小。双侧II区见多个淋巴结，相互融合，边界不清，较前明显缩小。右侧腮腺见小淋巴结，短径约为4mm。明显强化 左侧腮腺及双侧颌下腺未见异常。所示甲状腺未见异常。 所示脑实质常规MR及DTI未见明显异常信号灶。；检查结论: 鼻咽癌化疗后，鼻咽未见明显肿物，左侧咽旁、蝶窦肿物较前明显缩小。 颅底骨质破坏，大致同前。 双侧咽后及双颈II区淋巴结，较前缩小。 右侧腮腺小淋巴结。 鼻窦炎，左侧乳突炎症。\n- [全程D57] MRI；脑功能成像、DTI: 检查类型: MRI；检查名称: 脑功能成像、DTI；检查部位:；检查所见: 鼻咽癌化疗后复查，对比某次就诊时间片： 鼻咽腔稍狭窄，鼻咽肿物较前明显缩小，鼻咽顶壁及双侧壁粘膜欠光滑，双侧咽隐窝变浅，鼻咽未见明显肿物，左侧腭帆提肌张肌及头长肌轮廓不清，其内及左侧咽后区见异常信号灶，增强扫描轻度强化，病灶范围较前明显缩小，强化程度较前降低。 左侧咽旁脂肪间隙变窄，左侧颈动脉鞘区见肿物占据，范围较前缩小，强化程度较前降低。左侧腭帆张提肌及左侧头长肌受侵。 口咽双侧壁未见增厚。鼻腔未见肿物。 左侧翼腭窝见少许软组织影，大致同前。右侧翼腭窝、双侧颞下窝未见异常。 斜坡、左侧岩尖、左侧破裂孔，左侧蝶骨大翼、左侧翼突、左侧翼管、左侧圆孔、蝶骨基底部骨质破坏，大致同前。 蝶窦见软组织肿物，较前明显缩小。 双侧上颌窦、蝶窦、筛窦粘膜增厚，左侧乳突少量分泌物。 双侧眼眶未见异常。左侧海绵窦未见明显右侧。 左侧咽后淋巴结肿大，短径约10mm，较前稍缩小。右侧咽后见小淋巴结，短径约4mm，较前明显缩小。双侧II区见多个淋巴结，相互融合，边界不清，较前明显缩小。右侧腮腺见小淋巴结，短径约为4mm。明显强化 左侧腮腺及双侧颌下腺未见异常。所示甲状腺未见异常。 所示脑实质常规MR及DTI未见明显异常信号灶。；检查结论: 鼻咽癌化疗后，鼻咽未见明显肿物，左侧咽旁、蝶窦肿物较前明显缩小。 颅底骨质破坏，大致同前。 双侧咽后及双颈II区淋巴结，较前缩小。 右侧腮腺小淋巴结。 鼻窦炎，左侧乳突炎症。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者入院第2天，一般情况可，今日[姓名已隐去]医生信息已隐藏，详细听取病情汇报、检查患者后指示：尽快完善各项治疗前检查，明确诊断及分期，并了解有无合并其他基础疾病，待分期明确后再定治疗方案。遵嘱执行。\n- [全程D13] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。胡医生信息已隐藏：患者予复查血象变化，密切观察患者病情变化。遵嘱。\n- [全程D16] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。检查回报：白细胞 2.5×109/L 。胡医生信息已隐藏：患者出现II度骨髓抑制，考虑化疗引起的副反应，予升白等对症处理，密切观察患者病情变化。遵嘱。\n- [全程D19] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。检查结果回报：白细胞 11.8×109/L。胡医生信息已隐藏：患者血象已恢复正常，密切观察患者病情变化。遵嘱。\n- [全程D22] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。胡医生信息已隐藏：患者予对症处理，密切观察患者病情变化。遵嘱。\n- [全程D25] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。胡医生信息已隐藏：患者予对症处理，密切观察患者病情变化。遵嘱。\n- [全程D51] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者入院第2天，一般情况可，血常规、生化检查无明显异常。[姓名已隐去]医生信息已隐藏示：目前患者诊断明确，今日水化，明日开始第三程诱导化疗。\n- [全程D52] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，血常规、生化检查无明显异常。今日开始予多西他赛90mg/d1+PDD35mg/d1-3方案化疗。[姓名已隐去]医生信息已隐藏示：目前患者诊断明确，今日开始化疗，密切观察病情变化。\n- [全程D55] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，未诉特殊不适。[姓名已隐去]医生信息已隐藏示：目前患者今日化疗结束，密切观病情变化，如有不适，及时对症处理。\n- [全程D57] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，未诉特殊不适。[姓名已隐去]医生信息已隐藏示：目前患者化疗结束，病情稳定，可予出院。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估为诱导化疗后完全缓解（CR），予以出院并定期随访观察，暂缓后续放化疗。\nB. 评估为诱导化疗后部分缓解（PR），继续原方案（多西他赛+顺铂）行第4周期诱导化疗。\nC. 评估为诱导化疗后疾病稳定（SD），更改化疗方案为吉西他滨+顺铂继续诱导化疗。\nD. 评估为诱导化疗后疾病进展（PD），建议行姑息性放疗及靶向治疗。\nE. 评估为诱导化疗后部分缓解（PR），立即行双侧颈部淋巴结清扫术及鼻咽原发灶切除术。\nF. 评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排单纯根治性放疗。\nG. 评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排根治性放疗及靶向治疗。\nH. 评估为诱导化疗后完全缓解（CR），予以出院及对症支持治疗，并择期安排根治性放疗及同期化疗。\nI. 评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排根治性放疗及免疫治疗。\nJ. 评估为诱导化疗后部分缓解（PR），继续住院观察，待血象恢复后立即行第4周期诱导化疗。\nK. 评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排根治性放疗及同期化疗。\nL. 评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排姑息性放疗。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、颈动脉鞘、斜坡、海绵窦、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 间断性回吸性涕血1年余。；现病史: 患者近一年以来无明显原因出现回吸性涕血、近一个月左侧鼻塞明显，间断鼻衄。双侧耳鸣伴左耳听力下降，左侧头痛，双颈肿块。无面麻、张口困难、软腭麻痹，无咳嗽咳痰、呼吸困难。伴双侧咽后、颈部淋巴结转移。现为进一步诊治入院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重下降1Kg。；阳性症状体征: 体重下降,听力下降,双颈肿物,双耳鸣,涕血,鼻衄,左鼻塞,左侧头痛；既往史: 既往体健。4年前妊娠期间高血糖。3年前剖宫产。否认肝炎、结核等传染病史。否认心脏病、高血压史。预防接种史不详。过敏史:无药物及食物过敏史。；个人史: 出生于原籍，无烟酒药物等嗜好，无疫水接触史，否认不洁性生活史。无工业毒物，粉尘，放射性物质接触史。；家族史: 否认家族其他成员中有类似病患者或肿瘤患者。；体格检查: T36.5℃P78次/分R19次/分BP115/70mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。无鼻翼扇动、鼻衄。牙龈无肿胀、出血。气管居中，甲状腺不大。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率70bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。；专科检查: KPS 90。双颈II区触及多枚肿大淋巴结，直径约1.0cm，质韧、固定、相互融合。颅神经（-）。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 间断性回吸性涕血1年余。；现病史: 患者近一年以来无明显原因出现回吸性涕血、近一个月左侧鼻塞明显，间断鼻衄。双侧耳鸣伴左耳听力下降，左侧头痛，双颈肿块。无面麻、张口困难、软腭麻痹，无咳嗽咳痰、呼吸困难。当地医院CT提示：鼻咽癌侵犯枕斜坡双侧蝶窦。伴双侧咽后、颈部淋巴结转移。现为进一步诊治入院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重下降1Kg。；阳性症状体征: 体重下降,听力下降,双颈肿物,双耳鸣,涕血,鼻衄,左鼻塞,左侧头痛；既往史: 既往体健。4年前妊娠期间高血糖。3年前剖宫产。否认肝炎、结核等传染病史。否认心脏病、高血压史。预防接种史不详。过敏史:无药物及食物过敏史。；个人史: 出生于原籍，无烟酒药物等嗜好，无疫水接触史，否认不洁性生活史。无工业毒物，粉尘，放射性物质接触史。；家族史: 否认家族其他成员中有类似病患者或肿瘤患者。；体格检查: T36.5℃P78次/分R19次/分BP115/70mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。无鼻翼扇动、鼻衄。牙龈无肿胀、出血。气管居中，甲状腺不大。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率70bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。肛门外生殖器未见异常，生理反射存在，病理反射未引出。；专科检查: KPS 90。张口门齿距4.5cm，间接鼻咽镜：见鼻咽左侧壁肿物肿物；双颈II区触及多枚肿大淋巴结，直径约1.0cm，质韧、固定、相互融合。颅神经（-）。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 正常范围心电图\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理清晰，走行自然，双肺野内未见明确实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。双上胸膜略厚。；检查结论: 心肺未见明显病变。\n- [全程D1] 检验组合: 胱抑素(Cys-C)-静脉血: 0.8mg/L；钾离子(K+)-静脉血: 4.14mmol/L；肌酐(Crea)-静脉血: 65umol/L；葡萄糖(Glu)-静脉血: 5.25mmol/L；载脂蛋白B(apoB)-静脉血: 0.81g/L；碱性磷酸酶(ALP)-静脉血: 47U/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:20（参考: 阴性）；乳酸脱氢酶(LDH)-静脉血: 210.4U/L；纤维蛋白原(Fbg)-静脉血: 2.89g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.62；天门冬氨酸氨基转移酶(AST)-静脉血: 19.6U/L；阴离子间隙(AG)-静脉血: 14.7；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.376COI；总胆固醇(TC)-静脉血: 4.58mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.7mmolL；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.56g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.5mmol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 1.79COI；总胆汁酸(TBA)-静脉血: 2umol/L；平均血小板体积(MPV)-静脉血: 10.5fL；磷(P)-静脉血: 1.23mmol/L；单核细胞百分比(Mono%)-静脉血: 0.042；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 0.009COI；甘油三酯(TG)-静脉血: 0.86mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.1mmol/L；平均红细胞体积(MCV)-静脉血: 96.1fL；丙氨酸氨基转移酶(ALT)-静脉血: 15U/L；血小板分布宽度(PDW)-静脉血: 12.1%；C-反应蛋白(CRP)-静脉血: 0.28mg/L；α-L-岩藻糖苷酶(AFU)-静脉血: 33.2U/L；尿素氮(BUN)-静脉血: 4.7mmol/L；球蛋白(GLO)-静脉血: 28.21g/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 0.109……\n- [全程D2] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁 、顶后壁、左侧壁增厚，见软组织肿物影。左侧咽隐窝消失，右侧咽隐窝变浅；病灶呈稍长分期信息见历史辅助诊断节点稍长分期信息见历史辅助诊断节点信号，增强扫描强化明显。 口咽双侧壁未见增厚。鼻腔未见肿物影。 左侧咽旁脂肪间隙变窄，左侧颈动脉鞘区见肿物占据。左侧腭帆张提肌及左侧头长肌受侵。 左侧翼腭窝见软组织影；右侧翼腭窝、双侧颞下窝未见异常。 斜坡、左侧岩尖、左侧破裂孔，左侧蝶骨大翼、左侧翼突、左侧翼管、左侧圆孔、蝶骨基底部骨质破坏。 蝶窦见软组织肿物；右侧乳突、双侧上颌窦充气良好；蝶窦、筛窦及左侧乳突见分泌物。 双眼未见异常。 左侧海绵窦见可疑肿物侵犯。 双侧咽后淋巴结肿大，左侧短径大小约为15mm，见包膜外侵；右侧短径大小约为11mm。双侧II区见多个肿大淋巴结，相互融合，最大短径大小约为18mm。 右侧腮腺见小淋巴结，短径约为7mm。 双侧腮腺。颌下腺、甲状腺未见异常。；检查结论: 考虑鼻咽癌，左侧咽旁间隙、颅底骨质； 可疑左侧海绵窦受侵。 双侧咽后淋巴结，双侧II区淋巴结肿大，考虑转移。 右侧腮腺小淋巴结，性质待定。 副鼻窦炎症。 左侧乳突炎症。\n- [全程D2] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，肝内血管走行自然，门静脉内径约10mm，未见明确肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约26cm/s。 胆囊大小正常，壁不厚，光滑，其内未见异常回声。 脾脏大小正常，包膜光滑，实质回声均匀。 胰腺大小正常，包膜光滑，实质回声均匀，胰管无扩张。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位性病变。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D9] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；白细胞计数(WBC#)-静脉血: 9.210E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.812；单核细胞百分比(Mono%)-静脉血: 0.005；平均血小板体积(MPV)-静脉血: 11.2fL；平均红细胞体积(MCV)-静脉血: 95.5fL；血小板比容-静脉血: 21%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.1；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339g/L；大血小板百分比(P-LCR%)-静脉血: 36.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.178；平均红细胞血红蛋白含量(MCH)-静脉血: 32.4pg；单核细胞计数(Mono#)-静脉血: 0.110E9/L；红细胞计数(RBC#)-静脉血: 3.5210E12/L；血小板分布宽度(PDW)-静脉血: 13.8%；血小板计数(PLT#)-静脉血: 19010E9/L；红细胞比容(Hct)-静脉血: 33.6%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 114g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.4；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；中性粒细胞计数(Neut#)-静脉血: 7.410E9/L\n- [全程D13] 检验组合: 嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；大血小板百分比(P-LCR%)-静脉血: 33.8%；淋巴细胞百分比(Lymph%)-静脉血: 0.645；平均红细胞血红蛋白含量(MCH)-静脉血: 32.1pg；血红蛋白(Hb)-静脉血: 130g/L；白细胞计数(WBC#)-静脉血: 1.710E9/L；平均红细胞体积(MCV)-静脉血: 92.6fL；红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；单核细胞百分比(Mono%)-静脉血: 0.114；血小板分布宽度(PDW)-静脉血: 13%；中性粒细胞百分比(Neut%)-静脉血: 0.229；红细胞比容(Hct)-静脉血: 37.5%；单核细胞计数(Mono#)-静脉血: 0.210E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 35.6；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；血小板比容-静脉血: 27%；中性粒细胞计数(Neut#)-静脉血: 0.410E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.006；血小板计数(PLT#)-静脉血: 24210E9/L；平均血小板体积(MPV)-静脉血: 11fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 10.6；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L\n- [全程D14] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；淋巴细胞百分比(Lymph%)-静脉血: 0.51；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板比容-静脉血: 23%；红细胞计数(RBC#)-静脉血: 3.8110E12/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.8pg；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.8；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；白细胞计数(WBC#)-静脉血: 2.510E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.151；大血小板百分比(P-LCR%)-静脉血: 28.8%；红细胞比容(Hct)-静脉血: 34.9%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 121g/L；平均红细胞体积(MCV)-静脉血: 91.6fL；血小板分布宽度(PDW)-静脉血: 12.4%；单核细胞百分比(Mono%)-静脉血: 0.291；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；中性粒细胞计数(Neut#)-静脉血: 0.410E9/L；平均血小板体积(MPV)-静脉血: 10.4fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.3；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；血小板计数(PLT#)-静脉血: 22010E9/L\n- [全程D15] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；红细胞计数(RBC#)-静脉血: 3.8910E12/L；血小板分布宽度(PDW)-静脉血: 12.8%；平均红细胞体积(MCV)-静脉血: 94.6fL；中性粒细胞计数(Neut#)-静脉血: 2.610E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 35.8；平均血小板体积(MPV)-静脉血: 10.4fL；中性粒细胞百分比(Neut%)-静脉血: 0.496；淋巴细胞百分比(Lymph%)-静脉血: 0.292；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 334g/L；血红蛋白(Hb)-静脉血: 123g/L；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.202；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 10.8；白细胞计数(WBC#)-静脉血: 5.210E9/L；血小板计数(PLT#)-静脉血: 25410E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.6pg；血小板比容-静脉血: 26%；大血小板百分比(P-LCR%)-静脉血: 29%；红细胞比容(Hct)-静脉血: 36.8%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；单核细胞计数(Mono#)-静脉血: 1.110E9/L\n- [全程D16] 检验组合: 红细胞体积分布宽度SD(RDW-SD)-静脉血: 37；大血小板百分比(P-LCR%)-静脉血: 29.9%；红细胞比容(Hct)-静脉血: 34.2%；血小板计数(PLT#)-静脉血: 26510E9/L；单核细胞计数(Mono#)-静脉血: 1.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.128；血小板比容-静脉血: 28%；白细胞计数(WBC#)-静脉血: 11.810E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；血红蛋白(Hb)-静脉血: 113g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.8pg；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11；中性粒细胞计数(Neut#)-静脉血: 7.910E9/L；血小板分布宽度(PDW)-静脉血: 12.3%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；红细胞计数(RBC#)-静脉血: 3.5510E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.667；平均血小板体积(MPV)-静脉血: 10.5fL；淋巴细胞计数(Lymph#)-静脉血: 2.310E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.197；平均红细胞体积(MCV)-静脉血: 96.3fL\n- [全程D26] 检验组合: 直接胆红素(DBIL)-静脉血: 1.5umol/L；C-反应蛋白(CRP)-静脉血: 6.47mg/L；红细胞比容(Hct)-静脉血: 35.4%；阴离子间隙(AG)-静脉血: 8；血小板分布宽度(PDW)-静脉血: 10.3%；总钙(Ca)-静脉血: 2.27mmol/L；甘油三酯(TG)-静脉血: 0.74mmol/L；尿素氮(BUN)-静脉血: 4.68mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 32.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 32.4U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；葡萄糖(Glu)-静脉血: 5.39mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；白细胞计数(WBC#)-静脉血: 410E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 34U/L；磷(P)-静脉血: 1.35mmol/L；乳酸脱氢酶(LDH)-静脉血: 198.6U/L；血小板计数(PLT#)-静脉血: 25510E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.4；碱性磷酸酶(ALP)-静脉血: 92.4U/L；钾离子(K+)-静脉血: 3.9mmol/L；总蛋白(TP)-静脉血: 64.1g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.435；钠离子(Na+)-静脉血: 140.2mmol/L；胱抑素(Cys-C)-静脉血: 0.82mg/L；大血小板百分比(P-LCR%)-静脉血: 19.1%；间接胆红素(IBIL)-静脉血: 3.9umolL；红细胞计数(RBC#)-静脉血: 3.710E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.6pg；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；平均血小板体积(MPV)-静脉血: 9.3fL；氯离子(Cl-)-静脉血: 100.2mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.23g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.9；淋巴细胞百分比(Lymph%)-静脉血: 0.481；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.9；中性粒细胞计数(Neut#)-静脉……\n- [全程D36] 检验组合: 总胆固醇(TC)-静脉血: 4.01mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.55；γ-谷氨酰基转移酶(GGT)-静脉血: 22.5U/L；平均血小板体积(MPV)-静脉血: 10.1fL；淋巴细胞计数(Lymph#)-静脉血: 0.910E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.04；丙氨酸氨基转移酶(ALT)-静脉血: 42.3U/L；尿素氮(BUN)-静脉血: 6.2mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 26.3U/L；总胆红素(TBIL)-静脉血: 14.1umol/L；钠离子(Na+)-静脉血: 136mmol/L；碱性磷酸酶(ALP)-静脉血: 68U/L；白细胞计数(WBC#)-静脉血: 4.310E9/L；直接胆红素(DBIL)-静脉血: 4.6umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；单核细胞计数(Mono#)-静脉血: 0.110E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；磷(P)-静脉血: 0.99mmol/L；血红蛋白(Hb)-静脉血: 122g/L；氯离子(Cl-)-静脉血: 95mmol/L；血小板分布宽度(PDW)-静脉血: 12.3%；平均红细胞体积(MCV)-静脉血: 93.9fL；α-L-岩藻糖苷酶(AFU)-静脉血: 48.7U/L；阴离子间隙(AG)-静脉血: 14.1；钾离子(K+)-静脉血: 4.06mmol/L；红细胞比容(Hct)-静脉血: 35.7%；血小板比容-静脉血: 23%；白蛋白(ALB)-静脉血: 40.7g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；C-反应蛋白(CRP)-静脉血: 3.19mg/L；球蛋白(GLO)-静脉血: 26.19g/L；胱抑素(Cys-C)-静脉血: 0.64mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.04mmol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；载脂蛋白B(apoB)-静脉血: 0.72g/L；间接胆红素(IBIL)-静脉血: 9.5umolL；中性粒细胞百分比(Neut%)-静脉血: 0.729；尿酸(UA)-静脉血: 258.1umol/L；单核细胞百分比(Mono%)-静脉血: 0……\n- [全程D49] 检验组合: 单核细胞百分比(Mono%)-静脉血: 0.066；C-反应蛋白(CRP)-静脉血: 0.26mg/L；乳酸脱氢酶(LDH)-静脉血: 257.7U/L；氯离子(Cl-)-静脉血: 105.6mmol/L；总蛋白(TP)-静脉血: 65.51g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.002；甘油三酯(TG)-静脉血: 0.97mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.25mmolL；红细胞比容(Hct)-静脉血: 34.7%；间接胆红素(IBIL)-静脉血: 5.5umolL；单核细胞计数(Mono#)-静脉血: 0.310E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.5U/L；红细胞计数(RBC#)-静脉血: 3.5110E12/L；总钙(Ca)-静脉血: 2.08mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.94；葡萄糖(Glu)-静脉血: 4.89mmol/L；直接胆红素(DBIL)-静脉血: 2.4umol/L；镁离子(Mg2+)-静脉血: 1.09mmol/L；胱抑素(Cys-C)-静脉血: 0.69mg/L；总胆汁酸(TBA)-静脉血: 1.9umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 35.4U/L；肌酐(Crea)-静脉血: 52.4umol/L；载脂蛋白B(apoB)-静脉血: 0.81g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 48.8；平均红细胞血红蛋白含量(MCH)-静脉血: 32.5pg；钠离子(Na+)-静脉血: 141.4mmol/L；白蛋白(ALB)-静脉血: 40.9g/L；血小板分布宽度(PDW)-静脉血: 11%；血小板计数(PLT#)-静脉血: 19910E9/L；磷(P)-静脉血: 1.21mmol/L；钾离子(K+)-静脉血: 3.94mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.66；总胆固醇(TC)-静脉血: 4.19mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.55mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.465……\n- [全程D57] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后复查，对比某次就诊时间片： 鼻咽腔稍狭窄，鼻咽肿物较前明显缩小，鼻咽顶壁及双侧壁粘膜欠光滑，双侧咽隐窝变浅，鼻咽未见明显肿物，左侧腭帆提肌张肌及头长肌轮廓不清，其内及左侧咽后区见异常信号灶，增强扫描轻度强化，病灶范围较前明显缩小，强化程度较前降低。 左侧咽旁脂肪间隙变窄，左侧颈动脉鞘区见肿物占据，范围较前缩小，强化程度较前降低。左侧腭帆张提肌及左侧头长肌受侵。 口咽双侧壁未见增厚。鼻腔未见肿物。 左侧翼腭窝见少许软组织影，大致同前。右侧翼腭窝、双侧颞下窝未见异常。 斜坡、左侧岩尖、左侧破裂孔，左侧蝶骨大翼、左侧翼突、左侧翼管、左侧圆孔、蝶骨基底部骨质破坏，大致同前。 蝶窦见软组织肿物，较前明显缩小。 双侧上颌窦、蝶窦、筛窦粘膜增厚，左侧乳突少量分泌物。 双侧眼眶未见异常。左侧海绵窦未见明显右侧。 左侧咽后淋巴结肿大，短径约10mm，较前稍缩小。右侧咽后见小淋巴结，短径约4mm，较前明显缩小。双侧II区见多个淋巴结，相互融合，边界不清，较前明显缩小。右侧腮腺见小淋巴结，短径约为4mm。明显强化 左侧腮腺及双侧颌下腺未见异常。所示甲状腺未见异常。 所示脑实质常规MR及DTI未见明显异常信号灶。；检查结论: 鼻咽癌化疗后，鼻咽未见明显肿物，左侧咽旁、蝶窦肿物较前明显缩小。 颅底骨质破坏，大致同前。 双侧咽后及双颈II区淋巴结，较前缩小。 右侧腮腺小淋巴结。 鼻窦炎，左侧乳突炎症。\n- [全程D57] MRI；脑功能成像、DTI: 检查类型: MRI；检查名称: 脑功能成像、DTI；检查部位:；检查所见: 鼻咽癌化疗后复查，对比某次就诊时间片： 鼻咽腔稍狭窄，鼻咽肿物较前明显缩小，鼻咽顶壁及双侧壁粘膜欠光滑，双侧咽隐窝变浅，鼻咽未见明显肿物，左侧腭帆提肌张肌及头长肌轮廓不清，其内及左侧咽后区见异常信号灶，增强扫描轻度强化，病灶范围较前明显缩小，强化程度较前降低。 左侧咽旁脂肪间隙变窄，左侧颈动脉鞘区见肿物占据，范围较前缩小，强化程度较前降低。左侧腭帆张提肌及左侧头长肌受侵。 口咽双侧壁未见增厚。鼻腔未见肿物。 左侧翼腭窝见少许软组织影，大致同前。右侧翼腭窝、双侧颞下窝未见异常。 斜坡、左侧岩尖、左侧破裂孔，左侧蝶骨大翼、左侧翼突、左侧翼管、左侧圆孔、蝶骨基底部骨质破坏，大致同前。 蝶窦见软组织肿物，较前明显缩小。 双侧上颌窦、蝶窦、筛窦粘膜增厚，左侧乳突少量分泌物。 双侧眼眶未见异常。左侧海绵窦未见明显右侧。 左侧咽后淋巴结肿大，短径约10mm，较前稍缩小。右侧咽后见小淋巴结，短径约4mm，较前明显缩小。双侧II区见多个淋巴结，相互融合，边界不清，较前明显缩小。右侧腮腺见小淋巴结，短径约为4mm。明显强化 左侧腮腺及双侧颌下腺未见异常。所示甲状腺未见异常。 所示脑实质常规MR及DTI未见明显异常信号灶。；检查结论: 鼻咽癌化疗后，鼻咽未见明显肿物，左侧咽旁、蝶窦肿物较前明显缩小。 颅底骨质破坏，大致同前。 双侧咽后及双颈II区淋巴结，较前缩小。 右侧腮腺小淋巴结。 鼻窦炎，左侧乳突炎症。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者入院第2天，一般情况可，今日[姓名已隐去]医生信息已隐藏，详细听取病情汇报、检查患者后指示：尽快完善各项治疗前检查，明确诊断及分期，并了解有无合并其他基础疾病，待分期明确后再定治疗方案。遵嘱执行。\n- [全程D13] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。胡医生信息已隐藏：患者予复查血象变化，密切观察患者病情变化。遵嘱。\n- [全程D16] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。检查回报：白细胞 2.5×109/L 。胡医生信息已隐藏：患者出现II度骨髓抑制，考虑化疗引起的副反应，予升白等对症处理，密切观察患者病情变化。遵嘱。\n- [全程D19] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。检查结果回报：白细胞 11.8×109/L。胡医生信息已隐藏：患者血象已恢复正常，密切观察患者病情变化。遵嘱。\n- [全程D22] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。胡医生信息已隐藏：患者予对症处理，密切观察患者病情变化。遵嘱。\n- [全程D25] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。胡医生信息已隐藏：患者予对症处理，密切观察患者病情变化。遵嘱。\n- [全程D51] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者入院第2天，一般情况可，血常规、生化检查无明显异常。[姓名已隐去]医生信息已隐藏示：目前患者诊断明确，今日水化，明日开始第三程诱导化疗。\n- [全程D52] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，血常规、生化检查无明显异常。今日开始予多西他赛90mg/d1+PDD35mg/d1-3方案化疗。[姓名已隐去]医生信息已隐藏示：目前患者诊断明确，今日开始化疗，密切观察病情变化。\n- [全程D55] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，未诉特殊不适。[姓名已隐去]医生信息已隐藏示：目前患者今日化疗结束，密切观病情变化，如有不适，及时对症处理。\n- [全程D57] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，未诉特殊不适。[姓名已隐去]医生信息已隐藏示：目前患者化疗结束，病情稳定，可予出院。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估为诱导化疗后完全缓解（CR），予以出院并定期随访观察，暂缓后续放化疗。\nB. 评估为诱导化疗后部分缓解（PR），继续原方案（多西他赛+顺铂）行第4周期诱导化疗。\nC. 评估为诱导化疗后疾病稳定（SD），更改化疗方案为吉西他滨+顺铂继续诱导化疗。\nD. 评估为诱导化疗后疾病进展（PD），建议行姑息性放疗及靶向治疗。\nE. 评估为诱导化疗后部分缓解（PR），立即行双侧颈部淋巴结清扫术及鼻咽原发灶切除术。\nF. 评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排单纯根治性放疗。\nG. 评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排根治性放疗及靶向治疗。\nH. 评估为诱导化疗后完全缓解（CR），予以出院及对症支持治疗，并择期安排根治性放疗及同期化疗。\nI. 评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排根治性放疗及免疫治疗。\nJ. 评估为诱导化疗后部分缓解（PR），继续住院观察，待血象恢复后立即行第4周期诱导化疗。\nK. 评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排根治性放疗及同期化疗。\nL. 评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排姑息性放疗。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-c81d5e1363b1f79117650da1","patient_id":"patient-7c0941dbdd4694260fd4de38","turn_id":"turn01","turn_position":1,"turn_type":"initial_workup_choice","gold_letter":"L","gold_action":"颈部MRI平扫+增强、电子鼻咽镜检查、腹部超声检查。","options":[{"letter":"A","text":"颈部CT平扫+增强、电子鼻咽镜检查、全身PET-CT检查","is_gold":false},{"letter":"B","text":"颈部MRI平扫、间接鼻咽镜检查、腹部超声检查","is_gold":false},{"letter":"C","text":"颈部MRI平扫+增强、电子鼻咽镜下活检、腹部超声检查","is_gold":false},{"letter":"D","text":"颈部超声、电子鼻咽镜检查、胸腹部CT平扫","is_gold":false},{"letter":"E","text":"颈部CT平扫、电子鼻咽镜检查、腹部超声检查","is_gold":false},{"letter":"F","text":"颈部MRI平扫+增强、间接鼻咽镜检查、胸部X线片","is_gold":false},{"letter":"G","text":"鼻咽及颈部CT平扫+增强、电子鼻咽镜检查、全身骨扫描","is_gold":false},{"letter":"H","text":"颈部MRI平扫、电子鼻咽镜检查、腹部超声检查","is_gold":false},{"letter":"I","text":"颈部MRI平扫+增强、鼻咽活检、全身骨扫描","is_gold":false},{"letter":"J","text":"鼻咽部CT平扫、电子鼻咽镜检查、全身PET-CT检查","is_gold":false},{"letter":"K","text":"颈部MRI平扫+增强、电子鼻咽镜检查、全身骨扫描","is_gold":false},{"letter":"L","text":"颈部MRI平扫+增强、电子鼻咽镜检查、腹部超声检查","is_gold":true}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、口咽。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 反复右中耳积液半年余。；现病史: 简要入院病史:患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；阳性症状体征:；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史: 吸烟2包/日×20年，否认疫区接触史，否认冶游史，否认嗜酒。；家族史: 无特殊。；体格检查:；专科检查:；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 颈部CT平扫+增强、电子鼻咽镜检查、全身PET-CT检查\nB. 颈部MRI平扫、间接鼻咽镜检查、腹部超声检查\nC. 颈部MRI平扫+增强、电子鼻咽镜下活检、腹部超声检查\nD. 颈部超声、电子鼻咽镜检查、胸腹部CT平扫\nE. 颈部CT平扫、电子鼻咽镜检查、腹部超声检查\nF. 颈部MRI平扫+增强、间接鼻咽镜检查、胸部X线片\nG. 鼻咽及颈部CT平扫+增强、电子鼻咽镜检查、全身骨扫描\nH. 颈部MRI平扫、电子鼻咽镜检查、腹部超声检查\nI. 颈部MRI平扫+增强、鼻咽活检、全身骨扫描\nJ. 鼻咽部CT平扫、电子鼻咽镜检查、全身PET-CT检查\nK. 颈部MRI平扫+增强、电子鼻咽镜检查、全身骨扫描\nL. 颈部MRI平扫+增强、电子鼻咽镜检查、腹部超声检查\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、口咽。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 反复右中耳积液半年余。；现病史: 简要入院病史:患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；阳性症状体征:；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史: 吸烟2包/日×20年，否认疫区接触史，否认冶游史，否认嗜酒。；家族史: 无特殊。；体格检查:；专科检查:；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 颈部CT平扫+增强、电子鼻咽镜检查、全身PET-CT检查\nB. 颈部MRI平扫、间接鼻咽镜检查、腹部超声检查\nC. 颈部MRI平扫+增强、电子鼻咽镜下活检、腹部超声检查\nD. 颈部超声、电子鼻咽镜检查、胸腹部CT平扫\nE. 颈部CT平扫、电子鼻咽镜检查、腹部超声检查\nF. 颈部MRI平扫+增强、间接鼻咽镜检查、胸部X线片\nG. 鼻咽及颈部CT平扫+增强、电子鼻咽镜检查、全身骨扫描\nH. 颈部MRI平扫、电子鼻咽镜检查、腹部超声检查\nI. 颈部MRI平扫+增强、鼻咽活检、全身骨扫描\nJ. 鼻咽部CT平扫、电子鼻咽镜检查、全身PET-CT检查\nK. 颈部MRI平扫+增强、电子鼻咽镜检查、全身骨扫描\nL. 颈部MRI平扫+增强、电子鼻咽镜检查、腹部超声检查\n\n请仅输出一个选项字母（A-L）。"}]}
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full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、口咽。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 反复右中耳积液半年余。；现病史: 简要入院病史:患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；阳性症状体征:；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史: 吸烟2包/日×20年，否认疫区接触史，否认冶游史，否认嗜酒。；家族史: 无特殊。；体格检查:；专科检查:；KPS: 90；ECOG:\n- [时间未明] 门急诊记录: 主诉: 反复右中耳积液半年余。；现病史: 患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史:；家族史: 无特殊。；体格检查: KPS90分，DG4.0cm，鼻咽右侧隆突肿物，接近右侧后鼻孔，双颈未触及肿大淋巴结，颅神经检查阴性，心肺腹未及异常，全身骨无压痛。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D8] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽右侧咽隐窝区软组织影放射性浓聚，SUV41.8，病灶侵犯右腭帆肌群、右头长肌，病灶与蝶骨基底部右份及右翼突内板分界不清。右咽旁间隙变浅，右咽隐窝消失，左侧咽隐窝未见明显异常。口咽及喉咽结构及放射性分布未见明显异常。双侧上颌窦低密度影放射性分布未见异常；额窦、蝶窦、筛窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双颈多个小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 右中肺小片状影放射性分布未见异常；余双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏弥漫性密度减低，CT值约46Hu（脾脏CT值约58Hu），形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 盆腔放射性分布均匀，膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 右乳突气房内低密度影放射性分布未见异常；余颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽右咽隐窝病灶代谢活跃，符合鼻咽癌，病灶疑累及蝶骨基底部右份及右翼突内板。 双上颌窦炎症；右乳突炎症。 右中肺小片状影代谢未见异常，考虑增殖灶。 轻度脂肪肝。\n- [全程D8] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 早期复极改变 其余未见异常\n- [全程D8] 检验组合: 红细胞计数(RBC#)-静脉血: 5.2310E12/L；血液二氧化碳含量ctCO2(B)-静脉血: 25mmol/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.766COI；血小板分布宽度(PDW)-静脉血: 16.4%；单核细胞百分比(Mono%)-静脉血: 0.077；红细胞比容(Hct)-静脉血: 48.4%；凝血酶时间(TT)-静脉血: 19.8sec.；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 32.8U/L；凝血酶原时间(PT)-静脉血: 9.9sec.；淋巴细胞计数(Lymph#)-静脉血: 2.310E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.025；白蛋白(ALB)-静脉血: 46g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.61；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.08；胱抑素(Cys-C)-静脉血: 0.98mg/L；尿素氮(BUN)-静脉血: 5.5mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.597；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 6.1umolL；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；碱性磷酸酶(ALP)-静脉血: 60.9U/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 0.006COI；C-反应蛋白(CRP)-静脉血: 1.86mg/L；Rh血型-静脉血: 阳性；总钙(Ca)-静脉血: 2.14mmol/L；总胆汁酸(TBA)-静脉血: 8.3umol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.1ug/ml；丙氨酸氨基转移酶(ALT)-静脉血: 46.9U/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；氯离子(Cl-)-静脉血: 104.3mmol/L；低密度脂蛋白胆固醇……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行电子鼻咽镜检查及鼻咽肿物活检，并辅以颈部淋巴结彩超及穿刺活检\nB. 行电子鼻咽镜检查及鼻咽肿物活检，颈部淋巴结仅作临床触诊及随访\nC. 行颈部淋巴结切除活检明确病理，暂缓鼻咽部有创检查及活检\nD. 行鼻内镜下鼻咽肿物扩大切除术，同步完成病理诊断与局部治疗\nE. 行颈部淋巴结彩超及穿刺活检，若确诊转移则免于鼻咽部活检\nF. 行鼻咽部脱落细胞学涂片及血浆EBV-DNA检测，替代组织学活检\nG. 启动根治性放化疗，免于组织学活检及颈部淋巴结穿刺评估\nH. 行电子鼻咽镜检查及活检，并预防性行双侧颈部淋巴结清扫术\nI. 补充全身骨扫描及头颅增强MRI，暂缓鼻咽及颈部组织学活检\nJ. 行电子鼻咽镜评估局部侵犯范围，免于鼻咽肿物组织学活检\nK. 优先行鼓膜穿刺置管术缓解中耳积液，暂缓鼻咽部及颈部检查\nL. 予以诊断性抗炎治疗2周，随后复查PET/CT评估局部代谢变化\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、口咽。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 反复右中耳积液半年余。；现病史: 简要入院病史:患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；阳性症状体征:；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史: 吸烟2包/日×20年，否认疫区接触史，否认冶游史，否认嗜酒。；家族史: 无特殊。；体格检查:；专科检查:；KPS: 90；ECOG:\n- [时间未明] 门急诊记录: 主诉: 反复右中耳积液半年余。；现病史: 患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史:；家族史: 无特殊。；体格检查: KPS90分，DG4.0cm，鼻咽右侧隆突肿物，接近右侧后鼻孔，双颈未触及肿大淋巴结，颅神经检查阴性，心肺腹未及异常，全身骨无压痛。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D8] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽右侧咽隐窝区软组织影放射性浓聚，SUV41.8，病灶侵犯右腭帆肌群、右头长肌，病灶与蝶骨基底部右份及右翼突内板分界不清。右咽旁间隙变浅，右咽隐窝消失，左侧咽隐窝未见明显异常。口咽及喉咽结构及放射性分布未见明显异常。双侧上颌窦低密度影放射性分布未见异常；额窦、蝶窦、筛窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双颈多个小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 右中肺小片状影放射性分布未见异常；余双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏弥漫性密度减低，CT值约46Hu（脾脏CT值约58Hu），形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 盆腔放射性分布均匀，膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 右乳突气房内低密度影放射性分布未见异常；余颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽右咽隐窝病灶代谢活跃，符合鼻咽癌，病灶疑累及蝶骨基底部右份及右翼突内板。 双上颌窦炎症；右乳突炎症。 右中肺小片状影代谢未见异常，考虑增殖灶。 轻度脂肪肝。\n- [全程D8] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 早期复极改变 其余未见异常\n- [全程D8] 检验组合: 红细胞计数(RBC#)-静脉血: 5.2310E12/L；血液二氧化碳含量ctCO2(B)-静脉血: 25mmol/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.766COI；血小板分布宽度(PDW)-静脉血: 16.4%；单核细胞百分比(Mono%)-静脉血: 0.077；红细胞比容(Hct)-静脉血: 48.4%；凝血酶时间(TT)-静脉血: 19.8sec.；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 32.8U/L；凝血酶原时间(PT)-静脉血: 9.9sec.；淋巴细胞计数(Lymph#)-静脉血: 2.310E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.025；白蛋白(ALB)-静脉血: 46g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.61；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.08；胱抑素(Cys-C)-静脉血: 0.98mg/L；尿素氮(BUN)-静脉血: 5.5mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.597；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 6.1umolL；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；碱性磷酸酶(ALP)-静脉血: 60.9U/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 0.006COI；C-反应蛋白(CRP)-静脉血: 1.86mg/L；Rh血型-静脉血: 阳性；总钙(Ca)-静脉血: 2.14mmol/L；总胆汁酸(TBA)-静脉血: 8.3umol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.1ug/ml；丙氨酸氨基转移酶(ALT)-静脉血: 46.9U/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；氯离子(Cl-)-静脉血: 104.3mmol/L；低密度脂蛋白胆固醇……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行电子鼻咽镜检查及鼻咽肿物活检，并辅以颈部淋巴结彩超及穿刺活检\nB. 行电子鼻咽镜检查及鼻咽肿物活检，颈部淋巴结仅作临床触诊及随访\nC. 行颈部淋巴结切除活检明确病理，暂缓鼻咽部有创检查及活检\nD. 行鼻内镜下鼻咽肿物扩大切除术，同步完成病理诊断与局部治疗\nE. 行颈部淋巴结彩超及穿刺活检，若确诊转移则免于鼻咽部活检\nF. 行鼻咽部脱落细胞学涂片及血浆EBV-DNA检测，替代组织学活检\nG. 启动根治性放化疗，免于组织学活检及颈部淋巴结穿刺评估\nH. 行电子鼻咽镜检查及活检，并预防性行双侧颈部淋巴结清扫术\nI. 补充全身骨扫描及头颅增强MRI，暂缓鼻咽及颈部组织学活检\nJ. 行电子鼻咽镜评估局部侵犯范围，免于鼻咽肿物组织学活检\nK. 优先行鼓膜穿刺置管术缓解中耳积液，暂缓鼻咽部及颈部检查\nL. 予以诊断性抗炎治疗2周，随后复查PET/CT评估局部代谢变化\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-3ed269e9b5e894b444089bf3","patient_id":"patient-7c0941dbdd4694260fd4de38","turn_id":"turn04","turn_position":3,"turn_type":"initial_treatment_selection","gold_letter":"C","gold_action":"单纯根治性放疗（鼻咽及双侧颈部）","options":[{"letter":"A","text":"诱导化疗序贯单纯根治性放疗（鼻咽及双侧颈部）","is_gold":false},{"letter":"B","text":"同期放化疗（鼻咽及双侧颈部）","is_gold":false},{"letter":"C","text":"单纯根治性放疗（鼻咽及双侧颈部）","is_gold":true},{"letter":"D","text":"诱导化疗序贯同期放化疗（鼻咽及双侧颈部）","is_gold":false},{"letter":"E","text":"鼻咽原发灶切除术联合术后辅助放疗","is_gold":false},{"letter":"F","text":"靶向治疗联合单纯根治性放疗（鼻咽及双侧颈部）","is_gold":false},{"letter":"G","text":"免疫治疗联合单纯根治性放疗（鼻咽及双侧颈部）","is_gold":false},{"letter":"H","text":"诱导化疗联合免疫治疗序贯同期放化疗","is_gold":false},{"letter":"I","text":"单纯根治性放疗（仅照射鼻咽及右侧颈部）","is_gold":false},{"letter":"J","text":"姑息性全身化疗联合鼻咽局部减症放疗","is_gold":false},{"letter":"K","text":"诱导化疗后肿瘤退缩情况决定是否行根治性放疗","is_gold":false},{"letter":"L","text":"同期放化疗序贯全身辅助化疗","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、口咽。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 反复右中耳积液半年余。；现病史: 简要入院病史:患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；阳性症状体征:；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史: 吸烟2包/日×20年，否认疫区接触史，否认冶游史，否认嗜酒。；家族史: 无特殊。；体格检查:；专科检查:；KPS: 90；ECOG:\n- [时间未明] 门急诊记录: 主诉: 反复右中耳积液半年余。；现病史: 患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史:；家族史: 无特殊。；体格检查: KPS90分，DG4.0cm，鼻咽右侧隆突肿物，接近右侧后鼻孔，双颈未触及肿大淋巴结，颅神经检查阴性，心肺腹未及异常，全身骨无压痛。\n- [全程D24] 入院记录: 主诉: 反复右中耳积液半年余。；现病史: 简要入院病史:患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。后来我院，我院病理示未分化非角化性癌。我院鼻咽+颈部MR：鼻咽部肿物，考虑鼻咽癌。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；阳性症状体征:；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史: 吸烟2包/日×20年，否认疫区接触史，否认冶游史，否认嗜酒。；家族史: 无特殊。；体格检查:；专科检查:；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D8] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽右侧咽隐窝区软组织影放射性浓聚，SUV41.8，病灶侵犯右腭帆肌群、右头长肌，病灶与蝶骨基底部右份及右翼突内板分界不清。右咽旁间隙变浅，右咽隐窝消失，左侧咽隐窝未见明显异常。口咽及喉咽结构及放射性分布未见明显异常。双侧上颌窦低密度影放射性分布未见异常；额窦、蝶窦、筛窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双颈多个小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 右中肺小片状影放射性分布未见异常；余双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏弥漫性密度减低，CT值约46Hu（脾脏CT值约58Hu），形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 盆腔放射性分布均匀，膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 右乳突气房内低密度影放射性分布未见异常；余颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽右咽隐窝病灶代谢活跃，符合鼻咽癌，病灶疑累及蝶骨基底部右份及右翼突内板。 双上颌窦炎症；右乳突炎症。 右中肺小片状影代谢未见异常，考虑增殖灶。 轻度脂肪肝。\n- [全程D8] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 早期复极改变 其余未见异常\n- [全程D8] 检验组合: 红细胞计数(RBC#)-静脉血: 5.2310E12/L；血液二氧化碳含量ctCO2(B)-静脉血: 25mmol/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.766COI；血小板分布宽度(PDW)-静脉血: 16.4%；单核细胞百分比(Mono%)-静脉血: 0.077；红细胞比容(Hct)-静脉血: 48.4%；凝血酶时间(TT)-静脉血: 19.8sec.；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 32.8U/L；凝血酶原时间(PT)-静脉血: 9.9sec.；淋巴细胞计数(Lymph#)-静脉血: 2.310E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.025；白蛋白(ALB)-静脉血: 46g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.61；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.08；胱抑素(Cys-C)-静脉血: 0.98mg/L；尿素氮(BUN)-静脉血: 5.5mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.597；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 6.1umolL；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；碱性磷酸酶(ALP)-静脉血: 60.9U/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 0.006COI；C-反应蛋白(CRP)-静脉血: 1.86mg/L；Rh血型-静脉血: 阳性；总钙(Ca)-静脉血: 2.14mmol/L；总胆汁酸(TBA)-静脉血: 8.3umol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.1ug/ml；丙氨酸氨基转移酶(ALT)-静脉血: 46.9U/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；氯离子(Cl-)-静脉血: 104.3mmol/L；低密度脂蛋白胆固醇……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D9] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁明显增厚，右侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描强化较明显。左侧咽隐窝存在。肿块累及右侧口咽壁。 右侧咽旁脂肪间隙变窄；左侧咽旁间隙未见明显狭窄。右侧腭帆张提肌受侵，左侧腭帆张提肌、双侧头长肌、双侧翼内外肌未见受侵。 鼻腔内未见肿物。 双侧翼腭窝、双侧上颌后脂肪间隙及咀嚼肌间隙未见异常。 颅底骨质信号均匀，增强扫描未见异常强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧上颌窦内见囊性灶，最大长径约27mm，边界清，无强化。右侧乳突见分泌物。左乳突充气良好，骨壁完整。 右侧咽后见一肿大淋巴结，大小约6mm×9mm，增强扫描明显强化。左侧咽后未见肿大淋巴结。颈部双侧见多个小淋巴结，最大者约8mm×11mm，未见坏死及包膜外侵。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。 扫描范围脑实质信号未见异常。；检查结论: 鼻咽肿物，考虑鼻咽癌。 颅底骨质未见破坏。 右侧咽后肿大淋巴结，考虑转移。 颈部小淋巴结。 双侧上颌窦囊肿，右侧乳突炎。\n- [全程D13] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见: 双颈II区可见几个小淋巴结，最大约11mm×4mm（右），12mm×5mm（左），边界清，椭圆形，皮髓质分界清，淋巴门可见。 CDFI:上述淋巴结内可见点状血流信号。 双侧颈部淋巴结穿刺活检： （1）右侧颈部淋巴结穿刺活检：常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以16G穿刺针穿刺入右颈淋巴结内，进针2次，取出长约0.5-1cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。 （2）左侧颈部淋巴结穿刺活检：常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以18G穿刺针穿刺入左颈淋巴结内，进针2次，取出长约0.8-1cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。；检查结论: 双侧颈部淋巴结穿刺活检。 不适随诊。 4个工作日后凭发票到2号楼6楼病理科取结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 诱导化疗序贯单纯根治性放疗（鼻咽及双侧颈部）\nB. 同期放化疗（鼻咽及双侧颈部）\nC. 单纯根治性放疗（鼻咽及双侧颈部）\nD. 诱导化疗序贯同期放化疗（鼻咽及双侧颈部）\nE. 鼻咽原发灶切除术联合术后辅助放疗\nF. 靶向治疗联合单纯根治性放疗（鼻咽及双侧颈部）\nG. 免疫治疗联合单纯根治性放疗（鼻咽及双侧颈部）\nH. 诱导化疗联合免疫治疗序贯同期放化疗\nI. 单纯根治性放疗（仅照射鼻咽及右侧颈部）\nJ. 姑息性全身化疗联合鼻咽局部减症放疗\nK. 诱导化疗后肿瘤退缩情况决定是否行根治性放疗\nL. 同期放化疗序贯全身辅助化疗\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、口咽。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 反复右中耳积液半年余。；现病史: 简要入院病史:患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；阳性症状体征:；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史: 吸烟2包/日×20年，否认疫区接触史，否认冶游史，否认嗜酒。；家族史: 无特殊。；体格检查:；专科检查:；KPS: 90；ECOG:\n- [时间未明] 门急诊记录: 主诉: 反复右中耳积液半年余。；现病史: 患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史:；家族史: 无特殊。；体格检查: KPS90分，DG4.0cm，鼻咽右侧隆突肿物，接近右侧后鼻孔，双颈未触及肿大淋巴结，颅神经检查阴性，心肺腹未及异常，全身骨无压痛。\n- [全程D24] 入院记录: 主诉: 反复右中耳积液半年余。；现病史: 简要入院病史:患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。后来我院，我院病理示未分化非角化性癌。我院鼻咽+颈部MR：鼻咽部肿物，考虑鼻咽癌。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；阳性症状体征:；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史: 吸烟2包/日×20年，否认疫区接触史，否认冶游史，否认嗜酒。；家族史: 无特殊。；体格检查:；专科检查:；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D8] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽右侧咽隐窝区软组织影放射性浓聚，SUV41.8，病灶侵犯右腭帆肌群、右头长肌，病灶与蝶骨基底部右份及右翼突内板分界不清。右咽旁间隙变浅，右咽隐窝消失，左侧咽隐窝未见明显异常。口咽及喉咽结构及放射性分布未见明显异常。双侧上颌窦低密度影放射性分布未见异常；额窦、蝶窦、筛窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双颈多个小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 右中肺小片状影放射性分布未见异常；余双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏弥漫性密度减低，CT值约46Hu（脾脏CT值约58Hu），形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 盆腔放射性分布均匀，膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 右乳突气房内低密度影放射性分布未见异常；余颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽右咽隐窝病灶代谢活跃，符合鼻咽癌，病灶疑累及蝶骨基底部右份及右翼突内板。 双上颌窦炎症；右乳突炎症。 右中肺小片状影代谢未见异常，考虑增殖灶。 轻度脂肪肝。\n- [全程D8] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 早期复极改变 其余未见异常\n- [全程D8] 检验组合: 红细胞计数(RBC#)-静脉血: 5.2310E12/L；血液二氧化碳含量ctCO2(B)-静脉血: 25mmol/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.766COI；血小板分布宽度(PDW)-静脉血: 16.4%；单核细胞百分比(Mono%)-静脉血: 0.077；红细胞比容(Hct)-静脉血: 48.4%；凝血酶时间(TT)-静脉血: 19.8sec.；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 32.8U/L；凝血酶原时间(PT)-静脉血: 9.9sec.；淋巴细胞计数(Lymph#)-静脉血: 2.310E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.025；白蛋白(ALB)-静脉血: 46g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.61；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.08；胱抑素(Cys-C)-静脉血: 0.98mg/L；尿素氮(BUN)-静脉血: 5.5mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.597；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 6.1umolL；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；碱性磷酸酶(ALP)-静脉血: 60.9U/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 0.006COI；C-反应蛋白(CRP)-静脉血: 1.86mg/L；Rh血型-静脉血: 阳性；总钙(Ca)-静脉血: 2.14mmol/L；总胆汁酸(TBA)-静脉血: 8.3umol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.1ug/ml；丙氨酸氨基转移酶(ALT)-静脉血: 46.9U/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；氯离子(Cl-)-静脉血: 104.3mmol/L；低密度脂蛋白胆固醇……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D9] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁明显增厚，右侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描强化较明显。左侧咽隐窝存在。肿块累及右侧口咽壁。 右侧咽旁脂肪间隙变窄；左侧咽旁间隙未见明显狭窄。右侧腭帆张提肌受侵，左侧腭帆张提肌、双侧头长肌、双侧翼内外肌未见受侵。 鼻腔内未见肿物。 双侧翼腭窝、双侧上颌后脂肪间隙及咀嚼肌间隙未见异常。 颅底骨质信号均匀，增强扫描未见异常强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧上颌窦内见囊性灶，最大长径约27mm，边界清，无强化。右侧乳突见分泌物。左乳突充气良好，骨壁完整。 右侧咽后见一肿大淋巴结，大小约6mm×9mm，增强扫描明显强化。左侧咽后未见肿大淋巴结。颈部双侧见多个小淋巴结，最大者约8mm×11mm，未见坏死及包膜外侵。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。 扫描范围脑实质信号未见异常。；检查结论: 鼻咽肿物，考虑鼻咽癌。 颅底骨质未见破坏。 右侧咽后肿大淋巴结，考虑转移。 颈部小淋巴结。 双侧上颌窦囊肿，右侧乳突炎。\n- [全程D13] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见: 双颈II区可见几个小淋巴结，最大约11mm×4mm（右），12mm×5mm（左），边界清，椭圆形，皮髓质分界清，淋巴门可见。 CDFI:上述淋巴结内可见点状血流信号。 双侧颈部淋巴结穿刺活检： （1）右侧颈部淋巴结穿刺活检：常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以16G穿刺针穿刺入右颈淋巴结内，进针2次，取出长约0.5-1cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。 （2）左侧颈部淋巴结穿刺活检：常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以18G穿刺针穿刺入左颈淋巴结内，进针2次，取出长约0.8-1cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。；检查结论: 双侧颈部淋巴结穿刺活检。 不适随诊。 4个工作日后凭发票到2号楼6楼病理科取结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 诱导化疗序贯单纯根治性放疗（鼻咽及双侧颈部）\nB. 同期放化疗（鼻咽及双侧颈部）\nC. 单纯根治性放疗（鼻咽及双侧颈部）\nD. 诱导化疗序贯同期放化疗（鼻咽及双侧颈部）\nE. 鼻咽原发灶切除术联合术后辅助放疗\nF. 靶向治疗联合单纯根治性放疗（鼻咽及双侧颈部）\nG. 免疫治疗联合单纯根治性放疗（鼻咽及双侧颈部）\nH. 诱导化疗联合免疫治疗序贯同期放化疗\nI. 单纯根治性放疗（仅照射鼻咽及右侧颈部）\nJ. 姑息性全身化疗联合鼻咽局部减症放疗\nK. 诱导化疗后肿瘤退缩情况决定是否行根治性放疗\nL. 同期放化疗序贯全身辅助化疗\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-f6df1555c3bac7ae4b972cd4","patient_id":"patient-7c0941dbdd4694260fd4de38","turn_id":"turn05","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"D","gold_action":"继续当前根治性放疗计划，定期常规监测血象及生化。","options":[{"letter":"A","text":"继续放疗，加用多烯磷脂酰胆碱等保肝药物。","is_gold":false},{"letter":"B","text":"继续放疗，皮下注射重组人粒细胞刺激因子。","is_gold":false},{"letter":"C","text":"暂停放疗，完善超声心动图及动态心电图检查。","is_gold":false},{"letter":"D","text":"继续根治性放疗计划，定期常规监测血象及生化。","is_gold":true},{"letter":"E","text":"继续放疗，加用阿托伐他汀等降脂药物。","is_gold":false},{"letter":"F","text":"继续放疗，给予静脉补液及利尿治疗。","is_gold":false},{"letter":"G","text":"暂停放疗，静脉滴注广谱抗生素抗感染治疗。","is_gold":false},{"letter":"H","text":"继续放疗，口服头孢类抗生素及促排痰药物。","is_gold":false},{"letter":"I","text":"继续放疗，静脉滴注地塞米松及甘露醇。","is_gold":false},{"letter":"J","text":"调整放疗计划，降低右侧中耳及乳突区的照射剂量。","is_gold":false},{"letter":"K","text":"继续放疗，皮下注射促红细胞生成素。","is_gold":false},{"letter":"L","text":"暂停放疗，行鼻内镜下鼓膜穿刺置管引流术。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、口咽。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 反复右中耳积液半年余。；现病史: 简要入院病史:患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；阳性症状体征:；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史: 吸烟2包/日×20年，否认疫区接触史，否认冶游史，否认嗜酒。；家族史: 无特殊。；体格检查:；专科检查:；KPS: 90；ECOG:\n- [时间未明] 门急诊记录: 主诉: 反复右中耳积液半年余。；现病史: 患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史:；家族史: 无特殊。；体格检查: KPS90分，DG4.0cm，鼻咽右侧隆突肿物，接近右侧后鼻孔，双颈未触及肿大淋巴结，颅神经检查阴性，心肺腹未及异常，全身骨无压痛。\n- [全程D24] 入院记录: 主诉: 反复右中耳积液半年余。；现病史: 简要入院病史:患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。后来我院，我院病理示未分化非角化性癌。我院鼻咽+颈部MR：鼻咽部肿物，考虑鼻咽癌。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；阳性症状体征:；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史: 吸烟2包/日×20年，否认疫区接触史，否认冶游史，否认嗜酒。；家族史: 无特殊。；体格检查:；专科检查:；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D8] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽右侧咽隐窝区软组织影放射性浓聚，SUV41.8，病灶侵犯右腭帆肌群、右头长肌，病灶与蝶骨基底部右份及右翼突内板分界不清。右咽旁间隙变浅，右咽隐窝消失，左侧咽隐窝未见明显异常。口咽及喉咽结构及放射性分布未见明显异常。双侧上颌窦低密度影放射性分布未见异常；额窦、蝶窦、筛窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双颈多个小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 右中肺小片状影放射性分布未见异常；余双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏弥漫性密度减低，CT值约46Hu（脾脏CT值约58Hu），形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 盆腔放射性分布均匀，膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 右乳突气房内低密度影放射性分布未见异常；余颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽右咽隐窝病灶代谢活跃，符合鼻咽癌，病灶疑累及蝶骨基底部右份及右翼突内板。 双上颌窦炎症；右乳突炎症。 右中肺小片状影代谢未见异常，考虑增殖灶。 轻度脂肪肝。\n- [全程D8] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 早期复极改变 其余未见异常\n- [全程D8] 检验组合: 红细胞计数(RBC#)-静脉血: 5.2310E12/L；血液二氧化碳含量ctCO2(B)-静脉血: 25mmol/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.766COI；血小板分布宽度(PDW)-静脉血: 16.4%；单核细胞百分比(Mono%)-静脉血: 0.077；红细胞比容(Hct)-静脉血: 48.4%；凝血酶时间(TT)-静脉血: 19.8sec.；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 32.8U/L；凝血酶原时间(PT)-静脉血: 9.9sec.；淋巴细胞计数(Lymph#)-静脉血: 2.310E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.025；白蛋白(ALB)-静脉血: 46g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.61；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.08；胱抑素(Cys-C)-静脉血: 0.98mg/L；尿素氮(BUN)-静脉血: 5.5mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.597；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 6.1umolL；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；碱性磷酸酶(ALP)-静脉血: 60.9U/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 0.006COI；C-反应蛋白(CRP)-静脉血: 1.86mg/L；Rh血型-静脉血: 阳性；总钙(Ca)-静脉血: 2.14mmol/L；总胆汁酸(TBA)-静脉血: 8.3umol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.1ug/ml；丙氨酸氨基转移酶(ALT)-静脉血: 46.9U/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；氯离子(Cl-)-静脉血: 104.3mmol/L；低密度脂蛋白胆固醇……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D9] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁明显增厚，右侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描强化较明显。左侧咽隐窝存在。肿块累及右侧口咽壁。 右侧咽旁脂肪间隙变窄；左侧咽旁间隙未见明显狭窄。右侧腭帆张提肌受侵，左侧腭帆张提肌、双侧头长肌、双侧翼内外肌未见受侵。 鼻腔内未见肿物。 双侧翼腭窝、双侧上颌后脂肪间隙及咀嚼肌间隙未见异常。 颅底骨质信号均匀，增强扫描未见异常强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧上颌窦内见囊性灶，最大长径约27mm，边界清，无强化。右侧乳突见分泌物。左乳突充气良好，骨壁完整。 右侧咽后见一肿大淋巴结，大小约6mm×9mm，增强扫描明显强化。左侧咽后未见肿大淋巴结。颈部双侧见多个小淋巴结，最大者约8mm×11mm，未见坏死及包膜外侵。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。 扫描范围脑实质信号未见异常。；检查结论: 鼻咽肿物，考虑鼻咽癌。 颅底骨质未见破坏。 右侧咽后肿大淋巴结，考虑转移。 颈部小淋巴结。 双侧上颌窦囊肿，右侧乳突炎。\n- [全程D13] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见: 双颈II区可见几个小淋巴结，最大约11mm×4mm（右），12mm×5mm（左），边界清，椭圆形，皮髓质分界清，淋巴门可见。 CDFI:上述淋巴结内可见点状血流信号。 双侧颈部淋巴结穿刺活检： （1）右侧颈部淋巴结穿刺活检：常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以16G穿刺针穿刺入右颈淋巴结内，进针2次，取出长约0.5-1cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。 （2）左侧颈部淋巴结穿刺活检：常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以18G穿刺针穿刺入左颈淋巴结内，进针2次，取出长约0.8-1cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。；检查结论: 双侧颈部淋巴结穿刺活检。 不适随诊。 4个工作日后凭发票到2号楼6楼病理科取结果。\n- [全程D28] 检验组合: 总蛋白(TP)-静脉血: 67.97g/L；总胆红素(TBIL)-静脉血: 13.8umol/L；载脂蛋白B(apoB)-静脉血: 1.32g/L；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.99mmolL；大血小板百分比(P-LCR%)-静脉血: 25.7%；球蛋白(GLO)-静脉血: 23.97g/L；总钙(Ca)-静脉血: 2.26mmol/L；红细胞比容(Hct)-静脉血: 46.8%；血小板计数(PLT#)-静脉血: 20110E9/L；磷(P)-静脉血: 1.5mmol/L；血小板比容-静脉血: 20%；肌酐(Crea)-静脉血: 84.5umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.3；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；总胆汁酸(TBA)-静脉血: 3.5umol/L；钾离子(K+)-静脉血: 4mmol/L；C-反应蛋白(CRP)-静脉血: 2.01mg/L；间接胆红素(IBIL)-静脉血: 9.7umolL；胱抑素(Cys-C)-静脉血: 1.04mg/L；尿素氮(BUN)-静脉血: 6.93mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.6；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.11mmol/L；碱性磷酸酶(ALP)-静脉血: 50.9U/L；平均红细胞体积(MCV)-静脉血: 91.4fL；单核细胞计数(Mono#)-静脉血: 0.710E9/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；单核细胞百分比(Mono%)-静脉血: 0.081；红细胞计数(RBC#)-静脉血: 5.1210E12/L；白细胞计数(WBC#)-静脉血: 8.4210E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；平均血小板体积(MPV)-静脉血: 10.2fL；总胆固醇(TC)-静脉血: 5.98mmol/L；血红蛋白(Hb)-静脉血: 159g/L；直接胆红素(DBIL)-静脉血: 4.1umol/L；氯离子(Cl-)-静脉血: 105.9mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 340g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D27] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗1次，无特殊主诉。Rx：1.继续放疗。2.定期复查血常规等。3.对症支持。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 继续放疗，加用多烯磷脂酰胆碱等保肝药物。\nB. 继续放疗，皮下注射重组人粒细胞刺激因子。\nC. 暂停放疗，完善超声心动图及动态心电图检查。\nD. 继续根治性放疗计划，定期常规监测血象及生化。\nE. 继续放疗，加用阿托伐他汀等降脂药物。\nF. 继续放疗，给予静脉补液及利尿治疗。\nG. 暂停放疗，静脉滴注广谱抗生素抗感染治疗。\nH. 继续放疗，口服头孢类抗生素及促排痰药物。\nI. 继续放疗，静脉滴注地塞米松及甘露醇。\nJ. 调整放疗计划，降低右侧中耳及乳突区的照射剂量。\nK. 继续放疗，皮下注射促红细胞生成素。\nL. 暂停放疗，行鼻内镜下鼓膜穿刺置管引流术。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、口咽。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 反复右中耳积液半年余。；现病史: 简要入院病史:患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；阳性症状体征:；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史: 吸烟2包/日×20年，否认疫区接触史，否认冶游史，否认嗜酒。；家族史: 无特殊。；体格检查:；专科检查:；KPS: 90；ECOG:\n- [时间未明] 门急诊记录: 主诉: 反复右中耳积液半年余。；现病史: 患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史:；家族史: 无特殊。；体格检查: KPS90分，DG4.0cm，鼻咽右侧隆突肿物，接近右侧后鼻孔，双颈未触及肿大淋巴结，颅神经检查阴性，心肺腹未及异常，全身骨无压痛。\n- [全程D24] 入院记录: 主诉: 反复右中耳积液半年余。；现病史: 简要入院病史:患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。后来我院，我院病理示未分化非角化性癌。我院鼻咽+颈部MR：鼻咽部肿物，考虑鼻咽癌。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；阳性症状体征:；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史: 吸烟2包/日×20年，否认疫区接触史，否认冶游史，否认嗜酒。；家族史: 无特殊。；体格检查:；专科检查:；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D8] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽右侧咽隐窝区软组织影放射性浓聚，SUV41.8，病灶侵犯右腭帆肌群、右头长肌，病灶与蝶骨基底部右份及右翼突内板分界不清。右咽旁间隙变浅，右咽隐窝消失，左侧咽隐窝未见明显异常。口咽及喉咽结构及放射性分布未见明显异常。双侧上颌窦低密度影放射性分布未见异常；额窦、蝶窦、筛窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双颈多个小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 右中肺小片状影放射性分布未见异常；余双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏弥漫性密度减低，CT值约46Hu（脾脏CT值约58Hu），形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 盆腔放射性分布均匀，膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 右乳突气房内低密度影放射性分布未见异常；余颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽右咽隐窝病灶代谢活跃，符合鼻咽癌，病灶疑累及蝶骨基底部右份及右翼突内板。 双上颌窦炎症；右乳突炎症。 右中肺小片状影代谢未见异常，考虑增殖灶。 轻度脂肪肝。\n- [全程D8] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 早期复极改变 其余未见异常\n- [全程D8] 检验组合: 红细胞计数(RBC#)-静脉血: 5.2310E12/L；血液二氧化碳含量ctCO2(B)-静脉血: 25mmol/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.766COI；血小板分布宽度(PDW)-静脉血: 16.4%；单核细胞百分比(Mono%)-静脉血: 0.077；红细胞比容(Hct)-静脉血: 48.4%；凝血酶时间(TT)-静脉血: 19.8sec.；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 32.8U/L；凝血酶原时间(PT)-静脉血: 9.9sec.；淋巴细胞计数(Lymph#)-静脉血: 2.310E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.025；白蛋白(ALB)-静脉血: 46g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.61；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.08；胱抑素(Cys-C)-静脉血: 0.98mg/L；尿素氮(BUN)-静脉血: 5.5mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.597；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 6.1umolL；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；碱性磷酸酶(ALP)-静脉血: 60.9U/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 0.006COI；C-反应蛋白(CRP)-静脉血: 1.86mg/L；Rh血型-静脉血: 阳性；总钙(Ca)-静脉血: 2.14mmol/L；总胆汁酸(TBA)-静脉血: 8.3umol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.1ug/ml；丙氨酸氨基转移酶(ALT)-静脉血: 46.9U/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；氯离子(Cl-)-静脉血: 104.3mmol/L；低密度脂蛋白胆固醇……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D9] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁明显增厚，右侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描强化较明显。左侧咽隐窝存在。肿块累及右侧口咽壁。 右侧咽旁脂肪间隙变窄；左侧咽旁间隙未见明显狭窄。右侧腭帆张提肌受侵，左侧腭帆张提肌、双侧头长肌、双侧翼内外肌未见受侵。 鼻腔内未见肿物。 双侧翼腭窝、双侧上颌后脂肪间隙及咀嚼肌间隙未见异常。 颅底骨质信号均匀，增强扫描未见异常强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧上颌窦内见囊性灶，最大长径约27mm，边界清，无强化。右侧乳突见分泌物。左乳突充气良好，骨壁完整。 右侧咽后见一肿大淋巴结，大小约6mm×9mm，增强扫描明显强化。左侧咽后未见肿大淋巴结。颈部双侧见多个小淋巴结，最大者约8mm×11mm，未见坏死及包膜外侵。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。 扫描范围脑实质信号未见异常。；检查结论: 鼻咽肿物，考虑鼻咽癌。 颅底骨质未见破坏。 右侧咽后肿大淋巴结，考虑转移。 颈部小淋巴结。 双侧上颌窦囊肿，右侧乳突炎。\n- [全程D13] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见: 双颈II区可见几个小淋巴结，最大约11mm×4mm（右），12mm×5mm（左），边界清，椭圆形，皮髓质分界清，淋巴门可见。 CDFI:上述淋巴结内可见点状血流信号。 双侧颈部淋巴结穿刺活检： （1）右侧颈部淋巴结穿刺活检：常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以16G穿刺针穿刺入右颈淋巴结内，进针2次，取出长约0.5-1cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。 （2）左侧颈部淋巴结穿刺活检：常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以18G穿刺针穿刺入左颈淋巴结内，进针2次，取出长约0.8-1cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。；检查结论: 双侧颈部淋巴结穿刺活检。 不适随诊。 4个工作日后凭发票到2号楼6楼病理科取结果。\n- [全程D28] 检验组合: 总蛋白(TP)-静脉血: 67.97g/L；总胆红素(TBIL)-静脉血: 13.8umol/L；载脂蛋白B(apoB)-静脉血: 1.32g/L；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.99mmolL；大血小板百分比(P-LCR%)-静脉血: 25.7%；球蛋白(GLO)-静脉血: 23.97g/L；总钙(Ca)-静脉血: 2.26mmol/L；红细胞比容(Hct)-静脉血: 46.8%；血小板计数(PLT#)-静脉血: 20110E9/L；磷(P)-静脉血: 1.5mmol/L；血小板比容-静脉血: 20%；肌酐(Crea)-静脉血: 84.5umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.3；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；总胆汁酸(TBA)-静脉血: 3.5umol/L；钾离子(K+)-静脉血: 4mmol/L；C-反应蛋白(CRP)-静脉血: 2.01mg/L；间接胆红素(IBIL)-静脉血: 9.7umolL；胱抑素(Cys-C)-静脉血: 1.04mg/L；尿素氮(BUN)-静脉血: 6.93mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.6；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.11mmol/L；碱性磷酸酶(ALP)-静脉血: 50.9U/L；平均红细胞体积(MCV)-静脉血: 91.4fL；单核细胞计数(Mono#)-静脉血: 0.710E9/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；单核细胞百分比(Mono%)-静脉血: 0.081；红细胞计数(RBC#)-静脉血: 5.1210E12/L；白细胞计数(WBC#)-静脉血: 8.4210E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；平均血小板体积(MPV)-静脉血: 10.2fL；总胆固醇(TC)-静脉血: 5.98mmol/L；血红蛋白(Hb)-静脉血: 159g/L；直接胆红素(DBIL)-静脉血: 4.1umol/L；氯离子(Cl-)-静脉血: 105.9mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 340g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D27] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗1次，无特殊主诉。Rx：1.继续放疗。2.定期复查血常规等。3.对症支持。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 继续放疗，加用多烯磷脂酰胆碱等保肝药物。\nB. 继续放疗，皮下注射重组人粒细胞刺激因子。\nC. 暂停放疗，完善超声心动图及动态心电图检查。\nD. 继续根治性放疗计划，定期常规监测血象及生化。\nE. 继续放疗，加用阿托伐他汀等降脂药物。\nF. 继续放疗，给予静脉补液及利尿治疗。\nG. 暂停放疗，静脉滴注广谱抗生素抗感染治疗。\nH. 继续放疗，口服头孢类抗生素及促排痰药物。\nI. 继续放疗，静脉滴注地塞米松及甘露醇。\nJ. 调整放疗计划，降低右侧中耳及乳突区的照射剂量。\nK. 继续放疗，皮下注射促红细胞生成素。\nL. 暂停放疗，行鼻内镜下鼓膜穿刺置管引流术。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-f1eec05ca151dc9bde0f1f55","patient_id":"patient-7c0941dbdd4694260fd4de38","turn_id":"turn06","turn_position":5,"turn_type":"toxicity_or_support_decision","gold_letter":"E","gold_action":"继续调强放疗，给予局部含漱等对症处理，定期复查血常规及生化。","options":[{"letter":"A","text":"暂停调强放疗，待口腔黏膜炎恢复至Ⅰ度后恢复放疗，期间加强静脉营养支持。","is_gold":false},{"letter":"B","text":"继续调强放疗，加用全身静脉广谱抗生素，定期复查血常规及生化。","is_gold":false},{"letter":"C","text":"继续调强放疗，降低单次靶区照射剂量，给予局部含漱等对症处理。","is_gold":false},{"letter":"D","text":"继续调强放疗，加用静脉糖皮质激素，定期复查血常规及生化。","is_gold":false},{"letter":"E","text":"继续调强放疗，给予局部含漱等对症处理，定期复查血常规及生化。","is_gold":true},{"letter":"F","text":"暂停调强放疗，加用全身抗真菌药物，待黏膜白膜消退后恢复放疗。","is_gold":false},{"letter":"G","text":"继续调强放疗，加用顺铂单药同步化疗，给予局部含漱等对症处理。","is_gold":false},{"letter":"H","text":"继续调强放疗，给予重组人粒细胞刺激因子皮下注射，定期复查血常规。","is_gold":false},{"letter":"I","text":"暂停调强放疗，行鼻咽黏膜活检明确白膜性质，给予局部含漱等对症处理。","is_gold":false},{"letter":"J","text":"继续调强放疗，加用尼妥珠单抗靶向治疗，给予局部含漱等对症处理。","is_gold":false},{"letter":"K","text":"终止根治性放疗，转为姑息性放疗，加强镇痛及口腔局部护理。","is_gold":false},{"letter":"L","text":"继续调强放疗，预防性留置胃管，给予局部含漱等对症处理。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、口咽。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 反复右中耳积液半年余。；现病史: 简要入院病史:患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；阳性症状体征:；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史: 吸烟2包/日×20年，否认疫区接触史，否认冶游史，否认嗜酒。；家族史: 无特殊。；体格检查:；专科检查:；KPS: 90；ECOG:\n- [时间未明] 门急诊记录: 主诉: 反复右中耳积液半年余。；现病史: 患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史:；家族史: 无特殊。；体格检查: KPS90分，DG4.0cm，鼻咽右侧隆突肿物，接近右侧后鼻孔，双颈未触及肿大淋巴结，颅神经检查阴性，心肺腹未及异常，全身骨无压痛。\n- [全程D24] 入院记录: 主诉: 反复右中耳积液半年余。；现病史: 简要入院病史:患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。后来我院，我院病理示未分化非角化性癌。我院鼻咽+颈部MR：鼻咽部肿物，考虑鼻咽癌。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；阳性症状体征:；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史: 吸烟2包/日×20年，否认疫区接触史，否认冶游史，否认嗜酒。；家族史: 无特殊。；体格检查:；专科检查:；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D8] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽右侧咽隐窝区软组织影放射性浓聚，SUV41.8，病灶侵犯右腭帆肌群、右头长肌，病灶与蝶骨基底部右份及右翼突内板分界不清。右咽旁间隙变浅，右咽隐窝消失，左侧咽隐窝未见明显异常。口咽及喉咽结构及放射性分布未见明显异常。双侧上颌窦低密度影放射性分布未见异常；额窦、蝶窦、筛窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双颈多个小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 右中肺小片状影放射性分布未见异常；余双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏弥漫性密度减低，CT值约46Hu（脾脏CT值约58Hu），形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 盆腔放射性分布均匀，膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 右乳突气房内低密度影放射性分布未见异常；余颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽右咽隐窝病灶代谢活跃，符合鼻咽癌，病灶疑累及蝶骨基底部右份及右翼突内板。 双上颌窦炎症；右乳突炎症。 右中肺小片状影代谢未见异常，考虑增殖灶。 轻度脂肪肝。\n- [全程D8] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 早期复极改变 其余未见异常\n- [全程D8] 检验组合: 红细胞计数(RBC#)-静脉血: 5.2310E12/L；血液二氧化碳含量ctCO2(B)-静脉血: 25mmol/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.766COI；血小板分布宽度(PDW)-静脉血: 16.4%；单核细胞百分比(Mono%)-静脉血: 0.077；红细胞比容(Hct)-静脉血: 48.4%；凝血酶时间(TT)-静脉血: 19.8sec.；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 32.8U/L；凝血酶原时间(PT)-静脉血: 9.9sec.；淋巴细胞计数(Lymph#)-静脉血: 2.310E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.025；白蛋白(ALB)-静脉血: 46g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.61；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.08；胱抑素(Cys-C)-静脉血: 0.98mg/L；尿素氮(BUN)-静脉血: 5.5mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.597；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 6.1umolL；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；碱性磷酸酶(ALP)-静脉血: 60.9U/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 0.006COI；C-反应蛋白(CRP)-静脉血: 1.86mg/L；Rh血型-静脉血: 阳性；总钙(Ca)-静脉血: 2.14mmol/L；总胆汁酸(TBA)-静脉血: 8.3umol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.1ug/ml；丙氨酸氨基转移酶(ALT)-静脉血: 46.9U/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；氯离子(Cl-)-静脉血: 104.3mmol/L；低密度脂蛋白胆固醇……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D9] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁明显增厚，右侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描强化较明显。左侧咽隐窝存在。肿块累及右侧口咽壁。 右侧咽旁脂肪间隙变窄；左侧咽旁间隙未见明显狭窄。右侧腭帆张提肌受侵，左侧腭帆张提肌、双侧头长肌、双侧翼内外肌未见受侵。 鼻腔内未见肿物。 双侧翼腭窝、双侧上颌后脂肪间隙及咀嚼肌间隙未见异常。 颅底骨质信号均匀，增强扫描未见异常强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧上颌窦内见囊性灶，最大长径约27mm，边界清，无强化。右侧乳突见分泌物。左乳突充气良好，骨壁完整。 右侧咽后见一肿大淋巴结，大小约6mm×9mm，增强扫描明显强化。左侧咽后未见肿大淋巴结。颈部双侧见多个小淋巴结，最大者约8mm×11mm，未见坏死及包膜外侵。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。 扫描范围脑实质信号未见异常。；检查结论: 鼻咽肿物，考虑鼻咽癌。 颅底骨质未见破坏。 右侧咽后肿大淋巴结，考虑转移。 颈部小淋巴结。 双侧上颌窦囊肿，右侧乳突炎。\n- [全程D13] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见: 双颈II区可见几个小淋巴结，最大约11mm×4mm（右），12mm×5mm（左），边界清，椭圆形，皮髓质分界清，淋巴门可见。 CDFI:上述淋巴结内可见点状血流信号。 双侧颈部淋巴结穿刺活检： （1）右侧颈部淋巴结穿刺活检：常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以16G穿刺针穿刺入右颈淋巴结内，进针2次，取出长约0.5-1cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。 （2）左侧颈部淋巴结穿刺活检：常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以18G穿刺针穿刺入左颈淋巴结内，进针2次，取出长约0.8-1cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。；检查结论: 双侧颈部淋巴结穿刺活检。 不适随诊。 4个工作日后凭发票到2号楼6楼病理科取结果。\n- [全程D28] 检验组合: 总蛋白(TP)-静脉血: 67.97g/L；总胆红素(TBIL)-静脉血: 13.8umol/L；载脂蛋白B(apoB)-静脉血: 1.32g/L；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.99mmolL；大血小板百分比(P-LCR%)-静脉血: 25.7%；球蛋白(GLO)-静脉血: 23.97g/L；总钙(Ca)-静脉血: 2.26mmol/L；红细胞比容(Hct)-静脉血: 46.8%；血小板计数(PLT#)-静脉血: 20110E9/L；磷(P)-静脉血: 1.5mmol/L；血小板比容-静脉血: 20%；肌酐(Crea)-静脉血: 84.5umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.3；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；总胆汁酸(TBA)-静脉血: 3.5umol/L；钾离子(K+)-静脉血: 4mmol/L；C-反应蛋白(CRP)-静脉血: 2.01mg/L；间接胆红素(IBIL)-静脉血: 9.7umolL；胱抑素(Cys-C)-静脉血: 1.04mg/L；尿素氮(BUN)-静脉血: 6.93mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.6；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.11mmol/L；碱性磷酸酶(ALP)-静脉血: 50.9U/L；平均红细胞体积(MCV)-静脉血: 91.4fL；单核细胞计数(Mono#)-静脉血: 0.710E9/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；单核细胞百分比(Mono%)-静脉血: 0.081；红细胞计数(RBC#)-静脉血: 5.1210E12/L；白细胞计数(WBC#)-静脉血: 8.4210E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；平均血小板体积(MPV)-静脉血: 10.2fL；总胆固醇(TC)-静脉血: 5.98mmol/L；血红蛋白(Hb)-静脉血: 159g/L；直接胆红素(DBIL)-静脉血: 4.1umol/L；氯离子(Cl-)-静脉血: 105.9mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 340g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0……\n- [全程D36] 检验组合: 血小板比容-静脉血: 21%；红细胞计数(RBC#)-静脉血: 5.3510E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 327g/L；血小板计数(PLT#)-静脉血: 20710E9/L；大血小板百分比(P-LCR%)-静脉血: 25.9%；单核细胞计数(Mono#)-静脉血: 0.410E9/L；白细胞计数(WBC#)-静脉血: 5.9110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.654；血小板分布宽度(PDW)-静脉血: 11.9%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4；红细胞比容(Hct)-静脉血: 49.8%；单核细胞百分比(Mono%)-静脉血: 0.059；平均血小板体积(MPV)-静脉血: 10.1fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.9；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.262；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.022；平均红细胞体积(MCV)-静脉血: 93.1fL；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；血红蛋白(Hb)-静脉血: 163g/L\n- [全程D41] 检验组合: 红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.3%；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；血小板比容-静脉血: 15.7%；γ-谷氨酰基转移酶(GGT)-静脉血: 29.2U/L；红细胞计数(RBC#)-静脉血: 4.9510E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.024；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 338.3g/L；钠离子(Na+)-静脉血: 141.9mmol/L；单核细胞百分比(Mono%)-静脉血: 0.068；尿酸(UA)-静脉血: 478.3umol/L；钾离子(K+)-静脉血: 4.3mmol/L；间接胆红素(IBIL)-静脉血: 16.8umolL；乳酸脱氢酶(LDH)-静脉血: 152.4U/L；平均红细胞体积(MCV)-静脉血: 91.7fL；碱性磷酸酶(ALP)-静脉血: 56.1U/L；白蛋白(ALB)-静脉血: 45.9g/L；白细胞计数(WBC#)-静脉血: 8.1810E9/L；葡萄糖(Glu)-静脉血: 4.49mmol/L；阴离子间隙(AG)-静脉血: 17；血小板计数(PLT#)-静脉血: 193.210E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；总蛋白(TP)-静脉血: 70.66g/L；总钙(Ca)-静脉血: 2.29mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.9；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；中性粒细胞计数(Neut#)-静脉血: 610E9/L；胱抑素(Cys-C)-静脉血: 0.96mg/L；C-反应蛋白(CRP)-静脉血: 5.9mg/L；载脂蛋白B(apoB)-静脉血: 1.37g/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.5mmol/L；红细胞比容(Hct)-静脉血: 45.4%；丙氨酸氨基转移酶(ALT)-静脉血: 37.9U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.77mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 25.2U/……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D27] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗1次，无特殊主诉。Rx：1.继续放疗。2.定期复查血常规等。3.对症支持。\n- [全程D34] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗6次，无特殊主诉。复查血常规、生化未见明显异常。Rx：1.继续放疗。2.定期复查血常规等。3.对症支持。\n- [全程D41] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗11次，无特殊主诉。查体见鼻咽顶壁、右顶侧壁可见多个小结节，较前有所缩小，粘膜可见小片状白膜，双颈淋巴结未触及肿大，颅神经检查阴性，全身骨无压痛。和11-10复查血常规、血生化均未见明显异常。皮肤反应：0 Rx：1.继续放疗。粘膜反应：Ⅱ° 2.定期复查血常规等。3.对症支持。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停调强放疗，待口腔黏膜炎恢复至Ⅰ度后恢复放疗，期间加强静脉营养支持。\nB. 继续调强放疗，加用全身静脉广谱抗生素，定期复查血常规及生化。\nC. 继续调强放疗，降低单次靶区照射剂量，给予局部含漱等对症处理。\nD. 继续调强放疗，加用静脉糖皮质激素，定期复查血常规及生化。\nE. 继续调强放疗，给予局部含漱等对症处理，定期复查血常规及生化。\nF. 暂停调强放疗，加用全身抗真菌药物，待黏膜白膜消退后恢复放疗。\nG. 继续调强放疗，加用顺铂单药同步化疗，给予局部含漱等对症处理。\nH. 继续调强放疗，给予重组人粒细胞刺激因子皮下注射，定期复查血常规。\nI. 暂停调强放疗，行鼻咽黏膜活检明确白膜性质，给予局部含漱等对症处理。\nJ. 继续调强放疗，加用尼妥珠单抗靶向治疗，给予局部含漱等对症处理。\nK. 终止根治性放疗，转为姑息性放疗，加强镇痛及口腔局部护理。\nL. 继续调强放疗，预防性留置胃管，给予局部含漱等对症处理。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、口咽。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 反复右中耳积液半年余。；现病史: 简要入院病史:患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；阳性症状体征:；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史: 吸烟2包/日×20年，否认疫区接触史，否认冶游史，否认嗜酒。；家族史: 无特殊。；体格检查:；专科检查:；KPS: 90；ECOG:\n- [时间未明] 门急诊记录: 主诉: 反复右中耳积液半年余。；现病史: 患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史:；家族史: 无特殊。；体格检查: KPS90分，DG4.0cm，鼻咽右侧隆突肿物，接近右侧后鼻孔，双颈未触及肿大淋巴结，颅神经检查阴性，心肺腹未及异常，全身骨无压痛。\n- [全程D24] 入院记录: 主诉: 反复右中耳积液半年余。；现病史: 简要入院病史:患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。后来我院，我院病理示未分化非角化性癌。我院鼻咽+颈部MR：鼻咽部肿物，考虑鼻咽癌。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；阳性症状体征:；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史: 吸烟2包/日×20年，否认疫区接触史，否认冶游史，否认嗜酒。；家族史: 无特殊。；体格检查:；专科检查:；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D8] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽右侧咽隐窝区软组织影放射性浓聚，SUV41.8，病灶侵犯右腭帆肌群、右头长肌，病灶与蝶骨基底部右份及右翼突内板分界不清。右咽旁间隙变浅，右咽隐窝消失，左侧咽隐窝未见明显异常。口咽及喉咽结构及放射性分布未见明显异常。双侧上颌窦低密度影放射性分布未见异常；额窦、蝶窦、筛窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双颈多个小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 右中肺小片状影放射性分布未见异常；余双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏弥漫性密度减低，CT值约46Hu（脾脏CT值约58Hu），形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 盆腔放射性分布均匀，膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 右乳突气房内低密度影放射性分布未见异常；余颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽右咽隐窝病灶代谢活跃，符合鼻咽癌，病灶疑累及蝶骨基底部右份及右翼突内板。 双上颌窦炎症；右乳突炎症。 右中肺小片状影代谢未见异常，考虑增殖灶。 轻度脂肪肝。\n- [全程D8] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 早期复极改变 其余未见异常\n- [全程D8] 检验组合: 红细胞计数(RBC#)-静脉血: 5.2310E12/L；血液二氧化碳含量ctCO2(B)-静脉血: 25mmol/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.766COI；血小板分布宽度(PDW)-静脉血: 16.4%；单核细胞百分比(Mono%)-静脉血: 0.077；红细胞比容(Hct)-静脉血: 48.4%；凝血酶时间(TT)-静脉血: 19.8sec.；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 32.8U/L；凝血酶原时间(PT)-静脉血: 9.9sec.；淋巴细胞计数(Lymph#)-静脉血: 2.310E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.025；白蛋白(ALB)-静脉血: 46g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.61；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.08；胱抑素(Cys-C)-静脉血: 0.98mg/L；尿素氮(BUN)-静脉血: 5.5mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.597；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 6.1umolL；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；碱性磷酸酶(ALP)-静脉血: 60.9U/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 0.006COI；C-反应蛋白(CRP)-静脉血: 1.86mg/L；Rh血型-静脉血: 阳性；总钙(Ca)-静脉血: 2.14mmol/L；总胆汁酸(TBA)-静脉血: 8.3umol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.1ug/ml；丙氨酸氨基转移酶(ALT)-静脉血: 46.9U/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；氯离子(Cl-)-静脉血: 104.3mmol/L；低密度脂蛋白胆固醇……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D9] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁明显增厚，右侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描强化较明显。左侧咽隐窝存在。肿块累及右侧口咽壁。 右侧咽旁脂肪间隙变窄；左侧咽旁间隙未见明显狭窄。右侧腭帆张提肌受侵，左侧腭帆张提肌、双侧头长肌、双侧翼内外肌未见受侵。 鼻腔内未见肿物。 双侧翼腭窝、双侧上颌后脂肪间隙及咀嚼肌间隙未见异常。 颅底骨质信号均匀，增强扫描未见异常强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧上颌窦内见囊性灶，最大长径约27mm，边界清，无强化。右侧乳突见分泌物。左乳突充气良好，骨壁完整。 右侧咽后见一肿大淋巴结，大小约6mm×9mm，增强扫描明显强化。左侧咽后未见肿大淋巴结。颈部双侧见多个小淋巴结，最大者约8mm×11mm，未见坏死及包膜外侵。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。 扫描范围脑实质信号未见异常。；检查结论: 鼻咽肿物，考虑鼻咽癌。 颅底骨质未见破坏。 右侧咽后肿大淋巴结，考虑转移。 颈部小淋巴结。 双侧上颌窦囊肿，右侧乳突炎。\n- [全程D13] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见: 双颈II区可见几个小淋巴结，最大约11mm×4mm（右），12mm×5mm（左），边界清，椭圆形，皮髓质分界清，淋巴门可见。 CDFI:上述淋巴结内可见点状血流信号。 双侧颈部淋巴结穿刺活检： （1）右侧颈部淋巴结穿刺活检：常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以16G穿刺针穿刺入右颈淋巴结内，进针2次，取出长约0.5-1cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。 （2）左侧颈部淋巴结穿刺活检：常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以18G穿刺针穿刺入左颈淋巴结内，进针2次，取出长约0.8-1cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。；检查结论: 双侧颈部淋巴结穿刺活检。 不适随诊。 4个工作日后凭发票到2号楼6楼病理科取结果。\n- [全程D28] 检验组合: 总蛋白(TP)-静脉血: 67.97g/L；总胆红素(TBIL)-静脉血: 13.8umol/L；载脂蛋白B(apoB)-静脉血: 1.32g/L；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.99mmolL；大血小板百分比(P-LCR%)-静脉血: 25.7%；球蛋白(GLO)-静脉血: 23.97g/L；总钙(Ca)-静脉血: 2.26mmol/L；红细胞比容(Hct)-静脉血: 46.8%；血小板计数(PLT#)-静脉血: 20110E9/L；磷(P)-静脉血: 1.5mmol/L；血小板比容-静脉血: 20%；肌酐(Crea)-静脉血: 84.5umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.3；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；总胆汁酸(TBA)-静脉血: 3.5umol/L；钾离子(K+)-静脉血: 4mmol/L；C-反应蛋白(CRP)-静脉血: 2.01mg/L；间接胆红素(IBIL)-静脉血: 9.7umolL；胱抑素(Cys-C)-静脉血: 1.04mg/L；尿素氮(BUN)-静脉血: 6.93mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.6；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.11mmol/L；碱性磷酸酶(ALP)-静脉血: 50.9U/L；平均红细胞体积(MCV)-静脉血: 91.4fL；单核细胞计数(Mono#)-静脉血: 0.710E9/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；单核细胞百分比(Mono%)-静脉血: 0.081；红细胞计数(RBC#)-静脉血: 5.1210E12/L；白细胞计数(WBC#)-静脉血: 8.4210E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；平均血小板体积(MPV)-静脉血: 10.2fL；总胆固醇(TC)-静脉血: 5.98mmol/L；血红蛋白(Hb)-静脉血: 159g/L；直接胆红素(DBIL)-静脉血: 4.1umol/L；氯离子(Cl-)-静脉血: 105.9mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 340g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0……\n- [全程D36] 检验组合: 血小板比容-静脉血: 21%；红细胞计数(RBC#)-静脉血: 5.3510E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 327g/L；血小板计数(PLT#)-静脉血: 20710E9/L；大血小板百分比(P-LCR%)-静脉血: 25.9%；单核细胞计数(Mono#)-静脉血: 0.410E9/L；白细胞计数(WBC#)-静脉血: 5.9110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.654；血小板分布宽度(PDW)-静脉血: 11.9%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4；红细胞比容(Hct)-静脉血: 49.8%；单核细胞百分比(Mono%)-静脉血: 0.059；平均血小板体积(MPV)-静脉血: 10.1fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.9；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.262；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.022；平均红细胞体积(MCV)-静脉血: 93.1fL；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；血红蛋白(Hb)-静脉血: 163g/L\n- [全程D41] 检验组合: 红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.3%；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；血小板比容-静脉血: 15.7%；γ-谷氨酰基转移酶(GGT)-静脉血: 29.2U/L；红细胞计数(RBC#)-静脉血: 4.9510E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.024；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 338.3g/L；钠离子(Na+)-静脉血: 141.9mmol/L；单核细胞百分比(Mono%)-静脉血: 0.068；尿酸(UA)-静脉血: 478.3umol/L；钾离子(K+)-静脉血: 4.3mmol/L；间接胆红素(IBIL)-静脉血: 16.8umolL；乳酸脱氢酶(LDH)-静脉血: 152.4U/L；平均红细胞体积(MCV)-静脉血: 91.7fL；碱性磷酸酶(ALP)-静脉血: 56.1U/L；白蛋白(ALB)-静脉血: 45.9g/L；白细胞计数(WBC#)-静脉血: 8.1810E9/L；葡萄糖(Glu)-静脉血: 4.49mmol/L；阴离子间隙(AG)-静脉血: 17；血小板计数(PLT#)-静脉血: 193.210E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；总蛋白(TP)-静脉血: 70.66g/L；总钙(Ca)-静脉血: 2.29mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.9；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；中性粒细胞计数(Neut#)-静脉血: 610E9/L；胱抑素(Cys-C)-静脉血: 0.96mg/L；C-反应蛋白(CRP)-静脉血: 5.9mg/L；载脂蛋白B(apoB)-静脉血: 1.37g/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.5mmol/L；红细胞比容(Hct)-静脉血: 45.4%；丙氨酸氨基转移酶(ALT)-静脉血: 37.9U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.77mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 25.2U/……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D27] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗1次，无特殊主诉。Rx：1.继续放疗。2.定期复查血常规等。3.对症支持。\n- [全程D34] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗6次，无特殊主诉。复查血常规、生化未见明显异常。Rx：1.继续放疗。2.定期复查血常规等。3.对症支持。\n- [全程D41] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗11次，无特殊主诉。查体见鼻咽顶壁、右顶侧壁可见多个小结节，较前有所缩小，粘膜可见小片状白膜，双颈淋巴结未触及肿大，颅神经检查阴性，全身骨无压痛。和11-10复查血常规、血生化均未见明显异常。皮肤反应：0 Rx：1.继续放疗。粘膜反应：Ⅱ° 2.定期复查血常规等。3.对症支持。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停调强放疗，待口腔黏膜炎恢复至Ⅰ度后恢复放疗，期间加强静脉营养支持。\nB. 继续调强放疗，加用全身静脉广谱抗生素，定期复查血常规及生化。\nC. 继续调强放疗，降低单次靶区照射剂量，给予局部含漱等对症处理。\nD. 继续调强放疗，加用静脉糖皮质激素，定期复查血常规及生化。\nE. 继续调强放疗，给予局部含漱等对症处理，定期复查血常规及生化。\nF. 暂停调强放疗，加用全身抗真菌药物，待黏膜白膜消退后恢复放疗。\nG. 继续调强放疗，加用顺铂单药同步化疗，给予局部含漱等对症处理。\nH. 继续调强放疗，给予重组人粒细胞刺激因子皮下注射，定期复查血常规。\nI. 暂停调强放疗，行鼻咽黏膜活检明确白膜性质，给予局部含漱等对症处理。\nJ. 继续调强放疗，加用尼妥珠单抗靶向治疗，给予局部含漱等对症处理。\nK. 终止根治性放疗，转为姑息性放疗，加强镇痛及口腔局部护理。\nL. 继续调强放疗，预防性留置胃管，给予局部含漱等对症处理。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-be3624e29a98e9da91fced75","patient_id":"patient-7c0941dbdd4694260fd4de38","turn_id":"turn07","turn_position":6,"turn_type":"recurrence_or_salvage_decision","gold_letter":"F","gold_action":"维持规范随访观察，可根据症状给予一般对症及支持治疗，不启动挽救性局部治疗或全身抗肿瘤治疗。","options":[{"letter":"A","text":"安排鼻咽及颈部活检，准备行挽救性内镜下鼻咽切除术。","is_gold":false},{"letter":"B","text":"启动含铂双药方案全身化疗4-6个周期。","is_gold":false},{"letter":"C","text":"行全身PET/CT评估，若有局部高代谢灶则行挽救性放疗。","is_gold":false},{"letter":"D","text":"予以原发灶及颈部引流区局部推量补照4-6Gy。","is_gold":false},{"letter":"E","text":"给予卡培他滨单药口服维持治疗半年至一年。","is_gold":false},{"letter":"F","text":"维持规范随访观察，可症状给予一般对症及支持治疗。","is_gold":true},{"letter":"G","text":"行鼻咽及颈部MRI增强扫描，若有可疑残留则行诱导化疗。","is_gold":false},{"letter":"H","text":"启动PD-1抑制剂联合含铂双药全身化疗。","is_gold":false},{"letter":"I","text":"安排鼻咽内镜活检，若病理阳性则行双侧颈部淋巴结清扫术。","is_gold":false},{"letter":"J","text":"补充顺铂单药全身化疗2个周期以强化局部控制。","is_gold":false},{"letter":"K","text":"行全身骨扫描及头颅MRI，排除远处转移后行局部挽救性放疗。","is_gold":false},{"letter":"L","text":"予以吉西他滨联合顺铂全身化疗4-6个周期。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、口咽。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 反复右中耳积液半年余。；现病史: 简要入院病史:患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；阳性症状体征:；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史: 吸烟2包/日×20年，否认疫区接触史，否认冶游史，否认嗜酒。；家族史: 无特殊。；体格检查:；专科检查:；KPS: 90；ECOG:\n- [时间未明] 门急诊记录: 主诉: 反复右中耳积液半年余。；现病史: 患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史:；家族史: 无特殊。；体格检查: KPS90分，DG4.0cm，鼻咽右侧隆突肿物，接近右侧后鼻孔，双颈未触及肿大淋巴结，颅神经检查阴性，心肺腹未及异常，全身骨无压痛。\n- [全程D24] 入院记录: 主诉: 反复右中耳积液半年余。；现病史: 简要入院病史:患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。后来我院，我院病理示未分化非角化性癌。我院鼻咽+颈部MR：鼻咽部肿物，考虑鼻咽癌。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；阳性症状体征:；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史: 吸烟2包/日×20年，否认疫区接触史，否认冶游史，否认嗜酒。；家族史: 无特殊。；体格检查:；专科检查:；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D8] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽右侧咽隐窝区软组织影放射性浓聚，SUV41.8，病灶侵犯右腭帆肌群、右头长肌，病灶与蝶骨基底部右份及右翼突内板分界不清。右咽旁间隙变浅，右咽隐窝消失，左侧咽隐窝未见明显异常。口咽及喉咽结构及放射性分布未见明显异常。双侧上颌窦低密度影放射性分布未见异常；额窦、蝶窦、筛窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双颈多个小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 右中肺小片状影放射性分布未见异常；余双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏弥漫性密度减低，CT值约46Hu（脾脏CT值约58Hu），形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 盆腔放射性分布均匀，膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 右乳突气房内低密度影放射性分布未见异常；余颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽右咽隐窝病灶代谢活跃，符合鼻咽癌，病灶疑累及蝶骨基底部右份及右翼突内板。 双上颌窦炎症；右乳突炎症。 右中肺小片状影代谢未见异常，考虑增殖灶。 轻度脂肪肝。\n- [全程D8] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 早期复极改变 其余未见异常\n- [全程D8] 检验组合: 红细胞计数(RBC#)-静脉血: 5.2310E12/L；血液二氧化碳含量ctCO2(B)-静脉血: 25mmol/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.766COI；血小板分布宽度(PDW)-静脉血: 16.4%；单核细胞百分比(Mono%)-静脉血: 0.077；红细胞比容(Hct)-静脉血: 48.4%；凝血酶时间(TT)-静脉血: 19.8sec.；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 32.8U/L；凝血酶原时间(PT)-静脉血: 9.9sec.；淋巴细胞计数(Lymph#)-静脉血: 2.310E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.025；白蛋白(ALB)-静脉血: 46g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.61；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.08；胱抑素(Cys-C)-静脉血: 0.98mg/L；尿素氮(BUN)-静脉血: 5.5mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.597；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 6.1umolL；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；碱性磷酸酶(ALP)-静脉血: 60.9U/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 0.006COI；C-反应蛋白(CRP)-静脉血: 1.86mg/L；Rh血型-静脉血: 阳性；总钙(Ca)-静脉血: 2.14mmol/L；总胆汁酸(TBA)-静脉血: 8.3umol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.1ug/ml；丙氨酸氨基转移酶(ALT)-静脉血: 46.9U/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；氯离子(Cl-)-静脉血: 104.3mmol/L；低密度脂蛋白胆固醇……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D9] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁明显增厚，右侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描强化较明显。左侧咽隐窝存在。肿块累及右侧口咽壁。 右侧咽旁脂肪间隙变窄；左侧咽旁间隙未见明显狭窄。右侧腭帆张提肌受侵，左侧腭帆张提肌、双侧头长肌、双侧翼内外肌未见受侵。 鼻腔内未见肿物。 双侧翼腭窝、双侧上颌后脂肪间隙及咀嚼肌间隙未见异常。 颅底骨质信号均匀，增强扫描未见异常强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧上颌窦内见囊性灶，最大长径约27mm，边界清，无强化。右侧乳突见分泌物。左乳突充气良好，骨壁完整。 右侧咽后见一肿大淋巴结，大小约6mm×9mm，增强扫描明显强化。左侧咽后未见肿大淋巴结。颈部双侧见多个小淋巴结，最大者约8mm×11mm，未见坏死及包膜外侵。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。 扫描范围脑实质信号未见异常。；检查结论: 鼻咽肿物，考虑鼻咽癌。 颅底骨质未见破坏。 右侧咽后肿大淋巴结，考虑转移。 颈部小淋巴结。 双侧上颌窦囊肿，右侧乳突炎。\n- [全程D13] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见: 双颈II区可见几个小淋巴结，最大约11mm×4mm（右），12mm×5mm（左），边界清，椭圆形，皮髓质分界清，淋巴门可见。 CDFI:上述淋巴结内可见点状血流信号。 双侧颈部淋巴结穿刺活检： （1）右侧颈部淋巴结穿刺活检：常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以16G穿刺针穿刺入右颈淋巴结内，进针2次，取出长约0.5-1cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。 （2）左侧颈部淋巴结穿刺活检：常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以18G穿刺针穿刺入左颈淋巴结内，进针2次，取出长约0.8-1cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。；检查结论: 双侧颈部淋巴结穿刺活检。 不适随诊。 4个工作日后凭发票到2号楼6楼病理科取结果。\n- [全程D28] 检验组合: 总蛋白(TP)-静脉血: 67.97g/L；总胆红素(TBIL)-静脉血: 13.8umol/L；载脂蛋白B(apoB)-静脉血: 1.32g/L；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.99mmolL；大血小板百分比(P-LCR%)-静脉血: 25.7%；球蛋白(GLO)-静脉血: 23.97g/L；总钙(Ca)-静脉血: 2.26mmol/L；红细胞比容(Hct)-静脉血: 46.8%；血小板计数(PLT#)-静脉血: 20110E9/L；磷(P)-静脉血: 1.5mmol/L；血小板比容-静脉血: 20%；肌酐(Crea)-静脉血: 84.5umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.3；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；总胆汁酸(TBA)-静脉血: 3.5umol/L；钾离子(K+)-静脉血: 4mmol/L；C-反应蛋白(CRP)-静脉血: 2.01mg/L；间接胆红素(IBIL)-静脉血: 9.7umolL；胱抑素(Cys-C)-静脉血: 1.04mg/L；尿素氮(BUN)-静脉血: 6.93mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.6；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.11mmol/L；碱性磷酸酶(ALP)-静脉血: 50.9U/L；平均红细胞体积(MCV)-静脉血: 91.4fL；单核细胞计数(Mono#)-静脉血: 0.710E9/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；单核细胞百分比(Mono%)-静脉血: 0.081；红细胞计数(RBC#)-静脉血: 5.1210E12/L；白细胞计数(WBC#)-静脉血: 8.4210E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；平均血小板体积(MPV)-静脉血: 10.2fL；总胆固醇(TC)-静脉血: 5.98mmol/L；血红蛋白(Hb)-静脉血: 159g/L；直接胆红素(DBIL)-静脉血: 4.1umol/L；氯离子(Cl-)-静脉血: 105.9mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 340g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0……\n- [全程D36] 检验组合: 血小板比容-静脉血: 21%；红细胞计数(RBC#)-静脉血: 5.3510E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 327g/L；血小板计数(PLT#)-静脉血: 20710E9/L；大血小板百分比(P-LCR%)-静脉血: 25.9%；单核细胞计数(Mono#)-静脉血: 0.410E9/L；白细胞计数(WBC#)-静脉血: 5.9110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.654；血小板分布宽度(PDW)-静脉血: 11.9%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4；红细胞比容(Hct)-静脉血: 49.8%；单核细胞百分比(Mono%)-静脉血: 0.059；平均血小板体积(MPV)-静脉血: 10.1fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.9；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.262；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.022；平均红细胞体积(MCV)-静脉血: 93.1fL；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；血红蛋白(Hb)-静脉血: 163g/L\n- [全程D41] 检验组合: 红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.3%；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；血小板比容-静脉血: 15.7%；γ-谷氨酰基转移酶(GGT)-静脉血: 29.2U/L；红细胞计数(RBC#)-静脉血: 4.9510E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.024；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 338.3g/L；钠离子(Na+)-静脉血: 141.9mmol/L；单核细胞百分比(Mono%)-静脉血: 0.068；尿酸(UA)-静脉血: 478.3umol/L；钾离子(K+)-静脉血: 4.3mmol/L；间接胆红素(IBIL)-静脉血: 16.8umolL；乳酸脱氢酶(LDH)-静脉血: 152.4U/L；平均红细胞体积(MCV)-静脉血: 91.7fL；碱性磷酸酶(ALP)-静脉血: 56.1U/L；白蛋白(ALB)-静脉血: 45.9g/L；白细胞计数(WBC#)-静脉血: 8.1810E9/L；葡萄糖(Glu)-静脉血: 4.49mmol/L；阴离子间隙(AG)-静脉血: 17；血小板计数(PLT#)-静脉血: 193.210E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；总蛋白(TP)-静脉血: 70.66g/L；总钙(Ca)-静脉血: 2.29mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.9；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；中性粒细胞计数(Neut#)-静脉血: 610E9/L；胱抑素(Cys-C)-静脉血: 0.96mg/L；C-反应蛋白(CRP)-静脉血: 5.9mg/L；载脂蛋白B(apoB)-静脉血: 1.37g/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.5mmol/L；红细胞比容(Hct)-静脉血: 45.4%；丙氨酸氨基转移酶(ALT)-静脉血: 37.9U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.77mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 25.2U/……\n- [全程D50] 检验组合: 平均红细胞体积(MCV)-静脉血: 92.2fL；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.727；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.033；血小板计数(PLT#)-静脉血: 15910E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.165；单核细胞百分比(Mono%)-静脉血: 0.073；血红蛋白(Hb)-静脉血: 162g/L；平均血小板体积(MPV)-静脉血: 10.6fL；白细胞计数(WBC#)-静脉血: 4.210E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.9；红细胞计数(RBC#)-静脉血: 5.2310E12/L；中性粒细胞计数(Neut#)-静脉血: 3.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；大血小板百分比(P-LCR%)-静脉血: 28.7%；血小板分布宽度(PDW)-静脉血: 11.3%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.4；血小板比容-静脉血: 17%；单核细胞计数(Mono#)-静脉血: 0.310E9/L；红细胞比容(Hct)-静脉血: 48.2%\n- [全程D56] 检验组合: 血小板分布宽度(PDW)-静脉血: 12.4%；中性粒细胞百分比(Neut%)-静脉血: 0.84；单核细胞计数(Mono#)-静脉血: 0.410E9/L；血小板比容-静脉血: 19%；血红蛋白(Hb)-静脉血: 158g/L；红细胞计数(RBC#)-静脉血: 5.2110E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.7；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均血小板体积(MPV)-静脉血: 10.5fL；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；红细胞比容(Hct)-静脉血: 47.9%；血小板计数(PLT#)-静脉血: 17710E9/L；平均红细胞体积(MCV)-静脉血: 91.9fL；淋巴细胞百分比(Lymph%)-静脉血: 0.077；平均红细胞血红蛋白含量(MCH)-静脉血: 30.3pg；中性粒细胞计数(Neut#)-静脉血: 5.310E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；单核细胞百分比(Mono%)-静脉血: 0.061；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.9；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；大血小板百分比(P-LCR%)-静脉血: 28.7%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.016；白细胞计数(WBC#)-静脉血: 6.3510E9/L\n- [全程D62] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；血小板分布宽度(PDW)-静脉血: 13.6%；单核细胞计数(Mono#)-静脉血: 0.310E9/L；白细胞计数(WBC#)-静脉血: 5.1610E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.798；红细胞比容(Hct)-静脉血: 47.9%；单核细胞百分比(Mono%)-静脉血: 0.066；大血小板百分比(P-LCR%)-静脉血: 30.3%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.7；血小板计数(PLT#)-静脉血: 21110E9/L；血小板比容-静脉血: 22%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.7；平均红细胞体积(MCV)-静脉血: 91.6fL；平均红细胞血红蛋白含量(MCH)-静脉血: 30.4pg；红细胞计数(RBC#)-静脉血: 5.2310E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞计数(Neut#)-静脉血: 4.110E9/L；血红蛋白(Hb)-静脉血: 159g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；淋巴细胞百分比(Lymph%)-静脉血: 0.109；平均红细胞血红蛋白浓度(MCHC)-静脉血: 332g/L；平均血小板体积(MPV)-静脉血: 10.5fL；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L\n- [全程D63] 检验组合: 低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.79mmol/L；总蛋白(TP)-静脉血: 66.06g/L；乳酸脱氢酶(LDH)-静脉血: 190U/L；葡萄糖(Glu)-静脉血: 4.43mmol/L；C-反应蛋白(CRP)-静脉血: 8.61mg/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.48；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.01mmolL；γ-谷氨酰基转移酶(GGT)-静脉血: 16.1U/L；镁离子(Mg2+)-静脉血: 0.98mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21U/L；总胆固醇(TC)-静脉血: 5.22mmol/L；阴离子间隙(AG)-静脉血: 15.7；氯离子(Cl-)-静脉血: 99.4mmol/L；碱性磷酸酶(ALP)-静脉血: 59.5U/L；磷(P)-静脉血: 1.2mmol/L；钾离子(K+)-静脉血: 3.7mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.11；甘油三酯(TG)-静脉血: 1.21mmol/L；肌酐(Crea)-静脉血: 80.4umol/L；总胆红素(TBIL)-静脉血: 23.7umol/L；载脂蛋白B(apoB)-静脉血: 1.27g/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.4mmol/L；总钙(Ca)-静脉血: 2.2mmol/L；尿素氮(BUN)-静脉血: 6.6mmol/L；钠离子(Na+)-静脉血: 142.5mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 14.2U/L；载脂蛋白AI(apoAI)-静脉血: 0.95g/L；间接胆红素(IBIL)-静脉血: 17.2umolL；直接胆红素(DBIL)-静脉血: 6.5umol/L；尿酸(UA)-静脉血: 490.3umol/L；总胆汁酸(TBA)-静脉血: 3.4umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 15.5U/L；球蛋白(GLO)-静脉血: 21.26g/L；白蛋白(ALB)-静脉血: 44.8g/L；胱抑素(Cys-C)-静脉血: 0.81mg/L\n- [全程D65] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:80（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:20（参考: 阴性）\n- [全程D160] 超声；腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约12cm/s。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、脾脏未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D160] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺野纹理清晰，双肺野未见明显实质性病变。双侧肺门无增大，纵隔未见增宽，心影形态、大小、位置未见异常。双膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n- [全程D160] 检验组合: EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D27] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗1次，无特殊主诉。Rx：1.继续放疗。2.定期复查血常规等。3.对症支持。\n- [全程D34] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗6次，无特殊主诉。复查血常规、生化未见明显异常。Rx：1.继续放疗。2.定期复查血常规等。3.对症支持。\n- [全程D41] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗11次，无特殊主诉。查体见鼻咽顶壁、右顶侧壁可见多个小结节，较前有所缩小，粘膜可见小片状白膜，双颈淋巴结未触及肿大，颅神经检查阴性，全身骨无压痛。和11-10复查血常规、血生化均未见明显异常。皮肤反应：0 Rx：1.继续放疗。粘膜反应：Ⅱ° 2.定期复查血常规等。3.对症支持。\n- [全程D55] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗21次，诉口干、咽痛较前明显，乏力，余无特殊主诉。查体见鼻咽右顶侧壁稍增厚，炎性分泌物较多，粘膜充血水肿，双颈淋巴结未触及肿大，颅神经检查阴性，全身骨无压痛。复查血常规未见明显异常。皮肤反应：I°Rx：1.继续放疗。粘膜反应：Ⅱ° 2.定期复查血常规等。3.抗炎、止痛、营养对症支持。\n- [全程D62] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗26次，诉口干、咽痛较前缓解，仍觉乏力，无特殊主诉。和12-01复查血常规、生化均未见明显异常。皮肤反应：Ⅰ°Rx：1.继续放疗。粘膜反应：Ⅱ° 2.定期复查血常规等。3.营养对症支持。\n- [全程D65] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗28次，诉口干、咽痛好转，自觉体力虚弱，并拒绝最后2次放疗。皮肤反应：Ⅰ° Rx：1.定期复查。粘膜反应：Ⅰ° 2.不适随诊。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 安排鼻咽及颈部活检，准备行挽救性内镜下鼻咽切除术。\nB. 启动含铂双药方案全身化疗4-6个周期。\nC. 行全身PET/CT评估，若有局部高代谢灶则行挽救性放疗。\nD. 予以原发灶及颈部引流区局部推量补照4-6Gy。\nE. 给予卡培他滨单药口服维持治疗半年至一年。\nF. 维持规范随访观察，可症状给予一般对症及支持治疗。\nG. 行鼻咽及颈部MRI增强扫描，若有可疑残留则行诱导化疗。\nH. 启动PD-1抑制剂联合含铂双药全身化疗。\nI. 安排鼻咽内镜活检，若病理阳性则行双侧颈部淋巴结清扫术。\nJ. 补充顺铂单药全身化疗2个周期以强化局部控制。\nK. 行全身骨扫描及头颅MRI，排除远处转移后行局部挽救性放疗。\nL. 予以吉西他滨联合顺铂全身化疗4-6个周期。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、口咽。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 反复右中耳积液半年余。；现病史: 简要入院病史:患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；阳性症状体征:；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史: 吸烟2包/日×20年，否认疫区接触史，否认冶游史，否认嗜酒。；家族史: 无特殊。；体格检查:；专科检查:；KPS: 90；ECOG:\n- [时间未明] 门急诊记录: 主诉: 反复右中耳积液半年余。；现病史: 患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史:；家族史: 无特殊。；体格检查: KPS90分，DG4.0cm，鼻咽右侧隆突肿物，接近右侧后鼻孔，双颈未触及肿大淋巴结，颅神经检查阴性，心肺腹未及异常，全身骨无压痛。\n- [全程D24] 入院记录: 主诉: 反复右中耳积液半年余。；现病史: 简要入院病史:患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。后来我院，我院病理示未分化非角化性癌。我院鼻咽+颈部MR：鼻咽部肿物，考虑鼻咽癌。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；阳性症状体征:；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史: 吸烟2包/日×20年，否认疫区接触史，否认冶游史，否认嗜酒。；家族史: 无特殊。；体格检查:；专科检查:；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D8] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽右侧咽隐窝区软组织影放射性浓聚，SUV41.8，病灶侵犯右腭帆肌群、右头长肌，病灶与蝶骨基底部右份及右翼突内板分界不清。右咽旁间隙变浅，右咽隐窝消失，左侧咽隐窝未见明显异常。口咽及喉咽结构及放射性分布未见明显异常。双侧上颌窦低密度影放射性分布未见异常；额窦、蝶窦、筛窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双颈多个小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 右中肺小片状影放射性分布未见异常；余双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏弥漫性密度减低，CT值约46Hu（脾脏CT值约58Hu），形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 盆腔放射性分布均匀，膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 右乳突气房内低密度影放射性分布未见异常；余颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽右咽隐窝病灶代谢活跃，符合鼻咽癌，病灶疑累及蝶骨基底部右份及右翼突内板。 双上颌窦炎症；右乳突炎症。 右中肺小片状影代谢未见异常，考虑增殖灶。 轻度脂肪肝。\n- [全程D8] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 早期复极改变 其余未见异常\n- [全程D8] 检验组合: 红细胞计数(RBC#)-静脉血: 5.2310E12/L；血液二氧化碳含量ctCO2(B)-静脉血: 25mmol/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.766COI；血小板分布宽度(PDW)-静脉血: 16.4%；单核细胞百分比(Mono%)-静脉血: 0.077；红细胞比容(Hct)-静脉血: 48.4%；凝血酶时间(TT)-静脉血: 19.8sec.；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 32.8U/L；凝血酶原时间(PT)-静脉血: 9.9sec.；淋巴细胞计数(Lymph#)-静脉血: 2.310E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.025；白蛋白(ALB)-静脉血: 46g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.61；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.08；胱抑素(Cys-C)-静脉血: 0.98mg/L；尿素氮(BUN)-静脉血: 5.5mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.597；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 6.1umolL；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；碱性磷酸酶(ALP)-静脉血: 60.9U/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 0.006COI；C-反应蛋白(CRP)-静脉血: 1.86mg/L；Rh血型-静脉血: 阳性；总钙(Ca)-静脉血: 2.14mmol/L；总胆汁酸(TBA)-静脉血: 8.3umol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.1ug/ml；丙氨酸氨基转移酶(ALT)-静脉血: 46.9U/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；氯离子(Cl-)-静脉血: 104.3mmol/L；低密度脂蛋白胆固醇……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D9] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁明显增厚，右侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描强化较明显。左侧咽隐窝存在。肿块累及右侧口咽壁。 右侧咽旁脂肪间隙变窄；左侧咽旁间隙未见明显狭窄。右侧腭帆张提肌受侵，左侧腭帆张提肌、双侧头长肌、双侧翼内外肌未见受侵。 鼻腔内未见肿物。 双侧翼腭窝、双侧上颌后脂肪间隙及咀嚼肌间隙未见异常。 颅底骨质信号均匀，增强扫描未见异常强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧上颌窦内见囊性灶，最大长径约27mm，边界清，无强化。右侧乳突见分泌物。左乳突充气良好，骨壁完整。 右侧咽后见一肿大淋巴结，大小约6mm×9mm，增强扫描明显强化。左侧咽后未见肿大淋巴结。颈部双侧见多个小淋巴结，最大者约8mm×11mm，未见坏死及包膜外侵。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。 扫描范围脑实质信号未见异常。；检查结论: 鼻咽肿物，考虑鼻咽癌。 颅底骨质未见破坏。 右侧咽后肿大淋巴结，考虑转移。 颈部小淋巴结。 双侧上颌窦囊肿，右侧乳突炎。\n- [全程D13] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见: 双颈II区可见几个小淋巴结，最大约11mm×4mm（右），12mm×5mm（左），边界清，椭圆形，皮髓质分界清，淋巴门可见。 CDFI:上述淋巴结内可见点状血流信号。 双侧颈部淋巴结穿刺活检： （1）右侧颈部淋巴结穿刺活检：常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以16G穿刺针穿刺入右颈淋巴结内，进针2次，取出长约0.5-1cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。 （2）左侧颈部淋巴结穿刺活检：常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以18G穿刺针穿刺入左颈淋巴结内，进针2次，取出长约0.8-1cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。；检查结论: 双侧颈部淋巴结穿刺活检。 不适随诊。 4个工作日后凭发票到2号楼6楼病理科取结果。\n- [全程D28] 检验组合: 总蛋白(TP)-静脉血: 67.97g/L；总胆红素(TBIL)-静脉血: 13.8umol/L；载脂蛋白B(apoB)-静脉血: 1.32g/L；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.99mmolL；大血小板百分比(P-LCR%)-静脉血: 25.7%；球蛋白(GLO)-静脉血: 23.97g/L；总钙(Ca)-静脉血: 2.26mmol/L；红细胞比容(Hct)-静脉血: 46.8%；血小板计数(PLT#)-静脉血: 20110E9/L；磷(P)-静脉血: 1.5mmol/L；血小板比容-静脉血: 20%；肌酐(Crea)-静脉血: 84.5umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.3；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；总胆汁酸(TBA)-静脉血: 3.5umol/L；钾离子(K+)-静脉血: 4mmol/L；C-反应蛋白(CRP)-静脉血: 2.01mg/L；间接胆红素(IBIL)-静脉血: 9.7umolL；胱抑素(Cys-C)-静脉血: 1.04mg/L；尿素氮(BUN)-静脉血: 6.93mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.6；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.11mmol/L；碱性磷酸酶(ALP)-静脉血: 50.9U/L；平均红细胞体积(MCV)-静脉血: 91.4fL；单核细胞计数(Mono#)-静脉血: 0.710E9/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；单核细胞百分比(Mono%)-静脉血: 0.081；红细胞计数(RBC#)-静脉血: 5.1210E12/L；白细胞计数(WBC#)-静脉血: 8.4210E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；平均血小板体积(MPV)-静脉血: 10.2fL；总胆固醇(TC)-静脉血: 5.98mmol/L；血红蛋白(Hb)-静脉血: 159g/L；直接胆红素(DBIL)-静脉血: 4.1umol/L；氯离子(Cl-)-静脉血: 105.9mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 340g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0……\n- [全程D36] 检验组合: 血小板比容-静脉血: 21%；红细胞计数(RBC#)-静脉血: 5.3510E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 327g/L；血小板计数(PLT#)-静脉血: 20710E9/L；大血小板百分比(P-LCR%)-静脉血: 25.9%；单核细胞计数(Mono#)-静脉血: 0.410E9/L；白细胞计数(WBC#)-静脉血: 5.9110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.654；血小板分布宽度(PDW)-静脉血: 11.9%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4；红细胞比容(Hct)-静脉血: 49.8%；单核细胞百分比(Mono%)-静脉血: 0.059；平均血小板体积(MPV)-静脉血: 10.1fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.9；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.262；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.022；平均红细胞体积(MCV)-静脉血: 93.1fL；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；血红蛋白(Hb)-静脉血: 163g/L\n- [全程D41] 检验组合: 红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.3%；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；血小板比容-静脉血: 15.7%；γ-谷氨酰基转移酶(GGT)-静脉血: 29.2U/L；红细胞计数(RBC#)-静脉血: 4.9510E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.024；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 338.3g/L；钠离子(Na+)-静脉血: 141.9mmol/L；单核细胞百分比(Mono%)-静脉血: 0.068；尿酸(UA)-静脉血: 478.3umol/L；钾离子(K+)-静脉血: 4.3mmol/L；间接胆红素(IBIL)-静脉血: 16.8umolL；乳酸脱氢酶(LDH)-静脉血: 152.4U/L；平均红细胞体积(MCV)-静脉血: 91.7fL；碱性磷酸酶(ALP)-静脉血: 56.1U/L；白蛋白(ALB)-静脉血: 45.9g/L；白细胞计数(WBC#)-静脉血: 8.1810E9/L；葡萄糖(Glu)-静脉血: 4.49mmol/L；阴离子间隙(AG)-静脉血: 17；血小板计数(PLT#)-静脉血: 193.210E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；总蛋白(TP)-静脉血: 70.66g/L；总钙(Ca)-静脉血: 2.29mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.9；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；中性粒细胞计数(Neut#)-静脉血: 610E9/L；胱抑素(Cys-C)-静脉血: 0.96mg/L；C-反应蛋白(CRP)-静脉血: 5.9mg/L；载脂蛋白B(apoB)-静脉血: 1.37g/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.5mmol/L；红细胞比容(Hct)-静脉血: 45.4%；丙氨酸氨基转移酶(ALT)-静脉血: 37.9U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.77mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 25.2U/……\n- [全程D50] 检验组合: 平均红细胞体积(MCV)-静脉血: 92.2fL；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.727；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.033；血小板计数(PLT#)-静脉血: 15910E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.165；单核细胞百分比(Mono%)-静脉血: 0.073；血红蛋白(Hb)-静脉血: 162g/L；平均血小板体积(MPV)-静脉血: 10.6fL；白细胞计数(WBC#)-静脉血: 4.210E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.9；红细胞计数(RBC#)-静脉血: 5.2310E12/L；中性粒细胞计数(Neut#)-静脉血: 3.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；大血小板百分比(P-LCR%)-静脉血: 28.7%；血小板分布宽度(PDW)-静脉血: 11.3%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.4；血小板比容-静脉血: 17%；单核细胞计数(Mono#)-静脉血: 0.310E9/L；红细胞比容(Hct)-静脉血: 48.2%\n- [全程D56] 检验组合: 血小板分布宽度(PDW)-静脉血: 12.4%；中性粒细胞百分比(Neut%)-静脉血: 0.84；单核细胞计数(Mono#)-静脉血: 0.410E9/L；血小板比容-静脉血: 19%；血红蛋白(Hb)-静脉血: 158g/L；红细胞计数(RBC#)-静脉血: 5.2110E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.7；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均血小板体积(MPV)-静脉血: 10.5fL；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；红细胞比容(Hct)-静脉血: 47.9%；血小板计数(PLT#)-静脉血: 17710E9/L；平均红细胞体积(MCV)-静脉血: 91.9fL；淋巴细胞百分比(Lymph%)-静脉血: 0.077；平均红细胞血红蛋白含量(MCH)-静脉血: 30.3pg；中性粒细胞计数(Neut#)-静脉血: 5.310E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；单核细胞百分比(Mono%)-静脉血: 0.061；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.9；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；大血小板百分比(P-LCR%)-静脉血: 28.7%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.016；白细胞计数(WBC#)-静脉血: 6.3510E9/L\n- [全程D62] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；血小板分布宽度(PDW)-静脉血: 13.6%；单核细胞计数(Mono#)-静脉血: 0.310E9/L；白细胞计数(WBC#)-静脉血: 5.1610E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.798；红细胞比容(Hct)-静脉血: 47.9%；单核细胞百分比(Mono%)-静脉血: 0.066；大血小板百分比(P-LCR%)-静脉血: 30.3%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.7；血小板计数(PLT#)-静脉血: 21110E9/L；血小板比容-静脉血: 22%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.7；平均红细胞体积(MCV)-静脉血: 91.6fL；平均红细胞血红蛋白含量(MCH)-静脉血: 30.4pg；红细胞计数(RBC#)-静脉血: 5.2310E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞计数(Neut#)-静脉血: 4.110E9/L；血红蛋白(Hb)-静脉血: 159g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；淋巴细胞百分比(Lymph%)-静脉血: 0.109；平均红细胞血红蛋白浓度(MCHC)-静脉血: 332g/L；平均血小板体积(MPV)-静脉血: 10.5fL；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L\n- [全程D63] 检验组合: 低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.79mmol/L；总蛋白(TP)-静脉血: 66.06g/L；乳酸脱氢酶(LDH)-静脉血: 190U/L；葡萄糖(Glu)-静脉血: 4.43mmol/L；C-反应蛋白(CRP)-静脉血: 8.61mg/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.48；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.01mmolL；γ-谷氨酰基转移酶(GGT)-静脉血: 16.1U/L；镁离子(Mg2+)-静脉血: 0.98mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21U/L；总胆固醇(TC)-静脉血: 5.22mmol/L；阴离子间隙(AG)-静脉血: 15.7；氯离子(Cl-)-静脉血: 99.4mmol/L；碱性磷酸酶(ALP)-静脉血: 59.5U/L；磷(P)-静脉血: 1.2mmol/L；钾离子(K+)-静脉血: 3.7mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.11；甘油三酯(TG)-静脉血: 1.21mmol/L；肌酐(Crea)-静脉血: 80.4umol/L；总胆红素(TBIL)-静脉血: 23.7umol/L；载脂蛋白B(apoB)-静脉血: 1.27g/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.4mmol/L；总钙(Ca)-静脉血: 2.2mmol/L；尿素氮(BUN)-静脉血: 6.6mmol/L；钠离子(Na+)-静脉血: 142.5mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 14.2U/L；载脂蛋白AI(apoAI)-静脉血: 0.95g/L；间接胆红素(IBIL)-静脉血: 17.2umolL；直接胆红素(DBIL)-静脉血: 6.5umol/L；尿酸(UA)-静脉血: 490.3umol/L；总胆汁酸(TBA)-静脉血: 3.4umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 15.5U/L；球蛋白(GLO)-静脉血: 21.26g/L；白蛋白(ALB)-静脉血: 44.8g/L；胱抑素(Cys-C)-静脉血: 0.81mg/L\n- [全程D65] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:80（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:20（参考: 阴性）\n- [全程D160] 超声；腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约12cm/s。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、脾脏未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D160] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺野纹理清晰，双肺野未见明显实质性病变。双侧肺门无增大，纵隔未见增宽，心影形态、大小、位置未见异常。双膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n- [全程D160] 检验组合: EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D27] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗1次，无特殊主诉。Rx：1.继续放疗。2.定期复查血常规等。3.对症支持。\n- [全程D34] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗6次，无特殊主诉。复查血常规、生化未见明显异常。Rx：1.继续放疗。2.定期复查血常规等。3.对症支持。\n- [全程D41] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗11次，无特殊主诉。查体见鼻咽顶壁、右顶侧壁可见多个小结节，较前有所缩小，粘膜可见小片状白膜，双颈淋巴结未触及肿大，颅神经检查阴性，全身骨无压痛。和11-10复查血常规、血生化均未见明显异常。皮肤反应：0 Rx：1.继续放疗。粘膜反应：Ⅱ° 2.定期复查血常规等。3.对症支持。\n- [全程D55] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗21次，诉口干、咽痛较前明显，乏力，余无特殊主诉。查体见鼻咽右顶侧壁稍增厚，炎性分泌物较多，粘膜充血水肿，双颈淋巴结未触及肿大，颅神经检查阴性，全身骨无压痛。复查血常规未见明显异常。皮肤反应：I°Rx：1.继续放疗。粘膜反应：Ⅱ° 2.定期复查血常规等。3.抗炎、止痛、营养对症支持。\n- [全程D62] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗26次，诉口干、咽痛较前缓解，仍觉乏力，无特殊主诉。和12-01复查血常规、生化均未见明显异常。皮肤反应：Ⅰ°Rx：1.继续放疗。粘膜反应：Ⅱ° 2.定期复查血常规等。3.营养对症支持。\n- [全程D65] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗28次，诉口干、咽痛好转，自觉体力虚弱，并拒绝最后2次放疗。皮肤反应：Ⅰ° Rx：1.定期复查。粘膜反应：Ⅰ° 2.不适随诊。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 安排鼻咽及颈部活检，准备行挽救性内镜下鼻咽切除术。\nB. 启动含铂双药方案全身化疗4-6个周期。\nC. 行全身PET/CT评估，若有局部高代谢灶则行挽救性放疗。\nD. 予以原发灶及颈部引流区局部推量补照4-6Gy。\nE. 给予卡培他滨单药口服维持治疗半年至一年。\nF. 维持规范随访观察，可症状给予一般对症及支持治疗。\nG. 行鼻咽及颈部MRI增强扫描，若有可疑残留则行诱导化疗。\nH. 启动PD-1抑制剂联合含铂双药全身化疗。\nI. 安排鼻咽内镜活检，若病理阳性则行双侧颈部淋巴结清扫术。\nJ. 补充顺铂单药全身化疗2个周期以强化局部控制。\nK. 行全身骨扫描及头颅MRI，排除远处转移后行局部挽救性放疗。\nL. 予以吉西他滨联合顺铂全身化疗4-6个周期。\n\n请仅输出一个选项字母（A-L）。"}]}
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full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、鼻腔。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左颈肿物20天；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物；既往史: 20余年前患“血吸虫”病行脾脏切除术，当地医院检查示“早期肝硬化”，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：37.3℃，P：62次/分，R：20次/分，BP：121/75mmHg,Ht：165cm，Wt：58kg，BSA：1.63m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 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完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。\nI. 完善颈部淋巴结切除活检，行鼻咽及颈部MRI平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。\nJ. 完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，并完善骨扫描及头颅MRI检查。\nK. 完善电子鼻咽镜检查及活检，仅行鼻咽MRI平扫+增强，颈部行彩超评估，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。\nL. 完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，并完善全身骨髓穿刺活检。\n\n请仅输出一个选项字母（A-L）。"}]}
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full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、鼻腔。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左颈肿物20天；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物；既往史: 20余年前患“血吸虫”病行脾脏切除术，当地医院检查示“早期肝硬化”，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：37.3℃，P：62次/分，R：20次/分，BP：121/75mmHg,Ht：165cm，Wt：58kg，BSA：1.63m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽左侧顶后壁粘膜稍隆起；左侧颈部II区可扪及1个淋巴结，最大径1×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 逆钟向转位 正常范围心电图\n- [全程D1] 检验组合: 肌酐(Crea)-静脉血: 56.1umol/L；阴离子间隙(AG)-静脉血: 11.1；α-L-岩藻糖苷酶(AFU)-静脉血: 35.5U/L；凝血酶原时间(PT)-静脉血: 11.7sec.；胱抑素(Cys-C)-静脉血: 0.85mg/L；淋巴细胞百分比(Lymph%)-静脉血: 0.428；骨钙素N端中分子片段(N-MID)-静脉血: 19.3ng/ml；纤维蛋白原(Fbg)-静脉血: 2.07g/L；钠离子(Na+)-静脉血: 140.5mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；总钙(Ca)-静脉血: 2.29mmol/L；乳酸脱氢酶(LDH)-静脉血: 164U/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.44；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.35mmol/L；血小板分布宽度(PDW)-静脉血: 15.9%；平均红细胞血红蛋白含量(MCH)-静脉血: 31.5pg；总胆固醇(TC)-静脉血: 4.12mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；Rh血型-静脉血: 阳性；红细胞比容(Hct)-静脉血: 41.2%；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 9.9umolL；D-二聚体(D-Dimer)-静脉血: 5.09ug/ml；钾离子(K+)-静脉血: 4.24mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.424；直接胆红素(DBIL)-静脉血: 5.8umol/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；天门冬氨酸氨基转移酶(AST)-静脉血: 18.6U/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；透明质酸(HA)-静脉血: 71.337ng/ml；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.5；纤维蛋白原降解产物(FDP)-静脉血:……\n- [全程D2] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双下肺纹理稍粗，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n- [全程D4] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏形态失常，表面凸凹不平，边缘钝，肝实质回声不均匀，明显增强、粗糙，肝内未见明确肿块回声。门静脉主干内径约15mm。肝静脉、门静脉内未见异常回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约14cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏术后缺如。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约35×24×23mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝硬化声像。 脾脏术后缺如。 胆囊、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D7] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 左上颌骨可见片状放射性浓集灶。胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 左上颌骨炎症。 余全身骨骼未见明显异常。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行PET-CT检查以重新评估全身分期\nB. 行左侧颈部淋巴结切除活检以明确病理诊断\nC. 行左侧颈部淋巴结细针穿刺活检(FNAC)以明确病理诊断\nD. 行鼻咽脱落细胞涂片检查以替代组织活检\nE. 行肝脏增强MRI检查以进一步排查肝脏转移灶\nF. 行右侧颈部II区小淋巴结切除活检以明确对侧转移情况\nG. 行外周血EB病毒DNA定量检测作为确诊依据\nH. 行左上颌骨病灶穿刺活检以明确骨扫描异常灶性质\nI. 行鼻咽镜下鼻咽原发灶活检以明确病理诊断\nJ. 行鼻咽肿物广泛切除术以达到诊断与治疗目的\nK. 行颈部超声造影检查以进一步评估右颈淋巴结性质\nL. 行鼻咽及颈部CT平扫加增强以补充评估颅底骨质破坏\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、鼻腔。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左颈肿物20天；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物；既往史: 20余年前患“血吸虫”病行脾脏切除术，当地医院检查示“早期肝硬化”，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：37.3℃，P：62次/分，R：20次/分，BP：121/75mmHg,Ht：165cm，Wt：58kg，BSA：1.63m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽左侧顶后壁粘膜稍隆起；左侧颈部II区可扪及1个淋巴结，最大径1×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 逆钟向转位 正常范围心电图\n- [全程D1] 检验组合: 肌酐(Crea)-静脉血: 56.1umol/L；阴离子间隙(AG)-静脉血: 11.1；α-L-岩藻糖苷酶(AFU)-静脉血: 35.5U/L；凝血酶原时间(PT)-静脉血: 11.7sec.；胱抑素(Cys-C)-静脉血: 0.85mg/L；淋巴细胞百分比(Lymph%)-静脉血: 0.428；骨钙素N端中分子片段(N-MID)-静脉血: 19.3ng/ml；纤维蛋白原(Fbg)-静脉血: 2.07g/L；钠离子(Na+)-静脉血: 140.5mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；总钙(Ca)-静脉血: 2.29mmol/L；乳酸脱氢酶(LDH)-静脉血: 164U/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.44；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.35mmol/L；血小板分布宽度(PDW)-静脉血: 15.9%；平均红细胞血红蛋白含量(MCH)-静脉血: 31.5pg；总胆固醇(TC)-静脉血: 4.12mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；Rh血型-静脉血: 阳性；红细胞比容(Hct)-静脉血: 41.2%；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 9.9umolL；D-二聚体(D-Dimer)-静脉血: 5.09ug/ml；钾离子(K+)-静脉血: 4.24mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.424；直接胆红素(DBIL)-静脉血: 5.8umol/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；天门冬氨酸氨基转移酶(AST)-静脉血: 18.6U/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；透明质酸(HA)-静脉血: 71.337ng/ml；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.5；纤维蛋白原降解产物(FDP)-静脉血:……\n- [全程D2] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双下肺纹理稍粗，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n- [全程D4] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏形态失常，表面凸凹不平，边缘钝，肝实质回声不均匀，明显增强、粗糙，肝内未见明确肿块回声。门静脉主干内径约15mm。肝静脉、门静脉内未见异常回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约14cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏术后缺如。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约35×24×23mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝硬化声像。 脾脏术后缺如。 胆囊、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D7] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 左上颌骨可见片状放射性浓集灶。胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 左上颌骨炎症。 余全身骨骼未见明显异常。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行PET-CT检查以重新评估全身分期\nB. 行左侧颈部淋巴结切除活检以明确病理诊断\nC. 行左侧颈部淋巴结细针穿刺活检(FNAC)以明确病理诊断\nD. 行鼻咽脱落细胞涂片检查以替代组织活检\nE. 行肝脏增强MRI检查以进一步排查肝脏转移灶\nF. 行右侧颈部II区小淋巴结切除活检以明确对侧转移情况\nG. 行外周血EB病毒DNA定量检测作为确诊依据\nH. 行左上颌骨病灶穿刺活检以明确骨扫描异常灶性质\nI. 行鼻咽镜下鼻咽原发灶活检以明确病理诊断\nJ. 行鼻咽肿物广泛切除术以达到诊断与治疗目的\nK. 行颈部超声造影检查以进一步评估右颈淋巴结性质\nL. 行鼻咽及颈部CT平扫加增强以补充评估颅底骨质破坏\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-9895c4d0f7c600fd0c046a50","patient_id":"patient-02ca51eed4fedbb13e4db76d","turn_id":"turn05","turn_position":3,"turn_type":"toxicity_or_support_decision","gold_letter":"L","gold_action":"继续行第2程同期化疗，化疗后复查血象视情况予以升白细胞治疗，并给予静脉营养、补液及通便等对症支持。","options":[{"letter":"A","text":"暂停同期化疗，单纯行根治性放疗，立即予以重组人粒细胞集落刺激因子升白细胞治疗。","is_gold":false},{"letter":"B","text":"暂停放化疗，立即予以重组人粒细胞集落刺激因子，待白细胞恢复正常后再恢复放化综合治疗。","is_gold":false},{"letter":"C","text":"延迟第2程同期化疗，继续放疗，观察3天后复查血常规，若中性粒细胞达标再行化疗。","is_gold":false},{"letter":"D","text":"继续行第2程同期化疗，化疗前予以长效聚乙二醇化重组人粒细胞集落刺激因子预防性升白细胞。","is_gold":false},{"letter":"E","text":"继续行第2程同期化疗，化疗期间同步予以口服抗生素预防感染及静脉营养支持。","is_gold":false},{"letter":"F","text":"继续行第2程同期化疗，将顺铂剂量下调20%，并给予静脉营养、补液及通便等对症支持。","is_gold":false},{"letter":"G","text":"终止同期化疗，改为单纯放疗联合西妥昔单抗靶向治疗，并予以静脉营养支持。","is_gold":false},{"letter":"H","text":"继续行第2程同期化疗，化疗后立即常规予以重组人粒细胞集落刺激因子连续升白细胞治疗3天。","is_gold":false},{"letter":"I","text":"暂停放疗，按计划行第2程同期化疗，化疗后复查血象视情况予以升白细胞治疗。","is_gold":false},{"letter":"J","text":"继续行第2程同期化疗，将顺铂更换为卡铂，并给予静脉营养、补液及通便等对症支持。","is_gold":false},{"letter":"K","text":"延迟第2程同期化疗，予以静脉营养、补液及通便等对症支持，待1周后复查血象再决定是否化疗。","is_gold":false},{"letter":"L","text":"继续行第2程同期化疗，化疗后复查血象视情况予以升白细胞治疗，并给予静脉营养、补液及通便等对症支持。","is_gold":true}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、鼻腔。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左颈肿物20天；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物；既往史: 20余年前患“血吸虫”病行脾脏切除术，当地医院检查示“早期肝硬化”，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：37.3℃，P：62次/分，R：20次/分，BP：121/75mmHg,Ht：165cm，Wt：58kg，BSA：1.63m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽左侧顶后壁粘膜稍隆起；左侧颈部II区可扪及1个淋巴结，最大径1×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 左颈肿物20天；现病史: 缘于20天前患者无意中出现左颈肿物，未伴涕血、耳鸣、听力下降、头痛、面麻等不适，某次就诊时间在当地医院行左颈淋巴结穿刺，病理示未见癌，某次就诊时间行鼻咽活检病理示鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物；既往史: 20余年前患“血吸虫”病行脾脏切除术，当地医院检查示“早期肝硬化”，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：37.3℃，P：62次/分，R：20次/分，BP：121/75mmHg,Ht：165cm，Wt：58kg，BSA：1.63m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率62次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽左侧顶后壁粘膜稍隆起；左侧颈部II区可扪及1个淋巴结，最大径1×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D27] 入院记录: 主诉: 确诊鼻咽癌1月余；现病史: 缘于某次就诊时间9月下旬患者无意中出现左颈肿物，未伴涕血、耳鸣、听力下降、头痛、面麻等不适，某次就诊时间在当地医院行左颈淋巴结穿刺，病理示未见癌，某次就诊时间行鼻咽活检病理示分化非角化癌。某次就诊时间日入院予以治疗前相关检查，明确诊断为鼻咽分化非角化癌，[分期信息见历史辅助诊断节点],III期，予以行放疗计划设计，现放疗计划设计完成，入院行放化综合治疗。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物；既往史: 20余年前患“血吸虫”病行脾脏切除术，当地医院检查示“早期肝硬化”，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：37.3℃，P：62次/分，R：20次/分，BP：121/75mmHg,Ht：165cm，Wt：58kg，BSA：1.63m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率62次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽左侧顶后壁粘膜稍隆起；左侧颈部II区可扪及1个淋巴结，最大径1×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 逆钟向转位 正常范围心电图\n- [全程D1] 检验组合: 肌酐(Crea)-静脉血: 56.1umol/L；阴离子间隙(AG)-静脉血: 11.1；α-L-岩藻糖苷酶(AFU)-静脉血: 35.5U/L；凝血酶原时间(PT)-静脉血: 11.7sec.；胱抑素(Cys-C)-静脉血: 0.85mg/L；淋巴细胞百分比(Lymph%)-静脉血: 0.428；骨钙素N端中分子片段(N-MID)-静脉血: 19.3ng/ml；纤维蛋白原(Fbg)-静脉血: 2.07g/L；钠离子(Na+)-静脉血: 140.5mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；总钙(Ca)-静脉血: 2.29mmol/L；乳酸脱氢酶(LDH)-静脉血: 164U/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.44；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.35mmol/L；血小板分布宽度(PDW)-静脉血: 15.9%；平均红细胞血红蛋白含量(MCH)-静脉血: 31.5pg；总胆固醇(TC)-静脉血: 4.12mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；Rh血型-静脉血: 阳性；红细胞比容(Hct)-静脉血: 41.2%；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 9.9umolL；D-二聚体(D-Dimer)-静脉血: 5.09ug/ml；钾离子(K+)-静脉血: 4.24mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.424；直接胆红素(DBIL)-静脉血: 5.8umol/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；天门冬氨酸氨基转移酶(AST)-静脉血: 18.6U/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；透明质酸(HA)-静脉血: 71.337ng/ml；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.5；纤维蛋白原降解产物(FDP)-静脉血:……\n- [全程D2] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双下肺纹理稍粗，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n- [全程D4] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏形态失常，表面凸凹不平，边缘钝，肝实质回声不均匀，明显增强、粗糙，肝内未见明确肿块回声。门静脉主干内径约15mm。肝静脉、门静脉内未见异常回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约14cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏术后缺如。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约35×24×23mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝硬化声像。 脾脏术后缺如。 胆囊、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D7] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 左上颌骨可见片状放射性浓集灶。胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 左上颌骨炎症。 余全身骨骼未见明显异常。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D35] 检验组合: 碱性磷酸酶(ALP)-静脉血: 93.6U/L；丙氨酸氨基转移酶(ALT)-静脉血: 26.3U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.2U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 34.4U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.73；α-L-岩藻糖苷酶(AFU)-静脉血: 38.5U/L；乳酸脱氢酶(LDH)-静脉血: 195.7U/L；总胆汁酸(TBA)-静脉血: 2.9umol/L\n- [全程D39] 检验组合: 胱抑素(Cys-C)-静脉血: 0.84mg/L；肌酐(Crea)-静脉血: 62.7umol/L；阴离子间隙(AG)-静脉血: 11；单核细胞计数(Mono#)-静脉血: 0.510E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.8mmol/L；载脂蛋白B(apoB)-静脉血: 0.81g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.8U/L；平均红细胞体积(MCV)-静脉血: 93.8fL；单核细胞百分比(Mono%)-静脉血: 0.149；C-反应蛋白(CRP)-静脉血: 0.37mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；淋巴细胞百分比(Lymph%)-静脉血: 0.352；有核红细胞百分比(NRBC%)-静脉血: 0；尿素氮(BUN)-静脉血: 7.54mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.17g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 40U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；直接胆红素(DBIL)-静脉血: 6.9umol/L；平均血小板体积(MPV)-静脉血: 9.04fL；红细胞计数(RBC#)-静脉血: 4.2310E12/L；总胆固醇(TC)-静脉血: 4.39mmol/L；总钙(Ca)-静脉血: 2.39mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.21mmolL；丙氨酸氨基转移酶(ALT)-静脉血: 28.6U/L；间接胆红素(IBIL)-静脉血: 11.6umolL；甘油三酯(TG)-静脉血: 0.5mmol/L；尿酸(UA)-静脉血: 332.9umol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32.2pg；中性粒细胞计数(Neut#)-静脉血: 1.510E9/L；总胆红素(TBIL)-静脉血: 18.5umol/L；乳酸脱氢酶(LDH)-静脉血: 145.6U/L；磷(P)-静脉血: 1.34mmol/L；碱性磷酸酶(ALP)-静脉血: 93.2U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D28] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者今日返院，一般情况可，无明显不适主诉，体查情况基本同前，患者现放疗计划已设计完成并通过全科会诊，NPDT70Gy/30F,CTV1:60Gy/30F,CTV2：54Gy/30F，靶区剂量分布均匀，正常组织剂量在可接受范围内。[姓名已隐去]副医生信息已隐藏，患者放疗计划设计完成，可行放疗前复位及验证等准备，开始放疗，患者既往血吸虫肝硬化病史，患者化疗后可能出现肝功能损伤，肝衰竭，严重者可危及生命，与患者及家属沟通后，患者及家属表示愿意承担化疗风险，予以择期行DDP单药每周同时期化疗。\n- [全程D29] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 今日查房，患者一般情况可，无明显不适主诉，体查同入院。[姓名已隐去]副医生信息已隐藏示：依约开始放疗，嘱患者注意营养与休息。\n- [全程D34] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者已开始行根治性放疗，现放疗2F，昨日完成一程同期化疗，诉额、双侧颞部头痛，一般情况尚可，体查情况基本同前。[姓名已隐去]副医生信息已隐藏：现患者已开始放疗，一程化疗结束，针对患者主诉，考虑放疗引起不良反应，予以止痛等对症处理，病情继观。\n- [全程D39] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现处于放化综合治疗中，放疗3F，无诉，体查情况基本同前，血常规、生化常规结果示：WBC3.33*10E9/L、中性粒1.5*10E9/L；[姓名已隐去]副医生信息已隐藏：现患者血象稍低，明日予以行同期化疗二程，化疗后予以复查血象后再予以升白等对症处理，密观病情。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停同期化疗，单纯行根治性放疗，立即予以重组人粒细胞集落刺激因子升白细胞治疗。\nB. 暂停放化疗，立即予以重组人粒细胞集落刺激因子，待白细胞恢复正常后再恢复放化综合治疗。\nC. 延迟第2程同期化疗，继续放疗，观察3天后复查血常规，若中性粒细胞达标再行化疗。\nD. 继续行第2程同期化疗，化疗前予以长效聚乙二醇化重组人粒细胞集落刺激因子预防性升白细胞。\nE. 继续行第2程同期化疗，化疗期间同步予以口服抗生素预防感染及静脉营养支持。\nF. 继续行第2程同期化疗，将顺铂剂量下调20%，并给予静脉营养、补液及通便等对症支持。\nG. 终止同期化疗，改为单纯放疗联合西妥昔单抗靶向治疗，并予以静脉营养支持。\nH. 继续行第2程同期化疗，化疗后立即常规予以重组人粒细胞集落刺激因子连续升白细胞治疗3天。\nI. 暂停放疗，按计划行第2程同期化疗，化疗后复查血象视情况予以升白细胞治疗。\nJ. 继续行第2程同期化疗，将顺铂更换为卡铂，并给予静脉营养、补液及通便等对症支持。\nK. 延迟第2程同期化疗，予以静脉营养、补液及通便等对症支持，待1周后复查血象再决定是否化疗。\nL. 继续行第2程同期化疗，化疗后复查血象视情况予以升白细胞治疗，并给予静脉营养、补液及通便等对症支持。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、鼻腔。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左颈肿物20天；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物；既往史: 20余年前患“血吸虫”病行脾脏切除术，当地医院检查示“早期肝硬化”，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：37.3℃，P：62次/分，R：20次/分，BP：121/75mmHg,Ht：165cm，Wt：58kg，BSA：1.63m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽左侧顶后壁粘膜稍隆起；左侧颈部II区可扪及1个淋巴结，最大径1×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 左颈肿物20天；现病史: 缘于20天前患者无意中出现左颈肿物，未伴涕血、耳鸣、听力下降、头痛、面麻等不适，某次就诊时间在当地医院行左颈淋巴结穿刺，病理示未见癌，某次就诊时间行鼻咽活检病理示鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物；既往史: 20余年前患“血吸虫”病行脾脏切除术，当地医院检查示“早期肝硬化”，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：37.3℃，P：62次/分，R：20次/分，BP：121/75mmHg,Ht：165cm，Wt：58kg，BSA：1.63m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率62次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽左侧顶后壁粘膜稍隆起；左侧颈部II区可扪及1个淋巴结，最大径1×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D27] 入院记录: 主诉: 确诊鼻咽癌1月余；现病史: 缘于某次就诊时间9月下旬患者无意中出现左颈肿物，未伴涕血、耳鸣、听力下降、头痛、面麻等不适，某次就诊时间在当地医院行左颈淋巴结穿刺，病理示未见癌，某次就诊时间行鼻咽活检病理示分化非角化癌。某次就诊时间日入院予以治疗前相关检查，明确诊断为鼻咽分化非角化癌，[分期信息见历史辅助诊断节点],III期，予以行放疗计划设计，现放疗计划设计完成，入院行放化综合治疗。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物；既往史: 20余年前患“血吸虫”病行脾脏切除术，当地医院检查示“早期肝硬化”，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：37.3℃，P：62次/分，R：20次/分，BP：121/75mmHg,Ht：165cm，Wt：58kg，BSA：1.63m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率62次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽左侧顶后壁粘膜稍隆起；左侧颈部II区可扪及1个淋巴结，最大径1×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 逆钟向转位 正常范围心电图\n- [全程D1] 检验组合: 肌酐(Crea)-静脉血: 56.1umol/L；阴离子间隙(AG)-静脉血: 11.1；α-L-岩藻糖苷酶(AFU)-静脉血: 35.5U/L；凝血酶原时间(PT)-静脉血: 11.7sec.；胱抑素(Cys-C)-静脉血: 0.85mg/L；淋巴细胞百分比(Lymph%)-静脉血: 0.428；骨钙素N端中分子片段(N-MID)-静脉血: 19.3ng/ml；纤维蛋白原(Fbg)-静脉血: 2.07g/L；钠离子(Na+)-静脉血: 140.5mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；总钙(Ca)-静脉血: 2.29mmol/L；乳酸脱氢酶(LDH)-静脉血: 164U/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.44；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.35mmol/L；血小板分布宽度(PDW)-静脉血: 15.9%；平均红细胞血红蛋白含量(MCH)-静脉血: 31.5pg；总胆固醇(TC)-静脉血: 4.12mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；Rh血型-静脉血: 阳性；红细胞比容(Hct)-静脉血: 41.2%；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 9.9umolL；D-二聚体(D-Dimer)-静脉血: 5.09ug/ml；钾离子(K+)-静脉血: 4.24mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.424；直接胆红素(DBIL)-静脉血: 5.8umol/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；天门冬氨酸氨基转移酶(AST)-静脉血: 18.6U/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；透明质酸(HA)-静脉血: 71.337ng/ml；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.5；纤维蛋白原降解产物(FDP)-静脉血:……\n- [全程D2] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双下肺纹理稍粗，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n- [全程D4] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏形态失常，表面凸凹不平，边缘钝，肝实质回声不均匀，明显增强、粗糙，肝内未见明确肿块回声。门静脉主干内径约15mm。肝静脉、门静脉内未见异常回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约14cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏术后缺如。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约35×24×23mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝硬化声像。 脾脏术后缺如。 胆囊、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D7] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 左上颌骨可见片状放射性浓集灶。胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 左上颌骨炎症。 余全身骨骼未见明显异常。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D35] 检验组合: 碱性磷酸酶(ALP)-静脉血: 93.6U/L；丙氨酸氨基转移酶(ALT)-静脉血: 26.3U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.2U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 34.4U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.73；α-L-岩藻糖苷酶(AFU)-静脉血: 38.5U/L；乳酸脱氢酶(LDH)-静脉血: 195.7U/L；总胆汁酸(TBA)-静脉血: 2.9umol/L\n- [全程D39] 检验组合: 胱抑素(Cys-C)-静脉血: 0.84mg/L；肌酐(Crea)-静脉血: 62.7umol/L；阴离子间隙(AG)-静脉血: 11；单核细胞计数(Mono#)-静脉血: 0.510E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.8mmol/L；载脂蛋白B(apoB)-静脉血: 0.81g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.8U/L；平均红细胞体积(MCV)-静脉血: 93.8fL；单核细胞百分比(Mono%)-静脉血: 0.149；C-反应蛋白(CRP)-静脉血: 0.37mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；淋巴细胞百分比(Lymph%)-静脉血: 0.352；有核红细胞百分比(NRBC%)-静脉血: 0；尿素氮(BUN)-静脉血: 7.54mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.17g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 40U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；直接胆红素(DBIL)-静脉血: 6.9umol/L；平均血小板体积(MPV)-静脉血: 9.04fL；红细胞计数(RBC#)-静脉血: 4.2310E12/L；总胆固醇(TC)-静脉血: 4.39mmol/L；总钙(Ca)-静脉血: 2.39mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.21mmolL；丙氨酸氨基转移酶(ALT)-静脉血: 28.6U/L；间接胆红素(IBIL)-静脉血: 11.6umolL；甘油三酯(TG)-静脉血: 0.5mmol/L；尿酸(UA)-静脉血: 332.9umol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32.2pg；中性粒细胞计数(Neut#)-静脉血: 1.510E9/L；总胆红素(TBIL)-静脉血: 18.5umol/L；乳酸脱氢酶(LDH)-静脉血: 145.6U/L；磷(P)-静脉血: 1.34mmol/L；碱性磷酸酶(ALP)-静脉血: 93.2U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D28] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者今日返院，一般情况可，无明显不适主诉，体查情况基本同前，患者现放疗计划已设计完成并通过全科会诊，NPDT70Gy/30F,CTV1:60Gy/30F,CTV2：54Gy/30F，靶区剂量分布均匀，正常组织剂量在可接受范围内。[姓名已隐去]副医生信息已隐藏，患者放疗计划设计完成，可行放疗前复位及验证等准备，开始放疗，患者既往血吸虫肝硬化病史，患者化疗后可能出现肝功能损伤，肝衰竭，严重者可危及生命，与患者及家属沟通后，患者及家属表示愿意承担化疗风险，予以择期行DDP单药每周同时期化疗。\n- [全程D29] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 今日查房，患者一般情况可，无明显不适主诉，体查同入院。[姓名已隐去]副医生信息已隐藏示：依约开始放疗，嘱患者注意营养与休息。\n- [全程D34] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者已开始行根治性放疗，现放疗2F，昨日完成一程同期化疗，诉额、双侧颞部头痛，一般情况尚可，体查情况基本同前。[姓名已隐去]副医生信息已隐藏：现患者已开始放疗，一程化疗结束，针对患者主诉，考虑放疗引起不良反应，予以止痛等对症处理，病情继观。\n- [全程D39] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现处于放化综合治疗中，放疗3F，无诉，体查情况基本同前，血常规、生化常规结果示：WBC3.33*10E9/L、中性粒1.5*10E9/L；[姓名已隐去]副医生信息已隐藏：现患者血象稍低，明日予以行同期化疗二程，化疗后予以复查血象后再予以升白等对症处理，密观病情。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停同期化疗，单纯行根治性放疗，立即予以重组人粒细胞集落刺激因子升白细胞治疗。\nB. 暂停放化疗，立即予以重组人粒细胞集落刺激因子，待白细胞恢复正常后再恢复放化综合治疗。\nC. 延迟第2程同期化疗，继续放疗，观察3天后复查血常规，若中性粒细胞达标再行化疗。\nD. 继续行第2程同期化疗，化疗前予以长效聚乙二醇化重组人粒细胞集落刺激因子预防性升白细胞。\nE. 继续行第2程同期化疗，化疗期间同步予以口服抗生素预防感染及静脉营养支持。\nF. 继续行第2程同期化疗，将顺铂剂量下调20%，并给予静脉营养、补液及通便等对症支持。\nG. 终止同期化疗，改为单纯放疗联合西妥昔单抗靶向治疗，并予以静脉营养支持。\nH. 继续行第2程同期化疗，化疗后立即常规予以重组人粒细胞集落刺激因子连续升白细胞治疗3天。\nI. 暂停放疗，按计划行第2程同期化疗，化疗后复查血象视情况予以升白细胞治疗。\nJ. 继续行第2程同期化疗，将顺铂更换为卡铂，并给予静脉营养、补液及通便等对症支持。\nK. 延迟第2程同期化疗，予以静脉营养、补液及通便等对症支持，待1周后复查血象再决定是否化疗。\nL. 继续行第2程同期化疗，化疗后复查血象视情况予以升白细胞治疗，并给予静脉营养、补液及通便等对症支持。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-5f99c90d4e8627eaecab64fc","patient_id":"patient-02ca51eed4fedbb13e4db76d","turn_id":"turn06","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"A","gold_action":"继续按计划行放化综合治疗，并进行静脉导管常规维护。","options":[{"letter":"A","text":"继续按计划行放化综合治疗，并进行静脉导管常规维护。","is_gold":true},{"letter":"B","text":"暂停放化疗，再次给予粒细胞集落刺激因子（G-CSF）升白治疗。","is_gold":false},{"letter":"C","text":"暂停同期化疗，仅继续单纯放射治疗，并进行静脉导管常规维护。","is_gold":false},{"letter":"D","text":"继续按计划行放化综合治疗，并预防性输注单采血小板。","is_gold":false},{"letter":"E","text":"暂停放化疗，经验性给予广谱静脉抗生素抗感染治疗。","is_gold":false},{"letter":"F","text":"继续按计划行放化综合治疗，并预防性给予重组人促红素（EPO）治疗。","is_gold":false},{"letter":"G","text":"继续按计划行放化综合治疗，并拔除静脉留置导管改为口服给药。","is_gold":false},{"letter":"H","text":"继续按计划行放化综合治疗，但将后续同期化疗剂量减量20%。","is_gold":false},{"letter":"I","text":"提前结束同期化疗，仅继续完成剩余放射治疗。","is_gold":false},{"letter":"J","text":"暂停放化疗，给予保肝降酶药物静脉滴注。","is_gold":false},{"letter":"K","text":"继续按计划行放化综合治疗，并预防性给予白介素-11（IL-11）治疗。","is_gold":false},{"letter":"L","text":"继续按计划行放化综合治疗，并加用大剂量静脉糖皮质激素治疗。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、鼻腔。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左颈肿物20天；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物；既往史: 20余年前患“血吸虫”病行脾脏切除术，当地医院检查示“早期肝硬化”，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：37.3℃，P：62次/分，R：20次/分，BP：121/75mmHg,Ht：165cm，Wt：58kg，BSA：1.63m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽左侧顶后壁粘膜稍隆起；左侧颈部II区可扪及1个淋巴结，最大径1×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 左颈肿物20天；现病史: 缘于20天前患者无意中出现左颈肿物，未伴涕血、耳鸣、听力下降、头痛、面麻等不适，某次就诊时间在当地医院行左颈淋巴结穿刺，病理示未见癌，某次就诊时间行鼻咽活检病理示鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物；既往史: 20余年前患“血吸虫”病行脾脏切除术，当地医院检查示“早期肝硬化”，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：37.3℃，P：62次/分，R：20次/分，BP：121/75mmHg,Ht：165cm，Wt：58kg，BSA：1.63m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率62次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽左侧顶后壁粘膜稍隆起；左侧颈部II区可扪及1个淋巴结，最大径1×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D27] 入院记录: 主诉: 确诊鼻咽癌1月余；现病史: 缘于某次就诊时间9月下旬患者无意中出现左颈肿物，未伴涕血、耳鸣、听力下降、头痛、面麻等不适，某次就诊时间在当地医院行左颈淋巴结穿刺，病理示未见癌，某次就诊时间行鼻咽活检病理示分化非角化癌。某次就诊时间日入院予以治疗前相关检查，明确诊断为鼻咽分化非角化癌，[分期信息见历史辅助诊断节点],III期，予以行放疗计划设计，现放疗计划设计完成，入院行放化综合治疗。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物；既往史: 20余年前患“血吸虫”病行脾脏切除术，当地医院检查示“早期肝硬化”，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：37.3℃，P：62次/分，R：20次/分，BP：121/75mmHg,Ht：165cm，Wt：58kg，BSA：1.63m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率62次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽左侧顶后壁粘膜稍隆起；左侧颈部II区可扪及1个淋巴结，最大径1×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 逆钟向转位 正常范围心电图\n- [全程D1] 检验组合: 肌酐(Crea)-静脉血: 56.1umol/L；阴离子间隙(AG)-静脉血: 11.1；α-L-岩藻糖苷酶(AFU)-静脉血: 35.5U/L；凝血酶原时间(PT)-静脉血: 11.7sec.；胱抑素(Cys-C)-静脉血: 0.85mg/L；淋巴细胞百分比(Lymph%)-静脉血: 0.428；骨钙素N端中分子片段(N-MID)-静脉血: 19.3ng/ml；纤维蛋白原(Fbg)-静脉血: 2.07g/L；钠离子(Na+)-静脉血: 140.5mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；总钙(Ca)-静脉血: 2.29mmol/L；乳酸脱氢酶(LDH)-静脉血: 164U/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.44；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.35mmol/L；血小板分布宽度(PDW)-静脉血: 15.9%；平均红细胞血红蛋白含量(MCH)-静脉血: 31.5pg；总胆固醇(TC)-静脉血: 4.12mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；Rh血型-静脉血: 阳性；红细胞比容(Hct)-静脉血: 41.2%；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 9.9umolL；D-二聚体(D-Dimer)-静脉血: 5.09ug/ml；钾离子(K+)-静脉血: 4.24mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.424；直接胆红素(DBIL)-静脉血: 5.8umol/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；天门冬氨酸氨基转移酶(AST)-静脉血: 18.6U/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；透明质酸(HA)-静脉血: 71.337ng/ml；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.5；纤维蛋白原降解产物(FDP)-静脉血:……\n- [全程D2] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双下肺纹理稍粗，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n- [全程D4] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏形态失常，表面凸凹不平，边缘钝，肝实质回声不均匀，明显增强、粗糙，肝内未见明确肿块回声。门静脉主干内径约15mm。肝静脉、门静脉内未见异常回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约14cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏术后缺如。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约35×24×23mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝硬化声像。 脾脏术后缺如。 胆囊、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D7] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 左上颌骨可见片状放射性浓集灶。胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 左上颌骨炎症。 余全身骨骼未见明显异常。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D35] 检验组合: 碱性磷酸酶(ALP)-静脉血: 93.6U/L；丙氨酸氨基转移酶(ALT)-静脉血: 26.3U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.2U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 34.4U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.73；α-L-岩藻糖苷酶(AFU)-静脉血: 38.5U/L；乳酸脱氢酶(LDH)-静脉血: 195.7U/L；总胆汁酸(TBA)-静脉血: 2.9umol/L\n- [全程D39] 检验组合: 胱抑素(Cys-C)-静脉血: 0.84mg/L；肌酐(Crea)-静脉血: 62.7umol/L；阴离子间隙(AG)-静脉血: 11；单核细胞计数(Mono#)-静脉血: 0.510E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.8mmol/L；载脂蛋白B(apoB)-静脉血: 0.81g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.8U/L；平均红细胞体积(MCV)-静脉血: 93.8fL；单核细胞百分比(Mono%)-静脉血: 0.149；C-反应蛋白(CRP)-静脉血: 0.37mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；淋巴细胞百分比(Lymph%)-静脉血: 0.352；有核红细胞百分比(NRBC%)-静脉血: 0；尿素氮(BUN)-静脉血: 7.54mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.17g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 40U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；直接胆红素(DBIL)-静脉血: 6.9umol/L；平均血小板体积(MPV)-静脉血: 9.04fL；红细胞计数(RBC#)-静脉血: 4.2310E12/L；总胆固醇(TC)-静脉血: 4.39mmol/L；总钙(Ca)-静脉血: 2.39mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.21mmolL；丙氨酸氨基转移酶(ALT)-静脉血: 28.6U/L；间接胆红素(IBIL)-静脉血: 11.6umolL；甘油三酯(TG)-静脉血: 0.5mmol/L；尿酸(UA)-静脉血: 332.9umol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32.2pg；中性粒细胞计数(Neut#)-静脉血: 1.510E9/L；总胆红素(TBIL)-静脉血: 18.5umol/L；乳酸脱氢酶(LDH)-静脉血: 145.6U/L；磷(P)-静脉血: 1.34mmol/L；碱性磷酸酶(ALP)-静脉血: 93.2U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0……\n- [全程D42] 检验组合: 红细胞比容(Hct)-静脉血: 38.5%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 335g/L；红细胞计数(RBC#)-静脉血: 4.1110E12/L；平均红细胞体积(MCV)-静脉血: 93.7fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；血小板计数(PLT#)-静脉血: 26910E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；碱性磷酸酶(ALP)-静脉血: 88U/L；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18U/L；中性粒细胞百分比(Neut%)-静脉血: 0.659；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.019；乳酸脱氢酶(LDH)-静脉血: 139.5U/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6；α-L-岩藻糖苷酶(AFU)-静脉血: 41U/L；血小板分布宽度(PDW)-静脉血: 11.5%；中性粒细胞计数(Neut#)-静脉血: 2.110E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 24.4U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；平均红细胞血红蛋白含量(MCH)-静脉血: 31.4pg；总胆汁酸(TBA)-静脉血: 1umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 33.2U/L；平均血小板体积(MPV)-静脉血: 10.3fL；白细胞计数(WBC#)-静脉血: 3.1410E9/L；大血小板百分比(P-LCR%)-静脉血: 26.3%；单核细胞计数(Mono#)-静脉血: 0.410E9/L；血红蛋白(Hb)-静脉血: 129g/L；单核细胞百分比(Mono%)-静脉血: 0.134；血小板比容-静脉血: 28%；淋巴细胞百分比(Lymph%)-静脉血: 0.185；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43\n- [全程D46] 检验组合: 平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；C-反应蛋白(CRP)-静脉血: 0.38mg/L；γ-谷氨酰基转移酶(GGT)-静脉血: 34.2U/L；尿酸(UA)-静脉血: 292.5umol/L；红细胞计数(RBC#)-静脉血: 4.0510E12/L；总蛋白(TP)-静脉血: 70.3g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞计数(Neut#)-静脉血: 1.410E9/L；磷(P)-静脉血: 1.21mmol/L；总胆固醇(TC)-静脉血: 3.73mmol/L；单核细胞百分比(Mono%)-静脉血: 0.167；总钙(Ca)-静脉血: 2.2mmol/L；胱抑素(Cys-C)-静脉血: 0.68mg/L；葡萄糖(Glu)-静脉血: 4.54mmol/L；白细胞计数(WBC#)-静脉血: 2.3910E9/L；载脂蛋白B(apoB)-静脉血: 0.82g/L；直接胆红素(DBIL)-静脉血: 4.6umol/L；镁离子(Mg2+)-静脉血: 0.76mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.89；氯离子(Cl-)-静脉血: 100.1mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.197；肌酐(Crea)-静脉血: 56.4umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；血小板比容-静脉血: 22%；碱性磷酸酶(ALP)-静脉血: 81.9U/L；钾离子(K+)-静脉血: 4.1mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.1；球蛋白(GLO)-静脉血: 29.4g/L；总胆汁酸(TBA)-静脉血: 1.4umol/L；尿素氮(BUN)-静脉血: 6.3mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.4pg；天门冬氨酸氨基转移酶(AST)-静脉血: 17.1U/L；血小板计数(PLT#)-静脉血: 21610E9/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.09g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；钠离子(Na+)-静脉血: 138.5mmol/L；淋巴细胞计数(Lymph#)……\n- [全程D49] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；白细胞计数(WBC#)-静脉血: 28.910E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0；平均红细胞体积(MCV)-静脉血: 96.4fL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.77；α-L-岩藻糖苷酶(AFU)-静脉血: 37.1U/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.003；平均血小板体积(MPV)-静脉血: 8.48fL；血小板计数(PLT#)-静脉血: 16710E9/L；红细胞计数(RBC#)-静脉血: 3.9610E12/L；碱性磷酸酶(ALP)-静脉血: 119.8U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32.2pg；中性粒细胞百分比(Neut%)-静脉血: 0.933；血小板分布宽度(PDW)-静脉血: 15.7%；血小板比容-静脉血: 14.1%；中性粒细胞计数(Neut#)-静脉血: 2710E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 13.5U/L；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；红细胞比容(Hct)-静脉血: 38.2%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 334.1g/L；总胆汁酸(TBA)-静脉血: 1.5umol/L；单核细胞百分比(Mono%)-静脉血: 0.035；单核细胞计数(Mono#)-静脉血: 110E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 17.5U/L；血红蛋白(Hb)-静脉血: 127.7g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.028；乳酸脱氢酶(LDH)-静脉血: 177U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 34.4U/L\n- [全程D53] 检验组合: 总胆固醇(TC)-静脉血: 4.04mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 17.7U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.8；血小板计数(PLT#)-静脉血: 199.710E9/L；镁离子(Mg2+)-静脉血: 0.73mmol/L；红细胞比容(Hct)-静脉血: 38.2%；总蛋白(TP)-静脉血: 70.35g/L；载脂蛋白B(apoB)-静脉血: 0.83g/L；尿酸(UA)-静脉血: 359.2umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.133；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.6；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；血小板分布宽度(PDW)-静脉血: 15.6%；中性粒细胞百分比(Neut%)-静脉血: 0.671；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；球蛋白(GLO)-静脉血: 26.85g/L；氯离子(Cl-)-静脉血: 102.6mmol/L；肌酐(Crea)-静脉血: 59umol/L；平均红细胞体积(MCV)-静脉血: 95.9fL；血小板比容-静脉血: 16.6%；红细胞计数(RBC#)-静脉血: 3.9810E12/L；C-反应蛋白(CRP)-静脉血: 0.91mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.69mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 337.3g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.11mmolL；白蛋白(ALB)-静脉血: 43.5g/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32.3pg；白细胞计数(WBC#)-静脉血: 3.9610E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 38U/L；甘油三酯(TG)-静脉血: 0.67mmol/L；平均血小板体积(MPV)-静脉血: 8.31fL；葡萄糖(Glu)-静脉血: 4.61mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.6%；单核细胞百分比(Mono%)-静脉血: 0.143；总钙(Ca)-静脉血: 2.28mmol/L；血……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D28] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者今日返院，一般情况可，无明显不适主诉，体查情况基本同前，患者现放疗计划已设计完成并通过全科会诊，NPDT70Gy/30F,CTV1:60Gy/30F,CTV2：54Gy/30F，靶区剂量分布均匀，正常组织剂量在可接受范围内。[姓名已隐去]副医生信息已隐藏，患者放疗计划设计完成，可行放疗前复位及验证等准备，开始放疗，患者既往血吸虫肝硬化病史，患者化疗后可能出现肝功能损伤，肝衰竭，严重者可危及生命，与患者及家属沟通后，患者及家属表示愿意承担化疗风险，予以择期行DDP单药每周同时期化疗。\n- [全程D29] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 今日查房，患者一般情况可，无明显不适主诉，体查同入院。[姓名已隐去]副医生信息已隐藏示：依约开始放疗，嘱患者注意营养与休息。\n- [全程D34] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者已开始行根治性放疗，现放疗2F，昨日完成一程同期化疗，诉额、双侧颞部头痛，一般情况尚可，体查情况基本同前。[姓名已隐去]副医生信息已隐藏：现患者已开始放疗，一程化疗结束，针对患者主诉，考虑放疗引起不良反应，予以止痛等对症处理，病情继观。\n- [全程D39] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现处于放化综合治疗中，放疗3F，无诉，体查情况基本同前，血常规、生化常规结果示：WBC3.33*10E9/L、中性粒1.5*10E9/L；[姓名已隐去]副医生信息已隐藏：现患者血象稍低，明日予以行同期化疗二程，化疗后予以复查血象后再予以升白等对症处理，密观病情。\n- [全程D44] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现处于放化综合治疗中，放疗8F，诉口苦，体查情况基本同前，21号复查血常规、生化常规结果基本正常；[姓名已隐去]副医生信息已隐藏：现患者已完成同期化疗二程，继续放疗，余治疗不变，密观病情。\n- [全程D49] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现处于放化综合治疗中，放疗10F，诉喉咙疼痛，体查情况基本同前，25号血常规、生化常规结果示：WBC2.39*10E9/L、中性粒1.4*10E9/L，今日复查血常规、肝肾功能结果基本正常；[姓名已隐去]副医生信息已隐藏：患者25号血象示2度骨髓抑制，予以升白等对症处理，并于26号予以三程同期化疗，今日复查血象已恢复，继续予以放化综合治疗，密观病情。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 继续按计划行放化综合治疗，并进行静脉导管常规维护。\nB. 暂停放化疗，再次给予粒细胞集落刺激因子（G-CSF）升白治疗。\nC. 暂停同期化疗，仅继续单纯放射治疗，并进行静脉导管常规维护。\nD. 继续按计划行放化综合治疗，并预防性输注单采血小板。\nE. 暂停放化疗，经验性给予广谱静脉抗生素抗感染治疗。\nF. 继续按计划行放化综合治疗，并预防性给予重组人促红素（EPO）治疗。\nG. 继续按计划行放化综合治疗，并拔除静脉留置导管改为口服给药。\nH. 继续按计划行放化综合治疗，但将后续同期化疗剂量减量20%。\nI. 提前结束同期化疗，仅继续完成剩余放射治疗。\nJ. 暂停放化疗，给予保肝降酶药物静脉滴注。\nK. 继续按计划行放化综合治疗，并预防性给予白介素-11（IL-11）治疗。\nL. 继续按计划行放化综合治疗，并加用大剂量静脉糖皮质激素治疗。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、鼻腔。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左颈肿物20天；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物；既往史: 20余年前患“血吸虫”病行脾脏切除术，当地医院检查示“早期肝硬化”，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：37.3℃，P：62次/分，R：20次/分，BP：121/75mmHg,Ht：165cm，Wt：58kg，BSA：1.63m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽左侧顶后壁粘膜稍隆起；左侧颈部II区可扪及1个淋巴结，最大径1×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 左颈肿物20天；现病史: 缘于20天前患者无意中出现左颈肿物，未伴涕血、耳鸣、听力下降、头痛、面麻等不适，某次就诊时间在当地医院行左颈淋巴结穿刺，病理示未见癌，某次就诊时间行鼻咽活检病理示鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物；既往史: 20余年前患“血吸虫”病行脾脏切除术，当地医院检查示“早期肝硬化”，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：37.3℃，P：62次/分，R：20次/分，BP：121/75mmHg,Ht：165cm，Wt：58kg，BSA：1.63m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率62次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽左侧顶后壁粘膜稍隆起；左侧颈部II区可扪及1个淋巴结，最大径1×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D27] 入院记录: 主诉: 确诊鼻咽癌1月余；现病史: 缘于某次就诊时间9月下旬患者无意中出现左颈肿物，未伴涕血、耳鸣、听力下降、头痛、面麻等不适，某次就诊时间在当地医院行左颈淋巴结穿刺，病理示未见癌，某次就诊时间行鼻咽活检病理示分化非角化癌。某次就诊时间日入院予以治疗前相关检查，明确诊断为鼻咽分化非角化癌，[分期信息见历史辅助诊断节点],III期，予以行放疗计划设计，现放疗计划设计完成，入院行放化综合治疗。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物；既往史: 20余年前患“血吸虫”病行脾脏切除术，当地医院检查示“早期肝硬化”，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：37.3℃，P：62次/分，R：20次/分，BP：121/75mmHg,Ht：165cm，Wt：58kg，BSA：1.63m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率62次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽左侧顶后壁粘膜稍隆起；左侧颈部II区可扪及1个淋巴结，最大径1×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 逆钟向转位 正常范围心电图\n- [全程D1] 检验组合: 肌酐(Crea)-静脉血: 56.1umol/L；阴离子间隙(AG)-静脉血: 11.1；α-L-岩藻糖苷酶(AFU)-静脉血: 35.5U/L；凝血酶原时间(PT)-静脉血: 11.7sec.；胱抑素(Cys-C)-静脉血: 0.85mg/L；淋巴细胞百分比(Lymph%)-静脉血: 0.428；骨钙素N端中分子片段(N-MID)-静脉血: 19.3ng/ml；纤维蛋白原(Fbg)-静脉血: 2.07g/L；钠离子(Na+)-静脉血: 140.5mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；总钙(Ca)-静脉血: 2.29mmol/L；乳酸脱氢酶(LDH)-静脉血: 164U/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.44；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.35mmol/L；血小板分布宽度(PDW)-静脉血: 15.9%；平均红细胞血红蛋白含量(MCH)-静脉血: 31.5pg；总胆固醇(TC)-静脉血: 4.12mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；Rh血型-静脉血: 阳性；红细胞比容(Hct)-静脉血: 41.2%；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 9.9umolL；D-二聚体(D-Dimer)-静脉血: 5.09ug/ml；钾离子(K+)-静脉血: 4.24mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.424；直接胆红素(DBIL)-静脉血: 5.8umol/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；天门冬氨酸氨基转移酶(AST)-静脉血: 18.6U/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；透明质酸(HA)-静脉血: 71.337ng/ml；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.5；纤维蛋白原降解产物(FDP)-静脉血:……\n- [全程D2] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双下肺纹理稍粗，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n- [全程D4] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏形态失常，表面凸凹不平，边缘钝，肝实质回声不均匀，明显增强、粗糙，肝内未见明确肿块回声。门静脉主干内径约15mm。肝静脉、门静脉内未见异常回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约14cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏术后缺如。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约35×24×23mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝硬化声像。 脾脏术后缺如。 胆囊、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D7] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 左上颌骨可见片状放射性浓集灶。胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 左上颌骨炎症。 余全身骨骼未见明显异常。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D35] 检验组合: 碱性磷酸酶(ALP)-静脉血: 93.6U/L；丙氨酸氨基转移酶(ALT)-静脉血: 26.3U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.2U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 34.4U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.73；α-L-岩藻糖苷酶(AFU)-静脉血: 38.5U/L；乳酸脱氢酶(LDH)-静脉血: 195.7U/L；总胆汁酸(TBA)-静脉血: 2.9umol/L\n- [全程D39] 检验组合: 胱抑素(Cys-C)-静脉血: 0.84mg/L；肌酐(Crea)-静脉血: 62.7umol/L；阴离子间隙(AG)-静脉血: 11；单核细胞计数(Mono#)-静脉血: 0.510E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.8mmol/L；载脂蛋白B(apoB)-静脉血: 0.81g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.8U/L；平均红细胞体积(MCV)-静脉血: 93.8fL；单核细胞百分比(Mono%)-静脉血: 0.149；C-反应蛋白(CRP)-静脉血: 0.37mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；淋巴细胞百分比(Lymph%)-静脉血: 0.352；有核红细胞百分比(NRBC%)-静脉血: 0；尿素氮(BUN)-静脉血: 7.54mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.17g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 40U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；直接胆红素(DBIL)-静脉血: 6.9umol/L；平均血小板体积(MPV)-静脉血: 9.04fL；红细胞计数(RBC#)-静脉血: 4.2310E12/L；总胆固醇(TC)-静脉血: 4.39mmol/L；总钙(Ca)-静脉血: 2.39mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.21mmolL；丙氨酸氨基转移酶(ALT)-静脉血: 28.6U/L；间接胆红素(IBIL)-静脉血: 11.6umolL；甘油三酯(TG)-静脉血: 0.5mmol/L；尿酸(UA)-静脉血: 332.9umol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32.2pg；中性粒细胞计数(Neut#)-静脉血: 1.510E9/L；总胆红素(TBIL)-静脉血: 18.5umol/L；乳酸脱氢酶(LDH)-静脉血: 145.6U/L；磷(P)-静脉血: 1.34mmol/L；碱性磷酸酶(ALP)-静脉血: 93.2U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0……\n- [全程D42] 检验组合: 红细胞比容(Hct)-静脉血: 38.5%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 335g/L；红细胞计数(RBC#)-静脉血: 4.1110E12/L；平均红细胞体积(MCV)-静脉血: 93.7fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；血小板计数(PLT#)-静脉血: 26910E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；碱性磷酸酶(ALP)-静脉血: 88U/L；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18U/L；中性粒细胞百分比(Neut%)-静脉血: 0.659；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.019；乳酸脱氢酶(LDH)-静脉血: 139.5U/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6；α-L-岩藻糖苷酶(AFU)-静脉血: 41U/L；血小板分布宽度(PDW)-静脉血: 11.5%；中性粒细胞计数(Neut#)-静脉血: 2.110E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 24.4U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；平均红细胞血红蛋白含量(MCH)-静脉血: 31.4pg；总胆汁酸(TBA)-静脉血: 1umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 33.2U/L；平均血小板体积(MPV)-静脉血: 10.3fL；白细胞计数(WBC#)-静脉血: 3.1410E9/L；大血小板百分比(P-LCR%)-静脉血: 26.3%；单核细胞计数(Mono#)-静脉血: 0.410E9/L；血红蛋白(Hb)-静脉血: 129g/L；单核细胞百分比(Mono%)-静脉血: 0.134；血小板比容-静脉血: 28%；淋巴细胞百分比(Lymph%)-静脉血: 0.185；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43\n- [全程D46] 检验组合: 平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；C-反应蛋白(CRP)-静脉血: 0.38mg/L；γ-谷氨酰基转移酶(GGT)-静脉血: 34.2U/L；尿酸(UA)-静脉血: 292.5umol/L；红细胞计数(RBC#)-静脉血: 4.0510E12/L；总蛋白(TP)-静脉血: 70.3g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞计数(Neut#)-静脉血: 1.410E9/L；磷(P)-静脉血: 1.21mmol/L；总胆固醇(TC)-静脉血: 3.73mmol/L；单核细胞百分比(Mono%)-静脉血: 0.167；总钙(Ca)-静脉血: 2.2mmol/L；胱抑素(Cys-C)-静脉血: 0.68mg/L；葡萄糖(Glu)-静脉血: 4.54mmol/L；白细胞计数(WBC#)-静脉血: 2.3910E9/L；载脂蛋白B(apoB)-静脉血: 0.82g/L；直接胆红素(DBIL)-静脉血: 4.6umol/L；镁离子(Mg2+)-静脉血: 0.76mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.89；氯离子(Cl-)-静脉血: 100.1mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.197；肌酐(Crea)-静脉血: 56.4umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；血小板比容-静脉血: 22%；碱性磷酸酶(ALP)-静脉血: 81.9U/L；钾离子(K+)-静脉血: 4.1mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.1；球蛋白(GLO)-静脉血: 29.4g/L；总胆汁酸(TBA)-静脉血: 1.4umol/L；尿素氮(BUN)-静脉血: 6.3mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.4pg；天门冬氨酸氨基转移酶(AST)-静脉血: 17.1U/L；血小板计数(PLT#)-静脉血: 21610E9/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.09g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；钠离子(Na+)-静脉血: 138.5mmol/L；淋巴细胞计数(Lymph#)……\n- [全程D49] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；白细胞计数(WBC#)-静脉血: 28.910E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0；平均红细胞体积(MCV)-静脉血: 96.4fL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.77；α-L-岩藻糖苷酶(AFU)-静脉血: 37.1U/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.003；平均血小板体积(MPV)-静脉血: 8.48fL；血小板计数(PLT#)-静脉血: 16710E9/L；红细胞计数(RBC#)-静脉血: 3.9610E12/L；碱性磷酸酶(ALP)-静脉血: 119.8U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32.2pg；中性粒细胞百分比(Neut%)-静脉血: 0.933；血小板分布宽度(PDW)-静脉血: 15.7%；血小板比容-静脉血: 14.1%；中性粒细胞计数(Neut#)-静脉血: 2710E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 13.5U/L；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；红细胞比容(Hct)-静脉血: 38.2%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 334.1g/L；总胆汁酸(TBA)-静脉血: 1.5umol/L；单核细胞百分比(Mono%)-静脉血: 0.035；单核细胞计数(Mono#)-静脉血: 110E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 17.5U/L；血红蛋白(Hb)-静脉血: 127.7g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.028；乳酸脱氢酶(LDH)-静脉血: 177U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 34.4U/L\n- [全程D53] 检验组合: 总胆固醇(TC)-静脉血: 4.04mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 17.7U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.8；血小板计数(PLT#)-静脉血: 199.710E9/L；镁离子(Mg2+)-静脉血: 0.73mmol/L；红细胞比容(Hct)-静脉血: 38.2%；总蛋白(TP)-静脉血: 70.35g/L；载脂蛋白B(apoB)-静脉血: 0.83g/L；尿酸(UA)-静脉血: 359.2umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.133；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.6；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；血小板分布宽度(PDW)-静脉血: 15.6%；中性粒细胞百分比(Neut%)-静脉血: 0.671；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；球蛋白(GLO)-静脉血: 26.85g/L；氯离子(Cl-)-静脉血: 102.6mmol/L；肌酐(Crea)-静脉血: 59umol/L；平均红细胞体积(MCV)-静脉血: 95.9fL；血小板比容-静脉血: 16.6%；红细胞计数(RBC#)-静脉血: 3.9810E12/L；C-反应蛋白(CRP)-静脉血: 0.91mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.69mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 337.3g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.11mmolL；白蛋白(ALB)-静脉血: 43.5g/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32.3pg；白细胞计数(WBC#)-静脉血: 3.9610E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 38U/L；甘油三酯(TG)-静脉血: 0.67mmol/L；平均血小板体积(MPV)-静脉血: 8.31fL；葡萄糖(Glu)-静脉血: 4.61mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.6%；单核细胞百分比(Mono%)-静脉血: 0.143；总钙(Ca)-静脉血: 2.28mmol/L；血……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D28] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者今日返院，一般情况可，无明显不适主诉，体查情况基本同前，患者现放疗计划已设计完成并通过全科会诊，NPDT70Gy/30F,CTV1:60Gy/30F,CTV2：54Gy/30F，靶区剂量分布均匀，正常组织剂量在可接受范围内。[姓名已隐去]副医生信息已隐藏，患者放疗计划设计完成，可行放疗前复位及验证等准备，开始放疗，患者既往血吸虫肝硬化病史，患者化疗后可能出现肝功能损伤，肝衰竭，严重者可危及生命，与患者及家属沟通后，患者及家属表示愿意承担化疗风险，予以择期行DDP单药每周同时期化疗。\n- [全程D29] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 今日查房，患者一般情况可，无明显不适主诉，体查同入院。[姓名已隐去]副医生信息已隐藏示：依约开始放疗，嘱患者注意营养与休息。\n- [全程D34] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者已开始行根治性放疗，现放疗2F，昨日完成一程同期化疗，诉额、双侧颞部头痛，一般情况尚可，体查情况基本同前。[姓名已隐去]副医生信息已隐藏：现患者已开始放疗，一程化疗结束，针对患者主诉，考虑放疗引起不良反应，予以止痛等对症处理，病情继观。\n- [全程D39] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现处于放化综合治疗中，放疗3F，无诉，体查情况基本同前，血常规、生化常规结果示：WBC3.33*10E9/L、中性粒1.5*10E9/L；[姓名已隐去]副医生信息已隐藏：现患者血象稍低，明日予以行同期化疗二程，化疗后予以复查血象后再予以升白等对症处理，密观病情。\n- [全程D44] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现处于放化综合治疗中，放疗8F，诉口苦，体查情况基本同前，21号复查血常规、生化常规结果基本正常；[姓名已隐去]副医生信息已隐藏：现患者已完成同期化疗二程，继续放疗，余治疗不变，密观病情。\n- [全程D49] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现处于放化综合治疗中，放疗10F，诉喉咙疼痛，体查情况基本同前，25号血常规、生化常规结果示：WBC2.39*10E9/L、中性粒1.4*10E9/L，今日复查血常规、肝肾功能结果基本正常；[姓名已隐去]副医生信息已隐藏：患者25号血象示2度骨髓抑制，予以升白等对症处理，并于26号予以三程同期化疗，今日复查血象已恢复，继续予以放化综合治疗，密观病情。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 继续按计划行放化综合治疗，并进行静脉导管常规维护。\nB. 暂停放化疗，再次给予粒细胞集落刺激因子（G-CSF）升白治疗。\nC. 暂停同期化疗，仅继续单纯放射治疗，并进行静脉导管常规维护。\nD. 继续按计划行放化综合治疗，并预防性输注单采血小板。\nE. 暂停放化疗，经验性给予广谱静脉抗生素抗感染治疗。\nF. 继续按计划行放化综合治疗，并预防性给予重组人促红素（EPO）治疗。\nG. 继续按计划行放化综合治疗，并拔除静脉留置导管改为口服给药。\nH. 继续按计划行放化综合治疗，但将后续同期化疗剂量减量20%。\nI. 提前结束同期化疗，仅继续完成剩余放射治疗。\nJ. 暂停放化疗，给予保肝降酶药物静脉滴注。\nK. 继续按计划行放化综合治疗，并预防性给予白介素-11（IL-11）治疗。\nL. 继续按计划行放化综合治疗，并加用大剂量静脉糖皮质激素治疗。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-46fc2f7bd9dd0872ef1b356e","patient_id":"patient-36d433557e63f939b878347d","turn_id":"turn02","turn_position":1,"turn_type":"imaging_release_workup","gold_letter":"E","gold_action":"行鼻咽镜下肿物活检以明确病理诊断；当前影像学评估为 cT4N2M0","options":[{"letter":"A","text":"行鼻咽镜下肿物活检；影像学评估为 cT3N2M0","is_gold":false},{"letter":"B","text":"行鼻咽镜下肿物活检；影像学评估为 cT4N1M0","is_gold":false},{"letter":"C","text":"行颈部淋巴结穿刺活检；影像学评估为 cT4N2M0","is_gold":false},{"letter":"D","text":"完善血浆EBV-DNA检测；影像学评估为 cT4N2M0","is_gold":false},{"letter":"E","text":"行鼻咽镜下肿物活检；影像学评估为 cT4N2M0","is_gold":true},{"letter":"F","text":"安排诱导化疗联合根治性放疗；影像学评估为 cT4N2M0","is_gold":false},{"letter":"G","text":"行鼻咽镜下肿物活检；影像学评估为 cT4N3M0","is_gold":false},{"letter":"H","text":"行鼻咽镜下肿物活检；影像学评估为 cT3N1M0","is_gold":false},{"letter":"I","text":"行全身PET-CT检查；影像学评估为 cT4N2M0","is_gold":false},{"letter":"J","text":"行鼻咽镜下肿物活检；影像学评估为 cT2N2M0","is_gold":false},{"letter":"K","text":"行鼻咽镜下肿物活检；影像学评估为 cT4N0M0","is_gold":false},{"letter":"L","text":"行鼻咽镜下肿物活检；影像学评估为 cT1N2M0","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、海绵窦、翼突基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1078] 入院记录: 主诉: 外院可疑鼻咽癌；现病史: 简要入院病史:患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n- [全程D1081] 入院记录: 主诉: 回吸性涕血3月余；现病史: 患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：70次/分，R：14次/分，BP：126/71mmHg,Ht：155cm，Wt：48kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左颈Ⅱ区触及肿大淋巴结，约2×1.5cm，无融合，质地硬，边界尚清，活动度中等，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- [全程D1078] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 Ⅱ、Ⅲ、aVF、V4～V6导联ST段下移\n- [全程D1078] 检验组合: 镁离子(Mg2+)-静脉血: 0.96mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.6；Rh血型-静脉血: 阳性；直接胆红素(DBIL)-静脉血: 2umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.61COI；白蛋白(ALB)-静脉血: 45.5g/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 0.085COI；γ-谷氨酰基转移酶(GGT)-静脉血: 13.6U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.2fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；葡萄糖(Glu)-静脉血: 4.67mmol/L；总胆红素(TBIL)-静脉血: 8.3umol/L；单核细胞百分比(Mono%)-静脉血: 0.074；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.5U/L；红细胞比容(Hct)-静脉血: 41%；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 1.56COI；单核细胞计数(Mono#)-静脉血: 0.310E9/L；中性粒细胞计数(Neut#)-静脉血: 2.510E9/L；胱抑素(Cys-C)-静脉血: 0.84mg/L；碱性磷酸酶(ALP)-静脉血: 80.5U/L；钠离子(Na+)-静脉血: 143.8mmol/L；乳酸脱氢酶(LDH)-静脉血: 194.4U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；平均红细胞血红蛋白浓度(MCHC)-静脉血: 324g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21.7U/L；氯离子(Cl-)-静脉血: 105.2mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.74；平均红细胞体积(MCV)-静脉血: 92.8fL；C-反应蛋白(CRP)-静脉血: 1.78mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.4；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: >1000IU/L；总胆固醇(TC)-静脉血: 5.98mmol/L；血红蛋白(Hb)-静脉血: 133g/L；大血小板百分比(P-LCR%)-静脉血: 26.1%；间接胆红素(I……\n- [全程D1079] 检验组合: 梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）\n- [全程D1081] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 多个颈腰椎、双侧膝关节可见片状放射性浓集灶。余颅骨、胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 考虑多个颈腰椎、双侧膝关节骨质退行性变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行鼻咽镜下肿物活检；影像学评估为 cT3N2M0\nB. 行鼻咽镜下肿物活检；影像学评估为 cT4N1M0\nC. 行颈部淋巴结穿刺活检；影像学评估为 cT4N2M0\nD. 完善血浆EBV-DNA检测；影像学评估为 cT4N2M0\nE. 行鼻咽镜下肿物活检；影像学评估为 cT4N2M0\nF. 安排诱导化疗联合根治性放疗；影像学评估为 cT4N2M0\nG. 行鼻咽镜下肿物活检；影像学评估为 cT4N3M0\nH. 行鼻咽镜下肿物活检；影像学评估为 cT3N1M0\nI. 行全身PET-CT检查；影像学评估为 cT4N2M0\nJ. 行鼻咽镜下肿物活检；影像学评估为 cT2N2M0\nK. 行鼻咽镜下肿物活检；影像学评估为 cT4N0M0\nL. 行鼻咽镜下肿物活检；影像学评估为 cT1N2M0\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、海绵窦、翼突基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1078] 入院记录: 主诉: 外院可疑鼻咽癌；现病史: 简要入院病史:患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n- [全程D1081] 入院记录: 主诉: 回吸性涕血3月余；现病史: 患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：70次/分，R：14次/分，BP：126/71mmHg,Ht：155cm，Wt：48kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左颈Ⅱ区触及肿大淋巴结，约2×1.5cm，无融合，质地硬，边界尚清，活动度中等，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- [全程D1078] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 Ⅱ、Ⅲ、aVF、V4～V6导联ST段下移\n- [全程D1078] 检验组合: 镁离子(Mg2+)-静脉血: 0.96mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.6；Rh血型-静脉血: 阳性；直接胆红素(DBIL)-静脉血: 2umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.61COI；白蛋白(ALB)-静脉血: 45.5g/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 0.085COI；γ-谷氨酰基转移酶(GGT)-静脉血: 13.6U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.2fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；葡萄糖(Glu)-静脉血: 4.67mmol/L；总胆红素(TBIL)-静脉血: 8.3umol/L；单核细胞百分比(Mono%)-静脉血: 0.074；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.5U/L；红细胞比容(Hct)-静脉血: 41%；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 1.56COI；单核细胞计数(Mono#)-静脉血: 0.310E9/L；中性粒细胞计数(Neut#)-静脉血: 2.510E9/L；胱抑素(Cys-C)-静脉血: 0.84mg/L；碱性磷酸酶(ALP)-静脉血: 80.5U/L；钠离子(Na+)-静脉血: 143.8mmol/L；乳酸脱氢酶(LDH)-静脉血: 194.4U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；平均红细胞血红蛋白浓度(MCHC)-静脉血: 324g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21.7U/L；氯离子(Cl-)-静脉血: 105.2mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.74；平均红细胞体积(MCV)-静脉血: 92.8fL；C-反应蛋白(CRP)-静脉血: 1.78mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.4；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: >1000IU/L；总胆固醇(TC)-静脉血: 5.98mmol/L；血红蛋白(Hb)-静脉血: 133g/L；大血小板百分比(P-LCR%)-静脉血: 26.1%；间接胆红素(I……\n- [全程D1079] 检验组合: 梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）\n- [全程D1081] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 多个颈腰椎、双侧膝关节可见片状放射性浓集灶。余颅骨、胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 考虑多个颈腰椎、双侧膝关节骨质退行性变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行鼻咽镜下肿物活检；影像学评估为 cT3N2M0\nB. 行鼻咽镜下肿物活检；影像学评估为 cT4N1M0\nC. 行颈部淋巴结穿刺活检；影像学评估为 cT4N2M0\nD. 完善血浆EBV-DNA检测；影像学评估为 cT4N2M0\nE. 行鼻咽镜下肿物活检；影像学评估为 cT4N2M0\nF. 安排诱导化疗联合根治性放疗；影像学评估为 cT4N2M0\nG. 行鼻咽镜下肿物活检；影像学评估为 cT4N3M0\nH. 行鼻咽镜下肿物活检；影像学评估为 cT3N1M0\nI. 行全身PET-CT检查；影像学评估为 cT4N2M0\nJ. 行鼻咽镜下肿物活检；影像学评估为 cT2N2M0\nK. 行鼻咽镜下肿物活检；影像学评估为 cT4N0M0\nL. 行鼻咽镜下肿物活检；影像学评估为 cT1N2M0\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-7c52866e0776802e0c94516f","patient_id":"patient-36d433557e63f939b878347d","turn_id":"turn04","turn_position":2,"turn_type":"initial_treatment_selection","gold_letter":"G","gold_action":"完善头颈部MRI及全身分期检查，若评估为局部晚期，行诱导化疗序贯同步放化疗","options":[{"letter":"A","text":"暂缓影像学分期检查，直接启动根治性同步放化疗","is_gold":false},{"letter":"B","text":"完善头颈部MRI及全身分期检查，若评估为局部晚期，行单纯根治性放疗","is_gold":false},{"letter":"C","text":"完善头颈部MRI及全身分期检查，若评估为局部晚期，行诱导化疗序贯单纯根治性放疗","is_gold":false},{"letter":"D","text":"完善头颈部MRI及全身分期检查，若评估为局部晚期，行根治性手术切除序贯术后放疗","is_gold":false},{"letter":"E","text":"完善头颈部增强CT及全身分期检查，若评估为局部晚期，行诱导化疗序贯同步放化疗","is_gold":false},{"letter":"F","text":"完善头颈部MRI及全身分期检查，若评估为早期（I期），行诱导化疗序贯同步放化疗","is_gold":false},{"letter":"G","text":"完善头颈部MRI及全身分期检查，若评估为局部晚期，行诱导化疗序贯同步放化疗","is_gold":true},{"letter":"H","text":"完善头颈部MRI及全身分期检查，无论分期结果，均行诱导化疗序贯同步放化疗","is_gold":false},{"letter":"I","text":"仅行全身PET-CT替代所有常规分期检查，若评估为局部晚期，行诱导化疗序贯同步放化疗","is_gold":false},{"letter":"J","text":"完善头颈部MRI及全身分期检查，若评估为局部晚期，行抗EGFR单抗靶向治疗替代放疗","is_gold":false},{"letter":"K","text":"完善头颈部MRI及全身分期检查，若评估为局部晚期，行PD-1抑制剂单药根治性治疗","is_gold":false},{"letter":"L","text":"完善头颈部MRI及全身分期检查，若评估为局部晚期，行姑息性化疗联合最佳支持治疗","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、海绵窦、翼突基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1078] 入院记录: 主诉: 外院可疑鼻咽癌；现病史: 简要入院病史:患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n- [全程D1081] 入院记录: 主诉: 回吸性涕血3月余；现病史: 患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：70次/分，R：14次/分，BP：126/71mmHg,Ht：155cm，Wt：48kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左颈Ⅱ区触及肿大淋巴结，约2×1.5cm，无融合，质地硬，边界尚清，活动度中等，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS:；ECOG:\n- [全程D1078] 入院记录: 主诉: 外院可疑鼻咽癌；现病史: 简要入院病史:患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。某次就诊时间再次出现回吸性涕血，遂行鼻咽镜检查，活检示：鼻咽炎性渗出。行鼻咽部CT示：鼻咽左侧可见软组织占位。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- [全程D1078] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 Ⅱ、Ⅲ、aVF、V4～V6导联ST段下移\n- [全程D1078] 检验组合: 镁离子(Mg2+)-静脉血: 0.96mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.6；Rh血型-静脉血: 阳性；直接胆红素(DBIL)-静脉血: 2umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.61COI；白蛋白(ALB)-静脉血: 45.5g/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 0.085COI；γ-谷氨酰基转移酶(GGT)-静脉血: 13.6U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.2fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；葡萄糖(Glu)-静脉血: 4.67mmol/L；总胆红素(TBIL)-静脉血: 8.3umol/L；单核细胞百分比(Mono%)-静脉血: 0.074；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.5U/L；红细胞比容(Hct)-静脉血: 41%；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 1.56COI；单核细胞计数(Mono#)-静脉血: 0.310E9/L；中性粒细胞计数(Neut#)-静脉血: 2.510E9/L；胱抑素(Cys-C)-静脉血: 0.84mg/L；碱性磷酸酶(ALP)-静脉血: 80.5U/L；钠离子(Na+)-静脉血: 143.8mmol/L；乳酸脱氢酶(LDH)-静脉血: 194.4U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；平均红细胞血红蛋白浓度(MCHC)-静脉血: 324g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21.7U/L；氯离子(Cl-)-静脉血: 105.2mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.74；平均红细胞体积(MCV)-静脉血: 92.8fL；C-反应蛋白(CRP)-静脉血: 1.78mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.4；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: >1000IU/L；总胆固醇(TC)-静脉血: 5.98mmol/L；血红蛋白(Hb)-静脉血: 133g/L；大血小板百分比(P-LCR%)-静脉血: 26.1%；间接胆红素(I……\n- [全程D1079] 检验组合: 梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）\n- [全程D1081] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 多个颈腰椎、双侧膝关节可见片状放射性浓集灶。余颅骨、胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 考虑多个颈腰椎、双侧膝关节骨质退行性变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂缓影像学分期检查，直接启动根治性同步放化疗\nB. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行单纯根治性放疗\nC. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行诱导化疗序贯单纯根治性放疗\nD. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行根治性手术切除序贯术后放疗\nE. 完善头颈部增强CT及全身分期检查，若评估为局部晚期，行诱导化疗序贯同步放化疗\nF. 完善头颈部MRI及全身分期检查，若评估为早期（I期），行诱导化疗序贯同步放化疗\nG. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行诱导化疗序贯同步放化疗\nH. 完善头颈部MRI及全身分期检查，无论分期结果，均行诱导化疗序贯同步放化疗\nI. 仅行全身PET-CT替代所有常规分期检查，若评估为局部晚期，行诱导化疗序贯同步放化疗\nJ. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行抗EGFR单抗靶向治疗替代放疗\nK. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行PD-1抑制剂单药根治性治疗\nL. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行姑息性化疗联合最佳支持治疗\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、海绵窦、翼突基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1078] 入院记录: 主诉: 外院可疑鼻咽癌；现病史: 简要入院病史:患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n- [全程D1081] 入院记录: 主诉: 回吸性涕血3月余；现病史: 患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：70次/分，R：14次/分，BP：126/71mmHg,Ht：155cm，Wt：48kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左颈Ⅱ区触及肿大淋巴结，约2×1.5cm，无融合，质地硬，边界尚清，活动度中等，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS:；ECOG:\n- [全程D1078] 入院记录: 主诉: 外院可疑鼻咽癌；现病史: 简要入院病史:患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。某次就诊时间再次出现回吸性涕血，遂行鼻咽镜检查，活检示：鼻咽炎性渗出。行鼻咽部CT示：鼻咽左侧可见软组织占位。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- [全程D1078] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 Ⅱ、Ⅲ、aVF、V4～V6导联ST段下移\n- [全程D1078] 检验组合: 镁离子(Mg2+)-静脉血: 0.96mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.6；Rh血型-静脉血: 阳性；直接胆红素(DBIL)-静脉血: 2umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.61COI；白蛋白(ALB)-静脉血: 45.5g/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 0.085COI；γ-谷氨酰基转移酶(GGT)-静脉血: 13.6U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.2fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；葡萄糖(Glu)-静脉血: 4.67mmol/L；总胆红素(TBIL)-静脉血: 8.3umol/L；单核细胞百分比(Mono%)-静脉血: 0.074；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.5U/L；红细胞比容(Hct)-静脉血: 41%；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 1.56COI；单核细胞计数(Mono#)-静脉血: 0.310E9/L；中性粒细胞计数(Neut#)-静脉血: 2.510E9/L；胱抑素(Cys-C)-静脉血: 0.84mg/L；碱性磷酸酶(ALP)-静脉血: 80.5U/L；钠离子(Na+)-静脉血: 143.8mmol/L；乳酸脱氢酶(LDH)-静脉血: 194.4U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；平均红细胞血红蛋白浓度(MCHC)-静脉血: 324g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21.7U/L；氯离子(Cl-)-静脉血: 105.2mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.74；平均红细胞体积(MCV)-静脉血: 92.8fL；C-反应蛋白(CRP)-静脉血: 1.78mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.4；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: >1000IU/L；总胆固醇(TC)-静脉血: 5.98mmol/L；血红蛋白(Hb)-静脉血: 133g/L；大血小板百分比(P-LCR%)-静脉血: 26.1%；间接胆红素(I……\n- [全程D1079] 检验组合: 梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）\n- [全程D1081] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 多个颈腰椎、双侧膝关节可见片状放射性浓集灶。余颅骨、胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 考虑多个颈腰椎、双侧膝关节骨质退行性变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂缓影像学分期检查，直接启动根治性同步放化疗\nB. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行单纯根治性放疗\nC. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行诱导化疗序贯单纯根治性放疗\nD. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行根治性手术切除序贯术后放疗\nE. 完善头颈部增强CT及全身分期检查，若评估为局部晚期，行诱导化疗序贯同步放化疗\nF. 完善头颈部MRI及全身分期检查，若评估为早期（I期），行诱导化疗序贯同步放化疗\nG. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行诱导化疗序贯同步放化疗\nH. 完善头颈部MRI及全身分期检查，无论分期结果，均行诱导化疗序贯同步放化疗\nI. 仅行全身PET-CT替代所有常规分期检查，若评估为局部晚期，行诱导化疗序贯同步放化疗\nJ. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行抗EGFR单抗靶向治疗替代放疗\nK. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行PD-1抑制剂单药根治性治疗\nL. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行姑息性化疗联合最佳支持治疗\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-ce21ad4c82d0349356f5fbb9","patient_id":"patient-36d433557e63f939b878347d","turn_id":"turn05","turn_position":3,"turn_type":"toxicity_or_support_decision","gold_letter":"H","gold_action":"给予口服保肝药物（如复方甘草酸苷、葡醛内酯），按原计划执行顺铂同期化疗，并动态复查肝功能。","options":[{"letter":"A","text":"暂停同期化疗，给予静脉保肝药物治疗，待转氨酶降至正常后再启动顺铂化疗","is_gold":false},{"letter":"B","text":"按原计划执行顺铂同期化疗，暂不予特殊保肝处理，常规监测肝功能","is_gold":false},{"letter":"C","text":"给予口服保肝药物，将顺铂剂量下调20%后执行同期化疗","is_gold":false},{"letter":"D","text":"给予静脉双重保肝药物，按原计划执行顺铂同期化疗，并动态复查肝功能","is_gold":false},{"letter":"E","text":"停用顺铂，更改为卡铂方案执行同期化疗，并给予口服保肝药物","is_gold":false},{"letter":"F","text":"给予口服保肝药物，推迟顺铂化疗1周，期间正常进行放疗","is_gold":false},{"letter":"G","text":"停用顺铂，更改为西妥昔单抗靶向治疗联合放疗，并给予口服保肝药物","is_gold":false},{"letter":"H","text":"给予口服保肝药物（如复方甘草酸苷、葡醛内酯），按原计划执行顺铂同期化疗，并动态复查肝功能","is_gold":true},{"letter":"I","text":"暂停放化疗，行腹部增强CT排查肝脏转移，并给予静脉保肝治疗","is_gold":false},{"letter":"J","text":"给予口服保肝药物，按原计划执行顺铂同期化疗，并预防性使用重组人粒细胞刺激因子","is_gold":false},{"letter":"K","text":"给予口服保肝药物，按原计划执行顺铂同期化疗，并预防性使用广谱抗生素","is_gold":false},{"letter":"L","text":"给予口服保肝药物，将顺铂方案更改为奈达铂方案执行同期化疗","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、海绵窦、翼突基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1078] 入院记录: 主诉: 外院可疑鼻咽癌；现病史: 简要入院病史:患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n- [全程D1081] 入院记录: 主诉: 回吸性涕血3月余；现病史: 患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：70次/分，R：14次/分，BP：126/71mmHg,Ht：155cm，Wt：48kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左颈Ⅱ区触及肿大淋巴结，约2×1.5cm，无融合，质地硬，边界尚清，活动度中等，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS:；ECOG:\n- [全程D1078] 入院记录: 主诉: 外院可疑鼻咽癌；现病史: 简要入院病史:患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。某次就诊时间再次出现回吸性涕血，遂行鼻咽镜检查，活检示：鼻咽炎性渗出。行鼻咽部CT示：鼻咽左侧可见软组织占位。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n- [全程D1081] 入院记录: 主诉: 回吸性涕血3月余；现病史: 患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。某次就诊时间再次出现回吸性涕血，遂行鼻咽镜检查，活检示：鼻咽炎性渗出。行鼻咽部CT示：鼻咽左侧可见软组织占位。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：70次/分，R：14次/分，BP：126/71mmHg,Ht：155cm，Wt：48kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率70次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左颈Ⅱ区触及肿大淋巴结，约2×1.5cm，无融合，质地硬，边界尚清，活动度中等，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- [全程D1078] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 Ⅱ、Ⅲ、aVF、V4～V6导联ST段下移\n- [全程D1078] 检验组合: 镁离子(Mg2+)-静脉血: 0.96mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.6；Rh血型-静脉血: 阳性；直接胆红素(DBIL)-静脉血: 2umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.61COI；白蛋白(ALB)-静脉血: 45.5g/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 0.085COI；γ-谷氨酰基转移酶(GGT)-静脉血: 13.6U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.2fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；葡萄糖(Glu)-静脉血: 4.67mmol/L；总胆红素(TBIL)-静脉血: 8.3umol/L；单核细胞百分比(Mono%)-静脉血: 0.074；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.5U/L；红细胞比容(Hct)-静脉血: 41%；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 1.56COI；单核细胞计数(Mono#)-静脉血: 0.310E9/L；中性粒细胞计数(Neut#)-静脉血: 2.510E9/L；胱抑素(Cys-C)-静脉血: 0.84mg/L；碱性磷酸酶(ALP)-静脉血: 80.5U/L；钠离子(Na+)-静脉血: 143.8mmol/L；乳酸脱氢酶(LDH)-静脉血: 194.4U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；平均红细胞血红蛋白浓度(MCHC)-静脉血: 324g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21.7U/L；氯离子(Cl-)-静脉血: 105.2mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.74；平均红细胞体积(MCV)-静脉血: 92.8fL；C-反应蛋白(CRP)-静脉血: 1.78mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.4；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: >1000IU/L；总胆固醇(TC)-静脉血: 5.98mmol/L；血红蛋白(Hb)-静脉血: 133g/L；大血小板百分比(P-LCR%)-静脉血: 26.1%；间接胆红素(I……\n- [全程D1079] 检验组合: 梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）\n- [全程D1081] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 多个颈腰椎、双侧膝关节可见片状放射性浓集灶。余颅骨、胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 考虑多个颈腰椎、双侧膝关节骨质退行性变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1092] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.006；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；颜色-尿液: 无色；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮\n- [全程D1094] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 28/μL；比重(SG)-尿液: 1.025；葡萄糖(Glu)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 36/μL；白细胞计数(WBC#)-尿液: 5/μL；酸碱度(pH)-尿液: 6.5；颜色-尿液: Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D1095] 检验组合: 白蛋白(ALB)-静脉血: 40.5g/L；镁离子(Mg2+)-静脉血: 0.84mmol/L；碱性磷酸酶(ALP)-静脉血: 63.2U/L；载脂蛋白B(apoB)-静脉血: 0.8g/L；葡萄糖(Glu)-静脉血: 5.31mmol/L；血小板比容-静脉血: 19%；直接胆红素(DBIL)-静脉血: 2.3umol/L；载脂蛋白AI(apoAI)-静脉血: 1.4g/L；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；总胆固醇(TC)-静脉血: 5.3mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.69mmolL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 325g/L；红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.9pg；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；γ-谷氨酰基转移酶(GGT)-静脉血: 16.8U/L；间接胆红素(IBIL)-静脉血: 5.6umolL；红细胞比容(Hct)-静脉血: 37.2%；钠离子(Na+)-静脉血: 141.6mmol/L；尿酸(UA)-静脉血: 219.2umol/L；总钙(Ca)-静脉血: 2.16mmol/L；尿素氮(BUN)-静脉血: 4.72mmol/L；平均红细胞体积(MCV)-静脉血: 91.9fL；球蛋白(GLO)-静脉血: 22.71g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.1；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14；乳酸脱氢酶(LDH)-静脉血: 179.4U/L；总胆红素(TBIL)-静脉血: 7.9umol/L；阴离子间隙(AG)-静脉血: 12；中性粒细胞百分比(Neut%)-静脉血: 0.814；血红蛋白(Hb)-静脉血: 121g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.1；丙氨酸氨基转移酶(ALT)-静脉血: 55.1U/L；白细胞计数(WBC#)-静脉血: 6.1210E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 36.2U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.58mmol/L；胱抑素(Cys-C)-静脉血: 0.95mg/L；大血小板……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1082] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者目前诊断明确，[计划性表述已隐藏]根治性放疗及同期化疗。向患者及其家属交代病情，治疗方案及治疗风险，做好治疗前准备工作。\n- [全程D1083] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者入院第三天，无明显不适主诉，查体情况：一般情况可，余同入院。预约放疗。\n- [全程D1088] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 今日查房，患者无明显不适主诉，生命体征平稳。已予预约放疗。候治疗。\n- [全程D1093] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 今日查房，患者无明显不适主诉，生命体征平稳。查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常。患者现放疗计划已设计完成并通过全科会诊，靶区剂量分布均匀，正常组织剂量在可接受范围内。[姓名已隐去]医生信息已隐藏示：患者无明显放化疗禁忌症，拟于今日开始行根治性放疗+同时期化疗。向患者及其家属交代病情及化疗风险，表示理解并已签署知情同意书，可于今日执行第1程顺铂方案同时期化疗，注意化疗不良反应。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停同期化疗，给予静脉保肝药物治疗，待转氨酶降至正常后再启动顺铂化疗\nB. 按原计划执行顺铂同期化疗，暂不予特殊保肝处理，常规监测肝功能\nC. 给予口服保肝药物，将顺铂剂量下调20%后执行同期化疗\nD. 给予静脉双重保肝药物，按原计划执行顺铂同期化疗，并动态复查肝功能\nE. 停用顺铂，更改为卡铂方案执行同期化疗，并给予口服保肝药物\nF. 给予口服保肝药物，推迟顺铂化疗1周，期间正常进行放疗\nG. 停用顺铂，更改为西妥昔单抗靶向治疗联合放疗，并给予口服保肝药物\nH. 给予口服保肝药物（如复方甘草酸苷、葡醛内酯），按原计划执行顺铂同期化疗，并动态复查肝功能\nI. 暂停放化疗，行腹部增强CT排查肝脏转移，并给予静脉保肝治疗\nJ. 给予口服保肝药物，按原计划执行顺铂同期化疗，并预防性使用重组人粒细胞刺激因子\nK. 给予口服保肝药物，按原计划执行顺铂同期化疗，并预防性使用广谱抗生素\nL. 给予口服保肝药物，将顺铂方案更改为奈达铂方案执行同期化疗\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、海绵窦、翼突基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1078] 入院记录: 主诉: 外院可疑鼻咽癌；现病史: 简要入院病史:患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n- [全程D1081] 入院记录: 主诉: 回吸性涕血3月余；现病史: 患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：70次/分，R：14次/分，BP：126/71mmHg,Ht：155cm，Wt：48kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左颈Ⅱ区触及肿大淋巴结，约2×1.5cm，无融合，质地硬，边界尚清，活动度中等，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS:；ECOG:\n- [全程D1078] 入院记录: 主诉: 外院可疑鼻咽癌；现病史: 简要入院病史:患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。某次就诊时间再次出现回吸性涕血，遂行鼻咽镜检查，活检示：鼻咽炎性渗出。行鼻咽部CT示：鼻咽左侧可见软组织占位。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n- [全程D1081] 入院记录: 主诉: 回吸性涕血3月余；现病史: 患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。某次就诊时间再次出现回吸性涕血，遂行鼻咽镜检查，活检示：鼻咽炎性渗出。行鼻咽部CT示：鼻咽左侧可见软组织占位。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：70次/分，R：14次/分，BP：126/71mmHg,Ht：155cm，Wt：48kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率70次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左颈Ⅱ区触及肿大淋巴结，约2×1.5cm，无融合，质地硬，边界尚清，活动度中等，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- [全程D1078] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 Ⅱ、Ⅲ、aVF、V4～V6导联ST段下移\n- [全程D1078] 检验组合: 镁离子(Mg2+)-静脉血: 0.96mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.6；Rh血型-静脉血: 阳性；直接胆红素(DBIL)-静脉血: 2umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.61COI；白蛋白(ALB)-静脉血: 45.5g/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 0.085COI；γ-谷氨酰基转移酶(GGT)-静脉血: 13.6U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.2fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；葡萄糖(Glu)-静脉血: 4.67mmol/L；总胆红素(TBIL)-静脉血: 8.3umol/L；单核细胞百分比(Mono%)-静脉血: 0.074；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.5U/L；红细胞比容(Hct)-静脉血: 41%；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 1.56COI；单核细胞计数(Mono#)-静脉血: 0.310E9/L；中性粒细胞计数(Neut#)-静脉血: 2.510E9/L；胱抑素(Cys-C)-静脉血: 0.84mg/L；碱性磷酸酶(ALP)-静脉血: 80.5U/L；钠离子(Na+)-静脉血: 143.8mmol/L；乳酸脱氢酶(LDH)-静脉血: 194.4U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；平均红细胞血红蛋白浓度(MCHC)-静脉血: 324g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21.7U/L；氯离子(Cl-)-静脉血: 105.2mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.74；平均红细胞体积(MCV)-静脉血: 92.8fL；C-反应蛋白(CRP)-静脉血: 1.78mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.4；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: >1000IU/L；总胆固醇(TC)-静脉血: 5.98mmol/L；血红蛋白(Hb)-静脉血: 133g/L；大血小板百分比(P-LCR%)-静脉血: 26.1%；间接胆红素(I……\n- [全程D1079] 检验组合: 梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）\n- [全程D1081] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 多个颈腰椎、双侧膝关节可见片状放射性浓集灶。余颅骨、胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 考虑多个颈腰椎、双侧膝关节骨质退行性变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1092] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.006；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；颜色-尿液: 无色；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮\n- [全程D1094] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 28/μL；比重(SG)-尿液: 1.025；葡萄糖(Glu)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 36/μL；白细胞计数(WBC#)-尿液: 5/μL；酸碱度(pH)-尿液: 6.5；颜色-尿液: Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D1095] 检验组合: 白蛋白(ALB)-静脉血: 40.5g/L；镁离子(Mg2+)-静脉血: 0.84mmol/L；碱性磷酸酶(ALP)-静脉血: 63.2U/L；载脂蛋白B(apoB)-静脉血: 0.8g/L；葡萄糖(Glu)-静脉血: 5.31mmol/L；血小板比容-静脉血: 19%；直接胆红素(DBIL)-静脉血: 2.3umol/L；载脂蛋白AI(apoAI)-静脉血: 1.4g/L；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；总胆固醇(TC)-静脉血: 5.3mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.69mmolL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 325g/L；红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.9pg；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；γ-谷氨酰基转移酶(GGT)-静脉血: 16.8U/L；间接胆红素(IBIL)-静脉血: 5.6umolL；红细胞比容(Hct)-静脉血: 37.2%；钠离子(Na+)-静脉血: 141.6mmol/L；尿酸(UA)-静脉血: 219.2umol/L；总钙(Ca)-静脉血: 2.16mmol/L；尿素氮(BUN)-静脉血: 4.72mmol/L；平均红细胞体积(MCV)-静脉血: 91.9fL；球蛋白(GLO)-静脉血: 22.71g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.1；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14；乳酸脱氢酶(LDH)-静脉血: 179.4U/L；总胆红素(TBIL)-静脉血: 7.9umol/L；阴离子间隙(AG)-静脉血: 12；中性粒细胞百分比(Neut%)-静脉血: 0.814；血红蛋白(Hb)-静脉血: 121g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.1；丙氨酸氨基转移酶(ALT)-静脉血: 55.1U/L；白细胞计数(WBC#)-静脉血: 6.1210E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 36.2U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.58mmol/L；胱抑素(Cys-C)-静脉血: 0.95mg/L；大血小板……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1082] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者目前诊断明确，[计划性表述已隐藏]根治性放疗及同期化疗。向患者及其家属交代病情，治疗方案及治疗风险，做好治疗前准备工作。\n- [全程D1083] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者入院第三天，无明显不适主诉，查体情况：一般情况可，余同入院。预约放疗。\n- [全程D1088] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 今日查房，患者无明显不适主诉，生命体征平稳。已予预约放疗。候治疗。\n- [全程D1093] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 今日查房，患者无明显不适主诉，生命体征平稳。查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常。患者现放疗计划已设计完成并通过全科会诊，靶区剂量分布均匀，正常组织剂量在可接受范围内。[姓名已隐去]医生信息已隐藏示：患者无明显放化疗禁忌症，拟于今日开始行根治性放疗+同时期化疗。向患者及其家属交代病情及化疗风险，表示理解并已签署知情同意书，可于今日执行第1程顺铂方案同时期化疗，注意化疗不良反应。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停同期化疗，给予静脉保肝药物治疗，待转氨酶降至正常后再启动顺铂化疗\nB. 按原计划执行顺铂同期化疗，暂不予特殊保肝处理，常规监测肝功能\nC. 给予口服保肝药物，将顺铂剂量下调20%后执行同期化疗\nD. 给予静脉双重保肝药物，按原计划执行顺铂同期化疗，并动态复查肝功能\nE. 停用顺铂，更改为卡铂方案执行同期化疗，并给予口服保肝药物\nF. 给予口服保肝药物，推迟顺铂化疗1周，期间正常进行放疗\nG. 停用顺铂，更改为西妥昔单抗靶向治疗联合放疗，并给予口服保肝药物\nH. 给予口服保肝药物（如复方甘草酸苷、葡醛内酯），按原计划执行顺铂同期化疗，并动态复查肝功能\nI. 暂停放化疗，行腹部增强CT排查肝脏转移，并给予静脉保肝治疗\nJ. 给予口服保肝药物，按原计划执行顺铂同期化疗，并预防性使用重组人粒细胞刺激因子\nK. 给予口服保肝药物，按原计划执行顺铂同期化疗，并预防性使用广谱抗生素\nL. 给予口服保肝药物，将顺铂方案更改为奈达铂方案执行同期化疗\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-c47048c6a3961cfb24a6bb12","patient_id":"patient-36d433557e63f939b878347d","turn_id":"turn06","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"I","gold_action":"继续根治性放疗及同期化疗，暂不予集落刺激因子支持，密切监测血常规","options":[{"letter":"A","text":"暂停放化疗，给予重组人粒细胞集落刺激因子治疗，待白细胞恢复后继续","is_gold":false},{"letter":"B","text":"暂停同期化疗，仅继续根治性放疗，并给予重组人粒细胞集落刺激因子","is_gold":false},{"letter":"C","text":"继续根治性放疗及同期化疗，下一疗程顺铂剂量减量20%","is_gold":false},{"letter":"D","text":"继续根治性放疗及同期化疗，加用重组人粒细胞集落刺激因子","is_gold":false},{"letter":"E","text":"暂停放化疗，给予静脉高营养及强效止吐、补液支持，暂缓抗肿瘤治疗","is_gold":false},{"letter":"F","text":"继续根治性放疗及同期化疗，加用重组人血小板生成素","is_gold":false},{"letter":"G","text":"暂停同期化疗，将后续全身治疗更换为尼妥珠单抗靶向治疗","is_gold":false},{"letter":"H","text":"继续根治性放疗及同期化疗，加用促红细胞生成素及铁剂","is_gold":false},{"letter":"I","text":"继续根治性放疗及同期化疗，暂不予集落刺激因子支持，密切监测血常规","is_gold":true},{"letter":"J","text":"暂停放化疗，行骨髓穿刺评估造血功能后再决定后续治疗","is_gold":false},{"letter":"K","text":"继续根治性放疗，终止同期化疗，放疗结束后改为辅助化疗","is_gold":false},{"letter":"L","text":"继续根治性放疗及同期化疗，降低放疗靶区处方剂量","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、海绵窦、翼突基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1078] 入院记录: 主诉: 外院可疑鼻咽癌；现病史: 简要入院病史:患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n- [全程D1081] 入院记录: 主诉: 回吸性涕血3月余；现病史: 患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：70次/分，R：14次/分，BP：126/71mmHg,Ht：155cm，Wt：48kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左颈Ⅱ区触及肿大淋巴结，约2×1.5cm，无融合，质地硬，边界尚清，活动度中等，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS:；ECOG:\n- [全程D1078] 入院记录: 主诉: 外院可疑鼻咽癌；现病史: 简要入院病史:患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。某次就诊时间再次出现回吸性涕血，遂行鼻咽镜检查，活检示：鼻咽炎性渗出。行鼻咽部CT示：鼻咽左侧可见软组织占位。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n- [全程D1081] 入院记录: 主诉: 回吸性涕血3月余；现病史: 患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。某次就诊时间再次出现回吸性涕血，遂行鼻咽镜检查，活检示：鼻咽炎性渗出。行鼻咽部CT示：鼻咽左侧可见软组织占位。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：70次/分，R：14次/分，BP：126/71mmHg,Ht：155cm，Wt：48kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率70次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左颈Ⅱ区触及肿大淋巴结，约2×1.5cm，无融合，质地硬，边界尚清，活动度中等，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- [全程D1078] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 Ⅱ、Ⅲ、aVF、V4～V6导联ST段下移\n- [全程D1078] 检验组合: 镁离子(Mg2+)-静脉血: 0.96mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.6；Rh血型-静脉血: 阳性；直接胆红素(DBIL)-静脉血: 2umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.61COI；白蛋白(ALB)-静脉血: 45.5g/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 0.085COI；γ-谷氨酰基转移酶(GGT)-静脉血: 13.6U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.2fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；葡萄糖(Glu)-静脉血: 4.67mmol/L；总胆红素(TBIL)-静脉血: 8.3umol/L；单核细胞百分比(Mono%)-静脉血: 0.074；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.5U/L；红细胞比容(Hct)-静脉血: 41%；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 1.56COI；单核细胞计数(Mono#)-静脉血: 0.310E9/L；中性粒细胞计数(Neut#)-静脉血: 2.510E9/L；胱抑素(Cys-C)-静脉血: 0.84mg/L；碱性磷酸酶(ALP)-静脉血: 80.5U/L；钠离子(Na+)-静脉血: 143.8mmol/L；乳酸脱氢酶(LDH)-静脉血: 194.4U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；平均红细胞血红蛋白浓度(MCHC)-静脉血: 324g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21.7U/L；氯离子(Cl-)-静脉血: 105.2mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.74；平均红细胞体积(MCV)-静脉血: 92.8fL；C-反应蛋白(CRP)-静脉血: 1.78mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.4；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: >1000IU/L；总胆固醇(TC)-静脉血: 5.98mmol/L；血红蛋白(Hb)-静脉血: 133g/L；大血小板百分比(P-LCR%)-静脉血: 26.1%；间接胆红素(I……\n- [全程D1079] 检验组合: 梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）\n- [全程D1081] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 多个颈腰椎、双侧膝关节可见片状放射性浓集灶。余颅骨、胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 考虑多个颈腰椎、双侧膝关节骨质退行性变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1092] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.006；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；颜色-尿液: 无色；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮\n- [全程D1094] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 28/μL；比重(SG)-尿液: 1.025；葡萄糖(Glu)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 36/μL；白细胞计数(WBC#)-尿液: 5/μL；酸碱度(pH)-尿液: 6.5；颜色-尿液: Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D1095] 检验组合: 白蛋白(ALB)-静脉血: 40.5g/L；镁离子(Mg2+)-静脉血: 0.84mmol/L；碱性磷酸酶(ALP)-静脉血: 63.2U/L；载脂蛋白B(apoB)-静脉血: 0.8g/L；葡萄糖(Glu)-静脉血: 5.31mmol/L；血小板比容-静脉血: 19%；直接胆红素(DBIL)-静脉血: 2.3umol/L；载脂蛋白AI(apoAI)-静脉血: 1.4g/L；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；总胆固醇(TC)-静脉血: 5.3mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.69mmolL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 325g/L；红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.9pg；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；γ-谷氨酰基转移酶(GGT)-静脉血: 16.8U/L；间接胆红素(IBIL)-静脉血: 5.6umolL；红细胞比容(Hct)-静脉血: 37.2%；钠离子(Na+)-静脉血: 141.6mmol/L；尿酸(UA)-静脉血: 219.2umol/L；总钙(Ca)-静脉血: 2.16mmol/L；尿素氮(BUN)-静脉血: 4.72mmol/L；平均红细胞体积(MCV)-静脉血: 91.9fL；球蛋白(GLO)-静脉血: 22.71g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.1；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14；乳酸脱氢酶(LDH)-静脉血: 179.4U/L；总胆红素(TBIL)-静脉血: 7.9umol/L；阴离子间隙(AG)-静脉血: 12；中性粒细胞百分比(Neut%)-静脉血: 0.814；血红蛋白(Hb)-静脉血: 121g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.1；丙氨酸氨基转移酶(ALT)-静脉血: 55.1U/L；白细胞计数(WBC#)-静脉血: 6.1210E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 36.2U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.58mmol/L；胱抑素(Cys-C)-静脉血: 0.95mg/L；大血小板……\n- [全程D1102] 检验组合: 尿酸(UA)-静脉血: 238.2umol/L；总胆红素(TBIL)-静脉血: 6.2umol/L；白细胞计数(WBC#)-静脉血: 3.5310E9/L；间接胆红素(IBIL)-静脉血: 4.8umolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.3；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.02；阴离子间隙(AG)-静脉血: 15.1；磷(P)-静脉血: 1.08mmol/L；钠离子(Na+)-静脉血: 137.5mmol/L；总钙(Ca)-静脉血: 2.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 26.7U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.8；直接胆红素(DBIL)-静脉血: 1.4umol/L；球蛋白(GLO)-静脉血: 27.56g/L；载脂蛋白AI(apoAI)-静脉血: 1.46g/L；红细胞计数(RBC#)-静脉血: 4.6610E12/L；载脂蛋白B(apoB)-静脉血: 1.09g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；血红蛋白(Hb)-静脉血: 142g/L；葡萄糖(Glu)-静脉血: 5.62mmol/L；甘油三酯(TG)-静脉血: 0.98mmol/L；镁离子(Mg2+)-静脉血: 0.97mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；血小板分布宽度(PDW)-静脉血: 9.2%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；总胆固醇(TC)-静脉血: 5.85mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336g/L；平均血小板体积(MPV)-静脉血: 9fL；血小板计数(PLT#)-静脉血: 19010E9/L；血小板比容-静脉血: 17%；红细胞比容(Hct)-静脉血: 42.3%；总胆汁酸(TBA)-静脉血: 1.8umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.76mmolL；胱抑素(Cys-C)-静脉血: 0.89mg/L；肌酐(Crea)-静脉血: 54.9umol/L；白蛋白(ALB)-静脉血: 46.6g/L；氯离子(Cl-)-静脉血: 97.8mmol/L；钾离子(K+)-静脉血: 3.78mmol/……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1082] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者目前诊断明确，[计划性表述已隐藏]根治性放疗及同期化疗。向患者及其家属交代病情，治疗方案及治疗风险，做好治疗前准备工作。\n- [全程D1083] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者入院第三天，无明显不适主诉，查体情况：一般情况可，余同入院。预约放疗。\n- [全程D1088] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 今日查房，患者无明显不适主诉，生命体征平稳。已予预约放疗。候治疗。\n- [全程D1093] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 今日查房，患者无明显不适主诉，生命体征平稳。查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常。患者现放疗计划已设计完成并通过全科会诊，靶区剂量分布均匀，正常组织剂量在可接受范围内。[姓名已隐去]医生信息已隐藏示：患者无明显放化疗禁忌症，拟于今日开始行根治性放疗+同时期化疗。向患者及其家属交代病情及化疗风险，表示理解并已签署知情同意书，可于今日执行第1程顺铂方案同时期化疗，注意化疗不良反应。\n- [全程D1098] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中，第1程顺铂方案同时期化疗结束。今日查房，患者诉呕吐2次，咽痛、恶心、食欲下降，伴头晕，无腹痛、腹泻等不适。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放化疗，给予重组人粒细胞集落刺激因子治疗，待白细胞恢复后继续\nB. 暂停同期化疗，仅继续根治性放疗，并给予重组人粒细胞集落刺激因子\nC. 继续根治性放疗及同期化疗，下一疗程顺铂剂量减量20%\nD. 继续根治性放疗及同期化疗，加用重组人粒细胞集落刺激因子\nE. 暂停放化疗，给予静脉高营养及强效止吐、补液支持，暂缓抗肿瘤治疗\nF. 继续根治性放疗及同期化疗，加用重组人血小板生成素\nG. 暂停同期化疗，将后续全身治疗更换为尼妥珠单抗靶向治疗\nH. 继续根治性放疗及同期化疗，加用促红细胞生成素及铁剂\nI. 继续根治性放疗及同期化疗，暂不予集落刺激因子支持，密切监测血常规\nJ. 暂停放化疗，行骨髓穿刺评估造血功能后再决定后续治疗\nK. 继续根治性放疗，终止同期化疗，放疗结束后改为辅助化疗\nL. 继续根治性放疗及同期化疗，降低放疗靶区处方剂量\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、海绵窦、翼突基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1078] 入院记录: 主诉: 外院可疑鼻咽癌；现病史: 简要入院病史:患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n- [全程D1081] 入院记录: 主诉: 回吸性涕血3月余；现病史: 患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：70次/分，R：14次/分，BP：126/71mmHg,Ht：155cm，Wt：48kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左颈Ⅱ区触及肿大淋巴结，约2×1.5cm，无融合，质地硬，边界尚清，活动度中等，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS:；ECOG:\n- [全程D1078] 入院记录: 主诉: 外院可疑鼻咽癌；现病史: 简要入院病史:患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。某次就诊时间再次出现回吸性涕血，遂行鼻咽镜检查，活检示：鼻咽炎性渗出。行鼻咽部CT示：鼻咽左侧可见软组织占位。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n- [全程D1081] 入院记录: 主诉: 回吸性涕血3月余；现病史: 患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。某次就诊时间再次出现回吸性涕血，遂行鼻咽镜检查，活检示：鼻咽炎性渗出。行鼻咽部CT示：鼻咽左侧可见软组织占位。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：70次/分，R：14次/分，BP：126/71mmHg,Ht：155cm，Wt：48kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率70次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左颈Ⅱ区触及肿大淋巴结，约2×1.5cm，无融合，质地硬，边界尚清，活动度中等，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- [全程D1078] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 Ⅱ、Ⅲ、aVF、V4～V6导联ST段下移\n- [全程D1078] 检验组合: 镁离子(Mg2+)-静脉血: 0.96mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.6；Rh血型-静脉血: 阳性；直接胆红素(DBIL)-静脉血: 2umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.61COI；白蛋白(ALB)-静脉血: 45.5g/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 0.085COI；γ-谷氨酰基转移酶(GGT)-静脉血: 13.6U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.2fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；葡萄糖(Glu)-静脉血: 4.67mmol/L；总胆红素(TBIL)-静脉血: 8.3umol/L；单核细胞百分比(Mono%)-静脉血: 0.074；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.5U/L；红细胞比容(Hct)-静脉血: 41%；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 1.56COI；单核细胞计数(Mono#)-静脉血: 0.310E9/L；中性粒细胞计数(Neut#)-静脉血: 2.510E9/L；胱抑素(Cys-C)-静脉血: 0.84mg/L；碱性磷酸酶(ALP)-静脉血: 80.5U/L；钠离子(Na+)-静脉血: 143.8mmol/L；乳酸脱氢酶(LDH)-静脉血: 194.4U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；平均红细胞血红蛋白浓度(MCHC)-静脉血: 324g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21.7U/L；氯离子(Cl-)-静脉血: 105.2mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.74；平均红细胞体积(MCV)-静脉血: 92.8fL；C-反应蛋白(CRP)-静脉血: 1.78mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.4；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: >1000IU/L；总胆固醇(TC)-静脉血: 5.98mmol/L；血红蛋白(Hb)-静脉血: 133g/L；大血小板百分比(P-LCR%)-静脉血: 26.1%；间接胆红素(I……\n- [全程D1079] 检验组合: 梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）\n- [全程D1081] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 多个颈腰椎、双侧膝关节可见片状放射性浓集灶。余颅骨、胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 考虑多个颈腰椎、双侧膝关节骨质退行性变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1092] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.006；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；颜色-尿液: 无色；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮\n- [全程D1094] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 28/μL；比重(SG)-尿液: 1.025；葡萄糖(Glu)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 36/μL；白细胞计数(WBC#)-尿液: 5/μL；酸碱度(pH)-尿液: 6.5；颜色-尿液: Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D1095] 检验组合: 白蛋白(ALB)-静脉血: 40.5g/L；镁离子(Mg2+)-静脉血: 0.84mmol/L；碱性磷酸酶(ALP)-静脉血: 63.2U/L；载脂蛋白B(apoB)-静脉血: 0.8g/L；葡萄糖(Glu)-静脉血: 5.31mmol/L；血小板比容-静脉血: 19%；直接胆红素(DBIL)-静脉血: 2.3umol/L；载脂蛋白AI(apoAI)-静脉血: 1.4g/L；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；总胆固醇(TC)-静脉血: 5.3mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.69mmolL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 325g/L；红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.9pg；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；γ-谷氨酰基转移酶(GGT)-静脉血: 16.8U/L；间接胆红素(IBIL)-静脉血: 5.6umolL；红细胞比容(Hct)-静脉血: 37.2%；钠离子(Na+)-静脉血: 141.6mmol/L；尿酸(UA)-静脉血: 219.2umol/L；总钙(Ca)-静脉血: 2.16mmol/L；尿素氮(BUN)-静脉血: 4.72mmol/L；平均红细胞体积(MCV)-静脉血: 91.9fL；球蛋白(GLO)-静脉血: 22.71g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.1；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14；乳酸脱氢酶(LDH)-静脉血: 179.4U/L；总胆红素(TBIL)-静脉血: 7.9umol/L；阴离子间隙(AG)-静脉血: 12；中性粒细胞百分比(Neut%)-静脉血: 0.814；血红蛋白(Hb)-静脉血: 121g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.1；丙氨酸氨基转移酶(ALT)-静脉血: 55.1U/L；白细胞计数(WBC#)-静脉血: 6.1210E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 36.2U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.58mmol/L；胱抑素(Cys-C)-静脉血: 0.95mg/L；大血小板……\n- [全程D1102] 检验组合: 尿酸(UA)-静脉血: 238.2umol/L；总胆红素(TBIL)-静脉血: 6.2umol/L；白细胞计数(WBC#)-静脉血: 3.5310E9/L；间接胆红素(IBIL)-静脉血: 4.8umolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.3；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.02；阴离子间隙(AG)-静脉血: 15.1；磷(P)-静脉血: 1.08mmol/L；钠离子(Na+)-静脉血: 137.5mmol/L；总钙(Ca)-静脉血: 2.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 26.7U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.8；直接胆红素(DBIL)-静脉血: 1.4umol/L；球蛋白(GLO)-静脉血: 27.56g/L；载脂蛋白AI(apoAI)-静脉血: 1.46g/L；红细胞计数(RBC#)-静脉血: 4.6610E12/L；载脂蛋白B(apoB)-静脉血: 1.09g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；血红蛋白(Hb)-静脉血: 142g/L；葡萄糖(Glu)-静脉血: 5.62mmol/L；甘油三酯(TG)-静脉血: 0.98mmol/L；镁离子(Mg2+)-静脉血: 0.97mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；血小板分布宽度(PDW)-静脉血: 9.2%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；总胆固醇(TC)-静脉血: 5.85mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336g/L；平均血小板体积(MPV)-静脉血: 9fL；血小板计数(PLT#)-静脉血: 19010E9/L；血小板比容-静脉血: 17%；红细胞比容(Hct)-静脉血: 42.3%；总胆汁酸(TBA)-静脉血: 1.8umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.76mmolL；胱抑素(Cys-C)-静脉血: 0.89mg/L；肌酐(Crea)-静脉血: 54.9umol/L；白蛋白(ALB)-静脉血: 46.6g/L；氯离子(Cl-)-静脉血: 97.8mmol/L；钾离子(K+)-静脉血: 3.78mmol/……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1082] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者目前诊断明确，[计划性表述已隐藏]根治性放疗及同期化疗。向患者及其家属交代病情，治疗方案及治疗风险，做好治疗前准备工作。\n- [全程D1083] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者入院第三天，无明显不适主诉，查体情况：一般情况可，余同入院。预约放疗。\n- [全程D1088] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 今日查房，患者无明显不适主诉，生命体征平稳。已予预约放疗。候治疗。\n- [全程D1093] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 今日查房，患者无明显不适主诉，生命体征平稳。查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常。患者现放疗计划已设计完成并通过全科会诊，靶区剂量分布均匀，正常组织剂量在可接受范围内。[姓名已隐去]医生信息已隐藏示：患者无明显放化疗禁忌症，拟于今日开始行根治性放疗+同时期化疗。向患者及其家属交代病情及化疗风险，表示理解并已签署知情同意书，可于今日执行第1程顺铂方案同时期化疗，注意化疗不良反应。\n- [全程D1098] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中，第1程顺铂方案同时期化疗结束。今日查房，患者诉呕吐2次，咽痛、恶心、食欲下降，伴头晕，无腹痛、腹泻等不适。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放化疗，给予重组人粒细胞集落刺激因子治疗，待白细胞恢复后继续\nB. 暂停同期化疗，仅继续根治性放疗，并给予重组人粒细胞集落刺激因子\nC. 继续根治性放疗及同期化疗，下一疗程顺铂剂量减量20%\nD. 继续根治性放疗及同期化疗，加用重组人粒细胞集落刺激因子\nE. 暂停放化疗，给予静脉高营养及强效止吐、补液支持，暂缓抗肿瘤治疗\nF. 继续根治性放疗及同期化疗，加用重组人血小板生成素\nG. 暂停同期化疗，将后续全身治疗更换为尼妥珠单抗靶向治疗\nH. 继续根治性放疗及同期化疗，加用促红细胞生成素及铁剂\nI. 继续根治性放疗及同期化疗，暂不予集落刺激因子支持，密切监测血常规\nJ. 暂停放化疗，行骨髓穿刺评估造血功能后再决定后续治疗\nK. 继续根治性放疗，终止同期化疗，放疗结束后改为辅助化疗\nL. 继续根治性放疗及同期化疗，降低放疗靶区处方剂量\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-28a13cf2b32abdc303bbad45","patient_id":"patient-36d433557e63f939b878347d","turn_id":"turn07","turn_position":5,"turn_type":"response_assessment_decision","gold_letter":"I","gold_action":"评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，每周复查血常规及生化，指导功能锻炼。","options":[{"letter":"A","text":"评估临床症状完全缓解，提前终止放疗，办理出院并进入定期随访阶段，1个月后复查头颈部MRI。","is_gold":false},{"letter":"B","text":"评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，并口服替吉奥单药维持化疗。","is_gold":false},{"letter":"C","text":"评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，期间无需定期复查血液学指标。","is_gold":false},{"letter":"D","text":"评估肿瘤退缩缓慢，继续住院，将放疗方案调整为超分割放疗，并加用西妥昔单抗靶向治疗。","is_gold":false},{"letter":"E","text":"评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，期间暂停放疗2周以促进粘膜修复。","is_gold":false},{"letter":"F","text":"评估肿瘤部分缓解，继续住院完成根治性放疗，并每周行鼻咽部MRI以动态监测肿瘤退缩情况。","is_gold":false},{"letter":"G","text":"评估临床症状缓解且毒副反应可耐受，转外科行鼻咽及颈部残留病灶切除术，术后在门诊继续完成剩余放疗。","is_gold":false},{"letter":"H","text":"评估疑似疾病进展，停止放疗，改为吉西他滨联合顺铂方案全身姑息化疗并办理出院。","is_gold":false},{"letter":"I","text":"评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，每周复查血常规及生化，指导功能锻炼。","is_gold":true},{"letter":"J","text":"评估临床症状缓解且毒副反应可耐受，继续住院完成剩余根治性放疗，期间常规给予静脉高营养支持及预防性抗感染。","is_gold":false},{"letter":"K","text":"评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，并立即安排全身PET-CT确认疗效。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、海绵窦、翼突基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1078] 入院记录: 主诉: 外院可疑鼻咽癌；现病史: 简要入院病史:患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n- [全程D1081] 入院记录: 主诉: 回吸性涕血3月余；现病史: 患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：70次/分，R：14次/分，BP：126/71mmHg,Ht：155cm，Wt：48kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左颈Ⅱ区触及肿大淋巴结，约2×1.5cm，无融合，质地硬，边界尚清，活动度中等，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS:；ECOG:\n- [全程D1078] 入院记录: 主诉: 外院可疑鼻咽癌；现病史: 简要入院病史:患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。某次就诊时间再次出现回吸性涕血，遂行鼻咽镜检查，活检示：鼻咽炎性渗出。行鼻咽部CT示：鼻咽左侧可见软组织占位。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n- [全程D1081] 入院记录: 主诉: 回吸性涕血3月余；现病史: 患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。某次就诊时间再次出现回吸性涕血，遂行鼻咽镜检查，活检示：鼻咽炎性渗出。行鼻咽部CT示：鼻咽左侧可见软组织占位。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：70次/分，R：14次/分，BP：126/71mmHg,Ht：155cm，Wt：48kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率70次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左颈Ⅱ区触及肿大淋巴结，约2×1.5cm，无融合，质地硬，边界尚清，活动度中等，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- [全程D1078] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 Ⅱ、Ⅲ、aVF、V4～V6导联ST段下移\n- [全程D1078] 检验组合: 镁离子(Mg2+)-静脉血: 0.96mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.6；Rh血型-静脉血: 阳性；直接胆红素(DBIL)-静脉血: 2umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.61COI；白蛋白(ALB)-静脉血: 45.5g/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 0.085COI；γ-谷氨酰基转移酶(GGT)-静脉血: 13.6U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.2fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；葡萄糖(Glu)-静脉血: 4.67mmol/L；总胆红素(TBIL)-静脉血: 8.3umol/L；单核细胞百分比(Mono%)-静脉血: 0.074；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.5U/L；红细胞比容(Hct)-静脉血: 41%；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 1.56COI；单核细胞计数(Mono#)-静脉血: 0.310E9/L；中性粒细胞计数(Neut#)-静脉血: 2.510E9/L；胱抑素(Cys-C)-静脉血: 0.84mg/L；碱性磷酸酶(ALP)-静脉血: 80.5U/L；钠离子(Na+)-静脉血: 143.8mmol/L；乳酸脱氢酶(LDH)-静脉血: 194.4U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；平均红细胞血红蛋白浓度(MCHC)-静脉血: 324g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21.7U/L；氯离子(Cl-)-静脉血: 105.2mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.74；平均红细胞体积(MCV)-静脉血: 92.8fL；C-反应蛋白(CRP)-静脉血: 1.78mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.4；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: >1000IU/L；总胆固醇(TC)-静脉血: 5.98mmol/L；血红蛋白(Hb)-静脉血: 133g/L；大血小板百分比(P-LCR%)-静脉血: 26.1%；间接胆红素(I……\n- [全程D1079] 检验组合: 梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）\n- [全程D1081] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 多个颈腰椎、双侧膝关节可见片状放射性浓集灶。余颅骨、胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 考虑多个颈腰椎、双侧膝关节骨质退行性变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1092] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.006；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；颜色-尿液: 无色；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮\n- [全程D1094] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 28/μL；比重(SG)-尿液: 1.025；葡萄糖(Glu)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 36/μL；白细胞计数(WBC#)-尿液: 5/μL；酸碱度(pH)-尿液: 6.5；颜色-尿液: Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D1095] 检验组合: 白蛋白(ALB)-静脉血: 40.5g/L；镁离子(Mg2+)-静脉血: 0.84mmol/L；碱性磷酸酶(ALP)-静脉血: 63.2U/L；载脂蛋白B(apoB)-静脉血: 0.8g/L；葡萄糖(Glu)-静脉血: 5.31mmol/L；血小板比容-静脉血: 19%；直接胆红素(DBIL)-静脉血: 2.3umol/L；载脂蛋白AI(apoAI)-静脉血: 1.4g/L；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；总胆固醇(TC)-静脉血: 5.3mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.69mmolL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 325g/L；红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.9pg；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；γ-谷氨酰基转移酶(GGT)-静脉血: 16.8U/L；间接胆红素(IBIL)-静脉血: 5.6umolL；红细胞比容(Hct)-静脉血: 37.2%；钠离子(Na+)-静脉血: 141.6mmol/L；尿酸(UA)-静脉血: 219.2umol/L；总钙(Ca)-静脉血: 2.16mmol/L；尿素氮(BUN)-静脉血: 4.72mmol/L；平均红细胞体积(MCV)-静脉血: 91.9fL；球蛋白(GLO)-静脉血: 22.71g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.1；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14；乳酸脱氢酶(LDH)-静脉血: 179.4U/L；总胆红素(TBIL)-静脉血: 7.9umol/L；阴离子间隙(AG)-静脉血: 12；中性粒细胞百分比(Neut%)-静脉血: 0.814；血红蛋白(Hb)-静脉血: 121g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.1；丙氨酸氨基转移酶(ALT)-静脉血: 55.1U/L；白细胞计数(WBC#)-静脉血: 6.1210E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 36.2U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.58mmol/L；胱抑素(Cys-C)-静脉血: 0.95mg/L；大血小板……\n- [全程D1102] 检验组合: 尿酸(UA)-静脉血: 238.2umol/L；总胆红素(TBIL)-静脉血: 6.2umol/L；白细胞计数(WBC#)-静脉血: 3.5310E9/L；间接胆红素(IBIL)-静脉血: 4.8umolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.3；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.02；阴离子间隙(AG)-静脉血: 15.1；磷(P)-静脉血: 1.08mmol/L；钠离子(Na+)-静脉血: 137.5mmol/L；总钙(Ca)-静脉血: 2.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 26.7U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.8；直接胆红素(DBIL)-静脉血: 1.4umol/L；球蛋白(GLO)-静脉血: 27.56g/L；载脂蛋白AI(apoAI)-静脉血: 1.46g/L；红细胞计数(RBC#)-静脉血: 4.6610E12/L；载脂蛋白B(apoB)-静脉血: 1.09g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；血红蛋白(Hb)-静脉血: 142g/L；葡萄糖(Glu)-静脉血: 5.62mmol/L；甘油三酯(TG)-静脉血: 0.98mmol/L；镁离子(Mg2+)-静脉血: 0.97mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；血小板分布宽度(PDW)-静脉血: 9.2%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；总胆固醇(TC)-静脉血: 5.85mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336g/L；平均血小板体积(MPV)-静脉血: 9fL；血小板计数(PLT#)-静脉血: 19010E9/L；血小板比容-静脉血: 17%；红细胞比容(Hct)-静脉血: 42.3%；总胆汁酸(TBA)-静脉血: 1.8umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.76mmolL；胱抑素(Cys-C)-静脉血: 0.89mg/L；肌酐(Crea)-静脉血: 54.9umol/L；白蛋白(ALB)-静脉血: 46.6g/L；氯离子(Cl-)-静脉血: 97.8mmol/L；钾离子(K+)-静脉血: 3.78mmol/……\n- [全程D1109] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 28.2mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；钾离子(K+)-静脉血: 3.77mmol/L；甘油三酯(TG)-静脉血: 0.8mmol/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；红细胞计数(RBC#)-静脉血: 4.2410E12/L；总胆固醇(TC)-静脉血: 5.21mmol/L；镁离子(Mg2+)-静脉血: 0.97mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.6；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；总胆汁酸(TBA)-静脉血: 0.6umol/L；总胆红素(TBIL)-静脉血: 8.6umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.119；红细胞比容(Hct)-静脉血: 38.7%；尿素氮(BUN)-静脉血: 4.1mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；间接胆红素(IBIL)-静脉血: 6.5umolL；C-反应蛋白(CRP)-静脉血: 2.85mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.53mmolL；血小板分布宽度(PDW)-静脉血: 17.4%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.29mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；阴离子间隙(AG)-静脉血: 15；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；血小板计数(PLT#)-静脉血: 204.310E9/L；平均红细胞体积(MCV)-静脉血: 91.1fL；丙氨酸氨基转移酶(ALT)-静脉血: 12.3U/L；总蛋白(TP)-静脉血: 69.21g/L；直接胆红素(DBIL)-静脉血: 2.1umol/L；氯离子(Cl-)-静脉血: 95.7mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.784；中性粒细胞计数(Neut#)-静脉血: 2.310E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22.8U/L；平均血小板体积(MPV)-静脉血: 6.38fL；γ-谷氨酰基转移酶(GGT)-静脉血: 23.6U/L；总钙(Ca)-静脉血: 2.22mmol/L；单核……\n- [全程D1113] 检验组合: 血小板比容-静脉血: 15%；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 6.5；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.734；平均红细胞体积(MCV)-静脉血: 91.5fL；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；隐血(OB)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；中性粒细胞计数(Neut#)-静脉血: 2.310E9/L；总蛋白(TP)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 1/μL；红细胞计数(RBC#)-静脉血: 4.1310E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；血小板计数(PLT#)-静脉血: 16810E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；比重(SG)-尿液: 1.009；浊度(TRUB)-尿液: 清亮；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.05；大血小板百分比(P-LCR%)-静脉血: 18%；单核细胞计数(Mono#)-静脉血: 0.410E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.5；酮体(KET)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 13/μL；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-静脉血: 3.210E9/L；白细胞(LEU)-尿液: -（参考: 阴性）；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；红细胞比容(Hct)-静脉血: 37.8%；血红蛋白(Hb)-静脉血: 126g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.5；血小板分布宽度(PDW)-静脉血: 9.3%；淋巴细胞百分比(Lymph%)-静脉血: 0.103；平均红细胞血红蛋白浓度(MCHC)-静脉血: 333g/L；平均血小板体积(MPV)-静脉血: 8.9fL；单核细胞百分比(Mono%)-静脉血: 0.11\n- [全程D1114] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 16/μL；颜色-尿液: Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: +- 0.1g（参考: 阴性）；酮体(KET)-尿液: 1+ 1mmol（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 6.5；比重(SG)-尿液: 1.022；白细胞计数(WBC#)-尿液: 10/μL；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）\n- [全程D1116] 检验组合: 亚硝酸盐(NIT)-尿液: -（参考: 阴性）；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336.3g/L；阴离子间隙(AG)-静脉血: 12；总蛋白(TP)-尿液: -（参考: 阴性）；磷(P)-静脉血: 0.93mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20U/L；尿酸(UA)-静脉血: 199.4umol/L；平均红细胞体积(MCV)-静脉血: 92.9fL；碱性磷酸酶(ALP)-静脉血: 61.6U/L；酸碱度(pH)-尿液: 6.5；血小板分布宽度(PDW)-静脉血: 17%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.032；隐血(OB)-尿液: -（参考: 阴性）；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.44mmolL；肌酐(Crea)-静脉血: 67.5umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.2；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；氯离子(Cl-)-静脉血: 102.9mmol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；总胆红素(TBIL)-静脉血: 6.7umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14%；血小板计数(PLT#)-静脉血: 176.710E9/L；总蛋白(TP)-静脉血: 65.51g/L；尿素氮(BUN)-静脉血: 3.95mmol/L；红细胞计数(RBC#)-静脉血: 3.8510E12/L；甘油三酯(TG)-静脉血: 1.05mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；α-L-岩藻糖苷酶(AFU)-静脉血: 30U/L；间接胆红素(IBIL)-静脉血: 4.4umolL；总胆固醇(TC)-静脉血: 5.25mmol/L；浊度(TRUB)-尿液: 清亮；平均血小板体积(MPV)-静脉血: 6.6fL；胆红素(BIL)-尿液: -（参考: 阴性）；总胆汁酸(TBA)-静脉血: 0.2umol/L；载脂蛋白B(apoB)-静脉血: 0.98g/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；中性粒细胞计数(Neut#)-静脉血: 2.81……\n- [全程D1123] 检验组合: 红细胞计数(RBC#)-静脉血: 4.3710E12/L；中性粒细胞计数(Neut#)-静脉血: 310E9/L；平均红细胞体积(MCV)-静脉血: 90fL；甘油三酯(TG)-静脉血: 1.06mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.55；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.072；白蛋白(ALB)-静脉血: 44.8g/L；单核细胞百分比(Mono%)-静脉血: 0.081；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；红细胞比容(Hct)-静脉血: 39.4%；总钙(Ca)-静脉血: 2.44mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.8pg；血小板比容-静脉血: 10%；氯离子(Cl-)-静脉血: 92.5mmol/L；血小板计数(PLT#)-静脉血: 143.810E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.98mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4%；中性粒细胞百分比(Neut%)-静脉血: 0.841；总胆固醇(TC)-静脉血: 6.12mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 343.2g/L；间接胆红素(IBIL)-静脉血: 6.2umolL；尿素氮(BUN)-静脉血: 7.4mmol/L；平均血小板体积(MPV)-静脉血: 6.98fL；总胆红素(TBIL)-静脉血: 8.2umol/L；胱抑素(Cys-C)-静脉血: 0.86mg/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；载脂蛋白B(apoB)-静脉血: 1.37g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.9U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；C-反应蛋白(CRP)-静脉血: 10.49mg/L；球蛋白(GLO)-静脉血: 30.65g/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.46；葡萄糖(Glu)-静脉血: 5.64mmol/L；磷(P)-静脉血: 1.16mmol/L……\n- [全程D1125] 检验组合: 总钙(Ca)-静脉血: 2.38mmol/L；阴离子间隙(AG)-静脉血: 12.7；磷(P)-静脉血: 0.81mmol/L；氯离子(Cl-)-静脉血: 92.5mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 28.7mmol/L；钾离子(K+)-静脉血: 3.68mmol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；钠离子(Na+)-静脉血: 133.9mmol/L\n- [全程D1130] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对侧，双肺野纹理清晰，未见明显实质性病变。双侧肺门不大，纵隔不宽，心影形态、大小、位置未见异常。双膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见异常。\n- [全程D1130] 超声；肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。\n- [全程D1130] 检验组合: 有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞血红蛋白含量(MCH)-静脉血: 31.3pg；淋巴细胞百分比(Lymph%)-静脉血: 0.09；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4%；单核细胞计数(Mono#)-静脉血: 0.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.184；白蛋白(ALB)-静脉血: 43.5g/L；球蛋白(GLO)-静脉血: 29.66g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.32mmolL；总胆固醇(TC)-静脉血: 5.82mmol/L；葡萄糖(Glu)-静脉血: 5.74mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21U/L；中性粒细胞计数(Neut#)-静脉血: 1.510E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.9U/L；中性粒细胞百分比(Neut%)-静脉血: 0.715；尿酸(UA)-静脉血: 242.7umol/L；总胆汁酸(TBA)-静脉血: 0.2umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.005；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；血红蛋白(Hb)-静脉血: 125g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血小板分布宽度(PDW)-静脉血: 17.2%；总胆红素(TBIL)-静脉血: 6.6umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 28.4mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 344.5g/L；钾离子(K+)-静脉血: 3.7mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.8U/L；载脂蛋白B(apoB)-静脉血: 1.31g/L；红细胞计数(RBC#)-静脉血: 3.9910E12/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.4；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 90.9fL；总蛋白(TP)-静脉血: 73.16g/L；平均血小板体积(MPV)-静脉血: 6.84fL；血小板计数(PLT#)-静脉血: 181.410E9/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；低密度脂蛋白胆固醇(LDL-C)……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1082] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者目前诊断明确，[计划性表述已隐藏]根治性放疗及同期化疗。向患者及其家属交代病情，治疗方案及治疗风险，做好治疗前准备工作。\n- [全程D1083] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者入院第三天，无明显不适主诉，查体情况：一般情况可，余同入院。预约放疗。\n- [全程D1088] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 今日查房，患者无明显不适主诉，生命体征平稳。已予预约放疗。候治疗。\n- [全程D1093] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 今日查房，患者无明显不适主诉，生命体征平稳。查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常。患者现放疗计划已设计完成并通过全科会诊，靶区剂量分布均匀，正常组织剂量在可接受范围内。[姓名已隐去]医生信息已隐藏示：患者无明显放化疗禁忌症，拟于今日开始行根治性放疗+同时期化疗。向患者及其家属交代病情及化疗风险，表示理解并已签署知情同意书，可于今日执行第1程顺铂方案同时期化疗，注意化疗不良反应。\n- [全程D1098] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中，第1程顺铂方案同时期化疗结束。今日查房，患者诉呕吐2次，咽痛、恶心、食欲下降，伴头晕，无腹痛、腹泻等不适。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D1108] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中。今日查房，患者无明显不适主诉，生命体征平稳。[姓名已隐去]医生信息已隐藏：继续治疗。\n- [全程D1113] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中。今日查房，患者无明显不适主诉，生命体征平稳。查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：可于今日水化，明日执行第2程DDP方案同时期化疗，注意化疗不良反应。\n- [全程D1118] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中，第2程顺铂方案同时期化疗结束。诉咽痛、恶心、食欲下降，呕吐1次，伴头晕，无腹痛、腹泻等不适。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D1123] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中。今日查房，患者无明显不适主诉，生命体征平稳。[姓名已隐去]医生信息已隐藏：患者治疗疗程过半，予预约治疗结束后影像学复查。继续治疗。\n- [全程D1129] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中。今日查房，患者无明显不适主诉，生命体征平稳。[姓名已隐去]医生信息已隐藏：嘱患者冲洗鼻咽，保持鼻咽清洁。继续治疗。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 评估临床症状完全缓解，提前终止放疗，办理出院并进入定期随访阶段，1个月后复查头颈部MRI。\nB. 评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，并口服替吉奥单药维持化疗。\nC. 评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，期间无需定期复查血液学指标。\nD. 评估肿瘤退缩缓慢，继续住院，将放疗方案调整为超分割放疗，并加用西妥昔单抗靶向治疗。\nE. 评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，期间暂停放疗2周以促进粘膜修复。\nF. 评估肿瘤部分缓解，继续住院完成根治性放疗，并每周行鼻咽部MRI以动态监测肿瘤退缩情况。\nG. 评估临床症状缓解且毒副反应可耐受，转外科行鼻咽及颈部残留病灶切除术，术后在门诊继续完成剩余放疗。\nH. 评估疑似疾病进展，停止放疗，改为吉西他滨联合顺铂方案全身姑息化疗并办理出院。\nI. 评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，每周复查血常规及生化，指导功能锻炼。\nJ. 评估临床症状缓解且毒副反应可耐受，继续住院完成剩余根治性放疗，期间常规给予静脉高营养支持及预防性抗感染。\nK. 评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，并立即安排全身PET-CT确认疗效。\n\n请仅输出一个选项字母（A-K）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、海绵窦、翼突基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1078] 入院记录: 主诉: 外院可疑鼻咽癌；现病史: 简要入院病史:患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n- [全程D1081] 入院记录: 主诉: 回吸性涕血3月余；现病史: 患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：70次/分，R：14次/分，BP：126/71mmHg,Ht：155cm，Wt：48kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左颈Ⅱ区触及肿大淋巴结，约2×1.5cm，无融合，质地硬，边界尚清，活动度中等，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS:；ECOG:\n- [全程D1078] 入院记录: 主诉: 外院可疑鼻咽癌；现病史: 简要入院病史:患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。某次就诊时间再次出现回吸性涕血，遂行鼻咽镜检查，活检示：鼻咽炎性渗出。行鼻咽部CT示：鼻咽左侧可见软组织占位。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n- [全程D1081] 入院记录: 主诉: 回吸性涕血3月余；现病史: 患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。某次就诊时间再次出现回吸性涕血，遂行鼻咽镜检查，活检示：鼻咽炎性渗出。行鼻咽部CT示：鼻咽左侧可见软组织占位。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：70次/分，R：14次/分，BP：126/71mmHg,Ht：155cm，Wt：48kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率70次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左颈Ⅱ区触及肿大淋巴结，约2×1.5cm，无融合，质地硬，边界尚清，活动度中等，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- [全程D1078] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 Ⅱ、Ⅲ、aVF、V4～V6导联ST段下移\n- [全程D1078] 检验组合: 镁离子(Mg2+)-静脉血: 0.96mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.6；Rh血型-静脉血: 阳性；直接胆红素(DBIL)-静脉血: 2umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.61COI；白蛋白(ALB)-静脉血: 45.5g/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 0.085COI；γ-谷氨酰基转移酶(GGT)-静脉血: 13.6U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.2fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；葡萄糖(Glu)-静脉血: 4.67mmol/L；总胆红素(TBIL)-静脉血: 8.3umol/L；单核细胞百分比(Mono%)-静脉血: 0.074；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.5U/L；红细胞比容(Hct)-静脉血: 41%；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 1.56COI；单核细胞计数(Mono#)-静脉血: 0.310E9/L；中性粒细胞计数(Neut#)-静脉血: 2.510E9/L；胱抑素(Cys-C)-静脉血: 0.84mg/L；碱性磷酸酶(ALP)-静脉血: 80.5U/L；钠离子(Na+)-静脉血: 143.8mmol/L；乳酸脱氢酶(LDH)-静脉血: 194.4U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；平均红细胞血红蛋白浓度(MCHC)-静脉血: 324g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21.7U/L；氯离子(Cl-)-静脉血: 105.2mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.74；平均红细胞体积(MCV)-静脉血: 92.8fL；C-反应蛋白(CRP)-静脉血: 1.78mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.4；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: >1000IU/L；总胆固醇(TC)-静脉血: 5.98mmol/L；血红蛋白(Hb)-静脉血: 133g/L；大血小板百分比(P-LCR%)-静脉血: 26.1%；间接胆红素(I……\n- [全程D1079] 检验组合: 梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）\n- [全程D1081] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 多个颈腰椎、双侧膝关节可见片状放射性浓集灶。余颅骨、胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 考虑多个颈腰椎、双侧膝关节骨质退行性变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1092] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.006；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；颜色-尿液: 无色；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮\n- [全程D1094] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 28/μL；比重(SG)-尿液: 1.025；葡萄糖(Glu)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 36/μL；白细胞计数(WBC#)-尿液: 5/μL；酸碱度(pH)-尿液: 6.5；颜色-尿液: Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D1095] 检验组合: 白蛋白(ALB)-静脉血: 40.5g/L；镁离子(Mg2+)-静脉血: 0.84mmol/L；碱性磷酸酶(ALP)-静脉血: 63.2U/L；载脂蛋白B(apoB)-静脉血: 0.8g/L；葡萄糖(Glu)-静脉血: 5.31mmol/L；血小板比容-静脉血: 19%；直接胆红素(DBIL)-静脉血: 2.3umol/L；载脂蛋白AI(apoAI)-静脉血: 1.4g/L；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；总胆固醇(TC)-静脉血: 5.3mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.69mmolL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 325g/L；红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.9pg；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；γ-谷氨酰基转移酶(GGT)-静脉血: 16.8U/L；间接胆红素(IBIL)-静脉血: 5.6umolL；红细胞比容(Hct)-静脉血: 37.2%；钠离子(Na+)-静脉血: 141.6mmol/L；尿酸(UA)-静脉血: 219.2umol/L；总钙(Ca)-静脉血: 2.16mmol/L；尿素氮(BUN)-静脉血: 4.72mmol/L；平均红细胞体积(MCV)-静脉血: 91.9fL；球蛋白(GLO)-静脉血: 22.71g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.1；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14；乳酸脱氢酶(LDH)-静脉血: 179.4U/L；总胆红素(TBIL)-静脉血: 7.9umol/L；阴离子间隙(AG)-静脉血: 12；中性粒细胞百分比(Neut%)-静脉血: 0.814；血红蛋白(Hb)-静脉血: 121g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.1；丙氨酸氨基转移酶(ALT)-静脉血: 55.1U/L；白细胞计数(WBC#)-静脉血: 6.1210E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 36.2U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.58mmol/L；胱抑素(Cys-C)-静脉血: 0.95mg/L；大血小板……\n- [全程D1102] 检验组合: 尿酸(UA)-静脉血: 238.2umol/L；总胆红素(TBIL)-静脉血: 6.2umol/L；白细胞计数(WBC#)-静脉血: 3.5310E9/L；间接胆红素(IBIL)-静脉血: 4.8umolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.3；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.02；阴离子间隙(AG)-静脉血: 15.1；磷(P)-静脉血: 1.08mmol/L；钠离子(Na+)-静脉血: 137.5mmol/L；总钙(Ca)-静脉血: 2.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 26.7U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.8；直接胆红素(DBIL)-静脉血: 1.4umol/L；球蛋白(GLO)-静脉血: 27.56g/L；载脂蛋白AI(apoAI)-静脉血: 1.46g/L；红细胞计数(RBC#)-静脉血: 4.6610E12/L；载脂蛋白B(apoB)-静脉血: 1.09g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；血红蛋白(Hb)-静脉血: 142g/L；葡萄糖(Glu)-静脉血: 5.62mmol/L；甘油三酯(TG)-静脉血: 0.98mmol/L；镁离子(Mg2+)-静脉血: 0.97mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；血小板分布宽度(PDW)-静脉血: 9.2%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；总胆固醇(TC)-静脉血: 5.85mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336g/L；平均血小板体积(MPV)-静脉血: 9fL；血小板计数(PLT#)-静脉血: 19010E9/L；血小板比容-静脉血: 17%；红细胞比容(Hct)-静脉血: 42.3%；总胆汁酸(TBA)-静脉血: 1.8umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.76mmolL；胱抑素(Cys-C)-静脉血: 0.89mg/L；肌酐(Crea)-静脉血: 54.9umol/L；白蛋白(ALB)-静脉血: 46.6g/L；氯离子(Cl-)-静脉血: 97.8mmol/L；钾离子(K+)-静脉血: 3.78mmol/……\n- [全程D1109] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 28.2mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；钾离子(K+)-静脉血: 3.77mmol/L；甘油三酯(TG)-静脉血: 0.8mmol/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；红细胞计数(RBC#)-静脉血: 4.2410E12/L；总胆固醇(TC)-静脉血: 5.21mmol/L；镁离子(Mg2+)-静脉血: 0.97mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.6；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；总胆汁酸(TBA)-静脉血: 0.6umol/L；总胆红素(TBIL)-静脉血: 8.6umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.119；红细胞比容(Hct)-静脉血: 38.7%；尿素氮(BUN)-静脉血: 4.1mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；间接胆红素(IBIL)-静脉血: 6.5umolL；C-反应蛋白(CRP)-静脉血: 2.85mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.53mmolL；血小板分布宽度(PDW)-静脉血: 17.4%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.29mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；阴离子间隙(AG)-静脉血: 15；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；血小板计数(PLT#)-静脉血: 204.310E9/L；平均红细胞体积(MCV)-静脉血: 91.1fL；丙氨酸氨基转移酶(ALT)-静脉血: 12.3U/L；总蛋白(TP)-静脉血: 69.21g/L；直接胆红素(DBIL)-静脉血: 2.1umol/L；氯离子(Cl-)-静脉血: 95.7mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.784；中性粒细胞计数(Neut#)-静脉血: 2.310E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22.8U/L；平均血小板体积(MPV)-静脉血: 6.38fL；γ-谷氨酰基转移酶(GGT)-静脉血: 23.6U/L；总钙(Ca)-静脉血: 2.22mmol/L；单核……\n- [全程D1113] 检验组合: 血小板比容-静脉血: 15%；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 6.5；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.734；平均红细胞体积(MCV)-静脉血: 91.5fL；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；隐血(OB)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；中性粒细胞计数(Neut#)-静脉血: 2.310E9/L；总蛋白(TP)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 1/μL；红细胞计数(RBC#)-静脉血: 4.1310E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；血小板计数(PLT#)-静脉血: 16810E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；比重(SG)-尿液: 1.009；浊度(TRUB)-尿液: 清亮；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.05；大血小板百分比(P-LCR%)-静脉血: 18%；单核细胞计数(Mono#)-静脉血: 0.410E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.5；酮体(KET)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 13/μL；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-静脉血: 3.210E9/L；白细胞(LEU)-尿液: -（参考: 阴性）；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；红细胞比容(Hct)-静脉血: 37.8%；血红蛋白(Hb)-静脉血: 126g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.5；血小板分布宽度(PDW)-静脉血: 9.3%；淋巴细胞百分比(Lymph%)-静脉血: 0.103；平均红细胞血红蛋白浓度(MCHC)-静脉血: 333g/L；平均血小板体积(MPV)-静脉血: 8.9fL；单核细胞百分比(Mono%)-静脉血: 0.11\n- [全程D1114] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 16/μL；颜色-尿液: Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: +- 0.1g（参考: 阴性）；酮体(KET)-尿液: 1+ 1mmol（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 6.5；比重(SG)-尿液: 1.022；白细胞计数(WBC#)-尿液: 10/μL；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）\n- [全程D1116] 检验组合: 亚硝酸盐(NIT)-尿液: -（参考: 阴性）；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336.3g/L；阴离子间隙(AG)-静脉血: 12；总蛋白(TP)-尿液: -（参考: 阴性）；磷(P)-静脉血: 0.93mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20U/L；尿酸(UA)-静脉血: 199.4umol/L；平均红细胞体积(MCV)-静脉血: 92.9fL；碱性磷酸酶(ALP)-静脉血: 61.6U/L；酸碱度(pH)-尿液: 6.5；血小板分布宽度(PDW)-静脉血: 17%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.032；隐血(OB)-尿液: -（参考: 阴性）；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.44mmolL；肌酐(Crea)-静脉血: 67.5umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.2；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；氯离子(Cl-)-静脉血: 102.9mmol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；总胆红素(TBIL)-静脉血: 6.7umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14%；血小板计数(PLT#)-静脉血: 176.710E9/L；总蛋白(TP)-静脉血: 65.51g/L；尿素氮(BUN)-静脉血: 3.95mmol/L；红细胞计数(RBC#)-静脉血: 3.8510E12/L；甘油三酯(TG)-静脉血: 1.05mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；α-L-岩藻糖苷酶(AFU)-静脉血: 30U/L；间接胆红素(IBIL)-静脉血: 4.4umolL；总胆固醇(TC)-静脉血: 5.25mmol/L；浊度(TRUB)-尿液: 清亮；平均血小板体积(MPV)-静脉血: 6.6fL；胆红素(BIL)-尿液: -（参考: 阴性）；总胆汁酸(TBA)-静脉血: 0.2umol/L；载脂蛋白B(apoB)-静脉血: 0.98g/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；中性粒细胞计数(Neut#)-静脉血: 2.81……\n- [全程D1123] 检验组合: 红细胞计数(RBC#)-静脉血: 4.3710E12/L；中性粒细胞计数(Neut#)-静脉血: 310E9/L；平均红细胞体积(MCV)-静脉血: 90fL；甘油三酯(TG)-静脉血: 1.06mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.55；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.072；白蛋白(ALB)-静脉血: 44.8g/L；单核细胞百分比(Mono%)-静脉血: 0.081；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；红细胞比容(Hct)-静脉血: 39.4%；总钙(Ca)-静脉血: 2.44mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.8pg；血小板比容-静脉血: 10%；氯离子(Cl-)-静脉血: 92.5mmol/L；血小板计数(PLT#)-静脉血: 143.810E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.98mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4%；中性粒细胞百分比(Neut%)-静脉血: 0.841；总胆固醇(TC)-静脉血: 6.12mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 343.2g/L；间接胆红素(IBIL)-静脉血: 6.2umolL；尿素氮(BUN)-静脉血: 7.4mmol/L；平均血小板体积(MPV)-静脉血: 6.98fL；总胆红素(TBIL)-静脉血: 8.2umol/L；胱抑素(Cys-C)-静脉血: 0.86mg/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；载脂蛋白B(apoB)-静脉血: 1.37g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.9U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；C-反应蛋白(CRP)-静脉血: 10.49mg/L；球蛋白(GLO)-静脉血: 30.65g/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.46；葡萄糖(Glu)-静脉血: 5.64mmol/L；磷(P)-静脉血: 1.16mmol/L……\n- [全程D1125] 检验组合: 总钙(Ca)-静脉血: 2.38mmol/L；阴离子间隙(AG)-静脉血: 12.7；磷(P)-静脉血: 0.81mmol/L；氯离子(Cl-)-静脉血: 92.5mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 28.7mmol/L；钾离子(K+)-静脉血: 3.68mmol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；钠离子(Na+)-静脉血: 133.9mmol/L\n- [全程D1130] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对侧，双肺野纹理清晰，未见明显实质性病变。双侧肺门不大，纵隔不宽，心影形态、大小、位置未见异常。双膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见异常。\n- [全程D1130] 超声；肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。\n- [全程D1130] 检验组合: 有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞血红蛋白含量(MCH)-静脉血: 31.3pg；淋巴细胞百分比(Lymph%)-静脉血: 0.09；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4%；单核细胞计数(Mono#)-静脉血: 0.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.184；白蛋白(ALB)-静脉血: 43.5g/L；球蛋白(GLO)-静脉血: 29.66g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.32mmolL；总胆固醇(TC)-静脉血: 5.82mmol/L；葡萄糖(Glu)-静脉血: 5.74mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21U/L；中性粒细胞计数(Neut#)-静脉血: 1.510E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.9U/L；中性粒细胞百分比(Neut%)-静脉血: 0.715；尿酸(UA)-静脉血: 242.7umol/L；总胆汁酸(TBA)-静脉血: 0.2umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.005；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；血红蛋白(Hb)-静脉血: 125g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血小板分布宽度(PDW)-静脉血: 17.2%；总胆红素(TBIL)-静脉血: 6.6umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 28.4mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 344.5g/L；钾离子(K+)-静脉血: 3.7mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.8U/L；载脂蛋白B(apoB)-静脉血: 1.31g/L；红细胞计数(RBC#)-静脉血: 3.9910E12/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.4；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 90.9fL；总蛋白(TP)-静脉血: 73.16g/L；平均血小板体积(MPV)-静脉血: 6.84fL；血小板计数(PLT#)-静脉血: 181.410E9/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；低密度脂蛋白胆固醇(LDL-C)……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1082] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者目前诊断明确，[计划性表述已隐藏]根治性放疗及同期化疗。向患者及其家属交代病情，治疗方案及治疗风险，做好治疗前准备工作。\n- [全程D1083] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者入院第三天，无明显不适主诉，查体情况：一般情况可，余同入院。预约放疗。\n- [全程D1088] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 今日查房，患者无明显不适主诉，生命体征平稳。已予预约放疗。候治疗。\n- [全程D1093] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 今日查房，患者无明显不适主诉，生命体征平稳。查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常。患者现放疗计划已设计完成并通过全科会诊，靶区剂量分布均匀，正常组织剂量在可接受范围内。[姓名已隐去]医生信息已隐藏示：患者无明显放化疗禁忌症，拟于今日开始行根治性放疗+同时期化疗。向患者及其家属交代病情及化疗风险，表示理解并已签署知情同意书，可于今日执行第1程顺铂方案同时期化疗，注意化疗不良反应。\n- [全程D1098] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中，第1程顺铂方案同时期化疗结束。今日查房，患者诉呕吐2次，咽痛、恶心、食欲下降，伴头晕，无腹痛、腹泻等不适。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D1108] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中。今日查房，患者无明显不适主诉，生命体征平稳。[姓名已隐去]医生信息已隐藏：继续治疗。\n- [全程D1113] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中。今日查房，患者无明显不适主诉，生命体征平稳。查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：可于今日水化，明日执行第2程DDP方案同时期化疗，注意化疗不良反应。\n- [全程D1118] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中，第2程顺铂方案同时期化疗结束。诉咽痛、恶心、食欲下降，呕吐1次，伴头晕，无腹痛、腹泻等不适。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D1123] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中。今日查房，患者无明显不适主诉，生命体征平稳。[姓名已隐去]医生信息已隐藏：患者治疗疗程过半，予预约治疗结束后影像学复查。继续治疗。\n- [全程D1129] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中。今日查房，患者无明显不适主诉，生命体征平稳。[姓名已隐去]医生信息已隐藏：嘱患者冲洗鼻咽，保持鼻咽清洁。继续治疗。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 评估临床症状完全缓解，提前终止放疗，办理出院并进入定期随访阶段，1个月后复查头颈部MRI。\nB. 评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，并口服替吉奥单药维持化疗。\nC. 评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，期间无需定期复查血液学指标。\nD. 评估肿瘤退缩缓慢，继续住院，将放疗方案调整为超分割放疗，并加用西妥昔单抗靶向治疗。\nE. 评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，期间暂停放疗2周以促进粘膜修复。\nF. 评估肿瘤部分缓解，继续住院完成根治性放疗，并每周行鼻咽部MRI以动态监测肿瘤退缩情况。\nG. 评估临床症状缓解且毒副反应可耐受，转外科行鼻咽及颈部残留病灶切除术，术后在门诊继续完成剩余放疗。\nH. 评估疑似疾病进展，停止放疗，改为吉西他滨联合顺铂方案全身姑息化疗并办理出院。\nI. 评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，每周复查血常规及生化，指导功能锻炼。\nJ. 评估临床症状缓解且毒副反应可耐受，继续住院完成剩余根治性放疗，期间常规给予静脉高营养支持及预防性抗感染。\nK. 评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，并立即安排全身PET-CT确认疗效。\n\n请仅输出一个选项字母（A-K）。"}]}
+{"sample_id":"sample-40b7a6f655350cf46e9ce33c","patient_id":"patient-36d433557e63f939b878347d","turn_id":"turn08","turn_position":6,"turn_type":"response_assessment_decision","gold_letter":"K","gold_action":"办理出院，转门诊继续完成根治性放疗，每周复查血常规及生化，指导鼻腔冲洗与功能锻炼。","options":[{"letter":"A","text":"立即行鼻咽及颈部MRI复查，视近期疗效评估结果调整放疗靶区及剂量。","is_gold":false},{"letter":"B","text":"安排第3程顺铂同期化疗，并继续住院完成剩余根治性放疗疗程。","is_gold":false},{"letter":"C","text":"暂停放疗，行全身PET-CT检查以排除远处转移，待结果回报后决定后续方案。","is_gold":false},{"letter":"D","text":"办理出院，结束所有抗肿瘤治疗，进入定期随访阶段，1个月后复查MRI。","is_gold":false},{"letter":"E","text":"调整化疗方案为紫杉醇+顺铂，继续住院行第3程同期化疗及放疗。","is_gold":false},{"letter":"F","text":"立即行鼻咽镜检查及活检，视病理退缩情况调整后续放疗方案。","is_gold":false},{"letter":"G","text":"办理出院，转门诊继续放疗，并加用西妥昔单抗靶向治疗。","is_gold":false},{"letter":"H","text":"继续住院完成剩余放疗，期间每周复查血常规及生化，待放疗结束后出院。","is_gold":false},{"letter":"I","text":"办理出院，转门诊继续放疗，并立即启动顺铂+氟尿嘧啶方案辅助化疗。","is_gold":false},{"letter":"J","text":"立即行胸部CT及腹部增强CT，视全面评估结果决定是否继续门诊放疗。","is_gold":false},{"letter":"K","text":"办理出院，转门诊继续完成根治性放疗，每周复查血常规及生化，指导鼻腔冲洗与功能锻炼。","is_gold":true},{"letter":"L","text":"暂停放疗，给予重组人粒细胞刺激因子及升血小板治疗，待血象完全恢复正常后继续放疗。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、海绵窦、翼突基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1078] 入院记录: 主诉: 外院可疑鼻咽癌；现病史: 简要入院病史:患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n- [全程D1081] 入院记录: 主诉: 回吸性涕血3月余；现病史: 患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：70次/分，R：14次/分，BP：126/71mmHg,Ht：155cm，Wt：48kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左颈Ⅱ区触及肿大淋巴结，约2×1.5cm，无融合，质地硬，边界尚清，活动度中等，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS:；ECOG:\n- [全程D1078] 入院记录: 主诉: 外院可疑鼻咽癌；现病史: 简要入院病史:患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。某次就诊时间再次出现回吸性涕血，遂行鼻咽镜检查，活检示：鼻咽炎性渗出。行鼻咽部CT示：鼻咽左侧可见软组织占位。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n- [全程D1081] 入院记录: 主诉: 回吸性涕血3月余；现病史: 患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。某次就诊时间再次出现回吸性涕血，遂行鼻咽镜检查，活检示：鼻咽炎性渗出。行鼻咽部CT示：鼻咽左侧可见软组织占位。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：70次/分，R：14次/分，BP：126/71mmHg,Ht：155cm，Wt：48kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率70次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左颈Ⅱ区触及肿大淋巴结，约2×1.5cm，无融合，质地硬，边界尚清，活动度中等，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- [全程D1078] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 Ⅱ、Ⅲ、aVF、V4～V6导联ST段下移\n- [全程D1078] 检验组合: 镁离子(Mg2+)-静脉血: 0.96mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.6；Rh血型-静脉血: 阳性；直接胆红素(DBIL)-静脉血: 2umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.61COI；白蛋白(ALB)-静脉血: 45.5g/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 0.085COI；γ-谷氨酰基转移酶(GGT)-静脉血: 13.6U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.2fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；葡萄糖(Glu)-静脉血: 4.67mmol/L；总胆红素(TBIL)-静脉血: 8.3umol/L；单核细胞百分比(Mono%)-静脉血: 0.074；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.5U/L；红细胞比容(Hct)-静脉血: 41%；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 1.56COI；单核细胞计数(Mono#)-静脉血: 0.310E9/L；中性粒细胞计数(Neut#)-静脉血: 2.510E9/L；胱抑素(Cys-C)-静脉血: 0.84mg/L；碱性磷酸酶(ALP)-静脉血: 80.5U/L；钠离子(Na+)-静脉血: 143.8mmol/L；乳酸脱氢酶(LDH)-静脉血: 194.4U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；平均红细胞血红蛋白浓度(MCHC)-静脉血: 324g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21.7U/L；氯离子(Cl-)-静脉血: 105.2mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.74；平均红细胞体积(MCV)-静脉血: 92.8fL；C-反应蛋白(CRP)-静脉血: 1.78mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.4；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: >1000IU/L；总胆固醇(TC)-静脉血: 5.98mmol/L；血红蛋白(Hb)-静脉血: 133g/L；大血小板百分比(P-LCR%)-静脉血: 26.1%；间接胆红素(I……\n- [全程D1079] 检验组合: 梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）\n- [全程D1081] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 多个颈腰椎、双侧膝关节可见片状放射性浓集灶。余颅骨、胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 考虑多个颈腰椎、双侧膝关节骨质退行性变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1092] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.006；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；颜色-尿液: 无色；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮\n- [全程D1094] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 28/μL；比重(SG)-尿液: 1.025；葡萄糖(Glu)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 36/μL；白细胞计数(WBC#)-尿液: 5/μL；酸碱度(pH)-尿液: 6.5；颜色-尿液: Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D1095] 检验组合: 白蛋白(ALB)-静脉血: 40.5g/L；镁离子(Mg2+)-静脉血: 0.84mmol/L；碱性磷酸酶(ALP)-静脉血: 63.2U/L；载脂蛋白B(apoB)-静脉血: 0.8g/L；葡萄糖(Glu)-静脉血: 5.31mmol/L；血小板比容-静脉血: 19%；直接胆红素(DBIL)-静脉血: 2.3umol/L；载脂蛋白AI(apoAI)-静脉血: 1.4g/L；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；总胆固醇(TC)-静脉血: 5.3mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.69mmolL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 325g/L；红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.9pg；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；γ-谷氨酰基转移酶(GGT)-静脉血: 16.8U/L；间接胆红素(IBIL)-静脉血: 5.6umolL；红细胞比容(Hct)-静脉血: 37.2%；钠离子(Na+)-静脉血: 141.6mmol/L；尿酸(UA)-静脉血: 219.2umol/L；总钙(Ca)-静脉血: 2.16mmol/L；尿素氮(BUN)-静脉血: 4.72mmol/L；平均红细胞体积(MCV)-静脉血: 91.9fL；球蛋白(GLO)-静脉血: 22.71g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.1；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14；乳酸脱氢酶(LDH)-静脉血: 179.4U/L；总胆红素(TBIL)-静脉血: 7.9umol/L；阴离子间隙(AG)-静脉血: 12；中性粒细胞百分比(Neut%)-静脉血: 0.814；血红蛋白(Hb)-静脉血: 121g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.1；丙氨酸氨基转移酶(ALT)-静脉血: 55.1U/L；白细胞计数(WBC#)-静脉血: 6.1210E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 36.2U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.58mmol/L；胱抑素(Cys-C)-静脉血: 0.95mg/L；大血小板……\n- [全程D1102] 检验组合: 尿酸(UA)-静脉血: 238.2umol/L；总胆红素(TBIL)-静脉血: 6.2umol/L；白细胞计数(WBC#)-静脉血: 3.5310E9/L；间接胆红素(IBIL)-静脉血: 4.8umolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.3；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.02；阴离子间隙(AG)-静脉血: 15.1；磷(P)-静脉血: 1.08mmol/L；钠离子(Na+)-静脉血: 137.5mmol/L；总钙(Ca)-静脉血: 2.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 26.7U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.8；直接胆红素(DBIL)-静脉血: 1.4umol/L；球蛋白(GLO)-静脉血: 27.56g/L；载脂蛋白AI(apoAI)-静脉血: 1.46g/L；红细胞计数(RBC#)-静脉血: 4.6610E12/L；载脂蛋白B(apoB)-静脉血: 1.09g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；血红蛋白(Hb)-静脉血: 142g/L；葡萄糖(Glu)-静脉血: 5.62mmol/L；甘油三酯(TG)-静脉血: 0.98mmol/L；镁离子(Mg2+)-静脉血: 0.97mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；血小板分布宽度(PDW)-静脉血: 9.2%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；总胆固醇(TC)-静脉血: 5.85mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336g/L；平均血小板体积(MPV)-静脉血: 9fL；血小板计数(PLT#)-静脉血: 19010E9/L；血小板比容-静脉血: 17%；红细胞比容(Hct)-静脉血: 42.3%；总胆汁酸(TBA)-静脉血: 1.8umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.76mmolL；胱抑素(Cys-C)-静脉血: 0.89mg/L；肌酐(Crea)-静脉血: 54.9umol/L；白蛋白(ALB)-静脉血: 46.6g/L；氯离子(Cl-)-静脉血: 97.8mmol/L；钾离子(K+)-静脉血: 3.78mmol/……\n- [全程D1109] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 28.2mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；钾离子(K+)-静脉血: 3.77mmol/L；甘油三酯(TG)-静脉血: 0.8mmol/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；红细胞计数(RBC#)-静脉血: 4.2410E12/L；总胆固醇(TC)-静脉血: 5.21mmol/L；镁离子(Mg2+)-静脉血: 0.97mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.6；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；总胆汁酸(TBA)-静脉血: 0.6umol/L；总胆红素(TBIL)-静脉血: 8.6umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.119；红细胞比容(Hct)-静脉血: 38.7%；尿素氮(BUN)-静脉血: 4.1mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；间接胆红素(IBIL)-静脉血: 6.5umolL；C-反应蛋白(CRP)-静脉血: 2.85mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.53mmolL；血小板分布宽度(PDW)-静脉血: 17.4%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.29mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；阴离子间隙(AG)-静脉血: 15；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；血小板计数(PLT#)-静脉血: 204.310E9/L；平均红细胞体积(MCV)-静脉血: 91.1fL；丙氨酸氨基转移酶(ALT)-静脉血: 12.3U/L；总蛋白(TP)-静脉血: 69.21g/L；直接胆红素(DBIL)-静脉血: 2.1umol/L；氯离子(Cl-)-静脉血: 95.7mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.784；中性粒细胞计数(Neut#)-静脉血: 2.310E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22.8U/L；平均血小板体积(MPV)-静脉血: 6.38fL；γ-谷氨酰基转移酶(GGT)-静脉血: 23.6U/L；总钙(Ca)-静脉血: 2.22mmol/L；单核……\n- [全程D1113] 检验组合: 血小板比容-静脉血: 15%；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 6.5；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.734；平均红细胞体积(MCV)-静脉血: 91.5fL；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；隐血(OB)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；中性粒细胞计数(Neut#)-静脉血: 2.310E9/L；总蛋白(TP)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 1/μL；红细胞计数(RBC#)-静脉血: 4.1310E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；血小板计数(PLT#)-静脉血: 16810E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；比重(SG)-尿液: 1.009；浊度(TRUB)-尿液: 清亮；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.05；大血小板百分比(P-LCR%)-静脉血: 18%；单核细胞计数(Mono#)-静脉血: 0.410E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.5；酮体(KET)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 13/μL；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-静脉血: 3.210E9/L；白细胞(LEU)-尿液: -（参考: 阴性）；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；红细胞比容(Hct)-静脉血: 37.8%；血红蛋白(Hb)-静脉血: 126g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.5；血小板分布宽度(PDW)-静脉血: 9.3%；淋巴细胞百分比(Lymph%)-静脉血: 0.103；平均红细胞血红蛋白浓度(MCHC)-静脉血: 333g/L；平均血小板体积(MPV)-静脉血: 8.9fL；单核细胞百分比(Mono%)-静脉血: 0.11\n- [全程D1114] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 16/μL；颜色-尿液: Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: +- 0.1g（参考: 阴性）；酮体(KET)-尿液: 1+ 1mmol（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 6.5；比重(SG)-尿液: 1.022；白细胞计数(WBC#)-尿液: 10/μL；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）\n- [全程D1116] 检验组合: 亚硝酸盐(NIT)-尿液: -（参考: 阴性）；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336.3g/L；阴离子间隙(AG)-静脉血: 12；总蛋白(TP)-尿液: -（参考: 阴性）；磷(P)-静脉血: 0.93mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20U/L；尿酸(UA)-静脉血: 199.4umol/L；平均红细胞体积(MCV)-静脉血: 92.9fL；碱性磷酸酶(ALP)-静脉血: 61.6U/L；酸碱度(pH)-尿液: 6.5；血小板分布宽度(PDW)-静脉血: 17%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.032；隐血(OB)-尿液: -（参考: 阴性）；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.44mmolL；肌酐(Crea)-静脉血: 67.5umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.2；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；氯离子(Cl-)-静脉血: 102.9mmol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；总胆红素(TBIL)-静脉血: 6.7umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14%；血小板计数(PLT#)-静脉血: 176.710E9/L；总蛋白(TP)-静脉血: 65.51g/L；尿素氮(BUN)-静脉血: 3.95mmol/L；红细胞计数(RBC#)-静脉血: 3.8510E12/L；甘油三酯(TG)-静脉血: 1.05mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；α-L-岩藻糖苷酶(AFU)-静脉血: 30U/L；间接胆红素(IBIL)-静脉血: 4.4umolL；总胆固醇(TC)-静脉血: 5.25mmol/L；浊度(TRUB)-尿液: 清亮；平均血小板体积(MPV)-静脉血: 6.6fL；胆红素(BIL)-尿液: -（参考: 阴性）；总胆汁酸(TBA)-静脉血: 0.2umol/L；载脂蛋白B(apoB)-静脉血: 0.98g/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；中性粒细胞计数(Neut#)-静脉血: 2.81……\n- [全程D1123] 检验组合: 红细胞计数(RBC#)-静脉血: 4.3710E12/L；中性粒细胞计数(Neut#)-静脉血: 310E9/L；平均红细胞体积(MCV)-静脉血: 90fL；甘油三酯(TG)-静脉血: 1.06mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.55；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.072；白蛋白(ALB)-静脉血: 44.8g/L；单核细胞百分比(Mono%)-静脉血: 0.081；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；红细胞比容(Hct)-静脉血: 39.4%；总钙(Ca)-静脉血: 2.44mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.8pg；血小板比容-静脉血: 10%；氯离子(Cl-)-静脉血: 92.5mmol/L；血小板计数(PLT#)-静脉血: 143.810E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.98mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4%；中性粒细胞百分比(Neut%)-静脉血: 0.841；总胆固醇(TC)-静脉血: 6.12mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 343.2g/L；间接胆红素(IBIL)-静脉血: 6.2umolL；尿素氮(BUN)-静脉血: 7.4mmol/L；平均血小板体积(MPV)-静脉血: 6.98fL；总胆红素(TBIL)-静脉血: 8.2umol/L；胱抑素(Cys-C)-静脉血: 0.86mg/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；载脂蛋白B(apoB)-静脉血: 1.37g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.9U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；C-反应蛋白(CRP)-静脉血: 10.49mg/L；球蛋白(GLO)-静脉血: 30.65g/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.46；葡萄糖(Glu)-静脉血: 5.64mmol/L；磷(P)-静脉血: 1.16mmol/L……\n- [全程D1125] 检验组合: 总钙(Ca)-静脉血: 2.38mmol/L；阴离子间隙(AG)-静脉血: 12.7；磷(P)-静脉血: 0.81mmol/L；氯离子(Cl-)-静脉血: 92.5mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 28.7mmol/L；钾离子(K+)-静脉血: 3.68mmol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；钠离子(Na+)-静脉血: 133.9mmol/L\n- [全程D1130] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对侧，双肺野纹理清晰，未见明显实质性病变。双侧肺门不大，纵隔不宽，心影形态、大小、位置未见异常。双膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见异常。\n- [全程D1130] 超声；肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。\n- [全程D1130] 检验组合: 有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞血红蛋白含量(MCH)-静脉血: 31.3pg；淋巴细胞百分比(Lymph%)-静脉血: 0.09；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4%；单核细胞计数(Mono#)-静脉血: 0.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.184；白蛋白(ALB)-静脉血: 43.5g/L；球蛋白(GLO)-静脉血: 29.66g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.32mmolL；总胆固醇(TC)-静脉血: 5.82mmol/L；葡萄糖(Glu)-静脉血: 5.74mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21U/L；中性粒细胞计数(Neut#)-静脉血: 1.510E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.9U/L；中性粒细胞百分比(Neut%)-静脉血: 0.715；尿酸(UA)-静脉血: 242.7umol/L；总胆汁酸(TBA)-静脉血: 0.2umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.005；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；血红蛋白(Hb)-静脉血: 125g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血小板分布宽度(PDW)-静脉血: 17.2%；总胆红素(TBIL)-静脉血: 6.6umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 28.4mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 344.5g/L；钾离子(K+)-静脉血: 3.7mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.8U/L；载脂蛋白B(apoB)-静脉血: 1.31g/L；红细胞计数(RBC#)-静脉血: 3.9910E12/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.4；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 90.9fL；总蛋白(TP)-静脉血: 73.16g/L；平均血小板体积(MPV)-静脉血: 6.84fL；血小板计数(PLT#)-静脉血: 181.410E9/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；低密度脂蛋白胆固醇(LDL-C)……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1082] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者目前诊断明确，[计划性表述已隐藏]根治性放疗及同期化疗。向患者及其家属交代病情，治疗方案及治疗风险，做好治疗前准备工作。\n- [全程D1083] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者入院第三天，无明显不适主诉，查体情况：一般情况可，余同入院。预约放疗。\n- [全程D1088] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 今日查房，患者无明显不适主诉，生命体征平稳。已予预约放疗。候治疗。\n- [全程D1093] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 今日查房，患者无明显不适主诉，生命体征平稳。查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常。患者现放疗计划已设计完成并通过全科会诊，靶区剂量分布均匀，正常组织剂量在可接受范围内。[姓名已隐去]医生信息已隐藏示：患者无明显放化疗禁忌症，拟于今日开始行根治性放疗+同时期化疗。向患者及其家属交代病情及化疗风险，表示理解并已签署知情同意书，可于今日执行第1程顺铂方案同时期化疗，注意化疗不良反应。\n- [全程D1098] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中，第1程顺铂方案同时期化疗结束。今日查房，患者诉呕吐2次，咽痛、恶心、食欲下降，伴头晕，无腹痛、腹泻等不适。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D1108] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中。今日查房，患者无明显不适主诉，生命体征平稳。[姓名已隐去]医生信息已隐藏：继续治疗。\n- [全程D1113] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中。今日查房，患者无明显不适主诉，生命体征平稳。查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：可于今日水化，明日执行第2程DDP方案同时期化疗，注意化疗不良反应。\n- [全程D1118] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中，第2程顺铂方案同时期化疗结束。诉咽痛、恶心、食欲下降，呕吐1次，伴头晕，无腹痛、腹泻等不适。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D1123] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中。今日查房，患者无明显不适主诉，生命体征平稳。[姓名已隐去]医生信息已隐藏：患者治疗疗程过半，予预约治疗结束后影像学复查。继续治疗。\n- [全程D1129] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中。今日查房，患者无明显不适主诉，生命体征平稳。[姓名已隐去]医生信息已隐藏：嘱患者冲洗鼻咽，保持鼻咽清洁。继续治疗。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即行鼻咽及颈部MRI复查，视近期疗效评估结果调整放疗靶区及剂量。\nB. 安排第3程顺铂同期化疗，并继续住院完成剩余根治性放疗疗程。\nC. 暂停放疗，行全身PET-CT检查以排除远处转移，待结果回报后决定后续方案。\nD. 办理出院，结束所有抗肿瘤治疗，进入定期随访阶段，1个月后复查MRI。\nE. 调整化疗方案为紫杉醇+顺铂，继续住院行第3程同期化疗及放疗。\nF. 立即行鼻咽镜检查及活检，视病理退缩情况调整后续放疗方案。\nG. 办理出院，转门诊继续放疗，并加用西妥昔单抗靶向治疗。\nH. 继续住院完成剩余放疗，期间每周复查血常规及生化，待放疗结束后出院。\nI. 办理出院，转门诊继续放疗，并立即启动顺铂+氟尿嘧啶方案辅助化疗。\nJ. 立即行胸部CT及腹部增强CT，视全面评估结果决定是否继续门诊放疗。\nK. 办理出院，转门诊继续完成根治性放疗，每周复查血常规及生化，指导鼻腔冲洗与功能锻炼。\nL. 暂停放疗，给予重组人粒细胞刺激因子及升血小板治疗，待血象完全恢复正常后继续放疗。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、海绵窦、翼突基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1078] 入院记录: 主诉: 外院可疑鼻咽癌；现病史: 简要入院病史:患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n- [全程D1081] 入院记录: 主诉: 回吸性涕血3月余；现病史: 患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：70次/分，R：14次/分，BP：126/71mmHg,Ht：155cm，Wt：48kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左颈Ⅱ区触及肿大淋巴结，约2×1.5cm，无融合，质地硬，边界尚清，活动度中等，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS:；ECOG:\n- [全程D1078] 入院记录: 主诉: 外院可疑鼻咽癌；现病史: 简要入院病史:患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。某次就诊时间再次出现回吸性涕血，遂行鼻咽镜检查，活检示：鼻咽炎性渗出。行鼻咽部CT示：鼻咽左侧可见软组织占位。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n- [全程D1081] 入院记录: 主诉: 回吸性涕血3月余；现病史: 患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。某次就诊时间再次出现回吸性涕血，遂行鼻咽镜检查，活检示：鼻咽炎性渗出。行鼻咽部CT示：鼻咽左侧可见软组织占位。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：70次/分，R：14次/分，BP：126/71mmHg,Ht：155cm，Wt：48kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率70次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左颈Ⅱ区触及肿大淋巴结，约2×1.5cm，无融合，质地硬，边界尚清，活动度中等，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- [全程D1078] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 Ⅱ、Ⅲ、aVF、V4～V6导联ST段下移\n- [全程D1078] 检验组合: 镁离子(Mg2+)-静脉血: 0.96mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.6；Rh血型-静脉血: 阳性；直接胆红素(DBIL)-静脉血: 2umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.61COI；白蛋白(ALB)-静脉血: 45.5g/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 0.085COI；γ-谷氨酰基转移酶(GGT)-静脉血: 13.6U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.2fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；葡萄糖(Glu)-静脉血: 4.67mmol/L；总胆红素(TBIL)-静脉血: 8.3umol/L；单核细胞百分比(Mono%)-静脉血: 0.074；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.5U/L；红细胞比容(Hct)-静脉血: 41%；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 1.56COI；单核细胞计数(Mono#)-静脉血: 0.310E9/L；中性粒细胞计数(Neut#)-静脉血: 2.510E9/L；胱抑素(Cys-C)-静脉血: 0.84mg/L；碱性磷酸酶(ALP)-静脉血: 80.5U/L；钠离子(Na+)-静脉血: 143.8mmol/L；乳酸脱氢酶(LDH)-静脉血: 194.4U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；平均红细胞血红蛋白浓度(MCHC)-静脉血: 324g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21.7U/L；氯离子(Cl-)-静脉血: 105.2mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.74；平均红细胞体积(MCV)-静脉血: 92.8fL；C-反应蛋白(CRP)-静脉血: 1.78mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.4；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: >1000IU/L；总胆固醇(TC)-静脉血: 5.98mmol/L；血红蛋白(Hb)-静脉血: 133g/L；大血小板百分比(P-LCR%)-静脉血: 26.1%；间接胆红素(I……\n- [全程D1079] 检验组合: 梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）\n- [全程D1081] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 多个颈腰椎、双侧膝关节可见片状放射性浓集灶。余颅骨、胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 考虑多个颈腰椎、双侧膝关节骨质退行性变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1092] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.006；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；颜色-尿液: 无色；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮\n- [全程D1094] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 28/μL；比重(SG)-尿液: 1.025；葡萄糖(Glu)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 36/μL；白细胞计数(WBC#)-尿液: 5/μL；酸碱度(pH)-尿液: 6.5；颜色-尿液: Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D1095] 检验组合: 白蛋白(ALB)-静脉血: 40.5g/L；镁离子(Mg2+)-静脉血: 0.84mmol/L；碱性磷酸酶(ALP)-静脉血: 63.2U/L；载脂蛋白B(apoB)-静脉血: 0.8g/L；葡萄糖(Glu)-静脉血: 5.31mmol/L；血小板比容-静脉血: 19%；直接胆红素(DBIL)-静脉血: 2.3umol/L；载脂蛋白AI(apoAI)-静脉血: 1.4g/L；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；总胆固醇(TC)-静脉血: 5.3mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.69mmolL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 325g/L；红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.9pg；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；γ-谷氨酰基转移酶(GGT)-静脉血: 16.8U/L；间接胆红素(IBIL)-静脉血: 5.6umolL；红细胞比容(Hct)-静脉血: 37.2%；钠离子(Na+)-静脉血: 141.6mmol/L；尿酸(UA)-静脉血: 219.2umol/L；总钙(Ca)-静脉血: 2.16mmol/L；尿素氮(BUN)-静脉血: 4.72mmol/L；平均红细胞体积(MCV)-静脉血: 91.9fL；球蛋白(GLO)-静脉血: 22.71g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.1；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14；乳酸脱氢酶(LDH)-静脉血: 179.4U/L；总胆红素(TBIL)-静脉血: 7.9umol/L；阴离子间隙(AG)-静脉血: 12；中性粒细胞百分比(Neut%)-静脉血: 0.814；血红蛋白(Hb)-静脉血: 121g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.1；丙氨酸氨基转移酶(ALT)-静脉血: 55.1U/L；白细胞计数(WBC#)-静脉血: 6.1210E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 36.2U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.58mmol/L；胱抑素(Cys-C)-静脉血: 0.95mg/L；大血小板……\n- [全程D1102] 检验组合: 尿酸(UA)-静脉血: 238.2umol/L；总胆红素(TBIL)-静脉血: 6.2umol/L；白细胞计数(WBC#)-静脉血: 3.5310E9/L；间接胆红素(IBIL)-静脉血: 4.8umolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.3；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.02；阴离子间隙(AG)-静脉血: 15.1；磷(P)-静脉血: 1.08mmol/L；钠离子(Na+)-静脉血: 137.5mmol/L；总钙(Ca)-静脉血: 2.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 26.7U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.8；直接胆红素(DBIL)-静脉血: 1.4umol/L；球蛋白(GLO)-静脉血: 27.56g/L；载脂蛋白AI(apoAI)-静脉血: 1.46g/L；红细胞计数(RBC#)-静脉血: 4.6610E12/L；载脂蛋白B(apoB)-静脉血: 1.09g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；血红蛋白(Hb)-静脉血: 142g/L；葡萄糖(Glu)-静脉血: 5.62mmol/L；甘油三酯(TG)-静脉血: 0.98mmol/L；镁离子(Mg2+)-静脉血: 0.97mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；血小板分布宽度(PDW)-静脉血: 9.2%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；总胆固醇(TC)-静脉血: 5.85mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336g/L；平均血小板体积(MPV)-静脉血: 9fL；血小板计数(PLT#)-静脉血: 19010E9/L；血小板比容-静脉血: 17%；红细胞比容(Hct)-静脉血: 42.3%；总胆汁酸(TBA)-静脉血: 1.8umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.76mmolL；胱抑素(Cys-C)-静脉血: 0.89mg/L；肌酐(Crea)-静脉血: 54.9umol/L；白蛋白(ALB)-静脉血: 46.6g/L；氯离子(Cl-)-静脉血: 97.8mmol/L；钾离子(K+)-静脉血: 3.78mmol/……\n- [全程D1109] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 28.2mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；钾离子(K+)-静脉血: 3.77mmol/L；甘油三酯(TG)-静脉血: 0.8mmol/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；红细胞计数(RBC#)-静脉血: 4.2410E12/L；总胆固醇(TC)-静脉血: 5.21mmol/L；镁离子(Mg2+)-静脉血: 0.97mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.6；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；总胆汁酸(TBA)-静脉血: 0.6umol/L；总胆红素(TBIL)-静脉血: 8.6umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.119；红细胞比容(Hct)-静脉血: 38.7%；尿素氮(BUN)-静脉血: 4.1mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；间接胆红素(IBIL)-静脉血: 6.5umolL；C-反应蛋白(CRP)-静脉血: 2.85mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.53mmolL；血小板分布宽度(PDW)-静脉血: 17.4%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.29mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；阴离子间隙(AG)-静脉血: 15；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；血小板计数(PLT#)-静脉血: 204.310E9/L；平均红细胞体积(MCV)-静脉血: 91.1fL；丙氨酸氨基转移酶(ALT)-静脉血: 12.3U/L；总蛋白(TP)-静脉血: 69.21g/L；直接胆红素(DBIL)-静脉血: 2.1umol/L；氯离子(Cl-)-静脉血: 95.7mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.784；中性粒细胞计数(Neut#)-静脉血: 2.310E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22.8U/L；平均血小板体积(MPV)-静脉血: 6.38fL；γ-谷氨酰基转移酶(GGT)-静脉血: 23.6U/L；总钙(Ca)-静脉血: 2.22mmol/L；单核……\n- [全程D1113] 检验组合: 血小板比容-静脉血: 15%；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 6.5；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.734；平均红细胞体积(MCV)-静脉血: 91.5fL；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；隐血(OB)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；中性粒细胞计数(Neut#)-静脉血: 2.310E9/L；总蛋白(TP)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 1/μL；红细胞计数(RBC#)-静脉血: 4.1310E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；血小板计数(PLT#)-静脉血: 16810E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；比重(SG)-尿液: 1.009；浊度(TRUB)-尿液: 清亮；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.05；大血小板百分比(P-LCR%)-静脉血: 18%；单核细胞计数(Mono#)-静脉血: 0.410E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.5；酮体(KET)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 13/μL；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-静脉血: 3.210E9/L；白细胞(LEU)-尿液: -（参考: 阴性）；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；红细胞比容(Hct)-静脉血: 37.8%；血红蛋白(Hb)-静脉血: 126g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.5；血小板分布宽度(PDW)-静脉血: 9.3%；淋巴细胞百分比(Lymph%)-静脉血: 0.103；平均红细胞血红蛋白浓度(MCHC)-静脉血: 333g/L；平均血小板体积(MPV)-静脉血: 8.9fL；单核细胞百分比(Mono%)-静脉血: 0.11\n- [全程D1114] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 16/μL；颜色-尿液: Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: +- 0.1g（参考: 阴性）；酮体(KET)-尿液: 1+ 1mmol（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 6.5；比重(SG)-尿液: 1.022；白细胞计数(WBC#)-尿液: 10/μL；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）\n- [全程D1116] 检验组合: 亚硝酸盐(NIT)-尿液: -（参考: 阴性）；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336.3g/L；阴离子间隙(AG)-静脉血: 12；总蛋白(TP)-尿液: -（参考: 阴性）；磷(P)-静脉血: 0.93mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20U/L；尿酸(UA)-静脉血: 199.4umol/L；平均红细胞体积(MCV)-静脉血: 92.9fL；碱性磷酸酶(ALP)-静脉血: 61.6U/L；酸碱度(pH)-尿液: 6.5；血小板分布宽度(PDW)-静脉血: 17%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.032；隐血(OB)-尿液: -（参考: 阴性）；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.44mmolL；肌酐(Crea)-静脉血: 67.5umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.2；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；氯离子(Cl-)-静脉血: 102.9mmol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；总胆红素(TBIL)-静脉血: 6.7umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14%；血小板计数(PLT#)-静脉血: 176.710E9/L；总蛋白(TP)-静脉血: 65.51g/L；尿素氮(BUN)-静脉血: 3.95mmol/L；红细胞计数(RBC#)-静脉血: 3.8510E12/L；甘油三酯(TG)-静脉血: 1.05mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；α-L-岩藻糖苷酶(AFU)-静脉血: 30U/L；间接胆红素(IBIL)-静脉血: 4.4umolL；总胆固醇(TC)-静脉血: 5.25mmol/L；浊度(TRUB)-尿液: 清亮；平均血小板体积(MPV)-静脉血: 6.6fL；胆红素(BIL)-尿液: -（参考: 阴性）；总胆汁酸(TBA)-静脉血: 0.2umol/L；载脂蛋白B(apoB)-静脉血: 0.98g/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；中性粒细胞计数(Neut#)-静脉血: 2.81……\n- [全程D1123] 检验组合: 红细胞计数(RBC#)-静脉血: 4.3710E12/L；中性粒细胞计数(Neut#)-静脉血: 310E9/L；平均红细胞体积(MCV)-静脉血: 90fL；甘油三酯(TG)-静脉血: 1.06mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.55；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.072；白蛋白(ALB)-静脉血: 44.8g/L；单核细胞百分比(Mono%)-静脉血: 0.081；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；红细胞比容(Hct)-静脉血: 39.4%；总钙(Ca)-静脉血: 2.44mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.8pg；血小板比容-静脉血: 10%；氯离子(Cl-)-静脉血: 92.5mmol/L；血小板计数(PLT#)-静脉血: 143.810E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.98mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4%；中性粒细胞百分比(Neut%)-静脉血: 0.841；总胆固醇(TC)-静脉血: 6.12mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 343.2g/L；间接胆红素(IBIL)-静脉血: 6.2umolL；尿素氮(BUN)-静脉血: 7.4mmol/L；平均血小板体积(MPV)-静脉血: 6.98fL；总胆红素(TBIL)-静脉血: 8.2umol/L；胱抑素(Cys-C)-静脉血: 0.86mg/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；载脂蛋白B(apoB)-静脉血: 1.37g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.9U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；C-反应蛋白(CRP)-静脉血: 10.49mg/L；球蛋白(GLO)-静脉血: 30.65g/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.46；葡萄糖(Glu)-静脉血: 5.64mmol/L；磷(P)-静脉血: 1.16mmol/L……\n- [全程D1125] 检验组合: 总钙(Ca)-静脉血: 2.38mmol/L；阴离子间隙(AG)-静脉血: 12.7；磷(P)-静脉血: 0.81mmol/L；氯离子(Cl-)-静脉血: 92.5mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 28.7mmol/L；钾离子(K+)-静脉血: 3.68mmol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；钠离子(Na+)-静脉血: 133.9mmol/L\n- [全程D1130] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对侧，双肺野纹理清晰，未见明显实质性病变。双侧肺门不大，纵隔不宽，心影形态、大小、位置未见异常。双膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见异常。\n- [全程D1130] 超声；肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。\n- [全程D1130] 检验组合: 有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞血红蛋白含量(MCH)-静脉血: 31.3pg；淋巴细胞百分比(Lymph%)-静脉血: 0.09；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4%；单核细胞计数(Mono#)-静脉血: 0.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.184；白蛋白(ALB)-静脉血: 43.5g/L；球蛋白(GLO)-静脉血: 29.66g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.32mmolL；总胆固醇(TC)-静脉血: 5.82mmol/L；葡萄糖(Glu)-静脉血: 5.74mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21U/L；中性粒细胞计数(Neut#)-静脉血: 1.510E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.9U/L；中性粒细胞百分比(Neut%)-静脉血: 0.715；尿酸(UA)-静脉血: 242.7umol/L；总胆汁酸(TBA)-静脉血: 0.2umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.005；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；血红蛋白(Hb)-静脉血: 125g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血小板分布宽度(PDW)-静脉血: 17.2%；总胆红素(TBIL)-静脉血: 6.6umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 28.4mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 344.5g/L；钾离子(K+)-静脉血: 3.7mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.8U/L；载脂蛋白B(apoB)-静脉血: 1.31g/L；红细胞计数(RBC#)-静脉血: 3.9910E12/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.4；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 90.9fL；总蛋白(TP)-静脉血: 73.16g/L；平均血小板体积(MPV)-静脉血: 6.84fL；血小板计数(PLT#)-静脉血: 181.410E9/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；低密度脂蛋白胆固醇(LDL-C)……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1082] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者目前诊断明确，[计划性表述已隐藏]根治性放疗及同期化疗。向患者及其家属交代病情，治疗方案及治疗风险，做好治疗前准备工作。\n- [全程D1083] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者入院第三天，无明显不适主诉，查体情况：一般情况可，余同入院。预约放疗。\n- [全程D1088] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 今日查房，患者无明显不适主诉，生命体征平稳。已予预约放疗。候治疗。\n- [全程D1093] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 今日查房，患者无明显不适主诉，生命体征平稳。查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常。患者现放疗计划已设计完成并通过全科会诊，靶区剂量分布均匀，正常组织剂量在可接受范围内。[姓名已隐去]医生信息已隐藏示：患者无明显放化疗禁忌症，拟于今日开始行根治性放疗+同时期化疗。向患者及其家属交代病情及化疗风险，表示理解并已签署知情同意书，可于今日执行第1程顺铂方案同时期化疗，注意化疗不良反应。\n- [全程D1098] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中，第1程顺铂方案同时期化疗结束。今日查房，患者诉呕吐2次，咽痛、恶心、食欲下降，伴头晕，无腹痛、腹泻等不适。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D1108] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中。今日查房，患者无明显不适主诉，生命体征平稳。[姓名已隐去]医生信息已隐藏：继续治疗。\n- [全程D1113] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中。今日查房，患者无明显不适主诉，生命体征平稳。查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：可于今日水化，明日执行第2程DDP方案同时期化疗，注意化疗不良反应。\n- [全程D1118] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中，第2程顺铂方案同时期化疗结束。诉咽痛、恶心、食欲下降，呕吐1次，伴头晕，无腹痛、腹泻等不适。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D1123] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中。今日查房，患者无明显不适主诉，生命体征平稳。[姓名已隐去]医生信息已隐藏：患者治疗疗程过半，予预约治疗结束后影像学复查。继续治疗。\n- [全程D1129] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中。今日查房，患者无明显不适主诉，生命体征平稳。[姓名已隐去]医生信息已隐藏：嘱患者冲洗鼻咽，保持鼻咽清洁。继续治疗。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即行鼻咽及颈部MRI复查，视近期疗效评估结果调整放疗靶区及剂量。\nB. 安排第3程顺铂同期化疗，并继续住院完成剩余根治性放疗疗程。\nC. 暂停放疗，行全身PET-CT检查以排除远处转移，待结果回报后决定后续方案。\nD. 办理出院，结束所有抗肿瘤治疗，进入定期随访阶段，1个月后复查MRI。\nE. 调整化疗方案为紫杉醇+顺铂，继续住院行第3程同期化疗及放疗。\nF. 立即行鼻咽镜检查及活检，视病理退缩情况调整后续放疗方案。\nG. 办理出院，转门诊继续放疗，并加用西妥昔单抗靶向治疗。\nH. 继续住院完成剩余放疗，期间每周复查血常规及生化，待放疗结束后出院。\nI. 办理出院，转门诊继续放疗，并立即启动顺铂+氟尿嘧啶方案辅助化疗。\nJ. 立即行胸部CT及腹部增强CT，视全面评估结果决定是否继续门诊放疗。\nK. 办理出院，转门诊继续完成根治性放疗，每周复查血常规及生化，指导鼻腔冲洗与功能锻炼。\nL. 暂停放疗，给予重组人粒细胞刺激因子及升血小板治疗，待血象完全恢复正常后继续放疗。\n\n请仅输出一个选项字母（A-L）。"}]}
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full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 涕血1年余，头痛3月；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 额部疼痛,涕血；既往史: 高血压10年余服药治疗中，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.9℃，P：72次/分，R：20次/分，BP：127/91mmHg,Ht：160cm，Wt：62.5kg，BSA：1.65m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽右侧顶后壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 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90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 鼻咽及颈部增强CT，胸部CT、腹部超声及全身骨扫描，以及包含EBV-DNA的基线血液学检查\nB. 鼻咽镜检查及活检，鼻咽及颈部增强CT，胸部CT、腹部超声及全身骨扫描，以及常规血液学检查\nC. 鼻咽镜检查及活检，鼻咽及颈部增强MRI，常规血液学检查，暂缓全身远处转移筛查\nD. 鼻咽及颈部增强MRI，全身PET-CT，包含EBV-DNA的基线血液学检查，直接安排诱导化疗\nE. 鼻咽镜检查及活检，鼻咽及颈部增强MRI，胸部X线、腹部超声，以及常规血液学检查\nF. 鼻咽及颈部增强MRI，颈部淋巴结穿刺活检，胸部CT、腹部超声及全身骨扫描，以及包含EBV-DNA的基线血液学检查\nG. 鼻咽镜检查及活检，鼻咽及颈部增强MRI，全身PET-CT，随后行鼻咽肿物切除术\nH. 鼻咽镜检查及活检，鼻咽及颈部平扫MRI，胸部CT、腹部超声及全身骨扫描，以及包含EBV-DNA的基线血液学检查\nI. 鼻咽镜检查及活检，鼻咽及颈部增强MRI，胸部CT、腹部超声及全身骨扫描，暂缓基线血液学及EBV-DNA检测\nJ. 鼻咽镜检查及活检，鼻咽及颈部增强CT，全身PET-CT，以及包含EBV-DNA的基线血液学检查\nK. 鼻咽及颈部增强MRI，胸部CT、腹部超声及全身骨扫描，包含EBV-DNA的基线血液学检查，随后行根治性放疗\nL. 鼻咽镜检查及活检，鼻咽及颈部增强MRI，胸部CT、腹部超声及全身骨扫描，以及包含EBV-DNA的基线血液学检查\n\n请仅输出一个选项字母（A-L）。"}]}
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full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 涕血1年余，头痛3月；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 额部疼痛,涕血；既往史: 高血压10年余服药治疗中，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.9℃，P：72次/分，R：20次/分，BP：127/91mmHg,Ht：160cm，Wt：62.5kg，BSA：1.65m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽右侧顶后壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 Ⅰ、Ⅱ、Ⅲ、aVF、V4～V6导联ST段下移\n- [全程D1] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；球蛋白(GLO)-静脉血: 30.03g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.9mmol/L；D-二聚体(D-Dimer)-静脉血: 0.13ug/ml；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；氯离子(Cl-)-静脉血: 98.1mmol/L；平均红细胞体积(MCV)-静脉血: 87.2fL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.91；大血小板百分比(P-LCR%)-静脉血: 33.4%；甘油三酯(TG)-静脉血: 1.01mmol/L；总钙(Ca)-静脉血: 2.28mmol/L；总胆固醇(TC)-静脉血: 5.44mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 25.2U/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 40.9umol/L；纤维蛋白原(Fbg)-静脉血: 2.51g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 20U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.34mmolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.58mmol/L；白细胞计数(WBC#)-静脉血: 6.9810E9/L；凝血酶时间(TT)-静脉血: 17.5sec.；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.013；红细胞计数(RBC#)-静脉血: 4.6710E12/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.98；直接胆红素(DBIL)-静脉血: 3.4umol/L；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 26.3mmol/L；磷(P)-静脉血: 1.03mmol/L；尿酸(UA)-静脉血: 391.1umol/L；碱性磷酸酶(ALP)-静脉血……\n- [全程D5] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁及右侧壁粘膜增厚放射性浓聚，SUV约7.3，病灶疑累及蝶骨基底部；右侧咽隐窝变浅；双侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见明显异常。口咽及喉咽结构及放射性分布未见明显异常。额窦、蝶窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双上颈小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。双乳腺结构及放射性分布未见明显异常。 肝S7点状高密度影放射性缺损，CT值约124Hu；其余肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 子宫边缘弧形改变，见结节状稍高密度影放射性分布未见明显异常，大小约3.8×4.3cm；左附件囊性低密度影放射性稀疏，大小约2.2×2.3cm，CT值约22Hu。膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 所见颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽顶壁及右侧壁粘膜增厚代谢活跃，考虑鼻咽癌，疑累及蝶骨基底部。 肝S7肝内胆管结石。 子宫肌瘤。 左附件囊肿。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行鼻咽镜检查及局部活检，并完善鼻咽及颈部增强MRI\nB. 行鼻咽镜检查及局部活检，并完善鼻咽及颈部平扫CT\nC. 行鼻咽镜检查及局部活检，无需补充其他局部影像学检查\nD. 完善鼻咽及颈部增强MRI，并直接开始根治性放疗\nE. 行鼻咽镜检查及局部活检，并完善全身骨扫描及胸部平扫CT\nF. 行鼻咽镜检查及局部活检，并完善头颅增强MRI及颈部超声\nG. 完善鼻咽及颈部增强MRI，并择期行鼻咽部肿物切除术\nH. 行鼻咽镜检查及局部活检，并完善颈部淋巴结穿刺活检\nI. 行鼻咽镜检查及局部活检，并完善鼻咽及颈部增强CT\nJ. 完善鼻咽及颈部增强MRI，并完善外周血EBV-DNA定量检测\nK. 行鼻咽镜检查及局部活检，并完善盆腔增强MRI及妇科超声\nL. 行鼻咽镜检查及局部活检，并完善脑脊液脱落细胞学检查\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 涕血1年余，头痛3月；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 额部疼痛,涕血；既往史: 高血压10年余服药治疗中，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.9℃，P：72次/分，R：20次/分，BP：127/91mmHg,Ht：160cm，Wt：62.5kg，BSA：1.65m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽右侧顶后壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 Ⅰ、Ⅱ、Ⅲ、aVF、V4～V6导联ST段下移\n- [全程D1] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；球蛋白(GLO)-静脉血: 30.03g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.9mmol/L；D-二聚体(D-Dimer)-静脉血: 0.13ug/ml；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；氯离子(Cl-)-静脉血: 98.1mmol/L；平均红细胞体积(MCV)-静脉血: 87.2fL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.91；大血小板百分比(P-LCR%)-静脉血: 33.4%；甘油三酯(TG)-静脉血: 1.01mmol/L；总钙(Ca)-静脉血: 2.28mmol/L；总胆固醇(TC)-静脉血: 5.44mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 25.2U/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 40.9umol/L；纤维蛋白原(Fbg)-静脉血: 2.51g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 20U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.34mmolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.58mmol/L；白细胞计数(WBC#)-静脉血: 6.9810E9/L；凝血酶时间(TT)-静脉血: 17.5sec.；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.013；红细胞计数(RBC#)-静脉血: 4.6710E12/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.98；直接胆红素(DBIL)-静脉血: 3.4umol/L；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 26.3mmol/L；磷(P)-静脉血: 1.03mmol/L；尿酸(UA)-静脉血: 391.1umol/L；碱性磷酸酶(ALP)-静脉血……\n- [全程D5] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁及右侧壁粘膜增厚放射性浓聚，SUV约7.3，病灶疑累及蝶骨基底部；右侧咽隐窝变浅；双侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见明显异常。口咽及喉咽结构及放射性分布未见明显异常。额窦、蝶窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双上颈小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。双乳腺结构及放射性分布未见明显异常。 肝S7点状高密度影放射性缺损，CT值约124Hu；其余肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 子宫边缘弧形改变，见结节状稍高密度影放射性分布未见明显异常，大小约3.8×4.3cm；左附件囊性低密度影放射性稀疏，大小约2.2×2.3cm，CT值约22Hu。膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 所见颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽顶壁及右侧壁粘膜增厚代谢活跃，考虑鼻咽癌，疑累及蝶骨基底部。 肝S7肝内胆管结石。 子宫肌瘤。 左附件囊肿。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行鼻咽镜检查及局部活检，并完善鼻咽及颈部增强MRI\nB. 行鼻咽镜检查及局部活检，并完善鼻咽及颈部平扫CT\nC. 行鼻咽镜检查及局部活检，无需补充其他局部影像学检查\nD. 完善鼻咽及颈部增强MRI，并直接开始根治性放疗\nE. 行鼻咽镜检查及局部活检，并完善全身骨扫描及胸部平扫CT\nF. 行鼻咽镜检查及局部活检，并完善头颅增强MRI及颈部超声\nG. 完善鼻咽及颈部增强MRI，并择期行鼻咽部肿物切除术\nH. 行鼻咽镜检查及局部活检，并完善颈部淋巴结穿刺活检\nI. 行鼻咽镜检查及局部活检，并完善鼻咽及颈部增强CT\nJ. 完善鼻咽及颈部增强MRI，并完善外周血EBV-DNA定量检测\nK. 行鼻咽镜检查及局部活检，并完善盆腔增强MRI及妇科超声\nL. 行鼻咽镜检查及局部活检，并完善脑脊液脱落细胞学检查\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-75c75fa1e197461f4b0d7395","patient_id":"patient-79fa00752e4405e2980f6292","turn_id":"turn06","turn_position":3,"turn_type":"toxicity_or_support_decision","gold_letter":"E","gold_action":"继续根治性放疗与顺铂同期化疗，予以止呕、护胃、补液及补钾等支持治疗，并安排放疗中段MRI评估。","options":[{"letter":"A","text":"暂停顺铂同期化疗，继续根治性放疗，予以止呕、补液、补钾等支持治疗，并安排放疗中段MRI评估。","is_gold":false},{"letter":"B","text":"顺铂减量20%继续同期化疗，继续根治性放疗，予以止呕、补液等支持治疗，暂不复查MRI。","is_gold":false},{"letter":"C","text":"继续根治性放疗与顺铂同期化疗，予以止呕、护胃治疗，暂不予补液及补钾，并安排放疗中段MRI评估。","is_gold":false},{"letter":"D","text":"暂停根治性放疗与顺铂同期化疗，予以积极补液、补钾治疗，暂不安排影像学评估。","is_gold":false},{"letter":"E","text":"继续根治性放疗与顺铂同期化疗，予以止呕、护胃、补液及补钾等支持治疗，并安排放疗中段MRI评估。","is_gold":true},{"letter":"F","text":"继续根治性放疗与顺铂同期化疗，予以止呕、护胃、补液及补钾等支持治疗，并安排PET-CT评估全身疗效。","is_gold":false},{"letter":"G","text":"暂停顺铂同期化疗，改为替加氟口服化疗，继续根治性放疗，予以止呕、补钾等支持治疗。","is_gold":false},{"letter":"H","text":"继续根治性放疗与顺铂同期化疗，予以止呕、护胃、补液及补钾等支持治疗，并安排鼻咽镜活检评估疗效。","is_gold":false},{"letter":"I","text":"顺铂减量50%继续同期化疗，继续根治性放疗，予以止呕、补液及补钾等支持治疗，并安排放疗中段MRI评估。","is_gold":false},{"letter":"J","text":"继续根治性放疗，取消后续化疗，予以止呕、补液及补钾等支持治疗，并安排放疗中段MRI评估。","is_gold":false},{"letter":"K","text":"继续根治性放疗与顺铂同期化疗，予以止呕、护胃、补液治疗，暂不予补钾，并安排放疗中段MRI评估。","is_gold":false},{"letter":"L","text":"暂停根治性放疗，继续顺铂同期化疗，予以止呕、补液及补钾等支持治疗，并安排放疗中段MRI评估。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 涕血1年余，头痛3月；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 额部疼痛,涕血；既往史: 高血压10年余服药治疗中，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.9℃，P：72次/分，R：20次/分，BP：127/91mmHg,Ht：160cm，Wt：62.5kg，BSA：1.65m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽右侧顶后壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D52] 入院记录: 主诉: 鼻咽癌一程化疗后两周余；现病史: 缘于1年前患者无明显诱因出现回吸性涕血，无头痛、鼻塞、耳鸣、复视、面麻等不适，未予重视，3个月前出现前额部疼痛，伴鼻衅，并于当地医院行鼻咽活检病理考虑鼻咽低分化型癌可能性大。于某次就诊时间10月底来我科就诊，并行根治性放疗计划设计，于某次就诊时间开始行根治性放疗，同时期予以DDP化疗1程，治疗过程顺利。今同期化疗到期来我科继续治疗，患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 额部疼痛,涕血；既往史: 高血压10年余服药治疗中，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.9℃，P：72次/分，R：20次/分，BP：127/91mmHg,Ht：160cm，Wt：62.5kg，BSA：1.65m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率72次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽右侧顶后壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 Ⅰ、Ⅱ、Ⅲ、aVF、V4～V6导联ST段下移\n- [全程D1] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；球蛋白(GLO)-静脉血: 30.03g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.9mmol/L；D-二聚体(D-Dimer)-静脉血: 0.13ug/ml；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；氯离子(Cl-)-静脉血: 98.1mmol/L；平均红细胞体积(MCV)-静脉血: 87.2fL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.91；大血小板百分比(P-LCR%)-静脉血: 33.4%；甘油三酯(TG)-静脉血: 1.01mmol/L；总钙(Ca)-静脉血: 2.28mmol/L；总胆固醇(TC)-静脉血: 5.44mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 25.2U/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 40.9umol/L；纤维蛋白原(Fbg)-静脉血: 2.51g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 20U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.34mmolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.58mmol/L；白细胞计数(WBC#)-静脉血: 6.9810E9/L；凝血酶时间(TT)-静脉血: 17.5sec.；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.013；红细胞计数(RBC#)-静脉血: 4.6710E12/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.98；直接胆红素(DBIL)-静脉血: 3.4umol/L；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 26.3mmol/L；磷(P)-静脉血: 1.03mmol/L；尿酸(UA)-静脉血: 391.1umol/L；碱性磷酸酶(ALP)-静脉血……\n- [全程D5] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁及右侧壁粘膜增厚放射性浓聚，SUV约7.3，病灶疑累及蝶骨基底部；右侧咽隐窝变浅；双侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见明显异常。口咽及喉咽结构及放射性分布未见明显异常。额窦、蝶窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双上颈小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。双乳腺结构及放射性分布未见明显异常。 肝S7点状高密度影放射性缺损，CT值约124Hu；其余肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 子宫边缘弧形改变，见结节状稍高密度影放射性分布未见明显异常，大小约3.8×4.3cm；左附件囊性低密度影放射性稀疏，大小约2.2×2.3cm，CT值约22Hu。膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 所见颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽顶壁及右侧壁粘膜增厚代谢活跃，考虑鼻咽癌，疑累及蝶骨基底部。 肝S7肝内胆管结石。 子宫肌瘤。 左附件囊肿。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D26] 检验组合: 比重(SG)-尿液: 1.019；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；酮体(KET)-尿液: +-（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: Turbid；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 82/μL；总蛋白(TP)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；白细胞计数(WBC#)-尿液: 17/μL\n- [全程D27] 检验组合: 血小板分布宽度(PDW)-静脉血: 12.2%；平均血小板体积(MPV)-静脉血: 11.2fL；红细胞比容(Hct)-静脉血: 37.5%；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；红细胞比容(Hct)-静脉血: 35.5%；碱性磷酸酶(ALP)-静脉血: 91.7U/L；白蛋白(ALB)-静脉血: 45.5g/L；C-反应蛋白(CRP)-静脉血: 1.15mg/L；血红蛋白(Hb)-静脉血: 121g/L；直接胆红素(DBIL)-静脉血: 3.7umol/L；血红蛋白(Hb)-静脉血: 111g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.4；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；葡萄糖(Glu)-静脉血: 5.1mmol/L；白细胞计数(WBC#)-静脉血: 13.710E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.51mmolL；红细胞计数(RBC#)-静脉血: 3.8810E12/L；颜色-尿液: Light-Orange；尿素氮(BUN)-静脉血: 5.77mmol/L；胱抑素(Cys-C)-静脉血: 0.99mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.59；钾离子(K+)-静脉血: 4.2mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 19U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 266.5U/L；磷(P)-静脉血: 1.03mmol/L；中性粒细胞计数(Neut#)-静脉血: 4.110E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.241；平均红细胞体积(MCV)-静脉血: 82.9fL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.81mmol/L；大血小板百分比(P-LCR%)-静脉血: 27.5%；红细胞计数(RBC#)-静脉血: 4.1410E12/L；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；甘油三酯(TG)-静脉血: 1.02mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.9；尿酸(UA)-静脉血: 295.4umol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.……\n- [全程D31] 检验组合: 丙氨酸氨基转移酶(ALT)-静脉血: 91.9U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 30.5U/L；碱性磷酸酶(ALP)-静脉血: 104.1U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 114U/L；乳酸脱氢酶(LDH)-静脉血: 159.5U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 23.5U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.33；总胆汁酸(TBA)-静脉血: 2umol/L\n- [全程D42] 检验组合: 磷(P)-静脉血: 1.12mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.66；钠离子(Na+)-静脉血: 139.9mmol/L；白蛋白(ALB)-静脉血: 43.7g/L；镁离子(Mg2+)-静脉血: 0.74mmol/L；钾离子(K+)-静脉血: 4.14mmol/L；氯离子(Cl-)-静脉血: 98mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 91.5U/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.5U/L；总胆红素(TBIL)-静脉血: 10.2umol/L；尿素氮(BUN)-静脉血: 5.7mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.7mmol/L；阴离子间隙(AG)-静脉血: 16.2；直接胆红素(DBIL)-静脉血: 3.2umol/L；尿酸(UA)-静脉血: 335.2umol/L；碱性磷酸酶(ALP)-静脉血: 75.1U/L；间接胆红素(IBIL)-静脉血: 7umolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.28；α-L-岩藻糖苷酶(AFU)-静脉血: 18.2U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.3U/L；球蛋白(GLO)-静脉血: 26.28g/L；总钙(Ca)-静脉血: 2.33mmol/L；肌酐(Crea)-静脉血: 77.8umol/L；总蛋白(TP)-静脉血: 69.98g/L；乳酸脱氢酶(LDH)-静脉血: 203.7U/L；总胆汁酸(TBA)-静脉血: 1.9umol/L\n- [全程D52] 检验组合: 白细胞计数(WBC#)-尿液: 2/μL；非鳞状上皮细胞计数-尿液: 3/μL；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；酸碱度(pH)-尿液: 6.5；红细胞计数(RBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；隐血(OB)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.014；尿胆原(URO)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 28/μL；总蛋白(TP)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 26/μL；白细胞(LEU)-尿液: -（参考: 阴性）\n- [全程D54] 检验组合: 红细胞计数(RBC#)-静脉血: 3.9510E12/L；血小板分布宽度(PDW)-静脉血: 12.5%；载脂蛋白B(apoB)-静脉血: 1.08g/L；酸碱度(pH)-尿液: 6.5；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.002；丙氨酸氨基转移酶(ALT)-静脉血: 12.3U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.092；尿素氮(BUN)-静脉血: 4.3mmol/L；酮体(KET)-尿液: 1+ 2mmol（参考: 阴性）；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.6；阴离子间隙(AG)-静脉血: 13.6；浊度(TRUB)-尿液: Turbid；颜色-尿液: Yellow；隐血(OB)-尿液: -（参考: 阴性）；镁离子(Mg2+)-静脉血: 0.61mmol/L；透明管型计数(HYAL#)-尿液: 1/μL；总胆红素(TBIL)-静脉血: 12umol/L；磷(P)-静脉血: 1.12mmol/L；浊度(TRUB)-尿液: Turbid；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿酸(UA)-静脉血: 317.3umol/L；总蛋白(TP)-尿液: 1+ 0.3g（参考: 阴性）；白蛋白(ALB)-静脉血: 42.2g/L；平均血小板体积(MPV)-静脉血: 10.8fL；中性粒细胞计数(Neut#)-静脉血: 3.410E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.1U/L；透明管型计数(HYAL#)-尿液: 2/μL；直接胆红素(DBIL)-静脉血: 3.8umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.67；白细胞计数(WBC#)-尿液: 25/μL；钾离子(K+)-静脉血: 3.33mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.6；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.08mmolL；比重(SG)-尿液: 1.024；未分类管型计数(UNCC#)-尿液: 2/μL；载脂蛋白AI(apoAI)-静脉血: 1.1g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.6pg；未分类管型计数(UNCC#)-尿液: 4/μL；隐血(OB)-尿液: -（参考: 阴性）；球蛋白(GLO)-静脉血: 25.25g/L；红细胞比容(H……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D26] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者入院第三天，无特殊不适主诉，体查情况基本同前，患者现一般情况尚可，今日开始行根治性放疗，同时期予以DDP方案化疗，并予以护胃、止呕等对症支持处理，密观患者病情。\n- [全程D31] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现处于放化综合治疗中，放疗4F，现已基本完成一程同期化疗，诉口干、腹胀、纳差，体查：张口门齿距4.5cm；鼻咽右侧顶后壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。复查生化常规结果示：ALT87.0U/L，[姓名已隐去]副医生信息已隐藏：患者在院行一程同期化疗期间，出现肝功轻度损伤，期间予以护肝等对症处理，现患者复查生化示肝功指标仍有轻度升高，继续予以护肝等对症处理，今日可出院，每周定期复查血常规、生化常规，定期门诊复诊，门诊继续放疗，按期[计划性表述已隐藏]下程治疗，不适随诊。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D53] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者入院第二天，现处于放化综合治疗中，放疗21F，诉口苦，体查情况：张口门齿距4.5cm；鼻咽右侧顶后壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。复查血常规、生化常规结果基本正常。[姓名已隐去]副医生信息已隐藏：现患者入院[计划性表述已隐藏]第二程顺铂同期方案化疗，昨日开始予以水化，目前患者情况尚可，今日可行化疗，并予以止呕、护胃、加强营养等对症支持治疗，针对患者口苦症状，为放疗引起常见急性不良反应，予以对症处理，病情继观。\n- [全程D54] 上级查房记录；[姓名已隐去]医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医师查房记录；病程内容: 患者入院第三天，现处于放化综合治疗中，放疗22F，诉恶心、呕吐，体查情况基本同前。[姓名已隐去]医师查房后示：现患者处于DDP方案同期化疗中，目前患者情况尚可，继续予以止呕、护胃、加强营养等对症支持治疗，病情继观。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停顺铂同期化疗，继续根治性放疗，予以止呕、补液、补钾等支持治疗，并安排放疗中段MRI评估。\nB. 顺铂减量20%继续同期化疗，继续根治性放疗，予以止呕、补液等支持治疗，暂不复查MRI。\nC. 继续根治性放疗与顺铂同期化疗，予以止呕、护胃治疗，暂不予补液及补钾，并安排放疗中段MRI评估。\nD. 暂停根治性放疗与顺铂同期化疗，予以积极补液、补钾治疗，暂不安排影像学评估。\nE. 继续根治性放疗与顺铂同期化疗，予以止呕、护胃、补液及补钾等支持治疗，并安排放疗中段MRI评估。\nF. 继续根治性放疗与顺铂同期化疗，予以止呕、护胃、补液及补钾等支持治疗，并安排PET-CT评估全身疗效。\nG. 暂停顺铂同期化疗，改为替加氟口服化疗，继续根治性放疗，予以止呕、补钾等支持治疗。\nH. 继续根治性放疗与顺铂同期化疗，予以止呕、护胃、补液及补钾等支持治疗，并安排鼻咽镜活检评估疗效。\nI. 顺铂减量50%继续同期化疗，继续根治性放疗，予以止呕、补液及补钾等支持治疗，并安排放疗中段MRI评估。\nJ. 继续根治性放疗，取消后续化疗，予以止呕、补液及补钾等支持治疗，并安排放疗中段MRI评估。\nK. 继续根治性放疗与顺铂同期化疗，予以止呕、护胃、补液治疗，暂不予补钾，并安排放疗中段MRI评估。\nL. 暂停根治性放疗，继续顺铂同期化疗，予以止呕、补液及补钾等支持治疗，并安排放疗中段MRI评估。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 涕血1年余，头痛3月；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 额部疼痛,涕血；既往史: 高血压10年余服药治疗中，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.9℃，P：72次/分，R：20次/分，BP：127/91mmHg,Ht：160cm，Wt：62.5kg，BSA：1.65m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽右侧顶后壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D52] 入院记录: 主诉: 鼻咽癌一程化疗后两周余；现病史: 缘于1年前患者无明显诱因出现回吸性涕血，无头痛、鼻塞、耳鸣、复视、面麻等不适，未予重视，3个月前出现前额部疼痛，伴鼻衅，并于当地医院行鼻咽活检病理考虑鼻咽低分化型癌可能性大。于某次就诊时间10月底来我科就诊，并行根治性放疗计划设计，于某次就诊时间开始行根治性放疗，同时期予以DDP化疗1程，治疗过程顺利。今同期化疗到期来我科继续治疗，患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 额部疼痛,涕血；既往史: 高血压10年余服药治疗中，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.9℃，P：72次/分，R：20次/分，BP：127/91mmHg,Ht：160cm，Wt：62.5kg，BSA：1.65m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率72次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽右侧顶后壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 Ⅰ、Ⅱ、Ⅲ、aVF、V4～V6导联ST段下移\n- [全程D1] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；球蛋白(GLO)-静脉血: 30.03g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.9mmol/L；D-二聚体(D-Dimer)-静脉血: 0.13ug/ml；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；氯离子(Cl-)-静脉血: 98.1mmol/L；平均红细胞体积(MCV)-静脉血: 87.2fL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.91；大血小板百分比(P-LCR%)-静脉血: 33.4%；甘油三酯(TG)-静脉血: 1.01mmol/L；总钙(Ca)-静脉血: 2.28mmol/L；总胆固醇(TC)-静脉血: 5.44mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 25.2U/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 40.9umol/L；纤维蛋白原(Fbg)-静脉血: 2.51g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 20U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.34mmolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.58mmol/L；白细胞计数(WBC#)-静脉血: 6.9810E9/L；凝血酶时间(TT)-静脉血: 17.5sec.；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.013；红细胞计数(RBC#)-静脉血: 4.6710E12/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.98；直接胆红素(DBIL)-静脉血: 3.4umol/L；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 26.3mmol/L；磷(P)-静脉血: 1.03mmol/L；尿酸(UA)-静脉血: 391.1umol/L；碱性磷酸酶(ALP)-静脉血……\n- [全程D5] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁及右侧壁粘膜增厚放射性浓聚，SUV约7.3，病灶疑累及蝶骨基底部；右侧咽隐窝变浅；双侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见明显异常。口咽及喉咽结构及放射性分布未见明显异常。额窦、蝶窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双上颈小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。双乳腺结构及放射性分布未见明显异常。 肝S7点状高密度影放射性缺损，CT值约124Hu；其余肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 子宫边缘弧形改变，见结节状稍高密度影放射性分布未见明显异常，大小约3.8×4.3cm；左附件囊性低密度影放射性稀疏，大小约2.2×2.3cm，CT值约22Hu。膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 所见颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽顶壁及右侧壁粘膜增厚代谢活跃，考虑鼻咽癌，疑累及蝶骨基底部。 肝S7肝内胆管结石。 子宫肌瘤。 左附件囊肿。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D26] 检验组合: 比重(SG)-尿液: 1.019；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；酮体(KET)-尿液: +-（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: Turbid；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 82/μL；总蛋白(TP)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；白细胞计数(WBC#)-尿液: 17/μL\n- [全程D27] 检验组合: 血小板分布宽度(PDW)-静脉血: 12.2%；平均血小板体积(MPV)-静脉血: 11.2fL；红细胞比容(Hct)-静脉血: 37.5%；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；红细胞比容(Hct)-静脉血: 35.5%；碱性磷酸酶(ALP)-静脉血: 91.7U/L；白蛋白(ALB)-静脉血: 45.5g/L；C-反应蛋白(CRP)-静脉血: 1.15mg/L；血红蛋白(Hb)-静脉血: 121g/L；直接胆红素(DBIL)-静脉血: 3.7umol/L；血红蛋白(Hb)-静脉血: 111g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.4；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；葡萄糖(Glu)-静脉血: 5.1mmol/L；白细胞计数(WBC#)-静脉血: 13.710E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.51mmolL；红细胞计数(RBC#)-静脉血: 3.8810E12/L；颜色-尿液: Light-Orange；尿素氮(BUN)-静脉血: 5.77mmol/L；胱抑素(Cys-C)-静脉血: 0.99mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.59；钾离子(K+)-静脉血: 4.2mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 19U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 266.5U/L；磷(P)-静脉血: 1.03mmol/L；中性粒细胞计数(Neut#)-静脉血: 4.110E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.241；平均红细胞体积(MCV)-静脉血: 82.9fL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.81mmol/L；大血小板百分比(P-LCR%)-静脉血: 27.5%；红细胞计数(RBC#)-静脉血: 4.1410E12/L；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；甘油三酯(TG)-静脉血: 1.02mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.9；尿酸(UA)-静脉血: 295.4umol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.……\n- [全程D31] 检验组合: 丙氨酸氨基转移酶(ALT)-静脉血: 91.9U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 30.5U/L；碱性磷酸酶(ALP)-静脉血: 104.1U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 114U/L；乳酸脱氢酶(LDH)-静脉血: 159.5U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 23.5U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.33；总胆汁酸(TBA)-静脉血: 2umol/L\n- [全程D42] 检验组合: 磷(P)-静脉血: 1.12mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.66；钠离子(Na+)-静脉血: 139.9mmol/L；白蛋白(ALB)-静脉血: 43.7g/L；镁离子(Mg2+)-静脉血: 0.74mmol/L；钾离子(K+)-静脉血: 4.14mmol/L；氯离子(Cl-)-静脉血: 98mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 91.5U/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.5U/L；总胆红素(TBIL)-静脉血: 10.2umol/L；尿素氮(BUN)-静脉血: 5.7mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.7mmol/L；阴离子间隙(AG)-静脉血: 16.2；直接胆红素(DBIL)-静脉血: 3.2umol/L；尿酸(UA)-静脉血: 335.2umol/L；碱性磷酸酶(ALP)-静脉血: 75.1U/L；间接胆红素(IBIL)-静脉血: 7umolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.28；α-L-岩藻糖苷酶(AFU)-静脉血: 18.2U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.3U/L；球蛋白(GLO)-静脉血: 26.28g/L；总钙(Ca)-静脉血: 2.33mmol/L；肌酐(Crea)-静脉血: 77.8umol/L；总蛋白(TP)-静脉血: 69.98g/L；乳酸脱氢酶(LDH)-静脉血: 203.7U/L；总胆汁酸(TBA)-静脉血: 1.9umol/L\n- [全程D52] 检验组合: 白细胞计数(WBC#)-尿液: 2/μL；非鳞状上皮细胞计数-尿液: 3/μL；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；酸碱度(pH)-尿液: 6.5；红细胞计数(RBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；隐血(OB)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.014；尿胆原(URO)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 28/μL；总蛋白(TP)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 26/μL；白细胞(LEU)-尿液: -（参考: 阴性）\n- [全程D54] 检验组合: 红细胞计数(RBC#)-静脉血: 3.9510E12/L；血小板分布宽度(PDW)-静脉血: 12.5%；载脂蛋白B(apoB)-静脉血: 1.08g/L；酸碱度(pH)-尿液: 6.5；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.002；丙氨酸氨基转移酶(ALT)-静脉血: 12.3U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.092；尿素氮(BUN)-静脉血: 4.3mmol/L；酮体(KET)-尿液: 1+ 2mmol（参考: 阴性）；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.6；阴离子间隙(AG)-静脉血: 13.6；浊度(TRUB)-尿液: Turbid；颜色-尿液: Yellow；隐血(OB)-尿液: -（参考: 阴性）；镁离子(Mg2+)-静脉血: 0.61mmol/L；透明管型计数(HYAL#)-尿液: 1/μL；总胆红素(TBIL)-静脉血: 12umol/L；磷(P)-静脉血: 1.12mmol/L；浊度(TRUB)-尿液: Turbid；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿酸(UA)-静脉血: 317.3umol/L；总蛋白(TP)-尿液: 1+ 0.3g（参考: 阴性）；白蛋白(ALB)-静脉血: 42.2g/L；平均血小板体积(MPV)-静脉血: 10.8fL；中性粒细胞计数(Neut#)-静脉血: 3.410E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.1U/L；透明管型计数(HYAL#)-尿液: 2/μL；直接胆红素(DBIL)-静脉血: 3.8umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.67；白细胞计数(WBC#)-尿液: 25/μL；钾离子(K+)-静脉血: 3.33mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.6；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.08mmolL；比重(SG)-尿液: 1.024；未分类管型计数(UNCC#)-尿液: 2/μL；载脂蛋白AI(apoAI)-静脉血: 1.1g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.6pg；未分类管型计数(UNCC#)-尿液: 4/μL；隐血(OB)-尿液: -（参考: 阴性）；球蛋白(GLO)-静脉血: 25.25g/L；红细胞比容(H……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D26] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者入院第三天，无特殊不适主诉，体查情况基本同前，患者现一般情况尚可，今日开始行根治性放疗，同时期予以DDP方案化疗，并予以护胃、止呕等对症支持处理，密观患者病情。\n- [全程D31] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现处于放化综合治疗中，放疗4F，现已基本完成一程同期化疗，诉口干、腹胀、纳差，体查：张口门齿距4.5cm；鼻咽右侧顶后壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。复查生化常规结果示：ALT87.0U/L，[姓名已隐去]副医生信息已隐藏：患者在院行一程同期化疗期间，出现肝功轻度损伤，期间予以护肝等对症处理，现患者复查生化示肝功指标仍有轻度升高，继续予以护肝等对症处理，今日可出院，每周定期复查血常规、生化常规，定期门诊复诊，门诊继续放疗，按期[计划性表述已隐藏]下程治疗，不适随诊。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D53] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者入院第二天，现处于放化综合治疗中，放疗21F，诉口苦，体查情况：张口门齿距4.5cm；鼻咽右侧顶后壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。复查血常规、生化常规结果基本正常。[姓名已隐去]副医生信息已隐藏：现患者入院[计划性表述已隐藏]第二程顺铂同期方案化疗，昨日开始予以水化，目前患者情况尚可，今日可行化疗，并予以止呕、护胃、加强营养等对症支持治疗，针对患者口苦症状，为放疗引起常见急性不良反应，予以对症处理，病情继观。\n- [全程D54] 上级查房记录；[姓名已隐去]医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医师查房记录；病程内容: 患者入院第三天，现处于放化综合治疗中，放疗22F，诉恶心、呕吐，体查情况基本同前。[姓名已隐去]医师查房后示：现患者处于DDP方案同期化疗中，目前患者情况尚可，继续予以止呕、护胃、加强营养等对症支持治疗，病情继观。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停顺铂同期化疗，继续根治性放疗，予以止呕、补液、补钾等支持治疗，并安排放疗中段MRI评估。\nB. 顺铂减量20%继续同期化疗，继续根治性放疗，予以止呕、补液等支持治疗，暂不复查MRI。\nC. 继续根治性放疗与顺铂同期化疗，予以止呕、护胃治疗，暂不予补液及补钾，并安排放疗中段MRI评估。\nD. 暂停根治性放疗与顺铂同期化疗，予以积极补液、补钾治疗，暂不安排影像学评估。\nE. 继续根治性放疗与顺铂同期化疗，予以止呕、护胃、补液及补钾等支持治疗，并安排放疗中段MRI评估。\nF. 继续根治性放疗与顺铂同期化疗，予以止呕、护胃、补液及补钾等支持治疗，并安排PET-CT评估全身疗效。\nG. 暂停顺铂同期化疗，改为替加氟口服化疗，继续根治性放疗，予以止呕、补钾等支持治疗。\nH. 继续根治性放疗与顺铂同期化疗，予以止呕、护胃、补液及补钾等支持治疗，并安排鼻咽镜活检评估疗效。\nI. 顺铂减量50%继续同期化疗，继续根治性放疗，予以止呕、补液及补钾等支持治疗，并安排放疗中段MRI评估。\nJ. 继续根治性放疗，取消后续化疗，予以止呕、补液及补钾等支持治疗，并安排放疗中段MRI评估。\nK. 继续根治性放疗与顺铂同期化疗，予以止呕、护胃、补液治疗，暂不予补钾，并安排放疗中段MRI评估。\nL. 暂停根治性放疗，继续顺铂同期化疗，予以止呕、补液及补钾等支持治疗，并安排放疗中段MRI评估。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-cc72c6bbde9abe2a112ce0fc","patient_id":"patient-79fa00752e4405e2980f6292","turn_id":"turn07","turn_position":4,"turn_type":"response_assessment_decision","gold_letter":"B","gold_action":"评估腹部无转移征象，继续根治性放疗，予以重组人促红素皮下注射改善贫血，并动态复查血常规。","options":[{"letter":"A","text":"评估腹部无转移征象，继续根治性放疗，予以重组人粒细胞刺激因子皮下注射，待血常规恢复后重启化疗。","is_gold":false},{"letter":"B","text":"评估腹部无转移征象，继续根治性放疗，予以重组人促红素皮下注射改善贫血，并动态复查血常规。","is_gold":true},{"letter":"C","text":"腹部彩超见可疑占位，暂停放疗，行肝脏MRI平扫+增强以明确病变性质。","is_gold":false},{"letter":"D","text":"评估腹部无转移征象，继续根治性放疗，并即刻启动第三程顺铂同期化疗。","is_gold":false},{"letter":"E","text":"评估腹部无转移征象，提前结束放疗，转为顺铂联合氟尿嘧啶方案辅助化疗。","is_gold":false},{"letter":"F","text":"评估腹部无转移征象，继续根治性放疗，予以利可君口服改善骨髓抑制，并动态复查血常规。","is_gold":false},{"letter":"G","text":"评估腹部无转移征象，继续根治性放疗，予以异甘草酸镁静脉滴注强化保肝治疗。","is_gold":false},{"letter":"H","text":"评估腹部无转移征象，继续根治性放疗，予以输注单采血小板预防出血，并动态复查血常规。","is_gold":false},{"letter":"I","text":"评估腹部无转移征象，暂停放疗，行全身PET/CT检查以全面评估近期疗效。","is_gold":false},{"letter":"J","text":"评估腹部无转移征象，继续根治性放疗，予以昂丹司琼强化止吐，并预防性放置胃管。","is_gold":false},{"letter":"K","text":"评估腹部无转移征象，继续根治性放疗，加用尼妥珠单抗靶向治疗以提高局部控制率。","is_gold":false},{"letter":"L","text":"评估腹部无转移征象，继续根治性放疗，予以地塞米松口服改善骨髓抑制，并动态复查血常规。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 涕血1年余，头痛3月；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 额部疼痛,涕血；既往史: 高血压10年余服药治疗中，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.9℃，P：72次/分，R：20次/分，BP：127/91mmHg,Ht：160cm，Wt：62.5kg，BSA：1.65m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽右侧顶后壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D52] 入院记录: 主诉: 鼻咽癌一程化疗后两周余；现病史: 缘于1年前患者无明显诱因出现回吸性涕血，无头痛、鼻塞、耳鸣、复视、面麻等不适，未予重视，3个月前出现前额部疼痛，伴鼻衅，并于当地医院行鼻咽活检病理考虑鼻咽低分化型癌可能性大。于某次就诊时间10月底来我科就诊，并行根治性放疗计划设计，于某次就诊时间开始行根治性放疗，同时期予以DDP化疗1程，治疗过程顺利。今同期化疗到期来我科继续治疗，患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 额部疼痛,涕血；既往史: 高血压10年余服药治疗中，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.9℃，P：72次/分，R：20次/分，BP：127/91mmHg,Ht：160cm，Wt：62.5kg，BSA：1.65m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率72次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽右侧顶后壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 Ⅰ、Ⅱ、Ⅲ、aVF、V4～V6导联ST段下移\n- [全程D1] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；球蛋白(GLO)-静脉血: 30.03g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.9mmol/L；D-二聚体(D-Dimer)-静脉血: 0.13ug/ml；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；氯离子(Cl-)-静脉血: 98.1mmol/L；平均红细胞体积(MCV)-静脉血: 87.2fL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.91；大血小板百分比(P-LCR%)-静脉血: 33.4%；甘油三酯(TG)-静脉血: 1.01mmol/L；总钙(Ca)-静脉血: 2.28mmol/L；总胆固醇(TC)-静脉血: 5.44mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 25.2U/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 40.9umol/L；纤维蛋白原(Fbg)-静脉血: 2.51g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 20U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.34mmolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.58mmol/L；白细胞计数(WBC#)-静脉血: 6.9810E9/L；凝血酶时间(TT)-静脉血: 17.5sec.；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.013；红细胞计数(RBC#)-静脉血: 4.6710E12/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.98；直接胆红素(DBIL)-静脉血: 3.4umol/L；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 26.3mmol/L；磷(P)-静脉血: 1.03mmol/L；尿酸(UA)-静脉血: 391.1umol/L；碱性磷酸酶(ALP)-静脉血……\n- [全程D5] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁及右侧壁粘膜增厚放射性浓聚，SUV约7.3，病灶疑累及蝶骨基底部；右侧咽隐窝变浅；双侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见明显异常。口咽及喉咽结构及放射性分布未见明显异常。额窦、蝶窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双上颈小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。双乳腺结构及放射性分布未见明显异常。 肝S7点状高密度影放射性缺损，CT值约124Hu；其余肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 子宫边缘弧形改变，见结节状稍高密度影放射性分布未见明显异常，大小约3.8×4.3cm；左附件囊性低密度影放射性稀疏，大小约2.2×2.3cm，CT值约22Hu。膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 所见颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽顶壁及右侧壁粘膜增厚代谢活跃，考虑鼻咽癌，疑累及蝶骨基底部。 肝S7肝内胆管结石。 子宫肌瘤。 左附件囊肿。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D26] 检验组合: 比重(SG)-尿液: 1.019；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；酮体(KET)-尿液: +-（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: Turbid；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 82/μL；总蛋白(TP)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；白细胞计数(WBC#)-尿液: 17/μL\n- [全程D27] 检验组合: 血小板分布宽度(PDW)-静脉血: 12.2%；平均血小板体积(MPV)-静脉血: 11.2fL；红细胞比容(Hct)-静脉血: 37.5%；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；红细胞比容(Hct)-静脉血: 35.5%；碱性磷酸酶(ALP)-静脉血: 91.7U/L；白蛋白(ALB)-静脉血: 45.5g/L；C-反应蛋白(CRP)-静脉血: 1.15mg/L；血红蛋白(Hb)-静脉血: 121g/L；直接胆红素(DBIL)-静脉血: 3.7umol/L；血红蛋白(Hb)-静脉血: 111g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.4；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；葡萄糖(Glu)-静脉血: 5.1mmol/L；白细胞计数(WBC#)-静脉血: 13.710E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.51mmolL；红细胞计数(RBC#)-静脉血: 3.8810E12/L；颜色-尿液: Light-Orange；尿素氮(BUN)-静脉血: 5.77mmol/L；胱抑素(Cys-C)-静脉血: 0.99mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.59；钾离子(K+)-静脉血: 4.2mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 19U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 266.5U/L；磷(P)-静脉血: 1.03mmol/L；中性粒细胞计数(Neut#)-静脉血: 4.110E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.241；平均红细胞体积(MCV)-静脉血: 82.9fL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.81mmol/L；大血小板百分比(P-LCR%)-静脉血: 27.5%；红细胞计数(RBC#)-静脉血: 4.1410E12/L；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；甘油三酯(TG)-静脉血: 1.02mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.9；尿酸(UA)-静脉血: 295.4umol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.……\n- [全程D31] 检验组合: 丙氨酸氨基转移酶(ALT)-静脉血: 91.9U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 30.5U/L；碱性磷酸酶(ALP)-静脉血: 104.1U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 114U/L；乳酸脱氢酶(LDH)-静脉血: 159.5U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 23.5U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.33；总胆汁酸(TBA)-静脉血: 2umol/L\n- [全程D42] 检验组合: 磷(P)-静脉血: 1.12mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.66；钠离子(Na+)-静脉血: 139.9mmol/L；白蛋白(ALB)-静脉血: 43.7g/L；镁离子(Mg2+)-静脉血: 0.74mmol/L；钾离子(K+)-静脉血: 4.14mmol/L；氯离子(Cl-)-静脉血: 98mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 91.5U/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.5U/L；总胆红素(TBIL)-静脉血: 10.2umol/L；尿素氮(BUN)-静脉血: 5.7mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.7mmol/L；阴离子间隙(AG)-静脉血: 16.2；直接胆红素(DBIL)-静脉血: 3.2umol/L；尿酸(UA)-静脉血: 335.2umol/L；碱性磷酸酶(ALP)-静脉血: 75.1U/L；间接胆红素(IBIL)-静脉血: 7umolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.28；α-L-岩藻糖苷酶(AFU)-静脉血: 18.2U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.3U/L；球蛋白(GLO)-静脉血: 26.28g/L；总钙(Ca)-静脉血: 2.33mmol/L；肌酐(Crea)-静脉血: 77.8umol/L；总蛋白(TP)-静脉血: 69.98g/L；乳酸脱氢酶(LDH)-静脉血: 203.7U/L；总胆汁酸(TBA)-静脉血: 1.9umol/L\n- [全程D52] 检验组合: 白细胞计数(WBC#)-尿液: 2/μL；非鳞状上皮细胞计数-尿液: 3/μL；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；酸碱度(pH)-尿液: 6.5；红细胞计数(RBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；隐血(OB)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.014；尿胆原(URO)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 28/μL；总蛋白(TP)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 26/μL；白细胞(LEU)-尿液: -（参考: 阴性）\n- [全程D54] 检验组合: 红细胞计数(RBC#)-静脉血: 3.9510E12/L；血小板分布宽度(PDW)-静脉血: 12.5%；载脂蛋白B(apoB)-静脉血: 1.08g/L；酸碱度(pH)-尿液: 6.5；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.002；丙氨酸氨基转移酶(ALT)-静脉血: 12.3U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.092；尿素氮(BUN)-静脉血: 4.3mmol/L；酮体(KET)-尿液: 1+ 2mmol（参考: 阴性）；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.6；阴离子间隙(AG)-静脉血: 13.6；浊度(TRUB)-尿液: Turbid；颜色-尿液: Yellow；隐血(OB)-尿液: -（参考: 阴性）；镁离子(Mg2+)-静脉血: 0.61mmol/L；透明管型计数(HYAL#)-尿液: 1/μL；总胆红素(TBIL)-静脉血: 12umol/L；磷(P)-静脉血: 1.12mmol/L；浊度(TRUB)-尿液: Turbid；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿酸(UA)-静脉血: 317.3umol/L；总蛋白(TP)-尿液: 1+ 0.3g（参考: 阴性）；白蛋白(ALB)-静脉血: 42.2g/L；平均血小板体积(MPV)-静脉血: 10.8fL；中性粒细胞计数(Neut#)-静脉血: 3.410E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.1U/L；透明管型计数(HYAL#)-尿液: 2/μL；直接胆红素(DBIL)-静脉血: 3.8umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.67；白细胞计数(WBC#)-尿液: 25/μL；钾离子(K+)-静脉血: 3.33mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.6；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.08mmolL；比重(SG)-尿液: 1.024；未分类管型计数(UNCC#)-尿液: 2/μL；载脂蛋白AI(apoAI)-静脉血: 1.1g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.6pg；未分类管型计数(UNCC#)-尿液: 4/μL；隐血(OB)-尿液: -（参考: 阴性）；球蛋白(GLO)-静脉血: 25.25g/L；红细胞比容(H……\n- [全程D55] 检验组合: 中性粒细胞计数(Neut#)-静脉血: 8.410E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；直接胆红素(DBIL)-静脉血: 7umol/L；血小板计数(PLT#)-静脉血: 16910E9/L；红细胞计数(RBC#)-静脉血: 3.2710E12/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0；血小板比容-静脉血: 17%；碱性磷酸酶(ALP)-静脉血: 79.8U/L；阴离子间隙(AG)-静脉血: 13；天门冬氨酸氨基转移酶(AST)-静脉血: 19.5U/L；碱性磷酸酶(ALP)-静脉血: 58.6U/L；载脂蛋白AI(apoAI)-静脉血: 0.97g/L；丙氨酸氨基转移酶(ALT)-静脉血: 31.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；钾离子(K+)-静脉血: 3.14mmol/L；胱抑素(Cys-C)-静脉血: 1.36mg/L；血红蛋白(Hb)-静脉血: 96g/L；平均血小板体积(MPV)-静脉血: 9.9fL；血小板分布宽度(PDW)-静脉血: 16.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 30.3pg；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.66；载脂蛋白B(apoB)-静脉血: 1.48g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.5U/L；白细胞计数(WBC#)-静脉血: 9.3910E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.48mmolL；淋巴细胞百分比(Lymph%)-静脉血: 0.064；总钙(Ca)-静脉血: 2.53mmol/L；甘油三酯(TG)-静脉血: 1.31mmol/L；尿酸(UA)-静脉血: 560.6umol/L；阴离子间隙(AG)-静脉血: 17；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.81mmol/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；尿素氮(BUN)-静脉血: 4.58mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.04mmolL；尿酸(UA)-静脉血: 415.9umol/L；白蛋白(ALB)-静脉血: 47.6g/L；红细胞比容(Hct)-静脉血: 28.4%；球蛋白(GLO)-静脉血: 28.72g/L；肌酐(Crea)-静脉血: 10……\n- [全程D64] 超声；腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径9mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约22cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确肿物回声。 膀胱未充盈。；检查结论: 肝脏、胆囊、脾脏、胰腺、双肾未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D26] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者入院第三天，无特殊不适主诉，体查情况基本同前，患者现一般情况尚可，今日开始行根治性放疗，同时期予以DDP方案化疗，并予以护胃、止呕等对症支持处理，密观患者病情。\n- [全程D31] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现处于放化综合治疗中，放疗4F，现已基本完成一程同期化疗，诉口干、腹胀、纳差，体查：张口门齿距4.5cm；鼻咽右侧顶后壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。复查生化常规结果示：ALT87.0U/L，[姓名已隐去]副医生信息已隐藏：患者在院行一程同期化疗期间，出现肝功轻度损伤，期间予以护肝等对症处理，现患者复查生化示肝功指标仍有轻度升高，继续予以护肝等对症处理，今日可出院，每周定期复查血常规、生化常规，定期门诊复诊，门诊继续放疗，按期[计划性表述已隐藏]下程治疗，不适随诊。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D53] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者入院第二天，现处于放化综合治疗中，放疗21F，诉口苦，体查情况：张口门齿距4.5cm；鼻咽右侧顶后壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。复查血常规、生化常规结果基本正常。[姓名已隐去]副医生信息已隐藏：现患者入院[计划性表述已隐藏]第二程顺铂同期方案化疗，昨日开始予以水化，目前患者情况尚可，今日可行化疗，并予以止呕、护胃、加强营养等对症支持治疗，针对患者口苦症状，为放疗引起常见急性不良反应，予以对症处理，病情继观。\n- [全程D54] 上级查房记录；[姓名已隐去]医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医师查房记录；病程内容: 患者入院第三天，现处于放化综合治疗中，放疗22F，诉恶心、呕吐，体查情况基本同前。[姓名已隐去]医师查房后示：现患者处于DDP方案同期化疗中，目前患者情况尚可，继续予以止呕、护胃、加强营养等对症支持治疗，病情继观。\n- [全程D56] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现处于放化综合治疗中，放疗24F，诉恶心、呕吐较前好转，体查情况：KPS 90分；鼻咽部右侧壁肿物，双颈部淋巴结未触及；颅神经检查：阴性。[姓名已隐去]副医生信息已隐藏：现患者基本完成二程DDP方案同期化疗，目前患者情况尚可，继续予以对症支持，今日可予以出院，并嘱按时[计划性表述已隐藏]治疗后复查，不适随诊。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估腹部无转移征象，继续根治性放疗，予以重组人粒细胞刺激因子皮下注射，待血常规恢复后重启化疗。\nB. 评估腹部无转移征象，继续根治性放疗，予以重组人促红素皮下注射改善贫血，并动态复查血常规。\nC. 腹部彩超见可疑占位，暂停放疗，行肝脏MRI平扫+增强以明确病变性质。\nD. 评估腹部无转移征象，继续根治性放疗，并即刻启动第三程顺铂同期化疗。\nE. 评估腹部无转移征象，提前结束放疗，转为顺铂联合氟尿嘧啶方案辅助化疗。\nF. 评估腹部无转移征象，继续根治性放疗，予以利可君口服改善骨髓抑制，并动态复查血常规。\nG. 评估腹部无转移征象，继续根治性放疗，予以异甘草酸镁静脉滴注强化保肝治疗。\nH. 评估腹部无转移征象，继续根治性放疗，予以输注单采血小板预防出血，并动态复查血常规。\nI. 评估腹部无转移征象，暂停放疗，行全身PET/CT检查以全面评估近期疗效。\nJ. 评估腹部无转移征象，继续根治性放疗，予以昂丹司琼强化止吐，并预防性放置胃管。\nK. 评估腹部无转移征象，继续根治性放疗，加用尼妥珠单抗靶向治疗以提高局部控制率。\nL. 评估腹部无转移征象，继续根治性放疗，予以地塞米松口服改善骨髓抑制，并动态复查血常规。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 涕血1年余，头痛3月；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 额部疼痛,涕血；既往史: 高血压10年余服药治疗中，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.9℃，P：72次/分，R：20次/分，BP：127/91mmHg,Ht：160cm，Wt：62.5kg，BSA：1.65m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽右侧顶后壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D52] 入院记录: 主诉: 鼻咽癌一程化疗后两周余；现病史: 缘于1年前患者无明显诱因出现回吸性涕血，无头痛、鼻塞、耳鸣、复视、面麻等不适，未予重视，3个月前出现前额部疼痛，伴鼻衅，并于当地医院行鼻咽活检病理考虑鼻咽低分化型癌可能性大。于某次就诊时间10月底来我科就诊，并行根治性放疗计划设计，于某次就诊时间开始行根治性放疗，同时期予以DDP化疗1程，治疗过程顺利。今同期化疗到期来我科继续治疗，患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 额部疼痛,涕血；既往史: 高血压10年余服药治疗中，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.9℃，P：72次/分，R：20次/分，BP：127/91mmHg,Ht：160cm，Wt：62.5kg，BSA：1.65m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率72次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽右侧顶后壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 Ⅰ、Ⅱ、Ⅲ、aVF、V4～V6导联ST段下移\n- [全程D1] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；球蛋白(GLO)-静脉血: 30.03g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.9mmol/L；D-二聚体(D-Dimer)-静脉血: 0.13ug/ml；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；氯离子(Cl-)-静脉血: 98.1mmol/L；平均红细胞体积(MCV)-静脉血: 87.2fL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.91；大血小板百分比(P-LCR%)-静脉血: 33.4%；甘油三酯(TG)-静脉血: 1.01mmol/L；总钙(Ca)-静脉血: 2.28mmol/L；总胆固醇(TC)-静脉血: 5.44mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 25.2U/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 40.9umol/L；纤维蛋白原(Fbg)-静脉血: 2.51g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 20U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.34mmolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.58mmol/L；白细胞计数(WBC#)-静脉血: 6.9810E9/L；凝血酶时间(TT)-静脉血: 17.5sec.；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.013；红细胞计数(RBC#)-静脉血: 4.6710E12/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.98；直接胆红素(DBIL)-静脉血: 3.4umol/L；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 26.3mmol/L；磷(P)-静脉血: 1.03mmol/L；尿酸(UA)-静脉血: 391.1umol/L；碱性磷酸酶(ALP)-静脉血……\n- [全程D5] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁及右侧壁粘膜增厚放射性浓聚，SUV约7.3，病灶疑累及蝶骨基底部；右侧咽隐窝变浅；双侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见明显异常。口咽及喉咽结构及放射性分布未见明显异常。额窦、蝶窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双上颈小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。双乳腺结构及放射性分布未见明显异常。 肝S7点状高密度影放射性缺损，CT值约124Hu；其余肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 子宫边缘弧形改变，见结节状稍高密度影放射性分布未见明显异常，大小约3.8×4.3cm；左附件囊性低密度影放射性稀疏，大小约2.2×2.3cm，CT值约22Hu。膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 所见颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽顶壁及右侧壁粘膜增厚代谢活跃，考虑鼻咽癌，疑累及蝶骨基底部。 肝S7肝内胆管结石。 子宫肌瘤。 左附件囊肿。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D26] 检验组合: 比重(SG)-尿液: 1.019；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；酮体(KET)-尿液: +-（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: Turbid；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 82/μL；总蛋白(TP)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；白细胞计数(WBC#)-尿液: 17/μL\n- [全程D27] 检验组合: 血小板分布宽度(PDW)-静脉血: 12.2%；平均血小板体积(MPV)-静脉血: 11.2fL；红细胞比容(Hct)-静脉血: 37.5%；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；红细胞比容(Hct)-静脉血: 35.5%；碱性磷酸酶(ALP)-静脉血: 91.7U/L；白蛋白(ALB)-静脉血: 45.5g/L；C-反应蛋白(CRP)-静脉血: 1.15mg/L；血红蛋白(Hb)-静脉血: 121g/L；直接胆红素(DBIL)-静脉血: 3.7umol/L；血红蛋白(Hb)-静脉血: 111g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.4；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；葡萄糖(Glu)-静脉血: 5.1mmol/L；白细胞计数(WBC#)-静脉血: 13.710E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.51mmolL；红细胞计数(RBC#)-静脉血: 3.8810E12/L；颜色-尿液: Light-Orange；尿素氮(BUN)-静脉血: 5.77mmol/L；胱抑素(Cys-C)-静脉血: 0.99mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.59；钾离子(K+)-静脉血: 4.2mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 19U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 266.5U/L；磷(P)-静脉血: 1.03mmol/L；中性粒细胞计数(Neut#)-静脉血: 4.110E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.241；平均红细胞体积(MCV)-静脉血: 82.9fL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.81mmol/L；大血小板百分比(P-LCR%)-静脉血: 27.5%；红细胞计数(RBC#)-静脉血: 4.1410E12/L；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；甘油三酯(TG)-静脉血: 1.02mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.9；尿酸(UA)-静脉血: 295.4umol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.……\n- [全程D31] 检验组合: 丙氨酸氨基转移酶(ALT)-静脉血: 91.9U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 30.5U/L；碱性磷酸酶(ALP)-静脉血: 104.1U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 114U/L；乳酸脱氢酶(LDH)-静脉血: 159.5U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 23.5U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.33；总胆汁酸(TBA)-静脉血: 2umol/L\n- [全程D42] 检验组合: 磷(P)-静脉血: 1.12mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.66；钠离子(Na+)-静脉血: 139.9mmol/L；白蛋白(ALB)-静脉血: 43.7g/L；镁离子(Mg2+)-静脉血: 0.74mmol/L；钾离子(K+)-静脉血: 4.14mmol/L；氯离子(Cl-)-静脉血: 98mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 91.5U/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.5U/L；总胆红素(TBIL)-静脉血: 10.2umol/L；尿素氮(BUN)-静脉血: 5.7mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.7mmol/L；阴离子间隙(AG)-静脉血: 16.2；直接胆红素(DBIL)-静脉血: 3.2umol/L；尿酸(UA)-静脉血: 335.2umol/L；碱性磷酸酶(ALP)-静脉血: 75.1U/L；间接胆红素(IBIL)-静脉血: 7umolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.28；α-L-岩藻糖苷酶(AFU)-静脉血: 18.2U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.3U/L；球蛋白(GLO)-静脉血: 26.28g/L；总钙(Ca)-静脉血: 2.33mmol/L；肌酐(Crea)-静脉血: 77.8umol/L；总蛋白(TP)-静脉血: 69.98g/L；乳酸脱氢酶(LDH)-静脉血: 203.7U/L；总胆汁酸(TBA)-静脉血: 1.9umol/L\n- [全程D52] 检验组合: 白细胞计数(WBC#)-尿液: 2/μL；非鳞状上皮细胞计数-尿液: 3/μL；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；酸碱度(pH)-尿液: 6.5；红细胞计数(RBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；隐血(OB)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.014；尿胆原(URO)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 28/μL；总蛋白(TP)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 26/μL；白细胞(LEU)-尿液: -（参考: 阴性）\n- [全程D54] 检验组合: 红细胞计数(RBC#)-静脉血: 3.9510E12/L；血小板分布宽度(PDW)-静脉血: 12.5%；载脂蛋白B(apoB)-静脉血: 1.08g/L；酸碱度(pH)-尿液: 6.5；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.002；丙氨酸氨基转移酶(ALT)-静脉血: 12.3U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.092；尿素氮(BUN)-静脉血: 4.3mmol/L；酮体(KET)-尿液: 1+ 2mmol（参考: 阴性）；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.6；阴离子间隙(AG)-静脉血: 13.6；浊度(TRUB)-尿液: Turbid；颜色-尿液: Yellow；隐血(OB)-尿液: -（参考: 阴性）；镁离子(Mg2+)-静脉血: 0.61mmol/L；透明管型计数(HYAL#)-尿液: 1/μL；总胆红素(TBIL)-静脉血: 12umol/L；磷(P)-静脉血: 1.12mmol/L；浊度(TRUB)-尿液: Turbid；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿酸(UA)-静脉血: 317.3umol/L；总蛋白(TP)-尿液: 1+ 0.3g（参考: 阴性）；白蛋白(ALB)-静脉血: 42.2g/L；平均血小板体积(MPV)-静脉血: 10.8fL；中性粒细胞计数(Neut#)-静脉血: 3.410E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.1U/L；透明管型计数(HYAL#)-尿液: 2/μL；直接胆红素(DBIL)-静脉血: 3.8umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.67；白细胞计数(WBC#)-尿液: 25/μL；钾离子(K+)-静脉血: 3.33mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.6；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.08mmolL；比重(SG)-尿液: 1.024；未分类管型计数(UNCC#)-尿液: 2/μL；载脂蛋白AI(apoAI)-静脉血: 1.1g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.6pg；未分类管型计数(UNCC#)-尿液: 4/μL；隐血(OB)-尿液: -（参考: 阴性）；球蛋白(GLO)-静脉血: 25.25g/L；红细胞比容(H……\n- [全程D55] 检验组合: 中性粒细胞计数(Neut#)-静脉血: 8.410E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；直接胆红素(DBIL)-静脉血: 7umol/L；血小板计数(PLT#)-静脉血: 16910E9/L；红细胞计数(RBC#)-静脉血: 3.2710E12/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0；血小板比容-静脉血: 17%；碱性磷酸酶(ALP)-静脉血: 79.8U/L；阴离子间隙(AG)-静脉血: 13；天门冬氨酸氨基转移酶(AST)-静脉血: 19.5U/L；碱性磷酸酶(ALP)-静脉血: 58.6U/L；载脂蛋白AI(apoAI)-静脉血: 0.97g/L；丙氨酸氨基转移酶(ALT)-静脉血: 31.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；钾离子(K+)-静脉血: 3.14mmol/L；胱抑素(Cys-C)-静脉血: 1.36mg/L；血红蛋白(Hb)-静脉血: 96g/L；平均血小板体积(MPV)-静脉血: 9.9fL；血小板分布宽度(PDW)-静脉血: 16.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 30.3pg；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.66；载脂蛋白B(apoB)-静脉血: 1.48g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.5U/L；白细胞计数(WBC#)-静脉血: 9.3910E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.48mmolL；淋巴细胞百分比(Lymph%)-静脉血: 0.064；总钙(Ca)-静脉血: 2.53mmol/L；甘油三酯(TG)-静脉血: 1.31mmol/L；尿酸(UA)-静脉血: 560.6umol/L；阴离子间隙(AG)-静脉血: 17；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.81mmol/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；尿素氮(BUN)-静脉血: 4.58mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.04mmolL；尿酸(UA)-静脉血: 415.9umol/L；白蛋白(ALB)-静脉血: 47.6g/L；红细胞比容(Hct)-静脉血: 28.4%；球蛋白(GLO)-静脉血: 28.72g/L；肌酐(Crea)-静脉血: 10……\n- [全程D64] 超声；腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径9mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约22cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确肿物回声。 膀胱未充盈。；检查结论: 肝脏、胆囊、脾脏、胰腺、双肾未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D26] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者入院第三天，无特殊不适主诉，体查情况基本同前，患者现一般情况尚可，今日开始行根治性放疗，同时期予以DDP方案化疗，并予以护胃、止呕等对症支持处理，密观患者病情。\n- [全程D31] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现处于放化综合治疗中，放疗4F，现已基本完成一程同期化疗，诉口干、腹胀、纳差，体查：张口门齿距4.5cm；鼻咽右侧顶后壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。复查生化常规结果示：ALT87.0U/L，[姓名已隐去]副医生信息已隐藏：患者在院行一程同期化疗期间，出现肝功轻度损伤，期间予以护肝等对症处理，现患者复查生化示肝功指标仍有轻度升高，继续予以护肝等对症处理，今日可出院，每周定期复查血常规、生化常规，定期门诊复诊，门诊继续放疗，按期[计划性表述已隐藏]下程治疗，不适随诊。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D53] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者入院第二天，现处于放化综合治疗中，放疗21F，诉口苦，体查情况：张口门齿距4.5cm；鼻咽右侧顶后壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。复查血常规、生化常规结果基本正常。[姓名已隐去]副医生信息已隐藏：现患者入院[计划性表述已隐藏]第二程顺铂同期方案化疗，昨日开始予以水化，目前患者情况尚可，今日可行化疗，并予以止呕、护胃、加强营养等对症支持治疗，针对患者口苦症状，为放疗引起常见急性不良反应，予以对症处理，病情继观。\n- [全程D54] 上级查房记录；[姓名已隐去]医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医师查房记录；病程内容: 患者入院第三天，现处于放化综合治疗中，放疗22F，诉恶心、呕吐，体查情况基本同前。[姓名已隐去]医师查房后示：现患者处于DDP方案同期化疗中，目前患者情况尚可，继续予以止呕、护胃、加强营养等对症支持治疗，病情继观。\n- [全程D56] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现处于放化综合治疗中，放疗24F，诉恶心、呕吐较前好转，体查情况：KPS 90分；鼻咽部右侧壁肿物，双颈部淋巴结未触及；颅神经检查：阴性。[姓名已隐去]副医生信息已隐藏：现患者基本完成二程DDP方案同期化疗，目前患者情况尚可，继续予以对症支持，今日可予以出院，并嘱按时[计划性表述已隐藏]治疗后复查，不适随诊。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估腹部无转移征象，继续根治性放疗，予以重组人粒细胞刺激因子皮下注射，待血常规恢复后重启化疗。\nB. 评估腹部无转移征象，继续根治性放疗，予以重组人促红素皮下注射改善贫血，并动态复查血常规。\nC. 腹部彩超见可疑占位，暂停放疗，行肝脏MRI平扫+增强以明确病变性质。\nD. 评估腹部无转移征象，继续根治性放疗，并即刻启动第三程顺铂同期化疗。\nE. 评估腹部无转移征象，提前结束放疗，转为顺铂联合氟尿嘧啶方案辅助化疗。\nF. 评估腹部无转移征象，继续根治性放疗，予以利可君口服改善骨髓抑制，并动态复查血常规。\nG. 评估腹部无转移征象，继续根治性放疗，予以异甘草酸镁静脉滴注强化保肝治疗。\nH. 评估腹部无转移征象，继续根治性放疗，予以输注单采血小板预防出血，并动态复查血常规。\nI. 评估腹部无转移征象，暂停放疗，行全身PET/CT检查以全面评估近期疗效。\nJ. 评估腹部无转移征象，继续根治性放疗，予以昂丹司琼强化止吐，并预防性放置胃管。\nK. 评估腹部无转移征象，继续根治性放疗，加用尼妥珠单抗靶向治疗以提高局部控制率。\nL. 评估腹部无转移征象，继续根治性放疗，予以地塞米松口服改善骨髓抑制，并动态复查血常规。\n\n请仅输出一个选项字母（A-L）。"}]}
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+{"sample_id":"sample-06aacdbb23f806198bd0b70c","patient_id":"patient-e7eec542502a097814d58d8a","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"I","gold_action":"行鼻咽镜检查并取鼻咽部肿物活检。","options":[{"letter":"A","text":"行右侧颈部淋巴结切除活检术","is_gold":false},{"letter":"B","text":"行右侧颈部淋巴结细针穿刺抽吸活检","is_gold":false},{"letter":"C","text":"安排诱导化疗联合同期放化疗","is_gold":false},{"letter":"D","text":"行全身PET-CT检查","is_gold":false},{"letter":"E","text":"行全身骨显像检查","is_gold":false},{"letter":"F","text":"行鼻内镜下鼻咽部肿物切除术","is_gold":false},{"letter":"G","text":"行鼻咽部高分辨率CT检查","is_gold":false},{"letter":"H","text":"行右侧颈部淋巴结微创旋切活检术","is_gold":false},{"letter":"I","text":"行鼻咽镜检查并取鼻咽部肿物活检","is_gold":true},{"letter":"J","text":"行胸部增强CT及腹部增强CT检查","is_gold":false},{"letter":"K","text":"抽取外周血行血浆EBV-DNA定量检测","is_gold":false},{"letter":"L","text":"密切观察随访，1个月后复查鼻咽部MRI","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 双侧耳鸣2年，发现右颈肿物3天；现病史: 患者2年前无明显诱因间断出现双侧耳鸣，近2周自觉右侧耳鸣症状加重，无鼻塞、涕血等不适。今为进一步诊治收入我院。起病以来，患者无发热、咳嗽，无胸闷、胸痛，无恶心、呕吐，胃纳、睡眠、精神可，大小便正常，体重无明显变化。；阳性症状体征: 双耳鸣,右颈部肿物,右耳鸣；既往史: 10+年前因“腰椎间盘突出”行手术治疗，并予输血，无“输血反应”。否认\"肝炎\"、\"结核\"、\"高血压\"、\"糖尿病\"等疾病史；无外伤病史。过敏史:否认药物、食物过敏史。；个人史: 原籍出生、长大，无疫水、疫区暴露史；无吸烟、酗酒等不良嗜好。；家族史: 否认家族其他成员有肿瘤病史及遗传病史。；体格检查: T：36.0℃ P：81bpm R：18bpm BP：111/76mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。牙龈无肿胀、出血，咽无充血，双扁桃体无肿大。颈部检查详见肿瘤专科 检查。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率81bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显斑片或结节影。双侧肺门影未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见明显病变。\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 间接胆红素(IBIL)-静脉血: 9.6umolL；尿胆原(URO)-尿液: -（参考: 阴性）；钾离子(K+)-静脉血: 4mmol/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；总胆固醇(TC)-静脉血: 6.89mmol/L；肿瘤特异性生长因子(TSGF)-静脉血: 32U/mL；红细胞计数(RBC#)-静脉血: 4.9610E12/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.5U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.3pg；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 13.4umol/L；总蛋白(TP)-尿液: -（参考: 阴性）；血小板计数(PLT#)-静脉血: 319.310E9/L；比重(SG)-尿液: LAMPL.；凝血酶原时间活动度(PTA)-静脉血: 113.8%；直接胆红素(DBIL)-静脉血: 3.8umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-静脉血: 10.310E9/L；平均血小板体积(MPV)-静脉血: 7.46fL；镁离子(Mg2+)-静脉血: 0.98mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.310E9/L；鳞状细胞癌相关抗原(SCC)-静脉血: 0.4ng/ml；低密度脂蛋白胆固醇(LDL-C)-静脉血: 5.13mmol/L；血小板比容-静脉血: 23.8%；Rh血型-静脉血: 阳性；总前列腺特异性抗原(TPSA)-静脉血: 1ng/ml；神经元特异性烯醇化酶(NSE)-静脉血: 12.85ng/ml；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；游……\n- [全程D2] 检验组合: CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 0.8%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 3%；CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 24.9%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 9.8%；CD3+T淋巴细胞百分比-静脉血: 60.3%；CD4+/CD8+辅助/抑制T淋巴细胞比值(Th/Ts比值)-静脉血: 1.7；CD3-CD16+CD56+自然杀伤细胞百分比(NK%)-静脉血: 15.5%；CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 3.1%；CD3+CD4+辅助/诱导T淋巴细胞百分比(Th/Ti%)-静脉血: 29%；CD19+B淋巴细胞百分比-静脉血: 23%；CD3+CD8+抑制/细胞毒T淋巴细胞百分比(Ts/Tc%)-静脉血: 18.4%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 27.7%\n- [全程D7] 超声；双侧颈部、锁骨上区淋巴结彩超(套): 检查类型: 超声；检查名称: 双侧颈部、锁骨上区淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉内径约14mm，门静脉最大血流速度约17cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约44×36×33mm，包膜光滑，实质回声不均匀，可见强回声斑。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 前列腺钙化。 胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D7] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 右侧颈部II区可见数个淋巴结回声，最大约23×12mm，椭圆形，边界清，皮髓质分界不清，未见淋巴门。余右侧颈部未见明确异常淋巴结。 CDFI：上述最大淋巴结内可见周边型血流信号。 左侧颈部及锁骨上区未见明确异常淋巴结回声。；检查结论: 右侧颈部II区淋巴结，恶性待排，建议穿刺活检。 左侧颈部及锁骨上区未见明确异常淋巴结声像。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行右侧颈部淋巴结切除活检术\nB. 行右侧颈部淋巴结细针穿刺抽吸活检\nC. 安排诱导化疗联合同期放化疗\nD. 行全身PET-CT检查\nE. 行全身骨显像检查\nF. 行鼻内镜下鼻咽部肿物切除术\nG. 行鼻咽部高分辨率CT检查\nH. 行右侧颈部淋巴结微创旋切活检术\nI. 行鼻咽镜检查并取鼻咽部肿物活检\nJ. 行胸部增强CT及腹部增强CT检查\nK. 抽取外周血行血浆EBV-DNA定量检测\nL. 密切观察随访，1个月后复查鼻咽部MRI\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 双侧耳鸣2年，发现右颈肿物3天；现病史: 患者2年前无明显诱因间断出现双侧耳鸣，近2周自觉右侧耳鸣症状加重，无鼻塞、涕血等不适。今为进一步诊治收入我院。起病以来，患者无发热、咳嗽，无胸闷、胸痛，无恶心、呕吐，胃纳、睡眠、精神可，大小便正常，体重无明显变化。；阳性症状体征: 双耳鸣,右颈部肿物,右耳鸣；既往史: 10+年前因“腰椎间盘突出”行手术治疗，并予输血，无“输血反应”。否认\"肝炎\"、\"结核\"、\"高血压\"、\"糖尿病\"等疾病史；无外伤病史。过敏史:否认药物、食物过敏史。；个人史: 原籍出生、长大，无疫水、疫区暴露史；无吸烟、酗酒等不良嗜好。；家族史: 否认家族其他成员有肿瘤病史及遗传病史。；体格检查: T：36.0℃ P：81bpm R：18bpm BP：111/76mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。牙龈无肿胀、出血，咽无充血，双扁桃体无肿大。颈部检查详见肿瘤专科 检查。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率81bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显斑片或结节影。双侧肺门影未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见明显病变。\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 间接胆红素(IBIL)-静脉血: 9.6umolL；尿胆原(URO)-尿液: -（参考: 阴性）；钾离子(K+)-静脉血: 4mmol/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；总胆固醇(TC)-静脉血: 6.89mmol/L；肿瘤特异性生长因子(TSGF)-静脉血: 32U/mL；红细胞计数(RBC#)-静脉血: 4.9610E12/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.5U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.3pg；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 13.4umol/L；总蛋白(TP)-尿液: -（参考: 阴性）；血小板计数(PLT#)-静脉血: 319.310E9/L；比重(SG)-尿液: LAMPL.；凝血酶原时间活动度(PTA)-静脉血: 113.8%；直接胆红素(DBIL)-静脉血: 3.8umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-静脉血: 10.310E9/L；平均血小板体积(MPV)-静脉血: 7.46fL；镁离子(Mg2+)-静脉血: 0.98mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.310E9/L；鳞状细胞癌相关抗原(SCC)-静脉血: 0.4ng/ml；低密度脂蛋白胆固醇(LDL-C)-静脉血: 5.13mmol/L；血小板比容-静脉血: 23.8%；Rh血型-静脉血: 阳性；总前列腺特异性抗原(TPSA)-静脉血: 1ng/ml；神经元特异性烯醇化酶(NSE)-静脉血: 12.85ng/ml；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；游……\n- [全程D2] 检验组合: CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 0.8%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 3%；CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 24.9%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 9.8%；CD3+T淋巴细胞百分比-静脉血: 60.3%；CD4+/CD8+辅助/抑制T淋巴细胞比值(Th/Ts比值)-静脉血: 1.7；CD3-CD16+CD56+自然杀伤细胞百分比(NK%)-静脉血: 15.5%；CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 3.1%；CD3+CD4+辅助/诱导T淋巴细胞百分比(Th/Ti%)-静脉血: 29%；CD19+B淋巴细胞百分比-静脉血: 23%；CD3+CD8+抑制/细胞毒T淋巴细胞百分比(Ts/Tc%)-静脉血: 18.4%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 27.7%\n- [全程D7] 超声；双侧颈部、锁骨上区淋巴结彩超(套): 检查类型: 超声；检查名称: 双侧颈部、锁骨上区淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉内径约14mm，门静脉最大血流速度约17cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约44×36×33mm，包膜光滑，实质回声不均匀，可见强回声斑。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 前列腺钙化。 胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D7] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 右侧颈部II区可见数个淋巴结回声，最大约23×12mm，椭圆形，边界清，皮髓质分界不清，未见淋巴门。余右侧颈部未见明确异常淋巴结。 CDFI：上述最大淋巴结内可见周边型血流信号。 左侧颈部及锁骨上区未见明确异常淋巴结回声。；检查结论: 右侧颈部II区淋巴结，恶性待排，建议穿刺活检。 左侧颈部及锁骨上区未见明确异常淋巴结声像。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行右侧颈部淋巴结切除活检术\nB. 行右侧颈部淋巴结细针穿刺抽吸活检\nC. 安排诱导化疗联合同期放化疗\nD. 行全身PET-CT检查\nE. 行全身骨显像检查\nF. 行鼻内镜下鼻咽部肿物切除术\nG. 行鼻咽部高分辨率CT检查\nH. 行右侧颈部淋巴结微创旋切活检术\nI. 行鼻咽镜检查并取鼻咽部肿物活检\nJ. 行胸部增强CT及腹部增强CT检查\nK. 抽取外周血行血浆EBV-DNA定量检测\nL. 密切观察随访，1个月后复查鼻咽部MRI\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-9713cef7ba61651ea6a5f02e","patient_id":"patient-e7eec542502a097814d58d8a","turn_id":"turn05","turn_position":3,"turn_type":"toxicity_or_support_decision","gold_letter":"L","gold_action":"予以静脉水化及电解质（含钾）补充，嘱计24小时尿量，并常规行PICC导管护理。","options":[{"letter":"A","text":"暂不予静脉水化及电解质补充，待明日行顺铂化疗时同步予以补液支持。","is_gold":false},{"letter":"B","text":"予以静脉水化，暂不补充钾离子，嘱计24小时尿量，并常规行PICC导管护理。","is_gold":false},{"letter":"C","text":"予以静脉水化及电解质补充，常规静脉推注呋塞米强效利尿，并计24小时尿量。","is_gold":false},{"letter":"D","text":"予以静脉水化及电解质补充，皮下注射重组人粒细胞集落刺激因子预防骨髓抑制。","is_gold":false},{"letter":"E","text":"予以静脉水化及电解质补充，静脉滴注右丙亚胺预防大剂量顺铂相关心脏毒性。","is_gold":false},{"letter":"F","text":"予以静脉水化及电解质补充，静脉滴注阿米福汀预防大剂量顺铂相关肾毒性。","is_gold":false},{"letter":"G","text":"予以静脉水化及电解质补充，嘱计24小时尿量，并静脉滴注头孢菌素预防感染。","is_gold":false},{"letter":"H","text":"予以静脉水化及电解质补充，静脉滴注地塞米松及帕洛诺司琼进行止吐预处理。","is_gold":false},{"letter":"I","text":"予以静脉水化及电解质补充，静脉输注人血白蛋白以预防大剂量化疗后低蛋白血症。","is_gold":false},{"letter":"J","text":"予以静脉水化及电解质补充，静脉滴注异甘草酸镁预防大剂量顺铂相关肝损伤。","is_gold":false},{"letter":"K","text":"予以静脉水化及电解质补充，嘱计24小时尿量，并皮下注射促红细胞生成素。","is_gold":false},{"letter":"L","text":"予以静脉水化及电解质（含钾）补充，嘱计24小时尿量，并常规行PICC导管护理。","is_gold":true}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 双侧耳鸣2年，发现右颈肿物3天；现病史: 患者2年前无明显诱因间断出现双侧耳鸣，近2周自觉右侧耳鸣症状加重，无鼻塞、涕血等不适。今为进一步诊治收入我院。起病以来，患者无发热、咳嗽，无胸闷、胸痛，无恶心、呕吐，胃纳、睡眠、精神可，大小便正常，体重无明显变化。；阳性症状体征: 双耳鸣,右颈部肿物,右耳鸣；既往史: 10+年前因“腰椎间盘突出”行手术治疗，并予输血，无“输血反应”。否认\"肝炎\"、\"结核\"、\"高血压\"、\"糖尿病\"等疾病史；无外伤病史。过敏史:否认药物、食物过敏史。；个人史: 原籍出生、长大，无疫水、疫区暴露史；无吸烟、酗酒等不良嗜好。；家族史: 否认家族其他成员有肿瘤病史及遗传病史。；体格检查: T：36.0℃ P：81bpm R：18bpm BP：111/76mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。牙龈无肿胀、出血，咽无充血，双扁桃体无肿大。颈部检查详见肿瘤专科 检查。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率81bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 双侧耳鸣2年，发现右颈肿物3天；现病史: 患者2年前无明显诱因间断出现双侧耳鸣，近2周自觉右侧耳鸣症状加重，无鼻塞、涕血等不适。3天前无明显诱因发现右颈部肿物，遂就诊外院行CT检查示：鼻咽右侧壁增厚，考虑鼻咽癌可能，伴右侧乳突阻塞性炎症。今为进一步诊治收入我院。起病以来，患者无发热、咳嗽，无胸闷、胸痛，无恶心、呕吐，胃纳、睡眠、精神可，大小便正常，体重无明显变化。；阳性症状体征: 双耳鸣,右颈部肿物,右耳鸣；既往史: 10+年前因“腰椎间盘突出”行手术治疗，并予输血，无“输血反应”。否认\"肝炎\"、\"结核\"、\"高血压\"、\"糖尿病\"等疾病史；无外伤病史。过敏史:否认药物、食物过敏史。；个人史: 原籍出生、长大，无疫水、疫区暴露史；无吸烟、酗酒等不良嗜好。；家族史: 否认家族其他成员有肿瘤病史及遗传病史。；体格检查: T：36.0℃ P：81bpm R：18bpm BP：111/76mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。牙龈无肿胀、出血，咽无充血，双扁桃体无肿大。颈部检查详见肿瘤专科 检查。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率81bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。肛门外生殖器未见异常，生理反射存在，病理反射未引出。；专科检查: 间接鼻咽镜检查见双侧鼻腔通畅，内未窥及明显肿物；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显斑片或结节影。双侧肺门影未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见明显病变。\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 间接胆红素(IBIL)-静脉血: 9.6umolL；尿胆原(URO)-尿液: -（参考: 阴性）；钾离子(K+)-静脉血: 4mmol/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；总胆固醇(TC)-静脉血: 6.89mmol/L；肿瘤特异性生长因子(TSGF)-静脉血: 32U/mL；红细胞计数(RBC#)-静脉血: 4.9610E12/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.5U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.3pg；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 13.4umol/L；总蛋白(TP)-尿液: -（参考: 阴性）；血小板计数(PLT#)-静脉血: 319.310E9/L；比重(SG)-尿液: LAMPL.；凝血酶原时间活动度(PTA)-静脉血: 113.8%；直接胆红素(DBIL)-静脉血: 3.8umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-静脉血: 10.310E9/L；平均血小板体积(MPV)-静脉血: 7.46fL；镁离子(Mg2+)-静脉血: 0.98mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.310E9/L；鳞状细胞癌相关抗原(SCC)-静脉血: 0.4ng/ml；低密度脂蛋白胆固醇(LDL-C)-静脉血: 5.13mmol/L；血小板比容-静脉血: 23.8%；Rh血型-静脉血: 阳性；总前列腺特异性抗原(TPSA)-静脉血: 1ng/ml；神经元特异性烯醇化酶(NSE)-静脉血: 12.85ng/ml；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；游……\n- [全程D2] 检验组合: CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 0.8%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 3%；CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 24.9%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 9.8%；CD3+T淋巴细胞百分比-静脉血: 60.3%；CD4+/CD8+辅助/抑制T淋巴细胞比值(Th/Ts比值)-静脉血: 1.7；CD3-CD16+CD56+自然杀伤细胞百分比(NK%)-静脉血: 15.5%；CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 3.1%；CD3+CD4+辅助/诱导T淋巴细胞百分比(Th/Ti%)-静脉血: 29%；CD19+B淋巴细胞百分比-静脉血: 23%；CD3+CD8+抑制/细胞毒T淋巴细胞百分比(Ts/Tc%)-静脉血: 18.4%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 27.7%\n- [全程D7] 超声；双侧颈部、锁骨上区淋巴结彩超(套): 检查类型: 超声；检查名称: 双侧颈部、锁骨上区淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉内径约14mm，门静脉最大血流速度约17cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约44×36×33mm，包膜光滑，实质回声不均匀，可见强回声斑。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 前列腺钙化。 胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D7] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 右侧颈部II区可见数个淋巴结回声，最大约23×12mm，椭圆形，边界清，皮髓质分界不清，未见淋巴门。余右侧颈部未见明确异常淋巴结。 CDFI：上述最大淋巴结内可见周边型血流信号。 左侧颈部及锁骨上区未见明确异常淋巴结回声。；检查结论: 右侧颈部II区淋巴结，恶性待排，建议穿刺活检。 左侧颈部及锁骨上区未见明确异常淋巴结声像。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D24] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽右顶壁及右侧壁粘膜增厚放射性浓聚，SUV约16.7，病灶累及右翼突基底部及内侧板、右侧腭帆张提肌。右侧咽隐窝消失，左侧咽隐窝存在。双侧咽后未见肿大淋巴结及异常放射性分布。口咽、喉咽未见异常。筛窦、左上颌窦及右乳突内低密度影放射性稀疏；额窦、蝶窦、右上颌窦及左乳突结构及放射性分布未见明显异常。双侧海绵窦放射性分布未见明显异常。甲状腺结构及放射性分布未见明显异常。右颈II区数个淋巴结放射性浓聚，SUV约18.0，大者约1.5×2.2cm；余双颈小淋巴结放射性分布未见异常。 所见脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔主肺动脉窗小淋巴结放射性分布未见明显异常，大小约0.9×1.0cm。双肺门未见肿大淋巴结及异常放射性分布。双侧腋窝小淋巴结放射性未见明显异常。 肝脏密度减低，CT值约36Hu（脾脏CT值约56Hu），结构及放射性分布未见异常；肝门区未见占位及异常放射性分布。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。左肾上腺体部小结节影放射性略浓密，大小约1.0×1.1cm。脾脏、双肾、右肾上腺及胰腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺大小正常，内见数个点状钙化灶。膀胱及肠管形态、结构及放射性分布未见明显异常。双髂血管旁及双侧腹股沟未见肿大淋巴结及异常放射性分布。 颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，病灶累及右翼突基底部及内侧板、右侧腭帆张提肌；右颈II区数个淋巴结代谢活跃，考虑转移。 左肾上腺体部小结节代谢稍活跃，疑良性增生病变。 前列腺多发钙化灶。 脂肪肝。 副鼻窦炎症；右乳突炎症。\n- [全程D28] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T6上缘水平，估计导管末端位于上腔静脉上段内。；检查结论: PICC管末端位置如上述。\n- [全程D28] 检验组合: 红细胞计数(RBC#)-静脉血: 4.710E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7；钾离子(K+)-静脉血: 4.2mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 32.3U/L；尿素氮(BUN)-静脉血: 8.2mmol/L；间接胆红素(IBIL)-静脉血: 6.2umolL；氯离子(Cl-)-静脉血: 100.2mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 326g/L；红细胞比容(Hct)-静脉血: 43.5%；总胆固醇(TC)-静脉血: 5.88mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 22.9U/L；载脂蛋白AI(apoAI)-静脉血: 1.32g/L；血小板比容-静脉血: 32%；葡萄糖(Glu)-静脉血: 5.95mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.8mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.2pg；乳酸脱氢酶(LDH)-静脉血: 159.8U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.279；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.67；白细胞计数(WBC#)-静脉血: 10.7710E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 16.9U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.99mmol/L；中性粒细胞计数(Neut#)-静脉血: 6.410E9/L；平均红细胞体积(MCV)-静脉血: 92.6fL；平均血小板体积(MPV)-静脉血: 9.2fL；总胆红素(TBIL)-静脉血: 8.6umol/L；血小板分布宽度(PDW)-静脉血: 10%；磷(P)-静脉血: 1.6mmol/L；肌酐(Crea)-静脉血: 64.4umol/L；血小板计数(PLT#)-静脉血: 34410E9/L；C-反应蛋白(CRP)-静脉血: 3.29mg/L；碱性磷酸酶(ALP)-静脉血: 102.6U/L；白蛋白(ALB)-静脉血: 46.3g/L；淋巴细胞计数(Lymph#)-静脉血: 310E9/L；单核细胞计数(Mono#)-静脉血: 0.810E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 54U/L；大血小板百分比(P-LCR%)-静脉血: 18.4%；单核细胞百分比(Mono%)-静……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D9] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，无发热、涕血等不适症状。查体：生命体征平稳。电子喉镜检查示：鼻咽右隆突肿物，符合鼻咽癌。并取肿物活检，等待病理结果。[姓名已隐去]副教授示，结合患者病情及相关检查，诊断考虑鼻咽癌可能性大，明确诊断，予鼻咽科进一步诊治。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D15] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：KPS 90分；鼻咽右侧壁、顶后壁结节状肿物，右颈Ⅱ区可扪及已肿大淋巴结，大小约2*1cm，颅神经检查（-）。今日[姓名已隐去]医生信息已隐藏后示：患者已完善相关检查，并预约放疗，今日可结账出院，嘱出院后按时[计划性表述已隐藏]放化综合治疗，不适随诊。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂不予静脉水化及电解质补充，待明日行顺铂化疗时同步予以补液支持。\nB. 予以静脉水化，暂不补充钾离子，嘱计24小时尿量，并常规行PICC导管护理。\nC. 予以静脉水化及电解质补充，常规静脉推注呋塞米强效利尿，并计24小时尿量。\nD. 予以静脉水化及电解质补充，皮下注射重组人粒细胞集落刺激因子预防骨髓抑制。\nE. 予以静脉水化及电解质补充，静脉滴注右丙亚胺预防大剂量顺铂相关心脏毒性。\nF. 予以静脉水化及电解质补充，静脉滴注阿米福汀预防大剂量顺铂相关肾毒性。\nG. 予以静脉水化及电解质补充，嘱计24小时尿量，并静脉滴注头孢菌素预防感染。\nH. 予以静脉水化及电解质补充，静脉滴注地塞米松及帕洛诺司琼进行止吐预处理。\nI. 予以静脉水化及电解质补充，静脉输注人血白蛋白以预防大剂量化疗后低蛋白血症。\nJ. 予以静脉水化及电解质补充，静脉滴注异甘草酸镁预防大剂量顺铂相关肝损伤。\nK. 予以静脉水化及电解质补充，嘱计24小时尿量，并皮下注射促红细胞生成素。\nL. 予以静脉水化及电解质（含钾）补充，嘱计24小时尿量，并常规行PICC导管护理。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 双侧耳鸣2年，发现右颈肿物3天；现病史: 患者2年前无明显诱因间断出现双侧耳鸣，近2周自觉右侧耳鸣症状加重，无鼻塞、涕血等不适。今为进一步诊治收入我院。起病以来，患者无发热、咳嗽，无胸闷、胸痛，无恶心、呕吐，胃纳、睡眠、精神可，大小便正常，体重无明显变化。；阳性症状体征: 双耳鸣,右颈部肿物,右耳鸣；既往史: 10+年前因“腰椎间盘突出”行手术治疗，并予输血，无“输血反应”。否认\"肝炎\"、\"结核\"、\"高血压\"、\"糖尿病\"等疾病史；无外伤病史。过敏史:否认药物、食物过敏史。；个人史: 原籍出生、长大，无疫水、疫区暴露史；无吸烟、酗酒等不良嗜好。；家族史: 否认家族其他成员有肿瘤病史及遗传病史。；体格检查: T：36.0℃ P：81bpm R：18bpm BP：111/76mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。牙龈无肿胀、出血，咽无充血，双扁桃体无肿大。颈部检查详见肿瘤专科 检查。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率81bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 双侧耳鸣2年，发现右颈肿物3天；现病史: 患者2年前无明显诱因间断出现双侧耳鸣，近2周自觉右侧耳鸣症状加重，无鼻塞、涕血等不适。3天前无明显诱因发现右颈部肿物，遂就诊外院行CT检查示：鼻咽右侧壁增厚，考虑鼻咽癌可能，伴右侧乳突阻塞性炎症。今为进一步诊治收入我院。起病以来，患者无发热、咳嗽，无胸闷、胸痛，无恶心、呕吐，胃纳、睡眠、精神可，大小便正常，体重无明显变化。；阳性症状体征: 双耳鸣,右颈部肿物,右耳鸣；既往史: 10+年前因“腰椎间盘突出”行手术治疗，并予输血，无“输血反应”。否认\"肝炎\"、\"结核\"、\"高血压\"、\"糖尿病\"等疾病史；无外伤病史。过敏史:否认药物、食物过敏史。；个人史: 原籍出生、长大，无疫水、疫区暴露史；无吸烟、酗酒等不良嗜好。；家族史: 否认家族其他成员有肿瘤病史及遗传病史。；体格检查: T：36.0℃ P：81bpm R：18bpm BP：111/76mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。牙龈无肿胀、出血，咽无充血，双扁桃体无肿大。颈部检查详见肿瘤专科 检查。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率81bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。肛门外生殖器未见异常，生理反射存在，病理反射未引出。；专科检查: 间接鼻咽镜检查见双侧鼻腔通畅，内未窥及明显肿物；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显斑片或结节影。双侧肺门影未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见明显病变。\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 间接胆红素(IBIL)-静脉血: 9.6umolL；尿胆原(URO)-尿液: -（参考: 阴性）；钾离子(K+)-静脉血: 4mmol/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；总胆固醇(TC)-静脉血: 6.89mmol/L；肿瘤特异性生长因子(TSGF)-静脉血: 32U/mL；红细胞计数(RBC#)-静脉血: 4.9610E12/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.5U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.3pg；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 13.4umol/L；总蛋白(TP)-尿液: -（参考: 阴性）；血小板计数(PLT#)-静脉血: 319.310E9/L；比重(SG)-尿液: LAMPL.；凝血酶原时间活动度(PTA)-静脉血: 113.8%；直接胆红素(DBIL)-静脉血: 3.8umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-静脉血: 10.310E9/L；平均血小板体积(MPV)-静脉血: 7.46fL；镁离子(Mg2+)-静脉血: 0.98mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.310E9/L；鳞状细胞癌相关抗原(SCC)-静脉血: 0.4ng/ml；低密度脂蛋白胆固醇(LDL-C)-静脉血: 5.13mmol/L；血小板比容-静脉血: 23.8%；Rh血型-静脉血: 阳性；总前列腺特异性抗原(TPSA)-静脉血: 1ng/ml；神经元特异性烯醇化酶(NSE)-静脉血: 12.85ng/ml；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；游……\n- [全程D2] 检验组合: CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 0.8%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 3%；CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 24.9%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 9.8%；CD3+T淋巴细胞百分比-静脉血: 60.3%；CD4+/CD8+辅助/抑制T淋巴细胞比值(Th/Ts比值)-静脉血: 1.7；CD3-CD16+CD56+自然杀伤细胞百分比(NK%)-静脉血: 15.5%；CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 3.1%；CD3+CD4+辅助/诱导T淋巴细胞百分比(Th/Ti%)-静脉血: 29%；CD19+B淋巴细胞百分比-静脉血: 23%；CD3+CD8+抑制/细胞毒T淋巴细胞百分比(Ts/Tc%)-静脉血: 18.4%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 27.7%\n- [全程D7] 超声；双侧颈部、锁骨上区淋巴结彩超(套): 检查类型: 超声；检查名称: 双侧颈部、锁骨上区淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉内径约14mm，门静脉最大血流速度约17cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约44×36×33mm，包膜光滑，实质回声不均匀，可见强回声斑。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 前列腺钙化。 胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D7] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 右侧颈部II区可见数个淋巴结回声，最大约23×12mm，椭圆形，边界清，皮髓质分界不清，未见淋巴门。余右侧颈部未见明确异常淋巴结。 CDFI：上述最大淋巴结内可见周边型血流信号。 左侧颈部及锁骨上区未见明确异常淋巴结回声。；检查结论: 右侧颈部II区淋巴结，恶性待排，建议穿刺活检。 左侧颈部及锁骨上区未见明确异常淋巴结声像。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D24] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽右顶壁及右侧壁粘膜增厚放射性浓聚，SUV约16.7，病灶累及右翼突基底部及内侧板、右侧腭帆张提肌。右侧咽隐窝消失，左侧咽隐窝存在。双侧咽后未见肿大淋巴结及异常放射性分布。口咽、喉咽未见异常。筛窦、左上颌窦及右乳突内低密度影放射性稀疏；额窦、蝶窦、右上颌窦及左乳突结构及放射性分布未见明显异常。双侧海绵窦放射性分布未见明显异常。甲状腺结构及放射性分布未见明显异常。右颈II区数个淋巴结放射性浓聚，SUV约18.0，大者约1.5×2.2cm；余双颈小淋巴结放射性分布未见异常。 所见脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔主肺动脉窗小淋巴结放射性分布未见明显异常，大小约0.9×1.0cm。双肺门未见肿大淋巴结及异常放射性分布。双侧腋窝小淋巴结放射性未见明显异常。 肝脏密度减低，CT值约36Hu（脾脏CT值约56Hu），结构及放射性分布未见异常；肝门区未见占位及异常放射性分布。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。左肾上腺体部小结节影放射性略浓密，大小约1.0×1.1cm。脾脏、双肾、右肾上腺及胰腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺大小正常，内见数个点状钙化灶。膀胱及肠管形态、结构及放射性分布未见明显异常。双髂血管旁及双侧腹股沟未见肿大淋巴结及异常放射性分布。 颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，病灶累及右翼突基底部及内侧板、右侧腭帆张提肌；右颈II区数个淋巴结代谢活跃，考虑转移。 左肾上腺体部小结节代谢稍活跃，疑良性增生病变。 前列腺多发钙化灶。 脂肪肝。 副鼻窦炎症；右乳突炎症。\n- [全程D28] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T6上缘水平，估计导管末端位于上腔静脉上段内。；检查结论: PICC管末端位置如上述。\n- [全程D28] 检验组合: 红细胞计数(RBC#)-静脉血: 4.710E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7；钾离子(K+)-静脉血: 4.2mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 32.3U/L；尿素氮(BUN)-静脉血: 8.2mmol/L；间接胆红素(IBIL)-静脉血: 6.2umolL；氯离子(Cl-)-静脉血: 100.2mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 326g/L；红细胞比容(Hct)-静脉血: 43.5%；总胆固醇(TC)-静脉血: 5.88mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 22.9U/L；载脂蛋白AI(apoAI)-静脉血: 1.32g/L；血小板比容-静脉血: 32%；葡萄糖(Glu)-静脉血: 5.95mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.8mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.2pg；乳酸脱氢酶(LDH)-静脉血: 159.8U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.279；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.67；白细胞计数(WBC#)-静脉血: 10.7710E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 16.9U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.99mmol/L；中性粒细胞计数(Neut#)-静脉血: 6.410E9/L；平均红细胞体积(MCV)-静脉血: 92.6fL；平均血小板体积(MPV)-静脉血: 9.2fL；总胆红素(TBIL)-静脉血: 8.6umol/L；血小板分布宽度(PDW)-静脉血: 10%；磷(P)-静脉血: 1.6mmol/L；肌酐(Crea)-静脉血: 64.4umol/L；血小板计数(PLT#)-静脉血: 34410E9/L；C-反应蛋白(CRP)-静脉血: 3.29mg/L；碱性磷酸酶(ALP)-静脉血: 102.6U/L；白蛋白(ALB)-静脉血: 46.3g/L；淋巴细胞计数(Lymph#)-静脉血: 310E9/L；单核细胞计数(Mono#)-静脉血: 0.810E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 54U/L；大血小板百分比(P-LCR%)-静脉血: 18.4%；单核细胞百分比(Mono%)-静……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D9] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，无发热、涕血等不适症状。查体：生命体征平稳。电子喉镜检查示：鼻咽右隆突肿物，符合鼻咽癌。并取肿物活检，等待病理结果。[姓名已隐去]副教授示，结合患者病情及相关检查，诊断考虑鼻咽癌可能性大，明确诊断，予鼻咽科进一步诊治。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D15] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：KPS 90分；鼻咽右侧壁、顶后壁结节状肿物，右颈Ⅱ区可扪及已肿大淋巴结，大小约2*1cm，颅神经检查（-）。今日[姓名已隐去]医生信息已隐藏后示：患者已完善相关检查，并预约放疗，今日可结账出院，嘱出院后按时[计划性表述已隐藏]放化综合治疗，不适随诊。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂不予静脉水化及电解质补充，待明日行顺铂化疗时同步予以补液支持。\nB. 予以静脉水化，暂不补充钾离子，嘱计24小时尿量，并常规行PICC导管护理。\nC. 予以静脉水化及电解质补充，常规静脉推注呋塞米强效利尿，并计24小时尿量。\nD. 予以静脉水化及电解质补充，皮下注射重组人粒细胞集落刺激因子预防骨髓抑制。\nE. 予以静脉水化及电解质补充，静脉滴注右丙亚胺预防大剂量顺铂相关心脏毒性。\nF. 予以静脉水化及电解质补充，静脉滴注阿米福汀预防大剂量顺铂相关肾毒性。\nG. 予以静脉水化及电解质补充，嘱计24小时尿量，并静脉滴注头孢菌素预防感染。\nH. 予以静脉水化及电解质补充，静脉滴注地塞米松及帕洛诺司琼进行止吐预处理。\nI. 予以静脉水化及电解质补充，静脉输注人血白蛋白以预防大剂量化疗后低蛋白血症。\nJ. 予以静脉水化及电解质补充，静脉滴注异甘草酸镁预防大剂量顺铂相关肝损伤。\nK. 予以静脉水化及电解质补充，嘱计24小时尿量，并皮下注射促红细胞生成素。\nL. 予以静脉水化及电解质（含钾）补充，嘱计24小时尿量，并常规行PICC导管护理。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-e0f912ad55b7b1f092a1b468","patient_id":"patient-e7eec542502a097814d58d8a","turn_id":"turn06","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"L","gold_action":"仅常规复查血常规、生化常规及EBV-DNA定量，暂不予特殊药物干预","options":[{"letter":"A","text":"在无明显感染或疼痛症状的情况下经验性给予阿莫西林口服抗感染及酚咖片止痛，并复查血常规、生化常规及EBV-DNA定量","is_gold":false},{"letter":"B","text":"在无明显感染或疼痛症状的情况下静脉滴注头孢类抗生素并酚咖片止痛，同时复查血常规、生化常规及EBV-DNA定量","is_gold":false},{"letter":"C","text":"经验性给予阿莫西林口服抗感染及酚咖片止痛，并暂停放疗直至症状完全缓解","is_gold":false},{"letter":"D","text":"经验性给予酚咖片对症止痛，暂不予抗感染治疗，并复查血常规、生化常规及EBV-DNA定量","is_gold":false},{"letter":"E","text":"经验性给予阿莫西林口服抗感染，暂不予止痛治疗，并复查血常规、生化常规及EBV-DNA定量","is_gold":false},{"letter":"F","text":"经验性给予阿莫西林口服抗感染及酚咖片止痛，并提前安排第二程顺铂化疗","is_gold":false},{"letter":"G","text":"经验性给予阿莫西林口服抗感染及酚咖片止痛，并加用静脉地塞米松减轻局部水肿","is_gold":false},{"letter":"H","text":"经验性给予静脉滴注广谱抗生素及曲马多止痛，并复查血常规、生化常规及EBV-DNA定量","is_gold":false},{"letter":"I","text":"经验性给予阿莫西林口服抗感染及酚咖片止痛，并取消后续顺铂化疗计划","is_gold":false},{"letter":"J","text":"经验性给予阿莫西林口服抗感染及酚咖片止痛，并复查鼻咽颈部MRI评估近期疗效","is_gold":false},{"letter":"K","text":"经验性给予口服抗真菌药物及酚咖片止痛，并复查血常规、生化常规及EBV-DNA定量","is_gold":false},{"letter":"L","text":"仅常规复查血常规、生化常规及EBV-DNA定量，暂不予特殊药物干预","is_gold":true}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 双侧耳鸣2年，发现右颈肿物3天；现病史: 患者2年前无明显诱因间断出现双侧耳鸣，近2周自觉右侧耳鸣症状加重，无鼻塞、涕血等不适。今为进一步诊治收入我院。起病以来，患者无发热、咳嗽，无胸闷、胸痛，无恶心、呕吐，胃纳、睡眠、精神可，大小便正常，体重无明显变化。；阳性症状体征: 双耳鸣,右颈部肿物,右耳鸣；既往史: 10+年前因“腰椎间盘突出”行手术治疗，并予输血，无“输血反应”。否认\"肝炎\"、\"结核\"、\"高血压\"、\"糖尿病\"等疾病史；无外伤病史。过敏史:否认药物、食物过敏史。；个人史: 原籍出生、长大，无疫水、疫区暴露史；无吸烟、酗酒等不良嗜好。；家族史: 否认家族其他成员有肿瘤病史及遗传病史。；体格检查: T：36.0℃ P：81bpm R：18bpm BP：111/76mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。牙龈无肿胀、出血，咽无充血，双扁桃体无肿大。颈部检查详见肿瘤专科 检查。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率81bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 双侧耳鸣2年，发现右颈肿物3天；现病史: 患者2年前无明显诱因间断出现双侧耳鸣，近2周自觉右侧耳鸣症状加重，无鼻塞、涕血等不适。3天前无明显诱因发现右颈部肿物，遂就诊外院行CT检查示：鼻咽右侧壁增厚，考虑鼻咽癌可能，伴右侧乳突阻塞性炎症。今为进一步诊治收入我院。起病以来，患者无发热、咳嗽，无胸闷、胸痛，无恶心、呕吐，胃纳、睡眠、精神可，大小便正常，体重无明显变化。；阳性症状体征: 双耳鸣,右颈部肿物,右耳鸣；既往史: 10+年前因“腰椎间盘突出”行手术治疗，并予输血，无“输血反应”。否认\"肝炎\"、\"结核\"、\"高血压\"、\"糖尿病\"等疾病史；无外伤病史。过敏史:否认药物、食物过敏史。；个人史: 原籍出生、长大，无疫水、疫区暴露史；无吸烟、酗酒等不良嗜好。；家族史: 否认家族其他成员有肿瘤病史及遗传病史。；体格检查: T：36.0℃ P：81bpm R：18bpm BP：111/76mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。牙龈无肿胀、出血，咽无充血，双扁桃体无肿大。颈部检查详见肿瘤专科 检查。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率81bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。肛门外生殖器未见异常，生理反射存在，病理反射未引出。；专科检查: 间接鼻咽镜检查见双侧鼻腔通畅，内未窥及明显肿物；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显斑片或结节影。双侧肺门影未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见明显病变。\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 间接胆红素(IBIL)-静脉血: 9.6umolL；尿胆原(URO)-尿液: -（参考: 阴性）；钾离子(K+)-静脉血: 4mmol/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；总胆固醇(TC)-静脉血: 6.89mmol/L；肿瘤特异性生长因子(TSGF)-静脉血: 32U/mL；红细胞计数(RBC#)-静脉血: 4.9610E12/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.5U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.3pg；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 13.4umol/L；总蛋白(TP)-尿液: -（参考: 阴性）；血小板计数(PLT#)-静脉血: 319.310E9/L；比重(SG)-尿液: LAMPL.；凝血酶原时间活动度(PTA)-静脉血: 113.8%；直接胆红素(DBIL)-静脉血: 3.8umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-静脉血: 10.310E9/L；平均血小板体积(MPV)-静脉血: 7.46fL；镁离子(Mg2+)-静脉血: 0.98mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.310E9/L；鳞状细胞癌相关抗原(SCC)-静脉血: 0.4ng/ml；低密度脂蛋白胆固醇(LDL-C)-静脉血: 5.13mmol/L；血小板比容-静脉血: 23.8%；Rh血型-静脉血: 阳性；总前列腺特异性抗原(TPSA)-静脉血: 1ng/ml；神经元特异性烯醇化酶(NSE)-静脉血: 12.85ng/ml；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；游……\n- [全程D2] 检验组合: CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 0.8%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 3%；CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 24.9%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 9.8%；CD3+T淋巴细胞百分比-静脉血: 60.3%；CD4+/CD8+辅助/抑制T淋巴细胞比值(Th/Ts比值)-静脉血: 1.7；CD3-CD16+CD56+自然杀伤细胞百分比(NK%)-静脉血: 15.5%；CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 3.1%；CD3+CD4+辅助/诱导T淋巴细胞百分比(Th/Ti%)-静脉血: 29%；CD19+B淋巴细胞百分比-静脉血: 23%；CD3+CD8+抑制/细胞毒T淋巴细胞百分比(Ts/Tc%)-静脉血: 18.4%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 27.7%\n- [全程D7] 超声；双侧颈部、锁骨上区淋巴结彩超(套): 检查类型: 超声；检查名称: 双侧颈部、锁骨上区淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉内径约14mm，门静脉最大血流速度约17cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约44×36×33mm，包膜光滑，实质回声不均匀，可见强回声斑。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 前列腺钙化。 胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D7] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 右侧颈部II区可见数个淋巴结回声，最大约23×12mm，椭圆形，边界清，皮髓质分界不清，未见淋巴门。余右侧颈部未见明确异常淋巴结。 CDFI：上述最大淋巴结内可见周边型血流信号。 左侧颈部及锁骨上区未见明确异常淋巴结回声。；检查结论: 右侧颈部II区淋巴结，恶性待排，建议穿刺活检。 左侧颈部及锁骨上区未见明确异常淋巴结声像。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D24] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽右顶壁及右侧壁粘膜增厚放射性浓聚，SUV约16.7，病灶累及右翼突基底部及内侧板、右侧腭帆张提肌。右侧咽隐窝消失，左侧咽隐窝存在。双侧咽后未见肿大淋巴结及异常放射性分布。口咽、喉咽未见异常。筛窦、左上颌窦及右乳突内低密度影放射性稀疏；额窦、蝶窦、右上颌窦及左乳突结构及放射性分布未见明显异常。双侧海绵窦放射性分布未见明显异常。甲状腺结构及放射性分布未见明显异常。右颈II区数个淋巴结放射性浓聚，SUV约18.0，大者约1.5×2.2cm；余双颈小淋巴结放射性分布未见异常。 所见脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔主肺动脉窗小淋巴结放射性分布未见明显异常，大小约0.9×1.0cm。双肺门未见肿大淋巴结及异常放射性分布。双侧腋窝小淋巴结放射性未见明显异常。 肝脏密度减低，CT值约36Hu（脾脏CT值约56Hu），结构及放射性分布未见异常；肝门区未见占位及异常放射性分布。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。左肾上腺体部小结节影放射性略浓密，大小约1.0×1.1cm。脾脏、双肾、右肾上腺及胰腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺大小正常，内见数个点状钙化灶。膀胱及肠管形态、结构及放射性分布未见明显异常。双髂血管旁及双侧腹股沟未见肿大淋巴结及异常放射性分布。 颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，病灶累及右翼突基底部及内侧板、右侧腭帆张提肌；右颈II区数个淋巴结代谢活跃，考虑转移。 左肾上腺体部小结节代谢稍活跃，疑良性增生病变。 前列腺多发钙化灶。 脂肪肝。 副鼻窦炎症；右乳突炎症。\n- [全程D28] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T6上缘水平，估计导管末端位于上腔静脉上段内。；检查结论: PICC管末端位置如上述。\n- [全程D28] 检验组合: 红细胞计数(RBC#)-静脉血: 4.710E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7；钾离子(K+)-静脉血: 4.2mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 32.3U/L；尿素氮(BUN)-静脉血: 8.2mmol/L；间接胆红素(IBIL)-静脉血: 6.2umolL；氯离子(Cl-)-静脉血: 100.2mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 326g/L；红细胞比容(Hct)-静脉血: 43.5%；总胆固醇(TC)-静脉血: 5.88mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 22.9U/L；载脂蛋白AI(apoAI)-静脉血: 1.32g/L；血小板比容-静脉血: 32%；葡萄糖(Glu)-静脉血: 5.95mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.8mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.2pg；乳酸脱氢酶(LDH)-静脉血: 159.8U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.279；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.67；白细胞计数(WBC#)-静脉血: 10.7710E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 16.9U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.99mmol/L；中性粒细胞计数(Neut#)-静脉血: 6.410E9/L；平均红细胞体积(MCV)-静脉血: 92.6fL；平均血小板体积(MPV)-静脉血: 9.2fL；总胆红素(TBIL)-静脉血: 8.6umol/L；血小板分布宽度(PDW)-静脉血: 10%；磷(P)-静脉血: 1.6mmol/L；肌酐(Crea)-静脉血: 64.4umol/L；血小板计数(PLT#)-静脉血: 34410E9/L；C-反应蛋白(CRP)-静脉血: 3.29mg/L；碱性磷酸酶(ALP)-静脉血: 102.6U/L；白蛋白(ALB)-静脉血: 46.3g/L；淋巴细胞计数(Lymph#)-静脉血: 310E9/L；单核细胞计数(Mono#)-静脉血: 0.810E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 54U/L；大血小板百分比(P-LCR%)-静脉血: 18.4%；单核细胞百分比(Mono%)-静……\n- [全程D29] 检验组合: 隐血(OB)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；淀粉样蛋白A(SAA)-静脉血: 3.65mg/L；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；白细胞计数(WBC#)-尿液: 7/μL；比重(SG)-尿液: 1.027；总蛋白(TP)-尿液: +- 0.2g（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；葡萄糖(Glu)-尿液: 3+ 17mmol（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 80/μL\n- [全程D30] 检验组合: 颜色-尿液: Yellow；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 13/μL；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 6；总蛋白(TP)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.023\n- [全程D35] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.7；单核细胞计数(Mono#)-静脉血: 0.810E9/L；甘油三酯(TG)-静脉血: 2.15mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；载脂蛋白AI(apoAI)-静脉血: 1.26g/L；中性粒细胞百分比(Neut%)-静脉血: 0.702；葡萄糖(Glu)-静脉血: 6.03mmol/L；尿素氮(BUN)-静脉血: 7.02mmol/L；直接胆红素(DBIL)-静脉血: 4.8umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20U/L；C-反应蛋白(CRP)-静脉血: 2.65mg/L；乳酸脱氢酶(LDH)-静脉血: 166.9U/L；红细胞计数(RBC#)-静脉血: 4.7510E12/L；总胆汁酸(TBA)-静脉血: 1.5umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；总蛋白(TP)-静脉血: 71.69g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；肌酐(Crea)-静脉血: 69.7umol/L；总钙(Ca)-静脉血: 2.31mmol/L；白细胞计数(WBC#)-静脉血: 7.4610E9/L；镁离子(Mg2+)-静脉血: 1mmol/L；平均红细胞体积(MCV)-静脉血: 88.8fL；总胆固醇(TC)-静脉血: 5.15mmol/L；磷(P)-静脉血: 1.3mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；总胆红素(TBIL)-静脉血: 15umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；阴离子间隙(AG)-静脉血: 17；间接胆红素(IBIL)-静脉血: 10.2umolL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.18mmolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4；球蛋白(GLO)-静脉血: 26.39g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.168；血小板分布宽度(PDW)-静脉血: 9.8%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.015；血红蛋白(Hb)-静脉血: 141g/L；淋巴细胞计数(L……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D9] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，无发热、涕血等不适症状。查体：生命体征平稳。电子喉镜检查示：鼻咽右隆突肿物，符合鼻咽癌。并取肿物活检，等待病理结果。[姓名已隐去]副教授示，结合患者病情及相关检查，诊断考虑鼻咽癌可能性大，明确诊断，予鼻咽科进一步诊治。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D15] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：KPS 90分；鼻咽右侧壁、顶后壁结节状肿物，右颈Ⅱ区可扪及已肿大淋巴结，大小约2*1cm，颅神经检查（-）。今日[姓名已隐去]医生信息已隐藏后示：患者已完善相关检查，并预约放疗，今日可结账出院，嘱出院后按时[计划性表述已隐藏]放化综合治疗，不适随诊。\n- [全程D29] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者放疗1次。患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：基本同前。今日[姓名已隐去]副医生信息已隐藏后示：患于今日行第一程DDP方案化疗（100mg/m2）。继续放疗，续观。\n- [全程D34] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：KPS 90分； 间接鼻咽镜检查见双侧鼻腔通畅，内未窥及明显肿物；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。复查血常规、生化常规未见明显异常。今日[姓名已隐去]医生信息已隐藏后示：患者已结束第一程同时期DDP方案化疗（100mg/m2），治疗过程顺利，今日可结账出院，嘱出院后继续在门诊放疗，每周复查血常规、肝肾功能，并按时[计划性表述已隐藏]下一程治疗，不适随诊。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 在无明显感染或疼痛症状的情况下经验性给予阿莫西林口服抗感染及酚咖片止痛，并复查血常规、生化常规及EBV-DNA定量\nB. 在无明显感染或疼痛症状的情况下静脉滴注头孢类抗生素并酚咖片止痛，同时复查血常规、生化常规及EBV-DNA定量\nC. 经验性给予阿莫西林口服抗感染及酚咖片止痛，并暂停放疗直至症状完全缓解\nD. 经验性给予酚咖片对症止痛，暂不予抗感染治疗，并复查血常规、生化常规及EBV-DNA定量\nE. 经验性给予阿莫西林口服抗感染，暂不予止痛治疗，并复查血常规、生化常规及EBV-DNA定量\nF. 经验性给予阿莫西林口服抗感染及酚咖片止痛，并提前安排第二程顺铂化疗\nG. 经验性给予阿莫西林口服抗感染及酚咖片止痛，并加用静脉地塞米松减轻局部水肿\nH. 经验性给予静脉滴注广谱抗生素及曲马多止痛，并复查血常规、生化常规及EBV-DNA定量\nI. 经验性给予阿莫西林口服抗感染及酚咖片止痛，并取消后续顺铂化疗计划\nJ. 经验性给予阿莫西林口服抗感染及酚咖片止痛，并复查鼻咽颈部MRI评估近期疗效\nK. 经验性给予口服抗真菌药物及酚咖片止痛，并复查血常规、生化常规及EBV-DNA定量\nL. 仅常规复查血常规、生化常规及EBV-DNA定量，暂不予特殊药物干预\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 双侧耳鸣2年，发现右颈肿物3天；现病史: 患者2年前无明显诱因间断出现双侧耳鸣，近2周自觉右侧耳鸣症状加重，无鼻塞、涕血等不适。今为进一步诊治收入我院。起病以来，患者无发热、咳嗽，无胸闷、胸痛，无恶心、呕吐，胃纳、睡眠、精神可，大小便正常，体重无明显变化。；阳性症状体征: 双耳鸣,右颈部肿物,右耳鸣；既往史: 10+年前因“腰椎间盘突出”行手术治疗，并予输血，无“输血反应”。否认\"肝炎\"、\"结核\"、\"高血压\"、\"糖尿病\"等疾病史；无外伤病史。过敏史:否认药物、食物过敏史。；个人史: 原籍出生、长大，无疫水、疫区暴露史；无吸烟、酗酒等不良嗜好。；家族史: 否认家族其他成员有肿瘤病史及遗传病史。；体格检查: T：36.0℃ P：81bpm R：18bpm BP：111/76mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。牙龈无肿胀、出血，咽无充血，双扁桃体无肿大。颈部检查详见肿瘤专科 检查。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率81bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 双侧耳鸣2年，发现右颈肿物3天；现病史: 患者2年前无明显诱因间断出现双侧耳鸣，近2周自觉右侧耳鸣症状加重，无鼻塞、涕血等不适。3天前无明显诱因发现右颈部肿物，遂就诊外院行CT检查示：鼻咽右侧壁增厚，考虑鼻咽癌可能，伴右侧乳突阻塞性炎症。今为进一步诊治收入我院。起病以来，患者无发热、咳嗽，无胸闷、胸痛，无恶心、呕吐，胃纳、睡眠、精神可，大小便正常，体重无明显变化。；阳性症状体征: 双耳鸣,右颈部肿物,右耳鸣；既往史: 10+年前因“腰椎间盘突出”行手术治疗，并予输血，无“输血反应”。否认\"肝炎\"、\"结核\"、\"高血压\"、\"糖尿病\"等疾病史；无外伤病史。过敏史:否认药物、食物过敏史。；个人史: 原籍出生、长大，无疫水、疫区暴露史；无吸烟、酗酒等不良嗜好。；家族史: 否认家族其他成员有肿瘤病史及遗传病史。；体格检查: T：36.0℃ P：81bpm R：18bpm BP：111/76mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。牙龈无肿胀、出血，咽无充血，双扁桃体无肿大。颈部检查详见肿瘤专科 检查。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率81bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。肛门外生殖器未见异常，生理反射存在，病理反射未引出。；专科检查: 间接鼻咽镜检查见双侧鼻腔通畅，内未窥及明显肿物；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显斑片或结节影。双侧肺门影未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见明显病变。\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 间接胆红素(IBIL)-静脉血: 9.6umolL；尿胆原(URO)-尿液: -（参考: 阴性）；钾离子(K+)-静脉血: 4mmol/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；总胆固醇(TC)-静脉血: 6.89mmol/L；肿瘤特异性生长因子(TSGF)-静脉血: 32U/mL；红细胞计数(RBC#)-静脉血: 4.9610E12/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.5U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.3pg；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 13.4umol/L；总蛋白(TP)-尿液: -（参考: 阴性）；血小板计数(PLT#)-静脉血: 319.310E9/L；比重(SG)-尿液: LAMPL.；凝血酶原时间活动度(PTA)-静脉血: 113.8%；直接胆红素(DBIL)-静脉血: 3.8umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-静脉血: 10.310E9/L；平均血小板体积(MPV)-静脉血: 7.46fL；镁离子(Mg2+)-静脉血: 0.98mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.310E9/L；鳞状细胞癌相关抗原(SCC)-静脉血: 0.4ng/ml；低密度脂蛋白胆固醇(LDL-C)-静脉血: 5.13mmol/L；血小板比容-静脉血: 23.8%；Rh血型-静脉血: 阳性；总前列腺特异性抗原(TPSA)-静脉血: 1ng/ml；神经元特异性烯醇化酶(NSE)-静脉血: 12.85ng/ml；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；游……\n- [全程D2] 检验组合: CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 0.8%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 3%；CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 24.9%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 9.8%；CD3+T淋巴细胞百分比-静脉血: 60.3%；CD4+/CD8+辅助/抑制T淋巴细胞比值(Th/Ts比值)-静脉血: 1.7；CD3-CD16+CD56+自然杀伤细胞百分比(NK%)-静脉血: 15.5%；CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 3.1%；CD3+CD4+辅助/诱导T淋巴细胞百分比(Th/Ti%)-静脉血: 29%；CD19+B淋巴细胞百分比-静脉血: 23%；CD3+CD8+抑制/细胞毒T淋巴细胞百分比(Ts/Tc%)-静脉血: 18.4%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 27.7%\n- [全程D7] 超声；双侧颈部、锁骨上区淋巴结彩超(套): 检查类型: 超声；检查名称: 双侧颈部、锁骨上区淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉内径约14mm，门静脉最大血流速度约17cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约44×36×33mm，包膜光滑，实质回声不均匀，可见强回声斑。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 前列腺钙化。 胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D7] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 右侧颈部II区可见数个淋巴结回声，最大约23×12mm，椭圆形，边界清，皮髓质分界不清，未见淋巴门。余右侧颈部未见明确异常淋巴结。 CDFI：上述最大淋巴结内可见周边型血流信号。 左侧颈部及锁骨上区未见明确异常淋巴结回声。；检查结论: 右侧颈部II区淋巴结，恶性待排，建议穿刺活检。 左侧颈部及锁骨上区未见明确异常淋巴结声像。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D24] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽右顶壁及右侧壁粘膜增厚放射性浓聚，SUV约16.7，病灶累及右翼突基底部及内侧板、右侧腭帆张提肌。右侧咽隐窝消失，左侧咽隐窝存在。双侧咽后未见肿大淋巴结及异常放射性分布。口咽、喉咽未见异常。筛窦、左上颌窦及右乳突内低密度影放射性稀疏；额窦、蝶窦、右上颌窦及左乳突结构及放射性分布未见明显异常。双侧海绵窦放射性分布未见明显异常。甲状腺结构及放射性分布未见明显异常。右颈II区数个淋巴结放射性浓聚，SUV约18.0，大者约1.5×2.2cm；余双颈小淋巴结放射性分布未见异常。 所见脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔主肺动脉窗小淋巴结放射性分布未见明显异常，大小约0.9×1.0cm。双肺门未见肿大淋巴结及异常放射性分布。双侧腋窝小淋巴结放射性未见明显异常。 肝脏密度减低，CT值约36Hu（脾脏CT值约56Hu），结构及放射性分布未见异常；肝门区未见占位及异常放射性分布。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。左肾上腺体部小结节影放射性略浓密，大小约1.0×1.1cm。脾脏、双肾、右肾上腺及胰腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺大小正常，内见数个点状钙化灶。膀胱及肠管形态、结构及放射性分布未见明显异常。双髂血管旁及双侧腹股沟未见肿大淋巴结及异常放射性分布。 颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，病灶累及右翼突基底部及内侧板、右侧腭帆张提肌；右颈II区数个淋巴结代谢活跃，考虑转移。 左肾上腺体部小结节代谢稍活跃，疑良性增生病变。 前列腺多发钙化灶。 脂肪肝。 副鼻窦炎症；右乳突炎症。\n- [全程D28] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T6上缘水平，估计导管末端位于上腔静脉上段内。；检查结论: PICC管末端位置如上述。\n- [全程D28] 检验组合: 红细胞计数(RBC#)-静脉血: 4.710E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7；钾离子(K+)-静脉血: 4.2mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 32.3U/L；尿素氮(BUN)-静脉血: 8.2mmol/L；间接胆红素(IBIL)-静脉血: 6.2umolL；氯离子(Cl-)-静脉血: 100.2mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 326g/L；红细胞比容(Hct)-静脉血: 43.5%；总胆固醇(TC)-静脉血: 5.88mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 22.9U/L；载脂蛋白AI(apoAI)-静脉血: 1.32g/L；血小板比容-静脉血: 32%；葡萄糖(Glu)-静脉血: 5.95mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.8mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.2pg；乳酸脱氢酶(LDH)-静脉血: 159.8U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.279；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.67；白细胞计数(WBC#)-静脉血: 10.7710E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 16.9U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.99mmol/L；中性粒细胞计数(Neut#)-静脉血: 6.410E9/L；平均红细胞体积(MCV)-静脉血: 92.6fL；平均血小板体积(MPV)-静脉血: 9.2fL；总胆红素(TBIL)-静脉血: 8.6umol/L；血小板分布宽度(PDW)-静脉血: 10%；磷(P)-静脉血: 1.6mmol/L；肌酐(Crea)-静脉血: 64.4umol/L；血小板计数(PLT#)-静脉血: 34410E9/L；C-反应蛋白(CRP)-静脉血: 3.29mg/L；碱性磷酸酶(ALP)-静脉血: 102.6U/L；白蛋白(ALB)-静脉血: 46.3g/L；淋巴细胞计数(Lymph#)-静脉血: 310E9/L；单核细胞计数(Mono#)-静脉血: 0.810E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 54U/L；大血小板百分比(P-LCR%)-静脉血: 18.4%；单核细胞百分比(Mono%)-静……\n- [全程D29] 检验组合: 隐血(OB)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；淀粉样蛋白A(SAA)-静脉血: 3.65mg/L；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；白细胞计数(WBC#)-尿液: 7/μL；比重(SG)-尿液: 1.027；总蛋白(TP)-尿液: +- 0.2g（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；葡萄糖(Glu)-尿液: 3+ 17mmol（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 80/μL\n- [全程D30] 检验组合: 颜色-尿液: Yellow；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 13/μL；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 6；总蛋白(TP)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.023\n- [全程D35] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.7；单核细胞计数(Mono#)-静脉血: 0.810E9/L；甘油三酯(TG)-静脉血: 2.15mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；载脂蛋白AI(apoAI)-静脉血: 1.26g/L；中性粒细胞百分比(Neut%)-静脉血: 0.702；葡萄糖(Glu)-静脉血: 6.03mmol/L；尿素氮(BUN)-静脉血: 7.02mmol/L；直接胆红素(DBIL)-静脉血: 4.8umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20U/L；C-反应蛋白(CRP)-静脉血: 2.65mg/L；乳酸脱氢酶(LDH)-静脉血: 166.9U/L；红细胞计数(RBC#)-静脉血: 4.7510E12/L；总胆汁酸(TBA)-静脉血: 1.5umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；总蛋白(TP)-静脉血: 71.69g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；肌酐(Crea)-静脉血: 69.7umol/L；总钙(Ca)-静脉血: 2.31mmol/L；白细胞计数(WBC#)-静脉血: 7.4610E9/L；镁离子(Mg2+)-静脉血: 1mmol/L；平均红细胞体积(MCV)-静脉血: 88.8fL；总胆固醇(TC)-静脉血: 5.15mmol/L；磷(P)-静脉血: 1.3mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；总胆红素(TBIL)-静脉血: 15umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；阴离子间隙(AG)-静脉血: 17；间接胆红素(IBIL)-静脉血: 10.2umolL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.18mmolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4；球蛋白(GLO)-静脉血: 26.39g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.168；血小板分布宽度(PDW)-静脉血: 9.8%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.015；血红蛋白(Hb)-静脉血: 141g/L；淋巴细胞计数(L……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D9] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，无发热、涕血等不适症状。查体：生命体征平稳。电子喉镜检查示：鼻咽右隆突肿物，符合鼻咽癌。并取肿物活检，等待病理结果。[姓名已隐去]副教授示，结合患者病情及相关检查，诊断考虑鼻咽癌可能性大，明确诊断，予鼻咽科进一步诊治。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D15] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：KPS 90分；鼻咽右侧壁、顶后壁结节状肿物，右颈Ⅱ区可扪及已肿大淋巴结，大小约2*1cm，颅神经检查（-）。今日[姓名已隐去]医生信息已隐藏后示：患者已完善相关检查，并预约放疗，今日可结账出院，嘱出院后按时[计划性表述已隐藏]放化综合治疗，不适随诊。\n- [全程D29] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者放疗1次。患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：基本同前。今日[姓名已隐去]副医生信息已隐藏后示：患于今日行第一程DDP方案化疗（100mg/m2）。继续放疗，续观。\n- [全程D34] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：KPS 90分； 间接鼻咽镜检查见双侧鼻腔通畅，内未窥及明显肿物；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。复查血常规、生化常规未见明显异常。今日[姓名已隐去]医生信息已隐藏后示：患者已结束第一程同时期DDP方案化疗（100mg/m2），治疗过程顺利，今日可结账出院，嘱出院后继续在门诊放疗，每周复查血常规、肝肾功能，并按时[计划性表述已隐藏]下一程治疗，不适随诊。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 在无明显感染或疼痛症状的情况下经验性给予阿莫西林口服抗感染及酚咖片止痛，并复查血常规、生化常规及EBV-DNA定量\nB. 在无明显感染或疼痛症状的情况下静脉滴注头孢类抗生素并酚咖片止痛，同时复查血常规、生化常规及EBV-DNA定量\nC. 经验性给予阿莫西林口服抗感染及酚咖片止痛，并暂停放疗直至症状完全缓解\nD. 经验性给予酚咖片对症止痛，暂不予抗感染治疗，并复查血常规、生化常规及EBV-DNA定量\nE. 经验性给予阿莫西林口服抗感染，暂不予止痛治疗，并复查血常规、生化常规及EBV-DNA定量\nF. 经验性给予阿莫西林口服抗感染及酚咖片止痛，并提前安排第二程顺铂化疗\nG. 经验性给予阿莫西林口服抗感染及酚咖片止痛，并加用静脉地塞米松减轻局部水肿\nH. 经验性给予静脉滴注广谱抗生素及曲马多止痛，并复查血常规、生化常规及EBV-DNA定量\nI. 经验性给予阿莫西林口服抗感染及酚咖片止痛，并取消后续顺铂化疗计划\nJ. 经验性给予阿莫西林口服抗感染及酚咖片止痛，并复查鼻咽颈部MRI评估近期疗效\nK. 经验性给予口服抗真菌药物及酚咖片止痛，并复查血常规、生化常规及EBV-DNA定量\nL. 仅常规复查血常规、生化常规及EBV-DNA定量，暂不予特殊药物干预\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-67a2318574aada2f5af690c0","patient_id":"patient-e7eec542502a097814d58d8a","turn_id":"turn07","turn_position":5,"turn_type":"recurrence_or_salvage_decision","gold_letter":"B","gold_action":"继续完成原计划的根治性放疗，给予阿片类药物镇痛及静脉补液与营养支持治疗。","options":[{"letter":"A","text":"提前终止放疗，转为单纯全身化疗或靶向治疗，并给予静脉营养支持。","is_gold":false},{"letter":"B","text":"继续完成原计划的根治性放疗，给予阿片类药物镇痛及静脉补液与营养支持治疗。","is_gold":true},{"letter":"C","text":"暂停放疗直至口腔黏膜反应降至1度，期间给予广谱抗生素及静脉糖皮质激素治疗。","is_gold":false},{"letter":"D","text":"继续放疗，重新定位并缩减放疗靶区及处方剂量，同时给予非甾体类抗炎药镇痛。","is_gold":false},{"letter":"E","text":"暂停放疗，更改全身治疗方案为TPF方案化疗，待局部症状好转后择期恢复放疗。","is_gold":false},{"letter":"F","text":"继续完成根治性放疗，给予局部利多卡因含漱液及非甾体类抗炎药镇痛，并仅口服营养支持，无需静脉补液。","is_gold":false},{"letter":"G","text":"终止放疗，行右侧颈部淋巴结清扫术及鼻咽原发灶挽救性切除术。","is_gold":false},{"letter":"H","text":"继续放疗并同步行第3程大剂量顺铂化疗，给予阿片类药物镇痛，暂不予静脉补液。","is_gold":false},{"letter":"I","text":"暂停放疗，行鼻咽部内镜下微创手术切除残留病灶，术后继续静脉补液支持。","is_gold":false},{"letter":"J","text":"继续完成根治性放疗，行经皮内镜下胃造瘘术（PEG）以建立长期肠内营养途径。","is_gold":false},{"letter":"K","text":"提前终止放疗，改为PD-1抑制剂联合化疗的全身系统性维持治疗。","is_gold":false},{"letter":"L","text":"继续放疗，给予大剂量静脉糖皮质激素冲击治疗缓解黏膜反应，并继续口服营养液。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 双侧耳鸣2年，发现右颈肿物3天；现病史: 患者2年前无明显诱因间断出现双侧耳鸣，近2周自觉右侧耳鸣症状加重，无鼻塞、涕血等不适。今为进一步诊治收入我院。起病以来，患者无发热、咳嗽，无胸闷、胸痛，无恶心、呕吐，胃纳、睡眠、精神可，大小便正常，体重无明显变化。；阳性症状体征: 双耳鸣,右颈部肿物,右耳鸣；既往史: 10+年前因“腰椎间盘突出”行手术治疗，并予输血，无“输血反应”。否认\"肝炎\"、\"结核\"、\"高血压\"、\"糖尿病\"等疾病史；无外伤病史。过敏史:否认药物、食物过敏史。；个人史: 原籍出生、长大，无疫水、疫区暴露史；无吸烟、酗酒等不良嗜好。；家族史: 否认家族其他成员有肿瘤病史及遗传病史。；体格检查: T：36.0℃ P：81bpm R：18bpm BP：111/76mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。牙龈无肿胀、出血，咽无充血，双扁桃体无肿大。颈部检查详见肿瘤专科 检查。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率81bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 双侧耳鸣2年，发现右颈肿物3天；现病史: 患者2年前无明显诱因间断出现双侧耳鸣，近2周自觉右侧耳鸣症状加重，无鼻塞、涕血等不适。3天前无明显诱因发现右颈部肿物，遂就诊外院行CT检查示：鼻咽右侧壁增厚，考虑鼻咽癌可能，伴右侧乳突阻塞性炎症。今为进一步诊治收入我院。起病以来，患者无发热、咳嗽，无胸闷、胸痛，无恶心、呕吐，胃纳、睡眠、精神可，大小便正常，体重无明显变化。；阳性症状体征: 双耳鸣,右颈部肿物,右耳鸣；既往史: 10+年前因“腰椎间盘突出”行手术治疗，并予输血，无“输血反应”。否认\"肝炎\"、\"结核\"、\"高血压\"、\"糖尿病\"等疾病史；无外伤病史。过敏史:否认药物、食物过敏史。；个人史: 原籍出生、长大，无疫水、疫区暴露史；无吸烟、酗酒等不良嗜好。；家族史: 否认家族其他成员有肿瘤病史及遗传病史。；体格检查: T：36.0℃ P：81bpm R：18bpm BP：111/76mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。牙龈无肿胀、出血，咽无充血，双扁桃体无肿大。颈部检查详见肿瘤专科 检查。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率81bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。肛门外生殖器未见异常，生理反射存在，病理反射未引出。；专科检查: 间接鼻咽镜检查见双侧鼻腔通畅，内未窥及明显肿物；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显斑片或结节影。双侧肺门影未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见明显病变。\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 间接胆红素(IBIL)-静脉血: 9.6umolL；尿胆原(URO)-尿液: -（参考: 阴性）；钾离子(K+)-静脉血: 4mmol/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；总胆固醇(TC)-静脉血: 6.89mmol/L；肿瘤特异性生长因子(TSGF)-静脉血: 32U/mL；红细胞计数(RBC#)-静脉血: 4.9610E12/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.5U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.3pg；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 13.4umol/L；总蛋白(TP)-尿液: -（参考: 阴性）；血小板计数(PLT#)-静脉血: 319.310E9/L；比重(SG)-尿液: LAMPL.；凝血酶原时间活动度(PTA)-静脉血: 113.8%；直接胆红素(DBIL)-静脉血: 3.8umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-静脉血: 10.310E9/L；平均血小板体积(MPV)-静脉血: 7.46fL；镁离子(Mg2+)-静脉血: 0.98mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.310E9/L；鳞状细胞癌相关抗原(SCC)-静脉血: 0.4ng/ml；低密度脂蛋白胆固醇(LDL-C)-静脉血: 5.13mmol/L；血小板比容-静脉血: 23.8%；Rh血型-静脉血: 阳性；总前列腺特异性抗原(TPSA)-静脉血: 1ng/ml；神经元特异性烯醇化酶(NSE)-静脉血: 12.85ng/ml；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；游……\n- [全程D2] 检验组合: CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 0.8%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 3%；CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 24.9%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 9.8%；CD3+T淋巴细胞百分比-静脉血: 60.3%；CD4+/CD8+辅助/抑制T淋巴细胞比值(Th/Ts比值)-静脉血: 1.7；CD3-CD16+CD56+自然杀伤细胞百分比(NK%)-静脉血: 15.5%；CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 3.1%；CD3+CD4+辅助/诱导T淋巴细胞百分比(Th/Ti%)-静脉血: 29%；CD19+B淋巴细胞百分比-静脉血: 23%；CD3+CD8+抑制/细胞毒T淋巴细胞百分比(Ts/Tc%)-静脉血: 18.4%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 27.7%\n- [全程D7] 超声；双侧颈部、锁骨上区淋巴结彩超(套): 检查类型: 超声；检查名称: 双侧颈部、锁骨上区淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉内径约14mm，门静脉最大血流速度约17cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约44×36×33mm，包膜光滑，实质回声不均匀，可见强回声斑。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 前列腺钙化。 胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D7] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 右侧颈部II区可见数个淋巴结回声，最大约23×12mm，椭圆形，边界清，皮髓质分界不清，未见淋巴门。余右侧颈部未见明确异常淋巴结。 CDFI：上述最大淋巴结内可见周边型血流信号。 左侧颈部及锁骨上区未见明确异常淋巴结回声。；检查结论: 右侧颈部II区淋巴结，恶性待排，建议穿刺活检。 左侧颈部及锁骨上区未见明确异常淋巴结声像。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D24] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽右顶壁及右侧壁粘膜增厚放射性浓聚，SUV约16.7，病灶累及右翼突基底部及内侧板、右侧腭帆张提肌。右侧咽隐窝消失，左侧咽隐窝存在。双侧咽后未见肿大淋巴结及异常放射性分布。口咽、喉咽未见异常。筛窦、左上颌窦及右乳突内低密度影放射性稀疏；额窦、蝶窦、右上颌窦及左乳突结构及放射性分布未见明显异常。双侧海绵窦放射性分布未见明显异常。甲状腺结构及放射性分布未见明显异常。右颈II区数个淋巴结放射性浓聚，SUV约18.0，大者约1.5×2.2cm；余双颈小淋巴结放射性分布未见异常。 所见脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔主肺动脉窗小淋巴结放射性分布未见明显异常，大小约0.9×1.0cm。双肺门未见肿大淋巴结及异常放射性分布。双侧腋窝小淋巴结放射性未见明显异常。 肝脏密度减低，CT值约36Hu（脾脏CT值约56Hu），结构及放射性分布未见异常；肝门区未见占位及异常放射性分布。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。左肾上腺体部小结节影放射性略浓密，大小约1.0×1.1cm。脾脏、双肾、右肾上腺及胰腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺大小正常，内见数个点状钙化灶。膀胱及肠管形态、结构及放射性分布未见明显异常。双髂血管旁及双侧腹股沟未见肿大淋巴结及异常放射性分布。 颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，病灶累及右翼突基底部及内侧板、右侧腭帆张提肌；右颈II区数个淋巴结代谢活跃，考虑转移。 左肾上腺体部小结节代谢稍活跃，疑良性增生病变。 前列腺多发钙化灶。 脂肪肝。 副鼻窦炎症；右乳突炎症。\n- [全程D28] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T6上缘水平，估计导管末端位于上腔静脉上段内。；检查结论: PICC管末端位置如上述。\n- [全程D28] 检验组合: 红细胞计数(RBC#)-静脉血: 4.710E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7；钾离子(K+)-静脉血: 4.2mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 32.3U/L；尿素氮(BUN)-静脉血: 8.2mmol/L；间接胆红素(IBIL)-静脉血: 6.2umolL；氯离子(Cl-)-静脉血: 100.2mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 326g/L；红细胞比容(Hct)-静脉血: 43.5%；总胆固醇(TC)-静脉血: 5.88mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 22.9U/L；载脂蛋白AI(apoAI)-静脉血: 1.32g/L；血小板比容-静脉血: 32%；葡萄糖(Glu)-静脉血: 5.95mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.8mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.2pg；乳酸脱氢酶(LDH)-静脉血: 159.8U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.279；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.67；白细胞计数(WBC#)-静脉血: 10.7710E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 16.9U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.99mmol/L；中性粒细胞计数(Neut#)-静脉血: 6.410E9/L；平均红细胞体积(MCV)-静脉血: 92.6fL；平均血小板体积(MPV)-静脉血: 9.2fL；总胆红素(TBIL)-静脉血: 8.6umol/L；血小板分布宽度(PDW)-静脉血: 10%；磷(P)-静脉血: 1.6mmol/L；肌酐(Crea)-静脉血: 64.4umol/L；血小板计数(PLT#)-静脉血: 34410E9/L；C-反应蛋白(CRP)-静脉血: 3.29mg/L；碱性磷酸酶(ALP)-静脉血: 102.6U/L；白蛋白(ALB)-静脉血: 46.3g/L；淋巴细胞计数(Lymph#)-静脉血: 310E9/L；单核细胞计数(Mono#)-静脉血: 0.810E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 54U/L；大血小板百分比(P-LCR%)-静脉血: 18.4%；单核细胞百分比(Mono%)-静……\n- [全程D29] 检验组合: 隐血(OB)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；淀粉样蛋白A(SAA)-静脉血: 3.65mg/L；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；白细胞计数(WBC#)-尿液: 7/μL；比重(SG)-尿液: 1.027；总蛋白(TP)-尿液: +- 0.2g（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；葡萄糖(Glu)-尿液: 3+ 17mmol（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 80/μL\n- [全程D30] 检验组合: 颜色-尿液: Yellow；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 13/μL；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 6；总蛋白(TP)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.023\n- [全程D35] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.7；单核细胞计数(Mono#)-静脉血: 0.810E9/L；甘油三酯(TG)-静脉血: 2.15mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；载脂蛋白AI(apoAI)-静脉血: 1.26g/L；中性粒细胞百分比(Neut%)-静脉血: 0.702；葡萄糖(Glu)-静脉血: 6.03mmol/L；尿素氮(BUN)-静脉血: 7.02mmol/L；直接胆红素(DBIL)-静脉血: 4.8umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20U/L；C-反应蛋白(CRP)-静脉血: 2.65mg/L；乳酸脱氢酶(LDH)-静脉血: 166.9U/L；红细胞计数(RBC#)-静脉血: 4.7510E12/L；总胆汁酸(TBA)-静脉血: 1.5umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；总蛋白(TP)-静脉血: 71.69g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；肌酐(Crea)-静脉血: 69.7umol/L；总钙(Ca)-静脉血: 2.31mmol/L；白细胞计数(WBC#)-静脉血: 7.4610E9/L；镁离子(Mg2+)-静脉血: 1mmol/L；平均红细胞体积(MCV)-静脉血: 88.8fL；总胆固醇(TC)-静脉血: 5.15mmol/L；磷(P)-静脉血: 1.3mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；总胆红素(TBIL)-静脉血: 15umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；阴离子间隙(AG)-静脉血: 17；间接胆红素(IBIL)-静脉血: 10.2umolL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.18mmolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4；球蛋白(GLO)-静脉血: 26.39g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.168；血小板分布宽度(PDW)-静脉血: 9.8%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.015；血红蛋白(Hb)-静脉血: 141g/L；淋巴细胞计数(L……\n- [全程D49] 检验组合: 丙氨酸氨基转移酶(ALT)-静脉血: 18.4U/L；球蛋白(GLO)-静脉血: 27.24g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；γ-谷氨酰基转移酶(GGT)-静脉血: 42U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 16.9U/L；平均红细胞体积(MCV)-静脉血: 90.3fL；血小板比容-静脉血: 11.8%；血小板分布宽度(PDW)-静脉血: 16.8%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；钠离子(Na+)-静脉血: 138mmol/L；平均血小板体积(MPV)-静脉血: 6.76fL；总胆汁酸(TBA)-静脉血: 2.9umol/L；载脂蛋白B(apoB)-静脉血: 1.36g/L；总钙(Ca)-静脉血: 2.22mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.16g/L；红细胞计数(RBC#)-静脉血: 4.3410E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.019；血红蛋白(Hb)-静脉血: 133.6g/L；阴离子间隙(AG)-静脉血: 15.6；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；C-反应蛋白(CRP)-静脉血: 10.3mg/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.6mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.17；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.87mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9%；淀粉样蛋白A(SAA)-静脉血: 24.6mg/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.7pg；甘油三酯(TG)-静脉血: 2.36mmol/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；总蛋白(TP)-静脉血: 71.04g/L；碱性磷酸酶(ALP)-静脉血: 108.1U/L；总胆固醇(TC)-静脉血: 5.6mmol/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.104；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.92；平均红细胞血红蛋白浓度(MCHC)-静脉血: 340.7g/……\n- [全程D55] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位置位于第3胸椎体右下缘，估计位于右侧头臂静脉内。；检查结论: PICC管末端位置如上所述。\n- [全程D55] 检验组合: 葡萄糖(Glu)-尿液: +- 2.8mmol（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: 1+ 0.3g（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 3/μL；白细胞计数(WBC#)-尿液: 20/μL；酸碱度(pH)-尿液: 5.5；颜色-尿液: Yellow；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: +- 0.1g（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；比重(SG)-尿液: 1.021；红细胞计数(RBC#)-尿液: 2/μL；红细胞计数(RBC#)-尿液: 2/μL；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.025；浊度(TRUB)-尿液: 清亮；粘液丝计数(MUCS#)-尿液: 80/μL；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；葡萄糖(Glu)-尿液: 3+ 17mmol（参考: 阴性）；白细胞计数(WBC#)-尿液: 4/μL\n- [全程D63] 检验组合: 红细胞计数(RBC#)-静脉血: 3.910E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞计数(Neut#)-静脉血: 5.210E9/L；阴离子间隙(AG)-静脉血: 16.2；尿酸(UA)-静脉血: 364.7umol/L；钠离子(Na+)-静脉血: 132.6mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；球蛋白(GLO)-静脉血: 26.68g/L；单核细胞计数(Mono#)-静脉血: 1.110E9/L；葡萄糖(Glu)-静脉血: 4.06mmol/L；单核细胞百分比(Mono%)-静脉血: 0.166；平均血小板体积(MPV)-静脉血: 8.1fL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；尿素氮(BUN)-静脉血: 7.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 20.7U/L；白细胞计数(WBC#)-静脉血: 6.6710E9/L；甘油三酯(TG)-静脉血: 1.04mmol/L；氯离子(Cl-)-静脉血: 93.2mmol/L；磷(P)-静脉血: 1.24mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.2mmol/L；平均红细胞体积(MCV)-静脉血: 89.2fL；总胆汁酸(TBA)-静脉血: 0.9umol/L；载脂蛋白B(apoB)-静脉血: 1.28g/L；总钙(Ca)-静脉血: 2.2mmol/L；镁离子(Mg2+)-静脉血: 1.01mmol/L；红细胞比容(Hct)-静脉血: 34.8%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；乳酸脱氢酶(LDH)-静脉血: 151.8U/L；间接胆红素(IBIL)-静脉血: 9umolL；载脂蛋白AI(apoAI)-静脉血: 0.91g/L；总胆红素(TBIL)-静脉血: 12.8umol/L；大血小板百分比(P-LCR%)-静脉血: 9.3%；中性粒细胞百分比(Neut%)-静脉血: 0.782；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；血小板分布宽度(PDW)-静脉血: 8%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.1；碱性磷酸酶(ALP)-静脉血: 113.9U/L；平均红……\n- [全程D69] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌治疗后，与某次就诊时间0日片对比: 鼻咽腔未见明显狭窄，鼻咽顶后壁、右侧壁轻度增厚，见少许软组织影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，右侧咽隐窝消失。鼻咽左侧壁未见明显增厚，左侧咽隐窝稍浅。右侧咽旁脂肪间隙稍变窄，左侧咽旁脂肪间隙未见异常。 右侧腭帆提张肌信号不均匀，左侧腭帆提张肌、双侧头长肌未见受侵征象。 双侧翼腭窝、上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 口咽双侧壁未见受累增厚，病变未累及双侧后鼻孔。 右侧翼突内份及内板、蝶骨基底部右份骨质信号减低，增强扫描轻度强化，范围较前缩小。余颅底未见明确骨质破坏征象。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦、右侧乳突粘膜增厚，双侧上颌窦见少量分泌物，蝶窦、左侧乳突充气良好，骨壁完整。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 右侧咽后淋巴结短径约6mm，较前缩小。左侧咽后未见肿大淋巴结。 右颈IIb区见稍大淋巴结，较大者短径约7mm，增强扫描明显强化，较前缩小。双颈IIa区见数个小淋巴结，较大者短径约5mm，增强扫描轻度强化，大致同前。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 扫描所见脑实质未见明显异常。；检查结论: 鼻咽癌治疗后，与某次就诊时间0日片对比: 鼻咽病变较前缩小。 颅底骨质破坏，较前有修复。 右侧咽后肿大淋巴结，考虑转移，较前缩小。 右颈IIb区淋巴结肿大，考虑转移，较前缩小。 双颈IIa区小淋巴结。 副鼻窦炎，右侧乳突炎。\n- [全程D69] 检验组合: 直接胆红素(DBIL)-静脉血: 3.2umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.033；阴离子间隙(AG)-静脉血: 16.9；白细胞计数(WBC#)-静脉血: 3.510E9/L；总胆红素(TBIL)-静脉血: 11.7umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 24.1U/L；尿酸(UA)-静脉血: 468.3umol/L；白蛋白(ALB)-静脉血: 39.4g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.016；红细胞比容(Hct)-静脉血: 33.6%；磷(P)-静脉血: 1.09mmol/L；C-反应蛋白(CRP)-静脉血: 20.73mg/L；载脂蛋白B(apoB)-静脉血: 1.37g/L；葡萄糖(Glu)-静脉血: 4.3mmol/L；单核细胞百分比(Mono%)-静脉血: 0.112；血小板比容-静脉血: 15.3%；肌酐(Crea)-静脉血: 62.2umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4%；碱性磷酸酶(ALP)-静脉血: 92.8U/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.9mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.57；总蛋白(TP)-静脉血: 64.43g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.86；淋巴细胞计数(Lymph#)-静脉血: 0.110E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；球蛋白(GLO)-静脉血: 25.03g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 36.2U/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.839；甘油三酯(TG)-静脉血: 1.02mmol/L；间接胆红素(IBIL)-静脉血: 8.5umolL；丙氨酸氨基转移酶(ALT)-静脉血: 16.3U/L；血小板计数(PLT#)-静脉血: 266.210E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.27mmol/L；平均血小板体积(MPV)-静脉血: 5.77fL；胱抑素(Cys-C)-静脉血: 0.73mg/L；尿素氮(BUN)-静脉血: 5mmol/L；血小板分布宽度(PDW)-静脉……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D9] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，无发热、涕血等不适症状。查体：生命体征平稳。电子喉镜检查示：鼻咽右隆突肿物，符合鼻咽癌。并取肿物活检，等待病理结果。[姓名已隐去]副教授示，结合患者病情及相关检查，诊断考虑鼻咽癌可能性大，明确诊断，予鼻咽科进一步诊治。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D15] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：KPS 90分；鼻咽右侧壁、顶后壁结节状肿物，右颈Ⅱ区可扪及已肿大淋巴结，大小约2*1cm，颅神经检查（-）。今日[姓名已隐去]医生信息已隐藏后示：患者已完善相关检查，并预约放疗，今日可结账出院，嘱出院后按时[计划性表述已隐藏]放化综合治疗，不适随诊。\n- [全程D29] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者放疗1次。患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：基本同前。今日[姓名已隐去]副医生信息已隐藏后示：患于今日行第一程DDP方案化疗（100mg/m2）。继续放疗，续观。\n- [全程D34] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：KPS 90分； 间接鼻咽镜检查见双侧鼻腔通畅，内未窥及明显肿物；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。复查血常规、生化常规未见明显异常。今日[姓名已隐去]医生信息已隐藏后示：患者已结束第一程同时期DDP方案化疗（100mg/m2），治疗过程顺利，今日可结账出院，嘱出院后继续在门诊放疗，每周复查血常规、肝肾功能，并按时[计划性表述已隐藏]下一程治疗，不适随诊。\n- [全程D54] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者放疗16次，口腔黏膜反应2度，放射性皮炎1度，患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：KPS 90分；张口门齿距4.5cm，鼻咽顶后壁、右侧壁肿物，较前缩小；右颈II区扪及一肿大淋巴结，大小约1X1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。颅神经检查：阴性。今日[姓名已隐去]副医生信息已隐藏后示：今日开始行第2程同时期DDP方案（DDP100mg/m2）化疗，继续放疗，续观。\n- [全程D64] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者放疗22次，口腔黏膜反应2度，放射性皮炎1度，患者诉喉痛，余未诉特殊不适。生命体征平稳。查体：KPS 90分；张口门齿距4.5cm，鼻咽顶后壁、右侧壁肿物，较前缩小；双颈未触及肿大淋巴结；颅神经检查：阴性。今日[姓名已隐去]副医生信息已隐藏后示：患者诉喉痛，予患者奥施康定止痛，继续放疗，续观。\n- [全程D69] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者放疗26次，口腔黏膜反应3度，放射性皮炎2度，患者诉喉痛，余未诉特殊不适。生命体征平稳。查体：KPS 90分；张口门齿距4.5cm，鼻咽肿物已不明显；双颈未触及肿大淋巴结；颅神经检查：阴性。今日[姓名已隐去]医生信息已隐藏后示：患者诉喉痛，继续予患者奥施康定止痛，继续放疗，续观。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 提前终止放疗，转为单纯全身化疗或靶向治疗，并给予静脉营养支持。\nB. 继续完成原计划的根治性放疗，给予阿片类药物镇痛及静脉补液与营养支持治疗。\nC. 暂停放疗直至口腔黏膜反应降至1度，期间给予广谱抗生素及静脉糖皮质激素治疗。\nD. 继续放疗，重新定位并缩减放疗靶区及处方剂量，同时给予非甾体类抗炎药镇痛。\nE. 暂停放疗，更改全身治疗方案为TPF方案化疗，待局部症状好转后择期恢复放疗。\nF. 继续完成根治性放疗，给予局部利多卡因含漱液及非甾体类抗炎药镇痛，并仅口服营养支持，无需静脉补液。\nG. 终止放疗，行右侧颈部淋巴结清扫术及鼻咽原发灶挽救性切除术。\nH. 继续放疗并同步行第3程大剂量顺铂化疗，给予阿片类药物镇痛，暂不予静脉补液。\nI. 暂停放疗，行鼻咽部内镜下微创手术切除残留病灶，术后继续静脉补液支持。\nJ. 继续完成根治性放疗，行经皮内镜下胃造瘘术（PEG）以建立长期肠内营养途径。\nK. 提前终止放疗，改为PD-1抑制剂联合化疗的全身系统性维持治疗。\nL. 继续放疗，给予大剂量静脉糖皮质激素冲击治疗缓解黏膜反应，并继续口服营养液。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 双侧耳鸣2年，发现右颈肿物3天；现病史: 患者2年前无明显诱因间断出现双侧耳鸣，近2周自觉右侧耳鸣症状加重，无鼻塞、涕血等不适。今为进一步诊治收入我院。起病以来，患者无发热、咳嗽，无胸闷、胸痛，无恶心、呕吐，胃纳、睡眠、精神可，大小便正常，体重无明显变化。；阳性症状体征: 双耳鸣,右颈部肿物,右耳鸣；既往史: 10+年前因“腰椎间盘突出”行手术治疗，并予输血，无“输血反应”。否认\"肝炎\"、\"结核\"、\"高血压\"、\"糖尿病\"等疾病史；无外伤病史。过敏史:否认药物、食物过敏史。；个人史: 原籍出生、长大，无疫水、疫区暴露史；无吸烟、酗酒等不良嗜好。；家族史: 否认家族其他成员有肿瘤病史及遗传病史。；体格检查: T：36.0℃ P：81bpm R：18bpm BP：111/76mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。牙龈无肿胀、出血，咽无充血，双扁桃体无肿大。颈部检查详见肿瘤专科 检查。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率81bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 双侧耳鸣2年，发现右颈肿物3天；现病史: 患者2年前无明显诱因间断出现双侧耳鸣，近2周自觉右侧耳鸣症状加重，无鼻塞、涕血等不适。3天前无明显诱因发现右颈部肿物，遂就诊外院行CT检查示：鼻咽右侧壁增厚，考虑鼻咽癌可能，伴右侧乳突阻塞性炎症。今为进一步诊治收入我院。起病以来，患者无发热、咳嗽，无胸闷、胸痛，无恶心、呕吐，胃纳、睡眠、精神可，大小便正常，体重无明显变化。；阳性症状体征: 双耳鸣,右颈部肿物,右耳鸣；既往史: 10+年前因“腰椎间盘突出”行手术治疗，并予输血，无“输血反应”。否认\"肝炎\"、\"结核\"、\"高血压\"、\"糖尿病\"等疾病史；无外伤病史。过敏史:否认药物、食物过敏史。；个人史: 原籍出生、长大，无疫水、疫区暴露史；无吸烟、酗酒等不良嗜好。；家族史: 否认家族其他成员有肿瘤病史及遗传病史。；体格检查: T：36.0℃ P：81bpm R：18bpm BP：111/76mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。牙龈无肿胀、出血，咽无充血，双扁桃体无肿大。颈部检查详见肿瘤专科 检查。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率81bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。肛门外生殖器未见异常，生理反射存在，病理反射未引出。；专科检查: 间接鼻咽镜检查见双侧鼻腔通畅，内未窥及明显肿物；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显斑片或结节影。双侧肺门影未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见明显病变。\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 间接胆红素(IBIL)-静脉血: 9.6umolL；尿胆原(URO)-尿液: -（参考: 阴性）；钾离子(K+)-静脉血: 4mmol/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；总胆固醇(TC)-静脉血: 6.89mmol/L；肿瘤特异性生长因子(TSGF)-静脉血: 32U/mL；红细胞计数(RBC#)-静脉血: 4.9610E12/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.5U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.3pg；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 13.4umol/L；总蛋白(TP)-尿液: -（参考: 阴性）；血小板计数(PLT#)-静脉血: 319.310E9/L；比重(SG)-尿液: LAMPL.；凝血酶原时间活动度(PTA)-静脉血: 113.8%；直接胆红素(DBIL)-静脉血: 3.8umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-静脉血: 10.310E9/L；平均血小板体积(MPV)-静脉血: 7.46fL；镁离子(Mg2+)-静脉血: 0.98mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.310E9/L；鳞状细胞癌相关抗原(SCC)-静脉血: 0.4ng/ml；低密度脂蛋白胆固醇(LDL-C)-静脉血: 5.13mmol/L；血小板比容-静脉血: 23.8%；Rh血型-静脉血: 阳性；总前列腺特异性抗原(TPSA)-静脉血: 1ng/ml；神经元特异性烯醇化酶(NSE)-静脉血: 12.85ng/ml；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；游……\n- [全程D2] 检验组合: CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 0.8%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 3%；CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 24.9%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 9.8%；CD3+T淋巴细胞百分比-静脉血: 60.3%；CD4+/CD8+辅助/抑制T淋巴细胞比值(Th/Ts比值)-静脉血: 1.7；CD3-CD16+CD56+自然杀伤细胞百分比(NK%)-静脉血: 15.5%；CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 3.1%；CD3+CD4+辅助/诱导T淋巴细胞百分比(Th/Ti%)-静脉血: 29%；CD19+B淋巴细胞百分比-静脉血: 23%；CD3+CD8+抑制/细胞毒T淋巴细胞百分比(Ts/Tc%)-静脉血: 18.4%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 27.7%\n- [全程D7] 超声；双侧颈部、锁骨上区淋巴结彩超(套): 检查类型: 超声；检查名称: 双侧颈部、锁骨上区淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉内径约14mm，门静脉最大血流速度约17cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约44×36×33mm，包膜光滑，实质回声不均匀，可见强回声斑。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 前列腺钙化。 胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D7] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 右侧颈部II区可见数个淋巴结回声，最大约23×12mm，椭圆形，边界清，皮髓质分界不清，未见淋巴门。余右侧颈部未见明确异常淋巴结。 CDFI：上述最大淋巴结内可见周边型血流信号。 左侧颈部及锁骨上区未见明确异常淋巴结回声。；检查结论: 右侧颈部II区淋巴结，恶性待排，建议穿刺活检。 左侧颈部及锁骨上区未见明确异常淋巴结声像。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D24] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽右顶壁及右侧壁粘膜增厚放射性浓聚，SUV约16.7，病灶累及右翼突基底部及内侧板、右侧腭帆张提肌。右侧咽隐窝消失，左侧咽隐窝存在。双侧咽后未见肿大淋巴结及异常放射性分布。口咽、喉咽未见异常。筛窦、左上颌窦及右乳突内低密度影放射性稀疏；额窦、蝶窦、右上颌窦及左乳突结构及放射性分布未见明显异常。双侧海绵窦放射性分布未见明显异常。甲状腺结构及放射性分布未见明显异常。右颈II区数个淋巴结放射性浓聚，SUV约18.0，大者约1.5×2.2cm；余双颈小淋巴结放射性分布未见异常。 所见脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔主肺动脉窗小淋巴结放射性分布未见明显异常，大小约0.9×1.0cm。双肺门未见肿大淋巴结及异常放射性分布。双侧腋窝小淋巴结放射性未见明显异常。 肝脏密度减低，CT值约36Hu（脾脏CT值约56Hu），结构及放射性分布未见异常；肝门区未见占位及异常放射性分布。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。左肾上腺体部小结节影放射性略浓密，大小约1.0×1.1cm。脾脏、双肾、右肾上腺及胰腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺大小正常，内见数个点状钙化灶。膀胱及肠管形态、结构及放射性分布未见明显异常。双髂血管旁及双侧腹股沟未见肿大淋巴结及异常放射性分布。 颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，病灶累及右翼突基底部及内侧板、右侧腭帆张提肌；右颈II区数个淋巴结代谢活跃，考虑转移。 左肾上腺体部小结节代谢稍活跃，疑良性增生病变。 前列腺多发钙化灶。 脂肪肝。 副鼻窦炎症；右乳突炎症。\n- [全程D28] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T6上缘水平，估计导管末端位于上腔静脉上段内。；检查结论: PICC管末端位置如上述。\n- [全程D28] 检验组合: 红细胞计数(RBC#)-静脉血: 4.710E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7；钾离子(K+)-静脉血: 4.2mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 32.3U/L；尿素氮(BUN)-静脉血: 8.2mmol/L；间接胆红素(IBIL)-静脉血: 6.2umolL；氯离子(Cl-)-静脉血: 100.2mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 326g/L；红细胞比容(Hct)-静脉血: 43.5%；总胆固醇(TC)-静脉血: 5.88mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 22.9U/L；载脂蛋白AI(apoAI)-静脉血: 1.32g/L；血小板比容-静脉血: 32%；葡萄糖(Glu)-静脉血: 5.95mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.8mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.2pg；乳酸脱氢酶(LDH)-静脉血: 159.8U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.279；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.67；白细胞计数(WBC#)-静脉血: 10.7710E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 16.9U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.99mmol/L；中性粒细胞计数(Neut#)-静脉血: 6.410E9/L；平均红细胞体积(MCV)-静脉血: 92.6fL；平均血小板体积(MPV)-静脉血: 9.2fL；总胆红素(TBIL)-静脉血: 8.6umol/L；血小板分布宽度(PDW)-静脉血: 10%；磷(P)-静脉血: 1.6mmol/L；肌酐(Crea)-静脉血: 64.4umol/L；血小板计数(PLT#)-静脉血: 34410E9/L；C-反应蛋白(CRP)-静脉血: 3.29mg/L；碱性磷酸酶(ALP)-静脉血: 102.6U/L；白蛋白(ALB)-静脉血: 46.3g/L；淋巴细胞计数(Lymph#)-静脉血: 310E9/L；单核细胞计数(Mono#)-静脉血: 0.810E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 54U/L；大血小板百分比(P-LCR%)-静脉血: 18.4%；单核细胞百分比(Mono%)-静……\n- [全程D29] 检验组合: 隐血(OB)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；淀粉样蛋白A(SAA)-静脉血: 3.65mg/L；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；白细胞计数(WBC#)-尿液: 7/μL；比重(SG)-尿液: 1.027；总蛋白(TP)-尿液: +- 0.2g（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；葡萄糖(Glu)-尿液: 3+ 17mmol（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 80/μL\n- [全程D30] 检验组合: 颜色-尿液: Yellow；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 13/μL；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 6；总蛋白(TP)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.023\n- [全程D35] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.7；单核细胞计数(Mono#)-静脉血: 0.810E9/L；甘油三酯(TG)-静脉血: 2.15mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；载脂蛋白AI(apoAI)-静脉血: 1.26g/L；中性粒细胞百分比(Neut%)-静脉血: 0.702；葡萄糖(Glu)-静脉血: 6.03mmol/L；尿素氮(BUN)-静脉血: 7.02mmol/L；直接胆红素(DBIL)-静脉血: 4.8umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20U/L；C-反应蛋白(CRP)-静脉血: 2.65mg/L；乳酸脱氢酶(LDH)-静脉血: 166.9U/L；红细胞计数(RBC#)-静脉血: 4.7510E12/L；总胆汁酸(TBA)-静脉血: 1.5umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；总蛋白(TP)-静脉血: 71.69g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；肌酐(Crea)-静脉血: 69.7umol/L；总钙(Ca)-静脉血: 2.31mmol/L；白细胞计数(WBC#)-静脉血: 7.4610E9/L；镁离子(Mg2+)-静脉血: 1mmol/L；平均红细胞体积(MCV)-静脉血: 88.8fL；总胆固醇(TC)-静脉血: 5.15mmol/L；磷(P)-静脉血: 1.3mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；总胆红素(TBIL)-静脉血: 15umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；阴离子间隙(AG)-静脉血: 17；间接胆红素(IBIL)-静脉血: 10.2umolL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.18mmolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4；球蛋白(GLO)-静脉血: 26.39g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.168；血小板分布宽度(PDW)-静脉血: 9.8%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.015；血红蛋白(Hb)-静脉血: 141g/L；淋巴细胞计数(L……\n- [全程D49] 检验组合: 丙氨酸氨基转移酶(ALT)-静脉血: 18.4U/L；球蛋白(GLO)-静脉血: 27.24g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；γ-谷氨酰基转移酶(GGT)-静脉血: 42U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 16.9U/L；平均红细胞体积(MCV)-静脉血: 90.3fL；血小板比容-静脉血: 11.8%；血小板分布宽度(PDW)-静脉血: 16.8%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；钠离子(Na+)-静脉血: 138mmol/L；平均血小板体积(MPV)-静脉血: 6.76fL；总胆汁酸(TBA)-静脉血: 2.9umol/L；载脂蛋白B(apoB)-静脉血: 1.36g/L；总钙(Ca)-静脉血: 2.22mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.16g/L；红细胞计数(RBC#)-静脉血: 4.3410E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.019；血红蛋白(Hb)-静脉血: 133.6g/L；阴离子间隙(AG)-静脉血: 15.6；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；C-反应蛋白(CRP)-静脉血: 10.3mg/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.6mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.17；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.87mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9%；淀粉样蛋白A(SAA)-静脉血: 24.6mg/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.7pg；甘油三酯(TG)-静脉血: 2.36mmol/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；总蛋白(TP)-静脉血: 71.04g/L；碱性磷酸酶(ALP)-静脉血: 108.1U/L；总胆固醇(TC)-静脉血: 5.6mmol/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.104；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.92；平均红细胞血红蛋白浓度(MCHC)-静脉血: 340.7g/……\n- [全程D55] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位置位于第3胸椎体右下缘，估计位于右侧头臂静脉内。；检查结论: PICC管末端位置如上所述。\n- [全程D55] 检验组合: 葡萄糖(Glu)-尿液: +- 2.8mmol（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: 1+ 0.3g（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 3/μL；白细胞计数(WBC#)-尿液: 20/μL；酸碱度(pH)-尿液: 5.5；颜色-尿液: Yellow；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: +- 0.1g（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；比重(SG)-尿液: 1.021；红细胞计数(RBC#)-尿液: 2/μL；红细胞计数(RBC#)-尿液: 2/μL；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.025；浊度(TRUB)-尿液: 清亮；粘液丝计数(MUCS#)-尿液: 80/μL；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；葡萄糖(Glu)-尿液: 3+ 17mmol（参考: 阴性）；白细胞计数(WBC#)-尿液: 4/μL\n- [全程D63] 检验组合: 红细胞计数(RBC#)-静脉血: 3.910E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞计数(Neut#)-静脉血: 5.210E9/L；阴离子间隙(AG)-静脉血: 16.2；尿酸(UA)-静脉血: 364.7umol/L；钠离子(Na+)-静脉血: 132.6mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；球蛋白(GLO)-静脉血: 26.68g/L；单核细胞计数(Mono#)-静脉血: 1.110E9/L；葡萄糖(Glu)-静脉血: 4.06mmol/L；单核细胞百分比(Mono%)-静脉血: 0.166；平均血小板体积(MPV)-静脉血: 8.1fL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；尿素氮(BUN)-静脉血: 7.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 20.7U/L；白细胞计数(WBC#)-静脉血: 6.6710E9/L；甘油三酯(TG)-静脉血: 1.04mmol/L；氯离子(Cl-)-静脉血: 93.2mmol/L；磷(P)-静脉血: 1.24mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.2mmol/L；平均红细胞体积(MCV)-静脉血: 89.2fL；总胆汁酸(TBA)-静脉血: 0.9umol/L；载脂蛋白B(apoB)-静脉血: 1.28g/L；总钙(Ca)-静脉血: 2.2mmol/L；镁离子(Mg2+)-静脉血: 1.01mmol/L；红细胞比容(Hct)-静脉血: 34.8%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；乳酸脱氢酶(LDH)-静脉血: 151.8U/L；间接胆红素(IBIL)-静脉血: 9umolL；载脂蛋白AI(apoAI)-静脉血: 0.91g/L；总胆红素(TBIL)-静脉血: 12.8umol/L；大血小板百分比(P-LCR%)-静脉血: 9.3%；中性粒细胞百分比(Neut%)-静脉血: 0.782；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；血小板分布宽度(PDW)-静脉血: 8%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.1；碱性磷酸酶(ALP)-静脉血: 113.9U/L；平均红……\n- [全程D69] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌治疗后，与某次就诊时间0日片对比: 鼻咽腔未见明显狭窄，鼻咽顶后壁、右侧壁轻度增厚，见少许软组织影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，右侧咽隐窝消失。鼻咽左侧壁未见明显增厚，左侧咽隐窝稍浅。右侧咽旁脂肪间隙稍变窄，左侧咽旁脂肪间隙未见异常。 右侧腭帆提张肌信号不均匀，左侧腭帆提张肌、双侧头长肌未见受侵征象。 双侧翼腭窝、上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 口咽双侧壁未见受累增厚，病变未累及双侧后鼻孔。 右侧翼突内份及内板、蝶骨基底部右份骨质信号减低，增强扫描轻度强化，范围较前缩小。余颅底未见明确骨质破坏征象。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦、右侧乳突粘膜增厚，双侧上颌窦见少量分泌物，蝶窦、左侧乳突充气良好，骨壁完整。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 右侧咽后淋巴结短径约6mm，较前缩小。左侧咽后未见肿大淋巴结。 右颈IIb区见稍大淋巴结，较大者短径约7mm，增强扫描明显强化，较前缩小。双颈IIa区见数个小淋巴结，较大者短径约5mm，增强扫描轻度强化，大致同前。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 扫描所见脑实质未见明显异常。；检查结论: 鼻咽癌治疗后，与某次就诊时间0日片对比: 鼻咽病变较前缩小。 颅底骨质破坏，较前有修复。 右侧咽后肿大淋巴结，考虑转移，较前缩小。 右颈IIb区淋巴结肿大，考虑转移，较前缩小。 双颈IIa区小淋巴结。 副鼻窦炎，右侧乳突炎。\n- [全程D69] 检验组合: 直接胆红素(DBIL)-静脉血: 3.2umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.033；阴离子间隙(AG)-静脉血: 16.9；白细胞计数(WBC#)-静脉血: 3.510E9/L；总胆红素(TBIL)-静脉血: 11.7umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 24.1U/L；尿酸(UA)-静脉血: 468.3umol/L；白蛋白(ALB)-静脉血: 39.4g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.016；红细胞比容(Hct)-静脉血: 33.6%；磷(P)-静脉血: 1.09mmol/L；C-反应蛋白(CRP)-静脉血: 20.73mg/L；载脂蛋白B(apoB)-静脉血: 1.37g/L；葡萄糖(Glu)-静脉血: 4.3mmol/L；单核细胞百分比(Mono%)-静脉血: 0.112；血小板比容-静脉血: 15.3%；肌酐(Crea)-静脉血: 62.2umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4%；碱性磷酸酶(ALP)-静脉血: 92.8U/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.9mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.57；总蛋白(TP)-静脉血: 64.43g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.86；淋巴细胞计数(Lymph#)-静脉血: 0.110E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；球蛋白(GLO)-静脉血: 25.03g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 36.2U/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.839；甘油三酯(TG)-静脉血: 1.02mmol/L；间接胆红素(IBIL)-静脉血: 8.5umolL；丙氨酸氨基转移酶(ALT)-静脉血: 16.3U/L；血小板计数(PLT#)-静脉血: 266.210E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.27mmol/L；平均血小板体积(MPV)-静脉血: 5.77fL；胱抑素(Cys-C)-静脉血: 0.73mg/L；尿素氮(BUN)-静脉血: 5mmol/L；血小板分布宽度(PDW)-静脉……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D9] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，无发热、涕血等不适症状。查体：生命体征平稳。电子喉镜检查示：鼻咽右隆突肿物，符合鼻咽癌。并取肿物活检，等待病理结果。[姓名已隐去]副教授示，结合患者病情及相关检查，诊断考虑鼻咽癌可能性大，明确诊断，予鼻咽科进一步诊治。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D15] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：KPS 90分；鼻咽右侧壁、顶后壁结节状肿物，右颈Ⅱ区可扪及已肿大淋巴结，大小约2*1cm，颅神经检查（-）。今日[姓名已隐去]医生信息已隐藏后示：患者已完善相关检查，并预约放疗，今日可结账出院，嘱出院后按时[计划性表述已隐藏]放化综合治疗，不适随诊。\n- [全程D29] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者放疗1次。患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：基本同前。今日[姓名已隐去]副医生信息已隐藏后示：患于今日行第一程DDP方案化疗（100mg/m2）。继续放疗，续观。\n- [全程D34] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：KPS 90分； 间接鼻咽镜检查见双侧鼻腔通畅，内未窥及明显肿物；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。复查血常规、生化常规未见明显异常。今日[姓名已隐去]医生信息已隐藏后示：患者已结束第一程同时期DDP方案化疗（100mg/m2），治疗过程顺利，今日可结账出院，嘱出院后继续在门诊放疗，每周复查血常规、肝肾功能，并按时[计划性表述已隐藏]下一程治疗，不适随诊。\n- [全程D54] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者放疗16次，口腔黏膜反应2度，放射性皮炎1度，患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：KPS 90分；张口门齿距4.5cm，鼻咽顶后壁、右侧壁肿物，较前缩小；右颈II区扪及一肿大淋巴结，大小约1X1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。颅神经检查：阴性。今日[姓名已隐去]副医生信息已隐藏后示：今日开始行第2程同时期DDP方案（DDP100mg/m2）化疗，继续放疗，续观。\n- [全程D64] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者放疗22次，口腔黏膜反应2度，放射性皮炎1度，患者诉喉痛，余未诉特殊不适。生命体征平稳。查体：KPS 90分；张口门齿距4.5cm，鼻咽顶后壁、右侧壁肿物，较前缩小；双颈未触及肿大淋巴结；颅神经检查：阴性。今日[姓名已隐去]副医生信息已隐藏后示：患者诉喉痛，予患者奥施康定止痛，继续放疗，续观。\n- [全程D69] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者放疗26次，口腔黏膜反应3度，放射性皮炎2度，患者诉喉痛，余未诉特殊不适。生命体征平稳。查体：KPS 90分；张口门齿距4.5cm，鼻咽肿物已不明显；双颈未触及肿大淋巴结；颅神经检查：阴性。今日[姓名已隐去]医生信息已隐藏后示：患者诉喉痛，继续予患者奥施康定止痛，继续放疗，续观。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 提前终止放疗，转为单纯全身化疗或靶向治疗，并给予静脉营养支持。\nB. 继续完成原计划的根治性放疗，给予阿片类药物镇痛及静脉补液与营养支持治疗。\nC. 暂停放疗直至口腔黏膜反应降至1度，期间给予广谱抗生素及静脉糖皮质激素治疗。\nD. 继续放疗，重新定位并缩减放疗靶区及处方剂量，同时给予非甾体类抗炎药镇痛。\nE. 暂停放疗，更改全身治疗方案为TPF方案化疗，待局部症状好转后择期恢复放疗。\nF. 继续完成根治性放疗，给予局部利多卡因含漱液及非甾体类抗炎药镇痛，并仅口服营养支持，无需静脉补液。\nG. 终止放疗，行右侧颈部淋巴结清扫术及鼻咽原发灶挽救性切除术。\nH. 继续放疗并同步行第3程大剂量顺铂化疗，给予阿片类药物镇痛，暂不予静脉补液。\nI. 暂停放疗，行鼻咽部内镜下微创手术切除残留病灶，术后继续静脉补液支持。\nJ. 继续完成根治性放疗，行经皮内镜下胃造瘘术（PEG）以建立长期肠内营养途径。\nK. 提前终止放疗，改为PD-1抑制剂联合化疗的全身系统性维持治疗。\nL. 继续放疗，给予大剂量静脉糖皮质激素冲击治疗缓解黏膜反应，并继续口服营养液。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-5549469386bb20d944ce932b","patient_id":"patient-e7eec542502a097814d58d8a","turn_id":"turn08","turn_position":6,"turn_type":"response_assessment_decision","gold_letter":"C","gold_action":"影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；针对3度放射性口腔黏膜炎伴咽痛，继续予羟考酮镇痛及静脉营养支持，并常规行PICC导管护理。","options":[{"letter":"A","text":"影像学评估病灶较前缩小，疗效肯定，需暂停放疗，待3度放射性口腔黏膜炎恢复至1度后再恢复放疗，期间予静脉营养支持。","is_gold":false},{"letter":"B","text":"影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，局部使用含漱液及非甾体类抗炎药镇痛，停用阿片类药物。","is_gold":false},{"letter":"C","text":"影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎伴咽痛，继续予羟考酮镇痛及静脉营养支持，并常规行PICC导管护理。","is_gold":true},{"letter":"D","text":"影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，行预防性气管切开以防气道水肿梗阻，并予静脉营养支持。","is_gold":false},{"letter":"E","text":"影像学评估病灶较前缩小，疗效肯定，已完成26次放疗且出现3度黏膜炎，提前结束放疗并转为辅助化疗，同时予羟考酮镇痛。","is_gold":false},{"letter":"F","text":"影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，拔除PICC导管以预防导管相关性血流感染，改用外周静脉营养。","is_gold":false},{"letter":"G","text":"影像学评估病灶未见明显缩小，疗效评价为疾病稳定（SD），重新定位更改放疗靶区并提高局部照射剂量，同时予羟考酮镇痛及静脉营养支持。","is_gold":false},{"letter":"H","text":"影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，立即行经皮内镜下胃造瘘术（PEG）以保证肠内营养。","is_gold":false},{"letter":"I","text":"影像学评估病灶完全消失，疗效评价为完全缓解（CR），提前终止放疗，进入随访观察期，对咽痛继续予羟考酮镇痛。","is_gold":false},{"letter":"J","text":"影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；放疗已达26次且肿瘤退缩，同步加用西妥昔单抗以增强局部控制，并予静脉营养支持。","is_gold":false},{"letter":"K","text":"影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，静脉大剂量使用糖皮质激素以快速减轻炎症反应。","is_gold":false},{"letter":"L","text":"影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；出现3度放射性口腔黏膜炎，将后续放疗改为姑息性低剂量放疗，并予羟考酮镇痛。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 双侧耳鸣2年，发现右颈肿物3天；现病史: 患者2年前无明显诱因间断出现双侧耳鸣，近2周自觉右侧耳鸣症状加重，无鼻塞、涕血等不适。今为进一步诊治收入我院。起病以来，患者无发热、咳嗽，无胸闷、胸痛，无恶心、呕吐，胃纳、睡眠、精神可，大小便正常，体重无明显变化。；阳性症状体征: 双耳鸣,右颈部肿物,右耳鸣；既往史: 10+年前因“腰椎间盘突出”行手术治疗，并予输血，无“输血反应”。否认\"肝炎\"、\"结核\"、\"高血压\"、\"糖尿病\"等疾病史；无外伤病史。过敏史:否认药物、食物过敏史。；个人史: 原籍出生、长大，无疫水、疫区暴露史；无吸烟、酗酒等不良嗜好。；家族史: 否认家族其他成员有肿瘤病史及遗传病史。；体格检查: T：36.0℃ P：81bpm R：18bpm BP：111/76mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。牙龈无肿胀、出血，咽无充血，双扁桃体无肿大。颈部检查详见肿瘤专科 检查。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率81bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 双侧耳鸣2年，发现右颈肿物3天；现病史: 患者2年前无明显诱因间断出现双侧耳鸣，近2周自觉右侧耳鸣症状加重，无鼻塞、涕血等不适。3天前无明显诱因发现右颈部肿物，遂就诊外院行CT检查示：鼻咽右侧壁增厚，考虑鼻咽癌可能，伴右侧乳突阻塞性炎症。今为进一步诊治收入我院。起病以来，患者无发热、咳嗽，无胸闷、胸痛，无恶心、呕吐，胃纳、睡眠、精神可，大小便正常，体重无明显变化。；阳性症状体征: 双耳鸣,右颈部肿物,右耳鸣；既往史: 10+年前因“腰椎间盘突出”行手术治疗，并予输血，无“输血反应”。否认\"肝炎\"、\"结核\"、\"高血压\"、\"糖尿病\"等疾病史；无外伤病史。过敏史:否认药物、食物过敏史。；个人史: 原籍出生、长大，无疫水、疫区暴露史；无吸烟、酗酒等不良嗜好。；家族史: 否认家族其他成员有肿瘤病史及遗传病史。；体格检查: T：36.0℃ P：81bpm R：18bpm BP：111/76mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。牙龈无肿胀、出血，咽无充血，双扁桃体无肿大。颈部检查详见肿瘤专科 检查。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率81bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。肛门外生殖器未见异常，生理反射存在，病理反射未引出。；专科检查: 间接鼻咽镜检查见双侧鼻腔通畅，内未窥及明显肿物；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显斑片或结节影。双侧肺门影未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见明显病变。\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 间接胆红素(IBIL)-静脉血: 9.6umolL；尿胆原(URO)-尿液: -（参考: 阴性）；钾离子(K+)-静脉血: 4mmol/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；总胆固醇(TC)-静脉血: 6.89mmol/L；肿瘤特异性生长因子(TSGF)-静脉血: 32U/mL；红细胞计数(RBC#)-静脉血: 4.9610E12/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.5U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.3pg；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 13.4umol/L；总蛋白(TP)-尿液: -（参考: 阴性）；血小板计数(PLT#)-静脉血: 319.310E9/L；比重(SG)-尿液: LAMPL.；凝血酶原时间活动度(PTA)-静脉血: 113.8%；直接胆红素(DBIL)-静脉血: 3.8umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-静脉血: 10.310E9/L；平均血小板体积(MPV)-静脉血: 7.46fL；镁离子(Mg2+)-静脉血: 0.98mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.310E9/L；鳞状细胞癌相关抗原(SCC)-静脉血: 0.4ng/ml；低密度脂蛋白胆固醇(LDL-C)-静脉血: 5.13mmol/L；血小板比容-静脉血: 23.8%；Rh血型-静脉血: 阳性；总前列腺特异性抗原(TPSA)-静脉血: 1ng/ml；神经元特异性烯醇化酶(NSE)-静脉血: 12.85ng/ml；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；游……\n- [全程D2] 检验组合: CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 0.8%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 3%；CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 24.9%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 9.8%；CD3+T淋巴细胞百分比-静脉血: 60.3%；CD4+/CD8+辅助/抑制T淋巴细胞比值(Th/Ts比值)-静脉血: 1.7；CD3-CD16+CD56+自然杀伤细胞百分比(NK%)-静脉血: 15.5%；CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 3.1%；CD3+CD4+辅助/诱导T淋巴细胞百分比(Th/Ti%)-静脉血: 29%；CD19+B淋巴细胞百分比-静脉血: 23%；CD3+CD8+抑制/细胞毒T淋巴细胞百分比(Ts/Tc%)-静脉血: 18.4%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 27.7%\n- [全程D7] 超声；双侧颈部、锁骨上区淋巴结彩超(套): 检查类型: 超声；检查名称: 双侧颈部、锁骨上区淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉内径约14mm，门静脉最大血流速度约17cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约44×36×33mm，包膜光滑，实质回声不均匀，可见强回声斑。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 前列腺钙化。 胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D7] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 右侧颈部II区可见数个淋巴结回声，最大约23×12mm，椭圆形，边界清，皮髓质分界不清，未见淋巴门。余右侧颈部未见明确异常淋巴结。 CDFI：上述最大淋巴结内可见周边型血流信号。 左侧颈部及锁骨上区未见明确异常淋巴结回声。；检查结论: 右侧颈部II区淋巴结，恶性待排，建议穿刺活检。 左侧颈部及锁骨上区未见明确异常淋巴结声像。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D24] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽右顶壁及右侧壁粘膜增厚放射性浓聚，SUV约16.7，病灶累及右翼突基底部及内侧板、右侧腭帆张提肌。右侧咽隐窝消失，左侧咽隐窝存在。双侧咽后未见肿大淋巴结及异常放射性分布。口咽、喉咽未见异常。筛窦、左上颌窦及右乳突内低密度影放射性稀疏；额窦、蝶窦、右上颌窦及左乳突结构及放射性分布未见明显异常。双侧海绵窦放射性分布未见明显异常。甲状腺结构及放射性分布未见明显异常。右颈II区数个淋巴结放射性浓聚，SUV约18.0，大者约1.5×2.2cm；余双颈小淋巴结放射性分布未见异常。 所见脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔主肺动脉窗小淋巴结放射性分布未见明显异常，大小约0.9×1.0cm。双肺门未见肿大淋巴结及异常放射性分布。双侧腋窝小淋巴结放射性未见明显异常。 肝脏密度减低，CT值约36Hu（脾脏CT值约56Hu），结构及放射性分布未见异常；肝门区未见占位及异常放射性分布。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。左肾上腺体部小结节影放射性略浓密，大小约1.0×1.1cm。脾脏、双肾、右肾上腺及胰腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺大小正常，内见数个点状钙化灶。膀胱及肠管形态、结构及放射性分布未见明显异常。双髂血管旁及双侧腹股沟未见肿大淋巴结及异常放射性分布。 颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，病灶累及右翼突基底部及内侧板、右侧腭帆张提肌；右颈II区数个淋巴结代谢活跃，考虑转移。 左肾上腺体部小结节代谢稍活跃，疑良性增生病变。 前列腺多发钙化灶。 脂肪肝。 副鼻窦炎症；右乳突炎症。\n- [全程D28] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T6上缘水平，估计导管末端位于上腔静脉上段内。；检查结论: PICC管末端位置如上述。\n- [全程D28] 检验组合: 红细胞计数(RBC#)-静脉血: 4.710E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7；钾离子(K+)-静脉血: 4.2mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 32.3U/L；尿素氮(BUN)-静脉血: 8.2mmol/L；间接胆红素(IBIL)-静脉血: 6.2umolL；氯离子(Cl-)-静脉血: 100.2mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 326g/L；红细胞比容(Hct)-静脉血: 43.5%；总胆固醇(TC)-静脉血: 5.88mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 22.9U/L；载脂蛋白AI(apoAI)-静脉血: 1.32g/L；血小板比容-静脉血: 32%；葡萄糖(Glu)-静脉血: 5.95mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.8mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.2pg；乳酸脱氢酶(LDH)-静脉血: 159.8U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.279；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.67；白细胞计数(WBC#)-静脉血: 10.7710E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 16.9U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.99mmol/L；中性粒细胞计数(Neut#)-静脉血: 6.410E9/L；平均红细胞体积(MCV)-静脉血: 92.6fL；平均血小板体积(MPV)-静脉血: 9.2fL；总胆红素(TBIL)-静脉血: 8.6umol/L；血小板分布宽度(PDW)-静脉血: 10%；磷(P)-静脉血: 1.6mmol/L；肌酐(Crea)-静脉血: 64.4umol/L；血小板计数(PLT#)-静脉血: 34410E9/L；C-反应蛋白(CRP)-静脉血: 3.29mg/L；碱性磷酸酶(ALP)-静脉血: 102.6U/L；白蛋白(ALB)-静脉血: 46.3g/L；淋巴细胞计数(Lymph#)-静脉血: 310E9/L；单核细胞计数(Mono#)-静脉血: 0.810E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 54U/L；大血小板百分比(P-LCR%)-静脉血: 18.4%；单核细胞百分比(Mono%)-静……\n- [全程D29] 检验组合: 隐血(OB)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；淀粉样蛋白A(SAA)-静脉血: 3.65mg/L；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；白细胞计数(WBC#)-尿液: 7/μL；比重(SG)-尿液: 1.027；总蛋白(TP)-尿液: +- 0.2g（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；葡萄糖(Glu)-尿液: 3+ 17mmol（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 80/μL\n- [全程D30] 检验组合: 颜色-尿液: Yellow；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 13/μL；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 6；总蛋白(TP)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.023\n- [全程D35] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.7；单核细胞计数(Mono#)-静脉血: 0.810E9/L；甘油三酯(TG)-静脉血: 2.15mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；载脂蛋白AI(apoAI)-静脉血: 1.26g/L；中性粒细胞百分比(Neut%)-静脉血: 0.702；葡萄糖(Glu)-静脉血: 6.03mmol/L；尿素氮(BUN)-静脉血: 7.02mmol/L；直接胆红素(DBIL)-静脉血: 4.8umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20U/L；C-反应蛋白(CRP)-静脉血: 2.65mg/L；乳酸脱氢酶(LDH)-静脉血: 166.9U/L；红细胞计数(RBC#)-静脉血: 4.7510E12/L；总胆汁酸(TBA)-静脉血: 1.5umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；总蛋白(TP)-静脉血: 71.69g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；肌酐(Crea)-静脉血: 69.7umol/L；总钙(Ca)-静脉血: 2.31mmol/L；白细胞计数(WBC#)-静脉血: 7.4610E9/L；镁离子(Mg2+)-静脉血: 1mmol/L；平均红细胞体积(MCV)-静脉血: 88.8fL；总胆固醇(TC)-静脉血: 5.15mmol/L；磷(P)-静脉血: 1.3mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；总胆红素(TBIL)-静脉血: 15umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；阴离子间隙(AG)-静脉血: 17；间接胆红素(IBIL)-静脉血: 10.2umolL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.18mmolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4；球蛋白(GLO)-静脉血: 26.39g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.168；血小板分布宽度(PDW)-静脉血: 9.8%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.015；血红蛋白(Hb)-静脉血: 141g/L；淋巴细胞计数(L……\n- [全程D49] 检验组合: 丙氨酸氨基转移酶(ALT)-静脉血: 18.4U/L；球蛋白(GLO)-静脉血: 27.24g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；γ-谷氨酰基转移酶(GGT)-静脉血: 42U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 16.9U/L；平均红细胞体积(MCV)-静脉血: 90.3fL；血小板比容-静脉血: 11.8%；血小板分布宽度(PDW)-静脉血: 16.8%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；钠离子(Na+)-静脉血: 138mmol/L；平均血小板体积(MPV)-静脉血: 6.76fL；总胆汁酸(TBA)-静脉血: 2.9umol/L；载脂蛋白B(apoB)-静脉血: 1.36g/L；总钙(Ca)-静脉血: 2.22mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.16g/L；红细胞计数(RBC#)-静脉血: 4.3410E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.019；血红蛋白(Hb)-静脉血: 133.6g/L；阴离子间隙(AG)-静脉血: 15.6；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；C-反应蛋白(CRP)-静脉血: 10.3mg/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.6mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.17；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.87mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9%；淀粉样蛋白A(SAA)-静脉血: 24.6mg/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.7pg；甘油三酯(TG)-静脉血: 2.36mmol/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；总蛋白(TP)-静脉血: 71.04g/L；碱性磷酸酶(ALP)-静脉血: 108.1U/L；总胆固醇(TC)-静脉血: 5.6mmol/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.104；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.92；平均红细胞血红蛋白浓度(MCHC)-静脉血: 340.7g/……\n- [全程D55] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位置位于第3胸椎体右下缘，估计位于右侧头臂静脉内。；检查结论: PICC管末端位置如上所述。\n- [全程D55] 检验组合: 葡萄糖(Glu)-尿液: +- 2.8mmol（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: 1+ 0.3g（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 3/μL；白细胞计数(WBC#)-尿液: 20/μL；酸碱度(pH)-尿液: 5.5；颜色-尿液: Yellow；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: +- 0.1g（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；比重(SG)-尿液: 1.021；红细胞计数(RBC#)-尿液: 2/μL；红细胞计数(RBC#)-尿液: 2/μL；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.025；浊度(TRUB)-尿液: 清亮；粘液丝计数(MUCS#)-尿液: 80/μL；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；葡萄糖(Glu)-尿液: 3+ 17mmol（参考: 阴性）；白细胞计数(WBC#)-尿液: 4/μL\n- [全程D63] 检验组合: 红细胞计数(RBC#)-静脉血: 3.910E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞计数(Neut#)-静脉血: 5.210E9/L；阴离子间隙(AG)-静脉血: 16.2；尿酸(UA)-静脉血: 364.7umol/L；钠离子(Na+)-静脉血: 132.6mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；球蛋白(GLO)-静脉血: 26.68g/L；单核细胞计数(Mono#)-静脉血: 1.110E9/L；葡萄糖(Glu)-静脉血: 4.06mmol/L；单核细胞百分比(Mono%)-静脉血: 0.166；平均血小板体积(MPV)-静脉血: 8.1fL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；尿素氮(BUN)-静脉血: 7.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 20.7U/L；白细胞计数(WBC#)-静脉血: 6.6710E9/L；甘油三酯(TG)-静脉血: 1.04mmol/L；氯离子(Cl-)-静脉血: 93.2mmol/L；磷(P)-静脉血: 1.24mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.2mmol/L；平均红细胞体积(MCV)-静脉血: 89.2fL；总胆汁酸(TBA)-静脉血: 0.9umol/L；载脂蛋白B(apoB)-静脉血: 1.28g/L；总钙(Ca)-静脉血: 2.2mmol/L；镁离子(Mg2+)-静脉血: 1.01mmol/L；红细胞比容(Hct)-静脉血: 34.8%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；乳酸脱氢酶(LDH)-静脉血: 151.8U/L；间接胆红素(IBIL)-静脉血: 9umolL；载脂蛋白AI(apoAI)-静脉血: 0.91g/L；总胆红素(TBIL)-静脉血: 12.8umol/L；大血小板百分比(P-LCR%)-静脉血: 9.3%；中性粒细胞百分比(Neut%)-静脉血: 0.782；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；血小板分布宽度(PDW)-静脉血: 8%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.1；碱性磷酸酶(ALP)-静脉血: 113.9U/L；平均红……\n- [全程D69] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌治疗后，与某次就诊时间0日片对比: 鼻咽腔未见明显狭窄，鼻咽顶后壁、右侧壁轻度增厚，见少许软组织影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，右侧咽隐窝消失。鼻咽左侧壁未见明显增厚，左侧咽隐窝稍浅。右侧咽旁脂肪间隙稍变窄，左侧咽旁脂肪间隙未见异常。 右侧腭帆提张肌信号不均匀，左侧腭帆提张肌、双侧头长肌未见受侵征象。 双侧翼腭窝、上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 口咽双侧壁未见受累增厚，病变未累及双侧后鼻孔。 右侧翼突内份及内板、蝶骨基底部右份骨质信号减低，增强扫描轻度强化，范围较前缩小。余颅底未见明确骨质破坏征象。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦、右侧乳突粘膜增厚，双侧上颌窦见少量分泌物，蝶窦、左侧乳突充气良好，骨壁完整。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 右侧咽后淋巴结短径约6mm，较前缩小。左侧咽后未见肿大淋巴结。 右颈IIb区见稍大淋巴结，较大者短径约7mm，增强扫描明显强化，较前缩小。双颈IIa区见数个小淋巴结，较大者短径约5mm，增强扫描轻度强化，大致同前。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 扫描所见脑实质未见明显异常。；检查结论: 鼻咽癌治疗后，与某次就诊时间0日片对比: 鼻咽病变较前缩小。 颅底骨质破坏，较前有修复。 右侧咽后肿大淋巴结，考虑转移，较前缩小。 右颈IIb区淋巴结肿大，考虑转移，较前缩小。 双颈IIa区小淋巴结。 副鼻窦炎，右侧乳突炎。\n- [全程D69] 检验组合: 直接胆红素(DBIL)-静脉血: 3.2umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.033；阴离子间隙(AG)-静脉血: 16.9；白细胞计数(WBC#)-静脉血: 3.510E9/L；总胆红素(TBIL)-静脉血: 11.7umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 24.1U/L；尿酸(UA)-静脉血: 468.3umol/L；白蛋白(ALB)-静脉血: 39.4g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.016；红细胞比容(Hct)-静脉血: 33.6%；磷(P)-静脉血: 1.09mmol/L；C-反应蛋白(CRP)-静脉血: 20.73mg/L；载脂蛋白B(apoB)-静脉血: 1.37g/L；葡萄糖(Glu)-静脉血: 4.3mmol/L；单核细胞百分比(Mono%)-静脉血: 0.112；血小板比容-静脉血: 15.3%；肌酐(Crea)-静脉血: 62.2umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4%；碱性磷酸酶(ALP)-静脉血: 92.8U/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.9mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.57；总蛋白(TP)-静脉血: 64.43g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.86；淋巴细胞计数(Lymph#)-静脉血: 0.110E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；球蛋白(GLO)-静脉血: 25.03g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 36.2U/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.839；甘油三酯(TG)-静脉血: 1.02mmol/L；间接胆红素(IBIL)-静脉血: 8.5umolL；丙氨酸氨基转移酶(ALT)-静脉血: 16.3U/L；血小板计数(PLT#)-静脉血: 266.210E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.27mmol/L；平均血小板体积(MPV)-静脉血: 5.77fL；胱抑素(Cys-C)-静脉血: 0.73mg/L；尿素氮(BUN)-静脉血: 5mmol/L；血小板分布宽度(PDW)-静脉……\n- [全程D70] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质回声均匀，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉内径约11mm，门静脉最大血流速度约23cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约40×35×31mm，包膜光滑，实质回声不均匀，可见强回声斑。 腹主动脉旁未见明确肿物回声。；检查结论: 前列腺钙化。 肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D9] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，无发热、涕血等不适症状。查体：生命体征平稳。电子喉镜检查示：鼻咽右隆突肿物，符合鼻咽癌。并取肿物活检，等待病理结果。[姓名已隐去]副教授示，结合患者病情及相关检查，诊断考虑鼻咽癌可能性大，明确诊断，予鼻咽科进一步诊治。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D15] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：KPS 90分；鼻咽右侧壁、顶后壁结节状肿物，右颈Ⅱ区可扪及已肿大淋巴结，大小约2*1cm，颅神经检查（-）。今日[姓名已隐去]医生信息已隐藏后示：患者已完善相关检查，并预约放疗，今日可结账出院，嘱出院后按时[计划性表述已隐藏]放化综合治疗，不适随诊。\n- [全程D29] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者放疗1次。患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：基本同前。今日[姓名已隐去]副医生信息已隐藏后示：患于今日行第一程DDP方案化疗（100mg/m2）。继续放疗，续观。\n- [全程D34] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：KPS 90分； 间接鼻咽镜检查见双侧鼻腔通畅，内未窥及明显肿物；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。复查血常规、生化常规未见明显异常。今日[姓名已隐去]医生信息已隐藏后示：患者已结束第一程同时期DDP方案化疗（100mg/m2），治疗过程顺利，今日可结账出院，嘱出院后继续在门诊放疗，每周复查血常规、肝肾功能，并按时[计划性表述已隐藏]下一程治疗，不适随诊。\n- [全程D54] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者放疗16次，口腔黏膜反应2度，放射性皮炎1度，患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：KPS 90分；张口门齿距4.5cm，鼻咽顶后壁、右侧壁肿物，较前缩小；右颈II区扪及一肿大淋巴结，大小约1X1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。颅神经检查：阴性。今日[姓名已隐去]副医生信息已隐藏后示：今日开始行第2程同时期DDP方案（DDP100mg/m2）化疗，继续放疗，续观。\n- [全程D64] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者放疗22次，口腔黏膜反应2度，放射性皮炎1度，患者诉喉痛，余未诉特殊不适。生命体征平稳。查体：KPS 90分；张口门齿距4.5cm，鼻咽顶后壁、右侧壁肿物，较前缩小；双颈未触及肿大淋巴结；颅神经检查：阴性。今日[姓名已隐去]副医生信息已隐藏后示：患者诉喉痛，予患者奥施康定止痛，继续放疗，续观。\n- [全程D69] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者放疗26次，口腔黏膜反应3度，放射性皮炎2度，患者诉喉痛，余未诉特殊不适。生命体征平稳。查体：KPS 90分；张口门齿距4.5cm，鼻咽肿物已不明显；双颈未触及肿大淋巴结；颅神经检查：阴性。今日[姓名已隐去]医生信息已隐藏后示：患者诉喉痛，继续予患者奥施康定止痛，继续放疗，续观。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 影像学评估病灶较前缩小，疗效肯定，需暂停放疗，待3度放射性口腔黏膜炎恢复至1度后再恢复放疗，期间予静脉营养支持。\nB. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，局部使用含漱液及非甾体类抗炎药镇痛，停用阿片类药物。\nC. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎伴咽痛，继续予羟考酮镇痛及静脉营养支持，并常规行PICC导管护理。\nD. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，行预防性气管切开以防气道水肿梗阻，并予静脉营养支持。\nE. 影像学评估病灶较前缩小，疗效肯定，已完成26次放疗且出现3度黏膜炎，提前结束放疗并转为辅助化疗，同时予羟考酮镇痛。\nF. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，拔除PICC导管以预防导管相关性血流感染，改用外周静脉营养。\nG. 影像学评估病灶未见明显缩小，疗效评价为疾病稳定（SD），重新定位更改放疗靶区并提高局部照射剂量，同时予羟考酮镇痛及静脉营养支持。\nH. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，立即行经皮内镜下胃造瘘术（PEG）以保证肠内营养。\nI. 影像学评估病灶完全消失，疗效评价为完全缓解（CR），提前终止放疗，进入随访观察期，对咽痛继续予羟考酮镇痛。\nJ. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；放疗已达26次且肿瘤退缩，同步加用西妥昔单抗以增强局部控制，并予静脉营养支持。\nK. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，静脉大剂量使用糖皮质激素以快速减轻炎症反应。\nL. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；出现3度放射性口腔黏膜炎，将后续放疗改为姑息性低剂量放疗，并予羟考酮镇痛。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 双侧耳鸣2年，发现右颈肿物3天；现病史: 患者2年前无明显诱因间断出现双侧耳鸣，近2周自觉右侧耳鸣症状加重，无鼻塞、涕血等不适。今为进一步诊治收入我院。起病以来，患者无发热、咳嗽，无胸闷、胸痛，无恶心、呕吐，胃纳、睡眠、精神可，大小便正常，体重无明显变化。；阳性症状体征: 双耳鸣,右颈部肿物,右耳鸣；既往史: 10+年前因“腰椎间盘突出”行手术治疗，并予输血，无“输血反应”。否认\"肝炎\"、\"结核\"、\"高血压\"、\"糖尿病\"等疾病史；无外伤病史。过敏史:否认药物、食物过敏史。；个人史: 原籍出生、长大，无疫水、疫区暴露史；无吸烟、酗酒等不良嗜好。；家族史: 否认家族其他成员有肿瘤病史及遗传病史。；体格检查: T：36.0℃ P：81bpm R：18bpm BP：111/76mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。牙龈无肿胀、出血，咽无充血，双扁桃体无肿大。颈部检查详见肿瘤专科 检查。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率81bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 双侧耳鸣2年，发现右颈肿物3天；现病史: 患者2年前无明显诱因间断出现双侧耳鸣，近2周自觉右侧耳鸣症状加重，无鼻塞、涕血等不适。3天前无明显诱因发现右颈部肿物，遂就诊外院行CT检查示：鼻咽右侧壁增厚，考虑鼻咽癌可能，伴右侧乳突阻塞性炎症。今为进一步诊治收入我院。起病以来，患者无发热、咳嗽，无胸闷、胸痛，无恶心、呕吐，胃纳、睡眠、精神可，大小便正常，体重无明显变化。；阳性症状体征: 双耳鸣,右颈部肿物,右耳鸣；既往史: 10+年前因“腰椎间盘突出”行手术治疗，并予输血，无“输血反应”。否认\"肝炎\"、\"结核\"、\"高血压\"、\"糖尿病\"等疾病史；无外伤病史。过敏史:否认药物、食物过敏史。；个人史: 原籍出生、长大，无疫水、疫区暴露史；无吸烟、酗酒等不良嗜好。；家族史: 否认家族其他成员有肿瘤病史及遗传病史。；体格检查: T：36.0℃ P：81bpm R：18bpm BP：111/76mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。牙龈无肿胀、出血，咽无充血，双扁桃体无肿大。颈部检查详见肿瘤专科 检查。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率81bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。肛门外生殖器未见异常，生理反射存在，病理反射未引出。；专科检查: 间接鼻咽镜检查见双侧鼻腔通畅，内未窥及明显肿物；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显斑片或结节影。双侧肺门影未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见明显病变。\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 间接胆红素(IBIL)-静脉血: 9.6umolL；尿胆原(URO)-尿液: -（参考: 阴性）；钾离子(K+)-静脉血: 4mmol/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；总胆固醇(TC)-静脉血: 6.89mmol/L；肿瘤特异性生长因子(TSGF)-静脉血: 32U/mL；红细胞计数(RBC#)-静脉血: 4.9610E12/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.5U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.3pg；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 13.4umol/L；总蛋白(TP)-尿液: -（参考: 阴性）；血小板计数(PLT#)-静脉血: 319.310E9/L；比重(SG)-尿液: LAMPL.；凝血酶原时间活动度(PTA)-静脉血: 113.8%；直接胆红素(DBIL)-静脉血: 3.8umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-静脉血: 10.310E9/L；平均血小板体积(MPV)-静脉血: 7.46fL；镁离子(Mg2+)-静脉血: 0.98mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.310E9/L；鳞状细胞癌相关抗原(SCC)-静脉血: 0.4ng/ml；低密度脂蛋白胆固醇(LDL-C)-静脉血: 5.13mmol/L；血小板比容-静脉血: 23.8%；Rh血型-静脉血: 阳性；总前列腺特异性抗原(TPSA)-静脉血: 1ng/ml；神经元特异性烯醇化酶(NSE)-静脉血: 12.85ng/ml；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；游……\n- [全程D2] 检验组合: CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 0.8%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 3%；CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 24.9%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 9.8%；CD3+T淋巴细胞百分比-静脉血: 60.3%；CD4+/CD8+辅助/抑制T淋巴细胞比值(Th/Ts比值)-静脉血: 1.7；CD3-CD16+CD56+自然杀伤细胞百分比(NK%)-静脉血: 15.5%；CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 3.1%；CD3+CD4+辅助/诱导T淋巴细胞百分比(Th/Ti%)-静脉血: 29%；CD19+B淋巴细胞百分比-静脉血: 23%；CD3+CD8+抑制/细胞毒T淋巴细胞百分比(Ts/Tc%)-静脉血: 18.4%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 27.7%\n- [全程D7] 超声；双侧颈部、锁骨上区淋巴结彩超(套): 检查类型: 超声；检查名称: 双侧颈部、锁骨上区淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉内径约14mm，门静脉最大血流速度约17cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约44×36×33mm，包膜光滑，实质回声不均匀，可见强回声斑。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 前列腺钙化。 胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D7] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 右侧颈部II区可见数个淋巴结回声，最大约23×12mm，椭圆形，边界清，皮髓质分界不清，未见淋巴门。余右侧颈部未见明确异常淋巴结。 CDFI：上述最大淋巴结内可见周边型血流信号。 左侧颈部及锁骨上区未见明确异常淋巴结回声。；检查结论: 右侧颈部II区淋巴结，恶性待排，建议穿刺活检。 左侧颈部及锁骨上区未见明确异常淋巴结声像。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D24] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽右顶壁及右侧壁粘膜增厚放射性浓聚，SUV约16.7，病灶累及右翼突基底部及内侧板、右侧腭帆张提肌。右侧咽隐窝消失，左侧咽隐窝存在。双侧咽后未见肿大淋巴结及异常放射性分布。口咽、喉咽未见异常。筛窦、左上颌窦及右乳突内低密度影放射性稀疏；额窦、蝶窦、右上颌窦及左乳突结构及放射性分布未见明显异常。双侧海绵窦放射性分布未见明显异常。甲状腺结构及放射性分布未见明显异常。右颈II区数个淋巴结放射性浓聚，SUV约18.0，大者约1.5×2.2cm；余双颈小淋巴结放射性分布未见异常。 所见脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔主肺动脉窗小淋巴结放射性分布未见明显异常，大小约0.9×1.0cm。双肺门未见肿大淋巴结及异常放射性分布。双侧腋窝小淋巴结放射性未见明显异常。 肝脏密度减低，CT值约36Hu（脾脏CT值约56Hu），结构及放射性分布未见异常；肝门区未见占位及异常放射性分布。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。左肾上腺体部小结节影放射性略浓密，大小约1.0×1.1cm。脾脏、双肾、右肾上腺及胰腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺大小正常，内见数个点状钙化灶。膀胱及肠管形态、结构及放射性分布未见明显异常。双髂血管旁及双侧腹股沟未见肿大淋巴结及异常放射性分布。 颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，病灶累及右翼突基底部及内侧板、右侧腭帆张提肌；右颈II区数个淋巴结代谢活跃，考虑转移。 左肾上腺体部小结节代谢稍活跃，疑良性增生病变。 前列腺多发钙化灶。 脂肪肝。 副鼻窦炎症；右乳突炎症。\n- [全程D28] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T6上缘水平，估计导管末端位于上腔静脉上段内。；检查结论: PICC管末端位置如上述。\n- [全程D28] 检验组合: 红细胞计数(RBC#)-静脉血: 4.710E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7；钾离子(K+)-静脉血: 4.2mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 32.3U/L；尿素氮(BUN)-静脉血: 8.2mmol/L；间接胆红素(IBIL)-静脉血: 6.2umolL；氯离子(Cl-)-静脉血: 100.2mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 326g/L；红细胞比容(Hct)-静脉血: 43.5%；总胆固醇(TC)-静脉血: 5.88mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 22.9U/L；载脂蛋白AI(apoAI)-静脉血: 1.32g/L；血小板比容-静脉血: 32%；葡萄糖(Glu)-静脉血: 5.95mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.8mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.2pg；乳酸脱氢酶(LDH)-静脉血: 159.8U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.279；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.67；白细胞计数(WBC#)-静脉血: 10.7710E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 16.9U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.99mmol/L；中性粒细胞计数(Neut#)-静脉血: 6.410E9/L；平均红细胞体积(MCV)-静脉血: 92.6fL；平均血小板体积(MPV)-静脉血: 9.2fL；总胆红素(TBIL)-静脉血: 8.6umol/L；血小板分布宽度(PDW)-静脉血: 10%；磷(P)-静脉血: 1.6mmol/L；肌酐(Crea)-静脉血: 64.4umol/L；血小板计数(PLT#)-静脉血: 34410E9/L；C-反应蛋白(CRP)-静脉血: 3.29mg/L；碱性磷酸酶(ALP)-静脉血: 102.6U/L；白蛋白(ALB)-静脉血: 46.3g/L；淋巴细胞计数(Lymph#)-静脉血: 310E9/L；单核细胞计数(Mono#)-静脉血: 0.810E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 54U/L；大血小板百分比(P-LCR%)-静脉血: 18.4%；单核细胞百分比(Mono%)-静……\n- [全程D29] 检验组合: 隐血(OB)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；淀粉样蛋白A(SAA)-静脉血: 3.65mg/L；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；白细胞计数(WBC#)-尿液: 7/μL；比重(SG)-尿液: 1.027；总蛋白(TP)-尿液: +- 0.2g（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；葡萄糖(Glu)-尿液: 3+ 17mmol（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 80/μL\n- [全程D30] 检验组合: 颜色-尿液: Yellow；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 13/μL；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 6；总蛋白(TP)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.023\n- [全程D35] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.7；单核细胞计数(Mono#)-静脉血: 0.810E9/L；甘油三酯(TG)-静脉血: 2.15mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；载脂蛋白AI(apoAI)-静脉血: 1.26g/L；中性粒细胞百分比(Neut%)-静脉血: 0.702；葡萄糖(Glu)-静脉血: 6.03mmol/L；尿素氮(BUN)-静脉血: 7.02mmol/L；直接胆红素(DBIL)-静脉血: 4.8umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20U/L；C-反应蛋白(CRP)-静脉血: 2.65mg/L；乳酸脱氢酶(LDH)-静脉血: 166.9U/L；红细胞计数(RBC#)-静脉血: 4.7510E12/L；总胆汁酸(TBA)-静脉血: 1.5umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；总蛋白(TP)-静脉血: 71.69g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；肌酐(Crea)-静脉血: 69.7umol/L；总钙(Ca)-静脉血: 2.31mmol/L；白细胞计数(WBC#)-静脉血: 7.4610E9/L；镁离子(Mg2+)-静脉血: 1mmol/L；平均红细胞体积(MCV)-静脉血: 88.8fL；总胆固醇(TC)-静脉血: 5.15mmol/L；磷(P)-静脉血: 1.3mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；总胆红素(TBIL)-静脉血: 15umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；阴离子间隙(AG)-静脉血: 17；间接胆红素(IBIL)-静脉血: 10.2umolL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.18mmolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4；球蛋白(GLO)-静脉血: 26.39g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.168；血小板分布宽度(PDW)-静脉血: 9.8%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.015；血红蛋白(Hb)-静脉血: 141g/L；淋巴细胞计数(L……\n- [全程D49] 检验组合: 丙氨酸氨基转移酶(ALT)-静脉血: 18.4U/L；球蛋白(GLO)-静脉血: 27.24g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；γ-谷氨酰基转移酶(GGT)-静脉血: 42U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 16.9U/L；平均红细胞体积(MCV)-静脉血: 90.3fL；血小板比容-静脉血: 11.8%；血小板分布宽度(PDW)-静脉血: 16.8%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；钠离子(Na+)-静脉血: 138mmol/L；平均血小板体积(MPV)-静脉血: 6.76fL；总胆汁酸(TBA)-静脉血: 2.9umol/L；载脂蛋白B(apoB)-静脉血: 1.36g/L；总钙(Ca)-静脉血: 2.22mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.16g/L；红细胞计数(RBC#)-静脉血: 4.3410E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.019；血红蛋白(Hb)-静脉血: 133.6g/L；阴离子间隙(AG)-静脉血: 15.6；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；C-反应蛋白(CRP)-静脉血: 10.3mg/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.6mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.17；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.87mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9%；淀粉样蛋白A(SAA)-静脉血: 24.6mg/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.7pg；甘油三酯(TG)-静脉血: 2.36mmol/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；总蛋白(TP)-静脉血: 71.04g/L；碱性磷酸酶(ALP)-静脉血: 108.1U/L；总胆固醇(TC)-静脉血: 5.6mmol/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.104；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.92；平均红细胞血红蛋白浓度(MCHC)-静脉血: 340.7g/……\n- [全程D55] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位置位于第3胸椎体右下缘，估计位于右侧头臂静脉内。；检查结论: PICC管末端位置如上所述。\n- [全程D55] 检验组合: 葡萄糖(Glu)-尿液: +- 2.8mmol（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: 1+ 0.3g（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 3/μL；白细胞计数(WBC#)-尿液: 20/μL；酸碱度(pH)-尿液: 5.5；颜色-尿液: Yellow；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: +- 0.1g（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；比重(SG)-尿液: 1.021；红细胞计数(RBC#)-尿液: 2/μL；红细胞计数(RBC#)-尿液: 2/μL；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.025；浊度(TRUB)-尿液: 清亮；粘液丝计数(MUCS#)-尿液: 80/μL；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；葡萄糖(Glu)-尿液: 3+ 17mmol（参考: 阴性）；白细胞计数(WBC#)-尿液: 4/μL\n- [全程D63] 检验组合: 红细胞计数(RBC#)-静脉血: 3.910E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞计数(Neut#)-静脉血: 5.210E9/L；阴离子间隙(AG)-静脉血: 16.2；尿酸(UA)-静脉血: 364.7umol/L；钠离子(Na+)-静脉血: 132.6mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；球蛋白(GLO)-静脉血: 26.68g/L；单核细胞计数(Mono#)-静脉血: 1.110E9/L；葡萄糖(Glu)-静脉血: 4.06mmol/L；单核细胞百分比(Mono%)-静脉血: 0.166；平均血小板体积(MPV)-静脉血: 8.1fL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；尿素氮(BUN)-静脉血: 7.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 20.7U/L；白细胞计数(WBC#)-静脉血: 6.6710E9/L；甘油三酯(TG)-静脉血: 1.04mmol/L；氯离子(Cl-)-静脉血: 93.2mmol/L；磷(P)-静脉血: 1.24mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.2mmol/L；平均红细胞体积(MCV)-静脉血: 89.2fL；总胆汁酸(TBA)-静脉血: 0.9umol/L；载脂蛋白B(apoB)-静脉血: 1.28g/L；总钙(Ca)-静脉血: 2.2mmol/L；镁离子(Mg2+)-静脉血: 1.01mmol/L；红细胞比容(Hct)-静脉血: 34.8%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；乳酸脱氢酶(LDH)-静脉血: 151.8U/L；间接胆红素(IBIL)-静脉血: 9umolL；载脂蛋白AI(apoAI)-静脉血: 0.91g/L；总胆红素(TBIL)-静脉血: 12.8umol/L；大血小板百分比(P-LCR%)-静脉血: 9.3%；中性粒细胞百分比(Neut%)-静脉血: 0.782；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；血小板分布宽度(PDW)-静脉血: 8%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.1；碱性磷酸酶(ALP)-静脉血: 113.9U/L；平均红……\n- [全程D69] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌治疗后，与某次就诊时间0日片对比: 鼻咽腔未见明显狭窄，鼻咽顶后壁、右侧壁轻度增厚，见少许软组织影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，右侧咽隐窝消失。鼻咽左侧壁未见明显增厚，左侧咽隐窝稍浅。右侧咽旁脂肪间隙稍变窄，左侧咽旁脂肪间隙未见异常。 右侧腭帆提张肌信号不均匀，左侧腭帆提张肌、双侧头长肌未见受侵征象。 双侧翼腭窝、上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 口咽双侧壁未见受累增厚，病变未累及双侧后鼻孔。 右侧翼突内份及内板、蝶骨基底部右份骨质信号减低，增强扫描轻度强化，范围较前缩小。余颅底未见明确骨质破坏征象。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦、右侧乳突粘膜增厚，双侧上颌窦见少量分泌物，蝶窦、左侧乳突充气良好，骨壁完整。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 右侧咽后淋巴结短径约6mm，较前缩小。左侧咽后未见肿大淋巴结。 右颈IIb区见稍大淋巴结，较大者短径约7mm，增强扫描明显强化，较前缩小。双颈IIa区见数个小淋巴结，较大者短径约5mm，增强扫描轻度强化，大致同前。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 扫描所见脑实质未见明显异常。；检查结论: 鼻咽癌治疗后，与某次就诊时间0日片对比: 鼻咽病变较前缩小。 颅底骨质破坏，较前有修复。 右侧咽后肿大淋巴结，考虑转移，较前缩小。 右颈IIb区淋巴结肿大，考虑转移，较前缩小。 双颈IIa区小淋巴结。 副鼻窦炎，右侧乳突炎。\n- [全程D69] 检验组合: 直接胆红素(DBIL)-静脉血: 3.2umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.033；阴离子间隙(AG)-静脉血: 16.9；白细胞计数(WBC#)-静脉血: 3.510E9/L；总胆红素(TBIL)-静脉血: 11.7umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 24.1U/L；尿酸(UA)-静脉血: 468.3umol/L；白蛋白(ALB)-静脉血: 39.4g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.016；红细胞比容(Hct)-静脉血: 33.6%；磷(P)-静脉血: 1.09mmol/L；C-反应蛋白(CRP)-静脉血: 20.73mg/L；载脂蛋白B(apoB)-静脉血: 1.37g/L；葡萄糖(Glu)-静脉血: 4.3mmol/L；单核细胞百分比(Mono%)-静脉血: 0.112；血小板比容-静脉血: 15.3%；肌酐(Crea)-静脉血: 62.2umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4%；碱性磷酸酶(ALP)-静脉血: 92.8U/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.9mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.57；总蛋白(TP)-静脉血: 64.43g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.86；淋巴细胞计数(Lymph#)-静脉血: 0.110E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；球蛋白(GLO)-静脉血: 25.03g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 36.2U/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.839；甘油三酯(TG)-静脉血: 1.02mmol/L；间接胆红素(IBIL)-静脉血: 8.5umolL；丙氨酸氨基转移酶(ALT)-静脉血: 16.3U/L；血小板计数(PLT#)-静脉血: 266.210E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.27mmol/L；平均血小板体积(MPV)-静脉血: 5.77fL；胱抑素(Cys-C)-静脉血: 0.73mg/L；尿素氮(BUN)-静脉血: 5mmol/L；血小板分布宽度(PDW)-静脉……\n- [全程D70] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质回声均匀，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉内径约11mm，门静脉最大血流速度约23cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约40×35×31mm，包膜光滑，实质回声不均匀，可见强回声斑。 腹主动脉旁未见明确肿物回声。；检查结论: 前列腺钙化。 肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D9] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，无发热、涕血等不适症状。查体：生命体征平稳。电子喉镜检查示：鼻咽右隆突肿物，符合鼻咽癌。并取肿物活检，等待病理结果。[姓名已隐去]副教授示，结合患者病情及相关检查，诊断考虑鼻咽癌可能性大，明确诊断，予鼻咽科进一步诊治。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D15] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：KPS 90分；鼻咽右侧壁、顶后壁结节状肿物，右颈Ⅱ区可扪及已肿大淋巴结，大小约2*1cm，颅神经检查（-）。今日[姓名已隐去]医生信息已隐藏后示：患者已完善相关检查，并预约放疗，今日可结账出院，嘱出院后按时[计划性表述已隐藏]放化综合治疗，不适随诊。\n- [全程D29] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者放疗1次。患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：基本同前。今日[姓名已隐去]副医生信息已隐藏后示：患于今日行第一程DDP方案化疗（100mg/m2）。继续放疗，续观。\n- [全程D34] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：KPS 90分； 间接鼻咽镜检查见双侧鼻腔通畅，内未窥及明显肿物；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。复查血常规、生化常规未见明显异常。今日[姓名已隐去]医生信息已隐藏后示：患者已结束第一程同时期DDP方案化疗（100mg/m2），治疗过程顺利，今日可结账出院，嘱出院后继续在门诊放疗，每周复查血常规、肝肾功能，并按时[计划性表述已隐藏]下一程治疗，不适随诊。\n- [全程D54] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者放疗16次，口腔黏膜反应2度，放射性皮炎1度，患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：KPS 90分；张口门齿距4.5cm，鼻咽顶后壁、右侧壁肿物，较前缩小；右颈II区扪及一肿大淋巴结，大小约1X1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。颅神经检查：阴性。今日[姓名已隐去]副医生信息已隐藏后示：今日开始行第2程同时期DDP方案（DDP100mg/m2）化疗，继续放疗，续观。\n- [全程D64] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者放疗22次，口腔黏膜反应2度，放射性皮炎1度，患者诉喉痛，余未诉特殊不适。生命体征平稳。查体：KPS 90分；张口门齿距4.5cm，鼻咽顶后壁、右侧壁肿物，较前缩小；双颈未触及肿大淋巴结；颅神经检查：阴性。今日[姓名已隐去]副医生信息已隐藏后示：患者诉喉痛，予患者奥施康定止痛，继续放疗，续观。\n- [全程D69] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者放疗26次，口腔黏膜反应3度，放射性皮炎2度，患者诉喉痛，余未诉特殊不适。生命体征平稳。查体：KPS 90分；张口门齿距4.5cm，鼻咽肿物已不明显；双颈未触及肿大淋巴结；颅神经检查：阴性。今日[姓名已隐去]医生信息已隐藏后示：患者诉喉痛，继续予患者奥施康定止痛，继续放疗，续观。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 影像学评估病灶较前缩小，疗效肯定，需暂停放疗，待3度放射性口腔黏膜炎恢复至1度后再恢复放疗，期间予静脉营养支持。\nB. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，局部使用含漱液及非甾体类抗炎药镇痛，停用阿片类药物。\nC. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎伴咽痛，继续予羟考酮镇痛及静脉营养支持，并常规行PICC导管护理。\nD. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，行预防性气管切开以防气道水肿梗阻，并予静脉营养支持。\nE. 影像学评估病灶较前缩小，疗效肯定，已完成26次放疗且出现3度黏膜炎，提前结束放疗并转为辅助化疗，同时予羟考酮镇痛。\nF. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，拔除PICC导管以预防导管相关性血流感染，改用外周静脉营养。\nG. 影像学评估病灶未见明显缩小，疗效评价为疾病稳定（SD），重新定位更改放疗靶区并提高局部照射剂量，同时予羟考酮镇痛及静脉营养支持。\nH. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，立即行经皮内镜下胃造瘘术（PEG）以保证肠内营养。\nI. 影像学评估病灶完全消失，疗效评价为完全缓解（CR），提前终止放疗，进入随访观察期，对咽痛继续予羟考酮镇痛。\nJ. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；放疗已达26次且肿瘤退缩，同步加用西妥昔单抗以增强局部控制，并予静脉营养支持。\nK. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，静脉大剂量使用糖皮质激素以快速减轻炎症反应。\nL. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；出现3度放射性口腔黏膜炎，将后续放疗改为姑息性低剂量放疗，并予羟考酮镇痛。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-4da20c3d27d6501be61a2584","patient_id":"patient-f25e20b1e5c6eea840d4cc21","turn_id":"turn01","turn_position":1,"turn_type":"initial_workup_choice","gold_letter":"D","gold_action":"电子鼻咽镜及鼻咽活检，鼻咽及颈部MRI平扫+增强，腹部及浅表淋巴结彩超，心电图，以及包含EBV抗体的基线血液学检查。","options":[{"letter":"A","text":"电子鼻咽镜及鼻咽活检，鼻咽及颈部CT平扫+增强，胸部X线片，腹部彩超，基线血液学检查。","is_gold":false},{"letter":"B","text":"颈部淋巴结细针穿刺活检，鼻咽及颈部MRI平扫+增强，胸腹部CT平扫+增强，全身骨扫描。","is_gold":false},{"letter":"C","text":"全身PET-CT检查，电子鼻咽镜及鼻咽活检，头颅MRI平扫+增强，常规心电图及血液学检查。","is_gold":false},{"letter":"D","text":"电子鼻咽镜及鼻咽活检，鼻咽及颈部MRI平扫+增强，腹部及浅表淋巴结彩超，心电图，包含EBV抗体的基线血液学检查。","is_gold":true},{"letter":"E","text":"电子鼻咽镜检查，鼻咽及颈部MRI平扫+增强，胸腹部CT平扫+增强，待影像学评估后再决定是否活检。","is_gold":false},{"letter":"F","text":"鼻咽及颈部MRI平扫+增强，胸腹部CT平扫+增强，全身骨扫描，基线血液学检查。","is_gold":false},{"letter":"G","text":"电子鼻咽镜及鼻咽活检，鼻咽及颈部MRI平扫，腹部彩超，胸部CT平扫，基线血液学检查。","is_gold":false},{"letter":"H","text":"颈部淋巴结切除活检，鼻咽及颈部CT平扫+增强，腹部彩超，心电图，包含EBV抗体的基线血液学检查。","is_gold":false},{"letter":"I","text":"电子鼻咽镜及鼻咽活检，头颈部PET-CT，腹部及盆腔MRI平扫+增强，心电图，基线血液学检查。","is_gold":false},{"letter":"J","text":"电子鼻咽镜及鼻咽活检，鼻咽及颈部MRI平扫+增强，常规心电图及血液学检查，并直接安排诱导化疗。","is_gold":false},{"letter":"K","text":"鼻咽刷片细胞学检查，鼻咽及颈部MRI平扫+增强，胸腹部彩超，全身骨扫描，基线血液学检查。","is_gold":false},{"letter":"L","text":"电子鼻咽镜及鼻咽活检，鼻咽及颈部CT平扫，全身骨扫描，腹部彩超，心电图，基线血液学检查。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、鼻腔、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现右颈部肿块伴耳鸣、听力下降4个月。；现病史: 缘于4个月前患者无意中发现右颈部包块，如拇指大小，无压痛，伴耳鸣、听力下降，颈部包块后逐渐增大，近1周偶发头痛，白天明显，视物如常，无鼻塞、鼻血、面麻、等不适。为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,鼻咽肿物,右颈部包块,头痛；既往史: 4年前患痔疮，已治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:青霉素皮试阳性。；个人史: 长期居于原籍，无疫区居住史。吸烟3-4支/天*10年，饮酒1-2次/月。否认不洁性生活史。；家族史: 舅舅患鼻咽癌，舅妈患肺癌。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：103/73mmHg,Ht：174cm，Wt：79kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；右颈IIa区可扪及1个淋巴结，最大径2.5×2.5cm，左颈IIa区扪及1个淋巴结，最大径约3*3cm，无融合，质地韧，边界模糊，活动度好，无压痛，无皮肤浸润，无溃疡，右颈III区可见一长约4cm手术疤痕；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 电子鼻咽镜及鼻咽活检，鼻咽及颈部CT平扫+增强，胸部X线片，腹部彩超，基线血液学检查。\nB. 颈部淋巴结细针穿刺活检，鼻咽及颈部MRI平扫+增强，胸腹部CT平扫+增强，全身骨扫描。\nC. 全身PET-CT检查，电子鼻咽镜及鼻咽活检，头颅MRI平扫+增强，常规心电图及血液学检查。\nD. 电子鼻咽镜及鼻咽活检，鼻咽及颈部MRI平扫+增强，腹部及浅表淋巴结彩超，心电图，包含EBV抗体的基线血液学检查。\nE. 电子鼻咽镜检查，鼻咽及颈部MRI平扫+增强，胸腹部CT平扫+增强，待影像学评估后再决定是否活检。\nF. 鼻咽及颈部MRI平扫+增强，胸腹部CT平扫+增强，全身骨扫描，基线血液学检查。\nG. 电子鼻咽镜及鼻咽活检，鼻咽及颈部MRI平扫，腹部彩超，胸部CT平扫，基线血液学检查。\nH. 颈部淋巴结切除活检，鼻咽及颈部CT平扫+增强，腹部彩超，心电图，包含EBV抗体的基线血液学检查。\nI. 电子鼻咽镜及鼻咽活检，头颈部PET-CT，腹部及盆腔MRI平扫+增强，心电图，基线血液学检查。\nJ. 电子鼻咽镜及鼻咽活检，鼻咽及颈部MRI平扫+增强，常规心电图及血液学检查，并直接安排诱导化疗。\nK. 鼻咽刷片细胞学检查，鼻咽及颈部MRI平扫+增强，胸腹部彩超，全身骨扫描，基线血液学检查。\nL. 电子鼻咽镜及鼻咽活检，鼻咽及颈部CT平扫，全身骨扫描，腹部彩超，心电图，基线血液学检查。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、鼻腔、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现右颈部肿块伴耳鸣、听力下降4个月。；现病史: 缘于4个月前患者无意中发现右颈部包块，如拇指大小，无压痛，伴耳鸣、听力下降，颈部包块后逐渐增大，近1周偶发头痛，白天明显，视物如常，无鼻塞、鼻血、面麻、等不适。为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,鼻咽肿物,右颈部包块,头痛；既往史: 4年前患痔疮，已治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:青霉素皮试阳性。；个人史: 长期居于原籍，无疫区居住史。吸烟3-4支/天*10年，饮酒1-2次/月。否认不洁性生活史。；家族史: 舅舅患鼻咽癌，舅妈患肺癌。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：103/73mmHg,Ht：174cm，Wt：79kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；右颈IIa区可扪及1个淋巴结，最大径2.5×2.5cm，左颈IIa区扪及1个淋巴结，最大径约3*3cm，无融合，质地韧，边界模糊，活动度好，无压痛，无皮肤浸润，无溃疡，右颈III区可见一长约4cm手术疤痕；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 电子鼻咽镜及鼻咽活检，鼻咽及颈部CT平扫+增强，胸部X线片，腹部彩超，基线血液学检查。\nB. 颈部淋巴结细针穿刺活检，鼻咽及颈部MRI平扫+增强，胸腹部CT平扫+增强，全身骨扫描。\nC. 全身PET-CT检查，电子鼻咽镜及鼻咽活检，头颅MRI平扫+增强，常规心电图及血液学检查。\nD. 电子鼻咽镜及鼻咽活检，鼻咽及颈部MRI平扫+增强，腹部及浅表淋巴结彩超，心电图，包含EBV抗体的基线血液学检查。\nE. 电子鼻咽镜检查，鼻咽及颈部MRI平扫+增强，胸腹部CT平扫+增强，待影像学评估后再决定是否活检。\nF. 鼻咽及颈部MRI平扫+增强，胸腹部CT平扫+增强，全身骨扫描，基线血液学检查。\nG. 电子鼻咽镜及鼻咽活检，鼻咽及颈部MRI平扫，腹部彩超，胸部CT平扫，基线血液学检查。\nH. 颈部淋巴结切除活检，鼻咽及颈部CT平扫+增强，腹部彩超，心电图，包含EBV抗体的基线血液学检查。\nI. 电子鼻咽镜及鼻咽活检，头颈部PET-CT，腹部及盆腔MRI平扫+增强，心电图，基线血液学检查。\nJ. 电子鼻咽镜及鼻咽活检，鼻咽及颈部MRI平扫+增强，常规心电图及血液学检查，并直接安排诱导化疗。\nK. 鼻咽刷片细胞学检查，鼻咽及颈部MRI平扫+增强，胸腹部彩超，全身骨扫描，基线血液学检查。\nL. 电子鼻咽镜及鼻咽活检，鼻咽及颈部CT平扫，全身骨扫描，腹部彩超，心电图，基线血液学检查。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-cef4654d5f291c72b760bfcf","patient_id":"patient-f25e20b1e5c6eea840d4cc21","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"E","gold_action":"行鼻咽镜下活检明确病理，并补充胸部CT、全身骨扫描及血清EBV DNA检测。","options":[{"letter":"A","text":"安排适形调强放射治疗（IMRT）及同步化疗","is_gold":false},{"letter":"B","text":"行鼻咽镜下活检，并补充头颅PET-MR评估颅底受侵范围","is_gold":false},{"letter":"C","text":"行右颈部淋巴结细针穿刺活检，并补充胸部CT及全身骨扫描","is_gold":false},{"letter":"D","text":"行鼻咽镜下活检，并补充腹部增强CT排查肝脏转移","is_gold":false},{"letter":"E","text":"行鼻咽镜下活检，并补充胸部CT、全身骨扫描及血清EBV DNA检测","is_gold":true},{"letter":"F","text":"行鼻咽镜下活检，直接进行放疗定位及靶区勾画","is_gold":false},{"letter":"G","text":"行全身PET-CT进行分期，随后开始诱导化疗","is_gold":false},{"letter":"H","text":"行鼻咽镜下活检，并补充颈部超声评估淋巴结包膜外侵犯","is_gold":false},{"letter":"I","text":"行鼻咽镜下活检，并补充胸部X线及头颅CT平扫","is_gold":false},{"letter":"J","text":"行鼻咽镜下活检，并补充骨髓穿刺排除骨髓转移","is_gold":false},{"letter":"K","text":"行鼻咽镜下活检，并补充全身骨扫描，暂缓胸部影像学检查","is_gold":false},{"letter":"L","text":"行右颈部淋巴结切除活检，并补充胸部CT及血清EBV DNA检测","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、鼻腔、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现右颈部肿块伴耳鸣、听力下降4个月。；现病史: 缘于4个月前患者无意中发现右颈部包块，如拇指大小，无压痛，伴耳鸣、听力下降，颈部包块后逐渐增大，近1周偶发头痛，白天明显，视物如常，无鼻塞、鼻血、面麻、等不适。为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,鼻咽肿物,右颈部包块,头痛；既往史: 4年前患痔疮，已治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:青霉素皮试阳性。；个人史: 长期居于原籍，无疫区居住史。吸烟3-4支/天*10年，饮酒1-2次/月。否认不洁性生活史。；家族史: 舅舅患鼻咽癌，舅妈患肺癌。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：103/73mmHg,Ht：174cm，Wt：79kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；右颈IIa区可扪及1个淋巴结，最大径2.5×2.5cm，左颈IIa区扪及1个淋巴结，最大径约3*3cm，无融合，质地韧，边界模糊，活动度好，无压痛，无皮肤浸润，无溃疡，右颈III区可见一长约4cm手术疤痕；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 电轴左偏(轻度) 正常范围心电图\n- [全程D1] 检验组合: 血小板比容-静脉血: 19%；载脂蛋白B(apoB)-静脉血: 1.03g/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；肌酐(Crea)-静脉血: 66.2umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.1；球蛋白(GLO)-静脉血: 31.61g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.011；尿胆原(URO)-尿液: -（参考: 阴性）；红细胞比容(Hct)-静脉血: 48.9%；凝血酶原时间活动度(PTA)-静脉血: 111.2%；隐血(OB)-粪便: 阴性（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.91mg/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；碱性磷酸酶(ALP)-静脉血: 76.3U/L；载脂蛋白AI(apoAI)-静脉血: 1.04g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；葡萄糖(Glu)-静脉血: 4.96mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.5；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；血小板分布宽度(PDW)-静脉血: 13.9%；淋巴细胞百分比(Lymph%)-静脉血: 0.315；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；总胆红素(TBIL)-静脉血: 7umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.910E9/L；Rh血型-静脉血: 阳性；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.2sec.；酮体(KET)-尿液: -（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 21.9mmol/L；浊度(TRUB)-尿液: 清亮；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 4.88mmol/L；C-反应蛋白(C……\n- [全程D3] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D7] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及双侧壁增厚，以右侧为著，T1WI呈等信号，T2WI呈稍高信号，增强扫描强化明显，右侧咽隐窝消失，见增厚组织占据，左侧咽隐窝变浅。病变与右侧中鼻甲分界不清，口咽双侧壁未见增厚。 右侧咽旁间隙及右侧咽后间隙见不规则肿物突入。双侧腭帆提肌、右侧腭帆张肌、右侧头长肌受侵。左侧腭帆张肌、双侧翼内肌及双侧翼外肌未见受侵。 右侧翼腭窝内见少许软组织信号，增强扫描明显强化。 左侧翼腭窝、双侧上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 斜坡、蝶骨基底部、右侧翼突基底部及内外板、右侧蝶骨大翼及右侧岩尖骨质信号减低，增强扫描见不均匀强化。 右侧破裂扩大，右侧海绵窦增宽，内见不规则软组织信号灶，右侧蝶窦内见软组织信号灶突入，增强扫描上述病变强化明显。 左侧海绵窦未见增宽。蝶鞍形态正常，其内未见占位性病变。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧上颌窦、筛窦及蝶窦粘膜增厚。右侧乳突内见大量分泌物。 右侧咽后见肿大淋巴结，大者约12mm×17mm，增强扫描强化明显。双颈II、III、V区见多个肿大淋巴结，最大者约23mm×29mm，部分边界欠清晰，包膜不完整，信号欠均匀，增强扫描明显不均匀强化。双侧腮腺内及腮腺旁见数个淋巴结，大者短径约6mm，增强扫描强化明显。双颈I区见数个淋巴结，大者短径约7mm，信号尚均匀。 甲状腺双叶及峡部、喉咽、双侧颌下腺信号均匀，未见占位性病变。；检查结论: 鼻咽病变，考虑鼻咽癌，侵犯范围如上述。 颅底骨质破坏。 右侧咽后、双颈II、III、V区多发肿大淋巴结，考虑转移。 双侧腮腺内及腮腺旁数个淋巴结，性质待定。 鼻窦炎、右侧乳突炎。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 安排适形调强放射治疗（IMRT）及同步化疗\nB. 行鼻咽镜下活检，并补充头颅PET-MR评估颅底受侵范围\nC. 行右颈部淋巴结细针穿刺活检，并补充胸部CT及全身骨扫描\nD. 行鼻咽镜下活检，并补充腹部增强CT排查肝脏转移\nE. 行鼻咽镜下活检，并补充胸部CT、全身骨扫描及血清EBV DNA检测\nF. 行鼻咽镜下活检，直接进行放疗定位及靶区勾画\nG. 行全身PET-CT进行分期，随后开始诱导化疗\nH. 行鼻咽镜下活检，并补充颈部超声评估淋巴结包膜外侵犯\nI. 行鼻咽镜下活检，并补充胸部X线及头颅CT平扫\nJ. 行鼻咽镜下活检，并补充骨髓穿刺排除骨髓转移\nK. 行鼻咽镜下活检，并补充全身骨扫描，暂缓胸部影像学检查\nL. 行右颈部淋巴结切除活检，并补充胸部CT及血清EBV DNA检测\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、鼻腔、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现右颈部肿块伴耳鸣、听力下降4个月。；现病史: 缘于4个月前患者无意中发现右颈部包块，如拇指大小，无压痛，伴耳鸣、听力下降，颈部包块后逐渐增大，近1周偶发头痛，白天明显，视物如常，无鼻塞、鼻血、面麻、等不适。为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,鼻咽肿物,右颈部包块,头痛；既往史: 4年前患痔疮，已治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:青霉素皮试阳性。；个人史: 长期居于原籍，无疫区居住史。吸烟3-4支/天*10年，饮酒1-2次/月。否认不洁性生活史。；家族史: 舅舅患鼻咽癌，舅妈患肺癌。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：103/73mmHg,Ht：174cm，Wt：79kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；右颈IIa区可扪及1个淋巴结，最大径2.5×2.5cm，左颈IIa区扪及1个淋巴结，最大径约3*3cm，无融合，质地韧，边界模糊，活动度好，无压痛，无皮肤浸润，无溃疡，右颈III区可见一长约4cm手术疤痕；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 电轴左偏(轻度) 正常范围心电图\n- [全程D1] 检验组合: 血小板比容-静脉血: 19%；载脂蛋白B(apoB)-静脉血: 1.03g/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；肌酐(Crea)-静脉血: 66.2umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.1；球蛋白(GLO)-静脉血: 31.61g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.011；尿胆原(URO)-尿液: -（参考: 阴性）；红细胞比容(Hct)-静脉血: 48.9%；凝血酶原时间活动度(PTA)-静脉血: 111.2%；隐血(OB)-粪便: 阴性（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.91mg/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；碱性磷酸酶(ALP)-静脉血: 76.3U/L；载脂蛋白AI(apoAI)-静脉血: 1.04g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；葡萄糖(Glu)-静脉血: 4.96mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.5；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；血小板分布宽度(PDW)-静脉血: 13.9%；淋巴细胞百分比(Lymph%)-静脉血: 0.315；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；总胆红素(TBIL)-静脉血: 7umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.910E9/L；Rh血型-静脉血: 阳性；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.2sec.；酮体(KET)-尿液: -（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 21.9mmol/L；浊度(TRUB)-尿液: 清亮；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 4.88mmol/L；C-反应蛋白(C……\n- [全程D3] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D7] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及双侧壁增厚，以右侧为著，T1WI呈等信号，T2WI呈稍高信号，增强扫描强化明显，右侧咽隐窝消失，见增厚组织占据，左侧咽隐窝变浅。病变与右侧中鼻甲分界不清，口咽双侧壁未见增厚。 右侧咽旁间隙及右侧咽后间隙见不规则肿物突入。双侧腭帆提肌、右侧腭帆张肌、右侧头长肌受侵。左侧腭帆张肌、双侧翼内肌及双侧翼外肌未见受侵。 右侧翼腭窝内见少许软组织信号，增强扫描明显强化。 左侧翼腭窝、双侧上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 斜坡、蝶骨基底部、右侧翼突基底部及内外板、右侧蝶骨大翼及右侧岩尖骨质信号减低，增强扫描见不均匀强化。 右侧破裂扩大，右侧海绵窦增宽，内见不规则软组织信号灶，右侧蝶窦内见软组织信号灶突入，增强扫描上述病变强化明显。 左侧海绵窦未见增宽。蝶鞍形态正常，其内未见占位性病变。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧上颌窦、筛窦及蝶窦粘膜增厚。右侧乳突内见大量分泌物。 右侧咽后见肿大淋巴结，大者约12mm×17mm，增强扫描强化明显。双颈II、III、V区见多个肿大淋巴结，最大者约23mm×29mm，部分边界欠清晰，包膜不完整，信号欠均匀，增强扫描明显不均匀强化。双侧腮腺内及腮腺旁见数个淋巴结，大者短径约6mm，增强扫描强化明显。双颈I区见数个淋巴结，大者短径约7mm，信号尚均匀。 甲状腺双叶及峡部、喉咽、双侧颌下腺信号均匀，未见占位性病变。；检查结论: 鼻咽病变，考虑鼻咽癌，侵犯范围如上述。 颅底骨质破坏。 右侧咽后、双颈II、III、V区多发肿大淋巴结，考虑转移。 双侧腮腺内及腮腺旁数个淋巴结，性质待定。 鼻窦炎、右侧乳突炎。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 安排适形调强放射治疗（IMRT）及同步化疗\nB. 行鼻咽镜下活检，并补充头颅PET-MR评估颅底受侵范围\nC. 行右颈部淋巴结细针穿刺活检，并补充胸部CT及全身骨扫描\nD. 行鼻咽镜下活检，并补充腹部增强CT排查肝脏转移\nE. 行鼻咽镜下活检，并补充胸部CT、全身骨扫描及血清EBV DNA检测\nF. 行鼻咽镜下活检，直接进行放疗定位及靶区勾画\nG. 行全身PET-CT进行分期，随后开始诱导化疗\nH. 行鼻咽镜下活检，并补充颈部超声评估淋巴结包膜外侵犯\nI. 行鼻咽镜下活检，并补充胸部X线及头颅CT平扫\nJ. 行鼻咽镜下活检，并补充骨髓穿刺排除骨髓转移\nK. 行鼻咽镜下活检，并补充全身骨扫描，暂缓胸部影像学检查\nL. 行右颈部淋巴结切除活检，并补充胸部CT及血清EBV DNA检测\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-5ae78b6dca4ce8a61a44d0ca","patient_id":"patient-f25e20b1e5c6eea840d4cc21","turn_id":"turn04","turn_position":3,"turn_type":"initial_treatment_selection","gold_letter":"G","gold_action":"诱导化疗序贯同步放化疗","options":[{"letter":"A","text":"单纯根治性放疗","is_gold":false},{"letter":"B","text":"诱导化疗序贯单纯根治性放疗","is_gold":false},{"letter":"C","text":"同步放化疗序贯辅助化疗","is_gold":false},{"letter":"D","text":"根治性颈淋巴结清扫术序贯辅助放化疗","is_gold":false},{"letter":"E","text":"姑息性全身化疗联合靶向治疗","is_gold":false},{"letter":"F","text":"诱导化疗序贯根治性手术","is_gold":false},{"letter":"G","text":"诱导化疗序贯同步放化疗","is_gold":true},{"letter":"H","text":"免疫治疗联合同步放化疗","is_gold":false},{"letter":"I","text":"靶向治疗联合同步放化疗","is_gold":false},{"letter":"J","text":"诱导化疗序贯同步放化疗联合辅助化疗","is_gold":false},{"letter":"K","text":"根治性放疗序贯辅助化疗","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、鼻腔、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现右颈部肿块伴耳鸣、听力下降4个月。；现病史: 缘于4个月前患者无意中发现右颈部包块，如拇指大小，无压痛，伴耳鸣、听力下降，颈部包块后逐渐增大，近1周偶发头痛，白天明显，视物如常，无鼻塞、鼻血、面麻、等不适。为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,鼻咽肿物,右颈部包块,头痛；既往史: 4年前患痔疮，已治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:青霉素皮试阳性。；个人史: 长期居于原籍，无疫区居住史。吸烟3-4支/天*10年，饮酒1-2次/月。否认不洁性生活史。；家族史: 舅舅患鼻咽癌，舅妈患肺癌。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：103/73mmHg,Ht：174cm，Wt：79kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；右颈IIa区可扪及1个淋巴结，最大径2.5×2.5cm，左颈IIa区扪及1个淋巴结，最大径约3*3cm，无融合，质地韧，边界模糊，活动度好，无压痛，无皮肤浸润，无溃疡，右颈III区可见一长约4cm手术疤痕；颅神经检查：阴性。；KPS:；ECOG:\n- [全程D0] 入院记录: 主诉: 发现右颈部肿块伴耳鸣、听力下降4个月。；现病史: 缘于4个月前患者无意中发现右颈部包块，如拇指大小，无压痛，伴耳鸣、听力下降，颈部包块后逐渐增大，近1周偶发头痛，白天明显，视物如常，无鼻塞、鼻血、面麻、等不适。就诊[机构已隐去]，行右颈部淋巴结活检术，病理示转移性低分化鳞癌，行电子鼻咽镜检查见鼻咽肿物，取活检病理示可疑癌。为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,鼻咽肿物,右颈部包块,头痛；既往史: 4年前患痔疮，已治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:青霉素皮试阳性。；个人史: 长期居于原籍，无疫区居住史。吸烟3-4支/天*10年，饮酒1-2次/月。否认不洁性生活史。；家族史: 舅舅患鼻咽癌，舅妈患肺癌。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：103/73mmHg,Ht：174cm，Wt：79kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；右颈IIa区可扪及1个淋巴结，最大径2.5×2.5cm，左颈IIa区扪及1个淋巴结，最大径约3*3cm，无融合，质地韧，边界模糊，活动度好，无压痛，无皮肤浸润，无溃疡，右颈III区可见一长约4cm手术疤痕；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 电轴左偏(轻度) 正常范围心电图\n- [全程D1] 检验组合: 血小板比容-静脉血: 19%；载脂蛋白B(apoB)-静脉血: 1.03g/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；肌酐(Crea)-静脉血: 66.2umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.1；球蛋白(GLO)-静脉血: 31.61g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.011；尿胆原(URO)-尿液: -（参考: 阴性）；红细胞比容(Hct)-静脉血: 48.9%；凝血酶原时间活动度(PTA)-静脉血: 111.2%；隐血(OB)-粪便: 阴性（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.91mg/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；碱性磷酸酶(ALP)-静脉血: 76.3U/L；载脂蛋白AI(apoAI)-静脉血: 1.04g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；葡萄糖(Glu)-静脉血: 4.96mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.5；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；血小板分布宽度(PDW)-静脉血: 13.9%；淋巴细胞百分比(Lymph%)-静脉血: 0.315；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；总胆红素(TBIL)-静脉血: 7umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.910E9/L；Rh血型-静脉血: 阳性；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.2sec.；酮体(KET)-尿液: -（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 21.9mmol/L；浊度(TRUB)-尿液: 清亮；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 4.88mmol/L；C-反应蛋白(C……\n- [全程D3] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D7] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及双侧壁增厚，以右侧为著，T1WI呈等信号，T2WI呈稍高信号，增强扫描强化明显，右侧咽隐窝消失，见增厚组织占据，左侧咽隐窝变浅。病变与右侧中鼻甲分界不清，口咽双侧壁未见增厚。 右侧咽旁间隙及右侧咽后间隙见不规则肿物突入。双侧腭帆提肌、右侧腭帆张肌、右侧头长肌受侵。左侧腭帆张肌、双侧翼内肌及双侧翼外肌未见受侵。 右侧翼腭窝内见少许软组织信号，增强扫描明显强化。 左侧翼腭窝、双侧上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 斜坡、蝶骨基底部、右侧翼突基底部及内外板、右侧蝶骨大翼及右侧岩尖骨质信号减低，增强扫描见不均匀强化。 右侧破裂扩大，右侧海绵窦增宽，内见不规则软组织信号灶，右侧蝶窦内见软组织信号灶突入，增强扫描上述病变强化明显。 左侧海绵窦未见增宽。蝶鞍形态正常，其内未见占位性病变。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧上颌窦、筛窦及蝶窦粘膜增厚。右侧乳突内见大量分泌物。 右侧咽后见肿大淋巴结，大者约12mm×17mm，增强扫描强化明显。双颈II、III、V区见多个肿大淋巴结，最大者约23mm×29mm，部分边界欠清晰，包膜不完整，信号欠均匀，增强扫描明显不均匀强化。双侧腮腺内及腮腺旁见数个淋巴结，大者短径约6mm，增强扫描强化明显。双颈I区见数个淋巴结，大者短径约7mm，信号尚均匀。 甲状腺双叶及峡部、喉咽、双侧颌下腺信号均匀，未见占位性病变。；检查结论: 鼻咽病变，考虑鼻咽癌，侵犯范围如上述。 颅底骨质破坏。 右侧咽后、双颈II、III、V区多发肿大淋巴结，考虑转移。 双侧腮腺内及腮腺旁数个淋巴结，性质待定。 鼻窦炎、右侧乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 单纯根治性放疗\nB. 诱导化疗序贯单纯根治性放疗\nC. 同步放化疗序贯辅助化疗\nD. 根治性颈淋巴结清扫术序贯辅助放化疗\nE. 姑息性全身化疗联合靶向治疗\nF. 诱导化疗序贯根治性手术\nG. 诱导化疗序贯同步放化疗\nH. 免疫治疗联合同步放化疗\nI. 靶向治疗联合同步放化疗\nJ. 诱导化疗序贯同步放化疗联合辅助化疗\nK. 根治性放疗序贯辅助化疗\n\n请仅输出一个选项字母（A-K）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、鼻腔、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现右颈部肿块伴耳鸣、听力下降4个月。；现病史: 缘于4个月前患者无意中发现右颈部包块，如拇指大小，无压痛，伴耳鸣、听力下降，颈部包块后逐渐增大，近1周偶发头痛，白天明显，视物如常，无鼻塞、鼻血、面麻、等不适。为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,鼻咽肿物,右颈部包块,头痛；既往史: 4年前患痔疮，已治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:青霉素皮试阳性。；个人史: 长期居于原籍，无疫区居住史。吸烟3-4支/天*10年，饮酒1-2次/月。否认不洁性生活史。；家族史: 舅舅患鼻咽癌，舅妈患肺癌。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：103/73mmHg,Ht：174cm，Wt：79kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；右颈IIa区可扪及1个淋巴结，最大径2.5×2.5cm，左颈IIa区扪及1个淋巴结，最大径约3*3cm，无融合，质地韧，边界模糊，活动度好，无压痛，无皮肤浸润，无溃疡，右颈III区可见一长约4cm手术疤痕；颅神经检查：阴性。；KPS:；ECOG:\n- [全程D0] 入院记录: 主诉: 发现右颈部肿块伴耳鸣、听力下降4个月。；现病史: 缘于4个月前患者无意中发现右颈部包块，如拇指大小，无压痛，伴耳鸣、听力下降，颈部包块后逐渐增大，近1周偶发头痛，白天明显，视物如常，无鼻塞、鼻血、面麻、等不适。就诊[机构已隐去]，行右颈部淋巴结活检术，病理示转移性低分化鳞癌，行电子鼻咽镜检查见鼻咽肿物，取活检病理示可疑癌。为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,鼻咽肿物,右颈部包块,头痛；既往史: 4年前患痔疮，已治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:青霉素皮试阳性。；个人史: 长期居于原籍，无疫区居住史。吸烟3-4支/天*10年，饮酒1-2次/月。否认不洁性生活史。；家族史: 舅舅患鼻咽癌，舅妈患肺癌。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：103/73mmHg,Ht：174cm，Wt：79kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；右颈IIa区可扪及1个淋巴结，最大径2.5×2.5cm，左颈IIa区扪及1个淋巴结，最大径约3*3cm，无融合，质地韧，边界模糊，活动度好，无压痛，无皮肤浸润，无溃疡，右颈III区可见一长约4cm手术疤痕；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 电轴左偏(轻度) 正常范围心电图\n- [全程D1] 检验组合: 血小板比容-静脉血: 19%；载脂蛋白B(apoB)-静脉血: 1.03g/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；肌酐(Crea)-静脉血: 66.2umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.1；球蛋白(GLO)-静脉血: 31.61g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.011；尿胆原(URO)-尿液: -（参考: 阴性）；红细胞比容(Hct)-静脉血: 48.9%；凝血酶原时间活动度(PTA)-静脉血: 111.2%；隐血(OB)-粪便: 阴性（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.91mg/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；碱性磷酸酶(ALP)-静脉血: 76.3U/L；载脂蛋白AI(apoAI)-静脉血: 1.04g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；葡萄糖(Glu)-静脉血: 4.96mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.5；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；血小板分布宽度(PDW)-静脉血: 13.9%；淋巴细胞百分比(Lymph%)-静脉血: 0.315；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；总胆红素(TBIL)-静脉血: 7umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.910E9/L；Rh血型-静脉血: 阳性；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.2sec.；酮体(KET)-尿液: -（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 21.9mmol/L；浊度(TRUB)-尿液: 清亮；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 4.88mmol/L；C-反应蛋白(C……\n- [全程D3] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D7] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及双侧壁增厚，以右侧为著，T1WI呈等信号，T2WI呈稍高信号，增强扫描强化明显，右侧咽隐窝消失，见增厚组织占据，左侧咽隐窝变浅。病变与右侧中鼻甲分界不清，口咽双侧壁未见增厚。 右侧咽旁间隙及右侧咽后间隙见不规则肿物突入。双侧腭帆提肌、右侧腭帆张肌、右侧头长肌受侵。左侧腭帆张肌、双侧翼内肌及双侧翼外肌未见受侵。 右侧翼腭窝内见少许软组织信号，增强扫描明显强化。 左侧翼腭窝、双侧上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 斜坡、蝶骨基底部、右侧翼突基底部及内外板、右侧蝶骨大翼及右侧岩尖骨质信号减低，增强扫描见不均匀强化。 右侧破裂扩大，右侧海绵窦增宽，内见不规则软组织信号灶，右侧蝶窦内见软组织信号灶突入，增强扫描上述病变强化明显。 左侧海绵窦未见增宽。蝶鞍形态正常，其内未见占位性病变。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧上颌窦、筛窦及蝶窦粘膜增厚。右侧乳突内见大量分泌物。 右侧咽后见肿大淋巴结，大者约12mm×17mm，增强扫描强化明显。双颈II、III、V区见多个肿大淋巴结，最大者约23mm×29mm，部分边界欠清晰，包膜不完整，信号欠均匀，增强扫描明显不均匀强化。双侧腮腺内及腮腺旁见数个淋巴结，大者短径约6mm，增强扫描强化明显。双颈I区见数个淋巴结，大者短径约7mm，信号尚均匀。 甲状腺双叶及峡部、喉咽、双侧颌下腺信号均匀，未见占位性病变。；检查结论: 鼻咽病变，考虑鼻咽癌，侵犯范围如上述。 颅底骨质破坏。 右侧咽后、双颈II、III、V区多发肿大淋巴结，考虑转移。 双侧腮腺内及腮腺旁数个淋巴结，性质待定。 鼻窦炎、右侧乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 单纯根治性放疗\nB. 诱导化疗序贯单纯根治性放疗\nC. 同步放化疗序贯辅助化疗\nD. 根治性颈淋巴结清扫术序贯辅助放化疗\nE. 姑息性全身化疗联合靶向治疗\nF. 诱导化疗序贯根治性手术\nG. 诱导化疗序贯同步放化疗\nH. 免疫治疗联合同步放化疗\nI. 靶向治疗联合同步放化疗\nJ. 诱导化疗序贯同步放化疗联合辅助化疗\nK. 根治性放疗序贯辅助化疗\n\n请仅输出一个选项字母（A-K）。"}]}
+{"sample_id":"sample-a4cf25bef13a63de3e012971","patient_id":"patient-f25e20b1e5c6eea840d4cc21","turn_id":"turn05","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"H","gold_action":"完善放化疗前基线检验（血常规、生化、凝血、传染病、EBV等），全面评估器官功能。","options":[{"letter":"A","text":"完善放化疗前基线检验，若肌酐清除率>30ml/min即可启动大剂量顺铂同步化疗。","is_gold":false},{"letter":"B","text":"完善放化疗前基线检验，并预防性给予质子泵抑制剂和双环醇保肝治疗。","is_gold":false},{"letter":"C","text":"完善放化疗前基线检验，若中性粒细胞绝对值>1.0×10^9/L即可启动全身化疗。","is_gold":false},{"letter":"D","text":"完善放化疗前基线检验，并预防性给予长效重组人粒细胞集落刺激因子。","is_gold":false},{"letter":"E","text":"完善放化疗前基线检验，仅需心电图和血常规正常即可启动诱导化疗。","is_gold":false},{"letter":"F","text":"完善放化疗前基线检验，并常规预防性使用头孢类抗生素以防中耳炎加重。","is_gold":false},{"letter":"G","text":"完善放化疗前基线检验，若转氨酶升高超过正常上限1倍则直接放弃化疗。","is_gold":false},{"letter":"H","text":"完善放化疗前基线检验（血常规、生化、凝血、传染病、EBV等），全面评估器官功能。","is_gold":true},{"letter":"I","text":"完善放化疗前基线检验，并预防性给予地塞米松以减轻放疗引起的脑水肿。","is_gold":false},{"letter":"J","text":"完善放化疗前基线检验，若伴有右侧中耳乳突炎则需先完成乳突根治术再行放疗。","is_gold":false},{"letter":"K","text":"完善放化疗前基线检验，并常规行深静脉置管及低分子肝素预防性抗凝治疗。","is_gold":false},{"letter":"L","text":"完善放化疗前基线检验，若存在感音神经性听力下降则绝对禁忌使用任何含铂方案。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、鼻腔、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现右颈部肿块伴耳鸣、听力下降4个月。；现病史: 缘于4个月前患者无意中发现右颈部包块，如拇指大小，无压痛，伴耳鸣、听力下降，颈部包块后逐渐增大，近1周偶发头痛，白天明显，视物如常，无鼻塞、鼻血、面麻、等不适。为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,鼻咽肿物,右颈部包块,头痛；既往史: 4年前患痔疮，已治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:青霉素皮试阳性。；个人史: 长期居于原籍，无疫区居住史。吸烟3-4支/天*10年，饮酒1-2次/月。否认不洁性生活史。；家族史: 舅舅患鼻咽癌，舅妈患肺癌。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：103/73mmHg,Ht：174cm，Wt：79kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；右颈IIa区可扪及1个淋巴结，最大径2.5×2.5cm，左颈IIa区扪及1个淋巴结，最大径约3*3cm，无融合，质地韧，边界模糊，活动度好，无压痛，无皮肤浸润，无溃疡，右颈III区可见一长约4cm手术疤痕；颅神经检查：阴性。；KPS:；ECOG:\n- [全程D0] 入院记录: 主诉: 发现右颈部肿块伴耳鸣、听力下降4个月。；现病史: 缘于4个月前患者无意中发现右颈部包块，如拇指大小，无压痛，伴耳鸣、听力下降，颈部包块后逐渐增大，近1周偶发头痛，白天明显，视物如常，无鼻塞、鼻血、面麻、等不适。就诊[机构已隐去]，行右颈部淋巴结活检术，病理示转移性低分化鳞癌，行电子鼻咽镜检查见鼻咽肿物，取活检病理示可疑癌。为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,鼻咽肿物,右颈部包块,头痛；既往史: 4年前患痔疮，已治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:青霉素皮试阳性。；个人史: 长期居于原籍，无疫区居住史。吸烟3-4支/天*10年，饮酒1-2次/月。否认不洁性生活史。；家族史: 舅舅患鼻咽癌，舅妈患肺癌。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：103/73mmHg,Ht：174cm，Wt：79kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；右颈IIa区可扪及1个淋巴结，最大径2.5×2.5cm，左颈IIa区扪及1个淋巴结，最大径约3*3cm，无融合，质地韧，边界模糊，活动度好，无压痛，无皮肤浸润，无溃疡，右颈III区可见一长约4cm手术疤痕；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 电轴左偏(轻度) 正常范围心电图\n- [全程D1] 检验组合: 血小板比容-静脉血: 19%；载脂蛋白B(apoB)-静脉血: 1.03g/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；肌酐(Crea)-静脉血: 66.2umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.1；球蛋白(GLO)-静脉血: 31.61g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.011；尿胆原(URO)-尿液: -（参考: 阴性）；红细胞比容(Hct)-静脉血: 48.9%；凝血酶原时间活动度(PTA)-静脉血: 111.2%；隐血(OB)-粪便: 阴性（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.91mg/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；碱性磷酸酶(ALP)-静脉血: 76.3U/L；载脂蛋白AI(apoAI)-静脉血: 1.04g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；葡萄糖(Glu)-静脉血: 4.96mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.5；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；血小板分布宽度(PDW)-静脉血: 13.9%；淋巴细胞百分比(Lymph%)-静脉血: 0.315；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；总胆红素(TBIL)-静脉血: 7umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.910E9/L；Rh血型-静脉血: 阳性；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.2sec.；酮体(KET)-尿液: -（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 21.9mmol/L；浊度(TRUB)-尿液: 清亮；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 4.88mmol/L；C-反应蛋白(C……\n- [全程D3] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D7] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及双侧壁增厚，以右侧为著，T1WI呈等信号，T2WI呈稍高信号，增强扫描强化明显，右侧咽隐窝消失，见增厚组织占据，左侧咽隐窝变浅。病变与右侧中鼻甲分界不清，口咽双侧壁未见增厚。 右侧咽旁间隙及右侧咽后间隙见不规则肿物突入。双侧腭帆提肌、右侧腭帆张肌、右侧头长肌受侵。左侧腭帆张肌、双侧翼内肌及双侧翼外肌未见受侵。 右侧翼腭窝内见少许软组织信号，增强扫描明显强化。 左侧翼腭窝、双侧上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 斜坡、蝶骨基底部、右侧翼突基底部及内外板、右侧蝶骨大翼及右侧岩尖骨质信号减低，增强扫描见不均匀强化。 右侧破裂扩大，右侧海绵窦增宽，内见不规则软组织信号灶，右侧蝶窦内见软组织信号灶突入，增强扫描上述病变强化明显。 左侧海绵窦未见增宽。蝶鞍形态正常，其内未见占位性病变。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧上颌窦、筛窦及蝶窦粘膜增厚。右侧乳突内见大量分泌物。 右侧咽后见肿大淋巴结，大者约12mm×17mm，增强扫描强化明显。双颈II、III、V区见多个肿大淋巴结，最大者约23mm×29mm，部分边界欠清晰，包膜不完整，信号欠均匀，增强扫描明显不均匀强化。双侧腮腺内及腮腺旁见数个淋巴结，大者短径约6mm，增强扫描强化明显。双颈I区见数个淋巴结，大者短径约7mm，信号尚均匀。 甲状腺双叶及峡部、喉咽、双侧颌下腺信号均匀，未见占位性病变。；检查结论: 鼻咽病变，考虑鼻咽癌，侵犯范围如上述。 颅底骨质破坏。 右侧咽后、双颈II、III、V区多发肿大淋巴结，考虑转移。 双侧腮腺内及腮腺旁数个淋巴结，性质待定。 鼻窦炎、右侧乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。仍有听力下降，请[姓名已隐去]医生信息已隐藏出：根据患者外院鼻咽部检查提示鼻咽部病灶侵犯右侧海绵窦，颅底骨质等，分为分期信息见历史辅助诊断节点，双侧颈部淋巴结肿大，最大径＜6cm，分为分期信息见历史辅助诊断节点，未见远处转移，分为[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点，[计划性表述已隐藏]放疗及同步增敏化疗控制病情，目前行放疗前准备。.\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善放化疗前基线检验，若肌酐清除率>30ml/min即可启动大剂量顺铂同步化疗。\nB. 完善放化疗前基线检验，并预防性给予质子泵抑制剂和双环醇保肝治疗。\nC. 完善放化疗前基线检验，若中性粒细胞绝对值>1.0×10^9/L即可启动全身化疗。\nD. 完善放化疗前基线检验，并预防性给予长效重组人粒细胞集落刺激因子。\nE. 完善放化疗前基线检验，仅需心电图和血常规正常即可启动诱导化疗。\nF. 完善放化疗前基线检验，并常规预防性使用头孢类抗生素以防中耳炎加重。\nG. 完善放化疗前基线检验，若转氨酶升高超过正常上限1倍则直接放弃化疗。\nH. 完善放化疗前基线检验（血常规、生化、凝血、传染病、EBV等），全面评估器官功能。\nI. 完善放化疗前基线检验，并预防性给予地塞米松以减轻放疗引起的脑水肿。\nJ. 完善放化疗前基线检验，若伴有右侧中耳乳突炎则需先完成乳突根治术再行放疗。\nK. 完善放化疗前基线检验，并常规行深静脉置管及低分子肝素预防性抗凝治疗。\nL. 完善放化疗前基线检验，若存在感音神经性听力下降则绝对禁忌使用任何含铂方案。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、鼻腔、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现右颈部肿块伴耳鸣、听力下降4个月。；现病史: 缘于4个月前患者无意中发现右颈部包块，如拇指大小，无压痛，伴耳鸣、听力下降，颈部包块后逐渐增大，近1周偶发头痛，白天明显，视物如常，无鼻塞、鼻血、面麻、等不适。为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,鼻咽肿物,右颈部包块,头痛；既往史: 4年前患痔疮，已治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:青霉素皮试阳性。；个人史: 长期居于原籍，无疫区居住史。吸烟3-4支/天*10年，饮酒1-2次/月。否认不洁性生活史。；家族史: 舅舅患鼻咽癌，舅妈患肺癌。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：103/73mmHg,Ht：174cm，Wt：79kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；右颈IIa区可扪及1个淋巴结，最大径2.5×2.5cm，左颈IIa区扪及1个淋巴结，最大径约3*3cm，无融合，质地韧，边界模糊，活动度好，无压痛，无皮肤浸润，无溃疡，右颈III区可见一长约4cm手术疤痕；颅神经检查：阴性。；KPS:；ECOG:\n- [全程D0] 入院记录: 主诉: 发现右颈部肿块伴耳鸣、听力下降4个月。；现病史: 缘于4个月前患者无意中发现右颈部包块，如拇指大小，无压痛，伴耳鸣、听力下降，颈部包块后逐渐增大，近1周偶发头痛，白天明显，视物如常，无鼻塞、鼻血、面麻、等不适。就诊[机构已隐去]，行右颈部淋巴结活检术，病理示转移性低分化鳞癌，行电子鼻咽镜检查见鼻咽肿物，取活检病理示可疑癌。为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,鼻咽肿物,右颈部包块,头痛；既往史: 4年前患痔疮，已治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:青霉素皮试阳性。；个人史: 长期居于原籍，无疫区居住史。吸烟3-4支/天*10年，饮酒1-2次/月。否认不洁性生活史。；家族史: 舅舅患鼻咽癌，舅妈患肺癌。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：103/73mmHg,Ht：174cm，Wt：79kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；右颈IIa区可扪及1个淋巴结，最大径2.5×2.5cm，左颈IIa区扪及1个淋巴结，最大径约3*3cm，无融合，质地韧，边界模糊，活动度好，无压痛，无皮肤浸润，无溃疡，右颈III区可见一长约4cm手术疤痕；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 电轴左偏(轻度) 正常范围心电图\n- [全程D1] 检验组合: 血小板比容-静脉血: 19%；载脂蛋白B(apoB)-静脉血: 1.03g/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；肌酐(Crea)-静脉血: 66.2umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.1；球蛋白(GLO)-静脉血: 31.61g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.011；尿胆原(URO)-尿液: -（参考: 阴性）；红细胞比容(Hct)-静脉血: 48.9%；凝血酶原时间活动度(PTA)-静脉血: 111.2%；隐血(OB)-粪便: 阴性（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.91mg/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；碱性磷酸酶(ALP)-静脉血: 76.3U/L；载脂蛋白AI(apoAI)-静脉血: 1.04g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；葡萄糖(Glu)-静脉血: 4.96mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.5；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；血小板分布宽度(PDW)-静脉血: 13.9%；淋巴细胞百分比(Lymph%)-静脉血: 0.315；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；总胆红素(TBIL)-静脉血: 7umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.910E9/L；Rh血型-静脉血: 阳性；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.2sec.；酮体(KET)-尿液: -（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 21.9mmol/L；浊度(TRUB)-尿液: 清亮；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 4.88mmol/L；C-反应蛋白(C……\n- [全程D3] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D7] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及双侧壁增厚，以右侧为著，T1WI呈等信号，T2WI呈稍高信号，增强扫描强化明显，右侧咽隐窝消失，见增厚组织占据，左侧咽隐窝变浅。病变与右侧中鼻甲分界不清，口咽双侧壁未见增厚。 右侧咽旁间隙及右侧咽后间隙见不规则肿物突入。双侧腭帆提肌、右侧腭帆张肌、右侧头长肌受侵。左侧腭帆张肌、双侧翼内肌及双侧翼外肌未见受侵。 右侧翼腭窝内见少许软组织信号，增强扫描明显强化。 左侧翼腭窝、双侧上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 斜坡、蝶骨基底部、右侧翼突基底部及内外板、右侧蝶骨大翼及右侧岩尖骨质信号减低，增强扫描见不均匀强化。 右侧破裂扩大，右侧海绵窦增宽，内见不规则软组织信号灶，右侧蝶窦内见软组织信号灶突入，增强扫描上述病变强化明显。 左侧海绵窦未见增宽。蝶鞍形态正常，其内未见占位性病变。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧上颌窦、筛窦及蝶窦粘膜增厚。右侧乳突内见大量分泌物。 右侧咽后见肿大淋巴结，大者约12mm×17mm，增强扫描强化明显。双颈II、III、V区见多个肿大淋巴结，最大者约23mm×29mm，部分边界欠清晰，包膜不完整，信号欠均匀，增强扫描明显不均匀强化。双侧腮腺内及腮腺旁见数个淋巴结，大者短径约6mm，增强扫描强化明显。双颈I区见数个淋巴结，大者短径约7mm，信号尚均匀。 甲状腺双叶及峡部、喉咽、双侧颌下腺信号均匀，未见占位性病变。；检查结论: 鼻咽病变，考虑鼻咽癌，侵犯范围如上述。 颅底骨质破坏。 右侧咽后、双颈II、III、V区多发肿大淋巴结，考虑转移。 双侧腮腺内及腮腺旁数个淋巴结，性质待定。 鼻窦炎、右侧乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。仍有听力下降，请[姓名已隐去]医生信息已隐藏出：根据患者外院鼻咽部检查提示鼻咽部病灶侵犯右侧海绵窦，颅底骨质等，分为分期信息见历史辅助诊断节点，双侧颈部淋巴结肿大，最大径＜6cm，分为分期信息见历史辅助诊断节点，未见远处转移，分为[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点，[计划性表述已隐藏]放疗及同步增敏化疗控制病情，目前行放疗前准备。.\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善放化疗前基线检验，若肌酐清除率>30ml/min即可启动大剂量顺铂同步化疗。\nB. 完善放化疗前基线检验，并预防性给予质子泵抑制剂和双环醇保肝治疗。\nC. 完善放化疗前基线检验，若中性粒细胞绝对值>1.0×10^9/L即可启动全身化疗。\nD. 完善放化疗前基线检验，并预防性给予长效重组人粒细胞集落刺激因子。\nE. 完善放化疗前基线检验，仅需心电图和血常规正常即可启动诱导化疗。\nF. 完善放化疗前基线检验，并常规预防性使用头孢类抗生素以防中耳炎加重。\nG. 完善放化疗前基线检验，若转氨酶升高超过正常上限1倍则直接放弃化疗。\nH. 完善放化疗前基线检验（血常规、生化、凝血、传染病、EBV等），全面评估器官功能。\nI. 完善放化疗前基线检验，并预防性给予地塞米松以减轻放疗引起的脑水肿。\nJ. 完善放化疗前基线检验，若伴有右侧中耳乳突炎则需先完成乳突根治术再行放疗。\nK. 完善放化疗前基线检验，并常规行深静脉置管及低分子肝素预防性抗凝治疗。\nL. 完善放化疗前基线检验，若存在感音神经性听力下降则绝对禁忌使用任何含铂方案。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-44b84e88a5f0beade51ae0ca","patient_id":"patient-f25e20b1e5c6eea840d4cc21","turn_id":"turn06","turn_position":5,"turn_type":"toxicity_or_support_decision","gold_letter":"I","gold_action":"按计划启动放疗，并为顺铂（100mg/㎡）同期化疗行充分的静脉水化、甘露醇利尿及电解质补充，同时给予放疗局部保护用药。","options":[{"letter":"A","text":"按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗当天给予常规静脉补液，无需特殊水化与利尿处理。","is_gold":false},{"letter":"B","text":"暂缓放化疗，先静脉补充硫酸镁及氯化钾纠正电解质异常，待复查正常后再启动顺铂同期化疗。","is_gold":false},{"letter":"C","text":"按计划启动放疗，将顺铂剂量调整为40mg/㎡周疗，化疗期间仅需常规止吐，无需使用甘露醇利尿。","is_gold":false},{"letter":"D","text":"按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗前给予呋塞米静脉推注利尿，并预防性注射G-CSF。","is_gold":false},{"letter":"E","text":"按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗期间采用口服补液替代静脉水化，并外用三乙醇胺乳膏。","is_gold":false},{"letter":"F","text":"暂缓顺铂化疗，先行单纯根治性放疗，待放疗剂量达到40Gy后再评估并启动顺铂同期化疗。","is_gold":false},{"letter":"G","text":"按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗前给予大剂量糖皮质激素及NK-1受体拮抗剂，免除静脉水化。","is_gold":false},{"letter":"H","text":"按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗当天给予等渗盐水静脉滴注，避免使用甘露醇。","is_gold":false},{"letter":"I","text":"按计划启动放疗，并为顺铂（100mg/㎡）同期化疗行充分的静脉水化、甘露醇利尿及电解质补充，同时给予放疗局部保护用药。","is_gold":true},{"letter":"J","text":"按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗后连续3天静脉输注人血白蛋白以预防低蛋白血症。","is_gold":false},{"letter":"K","text":"暂缓放疗，先给予顺铂联合氟尿嘧啶方案诱导化疗2个周期，期间常规给予静脉水化及止吐处理。","is_gold":false},{"letter":"L","text":"按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗期间常规预防性静脉滴注广谱抗菌药物。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、鼻腔、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现右颈部肿块伴耳鸣、听力下降4个月。；现病史: 缘于4个月前患者无意中发现右颈部包块，如拇指大小，无压痛，伴耳鸣、听力下降，颈部包块后逐渐增大，近1周偶发头痛，白天明显，视物如常，无鼻塞、鼻血、面麻、等不适。为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,鼻咽肿物,右颈部包块,头痛；既往史: 4年前患痔疮，已治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:青霉素皮试阳性。；个人史: 长期居于原籍，无疫区居住史。吸烟3-4支/天*10年，饮酒1-2次/月。否认不洁性生活史。；家族史: 舅舅患鼻咽癌，舅妈患肺癌。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：103/73mmHg,Ht：174cm，Wt：79kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；右颈IIa区可扪及1个淋巴结，最大径2.5×2.5cm，左颈IIa区扪及1个淋巴结，最大径约3*3cm，无融合，质地韧，边界模糊，活动度好，无压痛，无皮肤浸润，无溃疡，右颈III区可见一长约4cm手术疤痕；颅神经检查：阴性。；KPS:；ECOG:\n- [全程D0] 入院记录: 主诉: 发现右颈部肿块伴耳鸣、听力下降4个月。；现病史: 缘于4个月前患者无意中发现右颈部包块，如拇指大小，无压痛，伴耳鸣、听力下降，颈部包块后逐渐增大，近1周偶发头痛，白天明显，视物如常，无鼻塞、鼻血、面麻、等不适。就诊[机构已隐去]，行右颈部淋巴结活检术，病理示转移性低分化鳞癌，行电子鼻咽镜检查见鼻咽肿物，取活检病理示可疑癌。为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,鼻咽肿物,右颈部包块,头痛；既往史: 4年前患痔疮，已治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:青霉素皮试阳性。；个人史: 长期居于原籍，无疫区居住史。吸烟3-4支/天*10年，饮酒1-2次/月。否认不洁性生活史。；家族史: 舅舅患鼻咽癌，舅妈患肺癌。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：103/73mmHg,Ht：174cm，Wt：79kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；右颈IIa区可扪及1个淋巴结，最大径2.5×2.5cm，左颈IIa区扪及1个淋巴结，最大径约3*3cm，无融合，质地韧，边界模糊，活动度好，无压痛，无皮肤浸润，无溃疡，右颈III区可见一长约4cm手术疤痕；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 电轴左偏(轻度) 正常范围心电图\n- [全程D1] 检验组合: 血小板比容-静脉血: 19%；载脂蛋白B(apoB)-静脉血: 1.03g/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；肌酐(Crea)-静脉血: 66.2umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.1；球蛋白(GLO)-静脉血: 31.61g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.011；尿胆原(URO)-尿液: -（参考: 阴性）；红细胞比容(Hct)-静脉血: 48.9%；凝血酶原时间活动度(PTA)-静脉血: 111.2%；隐血(OB)-粪便: 阴性（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.91mg/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；碱性磷酸酶(ALP)-静脉血: 76.3U/L；载脂蛋白AI(apoAI)-静脉血: 1.04g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；葡萄糖(Glu)-静脉血: 4.96mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.5；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；血小板分布宽度(PDW)-静脉血: 13.9%；淋巴细胞百分比(Lymph%)-静脉血: 0.315；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；总胆红素(TBIL)-静脉血: 7umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.910E9/L；Rh血型-静脉血: 阳性；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.2sec.；酮体(KET)-尿液: -（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 21.9mmol/L；浊度(TRUB)-尿液: 清亮；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 4.88mmol/L；C-反应蛋白(C……\n- [全程D3] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D7] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及双侧壁增厚，以右侧为著，T1WI呈等信号，T2WI呈稍高信号，增强扫描强化明显，右侧咽隐窝消失，见增厚组织占据，左侧咽隐窝变浅。病变与右侧中鼻甲分界不清，口咽双侧壁未见增厚。 右侧咽旁间隙及右侧咽后间隙见不规则肿物突入。双侧腭帆提肌、右侧腭帆张肌、右侧头长肌受侵。左侧腭帆张肌、双侧翼内肌及双侧翼外肌未见受侵。 右侧翼腭窝内见少许软组织信号，增强扫描明显强化。 左侧翼腭窝、双侧上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 斜坡、蝶骨基底部、右侧翼突基底部及内外板、右侧蝶骨大翼及右侧岩尖骨质信号减低，增强扫描见不均匀强化。 右侧破裂扩大，右侧海绵窦增宽，内见不规则软组织信号灶，右侧蝶窦内见软组织信号灶突入，增强扫描上述病变强化明显。 左侧海绵窦未见增宽。蝶鞍形态正常，其内未见占位性病变。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧上颌窦、筛窦及蝶窦粘膜增厚。右侧乳突内见大量分泌物。 右侧咽后见肿大淋巴结，大者约12mm×17mm，增强扫描强化明显。双颈II、III、V区见多个肿大淋巴结，最大者约23mm×29mm，部分边界欠清晰，包膜不完整，信号欠均匀，增强扫描明显不均匀强化。双侧腮腺内及腮腺旁见数个淋巴结，大者短径约6mm，增强扫描强化明显。双颈I区见数个淋巴结，大者短径约7mm，信号尚均匀。 甲状腺双叶及峡部、喉咽、双侧颌下腺信号均匀，未见占位性病变。；检查结论: 鼻咽病变，考虑鼻咽癌，侵犯范围如上述。 颅底骨质破坏。 右侧咽后、双颈II、III、V区多发肿大淋巴结，考虑转移。 双侧腮腺内及腮腺旁数个淋巴结，性质待定。 鼻窦炎、右侧乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D26] 检验组合: 镁离子(Mg2+)-静脉血: 0.88mmol/L；阴离子间隙(AG)-静脉血: 13.2；血小板比容-静脉血: 18%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；乳酸脱氢酶(LDH)-静脉血: 177.9U/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.7U/L；血小板分布宽度(PDW)-静脉血: 13.2%；钾离子(K+)-静脉血: 4.02mmol/L；白蛋白(ALB)-静脉血: 44.5g/L；直接胆红素(DBIL)-静脉血: 3.8umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.58mmol/L；大血小板百分比(P-LCR%)-静脉血: 28.9%；单核细胞计数(Mono#)-静脉血: 0.610E9/L；钠离子(Na+)-静脉血: 143.5mmol/L；总胆固醇(TC)-静脉血: 5.13mmol/L；总胆红素(TBIL)-静脉血: 11.7umol/L；甘油三酯(TG)-静脉血: 1.44mmol/L；红细胞比容(Hct)-静脉血: 48.1%；中性粒细胞计数(Neut#)-静脉血: 3.310E9/L；白细胞计数(WBC#)-静脉血: 6.2110E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.86；中性粒细胞百分比(Neut%)-静脉血: 0.528；总钙(Ca)-静脉血: 2.18mmol/L；总蛋白(TP)-静脉血: 76.63g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.38；α-L-岩藻糖苷酶(AFU)-静脉血: 35.5U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.97mmolL；淋巴细胞计数(Lymph#)-静脉血: 2.110E9/L；间接胆红素(IBIL)-静脉血: 7.9umolL；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；尿素氮(BUN)-静脉血: 4.1mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 333g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.9；单核细胞百分比(Mono%)-静脉血: 0.103；血液二氧化碳含量ctCO2(B)-静脉血: 26.……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。仍有听力下降，请[姓名已隐去]医生信息已隐藏出：根据患者外院鼻咽部检查提示鼻咽部病灶侵犯右侧海绵窦，颅底骨质等，分为分期信息见历史辅助诊断节点，双侧颈部淋巴结肿大，最大径＜6cm，分为分期信息见历史辅助诊断节点，未见远处转移，分为[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点，[计划性表述已隐藏]放疗及同步增敏化疗控制病情，目前行放疗前准备。.\n- [全程D14] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，继续行放化疗前准备，余无特殊。.\n- [全程D17] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，请[姓名已隐去]医生信息已隐藏出：患者目前无特殊，继续行放化疗前准备，继续观察病情。.\n- [全程D20] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，患者放疗计划准备完成，[计划性表述已隐藏]GTV70Gy/32f，GTVnd68Gy/32f，CTV1 60Gy/32f，CTV2 56Gy/32f。拟本周开始放疗，因患者分期晚，病变范围大，视神经、眼球、颞叶剂量较高，已与患者沟通不良反应，患者及时家属表示理解并同意治疗，继续观察病情。.\n- [全程D23] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，患者目前继续行放疗前准备，[姓名已隐去]医生信息已隐藏出：患者继续行放疗前准备，[计划性表述已隐藏]顺铂同期化疗，继续观察病情。.\n- [全程D26] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，患者目前无特殊，拟周一开始行放疗，周二行顺铂100mg/㎡同期化疗，继续行放化疗前准备，继续观察病情。.\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗当天给予常规静脉补液，无需特殊水化与利尿处理。\nB. 暂缓放化疗，先静脉补充硫酸镁及氯化钾纠正电解质异常，待复查正常后再启动顺铂同期化疗。\nC. 按计划启动放疗，将顺铂剂量调整为40mg/㎡周疗，化疗期间仅需常规止吐，无需使用甘露醇利尿。\nD. 按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗前给予呋塞米静脉推注利尿，并预防性注射G-CSF。\nE. 按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗期间采用口服补液替代静脉水化，并外用三乙醇胺乳膏。\nF. 暂缓顺铂化疗，先行单纯根治性放疗，待放疗剂量达到40Gy后再评估并启动顺铂同期化疗。\nG. 按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗前给予大剂量糖皮质激素及NK-1受体拮抗剂，免除静脉水化。\nH. 按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗当天给予等渗盐水静脉滴注，避免使用甘露醇。\nI. 按计划启动放疗，并为顺铂（100mg/㎡）同期化疗行充分的静脉水化、甘露醇利尿及电解质补充，同时给予放疗局部保护用药。\nJ. 按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗后连续3天静脉输注人血白蛋白以预防低蛋白血症。\nK. 暂缓放疗，先给予顺铂联合氟尿嘧啶方案诱导化疗2个周期，期间常规给予静脉水化及止吐处理。\nL. 按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗期间常规预防性静脉滴注广谱抗菌药物。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、鼻腔、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现右颈部肿块伴耳鸣、听力下降4个月。；现病史: 缘于4个月前患者无意中发现右颈部包块，如拇指大小，无压痛，伴耳鸣、听力下降，颈部包块后逐渐增大，近1周偶发头痛，白天明显，视物如常，无鼻塞、鼻血、面麻、等不适。为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,鼻咽肿物,右颈部包块,头痛；既往史: 4年前患痔疮，已治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:青霉素皮试阳性。；个人史: 长期居于原籍，无疫区居住史。吸烟3-4支/天*10年，饮酒1-2次/月。否认不洁性生活史。；家族史: 舅舅患鼻咽癌，舅妈患肺癌。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：103/73mmHg,Ht：174cm，Wt：79kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；右颈IIa区可扪及1个淋巴结，最大径2.5×2.5cm，左颈IIa区扪及1个淋巴结，最大径约3*3cm，无融合，质地韧，边界模糊，活动度好，无压痛，无皮肤浸润，无溃疡，右颈III区可见一长约4cm手术疤痕；颅神经检查：阴性。；KPS:；ECOG:\n- [全程D0] 入院记录: 主诉: 发现右颈部肿块伴耳鸣、听力下降4个月。；现病史: 缘于4个月前患者无意中发现右颈部包块，如拇指大小，无压痛，伴耳鸣、听力下降，颈部包块后逐渐增大，近1周偶发头痛，白天明显，视物如常，无鼻塞、鼻血、面麻、等不适。就诊[机构已隐去]，行右颈部淋巴结活检术，病理示转移性低分化鳞癌，行电子鼻咽镜检查见鼻咽肿物，取活检病理示可疑癌。为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,鼻咽肿物,右颈部包块,头痛；既往史: 4年前患痔疮，已治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:青霉素皮试阳性。；个人史: 长期居于原籍，无疫区居住史。吸烟3-4支/天*10年，饮酒1-2次/月。否认不洁性生活史。；家族史: 舅舅患鼻咽癌，舅妈患肺癌。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：103/73mmHg,Ht：174cm，Wt：79kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；右颈IIa区可扪及1个淋巴结，最大径2.5×2.5cm，左颈IIa区扪及1个淋巴结，最大径约3*3cm，无融合，质地韧，边界模糊，活动度好，无压痛，无皮肤浸润，无溃疡，右颈III区可见一长约4cm手术疤痕；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 电轴左偏(轻度) 正常范围心电图\n- [全程D1] 检验组合: 血小板比容-静脉血: 19%；载脂蛋白B(apoB)-静脉血: 1.03g/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；肌酐(Crea)-静脉血: 66.2umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.1；球蛋白(GLO)-静脉血: 31.61g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.011；尿胆原(URO)-尿液: -（参考: 阴性）；红细胞比容(Hct)-静脉血: 48.9%；凝血酶原时间活动度(PTA)-静脉血: 111.2%；隐血(OB)-粪便: 阴性（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.91mg/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；碱性磷酸酶(ALP)-静脉血: 76.3U/L；载脂蛋白AI(apoAI)-静脉血: 1.04g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；葡萄糖(Glu)-静脉血: 4.96mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.5；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；血小板分布宽度(PDW)-静脉血: 13.9%；淋巴细胞百分比(Lymph%)-静脉血: 0.315；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；总胆红素(TBIL)-静脉血: 7umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.910E9/L；Rh血型-静脉血: 阳性；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.2sec.；酮体(KET)-尿液: -（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 21.9mmol/L；浊度(TRUB)-尿液: 清亮；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 4.88mmol/L；C-反应蛋白(C……\n- [全程D3] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D7] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及双侧壁增厚，以右侧为著，T1WI呈等信号，T2WI呈稍高信号，增强扫描强化明显，右侧咽隐窝消失，见增厚组织占据，左侧咽隐窝变浅。病变与右侧中鼻甲分界不清，口咽双侧壁未见增厚。 右侧咽旁间隙及右侧咽后间隙见不规则肿物突入。双侧腭帆提肌、右侧腭帆张肌、右侧头长肌受侵。左侧腭帆张肌、双侧翼内肌及双侧翼外肌未见受侵。 右侧翼腭窝内见少许软组织信号，增强扫描明显强化。 左侧翼腭窝、双侧上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 斜坡、蝶骨基底部、右侧翼突基底部及内外板、右侧蝶骨大翼及右侧岩尖骨质信号减低，增强扫描见不均匀强化。 右侧破裂扩大，右侧海绵窦增宽，内见不规则软组织信号灶，右侧蝶窦内见软组织信号灶突入，增强扫描上述病变强化明显。 左侧海绵窦未见增宽。蝶鞍形态正常，其内未见占位性病变。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧上颌窦、筛窦及蝶窦粘膜增厚。右侧乳突内见大量分泌物。 右侧咽后见肿大淋巴结，大者约12mm×17mm，增强扫描强化明显。双颈II、III、V区见多个肿大淋巴结，最大者约23mm×29mm，部分边界欠清晰，包膜不完整，信号欠均匀，增强扫描明显不均匀强化。双侧腮腺内及腮腺旁见数个淋巴结，大者短径约6mm，增强扫描强化明显。双颈I区见数个淋巴结，大者短径约7mm，信号尚均匀。 甲状腺双叶及峡部、喉咽、双侧颌下腺信号均匀，未见占位性病变。；检查结论: 鼻咽病变，考虑鼻咽癌，侵犯范围如上述。 颅底骨质破坏。 右侧咽后、双颈II、III、V区多发肿大淋巴结，考虑转移。 双侧腮腺内及腮腺旁数个淋巴结，性质待定。 鼻窦炎、右侧乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D26] 检验组合: 镁离子(Mg2+)-静脉血: 0.88mmol/L；阴离子间隙(AG)-静脉血: 13.2；血小板比容-静脉血: 18%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；乳酸脱氢酶(LDH)-静脉血: 177.9U/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.7U/L；血小板分布宽度(PDW)-静脉血: 13.2%；钾离子(K+)-静脉血: 4.02mmol/L；白蛋白(ALB)-静脉血: 44.5g/L；直接胆红素(DBIL)-静脉血: 3.8umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.58mmol/L；大血小板百分比(P-LCR%)-静脉血: 28.9%；单核细胞计数(Mono#)-静脉血: 0.610E9/L；钠离子(Na+)-静脉血: 143.5mmol/L；总胆固醇(TC)-静脉血: 5.13mmol/L；总胆红素(TBIL)-静脉血: 11.7umol/L；甘油三酯(TG)-静脉血: 1.44mmol/L；红细胞比容(Hct)-静脉血: 48.1%；中性粒细胞计数(Neut#)-静脉血: 3.310E9/L；白细胞计数(WBC#)-静脉血: 6.2110E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.86；中性粒细胞百分比(Neut%)-静脉血: 0.528；总钙(Ca)-静脉血: 2.18mmol/L；总蛋白(TP)-静脉血: 76.63g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.38；α-L-岩藻糖苷酶(AFU)-静脉血: 35.5U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.97mmolL；淋巴细胞计数(Lymph#)-静脉血: 2.110E9/L；间接胆红素(IBIL)-静脉血: 7.9umolL；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；尿素氮(BUN)-静脉血: 4.1mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 333g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.9；单核细胞百分比(Mono%)-静脉血: 0.103；血液二氧化碳含量ctCO2(B)-静脉血: 26.……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。仍有听力下降，请[姓名已隐去]医生信息已隐藏出：根据患者外院鼻咽部检查提示鼻咽部病灶侵犯右侧海绵窦，颅底骨质等，分为分期信息见历史辅助诊断节点，双侧颈部淋巴结肿大，最大径＜6cm，分为分期信息见历史辅助诊断节点，未见远处转移，分为[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点，[计划性表述已隐藏]放疗及同步增敏化疗控制病情，目前行放疗前准备。.\n- [全程D14] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，继续行放化疗前准备，余无特殊。.\n- [全程D17] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，请[姓名已隐去]医生信息已隐藏出：患者目前无特殊，继续行放化疗前准备，继续观察病情。.\n- [全程D20] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，患者放疗计划准备完成，[计划性表述已隐藏]GTV70Gy/32f，GTVnd68Gy/32f，CTV1 60Gy/32f，CTV2 56Gy/32f。拟本周开始放疗，因患者分期晚，病变范围大，视神经、眼球、颞叶剂量较高，已与患者沟通不良反应，患者及时家属表示理解并同意治疗，继续观察病情。.\n- [全程D23] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，患者目前继续行放疗前准备，[姓名已隐去]医生信息已隐藏出：患者继续行放疗前准备，[计划性表述已隐藏]顺铂同期化疗，继续观察病情。.\n- [全程D26] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，患者目前无特殊，拟周一开始行放疗，周二行顺铂100mg/㎡同期化疗，继续行放化疗前准备，继续观察病情。.\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗当天给予常规静脉补液，无需特殊水化与利尿处理。\nB. 暂缓放化疗，先静脉补充硫酸镁及氯化钾纠正电解质异常，待复查正常后再启动顺铂同期化疗。\nC. 按计划启动放疗，将顺铂剂量调整为40mg/㎡周疗，化疗期间仅需常规止吐，无需使用甘露醇利尿。\nD. 按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗前给予呋塞米静脉推注利尿，并预防性注射G-CSF。\nE. 按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗期间采用口服补液替代静脉水化，并外用三乙醇胺乳膏。\nF. 暂缓顺铂化疗，先行单纯根治性放疗，待放疗剂量达到40Gy后再评估并启动顺铂同期化疗。\nG. 按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗前给予大剂量糖皮质激素及NK-1受体拮抗剂，免除静脉水化。\nH. 按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗当天给予等渗盐水静脉滴注，避免使用甘露醇。\nI. 按计划启动放疗，并为顺铂（100mg/㎡）同期化疗行充分的静脉水化、甘露醇利尿及电解质补充，同时给予放疗局部保护用药。\nJ. 按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗后连续3天静脉输注人血白蛋白以预防低蛋白血症。\nK. 暂缓放疗，先给予顺铂联合氟尿嘧啶方案诱导化疗2个周期，期间常规给予静脉水化及止吐处理。\nL. 按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗期间常规预防性静脉滴注广谱抗菌药物。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-0534c4bc264d81d07f7ff87c","patient_id":"patient-f25e20b1e5c6eea840d4cc21","turn_id":"turn07","turn_position":6,"turn_type":"response_assessment_decision","gold_letter":"J","gold_action":"结束住院诊疗办理出院，嘱定期返院复查以评估近期疗效。","options":[{"letter":"A","text":"立即行颈部淋巴结清扫术处理未完全消退的残存淋巴结。","is_gold":false},{"letter":"B","text":"立即安排鼻咽及颈部MRI与全身PET-CT检查全面评估近期疗效。","is_gold":false},{"letter":"C","text":"立即启动PF方案（顺铂+氟尿嘧啶）辅助化疗以巩固局部及全身控制。","is_gold":false},{"letter":"D","text":"继续住院给予静脉高营养及广谱抗生素治疗直至口腔黏膜反应完全消失。","is_gold":false},{"letter":"E","text":"立即行电子鼻咽镜下原发灶活检以明确是否达到病理完全缓解。","is_gold":false},{"letter":"F","text":"预防性给予长效G-CSF并口服抗生素后办理出院。","is_gold":false},{"letter":"G","text":"立即启动西妥昔单抗靶向维持治疗以降低局部复发风险。","is_gold":false},{"letter":"H","text":"对颈部残存淋巴结局部追加外照射放疗推量至75-80Gy。","is_gold":false},{"letter":"I","text":"立即复查血浆EBV-DNA，若阳性则继续给予单药顺铂化疗。","is_gold":false},{"letter":"J","text":"结束住院诊疗办理出院，嘱定期返院复查以评估近期疗效。","is_gold":true},{"letter":"K","text":"立即行胸腹部增强CT及骨ECT检查排除放化疗期间的远处转移。","is_gold":false},{"letter":"L","text":"立即请耳鼻喉科会诊行鼓膜穿刺抽液或置管术处理听力下降。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、鼻腔、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现右颈部肿块伴耳鸣、听力下降4个月。；现病史: 缘于4个月前患者无意中发现右颈部包块，如拇指大小，无压痛，伴耳鸣、听力下降，颈部包块后逐渐增大，近1周偶发头痛，白天明显，视物如常，无鼻塞、鼻血、面麻、等不适。为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,鼻咽肿物,右颈部包块,头痛；既往史: 4年前患痔疮，已治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:青霉素皮试阳性。；个人史: 长期居于原籍，无疫区居住史。吸烟3-4支/天*10年，饮酒1-2次/月。否认不洁性生活史。；家族史: 舅舅患鼻咽癌，舅妈患肺癌。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：103/73mmHg,Ht：174cm，Wt：79kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；右颈IIa区可扪及1个淋巴结，最大径2.5×2.5cm，左颈IIa区扪及1个淋巴结，最大径约3*3cm，无融合，质地韧，边界模糊，活动度好，无压痛，无皮肤浸润，无溃疡，右颈III区可见一长约4cm手术疤痕；颅神经检查：阴性。；KPS:；ECOG:\n- [全程D0] 入院记录: 主诉: 发现右颈部肿块伴耳鸣、听力下降4个月。；现病史: 缘于4个月前患者无意中发现右颈部包块，如拇指大小，无压痛，伴耳鸣、听力下降，颈部包块后逐渐增大，近1周偶发头痛，白天明显，视物如常，无鼻塞、鼻血、面麻、等不适。就诊[机构已隐去]，行右颈部淋巴结活检术，病理示转移性低分化鳞癌，行电子鼻咽镜检查见鼻咽肿物，取活检病理示可疑癌。为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,鼻咽肿物,右颈部包块,头痛；既往史: 4年前患痔疮，已治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:青霉素皮试阳性。；个人史: 长期居于原籍，无疫区居住史。吸烟3-4支/天*10年，饮酒1-2次/月。否认不洁性生活史。；家族史: 舅舅患鼻咽癌，舅妈患肺癌。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：103/73mmHg,Ht：174cm，Wt：79kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；右颈IIa区可扪及1个淋巴结，最大径2.5×2.5cm，左颈IIa区扪及1个淋巴结，最大径约3*3cm，无融合，质地韧，边界模糊，活动度好，无压痛，无皮肤浸润，无溃疡，右颈III区可见一长约4cm手术疤痕；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 电轴左偏(轻度) 正常范围心电图\n- [全程D1] 检验组合: 血小板比容-静脉血: 19%；载脂蛋白B(apoB)-静脉血: 1.03g/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；肌酐(Crea)-静脉血: 66.2umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.1；球蛋白(GLO)-静脉血: 31.61g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.011；尿胆原(URO)-尿液: -（参考: 阴性）；红细胞比容(Hct)-静脉血: 48.9%；凝血酶原时间活动度(PTA)-静脉血: 111.2%；隐血(OB)-粪便: 阴性（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.91mg/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；碱性磷酸酶(ALP)-静脉血: 76.3U/L；载脂蛋白AI(apoAI)-静脉血: 1.04g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；葡萄糖(Glu)-静脉血: 4.96mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.5；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；血小板分布宽度(PDW)-静脉血: 13.9%；淋巴细胞百分比(Lymph%)-静脉血: 0.315；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；总胆红素(TBIL)-静脉血: 7umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.910E9/L；Rh血型-静脉血: 阳性；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.2sec.；酮体(KET)-尿液: -（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 21.9mmol/L；浊度(TRUB)-尿液: 清亮；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 4.88mmol/L；C-反应蛋白(C……\n- [全程D3] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D7] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及双侧壁增厚，以右侧为著，T1WI呈等信号，T2WI呈稍高信号，增强扫描强化明显，右侧咽隐窝消失，见增厚组织占据，左侧咽隐窝变浅。病变与右侧中鼻甲分界不清，口咽双侧壁未见增厚。 右侧咽旁间隙及右侧咽后间隙见不规则肿物突入。双侧腭帆提肌、右侧腭帆张肌、右侧头长肌受侵。左侧腭帆张肌、双侧翼内肌及双侧翼外肌未见受侵。 右侧翼腭窝内见少许软组织信号，增强扫描明显强化。 左侧翼腭窝、双侧上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 斜坡、蝶骨基底部、右侧翼突基底部及内外板、右侧蝶骨大翼及右侧岩尖骨质信号减低，增强扫描见不均匀强化。 右侧破裂扩大，右侧海绵窦增宽，内见不规则软组织信号灶，右侧蝶窦内见软组织信号灶突入，增强扫描上述病变强化明显。 左侧海绵窦未见增宽。蝶鞍形态正常，其内未见占位性病变。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧上颌窦、筛窦及蝶窦粘膜增厚。右侧乳突内见大量分泌物。 右侧咽后见肿大淋巴结，大者约12mm×17mm，增强扫描强化明显。双颈II、III、V区见多个肿大淋巴结，最大者约23mm×29mm，部分边界欠清晰，包膜不完整，信号欠均匀，增强扫描明显不均匀强化。双侧腮腺内及腮腺旁见数个淋巴结，大者短径约6mm，增强扫描强化明显。双颈I区见数个淋巴结，大者短径约7mm，信号尚均匀。 甲状腺双叶及峡部、喉咽、双侧颌下腺信号均匀，未见占位性病变。；检查结论: 鼻咽病变，考虑鼻咽癌，侵犯范围如上述。 颅底骨质破坏。 右侧咽后、双颈II、III、V区多发肿大淋巴结，考虑转移。 双侧腮腺内及腮腺旁数个淋巴结，性质待定。 鼻窦炎、右侧乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D26] 检验组合: 镁离子(Mg2+)-静脉血: 0.88mmol/L；阴离子间隙(AG)-静脉血: 13.2；血小板比容-静脉血: 18%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；乳酸脱氢酶(LDH)-静脉血: 177.9U/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.7U/L；血小板分布宽度(PDW)-静脉血: 13.2%；钾离子(K+)-静脉血: 4.02mmol/L；白蛋白(ALB)-静脉血: 44.5g/L；直接胆红素(DBIL)-静脉血: 3.8umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.58mmol/L；大血小板百分比(P-LCR%)-静脉血: 28.9%；单核细胞计数(Mono#)-静脉血: 0.610E9/L；钠离子(Na+)-静脉血: 143.5mmol/L；总胆固醇(TC)-静脉血: 5.13mmol/L；总胆红素(TBIL)-静脉血: 11.7umol/L；甘油三酯(TG)-静脉血: 1.44mmol/L；红细胞比容(Hct)-静脉血: 48.1%；中性粒细胞计数(Neut#)-静脉血: 3.310E9/L；白细胞计数(WBC#)-静脉血: 6.2110E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.86；中性粒细胞百分比(Neut%)-静脉血: 0.528；总钙(Ca)-静脉血: 2.18mmol/L；总蛋白(TP)-静脉血: 76.63g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.38；α-L-岩藻糖苷酶(AFU)-静脉血: 35.5U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.97mmolL；淋巴细胞计数(Lymph#)-静脉血: 2.110E9/L；间接胆红素(IBIL)-静脉血: 7.9umolL；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；尿素氮(BUN)-静脉血: 4.1mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 333g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.9；单核细胞百分比(Mono%)-静脉血: 0.103；血液二氧化碳含量ctCO2(B)-静脉血: 26.……\n- [全程D44] 检验组合: 白细胞计数(WBC#)-静脉血: 4.4610E9/L；镁离子(Mg2+)-静脉血: 0.96mmol/L；葡萄糖(Glu)-静脉血: 4.12mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；丙氨酸氨基转移酶(ALT)-静脉血: 16U/L；总蛋白(TP)-静脉血: 72.33g/L；胱抑素(Cys-C)-静脉血: 0.78mg/L；血小板分布宽度(PDW)-静脉血: 11.6%；中性粒细胞计数(Neut#)-静脉血: 3.110E9/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.910E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 35.8U/L；C-反应蛋白(CRP)-静脉血: 3.43mg/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.1；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.32mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.9；氯离子(Cl-)-静脉血: 103mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 29mmol/L；乳酸脱氢酶(LDH)-静脉血: 172.3U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.195；直接胆红素(DBIL)-静脉血: 4.2umol/L；球蛋白(GLO)-静脉血: 29.23g/L；甘油三酯(TG)-静脉血: 1.13mmol/L；血小板计数(PLT#)-静脉血: 16510E9/L；钾离子(K+)-静脉血: 4.12mmol/L；肌酐(Crea)-静脉血: 67.7umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.3U/L；白蛋白(ALB)-静脉血: 43.1g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均血小板体积(MPV)-静脉血: 9.8fL；载脂蛋白AI(apoAI)-静脉血: 1.11g/L；总胆红素(TBIL)-静脉血: 12.6umol/L；单核细胞百分比(Mono%)-静脉血: 0.09；间接胆红素(IBIL)-静脉血: 8.4umolL；血红蛋白(Hb)-静脉血: 148g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 32.8U/L；红细胞……\n- [全程D51] 检验组合: 磷(P)-静脉血: 1.15mmol/L；氯离子(Cl-)-静脉血: 103.1mmol/L；球蛋白(GLO)-静脉血: 31.65g/L；中性粒细胞计数(Neut#)-静脉血: 1.110E9/L；钠离子(Na+)-静脉血: 141.8mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；中性粒细胞百分比(Neut%)-静脉血: 0.466；单核细胞百分比(Mono%)-静脉血: 0.221；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.03；血小板比容-静脉血: 15%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；乳酸脱氢酶(LDH)-静脉血: 170.6U/L；总胆红素(TBIL)-静脉血: 9.8umol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.2pg；肌酐(Crea)-静脉血: 72.4umol/L；尿素氮(BUN)-静脉血: 4.2mmol/L；尿酸(UA)-静脉血: 346.6umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.04；红细胞计数(RBC#)-静脉血: 5.1710E12/L；总蛋白(TP)-静脉血: 75.85g/L；平均血小板体积(MPV)-静脉血: 10fL；平均红细胞体积(MCV)-静脉血: 85.7fL；红细胞比容(Hct)-静脉血: 44.3%；白蛋白(ALB)-静脉血: 44.2g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.09mmolL；总胆固醇(TC)-静脉血: 5.11mmol/L；间接胆红素(IBIL)-静脉血: 6.3umolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.51mmol/L；胱抑素(Cys-C)-静脉血: 0.82mg/L；葡萄糖(Glu)-静脉血: 4.91mmol/L；C-反应蛋白(CRP)-静脉血: 2.13mg/L；碱性磷酸酶(ALP)-静脉血: 77.4U/L；总胆汁酸(TBA)-静脉血: 4.3umol/L；载脂蛋白AI(apoAI)-静脉血: 1.23g/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；直接胆红素(DBIL)-静脉血: 3.5umol/L；血小板分布宽度(PDW)-静脉血: 10.8%；血液二氧化碳含量ctCO2(B)-静脉血: 24.1m……\n- [全程D56] 检验组合: 血红蛋白(Hb)-静脉血: 154g/L；白细胞计数(WBC#)-静脉血: 510E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.28；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 48.1；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.6；中性粒细胞计数(Neut#)-静脉血: 3.110E9/L；大血小板百分比(P-LCR%)-静脉血: 28.9%；红细胞比容(Hct)-静脉血: 49.1%；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.612；单核细胞百分比(Mono%)-静脉血: 0.09；平均红细胞血红蛋白含量(MCH)-静脉血: 29.4pg；平均血小板体积(MPV)-静脉血: 10.4fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 11910E9/L；平均红细胞体积(MCV)-静脉血: 93.7fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0；血小板比容-静脉血: 12%；单核细胞计数(Mono#)-静脉血: 0.510E9/L；血小板分布宽度(PDW)-静脉血: 12.6%；红细胞计数(RBC#)-静脉血: 5.2410E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；平均红细胞血红蛋白浓度(MCHC)-静脉血: 314g/L\n- [全程D58] 检验组合: 白蛋白(ALB)-静脉血: 44.1g/L；血液二氧化碳含量ctCO2(B)-静脉血: 29.5mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 342.3g/L；尿酸(UA)-静脉血: 336.4umol/L；平均红细胞体积(MCV)-静脉血: 87.6fL；氯离子(Cl-)-静脉血: 101.4mmol/L；血小板计数(PLT#)-静脉血: 119.610E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.51；球蛋白(GLO)-静脉血: 30.98g/L；碱性磷酸酶(ALP)-静脉血: 84.6U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；天门冬氨酸氨基转移酶(AST)-静脉血: 16.5U/L；有核红细胞百分比(NRBC%)-静脉血: 0；间接胆红素(IBIL)-静脉血: 6umolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.02；载脂蛋白AI(apoAI)-静脉血: 1.07g/L；钠离子(Na+)-静脉血: 140.4mmol/L；葡萄糖(Glu)-静脉血: 4.22mmol/L；直接胆红素(DBIL)-静脉血: 2.9umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.71mmol/L；尿素氮(BUN)-静脉血: 5.4mmol/L；总胆固醇(TC)-静脉血: 5.2mmol/L；单核细胞百分比(Mono%)-静脉血: 0.141；胱抑素(Cys-C)-静脉血: 0.86mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.89mmolL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总胆汁酸(TBA)-静脉血: 7.2umol/L；总胆红素(TBIL)-静脉血: 8.9umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 27U/L；红细胞比容(Hct)-静脉血: 44.8%；淋巴细胞百分比(Lymph%)-静脉血: 0.143；乳酸脱氢酶(LDH)-静脉血: 185U/L；钾离子(K+)-静脉血: 3.96mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 34.8U/L；白细胞计数(WBC#)-静脉血: 4.5310E9/L；平均血小板体积(MPV)-静脉血: 8.57fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.……\n- [全程D64] 超声；腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约19cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D64] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对侧，双肺野纹理清晰，双肺野未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影形态、大小、位置未见异常。双膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。仍有听力下降，请[姓名已隐去]医生信息已隐藏出：根据患者外院鼻咽部检查提示鼻咽部病灶侵犯右侧海绵窦，颅底骨质等，分为分期信息见历史辅助诊断节点，双侧颈部淋巴结肿大，最大径＜6cm，分为分期信息见历史辅助诊断节点，未见远处转移，分为[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点，[计划性表述已隐藏]放疗及同步增敏化疗控制病情，目前行放疗前准备。.\n- [全程D14] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，继续行放化疗前准备，余无特殊。.\n- [全程D17] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，请[姓名已隐去]医生信息已隐藏出：患者目前无特殊，继续行放化疗前准备，继续观察病情。.\n- [全程D20] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，患者放疗计划准备完成，[计划性表述已隐藏]GTV70Gy/32f，GTVnd68Gy/32f，CTV1 60Gy/32f，CTV2 56Gy/32f。拟本周开始放疗，因患者分期晚，病变范围大，视神经、眼球、颞叶剂量较高，已与患者沟通不良反应，患者及时家属表示理解并同意治疗，继续观察病情。.\n- [全程D23] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，患者目前继续行放疗前准备，[姓名已隐去]医生信息已隐藏出：患者继续行放疗前准备，[计划性表述已隐藏]顺铂同期化疗，继续观察病情。.\n- [全程D26] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，患者目前无特殊，拟周一开始行放疗，周二行顺铂100mg/㎡同期化疗，继续行放化疗前准备，继续观察病情。.\n- [全程D52] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。诉吞咽稍有疼痛，体查:I度口腔粘膜反应。昨日查血常规示白细胞计数2.26*10E9/L ↓,中性粒细胞1.1*10E9/L↓，予以升白针对症治疗。下周复查血常规。继续当前放疗。\n- [全程D55] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。诉口干，吞咽稍有疼痛，体查:I度口腔粘膜反应。已予以升白针治疗三天，明日复查血常规，[计划性表述已隐藏]同期DDP第二程化疗。继续放疗治疗。\n- [全程D58] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。诉口干，吞咽稍有疼痛，体查:I度口腔粘膜反应。今日行同期DDP第二程化疗，予以护肝、护胃、制酸、止吐对症治疗。继续放疗治疗。\n- [全程D61] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。诉口干，吞咽稍有疼痛，体查:I度口腔粘膜反应。继续放疗治疗。\n- [全程D64] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者一般情况可，诉耳鸣、听力下降有所缓解，口干及轻微咽痛，无发热、咳嗽、咳痰等不适。查体：I度口腔粘膜反应，张口门齿距4.5cm；颈部淋巴结较前明显缩小，右颈III区可见一长约4cm手术疤痕，颈部皮肤呈放疗后改变。[姓名已隐去]医生信息已隐藏：患者一般情况良好，予以明天出院，嘱患者出院后定期返院复查。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即行颈部淋巴结清扫术处理未完全消退的残存淋巴结。\nB. 立即安排鼻咽及颈部MRI与全身PET-CT检查全面评估近期疗效。\nC. 立即启动PF方案（顺铂+氟尿嘧啶）辅助化疗以巩固局部及全身控制。\nD. 继续住院给予静脉高营养及广谱抗生素治疗直至口腔黏膜反应完全消失。\nE. 立即行电子鼻咽镜下原发灶活检以明确是否达到病理完全缓解。\nF. 预防性给予长效G-CSF并口服抗生素后办理出院。\nG. 立即启动西妥昔单抗靶向维持治疗以降低局部复发风险。\nH. 对颈部残存淋巴结局部追加外照射放疗推量至75-80Gy。\nI. 立即复查血浆EBV-DNA，若阳性则继续给予单药顺铂化疗。\nJ. 结束住院诊疗办理出院，嘱定期返院复查以评估近期疗效。\nK. 立即行胸腹部增强CT及骨ECT检查排除放化疗期间的远处转移。\nL. 立即请耳鼻喉科会诊行鼓膜穿刺抽液或置管术处理听力下降。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、鼻腔、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现右颈部肿块伴耳鸣、听力下降4个月。；现病史: 缘于4个月前患者无意中发现右颈部包块，如拇指大小，无压痛，伴耳鸣、听力下降，颈部包块后逐渐增大，近1周偶发头痛，白天明显，视物如常，无鼻塞、鼻血、面麻、等不适。为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,鼻咽肿物,右颈部包块,头痛；既往史: 4年前患痔疮，已治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:青霉素皮试阳性。；个人史: 长期居于原籍，无疫区居住史。吸烟3-4支/天*10年，饮酒1-2次/月。否认不洁性生活史。；家族史: 舅舅患鼻咽癌，舅妈患肺癌。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：103/73mmHg,Ht：174cm，Wt：79kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；右颈IIa区可扪及1个淋巴结，最大径2.5×2.5cm，左颈IIa区扪及1个淋巴结，最大径约3*3cm，无融合，质地韧，边界模糊，活动度好，无压痛，无皮肤浸润，无溃疡，右颈III区可见一长约4cm手术疤痕；颅神经检查：阴性。；KPS:；ECOG:\n- [全程D0] 入院记录: 主诉: 发现右颈部肿块伴耳鸣、听力下降4个月。；现病史: 缘于4个月前患者无意中发现右颈部包块，如拇指大小，无压痛，伴耳鸣、听力下降，颈部包块后逐渐增大，近1周偶发头痛，白天明显，视物如常，无鼻塞、鼻血、面麻、等不适。就诊[机构已隐去]，行右颈部淋巴结活检术，病理示转移性低分化鳞癌，行电子鼻咽镜检查见鼻咽肿物，取活检病理示可疑癌。为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,鼻咽肿物,右颈部包块,头痛；既往史: 4年前患痔疮，已治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:青霉素皮试阳性。；个人史: 长期居于原籍，无疫区居住史。吸烟3-4支/天*10年，饮酒1-2次/月。否认不洁性生活史。；家族史: 舅舅患鼻咽癌，舅妈患肺癌。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：103/73mmHg,Ht：174cm，Wt：79kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；右颈IIa区可扪及1个淋巴结，最大径2.5×2.5cm，左颈IIa区扪及1个淋巴结，最大径约3*3cm，无融合，质地韧，边界模糊，活动度好，无压痛，无皮肤浸润，无溃疡，右颈III区可见一长约4cm手术疤痕；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 电轴左偏(轻度) 正常范围心电图\n- [全程D1] 检验组合: 血小板比容-静脉血: 19%；载脂蛋白B(apoB)-静脉血: 1.03g/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；肌酐(Crea)-静脉血: 66.2umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.1；球蛋白(GLO)-静脉血: 31.61g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.011；尿胆原(URO)-尿液: -（参考: 阴性）；红细胞比容(Hct)-静脉血: 48.9%；凝血酶原时间活动度(PTA)-静脉血: 111.2%；隐血(OB)-粪便: 阴性（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.91mg/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；碱性磷酸酶(ALP)-静脉血: 76.3U/L；载脂蛋白AI(apoAI)-静脉血: 1.04g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；葡萄糖(Glu)-静脉血: 4.96mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.5；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；血小板分布宽度(PDW)-静脉血: 13.9%；淋巴细胞百分比(Lymph%)-静脉血: 0.315；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；总胆红素(TBIL)-静脉血: 7umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.910E9/L；Rh血型-静脉血: 阳性；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.2sec.；酮体(KET)-尿液: -（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 21.9mmol/L；浊度(TRUB)-尿液: 清亮；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 4.88mmol/L；C-反应蛋白(C……\n- [全程D3] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D7] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及双侧壁增厚，以右侧为著，T1WI呈等信号，T2WI呈稍高信号，增强扫描强化明显，右侧咽隐窝消失，见增厚组织占据，左侧咽隐窝变浅。病变与右侧中鼻甲分界不清，口咽双侧壁未见增厚。 右侧咽旁间隙及右侧咽后间隙见不规则肿物突入。双侧腭帆提肌、右侧腭帆张肌、右侧头长肌受侵。左侧腭帆张肌、双侧翼内肌及双侧翼外肌未见受侵。 右侧翼腭窝内见少许软组织信号，增强扫描明显强化。 左侧翼腭窝、双侧上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 斜坡、蝶骨基底部、右侧翼突基底部及内外板、右侧蝶骨大翼及右侧岩尖骨质信号减低，增强扫描见不均匀强化。 右侧破裂扩大，右侧海绵窦增宽，内见不规则软组织信号灶，右侧蝶窦内见软组织信号灶突入，增强扫描上述病变强化明显。 左侧海绵窦未见增宽。蝶鞍形态正常，其内未见占位性病变。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧上颌窦、筛窦及蝶窦粘膜增厚。右侧乳突内见大量分泌物。 右侧咽后见肿大淋巴结，大者约12mm×17mm，增强扫描强化明显。双颈II、III、V区见多个肿大淋巴结，最大者约23mm×29mm，部分边界欠清晰，包膜不完整，信号欠均匀，增强扫描明显不均匀强化。双侧腮腺内及腮腺旁见数个淋巴结，大者短径约6mm，增强扫描强化明显。双颈I区见数个淋巴结，大者短径约7mm，信号尚均匀。 甲状腺双叶及峡部、喉咽、双侧颌下腺信号均匀，未见占位性病变。；检查结论: 鼻咽病变，考虑鼻咽癌，侵犯范围如上述。 颅底骨质破坏。 右侧咽后、双颈II、III、V区多发肿大淋巴结，考虑转移。 双侧腮腺内及腮腺旁数个淋巴结，性质待定。 鼻窦炎、右侧乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D26] 检验组合: 镁离子(Mg2+)-静脉血: 0.88mmol/L；阴离子间隙(AG)-静脉血: 13.2；血小板比容-静脉血: 18%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；乳酸脱氢酶(LDH)-静脉血: 177.9U/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.7U/L；血小板分布宽度(PDW)-静脉血: 13.2%；钾离子(K+)-静脉血: 4.02mmol/L；白蛋白(ALB)-静脉血: 44.5g/L；直接胆红素(DBIL)-静脉血: 3.8umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.58mmol/L；大血小板百分比(P-LCR%)-静脉血: 28.9%；单核细胞计数(Mono#)-静脉血: 0.610E9/L；钠离子(Na+)-静脉血: 143.5mmol/L；总胆固醇(TC)-静脉血: 5.13mmol/L；总胆红素(TBIL)-静脉血: 11.7umol/L；甘油三酯(TG)-静脉血: 1.44mmol/L；红细胞比容(Hct)-静脉血: 48.1%；中性粒细胞计数(Neut#)-静脉血: 3.310E9/L；白细胞计数(WBC#)-静脉血: 6.2110E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.86；中性粒细胞百分比(Neut%)-静脉血: 0.528；总钙(Ca)-静脉血: 2.18mmol/L；总蛋白(TP)-静脉血: 76.63g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.38；α-L-岩藻糖苷酶(AFU)-静脉血: 35.5U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.97mmolL；淋巴细胞计数(Lymph#)-静脉血: 2.110E9/L；间接胆红素(IBIL)-静脉血: 7.9umolL；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；尿素氮(BUN)-静脉血: 4.1mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 333g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.9；单核细胞百分比(Mono%)-静脉血: 0.103；血液二氧化碳含量ctCO2(B)-静脉血: 26.……\n- [全程D44] 检验组合: 白细胞计数(WBC#)-静脉血: 4.4610E9/L；镁离子(Mg2+)-静脉血: 0.96mmol/L；葡萄糖(Glu)-静脉血: 4.12mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；丙氨酸氨基转移酶(ALT)-静脉血: 16U/L；总蛋白(TP)-静脉血: 72.33g/L；胱抑素(Cys-C)-静脉血: 0.78mg/L；血小板分布宽度(PDW)-静脉血: 11.6%；中性粒细胞计数(Neut#)-静脉血: 3.110E9/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.910E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 35.8U/L；C-反应蛋白(CRP)-静脉血: 3.43mg/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.1；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.32mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.9；氯离子(Cl-)-静脉血: 103mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 29mmol/L；乳酸脱氢酶(LDH)-静脉血: 172.3U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.195；直接胆红素(DBIL)-静脉血: 4.2umol/L；球蛋白(GLO)-静脉血: 29.23g/L；甘油三酯(TG)-静脉血: 1.13mmol/L；血小板计数(PLT#)-静脉血: 16510E9/L；钾离子(K+)-静脉血: 4.12mmol/L；肌酐(Crea)-静脉血: 67.7umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.3U/L；白蛋白(ALB)-静脉血: 43.1g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均血小板体积(MPV)-静脉血: 9.8fL；载脂蛋白AI(apoAI)-静脉血: 1.11g/L；总胆红素(TBIL)-静脉血: 12.6umol/L；单核细胞百分比(Mono%)-静脉血: 0.09；间接胆红素(IBIL)-静脉血: 8.4umolL；血红蛋白(Hb)-静脉血: 148g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 32.8U/L；红细胞……\n- [全程D51] 检验组合: 磷(P)-静脉血: 1.15mmol/L；氯离子(Cl-)-静脉血: 103.1mmol/L；球蛋白(GLO)-静脉血: 31.65g/L；中性粒细胞计数(Neut#)-静脉血: 1.110E9/L；钠离子(Na+)-静脉血: 141.8mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；中性粒细胞百分比(Neut%)-静脉血: 0.466；单核细胞百分比(Mono%)-静脉血: 0.221；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.03；血小板比容-静脉血: 15%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；乳酸脱氢酶(LDH)-静脉血: 170.6U/L；总胆红素(TBIL)-静脉血: 9.8umol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.2pg；肌酐(Crea)-静脉血: 72.4umol/L；尿素氮(BUN)-静脉血: 4.2mmol/L；尿酸(UA)-静脉血: 346.6umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.04；红细胞计数(RBC#)-静脉血: 5.1710E12/L；总蛋白(TP)-静脉血: 75.85g/L；平均血小板体积(MPV)-静脉血: 10fL；平均红细胞体积(MCV)-静脉血: 85.7fL；红细胞比容(Hct)-静脉血: 44.3%；白蛋白(ALB)-静脉血: 44.2g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.09mmolL；总胆固醇(TC)-静脉血: 5.11mmol/L；间接胆红素(IBIL)-静脉血: 6.3umolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.51mmol/L；胱抑素(Cys-C)-静脉血: 0.82mg/L；葡萄糖(Glu)-静脉血: 4.91mmol/L；C-反应蛋白(CRP)-静脉血: 2.13mg/L；碱性磷酸酶(ALP)-静脉血: 77.4U/L；总胆汁酸(TBA)-静脉血: 4.3umol/L；载脂蛋白AI(apoAI)-静脉血: 1.23g/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；直接胆红素(DBIL)-静脉血: 3.5umol/L；血小板分布宽度(PDW)-静脉血: 10.8%；血液二氧化碳含量ctCO2(B)-静脉血: 24.1m……\n- [全程D56] 检验组合: 血红蛋白(Hb)-静脉血: 154g/L；白细胞计数(WBC#)-静脉血: 510E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.28；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 48.1；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.6；中性粒细胞计数(Neut#)-静脉血: 3.110E9/L；大血小板百分比(P-LCR%)-静脉血: 28.9%；红细胞比容(Hct)-静脉血: 49.1%；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.612；单核细胞百分比(Mono%)-静脉血: 0.09；平均红细胞血红蛋白含量(MCH)-静脉血: 29.4pg；平均血小板体积(MPV)-静脉血: 10.4fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 11910E9/L；平均红细胞体积(MCV)-静脉血: 93.7fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0；血小板比容-静脉血: 12%；单核细胞计数(Mono#)-静脉血: 0.510E9/L；血小板分布宽度(PDW)-静脉血: 12.6%；红细胞计数(RBC#)-静脉血: 5.2410E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；平均红细胞血红蛋白浓度(MCHC)-静脉血: 314g/L\n- [全程D58] 检验组合: 白蛋白(ALB)-静脉血: 44.1g/L；血液二氧化碳含量ctCO2(B)-静脉血: 29.5mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 342.3g/L；尿酸(UA)-静脉血: 336.4umol/L；平均红细胞体积(MCV)-静脉血: 87.6fL；氯离子(Cl-)-静脉血: 101.4mmol/L；血小板计数(PLT#)-静脉血: 119.610E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.51；球蛋白(GLO)-静脉血: 30.98g/L；碱性磷酸酶(ALP)-静脉血: 84.6U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；天门冬氨酸氨基转移酶(AST)-静脉血: 16.5U/L；有核红细胞百分比(NRBC%)-静脉血: 0；间接胆红素(IBIL)-静脉血: 6umolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.02；载脂蛋白AI(apoAI)-静脉血: 1.07g/L；钠离子(Na+)-静脉血: 140.4mmol/L；葡萄糖(Glu)-静脉血: 4.22mmol/L；直接胆红素(DBIL)-静脉血: 2.9umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.71mmol/L；尿素氮(BUN)-静脉血: 5.4mmol/L；总胆固醇(TC)-静脉血: 5.2mmol/L；单核细胞百分比(Mono%)-静脉血: 0.141；胱抑素(Cys-C)-静脉血: 0.86mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.89mmolL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总胆汁酸(TBA)-静脉血: 7.2umol/L；总胆红素(TBIL)-静脉血: 8.9umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 27U/L；红细胞比容(Hct)-静脉血: 44.8%；淋巴细胞百分比(Lymph%)-静脉血: 0.143；乳酸脱氢酶(LDH)-静脉血: 185U/L；钾离子(K+)-静脉血: 3.96mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 34.8U/L；白细胞计数(WBC#)-静脉血: 4.5310E9/L；平均血小板体积(MPV)-静脉血: 8.57fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.……\n- [全程D64] 超声；腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约19cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D64] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对侧，双肺野纹理清晰，双肺野未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影形态、大小、位置未见异常。双膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。仍有听力下降，请[姓名已隐去]医生信息已隐藏出：根据患者外院鼻咽部检查提示鼻咽部病灶侵犯右侧海绵窦，颅底骨质等，分为分期信息见历史辅助诊断节点，双侧颈部淋巴结肿大，最大径＜6cm，分为分期信息见历史辅助诊断节点，未见远处转移，分为[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点，[计划性表述已隐藏]放疗及同步增敏化疗控制病情，目前行放疗前准备。.\n- [全程D14] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，继续行放化疗前准备，余无特殊。.\n- [全程D17] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，请[姓名已隐去]医生信息已隐藏出：患者目前无特殊，继续行放化疗前准备，继续观察病情。.\n- [全程D20] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，患者放疗计划准备完成，[计划性表述已隐藏]GTV70Gy/32f，GTVnd68Gy/32f，CTV1 60Gy/32f，CTV2 56Gy/32f。拟本周开始放疗，因患者分期晚，病变范围大，视神经、眼球、颞叶剂量较高，已与患者沟通不良反应，患者及时家属表示理解并同意治疗，继续观察病情。.\n- [全程D23] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，患者目前继续行放疗前准备，[姓名已隐去]医生信息已隐藏出：患者继续行放疗前准备，[计划性表述已隐藏]顺铂同期化疗，继续观察病情。.\n- [全程D26] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，患者目前无特殊，拟周一开始行放疗，周二行顺铂100mg/㎡同期化疗，继续行放化疗前准备，继续观察病情。.\n- [全程D52] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。诉吞咽稍有疼痛，体查:I度口腔粘膜反应。昨日查血常规示白细胞计数2.26*10E9/L ↓,中性粒细胞1.1*10E9/L↓，予以升白针对症治疗。下周复查血常规。继续当前放疗。\n- [全程D55] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。诉口干，吞咽稍有疼痛，体查:I度口腔粘膜反应。已予以升白针治疗三天，明日复查血常规，[计划性表述已隐藏]同期DDP第二程化疗。继续放疗治疗。\n- [全程D58] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。诉口干，吞咽稍有疼痛，体查:I度口腔粘膜反应。今日行同期DDP第二程化疗，予以护肝、护胃、制酸、止吐对症治疗。继续放疗治疗。\n- [全程D61] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。诉口干，吞咽稍有疼痛，体查:I度口腔粘膜反应。继续放疗治疗。\n- [全程D64] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者一般情况可，诉耳鸣、听力下降有所缓解，口干及轻微咽痛，无发热、咳嗽、咳痰等不适。查体：I度口腔粘膜反应，张口门齿距4.5cm；颈部淋巴结较前明显缩小，右颈III区可见一长约4cm手术疤痕，颈部皮肤呈放疗后改变。[姓名已隐去]医生信息已隐藏：患者一般情况良好，予以明天出院，嘱患者出院后定期返院复查。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即行颈部淋巴结清扫术处理未完全消退的残存淋巴结。\nB. 立即安排鼻咽及颈部MRI与全身PET-CT检查全面评估近期疗效。\nC. 立即启动PF方案（顺铂+氟尿嘧啶）辅助化疗以巩固局部及全身控制。\nD. 继续住院给予静脉高营养及广谱抗生素治疗直至口腔黏膜反应完全消失。\nE. 立即行电子鼻咽镜下原发灶活检以明确是否达到病理完全缓解。\nF. 预防性给予长效G-CSF并口服抗生素后办理出院。\nG. 立即启动西妥昔单抗靶向维持治疗以降低局部复发风险。\nH. 对颈部残存淋巴结局部追加外照射放疗推量至75-80Gy。\nI. 立即复查血浆EBV-DNA，若阳性则继续给予单药顺铂化疗。\nJ. 结束住院诊疗办理出院，嘱定期返院复查以评估近期疗效。\nK. 立即行胸腹部增强CT及骨ECT检查排除放化疗期间的远处转移。\nL. 立即请耳鼻喉科会诊行鼓膜穿刺抽液或置管术处理听力下降。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-03e671c4e9fab822b9938832","patient_id":"patient-f25e20b1e5c6eea840d4cc21","turn_id":"turn08","turn_position":7,"turn_type":"response_assessment_decision","gold_letter":"K","gold_action":"评估为有效，结束根治性放化疗，予以办理出院并嘱定期门诊随访复查。","options":[{"letter":"A","text":"评估为疾病进展，停用放疗，改行吉西他滨联合顺铂姑息性化疗。","is_gold":false},{"letter":"B","text":"评估为部分缓解，继续住院行第3周期顺铂单药同期化疗。","is_gold":false},{"letter":"C","text":"评估为部分缓解，序贯启动顺铂联合氟尿嘧啶方案辅助化疗3个周期。","is_gold":false},{"letter":"D","text":"评估为完全缓解，转入头颈外科行右侧颈部淋巴结清扫术。","is_gold":false},{"letter":"E","text":"评估为部分缓解，对右颈部残留淋巴结追加局部外照射放疗至74Gy。","is_gold":false},{"letter":"F","text":"评估为疾病稳定，加用西妥昔单抗靶向治疗并延长原发灶放疗疗程。","is_gold":false},{"letter":"G","text":"评估为部分缓解，转入头颈外科行内镜下鼻咽原发灶切除术。","is_gold":false},{"letter":"H","text":"评估为有效，继续住院静脉使用抗生素及营养支持以治疗口腔黏膜反应。","is_gold":false},{"letter":"I","text":"评估为有效，立即安排鼻咽及颈部增强MRI复查以确认靶区消退情况。","is_gold":false},{"letter":"J","text":"评估为有效，办理出院，并序贯启动PD-1抑制剂维持治疗1年。","is_gold":false},{"letter":"K","text":"评估为有效，结束根治性放化疗，予以办理出院并嘱定期门诊随访复查。","is_gold":true},{"letter":"L","text":"评估为有效，办理出院，并嘱出院后1个月常规行全身PET-CT检查。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、鼻腔、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现右颈部肿块伴耳鸣、听力下降4个月。；现病史: 缘于4个月前患者无意中发现右颈部包块，如拇指大小，无压痛，伴耳鸣、听力下降，颈部包块后逐渐增大，近1周偶发头痛，白天明显，视物如常，无鼻塞、鼻血、面麻、等不适。为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,鼻咽肿物,右颈部包块,头痛；既往史: 4年前患痔疮，已治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:青霉素皮试阳性。；个人史: 长期居于原籍，无疫区居住史。吸烟3-4支/天*10年，饮酒1-2次/月。否认不洁性生活史。；家族史: 舅舅患鼻咽癌，舅妈患肺癌。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：103/73mmHg,Ht：174cm，Wt：79kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；右颈IIa区可扪及1个淋巴结，最大径2.5×2.5cm，左颈IIa区扪及1个淋巴结，最大径约3*3cm，无融合，质地韧，边界模糊，活动度好，无压痛，无皮肤浸润，无溃疡，右颈III区可见一长约4cm手术疤痕；颅神经检查：阴性。；KPS:；ECOG:\n- [全程D0] 入院记录: 主诉: 发现右颈部肿块伴耳鸣、听力下降4个月。；现病史: 缘于4个月前患者无意中发现右颈部包块，如拇指大小，无压痛，伴耳鸣、听力下降，颈部包块后逐渐增大，近1周偶发头痛，白天明显，视物如常，无鼻塞、鼻血、面麻、等不适。就诊[机构已隐去]，行右颈部淋巴结活检术，病理示转移性低分化鳞癌，行电子鼻咽镜检查见鼻咽肿物，取活检病理示可疑癌。为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,鼻咽肿物,右颈部包块,头痛；既往史: 4年前患痔疮，已治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:青霉素皮试阳性。；个人史: 长期居于原籍，无疫区居住史。吸烟3-4支/天*10年，饮酒1-2次/月。否认不洁性生活史。；家族史: 舅舅患鼻咽癌，舅妈患肺癌。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：103/73mmHg,Ht：174cm，Wt：79kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；右颈IIa区可扪及1个淋巴结，最大径2.5×2.5cm，左颈IIa区扪及1个淋巴结，最大径约3*3cm，无融合，质地韧，边界模糊，活动度好，无压痛，无皮肤浸润，无溃疡，右颈III区可见一长约4cm手术疤痕；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 电轴左偏(轻度) 正常范围心电图\n- [全程D1] 检验组合: 血小板比容-静脉血: 19%；载脂蛋白B(apoB)-静脉血: 1.03g/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；肌酐(Crea)-静脉血: 66.2umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.1；球蛋白(GLO)-静脉血: 31.61g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.011；尿胆原(URO)-尿液: -（参考: 阴性）；红细胞比容(Hct)-静脉血: 48.9%；凝血酶原时间活动度(PTA)-静脉血: 111.2%；隐血(OB)-粪便: 阴性（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.91mg/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；碱性磷酸酶(ALP)-静脉血: 76.3U/L；载脂蛋白AI(apoAI)-静脉血: 1.04g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；葡萄糖(Glu)-静脉血: 4.96mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.5；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；血小板分布宽度(PDW)-静脉血: 13.9%；淋巴细胞百分比(Lymph%)-静脉血: 0.315；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；总胆红素(TBIL)-静脉血: 7umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.910E9/L；Rh血型-静脉血: 阳性；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.2sec.；酮体(KET)-尿液: -（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 21.9mmol/L；浊度(TRUB)-尿液: 清亮；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 4.88mmol/L；C-反应蛋白(C……\n- [全程D3] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D7] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及双侧壁增厚，以右侧为著，T1WI呈等信号，T2WI呈稍高信号，增强扫描强化明显，右侧咽隐窝消失，见增厚组织占据，左侧咽隐窝变浅。病变与右侧中鼻甲分界不清，口咽双侧壁未见增厚。 右侧咽旁间隙及右侧咽后间隙见不规则肿物突入。双侧腭帆提肌、右侧腭帆张肌、右侧头长肌受侵。左侧腭帆张肌、双侧翼内肌及双侧翼外肌未见受侵。 右侧翼腭窝内见少许软组织信号，增强扫描明显强化。 左侧翼腭窝、双侧上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 斜坡、蝶骨基底部、右侧翼突基底部及内外板、右侧蝶骨大翼及右侧岩尖骨质信号减低，增强扫描见不均匀强化。 右侧破裂扩大，右侧海绵窦增宽，内见不规则软组织信号灶，右侧蝶窦内见软组织信号灶突入，增强扫描上述病变强化明显。 左侧海绵窦未见增宽。蝶鞍形态正常，其内未见占位性病变。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧上颌窦、筛窦及蝶窦粘膜增厚。右侧乳突内见大量分泌物。 右侧咽后见肿大淋巴结，大者约12mm×17mm，增强扫描强化明显。双颈II、III、V区见多个肿大淋巴结，最大者约23mm×29mm，部分边界欠清晰，包膜不完整，信号欠均匀，增强扫描明显不均匀强化。双侧腮腺内及腮腺旁见数个淋巴结，大者短径约6mm，增强扫描强化明显。双颈I区见数个淋巴结，大者短径约7mm，信号尚均匀。 甲状腺双叶及峡部、喉咽、双侧颌下腺信号均匀，未见占位性病变。；检查结论: 鼻咽病变，考虑鼻咽癌，侵犯范围如上述。 颅底骨质破坏。 右侧咽后、双颈II、III、V区多发肿大淋巴结，考虑转移。 双侧腮腺内及腮腺旁数个淋巴结，性质待定。 鼻窦炎、右侧乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D26] 检验组合: 镁离子(Mg2+)-静脉血: 0.88mmol/L；阴离子间隙(AG)-静脉血: 13.2；血小板比容-静脉血: 18%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；乳酸脱氢酶(LDH)-静脉血: 177.9U/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.7U/L；血小板分布宽度(PDW)-静脉血: 13.2%；钾离子(K+)-静脉血: 4.02mmol/L；白蛋白(ALB)-静脉血: 44.5g/L；直接胆红素(DBIL)-静脉血: 3.8umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.58mmol/L；大血小板百分比(P-LCR%)-静脉血: 28.9%；单核细胞计数(Mono#)-静脉血: 0.610E9/L；钠离子(Na+)-静脉血: 143.5mmol/L；总胆固醇(TC)-静脉血: 5.13mmol/L；总胆红素(TBIL)-静脉血: 11.7umol/L；甘油三酯(TG)-静脉血: 1.44mmol/L；红细胞比容(Hct)-静脉血: 48.1%；中性粒细胞计数(Neut#)-静脉血: 3.310E9/L；白细胞计数(WBC#)-静脉血: 6.2110E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.86；中性粒细胞百分比(Neut%)-静脉血: 0.528；总钙(Ca)-静脉血: 2.18mmol/L；总蛋白(TP)-静脉血: 76.63g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.38；α-L-岩藻糖苷酶(AFU)-静脉血: 35.5U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.97mmolL；淋巴细胞计数(Lymph#)-静脉血: 2.110E9/L；间接胆红素(IBIL)-静脉血: 7.9umolL；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；尿素氮(BUN)-静脉血: 4.1mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 333g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.9；单核细胞百分比(Mono%)-静脉血: 0.103；血液二氧化碳含量ctCO2(B)-静脉血: 26.……\n- [全程D44] 检验组合: 白细胞计数(WBC#)-静脉血: 4.4610E9/L；镁离子(Mg2+)-静脉血: 0.96mmol/L；葡萄糖(Glu)-静脉血: 4.12mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；丙氨酸氨基转移酶(ALT)-静脉血: 16U/L；总蛋白(TP)-静脉血: 72.33g/L；胱抑素(Cys-C)-静脉血: 0.78mg/L；血小板分布宽度(PDW)-静脉血: 11.6%；中性粒细胞计数(Neut#)-静脉血: 3.110E9/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.910E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 35.8U/L；C-反应蛋白(CRP)-静脉血: 3.43mg/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.1；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.32mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.9；氯离子(Cl-)-静脉血: 103mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 29mmol/L；乳酸脱氢酶(LDH)-静脉血: 172.3U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.195；直接胆红素(DBIL)-静脉血: 4.2umol/L；球蛋白(GLO)-静脉血: 29.23g/L；甘油三酯(TG)-静脉血: 1.13mmol/L；血小板计数(PLT#)-静脉血: 16510E9/L；钾离子(K+)-静脉血: 4.12mmol/L；肌酐(Crea)-静脉血: 67.7umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.3U/L；白蛋白(ALB)-静脉血: 43.1g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均血小板体积(MPV)-静脉血: 9.8fL；载脂蛋白AI(apoAI)-静脉血: 1.11g/L；总胆红素(TBIL)-静脉血: 12.6umol/L；单核细胞百分比(Mono%)-静脉血: 0.09；间接胆红素(IBIL)-静脉血: 8.4umolL；血红蛋白(Hb)-静脉血: 148g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 32.8U/L；红细胞……\n- [全程D51] 检验组合: 磷(P)-静脉血: 1.15mmol/L；氯离子(Cl-)-静脉血: 103.1mmol/L；球蛋白(GLO)-静脉血: 31.65g/L；中性粒细胞计数(Neut#)-静脉血: 1.110E9/L；钠离子(Na+)-静脉血: 141.8mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；中性粒细胞百分比(Neut%)-静脉血: 0.466；单核细胞百分比(Mono%)-静脉血: 0.221；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.03；血小板比容-静脉血: 15%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；乳酸脱氢酶(LDH)-静脉血: 170.6U/L；总胆红素(TBIL)-静脉血: 9.8umol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.2pg；肌酐(Crea)-静脉血: 72.4umol/L；尿素氮(BUN)-静脉血: 4.2mmol/L；尿酸(UA)-静脉血: 346.6umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.04；红细胞计数(RBC#)-静脉血: 5.1710E12/L；总蛋白(TP)-静脉血: 75.85g/L；平均血小板体积(MPV)-静脉血: 10fL；平均红细胞体积(MCV)-静脉血: 85.7fL；红细胞比容(Hct)-静脉血: 44.3%；白蛋白(ALB)-静脉血: 44.2g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.09mmolL；总胆固醇(TC)-静脉血: 5.11mmol/L；间接胆红素(IBIL)-静脉血: 6.3umolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.51mmol/L；胱抑素(Cys-C)-静脉血: 0.82mg/L；葡萄糖(Glu)-静脉血: 4.91mmol/L；C-反应蛋白(CRP)-静脉血: 2.13mg/L；碱性磷酸酶(ALP)-静脉血: 77.4U/L；总胆汁酸(TBA)-静脉血: 4.3umol/L；载脂蛋白AI(apoAI)-静脉血: 1.23g/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；直接胆红素(DBIL)-静脉血: 3.5umol/L；血小板分布宽度(PDW)-静脉血: 10.8%；血液二氧化碳含量ctCO2(B)-静脉血: 24.1m……\n- [全程D56] 检验组合: 血红蛋白(Hb)-静脉血: 154g/L；白细胞计数(WBC#)-静脉血: 510E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.28；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 48.1；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.6；中性粒细胞计数(Neut#)-静脉血: 3.110E9/L；大血小板百分比(P-LCR%)-静脉血: 28.9%；红细胞比容(Hct)-静脉血: 49.1%；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.612；单核细胞百分比(Mono%)-静脉血: 0.09；平均红细胞血红蛋白含量(MCH)-静脉血: 29.4pg；平均血小板体积(MPV)-静脉血: 10.4fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 11910E9/L；平均红细胞体积(MCV)-静脉血: 93.7fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0；血小板比容-静脉血: 12%；单核细胞计数(Mono#)-静脉血: 0.510E9/L；血小板分布宽度(PDW)-静脉血: 12.6%；红细胞计数(RBC#)-静脉血: 5.2410E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；平均红细胞血红蛋白浓度(MCHC)-静脉血: 314g/L\n- [全程D58] 检验组合: 白蛋白(ALB)-静脉血: 44.1g/L；血液二氧化碳含量ctCO2(B)-静脉血: 29.5mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 342.3g/L；尿酸(UA)-静脉血: 336.4umol/L；平均红细胞体积(MCV)-静脉血: 87.6fL；氯离子(Cl-)-静脉血: 101.4mmol/L；血小板计数(PLT#)-静脉血: 119.610E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.51；球蛋白(GLO)-静脉血: 30.98g/L；碱性磷酸酶(ALP)-静脉血: 84.6U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；天门冬氨酸氨基转移酶(AST)-静脉血: 16.5U/L；有核红细胞百分比(NRBC%)-静脉血: 0；间接胆红素(IBIL)-静脉血: 6umolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.02；载脂蛋白AI(apoAI)-静脉血: 1.07g/L；钠离子(Na+)-静脉血: 140.4mmol/L；葡萄糖(Glu)-静脉血: 4.22mmol/L；直接胆红素(DBIL)-静脉血: 2.9umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.71mmol/L；尿素氮(BUN)-静脉血: 5.4mmol/L；总胆固醇(TC)-静脉血: 5.2mmol/L；单核细胞百分比(Mono%)-静脉血: 0.141；胱抑素(Cys-C)-静脉血: 0.86mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.89mmolL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总胆汁酸(TBA)-静脉血: 7.2umol/L；总胆红素(TBIL)-静脉血: 8.9umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 27U/L；红细胞比容(Hct)-静脉血: 44.8%；淋巴细胞百分比(Lymph%)-静脉血: 0.143；乳酸脱氢酶(LDH)-静脉血: 185U/L；钾离子(K+)-静脉血: 3.96mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 34.8U/L；白细胞计数(WBC#)-静脉血: 4.5310E9/L；平均血小板体积(MPV)-静脉血: 8.57fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.……\n- [全程D64] 超声；腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约19cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D64] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对侧，双肺野纹理清晰，双肺野未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影形态、大小、位置未见异常。双膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。仍有听力下降，请[姓名已隐去]医生信息已隐藏出：根据患者外院鼻咽部检查提示鼻咽部病灶侵犯右侧海绵窦，颅底骨质等，分为分期信息见历史辅助诊断节点，双侧颈部淋巴结肿大，最大径＜6cm，分为分期信息见历史辅助诊断节点，未见远处转移，分为[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点，[计划性表述已隐藏]放疗及同步增敏化疗控制病情，目前行放疗前准备。.\n- [全程D14] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，继续行放化疗前准备，余无特殊。.\n- [全程D17] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，请[姓名已隐去]医生信息已隐藏出：患者目前无特殊，继续行放化疗前准备，继续观察病情。.\n- [全程D20] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，患者放疗计划准备完成，[计划性表述已隐藏]GTV70Gy/32f，GTVnd68Gy/32f，CTV1 60Gy/32f，CTV2 56Gy/32f。拟本周开始放疗，因患者分期晚，病变范围大，视神经、眼球、颞叶剂量较高，已与患者沟通不良反应，患者及时家属表示理解并同意治疗，继续观察病情。.\n- [全程D23] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，患者目前继续行放疗前准备，[姓名已隐去]医生信息已隐藏出：患者继续行放疗前准备，[计划性表述已隐藏]顺铂同期化疗，继续观察病情。.\n- [全程D26] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，患者目前无特殊，拟周一开始行放疗，周二行顺铂100mg/㎡同期化疗，继续行放化疗前准备，继续观察病情。.\n- [全程D52] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。诉吞咽稍有疼痛，体查:I度口腔粘膜反应。昨日查血常规示白细胞计数2.26*10E9/L ↓,中性粒细胞1.1*10E9/L↓，予以升白针对症治疗。下周复查血常规。继续当前放疗。\n- [全程D55] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。诉口干，吞咽稍有疼痛，体查:I度口腔粘膜反应。已予以升白针治疗三天，明日复查血常规，[计划性表述已隐藏]同期DDP第二程化疗。继续放疗治疗。\n- [全程D58] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。诉口干，吞咽稍有疼痛，体查:I度口腔粘膜反应。今日行同期DDP第二程化疗，予以护肝、护胃、制酸、止吐对症治疗。继续放疗治疗。\n- [全程D61] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。诉口干，吞咽稍有疼痛，体查:I度口腔粘膜反应。继续放疗治疗。\n- [全程D64] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者一般情况可，诉耳鸣、听力下降有所缓解，口干及轻微咽痛，无发热、咳嗽、咳痰等不适。查体：I度口腔粘膜反应，张口门齿距4.5cm；颈部淋巴结较前明显缩小，右颈III区可见一长约4cm手术疤痕，颈部皮肤呈放疗后改变。[姓名已隐去]医生信息已隐藏：患者一般情况良好，予以明天出院，嘱患者出院后定期返院复查。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估为疾病进展，停用放疗，改行吉西他滨联合顺铂姑息性化疗。\nB. 评估为部分缓解，继续住院行第3周期顺铂单药同期化疗。\nC. 评估为部分缓解，序贯启动顺铂联合氟尿嘧啶方案辅助化疗3个周期。\nD. 评估为完全缓解，转入头颈外科行右侧颈部淋巴结清扫术。\nE. 评估为部分缓解，对右颈部残留淋巴结追加局部外照射放疗至74Gy。\nF. 评估为疾病稳定，加用西妥昔单抗靶向治疗并延长原发灶放疗疗程。\nG. 评估为部分缓解，转入头颈外科行内镜下鼻咽原发灶切除术。\nH. 评估为有效，继续住院静脉使用抗生素及营养支持以治疗口腔黏膜反应。\nI. 评估为有效，立即安排鼻咽及颈部增强MRI复查以确认靶区消退情况。\nJ. 评估为有效，办理出院，并序贯启动PD-1抑制剂维持治疗1年。\nK. 评估为有效，结束根治性放化疗，予以办理出院并嘱定期门诊随访复查。\nL. 评估为有效，办理出院，并嘱出院后1个月常规行全身PET-CT检查。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、鼻腔、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现右颈部肿块伴耳鸣、听力下降4个月。；现病史: 缘于4个月前患者无意中发现右颈部包块，如拇指大小，无压痛，伴耳鸣、听力下降，颈部包块后逐渐增大，近1周偶发头痛，白天明显，视物如常，无鼻塞、鼻血、面麻、等不适。为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,鼻咽肿物,右颈部包块,头痛；既往史: 4年前患痔疮，已治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:青霉素皮试阳性。；个人史: 长期居于原籍，无疫区居住史。吸烟3-4支/天*10年，饮酒1-2次/月。否认不洁性生活史。；家族史: 舅舅患鼻咽癌，舅妈患肺癌。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：103/73mmHg,Ht：174cm，Wt：79kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；右颈IIa区可扪及1个淋巴结，最大径2.5×2.5cm，左颈IIa区扪及1个淋巴结，最大径约3*3cm，无融合，质地韧，边界模糊，活动度好，无压痛，无皮肤浸润，无溃疡，右颈III区可见一长约4cm手术疤痕；颅神经检查：阴性。；KPS:；ECOG:\n- [全程D0] 入院记录: 主诉: 发现右颈部肿块伴耳鸣、听力下降4个月。；现病史: 缘于4个月前患者无意中发现右颈部包块，如拇指大小，无压痛，伴耳鸣、听力下降，颈部包块后逐渐增大，近1周偶发头痛，白天明显，视物如常，无鼻塞、鼻血、面麻、等不适。就诊[机构已隐去]，行右颈部淋巴结活检术，病理示转移性低分化鳞癌，行电子鼻咽镜检查见鼻咽肿物，取活检病理示可疑癌。为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,鼻咽肿物,右颈部包块,头痛；既往史: 4年前患痔疮，已治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:青霉素皮试阳性。；个人史: 长期居于原籍，无疫区居住史。吸烟3-4支/天*10年，饮酒1-2次/月。否认不洁性生活史。；家族史: 舅舅患鼻咽癌，舅妈患肺癌。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：103/73mmHg,Ht：174cm，Wt：79kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；右颈IIa区可扪及1个淋巴结，最大径2.5×2.5cm，左颈IIa区扪及1个淋巴结，最大径约3*3cm，无融合，质地韧，边界模糊，活动度好，无压痛，无皮肤浸润，无溃疡，右颈III区可见一长约4cm手术疤痕；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 电轴左偏(轻度) 正常范围心电图\n- [全程D1] 检验组合: 血小板比容-静脉血: 19%；载脂蛋白B(apoB)-静脉血: 1.03g/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；肌酐(Crea)-静脉血: 66.2umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.1；球蛋白(GLO)-静脉血: 31.61g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.011；尿胆原(URO)-尿液: -（参考: 阴性）；红细胞比容(Hct)-静脉血: 48.9%；凝血酶原时间活动度(PTA)-静脉血: 111.2%；隐血(OB)-粪便: 阴性（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.91mg/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；碱性磷酸酶(ALP)-静脉血: 76.3U/L；载脂蛋白AI(apoAI)-静脉血: 1.04g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；葡萄糖(Glu)-静脉血: 4.96mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.5；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；血小板分布宽度(PDW)-静脉血: 13.9%；淋巴细胞百分比(Lymph%)-静脉血: 0.315；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；总胆红素(TBIL)-静脉血: 7umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.910E9/L；Rh血型-静脉血: 阳性；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.2sec.；酮体(KET)-尿液: -（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 21.9mmol/L；浊度(TRUB)-尿液: 清亮；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 4.88mmol/L；C-反应蛋白(C……\n- [全程D3] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D7] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及双侧壁增厚，以右侧为著，T1WI呈等信号，T2WI呈稍高信号，增强扫描强化明显，右侧咽隐窝消失，见增厚组织占据，左侧咽隐窝变浅。病变与右侧中鼻甲分界不清，口咽双侧壁未见增厚。 右侧咽旁间隙及右侧咽后间隙见不规则肿物突入。双侧腭帆提肌、右侧腭帆张肌、右侧头长肌受侵。左侧腭帆张肌、双侧翼内肌及双侧翼外肌未见受侵。 右侧翼腭窝内见少许软组织信号，增强扫描明显强化。 左侧翼腭窝、双侧上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 斜坡、蝶骨基底部、右侧翼突基底部及内外板、右侧蝶骨大翼及右侧岩尖骨质信号减低，增强扫描见不均匀强化。 右侧破裂扩大，右侧海绵窦增宽，内见不规则软组织信号灶，右侧蝶窦内见软组织信号灶突入，增强扫描上述病变强化明显。 左侧海绵窦未见增宽。蝶鞍形态正常，其内未见占位性病变。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧上颌窦、筛窦及蝶窦粘膜增厚。右侧乳突内见大量分泌物。 右侧咽后见肿大淋巴结，大者约12mm×17mm，增强扫描强化明显。双颈II、III、V区见多个肿大淋巴结，最大者约23mm×29mm，部分边界欠清晰，包膜不完整，信号欠均匀，增强扫描明显不均匀强化。双侧腮腺内及腮腺旁见数个淋巴结，大者短径约6mm，增强扫描强化明显。双颈I区见数个淋巴结，大者短径约7mm，信号尚均匀。 甲状腺双叶及峡部、喉咽、双侧颌下腺信号均匀，未见占位性病变。；检查结论: 鼻咽病变，考虑鼻咽癌，侵犯范围如上述。 颅底骨质破坏。 右侧咽后、双颈II、III、V区多发肿大淋巴结，考虑转移。 双侧腮腺内及腮腺旁数个淋巴结，性质待定。 鼻窦炎、右侧乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D26] 检验组合: 镁离子(Mg2+)-静脉血: 0.88mmol/L；阴离子间隙(AG)-静脉血: 13.2；血小板比容-静脉血: 18%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；乳酸脱氢酶(LDH)-静脉血: 177.9U/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.7U/L；血小板分布宽度(PDW)-静脉血: 13.2%；钾离子(K+)-静脉血: 4.02mmol/L；白蛋白(ALB)-静脉血: 44.5g/L；直接胆红素(DBIL)-静脉血: 3.8umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.58mmol/L；大血小板百分比(P-LCR%)-静脉血: 28.9%；单核细胞计数(Mono#)-静脉血: 0.610E9/L；钠离子(Na+)-静脉血: 143.5mmol/L；总胆固醇(TC)-静脉血: 5.13mmol/L；总胆红素(TBIL)-静脉血: 11.7umol/L；甘油三酯(TG)-静脉血: 1.44mmol/L；红细胞比容(Hct)-静脉血: 48.1%；中性粒细胞计数(Neut#)-静脉血: 3.310E9/L；白细胞计数(WBC#)-静脉血: 6.2110E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.86；中性粒细胞百分比(Neut%)-静脉血: 0.528；总钙(Ca)-静脉血: 2.18mmol/L；总蛋白(TP)-静脉血: 76.63g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.38；α-L-岩藻糖苷酶(AFU)-静脉血: 35.5U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.97mmolL；淋巴细胞计数(Lymph#)-静脉血: 2.110E9/L；间接胆红素(IBIL)-静脉血: 7.9umolL；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；尿素氮(BUN)-静脉血: 4.1mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 333g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.9；单核细胞百分比(Mono%)-静脉血: 0.103；血液二氧化碳含量ctCO2(B)-静脉血: 26.……\n- [全程D44] 检验组合: 白细胞计数(WBC#)-静脉血: 4.4610E9/L；镁离子(Mg2+)-静脉血: 0.96mmol/L；葡萄糖(Glu)-静脉血: 4.12mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；丙氨酸氨基转移酶(ALT)-静脉血: 16U/L；总蛋白(TP)-静脉血: 72.33g/L；胱抑素(Cys-C)-静脉血: 0.78mg/L；血小板分布宽度(PDW)-静脉血: 11.6%；中性粒细胞计数(Neut#)-静脉血: 3.110E9/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.910E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 35.8U/L；C-反应蛋白(CRP)-静脉血: 3.43mg/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.1；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.32mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.9；氯离子(Cl-)-静脉血: 103mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 29mmol/L；乳酸脱氢酶(LDH)-静脉血: 172.3U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.195；直接胆红素(DBIL)-静脉血: 4.2umol/L；球蛋白(GLO)-静脉血: 29.23g/L；甘油三酯(TG)-静脉血: 1.13mmol/L；血小板计数(PLT#)-静脉血: 16510E9/L；钾离子(K+)-静脉血: 4.12mmol/L；肌酐(Crea)-静脉血: 67.7umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.3U/L；白蛋白(ALB)-静脉血: 43.1g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均血小板体积(MPV)-静脉血: 9.8fL；载脂蛋白AI(apoAI)-静脉血: 1.11g/L；总胆红素(TBIL)-静脉血: 12.6umol/L；单核细胞百分比(Mono%)-静脉血: 0.09；间接胆红素(IBIL)-静脉血: 8.4umolL；血红蛋白(Hb)-静脉血: 148g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 32.8U/L；红细胞……\n- [全程D51] 检验组合: 磷(P)-静脉血: 1.15mmol/L；氯离子(Cl-)-静脉血: 103.1mmol/L；球蛋白(GLO)-静脉血: 31.65g/L；中性粒细胞计数(Neut#)-静脉血: 1.110E9/L；钠离子(Na+)-静脉血: 141.8mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；中性粒细胞百分比(Neut%)-静脉血: 0.466；单核细胞百分比(Mono%)-静脉血: 0.221；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.03；血小板比容-静脉血: 15%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；乳酸脱氢酶(LDH)-静脉血: 170.6U/L；总胆红素(TBIL)-静脉血: 9.8umol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.2pg；肌酐(Crea)-静脉血: 72.4umol/L；尿素氮(BUN)-静脉血: 4.2mmol/L；尿酸(UA)-静脉血: 346.6umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.04；红细胞计数(RBC#)-静脉血: 5.1710E12/L；总蛋白(TP)-静脉血: 75.85g/L；平均血小板体积(MPV)-静脉血: 10fL；平均红细胞体积(MCV)-静脉血: 85.7fL；红细胞比容(Hct)-静脉血: 44.3%；白蛋白(ALB)-静脉血: 44.2g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.09mmolL；总胆固醇(TC)-静脉血: 5.11mmol/L；间接胆红素(IBIL)-静脉血: 6.3umolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.51mmol/L；胱抑素(Cys-C)-静脉血: 0.82mg/L；葡萄糖(Glu)-静脉血: 4.91mmol/L；C-反应蛋白(CRP)-静脉血: 2.13mg/L；碱性磷酸酶(ALP)-静脉血: 77.4U/L；总胆汁酸(TBA)-静脉血: 4.3umol/L；载脂蛋白AI(apoAI)-静脉血: 1.23g/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；直接胆红素(DBIL)-静脉血: 3.5umol/L；血小板分布宽度(PDW)-静脉血: 10.8%；血液二氧化碳含量ctCO2(B)-静脉血: 24.1m……\n- [全程D56] 检验组合: 血红蛋白(Hb)-静脉血: 154g/L；白细胞计数(WBC#)-静脉血: 510E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.28；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 48.1；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.6；中性粒细胞计数(Neut#)-静脉血: 3.110E9/L；大血小板百分比(P-LCR%)-静脉血: 28.9%；红细胞比容(Hct)-静脉血: 49.1%；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.612；单核细胞百分比(Mono%)-静脉血: 0.09；平均红细胞血红蛋白含量(MCH)-静脉血: 29.4pg；平均血小板体积(MPV)-静脉血: 10.4fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 11910E9/L；平均红细胞体积(MCV)-静脉血: 93.7fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0；血小板比容-静脉血: 12%；单核细胞计数(Mono#)-静脉血: 0.510E9/L；血小板分布宽度(PDW)-静脉血: 12.6%；红细胞计数(RBC#)-静脉血: 5.2410E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；平均红细胞血红蛋白浓度(MCHC)-静脉血: 314g/L\n- [全程D58] 检验组合: 白蛋白(ALB)-静脉血: 44.1g/L；血液二氧化碳含量ctCO2(B)-静脉血: 29.5mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 342.3g/L；尿酸(UA)-静脉血: 336.4umol/L；平均红细胞体积(MCV)-静脉血: 87.6fL；氯离子(Cl-)-静脉血: 101.4mmol/L；血小板计数(PLT#)-静脉血: 119.610E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.51；球蛋白(GLO)-静脉血: 30.98g/L；碱性磷酸酶(ALP)-静脉血: 84.6U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；天门冬氨酸氨基转移酶(AST)-静脉血: 16.5U/L；有核红细胞百分比(NRBC%)-静脉血: 0；间接胆红素(IBIL)-静脉血: 6umolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.02；载脂蛋白AI(apoAI)-静脉血: 1.07g/L；钠离子(Na+)-静脉血: 140.4mmol/L；葡萄糖(Glu)-静脉血: 4.22mmol/L；直接胆红素(DBIL)-静脉血: 2.9umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.71mmol/L；尿素氮(BUN)-静脉血: 5.4mmol/L；总胆固醇(TC)-静脉血: 5.2mmol/L；单核细胞百分比(Mono%)-静脉血: 0.141；胱抑素(Cys-C)-静脉血: 0.86mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.89mmolL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总胆汁酸(TBA)-静脉血: 7.2umol/L；总胆红素(TBIL)-静脉血: 8.9umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 27U/L；红细胞比容(Hct)-静脉血: 44.8%；淋巴细胞百分比(Lymph%)-静脉血: 0.143；乳酸脱氢酶(LDH)-静脉血: 185U/L；钾离子(K+)-静脉血: 3.96mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 34.8U/L；白细胞计数(WBC#)-静脉血: 4.5310E9/L；平均血小板体积(MPV)-静脉血: 8.57fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.……\n- [全程D64] 超声；腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约19cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D64] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对侧，双肺野纹理清晰，双肺野未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影形态、大小、位置未见异常。双膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。仍有听力下降，请[姓名已隐去]医生信息已隐藏出：根据患者外院鼻咽部检查提示鼻咽部病灶侵犯右侧海绵窦，颅底骨质等，分为分期信息见历史辅助诊断节点，双侧颈部淋巴结肿大，最大径＜6cm，分为分期信息见历史辅助诊断节点，未见远处转移，分为[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点，[计划性表述已隐藏]放疗及同步增敏化疗控制病情，目前行放疗前准备。.\n- [全程D14] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，继续行放化疗前准备，余无特殊。.\n- [全程D17] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，请[姓名已隐去]医生信息已隐藏出：患者目前无特殊，继续行放化疗前准备，继续观察病情。.\n- [全程D20] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，患者放疗计划准备完成，[计划性表述已隐藏]GTV70Gy/32f，GTVnd68Gy/32f，CTV1 60Gy/32f，CTV2 56Gy/32f。拟本周开始放疗，因患者分期晚，病变范围大，视神经、眼球、颞叶剂量较高，已与患者沟通不良反应，患者及时家属表示理解并同意治疗，继续观察病情。.\n- [全程D23] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，患者目前继续行放疗前准备，[姓名已隐去]医生信息已隐藏出：患者继续行放疗前准备，[计划性表述已隐藏]顺铂同期化疗，继续观察病情。.\n- [全程D26] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，患者目前无特殊，拟周一开始行放疗，周二行顺铂100mg/㎡同期化疗，继续行放化疗前准备，继续观察病情。.\n- [全程D52] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。诉吞咽稍有疼痛，体查:I度口腔粘膜反应。昨日查血常规示白细胞计数2.26*10E9/L ↓,中性粒细胞1.1*10E9/L↓，予以升白针对症治疗。下周复查血常规。继续当前放疗。\n- [全程D55] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。诉口干，吞咽稍有疼痛，体查:I度口腔粘膜反应。已予以升白针治疗三天，明日复查血常规，[计划性表述已隐藏]同期DDP第二程化疗。继续放疗治疗。\n- [全程D58] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。诉口干，吞咽稍有疼痛，体查:I度口腔粘膜反应。今日行同期DDP第二程化疗，予以护肝、护胃、制酸、止吐对症治疗。继续放疗治疗。\n- [全程D61] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。诉口干，吞咽稍有疼痛，体查:I度口腔粘膜反应。继续放疗治疗。\n- [全程D64] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者一般情况可，诉耳鸣、听力下降有所缓解，口干及轻微咽痛，无发热、咳嗽、咳痰等不适。查体：I度口腔粘膜反应，张口门齿距4.5cm；颈部淋巴结较前明显缩小，右颈III区可见一长约4cm手术疤痕，颈部皮肤呈放疗后改变。[姓名已隐去]医生信息已隐藏：患者一般情况良好，予以明天出院，嘱患者出院后定期返院复查。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估为疾病进展，停用放疗，改行吉西他滨联合顺铂姑息性化疗。\nB. 评估为部分缓解，继续住院行第3周期顺铂单药同期化疗。\nC. 评估为部分缓解，序贯启动顺铂联合氟尿嘧啶方案辅助化疗3个周期。\nD. 评估为完全缓解，转入头颈外科行右侧颈部淋巴结清扫术。\nE. 评估为部分缓解，对右颈部残留淋巴结追加局部外照射放疗至74Gy。\nF. 评估为疾病稳定，加用西妥昔单抗靶向治疗并延长原发灶放疗疗程。\nG. 评估为部分缓解，转入头颈外科行内镜下鼻咽原发灶切除术。\nH. 评估为有效，继续住院静脉使用抗生素及营养支持以治疗口腔黏膜反应。\nI. 评估为有效，立即安排鼻咽及颈部增强MRI复查以确认靶区消退情况。\nJ. 评估为有效，办理出院，并序贯启动PD-1抑制剂维持治疗1年。\nK. 评估为有效，结束根治性放化疗，予以办理出院并嘱定期门诊随访复查。\nL. 评估为有效，办理出院，并嘱出院后1个月常规行全身PET-CT检查。\n\n请仅输出一个选项字母（A-L）。"}]}
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+{"sample_id":"sample-057bee25fe3533856610d5c8","patient_id":"patient-9fcde7a95f4d57501ecbf7b2","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"A","gold_action":"行电子鼻咽镜检查及鼻咽肿物活检以明确病理诊断。","options":[{"letter":"A","text":"电子鼻咽镜检查及鼻咽肿物活检","is_gold":true},{"letter":"B","text":"颈部淋巴结切开活检术","is_gold":false},{"letter":"C","text":"超声引导下颈部淋巴结细针穿刺活检","is_gold":false},{"letter":"D","text":"全身PET-CT检查","is_gold":false},{"letter":"E","text":"胸部CT、腹部超声及全身骨扫描","is_gold":false},{"letter":"F","text":"鼻内镜下鼻咽肿物切除术","is_gold":false},{"letter":"G","text":"诊断性抗炎治疗2周后复查MRI","is_gold":false},{"letter":"H","text":"外周血EBV-DNA定量检测","is_gold":false},{"letter":"I","text":"鼻咽脱落细胞学检查","is_gold":false},{"letter":"J","text":"鼻咽及颈部CT平扫+增强","is_gold":false},{"letter":"K","text":"鼻咽颅底三维CT重建","is_gold":false},{"letter":"L","text":"颈部淋巴结清扫术","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：咽旁间隙、斜坡、蝶骨基底部、岩尖。\n文本分期信息：N3，M0。\n综合TNM状态：T3N3M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1] 入院记录: 主诉: 右颈肿物半年，右耳听力下降半月；现病史: 缘于6月前患者无意中出现右颈肿物，未予重视，进行性增大，半月前出现右耳听力下降，无头痛、复视，无涕血、面麻等，就诊于当地医院，发现鼻咽肿物。今为求进一步诊治来我院。患者发病以来,精神、饮食、睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟20支/日*5年，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.3℃，P：79次/分，R：20次/分，BP：105/65mmHg,Ht：168cm，Wt：56kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D4] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 V5～V6导联低电压 V1～V3导联r波递增不良\n- [全程D4] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 25.6U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.341；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；平均红细胞体积(MCV)-静脉血: 94.7fL；白细胞计数(WBC#)-静脉血: 4.5110E9/L；平均血小板体积(MPV)-静脉血: 12fL；D-二聚体(D-Dimer)-静脉血: 0.1ug/ml；单核细胞计数(Mono#)-静脉血: 0.510E9/L；磷(P)-静脉血: 1.36mmol/L；甘油三酯(TG)-静脉血: 2.22mmol/L；间接胆红素(IBIL)-静脉血: 5.2umolL；白蛋白(ALB)-静脉血: 44.8g/L；碱性磷酸酶(ALP)-静脉血: 81.9U/L；凝血酶时间(TT)-静脉血: 18.5sec.；载脂蛋白B(apoB)-静脉血: 0.57g/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.1U/L；阴离子间隙(AG)-静脉血: 11；血小板比容-静脉血: 15%；凝血酶原时间(PT)-静脉血: 11.7sec.；肌酐(Crea)-静脉血: 82.7umol/L；总胆红素(TBIL)-静脉血: 8.2umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.503；球蛋白(GLO)-静脉血: 25.56g/L；红细胞计数(RBC#)-静脉血: 4.5210E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；大血小板百分比(P-LCR%)-静脉血: 40%；血小板分布宽度(PDW)-静脉血: 14.2%；凝血酶原时间活动度(PTA)-静脉血: 90.4%；乳酸脱氢酶(LDH)-静脉血: 359.7U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32.3pg；ABO血型-静脉血: B；总钙(Ca)-静脉血: 2.3mmol/L；镁离子(Mg2+)-静脉血: 0.99mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 146g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；γ-谷氨酰基转移酶(GGT)-静脉血: 14.6U/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.1mmol/L……\n- [全程D5] 检验组合: 乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阳性(+)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D6] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、双侧壁明显不均匀增厚，平扫T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，双侧咽隐窝变浅，双侧咽旁脂肪间隙稍狭窄；双侧腭帆提肌、腭帆张肌、头长肌受压。双侧咽后见肿大淋巴结，左侧较大者短径11mm，右侧较大者短径12mm。 双侧后鼻孔堵塞，口咽双侧壁未见受累增厚。 双侧翼腭窝、颞下窝未见异常。 蝶骨基底部、斜坡、双侧岩尖、双侧枕骨基底部骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽；双侧筛窦、蝶窦，右乳突内见积液；上颌窦、左乳突充气良好，骨壁完整；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双颈II区、右颈III、IV区见淋巴结肿大，部分融合，较大者短径28mm，信号欠均匀，增强较明显不均匀强化。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。；检查结论: 鼻咽顶壁、顶后壁、双侧壁明显不均匀增厚，考虑鼻咽癌。 颅底骨质破坏。 双侧咽后、双颈部多发淋巴结肿大，考虑转移瘤。 副鼻窦炎；右乳突炎。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 电子鼻咽镜检查及鼻咽肿物活检\nB. 颈部淋巴结切开活检术\nC. 超声引导下颈部淋巴结细针穿刺活检\nD. 全身PET-CT检查\nE. 胸部CT、腹部超声及全身骨扫描\nF. 鼻内镜下鼻咽肿物切除术\nG. 诊断性抗炎治疗2周后复查MRI\nH. 外周血EBV-DNA定量检测\nI. 鼻咽脱落细胞学检查\nJ. 鼻咽及颈部CT平扫+增强\nK. 鼻咽颅底三维CT重建\nL. 颈部淋巴结清扫术\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：咽旁间隙、斜坡、蝶骨基底部、岩尖。\n文本分期信息：N3，M0。\n综合TNM状态：T3N3M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1] 入院记录: 主诉: 右颈肿物半年，右耳听力下降半月；现病史: 缘于6月前患者无意中出现右颈肿物，未予重视，进行性增大，半月前出现右耳听力下降，无头痛、复视，无涕血、面麻等，就诊于当地医院，发现鼻咽肿物。今为求进一步诊治来我院。患者发病以来,精神、饮食、睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟20支/日*5年，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.3℃，P：79次/分，R：20次/分，BP：105/65mmHg,Ht：168cm，Wt：56kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D4] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 V5～V6导联低电压 V1～V3导联r波递增不良\n- [全程D4] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 25.6U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.341；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；平均红细胞体积(MCV)-静脉血: 94.7fL；白细胞计数(WBC#)-静脉血: 4.5110E9/L；平均血小板体积(MPV)-静脉血: 12fL；D-二聚体(D-Dimer)-静脉血: 0.1ug/ml；单核细胞计数(Mono#)-静脉血: 0.510E9/L；磷(P)-静脉血: 1.36mmol/L；甘油三酯(TG)-静脉血: 2.22mmol/L；间接胆红素(IBIL)-静脉血: 5.2umolL；白蛋白(ALB)-静脉血: 44.8g/L；碱性磷酸酶(ALP)-静脉血: 81.9U/L；凝血酶时间(TT)-静脉血: 18.5sec.；载脂蛋白B(apoB)-静脉血: 0.57g/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.1U/L；阴离子间隙(AG)-静脉血: 11；血小板比容-静脉血: 15%；凝血酶原时间(PT)-静脉血: 11.7sec.；肌酐(Crea)-静脉血: 82.7umol/L；总胆红素(TBIL)-静脉血: 8.2umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.503；球蛋白(GLO)-静脉血: 25.56g/L；红细胞计数(RBC#)-静脉血: 4.5210E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；大血小板百分比(P-LCR%)-静脉血: 40%；血小板分布宽度(PDW)-静脉血: 14.2%；凝血酶原时间活动度(PTA)-静脉血: 90.4%；乳酸脱氢酶(LDH)-静脉血: 359.7U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32.3pg；ABO血型-静脉血: B；总钙(Ca)-静脉血: 2.3mmol/L；镁离子(Mg2+)-静脉血: 0.99mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 146g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；γ-谷氨酰基转移酶(GGT)-静脉血: 14.6U/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.1mmol/L……\n- [全程D5] 检验组合: 乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阳性(+)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D6] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、双侧壁明显不均匀增厚，平扫T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，双侧咽隐窝变浅，双侧咽旁脂肪间隙稍狭窄；双侧腭帆提肌、腭帆张肌、头长肌受压。双侧咽后见肿大淋巴结，左侧较大者短径11mm，右侧较大者短径12mm。 双侧后鼻孔堵塞，口咽双侧壁未见受累增厚。 双侧翼腭窝、颞下窝未见异常。 蝶骨基底部、斜坡、双侧岩尖、双侧枕骨基底部骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽；双侧筛窦、蝶窦，右乳突内见积液；上颌窦、左乳突充气良好，骨壁完整；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双颈II区、右颈III、IV区见淋巴结肿大，部分融合，较大者短径28mm，信号欠均匀，增强较明显不均匀强化。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。；检查结论: 鼻咽顶壁、顶后壁、双侧壁明显不均匀增厚，考虑鼻咽癌。 颅底骨质破坏。 双侧咽后、双颈部多发淋巴结肿大，考虑转移瘤。 副鼻窦炎；右乳突炎。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 电子鼻咽镜检查及鼻咽肿物活检\nB. 颈部淋巴结切开活检术\nC. 超声引导下颈部淋巴结细针穿刺活检\nD. 全身PET-CT检查\nE. 胸部CT、腹部超声及全身骨扫描\nF. 鼻内镜下鼻咽肿物切除术\nG. 诊断性抗炎治疗2周后复查MRI\nH. 外周血EBV-DNA定量检测\nI. 鼻咽脱落细胞学检查\nJ. 鼻咽及颈部CT平扫+增强\nK. 鼻咽颅底三维CT重建\nL. 颈部淋巴结清扫术\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-ea63b7a358722be15870f84c","patient_id":"patient-9fcde7a95f4d57501ecbf7b2","turn_id":"turn04","turn_position":3,"turn_type":"initial_treatment_selection","gold_letter":"C","gold_action":"完善中心静脉置管，行诱导化疗序贯根治性同期放化疗。","options":[{"letter":"A","text":"完善中心静脉置管，直接行根治性同期放化疗","is_gold":false},{"letter":"B","text":"完善中心静脉置管，行诱导化疗序贯单纯根治性放疗","is_gold":false},{"letter":"C","text":"完善中心静脉置管，行诱导化疗序贯根治性同期放化疗","is_gold":true},{"letter":"D","text":"完善中心静脉置管，行诱导化疗序贯根治性同期放化疗及辅助化疗","is_gold":false},{"letter":"E","text":"完善中心静脉置管，行诱导化疗联合PD-1单抗序贯根治性同期放化疗","is_gold":false},{"letter":"F","text":"完善中心静脉置管，直接行根治性同期放化疗及辅助化疗","is_gold":false},{"letter":"G","text":"完善中心静脉置管，行诱导化疗序贯根治性放疗联合EGFR单抗","is_gold":false},{"letter":"H","text":"完善中心静脉置管，行诱导化疗，放疗前行右颈部淋巴结清扫术","is_gold":false},{"letter":"I","text":"完善中心静脉置管，行姑息性化疗，视颈部淋巴结退缩情况决定放疗时机","is_gold":false},{"letter":"J","text":"完善中心静脉置管，直接行根治性放疗联合EGFR单抗","is_gold":false},{"letter":"K","text":"完善中心静脉置管，行诱导化疗序贯根治性放疗及辅助化疗","is_gold":false},{"letter":"L","text":"完善中心静脉置管，行诱导化疗联合EGFR单抗序贯单纯根治性放疗","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：咽旁间隙、斜坡、蝶骨基底部、岩尖。\n文本分期信息：N3，M0。\n综合TNM状态：T3N3M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1] 入院记录: 主诉: 右颈肿物半年，右耳听力下降半月；现病史: 缘于6月前患者无意中出现右颈肿物，未予重视，进行性增大，半月前出现右耳听力下降，无头痛、复视，无涕血、面麻等，就诊于当地医院，发现鼻咽肿物。今为求进一步诊治来我院。患者发病以来,精神、饮食、睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟20支/日*5年，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.3℃，P：79次/分，R：20次/分，BP：105/65mmHg,Ht：168cm，Wt：56kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D1] 入院记录: 主诉: 右颈肿物半年，右耳听力下降半月；现病史: 缘于6月前患者无意中出现右颈肿物，未予重视，进行性增大，半月前出现右耳听力下降，无头痛、复视，无涕血、面麻等，就诊于当地医院，发现鼻咽肿物。今为求进一步诊治来我院。患者发病以来,精神、饮食、睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟20支/日*5年，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.3℃，P：79次/分，R：20次/分，BP：105/65mmHg,Ht：168cm，Wt：56kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率79次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D4] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 V5～V6导联低电压 V1～V3导联r波递增不良\n- [全程D4] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 25.6U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.341；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；平均红细胞体积(MCV)-静脉血: 94.7fL；白细胞计数(WBC#)-静脉血: 4.5110E9/L；平均血小板体积(MPV)-静脉血: 12fL；D-二聚体(D-Dimer)-静脉血: 0.1ug/ml；单核细胞计数(Mono#)-静脉血: 0.510E9/L；磷(P)-静脉血: 1.36mmol/L；甘油三酯(TG)-静脉血: 2.22mmol/L；间接胆红素(IBIL)-静脉血: 5.2umolL；白蛋白(ALB)-静脉血: 44.8g/L；碱性磷酸酶(ALP)-静脉血: 81.9U/L；凝血酶时间(TT)-静脉血: 18.5sec.；载脂蛋白B(apoB)-静脉血: 0.57g/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.1U/L；阴离子间隙(AG)-静脉血: 11；血小板比容-静脉血: 15%；凝血酶原时间(PT)-静脉血: 11.7sec.；肌酐(Crea)-静脉血: 82.7umol/L；总胆红素(TBIL)-静脉血: 8.2umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.503；球蛋白(GLO)-静脉血: 25.56g/L；红细胞计数(RBC#)-静脉血: 4.5210E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；大血小板百分比(P-LCR%)-静脉血: 40%；血小板分布宽度(PDW)-静脉血: 14.2%；凝血酶原时间活动度(PTA)-静脉血: 90.4%；乳酸脱氢酶(LDH)-静脉血: 359.7U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32.3pg；ABO血型-静脉血: B；总钙(Ca)-静脉血: 2.3mmol/L；镁离子(Mg2+)-静脉血: 0.99mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 146g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；γ-谷氨酰基转移酶(GGT)-静脉血: 14.6U/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.1mmol/L……\n- [全程D5] 检验组合: 乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阳性(+)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D6] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、双侧壁明显不均匀增厚，平扫T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，双侧咽隐窝变浅，双侧咽旁脂肪间隙稍狭窄；双侧腭帆提肌、腭帆张肌、头长肌受压。双侧咽后见肿大淋巴结，左侧较大者短径11mm，右侧较大者短径12mm。 双侧后鼻孔堵塞，口咽双侧壁未见受累增厚。 双侧翼腭窝、颞下窝未见异常。 蝶骨基底部、斜坡、双侧岩尖、双侧枕骨基底部骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽；双侧筛窦、蝶窦，右乳突内见积液；上颌窦、左乳突充气良好，骨壁完整；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双颈II区、右颈III、IV区见淋巴结肿大，部分融合，较大者短径28mm，信号欠均匀，增强较明显不均匀强化。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。；检查结论: 鼻咽顶壁、顶后壁、双侧壁明显不均匀增厚，考虑鼻咽癌。 颅底骨质破坏。 双侧咽后、双颈部多发淋巴结肿大，考虑转移瘤。 副鼻窦炎；右乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见: 左颈II区可见多个大小不一肿大淋巴结，最大约22mm×12mm，边界清，椭圆形，内部回声均匀，后方回声稍增强，淋巴门未探及。 CDFI:上述淋巴结内可见周边型血流信号。 左颈淋巴结穿刺活检： 常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以16G穿刺针穿刺入左颈肿物内，进针2次，取出长约2cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。；检查结论: 左侧颈部肿大淋巴结穿刺活检。 不适随诊。 4个工作日后凭发票到2号楼6楼病理科取结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善中心静脉置管，直接行根治性同期放化疗\nB. 完善中心静脉置管，行诱导化疗序贯单纯根治性放疗\nC. 完善中心静脉置管，行诱导化疗序贯根治性同期放化疗\nD. 完善中心静脉置管，行诱导化疗序贯根治性同期放化疗及辅助化疗\nE. 完善中心静脉置管，行诱导化疗联合PD-1单抗序贯根治性同期放化疗\nF. 完善中心静脉置管，直接行根治性同期放化疗及辅助化疗\nG. 完善中心静脉置管，行诱导化疗序贯根治性放疗联合EGFR单抗\nH. 完善中心静脉置管，行诱导化疗，放疗前行右颈部淋巴结清扫术\nI. 完善中心静脉置管，行姑息性化疗，视颈部淋巴结退缩情况决定放疗时机\nJ. 完善中心静脉置管，直接行根治性放疗联合EGFR单抗\nK. 完善中心静脉置管，行诱导化疗序贯根治性放疗及辅助化疗\nL. 完善中心静脉置管，行诱导化疗联合EGFR单抗序贯单纯根治性放疗\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：咽旁间隙、斜坡、蝶骨基底部、岩尖。\n文本分期信息：N3，M0。\n综合TNM状态：T3N3M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1] 入院记录: 主诉: 右颈肿物半年，右耳听力下降半月；现病史: 缘于6月前患者无意中出现右颈肿物，未予重视，进行性增大，半月前出现右耳听力下降，无头痛、复视，无涕血、面麻等，就诊于当地医院，发现鼻咽肿物。今为求进一步诊治来我院。患者发病以来,精神、饮食、睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟20支/日*5年，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.3℃，P：79次/分，R：20次/分，BP：105/65mmHg,Ht：168cm，Wt：56kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D1] 入院记录: 主诉: 右颈肿物半年，右耳听力下降半月；现病史: 缘于6月前患者无意中出现右颈肿物，未予重视，进行性增大，半月前出现右耳听力下降，无头痛、复视，无涕血、面麻等，就诊于当地医院，发现鼻咽肿物。今为求进一步诊治来我院。患者发病以来,精神、饮食、睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟20支/日*5年，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.3℃，P：79次/分，R：20次/分，BP：105/65mmHg,Ht：168cm，Wt：56kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率79次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D4] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 V5～V6导联低电压 V1～V3导联r波递增不良\n- [全程D4] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 25.6U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.341；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；平均红细胞体积(MCV)-静脉血: 94.7fL；白细胞计数(WBC#)-静脉血: 4.5110E9/L；平均血小板体积(MPV)-静脉血: 12fL；D-二聚体(D-Dimer)-静脉血: 0.1ug/ml；单核细胞计数(Mono#)-静脉血: 0.510E9/L；磷(P)-静脉血: 1.36mmol/L；甘油三酯(TG)-静脉血: 2.22mmol/L；间接胆红素(IBIL)-静脉血: 5.2umolL；白蛋白(ALB)-静脉血: 44.8g/L；碱性磷酸酶(ALP)-静脉血: 81.9U/L；凝血酶时间(TT)-静脉血: 18.5sec.；载脂蛋白B(apoB)-静脉血: 0.57g/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.1U/L；阴离子间隙(AG)-静脉血: 11；血小板比容-静脉血: 15%；凝血酶原时间(PT)-静脉血: 11.7sec.；肌酐(Crea)-静脉血: 82.7umol/L；总胆红素(TBIL)-静脉血: 8.2umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.503；球蛋白(GLO)-静脉血: 25.56g/L；红细胞计数(RBC#)-静脉血: 4.5210E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；大血小板百分比(P-LCR%)-静脉血: 40%；血小板分布宽度(PDW)-静脉血: 14.2%；凝血酶原时间活动度(PTA)-静脉血: 90.4%；乳酸脱氢酶(LDH)-静脉血: 359.7U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32.3pg；ABO血型-静脉血: B；总钙(Ca)-静脉血: 2.3mmol/L；镁离子(Mg2+)-静脉血: 0.99mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 146g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；γ-谷氨酰基转移酶(GGT)-静脉血: 14.6U/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.1mmol/L……\n- [全程D5] 检验组合: 乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阳性(+)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D6] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、双侧壁明显不均匀增厚，平扫T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，双侧咽隐窝变浅，双侧咽旁脂肪间隙稍狭窄；双侧腭帆提肌、腭帆张肌、头长肌受压。双侧咽后见肿大淋巴结，左侧较大者短径11mm，右侧较大者短径12mm。 双侧后鼻孔堵塞，口咽双侧壁未见受累增厚。 双侧翼腭窝、颞下窝未见异常。 蝶骨基底部、斜坡、双侧岩尖、双侧枕骨基底部骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽；双侧筛窦、蝶窦，右乳突内见积液；上颌窦、左乳突充气良好，骨壁完整；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双颈II区、右颈III、IV区见淋巴结肿大，部分融合，较大者短径28mm，信号欠均匀，增强较明显不均匀强化。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。；检查结论: 鼻咽顶壁、顶后壁、双侧壁明显不均匀增厚，考虑鼻咽癌。 颅底骨质破坏。 双侧咽后、双颈部多发淋巴结肿大，考虑转移瘤。 副鼻窦炎；右乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见: 左颈II区可见多个大小不一肿大淋巴结，最大约22mm×12mm，边界清，椭圆形，内部回声均匀，后方回声稍增强，淋巴门未探及。 CDFI:上述淋巴结内可见周边型血流信号。 左颈淋巴结穿刺活检： 常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以16G穿刺针穿刺入左颈肿物内，进针2次，取出长约2cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。；检查结论: 左侧颈部肿大淋巴结穿刺活检。 不适随诊。 4个工作日后凭发票到2号楼6楼病理科取结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善中心静脉置管，直接行根治性同期放化疗\nB. 完善中心静脉置管，行诱导化疗序贯单纯根治性放疗\nC. 完善中心静脉置管，行诱导化疗序贯根治性同期放化疗\nD. 完善中心静脉置管，行诱导化疗序贯根治性同期放化疗及辅助化疗\nE. 完善中心静脉置管，行诱导化疗联合PD-1单抗序贯根治性同期放化疗\nF. 完善中心静脉置管，直接行根治性同期放化疗及辅助化疗\nG. 完善中心静脉置管，行诱导化疗序贯根治性放疗联合EGFR单抗\nH. 完善中心静脉置管，行诱导化疗，放疗前行右颈部淋巴结清扫术\nI. 完善中心静脉置管，行姑息性化疗，视颈部淋巴结退缩情况决定放疗时机\nJ. 完善中心静脉置管，直接行根治性放疗联合EGFR单抗\nK. 完善中心静脉置管，行诱导化疗序贯根治性放疗及辅助化疗\nL. 完善中心静脉置管，行诱导化疗联合EGFR单抗序贯单纯根治性放疗\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-077ecf4aba208fcc4f66c309","patient_id":"patient-9fcde7a95f4d57501ecbf7b2","turn_id":"turn05","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"D","gold_action":"继续放疗，针对轻度恶心给予常规止吐对症处理，按规范进行PICC导管维护，并定期复查血常规与生化。","options":[{"letter":"A","text":"暂停放疗，给予重组人粒细胞集落刺激因子皮下注射，处理淋巴细胞减少，待血象恢复后恢复放疗。","is_gold":false},{"letter":"B","text":"暂停放疗，给予静脉营养支持及补液，处理恶心症状，待胃肠道反应缓解后重新评估放疗计划。","is_gold":false},{"letter":"C","text":"继续放疗，对淋巴细胞减少预防性静脉滴注广谱抗生素，并常规进行PICC导管维护。","is_gold":false},{"letter":"D","text":"继续放疗，给予常规止吐对症处理，处理轻度恶心，按规范进行PICC导管维护，并定期复查血常规与生化。","is_gold":true},{"letter":"E","text":"继续放疗，对出现的骨髓抑制，将下一周期顺铂化疗剂量减量20%，并常规进行PICC导管维护。","is_gold":false},{"letter":"F","text":"暂停放疗，拔除PICC导管改用外周静脉留置针，继续常规止吐对症支持与定期复查。","is_gold":false},{"letter":"G","text":"继续放疗，给予重组人白介素-2免疫支持治疗，处理淋巴细胞减少，并定期复查血常规与生化。","is_gold":false},{"letter":"H","text":"暂停放疗，立即行鼻咽及颈部MRI复查以评估放化疗疗效，并决定后续放疗剂量。","is_gold":false},{"letter":"I","text":"继续放疗，终止同期化疗计划，后续仅行单纯放射治疗，并常规进行PICC导管维护。","is_gold":false},{"letter":"J","text":"继续放疗，加用大剂量糖皮质激素冲击止吐，处理恶心症状，并预防性使用抗真菌药物。","is_gold":false},{"letter":"K","text":"暂停放疗，转入重症监护室进行严密生命体征监测与器官功能支持，暂缓抗肿瘤治疗。","is_gold":false},{"letter":"L","text":"继续放疗，立即启动第二周期顺铂同期化疗，并给予5-HT3受体拮抗剂联合NK-1受体拮抗剂。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：咽旁间隙、斜坡、蝶骨基底部、岩尖。\n文本分期信息：N3，M0。\n综合TNM状态：T3N3M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1] 入院记录: 主诉: 右颈肿物半年，右耳听力下降半月；现病史: 缘于6月前患者无意中出现右颈肿物，未予重视，进行性增大，半月前出现右耳听力下降，无头痛、复视，无涕血、面麻等，就诊于当地医院，发现鼻咽肿物。今为求进一步诊治来我院。患者发病以来,精神、饮食、睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟20支/日*5年，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.3℃，P：79次/分，R：20次/分，BP：105/65mmHg,Ht：168cm，Wt：56kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D1] 入院记录: 主诉: 右颈肿物半年，右耳听力下降半月；现病史: 缘于6月前患者无意中出现右颈肿物，未予重视，进行性增大，半月前出现右耳听力下降，无头痛、复视，无涕血、面麻等，就诊于当地医院，发现鼻咽肿物。今为求进一步诊治来我院。患者发病以来,精神、饮食、睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟20支/日*5年，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.3℃，P：79次/分，R：20次/分，BP：105/65mmHg,Ht：168cm，Wt：56kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率79次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D4] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 V5～V6导联低电压 V1～V3导联r波递增不良\n- [全程D4] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 25.6U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.341；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；平均红细胞体积(MCV)-静脉血: 94.7fL；白细胞计数(WBC#)-静脉血: 4.5110E9/L；平均血小板体积(MPV)-静脉血: 12fL；D-二聚体(D-Dimer)-静脉血: 0.1ug/ml；单核细胞计数(Mono#)-静脉血: 0.510E9/L；磷(P)-静脉血: 1.36mmol/L；甘油三酯(TG)-静脉血: 2.22mmol/L；间接胆红素(IBIL)-静脉血: 5.2umolL；白蛋白(ALB)-静脉血: 44.8g/L；碱性磷酸酶(ALP)-静脉血: 81.9U/L；凝血酶时间(TT)-静脉血: 18.5sec.；载脂蛋白B(apoB)-静脉血: 0.57g/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.1U/L；阴离子间隙(AG)-静脉血: 11；血小板比容-静脉血: 15%；凝血酶原时间(PT)-静脉血: 11.7sec.；肌酐(Crea)-静脉血: 82.7umol/L；总胆红素(TBIL)-静脉血: 8.2umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.503；球蛋白(GLO)-静脉血: 25.56g/L；红细胞计数(RBC#)-静脉血: 4.5210E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；大血小板百分比(P-LCR%)-静脉血: 40%；血小板分布宽度(PDW)-静脉血: 14.2%；凝血酶原时间活动度(PTA)-静脉血: 90.4%；乳酸脱氢酶(LDH)-静脉血: 359.7U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32.3pg；ABO血型-静脉血: B；总钙(Ca)-静脉血: 2.3mmol/L；镁离子(Mg2+)-静脉血: 0.99mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 146g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；γ-谷氨酰基转移酶(GGT)-静脉血: 14.6U/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.1mmol/L……\n- [全程D5] 检验组合: 乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阳性(+)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D6] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、双侧壁明显不均匀增厚，平扫T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，双侧咽隐窝变浅，双侧咽旁脂肪间隙稍狭窄；双侧腭帆提肌、腭帆张肌、头长肌受压。双侧咽后见肿大淋巴结，左侧较大者短径11mm，右侧较大者短径12mm。 双侧后鼻孔堵塞，口咽双侧壁未见受累增厚。 双侧翼腭窝、颞下窝未见异常。 蝶骨基底部、斜坡、双侧岩尖、双侧枕骨基底部骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽；双侧筛窦、蝶窦，右乳突内见积液；上颌窦、左乳突充气良好，骨壁完整；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双颈II区、右颈III、IV区见淋巴结肿大，部分融合，较大者短径28mm，信号欠均匀，增强较明显不均匀强化。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。；检查结论: 鼻咽顶壁、顶后壁、双侧壁明显不均匀增厚，考虑鼻咽癌。 颅底骨质破坏。 双侧咽后、双颈部多发淋巴结肿大，考虑转移瘤。 副鼻窦炎；右乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见: 左颈II区可见多个大小不一肿大淋巴结，最大约22mm×12mm，边界清，椭圆形，内部回声均匀，后方回声稍增强，淋巴门未探及。 CDFI:上述淋巴结内可见周边型血流信号。 左颈淋巴结穿刺活检： 常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以16G穿刺针穿刺入左颈肿物内，进针2次，取出长约2cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。；检查结论: 左侧颈部肿大淋巴结穿刺活检。 不适随诊。 4个工作日后凭发票到2号楼6楼病理科取结果。\n- [全程D20] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右旁T7椎体横突水平，估计位于上腔静脉内。；检查结论: PICC管位置如上所述。\n- [全程D20] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 24mm AO 28mm MV E 0.53m/s EF 63% LV 37mm IVS 8mm A 0.41m/s FS 34% RA 35mm LVPW 6mm RV 16mm PA 14mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 心脏结构及运动未见异常 各房室腔及大血管未探及异常血流信号 心功能正常\n- [全程D21] 检验组合: 隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；酮体(KET)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；比重(SG)-尿液: 1.021；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D22] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 5.5；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.012；颜色-尿液: Light-Yellow；隐血(OB)-尿液: -（参考: 阴性）\n- [全程D28] 检验组合: 钠离子(Na+)-静脉血: 138.4mmol/L；胱抑素(Cys-C)-静脉血: 0.85mg/L；葡萄糖(Glu)-静脉血: 4.19mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；碱性磷酸酶(ALP)-静脉血: 77.2U/L；尿素氮(BUN)-静脉血: 4.1mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 32.5pg；淋巴细胞百分比(Lymph%)-静脉血: 0.13；C-反应蛋白(CRP)-静脉血: 2.54mg/L；氯离子(Cl-)-静脉血: 98.1mmol/L；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.64；阴离子间隙(AG)-静脉血: 16；红细胞比容(Hct)-静脉血: 43.3%；磷(P)-静脉血: 1.38mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.695；血液二氧化碳含量ctCO2(B)-静脉血: 24.3mmol/L；总胆汁酸(TBA)-静脉血: 2.1umol/L；总钙(Ca)-静脉血: 2.12mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 32.1U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.86；γ-谷氨酰基转移酶(GGT)-静脉血: 21.1U/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；甘油三酯(TG)-静脉血: 0.75mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；载脂蛋白B(apoB)-静脉血: 0.58g/L；直接胆红素(DBIL)-静脉血: 4.7umol/L；乳酸脱氢酶(LDH)-静脉血: 269.3U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 36.1U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；平均红细胞体积(MCV)-静脉血: 95.9fL；单核细胞百分比(Mono%)-静脉血: 0.13；总胆固醇(TC)-静脉血: 2.75mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339g/L；球蛋白(GLO)-静脉血: 21.89g/……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D2] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉右耳听力下降，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，结合患者检查，认为患者鼻咽癌可能性大，指示完善相关检查后在决定下一步治疗方案，遵嘱执行。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D14] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉右耳听力下降，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，指示尽快完成放疗计划，遵嘱执行。\n- [全程D19] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉右耳听力下降，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，考虑患者放疗计划即将完成，指示可提前2天先予以化疗，指示今日予以DDP方案化疗第1程，做好水化、护胃、止呕等对症支持处理，密切观察化疗中副反应，遵嘱执行。\n- [全程D24] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉恶心，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，较前缩小，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，认为患者化疗顺利完成，指示继续放疗，密切观察放疗中副反应，遵嘱执行。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，给予重组人粒细胞集落刺激因子皮下注射，处理淋巴细胞减少，待血象恢复后恢复放疗。\nB. 暂停放疗，给予静脉营养支持及补液，处理恶心症状，待胃肠道反应缓解后重新评估放疗计划。\nC. 继续放疗，对淋巴细胞减少预防性静脉滴注广谱抗生素，并常规进行PICC导管维护。\nD. 继续放疗，给予常规止吐对症处理，处理轻度恶心，按规范进行PICC导管维护，并定期复查血常规与生化。\nE. 继续放疗，对出现的骨髓抑制，将下一周期顺铂化疗剂量减量20%，并常规进行PICC导管维护。\nF. 暂停放疗，拔除PICC导管改用外周静脉留置针，继续常规止吐对症支持与定期复查。\nG. 继续放疗，给予重组人白介素-2免疫支持治疗，处理淋巴细胞减少，并定期复查血常规与生化。\nH. 暂停放疗，立即行鼻咽及颈部MRI复查以评估放化疗疗效，并决定后续放疗剂量。\nI. 继续放疗，终止同期化疗计划，后续仅行单纯放射治疗，并常规进行PICC导管维护。\nJ. 继续放疗，加用大剂量糖皮质激素冲击止吐，处理恶心症状，并预防性使用抗真菌药物。\nK. 暂停放疗，转入重症监护室进行严密生命体征监测与器官功能支持，暂缓抗肿瘤治疗。\nL. 继续放疗，立即启动第二周期顺铂同期化疗，并给予5-HT3受体拮抗剂联合NK-1受体拮抗剂。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：咽旁间隙、斜坡、蝶骨基底部、岩尖。\n文本分期信息：N3，M0。\n综合TNM状态：T3N3M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1] 入院记录: 主诉: 右颈肿物半年，右耳听力下降半月；现病史: 缘于6月前患者无意中出现右颈肿物，未予重视，进行性增大，半月前出现右耳听力下降，无头痛、复视，无涕血、面麻等，就诊于当地医院，发现鼻咽肿物。今为求进一步诊治来我院。患者发病以来,精神、饮食、睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟20支/日*5年，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.3℃，P：79次/分，R：20次/分，BP：105/65mmHg,Ht：168cm，Wt：56kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D1] 入院记录: 主诉: 右颈肿物半年，右耳听力下降半月；现病史: 缘于6月前患者无意中出现右颈肿物，未予重视，进行性增大，半月前出现右耳听力下降，无头痛、复视，无涕血、面麻等，就诊于当地医院，发现鼻咽肿物。今为求进一步诊治来我院。患者发病以来,精神、饮食、睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟20支/日*5年，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.3℃，P：79次/分，R：20次/分，BP：105/65mmHg,Ht：168cm，Wt：56kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率79次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D4] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 V5～V6导联低电压 V1～V3导联r波递增不良\n- [全程D4] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 25.6U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.341；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；平均红细胞体积(MCV)-静脉血: 94.7fL；白细胞计数(WBC#)-静脉血: 4.5110E9/L；平均血小板体积(MPV)-静脉血: 12fL；D-二聚体(D-Dimer)-静脉血: 0.1ug/ml；单核细胞计数(Mono#)-静脉血: 0.510E9/L；磷(P)-静脉血: 1.36mmol/L；甘油三酯(TG)-静脉血: 2.22mmol/L；间接胆红素(IBIL)-静脉血: 5.2umolL；白蛋白(ALB)-静脉血: 44.8g/L；碱性磷酸酶(ALP)-静脉血: 81.9U/L；凝血酶时间(TT)-静脉血: 18.5sec.；载脂蛋白B(apoB)-静脉血: 0.57g/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.1U/L；阴离子间隙(AG)-静脉血: 11；血小板比容-静脉血: 15%；凝血酶原时间(PT)-静脉血: 11.7sec.；肌酐(Crea)-静脉血: 82.7umol/L；总胆红素(TBIL)-静脉血: 8.2umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.503；球蛋白(GLO)-静脉血: 25.56g/L；红细胞计数(RBC#)-静脉血: 4.5210E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；大血小板百分比(P-LCR%)-静脉血: 40%；血小板分布宽度(PDW)-静脉血: 14.2%；凝血酶原时间活动度(PTA)-静脉血: 90.4%；乳酸脱氢酶(LDH)-静脉血: 359.7U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32.3pg；ABO血型-静脉血: B；总钙(Ca)-静脉血: 2.3mmol/L；镁离子(Mg2+)-静脉血: 0.99mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 146g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；γ-谷氨酰基转移酶(GGT)-静脉血: 14.6U/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.1mmol/L……\n- [全程D5] 检验组合: 乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阳性(+)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D6] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、双侧壁明显不均匀增厚，平扫T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，双侧咽隐窝变浅，双侧咽旁脂肪间隙稍狭窄；双侧腭帆提肌、腭帆张肌、头长肌受压。双侧咽后见肿大淋巴结，左侧较大者短径11mm，右侧较大者短径12mm。 双侧后鼻孔堵塞，口咽双侧壁未见受累增厚。 双侧翼腭窝、颞下窝未见异常。 蝶骨基底部、斜坡、双侧岩尖、双侧枕骨基底部骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽；双侧筛窦、蝶窦，右乳突内见积液；上颌窦、左乳突充气良好，骨壁完整；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双颈II区、右颈III、IV区见淋巴结肿大，部分融合，较大者短径28mm，信号欠均匀，增强较明显不均匀强化。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。；检查结论: 鼻咽顶壁、顶后壁、双侧壁明显不均匀增厚，考虑鼻咽癌。 颅底骨质破坏。 双侧咽后、双颈部多发淋巴结肿大，考虑转移瘤。 副鼻窦炎；右乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见: 左颈II区可见多个大小不一肿大淋巴结，最大约22mm×12mm，边界清，椭圆形，内部回声均匀，后方回声稍增强，淋巴门未探及。 CDFI:上述淋巴结内可见周边型血流信号。 左颈淋巴结穿刺活检： 常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以16G穿刺针穿刺入左颈肿物内，进针2次，取出长约2cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。；检查结论: 左侧颈部肿大淋巴结穿刺活检。 不适随诊。 4个工作日后凭发票到2号楼6楼病理科取结果。\n- [全程D20] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右旁T7椎体横突水平，估计位于上腔静脉内。；检查结论: PICC管位置如上所述。\n- [全程D20] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 24mm AO 28mm MV E 0.53m/s EF 63% LV 37mm IVS 8mm A 0.41m/s FS 34% RA 35mm LVPW 6mm RV 16mm PA 14mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 心脏结构及运动未见异常 各房室腔及大血管未探及异常血流信号 心功能正常\n- [全程D21] 检验组合: 隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；酮体(KET)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；比重(SG)-尿液: 1.021；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D22] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 5.5；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.012；颜色-尿液: Light-Yellow；隐血(OB)-尿液: -（参考: 阴性）\n- [全程D28] 检验组合: 钠离子(Na+)-静脉血: 138.4mmol/L；胱抑素(Cys-C)-静脉血: 0.85mg/L；葡萄糖(Glu)-静脉血: 4.19mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；碱性磷酸酶(ALP)-静脉血: 77.2U/L；尿素氮(BUN)-静脉血: 4.1mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 32.5pg；淋巴细胞百分比(Lymph%)-静脉血: 0.13；C-反应蛋白(CRP)-静脉血: 2.54mg/L；氯离子(Cl-)-静脉血: 98.1mmol/L；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.64；阴离子间隙(AG)-静脉血: 16；红细胞比容(Hct)-静脉血: 43.3%；磷(P)-静脉血: 1.38mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.695；血液二氧化碳含量ctCO2(B)-静脉血: 24.3mmol/L；总胆汁酸(TBA)-静脉血: 2.1umol/L；总钙(Ca)-静脉血: 2.12mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 32.1U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.86；γ-谷氨酰基转移酶(GGT)-静脉血: 21.1U/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；甘油三酯(TG)-静脉血: 0.75mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；载脂蛋白B(apoB)-静脉血: 0.58g/L；直接胆红素(DBIL)-静脉血: 4.7umol/L；乳酸脱氢酶(LDH)-静脉血: 269.3U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 36.1U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；平均红细胞体积(MCV)-静脉血: 95.9fL；单核细胞百分比(Mono%)-静脉血: 0.13；总胆固醇(TC)-静脉血: 2.75mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339g/L；球蛋白(GLO)-静脉血: 21.89g/……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D2] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉右耳听力下降，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，结合患者检查，认为患者鼻咽癌可能性大，指示完善相关检查后在决定下一步治疗方案，遵嘱执行。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D14] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉右耳听力下降，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，指示尽快完成放疗计划，遵嘱执行。\n- [全程D19] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉右耳听力下降，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，考虑患者放疗计划即将完成，指示可提前2天先予以化疗，指示今日予以DDP方案化疗第1程，做好水化、护胃、止呕等对症支持处理，密切观察化疗中副反应，遵嘱执行。\n- [全程D24] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉恶心，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，较前缩小，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，认为患者化疗顺利完成，指示继续放疗，密切观察放疗中副反应，遵嘱执行。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，给予重组人粒细胞集落刺激因子皮下注射，处理淋巴细胞减少，待血象恢复后恢复放疗。\nB. 暂停放疗，给予静脉营养支持及补液，处理恶心症状，待胃肠道反应缓解后重新评估放疗计划。\nC. 继续放疗，对淋巴细胞减少预防性静脉滴注广谱抗生素，并常规进行PICC导管维护。\nD. 继续放疗，给予常规止吐对症处理，处理轻度恶心，按规范进行PICC导管维护，并定期复查血常规与生化。\nE. 继续放疗，对出现的骨髓抑制，将下一周期顺铂化疗剂量减量20%，并常规进行PICC导管维护。\nF. 暂停放疗，拔除PICC导管改用外周静脉留置针，继续常规止吐对症支持与定期复查。\nG. 继续放疗，给予重组人白介素-2免疫支持治疗，处理淋巴细胞减少，并定期复查血常规与生化。\nH. 暂停放疗，立即行鼻咽及颈部MRI复查以评估放化疗疗效，并决定后续放疗剂量。\nI. 继续放疗，终止同期化疗计划，后续仅行单纯放射治疗，并常规进行PICC导管维护。\nJ. 继续放疗，加用大剂量糖皮质激素冲击止吐，处理恶心症状，并预防性使用抗真菌药物。\nK. 暂停放疗，转入重症监护室进行严密生命体征监测与器官功能支持，暂缓抗肿瘤治疗。\nL. 继续放疗，立即启动第二周期顺铂同期化疗，并给予5-HT3受体拮抗剂联合NK-1受体拮抗剂。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-6fc96ea65282f416f15f852e","patient_id":"patient-9fcde7a95f4d57501ecbf7b2","turn_id":"turn06","turn_position":5,"turn_type":"toxicity_or_support_decision","gold_letter":"E","gold_action":"继续放疗，予以洗鼻、免疫调节/辅助支持（如香菇多糖）及动静脉置管护理，复查血常规与生化常规。","options":[{"letter":"A","text":"暂停放疗，予以重组人血小板生成素（rhTPO）皮下注射，待血小板恢复后继续放疗。","is_gold":false},{"letter":"B","text":"继续放疗，予以重组人白介素-11（rhIL-11）皮下注射，复查血常规与生化常规。","is_gold":false},{"letter":"C","text":"暂停放疗，输注单采血小板1个治疗量，复查血常规与生化常规。","is_gold":false},{"letter":"D","text":"继续放疗，予以重组人粒细胞集落刺激因子（rhG-CSF）皮下注射，复查血常规。","is_gold":false},{"letter":"E","text":"继续放疗，予以洗鼻、免疫调节/辅助支持（如香菇多糖）及动静脉置管护理，复查血常规与生化常规。","is_gold":true},{"letter":"F","text":"暂停放疗，予以促红细胞生成素（EPO）皮下注射，待血红蛋白恢复后继续放疗。","is_gold":false},{"letter":"G","text":"继续放疗，予以低分子肝素皮下注射预防血栓，复查凝血功能与血常规。","is_gold":false},{"letter":"H","text":"暂停放疗，予以甲泼尼龙静脉滴注提升血小板，复查血常规与生化常规。","is_gold":false},{"letter":"I","text":"继续放疗，予以静脉输注人免疫球蛋白（IVIG），复查血常规与生化常规。","is_gold":false},{"letter":"J","text":"终止放疗，予以单药化疗维持，配合洗鼻及动静脉置管护理。","is_gold":false},{"letter":"K","text":"继续放疗，予以重组人血小板生成素与重组人粒细胞集落刺激因子联合皮下注射。","is_gold":false},{"letter":"L","text":"暂停放疗，予以洗鼻及动静脉置管护理，暂不予升血小板药物干预。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：咽旁间隙、斜坡、蝶骨基底部、岩尖。\n文本分期信息：N3，M0。\n综合TNM状态：T3N3M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1] 入院记录: 主诉: 右颈肿物半年，右耳听力下降半月；现病史: 缘于6月前患者无意中出现右颈肿物，未予重视，进行性增大，半月前出现右耳听力下降，无头痛、复视，无涕血、面麻等，就诊于当地医院，发现鼻咽肿物。今为求进一步诊治来我院。患者发病以来,精神、饮食、睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟20支/日*5年，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.3℃，P：79次/分，R：20次/分，BP：105/65mmHg,Ht：168cm，Wt：56kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D1] 入院记录: 主诉: 右颈肿物半年，右耳听力下降半月；现病史: 缘于6月前患者无意中出现右颈肿物，未予重视，进行性增大，半月前出现右耳听力下降，无头痛、复视，无涕血、面麻等，就诊于当地医院，发现鼻咽肿物。今为求进一步诊治来我院。患者发病以来,精神、饮食、睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟20支/日*5年，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.3℃，P：79次/分，R：20次/分，BP：105/65mmHg,Ht：168cm，Wt：56kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率79次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D4] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 V5～V6导联低电压 V1～V3导联r波递增不良\n- [全程D4] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 25.6U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.341；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；平均红细胞体积(MCV)-静脉血: 94.7fL；白细胞计数(WBC#)-静脉血: 4.5110E9/L；平均血小板体积(MPV)-静脉血: 12fL；D-二聚体(D-Dimer)-静脉血: 0.1ug/ml；单核细胞计数(Mono#)-静脉血: 0.510E9/L；磷(P)-静脉血: 1.36mmol/L；甘油三酯(TG)-静脉血: 2.22mmol/L；间接胆红素(IBIL)-静脉血: 5.2umolL；白蛋白(ALB)-静脉血: 44.8g/L；碱性磷酸酶(ALP)-静脉血: 81.9U/L；凝血酶时间(TT)-静脉血: 18.5sec.；载脂蛋白B(apoB)-静脉血: 0.57g/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.1U/L；阴离子间隙(AG)-静脉血: 11；血小板比容-静脉血: 15%；凝血酶原时间(PT)-静脉血: 11.7sec.；肌酐(Crea)-静脉血: 82.7umol/L；总胆红素(TBIL)-静脉血: 8.2umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.503；球蛋白(GLO)-静脉血: 25.56g/L；红细胞计数(RBC#)-静脉血: 4.5210E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；大血小板百分比(P-LCR%)-静脉血: 40%；血小板分布宽度(PDW)-静脉血: 14.2%；凝血酶原时间活动度(PTA)-静脉血: 90.4%；乳酸脱氢酶(LDH)-静脉血: 359.7U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32.3pg；ABO血型-静脉血: B；总钙(Ca)-静脉血: 2.3mmol/L；镁离子(Mg2+)-静脉血: 0.99mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 146g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；γ-谷氨酰基转移酶(GGT)-静脉血: 14.6U/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.1mmol/L……\n- [全程D5] 检验组合: 乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阳性(+)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D6] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、双侧壁明显不均匀增厚，平扫T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，双侧咽隐窝变浅，双侧咽旁脂肪间隙稍狭窄；双侧腭帆提肌、腭帆张肌、头长肌受压。双侧咽后见肿大淋巴结，左侧较大者短径11mm，右侧较大者短径12mm。 双侧后鼻孔堵塞，口咽双侧壁未见受累增厚。 双侧翼腭窝、颞下窝未见异常。 蝶骨基底部、斜坡、双侧岩尖、双侧枕骨基底部骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽；双侧筛窦、蝶窦，右乳突内见积液；上颌窦、左乳突充气良好，骨壁完整；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双颈II区、右颈III、IV区见淋巴结肿大，部分融合，较大者短径28mm，信号欠均匀，增强较明显不均匀强化。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。；检查结论: 鼻咽顶壁、顶后壁、双侧壁明显不均匀增厚，考虑鼻咽癌。 颅底骨质破坏。 双侧咽后、双颈部多发淋巴结肿大，考虑转移瘤。 副鼻窦炎；右乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见: 左颈II区可见多个大小不一肿大淋巴结，最大约22mm×12mm，边界清，椭圆形，内部回声均匀，后方回声稍增强，淋巴门未探及。 CDFI:上述淋巴结内可见周边型血流信号。 左颈淋巴结穿刺活检： 常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以16G穿刺针穿刺入左颈肿物内，进针2次，取出长约2cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。；检查结论: 左侧颈部肿大淋巴结穿刺活检。 不适随诊。 4个工作日后凭发票到2号楼6楼病理科取结果。\n- [全程D20] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右旁T7椎体横突水平，估计位于上腔静脉内。；检查结论: PICC管位置如上所述。\n- [全程D20] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 24mm AO 28mm MV E 0.53m/s EF 63% LV 37mm IVS 8mm A 0.41m/s FS 34% RA 35mm LVPW 6mm RV 16mm PA 14mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 心脏结构及运动未见异常 各房室腔及大血管未探及异常血流信号 心功能正常\n- [全程D21] 检验组合: 隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；酮体(KET)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；比重(SG)-尿液: 1.021；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D22] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 5.5；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.012；颜色-尿液: Light-Yellow；隐血(OB)-尿液: -（参考: 阴性）\n- [全程D28] 检验组合: 钠离子(Na+)-静脉血: 138.4mmol/L；胱抑素(Cys-C)-静脉血: 0.85mg/L；葡萄糖(Glu)-静脉血: 4.19mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；碱性磷酸酶(ALP)-静脉血: 77.2U/L；尿素氮(BUN)-静脉血: 4.1mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 32.5pg；淋巴细胞百分比(Lymph%)-静脉血: 0.13；C-反应蛋白(CRP)-静脉血: 2.54mg/L；氯离子(Cl-)-静脉血: 98.1mmol/L；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.64；阴离子间隙(AG)-静脉血: 16；红细胞比容(Hct)-静脉血: 43.3%；磷(P)-静脉血: 1.38mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.695；血液二氧化碳含量ctCO2(B)-静脉血: 24.3mmol/L；总胆汁酸(TBA)-静脉血: 2.1umol/L；总钙(Ca)-静脉血: 2.12mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 32.1U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.86；γ-谷氨酰基转移酶(GGT)-静脉血: 21.1U/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；甘油三酯(TG)-静脉血: 0.75mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；载脂蛋白B(apoB)-静脉血: 0.58g/L；直接胆红素(DBIL)-静脉血: 4.7umol/L；乳酸脱氢酶(LDH)-静脉血: 269.3U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 36.1U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；平均红细胞体积(MCV)-静脉血: 95.9fL；单核细胞百分比(Mono%)-静脉血: 0.13；总胆固醇(TC)-静脉血: 2.75mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339g/L；球蛋白(GLO)-静脉血: 21.89g/……\n- [全程D35] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；镁离子(Mg2+)-静脉血: 0.88mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44；载脂蛋白B(apoB)-静脉血: 0.56g/L；钠离子(Na+)-静脉血: 143.1mmol/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞比容(Hct)-静脉血: 37.1%；甘油三酯(TG)-静脉血: 0.68mmol/L；葡萄糖(Glu)-静脉血: 4.35mmol/L；C-反应蛋白(CRP)-静脉血: 16.07mg/L；平均血小板体积(MPV)-静脉血: 11.3fL；血红蛋白(Hb)-静脉血: 125g/L；载脂蛋白AI(apoAI)-静脉血: 0.89g/L；红细胞计数(RBC#)-静脉血: 3.9410E12/L；血小板比容-静脉血: 10%；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；血小板计数(PLT#)-静脉血: 8910E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.14；天门冬氨酸氨基转移酶(AST)-静脉血: 16U/L；丙氨酸氨基转移酶(ALT)-静脉血: 16.4U/L；总钙(Ca)-静脉血: 2.03mmol/L；钾离子(K+)-静脉血: 3.4mmol/L；磷(P)-静脉血: 1.05mmol/L；白蛋白(ALB)-静脉血: 36.3g/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 337g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；直接胆红素(DBIL)-静脉血: 5.4umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 94.2fL；氯离子(Cl-)-静脉血: 105.6mmol/L；肌酐(Crea)-静脉血: 70umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；胱抑素(Cys-C)-静脉血: 0.85mg/L；球蛋白(GLO)-静脉血: 21.19g/L；间接胆红素(IBIL)-静脉血: 5.9umolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D2] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉右耳听力下降，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，结合患者检查，认为患者鼻咽癌可能性大，指示完善相关检查后在决定下一步治疗方案，遵嘱执行。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D14] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉右耳听力下降，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，指示尽快完成放疗计划，遵嘱执行。\n- [全程D19] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉右耳听力下降，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，考虑患者放疗计划即将完成，指示可提前2天先予以化疗，指示今日予以DDP方案化疗第1程，做好水化、护胃、止呕等对症支持处理，密切观察化疗中副反应，遵嘱执行。\n- [全程D24] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉恶心，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，较前缩小，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，认为患者化疗顺利完成，指示继续放疗，密切观察放疗中副反应，遵嘱执行。\n- [全程D29] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，未诉特殊不适，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，较前缩小，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，指示继续放疗，密切观察放疗中副反应，遵嘱执行。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，予以重组人血小板生成素（rhTPO）皮下注射，待血小板恢复后继续放疗。\nB. 继续放疗，予以重组人白介素-11（rhIL-11）皮下注射，复查血常规与生化常规。\nC. 暂停放疗，输注单采血小板1个治疗量，复查血常规与生化常规。\nD. 继续放疗，予以重组人粒细胞集落刺激因子（rhG-CSF）皮下注射，复查血常规。\nE. 继续放疗，予以洗鼻、免疫调节/辅助支持（如香菇多糖）及动静脉置管护理，复查血常规与生化常规。\nF. 暂停放疗，予以促红细胞生成素（EPO）皮下注射，待血红蛋白恢复后继续放疗。\nG. 继续放疗，予以低分子肝素皮下注射预防血栓，复查凝血功能与血常规。\nH. 暂停放疗，予以甲泼尼龙静脉滴注提升血小板，复查血常规与生化常规。\nI. 继续放疗，予以静脉输注人免疫球蛋白（IVIG），复查血常规与生化常规。\nJ. 终止放疗，予以单药化疗维持，配合洗鼻及动静脉置管护理。\nK. 继续放疗，予以重组人血小板生成素与重组人粒细胞集落刺激因子联合皮下注射。\nL. 暂停放疗，予以洗鼻及动静脉置管护理，暂不予升血小板药物干预。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：咽旁间隙、斜坡、蝶骨基底部、岩尖。\n文本分期信息：N3，M0。\n综合TNM状态：T3N3M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1] 入院记录: 主诉: 右颈肿物半年，右耳听力下降半月；现病史: 缘于6月前患者无意中出现右颈肿物，未予重视，进行性增大，半月前出现右耳听力下降，无头痛、复视，无涕血、面麻等，就诊于当地医院，发现鼻咽肿物。今为求进一步诊治来我院。患者发病以来,精神、饮食、睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟20支/日*5年，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.3℃，P：79次/分，R：20次/分，BP：105/65mmHg,Ht：168cm，Wt：56kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D1] 入院记录: 主诉: 右颈肿物半年，右耳听力下降半月；现病史: 缘于6月前患者无意中出现右颈肿物，未予重视，进行性增大，半月前出现右耳听力下降，无头痛、复视，无涕血、面麻等，就诊于当地医院，发现鼻咽肿物。今为求进一步诊治来我院。患者发病以来,精神、饮食、睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟20支/日*5年，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.3℃，P：79次/分，R：20次/分，BP：105/65mmHg,Ht：168cm，Wt：56kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率79次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D4] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 V5～V6导联低电压 V1～V3导联r波递增不良\n- [全程D4] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 25.6U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.341；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；平均红细胞体积(MCV)-静脉血: 94.7fL；白细胞计数(WBC#)-静脉血: 4.5110E9/L；平均血小板体积(MPV)-静脉血: 12fL；D-二聚体(D-Dimer)-静脉血: 0.1ug/ml；单核细胞计数(Mono#)-静脉血: 0.510E9/L；磷(P)-静脉血: 1.36mmol/L；甘油三酯(TG)-静脉血: 2.22mmol/L；间接胆红素(IBIL)-静脉血: 5.2umolL；白蛋白(ALB)-静脉血: 44.8g/L；碱性磷酸酶(ALP)-静脉血: 81.9U/L；凝血酶时间(TT)-静脉血: 18.5sec.；载脂蛋白B(apoB)-静脉血: 0.57g/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.1U/L；阴离子间隙(AG)-静脉血: 11；血小板比容-静脉血: 15%；凝血酶原时间(PT)-静脉血: 11.7sec.；肌酐(Crea)-静脉血: 82.7umol/L；总胆红素(TBIL)-静脉血: 8.2umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.503；球蛋白(GLO)-静脉血: 25.56g/L；红细胞计数(RBC#)-静脉血: 4.5210E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；大血小板百分比(P-LCR%)-静脉血: 40%；血小板分布宽度(PDW)-静脉血: 14.2%；凝血酶原时间活动度(PTA)-静脉血: 90.4%；乳酸脱氢酶(LDH)-静脉血: 359.7U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32.3pg；ABO血型-静脉血: B；总钙(Ca)-静脉血: 2.3mmol/L；镁离子(Mg2+)-静脉血: 0.99mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 146g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；γ-谷氨酰基转移酶(GGT)-静脉血: 14.6U/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.1mmol/L……\n- [全程D5] 检验组合: 乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阳性(+)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D6] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、双侧壁明显不均匀增厚，平扫T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，双侧咽隐窝变浅，双侧咽旁脂肪间隙稍狭窄；双侧腭帆提肌、腭帆张肌、头长肌受压。双侧咽后见肿大淋巴结，左侧较大者短径11mm，右侧较大者短径12mm。 双侧后鼻孔堵塞，口咽双侧壁未见受累增厚。 双侧翼腭窝、颞下窝未见异常。 蝶骨基底部、斜坡、双侧岩尖、双侧枕骨基底部骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽；双侧筛窦、蝶窦，右乳突内见积液；上颌窦、左乳突充气良好，骨壁完整；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双颈II区、右颈III、IV区见淋巴结肿大，部分融合，较大者短径28mm，信号欠均匀，增强较明显不均匀强化。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。；检查结论: 鼻咽顶壁、顶后壁、双侧壁明显不均匀增厚，考虑鼻咽癌。 颅底骨质破坏。 双侧咽后、双颈部多发淋巴结肿大，考虑转移瘤。 副鼻窦炎；右乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见: 左颈II区可见多个大小不一肿大淋巴结，最大约22mm×12mm，边界清，椭圆形，内部回声均匀，后方回声稍增强，淋巴门未探及。 CDFI:上述淋巴结内可见周边型血流信号。 左颈淋巴结穿刺活检： 常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以16G穿刺针穿刺入左颈肿物内，进针2次，取出长约2cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。；检查结论: 左侧颈部肿大淋巴结穿刺活检。 不适随诊。 4个工作日后凭发票到2号楼6楼病理科取结果。\n- [全程D20] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右旁T7椎体横突水平，估计位于上腔静脉内。；检查结论: PICC管位置如上所述。\n- [全程D20] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 24mm AO 28mm MV E 0.53m/s EF 63% LV 37mm IVS 8mm A 0.41m/s FS 34% RA 35mm LVPW 6mm RV 16mm PA 14mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 心脏结构及运动未见异常 各房室腔及大血管未探及异常血流信号 心功能正常\n- [全程D21] 检验组合: 隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；酮体(KET)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；比重(SG)-尿液: 1.021；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D22] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 5.5；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.012；颜色-尿液: Light-Yellow；隐血(OB)-尿液: -（参考: 阴性）\n- [全程D28] 检验组合: 钠离子(Na+)-静脉血: 138.4mmol/L；胱抑素(Cys-C)-静脉血: 0.85mg/L；葡萄糖(Glu)-静脉血: 4.19mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；碱性磷酸酶(ALP)-静脉血: 77.2U/L；尿素氮(BUN)-静脉血: 4.1mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 32.5pg；淋巴细胞百分比(Lymph%)-静脉血: 0.13；C-反应蛋白(CRP)-静脉血: 2.54mg/L；氯离子(Cl-)-静脉血: 98.1mmol/L；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.64；阴离子间隙(AG)-静脉血: 16；红细胞比容(Hct)-静脉血: 43.3%；磷(P)-静脉血: 1.38mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.695；血液二氧化碳含量ctCO2(B)-静脉血: 24.3mmol/L；总胆汁酸(TBA)-静脉血: 2.1umol/L；总钙(Ca)-静脉血: 2.12mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 32.1U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.86；γ-谷氨酰基转移酶(GGT)-静脉血: 21.1U/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；甘油三酯(TG)-静脉血: 0.75mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；载脂蛋白B(apoB)-静脉血: 0.58g/L；直接胆红素(DBIL)-静脉血: 4.7umol/L；乳酸脱氢酶(LDH)-静脉血: 269.3U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 36.1U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；平均红细胞体积(MCV)-静脉血: 95.9fL；单核细胞百分比(Mono%)-静脉血: 0.13；总胆固醇(TC)-静脉血: 2.75mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339g/L；球蛋白(GLO)-静脉血: 21.89g/……\n- [全程D35] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；镁离子(Mg2+)-静脉血: 0.88mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44；载脂蛋白B(apoB)-静脉血: 0.56g/L；钠离子(Na+)-静脉血: 143.1mmol/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞比容(Hct)-静脉血: 37.1%；甘油三酯(TG)-静脉血: 0.68mmol/L；葡萄糖(Glu)-静脉血: 4.35mmol/L；C-反应蛋白(CRP)-静脉血: 16.07mg/L；平均血小板体积(MPV)-静脉血: 11.3fL；血红蛋白(Hb)-静脉血: 125g/L；载脂蛋白AI(apoAI)-静脉血: 0.89g/L；红细胞计数(RBC#)-静脉血: 3.9410E12/L；血小板比容-静脉血: 10%；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；血小板计数(PLT#)-静脉血: 8910E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.14；天门冬氨酸氨基转移酶(AST)-静脉血: 16U/L；丙氨酸氨基转移酶(ALT)-静脉血: 16.4U/L；总钙(Ca)-静脉血: 2.03mmol/L；钾离子(K+)-静脉血: 3.4mmol/L；磷(P)-静脉血: 1.05mmol/L；白蛋白(ALB)-静脉血: 36.3g/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 337g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；直接胆红素(DBIL)-静脉血: 5.4umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 94.2fL；氯离子(Cl-)-静脉血: 105.6mmol/L；肌酐(Crea)-静脉血: 70umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；胱抑素(Cys-C)-静脉血: 0.85mg/L；球蛋白(GLO)-静脉血: 21.19g/L；间接胆红素(IBIL)-静脉血: 5.9umolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D2] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉右耳听力下降，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，结合患者检查，认为患者鼻咽癌可能性大，指示完善相关检查后在决定下一步治疗方案，遵嘱执行。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D14] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉右耳听力下降，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，指示尽快完成放疗计划，遵嘱执行。\n- [全程D19] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉右耳听力下降，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，考虑患者放疗计划即将完成，指示可提前2天先予以化疗，指示今日予以DDP方案化疗第1程，做好水化、护胃、止呕等对症支持处理，密切观察化疗中副反应，遵嘱执行。\n- [全程D24] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉恶心，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，较前缩小，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，认为患者化疗顺利完成，指示继续放疗，密切观察放疗中副反应，遵嘱执行。\n- [全程D29] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，未诉特殊不适，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，较前缩小，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，指示继续放疗，密切观察放疗中副反应，遵嘱执行。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，予以重组人血小板生成素（rhTPO）皮下注射，待血小板恢复后继续放疗。\nB. 继续放疗，予以重组人白介素-11（rhIL-11）皮下注射，复查血常规与生化常规。\nC. 暂停放疗，输注单采血小板1个治疗量，复查血常规与生化常规。\nD. 继续放疗，予以重组人粒细胞集落刺激因子（rhG-CSF）皮下注射，复查血常规。\nE. 继续放疗，予以洗鼻、免疫调节/辅助支持（如香菇多糖）及动静脉置管护理，复查血常规与生化常规。\nF. 暂停放疗，予以促红细胞生成素（EPO）皮下注射，待血红蛋白恢复后继续放疗。\nG. 继续放疗，予以低分子肝素皮下注射预防血栓，复查凝血功能与血常规。\nH. 暂停放疗，予以甲泼尼龙静脉滴注提升血小板，复查血常规与生化常规。\nI. 继续放疗，予以静脉输注人免疫球蛋白（IVIG），复查血常规与生化常规。\nJ. 终止放疗，予以单药化疗维持，配合洗鼻及动静脉置管护理。\nK. 继续放疗，予以重组人血小板生成素与重组人粒细胞集落刺激因子联合皮下注射。\nL. 暂停放疗，予以洗鼻及动静脉置管护理，暂不予升血小板药物干预。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-08d32abcf26a92c62d1dc762","patient_id":"patient-9fcde7a95f4d57501ecbf7b2","turn_id":"turn07","turn_position":6,"turn_type":"response_assessment_decision","gold_letter":"F","gold_action":"取消第三程同期化疗，按原计划完成根治性放疗，胆囊结石暂予观察，放疗结束后择期行全面疗效评估。","options":[{"letter":"A","text":"强制收治入院完成第三程同期化疗，期间暂停放疗，待化疗结束后恢复放疗。","is_gold":false},{"letter":"B","text":"取消第三程同期化疗，加用西妥昔单抗靶向治疗联合放疗，放疗结束后行疗效评估。","is_gold":false},{"letter":"C","text":"提前终止放疗，行全身PET-CT及头颈部MRI评估，视肿瘤退缩情况决定后续辅助化疗方案。","is_gold":false},{"letter":"D","text":"取消第三程同期化疗，下调原定放疗处方剂量以减轻黏膜反应，放疗结束后即刻行鼻咽镜活检。","is_gold":false},{"letter":"E","text":"安排入院行TPF方案补充化疗，同时继续放疗，放疗结束后行全面疗效评估。","is_gold":false},{"letter":"F","text":"取消第三程同期化疗，按原计划完成根治性放疗，胆囊结石暂予观察，放疗结束后择期行全面疗效评估。","is_gold":true},{"letter":"G","text":"请普外科急会诊行腹腔镜胆囊切除术，术后择期恢复放疗，并取消后续化疗。","is_gold":false},{"letter":"H","text":"改用口服卡培他滨单药替代静脉化疗，继续门诊放疗，放疗结束后行辅助化疗。","is_gold":false},{"letter":"I","text":"立即行鼻咽及颈部MRI复查，若肿瘤已完全消退则提前结束放疗，进入随访阶段。","is_gold":false},{"letter":"J","text":"取消第三程同期化疗，增加放疗靶区外扩范围及处方剂量，放疗结束后择期行全面疗效评估。","is_gold":false},{"letter":"K","text":"暂停放疗，待咽痛及口腔黏膜反应完全缓解后再恢复放疗，并补充第三程化疗。","is_gold":false},{"letter":"L","text":"采用中药及针灸治疗替代第三程化疗，继续门诊放疗，放疗结束后常规行全身骨扫描。","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：咽旁间隙、斜坡、蝶骨基底部、岩尖。\n文本分期信息：N3，M0。\n综合TNM状态：T3N3M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1] 入院记录: 主诉: 右颈肿物半年，右耳听力下降半月；现病史: 缘于6月前患者无意中出现右颈肿物，未予重视，进行性增大，半月前出现右耳听力下降，无头痛、复视，无涕血、面麻等，就诊于当地医院，发现鼻咽肿物。今为求进一步诊治来我院。患者发病以来,精神、饮食、睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟20支/日*5年，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.3℃，P：79次/分，R：20次/分，BP：105/65mmHg,Ht：168cm，Wt：56kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D1] 入院记录: 主诉: 右颈肿物半年，右耳听力下降半月；现病史: 缘于6月前患者无意中出现右颈肿物，未予重视，进行性增大，半月前出现右耳听力下降，无头痛、复视，无涕血、面麻等，就诊于当地医院，发现鼻咽肿物。今为求进一步诊治来我院。患者发病以来,精神、饮食、睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟20支/日*5年，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.3℃，P：79次/分，R：20次/分，BP：105/65mmHg,Ht：168cm，Wt：56kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率79次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D4] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 V5～V6导联低电压 V1～V3导联r波递增不良\n- [全程D4] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 25.6U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.341；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；平均红细胞体积(MCV)-静脉血: 94.7fL；白细胞计数(WBC#)-静脉血: 4.5110E9/L；平均血小板体积(MPV)-静脉血: 12fL；D-二聚体(D-Dimer)-静脉血: 0.1ug/ml；单核细胞计数(Mono#)-静脉血: 0.510E9/L；磷(P)-静脉血: 1.36mmol/L；甘油三酯(TG)-静脉血: 2.22mmol/L；间接胆红素(IBIL)-静脉血: 5.2umolL；白蛋白(ALB)-静脉血: 44.8g/L；碱性磷酸酶(ALP)-静脉血: 81.9U/L；凝血酶时间(TT)-静脉血: 18.5sec.；载脂蛋白B(apoB)-静脉血: 0.57g/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.1U/L；阴离子间隙(AG)-静脉血: 11；血小板比容-静脉血: 15%；凝血酶原时间(PT)-静脉血: 11.7sec.；肌酐(Crea)-静脉血: 82.7umol/L；总胆红素(TBIL)-静脉血: 8.2umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.503；球蛋白(GLO)-静脉血: 25.56g/L；红细胞计数(RBC#)-静脉血: 4.5210E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；大血小板百分比(P-LCR%)-静脉血: 40%；血小板分布宽度(PDW)-静脉血: 14.2%；凝血酶原时间活动度(PTA)-静脉血: 90.4%；乳酸脱氢酶(LDH)-静脉血: 359.7U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32.3pg；ABO血型-静脉血: B；总钙(Ca)-静脉血: 2.3mmol/L；镁离子(Mg2+)-静脉血: 0.99mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 146g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；γ-谷氨酰基转移酶(GGT)-静脉血: 14.6U/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.1mmol/L……\n- [全程D5] 检验组合: 乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阳性(+)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D6] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、双侧壁明显不均匀增厚，平扫T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，双侧咽隐窝变浅，双侧咽旁脂肪间隙稍狭窄；双侧腭帆提肌、腭帆张肌、头长肌受压。双侧咽后见肿大淋巴结，左侧较大者短径11mm，右侧较大者短径12mm。 双侧后鼻孔堵塞，口咽双侧壁未见受累增厚。 双侧翼腭窝、颞下窝未见异常。 蝶骨基底部、斜坡、双侧岩尖、双侧枕骨基底部骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽；双侧筛窦、蝶窦，右乳突内见积液；上颌窦、左乳突充气良好，骨壁完整；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双颈II区、右颈III、IV区见淋巴结肿大，部分融合，较大者短径28mm，信号欠均匀，增强较明显不均匀强化。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。；检查结论: 鼻咽顶壁、顶后壁、双侧壁明显不均匀增厚，考虑鼻咽癌。 颅底骨质破坏。 双侧咽后、双颈部多发淋巴结肿大，考虑转移瘤。 副鼻窦炎；右乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见: 左颈II区可见多个大小不一肿大淋巴结，最大约22mm×12mm，边界清，椭圆形，内部回声均匀，后方回声稍增强，淋巴门未探及。 CDFI:上述淋巴结内可见周边型血流信号。 左颈淋巴结穿刺活检： 常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以16G穿刺针穿刺入左颈肿物内，进针2次，取出长约2cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。；检查结论: 左侧颈部肿大淋巴结穿刺活检。 不适随诊。 4个工作日后凭发票到2号楼6楼病理科取结果。\n- [全程D20] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右旁T7椎体横突水平，估计位于上腔静脉内。；检查结论: PICC管位置如上所述。\n- [全程D20] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 24mm AO 28mm MV E 0.53m/s EF 63% LV 37mm IVS 8mm A 0.41m/s FS 34% RA 35mm LVPW 6mm RV 16mm PA 14mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 心脏结构及运动未见异常 各房室腔及大血管未探及异常血流信号 心功能正常\n- [全程D21] 检验组合: 隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；酮体(KET)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；比重(SG)-尿液: 1.021；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D22] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 5.5；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.012；颜色-尿液: Light-Yellow；隐血(OB)-尿液: -（参考: 阴性）\n- [全程D28] 检验组合: 钠离子(Na+)-静脉血: 138.4mmol/L；胱抑素(Cys-C)-静脉血: 0.85mg/L；葡萄糖(Glu)-静脉血: 4.19mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；碱性磷酸酶(ALP)-静脉血: 77.2U/L；尿素氮(BUN)-静脉血: 4.1mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 32.5pg；淋巴细胞百分比(Lymph%)-静脉血: 0.13；C-反应蛋白(CRP)-静脉血: 2.54mg/L；氯离子(Cl-)-静脉血: 98.1mmol/L；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.64；阴离子间隙(AG)-静脉血: 16；红细胞比容(Hct)-静脉血: 43.3%；磷(P)-静脉血: 1.38mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.695；血液二氧化碳含量ctCO2(B)-静脉血: 24.3mmol/L；总胆汁酸(TBA)-静脉血: 2.1umol/L；总钙(Ca)-静脉血: 2.12mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 32.1U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.86；γ-谷氨酰基转移酶(GGT)-静脉血: 21.1U/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；甘油三酯(TG)-静脉血: 0.75mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；载脂蛋白B(apoB)-静脉血: 0.58g/L；直接胆红素(DBIL)-静脉血: 4.7umol/L；乳酸脱氢酶(LDH)-静脉血: 269.3U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 36.1U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；平均红细胞体积(MCV)-静脉血: 95.9fL；单核细胞百分比(Mono%)-静脉血: 0.13；总胆固醇(TC)-静脉血: 2.75mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339g/L；球蛋白(GLO)-静脉血: 21.89g/……\n- [全程D35] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；镁离子(Mg2+)-静脉血: 0.88mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44；载脂蛋白B(apoB)-静脉血: 0.56g/L；钠离子(Na+)-静脉血: 143.1mmol/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞比容(Hct)-静脉血: 37.1%；甘油三酯(TG)-静脉血: 0.68mmol/L；葡萄糖(Glu)-静脉血: 4.35mmol/L；C-反应蛋白(CRP)-静脉血: 16.07mg/L；平均血小板体积(MPV)-静脉血: 11.3fL；血红蛋白(Hb)-静脉血: 125g/L；载脂蛋白AI(apoAI)-静脉血: 0.89g/L；红细胞计数(RBC#)-静脉血: 3.9410E12/L；血小板比容-静脉血: 10%；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；血小板计数(PLT#)-静脉血: 8910E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.14；天门冬氨酸氨基转移酶(AST)-静脉血: 16U/L；丙氨酸氨基转移酶(ALT)-静脉血: 16.4U/L；总钙(Ca)-静脉血: 2.03mmol/L；钾离子(K+)-静脉血: 3.4mmol/L；磷(P)-静脉血: 1.05mmol/L；白蛋白(ALB)-静脉血: 36.3g/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 337g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；直接胆红素(DBIL)-静脉血: 5.4umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 94.2fL；氯离子(Cl-)-静脉血: 105.6mmol/L；肌酐(Crea)-静脉血: 70umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；胱抑素(Cys-C)-静脉血: 0.85mg/L；球蛋白(GLO)-静脉血: 21.19g/L；间接胆红素(IBIL)-静脉血: 5.9umolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.……\n- [全程D40] 检验组合: 钾离子(K+)-静脉血: 3.64mmol/L；血小板比容-静脉血: 12%；平均红细胞体积(MCV)-静脉血: 94.1fL；乳酸脱氢酶(LDH)-静脉血: 181.7U/L；碱性磷酸酶(ALP)-静脉血: 62.2U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.2；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.83mmolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.7；中性粒细胞计数(Neut#)-静脉血: 1.710E9/L；尿酸(UA)-静脉血: 230.6umol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.9pg；直接胆红素(DBIL)-静脉血: 3.3umol/L；磷(P)-静脉血: 1.27mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 13.3U/L；总胆固醇(TC)-静脉血: 2.44mmol/L；血小板分布宽度(PDW)-静脉血: 12%；平均血小板体积(MPV)-静脉血: 10.9fL；间接胆红素(IBIL)-静脉血: 3.9umolL；阴离子间隙(AG)-静脉血: 10.4；大血小板百分比(P-LCR%)-静脉血: 31.2%；镁离子(Mg2+)-静脉血: 0.87mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.028；低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.25mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 29.7mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.118；白细胞计数(WBC#)-静脉血: 2.4610E9/L；单核细胞百分比(Mono%)-静脉血: 0.179；单核细胞计数(Mono#)-静脉血: 0.410E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.16；丙氨酸氨基转移酶(ALT)-静脉血: 11.5U/L；C-反应蛋白(CRP)-静脉血: 17.05mg/L；白蛋白(ALB)-静脉血: 36.9g/L；总钙(Ca)-静脉血: 2.05mmol/L；总胆汁酸(TBA)-静脉血: 6.7umol/L；红细胞比容(Hct)-静脉血: 36.9%；葡萄糖(Glu)-静脉血: 5.02mmol/L；氯离子(Cl-)-静脉血: 102.1mmol/L；血小板计数(PLT#)……\n- [全程D42] 检验组合: 比重(SG)-尿液: 1.015；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 5；颜色-尿液: Light-Yellow；总蛋白(TP)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）\n- [全程D43] 检验组合: 颜色-尿液: Yellow；总蛋白(TP)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酮体(KET)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 10/μL；酸碱度(pH)-尿液: 5.5；胆红素(BIL)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 2/μL；比重(SG)-尿液: 1.02；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D46] 检验组合: 红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8%；间接胆红素(IBIL)-静脉血: 5.4umolL；尿酸(UA)-静脉血: 292.3umol/L；血小板分布宽度(PDW)-静脉血: 16.6%；磷(P)-静脉血: 1.39mmol/L；白细胞计数(WBC#)-静脉血: 3.2610E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 29.4U/L；中性粒细胞计数(Neut#)-静脉血: 2.510E9/L；总钙(Ca)-静脉血: 2.23mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 33pg；低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.63mmol/L；阴离子间隙(AG)-静脉血: 12；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.7；钠离子(Na+)-静脉血: 142mmol/L；钾离子(K+)-静脉血: 3.3mmol/L；氯离子(Cl-)-静脉血: 97.5mmol/L；白蛋白(ALB)-静脉血: 42.8g/L；总胆汁酸(TBA)-静脉血: 2.9umol/L；单核细胞百分比(Mono%)-静脉血: 0.143；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞比容(Hct)-静脉血: 40.8%；肌酐(Crea)-静脉血: 84.7umol/L；碱性磷酸酶(ALP)-静脉血: 64.7U/L；尿素氮(BUN)-静脉血: 5.06mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；总胆红素(TBIL)-静脉血: 9.3umol/L；载脂蛋白B(apoB)-静脉血: 0.65g/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；葡萄糖(Glu)-静脉血: 5.63mmol/L；球蛋白(GLO)-静脉血: 24.97g/L；C-反应蛋白(CRP)-静脉血: 6.22mg/L；镁离子(Mg2+)-静脉血: 0.97mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；α-L-岩藻糖苷酶(AFU)-静脉血: 40U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.009；平均红细胞血红蛋白浓度(MCHC)-静脉血: 342.2g/L；载脂蛋白AI(apoAI)-静脉血: 0.96g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 28.……\n- [全程D56] 检验组合: 碱性磷酸酶(ALP)-静脉血: 64.1U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；钾离子(K+)-静脉血: 3.65mmol/L；总蛋白(TP)-静脉血: 62.2g/L；血液二氧化碳含量ctCO2(B)-静脉血: 32mmol/L；胱抑素(Cys-C)-静脉血: 0.81mg/L；钠离子(Na+)-静脉血: 139.1mmol/L；红细胞比容(Hct)-静脉血: 38.2%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.5；载脂蛋白B(apoB)-静脉血: 0.72g/L；阴离子间隙(AG)-静脉血: 7.6；平均血小板体积(MPV)-静脉血: 10.7fL；丙氨酸氨基转移酶(ALT)-静脉血: 8.1U/L；中性粒细胞百分比(Neut%)-静脉血: 0.707；低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.56mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 13.8U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.69mmolL；总胆固醇(TC)-静脉血: 2.82mmol/L；总胆红素(TBIL)-静脉血: 9.5umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 14U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；乳酸脱氢酶(LDH)-静脉血: 146.4U/L；单核细胞百分比(Mono%)-静脉血: 0.202；血小板分布宽度(PDW)-静脉血: 12.5%；α-L-岩藻糖苷酶(AFU)-静脉血: 22.8U/L；肌酐(Crea)-静脉血: 73.2umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；磷(P)-静脉血: 1.17mmol/L；氯离子(Cl-)-静脉血: 99.5mmol/L；尿素氮(BUN)-静脉血: 4.3mmol/L；血小板比容-静脉血: 11%；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；总胆汁酸(TBA)-静脉血: 3.7umol/L；甘油三酯(TG)-静脉血: 0.85mmol/L；间接胆红素(IBIL)-静脉血: 5.5umolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.7；直接胆红素(DBIL)-静脉血: 4u……\n- [全程D62] 检验组合: 细菌涂片3-咽拭子: 未发现念珠状菌\n- [全程D63] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径10mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约27cm/s。 胆囊餐后改变，胆囊内可见一强回声团，直径约9mm，后方伴声影。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约33×27×24mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 胆囊结石。 肝脏、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D2] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉右耳听力下降，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，结合患者检查，认为患者鼻咽癌可能性大，指示完善相关检查后在决定下一步治疗方案，遵嘱执行。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D14] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉右耳听力下降，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，指示尽快完成放疗计划，遵嘱执行。\n- [全程D19] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉右耳听力下降，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，考虑患者放疗计划即将完成，指示可提前2天先予以化疗，指示今日予以DDP方案化疗第1程，做好水化、护胃、止呕等对症支持处理，密切观察化疗中副反应，遵嘱执行。\n- [全程D24] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉恶心，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，较前缩小，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，认为患者化疗顺利完成，指示继续放疗，密切观察放疗中副反应，遵嘱执行。\n- [全程D29] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，未诉特殊不适，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，较前缩小，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，指示继续放疗，密切观察放疗中副反应，遵嘱执行。\n- [全程D42] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉咽痛，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。BR、生化常规大致正常。[姓名已隐去]主诊医生信息已隐藏，考虑患者上次化疗已达3周，指示今日按[计划性表述已隐藏]以DDP方案化疗第二程，做好水化、护肝等对症支持处理，继续放疗，密切观察放化疗副反应，遵嘱执行。\n- [全程D47] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉咽痛，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，认为患者化疗顺利完成，指示继续放疗，密切观察放疗副反应，遵嘱执行。\n- [全程D52] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉咽痛，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，指示予以止痛、口腔粘膜保护对症处理，加强营养支持，继续放疗。\n- [全程D57] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，未诉明显特殊不适，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，指示继续放疗，遵嘱执行。\n- [全程D61] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，未诉明显特殊不适，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]医生信息已隐藏，考虑患者化疗即将到期，建议患者行第三程化疗，但患者拒绝，遂指示今日予以出院，于门诊继续放疗，遵嘱执行。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 强制收治入院完成第三程同期化疗，期间暂停放疗，待化疗结束后恢复放疗。\nB. 取消第三程同期化疗，加用西妥昔单抗靶向治疗联合放疗，放疗结束后行疗效评估。\nC. 提前终止放疗，行全身PET-CT及头颈部MRI评估，视肿瘤退缩情况决定后续辅助化疗方案。\nD. 取消第三程同期化疗，下调原定放疗处方剂量以减轻黏膜反应，放疗结束后即刻行鼻咽镜活检。\nE. 安排入院行TPF方案补充化疗，同时继续放疗，放疗结束后行全面疗效评估。\nF. 取消第三程同期化疗，按原计划完成根治性放疗，胆囊结石暂予观察，放疗结束后择期行全面疗效评估。\nG. 请普外科急会诊行腹腔镜胆囊切除术，术后择期恢复放疗，并取消后续化疗。\nH. 改用口服卡培他滨单药替代静脉化疗，继续门诊放疗，放疗结束后行辅助化疗。\nI. 立即行鼻咽及颈部MRI复查，若肿瘤已完全消退则提前结束放疗，进入随访阶段。\nJ. 取消第三程同期化疗，增加放疗靶区外扩范围及处方剂量，放疗结束后择期行全面疗效评估。\nK. 暂停放疗，待咽痛及口腔黏膜反应完全缓解后再恢复放疗，并补充第三程化疗。\nL. 采用中药及针灸治疗替代第三程化疗，继续门诊放疗，放疗结束后常规行全身骨扫描。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：咽旁间隙、斜坡、蝶骨基底部、岩尖。\n文本分期信息：N3，M0。\n综合TNM状态：T3N3M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1] 入院记录: 主诉: 右颈肿物半年，右耳听力下降半月；现病史: 缘于6月前患者无意中出现右颈肿物，未予重视，进行性增大，半月前出现右耳听力下降，无头痛、复视，无涕血、面麻等，就诊于当地医院，发现鼻咽肿物。今为求进一步诊治来我院。患者发病以来,精神、饮食、睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟20支/日*5年，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.3℃，P：79次/分，R：20次/分，BP：105/65mmHg,Ht：168cm，Wt：56kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D1] 入院记录: 主诉: 右颈肿物半年，右耳听力下降半月；现病史: 缘于6月前患者无意中出现右颈肿物，未予重视，进行性增大，半月前出现右耳听力下降，无头痛、复视，无涕血、面麻等，就诊于当地医院，发现鼻咽肿物。今为求进一步诊治来我院。患者发病以来,精神、饮食、睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟20支/日*5年，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.3℃，P：79次/分，R：20次/分，BP：105/65mmHg,Ht：168cm，Wt：56kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率79次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D4] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 V5～V6导联低电压 V1～V3导联r波递增不良\n- [全程D4] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 25.6U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.341；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；平均红细胞体积(MCV)-静脉血: 94.7fL；白细胞计数(WBC#)-静脉血: 4.5110E9/L；平均血小板体积(MPV)-静脉血: 12fL；D-二聚体(D-Dimer)-静脉血: 0.1ug/ml；单核细胞计数(Mono#)-静脉血: 0.510E9/L；磷(P)-静脉血: 1.36mmol/L；甘油三酯(TG)-静脉血: 2.22mmol/L；间接胆红素(IBIL)-静脉血: 5.2umolL；白蛋白(ALB)-静脉血: 44.8g/L；碱性磷酸酶(ALP)-静脉血: 81.9U/L；凝血酶时间(TT)-静脉血: 18.5sec.；载脂蛋白B(apoB)-静脉血: 0.57g/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.1U/L；阴离子间隙(AG)-静脉血: 11；血小板比容-静脉血: 15%；凝血酶原时间(PT)-静脉血: 11.7sec.；肌酐(Crea)-静脉血: 82.7umol/L；总胆红素(TBIL)-静脉血: 8.2umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.503；球蛋白(GLO)-静脉血: 25.56g/L；红细胞计数(RBC#)-静脉血: 4.5210E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；大血小板百分比(P-LCR%)-静脉血: 40%；血小板分布宽度(PDW)-静脉血: 14.2%；凝血酶原时间活动度(PTA)-静脉血: 90.4%；乳酸脱氢酶(LDH)-静脉血: 359.7U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32.3pg；ABO血型-静脉血: B；总钙(Ca)-静脉血: 2.3mmol/L；镁离子(Mg2+)-静脉血: 0.99mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 146g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；γ-谷氨酰基转移酶(GGT)-静脉血: 14.6U/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.1mmol/L……\n- [全程D5] 检验组合: 乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阳性(+)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D6] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、双侧壁明显不均匀增厚，平扫T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，双侧咽隐窝变浅，双侧咽旁脂肪间隙稍狭窄；双侧腭帆提肌、腭帆张肌、头长肌受压。双侧咽后见肿大淋巴结，左侧较大者短径11mm，右侧较大者短径12mm。 双侧后鼻孔堵塞，口咽双侧壁未见受累增厚。 双侧翼腭窝、颞下窝未见异常。 蝶骨基底部、斜坡、双侧岩尖、双侧枕骨基底部骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽；双侧筛窦、蝶窦，右乳突内见积液；上颌窦、左乳突充气良好，骨壁完整；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双颈II区、右颈III、IV区见淋巴结肿大，部分融合，较大者短径28mm，信号欠均匀，增强较明显不均匀强化。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。；检查结论: 鼻咽顶壁、顶后壁、双侧壁明显不均匀增厚，考虑鼻咽癌。 颅底骨质破坏。 双侧咽后、双颈部多发淋巴结肿大，考虑转移瘤。 副鼻窦炎；右乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见: 左颈II区可见多个大小不一肿大淋巴结，最大约22mm×12mm，边界清，椭圆形，内部回声均匀，后方回声稍增强，淋巴门未探及。 CDFI:上述淋巴结内可见周边型血流信号。 左颈淋巴结穿刺活检： 常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以16G穿刺针穿刺入左颈肿物内，进针2次，取出长约2cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。；检查结论: 左侧颈部肿大淋巴结穿刺活检。 不适随诊。 4个工作日后凭发票到2号楼6楼病理科取结果。\n- [全程D20] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右旁T7椎体横突水平，估计位于上腔静脉内。；检查结论: PICC管位置如上所述。\n- [全程D20] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 24mm AO 28mm MV E 0.53m/s EF 63% LV 37mm IVS 8mm A 0.41m/s FS 34% RA 35mm LVPW 6mm RV 16mm PA 14mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 心脏结构及运动未见异常 各房室腔及大血管未探及异常血流信号 心功能正常\n- [全程D21] 检验组合: 隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；酮体(KET)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；比重(SG)-尿液: 1.021；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D22] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 5.5；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.012；颜色-尿液: Light-Yellow；隐血(OB)-尿液: -（参考: 阴性）\n- [全程D28] 检验组合: 钠离子(Na+)-静脉血: 138.4mmol/L；胱抑素(Cys-C)-静脉血: 0.85mg/L；葡萄糖(Glu)-静脉血: 4.19mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；碱性磷酸酶(ALP)-静脉血: 77.2U/L；尿素氮(BUN)-静脉血: 4.1mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 32.5pg；淋巴细胞百分比(Lymph%)-静脉血: 0.13；C-反应蛋白(CRP)-静脉血: 2.54mg/L；氯离子(Cl-)-静脉血: 98.1mmol/L；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.64；阴离子间隙(AG)-静脉血: 16；红细胞比容(Hct)-静脉血: 43.3%；磷(P)-静脉血: 1.38mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.695；血液二氧化碳含量ctCO2(B)-静脉血: 24.3mmol/L；总胆汁酸(TBA)-静脉血: 2.1umol/L；总钙(Ca)-静脉血: 2.12mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 32.1U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.86；γ-谷氨酰基转移酶(GGT)-静脉血: 21.1U/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；甘油三酯(TG)-静脉血: 0.75mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；载脂蛋白B(apoB)-静脉血: 0.58g/L；直接胆红素(DBIL)-静脉血: 4.7umol/L；乳酸脱氢酶(LDH)-静脉血: 269.3U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 36.1U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；平均红细胞体积(MCV)-静脉血: 95.9fL；单核细胞百分比(Mono%)-静脉血: 0.13；总胆固醇(TC)-静脉血: 2.75mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339g/L；球蛋白(GLO)-静脉血: 21.89g/……\n- [全程D35] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；镁离子(Mg2+)-静脉血: 0.88mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44；载脂蛋白B(apoB)-静脉血: 0.56g/L；钠离子(Na+)-静脉血: 143.1mmol/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞比容(Hct)-静脉血: 37.1%；甘油三酯(TG)-静脉血: 0.68mmol/L；葡萄糖(Glu)-静脉血: 4.35mmol/L；C-反应蛋白(CRP)-静脉血: 16.07mg/L；平均血小板体积(MPV)-静脉血: 11.3fL；血红蛋白(Hb)-静脉血: 125g/L；载脂蛋白AI(apoAI)-静脉血: 0.89g/L；红细胞计数(RBC#)-静脉血: 3.9410E12/L；血小板比容-静脉血: 10%；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；血小板计数(PLT#)-静脉血: 8910E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.14；天门冬氨酸氨基转移酶(AST)-静脉血: 16U/L；丙氨酸氨基转移酶(ALT)-静脉血: 16.4U/L；总钙(Ca)-静脉血: 2.03mmol/L；钾离子(K+)-静脉血: 3.4mmol/L；磷(P)-静脉血: 1.05mmol/L；白蛋白(ALB)-静脉血: 36.3g/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 337g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；直接胆红素(DBIL)-静脉血: 5.4umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 94.2fL；氯离子(Cl-)-静脉血: 105.6mmol/L；肌酐(Crea)-静脉血: 70umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；胱抑素(Cys-C)-静脉血: 0.85mg/L；球蛋白(GLO)-静脉血: 21.19g/L；间接胆红素(IBIL)-静脉血: 5.9umolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.……\n- [全程D40] 检验组合: 钾离子(K+)-静脉血: 3.64mmol/L；血小板比容-静脉血: 12%；平均红细胞体积(MCV)-静脉血: 94.1fL；乳酸脱氢酶(LDH)-静脉血: 181.7U/L；碱性磷酸酶(ALP)-静脉血: 62.2U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.2；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.83mmolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.7；中性粒细胞计数(Neut#)-静脉血: 1.710E9/L；尿酸(UA)-静脉血: 230.6umol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.9pg；直接胆红素(DBIL)-静脉血: 3.3umol/L；磷(P)-静脉血: 1.27mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 13.3U/L；总胆固醇(TC)-静脉血: 2.44mmol/L；血小板分布宽度(PDW)-静脉血: 12%；平均血小板体积(MPV)-静脉血: 10.9fL；间接胆红素(IBIL)-静脉血: 3.9umolL；阴离子间隙(AG)-静脉血: 10.4；大血小板百分比(P-LCR%)-静脉血: 31.2%；镁离子(Mg2+)-静脉血: 0.87mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.028；低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.25mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 29.7mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.118；白细胞计数(WBC#)-静脉血: 2.4610E9/L；单核细胞百分比(Mono%)-静脉血: 0.179；单核细胞计数(Mono#)-静脉血: 0.410E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.16；丙氨酸氨基转移酶(ALT)-静脉血: 11.5U/L；C-反应蛋白(CRP)-静脉血: 17.05mg/L；白蛋白(ALB)-静脉血: 36.9g/L；总钙(Ca)-静脉血: 2.05mmol/L；总胆汁酸(TBA)-静脉血: 6.7umol/L；红细胞比容(Hct)-静脉血: 36.9%；葡萄糖(Glu)-静脉血: 5.02mmol/L；氯离子(Cl-)-静脉血: 102.1mmol/L；血小板计数(PLT#)……\n- [全程D42] 检验组合: 比重(SG)-尿液: 1.015；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 5；颜色-尿液: Light-Yellow；总蛋白(TP)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）\n- [全程D43] 检验组合: 颜色-尿液: Yellow；总蛋白(TP)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酮体(KET)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 10/μL；酸碱度(pH)-尿液: 5.5；胆红素(BIL)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 2/μL；比重(SG)-尿液: 1.02；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D46] 检验组合: 红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8%；间接胆红素(IBIL)-静脉血: 5.4umolL；尿酸(UA)-静脉血: 292.3umol/L；血小板分布宽度(PDW)-静脉血: 16.6%；磷(P)-静脉血: 1.39mmol/L；白细胞计数(WBC#)-静脉血: 3.2610E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 29.4U/L；中性粒细胞计数(Neut#)-静脉血: 2.510E9/L；总钙(Ca)-静脉血: 2.23mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 33pg；低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.63mmol/L；阴离子间隙(AG)-静脉血: 12；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.7；钠离子(Na+)-静脉血: 142mmol/L；钾离子(K+)-静脉血: 3.3mmol/L；氯离子(Cl-)-静脉血: 97.5mmol/L；白蛋白(ALB)-静脉血: 42.8g/L；总胆汁酸(TBA)-静脉血: 2.9umol/L；单核细胞百分比(Mono%)-静脉血: 0.143；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞比容(Hct)-静脉血: 40.8%；肌酐(Crea)-静脉血: 84.7umol/L；碱性磷酸酶(ALP)-静脉血: 64.7U/L；尿素氮(BUN)-静脉血: 5.06mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；总胆红素(TBIL)-静脉血: 9.3umol/L；载脂蛋白B(apoB)-静脉血: 0.65g/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；葡萄糖(Glu)-静脉血: 5.63mmol/L；球蛋白(GLO)-静脉血: 24.97g/L；C-反应蛋白(CRP)-静脉血: 6.22mg/L；镁离子(Mg2+)-静脉血: 0.97mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；α-L-岩藻糖苷酶(AFU)-静脉血: 40U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.009；平均红细胞血红蛋白浓度(MCHC)-静脉血: 342.2g/L；载脂蛋白AI(apoAI)-静脉血: 0.96g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 28.……\n- [全程D56] 检验组合: 碱性磷酸酶(ALP)-静脉血: 64.1U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；钾离子(K+)-静脉血: 3.65mmol/L；总蛋白(TP)-静脉血: 62.2g/L；血液二氧化碳含量ctCO2(B)-静脉血: 32mmol/L；胱抑素(Cys-C)-静脉血: 0.81mg/L；钠离子(Na+)-静脉血: 139.1mmol/L；红细胞比容(Hct)-静脉血: 38.2%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.5；载脂蛋白B(apoB)-静脉血: 0.72g/L；阴离子间隙(AG)-静脉血: 7.6；平均血小板体积(MPV)-静脉血: 10.7fL；丙氨酸氨基转移酶(ALT)-静脉血: 8.1U/L；中性粒细胞百分比(Neut%)-静脉血: 0.707；低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.56mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 13.8U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.69mmolL；总胆固醇(TC)-静脉血: 2.82mmol/L；总胆红素(TBIL)-静脉血: 9.5umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 14U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；乳酸脱氢酶(LDH)-静脉血: 146.4U/L；单核细胞百分比(Mono%)-静脉血: 0.202；血小板分布宽度(PDW)-静脉血: 12.5%；α-L-岩藻糖苷酶(AFU)-静脉血: 22.8U/L；肌酐(Crea)-静脉血: 73.2umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；磷(P)-静脉血: 1.17mmol/L；氯离子(Cl-)-静脉血: 99.5mmol/L；尿素氮(BUN)-静脉血: 4.3mmol/L；血小板比容-静脉血: 11%；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；总胆汁酸(TBA)-静脉血: 3.7umol/L；甘油三酯(TG)-静脉血: 0.85mmol/L；间接胆红素(IBIL)-静脉血: 5.5umolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.7；直接胆红素(DBIL)-静脉血: 4u……\n- [全程D62] 检验组合: 细菌涂片3-咽拭子: 未发现念珠状菌\n- [全程D63] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径10mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约27cm/s。 胆囊餐后改变，胆囊内可见一强回声团，直径约9mm，后方伴声影。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约33×27×24mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 胆囊结石。 肝脏、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D2] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉右耳听力下降，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，结合患者检查，认为患者鼻咽癌可能性大，指示完善相关检查后在决定下一步治疗方案，遵嘱执行。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D14] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉右耳听力下降，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，指示尽快完成放疗计划，遵嘱执行。\n- [全程D19] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉右耳听力下降，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，考虑患者放疗计划即将完成，指示可提前2天先予以化疗，指示今日予以DDP方案化疗第1程，做好水化、护胃、止呕等对症支持处理，密切观察化疗中副反应，遵嘱执行。\n- [全程D24] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉恶心，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，较前缩小，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，认为患者化疗顺利完成，指示继续放疗，密切观察放疗中副反应，遵嘱执行。\n- [全程D29] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，未诉特殊不适，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，较前缩小，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，指示继续放疗，密切观察放疗中副反应，遵嘱执行。\n- [全程D42] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉咽痛，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。BR、生化常规大致正常。[姓名已隐去]主诊医生信息已隐藏，考虑患者上次化疗已达3周，指示今日按[计划性表述已隐藏]以DDP方案化疗第二程，做好水化、护肝等对症支持处理，继续放疗，密切观察放化疗副反应，遵嘱执行。\n- [全程D47] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉咽痛，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，认为患者化疗顺利完成，指示继续放疗，密切观察放疗副反应，遵嘱执行。\n- [全程D52] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉咽痛，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，指示予以止痛、口腔粘膜保护对症处理，加强营养支持，继续放疗。\n- [全程D57] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，未诉明显特殊不适，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，指示继续放疗，遵嘱执行。\n- [全程D61] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，未诉明显特殊不适，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]医生信息已隐藏，考虑患者化疗即将到期，建议患者行第三程化疗，但患者拒绝，遂指示今日予以出院，于门诊继续放疗，遵嘱执行。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 强制收治入院完成第三程同期化疗，期间暂停放疗，待化疗结束后恢复放疗。\nB. 取消第三程同期化疗，加用西妥昔单抗靶向治疗联合放疗，放疗结束后行疗效评估。\nC. 提前终止放疗，行全身PET-CT及头颈部MRI评估，视肿瘤退缩情况决定后续辅助化疗方案。\nD. 取消第三程同期化疗，下调原定放疗处方剂量以减轻黏膜反应，放疗结束后即刻行鼻咽镜活检。\nE. 安排入院行TPF方案补充化疗，同时继续放疗，放疗结束后行全面疗效评估。\nF. 取消第三程同期化疗，按原计划完成根治性放疗，胆囊结石暂予观察，放疗结束后择期行全面疗效评估。\nG. 请普外科急会诊行腹腔镜胆囊切除术，术后择期恢复放疗，并取消后续化疗。\nH. 改用口服卡培他滨单药替代静脉化疗，继续门诊放疗，放疗结束后行辅助化疗。\nI. 立即行鼻咽及颈部MRI复查，若肿瘤已完全消退则提前结束放疗，进入随访阶段。\nJ. 取消第三程同期化疗，增加放疗靶区外扩范围及处方剂量，放疗结束后择期行全面疗效评估。\nK. 暂停放疗，待咽痛及口腔黏膜反应完全缓解后再恢复放疗，并补充第三程化疗。\nL. 采用中药及针灸治疗替代第三程化疗，继续门诊放疗，放疗结束后常规行全身骨扫描。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-bc1decc91eb488b9888718b5","patient_id":"patient-9fcde7a95f4d57501ecbf7b2","turn_id":"turn08","turn_position":7,"turn_type":"recurrence_or_salvage_decision","gold_letter":"G","gold_action":"结束根治性治疗进入随访，放疗后3个月复查影像学评估疗效","options":[{"letter":"A","text":"立即行双侧颈部淋巴结清扫术以彻底清除颈部残留病灶","is_gold":false},{"letter":"B","text":"立即行鼻咽及颈部局部追加外照射放疗10-15Gy推量","is_gold":false},{"letter":"C","text":"立即行全身PET-CT检查评估颈部淋巴结活性及远处转移","is_gold":false},{"letter":"D","text":"立即行鼻咽内镜下活检评估原发灶病理完全缓解情况","is_gold":false},{"letter":"E","text":"立即启动含铂双药方案辅助化疗2-3个周期强化全身控制","is_gold":false},{"letter":"F","text":"予以表皮生长因子受体靶向药物单药维持治疗半年至一年","is_gold":false},{"letter":"G","text":"结束根治性治疗进入随访，放疗后3个月复查影像学评估疗效","is_gold":true},{"letter":"H","text":"立即行颈部残留淋巴结细针穿刺活检以指导后续局部治疗","is_gold":false},{"letter":"I","text":"立即启动PD-1单抗等免疫检查点抑制剂维持治疗1年","is_gold":false},{"letter":"J","text":"予以抗炎及对症支持治疗，放疗后1个月复查鼻咽颈部MRI","is_gold":false},{"letter":"K","text":"立即采用原诱导化疗方案进行2至3个周期全身巩固化疗","is_gold":false},{"letter":"L","text":"立即行颈部残留淋巴结局部微波消融或放射性粒子植入术","is_gold":false}],"condition":"canonical_packed","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：咽旁间隙、斜坡、蝶骨基底部、岩尖。\n文本分期信息：N3，M0。\n综合TNM状态：T3N3M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1] 入院记录: 主诉: 右颈肿物半年，右耳听力下降半月；现病史: 缘于6月前患者无意中出现右颈肿物，未予重视，进行性增大，半月前出现右耳听力下降，无头痛、复视，无涕血、面麻等，就诊于当地医院，发现鼻咽肿物。今为求进一步诊治来我院。患者发病以来,精神、饮食、睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟20支/日*5年，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.3℃，P：79次/分，R：20次/分，BP：105/65mmHg,Ht：168cm，Wt：56kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D1] 入院记录: 主诉: 右颈肿物半年，右耳听力下降半月；现病史: 缘于6月前患者无意中出现右颈肿物，未予重视，进行性增大，半月前出现右耳听力下降，无头痛、复视，无涕血、面麻等，就诊于当地医院，发现鼻咽肿物。今为求进一步诊治来我院。患者发病以来,精神、饮食、睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟20支/日*5年，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.3℃，P：79次/分，R：20次/分，BP：105/65mmHg,Ht：168cm，Wt：56kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率79次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D4] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 V5～V6导联低电压 V1～V3导联r波递增不良\n- [全程D4] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 25.6U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.341；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；平均红细胞体积(MCV)-静脉血: 94.7fL；白细胞计数(WBC#)-静脉血: 4.5110E9/L；平均血小板体积(MPV)-静脉血: 12fL；D-二聚体(D-Dimer)-静脉血: 0.1ug/ml；单核细胞计数(Mono#)-静脉血: 0.510E9/L；磷(P)-静脉血: 1.36mmol/L；甘油三酯(TG)-静脉血: 2.22mmol/L；间接胆红素(IBIL)-静脉血: 5.2umolL；白蛋白(ALB)-静脉血: 44.8g/L；碱性磷酸酶(ALP)-静脉血: 81.9U/L；凝血酶时间(TT)-静脉血: 18.5sec.；载脂蛋白B(apoB)-静脉血: 0.57g/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.1U/L；阴离子间隙(AG)-静脉血: 11；血小板比容-静脉血: 15%；凝血酶原时间(PT)-静脉血: 11.7sec.；肌酐(Crea)-静脉血: 82.7umol/L；总胆红素(TBIL)-静脉血: 8.2umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.503；球蛋白(GLO)-静脉血: 25.56g/L；红细胞计数(RBC#)-静脉血: 4.5210E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；大血小板百分比(P-LCR%)-静脉血: 40%；血小板分布宽度(PDW)-静脉血: 14.2%；凝血酶原时间活动度(PTA)-静脉血: 90.4%；乳酸脱氢酶(LDH)-静脉血: 359.7U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32.3pg；ABO血型-静脉血: B；总钙(Ca)-静脉血: 2.3mmol/L；镁离子(Mg2+)-静脉血: 0.99mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 146g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；γ-谷氨酰基转移酶(GGT)-静脉血: 14.6U/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.1mmol/L……\n- [全程D5] 检验组合: 乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阳性(+)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D6] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、双侧壁明显不均匀增厚，平扫T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，双侧咽隐窝变浅，双侧咽旁脂肪间隙稍狭窄；双侧腭帆提肌、腭帆张肌、头长肌受压。双侧咽后见肿大淋巴结，左侧较大者短径11mm，右侧较大者短径12mm。 双侧后鼻孔堵塞，口咽双侧壁未见受累增厚。 双侧翼腭窝、颞下窝未见异常。 蝶骨基底部、斜坡、双侧岩尖、双侧枕骨基底部骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽；双侧筛窦、蝶窦，右乳突内见积液；上颌窦、左乳突充气良好，骨壁完整；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双颈II区、右颈III、IV区见淋巴结肿大，部分融合，较大者短径28mm，信号欠均匀，增强较明显不均匀强化。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。；检查结论: 鼻咽顶壁、顶后壁、双侧壁明显不均匀增厚，考虑鼻咽癌。 颅底骨质破坏。 双侧咽后、双颈部多发淋巴结肿大，考虑转移瘤。 副鼻窦炎；右乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见: 左颈II区可见多个大小不一肿大淋巴结，最大约22mm×12mm，边界清，椭圆形，内部回声均匀，后方回声稍增强，淋巴门未探及。 CDFI:上述淋巴结内可见周边型血流信号。 左颈淋巴结穿刺活检： 常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以16G穿刺针穿刺入左颈肿物内，进针2次，取出长约2cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。；检查结论: 左侧颈部肿大淋巴结穿刺活检。 不适随诊。 4个工作日后凭发票到2号楼6楼病理科取结果。\n- [全程D20] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右旁T7椎体横突水平，估计位于上腔静脉内。；检查结论: PICC管位置如上所述。\n- [全程D20] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 24mm AO 28mm MV E 0.53m/s EF 63% LV 37mm IVS 8mm A 0.41m/s FS 34% RA 35mm LVPW 6mm RV 16mm PA 14mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 心脏结构及运动未见异常 各房室腔及大血管未探及异常血流信号 心功能正常\n- [全程D21] 检验组合: 隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；酮体(KET)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；比重(SG)-尿液: 1.021；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D22] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 5.5；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.012；颜色-尿液: Light-Yellow；隐血(OB)-尿液: -（参考: 阴性）\n- [全程D28] 检验组合: 钠离子(Na+)-静脉血: 138.4mmol/L；胱抑素(Cys-C)-静脉血: 0.85mg/L；葡萄糖(Glu)-静脉血: 4.19mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；碱性磷酸酶(ALP)-静脉血: 77.2U/L；尿素氮(BUN)-静脉血: 4.1mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 32.5pg；淋巴细胞百分比(Lymph%)-静脉血: 0.13；C-反应蛋白(CRP)-静脉血: 2.54mg/L；氯离子(Cl-)-静脉血: 98.1mmol/L；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.64；阴离子间隙(AG)-静脉血: 16；红细胞比容(Hct)-静脉血: 43.3%；磷(P)-静脉血: 1.38mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.695；血液二氧化碳含量ctCO2(B)-静脉血: 24.3mmol/L；总胆汁酸(TBA)-静脉血: 2.1umol/L；总钙(Ca)-静脉血: 2.12mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 32.1U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.86；γ-谷氨酰基转移酶(GGT)-静脉血: 21.1U/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；甘油三酯(TG)-静脉血: 0.75mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；载脂蛋白B(apoB)-静脉血: 0.58g/L；直接胆红素(DBIL)-静脉血: 4.7umol/L；乳酸脱氢酶(LDH)-静脉血: 269.3U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 36.1U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；平均红细胞体积(MCV)-静脉血: 95.9fL；单核细胞百分比(Mono%)-静脉血: 0.13；总胆固醇(TC)-静脉血: 2.75mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339g/L；球蛋白(GLO)-静脉血: 21.89g/……\n- [全程D35] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；镁离子(Mg2+)-静脉血: 0.88mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44；载脂蛋白B(apoB)-静脉血: 0.56g/L；钠离子(Na+)-静脉血: 143.1mmol/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞比容(Hct)-静脉血: 37.1%；甘油三酯(TG)-静脉血: 0.68mmol/L；葡萄糖(Glu)-静脉血: 4.35mmol/L；C-反应蛋白(CRP)-静脉血: 16.07mg/L；平均血小板体积(MPV)-静脉血: 11.3fL；血红蛋白(Hb)-静脉血: 125g/L；载脂蛋白AI(apoAI)-静脉血: 0.89g/L；红细胞计数(RBC#)-静脉血: 3.9410E12/L；血小板比容-静脉血: 10%；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；血小板计数(PLT#)-静脉血: 8910E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.14；天门冬氨酸氨基转移酶(AST)-静脉血: 16U/L；丙氨酸氨基转移酶(ALT)-静脉血: 16.4U/L；总钙(Ca)-静脉血: 2.03mmol/L；钾离子(K+)-静脉血: 3.4mmol/L；磷(P)-静脉血: 1.05mmol/L；白蛋白(ALB)-静脉血: 36.3g/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 337g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；直接胆红素(DBIL)-静脉血: 5.4umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 94.2fL；氯离子(Cl-)-静脉血: 105.6mmol/L；肌酐(Crea)-静脉血: 70umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；胱抑素(Cys-C)-静脉血: 0.85mg/L；球蛋白(GLO)-静脉血: 21.19g/L；间接胆红素(IBIL)-静脉血: 5.9umolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.……\n- [全程D40] 检验组合: 钾离子(K+)-静脉血: 3.64mmol/L；血小板比容-静脉血: 12%；平均红细胞体积(MCV)-静脉血: 94.1fL；乳酸脱氢酶(LDH)-静脉血: 181.7U/L；碱性磷酸酶(ALP)-静脉血: 62.2U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.2；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.83mmolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.7；中性粒细胞计数(Neut#)-静脉血: 1.710E9/L；尿酸(UA)-静脉血: 230.6umol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.9pg；直接胆红素(DBIL)-静脉血: 3.3umol/L；磷(P)-静脉血: 1.27mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 13.3U/L；总胆固醇(TC)-静脉血: 2.44mmol/L；血小板分布宽度(PDW)-静脉血: 12%；平均血小板体积(MPV)-静脉血: 10.9fL；间接胆红素(IBIL)-静脉血: 3.9umolL；阴离子间隙(AG)-静脉血: 10.4；大血小板百分比(P-LCR%)-静脉血: 31.2%；镁离子(Mg2+)-静脉血: 0.87mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.028；低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.25mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 29.7mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.118；白细胞计数(WBC#)-静脉血: 2.4610E9/L；单核细胞百分比(Mono%)-静脉血: 0.179；单核细胞计数(Mono#)-静脉血: 0.410E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.16；丙氨酸氨基转移酶(ALT)-静脉血: 11.5U/L；C-反应蛋白(CRP)-静脉血: 17.05mg/L；白蛋白(ALB)-静脉血: 36.9g/L；总钙(Ca)-静脉血: 2.05mmol/L；总胆汁酸(TBA)-静脉血: 6.7umol/L；红细胞比容(Hct)-静脉血: 36.9%；葡萄糖(Glu)-静脉血: 5.02mmol/L；氯离子(Cl-)-静脉血: 102.1mmol/L；血小板计数(PLT#)……\n- [全程D42] 检验组合: 比重(SG)-尿液: 1.015；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 5；颜色-尿液: Light-Yellow；总蛋白(TP)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）\n- [全程D43] 检验组合: 颜色-尿液: Yellow；总蛋白(TP)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酮体(KET)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 10/μL；酸碱度(pH)-尿液: 5.5；胆红素(BIL)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 2/μL；比重(SG)-尿液: 1.02；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D46] 检验组合: 红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8%；间接胆红素(IBIL)-静脉血: 5.4umolL；尿酸(UA)-静脉血: 292.3umol/L；血小板分布宽度(PDW)-静脉血: 16.6%；磷(P)-静脉血: 1.39mmol/L；白细胞计数(WBC#)-静脉血: 3.2610E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 29.4U/L；中性粒细胞计数(Neut#)-静脉血: 2.510E9/L；总钙(Ca)-静脉血: 2.23mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 33pg；低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.63mmol/L；阴离子间隙(AG)-静脉血: 12；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.7；钠离子(Na+)-静脉血: 142mmol/L；钾离子(K+)-静脉血: 3.3mmol/L；氯离子(Cl-)-静脉血: 97.5mmol/L；白蛋白(ALB)-静脉血: 42.8g/L；总胆汁酸(TBA)-静脉血: 2.9umol/L；单核细胞百分比(Mono%)-静脉血: 0.143；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞比容(Hct)-静脉血: 40.8%；肌酐(Crea)-静脉血: 84.7umol/L；碱性磷酸酶(ALP)-静脉血: 64.7U/L；尿素氮(BUN)-静脉血: 5.06mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；总胆红素(TBIL)-静脉血: 9.3umol/L；载脂蛋白B(apoB)-静脉血: 0.65g/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；葡萄糖(Glu)-静脉血: 5.63mmol/L；球蛋白(GLO)-静脉血: 24.97g/L；C-反应蛋白(CRP)-静脉血: 6.22mg/L；镁离子(Mg2+)-静脉血: 0.97mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；α-L-岩藻糖苷酶(AFU)-静脉血: 40U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.009；平均红细胞血红蛋白浓度(MCHC)-静脉血: 342.2g/L；载脂蛋白AI(apoAI)-静脉血: 0.96g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 28.……\n- [全程D56] 检验组合: 碱性磷酸酶(ALP)-静脉血: 64.1U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；钾离子(K+)-静脉血: 3.65mmol/L；总蛋白(TP)-静脉血: 62.2g/L；血液二氧化碳含量ctCO2(B)-静脉血: 32mmol/L；胱抑素(Cys-C)-静脉血: 0.81mg/L；钠离子(Na+)-静脉血: 139.1mmol/L；红细胞比容(Hct)-静脉血: 38.2%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.5；载脂蛋白B(apoB)-静脉血: 0.72g/L；阴离子间隙(AG)-静脉血: 7.6；平均血小板体积(MPV)-静脉血: 10.7fL；丙氨酸氨基转移酶(ALT)-静脉血: 8.1U/L；中性粒细胞百分比(Neut%)-静脉血: 0.707；低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.56mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 13.8U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.69mmolL；总胆固醇(TC)-静脉血: 2.82mmol/L；总胆红素(TBIL)-静脉血: 9.5umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 14U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；乳酸脱氢酶(LDH)-静脉血: 146.4U/L；单核细胞百分比(Mono%)-静脉血: 0.202；血小板分布宽度(PDW)-静脉血: 12.5%；α-L-岩藻糖苷酶(AFU)-静脉血: 22.8U/L；肌酐(Crea)-静脉血: 73.2umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；磷(P)-静脉血: 1.17mmol/L；氯离子(Cl-)-静脉血: 99.5mmol/L；尿素氮(BUN)-静脉血: 4.3mmol/L；血小板比容-静脉血: 11%；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；总胆汁酸(TBA)-静脉血: 3.7umol/L；甘油三酯(TG)-静脉血: 0.85mmol/L；间接胆红素(IBIL)-静脉血: 5.5umolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.7；直接胆红素(DBIL)-静脉血: 4u……\n- [全程D62] 检验组合: 细菌涂片3-咽拭子: 未发现念珠状菌\n- [全程D63] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径10mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约27cm/s。 胆囊餐后改变，胆囊内可见一强回声团，直径约9mm，后方伴声影。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约33×27×24mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 胆囊结石。 肝脏、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D64] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双上肺纹理增粗，走行尚自然，双上肺野可见小斑点、条索影，双上胸膜稍增厚，余双肺野内未见明确实质性病变。双侧肺门未见增大，纵隔未见增宽，心影大小形态未见明显异常。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 双上肺少许纤维增殖灶并双上胸膜稍增厚。\n- [全程D64] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌放疗结束，对比某次就诊时间片： 鼻咽腔未见明显狭窄，鼻咽各壁未见明显增厚，粘膜表面尚光滑，增强扫描明显强化。双侧咽隐窝变浅，双侧咽旁脂肪间隙稍狭窄。 双侧腭帆提肌、腭帆张肌、头长肌结构清晰。双侧咽后见小淋巴结，较大者短径约7mm。 双侧后鼻孔未见堵塞，口咽双侧壁未见受累增厚。 双侧翼腭窝、颞下窝未见异常。 蝶骨基底部、斜坡、双侧岩尖、双侧枕骨基底部骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽。双侧筛窦、蝶窦、上颌窦粘膜增厚，双侧乳突内见积液。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。蝶鞍形态未见异常，其内未见占位性病变。 双侧颈II区、右侧颈III、IV区见多发淋巴结，部分融合，较大者短径11mm，信号欠均匀，增强较明显不均匀强化。 双侧颌下腺、腮腺大小、形态未见异常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态未见异常，信号均匀，未见占位性病变。喉咽腔形态未见异常，未见占位性病变。；检查结论: 鼻咽癌放疗后改变，较前明显好转。 颅底骨质破坏。 双侧咽后、双侧颈部多发淋巴结，较前缩小。 鼻窦炎，乳突炎。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D2] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉右耳听力下降，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，结合患者检查，认为患者鼻咽癌可能性大，指示完善相关检查后在决定下一步治疗方案，遵嘱执行。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D14] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉右耳听力下降，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，指示尽快完成放疗计划，遵嘱执行。\n- [全程D19] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉右耳听力下降，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，考虑患者放疗计划即将完成，指示可提前2天先予以化疗，指示今日予以DDP方案化疗第1程，做好水化、护胃、止呕等对症支持处理，密切观察化疗中副反应，遵嘱执行。\n- [全程D24] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉恶心，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，较前缩小，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，认为患者化疗顺利完成，指示继续放疗，密切观察放疗中副反应，遵嘱执行。\n- [全程D29] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，未诉特殊不适，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，较前缩小，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，指示继续放疗，密切观察放疗中副反应，遵嘱执行。\n- [全程D42] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉咽痛，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。BR、生化常规大致正常。[姓名已隐去]主诊医生信息已隐藏，考虑患者上次化疗已达3周，指示今日按[计划性表述已隐藏]以DDP方案化疗第二程，做好水化、护肝等对症支持处理，继续放疗，密切观察放化疗副反应，遵嘱执行。\n- [全程D47] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉咽痛，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，认为患者化疗顺利完成，指示继续放疗，密切观察放疗副反应，遵嘱执行。\n- [全程D52] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉咽痛，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，指示予以止痛、口腔粘膜保护对症处理，加强营养支持，继续放疗。\n- [全程D57] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，未诉明显特殊不适，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，指示继续放疗，遵嘱执行。\n- [全程D61] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，未诉明显特殊不适，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]医生信息已隐藏，考虑患者化疗即将到期，建议患者行第三程化疗，但患者拒绝，遂指示今日予以出院，于门诊继续放疗，遵嘱执行。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即行双侧颈部淋巴结清扫术以彻底清除颈部残留病灶\nB. 立即行鼻咽及颈部局部追加外照射放疗10-15Gy推量\nC. 立即行全身PET-CT检查评估颈部淋巴结活性及远处转移\nD. 立即行鼻咽内镜下活检评估原发灶病理完全缓解情况\nE. 立即启动含铂双药方案辅助化疗2-3个周期强化全身控制\nF. 予以表皮生长因子受体靶向药物单药维持治疗半年至一年\nG. 结束根治性治疗进入随访，放疗后3个月复查影像学评估疗效\nH. 立即行颈部残留淋巴结细针穿刺活检以指导后续局部治疗\nI. 立即启动PD-1单抗等免疫检查点抑制剂维持治疗1年\nJ. 予以抗炎及对症支持治疗，放疗后1个月复查鼻咽颈部MRI\nK. 立即采用原诱导化疗方案进行2至3个周期全身巩固化疗\nL. 立即行颈部残留淋巴结局部微波消融或放射性粒子植入术\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：咽旁间隙、斜坡、蝶骨基底部、岩尖。\n文本分期信息：N3，M0。\n综合TNM状态：T3N3M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1] 入院记录: 主诉: 右颈肿物半年，右耳听力下降半月；现病史: 缘于6月前患者无意中出现右颈肿物，未予重视，进行性增大，半月前出现右耳听力下降，无头痛、复视，无涕血、面麻等，就诊于当地医院，发现鼻咽肿物。今为求进一步诊治来我院。患者发病以来,精神、饮食、睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟20支/日*5年，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.3℃，P：79次/分，R：20次/分，BP：105/65mmHg,Ht：168cm，Wt：56kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D1] 入院记录: 主诉: 右颈肿物半年，右耳听力下降半月；现病史: 缘于6月前患者无意中出现右颈肿物，未予重视，进行性增大，半月前出现右耳听力下降，无头痛、复视，无涕血、面麻等，就诊于当地医院，发现鼻咽肿物。今为求进一步诊治来我院。患者发病以来,精神、饮食、睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟20支/日*5年，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.3℃，P：79次/分，R：20次/分，BP：105/65mmHg,Ht：168cm，Wt：56kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率79次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D4] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 V5～V6导联低电压 V1～V3导联r波递增不良\n- [全程D4] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 25.6U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.341；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；平均红细胞体积(MCV)-静脉血: 94.7fL；白细胞计数(WBC#)-静脉血: 4.5110E9/L；平均血小板体积(MPV)-静脉血: 12fL；D-二聚体(D-Dimer)-静脉血: 0.1ug/ml；单核细胞计数(Mono#)-静脉血: 0.510E9/L；磷(P)-静脉血: 1.36mmol/L；甘油三酯(TG)-静脉血: 2.22mmol/L；间接胆红素(IBIL)-静脉血: 5.2umolL；白蛋白(ALB)-静脉血: 44.8g/L；碱性磷酸酶(ALP)-静脉血: 81.9U/L；凝血酶时间(TT)-静脉血: 18.5sec.；载脂蛋白B(apoB)-静脉血: 0.57g/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.1U/L；阴离子间隙(AG)-静脉血: 11；血小板比容-静脉血: 15%；凝血酶原时间(PT)-静脉血: 11.7sec.；肌酐(Crea)-静脉血: 82.7umol/L；总胆红素(TBIL)-静脉血: 8.2umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.503；球蛋白(GLO)-静脉血: 25.56g/L；红细胞计数(RBC#)-静脉血: 4.5210E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；大血小板百分比(P-LCR%)-静脉血: 40%；血小板分布宽度(PDW)-静脉血: 14.2%；凝血酶原时间活动度(PTA)-静脉血: 90.4%；乳酸脱氢酶(LDH)-静脉血: 359.7U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32.3pg；ABO血型-静脉血: B；总钙(Ca)-静脉血: 2.3mmol/L；镁离子(Mg2+)-静脉血: 0.99mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 146g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；γ-谷氨酰基转移酶(GGT)-静脉血: 14.6U/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.1mmol/L……\n- [全程D5] 检验组合: 乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阳性(+)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D6] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、双侧壁明显不均匀增厚，平扫T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，双侧咽隐窝变浅，双侧咽旁脂肪间隙稍狭窄；双侧腭帆提肌、腭帆张肌、头长肌受压。双侧咽后见肿大淋巴结，左侧较大者短径11mm，右侧较大者短径12mm。 双侧后鼻孔堵塞，口咽双侧壁未见受累增厚。 双侧翼腭窝、颞下窝未见异常。 蝶骨基底部、斜坡、双侧岩尖、双侧枕骨基底部骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽；双侧筛窦、蝶窦，右乳突内见积液；上颌窦、左乳突充气良好，骨壁完整；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双颈II区、右颈III、IV区见淋巴结肿大，部分融合，较大者短径28mm，信号欠均匀，增强较明显不均匀强化。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。；检查结论: 鼻咽顶壁、顶后壁、双侧壁明显不均匀增厚，考虑鼻咽癌。 颅底骨质破坏。 双侧咽后、双颈部多发淋巴结肿大，考虑转移瘤。 副鼻窦炎；右乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见: 左颈II区可见多个大小不一肿大淋巴结，最大约22mm×12mm，边界清，椭圆形，内部回声均匀，后方回声稍增强，淋巴门未探及。 CDFI:上述淋巴结内可见周边型血流信号。 左颈淋巴结穿刺活检： 常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以16G穿刺针穿刺入左颈肿物内，进针2次，取出长约2cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。；检查结论: 左侧颈部肿大淋巴结穿刺活检。 不适随诊。 4个工作日后凭发票到2号楼6楼病理科取结果。\n- [全程D20] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右旁T7椎体横突水平，估计位于上腔静脉内。；检查结论: PICC管位置如上所述。\n- [全程D20] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 24mm AO 28mm MV E 0.53m/s EF 63% LV 37mm IVS 8mm A 0.41m/s FS 34% RA 35mm LVPW 6mm RV 16mm PA 14mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 心脏结构及运动未见异常 各房室腔及大血管未探及异常血流信号 心功能正常\n- [全程D21] 检验组合: 隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；酮体(KET)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；比重(SG)-尿液: 1.021；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D22] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 5.5；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.012；颜色-尿液: Light-Yellow；隐血(OB)-尿液: -（参考: 阴性）\n- [全程D28] 检验组合: 钠离子(Na+)-静脉血: 138.4mmol/L；胱抑素(Cys-C)-静脉血: 0.85mg/L；葡萄糖(Glu)-静脉血: 4.19mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；碱性磷酸酶(ALP)-静脉血: 77.2U/L；尿素氮(BUN)-静脉血: 4.1mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 32.5pg；淋巴细胞百分比(Lymph%)-静脉血: 0.13；C-反应蛋白(CRP)-静脉血: 2.54mg/L；氯离子(Cl-)-静脉血: 98.1mmol/L；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.64；阴离子间隙(AG)-静脉血: 16；红细胞比容(Hct)-静脉血: 43.3%；磷(P)-静脉血: 1.38mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.695；血液二氧化碳含量ctCO2(B)-静脉血: 24.3mmol/L；总胆汁酸(TBA)-静脉血: 2.1umol/L；总钙(Ca)-静脉血: 2.12mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 32.1U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.86；γ-谷氨酰基转移酶(GGT)-静脉血: 21.1U/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；甘油三酯(TG)-静脉血: 0.75mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；载脂蛋白B(apoB)-静脉血: 0.58g/L；直接胆红素(DBIL)-静脉血: 4.7umol/L；乳酸脱氢酶(LDH)-静脉血: 269.3U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 36.1U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；平均红细胞体积(MCV)-静脉血: 95.9fL；单核细胞百分比(Mono%)-静脉血: 0.13；总胆固醇(TC)-静脉血: 2.75mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339g/L；球蛋白(GLO)-静脉血: 21.89g/……\n- [全程D35] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；镁离子(Mg2+)-静脉血: 0.88mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44；载脂蛋白B(apoB)-静脉血: 0.56g/L；钠离子(Na+)-静脉血: 143.1mmol/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞比容(Hct)-静脉血: 37.1%；甘油三酯(TG)-静脉血: 0.68mmol/L；葡萄糖(Glu)-静脉血: 4.35mmol/L；C-反应蛋白(CRP)-静脉血: 16.07mg/L；平均血小板体积(MPV)-静脉血: 11.3fL；血红蛋白(Hb)-静脉血: 125g/L；载脂蛋白AI(apoAI)-静脉血: 0.89g/L；红细胞计数(RBC#)-静脉血: 3.9410E12/L；血小板比容-静脉血: 10%；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；血小板计数(PLT#)-静脉血: 8910E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.14；天门冬氨酸氨基转移酶(AST)-静脉血: 16U/L；丙氨酸氨基转移酶(ALT)-静脉血: 16.4U/L；总钙(Ca)-静脉血: 2.03mmol/L；钾离子(K+)-静脉血: 3.4mmol/L；磷(P)-静脉血: 1.05mmol/L；白蛋白(ALB)-静脉血: 36.3g/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 337g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；直接胆红素(DBIL)-静脉血: 5.4umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 94.2fL；氯离子(Cl-)-静脉血: 105.6mmol/L；肌酐(Crea)-静脉血: 70umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；胱抑素(Cys-C)-静脉血: 0.85mg/L；球蛋白(GLO)-静脉血: 21.19g/L；间接胆红素(IBIL)-静脉血: 5.9umolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.……\n- [全程D40] 检验组合: 钾离子(K+)-静脉血: 3.64mmol/L；血小板比容-静脉血: 12%；平均红细胞体积(MCV)-静脉血: 94.1fL；乳酸脱氢酶(LDH)-静脉血: 181.7U/L；碱性磷酸酶(ALP)-静脉血: 62.2U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.2；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.83mmolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.7；中性粒细胞计数(Neut#)-静脉血: 1.710E9/L；尿酸(UA)-静脉血: 230.6umol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.9pg；直接胆红素(DBIL)-静脉血: 3.3umol/L；磷(P)-静脉血: 1.27mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 13.3U/L；总胆固醇(TC)-静脉血: 2.44mmol/L；血小板分布宽度(PDW)-静脉血: 12%；平均血小板体积(MPV)-静脉血: 10.9fL；间接胆红素(IBIL)-静脉血: 3.9umolL；阴离子间隙(AG)-静脉血: 10.4；大血小板百分比(P-LCR%)-静脉血: 31.2%；镁离子(Mg2+)-静脉血: 0.87mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.028；低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.25mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 29.7mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.118；白细胞计数(WBC#)-静脉血: 2.4610E9/L；单核细胞百分比(Mono%)-静脉血: 0.179；单核细胞计数(Mono#)-静脉血: 0.410E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.16；丙氨酸氨基转移酶(ALT)-静脉血: 11.5U/L；C-反应蛋白(CRP)-静脉血: 17.05mg/L；白蛋白(ALB)-静脉血: 36.9g/L；总钙(Ca)-静脉血: 2.05mmol/L；总胆汁酸(TBA)-静脉血: 6.7umol/L；红细胞比容(Hct)-静脉血: 36.9%；葡萄糖(Glu)-静脉血: 5.02mmol/L；氯离子(Cl-)-静脉血: 102.1mmol/L；血小板计数(PLT#)……\n- [全程D42] 检验组合: 比重(SG)-尿液: 1.015；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 5；颜色-尿液: Light-Yellow；总蛋白(TP)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）\n- [全程D43] 检验组合: 颜色-尿液: Yellow；总蛋白(TP)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酮体(KET)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 10/μL；酸碱度(pH)-尿液: 5.5；胆红素(BIL)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 2/μL；比重(SG)-尿液: 1.02；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D46] 检验组合: 红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8%；间接胆红素(IBIL)-静脉血: 5.4umolL；尿酸(UA)-静脉血: 292.3umol/L；血小板分布宽度(PDW)-静脉血: 16.6%；磷(P)-静脉血: 1.39mmol/L；白细胞计数(WBC#)-静脉血: 3.2610E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 29.4U/L；中性粒细胞计数(Neut#)-静脉血: 2.510E9/L；总钙(Ca)-静脉血: 2.23mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 33pg；低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.63mmol/L；阴离子间隙(AG)-静脉血: 12；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.7；钠离子(Na+)-静脉血: 142mmol/L；钾离子(K+)-静脉血: 3.3mmol/L；氯离子(Cl-)-静脉血: 97.5mmol/L；白蛋白(ALB)-静脉血: 42.8g/L；总胆汁酸(TBA)-静脉血: 2.9umol/L；单核细胞百分比(Mono%)-静脉血: 0.143；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞比容(Hct)-静脉血: 40.8%；肌酐(Crea)-静脉血: 84.7umol/L；碱性磷酸酶(ALP)-静脉血: 64.7U/L；尿素氮(BUN)-静脉血: 5.06mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；总胆红素(TBIL)-静脉血: 9.3umol/L；载脂蛋白B(apoB)-静脉血: 0.65g/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；葡萄糖(Glu)-静脉血: 5.63mmol/L；球蛋白(GLO)-静脉血: 24.97g/L；C-反应蛋白(CRP)-静脉血: 6.22mg/L；镁离子(Mg2+)-静脉血: 0.97mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；α-L-岩藻糖苷酶(AFU)-静脉血: 40U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.009；平均红细胞血红蛋白浓度(MCHC)-静脉血: 342.2g/L；载脂蛋白AI(apoAI)-静脉血: 0.96g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 28.……\n- [全程D56] 检验组合: 碱性磷酸酶(ALP)-静脉血: 64.1U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；钾离子(K+)-静脉血: 3.65mmol/L；总蛋白(TP)-静脉血: 62.2g/L；血液二氧化碳含量ctCO2(B)-静脉血: 32mmol/L；胱抑素(Cys-C)-静脉血: 0.81mg/L；钠离子(Na+)-静脉血: 139.1mmol/L；红细胞比容(Hct)-静脉血: 38.2%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.5；载脂蛋白B(apoB)-静脉血: 0.72g/L；阴离子间隙(AG)-静脉血: 7.6；平均血小板体积(MPV)-静脉血: 10.7fL；丙氨酸氨基转移酶(ALT)-静脉血: 8.1U/L；中性粒细胞百分比(Neut%)-静脉血: 0.707；低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.56mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 13.8U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.69mmolL；总胆固醇(TC)-静脉血: 2.82mmol/L；总胆红素(TBIL)-静脉血: 9.5umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 14U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；乳酸脱氢酶(LDH)-静脉血: 146.4U/L；单核细胞百分比(Mono%)-静脉血: 0.202；血小板分布宽度(PDW)-静脉血: 12.5%；α-L-岩藻糖苷酶(AFU)-静脉血: 22.8U/L；肌酐(Crea)-静脉血: 73.2umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；磷(P)-静脉血: 1.17mmol/L；氯离子(Cl-)-静脉血: 99.5mmol/L；尿素氮(BUN)-静脉血: 4.3mmol/L；血小板比容-静脉血: 11%；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；总胆汁酸(TBA)-静脉血: 3.7umol/L；甘油三酯(TG)-静脉血: 0.85mmol/L；间接胆红素(IBIL)-静脉血: 5.5umolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.7；直接胆红素(DBIL)-静脉血: 4u……\n- [全程D62] 检验组合: 细菌涂片3-咽拭子: 未发现念珠状菌\n- [全程D63] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径10mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约27cm/s。 胆囊餐后改变，胆囊内可见一强回声团，直径约9mm，后方伴声影。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约33×27×24mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 胆囊结石。 肝脏、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D64] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双上肺纹理增粗，走行尚自然，双上肺野可见小斑点、条索影，双上胸膜稍增厚，余双肺野内未见明确实质性病变。双侧肺门未见增大，纵隔未见增宽，心影大小形态未见明显异常。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 双上肺少许纤维增殖灶并双上胸膜稍增厚。\n- [全程D64] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌放疗结束，对比某次就诊时间片： 鼻咽腔未见明显狭窄，鼻咽各壁未见明显增厚，粘膜表面尚光滑，增强扫描明显强化。双侧咽隐窝变浅，双侧咽旁脂肪间隙稍狭窄。 双侧腭帆提肌、腭帆张肌、头长肌结构清晰。双侧咽后见小淋巴结，较大者短径约7mm。 双侧后鼻孔未见堵塞，口咽双侧壁未见受累增厚。 双侧翼腭窝、颞下窝未见异常。 蝶骨基底部、斜坡、双侧岩尖、双侧枕骨基底部骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽。双侧筛窦、蝶窦、上颌窦粘膜增厚，双侧乳突内见积液。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。蝶鞍形态未见异常，其内未见占位性病变。 双侧颈II区、右侧颈III、IV区见多发淋巴结，部分融合，较大者短径11mm，信号欠均匀，增强较明显不均匀强化。 双侧颌下腺、腮腺大小、形态未见异常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态未见异常，信号均匀，未见占位性病变。喉咽腔形态未见异常，未见占位性病变。；检查结论: 鼻咽癌放疗后改变，较前明显好转。 颅底骨质破坏。 双侧咽后、双侧颈部多发淋巴结，较前缩小。 鼻窦炎，乳突炎。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D2] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉右耳听力下降，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，结合患者检查，认为患者鼻咽癌可能性大，指示完善相关检查后在决定下一步治疗方案，遵嘱执行。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D14] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉右耳听力下降，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，指示尽快完成放疗计划，遵嘱执行。\n- [全程D19] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉右耳听力下降，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，考虑患者放疗计划即将完成，指示可提前2天先予以化疗，指示今日予以DDP方案化疗第1程，做好水化、护胃、止呕等对症支持处理，密切观察化疗中副反应，遵嘱执行。\n- [全程D24] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉恶心，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，较前缩小，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，认为患者化疗顺利完成，指示继续放疗，密切观察放疗中副反应，遵嘱执行。\n- [全程D29] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，未诉特殊不适，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，较前缩小，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，指示继续放疗，密切观察放疗中副反应，遵嘱执行。\n- [全程D42] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉咽痛，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。BR、生化常规大致正常。[姓名已隐去]主诊医生信息已隐藏，考虑患者上次化疗已达3周，指示今日按[计划性表述已隐藏]以DDP方案化疗第二程，做好水化、护肝等对症支持处理，继续放疗，密切观察放化疗副反应，遵嘱执行。\n- [全程D47] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉咽痛，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，认为患者化疗顺利完成，指示继续放疗，密切观察放疗副反应，遵嘱执行。\n- [全程D52] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉咽痛，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，指示予以止痛、口腔粘膜保护对症处理，加强营养支持，继续放疗。\n- [全程D57] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，未诉明显特殊不适，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，指示继续放疗，遵嘱执行。\n- [全程D61] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，未诉明显特殊不适，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]医生信息已隐藏，考虑患者化疗即将到期，建议患者行第三程化疗，但患者拒绝，遂指示今日予以出院，于门诊继续放疗，遵嘱执行。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即行双侧颈部淋巴结清扫术以彻底清除颈部残留病灶\nB. 立即行鼻咽及颈部局部追加外照射放疗10-15Gy推量\nC. 立即行全身PET-CT检查评估颈部淋巴结活性及远处转移\nD. 立即行鼻咽内镜下活检评估原发灶病理完全缓解情况\nE. 立即启动含铂双药方案辅助化疗2-3个周期强化全身控制\nF. 予以表皮生长因子受体靶向药物单药维持治疗半年至一年\nG. 结束根治性治疗进入随访，放疗后3个月复查影像学评估疗效\nH. 立即行颈部残留淋巴结细针穿刺活检以指导后续局部治疗\nI. 立即启动PD-1单抗等免疫检查点抑制剂维持治疗1年\nJ. 予以抗炎及对症支持治疗，放疗后1个月复查鼻咽颈部MRI\nK. 立即采用原诱导化疗方案进行2至3个周期全身巩固化疗\nL. 立即行颈部残留淋巴结局部微波消融或放射性粒子植入术\n\n请仅输出一个选项字母（A-L）。"}]}
diff --git a/supplementary/carepath25/care.jsonl b/supplementary/carepath25/care.jsonl
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@@ -0,0 +1,146 @@
+{"sample_id":"sample-c56105087904f0da386b7001","patient_id":"patient-5fa48522b2703f35ead0224b","turn_id":"turn02","turn_type":"imaging_release_workup","gold_letter":"J","gold_action":"行颈部淋巴结穿刺活检或鼻咽镜活检以明确病理诊断，并完善全身分期检查（如胸腹部CT、骨扫描或PET-CT）。","options":[{"letter":"A","text":"完善血浆EBV-DNA检测，若结果阳性则临床确诊鼻咽癌并启动根治性放疗","is_gold":false},{"letter":"B","text":"行鼻咽肿物开放性切除活检以明确病理诊断，并完善胸腹部CT及骨扫描","is_gold":false},{"letter":"C","text":"行颈部淋巴结切除活检以明确病理诊断，暂缓全身远处转移排查","is_gold":false},{"letter":"D","text":"行颈部淋巴结细针穿刺细胞学检查（FNAC）作为最终确诊依据，并完善全身分期检查","is_gold":false},{"letter":"E","text":"行鼻咽镜下活检以明确病理诊断，无需常规进行胸腹部影像学分期","is_gold":false},{"letter":"F","text":"优先行全身PET-CT检查，若无远处转移则直接开始诱导化疗","is_gold":false},{"letter":"G","text":"行双侧颈部淋巴结清扫术并送常规病理，确诊后安排术后放疗","is_gold":false},{"letter":"H","text":"行鼻咽镜下活检以明确病理诊断，并仅行头颈部增强CT以补充评估颅底骨质破坏","is_gold":false},{"letter":"I","text":"行鼻咽镜下活检以明确病理诊断，并直接安排诱导化疗，化疗后补充全身分期检查","is_gold":false},{"letter":"J","text":"行颈部淋巴结穿刺活检或鼻咽镜活检以明确病理诊断，并完善全身分期检查","is_gold":true},{"letter":"K","text":"密切观察鼻咽部病灶及颈部淋巴结变化，1个月后复查头颈部MRI决定是否活检","is_gold":false},{"letter":"L","text":"行颈部淋巴结穿刺活检，确诊后直接启动根治性放疗，无需全身分期检查","is_gold":false}]}
+{"sample_id":"sample-9b76347b9a2749777a06cd80","patient_id":"patient-5fa48522b2703f35ead0224b","turn_id":"turn04","turn_type":"initial_treatment_selection","gold_letter":"L","gold_action":"诱导化疗（顺铂+氟尿嘧啶方案）","options":[{"letter":"A","text":"同步放化疗（顺铂单药方案）","is_gold":false},{"letter":"B","text":"诱导化疗（吉西他滨+顺铂方案）联合PD-1抑制剂","is_gold":false},{"letter":"C","text":"根治性放疗联合辅助化疗（顺铂+氟尿嘧啶方案）","is_gold":false},{"letter":"D","text":"诱导化疗（紫杉醇+卡铂方案）","is_gold":false},{"letter":"E","text":"诱导化疗（多西他赛+顺铂+氟尿嘧啶方案）联合西妥昔单抗","is_gold":false},{"letter":"F","text":"根治性放疗（单纯放疗）","is_gold":false},{"letter":"G","text":"诱导化疗（卡培他滨单药方案）","is_gold":false},{"letter":"H","text":"靶向治疗（尼妥珠单抗）联合同步放化疗","is_gold":false},{"letter":"I","text":"诱导化疗（依托泊苷+顺铂方案）","is_gold":false},{"letter":"J","text":"姑息性化疗（顺铂+氟尿嘧啶方案）","is_gold":false},{"letter":"K","text":"诱导化疗（顺铂单药方案）","is_gold":false},{"letter":"L","text":"诱导化疗（顺铂+氟尿嘧啶方案）","is_gold":true}]}
+{"sample_id":"sample-ad9c851cda35b0e3c9061982","patient_id":"patient-5fa48522b2703f35ead0224b","turn_id":"turn05","turn_type":"toxicity_or_support_decision","gold_letter":"A","gold_action":"办理出院，予以胸腺五肽皮下注射支持治疗，嘱每周复查血常规及生化，按期返院行第2程诱导化疗。","options":[{"letter":"A","text":"办理出院，予以胸腺五肽皮下注射支持治疗，嘱每周复查血常规及生化，按期返院行第2程诱导化疗。","is_gold":true},{"letter":"B","text":"暂缓出院，继续静脉给予5-HT3受体拮抗剂及补液支持，待恶心呕吐完全缓解后出院。","is_gold":false},{"letter":"C","text":"办理出院，嘱每周复查血常规及生化，第2程诱导化疗将顺铂剂量下调20%。","is_gold":false},{"letter":"D","text":"办理出院，嘱每周复查血常规及生化，第2程诱导化疗更改为吉西他滨+顺铂（GP）方案。","is_gold":false},{"letter":"E","text":"办理出院，予以重组人粒细胞集落刺激因子（G-CSF）皮下注射，按期返院行第2程诱导化疗。","is_gold":false},{"letter":"F","text":"办理出院，予以重组人促红素（EPO）皮下注射，按期返院行第2程诱导化疗。","is_gold":false},{"letter":"G","text":"办理出院，予以胸腺五肽皮下注射支持治疗，并安排左侧腋窝淋巴结穿刺活检。","is_gold":false},{"letter":"H","text":"办理出院，予以胸腺五肽皮下注射支持治疗，嘱返院直接开始根治性放疗及同步化疗。","is_gold":false},{"letter":"I","text":"办理出院，予以口服阿瑞匹坦带药，嘱第2程诱导化疗推迟1周进行。","is_gold":false},{"letter":"J","text":"办理出院，予以重组人血小板生成素（rhTPO）皮下注射，按期返院行第2程诱导化疗。","is_gold":false},{"letter":"K","text":"暂缓出院，复查鼻咽及颈部MRI评估近期疗效，结果决定第2程化疗方案。","is_gold":false},{"letter":"L","text":"办理出院，予以胸腺五肽皮下注射支持治疗，嘱第2程诱导化疗加用尼妥珠单抗。","is_gold":false}]}
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+{"sample_id":"sample-ba3079ee7b3ef01162117027","patient_id":"patient-5fa48522b2703f35ead0224b","turn_id":"turn07","turn_type":"recurrence_or_salvage_decision","gold_letter":"C","gold_action":"暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，动态监测血常规，待中性粒细胞计数恢复后再行下一程化疗。","options":[{"letter":"A","text":"立即按原剂量启动第二程5-FU+顺铂方案化疗，并预防性给予长效重组人粒细胞刺激因子皮下注射","is_gold":false},{"letter":"B","text":"立即按原剂量启动第二程5-FU+顺铂方案化疗，化疗期间同步给予短效重组人粒细胞刺激因子皮下注射","is_gold":false},{"letter":"C","text":"暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，动态监测血常规，待中性粒细胞计数恢复后再行下一程化疗","is_gold":true},{"letter":"D","text":"暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射及广谱抗菌药物静脉滴注，待中性粒细胞计数恢复后再行化疗","is_gold":false},{"letter":"E","text":"终止诱导化疗，直接进入根治性放疗阶段，并给予重组人粒细胞刺激因子皮下注射","is_gold":false},{"letter":"F","text":"暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，待中性粒细胞恢复后调整下一程化疗方案为单药顺铂","is_gold":false},{"letter":"G","text":"暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，待中性粒细胞恢复后将5-FU与顺铂剂量均减低20%行下一程化疗","is_gold":false},{"letter":"H","text":"暂缓本周期化疗，仅予密切观察和口服升白药物，待中性粒细胞计数自然恢复后再行化疗","is_gold":false},{"letter":"I","text":"暂缓本周期化疗，行左侧腋窝淋巴结穿刺活检，同时给予重组人粒细胞刺激因子皮下注射","is_gold":false},{"letter":"J","text":"立即按原剂量启动第二程5-FU+顺铂方案化疗，化疗结束后48小时给予重组人粒细胞刺激因子皮下注射","is_gold":false},{"letter":"K","text":"暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，并安排全身PET-CT重新评估肿瘤范围","is_gold":false},{"letter":"L","text":"终止诱导化疗，改为靶向治疗联合重组人粒细胞刺激因子皮下注射，动态监测血常规","is_gold":false}]}
+{"sample_id":"sample-800192dfaf82bbe4edb2533a","patient_id":"patient-5fa48522b2703f35ead0224b","turn_id":"turn08","turn_type":"response_assessment_decision","gold_letter":"A","gold_action":"完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动顺铂同期化放疗","options":[{"letter":"A","text":"完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动顺铂同期化放疗","is_gold":true},{"letter":"B","text":"完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动第3程5-FU+顺铂诱导化疗","is_gold":false},{"letter":"C","text":"完善左侧腋窝淋巴结穿刺活检，行放疗定位扫描，并启动顺铂同期化放疗","is_gold":false},{"letter":"D","text":"完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动尼妥珠单抗联合根治性放疗","is_gold":false},{"letter":"E","text":"完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动单纯根治性放疗","is_gold":false},{"letter":"F","text":"完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动信迪利单抗联合根治性放疗","is_gold":false},{"letter":"G","text":"完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动尼妥珠单抗联合顺铂同期化放疗","is_gold":false},{"letter":"H","text":"完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动卡培他滨同期化放疗","is_gold":false},{"letter":"I","text":"完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动西妥昔单抗联合根治性放疗","is_gold":false},{"letter":"J","text":"完善全身PET-CT复查，行放疗定位扫描，并启动尼妥珠单抗联合根治性放疗","is_gold":false},{"letter":"K","text":"完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动吉西他滨联合顺铂同期化放疗","is_gold":false},{"letter":"L","text":"完善鼻咽及颈部MRI复查，暂缓放疗定位，启动第3程5-FU+顺铂诱导化疗","is_gold":false}]}
+{"sample_id":"sample-1a7cec18df1c66d68f69d55f","patient_id":"patient-84fa3d6098d10a1d14b6b19e","turn_id":"turn01","turn_type":"initial_workup_choice","gold_letter":"E","gold_action":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT，常规血液学、心电图与超声检查。","options":[{"letter":"A","text":"鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸腹部CT平扫，常规血液学检查。","is_gold":false},{"letter":"B","text":"鼻咽及颈部MRI平扫+增强，全身PET/CT，常规血液学检查，直接安排诱导化疗。","is_gold":false},{"letter":"C","text":"鼻咽镜检查及活检，鼻咽MRI平扫+增强，胸部X线片，腹部超声，全身骨扫描。","is_gold":false},{"letter":"D","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫，全身PET/CT，常规血液学及心电图检查。","is_gold":false},{"letter":"E","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT，常规血液学、心电图与超声检查。","is_gold":true},{"letter":"F","text":"颈部淋巴结穿刺活检，鼻咽及颈部MRI平扫+增强，全身PET/CT，常规血液学检查。","is_gold":false},{"letter":"G","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，暂缓全身影像学检查待病理结果回报。","is_gold":false},{"letter":"H","text":"鼻咽镜检查及活检，头颅CT平扫，颈部超声，胸腹部CT平扫+增强，常规血液学检查。","is_gold":false},{"letter":"I","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部CT平扫，腹部超声，暂不进行骨骼检查。","is_gold":false},{"letter":"J","text":"鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，全身PET/CT，常规血液学及心电图检查。","is_gold":false},{"letter":"K","text":"鼻咽镜检查，鼻咽及颈部MRI平扫+增强，全身PET/CT，待影像学评估后再行内镜活检。","is_gold":false},{"letter":"L","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT，同步进行根治性放疗定位。","is_gold":false}]}
+{"sample_id":"sample-13d0893c195434e9115bcbbc","patient_id":"patient-84fa3d6098d10a1d14b6b19e","turn_id":"turn02","turn_type":"imaging_release_workup","gold_letter":"F","gold_action":"完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测。","options":[{"letter":"A","text":"完善基线血液学检查，包含血常规、生化常规及凝血功能，暂缓检测EB病毒DNA及骨代谢标志物。","is_gold":false},{"letter":"B","text":"完善基线血液学检查，包含生化常规、凝血功能及传染病筛查，并安排全身PET-CT替代常规影像学分期。","is_gold":false},{"letter":"C","text":"完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能及传染病筛查，暂缓检测骨代谢标志物。","is_gold":false},{"letter":"D","text":"完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查，并安排颈部淋巴结穿刺活检明确病理。","is_gold":false},{"letter":"E","text":"完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查，并安排头颅增强MRI评估颅内侵犯。","is_gold":false},{"letter":"F","text":"完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测。","is_gold":true},{"letter":"G","text":"完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并安排全身PET-CT替代所有常规分期检查。","is_gold":false},{"letter":"H","text":"完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并安排鼻咽部平扫MRI。","is_gold":false},{"letter":"I","text":"完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并安排颈部超声指导淋巴结清扫。","is_gold":false},{"letter":"J","text":"完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并安排鼻咽镜评估治疗疗效。","is_gold":false},{"letter":"K","text":"完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并首选胸部X线片排除肺转移。","is_gold":false},{"letter":"L","text":"完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并常规安排骨髓穿刺排除骨髓转移。","is_gold":false}]}
+{"sample_id":"sample-474b60646fc04122e2c1c7ce","patient_id":"patient-84fa3d6098d10a1d14b6b19e","turn_id":"turn04","turn_type":"initial_treatment_selection","gold_letter":"H","gold_action":"顺铂+氟尿嘧啶（PF方案）诱导化疗","options":[{"letter":"A","text":"顺铂单药同期放化疗","is_gold":false},{"letter":"B","text":"多西他赛+顺铂（TP方案）姑息化疗","is_gold":false},{"letter":"C","text":"鼻咽及颈部根治性放射治疗","is_gold":false},{"letter":"D","text":"顺铂+多西他赛（TP方案）同期放化疗","is_gold":false},{"letter":"E","text":"依托泊苷+顺铂（EP方案）诱导化疗","is_gold":false},{"letter":"F","text":"顺铂+氟尿嘧啶（PF方案）姑息化疗","is_gold":false},{"letter":"G","text":"西妥昔单抗联合根治性放疗","is_gold":false},{"letter":"H","text":"顺铂+氟尿嘧啶（PF方案）诱导化疗","is_gold":true},{"letter":"I","text":"氟尿嘧啶单药诱导化疗","is_gold":false},{"letter":"J","text":"吉西他滨+顺铂（GP方案）姑息化疗","is_gold":false},{"letter":"K","text":"顺铂单药诱导化疗","is_gold":false},{"letter":"L","text":"卡瑞利珠单抗联合PF方案姑息化疗","is_gold":false}]}
+{"sample_id":"sample-654cb1177e5cb9c5732eccb0","patient_id":"patient-84fa3d6098d10a1d14b6b19e","turn_id":"turn05","turn_type":"toxicity_or_support_decision","gold_letter":"I","gold_action":"继续当前化疗及对症支持治疗，执行动静脉置管常规护理，并常规监测血常规与生化指标。","options":[{"letter":"A","text":"暂停化疗，静脉滴注还原型谷胱甘肽进行保肝治疗，待肝功能恢复正常后重启化疗。","is_gold":false},{"letter":"B","text":"暂停化疗，静脉滴注头孢类抗生素进行经验性抗感染治疗，待白细胞计数恢复正常后重启化疗。","is_gold":false},{"letter":"C","text":"继续化疗，皮下注射重组人粒细胞集落刺激因子预防中性粒细胞缺乏。","is_gold":false},{"letter":"D","text":"终止诱导化疗，提前进入根治性放疗阶段，并静脉滴注保肝药物。","is_gold":false},{"letter":"E","text":"继续化疗，静脉滴注异甘草酸镁注射液进行保肝治疗，并每日复查肝功能。","is_gold":false},{"letter":"F","text":"暂停化疗，行腹部CT增强扫描以排除肝脏转移或化疗引起的急性肝损伤。","is_gold":false},{"letter":"G","text":"继续化疗，停用所有止吐及护胃药物以减轻肝脏代谢负担。","is_gold":false},{"letter":"H","text":"暂停化疗，静脉推注地塞米松及异丙嗪进行抗过敏治疗。","is_gold":false},{"letter":"I","text":"继续化疗及对症支持治疗，执行动静脉置管常规护理，并常规监测血常规与生化指标。","is_gold":true},{"letter":"J","text":"继续化疗，拔除动静脉置管以预防导管相关性血流感染，改用外周静脉穿刺。","is_gold":false},{"letter":"K","text":"暂停化疗，静脉滴注氯化钾进行补钾治疗，待血钾明显上升后继续化疗。","is_gold":false},{"letter":"L","text":"继续化疗，静脉推注呋塞米促进顺铂排泄，预防急性肾功能损伤。","is_gold":false}]}
+{"sample_id":"sample-b094635ac349a10618a48030","patient_id":"patient-84fa3d6098d10a1d14b6b19e","turn_id":"turn06","turn_type":"toxicity_or_support_decision","gold_letter":"J","gold_action":"予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，并监测24小时尿量，准备行下一程化疗。","options":[{"letter":"A","text":"予以口服升白细胞药物，静脉水化及补充电解质，皮下注射胸腺法新，并监测24小时尿量，准备行下一程化疗。","is_gold":false},{"letter":"B","text":"予以静脉滴注保肝药物，静脉水化及补充电解质，皮下注射胸腺法新，暂缓化疗待复查指标正常后继续。","is_gold":false},{"letter":"C","text":"予以静脉输注碳酸氢钠碱化尿液及利尿处理，静脉水化及补充电解质，将下一程化疗方案中的顺铂替换为卡铂。","is_gold":false},{"letter":"D","text":"予以静脉营养支持，静脉水化及补充电解质，皮下注射胸腺法新，下一程化疗顺铂剂量下调20%。","is_gold":false},{"letter":"E","text":"予以静脉水化、补充电解质及维生素，预防性皮下注射重组人粒细胞刺激因子，口服止咳药物，准备行下一程化疗。","is_gold":false},{"letter":"F","text":"予以静脉水化、补充电解质及维生素，预防性皮下注射重组人血小板生成素，口服止咳药物，准备行下一程化疗。","is_gold":false},{"letter":"G","text":"予以静脉水化、补充电解质及维生素，口服止咳药物，加用异烟肼预防性抗结核治疗，准备行下一程化疗。","is_gold":false},{"letter":"H","text":"予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，无需监测尿量，准备行下一程化疗。","is_gold":false},{"letter":"I","text":"予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，并监测24小时尿量，准备行单纯放射治疗。","is_gold":false},{"letter":"J","text":"予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，并监测24小时尿量，准备行下一程化疗。","is_gold":true},{"letter":"K","text":"予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，并监测24小时尿量，将下一程化疗方案更改为吉西他滨加顺铂。","is_gold":false},{"letter":"L","text":"予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，并监测24小时尿量，将下一程化疗方案更改为紫杉醇加顺铂。","is_gold":false}]}
+{"sample_id":"sample-237ee315803b648b5eb4c67f","patient_id":"patient-84fa3d6098d10a1d14b6b19e","turn_id":"turn07","turn_type":"response_assessment_decision","gold_letter":"K","gold_action":"评估PET/CT证实双肺结节无代谢活性（排除M1），维持局部晚期诊断；行静脉置管护理与通畅性维护，复查生化常规后，继续行第2程PF方案诱导化疗。","options":[{"letter":"A","text":"评估PET/CT双侧扁桃体代谢活跃为淋巴结转移，双肺结节无代谢活性；调整为GP方案（吉西他滨+顺铂）行第2程诱导化疗，并加强静脉导管护理。","is_gold":false},{"letter":"B","text":"评估PET/CT证实双肺结节无代谢活性（排除M1）；已完成1程诱导化疗，直接进入根治性放疗阶段，并辅以同期顺铂化疗，定期复查生化常规。","is_gold":false},{"letter":"C","text":"评估PET/CT见双肺多发结节伴鼻咽病灶广泛侵犯，考虑为IVB期（M1）；调整为姑息性化疗，采用TP方案联合PD-1抑制剂，并维持静脉通路。","is_gold":false},{"letter":"D","text":"评估PET/CT证实双肺结节无代谢活性；病灶侵犯视神经及海绵窦，第2程诱导化疗需升级为TPF方案（多西他赛+顺铂+5-FU），并复查生化。","is_gold":false},{"letter":"E","text":"评估PET/CT证实双肺结节无代谢活性；拔除原有静脉置管以防血栓，复查生化常规后，继续行第2程PF方案（5-FU+顺铂）诱导化疗。","is_gold":false},{"letter":"F","text":"评估PET/CT证实双肺结节无代谢活性；局部病灶侵犯广泛，暂停化疗，优先行局部病灶减瘤术以解除视神经压迫，术后继续PF方案化疗。","is_gold":false},{"letter":"G","text":"评估PET/CT证实双肺结节无代谢活性；为加强局部控制，第2程诱导化疗在PF方案基础上加用西妥昔单抗靶向治疗，并常规维护静脉导管。","is_gold":false},{"letter":"H","text":"评估PET/CT证实双肺结节无代谢活性；第1程化疗后出现胃肠道反应，第2程化疗将顺铂替换为卡铂，行5-FU+卡铂方案，复查生化常规。","is_gold":false},{"letter":"I","text":"评估PET/CT证实双肺结节无代谢活性；行静脉置管护理，复查生化常规后，提前终止诱导化疗，开始单纯根治性放疗，密切监测不良反应。","is_gold":false},{"letter":"J","text":"评估PET/CT证实双肺结节无代谢活性，鼻咽病灶SUV值偏高说明原方案疗效欠佳；换用吉西他滨+顺铂方案行第2程诱导化疗，并复查生化。","is_gold":false},{"letter":"K","text":"评估PET/CT证实双肺结节无代谢活性（排除M1），维持局部晚期诊断；行静脉置管护理与通畅性维护，复查生化常规后，继续行第2程PF方案诱导化疗。","is_gold":true},{"letter":"L","text":"评估PET/CT证实双肺结节无代谢活性；病灶累及颅底及海绵窦，行第2程PF方案诱导化疗的同时，加用局部姑息性放疗，并维护静脉导管。","is_gold":false}]}
+{"sample_id":"sample-c9510f9db8861176764ecc37","patient_id":"patient-84fa3d6098d10a1d14b6b19e","turn_id":"turn08","turn_type":"recurrence_or_salvage_decision","gold_letter":"L","gold_action":"行电子鼻咽镜检查（不活检）进一步评估鼻咽局部疗效，复查血常规与生化常规，并予动静脉置管护理。","options":[{"letter":"A","text":"立即启动根治性调强放射治疗及同步化疗，暂不安排其他局部影像或内镜检查。","is_gold":false},{"letter":"B","text":"行电子鼻咽镜检查并对残留病灶取活检以明确病理状态，复查血常规与生化常规。","is_gold":false},{"letter":"C","text":"继续予以第3程5-FU+顺铂方案诱导化疗，待化疗结束后再行鼻咽镜评估。","is_gold":false},{"letter":"D","text":"安排全身PET/CT复查以评估全身肿瘤代谢活性变化，随后制定放疗计划。","is_gold":false},{"letter":"E","text":"更改为紫杉醇+顺铂方案行第3程诱导化疗，并予动静脉置管常规护理。","is_gold":false},{"letter":"F","text":"安排鼻咽及颈部CT平扫+增强进一步评估颅底骨质破坏情况，复查血常规。","is_gold":false},{"letter":"G","text":"择期行双侧颈部淋巴结清扫术，术后启动鼻咽局部及颈部放射治疗。","is_gold":false},{"letter":"H","text":"行电子鼻咽镜检查（不活检）评估局部疗效，并拔除动静脉置管准备单纯放疗。","is_gold":false},{"letter":"I","text":"更改为吉西他滨+顺铂方案行第3程诱导化疗，复查血常规与生化常规。","is_gold":false},{"letter":"J","text":"行电子鼻咽镜检查（不活检），若无明显外生型肿物则暂缓放疗并定期随访。","is_gold":false},{"letter":"K","text":"立即启动单纯根治性放射治疗，并予动静脉置管常规护理。","is_gold":false},{"letter":"L","text":"行电子鼻咽镜检查（不活检）进一步评估鼻咽局部疗效，复查血常规与生化常规，并予动静脉置管护理。","is_gold":true}]}
+{"sample_id":"sample-eb32294d1506d6b48368496f","patient_id":"patient-34616c327ce5d69194ca7f4d","turn_id":"turn01","turn_type":"initial_workup_choice","gold_letter":"A","gold_action":"完善鼻咽镜检查及活检，检测EBV DNA定量、常规血液学指标，并进行胸部DR与腹盆腔彩超检查。","options":[{"letter":"A","text":"完善鼻咽镜检查及活检，检测EBV DNA定量、常规血液学指标，并进行胸部DR与腹盆腔彩超检查","is_gold":true},{"letter":"B","text":"完善鼻咽镜检查及活检，检测EBV DNA定量，并进行全身PET-CT检查，暂缓常规血液学指标检测","is_gold":false},{"letter":"C","text":"完善鼻咽镜检查及活检，检测EBV DNA定量，并进行胸腹部增强CT检查，暂缓常规血液学指标检测","is_gold":false},{"letter":"D","text":"行头颈部MRI及颅底薄层CT检查，待影像学显示异常后再行鼻咽镜活检及EBV DNA检测","is_gold":false},{"letter":"E","text":"检测EBV DNA定量及常规血液学指标，待EBV DNA结果阳性后再行鼻咽镜活检及影像学检查","is_gold":false},{"letter":"F","text":"完善鼻咽镜检查及活检，检测常规血液学指标，并进行胸部DR与腹盆腔彩超检查，暂不检测EBV DNA","is_gold":false},{"letter":"G","text":"完善鼻咽镜检查（暂不活检），检测EBV DNA定量、常规血液学指标，并进行胸部DR与腹盆腔彩超检查","is_gold":false},{"letter":"H","text":"行全身骨扫描及头颅增强MRI检查，暂缓鼻咽镜活检及EBV DNA定量检测","is_gold":false},{"letter":"I","text":"完善鼻咽镜检查及活检，检测EBV DNA定量，并进行全身骨扫描，暂缓胸部及腹盆腔影像学检查","is_gold":false},{"letter":"J","text":"完善鼻咽镜检查及活检，检测EBV DNA定量、常规血液学指标，仅行胸部CT检查，暂不进行腹盆腔影像学评估","is_gold":false},{"letter":"K","text":"行常规血液学指标检测及基础影像学检查（胸部DR、腹盆腔彩超），暂缓鼻咽镜活检及EBV DNA检测","is_gold":false},{"letter":"L","text":"完善鼻咽镜检查及活检，检测常规血液学指标，行头颈部PET-CT检查，暂不检测EBV DNA定量","is_gold":false}]}
+{"sample_id":"sample-f19200235c8a99467249ed0c","patient_id":"patient-34616c327ce5d69194ca7f4d","turn_id":"turn02","turn_type":"imaging_release_workup","gold_letter":"B","gold_action":"评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查","options":[{"letter":"A","text":"评估影像分期为 cT3N1M0（AJCC 第9版 II期），直接安排诱导化疗联合同期放化疗，并补充生化常规检查","is_gold":false},{"letter":"B","text":"评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查","is_gold":true},{"letter":"C","text":"评估影像分期为 cT4N1M0（AJCC 第9版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查","is_gold":false},{"letter":"D","text":"评估影像分期为 cT3N2M0（AJCC 第9版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查","is_gold":false},{"letter":"E","text":"评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽镜及活检以获取病理确诊，并补充全身PET-CT检查","is_gold":false},{"letter":"F","text":"评估影像分期为 cT2N1M0（AJCC 第9版 I期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查","is_gold":false},{"letter":"G","text":"评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽镜及活检以获取病理确诊，并补充头颅增强MRI检查","is_gold":false},{"letter":"H","text":"评估影像分期为 cT3N1M1（AJCC 第9版 IVB期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查","is_gold":false},{"letter":"I","text":"评估影像分期为 cT3N1M0（AJCC 第8版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查","is_gold":false},{"letter":"J","text":"评估影像分期为 cT4N2M0（AJCC 第9版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查","is_gold":false},{"letter":"K","text":"评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽肿物切除活检以获取病理确诊，并补充生化常规检查","is_gold":false},{"letter":"L","text":"评估影像分期为 cT3N1M0（AJCC 第9版 II期），行右颈部淋巴结穿刺活检以获取病理确诊，并补充生化常规检查","is_gold":false}]}
+{"sample_id":"sample-2288420a623ad83bf0b0a558","patient_id":"patient-34616c327ce5d69194ca7f4d","turn_id":"turn04","turn_type":"initial_treatment_selection","gold_letter":"D","gold_action":"含铂方案诱导化疗序贯根治性放化疗，或根治性放疗联合含铂方案同步化疗","options":[{"letter":"A","text":"单纯根治性调强放射治疗","is_gold":false},{"letter":"B","text":"含铂双药方案诱导化疗序贯单纯根治性放疗","is_gold":false},{"letter":"C","text":"根治性放疗联合含铂方案同步化疗，序贯含铂双药辅助化疗","is_gold":false},{"letter":"D","text":"含铂方案诱导化疗序贯根治性放化疗，或根治性放疗联合含铂方案同步化疗","is_gold":true},{"letter":"E","text":"根治性放疗联合西妥昔单抗等EGFR靶向治疗","is_gold":false},{"letter":"F","text":"根治性放疗联合PD-1抑制剂同步免疫治疗","is_gold":false},{"letter":"G","text":"姑息性全身化疗联合局部病灶姑息性放疗","is_gold":false},{"letter":"H","text":"含铂双药方案诱导化疗序贯鼻咽原发灶切除及颈部淋巴结清扫术","is_gold":false},{"letter":"I","text":"根治性放疗联合大分子抗血管生成靶向治疗","is_gold":false},{"letter":"J","text":"单纯含铂双药方案全身化疗4-6个周期","is_gold":false},{"letter":"K","text":"鼻咽原发灶切除及颈部淋巴结清扫术序贯术后辅助放化疗","is_gold":false},{"letter":"L","text":"含铂双药方案诱导化疗序贯根治性放疗及PD-1抑制剂维持治疗","is_gold":false}]}
+{"sample_id":"sample-258f93513eac99791d84464c","patient_id":"patient-34616c327ce5d69194ca7f4d","turn_id":"turn05","turn_type":"toxicity_or_support_decision","gold_letter":"E","gold_action":"继续当前放化疗方案，定期复查血常规及生化指标。","options":[{"letter":"A","text":"暂停同期化疗，继续单纯放疗，并加用保肝药物","is_gold":false},{"letter":"B","text":"暂停放化疗，给予重组人粒细胞刺激因子支持治疗","is_gold":false},{"letter":"C","text":"继续放疗，将同期化疗剂量减低20%","is_gold":false},{"letter":"D","text":"继续放化疗方案，给予重组人血小板生成素","is_gold":false},{"letter":"E","text":"继续放化疗方案，定期复查血常规及生化指标","is_gold":true},{"letter":"F","text":"暂停放化疗，给予还原型谷胱甘肽保肝治疗","is_gold":false},{"letter":"G","text":"继续放化疗方案，加用双环醇保肝治疗","is_gold":false},{"letter":"H","text":"继续放化疗方案，给予重组人粒细胞刺激因子","is_gold":false},{"letter":"I","text":"暂停同期化疗，给予静脉补液及利尿处理","is_gold":false},{"letter":"J","text":"继续放疗，取消同期化疗，改为西妥昔单抗治疗","is_gold":false},{"letter":"K","text":"暂停放疗，继续同期化疗，给予促红细胞生成素治疗","is_gold":false},{"letter":"L","text":"继续放化疗方案，输注单采血小板","is_gold":false}]}
+{"sample_id":"sample-5a0d01adf33246131a9f67e1","patient_id":"patient-34616c327ce5d69194ca7f4d","turn_id":"turn06","turn_type":"toxicity_or_support_decision","gold_letter":"F","gold_action":"继续按计划完成根治性放疗，并维持当前口腔含漱等常规对症支持治疗。","options":[{"letter":"A","text":"暂停放疗，给予静脉营养支持及广谱抗生素，待黏膜反应恢复后恢复放疗。","is_gold":false},{"letter":"B","text":"暂停放疗，复查鼻咽颈部MRI评估疗效，若肿瘤完全消退则提前终止放疗。","is_gold":false},{"letter":"C","text":"继续放疗，给予重组人粒细胞集落刺激因子皮下注射以纠正淋巴细胞减少。","is_gold":false},{"letter":"D","text":"继续放疗，加用大剂量糖皮质激素静脉滴注以减轻放射性口腔黏膜炎。","is_gold":false},{"letter":"E","text":"暂停放疗，行经皮内镜下胃造瘘术以保障后续营养摄入及防止体重下降。","is_gold":false},{"letter":"F","text":"继续按计划完成根治性放疗，并维持口腔含漱等常规对症支持治疗。","is_gold":true},{"letter":"G","text":"继续放疗，加用氟康唑口服以预防放疗后期可能出现的真菌性口腔炎。","is_gold":false},{"letter":"H","text":"暂停放疗，给予局部放射性保护剂及高压氧治疗，待口干症状缓解后继续。","is_gold":false},{"letter":"I","text":"继续放疗，降低单次放疗剂量以减少对双侧腮腺及颌下腺的进一步损伤。","is_gold":false},{"letter":"J","text":"提前结束放疗，转为单药辅助化学治疗以控制微小转移灶并减轻局部毒性。","is_gold":false},{"letter":"K","text":"继续放疗，预防性留置鼻胃管以应对放疗末期可能加重的吞咽困难。","is_gold":false},{"letter":"L","text":"暂停放疗，行全身PET-CT排除远处转移后再决定是否完成剩余放疗。","is_gold":false}]}
+{"sample_id":"sample-a4894f941ebb70f32d9155cc","patient_id":"patient-9bf5c8c03860cdf61108611d","turn_id":"turn01","turn_type":"initial_workup_choice","gold_letter":"G","gold_action":"电子鼻咽镜检查及活检，鼻咽及颈部增强MRI，胸部X线、腹部彩超、全身骨显像，以及EBV抗体检测。","options":[{"letter":"A","text":"电子鼻咽镜检查及活检，鼻咽及颈部平扫CT，胸部X线、腹部彩超，暂缓全身骨显像及EBV检测","is_gold":false},{"letter":"B","text":"左颈部淋巴结切除活检，鼻咽及颈部增强MRI，胸部X线、腹部彩超、全身骨显像及EBV检测","is_gold":false},{"letter":"C","text":"电子鼻咽镜检查及活检，鼻咽及颈部增强CT，胸部X线、腹部彩超、全身骨显像，暂缓EBV检测","is_gold":false},{"letter":"D","text":"电子鼻咽镜检查（暂不活检），鼻咽及颈部增强MRI，全身PET-CT，以及EBV抗体检测","is_gold":false},{"letter":"E","text":"左颈部淋巴结细针穿刺活检，鼻咽及颈部平扫MRI，胸部X线、腹部彩超、全身骨显像","is_gold":false},{"letter":"F","text":"电子鼻咽镜检查及活检，鼻咽及颈部增强MRI，仅行胸部X线及腹部彩超，无需全身骨显像","is_gold":false},{"letter":"G","text":"电子鼻咽镜检查及活检，鼻咽及颈部增强MRI，胸部X线、腹部彩超、全身骨显像，以及EBV抗体检测","is_gold":true},{"letter":"H","text":"电子鼻咽镜检查及活检，鼻咽及颈部增强MRI，头颅增强MRI，全身骨髓穿刺活检及EBV检测","is_gold":false},{"letter":"I","text":"电子鼻咽镜检查及活检，鼻咽及颈部增强MRI，胸部X线、腹部彩超、全身骨显像，并预防性气管切开","is_gold":false},{"letter":"J","text":"电子鼻咽镜检查及活检，鼻咽及颈部平扫MRI，胸部X线、腹部彩超、全身骨显像，以及EBV抗体检测","is_gold":false},{"letter":"K","text":"鼻咽及颈部增强MRI，胸部X线、腹部彩超、全身骨显像，待影像学出具恶性报告后再行鼻咽镜活检","is_gold":false},{"letter":"L","text":"电子鼻咽镜检查及活检，鼻咽及颈部增强MRI，直接行全身骨显像及头颅CT，免除胸腹部影像学检查","is_gold":false}]}
+{"sample_id":"sample-487e8333de7d37de56947d09","patient_id":"patient-9bf5c8c03860cdf61108611d","turn_id":"turn02","turn_type":"imaging_release_workup","gold_letter":"H","gold_action":"完善电子鼻咽镜检查并取活检明确病理诊断。","options":[{"letter":"A","text":"完善颈部淋巴结细针穿刺活检作为首选病理确诊手段。","is_gold":false},{"letter":"B","text":"完善全身PET-CT检查，若无远处转移则直接开始根治性放疗。","is_gold":false},{"letter":"C","text":"完善电子鼻咽镜检查评估局部侵犯范围，暂不取活检以防大出血。","is_gold":false},{"letter":"D","text":"完善鼻咽镜检查并取活检，同时行颈部淋巴结切除活检以明确分期。","is_gold":false},{"letter":"E","text":"完善鼻咽部刷片细胞学检查明确病理诊断。","is_gold":false},{"letter":"F","text":"完善鼻内镜下鼻咽肿物切除术，术后送常规病理。","is_gold":false},{"letter":"G","text":"完善电子鼻咽镜检查并取活检，若首次活检阴性则按临床诊断开始化疗。","is_gold":false},{"letter":"H","text":"完善电子鼻咽镜检查并取活检明确病理诊断。","is_gold":true},{"letter":"I","text":"完善颈部淋巴结切除活检作为首选病理确诊手段。","is_gold":false},{"letter":"J","text":"完善电子鼻咽镜检查并取活检，同时行预防性气管切开。","is_gold":false},{"letter":"K","text":"完善鼻咽镜检查并取活检，同时行扁桃体切除活检排除隐匿原发灶。","is_gold":false},{"letter":"L","text":"完善全身骨扫描及腹部超声，待全身分期明确后再行鼻咽活检。","is_gold":false}]}
+{"sample_id":"sample-7ff1cd1ea3ebf1a9891b521d","patient_id":"patient-9bf5c8c03860cdf61108611d","turn_id":"turn05","turn_type":"toxicity_or_support_decision","gold_letter":"K","gold_action":"按原剂量行第二程GP（吉西他滨+顺铂）诱导化疗，并辅以常规止吐、护胃及水化利尿等支持治疗。","options":[{"letter":"A","text":"暂缓化疗，给予重组人血小板生成素升血小板治疗，待血小板恢复至正常范围后原剂量行第二程GP诱导化疗。","is_gold":false},{"letter":"B","text":"行第二程GP诱导化疗，吉西他滨剂量下调25%，顺铂维持原剂量，辅以常规止吐及水化利尿等支持治疗。","is_gold":false},{"letter":"C","text":"停用GP诱导化疗方案，直接转入根治性单纯放疗阶段，并安排心血管专科随访与干预。","is_gold":false},{"letter":"D","text":"更改诱导化疗方案，将第二程方案由GP（吉西他滨+顺铂）调整为TP（多西他赛+顺铂）方案并按原剂量给药。","is_gold":false},{"letter":"E","text":"按原剂量行第二程GP诱导化疗，并于化疗结束后预防性给予聚乙二醇化重组人粒细胞刺激因子支持。","is_gold":false},{"letter":"F","text":"暂缓化疗，请心血管内科会诊并完善超声心动图等检查，待心血管专科评估通过后再行第二程GP化疗。","is_gold":false},{"letter":"G","text":"按原剂量行第二程GP诱导化疗，并同步皮下注射重组人促红细胞生成素以提升血红蛋白水平。","is_gold":false},{"letter":"H","text":"行第二程GP诱导化疗，顺铂剂量下调25%，吉西他滨维持原剂量，辅以常规止吐及水化利尿等支持治疗。","is_gold":false},{"letter":"I","text":"终止诱导化疗，直接进入根治性同步放化疗阶段，同步化疗采用单药顺铂标准剂量方案。","is_gold":false},{"letter":"J","text":"按原剂量行第二程GP诱导化疗，化疗前预防性输注单采血小板1个治疗量以降低出血风险。","is_gold":false},{"letter":"K","text":"按原剂量行第二程GP诱导化疗，并辅以常规止吐、护胃及水化利尿等支持治疗。","is_gold":true},{"letter":"L","text":"按原剂量行第二程GP诱导化疗，并预防性加用异甘草酸镁等保肝药物以防止化疗相关肝损伤。","is_gold":false}]}
+{"sample_id":"sample-9fc5959f48286f0a038d3acb","patient_id":"patient-9bf5c8c03860cdf61108611d","turn_id":"turn07","turn_type":"response_assessment_decision","gold_letter":"A","gold_action":"完善鼻咽及颈部MRI评估疗效；取消同期顺铂化疗，予以纠正贫血并单纯根治性调强放疗（或联合靶向治疗）。","options":[{"letter":"A","text":"完善鼻咽及颈部MRI评估疗效；取消同期顺铂化疗，予以纠正贫血并单纯根治性调强放疗（或联合靶向治疗）。","is_gold":true},{"letter":"B","text":"完善鼻咽及颈部MRI评估疗效；按原计划行同期顺铂化疗联合根治性调强放疗。","is_gold":false},{"letter":"C","text":"完善鼻咽及颈部MRI评估疗效；将同期顺铂减量至40mg/m2周疗，联合根治性调强放疗。","is_gold":false},{"letter":"D","text":"完善鼻咽及颈部MRI评估疗效；将同期化疗方案更换为卡铂，联合根治性调强放疗。","is_gold":false},{"letter":"E","text":"完善鼻咽及颈部MRI评估疗效；暂停抗肿瘤治疗，待血红蛋白恢复至100g/L以上后再行同期放化疗。","is_gold":false},{"letter":"F","text":"完善鼻咽及颈部MRI评估疗效；予以输血支持，待贫血纠正后按原计划行同期顺铂化疗联合调强放疗。","is_gold":false},{"letter":"G","text":"完善鼻咽及颈部MRI评估疗效；取消同期顺铂化疗，直接行根治性调强放疗，暂不予纠正贫血。","is_gold":false},{"letter":"H","text":"完善鼻咽及颈部MRI评估疗效；将同期化疗方案更换为氟尿嘧啶单药，联合根治性调强放疗。","is_gold":false},{"letter":"I","text":"完善鼻咽及颈部MRI评估疗效；取消同期顺铂化疗，予以纠正贫血并联合PD-1抑制剂及调强放疗。","is_gold":false},{"letter":"J","text":"完善鼻咽及颈部MRI评估疗效；将同期化疗方案更换为吉西他滨单药，联合根治性调强放疗。","is_gold":false},{"letter":"K","text":"完善鼻咽及颈部MRI评估疗效；取消放疗，继续行非铂类方案（如紫杉醇单药）化疗。","is_gold":false}]}
+{"sample_id":"sample-340a8b44018e54c31bcf1d9c","patient_id":"patient-9bf5c8c03860cdf61108611d","turn_id":"turn08","turn_type":"response_assessment_decision","gold_letter":"B","gold_action":"判定为放疗后改变或临床完全缓解，进入定期随访观察","options":[{"letter":"A","text":"判定为局部残留，行鼻咽及颈部挽救性手术","is_gold":false},{"letter":"B","text":"判定为放疗后改变或临床完全缓解，进入定期随访观察","is_gold":true},{"letter":"C","text":"判定为局部残留，行鼻咽及颈部局部追加放疗","is_gold":false},{"letter":"D","text":"判定为疾病稳定，启动卡培他滨维持化疗","is_gold":false},{"letter":"E","text":"判定为疾病进展，启动含铂双药联合免疫全身治疗","is_gold":false},{"letter":"F","text":"判定为放疗后改变，启动尼妥珠单抗靶向维持治疗","is_gold":false},{"letter":"G","text":"判定为颈部淋巴结残留，行双侧颈淋巴结清扫术","is_gold":false},{"letter":"H","text":"判定为颅底骨质受侵进展，行颅底病灶切除术","is_gold":false},{"letter":"I","text":"判定为疗效不确定，行全身PET-CT检查明确病灶活性","is_gold":false},{"letter":"J","text":"判定为放疗后改变，行鼻咽黏膜活检排除微小残留","is_gold":false},{"letter":"K","text":"判定为临床完全缓解，启动PD-1抑制剂维持治疗","is_gold":false},{"letter":"L","text":"判定为局部残留，行原全身化疗方案追加2个周期","is_gold":false}]}
+{"sample_id":"sample-de1b18b9f870f76853282d28","patient_id":"patient-5ee5dba6116030961a7a97b5","turn_id":"turn01","turn_type":"initial_workup_choice","gold_letter":"K","gold_action":"鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查及活检、PET/CT全身显像、EB病毒DNA定量及常规血液生化检查","options":[{"letter":"A","text":"鼻咽及颈部CT平扫+增强、间接鼻咽镜检查及活检、PET/CT全身显像、EB病毒DNA定量及常规血液生化检查","is_gold":false},{"letter":"B","text":"鼻咽及颈部MRI平扫、间接鼻咽镜检查及活检、PET/CT全身显像、EB病毒DNA定量及常规血液生化检查","is_gold":false},{"letter":"C","text":"鼻咽MRI平扫+增强、间接鼻咽镜检查及活检、PET/CT全身显像、EB病毒DNA定量及常规血液生化检查","is_gold":false},{"letter":"D","text":"鼻咽及颈部MRI平扫+增强、右颈部肿物穿刺活检、PET/CT全身显像、EB病毒DNA定量及常规血液生化检查","is_gold":false},{"letter":"E","text":"鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查及活检、胸部X线及腹部B超、EB病毒DNA定量及常规血液生化检查","is_gold":false},{"letter":"F","text":"鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查及活检、PET/CT全身显像、常规血液生化检查","is_gold":false},{"letter":"G","text":"鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查及活检、头颅MRI平扫+增强、EB病毒DNA定量及常规血液生化检查","is_gold":false},{"letter":"H","text":"鼻咽及颈部CT平扫、间接鼻咽镜检查及活检、PET/CT全身显像、EB病毒DNA定量及常规血液生化检查","is_gold":false},{"letter":"I","text":"鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查及活检、PET/CT全身显像、EB病毒VCA-IgA检测及常规血液生化检查","is_gold":false},{"letter":"J","text":"鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查及活检、全身骨扫描、EB病毒DNA定量及常规血液生化检查","is_gold":false},{"letter":"K","text":"鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查及活检、PET/CT全身显像、EB病毒DNA定量及常规血液生化检查","is_gold":true},{"letter":"L","text":"鼻咽及颈部MRI平扫+增强、PET/CT全身显像、EB病毒DNA定量及常规血液生化检查、直接行诱导化疗","is_gold":false}]}
+{"sample_id":"sample-2c772b6972f0c7fdbd562b73","patient_id":"patient-5ee5dba6116030961a7a97b5","turn_id":"turn02","turn_type":"imaging_release_workup","gold_letter":"L","gold_action":"在尚未完成病理确诊和EB病毒DNA定量检测的前提下，下一步应行电子鼻咽镜检查及活检明确病理诊断，并补充EB病毒DNA荧光定量PCR检测","options":[{"letter":"A","text":"安排颈部淋巴结细针穿刺活检明确病理，并补充全身PET-CT检查","is_gold":false},{"letter":"B","text":"安排右侧颈部肿大淋巴结切除活检，并补充EB病毒DNA荧光定量PCR检测","is_gold":false},{"letter":"C","text":"直接基于MRI及EBV抗体阳性结果启动根治性放化疗","is_gold":false},{"letter":"D","text":"行电子鼻咽镜检查观察肿瘤范围，并补充全身骨扫描及胸腹部CT","is_gold":false},{"letter":"E","text":"行电子鼻咽镜检查及活检明确病理诊断，但不安排任何与EB病毒相关的检查","is_gold":false},{"letter":"F","text":"安排鼻内镜下鼻咽肿物切除术，并补充EB病毒DNA荧光定量PCR检测","is_gold":false},{"letter":"G","text":"安排颈部淋巴结细针穿刺活检，并补充EB病毒DNA荧光定量PCR检测","is_gold":false},{"letter":"H","text":"行电子鼻咽镜检查及活检明确病理诊断，并立即行右颈部淋巴结切除活检","is_gold":false},{"letter":"I","text":"补充EB病毒DNA荧光定量PCR检测，待结果回报后再决定是否行鼻咽活检","is_gold":false},{"letter":"J","text":"行电子鼻咽镜检查及活检明确病理诊断，并预防性行右颈淋巴结清扫术","is_gold":false},{"letter":"K","text":"安排颈部淋巴结穿刺活检及鼻咽镜下活检，并直接启动诱导化疗","is_gold":false},{"letter":"L","text":"行电子鼻咽镜检查及活检明确病理诊断，并补充EB病毒DNA荧光定量PCR检测","is_gold":true}]}
+{"sample_id":"sample-8976031a638416cb5f037a59","patient_id":"patient-5ee5dba6116030961a7a97b5","turn_id":"turn04","turn_type":"initial_treatment_selection","gold_letter":"A","gold_action":"行吉西他滨+顺铂方案诱导化疗联合PD-1抑制剂","options":[{"letter":"A","text":"行吉西他滨+顺铂方案诱导化疗联合PD-1抑制剂","is_gold":true},{"letter":"B","text":"行单纯根治性放射治疗","is_gold":false},{"letter":"C","text":"行紫杉醇+顺铂+氟尿嘧啶方案诱导化疗联合西妥昔单抗","is_gold":false},{"letter":"D","text":"行鼻咽原发灶及颈部淋巴结根治性切除术","is_gold":false},{"letter":"E","text":"行洛铂+氟尿嘧啶方案姑息性化疗","is_gold":false},{"letter":"F","text":"行卡培他滨单药节拍化疗","is_gold":false},{"letter":"G","text":"行洛铂+氟尿嘧啶方案诱导化疗后序贯颈部淋巴结清扫术","is_gold":false},{"letter":"H","text":"行多西他赛+顺铂方案同期放化疗","is_gold":false},{"letter":"I","text":"行吉西他滨单药诱导化疗","is_gold":false},{"letter":"J","text":"行依托泊苷+顺铂方案诱导化疗","is_gold":false}]}
+{"sample_id":"sample-5d943566dde88ca9f3640bc0","patient_id":"patient-5ee5dba6116030961a7a97b5","turn_id":"turn05","turn_type":"toxicity_or_support_decision","gold_letter":"C","gold_action":"办理出院，嘱每周复查血常规及肝肾功能，2周后返院继续下一阶段治疗。","options":[{"letter":"A","text":"办理出院，嘱每3天复查血常规及肝肾功能，1周后返院继续下一阶段治疗","is_gold":false},{"letter":"B","text":"予以重组人粒细胞刺激因子皮下注射后办理出院，嘱每周复查血常规，2周后返院","is_gold":false},{"letter":"C","text":"办理出院，嘱每周复查血常规及肝肾功能，2周后返院继续下一阶段治疗","is_gold":true},{"letter":"D","text":"办理出院，嘱每2周复查血常规及肝肾功能，3周后返院继续下一阶段治疗","is_gold":false},{"letter":"E","text":"暂缓出院，继续住院观察并每日复查血常规，待血液学指标进一步稳定后出院","is_gold":false},{"letter":"F","text":"办理出院，嘱每月复查血常规及肝肾功能，4周后返院评估疗效并决定后续治疗","is_gold":false},{"letter":"G","text":"予以静脉滴注保肝药物治疗，待复查肝功能指标完全正常后办理出院","is_gold":false},{"letter":"H","text":"办理出院，处方口服升血小板药物，嘱每周复查血常规，2周后返院","is_gold":false},{"letter":"I","text":"办理出院，处方口服卡培他滨单药维持，嘱每周复查血常规，3周后返院","is_gold":false},{"letter":"J","text":"办理出院，嘱每周复查血常规及肝肾功能，4周后返院行MRI复查评估疗效","is_gold":false},{"letter":"K","text":"予以口服氯化钾缓释片补钾治疗，每日监测电解质，待血钾水平上升后办理出院","is_gold":false},{"letter":"L","text":"办理出院，无需定期复查化验指标，嘱出现发热或出血症状时急诊就诊，3周后返院","is_gold":false}]}
+{"sample_id":"sample-90c3b83f1d4c9db69ef01572","patient_id":"patient-5ee5dba6116030961a7a97b5","turn_id":"turn06","turn_type":"toxicity_or_support_decision","gold_letter":"K","gold_action":"继续同期放化疗，予以甲氧氯普胺口服止吐，暂不予静脉营养及免疫调节支持。","options":[{"letter":"A","text":"继续同期放化疗，予以重组人粒细胞刺激因子皮下注射及甲氧氯普胺口服止吐。","is_gold":false},{"letter":"B","text":"继续同期放化疗，予以重组人血小板生成素皮下注射及脂肪乳氨基酸葡萄糖静脉营养。","is_gold":false},{"letter":"C","text":"继续同期放化疗，予以多烯磷脂酰胆碱静脉滴注保肝及甲氧氯普胺口服止吐。","is_gold":false},{"letter":"D","text":"继续同期放化疗，予以甲氧氯普胺口服止吐，加用脂肪乳氨基酸葡萄糖静脉营养及胸腺五肽支持治疗。","is_gold":false},{"letter":"E","text":"暂停同期化疗，仅行单纯放疗，予以甲氧氯普胺口服止吐及脂肪乳氨基酸葡萄糖静脉营养。","is_gold":false},{"letter":"F","text":"继续同期放化疗，予以促红细胞生成素皮下注射及胸腺五肽支持治疗。","is_gold":false},{"letter":"G","text":"暂停放化疗，予以静脉输注红细胞悬液及脂肪乳氨基酸葡萄糖静脉营养。","is_gold":false},{"letter":"H","text":"继续同期放化疗，予以5-HT3受体拮抗剂静脉推注强化止吐，暂不予静脉营养支持。","is_gold":false},{"letter":"I","text":"继续同期放化疗，予以水化碱化尿液及甲氧氯普胺口服止吐。","is_gold":false},{"letter":"J","text":"暂停放化疗，予以广谱抗生素静脉滴注抗感染及胸腺五肽支持治疗。","is_gold":false},{"letter":"K","text":"继续同期放化疗，予以甲氧氯普胺口服止吐，暂不予静脉营养及免疫调节支持。","is_gold":true},{"letter":"L","text":"继续同期放化疗，予以重组人粒细胞刺激因子及促红细胞生成素双重支持。","is_gold":false}]}
+{"sample_id":"sample-d1b602a57ed6c599e7f441cc","patient_id":"patient-5ee5dba6116030961a7a97b5","turn_id":"turn07","turn_type":"response_assessment_decision","gold_letter":"E","gold_action":"评估为诱导化疗部分缓解（PR），完善放疗前常规血液学检查，启动根治性调强放射治疗（IMRT）及放疗相关支持治疗。","options":[{"letter":"A","text":"评估为诱导化疗疾病稳定（SD），原方案（洛铂+5-FU）继续第3程诱导化疗，随后再评估放疗指征。","is_gold":false},{"letter":"B","text":"评估为诱导化疗部分缓解（PR），原方案（洛铂+5-FU）继续第3程诱导化疗，以期达到完全缓解后放疗。","is_gold":false},{"letter":"C","text":"评估为诱导化疗部分缓解（PR），行鼻咽及颈部病灶根治性手术切除，术后辅助调强放射治疗。","is_gold":false},{"letter":"D","text":"评估为诱导化疗完全缓解（CR），暂缓放射治疗，进入定期随访观察阶段。","is_gold":false},{"letter":"E","text":"评估为诱导化疗部分缓解（PR），完善放疗前常规血液学检查，启动根治性调强放射治疗（IMRT）及放疗相关支持治疗。","is_gold":true},{"letter":"F","text":"评估为诱导化疗部分缓解（PR），启动根治性三维适形放射治疗（3D-CRT）及放疗相关支持治疗。","is_gold":false},{"letter":"G","text":"评估为诱导化疗疾病进展（PD），更改诱导化疗方案为吉西他滨+顺铂（GP），2程后再次评估。","is_gold":false},{"letter":"H","text":"评估为诱导化疗部分缓解（PR），行颈部淋巴结清扫术，术后行鼻咽局部调强放射治疗。","is_gold":false},{"letter":"I","text":"评估为诱导化疗部分缓解（PR），启动姑息性减症放射治疗，剂量控制在40Gy左右。","is_gold":false},{"letter":"J","text":"评估为诱导化疗疾病稳定（SD），加用免疫检查点抑制剂联合原方案化疗。","is_gold":false},{"letter":"K","text":"评估为诱导化疗部分缓解（PR），等待4周后复查PET-CT，视代谢活性决定是否启动放射治疗。","is_gold":false},{"letter":"L","text":"评估为诱导化疗部分缓解（PR），停用化疗，单用靶向药物维持治疗。","is_gold":false}]}
+{"sample_id":"sample-c2aa48d510cb846f4ee51384","patient_id":"patient-5ee5dba6116030961a7a97b5","turn_id":"turn08","turn_type":"response_assessment_decision","gold_letter":"F","gold_action":"行电子鼻咽镜检查（不活检）评估局部情况，安排出院并予以镇痛、黏膜保护及雾化等对症药物。","options":[{"letter":"A","text":"行鼻咽部MRI及全身PET-CT全面评估疗效，若疑有残留即刻行局部挽救性手术。","is_gold":false},{"letter":"B","text":"行电子鼻咽镜检查并对原发灶区域行多点活检，明确病理缓解情况后决定是否追加化疗。","is_gold":false},{"letter":"C","text":"暂缓局部内镜检查，继续原方案洛铂单药辅助化疗2个周期后再行全面评估。","is_gold":false},{"letter":"D","text":"行电子鼻咽镜检查评估局部疗效，并继续住院行第3周期洛铂同期化疗。","is_gold":false},{"letter":"E","text":"直接安排出院，嘱3个月后返院行鼻咽镜及MRI检查，期间停用所有处方药物。","is_gold":false},{"letter":"F","text":"行电子鼻咽镜检查（不活检）评估局部情况，安排出院并予以镇痛、黏膜保护及雾化等对症药物。","is_gold":true},{"letter":"G","text":"行鼻咽部及颈部增强CT评估病灶退缩情况，若有残留予以局部追加放疗推量。","is_gold":false},{"letter":"H","text":"行电子鼻咽镜检查评估局部疗效，安排出院并立即开始PD-1抑制剂维持治疗半年。","is_gold":false},{"letter":"I","text":"行全身骨扫描及腹部超声评估远处转移情况，若阴性则安排出院并定期随访。","is_gold":false},{"letter":"J","text":"行电子鼻咽镜检查（不活检）评估局部情况，并转入头颈外科行右颈淋巴结清扫术。","is_gold":false},{"letter":"K","text":"安排出院并予以镇痛药物，1个月后返院行鼻咽镜下活检以明确是否达到病理完全缓解。","is_gold":false},{"letter":"L","text":"行鼻咽部MRI评估局部疗效，若达到完全缓解则安排出院并逐步停用所有镇痛药物。","is_gold":false}]}
+{"sample_id":"sample-6a54e1ca8d841063a11b801b","patient_id":"patient-f402aced5926698da3194c37","turn_id":"turn01","turn_type":"initial_workup_choice","gold_letter":"G","gold_action":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT显像，常规血液学、心电图与心脏彩超检查。","options":[{"letter":"A","text":"电子鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸部及腹部CT平扫，常规血液学检查。","is_gold":false},{"letter":"B","text":"颈部淋巴结切除活检，鼻咽及颈部MRI平扫+增强，全身PET/CT显像，常规血液学检查。","is_gold":false},{"letter":"C","text":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，颈部超声，暂缓全身影像学分期。","is_gold":false},{"letter":"D","text":"鼻咽及颈部MRI平扫+增强，全身PET/CT显像，先行诱导化疗待肿瘤缩小后行鼻咽活检。","is_gold":false},{"letter":"E","text":"电子鼻咽镜检查及活检，鼻咽MRI平扫+增强，胸部X线，腹部超声，全身骨显像。","is_gold":false},{"letter":"F","text":"颈部淋巴结细针穿刺活检，鼻咽及颈部CT平扫+增强，全身PET/CT显像，常规血液学检查。","is_gold":false},{"letter":"G","text":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT显像，常规血液学、心电图与心脏彩超检查。","is_gold":true},{"letter":"H","text":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸腹部CT平扫+增强，免除全身骨显像。","is_gold":false},{"letter":"I","text":"电子鼻咽镜检查及活检，头颅MRI平扫+增强，颈部超声，全身PET/CT显像，常规血液学检查。","is_gold":false},{"letter":"J","text":"鼻咽刷片细胞学检查，鼻咽及颈部MRI平扫+增强，全身PET/CT显像，常规血液学检查。","is_gold":false},{"letter":"K","text":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫，全身PET/CT显像，常规血液学检查。","is_gold":false},{"letter":"L","text":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT显像，同步安排根治性放疗定位。","is_gold":false}]}
+{"sample_id":"sample-1d99d3a2f71afa9bcb3f941a","patient_id":"patient-f402aced5926698da3194c37","turn_id":"turn02","turn_type":"imaging_release_workup","gold_letter":"H","gold_action":"行鼻咽内镜组织活检，完善鼻咽及颈部MRI平扫+增强，查乙肝病毒DNA定量","options":[{"letter":"A","text":"行颈部淋巴结细针穿刺活检，完善鼻咽及颈部CT平扫+增强，查乙肝病毒DNA定量","is_gold":false},{"letter":"B","text":"行鼻咽内镜组织活检，完善鼻咽及颈部CT平扫+增强，查乙肝病毒DNA定量","is_gold":false},{"letter":"C","text":"行鼻咽内镜组织活检，完善鼻咽及颈部MRI平扫+增强，暂不查乙肝病毒DNA定量","is_gold":false},{"letter":"D","text":"行颈部淋巴结切除活检，完善鼻咽及颈部MRI平扫+增强，查乙肝病毒DNA定量","is_gold":false},{"letter":"E","text":"行鼻咽内镜组织活检，完善鼻咽及颈部CT平扫+增强，查丙肝病毒RNA定量","is_gold":false},{"letter":"F","text":"行鼻咽内镜组织活检，完善头颅MRI平扫+增强，查乙肝病毒DNA定量","is_gold":false},{"letter":"G","text":"行颈部淋巴结细针穿刺活检，完善鼻咽及颈部MRI平扫+增强，暂不查乙肝病毒DNA定量","is_gold":false},{"letter":"H","text":"行鼻咽内镜组织活检，完善鼻咽及颈部MRI平扫+增强，查乙肝病毒DNA定量","is_gold":true},{"letter":"I","text":"行鼻咽内镜组织活检及颈部淋巴结穿刺活检，完善鼻咽及颈部MRI平扫+增强","is_gold":false},{"letter":"J","text":"行鼻咽内镜组织活检，完善鼻咽及颈部MRI平扫+增强，查丙肝病毒RNA定量","is_gold":false},{"letter":"K","text":"行鼻咽内镜组织活检，完善颈部超声造影，查乙肝病毒DNA定量","is_gold":false},{"letter":"L","text":"行鼻咽内镜组织活检，完善全身骨扫描，查乙肝病毒DNA定量","is_gold":false}]}
+{"sample_id":"sample-9fa3bde2f5d0ac4e910cb3cb","patient_id":"patient-f402aced5926698da3194c37","turn_id":"turn05","turn_type":"toxicity_or_support_decision","gold_letter":"K","gold_action":"按原剂量执行第2程洛铂+5-FU诱导化疗，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗","options":[{"letter":"A","text":"将第2程洛铂+5-FU诱导化疗减量20%，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗","is_gold":false},{"letter":"B","text":"暂停第2程诱导化疗，仅给予肠内营养及护胃支持，待胃肠道症状完全缓解后再评估化疗指征","is_gold":false},{"letter":"C","text":"按原剂量执行第2程洛铂+5-FU诱导化疗，并预防性给予重组人粒细胞集落刺激因子及止吐护胃支持治疗","is_gold":false},{"letter":"D","text":"按原剂量执行第2程洛铂+5-FU诱导化疗，并预防性给予重组人血小板生成素及止吐护胃支持治疗","is_gold":false},{"letter":"E","text":"将第2程诱导化疗方案更改为吉西他滨+顺铂，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗","is_gold":false},{"letter":"F","text":"将第2程诱导化疗方案更改为多西他赛+顺铂，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗","is_gold":false},{"letter":"G","text":"终止诱导化疗直接进入根治性放疗及同期化疗，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗","is_gold":false},{"letter":"H","text":"延迟第2程诱导化疗1周，期间给予护胃及止吐支持，待胃肠道症状完全缓解后再按原剂量化疗","is_gold":false},{"letter":"I","text":"按原剂量执行第2程洛铂+5-FU诱导化疗，取消常规止吐及护胃支持，仅在出现严重呕吐时给予解救治疗","is_gold":false},{"letter":"J","text":"将第2程洛铂+5-FU诱导化疗减量25%，并预防性给予重组人粒细胞集落刺激因子及止吐护胃支持治疗","is_gold":false},{"letter":"K","text":"按原剂量执行第2程洛铂+5-FU诱导化疗，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗","is_gold":true},{"letter":"L","text":"停用静脉化疗，改为口服卡培他滨单药化疗，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗","is_gold":false}]}
+{"sample_id":"sample-cc3b58d3bf4229805e8c7b84","patient_id":"patient-f402aced5926698da3194c37","turn_id":"turn06","turn_type":"toxicity_or_support_decision","gold_letter":"D","gold_action":"暂不予特殊药物支持治疗，仅常规监测血常规、生化常规","options":[{"letter":"A","text":"予以静脉输注红细胞悬液，并常规监测血常规、生化常规","is_gold":false},{"letter":"B","text":"予以重组人促红素（EPO）皮下注射，并常规监测血常规、生化常规","is_gold":false},{"letter":"C","text":"予以静脉滴注蔗糖铁注射液，并常规监测血常规、生化常规","is_gold":false},{"letter":"D","text":"暂不予特殊药物支持治疗，仅常规监测血常规、生化常规","is_gold":true},{"letter":"E","text":"予以粒细胞集落刺激因子（G-CSF）皮下注射，并常规监测血常规、生化常规","is_gold":false},{"letter":"F","text":"予以重组人血小板生成素（rhTPO）皮下注射，并常规监测血常规、生化常规","is_gold":false},{"letter":"G","text":"予以静脉滴注人血白蛋白，并常规监测血常规、生化常规","is_gold":false},{"letter":"H","text":"予以口服叶酸及维生素B12片，并常规监测血常规、生化常规","is_gold":false},{"letter":"I","text":"予以口服利血生及鲨肝醇片，并常规监测血常规、生化常规","is_gold":false},{"letter":"J","text":"予以静脉滴注右旋糖酐铁注射液，并常规监测血常规、生化常规","is_gold":false},{"letter":"K","text":"予以静脉滴注地塞米松及托烷司琼，并常规监测血常规、生化常规","is_gold":false},{"letter":"L","text":"予以口服多糖铁复合物胶囊，并常规监测血常规、生化常规","is_gold":false}]}
+{"sample_id":"sample-80438584d0b66a199c599a7d","patient_id":"patient-f402aced5926698da3194c37","turn_id":"turn07","turn_type":"response_assessment_decision","gold_letter":"A","gold_action":"疗效评估为部分缓解（PR），启动靶向治疗（西妥昔单抗）联合同期放化疗。","options":[{"letter":"A","text":"疗效评估为部分缓解（PR），启动靶向治疗（西妥昔单抗）联合同期放化疗","is_gold":true},{"letter":"B","text":"疗效评估为部分缓解（PR），启动靶向治疗（尼妥珠单抗）联合同期放化疗","is_gold":false},{"letter":"C","text":"疗效评估为部分缓解（PR），继续原方案（洛铂+5-FU）第3程诱导化疗","is_gold":false},{"letter":"D","text":"疗效评估为部分缓解（PR），启动同期放化疗，暂不联合靶向治疗","is_gold":false},{"letter":"E","text":"疗效评估为疾病稳定（SD），启动免疫治疗（卡瑞利珠单抗）联合同期放化疗","is_gold":false},{"letter":"F","text":"疗效评估为疾病进展（PD），更改化疗方案为吉西他滨+顺铂诱导化疗","is_gold":false},{"letter":"G","text":"疗效评估为部分缓解（PR），行鼻咽及颈部根治性放疗，不联合全身治疗","is_gold":false},{"letter":"H","text":"疗效评估为部分缓解（PR），暂停抗肿瘤治疗，单纯行纠正贫血支持治疗","is_gold":false},{"letter":"I","text":"疗效评估为部分缓解（PR），行双侧颈部淋巴结清扫术，术后辅助放疗","is_gold":false},{"letter":"J","text":"疗效评估为完全缓解（CR），启动靶向治疗（西妥昔单抗）联合同期放化疗","is_gold":false},{"letter":"K","text":"疗效评估为部分缓解（PR），启动靶向治疗（贝伐珠单抗）联合同期放化疗","is_gold":false},{"letter":"L","text":"疗效评估为部分缓解（PR），启动免疫治疗（帕博利珠单抗）联合同期放化疗","is_gold":false}]}
+{"sample_id":"sample-8b39359cc6c7b630fd005591","patient_id":"patient-f402aced5926698da3194c37","turn_id":"turn08","turn_type":"response_assessment_decision","gold_letter":"B","gold_action":"确认腹部彩超无转移，继续门诊放疗，左肾结石暂予观察，并予乳果糖口服液。","options":[{"letter":"A","text":"确认腹部彩超无转移，暂停放疗，请泌尿外科会诊行左肾结石碎石治疗，并予乳果糖口服液。","is_gold":false},{"letter":"B","text":"确认腹部彩超无转移，继续门诊放疗，左肾结石暂予观察，并予乳果糖口服液。","is_gold":true},{"letter":"C","text":"确认腹部彩超无转移，继续门诊放疗，左肾结石暂予观察，并加用洛铂行第3程同期化疗。","is_gold":false},{"letter":"D","text":"确认腹部彩超无转移，暂停门诊放疗，复查鼻咽及颈部MRI评估局部疗效，并予乳果糖口服液。","is_gold":false},{"letter":"E","text":"确认腹部彩超无转移，继续门诊放疗，对左肾结石予排石颗粒，并加用西妥昔单抗靶向治疗。","is_gold":false},{"letter":"F","text":"确认腹部彩超无转移，终止放疗，左肾结石暂予观察，转入康复科行便秘治疗。","is_gold":false},{"letter":"G","text":"确认腹部彩超无转移，继续门诊放疗，对左肾结石予留置双J管，并予乳果糖口服液。","is_gold":false},{"letter":"H","text":"确认腹部彩超无转移，暂停门诊放疗，予温肥皂水灌肠处理便秘，左肾结石暂予观察。","is_gold":false},{"letter":"I","text":"确认腹部彩超无转移，继续门诊放疗，左肾结石暂予观察，并予洛哌丁胺口服。","is_gold":false},{"letter":"J","text":"确认腹部彩超无转移，继续门诊放疗，左肾结石暂予观察，并予开塞露联合新斯的明肌注。","is_gold":false},{"letter":"K","text":"确认腹部彩超无转移，暂停门诊放疗，行全身PET-CT评估疗效，左肾结石暂予观察。","is_gold":false},{"letter":"L","text":"确认腹部彩超无转移，继续门诊放疗，行体外冲击波碎石，处理左肾结石，并予乳果糖口服液。","is_gold":false}]}
+{"sample_id":"sample-9e8ddeeab49a15f0eb3930d7","patient_id":"patient-51e6f99c527367bbd97aebd8","turn_id":"turn01","turn_type":"initial_workup_choice","gold_letter":"C","gold_action":"完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像，并进行病理会诊或鼻咽活检及心电图等基线检查。","options":[{"letter":"A","text":"完善鼻咽及颈部CT平扫+增强、胸腹部CT平扫+增强、全身骨扫描，并进行病理会诊或鼻咽活检。","is_gold":false},{"letter":"B","text":"完善鼻咽MRI平扫+增强、胸腹部CT平扫+增强、全身骨扫描，暂缓病理检查。","is_gold":false},{"letter":"C","text":"完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像，并进行病理会诊或鼻咽活检及心电图等基线检查。","is_gold":true},{"letter":"D","text":"完善鼻咽及颈部MRI平扫、PET/CT全身显像，并进行病理会诊或鼻咽活检。","is_gold":false},{"letter":"E","text":"完善鼻咽及颈部MRI平扫+增强、头颅MRI平扫+增强，直接安排放疗定位。","is_gold":false},{"letter":"F","text":"完善鼻咽及颈部CT平扫、PET/CT全身显像，并进行鼻咽肿物切除活检。","is_gold":false},{"letter":"G","text":"完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像，并进行颈部淋巴结穿刺活检。","is_gold":false},{"letter":"H","text":"完善鼻咽及颈部MRI平扫+增强、胸部X线、腹部超声，并进行病理会诊或鼻咽活检。","is_gold":false},{"letter":"I","text":"完善鼻咽及颈部MRI平扫+增强、全身骨扫描，并进行病理会诊或鼻咽活检。","is_gold":false},{"letter":"J","text":"完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像，直接开始诱导化疗。","is_gold":false},{"letter":"K","text":"完善鼻咽及颈部MRI平扫+增强、胸腹部CT平扫+增强、全身骨扫描，并进行鼻内镜下鼻咽肿物扩大切除术。","is_gold":false}]}
+{"sample_id":"sample-78b27b455a910a93bd013384","patient_id":"patient-51e6f99c527367bbd97aebd8","turn_id":"turn02","turn_type":"imaging_release_workup","gold_letter":"D","gold_action":"明确鼻咽癌临床分期为 cT1N0M0，IA期（肿瘤累及鼻咽及左侧后鼻孔，无颈部淋巴结转移）","options":[{"letter":"A","text":"明确鼻咽癌临床分期为 cT2N0M0，II期（肿瘤累及左侧后鼻孔，无颈部淋巴结转移）","is_gold":false},{"letter":"B","text":"明确鼻咽癌临床分期为 cT1N1M0，II期（肿瘤局限于鼻咽，伴单侧咽后淋巴结转移）","is_gold":false},{"letter":"C","text":"明确鼻咽癌临床分期为 cT2N1M0，II期（肿瘤累及左侧后鼻孔及咽旁间隙，伴单侧颈部淋巴结转移）","is_gold":false},{"letter":"D","text":"明确鼻咽癌临床分期为 cT1N0M0，IA期（肿瘤累及鼻咽及左侧后鼻孔，无颈部淋巴结转移）","is_gold":true},{"letter":"E","text":"明确鼻咽癌临床分期为 cT3N0M0，III期（肿瘤累及颅底骨质，无颈部淋巴结转移）","is_gold":false},{"letter":"F","text":"明确鼻咽癌临床分期为 cT1N0M0，IA期（肿瘤局限于鼻咽，未累及鼻腔及口咽等邻近结构）","is_gold":false},{"letter":"G","text":"明确鼻咽癌临床分期为 cT2N0M0，II期（肿瘤累及鼻咽及口咽，无颈部淋巴结转移）","is_gold":false},{"letter":"H","text":"明确鼻咽癌临床分期为 cT1N2M0，III期（肿瘤累及左侧后鼻孔，伴双侧颈部淋巴结转移）","is_gold":false},{"letter":"I","text":"明确鼻咽癌临床分期为 cT3N1M0，III期（肿瘤累及翼内肌，伴单侧颈部淋巴结转移）","is_gold":false},{"letter":"J","text":"明确鼻咽癌临床分期为 cT4N0M0，IVA期（肿瘤累及海绵窦，无颈部淋巴结转移）","is_gold":false},{"letter":"K","text":"明确鼻咽癌临床分期为 cT1N0M1，IVB期（肿瘤累及左侧后鼻孔，伴远处器官转移）","is_gold":false},{"letter":"L","text":"明确鼻咽癌临床分期为 cT2N2M0，III期（肿瘤累及咽旁间隙，伴双侧颈部淋巴结转移）","is_gold":false}]}
+{"sample_id":"sample-db8d6d3eabcfcb123b0c3cb1","patient_id":"patient-51e6f99c527367bbd97aebd8","turn_id":"turn05","turn_type":"toxicity_or_support_decision","gold_letter":"F","gold_action":"暂停顺铂化疗，继续单纯放疗，给予静脉保肝治疗，待肝功能恢复后补足化疗周期。","options":[{"letter":"A","text":"暂停放化疗，给予多烯磷脂酰胆碱、还原型谷胱甘肽等静脉保肝治疗，待肝功能恢复正常后恢复放化疗。","is_gold":false},{"letter":"B","text":"继续放化疗，仅密切监测肝功能变化，暂不给予静脉保肝药物干预。","is_gold":false},{"letter":"C","text":"继续放化疗，给予广谱抗生素静脉滴注预防感染，并辅以雾化吸入及止吐等对症支持处理。","is_gold":false},{"letter":"D","text":"将顺铂方案调整为卡铂方案同时期化疗，并给予静脉保肝治疗及止吐等对症支持处理。","is_gold":false},{"letter":"E","text":"顺铂剂量减低25%继续同时期化疗，给予静脉保肝治疗，辅以雾化吸入及止吐等对症支持处理。","is_gold":false},{"letter":"F","text":"暂停顺铂化疗，继续单纯放疗，给予静脉保肝治疗，待肝功能恢复后补足化疗周期。","is_gold":true},{"letter":"G","text":"给予多烯磷脂酰胆碱、还原型谷胱甘肽、复方甘草酸苷等静脉保肝治疗，辅以雾化吸入及止吐等对症支持处理。","is_gold":false},{"letter":"H","text":"给予大剂量质子泵抑制剂静脉滴注预防消化道出血，暂缓保肝治疗，继续放化疗。","is_gold":false},{"letter":"I","text":"暂停放疗，继续顺铂化疗，给予静脉保肝治疗及止吐等对症支持处理。","is_gold":false},{"letter":"J","text":"给予静脉保肝治疗，行骨髓穿刺检查排除血液系统异常，继续放化疗。","is_gold":false},{"letter":"K","text":"终止临床试验，转为常规单药顺铂同时期放化疗，并给予静脉保肝治疗。","is_gold":false},{"letter":"L","text":"给予口服保肝药物治疗，辅以雾化吸入及止吐等对症支持处理，继续放化疗。","is_gold":false}]}
+{"sample_id":"sample-1d71f20ed555c71c5a4de4ee","patient_id":"patient-51e6f99c527367bbd97aebd8","turn_id":"turn06","turn_type":"toxicity_or_support_decision","gold_letter":"H","gold_action":"给予联苯双酯等保肝降酶药物，辅以静脉营养支持，并密切复查肝功能。","options":[{"letter":"A","text":"暂停放疗与化疗，给予异甘草酸镁静脉滴注，待转氨酶降至正常水平后重启治疗。","is_gold":false},{"letter":"B","text":"终止顺铂化疗，后续疗程替换为卡铂，并加用甲泼尼龙静脉滴注。","is_gold":false},{"letter":"C","text":"暂停放疗，继续按计划执行化疗，给予联苯双酯口服及静脉营养支持。","is_gold":false},{"letter":"D","text":"维持治疗节奏，暂不加用保肝药物，1周后常规复查肝肾功能。","is_gold":false},{"letter":"E","text":"加用恩替卡韦口服抗病毒治疗，并维持放化疗方案不变。","is_gold":false},{"letter":"F","text":"安排肝脏病灶穿刺活检，明确病理性质前暂停所有抗肿瘤治疗。","is_gold":false},{"letter":"G","text":"给予重组人粒细胞集落刺激因子皮下注射，辅以静脉营养支持。","is_gold":false},{"letter":"H","text":"给予联苯双酯等保肝降酶药物，辅以静脉营养支持，并密切复查肝功能。","is_gold":true},{"letter":"I","text":"给予重组人血小板生成素皮下注射，并推迟下一疗程化疗。","is_gold":false},{"letter":"J","text":"给予头孢哌酮舒巴坦静脉滴注抗感染，并密切复查肝功能。","is_gold":false},{"letter":"K","text":"给予保肝降酶药物治疗，并按比例降低后续颈部放疗靶区处方剂量。","is_gold":false},{"letter":"L","text":"立即行血浆置换治疗，暂停放疗及化疗。","is_gold":false}]}
+{"sample_id":"sample-5eba0030ab5d024288a0d69d","patient_id":"patient-51e6f99c527367bbd97aebd8","turn_id":"turn07","turn_type":"response_assessment_decision","gold_letter":"I","gold_action":"继续根治性放疗，给予雾化吸入氨溴索与地塞米松，并局部外用三乙醇胺乳膏。","options":[{"letter":"A","text":"暂停放疗，给予静脉滴注广谱抗菌药物及大剂量糖皮质激素。","is_gold":false},{"letter":"B","text":"暂停放疗，行肝脏穿刺活检明确肝脏病灶性质后调整全身系统性化疗方案。","is_gold":false},{"letter":"C","text":"继续根治性放疗，给予重组人粒细胞集落刺激因子（G-CSF）皮下注射。","is_gold":false},{"letter":"D","text":"继续根治性放疗，加用第3程顺铂同期化疗，并给予静脉保肝药物。","is_gold":false},{"letter":"E","text":"终止放疗，转为TPF方案全身系统性化疗。","is_gold":false},{"letter":"F","text":"继续根治性放疗，局部外用强效糖皮质激素软膏，并口服非甾体抗炎药。","is_gold":false},{"letter":"G","text":"暂停放疗，复查鼻咽及颈部MRI以决定是否降低后续放疗靶区剂量。","is_gold":false},{"letter":"H","text":"继续根治性放疗，给予静脉异甘草酸镁及还原型谷胱甘肽保肝治疗。","is_gold":false},{"letter":"I","text":"继续根治性放疗，给予雾化吸入氨溴索与地塞米松，并局部外用三乙醇胺乳膏。","is_gold":true},{"letter":"J","text":"继续根治性放疗，联合靶向药物尼妥珠单抗及PD-1抑制剂治疗。","is_gold":false},{"letter":"K","text":"继续根治性放疗，给予静脉滴注地塞米松，并局部外用莫匹罗星软膏。","is_gold":false},{"letter":"L","text":"结束放化疗综合治疗，进入随访观察期，定期复查鼻咽MRI及颈部超声。","is_gold":false}]}
+{"sample_id":"sample-24c04c80074ea3aab5465600","patient_id":"patient-51e6f99c527367bbd97aebd8","turn_id":"turn08","turn_type":"response_assessment_decision","gold_letter":"J","gold_action":"继续根治性放疗，给予雾化吸入（氨溴索、地塞米松）及局部外用药（三乙醇胺乳膏）处理急性放射性黏膜炎和皮炎。","options":[{"letter":"A","text":"暂停放疗，行腹部增强MRI或穿刺活检明确肝脏囊性病灶性质，待明确性质后再决定后续治疗方案。","is_gold":false},{"letter":"B","text":"继续根治性放疗，启动第三程顺铂单药同期化疗，并给予保肝、止吐及水化等预防性对症支持治疗。","is_gold":false},{"letter":"C","text":"继续根治性放疗，加用卡培他滨口服节拍化疗，并给予雾化吸入及局部外用药处理放疗反应。","is_gold":false},{"letter":"D","text":"提前结束放疗，给予静脉滴注大剂量糖皮质激素及广谱抗生素处理放射性黏膜炎和皮炎。","is_gold":false},{"letter":"E","text":"继续根治性放疗，给予静脉高营养支持处理急性放射性黏膜炎，并预防性使用重组人粒细胞刺激因子。","is_gold":false},{"letter":"F","text":"暂停放疗，复查鼻咽及颈部MRI，重新定位并缩减原发灶及颈部放疗靶区。","is_gold":false},{"letter":"G","text":"继续根治性放疗，行肝脏囊性灶局部射频消融治疗，并给予雾化吸入及局部外用药处理放疗反应。","is_gold":false},{"letter":"H","text":"继续根治性放疗，继续给予静脉双环醇等保肝药物强化治疗，并给予局部外用药处理放疗反应。","is_gold":false},{"letter":"I","text":"暂停放疗，给予局部清创换药，待皮肤及黏膜反应恢复至1级以下再恢复根治性放疗。","is_gold":false},{"letter":"J","text":"继续根治性放疗，给予雾化吸入（氨溴索、地塞米松）及局部外用药（三乙醇胺乳膏）处理急性放射性黏膜炎和皮炎。","is_gold":true},{"letter":"K","text":"继续根治性放疗，给予口服非甾体抗炎药缓解黏膜疼痛，并在局部皮炎处预防性涂抹抗生素软膏。","is_gold":false},{"letter":"L","text":"结束根治性放疗，进入定期随访阶段，给予雾化吸入及局部外用药处理急性放射性黏膜炎和皮炎。","is_gold":false}]}
+{"sample_id":"sample-6bc929b6a549b509a4ffbecf","patient_id":"patient-867f2373fc1b04e0b8b80452","turn_id":"turn01","turn_type":"initial_workup_choice","gold_letter":"K","gold_action":"行电子鼻咽镜检查及组织活检以明确病理诊断，同时完善鼻咽及颈部MRI平扫加增强进行局部区域分期，并进行常规血液学检查。","options":[{"letter":"A","text":"电子鼻咽镜下活检，鼻咽及颈部CT平扫加增强，常规血液学检查","is_gold":false},{"letter":"B","text":"鼻咽及颈部MRI平扫加增强，全身PET-CT检查，常规血液学检查","is_gold":false},{"letter":"C","text":"电子鼻咽镜下活检，鼻咽MRI平扫加增强，常规血液学检查","is_gold":false},{"letter":"D","text":"电子鼻咽镜下活检，鼻咽及颈部MRI平扫，常规血液学检查","is_gold":false},{"letter":"E","text":"鼻咽及颈部CT平扫加增强，全身骨扫描，常规血液学检查","is_gold":false},{"letter":"F","text":"电子鼻咽镜下活检，鼻咽及颈部MRI平扫加增强，腰椎穿刺脑脊液检查","is_gold":false},{"letter":"G","text":"电子鼻咽镜下活检，全身PET-CT检查，常规血液学检查","is_gold":false},{"letter":"H","text":"鼻咽刷片细胞学检查，鼻咽及颈部MRI平扫加增强，常规血液学检查","is_gold":false},{"letter":"I","text":"电子鼻咽镜下活检，鼻咽及颈部MRI平扫加增强，颈部淋巴结穿刺活检","is_gold":false},{"letter":"J","text":"电子鼻咽镜下活检，鼻咽及颈部超声检查，常规血液学检查","is_gold":false},{"letter":"K","text":"电子鼻咽镜下活检，鼻咽及颈部MRI平扫加增强，常规血液学检查","is_gold":true},{"letter":"L","text":"鼻咽及颈部MRI平扫加增强，常规血液学检查，择期行鼻咽肿物切除术","is_gold":false}]}
+{"sample_id":"sample-31a839b9f99ab6bf0a218575","patient_id":"patient-867f2373fc1b04e0b8b80452","turn_id":"turn02","turn_type":"imaging_release_workup","gold_letter":"L","gold_action":"完善全身远处转移排查（如PET-CT或胸腹部CT联合骨扫描）及血浆EBV-DNA检测，并行超声引导下中心静脉穿刺置管及X线定位，为全身化疗做准备。","options":[{"letter":"A","text":"完善全身远处转移排查及血浆EBV-DNA检测，并直接安排单纯根治性放射治疗定位。","is_gold":false},{"letter":"B","text":"完善全身远处转移排查及血浆EBV-DNA检测，并请头颈外科会诊评估鼻咽及颈部病灶根治性切除可能。","is_gold":false},{"letter":"C","text":"完善胸部X线、腹部超声及血浆EBV-DNA检测进行分期，并行超声引导下中心静脉穿刺置管及X线定位，为全身化疗做准备。","is_gold":false},{"letter":"D","text":"完善全身远处转移排查及血浆EBV-DNA检测，并预防性行经皮内镜下胃造瘘术（PEG）以保障放化疗期间营养。","is_gold":false},{"letter":"E","text":"安排鼻咽镜下再次活检以明确组织学亚型，暂缓全身远处转移排查及静脉置管，待病理亚型确诊后再行后续安排。","is_gold":false},{"letter":"F","text":"完善全身远处转移排查及血浆EBV-DNA检测，并直接通过外周静脉留置针（PIV）启动全身化疗。","is_gold":false},{"letter":"G","text":"完善全身骨扫描及血浆EBV-DNA检测，并行超声引导下中心静脉穿刺置管及X线定位，为全身化疗做准备。","is_gold":false},{"letter":"H","text":"完善全身远处转移排查及血浆EBV-DNA检测，并先行双侧颈部淋巴结清扫术，术后行全身化疗。","is_gold":false},{"letter":"I","text":"完善全身远处转移排查及血浆EBV-DNA检测，并安排单药免疫治疗作为诱导治疗，无需中心静脉置管。","is_gold":false},{"letter":"J","text":"完善全身远处转移排查及血浆EBV-DNA检测，并安排超声引导下颈部淋巴结穿刺活检以病理确诊N分期。","is_gold":false},{"letter":"K","text":"完善全身远处转移排查及血浆EBV-DNA检测，并常规安排腰椎穿刺脑脊液检查以排除脑膜转移。","is_gold":false},{"letter":"L","text":"完善全身远处转移排查（如PET-CT或胸腹部CT联合骨扫描）及血浆EBV-DNA检测，并行超声引导下中心静脉穿刺置管及X线定位，为全身化疗做准备。","is_gold":true}]}
+{"sample_id":"sample-9833293530ca96a9a65dbbb8","patient_id":"patient-867f2373fc1b04e0b8b80452","turn_id":"turn04","turn_type":"initial_treatment_selection","gold_letter":"B","gold_action":"诱导化疗（洛铂+氟尿嘧啶）序贯同期放化疗","options":[{"letter":"A","text":"诱导化疗（吉西他滨+顺铂）序贯单纯根治性放疗","is_gold":false},{"letter":"B","text":"诱导化疗（洛铂+氟尿嘧啶）序贯同期放化疗","is_gold":true},{"letter":"C","text":"同期放化疗（顺铂单药）序贯辅助化疗","is_gold":false},{"letter":"D","text":"诱导化疗（多西他赛+顺铂+氟尿嘧啶）序贯单纯根治性放疗","is_gold":false},{"letter":"E","text":"诱导化疗（紫杉醇+卡铂）序贯同期放化疗","is_gold":false},{"letter":"F","text":"靶向治疗（西妥昔单抗）联合根治性放疗","is_gold":false},{"letter":"G","text":"诱导化疗（洛铂+氟尿嘧啶）联合特瑞普利单抗序贯同期放化疗","is_gold":false},{"letter":"H","text":"诱导化疗（依托泊苷+顺铂）序贯同期放化疗","is_gold":false},{"letter":"I","text":"单纯根治性放疗序贯辅助化疗","is_gold":false},{"letter":"J","text":"诱导化疗（顺铂+氟尿嘧啶）序贯单纯根治性放疗","is_gold":false},{"letter":"K","text":"诱导化疗（吉西他滨+卡培他滨）序贯同期放化疗","is_gold":false},{"letter":"L","text":"姑息性化疗（洛铂+氟尿嘧啶）序贯姑息性放疗","is_gold":false}]}
+{"sample_id":"sample-5d0eff95cd33597017422fc5","patient_id":"patient-867f2373fc1b04e0b8b80452","turn_id":"turn05","turn_type":"toxicity_or_support_decision","gold_letter":"C","gold_action":"予以止呕、护胃等对症支持，办理出院；嘱院外每周复查血常规及肝肾功能，定期进行PICC导管维护，按期返院行下一程治疗。","options":[{"letter":"A","text":"予以止呕、护胃等对症支持，继续住院观察至消化道反应完全缓解后再予出院，出院后按期返院行下一程治疗。","is_gold":false},{"letter":"B","text":"予以止呕、护胃等对症支持，办理出院；下一程化疗将洛铂及5-FU剂量下调20%，嘱院外每周复查血常规及肝肾功能。","is_gold":false},{"letter":"C","text":"予以止呕、护胃等对症支持，办理出院；嘱院外每周复查血常规及肝肾功能，定期进行PICC导管维护，按期返院行下一程治疗。","is_gold":true},{"letter":"D","text":"予以止呕、护胃等对症支持，办理出院；嘱院外预防性皮下注射重组人粒细胞刺激因子（G-CSF），每周复查血常规。","is_gold":false},{"letter":"E","text":"予以止呕、护胃等对症支持，办理出院；下一程化疗方案更改为吉西他滨+顺铂（GP方案），嘱院外每周复查血常规。","is_gold":false},{"letter":"F","text":"予以止呕、护胃等对症支持，办理出院；嘱院外每周复查血常规及肝肾功能，并拔除PICC导管以防感染。","is_gold":false},{"letter":"G","text":"予以止呕、护胃等对症支持，办理出院；嘱院外每月复查一次血常规及肝肾功能，按期返院行下一程治疗。","is_gold":false},{"letter":"H","text":"予以止呕、护胃等对症支持，办理出院；上报严重不良事件（SAE）并暂停临床试验入组治疗，转为常规放化疗。","is_gold":false},{"letter":"I","text":"予以止呕、护胃等对症支持，办理出院；嘱院外口服卡培他滨维持治疗，按期返院行下一程静脉化疗。","is_gold":false},{"letter":"J","text":"予以止呕、护胃等对症支持，办理出院；嘱院外每周复查血常规及肝肾功能，并于院外立即开始同步放射治疗。","is_gold":false},{"letter":"K","text":"予以止呕、护胃等对症支持，常规留取大便隐血及行腹部CT检查排除消化道并发症后，再办理出院。","is_gold":false},{"letter":"L","text":"予以止呕、护胃等对症支持，办理出院；嘱院外每周复查血常规及肝肾功能，若出现发热则自行口服抗生素观察。","is_gold":false}]}
+{"sample_id":"sample-be610c2d167fae3585440ece","patient_id":"patient-867f2373fc1b04e0b8b80452","turn_id":"turn06","turn_type":"toxicity_or_support_decision","gold_letter":"D","gold_action":"按计划开展第二周期洛铂+5-FU诱导化疗，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗","options":[{"letter":"A","text":"暂缓化疗，予以重组人粒细胞集落刺激因子升白治疗，待中性粒细胞绝对值恢复至2.0×10^9/L以上再行第二周期化疗","is_gold":false},{"letter":"B","text":"开展第二周期洛铂+5-FU诱导化疗，将洛铂剂量下调20%，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃","is_gold":false},{"letter":"C","text":"终止诱导化疗，直接进入同期放化疗阶段，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗","is_gold":false},{"letter":"D","text":"按计划开展第二周期洛铂+5-FU诱导化疗，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗","is_gold":true},{"letter":"E","text":"开展第二周期洛铂+5-FU诱导化疗，暂不予以预防性止吐，待出现恶心呕吐症状时再予以甲氧氯普胺解痉止吐","is_gold":false},{"letter":"F","text":"更改化疗方案为紫杉醇+顺铂方案进行第二周期诱导化疗，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃","is_gold":false},{"letter":"G","text":"开展第二周期洛铂+5-FU诱导化疗，并预防性予以阿瑞匹坦、地塞米松联合5-HT3受体拮抗剂三联强效止吐","is_gold":false},{"letter":"H","text":"暂缓化疗，复查鼻咽颈部MRI评估一程化疗疗效，若肿瘤缩小则继续原方案，否则更改为紫杉醇+顺铂方案","is_gold":false},{"letter":"I","text":"开展第二周期洛铂+5-FU诱导化疗，将5-FU剂量下调25%，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃","is_gold":false},{"letter":"J","text":"暂缓化疗，予以静脉高营养支持及补液治疗，待消化道症状完全缓解、体重增加后再行第二周期诱导化疗","is_gold":false},{"letter":"K","text":"退出临床试验，更改为顺铂+5-FU方案进行第二周期诱导化疗，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃","is_gold":false},{"letter":"L","text":"开展第二周期洛铂+5-FU诱导化疗，并预防性予以奥氮平联合地塞米松双联止吐及质子泵抑制剂护胃支持治疗","is_gold":false}]}
+{"sample_id":"sample-08c11518d363599b5511b9c9","patient_id":"patient-867f2373fc1b04e0b8b80452","turn_id":"turn07","turn_type":"recurrence_or_salvage_decision","gold_letter":"B","gold_action":"启动根治性放疗及同步化疗，每周复查血常规，暂不予以重组人白介素-11及粒细胞刺激因子。","options":[{"letter":"A","text":"继续行洛铂联合5-FU方案第3程诱导化疗，予以重组人粒细胞刺激因子支持治疗，暂缓放疗。","is_gold":false},{"letter":"B","text":"启动根治性放疗及同步化疗，每周复查血常规，暂不予以重组人白介素-11及粒细胞刺激因子。","is_gold":true},{"letter":"C","text":"准备行根治性放疗及同步化疗，予以重组人促红素及重组人粒细胞刺激因子支持治疗，动态复查血常规。","is_gold":false},{"letter":"D","text":"更改化疗方案为吉西他滨联合顺铂诱导化疗，予以重组人白介素-11支持治疗，暂缓放疗。","is_gold":false},{"letter":"E","text":"准备行根治性放疗及同步化疗，予以输注单采血小板及红细胞悬液支持治疗，动态复查血常规。","is_gold":false},{"letter":"F","text":"准备行根治性放疗及同步化疗，因骨髓抑制降低同步化疗药物剂量，予以重组人粒细胞刺激因子支持治疗。","is_gold":false},{"letter":"G","text":"继续行洛铂联合5-FU方案第3程诱导化疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗。","is_gold":false},{"letter":"H","text":"准备行单纯根治性放疗，取消同步化疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗。","is_gold":false},{"letter":"I","text":"转为姑息性放疗及最佳支持治疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗。","is_gold":false},{"letter":"J","text":"准备行根治性放疗及同步化疗，予以重组人血小板生成素支持治疗，暂不使用粒细胞刺激因子。","is_gold":false},{"letter":"K","text":"暂停抗肿瘤治疗，待血象自然恢复后，再行第3程洛铂联合5-FU方案诱导化疗，暂缓放疗。","is_gold":false}]}
+{"sample_id":"sample-070df43e0c39a4c5f77b459e","patient_id":"patient-867f2373fc1b04e0b8b80452","turn_id":"turn08","turn_type":"recurrence_or_salvage_decision","gold_letter":"D","gold_action":"立即开展根治性放疗及洛铂同步化疗，期间定期监测血常规，暂不予造血生长因子干预。","options":[{"letter":"A","text":"立即开展根治性放疗及顺铂同步化疗，期间定期监测血常规，暂不予造血生长因子干预。","is_gold":false},{"letter":"B","text":"予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及顺铂同步化疗。","is_gold":false},{"letter":"C","text":"仅予以重组人白介素-11升血小板治疗，动态复查血常规，并序贯开展根治性放疗及顺铂同步化疗。","is_gold":false},{"letter":"D","text":"立即开展根治性放疗及洛铂同步化疗，期间定期监测血常规，暂不予造血生长因子干预。","is_gold":true},{"letter":"E","text":"仅予以重组人粒细胞刺激因子升白细胞治疗，动态复查血常规，并序贯开展根治性放疗及洛铂同步化疗。","is_gold":false},{"letter":"F","text":"予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及洛铂同步化疗。","is_gold":false},{"letter":"G","text":"予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并转为洛铂单药姑息性化疗。","is_gold":false},{"letter":"H","text":"予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展开放性手术切除原发灶及颈部淋巴结。","is_gold":false},{"letter":"I","text":"予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及西妥昔单抗靶向治疗。","is_gold":false},{"letter":"J","text":"予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及PD-1抑制剂免疫治疗。","is_gold":false},{"letter":"K","text":"暂暂停抗肿瘤治疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，待血象恢复后继续行第三程洛铂+5FU诱导化疗。","is_gold":false},{"letter":"L","text":"予以输注单采血小板及洗涤红细胞支持治疗，动态复查血常规，并序贯开展根治性放疗及洛铂同步化疗。","is_gold":false}]}
+{"sample_id":"sample-ce0b8b89ec8b1d9a2405353d","patient_id":"patient-5731cc38ced94b2ee39c442a","turn_id":"turn01","turn_type":"initial_workup_choice","gold_letter":"G","gold_action":"完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描（或PET-CT），EBV-DNA及抗体检测，常规血液学检查。","options":[{"letter":"A","text":"完善鼻咽+颈部增强CT，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查，择期行颈部淋巴结穿刺活检。","is_gold":false},{"letter":"B","text":"完善鼻咽镜及活检，鼻咽+颈部增强CT，胸腹部超声及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。","is_gold":false},{"letter":"C","text":"完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，常规血液学检查，暂缓EBV相关检测。","is_gold":false},{"letter":"D","text":"完善鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查，若影像典型直接开始放化疗。","is_gold":false},{"letter":"E","text":"完善鼻咽镜及活检，头颅增强MRI，颈部超声，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。","is_gold":false},{"letter":"F","text":"完善鼻咽镜及活检，鼻咽+颈部平扫MRI，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。","is_gold":false},{"letter":"G","text":"完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描（或PET-CT），EBV-DNA及抗体检测，常规血液学检查。","is_gold":true},{"letter":"H","text":"完善鼻咽镜及活检，鼻咽+颈部增强MRI，EBV-DNA及抗体检测，常规血液学检查，待局部放疗结束后再行全身转移排查。","is_gold":false},{"letter":"I","text":"完善颈部淋巴结切除活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。","is_gold":false},{"letter":"J","text":"完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，常规血液学检查，并立即行诱导化疗。","is_gold":false},{"letter":"K","text":"完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸部X线，腹部超声，全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。","is_gold":false},{"letter":"L","text":"完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查，并预防性行气管切开。","is_gold":false}]}
+{"sample_id":"sample-e3ed1270448c84eefbda9f61","patient_id":"patient-5731cc38ced94b2ee39c442a","turn_id":"turn02","turn_type":"imaging_release_workup","gold_letter":"H","gold_action":"完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充血浆EBV DNA定量检测","options":[{"letter":"A","text":"完善胸部CT、腹部CT及全身骨扫描，并补充颈部淋巴结切除活检","is_gold":false},{"letter":"B","text":"完善全身PET-CT检查，并补充颈部淋巴结穿刺活检","is_gold":false},{"letter":"C","text":"完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充头颈部CTA检查","is_gold":false},{"letter":"D","text":"完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充颈部淋巴结穿刺活检","is_gold":false},{"letter":"E","text":"完善胸部CT、腹部CT，并补充脑部MRI平扫及增强","is_gold":false},{"letter":"F","text":"完善全身骨扫描及脑部MRI增强，并补充血浆EBV DNA定量检测","is_gold":false},{"letter":"G","text":"完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充鼻咽脱落细胞学检查","is_gold":false},{"letter":"H","text":"完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充血浆EBV DNA定量检测","is_gold":true},{"letter":"I","text":"完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充骨髓穿刺活检","is_gold":false},{"letter":"J","text":"完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充EBV抗体滴度复查","is_gold":false},{"letter":"K","text":"完善胸部CT、腹部CT及全身骨扫描，并补充头颅PET-MR检查","is_gold":false},{"letter":"L","text":"完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并立即开始诱导化疗","is_gold":false}]}
+{"sample_id":"sample-cd1385d4e13dda199ba81658","patient_id":"patient-5731cc38ced94b2ee39c442a","turn_id":"turn05","turn_type":"toxicity_or_support_decision","gold_letter":"K","gold_action":"办理出院，开具口服保肝药物（如多烯磷脂酰胆碱等），嘱每周复查血常规和生化，按期返院行下一程诱导化疗。","options":[{"letter":"A","text":"办理出院，暂不予保肝药物干预，嘱每周复查血常规和生化，按期返院行下一程诱导化疗。","is_gold":false},{"letter":"B","text":"暂缓出院，予静脉滴注保肝降酶药物，待转氨酶及胆红素完全恢复正常后出院，按期行下一程诱导化疗。","is_gold":false},{"letter":"C","text":"办理出院，开具口服保肝药物，终止后续诱导化疗计划，择期直接开始根治性同期放化疗。","is_gold":false},{"letter":"D","text":"办理出院，开具口服保肝药物，下一程诱导化疗直接将多西他赛及顺铂剂量下调20%。","is_gold":false},{"letter":"E","text":"办理出院，开具口服保肝药物，下一程诱导化疗方案更改为吉西他滨联合顺铂（GP方案）。","is_gold":false},{"letter":"F","text":"暂缓出院，请感染内科会诊排除乙肝病毒再激活，待专科意见明确后再决定后续抗肿瘤治疗计划。","is_gold":false},{"letter":"G","text":"办理出院，开具口服保肝药物，嘱每周复查血常规和生化，将下一程诱导化疗推迟1至2周进行。","is_gold":false},{"letter":"H","text":"办理出院，开具口服保肝药物，并预防性给予长效G-CSF支持，按期返院行下一程诱导化疗。","is_gold":false},{"letter":"I","text":"暂缓出院，按重度药物性肝损伤启动多学科联合诊疗，待肝功能好转后，按期行下一程诱导化疗。","is_gold":false},{"letter":"J","text":"办理出院，开具口服保肝药物，下一程治疗停用尼妥珠单抗，仅行TPF方案诱导化疗。","is_gold":false},{"letter":"K","text":"办理出院，开具口服保肝药物（如多烯磷脂酰胆碱等），嘱每周复查血常规和生化，按期返院行下一程诱导化疗。","is_gold":true},{"letter":"L","text":"办理出院，开具口服保肝药物，下一程诱导化疗剔除氟尿嘧啶，改为多西他赛联合顺铂双药方案。","is_gold":false}]}
+{"sample_id":"sample-ad5a1060b6801c87debff9d0","patient_id":"patient-5731cc38ced94b2ee39c442a","turn_id":"turn06","turn_type":"toxicity_or_support_decision","gold_letter":"L","gold_action":"开具口服升白细胞药物（如咖啡酸片）、保肝药物（如复方甘草酸苷）及抑酸护胃、促动力药物进行对症支持。","options":[{"letter":"A","text":"予以皮下注射重组人粒细胞集落刺激因子（G-CSF），并静脉滴注异甘草酸镁进行保肝治疗。","is_gold":false},{"letter":"B","text":"嘱多饮水及注意休息，暂不予药物干预，定期门诊复查血常规及肝肾功能以评估毒性。","is_gold":false},{"letter":"C","text":"开具口服升白细胞药物（如咖啡酸片）及保肝药物（如复方甘草酸苷），暂不使用护胃止吐药物。","is_gold":false},{"letter":"D","text":"立即收治入院，予以静脉滴注质子泵抑制剂、止吐药及保肝药物，并密切监测血常规变化。","is_gold":false},{"letter":"E","text":"开具口服抑酸护胃及促胃动力药物（如艾司奥美拉唑、多潘立酮），暂不处理白细胞及肝功能异常。","is_gold":false},{"letter":"F","text":"提前开始第二周期TPF诱导化疗，并预防性给予长效G-CSF及静脉保肝药物支持治疗。","is_gold":false},{"letter":"G","text":"开具口服保肝药物（如复方甘草酸苷）及护胃止吐药物，暂不予口服升白细胞药物进行干预。","is_gold":false},{"letter":"H","text":"予以皮下注射重组人促红素（EPO），并开具口服保肝、护胃及促动力药物进行对症支持。","is_gold":false},{"letter":"I","text":"开具口服升白细胞药物（如咖啡酸片）、抑酸护胃及促胃动力药物，暂不予保肝药物治疗。","is_gold":false},{"letter":"J","text":"安排骨髓穿刺检查以明确白细胞减少原因，同时开具口服保肝及护胃药物进行对症支持。","is_gold":false},{"letter":"K","text":"门诊静脉推注地塞米松及昂丹司琼强化止吐，并开具口服保肝及升白药物进行对症支持。","is_gold":false},{"letter":"L","text":"开具口服升白细胞药物（如咖啡酸片）、保肝药物（如复方甘草酸苷）及抑酸护胃、促动力药物进行对症支持。","is_gold":true}]}
+{"sample_id":"sample-b10ed2b10a17f1626353b252","patient_id":"patient-5731cc38ced94b2ee39c442a","turn_id":"turn07","turn_type":"recurrence_or_salvage_decision","gold_letter":"A","gold_action":"结束诱导化疗，序贯开展根治性放射治疗。","options":[{"letter":"A","text":"结束诱导化疗，序贯开展根治性放射治疗","is_gold":true},{"letter":"B","text":"继续原方案（TPF联合尼妥珠单抗）诱导化疗至第6周期后再行放射治疗","is_gold":false},{"letter":"C","text":"更换为GP方案（吉西他滨联合顺铂）继续诱导化疗2个周期","is_gold":false},{"letter":"D","text":"行鼻咽原发灶及双侧颈部淋巴结根治性切除术","is_gold":false},{"letter":"E","text":"行双侧颈部淋巴结清扫术，术后序贯鼻咽局部放射治疗","is_gold":false},{"letter":"F","text":"加用PD-1抑制剂联合原方案继续诱导化疗2个周期","is_gold":false},{"letter":"G","text":"暂停抗肿瘤治疗，进入定期随访观察阶段","is_gold":false},{"letter":"H","text":"完善全身PET-CT重新分期后再决定后续局部治疗方案","is_gold":false},{"letter":"I","text":"仅行根治性放射治疗，处理鼻咽原发灶，颈部病灶继续随访观察","is_gold":false},{"letter":"J","text":"结束诱导化疗，序贯开展尼妥珠单抗单药靶向维持治疗","is_gold":false},{"letter":"K","text":"行放射性粒子植入术，处理鼻咽及颈部残留病灶直接","is_gold":false},{"letter":"L","text":"采用卡培他滨单药维持化疗，推迟局部放射治疗","is_gold":false}]}
+{"sample_id":"sample-95ccde5ff1e164e8d7edc6f5","patient_id":"patient-5731cc38ced94b2ee39c442a","turn_id":"turn08","turn_type":"recurrence_or_salvage_decision","gold_letter":"B","gold_action":"行鼻咽及颈部MRI增强扫描评估近期疗效，继续定期随访","options":[{"letter":"A","text":"行全身PET-CT扫描评估全身肿瘤负荷及近期疗效","is_gold":false},{"letter":"B","text":"行鼻咽及颈部MRI增强扫描评估近期疗效，继续定期随访","is_gold":true},{"letter":"C","text":"行鼻咽镜检查并对原发灶区域进行常规多点活检排除残留","is_gold":false},{"letter":"D","text":"启动卡培他滨节拍性维持化疗降低远处转移风险","is_gold":false},{"letter":"E","text":"启动PD-1抑制剂维持治疗巩固靶向联合放疗的近期疗效","is_gold":false},{"letter":"F","text":"仅定期复查血常规、生化及EBV-DNA，暂不复查局部影像学","is_gold":false},{"letter":"G","text":"直接安排鼻咽原发灶内镜下挽救性切除手术","is_gold":false},{"letter":"H","text":"直接安排鼻咽原发灶挽救性立体定向放疗","is_gold":false},{"letter":"I","text":"行胸部及全腹部增强CT扫描，暂缓头颈部局部影像学复查","is_gold":false},{"letter":"J","text":"行全身骨扫描及头颅MRI排除无症状的远处器官转移风险","is_gold":false},{"letter":"K","text":"启动吉西他滨联合顺铂方案全身化疗清除潜在微小转移灶","is_gold":false},{"letter":"L","text":"继续使用尼妥珠单抗单药维持治疗至满一年巩固局部疗效","is_gold":false}]}
+{"sample_id":"sample-9d5015177e675883e0c4ec7b","patient_id":"patient-9149023ec8599161ec3e5cfd","turn_id":"turn01","turn_type":"initial_workup_choice","gold_letter":"C","gold_action":"行电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部及上腹部CT平扫+增强，全身骨显像。","options":[{"letter":"A","text":"电子鼻咽镜检查及活检，颈部超声，胸部X线片，腹部超声","is_gold":false},{"letter":"B","text":"电子鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，全身PET-CT","is_gold":false},{"letter":"C","text":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部及上腹部CT平扫+增强，全身骨显像","is_gold":true},{"letter":"D","text":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，暂不安排胸腹部及骨骼影像学检查","is_gold":false},{"letter":"E","text":"鼻咽及颈部MRI平扫+增强，胸部及上腹部CT平扫+增强，全身骨显像，暂不安排内镜活检","is_gold":false},{"letter":"F","text":"颈部淋巴结切除活检，鼻咽及颈部MRI平扫+增强，胸部及上腹部CT平扫+增强，全身骨显像","is_gold":false},{"letter":"G","text":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫，胸部及上腹部CT平扫，全身骨显像","is_gold":false},{"letter":"H","text":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部CT平扫+增强，腹部超声","is_gold":false},{"letter":"I","text":"电子鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸部及上腹部CT平扫+增强，全身骨显像","is_gold":false},{"letter":"J","text":"颈部淋巴结细针穿刺活检，鼻咽及颈部MRI平扫+增强，胸部及上腹部CT平扫+增强，全身骨显像","is_gold":false},{"letter":"K","text":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身骨显像，头颅MRI平扫+增强","is_gold":false},{"letter":"L","text":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部及上腹部CT平扫+增强，骨髓穿刺活检","is_gold":false}]}
+{"sample_id":"sample-ebeecf0887be3e478e385ec0","patient_id":"patient-9149023ec8599161ec3e5cfd","turn_id":"turn02","turn_type":"imaging_release_workup","gold_letter":"D","gold_action":"行鼻咽镜下活检明确病理，并完善胸腹部及骨骼等远处转移排查","options":[{"letter":"A","text":"安排根治性放化疗并完善胸腹部及骨骼等远处转移排查","is_gold":false},{"letter":"B","text":"行颈部淋巴结切除活检明确病理并完善胸腹部及骨骼等远处转移排查","is_gold":false},{"letter":"C","text":"行鼻咽镜下活检明确病理并暂缓远处转移排查直至病理确诊","is_gold":false},{"letter":"D","text":"行鼻咽镜下活检明确病理并完善胸腹部及骨骼等远处转移排查","is_gold":true},{"letter":"E","text":"行鼻咽镜下活检明确病理并安排诱导化疗联合同步放化疗","is_gold":false},{"letter":"F","text":"完善全身PET-CT检查排查远处转移并安排根治性放疗","is_gold":false},{"letter":"G","text":"行鼻咽镜下活检明确病理并完善头颅CT进一步评估颅底骨质破坏","is_gold":false},{"letter":"H","text":"行鼻咽镜下活检明确病理并完善EBV-DNA定量检测暂缓影像学排查","is_gold":false},{"letter":"I","text":"行颈部淋巴结穿刺活检明确病理并完善胸腹部及骨骼等远处转移排查","is_gold":false},{"letter":"J","text":"完善胸部CT和腹部超声排查远处转移并暂缓鼻咽原发灶活检","is_gold":false},{"letter":"K","text":"行鼻咽镜下活检明确病理并完善全身骨扫描暂缓胸腹部影像学检查","is_gold":false},{"letter":"L","text":"安排鼻咽部肿物切除术明确病理并完善胸腹部及骨骼等远处转移排查","is_gold":false}]}
+{"sample_id":"sample-220f428c46f369e75a66e1ab","patient_id":"patient-9149023ec8599161ec3e5cfd","turn_id":"turn04","turn_type":"initial_treatment_selection","gold_letter":"F","gold_action":"诱导化疗序贯同步放化疗","options":[{"letter":"A","text":"单纯根治性放疗","is_gold":false},{"letter":"B","text":"同步放化疗","is_gold":false},{"letter":"C","text":"诱导化疗序贯单纯根治性放疗","is_gold":false},{"letter":"D","text":"同步放化疗序贯辅助化疗","is_gold":false},{"letter":"E","text":"诱导化疗联合靶向治疗序贯放疗","is_gold":false},{"letter":"F","text":"诱导化疗序贯同步放化疗","is_gold":true},{"letter":"G","text":"根治性放疗序贯辅助化疗","is_gold":false},{"letter":"H","text":"诱导化疗序贯免疫联合同步放化疗","is_gold":false},{"letter":"I","text":"姑息性化疗联合免疫治疗","is_gold":false},{"letter":"J","text":"鼻咽放疗联合颈部淋巴结清扫术","is_gold":false},{"letter":"K","text":"靶向治疗联合同步放化疗","is_gold":false},{"letter":"L","text":"诱导化疗序贯颈部淋巴结清扫术","is_gold":false}]}
+{"sample_id":"sample-ed1b449691d94cea18e7b28b","patient_id":"patient-9149023ec8599161ec3e5cfd","turn_id":"turn05","turn_type":"toxicity_or_support_decision","gold_letter":"K","gold_action":"安排鼻咽及颈部MRI平扫+增强、头颅MRI平扫+增强，暂缓胸部X线及腹部彩超检查，作为当前时点针对左侧颞叶新发病灶的重点影像随访；常规胸片、腹部彩超、EBV-DNA及甲功等全身随访可在下一随访窗口期再行安排。","options":[{"letter":"A","text":"给予大剂量糖皮质激素冲击治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超","is_gold":false},{"letter":"B","text":"给予贝伐珠单抗靶向治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项","is_gold":false},{"letter":"C","text":"安排头颅PET-CT检查鉴别左侧颞叶病变性质，并安排胸部X线、腹部彩超、甲功五项","is_gold":false},{"letter":"D","text":"安排立体定向脑活检明确左侧颞叶病变性质，并安排胸部X线、腹部彩超、甲功五项","is_gold":false},{"letter":"E","text":"给予高压氧治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项","is_gold":false},{"letter":"F","text":"给予甘露醇静脉滴注脱水降颅压，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超","is_gold":false},{"letter":"G","text":"安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项及EBV-DNA定量检测","is_gold":false},{"letter":"H","text":"给予神经营养药物治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项","is_gold":false},{"letter":"I","text":"安排鼻咽及颈部CT平扫+增强、胸部CT平扫、腹部CT平扫、甲功五项及EBV-DNA定量检测","is_gold":false},{"letter":"J","text":"安排立体定向放射外科治疗左侧颞叶病变，并安排胸部X线、腹部彩超、甲功五项","is_gold":false},{"letter":"K","text":"安排鼻咽及颈部MRI平扫+增强、头颅MRI平扫+增强，暂缓胸部X线及腹部彩超检查","is_gold":true},{"letter":"L","text":"给予抗癫痫药物预防性治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超","is_gold":false}]}
+{"sample_id":"sample-2fc2bca32acf3eb67f65396b","patient_id":"patient-9149023ec8599161ec3e5cfd","turn_id":"turn07","turn_type":"recurrence_or_salvage_decision","gold_letter":"I","gold_action":"继续行第3周期GP方案第8天化疗（吉西他滨），辅以肠内营养支持，并安排出院。","options":[{"letter":"A","text":"提前终止第3周期诱导化疗，直接进入根治性同步放化疗阶段。","is_gold":false},{"letter":"B","text":"暂停第8天化疗，予重组人粒细胞集落刺激因子升白治疗后复查血常规。","is_gold":false},{"letter":"C","text":"更改诱导化疗方案为TP（多西他赛+顺铂）进行第4周期治疗。","is_gold":false},{"letter":"D","text":"继续行第3周期GP方案第8天化疗（吉西他滨联合顺铂），并安排出院。","is_gold":false},{"letter":"E","text":"计划在第3周期结束后，继续行第4周期GP方案诱导化疗。","is_gold":false},{"letter":"F","text":"暂停化疗，行双侧颈部淋巴结清扫术及鼻咽原发灶切除术。","is_gold":false},{"letter":"G","text":"终止后续放疗计划，按完全缓解（CR）状态进入定期随访观察。","is_gold":false},{"letter":"H","text":"将第8天吉西他滨剂量下调25%后给药，并密切监测血常规。","is_gold":false},{"letter":"I","text":"继续行第3周期GP方案第8天化疗（吉西他滨），辅以肠内营养支持，并安排出院。","is_gold":true},{"letter":"J","text":"暂停治疗，行全身PET-CT检查以重新评估全身肿瘤负荷。","is_gold":false},{"letter":"K","text":"在第8天化疗基础上加用PD-1抑制剂（如特瑞普利单抗）进行联合治疗。","is_gold":false},{"letter":"L","text":"立即启动根治性调强放疗，并同步给予吉西他滨单药化疗。","is_gold":false}]}
+{"sample_id":"sample-655ad2033595c09c6c4ce571","patient_id":"patient-4e3ac84b9e1451cea981f98e","turn_id":"turn01","turn_type":"initial_workup_choice","gold_letter":"B","gold_action":"完善血常规、肝肾功能、凝血功能，并安排鼻咽部活检。","options":[{"letter":"A","text":"完善血常规、肝肾功能、EBV-DNA检测，并安排全身PET-CT。","is_gold":false},{"letter":"B","text":"完善血常规、肝肾功能、凝血功能，并安排鼻咽部活检。","is_gold":true},{"letter":"C","text":"完善血常规、肝功能、EBV-DNA检测，并直接开始诱导化疗。","is_gold":false},{"letter":"D","text":"完善血常规、肝功能、甲状腺功能检测，并安排胸部CT和腹部增强CT。","is_gold":false},{"letter":"E","text":"完善血常规、肝功能、肾功能及心电图检查，暂不检测内分泌功能。","is_gold":false},{"letter":"F","text":"完善血常规、肝功能、脑垂体激素五项检测，暂不检测甲状腺功能。","is_gold":false},{"letter":"G","text":"完善血常规、肝功能、甲状腺功能及性激素六项检测。","is_gold":false},{"letter":"H","text":"完善血常规、肝功能检测，并安排骨扫描。","is_gold":false},{"letter":"I","text":"完善血常规、肝功能、甲状腺功能及肾上腺皮质激素检测。","is_gold":false},{"letter":"J","text":"完善血常规、肝功能、甲状腺功能及脑垂体激素五项检测。","is_gold":false},{"letter":"K","text":"完善血常规、肝功能、甲状腺功能及脑垂体激素五项检测，并立即行胸椎穿刺活检。","is_gold":false},{"letter":"L","text":"完善血常规、肝功能检测，并安排全身骨髓穿刺。","is_gold":false}]}
+{"sample_id":"sample-49bfe4582a9d9a75f21d4be4","patient_id":"patient-4e3ac84b9e1451cea981f98e","turn_id":"turn02","turn_type":"imaging_release_workup","gold_letter":"K","gold_action":"临床分期为 cT2N1M0（AJCC v9 IB期），头长肌受侵定为T2，双侧咽后及单侧颈部淋巴结转移定为N1，骨显像异常考虑良性暂定M0。","options":[{"letter":"A","text":"临床分期为 cT1N1M0（AJCC v9 IB期），病变局限于鼻咽腔及咽隐窝，未见明确周围软组织受侵，骨显像异常考虑良性。","is_gold":false},{"letter":"B","text":"临床分期为 cT2N2M0（AJCC v9 II期），双侧咽后淋巴结受累按分期规则应评为N2，骨显像异常考虑良性。","is_gold":false},{"letter":"C","text":"临床分期为 cT2N1M1（AJCC v9 IVB期），骨显像胸椎及股骨代谢活跃表现已达到多发骨转移诊断标准。","is_gold":false},{"letter":"D","text":"临床分期为 cT3N1M0（AJCC v9 II期），病灶堵塞后鼻孔已构成鼻腔侵犯，按分期规则应评为T3。","is_gold":false},{"letter":"E","text":"临床分期为 cT2N1M0（AJCC v9 II期），头长肌受侵定为T2，单侧颈部淋巴结转移定为N1，综合评为II期。","is_gold":false},{"letter":"F","text":"临床分期暂定 cT2N1Mx，骨显像异常代谢灶性质未明，需常规补充全身PET-CT或骨活检明确M分期。","is_gold":false},{"letter":"G","text":"临床分期为 cT1N2M0（AJCC v9 II期），左侧咽后及左颈II区淋巴结转移评为N2，未见明确T2结构受侵。","is_gold":false},{"letter":"H","text":"临床分期为 cT3N1M0（AJCC v9 II期），腭帆提肌受侵代表侵犯咽旁间隙以外结构，按分期规则应评为T3。","is_gold":false},{"letter":"I","text":"临床分期为 cT2N0M0（AJCC v9 IB期），咽后及颈部淋巴结短径均小于15mm，未达转移诊断标准，应评为N0。","is_gold":false},{"letter":"J","text":"临床分期为 cT4N1M0（AJCC v9 III期），病变侵犯头长肌属于广泛软组织受侵，按分期规则应评为T4。","is_gold":false},{"letter":"K","text":"临床分期为 cT2N1M0（AJCC v9 IB期），头长肌受侵定为T2，双侧咽后及单侧颈部淋巴结转移定为N1，骨显像异常考虑良性暂定M0。","is_gold":true},{"letter":"L","text":"临床分期为 cT2N1M0（AJCC v9 IB期），腭帆提肌受侵定为T2，建议加做全身PET-CT以排除隐匿性转移。","is_gold":false}]}
+{"sample_id":"sample-04c8674f03cec4de991fcf32","patient_id":"patient-4e3ac84b9e1451cea981f98e","turn_id":"turn04","turn_type":"initial_treatment_selection","gold_letter":"A","gold_action":"单纯根治性放射治疗或根治性放化疗","options":[{"letter":"A","text":"单纯根治性放射治疗或根治性放化疗","is_gold":true},{"letter":"B","text":"诱导化疗后序贯单纯根治性放射治疗","is_gold":false},{"letter":"C","text":"诱导化疗后序贯根治性放化疗","is_gold":false},{"letter":"D","text":"单纯根治性放射治疗后序贯辅助化疗","is_gold":false},{"letter":"E","text":"根治性放化疗后序贯辅助化疗","is_gold":false},{"letter":"F","text":"诱导化疗后序贯根治性放化疗及辅助化疗","is_gold":false},{"letter":"G","text":"姑息性放射治疗联合全身系统性化疗","is_gold":false},{"letter":"H","text":"单纯根治性放射治疗联合EGFR靶向治疗","is_gold":false},{"letter":"I","text":"诱导化疗联合EGFR靶向治疗后序贯放疗","is_gold":false},{"letter":"J","text":"根治性放化疗联合PD-1抑制剂治疗","is_gold":false},{"letter":"K","text":"诱导化疗联合PD-1抑制剂后序贯放化疗","is_gold":false},{"letter":"L","text":"单纯全身系统性化疗","is_gold":false}]}
+{"sample_id":"sample-453547f6b6c780c6834cd926","patient_id":"patient-4e3ac84b9e1451cea981f98e","turn_id":"turn05","turn_type":"toxicity_or_support_decision","gold_letter":"B","gold_action":"继续当前调强放疗，定期监测血常规及肝肾功能，暂不予特殊药物干预。","options":[{"letter":"A","text":"暂停放疗，给予静脉保肝降酶药物，待转氨酶正常后重启放疗","is_gold":false},{"letter":"B","text":"继续调强放疗，定期监测血常规及肝肾功能，暂不予特殊药物干预","is_gold":true},{"letter":"C","text":"暂停放疗，经验性静脉滴注广谱抗生素，待中性粒细胞正常后重启放疗","is_gold":false},{"letter":"D","text":"继续调强放疗，皮下注射重组人粒细胞集落刺激因子","is_gold":false},{"letter":"E","text":"暂停放疗，给予大剂量静脉水化及利尿治疗","is_gold":false},{"letter":"F","text":"继续调强放疗，计划在下一周期将顺铂剂量下调20%","is_gold":false},{"letter":"G","text":"暂停放疗，完善血培养及降钙素原检查","is_gold":false},{"letter":"H","text":"继续调强放疗，静脉滴注大剂量糖皮质激素","is_gold":false},{"letter":"I","text":"暂停放疗，给予静脉输注人血白蛋白及肠外营养支持","is_gold":false},{"letter":"J","text":"继续调强放疗，计划将下一周期同期化疗药物替换为卡铂","is_gold":false},{"letter":"K","text":"暂停放疗，复查鼻咽及颈部增强MRI","is_gold":false},{"letter":"L","text":"继续调强放疗，取消后续同期化疗周期","is_gold":false}]}
+{"sample_id":"sample-192932039e740110f5fb9ae6","patient_id":"patient-4e3ac84b9e1451cea981f98e","turn_id":"turn06","turn_type":"toxicity_or_support_decision","gold_letter":"C","gold_action":"继续按计划执行调强放疗，定期复查血常规及肝肾功能","options":[{"letter":"A","text":"暂停放疗，给予重组人粒细胞刺激因子皮下注射","is_gold":false},{"letter":"B","text":"继续放疗，给予重组人血小板生成素皮下注射","is_gold":false},{"letter":"C","text":"继续按计划执行调强放疗，定期复查血常规及肝肾功能","is_gold":true},{"letter":"D","text":"暂停放疗，给予静脉保肝降酶治疗并密切监测","is_gold":false},{"letter":"E","text":"继续放疗，立即启动第二周期顺铂同期化疗","is_gold":false},{"letter":"F","text":"继续放疗，将第二周期顺铂同期化疗剂量下调20%","is_gold":false},{"letter":"G","text":"继续放疗，将第二周期同期化疗药物更换为卡铂","is_gold":false},{"letter":"H","text":"暂停放疗，完善鼻咽及颈部MRI评估近期疗效","is_gold":false},{"letter":"I","text":"继续放疗，给予大剂量静脉水化及利尿促排治疗","is_gold":false},{"letter":"J","text":"继续放疗，联合尼妥珠单抗靶向治疗以增强疗效","is_gold":false},{"letter":"K","text":"继续放疗，给予促红细胞生成素皮下注射纠正贫血","is_gold":false},{"letter":"L","text":"终止放疗，转为全身静脉化疗并评估后续方案","is_gold":false}]}
+{"sample_id":"sample-7fddfe1b2a584f133c3b89f7","patient_id":"patient-e5fcd31b4b8b85194b146991","turn_id":"turn01","turn_type":"initial_workup_choice","gold_letter":"B","gold_action":"完善鼻咽及颈部MRI平扫+增强、胸腹部CT、全身骨扫描、电子鼻咽镜检查及活检。","options":[{"letter":"A","text":"完善鼻咽及颈部CT平扫+增强、胸腹部CT、全身骨扫描、电子鼻咽镜检查及活检。","is_gold":false},{"letter":"B","text":"完善鼻咽及颈部MRI平扫+增强、胸腹部CT、全身骨扫描、电子鼻咽镜检查及活检。","is_gold":true},{"letter":"C","text":"完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像、电子鼻咽镜检查及活检。","is_gold":false},{"letter":"D","text":"完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像、电子鼻咽镜检查及病理会诊。","is_gold":false},{"letter":"E","text":"完善鼻咽及颈部MRI平扫+增强、胸腹部CT、全身骨扫描、电子鼻咽镜检查及病理会诊。","is_gold":false},{"letter":"F","text":"完善鼻咽及颈部CT平扫+增强、PET/CT全身显像、电子鼻咽镜检查及病理会诊。","is_gold":false},{"letter":"G","text":"完善鼻咽MRI平扫+增强、颈部超声、PET/CT全身显像、电子鼻咽镜检查及病理会诊。","is_gold":false},{"letter":"H","text":"完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像、直接安排诱导化疗。","is_gold":false},{"letter":"I","text":"完善鼻咽及颈部MRI平扫+增强、胸腹部CT、全身骨扫描、直接安排根治性放疗。","is_gold":false},{"letter":"J","text":"完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像、鼻内镜下鼻咽肿物切除术。","is_gold":false},{"letter":"K","text":"完善鼻咽及颈部CT平扫+增强、胸腹部CT、全身骨扫描、电子鼻咽镜检查及病理会诊。","is_gold":false},{"letter":"L","text":"完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像、EBV-DNA检测、暂缓病理确诊。","is_gold":false}]}
+{"sample_id":"sample-bc7a956bb6d6b0bc48992292","patient_id":"patient-e5fcd31b4b8b85194b146991","turn_id":"turn02","turn_type":"imaging_release_workup","gold_letter":"E","gold_action":"安排电子鼻咽镜及鼻咽肿物活检，并完善胸腹部CT及骨扫描（或PET-CT）","options":[{"letter":"A","text":"安排颈部淋巴结切除活检，并完善全身PET-CT检查","is_gold":false},{"letter":"B","text":"安排鼻咽镜下活检，并完善头颅CT检查","is_gold":false},{"letter":"C","text":"安排颈部淋巴结细针穿刺活检，并完善胸腹部CT及骨扫描","is_gold":false},{"letter":"D","text":"安排鼻咽镜下活检，并完善EBV-DNA定量检测，暂缓全身影像学检查","is_gold":false},{"letter":"E","text":"安排电子鼻咽镜及鼻咽肿物活检，并完善胸腹部CT及骨扫描（或PET-CT）","is_gold":true},{"letter":"F","text":"安排鼻咽肿物及颈部淋巴结双重活检，并完善胸腹部MRI检查","is_gold":false},{"letter":"G","text":"安排鼻咽镜下活检，并完善颈部超声检查","is_gold":false},{"letter":"H","text":"安排全身PET-CT检查，并直接开始根治性放化疗","is_gold":false},{"letter":"I","text":"安排电子鼻咽镜检查，并直接进入放疗定位阶段","is_gold":false},{"letter":"J","text":"安排鼻咽镜下活检，并直接开始根治性放疗","is_gold":false},{"letter":"K","text":"安排鼻咽肿物活检，并直接进入诱导化疗阶段","is_gold":false},{"letter":"L","text":"安排鼻咽镜下活检，并完善全身骨髓穿刺检查","is_gold":false}]}
+{"sample_id":"sample-49519c2b08d621c382f2a093","patient_id":"patient-e5fcd31b4b8b85194b146991","turn_id":"turn04","turn_type":"initial_treatment_selection","gold_letter":"G","gold_action":"诱导化疗（顺铂+氟尿嘧啶，PF方案）","options":[{"letter":"A","text":"根治性单纯放疗","is_gold":false},{"letter":"B","text":"诱导化疗（紫杉醇+卡铂）","is_gold":false},{"letter":"C","text":"诱导化疗（吉西他滨+奥沙利铂）","is_gold":false},{"letter":"D","text":"同期放化疗（顺铂）","is_gold":false},{"letter":"E","text":"诱导化疗（依托泊苷+顺铂）","is_gold":false},{"letter":"F","text":"诱导化疗（长春瑞滨+顺铂）","is_gold":false},{"letter":"G","text":"诱导化疗（顺铂+氟尿嘧啶）","is_gold":true},{"letter":"H","text":"靶向单药治疗（西妥昔单抗）","is_gold":false},{"letter":"I","text":"诱导化疗（多柔比星+环磷酰胺）","is_gold":false},{"letter":"J","text":"姑息性单药化疗（卡培他滨）","is_gold":false},{"letter":"K","text":"免疫单药治疗（帕博利珠单抗）","is_gold":false},{"letter":"L","text":"鼻咽及颈部淋巴结根治性切除术","is_gold":false}]}
+{"sample_id":"sample-ba0bc8aff143756f9ee645b5","patient_id":"patient-e5fcd31b4b8b85194b146991","turn_id":"turn05","turn_type":"toxicity_or_support_decision","gold_letter":"H","gold_action":"办理出院，予以帕洛诺司琼等止吐处理，嘱出院后每周复查血常规及肝肾功能，按计划返院行下一程化疗。","options":[{"letter":"A","text":"办理出院，无需特殊用药，嘱出院后每2周复查血常规及肝肾功能，按计划返院行下一程诱导化疗。","is_gold":false},{"letter":"B","text":"暂缓出院，予以静脉营养支持及强效止吐治疗，待恶心症状完全缓解后出院，按计划返院行下一程化疗。","is_gold":false},{"letter":"C","text":"办理出院，予以止吐处理并预防性给予长效G-CSF支持，嘱出院后每周复查血常规，按计划返院行下一程化疗。","is_gold":false},{"letter":"D","text":"办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，下一程化疗方案需减量20%并延迟1周进行。","is_gold":false},{"letter":"E","text":"暂缓出院，予以保肝降酶及护胃治疗，待复查肝功能及消化道症状好转后出院，按计划返院行下一程化疗。","is_gold":false},{"letter":"F","text":"办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，下一阶段直接转入同期放化疗。","is_gold":false},{"letter":"G","text":"办理出院，予以止吐处理，嘱出院后每3天复查肾功能及电解质，按计划返院行下一程诱导化疗。","is_gold":false},{"letter":"H","text":"办理出院，予以帕洛诺司琼等止吐处理，嘱出院后每周复查血常规及肝肾功能，按计划返院行下一程化疗。","is_gold":true},{"letter":"I","text":"暂缓出院，予以静脉补液及纠正电解质紊乱治疗，复查生化指标正常后出院，按计划返院行下一程化疗。","is_gold":false},{"letter":"J","text":"办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，下一程化疗更改为单药方案以减轻反应。","is_gold":false},{"letter":"K","text":"办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，按计划返院行靶向治疗联合放疗。","is_gold":false},{"letter":"L","text":"暂缓出院，予以质子泵抑制剂静脉滴注预防应激性溃疡，观察3天后出院，按计划返院行下一程化疗。","is_gold":false}]}
+{"sample_id":"sample-f5ab8fe6b2ae40df32eed56b","patient_id":"patient-e5fcd31b4b8b85194b146991","turn_id":"turn06","turn_type":"toxicity_or_support_decision","gold_letter":"I","gold_action":"行PICC导管常规维护（更换敷料与正压接头），并完善间接鼻咽镜检查准备下一周期治疗。","options":[{"letter":"A","text":"拔除PICC导管改行外周静脉穿刺，并完善间接鼻咽镜检查准备下一周期治疗。","is_gold":false},{"letter":"B","text":"予重组人粒细胞刺激因子皮下注射，并行动静脉置管常规护理准备下一周期治疗。","is_gold":false},{"letter":"C","text":"予静脉补钾、补镁及水化利尿治疗，并行动静脉置管常规护理准备下一周期治疗。","is_gold":false},{"letter":"D","text":"予静脉输注红细胞悬液，并行动静脉置管常规护理准备下一周期治疗。","is_gold":false},{"letter":"E","text":"予静脉滴注广谱抗菌药物，并完善间接鼻咽镜检查准备下一周期治疗。","is_gold":false},{"letter":"F","text":"拔除PICC导管更换为锁骨下静脉置管，并完善间接鼻咽镜检查准备下一周期治疗。","is_gold":false},{"letter":"G","text":"予静脉滴注5-HT3受体拮抗剂，并行动静脉置管常规护理准备下一周期治疗。","is_gold":false},{"letter":"H","text":"予静脉输注肠外营养液，并完善间接鼻咽镜检查准备下一周期治疗。","is_gold":false},{"letter":"I","text":"行PICC导管常规维护（更换敷料与正压接头），并完善间接鼻咽镜检查准备下一周期治疗。","is_gold":true},{"letter":"J","text":"行鼻咽内镜下组织活检，并行动静脉置管常规护理准备下一周期治疗。","is_gold":false},{"letter":"K","text":"予静脉输注人血白蛋白，并行动静脉置管常规护理准备下一周期治疗。","is_gold":false},{"letter":"L","text":"予口服保肝药物，并完善间接鼻咽镜检查准备下一周期治疗。","is_gold":false}]}
+{"sample_id":"sample-dd7067359645093ab08b6c16","patient_id":"patient-e5fcd31b4b8b85194b146991","turn_id":"turn07","turn_type":"recurrence_or_salvage_decision","gold_letter":"J","gold_action":"出院休养并对症处理化疗副反应，定期复查血常规及肝肾功能，按计划返院行根治性放射治疗。","options":[{"letter":"A","text":"立即启动第三程PF方案诱导化疗，随后再行根治性放射治疗。","is_gold":false},{"letter":"B","text":"更改化疗方案为TP或GP方案继续诱导化疗，随后再行根治性放射治疗。","is_gold":false},{"letter":"C","text":"立即行鼻咽及颈部根治性手术切除，术后辅以根治性放射治疗。","is_gold":false},{"letter":"D","text":"出院休养，待化疗副反应恢复后，行右颈部淋巴结清扫术，再行根治性放疗。","is_gold":false},{"letter":"E","text":"立即予以全量根治性放射治疗，并联合靶向药物如西妥昔单抗。","is_gold":false},{"letter":"F","text":"出院休养，行颈部淋巴结穿刺活检明确病理，再决定后续放疗方案。","is_gold":false},{"letter":"G","text":"立即启动根治性放射治疗，暂缓处理骨髓抑制及胃肠道反应。","is_gold":false},{"letter":"H","text":"出院休养，待化疗副反应恢复后，行姑息性放射治疗联合免疫治疗。","is_gold":false},{"letter":"I","text":"行全身PET-CT重新评估远处转移情况，再决定是否启动根治性放疗。","is_gold":false},{"letter":"J","text":"出院休养并对症处理化疗副反应，定期复查血常规及肝肾功能，按计划返院行根治性放射治疗。","is_gold":true},{"letter":"K","text":"出院休养，定期复查血常规及肝肾功能，待恢复后返院行第三程PF方案诱导化疗。","is_gold":false},{"letter":"L","text":"立即予以同期放化疗，并对右颈淋巴结局部推量加量放疗。","is_gold":false}]}
+{"sample_id":"sample-9cd68a6b9c75f1d90e6a9dbe","patient_id":"patient-e5fcd31b4b8b85194b146991","turn_id":"turn08","turn_type":"response_assessment_decision","gold_letter":"K","gold_action":"评估为放化疗后临床缓解，按计划结疗出院，嘱鼻腔冲洗、张口及颈部功能锻炼，定期随访复查。","options":[{"letter":"A","text":"评估为原发灶缓解但颈部淋巴结残留，行双侧颈部淋巴结清扫术，术后定期随访复查。","is_gold":false},{"letter":"B","text":"评估为颅底骨质破坏未缓解，局部追加立体定向放射治疗推量，并定期随访复查。","is_gold":false},{"letter":"C","text":"评估为放化疗后部分缓解，继续原方案辅助化疗2个周期以巩固疗效。","is_gold":false},{"letter":"D","text":"评估为放化疗后临床缓解，按计划结疗出院，序贯PD-1抑制剂维持治疗1年。","is_gold":false},{"letter":"E","text":"评估为原发灶残留，行鼻咽内镜下挽救性切除术，术后配合张口及颈部功能锻炼。","is_gold":false},{"letter":"F","text":"评估为放化疗后临床缓解，按计划结疗出院，3个月后行PET-CT评估，期间无需特殊干预。","is_gold":false},{"letter":"G","text":"评估为放化疗后病情稳定，更改化疗方案为吉西他滨联合顺铂进行二线化疗。","is_gold":false},{"letter":"H","text":"评估为放化疗后临床缓解，按计划结疗出院，预防性给予全脑放射治疗。","is_gold":false},{"letter":"I","text":"评估为颈部淋巴结残留，局部追加电子线放射治疗推量，并加强营养支持。","is_gold":false},{"letter":"J","text":"评估为放化疗后临床缓解，按计划结疗出院，序贯口服卡培他滨节拍维持治疗1年。","is_gold":false},{"letter":"K","text":"评估为放化疗后临床缓解，按计划结疗出院，嘱鼻腔冲洗、张口及颈部功能锻炼，定期随访复查。","is_gold":true},{"letter":"L","text":"评估为颅底病灶残留，转诊行质子重离子放射治疗以提高局部控制率。","is_gold":false}]}
+{"sample_id":"sample-deb84ffb5f7c209f58040b0d","patient_id":"patient-d6812a1c46ed21fda9ebb9f8","turn_id":"turn01","turn_type":"initial_workup_choice","gold_letter":"D","gold_action":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部X线，腹部彩超及心电图","options":[{"letter":"A","text":"鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸部X线，腹部彩超","is_gold":false},{"letter":"B","text":"鼻咽及颈部MRI平扫+增强，全身PET-CT检查，暂缓鼻咽活检","is_gold":false},{"letter":"C","text":"鼻咽镜检查及活检，仅行鼻咽MRI平扫+增强，胸部CT，腹部彩超","is_gold":false},{"letter":"D","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部X线，腹部彩超及心电图","is_gold":true},{"letter":"E","text":"鼻咽镜检查及活检，全身PET-CT检查，头颅MRI平扫+增强","is_gold":false},{"letter":"F","text":"鼻咽及颈部根治性放疗，同步行胸部及腹部影像学检查","is_gold":false},{"letter":"G","text":"鼻咽肿物切除活检，鼻咽及颈部MRI平扫+增强，胸部X线，腹部彩超","is_gold":false},{"letter":"H","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，暂不进行胸腹部影像学检查","is_gold":false},{"letter":"I","text":"鼻咽镜检查及活检，鼻咽CT平扫+增强，颈部超声，胸部X线，腹部彩超","is_gold":false},{"letter":"J","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身骨扫描，头颅CT","is_gold":false},{"letter":"K","text":"鼻咽脱落细胞学检查，鼻咽及颈部MRI平扫+增强，胸部CT，腹部彩超","is_gold":false},{"letter":"L","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，预防性颈部淋巴结清扫术","is_gold":false}]}
+{"sample_id":"sample-76e183c8ae4202bcecbc9d87","patient_id":"patient-d6812a1c46ed21fda9ebb9f8","turn_id":"turn02","turn_type":"imaging_release_workup","gold_letter":"E","gold_action":"行鼻咽肿物活检明确病理诊断，并安排甲状腺超声检查。","options":[{"letter":"A","text":"行鼻咽肿物活检明确病理诊断，并安排全身PET-CT检查","is_gold":false},{"letter":"B","text":"行鼻咽肿物活检明确病理诊断，并安排全身骨扫描检查","is_gold":false},{"letter":"C","text":"行颈部淋巴结细针穿刺活检明确病理诊断，并安排甲状腺超声检查","is_gold":false},{"letter":"D","text":"行鼻咽肿物活检明确病理诊断，并直接安排甲状腺结节细针穿刺活检","is_gold":false},{"letter":"E","text":"行鼻咽肿物活检明确病理诊断，并安排甲状腺超声检查","is_gold":true},{"letter":"F","text":"行鼻咽肿物活检明确病理诊断，并安排胸部增强CT检查","is_gold":false},{"letter":"G","text":"行鼻咽肿物活检明确病理诊断，并安排头颅增强MRI检查","is_gold":false},{"letter":"H","text":"行鼻咽肿物活检明确病理诊断，并安排甲状腺功能生化检查","is_gold":false},{"letter":"I","text":"行鼻咽肿物活检明确病理诊断，并安排颈部超声检查","is_gold":false},{"letter":"J","text":"行鼻咽肿物活检明确病理诊断，并安排肝脏增强MRI检查","is_gold":false},{"letter":"K","text":"行鼻咽肿物活检明确病理诊断，并安排甲状腺核素扫描检查","is_gold":false},{"letter":"L","text":"暂缓活检操作，先行诊断性抗炎治疗两周后复查鼻咽部MRI","is_gold":false}]}
+{"sample_id":"sample-bf94c856279752df44d2b5a5","patient_id":"patient-d6812a1c46ed21fda9ebb9f8","turn_id":"turn05","turn_type":"toxicity_or_support_decision","gold_letter":"H","gold_action":"停止静脉输液，予以口服氯化钾缓释片维持补钾，行PICC导管常规护理，安排出院休养。","options":[{"letter":"A","text":"继续静脉滴注氯化钾及氯化钠注射液，暂缓出院继续住院观察。","is_gold":false},{"letter":"B","text":"停止静脉输液，停用所有补钾药物，拔除PICC导管，安排出院休养。","is_gold":false},{"letter":"C","text":"停止静脉输液，予以口服氯化钾缓释片，拔除PICC导管，安排出院休养。","is_gold":false},{"letter":"D","text":"继续静脉滴注氯化钾，行PICC导管常规护理，暂缓出院继续住院观察。","is_gold":false},{"letter":"E","text":"停止静脉输液，停用所有补钾药物，行PICC导管常规护理，安排出院休养。","is_gold":false},{"letter":"F","text":"予以静脉推注氯化钾注射液，行PICC导管常规护理，暂缓出院继续住院观察。","is_gold":false},{"letter":"G","text":"停止静脉输液，予以口服氯化钾缓释片及螺内酯，行PICC导管常规护理，安排出院休养。","is_gold":false},{"letter":"H","text":"停止静脉输液，予以口服氯化钾缓释片，行PICC导管常规护理，安排出院休养。","is_gold":true},{"letter":"I","text":"继续静脉滴注氯化钠注射液，予以口服氯化钾缓释片，行PICC导管常规护理，暂缓出院。","is_gold":false},{"letter":"J","text":"停止静脉输液，予以口服聚苯乙烯磺酸钙散，行PICC导管常规护理，安排出院休养。","is_gold":false},{"letter":"K","text":"停止静脉输液，予以静脉泵入氯化钾注射液，行PICC导管常规护理，暂缓出院。","is_gold":false},{"letter":"L","text":"继续静脉滴注氯化钾及氯化钠注射液，行PICC导管常规护理，带静脉输液装置出院。","is_gold":false}]}
+{"sample_id":"sample-9549c3c98f10ace802cbb08b","patient_id":"patient-d6812a1c46ed21fda9ebb9f8","turn_id":"turn06","turn_type":"toxicity_or_support_decision","gold_letter":"I","gold_action":"继续顺铂单药化疗，并给予地塞米松、甲氧氯普胺、奥美拉唑止吐，辅以静脉水化及补钾支持治疗。","options":[{"letter":"A","text":"暂停化疗，给予重组人粒细胞集落刺激因子升白细胞治疗，待白细胞恢复后继续顺铂化疗。","is_gold":false},{"letter":"B","text":"暂停化疗，给予3%氯化钠注射液强化纠正低钠血症，待血钠持续稳定正常后再考虑恢复顺铂化疗。","is_gold":false},{"letter":"C","text":"将化疗方案调整为卡铂单药，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化支持治疗。","is_gold":false},{"letter":"D","text":"继续顺铂化疗，并给予地塞米松、甲氧氯普胺、奥美拉唑止吐，无需常规静脉水化及补钾。","is_gold":false},{"letter":"E","text":"继续顺铂化疗，并给予昂丹司琼单药止吐，辅以静脉水化及补钾支持治疗。","is_gold":false},{"letter":"F","text":"继续顺铂联合5-氟尿嘧啶化疗，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化支持治疗。","is_gold":false},{"letter":"G","text":"继续顺铂化疗，并给予地塞米松、甲氧氯普胺、奥美拉唑止吐，同时预防性使用重组人粒细胞集落刺激因子。","is_gold":false},{"letter":"H","text":"终止化疗，仅行单纯放射治疗，并给予静脉水化及营养支持。","is_gold":false},{"letter":"I","text":"继续顺铂化疗，并给予地塞米松、甲氧氯普胺、奥美拉唑止吐，辅以静脉水化及补钾支持治疗。","is_gold":true},{"letter":"J","text":"继续顺铂化疗，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化，同时加用呋塞米强迫利尿且不补钾。","is_gold":false},{"letter":"K","text":"暂停化疗，给予保肝降酶治疗，待肝功能恢复后继续顺铂化疗。","is_gold":false},{"letter":"L","text":"将化疗方案调整为紫杉醇单药，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化支持治疗。","is_gold":false}]}
+{"sample_id":"sample-5acaafa7f13a3c4be08160aa","patient_id":"patient-d6812a1c46ed21fda9ebb9f8","turn_id":"turn07","turn_type":"response_assessment_decision","gold_letter":"J","gold_action":"疗效评估为放化疗有效，针对进食差及低钾血症予以静脉营养支持及补钾，继续根治性放疗并按期行第三程同期化疗。","options":[{"letter":"A","text":"疗效评估为疾病进展，存在低钾血症，暂停放疗，改为单药靶向治疗并静脉补钾。","is_gold":false},{"letter":"B","text":"疗效评估为放化疗有效，存在低钾血症及进食差，终止同期化疗，仅继续单纯放疗及口服补钾。","is_gold":false},{"letter":"C","text":"疗效评估为放化疗有效，存在低钾血症，暂停放疗及化疗，待血钾恢复正常后再恢复原方案。","is_gold":false},{"letter":"D","text":"疗效评估为疾病稳定，存在骨髓抑制，给予重组人血小板生成素并推迟后续化疗。","is_gold":false},{"letter":"E","text":"疗效评估为放化疗有效，右肾多发囊肿，请泌尿外科急会诊行囊肿穿刺引流，暂缓化疗。","is_gold":false},{"letter":"F","text":"疗效评估为疾病进展，复查鼻咽 MRI 及全身 PET-CT，更改化疗方案为吉西他滨联合顺铂。","is_gold":false},{"letter":"G","text":"疗效评估为放化疗有效，进食差，行经皮胃造瘘术进行肠内营养，继续放化疗。","is_gold":false},{"letter":"H","text":"疗效评估为放化疗有效，存在低钾血症，门诊口服氯化钾缓释片，继续放疗，取消第三程化疗。","is_gold":false},{"letter":"I","text":"疗效评估为放化疗有效，存在肝功能损害，停用顺铂，改为西妥昔单抗靶向治疗并保肝处理。","is_gold":false},{"letter":"J","text":"疗效评估为放化疗有效，予以静脉营养支持及补钾，处理进食差及低钾血症，继续根治性放疗并按期行第三程同期化疗。","is_gold":true},{"letter":"K","text":"疗效评估为放化疗有效，予以静脉补钾，处理低钾血症，结束同期化疗阶段，后续仅需完成单纯放疗。","is_gold":false},{"letter":"L","text":"疗效评估为疾病稳定，存在恶心呕吐，预防性给予三联止吐方案，提前结束放疗并转为辅助化疗。","is_gold":false}]}
+{"sample_id":"sample-47e9b2e315a805773d669325","patient_id":"patient-d6812a1c46ed21fda9ebb9f8","turn_id":"turn08","turn_type":"response_assessment_decision","gold_letter":"K","gold_action":"疗效评估为部分缓解（PR），继续完成根治性放疗及既定化疗计划，并加强静脉营养支持与补钾等对症处理。","options":[{"letter":"A","text":"疗效评估为疾病进展（PD），终止放化疗计划，改行鼻咽及颈部挽救性手术切除。","is_gold":false},{"letter":"B","text":"疗效评估为疾病进展（PD），停用顺铂，更改化疗方案为吉西他滨联合氟尿嘧啶并继续放疗。","is_gold":false},{"letter":"C","text":"疗效评估为部分缓解（PR），继续完成根治性放疗，对鼻咽及颈部残留病灶局部加量至76Gy。","is_gold":false},{"letter":"D","text":"疗效评估为部分缓解（PR），继续完成根治性放疗，取消后续化疗计划，仅予口服补钾与营养支持。","is_gold":false},{"letter":"E","text":"疗效评估为部分缓解（PR），继续完成根治性放疗及既定化疗计划，并加用尼妥珠单抗靶向治疗。","is_gold":false},{"letter":"F","text":"疗效评估为完全缓解（CR），提前终止放疗与化疗，拔除静脉通道，转入定期门诊随访观察阶段。","is_gold":false},{"letter":"G","text":"疗效评估为部分缓解（PR），继续完成根治性放疗，并行局部清扫术，处理右侧咽旁及咽后残留病灶。","is_gold":false},{"letter":"H","text":"疗效评估为疾病稳定（SD），继续放疗，并联合PD-1抑制剂以增强局部控制与全身抗肿瘤反应。","is_gold":false},{"letter":"I","text":"疗效评估为部分缓解（PR），暂停放疗优先纠正低钾血症与营养不良，待电解质完全恢复后重启放疗。","is_gold":false},{"letter":"J","text":"疗效评估为部分缓解（PR），继续完成根治性放疗及既定化疗计划，无需特殊支持治疗，定期复查即可。","is_gold":false},{"letter":"K","text":"疗效评估为部分缓解（PR），继续完成根治性放疗及既定化疗计划，并加强静脉营养支持与补钾等对症处理。","is_gold":true},{"letter":"L","text":"疗效评估为疾病稳定（SD），继续完成根治性放疗，将后续化疗方案调整为紫杉醇联合卡铂以克服耐药。","is_gold":false}]}
+{"sample_id":"sample-7a40e0f2bd95183560f7b041","patient_id":"patient-eecadcdf172a1efe8947b052","turn_id":"turn01","turn_type":"initial_workup_choice","gold_letter":"H","gold_action":"行鼻咽镜下活检明确病理，并抽血查血常规、生化、EBV-DNA等基线指标。","options":[{"letter":"A","text":"直接安排根治性同步放化疗，暂缓病理活检及血液学检查","is_gold":false},{"letter":"B","text":"行鼻咽及颈部增强CT评估局部病变，暂缓病理活检及血液学检查","is_gold":false},{"letter":"C","text":"行颈部淋巴结切除活检明确病理，并完善全身PET-CT及基线血液学检查","is_gold":false},{"letter":"D","text":"行鼻咽镜下活检明确病理，并直接开始诱导化疗，暂缓基线血液学检查","is_gold":false},{"letter":"E","text":"抽血查EBV-DNA及肿瘤标志物，若阳性则直接开始根治性放疗","is_gold":false},{"letter":"F","text":"行全身骨扫描及头颅增强MRI，待排除远处转移后再行鼻咽局部活检","is_gold":false},{"letter":"G","text":"行鼻咽镜下活检明确病理，并预防性行双侧颈部淋巴结清扫术","is_gold":false},{"letter":"H","text":"行鼻咽镜下活检明确病理，并抽血查血常规、生化、EBV-DNA等基线指标","is_gold":true},{"letter":"I","text":"行鼻咽脱落细胞学检查明确病理，并抽血查血常规、生化、EBV-DNA等基线指标","is_gold":false},{"letter":"J","text":"行胸腹部增强CT及全身骨扫描，待排除远处转移后再行鼻咽活检及血液学检查","is_gold":false},{"letter":"K","text":"行鼻咽镜下活检明确病理，并立即给予大剂量甲氨蝶呤静脉化疗","is_gold":false},{"letter":"L","text":"行颈部淋巴结细针穿刺活检明确病理，并抽血查血常规、生化、EBV-DNA等基线指标","is_gold":false}]}
+{"sample_id":"sample-fd63f0707132f4eb9174ab3e","patient_id":"patient-eecadcdf172a1efe8947b052","turn_id":"turn02","turn_type":"imaging_release_workup","gold_letter":"I","gold_action":"明确临床分期为T4N1M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。","options":[{"letter":"A","text":"明确临床分期为T3N1M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。","is_gold":false},{"letter":"B","text":"明确临床分期为T4N2M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。","is_gold":false},{"letter":"C","text":"明确临床分期为T4N1M0，并直接安排鼻咽及颈部根治性放疗，暂不留置静脉导管。","is_gold":false},{"letter":"D","text":"明确临床分期为T4N1M0，并安排全身PET-CT以进一步明确双颈部淋巴结性质。","is_gold":false},{"letter":"E","text":"明确临床分期为T4N0M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。","is_gold":false},{"letter":"F","text":"明确临床分期为T3N2M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。","is_gold":false},{"letter":"G","text":"明确临床分期为T4N1M0，并安排垂体MRI动态增强扫描以明确垂体受累情况。","is_gold":false},{"letter":"H","text":"明确临床分期为T4N1M0，并安排颈部淋巴结穿刺活检以明确N分期。","is_gold":false},{"letter":"I","text":"明确临床分期为T4N1M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。","is_gold":true},{"letter":"J","text":"明确临床分期为T4N1M0，并安排骨扫描及头颅CT以排除远处转移。","is_gold":false},{"letter":"K","text":"明确临床分期为T4N1M0，并安排鼻咽肿物再次活检以进行EBV相关基因检测。","is_gold":false},{"letter":"L","text":"明确临床分期为T4N1M0，并留置CVC导管及行胸部CT确认管端位置，为后续静脉给药做准备。","is_gold":false}]}
+{"sample_id":"sample-1a0c7a960fe6a9b60533da3d","patient_id":"patient-eecadcdf172a1efe8947b052","turn_id":"turn05","turn_type":"toxicity_or_support_decision","gold_letter":"L","gold_action":"继续本周期化疗，给予止吐、护肝及静脉营养等支持治疗，并完善脑垂体激素五项检查。","options":[{"letter":"A","text":"停止本周期化疗，给予粒细胞集落刺激因子及抗感染支持治疗，并完善脑垂体激素五项检查。","is_gold":false},{"letter":"B","text":"继续本周期化疗，给予止吐、护肝及静脉营养等支持治疗，并完善甲状腺功能及皮质醇检查。","is_gold":false},{"letter":"C","text":"停止本周期化疗，给予大剂量水化、碱化尿液及利尿处理，并完善脑垂体激素五项检查。","is_gold":false},{"letter":"D","text":"继续本周期化疗，给予止吐、护胃及静脉营养支持治疗，暂不进行内分泌功能相关检查。","is_gold":false},{"letter":"E","text":"提前结束本周期化疗，给予全静脉营养支持及强效止吐治疗，并完善脑垂体激素五项检查。","is_gold":false},{"letter":"F","text":"继续本周期化疗，给予止吐、护肝及静脉营养支持治疗，同时行腰椎穿刺脑脊液常规及生化检查。","is_gold":false},{"letter":"G","text":"结束本周期化疗，给予预防性抗感染及护肝支持治疗，并完善脑垂体激素五项检查。","is_gold":false},{"letter":"H","text":"继续本周期化疗，给予止吐及肠内营养支持治疗，避免静脉营养，并复查鼻咽及垂体增强MRI。","is_gold":false},{"letter":"I","text":"暂停氟尿嘧啶持续静脉滴注，给予口腔局部镇痛及促进黏膜愈合处理，并完善脑垂体激素五项检查。","is_gold":false},{"letter":"J","text":"继续本周期化疗，给予止吐、护肝支持治疗，暂不予静脉营养，并请内分泌科急会诊。","is_gold":false},{"letter":"K","text":"结束本周期化疗，给予止吐、护肝及静脉营养支持治疗，并于次日开始局部区域调强放疗。","is_gold":false},{"letter":"L","text":"继续本周期化疗，给予止吐、护肝及静脉营养等支持治疗，并完善脑垂体激素五项检查。","is_gold":true}]}
+{"sample_id":"sample-efbe1e2a6ec0abf3be38883f","patient_id":"patient-eecadcdf172a1efe8947b052","turn_id":"turn07","turn_type":"response_assessment_decision","gold_letter":"B","gold_action":"评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行根治性同期放化疗。","options":[{"letter":"A","text":"评估诱导化疗疗效为疾病稳定，继续原方案第4程诱导化疗，并予以静脉补钾、补钠及护肾治疗后出院。","is_gold":false},{"letter":"B","text":"评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行根治性同期放化疗。","is_gold":true},{"letter":"C","text":"评估诱导化疗疗效为完全缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行单纯根治性放疗。","is_gold":false},{"letter":"D","text":"评估诱导化疗疗效为部分缓解，予以静脉补钾、补钠及护肾治疗，待电解质及肾功能恢复正常后立即开始第4程诱导化疗。","is_gold":false},{"letter":"E","text":"评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行单纯根治性放疗。","is_gold":false},{"letter":"F","text":"评估诱导化疗疗效为疾病进展，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院更改为GP方案化疗。","is_gold":false},{"letter":"G","text":"评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行根治性放疗联合靶向治疗。","is_gold":false},{"letter":"H","text":"评估诱导化疗疗效为部分缓解，因出现肾功能损害，予以护肾治疗后出院，并安排按期返院行单纯根治性放疗，取消同期化疗。","is_gold":false},{"letter":"I","text":"评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行姑息性放化疗。","is_gold":false},{"letter":"J","text":"评估诱导化疗疗效为部分缓解，予以静脉补钾、补钠及护肾治疗，住院期间直接开始根治性同期放化疗。","is_gold":false},{"letter":"K","text":"评估诱导化疗疗效为疾病稳定，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行根治性同期放化疗。","is_gold":false},{"letter":"L","text":"评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行鼻咽及颈部淋巴结清扫术。","is_gold":false}]}
+{"sample_id":"sample-a1bcb1dd845b682149871b63","patient_id":"patient-eecadcdf172a1efe8947b052","turn_id":"turn08","turn_type":"response_assessment_decision","gold_letter":"C","gold_action":"完善EB病毒DNA定量及EBV抗体（VCA-IgA、EA-IgA）检测，继续定期随访观察。","options":[{"letter":"A","text":"完善鼻咽及颈部MRI检查，暂缓EB病毒DNA及抗体检测。","is_gold":false},{"letter":"B","text":"安排全身PET-CT检查，替代常规影像学及EB病毒相关指标随访。","is_gold":false},{"letter":"C","text":"完善EB病毒DNA定量及EBV抗体（VCA-IgA、EA-IgA）检测，继续定期随访观察。","is_gold":true},{"letter":"D","text":"完善胸部增强CT及全身骨扫描，暂缓EB病毒DNA定量检测。","is_gold":false},{"letter":"E","text":"延长随访间隔至每半年一次，仅复查腹部彩超及血常规。","is_gold":false},{"letter":"F","text":"安排鼻内镜检查并常规行鼻咽部组织活检，复查EB病毒DNA。","is_gold":false},{"letter":"G","text":"给予抗病毒药物治疗以降低EBV-VCA-IgA滴度，继续随访观察。","is_gold":false},{"letter":"H","text":"启动卡培他滨节拍维持治疗，并每半年复查EB病毒DNA定量。","is_gold":false},{"letter":"I","text":"完善鼻咽及颈部CT平扫，替代MRI及EB病毒DNA定量检测。","is_gold":false},{"letter":"J","text":"安排双侧颈部淋巴结彩超检查，暂缓EB病毒相关指标检测。","is_gold":false},{"letter":"K","text":"启动PD-1抑制剂免疫维持治疗，并定期复查EB病毒DNA定量。","is_gold":false},{"letter":"L","text":"完善头颅增强MRI检查，暂缓鼻咽部及颈部影像学评估。","is_gold":false}]}
+{"sample_id":"sample-32fca5d8e1da4de5e54c5c0b","patient_id":"patient-290a042206ccfe67e72f9a19","turn_id":"turn01","turn_type":"initial_workup_choice","gold_letter":"D","gold_action":"行电子鼻咽镜检查及活检，并完善鼻咽及颈部MRI平扫+增强，常规心电图检查","options":[{"letter":"A","text":"行电子鼻咽镜检查（不活检），并完善鼻咽及颈部CT平扫+增强，常规心电图检查","is_gold":false},{"letter":"B","text":"行颈部淋巴结切除活检，并完善鼻咽及颈部MRI平扫+增强，常规心电图检查","is_gold":false},{"letter":"C","text":"行电子鼻咽镜检查及活检，并完善鼻咽及颈部MRI平扫（不增强），常规心电图检查","is_gold":false},{"letter":"D","text":"行电子鼻咽镜检查及活检，并完善鼻咽及颈部MRI平扫+增强，常规心电图检查","is_gold":true},{"letter":"E","text":"行电子鼻咽镜检查及活检，并完善鼻咽MRI平扫+增强，暂缓颈部影像学检查","is_gold":false},{"letter":"F","text":"直接行全身PET-CT检查，暂缓电子鼻咽镜及活检与局部MRI","is_gold":false},{"letter":"G","text":"行电子鼻咽镜检查及活检，并完善胸部及腹部CT平扫+增强，暂缓头颈部MRI","is_gold":false},{"letter":"H","text":"行鼻咽及颈部MRI平扫+增强，常规心电图检查，暂缓鼻咽镜检查及活检","is_gold":false},{"letter":"I","text":"行电子鼻咽镜检查及活检，并完善鼻咽及颈部CT平扫，常规心电图检查","is_gold":false},{"letter":"J","text":"行颈部淋巴结穿刺活检，并完善鼻咽及颈部MRI平扫+增强，常规心电图检查","is_gold":false},{"letter":"K","text":"行电子鼻咽镜检查（不活检），并完善全身PET-CT检查，常规心电图检查","is_gold":false},{"letter":"L","text":"行电子鼻咽镜检查及活检，并完善鼻咽及颈部超声检查，常规心电图检查","is_gold":false}]}
+{"sample_id":"sample-95b51d663e429afb86c572e7","patient_id":"patient-290a042206ccfe67e72f9a19","turn_id":"turn02","turn_type":"imaging_release_workup","gold_letter":"E","gold_action":"行外院疑难病理会诊，完善PET/CT全身显像及血浆EBV DNA检测","options":[{"letter":"A","text":"行鼻咽镜下重新活检，完善胸部CT、腹部超声及全身骨扫描，检测血浆EBV DNA","is_gold":false},{"letter":"B","text":"行外院疑难病理会诊，完善胸部CT、腹部超声，暂缓全身骨扫描，检测血浆EBV DNA","is_gold":false},{"letter":"C","text":"沿用外院病理诊断，完善PET/CT全身显像及血浆EBV DNA检测","is_gold":false},{"letter":"D","text":"行外院疑难病理会诊，完善胸部增强CT及腹部增强CT，暂缓全身骨扫描","is_gold":false},{"letter":"E","text":"行外院疑难病理会诊，完善PET/CT全身显像及血浆EBV DNA检测","is_gold":true},{"letter":"F","text":"行鼻咽镜下重新活检，完善PET/CT全身显像及血浆EBV DNA检测","is_gold":false},{"letter":"G","text":"行外院疑难病理会诊，完善PET/CT全身显像，暂缓血浆EBV DNA检测","is_gold":false},{"letter":"H","text":"行外院疑难病理会诊，完善胸部CT及腹部CT，暂缓全身骨扫描及血浆EBV DNA检测","is_gold":false},{"letter":"I","text":"沿用外院病理诊断，完善PET/CT全身显像，暂缓血浆EBV DNA检测","is_gold":false},{"letter":"J","text":"行外院疑难病理会诊，完善头颈部局部PET/CT及血浆EBV DNA检测","is_gold":false},{"letter":"K","text":"行鼻咽镜下重新活检，完善胸部CT及腹部CT，暂缓血浆EBV DNA检测","is_gold":false}]}
+{"sample_id":"sample-ac55ce5273aeb2587f3051e7","patient_id":"patient-290a042206ccfe67e72f9a19","turn_id":"turn05","turn_type":"toxicity_or_support_decision","gold_letter":"I","gold_action":"予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，暂不予口服保肝药物治疗，并复查血常规及生化后安排出院。","options":[{"letter":"A","text":"予以短效重组人粒细胞刺激因子（rhG-CSF）皮下注射，暂不予口服保肝药物治疗，并复查血常规及生化后继续住院观察。","is_gold":false},{"letter":"B","text":"暂不予粒细胞集落刺激因子预防，仅口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。","is_gold":false},{"letter":"C","text":"予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，静脉滴注头孢菌素预防感染，并复查血常规及生化后安排出院。","is_gold":false},{"letter":"D","text":"予以短效重组人粒细胞刺激因子（rhG-CSF）皮下注射，静脉滴注异甘草酸镁强效保肝，并复查血常规及生化后继续住院观察。","is_gold":false},{"letter":"E","text":"暂不予粒细胞集落刺激因子预防，暂不予口服保肝药物治疗，直接安排出院并嘱院外定期复查血常规及生化。","is_gold":false},{"letter":"F","text":"予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，口服恩替卡韦抗病毒治疗，并复查血常规及生化后安排出院。","is_gold":false},{"letter":"G","text":"予以短效重组人粒细胞刺激因子（rhG-CSF）皮下注射，口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。","is_gold":false},{"letter":"H","text":"予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。","is_gold":false},{"letter":"I","text":"予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，暂不予口服保肝药物治疗，并复查血常规及生化后安排出院。","is_gold":true},{"letter":"J","text":"予以重组人促血小板生成素（rhTPO）皮下注射，口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。","is_gold":false},{"letter":"K","text":"予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，静脉滴注还原型谷胱甘肽保肝，并复查血常规及生化后继续住院观察。","is_gold":false},{"letter":"L","text":"暂不予任何药物处理，直接安排出院，嘱院外定期复查血常规及生化，若出现发热再返院使用粒细胞集落刺激因子。","is_gold":false}]}
+{"sample_id":"sample-6d1ca43d48e1d74031505487","patient_id":"patient-290a042206ccfe67e72f9a19","turn_id":"turn07","turn_type":"recurrence_or_salvage_decision","gold_letter":"J","gold_action":"继续予以抑酸护胃及静脉高营养等对症支持治疗，待体能恢复后序贯开展根治性放疗或同步放化疗。","options":[{"letter":"A","text":"立即启动根治性调强放疗联合同步顺铂化疗，停止静脉高营养以避免导管相关感染。","is_gold":false},{"letter":"B","text":"更换为吉西他滨联合顺铂方案进行第四周期诱导化疗，并继续抑酸护胃治疗。","is_gold":false},{"letter":"C","text":"安排鼻咽原发灶及双侧颈部淋巴结根治性切除术，术后辅以静脉营养支持。","is_gold":false},{"letter":"D","text":"维持静脉营养支持，并立即启动根治性放疗联合PD-1抑制剂及靶向治疗。","is_gold":false},{"letter":"E","text":"继续原方案（多西紫杉醇+顺铂+5-FU）进行第四周期诱导化疗，并辅以抑酸护胃治疗。","is_gold":false},{"letter":"F","text":"暂停所有抗肿瘤治疗，仅维持静脉营养支持及抑酸治疗，1个月后复查MRI决定后续方案。","is_gold":false},{"letter":"G","text":"安排全身PET-CT检查评估全身情况，若无远处转移则继续原方案诱导化疗两周期。","is_gold":false},{"letter":"H","text":"行局部清扫术，处理颈部残留淋巴结，术后序贯鼻咽部根治性放疗及静脉营养支持。","is_gold":false},{"letter":"I","text":"调整为卡培他滨节拍化疗联合静脉营养支持，待消化道反应完全缓解后启动放疗。","is_gold":false},{"letter":"J","text":"继续予以抑酸护胃及静脉高营养等对症支持治疗，待体能恢复后序贯开展根治性放疗或同步放化疗。","is_gold":true},{"letter":"K","text":"启动姑息性放疗控制局部及颈部病灶，并联合阿帕替尼等抗血管生成药物治疗。","is_gold":false},{"letter":"L","text":"维持静脉营养支持，并安排鼻咽镜下局部病灶再次活检以病理确认肿瘤退缩程度。","is_gold":false}]}
+{"sample_id":"sample-23bcdf34802b996618f9500b","patient_id":"patient-e45c55cc63c050892e6b2467","turn_id":"turn01","turn_type":"initial_workup_choice","gold_letter":"L","gold_action":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身骨显像、腹部彩超及心电图等基线检查。","options":[{"letter":"A","text":"鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，暂缓全身影像学分期检查。","is_gold":false},{"letter":"B","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，PET-CT全身显像。","is_gold":false},{"letter":"C","text":"右颈部肿物切除活检，鼻咽及颈部MRI平扫+增强，全身骨显像，腹部彩超。","is_gold":false},{"letter":"D","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫，全身骨显像，腹部彩超，心电图。","is_gold":false},{"letter":"E","text":"鼻咽镜检查及活检，头颅MRI平扫+增强，颈部彩超，全身骨显像，腹部彩超。","is_gold":false},{"letter":"F","text":"鼻咽刷片细胞学检查，鼻咽及颈部MRI平扫+增强，全身骨显像，腹部彩超。","is_gold":false},{"letter":"G","text":"鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，全身骨显像，腹部彩超，心电图。","is_gold":false},{"letter":"H","text":"右颈部肿物细针穿刺活检，鼻咽及颈部MRI平扫+增强，全身骨显像，腹部彩超。","is_gold":false},{"letter":"I","text":"鼻咽镜检查及活检，鼻咽MRI平扫+增强，全身骨显像，腹部彩超，心电图。","is_gold":false},{"letter":"J","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，骨髓穿刺活检，腹部彩超。","is_gold":false},{"letter":"K","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部及腹部MRI平扫+增强。","is_gold":false},{"letter":"L","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身骨显像、腹部彩超及心电图等基线检查。","is_gold":true}]}
+{"sample_id":"sample-6cb68b4fe11abd5f5e27ea88","patient_id":"patient-e45c55cc63c050892e6b2467","turn_id":"turn02","turn_type":"imaging_release_workup","gold_letter":"A","gold_action":"行鼻咽镜检查及活检，并完善胸片或胸部CT检查。","options":[{"letter":"A","text":"行鼻咽镜检查及活检，并完善胸片或胸部CT检查。","is_gold":true},{"letter":"B","text":"行右颈部肿大淋巴结切除活检，并完善胸片或胸部CT检查。","is_gold":false},{"letter":"C","text":"行鼻咽镜检查及活检，并完善头颅增强MRI检查。","is_gold":false},{"letter":"D","text":"行右颈部肿大淋巴结细针穿刺活检，并完善全身骨扫描。","is_gold":false},{"letter":"E","text":"行全身PET-CT检查，暂缓鼻咽及颈部活检。","is_gold":false},{"letter":"F","text":"行鼻咽镜检查及活检，暂不安排其他部位影像学检查。","is_gold":false},{"letter":"G","text":"完善胸部及全腹部增强CT检查，待结果回报后再行活检。","is_gold":false},{"letter":"H","text":"行鼻咽镜检查及活检，并复查颈部彩超评估淋巴结。","is_gold":false},{"letter":"I","text":"安排鼻咽及颈部根治性放疗，同步完善胸片或胸部CT检查。","is_gold":false},{"letter":"J","text":"行鼻咽镜检查及活检，并完善全身骨扫描检查。","is_gold":false},{"letter":"K","text":"给予抗炎治疗2周后复查鼻咽MRI，再决定是否行鼻咽活检。","is_gold":false},{"letter":"L","text":"行鼻咽镜检查及活检，并完善血浆EBV-DNA检测，暂缓胸部影像学检查。","is_gold":false}]}
+{"sample_id":"sample-51ced222567a8eb77bc8161d","patient_id":"patient-e45c55cc63c050892e6b2467","turn_id":"turn04","turn_type":"initial_treatment_selection","gold_letter":"B","gold_action":"予以诱导化疗序贯同期放化疗","options":[{"letter":"A","text":"予以根治性单纯放疗","is_gold":false},{"letter":"B","text":"予以诱导化疗序贯同期放化疗","is_gold":true},{"letter":"C","text":"予以诱导化疗序贯单纯放疗","is_gold":false},{"letter":"D","text":"予以同期放化疗序贯辅助化疗","is_gold":false},{"letter":"E","text":"予以靶向治疗联合同期放化疗","is_gold":false},{"letter":"F","text":"予以免疫治疗联合同期放化疗","is_gold":false},{"letter":"G","text":"予以诱导化疗序贯靶向治疗联合放疗","is_gold":false},{"letter":"H","text":"行颈部淋巴结清扫术序贯根治性放疗","is_gold":false},{"letter":"I","text":"行鼻咽原发灶切除联合颈部淋巴结清扫术","is_gold":false},{"letter":"J","text":"予以姑息性化疗联合局部姑息性放疗","is_gold":false},{"letter":"K","text":"予以诱导化疗序贯根治性手术切除","is_gold":false}]}
+{"sample_id":"sample-31164fa636b978a86d54f0c9","patient_id":"patient-e45c55cc63c050892e6b2467","turn_id":"turn05","turn_type":"toxicity_or_support_decision","gold_letter":"D","gold_action":"完善全麻下鼻咽及颈部肿物活检术前准备，予以配血备用及口服地西泮镇静。","options":[{"letter":"A","text":"完善局麻下鼻咽及颈部肿物活检术前准备，予以口服地西泮镇静及配血备用。","is_gold":false},{"letter":"B","text":"完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注头孢类抗生素预防感染。","is_gold":false},{"letter":"C","text":"完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注氨甲环酸预防术中出血。","is_gold":false},{"letter":"D","text":"完善全麻下鼻咽及颈部肿物活检术前准备，予以配血备用及口服地西泮镇静。","is_gold":true},{"letter":"E","text":"完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注人血白蛋白及复方氨基酸。","is_gold":false},{"letter":"F","text":"完善全麻下鼻咽及颈部肿物活检术前准备，予以皮下注射低分子肝素及下肢气压治疗。","is_gold":false},{"letter":"G","text":"完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉滴注地塞米松及雾化吸入。","is_gold":false},{"letter":"H","text":"完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉补充氯化钾及晶体液扩容。","is_gold":false},{"letter":"I","text":"暂缓活检手术，予以静脉输注广谱抗生素及补液支持治疗。","is_gold":false},{"letter":"J","text":"暂缓活检手术，予以口服非甾体类抗炎药及局部热敷理疗。","is_gold":false},{"letter":"K","text":"完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注单采血小板及冷沉淀。","is_gold":false},{"letter":"L","text":"完善全麻下鼻咽及颈部肿物活检术前准备，予以口服氯雷他定及局部涂抹糖皮质激素。","is_gold":false}]}
+{"sample_id":"sample-e79a5ee2227343d5e15dc4d1","patient_id":"patient-e45c55cc63c050892e6b2467","turn_id":"turn06","turn_type":"toxicity_or_support_decision","gold_letter":"E","gold_action":"继续抗炎及支持治疗，完善血常规、尿常规及生化常规检查。","options":[{"letter":"A","text":"立即启动含铂双药诱导化疗，并完善心电图及超声心动图检查。","is_gold":false},{"letter":"B","text":"予以静脉输注氨甲环酸，并完善凝血常规及D-二聚体检查。","is_gold":false},{"letter":"C","text":"安排右颈部淋巴结清扫术，并静脉使用广谱抗生素抗感染。","is_gold":false},{"letter":"D","text":"予以阿片类药物滴定止痛，并完善全身骨扫描检查。","is_gold":false},{"letter":"E","text":"继续抗炎及支持治疗，完善血常规、尿常规及生化常规检查。","is_gold":true},{"letter":"F","text":"启动根治性调强放射治疗，并复查鼻咽及颈部增强MRI。","is_gold":false},{"letter":"G","text":"予以静脉高营养支持治疗，并复查血浆EBV-DNA定量。","is_gold":false},{"letter":"H","text":"预防性皮下注射低分子肝素，并完善双下肢深静脉彩超。","is_gold":false},{"letter":"I","text":"予以静脉滴注地塞米松，并复查头颈部增强CT。","is_gold":false},{"letter":"J","text":"拔除静脉留置针，仅予以口服非甾体抗炎药，并继续留院观察。","is_gold":false},{"letter":"K","text":"停止静脉用药，改为口服头孢类抗生素，并立即办理出院。","is_gold":false},{"letter":"L","text":"予以颈部局部姑息性放疗，并完善甲状腺功能检查。","is_gold":false}]}
+{"sample_id":"sample-3246297632d882a392dfe20a","patient_id":"patient-e45c55cc63c050892e6b2467","turn_id":"turn07","turn_type":"recurrence_or_salvage_decision","gold_letter":"F","gold_action":"完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检及颈部肿物活检术。","options":[{"letter":"A","text":"完善术前准备，在局麻下行经鼻内镜鼻咽肿物活检及颈部肿物活检术。","is_gold":false},{"letter":"B","text":"直接以颈部淋巴结转移性鳞癌及影像学表现为依据，开始诱导化疗。","is_gold":false},{"letter":"C","text":"完善术前准备，在全麻下仅行经鼻内镜鼻咽肿物活检术。","is_gold":false},{"letter":"D","text":"完善术前准备，在全麻下仅行颈部肿物切除活检术。","is_gold":false},{"letter":"E","text":"完善术前准备，在全麻下行鼻咽肿物活检术，并预防性切除双侧扁桃体。","is_gold":false},{"letter":"F","text":"完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检及颈部肿物活检术。","is_gold":true},{"letter":"G","text":"完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检，若为阴性则行颈部淋巴结清扫术。","is_gold":false},{"letter":"H","text":"暂缓活检，先行EBV-DNA及鼻咽部PET-CT检查，结果决定是否再次活检。","is_gold":false},{"letter":"I","text":"完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检及颈部肿物细针穿刺活检术。","is_gold":false},{"letter":"J","text":"完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检，并同期行鼻咽部及颈部放疗定位。","is_gold":false},{"letter":"K","text":"完善术前准备，在局麻下行颈部肿物切除活检，待病理确诊后再行鼻咽活检。","is_gold":false},{"letter":"L","text":"完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检及右侧颈部淋巴结清扫术。","is_gold":false}]}
+{"sample_id":"sample-da812d38ab5771a5dbc8fc87","patient_id":"patient-e45c55cc63c050892e6b2467","turn_id":"turn08","turn_type":"recurrence_or_salvage_decision","gold_letter":"G","gold_action":"继续根治性放疗，完善电子鼻咽镜检查，并予以肠内营养支持及定期复查血常规。","options":[{"letter":"A","text":"终止放化疗，转为手术切除鼻咽原发灶及颈部残留淋巴结。","is_gold":false},{"letter":"B","text":"暂停放疗，予以静脉抗感染治疗，2周后恢复放疗。","is_gold":false},{"letter":"C","text":"重新定位并修改放疗计划，缩减原发灶及颈部淋巴结的照射靶区，继续放疗。","is_gold":false},{"letter":"D","text":"提前结束放疗，改为单药靶向治疗或PD-1抑制剂维持治疗。","is_gold":false},{"letter":"E","text":"继续根治性放疗，停用原化疗方案，改用吉西他滨联合顺铂方案化疗。","is_gold":false},{"letter":"F","text":"暂停治疗，完善全身PET-CT检查评估远处转移情况，再决定后续方案。","is_gold":false},{"letter":"G","text":"继续根治性放疗，完善电子鼻咽镜检查，并予以肠内营养支持及定期复查血常规。","is_gold":true},{"letter":"H","text":"终止放化疗，转为定期随访观察，3个月后复查鼻咽及颈部MRI。","is_gold":false},{"letter":"I","text":"继续根治性放疗，常规加用大剂量地塞米松以减轻局部黏膜炎症反应。","is_gold":false},{"letter":"J","text":"暂停放疗，行右颈部残留淋巴结穿刺活检明确病理，再制定后续治疗计划。","is_gold":false},{"letter":"K","text":"继续根治性放疗，并择期行右侧颈部淋巴结清扫术。","is_gold":false}]}
+{"sample_id":"sample-6d0ec36f585feac9ee8c0aa5","patient_id":"patient-a48d1d72efa6c4217cf5b79c","turn_id":"turn01","turn_type":"initial_workup_choice","gold_letter":"H","gold_action":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT检查","options":[{"letter":"A","text":"鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸腹部CT平扫","is_gold":false},{"letter":"B","text":"颈部淋巴结切除活检，鼻咽及颈部MRI平扫+增强，全身PET/CT检查","is_gold":false},{"letter":"C","text":"鼻咽镜检查及活检，鼻咽部MRI平扫+增强，胸部X线，腹部B超","is_gold":false},{"letter":"D","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，暂不进行全身分期检查","is_gold":false},{"letter":"E","text":"颈部淋巴结细针穿刺活检，鼻咽及颈部CT平扫+增强，全身骨扫描","is_gold":false},{"letter":"F","text":"鼻咽镜检查及活检，鼻咽部MRI平扫+增强，全身PET/CT检查","is_gold":false},{"letter":"G","text":"鼻咽及颈部MRI平扫+增强，全身PET/CT检查，直接安排根治性放疗","is_gold":false},{"letter":"H","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT检查","is_gold":true},{"letter":"I","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫，胸腹部CT平扫+增强，全身骨扫描","is_gold":false},{"letter":"J","text":"鼻咽脱落细胞学涂片，鼻咽及颈部MRI平扫+增强，全身PET/CT检查","is_gold":false},{"letter":"K","text":"鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，全身PET/CT检查","is_gold":false},{"letter":"L","text":"鼻咽及颈部MRI平扫+增强，EBV-DNA检测，胸腹部CT平扫+增强","is_gold":false}]}
+{"sample_id":"sample-11ca3bd9dd2a5877fa6a6b49","patient_id":"patient-a48d1d72efa6c4217cf5b79c","turn_id":"turn02","turn_type":"imaging_release_workup","gold_letter":"I","gold_action":"影像评估为 cT3N2，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期","options":[{"letter":"A","text":"影像评估为 cT4N2，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期","is_gold":false},{"letter":"B","text":"影像评估为 cT3N1，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期","is_gold":false},{"letter":"C","text":"影像评估为 cT3N2，需完善鼻咽镜及活检明确病理，无需常规进行胸腹部及骨骼的远处转移筛查","is_gold":false},{"letter":"D","text":"影像评估为 cT4N3，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期","is_gold":false},{"letter":"E","text":"影像评估为 cT2N2，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期","is_gold":false},{"letter":"F","text":"影像评估为 cT3N2，需完善颈部淋巴结穿刺活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期","is_gold":false},{"letter":"G","text":"影像评估为 cT3N2，已具备影像学确诊条件，直接安排诱导化疗及后续根治性放疗","is_gold":false},{"letter":"H","text":"影像评估为 cT4N2，需完善颈部淋巴结穿刺活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期","is_gold":false},{"letter":"I","text":"影像评估为 cT3N2，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期","is_gold":true},{"letter":"J","text":"影像评估为 cT3N3，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期","is_gold":false},{"letter":"K","text":"影像评估为 cT2N1，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期","is_gold":false},{"letter":"L","text":"影像评估为 cT3N2，需完善鼻咽镜及活检明确病理，并完善头颅MRI及脑脊液检查以排除中枢神经系统转移","is_gold":false}]}
+{"sample_id":"sample-b061f796c98789c2958f0baf","patient_id":"patient-a48d1d72efa6c4217cf5b79c","turn_id":"turn04","turn_type":"initial_treatment_selection","gold_letter":"K","gold_action":"启动首周期诱导化疗（辅以水化、止吐预处理），计划序贯根治性同步放化疗","options":[{"letter":"A","text":"启动首周期同步放化疗（辅以水化、止吐预处理），不考虑诱导化疗","is_gold":false},{"letter":"B","text":"启动首周期诱导化疗，计划序贯根治性单纯放疗","is_gold":false},{"letter":"C","text":"启动首周期诱导化疗联合PD-1抑制剂，计划序贯根治性同步放化疗","is_gold":false},{"letter":"D","text":"启动首周期诱导化疗，计划序贯手术切除原发灶及颈部淋巴结","is_gold":false},{"letter":"E","text":"启动根治性单纯放疗，计划放疗结束后行多周期辅助化疗","is_gold":false},{"letter":"F","text":"启动根治性放疗联合EGFR靶向治疗，免除全身静脉化疗","is_gold":false},{"letter":"G","text":"优先行双侧颈部淋巴结清扫术，术后行根治性同步放化疗","is_gold":false},{"letter":"H","text":"优先行鼻咽原发灶内镜下切除术，术后行根治性同步放化疗","is_gold":false},{"letter":"I","text":"启动首周期姑息性化疗，计划化疗后行局部姑息性放疗","is_gold":false},{"letter":"J","text":"启动首周期诱导化疗，若疗效达完全缓解（CR）则免除后续放疗","is_gold":false},{"letter":"K","text":"启动首周期诱导化疗（辅以水化、止吐预处理），计划序贯根治性同步放化疗","is_gold":true},{"letter":"L","text":"启动首周期同步放化疗，计划放疗结束后行多周期辅助化疗","is_gold":false}]}
+{"sample_id":"sample-b024e6abb04a58aab366631a","patient_id":"patient-a48d1d72efa6c4217cf5b79c","turn_id":"turn07","turn_type":"response_assessment_decision","gold_letter":"B","gold_action":"继续完成既定根治性放疗计划；加用重组人表皮生长因子、GM-CSF含漱液局部治疗，并予以静脉营养支持及抗感染治疗。","options":[{"letter":"A","text":"提前终止放疗；给予重组人表皮生长因子、GM-CSF含漱液局部促修复及静脉营养支持治疗。","is_gold":false},{"letter":"B","text":"继续完成既定根治性放疗计划；加用重组人表皮生长因子、GM-CSF含漱液局部治疗，并予以静脉营养支持及抗感染治疗。","is_gold":true},{"letter":"C","text":"暂停放疗及靶向治疗直至黏膜炎好转；给予重组人表皮生长因子、GM-CSF含漱液局部治疗及静脉营养支持。","is_gold":false},{"letter":"D","text":"继续完成既定根治性放疗计划；仅给予氯化钠含漱液及常规饮食指导，避免使用生长因子类药物及静脉营养。","is_gold":false},{"letter":"E","text":"继续完成既定根治性放疗计划；加用氟康唑等广谱抗真菌药物静脉滴注，并予以静脉营养支持治疗。","is_gold":false},{"letter":"F","text":"继续完成既定根治性放疗计划并立即安排鼻咽部局部加量放疗；给予重组人表皮生长因子含漱液及静脉营养支持。","is_gold":false},{"letter":"G","text":"继续完成既定根治性放疗计划；行预防性经皮内镜下胃造瘘术（PEG）替代静脉营养支持。","is_gold":false},{"letter":"H","text":"暂停放疗计划；复查鼻咽及颈部MRI以明确肿瘤退缩情况，再决定后续放疗靶区及剂量。","is_gold":false},{"letter":"I","text":"继续完成既定根治性放疗计划；给予大剂量静脉糖皮质激素冲击治疗，暂缓静脉营养支持。","is_gold":false},{"letter":"J","text":"继续完成既定根治性放疗计划；立即给予聚乙二醇化重组人粒细胞刺激因子皮下注射及静脉营养支持。","is_gold":false},{"letter":"K","text":"提前结束放疗，转为维持性靶向治疗及免疫治疗；给予重组人表皮生长因子及静脉营养支持。","is_gold":false},{"letter":"L","text":"继续完成既定根治性放疗计划；行预防性气管切开术，并予以静脉营养支持及抗感染治疗。","is_gold":false}]}
+{"sample_id":"sample-c54efc446616b72b81ae7555","patient_id":"patient-a48d1d72efa6c4217cf5b79c","turn_id":"turn08","turn_type":"recurrence_or_salvage_decision","gold_letter":"C","gold_action":"行电子鼻咽镜检查评估局部肿瘤退缩情况，并继续使用重组人表皮生长因子、重组人粒细胞巨噬细胞刺激因子等含漱药物促进粘膜修复。","options":[{"letter":"A","text":"行电子鼻咽镜检查并在可疑残留区域取活检，继续静脉滴注莫西沙星及地塞米松预防感染与水肿，暂不予抗肿瘤治疗。","is_gold":false},{"letter":"B","text":"安排全身PET-CT检查评估放化疗后全身代谢缓解情况，并继续静脉滴注脂肪乳及氨基酸等营养支持治疗。","is_gold":false},{"letter":"C","text":"行电子鼻咽镜检查评估局部肿瘤退缩情况，并继续使用重组人表皮生长因子、重组人粒细胞巨噬细胞刺激因子等含漱药物促进粘膜修复。","is_gold":true},{"letter":"D","text":"对右侧咽后及颈部残留淋巴结行局部追加放疗推量，并继续使用重组人表皮生长因子等含漱药物促进粘膜修复。","is_gold":false},{"letter":"E","text":"行电子鼻咽镜检查评估局部疗效，并启动吉西他滨联合顺铂方案进行2至3个周期的辅助化疗以巩固全身疗效。","is_gold":false},{"letter":"F","text":"行右侧颈部淋巴结清扫术处理残留淋巴结，术后继续使用重组人表皮生长因子外用溶液促进局部创面愈合。","is_gold":false},{"letter":"G","text":"行鼻咽及颈部超声检查评估淋巴结结构，并加用卡培他滨口服进行为期1年的节拍化疗作为维持治疗。","is_gold":false},{"letter":"H","text":"暂不进行鼻咽镜检查，直接出院，嘱1个月后返院行鼻咽部活检及MRI复查，期间继续静脉营养支持。","is_gold":false},{"letter":"I","text":"行电子鼻咽镜检查评估局部疗效，并继续静脉滴注脂肪乳、氨基酸及复方氯化钠注射液加强全身营养支持。","is_gold":false},{"letter":"J","text":"安排头颅增强MRI及全身骨扫描排除远处转移，并继续原方案靶向治疗至满1年，辅以局部含漱药物治疗。","is_gold":false},{"letter":"K","text":"行电子鼻咽镜检查评估局部疗效，若发现粘膜坏死则立即行内镜下清创术，并静脉滴注大剂量抗生素抗感染。","is_gold":false},{"letter":"L","text":"继续静脉滴注莫西沙星及地塞米松抗炎治疗2周以控制鼻窦炎及乳突炎，并定期复查鼻窦CT评估炎症吸收情况。","is_gold":false}]}
+{"sample_id":"sample-37f31044df5e45295b88793a","patient_id":"patient-e90c2443e271b2e927262653","turn_id":"turn01","turn_type":"initial_workup_choice","gold_letter":"D","gold_action":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部DR、腹部彩超、全身骨显像","options":[{"letter":"A","text":"电子鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸部DR、腹部彩超、全身骨显像","is_gold":false},{"letter":"B","text":"鼻咽及颈部MRI平扫+增强，胸部DR、腹部彩超、全身骨显像，暂缓鼻咽镜及活检","is_gold":false},{"letter":"C","text":"颈部淋巴结切除活检，鼻咽及颈部MRI平扫+增强，胸部DR、腹部彩超、全身骨显像","is_gold":false},{"letter":"D","text":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部DR、腹部彩超、全身骨显像","is_gold":true},{"letter":"E","text":"电子鼻咽镜检查及活检，鼻咽MRI平扫+增强，胸部DR、腹部彩超、全身骨显像","is_gold":false},{"letter":"F","text":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，暂缓胸腹部及骨骼影像学筛查","is_gold":false},{"letter":"G","text":"全身PET-CT检查，颈部淋巴结细针穿刺活检，暂缓电子鼻咽镜检查及活检","is_gold":false},{"letter":"H","text":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫，胸部DR、腹部彩超、全身骨显像","is_gold":false},{"letter":"I","text":"电子鼻咽镜检查，鼻咽及颈部MRI平扫+增强，胸部CT、腹部CT，暂缓组织活检","is_gold":false},{"letter":"J","text":"颈部淋巴结穿刺活检，鼻咽及颈部CT平扫+增强，胸部DR、腹部彩超、全身骨显像","is_gold":false},{"letter":"K","text":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，头颅CT平扫，暂缓远处转移筛查","is_gold":false},{"letter":"L","text":"电子鼻咽镜检查及活检，鼻咽及颈部超声检查，胸部DR、腹部彩超、全身骨显像","is_gold":false}]}
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+{"sample_id":"sample-9253a0b82814c8e2231522e6","patient_id":"patient-e90c2443e271b2e927262653","turn_id":"turn05","turn_type":"toxicity_or_support_decision","gold_letter":"H","gold_action":"不额外给予预防性升白、保肝或抗凝等支持治疗，继续完善乙肝定量、凝血功能、HIV/梅毒筛查及其他治疗前基线血液学和感染学检查。","options":[{"letter":"A","text":"给予重组人粒细胞集落刺激因子（rhG-CSF）皮下注射，并完善基线心电图及超声心动图检查。","is_gold":false},{"letter":"B","text":"给予地塞米松及20%甘露醇注射液静脉滴注，并紧急行头颅CT平扫。","is_gold":false},{"letter":"C","text":"给予异甘草酸镁注射液静脉滴注进行预防性保肝治疗。","is_gold":false},{"letter":"D","text":"给予唑来膦酸静脉滴注，并完善全身骨骼核素扫描（ECT）。","is_gold":false},{"letter":"E","text":"给予肠内营养粉剂口服进行营养支持，并留置鼻胃管。","is_gold":false},{"letter":"F","text":"给予静脉铁剂及重组人促红素（rhEPO）皮下注射，并复查血常规及网织红细胞。","is_gold":false},{"letter":"G","text":"给予头孢曲松钠静脉滴注进行预防性抗感染治疗，并完善血培养及药敏试验。","is_gold":false},{"letter":"H","text":"不额外给予预防性升白、保肝或抗凝等支持治疗，继续完善乙肝定量、凝血功能及其他治疗前基线血液学和感染学筛查。","is_gold":true},{"letter":"I","text":"给予塞来昔布胶囊常规口服进行镇痛治疗，并局部外用氟比洛芬凝胶贴膏。","is_gold":false},{"letter":"J","text":"给予低分子量肝素钙皮下注射进行抗凝治疗，并完善双下肢深静脉彩超。","is_gold":false},{"letter":"K","text":"给予奥美拉唑肠溶胶囊口服进行抑酸护胃治疗，并完善胃镜检查。","is_gold":false},{"letter":"L","text":"给予安替可及硒酵母口服进行辅助治疗，并暂缓乙肝及梅毒等传染病筛查。","is_gold":false}]}
+{"sample_id":"sample-3b37bb5b3505f87a241c1a6f","patient_id":"patient-e90c2443e271b2e927262653","turn_id":"turn06","turn_type":"toxicity_or_support_decision","gold_letter":"I","gold_action":"暂不需集落刺激因子支持，予以复方氨基酸及转化糖电解质静脉营养支持，并进行动静脉置管护理。","options":[{"letter":"A","text":"预防性给予重组人粒细胞集落刺激因子（G-CSF）皮下注射，并推迟后续抗肿瘤治疗。","is_gold":false},{"letter":"B","text":"立即输注红细胞悬液2U，并皮下注射促红细胞生成素（EPO）纠正贫血。","is_gold":false},{"letter":"C","text":"启动异甘草酸镁及多烯磷脂酰胆碱静脉滴注，进行双靶点强化保肝治疗。","is_gold":false},{"letter":"D","text":"建立中心静脉通道，给予10%氯化钾注射液微量泵持续静脉泵入补钾。","is_gold":false},{"letter":"E","text":"留取血培养后，经验性静脉滴注头孢哌酮舒巴坦等广谱抗菌药物抗感染。","is_gold":false},{"letter":"F","text":"每日静脉输注人血白蛋白10g，并配合静脉推注呋塞米进行利尿消肿。","is_gold":false},{"letter":"G","text":"给予碳酸氢钠静脉滴注碱化尿液，并进行每日3000ml以上大剂量水化。","is_gold":false},{"letter":"H","text":"启动胰岛素泵持续皮下泵入强化降糖治疗，并严格限制碳水化合物摄入。","is_gold":false},{"letter":"I","text":"暂不需集落刺激因子支持，予以复方氨基酸及转化糖电解质静脉营养支持，并进行动静脉置管护理。","is_gold":true},{"letter":"J","text":"持续静脉泵入质子泵抑制剂及5-HT3受体拮抗剂，进行强化抑酸止吐。","is_gold":false},{"letter":"K","text":"预防性输注单采血小板1个治疗量，并皮下注射重组人血小板生成素。","is_gold":false},{"letter":"L","text":"给予拉布立酶静脉滴注，并配合大剂量静脉水化预防肿瘤溶解综合征。","is_gold":false}]}
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+{"sample_id":"sample-72b57dbdb0633da918062d61","patient_id":"patient-7c0941dbdd4694260fd4de38","turn_id":"turn02","turn_type":"imaging_release_workup","gold_letter":"A","gold_action":"行电子鼻咽镜检查及鼻咽肿物活检，并辅以颈部淋巴结彩超及穿刺活检，以明确病理诊断及淋巴结分期。","options":[{"letter":"A","text":"行电子鼻咽镜检查及鼻咽肿物活检，并辅以颈部淋巴结彩超及穿刺活检","is_gold":true},{"letter":"B","text":"行电子鼻咽镜检查及鼻咽肿物活检，颈部淋巴结仅作临床触诊及随访","is_gold":false},{"letter":"C","text":"行颈部淋巴结切除活检明确病理，暂缓鼻咽部有创检查及活检","is_gold":false},{"letter":"D","text":"行鼻内镜下鼻咽肿物扩大切除术，同步完成病理诊断与局部治疗","is_gold":false},{"letter":"E","text":"行颈部淋巴结彩超及穿刺活检，若确诊转移则免于鼻咽部活检","is_gold":false},{"letter":"F","text":"行鼻咽部脱落细胞学涂片及血浆EBV-DNA检测，替代组织学活检","is_gold":false},{"letter":"G","text":"启动根治性放化疗，免于组织学活检及颈部淋巴结穿刺评估","is_gold":false},{"letter":"H","text":"行电子鼻咽镜检查及活检，并预防性行双侧颈部淋巴结清扫术","is_gold":false},{"letter":"I","text":"补充全身骨扫描及头颅增强MRI，暂缓鼻咽及颈部组织学活检","is_gold":false},{"letter":"J","text":"行电子鼻咽镜评估局部侵犯范围，免于鼻咽肿物组织学活检","is_gold":false},{"letter":"K","text":"优先行鼓膜穿刺置管术缓解中耳积液，暂缓鼻咽部及颈部检查","is_gold":false},{"letter":"L","text":"予以诊断性抗炎治疗2周，随后复查PET/CT评估局部代谢变化","is_gold":false}]}
+{"sample_id":"sample-3ed269e9b5e894b444089bf3","patient_id":"patient-7c0941dbdd4694260fd4de38","turn_id":"turn04","turn_type":"initial_treatment_selection","gold_letter":"C","gold_action":"单纯根治性放疗（鼻咽及双侧颈部）","options":[{"letter":"A","text":"诱导化疗序贯单纯根治性放疗（鼻咽及双侧颈部）","is_gold":false},{"letter":"B","text":"同期放化疗（鼻咽及双侧颈部）","is_gold":false},{"letter":"C","text":"单纯根治性放疗（鼻咽及双侧颈部）","is_gold":true},{"letter":"D","text":"诱导化疗序贯同期放化疗（鼻咽及双侧颈部）","is_gold":false},{"letter":"E","text":"鼻咽原发灶切除术联合术后辅助放疗","is_gold":false},{"letter":"F","text":"靶向治疗联合单纯根治性放疗（鼻咽及双侧颈部）","is_gold":false},{"letter":"G","text":"免疫治疗联合单纯根治性放疗（鼻咽及双侧颈部）","is_gold":false},{"letter":"H","text":"诱导化疗联合免疫治疗序贯同期放化疗","is_gold":false},{"letter":"I","text":"单纯根治性放疗（仅照射鼻咽及右侧颈部）","is_gold":false},{"letter":"J","text":"姑息性全身化疗联合鼻咽局部减症放疗","is_gold":false},{"letter":"K","text":"诱导化疗后肿瘤退缩情况决定是否行根治性放疗","is_gold":false},{"letter":"L","text":"同期放化疗序贯全身辅助化疗","is_gold":false}]}
+{"sample_id":"sample-f6df1555c3bac7ae4b972cd4","patient_id":"patient-7c0941dbdd4694260fd4de38","turn_id":"turn05","turn_type":"toxicity_or_support_decision","gold_letter":"D","gold_action":"继续当前根治性放疗计划，定期常规监测血象及生化。","options":[{"letter":"A","text":"继续放疗，加用多烯磷脂酰胆碱等保肝药物。","is_gold":false},{"letter":"B","text":"继续放疗，皮下注射重组人粒细胞刺激因子。","is_gold":false},{"letter":"C","text":"暂停放疗，完善超声心动图及动态心电图检查。","is_gold":false},{"letter":"D","text":"继续根治性放疗计划，定期常规监测血象及生化。","is_gold":true},{"letter":"E","text":"继续放疗，加用阿托伐他汀等降脂药物。","is_gold":false},{"letter":"F","text":"继续放疗，给予静脉补液及利尿治疗。","is_gold":false},{"letter":"G","text":"暂停放疗，静脉滴注广谱抗生素抗感染治疗。","is_gold":false},{"letter":"H","text":"继续放疗，口服头孢类抗生素及促排痰药物。","is_gold":false},{"letter":"I","text":"继续放疗，静脉滴注地塞米松及甘露醇。","is_gold":false},{"letter":"J","text":"调整放疗计划，降低右侧中耳及乳突区的照射剂量。","is_gold":false},{"letter":"K","text":"继续放疗，皮下注射促红细胞生成素。","is_gold":false},{"letter":"L","text":"暂停放疗，行鼻内镜下鼓膜穿刺置管引流术。","is_gold":false}]}
+{"sample_id":"sample-f1eec05ca151dc9bde0f1f55","patient_id":"patient-7c0941dbdd4694260fd4de38","turn_id":"turn06","turn_type":"toxicity_or_support_decision","gold_letter":"E","gold_action":"继续调强放疗，给予局部含漱等对症处理，定期复查血常规及生化。","options":[{"letter":"A","text":"暂停调强放疗，待口腔黏膜炎恢复至Ⅰ度后恢复放疗，期间加强静脉营养支持。","is_gold":false},{"letter":"B","text":"继续调强放疗，加用全身静脉广谱抗生素，定期复查血常规及生化。","is_gold":false},{"letter":"C","text":"继续调强放疗，降低单次靶区照射剂量，给予局部含漱等对症处理。","is_gold":false},{"letter":"D","text":"继续调强放疗，加用静脉糖皮质激素，定期复查血常规及生化。","is_gold":false},{"letter":"E","text":"继续调强放疗，给予局部含漱等对症处理，定期复查血常规及生化。","is_gold":true},{"letter":"F","text":"暂停调强放疗，加用全身抗真菌药物，待黏膜白膜消退后恢复放疗。","is_gold":false},{"letter":"G","text":"继续调强放疗，加用顺铂单药同步化疗，给予局部含漱等对症处理。","is_gold":false},{"letter":"H","text":"继续调强放疗，给予重组人粒细胞刺激因子皮下注射，定期复查血常规。","is_gold":false},{"letter":"I","text":"暂停调强放疗，行鼻咽黏膜活检明确白膜性质，给予局部含漱等对症处理。","is_gold":false},{"letter":"J","text":"继续调强放疗，加用尼妥珠单抗靶向治疗，给予局部含漱等对症处理。","is_gold":false},{"letter":"K","text":"终止根治性放疗，转为姑息性放疗，加强镇痛及口腔局部护理。","is_gold":false},{"letter":"L","text":"继续调强放疗，预防性留置胃管，给予局部含漱等对症处理。","is_gold":false}]}
+{"sample_id":"sample-be3624e29a98e9da91fced75","patient_id":"patient-7c0941dbdd4694260fd4de38","turn_id":"turn07","turn_type":"recurrence_or_salvage_decision","gold_letter":"F","gold_action":"维持规范随访观察，可根据症状给予一般对症及支持治疗，不启动挽救性局部治疗或全身抗肿瘤治疗。","options":[{"letter":"A","text":"安排鼻咽及颈部活检，准备行挽救性内镜下鼻咽切除术。","is_gold":false},{"letter":"B","text":"启动含铂双药方案全身化疗4-6个周期。","is_gold":false},{"letter":"C","text":"行全身PET/CT评估，若有局部高代谢灶则行挽救性放疗。","is_gold":false},{"letter":"D","text":"予以原发灶及颈部引流区局部推量补照4-6Gy。","is_gold":false},{"letter":"E","text":"给予卡培他滨单药口服维持治疗半年至一年。","is_gold":false},{"letter":"F","text":"维持规范随访观察，可症状给予一般对症及支持治疗。","is_gold":true},{"letter":"G","text":"行鼻咽及颈部MRI增强扫描，若有可疑残留则行诱导化疗。","is_gold":false},{"letter":"H","text":"启动PD-1抑制剂联合含铂双药全身化疗。","is_gold":false},{"letter":"I","text":"安排鼻咽内镜活检，若病理阳性则行双侧颈部淋巴结清扫术。","is_gold":false},{"letter":"J","text":"补充顺铂单药全身化疗2个周期以强化局部控制。","is_gold":false},{"letter":"K","text":"行全身骨扫描及头颅MRI，排除远处转移后行局部挽救性放疗。","is_gold":false},{"letter":"L","text":"予以吉西他滨联合顺铂全身化疗4-6个周期。","is_gold":false}]}
+{"sample_id":"sample-5737526b7d92f1b3d5423663","patient_id":"patient-02ca51eed4fedbb13e4db76d","turn_id":"turn01","turn_type":"initial_workup_choice","gold_letter":"H","gold_action":"完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。","options":[{"letter":"A","text":"完善电子鼻咽镜检查及活检，行鼻咽及颈部CT平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。","is_gold":false},{"letter":"B","text":"完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，并直接行全身PET-CT评估远处转移。","is_gold":false},{"letter":"C","text":"完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，暂不进行胸腹部影像学检查待病理确诊。","is_gold":false},{"letter":"D","text":"完善间接鼻咽镜检查，行鼻咽及颈部MRI平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。","is_gold":false},{"letter":"E","text":"完善颈部淋巴结细针穿刺活检，行鼻咽及颈部MRI平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。","is_gold":false},{"letter":"F","text":"完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。","is_gold":false},{"letter":"G","text":"完善电子鼻咽镜检查及活检，行鼻咽及颈部CT平扫，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。","is_gold":false},{"letter":"H","text":"完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。","is_gold":true},{"letter":"I","text":"完善颈部淋巴结切除活检，行鼻咽及颈部MRI平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。","is_gold":false},{"letter":"J","text":"完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，并完善骨扫描及头颅MRI检查。","is_gold":false},{"letter":"K","text":"完善电子鼻咽镜检查及活检，仅行鼻咽MRI平扫+增强，颈部行彩超评估，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。","is_gold":false},{"letter":"L","text":"完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，并完善全身骨髓穿刺活检。","is_gold":false}]}
+{"sample_id":"sample-84b4eab1f1613c7517fd613a","patient_id":"patient-02ca51eed4fedbb13e4db76d","turn_id":"turn02","turn_type":"imaging_release_workup","gold_letter":"I","gold_action":"行鼻咽镜下鼻咽原发灶活检以明确病理诊断","options":[{"letter":"A","text":"行PET-CT检查以重新评估全身分期","is_gold":false},{"letter":"B","text":"行左侧颈部淋巴结切除活检以明确病理诊断","is_gold":false},{"letter":"C","text":"行左侧颈部淋巴结细针穿刺活检(FNAC)以明确病理诊断","is_gold":false},{"letter":"D","text":"行鼻咽脱落细胞涂片检查以替代组织活检","is_gold":false},{"letter":"E","text":"行肝脏增强MRI检查以进一步排查肝脏转移灶","is_gold":false},{"letter":"F","text":"行右侧颈部II区小淋巴结切除活检以明确对侧转移情况","is_gold":false},{"letter":"G","text":"行外周血EB病毒DNA定量检测作为确诊依据","is_gold":false},{"letter":"H","text":"行左上颌骨病灶穿刺活检以明确骨扫描异常灶性质","is_gold":false},{"letter":"I","text":"行鼻咽镜下鼻咽原发灶活检以明确病理诊断","is_gold":true},{"letter":"J","text":"行鼻咽肿物广泛切除术以达到诊断与治疗目的","is_gold":false},{"letter":"K","text":"行颈部超声造影检查以进一步评估右颈淋巴结性质","is_gold":false},{"letter":"L","text":"行鼻咽及颈部CT平扫加增强以补充评估颅底骨质破坏","is_gold":false}]}
+{"sample_id":"sample-9895c4d0f7c600fd0c046a50","patient_id":"patient-02ca51eed4fedbb13e4db76d","turn_id":"turn05","turn_type":"toxicity_or_support_decision","gold_letter":"L","gold_action":"继续行第2程同期化疗，化疗后复查血象视情况予以升白细胞治疗，并给予静脉营养、补液及通便等对症支持。","options":[{"letter":"A","text":"暂停同期化疗，单纯行根治性放疗，立即予以重组人粒细胞集落刺激因子升白细胞治疗。","is_gold":false},{"letter":"B","text":"暂停放化疗，立即予以重组人粒细胞集落刺激因子，待白细胞恢复正常后再恢复放化综合治疗。","is_gold":false},{"letter":"C","text":"延迟第2程同期化疗，继续放疗，观察3天后复查血常规，若中性粒细胞达标再行化疗。","is_gold":false},{"letter":"D","text":"继续行第2程同期化疗，化疗前予以长效聚乙二醇化重组人粒细胞集落刺激因子预防性升白细胞。","is_gold":false},{"letter":"E","text":"继续行第2程同期化疗，化疗期间同步予以口服抗生素预防感染及静脉营养支持。","is_gold":false},{"letter":"F","text":"继续行第2程同期化疗，将顺铂剂量下调20%，并给予静脉营养、补液及通便等对症支持。","is_gold":false},{"letter":"G","text":"终止同期化疗，改为单纯放疗联合西妥昔单抗靶向治疗，并予以静脉营养支持。","is_gold":false},{"letter":"H","text":"继续行第2程同期化疗，化疗后立即常规予以重组人粒细胞集落刺激因子连续升白细胞治疗3天。","is_gold":false},{"letter":"I","text":"暂停放疗，按计划行第2程同期化疗，化疗后复查血象视情况予以升白细胞治疗。","is_gold":false},{"letter":"J","text":"继续行第2程同期化疗，将顺铂更换为卡铂，并给予静脉营养、补液及通便等对症支持。","is_gold":false},{"letter":"K","text":"延迟第2程同期化疗，予以静脉营养、补液及通便等对症支持，待1周后复查血象再决定是否化疗。","is_gold":false},{"letter":"L","text":"继续行第2程同期化疗，化疗后复查血象视情况予以升白细胞治疗，并给予静脉营养、补液及通便等对症支持。","is_gold":true}]}
+{"sample_id":"sample-5f99c90d4e8627eaecab64fc","patient_id":"patient-02ca51eed4fedbb13e4db76d","turn_id":"turn06","turn_type":"toxicity_or_support_decision","gold_letter":"A","gold_action":"继续按计划行放化综合治疗，并进行静脉导管常规维护。","options":[{"letter":"A","text":"继续按计划行放化综合治疗，并进行静脉导管常规维护。","is_gold":true},{"letter":"B","text":"暂停放化疗，再次给予粒细胞集落刺激因子（G-CSF）升白治疗。","is_gold":false},{"letter":"C","text":"暂停同期化疗，仅继续单纯放射治疗，并进行静脉导管常规维护。","is_gold":false},{"letter":"D","text":"继续按计划行放化综合治疗，并预防性输注单采血小板。","is_gold":false},{"letter":"E","text":"暂停放化疗，经验性给予广谱静脉抗生素抗感染治疗。","is_gold":false},{"letter":"F","text":"继续按计划行放化综合治疗，并预防性给予重组人促红素（EPO）治疗。","is_gold":false},{"letter":"G","text":"继续按计划行放化综合治疗，并拔除静脉留置导管改为口服给药。","is_gold":false},{"letter":"H","text":"继续按计划行放化综合治疗，但将后续同期化疗剂量减量20%。","is_gold":false},{"letter":"I","text":"提前结束同期化疗，仅继续完成剩余放射治疗。","is_gold":false},{"letter":"J","text":"暂停放化疗，给予保肝降酶药物静脉滴注。","is_gold":false},{"letter":"K","text":"继续按计划行放化综合治疗，并预防性给予白介素-11（IL-11）治疗。","is_gold":false},{"letter":"L","text":"继续按计划行放化综合治疗，并加用大剂量静脉糖皮质激素治疗。","is_gold":false}]}
+{"sample_id":"sample-46fc2f7bd9dd0872ef1b356e","patient_id":"patient-36d433557e63f939b878347d","turn_id":"turn02","turn_type":"imaging_release_workup","gold_letter":"E","gold_action":"行鼻咽镜下肿物活检以明确病理诊断；当前影像学评估为 cT4N2M0","options":[{"letter":"A","text":"行鼻咽镜下肿物活检；影像学评估为 cT3N2M0","is_gold":false},{"letter":"B","text":"行鼻咽镜下肿物活检；影像学评估为 cT4N1M0","is_gold":false},{"letter":"C","text":"行颈部淋巴结穿刺活检；影像学评估为 cT4N2M0","is_gold":false},{"letter":"D","text":"完善血浆EBV-DNA检测；影像学评估为 cT4N2M0","is_gold":false},{"letter":"E","text":"行鼻咽镜下肿物活检；影像学评估为 cT4N2M0","is_gold":true},{"letter":"F","text":"安排诱导化疗联合根治性放疗；影像学评估为 cT4N2M0","is_gold":false},{"letter":"G","text":"行鼻咽镜下肿物活检；影像学评估为 cT4N3M0","is_gold":false},{"letter":"H","text":"行鼻咽镜下肿物活检；影像学评估为 cT3N1M0","is_gold":false},{"letter":"I","text":"行全身PET-CT检查；影像学评估为 cT4N2M0","is_gold":false},{"letter":"J","text":"行鼻咽镜下肿物活检；影像学评估为 cT2N2M0","is_gold":false},{"letter":"K","text":"行鼻咽镜下肿物活检；影像学评估为 cT4N0M0","is_gold":false},{"letter":"L","text":"行鼻咽镜下肿物活检；影像学评估为 cT1N2M0","is_gold":false}]}
+{"sample_id":"sample-7c52866e0776802e0c94516f","patient_id":"patient-36d433557e63f939b878347d","turn_id":"turn04","turn_type":"initial_treatment_selection","gold_letter":"G","gold_action":"完善头颈部MRI及全身分期检查，若评估为局部晚期，行诱导化疗序贯同步放化疗","options":[{"letter":"A","text":"暂缓影像学分期检查，直接启动根治性同步放化疗","is_gold":false},{"letter":"B","text":"完善头颈部MRI及全身分期检查，若评估为局部晚期，行单纯根治性放疗","is_gold":false},{"letter":"C","text":"完善头颈部MRI及全身分期检查，若评估为局部晚期，行诱导化疗序贯单纯根治性放疗","is_gold":false},{"letter":"D","text":"完善头颈部MRI及全身分期检查，若评估为局部晚期，行根治性手术切除序贯术后放疗","is_gold":false},{"letter":"E","text":"完善头颈部增强CT及全身分期检查，若评估为局部晚期，行诱导化疗序贯同步放化疗","is_gold":false},{"letter":"F","text":"完善头颈部MRI及全身分期检查，若评估为早期（I期），行诱导化疗序贯同步放化疗","is_gold":false},{"letter":"G","text":"完善头颈部MRI及全身分期检查，若评估为局部晚期，行诱导化疗序贯同步放化疗","is_gold":true},{"letter":"H","text":"完善头颈部MRI及全身分期检查，无论分期结果，均行诱导化疗序贯同步放化疗","is_gold":false},{"letter":"I","text":"仅行全身PET-CT替代所有常规分期检查，若评估为局部晚期，行诱导化疗序贯同步放化疗","is_gold":false},{"letter":"J","text":"完善头颈部MRI及全身分期检查，若评估为局部晚期，行抗EGFR单抗靶向治疗替代放疗","is_gold":false},{"letter":"K","text":"完善头颈部MRI及全身分期检查，若评估为局部晚期，行PD-1抑制剂单药根治性治疗","is_gold":false},{"letter":"L","text":"完善头颈部MRI及全身分期检查，若评估为局部晚期，行姑息性化疗联合最佳支持治疗","is_gold":false}]}
+{"sample_id":"sample-ce21ad4c82d0349356f5fbb9","patient_id":"patient-36d433557e63f939b878347d","turn_id":"turn05","turn_type":"toxicity_or_support_decision","gold_letter":"H","gold_action":"给予口服保肝药物（如复方甘草酸苷、葡醛内酯），按原计划执行顺铂同期化疗，并动态复查肝功能。","options":[{"letter":"A","text":"暂停同期化疗，给予静脉保肝药物治疗，待转氨酶降至正常后再启动顺铂化疗","is_gold":false},{"letter":"B","text":"按原计划执行顺铂同期化疗，暂不予特殊保肝处理，常规监测肝功能","is_gold":false},{"letter":"C","text":"给予口服保肝药物，将顺铂剂量下调20%后执行同期化疗","is_gold":false},{"letter":"D","text":"给予静脉双重保肝药物，按原计划执行顺铂同期化疗，并动态复查肝功能","is_gold":false},{"letter":"E","text":"停用顺铂，更改为卡铂方案执行同期化疗，并给予口服保肝药物","is_gold":false},{"letter":"F","text":"给予口服保肝药物，推迟顺铂化疗1周，期间正常进行放疗","is_gold":false},{"letter":"G","text":"停用顺铂，更改为西妥昔单抗靶向治疗联合放疗，并给予口服保肝药物","is_gold":false},{"letter":"H","text":"给予口服保肝药物（如复方甘草酸苷、葡醛内酯），按原计划执行顺铂同期化疗，并动态复查肝功能","is_gold":true},{"letter":"I","text":"暂停放化疗，行腹部增强CT排查肝脏转移，并给予静脉保肝治疗","is_gold":false},{"letter":"J","text":"给予口服保肝药物，按原计划执行顺铂同期化疗，并预防性使用重组人粒细胞刺激因子","is_gold":false},{"letter":"K","text":"给予口服保肝药物，按原计划执行顺铂同期化疗，并预防性使用广谱抗生素","is_gold":false},{"letter":"L","text":"给予口服保肝药物，将顺铂方案更改为奈达铂方案执行同期化疗","is_gold":false}]}
+{"sample_id":"sample-c47048c6a3961cfb24a6bb12","patient_id":"patient-36d433557e63f939b878347d","turn_id":"turn06","turn_type":"toxicity_or_support_decision","gold_letter":"I","gold_action":"继续根治性放疗及同期化疗，暂不予集落刺激因子支持，密切监测血常规","options":[{"letter":"A","text":"暂停放化疗，给予重组人粒细胞集落刺激因子治疗，待白细胞恢复后继续","is_gold":false},{"letter":"B","text":"暂停同期化疗，仅继续根治性放疗，并给予重组人粒细胞集落刺激因子","is_gold":false},{"letter":"C","text":"继续根治性放疗及同期化疗，下一疗程顺铂剂量减量20%","is_gold":false},{"letter":"D","text":"继续根治性放疗及同期化疗，加用重组人粒细胞集落刺激因子","is_gold":false},{"letter":"E","text":"暂停放化疗，给予静脉高营养及强效止吐、补液支持，暂缓抗肿瘤治疗","is_gold":false},{"letter":"F","text":"继续根治性放疗及同期化疗，加用重组人血小板生成素","is_gold":false},{"letter":"G","text":"暂停同期化疗，将后续全身治疗更换为尼妥珠单抗靶向治疗","is_gold":false},{"letter":"H","text":"继续根治性放疗及同期化疗，加用促红细胞生成素及铁剂","is_gold":false},{"letter":"I","text":"继续根治性放疗及同期化疗，暂不予集落刺激因子支持，密切监测血常规","is_gold":true},{"letter":"J","text":"暂停放化疗，行骨髓穿刺评估造血功能后再决定后续治疗","is_gold":false},{"letter":"K","text":"继续根治性放疗，终止同期化疗，放疗结束后改为辅助化疗","is_gold":false},{"letter":"L","text":"继续根治性放疗及同期化疗，降低放疗靶区处方剂量","is_gold":false}]}
+{"sample_id":"sample-28a13cf2b32abdc303bbad45","patient_id":"patient-36d433557e63f939b878347d","turn_id":"turn07","turn_type":"response_assessment_decision","gold_letter":"I","gold_action":"评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，每周复查血常规及生化，指导功能锻炼。","options":[{"letter":"A","text":"评估临床症状完全缓解，提前终止放疗，办理出院并进入定期随访阶段，1个月后复查头颈部MRI。","is_gold":false},{"letter":"B","text":"评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，并口服替吉奥单药维持化疗。","is_gold":false},{"letter":"C","text":"评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，期间无需定期复查血液学指标。","is_gold":false},{"letter":"D","text":"评估肿瘤退缩缓慢，继续住院，将放疗方案调整为超分割放疗，并加用西妥昔单抗靶向治疗。","is_gold":false},{"letter":"E","text":"评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，期间暂停放疗2周以促进粘膜修复。","is_gold":false},{"letter":"F","text":"评估肿瘤部分缓解，继续住院完成根治性放疗，并每周行鼻咽部MRI以动态监测肿瘤退缩情况。","is_gold":false},{"letter":"G","text":"评估临床症状缓解且毒副反应可耐受，转外科行鼻咽及颈部残留病灶切除术，术后在门诊继续完成剩余放疗。","is_gold":false},{"letter":"H","text":"评估疑似疾病进展，停止放疗，改为吉西他滨联合顺铂方案全身姑息化疗并办理出院。","is_gold":false},{"letter":"I","text":"评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，每周复查血常规及生化，指导功能锻炼。","is_gold":true},{"letter":"J","text":"评估临床症状缓解且毒副反应可耐受，继续住院完成剩余根治性放疗，期间常规给予静脉高营养支持及预防性抗感染。","is_gold":false},{"letter":"K","text":"评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，并立即安排全身PET-CT确认疗效。","is_gold":false}]}
+{"sample_id":"sample-40b7a6f655350cf46e9ce33c","patient_id":"patient-36d433557e63f939b878347d","turn_id":"turn08","turn_type":"response_assessment_decision","gold_letter":"K","gold_action":"办理出院，转门诊继续完成根治性放疗，每周复查血常规及生化，指导鼻腔冲洗与功能锻炼。","options":[{"letter":"A","text":"立即行鼻咽及颈部MRI复查，视近期疗效评估结果调整放疗靶区及剂量。","is_gold":false},{"letter":"B","text":"安排第3程顺铂同期化疗，并继续住院完成剩余根治性放疗疗程。","is_gold":false},{"letter":"C","text":"暂停放疗，行全身PET-CT检查以排除远处转移，待结果回报后决定后续方案。","is_gold":false},{"letter":"D","text":"办理出院，结束所有抗肿瘤治疗，进入定期随访阶段，1个月后复查MRI。","is_gold":false},{"letter":"E","text":"调整化疗方案为紫杉醇+顺铂，继续住院行第3程同期化疗及放疗。","is_gold":false},{"letter":"F","text":"立即行鼻咽镜检查及活检，视病理退缩情况调整后续放疗方案。","is_gold":false},{"letter":"G","text":"办理出院，转门诊继续放疗，并加用西妥昔单抗靶向治疗。","is_gold":false},{"letter":"H","text":"继续住院完成剩余放疗，期间每周复查血常规及生化，待放疗结束后出院。","is_gold":false},{"letter":"I","text":"办理出院，转门诊继续放疗，并立即启动顺铂+氟尿嘧啶方案辅助化疗。","is_gold":false},{"letter":"J","text":"立即行胸部CT及腹部增强CT，视全面评估结果决定是否继续门诊放疗。","is_gold":false},{"letter":"K","text":"办理出院，转门诊继续完成根治性放疗，每周复查血常规及生化，指导鼻腔冲洗与功能锻炼。","is_gold":true},{"letter":"L","text":"暂停放疗，给予重组人粒细胞刺激因子及升血小板治疗，待血象完全恢复正常后继续放疗。","is_gold":false}]}
+{"sample_id":"sample-295d4b99725721eb1811c149","patient_id":"patient-79fa00752e4405e2980f6292","turn_id":"turn01","turn_type":"initial_workup_choice","gold_letter":"L","gold_action":"鼻咽镜检查及活检，鼻咽及颈部增强MRI，胸部CT、腹部超声及全身骨扫描，以及包含EBV-DNA的基线血液学检查","options":[{"letter":"A","text":"鼻咽及颈部增强CT，胸部CT、腹部超声及全身骨扫描，以及包含EBV-DNA的基线血液学检查","is_gold":false},{"letter":"B","text":"鼻咽镜检查及活检，鼻咽及颈部增强CT，胸部CT、腹部超声及全身骨扫描，以及常规血液学检查","is_gold":false},{"letter":"C","text":"鼻咽镜检查及活检，鼻咽及颈部增强MRI，常规血液学检查，暂缓全身远处转移筛查","is_gold":false},{"letter":"D","text":"鼻咽及颈部增强MRI，全身PET-CT，包含EBV-DNA的基线血液学检查，直接安排诱导化疗","is_gold":false},{"letter":"E","text":"鼻咽镜检查及活检，鼻咽及颈部增强MRI，胸部X线、腹部超声，以及常规血液学检查","is_gold":false},{"letter":"F","text":"鼻咽及颈部增强MRI，颈部淋巴结穿刺活检，胸部CT、腹部超声及全身骨扫描，以及包含EBV-DNA的基线血液学检查","is_gold":false},{"letter":"G","text":"鼻咽镜检查及活检，鼻咽及颈部增强MRI，全身PET-CT，随后行鼻咽肿物切除术","is_gold":false},{"letter":"H","text":"鼻咽镜检查及活检，鼻咽及颈部平扫MRI，胸部CT、腹部超声及全身骨扫描，以及包含EBV-DNA的基线血液学检查","is_gold":false},{"letter":"I","text":"鼻咽镜检查及活检，鼻咽及颈部增强MRI，胸部CT、腹部超声及全身骨扫描，暂缓基线血液学及EBV-DNA检测","is_gold":false},{"letter":"J","text":"鼻咽镜检查及活检，鼻咽及颈部增强CT，全身PET-CT，以及包含EBV-DNA的基线血液学检查","is_gold":false},{"letter":"K","text":"鼻咽及颈部增强MRI，胸部CT、腹部超声及全身骨扫描，包含EBV-DNA的基线血液学检查，随后行根治性放疗","is_gold":false},{"letter":"L","text":"鼻咽镜检查及活检，鼻咽及颈部增强MRI，胸部CT、腹部超声及全身骨扫描，以及包含EBV-DNA的基线血液学检查","is_gold":true}]}
+{"sample_id":"sample-58cbc880ddd38089d56cda8c","patient_id":"patient-79fa00752e4405e2980f6292","turn_id":"turn02","turn_type":"imaging_release_workup","gold_letter":"A","gold_action":"行鼻咽镜检查及局部活检，并完善鼻咽及颈部增强MRI","options":[{"letter":"A","text":"行鼻咽镜检查及局部活检，并完善鼻咽及颈部增强MRI","is_gold":true},{"letter":"B","text":"行鼻咽镜检查及局部活检，并完善鼻咽及颈部平扫CT","is_gold":false},{"letter":"C","text":"行鼻咽镜检查及局部活检，无需补充其他局部影像学检查","is_gold":false},{"letter":"D","text":"完善鼻咽及颈部增强MRI，并直接开始根治性放疗","is_gold":false},{"letter":"E","text":"行鼻咽镜检查及局部活检，并完善全身骨扫描及胸部平扫CT","is_gold":false},{"letter":"F","text":"行鼻咽镜检查及局部活检，并完善头颅增强MRI及颈部超声","is_gold":false},{"letter":"G","text":"完善鼻咽及颈部增强MRI，并择期行鼻咽部肿物切除术","is_gold":false},{"letter":"H","text":"行鼻咽镜检查及局部活检，并完善颈部淋巴结穿刺活检","is_gold":false},{"letter":"I","text":"行鼻咽镜检查及局部活检，并完善鼻咽及颈部增强CT","is_gold":false},{"letter":"J","text":"完善鼻咽及颈部增强MRI，并完善外周血EBV-DNA定量检测","is_gold":false},{"letter":"K","text":"行鼻咽镜检查及局部活检，并完善盆腔增强MRI及妇科超声","is_gold":false},{"letter":"L","text":"行鼻咽镜检查及局部活检，并完善脑脊液脱落细胞学检查","is_gold":false}]}
+{"sample_id":"sample-75c75fa1e197461f4b0d7395","patient_id":"patient-79fa00752e4405e2980f6292","turn_id":"turn06","turn_type":"toxicity_or_support_decision","gold_letter":"E","gold_action":"继续根治性放疗与顺铂同期化疗，予以止呕、护胃、补液及补钾等支持治疗，并安排放疗中段MRI评估。","options":[{"letter":"A","text":"暂停顺铂同期化疗，继续根治性放疗，予以止呕、补液、补钾等支持治疗，并安排放疗中段MRI评估。","is_gold":false},{"letter":"B","text":"顺铂减量20%继续同期化疗，继续根治性放疗，予以止呕、补液等支持治疗，暂不复查MRI。","is_gold":false},{"letter":"C","text":"继续根治性放疗与顺铂同期化疗，予以止呕、护胃治疗，暂不予补液及补钾，并安排放疗中段MRI评估。","is_gold":false},{"letter":"D","text":"暂停根治性放疗与顺铂同期化疗，予以积极补液、补钾治疗，暂不安排影像学评估。","is_gold":false},{"letter":"E","text":"继续根治性放疗与顺铂同期化疗，予以止呕、护胃、补液及补钾等支持治疗，并安排放疗中段MRI评估。","is_gold":true},{"letter":"F","text":"继续根治性放疗与顺铂同期化疗，予以止呕、护胃、补液及补钾等支持治疗，并安排PET-CT评估全身疗效。","is_gold":false},{"letter":"G","text":"暂停顺铂同期化疗，改为替加氟口服化疗，继续根治性放疗，予以止呕、补钾等支持治疗。","is_gold":false},{"letter":"H","text":"继续根治性放疗与顺铂同期化疗，予以止呕、护胃、补液及补钾等支持治疗，并安排鼻咽镜活检评估疗效。","is_gold":false},{"letter":"I","text":"顺铂减量50%继续同期化疗，继续根治性放疗，予以止呕、补液及补钾等支持治疗，并安排放疗中段MRI评估。","is_gold":false},{"letter":"J","text":"继续根治性放疗，取消后续化疗，予以止呕、补液及补钾等支持治疗，并安排放疗中段MRI评估。","is_gold":false},{"letter":"K","text":"继续根治性放疗与顺铂同期化疗，予以止呕、护胃、补液治疗，暂不予补钾，并安排放疗中段MRI评估。","is_gold":false},{"letter":"L","text":"暂停根治性放疗，继续顺铂同期化疗，予以止呕、补液及补钾等支持治疗，并安排放疗中段MRI评估。","is_gold":false}]}
+{"sample_id":"sample-cc72c6bbde9abe2a112ce0fc","patient_id":"patient-79fa00752e4405e2980f6292","turn_id":"turn07","turn_type":"response_assessment_decision","gold_letter":"B","gold_action":"评估腹部无转移征象，继续根治性放疗，予以重组人促红素皮下注射改善贫血，并动态复查血常规。","options":[{"letter":"A","text":"评估腹部无转移征象，继续根治性放疗，予以重组人粒细胞刺激因子皮下注射，待血常规恢复后重启化疗。","is_gold":false},{"letter":"B","text":"评估腹部无转移征象，继续根治性放疗，予以重组人促红素皮下注射改善贫血，并动态复查血常规。","is_gold":true},{"letter":"C","text":"腹部彩超见可疑占位，暂停放疗，行肝脏MRI平扫+增强以明确病变性质。","is_gold":false},{"letter":"D","text":"评估腹部无转移征象，继续根治性放疗，并即刻启动第三程顺铂同期化疗。","is_gold":false},{"letter":"E","text":"评估腹部无转移征象，提前结束放疗，转为顺铂联合氟尿嘧啶方案辅助化疗。","is_gold":false},{"letter":"F","text":"评估腹部无转移征象，继续根治性放疗，予以利可君口服改善骨髓抑制，并动态复查血常规。","is_gold":false},{"letter":"G","text":"评估腹部无转移征象，继续根治性放疗，予以异甘草酸镁静脉滴注强化保肝治疗。","is_gold":false},{"letter":"H","text":"评估腹部无转移征象，继续根治性放疗，予以输注单采血小板预防出血，并动态复查血常规。","is_gold":false},{"letter":"I","text":"评估腹部无转移征象，暂停放疗，行全身PET/CT检查以全面评估近期疗效。","is_gold":false},{"letter":"J","text":"评估腹部无转移征象，继续根治性放疗，予以昂丹司琼强化止吐，并预防性放置胃管。","is_gold":false},{"letter":"K","text":"评估腹部无转移征象，继续根治性放疗，加用尼妥珠单抗靶向治疗以提高局部控制率。","is_gold":false},{"letter":"L","text":"评估腹部无转移征象，继续根治性放疗，予以地塞米松口服改善骨髓抑制，并动态复查血常规。","is_gold":false}]}
+{"sample_id":"sample-38fe8a3260ea673c5c5ddb90","patient_id":"patient-e7eec542502a097814d58d8a","turn_id":"turn01","turn_type":"initial_workup_choice","gold_letter":"H","gold_action":"完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部及腹部彩超，全身骨显像，常规血液学与心电图检查。","options":[{"letter":"A","text":"完善鼻咽镜检查及活检，行头颈部CT平扫+增强，颈部及腹部彩超，常规血液学与心电图检查。","is_gold":false},{"letter":"B","text":"行右颈部肿物切除活检，待病理确诊后再行头颈部MRI平扫+增强，颈部及腹部彩超，全身骨显像。","is_gold":false},{"letter":"C","text":"完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，全身PET-CT显像，常规血液学与心电图检查。","is_gold":false},{"letter":"D","text":"完善鼻咽镜检查及活检，行头颈部MRI平扫，颈部及腹部彩超，全身骨显像，常规血液学与心电图检查。","is_gold":false},{"letter":"E","text":"行右颈部肿物细针穿刺活检，待病理确诊后再行鼻咽镜检查，头颈部MRI平扫+增强，全身骨显像。","is_gold":false},{"letter":"F","text":"完善鼻咽镜检查及活检，行头颈部CT平扫，颈部及腹部彩超，全身骨显像，常规血液学与心电图检查。","is_gold":false},{"letter":"G","text":"完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部彩超，常规血液学与心电图检查，暂缓全身骨显像。","is_gold":false},{"letter":"H","text":"完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部及腹部彩超，全身骨显像，常规血液学与心电图检查。","is_gold":true},{"letter":"I","text":"完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部彩超，全身骨显像，常规血液学与心电图检查。","is_gold":false},{"letter":"J","text":"完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部及腹部彩超，头颅MRI平扫+增强，常规血液学检查。","is_gold":false},{"letter":"K","text":"完善鼻咽镜检查及活检，行头颈部CT平扫+增强，颈部及腹部彩超，全身骨显像，常规血液学与心电图检查。","is_gold":false},{"letter":"L","text":"完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部及腹部彩超，全身骨显像，骨髓穿刺活检。","is_gold":false}]}
+{"sample_id":"sample-06aacdbb23f806198bd0b70c","patient_id":"patient-e7eec542502a097814d58d8a","turn_id":"turn02","turn_type":"imaging_release_workup","gold_letter":"I","gold_action":"行鼻咽镜检查并取鼻咽部肿物活检。","options":[{"letter":"A","text":"行右侧颈部淋巴结切除活检术","is_gold":false},{"letter":"B","text":"行右侧颈部淋巴结细针穿刺抽吸活检","is_gold":false},{"letter":"C","text":"安排诱导化疗联合同期放化疗","is_gold":false},{"letter":"D","text":"行全身PET-CT检查","is_gold":false},{"letter":"E","text":"行全身骨显像检查","is_gold":false},{"letter":"F","text":"行鼻内镜下鼻咽部肿物切除术","is_gold":false},{"letter":"G","text":"行鼻咽部高分辨率CT检查","is_gold":false},{"letter":"H","text":"行右侧颈部淋巴结微创旋切活检术","is_gold":false},{"letter":"I","text":"行鼻咽镜检查并取鼻咽部肿物活检","is_gold":true},{"letter":"J","text":"行胸部增强CT及腹部增强CT检查","is_gold":false},{"letter":"K","text":"抽取外周血行血浆EBV-DNA定量检测","is_gold":false},{"letter":"L","text":"密切观察随访，1个月后复查鼻咽部MRI","is_gold":false}]}
+{"sample_id":"sample-9713cef7ba61651ea6a5f02e","patient_id":"patient-e7eec542502a097814d58d8a","turn_id":"turn05","turn_type":"toxicity_or_support_decision","gold_letter":"L","gold_action":"予以静脉水化及电解质（含钾）补充，嘱计24小时尿量，并常规行PICC导管护理。","options":[{"letter":"A","text":"暂不予静脉水化及电解质补充，待明日行顺铂化疗时同步予以补液支持。","is_gold":false},{"letter":"B","text":"予以静脉水化，暂不补充钾离子，嘱计24小时尿量，并常规行PICC导管护理。","is_gold":false},{"letter":"C","text":"予以静脉水化及电解质补充，常规静脉推注呋塞米强效利尿，并计24小时尿量。","is_gold":false},{"letter":"D","text":"予以静脉水化及电解质补充，皮下注射重组人粒细胞集落刺激因子预防骨髓抑制。","is_gold":false},{"letter":"E","text":"予以静脉水化及电解质补充，静脉滴注右丙亚胺预防大剂量顺铂相关心脏毒性。","is_gold":false},{"letter":"F","text":"予以静脉水化及电解质补充，静脉滴注阿米福汀预防大剂量顺铂相关肾毒性。","is_gold":false},{"letter":"G","text":"予以静脉水化及电解质补充，嘱计24小时尿量，并静脉滴注头孢菌素预防感染。","is_gold":false},{"letter":"H","text":"予以静脉水化及电解质补充，静脉滴注地塞米松及帕洛诺司琼进行止吐预处理。","is_gold":false},{"letter":"I","text":"予以静脉水化及电解质补充，静脉输注人血白蛋白以预防大剂量化疗后低蛋白血症。","is_gold":false},{"letter":"J","text":"予以静脉水化及电解质补充，静脉滴注异甘草酸镁预防大剂量顺铂相关肝损伤。","is_gold":false},{"letter":"K","text":"予以静脉水化及电解质补充，嘱计24小时尿量，并皮下注射促红细胞生成素。","is_gold":false},{"letter":"L","text":"予以静脉水化及电解质（含钾）补充，嘱计24小时尿量，并常规行PICC导管护理。","is_gold":true}]}
+{"sample_id":"sample-e0f912ad55b7b1f092a1b468","patient_id":"patient-e7eec542502a097814d58d8a","turn_id":"turn06","turn_type":"toxicity_or_support_decision","gold_letter":"L","gold_action":"仅常规复查血常规、生化常规及EBV-DNA定量，暂不予特殊药物干预","options":[{"letter":"A","text":"在无明显感染或疼痛症状的情况下经验性给予阿莫西林口服抗感染及酚咖片止痛，并复查血常规、生化常规及EBV-DNA定量","is_gold":false},{"letter":"B","text":"在无明显感染或疼痛症状的情况下静脉滴注头孢类抗生素并酚咖片止痛，同时复查血常规、生化常规及EBV-DNA定量","is_gold":false},{"letter":"C","text":"经验性给予阿莫西林口服抗感染及酚咖片止痛，并暂停放疗直至症状完全缓解","is_gold":false},{"letter":"D","text":"经验性给予酚咖片对症止痛，暂不予抗感染治疗，并复查血常规、生化常规及EBV-DNA定量","is_gold":false},{"letter":"E","text":"经验性给予阿莫西林口服抗感染，暂不予止痛治疗，并复查血常规、生化常规及EBV-DNA定量","is_gold":false},{"letter":"F","text":"经验性给予阿莫西林口服抗感染及酚咖片止痛，并提前安排第二程顺铂化疗","is_gold":false},{"letter":"G","text":"经验性给予阿莫西林口服抗感染及酚咖片止痛，并加用静脉地塞米松减轻局部水肿","is_gold":false},{"letter":"H","text":"经验性给予静脉滴注广谱抗生素及曲马多止痛，并复查血常规、生化常规及EBV-DNA定量","is_gold":false},{"letter":"I","text":"经验性给予阿莫西林口服抗感染及酚咖片止痛，并取消后续顺铂化疗计划","is_gold":false},{"letter":"J","text":"经验性给予阿莫西林口服抗感染及酚咖片止痛，并复查鼻咽颈部MRI评估近期疗效","is_gold":false},{"letter":"K","text":"经验性给予口服抗真菌药物及酚咖片止痛，并复查血常规、生化常规及EBV-DNA定量","is_gold":false},{"letter":"L","text":"仅常规复查血常规、生化常规及EBV-DNA定量，暂不予特殊药物干预","is_gold":true}]}
+{"sample_id":"sample-67a2318574aada2f5af690c0","patient_id":"patient-e7eec542502a097814d58d8a","turn_id":"turn07","turn_type":"recurrence_or_salvage_decision","gold_letter":"B","gold_action":"继续完成原计划的根治性放疗，给予阿片类药物镇痛及静脉补液与营养支持治疗。","options":[{"letter":"A","text":"提前终止放疗，转为单纯全身化疗或靶向治疗，并给予静脉营养支持。","is_gold":false},{"letter":"B","text":"继续完成原计划的根治性放疗，给予阿片类药物镇痛及静脉补液与营养支持治疗。","is_gold":true},{"letter":"C","text":"暂停放疗直至口腔黏膜反应降至1度，期间给予广谱抗生素及静脉糖皮质激素治疗。","is_gold":false},{"letter":"D","text":"继续放疗，重新定位并缩减放疗靶区及处方剂量，同时给予非甾体类抗炎药镇痛。","is_gold":false},{"letter":"E","text":"暂停放疗，更改全身治疗方案为TPF方案化疗，待局部症状好转后择期恢复放疗。","is_gold":false},{"letter":"F","text":"继续完成根治性放疗，给予局部利多卡因含漱液及非甾体类抗炎药镇痛，并仅口服营养支持，无需静脉补液。","is_gold":false},{"letter":"G","text":"终止放疗，行右侧颈部淋巴结清扫术及鼻咽原发灶挽救性切除术。","is_gold":false},{"letter":"H","text":"继续放疗并同步行第3程大剂量顺铂化疗，给予阿片类药物镇痛，暂不予静脉补液。","is_gold":false},{"letter":"I","text":"暂停放疗，行鼻咽部内镜下微创手术切除残留病灶，术后继续静脉补液支持。","is_gold":false},{"letter":"J","text":"继续完成根治性放疗，行经皮内镜下胃造瘘术（PEG）以建立长期肠内营养途径。","is_gold":false},{"letter":"K","text":"提前终止放疗，改为PD-1抑制剂联合化疗的全身系统性维持治疗。","is_gold":false},{"letter":"L","text":"继续放疗，给予大剂量静脉糖皮质激素冲击治疗缓解黏膜反应，并继续口服营养液。","is_gold":false}]}
+{"sample_id":"sample-5549469386bb20d944ce932b","patient_id":"patient-e7eec542502a097814d58d8a","turn_id":"turn08","turn_type":"response_assessment_decision","gold_letter":"C","gold_action":"影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；针对3度放射性口腔黏膜炎伴咽痛，继续予羟考酮镇痛及静脉营养支持，并常规行PICC导管护理。","options":[{"letter":"A","text":"影像学评估病灶较前缩小，疗效肯定，需暂停放疗，待3度放射性口腔黏膜炎恢复至1度后再恢复放疗，期间予静脉营养支持。","is_gold":false},{"letter":"B","text":"影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，局部使用含漱液及非甾体类抗炎药镇痛，停用阿片类药物。","is_gold":false},{"letter":"C","text":"影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎伴咽痛，继续予羟考酮镇痛及静脉营养支持，并常规行PICC导管护理。","is_gold":true},{"letter":"D","text":"影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，行预防性气管切开以防气道水肿梗阻，并予静脉营养支持。","is_gold":false},{"letter":"E","text":"影像学评估病灶较前缩小，疗效肯定，已完成26次放疗且出现3度黏膜炎，提前结束放疗并转为辅助化疗，同时予羟考酮镇痛。","is_gold":false},{"letter":"F","text":"影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，拔除PICC导管以预防导管相关性血流感染，改用外周静脉营养。","is_gold":false},{"letter":"G","text":"影像学评估病灶未见明显缩小，疗效评价为疾病稳定（SD），重新定位更改放疗靶区并提高局部照射剂量，同时予羟考酮镇痛及静脉营养支持。","is_gold":false},{"letter":"H","text":"影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，立即行经皮内镜下胃造瘘术（PEG）以保证肠内营养。","is_gold":false},{"letter":"I","text":"影像学评估病灶完全消失，疗效评价为完全缓解（CR），提前终止放疗，进入随访观察期，对咽痛继续予羟考酮镇痛。","is_gold":false},{"letter":"J","text":"影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；放疗已达26次且肿瘤退缩，同步加用西妥昔单抗以增强局部控制，并予静脉营养支持。","is_gold":false},{"letter":"K","text":"影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，静脉大剂量使用糖皮质激素以快速减轻炎症反应。","is_gold":false},{"letter":"L","text":"影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；出现3度放射性口腔黏膜炎，将后续放疗改为姑息性低剂量放疗，并予羟考酮镇痛。","is_gold":false}]}
+{"sample_id":"sample-4da20c3d27d6501be61a2584","patient_id":"patient-f25e20b1e5c6eea840d4cc21","turn_id":"turn01","turn_type":"initial_workup_choice","gold_letter":"D","gold_action":"电子鼻咽镜及鼻咽活检，鼻咽及颈部MRI平扫+增强，腹部及浅表淋巴结彩超，心电图，以及包含EBV抗体的基线血液学检查。","options":[{"letter":"A","text":"电子鼻咽镜及鼻咽活检，鼻咽及颈部CT平扫+增强，胸部X线片，腹部彩超，基线血液学检查。","is_gold":false},{"letter":"B","text":"颈部淋巴结细针穿刺活检，鼻咽及颈部MRI平扫+增强，胸腹部CT平扫+增强，全身骨扫描。","is_gold":false},{"letter":"C","text":"全身PET-CT检查，电子鼻咽镜及鼻咽活检，头颅MRI平扫+增强，常规心电图及血液学检查。","is_gold":false},{"letter":"D","text":"电子鼻咽镜及鼻咽活检，鼻咽及颈部MRI平扫+增强，腹部及浅表淋巴结彩超，心电图，包含EBV抗体的基线血液学检查。","is_gold":true},{"letter":"E","text":"电子鼻咽镜检查，鼻咽及颈部MRI平扫+增强，胸腹部CT平扫+增强，待影像学评估后再决定是否活检。","is_gold":false},{"letter":"F","text":"鼻咽及颈部MRI平扫+增强，胸腹部CT平扫+增强，全身骨扫描，基线血液学检查。","is_gold":false},{"letter":"G","text":"电子鼻咽镜及鼻咽活检，鼻咽及颈部MRI平扫，腹部彩超，胸部CT平扫，基线血液学检查。","is_gold":false},{"letter":"H","text":"颈部淋巴结切除活检，鼻咽及颈部CT平扫+增强，腹部彩超，心电图，包含EBV抗体的基线血液学检查。","is_gold":false},{"letter":"I","text":"电子鼻咽镜及鼻咽活检，头颈部PET-CT，腹部及盆腔MRI平扫+增强，心电图，基线血液学检查。","is_gold":false},{"letter":"J","text":"电子鼻咽镜及鼻咽活检，鼻咽及颈部MRI平扫+增强，常规心电图及血液学检查，并直接安排诱导化疗。","is_gold":false},{"letter":"K","text":"鼻咽刷片细胞学检查，鼻咽及颈部MRI平扫+增强，胸腹部彩超，全身骨扫描，基线血液学检查。","is_gold":false},{"letter":"L","text":"电子鼻咽镜及鼻咽活检，鼻咽及颈部CT平扫，全身骨扫描，腹部彩超，心电图，基线血液学检查。","is_gold":false}]}
+{"sample_id":"sample-cef4654d5f291c72b760bfcf","patient_id":"patient-f25e20b1e5c6eea840d4cc21","turn_id":"turn02","turn_type":"imaging_release_workup","gold_letter":"E","gold_action":"行鼻咽镜下活检明确病理，并补充胸部CT、全身骨扫描及血清EBV DNA检测。","options":[{"letter":"A","text":"安排适形调强放射治疗（IMRT）及同步化疗","is_gold":false},{"letter":"B","text":"行鼻咽镜下活检，并补充头颅PET-MR评估颅底受侵范围","is_gold":false},{"letter":"C","text":"行右颈部淋巴结细针穿刺活检，并补充胸部CT及全身骨扫描","is_gold":false},{"letter":"D","text":"行鼻咽镜下活检，并补充腹部增强CT排查肝脏转移","is_gold":false},{"letter":"E","text":"行鼻咽镜下活检，并补充胸部CT、全身骨扫描及血清EBV DNA检测","is_gold":true},{"letter":"F","text":"行鼻咽镜下活检，直接进行放疗定位及靶区勾画","is_gold":false},{"letter":"G","text":"行全身PET-CT进行分期，随后开始诱导化疗","is_gold":false},{"letter":"H","text":"行鼻咽镜下活检，并补充颈部超声评估淋巴结包膜外侵犯","is_gold":false},{"letter":"I","text":"行鼻咽镜下活检，并补充胸部X线及头颅CT平扫","is_gold":false},{"letter":"J","text":"行鼻咽镜下活检，并补充骨髓穿刺排除骨髓转移","is_gold":false},{"letter":"K","text":"行鼻咽镜下活检，并补充全身骨扫描，暂缓胸部影像学检查","is_gold":false},{"letter":"L","text":"行右颈部淋巴结切除活检，并补充胸部CT及血清EBV DNA检测","is_gold":false}]}
+{"sample_id":"sample-5ae78b6dca4ce8a61a44d0ca","patient_id":"patient-f25e20b1e5c6eea840d4cc21","turn_id":"turn04","turn_type":"initial_treatment_selection","gold_letter":"G","gold_action":"诱导化疗序贯同步放化疗","options":[{"letter":"A","text":"单纯根治性放疗","is_gold":false},{"letter":"B","text":"诱导化疗序贯单纯根治性放疗","is_gold":false},{"letter":"C","text":"同步放化疗序贯辅助化疗","is_gold":false},{"letter":"D","text":"根治性颈淋巴结清扫术序贯辅助放化疗","is_gold":false},{"letter":"E","text":"姑息性全身化疗联合靶向治疗","is_gold":false},{"letter":"F","text":"诱导化疗序贯根治性手术","is_gold":false},{"letter":"G","text":"诱导化疗序贯同步放化疗","is_gold":true},{"letter":"H","text":"免疫治疗联合同步放化疗","is_gold":false},{"letter":"I","text":"靶向治疗联合同步放化疗","is_gold":false},{"letter":"J","text":"诱导化疗序贯同步放化疗联合辅助化疗","is_gold":false},{"letter":"K","text":"根治性放疗序贯辅助化疗","is_gold":false}]}
+{"sample_id":"sample-a4cf25bef13a63de3e012971","patient_id":"patient-f25e20b1e5c6eea840d4cc21","turn_id":"turn05","turn_type":"toxicity_or_support_decision","gold_letter":"H","gold_action":"完善放化疗前基线检验（血常规、生化、凝血、传染病、EBV等），全面评估器官功能。","options":[{"letter":"A","text":"完善放化疗前基线检验，若肌酐清除率>30ml/min即可启动大剂量顺铂同步化疗。","is_gold":false},{"letter":"B","text":"完善放化疗前基线检验，并预防性给予质子泵抑制剂和双环醇保肝治疗。","is_gold":false},{"letter":"C","text":"完善放化疗前基线检验，若中性粒细胞绝对值>1.0×10^9/L即可启动全身化疗。","is_gold":false},{"letter":"D","text":"完善放化疗前基线检验，并预防性给予长效重组人粒细胞集落刺激因子。","is_gold":false},{"letter":"E","text":"完善放化疗前基线检验，仅需心电图和血常规正常即可启动诱导化疗。","is_gold":false},{"letter":"F","text":"完善放化疗前基线检验，并常规预防性使用头孢类抗生素以防中耳炎加重。","is_gold":false},{"letter":"G","text":"完善放化疗前基线检验，若转氨酶升高超过正常上限1倍则直接放弃化疗。","is_gold":false},{"letter":"H","text":"完善放化疗前基线检验（血常规、生化、凝血、传染病、EBV等），全面评估器官功能。","is_gold":true},{"letter":"I","text":"完善放化疗前基线检验，并预防性给予地塞米松以减轻放疗引起的脑水肿。","is_gold":false},{"letter":"J","text":"完善放化疗前基线检验，若伴有右侧中耳乳突炎则需先完成乳突根治术再行放疗。","is_gold":false},{"letter":"K","text":"完善放化疗前基线检验，并常规行深静脉置管及低分子肝素预防性抗凝治疗。","is_gold":false},{"letter":"L","text":"完善放化疗前基线检验，若存在感音神经性听力下降则绝对禁忌使用任何含铂方案。","is_gold":false}]}
+{"sample_id":"sample-44b84e88a5f0beade51ae0ca","patient_id":"patient-f25e20b1e5c6eea840d4cc21","turn_id":"turn06","turn_type":"toxicity_or_support_decision","gold_letter":"I","gold_action":"按计划启动放疗，并为顺铂（100mg/㎡）同期化疗行充分的静脉水化、甘露醇利尿及电解质补充，同时给予放疗局部保护用药。","options":[{"letter":"A","text":"按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗当天给予常规静脉补液，无需特殊水化与利尿处理。","is_gold":false},{"letter":"B","text":"暂缓放化疗，先静脉补充硫酸镁及氯化钾纠正电解质异常，待复查正常后再启动顺铂同期化疗。","is_gold":false},{"letter":"C","text":"按计划启动放疗，将顺铂剂量调整为40mg/㎡周疗，化疗期间仅需常规止吐，无需使用甘露醇利尿。","is_gold":false},{"letter":"D","text":"按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗前给予呋塞米静脉推注利尿，并预防性注射G-CSF。","is_gold":false},{"letter":"E","text":"按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗期间采用口服补液替代静脉水化，并外用三乙醇胺乳膏。","is_gold":false},{"letter":"F","text":"暂缓顺铂化疗，先行单纯根治性放疗，待放疗剂量达到40Gy后再评估并启动顺铂同期化疗。","is_gold":false},{"letter":"G","text":"按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗前给予大剂量糖皮质激素及NK-1受体拮抗剂，免除静脉水化。","is_gold":false},{"letter":"H","text":"按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗当天给予等渗盐水静脉滴注，避免使用甘露醇。","is_gold":false},{"letter":"I","text":"按计划启动放疗，并为顺铂（100mg/㎡）同期化疗行充分的静脉水化、甘露醇利尿及电解质补充，同时给予放疗局部保护用药。","is_gold":true},{"letter":"J","text":"按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗后连续3天静脉输注人血白蛋白以预防低蛋白血症。","is_gold":false},{"letter":"K","text":"暂缓放疗，先给予顺铂联合氟尿嘧啶方案诱导化疗2个周期，期间常规给予静脉水化及止吐处理。","is_gold":false},{"letter":"L","text":"按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗期间常规预防性静脉滴注广谱抗菌药物。","is_gold":false}]}
+{"sample_id":"sample-0534c4bc264d81d07f7ff87c","patient_id":"patient-f25e20b1e5c6eea840d4cc21","turn_id":"turn07","turn_type":"response_assessment_decision","gold_letter":"J","gold_action":"结束住院诊疗办理出院，嘱定期返院复查以评估近期疗效。","options":[{"letter":"A","text":"立即行颈部淋巴结清扫术处理未完全消退的残存淋巴结。","is_gold":false},{"letter":"B","text":"立即安排鼻咽及颈部MRI与全身PET-CT检查全面评估近期疗效。","is_gold":false},{"letter":"C","text":"立即启动PF方案（顺铂+氟尿嘧啶）辅助化疗以巩固局部及全身控制。","is_gold":false},{"letter":"D","text":"继续住院给予静脉高营养及广谱抗生素治疗直至口腔黏膜反应完全消失。","is_gold":false},{"letter":"E","text":"立即行电子鼻咽镜下原发灶活检以明确是否达到病理完全缓解。","is_gold":false},{"letter":"F","text":"预防性给予长效G-CSF并口服抗生素后办理出院。","is_gold":false},{"letter":"G","text":"立即启动西妥昔单抗靶向维持治疗以降低局部复发风险。","is_gold":false},{"letter":"H","text":"对颈部残存淋巴结局部追加外照射放疗推量至75-80Gy。","is_gold":false},{"letter":"I","text":"立即复查血浆EBV-DNA，若阳性则继续给予单药顺铂化疗。","is_gold":false},{"letter":"J","text":"结束住院诊疗办理出院，嘱定期返院复查以评估近期疗效。","is_gold":true},{"letter":"K","text":"立即行胸腹部增强CT及骨ECT检查排除放化疗期间的远处转移。","is_gold":false},{"letter":"L","text":"立即请耳鼻喉科会诊行鼓膜穿刺抽液或置管术处理听力下降。","is_gold":false}]}
+{"sample_id":"sample-03e671c4e9fab822b9938832","patient_id":"patient-f25e20b1e5c6eea840d4cc21","turn_id":"turn08","turn_type":"response_assessment_decision","gold_letter":"K","gold_action":"评估为有效，结束根治性放化疗，予以办理出院并嘱定期门诊随访复查。","options":[{"letter":"A","text":"评估为疾病进展，停用放疗，改行吉西他滨联合顺铂姑息性化疗。","is_gold":false},{"letter":"B","text":"评估为部分缓解，继续住院行第3周期顺铂单药同期化疗。","is_gold":false},{"letter":"C","text":"评估为部分缓解，序贯启动顺铂联合氟尿嘧啶方案辅助化疗3个周期。","is_gold":false},{"letter":"D","text":"评估为完全缓解，转入头颈外科行右侧颈部淋巴结清扫术。","is_gold":false},{"letter":"E","text":"评估为部分缓解，对右颈部残留淋巴结追加局部外照射放疗至74Gy。","is_gold":false},{"letter":"F","text":"评估为疾病稳定，加用西妥昔单抗靶向治疗并延长原发灶放疗疗程。","is_gold":false},{"letter":"G","text":"评估为部分缓解，转入头颈外科行内镜下鼻咽原发灶切除术。","is_gold":false},{"letter":"H","text":"评估为有效，继续住院静脉使用抗生素及营养支持以治疗口腔黏膜反应。","is_gold":false},{"letter":"I","text":"评估为有效，立即安排鼻咽及颈部增强MRI复查以确认靶区消退情况。","is_gold":false},{"letter":"J","text":"评估为有效，办理出院，并序贯启动PD-1抑制剂维持治疗1年。","is_gold":false},{"letter":"K","text":"评估为有效，结束根治性放化疗，予以办理出院并嘱定期门诊随访复查。","is_gold":true},{"letter":"L","text":"评估为有效，办理出院，并嘱出院后1个月常规行全身PET-CT检查。","is_gold":false}]}
+{"sample_id":"sample-b03a0a9310651ef3f13754f1","patient_id":"patient-9fcde7a95f4d57501ecbf7b2","turn_id":"turn01","turn_type":"initial_workup_choice","gold_letter":"K","gold_action":"行鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查，并完善心电图及基线抽血化验。","options":[{"letter":"A","text":"行鼻咽及颈部CT平扫+增强、间接鼻咽镜检查，并完善心电图及基线抽血化验。","is_gold":false},{"letter":"B","text":"行鼻咽及颈部MRI平扫（不加增强）、间接鼻咽镜检查，并完善心电图及基线抽血化验。","is_gold":false},{"letter":"C","text":"行鼻咽及颈部MRI平扫+增强，暂缓鼻咽镜检查，先行颈部淋巴结细针穿刺活检。","is_gold":false},{"letter":"D","text":"行鼻咽及颈部CT平扫+增强，暂缓鼻咽镜检查，先行颈部淋巴结切除活检。","is_gold":false},{"letter":"E","text":"行鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查，并直接安排全身骨扫描及肝脏超声。","is_gold":false},{"letter":"F","text":"行鼻咽及颈部MRI平扫+增强、鼻内镜下鼻腔扩宽术，并完善心电图及基线抽血化验。","is_gold":false},{"letter":"G","text":"行鼻咽及颈部超声检查、间接鼻咽镜检查，并完善心电图及基线抽血化验。","is_gold":false},{"letter":"H","text":"行鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查，并完善心电图，暂缓抽血化验。","is_gold":false},{"letter":"I","text":"行鼻咽及颈部MRI平扫+增强、直接喉镜检查，并完善心电图及基线抽血化验。","is_gold":false},{"letter":"J","text":"行鼻咽及颈部CT平扫+增强、间接鼻咽镜检查，并直接安排胸腹部CT平扫+增强。","is_gold":false},{"letter":"K","text":"行鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查，并完善心电图及基线抽血化验。","is_gold":true}]}
+{"sample_id":"sample-057bee25fe3533856610d5c8","patient_id":"patient-9fcde7a95f4d57501ecbf7b2","turn_id":"turn02","turn_type":"imaging_release_workup","gold_letter":"A","gold_action":"行电子鼻咽镜检查及鼻咽肿物活检以明确病理诊断。","options":[{"letter":"A","text":"电子鼻咽镜检查及鼻咽肿物活检","is_gold":true},{"letter":"B","text":"颈部淋巴结切开活检术","is_gold":false},{"letter":"C","text":"超声引导下颈部淋巴结细针穿刺活检","is_gold":false},{"letter":"D","text":"全身PET-CT检查","is_gold":false},{"letter":"E","text":"胸部CT、腹部超声及全身骨扫描","is_gold":false},{"letter":"F","text":"鼻内镜下鼻咽肿物切除术","is_gold":false},{"letter":"G","text":"诊断性抗炎治疗2周后复查MRI","is_gold":false},{"letter":"H","text":"外周血EBV-DNA定量检测","is_gold":false},{"letter":"I","text":"鼻咽脱落细胞学检查","is_gold":false},{"letter":"J","text":"鼻咽及颈部CT平扫+增强","is_gold":false},{"letter":"K","text":"鼻咽颅底三维CT重建","is_gold":false},{"letter":"L","text":"颈部淋巴结清扫术","is_gold":false}]}
+{"sample_id":"sample-ea63b7a358722be15870f84c","patient_id":"patient-9fcde7a95f4d57501ecbf7b2","turn_id":"turn04","turn_type":"initial_treatment_selection","gold_letter":"C","gold_action":"完善中心静脉置管，行诱导化疗序贯根治性同期放化疗。","options":[{"letter":"A","text":"完善中心静脉置管，直接行根治性同期放化疗","is_gold":false},{"letter":"B","text":"完善中心静脉置管，行诱导化疗序贯单纯根治性放疗","is_gold":false},{"letter":"C","text":"完善中心静脉置管，行诱导化疗序贯根治性同期放化疗","is_gold":true},{"letter":"D","text":"完善中心静脉置管，行诱导化疗序贯根治性同期放化疗及辅助化疗","is_gold":false},{"letter":"E","text":"完善中心静脉置管，行诱导化疗联合PD-1单抗序贯根治性同期放化疗","is_gold":false},{"letter":"F","text":"完善中心静脉置管，直接行根治性同期放化疗及辅助化疗","is_gold":false},{"letter":"G","text":"完善中心静脉置管，行诱导化疗序贯根治性放疗联合EGFR单抗","is_gold":false},{"letter":"H","text":"完善中心静脉置管，行诱导化疗，放疗前行右颈部淋巴结清扫术","is_gold":false},{"letter":"I","text":"完善中心静脉置管，行姑息性化疗，视颈部淋巴结退缩情况决定放疗时机","is_gold":false},{"letter":"J","text":"完善中心静脉置管，直接行根治性放疗联合EGFR单抗","is_gold":false},{"letter":"K","text":"完善中心静脉置管，行诱导化疗序贯根治性放疗及辅助化疗","is_gold":false},{"letter":"L","text":"完善中心静脉置管，行诱导化疗联合EGFR单抗序贯单纯根治性放疗","is_gold":false}]}
+{"sample_id":"sample-077ecf4aba208fcc4f66c309","patient_id":"patient-9fcde7a95f4d57501ecbf7b2","turn_id":"turn05","turn_type":"toxicity_or_support_decision","gold_letter":"D","gold_action":"继续放疗，针对轻度恶心给予常规止吐对症处理，按规范进行PICC导管维护，并定期复查血常规与生化。","options":[{"letter":"A","text":"暂停放疗，给予重组人粒细胞集落刺激因子皮下注射，处理淋巴细胞减少，待血象恢复后恢复放疗。","is_gold":false},{"letter":"B","text":"暂停放疗，给予静脉营养支持及补液，处理恶心症状，待胃肠道反应缓解后重新评估放疗计划。","is_gold":false},{"letter":"C","text":"继续放疗，对淋巴细胞减少预防性静脉滴注广谱抗生素，并常规进行PICC导管维护。","is_gold":false},{"letter":"D","text":"继续放疗，给予常规止吐对症处理，处理轻度恶心，按规范进行PICC导管维护，并定期复查血常规与生化。","is_gold":true},{"letter":"E","text":"继续放疗，对出现的骨髓抑制，将下一周期顺铂化疗剂量减量20%，并常规进行PICC导管维护。","is_gold":false},{"letter":"F","text":"暂停放疗，拔除PICC导管改用外周静脉留置针，继续常规止吐对症支持与定期复查。","is_gold":false},{"letter":"G","text":"继续放疗，给予重组人白介素-2免疫支持治疗，处理淋巴细胞减少，并定期复查血常规与生化。","is_gold":false},{"letter":"H","text":"暂停放疗，立即行鼻咽及颈部MRI复查以评估放化疗疗效，并决定后续放疗剂量。","is_gold":false},{"letter":"I","text":"继续放疗，终止同期化疗计划，后续仅行单纯放射治疗，并常规进行PICC导管维护。","is_gold":false},{"letter":"J","text":"继续放疗，加用大剂量糖皮质激素冲击止吐，处理恶心症状，并预防性使用抗真菌药物。","is_gold":false},{"letter":"K","text":"暂停放疗，转入重症监护室进行严密生命体征监测与器官功能支持，暂缓抗肿瘤治疗。","is_gold":false},{"letter":"L","text":"继续放疗，立即启动第二周期顺铂同期化疗，并给予5-HT3受体拮抗剂联合NK-1受体拮抗剂。","is_gold":false}]}
+{"sample_id":"sample-6fc96ea65282f416f15f852e","patient_id":"patient-9fcde7a95f4d57501ecbf7b2","turn_id":"turn06","turn_type":"toxicity_or_support_decision","gold_letter":"E","gold_action":"继续放疗，予以洗鼻、免疫调节/辅助支持（如香菇多糖）及动静脉置管护理，复查血常规与生化常规。","options":[{"letter":"A","text":"暂停放疗，予以重组人血小板生成素（rhTPO）皮下注射，待血小板恢复后继续放疗。","is_gold":false},{"letter":"B","text":"继续放疗，予以重组人白介素-11（rhIL-11）皮下注射，复查血常规与生化常规。","is_gold":false},{"letter":"C","text":"暂停放疗，输注单采血小板1个治疗量，复查血常规与生化常规。","is_gold":false},{"letter":"D","text":"继续放疗，予以重组人粒细胞集落刺激因子（rhG-CSF）皮下注射，复查血常规。","is_gold":false},{"letter":"E","text":"继续放疗，予以洗鼻、免疫调节/辅助支持（如香菇多糖）及动静脉置管护理，复查血常规与生化常规。","is_gold":true},{"letter":"F","text":"暂停放疗，予以促红细胞生成素（EPO）皮下注射，待血红蛋白恢复后继续放疗。","is_gold":false},{"letter":"G","text":"继续放疗，予以低分子肝素皮下注射预防血栓，复查凝血功能与血常规。","is_gold":false},{"letter":"H","text":"暂停放疗，予以甲泼尼龙静脉滴注提升血小板，复查血常规与生化常规。","is_gold":false},{"letter":"I","text":"继续放疗，予以静脉输注人免疫球蛋白（IVIG），复查血常规与生化常规。","is_gold":false},{"letter":"J","text":"终止放疗，予以单药化疗维持，配合洗鼻及动静脉置管护理。","is_gold":false},{"letter":"K","text":"继续放疗，予以重组人血小板生成素与重组人粒细胞集落刺激因子联合皮下注射。","is_gold":false},{"letter":"L","text":"暂停放疗，予以洗鼻及动静脉置管护理，暂不予升血小板药物干预。","is_gold":false}]}
+{"sample_id":"sample-08d32abcf26a92c62d1dc762","patient_id":"patient-9fcde7a95f4d57501ecbf7b2","turn_id":"turn07","turn_type":"response_assessment_decision","gold_letter":"F","gold_action":"取消第三程同期化疗，按原计划完成根治性放疗，胆囊结石暂予观察，放疗结束后择期行全面疗效评估。","options":[{"letter":"A","text":"强制收治入院完成第三程同期化疗，期间暂停放疗，待化疗结束后恢复放疗。","is_gold":false},{"letter":"B","text":"取消第三程同期化疗，加用西妥昔单抗靶向治疗联合放疗，放疗结束后行疗效评估。","is_gold":false},{"letter":"C","text":"提前终止放疗，行全身PET-CT及头颈部MRI评估，视肿瘤退缩情况决定后续辅助化疗方案。","is_gold":false},{"letter":"D","text":"取消第三程同期化疗，下调原定放疗处方剂量以减轻黏膜反应，放疗结束后即刻行鼻咽镜活检。","is_gold":false},{"letter":"E","text":"安排入院行TPF方案补充化疗，同时继续放疗，放疗结束后行全面疗效评估。","is_gold":false},{"letter":"F","text":"取消第三程同期化疗，按原计划完成根治性放疗，胆囊结石暂予观察，放疗结束后择期行全面疗效评估。","is_gold":true},{"letter":"G","text":"请普外科急会诊行腹腔镜胆囊切除术，术后择期恢复放疗，并取消后续化疗。","is_gold":false},{"letter":"H","text":"改用口服卡培他滨单药替代静脉化疗，继续门诊放疗，放疗结束后行辅助化疗。","is_gold":false},{"letter":"I","text":"立即行鼻咽及颈部MRI复查，若肿瘤已完全消退则提前结束放疗，进入随访阶段。","is_gold":false},{"letter":"J","text":"取消第三程同期化疗，增加放疗靶区外扩范围及处方剂量，放疗结束后择期行全面疗效评估。","is_gold":false},{"letter":"K","text":"暂停放疗，待咽痛及口腔黏膜反应完全缓解后再恢复放疗，并补充第三程化疗。","is_gold":false},{"letter":"L","text":"采用中药及针灸治疗替代第三程化疗，继续门诊放疗，放疗结束后常规行全身骨扫描。","is_gold":false}]}
+{"sample_id":"sample-bc1decc91eb488b9888718b5","patient_id":"patient-9fcde7a95f4d57501ecbf7b2","turn_id":"turn08","turn_type":"recurrence_or_salvage_decision","gold_letter":"G","gold_action":"结束根治性治疗进入随访，放疗后3个月复查影像学评估疗效","options":[{"letter":"A","text":"立即行双侧颈部淋巴结清扫术以彻底清除颈部残留病灶","is_gold":false},{"letter":"B","text":"立即行鼻咽及颈部局部追加外照射放疗10-15Gy推量","is_gold":false},{"letter":"C","text":"立即行全身PET-CT检查评估颈部淋巴结活性及远处转移","is_gold":false},{"letter":"D","text":"立即行鼻咽内镜下活检评估原发灶病理完全缓解情况","is_gold":false},{"letter":"E","text":"立即启动含铂双药方案辅助化疗2-3个周期强化全身控制","is_gold":false},{"letter":"F","text":"予以表皮生长因子受体靶向药物单药维持治疗半年至一年","is_gold":false},{"letter":"G","text":"结束根治性治疗进入随访，放疗后3个月复查影像学评估疗效","is_gold":true},{"letter":"H","text":"立即行颈部残留淋巴结细针穿刺活检以指导后续局部治疗","is_gold":false},{"letter":"I","text":"立即启动PD-1单抗等免疫检查点抑制剂维持治疗1年","is_gold":false},{"letter":"J","text":"予以抗炎及对症支持治疗，放疗后1个月复查鼻咽颈部MRI","is_gold":false},{"letter":"K","text":"立即采用原诱导化疗方案进行2至3个周期全身巩固化疗","is_gold":false},{"letter":"L","text":"立即行颈部残留淋巴结局部微波消融或放射性粒子植入术","is_gold":false}]}
diff --git a/supplementary/carepath25/episode_replay.jsonl b/supplementary/carepath25/episode_replay.jsonl
new file mode 100644
index 0000000000000000000000000000000000000000..94c3418f0086ad75498a4854cc971d0a67984cd3
--- /dev/null
+++ b/supplementary/carepath25/episode_replay.jsonl
@@ -0,0 +1,25 @@
+{"episode_id":"episode-5739a21b532ed958ab3756d5","patient_id":"patient-5fa48522b2703f35ead0224b","care_turn_count":6,"turns":[{"sample_id":"sample-c56105087904f0da386b7001","patient_id":"patient-5fa48522b2703f35ead0224b","turn_id":"turn02","turn_position":1,"turn_type":"imaging_release_workup","gold_letter":"J","gold_action":"行颈部淋巴结穿刺活检或鼻咽镜活检以明确病理诊断，并完善全身分期检查（如胸腹部CT、骨扫描或PET-CT）。","options":[{"letter":"A","text":"完善血浆EBV-DNA检测，若结果阳性则临床确诊鼻咽癌并启动根治性放疗","is_gold":false},{"letter":"B","text":"行鼻咽肿物开放性切除活检以明确病理诊断，并完善胸腹部CT及骨扫描","is_gold":false},{"letter":"C","text":"行颈部淋巴结切除活检以明确病理诊断，暂缓全身远处转移排查","is_gold":false},{"letter":"D","text":"行颈部淋巴结细针穿刺细胞学检查（FNAC）作为最终确诊依据，并完善全身分期检查","is_gold":false},{"letter":"E","text":"行鼻咽镜下活检以明确病理诊断，无需常规进行胸腹部影像学分期","is_gold":false},{"letter":"F","text":"优先行全身PET-CT检查，若无远处转移则直接开始诱导化疗","is_gold":false},{"letter":"G","text":"行双侧颈部淋巴结清扫术并送常规病理，确诊后安排术后放疗","is_gold":false},{"letter":"H","text":"行鼻咽镜下活检以明确病理诊断，并仅行头颈部增强CT以补充评估颅底骨质破坏","is_gold":false},{"letter":"I","text":"行鼻咽镜下活检以明确病理诊断，并直接安排诱导化疗，化疗后补充全身分期检查","is_gold":false},{"letter":"J","text":"行颈部淋巴结穿刺活检或鼻咽镜活检以明确病理诊断，并完善全身分期检查","is_gold":true},{"letter":"K","text":"密切观察鼻咽部病灶及颈部淋巴结变化，1个月后复查头颈部MRI决定是否活检","is_gold":false},{"letter":"L","text":"行颈部淋巴结穿刺活检，确诊后直接启动根治性放疗，无需全身分期检查","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、斜坡、口咽、蝶骨基底部、岩尖。\n文本分期信息：N2，Mx 左侧腋窝淋巴结可疑转移。\n综合TNM状态：T3N2Mx 左侧腋窝淋巴结可疑转移。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 正常范围心电图\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽左顶壁、左顶后壁、左侧壁增厚，并见团块状软组织信号影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，鼻咽右侧壁粘膜未见增厚，左侧咽隐窝闭塞，右侧咽隐窝存在，左侧咽旁脂肪间隙狭窄。左侧腭帆提肌、腭帆张肌、头长肌、翼内肌受侵犯，余咽旁诸肌未见异常； 左侧咽后见肿大的淋巴结，短径22mm，右侧咽后见小淋巴结，短径5mm。 病灶向前堵塞左侧后鼻孔，口咽左侧壁受侵增厚。 左侧翼腭窝软组织影稍增多，右侧翼腭窝、双侧颞下窝未见异常。 蝶骨基底部、斜坡左侧份、左侧岩尖骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、上颌窦粘膜增厚；蝶窦、双侧乳突气化良好，未见异常信号影；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。 双颈II区、左颈III区见多个淋巴结，较大者短径24mm，信号欠均匀，增强扫描不均匀强化。；检查结论: 鼻咽左顶后壁、左侧壁病灶，考虑鼻咽癌，侵犯左侧咽旁、口咽左侧壁。 颅底骨质破坏。 双侧咽后、双颈II区、左颈III区淋巴结，考虑转移瘤。 副鼻窦炎。\n- [全程D5] 检验组合: 红细胞比容(Hct)-静脉血: 38.9%；血红蛋白(Hb)-静脉血: 131.6g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.5mmolL；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；总蛋白(TP)-静脉血: 69.64g/L；总钙(Ca)-静脉血: 2.26mmol/L；白蛋白(ALB)-静脉血: 43.1g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.42mmol/L；磷(P)-静脉血: 1.22mmol/L；凝血酶时间(TT)-静脉血: 17.3sec.；淋巴细胞百分比(Lymph%)-静脉血: 0.325；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；钠离子(Na+)-静脉血: 140.5mmol/L；单核细胞百分比(Mono%)-静脉血: 0.0954；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；载脂蛋白AI(apoAI)-静脉血: 1.38g/L；丙氨酸氨基转移酶(ALT)-静脉血: 21.7U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；氯离子(Cl-)-静脉血: 103.9mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；血小板计数(PLT#)-静脉血: 270.910E9/L；总胆固醇(TC)-静脉血: 5.3mmol/L；C-反应蛋白(CRP)-静脉血: 0.37mg/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.69mmol/L；甘油三酯(TG)-静脉血: 0.78mmol/L；淋巴细胞计数(Lymph#)-静脉血: 210E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.568；凝血酶原时间活动度(PTA)-静脉血: 94%；活化部分凝血活酶时间(APTT)-静脉血: 25.3sec.；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；平均红细胞血红蛋白含量(MCH)-静脉血: 30.2pg；凝血酶原时间(PT)-静脉血: 11.4sec.；纤维蛋白原(Fbg)-静脉血: 2.62g/L；天门冬氨酸氨基转移酶/丙氨酸氨……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善血浆EBV-DNA检测，若结果阳性则临床确诊鼻咽癌并启动根治性放疗\nB. 行鼻咽肿物开放性切除活检以明确病理诊断，并完善胸腹部CT及骨扫描\nC. 行颈部淋巴结切除活检以明确病理诊断，暂缓全身远处转移排查\nD. 行颈部淋巴结细针穿刺细胞学检查（FNAC）作为最终确诊依据，并完善全身分期检查\nE. 行鼻咽镜下活检以明确病理诊断，无需常规进行胸腹部影像学分期\nF. 优先行全身PET-CT检查，若无远处转移则直接开始诱导化疗\nG. 行双侧颈部淋巴结清扫术并送常规病理，确诊后安排术后放疗\nH. 行鼻咽镜下活检以明确病理诊断，并仅行头颈部增强CT以补充评估颅底骨质破坏\nI. 行鼻咽镜下活检以明确病理诊断，并直接安排诱导化疗，化疗后补充全身分期检查\nJ. 行颈部淋巴结穿刺活检或鼻咽镜活检以明确病理诊断，并完善全身分期检查\nK. 密切观察鼻咽部病灶及颈部淋巴结变化，1个月后复查头颈部MRI决定是否活检\nL. 行颈部淋巴结穿刺活检，确诊后直接启动根治性放疗，无需全身分期检查\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、斜坡、口咽、蝶骨基底部、岩尖。\n文本分期信息：N2，Mx 左侧腋窝淋巴结可疑转移。\n综合TNM状态：T3N2Mx 左侧腋窝淋巴结可疑转移。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 正常范围心电图\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽左顶壁、左顶后壁、左侧壁增厚，并见团块状软组织信号影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，鼻咽右侧壁粘膜未见增厚，左侧咽隐窝闭塞，右侧咽隐窝存在，左侧咽旁脂肪间隙狭窄。左侧腭帆提肌、腭帆张肌、头长肌、翼内肌受侵犯，余咽旁诸肌未见异常； 左侧咽后见肿大的淋巴结，短径22mm，右侧咽后见小淋巴结，短径5mm。 病灶向前堵塞左侧后鼻孔，口咽左侧壁受侵增厚。 左侧翼腭窝软组织影稍增多，右侧翼腭窝、双侧颞下窝未见异常。 蝶骨基底部、斜坡左侧份、左侧岩尖骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、上颌窦粘膜增厚；蝶窦、双侧乳突气化良好，未见异常信号影；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。 双颈II区、左颈III区见多个淋巴结，较大者短径24mm，信号欠均匀，增强扫描不均匀强化。；检查结论: 鼻咽左顶后壁、左侧壁病灶，考虑鼻咽癌，侵犯左侧咽旁、口咽左侧壁。 颅底骨质破坏。 双侧咽后、双颈II区、左颈III区淋巴结，考虑转移瘤。 副鼻窦炎。\n- [全程D5] 检验组合: 红细胞比容(Hct)-静脉血: 38.9%；血红蛋白(Hb)-静脉血: 131.6g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.5mmolL；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；总蛋白(TP)-静脉血: 69.64g/L；总钙(Ca)-静脉血: 2.26mmol/L；白蛋白(ALB)-静脉血: 43.1g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.42mmol/L；磷(P)-静脉血: 1.22mmol/L；凝血酶时间(TT)-静脉血: 17.3sec.；淋巴细胞百分比(Lymph%)-静脉血: 0.325；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；钠离子(Na+)-静脉血: 140.5mmol/L；单核细胞百分比(Mono%)-静脉血: 0.0954；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；载脂蛋白AI(apoAI)-静脉血: 1.38g/L；丙氨酸氨基转移酶(ALT)-静脉血: 21.7U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；氯离子(Cl-)-静脉血: 103.9mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；血小板计数(PLT#)-静脉血: 270.910E9/L；总胆固醇(TC)-静脉血: 5.3mmol/L；C-反应蛋白(CRP)-静脉血: 0.37mg/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.69mmol/L；甘油三酯(TG)-静脉血: 0.78mmol/L；淋巴细胞计数(Lymph#)-静脉血: 210E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.568；凝血酶原时间活动度(PTA)-静脉血: 94%；活化部分凝血活酶时间(APTT)-静脉血: 25.3sec.；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；平均红细胞血红蛋白含量(MCH)-静脉血: 30.2pg；凝血酶原时间(PT)-静脉血: 11.4sec.；纤维蛋白原(Fbg)-静脉血: 2.62g/L；天门冬氨酸氨基转移酶/丙氨酸氨……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善血浆EBV-DNA检测，若结果阳性则临床确诊鼻咽癌并启动根治性放疗\nB. 行鼻咽肿物开放性切除活检以明确病理诊断，并完善胸腹部CT及骨扫描\nC. 行颈部淋巴结切除活检以明确病理诊断，暂缓全身远处转移排查\nD. 行颈部淋巴结细针穿刺细胞学检查（FNAC）作为最终确诊依据，并完善全身分期检查\nE. 行鼻咽镜下活检以明确病理诊断，无需常规进行胸腹部影像学分期\nF. 优先行全身PET-CT检查，若无远处转移则直接开始诱导化疗\nG. 行双侧颈部淋巴结清扫术并送常规病理，确诊后安排术后放疗\nH. 行鼻咽镜下活检以明确病理诊断，并仅行头颈部增强CT以补充评估颅底骨质破坏\nI. 行鼻咽镜下活检以明确病理诊断，并直接安排诱导化疗，化疗后补充全身分期检查\nJ. 行颈部淋巴结穿刺活检或鼻咽镜活检以明确病理诊断，并完善全身分期检查\nK. 密切观察鼻咽部病灶及颈部淋巴结变化，1个月后复查头颈部MRI决定是否活检\nL. 行颈部淋巴结穿刺活检，确诊后直接启动根治性放疗，无需全身分期检查\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、斜坡、口咽、蝶骨基底部、岩尖。\n文本分期信息：N2，Mx 左侧腋窝淋巴结可疑转移。\n综合TNM状态：T3N2Mx 左侧腋窝淋巴结可疑转移。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 正常范围心电图\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽左顶壁、左顶后壁、左侧壁增厚，并见团块状软组织信号影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，鼻咽右侧壁粘膜未见增厚，左侧咽隐窝闭塞，右侧咽隐窝存在，左侧咽旁脂肪间隙狭窄。左侧腭帆提肌、腭帆张肌、头长肌、翼内肌受侵犯，余咽旁诸肌未见异常； 左侧咽后见肿大的淋巴结，短径22mm，右侧咽后见小淋巴结，短径5mm。 病灶向前堵塞左侧后鼻孔，口咽左侧壁受侵增厚。 左侧翼腭窝软组织影稍增多，右侧翼腭窝、双侧颞下窝未见异常。 蝶骨基底部、斜坡左侧份、左侧岩尖骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、上颌窦粘膜增厚；蝶窦、双侧乳突气化良好，未见异常信号影；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。 双颈II区、左颈III区见多个淋巴结，较大者短径24mm，信号欠均匀，增强扫描不均匀强化。；检查结论: 鼻咽左顶后壁、左侧壁病灶，考虑鼻咽癌，侵犯左侧咽旁、口咽左侧壁。 颅底骨质破坏。 双侧咽后、双颈II区、左颈III区淋巴结，考虑转移瘤。 副鼻窦炎。\n- [全程D5] 检验组合: 红细胞比容(Hct)-静脉血: 38.9%；血红蛋白(Hb)-静脉血: 131.6g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.5mmolL；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；总蛋白(TP)-静脉血: 69.64g/L；总钙(Ca)-静脉血: 2.26mmol/L；白蛋白(ALB)-静脉血: 43.1g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.42mmol/L；磷(P)-静脉血: 1.22mmol/L；凝血酶时间(TT)-静脉血: 17.3sec.；淋巴细胞百分比(Lymph%)-静脉血: 0.325；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；钠离子(Na+)-静脉血: 140.5mmol/L；单核细胞百分比(Mono%)-静脉血: 0.0954；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；载脂蛋白AI(apoAI)-静脉血: 1.38g/L；丙氨酸氨基转移酶(ALT)-静脉血: 21.7U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；氯离子(Cl-)-静脉血: 103.9mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；血小板计数(PLT#)-静脉血: 270.910E9/L；总胆固醇(TC)-静脉血: 5.3mmol/L；C-反应蛋白(CRP)-静脉血: 0.37mg/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.69mmol/L；甘油三酯(TG)-静脉血: 0.78mmol/L；淋巴细胞计数(Lymph#)-静脉血: 210E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.568；凝血酶原时间活动度(PTA)-静脉血: 94%；活化部分凝血活酶时间(APTT)-静脉血: 25.3sec.；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；平均红细胞血红蛋白含量(MCH)-静脉血: 30.2pg；凝血酶原时间(PT)-静脉血: 11.4sec.；纤维蛋白原(Fbg)-静脉血: 2.62g/L；天门冬氨酸氨基转移酶/丙氨酸氨……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善血浆EBV-DNA检测，若结果阳性则临床确诊鼻咽癌并启动根治性放疗\nB. 行鼻咽肿物开放性切除活检以明确病理诊断，并完善胸腹部CT及骨扫描\nC. 行颈部淋巴结切除活检以明确病理诊断，暂缓全身远处转移排查\nD. 行颈部淋巴结细针穿刺细胞学检查（FNAC）作为最终确诊依据，并完善全身分期检查\nE. 行鼻咽镜下活检以明确病理诊断，无需常规进行胸腹部影像学分期\nF. 优先行全身PET-CT检查，若无远处转移则直接开始诱导化疗\nG. 行双侧颈部淋巴结清扫术并送常规病理，确诊后安排术后放疗\nH. 行鼻咽镜下活检以明确病理诊断，并仅行头颈部增强CT以补充评估颅底骨质破坏\nI. 行鼻咽镜下活检以明确病理诊断，并直接安排诱导化疗，化疗后补充全身分期检查\nJ. 行颈部淋巴结穿刺活检或鼻咽镜活检以明确病理诊断，并完善全身分期检查\nK. 密切观察鼻咽部病灶及颈部淋巴结变化，1个月后复查头颈部MRI决定是否活检\nL. 行颈部淋巴结穿刺活检，确诊后直接启动根治性放疗，无需全身分期检查\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-9b76347b9a2749777a06cd80","patient_id":"patient-5fa48522b2703f35ead0224b","turn_id":"turn04","turn_position":2,"turn_type":"initial_treatment_selection","gold_letter":"L","gold_action":"诱导化疗（顺铂+氟尿嘧啶方案）","options":[{"letter":"A","text":"同步放化疗（顺铂单药方案）","is_gold":false},{"letter":"B","text":"诱导化疗（吉西他滨+顺铂方案）联合PD-1抑制剂","is_gold":false},{"letter":"C","text":"根治性放疗联合辅助化疗（顺铂+氟尿嘧啶方案）","is_gold":false},{"letter":"D","text":"诱导化疗（紫杉醇+卡铂方案）","is_gold":false},{"letter":"E","text":"诱导化疗（多西他赛+顺铂+氟尿嘧啶方案）联合西妥昔单抗","is_gold":false},{"letter":"F","text":"根治性放疗（单纯放疗）","is_gold":false},{"letter":"G","text":"诱导化疗（卡培他滨单药方案）","is_gold":false},{"letter":"H","text":"靶向治疗（尼妥珠单抗）联合同步放化疗","is_gold":false},{"letter":"I","text":"诱导化疗（依托泊苷+顺铂方案）","is_gold":false},{"letter":"J","text":"姑息性化疗（顺铂+氟尿嘧啶方案）","is_gold":false},{"letter":"K","text":"诱导化疗（顺铂单药方案）","is_gold":false},{"letter":"L","text":"诱导化疗（顺铂+氟尿嘧啶方案）","is_gold":true}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、斜坡、口咽、蝶骨基底部、岩尖。\n文本分期信息：N2，Mx 左侧腋窝淋巴结可疑转移。\n综合TNM状态：T3N2Mx 左侧腋窝淋巴结可疑转移。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 正常范围心电图\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽左顶壁、左顶后壁、左侧壁增厚，并见团块状软组织信号影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，鼻咽右侧壁粘膜未见增厚，左侧咽隐窝闭塞，右侧咽隐窝存在，左侧咽旁脂肪间隙狭窄。左侧腭帆提肌、腭帆张肌、头长肌、翼内肌受侵犯，余咽旁诸肌未见异常； 左侧咽后见肿大的淋巴结，短径22mm，右侧咽后见小淋巴结，短径5mm。 病灶向前堵塞左侧后鼻孔，口咽左侧壁受侵增厚。 左侧翼腭窝软组织影稍增多，右侧翼腭窝、双侧颞下窝未见异常。 蝶骨基底部、斜坡左侧份、左侧岩尖骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、上颌窦粘膜增厚；蝶窦、双侧乳突气化良好，未见异常信号影；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。 双颈II区、左颈III区见多个淋巴结，较大者短径24mm，信号欠均匀，增强扫描不均匀强化。；检查结论: 鼻咽左顶后壁、左侧壁病灶，考虑鼻咽癌，侵犯左侧咽旁、口咽左侧壁。 颅底骨质破坏。 双侧咽后、双颈II区、左颈III区淋巴结，考虑转移瘤。 副鼻窦炎。\n- [全程D5] 检验组合: 红细胞比容(Hct)-静脉血: 38.9%；血红蛋白(Hb)-静脉血: 131.6g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.5mmolL；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；总蛋白(TP)-静脉血: 69.64g/L；总钙(Ca)-静脉血: 2.26mmol/L；白蛋白(ALB)-静脉血: 43.1g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.42mmol/L；磷(P)-静脉血: 1.22mmol/L；凝血酶时间(TT)-静脉血: 17.3sec.；淋巴细胞百分比(Lymph%)-静脉血: 0.325；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；钠离子(Na+)-静脉血: 140.5mmol/L；单核细胞百分比(Mono%)-静脉血: 0.0954；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；载脂蛋白AI(apoAI)-静脉血: 1.38g/L；丙氨酸氨基转移酶(ALT)-静脉血: 21.7U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；氯离子(Cl-)-静脉血: 103.9mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；血小板计数(PLT#)-静脉血: 270.910E9/L；总胆固醇(TC)-静脉血: 5.3mmol/L；C-反应蛋白(CRP)-静脉血: 0.37mg/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.69mmol/L；甘油三酯(TG)-静脉血: 0.78mmol/L；淋巴细胞计数(Lymph#)-静脉血: 210E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.568；凝血酶原时间活动度(PTA)-静脉血: 94%；活化部分凝血活酶时间(APTT)-静脉血: 25.3sec.；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；平均红细胞血红蛋白含量(MCH)-静脉血: 30.2pg；凝血酶原时间(PT)-静脉血: 11.4sec.；纤维蛋白原(Fbg)-静脉血: 2.62g/L；天门冬氨酸氨基转移酶/丙氨酸氨……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D8] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见:；检查结论:\n- [全程D14] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；透明质酸(HA)-静脉血: 76.89ng/ml；III型前胶原氨基端肽(PIIINP)-静脉血: 28.08ng/ml；葡萄糖(Glu)-尿液: -（参考: 阴性）；降钙素(CT)-静脉血: 22.05pg/ml；总蛋白(TP)-尿液: -（参考: 阴性）；IV型胶原(C-IV)-静脉血: 28.93ng/ml；比重(SG)-尿液: 1.008；颜色-尿液: 无色；酸碱度(pH)-尿液: 6.5；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；层粘连蛋白(LN)-静脉血: 35.29ng/ml；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮\n- [全程D15] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T6水平，估计导管末端位于上腔静脉内。；检查结论: PICC管末端位置如上述。\n- [全程D15] 检验组合: 骨钙素N端中分子片段(N-MID)-静脉血: 11.9ng/ml；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.318ng/ml\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 同步放化疗（顺铂单药方案）\nB. 诱导化疗（吉西他滨+顺铂方案）联合PD-1抑制剂\nC. 根治性放疗联合辅助化疗（顺铂+氟尿嘧啶方案）\nD. 诱导化疗（紫杉醇+卡铂方案）\nE. 诱导化疗（多西他赛+顺铂+氟尿嘧啶方案）联合西妥昔单抗\nF. 根治性放疗（单纯放疗）\nG. 诱导化疗（卡培他滨单药方案）\nH. 靶向治疗（尼妥珠单抗）联合同步放化疗\nI. 诱导化疗（依托泊苷+顺铂方案）\nJ. 姑息性化疗（顺铂+氟尿嘧啶方案）\nK. 诱导化疗（顺铂单药方案）\nL. 诱导化疗（顺铂+氟尿嘧啶方案）\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D8] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见:；检查结论:\n- [全程D14] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；透明质酸(HA)-静脉血: 76.89ng/ml；III型前胶原氨基端肽(PIIINP)-静脉血: 28.08ng/ml；葡萄糖(Glu)-尿液: -（参考: 阴性）；降钙素(CT)-静脉血: 22.05pg/ml；总蛋白(TP)-尿液: -（参考: 阴性）；IV型胶原(C-IV)-静脉血: 28.93ng/ml；比重(SG)-尿液: 1.008；颜色-尿液: 无色；酸碱度(pH)-尿液: 6.5；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；层粘连蛋白(LN)-静脉血: 35.29ng/ml；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮\n- [全程D15] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T6水平，估计导管末端位于上腔静脉内。；检查结论: PICC管末端位置如上述。\n- [全程D15] 检验组合: 骨钙素N端中分子片段(N-MID)-静脉血: 11.9ng/ml；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.318ng/ml\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 同步放化疗（顺铂单药方案）\nB. 诱导化疗（吉西他滨+顺铂方案）联合PD-1抑制剂\nC. 根治性放疗联合辅助化疗（顺铂+氟尿嘧啶方案）\nD. 诱导化疗（紫杉醇+卡铂方案）\nE. 诱导化疗（多西他赛+顺铂+氟尿嘧啶方案）联合西妥昔单抗\nF. 根治性放疗（单纯放疗）\nG. 诱导化疗（卡培他滨单药方案）\nH. 靶向治疗（尼妥珠单抗）联合同步放化疗\nI. 诱导化疗（依托泊苷+顺铂方案）\nJ. 姑息性化疗（顺铂+氟尿嘧啶方案）\nK. 诱导化疗（顺铂单药方案）\nL. 诱导化疗（顺铂+氟尿嘧啶方案）\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、斜坡、口咽、蝶骨基底部、岩尖。\n文本分期信息：N2，Mx 左侧腋窝淋巴结可疑转移。\n综合TNM状态：T3N2Mx 左侧腋窝淋巴结可疑转移。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D8] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见:；检查结论:\n- [全程D14] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；透明质酸(HA)-静脉血: 76.89ng/ml；III型前胶原氨基端肽(PIIINP)-静脉血: 28.08ng/ml；葡萄糖(Glu)-尿液: -（参考: 阴性）；降钙素(CT)-静脉血: 22.05pg/ml；总蛋白(TP)-尿液: -（参考: 阴性）；IV型胶原(C-IV)-静脉血: 28.93ng/ml；比重(SG)-尿液: 1.008；颜色-尿液: 无色；酸碱度(pH)-尿液: 6.5；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；层粘连蛋白(LN)-静脉血: 35.29ng/ml；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮\n- [全程D15] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T6水平，估计导管末端位于上腔静脉内。；检查结论: PICC管末端位置如上述。\n- [全程D15] 检验组合: 骨钙素N端中分子片段(N-MID)-静脉血: 11.9ng/ml；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.318ng/ml\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 同步放化疗（顺铂单药方案）\nB. 诱导化疗（吉西他滨+顺铂方案）联合PD-1抑制剂\nC. 根治性放疗联合辅助化疗（顺铂+氟尿嘧啶方案）\nD. 诱导化疗（紫杉醇+卡铂方案）\nE. 诱导化疗（多西他赛+顺铂+氟尿嘧啶方案）联合西妥昔单抗\nF. 根治性放疗（单纯放疗）\nG. 诱导化疗（卡培他滨单药方案）\nH. 靶向治疗（尼妥珠单抗）联合同步放化疗\nI. 诱导化疗（依托泊苷+顺铂方案）\nJ. 姑息性化疗（顺铂+氟尿嘧啶方案）\nK. 诱导化疗（顺铂单药方案）\nL. 诱导化疗（顺铂+氟尿嘧啶方案）\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-ad9c851cda35b0e3c9061982","patient_id":"patient-5fa48522b2703f35ead0224b","turn_id":"turn05","turn_position":3,"turn_type":"toxicity_or_support_decision","gold_letter":"A","gold_action":"办理出院，予以胸腺五肽皮下注射支持治疗，嘱每周复查血常规及生化，按期返院行第2程诱导化疗。","options":[{"letter":"A","text":"办理出院，予以胸腺五肽皮下注射支持治疗，嘱每周复查血常规及生化，按期返院行第2程诱导化疗。","is_gold":true},{"letter":"B","text":"暂缓出院，继续静脉给予5-HT3受体拮抗剂及补液支持，待恶心呕吐完全缓解后出院。","is_gold":false},{"letter":"C","text":"办理出院，嘱每周复查血常规及生化，第2程诱导化疗将顺铂剂量下调20%。","is_gold":false},{"letter":"D","text":"办理出院，嘱每周复查血常规及生化，第2程诱导化疗更改为吉西他滨+顺铂（GP）方案。","is_gold":false},{"letter":"E","text":"办理出院，予以重组人粒细胞集落刺激因子（G-CSF）皮下注射，按期返院行第2程诱导化疗。","is_gold":false},{"letter":"F","text":"办理出院，予以重组人促红素（EPO）皮下注射，按期返院行第2程诱导化疗。","is_gold":false},{"letter":"G","text":"办理出院，予以胸腺五肽皮下注射支持治疗，并安排左侧腋窝淋巴结穿刺活检。","is_gold":false},{"letter":"H","text":"办理出院，予以胸腺五肽皮下注射支持治疗，嘱返院直接开始根治性放疗及同步化疗。","is_gold":false},{"letter":"I","text":"办理出院，予以口服阿瑞匹坦带药，嘱第2程诱导化疗推迟1周进行。","is_gold":false},{"letter":"J","text":"办理出院，予以重组人血小板生成素（rhTPO）皮下注射，按期返院行第2程诱导化疗。","is_gold":false},{"letter":"K","text":"暂缓出院，复查鼻咽及颈部MRI评估近期疗效，结果决定第2程化疗方案。","is_gold":false},{"letter":"L","text":"办理出院，予以胸腺五肽皮下注射支持治疗，嘱第2程诱导化疗加用尼妥珠单抗。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、斜坡、口咽、蝶骨基底部、岩尖。\n文本分期信息：N2，Mx 左侧腋窝淋巴结可疑转移。\n综合TNM状态：T3N2Mx 左侧腋窝淋巴结可疑转移。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 正常范围心电图\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽左顶壁、左顶后壁、左侧壁增厚，并见团块状软组织信号影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，鼻咽右侧壁粘膜未见增厚，左侧咽隐窝闭塞，右侧咽隐窝存在，左侧咽旁脂肪间隙狭窄。左侧腭帆提肌、腭帆张肌、头长肌、翼内肌受侵犯，余咽旁诸肌未见异常； 左侧咽后见肿大的淋巴结，短径22mm，右侧咽后见小淋巴结，短径5mm。 病灶向前堵塞左侧后鼻孔，口咽左侧壁受侵增厚。 左侧翼腭窝软组织影稍增多，右侧翼腭窝、双侧颞下窝未见异常。 蝶骨基底部、斜坡左侧份、左侧岩尖骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、上颌窦粘膜增厚；蝶窦、双侧乳突气化良好，未见异常信号影；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。 双颈II区、左颈III区见多个淋巴结，较大者短径24mm，信号欠均匀，增强扫描不均匀强化。；检查结论: 鼻咽左顶后壁、左侧壁病灶，考虑鼻咽癌，侵犯左侧咽旁、口咽左侧壁。 颅底骨质破坏。 双侧咽后、双颈II区、左颈III区淋巴结，考虑转移瘤。 副鼻窦炎。\n- [全程D5] 检验组合: 红细胞比容(Hct)-静脉血: 38.9%；血红蛋白(Hb)-静脉血: 131.6g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.5mmolL；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；总蛋白(TP)-静脉血: 69.64g/L；总钙(Ca)-静脉血: 2.26mmol/L；白蛋白(ALB)-静脉血: 43.1g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.42mmol/L；磷(P)-静脉血: 1.22mmol/L；凝血酶时间(TT)-静脉血: 17.3sec.；淋巴细胞百分比(Lymph%)-静脉血: 0.325；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；钠离子(Na+)-静脉血: 140.5mmol/L；单核细胞百分比(Mono%)-静脉血: 0.0954；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；载脂蛋白AI(apoAI)-静脉血: 1.38g/L；丙氨酸氨基转移酶(ALT)-静脉血: 21.7U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；氯离子(Cl-)-静脉血: 103.9mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；血小板计数(PLT#)-静脉血: 270.910E9/L；总胆固醇(TC)-静脉血: 5.3mmol/L；C-反应蛋白(CRP)-静脉血: 0.37mg/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.69mmol/L；甘油三酯(TG)-静脉血: 0.78mmol/L；淋巴细胞计数(Lymph#)-静脉血: 210E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.568；凝血酶原时间活动度(PTA)-静脉血: 94%；活化部分凝血活酶时间(APTT)-静脉血: 25.3sec.；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；平均红细胞血红蛋白含量(MCH)-静脉血: 30.2pg；凝血酶原时间(PT)-静脉血: 11.4sec.；纤维蛋白原(Fbg)-静脉血: 2.62g/L；天门冬氨酸氨基转移酶/丙氨酸氨……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D8] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见:；检查结论:\n- [全程D14] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；透明质酸(HA)-静脉血: 76.89ng/ml；III型前胶原氨基端肽(PIIINP)-静脉血: 28.08ng/ml；葡萄糖(Glu)-尿液: -（参考: 阴性）；降钙素(CT)-静脉血: 22.05pg/ml；总蛋白(TP)-尿液: -（参考: 阴性）；IV型胶原(C-IV)-静脉血: 28.93ng/ml；比重(SG)-尿液: 1.008；颜色-尿液: 无色；酸碱度(pH)-尿液: 6.5；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；层粘连蛋白(LN)-静脉血: 35.29ng/ml；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮\n- [全程D15] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T6水平，估计导管末端位于上腔静脉内。；检查结论: PICC管末端位置如上述。\n- [全程D15] 检验组合: 骨钙素N端中分子片段(N-MID)-静脉血: 11.9ng/ml；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.318ng/ml\n- [全程D16] 检验组合: 浊度(TRUB)-尿液: 清亮；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: +-（参考: 阴性）；酸碱度(pH)-尿液: 7；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.016；葡萄糖(Glu)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 3/μL\n- [全程D17] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 31/μL；颜色-尿液: Yellow；鳞状上皮细胞计数(SQEP#)-尿液: 7/μL；白细胞计数(WBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.021；浊度(TRUB)-尿液: 清亮；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D19] 检验组合: 总钙(Ca)-静脉血: 2.15mmol/L；钠离子(Na+)-静脉血: 138.8mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.2mmol/L；钾离子(K+)-静脉血: 3.08mmol/L；氯离子(Cl-)-静脉血: 102.2mmol/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；磷(P)-静脉血: 1.19mmol/L；阴离子间隙(AG)-静脉血: 15.4\n- [全程D20] 超声；双侧腋窝淋巴结彩超(套): 检查类型: 超声；检查名称: 双侧腋窝淋巴结彩超(套)；检查部位:；检查所见: 左侧腋窝腋下组可见1个淋巴结回声，大小约16x4mm，椭圆形，边界清，皮髓质分界清，淋巴门结构可探及。腋上组及腋中组未见明显异常淋巴结回声。 CDFI：上述淋巴结内可见门型血流信号。；检查结论: 左侧腋窝腋下组淋巴结，符合良性淋巴结声像。\n- [全程D20] 检验组合: 血小板计数(PLT#)-静脉血: 250.210E9/L；肌酐(Crea)-静脉血: 54umol/L；总胆红素(TBIL)-静脉血: 13.7umol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；阴离子间隙(AG)-静脉血: 12.4；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；碱性磷酸酶(ALP)-静脉血: 59.5U/L；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；球蛋白(GLO)-静脉血: 25.26g/L；葡萄糖(Glu)-静脉血: 4.81mmol/L；白蛋白(ALB)-静脉血: 40.9g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；尿素氮(BUN)-静脉血: 3.9mmol/L；血小板分布宽度(PDW)-静脉血: 15.8%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.38mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.05mmolL；乳酸脱氢酶(LDH)-静脉血: 275.2U/L；单核细胞百分比(Mono%)-静脉血: 0.0621；中性粒细胞计数(Neut#)-静脉血: 4.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.711；γ-谷氨酰基转移酶(GGT)-静脉血: 19.5U/L；甘油三酯(TG)-静脉血: 1.23mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.5pg；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.0032；磷(P)-静脉血: 1.37mmol/L；总钙(Ca)-静脉血: 2.23mmol/L；间接胆红素(IBIL)-静脉血: 9umolL；血小板比容-静脉血: 20.8%；C-反应蛋白(CRP)-静脉血: 0.65mg/L；载脂蛋白AI(apoAI)-静脉血: 1.12g/L；总蛋白(TP)-静脉血: 66.16g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.62；单核细胞计数(Mono#)-静脉血: 0.410E9/L；钠离子(Na+)-静脉血: 137.8mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 27.7U/L；丙氨酸氨基转移酶(ALT)-静脉……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D15] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D20] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗结束，诉呕吐 次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程5-FU+顺铂方案诱导化疗结束，无诉特殊不适，可予出院，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 办理出院，予以胸腺五肽皮下注射支持治疗，嘱每周复查血常规及生化，按期返院行第2程诱导化疗。\nB. 暂缓出院，继续静脉给予5-HT3受体拮抗剂及补液支持，待恶心呕吐完全缓解后出院。\nC. 办理出院，嘱每周复查血常规及生化，第2程诱导化疗将顺铂剂量下调20%。\nD. 办理出院，嘱每周复查血常规及生化，第2程诱导化疗更改为吉西他滨+顺铂（GP）方案。\nE. 办理出院，予以重组人粒细胞集落刺激因子（G-CSF）皮下注射，按期返院行第2程诱导化疗。\nF. 办理出院，予以重组人促红素（EPO）皮下注射，按期返院行第2程诱导化疗。\nG. 办理出院，予以胸腺五肽皮下注射支持治疗，并安排左侧腋窝淋巴结穿刺活检。\nH. 办理出院，予以胸腺五肽皮下注射支持治疗，嘱返院直接开始根治性放疗及同步化疗。\nI. 办理出院，予以口服阿瑞匹坦带药，嘱第2程诱导化疗推迟1周进行。\nJ. 办理出院，予以重组人血小板生成素（rhTPO）皮下注射，按期返院行第2程诱导化疗。\nK. 暂缓出院，复查鼻咽及颈部MRI评估近期疗效，结果决定第2程化疗方案。\nL. 办理出院，予以胸腺五肽皮下注射支持治疗，嘱第2程诱导化疗加用尼妥珠单抗。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D16] 检验组合: 浊度(TRUB)-尿液: 清亮；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: +-（参考: 阴性）；酸碱度(pH)-尿液: 7；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.016；葡萄糖(Glu)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 3/μL\n- [全程D17] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 31/μL；颜色-尿液: Yellow；鳞状上皮细胞计数(SQEP#)-尿液: 7/μL；白细胞计数(WBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.021；浊度(TRUB)-尿液: 清亮；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D19] 检验组合: 总钙(Ca)-静脉血: 2.15mmol/L；钠离子(Na+)-静脉血: 138.8mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.2mmol/L；钾离子(K+)-静脉血: 3.08mmol/L；氯离子(Cl-)-静脉血: 102.2mmol/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；磷(P)-静脉血: 1.19mmol/L；阴离子间隙(AG)-静脉血: 15.4\n- [全程D20] 超声；双侧腋窝淋巴结彩超(套): 检查类型: 超声；检查名称: 双侧腋窝淋巴结彩超(套)；检查部位:；检查所见: 左侧腋窝腋下组可见1个淋巴结回声，大小约16x4mm，椭圆形，边界清，皮髓质分界清，淋巴门结构可探及。腋上组及腋中组未见明显异常淋巴结回声。 CDFI：上述淋巴结内可见门型血流信号。；检查结论: 左侧腋窝腋下组淋巴结，符合良性淋巴结声像。\n- [全程D20] 检验组合: 血小板计数(PLT#)-静脉血: 250.210E9/L；肌酐(Crea)-静脉血: 54umol/L；总胆红素(TBIL)-静脉血: 13.7umol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；阴离子间隙(AG)-静脉血: 12.4；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；碱性磷酸酶(ALP)-静脉血: 59.5U/L；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；球蛋白(GLO)-静脉血: 25.26g/L；葡萄糖(Glu)-静脉血: 4.81mmol/L；白蛋白(ALB)-静脉血: 40.9g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；尿素氮(BUN)-静脉血: 3.9mmol/L；血小板分布宽度(PDW)-静脉血: 15.8%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.38mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.05mmolL；乳酸脱氢酶(LDH)-静脉血: 275.2U/L；单核细胞百分比(Mono%)-静脉血: 0.0621；中性粒细胞计数(Neut#)-静脉血: 4.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.711；γ-谷氨酰基转移酶(GGT)-静脉血: 19.5U/L；甘油三酯(TG)-静脉血: 1.23mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.5pg；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.0032；磷(P)-静脉血: 1.37mmol/L；总钙(Ca)-静脉血: 2.23mmol/L；间接胆红素(IBIL)-静脉血: 9umolL；血小板比容-静脉血: 20.8%；C-反应蛋白(CRP)-静脉血: 0.65mg/L；载脂蛋白AI(apoAI)-静脉血: 1.12g/L；总蛋白(TP)-静脉血: 66.16g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.62；单核细胞计数(Mono#)-静脉血: 0.410E9/L；钠离子(Na+)-静脉血: 137.8mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 27.7U/L；丙氨酸氨基转移酶(ALT)-静脉……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D15] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D20] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗结束，诉呕吐 次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程5-FU+顺铂方案诱导化疗结束，无诉特殊不适，可予出院，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 办理出院，予以胸腺五肽皮下注射支持治疗，嘱每周复查血常规及生化，按期返院行第2程诱导化疗。\nB. 暂缓出院，继续静脉给予5-HT3受体拮抗剂及补液支持，待恶心呕吐完全缓解后出院。\nC. 办理出院，嘱每周复查血常规及生化，第2程诱导化疗将顺铂剂量下调20%。\nD. 办理出院，嘱每周复查血常规及生化，第2程诱导化疗更改为吉西他滨+顺铂（GP）方案。\nE. 办理出院，予以重组人粒细胞集落刺激因子（G-CSF）皮下注射，按期返院行第2程诱导化疗。\nF. 办理出院，予以重组人促红素（EPO）皮下注射，按期返院行第2程诱导化疗。\nG. 办理出院，予以胸腺五肽皮下注射支持治疗，并安排左侧腋窝淋巴结穿刺活检。\nH. 办理出院，予以胸腺五肽皮下注射支持治疗，嘱返院直接开始根治性放疗及同步化疗。\nI. 办理出院，予以口服阿瑞匹坦带药，嘱第2程诱导化疗推迟1周进行。\nJ. 办理出院，予以重组人血小板生成素（rhTPO）皮下注射，按期返院行第2程诱导化疗。\nK. 暂缓出院，复查鼻咽及颈部MRI评估近期疗效，结果决定第2程化疗方案。\nL. 办理出院，予以胸腺五肽皮下注射支持治疗，嘱第2程诱导化疗加用尼妥珠单抗。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、斜坡、口咽、蝶骨基底部、岩尖。\n文本分期信息：N2，Mx 左侧腋窝淋巴结可疑转移。\n综合TNM状态：T3N2Mx 左侧腋窝淋巴结可疑转移。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D16] 检验组合: 浊度(TRUB)-尿液: 清亮；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: +-（参考: 阴性）；酸碱度(pH)-尿液: 7；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.016；葡萄糖(Glu)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 3/μL\n- [全程D17] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 31/μL；颜色-尿液: Yellow；鳞状上皮细胞计数(SQEP#)-尿液: 7/μL；白细胞计数(WBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.021；浊度(TRUB)-尿液: 清亮；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D19] 检验组合: 总钙(Ca)-静脉血: 2.15mmol/L；钠离子(Na+)-静脉血: 138.8mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.2mmol/L；钾离子(K+)-静脉血: 3.08mmol/L；氯离子(Cl-)-静脉血: 102.2mmol/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；磷(P)-静脉血: 1.19mmol/L；阴离子间隙(AG)-静脉血: 15.4\n- [全程D20] 超声；双侧腋窝淋巴结彩超(套): 检查类型: 超声；检查名称: 双侧腋窝淋巴结彩超(套)；检查部位:；检查所见: 左侧腋窝腋下组可见1个淋巴结回声，大小约16x4mm，椭圆形，边界清，皮髓质分界清，淋巴门结构可探及。腋上组及腋中组未见明显异常淋巴结回声。 CDFI：上述淋巴结内可见门型血流信号。；检查结论: 左侧腋窝腋下组淋巴结，符合良性淋巴结声像。\n- [全程D20] 检验组合: 血小板计数(PLT#)-静脉血: 250.210E9/L；肌酐(Crea)-静脉血: 54umol/L；总胆红素(TBIL)-静脉血: 13.7umol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；阴离子间隙(AG)-静脉血: 12.4；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；碱性磷酸酶(ALP)-静脉血: 59.5U/L；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；球蛋白(GLO)-静脉血: 25.26g/L；葡萄糖(Glu)-静脉血: 4.81mmol/L；白蛋白(ALB)-静脉血: 40.9g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；尿素氮(BUN)-静脉血: 3.9mmol/L；血小板分布宽度(PDW)-静脉血: 15.8%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.38mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.05mmolL；乳酸脱氢酶(LDH)-静脉血: 275.2U/L；单核细胞百分比(Mono%)-静脉血: 0.0621；中性粒细胞计数(Neut#)-静脉血: 4.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.711；γ-谷氨酰基转移酶(GGT)-静脉血: 19.5U/L；甘油三酯(TG)-静脉血: 1.23mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.5pg；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.0032；磷(P)-静脉血: 1.37mmol/L；总钙(Ca)-静脉血: 2.23mmol/L；间接胆红素(IBIL)-静脉血: 9umolL；血小板比容-静脉血: 20.8%；C-反应蛋白(CRP)-静脉血: 0.65mg/L；载脂蛋白AI(apoAI)-静脉血: 1.12g/L；总蛋白(TP)-静脉血: 66.16g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.62；单核细胞计数(Mono#)-静脉血: 0.410E9/L；钠离子(Na+)-静脉血: 137.8mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 27.7U/L；丙氨酸氨基转移酶(ALT)-静脉……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D15] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D20] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗结束，诉呕吐 次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程5-FU+顺铂方案诱导化疗结束，无诉特殊不适，可予出院，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 办理出院，予以胸腺五肽皮下注射支持治疗，嘱每周复查血常规及生化，按期返院行第2程诱导化疗。\nB. 暂缓出院，继续静脉给予5-HT3受体拮抗剂及补液支持，待恶心呕吐完全缓解后出院。\nC. 办理出院，嘱每周复查血常规及生化，第2程诱导化疗将顺铂剂量下调20%。\nD. 办理出院，嘱每周复查血常规及生化，第2程诱导化疗更改为吉西他滨+顺铂（GP）方案。\nE. 办理出院，予以重组人粒细胞集落刺激因子（G-CSF）皮下注射，按期返院行第2程诱导化疗。\nF. 办理出院，予以重组人促红素（EPO）皮下注射，按期返院行第2程诱导化疗。\nG. 办理出院，予以胸腺五肽皮下注射支持治疗，并安排左侧腋窝淋巴结穿刺活检。\nH. 办理出院，予以胸腺五肽皮下注射支持治疗，嘱返院直接开始根治性放疗及同步化疗。\nI. 办理出院，予以口服阿瑞匹坦带药，嘱第2程诱导化疗推迟1周进行。\nJ. 办理出院，予以重组人血小板生成素（rhTPO）皮下注射，按期返院行第2程诱导化疗。\nK. 暂缓出院，复查鼻咽及颈部MRI评估近期疗效，结果决定第2程化疗方案。\nL. 办理出院，予以胸腺五肽皮下注射支持治疗，嘱第2程诱导化疗加用尼妥珠单抗。\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-9acca1b0c829ebdd4e952950","patient_id":"patient-5fa48522b2703f35ead0224b","turn_id":"turn06","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"B","gold_action":"开始适形调强放射治疗（IMRT），并予以雾化吸入、鼻腔冲洗、皮肤及黏膜保护剂等放疗支持处理。","options":[{"letter":"A","text":"予以第3程5-FU+顺铂方案诱导化疗，并继续予以护胃、止呕、补液等常规对症支持治疗。","is_gold":false},{"letter":"B","text":"开始适形调强放射治疗（IMRT），并予以雾化吸入、鼻腔冲洗、皮肤及黏膜保护剂等放疗支持处理。","is_gold":true},{"letter":"C","text":"开始适形调强放射治疗（IMRT），待出现III度以上放射性皮炎或黏膜炎时再启动局部保护剂及雾化治疗。","is_gold":false},{"letter":"D","text":"予以第3程5-FU+顺铂方案诱导化疗，并预防性使用长效重组人粒细胞集落刺激因子。","is_gold":false},{"letter":"E","text":"开始适形调强放射治疗（IMRT），并常规预防性静脉滴注头孢类广谱抗生素及抗真菌药物。","is_gold":false},{"letter":"F","text":"暂缓抗肿瘤治疗，继续予以升白细胞及营养支持治疗，观察1-2周后再复查各项生化指标。","is_gold":false},{"letter":"G","text":"开始适形调强放射治疗（IMRT），并常规预防性静脉滴注大剂量糖皮质激素及甘露醇脱水。","is_gold":false},{"letter":"H","text":"开始适形调强放射治疗（IMRT），并预防性给予全胃肠外营养（TPN）及静脉高营养支持。","is_gold":false},{"letter":"I","text":"予以单药顺铂同期化疗，并常规予以水化、利尿及止吐等支持治疗，暂缓启动放射治疗。","is_gold":false},{"letter":"J","text":"开始适形调强放射治疗（IMRT），并常规预防性口服非甾体抗炎药及阿片类镇痛药物。","is_gold":false},{"letter":"K","text":"开始适形调强放射治疗（IMRT），并予以预防性低分子肝素抗凝及深静脉置管常规护理。","is_gold":false},{"letter":"L","text":"予以靶向治疗联合适形调强放射治疗（IMRT），并常规予以抗过敏及皮疹预防对症处理。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、斜坡、口咽、蝶骨基底部、岩尖。\n文本分期信息：N2，Mx 左侧腋窝淋巴结可疑转移。\n综合TNM状态：T3N2Mx 左侧腋窝淋巴结可疑转移。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 正常范围心电图\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽左顶壁、左顶后壁、左侧壁增厚，并见团块状软组织信号影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，鼻咽右侧壁粘膜未见增厚，左侧咽隐窝闭塞，右侧咽隐窝存在，左侧咽旁脂肪间隙狭窄。左侧腭帆提肌、腭帆张肌、头长肌、翼内肌受侵犯，余咽旁诸肌未见异常； 左侧咽后见肿大的淋巴结，短径22mm，右侧咽后见小淋巴结，短径5mm。 病灶向前堵塞左侧后鼻孔，口咽左侧壁受侵增厚。 左侧翼腭窝软组织影稍增多，右侧翼腭窝、双侧颞下窝未见异常。 蝶骨基底部、斜坡左侧份、左侧岩尖骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、上颌窦粘膜增厚；蝶窦、双侧乳突气化良好，未见异常信号影；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。 双颈II区、左颈III区见多个淋巴结，较大者短径24mm，信号欠均匀，增强扫描不均匀强化。；检查结论: 鼻咽左顶后壁、左侧壁病灶，考虑鼻咽癌，侵犯左侧咽旁、口咽左侧壁。 颅底骨质破坏。 双侧咽后、双颈II区、左颈III区淋巴结，考虑转移瘤。 副鼻窦炎。\n- [全程D5] 检验组合: 红细胞比容(Hct)-静脉血: 38.9%；血红蛋白(Hb)-静脉血: 131.6g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.5mmolL；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；总蛋白(TP)-静脉血: 69.64g/L；总钙(Ca)-静脉血: 2.26mmol/L；白蛋白(ALB)-静脉血: 43.1g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.42mmol/L；磷(P)-静脉血: 1.22mmol/L；凝血酶时间(TT)-静脉血: 17.3sec.；淋巴细胞百分比(Lymph%)-静脉血: 0.325；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；钠离子(Na+)-静脉血: 140.5mmol/L；单核细胞百分比(Mono%)-静脉血: 0.0954；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；载脂蛋白AI(apoAI)-静脉血: 1.38g/L；丙氨酸氨基转移酶(ALT)-静脉血: 21.7U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；氯离子(Cl-)-静脉血: 103.9mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；血小板计数(PLT#)-静脉血: 270.910E9/L；总胆固醇(TC)-静脉血: 5.3mmol/L；C-反应蛋白(CRP)-静脉血: 0.37mg/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.69mmol/L；甘油三酯(TG)-静脉血: 0.78mmol/L；淋巴细胞计数(Lymph#)-静脉血: 210E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.568；凝血酶原时间活动度(PTA)-静脉血: 94%；活化部分凝血活酶时间(APTT)-静脉血: 25.3sec.；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；平均红细胞血红蛋白含量(MCH)-静脉血: 30.2pg；凝血酶原时间(PT)-静脉血: 11.4sec.；纤维蛋白原(Fbg)-静脉血: 2.62g/L；天门冬氨酸氨基转移酶/丙氨酸氨……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D8] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见:；检查结论:\n- [全程D14] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；透明质酸(HA)-静脉血: 76.89ng/ml；III型前胶原氨基端肽(PIIINP)-静脉血: 28.08ng/ml；葡萄糖(Glu)-尿液: -（参考: 阴性）；降钙素(CT)-静脉血: 22.05pg/ml；总蛋白(TP)-尿液: -（参考: 阴性）；IV型胶原(C-IV)-静脉血: 28.93ng/ml；比重(SG)-尿液: 1.008；颜色-尿液: 无色；酸碱度(pH)-尿液: 6.5；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；层粘连蛋白(LN)-静脉血: 35.29ng/ml；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮\n- [全程D15] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T6水平，估计导管末端位于上腔静脉内。；检查结论: PICC管末端位置如上述。\n- [全程D15] 检验组合: 骨钙素N端中分子片段(N-MID)-静脉血: 11.9ng/ml；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.318ng/ml\n- [全程D16] 检验组合: 浊度(TRUB)-尿液: 清亮；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: +-（参考: 阴性）；酸碱度(pH)-尿液: 7；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.016；葡萄糖(Glu)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 3/μL\n- [全程D17] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 31/μL；颜色-尿液: Yellow；鳞状上皮细胞计数(SQEP#)-尿液: 7/μL；白细胞计数(WBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.021；浊度(TRUB)-尿液: 清亮；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D19] 检验组合: 总钙(Ca)-静脉血: 2.15mmol/L；钠离子(Na+)-静脉血: 138.8mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.2mmol/L；钾离子(K+)-静脉血: 3.08mmol/L；氯离子(Cl-)-静脉血: 102.2mmol/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；磷(P)-静脉血: 1.19mmol/L；阴离子间隙(AG)-静脉血: 15.4\n- [全程D20] 超声；双侧腋窝淋巴结彩超(套): 检查类型: 超声；检查名称: 双侧腋窝淋巴结彩超(套)；检查部位:；检查所见: 左侧腋窝腋下组可见1个淋巴结回声，大小约16x4mm，椭圆形，边界清，皮髓质分界清，淋巴门结构可探及。腋上组及腋中组未见明显异常淋巴结回声。 CDFI：上述淋巴结内可见门型血流信号。；检查结论: 左侧腋窝腋下组淋巴结，符合良性淋巴结声像。\n- [全程D20] 检验组合: 血小板计数(PLT#)-静脉血: 250.210E9/L；肌酐(Crea)-静脉血: 54umol/L；总胆红素(TBIL)-静脉血: 13.7umol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；阴离子间隙(AG)-静脉血: 12.4；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；碱性磷酸酶(ALP)-静脉血: 59.5U/L；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；球蛋白(GLO)-静脉血: 25.26g/L；葡萄糖(Glu)-静脉血: 4.81mmol/L；白蛋白(ALB)-静脉血: 40.9g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；尿素氮(BUN)-静脉血: 3.9mmol/L；血小板分布宽度(PDW)-静脉血: 15.8%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.38mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.05mmolL；乳酸脱氢酶(LDH)-静脉血: 275.2U/L；单核细胞百分比(Mono%)-静脉血: 0.0621；中性粒细胞计数(Neut#)-静脉血: 4.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.711；γ-谷氨酰基转移酶(GGT)-静脉血: 19.5U/L；甘油三酯(TG)-静脉血: 1.23mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.5pg；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.0032；磷(P)-静脉血: 1.37mmol/L；总钙(Ca)-静脉血: 2.23mmol/L；间接胆红素(IBIL)-静脉血: 9umolL；血小板比容-静脉血: 20.8%；C-反应蛋白(CRP)-静脉血: 0.65mg/L；载脂蛋白AI(apoAI)-静脉血: 1.12g/L；总蛋白(TP)-静脉血: 66.16g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.62；单核细胞计数(Mono#)-静脉血: 0.410E9/L；钠离子(Na+)-静脉血: 137.8mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 27.7U/L；丙氨酸氨基转移酶(ALT)-静脉……\n- [全程D37] 检验组合: 嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.4；红细胞比容(Hct)-静脉血: 35.6%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞体积(MCV)-静脉血: 89.9fL；单核细胞百分比(Mono%)-静脉血: 0.046；血小板计数(PLT#)-静脉血: 21310E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.8pg；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.9；平均血小板体积(MPV)-静脉血: 9.2fL；单核细胞计数(Mono#)-静脉血: 0.410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；中性粒细胞百分比(Neut%)-静脉血: 0.79；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；血小板比容-静脉血: 20%；血红蛋白(Hb)-静脉血: 118g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.009；淋巴细胞百分比(Lymph%)-静脉血: 0.147；红细胞计数(RBC#)-静脉血: 3.9610E12/L；血小板分布宽度(PDW)-静脉血: 9.9%；大血小板百分比(P-LCR%)-静脉血: 18.7%；中性粒细胞计数(Neut#)-静脉血: 7.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；白细胞计数(WBC#)-静脉血: 910E9/L\n- [全程D40] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.018；草酸钙结晶计数(CAOX#)-尿液: 10/μL；红细胞计数(RBC#)-尿液: 4/μL；总蛋白(TP)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: 无色；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D41] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；红细胞计数(RBC#)-尿液: 4/μL；白细胞(LEU)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；酮体(KET)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 1/μL；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.024；颜色-尿液: Light-Yellow\n- [全程D42] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 6/μL；隐血(OB)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 4/μL；总蛋白(TP)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7；颜色-尿液: Light-Yellow；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.023；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）；细菌计数(BACT#)-尿液: 8/μL\n- [全程D47] 超声；双侧腋窝淋巴结彩超(套): 检查类型: 超声；检查名称: 双侧腋窝淋巴结彩超(套)；检查部位:；检查所见: 双侧侧腋窝腋下组可见多个淋巴结回声，最大约12x6mm，椭圆形，边界清，皮髓质分界清，淋巴门结构可探及。腋上组及腋中组未见明显异常淋巴结回声。 CDFI：上述淋巴结内可见门型血流信号。；检查结论: 左侧腋窝腋下组淋巴结，符合良性淋巴结声像。\n- [全程D47] 检验组合: 有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 89.5fL；钠离子(Na+)-静脉血: 135.9mmol/L；尿酸(UA)-静脉血: 277.5umol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.0062；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；血红蛋白(Hb)-静脉血: 115.6g/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 332.5g/L；碱性磷酸酶(ALP)-静脉血: 63.1U/L；白蛋白(ALB)-静脉血: 39.9g/L；单核细胞百分比(Mono%)-静脉血: 0.056；α-L-岩藻糖苷酶(AFU)-静脉血: 42.7U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.315；尿素氮(BUN)-静脉血: 5.4mmol/L；白细胞计数(WBC#)-静脉血: 4.0510E9/L；总胆固醇(TC)-静脉血: 4.12mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24U/L；氯离子(Cl-)-静脉血: 99.2mmol/L；载脂蛋白B(apoB)-静脉血: 0.78g/L；丙氨酸氨基转移酶(ALT)-静脉血: 41.3U/L；总胆汁酸(TBA)-静脉血: 0.5umol/L；血小板计数(PLT#)-静脉血: 196.310E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.5%；葡萄糖(Glu)-静脉血: 4.67mmol/L；球蛋白(GLO)-静脉血: 23.82g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.3mmol/L；间接胆红素(IBIL)-静脉血: 7umolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.0051；镁离子(Mg2+)-静脉血: 0.69mmol/L；磷(P)-静脉血: 1.4mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 3.7umol/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；总钙(Ca)-静脉血: 2.27mmol/L；胱抑素(Cys-C)-静脉血: 0.95mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.68；中性粒细胞百分比(……\n- [全程D49] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后： 鼻咽腔轻度狭窄，鼻咽左顶壁、左顶后壁、左侧壁增厚，并见团块状软组织信号影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。鼻咽右侧壁粘膜未见增厚，左侧咽隐窝闭塞，右侧咽隐窝存在，左侧咽旁脂肪间隙狭窄。左侧腭帆提肌、腭帆张肌、头长肌受侵犯，余咽旁诸肌未见异常。 鼻腔未见肿物，口咽左侧壁受侵稍增厚。 双侧翼腭窝、双侧颞下窝未见异常。 蝶骨基底部、斜坡左侧份、左侧岩尖、左侧翼突基底部、左侧翼突内侧板骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、上颌窦、蝶窦、双侧乳突气化良好，未见异常信号影。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。蝶鞍形态正常，其内未见占位性病变。 左侧咽后见肿大的淋巴结，短径17mm，右侧咽后见小淋巴结，短径5mm。左颈II、III区见多个肿大淋巴结，较大者短径13mm，信号欠均匀，增强扫描不均匀强化。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。 扫描所见脑组织未见明确异常。；检查结论: 鼻咽癌化疗后，对比某次就诊时间日片： 鼻咽肿物，较前明显缩小。 颅底骨质破坏，基本同前。 左侧咽后淋巴结、左颈II、III区淋巴结，考虑转移瘤，较前明显缩小。右侧咽后小淋巴结，较前变化不大。\n- [全程D50] 检验组合: 总胆红素(TBIL)-静脉血: 8.1umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 20710E9/L；磷(P)-静脉血: 1.19mmol/L；中性粒细胞计数(Neut#)-静脉血: 2.810E9/L；葡萄糖(Glu)-静脉血: 5.75mmol/L；血红蛋白(Hb)-静脉血: 118g/L；尿酸(UA)-静脉血: 347.3umol/L；平均红细胞体积(MCV)-静脉血: 85.6fL；胱抑素(Cys-C)-静脉血: 1.01mg/L；红细胞比容(Hct)-静脉血: 34%；C-反应蛋白(CRP)-静脉血: 0.45mg/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；白蛋白(ALB)-静脉血: 44.1g/L；肌酐(Crea)-静脉血: 93.9umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 44.6U/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；总钙(Ca)-静脉血: 2.32mmol/L；红细胞计数(RBC#)-静脉血: 3.9710E12/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.1；球蛋白(GLO)-静脉血: 26.11g/L；尿素氮(BUN)-静脉血: 7.9mmol/L；钾离子(K+)-静脉血: 3.55mmol/L；载脂蛋白B(apoB)-静脉血: 0.88g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.72mmol/L；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.592；载脂蛋白AI(apoAI)-静脉血: 1.31g/L；乳酸脱氢酶(LDH)-静脉血: 232.4U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；总胆汁酸(TBA)-静脉血: 2.1umol/L；氯离子(Cl-)-静脉血: 102mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 23.5U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.33mmolL；总蛋白(TP)-静脉血: 70.21g/L；阴离子间隙(AG)-静脉血: 12.8；α-L-岩藻糖苷酶(AFU)-静脉血: 40.7U/L；总胆固醇(TC)-静脉血: 4.57mmol/L；白细胞计数(W……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D15] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D20] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗结束，诉呕吐 次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程5-FU+顺铂方案诱导化疗结束，无诉特殊不适，可予出院，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n- [全程D36] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者复查血常规：中性粒细胞1.2×109/L。郭医生信息已隐藏：暂停化疗，予以患者升中西粒细胞处理。\n- [全程D37] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 患者入院第三天，继续升白细胞处理，今日复查血常规，白细胞已经恢复正常，郭医生信息已隐藏：下周一予以患者第二程化疗。\n- [全程D40] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，可于今日执行第2程5-FU+顺铂方案诱导化疗，注意化疗不良反应。\n- [全程D43] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D47] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+顺铂方案诱导化疗结束，诉恶心、食欲下降，无发热、呕吐、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第2程5-FU+顺铂方案诱导化疗结束，无诉特殊不适，嘱其完成鼻咽、颈MRI复查，以及放疗定位扫描，定期返院治疗。遵嘱。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 予以第3程5-FU+顺铂方案诱导化疗，并继续予以护胃、止呕、补液等常规对症支持治疗。\nB. 开始适形调强放射治疗（IMRT），并予以雾化吸入、鼻腔冲洗、皮肤及黏膜保护剂等放疗支持处理。\nC. 开始适形调强放射治疗（IMRT），待出现III度以上放射性皮炎或黏膜炎时再启动局部保护剂及雾化治疗。\nD. 予以第3程5-FU+顺铂方案诱导化疗，并预防性使用长效重组人粒细胞集落刺激因子。\nE. 开始适形调强放射治疗（IMRT），并常规预防性静脉滴注头孢类广谱抗生素及抗真菌药物。\nF. 暂缓抗肿瘤治疗，继续予以升白细胞及营养支持治疗，观察1-2周后再复查各项生化指标。\nG. 开始适形调强放射治疗（IMRT），并常规预防性静脉滴注大剂量糖皮质激素及甘露醇脱水。\nH. 开始适形调强放射治疗（IMRT），并预防性给予全胃肠外营养（TPN）及静脉高营养支持。\nI. 予以单药顺铂同期化疗，并常规予以水化、利尿及止吐等支持治疗，暂缓启动放射治疗。\nJ. 开始适形调强放射治疗（IMRT），并常规预防性口服非甾体抗炎药及阿片类镇痛药物。\nK. 开始适形调强放射治疗（IMRT），并予以预防性低分子肝素抗凝及深静脉置管常规护理。\nL. 予以靶向治疗联合适形调强放射治疗（IMRT），并常规予以抗过敏及皮疹预防对症处理。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D37] 检验组合: 嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.4；红细胞比容(Hct)-静脉血: 35.6%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞体积(MCV)-静脉血: 89.9fL；单核细胞百分比(Mono%)-静脉血: 0.046；血小板计数(PLT#)-静脉血: 21310E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.8pg；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.9；平均血小板体积(MPV)-静脉血: 9.2fL；单核细胞计数(Mono#)-静脉血: 0.410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；中性粒细胞百分比(Neut%)-静脉血: 0.79；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；血小板比容-静脉血: 20%；血红蛋白(Hb)-静脉血: 118g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.009；淋巴细胞百分比(Lymph%)-静脉血: 0.147；红细胞计数(RBC#)-静脉血: 3.9610E12/L；血小板分布宽度(PDW)-静脉血: 9.9%；大血小板百分比(P-LCR%)-静脉血: 18.7%；中性粒细胞计数(Neut#)-静脉血: 7.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；白细胞计数(WBC#)-静脉血: 910E9/L\n- [全程D40] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.018；草酸钙结晶计数(CAOX#)-尿液: 10/μL；红细胞计数(RBC#)-尿液: 4/μL；总蛋白(TP)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: 无色；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D41] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；红细胞计数(RBC#)-尿液: 4/μL；白细胞(LEU)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；酮体(KET)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 1/μL；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.024；颜色-尿液: Light-Yellow\n- [全程D42] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 6/μL；隐血(OB)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 4/μL；总蛋白(TP)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7；颜色-尿液: Light-Yellow；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.023；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）；细菌计数(BACT#)-尿液: 8/μL\n- [全程D47] 超声；双侧腋窝淋巴结彩超(套): 检查类型: 超声；检查名称: 双侧腋窝淋巴结彩超(套)；检查部位:；检查所见: 双侧侧腋窝腋下组可见多个淋巴结回声，最大约12x6mm，椭圆形，边界清，皮髓质分界清，淋巴门结构可探及。腋上组及腋中组未见明显异常淋巴结回声。 CDFI：上述淋巴结内可见门型血流信号。；检查结论: 左侧腋窝腋下组淋巴结，符合良性淋巴结声像。\n- [全程D47] 检验组合: 有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 89.5fL；钠离子(Na+)-静脉血: 135.9mmol/L；尿酸(UA)-静脉血: 277.5umol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.0062；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；血红蛋白(Hb)-静脉血: 115.6g/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 332.5g/L；碱性磷酸酶(ALP)-静脉血: 63.1U/L；白蛋白(ALB)-静脉血: 39.9g/L；单核细胞百分比(Mono%)-静脉血: 0.056；α-L-岩藻糖苷酶(AFU)-静脉血: 42.7U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.315；尿素氮(BUN)-静脉血: 5.4mmol/L；白细胞计数(WBC#)-静脉血: 4.0510E9/L；总胆固醇(TC)-静脉血: 4.12mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24U/L；氯离子(Cl-)-静脉血: 99.2mmol/L；载脂蛋白B(apoB)-静脉血: 0.78g/L；丙氨酸氨基转移酶(ALT)-静脉血: 41.3U/L；总胆汁酸(TBA)-静脉血: 0.5umol/L；血小板计数(PLT#)-静脉血: 196.310E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.5%；葡萄糖(Glu)-静脉血: 4.67mmol/L；球蛋白(GLO)-静脉血: 23.82g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.3mmol/L；间接胆红素(IBIL)-静脉血: 7umolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.0051；镁离子(Mg2+)-静脉血: 0.69mmol/L；磷(P)-静脉血: 1.4mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 3.7umol/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；总钙(Ca)-静脉血: 2.27mmol/L；胱抑素(Cys-C)-静脉血: 0.95mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.68；中性粒细胞百分比(……\n- [全程D49] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后： 鼻咽腔轻度狭窄，鼻咽左顶壁、左顶后壁、左侧壁增厚，并见团块状软组织信号影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。鼻咽右侧壁粘膜未见增厚，左侧咽隐窝闭塞，右侧咽隐窝存在，左侧咽旁脂肪间隙狭窄。左侧腭帆提肌、腭帆张肌、头长肌受侵犯，余咽旁诸肌未见异常。 鼻腔未见肿物，口咽左侧壁受侵稍增厚。 双侧翼腭窝、双侧颞下窝未见异常。 蝶骨基底部、斜坡左侧份、左侧岩尖、左侧翼突基底部、左侧翼突内侧板骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、上颌窦、蝶窦、双侧乳突气化良好，未见异常信号影。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。蝶鞍形态正常，其内未见占位性病变。 左侧咽后见肿大的淋巴结，短径17mm，右侧咽后见小淋巴结，短径5mm。左颈II、III区见多个肿大淋巴结，较大者短径13mm，信号欠均匀，增强扫描不均匀强化。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。 扫描所见脑组织未见明确异常。；检查结论: 鼻咽癌化疗后，对比某次就诊时间日片： 鼻咽肿物，较前明显缩小。 颅底骨质破坏，基本同前。 左侧咽后淋巴结、左颈II、III区淋巴结，考虑转移瘤，较前明显缩小。右侧咽后小淋巴结，较前变化不大。\n- [全程D50] 检验组合: 总胆红素(TBIL)-静脉血: 8.1umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 20710E9/L；磷(P)-静脉血: 1.19mmol/L；中性粒细胞计数(Neut#)-静脉血: 2.810E9/L；葡萄糖(Glu)-静脉血: 5.75mmol/L；血红蛋白(Hb)-静脉血: 118g/L；尿酸(UA)-静脉血: 347.3umol/L；平均红细胞体积(MCV)-静脉血: 85.6fL；胱抑素(Cys-C)-静脉血: 1.01mg/L；红细胞比容(Hct)-静脉血: 34%；C-反应蛋白(CRP)-静脉血: 0.45mg/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；白蛋白(ALB)-静脉血: 44.1g/L；肌酐(Crea)-静脉血: 93.9umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 44.6U/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；总钙(Ca)-静脉血: 2.32mmol/L；红细胞计数(RBC#)-静脉血: 3.9710E12/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.1；球蛋白(GLO)-静脉血: 26.11g/L；尿素氮(BUN)-静脉血: 7.9mmol/L；钾离子(K+)-静脉血: 3.55mmol/L；载脂蛋白B(apoB)-静脉血: 0.88g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.72mmol/L；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.592；载脂蛋白AI(apoAI)-静脉血: 1.31g/L；乳酸脱氢酶(LDH)-静脉血: 232.4U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；总胆汁酸(TBA)-静脉血: 2.1umol/L；氯离子(Cl-)-静脉血: 102mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 23.5U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.33mmolL；总蛋白(TP)-静脉血: 70.21g/L；阴离子间隙(AG)-静脉血: 12.8；α-L-岩藻糖苷酶(AFU)-静脉血: 40.7U/L；总胆固醇(TC)-静脉血: 4.57mmol/L；白细胞计数(W……\n\n【既往治疗与反应】\n- [全程D36] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者复查血常规：中性粒细胞1.2×109/L。郭医生信息已隐藏：暂停化疗，予以患者升中西粒细胞处理。\n- [全程D37] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 患者入院第三天，继续升白细胞处理，今日复查血常规，白细胞已经恢复正常，郭医生信息已隐藏：下周一予以患者第二程化疗。\n- [全程D40] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，可于今日执行第2程5-FU+顺铂方案诱导化疗，注意化疗不良反应。\n- [全程D43] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D47] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+顺铂方案诱导化疗结束，诉恶心、食欲下降，无发热、呕吐、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第2程5-FU+顺铂方案诱导化疗结束，无诉特殊不适，嘱其完成鼻咽、颈MRI复查，以及放疗定位扫描，定期返院治疗。遵嘱。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 予以第3程5-FU+顺铂方案诱导化疗，并继续予以护胃、止呕、补液等常规对症支持治疗。\nB. 开始适形调强放射治疗（IMRT），并予以雾化吸入、鼻腔冲洗、皮肤及黏膜保护剂等放疗支持处理。\nC. 开始适形调强放射治疗（IMRT），待出现III度以上放射性皮炎或黏膜炎时再启动局部保护剂及雾化治疗。\nD. 予以第3程5-FU+顺铂方案诱导化疗，并预防性使用长效重组人粒细胞集落刺激因子。\nE. 开始适形调强放射治疗（IMRT），并常规预防性静脉滴注头孢类广谱抗生素及抗真菌药物。\nF. 暂缓抗肿瘤治疗，继续予以升白细胞及营养支持治疗，观察1-2周后再复查各项生化指标。\nG. 开始适形调强放射治疗（IMRT），并常规预防性静脉滴注大剂量糖皮质激素及甘露醇脱水。\nH. 开始适形调强放射治疗（IMRT），并预防性给予全胃肠外营养（TPN）及静脉高营养支持。\nI. 予以单药顺铂同期化疗，并常规予以水化、利尿及止吐等支持治疗，暂缓启动放射治疗。\nJ. 开始适形调强放射治疗（IMRT），并常规预防性口服非甾体抗炎药及阿片类镇痛药物。\nK. 开始适形调强放射治疗（IMRT），并予以预防性低分子肝素抗凝及深静脉置管常规护理。\nL. 予以靶向治疗联合适形调强放射治疗（IMRT），并常规予以抗过敏及皮疹预防对症处理。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、斜坡、口咽、蝶骨基底部、岩尖。\n文本分期信息：N2，Mx 左侧腋窝淋巴结可疑转移。\n综合TNM状态：T3N2Mx 左侧腋窝淋巴结可疑转移。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D37] 检验组合: 嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.4；红细胞比容(Hct)-静脉血: 35.6%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞体积(MCV)-静脉血: 89.9fL；单核细胞百分比(Mono%)-静脉血: 0.046；血小板计数(PLT#)-静脉血: 21310E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.8pg；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.9；平均血小板体积(MPV)-静脉血: 9.2fL；单核细胞计数(Mono#)-静脉血: 0.410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；中性粒细胞百分比(Neut%)-静脉血: 0.79；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；血小板比容-静脉血: 20%；血红蛋白(Hb)-静脉血: 118g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.009；淋巴细胞百分比(Lymph%)-静脉血: 0.147；红细胞计数(RBC#)-静脉血: 3.9610E12/L；血小板分布宽度(PDW)-静脉血: 9.9%；大血小板百分比(P-LCR%)-静脉血: 18.7%；中性粒细胞计数(Neut#)-静脉血: 7.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；白细胞计数(WBC#)-静脉血: 910E9/L\n- [全程D40] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.018；草酸钙结晶计数(CAOX#)-尿液: 10/μL；红细胞计数(RBC#)-尿液: 4/μL；总蛋白(TP)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: 无色；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D41] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；红细胞计数(RBC#)-尿液: 4/μL；白细胞(LEU)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；酮体(KET)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 1/μL；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.024；颜色-尿液: Light-Yellow\n- [全程D42] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 6/μL；隐血(OB)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 4/μL；总蛋白(TP)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7；颜色-尿液: Light-Yellow；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.023；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）；细菌计数(BACT#)-尿液: 8/μL\n- [全程D47] 超声；双侧腋窝淋巴结彩超(套): 检查类型: 超声；检查名称: 双侧腋窝淋巴结彩超(套)；检查部位:；检查所见: 双侧侧腋窝腋下组可见多个淋巴结回声，最大约12x6mm，椭圆形，边界清，皮髓质分界清，淋巴门结构可探及。腋上组及腋中组未见明显异常淋巴结回声。 CDFI：上述淋巴结内可见门型血流信号。；检查结论: 左侧腋窝腋下组淋巴结，符合良性淋巴结声像。\n- [全程D47] 检验组合: 有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 89.5fL；钠离子(Na+)-静脉血: 135.9mmol/L；尿酸(UA)-静脉血: 277.5umol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.0062；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；血红蛋白(Hb)-静脉血: 115.6g/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 332.5g/L；碱性磷酸酶(ALP)-静脉血: 63.1U/L；白蛋白(ALB)-静脉血: 39.9g/L；单核细胞百分比(Mono%)-静脉血: 0.056；α-L-岩藻糖苷酶(AFU)-静脉血: 42.7U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.315；尿素氮(BUN)-静脉血: 5.4mmol/L；白细胞计数(WBC#)-静脉血: 4.0510E9/L；总胆固醇(TC)-静脉血: 4.12mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24U/L；氯离子(Cl-)-静脉血: 99.2mmol/L；载脂蛋白B(apoB)-静脉血: 0.78g/L；丙氨酸氨基转移酶(ALT)-静脉血: 41.3U/L；总胆汁酸(TBA)-静脉血: 0.5umol/L；血小板计数(PLT#)-静脉血: 196.310E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.5%；葡萄糖(Glu)-静脉血: 4.67mmol/L；球蛋白(GLO)-静脉血: 23.82g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.3mmol/L；间接胆红素(IBIL)-静脉血: 7umolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.0051；镁离子(Mg2+)-静脉血: 0.69mmol/L；磷(P)-静脉血: 1.4mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 3.7umol/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；总钙(Ca)-静脉血: 2.27mmol/L；胱抑素(Cys-C)-静脉血: 0.95mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.68；中性粒细胞百分比(……\n- [全程D49] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后： 鼻咽腔轻度狭窄，鼻咽左顶壁、左顶后壁、左侧壁增厚，并见团块状软组织信号影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。鼻咽右侧壁粘膜未见增厚，左侧咽隐窝闭塞，右侧咽隐窝存在，左侧咽旁脂肪间隙狭窄。左侧腭帆提肌、腭帆张肌、头长肌受侵犯，余咽旁诸肌未见异常。 鼻腔未见肿物，口咽左侧壁受侵稍增厚。 双侧翼腭窝、双侧颞下窝未见异常。 蝶骨基底部、斜坡左侧份、左侧岩尖、左侧翼突基底部、左侧翼突内侧板骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、上颌窦、蝶窦、双侧乳突气化良好，未见异常信号影。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。蝶鞍形态正常，其内未见占位性病变。 左侧咽后见肿大的淋巴结，短径17mm，右侧咽后见小淋巴结，短径5mm。左颈II、III区见多个肿大淋巴结，较大者短径13mm，信号欠均匀，增强扫描不均匀强化。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。 扫描所见脑组织未见明确异常。；检查结论: 鼻咽癌化疗后，对比某次就诊时间日片： 鼻咽肿物，较前明显缩小。 颅底骨质破坏，基本同前。 左侧咽后淋巴结、左颈II、III区淋巴结，考虑转移瘤，较前明显缩小。右侧咽后小淋巴结，较前变化不大。\n- [全程D50] 检验组合: 总胆红素(TBIL)-静脉血: 8.1umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 20710E9/L；磷(P)-静脉血: 1.19mmol/L；中性粒细胞计数(Neut#)-静脉血: 2.810E9/L；葡萄糖(Glu)-静脉血: 5.75mmol/L；血红蛋白(Hb)-静脉血: 118g/L；尿酸(UA)-静脉血: 347.3umol/L；平均红细胞体积(MCV)-静脉血: 85.6fL；胱抑素(Cys-C)-静脉血: 1.01mg/L；红细胞比容(Hct)-静脉血: 34%；C-反应蛋白(CRP)-静脉血: 0.45mg/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；白蛋白(ALB)-静脉血: 44.1g/L；肌酐(Crea)-静脉血: 93.9umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 44.6U/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；总钙(Ca)-静脉血: 2.32mmol/L；红细胞计数(RBC#)-静脉血: 3.9710E12/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.1；球蛋白(GLO)-静脉血: 26.11g/L；尿素氮(BUN)-静脉血: 7.9mmol/L；钾离子(K+)-静脉血: 3.55mmol/L；载脂蛋白B(apoB)-静脉血: 0.88g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.72mmol/L；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.592；载脂蛋白AI(apoAI)-静脉血: 1.31g/L；乳酸脱氢酶(LDH)-静脉血: 232.4U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；总胆汁酸(TBA)-静脉血: 2.1umol/L；氯离子(Cl-)-静脉血: 102mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 23.5U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.33mmolL；总蛋白(TP)-静脉血: 70.21g/L；阴离子间隙(AG)-静脉血: 12.8；α-L-岩藻糖苷酶(AFU)-静脉血: 40.7U/L；总胆固醇(TC)-静脉血: 4.57mmol/L；白细胞计数(W……\n\n【既往治疗与反应】\n- [全程D36] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者复查血常规：中性粒细胞1.2×109/L。郭医生信息已隐藏：暂停化疗，予以患者升中西粒细胞处理。\n- [全程D37] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 患者入院第三天，继续升白细胞处理，今日复查血常规，白细胞已经恢复正常，郭医生信息已隐藏：下周一予以患者第二程化疗。\n- [全程D40] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，可于今日执行第2程5-FU+顺铂方案诱导化疗，注意化疗不良反应。\n- [全程D43] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D47] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+顺铂方案诱导化疗结束，诉恶心、食欲下降，无发热、呕吐、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第2程5-FU+顺铂方案诱导化疗结束，无诉特殊不适，嘱其完成鼻咽、颈MRI复查，以及放疗定位扫描，定期返院治疗。遵嘱。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 予以第3程5-FU+顺铂方案诱导化疗，并继续予以护胃、止呕、补液等常规对症支持治疗。\nB. 开始适形调强放射治疗（IMRT），并予以雾化吸入、鼻腔冲洗、皮肤及黏膜保护剂等放疗支持处理。\nC. 开始适形调强放射治疗（IMRT），待出现III度以上放射性皮炎或黏膜炎时再启动局部保护剂及雾化治疗。\nD. 予以第3程5-FU+顺铂方案诱导化疗，并预防性使用长效重组人粒细胞集落刺激因子。\nE. 开始适形调强放射治疗（IMRT），并常规预防性静脉滴注头孢类广谱抗生素及抗真菌药物。\nF. 暂缓抗肿瘤治疗，继续予以升白细胞及营养支持治疗，观察1-2周后再复查各项生化指标。\nG. 开始适形调强放射治疗（IMRT），并常规预防性静脉滴注大剂量糖皮质激素及甘露醇脱水。\nH. 开始适形调强放射治疗（IMRT），并预防性给予全胃肠外营养（TPN）及静脉高营养支持。\nI. 予以单药顺铂同期化疗，并常规予以水化、利尿及止吐等支持治疗，暂缓启动放射治疗。\nJ. 开始适形调强放射治疗（IMRT），并常规预防性口服非甾体抗炎药及阿片类镇痛药物。\nK. 开始适形调强放射治疗（IMRT），并予以预防性低分子肝素抗凝及深静脉置管常规护理。\nL. 予以靶向治疗联合适形调强放射治疗（IMRT），并常规予以抗过敏及皮疹预防对症处理。\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-ba3079ee7b3ef01162117027","patient_id":"patient-5fa48522b2703f35ead0224b","turn_id":"turn07","turn_position":5,"turn_type":"recurrence_or_salvage_decision","gold_letter":"C","gold_action":"暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，动态监测血常规，待中性粒细胞计数恢复后再行下一程化疗。","options":[{"letter":"A","text":"立即按原剂量启动第二程5-FU+顺铂方案化疗，并预防性给予长效重组人粒细胞刺激因子皮下注射","is_gold":false},{"letter":"B","text":"立即按原剂量启动第二程5-FU+顺铂方案化疗，化疗期间同步给予短效重组人粒细胞刺激因子皮下注射","is_gold":false},{"letter":"C","text":"暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，动态监测血常规，待中性粒细胞计数恢复后再行下一程化疗","is_gold":true},{"letter":"D","text":"暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射及广谱抗菌药物静脉滴注，待中性粒细胞计数恢复后再行化疗","is_gold":false},{"letter":"E","text":"终止诱导化疗，直接进入根治性放疗阶段，并给予重组人粒细胞刺激因子皮下注射","is_gold":false},{"letter":"F","text":"暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，待中性粒细胞恢复后调整下一程化疗方案为单药顺铂","is_gold":false},{"letter":"G","text":"暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，待中性粒细胞恢复后将5-FU与顺铂剂量均减低20%行下一程化疗","is_gold":false},{"letter":"H","text":"暂缓本周期化疗，仅予密切观察和口服升白药物，待中性粒细胞计数自然恢复后再行化疗","is_gold":false},{"letter":"I","text":"暂缓本周期化疗，行左侧腋窝淋巴结穿刺活检，同时给予重组人粒细胞刺激因子皮下注射","is_gold":false},{"letter":"J","text":"立即按原剂量启动第二程5-FU+顺铂方案化疗，化疗结束后48小时给予重组人粒细胞刺激因子皮下注射","is_gold":false},{"letter":"K","text":"暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，并安排全身PET-CT重新评估肿瘤范围","is_gold":false},{"letter":"L","text":"终止诱导化疗，改为靶向治疗联合重组人粒细胞刺激因子皮下注射，动态监测血常规","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、斜坡、口咽、蝶骨基底部、岩尖。\n文本分期信息：N2，Mx 左侧腋窝淋巴结可疑转移。\n综合TNM状态：T3N2Mx 左侧腋窝淋巴结可疑转移。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 正常范围心电图\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽左顶壁、左顶后壁、左侧壁增厚，并见团块状软组织信号影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，鼻咽右侧壁粘膜未见增厚，左侧咽隐窝闭塞，右侧咽隐窝存在，左侧咽旁脂肪间隙狭窄。左侧腭帆提肌、腭帆张肌、头长肌、翼内肌受侵犯，余咽旁诸肌未见异常； 左侧咽后见肿大的淋巴结，短径22mm，右侧咽后见小淋巴结，短径5mm。 病灶向前堵塞左侧后鼻孔，口咽左侧壁受侵增厚。 左侧翼腭窝软组织影稍增多，右侧翼腭窝、双侧颞下窝未见异常。 蝶骨基底部、斜坡左侧份、左侧岩尖骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、上颌窦粘膜增厚；蝶窦、双侧乳突气化良好，未见异常信号影；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。 双颈II区、左颈III区见多个淋巴结，较大者短径24mm，信号欠均匀，增强扫描不均匀强化。；检查结论: 鼻咽左顶后壁、左侧壁病灶，考虑鼻咽癌，侵犯左侧咽旁、口咽左侧壁。 颅底骨质破坏。 双侧咽后、双颈II区、左颈III区淋巴结，考虑转移瘤。 副鼻窦炎。\n- [全程D5] 检验组合: 红细胞比容(Hct)-静脉血: 38.9%；血红蛋白(Hb)-静脉血: 131.6g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.5mmolL；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；总蛋白(TP)-静脉血: 69.64g/L；总钙(Ca)-静脉血: 2.26mmol/L；白蛋白(ALB)-静脉血: 43.1g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.42mmol/L；磷(P)-静脉血: 1.22mmol/L；凝血酶时间(TT)-静脉血: 17.3sec.；淋巴细胞百分比(Lymph%)-静脉血: 0.325；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；钠离子(Na+)-静脉血: 140.5mmol/L；单核细胞百分比(Mono%)-静脉血: 0.0954；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；载脂蛋白AI(apoAI)-静脉血: 1.38g/L；丙氨酸氨基转移酶(ALT)-静脉血: 21.7U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；氯离子(Cl-)-静脉血: 103.9mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；血小板计数(PLT#)-静脉血: 270.910E9/L；总胆固醇(TC)-静脉血: 5.3mmol/L；C-反应蛋白(CRP)-静脉血: 0.37mg/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.69mmol/L；甘油三酯(TG)-静脉血: 0.78mmol/L；淋巴细胞计数(Lymph#)-静脉血: 210E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.568；凝血酶原时间活动度(PTA)-静脉血: 94%；活化部分凝血活酶时间(APTT)-静脉血: 25.3sec.；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；平均红细胞血红蛋白含量(MCH)-静脉血: 30.2pg；凝血酶原时间(PT)-静脉血: 11.4sec.；纤维蛋白原(Fbg)-静脉血: 2.62g/L；天门冬氨酸氨基转移酶/丙氨酸氨……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D8] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见:；检查结论:\n- [全程D14] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；透明质酸(HA)-静脉血: 76.89ng/ml；III型前胶原氨基端肽(PIIINP)-静脉血: 28.08ng/ml；葡萄糖(Glu)-尿液: -（参考: 阴性）；降钙素(CT)-静脉血: 22.05pg/ml；总蛋白(TP)-尿液: -（参考: 阴性）；IV型胶原(C-IV)-静脉血: 28.93ng/ml；比重(SG)-尿液: 1.008；颜色-尿液: 无色；酸碱度(pH)-尿液: 6.5；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；层粘连蛋白(LN)-静脉血: 35.29ng/ml；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮\n- [全程D15] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T6水平，估计导管末端位于上腔静脉内。；检查结论: PICC管末端位置如上述。\n- [全程D15] 检验组合: 骨钙素N端中分子片段(N-MID)-静脉血: 11.9ng/ml；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.318ng/ml\n- [全程D16] 检验组合: 浊度(TRUB)-尿液: 清亮；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: +-（参考: 阴性）；酸碱度(pH)-尿液: 7；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.016；葡萄糖(Glu)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 3/μL\n- [全程D17] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 31/μL；颜色-尿液: Yellow；鳞状上皮细胞计数(SQEP#)-尿液: 7/μL；白细胞计数(WBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.021；浊度(TRUB)-尿液: 清亮；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D19] 检验组合: 总钙(Ca)-静脉血: 2.15mmol/L；钠离子(Na+)-静脉血: 138.8mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.2mmol/L；钾离子(K+)-静脉血: 3.08mmol/L；氯离子(Cl-)-静脉血: 102.2mmol/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；磷(P)-静脉血: 1.19mmol/L；阴离子间隙(AG)-静脉血: 15.4\n- [全程D20] 超声；双侧腋窝淋巴结彩超(套): 检查类型: 超声；检查名称: 双侧腋窝淋巴结彩超(套)；检查部位:；检查所见: 左侧腋窝腋下组可见1个淋巴结回声，大小约16x4mm，椭圆形，边界清，皮髓质分界清，淋巴门结构可探及。腋上组及腋中组未见明显异常淋巴结回声。 CDFI：上述淋巴结内可见门型血流信号。；检查结论: 左侧腋窝腋下组淋巴结，符合良性淋巴结声像。\n- [全程D20] 检验组合: 血小板计数(PLT#)-静脉血: 250.210E9/L；肌酐(Crea)-静脉血: 54umol/L；总胆红素(TBIL)-静脉血: 13.7umol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；阴离子间隙(AG)-静脉血: 12.4；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；碱性磷酸酶(ALP)-静脉血: 59.5U/L；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；球蛋白(GLO)-静脉血: 25.26g/L；葡萄糖(Glu)-静脉血: 4.81mmol/L；白蛋白(ALB)-静脉血: 40.9g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；尿素氮(BUN)-静脉血: 3.9mmol/L；血小板分布宽度(PDW)-静脉血: 15.8%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.38mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.05mmolL；乳酸脱氢酶(LDH)-静脉血: 275.2U/L；单核细胞百分比(Mono%)-静脉血: 0.0621；中性粒细胞计数(Neut#)-静脉血: 4.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.711；γ-谷氨酰基转移酶(GGT)-静脉血: 19.5U/L；甘油三酯(TG)-静脉血: 1.23mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.5pg；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.0032；磷(P)-静脉血: 1.37mmol/L；总钙(Ca)-静脉血: 2.23mmol/L；间接胆红素(IBIL)-静脉血: 9umolL；血小板比容-静脉血: 20.8%；C-反应蛋白(CRP)-静脉血: 0.65mg/L；载脂蛋白AI(apoAI)-静脉血: 1.12g/L；总蛋白(TP)-静脉血: 66.16g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.62；单核细胞计数(Mono#)-静脉血: 0.410E9/L；钠离子(Na+)-静脉血: 137.8mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 27.7U/L；丙氨酸氨基转移酶(ALT)-静脉……\n- [全程D37] 检验组合: 嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.4；红细胞比容(Hct)-静脉血: 35.6%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞体积(MCV)-静脉血: 89.9fL；单核细胞百分比(Mono%)-静脉血: 0.046；血小板计数(PLT#)-静脉血: 21310E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.8pg；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.9；平均血小板体积(MPV)-静脉血: 9.2fL；单核细胞计数(Mono#)-静脉血: 0.410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；中性粒细胞百分比(Neut%)-静脉血: 0.79；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；血小板比容-静脉血: 20%；血红蛋白(Hb)-静脉血: 118g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.009；淋巴细胞百分比(Lymph%)-静脉血: 0.147；红细胞计数(RBC#)-静脉血: 3.9610E12/L；血小板分布宽度(PDW)-静脉血: 9.9%；大血小板百分比(P-LCR%)-静脉血: 18.7%；中性粒细胞计数(Neut#)-静脉血: 7.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；白细胞计数(WBC#)-静脉血: 910E9/L\n- [全程D40] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.018；草酸钙结晶计数(CAOX#)-尿液: 10/μL；红细胞计数(RBC#)-尿液: 4/μL；总蛋白(TP)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: 无色；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D41] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；红细胞计数(RBC#)-尿液: 4/μL；白细胞(LEU)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；酮体(KET)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 1/μL；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.024；颜色-尿液: Light-Yellow\n- [全程D42] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 6/μL；隐血(OB)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 4/μL；总蛋白(TP)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7；颜色-尿液: Light-Yellow；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.023；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）；细菌计数(BACT#)-尿液: 8/μL\n- [全程D47] 超声；双侧腋窝淋巴结彩超(套): 检查类型: 超声；检查名称: 双侧腋窝淋巴结彩超(套)；检查部位:；检查所见: 双侧侧腋窝腋下组可见多个淋巴结回声，最大约12x6mm，椭圆形，边界清，皮髓质分界清，淋巴门结构可探及。腋上组及腋中组未见明显异常淋巴结回声。 CDFI：上述淋巴结内可见门型血流信号。；检查结论: 左侧腋窝腋下组淋巴结，符合良性淋巴结声像。\n- [全程D47] 检验组合: 有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 89.5fL；钠离子(Na+)-静脉血: 135.9mmol/L；尿酸(UA)-静脉血: 277.5umol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.0062；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；血红蛋白(Hb)-静脉血: 115.6g/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 332.5g/L；碱性磷酸酶(ALP)-静脉血: 63.1U/L；白蛋白(ALB)-静脉血: 39.9g/L；单核细胞百分比(Mono%)-静脉血: 0.056；α-L-岩藻糖苷酶(AFU)-静脉血: 42.7U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.315；尿素氮(BUN)-静脉血: 5.4mmol/L；白细胞计数(WBC#)-静脉血: 4.0510E9/L；总胆固醇(TC)-静脉血: 4.12mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24U/L；氯离子(Cl-)-静脉血: 99.2mmol/L；载脂蛋白B(apoB)-静脉血: 0.78g/L；丙氨酸氨基转移酶(ALT)-静脉血: 41.3U/L；总胆汁酸(TBA)-静脉血: 0.5umol/L；血小板计数(PLT#)-静脉血: 196.310E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.5%；葡萄糖(Glu)-静脉血: 4.67mmol/L；球蛋白(GLO)-静脉血: 23.82g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.3mmol/L；间接胆红素(IBIL)-静脉血: 7umolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.0051；镁离子(Mg2+)-静脉血: 0.69mmol/L；磷(P)-静脉血: 1.4mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 3.7umol/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；总钙(Ca)-静脉血: 2.27mmol/L；胱抑素(Cys-C)-静脉血: 0.95mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.68；中性粒细胞百分比(……\n- [全程D49] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后： 鼻咽腔轻度狭窄，鼻咽左顶壁、左顶后壁、左侧壁增厚，并见团块状软组织信号影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。鼻咽右侧壁粘膜未见增厚，左侧咽隐窝闭塞，右侧咽隐窝存在，左侧咽旁脂肪间隙狭窄。左侧腭帆提肌、腭帆张肌、头长肌受侵犯，余咽旁诸肌未见异常。 鼻腔未见肿物，口咽左侧壁受侵稍增厚。 双侧翼腭窝、双侧颞下窝未见异常。 蝶骨基底部、斜坡左侧份、左侧岩尖、左侧翼突基底部、左侧翼突内侧板骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、上颌窦、蝶窦、双侧乳突气化良好，未见异常信号影。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。蝶鞍形态正常，其内未见占位性病变。 左侧咽后见肿大的淋巴结，短径17mm，右侧咽后见小淋巴结，短径5mm。左颈II、III区见多个肿大淋巴结，较大者短径13mm，信号欠均匀，增强扫描不均匀强化。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。 扫描所见脑组织未见明确异常。；检查结论: 鼻咽癌化疗后，对比某次就诊时间日片： 鼻咽肿物，较前明显缩小。 颅底骨质破坏，基本同前。 左侧咽后淋巴结、左颈II、III区淋巴结，考虑转移瘤，较前明显缩小。右侧咽后小淋巴结，较前变化不大。\n- [全程D50] 检验组合: 总胆红素(TBIL)-静脉血: 8.1umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 20710E9/L；磷(P)-静脉血: 1.19mmol/L；中性粒细胞计数(Neut#)-静脉血: 2.810E9/L；葡萄糖(Glu)-静脉血: 5.75mmol/L；血红蛋白(Hb)-静脉血: 118g/L；尿酸(UA)-静脉血: 347.3umol/L；平均红细胞体积(MCV)-静脉血: 85.6fL；胱抑素(Cys-C)-静脉血: 1.01mg/L；红细胞比容(Hct)-静脉血: 34%；C-反应蛋白(CRP)-静脉血: 0.45mg/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；白蛋白(ALB)-静脉血: 44.1g/L；肌酐(Crea)-静脉血: 93.9umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 44.6U/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；总钙(Ca)-静脉血: 2.32mmol/L；红细胞计数(RBC#)-静脉血: 3.9710E12/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.1；球蛋白(GLO)-静脉血: 26.11g/L；尿素氮(BUN)-静脉血: 7.9mmol/L；钾离子(K+)-静脉血: 3.55mmol/L；载脂蛋白B(apoB)-静脉血: 0.88g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.72mmol/L；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.592；载脂蛋白AI(apoAI)-静脉血: 1.31g/L；乳酸脱氢酶(LDH)-静脉血: 232.4U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；总胆汁酸(TBA)-静脉血: 2.1umol/L；氯离子(Cl-)-静脉血: 102mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 23.5U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.33mmolL；总蛋白(TP)-静脉血: 70.21g/L；阴离子间隙(AG)-静脉血: 12.8；α-L-岩藻糖苷酶(AFU)-静脉血: 40.7U/L；总胆固醇(TC)-静脉血: 4.57mmol/L；白细胞计数(W……\n- [全程D34] 检验组合: 中性粒细胞百分比(Neut%)-静脉血: 0.356；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329.8g/L；中性粒细胞计数(Neut#)-静脉血: 1.210E9/L；载脂蛋白AI(apoAI)-静脉血: 1.23g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 1.9umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.3；平均红细胞体积(MCV)-静脉血: 89.7fL；钾离子(K+)-静脉血: 3.9mmol/L；总蛋白(TP)-静脉血: 68.46g/L；球蛋白(GLO)-静脉血: 29.66g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.5%；血小板分布宽度(PDW)-静脉血: 16%；白细胞计数(WBC#)-静脉血: 3.2410E9/L；磷(P)-静脉血: 1.24mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.0079；间接胆红素(IBIL)-静脉血: 2.8umolL；镁离子(Mg2+)-静脉血: 0.89mmol/L；碱性磷酸酶(ALP)-静脉血: 66.5U/L；红细胞比容(Hct)-静脉血: 36.1%；丙氨酸氨基转移酶(ALT)-静脉血: 18.5U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.51；单核细胞百分比(Mono%)-静脉血: 0.1112；尿素氮(BUN)-静脉血: 5.39mmol/L；红细胞计数(RBC#)-静脉血: 4.0210E12/L；血小板计数(PLT#)-静脉血: 240.610E9/L；胱抑素(Cys-C)-静脉血: 0.87mg/L；天门冬氨酸氨基转移酶(AST)-静脉血: 22.2U/L；C-反应蛋白(CRP)-静脉血: 0.37mg/L；阴离子间隙(AG)-静脉血: 13；总胆汁酸(TBA)-静脉血: 0.8umol/L；葡萄糖(Glu)-静脉血: 4.81mmol/L；总钙(Ca)-静脉血: 2.31mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；总胆红素(TBIL)-静脉血: 4.7umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.2；平均血小板体积(MPV)-静脉血……\n- [全程D35] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁、后壁及左侧壁增厚放射性浓聚，SUV约22.8，病灶向下侵犯软腭及口咽左侧壁；病灶侵犯左头长肌、左侧腭帆提张肌及左咽旁间隙，左侧咽隐窝消失，左侧咽旁间隙消失。左咽后肿大淋巴结放射性浓聚，SUV约19.2，与鼻咽病灶分界不清。喉咽结构及放射性分布未见明显异常。额窦、蝶窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。左颈II、III区数个淋巴结放射性浓聚，SUV约20.2，最大约1.8×3.3cm；右颈II、Va区数个小淋巴结部分放射性分布略浓密，SUV约3.3，最大约0.6×1.1cm；余双颈小淋巴结放射性分布未见异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。心脏及纵隔大血管未见明显异常。左腋窝淋巴结放射性分布浓密，SUV约9.0，大小约0.9×1.5cm；纵隔、双肺门及右侧腋窝未见肿大淋巴结及异常放射性分布。双侧乳腺放射性分布未见明显异常。 肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 子宫体积增大，外形呈波浪状，放射性分布未见异常；子宫旁见高密度节育器影；膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，病灶侵犯软腭、口咽左侧壁及左咽旁间隙；左咽后及左颈II、III区淋巴结代谢活跃，考虑转移；左腋窝淋巴结代谢活跃，不排除转移。 右颈II、Va区小淋巴结部分代谢略活跃，疑炎性病变，请结合临床。 疑子宫肌瘤。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D15] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D20] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗结束，诉呕吐 次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程5-FU+顺铂方案诱导化疗结束，无诉特殊不适，可予出院，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n- [全程D36] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者复查血常规：中性粒细胞1.2×109/L。郭医生信息已隐藏：暂停化疗，予以患者升中西粒细胞处理。\n- [全程D37] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 患者入院第三天，继续升白细胞处理，今日复查血常规，白细胞已经恢复正常，郭医生信息已隐藏：下周一予以患者第二程化疗。\n- [全程D40] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，可于今日执行第2程5-FU+顺铂方案诱导化疗，注意化疗不良反应。\n- [全程D43] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D47] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+顺铂方案诱导化疗结束，诉恶心、食欲下降，无发热、呕吐、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第2程5-FU+顺铂方案诱导化疗结束，无诉特殊不适，嘱其完成鼻咽、颈MRI复查，以及放疗定位扫描，定期返院治疗。遵嘱。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即按原剂量启动第二程5-FU+顺铂方案化疗，并预防性给予长效重组人粒细胞刺激因子皮下注射\nB. 立即按原剂量启动第二程5-FU+顺铂方案化疗，化疗期间同步给予短效重组人粒细胞刺激因子皮下注射\nC. 暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，动态监测血常规，待中性粒细胞计数恢复后再行下一程化疗\nD. 暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射及广谱抗菌药物静脉滴注，待中性粒细胞计数恢复后再行化疗\nE. 终止诱导化疗，直接进入根治性放疗阶段，并给予重组人粒细胞刺激因子皮下注射\nF. 暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，待中性粒细胞恢复后调整下一程化疗方案为单药顺铂\nG. 暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，待中性粒细胞恢复后将5-FU与顺铂剂量均减低20%行下一程化疗\nH. 暂缓本周期化疗，仅予密切观察和口服升白药物，待中性粒细胞计数自然恢复后再行化疗\nI. 暂缓本周期化疗，行左侧腋窝淋巴结穿刺活检，同时给予重组人粒细胞刺激因子皮下注射\nJ. 立即按原剂量启动第二程5-FU+顺铂方案化疗，化疗结束后48小时给予重组人粒细胞刺激因子皮下注射\nK. 暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，并安排全身PET-CT重新评估肿瘤范围\nL. 终止诱导化疗，改为靶向治疗联合重组人粒细胞刺激因子皮下注射，动态监测血常规\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D34] 检验组合: 中性粒细胞百分比(Neut%)-静脉血: 0.356；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329.8g/L；中性粒细胞计数(Neut#)-静脉血: 1.210E9/L；载脂蛋白AI(apoAI)-静脉血: 1.23g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 1.9umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.3；平均红细胞体积(MCV)-静脉血: 89.7fL；钾离子(K+)-静脉血: 3.9mmol/L；总蛋白(TP)-静脉血: 68.46g/L；球蛋白(GLO)-静脉血: 29.66g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.5%；血小板分布宽度(PDW)-静脉血: 16%；白细胞计数(WBC#)-静脉血: 3.2410E9/L；磷(P)-静脉血: 1.24mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.0079；间接胆红素(IBIL)-静脉血: 2.8umolL；镁离子(Mg2+)-静脉血: 0.89mmol/L；碱性磷酸酶(ALP)-静脉血: 66.5U/L；红细胞比容(Hct)-静脉血: 36.1%；丙氨酸氨基转移酶(ALT)-静脉血: 18.5U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.51；单核细胞百分比(Mono%)-静脉血: 0.1112；尿素氮(BUN)-静脉血: 5.39mmol/L；红细胞计数(RBC#)-静脉血: 4.0210E12/L；血小板计数(PLT#)-静脉血: 240.610E9/L；胱抑素(Cys-C)-静脉血: 0.87mg/L；天门冬氨酸氨基转移酶(AST)-静脉血: 22.2U/L；C-反应蛋白(CRP)-静脉血: 0.37mg/L；阴离子间隙(AG)-静脉血: 13；总胆汁酸(TBA)-静脉血: 0.8umol/L；葡萄糖(Glu)-静脉血: 4.81mmol/L；总钙(Ca)-静脉血: 2.31mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；总胆红素(TBIL)-静脉血: 4.7umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.2；平均血小板体积(MPV)-静脉血……\n- [全程D35] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁、后壁及左侧壁增厚放射性浓聚，SUV约22.8，病灶向下侵犯软腭及口咽左侧壁；病灶侵犯左头长肌、左侧腭帆提张肌及左咽旁间隙，左侧咽隐窝消失，左侧咽旁间隙消失。左咽后肿大淋巴结放射性浓聚，SUV约19.2，与鼻咽病灶分界不清。喉咽结构及放射性分布未见明显异常。额窦、蝶窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。左颈II、III区数个淋巴结放射性浓聚，SUV约20.2，最大约1.8×3.3cm；右颈II、Va区数个小淋巴结部分放射性分布略浓密，SUV约3.3，最大约0.6×1.1cm；余双颈小淋巴结放射性分布未见异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。心脏及纵隔大血管未见明显异常。左腋窝淋巴结放射性分布浓密，SUV约9.0，大小约0.9×1.5cm；纵隔、双肺门及右侧腋窝未见肿大淋巴结及异常放射性分布。双侧乳腺放射性分布未见明显异常。 肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 子宫体积增大，外形呈波浪状，放射性分布未见异常；子宫旁见高密度节育器影；膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，病灶侵犯软腭、口咽左侧壁及左咽旁间隙；左咽后及左颈II、III区淋巴结代谢活跃，考虑转移；左腋窝淋巴结代谢活跃，不排除转移。 右颈II、Va区小淋巴结部分代谢略活跃，疑炎性病变，请结合临床。 疑子宫肌瘤。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即按原剂量启动第二程5-FU+顺铂方案化疗，并预防性给予长效重组人粒细胞刺激因子皮下注射\nB. 立即按原剂量启动第二程5-FU+顺铂方案化疗，化疗期间同步给予短效重组人粒细胞刺激因子皮下注射\nC. 暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，动态监测血常规，待中性粒细胞计数恢复后再行下一程化疗\nD. 暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射及广谱抗菌药物静脉滴注，待中性粒细胞计数恢复后再行化疗\nE. 终止诱导化疗，直接进入根治性放疗阶段，并给予重组人粒细胞刺激因子皮下注射\nF. 暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，待中性粒细胞恢复后调整下一程化疗方案为单药顺铂\nG. 暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，待中性粒细胞恢复后将5-FU与顺铂剂量均减低20%行下一程化疗\nH. 暂缓本周期化疗，仅予密切观察和口服升白药物，待中性粒细胞计数自然恢复后再行化疗\nI. 暂缓本周期化疗，行左侧腋窝淋巴结穿刺活检，同时给予重组人粒细胞刺激因子皮下注射\nJ. 立即按原剂量启动第二程5-FU+顺铂方案化疗，化疗结束后48小时给予重组人粒细胞刺激因子皮下注射\nK. 暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，并安排全身PET-CT重新评估肿瘤范围\nL. 终止诱导化疗，改为靶向治疗联合重组人粒细胞刺激因子皮下注射，动态监测血常规\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、斜坡、口咽、蝶骨基底部、岩尖。\n文本分期信息：N2，Mx 左侧腋窝淋巴结可疑转移。\n综合TNM状态：T3N2Mx 左侧腋窝淋巴结可疑转移。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D34] 检验组合: 中性粒细胞百分比(Neut%)-静脉血: 0.356；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329.8g/L；中性粒细胞计数(Neut#)-静脉血: 1.210E9/L；载脂蛋白AI(apoAI)-静脉血: 1.23g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 1.9umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.3；平均红细胞体积(MCV)-静脉血: 89.7fL；钾离子(K+)-静脉血: 3.9mmol/L；总蛋白(TP)-静脉血: 68.46g/L；球蛋白(GLO)-静脉血: 29.66g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.5%；血小板分布宽度(PDW)-静脉血: 16%；白细胞计数(WBC#)-静脉血: 3.2410E9/L；磷(P)-静脉血: 1.24mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.0079；间接胆红素(IBIL)-静脉血: 2.8umolL；镁离子(Mg2+)-静脉血: 0.89mmol/L；碱性磷酸酶(ALP)-静脉血: 66.5U/L；红细胞比容(Hct)-静脉血: 36.1%；丙氨酸氨基转移酶(ALT)-静脉血: 18.5U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.51；单核细胞百分比(Mono%)-静脉血: 0.1112；尿素氮(BUN)-静脉血: 5.39mmol/L；红细胞计数(RBC#)-静脉血: 4.0210E12/L；血小板计数(PLT#)-静脉血: 240.610E9/L；胱抑素(Cys-C)-静脉血: 0.87mg/L；天门冬氨酸氨基转移酶(AST)-静脉血: 22.2U/L；C-反应蛋白(CRP)-静脉血: 0.37mg/L；阴离子间隙(AG)-静脉血: 13；总胆汁酸(TBA)-静脉血: 0.8umol/L；葡萄糖(Glu)-静脉血: 4.81mmol/L；总钙(Ca)-静脉血: 2.31mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；总胆红素(TBIL)-静脉血: 4.7umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.2；平均血小板体积(MPV)-静脉血……\n- [全程D35] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁、后壁及左侧壁增厚放射性浓聚，SUV约22.8，病灶向下侵犯软腭及口咽左侧壁；病灶侵犯左头长肌、左侧腭帆提张肌及左咽旁间隙，左侧咽隐窝消失，左侧咽旁间隙消失。左咽后肿大淋巴结放射性浓聚，SUV约19.2，与鼻咽病灶分界不清。喉咽结构及放射性分布未见明显异常。额窦、蝶窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。左颈II、III区数个淋巴结放射性浓聚，SUV约20.2，最大约1.8×3.3cm；右颈II、Va区数个小淋巴结部分放射性分布略浓密，SUV约3.3，最大约0.6×1.1cm；余双颈小淋巴结放射性分布未见异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。心脏及纵隔大血管未见明显异常。左腋窝淋巴结放射性分布浓密，SUV约9.0，大小约0.9×1.5cm；纵隔、双肺门及右侧腋窝未见肿大淋巴结及异常放射性分布。双侧乳腺放射性分布未见明显异常。 肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 子宫体积增大，外形呈波浪状，放射性分布未见异常；子宫旁见高密度节育器影；膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，病灶侵犯软腭、口咽左侧壁及左咽旁间隙；左咽后及左颈II、III区淋巴结代谢活跃，考虑转移；左腋窝淋巴结代谢活跃，不排除转移。 右颈II、Va区小淋巴结部分代谢略活跃，疑炎性病变，请结合临床。 疑子宫肌瘤。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即按原剂量启动第二程5-FU+顺铂方案化疗，并预防性给予长效重组人粒细胞刺激因子皮下注射\nB. 立即按原剂量启动第二程5-FU+顺铂方案化疗，化疗期间同步给予短效重组人粒细胞刺激因子皮下注射\nC. 暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，动态监测血常规，待中性粒细胞计数恢复后再行下一程化疗\nD. 暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射及广谱抗菌药物静脉滴注，待中性粒细胞计数恢复后再行化疗\nE. 终止诱导化疗，直接进入根治性放疗阶段，并给予重组人粒细胞刺激因子皮下注射\nF. 暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，待中性粒细胞恢复后调整下一程化疗方案为单药顺铂\nG. 暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，待中性粒细胞恢复后将5-FU与顺铂剂量均减低20%行下一程化疗\nH. 暂缓本周期化疗，仅予密切观察和口服升白药物，待中性粒细胞计数自然恢复后再行化疗\nI. 暂缓本周期化疗，行左侧腋窝淋巴结穿刺活检，同时给予重组人粒细胞刺激因子皮下注射\nJ. 立即按原剂量启动第二程5-FU+顺铂方案化疗，化疗结束后48小时给予重组人粒细胞刺激因子皮下注射\nK. 暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，并安排全身PET-CT重新评估肿瘤范围\nL. 终止诱导化疗，改为靶向治疗联合重组人粒细胞刺激因子皮下注射，动态监测血常规\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-800192dfaf82bbe4edb2533a","patient_id":"patient-5fa48522b2703f35ead0224b","turn_id":"turn08","turn_position":6,"turn_type":"response_assessment_decision","gold_letter":"A","gold_action":"完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动顺铂同期化放疗","options":[{"letter":"A","text":"完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动顺铂同期化放疗","is_gold":true},{"letter":"B","text":"完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动第3程5-FU+顺铂诱导化疗","is_gold":false},{"letter":"C","text":"完善左侧腋窝淋巴结穿刺活检，行放疗定位扫描，并启动顺铂同期化放疗","is_gold":false},{"letter":"D","text":"完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动尼妥珠单抗联合根治性放疗","is_gold":false},{"letter":"E","text":"完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动单纯根治性放疗","is_gold":false},{"letter":"F","text":"完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动信迪利单抗联合根治性放疗","is_gold":false},{"letter":"G","text":"完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动尼妥珠单抗联合顺铂同期化放疗","is_gold":false},{"letter":"H","text":"完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动卡培他滨同期化放疗","is_gold":false},{"letter":"I","text":"完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动西妥昔单抗联合根治性放疗","is_gold":false},{"letter":"J","text":"完善全身PET-CT复查，行放疗定位扫描，并启动尼妥珠单抗联合根治性放疗","is_gold":false},{"letter":"K","text":"完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动吉西他滨联合顺铂同期化放疗","is_gold":false},{"letter":"L","text":"完善鼻咽及颈部MRI复查，暂缓放疗定位，启动第3程5-FU+顺铂诱导化疗","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、斜坡、口咽、蝶骨基底部、岩尖。\n文本分期信息：N2，Mx 左侧腋窝淋巴结可疑转移。\n综合TNM状态：T3N2Mx 左侧腋窝淋巴结可疑转移。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 正常范围心电图\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽左顶壁、左顶后壁、左侧壁增厚，并见团块状软组织信号影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，鼻咽右侧壁粘膜未见增厚，左侧咽隐窝闭塞，右侧咽隐窝存在，左侧咽旁脂肪间隙狭窄。左侧腭帆提肌、腭帆张肌、头长肌、翼内肌受侵犯，余咽旁诸肌未见异常； 左侧咽后见肿大的淋巴结，短径22mm，右侧咽后见小淋巴结，短径5mm。 病灶向前堵塞左侧后鼻孔，口咽左侧壁受侵增厚。 左侧翼腭窝软组织影稍增多，右侧翼腭窝、双侧颞下窝未见异常。 蝶骨基底部、斜坡左侧份、左侧岩尖骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、上颌窦粘膜增厚；蝶窦、双侧乳突气化良好，未见异常信号影；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。 双颈II区、左颈III区见多个淋巴结，较大者短径24mm，信号欠均匀，增强扫描不均匀强化。；检查结论: 鼻咽左顶后壁、左侧壁病灶，考虑鼻咽癌，侵犯左侧咽旁、口咽左侧壁。 颅底骨质破坏。 双侧咽后、双颈II区、左颈III区淋巴结，考虑转移瘤。 副鼻窦炎。\n- [全程D5] 检验组合: 红细胞比容(Hct)-静脉血: 38.9%；血红蛋白(Hb)-静脉血: 131.6g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.5mmolL；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；总蛋白(TP)-静脉血: 69.64g/L；总钙(Ca)-静脉血: 2.26mmol/L；白蛋白(ALB)-静脉血: 43.1g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.42mmol/L；磷(P)-静脉血: 1.22mmol/L；凝血酶时间(TT)-静脉血: 17.3sec.；淋巴细胞百分比(Lymph%)-静脉血: 0.325；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；钠离子(Na+)-静脉血: 140.5mmol/L；单核细胞百分比(Mono%)-静脉血: 0.0954；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；载脂蛋白AI(apoAI)-静脉血: 1.38g/L；丙氨酸氨基转移酶(ALT)-静脉血: 21.7U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；氯离子(Cl-)-静脉血: 103.9mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；血小板计数(PLT#)-静脉血: 270.910E9/L；总胆固醇(TC)-静脉血: 5.3mmol/L；C-反应蛋白(CRP)-静脉血: 0.37mg/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.69mmol/L；甘油三酯(TG)-静脉血: 0.78mmol/L；淋巴细胞计数(Lymph#)-静脉血: 210E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.568；凝血酶原时间活动度(PTA)-静脉血: 94%；活化部分凝血活酶时间(APTT)-静脉血: 25.3sec.；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；平均红细胞血红蛋白含量(MCH)-静脉血: 30.2pg；凝血酶原时间(PT)-静脉血: 11.4sec.；纤维蛋白原(Fbg)-静脉血: 2.62g/L；天门冬氨酸氨基转移酶/丙氨酸氨……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D8] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见:；检查结论:\n- [全程D14] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；透明质酸(HA)-静脉血: 76.89ng/ml；III型前胶原氨基端肽(PIIINP)-静脉血: 28.08ng/ml；葡萄糖(Glu)-尿液: -（参考: 阴性）；降钙素(CT)-静脉血: 22.05pg/ml；总蛋白(TP)-尿液: -（参考: 阴性）；IV型胶原(C-IV)-静脉血: 28.93ng/ml；比重(SG)-尿液: 1.008；颜色-尿液: 无色；酸碱度(pH)-尿液: 6.5；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；层粘连蛋白(LN)-静脉血: 35.29ng/ml；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮\n- [全程D15] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T6水平，估计导管末端位于上腔静脉内。；检查结论: PICC管末端位置如上述。\n- [全程D15] 检验组合: 骨钙素N端中分子片段(N-MID)-静脉血: 11.9ng/ml；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.318ng/ml\n- [全程D16] 检验组合: 浊度(TRUB)-尿液: 清亮；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: +-（参考: 阴性）；酸碱度(pH)-尿液: 7；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.016；葡萄糖(Glu)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 3/μL\n- [全程D17] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 31/μL；颜色-尿液: Yellow；鳞状上皮细胞计数(SQEP#)-尿液: 7/μL；白细胞计数(WBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.021；浊度(TRUB)-尿液: 清亮；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D19] 检验组合: 总钙(Ca)-静脉血: 2.15mmol/L；钠离子(Na+)-静脉血: 138.8mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.2mmol/L；钾离子(K+)-静脉血: 3.08mmol/L；氯离子(Cl-)-静脉血: 102.2mmol/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；磷(P)-静脉血: 1.19mmol/L；阴离子间隙(AG)-静脉血: 15.4\n- [全程D20] 超声；双侧腋窝淋巴结彩超(套): 检查类型: 超声；检查名称: 双侧腋窝淋巴结彩超(套)；检查部位:；检查所见: 左侧腋窝腋下组可见1个淋巴结回声，大小约16x4mm，椭圆形，边界清，皮髓质分界清，淋巴门结构可探及。腋上组及腋中组未见明显异常淋巴结回声。 CDFI：上述淋巴结内可见门型血流信号。；检查结论: 左侧腋窝腋下组淋巴结，符合良性淋巴结声像。\n- [全程D20] 检验组合: 血小板计数(PLT#)-静脉血: 250.210E9/L；肌酐(Crea)-静脉血: 54umol/L；总胆红素(TBIL)-静脉血: 13.7umol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；阴离子间隙(AG)-静脉血: 12.4；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；碱性磷酸酶(ALP)-静脉血: 59.5U/L；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；球蛋白(GLO)-静脉血: 25.26g/L；葡萄糖(Glu)-静脉血: 4.81mmol/L；白蛋白(ALB)-静脉血: 40.9g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；尿素氮(BUN)-静脉血: 3.9mmol/L；血小板分布宽度(PDW)-静脉血: 15.8%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.38mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.05mmolL；乳酸脱氢酶(LDH)-静脉血: 275.2U/L；单核细胞百分比(Mono%)-静脉血: 0.0621；中性粒细胞计数(Neut#)-静脉血: 4.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.711；γ-谷氨酰基转移酶(GGT)-静脉血: 19.5U/L；甘油三酯(TG)-静脉血: 1.23mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.5pg；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.0032；磷(P)-静脉血: 1.37mmol/L；总钙(Ca)-静脉血: 2.23mmol/L；间接胆红素(IBIL)-静脉血: 9umolL；血小板比容-静脉血: 20.8%；C-反应蛋白(CRP)-静脉血: 0.65mg/L；载脂蛋白AI(apoAI)-静脉血: 1.12g/L；总蛋白(TP)-静脉血: 66.16g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.62；单核细胞计数(Mono#)-静脉血: 0.410E9/L；钠离子(Na+)-静脉血: 137.8mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 27.7U/L；丙氨酸氨基转移酶(ALT)-静脉……\n- [全程D37] 检验组合: 嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.4；红细胞比容(Hct)-静脉血: 35.6%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞体积(MCV)-静脉血: 89.9fL；单核细胞百分比(Mono%)-静脉血: 0.046；血小板计数(PLT#)-静脉血: 21310E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.8pg；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.9；平均血小板体积(MPV)-静脉血: 9.2fL；单核细胞计数(Mono#)-静脉血: 0.410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；中性粒细胞百分比(Neut%)-静脉血: 0.79；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；血小板比容-静脉血: 20%；血红蛋白(Hb)-静脉血: 118g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.009；淋巴细胞百分比(Lymph%)-静脉血: 0.147；红细胞计数(RBC#)-静脉血: 3.9610E12/L；血小板分布宽度(PDW)-静脉血: 9.9%；大血小板百分比(P-LCR%)-静脉血: 18.7%；中性粒细胞计数(Neut#)-静脉血: 7.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；白细胞计数(WBC#)-静脉血: 910E9/L\n- [全程D40] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.018；草酸钙结晶计数(CAOX#)-尿液: 10/μL；红细胞计数(RBC#)-尿液: 4/μL；总蛋白(TP)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: 无色；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D41] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；红细胞计数(RBC#)-尿液: 4/μL；白细胞(LEU)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；酮体(KET)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 1/μL；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.024；颜色-尿液: Light-Yellow\n- [全程D42] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 6/μL；隐血(OB)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 4/μL；总蛋白(TP)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7；颜色-尿液: Light-Yellow；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.023；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）；细菌计数(BACT#)-尿液: 8/μL\n- [全程D47] 超声；双侧腋窝淋巴结彩超(套): 检查类型: 超声；检查名称: 双侧腋窝淋巴结彩超(套)；检查部位:；检查所见: 双侧侧腋窝腋下组可见多个淋巴结回声，最大约12x6mm，椭圆形，边界清，皮髓质分界清，淋巴门结构可探及。腋上组及腋中组未见明显异常淋巴结回声。 CDFI：上述淋巴结内可见门型血流信号。；检查结论: 左侧腋窝腋下组淋巴结，符合良性淋巴结声像。\n- [全程D47] 检验组合: 有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 89.5fL；钠离子(Na+)-静脉血: 135.9mmol/L；尿酸(UA)-静脉血: 277.5umol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.0062；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；血红蛋白(Hb)-静脉血: 115.6g/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 332.5g/L；碱性磷酸酶(ALP)-静脉血: 63.1U/L；白蛋白(ALB)-静脉血: 39.9g/L；单核细胞百分比(Mono%)-静脉血: 0.056；α-L-岩藻糖苷酶(AFU)-静脉血: 42.7U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.315；尿素氮(BUN)-静脉血: 5.4mmol/L；白细胞计数(WBC#)-静脉血: 4.0510E9/L；总胆固醇(TC)-静脉血: 4.12mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24U/L；氯离子(Cl-)-静脉血: 99.2mmol/L；载脂蛋白B(apoB)-静脉血: 0.78g/L；丙氨酸氨基转移酶(ALT)-静脉血: 41.3U/L；总胆汁酸(TBA)-静脉血: 0.5umol/L；血小板计数(PLT#)-静脉血: 196.310E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.5%；葡萄糖(Glu)-静脉血: 4.67mmol/L；球蛋白(GLO)-静脉血: 23.82g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.3mmol/L；间接胆红素(IBIL)-静脉血: 7umolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.0051；镁离子(Mg2+)-静脉血: 0.69mmol/L；磷(P)-静脉血: 1.4mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 3.7umol/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；总钙(Ca)-静脉血: 2.27mmol/L；胱抑素(Cys-C)-静脉血: 0.95mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.68；中性粒细胞百分比(……\n- [全程D49] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后： 鼻咽腔轻度狭窄，鼻咽左顶壁、左顶后壁、左侧壁增厚，并见团块状软组织信号影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。鼻咽右侧壁粘膜未见增厚，左侧咽隐窝闭塞，右侧咽隐窝存在，左侧咽旁脂肪间隙狭窄。左侧腭帆提肌、腭帆张肌、头长肌受侵犯，余咽旁诸肌未见异常。 鼻腔未见肿物，口咽左侧壁受侵稍增厚。 双侧翼腭窝、双侧颞下窝未见异常。 蝶骨基底部、斜坡左侧份、左侧岩尖、左侧翼突基底部、左侧翼突内侧板骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、上颌窦、蝶窦、双侧乳突气化良好，未见异常信号影。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。蝶鞍形态正常，其内未见占位性病变。 左侧咽后见肿大的淋巴结，短径17mm，右侧咽后见小淋巴结，短径5mm。左颈II、III区见多个肿大淋巴结，较大者短径13mm，信号欠均匀，增强扫描不均匀强化。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。 扫描所见脑组织未见明确异常。；检查结论: 鼻咽癌化疗后，对比某次就诊时间日片： 鼻咽肿物，较前明显缩小。 颅底骨质破坏，基本同前。 左侧咽后淋巴结、左颈II、III区淋巴结，考虑转移瘤，较前明显缩小。右侧咽后小淋巴结，较前变化不大。\n- [全程D50] 检验组合: 总胆红素(TBIL)-静脉血: 8.1umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 20710E9/L；磷(P)-静脉血: 1.19mmol/L；中性粒细胞计数(Neut#)-静脉血: 2.810E9/L；葡萄糖(Glu)-静脉血: 5.75mmol/L；血红蛋白(Hb)-静脉血: 118g/L；尿酸(UA)-静脉血: 347.3umol/L；平均红细胞体积(MCV)-静脉血: 85.6fL；胱抑素(Cys-C)-静脉血: 1.01mg/L；红细胞比容(Hct)-静脉血: 34%；C-反应蛋白(CRP)-静脉血: 0.45mg/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；白蛋白(ALB)-静脉血: 44.1g/L；肌酐(Crea)-静脉血: 93.9umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 44.6U/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；总钙(Ca)-静脉血: 2.32mmol/L；红细胞计数(RBC#)-静脉血: 3.9710E12/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.1；球蛋白(GLO)-静脉血: 26.11g/L；尿素氮(BUN)-静脉血: 7.9mmol/L；钾离子(K+)-静脉血: 3.55mmol/L；载脂蛋白B(apoB)-静脉血: 0.88g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.72mmol/L；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.592；载脂蛋白AI(apoAI)-静脉血: 1.31g/L；乳酸脱氢酶(LDH)-静脉血: 232.4U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；总胆汁酸(TBA)-静脉血: 2.1umol/L；氯离子(Cl-)-静脉血: 102mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 23.5U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.33mmolL；总蛋白(TP)-静脉血: 70.21g/L；阴离子间隙(AG)-静脉血: 12.8；α-L-岩藻糖苷酶(AFU)-静脉血: 40.7U/L；总胆固醇(TC)-静脉血: 4.57mmol/L；白细胞计数(W……\n- [全程D34] 检验组合: 中性粒细胞百分比(Neut%)-静脉血: 0.356；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329.8g/L；中性粒细胞计数(Neut#)-静脉血: 1.210E9/L；载脂蛋白AI(apoAI)-静脉血: 1.23g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 1.9umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.3；平均红细胞体积(MCV)-静脉血: 89.7fL；钾离子(K+)-静脉血: 3.9mmol/L；总蛋白(TP)-静脉血: 68.46g/L；球蛋白(GLO)-静脉血: 29.66g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.5%；血小板分布宽度(PDW)-静脉血: 16%；白细胞计数(WBC#)-静脉血: 3.2410E9/L；磷(P)-静脉血: 1.24mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.0079；间接胆红素(IBIL)-静脉血: 2.8umolL；镁离子(Mg2+)-静脉血: 0.89mmol/L；碱性磷酸酶(ALP)-静脉血: 66.5U/L；红细胞比容(Hct)-静脉血: 36.1%；丙氨酸氨基转移酶(ALT)-静脉血: 18.5U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.51；单核细胞百分比(Mono%)-静脉血: 0.1112；尿素氮(BUN)-静脉血: 5.39mmol/L；红细胞计数(RBC#)-静脉血: 4.0210E12/L；血小板计数(PLT#)-静脉血: 240.610E9/L；胱抑素(Cys-C)-静脉血: 0.87mg/L；天门冬氨酸氨基转移酶(AST)-静脉血: 22.2U/L；C-反应蛋白(CRP)-静脉血: 0.37mg/L；阴离子间隙(AG)-静脉血: 13；总胆汁酸(TBA)-静脉血: 0.8umol/L；葡萄糖(Glu)-静脉血: 4.81mmol/L；总钙(Ca)-静脉血: 2.31mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；总胆红素(TBIL)-静脉血: 4.7umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.2；平均血小板体积(MPV)-静脉血……\n- [全程D35] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁、后壁及左侧壁增厚放射性浓聚，SUV约22.8，病灶向下侵犯软腭及口咽左侧壁；病灶侵犯左头长肌、左侧腭帆提张肌及左咽旁间隙，左侧咽隐窝消失，左侧咽旁间隙消失。左咽后肿大淋巴结放射性浓聚，SUV约19.2，与鼻咽病灶分界不清。喉咽结构及放射性分布未见明显异常。额窦、蝶窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。左颈II、III区数个淋巴结放射性浓聚，SUV约20.2，最大约1.8×3.3cm；右颈II、Va区数个小淋巴结部分放射性分布略浓密，SUV约3.3，最大约0.6×1.1cm；余双颈小淋巴结放射性分布未见异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。心脏及纵隔大血管未见明显异常。左腋窝淋巴结放射性分布浓密，SUV约9.0，大小约0.9×1.5cm；纵隔、双肺门及右侧腋窝未见肿大淋巴结及异常放射性分布。双侧乳腺放射性分布未见明显异常。 肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 子宫体积增大，外形呈波浪状，放射性分布未见异常；子宫旁见高密度节育器影；膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，病灶侵犯软腭、口咽左侧壁及左咽旁间隙；左咽后及左颈II、III区淋巴结代谢活跃，考虑转移；左腋窝淋巴结代谢活跃，不排除转移。 右颈II、Va区小淋巴结部分代谢略活跃，疑炎性病变，请结合临床。 疑子宫肌瘤。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D15] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D20] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗结束，诉呕吐 次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程5-FU+顺铂方案诱导化疗结束，无诉特殊不适，可予出院，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n- [全程D36] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者复查血常规：中性粒细胞1.2×109/L。郭医生信息已隐藏：暂停化疗，予以患者升中西粒细胞处理。\n- [全程D37] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 患者入院第三天，继续升白细胞处理，今日复查血常规，白细胞已经恢复正常，郭医生信息已隐藏：下周一予以患者第二程化疗。\n- [全程D40] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，可于今日执行第2程5-FU+顺铂方案诱导化疗，注意化疗不良反应。\n- [全程D43] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D47] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+顺铂方案诱导化疗结束，诉恶心、食欲下降，无发热、呕吐、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第2程5-FU+顺铂方案诱导化疗结束，无诉特殊不适，嘱其完成鼻咽、颈MRI复查，以及放疗定位扫描，定期返院治疗。遵嘱。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动顺铂同期化放疗\nB. 完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动第3程5-FU+顺铂诱导化疗\nC. 完善左侧腋窝淋巴结穿刺活检，行放疗定位扫描，并启动顺铂同期化放疗\nD. 完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动尼妥珠单抗联合根治性放疗\nE. 完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动单纯根治性放疗\nF. 完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动信迪利单抗联合根治性放疗\nG. 完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动尼妥珠单抗联合顺铂同期化放疗\nH. 完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动卡培他滨同期化放疗\nI. 完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动西妥昔单抗联合根治性放疗\nJ. 完善全身PET-CT复查，行放疗定位扫描，并启动尼妥珠单抗联合根治性放疗\nK. 完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动吉西他滨联合顺铂同期化放疗\nL. 完善鼻咽及颈部MRI复查，暂缓放疗定位，启动第3程5-FU+顺铂诱导化疗\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- 无可展示记录。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动顺铂同期化放疗\nB. 完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动第3程5-FU+顺铂诱导化疗\nC. 完善左侧腋窝淋巴结穿刺活检，行放疗定位扫描，并启动顺铂同期化放疗\nD. 完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动尼妥珠单抗联合根治性放疗\nE. 完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动单纯根治性放疗\nF. 完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动信迪利单抗联合根治性放疗\nG. 完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动尼妥珠单抗联合顺铂同期化放疗\nH. 完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动卡培他滨同期化放疗\nI. 完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动西妥昔单抗联合根治性放疗\nJ. 完善全身PET-CT复查，行放疗定位扫描，并启动尼妥珠单抗联合根治性放疗\nK. 完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动吉西他滨联合顺铂同期化放疗\nL. 完善鼻咽及颈部MRI复查，暂缓放疗定位，启动第3程5-FU+顺铂诱导化疗\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 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full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、斜坡、海绵窦、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左耳听力下降1年余；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右耳鸣；既往史: 某次就诊时间患“结核性胸膜炎”已治愈，某次就诊时间患“急性胰腺炎”已治愈。否认\"肝炎、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟史30年，1包每天，常饮酒，两天/次，每次500ml。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：120/80mmHg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧壁、顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸腹部CT平扫，常规血液学检查。\nB. 鼻咽及颈部MRI平扫+增强，全身PET/CT，常规血液学检查，直接安排诱导化疗。\nC. 鼻咽镜检查及活检，鼻咽MRI平扫+增强，胸部X线片，腹部超声，全身骨扫描。\nD. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫，全身PET/CT，常规血液学及心电图检查。\nE. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT，常规血液学、心电图与超声检查。\nF. 颈部淋巴结穿刺活检，鼻咽及颈部MRI平扫+增强，全身PET/CT，常规血液学检查。\nG. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，暂缓全身影像学检查待病理结果回报。\nH. 鼻咽镜检查及活检，头颅CT平扫，颈部超声，胸腹部CT平扫+增强，常规血液学检查。\nI. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部CT平扫，腹部超声，暂不进行骨骼检查。\nJ. 鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，全身PET/CT，常规血液学及心电图检查。\nK. 鼻咽镜检查，鼻咽及颈部MRI平扫+增强，全身PET/CT，待影像学评估后再行内镜活检。\nL. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT，同步进行根治性放疗定位。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"你正在参与一名鼻咽癌相关患者的 full-care 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张口门齿距4.5cm；鼻咽双侧壁、顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸腹部CT平扫，常规血液学检查。\nB. 鼻咽及颈部MRI平扫+增强，全身PET/CT，常规血液学检查，直接安排诱导化疗。\nC. 鼻咽镜检查及活检，鼻咽MRI平扫+增强，胸部X线片，腹部超声，全身骨扫描。\nD. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫，全身PET/CT，常规血液学及心电图检查。\nE. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT，常规血液学、心电图与超声检查。\nF. 颈部淋巴结穿刺活检，鼻咽及颈部MRI平扫+增强，全身PET/CT，常规血液学检查。\nG. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，暂缓全身影像学检查待病理结果回报。\nH. 鼻咽镜检查及活检，头颅CT平扫，颈部超声，胸腹部CT平扫+增强，常规血液学检查。\nI. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部CT平扫，腹部超声，暂不进行骨骼检查。\nJ. 鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，全身PET/CT，常规血液学及心电图检查。\nK. 鼻咽镜检查，鼻咽及颈部MRI平扫+增强，全身PET/CT，待影像学评估后再行内镜活检。\nL. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT，同步进行根治性放疗定位。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、斜坡、海绵窦、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左耳听力下降1年余；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右耳鸣；既往史: 某次就诊时间患“结核性胸膜炎”已治愈，某次就诊时间患“急性胰腺炎”已治愈。否认\"肝炎、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟史30年，1包每天，常饮酒，两天/次，每次500ml。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：120/80mmHg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧壁、顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸腹部CT平扫，常规血液学检查。\nB. 鼻咽及颈部MRI平扫+增强，全身PET/CT，常规血液学检查，直接安排诱导化疗。\nC. 鼻咽镜检查及活检，鼻咽MRI平扫+增强，胸部X线片，腹部超声，全身骨扫描。\nD. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫，全身PET/CT，常规血液学及心电图检查。\nE. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT，常规血液学、心电图与超声检查。\nF. 颈部淋巴结穿刺活检，鼻咽及颈部MRI平扫+增强，全身PET/CT，常规血液学检查。\nG. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，暂缓全身影像学检查待病理结果回报。\nH. 鼻咽镜检查及活检，头颅CT平扫，颈部超声，胸腹部CT平扫+增强，常规血液学检查。\nI. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部CT平扫，腹部超声，暂不进行骨骼检查。\nJ. 鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，全身PET/CT，常规血液学及心电图检查。\nK. 鼻咽镜检查，鼻咽及颈部MRI平扫+增强，全身PET/CT，待影像学评估后再行内镜活检。\nL. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT，同步进行根治性放疗定位。\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-13d0893c195434e9115bcbbc","patient_id":"patient-84fa3d6098d10a1d14b6b19e","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"F","gold_action":"完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测。","options":[{"letter":"A","text":"完善基线血液学检查，包含血常规、生化常规及凝血功能，暂缓检测EB病毒DNA及骨代谢标志物。","is_gold":false},{"letter":"B","text":"完善基线血液学检查，包含生化常规、凝血功能及传染病筛查，并安排全身PET-CT替代常规影像学分期。","is_gold":false},{"letter":"C","text":"完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能及传染病筛查，暂缓检测骨代谢标志物。","is_gold":false},{"letter":"D","text":"完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查，并安排颈部淋巴结穿刺活检明确病理。","is_gold":false},{"letter":"E","text":"完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查，并安排头颅增强MRI评估颅内侵犯。","is_gold":false},{"letter":"F","text":"完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测。","is_gold":true},{"letter":"G","text":"完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并安排全身PET-CT替代所有常规分期检查。","is_gold":false},{"letter":"H","text":"完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并安排鼻咽部平扫MRI。","is_gold":false},{"letter":"I","text":"完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并安排颈部超声指导淋巴结清扫。","is_gold":false},{"letter":"J","text":"完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并安排鼻咽镜评估治疗疗效。","is_gold":false},{"letter":"K","text":"完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并首选胸部X线片排除肺转移。","is_gold":false},{"letter":"L","text":"完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并常规安排骨髓穿刺排除骨髓转移。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、斜坡、海绵窦、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左耳听力下降1年余；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右耳鸣；既往史: 某次就诊时间患“结核性胸膜炎”已治愈，某次就诊时间患“急性胰腺炎”已治愈。否认\"肝炎、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟史30年，1包每天，常饮酒，两天/次，每次500ml。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：120/80mmHg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧壁、顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善基线血液学检查，包含血常规、生化常规及凝血功能，暂缓检测EB病毒DNA及骨代谢标志物。\nB. 完善基线血液学检查，包含生化常规、凝血功能及传染病筛查，并安排全身PET-CT替代常规影像学分期。\nC. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能及传染病筛查，暂缓检测骨代谢标志物。\nD. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查，并安排颈部淋巴结穿刺活检明确病理。\nE. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查，并安排头颅增强MRI评估颅内侵犯。\nF. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测。\nG. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并安排全身PET-CT替代所有常规分期检查。\nH. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并安排鼻咽部平扫MRI。\nI. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并安排颈部超声指导淋巴结清扫。\nJ. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并安排鼻咽镜评估治疗疗效。\nK. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并首选胸部X线片排除肺转移。\nL. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并常规安排骨髓穿刺排除骨髓转移。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善基线血液学检查，包含血常规、生化常规及凝血功能，暂缓检测EB病毒DNA及骨代谢标志物。\nB. 完善基线血液学检查，包含生化常规、凝血功能及传染病筛查，并安排全身PET-CT替代常规影像学分期。\nC. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能及传染病筛查，暂缓检测骨代谢标志物。\nD. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查，并安排颈部淋巴结穿刺活检明确病理。\nE. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查，并安排头颅增强MRI评估颅内侵犯。\nF. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测。\nG. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并安排全身PET-CT替代所有常规分期检查。\nH. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并安排鼻咽部平扫MRI。\nI. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并安排颈部超声指导淋巴结清扫。\nJ. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并安排鼻咽镜评估治疗疗效。\nK. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并首选胸部X线片排除肺转移。\nL. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并常规安排骨髓穿刺排除骨髓转移。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、斜坡、海绵窦、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善基线血液学检查，包含血常规、生化常规及凝血功能，暂缓检测EB病毒DNA及骨代谢标志物。\nB. 完善基线血液学检查，包含生化常规、凝血功能及传染病筛查，并安排全身PET-CT替代常规影像学分期。\nC. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能及传染病筛查，暂缓检测骨代谢标志物。\nD. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查，并安排颈部淋巴结穿刺活检明确病理。\nE. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查，并安排头颅增强MRI评估颅内侵犯。\nF. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测。\nG. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并安排全身PET-CT替代所有常规分期检查。\nH. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并安排鼻咽部平扫MRI。\nI. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并安排颈部超声指导淋巴结清扫。\nJ. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并安排鼻咽镜评估治疗疗效。\nK. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并首选胸部X线片排除肺转移。\nL. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并常规安排骨髓穿刺排除骨髓转移。\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-474b60646fc04122e2c1c7ce","patient_id":"patient-84fa3d6098d10a1d14b6b19e","turn_id":"turn04","turn_position":3,"turn_type":"initial_treatment_selection","gold_letter":"H","gold_action":"顺铂+氟尿嘧啶（PF方案）诱导化疗","options":[{"letter":"A","text":"顺铂单药同期放化疗","is_gold":false},{"letter":"B","text":"多西他赛+顺铂（TP方案）姑息化疗","is_gold":false},{"letter":"C","text":"鼻咽及颈部根治性放射治疗","is_gold":false},{"letter":"D","text":"顺铂+多西他赛（TP方案）同期放化疗","is_gold":false},{"letter":"E","text":"依托泊苷+顺铂（EP方案）诱导化疗","is_gold":false},{"letter":"F","text":"顺铂+氟尿嘧啶（PF方案）姑息化疗","is_gold":false},{"letter":"G","text":"西妥昔单抗联合根治性放疗","is_gold":false},{"letter":"H","text":"顺铂+氟尿嘧啶（PF方案）诱导化疗","is_gold":true},{"letter":"I","text":"氟尿嘧啶单药诱导化疗","is_gold":false},{"letter":"J","text":"吉西他滨+顺铂（GP方案）姑息化疗","is_gold":false},{"letter":"K","text":"顺铂单药诱导化疗","is_gold":false},{"letter":"L","text":"卡瑞利珠单抗联合PF方案姑息化疗","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、斜坡、海绵窦、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左耳听力下降1年余；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右耳鸣；既往史: 某次就诊时间患“结核性胸膜炎”已治愈，某次就诊时间患“急性胰腺炎”已治愈。否认\"肝炎、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟史30年，1包每天，常饮酒，两天/次，每次500ml。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：120/80mmHg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧壁、顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D3] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D3] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 38mm AO 26mm MV E 0.79m/s EF 75% LV 50mm IVS 11mm A 0.67m/s FS 45% RA 33mm LVPW 8mm RV 20mm PA 19mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 左房稍大，余各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 左房稍大 各房室腔及大血管未探及异常血流信号 心功能正常\n- [全程D3] 检验组合: 丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D4] CT；胸部CT平扫＋增强: 检查类型: CT；检查名称: 胸部CT平扫＋增强；检查部位:；检查所见: 右中肺及双下肺见数个类结节影，最大者直径约 5 mm，病灶边界清楚而不规则，密度较高而不均匀；气管及支气管分枝通畅，未见明显软组织肿物或受压变窄；双侧肺门及纵隔未见明确肿大淋巴结；双侧胸腔未见积液；胸膜未见增厚；扫描范围内胸椎、胸壁骨未见骨质破坏征象。；检查结论: 双肺类结节影，转移瘤可能性大。\n- [全程D4] 检验组合: 酮体(KET)-尿液: +-（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；尿胆原(URO)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 4/μL；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；白细胞计数(WBC#)-尿液: 26/μL；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；酸碱度(pH)-尿液: 6；总蛋白(TP)-尿液: -（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性（参考: 阴性）；颜色-尿液: Light-Yellow；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；非鳞状上皮细胞计数-尿液: 2/μL；比重(SG)-尿液: 1.032；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.05；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 顺铂单药同期放化疗\nB. 多西他赛+顺铂（TP方案）姑息化疗\nC. 鼻咽及颈部根治性放射治疗\nD. 顺铂+多西他赛（TP方案）同期放化疗\nE. 依托泊苷+顺铂（EP方案）诱导化疗\nF. 顺铂+氟尿嘧啶（PF方案）姑息化疗\nG. 西妥昔单抗联合根治性放疗\nH. 顺铂+氟尿嘧啶（PF方案）诱导化疗\nI. 氟尿嘧啶单药诱导化疗\nJ. 吉西他滨+顺铂（GP方案）姑息化疗\nK. 顺铂单药诱导化疗\nL. 卡瑞利珠单抗联合PF方案姑息化疗\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D3] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D3] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 38mm AO 26mm MV E 0.79m/s EF 75% LV 50mm IVS 11mm A 0.67m/s FS 45% RA 33mm LVPW 8mm RV 20mm PA 19mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 左房稍大，余各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 左房稍大 各房室腔及大血管未探及异常血流信号 心功能正常\n- [全程D3] 检验组合: 丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D4] CT；胸部CT平扫＋增强: 检查类型: CT；检查名称: 胸部CT平扫＋增强；检查部位:；检查所见: 右中肺及双下肺见数个类结节影，最大者直径约 5 mm，病灶边界清楚而不规则，密度较高而不均匀；气管及支气管分枝通畅，未见明显软组织肿物或受压变窄；双侧肺门及纵隔未见明确肿大淋巴结；双侧胸腔未见积液；胸膜未见增厚；扫描范围内胸椎、胸壁骨未见骨质破坏征象。；检查结论: 双肺类结节影，转移瘤可能性大。\n- [全程D4] 检验组合: 酮体(KET)-尿液: +-（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；尿胆原(URO)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 4/μL；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；白细胞计数(WBC#)-尿液: 26/μL；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；酸碱度(pH)-尿液: 6；总蛋白(TP)-尿液: -（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性（参考: 阴性）；颜色-尿液: Light-Yellow；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；非鳞状上皮细胞计数-尿液: 2/μL；比重(SG)-尿液: 1.032；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.05；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 顺铂单药同期放化疗\nB. 多西他赛+顺铂（TP方案）姑息化疗\nC. 鼻咽及颈部根治性放射治疗\nD. 顺铂+多西他赛（TP方案）同期放化疗\nE. 依托泊苷+顺铂（EP方案）诱导化疗\nF. 顺铂+氟尿嘧啶（PF方案）姑息化疗\nG. 西妥昔单抗联合根治性放疗\nH. 顺铂+氟尿嘧啶（PF方案）诱导化疗\nI. 氟尿嘧啶单药诱导化疗\nJ. 吉西他滨+顺铂（GP方案）姑息化疗\nK. 顺铂单药诱导化疗\nL. 卡瑞利珠单抗联合PF方案姑息化疗\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、斜坡、海绵窦、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D3] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D3] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 38mm AO 26mm MV E 0.79m/s EF 75% LV 50mm IVS 11mm A 0.67m/s FS 45% RA 33mm LVPW 8mm RV 20mm PA 19mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 左房稍大，余各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 左房稍大 各房室腔及大血管未探及异常血流信号 心功能正常\n- [全程D3] 检验组合: 丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D4] CT；胸部CT平扫＋增强: 检查类型: CT；检查名称: 胸部CT平扫＋增强；检查部位:；检查所见: 右中肺及双下肺见数个类结节影，最大者直径约 5 mm，病灶边界清楚而不规则，密度较高而不均匀；气管及支气管分枝通畅，未见明显软组织肿物或受压变窄；双侧肺门及纵隔未见明确肿大淋巴结；双侧胸腔未见积液；胸膜未见增厚；扫描范围内胸椎、胸壁骨未见骨质破坏征象。；检查结论: 双肺类结节影，转移瘤可能性大。\n- [全程D4] 检验组合: 酮体(KET)-尿液: +-（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；尿胆原(URO)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 4/μL；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；白细胞计数(WBC#)-尿液: 26/μL；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；酸碱度(pH)-尿液: 6；总蛋白(TP)-尿液: -（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性（参考: 阴性）；颜色-尿液: Light-Yellow；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；非鳞状上皮细胞计数-尿液: 2/μL；比重(SG)-尿液: 1.032；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.05；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 顺铂单药同期放化疗\nB. 多西他赛+顺铂（TP方案）姑息化疗\nC. 鼻咽及颈部根治性放射治疗\nD. 顺铂+多西他赛（TP方案）同期放化疗\nE. 依托泊苷+顺铂（EP方案）诱导化疗\nF. 顺铂+氟尿嘧啶（PF方案）姑息化疗\nG. 西妥昔单抗联合根治性放疗\nH. 顺铂+氟尿嘧啶（PF方案）诱导化疗\nI. 氟尿嘧啶单药诱导化疗\nJ. 吉西他滨+顺铂（GP方案）姑息化疗\nK. 顺铂单药诱导化疗\nL. 卡瑞利珠单抗联合PF方案姑息化疗\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-654cb1177e5cb9c5732eccb0","patient_id":"patient-84fa3d6098d10a1d14b6b19e","turn_id":"turn05","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"I","gold_action":"继续当前化疗及对症支持治疗，执行动静脉置管常规护理，并常规监测血常规与生化指标。","options":[{"letter":"A","text":"暂停化疗，静脉滴注还原型谷胱甘肽进行保肝治疗，待肝功能恢复正常后重启化疗。","is_gold":false},{"letter":"B","text":"暂停化疗，静脉滴注头孢类抗生素进行经验性抗感染治疗，待白细胞计数恢复正常后重启化疗。","is_gold":false},{"letter":"C","text":"继续化疗，皮下注射重组人粒细胞集落刺激因子预防中性粒细胞缺乏。","is_gold":false},{"letter":"D","text":"终止诱导化疗，提前进入根治性放疗阶段，并静脉滴注保肝药物。","is_gold":false},{"letter":"E","text":"继续化疗，静脉滴注异甘草酸镁注射液进行保肝治疗，并每日复查肝功能。","is_gold":false},{"letter":"F","text":"暂停化疗，行腹部CT增强扫描以排除肝脏转移或化疗引起的急性肝损伤。","is_gold":false},{"letter":"G","text":"继续化疗，停用所有止吐及护胃药物以减轻肝脏代谢负担。","is_gold":false},{"letter":"H","text":"暂停化疗，静脉推注地塞米松及异丙嗪进行抗过敏治疗。","is_gold":false},{"letter":"I","text":"继续化疗及对症支持治疗，执行动静脉置管常规护理，并常规监测血常规与生化指标。","is_gold":true},{"letter":"J","text":"继续化疗，拔除动静脉置管以预防导管相关性血流感染，改用外周静脉穿刺。","is_gold":false},{"letter":"K","text":"暂停化疗，静脉滴注氯化钾进行补钾治疗，待血钾明显上升后继续化疗。","is_gold":false},{"letter":"L","text":"继续化疗，静脉推注呋塞米促进顺铂排泄，预防急性肾功能损伤。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、斜坡、海绵窦、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左耳听力下降1年余；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右耳鸣；既往史: 某次就诊时间患“结核性胸膜炎”已治愈，某次就诊时间患“急性胰腺炎”已治愈。否认\"肝炎、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟史30年，1包每天，常饮酒，两天/次，每次500ml。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：120/80mmHg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧壁、顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D3] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D3] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 38mm AO 26mm MV E 0.79m/s EF 75% LV 50mm IVS 11mm A 0.67m/s FS 45% RA 33mm LVPW 8mm RV 20mm PA 19mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 左房稍大，余各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 左房稍大 各房室腔及大血管未探及异常血流信号 心功能正常\n- [全程D3] 检验组合: 丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D4] CT；胸部CT平扫＋增强: 检查类型: CT；检查名称: 胸部CT平扫＋增强；检查部位:；检查所见: 右中肺及双下肺见数个类结节影，最大者直径约 5 mm，病灶边界清楚而不规则，密度较高而不均匀；气管及支气管分枝通畅，未见明显软组织肿物或受压变窄；双侧肺门及纵隔未见明确肿大淋巴结；双侧胸腔未见积液；胸膜未见增厚；扫描范围内胸椎、胸壁骨未见骨质破坏征象。；检查结论: 双肺类结节影，转移瘤可能性大。\n- [全程D4] 检验组合: 酮体(KET)-尿液: +-（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；尿胆原(URO)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 4/μL；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；白细胞计数(WBC#)-尿液: 26/μL；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；酸碱度(pH)-尿液: 6；总蛋白(TP)-尿液: -（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性（参考: 阴性）；颜色-尿液: Light-Yellow；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；非鳞状上皮细胞计数-尿液: 2/μL；比重(SG)-尿液: 1.032；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.05；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL\n- [全程D2] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: 右臂静脉插管,导管末端位于T 6右旁，估计位于上腔静脉中段。；检查结论: 导管末端位置如上述。\n- [全程D2] 检验组合: 血小板分布宽度(PDW)-静脉血: 13.8%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；淋巴细胞百分比(Lymph%)-静脉血: 0.262；单核细胞计数(Mono#)-静脉血: 0.510E9/L；胱抑素(Cys-C)-静脉血: 1.01mg/L；总蛋白(TP)-静脉血: 68.46g/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.16COI；透明质酸(HA)-静脉血: 61.97ng/ml；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；大血小板百分比(P-LCR%)-静脉血: 32.4%；白蛋白(ALB)-静脉血: 43.7g/L；总胆固醇(TC)-静脉血: 5.59mmol/L；总胆红素(TBIL)-静脉血: 14.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.84；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.009；丙氨酸氨基转移酶(ALT)-静脉血: 27U/L；氯离子(Cl-)-静脉血: 103.1mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；淋巴细胞计数(Lymph#)-静脉血: 2.510E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.63mmol/L；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.06S/CO；血小板比容-静脉血: 21%；载脂蛋白B(apoB)-静脉血: 1.22g/L；C-反应蛋白(CRP)-静脉血: 4.05mg/L；ABO血型-静脉血: A；载脂蛋白AI(apoAI)-静脉血: 1.2g/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；单核细胞百分比(Mono%)-静脉血: 0.049；钠离子(Na+)-静脉血: 139.6mmol/L；凝血酶原时间(PT)-静脉血: 10.3sec.；球蛋白(GLO)-静脉血: 24.76g/L；纤维蛋白原(Fbg)-静脉血: 2.49g/L；凝血酶时间(TT)-静脉血: 20sec.；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44.6；Rh血型-静脉血: 阳性；平均红细胞体积(MCV)-静脉血: 85.8fL；直接胆红素(DBIL)-静脉血: 3.3umol/L；凝血酶原时间活动度(PTA)-静脉血: 113.8……\n- [全程D5] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: 3+500Leu（参考: 阴性）；白细胞计数(WBC#)-尿液: 18/μL；鳞状上皮细胞计数(SQEP#)-尿液: 5/μL；比重(SG)-尿液: 1.02；总蛋白(TP)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: Turbid；隐血(OB)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；未分类结晶计数(UNCX#)-尿液: 25/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；非鳞状上皮细胞计数-尿液: 5/μL\n- [全程D9] 检验组合: 钾离子(K+)-静脉血: 3.73mmol/L；红细胞比容(Hct)-静脉血: 48.1%；血小板比容-静脉血: 19%；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.94mmolL；尿素氮(BUN)-静脉血: 9.5mmol/L；钠离子(Na+)-静脉血: 137.8mmol/L；血红蛋白(Hb)-静脉血: 159g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.095；总钙(Ca)-静脉血: 1.93mmol/L；血小板分布宽度(PDW)-静脉血: 13.3%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；丙氨酸氨基转移酶(ALT)-静脉血: 94.9U/L；载脂蛋白B(apoB)-静脉血: 1.06g/L；白蛋白(ALB)-静脉血: 40.3g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.46；白细胞计数(WBC#)-静脉血: 14.910E9/L；胱抑素(Cys-C)-静脉血: 1.26mg/L；平均血小板体积(MPV)-静脉血: 10.4fL；中性粒细胞百分比(Neut%)-静脉血: 0.837；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.45mmol/L；血小板计数(PLT#)-静脉血: 17910E9/L；总胆固醇(TC)-静脉血: 5.1mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.4；球蛋白(GLO)-静脉血: 23.17g/L；磷(P)-静脉血: 1.26mmol/L；间接胆红素(IBIL)-静脉血: 13.1umolL；红细胞计数(RBC#)-静脉血: 5.5910E12/L；直接胆红素(DBIL)-静脉血: 5.4umol/L；总胆汁酸(TBA)-静脉血: 0.1umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；单核细胞百分比(Mono%)-静脉血: 0.06；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 42.8U/L；肌酐(Crea)-静脉血: 101.5umol/L；载脂蛋白AI(apoAI)-静脉血: 0.99g/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.4mmol/L；单核细胞计……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者无诉特殊不适，完善各项检查中，体查同入院时，[姓名已隐去]主任查房指示，待各项检查完成明确分期后，再决定下一步治疗。\n- [全程D8] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停化疗，静脉滴注还原型谷胱甘肽进行保肝治疗，待肝功能恢复正常后重启化疗。\nB. 暂停化疗，静脉滴注头孢类抗生素进行经验性抗感染治疗，待白细胞计数恢复正常后重启化疗。\nC. 继续化疗，皮下注射重组人粒细胞集落刺激因子预防中性粒细胞缺乏。\nD. 终止诱导化疗，提前进入根治性放疗阶段，并静脉滴注保肝药物。\nE. 继续化疗，静脉滴注异甘草酸镁注射液进行保肝治疗，并每日复查肝功能。\nF. 暂停化疗，行腹部CT增强扫描以排除肝脏转移或化疗引起的急性肝损伤。\nG. 继续化疗，停用所有止吐及护胃药物以减轻肝脏代谢负担。\nH. 暂停化疗，静脉推注地塞米松及异丙嗪进行抗过敏治疗。\nI. 继续化疗及对症支持治疗，执行动静脉置管常规护理，并常规监测血常规与生化指标。\nJ. 继续化疗，拔除动静脉置管以预防导管相关性血流感染，改用外周静脉穿刺。\nK. 暂停化疗，静脉滴注氯化钾进行补钾治疗，待血钾明显上升后继续化疗。\nL. 继续化疗，静脉推注呋塞米促进顺铂排泄，预防急性肾功能损伤。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D2] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: 右臂静脉插管,导管末端位于T 6右旁，估计位于上腔静脉中段。；检查结论: 导管末端位置如上述。\n- [全程D2] 检验组合: 血小板分布宽度(PDW)-静脉血: 13.8%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；淋巴细胞百分比(Lymph%)-静脉血: 0.262；单核细胞计数(Mono#)-静脉血: 0.510E9/L；胱抑素(Cys-C)-静脉血: 1.01mg/L；总蛋白(TP)-静脉血: 68.46g/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.16COI；透明质酸(HA)-静脉血: 61.97ng/ml；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；大血小板百分比(P-LCR%)-静脉血: 32.4%；白蛋白(ALB)-静脉血: 43.7g/L；总胆固醇(TC)-静脉血: 5.59mmol/L；总胆红素(TBIL)-静脉血: 14.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.84；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.009；丙氨酸氨基转移酶(ALT)-静脉血: 27U/L；氯离子(Cl-)-静脉血: 103.1mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；淋巴细胞计数(Lymph#)-静脉血: 2.510E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.63mmol/L；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.06S/CO；血小板比容-静脉血: 21%；载脂蛋白B(apoB)-静脉血: 1.22g/L；C-反应蛋白(CRP)-静脉血: 4.05mg/L；ABO血型-静脉血: A；载脂蛋白AI(apoAI)-静脉血: 1.2g/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；单核细胞百分比(Mono%)-静脉血: 0.049；钠离子(Na+)-静脉血: 139.6mmol/L；凝血酶原时间(PT)-静脉血: 10.3sec.；球蛋白(GLO)-静脉血: 24.76g/L；纤维蛋白原(Fbg)-静脉血: 2.49g/L；凝血酶时间(TT)-静脉血: 20sec.；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44.6；Rh血型-静脉血: 阳性；平均红细胞体积(MCV)-静脉血: 85.8fL；直接胆红素(DBIL)-静脉血: 3.3umol/L；凝血酶原时间活动度(PTA)-静脉血: 113.8……\n- [全程D5] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: 3+500Leu（参考: 阴性）；白细胞计数(WBC#)-尿液: 18/μL；鳞状上皮细胞计数(SQEP#)-尿液: 5/μL；比重(SG)-尿液: 1.02；总蛋白(TP)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: Turbid；隐血(OB)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；未分类结晶计数(UNCX#)-尿液: 25/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；非鳞状上皮细胞计数-尿液: 5/μL\n- [全程D9] 检验组合: 钾离子(K+)-静脉血: 3.73mmol/L；红细胞比容(Hct)-静脉血: 48.1%；血小板比容-静脉血: 19%；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.94mmolL；尿素氮(BUN)-静脉血: 9.5mmol/L；钠离子(Na+)-静脉血: 137.8mmol/L；血红蛋白(Hb)-静脉血: 159g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.095；总钙(Ca)-静脉血: 1.93mmol/L；血小板分布宽度(PDW)-静脉血: 13.3%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；丙氨酸氨基转移酶(ALT)-静脉血: 94.9U/L；载脂蛋白B(apoB)-静脉血: 1.06g/L；白蛋白(ALB)-静脉血: 40.3g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.46；白细胞计数(WBC#)-静脉血: 14.910E9/L；胱抑素(Cys-C)-静脉血: 1.26mg/L；平均血小板体积(MPV)-静脉血: 10.4fL；中性粒细胞百分比(Neut%)-静脉血: 0.837；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.45mmol/L；血小板计数(PLT#)-静脉血: 17910E9/L；总胆固醇(TC)-静脉血: 5.1mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.4；球蛋白(GLO)-静脉血: 23.17g/L；磷(P)-静脉血: 1.26mmol/L；间接胆红素(IBIL)-静脉血: 13.1umolL；红细胞计数(RBC#)-静脉血: 5.5910E12/L；直接胆红素(DBIL)-静脉血: 5.4umol/L；总胆汁酸(TBA)-静脉血: 0.1umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；单核细胞百分比(Mono%)-静脉血: 0.06；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 42.8U/L；肌酐(Crea)-静脉血: 101.5umol/L；载脂蛋白AI(apoAI)-静脉血: 0.99g/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.4mmol/L；单核细胞计……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者无诉特殊不适，完善各项检查中，体查同入院时，[姓名已隐去]主任查房指示，待各项检查完成明确分期后，再决定下一步治疗。\n- [全程D8] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停化疗，静脉滴注还原型谷胱甘肽进行保肝治疗，待肝功能恢复正常后重启化疗。\nB. 暂停化疗，静脉滴注头孢类抗生素进行经验性抗感染治疗，待白细胞计数恢复正常后重启化疗。\nC. 继续化疗，皮下注射重组人粒细胞集落刺激因子预防中性粒细胞缺乏。\nD. 终止诱导化疗，提前进入根治性放疗阶段，并静脉滴注保肝药物。\nE. 继续化疗，静脉滴注异甘草酸镁注射液进行保肝治疗，并每日复查肝功能。\nF. 暂停化疗，行腹部CT增强扫描以排除肝脏转移或化疗引起的急性肝损伤。\nG. 继续化疗，停用所有止吐及护胃药物以减轻肝脏代谢负担。\nH. 暂停化疗，静脉推注地塞米松及异丙嗪进行抗过敏治疗。\nI. 继续化疗及对症支持治疗，执行动静脉置管常规护理，并常规监测血常规与生化指标。\nJ. 继续化疗，拔除动静脉置管以预防导管相关性血流感染，改用外周静脉穿刺。\nK. 暂停化疗，静脉滴注氯化钾进行补钾治疗，待血钾明显上升后继续化疗。\nL. 继续化疗，静脉推注呋塞米促进顺铂排泄，预防急性肾功能损伤。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、斜坡、海绵窦、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D2] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: 右臂静脉插管,导管末端位于T 6右旁，估计位于上腔静脉中段。；检查结论: 导管末端位置如上述。\n- [全程D2] 检验组合: 血小板分布宽度(PDW)-静脉血: 13.8%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；淋巴细胞百分比(Lymph%)-静脉血: 0.262；单核细胞计数(Mono#)-静脉血: 0.510E9/L；胱抑素(Cys-C)-静脉血: 1.01mg/L；总蛋白(TP)-静脉血: 68.46g/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.16COI；透明质酸(HA)-静脉血: 61.97ng/ml；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；大血小板百分比(P-LCR%)-静脉血: 32.4%；白蛋白(ALB)-静脉血: 43.7g/L；总胆固醇(TC)-静脉血: 5.59mmol/L；总胆红素(TBIL)-静脉血: 14.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.84；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.009；丙氨酸氨基转移酶(ALT)-静脉血: 27U/L；氯离子(Cl-)-静脉血: 103.1mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；淋巴细胞计数(Lymph#)-静脉血: 2.510E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.63mmol/L；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.06S/CO；血小板比容-静脉血: 21%；载脂蛋白B(apoB)-静脉血: 1.22g/L；C-反应蛋白(CRP)-静脉血: 4.05mg/L；ABO血型-静脉血: A；载脂蛋白AI(apoAI)-静脉血: 1.2g/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；单核细胞百分比(Mono%)-静脉血: 0.049；钠离子(Na+)-静脉血: 139.6mmol/L；凝血酶原时间(PT)-静脉血: 10.3sec.；球蛋白(GLO)-静脉血: 24.76g/L；纤维蛋白原(Fbg)-静脉血: 2.49g/L；凝血酶时间(TT)-静脉血: 20sec.；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44.6；Rh血型-静脉血: 阳性；平均红细胞体积(MCV)-静脉血: 85.8fL；直接胆红素(DBIL)-静脉血: 3.3umol/L；凝血酶原时间活动度(PTA)-静脉血: 113.8……\n- [全程D5] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: 3+500Leu（参考: 阴性）；白细胞计数(WBC#)-尿液: 18/μL；鳞状上皮细胞计数(SQEP#)-尿液: 5/μL；比重(SG)-尿液: 1.02；总蛋白(TP)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: Turbid；隐血(OB)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；未分类结晶计数(UNCX#)-尿液: 25/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；非鳞状上皮细胞计数-尿液: 5/μL\n- [全程D9] 检验组合: 钾离子(K+)-静脉血: 3.73mmol/L；红细胞比容(Hct)-静脉血: 48.1%；血小板比容-静脉血: 19%；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.94mmolL；尿素氮(BUN)-静脉血: 9.5mmol/L；钠离子(Na+)-静脉血: 137.8mmol/L；血红蛋白(Hb)-静脉血: 159g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.095；总钙(Ca)-静脉血: 1.93mmol/L；血小板分布宽度(PDW)-静脉血: 13.3%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；丙氨酸氨基转移酶(ALT)-静脉血: 94.9U/L；载脂蛋白B(apoB)-静脉血: 1.06g/L；白蛋白(ALB)-静脉血: 40.3g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.46；白细胞计数(WBC#)-静脉血: 14.910E9/L；胱抑素(Cys-C)-静脉血: 1.26mg/L；平均血小板体积(MPV)-静脉血: 10.4fL；中性粒细胞百分比(Neut%)-静脉血: 0.837；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.45mmol/L；血小板计数(PLT#)-静脉血: 17910E9/L；总胆固醇(TC)-静脉血: 5.1mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.4；球蛋白(GLO)-静脉血: 23.17g/L；磷(P)-静脉血: 1.26mmol/L；间接胆红素(IBIL)-静脉血: 13.1umolL；红细胞计数(RBC#)-静脉血: 5.5910E12/L；直接胆红素(DBIL)-静脉血: 5.4umol/L；总胆汁酸(TBA)-静脉血: 0.1umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；单核细胞百分比(Mono%)-静脉血: 0.06；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 42.8U/L；肌酐(Crea)-静脉血: 101.5umol/L；载脂蛋白AI(apoAI)-静脉血: 0.99g/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.4mmol/L；单核细胞计……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者无诉特殊不适，完善各项检查中，体查同入院时，[姓名已隐去]主任查房指示，待各项检查完成明确分期后，再决定下一步治疗。\n- [全程D8] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停化疗，静脉滴注还原型谷胱甘肽进行保肝治疗，待肝功能恢复正常后重启化疗。\nB. 暂停化疗，静脉滴注头孢类抗生素进行经验性抗感染治疗，待白细胞计数恢复正常后重启化疗。\nC. 继续化疗，皮下注射重组人粒细胞集落刺激因子预防中性粒细胞缺乏。\nD. 终止诱导化疗，提前进入根治性放疗阶段，并静脉滴注保肝药物。\nE. 继续化疗，静脉滴注异甘草酸镁注射液进行保肝治疗，并每日复查肝功能。\nF. 暂停化疗，行腹部CT增强扫描以排除肝脏转移或化疗引起的急性肝损伤。\nG. 继续化疗，停用所有止吐及护胃药物以减轻肝脏代谢负担。\nH. 暂停化疗，静脉推注地塞米松及异丙嗪进行抗过敏治疗。\nI. 继续化疗及对症支持治疗，执行动静脉置管常规护理，并常规监测血常规与生化指标。\nJ. 继续化疗，拔除动静脉置管以预防导管相关性血流感染，改用外周静脉穿刺。\nK. 暂停化疗，静脉滴注氯化钾进行补钾治疗，待血钾明显上升后继续化疗。\nL. 继续化疗，静脉推注呋塞米促进顺铂排泄，预防急性肾功能损伤。\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-b094635ac349a10618a48030","patient_id":"patient-84fa3d6098d10a1d14b6b19e","turn_id":"turn06","turn_position":5,"turn_type":"toxicity_or_support_decision","gold_letter":"J","gold_action":"予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，并监测24小时尿量，准备行下一程化疗。","options":[{"letter":"A","text":"予以口服升白细胞药物，静脉水化及补充电解质，皮下注射胸腺法新，并监测24小时尿量，准备行下一程化疗。","is_gold":false},{"letter":"B","text":"予以静脉滴注保肝药物，静脉水化及补充电解质，皮下注射胸腺法新，暂缓化疗待复查指标正常后继续。","is_gold":false},{"letter":"C","text":"予以静脉输注碳酸氢钠碱化尿液及利尿处理，静脉水化及补充电解质，将下一程化疗方案中的顺铂替换为卡铂。","is_gold":false},{"letter":"D","text":"予以静脉营养支持，静脉水化及补充电解质，皮下注射胸腺法新，下一程化疗顺铂剂量下调20%。","is_gold":false},{"letter":"E","text":"予以静脉水化、补充电解质及维生素，预防性皮下注射重组人粒细胞刺激因子，口服止咳药物，准备行下一程化疗。","is_gold":false},{"letter":"F","text":"予以静脉水化、补充电解质及维生素，预防性皮下注射重组人血小板生成素，口服止咳药物，准备行下一程化疗。","is_gold":false},{"letter":"G","text":"予以静脉水化、补充电解质及维生素，口服止咳药物，加用异烟肼预防性抗结核治疗，准备行下一程化疗。","is_gold":false},{"letter":"H","text":"予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，无需监测尿量，准备行下一程化疗。","is_gold":false},{"letter":"I","text":"予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，并监测24小时尿量，准备行单纯放射治疗。","is_gold":false},{"letter":"J","text":"予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，并监测24小时尿量，准备行下一程化疗。","is_gold":true},{"letter":"K","text":"予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，并监测24小时尿量，将下一程化疗方案更改为吉西他滨加顺铂。","is_gold":false},{"letter":"L","text":"予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，并监测24小时尿量，将下一程化疗方案更改为紫杉醇加顺铂。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、斜坡、海绵窦、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左耳听力下降1年余；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右耳鸣；既往史: 某次就诊时间患“结核性胸膜炎”已治愈，某次就诊时间患“急性胰腺炎”已治愈。否认\"肝炎、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟史30年，1包每天，常饮酒，两天/次，每次500ml。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：120/80mmHg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧壁、顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D3] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D3] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 38mm AO 26mm MV E 0.79m/s EF 75% LV 50mm IVS 11mm A 0.67m/s FS 45% RA 33mm LVPW 8mm RV 20mm PA 19mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 左房稍大，余各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 左房稍大 各房室腔及大血管未探及异常血流信号 心功能正常\n- [全程D3] 检验组合: 丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D4] CT；胸部CT平扫＋增强: 检查类型: CT；检查名称: 胸部CT平扫＋增强；检查部位:；检查所见: 右中肺及双下肺见数个类结节影，最大者直径约 5 mm，病灶边界清楚而不规则，密度较高而不均匀；气管及支气管分枝通畅，未见明显软组织肿物或受压变窄；双侧肺门及纵隔未见明确肿大淋巴结；双侧胸腔未见积液；胸膜未见增厚；扫描范围内胸椎、胸壁骨未见骨质破坏征象。；检查结论: 双肺类结节影，转移瘤可能性大。\n- [全程D4] 检验组合: 酮体(KET)-尿液: +-（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；尿胆原(URO)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 4/μL；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；白细胞计数(WBC#)-尿液: 26/μL；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；酸碱度(pH)-尿液: 6；总蛋白(TP)-尿液: -（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性（参考: 阴性）；颜色-尿液: Light-Yellow；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；非鳞状上皮细胞计数-尿液: 2/μL；比重(SG)-尿液: 1.032；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.05；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL\n- [全程D2] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: 右臂静脉插管,导管末端位于T 6右旁，估计位于上腔静脉中段。；检查结论: 导管末端位置如上述。\n- [全程D2] 检验组合: 血小板分布宽度(PDW)-静脉血: 13.8%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；淋巴细胞百分比(Lymph%)-静脉血: 0.262；单核细胞计数(Mono#)-静脉血: 0.510E9/L；胱抑素(Cys-C)-静脉血: 1.01mg/L；总蛋白(TP)-静脉血: 68.46g/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.16COI；透明质酸(HA)-静脉血: 61.97ng/ml；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；大血小板百分比(P-LCR%)-静脉血: 32.4%；白蛋白(ALB)-静脉血: 43.7g/L；总胆固醇(TC)-静脉血: 5.59mmol/L；总胆红素(TBIL)-静脉血: 14.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.84；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.009；丙氨酸氨基转移酶(ALT)-静脉血: 27U/L；氯离子(Cl-)-静脉血: 103.1mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；淋巴细胞计数(Lymph#)-静脉血: 2.510E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.63mmol/L；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.06S/CO；血小板比容-静脉血: 21%；载脂蛋白B(apoB)-静脉血: 1.22g/L；C-反应蛋白(CRP)-静脉血: 4.05mg/L；ABO血型-静脉血: A；载脂蛋白AI(apoAI)-静脉血: 1.2g/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；单核细胞百分比(Mono%)-静脉血: 0.049；钠离子(Na+)-静脉血: 139.6mmol/L；凝血酶原时间(PT)-静脉血: 10.3sec.；球蛋白(GLO)-静脉血: 24.76g/L；纤维蛋白原(Fbg)-静脉血: 2.49g/L；凝血酶时间(TT)-静脉血: 20sec.；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44.6；Rh血型-静脉血: 阳性；平均红细胞体积(MCV)-静脉血: 85.8fL；直接胆红素(DBIL)-静脉血: 3.3umol/L；凝血酶原时间活动度(PTA)-静脉血: 113.8……\n- [全程D5] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: 3+500Leu（参考: 阴性）；白细胞计数(WBC#)-尿液: 18/μL；鳞状上皮细胞计数(SQEP#)-尿液: 5/μL；比重(SG)-尿液: 1.02；总蛋白(TP)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: Turbid；隐血(OB)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；未分类结晶计数(UNCX#)-尿液: 25/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；非鳞状上皮细胞计数-尿液: 5/μL\n- [全程D9] 检验组合: 钾离子(K+)-静脉血: 3.73mmol/L；红细胞比容(Hct)-静脉血: 48.1%；血小板比容-静脉血: 19%；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.94mmolL；尿素氮(BUN)-静脉血: 9.5mmol/L；钠离子(Na+)-静脉血: 137.8mmol/L；血红蛋白(Hb)-静脉血: 159g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.095；总钙(Ca)-静脉血: 1.93mmol/L；血小板分布宽度(PDW)-静脉血: 13.3%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；丙氨酸氨基转移酶(ALT)-静脉血: 94.9U/L；载脂蛋白B(apoB)-静脉血: 1.06g/L；白蛋白(ALB)-静脉血: 40.3g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.46；白细胞计数(WBC#)-静脉血: 14.910E9/L；胱抑素(Cys-C)-静脉血: 1.26mg/L；平均血小板体积(MPV)-静脉血: 10.4fL；中性粒细胞百分比(Neut%)-静脉血: 0.837；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.45mmol/L；血小板计数(PLT#)-静脉血: 17910E9/L；总胆固醇(TC)-静脉血: 5.1mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.4；球蛋白(GLO)-静脉血: 23.17g/L；磷(P)-静脉血: 1.26mmol/L；间接胆红素(IBIL)-静脉血: 13.1umolL；红细胞计数(RBC#)-静脉血: 5.5910E12/L；直接胆红素(DBIL)-静脉血: 5.4umol/L；总胆汁酸(TBA)-静脉血: 0.1umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；单核细胞百分比(Mono%)-静脉血: 0.06；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 42.8U/L；肌酐(Crea)-静脉血: 101.5umol/L；载脂蛋白AI(apoAI)-静脉血: 0.99g/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.4mmol/L；单核细胞计……\n- [全程D16] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及双侧壁增厚放射性浓聚，SUV约11.9，双侧咽隐窝消失；病灶侵犯双侧腭帆提肌、左侧腭帆张肌、左翼内肌，左咽旁间隙及左咽后间隙消失；病灶向上侵犯蝶骨基底部、左翼突区、左蝶骨大翼、左卵圆孔及左海绵窦；向前侵犯左翼腭窝、左上颌后脂肪间隙、左眶尖及左眶内后份，左框内病灶与视神经分界不清。右咽后小淋巴结放射性分布未见明显异常。双侧扁桃体放射性浓聚，SUV约9.4；喉咽结构及放射性分布未见明显异常。双侧上颌窦低密度影放射性分布未见异常；额窦、蝶窦、筛窦结构及放射性分布未见明显异常。甲状腺双叶密度减低，放射性分布未见异常。双颈多个小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺散在多发结节影放射性分布未见明显异常，最大约0.6×0.8cm；左上肺舌段条索影放射性分布未见异常；气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。心脏及纵隔大血管未见明显异常。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏弥漫性密度减低，CT值约36Hu（脾脏CT值约51Hu），放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾门区结节影放射性分布未见异常，大小约1.1×1.4cm（副脾）；脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 双侧乳突气房内低密度影放射性分布未见异常；余颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌病灶，侵犯左咽后及左咽旁间隙、颅底骨骼、左卵圆孔、左海绵窦、左翼腭窝、左上颌后脂肪间隙、左眶尖及左眶内后份，累及左视神经。 双肺多发小结节影代谢未见异常，疑增殖灶。 双侧上颌窦炎症；双侧乳突炎症。 双侧扁桃体代谢活跃，考虑炎性病变。 脂肪肝。\n- [全程D24] 检验组合: 红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.4%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.71mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.0123；平均血小板体积(MPV)-静脉血: 8.22fL；载脂蛋白B(apoB)-静脉血: 1.13g/L；总胆固醇(TC)-静脉血: 5.18mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.281；有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞血红蛋白浓度(MCHC)-静脉血: 325.6g/L；磷(P)-静脉血: 1.14mmol/L；胱抑素(Cys-C)-静脉血: 1.19mg/L；尿素氮(BUN)-静脉血: 7.71mmol/L；血小板分布宽度(PDW)-静脉血: 16.4%；丙氨酸氨基转移酶(ALT)-静脉血: 28.8U/L；直接胆红素(DBIL)-静脉血: 2.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.8；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.14mmolL；氯离子(Cl-)-静脉血: 105.9mmol/L；血小板计数(PLT#)-静脉血: 18310E9/L；中性粒细胞计数(Neut#)-静脉血: 510E9/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；乳酸脱氢酶(LDH)-静脉血: 159U/L；平均红细胞体积(MCV)-静脉血: 84.3fL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；红细胞计数(RBC#)-静脉血: 5.2310E12/L；球蛋白(GLO)-静脉血: 27.58g/L；葡萄糖(Glu)-静脉血: 4.55mmol/L；肌酐(Crea)-静脉血: 91.9umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；血小板比容-静脉血: 15%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 50.8U/L；白细胞计数(WBC#)-静脉血: 7.810E9/L；单核细胞百分比(Mono%)-静脉血: 0.0665；淋巴细胞计数(Lymph#)-静脉血: 2.210E9/L；C-反应蛋白(CRP)-静脉血: 4.59mg/L；红细胞比容(Hct)-静脉血:……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者无诉特殊不适，完善各项检查中，体查同入院时，[姓名已隐去]主任查房指示，待各项检查完成明确分期后，再决定下一步治疗。\n- [全程D8] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D10] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗结束，诉呕吐2次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程5-FU+顺铂方案诱导化疗结束，无诉特殊不适，可予请假至6月13日，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n- [全程D15] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者请假至.吕星\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 予以口服升白细胞药物，静脉水化及补充电解质，皮下注射胸腺法新，并监测24小时尿量，准备行下一程化疗。\nB. 予以静脉滴注保肝药物，静脉水化及补充电解质，皮下注射胸腺法新，暂缓化疗待复查指标正常后继续。\nC. 予以静脉输注碳酸氢钠碱化尿液及利尿处理，静脉水化及补充电解质，将下一程化疗方案中的顺铂替换为卡铂。\nD. 予以静脉营养支持，静脉水化及补充电解质，皮下注射胸腺法新，下一程化疗顺铂剂量下调20%。\nE. 予以静脉水化、补充电解质及维生素，预防性皮下注射重组人粒细胞刺激因子，口服止咳药物，准备行下一程化疗。\nF. 予以静脉水化、补充电解质及维生素，预防性皮下注射重组人血小板生成素，口服止咳药物，准备行下一程化疗。\nG. 予以静脉水化、补充电解质及维生素，口服止咳药物，加用异烟肼预防性抗结核治疗，准备行下一程化疗。\nH. 予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，无需监测尿量，准备行下一程化疗。\nI. 予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，并监测24小时尿量，准备行单纯放射治疗。\nJ. 予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，并监测24小时尿量，准备行下一程化疗。\nK. 予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，并监测24小时尿量，将下一程化疗方案更改为吉西他滨加顺铂。\nL. 予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，并监测24小时尿量，将下一程化疗方案更改为紫杉醇加顺铂。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D16] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及双侧壁增厚放射性浓聚，SUV约11.9，双侧咽隐窝消失；病灶侵犯双侧腭帆提肌、左侧腭帆张肌、左翼内肌，左咽旁间隙及左咽后间隙消失；病灶向上侵犯蝶骨基底部、左翼突区、左蝶骨大翼、左卵圆孔及左海绵窦；向前侵犯左翼腭窝、左上颌后脂肪间隙、左眶尖及左眶内后份，左框内病灶与视神经分界不清。右咽后小淋巴结放射性分布未见明显异常。双侧扁桃体放射性浓聚，SUV约9.4；喉咽结构及放射性分布未见明显异常。双侧上颌窦低密度影放射性分布未见异常；额窦、蝶窦、筛窦结构及放射性分布未见明显异常。甲状腺双叶密度减低，放射性分布未见异常。双颈多个小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺散在多发结节影放射性分布未见明显异常，最大约0.6×0.8cm；左上肺舌段条索影放射性分布未见异常；气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。心脏及纵隔大血管未见明显异常。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏弥漫性密度减低，CT值约36Hu（脾脏CT值约51Hu），放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾门区结节影放射性分布未见异常，大小约1.1×1.4cm（副脾）；脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 双侧乳突气房内低密度影放射性分布未见异常；余颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌病灶，侵犯左咽后及左咽旁间隙、颅底骨骼、左卵圆孔、左海绵窦、左翼腭窝、左上颌后脂肪间隙、左眶尖及左眶内后份，累及左视神经。 双肺多发小结节影代谢未见异常，疑增殖灶。 双侧上颌窦炎症；双侧乳突炎症。 双侧扁桃体代谢活跃，考虑炎性病变。 脂肪肝。\n- [全程D24] 检验组合: 红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.4%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.71mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.0123；平均血小板体积(MPV)-静脉血: 8.22fL；载脂蛋白B(apoB)-静脉血: 1.13g/L；总胆固醇(TC)-静脉血: 5.18mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.281；有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞血红蛋白浓度(MCHC)-静脉血: 325.6g/L；磷(P)-静脉血: 1.14mmol/L；胱抑素(Cys-C)-静脉血: 1.19mg/L；尿素氮(BUN)-静脉血: 7.71mmol/L；血小板分布宽度(PDW)-静脉血: 16.4%；丙氨酸氨基转移酶(ALT)-静脉血: 28.8U/L；直接胆红素(DBIL)-静脉血: 2.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.8；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.14mmolL；氯离子(Cl-)-静脉血: 105.9mmol/L；血小板计数(PLT#)-静脉血: 18310E9/L；中性粒细胞计数(Neut#)-静脉血: 510E9/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；乳酸脱氢酶(LDH)-静脉血: 159U/L；平均红细胞体积(MCV)-静脉血: 84.3fL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；红细胞计数(RBC#)-静脉血: 5.2310E12/L；球蛋白(GLO)-静脉血: 27.58g/L；葡萄糖(Glu)-静脉血: 4.55mmol/L；肌酐(Crea)-静脉血: 91.9umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；血小板比容-静脉血: 15%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 50.8U/L；白细胞计数(WBC#)-静脉血: 7.810E9/L；单核细胞百分比(Mono%)-静脉血: 0.0665；淋巴细胞计数(Lymph#)-静脉血: 2.210E9/L；C-反应蛋白(CRP)-静脉血: 4.59mg/L；红细胞比容(Hct)-静脉血:……\n\n【既往治疗与反应】\n- [全程D10] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗结束，诉呕吐2次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程5-FU+顺铂方案诱导化疗结束，无诉特殊不适，可予请假至6月13日，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n- [全程D15] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者请假至.吕星\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 予以口服升白细胞药物，静脉水化及补充电解质，皮下注射胸腺法新，并监测24小时尿量，准备行下一程化疗。\nB. 予以静脉滴注保肝药物，静脉水化及补充电解质，皮下注射胸腺法新，暂缓化疗待复查指标正常后继续。\nC. 予以静脉输注碳酸氢钠碱化尿液及利尿处理，静脉水化及补充电解质，将下一程化疗方案中的顺铂替换为卡铂。\nD. 予以静脉营养支持，静脉水化及补充电解质，皮下注射胸腺法新，下一程化疗顺铂剂量下调20%。\nE. 予以静脉水化、补充电解质及维生素，预防性皮下注射重组人粒细胞刺激因子，口服止咳药物，准备行下一程化疗。\nF. 予以静脉水化、补充电解质及维生素，预防性皮下注射重组人血小板生成素，口服止咳药物，准备行下一程化疗。\nG. 予以静脉水化、补充电解质及维生素，口服止咳药物，加用异烟肼预防性抗结核治疗，准备行下一程化疗。\nH. 予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，无需监测尿量，准备行下一程化疗。\nI. 予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，并监测24小时尿量，准备行单纯放射治疗。\nJ. 予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，并监测24小时尿量，准备行下一程化疗。\nK. 予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，并监测24小时尿量，将下一程化疗方案更改为吉西他滨加顺铂。\nL. 予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，并监测24小时尿量，将下一程化疗方案更改为紫杉醇加顺铂。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、斜坡、海绵窦、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D16] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及双侧壁增厚放射性浓聚，SUV约11.9，双侧咽隐窝消失；病灶侵犯双侧腭帆提肌、左侧腭帆张肌、左翼内肌，左咽旁间隙及左咽后间隙消失；病灶向上侵犯蝶骨基底部、左翼突区、左蝶骨大翼、左卵圆孔及左海绵窦；向前侵犯左翼腭窝、左上颌后脂肪间隙、左眶尖及左眶内后份，左框内病灶与视神经分界不清。右咽后小淋巴结放射性分布未见明显异常。双侧扁桃体放射性浓聚，SUV约9.4；喉咽结构及放射性分布未见明显异常。双侧上颌窦低密度影放射性分布未见异常；额窦、蝶窦、筛窦结构及放射性分布未见明显异常。甲状腺双叶密度减低，放射性分布未见异常。双颈多个小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺散在多发结节影放射性分布未见明显异常，最大约0.6×0.8cm；左上肺舌段条索影放射性分布未见异常；气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。心脏及纵隔大血管未见明显异常。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏弥漫性密度减低，CT值约36Hu（脾脏CT值约51Hu），放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾门区结节影放射性分布未见异常，大小约1.1×1.4cm（副脾）；脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 双侧乳突气房内低密度影放射性分布未见异常；余颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌病灶，侵犯左咽后及左咽旁间隙、颅底骨骼、左卵圆孔、左海绵窦、左翼腭窝、左上颌后脂肪间隙、左眶尖及左眶内后份，累及左视神经。 双肺多发小结节影代谢未见异常，疑增殖灶。 双侧上颌窦炎症；双侧乳突炎症。 双侧扁桃体代谢活跃，考虑炎性病变。 脂肪肝。\n- [全程D24] 检验组合: 红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.4%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.71mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.0123；平均血小板体积(MPV)-静脉血: 8.22fL；载脂蛋白B(apoB)-静脉血: 1.13g/L；总胆固醇(TC)-静脉血: 5.18mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.281；有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞血红蛋白浓度(MCHC)-静脉血: 325.6g/L；磷(P)-静脉血: 1.14mmol/L；胱抑素(Cys-C)-静脉血: 1.19mg/L；尿素氮(BUN)-静脉血: 7.71mmol/L；血小板分布宽度(PDW)-静脉血: 16.4%；丙氨酸氨基转移酶(ALT)-静脉血: 28.8U/L；直接胆红素(DBIL)-静脉血: 2.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.8；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.14mmolL；氯离子(Cl-)-静脉血: 105.9mmol/L；血小板计数(PLT#)-静脉血: 18310E9/L；中性粒细胞计数(Neut#)-静脉血: 510E9/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；乳酸脱氢酶(LDH)-静脉血: 159U/L；平均红细胞体积(MCV)-静脉血: 84.3fL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；红细胞计数(RBC#)-静脉血: 5.2310E12/L；球蛋白(GLO)-静脉血: 27.58g/L；葡萄糖(Glu)-静脉血: 4.55mmol/L；肌酐(Crea)-静脉血: 91.9umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；血小板比容-静脉血: 15%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 50.8U/L；白细胞计数(WBC#)-静脉血: 7.810E9/L；单核细胞百分比(Mono%)-静脉血: 0.0665；淋巴细胞计数(Lymph#)-静脉血: 2.210E9/L；C-反应蛋白(CRP)-静脉血: 4.59mg/L；红细胞比容(Hct)-静脉血:……\n\n【既往治疗与反应】\n- [全程D10] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗结束，诉呕吐2次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程5-FU+顺铂方案诱导化疗结束，无诉特殊不适，可予请假至6月13日，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n- [全程D15] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者请假至.吕星\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 予以口服升白细胞药物，静脉水化及补充电解质，皮下注射胸腺法新，并监测24小时尿量，准备行下一程化疗。\nB. 予以静脉滴注保肝药物，静脉水化及补充电解质，皮下注射胸腺法新，暂缓化疗待复查指标正常后继续。\nC. 予以静脉输注碳酸氢钠碱化尿液及利尿处理，静脉水化及补充电解质，将下一程化疗方案中的顺铂替换为卡铂。\nD. 予以静脉营养支持，静脉水化及补充电解质，皮下注射胸腺法新，下一程化疗顺铂剂量下调20%。\nE. 予以静脉水化、补充电解质及维生素，预防性皮下注射重组人粒细胞刺激因子，口服止咳药物，准备行下一程化疗。\nF. 予以静脉水化、补充电解质及维生素，预防性皮下注射重组人血小板生成素，口服止咳药物，准备行下一程化疗。\nG. 予以静脉水化、补充电解质及维生素，口服止咳药物，加用异烟肼预防性抗结核治疗，准备行下一程化疗。\nH. 予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，无需监测尿量，准备行下一程化疗。\nI. 予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，并监测24小时尿量，准备行单纯放射治疗。\nJ. 予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，并监测24小时尿量，准备行下一程化疗。\nK. 予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，并监测24小时尿量，将下一程化疗方案更改为吉西他滨加顺铂。\nL. 予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，并监测24小时尿量，将下一程化疗方案更改为紫杉醇加顺铂。\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-237ee315803b648b5eb4c67f","patient_id":"patient-84fa3d6098d10a1d14b6b19e","turn_id":"turn07","turn_position":6,"turn_type":"response_assessment_decision","gold_letter":"K","gold_action":"评估PET/CT证实双肺结节无代谢活性（排除M1），维持局部晚期诊断；行静脉置管护理与通畅性维护，复查生化常规后，继续行第2程PF方案诱导化疗。","options":[{"letter":"A","text":"评估PET/CT双侧扁桃体代谢活跃为淋巴结转移，双肺结节无代谢活性；调整为GP方案（吉西他滨+顺铂）行第2程诱导化疗，并加强静脉导管护理。","is_gold":false},{"letter":"B","text":"评估PET/CT证实双肺结节无代谢活性（排除M1）；已完成1程诱导化疗，直接进入根治性放疗阶段，并辅以同期顺铂化疗，定期复查生化常规。","is_gold":false},{"letter":"C","text":"评估PET/CT见双肺多发结节伴鼻咽病灶广泛侵犯，考虑为IVB期（M1）；调整为姑息性化疗，采用TP方案联合PD-1抑制剂，并维持静脉通路。","is_gold":false},{"letter":"D","text":"评估PET/CT证实双肺结节无代谢活性；病灶侵犯视神经及海绵窦，第2程诱导化疗需升级为TPF方案（多西他赛+顺铂+5-FU），并复查生化。","is_gold":false},{"letter":"E","text":"评估PET/CT证实双肺结节无代谢活性；拔除原有静脉置管以防血栓，复查生化常规后，继续行第2程PF方案（5-FU+顺铂）诱导化疗。","is_gold":false},{"letter":"F","text":"评估PET/CT证实双肺结节无代谢活性；局部病灶侵犯广泛，暂停化疗，优先行局部病灶减瘤术以解除视神经压迫，术后继续PF方案化疗。","is_gold":false},{"letter":"G","text":"评估PET/CT证实双肺结节无代谢活性；为加强局部控制，第2程诱导化疗在PF方案基础上加用西妥昔单抗靶向治疗，并常规维护静脉导管。","is_gold":false},{"letter":"H","text":"评估PET/CT证实双肺结节无代谢活性；第1程化疗后出现胃肠道反应，第2程化疗将顺铂替换为卡铂，行5-FU+卡铂方案，复查生化常规。","is_gold":false},{"letter":"I","text":"评估PET/CT证实双肺结节无代谢活性；行静脉置管护理，复查生化常规后，提前终止诱导化疗，开始单纯根治性放疗，密切监测不良反应。","is_gold":false},{"letter":"J","text":"评估PET/CT证实双肺结节无代谢活性，鼻咽病灶SUV值偏高说明原方案疗效欠佳；换用吉西他滨+顺铂方案行第2程诱导化疗，并复查生化。","is_gold":false},{"letter":"K","text":"评估PET/CT证实双肺结节无代谢活性（排除M1），维持局部晚期诊断；行静脉置管护理与通畅性维护，复查生化常规后，继续行第2程PF方案诱导化疗。","is_gold":true},{"letter":"L","text":"评估PET/CT证实双肺结节无代谢活性；病灶累及颅底及海绵窦，行第2程PF方案诱导化疗的同时，加用局部姑息性放疗，并维护静脉导管。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、斜坡、海绵窦、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左耳听力下降1年余；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右耳鸣；既往史: 某次就诊时间患“结核性胸膜炎”已治愈，某次就诊时间患“急性胰腺炎”已治愈。否认\"肝炎、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟史30年，1包每天，常饮酒，两天/次，每次500ml。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：120/80mmHg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧壁、顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D3] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D3] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 38mm AO 26mm MV E 0.79m/s EF 75% LV 50mm IVS 11mm A 0.67m/s FS 45% RA 33mm LVPW 8mm RV 20mm PA 19mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 左房稍大，余各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 左房稍大 各房室腔及大血管未探及异常血流信号 心功能正常\n- [全程D3] 检验组合: 丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D4] CT；胸部CT平扫＋增强: 检查类型: CT；检查名称: 胸部CT平扫＋增强；检查部位:；检查所见: 右中肺及双下肺见数个类结节影，最大者直径约 5 mm，病灶边界清楚而不规则，密度较高而不均匀；气管及支气管分枝通畅，未见明显软组织肿物或受压变窄；双侧肺门及纵隔未见明确肿大淋巴结；双侧胸腔未见积液；胸膜未见增厚；扫描范围内胸椎、胸壁骨未见骨质破坏征象。；检查结论: 双肺类结节影，转移瘤可能性大。\n- [全程D4] 检验组合: 酮体(KET)-尿液: +-（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；尿胆原(URO)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 4/μL；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；白细胞计数(WBC#)-尿液: 26/μL；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；酸碱度(pH)-尿液: 6；总蛋白(TP)-尿液: -（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性（参考: 阴性）；颜色-尿液: Light-Yellow；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；非鳞状上皮细胞计数-尿液: 2/μL；比重(SG)-尿液: 1.032；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.05；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL\n- [全程D2] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: 右臂静脉插管,导管末端位于T 6右旁，估计位于上腔静脉中段。；检查结论: 导管末端位置如上述。\n- [全程D2] 检验组合: 血小板分布宽度(PDW)-静脉血: 13.8%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；淋巴细胞百分比(Lymph%)-静脉血: 0.262；单核细胞计数(Mono#)-静脉血: 0.510E9/L；胱抑素(Cys-C)-静脉血: 1.01mg/L；总蛋白(TP)-静脉血: 68.46g/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.16COI；透明质酸(HA)-静脉血: 61.97ng/ml；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；大血小板百分比(P-LCR%)-静脉血: 32.4%；白蛋白(ALB)-静脉血: 43.7g/L；总胆固醇(TC)-静脉血: 5.59mmol/L；总胆红素(TBIL)-静脉血: 14.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.84；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.009；丙氨酸氨基转移酶(ALT)-静脉血: 27U/L；氯离子(Cl-)-静脉血: 103.1mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；淋巴细胞计数(Lymph#)-静脉血: 2.510E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.63mmol/L；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.06S/CO；血小板比容-静脉血: 21%；载脂蛋白B(apoB)-静脉血: 1.22g/L；C-反应蛋白(CRP)-静脉血: 4.05mg/L；ABO血型-静脉血: A；载脂蛋白AI(apoAI)-静脉血: 1.2g/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；单核细胞百分比(Mono%)-静脉血: 0.049；钠离子(Na+)-静脉血: 139.6mmol/L；凝血酶原时间(PT)-静脉血: 10.3sec.；球蛋白(GLO)-静脉血: 24.76g/L；纤维蛋白原(Fbg)-静脉血: 2.49g/L；凝血酶时间(TT)-静脉血: 20sec.；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44.6；Rh血型-静脉血: 阳性；平均红细胞体积(MCV)-静脉血: 85.8fL；直接胆红素(DBIL)-静脉血: 3.3umol/L；凝血酶原时间活动度(PTA)-静脉血: 113.8……\n- [全程D5] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: 3+500Leu（参考: 阴性）；白细胞计数(WBC#)-尿液: 18/μL；鳞状上皮细胞计数(SQEP#)-尿液: 5/μL；比重(SG)-尿液: 1.02；总蛋白(TP)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: Turbid；隐血(OB)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；未分类结晶计数(UNCX#)-尿液: 25/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；非鳞状上皮细胞计数-尿液: 5/μL\n- [全程D9] 检验组合: 钾离子(K+)-静脉血: 3.73mmol/L；红细胞比容(Hct)-静脉血: 48.1%；血小板比容-静脉血: 19%；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.94mmolL；尿素氮(BUN)-静脉血: 9.5mmol/L；钠离子(Na+)-静脉血: 137.8mmol/L；血红蛋白(Hb)-静脉血: 159g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.095；总钙(Ca)-静脉血: 1.93mmol/L；血小板分布宽度(PDW)-静脉血: 13.3%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；丙氨酸氨基转移酶(ALT)-静脉血: 94.9U/L；载脂蛋白B(apoB)-静脉血: 1.06g/L；白蛋白(ALB)-静脉血: 40.3g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.46；白细胞计数(WBC#)-静脉血: 14.910E9/L；胱抑素(Cys-C)-静脉血: 1.26mg/L；平均血小板体积(MPV)-静脉血: 10.4fL；中性粒细胞百分比(Neut%)-静脉血: 0.837；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.45mmol/L；血小板计数(PLT#)-静脉血: 17910E9/L；总胆固醇(TC)-静脉血: 5.1mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.4；球蛋白(GLO)-静脉血: 23.17g/L；磷(P)-静脉血: 1.26mmol/L；间接胆红素(IBIL)-静脉血: 13.1umolL；红细胞计数(RBC#)-静脉血: 5.5910E12/L；直接胆红素(DBIL)-静脉血: 5.4umol/L；总胆汁酸(TBA)-静脉血: 0.1umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；单核细胞百分比(Mono%)-静脉血: 0.06；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 42.8U/L；肌酐(Crea)-静脉血: 101.5umol/L；载脂蛋白AI(apoAI)-静脉血: 0.99g/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.4mmol/L；单核细胞计……\n- [全程D16] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及双侧壁增厚放射性浓聚，SUV约11.9，双侧咽隐窝消失；病灶侵犯双侧腭帆提肌、左侧腭帆张肌、左翼内肌，左咽旁间隙及左咽后间隙消失；病灶向上侵犯蝶骨基底部、左翼突区、左蝶骨大翼、左卵圆孔及左海绵窦；向前侵犯左翼腭窝、左上颌后脂肪间隙、左眶尖及左眶内后份，左框内病灶与视神经分界不清。右咽后小淋巴结放射性分布未见明显异常。双侧扁桃体放射性浓聚，SUV约9.4；喉咽结构及放射性分布未见明显异常。双侧上颌窦低密度影放射性分布未见异常；额窦、蝶窦、筛窦结构及放射性分布未见明显异常。甲状腺双叶密度减低，放射性分布未见异常。双颈多个小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺散在多发结节影放射性分布未见明显异常，最大约0.6×0.8cm；左上肺舌段条索影放射性分布未见异常；气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。心脏及纵隔大血管未见明显异常。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏弥漫性密度减低，CT值约36Hu（脾脏CT值约51Hu），放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾门区结节影放射性分布未见异常，大小约1.1×1.4cm（副脾）；脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 双侧乳突气房内低密度影放射性分布未见异常；余颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌病灶，侵犯左咽后及左咽旁间隙、颅底骨骼、左卵圆孔、左海绵窦、左翼腭窝、左上颌后脂肪间隙、左眶尖及左眶内后份，累及左视神经。 双肺多发小结节影代谢未见异常，疑增殖灶。 双侧上颌窦炎症；双侧乳突炎症。 双侧扁桃体代谢活跃，考虑炎性病变。 脂肪肝。\n- [全程D24] 检验组合: 红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.4%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.71mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.0123；平均血小板体积(MPV)-静脉血: 8.22fL；载脂蛋白B(apoB)-静脉血: 1.13g/L；总胆固醇(TC)-静脉血: 5.18mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.281；有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞血红蛋白浓度(MCHC)-静脉血: 325.6g/L；磷(P)-静脉血: 1.14mmol/L；胱抑素(Cys-C)-静脉血: 1.19mg/L；尿素氮(BUN)-静脉血: 7.71mmol/L；血小板分布宽度(PDW)-静脉血: 16.4%；丙氨酸氨基转移酶(ALT)-静脉血: 28.8U/L；直接胆红素(DBIL)-静脉血: 2.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.8；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.14mmolL；氯离子(Cl-)-静脉血: 105.9mmol/L；血小板计数(PLT#)-静脉血: 18310E9/L；中性粒细胞计数(Neut#)-静脉血: 510E9/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；乳酸脱氢酶(LDH)-静脉血: 159U/L；平均红细胞体积(MCV)-静脉血: 84.3fL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；红细胞计数(RBC#)-静脉血: 5.2310E12/L；球蛋白(GLO)-静脉血: 27.58g/L；葡萄糖(Glu)-静脉血: 4.55mmol/L；肌酐(Crea)-静脉血: 91.9umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；血小板比容-静脉血: 15%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 50.8U/L；白细胞计数(WBC#)-静脉血: 7.810E9/L；单核细胞百分比(Mono%)-静脉血: 0.0665；淋巴细胞计数(Lymph#)-静脉血: 2.210E9/L；C-反应蛋白(CRP)-静脉血: 4.59mg/L；红细胞比容(Hct)-静脉血:……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者无诉特殊不适，完善各项检查中，体查同入院时，[姓名已隐去]主任查房指示，待各项检查完成明确分期后，再决定下一步治疗。\n- [全程D8] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D10] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗结束，诉呕吐2次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程5-FU+顺铂方案诱导化疗结束，无诉特殊不适，可予请假至6月13日，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n- [全程D15] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者请假至.吕星\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估PET/CT双侧扁桃体代谢活跃为淋巴结转移，双肺结节无代谢活性；调整为GP方案（吉西他滨+顺铂）行第2程诱导化疗，并加强静脉导管护理。\nB. 评估PET/CT证实双肺结节无代谢活性（排除M1）；已完成1程诱导化疗，直接进入根治性放疗阶段，并辅以同期顺铂化疗，定期复查生化常规。\nC. 评估PET/CT见双肺多发结节伴鼻咽病灶广泛侵犯，考虑为IVB期（M1）；调整为姑息性化疗，采用TP方案联合PD-1抑制剂，并维持静脉通路。\nD. 评估PET/CT证实双肺结节无代谢活性；病灶侵犯视神经及海绵窦，第2程诱导化疗需升级为TPF方案（多西他赛+顺铂+5-FU），并复查生化。\nE. 评估PET/CT证实双肺结节无代谢活性；拔除原有静脉置管以防血栓，复查生化常规后，继续行第2程PF方案（5-FU+顺铂）诱导化疗。\nF. 评估PET/CT证实双肺结节无代谢活性；局部病灶侵犯广泛，暂停化疗，优先行局部病灶减瘤术以解除视神经压迫，术后继续PF方案化疗。\nG. 评估PET/CT证实双肺结节无代谢活性；为加强局部控制，第2程诱导化疗在PF方案基础上加用西妥昔单抗靶向治疗，并常规维护静脉导管。\nH. 评估PET/CT证实双肺结节无代谢活性；第1程化疗后出现胃肠道反应，第2程化疗将顺铂替换为卡铂，行5-FU+卡铂方案，复查生化常规。\nI. 评估PET/CT证实双肺结节无代谢活性；行静脉置管护理，复查生化常规后，提前终止诱导化疗，开始单纯根治性放疗，密切监测不良反应。\nJ. 评估PET/CT证实双肺结节无代谢活性，鼻咽病灶SUV值偏高说明原方案疗效欠佳；换用吉西他滨+顺铂方案行第2程诱导化疗，并复查生化。\nK. 评估PET/CT证实双肺结节无代谢活性（排除M1），维持局部晚期诊断；行静脉置管护理与通畅性维护，复查生化常规后，继续行第2程PF方案诱导化疗。\nL. 评估PET/CT证实双肺结节无代谢活性；病灶累及颅底及海绵窦，行第2程PF方案诱导化疗的同时，加用局部姑息性放疗，并维护静脉导管。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- 无可展示记录。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估PET/CT双侧扁桃体代谢活跃为淋巴结转移，双肺结节无代谢活性；调整为GP方案（吉西他滨+顺铂）行第2程诱导化疗，并加强静脉导管护理。\nB. 评估PET/CT证实双肺结节无代谢活性（排除M1）；已完成1程诱导化疗，直接进入根治性放疗阶段，并辅以同期顺铂化疗，定期复查生化常规。\nC. 评估PET/CT见双肺多发结节伴鼻咽病灶广泛侵犯，考虑为IVB期（M1）；调整为姑息性化疗，采用TP方案联合PD-1抑制剂，并维持静脉通路。\nD. 评估PET/CT证实双肺结节无代谢活性；病灶侵犯视神经及海绵窦，第2程诱导化疗需升级为TPF方案（多西他赛+顺铂+5-FU），并复查生化。\nE. 评估PET/CT证实双肺结节无代谢活性；拔除原有静脉置管以防血栓，复查生化常规后，继续行第2程PF方案（5-FU+顺铂）诱导化疗。\nF. 评估PET/CT证实双肺结节无代谢活性；局部病灶侵犯广泛，暂停化疗，优先行局部病灶减瘤术以解除视神经压迫，术后继续PF方案化疗。\nG. 评估PET/CT证实双肺结节无代谢活性；为加强局部控制，第2程诱导化疗在PF方案基础上加用西妥昔单抗靶向治疗，并常规维护静脉导管。\nH. 评估PET/CT证实双肺结节无代谢活性；第1程化疗后出现胃肠道反应，第2程化疗将顺铂替换为卡铂，行5-FU+卡铂方案，复查生化常规。\nI. 评估PET/CT证实双肺结节无代谢活性；行静脉置管护理，复查生化常规后，提前终止诱导化疗，开始单纯根治性放疗，密切监测不良反应。\nJ. 评估PET/CT证实双肺结节无代谢活性，鼻咽病灶SUV值偏高说明原方案疗效欠佳；换用吉西他滨+顺铂方案行第2程诱导化疗，并复查生化。\nK. 评估PET/CT证实双肺结节无代谢活性（排除M1），维持局部晚期诊断；行静脉置管护理与通畅性维护，复查生化常规后，继续行第2程PF方案诱导化疗。\nL. 评估PET/CT证实双肺结节无代谢活性；病灶累及颅底及海绵窦，行第2程PF方案诱导化疗的同时，加用局部姑息性放疗，并维护静脉导管。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、斜坡、海绵窦、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- 无可展示记录。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估PET/CT双侧扁桃体代谢活跃为淋巴结转移，双肺结节无代谢活性；调整为GP方案（吉西他滨+顺铂）行第2程诱导化疗，并加强静脉导管护理。\nB. 评估PET/CT证实双肺结节无代谢活性（排除M1）；已完成1程诱导化疗，直接进入根治性放疗阶段，并辅以同期顺铂化疗，定期复查生化常规。\nC. 评估PET/CT见双肺多发结节伴鼻咽病灶广泛侵犯，考虑为IVB期（M1）；调整为姑息性化疗，采用TP方案联合PD-1抑制剂，并维持静脉通路。\nD. 评估PET/CT证实双肺结节无代谢活性；病灶侵犯视神经及海绵窦，第2程诱导化疗需升级为TPF方案（多西他赛+顺铂+5-FU），并复查生化。\nE. 评估PET/CT证实双肺结节无代谢活性；拔除原有静脉置管以防血栓，复查生化常规后，继续行第2程PF方案（5-FU+顺铂）诱导化疗。\nF. 评估PET/CT证实双肺结节无代谢活性；局部病灶侵犯广泛，暂停化疗，优先行局部病灶减瘤术以解除视神经压迫，术后继续PF方案化疗。\nG. 评估PET/CT证实双肺结节无代谢活性；为加强局部控制，第2程诱导化疗在PF方案基础上加用西妥昔单抗靶向治疗，并常规维护静脉导管。\nH. 评估PET/CT证实双肺结节无代谢活性；第1程化疗后出现胃肠道反应，第2程化疗将顺铂替换为卡铂，行5-FU+卡铂方案，复查生化常规。\nI. 评估PET/CT证实双肺结节无代谢活性；行静脉置管护理，复查生化常规后，提前终止诱导化疗，开始单纯根治性放疗，密切监测不良反应。\nJ. 评估PET/CT证实双肺结节无代谢活性，鼻咽病灶SUV值偏高说明原方案疗效欠佳；换用吉西他滨+顺铂方案行第2程诱导化疗，并复查生化。\nK. 评估PET/CT证实双肺结节无代谢活性（排除M1），维持局部晚期诊断；行静脉置管护理与通畅性维护，复查生化常规后，继续行第2程PF方案诱导化疗。\nL. 评估PET/CT证实双肺结节无代谢活性；病灶累及颅底及海绵窦，行第2程PF方案诱导化疗的同时，加用局部姑息性放疗，并维护静脉导管。\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-c9510f9db8861176764ecc37","patient_id":"patient-84fa3d6098d10a1d14b6b19e","turn_id":"turn08","turn_position":7,"turn_type":"recurrence_or_salvage_decision","gold_letter":"L","gold_action":"行电子鼻咽镜检查（不活检）进一步评估鼻咽局部疗效，复查血常规与生化常规，并予动静脉置管护理。","options":[{"letter":"A","text":"立即启动根治性调强放射治疗及同步化疗，暂不安排其他局部影像或内镜检查。","is_gold":false},{"letter":"B","text":"行电子鼻咽镜检查并对残留病灶取活检以明确病理状态，复查血常规与生化常规。","is_gold":false},{"letter":"C","text":"继续予以第3程5-FU+顺铂方案诱导化疗，待化疗结束后再行鼻咽镜评估。","is_gold":false},{"letter":"D","text":"安排全身PET/CT复查以评估全身肿瘤代谢活性变化，随后制定放疗计划。","is_gold":false},{"letter":"E","text":"更改为紫杉醇+顺铂方案行第3程诱导化疗，并予动静脉置管常规护理。","is_gold":false},{"letter":"F","text":"安排鼻咽及颈部CT平扫+增强进一步评估颅底骨质破坏情况，复查血常规。","is_gold":false},{"letter":"G","text":"择期行双侧颈部淋巴结清扫术，术后启动鼻咽局部及颈部放射治疗。","is_gold":false},{"letter":"H","text":"行电子鼻咽镜检查（不活检）评估局部疗效，并拔除动静脉置管准备单纯放疗。","is_gold":false},{"letter":"I","text":"更改为吉西他滨+顺铂方案行第3程诱导化疗，复查血常规与生化常规。","is_gold":false},{"letter":"J","text":"行电子鼻咽镜检查（不活检），若无明显外生型肿物则暂缓放疗并定期随访。","is_gold":false},{"letter":"K","text":"立即启动单纯根治性放射治疗，并予动静脉置管常规护理。","is_gold":false},{"letter":"L","text":"行电子鼻咽镜检查（不活检）进一步评估鼻咽局部疗效，复查血常规与生化常规，并予动静脉置管护理。","is_gold":true}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、斜坡、海绵窦、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左耳听力下降1年余；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右耳鸣；既往史: 某次就诊时间患“结核性胸膜炎”已治愈，某次就诊时间患“急性胰腺炎”已治愈。否认\"肝炎、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟史30年，1包每天，常饮酒，两天/次，每次500ml。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：120/80mmHg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧壁、顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D3] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D3] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 38mm AO 26mm MV E 0.79m/s EF 75% LV 50mm IVS 11mm A 0.67m/s FS 45% RA 33mm LVPW 8mm RV 20mm PA 19mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 左房稍大，余各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 左房稍大 各房室腔及大血管未探及异常血流信号 心功能正常\n- [全程D3] 检验组合: 丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D4] CT；胸部CT平扫＋增强: 检查类型: CT；检查名称: 胸部CT平扫＋增强；检查部位:；检查所见: 右中肺及双下肺见数个类结节影，最大者直径约 5 mm，病灶边界清楚而不规则，密度较高而不均匀；气管及支气管分枝通畅，未见明显软组织肿物或受压变窄；双侧肺门及纵隔未见明确肿大淋巴结；双侧胸腔未见积液；胸膜未见增厚；扫描范围内胸椎、胸壁骨未见骨质破坏征象。；检查结论: 双肺类结节影，转移瘤可能性大。\n- [全程D4] 检验组合: 酮体(KET)-尿液: +-（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；尿胆原(URO)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 4/μL；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；白细胞计数(WBC#)-尿液: 26/μL；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；酸碱度(pH)-尿液: 6；总蛋白(TP)-尿液: -（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性（参考: 阴性）；颜色-尿液: Light-Yellow；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；非鳞状上皮细胞计数-尿液: 2/μL；比重(SG)-尿液: 1.032；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.05；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL\n- [全程D2] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: 右臂静脉插管,导管末端位于T 6右旁，估计位于上腔静脉中段。；检查结论: 导管末端位置如上述。\n- [全程D2] 检验组合: 血小板分布宽度(PDW)-静脉血: 13.8%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；淋巴细胞百分比(Lymph%)-静脉血: 0.262；单核细胞计数(Mono#)-静脉血: 0.510E9/L；胱抑素(Cys-C)-静脉血: 1.01mg/L；总蛋白(TP)-静脉血: 68.46g/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.16COI；透明质酸(HA)-静脉血: 61.97ng/ml；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；大血小板百分比(P-LCR%)-静脉血: 32.4%；白蛋白(ALB)-静脉血: 43.7g/L；总胆固醇(TC)-静脉血: 5.59mmol/L；总胆红素(TBIL)-静脉血: 14.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.84；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.009；丙氨酸氨基转移酶(ALT)-静脉血: 27U/L；氯离子(Cl-)-静脉血: 103.1mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；淋巴细胞计数(Lymph#)-静脉血: 2.510E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.63mmol/L；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.06S/CO；血小板比容-静脉血: 21%；载脂蛋白B(apoB)-静脉血: 1.22g/L；C-反应蛋白(CRP)-静脉血: 4.05mg/L；ABO血型-静脉血: A；载脂蛋白AI(apoAI)-静脉血: 1.2g/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；单核细胞百分比(Mono%)-静脉血: 0.049；钠离子(Na+)-静脉血: 139.6mmol/L；凝血酶原时间(PT)-静脉血: 10.3sec.；球蛋白(GLO)-静脉血: 24.76g/L；纤维蛋白原(Fbg)-静脉血: 2.49g/L；凝血酶时间(TT)-静脉血: 20sec.；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44.6；Rh血型-静脉血: 阳性；平均红细胞体积(MCV)-静脉血: 85.8fL；直接胆红素(DBIL)-静脉血: 3.3umol/L；凝血酶原时间活动度(PTA)-静脉血: 113.8……\n- [全程D5] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: 3+500Leu（参考: 阴性）；白细胞计数(WBC#)-尿液: 18/μL；鳞状上皮细胞计数(SQEP#)-尿液: 5/μL；比重(SG)-尿液: 1.02；总蛋白(TP)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: Turbid；隐血(OB)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；未分类结晶计数(UNCX#)-尿液: 25/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；非鳞状上皮细胞计数-尿液: 5/μL\n- [全程D9] 检验组合: 钾离子(K+)-静脉血: 3.73mmol/L；红细胞比容(Hct)-静脉血: 48.1%；血小板比容-静脉血: 19%；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.94mmolL；尿素氮(BUN)-静脉血: 9.5mmol/L；钠离子(Na+)-静脉血: 137.8mmol/L；血红蛋白(Hb)-静脉血: 159g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.095；总钙(Ca)-静脉血: 1.93mmol/L；血小板分布宽度(PDW)-静脉血: 13.3%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；丙氨酸氨基转移酶(ALT)-静脉血: 94.9U/L；载脂蛋白B(apoB)-静脉血: 1.06g/L；白蛋白(ALB)-静脉血: 40.3g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.46；白细胞计数(WBC#)-静脉血: 14.910E9/L；胱抑素(Cys-C)-静脉血: 1.26mg/L；平均血小板体积(MPV)-静脉血: 10.4fL；中性粒细胞百分比(Neut%)-静脉血: 0.837；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.45mmol/L；血小板计数(PLT#)-静脉血: 17910E9/L；总胆固醇(TC)-静脉血: 5.1mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.4；球蛋白(GLO)-静脉血: 23.17g/L；磷(P)-静脉血: 1.26mmol/L；间接胆红素(IBIL)-静脉血: 13.1umolL；红细胞计数(RBC#)-静脉血: 5.5910E12/L；直接胆红素(DBIL)-静脉血: 5.4umol/L；总胆汁酸(TBA)-静脉血: 0.1umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；单核细胞百分比(Mono%)-静脉血: 0.06；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 42.8U/L；肌酐(Crea)-静脉血: 101.5umol/L；载脂蛋白AI(apoAI)-静脉血: 0.99g/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.4mmol/L；单核细胞计……\n- [全程D16] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及双侧壁增厚放射性浓聚，SUV约11.9，双侧咽隐窝消失；病灶侵犯双侧腭帆提肌、左侧腭帆张肌、左翼内肌，左咽旁间隙及左咽后间隙消失；病灶向上侵犯蝶骨基底部、左翼突区、左蝶骨大翼、左卵圆孔及左海绵窦；向前侵犯左翼腭窝、左上颌后脂肪间隙、左眶尖及左眶内后份，左框内病灶与视神经分界不清。右咽后小淋巴结放射性分布未见明显异常。双侧扁桃体放射性浓聚，SUV约9.4；喉咽结构及放射性分布未见明显异常。双侧上颌窦低密度影放射性分布未见异常；额窦、蝶窦、筛窦结构及放射性分布未见明显异常。甲状腺双叶密度减低，放射性分布未见异常。双颈多个小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺散在多发结节影放射性分布未见明显异常，最大约0.6×0.8cm；左上肺舌段条索影放射性分布未见异常；气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。心脏及纵隔大血管未见明显异常。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏弥漫性密度减低，CT值约36Hu（脾脏CT值约51Hu），放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾门区结节影放射性分布未见异常，大小约1.1×1.4cm（副脾）；脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 双侧乳突气房内低密度影放射性分布未见异常；余颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌病灶，侵犯左咽后及左咽旁间隙、颅底骨骼、左卵圆孔、左海绵窦、左翼腭窝、左上颌后脂肪间隙、左眶尖及左眶内后份，累及左视神经。 双肺多发小结节影代谢未见异常，疑增殖灶。 双侧上颌窦炎症；双侧乳突炎症。 双侧扁桃体代谢活跃，考虑炎性病变。 脂肪肝。\n- [全程D24] 检验组合: 红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.4%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.71mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.0123；平均血小板体积(MPV)-静脉血: 8.22fL；载脂蛋白B(apoB)-静脉血: 1.13g/L；总胆固醇(TC)-静脉血: 5.18mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.281；有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞血红蛋白浓度(MCHC)-静脉血: 325.6g/L；磷(P)-静脉血: 1.14mmol/L；胱抑素(Cys-C)-静脉血: 1.19mg/L；尿素氮(BUN)-静脉血: 7.71mmol/L；血小板分布宽度(PDW)-静脉血: 16.4%；丙氨酸氨基转移酶(ALT)-静脉血: 28.8U/L；直接胆红素(DBIL)-静脉血: 2.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.8；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.14mmolL；氯离子(Cl-)-静脉血: 105.9mmol/L；血小板计数(PLT#)-静脉血: 18310E9/L；中性粒细胞计数(Neut#)-静脉血: 510E9/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；乳酸脱氢酶(LDH)-静脉血: 159U/L；平均红细胞体积(MCV)-静脉血: 84.3fL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；红细胞计数(RBC#)-静脉血: 5.2310E12/L；球蛋白(GLO)-静脉血: 27.58g/L；葡萄糖(Glu)-静脉血: 4.55mmol/L；肌酐(Crea)-静脉血: 91.9umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；血小板比容-静脉血: 15%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 50.8U/L；白细胞计数(WBC#)-静脉血: 7.810E9/L；单核细胞百分比(Mono%)-静脉血: 0.0665；淋巴细胞计数(Lymph#)-静脉血: 2.210E9/L；C-反应蛋白(CRP)-静脉血: 4.59mg/L；红细胞比容(Hct)-静脉血:……\n- [全程D25] 检验组合: 浊度(TRUB)-尿液: 清亮；白细胞计数(WBC#)-尿液: 100/μL；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；红细胞计数(RBC#)-尿液: 4/μL；比重(SG)-尿液: 1.028；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -+25Leu（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow\n- [全程D26] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.027；颜色-尿液: Light-Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；葡萄糖(Glu)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）\n- [全程D27] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 9/μL；酮体(KET)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.026；酸碱度(pH)-尿液: 6.5；颜色-尿液: Light-Yellow；浊度(TRUB)-尿液: 清亮；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）\n- [全程D31] 检验组合: 钠离子(Na+)-静脉血: 137.1mmol/L；直接胆红素(DBIL)-静脉血: 5.1umol/L；磷(P)-静脉血: 1.46mmol/L；红细胞计数(RBC#)-静脉血: 5.0710E12/L；镁离子(Mg2+)-静脉血: 0.64mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.7mmol/L；血小板计数(PLT#)-静脉血: 11810E9/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；胱抑素(Cys-C)-静脉血: 1.51mg/L；间接胆红素(IBIL)-静脉血: 9umolL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.9；中性粒细胞百分比(Neut%)-静脉血: 0.581；甘油三酯(TG)-静脉血: 1.92mmol/L；血小板分布宽度(PDW)-静脉血: 11.5%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.006；氯离子(Cl-)-静脉血: 98.9mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.94mmolL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；总蛋白(TP)-静脉血: 63.22g/L；尿素氮(BUN)-静脉血: 10.16mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 27.6pg；总胆汁酸(TBA)-静脉血: 0.3umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.710E9/L；葡萄糖(Glu)-静脉血: 5.19mmol/L；血红蛋白(Hb)-静脉血: 140g/L；载脂蛋白AI(apoAI)-静脉血: 1.13g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 41.9U/L；总胆固醇(TC)-静脉血: 5.12mmol/L；肌酐(Crea)-静脉血: 132.7umol/L；总钙(Ca)-静脉血: 1.91mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 44U/L；球蛋白(GLO)-静脉血: 24.42g/L；白蛋白(ALB)-静脉血: 38.8g/L；平均红细胞体积(MCV)-静脉血: 83.8fL；乳酸脱氢酶(LDH)-静脉血: 199.2U/L；总胆红素(TBIL)-静脉血: 14.1umol/L；钾离子(K+)……\n- [全程D32] 检验组合: 肌酐(Crea)-静脉血: 122.2umol/L；磷(P)-静脉血: 1.38mmol/L；尿素氮(BUN)-静脉血: 9.9mmol/L；总胆红素(TBIL)-静脉血: 14.5umol/L；尿酸(UA)-静脉血: 496.4umol/L；镁离子(Mg2+)-静脉血: 0.57mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.76；总钙(Ca)-静脉血: 1.79mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.5mmol/L；球蛋白(GLO)-静脉血: 23.74g/L；氯离子(Cl-)-静脉血: 97.6mmol/L；钠离子(Na+)-静脉血: 136.5mmol/L；阴离子间隙(AG)-静脉血: 16.4；间接胆红素(IBIL)-静脉血: 10.3umolL；直接胆红素(DBIL)-静脉血: 4.2umol/L；白蛋白(ALB)-静脉血: 41.9g/L；总蛋白(TP)-静脉血: 65.64g/L；钾离子(K+)-静脉血: 3.56mmol/L\n- [全程D35] 检验组合: 磷(P)-静脉血: 1.32mmol/L；镁离子(Mg2+)-静脉血: 0.53mmol/L；阴离子间隙(AG)-静脉血: 14.8；球蛋白(GLO)-静脉血: 21.96g/L；总钙(Ca)-静脉血: 1.51mmol/L；总胆红素(TBIL)-静脉血: 7.6umol/L；总蛋白(TP)-静脉血: 60.56g/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.2mmol/L；间接胆红素(IBIL)-静脉血: 5umolL；尿素氮(BUN)-静脉血: 11.2mmol/L；钾离子(K+)-静脉血: 3.94mmol/L；白蛋白(ALB)-静脉血: 38.6g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.76；尿酸(UA)-静脉血: 490.1umol/L；肌酐(Crea)-静脉血: 116.6umol/L；直接胆红素(DBIL)-静脉血: 2.6umol/L；氯离子(Cl-)-静脉血: 104.1mmol/L；钠离子(Na+)-静脉血: 140.1mmol/L\n- [全程D36] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌两程诱导化疗后复查：对比某次就诊时间MRI， 鼻咽顶壁、顶后壁、后壁及双侧壁稍增厚，形成软组织肿物向腔内突出，T1WI呈等信号，T2WI呈高信号，增强后明显强化。肿物占据双侧咽隐窝，侵犯双侧腭帆张、提肌及左侧翼内肌。右侧翼外肌未见明显异常。双侧咽旁间隙清晰。 口咽未见明确病变。 蝶骨基底部、左侧岩尖骨质信号减低 ，增强后明显强化。 双侧海绵窦形态正常，未见增宽。 双侧蝶窦、筛窦、额窦粘膜增厚，呈长分期信息见历史辅助诊断节点长分期信息见历史辅助诊断节点信号，增强后边缘轻度强化，双侧乳突内见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点信号分泌物，骨壁完好。 双侧眼球大小、形态、位置均属正常，信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变。 双侧咽后各见一淋巴结，大小分别约为6mm×6mm（左）、7mm×4mm（右），边界清，信号均，增强后可见强化。 双颈II区见数个稍大淋巴结，边缘清，信号欠均，增强后明显强化，孤立散在，未见明显坏死，最大者位于右颈II区，大小约13mm×9mm。 双颈II~IV区可见小淋巴结，边缘清，信号尚均，增强后可见强化。 喉咽腔形态正常，未见占位性病变。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽占位，对比某次就诊时间MRI所见病变明显缩小好转。 颅底骨质破坏。 双颈II区稍大淋巴结，不除外转移。 鼻窦炎、乳突炎。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者无诉特殊不适，完善各项检查中，体查同入院时，[姓名已隐去]主任查房指示，待各项检查完成明确分期后，再决定下一步治疗。\n- [全程D8] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D10] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗结束，诉呕吐2次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程5-FU+顺铂方案诱导化疗结束，无诉特殊不适，可予请假至6月13日，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n- [全程D15] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者请假至.吕星\n- [全程D25] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者安返病房，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，可于今日执行第2程5-FU+顺铂方案诱导化疗，注意化疗不良反应。\n- [全程D27] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D36] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者请假至.\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即启动根治性调强放射治疗及同步化疗，暂不安排其他局部影像或内镜检查。\nB. 行电子鼻咽镜检查并对残留病灶取活检以明确病理状态，复查血常规与生化常规。\nC. 继续予以第3程5-FU+顺铂方案诱导化疗，待化疗结束后再行鼻咽镜评估。\nD. 安排全身PET/CT复查以评估全身肿瘤代谢活性变化，随后制定放疗计划。\nE. 更改为紫杉醇+顺铂方案行第3程诱导化疗，并予动静脉置管常规护理。\nF. 安排鼻咽及颈部CT平扫+增强进一步评估颅底骨质破坏情况，复查血常规。\nG. 择期行双侧颈部淋巴结清扫术，术后启动鼻咽局部及颈部放射治疗。\nH. 行电子鼻咽镜检查（不活检）评估局部疗效，并拔除动静脉置管准备单纯放疗。\nI. 更改为吉西他滨+顺铂方案行第3程诱导化疗，复查血常规与生化常规。\nJ. 行电子鼻咽镜检查（不活检），若无明显外生型肿物则暂缓放疗并定期随访。\nK. 立即启动单纯根治性放射治疗，并予动静脉置管常规护理。\nL. 行电子鼻咽镜检查（不活检）进一步评估鼻咽局部疗效，复查血常规与生化常规，并予动静脉置管护理。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D25] 检验组合: 浊度(TRUB)-尿液: 清亮；白细胞计数(WBC#)-尿液: 100/μL；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；红细胞计数(RBC#)-尿液: 4/μL；比重(SG)-尿液: 1.028；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -+25Leu（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow\n- [全程D26] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.027；颜色-尿液: Light-Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；葡萄糖(Glu)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）\n- [全程D27] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 9/μL；酮体(KET)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.026；酸碱度(pH)-尿液: 6.5；颜色-尿液: Light-Yellow；浊度(TRUB)-尿液: 清亮；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）\n- [全程D31] 检验组合: 钠离子(Na+)-静脉血: 137.1mmol/L；直接胆红素(DBIL)-静脉血: 5.1umol/L；磷(P)-静脉血: 1.46mmol/L；红细胞计数(RBC#)-静脉血: 5.0710E12/L；镁离子(Mg2+)-静脉血: 0.64mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.7mmol/L；血小板计数(PLT#)-静脉血: 11810E9/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；胱抑素(Cys-C)-静脉血: 1.51mg/L；间接胆红素(IBIL)-静脉血: 9umolL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.9；中性粒细胞百分比(Neut%)-静脉血: 0.581；甘油三酯(TG)-静脉血: 1.92mmol/L；血小板分布宽度(PDW)-静脉血: 11.5%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.006；氯离子(Cl-)-静脉血: 98.9mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.94mmolL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；总蛋白(TP)-静脉血: 63.22g/L；尿素氮(BUN)-静脉血: 10.16mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 27.6pg；总胆汁酸(TBA)-静脉血: 0.3umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.710E9/L；葡萄糖(Glu)-静脉血: 5.19mmol/L；血红蛋白(Hb)-静脉血: 140g/L；载脂蛋白AI(apoAI)-静脉血: 1.13g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 41.9U/L；总胆固醇(TC)-静脉血: 5.12mmol/L；肌酐(Crea)-静脉血: 132.7umol/L；总钙(Ca)-静脉血: 1.91mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 44U/L；球蛋白(GLO)-静脉血: 24.42g/L；白蛋白(ALB)-静脉血: 38.8g/L；平均红细胞体积(MCV)-静脉血: 83.8fL；乳酸脱氢酶(LDH)-静脉血: 199.2U/L；总胆红素(TBIL)-静脉血: 14.1umol/L；钾离子(K+)……\n- [全程D32] 检验组合: 肌酐(Crea)-静脉血: 122.2umol/L；磷(P)-静脉血: 1.38mmol/L；尿素氮(BUN)-静脉血: 9.9mmol/L；总胆红素(TBIL)-静脉血: 14.5umol/L；尿酸(UA)-静脉血: 496.4umol/L；镁离子(Mg2+)-静脉血: 0.57mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.76；总钙(Ca)-静脉血: 1.79mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.5mmol/L；球蛋白(GLO)-静脉血: 23.74g/L；氯离子(Cl-)-静脉血: 97.6mmol/L；钠离子(Na+)-静脉血: 136.5mmol/L；阴离子间隙(AG)-静脉血: 16.4；间接胆红素(IBIL)-静脉血: 10.3umolL；直接胆红素(DBIL)-静脉血: 4.2umol/L；白蛋白(ALB)-静脉血: 41.9g/L；总蛋白(TP)-静脉血: 65.64g/L；钾离子(K+)-静脉血: 3.56mmol/L\n- [全程D35] 检验组合: 磷(P)-静脉血: 1.32mmol/L；镁离子(Mg2+)-静脉血: 0.53mmol/L；阴离子间隙(AG)-静脉血: 14.8；球蛋白(GLO)-静脉血: 21.96g/L；总钙(Ca)-静脉血: 1.51mmol/L；总胆红素(TBIL)-静脉血: 7.6umol/L；总蛋白(TP)-静脉血: 60.56g/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.2mmol/L；间接胆红素(IBIL)-静脉血: 5umolL；尿素氮(BUN)-静脉血: 11.2mmol/L；钾离子(K+)-静脉血: 3.94mmol/L；白蛋白(ALB)-静脉血: 38.6g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.76；尿酸(UA)-静脉血: 490.1umol/L；肌酐(Crea)-静脉血: 116.6umol/L；直接胆红素(DBIL)-静脉血: 2.6umol/L；氯离子(Cl-)-静脉血: 104.1mmol/L；钠离子(Na+)-静脉血: 140.1mmol/L\n- [全程D36] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌两程诱导化疗后复查：对比某次就诊时间MRI， 鼻咽顶壁、顶后壁、后壁及双侧壁稍增厚，形成软组织肿物向腔内突出，T1WI呈等信号，T2WI呈高信号，增强后明显强化。肿物占据双侧咽隐窝，侵犯双侧腭帆张、提肌及左侧翼内肌。右侧翼外肌未见明显异常。双侧咽旁间隙清晰。 口咽未见明确病变。 蝶骨基底部、左侧岩尖骨质信号减低 ，增强后明显强化。 双侧海绵窦形态正常，未见增宽。 双侧蝶窦、筛窦、额窦粘膜增厚，呈长分期信息见历史辅助诊断节点长分期信息见历史辅助诊断节点信号，增强后边缘轻度强化，双侧乳突内见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点信号分泌物，骨壁完好。 双侧眼球大小、形态、位置均属正常，信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变。 双侧咽后各见一淋巴结，大小分别约为6mm×6mm（左）、7mm×4mm（右），边界清，信号均，增强后可见强化。 双颈II区见数个稍大淋巴结，边缘清，信号欠均，增强后明显强化，孤立散在，未见明显坏死，最大者位于右颈II区，大小约13mm×9mm。 双颈II~IV区可见小淋巴结，边缘清，信号尚均，增强后可见强化。 喉咽腔形态正常，未见占位性病变。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽占位，对比某次就诊时间MRI所见病变明显缩小好转。 颅底骨质破坏。 双颈II区稍大淋巴结，不除外转移。 鼻窦炎、乳突炎。\n\n【既往治疗与反应】\n- [全程D25] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者安返病房，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，可于今日执行第2程5-FU+顺铂方案诱导化疗，注意化疗不良反应。\n- [全程D27] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D36] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者请假至.\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即启动根治性调强放射治疗及同步化疗，暂不安排其他局部影像或内镜检查。\nB. 行电子鼻咽镜检查并对残留病灶取活检以明确病理状态，复查血常规与生化常规。\nC. 继续予以第3程5-FU+顺铂方案诱导化疗，待化疗结束后再行鼻咽镜评估。\nD. 安排全身PET/CT复查以评估全身肿瘤代谢活性变化，随后制定放疗计划。\nE. 更改为紫杉醇+顺铂方案行第3程诱导化疗，并予动静脉置管常规护理。\nF. 安排鼻咽及颈部CT平扫+增强进一步评估颅底骨质破坏情况，复查血常规。\nG. 择期行双侧颈部淋巴结清扫术，术后启动鼻咽局部及颈部放射治疗。\nH. 行电子鼻咽镜检查（不活检）评估局部疗效，并拔除动静脉置管准备单纯放疗。\nI. 更改为吉西他滨+顺铂方案行第3程诱导化疗，复查血常规与生化常规。\nJ. 行电子鼻咽镜检查（不活检），若无明显外生型肿物则暂缓放疗并定期随访。\nK. 立即启动单纯根治性放射治疗，并予动静脉置管常规护理。\nL. 行电子鼻咽镜检查（不活检）进一步评估鼻咽局部疗效，复查血常规与生化常规，并予动静脉置管护理。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、斜坡、海绵窦、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D25] 检验组合: 浊度(TRUB)-尿液: 清亮；白细胞计数(WBC#)-尿液: 100/μL；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；红细胞计数(RBC#)-尿液: 4/μL；比重(SG)-尿液: 1.028；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -+25Leu（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow\n- [全程D26] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.027；颜色-尿液: Light-Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；葡萄糖(Glu)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）\n- [全程D27] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 9/μL；酮体(KET)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.026；酸碱度(pH)-尿液: 6.5；颜色-尿液: Light-Yellow；浊度(TRUB)-尿液: 清亮；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）\n- [全程D31] 检验组合: 钠离子(Na+)-静脉血: 137.1mmol/L；直接胆红素(DBIL)-静脉血: 5.1umol/L；磷(P)-静脉血: 1.46mmol/L；红细胞计数(RBC#)-静脉血: 5.0710E12/L；镁离子(Mg2+)-静脉血: 0.64mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.7mmol/L；血小板计数(PLT#)-静脉血: 11810E9/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；胱抑素(Cys-C)-静脉血: 1.51mg/L；间接胆红素(IBIL)-静脉血: 9umolL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.9；中性粒细胞百分比(Neut%)-静脉血: 0.581；甘油三酯(TG)-静脉血: 1.92mmol/L；血小板分布宽度(PDW)-静脉血: 11.5%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.006；氯离子(Cl-)-静脉血: 98.9mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.94mmolL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；总蛋白(TP)-静脉血: 63.22g/L；尿素氮(BUN)-静脉血: 10.16mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 27.6pg；总胆汁酸(TBA)-静脉血: 0.3umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.710E9/L；葡萄糖(Glu)-静脉血: 5.19mmol/L；血红蛋白(Hb)-静脉血: 140g/L；载脂蛋白AI(apoAI)-静脉血: 1.13g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 41.9U/L；总胆固醇(TC)-静脉血: 5.12mmol/L；肌酐(Crea)-静脉血: 132.7umol/L；总钙(Ca)-静脉血: 1.91mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 44U/L；球蛋白(GLO)-静脉血: 24.42g/L；白蛋白(ALB)-静脉血: 38.8g/L；平均红细胞体积(MCV)-静脉血: 83.8fL；乳酸脱氢酶(LDH)-静脉血: 199.2U/L；总胆红素(TBIL)-静脉血: 14.1umol/L；钾离子(K+)……\n- [全程D32] 检验组合: 肌酐(Crea)-静脉血: 122.2umol/L；磷(P)-静脉血: 1.38mmol/L；尿素氮(BUN)-静脉血: 9.9mmol/L；总胆红素(TBIL)-静脉血: 14.5umol/L；尿酸(UA)-静脉血: 496.4umol/L；镁离子(Mg2+)-静脉血: 0.57mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.76；总钙(Ca)-静脉血: 1.79mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.5mmol/L；球蛋白(GLO)-静脉血: 23.74g/L；氯离子(Cl-)-静脉血: 97.6mmol/L；钠离子(Na+)-静脉血: 136.5mmol/L；阴离子间隙(AG)-静脉血: 16.4；间接胆红素(IBIL)-静脉血: 10.3umolL；直接胆红素(DBIL)-静脉血: 4.2umol/L；白蛋白(ALB)-静脉血: 41.9g/L；总蛋白(TP)-静脉血: 65.64g/L；钾离子(K+)-静脉血: 3.56mmol/L\n- [全程D35] 检验组合: 磷(P)-静脉血: 1.32mmol/L；镁离子(Mg2+)-静脉血: 0.53mmol/L；阴离子间隙(AG)-静脉血: 14.8；球蛋白(GLO)-静脉血: 21.96g/L；总钙(Ca)-静脉血: 1.51mmol/L；总胆红素(TBIL)-静脉血: 7.6umol/L；总蛋白(TP)-静脉血: 60.56g/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.2mmol/L；间接胆红素(IBIL)-静脉血: 5umolL；尿素氮(BUN)-静脉血: 11.2mmol/L；钾离子(K+)-静脉血: 3.94mmol/L；白蛋白(ALB)-静脉血: 38.6g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.76；尿酸(UA)-静脉血: 490.1umol/L；肌酐(Crea)-静脉血: 116.6umol/L；直接胆红素(DBIL)-静脉血: 2.6umol/L；氯离子(Cl-)-静脉血: 104.1mmol/L；钠离子(Na+)-静脉血: 140.1mmol/L\n- [全程D36] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌两程诱导化疗后复查：对比某次就诊时间MRI， 鼻咽顶壁、顶后壁、后壁及双侧壁稍增厚，形成软组织肿物向腔内突出，T1WI呈等信号，T2WI呈高信号，增强后明显强化。肿物占据双侧咽隐窝，侵犯双侧腭帆张、提肌及左侧翼内肌。右侧翼外肌未见明显异常。双侧咽旁间隙清晰。 口咽未见明确病变。 蝶骨基底部、左侧岩尖骨质信号减低 ，增强后明显强化。 双侧海绵窦形态正常，未见增宽。 双侧蝶窦、筛窦、额窦粘膜增厚，呈长分期信息见历史辅助诊断节点长分期信息见历史辅助诊断节点信号，增强后边缘轻度强化，双侧乳突内见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点信号分泌物，骨壁完好。 双侧眼球大小、形态、位置均属正常，信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变。 双侧咽后各见一淋巴结，大小分别约为6mm×6mm（左）、7mm×4mm（右），边界清，信号均，增强后可见强化。 双颈II区见数个稍大淋巴结，边缘清，信号欠均，增强后明显强化，孤立散在，未见明显坏死，最大者位于右颈II区，大小约13mm×9mm。 双颈II~IV区可见小淋巴结，边缘清，信号尚均，增强后可见强化。 喉咽腔形态正常，未见占位性病变。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽占位，对比某次就诊时间MRI所见病变明显缩小好转。 颅底骨质破坏。 双颈II区稍大淋巴结，不除外转移。 鼻窦炎、乳突炎。\n\n【既往治疗与反应】\n- [全程D25] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者安返病房，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，可于今日执行第2程5-FU+顺铂方案诱导化疗，注意化疗不良反应。\n- [全程D27] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D36] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者请假至.\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即启动根治性调强放射治疗及同步化疗，暂不安排其他局部影像或内镜检查。\nB. 行电子鼻咽镜检查并对残留病灶取活检以明确病理状态，复查血常规与生化常规。\nC. 继续予以第3程5-FU+顺铂方案诱导化疗，待化疗结束后再行鼻咽镜评估。\nD. 安排全身PET/CT复查以评估全身肿瘤代谢活性变化，随后制定放疗计划。\nE. 更改为紫杉醇+顺铂方案行第3程诱导化疗，并予动静脉置管常规护理。\nF. 安排鼻咽及颈部CT平扫+增强进一步评估颅底骨质破坏情况，复查血常规。\nG. 择期行双侧颈部淋巴结清扫术，术后启动鼻咽局部及颈部放射治疗。\nH. 行电子鼻咽镜检查（不活检）评估局部疗效，并拔除动静脉置管准备单纯放疗。\nI. 更改为吉西他滨+顺铂方案行第3程诱导化疗，复查血常规与生化常规。\nJ. 行电子鼻咽镜检查（不活检），若无明显外生型肿物则暂缓放疗并定期随访。\nK. 立即启动单纯根治性放射治疗，并予动静脉置管常规护理。\nL. 行电子鼻咽镜检查（不活检）进一步评估鼻咽局部疗效，复查血常规与生化常规，并予动静脉置管护理。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"episode_id":"episode-0ea7d3f279d6b06d9596d94f","patient_id":"patient-34616c327ce5d69194ca7f4d","care_turn_count":5,"turns":[{"sample_id":"sample-eb32294d1506d6b48368496f","patient_id":"patient-34616c327ce5d69194ca7f4d","turn_id":"turn01","turn_position":1,"turn_type":"initial_workup_choice","gold_letter":"A","gold_action":"完善鼻咽镜检查及活检，检测EBV DNA定量、常规血液学指标，并进行胸部DR与腹盆腔彩超检查。","options":[{"letter":"A","text":"完善鼻咽镜检查及活检，检测EBV DNA定量、常规血液学指标，并进行胸部DR与腹盆腔彩超检查","is_gold":true},{"letter":"B","text":"完善鼻咽镜检查及活检，检测EBV DNA定量，并进行全身PET-CT检查，暂缓常规血液学指标检测","is_gold":false},{"letter":"C","text":"完善鼻咽镜检查及活检，检测EBV DNA定量，并进行胸腹部增强CT检查，暂缓常规血液学指标检测","is_gold":false},{"letter":"D","text":"行头颈部MRI及颅底薄层CT检查，待影像学显示异常后再行鼻咽镜活检及EBV DNA检测","is_gold":false},{"letter":"E","text":"检测EBV DNA定量及常规血液学指标，待EBV DNA结果阳性后再行鼻咽镜活检及影像学检查","is_gold":false},{"letter":"F","text":"完善鼻咽镜检查及活检，检测常规血液学指标，并进行胸部DR与腹盆腔彩超检查，暂不检测EBV DNA","is_gold":false},{"letter":"G","text":"完善鼻咽镜检查（暂不活检），检测EBV DNA定量、常规血液学指标，并进行胸部DR与腹盆腔彩超检查","is_gold":false},{"letter":"H","text":"行全身骨扫描及头颅增强MRI检查，暂缓鼻咽镜活检及EBV DNA定量检测","is_gold":false},{"letter":"I","text":"完善鼻咽镜检查及活检，检测EBV DNA定量，并进行全身骨扫描，暂缓胸部及腹盆腔影像学检查","is_gold":false},{"letter":"J","text":"完善鼻咽镜检查及活检，检测EBV DNA定量、常规血液学指标，仅行胸部CT检查，暂不进行腹盆腔影像学评估","is_gold":false},{"letter":"K","text":"行常规血液学指标检测及基础影像学检查（胸部DR、腹盆腔彩超），暂缓鼻咽镜活检及EBV DNA检测","is_gold":false},{"letter":"L","text":"完善鼻咽镜检查及活检，检测常规血液学指标，行头颈部PET-CT检查，暂不检测EBV DNA定量","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D3189] 门急诊记录: 主诉: 鼻咽癌治疗后8年；患者家属自述行放疗（具体方案不详）。患者家属来诊，诉近来头后部疼痛，持续二月余，逐渐加重，无其他明显，来诊咨询诊疗意见。；既往史: 是否有过敏史无过敏史。是否有吸烟史吸烟史详情；个人史:；家族史:；体格检查:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善鼻咽镜检查及活检，检测EBV DNA定量、常规血液学指标，并进行胸部DR与腹盆腔彩超检查\nB. 完善鼻咽镜检查及活检，检测EBV DNA定量，并进行全身PET-CT检查，暂缓常规血液学指标检测\nC. 完善鼻咽镜检查及活检，检测EBV DNA定量，并进行胸腹部增强CT检查，暂缓常规血液学指标检测\nD. 行头颈部MRI及颅底薄层CT检查，待影像学显示异常后再行鼻咽镜活检及EBV DNA检测\nE. 检测EBV DNA定量及常规血液学指标，待EBV DNA结果阳性后再行鼻咽镜活检及影像学检查\nF. 完善鼻咽镜检查及活检，检测常规血液学指标，并进行胸部DR与腹盆腔彩超检查，暂不检测EBV DNA\nG. 完善鼻咽镜检查（暂不活检），检测EBV DNA定量、常规血液学指标，并进行胸部DR与腹盆腔彩超检查\nH. 行全身骨扫描及头颅增强MRI检查，暂缓鼻咽镜活检及EBV DNA定量检测\nI. 完善鼻咽镜检查及活检，检测EBV DNA定量，并进行全身骨扫描，暂缓胸部及腹盆腔影像学检查\nJ. 完善鼻咽镜检查及活检，检测EBV DNA定量、常规血液学指标，仅行胸部CT检查，暂不进行腹盆腔影像学评估\nK. 行常规血液学指标检测及基础影像学检查（胸部DR、腹盆腔彩超），暂缓鼻咽镜活检及EBV DNA检测\nL. 完善鼻咽镜检查及活检，检测常规血液学指标，行头颈部PET-CT检查，暂不检测EBV DNA定量\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D3189] 门急诊记录: 主诉: 鼻咽癌治疗后8年；患者家属自述行放疗（具体方案不详）。患者家属来诊，诉近来头后部疼痛，持续二月余，逐渐加重，无其他明显，来诊咨询诊疗意见。；既往史: 是否有过敏史无过敏史。是否有吸烟史吸烟史详情；个人史:；家族史:；体格检查:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善鼻咽镜检查及活检，检测EBV DNA定量、常规血液学指标，并进行胸部DR与腹盆腔彩超检查\nB. 完善鼻咽镜检查及活检，检测EBV DNA定量，并进行全身PET-CT检查，暂缓常规血液学指标检测\nC. 完善鼻咽镜检查及活检，检测EBV DNA定量，并进行胸腹部增强CT检查，暂缓常规血液学指标检测\nD. 行头颈部MRI及颅底薄层CT检查，待影像学显示异常后再行鼻咽镜活检及EBV DNA检测\nE. 检测EBV DNA定量及常规血液学指标，待EBV DNA结果阳性后再行鼻咽镜活检及影像学检查\nF. 完善鼻咽镜检查及活检，检测常规血液学指标，并进行胸部DR与腹盆腔彩超检查，暂不检测EBV DNA\nG. 完善鼻咽镜检查（暂不活检），检测EBV DNA定量、常规血液学指标，并进行胸部DR与腹盆腔彩超检查\nH. 行全身骨扫描及头颅增强MRI检查，暂缓鼻咽镜活检及EBV DNA定量检测\nI. 完善鼻咽镜检查及活检，检测EBV DNA定量，并进行全身骨扫描，暂缓胸部及腹盆腔影像学检查\nJ. 完善鼻咽镜检查及活检，检测EBV DNA定量、常规血液学指标，仅行胸部CT检查，暂不进行腹盆腔影像学评估\nK. 行常规血液学指标检测及基础影像学检查（胸部DR、腹盆腔彩超），暂缓鼻咽镜活检及EBV DNA检测\nL. 完善鼻咽镜检查及活检，检测常规血液学指标，行头颈部PET-CT检查，暂不检测EBV DNA定量\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D3189] 门急诊记录: 主诉: 鼻咽癌治疗后8年；患者家属自述行放疗（具体方案不详）。患者家属来诊，诉近来头后部疼痛，持续二月余，逐渐加重，无其他明显，来诊咨询诊疗意见。；既往史: 是否有过敏史无过敏史。是否有吸烟史吸烟史详情；个人史:；家族史:；体格检查:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善鼻咽镜检查及活检，检测EBV DNA定量、常规血液学指标，并进行胸部DR与腹盆腔彩超检查\nB. 完善鼻咽镜检查及活检，检测EBV DNA定量，并进行全身PET-CT检查，暂缓常规血液学指标检测\nC. 完善鼻咽镜检查及活检，检测EBV DNA定量，并进行胸腹部增强CT检查，暂缓常规血液学指标检测\nD. 行头颈部MRI及颅底薄层CT检查，待影像学显示异常后再行鼻咽镜活检及EBV DNA检测\nE. 检测EBV DNA定量及常规血液学指标，待EBV DNA结果阳性后再行鼻咽镜活检及影像学检查\nF. 完善鼻咽镜检查及活检，检测常规血液学指标，并进行胸部DR与腹盆腔彩超检查，暂不检测EBV DNA\nG. 完善鼻咽镜检查（暂不活检），检测EBV DNA定量、常规血液学指标，并进行胸部DR与腹盆腔彩超检查\nH. 行全身骨扫描及头颅增强MRI检查，暂缓鼻咽镜活检及EBV DNA定量检测\nI. 完善鼻咽镜检查及活检，检测EBV DNA定量，并进行全身骨扫描，暂缓胸部及腹盆腔影像学检查\nJ. 完善鼻咽镜检查及活检，检测EBV DNA定量、常规血液学指标，仅行胸部CT检查，暂不进行腹盆腔影像学评估\nK. 行常规血液学指标检测及基础影像学检查（胸部DR、腹盆腔彩超），暂缓鼻咽镜活检及EBV DNA检测\nL. 完善鼻咽镜检查及活检，检测常规血液学指标，行头颈部PET-CT检查，暂不检测EBV DNA定量\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-f19200235c8a99467249ed0c","patient_id":"patient-34616c327ce5d69194ca7f4d","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"B","gold_action":"评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查","options":[{"letter":"A","text":"评估影像分期为 cT3N1M0（AJCC 第9版 II期），直接安排诱导化疗联合同期放化疗，并补充生化常规检查","is_gold":false},{"letter":"B","text":"评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查","is_gold":true},{"letter":"C","text":"评估影像分期为 cT4N1M0（AJCC 第9版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查","is_gold":false},{"letter":"D","text":"评估影像分期为 cT3N2M0（AJCC 第9版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查","is_gold":false},{"letter":"E","text":"评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽镜及活检以获取病理确诊，并补充全身PET-CT检查","is_gold":false},{"letter":"F","text":"评估影像分期为 cT2N1M0（AJCC 第9版 I期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查","is_gold":false},{"letter":"G","text":"评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽镜及活检以获取病理确诊，并补充头颅增强MRI检查","is_gold":false},{"letter":"H","text":"评估影像分期为 cT3N1M1（AJCC 第9版 IVB期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查","is_gold":false},{"letter":"I","text":"评估影像分期为 cT3N1M0（AJCC 第8版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查","is_gold":false},{"letter":"J","text":"评估影像分期为 cT4N2M0（AJCC 第9版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查","is_gold":false},{"letter":"K","text":"评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽肿物切除活检以获取病理确诊，并补充生化常规检查","is_gold":false},{"letter":"L","text":"评估影像分期为 cT3N1M0（AJCC 第9版 II期），行右颈部淋巴结穿刺活检以获取病理确诊，并补充生化常规检查","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D3189] 门急诊记录: 主诉: 鼻咽癌治疗后8年；患者家属自述行放疗（具体方案不详）。患者家属来诊，诉近来头后部疼痛，持续二月余，逐渐加重，无其他明显，来诊咨询诊疗意见。；既往史: 是否有过敏史无过敏史。是否有吸烟史吸烟史详情；个人史:；家族史:；体格检查:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 检验组合: 嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；凝血酶原时间活动度(PTA)-静脉血: 89%；平均血小板体积(MPV)-静脉血: 9.4fL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 334g/L；D-二聚体(D-Dimer)-静脉血: 0.29ug/ml；凝血酶原国际标准化比值(PT-INR)-静脉血: 1.02；纤维蛋白原(Fbg)-静脉血: 3.21g/L；红细胞比容(Hct)-静脉血: 48.2%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；平均红细胞血红蛋白含量(MCH)-静脉血: 32pg；红细胞计数(RBC#)-静脉血: 5.0310E12/L；淋巴细胞百分比(Lymph%)-静脉血: 0.271；中性粒细胞计数(Neut#)-静脉血: 5.910E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.65；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.8；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；大血小板百分比(P-LCR%)-静脉血: 20.8%；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；血小板比容-静脉血: 27%；平均红细胞体积(MCV)-静脉血: 95.8fL；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.06S/CO；血小板分布宽度(PDW)-静脉血: 10.8%；单核细胞计数(Mono#)-静脉血: 0.510E9/L；活化部分凝血活酶时间(APTT)-静脉血: 29.2sec.；凝血酶原时间(PT)-静脉血: 11.4sec.；纤维蛋白原降解产物(FDP)-静脉血: 2.8ug/ml；淋巴细胞计数(Lymph#)-静脉血: 2.510E9/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.01IU/mL；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.13COI；凝血酶时间(TT)-静脉血: 20sec.；血小板计数(PLT#)-静脉血: 28910E9/L；Rh血型-静脉血: 阳性；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.06S/CO；血红蛋白(Hb)-静脉血: 161g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；白细胞计数(WBC……\n- [全程D14] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 左前分支阻滞\n- [全程D14] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理稍增粗，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见重要病变。\n- [全程D15] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 右侧乳突可见片状放射性浓集灶。胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 右侧乳突炎症。 余全身骨骼未见明显异常。\n- [全程D16] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，肝S7可见一强回声斑，直径约5mm，后方伴声影。血管走行清晰、自然，肝内胆管不扩张，门静脉内径14mm。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约21cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约36×26×23mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝S7强回声斑，考虑肝内胆管结石。 胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估影像分期为 cT3N1M0（AJCC 第9版 II期），直接安排诱导化疗联合同期放化疗，并补充生化常规检查\nB. 评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nC. 评估影像分期为 cT4N1M0（AJCC 第9版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nD. 评估影像分期为 cT3N2M0（AJCC 第9版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nE. 评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽镜及活检以获取病理确诊，并补充全身PET-CT检查\nF. 评估影像分期为 cT2N1M0（AJCC 第9版 I期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nG. 评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽镜及活检以获取病理确诊，并补充头颅增强MRI检查\nH. 评估影像分期为 cT3N1M1（AJCC 第9版 IVB期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nI. 评估影像分期为 cT3N1M0（AJCC 第8版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nJ. 评估影像分期为 cT4N2M0（AJCC 第9版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nK. 评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽肿物切除活检以获取病理确诊，并补充生化常规检查\nL. 评估影像分期为 cT3N1M0（AJCC 第9版 II期），行右颈部淋巴结穿刺活检以获取病理确诊，并补充生化常规检查\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D0] 检验组合: 嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；凝血酶原时间活动度(PTA)-静脉血: 89%；平均血小板体积(MPV)-静脉血: 9.4fL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 334g/L；D-二聚体(D-Dimer)-静脉血: 0.29ug/ml；凝血酶原国际标准化比值(PT-INR)-静脉血: 1.02；纤维蛋白原(Fbg)-静脉血: 3.21g/L；红细胞比容(Hct)-静脉血: 48.2%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；平均红细胞血红蛋白含量(MCH)-静脉血: 32pg；红细胞计数(RBC#)-静脉血: 5.0310E12/L；淋巴细胞百分比(Lymph%)-静脉血: 0.271；中性粒细胞计数(Neut#)-静脉血: 5.910E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.65；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.8；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；大血小板百分比(P-LCR%)-静脉血: 20.8%；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；血小板比容-静脉血: 27%；平均红细胞体积(MCV)-静脉血: 95.8fL；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.06S/CO；血小板分布宽度(PDW)-静脉血: 10.8%；单核细胞计数(Mono#)-静脉血: 0.510E9/L；活化部分凝血活酶时间(APTT)-静脉血: 29.2sec.；凝血酶原时间(PT)-静脉血: 11.4sec.；纤维蛋白原降解产物(FDP)-静脉血: 2.8ug/ml；淋巴细胞计数(Lymph#)-静脉血: 2.510E9/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.01IU/mL；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.13COI；凝血酶时间(TT)-静脉血: 20sec.；血小板计数(PLT#)-静脉血: 28910E9/L；Rh血型-静脉血: 阳性；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.06S/CO；血红蛋白(Hb)-静脉血: 161g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；白细胞计数(WBC……\n- [全程D14] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 左前分支阻滞\n- [全程D14] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理稍增粗，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见重要病变。\n- [全程D15] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 右侧乳突可见片状放射性浓集灶。胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 右侧乳突炎症。 余全身骨骼未见明显异常。\n- [全程D16] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，肝S7可见一强回声斑，直径约5mm，后方伴声影。血管走行清晰、自然，肝内胆管不扩张，门静脉内径14mm。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约21cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约36×26×23mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝S7强回声斑，考虑肝内胆管结石。 胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估影像分期为 cT3N1M0（AJCC 第9版 II期），直接安排诱导化疗联合同期放化疗，并补充生化常规检查\nB. 评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nC. 评估影像分期为 cT4N1M0（AJCC 第9版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nD. 评估影像分期为 cT3N2M0（AJCC 第9版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nE. 评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽镜及活检以获取病理确诊，并补充全身PET-CT检查\nF. 评估影像分期为 cT2N1M0（AJCC 第9版 I期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nG. 评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽镜及活检以获取病理确诊，并补充头颅增强MRI检查\nH. 评估影像分期为 cT3N1M1（AJCC 第9版 IVB期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nI. 评估影像分期为 cT3N1M0（AJCC 第8版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nJ. 评估影像分期为 cT4N2M0（AJCC 第9版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nK. 评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽肿物切除活检以获取病理确诊，并补充生化常规检查\nL. 评估影像分期为 cT3N1M0（AJCC 第9版 II期），行右颈部淋巴结穿刺活检以获取病理确诊，并补充生化常规检查\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D0] 检验组合: 嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；凝血酶原时间活动度(PTA)-静脉血: 89%；平均血小板体积(MPV)-静脉血: 9.4fL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 334g/L；D-二聚体(D-Dimer)-静脉血: 0.29ug/ml；凝血酶原国际标准化比值(PT-INR)-静脉血: 1.02；纤维蛋白原(Fbg)-静脉血: 3.21g/L；红细胞比容(Hct)-静脉血: 48.2%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；平均红细胞血红蛋白含量(MCH)-静脉血: 32pg；红细胞计数(RBC#)-静脉血: 5.0310E12/L；淋巴细胞百分比(Lymph%)-静脉血: 0.271；中性粒细胞计数(Neut#)-静脉血: 5.910E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.65；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.8；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；大血小板百分比(P-LCR%)-静脉血: 20.8%；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；血小板比容-静脉血: 27%；平均红细胞体积(MCV)-静脉血: 95.8fL；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.06S/CO；血小板分布宽度(PDW)-静脉血: 10.8%；单核细胞计数(Mono#)-静脉血: 0.510E9/L；活化部分凝血活酶时间(APTT)-静脉血: 29.2sec.；凝血酶原时间(PT)-静脉血: 11.4sec.；纤维蛋白原降解产物(FDP)-静脉血: 2.8ug/ml；淋巴细胞计数(Lymph#)-静脉血: 2.510E9/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.01IU/mL；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.13COI；凝血酶时间(TT)-静脉血: 20sec.；血小板计数(PLT#)-静脉血: 28910E9/L；Rh血型-静脉血: 阳性；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.06S/CO；血红蛋白(Hb)-静脉血: 161g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；白细胞计数(WBC……\n- [全程D14] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 左前分支阻滞\n- [全程D14] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理稍增粗，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见重要病变。\n- [全程D15] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 右侧乳突可见片状放射性浓集灶。胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 右侧乳突炎症。 余全身骨骼未见明显异常。\n- [全程D16] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，肝S7可见一强回声斑，直径约5mm，后方伴声影。血管走行清晰、自然，肝内胆管不扩张，门静脉内径14mm。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约21cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约36×26×23mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝S7强回声斑，考虑肝内胆管结石。 胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估影像分期为 cT3N1M0（AJCC 第9版 II期），直接安排诱导化疗联合同期放化疗，并补充生化常规检查\nB. 评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nC. 评估影像分期为 cT4N1M0（AJCC 第9版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nD. 评估影像分期为 cT3N2M0（AJCC 第9版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nE. 评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽镜及活检以获取病理确诊，并补充全身PET-CT检查\nF. 评估影像分期为 cT2N1M0（AJCC 第9版 I期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nG. 评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽镜及活检以获取病理确诊，并补充头颅增强MRI检查\nH. 评估影像分期为 cT3N1M1（AJCC 第9版 IVB期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nI. 评估影像分期为 cT3N1M0（AJCC 第8版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nJ. 评估影像分期为 cT4N2M0（AJCC 第9版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nK. 评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽肿物切除活检以获取病理确诊，并补充生化常规检查\nL. 评估影像分期为 cT3N1M0（AJCC 第9版 II期），行右颈部淋巴结穿刺活检以获取病理确诊，并补充生化常规检查\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-2288420a623ad83bf0b0a558","patient_id":"patient-34616c327ce5d69194ca7f4d","turn_id":"turn04","turn_position":3,"turn_type":"initial_treatment_selection","gold_letter":"D","gold_action":"含铂方案诱导化疗序贯根治性放化疗，或根治性放疗联合含铂方案同步化疗","options":[{"letter":"A","text":"单纯根治性调强放射治疗","is_gold":false},{"letter":"B","text":"含铂双药方案诱导化疗序贯单纯根治性放疗","is_gold":false},{"letter":"C","text":"根治性放疗联合含铂方案同步化疗，序贯含铂双药辅助化疗","is_gold":false},{"letter":"D","text":"含铂方案诱导化疗序贯根治性放化疗，或根治性放疗联合含铂方案同步化疗","is_gold":true},{"letter":"E","text":"根治性放疗联合西妥昔单抗等EGFR靶向治疗","is_gold":false},{"letter":"F","text":"根治性放疗联合PD-1抑制剂同步免疫治疗","is_gold":false},{"letter":"G","text":"姑息性全身化疗联合局部病灶姑息性放疗","is_gold":false},{"letter":"H","text":"含铂双药方案诱导化疗序贯鼻咽原发灶切除及颈部淋巴结清扫术","is_gold":false},{"letter":"I","text":"根治性放疗联合大分子抗血管生成靶向治疗","is_gold":false},{"letter":"J","text":"单纯含铂双药方案全身化疗4-6个周期","is_gold":false},{"letter":"K","text":"鼻咽原发灶切除及颈部淋巴结清扫术序贯术后辅助放化疗","is_gold":false},{"letter":"L","text":"含铂双药方案诱导化疗序贯根治性放疗及PD-1抑制剂维持治疗","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D3189] 门急诊记录: 主诉: 鼻咽癌治疗后8年；患者家属自述行放疗（具体方案不详）。患者家属来诊，诉近来头后部疼痛，持续二月余，逐渐加重，无其他明显，来诊咨询诊疗意见。；既往史: 是否有过敏史无过敏史。是否有吸烟史吸烟史详情；个人史:；家族史:；体格检查:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 检验组合: 嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；凝血酶原时间活动度(PTA)-静脉血: 89%；平均血小板体积(MPV)-静脉血: 9.4fL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 334g/L；D-二聚体(D-Dimer)-静脉血: 0.29ug/ml；凝血酶原国际标准化比值(PT-INR)-静脉血: 1.02；纤维蛋白原(Fbg)-静脉血: 3.21g/L；红细胞比容(Hct)-静脉血: 48.2%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；平均红细胞血红蛋白含量(MCH)-静脉血: 32pg；红细胞计数(RBC#)-静脉血: 5.0310E12/L；淋巴细胞百分比(Lymph%)-静脉血: 0.271；中性粒细胞计数(Neut#)-静脉血: 5.910E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.65；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.8；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；大血小板百分比(P-LCR%)-静脉血: 20.8%；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；血小板比容-静脉血: 27%；平均红细胞体积(MCV)-静脉血: 95.8fL；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.06S/CO；血小板分布宽度(PDW)-静脉血: 10.8%；单核细胞计数(Mono#)-静脉血: 0.510E9/L；活化部分凝血活酶时间(APTT)-静脉血: 29.2sec.；凝血酶原时间(PT)-静脉血: 11.4sec.；纤维蛋白原降解产物(FDP)-静脉血: 2.8ug/ml；淋巴细胞计数(Lymph#)-静脉血: 2.510E9/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.01IU/mL；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.13COI；凝血酶时间(TT)-静脉血: 20sec.；血小板计数(PLT#)-静脉血: 28910E9/L；Rh血型-静脉血: 阳性；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.06S/CO；血红蛋白(Hb)-静脉血: 161g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；白细胞计数(WBC……\n- [全程D14] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 左前分支阻滞\n- [全程D14] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理稍增粗，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见重要病变。\n- [全程D15] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 右侧乳突可见片状放射性浓集灶。胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 右侧乳突炎症。 余全身骨骼未见明显异常。\n- [全程D16] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，肝S7可见一强回声斑，直径约5mm，后方伴声影。血管走行清晰、自然，肝内胆管不扩张，门静脉内径14mm。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约21cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约36×26×23mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝S7强回声斑，考虑肝内胆管结石。 胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D22] 检验组合: 钾离子(K+)-静脉血: 4.18mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 46.8U/L；氯离子(Cl-)-静脉血: 101.7mmol/L；直接胆红素(DBIL)-静脉血: 2.5umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；乳酸脱氢酶(LDH)-静脉血: 172.2U/L；尿酸(UA)-静脉血: 299umol/L；碱性磷酸酶(ALP)-静脉血: 35.4U/L；载脂蛋白B(apoB)-静脉血: 0.71g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.09mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.82；γ-谷氨酰基转移酶(GGT)-静脉血: 23.1U/L；总钙(Ca)-静脉血: 2.31mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.1U/L；间接胆红素(IBIL)-静脉血: 4.8umolL；血液二氧化碳含量ctCO2(B)-静脉血: 22.5mmol/L；总蛋白(TP)-静脉血: 76.15g/L；阴离子间隙(AG)-静脉血: 16.8；总胆固醇(TC)-静脉血: 4.05mmol/L；总胆汁酸(TBA)-静脉血: 3.1umol/L；总胆红素(TBIL)-静脉血: 7.3umol/L；肌酐(Crea)-静脉血: 58.1umol/L；载脂蛋白AI(apoAI)-静脉血: 1.48g/L；球蛋白(GLO)-静脉血: 30.25g/L；C-反应蛋白(CRP)-静脉血: 3.66mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.33mmolL；镁离子(Mg2+)-静脉血: 0.86mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.3U/L；胱抑素(Cys-C)-静脉血: 0.88mg/L；尿素氮(BUN)-静脉血: 3.4mmol/L；葡萄糖(Glu)-静脉血: 5.59mmol/L；甘油三酯(TG)-静脉血: 2.5mmol/L；磷(P)-静脉血: 1.15mmol/L；白蛋白(ALB)-静脉血: 45.9g/L；钠离子(Na+)-静脉血: 141mmol/L\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 单纯根治性调强放射治疗\nB. 含铂双药方案诱导化疗序贯单纯根治性放疗\nC. 根治性放疗联合含铂方案同步化疗，序贯含铂双药辅助化疗\nD. 含铂方案诱导化疗序贯根治性放化疗，或根治性放疗联合含铂方案同步化疗\nE. 根治性放疗联合西妥昔单抗等EGFR靶向治疗\nF. 根治性放疗联合PD-1抑制剂同步免疫治疗\nG. 姑息性全身化疗联合局部病灶姑息性放疗\nH. 含铂双药方案诱导化疗序贯鼻咽原发灶切除及颈部淋巴结清扫术\nI. 根治性放疗联合大分子抗血管生成靶向治疗\nJ. 单纯含铂双药方案全身化疗4-6个周期\nK. 鼻咽原发灶切除及颈部淋巴结清扫术序贯术后辅助放化疗\nL. 含铂双药方案诱导化疗序贯根治性放疗及PD-1抑制剂维持治疗\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D22] 检验组合: 钾离子(K+)-静脉血: 4.18mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 46.8U/L；氯离子(Cl-)-静脉血: 101.7mmol/L；直接胆红素(DBIL)-静脉血: 2.5umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；乳酸脱氢酶(LDH)-静脉血: 172.2U/L；尿酸(UA)-静脉血: 299umol/L；碱性磷酸酶(ALP)-静脉血: 35.4U/L；载脂蛋白B(apoB)-静脉血: 0.71g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.09mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.82；γ-谷氨酰基转移酶(GGT)-静脉血: 23.1U/L；总钙(Ca)-静脉血: 2.31mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.1U/L；间接胆红素(IBIL)-静脉血: 4.8umolL；血液二氧化碳含量ctCO2(B)-静脉血: 22.5mmol/L；总蛋白(TP)-静脉血: 76.15g/L；阴离子间隙(AG)-静脉血: 16.8；总胆固醇(TC)-静脉血: 4.05mmol/L；总胆汁酸(TBA)-静脉血: 3.1umol/L；总胆红素(TBIL)-静脉血: 7.3umol/L；肌酐(Crea)-静脉血: 58.1umol/L；载脂蛋白AI(apoAI)-静脉血: 1.48g/L；球蛋白(GLO)-静脉血: 30.25g/L；C-反应蛋白(CRP)-静脉血: 3.66mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.33mmolL；镁离子(Mg2+)-静脉血: 0.86mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.3U/L；胱抑素(Cys-C)-静脉血: 0.88mg/L；尿素氮(BUN)-静脉血: 3.4mmol/L；葡萄糖(Glu)-静脉血: 5.59mmol/L；甘油三酯(TG)-静脉血: 2.5mmol/L；磷(P)-静脉血: 1.15mmol/L；白蛋白(ALB)-静脉血: 45.9g/L；钠离子(Na+)-静脉血: 141mmol/L\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 单纯根治性调强放射治疗\nB. 含铂双药方案诱导化疗序贯单纯根治性放疗\nC. 根治性放疗联合含铂方案同步化疗，序贯含铂双药辅助化疗\nD. 含铂方案诱导化疗序贯根治性放化疗，或根治性放疗联合含铂方案同步化疗\nE. 根治性放疗联合西妥昔单抗等EGFR靶向治疗\nF. 根治性放疗联合PD-1抑制剂同步免疫治疗\nG. 姑息性全身化疗联合局部病灶姑息性放疗\nH. 含铂双药方案诱导化疗序贯鼻咽原发灶切除及颈部淋巴结清扫术\nI. 根治性放疗联合大分子抗血管生成靶向治疗\nJ. 单纯含铂双药方案全身化疗4-6个周期\nK. 鼻咽原发灶切除及颈部淋巴结清扫术序贯术后辅助放化疗\nL. 含铂双药方案诱导化疗序贯根治性放疗及PD-1抑制剂维持治疗\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D22] 检验组合: 钾离子(K+)-静脉血: 4.18mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 46.8U/L；氯离子(Cl-)-静脉血: 101.7mmol/L；直接胆红素(DBIL)-静脉血: 2.5umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；乳酸脱氢酶(LDH)-静脉血: 172.2U/L；尿酸(UA)-静脉血: 299umol/L；碱性磷酸酶(ALP)-静脉血: 35.4U/L；载脂蛋白B(apoB)-静脉血: 0.71g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.09mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.82；γ-谷氨酰基转移酶(GGT)-静脉血: 23.1U/L；总钙(Ca)-静脉血: 2.31mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.1U/L；间接胆红素(IBIL)-静脉血: 4.8umolL；血液二氧化碳含量ctCO2(B)-静脉血: 22.5mmol/L；总蛋白(TP)-静脉血: 76.15g/L；阴离子间隙(AG)-静脉血: 16.8；总胆固醇(TC)-静脉血: 4.05mmol/L；总胆汁酸(TBA)-静脉血: 3.1umol/L；总胆红素(TBIL)-静脉血: 7.3umol/L；肌酐(Crea)-静脉血: 58.1umol/L；载脂蛋白AI(apoAI)-静脉血: 1.48g/L；球蛋白(GLO)-静脉血: 30.25g/L；C-反应蛋白(CRP)-静脉血: 3.66mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.33mmolL；镁离子(Mg2+)-静脉血: 0.86mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.3U/L；胱抑素(Cys-C)-静脉血: 0.88mg/L；尿素氮(BUN)-静脉血: 3.4mmol/L；葡萄糖(Glu)-静脉血: 5.59mmol/L；甘油三酯(TG)-静脉血: 2.5mmol/L；磷(P)-静脉血: 1.15mmol/L；白蛋白(ALB)-静脉血: 45.9g/L；钠离子(Na+)-静脉血: 141mmol/L\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 单纯根治性调强放射治疗\nB. 含铂双药方案诱导化疗序贯单纯根治性放疗\nC. 根治性放疗联合含铂方案同步化疗，序贯含铂双药辅助化疗\nD. 含铂方案诱导化疗序贯根治性放化疗，或根治性放疗联合含铂方案同步化疗\nE. 根治性放疗联合西妥昔单抗等EGFR靶向治疗\nF. 根治性放疗联合PD-1抑制剂同步免疫治疗\nG. 姑息性全身化疗联合局部病灶姑息性放疗\nH. 含铂双药方案诱导化疗序贯鼻咽原发灶切除及颈部淋巴结清扫术\nI. 根治性放疗联合大分子抗血管生成靶向治疗\nJ. 单纯含铂双药方案全身化疗4-6个周期\nK. 鼻咽原发灶切除及颈部淋巴结清扫术序贯术后辅助放化疗\nL. 含铂双药方案诱导化疗序贯根治性放疗及PD-1抑制剂维持治疗\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-258f93513eac99791d84464c","patient_id":"patient-34616c327ce5d69194ca7f4d","turn_id":"turn05","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"E","gold_action":"继续当前放化疗方案，定期复查血常规及生化指标。","options":[{"letter":"A","text":"暂停同期化疗，继续单纯放疗，并加用保肝药物","is_gold":false},{"letter":"B","text":"暂停放化疗，给予重组人粒细胞刺激因子支持治疗","is_gold":false},{"letter":"C","text":"继续放疗，将同期化疗剂量减低20%","is_gold":false},{"letter":"D","text":"继续放化疗方案，给予重组人血小板生成素","is_gold":false},{"letter":"E","text":"继续放化疗方案，定期复查血常规及生化指标","is_gold":true},{"letter":"F","text":"暂停放化疗，给予还原型谷胱甘肽保肝治疗","is_gold":false},{"letter":"G","text":"继续放化疗方案，加用双环醇保肝治疗","is_gold":false},{"letter":"H","text":"继续放化疗方案，给予重组人粒细胞刺激因子","is_gold":false},{"letter":"I","text":"暂停同期化疗，给予静脉补液及利尿处理","is_gold":false},{"letter":"J","text":"继续放疗，取消同期化疗，改为西妥昔单抗治疗","is_gold":false},{"letter":"K","text":"暂停放疗，继续同期化疗，给予促红细胞生成素治疗","is_gold":false},{"letter":"L","text":"继续放化疗方案，输注单采血小板","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D3189] 门急诊记录: 主诉: 鼻咽癌治疗后8年；患者家属自述行放疗（具体方案不详）。患者家属来诊，诉近来头后部疼痛，持续二月余，逐渐加重，无其他明显，来诊咨询诊疗意见。；既往史: 是否有过敏史无过敏史。是否有吸烟史吸烟史详情；个人史:；家族史:；体格检查:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 检验组合: 嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；凝血酶原时间活动度(PTA)-静脉血: 89%；平均血小板体积(MPV)-静脉血: 9.4fL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 334g/L；D-二聚体(D-Dimer)-静脉血: 0.29ug/ml；凝血酶原国际标准化比值(PT-INR)-静脉血: 1.02；纤维蛋白原(Fbg)-静脉血: 3.21g/L；红细胞比容(Hct)-静脉血: 48.2%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；平均红细胞血红蛋白含量(MCH)-静脉血: 32pg；红细胞计数(RBC#)-静脉血: 5.0310E12/L；淋巴细胞百分比(Lymph%)-静脉血: 0.271；中性粒细胞计数(Neut#)-静脉血: 5.910E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.65；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.8；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；大血小板百分比(P-LCR%)-静脉血: 20.8%；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；血小板比容-静脉血: 27%；平均红细胞体积(MCV)-静脉血: 95.8fL；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.06S/CO；血小板分布宽度(PDW)-静脉血: 10.8%；单核细胞计数(Mono#)-静脉血: 0.510E9/L；活化部分凝血活酶时间(APTT)-静脉血: 29.2sec.；凝血酶原时间(PT)-静脉血: 11.4sec.；纤维蛋白原降解产物(FDP)-静脉血: 2.8ug/ml；淋巴细胞计数(Lymph#)-静脉血: 2.510E9/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.01IU/mL；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.13COI；凝血酶时间(TT)-静脉血: 20sec.；血小板计数(PLT#)-静脉血: 28910E9/L；Rh血型-静脉血: 阳性；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.06S/CO；血红蛋白(Hb)-静脉血: 161g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；白细胞计数(WBC……\n- [全程D14] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 左前分支阻滞\n- [全程D14] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理稍增粗，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见重要病变。\n- [全程D15] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 右侧乳突可见片状放射性浓集灶。胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 右侧乳突炎症。 余全身骨骼未见明显异常。\n- [全程D16] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，肝S7可见一强回声斑，直径约5mm，后方伴声影。血管走行清晰、自然，肝内胆管不扩张，门静脉内径14mm。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约21cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约36×26×23mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝S7强回声斑，考虑肝内胆管结石。 胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D22] 检验组合: 钾离子(K+)-静脉血: 4.18mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 46.8U/L；氯离子(Cl-)-静脉血: 101.7mmol/L；直接胆红素(DBIL)-静脉血: 2.5umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；乳酸脱氢酶(LDH)-静脉血: 172.2U/L；尿酸(UA)-静脉血: 299umol/L；碱性磷酸酶(ALP)-静脉血: 35.4U/L；载脂蛋白B(apoB)-静脉血: 0.71g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.09mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.82；γ-谷氨酰基转移酶(GGT)-静脉血: 23.1U/L；总钙(Ca)-静脉血: 2.31mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.1U/L；间接胆红素(IBIL)-静脉血: 4.8umolL；血液二氧化碳含量ctCO2(B)-静脉血: 22.5mmol/L；总蛋白(TP)-静脉血: 76.15g/L；阴离子间隙(AG)-静脉血: 16.8；总胆固醇(TC)-静脉血: 4.05mmol/L；总胆汁酸(TBA)-静脉血: 3.1umol/L；总胆红素(TBIL)-静脉血: 7.3umol/L；肌酐(Crea)-静脉血: 58.1umol/L；载脂蛋白AI(apoAI)-静脉血: 1.48g/L；球蛋白(GLO)-静脉血: 30.25g/L；C-反应蛋白(CRP)-静脉血: 3.66mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.33mmolL；镁离子(Mg2+)-静脉血: 0.86mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.3U/L；胱抑素(Cys-C)-静脉血: 0.88mg/L；尿素氮(BUN)-静脉血: 3.4mmol/L；葡萄糖(Glu)-静脉血: 5.59mmol/L；甘油三酯(TG)-静脉血: 2.5mmol/L；磷(P)-静脉血: 1.15mmol/L；白蛋白(ALB)-静脉血: 45.9g/L；钠离子(Na+)-静脉血: 141mmol/L\n- [全程D70] 检验组合: 低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.66mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.6；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32pg；白细胞计数(WBC#)-静脉血: 7.7410E9/L；血红蛋白(Hb)-静脉血: 164g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 27.3U/L；磷(P)-静脉血: 1.31mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 20.8mmol/L；尿酸(UA)-静脉血: 323.7umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 44.8U/L；C-反应蛋白(CRP)-静脉血: 1.33mg/L；血小板比容-静脉血: 22%；血小板计数(PLT#)-静脉血: 23710E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.35mmolL；总胆红素(TBIL)-静脉血: 10.7umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 36.6U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.75；平均红细胞血红蛋白浓度(MCHC)-静脉血: 342g/L；肌酐(Crea)-静脉血: 62.3umol/L；总蛋白(TP)-静脉血: 75.99g/L；单核细胞百分比(Mono%)-静脉血: 0.056；平均红细胞血红蛋白浓度(MCHC)-静脉血: 337g/L；平均血小板体积(MPV)-静脉血: 9.5fL；血小板计数(PLT#)-静脉血: 24810E9/L；甘油三酯(TG)-静脉血: 1.02mmol/L；单核细胞百分比(Mono%)-静脉血: 0.081；球蛋白(GLO)-静脉血: 29.79g/L；平均红细胞体积(MCV)-静脉血: 95.1fL；总钙(Ca)-静脉血: 2.3mmol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；直接胆红素(DBIL)-静脉血: 3.9umol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；载脂蛋白AI(apoAI)-静脉血: 1.36g/L；大血小板百分比(P-LCR%)-静脉血: 17.2%；血红蛋白(Hb)-静脉血: 158g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32pg……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D64] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者近日精神好，胃纳尚可，暂无特殊不适。体查大致同入院。患者目前无放疗禁忌症，开始予以行鼻咽癌放疗。靶区剂量为：GTV70Gy/31F。放疗期间予同期化疗，并予加强对症、支持治疗。注意观察放疗不良反应表现。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停同期化疗，继续单纯放疗，并加用保肝药物\nB. 暂停放化疗，给予重组人粒细胞刺激因子支持治疗\nC. 继续放疗，将同期化疗剂量减低20%\nD. 继续放化疗方案，给予重组人血小板生成素\nE. 继续放化疗方案，定期复查血常规及生化指标\nF. 暂停放化疗，给予还原型谷胱甘肽保肝治疗\nG. 继续放化疗方案，加用双环醇保肝治疗\nH. 继续放化疗方案，给予重组人粒细胞刺激因子\nI. 暂停同期化疗，给予静脉补液及利尿处理\nJ. 继续放疗，取消同期化疗，改为西妥昔单抗治疗\nK. 暂停放疗，继续同期化疗，给予促红细胞生成素治疗\nL. 继续放化疗方案，输注单采血小板\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D70] 检验组合: 低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.66mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.6；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32pg；白细胞计数(WBC#)-静脉血: 7.7410E9/L；血红蛋白(Hb)-静脉血: 164g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 27.3U/L；磷(P)-静脉血: 1.31mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 20.8mmol/L；尿酸(UA)-静脉血: 323.7umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 44.8U/L；C-反应蛋白(CRP)-静脉血: 1.33mg/L；血小板比容-静脉血: 22%；血小板计数(PLT#)-静脉血: 23710E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.35mmolL；总胆红素(TBIL)-静脉血: 10.7umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 36.6U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.75；平均红细胞血红蛋白浓度(MCHC)-静脉血: 342g/L；肌酐(Crea)-静脉血: 62.3umol/L；总蛋白(TP)-静脉血: 75.99g/L；单核细胞百分比(Mono%)-静脉血: 0.056；平均红细胞血红蛋白浓度(MCHC)-静脉血: 337g/L；平均血小板体积(MPV)-静脉血: 9.5fL；血小板计数(PLT#)-静脉血: 24810E9/L；甘油三酯(TG)-静脉血: 1.02mmol/L；单核细胞百分比(Mono%)-静脉血: 0.081；球蛋白(GLO)-静脉血: 29.79g/L；平均红细胞体积(MCV)-静脉血: 95.1fL；总钙(Ca)-静脉血: 2.3mmol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；直接胆红素(DBIL)-静脉血: 3.9umol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；载脂蛋白AI(apoAI)-静脉血: 1.36g/L；大血小板百分比(P-LCR%)-静脉血: 17.2%；血红蛋白(Hb)-静脉血: 158g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32pg……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D64] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者近日精神好，胃纳尚可，暂无特殊不适。体查大致同入院。患者目前无放疗禁忌症，开始予以行鼻咽癌放疗。靶区剂量为：GTV70Gy/31F。放疗期间予同期化疗，并予加强对症、支持治疗。注意观察放疗不良反应表现。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停同期化疗，继续单纯放疗，并加用保肝药物\nB. 暂停放化疗，给予重组人粒细胞刺激因子支持治疗\nC. 继续放疗，将同期化疗剂量减低20%\nD. 继续放化疗方案，给予重组人血小板生成素\nE. 继续放化疗方案，定期复查血常规及生化指标\nF. 暂停放化疗，给予还原型谷胱甘肽保肝治疗\nG. 继续放化疗方案，加用双环醇保肝治疗\nH. 继续放化疗方案，给予重组人粒细胞刺激因子\nI. 暂停同期化疗，给予静脉补液及利尿处理\nJ. 继续放疗，取消同期化疗，改为西妥昔单抗治疗\nK. 暂停放疗，继续同期化疗，给予促红细胞生成素治疗\nL. 继续放化疗方案，输注单采血小板\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D70] 检验组合: 低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.66mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.6；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32pg；白细胞计数(WBC#)-静脉血: 7.7410E9/L；血红蛋白(Hb)-静脉血: 164g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 27.3U/L；磷(P)-静脉血: 1.31mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 20.8mmol/L；尿酸(UA)-静脉血: 323.7umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 44.8U/L；C-反应蛋白(CRP)-静脉血: 1.33mg/L；血小板比容-静脉血: 22%；血小板计数(PLT#)-静脉血: 23710E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.35mmolL；总胆红素(TBIL)-静脉血: 10.7umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 36.6U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.75；平均红细胞血红蛋白浓度(MCHC)-静脉血: 342g/L；肌酐(Crea)-静脉血: 62.3umol/L；总蛋白(TP)-静脉血: 75.99g/L；单核细胞百分比(Mono%)-静脉血: 0.056；平均红细胞血红蛋白浓度(MCHC)-静脉血: 337g/L；平均血小板体积(MPV)-静脉血: 9.5fL；血小板计数(PLT#)-静脉血: 24810E9/L；甘油三酯(TG)-静脉血: 1.02mmol/L；单核细胞百分比(Mono%)-静脉血: 0.081；球蛋白(GLO)-静脉血: 29.79g/L；平均红细胞体积(MCV)-静脉血: 95.1fL；总钙(Ca)-静脉血: 2.3mmol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；直接胆红素(DBIL)-静脉血: 3.9umol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；载脂蛋白AI(apoAI)-静脉血: 1.36g/L；大血小板百分比(P-LCR%)-静脉血: 17.2%；血红蛋白(Hb)-静脉血: 158g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32pg……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D64] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者近日精神好，胃纳尚可，暂无特殊不适。体查大致同入院。患者目前无放疗禁忌症，开始予以行鼻咽癌放疗。靶区剂量为：GTV70Gy/31F。放疗期间予同期化疗，并予加强对症、支持治疗。注意观察放疗不良反应表现。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停同期化疗，继续单纯放疗，并加用保肝药物\nB. 暂停放化疗，给予重组人粒细胞刺激因子支持治疗\nC. 继续放疗，将同期化疗剂量减低20%\nD. 继续放化疗方案，给予重组人血小板生成素\nE. 继续放化疗方案，定期复查血常规及生化指标\nF. 暂停放化疗，给予还原型谷胱甘肽保肝治疗\nG. 继续放化疗方案，加用双环醇保肝治疗\nH. 继续放化疗方案，给予重组人粒细胞刺激因子\nI. 暂停同期化疗，给予静脉补液及利尿处理\nJ. 继续放疗，取消同期化疗，改为西妥昔单抗治疗\nK. 暂停放疗，继续同期化疗，给予促红细胞生成素治疗\nL. 继续放化疗方案，输注单采血小板\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-5a0d01adf33246131a9f67e1","patient_id":"patient-34616c327ce5d69194ca7f4d","turn_id":"turn06","turn_position":5,"turn_type":"toxicity_or_support_decision","gold_letter":"F","gold_action":"继续按计划完成根治性放疗，并维持当前口腔含漱等常规对症支持治疗。","options":[{"letter":"A","text":"暂停放疗，给予静脉营养支持及广谱抗生素，待黏膜反应恢复后恢复放疗。","is_gold":false},{"letter":"B","text":"暂停放疗，复查鼻咽颈部MRI评估疗效，若肿瘤完全消退则提前终止放疗。","is_gold":false},{"letter":"C","text":"继续放疗，给予重组人粒细胞集落刺激因子皮下注射以纠正淋巴细胞减少。","is_gold":false},{"letter":"D","text":"继续放疗，加用大剂量糖皮质激素静脉滴注以减轻放射性口腔黏膜炎。","is_gold":false},{"letter":"E","text":"暂停放疗，行经皮内镜下胃造瘘术以保障后续营养摄入及防止体重下降。","is_gold":false},{"letter":"F","text":"继续按计划完成根治性放疗，并维持口腔含漱等常规对症支持治疗。","is_gold":true},{"letter":"G","text":"继续放疗，加用氟康唑口服以预防放疗后期可能出现的真菌性口腔炎。","is_gold":false},{"letter":"H","text":"暂停放疗，给予局部放射性保护剂及高压氧治疗，待口干症状缓解后继续。","is_gold":false},{"letter":"I","text":"继续放疗，降低单次放疗剂量以减少对双侧腮腺及颌下腺的进一步损伤。","is_gold":false},{"letter":"J","text":"提前结束放疗，转为单药辅助化学治疗以控制微小转移灶并减轻局部毒性。","is_gold":false},{"letter":"K","text":"继续放疗，预防性留置鼻胃管以应对放疗末期可能加重的吞咽困难。","is_gold":false},{"letter":"L","text":"暂停放疗，行全身PET-CT排除远处转移后再决定是否完成剩余放疗。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D3189] 门急诊记录: 主诉: 鼻咽癌治疗后8年；患者家属自述行放疗（具体方案不详）。患者家属来诊，诉近来头后部疼痛，持续二月余，逐渐加重，无其他明显，来诊咨询诊疗意见。；既往史: 是否有过敏史无过敏史。是否有吸烟史吸烟史详情；个人史:；家族史:；体格检查:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 检验组合: 嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；凝血酶原时间活动度(PTA)-静脉血: 89%；平均血小板体积(MPV)-静脉血: 9.4fL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 334g/L；D-二聚体(D-Dimer)-静脉血: 0.29ug/ml；凝血酶原国际标准化比值(PT-INR)-静脉血: 1.02；纤维蛋白原(Fbg)-静脉血: 3.21g/L；红细胞比容(Hct)-静脉血: 48.2%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；平均红细胞血红蛋白含量(MCH)-静脉血: 32pg；红细胞计数(RBC#)-静脉血: 5.0310E12/L；淋巴细胞百分比(Lymph%)-静脉血: 0.271；中性粒细胞计数(Neut#)-静脉血: 5.910E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.65；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.8；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；大血小板百分比(P-LCR%)-静脉血: 20.8%；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；血小板比容-静脉血: 27%；平均红细胞体积(MCV)-静脉血: 95.8fL；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.06S/CO；血小板分布宽度(PDW)-静脉血: 10.8%；单核细胞计数(Mono#)-静脉血: 0.510E9/L；活化部分凝血活酶时间(APTT)-静脉血: 29.2sec.；凝血酶原时间(PT)-静脉血: 11.4sec.；纤维蛋白原降解产物(FDP)-静脉血: 2.8ug/ml；淋巴细胞计数(Lymph#)-静脉血: 2.510E9/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.01IU/mL；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.13COI；凝血酶时间(TT)-静脉血: 20sec.；血小板计数(PLT#)-静脉血: 28910E9/L；Rh血型-静脉血: 阳性；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.06S/CO；血红蛋白(Hb)-静脉血: 161g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；白细胞计数(WBC……\n- [全程D14] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 左前分支阻滞\n- [全程D14] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理稍增粗，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见重要病变。\n- [全程D15] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 右侧乳突可见片状放射性浓集灶。胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 右侧乳突炎症。 余全身骨骼未见明显异常。\n- [全程D16] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，肝S7可见一强回声斑，直径约5mm，后方伴声影。血管走行清晰、自然，肝内胆管不扩张，门静脉内径14mm。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约21cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约36×26×23mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝S7强回声斑，考虑肝内胆管结石。 胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D22] 检验组合: 钾离子(K+)-静脉血: 4.18mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 46.8U/L；氯离子(Cl-)-静脉血: 101.7mmol/L；直接胆红素(DBIL)-静脉血: 2.5umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；乳酸脱氢酶(LDH)-静脉血: 172.2U/L；尿酸(UA)-静脉血: 299umol/L；碱性磷酸酶(ALP)-静脉血: 35.4U/L；载脂蛋白B(apoB)-静脉血: 0.71g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.09mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.82；γ-谷氨酰基转移酶(GGT)-静脉血: 23.1U/L；总钙(Ca)-静脉血: 2.31mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.1U/L；间接胆红素(IBIL)-静脉血: 4.8umolL；血液二氧化碳含量ctCO2(B)-静脉血: 22.5mmol/L；总蛋白(TP)-静脉血: 76.15g/L；阴离子间隙(AG)-静脉血: 16.8；总胆固醇(TC)-静脉血: 4.05mmol/L；总胆汁酸(TBA)-静脉血: 3.1umol/L；总胆红素(TBIL)-静脉血: 7.3umol/L；肌酐(Crea)-静脉血: 58.1umol/L；载脂蛋白AI(apoAI)-静脉血: 1.48g/L；球蛋白(GLO)-静脉血: 30.25g/L；C-反应蛋白(CRP)-静脉血: 3.66mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.33mmolL；镁离子(Mg2+)-静脉血: 0.86mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.3U/L；胱抑素(Cys-C)-静脉血: 0.88mg/L；尿素氮(BUN)-静脉血: 3.4mmol/L；葡萄糖(Glu)-静脉血: 5.59mmol/L；甘油三酯(TG)-静脉血: 2.5mmol/L；磷(P)-静脉血: 1.15mmol/L；白蛋白(ALB)-静脉血: 45.9g/L；钠离子(Na+)-静脉血: 141mmol/L\n- [全程D70] 检验组合: 低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.66mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.6；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32pg；白细胞计数(WBC#)-静脉血: 7.7410E9/L；血红蛋白(Hb)-静脉血: 164g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 27.3U/L；磷(P)-静脉血: 1.31mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 20.8mmol/L；尿酸(UA)-静脉血: 323.7umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 44.8U/L；C-反应蛋白(CRP)-静脉血: 1.33mg/L；血小板比容-静脉血: 22%；血小板计数(PLT#)-静脉血: 23710E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.35mmolL；总胆红素(TBIL)-静脉血: 10.7umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 36.6U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.75；平均红细胞血红蛋白浓度(MCHC)-静脉血: 342g/L；肌酐(Crea)-静脉血: 62.3umol/L；总蛋白(TP)-静脉血: 75.99g/L；单核细胞百分比(Mono%)-静脉血: 0.056；平均红细胞血红蛋白浓度(MCHC)-静脉血: 337g/L；平均血小板体积(MPV)-静脉血: 9.5fL；血小板计数(PLT#)-静脉血: 24810E9/L；甘油三酯(TG)-静脉血: 1.02mmol/L；单核细胞百分比(Mono%)-静脉血: 0.081；球蛋白(GLO)-静脉血: 29.79g/L；平均红细胞体积(MCV)-静脉血: 95.1fL；总钙(Ca)-静脉血: 2.3mmol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；直接胆红素(DBIL)-静脉血: 3.9umol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；载脂蛋白AI(apoAI)-静脉血: 1.36g/L；大血小板百分比(P-LCR%)-静脉血: 17.2%；血红蛋白(Hb)-静脉血: 158g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32pg……\n- [全程D83] 检验组合: 平均红细胞血红蛋白含量(MCH)-静脉血: 32.2pg；乳酸脱氢酶(LDH)-静脉血: 190.8U/L；直接胆红素(DBIL)-静脉血: 5.3umol/L；血小板计数(PLT#)-静脉血: 22010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.8；中性粒细胞计数(Neut#)-静脉血: 6.310E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.5；白蛋白(ALB)-静脉血: 45.7g/L；大血小板百分比(P-LCR%)-静脉血: 18.3%；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.81；球蛋白(GLO)-静脉血: 30.11g/L；血小板比容-静脉血: 20%；间接胆红素(IBIL)-静脉血: 8.8umolL；淋巴细胞百分比(Lymph%)-静脉血: 0.068；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 27.5U/L；总胆红素(TBIL)-静脉血: 14.1umol/L；单核细胞百分比(Mono%)-静脉血: 0.075；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；碱性磷酸酶(ALP)-静脉血: 31.2U/L；肌酐(Crea)-静脉血: 68.3umol/L；白细胞计数(WBC#)-静脉血: 7.610E9/L；总蛋白(TP)-静脉血: 75.81g/L；尿素氮(BUN)-静脉血: 4.4mmol/L；总胆汁酸(TBA)-静脉血: 1.8umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 343g/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；红细胞计数(RBC#)-静脉血: 4.910E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；红细胞比容(Hct)-静脉血: 46.1%；平均血小板体积(MPV)-静脉血: 9.3fL；平均红细胞体积(MCV)-静脉血: 94.1fL；尿酸(UA)-静脉血: 343.1umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 39U/L；中……\n- [全程D97] 检验组合: 磷(P)-静脉血: 1.26mmol/L；阴离子间隙(AG)-静脉血: 17.4；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；间接胆红素(IBIL)-静脉血: 5.9umolL；白蛋白(ALB)-静脉血: 45.2g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14；镁离子(Mg2+)-静脉血: 0.87mmol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；葡萄糖(Glu)-静脉血: 4.31mmol/L；尿酸(UA)-静脉血: 265.3umol/L；尿素氮(BUN)-静脉血: 3.1mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.6mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；单核细胞百分比(Mono%)-静脉血: 0.093；总胆汁酸(TBA)-静脉血: 0.9umol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；胱抑素(Cys-C)-静脉血: 0.73mg/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20.7U/L；钾离子(K+)-静脉血: 3.7mmol/L；总胆红素(TBIL)-静脉血: 11.1umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.98；载脂蛋白AI(apoAI)-静脉血: 1.29g/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；红细胞计数(RBC#)-静脉血: 4.5510E12/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336g/L；红细胞比容(Hct)-静脉血: 43.4%；球蛋白(GLO)-静脉血: 29.28g/L；肌酐(Crea)-静脉血: 63.8umol/L；中性粒细胞计数(Neut#)-静脉血: 4.910E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.8；大血小板百分比(P-LCR%)-静脉血: 16.8%；血红蛋白(Hb)-静脉血: 146g/L；直接胆红素(DBIL)-静脉血: 5.2umol/L；总胆固醇(TC)-静脉血: 3.12mmol/L；血小板分布宽度(PDW)-静脉血: 9.8%；总钙(Ca)-静脉血: 2.2mmol/L；血小板比容-静脉血: 13%；丙氨酸氨基转移酶(ALT)-静脉血: 21.2U/L……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D64] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者近日精神好，胃纳尚可，暂无特殊不适。体查大致同入院。患者目前无放疗禁忌症，开始予以行鼻咽癌放疗。靶区剂量为：GTV70Gy/31F。放疗期间予同期化疗，并予加强对症、支持治疗。注意观察放疗不良反应表现。\n- [全程D71] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者近1周放疗期间一般情况好，精神好，胃纳佳，无耳鸣、无涕血、无鼻塞，无头痛、面麻，无视物模糊、复视，无声嘶、饮水呛咳、无发热，二便正常。体查大致同前。至今天，患者共完成放疗11F，暂无特殊不良反应表现。继续予以目前放疗及对症治疗。\n- [全程D78] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者至今天已行放疗16F，过程顺利。今患者精神好，胃纳尚可，诉口干、味觉改变，无咽痛，无耳鸣、无涕血、无鼻塞，无头痛、面麻，无视物模糊、复视，无声嘶、饮水呛咳、无发热，二便正常。体查：鼻咽顶后壁及右侧壁结节状肿物，肿物较放疗前稍有缩小，双颈未及明显肿大淋巴结，颅神经（－）。患者放疗期间出现口干、味觉改变，考虑为放疗副作用所致，嘱患者勤含漱，余继续予以放疗对症治疗。\n- [全程D85] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 今患者精神好，胃纳尚可，诉口干、味觉改变，轻微咽痛，无耳鸣、无涕血、无鼻塞，无头痛、面麻，无视物模糊、复视，无声嘶、饮水呛咳、无发热，二便正常。患者至今天已行放疗18F。体查：口咽黏膜充血，无明显破溃，鼻咽顶后壁及右侧壁结节状肿物，肿物较放疗前继续有缩小，双颈未及明显肿大淋巴结，颅神经（－）。患者放疗期间出现轻微咽痛，考虑为放疗所致口咽黏膜反应，予以继续加强含漱对症治疗，余继续予以放疗对症治疗。\n- [全程D92] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者近1周放疗期间一般情况好，精神好，胃纳佳，诉咽痛症状较前好转，仍有口干、味觉改变，无头痛，无发热，二便正常。体查大致同前。至今天，患者共完成放疗22F，继续予以目前放疗及对症治疗。\n- [全程D97] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者近1周放疗期间一般情况好，精神好，胃纳佳，诉咽痛症状较前好转，仍有口干、味觉改变，无头痛，无发热，二便正常。体查大致同前。至今天，患者共完成放疗27F，继续予以目前放疗及对症治疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，给予静脉营养支持及广谱抗生素，待黏膜反应恢复后恢复放疗。\nB. 暂停放疗，复查鼻咽颈部MRI评估疗效，若肿瘤完全消退则提前终止放疗。\nC. 继续放疗，给予重组人粒细胞集落刺激因子皮下注射以纠正淋巴细胞减少。\nD. 继续放疗，加用大剂量糖皮质激素静脉滴注以减轻放射性口腔黏膜炎。\nE. 暂停放疗，行经皮内镜下胃造瘘术以保障后续营养摄入及防止体重下降。\nF. 继续按计划完成根治性放疗，并维持口腔含漱等常规对症支持治疗。\nG. 继续放疗，加用氟康唑口服以预防放疗后期可能出现的真菌性口腔炎。\nH. 暂停放疗，给予局部放射性保护剂及高压氧治疗，待口干症状缓解后继续。\nI. 继续放疗，降低单次放疗剂量以减少对双侧腮腺及颌下腺的进一步损伤。\nJ. 提前结束放疗，转为单药辅助化学治疗以控制微小转移灶并减轻局部毒性。\nK. 继续放疗，预防性留置鼻胃管以应对放疗末期可能加重的吞咽困难。\nL. 暂停放疗，行全身PET-CT排除远处转移后再决定是否完成剩余放疗。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D83] 检验组合: 平均红细胞血红蛋白含量(MCH)-静脉血: 32.2pg；乳酸脱氢酶(LDH)-静脉血: 190.8U/L；直接胆红素(DBIL)-静脉血: 5.3umol/L；血小板计数(PLT#)-静脉血: 22010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.8；中性粒细胞计数(Neut#)-静脉血: 6.310E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.5；白蛋白(ALB)-静脉血: 45.7g/L；大血小板百分比(P-LCR%)-静脉血: 18.3%；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.81；球蛋白(GLO)-静脉血: 30.11g/L；血小板比容-静脉血: 20%；间接胆红素(IBIL)-静脉血: 8.8umolL；淋巴细胞百分比(Lymph%)-静脉血: 0.068；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 27.5U/L；总胆红素(TBIL)-静脉血: 14.1umol/L；单核细胞百分比(Mono%)-静脉血: 0.075；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；碱性磷酸酶(ALP)-静脉血: 31.2U/L；肌酐(Crea)-静脉血: 68.3umol/L；白细胞计数(WBC#)-静脉血: 7.610E9/L；总蛋白(TP)-静脉血: 75.81g/L；尿素氮(BUN)-静脉血: 4.4mmol/L；总胆汁酸(TBA)-静脉血: 1.8umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 343g/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；红细胞计数(RBC#)-静脉血: 4.910E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；红细胞比容(Hct)-静脉血: 46.1%；平均血小板体积(MPV)-静脉血: 9.3fL；平均红细胞体积(MCV)-静脉血: 94.1fL；尿酸(UA)-静脉血: 343.1umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 39U/L；中……\n- [全程D97] 检验组合: 磷(P)-静脉血: 1.26mmol/L；阴离子间隙(AG)-静脉血: 17.4；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；间接胆红素(IBIL)-静脉血: 5.9umolL；白蛋白(ALB)-静脉血: 45.2g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14；镁离子(Mg2+)-静脉血: 0.87mmol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；葡萄糖(Glu)-静脉血: 4.31mmol/L；尿酸(UA)-静脉血: 265.3umol/L；尿素氮(BUN)-静脉血: 3.1mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.6mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；单核细胞百分比(Mono%)-静脉血: 0.093；总胆汁酸(TBA)-静脉血: 0.9umol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；胱抑素(Cys-C)-静脉血: 0.73mg/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20.7U/L；钾离子(K+)-静脉血: 3.7mmol/L；总胆红素(TBIL)-静脉血: 11.1umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.98；载脂蛋白AI(apoAI)-静脉血: 1.29g/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；红细胞计数(RBC#)-静脉血: 4.5510E12/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336g/L；红细胞比容(Hct)-静脉血: 43.4%；球蛋白(GLO)-静脉血: 29.28g/L；肌酐(Crea)-静脉血: 63.8umol/L；中性粒细胞计数(Neut#)-静脉血: 4.910E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.8；大血小板百分比(P-LCR%)-静脉血: 16.8%；血红蛋白(Hb)-静脉血: 146g/L；直接胆红素(DBIL)-静脉血: 5.2umol/L；总胆固醇(TC)-静脉血: 3.12mmol/L；血小板分布宽度(PDW)-静脉血: 9.8%；总钙(Ca)-静脉血: 2.2mmol/L；血小板比容-静脉血: 13%；丙氨酸氨基转移酶(ALT)-静脉血: 21.2U/L……\n\n【既往治疗与反应】\n- [全程D71] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者近1周放疗期间一般情况好，精神好，胃纳佳，无耳鸣、无涕血、无鼻塞，无头痛、面麻，无视物模糊、复视，无声嘶、饮水呛咳、无发热，二便正常。体查大致同前。至今天，患者共完成放疗11F，暂无特殊不良反应表现。继续予以目前放疗及对症治疗。\n- [全程D78] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者至今天已行放疗16F，过程顺利。今患者精神好，胃纳尚可，诉口干、味觉改变，无咽痛，无耳鸣、无涕血、无鼻塞，无头痛、面麻，无视物模糊、复视，无声嘶、饮水呛咳、无发热，二便正常。体查：鼻咽顶后壁及右侧壁结节状肿物，肿物较放疗前稍有缩小，双颈未及明显肿大淋巴结，颅神经（－）。患者放疗期间出现口干、味觉改变，考虑为放疗副作用所致，嘱患者勤含漱，余继续予以放疗对症治疗。\n- [全程D85] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 今患者精神好，胃纳尚可，诉口干、味觉改变，轻微咽痛，无耳鸣、无涕血、无鼻塞，无头痛、面麻，无视物模糊、复视，无声嘶、饮水呛咳、无发热，二便正常。患者至今天已行放疗18F。体查：口咽黏膜充血，无明显破溃，鼻咽顶后壁及右侧壁结节状肿物，肿物较放疗前继续有缩小，双颈未及明显肿大淋巴结，颅神经（－）。患者放疗期间出现轻微咽痛，考虑为放疗所致口咽黏膜反应，予以继续加强含漱对症治疗，余继续予以放疗对症治疗。\n- [全程D92] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者近1周放疗期间一般情况好，精神好，胃纳佳，诉咽痛症状较前好转，仍有口干、味觉改变，无头痛，无发热，二便正常。体查大致同前。至今天，患者共完成放疗22F，继续予以目前放疗及对症治疗。\n- [全程D97] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者近1周放疗期间一般情况好，精神好，胃纳佳，诉咽痛症状较前好转，仍有口干、味觉改变，无头痛，无发热，二便正常。体查大致同前。至今天，患者共完成放疗27F，继续予以目前放疗及对症治疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，给予静脉营养支持及广谱抗生素，待黏膜反应恢复后恢复放疗。\nB. 暂停放疗，复查鼻咽颈部MRI评估疗效，若肿瘤完全消退则提前终止放疗。\nC. 继续放疗，给予重组人粒细胞集落刺激因子皮下注射以纠正淋巴细胞减少。\nD. 继续放疗，加用大剂量糖皮质激素静脉滴注以减轻放射性口腔黏膜炎。\nE. 暂停放疗，行经皮内镜下胃造瘘术以保障后续营养摄入及防止体重下降。\nF. 继续按计划完成根治性放疗，并维持口腔含漱等常规对症支持治疗。\nG. 继续放疗，加用氟康唑口服以预防放疗后期可能出现的真菌性口腔炎。\nH. 暂停放疗，给予局部放射性保护剂及高压氧治疗，待口干症状缓解后继续。\nI. 继续放疗，降低单次放疗剂量以减少对双侧腮腺及颌下腺的进一步损伤。\nJ. 提前结束放疗，转为单药辅助化学治疗以控制微小转移灶并减轻局部毒性。\nK. 继续放疗，预防性留置鼻胃管以应对放疗末期可能加重的吞咽困难。\nL. 暂停放疗，行全身PET-CT排除远处转移后再决定是否完成剩余放疗。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D83] 检验组合: 平均红细胞血红蛋白含量(MCH)-静脉血: 32.2pg；乳酸脱氢酶(LDH)-静脉血: 190.8U/L；直接胆红素(DBIL)-静脉血: 5.3umol/L；血小板计数(PLT#)-静脉血: 22010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.8；中性粒细胞计数(Neut#)-静脉血: 6.310E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.5；白蛋白(ALB)-静脉血: 45.7g/L；大血小板百分比(P-LCR%)-静脉血: 18.3%；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.81；球蛋白(GLO)-静脉血: 30.11g/L；血小板比容-静脉血: 20%；间接胆红素(IBIL)-静脉血: 8.8umolL；淋巴细胞百分比(Lymph%)-静脉血: 0.068；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 27.5U/L；总胆红素(TBIL)-静脉血: 14.1umol/L；单核细胞百分比(Mono%)-静脉血: 0.075；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；碱性磷酸酶(ALP)-静脉血: 31.2U/L；肌酐(Crea)-静脉血: 68.3umol/L；白细胞计数(WBC#)-静脉血: 7.610E9/L；总蛋白(TP)-静脉血: 75.81g/L；尿素氮(BUN)-静脉血: 4.4mmol/L；总胆汁酸(TBA)-静脉血: 1.8umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 343g/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；红细胞计数(RBC#)-静脉血: 4.910E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；红细胞比容(Hct)-静脉血: 46.1%；平均血小板体积(MPV)-静脉血: 9.3fL；平均红细胞体积(MCV)-静脉血: 94.1fL；尿酸(UA)-静脉血: 343.1umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 39U/L；中……\n- [全程D97] 检验组合: 磷(P)-静脉血: 1.26mmol/L；阴离子间隙(AG)-静脉血: 17.4；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；间接胆红素(IBIL)-静脉血: 5.9umolL；白蛋白(ALB)-静脉血: 45.2g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14；镁离子(Mg2+)-静脉血: 0.87mmol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；葡萄糖(Glu)-静脉血: 4.31mmol/L；尿酸(UA)-静脉血: 265.3umol/L；尿素氮(BUN)-静脉血: 3.1mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.6mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；单核细胞百分比(Mono%)-静脉血: 0.093；总胆汁酸(TBA)-静脉血: 0.9umol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；胱抑素(Cys-C)-静脉血: 0.73mg/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20.7U/L；钾离子(K+)-静脉血: 3.7mmol/L；总胆红素(TBIL)-静脉血: 11.1umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.98；载脂蛋白AI(apoAI)-静脉血: 1.29g/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；红细胞计数(RBC#)-静脉血: 4.5510E12/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336g/L；红细胞比容(Hct)-静脉血: 43.4%；球蛋白(GLO)-静脉血: 29.28g/L；肌酐(Crea)-静脉血: 63.8umol/L；中性粒细胞计数(Neut#)-静脉血: 4.910E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.8；大血小板百分比(P-LCR%)-静脉血: 16.8%；血红蛋白(Hb)-静脉血: 146g/L；直接胆红素(DBIL)-静脉血: 5.2umol/L；总胆固醇(TC)-静脉血: 3.12mmol/L；血小板分布宽度(PDW)-静脉血: 9.8%；总钙(Ca)-静脉血: 2.2mmol/L；血小板比容-静脉血: 13%；丙氨酸氨基转移酶(ALT)-静脉血: 21.2U/L……\n\n【既往治疗与反应】\n- [全程D71] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者近1周放疗期间一般情况好，精神好，胃纳佳，无耳鸣、无涕血、无鼻塞，无头痛、面麻，无视物模糊、复视，无声嘶、饮水呛咳、无发热，二便正常。体查大致同前。至今天，患者共完成放疗11F，暂无特殊不良反应表现。继续予以目前放疗及对症治疗。\n- [全程D78] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者至今天已行放疗16F，过程顺利。今患者精神好，胃纳尚可，诉口干、味觉改变，无咽痛，无耳鸣、无涕血、无鼻塞，无头痛、面麻，无视物模糊、复视，无声嘶、饮水呛咳、无发热，二便正常。体查：鼻咽顶后壁及右侧壁结节状肿物，肿物较放疗前稍有缩小，双颈未及明显肿大淋巴结，颅神经（－）。患者放疗期间出现口干、味觉改变，考虑为放疗副作用所致，嘱患者勤含漱，余继续予以放疗对症治疗。\n- [全程D85] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 今患者精神好，胃纳尚可，诉口干、味觉改变，轻微咽痛，无耳鸣、无涕血、无鼻塞，无头痛、面麻，无视物模糊、复视，无声嘶、饮水呛咳、无发热，二便正常。患者至今天已行放疗18F。体查：口咽黏膜充血，无明显破溃，鼻咽顶后壁及右侧壁结节状肿物，肿物较放疗前继续有缩小，双颈未及明显肿大淋巴结，颅神经（－）。患者放疗期间出现轻微咽痛，考虑为放疗所致口咽黏膜反应，予以继续加强含漱对症治疗，余继续予以放疗对症治疗。\n- [全程D92] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者近1周放疗期间一般情况好，精神好，胃纳佳，诉咽痛症状较前好转，仍有口干、味觉改变，无头痛，无发热，二便正常。体查大致同前。至今天，患者共完成放疗22F，继续予以目前放疗及对症治疗。\n- [全程D97] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者近1周放疗期间一般情况好，精神好，胃纳佳，诉咽痛症状较前好转，仍有口干、味觉改变，无头痛，无发热，二便正常。体查大致同前。至今天，患者共完成放疗27F，继续予以目前放疗及对症治疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，给予静脉营养支持及广谱抗生素，待黏膜反应恢复后恢复放疗。\nB. 暂停放疗，复查鼻咽颈部MRI评估疗效，若肿瘤完全消退则提前终止放疗。\nC. 继续放疗，给予重组人粒细胞集落刺激因子皮下注射以纠正淋巴细胞减少。\nD. 继续放疗，加用大剂量糖皮质激素静脉滴注以减轻放射性口腔黏膜炎。\nE. 暂停放疗，行经皮内镜下胃造瘘术以保障后续营养摄入及防止体重下降。\nF. 继续按计划完成根治性放疗，并维持口腔含漱等常规对症支持治疗。\nG. 继续放疗，加用氟康唑口服以预防放疗后期可能出现的真菌性口腔炎。\nH. 暂停放疗，给予局部放射性保护剂及高压氧治疗，待口干症状缓解后继续。\nI. 继续放疗，降低单次放疗剂量以减少对双侧腮腺及颌下腺的进一步损伤。\nJ. 提前结束放疗，转为单药辅助化学治疗以控制微小转移灶并减轻局部毒性。\nK. 继续放疗，预防性留置鼻胃管以应对放疗末期可能加重的吞咽困难。\nL. 暂停放疗，行全身PET-CT排除远处转移后再决定是否完成剩余放疗。\n\n请仅输出一个选项字母（A-L）。"}]}
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情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左侧颈部IIa区可扪及1个淋巴结，最大径7×3cm，无融合，质地硬，边界清，活动度差，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 电子鼻咽镜检查及活检，鼻咽及颈部平扫CT，胸部X线、腹部彩超，暂缓全身骨显像及EBV检测\nB. 左颈部淋巴结切除活检，鼻咽及颈部增强MRI，胸部X线、腹部彩超、全身骨显像及EBV检测\nC. 电子鼻咽镜检查及活检，鼻咽及颈部增强CT，胸部X线、腹部彩超、全身骨显像，暂缓EBV检测\nD. 电子鼻咽镜检查（暂不活检），鼻咽及颈部增强MRI，全身PET-CT，以及EBV抗体检测\nE. 左颈部淋巴结细针穿刺活检，鼻咽及颈部平扫MRI，胸部X线、腹部彩超、全身骨显像\nF. 电子鼻咽镜检查及活检，鼻咽及颈部增强MRI，仅行胸部X线及腹部彩超，无需全身骨显像\nG. 电子鼻咽镜检查及活检，鼻咽及颈部增强MRI，胸部X线、腹部彩超、全身骨显像，以及EBV抗体检测\nH. 电子鼻咽镜检查及活检，鼻咽及颈部增强MRI，头颅增强MRI，全身骨髓穿刺活检及EBV检测\nI. 电子鼻咽镜检查及活检，鼻咽及颈部增强MRI，胸部X线、腹部彩超、全身骨显像，并预防性气管切开\nJ. 电子鼻咽镜检查及活检，鼻咽及颈部平扫MRI，胸部X线、腹部彩超、全身骨显像，以及EBV抗体检测\nK. 鼻咽及颈部增强MRI，胸部X线、腹部彩超、全身骨显像，待影像学出具恶性报告后再行鼻咽镜活检\nL. 电子鼻咽镜检查及活检，鼻咽及颈部增强MRI，直接行全身骨显像及头颅CT，免除胸腹部影像学检查\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-487e8333de7d37de56947d09","patient_id":"patient-9bf5c8c03860cdf61108611d","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"H","gold_action":"完善电子鼻咽镜检查并取活检明确病理诊断。","options":[{"letter":"A","text":"完善颈部淋巴结细针穿刺活检作为首选病理确诊手段。","is_gold":false},{"letter":"B","text":"完善全身PET-CT检查，若无远处转移则直接开始根治性放疗。","is_gold":false},{"letter":"C","text":"完善电子鼻咽镜检查评估局部侵犯范围，暂不取活检以防大出血。","is_gold":false},{"letter":"D","text":"完善鼻咽镜检查并取活检，同时行颈部淋巴结切除活检以明确分期。","is_gold":false},{"letter":"E","text":"完善鼻咽部刷片细胞学检查明确病理诊断。","is_gold":false},{"letter":"F","text":"完善鼻内镜下鼻咽肿物切除术，术后送常规病理。","is_gold":false},{"letter":"G","text":"完善电子鼻咽镜检查并取活检，若首次活检阴性则按临床诊断开始化疗。","is_gold":false},{"letter":"H","text":"完善电子鼻咽镜检查并取活检明确病理诊断。","is_gold":true},{"letter":"I","text":"完善颈部淋巴结切除活检作为首选病理确诊手段。","is_gold":false},{"letter":"J","text":"完善电子鼻咽镜检查并取活检，同时行预防性气管切开。","is_gold":false},{"letter":"K","text":"完善鼻咽镜检查并取活检，同时行扁桃体切除活检排除隐匿原发灶。","is_gold":false},{"letter":"L","text":"完善全身骨扫描及腹部超声，待全身分期明确后再行鼻咽活检。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：腭帆提肌。\n文本分期信息：N2，M0。\n综合TNM状态：T1N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 听力下降8月，发现左颈部包块1月余；现病史: 患者于某次就诊时间初开始无明显诱因出现听力下降，以右侧为著，未予重视。某次就诊时间7月初患者无意中发现左颈部包块，大小约4×4cm，无疼痛，无表面皮肤发红，未就诊，肿物进行性增大。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,左颈部包块,颈部肿物；既往史: 发现血糖升高一年余，未行药物治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟：30－40支/天×30余。否认饮酒史。否认不洁性生活史。；家族史: 两个舅舅分别患有肝癌及骨肿瘤。；体格检查: T：36.4℃，P：83次/分，R：20次/分，BP：100/65mmHg,Ht：164cm，Wt：87kg，BSA：1.93m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左侧颈部IIa区可扪及1个淋巴结，最大径7×3cm，无融合，质地硬，边界清，活动度差，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D0] 检验组合: 隐血(OB)-粪便: 阴性（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-粪便: 棕色；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；比重(SG)-尿液: 1.021；浊度(TRUB)-尿液: 清亮；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 5.5；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；白细胞计数(WBC#)-尿液: 3/μL；虫卵-粪便: 未见虫卵（参考: 未见虫卵）\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理增多增粗，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，右肋膈角锐利，左肋膈角模糊。；检查结论: 考虑双肺慢性支气管炎X线改变。 左侧胸膜稍增厚。\n- [全程D1] 检验组合: 人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；载脂蛋白B(apoB)-静脉血: 1.08g/L；间接胆红素(IBIL)-静脉血: 5.9umolL；钾离子(K+)-静脉血: 4.1mmol/L；阴离子间隙(AG)-静脉血: 17.5；血红蛋白(Hb)-静脉血: 151g/L；凝血酶原时间活动度(PTA)-静脉血: 113.8%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；单核细胞计数(Mono#)-静脉血: 0.610E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.99mmol/L；ABO血型-静脉血: O；中性粒细胞百分比(Neut%)-静脉血: 0.578；血小板比容-静脉血: 24%；Rh血型-静脉血: 阳性；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 5.12mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；梅毒非特异性抗体甲苯胺红不加热血清试验(TRUST)-静脉血: 阴性(-)（参考: 阴性）；淋巴细胞百分比(Lymph%)-静脉血: 0.307；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.9；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 7.9umol/L；白细胞计数(WBC#)-静脉血: 7.610E9/L；直接胆红素(DBIL)-静脉血: 2umol/L；红细胞计数(RBC#)-静脉血: 5.2510E12/L；白蛋白(ALB)-静脉血: 42.2g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；红细胞比容(Hct)-静脉血: 44.7%；糖化血红蛋白A1c(HbA1c)-静脉血: 7.2%；总蛋白(TP)-静脉血: 76.24g/L；凝血酶时间(TT)-静脉血: 18.9sec.；纤维蛋白原(Fbg)-静脉血: 2.44g/L；钠离子(Na+)-静脉血……\n- [全程D4] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔变窄，鼻咽各壁粘膜明显增厚，见结节状肿物向鼻咽腔内突出，T1WI呈等信号，T2WI呈稍高信号，增强扫描轻度不均匀强化，双侧咽隐窝见肿物填塞。口咽双侧壁未见受累增厚，病变未累及双侧后鼻孔。 双侧腭帆提肌受侵，双侧腭帆张肌及头长肌、双侧翼内外肌未见受侵征象。 双侧翼腭窝、双侧上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 颅底骨质未见破坏。 双侧海绵窦形态未见异常。 双侧筛窦、双侧上颌窦粘膜增厚，增强扫描呈轻度强化。双侧乳突未见分泌物。 双眼未见异常，球后未见占位性病变。蝶鞍形态未见异常，其内未见占位性病变。 双侧咽后见淋巴结，大小约7mm×9mm，增强扫描明显强化。 双颈II区、左颈III区见多个肿大淋巴结，最大约33mm×27mm，边界欠清，增强扫描呈明显强化。 右颈III区、双颈I区见数个小淋巴结，最大约5mm×11mm，边界清楚，孤立散在。 甲状腺双叶及峡部形态未见异常，信号均匀，未见占位性病变。喉咽腔形态未见异常，未见占位性病变。双侧颌下腺、腮腺大小、形态未见异常，信号均匀，未见占位性病变。 扫描所见脑组织未见明确异常。；检查结论: 鼻咽肿物，考虑鼻咽癌。 颅底骨质未见破坏。 双侧咽后、双颈II区、左颈III区肿大淋巴结，考虑转移。 鼻窦炎。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善颈部淋巴结细针穿刺活检作为首选病理确诊手段。\nB. 完善全身PET-CT检查，若无远处转移则直接开始根治性放疗。\nC. 完善电子鼻咽镜检查评估局部侵犯范围，暂不取活检以防大出血。\nD. 完善鼻咽镜检查并取活检，同时行颈部淋巴结切除活检以明确分期。\nE. 完善鼻咽部刷片细胞学检查明确病理诊断。\nF. 完善鼻内镜下鼻咽肿物切除术，术后送常规病理。\nG. 完善电子鼻咽镜检查并取活检，若首次活检阴性则按临床诊断开始化疗。\nH. 完善电子鼻咽镜检查并取活检明确病理诊断。\nI. 完善颈部淋巴结切除活检作为首选病理确诊手段。\nJ. 完善电子鼻咽镜检查并取活检，同时行预防性气管切开。\nK. 完善鼻咽镜检查并取活检，同时行扁桃体切除活检排除隐匿原发灶。\nL. 完善全身骨扫描及腹部超声，待全身分期明确后再行鼻咽活检。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D0] 检验组合: 隐血(OB)-粪便: 阴性（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-粪便: 棕色；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；比重(SG)-尿液: 1.021；浊度(TRUB)-尿液: 清亮；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 5.5；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；白细胞计数(WBC#)-尿液: 3/μL；虫卵-粪便: 未见虫卵（参考: 未见虫卵）\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理增多增粗，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，右肋膈角锐利，左肋膈角模糊。；检查结论: 考虑双肺慢性支气管炎X线改变。 左侧胸膜稍增厚。\n- [全程D1] 检验组合: 人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；载脂蛋白B(apoB)-静脉血: 1.08g/L；间接胆红素(IBIL)-静脉血: 5.9umolL；钾离子(K+)-静脉血: 4.1mmol/L；阴离子间隙(AG)-静脉血: 17.5；血红蛋白(Hb)-静脉血: 151g/L；凝血酶原时间活动度(PTA)-静脉血: 113.8%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；单核细胞计数(Mono#)-静脉血: 0.610E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.99mmol/L；ABO血型-静脉血: O；中性粒细胞百分比(Neut%)-静脉血: 0.578；血小板比容-静脉血: 24%；Rh血型-静脉血: 阳性；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 5.12mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；梅毒非特异性抗体甲苯胺红不加热血清试验(TRUST)-静脉血: 阴性(-)（参考: 阴性）；淋巴细胞百分比(Lymph%)-静脉血: 0.307；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.9；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 7.9umol/L；白细胞计数(WBC#)-静脉血: 7.610E9/L；直接胆红素(DBIL)-静脉血: 2umol/L；红细胞计数(RBC#)-静脉血: 5.2510E12/L；白蛋白(ALB)-静脉血: 42.2g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；红细胞比容(Hct)-静脉血: 44.7%；糖化血红蛋白A1c(HbA1c)-静脉血: 7.2%；总蛋白(TP)-静脉血: 76.24g/L；凝血酶时间(TT)-静脉血: 18.9sec.；纤维蛋白原(Fbg)-静脉血: 2.44g/L；钠离子(Na+)-静脉血……\n- [全程D4] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔变窄，鼻咽各壁粘膜明显增厚，见结节状肿物向鼻咽腔内突出，T1WI呈等信号，T2WI呈稍高信号，增强扫描轻度不均匀强化，双侧咽隐窝见肿物填塞。口咽双侧壁未见受累增厚，病变未累及双侧后鼻孔。 双侧腭帆提肌受侵，双侧腭帆张肌及头长肌、双侧翼内外肌未见受侵征象。 双侧翼腭窝、双侧上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 颅底骨质未见破坏。 双侧海绵窦形态未见异常。 双侧筛窦、双侧上颌窦粘膜增厚，增强扫描呈轻度强化。双侧乳突未见分泌物。 双眼未见异常，球后未见占位性病变。蝶鞍形态未见异常，其内未见占位性病变。 双侧咽后见淋巴结，大小约7mm×9mm，增强扫描明显强化。 双颈II区、左颈III区见多个肿大淋巴结，最大约33mm×27mm，边界欠清，增强扫描呈明显强化。 右颈III区、双颈I区见数个小淋巴结，最大约5mm×11mm，边界清楚，孤立散在。 甲状腺双叶及峡部形态未见异常，信号均匀，未见占位性病变。喉咽腔形态未见异常，未见占位性病变。双侧颌下腺、腮腺大小、形态未见异常，信号均匀，未见占位性病变。 扫描所见脑组织未见明确异常。；检查结论: 鼻咽肿物，考虑鼻咽癌。 颅底骨质未见破坏。 双侧咽后、双颈II区、左颈III区肿大淋巴结，考虑转移。 鼻窦炎。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善颈部淋巴结细针穿刺活检作为首选病理确诊手段。\nB. 完善全身PET-CT检查，若无远处转移则直接开始根治性放疗。\nC. 完善电子鼻咽镜检查评估局部侵犯范围，暂不取活检以防大出血。\nD. 完善鼻咽镜检查并取活检，同时行颈部淋巴结切除活检以明确分期。\nE. 完善鼻咽部刷片细胞学检查明确病理诊断。\nF. 完善鼻内镜下鼻咽肿物切除术，术后送常规病理。\nG. 完善电子鼻咽镜检查并取活检，若首次活检阴性则按临床诊断开始化疗。\nH. 完善电子鼻咽镜检查并取活检明确病理诊断。\nI. 完善颈部淋巴结切除活检作为首选病理确诊手段。\nJ. 完善电子鼻咽镜检查并取活检，同时行预防性气管切开。\nK. 完善鼻咽镜检查并取活检，同时行扁桃体切除活检排除隐匿原发灶。\nL. 完善全身骨扫描及腹部超声，待全身分期明确后再行鼻咽活检。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：腭帆提肌。\n文本分期信息：N2，M0。\n综合TNM状态：T1N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D0] 检验组合: 隐血(OB)-粪便: 阴性（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-粪便: 棕色；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；比重(SG)-尿液: 1.021；浊度(TRUB)-尿液: 清亮；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 5.5；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；白细胞计数(WBC#)-尿液: 3/μL；虫卵-粪便: 未见虫卵（参考: 未见虫卵）\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理增多增粗，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，右肋膈角锐利，左肋膈角模糊。；检查结论: 考虑双肺慢性支气管炎X线改变。 左侧胸膜稍增厚。\n- [全程D1] 检验组合: 人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；载脂蛋白B(apoB)-静脉血: 1.08g/L；间接胆红素(IBIL)-静脉血: 5.9umolL；钾离子(K+)-静脉血: 4.1mmol/L；阴离子间隙(AG)-静脉血: 17.5；血红蛋白(Hb)-静脉血: 151g/L；凝血酶原时间活动度(PTA)-静脉血: 113.8%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；单核细胞计数(Mono#)-静脉血: 0.610E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.99mmol/L；ABO血型-静脉血: O；中性粒细胞百分比(Neut%)-静脉血: 0.578；血小板比容-静脉血: 24%；Rh血型-静脉血: 阳性；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 5.12mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；梅毒非特异性抗体甲苯胺红不加热血清试验(TRUST)-静脉血: 阴性(-)（参考: 阴性）；淋巴细胞百分比(Lymph%)-静脉血: 0.307；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.9；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 7.9umol/L；白细胞计数(WBC#)-静脉血: 7.610E9/L；直接胆红素(DBIL)-静脉血: 2umol/L；红细胞计数(RBC#)-静脉血: 5.2510E12/L；白蛋白(ALB)-静脉血: 42.2g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；红细胞比容(Hct)-静脉血: 44.7%；糖化血红蛋白A1c(HbA1c)-静脉血: 7.2%；总蛋白(TP)-静脉血: 76.24g/L；凝血酶时间(TT)-静脉血: 18.9sec.；纤维蛋白原(Fbg)-静脉血: 2.44g/L；钠离子(Na+)-静脉血……\n- [全程D4] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔变窄，鼻咽各壁粘膜明显增厚，见结节状肿物向鼻咽腔内突出，T1WI呈等信号，T2WI呈稍高信号，增强扫描轻度不均匀强化，双侧咽隐窝见肿物填塞。口咽双侧壁未见受累增厚，病变未累及双侧后鼻孔。 双侧腭帆提肌受侵，双侧腭帆张肌及头长肌、双侧翼内外肌未见受侵征象。 双侧翼腭窝、双侧上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 颅底骨质未见破坏。 双侧海绵窦形态未见异常。 双侧筛窦、双侧上颌窦粘膜增厚，增强扫描呈轻度强化。双侧乳突未见分泌物。 双眼未见异常，球后未见占位性病变。蝶鞍形态未见异常，其内未见占位性病变。 双侧咽后见淋巴结，大小约7mm×9mm，增强扫描明显强化。 双颈II区、左颈III区见多个肿大淋巴结，最大约33mm×27mm，边界欠清，增强扫描呈明显强化。 右颈III区、双颈I区见数个小淋巴结，最大约5mm×11mm，边界清楚，孤立散在。 甲状腺双叶及峡部形态未见异常，信号均匀，未见占位性病变。喉咽腔形态未见异常，未见占位性病变。双侧颌下腺、腮腺大小、形态未见异常，信号均匀，未见占位性病变。 扫描所见脑组织未见明确异常。；检查结论: 鼻咽肿物，考虑鼻咽癌。 颅底骨质未见破坏。 双侧咽后、双颈II区、左颈III区肿大淋巴结，考虑转移。 鼻窦炎。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善颈部淋巴结细针穿刺活检作为首选病理确诊手段。\nB. 完善全身PET-CT检查，若无远处转移则直接开始根治性放疗。\nC. 完善电子鼻咽镜检查评估局部侵犯范围，暂不取活检以防大出血。\nD. 完善鼻咽镜检查并取活检，同时行颈部淋巴结切除活检以明确分期。\nE. 完善鼻咽部刷片细胞学检查明确病理诊断。\nF. 完善鼻内镜下鼻咽肿物切除术，术后送常规病理。\nG. 完善电子鼻咽镜检查并取活检，若首次活检阴性则按临床诊断开始化疗。\nH. 完善电子鼻咽镜检查并取活检明确病理诊断。\nI. 完善颈部淋巴结切除活检作为首选病理确诊手段。\nJ. 完善电子鼻咽镜检查并取活检，同时行预防性气管切开。\nK. 完善鼻咽镜检查并取活检，同时行扁桃体切除活检排除隐匿原发灶。\nL. 完善全身骨扫描及腹部超声，待全身分期明确后再行鼻咽活检。\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-7ff1cd1ea3ebf1a9891b521d","patient_id":"patient-9bf5c8c03860cdf61108611d","turn_id":"turn05","turn_position":3,"turn_type":"toxicity_or_support_decision","gold_letter":"K","gold_action":"按原剂量行第二程GP（吉西他滨+顺铂）诱导化疗，并辅以常规止吐、护胃及水化利尿等支持治疗。","options":[{"letter":"A","text":"暂缓化疗，给予重组人血小板生成素升血小板治疗，待血小板恢复至正常范围后原剂量行第二程GP诱导化疗。","is_gold":false},{"letter":"B","text":"行第二程GP诱导化疗，吉西他滨剂量下调25%，顺铂维持原剂量，辅以常规止吐及水化利尿等支持治疗。","is_gold":false},{"letter":"C","text":"停用GP诱导化疗方案，直接转入根治性单纯放疗阶段，并安排心血管专科随访与干预。","is_gold":false},{"letter":"D","text":"更改诱导化疗方案，将第二程方案由GP（吉西他滨+顺铂）调整为TP（多西他赛+顺铂）方案并按原剂量给药。","is_gold":false},{"letter":"E","text":"按原剂量行第二程GP诱导化疗，并于化疗结束后预防性给予聚乙二醇化重组人粒细胞刺激因子支持。","is_gold":false},{"letter":"F","text":"暂缓化疗，请心血管内科会诊并完善超声心动图等检查，待心血管专科评估通过后再行第二程GP化疗。","is_gold":false},{"letter":"G","text":"按原剂量行第二程GP诱导化疗，并同步皮下注射重组人促红细胞生成素以提升血红蛋白水平。","is_gold":false},{"letter":"H","text":"行第二程GP诱导化疗，顺铂剂量下调25%，吉西他滨维持原剂量，辅以常规止吐及水化利尿等支持治疗。","is_gold":false},{"letter":"I","text":"终止诱导化疗，直接进入根治性同步放化疗阶段，同步化疗采用单药顺铂标准剂量方案。","is_gold":false},{"letter":"J","text":"按原剂量行第二程GP诱导化疗，化疗前预防性输注单采血小板1个治疗量以降低出血风险。","is_gold":false},{"letter":"K","text":"按原剂量行第二程GP诱导化疗，并辅以常规止吐、护胃及水化利尿等支持治疗。","is_gold":true},{"letter":"L","text":"按原剂量行第二程GP诱导化疗，并预防性加用异甘草酸镁等保肝药物以防止化疗相关肝损伤。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：腭帆提肌。\n文本分期信息：N2，M0。\n综合TNM状态：T1N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 听力下降8月，发现左颈部包块1月余；现病史: 患者于某次就诊时间初开始无明显诱因出现听力下降，以右侧为著，未予重视。某次就诊时间7月初患者无意中发现左颈部包块，大小约4×4cm，无疼痛，无表面皮肤发红，未就诊，肿物进行性增大。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,左颈部包块,颈部肿物；既往史: 发现血糖升高一年余，未行药物治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟：30－40支/天×30余。否认饮酒史。否认不洁性生活史。；家族史: 两个舅舅分别患有肝癌及骨肿瘤。；体格检查: T：36.4℃，P：83次/分，R：20次/分，BP：100/65mmHg,Ht：164cm，Wt：87kg，BSA：1.93m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左侧颈部IIa区可扪及1个淋巴结，最大径7×3cm，无融合，质地硬，边界清，活动度差，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D8] 入院记录: 主诉: 听力下降8月，发现左颈部包块1月余；现病史: 简要入院病史:患者于某次就诊时间初开始无明显诱因出现听力下降，以右侧为著，未予重视。某次就诊时间7月初患者无意中发现左颈部包块，大小约4×4cm，无疼痛，无表面皮肤发红，未就诊，肿物进行性增大。8月初肿物增大至鸡蛋大小，就诊地域信息已隐藏，行颈部肿块穿刺，病理回报：转移癌可能性大。8－11行鼻咽＋颈部MRI提示：鼻咽双侧壁及顶后壁软组织增厚，考虑鼻咽癌并双侧咽后、双颈部多发淋巴结肿大。胸部MRI检查未见异常。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,左颈部包块,颈部肿物；既往史: 发现血糖升高一年余，未行药物治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、肾病”病史；否认手术、外伤、输血史及献血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D0] 检验组合: 隐血(OB)-粪便: 阴性（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-粪便: 棕色；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；比重(SG)-尿液: 1.021；浊度(TRUB)-尿液: 清亮；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 5.5；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；白细胞计数(WBC#)-尿液: 3/μL；虫卵-粪便: 未见虫卵（参考: 未见虫卵）\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理增多增粗，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，右肋膈角锐利，左肋膈角模糊。；检查结论: 考虑双肺慢性支气管炎X线改变。 左侧胸膜稍增厚。\n- [全程D1] 检验组合: 人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；载脂蛋白B(apoB)-静脉血: 1.08g/L；间接胆红素(IBIL)-静脉血: 5.9umolL；钾离子(K+)-静脉血: 4.1mmol/L；阴离子间隙(AG)-静脉血: 17.5；血红蛋白(Hb)-静脉血: 151g/L；凝血酶原时间活动度(PTA)-静脉血: 113.8%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；单核细胞计数(Mono#)-静脉血: 0.610E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.99mmol/L；ABO血型-静脉血: O；中性粒细胞百分比(Neut%)-静脉血: 0.578；血小板比容-静脉血: 24%；Rh血型-静脉血: 阳性；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 5.12mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；梅毒非特异性抗体甲苯胺红不加热血清试验(TRUST)-静脉血: 阴性(-)（参考: 阴性）；淋巴细胞百分比(Lymph%)-静脉血: 0.307；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.9；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 7.9umol/L；白细胞计数(WBC#)-静脉血: 7.610E9/L；直接胆红素(DBIL)-静脉血: 2umol/L；红细胞计数(RBC#)-静脉血: 5.2510E12/L；白蛋白(ALB)-静脉血: 42.2g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；红细胞比容(Hct)-静脉血: 44.7%；糖化血红蛋白A1c(HbA1c)-静脉血: 7.2%；总蛋白(TP)-静脉血: 76.24g/L；凝血酶时间(TT)-静脉血: 18.9sec.；纤维蛋白原(Fbg)-静脉血: 2.44g/L；钠离子(Na+)-静脉血……\n- [全程D4] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔变窄，鼻咽各壁粘膜明显增厚，见结节状肿物向鼻咽腔内突出，T1WI呈等信号，T2WI呈稍高信号，增强扫描轻度不均匀强化，双侧咽隐窝见肿物填塞。口咽双侧壁未见受累增厚，病变未累及双侧后鼻孔。 双侧腭帆提肌受侵，双侧腭帆张肌及头长肌、双侧翼内外肌未见受侵征象。 双侧翼腭窝、双侧上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 颅底骨质未见破坏。 双侧海绵窦形态未见异常。 双侧筛窦、双侧上颌窦粘膜增厚，增强扫描呈轻度强化。双侧乳突未见分泌物。 双眼未见异常，球后未见占位性病变。蝶鞍形态未见异常，其内未见占位性病变。 双侧咽后见淋巴结，大小约7mm×9mm，增强扫描明显强化。 双颈II区、左颈III区见多个肿大淋巴结，最大约33mm×27mm，边界欠清，增强扫描呈明显强化。 右颈III区、双颈I区见数个小淋巴结，最大约5mm×11mm，边界清楚，孤立散在。 甲状腺双叶及峡部形态未见异常，信号均匀，未见占位性病变。喉咽腔形态未见异常，未见占位性病变。双侧颌下腺、腮腺大小、形态未见异常，信号均匀，未见占位性病变。 扫描所见脑组织未见明确异常。；检查结论: 鼻咽肿物，考虑鼻咽癌。 颅底骨质未见破坏。 双侧咽后、双颈II区、左颈III区肿大淋巴结，考虑转移。 鼻窦炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D5] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约15cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D7] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 双上颌骨可见片状放射性浓集灶。胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 双上颌骨炎症。 余全身骨骼未见明显异常。\n- [全程D12] 检验组合: 平均红细胞血红蛋白浓度(MCHC)-静脉血: 340g/L；血小板比容-静脉血: 24%；单核细胞计数(Mono#)-静脉血: 0.110E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；红细胞比容(Hct)-静脉血: 41.8%；平均红细胞血红蛋白含量(MCH)-静脉血: 29pg；单核细胞百分比(Mono%)-静脉血: 0.016；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.1；平均血小板体积(MPV)-静脉血: 10.3fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.007；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；红细胞计数(RBC#)-静脉血: 4.8910E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；大血小板百分比(P-LCR%)-静脉血: 27%；淋巴细胞百分比(Lymph%)-静脉血: 0.422；血小板计数(PLT#)-静脉血: 23710E9/L；平均红细胞体积(MCV)-静脉血: 85.5fL；淋巴细胞计数(Lymph#)-静脉血: 310E9/L；白细胞计数(WBC#)-静脉血: 710E9/L；血小板分布宽度(PDW)-静脉血: 11.6%；血红蛋白(Hb)-静脉血: 142g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；中性粒细胞百分比(Neut%)-静脉血: 0.552\n- [全程D15] 检验组合: 单核细胞计数(Mono#)-静脉血: 0.310E9/L；血小板计数(PLT#)-静脉血: 19810E9/L；红细胞比容(Hct)-静脉血: 44.3%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13；大血小板百分比(P-LCR%)-静脉血: 22.1%；红细胞计数(RBC#)-静脉血: 5.2510E12/L；淋巴细胞百分比(Lymph%)-静脉血: 0.443；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；血小板比容-静脉血: 19%；血红蛋白(Hb)-静脉血: 151g/L；血小板分布宽度(PDW)-静脉血: 11.5%；平均红细胞体积(MCV)-静脉血: 84.4fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.033；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；单核细胞百分比(Mono%)-静脉血: 0.059；平均血小板体积(MPV)-静脉血: 9.5fL；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.46；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；白细胞计数(WBC#)-静脉血: 5.7610E9/L；淋巴细胞计数(Lymph#)-静脉血: 2.610E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.8\n- [全程D19] 检验组合: 中性粒细胞计数(Neut#)-静脉血: 5.210E9/L；单核细胞计数(Mono#)-静脉血: 0.110E9/L；血红蛋白(Hb)-静脉血: 131g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.231；红细胞计数(RBC#)-静脉血: 4.510E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.742；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；大血小板百分比(P-LCR%)-静脉血: 21.7%；血小板计数(PLT#)-静脉血: 14310E9/L；血小板分布宽度(PDW)-静脉血: 10.7%；平均红细胞体积(MCV)-静脉血: 88.9fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.6；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；血小板比容-静脉血: 14%；白细胞计数(WBC#)-静脉血: 710E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.3；单核细胞百分比(Mono%)-静脉血: 0.01；平均血小板体积(MPV)-静脉血: 9.5fL；红细胞比容(Hct)-静脉血: 40%；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L\n- [全程D27] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 拟不完全性右束支传导阻滞\n- [全程D27] 检验组合: 镁离子(Mg2+)-静脉血: 0.82mmol/L；氯离子(Cl-)-静脉血: 103.6mmol/L；总胆固醇(TC)-静脉血: 5.1mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.25mmol/L；总胆汁酸(TBA)-静脉血: 4.1umol/L；肌酐(Crea)-静脉血: 76.9umol/L；直接胆红素(DBIL)-静脉血: 1.6umol/L；总钙(Ca)-静脉血: 2.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 19.8U/L；总蛋白(TP)-静脉血: 75.08g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.29；尿酸(UA)-静脉血: 440.4umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 19.1mmol/L；磷(P)-静脉血: 1.09mmol/L；胱抑素(Cys-C)-静脉血: 1.21mg/L；C-反应蛋白(CRP)-静脉血: 4.53mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.06mmolL；碱性磷酸酶(ALP)-静脉血: 84.7U/L；白蛋白(ALB)-静脉血: 42.3g/L；载脂蛋白B(apoB)-静脉血: 1.13g/L；球蛋白(GLO)-静脉血: 32.78g/L；尿素氮(BUN)-静脉血: 7.3mmol/L；钠离子(Na+)-静脉血: 138.8mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 47.8U/L；甘油三酯(TG)-静脉血: 2.38mmol/L；乳酸脱氢酶(LDH)-静脉血: 183.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 54U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.2U/L；葡萄糖(Glu)-静脉血: 7.26mmol/L；总胆红素(TBIL)-静脉血: 5.3umol/L；载脂蛋白AI(apoAI)-静脉血: 1.29g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.92；钾离子(K+)-静脉血: 4.48mmol/L；间接胆红素(IBIL)-静脉血: 3.7umolL；阴离子间隙(AG)-静脉血: 16.1\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂缓化疗，给予重组人血小板生成素升血小板治疗，待血小板恢复至正常范围后原剂量行第二程GP诱导化疗。\nB. 行第二程GP诱导化疗，吉西他滨剂量下调25%，顺铂维持原剂量，辅以常规止吐及水化利尿等支持治疗。\nC. 停用GP诱导化疗方案，直接转入根治性单纯放疗阶段，并安排心血管专科随访与干预。\nD. 更改诱导化疗方案，将第二程方案由GP（吉西他滨+顺铂）调整为TP（多西他赛+顺铂）方案并按原剂量给药。\nE. 按原剂量行第二程GP诱导化疗，并于化疗结束后预防性给予聚乙二醇化重组人粒细胞刺激因子支持。\nF. 暂缓化疗，请心血管内科会诊并完善超声心动图等检查，待心血管专科评估通过后再行第二程GP化疗。\nG. 按原剂量行第二程GP诱导化疗，并同步皮下注射重组人促红细胞生成素以提升血红蛋白水平。\nH. 行第二程GP诱导化疗，顺铂剂量下调25%，吉西他滨维持原剂量，辅以常规止吐及水化利尿等支持治疗。\nI. 终止诱导化疗，直接进入根治性同步放化疗阶段，同步化疗采用单药顺铂标准剂量方案。\nJ. 按原剂量行第二程GP诱导化疗，化疗前预防性输注单采血小板1个治疗量以降低出血风险。\nK. 按原剂量行第二程GP诱导化疗，并辅以常规止吐、护胃及水化利尿等支持治疗。\nL. 按原剂量行第二程GP诱导化疗，并预防性加用异甘草酸镁等保肝药物以防止化疗相关肝损伤。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D8] 入院记录: 主诉: 听力下降8月，发现左颈部包块1月余；现病史: 简要入院病史:患者于某次就诊时间初开始无明显诱因出现听力下降，以右侧为著，未予重视。某次就诊时间7月初患者无意中发现左颈部包块，大小约4×4cm，无疼痛，无表面皮肤发红，未就诊，肿物进行性增大。8月初肿物增大至鸡蛋大小，就诊地域信息已隐藏，行颈部肿块穿刺，病理回报：转移癌可能性大。8－11行鼻咽＋颈部MRI提示：鼻咽双侧壁及顶后壁软组织增厚，考虑鼻咽癌并双侧咽后、双颈部多发淋巴结肿大。胸部MRI检查未见异常。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,左颈部包块,颈部肿物；既往史: 发现血糖升高一年余，未行药物治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、肾病”病史；否认手术、外伤、输血史及献血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D5] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约15cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D7] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 双上颌骨可见片状放射性浓集灶。胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 双上颌骨炎症。 余全身骨骼未见明显异常。\n- [全程D12] 检验组合: 平均红细胞血红蛋白浓度(MCHC)-静脉血: 340g/L；血小板比容-静脉血: 24%；单核细胞计数(Mono#)-静脉血: 0.110E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；红细胞比容(Hct)-静脉血: 41.8%；平均红细胞血红蛋白含量(MCH)-静脉血: 29pg；单核细胞百分比(Mono%)-静脉血: 0.016；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.1；平均血小板体积(MPV)-静脉血: 10.3fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.007；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；红细胞计数(RBC#)-静脉血: 4.8910E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；大血小板百分比(P-LCR%)-静脉血: 27%；淋巴细胞百分比(Lymph%)-静脉血: 0.422；血小板计数(PLT#)-静脉血: 23710E9/L；平均红细胞体积(MCV)-静脉血: 85.5fL；淋巴细胞计数(Lymph#)-静脉血: 310E9/L；白细胞计数(WBC#)-静脉血: 710E9/L；血小板分布宽度(PDW)-静脉血: 11.6%；血红蛋白(Hb)-静脉血: 142g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；中性粒细胞百分比(Neut%)-静脉血: 0.552\n- [全程D15] 检验组合: 单核细胞计数(Mono#)-静脉血: 0.310E9/L；血小板计数(PLT#)-静脉血: 19810E9/L；红细胞比容(Hct)-静脉血: 44.3%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13；大血小板百分比(P-LCR%)-静脉血: 22.1%；红细胞计数(RBC#)-静脉血: 5.2510E12/L；淋巴细胞百分比(Lymph%)-静脉血: 0.443；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；血小板比容-静脉血: 19%；血红蛋白(Hb)-静脉血: 151g/L；血小板分布宽度(PDW)-静脉血: 11.5%；平均红细胞体积(MCV)-静脉血: 84.4fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.033；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；单核细胞百分比(Mono%)-静脉血: 0.059；平均血小板体积(MPV)-静脉血: 9.5fL；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.46；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；白细胞计数(WBC#)-静脉血: 5.7610E9/L；淋巴细胞计数(Lymph#)-静脉血: 2.610E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.8\n- [全程D19] 检验组合: 中性粒细胞计数(Neut#)-静脉血: 5.210E9/L；单核细胞计数(Mono#)-静脉血: 0.110E9/L；血红蛋白(Hb)-静脉血: 131g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.231；红细胞计数(RBC#)-静脉血: 4.510E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.742；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；大血小板百分比(P-LCR%)-静脉血: 21.7%；血小板计数(PLT#)-静脉血: 14310E9/L；血小板分布宽度(PDW)-静脉血: 10.7%；平均红细胞体积(MCV)-静脉血: 88.9fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.6；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；血小板比容-静脉血: 14%；白细胞计数(WBC#)-静脉血: 710E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.3；单核细胞百分比(Mono%)-静脉血: 0.01；平均血小板体积(MPV)-静脉血: 9.5fL；红细胞比容(Hct)-静脉血: 40%；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L\n- [全程D27] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 拟不完全性右束支传导阻滞\n- [全程D27] 检验组合: 镁离子(Mg2+)-静脉血: 0.82mmol/L；氯离子(Cl-)-静脉血: 103.6mmol/L；总胆固醇(TC)-静脉血: 5.1mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.25mmol/L；总胆汁酸(TBA)-静脉血: 4.1umol/L；肌酐(Crea)-静脉血: 76.9umol/L；直接胆红素(DBIL)-静脉血: 1.6umol/L；总钙(Ca)-静脉血: 2.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 19.8U/L；总蛋白(TP)-静脉血: 75.08g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.29；尿酸(UA)-静脉血: 440.4umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 19.1mmol/L；磷(P)-静脉血: 1.09mmol/L；胱抑素(Cys-C)-静脉血: 1.21mg/L；C-反应蛋白(CRP)-静脉血: 4.53mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.06mmolL；碱性磷酸酶(ALP)-静脉血: 84.7U/L；白蛋白(ALB)-静脉血: 42.3g/L；载脂蛋白B(apoB)-静脉血: 1.13g/L；球蛋白(GLO)-静脉血: 32.78g/L；尿素氮(BUN)-静脉血: 7.3mmol/L；钠离子(Na+)-静脉血: 138.8mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 47.8U/L；甘油三酯(TG)-静脉血: 2.38mmol/L；乳酸脱氢酶(LDH)-静脉血: 183.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 54U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.2U/L；葡萄糖(Glu)-静脉血: 7.26mmol/L；总胆红素(TBIL)-静脉血: 5.3umol/L；载脂蛋白AI(apoAI)-静脉血: 1.29g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.92；钾离子(K+)-静脉血: 4.48mmol/L；间接胆红素(IBIL)-静脉血: 3.7umolL；阴离子间隙(AG)-静脉血: 16.1\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂缓化疗，给予重组人血小板生成素升血小板治疗，待血小板恢复至正常范围后原剂量行第二程GP诱导化疗。\nB. 行第二程GP诱导化疗，吉西他滨剂量下调25%，顺铂维持原剂量，辅以常规止吐及水化利尿等支持治疗。\nC. 停用GP诱导化疗方案，直接转入根治性单纯放疗阶段，并安排心血管专科随访与干预。\nD. 更改诱导化疗方案，将第二程方案由GP（吉西他滨+顺铂）调整为TP（多西他赛+顺铂）方案并按原剂量给药。\nE. 按原剂量行第二程GP诱导化疗，并于化疗结束后预防性给予聚乙二醇化重组人粒细胞刺激因子支持。\nF. 暂缓化疗，请心血管内科会诊并完善超声心动图等检查，待心血管专科评估通过后再行第二程GP化疗。\nG. 按原剂量行第二程GP诱导化疗，并同步皮下注射重组人促红细胞生成素以提升血红蛋白水平。\nH. 行第二程GP诱导化疗，顺铂剂量下调25%，吉西他滨维持原剂量，辅以常规止吐及水化利尿等支持治疗。\nI. 终止诱导化疗，直接进入根治性同步放化疗阶段，同步化疗采用单药顺铂标准剂量方案。\nJ. 按原剂量行第二程GP诱导化疗，化疗前预防性输注单采血小板1个治疗量以降低出血风险。\nK. 按原剂量行第二程GP诱导化疗，并辅以常规止吐、护胃及水化利尿等支持治疗。\nL. 按原剂量行第二程GP诱导化疗，并预防性加用异甘草酸镁等保肝药物以防止化疗相关肝损伤。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：腭帆提肌。\n文本分期信息：N2，M0。\n综合TNM状态：T1N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D8] 入院记录: 主诉: 听力下降8月，发现左颈部包块1月余；现病史: 简要入院病史:患者于某次就诊时间初开始无明显诱因出现听力下降，以右侧为著，未予重视。某次就诊时间7月初患者无意中发现左颈部包块，大小约4×4cm，无疼痛，无表面皮肤发红，未就诊，肿物进行性增大。8月初肿物增大至鸡蛋大小，就诊地域信息已隐藏，行颈部肿块穿刺，病理回报：转移癌可能性大。8－11行鼻咽＋颈部MRI提示：鼻咽双侧壁及顶后壁软组织增厚，考虑鼻咽癌并双侧咽后、双颈部多发淋巴结肿大。胸部MRI检查未见异常。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,左颈部包块,颈部肿物；既往史: 发现血糖升高一年余，未行药物治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、肾病”病史；否认手术、外伤、输血史及献血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D5] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约15cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D7] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 双上颌骨可见片状放射性浓集灶。胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 双上颌骨炎症。 余全身骨骼未见明显异常。\n- [全程D12] 检验组合: 平均红细胞血红蛋白浓度(MCHC)-静脉血: 340g/L；血小板比容-静脉血: 24%；单核细胞计数(Mono#)-静脉血: 0.110E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；红细胞比容(Hct)-静脉血: 41.8%；平均红细胞血红蛋白含量(MCH)-静脉血: 29pg；单核细胞百分比(Mono%)-静脉血: 0.016；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.1；平均血小板体积(MPV)-静脉血: 10.3fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.007；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；红细胞计数(RBC#)-静脉血: 4.8910E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；大血小板百分比(P-LCR%)-静脉血: 27%；淋巴细胞百分比(Lymph%)-静脉血: 0.422；血小板计数(PLT#)-静脉血: 23710E9/L；平均红细胞体积(MCV)-静脉血: 85.5fL；淋巴细胞计数(Lymph#)-静脉血: 310E9/L；白细胞计数(WBC#)-静脉血: 710E9/L；血小板分布宽度(PDW)-静脉血: 11.6%；血红蛋白(Hb)-静脉血: 142g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；中性粒细胞百分比(Neut%)-静脉血: 0.552\n- [全程D15] 检验组合: 单核细胞计数(Mono#)-静脉血: 0.310E9/L；血小板计数(PLT#)-静脉血: 19810E9/L；红细胞比容(Hct)-静脉血: 44.3%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13；大血小板百分比(P-LCR%)-静脉血: 22.1%；红细胞计数(RBC#)-静脉血: 5.2510E12/L；淋巴细胞百分比(Lymph%)-静脉血: 0.443；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；血小板比容-静脉血: 19%；血红蛋白(Hb)-静脉血: 151g/L；血小板分布宽度(PDW)-静脉血: 11.5%；平均红细胞体积(MCV)-静脉血: 84.4fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.033；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；单核细胞百分比(Mono%)-静脉血: 0.059；平均血小板体积(MPV)-静脉血: 9.5fL；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.46；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；白细胞计数(WBC#)-静脉血: 5.7610E9/L；淋巴细胞计数(Lymph#)-静脉血: 2.610E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.8\n- [全程D19] 检验组合: 中性粒细胞计数(Neut#)-静脉血: 5.210E9/L；单核细胞计数(Mono#)-静脉血: 0.110E9/L；血红蛋白(Hb)-静脉血: 131g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.231；红细胞计数(RBC#)-静脉血: 4.510E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.742；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；大血小板百分比(P-LCR%)-静脉血: 21.7%；血小板计数(PLT#)-静脉血: 14310E9/L；血小板分布宽度(PDW)-静脉血: 10.7%；平均红细胞体积(MCV)-静脉血: 88.9fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.6；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；血小板比容-静脉血: 14%；白细胞计数(WBC#)-静脉血: 710E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.3；单核细胞百分比(Mono%)-静脉血: 0.01；平均血小板体积(MPV)-静脉血: 9.5fL；红细胞比容(Hct)-静脉血: 40%；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L\n- [全程D27] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 拟不完全性右束支传导阻滞\n- [全程D27] 检验组合: 镁离子(Mg2+)-静脉血: 0.82mmol/L；氯离子(Cl-)-静脉血: 103.6mmol/L；总胆固醇(TC)-静脉血: 5.1mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.25mmol/L；总胆汁酸(TBA)-静脉血: 4.1umol/L；肌酐(Crea)-静脉血: 76.9umol/L；直接胆红素(DBIL)-静脉血: 1.6umol/L；总钙(Ca)-静脉血: 2.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 19.8U/L；总蛋白(TP)-静脉血: 75.08g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.29；尿酸(UA)-静脉血: 440.4umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 19.1mmol/L；磷(P)-静脉血: 1.09mmol/L；胱抑素(Cys-C)-静脉血: 1.21mg/L；C-反应蛋白(CRP)-静脉血: 4.53mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.06mmolL；碱性磷酸酶(ALP)-静脉血: 84.7U/L；白蛋白(ALB)-静脉血: 42.3g/L；载脂蛋白B(apoB)-静脉血: 1.13g/L；球蛋白(GLO)-静脉血: 32.78g/L；尿素氮(BUN)-静脉血: 7.3mmol/L；钠离子(Na+)-静脉血: 138.8mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 47.8U/L；甘油三酯(TG)-静脉血: 2.38mmol/L；乳酸脱氢酶(LDH)-静脉血: 183.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 54U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.2U/L；葡萄糖(Glu)-静脉血: 7.26mmol/L；总胆红素(TBIL)-静脉血: 5.3umol/L；载脂蛋白AI(apoAI)-静脉血: 1.29g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.92；钾离子(K+)-静脉血: 4.48mmol/L；间接胆红素(IBIL)-静脉血: 3.7umolL；阴离子间隙(AG)-静脉血: 16.1\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂缓化疗，给予重组人血小板生成素升血小板治疗，待血小板恢复至正常范围后原剂量行第二程GP诱导化疗。\nB. 行第二程GP诱导化疗，吉西他滨剂量下调25%，顺铂维持原剂量，辅以常规止吐及水化利尿等支持治疗。\nC. 停用GP诱导化疗方案，直接转入根治性单纯放疗阶段，并安排心血管专科随访与干预。\nD. 更改诱导化疗方案，将第二程方案由GP（吉西他滨+顺铂）调整为TP（多西他赛+顺铂）方案并按原剂量给药。\nE. 按原剂量行第二程GP诱导化疗，并于化疗结束后预防性给予聚乙二醇化重组人粒细胞刺激因子支持。\nF. 暂缓化疗，请心血管内科会诊并完善超声心动图等检查，待心血管专科评估通过后再行第二程GP化疗。\nG. 按原剂量行第二程GP诱导化疗，并同步皮下注射重组人促红细胞生成素以提升血红蛋白水平。\nH. 行第二程GP诱导化疗，顺铂剂量下调25%，吉西他滨维持原剂量，辅以常规止吐及水化利尿等支持治疗。\nI. 终止诱导化疗，直接进入根治性同步放化疗阶段，同步化疗采用单药顺铂标准剂量方案。\nJ. 按原剂量行第二程GP诱导化疗，化疗前预防性输注单采血小板1个治疗量以降低出血风险。\nK. 按原剂量行第二程GP诱导化疗，并辅以常规止吐、护胃及水化利尿等支持治疗。\nL. 按原剂量行第二程GP诱导化疗，并预防性加用异甘草酸镁等保肝药物以防止化疗相关肝损伤。\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-9fc5959f48286f0a038d3acb","patient_id":"patient-9bf5c8c03860cdf61108611d","turn_id":"turn07","turn_position":4,"turn_type":"response_assessment_decision","gold_letter":"A","gold_action":"完善鼻咽及颈部MRI评估疗效；取消同期顺铂化疗，予以纠正贫血并单纯根治性调强放疗（或联合靶向治疗）。","options":[{"letter":"A","text":"完善鼻咽及颈部MRI评估疗效；取消同期顺铂化疗，予以纠正贫血并单纯根治性调强放疗（或联合靶向治疗）。","is_gold":true},{"letter":"B","text":"完善鼻咽及颈部MRI评估疗效；按原计划行同期顺铂化疗联合根治性调强放疗。","is_gold":false},{"letter":"C","text":"完善鼻咽及颈部MRI评估疗效；将同期顺铂减量至40mg/m2周疗，联合根治性调强放疗。","is_gold":false},{"letter":"D","text":"完善鼻咽及颈部MRI评估疗效；将同期化疗方案更换为卡铂，联合根治性调强放疗。","is_gold":false},{"letter":"E","text":"完善鼻咽及颈部MRI评估疗效；暂停抗肿瘤治疗，待血红蛋白恢复至100g/L以上后再行同期放化疗。","is_gold":false},{"letter":"F","text":"完善鼻咽及颈部MRI评估疗效；予以输血支持，待贫血纠正后按原计划行同期顺铂化疗联合调强放疗。","is_gold":false},{"letter":"G","text":"完善鼻咽及颈部MRI评估疗效；取消同期顺铂化疗，直接行根治性调强放疗，暂不予纠正贫血。","is_gold":false},{"letter":"H","text":"完善鼻咽及颈部MRI评估疗效；将同期化疗方案更换为氟尿嘧啶单药，联合根治性调强放疗。","is_gold":false},{"letter":"I","text":"完善鼻咽及颈部MRI评估疗效；取消同期顺铂化疗，予以纠正贫血并联合PD-1抑制剂及调强放疗。","is_gold":false},{"letter":"J","text":"完善鼻咽及颈部MRI评估疗效；将同期化疗方案更换为吉西他滨单药，联合根治性调强放疗。","is_gold":false},{"letter":"K","text":"完善鼻咽及颈部MRI评估疗效；取消放疗，继续行非铂类方案（如紫杉醇单药）化疗。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：腭帆提肌。\n文本分期信息：N2，M0。\n综合TNM状态：T1N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 听力下降8月，发现左颈部包块1月余；现病史: 患者于某次就诊时间初开始无明显诱因出现听力下降，以右侧为著，未予重视。某次就诊时间7月初患者无意中发现左颈部包块，大小约4×4cm，无疼痛，无表面皮肤发红，未就诊，肿物进行性增大。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,左颈部包块,颈部肿物；既往史: 发现血糖升高一年余，未行药物治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟：30－40支/天×30余。否认饮酒史。否认不洁性生活史。；家族史: 两个舅舅分别患有肝癌及骨肿瘤。；体格检查: T：36.4℃，P：83次/分，R：20次/分，BP：100/65mmHg,Ht：164cm，Wt：87kg，BSA：1.93m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左侧颈部IIa区可扪及1个淋巴结，最大径7×3cm，无融合，质地硬，边界清，活动度差，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D8] 入院记录: 主诉: 听力下降8月，发现左颈部包块1月余；现病史: 简要入院病史:患者于某次就诊时间初开始无明显诱因出现听力下降，以右侧为著，未予重视。某次就诊时间7月初患者无意中发现左颈部包块，大小约4×4cm，无疼痛，无表面皮肤发红，未就诊，肿物进行性增大。8月初肿物增大至鸡蛋大小，就诊地域信息已隐藏，行颈部肿块穿刺，病理回报：转移癌可能性大。8－11行鼻咽＋颈部MRI提示：鼻咽双侧壁及顶后壁软组织增厚，考虑鼻咽癌并双侧咽后、双颈部多发淋巴结肿大。胸部MRI检查未见异常。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,左颈部包块,颈部肿物；既往史: 发现血糖升高一年余，未行药物治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、肾病”病史；否认手术、外伤、输血史及献血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n- [全程D69] 入院记录: 主诉: 鼻咽癌3程诱导化疗后2周；现病史: 患者于某次就诊时间初开始无明显诱因出现听力下降，以右侧为著，未予重视。某次就诊时间7月初患者无意中发现左颈部包块，大小约4×4cm，无疼痛，无表面皮肤发红，未就诊，肿物进行性增大。8月初肿物增大至鸡蛋大小，就诊地域信息已隐藏，行颈部肿块穿刺，病理回报：转移癌可能性大。8－11行鼻咽＋颈部MRI提示：鼻咽双侧壁及顶后壁软组织增厚，考虑鼻咽癌并双侧咽后、双颈部多发淋巴结肿大。胸部MRI检查未见异常。于某次就诊时间、某次就诊时间、某次就诊时间我院各行一程GP诱导化疗，（剂量：吉西他滨：1g/m^2,d1,d8;顺铂：80mg/m^2,d1），现为同期放化疗入院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,左颈部包块,颈部肿物；既往史: 发现血糖升高一年余，未行药物治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、肾病”病史；否认手术、外伤、输血史及献血史。；个人史: 长期居于原籍，无疫区居住史。吸烟：30－40支/天×30余。否认饮酒史。否认不洁性生活史。；家族史: 两个舅舅分别患有肝癌及骨肿瘤。；体格检查:；专科检查:；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D0] 检验组合: 隐血(OB)-粪便: 阴性（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-粪便: 棕色；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；比重(SG)-尿液: 1.021；浊度(TRUB)-尿液: 清亮；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 5.5；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；白细胞计数(WBC#)-尿液: 3/μL；虫卵-粪便: 未见虫卵（参考: 未见虫卵）\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理增多增粗，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，右肋膈角锐利，左肋膈角模糊。；检查结论: 考虑双肺慢性支气管炎X线改变。 左侧胸膜稍增厚。\n- [全程D1] 检验组合: 人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；载脂蛋白B(apoB)-静脉血: 1.08g/L；间接胆红素(IBIL)-静脉血: 5.9umolL；钾离子(K+)-静脉血: 4.1mmol/L；阴离子间隙(AG)-静脉血: 17.5；血红蛋白(Hb)-静脉血: 151g/L；凝血酶原时间活动度(PTA)-静脉血: 113.8%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；单核细胞计数(Mono#)-静脉血: 0.610E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.99mmol/L；ABO血型-静脉血: O；中性粒细胞百分比(Neut%)-静脉血: 0.578；血小板比容-静脉血: 24%；Rh血型-静脉血: 阳性；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 5.12mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；梅毒非特异性抗体甲苯胺红不加热血清试验(TRUST)-静脉血: 阴性(-)（参考: 阴性）；淋巴细胞百分比(Lymph%)-静脉血: 0.307；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.9；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 7.9umol/L；白细胞计数(WBC#)-静脉血: 7.610E9/L；直接胆红素(DBIL)-静脉血: 2umol/L；红细胞计数(RBC#)-静脉血: 5.2510E12/L；白蛋白(ALB)-静脉血: 42.2g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；红细胞比容(Hct)-静脉血: 44.7%；糖化血红蛋白A1c(HbA1c)-静脉血: 7.2%；总蛋白(TP)-静脉血: 76.24g/L；凝血酶时间(TT)-静脉血: 18.9sec.；纤维蛋白原(Fbg)-静脉血: 2.44g/L；钠离子(Na+)-静脉血……\n- [全程D4] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔变窄，鼻咽各壁粘膜明显增厚，见结节状肿物向鼻咽腔内突出，T1WI呈等信号，T2WI呈稍高信号，增强扫描轻度不均匀强化，双侧咽隐窝见肿物填塞。口咽双侧壁未见受累增厚，病变未累及双侧后鼻孔。 双侧腭帆提肌受侵，双侧腭帆张肌及头长肌、双侧翼内外肌未见受侵征象。 双侧翼腭窝、双侧上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 颅底骨质未见破坏。 双侧海绵窦形态未见异常。 双侧筛窦、双侧上颌窦粘膜增厚，增强扫描呈轻度强化。双侧乳突未见分泌物。 双眼未见异常，球后未见占位性病变。蝶鞍形态未见异常，其内未见占位性病变。 双侧咽后见淋巴结，大小约7mm×9mm，增强扫描明显强化。 双颈II区、左颈III区见多个肿大淋巴结，最大约33mm×27mm，边界欠清，增强扫描呈明显强化。 右颈III区、双颈I区见数个小淋巴结，最大约5mm×11mm，边界清楚，孤立散在。 甲状腺双叶及峡部形态未见异常，信号均匀，未见占位性病变。喉咽腔形态未见异常，未见占位性病变。双侧颌下腺、腮腺大小、形态未见异常，信号均匀，未见占位性病变。 扫描所见脑组织未见明确异常。；检查结论: 鼻咽肿物，考虑鼻咽癌。 颅底骨质未见破坏。 双侧咽后、双颈II区、左颈III区肿大淋巴结，考虑转移。 鼻窦炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D5] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约15cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D7] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 双上颌骨可见片状放射性浓集灶。胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 双上颌骨炎症。 余全身骨骼未见明显异常。\n- [全程D12] 检验组合: 平均红细胞血红蛋白浓度(MCHC)-静脉血: 340g/L；血小板比容-静脉血: 24%；单核细胞计数(Mono#)-静脉血: 0.110E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；红细胞比容(Hct)-静脉血: 41.8%；平均红细胞血红蛋白含量(MCH)-静脉血: 29pg；单核细胞百分比(Mono%)-静脉血: 0.016；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.1；平均血小板体积(MPV)-静脉血: 10.3fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.007；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；红细胞计数(RBC#)-静脉血: 4.8910E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；大血小板百分比(P-LCR%)-静脉血: 27%；淋巴细胞百分比(Lymph%)-静脉血: 0.422；血小板计数(PLT#)-静脉血: 23710E9/L；平均红细胞体积(MCV)-静脉血: 85.5fL；淋巴细胞计数(Lymph#)-静脉血: 310E9/L；白细胞计数(WBC#)-静脉血: 710E9/L；血小板分布宽度(PDW)-静脉血: 11.6%；血红蛋白(Hb)-静脉血: 142g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；中性粒细胞百分比(Neut%)-静脉血: 0.552\n- [全程D15] 检验组合: 单核细胞计数(Mono#)-静脉血: 0.310E9/L；血小板计数(PLT#)-静脉血: 19810E9/L；红细胞比容(Hct)-静脉血: 44.3%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13；大血小板百分比(P-LCR%)-静脉血: 22.1%；红细胞计数(RBC#)-静脉血: 5.2510E12/L；淋巴细胞百分比(Lymph%)-静脉血: 0.443；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；血小板比容-静脉血: 19%；血红蛋白(Hb)-静脉血: 151g/L；血小板分布宽度(PDW)-静脉血: 11.5%；平均红细胞体积(MCV)-静脉血: 84.4fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.033；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；单核细胞百分比(Mono%)-静脉血: 0.059；平均血小板体积(MPV)-静脉血: 9.5fL；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.46；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；白细胞计数(WBC#)-静脉血: 5.7610E9/L；淋巴细胞计数(Lymph#)-静脉血: 2.610E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.8\n- [全程D19] 检验组合: 中性粒细胞计数(Neut#)-静脉血: 5.210E9/L；单核细胞计数(Mono#)-静脉血: 0.110E9/L；血红蛋白(Hb)-静脉血: 131g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.231；红细胞计数(RBC#)-静脉血: 4.510E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.742；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；大血小板百分比(P-LCR%)-静脉血: 21.7%；血小板计数(PLT#)-静脉血: 14310E9/L；血小板分布宽度(PDW)-静脉血: 10.7%；平均红细胞体积(MCV)-静脉血: 88.9fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.6；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；血小板比容-静脉血: 14%；白细胞计数(WBC#)-静脉血: 710E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.3；单核细胞百分比(Mono%)-静脉血: 0.01；平均血小板体积(MPV)-静脉血: 9.5fL；红细胞比容(Hct)-静脉血: 40%；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L\n- [全程D27] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 拟不完全性右束支传导阻滞\n- [全程D27] 检验组合: 镁离子(Mg2+)-静脉血: 0.82mmol/L；氯离子(Cl-)-静脉血: 103.6mmol/L；总胆固醇(TC)-静脉血: 5.1mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.25mmol/L；总胆汁酸(TBA)-静脉血: 4.1umol/L；肌酐(Crea)-静脉血: 76.9umol/L；直接胆红素(DBIL)-静脉血: 1.6umol/L；总钙(Ca)-静脉血: 2.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 19.8U/L；总蛋白(TP)-静脉血: 75.08g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.29；尿酸(UA)-静脉血: 440.4umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 19.1mmol/L；磷(P)-静脉血: 1.09mmol/L；胱抑素(Cys-C)-静脉血: 1.21mg/L；C-反应蛋白(CRP)-静脉血: 4.53mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.06mmolL；碱性磷酸酶(ALP)-静脉血: 84.7U/L；白蛋白(ALB)-静脉血: 42.3g/L；载脂蛋白B(apoB)-静脉血: 1.13g/L；球蛋白(GLO)-静脉血: 32.78g/L；尿素氮(BUN)-静脉血: 7.3mmol/L；钠离子(Na+)-静脉血: 138.8mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 47.8U/L；甘油三酯(TG)-静脉血: 2.38mmol/L；乳酸脱氢酶(LDH)-静脉血: 183.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 54U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.2U/L；葡萄糖(Glu)-静脉血: 7.26mmol/L；总胆红素(TBIL)-静脉血: 5.3umol/L；载脂蛋白AI(apoAI)-静脉血: 1.29g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.92；钾离子(K+)-静脉血: 4.48mmol/L；间接胆红素(IBIL)-静脉血: 3.7umolL；阴离子间隙(AG)-静脉血: 16.1\n- [全程D64] 检验组合: 肌酐(Crea)-静脉血: 160.7umol/L；葡萄糖(Glu)-静脉血: 8.34mmol/L；碱性磷酸酶(ALP)-静脉血: 72.1U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 55U/L；C-反应蛋白(CRP)-静脉血: 2.43mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.94mmol/L；总胆固醇(TC)-静脉血: 4.9mmol/L；镁离子(Mg2+)-静脉血: 0.61mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；总钙(Ca)-静脉血: 2.32mmol/L；氯离子(Cl-)-静脉血: 96.3mmol/L；甘油三酯(TG)-静脉血: 2.49mmol/L；尿素氮(BUN)-静脉血: 9.9mmol/L；直接胆红素(DBIL)-静脉血: 2.6umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.2mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 23.9U/L；载脂蛋白B(apoB)-静脉血: 1.05g/L；乳酸脱氢酶(LDH)-静脉血: 221.5U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.43；间接胆红素(IBIL)-静脉血: 5.8umolL；尿酸(UA)-静脉血: 602.1umol/L；球蛋白(GLO)-静脉血: 30.83g/L；胱抑素(Cys-C)-静脉血: 1.84mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.13mmolL；γ-谷氨酰基转移酶(GGT)-静脉血: 54.4U/L；总胆红素(TBIL)-静脉血: 8.4umol/L；钾离子(K+)-静脉血: 3.86mmol/L；白蛋白(ALB)-静脉血: 44g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.97；丙氨酸氨基转移酶(ALT)-静脉血: 24.7U/L；磷(P)-静脉血: 1.33mmol/L；总胆汁酸(TBA)-静脉血: 2.2umol/L；钠离子(Na+)-静脉血: 136.5mmol/L；阴离子间隙(AG)-静脉血: 15；总蛋白(TP)-静脉血: 74.83g/L\n- [全程D71] 检验组合: 平均红细胞体积(MCV)-静脉血: 86.5fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.015；中性粒细胞计数(Neut#)-静脉血: 2.210E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.8；血红蛋白(Hb)-静脉血: 111g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.011；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.36；平均红细胞血红蛋白浓度(MCHC)-静脉血: 352g/L；红细胞计数(RBC#)-静脉血: 3.6410E12/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.482；大血小板百分比(P-LCR%)-静脉血: 19.1%；血小板比容-静脉血: 10%；平均血小板体积(MPV)-静脉血: 9.3fL；红细胞比容(Hct)-静脉血: 31.5%；单核细胞百分比(Mono%)-静脉血: 0.132；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；血小板分布宽度(PDW)-静脉血: 9.1%；血小板计数(PLT#)-静脉血: 10910E9/L；白细胞计数(WBC#)-静脉血: 4.610E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.1\n- [全程D78] 检验组合: 嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；红细胞比容(Hct)-静脉血: 31.2%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；血小板计数(PLT#)-静脉血: 22110E9/L；血小板比容-静脉血: 20%；大血小板百分比(P-LCR%)-静脉血: 19.1%；单核细胞百分比(Mono%)-静脉血: 0.108；血红蛋白(Hb)-静脉血: 108g/L；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；血小板分布宽度(PDW)-静脉血: 10%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.02；白细胞计数(WBC#)-静脉血: 4.510E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.653；平均红细胞体积(MCV)-静脉血: 86.9fL；平均血小板体积(MPV)-静脉血: 9.2fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.9；中性粒细胞计数(Neut#)-静脉血: 310E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.215；平均红细胞血红蛋白浓度(MCHC)-静脉血: 346g/L；红细胞计数(RBC#)-静脉血: 3.5910E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；单核细胞计数(Mono#)-静脉血: 0.510E9/L\n- [全程D85] 检验组合: 平均血小板体积(MPV)-静脉血: 9fL；血小板计数(PLT#)-静脉血: 26310E9/L；血小板分布宽度(PDW)-静脉血: 9.9%；淋巴细胞计数(Lymph#)-静脉血: 1.210E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.9；血红蛋白(Hb)-静脉血: 103g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；平均红细胞体积(MCV)-静脉血: 88.5fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.7；白细胞计数(WBC#)-静脉血: 4.2910E9/L；大血小板百分比(P-LCR%)-静脉血: 17.7%；单核细胞百分比(Mono%)-静脉血: 0.191；平均红细胞血红蛋白含量(MCH)-静脉血: 30.3pg；血小板比容-静脉血: 24%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 342g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞计数(RBC#)-静脉血: 3.410E12/L；红细胞比容(Hct)-静脉血: 30.1%；淋巴细胞百分比(Lymph%)-静脉血: 0.27；中性粒细胞百分比(Neut%)-静脉血: 0.513；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.021；单核细胞计数(Mono#)-静脉血: 0.810E9/L；中性粒细胞计数(Neut#)-静脉血: 2.210E9/L\n- [全程D85] 检验组合: 总胆固醇(TC)-静脉血: 5mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 41U/L；球蛋白(GLO)-静脉血: 29.79g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.3；血液二氧化碳含量ctCO2(B)-静脉血: 20.9mmol/L；钠离子(Na+)-静脉血: 137.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.12g/L；载脂蛋白B(apoB)-静脉血: 1.02g/L；丙氨酸氨基转移酶(ALT)-静脉血: 15.3U/L；阴离子间隙(AG)-静脉血: 16；氯离子(Cl-)-静脉血: 100.4mmol/L；磷(P)-静脉血: 1.27mmol/L；总钙(Ca)-静脉血: 2.29mmol/L；总胆红素(TBIL)-静脉血: 10.7umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 32.1U/L；尿酸(UA)-静脉血: 642.2umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.2mmol/L；钾离子(K+)-静脉血: 4.6mmol/L；镁离子(Mg2+)-静脉血: 0.56mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20.5U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；间接胆红素(IBIL)-静脉血: 6.8umolL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；胱抑素(Cys-C)-静脉血: 1.89mg/L；肌酐(Crea)-静脉血: 171.5umol/L；碱性磷酸酶(ALP)-静脉血: 55.8U/L；乳酸脱氢酶(LDH)-静脉血: 182U/L；总胆汁酸(TBA)-静脉血: 1.2umol/L；总蛋白(TP)-静脉血: 72.99g/L；直接胆红素(DBIL)-静脉血: 3.9umol/L；C-反应蛋白(CRP)-静脉血: 2.96mg/L；甘油三酯(TG)-静脉血: 2.22mmol/L；葡萄糖(Glu)-静脉血: 6.63mmol/L；尿素氮(BUN)-静脉血: 10.78mmol/L；白蛋白(ALB)-静脉血: 43.2g/L\n- [全程D92] 检验组合: 嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；单核细胞百分比(Mono%)-静脉血: 0.13；中性粒细胞计数(Neut#)-静脉血: 5.310E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.7pg；血小板比容-静脉血: 24%；红细胞计数(RBC#)-静脉血: 3.3610E12/L；平均红细胞体积(MCV)-静脉血: 89.9fL；血红蛋白(Hb)-静脉血: 103g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.9；单核细胞计数(Mono#)-静脉血: 0.910E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；血小板计数(PLT#)-静脉血: 26210E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；大血小板百分比(P-LCR%)-静脉血: 17.3%；白细胞计数(WBC#)-静脉血: 710E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.103；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.8；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；中性粒细胞百分比(Neut%)-静脉血: 0.757；红细胞比容(Hct)-静脉血: 30.2%；血小板分布宽度(PDW)-静脉血: 9.9%；平均血小板体积(MPV)-静脉血: 9.1fL\n- [全程D99] 检验组合: 球蛋白(GLO)-静脉血: 25.82g/L；血小板比容-静脉血: 12%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 4.5umol/L；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 14.7mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.104；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；总胆红素(TBIL)-静脉血: 11.3umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 33.1U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.1；总钙(Ca)-静脉血: 1.94mmol/L；间接胆红素(IBIL)-静脉血: 6.8umolL；血红蛋白(Hb)-静脉血: 92g/L；肌酐(Crea)-静脉血: 230.6umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.53；单核细胞计数(Mono#)-静脉血: 0.710E9/L；磷(P)-静脉血: 1.43mmol/L；尿素氮(BUN)-静脉血: 14.3mmol/L；尿酸(UA)-静脉血: 664.3umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.5；氯离子(Cl-)-静脉血: 101.4mmol/L；镁离子(Mg2+)-静脉血: 0.39mmol/L；载脂蛋白AI(apoAI)-静脉血: 0.93g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；红细胞比容(Hct)-静脉血: 27.4%；γ-谷氨酰基转移酶(GGT)-静脉血: 32.2U/L；阴离子间隙(AG)-静脉血: 22；血小板分布宽度(PDW)-静脉血: 10.5%；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.41；总蛋白(TP)-静脉血: 65.22g/L；单核细胞百分比(Mono%)-静脉血: 0.138；白蛋白(ALB)-静脉血: 39.4g/L；乳酸脱氢酶(LDH)-静脉血: 174.3U/L；C-反应蛋白(CRP)-静脉血: 5.63mg/L；血小板计数(PLT#)-静脉血: 13410E9/L；总胆汁酸(TBA)-静脉血: 1.9um……\n- [全程D103] 检验组合: 白蛋白(ALB)-静脉血: 38.8g/L；肌酐(Crea)-静脉血: 213.9umol/L；球蛋白(GLO)-静脉血: 26.15g/L；间接胆红素(IBIL)-静脉血: 6.6umolL；总胆红素(TBIL)-静脉血: 10.9umol/L；总蛋白(TP)-静脉血: 64.95g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.48；直接胆红素(DBIL)-静脉血: 4.3umol/L；尿素氮(BUN)-静脉血: 14.5mmol/L；尿酸(UA)-静脉血: 660.5umol/L\n- [全程D106] 检验组合: 平均血小板体积(MPV)-静脉血: 9.5fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44.6；血小板计数(PLT#)-静脉血: 7110E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；血红蛋白(Hb)-静脉血: 75g/L；红细胞比容(Hct)-静脉血: 21.6%；白细胞计数(WBC#)-静脉血: 3.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.089；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；单核细胞计数(Mono#)-静脉血: 0.310E9/L；血小板分布宽度(PDW)-静脉血: 9.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 31.9pg；中性粒细胞百分比(Neut%)-静脉血: 0.784；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；大血小板百分比(P-LCR%)-静脉血: 20.6%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.098；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板比容-静脉血: 6%；红细胞计数(RBC#)-静脉血: 2.3510E12/L；平均红细胞体积(MCV)-静脉血: 91.9fL\n- [全程D109] 检验组合: 红细胞比容(Hct)-静脉血: 21.5%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.7；白细胞计数(WBC#)-静脉血: 4.210E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.4pg；单核细胞百分比(Mono%)-静脉血: 0.057；平均红细胞血红蛋白浓度(MCHC)-静脉血: 335g/L；血红蛋白(Hb)-静脉血: 72g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；红细胞计数(RBC#)-静脉血: 2.2910E12/L；血小板计数(PLT#)-静脉血: 6210E9/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.041；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；大血小板百分比(P-LCR%)-静脉血: 21.1%；平均血小板体积(MPV)-静脉血: 9.4fL；平均红细胞体积(MCV)-静脉血: 93.9fL；血小板比容-静脉血: 6%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；血小板分布宽度(PDW)-静脉血: 10.3%；中性粒细胞百分比(Neut%)-静脉血: 0.847；淋巴细胞百分比(Lymph%)-静脉血: 0.05；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L\n- [全程D113] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.082；血小板分布宽度(PDW)-静脉血: 10.8%；淋巴细胞百分比(Lymph%)-静脉血: 0.114；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；红细胞比容(Hct)-静脉血: 22.8%；平均血小板体积(MPV)-静脉血: 9.8fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 48.1；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；中性粒细胞计数(Neut#)-静脉血: 1.610E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1；白细胞计数(WBC#)-静脉血: 2.210E9/L；血小板计数(PLT#)-静脉血: 11810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.722；大血小板百分比(P-LCR%)-静脉血: 24.7%；单核细胞计数(Mono#)-静脉血: 0.210E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 320g/L；红细胞计数(RBC#)-静脉血: 2.2910E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.9pg；血小板比容-静脉血: 12%；血红蛋白(Hb)-静脉血: 73g/L；平均红细胞体积(MCV)-静脉血: 99.6fL；单核细胞百分比(Mono%)-静脉血: 0.077；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L\n- [全程D117] 检验组合: 天门冬氨酸氨基转移酶(AST)-静脉血: 14.1U/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；镁离子(Mg2+)-静脉血: 0.67mmol/L；血小板计数(PLT#)-静脉血: 23410E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.72mmolL；中性粒细胞计数(Neut#)-静脉血: 2.410E9/L；胱抑素(Cys-C)-静脉血: 2.73mg/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；血小板分布宽度(PDW)-静脉血: 10.4%；总蛋白(TP)-静脉血: 69.47g/L；大血小板百分比(P-LCR%)-静脉血: 22%；球蛋白(GLO)-静脉血: 32.07g/L；氯离子(Cl-)-静脉血: 102.3mmol/L；尿素氮(BUN)-静脉血: 14.7mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.136；丙氨酸氨基转移酶(ALT)-静脉血: 11.2U/L；葡萄糖(Glu)-静脉血: 7.22mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 19.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 0.81g/L；总胆固醇(TC)-静脉血: 4.12mmol/L；血小板比容-静脉血: 22%；C-反应蛋白(CRP)-静脉血: 15.19mg/L；总胆汁酸(TBA)-静脉血: 2.1umol/L；直接胆红素(DBIL)-静脉血: 2.3umol/L；尿酸(UA)-静脉血: 692umol/L；白细胞计数(WBC#)-静脉血: 3.710E9/L；乳酸脱氢酶(LDH)-静脉血: 178.2U/L；中性粒细胞百分比(Neut%)-静脉血: 0.651；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；肌酐(Crea)-静脉血: 220.1umol/L；红细胞计数(RBC#)-静脉血: 2.3510E12/L；钠离子(Na+)-静脉血: 138.8mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.26；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.6mmol/L；红细胞比容(Hct)-静脉血: 23.1%；钾离子(K+)-静脉血: 4.79mmol/L……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 完善鼻咽及颈部MRI评估疗效；取消同期顺铂化疗，予以纠正贫血并单纯根治性调强放疗（或联合靶向治疗）。\nB. 完善鼻咽及颈部MRI评估疗效；按原计划行同期顺铂化疗联合根治性调强放疗。\nC. 完善鼻咽及颈部MRI评估疗效；将同期顺铂减量至40mg/m2周疗，联合根治性调强放疗。\nD. 完善鼻咽及颈部MRI评估疗效；将同期化疗方案更换为卡铂，联合根治性调强放疗。\nE. 完善鼻咽及颈部MRI评估疗效；暂停抗肿瘤治疗，待血红蛋白恢复至100g/L以上后再行同期放化疗。\nF. 完善鼻咽及颈部MRI评估疗效；予以输血支持，待贫血纠正后按原计划行同期顺铂化疗联合调强放疗。\nG. 完善鼻咽及颈部MRI评估疗效；取消同期顺铂化疗，直接行根治性调强放疗，暂不予纠正贫血。\nH. 完善鼻咽及颈部MRI评估疗效；将同期化疗方案更换为氟尿嘧啶单药，联合根治性调强放疗。\nI. 完善鼻咽及颈部MRI评估疗效；取消同期顺铂化疗，予以纠正贫血并联合PD-1抑制剂及调强放疗。\nJ. 完善鼻咽及颈部MRI评估疗效；将同期化疗方案更换为吉西他滨单药，联合根治性调强放疗。\nK. 完善鼻咽及颈部MRI评估疗效；取消放疗，继续行非铂类方案（如紫杉醇单药）化疗。\n\n请仅输出一个选项字母（A-K）。","incremental_user_message":"【已知病史与当前主诉】\n- [全程D69] 入院记录: 主诉: 鼻咽癌3程诱导化疗后2周；现病史: 患者于某次就诊时间初开始无明显诱因出现听力下降，以右侧为著，未予重视。某次就诊时间7月初患者无意中发现左颈部包块，大小约4×4cm，无疼痛，无表面皮肤发红，未就诊，肿物进行性增大。8月初肿物增大至鸡蛋大小，就诊地域信息已隐藏，行颈部肿块穿刺，病理回报：转移癌可能性大。8－11行鼻咽＋颈部MRI提示：鼻咽双侧壁及顶后壁软组织增厚，考虑鼻咽癌并双侧咽后、双颈部多发淋巴结肿大。胸部MRI检查未见异常。于某次就诊时间、某次就诊时间、某次就诊时间我院各行一程GP诱导化疗，（剂量：吉西他滨：1g/m^2,d1,d8;顺铂：80mg/m^2,d1），现为同期放化疗入院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,左颈部包块,颈部肿物；既往史: 发现血糖升高一年余，未行药物治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、肾病”病史；否认手术、外伤、输血史及献血史。；个人史: 长期居于原籍，无疫区居住史。吸烟：30－40支/天×30余。否认饮酒史。否认不洁性生活史。；家族史: 两个舅舅分别患有肝癌及骨肿瘤。；体格检查:；专科检查:；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- [全程D64] 检验组合: 肌酐(Crea)-静脉血: 160.7umol/L；葡萄糖(Glu)-静脉血: 8.34mmol/L；碱性磷酸酶(ALP)-静脉血: 72.1U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 55U/L；C-反应蛋白(CRP)-静脉血: 2.43mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.94mmol/L；总胆固醇(TC)-静脉血: 4.9mmol/L；镁离子(Mg2+)-静脉血: 0.61mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；总钙(Ca)-静脉血: 2.32mmol/L；氯离子(Cl-)-静脉血: 96.3mmol/L；甘油三酯(TG)-静脉血: 2.49mmol/L；尿素氮(BUN)-静脉血: 9.9mmol/L；直接胆红素(DBIL)-静脉血: 2.6umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.2mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 23.9U/L；载脂蛋白B(apoB)-静脉血: 1.05g/L；乳酸脱氢酶(LDH)-静脉血: 221.5U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.43；间接胆红素(IBIL)-静脉血: 5.8umolL；尿酸(UA)-静脉血: 602.1umol/L；球蛋白(GLO)-静脉血: 30.83g/L；胱抑素(Cys-C)-静脉血: 1.84mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.13mmolL；γ-谷氨酰基转移酶(GGT)-静脉血: 54.4U/L；总胆红素(TBIL)-静脉血: 8.4umol/L；钾离子(K+)-静脉血: 3.86mmol/L；白蛋白(ALB)-静脉血: 44g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.97；丙氨酸氨基转移酶(ALT)-静脉血: 24.7U/L；磷(P)-静脉血: 1.33mmol/L；总胆汁酸(TBA)-静脉血: 2.2umol/L；钠离子(Na+)-静脉血: 136.5mmol/L；阴离子间隙(AG)-静脉血: 15；总蛋白(TP)-静脉血: 74.83g/L\n- [全程D71] 检验组合: 平均红细胞体积(MCV)-静脉血: 86.5fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.015；中性粒细胞计数(Neut#)-静脉血: 2.210E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.8；血红蛋白(Hb)-静脉血: 111g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.011；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.36；平均红细胞血红蛋白浓度(MCHC)-静脉血: 352g/L；红细胞计数(RBC#)-静脉血: 3.6410E12/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.482；大血小板百分比(P-LCR%)-静脉血: 19.1%；血小板比容-静脉血: 10%；平均血小板体积(MPV)-静脉血: 9.3fL；红细胞比容(Hct)-静脉血: 31.5%；单核细胞百分比(Mono%)-静脉血: 0.132；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；血小板分布宽度(PDW)-静脉血: 9.1%；血小板计数(PLT#)-静脉血: 10910E9/L；白细胞计数(WBC#)-静脉血: 4.610E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.1\n- [全程D78] 检验组合: 嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；红细胞比容(Hct)-静脉血: 31.2%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；血小板计数(PLT#)-静脉血: 22110E9/L；血小板比容-静脉血: 20%；大血小板百分比(P-LCR%)-静脉血: 19.1%；单核细胞百分比(Mono%)-静脉血: 0.108；血红蛋白(Hb)-静脉血: 108g/L；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；血小板分布宽度(PDW)-静脉血: 10%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.02；白细胞计数(WBC#)-静脉血: 4.510E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.653；平均红细胞体积(MCV)-静脉血: 86.9fL；平均血小板体积(MPV)-静脉血: 9.2fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.9；中性粒细胞计数(Neut#)-静脉血: 310E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.215；平均红细胞血红蛋白浓度(MCHC)-静脉血: 346g/L；红细胞计数(RBC#)-静脉血: 3.5910E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；单核细胞计数(Mono#)-静脉血: 0.510E9/L\n- [全程D85] 检验组合: 平均血小板体积(MPV)-静脉血: 9fL；血小板计数(PLT#)-静脉血: 26310E9/L；血小板分布宽度(PDW)-静脉血: 9.9%；淋巴细胞计数(Lymph#)-静脉血: 1.210E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.9；血红蛋白(Hb)-静脉血: 103g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；平均红细胞体积(MCV)-静脉血: 88.5fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.7；白细胞计数(WBC#)-静脉血: 4.2910E9/L；大血小板百分比(P-LCR%)-静脉血: 17.7%；单核细胞百分比(Mono%)-静脉血: 0.191；平均红细胞血红蛋白含量(MCH)-静脉血: 30.3pg；血小板比容-静脉血: 24%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 342g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞计数(RBC#)-静脉血: 3.410E12/L；红细胞比容(Hct)-静脉血: 30.1%；淋巴细胞百分比(Lymph%)-静脉血: 0.27；中性粒细胞百分比(Neut%)-静脉血: 0.513；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.021；单核细胞计数(Mono#)-静脉血: 0.810E9/L；中性粒细胞计数(Neut#)-静脉血: 2.210E9/L\n- [全程D85] 检验组合: 总胆固醇(TC)-静脉血: 5mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 41U/L；球蛋白(GLO)-静脉血: 29.79g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.3；血液二氧化碳含量ctCO2(B)-静脉血: 20.9mmol/L；钠离子(Na+)-静脉血: 137.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.12g/L；载脂蛋白B(apoB)-静脉血: 1.02g/L；丙氨酸氨基转移酶(ALT)-静脉血: 15.3U/L；阴离子间隙(AG)-静脉血: 16；氯离子(Cl-)-静脉血: 100.4mmol/L；磷(P)-静脉血: 1.27mmol/L；总钙(Ca)-静脉血: 2.29mmol/L；总胆红素(TBIL)-静脉血: 10.7umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 32.1U/L；尿酸(UA)-静脉血: 642.2umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.2mmol/L；钾离子(K+)-静脉血: 4.6mmol/L；镁离子(Mg2+)-静脉血: 0.56mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20.5U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；间接胆红素(IBIL)-静脉血: 6.8umolL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；胱抑素(Cys-C)-静脉血: 1.89mg/L；肌酐(Crea)-静脉血: 171.5umol/L；碱性磷酸酶(ALP)-静脉血: 55.8U/L；乳酸脱氢酶(LDH)-静脉血: 182U/L；总胆汁酸(TBA)-静脉血: 1.2umol/L；总蛋白(TP)-静脉血: 72.99g/L；直接胆红素(DBIL)-静脉血: 3.9umol/L；C-反应蛋白(CRP)-静脉血: 2.96mg/L；甘油三酯(TG)-静脉血: 2.22mmol/L；葡萄糖(Glu)-静脉血: 6.63mmol/L；尿素氮(BUN)-静脉血: 10.78mmol/L；白蛋白(ALB)-静脉血: 43.2g/L\n- [全程D92] 检验组合: 嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；单核细胞百分比(Mono%)-静脉血: 0.13；中性粒细胞计数(Neut#)-静脉血: 5.310E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.7pg；血小板比容-静脉血: 24%；红细胞计数(RBC#)-静脉血: 3.3610E12/L；平均红细胞体积(MCV)-静脉血: 89.9fL；血红蛋白(Hb)-静脉血: 103g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.9；单核细胞计数(Mono#)-静脉血: 0.910E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；血小板计数(PLT#)-静脉血: 26210E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；大血小板百分比(P-LCR%)-静脉血: 17.3%；白细胞计数(WBC#)-静脉血: 710E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.103；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.8；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；中性粒细胞百分比(Neut%)-静脉血: 0.757；红细胞比容(Hct)-静脉血: 30.2%；血小板分布宽度(PDW)-静脉血: 9.9%；平均血小板体积(MPV)-静脉血: 9.1fL\n- [全程D99] 检验组合: 球蛋白(GLO)-静脉血: 25.82g/L；血小板比容-静脉血: 12%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 4.5umol/L；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 14.7mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.104；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；总胆红素(TBIL)-静脉血: 11.3umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 33.1U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.1；总钙(Ca)-静脉血: 1.94mmol/L；间接胆红素(IBIL)-静脉血: 6.8umolL；血红蛋白(Hb)-静脉血: 92g/L；肌酐(Crea)-静脉血: 230.6umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.53；单核细胞计数(Mono#)-静脉血: 0.710E9/L；磷(P)-静脉血: 1.43mmol/L；尿素氮(BUN)-静脉血: 14.3mmol/L；尿酸(UA)-静脉血: 664.3umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.5；氯离子(Cl-)-静脉血: 101.4mmol/L；镁离子(Mg2+)-静脉血: 0.39mmol/L；载脂蛋白AI(apoAI)-静脉血: 0.93g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；红细胞比容(Hct)-静脉血: 27.4%；γ-谷氨酰基转移酶(GGT)-静脉血: 32.2U/L；阴离子间隙(AG)-静脉血: 22；血小板分布宽度(PDW)-静脉血: 10.5%；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.41；总蛋白(TP)-静脉血: 65.22g/L；单核细胞百分比(Mono%)-静脉血: 0.138；白蛋白(ALB)-静脉血: 39.4g/L；乳酸脱氢酶(LDH)-静脉血: 174.3U/L；C-反应蛋白(CRP)-静脉血: 5.63mg/L；血小板计数(PLT#)-静脉血: 13410E9/L；总胆汁酸(TBA)-静脉血: 1.9um……\n- [全程D103] 检验组合: 白蛋白(ALB)-静脉血: 38.8g/L；肌酐(Crea)-静脉血: 213.9umol/L；球蛋白(GLO)-静脉血: 26.15g/L；间接胆红素(IBIL)-静脉血: 6.6umolL；总胆红素(TBIL)-静脉血: 10.9umol/L；总蛋白(TP)-静脉血: 64.95g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.48；直接胆红素(DBIL)-静脉血: 4.3umol/L；尿素氮(BUN)-静脉血: 14.5mmol/L；尿酸(UA)-静脉血: 660.5umol/L\n- [全程D106] 检验组合: 平均血小板体积(MPV)-静脉血: 9.5fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44.6；血小板计数(PLT#)-静脉血: 7110E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；血红蛋白(Hb)-静脉血: 75g/L；红细胞比容(Hct)-静脉血: 21.6%；白细胞计数(WBC#)-静脉血: 3.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.089；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；单核细胞计数(Mono#)-静脉血: 0.310E9/L；血小板分布宽度(PDW)-静脉血: 9.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 31.9pg；中性粒细胞百分比(Neut%)-静脉血: 0.784；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；大血小板百分比(P-LCR%)-静脉血: 20.6%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.098；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板比容-静脉血: 6%；红细胞计数(RBC#)-静脉血: 2.3510E12/L；平均红细胞体积(MCV)-静脉血: 91.9fL\n- [全程D109] 检验组合: 红细胞比容(Hct)-静脉血: 21.5%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.7；白细胞计数(WBC#)-静脉血: 4.210E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.4pg；单核细胞百分比(Mono%)-静脉血: 0.057；平均红细胞血红蛋白浓度(MCHC)-静脉血: 335g/L；血红蛋白(Hb)-静脉血: 72g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；红细胞计数(RBC#)-静脉血: 2.2910E12/L；血小板计数(PLT#)-静脉血: 6210E9/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.041；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；大血小板百分比(P-LCR%)-静脉血: 21.1%；平均血小板体积(MPV)-静脉血: 9.4fL；平均红细胞体积(MCV)-静脉血: 93.9fL；血小板比容-静脉血: 6%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；血小板分布宽度(PDW)-静脉血: 10.3%；中性粒细胞百分比(Neut%)-静脉血: 0.847；淋巴细胞百分比(Lymph%)-静脉血: 0.05；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L\n- [全程D113] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.082；血小板分布宽度(PDW)-静脉血: 10.8%；淋巴细胞百分比(Lymph%)-静脉血: 0.114；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；红细胞比容(Hct)-静脉血: 22.8%；平均血小板体积(MPV)-静脉血: 9.8fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 48.1；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；中性粒细胞计数(Neut#)-静脉血: 1.610E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1；白细胞计数(WBC#)-静脉血: 2.210E9/L；血小板计数(PLT#)-静脉血: 11810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.722；大血小板百分比(P-LCR%)-静脉血: 24.7%；单核细胞计数(Mono#)-静脉血: 0.210E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 320g/L；红细胞计数(RBC#)-静脉血: 2.2910E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.9pg；血小板比容-静脉血: 12%；血红蛋白(Hb)-静脉血: 73g/L；平均红细胞体积(MCV)-静脉血: 99.6fL；单核细胞百分比(Mono%)-静脉血: 0.077；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L\n- [全程D117] 检验组合: 天门冬氨酸氨基转移酶(AST)-静脉血: 14.1U/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；镁离子(Mg2+)-静脉血: 0.67mmol/L；血小板计数(PLT#)-静脉血: 23410E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.72mmolL；中性粒细胞计数(Neut#)-静脉血: 2.410E9/L；胱抑素(Cys-C)-静脉血: 2.73mg/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；血小板分布宽度(PDW)-静脉血: 10.4%；总蛋白(TP)-静脉血: 69.47g/L；大血小板百分比(P-LCR%)-静脉血: 22%；球蛋白(GLO)-静脉血: 32.07g/L；氯离子(Cl-)-静脉血: 102.3mmol/L；尿素氮(BUN)-静脉血: 14.7mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.136；丙氨酸氨基转移酶(ALT)-静脉血: 11.2U/L；葡萄糖(Glu)-静脉血: 7.22mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 19.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 0.81g/L；总胆固醇(TC)-静脉血: 4.12mmol/L；血小板比容-静脉血: 22%；C-反应蛋白(CRP)-静脉血: 15.19mg/L；总胆汁酸(TBA)-静脉血: 2.1umol/L；直接胆红素(DBIL)-静脉血: 2.3umol/L；尿酸(UA)-静脉血: 692umol/L；白细胞计数(WBC#)-静脉血: 3.710E9/L；乳酸脱氢酶(LDH)-静脉血: 178.2U/L；中性粒细胞百分比(Neut%)-静脉血: 0.651；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；肌酐(Crea)-静脉血: 220.1umol/L；红细胞计数(RBC#)-静脉血: 2.3510E12/L；钠离子(Na+)-静脉血: 138.8mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.26；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.6mmol/L；红细胞比容(Hct)-静脉血: 23.1%；钾离子(K+)-静脉血: 4.79mmol/L……\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 完善鼻咽及颈部MRI评估疗效；取消同期顺铂化疗，予以纠正贫血并单纯根治性调强放疗（或联合靶向治疗）。\nB. 完善鼻咽及颈部MRI评估疗效；按原计划行同期顺铂化疗联合根治性调强放疗。\nC. 完善鼻咽及颈部MRI评估疗效；将同期顺铂减量至40mg/m2周疗，联合根治性调强放疗。\nD. 完善鼻咽及颈部MRI评估疗效；将同期化疗方案更换为卡铂，联合根治性调强放疗。\nE. 完善鼻咽及颈部MRI评估疗效；暂停抗肿瘤治疗，待血红蛋白恢复至100g/L以上后再行同期放化疗。\nF. 完善鼻咽及颈部MRI评估疗效；予以输血支持，待贫血纠正后按原计划行同期顺铂化疗联合调强放疗。\nG. 完善鼻咽及颈部MRI评估疗效；取消同期顺铂化疗，直接行根治性调强放疗，暂不予纠正贫血。\nH. 完善鼻咽及颈部MRI评估疗效；将同期化疗方案更换为氟尿嘧啶单药，联合根治性调强放疗。\nI. 完善鼻咽及颈部MRI评估疗效；取消同期顺铂化疗，予以纠正贫血并联合PD-1抑制剂及调强放疗。\nJ. 完善鼻咽及颈部MRI评估疗效；将同期化疗方案更换为吉西他滨单药，联合根治性调强放疗。\nK. 完善鼻咽及颈部MRI评估疗效；取消放疗，继续行非铂类方案（如紫杉醇单药）化疗。\n\n请仅输出一个选项字母（A-K）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：腭帆提肌。\n文本分期信息：N2，M0。\n综合TNM状态：T1N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D69] 入院记录: 主诉: 鼻咽癌3程诱导化疗后2周；现病史: 患者于某次就诊时间初开始无明显诱因出现听力下降，以右侧为著，未予重视。某次就诊时间7月初患者无意中发现左颈部包块，大小约4×4cm，无疼痛，无表面皮肤发红，未就诊，肿物进行性增大。8月初肿物增大至鸡蛋大小，就诊地域信息已隐藏，行颈部肿块穿刺，病理回报：转移癌可能性大。8－11行鼻咽＋颈部MRI提示：鼻咽双侧壁及顶后壁软组织增厚，考虑鼻咽癌并双侧咽后、双颈部多发淋巴结肿大。胸部MRI检查未见异常。于某次就诊时间、某次就诊时间、某次就诊时间我院各行一程GP诱导化疗，（剂量：吉西他滨：1g/m^2,d1,d8;顺铂：80mg/m^2,d1），现为同期放化疗入院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,左颈部包块,颈部肿物；既往史: 发现血糖升高一年余，未行药物治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、肾病”病史；否认手术、外伤、输血史及献血史。；个人史: 长期居于原籍，无疫区居住史。吸烟：30－40支/天×30余。否认饮酒史。否认不洁性生活史。；家族史: 两个舅舅分别患有肝癌及骨肿瘤。；体格检查:；专科检查:；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- [全程D64] 检验组合: 肌酐(Crea)-静脉血: 160.7umol/L；葡萄糖(Glu)-静脉血: 8.34mmol/L；碱性磷酸酶(ALP)-静脉血: 72.1U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 55U/L；C-反应蛋白(CRP)-静脉血: 2.43mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.94mmol/L；总胆固醇(TC)-静脉血: 4.9mmol/L；镁离子(Mg2+)-静脉血: 0.61mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；总钙(Ca)-静脉血: 2.32mmol/L；氯离子(Cl-)-静脉血: 96.3mmol/L；甘油三酯(TG)-静脉血: 2.49mmol/L；尿素氮(BUN)-静脉血: 9.9mmol/L；直接胆红素(DBIL)-静脉血: 2.6umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.2mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 23.9U/L；载脂蛋白B(apoB)-静脉血: 1.05g/L；乳酸脱氢酶(LDH)-静脉血: 221.5U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.43；间接胆红素(IBIL)-静脉血: 5.8umolL；尿酸(UA)-静脉血: 602.1umol/L；球蛋白(GLO)-静脉血: 30.83g/L；胱抑素(Cys-C)-静脉血: 1.84mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.13mmolL；γ-谷氨酰基转移酶(GGT)-静脉血: 54.4U/L；总胆红素(TBIL)-静脉血: 8.4umol/L；钾离子(K+)-静脉血: 3.86mmol/L；白蛋白(ALB)-静脉血: 44g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.97；丙氨酸氨基转移酶(ALT)-静脉血: 24.7U/L；磷(P)-静脉血: 1.33mmol/L；总胆汁酸(TBA)-静脉血: 2.2umol/L；钠离子(Na+)-静脉血: 136.5mmol/L；阴离子间隙(AG)-静脉血: 15；总蛋白(TP)-静脉血: 74.83g/L\n- [全程D71] 检验组合: 平均红细胞体积(MCV)-静脉血: 86.5fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.015；中性粒细胞计数(Neut#)-静脉血: 2.210E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.8；血红蛋白(Hb)-静脉血: 111g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.011；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.36；平均红细胞血红蛋白浓度(MCHC)-静脉血: 352g/L；红细胞计数(RBC#)-静脉血: 3.6410E12/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.482；大血小板百分比(P-LCR%)-静脉血: 19.1%；血小板比容-静脉血: 10%；平均血小板体积(MPV)-静脉血: 9.3fL；红细胞比容(Hct)-静脉血: 31.5%；单核细胞百分比(Mono%)-静脉血: 0.132；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；血小板分布宽度(PDW)-静脉血: 9.1%；血小板计数(PLT#)-静脉血: 10910E9/L；白细胞计数(WBC#)-静脉血: 4.610E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.1\n- [全程D78] 检验组合: 嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；红细胞比容(Hct)-静脉血: 31.2%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；血小板计数(PLT#)-静脉血: 22110E9/L；血小板比容-静脉血: 20%；大血小板百分比(P-LCR%)-静脉血: 19.1%；单核细胞百分比(Mono%)-静脉血: 0.108；血红蛋白(Hb)-静脉血: 108g/L；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；血小板分布宽度(PDW)-静脉血: 10%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.02；白细胞计数(WBC#)-静脉血: 4.510E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.653；平均红细胞体积(MCV)-静脉血: 86.9fL；平均血小板体积(MPV)-静脉血: 9.2fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.9；中性粒细胞计数(Neut#)-静脉血: 310E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.215；平均红细胞血红蛋白浓度(MCHC)-静脉血: 346g/L；红细胞计数(RBC#)-静脉血: 3.5910E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；单核细胞计数(Mono#)-静脉血: 0.510E9/L\n- [全程D85] 检验组合: 平均血小板体积(MPV)-静脉血: 9fL；血小板计数(PLT#)-静脉血: 26310E9/L；血小板分布宽度(PDW)-静脉血: 9.9%；淋巴细胞计数(Lymph#)-静脉血: 1.210E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.9；血红蛋白(Hb)-静脉血: 103g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；平均红细胞体积(MCV)-静脉血: 88.5fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.7；白细胞计数(WBC#)-静脉血: 4.2910E9/L；大血小板百分比(P-LCR%)-静脉血: 17.7%；单核细胞百分比(Mono%)-静脉血: 0.191；平均红细胞血红蛋白含量(MCH)-静脉血: 30.3pg；血小板比容-静脉血: 24%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 342g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞计数(RBC#)-静脉血: 3.410E12/L；红细胞比容(Hct)-静脉血: 30.1%；淋巴细胞百分比(Lymph%)-静脉血: 0.27；中性粒细胞百分比(Neut%)-静脉血: 0.513；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.021；单核细胞计数(Mono#)-静脉血: 0.810E9/L；中性粒细胞计数(Neut#)-静脉血: 2.210E9/L\n- [全程D85] 检验组合: 总胆固醇(TC)-静脉血: 5mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 41U/L；球蛋白(GLO)-静脉血: 29.79g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.3；血液二氧化碳含量ctCO2(B)-静脉血: 20.9mmol/L；钠离子(Na+)-静脉血: 137.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.12g/L；载脂蛋白B(apoB)-静脉血: 1.02g/L；丙氨酸氨基转移酶(ALT)-静脉血: 15.3U/L；阴离子间隙(AG)-静脉血: 16；氯离子(Cl-)-静脉血: 100.4mmol/L；磷(P)-静脉血: 1.27mmol/L；总钙(Ca)-静脉血: 2.29mmol/L；总胆红素(TBIL)-静脉血: 10.7umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 32.1U/L；尿酸(UA)-静脉血: 642.2umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.2mmol/L；钾离子(K+)-静脉血: 4.6mmol/L；镁离子(Mg2+)-静脉血: 0.56mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20.5U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；间接胆红素(IBIL)-静脉血: 6.8umolL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；胱抑素(Cys-C)-静脉血: 1.89mg/L；肌酐(Crea)-静脉血: 171.5umol/L；碱性磷酸酶(ALP)-静脉血: 55.8U/L；乳酸脱氢酶(LDH)-静脉血: 182U/L；总胆汁酸(TBA)-静脉血: 1.2umol/L；总蛋白(TP)-静脉血: 72.99g/L；直接胆红素(DBIL)-静脉血: 3.9umol/L；C-反应蛋白(CRP)-静脉血: 2.96mg/L；甘油三酯(TG)-静脉血: 2.22mmol/L；葡萄糖(Glu)-静脉血: 6.63mmol/L；尿素氮(BUN)-静脉血: 10.78mmol/L；白蛋白(ALB)-静脉血: 43.2g/L\n- [全程D92] 检验组合: 嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；单核细胞百分比(Mono%)-静脉血: 0.13；中性粒细胞计数(Neut#)-静脉血: 5.310E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.7pg；血小板比容-静脉血: 24%；红细胞计数(RBC#)-静脉血: 3.3610E12/L；平均红细胞体积(MCV)-静脉血: 89.9fL；血红蛋白(Hb)-静脉血: 103g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.9；单核细胞计数(Mono#)-静脉血: 0.910E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；血小板计数(PLT#)-静脉血: 26210E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；大血小板百分比(P-LCR%)-静脉血: 17.3%；白细胞计数(WBC#)-静脉血: 710E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.103；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.8；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；中性粒细胞百分比(Neut%)-静脉血: 0.757；红细胞比容(Hct)-静脉血: 30.2%；血小板分布宽度(PDW)-静脉血: 9.9%；平均血小板体积(MPV)-静脉血: 9.1fL\n- [全程D99] 检验组合: 球蛋白(GLO)-静脉血: 25.82g/L；血小板比容-静脉血: 12%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 4.5umol/L；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 14.7mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.104；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；总胆红素(TBIL)-静脉血: 11.3umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 33.1U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.1；总钙(Ca)-静脉血: 1.94mmol/L；间接胆红素(IBIL)-静脉血: 6.8umolL；血红蛋白(Hb)-静脉血: 92g/L；肌酐(Crea)-静脉血: 230.6umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.53；单核细胞计数(Mono#)-静脉血: 0.710E9/L；磷(P)-静脉血: 1.43mmol/L；尿素氮(BUN)-静脉血: 14.3mmol/L；尿酸(UA)-静脉血: 664.3umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.5；氯离子(Cl-)-静脉血: 101.4mmol/L；镁离子(Mg2+)-静脉血: 0.39mmol/L；载脂蛋白AI(apoAI)-静脉血: 0.93g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；红细胞比容(Hct)-静脉血: 27.4%；γ-谷氨酰基转移酶(GGT)-静脉血: 32.2U/L；阴离子间隙(AG)-静脉血: 22；血小板分布宽度(PDW)-静脉血: 10.5%；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.41；总蛋白(TP)-静脉血: 65.22g/L；单核细胞百分比(Mono%)-静脉血: 0.138；白蛋白(ALB)-静脉血: 39.4g/L；乳酸脱氢酶(LDH)-静脉血: 174.3U/L；C-反应蛋白(CRP)-静脉血: 5.63mg/L；血小板计数(PLT#)-静脉血: 13410E9/L；总胆汁酸(TBA)-静脉血: 1.9um……\n- [全程D103] 检验组合: 白蛋白(ALB)-静脉血: 38.8g/L；肌酐(Crea)-静脉血: 213.9umol/L；球蛋白(GLO)-静脉血: 26.15g/L；间接胆红素(IBIL)-静脉血: 6.6umolL；总胆红素(TBIL)-静脉血: 10.9umol/L；总蛋白(TP)-静脉血: 64.95g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.48；直接胆红素(DBIL)-静脉血: 4.3umol/L；尿素氮(BUN)-静脉血: 14.5mmol/L；尿酸(UA)-静脉血: 660.5umol/L\n- [全程D106] 检验组合: 平均血小板体积(MPV)-静脉血: 9.5fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44.6；血小板计数(PLT#)-静脉血: 7110E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；血红蛋白(Hb)-静脉血: 75g/L；红细胞比容(Hct)-静脉血: 21.6%；白细胞计数(WBC#)-静脉血: 3.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.089；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；单核细胞计数(Mono#)-静脉血: 0.310E9/L；血小板分布宽度(PDW)-静脉血: 9.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 31.9pg；中性粒细胞百分比(Neut%)-静脉血: 0.784；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；大血小板百分比(P-LCR%)-静脉血: 20.6%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.098；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板比容-静脉血: 6%；红细胞计数(RBC#)-静脉血: 2.3510E12/L；平均红细胞体积(MCV)-静脉血: 91.9fL\n- [全程D109] 检验组合: 红细胞比容(Hct)-静脉血: 21.5%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.7；白细胞计数(WBC#)-静脉血: 4.210E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.4pg；单核细胞百分比(Mono%)-静脉血: 0.057；平均红细胞血红蛋白浓度(MCHC)-静脉血: 335g/L；血红蛋白(Hb)-静脉血: 72g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；红细胞计数(RBC#)-静脉血: 2.2910E12/L；血小板计数(PLT#)-静脉血: 6210E9/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.041；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；大血小板百分比(P-LCR%)-静脉血: 21.1%；平均血小板体积(MPV)-静脉血: 9.4fL；平均红细胞体积(MCV)-静脉血: 93.9fL；血小板比容-静脉血: 6%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；血小板分布宽度(PDW)-静脉血: 10.3%；中性粒细胞百分比(Neut%)-静脉血: 0.847；淋巴细胞百分比(Lymph%)-静脉血: 0.05；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L\n- [全程D113] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.082；血小板分布宽度(PDW)-静脉血: 10.8%；淋巴细胞百分比(Lymph%)-静脉血: 0.114；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；红细胞比容(Hct)-静脉血: 22.8%；平均血小板体积(MPV)-静脉血: 9.8fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 48.1；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；中性粒细胞计数(Neut#)-静脉血: 1.610E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1；白细胞计数(WBC#)-静脉血: 2.210E9/L；血小板计数(PLT#)-静脉血: 11810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.722；大血小板百分比(P-LCR%)-静脉血: 24.7%；单核细胞计数(Mono#)-静脉血: 0.210E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 320g/L；红细胞计数(RBC#)-静脉血: 2.2910E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.9pg；血小板比容-静脉血: 12%；血红蛋白(Hb)-静脉血: 73g/L；平均红细胞体积(MCV)-静脉血: 99.6fL；单核细胞百分比(Mono%)-静脉血: 0.077；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L\n- [全程D117] 检验组合: 天门冬氨酸氨基转移酶(AST)-静脉血: 14.1U/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；镁离子(Mg2+)-静脉血: 0.67mmol/L；血小板计数(PLT#)-静脉血: 23410E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.72mmolL；中性粒细胞计数(Neut#)-静脉血: 2.410E9/L；胱抑素(Cys-C)-静脉血: 2.73mg/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；血小板分布宽度(PDW)-静脉血: 10.4%；总蛋白(TP)-静脉血: 69.47g/L；大血小板百分比(P-LCR%)-静脉血: 22%；球蛋白(GLO)-静脉血: 32.07g/L；氯离子(Cl-)-静脉血: 102.3mmol/L；尿素氮(BUN)-静脉血: 14.7mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.136；丙氨酸氨基转移酶(ALT)-静脉血: 11.2U/L；葡萄糖(Glu)-静脉血: 7.22mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 19.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 0.81g/L；总胆固醇(TC)-静脉血: 4.12mmol/L；血小板比容-静脉血: 22%；C-反应蛋白(CRP)-静脉血: 15.19mg/L；总胆汁酸(TBA)-静脉血: 2.1umol/L；直接胆红素(DBIL)-静脉血: 2.3umol/L；尿酸(UA)-静脉血: 692umol/L；白细胞计数(WBC#)-静脉血: 3.710E9/L；乳酸脱氢酶(LDH)-静脉血: 178.2U/L；中性粒细胞百分比(Neut%)-静脉血: 0.651；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；肌酐(Crea)-静脉血: 220.1umol/L；红细胞计数(RBC#)-静脉血: 2.3510E12/L；钠离子(Na+)-静脉血: 138.8mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.26；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.6mmol/L；红细胞比容(Hct)-静脉血: 23.1%；钾离子(K+)-静脉血: 4.79mmol/L……\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 完善鼻咽及颈部MRI评估疗效；取消同期顺铂化疗，予以纠正贫血并单纯根治性调强放疗（或联合靶向治疗）。\nB. 完善鼻咽及颈部MRI评估疗效；按原计划行同期顺铂化疗联合根治性调强放疗。\nC. 完善鼻咽及颈部MRI评估疗效；将同期顺铂减量至40mg/m2周疗，联合根治性调强放疗。\nD. 完善鼻咽及颈部MRI评估疗效；将同期化疗方案更换为卡铂，联合根治性调强放疗。\nE. 完善鼻咽及颈部MRI评估疗效；暂停抗肿瘤治疗，待血红蛋白恢复至100g/L以上后再行同期放化疗。\nF. 完善鼻咽及颈部MRI评估疗效；予以输血支持，待贫血纠正后按原计划行同期顺铂化疗联合调强放疗。\nG. 完善鼻咽及颈部MRI评估疗效；取消同期顺铂化疗，直接行根治性调强放疗，暂不予纠正贫血。\nH. 完善鼻咽及颈部MRI评估疗效；将同期化疗方案更换为氟尿嘧啶单药，联合根治性调强放疗。\nI. 完善鼻咽及颈部MRI评估疗效；取消同期顺铂化疗，予以纠正贫血并联合PD-1抑制剂及调强放疗。\nJ. 完善鼻咽及颈部MRI评估疗效；将同期化疗方案更换为吉西他滨单药，联合根治性调强放疗。\nK. 完善鼻咽及颈部MRI评估疗效；取消放疗，继续行非铂类方案（如紫杉醇单药）化疗。\n\n请仅输出一个选项字母（A-K）。"},{"sample_id":"sample-340a8b44018e54c31bcf1d9c","patient_id":"patient-9bf5c8c03860cdf61108611d","turn_id":"turn08","turn_position":5,"turn_type":"response_assessment_decision","gold_letter":"B","gold_action":"判定为放疗后改变或临床完全缓解，进入定期随访观察","options":[{"letter":"A","text":"判定为局部残留，行鼻咽及颈部挽救性手术","is_gold":false},{"letter":"B","text":"判定为放疗后改变或临床完全缓解，进入定期随访观察","is_gold":true},{"letter":"C","text":"判定为局部残留，行鼻咽及颈部局部追加放疗","is_gold":false},{"letter":"D","text":"判定为疾病稳定，启动卡培他滨维持化疗","is_gold":false},{"letter":"E","text":"判定为疾病进展，启动含铂双药联合免疫全身治疗","is_gold":false},{"letter":"F","text":"判定为放疗后改变，启动尼妥珠单抗靶向维持治疗","is_gold":false},{"letter":"G","text":"判定为颈部淋巴结残留，行双侧颈淋巴结清扫术","is_gold":false},{"letter":"H","text":"判定为颅底骨质受侵进展，行颅底病灶切除术","is_gold":false},{"letter":"I","text":"判定为疗效不确定，行全身PET-CT检查明确病灶活性","is_gold":false},{"letter":"J","text":"判定为放疗后改变，行鼻咽黏膜活检排除微小残留","is_gold":false},{"letter":"K","text":"判定为临床完全缓解，启动PD-1抑制剂维持治疗","is_gold":false},{"letter":"L","text":"判定为局部残留，行原全身化疗方案追加2个周期","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：腭帆提肌。\n文本分期信息：N2，M0。\n综合TNM状态：T1N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 听力下降8月，发现左颈部包块1月余；现病史: 患者于某次就诊时间初开始无明显诱因出现听力下降，以右侧为著，未予重视。某次就诊时间7月初患者无意中发现左颈部包块，大小约4×4cm，无疼痛，无表面皮肤发红，未就诊，肿物进行性增大。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,左颈部包块,颈部肿物；既往史: 发现血糖升高一年余，未行药物治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟：30－40支/天×30余。否认饮酒史。否认不洁性生活史。；家族史: 两个舅舅分别患有肝癌及骨肿瘤。；体格检查: T：36.4℃，P：83次/分，R：20次/分，BP：100/65mmHg,Ht：164cm，Wt：87kg，BSA：1.93m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左侧颈部IIa区可扪及1个淋巴结，最大径7×3cm，无融合，质地硬，边界清，活动度差，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D8] 入院记录: 主诉: 听力下降8月，发现左颈部包块1月余；现病史: 简要入院病史:患者于某次就诊时间初开始无明显诱因出现听力下降，以右侧为著，未予重视。某次就诊时间7月初患者无意中发现左颈部包块，大小约4×4cm，无疼痛，无表面皮肤发红，未就诊，肿物进行性增大。8月初肿物增大至鸡蛋大小，就诊地域信息已隐藏，行颈部肿块穿刺，病理回报：转移癌可能性大。8－11行鼻咽＋颈部MRI提示：鼻咽双侧壁及顶后壁软组织增厚，考虑鼻咽癌并双侧咽后、双颈部多发淋巴结肿大。胸部MRI检查未见异常。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,左颈部包块,颈部肿物；既往史: 发现血糖升高一年余，未行药物治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、肾病”病史；否认手术、外伤、输血史及献血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n- [全程D69] 入院记录: 主诉: 鼻咽癌3程诱导化疗后2周；现病史: 患者于某次就诊时间初开始无明显诱因出现听力下降，以右侧为著，未予重视。某次就诊时间7月初患者无意中发现左颈部包块，大小约4×4cm，无疼痛，无表面皮肤发红，未就诊，肿物进行性增大。8月初肿物增大至鸡蛋大小，就诊地域信息已隐藏，行颈部肿块穿刺，病理回报：转移癌可能性大。8－11行鼻咽＋颈部MRI提示：鼻咽双侧壁及顶后壁软组织增厚，考虑鼻咽癌并双侧咽后、双颈部多发淋巴结肿大。胸部MRI检查未见异常。于某次就诊时间、某次就诊时间、某次就诊时间我院各行一程GP诱导化疗，（剂量：吉西他滨：1g/m^2,d1,d8;顺铂：80mg/m^2,d1），现为同期放化疗入院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,左颈部包块,颈部肿物；既往史: 发现血糖升高一年余，未行药物治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、肾病”病史；否认手术、外伤、输血史及献血史。；个人史: 长期居于原籍，无疫区居住史。吸烟：30－40支/天×30余。否认饮酒史。否认不洁性生活史。；家族史: 两个舅舅分别患有肝癌及骨肿瘤。；体格检查:；专科检查:；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D0] 检验组合: 隐血(OB)-粪便: 阴性（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-粪便: 棕色；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；比重(SG)-尿液: 1.021；浊度(TRUB)-尿液: 清亮；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 5.5；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；白细胞计数(WBC#)-尿液: 3/μL；虫卵-粪便: 未见虫卵（参考: 未见虫卵）\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理增多增粗，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，右肋膈角锐利，左肋膈角模糊。；检查结论: 考虑双肺慢性支气管炎X线改变。 左侧胸膜稍增厚。\n- [全程D1] 检验组合: 人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；载脂蛋白B(apoB)-静脉血: 1.08g/L；间接胆红素(IBIL)-静脉血: 5.9umolL；钾离子(K+)-静脉血: 4.1mmol/L；阴离子间隙(AG)-静脉血: 17.5；血红蛋白(Hb)-静脉血: 151g/L；凝血酶原时间活动度(PTA)-静脉血: 113.8%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；单核细胞计数(Mono#)-静脉血: 0.610E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.99mmol/L；ABO血型-静脉血: O；中性粒细胞百分比(Neut%)-静脉血: 0.578；血小板比容-静脉血: 24%；Rh血型-静脉血: 阳性；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 5.12mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；梅毒非特异性抗体甲苯胺红不加热血清试验(TRUST)-静脉血: 阴性(-)（参考: 阴性）；淋巴细胞百分比(Lymph%)-静脉血: 0.307；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.9；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 7.9umol/L；白细胞计数(WBC#)-静脉血: 7.610E9/L；直接胆红素(DBIL)-静脉血: 2umol/L；红细胞计数(RBC#)-静脉血: 5.2510E12/L；白蛋白(ALB)-静脉血: 42.2g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；红细胞比容(Hct)-静脉血: 44.7%；糖化血红蛋白A1c(HbA1c)-静脉血: 7.2%；总蛋白(TP)-静脉血: 76.24g/L；凝血酶时间(TT)-静脉血: 18.9sec.；纤维蛋白原(Fbg)-静脉血: 2.44g/L；钠离子(Na+)-静脉血……\n- [全程D4] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔变窄，鼻咽各壁粘膜明显增厚，见结节状肿物向鼻咽腔内突出，T1WI呈等信号，T2WI呈稍高信号，增强扫描轻度不均匀强化，双侧咽隐窝见肿物填塞。口咽双侧壁未见受累增厚，病变未累及双侧后鼻孔。 双侧腭帆提肌受侵，双侧腭帆张肌及头长肌、双侧翼内外肌未见受侵征象。 双侧翼腭窝、双侧上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 颅底骨质未见破坏。 双侧海绵窦形态未见异常。 双侧筛窦、双侧上颌窦粘膜增厚，增强扫描呈轻度强化。双侧乳突未见分泌物。 双眼未见异常，球后未见占位性病变。蝶鞍形态未见异常，其内未见占位性病变。 双侧咽后见淋巴结，大小约7mm×9mm，增强扫描明显强化。 双颈II区、左颈III区见多个肿大淋巴结，最大约33mm×27mm，边界欠清，增强扫描呈明显强化。 右颈III区、双颈I区见数个小淋巴结，最大约5mm×11mm，边界清楚，孤立散在。 甲状腺双叶及峡部形态未见异常，信号均匀，未见占位性病变。喉咽腔形态未见异常，未见占位性病变。双侧颌下腺、腮腺大小、形态未见异常，信号均匀，未见占位性病变。 扫描所见脑组织未见明确异常。；检查结论: 鼻咽肿物，考虑鼻咽癌。 颅底骨质未见破坏。 双侧咽后、双颈II区、左颈III区肿大淋巴结，考虑转移。 鼻窦炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D5] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约15cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D7] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 双上颌骨可见片状放射性浓集灶。胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 双上颌骨炎症。 余全身骨骼未见明显异常。\n- [全程D12] 检验组合: 平均红细胞血红蛋白浓度(MCHC)-静脉血: 340g/L；血小板比容-静脉血: 24%；单核细胞计数(Mono#)-静脉血: 0.110E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；红细胞比容(Hct)-静脉血: 41.8%；平均红细胞血红蛋白含量(MCH)-静脉血: 29pg；单核细胞百分比(Mono%)-静脉血: 0.016；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.1；平均血小板体积(MPV)-静脉血: 10.3fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.007；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；红细胞计数(RBC#)-静脉血: 4.8910E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；大血小板百分比(P-LCR%)-静脉血: 27%；淋巴细胞百分比(Lymph%)-静脉血: 0.422；血小板计数(PLT#)-静脉血: 23710E9/L；平均红细胞体积(MCV)-静脉血: 85.5fL；淋巴细胞计数(Lymph#)-静脉血: 310E9/L；白细胞计数(WBC#)-静脉血: 710E9/L；血小板分布宽度(PDW)-静脉血: 11.6%；血红蛋白(Hb)-静脉血: 142g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；中性粒细胞百分比(Neut%)-静脉血: 0.552\n- [全程D15] 检验组合: 单核细胞计数(Mono#)-静脉血: 0.310E9/L；血小板计数(PLT#)-静脉血: 19810E9/L；红细胞比容(Hct)-静脉血: 44.3%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13；大血小板百分比(P-LCR%)-静脉血: 22.1%；红细胞计数(RBC#)-静脉血: 5.2510E12/L；淋巴细胞百分比(Lymph%)-静脉血: 0.443；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；血小板比容-静脉血: 19%；血红蛋白(Hb)-静脉血: 151g/L；血小板分布宽度(PDW)-静脉血: 11.5%；平均红细胞体积(MCV)-静脉血: 84.4fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.033；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；单核细胞百分比(Mono%)-静脉血: 0.059；平均血小板体积(MPV)-静脉血: 9.5fL；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.46；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；白细胞计数(WBC#)-静脉血: 5.7610E9/L；淋巴细胞计数(Lymph#)-静脉血: 2.610E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.8\n- [全程D19] 检验组合: 中性粒细胞计数(Neut#)-静脉血: 5.210E9/L；单核细胞计数(Mono#)-静脉血: 0.110E9/L；血红蛋白(Hb)-静脉血: 131g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.231；红细胞计数(RBC#)-静脉血: 4.510E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.742；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；大血小板百分比(P-LCR%)-静脉血: 21.7%；血小板计数(PLT#)-静脉血: 14310E9/L；血小板分布宽度(PDW)-静脉血: 10.7%；平均红细胞体积(MCV)-静脉血: 88.9fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.6；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；血小板比容-静脉血: 14%；白细胞计数(WBC#)-静脉血: 710E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.3；单核细胞百分比(Mono%)-静脉血: 0.01；平均血小板体积(MPV)-静脉血: 9.5fL；红细胞比容(Hct)-静脉血: 40%；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L\n- [全程D27] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 拟不完全性右束支传导阻滞\n- [全程D27] 检验组合: 镁离子(Mg2+)-静脉血: 0.82mmol/L；氯离子(Cl-)-静脉血: 103.6mmol/L；总胆固醇(TC)-静脉血: 5.1mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.25mmol/L；总胆汁酸(TBA)-静脉血: 4.1umol/L；肌酐(Crea)-静脉血: 76.9umol/L；直接胆红素(DBIL)-静脉血: 1.6umol/L；总钙(Ca)-静脉血: 2.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 19.8U/L；总蛋白(TP)-静脉血: 75.08g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.29；尿酸(UA)-静脉血: 440.4umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 19.1mmol/L；磷(P)-静脉血: 1.09mmol/L；胱抑素(Cys-C)-静脉血: 1.21mg/L；C-反应蛋白(CRP)-静脉血: 4.53mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.06mmolL；碱性磷酸酶(ALP)-静脉血: 84.7U/L；白蛋白(ALB)-静脉血: 42.3g/L；载脂蛋白B(apoB)-静脉血: 1.13g/L；球蛋白(GLO)-静脉血: 32.78g/L；尿素氮(BUN)-静脉血: 7.3mmol/L；钠离子(Na+)-静脉血: 138.8mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 47.8U/L；甘油三酯(TG)-静脉血: 2.38mmol/L；乳酸脱氢酶(LDH)-静脉血: 183.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 54U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.2U/L；葡萄糖(Glu)-静脉血: 7.26mmol/L；总胆红素(TBIL)-静脉血: 5.3umol/L；载脂蛋白AI(apoAI)-静脉血: 1.29g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.92；钾离子(K+)-静脉血: 4.48mmol/L；间接胆红素(IBIL)-静脉血: 3.7umolL；阴离子间隙(AG)-静脉血: 16.1\n- [全程D64] 检验组合: 肌酐(Crea)-静脉血: 160.7umol/L；葡萄糖(Glu)-静脉血: 8.34mmol/L；碱性磷酸酶(ALP)-静脉血: 72.1U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 55U/L；C-反应蛋白(CRP)-静脉血: 2.43mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.94mmol/L；总胆固醇(TC)-静脉血: 4.9mmol/L；镁离子(Mg2+)-静脉血: 0.61mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；总钙(Ca)-静脉血: 2.32mmol/L；氯离子(Cl-)-静脉血: 96.3mmol/L；甘油三酯(TG)-静脉血: 2.49mmol/L；尿素氮(BUN)-静脉血: 9.9mmol/L；直接胆红素(DBIL)-静脉血: 2.6umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.2mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 23.9U/L；载脂蛋白B(apoB)-静脉血: 1.05g/L；乳酸脱氢酶(LDH)-静脉血: 221.5U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.43；间接胆红素(IBIL)-静脉血: 5.8umolL；尿酸(UA)-静脉血: 602.1umol/L；球蛋白(GLO)-静脉血: 30.83g/L；胱抑素(Cys-C)-静脉血: 1.84mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.13mmolL；γ-谷氨酰基转移酶(GGT)-静脉血: 54.4U/L；总胆红素(TBIL)-静脉血: 8.4umol/L；钾离子(K+)-静脉血: 3.86mmol/L；白蛋白(ALB)-静脉血: 44g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.97；丙氨酸氨基转移酶(ALT)-静脉血: 24.7U/L；磷(P)-静脉血: 1.33mmol/L；总胆汁酸(TBA)-静脉血: 2.2umol/L；钠离子(Na+)-静脉血: 136.5mmol/L；阴离子间隙(AG)-静脉血: 15；总蛋白(TP)-静脉血: 74.83g/L\n- [全程D71] 检验组合: 平均红细胞体积(MCV)-静脉血: 86.5fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.015；中性粒细胞计数(Neut#)-静脉血: 2.210E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.8；血红蛋白(Hb)-静脉血: 111g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.011；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.36；平均红细胞血红蛋白浓度(MCHC)-静脉血: 352g/L；红细胞计数(RBC#)-静脉血: 3.6410E12/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.482；大血小板百分比(P-LCR%)-静脉血: 19.1%；血小板比容-静脉血: 10%；平均血小板体积(MPV)-静脉血: 9.3fL；红细胞比容(Hct)-静脉血: 31.5%；单核细胞百分比(Mono%)-静脉血: 0.132；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；血小板分布宽度(PDW)-静脉血: 9.1%；血小板计数(PLT#)-静脉血: 10910E9/L；白细胞计数(WBC#)-静脉血: 4.610E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.1\n- [全程D78] 检验组合: 嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；红细胞比容(Hct)-静脉血: 31.2%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；血小板计数(PLT#)-静脉血: 22110E9/L；血小板比容-静脉血: 20%；大血小板百分比(P-LCR%)-静脉血: 19.1%；单核细胞百分比(Mono%)-静脉血: 0.108；血红蛋白(Hb)-静脉血: 108g/L；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；血小板分布宽度(PDW)-静脉血: 10%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.02；白细胞计数(WBC#)-静脉血: 4.510E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.653；平均红细胞体积(MCV)-静脉血: 86.9fL；平均血小板体积(MPV)-静脉血: 9.2fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.9；中性粒细胞计数(Neut#)-静脉血: 310E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.215；平均红细胞血红蛋白浓度(MCHC)-静脉血: 346g/L；红细胞计数(RBC#)-静脉血: 3.5910E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；单核细胞计数(Mono#)-静脉血: 0.510E9/L\n- [全程D85] 检验组合: 平均血小板体积(MPV)-静脉血: 9fL；血小板计数(PLT#)-静脉血: 26310E9/L；血小板分布宽度(PDW)-静脉血: 9.9%；淋巴细胞计数(Lymph#)-静脉血: 1.210E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.9；血红蛋白(Hb)-静脉血: 103g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；平均红细胞体积(MCV)-静脉血: 88.5fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.7；白细胞计数(WBC#)-静脉血: 4.2910E9/L；大血小板百分比(P-LCR%)-静脉血: 17.7%；单核细胞百分比(Mono%)-静脉血: 0.191；平均红细胞血红蛋白含量(MCH)-静脉血: 30.3pg；血小板比容-静脉血: 24%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 342g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞计数(RBC#)-静脉血: 3.410E12/L；红细胞比容(Hct)-静脉血: 30.1%；淋巴细胞百分比(Lymph%)-静脉血: 0.27；中性粒细胞百分比(Neut%)-静脉血: 0.513；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.021；单核细胞计数(Mono#)-静脉血: 0.810E9/L；中性粒细胞计数(Neut#)-静脉血: 2.210E9/L\n- [全程D85] 检验组合: 总胆固醇(TC)-静脉血: 5mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 41U/L；球蛋白(GLO)-静脉血: 29.79g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.3；血液二氧化碳含量ctCO2(B)-静脉血: 20.9mmol/L；钠离子(Na+)-静脉血: 137.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.12g/L；载脂蛋白B(apoB)-静脉血: 1.02g/L；丙氨酸氨基转移酶(ALT)-静脉血: 15.3U/L；阴离子间隙(AG)-静脉血: 16；氯离子(Cl-)-静脉血: 100.4mmol/L；磷(P)-静脉血: 1.27mmol/L；总钙(Ca)-静脉血: 2.29mmol/L；总胆红素(TBIL)-静脉血: 10.7umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 32.1U/L；尿酸(UA)-静脉血: 642.2umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.2mmol/L；钾离子(K+)-静脉血: 4.6mmol/L；镁离子(Mg2+)-静脉血: 0.56mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20.5U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；间接胆红素(IBIL)-静脉血: 6.8umolL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；胱抑素(Cys-C)-静脉血: 1.89mg/L；肌酐(Crea)-静脉血: 171.5umol/L；碱性磷酸酶(ALP)-静脉血: 55.8U/L；乳酸脱氢酶(LDH)-静脉血: 182U/L；总胆汁酸(TBA)-静脉血: 1.2umol/L；总蛋白(TP)-静脉血: 72.99g/L；直接胆红素(DBIL)-静脉血: 3.9umol/L；C-反应蛋白(CRP)-静脉血: 2.96mg/L；甘油三酯(TG)-静脉血: 2.22mmol/L；葡萄糖(Glu)-静脉血: 6.63mmol/L；尿素氮(BUN)-静脉血: 10.78mmol/L；白蛋白(ALB)-静脉血: 43.2g/L\n- [全程D92] 检验组合: 嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；单核细胞百分比(Mono%)-静脉血: 0.13；中性粒细胞计数(Neut#)-静脉血: 5.310E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.7pg；血小板比容-静脉血: 24%；红细胞计数(RBC#)-静脉血: 3.3610E12/L；平均红细胞体积(MCV)-静脉血: 89.9fL；血红蛋白(Hb)-静脉血: 103g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.9；单核细胞计数(Mono#)-静脉血: 0.910E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；血小板计数(PLT#)-静脉血: 26210E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；大血小板百分比(P-LCR%)-静脉血: 17.3%；白细胞计数(WBC#)-静脉血: 710E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.103；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.8；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；中性粒细胞百分比(Neut%)-静脉血: 0.757；红细胞比容(Hct)-静脉血: 30.2%；血小板分布宽度(PDW)-静脉血: 9.9%；平均血小板体积(MPV)-静脉血: 9.1fL\n- [全程D99] 检验组合: 球蛋白(GLO)-静脉血: 25.82g/L；血小板比容-静脉血: 12%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 4.5umol/L；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 14.7mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.104；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；总胆红素(TBIL)-静脉血: 11.3umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 33.1U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.1；总钙(Ca)-静脉血: 1.94mmol/L；间接胆红素(IBIL)-静脉血: 6.8umolL；血红蛋白(Hb)-静脉血: 92g/L；肌酐(Crea)-静脉血: 230.6umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.53；单核细胞计数(Mono#)-静脉血: 0.710E9/L；磷(P)-静脉血: 1.43mmol/L；尿素氮(BUN)-静脉血: 14.3mmol/L；尿酸(UA)-静脉血: 664.3umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.5；氯离子(Cl-)-静脉血: 101.4mmol/L；镁离子(Mg2+)-静脉血: 0.39mmol/L；载脂蛋白AI(apoAI)-静脉血: 0.93g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；红细胞比容(Hct)-静脉血: 27.4%；γ-谷氨酰基转移酶(GGT)-静脉血: 32.2U/L；阴离子间隙(AG)-静脉血: 22；血小板分布宽度(PDW)-静脉血: 10.5%；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.41；总蛋白(TP)-静脉血: 65.22g/L；单核细胞百分比(Mono%)-静脉血: 0.138；白蛋白(ALB)-静脉血: 39.4g/L；乳酸脱氢酶(LDH)-静脉血: 174.3U/L；C-反应蛋白(CRP)-静脉血: 5.63mg/L；血小板计数(PLT#)-静脉血: 13410E9/L；总胆汁酸(TBA)-静脉血: 1.9um……\n- [全程D103] 检验组合: 白蛋白(ALB)-静脉血: 38.8g/L；肌酐(Crea)-静脉血: 213.9umol/L；球蛋白(GLO)-静脉血: 26.15g/L；间接胆红素(IBIL)-静脉血: 6.6umolL；总胆红素(TBIL)-静脉血: 10.9umol/L；总蛋白(TP)-静脉血: 64.95g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.48；直接胆红素(DBIL)-静脉血: 4.3umol/L；尿素氮(BUN)-静脉血: 14.5mmol/L；尿酸(UA)-静脉血: 660.5umol/L\n- [全程D106] 检验组合: 平均血小板体积(MPV)-静脉血: 9.5fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44.6；血小板计数(PLT#)-静脉血: 7110E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；血红蛋白(Hb)-静脉血: 75g/L；红细胞比容(Hct)-静脉血: 21.6%；白细胞计数(WBC#)-静脉血: 3.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.089；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；单核细胞计数(Mono#)-静脉血: 0.310E9/L；血小板分布宽度(PDW)-静脉血: 9.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 31.9pg；中性粒细胞百分比(Neut%)-静脉血: 0.784；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；大血小板百分比(P-LCR%)-静脉血: 20.6%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.098；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板比容-静脉血: 6%；红细胞计数(RBC#)-静脉血: 2.3510E12/L；平均红细胞体积(MCV)-静脉血: 91.9fL\n- [全程D109] 检验组合: 红细胞比容(Hct)-静脉血: 21.5%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.7；白细胞计数(WBC#)-静脉血: 4.210E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.4pg；单核细胞百分比(Mono%)-静脉血: 0.057；平均红细胞血红蛋白浓度(MCHC)-静脉血: 335g/L；血红蛋白(Hb)-静脉血: 72g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；红细胞计数(RBC#)-静脉血: 2.2910E12/L；血小板计数(PLT#)-静脉血: 6210E9/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.041；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；大血小板百分比(P-LCR%)-静脉血: 21.1%；平均血小板体积(MPV)-静脉血: 9.4fL；平均红细胞体积(MCV)-静脉血: 93.9fL；血小板比容-静脉血: 6%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；血小板分布宽度(PDW)-静脉血: 10.3%；中性粒细胞百分比(Neut%)-静脉血: 0.847；淋巴细胞百分比(Lymph%)-静脉血: 0.05；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L\n- [全程D113] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.082；血小板分布宽度(PDW)-静脉血: 10.8%；淋巴细胞百分比(Lymph%)-静脉血: 0.114；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；红细胞比容(Hct)-静脉血: 22.8%；平均血小板体积(MPV)-静脉血: 9.8fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 48.1；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；中性粒细胞计数(Neut#)-静脉血: 1.610E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1；白细胞计数(WBC#)-静脉血: 2.210E9/L；血小板计数(PLT#)-静脉血: 11810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.722；大血小板百分比(P-LCR%)-静脉血: 24.7%；单核细胞计数(Mono#)-静脉血: 0.210E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 320g/L；红细胞计数(RBC#)-静脉血: 2.2910E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.9pg；血小板比容-静脉血: 12%；血红蛋白(Hb)-静脉血: 73g/L；平均红细胞体积(MCV)-静脉血: 99.6fL；单核细胞百分比(Mono%)-静脉血: 0.077；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L\n- [全程D117] 检验组合: 天门冬氨酸氨基转移酶(AST)-静脉血: 14.1U/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；镁离子(Mg2+)-静脉血: 0.67mmol/L；血小板计数(PLT#)-静脉血: 23410E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.72mmolL；中性粒细胞计数(Neut#)-静脉血: 2.410E9/L；胱抑素(Cys-C)-静脉血: 2.73mg/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；血小板分布宽度(PDW)-静脉血: 10.4%；总蛋白(TP)-静脉血: 69.47g/L；大血小板百分比(P-LCR%)-静脉血: 22%；球蛋白(GLO)-静脉血: 32.07g/L；氯离子(Cl-)-静脉血: 102.3mmol/L；尿素氮(BUN)-静脉血: 14.7mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.136；丙氨酸氨基转移酶(ALT)-静脉血: 11.2U/L；葡萄糖(Glu)-静脉血: 7.22mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 19.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 0.81g/L；总胆固醇(TC)-静脉血: 4.12mmol/L；血小板比容-静脉血: 22%；C-反应蛋白(CRP)-静脉血: 15.19mg/L；总胆汁酸(TBA)-静脉血: 2.1umol/L；直接胆红素(DBIL)-静脉血: 2.3umol/L；尿酸(UA)-静脉血: 692umol/L；白细胞计数(WBC#)-静脉血: 3.710E9/L；乳酸脱氢酶(LDH)-静脉血: 178.2U/L；中性粒细胞百分比(Neut%)-静脉血: 0.651；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；肌酐(Crea)-静脉血: 220.1umol/L；红细胞计数(RBC#)-静脉血: 2.3510E12/L；钠离子(Na+)-静脉血: 138.8mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.26；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.6mmol/L；红细胞比容(Hct)-静脉血: 23.1%；钾离子(K+)-静脉血: 4.79mmol/L……\n- [全程D209] CT；胸、上腹CT平扫+增强: 检查类型: CT；检查名称: 胸、上腹CT平扫+增强；检查部位:；检查所见: 双肺纹理清晰，未见结节影；气管及支气管分枝通畅，未见明显软组织肿物或受压变窄；双锁上、双腋窝、双肺门及纵隔未见明显肿大淋巴结；双侧胸腔未见积液；胸膜未见增厚。 肝脏形态正常，比例正常，外形轮廓光整，密度均匀，快速注射造影剂后，动脉期未见明确异常强化灶，门脉期及平衡期未见明确低密度区，肝内见数个（约3个）囊肿影，大小约为 4 × 3 mm至 12 × 10 mm，边界清楚，密度均匀，未见强化；肝内胆管未见扩张，胆囊大小正常，内未见结石影，胆总管未见扩张；肝门区未见肿大淋巴结；门静脉未见充盈缺损；脾大小正常，密度均匀；胰腺大小、形态正常，密度均匀；双肾大小、形态正常，排泌功能正常，双肾见多个囊肿影，大小约为 3 × 3 mm 至 60 × 40 mm；双侧肾上腺大小、形态、密度正常；膈脚后、腹主动脉旁未见肿大淋巴结。 扫描范围内胸椎、腰椎、肋骨未见明确骨质破坏征象。；检查结论: 胸部、腹部未见明显占位性病变， 肝、肾囊肿。\n- [全程D210] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌放疗后复查： 鼻咽腔变窄，鼻咽各壁粘膜增厚，T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化，双侧咽隐窝变浅。口咽双侧壁未见受累增厚，病变未累及双侧后鼻孔。 双侧腭帆提肌结构欠清晰，双侧腭帆张肌及头长肌、双侧翼内外肌未见受侵征象。 双侧翼腭窝、双侧上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 双侧翼突基底部及内板骨质信号减低，增强扫描可见轻度强化。 双侧海绵窦形态未见异常。 双侧筛窦、双侧上颌窦粘膜增厚，增强扫描呈轻度强化。双侧乳突内见分泌物。 双眼未见异常，球后未见占位性病变。蝶鞍形态未见异常，其内未见占位性病变。 双侧咽后未见肿大淋巴结。 双颈II区、III区见多个小淋巴结，最大约6mm×13mm，部分边界欠，呈明显强化。 甲状腺双叶及峡部形态未见异常，信号均匀，未见占位性病变。 喉咽腔形态未见异常，未见占位性病变。 双侧颌下腺、腮腺大小、形态未见异常，信号均匀，未见占位性病变。 扫描所见脑组织未见明确异常。；检查结论: 鼻咽癌放疗后复查，与某次就诊时间片比较： 鼻咽肿物已不明显，现鼻咽粘膜增厚，考虑放疗后改变可能，建议随诊。 颅底骨质异常信号，放疗后改变？建议随诊。 双侧咽后未见肿大淋巴结。 双颈II、III区小淋巴结，较前明显缩小。 鼻窦炎；双侧乳突炎。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 判定为局部残留，行鼻咽及颈部挽救性手术\nB. 判定为放疗后改变或临床完全缓解，进入定期随访观察\nC. 判定为局部残留，行鼻咽及颈部局部追加放疗\nD. 判定为疾病稳定，启动卡培他滨维持化疗\nE. 判定为疾病进展，启动含铂双药联合免疫全身治疗\nF. 判定为放疗后改变，启动尼妥珠单抗靶向维持治疗\nG. 判定为颈部淋巴结残留，行双侧颈淋巴结清扫术\nH. 判定为颅底骨质受侵进展，行颅底病灶切除术\nI. 判定为疗效不确定，行全身PET-CT检查明确病灶活性\nJ. 判定为放疗后改变，行鼻咽黏膜活检排除微小残留\nK. 判定为临床完全缓解，启动PD-1抑制剂维持治疗\nL. 判定为局部残留，行原全身化疗方案追加2个周期\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D209] CT；胸、上腹CT平扫+增强: 检查类型: CT；检查名称: 胸、上腹CT平扫+增强；检查部位:；检查所见: 双肺纹理清晰，未见结节影；气管及支气管分枝通畅，未见明显软组织肿物或受压变窄；双锁上、双腋窝、双肺门及纵隔未见明显肿大淋巴结；双侧胸腔未见积液；胸膜未见增厚。 肝脏形态正常，比例正常，外形轮廓光整，密度均匀，快速注射造影剂后，动脉期未见明确异常强化灶，门脉期及平衡期未见明确低密度区，肝内见数个（约3个）囊肿影，大小约为 4 × 3 mm至 12 × 10 mm，边界清楚，密度均匀，未见强化；肝内胆管未见扩张，胆囊大小正常，内未见结石影，胆总管未见扩张；肝门区未见肿大淋巴结；门静脉未见充盈缺损；脾大小正常，密度均匀；胰腺大小、形态正常，密度均匀；双肾大小、形态正常，排泌功能正常，双肾见多个囊肿影，大小约为 3 × 3 mm 至 60 × 40 mm；双侧肾上腺大小、形态、密度正常；膈脚后、腹主动脉旁未见肿大淋巴结。 扫描范围内胸椎、腰椎、肋骨未见明确骨质破坏征象。；检查结论: 胸部、腹部未见明显占位性病变， 肝、肾囊肿。\n- [全程D210] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌放疗后复查： 鼻咽腔变窄，鼻咽各壁粘膜增厚，T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化，双侧咽隐窝变浅。口咽双侧壁未见受累增厚，病变未累及双侧后鼻孔。 双侧腭帆提肌结构欠清晰，双侧腭帆张肌及头长肌、双侧翼内外肌未见受侵征象。 双侧翼腭窝、双侧上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 双侧翼突基底部及内板骨质信号减低，增强扫描可见轻度强化。 双侧海绵窦形态未见异常。 双侧筛窦、双侧上颌窦粘膜增厚，增强扫描呈轻度强化。双侧乳突内见分泌物。 双眼未见异常，球后未见占位性病变。蝶鞍形态未见异常，其内未见占位性病变。 双侧咽后未见肿大淋巴结。 双颈II区、III区见多个小淋巴结，最大约6mm×13mm，部分边界欠，呈明显强化。 甲状腺双叶及峡部形态未见异常，信号均匀，未见占位性病变。 喉咽腔形态未见异常，未见占位性病变。 双侧颌下腺、腮腺大小、形态未见异常，信号均匀，未见占位性病变。 扫描所见脑组织未见明确异常。；检查结论: 鼻咽癌放疗后复查，与某次就诊时间片比较： 鼻咽肿物已不明显，现鼻咽粘膜增厚，考虑放疗后改变可能，建议随诊。 颅底骨质异常信号，放疗后改变？建议随诊。 双侧咽后未见肿大淋巴结。 双颈II、III区小淋巴结，较前明显缩小。 鼻窦炎；双侧乳突炎。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 判定为局部残留，行鼻咽及颈部挽救性手术\nB. 判定为放疗后改变或临床完全缓解，进入定期随访观察\nC. 判定为局部残留，行鼻咽及颈部局部追加放疗\nD. 判定为疾病稳定，启动卡培他滨维持化疗\nE. 判定为疾病进展，启动含铂双药联合免疫全身治疗\nF. 判定为放疗后改变，启动尼妥珠单抗靶向维持治疗\nG. 判定为颈部淋巴结残留，行双侧颈淋巴结清扫术\nH. 判定为颅底骨质受侵进展，行颅底病灶切除术\nI. 判定为疗效不确定，行全身PET-CT检查明确病灶活性\nJ. 判定为放疗后改变，行鼻咽黏膜活检排除微小残留\nK. 判定为临床完全缓解，启动PD-1抑制剂维持治疗\nL. 判定为局部残留，行原全身化疗方案追加2个周期\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：腭帆提肌。\n文本分期信息：N2，M0。\n综合TNM状态：T1N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D209] CT；胸、上腹CT平扫+增强: 检查类型: CT；检查名称: 胸、上腹CT平扫+增强；检查部位:；检查所见: 双肺纹理清晰，未见结节影；气管及支气管分枝通畅，未见明显软组织肿物或受压变窄；双锁上、双腋窝、双肺门及纵隔未见明显肿大淋巴结；双侧胸腔未见积液；胸膜未见增厚。 肝脏形态正常，比例正常，外形轮廓光整，密度均匀，快速注射造影剂后，动脉期未见明确异常强化灶，门脉期及平衡期未见明确低密度区，肝内见数个（约3个）囊肿影，大小约为 4 × 3 mm至 12 × 10 mm，边界清楚，密度均匀，未见强化；肝内胆管未见扩张，胆囊大小正常，内未见结石影，胆总管未见扩张；肝门区未见肿大淋巴结；门静脉未见充盈缺损；脾大小正常，密度均匀；胰腺大小、形态正常，密度均匀；双肾大小、形态正常，排泌功能正常，双肾见多个囊肿影，大小约为 3 × 3 mm 至 60 × 40 mm；双侧肾上腺大小、形态、密度正常；膈脚后、腹主动脉旁未见肿大淋巴结。 扫描范围内胸椎、腰椎、肋骨未见明确骨质破坏征象。；检查结论: 胸部、腹部未见明显占位性病变， 肝、肾囊肿。\n- [全程D210] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌放疗后复查： 鼻咽腔变窄，鼻咽各壁粘膜增厚，T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化，双侧咽隐窝变浅。口咽双侧壁未见受累增厚，病变未累及双侧后鼻孔。 双侧腭帆提肌结构欠清晰，双侧腭帆张肌及头长肌、双侧翼内外肌未见受侵征象。 双侧翼腭窝、双侧上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 双侧翼突基底部及内板骨质信号减低，增强扫描可见轻度强化。 双侧海绵窦形态未见异常。 双侧筛窦、双侧上颌窦粘膜增厚，增强扫描呈轻度强化。双侧乳突内见分泌物。 双眼未见异常，球后未见占位性病变。蝶鞍形态未见异常，其内未见占位性病变。 双侧咽后未见肿大淋巴结。 双颈II区、III区见多个小淋巴结，最大约6mm×13mm，部分边界欠，呈明显强化。 甲状腺双叶及峡部形态未见异常，信号均匀，未见占位性病变。 喉咽腔形态未见异常，未见占位性病变。 双侧颌下腺、腮腺大小、形态未见异常，信号均匀，未见占位性病变。 扫描所见脑组织未见明确异常。；检查结论: 鼻咽癌放疗后复查，与某次就诊时间片比较： 鼻咽肿物已不明显，现鼻咽粘膜增厚，考虑放疗后改变可能，建议随诊。 颅底骨质异常信号，放疗后改变？建议随诊。 双侧咽后未见肿大淋巴结。 双颈II、III区小淋巴结，较前明显缩小。 鼻窦炎；双侧乳突炎。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 判定为局部残留，行鼻咽及颈部挽救性手术\nB. 判定为放疗后改变或临床完全缓解，进入定期随访观察\nC. 判定为局部残留，行鼻咽及颈部局部追加放疗\nD. 判定为疾病稳定，启动卡培他滨维持化疗\nE. 判定为疾病进展，启动含铂双药联合免疫全身治疗\nF. 判定为放疗后改变，启动尼妥珠单抗靶向维持治疗\nG. 判定为颈部淋巴结残留，行双侧颈淋巴结清扫术\nH. 判定为颅底骨质受侵进展，行颅底病灶切除术\nI. 判定为疗效不确定，行全身PET-CT检查明确病灶活性\nJ. 判定为放疗后改变，行鼻咽黏膜活检排除微小残留\nK. 判定为临床完全缓解，启动PD-1抑制剂维持治疗\nL. 判定为局部残留，行原全身化疗方案追加2个周期\n\n请仅输出一个选项字母（A-L）。"}]}
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情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 鼻咽及颈部CT平扫+增强、间接鼻咽镜检查及活检、PET/CT全身显像、EB病毒DNA定量及常规血液生化检查\nB. 鼻咽及颈部MRI平扫、间接鼻咽镜检查及活检、PET/CT全身显像、EB病毒DNA定量及常规血液生化检查\nC. 鼻咽MRI平扫+增强、间接鼻咽镜检查及活检、PET/CT全身显像、EB病毒DNA定量及常规血液生化检查\nD. 鼻咽及颈部MRI平扫+增强、右颈部肿物穿刺活检、PET/CT全身显像、EB病毒DNA定量及常规血液生化检查\nE. 鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查及活检、胸部X线及腹部B超、EB病毒DNA定量及常规血液生化检查\nF. 鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查及活检、PET/CT全身显像、常规血液生化检查\nG. 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T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 鼻咽及颈部CT平扫+增强、间接鼻咽镜检查及活检、PET/CT全身显像、EB病毒DNA定量及常规血液生化检查\nB. 鼻咽及颈部MRI平扫、间接鼻咽镜检查及活检、PET/CT全身显像、EB病毒DNA定量及常规血液生化检查\nC. 鼻咽MRI平扫+增强、间接鼻咽镜检查及活检、PET/CT全身显像、EB病毒DNA定量及常规血液生化检查\nD. 鼻咽及颈部MRI平扫+增强、右颈部肿物穿刺活检、PET/CT全身显像、EB病毒DNA定量及常规血液生化检查\nE. 鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查及活检、胸部X线及腹部B超、EB病毒DNA定量及常规血液生化检查\nF. 鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查及活检、PET/CT全身显像、常规血液生化检查\nG. 鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查及活检、头颅MRI平扫+增强、EB病毒DNA定量及常规血液生化检查\nH. 鼻咽及颈部CT平扫、间接鼻咽镜检查及活检、PET/CT全身显像、EB病毒DNA定量及常规血液生化检查\nI. 鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查及活检、PET/CT全身显像、EB病毒VCA-IgA检测及常规血液生化检查\nJ. 鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查及活检、全身骨扫描、EB病毒DNA定量及常规血液生化检查\nK. 鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查及活检、PET/CT全身显像、EB病毒DNA定量及常规血液生化检查\nL. 鼻咽及颈部MRI平扫+增强、PET/CT全身显像、EB病毒DNA定量及常规血液生化检查、直接行诱导化疗\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-2c772b6972f0c7fdbd562b73","patient_id":"patient-5ee5dba6116030961a7a97b5","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"L","gold_action":"在尚未完成病理确诊和EB病毒DNA定量检测的前提下，下一步应行电子鼻咽镜检查及活检明确病理诊断，并补充EB病毒DNA荧光定量PCR检测","options":[{"letter":"A","text":"安排颈部淋巴结细针穿刺活检明确病理，并补充全身PET-CT检查","is_gold":false},{"letter":"B","text":"安排右侧颈部肿大淋巴结切除活检，并补充EB病毒DNA荧光定量PCR检测","is_gold":false},{"letter":"C","text":"直接基于MRI及EBV抗体阳性结果启动根治性放化疗","is_gold":false},{"letter":"D","text":"行电子鼻咽镜检查观察肿瘤范围，并补充全身骨扫描及胸腹部CT","is_gold":false},{"letter":"E","text":"行电子鼻咽镜检查及活检明确病理诊断，但不安排任何与EB病毒相关的检查","is_gold":false},{"letter":"F","text":"安排鼻内镜下鼻咽肿物切除术，并补充EB病毒DNA荧光定量PCR检测","is_gold":false},{"letter":"G","text":"安排颈部淋巴结细针穿刺活检，并补充EB病毒DNA荧光定量PCR检测","is_gold":false},{"letter":"H","text":"行电子鼻咽镜检查及活检明确病理诊断，并立即行右颈部淋巴结切除活检","is_gold":false},{"letter":"I","text":"补充EB病毒DNA荧光定量PCR检测，待结果回报后再决定是否行鼻咽活检","is_gold":false},{"letter":"J","text":"行电子鼻咽镜检查及活检明确病理诊断，并预防性行右颈淋巴结清扫术","is_gold":false},{"letter":"K","text":"安排颈部淋巴结穿刺活检及鼻咽镜下活检，并直接启动诱导化疗","is_gold":false},{"letter":"L","text":"行电子鼻咽镜检查及活检明确病理诊断，并补充EB病毒DNA荧光定量PCR检测","is_gold":true}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 涕血半年伴右颈肿物2周；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D3] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁增厚，可见软组织肿块形成，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。双侧咽隐窝见软组织占据，双侧咽旁脂肪间隙受压变窄，病灶侵犯双侧腭帆提肌。双侧腭帆张肌、头长肌未见受侵。 双侧翼腭窝、颞下窝未见异常；口咽双侧壁未见受累增厚，病变未累及后鼻孔。 双侧翼突基底内份、蝶骨基底部右份骨髓信号减低，增强可见轻度强化。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 双侧咽后间隙见肿大淋巴结，右侧大小约为7mm ×8 mm，左侧大小约3mm×4mm。双颈II区、III区见数个淋巴结，最大位于右颈II区，大小约为15mm×27mm。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽肿块，考虑鼻咽癌。 颅底骨质破坏。 右侧咽后及右颈淋巴结肿大，考虑转移瘤。 左侧咽后及左颈小淋巴结。 鼻窦炎、右乳突炎。\n- [全程D3] 检验组合: 平均红细胞体积(MCV)-静脉血: 93.7fL；凝血酶原时间活动度(PTA)-静脉血: 97%；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；中性粒细胞计数(Neut#)-静脉血: 3.610E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.7sec.；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；尿酸(UA)-静脉血: 413.6umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；血小板分布宽度(PDW)-静脉血: 14.7%；间接胆红素(IBIL)-静脉血: 9.7umolL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；丙氨酸氨基转移酶(ALT)-静脉血: 24U/L；碱性磷酸酶(ALP)-静脉血: 84.3U/L；总胆汁酸(TBA)-静脉血: 2.2umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.3mmol/L；葡萄糖(Glu)-静脉血: 4.51mmol/L；磷(P)-静脉血: 1.39mmol/L；C-反应蛋白(CRP)-静脉血: 4.68mg/L；血小板比容-静脉血: 25%；大血小板百分比(P-LCR%)-静脉血: 35.8%；血小板计数(PLT#)-静脉血: 21810E9/L；红细胞计数(RBC#)-静脉血: 4.5910E12/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；阴离子间隙(AG)-静脉血: 18；凝血酶时间(TT)-静脉血: 21.4sec.；红细胞比容(Hct)-静脉血: 43%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 344g/L；纤维蛋白原(Fbg)-静脉血: 3.09g/L；乳酸脱氢酶(LDH)-静脉血: 116.6U/L；总蛋白(TP)-静脉血: 69.58g/L；总钙(Ca)-静脉血: 2.31mmol/L；总胆固醇(TC)-静脉血: 5.94mmol/L；甘油三酯(TG)-静脉血: 1.79mmol/L；总胆红素(TBIL)-静脉血: 13.9umol/L；尿素氮(BUN……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 安排颈部淋巴结细针穿刺活检明确病理，并补充全身PET-CT检查\nB. 安排右侧颈部肿大淋巴结切除活检，并补充EB病毒DNA荧光定量PCR检测\nC. 直接基于MRI及EBV抗体阳性结果启动根治性放化疗\nD. 行电子鼻咽镜检查观察肿瘤范围，并补充全身骨扫描及胸腹部CT\nE. 行电子鼻咽镜检查及活检明确病理诊断，但不安排任何与EB病毒相关的检查\nF. 安排鼻内镜下鼻咽肿物切除术，并补充EB病毒DNA荧光定量PCR检测\nG. 安排颈部淋巴结细针穿刺活检，并补充EB病毒DNA荧光定量PCR检测\nH. 行电子鼻咽镜检查及活检明确病理诊断，并立即行右颈部淋巴结切除活检\nI. 补充EB病毒DNA荧光定量PCR检测，待结果回报后再决定是否行鼻咽活检\nJ. 行电子鼻咽镜检查及活检明确病理诊断，并预防性行右颈淋巴结清扫术\nK. 安排颈部淋巴结穿刺活检及鼻咽镜下活检，并直接启动诱导化疗\nL. 行电子鼻咽镜检查及活检明确病理诊断，并补充EB病毒DNA荧光定量PCR检测\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D3] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁增厚，可见软组织肿块形成，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。双侧咽隐窝见软组织占据，双侧咽旁脂肪间隙受压变窄，病灶侵犯双侧腭帆提肌。双侧腭帆张肌、头长肌未见受侵。 双侧翼腭窝、颞下窝未见异常；口咽双侧壁未见受累增厚，病变未累及后鼻孔。 双侧翼突基底内份、蝶骨基底部右份骨髓信号减低，增强可见轻度强化。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 双侧咽后间隙见肿大淋巴结，右侧大小约为7mm ×8 mm，左侧大小约3mm×4mm。双颈II区、III区见数个淋巴结，最大位于右颈II区，大小约为15mm×27mm。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽肿块，考虑鼻咽癌。 颅底骨质破坏。 右侧咽后及右颈淋巴结肿大，考虑转移瘤。 左侧咽后及左颈小淋巴结。 鼻窦炎、右乳突炎。\n- [全程D3] 检验组合: 平均红细胞体积(MCV)-静脉血: 93.7fL；凝血酶原时间活动度(PTA)-静脉血: 97%；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；中性粒细胞计数(Neut#)-静脉血: 3.610E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.7sec.；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；尿酸(UA)-静脉血: 413.6umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；血小板分布宽度(PDW)-静脉血: 14.7%；间接胆红素(IBIL)-静脉血: 9.7umolL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；丙氨酸氨基转移酶(ALT)-静脉血: 24U/L；碱性磷酸酶(ALP)-静脉血: 84.3U/L；总胆汁酸(TBA)-静脉血: 2.2umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.3mmol/L；葡萄糖(Glu)-静脉血: 4.51mmol/L；磷(P)-静脉血: 1.39mmol/L；C-反应蛋白(CRP)-静脉血: 4.68mg/L；血小板比容-静脉血: 25%；大血小板百分比(P-LCR%)-静脉血: 35.8%；血小板计数(PLT#)-静脉血: 21810E9/L；红细胞计数(RBC#)-静脉血: 4.5910E12/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；阴离子间隙(AG)-静脉血: 18；凝血酶时间(TT)-静脉血: 21.4sec.；红细胞比容(Hct)-静脉血: 43%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 344g/L；纤维蛋白原(Fbg)-静脉血: 3.09g/L；乳酸脱氢酶(LDH)-静脉血: 116.6U/L；总蛋白(TP)-静脉血: 69.58g/L；总钙(Ca)-静脉血: 2.31mmol/L；总胆固醇(TC)-静脉血: 5.94mmol/L；甘油三酯(TG)-静脉血: 1.79mmol/L；总胆红素(TBIL)-静脉血: 13.9umol/L；尿素氮(BUN……\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 安排颈部淋巴结细针穿刺活检明确病理，并补充全身PET-CT检查\nB. 安排右侧颈部肿大淋巴结切除活检，并补充EB病毒DNA荧光定量PCR检测\nC. 直接基于MRI及EBV抗体阳性结果启动根治性放化疗\nD. 行电子鼻咽镜检查观察肿瘤范围，并补充全身骨扫描及胸腹部CT\nE. 行电子鼻咽镜检查及活检明确病理诊断，但不安排任何与EB病毒相关的检查\nF. 安排鼻内镜下鼻咽肿物切除术，并补充EB病毒DNA荧光定量PCR检测\nG. 安排颈部淋巴结细针穿刺活检，并补充EB病毒DNA荧光定量PCR检测\nH. 行电子鼻咽镜检查及活检明确病理诊断，并立即行右颈部淋巴结切除活检\nI. 补充EB病毒DNA荧光定量PCR检测，待结果回报后再决定是否行鼻咽活检\nJ. 行电子鼻咽镜检查及活检明确病理诊断，并预防性行右颈淋巴结清扫术\nK. 安排颈部淋巴结穿刺活检及鼻咽镜下活检，并直接启动诱导化疗\nL. 行电子鼻咽镜检查及活检明确病理诊断，并补充EB病毒DNA荧光定量PCR检测\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D3] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁增厚，可见软组织肿块形成，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。双侧咽隐窝见软组织占据，双侧咽旁脂肪间隙受压变窄，病灶侵犯双侧腭帆提肌。双侧腭帆张肌、头长肌未见受侵。 双侧翼腭窝、颞下窝未见异常；口咽双侧壁未见受累增厚，病变未累及后鼻孔。 双侧翼突基底内份、蝶骨基底部右份骨髓信号减低，增强可见轻度强化。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 双侧咽后间隙见肿大淋巴结，右侧大小约为7mm ×8 mm，左侧大小约3mm×4mm。双颈II区、III区见数个淋巴结，最大位于右颈II区，大小约为15mm×27mm。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽肿块，考虑鼻咽癌。 颅底骨质破坏。 右侧咽后及右颈淋巴结肿大，考虑转移瘤。 左侧咽后及左颈小淋巴结。 鼻窦炎、右乳突炎。\n- [全程D3] 检验组合: 平均红细胞体积(MCV)-静脉血: 93.7fL；凝血酶原时间活动度(PTA)-静脉血: 97%；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；中性粒细胞计数(Neut#)-静脉血: 3.610E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.7sec.；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；尿酸(UA)-静脉血: 413.6umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；血小板分布宽度(PDW)-静脉血: 14.7%；间接胆红素(IBIL)-静脉血: 9.7umolL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；丙氨酸氨基转移酶(ALT)-静脉血: 24U/L；碱性磷酸酶(ALP)-静脉血: 84.3U/L；总胆汁酸(TBA)-静脉血: 2.2umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.3mmol/L；葡萄糖(Glu)-静脉血: 4.51mmol/L；磷(P)-静脉血: 1.39mmol/L；C-反应蛋白(CRP)-静脉血: 4.68mg/L；血小板比容-静脉血: 25%；大血小板百分比(P-LCR%)-静脉血: 35.8%；血小板计数(PLT#)-静脉血: 21810E9/L；红细胞计数(RBC#)-静脉血: 4.5910E12/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；阴离子间隙(AG)-静脉血: 18；凝血酶时间(TT)-静脉血: 21.4sec.；红细胞比容(Hct)-静脉血: 43%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 344g/L；纤维蛋白原(Fbg)-静脉血: 3.09g/L；乳酸脱氢酶(LDH)-静脉血: 116.6U/L；总蛋白(TP)-静脉血: 69.58g/L；总钙(Ca)-静脉血: 2.31mmol/L；总胆固醇(TC)-静脉血: 5.94mmol/L；甘油三酯(TG)-静脉血: 1.79mmol/L；总胆红素(TBIL)-静脉血: 13.9umol/L；尿素氮(BUN……\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 安排颈部淋巴结细针穿刺活检明确病理，并补充全身PET-CT检查\nB. 安排右侧颈部肿大淋巴结切除活检，并补充EB病毒DNA荧光定量PCR检测\nC. 直接基于MRI及EBV抗体阳性结果启动根治性放化疗\nD. 行电子鼻咽镜检查观察肿瘤范围，并补充全身骨扫描及胸腹部CT\nE. 行电子鼻咽镜检查及活检明确病理诊断，但不安排任何与EB病毒相关的检查\nF. 安排鼻内镜下鼻咽肿物切除术，并补充EB病毒DNA荧光定量PCR检测\nG. 安排颈部淋巴结细针穿刺活检，并补充EB病毒DNA荧光定量PCR检测\nH. 行电子鼻咽镜检查及活检明确病理诊断，并立即行右颈部淋巴结切除活检\nI. 补充EB病毒DNA荧光定量PCR检测，待结果回报后再决定是否行鼻咽活检\nJ. 行电子鼻咽镜检查及活检明确病理诊断，并预防性行右颈淋巴结清扫术\nK. 安排颈部淋巴结穿刺活检及鼻咽镜下活检，并直接启动诱导化疗\nL. 行电子鼻咽镜检查及活检明确病理诊断，并补充EB病毒DNA荧光定量PCR检测\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-8976031a638416cb5f037a59","patient_id":"patient-5ee5dba6116030961a7a97b5","turn_id":"turn04","turn_position":3,"turn_type":"initial_treatment_selection","gold_letter":"A","gold_action":"行吉西他滨+顺铂方案诱导化疗联合PD-1抑制剂","options":[{"letter":"A","text":"行吉西他滨+顺铂方案诱导化疗联合PD-1抑制剂","is_gold":true},{"letter":"B","text":"行单纯根治性放射治疗","is_gold":false},{"letter":"C","text":"行紫杉醇+顺铂+氟尿嘧啶方案诱导化疗联合西妥昔单抗","is_gold":false},{"letter":"D","text":"行鼻咽原发灶及颈部淋巴结根治性切除术","is_gold":false},{"letter":"E","text":"行洛铂+氟尿嘧啶方案姑息性化疗","is_gold":false},{"letter":"F","text":"行卡培他滨单药节拍化疗","is_gold":false},{"letter":"G","text":"行洛铂+氟尿嘧啶方案诱导化疗后序贯颈部淋巴结清扫术","is_gold":false},{"letter":"H","text":"行多西他赛+顺铂方案同期放化疗","is_gold":false},{"letter":"I","text":"行吉西他滨单药诱导化疗","is_gold":false},{"letter":"J","text":"行依托泊苷+顺铂方案诱导化疗","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 涕血半年伴右颈肿物2周；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 涕血半年伴右颈肿物2周；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D10] 入院记录: 主诉: 涕血半年伴右颈肿物2周.；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D3] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁增厚，可见软组织肿块形成，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。双侧咽隐窝见软组织占据，双侧咽旁脂肪间隙受压变窄，病灶侵犯双侧腭帆提肌。双侧腭帆张肌、头长肌未见受侵。 双侧翼腭窝、颞下窝未见异常；口咽双侧壁未见受累增厚，病变未累及后鼻孔。 双侧翼突基底内份、蝶骨基底部右份骨髓信号减低，增强可见轻度强化。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 双侧咽后间隙见肿大淋巴结，右侧大小约为7mm ×8 mm，左侧大小约3mm×4mm。双颈II区、III区见数个淋巴结，最大位于右颈II区，大小约为15mm×27mm。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽肿块，考虑鼻咽癌。 颅底骨质破坏。 右侧咽后及右颈淋巴结肿大，考虑转移瘤。 左侧咽后及左颈小淋巴结。 鼻窦炎、右乳突炎。\n- [全程D3] 检验组合: 平均红细胞体积(MCV)-静脉血: 93.7fL；凝血酶原时间活动度(PTA)-静脉血: 97%；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；中性粒细胞计数(Neut#)-静脉血: 3.610E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.7sec.；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；尿酸(UA)-静脉血: 413.6umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；血小板分布宽度(PDW)-静脉血: 14.7%；间接胆红素(IBIL)-静脉血: 9.7umolL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；丙氨酸氨基转移酶(ALT)-静脉血: 24U/L；碱性磷酸酶(ALP)-静脉血: 84.3U/L；总胆汁酸(TBA)-静脉血: 2.2umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.3mmol/L；葡萄糖(Glu)-静脉血: 4.51mmol/L；磷(P)-静脉血: 1.39mmol/L；C-反应蛋白(CRP)-静脉血: 4.68mg/L；血小板比容-静脉血: 25%；大血小板百分比(P-LCR%)-静脉血: 35.8%；血小板计数(PLT#)-静脉血: 21810E9/L；红细胞计数(RBC#)-静脉血: 4.5910E12/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；阴离子间隙(AG)-静脉血: 18；凝血酶时间(TT)-静脉血: 21.4sec.；红细胞比容(Hct)-静脉血: 43%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 344g/L；纤维蛋白原(Fbg)-静脉血: 3.09g/L；乳酸脱氢酶(LDH)-静脉血: 116.6U/L；总蛋白(TP)-静脉血: 69.58g/L；总钙(Ca)-静脉血: 2.31mmol/L；总胆固醇(TC)-静脉血: 5.94mmol/L；甘油三酯(TG)-静脉血: 1.79mmol/L；总胆红素(TBIL)-静脉血: 13.9umol/L；尿素氮(BUN……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D4] 检验组合: 乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D5] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶后壁及双侧壁粘膜增厚放射性浓聚，SUV约23.1；病灶填塞双侧鼻后孔，向上侵犯蝶骨基底部、双翼突基底部、犁骨及枕骨斜坡，局部骨质稍模糊放射性分布浓密。双侧破裂孔未见明显异常。双侧咽隐窝变浅。双侧咽旁间隙结构尚清。右侧咽后淋巴结放射性浓聚，SUV约11.4，大小约0.7×1.0cm；左侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见异常。筛窦、右上颌窦及右乳突稍低密度影放射性分布未见异常；额窦、蝶窦、左侧上颌窦及左乳突结构及放射性分布未见明显异常。口咽、喉咽未见明显异常。甲状腺放射性分布未见异常。双颈Ⅱ区肿大淋巴结放射性浓聚，SUV约10.2，最大约1.6×2.6cm；余双侧颈部未见肿大淋巴结及异常放射性分布。 双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺纹理清晰，双侧肺野未见确切病灶和异常放射性分布。气管、支气管通畅。心脏及大血管放射性分布未见异常。胸壁未见确切病灶和异常放射性分布。双肺门、纵隔及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏密度不均匀降低，放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管及胆总管未见扩张。胆囊、胃及十二指肠放射性分布未见异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、肠管等形态、结构及放射性分布未见明显异常。前列腺点状高密度影放射性分布未见异常。双侧髂血管旁及腹股沟未见明显肿大淋巴结及异常放射性分布。 余所见颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，病灶侵犯颅底骨；右咽后及双颈Ⅱ区淋巴结代谢较活跃，考虑转移。 鼻窦炎；右乳突炎。 脂肪肝。 前列腺钙化灶。\n- [全程D10] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: 右臂静脉插管, 导管末端位于胸椎右旁T 7上缘水平，估计位于上腔静脉下段。；检查结论: 导管末端位置如上述。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-J 选项中选择唯一最合适的答案。\nA. 行吉西他滨+顺铂方案诱导化疗联合PD-1抑制剂\nB. 行单纯根治性放射治疗\nC. 行紫杉醇+顺铂+氟尿嘧啶方案诱导化疗联合西妥昔单抗\nD. 行鼻咽原发灶及颈部淋巴结根治性切除术\nE. 行洛铂+氟尿嘧啶方案姑息性化疗\nF. 行卡培他滨单药节拍化疗\nG. 行洛铂+氟尿嘧啶方案诱导化疗后序贯颈部淋巴结清扫术\nH. 行多西他赛+顺铂方案同期放化疗\nI. 行吉西他滨单药诱导化疗\nJ. 行依托泊苷+顺铂方案诱导化疗\n\n请仅输出一个选项字母（A-J）。","incremental_user_message":"【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 涕血半年伴右颈肿物2周；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D10] 入院记录: 主诉: 涕血半年伴右颈肿物2周.；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D4] 检验组合: 乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D5] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶后壁及双侧壁粘膜增厚放射性浓聚，SUV约23.1；病灶填塞双侧鼻后孔，向上侵犯蝶骨基底部、双翼突基底部、犁骨及枕骨斜坡，局部骨质稍模糊放射性分布浓密。双侧破裂孔未见明显异常。双侧咽隐窝变浅。双侧咽旁间隙结构尚清。右侧咽后淋巴结放射性浓聚，SUV约11.4，大小约0.7×1.0cm；左侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见异常。筛窦、右上颌窦及右乳突稍低密度影放射性分布未见异常；额窦、蝶窦、左侧上颌窦及左乳突结构及放射性分布未见明显异常。口咽、喉咽未见明显异常。甲状腺放射性分布未见异常。双颈Ⅱ区肿大淋巴结放射性浓聚，SUV约10.2，最大约1.6×2.6cm；余双侧颈部未见肿大淋巴结及异常放射性分布。 双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺纹理清晰，双侧肺野未见确切病灶和异常放射性分布。气管、支气管通畅。心脏及大血管放射性分布未见异常。胸壁未见确切病灶和异常放射性分布。双肺门、纵隔及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏密度不均匀降低，放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管及胆总管未见扩张。胆囊、胃及十二指肠放射性分布未见异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、肠管等形态、结构及放射性分布未见明显异常。前列腺点状高密度影放射性分布未见异常。双侧髂血管旁及腹股沟未见明显肿大淋巴结及异常放射性分布。 余所见颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，病灶侵犯颅底骨；右咽后及双颈Ⅱ区淋巴结代谢较活跃，考虑转移。 鼻窦炎；右乳突炎。 脂肪肝。 前列腺钙化灶。\n- [全程D10] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: 右臂静脉插管, 导管末端位于胸椎右旁T 7上缘水平，估计位于上腔静脉下段。；检查结论: 导管末端位置如上述。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-J 选项中选择唯一最合适的答案。\nA. 行吉西他滨+顺铂方案诱导化疗联合PD-1抑制剂\nB. 行单纯根治性放射治疗\nC. 行紫杉醇+顺铂+氟尿嘧啶方案诱导化疗联合西妥昔单抗\nD. 行鼻咽原发灶及颈部淋巴结根治性切除术\nE. 行洛铂+氟尿嘧啶方案姑息性化疗\nF. 行卡培他滨单药节拍化疗\nG. 行洛铂+氟尿嘧啶方案诱导化疗后序贯颈部淋巴结清扫术\nH. 行多西他赛+顺铂方案同期放化疗\nI. 行吉西他滨单药诱导化疗\nJ. 行依托泊苷+顺铂方案诱导化疗\n\n请仅输出一个选项字母（A-J）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 涕血半年伴右颈肿物2周；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D10] 入院记录: 主诉: 涕血半年伴右颈肿物2周.；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D4] 检验组合: 乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D5] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶后壁及双侧壁粘膜增厚放射性浓聚，SUV约23.1；病灶填塞双侧鼻后孔，向上侵犯蝶骨基底部、双翼突基底部、犁骨及枕骨斜坡，局部骨质稍模糊放射性分布浓密。双侧破裂孔未见明显异常。双侧咽隐窝变浅。双侧咽旁间隙结构尚清。右侧咽后淋巴结放射性浓聚，SUV约11.4，大小约0.7×1.0cm；左侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见异常。筛窦、右上颌窦及右乳突稍低密度影放射性分布未见异常；额窦、蝶窦、左侧上颌窦及左乳突结构及放射性分布未见明显异常。口咽、喉咽未见明显异常。甲状腺放射性分布未见异常。双颈Ⅱ区肿大淋巴结放射性浓聚，SUV约10.2，最大约1.6×2.6cm；余双侧颈部未见肿大淋巴结及异常放射性分布。 双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺纹理清晰，双侧肺野未见确切病灶和异常放射性分布。气管、支气管通畅。心脏及大血管放射性分布未见异常。胸壁未见确切病灶和异常放射性分布。双肺门、纵隔及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏密度不均匀降低，放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管及胆总管未见扩张。胆囊、胃及十二指肠放射性分布未见异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、肠管等形态、结构及放射性分布未见明显异常。前列腺点状高密度影放射性分布未见异常。双侧髂血管旁及腹股沟未见明显肿大淋巴结及异常放射性分布。 余所见颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，病灶侵犯颅底骨；右咽后及双颈Ⅱ区淋巴结代谢较活跃，考虑转移。 鼻窦炎；右乳突炎。 脂肪肝。 前列腺钙化灶。\n- [全程D10] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: 右臂静脉插管, 导管末端位于胸椎右旁T 7上缘水平，估计位于上腔静脉下段。；检查结论: 导管末端位置如上述。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-J 选项中选择唯一最合适的答案。\nA. 行吉西他滨+顺铂方案诱导化疗联合PD-1抑制剂\nB. 行单纯根治性放射治疗\nC. 行紫杉醇+顺铂+氟尿嘧啶方案诱导化疗联合西妥昔单抗\nD. 行鼻咽原发灶及颈部淋巴结根治性切除术\nE. 行洛铂+氟尿嘧啶方案姑息性化疗\nF. 行卡培他滨单药节拍化疗\nG. 行洛铂+氟尿嘧啶方案诱导化疗后序贯颈部淋巴结清扫术\nH. 行多西他赛+顺铂方案同期放化疗\nI. 行吉西他滨单药诱导化疗\nJ. 行依托泊苷+顺铂方案诱导化疗\n\n请仅输出一个选项字母（A-J）。"},{"sample_id":"sample-5d943566dde88ca9f3640bc0","patient_id":"patient-5ee5dba6116030961a7a97b5","turn_id":"turn05","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"C","gold_action":"办理出院，嘱每周复查血常规及肝肾功能，2周后返院继续下一阶段治疗。","options":[{"letter":"A","text":"办理出院，嘱每3天复查血常规及肝肾功能，1周后返院继续下一阶段治疗","is_gold":false},{"letter":"B","text":"予以重组人粒细胞刺激因子皮下注射后办理出院，嘱每周复查血常规，2周后返院","is_gold":false},{"letter":"C","text":"办理出院，嘱每周复查血常规及肝肾功能，2周后返院继续下一阶段治疗","is_gold":true},{"letter":"D","text":"办理出院，嘱每2周复查血常规及肝肾功能，3周后返院继续下一阶段治疗","is_gold":false},{"letter":"E","text":"暂缓出院，继续住院观察并每日复查血常规，待血液学指标进一步稳定后出院","is_gold":false},{"letter":"F","text":"办理出院，嘱每月复查血常规及肝肾功能，4周后返院评估疗效并决定后续治疗","is_gold":false},{"letter":"G","text":"予以静脉滴注保肝药物治疗，待复查肝功能指标完全正常后办理出院","is_gold":false},{"letter":"H","text":"办理出院，处方口服升血小板药物，嘱每周复查血常规，2周后返院","is_gold":false},{"letter":"I","text":"办理出院，处方口服卡培他滨单药维持，嘱每周复查血常规，3周后返院","is_gold":false},{"letter":"J","text":"办理出院，嘱每周复查血常规及肝肾功能，4周后返院行MRI复查评估疗效","is_gold":false},{"letter":"K","text":"予以口服氯化钾缓释片补钾治疗，每日监测电解质，待血钾水平上升后办理出院","is_gold":false},{"letter":"L","text":"办理出院，无需定期复查化验指标，嘱出现发热或出血症状时急诊就诊，3周后返院","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 涕血半年伴右颈肿物2周；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 涕血半年伴右颈肿物2周；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D10] 入院记录: 主诉: 涕血半年伴右颈肿物2周.；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D3] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁增厚，可见软组织肿块形成，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。双侧咽隐窝见软组织占据，双侧咽旁脂肪间隙受压变窄，病灶侵犯双侧腭帆提肌。双侧腭帆张肌、头长肌未见受侵。 双侧翼腭窝、颞下窝未见异常；口咽双侧壁未见受累增厚，病变未累及后鼻孔。 双侧翼突基底内份、蝶骨基底部右份骨髓信号减低，增强可见轻度强化。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 双侧咽后间隙见肿大淋巴结，右侧大小约为7mm ×8 mm，左侧大小约3mm×4mm。双颈II区、III区见数个淋巴结，最大位于右颈II区，大小约为15mm×27mm。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽肿块，考虑鼻咽癌。 颅底骨质破坏。 右侧咽后及右颈淋巴结肿大，考虑转移瘤。 左侧咽后及左颈小淋巴结。 鼻窦炎、右乳突炎。\n- [全程D3] 检验组合: 平均红细胞体积(MCV)-静脉血: 93.7fL；凝血酶原时间活动度(PTA)-静脉血: 97%；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；中性粒细胞计数(Neut#)-静脉血: 3.610E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.7sec.；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；尿酸(UA)-静脉血: 413.6umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；血小板分布宽度(PDW)-静脉血: 14.7%；间接胆红素(IBIL)-静脉血: 9.7umolL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；丙氨酸氨基转移酶(ALT)-静脉血: 24U/L；碱性磷酸酶(ALP)-静脉血: 84.3U/L；总胆汁酸(TBA)-静脉血: 2.2umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.3mmol/L；葡萄糖(Glu)-静脉血: 4.51mmol/L；磷(P)-静脉血: 1.39mmol/L；C-反应蛋白(CRP)-静脉血: 4.68mg/L；血小板比容-静脉血: 25%；大血小板百分比(P-LCR%)-静脉血: 35.8%；血小板计数(PLT#)-静脉血: 21810E9/L；红细胞计数(RBC#)-静脉血: 4.5910E12/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；阴离子间隙(AG)-静脉血: 18；凝血酶时间(TT)-静脉血: 21.4sec.；红细胞比容(Hct)-静脉血: 43%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 344g/L；纤维蛋白原(Fbg)-静脉血: 3.09g/L；乳酸脱氢酶(LDH)-静脉血: 116.6U/L；总蛋白(TP)-静脉血: 69.58g/L；总钙(Ca)-静脉血: 2.31mmol/L；总胆固醇(TC)-静脉血: 5.94mmol/L；甘油三酯(TG)-静脉血: 1.79mmol/L；总胆红素(TBIL)-静脉血: 13.9umol/L；尿素氮(BUN……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D4] 检验组合: 乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D5] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶后壁及双侧壁粘膜增厚放射性浓聚，SUV约23.1；病灶填塞双侧鼻后孔，向上侵犯蝶骨基底部、双翼突基底部、犁骨及枕骨斜坡，局部骨质稍模糊放射性分布浓密。双侧破裂孔未见明显异常。双侧咽隐窝变浅。双侧咽旁间隙结构尚清。右侧咽后淋巴结放射性浓聚，SUV约11.4，大小约0.7×1.0cm；左侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见异常。筛窦、右上颌窦及右乳突稍低密度影放射性分布未见异常；额窦、蝶窦、左侧上颌窦及左乳突结构及放射性分布未见明显异常。口咽、喉咽未见明显异常。甲状腺放射性分布未见异常。双颈Ⅱ区肿大淋巴结放射性浓聚，SUV约10.2，最大约1.6×2.6cm；余双侧颈部未见肿大淋巴结及异常放射性分布。 双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺纹理清晰，双侧肺野未见确切病灶和异常放射性分布。气管、支气管通畅。心脏及大血管放射性分布未见异常。胸壁未见确切病灶和异常放射性分布。双肺门、纵隔及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏密度不均匀降低，放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管及胆总管未见扩张。胆囊、胃及十二指肠放射性分布未见异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、肠管等形态、结构及放射性分布未见明显异常。前列腺点状高密度影放射性分布未见异常。双侧髂血管旁及腹股沟未见明显肿大淋巴结及异常放射性分布。 余所见颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，病灶侵犯颅底骨；右咽后及双颈Ⅱ区淋巴结代谢较活跃，考虑转移。 鼻窦炎；右乳突炎。 脂肪肝。 前列腺钙化灶。\n- [全程D10] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: 右臂静脉插管, 导管末端位于胸椎右旁T 7上缘水平，估计位于上腔静脉下段。；检查结论: 导管末端位置如上述。\n- [全程D39] 检验组合: 胱抑素(Cys-C)-静脉血: 0.78mg/L；血小板比容-静脉血: 14.8%；中性粒细胞百分比(Neut%)-静脉血: 0.61；γ-谷氨酰基转移酶(GGT)-静脉血: 57.8U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；总蛋白(TP)-静脉血: 67.84g/L；平均红细胞体积(MCV)-静脉血: 96.4fL；镁离子(Mg2+)-静脉血: 0.92mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.05mmolL；钠离子(Na+)-静脉血: 139.4mmol/L；磷(P)-静脉血: 1.36mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.302；氯离子(Cl-)-静脉血: 103.4mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.54；平均红细胞血红蛋白含量(MCH)-静脉血: 32.7pg；平均血小板体积(MPV)-静脉血: 8.84fL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.59；钾离子(K+)-静脉血: 3.79mmol/L；单核细胞百分比(Mono%)-静脉血: 0.06；白细胞计数(WBC#)-静脉血: 5.4510E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；α-L-岩藻糖苷酶(AFU)-静脉血: 35.8U/L；血小板分布宽度(PDW)-静脉血: 16.9%；红细胞比容(Hct)-静脉血: 40.3%；乳酸脱氢酶(LDH)-静脉血: 149.5U/L；红细胞计数(RBC#)-静脉血: 4.1810E12/L；C-反应蛋白(CRP)-静脉血: 2.31mg/L；总钙(Ca)-静脉血: 2.19mmol/L；尿素氮(BUN)-静脉血: 3.8mmol/L；尿酸(UA)-静脉血: 285umol/L；阴离子间隙(AG)-静脉血: 11.3；葡萄糖(Glu)-静脉血: 4.38mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339.2g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 32.4U/L；甘油三酯(TG)-静脉血: 2.32mmol/L；白蛋白(ALB)-静脉血: 41.6g/L；血小板计数(PLT#)-静脉血: 167.……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D34] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者今日洛铂+5-FU化疗第2天，诉食欲较差，无恶心、呕吐等不适，精神、睡眠尚可，大小便正常。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者化疗第2日，一般情况可，嘱患者注意饮食，加强营养，续行化疗。密切观察化疗反应，必要时加强处理。现已按查房指示执行。\n- [全程D35] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者今日洛铂+5-FU化疗第3天，诉食欲较差，无恶心、呕吐等不适，精神、睡眠尚可，大小便正常。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者化疗第3日，一般情况可，密切观察化疗反应，必要时加强处理。现已按查房指示执行。\n- [全程D39] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者计划于今日完成第2程洛铂+5-FU方案诱导化疗，未诉特殊不适。[姓名已隐去]主诊医生信息已隐藏：患者现完成第2程洛铂+5-FU方案诱导化疗，一般情况可，予今日出院。嘱患者出院后定期每周复查血常规、肝肾功能，2周后返院续治。现已按查房指示执行。\n- [时间未明] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 现已按查房指示执行。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 办理出院，嘱每3天复查血常规及肝肾功能，1周后返院继续下一阶段治疗\nB. 予以重组人粒细胞刺激因子皮下注射后办理出院，嘱每周复查血常规，2周后返院\nC. 办理出院，嘱每周复查血常规及肝肾功能，2周后返院继续下一阶段治疗\nD. 办理出院，嘱每2周复查血常规及肝肾功能，3周后返院继续下一阶段治疗\nE. 暂缓出院，继续住院观察并每日复查血常规，待血液学指标进一步稳定后出院\nF. 办理出院，嘱每月复查血常规及肝肾功能，4周后返院评估疗效并决定后续治疗\nG. 予以静脉滴注保肝药物治疗，待复查肝功能指标完全正常后办理出院\nH. 办理出院，处方口服升血小板药物，嘱每周复查血常规，2周后返院\nI. 办理出院，处方口服卡培他滨单药维持，嘱每周复查血常规，3周后返院\nJ. 办理出院，嘱每周复查血常规及肝肾功能，4周后返院行MRI复查评估疗效\nK. 予以口服氯化钾缓释片补钾治疗，每日监测电解质，待血钾水平上升后办理出院\nL. 办理出院，无需定期复查化验指标，嘱出现发热或出血症状时急诊就诊，3周后返院\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D39] 检验组合: 胱抑素(Cys-C)-静脉血: 0.78mg/L；血小板比容-静脉血: 14.8%；中性粒细胞百分比(Neut%)-静脉血: 0.61；γ-谷氨酰基转移酶(GGT)-静脉血: 57.8U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；总蛋白(TP)-静脉血: 67.84g/L；平均红细胞体积(MCV)-静脉血: 96.4fL；镁离子(Mg2+)-静脉血: 0.92mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.05mmolL；钠离子(Na+)-静脉血: 139.4mmol/L；磷(P)-静脉血: 1.36mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.302；氯离子(Cl-)-静脉血: 103.4mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.54；平均红细胞血红蛋白含量(MCH)-静脉血: 32.7pg；平均血小板体积(MPV)-静脉血: 8.84fL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.59；钾离子(K+)-静脉血: 3.79mmol/L；单核细胞百分比(Mono%)-静脉血: 0.06；白细胞计数(WBC#)-静脉血: 5.4510E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；α-L-岩藻糖苷酶(AFU)-静脉血: 35.8U/L；血小板分布宽度(PDW)-静脉血: 16.9%；红细胞比容(Hct)-静脉血: 40.3%；乳酸脱氢酶(LDH)-静脉血: 149.5U/L；红细胞计数(RBC#)-静脉血: 4.1810E12/L；C-反应蛋白(CRP)-静脉血: 2.31mg/L；总钙(Ca)-静脉血: 2.19mmol/L；尿素氮(BUN)-静脉血: 3.8mmol/L；尿酸(UA)-静脉血: 285umol/L；阴离子间隙(AG)-静脉血: 11.3；葡萄糖(Glu)-静脉血: 4.38mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339.2g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 32.4U/L；甘油三酯(TG)-静脉血: 2.32mmol/L；白蛋白(ALB)-静脉血: 41.6g/L；血小板计数(PLT#)-静脉血: 167.……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D34] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者今日洛铂+5-FU化疗第2天，诉食欲较差，无恶心、呕吐等不适，精神、睡眠尚可，大小便正常。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者化疗第2日，一般情况可，嘱患者注意饮食，加强营养，续行化疗。密切观察化疗反应，必要时加强处理。现已按查房指示执行。\n- [全程D35] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者今日洛铂+5-FU化疗第3天，诉食欲较差，无恶心、呕吐等不适，精神、睡眠尚可，大小便正常。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者化疗第3日，一般情况可，密切观察化疗反应，必要时加强处理。现已按查房指示执行。\n- [全程D39] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者计划于今日完成第2程洛铂+5-FU方案诱导化疗，未诉特殊不适。[姓名已隐去]主诊医生信息已隐藏：患者现完成第2程洛铂+5-FU方案诱导化疗，一般情况可，予今日出院。嘱患者出院后定期每周复查血常规、肝肾功能，2周后返院续治。现已按查房指示执行。\n- [时间未明] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 现已按查房指示执行。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 办理出院，嘱每3天复查血常规及肝肾功能，1周后返院继续下一阶段治疗\nB. 予以重组人粒细胞刺激因子皮下注射后办理出院，嘱每周复查血常规，2周后返院\nC. 办理出院，嘱每周复查血常规及肝肾功能，2周后返院继续下一阶段治疗\nD. 办理出院，嘱每2周复查血常规及肝肾功能，3周后返院继续下一阶段治疗\nE. 暂缓出院，继续住院观察并每日复查血常规，待血液学指标进一步稳定后出院\nF. 办理出院，嘱每月复查血常规及肝肾功能，4周后返院评估疗效并决定后续治疗\nG. 予以静脉滴注保肝药物治疗，待复查肝功能指标完全正常后办理出院\nH. 办理出院，处方口服升血小板药物，嘱每周复查血常规，2周后返院\nI. 办理出院，处方口服卡培他滨单药维持，嘱每周复查血常规，3周后返院\nJ. 办理出院，嘱每周复查血常规及肝肾功能，4周后返院行MRI复查评估疗效\nK. 予以口服氯化钾缓释片补钾治疗，每日监测电解质，待血钾水平上升后办理出院\nL. 办理出院，无需定期复查化验指标，嘱出现发热或出血症状时急诊就诊，3周后返院\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D39] 检验组合: 胱抑素(Cys-C)-静脉血: 0.78mg/L；血小板比容-静脉血: 14.8%；中性粒细胞百分比(Neut%)-静脉血: 0.61；γ-谷氨酰基转移酶(GGT)-静脉血: 57.8U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；总蛋白(TP)-静脉血: 67.84g/L；平均红细胞体积(MCV)-静脉血: 96.4fL；镁离子(Mg2+)-静脉血: 0.92mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.05mmolL；钠离子(Na+)-静脉血: 139.4mmol/L；磷(P)-静脉血: 1.36mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.302；氯离子(Cl-)-静脉血: 103.4mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.54；平均红细胞血红蛋白含量(MCH)-静脉血: 32.7pg；平均血小板体积(MPV)-静脉血: 8.84fL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.59；钾离子(K+)-静脉血: 3.79mmol/L；单核细胞百分比(Mono%)-静脉血: 0.06；白细胞计数(WBC#)-静脉血: 5.4510E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；α-L-岩藻糖苷酶(AFU)-静脉血: 35.8U/L；血小板分布宽度(PDW)-静脉血: 16.9%；红细胞比容(Hct)-静脉血: 40.3%；乳酸脱氢酶(LDH)-静脉血: 149.5U/L；红细胞计数(RBC#)-静脉血: 4.1810E12/L；C-反应蛋白(CRP)-静脉血: 2.31mg/L；总钙(Ca)-静脉血: 2.19mmol/L；尿素氮(BUN)-静脉血: 3.8mmol/L；尿酸(UA)-静脉血: 285umol/L；阴离子间隙(AG)-静脉血: 11.3；葡萄糖(Glu)-静脉血: 4.38mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339.2g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 32.4U/L；甘油三酯(TG)-静脉血: 2.32mmol/L；白蛋白(ALB)-静脉血: 41.6g/L；血小板计数(PLT#)-静脉血: 167.……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D34] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者今日洛铂+5-FU化疗第2天，诉食欲较差，无恶心、呕吐等不适，精神、睡眠尚可，大小便正常。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者化疗第2日，一般情况可，嘱患者注意饮食，加强营养，续行化疗。密切观察化疗反应，必要时加强处理。现已按查房指示执行。\n- [全程D35] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者今日洛铂+5-FU化疗第3天，诉食欲较差，无恶心、呕吐等不适，精神、睡眠尚可，大小便正常。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者化疗第3日，一般情况可，密切观察化疗反应，必要时加强处理。现已按查房指示执行。\n- [全程D39] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者计划于今日完成第2程洛铂+5-FU方案诱导化疗，未诉特殊不适。[姓名已隐去]主诊医生信息已隐藏：患者现完成第2程洛铂+5-FU方案诱导化疗，一般情况可，予今日出院。嘱患者出院后定期每周复查血常规、肝肾功能，2周后返院续治。现已按查房指示执行。\n- [时间未明] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 现已按查房指示执行。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 办理出院，嘱每3天复查血常规及肝肾功能，1周后返院继续下一阶段治疗\nB. 予以重组人粒细胞刺激因子皮下注射后办理出院，嘱每周复查血常规，2周后返院\nC. 办理出院，嘱每周复查血常规及肝肾功能，2周后返院继续下一阶段治疗\nD. 办理出院，嘱每2周复查血常规及肝肾功能，3周后返院继续下一阶段治疗\nE. 暂缓出院，继续住院观察并每日复查血常规，待血液学指标进一步稳定后出院\nF. 办理出院，嘱每月复查血常规及肝肾功能，4周后返院评估疗效并决定后续治疗\nG. 予以静脉滴注保肝药物治疗，待复查肝功能指标完全正常后办理出院\nH. 办理出院，处方口服升血小板药物，嘱每周复查血常规，2周后返院\nI. 办理出院，处方口服卡培他滨单药维持，嘱每周复查血常规，3周后返院\nJ. 办理出院，嘱每周复查血常规及肝肾功能，4周后返院行MRI复查评估疗效\nK. 予以口服氯化钾缓释片补钾治疗，每日监测电解质，待血钾水平上升后办理出院\nL. 办理出院，无需定期复查化验指标，嘱出现发热或出血症状时急诊就诊，3周后返院\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-90c3b83f1d4c9db69ef01572","patient_id":"patient-5ee5dba6116030961a7a97b5","turn_id":"turn06","turn_position":5,"turn_type":"toxicity_or_support_decision","gold_letter":"K","gold_action":"继续同期放化疗，予以甲氧氯普胺口服止吐，暂不予静脉营养及免疫调节支持。","options":[{"letter":"A","text":"继续同期放化疗，予以重组人粒细胞刺激因子皮下注射及甲氧氯普胺口服止吐。","is_gold":false},{"letter":"B","text":"继续同期放化疗，予以重组人血小板生成素皮下注射及脂肪乳氨基酸葡萄糖静脉营养。","is_gold":false},{"letter":"C","text":"继续同期放化疗，予以多烯磷脂酰胆碱静脉滴注保肝及甲氧氯普胺口服止吐。","is_gold":false},{"letter":"D","text":"继续同期放化疗，予以甲氧氯普胺口服止吐，加用脂肪乳氨基酸葡萄糖静脉营养及胸腺五肽支持治疗。","is_gold":false},{"letter":"E","text":"暂停同期化疗，仅行单纯放疗，予以甲氧氯普胺口服止吐及脂肪乳氨基酸葡萄糖静脉营养。","is_gold":false},{"letter":"F","text":"继续同期放化疗，予以促红细胞生成素皮下注射及胸腺五肽支持治疗。","is_gold":false},{"letter":"G","text":"暂停放化疗，予以静脉输注红细胞悬液及脂肪乳氨基酸葡萄糖静脉营养。","is_gold":false},{"letter":"H","text":"继续同期放化疗，予以5-HT3受体拮抗剂静脉推注强化止吐，暂不予静脉营养支持。","is_gold":false},{"letter":"I","text":"继续同期放化疗，予以水化碱化尿液及甲氧氯普胺口服止吐。","is_gold":false},{"letter":"J","text":"暂停放化疗，予以广谱抗生素静脉滴注抗感染及胸腺五肽支持治疗。","is_gold":false},{"letter":"K","text":"继续同期放化疗，予以甲氧氯普胺口服止吐，暂不予静脉营养及免疫调节支持。","is_gold":true},{"letter":"L","text":"继续同期放化疗，予以重组人粒细胞刺激因子及促红细胞生成素双重支持。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 涕血半年伴右颈肿物2周；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 涕血半年伴右颈肿物2周；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D10] 入院记录: 主诉: 涕血半年伴右颈肿物2周.；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D3] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁增厚，可见软组织肿块形成，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。双侧咽隐窝见软组织占据，双侧咽旁脂肪间隙受压变窄，病灶侵犯双侧腭帆提肌。双侧腭帆张肌、头长肌未见受侵。 双侧翼腭窝、颞下窝未见异常；口咽双侧壁未见受累增厚，病变未累及后鼻孔。 双侧翼突基底内份、蝶骨基底部右份骨髓信号减低，增强可见轻度强化。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 双侧咽后间隙见肿大淋巴结，右侧大小约为7mm ×8 mm，左侧大小约3mm×4mm。双颈II区、III区见数个淋巴结，最大位于右颈II区，大小约为15mm×27mm。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽肿块，考虑鼻咽癌。 颅底骨质破坏。 右侧咽后及右颈淋巴结肿大，考虑转移瘤。 左侧咽后及左颈小淋巴结。 鼻窦炎、右乳突炎。\n- [全程D3] 检验组合: 平均红细胞体积(MCV)-静脉血: 93.7fL；凝血酶原时间活动度(PTA)-静脉血: 97%；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；中性粒细胞计数(Neut#)-静脉血: 3.610E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.7sec.；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；尿酸(UA)-静脉血: 413.6umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；血小板分布宽度(PDW)-静脉血: 14.7%；间接胆红素(IBIL)-静脉血: 9.7umolL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；丙氨酸氨基转移酶(ALT)-静脉血: 24U/L；碱性磷酸酶(ALP)-静脉血: 84.3U/L；总胆汁酸(TBA)-静脉血: 2.2umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.3mmol/L；葡萄糖(Glu)-静脉血: 4.51mmol/L；磷(P)-静脉血: 1.39mmol/L；C-反应蛋白(CRP)-静脉血: 4.68mg/L；血小板比容-静脉血: 25%；大血小板百分比(P-LCR%)-静脉血: 35.8%；血小板计数(PLT#)-静脉血: 21810E9/L；红细胞计数(RBC#)-静脉血: 4.5910E12/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；阴离子间隙(AG)-静脉血: 18；凝血酶时间(TT)-静脉血: 21.4sec.；红细胞比容(Hct)-静脉血: 43%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 344g/L；纤维蛋白原(Fbg)-静脉血: 3.09g/L；乳酸脱氢酶(LDH)-静脉血: 116.6U/L；总蛋白(TP)-静脉血: 69.58g/L；总钙(Ca)-静脉血: 2.31mmol/L；总胆固醇(TC)-静脉血: 5.94mmol/L；甘油三酯(TG)-静脉血: 1.79mmol/L；总胆红素(TBIL)-静脉血: 13.9umol/L；尿素氮(BUN……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D4] 检验组合: 乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D5] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶后壁及双侧壁粘膜增厚放射性浓聚，SUV约23.1；病灶填塞双侧鼻后孔，向上侵犯蝶骨基底部、双翼突基底部、犁骨及枕骨斜坡，局部骨质稍模糊放射性分布浓密。双侧破裂孔未见明显异常。双侧咽隐窝变浅。双侧咽旁间隙结构尚清。右侧咽后淋巴结放射性浓聚，SUV约11.4，大小约0.7×1.0cm；左侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见异常。筛窦、右上颌窦及右乳突稍低密度影放射性分布未见异常；额窦、蝶窦、左侧上颌窦及左乳突结构及放射性分布未见明显异常。口咽、喉咽未见明显异常。甲状腺放射性分布未见异常。双颈Ⅱ区肿大淋巴结放射性浓聚，SUV约10.2，最大约1.6×2.6cm；余双侧颈部未见肿大淋巴结及异常放射性分布。 双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺纹理清晰，双侧肺野未见确切病灶和异常放射性分布。气管、支气管通畅。心脏及大血管放射性分布未见异常。胸壁未见确切病灶和异常放射性分布。双肺门、纵隔及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏密度不均匀降低，放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管及胆总管未见扩张。胆囊、胃及十二指肠放射性分布未见异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、肠管等形态、结构及放射性分布未见明显异常。前列腺点状高密度影放射性分布未见异常。双侧髂血管旁及腹股沟未见明显肿大淋巴结及异常放射性分布。 余所见颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，病灶侵犯颅底骨；右咽后及双颈Ⅱ区淋巴结代谢较活跃，考虑转移。 鼻窦炎；右乳突炎。 脂肪肝。 前列腺钙化灶。\n- [全程D10] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: 右臂静脉插管, 导管末端位于胸椎右旁T 7上缘水平，估计位于上腔静脉下段。；检查结论: 导管末端位置如上述。\n- [全程D39] 检验组合: 胱抑素(Cys-C)-静脉血: 0.78mg/L；血小板比容-静脉血: 14.8%；中性粒细胞百分比(Neut%)-静脉血: 0.61；γ-谷氨酰基转移酶(GGT)-静脉血: 57.8U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；总蛋白(TP)-静脉血: 67.84g/L；平均红细胞体积(MCV)-静脉血: 96.4fL；镁离子(Mg2+)-静脉血: 0.92mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.05mmolL；钠离子(Na+)-静脉血: 139.4mmol/L；磷(P)-静脉血: 1.36mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.302；氯离子(Cl-)-静脉血: 103.4mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.54；平均红细胞血红蛋白含量(MCH)-静脉血: 32.7pg；平均血小板体积(MPV)-静脉血: 8.84fL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.59；钾离子(K+)-静脉血: 3.79mmol/L；单核细胞百分比(Mono%)-静脉血: 0.06；白细胞计数(WBC#)-静脉血: 5.4510E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；α-L-岩藻糖苷酶(AFU)-静脉血: 35.8U/L；血小板分布宽度(PDW)-静脉血: 16.9%；红细胞比容(Hct)-静脉血: 40.3%；乳酸脱氢酶(LDH)-静脉血: 149.5U/L；红细胞计数(RBC#)-静脉血: 4.1810E12/L；C-反应蛋白(CRP)-静脉血: 2.31mg/L；总钙(Ca)-静脉血: 2.19mmol/L；尿素氮(BUN)-静脉血: 3.8mmol/L；尿酸(UA)-静脉血: 285umol/L；阴离子间隙(AG)-静脉血: 11.3；葡萄糖(Glu)-静脉血: 4.38mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339.2g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 32.4U/L；甘油三酯(TG)-静脉血: 2.32mmol/L；白蛋白(ALB)-静脉血: 41.6g/L；血小板计数(PLT#)-静脉血: 167.……\n- [全程D45] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌2程化疗后，与某次就诊时间片对比： 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁增厚，可见软组织肿块形成，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，对比前片，较前明显缩小。双侧咽隐窝见软组织占据，双侧咽旁脂肪间隙受压变窄，病灶侵犯双侧腭帆提肌，范围较前稍缩小。双侧腭帆张肌、头长肌未见受侵。 双侧翼腭窝、颞下窝未见异常；口咽双侧壁未见受累增厚，病变未累及后鼻孔。 双侧翼突基底内份、蝶骨基底部右份骨髓信号减低，增强可见轻度强化。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 双侧咽后间隙见肿大淋巴结，右侧大小约为6mm ×7 mm，左侧大小约4mm×6mm。双颈II区、III区见数个淋巴结，最大位于右颈II区，大小约为11mm×24mm，较前明显缩小。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌2程化疗后： 鼻咽病灶较前明显缩小。 颅底骨质破坏。 双侧咽后及颈部淋巴结，较前明显缩小。 鼻窦炎、右乳突炎。\n- [全程D60] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 28.3U/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.1g/L；平均红细胞体积(MCV)-静脉血: 97.9fL；血液二氧化碳含量ctCO2(B)-静脉血: 22.6mmol/L；血小板计数(PLT#)-静脉血: 152.910E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；钾离子(K+)-静脉血: 4.2mmol/L；碱性磷酸酶(ALP)-静脉血: 76.4U/L；单核细胞百分比(Mono%)-静脉血: 0.073；γ-谷氨酰基转移酶(GGT)-静脉血: 46.4U/L；血红蛋白(Hb)-静脉血: 145.2g/L；胱抑素(Cys-C)-静脉血: 0.82mg/L；阴离子间隙(AG)-静脉血: 18；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；甘油三酯(TG)-静脉血: 1.57mmol/L；直接胆红素(DBIL)-静脉血: 6.7umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 345.2g/L；间接胆红素(IBIL)-静脉血: 17.9umolL；中性粒细胞百分比(Neut%)-静脉血: 0.676；乳酸脱氢酶(LDH)-静脉血: 132.5U/L；总蛋白(TP)-静脉血: 71.34g/L；总胆固醇(TC)-静脉血: 6.52mmol/L；总钙(Ca)-静脉血: 2.33mmol/L；血小板分布宽度(PDW)-静脉血: 16.9%；血小板比容-静脉血: 13%；尿酸(UA)-静脉血: 305.5umol/L；平均血小板体积(MPV)-静脉血: 8.53fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1%；淋巴细胞百分比(Lymph%)-静脉血: 0.221；钠离子(Na+)-静脉血: 139.5mmol/L；载脂蛋白B(apoB)-静脉血: 1.31g/L；有核红细胞百分比(NRBC%)-静脉血: 0；总胆汁酸(TBA)-静脉血: 3.6umol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总胆红素(TBIL)-静脉血: 24.6umol/L……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D34] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者今日洛铂+5-FU化疗第2天，诉食欲较差，无恶心、呕吐等不适，精神、睡眠尚可，大小便正常。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者化疗第2日，一般情况可，嘱患者注意饮食，加强营养，续行化疗。密切观察化疗反应，必要时加强处理。现已按查房指示执行。\n- [全程D35] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者今日洛铂+5-FU化疗第3天，诉食欲较差，无恶心、呕吐等不适，精神、睡眠尚可，大小便正常。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者化疗第3日，一般情况可，密切观察化疗反应，必要时加强处理。现已按查房指示执行。\n- [全程D39] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者计划于今日完成第2程洛铂+5-FU方案诱导化疗，未诉特殊不适。[姓名已隐去]主诊医生信息已隐藏：患者现完成第2程洛铂+5-FU方案诱导化疗，一般情况可，予今日出院。嘱患者出院后定期每周复查血常规、肝肾功能，2周后返院续治。现已按查房指示执行。\n- [时间未明] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 现已按查房指示执行。\n- [全程D55] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者未诉特殊不适，饮食、睡眠、精神尚可，大小便正常。查体：基本同前。[姓名已隐去]主诊医生信息已隐藏：患者诊断明确，已完成患者靶区设计，并通过全科会诊，剂量分布均匀，予GTVnx:70Gy/30F,GTVnd(L):66Gy/30F,GTVnd(R):66Gy/30F。考虑联合洛铂同期放化疗，告知患者放疗及化疗的可能获益及相关风险，患者表示已知情并同意。续观。现已按查房指示执行。\n- [全程D56] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现放疗1F，未诉特殊不适。生命体征平稳。查体情况大致同前。[姓名已隐去]主诊医生信息已隐藏：考虑患者一般情况可，继续放疗，密切关注放疗副反应，必要时加强处理。现已按查房指示执行。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 继续同期放化疗，予以重组人粒细胞刺激因子皮下注射及甲氧氯普胺口服止吐。\nB. 继续同期放化疗，予以重组人血小板生成素皮下注射及脂肪乳氨基酸葡萄糖静脉营养。\nC. 继续同期放化疗，予以多烯磷脂酰胆碱静脉滴注保肝及甲氧氯普胺口服止吐。\nD. 继续同期放化疗，予以甲氧氯普胺口服止吐，加用脂肪乳氨基酸葡萄糖静脉营养及胸腺五肽支持治疗。\nE. 暂停同期化疗，仅行单纯放疗，予以甲氧氯普胺口服止吐及脂肪乳氨基酸葡萄糖静脉营养。\nF. 继续同期放化疗，予以促红细胞生成素皮下注射及胸腺五肽支持治疗。\nG. 暂停放化疗，予以静脉输注红细胞悬液及脂肪乳氨基酸葡萄糖静脉营养。\nH. 继续同期放化疗，予以5-HT3受体拮抗剂静脉推注强化止吐，暂不予静脉营养支持。\nI. 继续同期放化疗，予以水化碱化尿液及甲氧氯普胺口服止吐。\nJ. 暂停放化疗，予以广谱抗生素静脉滴注抗感染及胸腺五肽支持治疗。\nK. 继续同期放化疗，予以甲氧氯普胺口服止吐，暂不予静脉营养及免疫调节支持。\nL. 继续同期放化疗，予以重组人粒细胞刺激因子及促红细胞生成素双重支持。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D45] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌2程化疗后，与某次就诊时间片对比： 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁增厚，可见软组织肿块形成，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，对比前片，较前明显缩小。双侧咽隐窝见软组织占据，双侧咽旁脂肪间隙受压变窄，病灶侵犯双侧腭帆提肌，范围较前稍缩小。双侧腭帆张肌、头长肌未见受侵。 双侧翼腭窝、颞下窝未见异常；口咽双侧壁未见受累增厚，病变未累及后鼻孔。 双侧翼突基底内份、蝶骨基底部右份骨髓信号减低，增强可见轻度强化。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 双侧咽后间隙见肿大淋巴结，右侧大小约为6mm ×7 mm，左侧大小约4mm×6mm。双颈II区、III区见数个淋巴结，最大位于右颈II区，大小约为11mm×24mm，较前明显缩小。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌2程化疗后： 鼻咽病灶较前明显缩小。 颅底骨质破坏。 双侧咽后及颈部淋巴结，较前明显缩小。 鼻窦炎、右乳突炎。\n- [全程D60] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 28.3U/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.1g/L；平均红细胞体积(MCV)-静脉血: 97.9fL；血液二氧化碳含量ctCO2(B)-静脉血: 22.6mmol/L；血小板计数(PLT#)-静脉血: 152.910E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；钾离子(K+)-静脉血: 4.2mmol/L；碱性磷酸酶(ALP)-静脉血: 76.4U/L；单核细胞百分比(Mono%)-静脉血: 0.073；γ-谷氨酰基转移酶(GGT)-静脉血: 46.4U/L；血红蛋白(Hb)-静脉血: 145.2g/L；胱抑素(Cys-C)-静脉血: 0.82mg/L；阴离子间隙(AG)-静脉血: 18；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；甘油三酯(TG)-静脉血: 1.57mmol/L；直接胆红素(DBIL)-静脉血: 6.7umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 345.2g/L；间接胆红素(IBIL)-静脉血: 17.9umolL；中性粒细胞百分比(Neut%)-静脉血: 0.676；乳酸脱氢酶(LDH)-静脉血: 132.5U/L；总蛋白(TP)-静脉血: 71.34g/L；总胆固醇(TC)-静脉血: 6.52mmol/L；总钙(Ca)-静脉血: 2.33mmol/L；血小板分布宽度(PDW)-静脉血: 16.9%；血小板比容-静脉血: 13%；尿酸(UA)-静脉血: 305.5umol/L；平均血小板体积(MPV)-静脉血: 8.53fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1%；淋巴细胞百分比(Lymph%)-静脉血: 0.221；钠离子(Na+)-静脉血: 139.5mmol/L；载脂蛋白B(apoB)-静脉血: 1.31g/L；有核红细胞百分比(NRBC%)-静脉血: 0；总胆汁酸(TBA)-静脉血: 3.6umol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总胆红素(TBIL)-静脉血: 24.6umol/L……\n\n【既往治疗与反应】\n- [全程D55] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者未诉特殊不适，饮食、睡眠、精神尚可，大小便正常。查体：基本同前。[姓名已隐去]主诊医生信息已隐藏：患者诊断明确，已完成患者靶区设计，并通过全科会诊，剂量分布均匀，予GTVnx:70Gy/30F,GTVnd(L):66Gy/30F,GTVnd(R):66Gy/30F。考虑联合洛铂同期放化疗，告知患者放疗及化疗的可能获益及相关风险，患者表示已知情并同意。续观。现已按查房指示执行。\n- [全程D56] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现放疗1F，未诉特殊不适。生命体征平稳。查体情况大致同前。[姓名已隐去]主诊医生信息已隐藏：考虑患者一般情况可，继续放疗，密切关注放疗副反应，必要时加强处理。现已按查房指示执行。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 继续同期放化疗，予以重组人粒细胞刺激因子皮下注射及甲氧氯普胺口服止吐。\nB. 继续同期放化疗，予以重组人血小板生成素皮下注射及脂肪乳氨基酸葡萄糖静脉营养。\nC. 继续同期放化疗，予以多烯磷脂酰胆碱静脉滴注保肝及甲氧氯普胺口服止吐。\nD. 继续同期放化疗，予以甲氧氯普胺口服止吐，加用脂肪乳氨基酸葡萄糖静脉营养及胸腺五肽支持治疗。\nE. 暂停同期化疗，仅行单纯放疗，予以甲氧氯普胺口服止吐及脂肪乳氨基酸葡萄糖静脉营养。\nF. 继续同期放化疗，予以促红细胞生成素皮下注射及胸腺五肽支持治疗。\nG. 暂停放化疗，予以静脉输注红细胞悬液及脂肪乳氨基酸葡萄糖静脉营养。\nH. 继续同期放化疗，予以5-HT3受体拮抗剂静脉推注强化止吐，暂不予静脉营养支持。\nI. 继续同期放化疗，予以水化碱化尿液及甲氧氯普胺口服止吐。\nJ. 暂停放化疗，予以广谱抗生素静脉滴注抗感染及胸腺五肽支持治疗。\nK. 继续同期放化疗，予以甲氧氯普胺口服止吐，暂不予静脉营养及免疫调节支持。\nL. 继续同期放化疗，予以重组人粒细胞刺激因子及促红细胞生成素双重支持。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D45] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌2程化疗后，与某次就诊时间片对比： 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁增厚，可见软组织肿块形成，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，对比前片，较前明显缩小。双侧咽隐窝见软组织占据，双侧咽旁脂肪间隙受压变窄，病灶侵犯双侧腭帆提肌，范围较前稍缩小。双侧腭帆张肌、头长肌未见受侵。 双侧翼腭窝、颞下窝未见异常；口咽双侧壁未见受累增厚，病变未累及后鼻孔。 双侧翼突基底内份、蝶骨基底部右份骨髓信号减低，增强可见轻度强化。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 双侧咽后间隙见肿大淋巴结，右侧大小约为6mm ×7 mm，左侧大小约4mm×6mm。双颈II区、III区见数个淋巴结，最大位于右颈II区，大小约为11mm×24mm，较前明显缩小。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌2程化疗后： 鼻咽病灶较前明显缩小。 颅底骨质破坏。 双侧咽后及颈部淋巴结，较前明显缩小。 鼻窦炎、右乳突炎。\n- [全程D60] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 28.3U/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.1g/L；平均红细胞体积(MCV)-静脉血: 97.9fL；血液二氧化碳含量ctCO2(B)-静脉血: 22.6mmol/L；血小板计数(PLT#)-静脉血: 152.910E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；钾离子(K+)-静脉血: 4.2mmol/L；碱性磷酸酶(ALP)-静脉血: 76.4U/L；单核细胞百分比(Mono%)-静脉血: 0.073；γ-谷氨酰基转移酶(GGT)-静脉血: 46.4U/L；血红蛋白(Hb)-静脉血: 145.2g/L；胱抑素(Cys-C)-静脉血: 0.82mg/L；阴离子间隙(AG)-静脉血: 18；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；甘油三酯(TG)-静脉血: 1.57mmol/L；直接胆红素(DBIL)-静脉血: 6.7umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 345.2g/L；间接胆红素(IBIL)-静脉血: 17.9umolL；中性粒细胞百分比(Neut%)-静脉血: 0.676；乳酸脱氢酶(LDH)-静脉血: 132.5U/L；总蛋白(TP)-静脉血: 71.34g/L；总胆固醇(TC)-静脉血: 6.52mmol/L；总钙(Ca)-静脉血: 2.33mmol/L；血小板分布宽度(PDW)-静脉血: 16.9%；血小板比容-静脉血: 13%；尿酸(UA)-静脉血: 305.5umol/L；平均血小板体积(MPV)-静脉血: 8.53fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1%；淋巴细胞百分比(Lymph%)-静脉血: 0.221；钠离子(Na+)-静脉血: 139.5mmol/L；载脂蛋白B(apoB)-静脉血: 1.31g/L；有核红细胞百分比(NRBC%)-静脉血: 0；总胆汁酸(TBA)-静脉血: 3.6umol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总胆红素(TBIL)-静脉血: 24.6umol/L……\n\n【既往治疗与反应】\n- [全程D55] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者未诉特殊不适，饮食、睡眠、精神尚可，大小便正常。查体：基本同前。[姓名已隐去]主诊医生信息已隐藏：患者诊断明确，已完成患者靶区设计，并通过全科会诊，剂量分布均匀，予GTVnx:70Gy/30F,GTVnd(L):66Gy/30F,GTVnd(R):66Gy/30F。考虑联合洛铂同期放化疗，告知患者放疗及化疗的可能获益及相关风险，患者表示已知情并同意。续观。现已按查房指示执行。\n- [全程D56] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现放疗1F，未诉特殊不适。生命体征平稳。查体情况大致同前。[姓名已隐去]主诊医生信息已隐藏：考虑患者一般情况可，继续放疗，密切关注放疗副反应，必要时加强处理。现已按查房指示执行。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 继续同期放化疗，予以重组人粒细胞刺激因子皮下注射及甲氧氯普胺口服止吐。\nB. 继续同期放化疗，予以重组人血小板生成素皮下注射及脂肪乳氨基酸葡萄糖静脉营养。\nC. 继续同期放化疗，予以多烯磷脂酰胆碱静脉滴注保肝及甲氧氯普胺口服止吐。\nD. 继续同期放化疗，予以甲氧氯普胺口服止吐，加用脂肪乳氨基酸葡萄糖静脉营养及胸腺五肽支持治疗。\nE. 暂停同期化疗，仅行单纯放疗，予以甲氧氯普胺口服止吐及脂肪乳氨基酸葡萄糖静脉营养。\nF. 继续同期放化疗，予以促红细胞生成素皮下注射及胸腺五肽支持治疗。\nG. 暂停放化疗，予以静脉输注红细胞悬液及脂肪乳氨基酸葡萄糖静脉营养。\nH. 继续同期放化疗，予以5-HT3受体拮抗剂静脉推注强化止吐，暂不予静脉营养支持。\nI. 继续同期放化疗，予以水化碱化尿液及甲氧氯普胺口服止吐。\nJ. 暂停放化疗，予以广谱抗生素静脉滴注抗感染及胸腺五肽支持治疗。\nK. 继续同期放化疗，予以甲氧氯普胺口服止吐，暂不予静脉营养及免疫调节支持。\nL. 继续同期放化疗，予以重组人粒细胞刺激因子及促红细胞生成素双重支持。\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-d1b602a57ed6c599e7f441cc","patient_id":"patient-5ee5dba6116030961a7a97b5","turn_id":"turn07","turn_position":6,"turn_type":"response_assessment_decision","gold_letter":"E","gold_action":"评估为诱导化疗部分缓解（PR），完善放疗前常规血液学检查，启动根治性调强放射治疗（IMRT）及放疗相关支持治疗。","options":[{"letter":"A","text":"评估为诱导化疗疾病稳定（SD），原方案（洛铂+5-FU）继续第3程诱导化疗，随后再评估放疗指征。","is_gold":false},{"letter":"B","text":"评估为诱导化疗部分缓解（PR），原方案（洛铂+5-FU）继续第3程诱导化疗，以期达到完全缓解后放疗。","is_gold":false},{"letter":"C","text":"评估为诱导化疗部分缓解（PR），行鼻咽及颈部病灶根治性手术切除，术后辅助调强放射治疗。","is_gold":false},{"letter":"D","text":"评估为诱导化疗完全缓解（CR），暂缓放射治疗，进入定期随访观察阶段。","is_gold":false},{"letter":"E","text":"评估为诱导化疗部分缓解（PR），完善放疗前常规血液学检查，启动根治性调强放射治疗（IMRT）及放疗相关支持治疗。","is_gold":true},{"letter":"F","text":"评估为诱导化疗部分缓解（PR），启动根治性三维适形放射治疗（3D-CRT）及放疗相关支持治疗。","is_gold":false},{"letter":"G","text":"评估为诱导化疗疾病进展（PD），更改诱导化疗方案为吉西他滨+顺铂（GP），2程后再次评估。","is_gold":false},{"letter":"H","text":"评估为诱导化疗部分缓解（PR），行颈部淋巴结清扫术，术后行鼻咽局部调强放射治疗。","is_gold":false},{"letter":"I","text":"评估为诱导化疗部分缓解（PR），启动姑息性减症放射治疗，剂量控制在40Gy左右。","is_gold":false},{"letter":"J","text":"评估为诱导化疗疾病稳定（SD），加用免疫检查点抑制剂联合原方案化疗。","is_gold":false},{"letter":"K","text":"评估为诱导化疗部分缓解（PR），等待4周后复查PET-CT，视代谢活性决定是否启动放射治疗。","is_gold":false},{"letter":"L","text":"评估为诱导化疗部分缓解（PR），停用化疗，单用靶向药物维持治疗。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 涕血半年伴右颈肿物2周；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 涕血半年伴右颈肿物2周；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D10] 入院记录: 主诉: 涕血半年伴右颈肿物2周.；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D3] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁增厚，可见软组织肿块形成，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。双侧咽隐窝见软组织占据，双侧咽旁脂肪间隙受压变窄，病灶侵犯双侧腭帆提肌。双侧腭帆张肌、头长肌未见受侵。 双侧翼腭窝、颞下窝未见异常；口咽双侧壁未见受累增厚，病变未累及后鼻孔。 双侧翼突基底内份、蝶骨基底部右份骨髓信号减低，增强可见轻度强化。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 双侧咽后间隙见肿大淋巴结，右侧大小约为7mm ×8 mm，左侧大小约3mm×4mm。双颈II区、III区见数个淋巴结，最大位于右颈II区，大小约为15mm×27mm。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽肿块，考虑鼻咽癌。 颅底骨质破坏。 右侧咽后及右颈淋巴结肿大，考虑转移瘤。 左侧咽后及左颈小淋巴结。 鼻窦炎、右乳突炎。\n- [全程D3] 检验组合: 平均红细胞体积(MCV)-静脉血: 93.7fL；凝血酶原时间活动度(PTA)-静脉血: 97%；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；中性粒细胞计数(Neut#)-静脉血: 3.610E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.7sec.；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；尿酸(UA)-静脉血: 413.6umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；血小板分布宽度(PDW)-静脉血: 14.7%；间接胆红素(IBIL)-静脉血: 9.7umolL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；丙氨酸氨基转移酶(ALT)-静脉血: 24U/L；碱性磷酸酶(ALP)-静脉血: 84.3U/L；总胆汁酸(TBA)-静脉血: 2.2umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.3mmol/L；葡萄糖(Glu)-静脉血: 4.51mmol/L；磷(P)-静脉血: 1.39mmol/L；C-反应蛋白(CRP)-静脉血: 4.68mg/L；血小板比容-静脉血: 25%；大血小板百分比(P-LCR%)-静脉血: 35.8%；血小板计数(PLT#)-静脉血: 21810E9/L；红细胞计数(RBC#)-静脉血: 4.5910E12/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；阴离子间隙(AG)-静脉血: 18；凝血酶时间(TT)-静脉血: 21.4sec.；红细胞比容(Hct)-静脉血: 43%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 344g/L；纤维蛋白原(Fbg)-静脉血: 3.09g/L；乳酸脱氢酶(LDH)-静脉血: 116.6U/L；总蛋白(TP)-静脉血: 69.58g/L；总钙(Ca)-静脉血: 2.31mmol/L；总胆固醇(TC)-静脉血: 5.94mmol/L；甘油三酯(TG)-静脉血: 1.79mmol/L；总胆红素(TBIL)-静脉血: 13.9umol/L；尿素氮(BUN……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D4] 检验组合: 乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D5] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶后壁及双侧壁粘膜增厚放射性浓聚，SUV约23.1；病灶填塞双侧鼻后孔，向上侵犯蝶骨基底部、双翼突基底部、犁骨及枕骨斜坡，局部骨质稍模糊放射性分布浓密。双侧破裂孔未见明显异常。双侧咽隐窝变浅。双侧咽旁间隙结构尚清。右侧咽后淋巴结放射性浓聚，SUV约11.4，大小约0.7×1.0cm；左侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见异常。筛窦、右上颌窦及右乳突稍低密度影放射性分布未见异常；额窦、蝶窦、左侧上颌窦及左乳突结构及放射性分布未见明显异常。口咽、喉咽未见明显异常。甲状腺放射性分布未见异常。双颈Ⅱ区肿大淋巴结放射性浓聚，SUV约10.2，最大约1.6×2.6cm；余双侧颈部未见肿大淋巴结及异常放射性分布。 双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺纹理清晰，双侧肺野未见确切病灶和异常放射性分布。气管、支气管通畅。心脏及大血管放射性分布未见异常。胸壁未见确切病灶和异常放射性分布。双肺门、纵隔及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏密度不均匀降低，放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管及胆总管未见扩张。胆囊、胃及十二指肠放射性分布未见异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、肠管等形态、结构及放射性分布未见明显异常。前列腺点状高密度影放射性分布未见异常。双侧髂血管旁及腹股沟未见明显肿大淋巴结及异常放射性分布。 余所见颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，病灶侵犯颅底骨；右咽后及双颈Ⅱ区淋巴结代谢较活跃，考虑转移。 鼻窦炎；右乳突炎。 脂肪肝。 前列腺钙化灶。\n- [全程D10] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: 右臂静脉插管, 导管末端位于胸椎右旁T 7上缘水平，估计位于上腔静脉下段。；检查结论: 导管末端位置如上述。\n- [全程D39] 检验组合: 胱抑素(Cys-C)-静脉血: 0.78mg/L；血小板比容-静脉血: 14.8%；中性粒细胞百分比(Neut%)-静脉血: 0.61；γ-谷氨酰基转移酶(GGT)-静脉血: 57.8U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；总蛋白(TP)-静脉血: 67.84g/L；平均红细胞体积(MCV)-静脉血: 96.4fL；镁离子(Mg2+)-静脉血: 0.92mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.05mmolL；钠离子(Na+)-静脉血: 139.4mmol/L；磷(P)-静脉血: 1.36mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.302；氯离子(Cl-)-静脉血: 103.4mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.54；平均红细胞血红蛋白含量(MCH)-静脉血: 32.7pg；平均血小板体积(MPV)-静脉血: 8.84fL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.59；钾离子(K+)-静脉血: 3.79mmol/L；单核细胞百分比(Mono%)-静脉血: 0.06；白细胞计数(WBC#)-静脉血: 5.4510E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；α-L-岩藻糖苷酶(AFU)-静脉血: 35.8U/L；血小板分布宽度(PDW)-静脉血: 16.9%；红细胞比容(Hct)-静脉血: 40.3%；乳酸脱氢酶(LDH)-静脉血: 149.5U/L；红细胞计数(RBC#)-静脉血: 4.1810E12/L；C-反应蛋白(CRP)-静脉血: 2.31mg/L；总钙(Ca)-静脉血: 2.19mmol/L；尿素氮(BUN)-静脉血: 3.8mmol/L；尿酸(UA)-静脉血: 285umol/L；阴离子间隙(AG)-静脉血: 11.3；葡萄糖(Glu)-静脉血: 4.38mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339.2g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 32.4U/L；甘油三酯(TG)-静脉血: 2.32mmol/L；白蛋白(ALB)-静脉血: 41.6g/L；血小板计数(PLT#)-静脉血: 167.……\n- [全程D45] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌2程化疗后，与某次就诊时间片对比： 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁增厚，可见软组织肿块形成，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，对比前片，较前明显缩小。双侧咽隐窝见软组织占据，双侧咽旁脂肪间隙受压变窄，病灶侵犯双侧腭帆提肌，范围较前稍缩小。双侧腭帆张肌、头长肌未见受侵。 双侧翼腭窝、颞下窝未见异常；口咽双侧壁未见受累增厚，病变未累及后鼻孔。 双侧翼突基底内份、蝶骨基底部右份骨髓信号减低，增强可见轻度强化。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 双侧咽后间隙见肿大淋巴结，右侧大小约为6mm ×7 mm，左侧大小约4mm×6mm。双颈II区、III区见数个淋巴结，最大位于右颈II区，大小约为11mm×24mm，较前明显缩小。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌2程化疗后： 鼻咽病灶较前明显缩小。 颅底骨质破坏。 双侧咽后及颈部淋巴结，较前明显缩小。 鼻窦炎、右乳突炎。\n- [全程D60] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 28.3U/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.1g/L；平均红细胞体积(MCV)-静脉血: 97.9fL；血液二氧化碳含量ctCO2(B)-静脉血: 22.6mmol/L；血小板计数(PLT#)-静脉血: 152.910E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；钾离子(K+)-静脉血: 4.2mmol/L；碱性磷酸酶(ALP)-静脉血: 76.4U/L；单核细胞百分比(Mono%)-静脉血: 0.073；γ-谷氨酰基转移酶(GGT)-静脉血: 46.4U/L；血红蛋白(Hb)-静脉血: 145.2g/L；胱抑素(Cys-C)-静脉血: 0.82mg/L；阴离子间隙(AG)-静脉血: 18；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；甘油三酯(TG)-静脉血: 1.57mmol/L；直接胆红素(DBIL)-静脉血: 6.7umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 345.2g/L；间接胆红素(IBIL)-静脉血: 17.9umolL；中性粒细胞百分比(Neut%)-静脉血: 0.676；乳酸脱氢酶(LDH)-静脉血: 132.5U/L；总蛋白(TP)-静脉血: 71.34g/L；总胆固醇(TC)-静脉血: 6.52mmol/L；总钙(Ca)-静脉血: 2.33mmol/L；血小板分布宽度(PDW)-静脉血: 16.9%；血小板比容-静脉血: 13%；尿酸(UA)-静脉血: 305.5umol/L；平均血小板体积(MPV)-静脉血: 8.53fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1%；淋巴细胞百分比(Lymph%)-静脉血: 0.221；钠离子(Na+)-静脉血: 139.5mmol/L；载脂蛋白B(apoB)-静脉血: 1.31g/L；有核红细胞百分比(NRBC%)-静脉血: 0；总胆汁酸(TBA)-静脉血: 3.6umol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总胆红素(TBIL)-静脉血: 24.6umol/L……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D34] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者今日洛铂+5-FU化疗第2天，诉食欲较差，无恶心、呕吐等不适，精神、睡眠尚可，大小便正常。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者化疗第2日，一般情况可，嘱患者注意饮食，加强营养，续行化疗。密切观察化疗反应，必要时加强处理。现已按查房指示执行。\n- [全程D35] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者今日洛铂+5-FU化疗第3天，诉食欲较差，无恶心、呕吐等不适，精神、睡眠尚可，大小便正常。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者化疗第3日，一般情况可，密切观察化疗反应，必要时加强处理。现已按查房指示执行。\n- [全程D39] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者计划于今日完成第2程洛铂+5-FU方案诱导化疗，未诉特殊不适。[姓名已隐去]主诊医生信息已隐藏：患者现完成第2程洛铂+5-FU方案诱导化疗，一般情况可，予今日出院。嘱患者出院后定期每周复查血常规、肝肾功能，2周后返院续治。现已按查房指示执行。\n- [时间未明] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 现已按查房指示执行。\n- [全程D55] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者未诉特殊不适，饮食、睡眠、精神尚可，大小便正常。查体：基本同前。[姓名已隐去]主诊医生信息已隐藏：患者诊断明确，已完成患者靶区设计，并通过全科会诊，剂量分布均匀，予GTVnx:70Gy/30F,GTVnd(L):66Gy/30F,GTVnd(R):66Gy/30F。考虑联合洛铂同期放化疗，告知患者放疗及化疗的可能获益及相关风险，患者表示已知情并同意。续观。现已按查房指示执行。\n- [全程D56] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现放疗1F，未诉特殊不适。生命体征平稳。查体情况大致同前。[姓名已隐去]主诊医生信息已隐藏：考虑患者一般情况可，继续放疗，密切关注放疗副反应，必要时加强处理。现已按查房指示执行。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估为诱导化疗疾病稳定（SD），原方案（洛铂+5-FU）继续第3程诱导化疗，随后再评估放疗指征。\nB. 评估为诱导化疗部分缓解（PR），原方案（洛铂+5-FU）继续第3程诱导化疗，以期达到完全缓解后放疗。\nC. 评估为诱导化疗部分缓解（PR），行鼻咽及颈部病灶根治性手术切除，术后辅助调强放射治疗。\nD. 评估为诱导化疗完全缓解（CR），暂缓放射治疗，进入定期随访观察阶段。\nE. 评估为诱导化疗部分缓解（PR），完善放疗前常规血液学检查，启动根治性调强放射治疗（IMRT）及放疗相关支持治疗。\nF. 评估为诱导化疗部分缓解（PR），启动根治性三维适形放射治疗（3D-CRT）及放疗相关支持治疗。\nG. 评估为诱导化疗疾病进展（PD），更改诱导化疗方案为吉西他滨+顺铂（GP），2程后再次评估。\nH. 评估为诱导化疗部分缓解（PR），行颈部淋巴结清扫术，术后行鼻咽局部调强放射治疗。\nI. 评估为诱导化疗部分缓解（PR），启动姑息性减症放射治疗，剂量控制在40Gy左右。\nJ. 评估为诱导化疗疾病稳定（SD），加用免疫检查点抑制剂联合原方案化疗。\nK. 评估为诱导化疗部分缓解（PR），等待4周后复查PET-CT，视代谢活性决定是否启动放射治疗。\nL. 评估为诱导化疗部分缓解（PR），停用化疗，单用靶向药物维持治疗。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- 无可展示记录。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估为诱导化疗疾病稳定（SD），原方案（洛铂+5-FU）继续第3程诱导化疗，随后再评估放疗指征。\nB. 评估为诱导化疗部分缓解（PR），原方案（洛铂+5-FU）继续第3程诱导化疗，以期达到完全缓解后放疗。\nC. 评估为诱导化疗部分缓解（PR），行鼻咽及颈部病灶根治性手术切除，术后辅助调强放射治疗。\nD. 评估为诱导化疗完全缓解（CR），暂缓放射治疗，进入定期随访观察阶段。\nE. 评估为诱导化疗部分缓解（PR），完善放疗前常规血液学检查，启动根治性调强放射治疗（IMRT）及放疗相关支持治疗。\nF. 评估为诱导化疗部分缓解（PR），启动根治性三维适形放射治疗（3D-CRT）及放疗相关支持治疗。\nG. 评估为诱导化疗疾病进展（PD），更改诱导化疗方案为吉西他滨+顺铂（GP），2程后再次评估。\nH. 评估为诱导化疗部分缓解（PR），行颈部淋巴结清扫术，术后行鼻咽局部调强放射治疗。\nI. 评估为诱导化疗部分缓解（PR），启动姑息性减症放射治疗，剂量控制在40Gy左右。\nJ. 评估为诱导化疗疾病稳定（SD），加用免疫检查点抑制剂联合原方案化疗。\nK. 评估为诱导化疗部分缓解（PR），等待4周后复查PET-CT，视代谢活性决定是否启动放射治疗。\nL. 评估为诱导化疗部分缓解（PR），停用化疗，单用靶向药物维持治疗。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- 无可展示记录。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估为诱导化疗疾病稳定（SD），原方案（洛铂+5-FU）继续第3程诱导化疗，随后再评估放疗指征。\nB. 评估为诱导化疗部分缓解（PR），原方案（洛铂+5-FU）继续第3程诱导化疗，以期达到完全缓解后放疗。\nC. 评估为诱导化疗部分缓解（PR），行鼻咽及颈部病灶根治性手术切除，术后辅助调强放射治疗。\nD. 评估为诱导化疗完全缓解（CR），暂缓放射治疗，进入定期随访观察阶段。\nE. 评估为诱导化疗部分缓解（PR），完善放疗前常规血液学检查，启动根治性调强放射治疗（IMRT）及放疗相关支持治疗。\nF. 评估为诱导化疗部分缓解（PR），启动根治性三维适形放射治疗（3D-CRT）及放疗相关支持治疗。\nG. 评估为诱导化疗疾病进展（PD），更改诱导化疗方案为吉西他滨+顺铂（GP），2程后再次评估。\nH. 评估为诱导化疗部分缓解（PR），行颈部淋巴结清扫术，术后行鼻咽局部调强放射治疗。\nI. 评估为诱导化疗部分缓解（PR），启动姑息性减症放射治疗，剂量控制在40Gy左右。\nJ. 评估为诱导化疗疾病稳定（SD），加用免疫检查点抑制剂联合原方案化疗。\nK. 评估为诱导化疗部分缓解（PR），等待4周后复查PET-CT，视代谢活性决定是否启动放射治疗。\nL. 评估为诱导化疗部分缓解（PR），停用化疗，单用靶向药物维持治疗。\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-c2aa48d510cb846f4ee51384","patient_id":"patient-5ee5dba6116030961a7a97b5","turn_id":"turn08","turn_position":7,"turn_type":"response_assessment_decision","gold_letter":"F","gold_action":"行电子鼻咽镜检查（不活检）评估局部情况，安排出院并予以镇痛、黏膜保护及雾化等对症药物。","options":[{"letter":"A","text":"行鼻咽部MRI及全身PET-CT全面评估疗效，若疑有残留即刻行局部挽救性手术。","is_gold":false},{"letter":"B","text":"行电子鼻咽镜检查并对原发灶区域行多点活检，明确病理缓解情况后决定是否追加化疗。","is_gold":false},{"letter":"C","text":"暂缓局部内镜检查，继续原方案洛铂单药辅助化疗2个周期后再行全面评估。","is_gold":false},{"letter":"D","text":"行电子鼻咽镜检查评估局部疗效，并继续住院行第3周期洛铂同期化疗。","is_gold":false},{"letter":"E","text":"直接安排出院，嘱3个月后返院行鼻咽镜及MRI检查，期间停用所有处方药物。","is_gold":false},{"letter":"F","text":"行电子鼻咽镜检查（不活检）评估局部情况，安排出院并予以镇痛、黏膜保护及雾化等对症药物。","is_gold":true},{"letter":"G","text":"行鼻咽部及颈部增强CT评估病灶退缩情况，若有残留予以局部追加放疗推量。","is_gold":false},{"letter":"H","text":"行电子鼻咽镜检查评估局部疗效，安排出院并立即开始PD-1抑制剂维持治疗半年。","is_gold":false},{"letter":"I","text":"行全身骨扫描及腹部超声评估远处转移情况，若阴性则安排出院并定期随访。","is_gold":false},{"letter":"J","text":"行电子鼻咽镜检查（不活检）评估局部情况，并转入头颈外科行右颈淋巴结清扫术。","is_gold":false},{"letter":"K","text":"安排出院并予以镇痛药物，1个月后返院行鼻咽镜下活检以明确是否达到病理完全缓解。","is_gold":false},{"letter":"L","text":"行鼻咽部MRI评估局部疗效，若达到完全缓解则安排出院并逐步停用所有镇痛药物。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 涕血半年伴右颈肿物2周；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 涕血半年伴右颈肿物2周；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D10] 入院记录: 主诉: 涕血半年伴右颈肿物2周.；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D3] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁增厚，可见软组织肿块形成，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。双侧咽隐窝见软组织占据，双侧咽旁脂肪间隙受压变窄，病灶侵犯双侧腭帆提肌。双侧腭帆张肌、头长肌未见受侵。 双侧翼腭窝、颞下窝未见异常；口咽双侧壁未见受累增厚，病变未累及后鼻孔。 双侧翼突基底内份、蝶骨基底部右份骨髓信号减低，增强可见轻度强化。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 双侧咽后间隙见肿大淋巴结，右侧大小约为7mm ×8 mm，左侧大小约3mm×4mm。双颈II区、III区见数个淋巴结，最大位于右颈II区，大小约为15mm×27mm。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽肿块，考虑鼻咽癌。 颅底骨质破坏。 右侧咽后及右颈淋巴结肿大，考虑转移瘤。 左侧咽后及左颈小淋巴结。 鼻窦炎、右乳突炎。\n- [全程D3] 检验组合: 平均红细胞体积(MCV)-静脉血: 93.7fL；凝血酶原时间活动度(PTA)-静脉血: 97%；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；中性粒细胞计数(Neut#)-静脉血: 3.610E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.7sec.；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；尿酸(UA)-静脉血: 413.6umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；血小板分布宽度(PDW)-静脉血: 14.7%；间接胆红素(IBIL)-静脉血: 9.7umolL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；丙氨酸氨基转移酶(ALT)-静脉血: 24U/L；碱性磷酸酶(ALP)-静脉血: 84.3U/L；总胆汁酸(TBA)-静脉血: 2.2umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.3mmol/L；葡萄糖(Glu)-静脉血: 4.51mmol/L；磷(P)-静脉血: 1.39mmol/L；C-反应蛋白(CRP)-静脉血: 4.68mg/L；血小板比容-静脉血: 25%；大血小板百分比(P-LCR%)-静脉血: 35.8%；血小板计数(PLT#)-静脉血: 21810E9/L；红细胞计数(RBC#)-静脉血: 4.5910E12/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；阴离子间隙(AG)-静脉血: 18；凝血酶时间(TT)-静脉血: 21.4sec.；红细胞比容(Hct)-静脉血: 43%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 344g/L；纤维蛋白原(Fbg)-静脉血: 3.09g/L；乳酸脱氢酶(LDH)-静脉血: 116.6U/L；总蛋白(TP)-静脉血: 69.58g/L；总钙(Ca)-静脉血: 2.31mmol/L；总胆固醇(TC)-静脉血: 5.94mmol/L；甘油三酯(TG)-静脉血: 1.79mmol/L；总胆红素(TBIL)-静脉血: 13.9umol/L；尿素氮(BUN……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D4] 检验组合: 乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D5] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶后壁及双侧壁粘膜增厚放射性浓聚，SUV约23.1；病灶填塞双侧鼻后孔，向上侵犯蝶骨基底部、双翼突基底部、犁骨及枕骨斜坡，局部骨质稍模糊放射性分布浓密。双侧破裂孔未见明显异常。双侧咽隐窝变浅。双侧咽旁间隙结构尚清。右侧咽后淋巴结放射性浓聚，SUV约11.4，大小约0.7×1.0cm；左侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见异常。筛窦、右上颌窦及右乳突稍低密度影放射性分布未见异常；额窦、蝶窦、左侧上颌窦及左乳突结构及放射性分布未见明显异常。口咽、喉咽未见明显异常。甲状腺放射性分布未见异常。双颈Ⅱ区肿大淋巴结放射性浓聚，SUV约10.2，最大约1.6×2.6cm；余双侧颈部未见肿大淋巴结及异常放射性分布。 双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺纹理清晰，双侧肺野未见确切病灶和异常放射性分布。气管、支气管通畅。心脏及大血管放射性分布未见异常。胸壁未见确切病灶和异常放射性分布。双肺门、纵隔及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏密度不均匀降低，放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管及胆总管未见扩张。胆囊、胃及十二指肠放射性分布未见异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、肠管等形态、结构及放射性分布未见明显异常。前列腺点状高密度影放射性分布未见异常。双侧髂血管旁及腹股沟未见明显肿大淋巴结及异常放射性分布。 余所见颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，病灶侵犯颅底骨；右咽后及双颈Ⅱ区淋巴结代谢较活跃，考虑转移。 鼻窦炎；右乳突炎。 脂肪肝。 前列腺钙化灶。\n- [全程D10] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: 右臂静脉插管, 导管末端位于胸椎右旁T 7上缘水平，估计位于上腔静脉下段。；检查结论: 导管末端位置如上述。\n- [全程D39] 检验组合: 胱抑素(Cys-C)-静脉血: 0.78mg/L；血小板比容-静脉血: 14.8%；中性粒细胞百分比(Neut%)-静脉血: 0.61；γ-谷氨酰基转移酶(GGT)-静脉血: 57.8U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；总蛋白(TP)-静脉血: 67.84g/L；平均红细胞体积(MCV)-静脉血: 96.4fL；镁离子(Mg2+)-静脉血: 0.92mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.05mmolL；钠离子(Na+)-静脉血: 139.4mmol/L；磷(P)-静脉血: 1.36mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.302；氯离子(Cl-)-静脉血: 103.4mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.54；平均红细胞血红蛋白含量(MCH)-静脉血: 32.7pg；平均血小板体积(MPV)-静脉血: 8.84fL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.59；钾离子(K+)-静脉血: 3.79mmol/L；单核细胞百分比(Mono%)-静脉血: 0.06；白细胞计数(WBC#)-静脉血: 5.4510E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；α-L-岩藻糖苷酶(AFU)-静脉血: 35.8U/L；血小板分布宽度(PDW)-静脉血: 16.9%；红细胞比容(Hct)-静脉血: 40.3%；乳酸脱氢酶(LDH)-静脉血: 149.5U/L；红细胞计数(RBC#)-静脉血: 4.1810E12/L；C-反应蛋白(CRP)-静脉血: 2.31mg/L；总钙(Ca)-静脉血: 2.19mmol/L；尿素氮(BUN)-静脉血: 3.8mmol/L；尿酸(UA)-静脉血: 285umol/L；阴离子间隙(AG)-静脉血: 11.3；葡萄糖(Glu)-静脉血: 4.38mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339.2g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 32.4U/L；甘油三酯(TG)-静脉血: 2.32mmol/L；白蛋白(ALB)-静脉血: 41.6g/L；血小板计数(PLT#)-静脉血: 167.……\n- [全程D45] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌2程化疗后，与某次就诊时间片对比： 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁增厚，可见软组织肿块形成，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，对比前片，较前明显缩小。双侧咽隐窝见软组织占据，双侧咽旁脂肪间隙受压变窄，病灶侵犯双侧腭帆提肌，范围较前稍缩小。双侧腭帆张肌、头长肌未见受侵。 双侧翼腭窝、颞下窝未见异常；口咽双侧壁未见受累增厚，病变未累及后鼻孔。 双侧翼突基底内份、蝶骨基底部右份骨髓信号减低，增强可见轻度强化。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 双侧咽后间隙见肿大淋巴结，右侧大小约为6mm ×7 mm，左侧大小约4mm×6mm。双颈II区、III区见数个淋巴结，最大位于右颈II区，大小约为11mm×24mm，较前明显缩小。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌2程化疗后： 鼻咽病灶较前明显缩小。 颅底骨质破坏。 双侧咽后及颈部淋巴结，较前明显缩小。 鼻窦炎、右乳突炎。\n- [全程D60] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 28.3U/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.1g/L；平均红细胞体积(MCV)-静脉血: 97.9fL；血液二氧化碳含量ctCO2(B)-静脉血: 22.6mmol/L；血小板计数(PLT#)-静脉血: 152.910E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；钾离子(K+)-静脉血: 4.2mmol/L；碱性磷酸酶(ALP)-静脉血: 76.4U/L；单核细胞百分比(Mono%)-静脉血: 0.073；γ-谷氨酰基转移酶(GGT)-静脉血: 46.4U/L；血红蛋白(Hb)-静脉血: 145.2g/L；胱抑素(Cys-C)-静脉血: 0.82mg/L；阴离子间隙(AG)-静脉血: 18；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；甘油三酯(TG)-静脉血: 1.57mmol/L；直接胆红素(DBIL)-静脉血: 6.7umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 345.2g/L；间接胆红素(IBIL)-静脉血: 17.9umolL；中性粒细胞百分比(Neut%)-静脉血: 0.676；乳酸脱氢酶(LDH)-静脉血: 132.5U/L；总蛋白(TP)-静脉血: 71.34g/L；总胆固醇(TC)-静脉血: 6.52mmol/L；总钙(Ca)-静脉血: 2.33mmol/L；血小板分布宽度(PDW)-静脉血: 16.9%；血小板比容-静脉血: 13%；尿酸(UA)-静脉血: 305.5umol/L；平均血小板体积(MPV)-静脉血: 8.53fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1%；淋巴细胞百分比(Lymph%)-静脉血: 0.221；钠离子(Na+)-静脉血: 139.5mmol/L；载脂蛋白B(apoB)-静脉血: 1.31g/L；有核红细胞百分比(NRBC%)-静脉血: 0；总胆汁酸(TBA)-静脉血: 3.6umol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总胆红素(TBIL)-静脉血: 24.6umol/L……\n- [全程D67] 检验组合: 平均红细胞血红蛋白浓度(MCHC)-静脉血: 349g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.5；血小板比容-静脉血: 12%；总蛋白(TP)-静脉血: 64.55g/L；镁离子(Mg2+)-静脉血: 0.9mmol/L；乳酸脱氢酶(LDH)-静脉血: 113.1U/L；总胆固醇(TC)-静脉血: 5.45mmol/L；葡萄糖(Glu)-静脉血: 4.72mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.5；钠离子(Na+)-静脉血: 142.5mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 33.4pg；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.022；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；总胆汁酸(TBA)-静脉血: 2.5umol/L；阴离子间隙(AG)-静脉血: 10；胱抑素(Cys-C)-静脉血: 0.75mg/L；间接胆红素(IBIL)-静脉血: 8.9umolL；钾离子(K+)-静脉血: 3.8mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 36.7U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；红细胞比容(Hct)-静脉血: 39%；血小板分布宽度(PDW)-静脉血: 12.4%；中性粒细胞百分比(Neut%)-静脉血: 0.753；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；球蛋白(GLO)-静脉血: 26.65g/L；甘油三酯(TG)-静脉血: 1.38mmol/L；碱性磷酸酶(ALP)-静脉血: 67.5U/L；白细胞计数(WBC#)-静脉血: 5.0810E9/L；总胆红素(TBIL)-静脉血: 13.1umol/L；单核细胞百分比(Mono%)-静脉血: 0.089；α-L-岩藻糖苷酶(AFU)-静脉血: 26U/L；尿酸(UA)-静脉血: 318.1umol/L；尿素氮(BUN)-静脉血: 3.21mmol/L；平均血小板体积(MPV)-静脉血: 10.4fL；载脂蛋白B(apoB)-静脉血: 1.08g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；血红蛋白(Hb)-静脉血: 136g/L；氯离子(Cl-)-静……\n- [全程D74] 检验组合: 有核红细胞计数(NRBC#)-静脉血: 010E9/L；乳酸脱氢酶(LDH)-静脉血: 120.6U/L；磷(P)-静脉血: 1.42mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.111；天门冬氨酸氨基转移酶(AST)-静脉血: 20.1U/L；直接胆红素(DBIL)-静脉血: 5.8umol/L；胱抑素(Cys-C)-静脉血: 0.73mg/L；血小板比容-静脉血: 12.1%；载脂蛋白AI(apoAI)-静脉血: 1.03g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；C-反应蛋白(CRP)-静脉血: 12.33mg/L；血红蛋白(Hb)-静脉血: 131.8g/L；尿素氮(BUN)-静脉血: 4.01mmol/L；载脂蛋白B(apoB)-静脉血: 1.28g/L；甘油三酯(TG)-静脉血: 1.16mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 34pg；单核细胞百分比(Mono%)-静脉血: 0.103；总钙(Ca)-静脉血: 2.21mmol/L；红细胞计数(RBC#)-静脉血: 3.8710E12/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；尿酸(UA)-静脉血: 319.8umol/L；总胆红素(TBIL)-静脉血: 18.5umol/L；钠离子(Na+)-静脉血: 140.1mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.11mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347.8g/L；中性粒细胞百分比(Neut%)-静脉血: 0.746；红细胞比容(Hct)-静脉血: 37.8%；血小板分布宽度(PDW)-静脉血: 16.7%；球蛋白(GLO)-静脉血: 21.96g/L；肌酐(Crea)-静脉血: 61.6umol/L；总胆汁酸(TBA)-静脉血: 3.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 34.1U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.01mmolL；碱性磷酸酶(ALP)-静脉血: 65.6U/L；葡萄糖(Glu)-静脉血: 5.14mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.036；嗜碱性粒细胞计数(B……\n- [全程D81] 检验组合: 红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.6；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.77；平均红细胞体积(MCV)-静脉血: 95.3fL；直接胆红素(DBIL)-静脉血: 6.5umol/L；平均血小板体积(MPV)-静脉血: 10fL；大血小板百分比(P-LCR%)-静脉血: 25.7%；白蛋白(ALB)-静脉血: 41.6g/L；肌酐(Crea)-静脉血: 53.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.75；钠离子(Na+)-静脉血: 137.9mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.7U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7；间接胆红素(IBIL)-静脉血: 17.4umolL；球蛋白(GLO)-静脉血: 23.48g/L；总胆固醇(TC)-静脉血: 5.17mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.833；胱抑素(Cys-C)-静脉血: 0.67mg/L；乳酸脱氢酶(LDH)-静脉血: 137.4U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.51mmol/L；血小板分布宽度(PDW)-静脉血: 11.9%；白细胞计数(WBC#)-静脉血: 3.7810E9/L；载脂蛋白B(apoB)-静脉血: 1.17g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 38.7U/L；中性粒细胞计数(Neut#)-静脉血: 3.210E9/L；总胆红素(TBIL)-静脉血: 23.9umol/L；阴离子间隙(AG)-静脉血: 11.3；α-L-岩藻糖苷酶(AFU)-静脉血: 30.5U/L；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；血小板比容-静脉血: 15%；C-反应蛋白(CRP)-静脉血: 15.45mg/L；氯离子(Cl-)-静脉血: 100.4mmol/L；总胆汁酸(TBA)-静脉血: 1.2umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.024；尿素氮(BUN)-静脉血: 4.4mmol/L；血红蛋白(Hb)-静脉血: 134g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.8U/L；单核细胞计数(……\n- [全程D88] 检验组合: C-反应蛋白(CRP)-静脉血: 7.88mg/L；甘油三酯(TG)-静脉血: 1.18mmol/L；平均红细胞体积(MCV)-静脉血: 96.4fL；载脂蛋白B(apoB)-静脉血: 1.03g/L；血小板计数(PLT#)-静脉血: 92.910E9/L；总胆红素(TBIL)-静脉血: 29umol/L；中性粒细胞计数(Neut#)-静脉血: 2.810E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 30.3U/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；葡萄糖(Glu)-静脉血: 4.55mmol/L；总胆汁酸(TBA)-静脉血: 2.3umol/L；血小板比容-静脉血: 7.5%；红细胞比容(Hct)-静脉血: 32.9%；中性粒细胞百分比(Neut%)-静脉血: 0.784；载脂蛋白AI(apoAI)-静脉血: 0.93g/L；血红蛋白(Hb)-静脉血: 117.2g/L；间接胆红素(IBIL)-静脉血: 20.4umolL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；白细胞计数(WBC#)-静脉血: 3.5310E9/L；总胆固醇(TC)-静脉血: 4.84mmol/L；总钙(Ca)-静脉血: 2.27mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；平均红细胞血红蛋白含量(MCH)-静脉血: 34.2pg；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总蛋白(TP)-静脉血: 62g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.86mmolL；单核细胞计数(Mono#)-静脉血: 0.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.108；直接胆红素(DBIL)-静脉血: 8.6umol/L；钠离子(Na+)-静脉血: 141mmol/L；镁离子(Mg2+)-静脉血: 0.94mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.088；钾离子(K+)-静脉血: 4.2mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 48.3U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；尿酸(UA)-静脉血: 281.5umol/L；白蛋白(ALB)-静……\n- [全程D94] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理清晰，走行自然，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影形态、大小未见异常。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见异常。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D34] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者今日洛铂+5-FU化疗第2天，诉食欲较差，无恶心、呕吐等不适，精神、睡眠尚可，大小便正常。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者化疗第2日，一般情况可，嘱患者注意饮食，加强营养，续行化疗。密切观察化疗反应，必要时加强处理。现已按查房指示执行。\n- [全程D35] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者今日洛铂+5-FU化疗第3天，诉食欲较差，无恶心、呕吐等不适，精神、睡眠尚可，大小便正常。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者化疗第3日，一般情况可，密切观察化疗反应，必要时加强处理。现已按查房指示执行。\n- [全程D39] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者计划于今日完成第2程洛铂+5-FU方案诱导化疗，未诉特殊不适。[姓名已隐去]主诊医生信息已隐藏：患者现完成第2程洛铂+5-FU方案诱导化疗，一般情况可，予今日出院。嘱患者出院后定期每周复查血常规、肝肾功能，2周后返院续治。现已按查房指示执行。\n- [时间未明] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 现已按查房指示执行。\n- [全程D55] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者未诉特殊不适，饮食、睡眠、精神尚可，大小便正常。查体：基本同前。[姓名已隐去]主诊医生信息已隐藏：患者诊断明确，已完成患者靶区设计，并通过全科会诊，剂量分布均匀，予GTVnx:70Gy/30F,GTVnd(L):66Gy/30F,GTVnd(R):66Gy/30F。考虑联合洛铂同期放化疗，告知患者放疗及化疗的可能获益及相关风险，患者表示已知情并同意。续观。现已按查房指示执行。\n- [全程D56] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现放疗1F，未诉特殊不适。生命体征平稳。查体情况大致同前。[姓名已隐去]主诊医生信息已隐藏：考虑患者一般情况可，继续放疗，密切关注放疗副反应，必要时加强处理。现已按查房指示执行。\n- [全程D71] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现放疗13F，诉口干，轻微咽痛，偶有咳嗽，食欲欠佳，无恶心、呕吐等不适，精神、睡眠欠佳，大小便正常。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者放疗初期出现口腔粘膜反应，予止咳、止痛等对症处理，继续放疗，密切关注放疗副反应，定期复查血常规，必要时加强处理。现已按查房指示执行。\n- [全程D76] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现放疗16F，DDP同期化疗第1日，诉咽痛较前加重，偶有咳嗽，食欲欠佳，无恶心、呕吐等不适，精神、睡眠欠佳，大小便正常。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者咽痛较前加重，予加强止痛。患者今日洛铂同期化疗第1日，密切观察化疗反应，加强止呕处理，注意放化疗叠加副反应，继续喷喉、洗鼻等对症处理，续行放疗。现已按查房指示执行。\n- [全程D91] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现放疗26F，诉口干，咽痛较前明显，食欲较前变差，余无不适，精神、睡眠一般。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者现于同时期放化疗中，放射性口腔粘膜反应1度，予止痛、静脉营养支持等加强处理，继续予喷喉、洗鼻等对症处理，定期复查血常规，续行放疗。现已按查房指示执行。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行鼻咽部MRI及全身PET-CT全面评估疗效，若疑有残留即刻行局部挽救性手术。\nB. 行电子鼻咽镜检查并对原发灶区域行多点活检，明确病理缓解情况后决定是否追加化疗。\nC. 暂缓局部内镜检查，继续原方案洛铂单药辅助化疗2个周期后再行全面评估。\nD. 行电子鼻咽镜检查评估局部疗效，并继续住院行第3周期洛铂同期化疗。\nE. 直接安排出院，嘱3个月后返院行鼻咽镜及MRI检查，期间停用所有处方药物。\nF. 行电子鼻咽镜检查（不活检）评估局部情况，安排出院并予以镇痛、黏膜保护及雾化等对症药物。\nG. 行鼻咽部及颈部增强CT评估病灶退缩情况，若有残留予以局部追加放疗推量。\nH. 行电子鼻咽镜检查评估局部疗效，安排出院并立即开始PD-1抑制剂维持治疗半年。\nI. 行全身骨扫描及腹部超声评估远处转移情况，若阴性则安排出院并定期随访。\nJ. 行电子鼻咽镜检查（不活检）评估局部情况，并转入头颈外科行右颈淋巴结清扫术。\nK. 安排出院并予以镇痛药物，1个月后返院行鼻咽镜下活检以明确是否达到病理完全缓解。\nL. 行鼻咽部MRI评估局部疗效，若达到完全缓解则安排出院并逐步停用所有镇痛药物。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D67] 检验组合: 平均红细胞血红蛋白浓度(MCHC)-静脉血: 349g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.5；血小板比容-静脉血: 12%；总蛋白(TP)-静脉血: 64.55g/L；镁离子(Mg2+)-静脉血: 0.9mmol/L；乳酸脱氢酶(LDH)-静脉血: 113.1U/L；总胆固醇(TC)-静脉血: 5.45mmol/L；葡萄糖(Glu)-静脉血: 4.72mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.5；钠离子(Na+)-静脉血: 142.5mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 33.4pg；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.022；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；总胆汁酸(TBA)-静脉血: 2.5umol/L；阴离子间隙(AG)-静脉血: 10；胱抑素(Cys-C)-静脉血: 0.75mg/L；间接胆红素(IBIL)-静脉血: 8.9umolL；钾离子(K+)-静脉血: 3.8mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 36.7U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；红细胞比容(Hct)-静脉血: 39%；血小板分布宽度(PDW)-静脉血: 12.4%；中性粒细胞百分比(Neut%)-静脉血: 0.753；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；球蛋白(GLO)-静脉血: 26.65g/L；甘油三酯(TG)-静脉血: 1.38mmol/L；碱性磷酸酶(ALP)-静脉血: 67.5U/L；白细胞计数(WBC#)-静脉血: 5.0810E9/L；总胆红素(TBIL)-静脉血: 13.1umol/L；单核细胞百分比(Mono%)-静脉血: 0.089；α-L-岩藻糖苷酶(AFU)-静脉血: 26U/L；尿酸(UA)-静脉血: 318.1umol/L；尿素氮(BUN)-静脉血: 3.21mmol/L；平均血小板体积(MPV)-静脉血: 10.4fL；载脂蛋白B(apoB)-静脉血: 1.08g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；血红蛋白(Hb)-静脉血: 136g/L；氯离子(Cl-)-静……\n- [全程D74] 检验组合: 有核红细胞计数(NRBC#)-静脉血: 010E9/L；乳酸脱氢酶(LDH)-静脉血: 120.6U/L；磷(P)-静脉血: 1.42mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.111；天门冬氨酸氨基转移酶(AST)-静脉血: 20.1U/L；直接胆红素(DBIL)-静脉血: 5.8umol/L；胱抑素(Cys-C)-静脉血: 0.73mg/L；血小板比容-静脉血: 12.1%；载脂蛋白AI(apoAI)-静脉血: 1.03g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；C-反应蛋白(CRP)-静脉血: 12.33mg/L；血红蛋白(Hb)-静脉血: 131.8g/L；尿素氮(BUN)-静脉血: 4.01mmol/L；载脂蛋白B(apoB)-静脉血: 1.28g/L；甘油三酯(TG)-静脉血: 1.16mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 34pg；单核细胞百分比(Mono%)-静脉血: 0.103；总钙(Ca)-静脉血: 2.21mmol/L；红细胞计数(RBC#)-静脉血: 3.8710E12/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；尿酸(UA)-静脉血: 319.8umol/L；总胆红素(TBIL)-静脉血: 18.5umol/L；钠离子(Na+)-静脉血: 140.1mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.11mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347.8g/L；中性粒细胞百分比(Neut%)-静脉血: 0.746；红细胞比容(Hct)-静脉血: 37.8%；血小板分布宽度(PDW)-静脉血: 16.7%；球蛋白(GLO)-静脉血: 21.96g/L；肌酐(Crea)-静脉血: 61.6umol/L；总胆汁酸(TBA)-静脉血: 3.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 34.1U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.01mmolL；碱性磷酸酶(ALP)-静脉血: 65.6U/L；葡萄糖(Glu)-静脉血: 5.14mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.036；嗜碱性粒细胞计数(B……\n- [全程D81] 检验组合: 红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.6；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.77；平均红细胞体积(MCV)-静脉血: 95.3fL；直接胆红素(DBIL)-静脉血: 6.5umol/L；平均血小板体积(MPV)-静脉血: 10fL；大血小板百分比(P-LCR%)-静脉血: 25.7%；白蛋白(ALB)-静脉血: 41.6g/L；肌酐(Crea)-静脉血: 53.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.75；钠离子(Na+)-静脉血: 137.9mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.7U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7；间接胆红素(IBIL)-静脉血: 17.4umolL；球蛋白(GLO)-静脉血: 23.48g/L；总胆固醇(TC)-静脉血: 5.17mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.833；胱抑素(Cys-C)-静脉血: 0.67mg/L；乳酸脱氢酶(LDH)-静脉血: 137.4U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.51mmol/L；血小板分布宽度(PDW)-静脉血: 11.9%；白细胞计数(WBC#)-静脉血: 3.7810E9/L；载脂蛋白B(apoB)-静脉血: 1.17g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 38.7U/L；中性粒细胞计数(Neut#)-静脉血: 3.210E9/L；总胆红素(TBIL)-静脉血: 23.9umol/L；阴离子间隙(AG)-静脉血: 11.3；α-L-岩藻糖苷酶(AFU)-静脉血: 30.5U/L；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；血小板比容-静脉血: 15%；C-反应蛋白(CRP)-静脉血: 15.45mg/L；氯离子(Cl-)-静脉血: 100.4mmol/L；总胆汁酸(TBA)-静脉血: 1.2umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.024；尿素氮(BUN)-静脉血: 4.4mmol/L；血红蛋白(Hb)-静脉血: 134g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.8U/L；单核细胞计数(……\n- [全程D88] 检验组合: C-反应蛋白(CRP)-静脉血: 7.88mg/L；甘油三酯(TG)-静脉血: 1.18mmol/L；平均红细胞体积(MCV)-静脉血: 96.4fL；载脂蛋白B(apoB)-静脉血: 1.03g/L；血小板计数(PLT#)-静脉血: 92.910E9/L；总胆红素(TBIL)-静脉血: 29umol/L；中性粒细胞计数(Neut#)-静脉血: 2.810E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 30.3U/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；葡萄糖(Glu)-静脉血: 4.55mmol/L；总胆汁酸(TBA)-静脉血: 2.3umol/L；血小板比容-静脉血: 7.5%；红细胞比容(Hct)-静脉血: 32.9%；中性粒细胞百分比(Neut%)-静脉血: 0.784；载脂蛋白AI(apoAI)-静脉血: 0.93g/L；血红蛋白(Hb)-静脉血: 117.2g/L；间接胆红素(IBIL)-静脉血: 20.4umolL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；白细胞计数(WBC#)-静脉血: 3.5310E9/L；总胆固醇(TC)-静脉血: 4.84mmol/L；总钙(Ca)-静脉血: 2.27mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；平均红细胞血红蛋白含量(MCH)-静脉血: 34.2pg；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总蛋白(TP)-静脉血: 62g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.86mmolL；单核细胞计数(Mono#)-静脉血: 0.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.108；直接胆红素(DBIL)-静脉血: 8.6umol/L；钠离子(Na+)-静脉血: 141mmol/L；镁离子(Mg2+)-静脉血: 0.94mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.088；钾离子(K+)-静脉血: 4.2mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 48.3U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；尿酸(UA)-静脉血: 281.5umol/L；白蛋白(ALB)-静……\n- [全程D94] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理清晰，走行自然，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影形态、大小未见异常。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见异常。\n\n【既往治疗与反应】\n- [全程D71] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现放疗13F，诉口干，轻微咽痛，偶有咳嗽，食欲欠佳，无恶心、呕吐等不适，精神、睡眠欠佳，大小便正常。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者放疗初期出现口腔粘膜反应，予止咳、止痛等对症处理，继续放疗，密切关注放疗副反应，定期复查血常规，必要时加强处理。现已按查房指示执行。\n- [全程D76] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现放疗16F，DDP同期化疗第1日，诉咽痛较前加重，偶有咳嗽，食欲欠佳，无恶心、呕吐等不适，精神、睡眠欠佳，大小便正常。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者咽痛较前加重，予加强止痛。患者今日洛铂同期化疗第1日，密切观察化疗反应，加强止呕处理，注意放化疗叠加副反应，继续喷喉、洗鼻等对症处理，续行放疗。现已按查房指示执行。\n- [全程D91] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现放疗26F，诉口干，咽痛较前明显，食欲较前变差，余无不适，精神、睡眠一般。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者现于同时期放化疗中，放射性口腔粘膜反应1度，予止痛、静脉营养支持等加强处理，继续予喷喉、洗鼻等对症处理，定期复查血常规，续行放疗。现已按查房指示执行。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行鼻咽部MRI及全身PET-CT全面评估疗效，若疑有残留即刻行局部挽救性手术。\nB. 行电子鼻咽镜检查并对原发灶区域行多点活检，明确病理缓解情况后决定是否追加化疗。\nC. 暂缓局部内镜检查，继续原方案洛铂单药辅助化疗2个周期后再行全面评估。\nD. 行电子鼻咽镜检查评估局部疗效，并继续住院行第3周期洛铂同期化疗。\nE. 直接安排出院，嘱3个月后返院行鼻咽镜及MRI检查，期间停用所有处方药物。\nF. 行电子鼻咽镜检查（不活检）评估局部情况，安排出院并予以镇痛、黏膜保护及雾化等对症药物。\nG. 行鼻咽部及颈部增强CT评估病灶退缩情况，若有残留予以局部追加放疗推量。\nH. 行电子鼻咽镜检查评估局部疗效，安排出院并立即开始PD-1抑制剂维持治疗半年。\nI. 行全身骨扫描及腹部超声评估远处转移情况，若阴性则安排出院并定期随访。\nJ. 行电子鼻咽镜检查（不活检）评估局部情况，并转入头颈外科行右颈淋巴结清扫术。\nK. 安排出院并予以镇痛药物，1个月后返院行鼻咽镜下活检以明确是否达到病理完全缓解。\nL. 行鼻咽部MRI评估局部疗效，若达到完全缓解则安排出院并逐步停用所有镇痛药物。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D67] 检验组合: 平均红细胞血红蛋白浓度(MCHC)-静脉血: 349g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.5；血小板比容-静脉血: 12%；总蛋白(TP)-静脉血: 64.55g/L；镁离子(Mg2+)-静脉血: 0.9mmol/L；乳酸脱氢酶(LDH)-静脉血: 113.1U/L；总胆固醇(TC)-静脉血: 5.45mmol/L；葡萄糖(Glu)-静脉血: 4.72mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.5；钠离子(Na+)-静脉血: 142.5mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 33.4pg；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.022；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；总胆汁酸(TBA)-静脉血: 2.5umol/L；阴离子间隙(AG)-静脉血: 10；胱抑素(Cys-C)-静脉血: 0.75mg/L；间接胆红素(IBIL)-静脉血: 8.9umolL；钾离子(K+)-静脉血: 3.8mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 36.7U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；红细胞比容(Hct)-静脉血: 39%；血小板分布宽度(PDW)-静脉血: 12.4%；中性粒细胞百分比(Neut%)-静脉血: 0.753；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；球蛋白(GLO)-静脉血: 26.65g/L；甘油三酯(TG)-静脉血: 1.38mmol/L；碱性磷酸酶(ALP)-静脉血: 67.5U/L；白细胞计数(WBC#)-静脉血: 5.0810E9/L；总胆红素(TBIL)-静脉血: 13.1umol/L；单核细胞百分比(Mono%)-静脉血: 0.089；α-L-岩藻糖苷酶(AFU)-静脉血: 26U/L；尿酸(UA)-静脉血: 318.1umol/L；尿素氮(BUN)-静脉血: 3.21mmol/L；平均血小板体积(MPV)-静脉血: 10.4fL；载脂蛋白B(apoB)-静脉血: 1.08g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；血红蛋白(Hb)-静脉血: 136g/L；氯离子(Cl-)-静……\n- [全程D74] 检验组合: 有核红细胞计数(NRBC#)-静脉血: 010E9/L；乳酸脱氢酶(LDH)-静脉血: 120.6U/L；磷(P)-静脉血: 1.42mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.111；天门冬氨酸氨基转移酶(AST)-静脉血: 20.1U/L；直接胆红素(DBIL)-静脉血: 5.8umol/L；胱抑素(Cys-C)-静脉血: 0.73mg/L；血小板比容-静脉血: 12.1%；载脂蛋白AI(apoAI)-静脉血: 1.03g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；C-反应蛋白(CRP)-静脉血: 12.33mg/L；血红蛋白(Hb)-静脉血: 131.8g/L；尿素氮(BUN)-静脉血: 4.01mmol/L；载脂蛋白B(apoB)-静脉血: 1.28g/L；甘油三酯(TG)-静脉血: 1.16mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 34pg；单核细胞百分比(Mono%)-静脉血: 0.103；总钙(Ca)-静脉血: 2.21mmol/L；红细胞计数(RBC#)-静脉血: 3.8710E12/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；尿酸(UA)-静脉血: 319.8umol/L；总胆红素(TBIL)-静脉血: 18.5umol/L；钠离子(Na+)-静脉血: 140.1mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.11mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347.8g/L；中性粒细胞百分比(Neut%)-静脉血: 0.746；红细胞比容(Hct)-静脉血: 37.8%；血小板分布宽度(PDW)-静脉血: 16.7%；球蛋白(GLO)-静脉血: 21.96g/L；肌酐(Crea)-静脉血: 61.6umol/L；总胆汁酸(TBA)-静脉血: 3.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 34.1U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.01mmolL；碱性磷酸酶(ALP)-静脉血: 65.6U/L；葡萄糖(Glu)-静脉血: 5.14mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.036；嗜碱性粒细胞计数(B……\n- [全程D81] 检验组合: 红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.6；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.77；平均红细胞体积(MCV)-静脉血: 95.3fL；直接胆红素(DBIL)-静脉血: 6.5umol/L；平均血小板体积(MPV)-静脉血: 10fL；大血小板百分比(P-LCR%)-静脉血: 25.7%；白蛋白(ALB)-静脉血: 41.6g/L；肌酐(Crea)-静脉血: 53.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.75；钠离子(Na+)-静脉血: 137.9mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.7U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7；间接胆红素(IBIL)-静脉血: 17.4umolL；球蛋白(GLO)-静脉血: 23.48g/L；总胆固醇(TC)-静脉血: 5.17mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.833；胱抑素(Cys-C)-静脉血: 0.67mg/L；乳酸脱氢酶(LDH)-静脉血: 137.4U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.51mmol/L；血小板分布宽度(PDW)-静脉血: 11.9%；白细胞计数(WBC#)-静脉血: 3.7810E9/L；载脂蛋白B(apoB)-静脉血: 1.17g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 38.7U/L；中性粒细胞计数(Neut#)-静脉血: 3.210E9/L；总胆红素(TBIL)-静脉血: 23.9umol/L；阴离子间隙(AG)-静脉血: 11.3；α-L-岩藻糖苷酶(AFU)-静脉血: 30.5U/L；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；血小板比容-静脉血: 15%；C-反应蛋白(CRP)-静脉血: 15.45mg/L；氯离子(Cl-)-静脉血: 100.4mmol/L；总胆汁酸(TBA)-静脉血: 1.2umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.024；尿素氮(BUN)-静脉血: 4.4mmol/L；血红蛋白(Hb)-静脉血: 134g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.8U/L；单核细胞计数(……\n- [全程D88] 检验组合: C-反应蛋白(CRP)-静脉血: 7.88mg/L；甘油三酯(TG)-静脉血: 1.18mmol/L；平均红细胞体积(MCV)-静脉血: 96.4fL；载脂蛋白B(apoB)-静脉血: 1.03g/L；血小板计数(PLT#)-静脉血: 92.910E9/L；总胆红素(TBIL)-静脉血: 29umol/L；中性粒细胞计数(Neut#)-静脉血: 2.810E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 30.3U/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；葡萄糖(Glu)-静脉血: 4.55mmol/L；总胆汁酸(TBA)-静脉血: 2.3umol/L；血小板比容-静脉血: 7.5%；红细胞比容(Hct)-静脉血: 32.9%；中性粒细胞百分比(Neut%)-静脉血: 0.784；载脂蛋白AI(apoAI)-静脉血: 0.93g/L；血红蛋白(Hb)-静脉血: 117.2g/L；间接胆红素(IBIL)-静脉血: 20.4umolL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；白细胞计数(WBC#)-静脉血: 3.5310E9/L；总胆固醇(TC)-静脉血: 4.84mmol/L；总钙(Ca)-静脉血: 2.27mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；平均红细胞血红蛋白含量(MCH)-静脉血: 34.2pg；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总蛋白(TP)-静脉血: 62g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.86mmolL；单核细胞计数(Mono#)-静脉血: 0.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.108；直接胆红素(DBIL)-静脉血: 8.6umol/L；钠离子(Na+)-静脉血: 141mmol/L；镁离子(Mg2+)-静脉血: 0.94mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.088；钾离子(K+)-静脉血: 4.2mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 48.3U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；尿酸(UA)-静脉血: 281.5umol/L；白蛋白(ALB)-静……\n- [全程D94] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理清晰，走行自然，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影形态、大小未见异常。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见异常。\n\n【既往治疗与反应】\n- [全程D71] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现放疗13F，诉口干，轻微咽痛，偶有咳嗽，食欲欠佳，无恶心、呕吐等不适，精神、睡眠欠佳，大小便正常。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者放疗初期出现口腔粘膜反应，予止咳、止痛等对症处理，继续放疗，密切关注放疗副反应，定期复查血常规，必要时加强处理。现已按查房指示执行。\n- [全程D76] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现放疗16F，DDP同期化疗第1日，诉咽痛较前加重，偶有咳嗽，食欲欠佳，无恶心、呕吐等不适，精神、睡眠欠佳，大小便正常。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者咽痛较前加重，予加强止痛。患者今日洛铂同期化疗第1日，密切观察化疗反应，加强止呕处理，注意放化疗叠加副反应，继续喷喉、洗鼻等对症处理，续行放疗。现已按查房指示执行。\n- [全程D91] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现放疗26F，诉口干，咽痛较前明显，食欲较前变差，余无不适，精神、睡眠一般。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者现于同时期放化疗中，放射性口腔粘膜反应1度，予止痛、静脉营养支持等加强处理，继续予喷喉、洗鼻等对症处理，定期复查血常规，续行放疗。现已按查房指示执行。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行鼻咽部MRI及全身PET-CT全面评估疗效，若疑有残留即刻行局部挽救性手术。\nB. 行电子鼻咽镜检查并对原发灶区域行多点活检，明确病理缓解情况后决定是否追加化疗。\nC. 暂缓局部内镜检查，继续原方案洛铂单药辅助化疗2个周期后再行全面评估。\nD. 行电子鼻咽镜检查评估局部疗效，并继续住院行第3周期洛铂同期化疗。\nE. 直接安排出院，嘱3个月后返院行鼻咽镜及MRI检查，期间停用所有处方药物。\nF. 行电子鼻咽镜检查（不活检）评估局部情况，安排出院并予以镇痛、黏膜保护及雾化等对症药物。\nG. 行鼻咽部及颈部增强CT评估病灶退缩情况，若有残留予以局部追加放疗推量。\nH. 行电子鼻咽镜检查评估局部疗效，安排出院并立即开始PD-1抑制剂维持治疗半年。\nI. 行全身骨扫描及腹部超声评估远处转移情况，若阴性则安排出院并定期随访。\nJ. 行电子鼻咽镜检查（不活检）评估局部情况，并转入头颈外科行右颈淋巴结清扫术。\nK. 安排出院并予以镇痛药物，1个月后返院行鼻咽镜下活检以明确是否达到病理完全缓解。\nL. 行鼻咽部MRI评估局部疗效，若达到完全缓解则安排出院并逐步停用所有镇痛药物。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"episode_id":"episode-7187823cea44ad86a069561b","patient_id":"patient-f402aced5926698da3194c37","care_turn_count":6,"turns":[{"sample_id":"sample-6a54e1ca8d841063a11b801b","patient_id":"patient-f402aced5926698da3194c37","turn_id":"turn01","turn_position":1,"turn_type":"initial_workup_choice","gold_letter":"G","gold_action":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT显像，常规血液学、心电图与心脏彩超检查。","options":[{"letter":"A","text":"电子鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸部及腹部CT平扫，常规血液学检查。","is_gold":false},{"letter":"B","text":"颈部淋巴结切除活检，鼻咽及颈部MRI平扫+增强，全身PET/CT显像，常规血液学检查。","is_gold":false},{"letter":"C","text":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，颈部超声，暂缓全身影像学分期。","is_gold":false},{"letter":"D","text":"鼻咽及颈部MRI平扫+增强，全身PET/CT显像，先行诱导化疗待肿瘤缩小后行鼻咽活检。","is_gold":false},{"letter":"E","text":"电子鼻咽镜检查及活检，鼻咽MRI平扫+增强，胸部X线，腹部超声，全身骨显像。","is_gold":false},{"letter":"F","text":"颈部淋巴结细针穿刺活检，鼻咽及颈部CT平扫+增强，全身PET/CT显像，常规血液学检查。","is_gold":false},{"letter":"G","text":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT显像，常规血液学、心电图与心脏彩超检查。","is_gold":true},{"letter":"H","text":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸腹部CT平扫+增强，免除全身骨显像。","is_gold":false},{"letter":"I","text":"电子鼻咽镜检查及活检，头颅MRI平扫+增强，颈部超声，全身PET/CT显像，常规血液学检查。","is_gold":false},{"letter":"J","text":"鼻咽刷片细胞学检查，鼻咽及颈部MRI平扫+增强，全身PET/CT显像，常规血液学检查。","is_gold":false},{"letter":"K","text":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫，全身PET/CT显像，常规血液学检查。","is_gold":false},{"letter":"L","text":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT显像，同步安排根治性放疗定位。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左颈肿物20余天；现病史: 20余天前患者无明显诱因自觉左颈肿物，无发热、疼痛，伴涕血、左耳堵塞感。无头痛、面麻、鼻塞、复视、张口困难等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左耳闷胀感,涕血,左颈肿物；既往史: 高血压10余年，规律服药，血压控制在130/80mmHg左右。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:穿山甲壳、蜂蛹、伟哥过敏。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 大儿子患“脑胶质瘤”，已病逝。；体格检查: T：36.4℃，P：66次/分，R：20次/分，BP：134/81mmHg,Ht：175cm，Wt：84kg，BSA：2.0m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 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多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左颈肿物20余天；现病史: 20余天前患者无明显诱因自觉左颈肿物，无发热、疼痛，伴涕血、左耳堵塞感。无头痛、面麻、鼻塞、复视、张口困难等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左耳闷胀感,涕血,左颈肿物；既往史: 高血压10余年，规律服药，血压控制在130/80mmHg左右。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:穿山甲壳、蜂蛹、伟哥过敏。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 大儿子患“脑胶质瘤”，已病逝。；体格检查: T：36.4℃，P：66次/分，R：20次/分，BP：134/81mmHg,Ht：175cm，Wt：84kg，BSA：2.0m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 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阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽顶后壁、左侧壁结节状肿物；双侧颈部II区可扪及1个淋巴结，最大径6×5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 电子鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸部及腹部CT平扫，常规血液学检查。\nB. 颈部淋巴结切除活检，鼻咽及颈部MRI平扫+增强，全身PET/CT显像，常规血液学检查。\nC. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，颈部超声，暂缓全身影像学分期。\nD. 鼻咽及颈部MRI平扫+增强，全身PET/CT显像，先行诱导化疗待肿瘤缩小后行鼻咽活检。\nE. 电子鼻咽镜检查及活检，鼻咽MRI平扫+增强，胸部X线，腹部超声，全身骨显像。\nF. 颈部淋巴结细针穿刺活检，鼻咽及颈部CT平扫+增强，全身PET/CT显像，常规血液学检查。\nG. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT显像，常规血液学、心电图与心脏彩超检查。\nH. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸腹部CT平扫+增强，免除全身骨显像。\nI. 电子鼻咽镜检查及活检，头颅MRI平扫+增强，颈部超声，全身PET/CT显像，常规血液学检查。\nJ. 鼻咽刷片细胞学检查，鼻咽及颈部MRI平扫+增强，全身PET/CT显像，常规血液学检查。\nK. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫，全身PET/CT显像，常规血液学检查。\nL. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT显像，同步安排根治性放疗定位。\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-1d99d3a2f71afa9bcb3f941a","patient_id":"patient-f402aced5926698da3194c37","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"H","gold_action":"行鼻咽内镜组织活检，完善鼻咽及颈部MRI平扫+增强，查乙肝病毒DNA定量","options":[{"letter":"A","text":"行颈部淋巴结细针穿刺活检，完善鼻咽及颈部CT平扫+增强，查乙肝病毒DNA定量","is_gold":false},{"letter":"B","text":"行鼻咽内镜组织活检，完善鼻咽及颈部CT平扫+增强，查乙肝病毒DNA定量","is_gold":false},{"letter":"C","text":"行鼻咽内镜组织活检，完善鼻咽及颈部MRI平扫+增强，暂不查乙肝病毒DNA定量","is_gold":false},{"letter":"D","text":"行颈部淋巴结切除活检，完善鼻咽及颈部MRI平扫+增强，查乙肝病毒DNA定量","is_gold":false},{"letter":"E","text":"行鼻咽内镜组织活检，完善鼻咽及颈部CT平扫+增强，查丙肝病毒RNA定量","is_gold":false},{"letter":"F","text":"行鼻咽内镜组织活检，完善头颅MRI平扫+增强，查乙肝病毒DNA定量","is_gold":false},{"letter":"G","text":"行颈部淋巴结细针穿刺活检，完善鼻咽及颈部MRI平扫+增强，暂不查乙肝病毒DNA定量","is_gold":false},{"letter":"H","text":"行鼻咽内镜组织活检，完善鼻咽及颈部MRI平扫+增强，查乙肝病毒DNA定量","is_gold":true},{"letter":"I","text":"行鼻咽内镜组织活检及颈部淋巴结穿刺活检，完善鼻咽及颈部MRI平扫+增强","is_gold":false},{"letter":"J","text":"行鼻咽内镜组织活检，完善鼻咽及颈部MRI平扫+增强，查丙肝病毒RNA定量","is_gold":false},{"letter":"K","text":"行鼻咽内镜组织活检，完善颈部超声造影，查乙肝病毒DNA定量","is_gold":false},{"letter":"L","text":"行鼻咽内镜组织活检，完善全身骨扫描，查乙肝病毒DNA定量","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左颈肿物20余天；现病史: 20余天前患者无明显诱因自觉左颈肿物，无发热、疼痛，伴涕血、左耳堵塞感。无头痛、面麻、鼻塞、复视、张口困难等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左耳闷胀感,涕血,左颈肿物；既往史: 高血压10余年，规律服药，血压控制在130/80mmHg左右。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:穿山甲壳、蜂蛹、伟哥过敏。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 大儿子患“脑胶质瘤”，已病逝。；体格检查: T：36.4℃，P：66次/分，R：20次/分，BP：134/81mmHg,Ht：175cm，Wt：84kg，BSA：2.0m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽顶后壁、左侧壁结节状肿物；双侧颈部II区可扪及1个淋巴结，最大径6×5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 ST-T轻度改变\n- [全程D1] 检验组合: 梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；有核红细胞计数(NRBC#)-静脉血: 010E9/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；单核细胞计数(Mono#)-静脉血: 0.510E9/L；胱抑素(Cys-C)-静脉血: 0.76mg/L；磷(P)-静脉血: 1.12mmol/L；纤维蛋白原(Fbg)-静脉血: 3.32g/L；Rh血型-静脉血: 阳性；血红蛋白(Hb)-静脉血: 136.2g/L；ABO血型-静脉血: O；骨钙素N端中分子片段(N-MID)-静脉血: 14.08ng/ml；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；直接胆红素(DBIL)-静脉血: 3.1umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 28.5U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；中性粒细胞百分比(Neut%)-静脉血: 0.617；镁离子(Mg2+)-静脉血: 0.88mmol/L；白细胞计数(WBC#)-静脉血: 7.0810E9/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 26.4U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.295ng/ml（参考: <0.704）；凝血酶原时间活动度(PTA)-静脉血: 120%；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.9mmol/L；血小板比容-静脉血: 18.3%；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.05S/CO；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.23mmolL；平均红细胞血红蛋白含量(MCH)-静脉血: 30pg；单核细胞百分比(Mono%)-静脉血: 0.072；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；总蛋白(TP)-静脉血: 71.09g/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40……\n- [全程D3] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及左侧壁粘膜增厚放射性浓聚，SUV约14.5，病灶累及蝶骨基底部、枕骨斜坡、左侧翼突、左岩尖、左侧破裂孔及左侧鼻后孔。双侧咽隐窝消失。双侧咽后未见明显肿大淋巴结及异常放射性分布。口咽及喉咽结构及放射性分布未见明显异常。左侧上颌窦及蝶窦内见低密度影放射性分布未见明显异常，额窦、筛窦及右侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双颈Ⅱ区多发肿大淋巴结放射性浓聚，SUV约14.2，最大约2.2×2.6cm。 双侧苍白球钙化放射性分布缺损，余所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。左肾盂小结石放射性分布缺损。脾脏、胰腺、右肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺小点状钙化灶。余盆腔放射性分布均匀，膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 所见颅盖骨、余躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽顶壁、顶后壁及左侧壁粘膜增厚代谢活跃，考虑鼻咽癌，病灶累及颅底骨、左侧破裂孔及左侧鼻后孔；双颈Ⅱ区多发肿大淋巴结代谢活跃，考虑转移。 左侧上颌窦及蝶窦炎症。 左肾盂小结石。 前列腺钙化。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行颈部淋巴结细针穿刺活检，完善鼻咽及颈部CT平扫+增强，查乙肝病毒DNA定量\nB. 行鼻咽内镜组织活检，完善鼻咽及颈部CT平扫+增强，查乙肝病毒DNA定量\nC. 行鼻咽内镜组织活检，完善鼻咽及颈部MRI平扫+增强，暂不查乙肝病毒DNA定量\nD. 行颈部淋巴结切除活检，完善鼻咽及颈部MRI平扫+增强，查乙肝病毒DNA定量\nE. 行鼻咽内镜组织活检，完善鼻咽及颈部CT平扫+增强，查丙肝病毒RNA定量\nF. 行鼻咽内镜组织活检，完善头颅MRI平扫+增强，查乙肝病毒DNA定量\nG. 行颈部淋巴结细针穿刺活检，完善鼻咽及颈部MRI平扫+增强，暂不查乙肝病毒DNA定量\nH. 行鼻咽内镜组织活检，完善鼻咽及颈部MRI平扫+增强，查乙肝病毒DNA定量\nI. 行鼻咽内镜组织活检及颈部淋巴结穿刺活检，完善鼻咽及颈部MRI平扫+增强\nJ. 行鼻咽内镜组织活检，完善鼻咽及颈部MRI平扫+增强，查丙肝病毒RNA定量\nK. 行鼻咽内镜组织活检，完善颈部超声造影，查乙肝病毒DNA定量\nL. 行鼻咽内镜组织活检，完善全身骨扫描，查乙肝病毒DNA定量\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 ST-T轻度改变\n- [全程D1] 检验组合: 梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；有核红细胞计数(NRBC#)-静脉血: 010E9/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；单核细胞计数(Mono#)-静脉血: 0.510E9/L；胱抑素(Cys-C)-静脉血: 0.76mg/L；磷(P)-静脉血: 1.12mmol/L；纤维蛋白原(Fbg)-静脉血: 3.32g/L；Rh血型-静脉血: 阳性；血红蛋白(Hb)-静脉血: 136.2g/L；ABO血型-静脉血: O；骨钙素N端中分子片段(N-MID)-静脉血: 14.08ng/ml；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；直接胆红素(DBIL)-静脉血: 3.1umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 28.5U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；中性粒细胞百分比(Neut%)-静脉血: 0.617；镁离子(Mg2+)-静脉血: 0.88mmol/L；白细胞计数(WBC#)-静脉血: 7.0810E9/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 26.4U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.295ng/ml（参考: <0.704）；凝血酶原时间活动度(PTA)-静脉血: 120%；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.9mmol/L；血小板比容-静脉血: 18.3%；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.05S/CO；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.23mmolL；平均红细胞血红蛋白含量(MCH)-静脉血: 30pg；单核细胞百分比(Mono%)-静脉血: 0.072；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；总蛋白(TP)-静脉血: 71.09g/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40……\n- [全程D3] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及左侧壁粘膜增厚放射性浓聚，SUV约14.5，病灶累及蝶骨基底部、枕骨斜坡、左侧翼突、左岩尖、左侧破裂孔及左侧鼻后孔。双侧咽隐窝消失。双侧咽后未见明显肿大淋巴结及异常放射性分布。口咽及喉咽结构及放射性分布未见明显异常。左侧上颌窦及蝶窦内见低密度影放射性分布未见明显异常，额窦、筛窦及右侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双颈Ⅱ区多发肿大淋巴结放射性浓聚，SUV约14.2，最大约2.2×2.6cm。 双侧苍白球钙化放射性分布缺损，余所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。左肾盂小结石放射性分布缺损。脾脏、胰腺、右肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺小点状钙化灶。余盆腔放射性分布均匀，膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 所见颅盖骨、余躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽顶壁、顶后壁及左侧壁粘膜增厚代谢活跃，考虑鼻咽癌，病灶累及颅底骨、左侧破裂孔及左侧鼻后孔；双颈Ⅱ区多发肿大淋巴结代谢活跃，考虑转移。 左侧上颌窦及蝶窦炎症。 左肾盂小结石。 前列腺钙化。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行颈部淋巴结细针穿刺活检，完善鼻咽及颈部CT平扫+增强，查乙肝病毒DNA定量\nB. 行鼻咽内镜组织活检，完善鼻咽及颈部CT平扫+增强，查乙肝病毒DNA定量\nC. 行鼻咽内镜组织活检，完善鼻咽及颈部MRI平扫+增强，暂不查乙肝病毒DNA定量\nD. 行颈部淋巴结切除活检，完善鼻咽及颈部MRI平扫+增强，查乙肝病毒DNA定量\nE. 行鼻咽内镜组织活检，完善鼻咽及颈部CT平扫+增强，查丙肝病毒RNA定量\nF. 行鼻咽内镜组织活检，完善头颅MRI平扫+增强，查乙肝病毒DNA定量\nG. 行颈部淋巴结细针穿刺活检，完善鼻咽及颈部MRI平扫+增强，暂不查乙肝病毒DNA定量\nH. 行鼻咽内镜组织活检，完善鼻咽及颈部MRI平扫+增强，查乙肝病毒DNA定量\nI. 行鼻咽内镜组织活检及颈部淋巴结穿刺活检，完善鼻咽及颈部MRI平扫+增强\nJ. 行鼻咽内镜组织活检，完善鼻咽及颈部MRI平扫+增强，查丙肝病毒RNA定量\nK. 行鼻咽内镜组织活检，完善颈部超声造影，查乙肝病毒DNA定量\nL. 行鼻咽内镜组织活检，完善全身骨扫描，查乙肝病毒DNA定量\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 ST-T轻度改变\n- [全程D1] 检验组合: 梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；有核红细胞计数(NRBC#)-静脉血: 010E9/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；单核细胞计数(Mono#)-静脉血: 0.510E9/L；胱抑素(Cys-C)-静脉血: 0.76mg/L；磷(P)-静脉血: 1.12mmol/L；纤维蛋白原(Fbg)-静脉血: 3.32g/L；Rh血型-静脉血: 阳性；血红蛋白(Hb)-静脉血: 136.2g/L；ABO血型-静脉血: O；骨钙素N端中分子片段(N-MID)-静脉血: 14.08ng/ml；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；直接胆红素(DBIL)-静脉血: 3.1umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 28.5U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；中性粒细胞百分比(Neut%)-静脉血: 0.617；镁离子(Mg2+)-静脉血: 0.88mmol/L；白细胞计数(WBC#)-静脉血: 7.0810E9/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 26.4U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.295ng/ml（参考: <0.704）；凝血酶原时间活动度(PTA)-静脉血: 120%；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.9mmol/L；血小板比容-静脉血: 18.3%；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.05S/CO；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.23mmolL；平均红细胞血红蛋白含量(MCH)-静脉血: 30pg；单核细胞百分比(Mono%)-静脉血: 0.072；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；总蛋白(TP)-静脉血: 71.09g/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40……\n- [全程D3] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及左侧壁粘膜增厚放射性浓聚，SUV约14.5，病灶累及蝶骨基底部、枕骨斜坡、左侧翼突、左岩尖、左侧破裂孔及左侧鼻后孔。双侧咽隐窝消失。双侧咽后未见明显肿大淋巴结及异常放射性分布。口咽及喉咽结构及放射性分布未见明显异常。左侧上颌窦及蝶窦内见低密度影放射性分布未见明显异常，额窦、筛窦及右侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双颈Ⅱ区多发肿大淋巴结放射性浓聚，SUV约14.2，最大约2.2×2.6cm。 双侧苍白球钙化放射性分布缺损，余所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。左肾盂小结石放射性分布缺损。脾脏、胰腺、右肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺小点状钙化灶。余盆腔放射性分布均匀，膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 所见颅盖骨、余躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽顶壁、顶后壁及左侧壁粘膜增厚代谢活跃，考虑鼻咽癌，病灶累及颅底骨、左侧破裂孔及左侧鼻后孔；双颈Ⅱ区多发肿大淋巴结代谢活跃，考虑转移。 左侧上颌窦及蝶窦炎症。 左肾盂小结石。 前列腺钙化。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行颈部淋巴结细针穿刺活检，完善鼻咽及颈部CT平扫+增强，查乙肝病毒DNA定量\nB. 行鼻咽内镜组织活检，完善鼻咽及颈部CT平扫+增强，查乙肝病毒DNA定量\nC. 行鼻咽内镜组织活检，完善鼻咽及颈部MRI平扫+增强，暂不查乙肝病毒DNA定量\nD. 行颈部淋巴结切除活检，完善鼻咽及颈部MRI平扫+增强，查乙肝病毒DNA定量\nE. 行鼻咽内镜组织活检，完善鼻咽及颈部CT平扫+增强，查丙肝病毒RNA定量\nF. 行鼻咽内镜组织活检，完善头颅MRI平扫+增强，查乙肝病毒DNA定量\nG. 行颈部淋巴结细针穿刺活检，完善鼻咽及颈部MRI平扫+增强，暂不查乙肝病毒DNA定量\nH. 行鼻咽内镜组织活检，完善鼻咽及颈部MRI平扫+增强，查乙肝病毒DNA定量\nI. 行鼻咽内镜组织活检及颈部淋巴结穿刺活检，完善鼻咽及颈部MRI平扫+增强\nJ. 行鼻咽内镜组织活检，完善鼻咽及颈部MRI平扫+增强，查丙肝病毒RNA定量\nK. 行鼻咽内镜组织活检，完善颈部超声造影，查乙肝病毒DNA定量\nL. 行鼻咽内镜组织活检，完善全身骨扫描，查乙肝病毒DNA定量\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-9fa3bde2f5d0ac4e910cb3cb","patient_id":"patient-f402aced5926698da3194c37","turn_id":"turn05","turn_position":3,"turn_type":"toxicity_or_support_decision","gold_letter":"K","gold_action":"按原剂量执行第2程洛铂+5-FU诱导化疗，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗","options":[{"letter":"A","text":"将第2程洛铂+5-FU诱导化疗减量20%，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗","is_gold":false},{"letter":"B","text":"暂停第2程诱导化疗，仅给予肠内营养及护胃支持，待胃肠道症状完全缓解后再评估化疗指征","is_gold":false},{"letter":"C","text":"按原剂量执行第2程洛铂+5-FU诱导化疗，并预防性给予重组人粒细胞集落刺激因子及止吐护胃支持治疗","is_gold":false},{"letter":"D","text":"按原剂量执行第2程洛铂+5-FU诱导化疗，并预防性给予重组人血小板生成素及止吐护胃支持治疗","is_gold":false},{"letter":"E","text":"将第2程诱导化疗方案更改为吉西他滨+顺铂，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗","is_gold":false},{"letter":"F","text":"将第2程诱导化疗方案更改为多西他赛+顺铂，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗","is_gold":false},{"letter":"G","text":"终止诱导化疗直接进入根治性放疗及同期化疗，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗","is_gold":false},{"letter":"H","text":"延迟第2程诱导化疗1周，期间给予护胃及止吐支持，待胃肠道症状完全缓解后再按原剂量化疗","is_gold":false},{"letter":"I","text":"按原剂量执行第2程洛铂+5-FU诱导化疗，取消常规止吐及护胃支持，仅在出现严重呕吐时给予解救治疗","is_gold":false},{"letter":"J","text":"将第2程洛铂+5-FU诱导化疗减量25%，并预防性给予重组人粒细胞集落刺激因子及止吐护胃支持治疗","is_gold":false},{"letter":"K","text":"按原剂量执行第2程洛铂+5-FU诱导化疗，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗","is_gold":true},{"letter":"L","text":"停用静脉化疗，改为口服卡培他滨单药化疗，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左颈肿物20余天；现病史: 20余天前患者无明显诱因自觉左颈肿物，无发热、疼痛，伴涕血、左耳堵塞感。无头痛、面麻、鼻塞、复视、张口困难等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左耳闷胀感,涕血,左颈肿物；既往史: 高血压10余年，规律服药，血压控制在130/80mmHg左右。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:穿山甲壳、蜂蛹、伟哥过敏。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 大儿子患“脑胶质瘤”，已病逝。；体格检查: T：36.4℃，P：66次/分，R：20次/分，BP：134/81mmHg,Ht：175cm，Wt：84kg，BSA：2.0m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽顶后壁、左侧壁结节状肿物；双侧颈部II区可扪及1个淋巴结，最大径6×5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 ST-T轻度改变\n- [全程D1] 检验组合: 梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；有核红细胞计数(NRBC#)-静脉血: 010E9/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；单核细胞计数(Mono#)-静脉血: 0.510E9/L；胱抑素(Cys-C)-静脉血: 0.76mg/L；磷(P)-静脉血: 1.12mmol/L；纤维蛋白原(Fbg)-静脉血: 3.32g/L；Rh血型-静脉血: 阳性；血红蛋白(Hb)-静脉血: 136.2g/L；ABO血型-静脉血: O；骨钙素N端中分子片段(N-MID)-静脉血: 14.08ng/ml；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；直接胆红素(DBIL)-静脉血: 3.1umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 28.5U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；中性粒细胞百分比(Neut%)-静脉血: 0.617；镁离子(Mg2+)-静脉血: 0.88mmol/L；白细胞计数(WBC#)-静脉血: 7.0810E9/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 26.4U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.295ng/ml（参考: <0.704）；凝血酶原时间活动度(PTA)-静脉血: 120%；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.9mmol/L；血小板比容-静脉血: 18.3%；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.05S/CO；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.23mmolL；平均红细胞血红蛋白含量(MCH)-静脉血: 30pg；单核细胞百分比(Mono%)-静脉血: 0.072；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；总蛋白(TP)-静脉血: 71.09g/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40……\n- [全程D3] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及左侧壁粘膜增厚放射性浓聚，SUV约14.5，病灶累及蝶骨基底部、枕骨斜坡、左侧翼突、左岩尖、左侧破裂孔及左侧鼻后孔。双侧咽隐窝消失。双侧咽后未见明显肿大淋巴结及异常放射性分布。口咽及喉咽结构及放射性分布未见明显异常。左侧上颌窦及蝶窦内见低密度影放射性分布未见明显异常，额窦、筛窦及右侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双颈Ⅱ区多发肿大淋巴结放射性浓聚，SUV约14.2，最大约2.2×2.6cm。 双侧苍白球钙化放射性分布缺损，余所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。左肾盂小结石放射性分布缺损。脾脏、胰腺、右肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺小点状钙化灶。余盆腔放射性分布均匀，膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 所见颅盖骨、余躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽顶壁、顶后壁及左侧壁粘膜增厚代谢活跃，考虑鼻咽癌，病灶累及颅底骨、左侧破裂孔及左侧鼻后孔；双颈Ⅱ区多发肿大淋巴结代谢活跃，考虑转移。 左侧上颌窦及蝶窦炎症。 左肾盂小结石。 前列腺钙化。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D6] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽左侧壁、顶壁及后壁增厚，见软组织灶形成，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，病灶占据左侧咽隐窝，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，右侧咽隐窝稍变浅，右侧咽旁脂肪间隙及颈动脉鞘区未见异常； 左侧腭帆提肌、双侧头长肌直接受侵；病灶累及左侧破裂孔、左侧后鼻孔； 双侧侧翼腭窝、颞下窝未见异常；口咽各壁无受累增厚。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部骨质破坏。 双侧海绵窦形态正常，未见增宽。 左侧上颌窦、蝶窦、左侧乳突粘膜稍增厚，双侧筛窦、右侧乳突气化好，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 左侧咽后间隙见小淋巴结，短径约4mm；双颈II区见肿大淋巴结，较大者短径约25mm；左颈III、V区见多发淋巴结，边界清，信号均匀，较大者短径约7mm。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 考虑鼻咽癌可能性大。 颅底骨质破坏。 左侧咽后小淋巴结。 双颈II区淋巴结肿大。\n- [全程D6] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T7上缘水平，估计导管末端位于上腔静脉下段内。；检查结论: PICC管末端位置如上述。\n- [全程D6] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 28mm AO 29mm MV E 0.51m/s EF 73% LV 49mm IVS 9mm A 0.73m/s FS 42% RA 28mm LVPW 10mm RV 18mm PA 20mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 心脏结构及运动未见异常 各房室腔及大血管未探及异常血流信号 左室舒张功能减低，收缩功能正常\n- [全程D13] 检验组合: 镁离子(Mg2+)-静脉血: 0.89mmol/L；总胆红素(TBIL)-静脉血: 13.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 23.7U/L；丙氨酸氨基转移酶(ALT)-静脉血: 21.4U/L；总钙(Ca)-静脉血: 2.2mmol/L；氯离子(Cl-)-静脉血: 104mmol/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；直接胆红素(DBIL)-静脉血: 5umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6；红细胞比容(Hct)-静脉血: 38.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.358；间接胆红素(IBIL)-静脉血: 8.3umolL；平均红细胞体积(MCV)-静脉血: 87.1fL；载脂蛋白AI(apoAI)-静脉血: 1.11g/L；球蛋白(GLO)-静脉血: 29.01g/L；C-反应蛋白(CRP)-静脉血: 13.69mg/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；白细胞计数(WBC#)-静脉血: 4.8310E9/L；碱性磷酸酶(ALP)-静脉血: 70.4U/L；血小板比容-静脉血: 18%；载脂蛋白B(apoB)-静脉血: 0.67g/L；中性粒细胞百分比(Neut%)-静脉血: 0.566；淋巴细胞计数(Lymph#)-静脉血: 1.710E9/L；钾离子(K+)-静脉血: 4.1mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；乳酸脱氢酶(LDH)-静脉血: 203.5U/L；阴离子间隙(AG)-静脉血: 14；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；甘油三酯(TG)-静脉血: 1.28mmol/L；红细胞计数(RBC#)-静脉血: 4.4310E12/L；血小板分布宽度(PDW)-静脉血: 8.5%；单核细胞百分比(Mono%)-静脉血: 0.058；大血小板百分比(P-LCR%)-静脉血: 11.6%；血液二氧化碳含量ctCO2(B)-静脉血: 25.1mmol/L；白蛋白(ALB)-静脉血: 40.2g/L；尿素氮(BUN)-静脉血: 5.8mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.3U/L；尿酸(UA)-静脉血: 378.8umol/L；总胆固醇(TC)-……\n- [全程D21] 检验组合: 单核细胞百分比(Mono%)-静脉血: 0.062；中性粒细胞百分比(Neut%)-静脉血: 0.67；白细胞计数(WBC#)-静脉血: 5.9710E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.9；平均红细胞血红蛋白含量(MCH)-静脉血: 29.3pg；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 134g/L；红细胞比容(Hct)-静脉血: 41.3%；血小板比容-静脉血: 13%；平均红细胞体积(MCV)-静脉血: 90.4fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；平均血小板体积(MPV)-静脉血: 9.4fL；血小板计数(PLT#)-静脉血: 13810E9/L；中性粒细胞计数(Neut#)-静脉血: 410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 324g/L；血小板分布宽度(PDW)-静脉血: 9.9%；大血小板百分比(P-LCR%)-静脉血: 21.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.255；单核细胞计数(Mono#)-静脉血: 0.410E9/L；红细胞计数(RBC#)-静脉血: 4.5710E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.2\n- [全程D27] 检验组合: 红细胞计数(RBC#)-静脉血: 4.3410E12/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.85mmol/L；血小板计数(PLT#)-静脉血: 255.510E9/L；白细胞计数(WBC#)-静脉血: 6.210E9/L；氯离子(Cl-)-静脉血: 104.9mmol/L；总胆汁酸(TBA)-静脉血: 1umol/L；肌酐(Crea)-静脉血: 96.8umol/L；钾离子(K+)-静脉血: 4.5mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.386；乳酸脱氢酶(LDH)-静脉血: 212.1U/L；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.33mmolL；淋巴细胞计数(Lymph#)-静脉血: 2.410E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21U/L；平均红细胞体积(MCV)-静脉血: 90.1fL；总蛋白(TP)-静脉血: 70.21g/L；丙氨酸氨基转移酶(ALT)-静脉血: 19.6U/L；间接胆红素(IBIL)-静脉血: 4.6umolL；尿酸(UA)-静脉血: 469.1umol/L；血小板比容-静脉血: 15.3%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；甘油三酯(TG)-静脉血: 1.12mmol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白B(apoB)-静脉血: 0.9g/L；平均血小板体积(MPV)-静脉血: 6.02fL；总钙(Ca)-静脉血: 2.25mmol/L；单核细胞百分比(Mono%)-静脉血: 0.066；红细胞比容(Hct)-静脉血: 39.1%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；γ-谷氨酰基转移酶(GGT)-静脉血: 25.5U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.7pg；尿素氮(BUN)-静脉血: 4.22mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341.2g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；中性粒细胞计数(Neut#)-静脉血: 3.310E9/L；有核红细胞计数(NRBC#)-静脉血: 010E……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+洛铂方案诱导化疗结束，诉呕吐1次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程5-FU+洛铂方案诱导化疗结束，无诉特殊不适，可予出院，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 将第2程洛铂+5-FU诱导化疗减量20%，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nB. 暂停第2程诱导化疗，仅给予肠内营养及护胃支持，待胃肠道症状完全缓解后再评估化疗指征\nC. 按原剂量执行第2程洛铂+5-FU诱导化疗，并预防性给予重组人粒细胞集落刺激因子及止吐护胃支持治疗\nD. 按原剂量执行第2程洛铂+5-FU诱导化疗，并预防性给予重组人血小板生成素及止吐护胃支持治疗\nE. 将第2程诱导化疗方案更改为吉西他滨+顺铂，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nF. 将第2程诱导化疗方案更改为多西他赛+顺铂，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nG. 终止诱导化疗直接进入根治性放疗及同期化疗，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nH. 延迟第2程诱导化疗1周，期间给予护胃及止吐支持，待胃肠道症状完全缓解后再按原剂量化疗\nI. 按原剂量执行第2程洛铂+5-FU诱导化疗，取消常规止吐及护胃支持，仅在出现严重呕吐时给予解救治疗\nJ. 将第2程洛铂+5-FU诱导化疗减量25%，并预防性给予重组人粒细胞集落刺激因子及止吐护胃支持治疗\nK. 按原剂量执行第2程洛铂+5-FU诱导化疗，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nL. 停用静脉化疗，改为口服卡培他滨单药化疗，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D6] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽左侧壁、顶壁及后壁增厚，见软组织灶形成，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，病灶占据左侧咽隐窝，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，右侧咽隐窝稍变浅，右侧咽旁脂肪间隙及颈动脉鞘区未见异常； 左侧腭帆提肌、双侧头长肌直接受侵；病灶累及左侧破裂孔、左侧后鼻孔； 双侧侧翼腭窝、颞下窝未见异常；口咽各壁无受累增厚。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部骨质破坏。 双侧海绵窦形态正常，未见增宽。 左侧上颌窦、蝶窦、左侧乳突粘膜稍增厚，双侧筛窦、右侧乳突气化好，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 左侧咽后间隙见小淋巴结，短径约4mm；双颈II区见肿大淋巴结，较大者短径约25mm；左颈III、V区见多发淋巴结，边界清，信号均匀，较大者短径约7mm。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 考虑鼻咽癌可能性大。 颅底骨质破坏。 左侧咽后小淋巴结。 双颈II区淋巴结肿大。\n- [全程D6] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T7上缘水平，估计导管末端位于上腔静脉下段内。；检查结论: PICC管末端位置如上述。\n- [全程D6] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 28mm AO 29mm MV E 0.51m/s EF 73% LV 49mm IVS 9mm A 0.73m/s FS 42% RA 28mm LVPW 10mm RV 18mm PA 20mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 心脏结构及运动未见异常 各房室腔及大血管未探及异常血流信号 左室舒张功能减低，收缩功能正常\n- [全程D13] 检验组合: 镁离子(Mg2+)-静脉血: 0.89mmol/L；总胆红素(TBIL)-静脉血: 13.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 23.7U/L；丙氨酸氨基转移酶(ALT)-静脉血: 21.4U/L；总钙(Ca)-静脉血: 2.2mmol/L；氯离子(Cl-)-静脉血: 104mmol/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；直接胆红素(DBIL)-静脉血: 5umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6；红细胞比容(Hct)-静脉血: 38.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.358；间接胆红素(IBIL)-静脉血: 8.3umolL；平均红细胞体积(MCV)-静脉血: 87.1fL；载脂蛋白AI(apoAI)-静脉血: 1.11g/L；球蛋白(GLO)-静脉血: 29.01g/L；C-反应蛋白(CRP)-静脉血: 13.69mg/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；白细胞计数(WBC#)-静脉血: 4.8310E9/L；碱性磷酸酶(ALP)-静脉血: 70.4U/L；血小板比容-静脉血: 18%；载脂蛋白B(apoB)-静脉血: 0.67g/L；中性粒细胞百分比(Neut%)-静脉血: 0.566；淋巴细胞计数(Lymph#)-静脉血: 1.710E9/L；钾离子(K+)-静脉血: 4.1mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；乳酸脱氢酶(LDH)-静脉血: 203.5U/L；阴离子间隙(AG)-静脉血: 14；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；甘油三酯(TG)-静脉血: 1.28mmol/L；红细胞计数(RBC#)-静脉血: 4.4310E12/L；血小板分布宽度(PDW)-静脉血: 8.5%；单核细胞百分比(Mono%)-静脉血: 0.058；大血小板百分比(P-LCR%)-静脉血: 11.6%；血液二氧化碳含量ctCO2(B)-静脉血: 25.1mmol/L；白蛋白(ALB)-静脉血: 40.2g/L；尿素氮(BUN)-静脉血: 5.8mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.3U/L；尿酸(UA)-静脉血: 378.8umol/L；总胆固醇(TC)-……\n- [全程D21] 检验组合: 单核细胞百分比(Mono%)-静脉血: 0.062；中性粒细胞百分比(Neut%)-静脉血: 0.67；白细胞计数(WBC#)-静脉血: 5.9710E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.9；平均红细胞血红蛋白含量(MCH)-静脉血: 29.3pg；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 134g/L；红细胞比容(Hct)-静脉血: 41.3%；血小板比容-静脉血: 13%；平均红细胞体积(MCV)-静脉血: 90.4fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；平均血小板体积(MPV)-静脉血: 9.4fL；血小板计数(PLT#)-静脉血: 13810E9/L；中性粒细胞计数(Neut#)-静脉血: 410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 324g/L；血小板分布宽度(PDW)-静脉血: 9.9%；大血小板百分比(P-LCR%)-静脉血: 21.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.255；单核细胞计数(Mono#)-静脉血: 0.410E9/L；红细胞计数(RBC#)-静脉血: 4.5710E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.2\n- [全程D27] 检验组合: 红细胞计数(RBC#)-静脉血: 4.3410E12/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.85mmol/L；血小板计数(PLT#)-静脉血: 255.510E9/L；白细胞计数(WBC#)-静脉血: 6.210E9/L；氯离子(Cl-)-静脉血: 104.9mmol/L；总胆汁酸(TBA)-静脉血: 1umol/L；肌酐(Crea)-静脉血: 96.8umol/L；钾离子(K+)-静脉血: 4.5mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.386；乳酸脱氢酶(LDH)-静脉血: 212.1U/L；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.33mmolL；淋巴细胞计数(Lymph#)-静脉血: 2.410E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21U/L；平均红细胞体积(MCV)-静脉血: 90.1fL；总蛋白(TP)-静脉血: 70.21g/L；丙氨酸氨基转移酶(ALT)-静脉血: 19.6U/L；间接胆红素(IBIL)-静脉血: 4.6umolL；尿酸(UA)-静脉血: 469.1umol/L；血小板比容-静脉血: 15.3%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；甘油三酯(TG)-静脉血: 1.12mmol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白B(apoB)-静脉血: 0.9g/L；平均血小板体积(MPV)-静脉血: 6.02fL；总钙(Ca)-静脉血: 2.25mmol/L；单核细胞百分比(Mono%)-静脉血: 0.066；红细胞比容(Hct)-静脉血: 39.1%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；γ-谷氨酰基转移酶(GGT)-静脉血: 25.5U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.7pg；尿素氮(BUN)-静脉血: 4.22mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341.2g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；中性粒细胞计数(Neut#)-静脉血: 3.310E9/L；有核红细胞计数(NRBC#)-静脉血: 010E……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+洛铂方案诱导化疗结束，诉呕吐1次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程5-FU+洛铂方案诱导化疗结束，无诉特殊不适，可予出院，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 将第2程洛铂+5-FU诱导化疗减量20%，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nB. 暂停第2程诱导化疗，仅给予肠内营养及护胃支持，待胃肠道症状完全缓解后再评估化疗指征\nC. 按原剂量执行第2程洛铂+5-FU诱导化疗，并预防性给予重组人粒细胞集落刺激因子及止吐护胃支持治疗\nD. 按原剂量执行第2程洛铂+5-FU诱导化疗，并预防性给予重组人血小板生成素及止吐护胃支持治疗\nE. 将第2程诱导化疗方案更改为吉西他滨+顺铂，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nF. 将第2程诱导化疗方案更改为多西他赛+顺铂，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nG. 终止诱导化疗直接进入根治性放疗及同期化疗，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nH. 延迟第2程诱导化疗1周，期间给予护胃及止吐支持，待胃肠道症状完全缓解后再按原剂量化疗\nI. 按原剂量执行第2程洛铂+5-FU诱导化疗，取消常规止吐及护胃支持，仅在出现严重呕吐时给予解救治疗\nJ. 将第2程洛铂+5-FU诱导化疗减量25%，并预防性给予重组人粒细胞集落刺激因子及止吐护胃支持治疗\nK. 按原剂量执行第2程洛铂+5-FU诱导化疗，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nL. 停用静脉化疗，改为口服卡培他滨单药化疗，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D6] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽左侧壁、顶壁及后壁增厚，见软组织灶形成，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，病灶占据左侧咽隐窝，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，右侧咽隐窝稍变浅，右侧咽旁脂肪间隙及颈动脉鞘区未见异常； 左侧腭帆提肌、双侧头长肌直接受侵；病灶累及左侧破裂孔、左侧后鼻孔； 双侧侧翼腭窝、颞下窝未见异常；口咽各壁无受累增厚。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部骨质破坏。 双侧海绵窦形态正常，未见增宽。 左侧上颌窦、蝶窦、左侧乳突粘膜稍增厚，双侧筛窦、右侧乳突气化好，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 左侧咽后间隙见小淋巴结，短径约4mm；双颈II区见肿大淋巴结，较大者短径约25mm；左颈III、V区见多发淋巴结，边界清，信号均匀，较大者短径约7mm。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 考虑鼻咽癌可能性大。 颅底骨质破坏。 左侧咽后小淋巴结。 双颈II区淋巴结肿大。\n- [全程D6] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T7上缘水平，估计导管末端位于上腔静脉下段内。；检查结论: PICC管末端位置如上述。\n- [全程D6] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 28mm AO 29mm MV E 0.51m/s EF 73% LV 49mm IVS 9mm A 0.73m/s FS 42% RA 28mm LVPW 10mm RV 18mm PA 20mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 心脏结构及运动未见异常 各房室腔及大血管未探及异常血流信号 左室舒张功能减低，收缩功能正常\n- [全程D13] 检验组合: 镁离子(Mg2+)-静脉血: 0.89mmol/L；总胆红素(TBIL)-静脉血: 13.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 23.7U/L；丙氨酸氨基转移酶(ALT)-静脉血: 21.4U/L；总钙(Ca)-静脉血: 2.2mmol/L；氯离子(Cl-)-静脉血: 104mmol/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；直接胆红素(DBIL)-静脉血: 5umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6；红细胞比容(Hct)-静脉血: 38.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.358；间接胆红素(IBIL)-静脉血: 8.3umolL；平均红细胞体积(MCV)-静脉血: 87.1fL；载脂蛋白AI(apoAI)-静脉血: 1.11g/L；球蛋白(GLO)-静脉血: 29.01g/L；C-反应蛋白(CRP)-静脉血: 13.69mg/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；白细胞计数(WBC#)-静脉血: 4.8310E9/L；碱性磷酸酶(ALP)-静脉血: 70.4U/L；血小板比容-静脉血: 18%；载脂蛋白B(apoB)-静脉血: 0.67g/L；中性粒细胞百分比(Neut%)-静脉血: 0.566；淋巴细胞计数(Lymph#)-静脉血: 1.710E9/L；钾离子(K+)-静脉血: 4.1mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；乳酸脱氢酶(LDH)-静脉血: 203.5U/L；阴离子间隙(AG)-静脉血: 14；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；甘油三酯(TG)-静脉血: 1.28mmol/L；红细胞计数(RBC#)-静脉血: 4.4310E12/L；血小板分布宽度(PDW)-静脉血: 8.5%；单核细胞百分比(Mono%)-静脉血: 0.058；大血小板百分比(P-LCR%)-静脉血: 11.6%；血液二氧化碳含量ctCO2(B)-静脉血: 25.1mmol/L；白蛋白(ALB)-静脉血: 40.2g/L；尿素氮(BUN)-静脉血: 5.8mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.3U/L；尿酸(UA)-静脉血: 378.8umol/L；总胆固醇(TC)-……\n- [全程D21] 检验组合: 单核细胞百分比(Mono%)-静脉血: 0.062；中性粒细胞百分比(Neut%)-静脉血: 0.67；白细胞计数(WBC#)-静脉血: 5.9710E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.9；平均红细胞血红蛋白含量(MCH)-静脉血: 29.3pg；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 134g/L；红细胞比容(Hct)-静脉血: 41.3%；血小板比容-静脉血: 13%；平均红细胞体积(MCV)-静脉血: 90.4fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；平均血小板体积(MPV)-静脉血: 9.4fL；血小板计数(PLT#)-静脉血: 13810E9/L；中性粒细胞计数(Neut#)-静脉血: 410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 324g/L；血小板分布宽度(PDW)-静脉血: 9.9%；大血小板百分比(P-LCR%)-静脉血: 21.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.255；单核细胞计数(Mono#)-静脉血: 0.410E9/L；红细胞计数(RBC#)-静脉血: 4.5710E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.2\n- [全程D27] 检验组合: 红细胞计数(RBC#)-静脉血: 4.3410E12/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.85mmol/L；血小板计数(PLT#)-静脉血: 255.510E9/L；白细胞计数(WBC#)-静脉血: 6.210E9/L；氯离子(Cl-)-静脉血: 104.9mmol/L；总胆汁酸(TBA)-静脉血: 1umol/L；肌酐(Crea)-静脉血: 96.8umol/L；钾离子(K+)-静脉血: 4.5mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.386；乳酸脱氢酶(LDH)-静脉血: 212.1U/L；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.33mmolL；淋巴细胞计数(Lymph#)-静脉血: 2.410E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21U/L；平均红细胞体积(MCV)-静脉血: 90.1fL；总蛋白(TP)-静脉血: 70.21g/L；丙氨酸氨基转移酶(ALT)-静脉血: 19.6U/L；间接胆红素(IBIL)-静脉血: 4.6umolL；尿酸(UA)-静脉血: 469.1umol/L；血小板比容-静脉血: 15.3%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；甘油三酯(TG)-静脉血: 1.12mmol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白B(apoB)-静脉血: 0.9g/L；平均血小板体积(MPV)-静脉血: 6.02fL；总钙(Ca)-静脉血: 2.25mmol/L；单核细胞百分比(Mono%)-静脉血: 0.066；红细胞比容(Hct)-静脉血: 39.1%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；γ-谷氨酰基转移酶(GGT)-静脉血: 25.5U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.7pg；尿素氮(BUN)-静脉血: 4.22mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341.2g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；中性粒细胞计数(Neut#)-静脉血: 3.310E9/L；有核红细胞计数(NRBC#)-静脉血: 010E……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+洛铂方案诱导化疗结束，诉呕吐1次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程5-FU+洛铂方案诱导化疗结束，无诉特殊不适，可予出院，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 将第2程洛铂+5-FU诱导化疗减量20%，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nB. 暂停第2程诱导化疗，仅给予肠内营养及护胃支持，待胃肠道症状完全缓解后再评估化疗指征\nC. 按原剂量执行第2程洛铂+5-FU诱导化疗，并预防性给予重组人粒细胞集落刺激因子及止吐护胃支持治疗\nD. 按原剂量执行第2程洛铂+5-FU诱导化疗，并预防性给予重组人血小板生成素及止吐护胃支持治疗\nE. 将第2程诱导化疗方案更改为吉西他滨+顺铂，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nF. 将第2程诱导化疗方案更改为多西他赛+顺铂，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nG. 终止诱导化疗直接进入根治性放疗及同期化疗，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nH. 延迟第2程诱导化疗1周，期间给予护胃及止吐支持，待胃肠道症状完全缓解后再按原剂量化疗\nI. 按原剂量执行第2程洛铂+5-FU诱导化疗，取消常规止吐及护胃支持，仅在出现严重呕吐时给予解救治疗\nJ. 将第2程洛铂+5-FU诱导化疗减量25%，并预防性给予重组人粒细胞集落刺激因子及止吐护胃支持治疗\nK. 按原剂量执行第2程洛铂+5-FU诱导化疗，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nL. 停用静脉化疗，改为口服卡培他滨单药化疗，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-cc3b58d3bf4229805e8c7b84","patient_id":"patient-f402aced5926698da3194c37","turn_id":"turn06","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"D","gold_action":"暂不予特殊药物支持治疗，仅常规监测血常规、生化常规","options":[{"letter":"A","text":"予以静脉输注红细胞悬液，并常规监测血常规、生化常规","is_gold":false},{"letter":"B","text":"予以重组人促红素（EPO）皮下注射，并常规监测血常规、生化常规","is_gold":false},{"letter":"C","text":"予以静脉滴注蔗糖铁注射液，并常规监测血常规、生化常规","is_gold":false},{"letter":"D","text":"暂不予特殊药物支持治疗，仅常规监测血常规、生化常规","is_gold":true},{"letter":"E","text":"予以粒细胞集落刺激因子（G-CSF）皮下注射，并常规监测血常规、生化常规","is_gold":false},{"letter":"F","text":"予以重组人血小板生成素（rhTPO）皮下注射，并常规监测血常规、生化常规","is_gold":false},{"letter":"G","text":"予以静脉滴注人血白蛋白，并常规监测血常规、生化常规","is_gold":false},{"letter":"H","text":"予以口服叶酸及维生素B12片，并常规监测血常规、生化常规","is_gold":false},{"letter":"I","text":"予以口服利血生及鲨肝醇片，并常规监测血常规、生化常规","is_gold":false},{"letter":"J","text":"予以静脉滴注右旋糖酐铁注射液，并常规监测血常规、生化常规","is_gold":false},{"letter":"K","text":"予以静脉滴注地塞米松及托烷司琼，并常规监测血常规、生化常规","is_gold":false},{"letter":"L","text":"予以口服多糖铁复合物胶囊，并常规监测血常规、生化常规","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左颈肿物20余天；现病史: 20余天前患者无明显诱因自觉左颈肿物，无发热、疼痛，伴涕血、左耳堵塞感。无头痛、面麻、鼻塞、复视、张口困难等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左耳闷胀感,涕血,左颈肿物；既往史: 高血压10余年，规律服药，血压控制在130/80mmHg左右。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:穿山甲壳、蜂蛹、伟哥过敏。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 大儿子患“脑胶质瘤”，已病逝。；体格检查: T：36.4℃，P：66次/分，R：20次/分，BP：134/81mmHg,Ht：175cm，Wt：84kg，BSA：2.0m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽顶后壁、左侧壁结节状肿物；双侧颈部II区可扪及1个淋巴结，最大径6×5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 ST-T轻度改变\n- [全程D1] 检验组合: 梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；有核红细胞计数(NRBC#)-静脉血: 010E9/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；单核细胞计数(Mono#)-静脉血: 0.510E9/L；胱抑素(Cys-C)-静脉血: 0.76mg/L；磷(P)-静脉血: 1.12mmol/L；纤维蛋白原(Fbg)-静脉血: 3.32g/L；Rh血型-静脉血: 阳性；血红蛋白(Hb)-静脉血: 136.2g/L；ABO血型-静脉血: O；骨钙素N端中分子片段(N-MID)-静脉血: 14.08ng/ml；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；直接胆红素(DBIL)-静脉血: 3.1umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 28.5U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；中性粒细胞百分比(Neut%)-静脉血: 0.617；镁离子(Mg2+)-静脉血: 0.88mmol/L；白细胞计数(WBC#)-静脉血: 7.0810E9/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 26.4U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.295ng/ml（参考: <0.704）；凝血酶原时间活动度(PTA)-静脉血: 120%；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.9mmol/L；血小板比容-静脉血: 18.3%；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.05S/CO；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.23mmolL；平均红细胞血红蛋白含量(MCH)-静脉血: 30pg；单核细胞百分比(Mono%)-静脉血: 0.072；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；总蛋白(TP)-静脉血: 71.09g/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40……\n- [全程D3] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及左侧壁粘膜增厚放射性浓聚，SUV约14.5，病灶累及蝶骨基底部、枕骨斜坡、左侧翼突、左岩尖、左侧破裂孔及左侧鼻后孔。双侧咽隐窝消失。双侧咽后未见明显肿大淋巴结及异常放射性分布。口咽及喉咽结构及放射性分布未见明显异常。左侧上颌窦及蝶窦内见低密度影放射性分布未见明显异常，额窦、筛窦及右侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双颈Ⅱ区多发肿大淋巴结放射性浓聚，SUV约14.2，最大约2.2×2.6cm。 双侧苍白球钙化放射性分布缺损，余所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。左肾盂小结石放射性分布缺损。脾脏、胰腺、右肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺小点状钙化灶。余盆腔放射性分布均匀，膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 所见颅盖骨、余躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽顶壁、顶后壁及左侧壁粘膜增厚代谢活跃，考虑鼻咽癌，病灶累及颅底骨、左侧破裂孔及左侧鼻后孔；双颈Ⅱ区多发肿大淋巴结代谢活跃，考虑转移。 左侧上颌窦及蝶窦炎症。 左肾盂小结石。 前列腺钙化。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D6] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽左侧壁、顶壁及后壁增厚，见软组织灶形成，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，病灶占据左侧咽隐窝，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，右侧咽隐窝稍变浅，右侧咽旁脂肪间隙及颈动脉鞘区未见异常； 左侧腭帆提肌、双侧头长肌直接受侵；病灶累及左侧破裂孔、左侧后鼻孔； 双侧侧翼腭窝、颞下窝未见异常；口咽各壁无受累增厚。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部骨质破坏。 双侧海绵窦形态正常，未见增宽。 左侧上颌窦、蝶窦、左侧乳突粘膜稍增厚，双侧筛窦、右侧乳突气化好，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 左侧咽后间隙见小淋巴结，短径约4mm；双颈II区见肿大淋巴结，较大者短径约25mm；左颈III、V区见多发淋巴结，边界清，信号均匀，较大者短径约7mm。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 考虑鼻咽癌可能性大。 颅底骨质破坏。 左侧咽后小淋巴结。 双颈II区淋巴结肿大。\n- [全程D6] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T7上缘水平，估计导管末端位于上腔静脉下段内。；检查结论: PICC管末端位置如上述。\n- [全程D6] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 28mm AO 29mm MV E 0.51m/s EF 73% LV 49mm IVS 9mm A 0.73m/s FS 42% RA 28mm LVPW 10mm RV 18mm PA 20mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 心脏结构及运动未见异常 各房室腔及大血管未探及异常血流信号 左室舒张功能减低，收缩功能正常\n- [全程D13] 检验组合: 镁离子(Mg2+)-静脉血: 0.89mmol/L；总胆红素(TBIL)-静脉血: 13.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 23.7U/L；丙氨酸氨基转移酶(ALT)-静脉血: 21.4U/L；总钙(Ca)-静脉血: 2.2mmol/L；氯离子(Cl-)-静脉血: 104mmol/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；直接胆红素(DBIL)-静脉血: 5umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6；红细胞比容(Hct)-静脉血: 38.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.358；间接胆红素(IBIL)-静脉血: 8.3umolL；平均红细胞体积(MCV)-静脉血: 87.1fL；载脂蛋白AI(apoAI)-静脉血: 1.11g/L；球蛋白(GLO)-静脉血: 29.01g/L；C-反应蛋白(CRP)-静脉血: 13.69mg/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；白细胞计数(WBC#)-静脉血: 4.8310E9/L；碱性磷酸酶(ALP)-静脉血: 70.4U/L；血小板比容-静脉血: 18%；载脂蛋白B(apoB)-静脉血: 0.67g/L；中性粒细胞百分比(Neut%)-静脉血: 0.566；淋巴细胞计数(Lymph#)-静脉血: 1.710E9/L；钾离子(K+)-静脉血: 4.1mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；乳酸脱氢酶(LDH)-静脉血: 203.5U/L；阴离子间隙(AG)-静脉血: 14；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；甘油三酯(TG)-静脉血: 1.28mmol/L；红细胞计数(RBC#)-静脉血: 4.4310E12/L；血小板分布宽度(PDW)-静脉血: 8.5%；单核细胞百分比(Mono%)-静脉血: 0.058；大血小板百分比(P-LCR%)-静脉血: 11.6%；血液二氧化碳含量ctCO2(B)-静脉血: 25.1mmol/L；白蛋白(ALB)-静脉血: 40.2g/L；尿素氮(BUN)-静脉血: 5.8mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.3U/L；尿酸(UA)-静脉血: 378.8umol/L；总胆固醇(TC)-……\n- [全程D21] 检验组合: 单核细胞百分比(Mono%)-静脉血: 0.062；中性粒细胞百分比(Neut%)-静脉血: 0.67；白细胞计数(WBC#)-静脉血: 5.9710E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.9；平均红细胞血红蛋白含量(MCH)-静脉血: 29.3pg；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 134g/L；红细胞比容(Hct)-静脉血: 41.3%；血小板比容-静脉血: 13%；平均红细胞体积(MCV)-静脉血: 90.4fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；平均血小板体积(MPV)-静脉血: 9.4fL；血小板计数(PLT#)-静脉血: 13810E9/L；中性粒细胞计数(Neut#)-静脉血: 410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 324g/L；血小板分布宽度(PDW)-静脉血: 9.9%；大血小板百分比(P-LCR%)-静脉血: 21.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.255；单核细胞计数(Mono#)-静脉血: 0.410E9/L；红细胞计数(RBC#)-静脉血: 4.5710E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.2\n- [全程D27] 检验组合: 红细胞计数(RBC#)-静脉血: 4.3410E12/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.85mmol/L；血小板计数(PLT#)-静脉血: 255.510E9/L；白细胞计数(WBC#)-静脉血: 6.210E9/L；氯离子(Cl-)-静脉血: 104.9mmol/L；总胆汁酸(TBA)-静脉血: 1umol/L；肌酐(Crea)-静脉血: 96.8umol/L；钾离子(K+)-静脉血: 4.5mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.386；乳酸脱氢酶(LDH)-静脉血: 212.1U/L；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.33mmolL；淋巴细胞计数(Lymph#)-静脉血: 2.410E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21U/L；平均红细胞体积(MCV)-静脉血: 90.1fL；总蛋白(TP)-静脉血: 70.21g/L；丙氨酸氨基转移酶(ALT)-静脉血: 19.6U/L；间接胆红素(IBIL)-静脉血: 4.6umolL；尿酸(UA)-静脉血: 469.1umol/L；血小板比容-静脉血: 15.3%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；甘油三酯(TG)-静脉血: 1.12mmol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白B(apoB)-静脉血: 0.9g/L；平均血小板体积(MPV)-静脉血: 6.02fL；总钙(Ca)-静脉血: 2.25mmol/L；单核细胞百分比(Mono%)-静脉血: 0.066；红细胞比容(Hct)-静脉血: 39.1%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；γ-谷氨酰基转移酶(GGT)-静脉血: 25.5U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.7pg；尿素氮(BUN)-静脉血: 4.22mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341.2g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；中性粒细胞计数(Neut#)-静脉血: 3.310E9/L；有核红细胞计数(NRBC#)-静脉血: 010E……\n- [全程D33] 检验组合: 尿素氮(BUN)-静脉血: 3.5mmol/L；直接胆红素(DBIL)-静脉血: 9umol/L；红细胞计数(RBC#)-静脉血: 3.8710E12/L；球蛋白(GLO)-静脉血: 27.06g/L；总胆红素(TBIL)-静脉血: 28.4umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.08mmolL；钾离子(K+)-静脉血: 3.68mmol/L；钠离子(Na+)-静脉血: 140.7mmol/L；肌酐(Crea)-静脉血: 71.4umol/L；红细胞比容(Hct)-静脉血: 34.5%；血小板比容-静脉血: 13.9%；总胆固醇(TC)-静脉血: 3.79mmol/L；磷(P)-静脉血: 1.21mmol/L；阴离子间隙(AG)-静脉血: 14.8；C-反应蛋白(CRP)-静脉血: 15.32mg/L；有核红细胞百分比(NRBC%)-静脉血: 0；乳酸脱氢酶(LDH)-静脉血: 214.8U/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15.3U/L；间接胆红素(IBIL)-静脉血: 19.4umolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.21mmol/L；白蛋白(ALB)-静脉血: 36.4g/L；总钙(Ca)-静脉血: 2.01mmol/L；载脂蛋白B(apoB)-静脉血: 0.79g/L；中性粒细胞计数(Neut#)-静脉血: 3.210E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.308；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.02；平均红细胞血红蛋白含量(MCH)-静脉血: 30.6pg；载脂蛋白AI(apoAI)-静脉血: 1.04g/L；尿酸(UA)-静脉血: 290.1umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.35；平均红细胞体积(MCV)-静脉血: 89.1fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；碱性磷酸酶(ALP)-静脉血: 60.5U/L；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；血小板计数(PLT#)-静脉血: 230.610E9/L；γ-谷氨酰基转移酶(GGT)-静……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+洛铂方案诱导化疗结束，诉呕吐1次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程5-FU+洛铂方案诱导化疗结束，无诉特殊不适，可予出院，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n- [全程D28] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，可于今日执行第2程5-FU+洛铂方案诱导化疗，注意化疗不良反应。\n- [全程D29] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+洛铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 予以静脉输注红细胞悬液，并常规监测血常规、生化常规\nB. 予以重组人促红素（EPO）皮下注射，并常规监测血常规、生化常规\nC. 予以静脉滴注蔗糖铁注射液，并常规监测血常规、生化常规\nD. 暂不予特殊药物支持治疗，仅常规监测血常规、生化常规\nE. 予以粒细胞集落刺激因子（G-CSF）皮下注射，并常规监测血常规、生化常规\nF. 予以重组人血小板生成素（rhTPO）皮下注射，并常规监测血常规、生化常规\nG. 予以静脉滴注人血白蛋白，并常规监测血常规、生化常规\nH. 予以口服叶酸及维生素B12片，并常规监测血常规、生化常规\nI. 予以口服利血生及鲨肝醇片，并常规监测血常规、生化常规\nJ. 予以静脉滴注右旋糖酐铁注射液，并常规监测血常规、生化常规\nK. 予以静脉滴注地塞米松及托烷司琼，并常规监测血常规、生化常规\nL. 予以口服多糖铁复合物胶囊，并常规监测血常规、生化常规\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D33] 检验组合: 尿素氮(BUN)-静脉血: 3.5mmol/L；直接胆红素(DBIL)-静脉血: 9umol/L；红细胞计数(RBC#)-静脉血: 3.8710E12/L；球蛋白(GLO)-静脉血: 27.06g/L；总胆红素(TBIL)-静脉血: 28.4umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.08mmolL；钾离子(K+)-静脉血: 3.68mmol/L；钠离子(Na+)-静脉血: 140.7mmol/L；肌酐(Crea)-静脉血: 71.4umol/L；红细胞比容(Hct)-静脉血: 34.5%；血小板比容-静脉血: 13.9%；总胆固醇(TC)-静脉血: 3.79mmol/L；磷(P)-静脉血: 1.21mmol/L；阴离子间隙(AG)-静脉血: 14.8；C-反应蛋白(CRP)-静脉血: 15.32mg/L；有核红细胞百分比(NRBC%)-静脉血: 0；乳酸脱氢酶(LDH)-静脉血: 214.8U/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15.3U/L；间接胆红素(IBIL)-静脉血: 19.4umolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.21mmol/L；白蛋白(ALB)-静脉血: 36.4g/L；总钙(Ca)-静脉血: 2.01mmol/L；载脂蛋白B(apoB)-静脉血: 0.79g/L；中性粒细胞计数(Neut#)-静脉血: 3.210E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.308；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.02；平均红细胞血红蛋白含量(MCH)-静脉血: 30.6pg；载脂蛋白AI(apoAI)-静脉血: 1.04g/L；尿酸(UA)-静脉血: 290.1umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.35；平均红细胞体积(MCV)-静脉血: 89.1fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；碱性磷酸酶(ALP)-静脉血: 60.5U/L；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；血小板计数(PLT#)-静脉血: 230.610E9/L；γ-谷氨酰基转移酶(GGT)-静……\n\n【既往治疗与反应】\n- [全程D28] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，可于今日执行第2程5-FU+洛铂方案诱导化疗，注意化疗不良反应。\n- [全程D29] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+洛铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 予以静脉输注红细胞悬液，并常规监测血常规、生化常规\nB. 予以重组人促红素（EPO）皮下注射，并常规监测血常规、生化常规\nC. 予以静脉滴注蔗糖铁注射液，并常规监测血常规、生化常规\nD. 暂不予特殊药物支持治疗，仅常规监测血常规、生化常规\nE. 予以粒细胞集落刺激因子（G-CSF）皮下注射，并常规监测血常规、生化常规\nF. 予以重组人血小板生成素（rhTPO）皮下注射，并常规监测血常规、生化常规\nG. 予以静脉滴注人血白蛋白，并常规监测血常规、生化常规\nH. 予以口服叶酸及维生素B12片，并常规监测血常规、生化常规\nI. 予以口服利血生及鲨肝醇片，并常规监测血常规、生化常规\nJ. 予以静脉滴注右旋糖酐铁注射液，并常规监测血常规、生化常规\nK. 予以静脉滴注地塞米松及托烷司琼，并常规监测血常规、生化常规\nL. 予以口服多糖铁复合物胶囊，并常规监测血常规、生化常规\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D33] 检验组合: 尿素氮(BUN)-静脉血: 3.5mmol/L；直接胆红素(DBIL)-静脉血: 9umol/L；红细胞计数(RBC#)-静脉血: 3.8710E12/L；球蛋白(GLO)-静脉血: 27.06g/L；总胆红素(TBIL)-静脉血: 28.4umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.08mmolL；钾离子(K+)-静脉血: 3.68mmol/L；钠离子(Na+)-静脉血: 140.7mmol/L；肌酐(Crea)-静脉血: 71.4umol/L；红细胞比容(Hct)-静脉血: 34.5%；血小板比容-静脉血: 13.9%；总胆固醇(TC)-静脉血: 3.79mmol/L；磷(P)-静脉血: 1.21mmol/L；阴离子间隙(AG)-静脉血: 14.8；C-反应蛋白(CRP)-静脉血: 15.32mg/L；有核红细胞百分比(NRBC%)-静脉血: 0；乳酸脱氢酶(LDH)-静脉血: 214.8U/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15.3U/L；间接胆红素(IBIL)-静脉血: 19.4umolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.21mmol/L；白蛋白(ALB)-静脉血: 36.4g/L；总钙(Ca)-静脉血: 2.01mmol/L；载脂蛋白B(apoB)-静脉血: 0.79g/L；中性粒细胞计数(Neut#)-静脉血: 3.210E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.308；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.02；平均红细胞血红蛋白含量(MCH)-静脉血: 30.6pg；载脂蛋白AI(apoAI)-静脉血: 1.04g/L；尿酸(UA)-静脉血: 290.1umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.35；平均红细胞体积(MCV)-静脉血: 89.1fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；碱性磷酸酶(ALP)-静脉血: 60.5U/L；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；血小板计数(PLT#)-静脉血: 230.610E9/L；γ-谷氨酰基转移酶(GGT)-静……\n\n【既往治疗与反应】\n- [全程D28] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，可于今日执行第2程5-FU+洛铂方案诱导化疗，注意化疗不良反应。\n- [全程D29] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+洛铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 予以静脉输注红细胞悬液，并常规监测血常规、生化常规\nB. 予以重组人促红素（EPO）皮下注射，并常规监测血常规、生化常规\nC. 予以静脉滴注蔗糖铁注射液，并常规监测血常规、生化常规\nD. 暂不予特殊药物支持治疗，仅常规监测血常规、生化常规\nE. 予以粒细胞集落刺激因子（G-CSF）皮下注射，并常规监测血常规、生化常规\nF. 予以重组人血小板生成素（rhTPO）皮下注射，并常规监测血常规、生化常规\nG. 予以静脉滴注人血白蛋白，并常规监测血常规、生化常规\nH. 予以口服叶酸及维生素B12片，并常规监测血常规、生化常规\nI. 予以口服利血生及鲨肝醇片，并常规监测血常规、生化常规\nJ. 予以静脉滴注右旋糖酐铁注射液，并常规监测血常规、生化常规\nK. 予以静脉滴注地塞米松及托烷司琼，并常规监测血常规、生化常规\nL. 予以口服多糖铁复合物胶囊，并常规监测血常规、生化常规\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-80438584d0b66a199c599a7d","patient_id":"patient-f402aced5926698da3194c37","turn_id":"turn07","turn_position":5,"turn_type":"response_assessment_decision","gold_letter":"A","gold_action":"疗效评估为部分缓解（PR），启动靶向治疗（西妥昔单抗）联合同期放化疗。","options":[{"letter":"A","text":"疗效评估为部分缓解（PR），启动靶向治疗（西妥昔单抗）联合同期放化疗","is_gold":true},{"letter":"B","text":"疗效评估为部分缓解（PR），启动靶向治疗（尼妥珠单抗）联合同期放化疗","is_gold":false},{"letter":"C","text":"疗效评估为部分缓解（PR），继续原方案（洛铂+5-FU）第3程诱导化疗","is_gold":false},{"letter":"D","text":"疗效评估为部分缓解（PR），启动同期放化疗，暂不联合靶向治疗","is_gold":false},{"letter":"E","text":"疗效评估为疾病稳定（SD），启动免疫治疗（卡瑞利珠单抗）联合同期放化疗","is_gold":false},{"letter":"F","text":"疗效评估为疾病进展（PD），更改化疗方案为吉西他滨+顺铂诱导化疗","is_gold":false},{"letter":"G","text":"疗效评估为部分缓解（PR），行鼻咽及颈部根治性放疗，不联合全身治疗","is_gold":false},{"letter":"H","text":"疗效评估为部分缓解（PR），暂停抗肿瘤治疗，单纯行纠正贫血支持治疗","is_gold":false},{"letter":"I","text":"疗效评估为部分缓解（PR），行双侧颈部淋巴结清扫术，术后辅助放疗","is_gold":false},{"letter":"J","text":"疗效评估为完全缓解（CR），启动靶向治疗（西妥昔单抗）联合同期放化疗","is_gold":false},{"letter":"K","text":"疗效评估为部分缓解（PR），启动靶向治疗（贝伐珠单抗）联合同期放化疗","is_gold":false},{"letter":"L","text":"疗效评估为部分缓解（PR），启动免疫治疗（帕博利珠单抗）联合同期放化疗","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左颈肿物20余天；现病史: 20余天前患者无明显诱因自觉左颈肿物，无发热、疼痛，伴涕血、左耳堵塞感。无头痛、面麻、鼻塞、复视、张口困难等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左耳闷胀感,涕血,左颈肿物；既往史: 高血压10余年，规律服药，血压控制在130/80mmHg左右。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:穿山甲壳、蜂蛹、伟哥过敏。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 大儿子患“脑胶质瘤”，已病逝。；体格检查: T：36.4℃，P：66次/分，R：20次/分，BP：134/81mmHg,Ht：175cm，Wt：84kg，BSA：2.0m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽顶后壁、左侧壁结节状肿物；双侧颈部II区可扪及1个淋巴结，最大径6×5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 ST-T轻度改变\n- [全程D1] 检验组合: 梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；有核红细胞计数(NRBC#)-静脉血: 010E9/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；单核细胞计数(Mono#)-静脉血: 0.510E9/L；胱抑素(Cys-C)-静脉血: 0.76mg/L；磷(P)-静脉血: 1.12mmol/L；纤维蛋白原(Fbg)-静脉血: 3.32g/L；Rh血型-静脉血: 阳性；血红蛋白(Hb)-静脉血: 136.2g/L；ABO血型-静脉血: O；骨钙素N端中分子片段(N-MID)-静脉血: 14.08ng/ml；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；直接胆红素(DBIL)-静脉血: 3.1umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 28.5U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；中性粒细胞百分比(Neut%)-静脉血: 0.617；镁离子(Mg2+)-静脉血: 0.88mmol/L；白细胞计数(WBC#)-静脉血: 7.0810E9/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 26.4U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.295ng/ml（参考: <0.704）；凝血酶原时间活动度(PTA)-静脉血: 120%；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.9mmol/L；血小板比容-静脉血: 18.3%；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.05S/CO；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.23mmolL；平均红细胞血红蛋白含量(MCH)-静脉血: 30pg；单核细胞百分比(Mono%)-静脉血: 0.072；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；总蛋白(TP)-静脉血: 71.09g/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40……\n- [全程D3] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及左侧壁粘膜增厚放射性浓聚，SUV约14.5，病灶累及蝶骨基底部、枕骨斜坡、左侧翼突、左岩尖、左侧破裂孔及左侧鼻后孔。双侧咽隐窝消失。双侧咽后未见明显肿大淋巴结及异常放射性分布。口咽及喉咽结构及放射性分布未见明显异常。左侧上颌窦及蝶窦内见低密度影放射性分布未见明显异常，额窦、筛窦及右侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双颈Ⅱ区多发肿大淋巴结放射性浓聚，SUV约14.2，最大约2.2×2.6cm。 双侧苍白球钙化放射性分布缺损，余所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。左肾盂小结石放射性分布缺损。脾脏、胰腺、右肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺小点状钙化灶。余盆腔放射性分布均匀，膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 所见颅盖骨、余躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽顶壁、顶后壁及左侧壁粘膜增厚代谢活跃，考虑鼻咽癌，病灶累及颅底骨、左侧破裂孔及左侧鼻后孔；双颈Ⅱ区多发肿大淋巴结代谢活跃，考虑转移。 左侧上颌窦及蝶窦炎症。 左肾盂小结石。 前列腺钙化。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D6] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽左侧壁、顶壁及后壁增厚，见软组织灶形成，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，病灶占据左侧咽隐窝，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，右侧咽隐窝稍变浅，右侧咽旁脂肪间隙及颈动脉鞘区未见异常； 左侧腭帆提肌、双侧头长肌直接受侵；病灶累及左侧破裂孔、左侧后鼻孔； 双侧侧翼腭窝、颞下窝未见异常；口咽各壁无受累增厚。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部骨质破坏。 双侧海绵窦形态正常，未见增宽。 左侧上颌窦、蝶窦、左侧乳突粘膜稍增厚，双侧筛窦、右侧乳突气化好，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 左侧咽后间隙见小淋巴结，短径约4mm；双颈II区见肿大淋巴结，较大者短径约25mm；左颈III、V区见多发淋巴结，边界清，信号均匀，较大者短径约7mm。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 考虑鼻咽癌可能性大。 颅底骨质破坏。 左侧咽后小淋巴结。 双颈II区淋巴结肿大。\n- [全程D6] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T7上缘水平，估计导管末端位于上腔静脉下段内。；检查结论: PICC管末端位置如上述。\n- [全程D6] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 28mm AO 29mm MV E 0.51m/s EF 73% LV 49mm IVS 9mm A 0.73m/s FS 42% RA 28mm LVPW 10mm RV 18mm PA 20mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 心脏结构及运动未见异常 各房室腔及大血管未探及异常血流信号 左室舒张功能减低，收缩功能正常\n- [全程D13] 检验组合: 镁离子(Mg2+)-静脉血: 0.89mmol/L；总胆红素(TBIL)-静脉血: 13.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 23.7U/L；丙氨酸氨基转移酶(ALT)-静脉血: 21.4U/L；总钙(Ca)-静脉血: 2.2mmol/L；氯离子(Cl-)-静脉血: 104mmol/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；直接胆红素(DBIL)-静脉血: 5umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6；红细胞比容(Hct)-静脉血: 38.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.358；间接胆红素(IBIL)-静脉血: 8.3umolL；平均红细胞体积(MCV)-静脉血: 87.1fL；载脂蛋白AI(apoAI)-静脉血: 1.11g/L；球蛋白(GLO)-静脉血: 29.01g/L；C-反应蛋白(CRP)-静脉血: 13.69mg/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；白细胞计数(WBC#)-静脉血: 4.8310E9/L；碱性磷酸酶(ALP)-静脉血: 70.4U/L；血小板比容-静脉血: 18%；载脂蛋白B(apoB)-静脉血: 0.67g/L；中性粒细胞百分比(Neut%)-静脉血: 0.566；淋巴细胞计数(Lymph#)-静脉血: 1.710E9/L；钾离子(K+)-静脉血: 4.1mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；乳酸脱氢酶(LDH)-静脉血: 203.5U/L；阴离子间隙(AG)-静脉血: 14；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；甘油三酯(TG)-静脉血: 1.28mmol/L；红细胞计数(RBC#)-静脉血: 4.4310E12/L；血小板分布宽度(PDW)-静脉血: 8.5%；单核细胞百分比(Mono%)-静脉血: 0.058；大血小板百分比(P-LCR%)-静脉血: 11.6%；血液二氧化碳含量ctCO2(B)-静脉血: 25.1mmol/L；白蛋白(ALB)-静脉血: 40.2g/L；尿素氮(BUN)-静脉血: 5.8mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.3U/L；尿酸(UA)-静脉血: 378.8umol/L；总胆固醇(TC)-……\n- [全程D21] 检验组合: 单核细胞百分比(Mono%)-静脉血: 0.062；中性粒细胞百分比(Neut%)-静脉血: 0.67；白细胞计数(WBC#)-静脉血: 5.9710E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.9；平均红细胞血红蛋白含量(MCH)-静脉血: 29.3pg；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 134g/L；红细胞比容(Hct)-静脉血: 41.3%；血小板比容-静脉血: 13%；平均红细胞体积(MCV)-静脉血: 90.4fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；平均血小板体积(MPV)-静脉血: 9.4fL；血小板计数(PLT#)-静脉血: 13810E9/L；中性粒细胞计数(Neut#)-静脉血: 410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 324g/L；血小板分布宽度(PDW)-静脉血: 9.9%；大血小板百分比(P-LCR%)-静脉血: 21.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.255；单核细胞计数(Mono#)-静脉血: 0.410E9/L；红细胞计数(RBC#)-静脉血: 4.5710E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.2\n- [全程D27] 检验组合: 红细胞计数(RBC#)-静脉血: 4.3410E12/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.85mmol/L；血小板计数(PLT#)-静脉血: 255.510E9/L；白细胞计数(WBC#)-静脉血: 6.210E9/L；氯离子(Cl-)-静脉血: 104.9mmol/L；总胆汁酸(TBA)-静脉血: 1umol/L；肌酐(Crea)-静脉血: 96.8umol/L；钾离子(K+)-静脉血: 4.5mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.386；乳酸脱氢酶(LDH)-静脉血: 212.1U/L；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.33mmolL；淋巴细胞计数(Lymph#)-静脉血: 2.410E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21U/L；平均红细胞体积(MCV)-静脉血: 90.1fL；总蛋白(TP)-静脉血: 70.21g/L；丙氨酸氨基转移酶(ALT)-静脉血: 19.6U/L；间接胆红素(IBIL)-静脉血: 4.6umolL；尿酸(UA)-静脉血: 469.1umol/L；血小板比容-静脉血: 15.3%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；甘油三酯(TG)-静脉血: 1.12mmol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白B(apoB)-静脉血: 0.9g/L；平均血小板体积(MPV)-静脉血: 6.02fL；总钙(Ca)-静脉血: 2.25mmol/L；单核细胞百分比(Mono%)-静脉血: 0.066；红细胞比容(Hct)-静脉血: 39.1%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；γ-谷氨酰基转移酶(GGT)-静脉血: 25.5U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.7pg；尿素氮(BUN)-静脉血: 4.22mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341.2g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；中性粒细胞计数(Neut#)-静脉血: 3.310E9/L；有核红细胞计数(NRBC#)-静脉血: 010E……\n- [全程D33] 检验组合: 尿素氮(BUN)-静脉血: 3.5mmol/L；直接胆红素(DBIL)-静脉血: 9umol/L；红细胞计数(RBC#)-静脉血: 3.8710E12/L；球蛋白(GLO)-静脉血: 27.06g/L；总胆红素(TBIL)-静脉血: 28.4umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.08mmolL；钾离子(K+)-静脉血: 3.68mmol/L；钠离子(Na+)-静脉血: 140.7mmol/L；肌酐(Crea)-静脉血: 71.4umol/L；红细胞比容(Hct)-静脉血: 34.5%；血小板比容-静脉血: 13.9%；总胆固醇(TC)-静脉血: 3.79mmol/L；磷(P)-静脉血: 1.21mmol/L；阴离子间隙(AG)-静脉血: 14.8；C-反应蛋白(CRP)-静脉血: 15.32mg/L；有核红细胞百分比(NRBC%)-静脉血: 0；乳酸脱氢酶(LDH)-静脉血: 214.8U/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15.3U/L；间接胆红素(IBIL)-静脉血: 19.4umolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.21mmol/L；白蛋白(ALB)-静脉血: 36.4g/L；总钙(Ca)-静脉血: 2.01mmol/L；载脂蛋白B(apoB)-静脉血: 0.79g/L；中性粒细胞计数(Neut#)-静脉血: 3.210E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.308；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.02；平均红细胞血红蛋白含量(MCH)-静脉血: 30.6pg；载脂蛋白AI(apoAI)-静脉血: 1.04g/L；尿酸(UA)-静脉血: 290.1umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.35；平均红细胞体积(MCV)-静脉血: 89.1fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；碱性磷酸酶(ALP)-静脉血: 60.5U/L；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；血小板计数(PLT#)-静脉血: 230.610E9/L；γ-谷氨酰基转移酶(GGT)-静……\n- [全程D36] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后，与某次就诊时间片对比， 鼻咽腔狭窄，鼻咽左侧壁、顶壁及后壁增厚，见软组织灶形成，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，病灶占据左侧咽隐窝，向前堵塞左侧后鼻孔，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，右侧咽隐窝稍变浅，范围较前缩小，右侧咽旁脂肪间隙及颈动脉鞘区未见异常。 左侧腭帆提肌、双侧头长肌受侵。 双侧翼腭窝、咀嚼肌间隙未见明显异常；口咽各壁无受累增厚。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部骨质破坏。双侧海绵窦形态正常，未见增宽。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。蝶鞍形态正常，其内未见占位性病变。 双侧上颌窦、蝶窦、筛窦、左侧乳突粘膜增厚，见不等量分泌物，右侧乳突气化好，骨壁完整。 左侧咽后间隙见小淋巴结，短径约4mm，较前未见明显变化。 双颈II区见肿大淋巴结，较大者短径约22mm，较前稍缩小。 左颈III、V区见多发小淋巴结，边界清，信号均匀，较大者短径约7mm，较前未见明显变化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。 喉咽腔形态正常，未见占位性病变。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗后，鼻咽肿物较前缩小。 颅底骨质破坏。 左侧咽后小淋巴结，较前未见明显变化。 双颈II区淋巴结肿大，较前稍缩小。 左颈III、V区多发小淋巴结，较前未见明显变化。 副鼻窦炎、左侧乳突炎。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+洛铂方案诱导化疗结束，诉呕吐1次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程5-FU+洛铂方案诱导化疗结束，无诉特殊不适，可予出院，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n- [全程D28] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，可于今日执行第2程5-FU+洛铂方案诱导化疗，注意化疗不良反应。\n- [全程D29] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+洛铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D34] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+洛铂方案诱导化疗结束，诉恶心、食欲下降，无发热、呕吐、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规示轻度贫血，肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第2程5-FU+洛铂方案诱导化疗结束，无诉特殊不适，血象提示轻度贫血，予铁剂口服等纠正贫血治疗，下周及时监测血常规、肝肾功能，备行同时期放化疗+靶向治疗。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 疗效评估为部分缓解（PR），启动靶向治疗（西妥昔单抗）联合同期放化疗\nB. 疗效评估为部分缓解（PR），启动靶向治疗（尼妥珠单抗）联合同期放化疗\nC. 疗效评估为部分缓解（PR），继续原方案（洛铂+5-FU）第3程诱导化疗\nD. 疗效评估为部分缓解（PR），启动同期放化疗，暂不联合靶向治疗\nE. 疗效评估为疾病稳定（SD），启动免疫治疗（卡瑞利珠单抗）联合同期放化疗\nF. 疗效评估为疾病进展（PD），更改化疗方案为吉西他滨+顺铂诱导化疗\nG. 疗效评估为部分缓解（PR），行鼻咽及颈部根治性放疗，不联合全身治疗\nH. 疗效评估为部分缓解（PR），暂停抗肿瘤治疗，单纯行纠正贫血支持治疗\nI. 疗效评估为部分缓解（PR），行双侧颈部淋巴结清扫术，术后辅助放疗\nJ. 疗效评估为完全缓解（CR），启动靶向治疗（西妥昔单抗）联合同期放化疗\nK. 疗效评估为部分缓解（PR），启动靶向治疗（贝伐珠单抗）联合同期放化疗\nL. 疗效评估为部分缓解（PR），启动免疫治疗（帕博利珠单抗）联合同期放化疗\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D36] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后，与某次就诊时间片对比， 鼻咽腔狭窄，鼻咽左侧壁、顶壁及后壁增厚，见软组织灶形成，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，病灶占据左侧咽隐窝，向前堵塞左侧后鼻孔，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，右侧咽隐窝稍变浅，范围较前缩小，右侧咽旁脂肪间隙及颈动脉鞘区未见异常。 左侧腭帆提肌、双侧头长肌受侵。 双侧翼腭窝、咀嚼肌间隙未见明显异常；口咽各壁无受累增厚。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部骨质破坏。双侧海绵窦形态正常，未见增宽。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。蝶鞍形态正常，其内未见占位性病变。 双侧上颌窦、蝶窦、筛窦、左侧乳突粘膜增厚，见不等量分泌物，右侧乳突气化好，骨壁完整。 左侧咽后间隙见小淋巴结，短径约4mm，较前未见明显变化。 双颈II区见肿大淋巴结，较大者短径约22mm，较前稍缩小。 左颈III、V区见多发小淋巴结，边界清，信号均匀，较大者短径约7mm，较前未见明显变化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。 喉咽腔形态正常，未见占位性病变。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗后，鼻咽肿物较前缩小。 颅底骨质破坏。 左侧咽后小淋巴结，较前未见明显变化。 双颈II区淋巴结肿大，较前稍缩小。 左颈III、V区多发小淋巴结，较前未见明显变化。 副鼻窦炎、左侧乳突炎。\n\n【既往治疗与反应】\n- [全程D34] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+洛铂方案诱导化疗结束，诉恶心、食欲下降，无发热、呕吐、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规示轻度贫血，肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第2程5-FU+洛铂方案诱导化疗结束，无诉特殊不适，血象提示轻度贫血，予铁剂口服等纠正贫血治疗，下周及时监测血常规、肝肾功能，备行同时期放化疗+靶向治疗。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 疗效评估为部分缓解（PR），启动靶向治疗（西妥昔单抗）联合同期放化疗\nB. 疗效评估为部分缓解（PR），启动靶向治疗（尼妥珠单抗）联合同期放化疗\nC. 疗效评估为部分缓解（PR），继续原方案（洛铂+5-FU）第3程诱导化疗\nD. 疗效评估为部分缓解（PR），启动同期放化疗，暂不联合靶向治疗\nE. 疗效评估为疾病稳定（SD），启动免疫治疗（卡瑞利珠单抗）联合同期放化疗\nF. 疗效评估为疾病进展（PD），更改化疗方案为吉西他滨+顺铂诱导化疗\nG. 疗效评估为部分缓解（PR），行鼻咽及颈部根治性放疗，不联合全身治疗\nH. 疗效评估为部分缓解（PR），暂停抗肿瘤治疗，单纯行纠正贫血支持治疗\nI. 疗效评估为部分缓解（PR），行双侧颈部淋巴结清扫术，术后辅助放疗\nJ. 疗效评估为完全缓解（CR），启动靶向治疗（西妥昔单抗）联合同期放化疗\nK. 疗效评估为部分缓解（PR），启动靶向治疗（贝伐珠单抗）联合同期放化疗\nL. 疗效评估为部分缓解（PR），启动免疫治疗（帕博利珠单抗）联合同期放化疗\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D36] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后，与某次就诊时间片对比， 鼻咽腔狭窄，鼻咽左侧壁、顶壁及后壁增厚，见软组织灶形成，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，病灶占据左侧咽隐窝，向前堵塞左侧后鼻孔，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，右侧咽隐窝稍变浅，范围较前缩小，右侧咽旁脂肪间隙及颈动脉鞘区未见异常。 左侧腭帆提肌、双侧头长肌受侵。 双侧翼腭窝、咀嚼肌间隙未见明显异常；口咽各壁无受累增厚。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部骨质破坏。双侧海绵窦形态正常，未见增宽。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。蝶鞍形态正常，其内未见占位性病变。 双侧上颌窦、蝶窦、筛窦、左侧乳突粘膜增厚，见不等量分泌物，右侧乳突气化好，骨壁完整。 左侧咽后间隙见小淋巴结，短径约4mm，较前未见明显变化。 双颈II区见肿大淋巴结，较大者短径约22mm，较前稍缩小。 左颈III、V区见多发小淋巴结，边界清，信号均匀，较大者短径约7mm，较前未见明显变化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。 喉咽腔形态正常，未见占位性病变。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗后，鼻咽肿物较前缩小。 颅底骨质破坏。 左侧咽后小淋巴结，较前未见明显变化。 双颈II区淋巴结肿大，较前稍缩小。 左颈III、V区多发小淋巴结，较前未见明显变化。 副鼻窦炎、左侧乳突炎。\n\n【既往治疗与反应】\n- [全程D34] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+洛铂方案诱导化疗结束，诉恶心、食欲下降，无发热、呕吐、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规示轻度贫血，肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第2程5-FU+洛铂方案诱导化疗结束，无诉特殊不适，血象提示轻度贫血，予铁剂口服等纠正贫血治疗，下周及时监测血常规、肝肾功能，备行同时期放化疗+靶向治疗。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 疗效评估为部分缓解（PR），启动靶向治疗（西妥昔单抗）联合同期放化疗\nB. 疗效评估为部分缓解（PR），启动靶向治疗（尼妥珠单抗）联合同期放化疗\nC. 疗效评估为部分缓解（PR），继续原方案（洛铂+5-FU）第3程诱导化疗\nD. 疗效评估为部分缓解（PR），启动同期放化疗，暂不联合靶向治疗\nE. 疗效评估为疾病稳定（SD），启动免疫治疗（卡瑞利珠单抗）联合同期放化疗\nF. 疗效评估为疾病进展（PD），更改化疗方案为吉西他滨+顺铂诱导化疗\nG. 疗效评估为部分缓解（PR），行鼻咽及颈部根治性放疗，不联合全身治疗\nH. 疗效评估为部分缓解（PR），暂停抗肿瘤治疗，单纯行纠正贫血支持治疗\nI. 疗效评估为部分缓解（PR），行双侧颈部淋巴结清扫术，术后辅助放疗\nJ. 疗效评估为完全缓解（CR），启动靶向治疗（西妥昔单抗）联合同期放化疗\nK. 疗效评估为部分缓解（PR），启动靶向治疗（贝伐珠单抗）联合同期放化疗\nL. 疗效评估为部分缓解（PR），启动免疫治疗（帕博利珠单抗）联合同期放化疗\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-8b39359cc6c7b630fd005591","patient_id":"patient-f402aced5926698da3194c37","turn_id":"turn08","turn_position":6,"turn_type":"response_assessment_decision","gold_letter":"B","gold_action":"确认腹部彩超无转移，继续门诊放疗，左肾结石暂予观察，并予乳果糖口服液。","options":[{"letter":"A","text":"确认腹部彩超无转移，暂停放疗，请泌尿外科会诊行左肾结石碎石治疗，并予乳果糖口服液。","is_gold":false},{"letter":"B","text":"确认腹部彩超无转移，继续门诊放疗，左肾结石暂予观察，并予乳果糖口服液。","is_gold":true},{"letter":"C","text":"确认腹部彩超无转移，继续门诊放疗，左肾结石暂予观察，并加用洛铂行第3程同期化疗。","is_gold":false},{"letter":"D","text":"确认腹部彩超无转移，暂停门诊放疗，复查鼻咽及颈部MRI评估局部疗效，并予乳果糖口服液。","is_gold":false},{"letter":"E","text":"确认腹部彩超无转移，继续门诊放疗，对左肾结石予排石颗粒，并加用西妥昔单抗靶向治疗。","is_gold":false},{"letter":"F","text":"确认腹部彩超无转移，终止放疗，左肾结石暂予观察，转入康复科行便秘治疗。","is_gold":false},{"letter":"G","text":"确认腹部彩超无转移，继续门诊放疗，对左肾结石予留置双J管，并予乳果糖口服液。","is_gold":false},{"letter":"H","text":"确认腹部彩超无转移，暂停门诊放疗，予温肥皂水灌肠处理便秘，左肾结石暂予观察。","is_gold":false},{"letter":"I","text":"确认腹部彩超无转移，继续门诊放疗，左肾结石暂予观察，并予洛哌丁胺口服。","is_gold":false},{"letter":"J","text":"确认腹部彩超无转移，继续门诊放疗，左肾结石暂予观察，并予开塞露联合新斯的明肌注。","is_gold":false},{"letter":"K","text":"确认腹部彩超无转移，暂停门诊放疗，行全身PET-CT评估疗效，左肾结石暂予观察。","is_gold":false},{"letter":"L","text":"确认腹部彩超无转移，继续门诊放疗，行体外冲击波碎石，处理左肾结石，并予乳果糖口服液。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左颈肿物20余天；现病史: 20余天前患者无明显诱因自觉左颈肿物，无发热、疼痛，伴涕血、左耳堵塞感。无头痛、面麻、鼻塞、复视、张口困难等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左耳闷胀感,涕血,左颈肿物；既往史: 高血压10余年，规律服药，血压控制在130/80mmHg左右。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:穿山甲壳、蜂蛹、伟哥过敏。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 大儿子患“脑胶质瘤”，已病逝。；体格检查: T：36.4℃，P：66次/分，R：20次/分，BP：134/81mmHg,Ht：175cm，Wt：84kg，BSA：2.0m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽顶后壁、左侧壁结节状肿物；双侧颈部II区可扪及1个淋巴结，最大径6×5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 ST-T轻度改变\n- [全程D1] 检验组合: 梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；有核红细胞计数(NRBC#)-静脉血: 010E9/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；单核细胞计数(Mono#)-静脉血: 0.510E9/L；胱抑素(Cys-C)-静脉血: 0.76mg/L；磷(P)-静脉血: 1.12mmol/L；纤维蛋白原(Fbg)-静脉血: 3.32g/L；Rh血型-静脉血: 阳性；血红蛋白(Hb)-静脉血: 136.2g/L；ABO血型-静脉血: O；骨钙素N端中分子片段(N-MID)-静脉血: 14.08ng/ml；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；直接胆红素(DBIL)-静脉血: 3.1umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 28.5U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；中性粒细胞百分比(Neut%)-静脉血: 0.617；镁离子(Mg2+)-静脉血: 0.88mmol/L；白细胞计数(WBC#)-静脉血: 7.0810E9/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 26.4U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.295ng/ml（参考: <0.704）；凝血酶原时间活动度(PTA)-静脉血: 120%；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.9mmol/L；血小板比容-静脉血: 18.3%；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.05S/CO；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.23mmolL；平均红细胞血红蛋白含量(MCH)-静脉血: 30pg；单核细胞百分比(Mono%)-静脉血: 0.072；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；总蛋白(TP)-静脉血: 71.09g/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40……\n- [全程D3] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及左侧壁粘膜增厚放射性浓聚，SUV约14.5，病灶累及蝶骨基底部、枕骨斜坡、左侧翼突、左岩尖、左侧破裂孔及左侧鼻后孔。双侧咽隐窝消失。双侧咽后未见明显肿大淋巴结及异常放射性分布。口咽及喉咽结构及放射性分布未见明显异常。左侧上颌窦及蝶窦内见低密度影放射性分布未见明显异常，额窦、筛窦及右侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双颈Ⅱ区多发肿大淋巴结放射性浓聚，SUV约14.2，最大约2.2×2.6cm。 双侧苍白球钙化放射性分布缺损，余所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。左肾盂小结石放射性分布缺损。脾脏、胰腺、右肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺小点状钙化灶。余盆腔放射性分布均匀，膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 所见颅盖骨、余躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽顶壁、顶后壁及左侧壁粘膜增厚代谢活跃，考虑鼻咽癌，病灶累及颅底骨、左侧破裂孔及左侧鼻后孔；双颈Ⅱ区多发肿大淋巴结代谢活跃，考虑转移。 左侧上颌窦及蝶窦炎症。 左肾盂小结石。 前列腺钙化。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D6] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽左侧壁、顶壁及后壁增厚，见软组织灶形成，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，病灶占据左侧咽隐窝，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，右侧咽隐窝稍变浅，右侧咽旁脂肪间隙及颈动脉鞘区未见异常； 左侧腭帆提肌、双侧头长肌直接受侵；病灶累及左侧破裂孔、左侧后鼻孔； 双侧侧翼腭窝、颞下窝未见异常；口咽各壁无受累增厚。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部骨质破坏。 双侧海绵窦形态正常，未见增宽。 左侧上颌窦、蝶窦、左侧乳突粘膜稍增厚，双侧筛窦、右侧乳突气化好，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 左侧咽后间隙见小淋巴结，短径约4mm；双颈II区见肿大淋巴结，较大者短径约25mm；左颈III、V区见多发淋巴结，边界清，信号均匀，较大者短径约7mm。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 考虑鼻咽癌可能性大。 颅底骨质破坏。 左侧咽后小淋巴结。 双颈II区淋巴结肿大。\n- [全程D6] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T7上缘水平，估计导管末端位于上腔静脉下段内。；检查结论: PICC管末端位置如上述。\n- [全程D6] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 28mm AO 29mm MV E 0.51m/s EF 73% LV 49mm IVS 9mm A 0.73m/s FS 42% RA 28mm LVPW 10mm RV 18mm PA 20mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 心脏结构及运动未见异常 各房室腔及大血管未探及异常血流信号 左室舒张功能减低，收缩功能正常\n- [全程D13] 检验组合: 镁离子(Mg2+)-静脉血: 0.89mmol/L；总胆红素(TBIL)-静脉血: 13.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 23.7U/L；丙氨酸氨基转移酶(ALT)-静脉血: 21.4U/L；总钙(Ca)-静脉血: 2.2mmol/L；氯离子(Cl-)-静脉血: 104mmol/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；直接胆红素(DBIL)-静脉血: 5umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6；红细胞比容(Hct)-静脉血: 38.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.358；间接胆红素(IBIL)-静脉血: 8.3umolL；平均红细胞体积(MCV)-静脉血: 87.1fL；载脂蛋白AI(apoAI)-静脉血: 1.11g/L；球蛋白(GLO)-静脉血: 29.01g/L；C-反应蛋白(CRP)-静脉血: 13.69mg/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；白细胞计数(WBC#)-静脉血: 4.8310E9/L；碱性磷酸酶(ALP)-静脉血: 70.4U/L；血小板比容-静脉血: 18%；载脂蛋白B(apoB)-静脉血: 0.67g/L；中性粒细胞百分比(Neut%)-静脉血: 0.566；淋巴细胞计数(Lymph#)-静脉血: 1.710E9/L；钾离子(K+)-静脉血: 4.1mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；乳酸脱氢酶(LDH)-静脉血: 203.5U/L；阴离子间隙(AG)-静脉血: 14；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；甘油三酯(TG)-静脉血: 1.28mmol/L；红细胞计数(RBC#)-静脉血: 4.4310E12/L；血小板分布宽度(PDW)-静脉血: 8.5%；单核细胞百分比(Mono%)-静脉血: 0.058；大血小板百分比(P-LCR%)-静脉血: 11.6%；血液二氧化碳含量ctCO2(B)-静脉血: 25.1mmol/L；白蛋白(ALB)-静脉血: 40.2g/L；尿素氮(BUN)-静脉血: 5.8mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.3U/L；尿酸(UA)-静脉血: 378.8umol/L；总胆固醇(TC)-……\n- [全程D21] 检验组合: 单核细胞百分比(Mono%)-静脉血: 0.062；中性粒细胞百分比(Neut%)-静脉血: 0.67；白细胞计数(WBC#)-静脉血: 5.9710E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.9；平均红细胞血红蛋白含量(MCH)-静脉血: 29.3pg；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 134g/L；红细胞比容(Hct)-静脉血: 41.3%；血小板比容-静脉血: 13%；平均红细胞体积(MCV)-静脉血: 90.4fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；平均血小板体积(MPV)-静脉血: 9.4fL；血小板计数(PLT#)-静脉血: 13810E9/L；中性粒细胞计数(Neut#)-静脉血: 410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 324g/L；血小板分布宽度(PDW)-静脉血: 9.9%；大血小板百分比(P-LCR%)-静脉血: 21.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.255；单核细胞计数(Mono#)-静脉血: 0.410E9/L；红细胞计数(RBC#)-静脉血: 4.5710E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.2\n- [全程D27] 检验组合: 红细胞计数(RBC#)-静脉血: 4.3410E12/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.85mmol/L；血小板计数(PLT#)-静脉血: 255.510E9/L；白细胞计数(WBC#)-静脉血: 6.210E9/L；氯离子(Cl-)-静脉血: 104.9mmol/L；总胆汁酸(TBA)-静脉血: 1umol/L；肌酐(Crea)-静脉血: 96.8umol/L；钾离子(K+)-静脉血: 4.5mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.386；乳酸脱氢酶(LDH)-静脉血: 212.1U/L；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.33mmolL；淋巴细胞计数(Lymph#)-静脉血: 2.410E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21U/L；平均红细胞体积(MCV)-静脉血: 90.1fL；总蛋白(TP)-静脉血: 70.21g/L；丙氨酸氨基转移酶(ALT)-静脉血: 19.6U/L；间接胆红素(IBIL)-静脉血: 4.6umolL；尿酸(UA)-静脉血: 469.1umol/L；血小板比容-静脉血: 15.3%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；甘油三酯(TG)-静脉血: 1.12mmol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白B(apoB)-静脉血: 0.9g/L；平均血小板体积(MPV)-静脉血: 6.02fL；总钙(Ca)-静脉血: 2.25mmol/L；单核细胞百分比(Mono%)-静脉血: 0.066；红细胞比容(Hct)-静脉血: 39.1%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；γ-谷氨酰基转移酶(GGT)-静脉血: 25.5U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.7pg；尿素氮(BUN)-静脉血: 4.22mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341.2g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；中性粒细胞计数(Neut#)-静脉血: 3.310E9/L；有核红细胞计数(NRBC#)-静脉血: 010E……\n- [全程D33] 检验组合: 尿素氮(BUN)-静脉血: 3.5mmol/L；直接胆红素(DBIL)-静脉血: 9umol/L；红细胞计数(RBC#)-静脉血: 3.8710E12/L；球蛋白(GLO)-静脉血: 27.06g/L；总胆红素(TBIL)-静脉血: 28.4umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.08mmolL；钾离子(K+)-静脉血: 3.68mmol/L；钠离子(Na+)-静脉血: 140.7mmol/L；肌酐(Crea)-静脉血: 71.4umol/L；红细胞比容(Hct)-静脉血: 34.5%；血小板比容-静脉血: 13.9%；总胆固醇(TC)-静脉血: 3.79mmol/L；磷(P)-静脉血: 1.21mmol/L；阴离子间隙(AG)-静脉血: 14.8；C-反应蛋白(CRP)-静脉血: 15.32mg/L；有核红细胞百分比(NRBC%)-静脉血: 0；乳酸脱氢酶(LDH)-静脉血: 214.8U/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15.3U/L；间接胆红素(IBIL)-静脉血: 19.4umolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.21mmol/L；白蛋白(ALB)-静脉血: 36.4g/L；总钙(Ca)-静脉血: 2.01mmol/L；载脂蛋白B(apoB)-静脉血: 0.79g/L；中性粒细胞计数(Neut#)-静脉血: 3.210E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.308；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.02；平均红细胞血红蛋白含量(MCH)-静脉血: 30.6pg；载脂蛋白AI(apoAI)-静脉血: 1.04g/L；尿酸(UA)-静脉血: 290.1umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.35；平均红细胞体积(MCV)-静脉血: 89.1fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；碱性磷酸酶(ALP)-静脉血: 60.5U/L；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；血小板计数(PLT#)-静脉血: 230.610E9/L；γ-谷氨酰基转移酶(GGT)-静……\n- [全程D36] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后，与某次就诊时间片对比， 鼻咽腔狭窄，鼻咽左侧壁、顶壁及后壁增厚，见软组织灶形成，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，病灶占据左侧咽隐窝，向前堵塞左侧后鼻孔，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，右侧咽隐窝稍变浅，范围较前缩小，右侧咽旁脂肪间隙及颈动脉鞘区未见异常。 左侧腭帆提肌、双侧头长肌受侵。 双侧翼腭窝、咀嚼肌间隙未见明显异常；口咽各壁无受累增厚。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部骨质破坏。双侧海绵窦形态正常，未见增宽。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。蝶鞍形态正常，其内未见占位性病变。 双侧上颌窦、蝶窦、筛窦、左侧乳突粘膜增厚，见不等量分泌物，右侧乳突气化好，骨壁完整。 左侧咽后间隙见小淋巴结，短径约4mm，较前未见明显变化。 双颈II区见肿大淋巴结，较大者短径约22mm，较前稍缩小。 左颈III、V区见多发小淋巴结，边界清，信号均匀，较大者短径约7mm，较前未见明显变化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。 喉咽腔形态正常，未见占位性病变。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗后，鼻咽肿物较前缩小。 颅底骨质破坏。 左侧咽后小淋巴结，较前未见明显变化。 双颈II区淋巴结肿大，较前稍缩小。 左颈III、V区多发小淋巴结，较前未见明显变化。 副鼻窦炎、左侧乳突炎。\n- [全程D58] 检验组合: 红细胞比容(Hct)-静脉血: 34.3%；载脂蛋白B(apoB)-静脉血: 0.73g/L；碱性磷酸酶(ALP)-静脉血: 76U/L；肌酐(Crea)-静脉血: 67.8umol/L；胱抑素(Cys-C)-静脉血: 0.64mg/L；中性粒细胞百分比(Neut%)-静脉血: 0.768；血红蛋白(Hb)-静脉血: 116g/L；平均血小板体积(MPV)-静脉血: 8.4fL；总胆红素(TBIL)-静脉血: 15.8umol/L；尿素氮(BUN)-静脉血: 3.79mmol/L；镁离子(Mg2+)-静脉血: 0.9mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 22.5U/L；钾离子(K+)-静脉血: 3.6mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 16U/L；直接胆红素(DBIL)-静脉血: 6.5umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.5mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.5；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.7；白蛋白(ALB)-静脉血: 35.4g/L；钠离子(Na+)-静脉血: 138.1mmol/L；总钙(Ca)-静脉血: 2.12mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.08mmolL；磷(P)-静脉血: 1.18mmol/L；C-反应蛋白(CRP)-静脉血: 30.45mg/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.005；总胆汁酸(TBA)-静脉血: 1.6umol/L；乳酸脱氢酶(LDH)-静脉血: 175.3U/L；甘油三酯(TG)-静脉血: 0.98mmol/L；红细胞计数(RBC#)-静脉血: 3.8810E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血小板比容-静脉血: 13%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.28mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.04g/L；间接胆红素(IBIL)-静脉血: 9.3umolL；平均红细胞血红蛋白含量(MCH)-静脉血: 29.9pg；氯离子(Cl-)-静脉血: 102.7mmol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L……\n- [全程D65] 检验组合: 钾离子(K+)-静脉血: 3.65mmol/L；总胆固醇(TC)-静脉血: 3.47mmol/L；阴离子间隙(AG)-静脉血: 9.1；磷(P)-静脉血: 1.16mmol/L；间接胆红素(IBIL)-静脉血: 7.2umolL；总蛋白(TP)-静脉血: 66.88g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 14.2U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.07mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；红细胞比容(Hct)-静脉血: 35.8%；淋巴细胞百分比(Lymph%)-静脉血: 0.077；红细胞体积分布宽度CV(RDW-CV)-静脉血: 15.7%；丙氨酸氨基转移酶(ALT)-静脉血: 15.7U/L；钠离子(Na+)-静脉血: 141.1mmol/L；乳酸脱氢酶(LDH)-静脉血: 147.8U/L；C-反应蛋白(CRP)-静脉血: 23.42mg/L；甘油三酯(TG)-静脉血: 1.16mmol/L；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；血小板分布宽度(PDW)-静脉血: 17.3%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；肌酐(Crea)-静脉血: 62.8umol/L；镁离子(Mg2+)-静脉血: 0.8mmol/L；总胆红素(TBIL)-静脉血: 12.5umol/L；淋巴细胞计数(Lymph#)-静脉血: 0.410E9/L；直接胆红素(DBIL)-静脉血: 5.3umol/L；球蛋白(GLO)-静脉血: 30.38g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；尿素氮(BUN)-静脉血: 3.1mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 35.9U/L；载脂蛋白AI(apoAI)-静脉血: 0.9g/L；白蛋白(ALB)-静脉血: 36.5g/L；血红蛋白(Hb)-静脉血: 118.5g/L；载脂蛋白B(apoB)-静脉血: 0.74g/L；白细胞计数(WBC#)-静脉血: 4.5110E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 18.3U/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血……\n- [全程D72] 检验组合: 磷(P)-静脉血: 1.31mmol/L；总钙(Ca)-静脉血: 2.11mmol/L；总胆红素(TBIL)-静脉血: 12umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.745；镁离子(Mg2+)-静脉血: 0.8mmol/L；总蛋白(TP)-静脉血: 65.97g/L；单核细胞百分比(Mono%)-静脉血: 0.132；血小板计数(PLT#)-静脉血: 17910E9/L；球蛋白(GLO)-静脉血: 33.37g/L；尿素氮(BUN)-静脉血: 3.82mmol/L；尿酸(UA)-静脉血: 232.9umol/L；间接胆红素(IBIL)-静脉血: 6.9umolL；中性粒细胞计数(Neut#)-静脉血: 2.510E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.9；氯离子(Cl-)-静脉血: 105mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.6；血小板比容-静脉血: 15%；平均红细胞血红蛋白含量(MCH)-静脉血: 29.2pg；总胆固醇(TC)-静脉血: 3.73mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；载脂蛋白AI(apoAI)-静脉血: 0.88g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 36.1U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.026；胱抑素(Cys-C)-静脉血: 0.62mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.91mmolL；乳酸脱氢酶(LDH)-静脉血: 137U/L；肌酐(Crea)-静脉血: 68.5umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 87.7fL；血小板分布宽度(PDW)-静脉血: 7.4%；白蛋白(ALB)-静脉血: 32.6g/L；甘油三酯(TG)-静脉血: 0.96mmol/L；大血小板百分比(P-LCR%)-静脉血: 11.2%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15.9U/L；丙氨酸氨基转移酶(ALT)-静脉血: 17.3U/L；钠离子(Na+)-静脉血: 141.2mmol……\n- [全程D75] 检验组合: 白细胞计数(WBC#)-静脉血: 3.3210E9/L；血小板分布宽度(PDW)-静脉血: 7.9%；钾离子(K+)-静脉血: 3.4mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 18.6U/L；C-反应蛋白(CRP)-静脉血: 56.54mg/L；红细胞比容(Hct)-静脉血: 33.5%；单核细胞百分比(Mono%)-静脉血: 0.117；肌酐(Crea)-静脉血: 63.4umol/L；尿酸(UA)-静脉血: 304umol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；血小板比容-静脉血: 18%；α-L-岩藻糖苷酶(AFU)-静脉血: 22U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.72mmol/L；血小板计数(PLT#)-静脉血: 21110E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.9；中性粒细胞百分比(Neut%)-静脉血: 0.772；淋巴细胞百分比(Lymph%)-静脉血: 0.072；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；总钙(Ca)-静脉血: 2.12mmol/L；药物曲线下面积(AUC)-静脉血: 1；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；总胆固醇(TC)-静脉血: 4.15mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.88mmolL；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 16.7U/L；白蛋白(ALB)-静脉血: 33g/L；平均血小板体积(MPV)-静脉血: 8.3fL；总胆红素(TBIL)-静脉血: 13.6umol/L；磷(P)-静脉血: 1.15mmol/L；球蛋白(GLO)-静脉血: 33.66g/L；阴离子间隙(AG)-静脉血: 14；葡萄糖(Glu)-静脉血: 5.63mmol/L；载脂蛋白AI(apoAI)-静脉血: 0.81g/L；总胆汁酸(TBA)-静脉血: 1.4umol/L；间接胆红素(IBIL)-静脉血: 7.9umolL；尿素氮(BUN)-静脉血: 5.04mmol/L；胱抑素(Cys-C)-静脉血: 0.65mg/L；红细胞计数(RBC#)-静脉血: 3.8110E12/L；红细胞体积分布宽度……\n- [全程D86] 检验组合: 总胆汁酸(TBA)-静脉血: 1.6umol/L；直接胆红素(DBIL)-静脉血: 2.4umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 16U/L；C-反应蛋白(CRP)-静脉血: 15.4mg/L；淋巴细胞百分比(Lymph%)-静脉血: 0.142；总钙(Ca)-静脉血: 2.08mmol/L；阴离子间隙(AG)-静脉血: 10；丙氨酸氨基转移酶(ALT)-静脉血: 27.7U/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；白蛋白(ALB)-静脉血: 30.3g/L；钾离子(K+)-静脉血: 3.2mmol/L；葡萄糖(Glu)-静脉血: 5.56mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.27mmol/L；总胆固醇(TC)-静脉血: 3.75mmol/L；平均红细胞体积(MCV)-静脉血: 89.4fL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.83mmolL；肌酐(Crea)-静脉血: 72.9umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 53U/L；尿酸(UA)-静脉血: 338.6umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.9mmol/L；白细胞计数(WBC#)-静脉血: 2.610E9/L；钠离子(Na+)-静脉血: 140.5mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.4pg；单核细胞百分比(Mono%)-静脉血: 0.281；大血小板百分比(P-LCR%)-静脉血: 12.6%；载脂蛋白B(apoB)-静脉血: 0.76g/L；载脂蛋白AI(apoAI)-静脉血: 0.84g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.6U/L；间接胆红素(IBIL)-静脉血: 3umolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.7；甘油三酯(TG)-静脉血: 1.42mmol/L；磷(P)-静脉血: 1.4mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.8；碱性磷酸酶(ALP)-静脉血: 70.5U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；尿素氮……\n- [全程D88] 检验组合: 血红蛋白(Hb)-静脉血: 118g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.26；平均血小板体积(MPV)-静脉血: 8.5fL；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；红细胞比容(Hct)-静脉血: 35.8%；血小板比容-静脉血: 14%；血小板分布宽度(PDW)-静脉血: 7.6%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.7；平均红细胞体积(MCV)-静脉血: 90.4fL；血小板计数(PLT#)-静脉血: 16910E9/L；红细胞计数(RBC#)-静脉血: 3.9610E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.028；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；单核细胞百分比(Mono%)-静脉血: 0.097；大血小板百分比(P-LCR%)-静脉血: 14.3%；白细胞计数(WBC#)-静脉血: 2.8810E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.8pg；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.5；中性粒细胞计数(Neut#)-静脉血: 1.810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.612\n- [全程D93] 检验组合: 低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.82mmol/L；白蛋白(ALB)-静脉血: 37.8g/L；总胆红素(TBIL)-静脉血: 9.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 39.6U/L；胱抑素(Cys-C)-静脉血: 0.78mg/L；淋巴细胞百分比(Lymph%)-静脉血: 0.15；天门冬氨酸氨基转移酶(AST)-静脉血: 21.3U/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；尿酸(UA)-静脉血: 295.9umol/L；血小板比容-静脉血: 12.1%；中性粒细胞计数(Neut#)-静脉血: 2.410E9/L；氯离子(Cl-)-静脉血: 102mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.7mmol/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；阴离子间隙(AG)-静脉血: 13.1；钠离子(Na+)-静脉血: 142.8mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 16.1%；血小板分布宽度(PDW)-静脉血: 15.9%；红细胞比容(Hct)-静脉血: 36.4%；磷(P)-静脉血: 1.26mmol/L；直接胆红素(DBIL)-静脉血: 3.4umol/L；总蛋白(TP)-静脉血: 70.94g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；葡萄糖(Glu)-静脉血: 6.22mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.019；间接胆红素(IBIL)-静脉血: 5.9umolL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；载脂蛋白B(apoB)-静脉血: 0.94g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.11mmolL；总胆固醇(TC)-静脉血: 4.28mmol/L；碱性磷酸酶(ALP)-静脉血: 88.1U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.5pg；血小板计数(PLT#)-静脉血: 215.910E9/L；钾离子(K+)-静脉血: 3.96mmol/L；单核细胞百分比(Mono%)-静脉血: 0.146；平均血小板体积(MPV)-静脉血: 5.62fL；有核红细胞百分比(NRBC%)-静脉血:……\n- [全程D94] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约28cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，右肾实质回声均匀，未见明显异常回声。左肾下盏可见一强回声团，直径约6mm，边界清。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约28×25×25mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 左肾结石。 肝脏、胆囊、脾脏、胰腺、右肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+洛铂方案诱导化疗结束，诉呕吐1次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程5-FU+洛铂方案诱导化疗结束，无诉特殊不适，可予出院，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n- [全程D28] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，可于今日执行第2程5-FU+洛铂方案诱导化疗，注意化疗不良反应。\n- [全程D29] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+洛铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D34] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+洛铂方案诱导化疗结束，诉恶心、食欲下降，无发热、呕吐、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规示轻度贫血，肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第2程5-FU+洛铂方案诱导化疗结束，无诉特殊不适，血象提示轻度贫血，予铁剂口服等纠正贫血治疗，下周及时监测血常规、肝肾功能，备行同时期放化疗+靶向治疗。\n- [全程D64] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者放疗中，第4程爱必妥靶向治疗后3天，诉口感、咽痛、纳差。查体同前。[姓名已隐去]医生信息已隐藏：予喷喉、洗鼻、保护皮肤处理，加强营养，继续放疗。\n- [全程D69] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者放疗中，今日第5程爱必妥靶向治疗，诉头面部皮疹，口感、咽痛，余无明显不适。查体：头面部散在红疹，无脱皮、水泡，余同前。[姓名已隐去]医生信息已隐藏：予红外线治疗，喷喉、洗鼻、保护皮肤处理，加强营养，继续放疗。\n- [全程D74] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者放疗中，第2程洛铂方案同时期化疗结束，诉恶心、食欲下降，呕吐1次，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规示轻度贫血，肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第2程洛铂方案同时期化疗结束，诉恶心、呕吐，予止呕护胃处理，继续放疗。\n- [全程D78] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者2月18日至2月26日春节请假中。\n- [全程D88] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者放疗中，第6程爱必妥靶向治疗结束，诉头面部皮疹，口感、咽痛，余无明显不适。查体：头面部散在红疹，无脱皮、水泡，余同前。复查血常规、生化插管基本正常。[姓名已隐去]医生信息已隐藏：予喷喉、洗鼻、保护皮肤处理，加强营养，今日可办理出院，继续门诊放疗，按时间行复查。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 确认腹部彩超无转移，暂停放疗，请泌尿外科会诊行左肾结石碎石治疗，并予乳果糖口服液。\nB. 确认腹部彩超无转移，继续门诊放疗，左肾结石暂予观察，并予乳果糖口服液。\nC. 确认腹部彩超无转移，继续门诊放疗，左肾结石暂予观察，并加用洛铂行第3程同期化疗。\nD. 确认腹部彩超无转移，暂停门诊放疗，复查鼻咽及颈部MRI评估局部疗效，并予乳果糖口服液。\nE. 确认腹部彩超无转移，继续门诊放疗，对左肾结石予排石颗粒，并加用西妥昔单抗靶向治疗。\nF. 确认腹部彩超无转移，终止放疗，左肾结石暂予观察，转入康复科行便秘治疗。\nG. 确认腹部彩超无转移，继续门诊放疗，对左肾结石予留置双J管，并予乳果糖口服液。\nH. 确认腹部彩超无转移，暂停门诊放疗，予温肥皂水灌肠处理便秘，左肾结石暂予观察。\nI. 确认腹部彩超无转移，继续门诊放疗，左肾结石暂予观察，并予洛哌丁胺口服。\nJ. 确认腹部彩超无转移，继续门诊放疗，左肾结石暂予观察，并予开塞露联合新斯的明肌注。\nK. 确认腹部彩超无转移，暂停门诊放疗，行全身PET-CT评估疗效，左肾结石暂予观察。\nL. 确认腹部彩超无转移，继续门诊放疗，行体外冲击波碎石，处理左肾结石，并予乳果糖口服液。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D58] 检验组合: 红细胞比容(Hct)-静脉血: 34.3%；载脂蛋白B(apoB)-静脉血: 0.73g/L；碱性磷酸酶(ALP)-静脉血: 76U/L；肌酐(Crea)-静脉血: 67.8umol/L；胱抑素(Cys-C)-静脉血: 0.64mg/L；中性粒细胞百分比(Neut%)-静脉血: 0.768；血红蛋白(Hb)-静脉血: 116g/L；平均血小板体积(MPV)-静脉血: 8.4fL；总胆红素(TBIL)-静脉血: 15.8umol/L；尿素氮(BUN)-静脉血: 3.79mmol/L；镁离子(Mg2+)-静脉血: 0.9mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 22.5U/L；钾离子(K+)-静脉血: 3.6mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 16U/L；直接胆红素(DBIL)-静脉血: 6.5umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.5mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.5；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.7；白蛋白(ALB)-静脉血: 35.4g/L；钠离子(Na+)-静脉血: 138.1mmol/L；总钙(Ca)-静脉血: 2.12mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.08mmolL；磷(P)-静脉血: 1.18mmol/L；C-反应蛋白(CRP)-静脉血: 30.45mg/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.005；总胆汁酸(TBA)-静脉血: 1.6umol/L；乳酸脱氢酶(LDH)-静脉血: 175.3U/L；甘油三酯(TG)-静脉血: 0.98mmol/L；红细胞计数(RBC#)-静脉血: 3.8810E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血小板比容-静脉血: 13%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.28mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.04g/L；间接胆红素(IBIL)-静脉血: 9.3umolL；平均红细胞血红蛋白含量(MCH)-静脉血: 29.9pg；氯离子(Cl-)-静脉血: 102.7mmol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L……\n- [全程D65] 检验组合: 钾离子(K+)-静脉血: 3.65mmol/L；总胆固醇(TC)-静脉血: 3.47mmol/L；阴离子间隙(AG)-静脉血: 9.1；磷(P)-静脉血: 1.16mmol/L；间接胆红素(IBIL)-静脉血: 7.2umolL；总蛋白(TP)-静脉血: 66.88g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 14.2U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.07mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；红细胞比容(Hct)-静脉血: 35.8%；淋巴细胞百分比(Lymph%)-静脉血: 0.077；红细胞体积分布宽度CV(RDW-CV)-静脉血: 15.7%；丙氨酸氨基转移酶(ALT)-静脉血: 15.7U/L；钠离子(Na+)-静脉血: 141.1mmol/L；乳酸脱氢酶(LDH)-静脉血: 147.8U/L；C-反应蛋白(CRP)-静脉血: 23.42mg/L；甘油三酯(TG)-静脉血: 1.16mmol/L；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；血小板分布宽度(PDW)-静脉血: 17.3%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；肌酐(Crea)-静脉血: 62.8umol/L；镁离子(Mg2+)-静脉血: 0.8mmol/L；总胆红素(TBIL)-静脉血: 12.5umol/L；淋巴细胞计数(Lymph#)-静脉血: 0.410E9/L；直接胆红素(DBIL)-静脉血: 5.3umol/L；球蛋白(GLO)-静脉血: 30.38g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；尿素氮(BUN)-静脉血: 3.1mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 35.9U/L；载脂蛋白AI(apoAI)-静脉血: 0.9g/L；白蛋白(ALB)-静脉血: 36.5g/L；血红蛋白(Hb)-静脉血: 118.5g/L；载脂蛋白B(apoB)-静脉血: 0.74g/L；白细胞计数(WBC#)-静脉血: 4.5110E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 18.3U/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血……\n- [全程D72] 检验组合: 磷(P)-静脉血: 1.31mmol/L；总钙(Ca)-静脉血: 2.11mmol/L；总胆红素(TBIL)-静脉血: 12umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.745；镁离子(Mg2+)-静脉血: 0.8mmol/L；总蛋白(TP)-静脉血: 65.97g/L；单核细胞百分比(Mono%)-静脉血: 0.132；血小板计数(PLT#)-静脉血: 17910E9/L；球蛋白(GLO)-静脉血: 33.37g/L；尿素氮(BUN)-静脉血: 3.82mmol/L；尿酸(UA)-静脉血: 232.9umol/L；间接胆红素(IBIL)-静脉血: 6.9umolL；中性粒细胞计数(Neut#)-静脉血: 2.510E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.9；氯离子(Cl-)-静脉血: 105mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.6；血小板比容-静脉血: 15%；平均红细胞血红蛋白含量(MCH)-静脉血: 29.2pg；总胆固醇(TC)-静脉血: 3.73mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；载脂蛋白AI(apoAI)-静脉血: 0.88g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 36.1U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.026；胱抑素(Cys-C)-静脉血: 0.62mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.91mmolL；乳酸脱氢酶(LDH)-静脉血: 137U/L；肌酐(Crea)-静脉血: 68.5umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 87.7fL；血小板分布宽度(PDW)-静脉血: 7.4%；白蛋白(ALB)-静脉血: 32.6g/L；甘油三酯(TG)-静脉血: 0.96mmol/L；大血小板百分比(P-LCR%)-静脉血: 11.2%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15.9U/L；丙氨酸氨基转移酶(ALT)-静脉血: 17.3U/L；钠离子(Na+)-静脉血: 141.2mmol……\n- [全程D75] 检验组合: 白细胞计数(WBC#)-静脉血: 3.3210E9/L；血小板分布宽度(PDW)-静脉血: 7.9%；钾离子(K+)-静脉血: 3.4mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 18.6U/L；C-反应蛋白(CRP)-静脉血: 56.54mg/L；红细胞比容(Hct)-静脉血: 33.5%；单核细胞百分比(Mono%)-静脉血: 0.117；肌酐(Crea)-静脉血: 63.4umol/L；尿酸(UA)-静脉血: 304umol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；血小板比容-静脉血: 18%；α-L-岩藻糖苷酶(AFU)-静脉血: 22U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.72mmol/L；血小板计数(PLT#)-静脉血: 21110E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.9；中性粒细胞百分比(Neut%)-静脉血: 0.772；淋巴细胞百分比(Lymph%)-静脉血: 0.072；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；总钙(Ca)-静脉血: 2.12mmol/L；药物曲线下面积(AUC)-静脉血: 1；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；总胆固醇(TC)-静脉血: 4.15mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.88mmolL；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 16.7U/L；白蛋白(ALB)-静脉血: 33g/L；平均血小板体积(MPV)-静脉血: 8.3fL；总胆红素(TBIL)-静脉血: 13.6umol/L；磷(P)-静脉血: 1.15mmol/L；球蛋白(GLO)-静脉血: 33.66g/L；阴离子间隙(AG)-静脉血: 14；葡萄糖(Glu)-静脉血: 5.63mmol/L；载脂蛋白AI(apoAI)-静脉血: 0.81g/L；总胆汁酸(TBA)-静脉血: 1.4umol/L；间接胆红素(IBIL)-静脉血: 7.9umolL；尿素氮(BUN)-静脉血: 5.04mmol/L；胱抑素(Cys-C)-静脉血: 0.65mg/L；红细胞计数(RBC#)-静脉血: 3.8110E12/L；红细胞体积分布宽度……\n- [全程D86] 检验组合: 总胆汁酸(TBA)-静脉血: 1.6umol/L；直接胆红素(DBIL)-静脉血: 2.4umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 16U/L；C-反应蛋白(CRP)-静脉血: 15.4mg/L；淋巴细胞百分比(Lymph%)-静脉血: 0.142；总钙(Ca)-静脉血: 2.08mmol/L；阴离子间隙(AG)-静脉血: 10；丙氨酸氨基转移酶(ALT)-静脉血: 27.7U/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；白蛋白(ALB)-静脉血: 30.3g/L；钾离子(K+)-静脉血: 3.2mmol/L；葡萄糖(Glu)-静脉血: 5.56mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.27mmol/L；总胆固醇(TC)-静脉血: 3.75mmol/L；平均红细胞体积(MCV)-静脉血: 89.4fL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.83mmolL；肌酐(Crea)-静脉血: 72.9umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 53U/L；尿酸(UA)-静脉血: 338.6umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.9mmol/L；白细胞计数(WBC#)-静脉血: 2.610E9/L；钠离子(Na+)-静脉血: 140.5mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.4pg；单核细胞百分比(Mono%)-静脉血: 0.281；大血小板百分比(P-LCR%)-静脉血: 12.6%；载脂蛋白B(apoB)-静脉血: 0.76g/L；载脂蛋白AI(apoAI)-静脉血: 0.84g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.6U/L；间接胆红素(IBIL)-静脉血: 3umolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.7；甘油三酯(TG)-静脉血: 1.42mmol/L；磷(P)-静脉血: 1.4mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.8；碱性磷酸酶(ALP)-静脉血: 70.5U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；尿素氮……\n- [全程D88] 检验组合: 血红蛋白(Hb)-静脉血: 118g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.26；平均血小板体积(MPV)-静脉血: 8.5fL；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；红细胞比容(Hct)-静脉血: 35.8%；血小板比容-静脉血: 14%；血小板分布宽度(PDW)-静脉血: 7.6%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.7；平均红细胞体积(MCV)-静脉血: 90.4fL；血小板计数(PLT#)-静脉血: 16910E9/L；红细胞计数(RBC#)-静脉血: 3.9610E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.028；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；单核细胞百分比(Mono%)-静脉血: 0.097；大血小板百分比(P-LCR%)-静脉血: 14.3%；白细胞计数(WBC#)-静脉血: 2.8810E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.8pg；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.5；中性粒细胞计数(Neut#)-静脉血: 1.810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.612\n- [全程D93] 检验组合: 低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.82mmol/L；白蛋白(ALB)-静脉血: 37.8g/L；总胆红素(TBIL)-静脉血: 9.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 39.6U/L；胱抑素(Cys-C)-静脉血: 0.78mg/L；淋巴细胞百分比(Lymph%)-静脉血: 0.15；天门冬氨酸氨基转移酶(AST)-静脉血: 21.3U/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；尿酸(UA)-静脉血: 295.9umol/L；血小板比容-静脉血: 12.1%；中性粒细胞计数(Neut#)-静脉血: 2.410E9/L；氯离子(Cl-)-静脉血: 102mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.7mmol/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；阴离子间隙(AG)-静脉血: 13.1；钠离子(Na+)-静脉血: 142.8mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 16.1%；血小板分布宽度(PDW)-静脉血: 15.9%；红细胞比容(Hct)-静脉血: 36.4%；磷(P)-静脉血: 1.26mmol/L；直接胆红素(DBIL)-静脉血: 3.4umol/L；总蛋白(TP)-静脉血: 70.94g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；葡萄糖(Glu)-静脉血: 6.22mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.019；间接胆红素(IBIL)-静脉血: 5.9umolL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；载脂蛋白B(apoB)-静脉血: 0.94g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.11mmolL；总胆固醇(TC)-静脉血: 4.28mmol/L；碱性磷酸酶(ALP)-静脉血: 88.1U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.5pg；血小板计数(PLT#)-静脉血: 215.910E9/L；钾离子(K+)-静脉血: 3.96mmol/L；单核细胞百分比(Mono%)-静脉血: 0.146；平均血小板体积(MPV)-静脉血: 5.62fL；有核红细胞百分比(NRBC%)-静脉血:……\n- [全程D94] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约28cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，右肾实质回声均匀，未见明显异常回声。左肾下盏可见一强回声团，直径约6mm，边界清。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约28×25×25mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 左肾结石。 肝脏、胆囊、脾脏、胰腺、右肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n\n【既往治疗与反应】\n- [全程D64] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者放疗中，第4程爱必妥靶向治疗后3天，诉口感、咽痛、纳差。查体同前。[姓名已隐去]医生信息已隐藏：予喷喉、洗鼻、保护皮肤处理，加强营养，继续放疗。\n- [全程D69] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者放疗中，今日第5程爱必妥靶向治疗，诉头面部皮疹，口感、咽痛，余无明显不适。查体：头面部散在红疹，无脱皮、水泡，余同前。[姓名已隐去]医生信息已隐藏：予红外线治疗，喷喉、洗鼻、保护皮肤处理，加强营养，继续放疗。\n- [全程D74] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者放疗中，第2程洛铂方案同时期化疗结束，诉恶心、食欲下降，呕吐1次，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规示轻度贫血，肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第2程洛铂方案同时期化疗结束，诉恶心、呕吐，予止呕护胃处理，继续放疗。\n- [全程D78] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者2月18日至2月26日春节请假中。\n- [全程D88] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者放疗中，第6程爱必妥靶向治疗结束，诉头面部皮疹，口感、咽痛，余无明显不适。查体：头面部散在红疹，无脱皮、水泡，余同前。复查血常规、生化插管基本正常。[姓名已隐去]医生信息已隐藏：予喷喉、洗鼻、保护皮肤处理，加强营养，今日可办理出院，继续门诊放疗，按时间行复查。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 确认腹部彩超无转移，暂停放疗，请泌尿外科会诊行左肾结石碎石治疗，并予乳果糖口服液。\nB. 确认腹部彩超无转移，继续门诊放疗，左肾结石暂予观察，并予乳果糖口服液。\nC. 确认腹部彩超无转移，继续门诊放疗，左肾结石暂予观察，并加用洛铂行第3程同期化疗。\nD. 确认腹部彩超无转移，暂停门诊放疗，复查鼻咽及颈部MRI评估局部疗效，并予乳果糖口服液。\nE. 确认腹部彩超无转移，继续门诊放疗，对左肾结石予排石颗粒，并加用西妥昔单抗靶向治疗。\nF. 确认腹部彩超无转移，终止放疗，左肾结石暂予观察，转入康复科行便秘治疗。\nG. 确认腹部彩超无转移，继续门诊放疗，对左肾结石予留置双J管，并予乳果糖口服液。\nH. 确认腹部彩超无转移，暂停门诊放疗，予温肥皂水灌肠处理便秘，左肾结石暂予观察。\nI. 确认腹部彩超无转移，继续门诊放疗，左肾结石暂予观察，并予洛哌丁胺口服。\nJ. 确认腹部彩超无转移，继续门诊放疗，左肾结石暂予观察，并予开塞露联合新斯的明肌注。\nK. 确认腹部彩超无转移，暂停门诊放疗，行全身PET-CT评估疗效，左肾结石暂予观察。\nL. 确认腹部彩超无转移，继续门诊放疗，行体外冲击波碎石，处理左肾结石，并予乳果糖口服液。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D58] 检验组合: 红细胞比容(Hct)-静脉血: 34.3%；载脂蛋白B(apoB)-静脉血: 0.73g/L；碱性磷酸酶(ALP)-静脉血: 76U/L；肌酐(Crea)-静脉血: 67.8umol/L；胱抑素(Cys-C)-静脉血: 0.64mg/L；中性粒细胞百分比(Neut%)-静脉血: 0.768；血红蛋白(Hb)-静脉血: 116g/L；平均血小板体积(MPV)-静脉血: 8.4fL；总胆红素(TBIL)-静脉血: 15.8umol/L；尿素氮(BUN)-静脉血: 3.79mmol/L；镁离子(Mg2+)-静脉血: 0.9mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 22.5U/L；钾离子(K+)-静脉血: 3.6mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 16U/L；直接胆红素(DBIL)-静脉血: 6.5umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.5mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.5；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.7；白蛋白(ALB)-静脉血: 35.4g/L；钠离子(Na+)-静脉血: 138.1mmol/L；总钙(Ca)-静脉血: 2.12mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.08mmolL；磷(P)-静脉血: 1.18mmol/L；C-反应蛋白(CRP)-静脉血: 30.45mg/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.005；总胆汁酸(TBA)-静脉血: 1.6umol/L；乳酸脱氢酶(LDH)-静脉血: 175.3U/L；甘油三酯(TG)-静脉血: 0.98mmol/L；红细胞计数(RBC#)-静脉血: 3.8810E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血小板比容-静脉血: 13%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.28mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.04g/L；间接胆红素(IBIL)-静脉血: 9.3umolL；平均红细胞血红蛋白含量(MCH)-静脉血: 29.9pg；氯离子(Cl-)-静脉血: 102.7mmol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L……\n- [全程D65] 检验组合: 钾离子(K+)-静脉血: 3.65mmol/L；总胆固醇(TC)-静脉血: 3.47mmol/L；阴离子间隙(AG)-静脉血: 9.1；磷(P)-静脉血: 1.16mmol/L；间接胆红素(IBIL)-静脉血: 7.2umolL；总蛋白(TP)-静脉血: 66.88g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 14.2U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.07mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；红细胞比容(Hct)-静脉血: 35.8%；淋巴细胞百分比(Lymph%)-静脉血: 0.077；红细胞体积分布宽度CV(RDW-CV)-静脉血: 15.7%；丙氨酸氨基转移酶(ALT)-静脉血: 15.7U/L；钠离子(Na+)-静脉血: 141.1mmol/L；乳酸脱氢酶(LDH)-静脉血: 147.8U/L；C-反应蛋白(CRP)-静脉血: 23.42mg/L；甘油三酯(TG)-静脉血: 1.16mmol/L；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；血小板分布宽度(PDW)-静脉血: 17.3%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；肌酐(Crea)-静脉血: 62.8umol/L；镁离子(Mg2+)-静脉血: 0.8mmol/L；总胆红素(TBIL)-静脉血: 12.5umol/L；淋巴细胞计数(Lymph#)-静脉血: 0.410E9/L；直接胆红素(DBIL)-静脉血: 5.3umol/L；球蛋白(GLO)-静脉血: 30.38g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；尿素氮(BUN)-静脉血: 3.1mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 35.9U/L；载脂蛋白AI(apoAI)-静脉血: 0.9g/L；白蛋白(ALB)-静脉血: 36.5g/L；血红蛋白(Hb)-静脉血: 118.5g/L；载脂蛋白B(apoB)-静脉血: 0.74g/L；白细胞计数(WBC#)-静脉血: 4.5110E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 18.3U/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血……\n- [全程D72] 检验组合: 磷(P)-静脉血: 1.31mmol/L；总钙(Ca)-静脉血: 2.11mmol/L；总胆红素(TBIL)-静脉血: 12umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.745；镁离子(Mg2+)-静脉血: 0.8mmol/L；总蛋白(TP)-静脉血: 65.97g/L；单核细胞百分比(Mono%)-静脉血: 0.132；血小板计数(PLT#)-静脉血: 17910E9/L；球蛋白(GLO)-静脉血: 33.37g/L；尿素氮(BUN)-静脉血: 3.82mmol/L；尿酸(UA)-静脉血: 232.9umol/L；间接胆红素(IBIL)-静脉血: 6.9umolL；中性粒细胞计数(Neut#)-静脉血: 2.510E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.9；氯离子(Cl-)-静脉血: 105mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.6；血小板比容-静脉血: 15%；平均红细胞血红蛋白含量(MCH)-静脉血: 29.2pg；总胆固醇(TC)-静脉血: 3.73mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；载脂蛋白AI(apoAI)-静脉血: 0.88g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 36.1U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.026；胱抑素(Cys-C)-静脉血: 0.62mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.91mmolL；乳酸脱氢酶(LDH)-静脉血: 137U/L；肌酐(Crea)-静脉血: 68.5umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 87.7fL；血小板分布宽度(PDW)-静脉血: 7.4%；白蛋白(ALB)-静脉血: 32.6g/L；甘油三酯(TG)-静脉血: 0.96mmol/L；大血小板百分比(P-LCR%)-静脉血: 11.2%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15.9U/L；丙氨酸氨基转移酶(ALT)-静脉血: 17.3U/L；钠离子(Na+)-静脉血: 141.2mmol……\n- [全程D75] 检验组合: 白细胞计数(WBC#)-静脉血: 3.3210E9/L；血小板分布宽度(PDW)-静脉血: 7.9%；钾离子(K+)-静脉血: 3.4mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 18.6U/L；C-反应蛋白(CRP)-静脉血: 56.54mg/L；红细胞比容(Hct)-静脉血: 33.5%；单核细胞百分比(Mono%)-静脉血: 0.117；肌酐(Crea)-静脉血: 63.4umol/L；尿酸(UA)-静脉血: 304umol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；血小板比容-静脉血: 18%；α-L-岩藻糖苷酶(AFU)-静脉血: 22U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.72mmol/L；血小板计数(PLT#)-静脉血: 21110E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.9；中性粒细胞百分比(Neut%)-静脉血: 0.772；淋巴细胞百分比(Lymph%)-静脉血: 0.072；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；总钙(Ca)-静脉血: 2.12mmol/L；药物曲线下面积(AUC)-静脉血: 1；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；总胆固醇(TC)-静脉血: 4.15mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.88mmolL；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 16.7U/L；白蛋白(ALB)-静脉血: 33g/L；平均血小板体积(MPV)-静脉血: 8.3fL；总胆红素(TBIL)-静脉血: 13.6umol/L；磷(P)-静脉血: 1.15mmol/L；球蛋白(GLO)-静脉血: 33.66g/L；阴离子间隙(AG)-静脉血: 14；葡萄糖(Glu)-静脉血: 5.63mmol/L；载脂蛋白AI(apoAI)-静脉血: 0.81g/L；总胆汁酸(TBA)-静脉血: 1.4umol/L；间接胆红素(IBIL)-静脉血: 7.9umolL；尿素氮(BUN)-静脉血: 5.04mmol/L；胱抑素(Cys-C)-静脉血: 0.65mg/L；红细胞计数(RBC#)-静脉血: 3.8110E12/L；红细胞体积分布宽度……\n- [全程D86] 检验组合: 总胆汁酸(TBA)-静脉血: 1.6umol/L；直接胆红素(DBIL)-静脉血: 2.4umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 16U/L；C-反应蛋白(CRP)-静脉血: 15.4mg/L；淋巴细胞百分比(Lymph%)-静脉血: 0.142；总钙(Ca)-静脉血: 2.08mmol/L；阴离子间隙(AG)-静脉血: 10；丙氨酸氨基转移酶(ALT)-静脉血: 27.7U/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；白蛋白(ALB)-静脉血: 30.3g/L；钾离子(K+)-静脉血: 3.2mmol/L；葡萄糖(Glu)-静脉血: 5.56mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.27mmol/L；总胆固醇(TC)-静脉血: 3.75mmol/L；平均红细胞体积(MCV)-静脉血: 89.4fL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.83mmolL；肌酐(Crea)-静脉血: 72.9umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 53U/L；尿酸(UA)-静脉血: 338.6umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.9mmol/L；白细胞计数(WBC#)-静脉血: 2.610E9/L；钠离子(Na+)-静脉血: 140.5mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.4pg；单核细胞百分比(Mono%)-静脉血: 0.281；大血小板百分比(P-LCR%)-静脉血: 12.6%；载脂蛋白B(apoB)-静脉血: 0.76g/L；载脂蛋白AI(apoAI)-静脉血: 0.84g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.6U/L；间接胆红素(IBIL)-静脉血: 3umolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.7；甘油三酯(TG)-静脉血: 1.42mmol/L；磷(P)-静脉血: 1.4mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.8；碱性磷酸酶(ALP)-静脉血: 70.5U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；尿素氮……\n- [全程D88] 检验组合: 血红蛋白(Hb)-静脉血: 118g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.26；平均血小板体积(MPV)-静脉血: 8.5fL；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；红细胞比容(Hct)-静脉血: 35.8%；血小板比容-静脉血: 14%；血小板分布宽度(PDW)-静脉血: 7.6%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.7；平均红细胞体积(MCV)-静脉血: 90.4fL；血小板计数(PLT#)-静脉血: 16910E9/L；红细胞计数(RBC#)-静脉血: 3.9610E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.028；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；单核细胞百分比(Mono%)-静脉血: 0.097；大血小板百分比(P-LCR%)-静脉血: 14.3%；白细胞计数(WBC#)-静脉血: 2.8810E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.8pg；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.5；中性粒细胞计数(Neut#)-静脉血: 1.810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.612\n- [全程D93] 检验组合: 低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.82mmol/L；白蛋白(ALB)-静脉血: 37.8g/L；总胆红素(TBIL)-静脉血: 9.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 39.6U/L；胱抑素(Cys-C)-静脉血: 0.78mg/L；淋巴细胞百分比(Lymph%)-静脉血: 0.15；天门冬氨酸氨基转移酶(AST)-静脉血: 21.3U/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；尿酸(UA)-静脉血: 295.9umol/L；血小板比容-静脉血: 12.1%；中性粒细胞计数(Neut#)-静脉血: 2.410E9/L；氯离子(Cl-)-静脉血: 102mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.7mmol/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；阴离子间隙(AG)-静脉血: 13.1；钠离子(Na+)-静脉血: 142.8mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 16.1%；血小板分布宽度(PDW)-静脉血: 15.9%；红细胞比容(Hct)-静脉血: 36.4%；磷(P)-静脉血: 1.26mmol/L；直接胆红素(DBIL)-静脉血: 3.4umol/L；总蛋白(TP)-静脉血: 70.94g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；葡萄糖(Glu)-静脉血: 6.22mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.019；间接胆红素(IBIL)-静脉血: 5.9umolL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；载脂蛋白B(apoB)-静脉血: 0.94g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.11mmolL；总胆固醇(TC)-静脉血: 4.28mmol/L；碱性磷酸酶(ALP)-静脉血: 88.1U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.5pg；血小板计数(PLT#)-静脉血: 215.910E9/L；钾离子(K+)-静脉血: 3.96mmol/L；单核细胞百分比(Mono%)-静脉血: 0.146；平均血小板体积(MPV)-静脉血: 5.62fL；有核红细胞百分比(NRBC%)-静脉血:……\n- [全程D94] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约28cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，右肾实质回声均匀，未见明显异常回声。左肾下盏可见一强回声团，直径约6mm，边界清。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约28×25×25mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 左肾结石。 肝脏、胆囊、脾脏、胰腺、右肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n\n【既往治疗与反应】\n- [全程D64] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者放疗中，第4程爱必妥靶向治疗后3天，诉口感、咽痛、纳差。查体同前。[姓名已隐去]医生信息已隐藏：予喷喉、洗鼻、保护皮肤处理，加强营养，继续放疗。\n- [全程D69] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者放疗中，今日第5程爱必妥靶向治疗，诉头面部皮疹，口感、咽痛，余无明显不适。查体：头面部散在红疹，无脱皮、水泡，余同前。[姓名已隐去]医生信息已隐藏：予红外线治疗，喷喉、洗鼻、保护皮肤处理，加强营养，继续放疗。\n- [全程D74] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者放疗中，第2程洛铂方案同时期化疗结束，诉恶心、食欲下降，呕吐1次，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规示轻度贫血，肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第2程洛铂方案同时期化疗结束，诉恶心、呕吐，予止呕护胃处理，继续放疗。\n- [全程D78] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者2月18日至2月26日春节请假中。\n- [全程D88] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者放疗中，第6程爱必妥靶向治疗结束，诉头面部皮疹，口感、咽痛，余无明显不适。查体：头面部散在红疹，无脱皮、水泡，余同前。复查血常规、生化插管基本正常。[姓名已隐去]医生信息已隐藏：予喷喉、洗鼻、保护皮肤处理，加强营养，今日可办理出院，继续门诊放疗，按时间行复查。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 确认腹部彩超无转移，暂停放疗，请泌尿外科会诊行左肾结石碎石治疗，并予乳果糖口服液。\nB. 确认腹部彩超无转移，继续门诊放疗，左肾结石暂予观察，并予乳果糖口服液。\nC. 确认腹部彩超无转移，继续门诊放疗，左肾结石暂予观察，并加用洛铂行第3程同期化疗。\nD. 确认腹部彩超无转移，暂停门诊放疗，复查鼻咽及颈部MRI评估局部疗效，并予乳果糖口服液。\nE. 确认腹部彩超无转移，继续门诊放疗，对左肾结石予排石颗粒，并加用西妥昔单抗靶向治疗。\nF. 确认腹部彩超无转移，终止放疗，左肾结石暂予观察，转入康复科行便秘治疗。\nG. 确认腹部彩超无转移，继续门诊放疗，对左肾结石予留置双J管，并予乳果糖口服液。\nH. 确认腹部彩超无转移，暂停门诊放疗，予温肥皂水灌肠处理便秘，左肾结石暂予观察。\nI. 确认腹部彩超无转移，继续门诊放疗，左肾结石暂予观察，并予洛哌丁胺口服。\nJ. 确认腹部彩超无转移，继续门诊放疗，左肾结石暂予观察，并予开塞露联合新斯的明肌注。\nK. 确认腹部彩超无转移，暂停门诊放疗，行全身PET-CT评估疗效，左肾结石暂予观察。\nL. 确认腹部彩超无转移，继续门诊放疗，行体外冲击波碎石，处理左肾结石，并予乳果糖口服液。\n\n请仅输出一个选项字母（A-L）。"}]}
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[全程D6] 入院记录: 主诉: 涕血2月；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血；既往史: “胃溃疡”病史22年，于某次就诊时间、某次就诊时间发生2次“胃出血”，经“输血”、“药物”治疗后好转，具体不详。某次就诊时间发现“胃底息肉”，行“内镜下胃底息肉切除术”。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：114/69mmHg,Ht：157cm，Wt：53kg，BSA：1.52m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽左侧壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 完善鼻咽及颈部CT平扫+增强、胸腹部CT平扫+增强、全身骨扫描，并进行病理会诊或鼻咽活检。\nB. 完善鼻咽MRI平扫+增强、胸腹部CT平扫+增强、全身骨扫描，暂缓病理检查。\nC. 完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像，并进行病理会诊或鼻咽活检及心电图等基线检查。\nD. 完善鼻咽及颈部MRI平扫、PET/CT全身显像，并进行病理会诊或鼻咽活检。\nE. 完善鼻咽及颈部MRI平扫+增强、头颅MRI平扫+增强，直接安排放疗定位。\nF. 完善鼻咽及颈部CT平扫、PET/CT全身显像，并进行鼻咽肿物切除活检。\nG. 完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像，并进行颈部淋巴结穿刺活检。\nH. 完善鼻咽及颈部MRI平扫+增强、胸部X线、腹部超声，并进行病理会诊或鼻咽活检。\nI. 完善鼻咽及颈部MRI平扫+增强、全身骨扫描，并进行病理会诊或鼻咽活检。\nJ. 完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像，直接开始诱导化疗。\nK. 完善鼻咽及颈部MRI平扫+增强、胸腹部CT平扫+增强、全身骨扫描，并进行鼻内镜下鼻咽肿物扩大切除术。\n\n请仅输出一个选项字母（A-K）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：鼻腔。\n文本分期信息：N0，M0。\n综合TNM状态：T1N0M0。\n综合分期：IA。\n\n【已知病史与当前主诉】\n- [全程D6] 入院记录: 主诉: 涕血2月；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血；既往史: “胃溃疡”病史22年，于某次就诊时间、某次就诊时间发生2次“胃出血”，经“输血”、“药物”治疗后好转，具体不详。某次就诊时间发现“胃底息肉”，行“内镜下胃底息肉切除术”。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：114/69mmHg,Ht：157cm，Wt：53kg，BSA：1.52m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽左侧壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 完善鼻咽及颈部CT平扫+增强、胸腹部CT平扫+增强、全身骨扫描，并进行病理会诊或鼻咽活检。\nB. 完善鼻咽MRI平扫+增强、胸腹部CT平扫+增强、全身骨扫描，暂缓病理检查。\nC. 完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像，并进行病理会诊或鼻咽活检及心电图等基线检查。\nD. 完善鼻咽及颈部MRI平扫、PET/CT全身显像，并进行病理会诊或鼻咽活检。\nE. 完善鼻咽及颈部MRI平扫+增强、头颅MRI平扫+增强，直接安排放疗定位。\nF. 完善鼻咽及颈部CT平扫、PET/CT全身显像，并进行鼻咽肿物切除活检。\nG. 完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像，并进行颈部淋巴结穿刺活检。\nH. 完善鼻咽及颈部MRI平扫+增强、胸部X线、腹部超声，并进行病理会诊或鼻咽活检。\nI. 完善鼻咽及颈部MRI平扫+增强、全身骨扫描，并进行病理会诊或鼻咽活检。\nJ. 完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像，直接开始诱导化疗。\nK. 完善鼻咽及颈部MRI平扫+增强、胸腹部CT平扫+增强、全身骨扫描，并进行鼻内镜下鼻咽肿物扩大切除术。\n\n请仅输出一个选项字母（A-K）。"},{"sample_id":"sample-78b27b455a910a93bd013384","patient_id":"patient-51e6f99c527367bbd97aebd8","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"D","gold_action":"明确鼻咽癌临床分期为 cT1N0M0，IA期（肿瘤累及鼻咽及左侧后鼻孔，无颈部淋巴结转移）","options":[{"letter":"A","text":"明确鼻咽癌临床分期为 cT2N0M0，II期（肿瘤累及左侧后鼻孔，无颈部淋巴结转移）","is_gold":false},{"letter":"B","text":"明确鼻咽癌临床分期为 cT1N1M0，II期（肿瘤局限于鼻咽，伴单侧咽后淋巴结转移）","is_gold":false},{"letter":"C","text":"明确鼻咽癌临床分期为 cT2N1M0，II期（肿瘤累及左侧后鼻孔及咽旁间隙，伴单侧颈部淋巴结转移）","is_gold":false},{"letter":"D","text":"明确鼻咽癌临床分期为 cT1N0M0，IA期（肿瘤累及鼻咽及左侧后鼻孔，无颈部淋巴结转移）","is_gold":true},{"letter":"E","text":"明确鼻咽癌临床分期为 cT3N0M0，III期（肿瘤累及颅底骨质，无颈部淋巴结转移）","is_gold":false},{"letter":"F","text":"明确鼻咽癌临床分期为 cT1N0M0，IA期（肿瘤局限于鼻咽，未累及鼻腔及口咽等邻近结构）","is_gold":false},{"letter":"G","text":"明确鼻咽癌临床分期为 cT2N0M0，II期（肿瘤累及鼻咽及口咽，无颈部淋巴结转移）","is_gold":false},{"letter":"H","text":"明确鼻咽癌临床分期为 cT1N2M0，III期（肿瘤累及左侧后鼻孔，伴双侧颈部淋巴结转移）","is_gold":false},{"letter":"I","text":"明确鼻咽癌临床分期为 cT3N1M0，III期（肿瘤累及翼内肌，伴单侧颈部淋巴结转移）","is_gold":false},{"letter":"J","text":"明确鼻咽癌临床分期为 cT4N0M0，IVA期（肿瘤累及海绵窦，无颈部淋巴结转移）","is_gold":false},{"letter":"K","text":"明确鼻咽癌临床分期为 cT1N0M1，IVB期（肿瘤累及左侧后鼻孔，伴远处器官转移）","is_gold":false},{"letter":"L","text":"明确鼻咽癌临床分期为 cT2N2M0，III期（肿瘤累及咽旁间隙，伴双侧颈部淋巴结转移）","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：鼻腔。\n文本分期信息：N0，M0。\n综合TNM状态：T1N0M0。\n综合分期：IA。\n\n【已知病史与当前主诉】\n- [全程D6] 入院记录: 主诉: 涕血2月；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血；既往史: “胃溃疡”病史22年，于某次就诊时间、某次就诊时间发生2次“胃出血”，经“输血”、“药物”治疗后好转，具体不详。某次就诊时间发现“胃底息肉”，行“内镜下胃底息肉切除术”。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：114/69mmHg,Ht：157cm，Wt：53kg，BSA：1.52m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽左侧壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D7] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- [全程D7] 检验组合: 平均红细胞体积(MCV)-静脉血: 91.1fL；总钙(Ca)-静脉血: 2.21mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24.2U/L；碱性磷酸酶(ALP)-静脉血: 74.3U/L；IV型胶原(C-IV)-静脉血: 12.97ng/ml；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 35.9U/L；钾离子(K+)-静脉血: 3.76mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；D-二聚体(D-Dimer)-静脉血: 0.07ug/ml；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；淀粉样蛋白A(SAA)-静脉血: 2.44mg/L；C-反应蛋白(CRP)-静脉血: 1.92mg/L；凝血酶原时间活动度(PTA)-静脉血: 120%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.67；载脂蛋白B(apoB)-静脉血: 1.07g/L；球蛋白(GLO)-静脉血: 26.18g/L；磷(P)-静脉血: 1.03mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；胱抑素(Cys-C)-静脉血: 0.79mg/L；红细胞计数(RBC#)-静脉血: 5.2710E12/L；单核细胞计数(Mono#)-静脉血: 110E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.6sec.；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.87；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.411ng/ml（参考: <0.584）；尿素氮(BUN)-静脉血: 4.7mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；血小板计数(PLT#)-静脉血: 21810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.578；凝血酶原时间(PT)-静脉血: 10.1sec.；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.05mmol/L；尿酸(UA)-静脉血: 331.5umol/L；阴离子间隙(AG)-静脉血: 15.7；层粘……\n- [全程D10] 内镜；胃镜: 检查类型: 内镜；检查名称: 胃镜；检查部位:；检查所见: 插镜情况：顺利 送达部位：十二指肠降部。 食 管：粘膜光滑, 舒缩好。 贲 门：开闭好, E-G线清楚。 胃 底：粘液湖清亮，粘膜光滑，无静脉曲张。 胃 体：花斑样充血，未见溃疡肿物。 胃 角：弧形， 光滑。 胃 窦：蠕动好，粘膜呈花斑样充血，未见溃疡肿物。 幽 门：圆， 开闭好。 球 部：球腔变形，后壁可见霜斑样溃疡，表面附着白苔。 降 部：十二指肠乳头及降部粘膜未见异常。 请4个工作日后到病理科（5楼）取活检结果。；检查结论: 十二指肠球部霜斑样溃疡 慢性浅表性胃炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 明确鼻咽癌临床分期为 cT2N0M0，II期（肿瘤累及左侧后鼻孔，无颈部淋巴结转移）\nB. 明确鼻咽癌临床分期为 cT1N1M0，II期（肿瘤局限于鼻咽，伴单侧咽后淋巴结转移）\nC. 明确鼻咽癌临床分期为 cT2N1M0，II期（肿瘤累及左侧后鼻孔及咽旁间隙，伴单侧颈部淋巴结转移）\nD. 明确鼻咽癌临床分期为 cT1N0M0，IA期（肿瘤累及鼻咽及左侧后鼻孔，无颈部淋巴结转移）\nE. 明确鼻咽癌临床分期为 cT3N0M0，III期（肿瘤累及颅底骨质，无颈部淋巴结转移）\nF. 明确鼻咽癌临床分期为 cT1N0M0，IA期（肿瘤局限于鼻咽，未累及鼻腔及口咽等邻近结构）\nG. 明确鼻咽癌临床分期为 cT2N0M0，II期（肿瘤累及鼻咽及口咽，无颈部淋巴结转移）\nH. 明确鼻咽癌临床分期为 cT1N2M0，III期（肿瘤累及左侧后鼻孔，伴双侧颈部淋巴结转移）\nI. 明确鼻咽癌临床分期为 cT3N1M0，III期（肿瘤累及翼内肌，伴单侧颈部淋巴结转移）\nJ. 明确鼻咽癌临床分期为 cT4N0M0，IVA期（肿瘤累及海绵窦，无颈部淋巴结转移）\nK. 明确鼻咽癌临床分期为 cT1N0M1，IVB期（肿瘤累及左侧后鼻孔，伴远处器官转移）\nL. 明确鼻咽癌临床分期为 cT2N2M0，III期（肿瘤累及咽旁间隙，伴双侧颈部淋巴结转移）\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D7] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- [全程D7] 检验组合: 平均红细胞体积(MCV)-静脉血: 91.1fL；总钙(Ca)-静脉血: 2.21mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24.2U/L；碱性磷酸酶(ALP)-静脉血: 74.3U/L；IV型胶原(C-IV)-静脉血: 12.97ng/ml；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 35.9U/L；钾离子(K+)-静脉血: 3.76mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；D-二聚体(D-Dimer)-静脉血: 0.07ug/ml；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；淀粉样蛋白A(SAA)-静脉血: 2.44mg/L；C-反应蛋白(CRP)-静脉血: 1.92mg/L；凝血酶原时间活动度(PTA)-静脉血: 120%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.67；载脂蛋白B(apoB)-静脉血: 1.07g/L；球蛋白(GLO)-静脉血: 26.18g/L；磷(P)-静脉血: 1.03mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；胱抑素(Cys-C)-静脉血: 0.79mg/L；红细胞计数(RBC#)-静脉血: 5.2710E12/L；单核细胞计数(Mono#)-静脉血: 110E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.6sec.；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.87；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.411ng/ml（参考: <0.584）；尿素氮(BUN)-静脉血: 4.7mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；血小板计数(PLT#)-静脉血: 21810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.578；凝血酶原时间(PT)-静脉血: 10.1sec.；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.05mmol/L；尿酸(UA)-静脉血: 331.5umol/L；阴离子间隙(AG)-静脉血: 15.7；层粘……\n- [全程D10] 内镜；胃镜: 检查类型: 内镜；检查名称: 胃镜；检查部位:；检查所见: 插镜情况：顺利 送达部位：十二指肠降部。 食 管：粘膜光滑, 舒缩好。 贲 门：开闭好, E-G线清楚。 胃 底：粘液湖清亮，粘膜光滑，无静脉曲张。 胃 体：花斑样充血，未见溃疡肿物。 胃 角：弧形， 光滑。 胃 窦：蠕动好，粘膜呈花斑样充血，未见溃疡肿物。 幽 门：圆， 开闭好。 球 部：球腔变形，后壁可见霜斑样溃疡，表面附着白苔。 降 部：十二指肠乳头及降部粘膜未见异常。 请4个工作日后到病理科（5楼）取活检结果。；检查结论: 十二指肠球部霜斑样溃疡 慢性浅表性胃炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 明确鼻咽癌临床分期为 cT2N0M0，II期（肿瘤累及左侧后鼻孔，无颈部淋巴结转移）\nB. 明确鼻咽癌临床分期为 cT1N1M0，II期（肿瘤局限于鼻咽，伴单侧咽后淋巴结转移）\nC. 明确鼻咽癌临床分期为 cT2N1M0，II期（肿瘤累及左侧后鼻孔及咽旁间隙，伴单侧颈部淋巴结转移）\nD. 明确鼻咽癌临床分期为 cT1N0M0，IA期（肿瘤累及鼻咽及左侧后鼻孔，无颈部淋巴结转移）\nE. 明确鼻咽癌临床分期为 cT3N0M0，III期（肿瘤累及颅底骨质，无颈部淋巴结转移）\nF. 明确鼻咽癌临床分期为 cT1N0M0，IA期（肿瘤局限于鼻咽，未累及鼻腔及口咽等邻近结构）\nG. 明确鼻咽癌临床分期为 cT2N0M0，II期（肿瘤累及鼻咽及口咽，无颈部淋巴结转移）\nH. 明确鼻咽癌临床分期为 cT1N2M0，III期（肿瘤累及左侧后鼻孔，伴双侧颈部淋巴结转移）\nI. 明确鼻咽癌临床分期为 cT3N1M0，III期（肿瘤累及翼内肌，伴单侧颈部淋巴结转移）\nJ. 明确鼻咽癌临床分期为 cT4N0M0，IVA期（肿瘤累及海绵窦，无颈部淋巴结转移）\nK. 明确鼻咽癌临床分期为 cT1N0M1，IVB期（肿瘤累及左侧后鼻孔，伴远处器官转移）\nL. 明确鼻咽癌临床分期为 cT2N2M0，III期（肿瘤累及咽旁间隙，伴双侧颈部淋巴结转移）\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：鼻腔。\n文本分期信息：N0，M0。\n综合TNM状态：T1N0M0。\n综合分期：IA。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D7] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- [全程D7] 检验组合: 平均红细胞体积(MCV)-静脉血: 91.1fL；总钙(Ca)-静脉血: 2.21mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24.2U/L；碱性磷酸酶(ALP)-静脉血: 74.3U/L；IV型胶原(C-IV)-静脉血: 12.97ng/ml；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 35.9U/L；钾离子(K+)-静脉血: 3.76mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；D-二聚体(D-Dimer)-静脉血: 0.07ug/ml；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；淀粉样蛋白A(SAA)-静脉血: 2.44mg/L；C-反应蛋白(CRP)-静脉血: 1.92mg/L；凝血酶原时间活动度(PTA)-静脉血: 120%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.67；载脂蛋白B(apoB)-静脉血: 1.07g/L；球蛋白(GLO)-静脉血: 26.18g/L；磷(P)-静脉血: 1.03mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；胱抑素(Cys-C)-静脉血: 0.79mg/L；红细胞计数(RBC#)-静脉血: 5.2710E12/L；单核细胞计数(Mono#)-静脉血: 110E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.6sec.；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.87；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.411ng/ml（参考: <0.584）；尿素氮(BUN)-静脉血: 4.7mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；血小板计数(PLT#)-静脉血: 21810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.578；凝血酶原时间(PT)-静脉血: 10.1sec.；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.05mmol/L；尿酸(UA)-静脉血: 331.5umol/L；阴离子间隙(AG)-静脉血: 15.7；层粘……\n- [全程D10] 内镜；胃镜: 检查类型: 内镜；检查名称: 胃镜；检查部位:；检查所见: 插镜情况：顺利 送达部位：十二指肠降部。 食 管：粘膜光滑, 舒缩好。 贲 门：开闭好, E-G线清楚。 胃 底：粘液湖清亮，粘膜光滑，无静脉曲张。 胃 体：花斑样充血，未见溃疡肿物。 胃 角：弧形， 光滑。 胃 窦：蠕动好，粘膜呈花斑样充血，未见溃疡肿物。 幽 门：圆， 开闭好。 球 部：球腔变形，后壁可见霜斑样溃疡，表面附着白苔。 降 部：十二指肠乳头及降部粘膜未见异常。 请4个工作日后到病理科（5楼）取活检结果。；检查结论: 十二指肠球部霜斑样溃疡 慢性浅表性胃炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 明确鼻咽癌临床分期为 cT2N0M0，II期（肿瘤累及左侧后鼻孔，无颈部淋巴结转移）\nB. 明确鼻咽癌临床分期为 cT1N1M0，II期（肿瘤局限于鼻咽，伴单侧咽后淋巴结转移）\nC. 明确鼻咽癌临床分期为 cT2N1M0，II期（肿瘤累及左侧后鼻孔及咽旁间隙，伴单侧颈部淋巴结转移）\nD. 明确鼻咽癌临床分期为 cT1N0M0，IA期（肿瘤累及鼻咽及左侧后鼻孔，无颈部淋巴结转移）\nE. 明确鼻咽癌临床分期为 cT3N0M0，III期（肿瘤累及颅底骨质，无颈部淋巴结转移）\nF. 明确鼻咽癌临床分期为 cT1N0M0，IA期（肿瘤局限于鼻咽，未累及鼻腔及口咽等邻近结构）\nG. 明确鼻咽癌临床分期为 cT2N0M0，II期（肿瘤累及鼻咽及口咽，无颈部淋巴结转移）\nH. 明确鼻咽癌临床分期为 cT1N2M0，III期（肿瘤累及左侧后鼻孔，伴双侧颈部淋巴结转移）\nI. 明确鼻咽癌临床分期为 cT3N1M0，III期（肿瘤累及翼内肌，伴单侧颈部淋巴结转移）\nJ. 明确鼻咽癌临床分期为 cT4N0M0，IVA期（肿瘤累及海绵窦，无颈部淋巴结转移）\nK. 明确鼻咽癌临床分期为 cT1N0M1，IVB期（肿瘤累及左侧后鼻孔，伴远处器官转移）\nL. 明确鼻咽癌临床分期为 cT2N2M0，III期（肿瘤累及咽旁间隙，伴双侧颈部淋巴结转移）\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-db8d6d3eabcfcb123b0c3cb1","patient_id":"patient-51e6f99c527367bbd97aebd8","turn_id":"turn05","turn_position":3,"turn_type":"toxicity_or_support_decision","gold_letter":"F","gold_action":"暂停顺铂化疗，继续单纯放疗，给予静脉保肝治疗，待肝功能恢复后补足化疗周期。","options":[{"letter":"A","text":"暂停放化疗，给予多烯磷脂酰胆碱、还原型谷胱甘肽等静脉保肝治疗，待肝功能恢复正常后恢复放化疗。","is_gold":false},{"letter":"B","text":"继续放化疗，仅密切监测肝功能变化，暂不给予静脉保肝药物干预。","is_gold":false},{"letter":"C","text":"继续放化疗，给予广谱抗生素静脉滴注预防感染，并辅以雾化吸入及止吐等对症支持处理。","is_gold":false},{"letter":"D","text":"将顺铂方案调整为卡铂方案同时期化疗，并给予静脉保肝治疗及止吐等对症支持处理。","is_gold":false},{"letter":"E","text":"顺铂剂量减低25%继续同时期化疗，给予静脉保肝治疗，辅以雾化吸入及止吐等对症支持处理。","is_gold":false},{"letter":"F","text":"暂停顺铂化疗，继续单纯放疗，给予静脉保肝治疗，待肝功能恢复后补足化疗周期。","is_gold":true},{"letter":"G","text":"给予多烯磷脂酰胆碱、还原型谷胱甘肽、复方甘草酸苷等静脉保肝治疗，辅以雾化吸入及止吐等对症支持处理。","is_gold":false},{"letter":"H","text":"给予大剂量质子泵抑制剂静脉滴注预防消化道出血，暂缓保肝治疗，继续放化疗。","is_gold":false},{"letter":"I","text":"暂停放疗，继续顺铂化疗，给予静脉保肝治疗及止吐等对症支持处理。","is_gold":false},{"letter":"J","text":"给予静脉保肝治疗，行骨髓穿刺检查排除血液系统异常，继续放化疗。","is_gold":false},{"letter":"K","text":"终止临床试验，转为常规单药顺铂同时期放化疗，并给予静脉保肝治疗。","is_gold":false},{"letter":"L","text":"给予口服保肝药物治疗，辅以雾化吸入及止吐等对症支持处理，继续放化疗。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：鼻腔。\n文本分期信息：N0，M0。\n综合TNM状态：T1N0M0。\n综合分期：IA。\n\n【已知病史与当前主诉】\n- [全程D6] 入院记录: 主诉: 涕血2月；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血；既往史: “胃溃疡”病史22年，于某次就诊时间、某次就诊时间发生2次“胃出血”，经“输血”、“药物”治疗后好转，具体不详。某次就诊时间发现“胃底息肉”，行“内镜下胃底息肉切除术”。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：114/69mmHg,Ht：157cm，Wt：53kg，BSA：1.52m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽左侧壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D7] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- [全程D7] 检验组合: 平均红细胞体积(MCV)-静脉血: 91.1fL；总钙(Ca)-静脉血: 2.21mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24.2U/L；碱性磷酸酶(ALP)-静脉血: 74.3U/L；IV型胶原(C-IV)-静脉血: 12.97ng/ml；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 35.9U/L；钾离子(K+)-静脉血: 3.76mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；D-二聚体(D-Dimer)-静脉血: 0.07ug/ml；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；淀粉样蛋白A(SAA)-静脉血: 2.44mg/L；C-反应蛋白(CRP)-静脉血: 1.92mg/L；凝血酶原时间活动度(PTA)-静脉血: 120%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.67；载脂蛋白B(apoB)-静脉血: 1.07g/L；球蛋白(GLO)-静脉血: 26.18g/L；磷(P)-静脉血: 1.03mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；胱抑素(Cys-C)-静脉血: 0.79mg/L；红细胞计数(RBC#)-静脉血: 5.2710E12/L；单核细胞计数(Mono#)-静脉血: 110E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.6sec.；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.87；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.411ng/ml（参考: <0.584）；尿素氮(BUN)-静脉血: 4.7mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；血小板计数(PLT#)-静脉血: 21810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.578；凝血酶原时间(PT)-静脉血: 10.1sec.；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.05mmol/L；尿酸(UA)-静脉血: 331.5umol/L；阴离子间隙(AG)-静脉血: 15.7；层粘……\n- [全程D10] 内镜；胃镜: 检查类型: 内镜；检查名称: 胃镜；检查部位:；检查所见: 插镜情况：顺利 送达部位：十二指肠降部。 食 管：粘膜光滑, 舒缩好。 贲 门：开闭好, E-G线清楚。 胃 底：粘液湖清亮，粘膜光滑，无静脉曲张。 胃 体：花斑样充血，未见溃疡肿物。 胃 角：弧形， 光滑。 胃 窦：蠕动好，粘膜呈花斑样充血，未见溃疡肿物。 幽 门：圆， 开闭好。 球 部：球腔变形，后壁可见霜斑样溃疡，表面附着白苔。 降 部：十二指肠乳头及降部粘膜未见异常。 请4个工作日后到病理科（5楼）取活检结果。；检查结论: 十二指肠球部霜斑样溃疡 慢性浅表性胃炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D24] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽左侧顶后壁及左侧壁局部粘膜增厚形成软组织影放射性浓聚，SUV约21.0，堵塞左侧鼻后孔，鼻咽腔变窄，累及左侧翼突基底部及犁骨。左侧咽隐窝变，右侧咽隐窝未见明显异常，双侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。口咽及喉咽结构及放射性分布未见明显异常。额窦、蝶窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双上颈小淋巴结放射性分布未见明显异常。 双上肺尖、右中肺内侧段及左下肺后基底段少许条索影放射性分布未见明显异常；其余双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏S4低密度影放射性分布未见明显异常，大小约0.6×0.6cm，边界尚清，密度欠均匀，CT值约26Hu；其余肝脏密度减低，CT值约50Hu，结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。盆腔盆底静脉内多发点状/小结节状高密度影放射性缺损。 所见颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，侵犯左侧鼻后孔，累及颅底骨。 肝S4低密度影代谢未见明显异常，建议随诊。 脂肪肝。\n- [全程D29] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.013；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 6.5\n- [全程D30] 检验组合: 浊度(TRUB)-尿液: 清亮；白细胞计数(WBC#)-尿液: 3/μL；白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.023；酮体(KET)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 13/μL；颜色-尿液: Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；隐血(OB)-尿液: 1+ 0.6mg（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D31] 检验组合: 红细胞计数(RBC#)-静脉血: 4.6210E12/L；血小板计数(PLT#)-静脉血: 22810E9/L；大血小板百分比(P-LCR%)-静脉血: 21.2%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.61mmol/L；白蛋白(ALB)-静脉血: 38.5g/L；间接胆红素(IBIL)-静脉血: 8.4umolL；球蛋白(GLO)-静脉血: 25.82g/L；单核细胞百分比(Mono%)-静脉血: 0.093；血小板分布宽度(PDW)-静脉血: 10.8%；红细胞比容(Hct)-静脉血: 41.4%；总蛋白(TP)-静脉血: 64.32g/L；单核细胞计数(Mono#)-静脉血: 1.510E9/L；葡萄糖(Glu)-静脉血: 5.98mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.6；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；总胆红素(TBIL)-静脉血: 12.9umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 176.9U/L；甘油三酯(TG)-静脉血: 1.4mmol/L；乳酸脱氢酶(LDH)-静脉血: 239U/L；总胆汁酸(TBA)-静脉血: 3umol/L；直接胆红素(DBIL)-静脉血: 4.5umol/L；肌酐(Crea)-静脉血: 70umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.7；尿素氮(BUN)-静脉血: 6.02mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 136.5U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；天门冬氨酸氨基转移酶(AST)-静脉血: 104.5U/L；磷(P)-静脉血: 1.34mmol/L；钠离子(Na+)-静脉血: 138.8mmol/L；平均红细胞体积(MCV)-静脉血: 89.6fL；白细胞计数(WBC#)-静脉血: 15.9910E9/L；载脂蛋白AI(apoAI)-静脉血: 1.29g/L；阴离子间隙(AG)-静脉血: 14；C-反应蛋白(CRP)-静脉血: 1.98mg/L；钾离子(K+)-静脉血: 3.5mmol/L；碱性磷酸酶(ALP)-静脉血:……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D8] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者相关检查完善中，请假未回病房。\n- [全程D13] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者相关检查完善中，请假未回病房。\n- [全程D19] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者元旦假期请假中。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D29] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者无明显不适主诉，查体情况：一般情况可，余同入院。放疗计划已完善。[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，向患者及其家属交代病情及化疗风险，表示理解并已签署知情同意书，同意入组三周/单周DDP同时期化疗临床试验，抽签入三周组，可于今日执行第1程顺铂方案同时期化疗，注意化疗不良反应，开始放疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放化疗，给予多烯磷脂酰胆碱、还原型谷胱甘肽等静脉保肝治疗，待肝功能恢复正常后恢复放化疗。\nB. 继续放化疗，仅密切监测肝功能变化，暂不给予静脉保肝药物干预。\nC. 继续放化疗，给予广谱抗生素静脉滴注预防感染，并辅以雾化吸入及止吐等对症支持处理。\nD. 将顺铂方案调整为卡铂方案同时期化疗，并给予静脉保肝治疗及止吐等对症支持处理。\nE. 顺铂剂量减低25%继续同时期化疗，给予静脉保肝治疗，辅以雾化吸入及止吐等对症支持处理。\nF. 暂停顺铂化疗，继续单纯放疗，给予静脉保肝治疗，待肝功能恢复后补足化疗周期。\nG. 给予多烯磷脂酰胆碱、还原型谷胱甘肽、复方甘草酸苷等静脉保肝治疗，辅以雾化吸入及止吐等对症支持处理。\nH. 给予大剂量质子泵抑制剂静脉滴注预防消化道出血，暂缓保肝治疗，继续放化疗。\nI. 暂停放疗，继续顺铂化疗，给予静脉保肝治疗及止吐等对症支持处理。\nJ. 给予静脉保肝治疗，行骨髓穿刺检查排除血液系统异常，继续放化疗。\nK. 终止临床试验，转为常规单药顺铂同时期放化疗，并给予静脉保肝治疗。\nL. 给予口服保肝药物治疗，辅以雾化吸入及止吐等对症支持处理，继续放化疗。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D24] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽左侧顶后壁及左侧壁局部粘膜增厚形成软组织影放射性浓聚，SUV约21.0，堵塞左侧鼻后孔，鼻咽腔变窄，累及左侧翼突基底部及犁骨。左侧咽隐窝变，右侧咽隐窝未见明显异常，双侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。口咽及喉咽结构及放射性分布未见明显异常。额窦、蝶窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双上颈小淋巴结放射性分布未见明显异常。 双上肺尖、右中肺内侧段及左下肺后基底段少许条索影放射性分布未见明显异常；其余双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏S4低密度影放射性分布未见明显异常，大小约0.6×0.6cm，边界尚清，密度欠均匀，CT值约26Hu；其余肝脏密度减低，CT值约50Hu，结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。盆腔盆底静脉内多发点状/小结节状高密度影放射性缺损。 所见颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，侵犯左侧鼻后孔，累及颅底骨。 肝S4低密度影代谢未见明显异常，建议随诊。 脂肪肝。\n- [全程D29] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.013；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 6.5\n- [全程D30] 检验组合: 浊度(TRUB)-尿液: 清亮；白细胞计数(WBC#)-尿液: 3/μL；白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.023；酮体(KET)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 13/μL；颜色-尿液: Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；隐血(OB)-尿液: 1+ 0.6mg（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D31] 检验组合: 红细胞计数(RBC#)-静脉血: 4.6210E12/L；血小板计数(PLT#)-静脉血: 22810E9/L；大血小板百分比(P-LCR%)-静脉血: 21.2%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.61mmol/L；白蛋白(ALB)-静脉血: 38.5g/L；间接胆红素(IBIL)-静脉血: 8.4umolL；球蛋白(GLO)-静脉血: 25.82g/L；单核细胞百分比(Mono%)-静脉血: 0.093；血小板分布宽度(PDW)-静脉血: 10.8%；红细胞比容(Hct)-静脉血: 41.4%；总蛋白(TP)-静脉血: 64.32g/L；单核细胞计数(Mono#)-静脉血: 1.510E9/L；葡萄糖(Glu)-静脉血: 5.98mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.6；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；总胆红素(TBIL)-静脉血: 12.9umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 176.9U/L；甘油三酯(TG)-静脉血: 1.4mmol/L；乳酸脱氢酶(LDH)-静脉血: 239U/L；总胆汁酸(TBA)-静脉血: 3umol/L；直接胆红素(DBIL)-静脉血: 4.5umol/L；肌酐(Crea)-静脉血: 70umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.7；尿素氮(BUN)-静脉血: 6.02mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 136.5U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；天门冬氨酸氨基转移酶(AST)-静脉血: 104.5U/L；磷(P)-静脉血: 1.34mmol/L；钠离子(Na+)-静脉血: 138.8mmol/L；平均红细胞体积(MCV)-静脉血: 89.6fL；白细胞计数(WBC#)-静脉血: 15.9910E9/L；载脂蛋白AI(apoAI)-静脉血: 1.29g/L；阴离子间隙(AG)-静脉血: 14；C-反应蛋白(CRP)-静脉血: 1.98mg/L；钾离子(K+)-静脉血: 3.5mmol/L；碱性磷酸酶(ALP)-静脉血:……\n\n【既往治疗与反应】\n- [全程D8] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者相关检查完善中，请假未回病房。\n- [全程D13] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者相关检查完善中，请假未回病房。\n- [全程D19] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者元旦假期请假中。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D29] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者无明显不适主诉，查体情况：一般情况可，余同入院。放疗计划已完善。[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，向患者及其家属交代病情及化疗风险，表示理解并已签署知情同意书，同意入组三周/单周DDP同时期化疗临床试验，抽签入三周组，可于今日执行第1程顺铂方案同时期化疗，注意化疗不良反应，开始放疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放化疗，给予多烯磷脂酰胆碱、还原型谷胱甘肽等静脉保肝治疗，待肝功能恢复正常后恢复放化疗。\nB. 继续放化疗，仅密切监测肝功能变化，暂不给予静脉保肝药物干预。\nC. 继续放化疗，给予广谱抗生素静脉滴注预防感染，并辅以雾化吸入及止吐等对症支持处理。\nD. 将顺铂方案调整为卡铂方案同时期化疗，并给予静脉保肝治疗及止吐等对症支持处理。\nE. 顺铂剂量减低25%继续同时期化疗，给予静脉保肝治疗，辅以雾化吸入及止吐等对症支持处理。\nF. 暂停顺铂化疗，继续单纯放疗，给予静脉保肝治疗，待肝功能恢复后补足化疗周期。\nG. 给予多烯磷脂酰胆碱、还原型谷胱甘肽、复方甘草酸苷等静脉保肝治疗，辅以雾化吸入及止吐等对症支持处理。\nH. 给予大剂量质子泵抑制剂静脉滴注预防消化道出血，暂缓保肝治疗，继续放化疗。\nI. 暂停放疗，继续顺铂化疗，给予静脉保肝治疗及止吐等对症支持处理。\nJ. 给予静脉保肝治疗，行骨髓穿刺检查排除血液系统异常，继续放化疗。\nK. 终止临床试验，转为常规单药顺铂同时期放化疗，并给予静脉保肝治疗。\nL. 给予口服保肝药物治疗，辅以雾化吸入及止吐等对症支持处理，继续放化疗。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：鼻腔。\n文本分期信息：N0，M0。\n综合TNM状态：T1N0M0。\n综合分期：IA。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D24] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽左侧顶后壁及左侧壁局部粘膜增厚形成软组织影放射性浓聚，SUV约21.0，堵塞左侧鼻后孔，鼻咽腔变窄，累及左侧翼突基底部及犁骨。左侧咽隐窝变，右侧咽隐窝未见明显异常，双侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。口咽及喉咽结构及放射性分布未见明显异常。额窦、蝶窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双上颈小淋巴结放射性分布未见明显异常。 双上肺尖、右中肺内侧段及左下肺后基底段少许条索影放射性分布未见明显异常；其余双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏S4低密度影放射性分布未见明显异常，大小约0.6×0.6cm，边界尚清，密度欠均匀，CT值约26Hu；其余肝脏密度减低，CT值约50Hu，结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。盆腔盆底静脉内多发点状/小结节状高密度影放射性缺损。 所见颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，侵犯左侧鼻后孔，累及颅底骨。 肝S4低密度影代谢未见明显异常，建议随诊。 脂肪肝。\n- [全程D29] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.013；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 6.5\n- [全程D30] 检验组合: 浊度(TRUB)-尿液: 清亮；白细胞计数(WBC#)-尿液: 3/μL；白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.023；酮体(KET)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 13/μL；颜色-尿液: Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；隐血(OB)-尿液: 1+ 0.6mg（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D31] 检验组合: 红细胞计数(RBC#)-静脉血: 4.6210E12/L；血小板计数(PLT#)-静脉血: 22810E9/L；大血小板百分比(P-LCR%)-静脉血: 21.2%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.61mmol/L；白蛋白(ALB)-静脉血: 38.5g/L；间接胆红素(IBIL)-静脉血: 8.4umolL；球蛋白(GLO)-静脉血: 25.82g/L；单核细胞百分比(Mono%)-静脉血: 0.093；血小板分布宽度(PDW)-静脉血: 10.8%；红细胞比容(Hct)-静脉血: 41.4%；总蛋白(TP)-静脉血: 64.32g/L；单核细胞计数(Mono#)-静脉血: 1.510E9/L；葡萄糖(Glu)-静脉血: 5.98mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.6；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；总胆红素(TBIL)-静脉血: 12.9umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 176.9U/L；甘油三酯(TG)-静脉血: 1.4mmol/L；乳酸脱氢酶(LDH)-静脉血: 239U/L；总胆汁酸(TBA)-静脉血: 3umol/L；直接胆红素(DBIL)-静脉血: 4.5umol/L；肌酐(Crea)-静脉血: 70umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.7；尿素氮(BUN)-静脉血: 6.02mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 136.5U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；天门冬氨酸氨基转移酶(AST)-静脉血: 104.5U/L；磷(P)-静脉血: 1.34mmol/L；钠离子(Na+)-静脉血: 138.8mmol/L；平均红细胞体积(MCV)-静脉血: 89.6fL；白细胞计数(WBC#)-静脉血: 15.9910E9/L；载脂蛋白AI(apoAI)-静脉血: 1.29g/L；阴离子间隙(AG)-静脉血: 14；C-反应蛋白(CRP)-静脉血: 1.98mg/L；钾离子(K+)-静脉血: 3.5mmol/L；碱性磷酸酶(ALP)-静脉血:……\n\n【既往治疗与反应】\n- [全程D8] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者相关检查完善中，请假未回病房。\n- [全程D13] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者相关检查完善中，请假未回病房。\n- [全程D19] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者元旦假期请假中。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D29] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者无明显不适主诉，查体情况：一般情况可，余同入院。放疗计划已完善。[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，向患者及其家属交代病情及化疗风险，表示理解并已签署知情同意书，同意入组三周/单周DDP同时期化疗临床试验，抽签入三周组，可于今日执行第1程顺铂方案同时期化疗，注意化疗不良反应，开始放疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放化疗，给予多烯磷脂酰胆碱、还原型谷胱甘肽等静脉保肝治疗，待肝功能恢复正常后恢复放化疗。\nB. 继续放化疗，仅密切监测肝功能变化，暂不给予静脉保肝药物干预。\nC. 继续放化疗，给予广谱抗生素静脉滴注预防感染，并辅以雾化吸入及止吐等对症支持处理。\nD. 将顺铂方案调整为卡铂方案同时期化疗，并给予静脉保肝治疗及止吐等对症支持处理。\nE. 顺铂剂量减低25%继续同时期化疗，给予静脉保肝治疗，辅以雾化吸入及止吐等对症支持处理。\nF. 暂停顺铂化疗，继续单纯放疗，给予静脉保肝治疗，待肝功能恢复后补足化疗周期。\nG. 给予多烯磷脂酰胆碱、还原型谷胱甘肽、复方甘草酸苷等静脉保肝治疗，辅以雾化吸入及止吐等对症支持处理。\nH. 给予大剂量质子泵抑制剂静脉滴注预防消化道出血，暂缓保肝治疗，继续放化疗。\nI. 暂停放疗，继续顺铂化疗，给予静脉保肝治疗及止吐等对症支持处理。\nJ. 给予静脉保肝治疗，行骨髓穿刺检查排除血液系统异常，继续放化疗。\nK. 终止临床试验，转为常规单药顺铂同时期放化疗，并给予静脉保肝治疗。\nL. 给予口服保肝药物治疗，辅以雾化吸入及止吐等对症支持处理，继续放化疗。\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-1d71f20ed555c71c5a4de4ee","patient_id":"patient-51e6f99c527367bbd97aebd8","turn_id":"turn06","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"H","gold_action":"给予联苯双酯等保肝降酶药物，辅以静脉营养支持，并密切复查肝功能。","options":[{"letter":"A","text":"暂停放疗与化疗，给予异甘草酸镁静脉滴注，待转氨酶降至正常水平后重启治疗。","is_gold":false},{"letter":"B","text":"终止顺铂化疗，后续疗程替换为卡铂，并加用甲泼尼龙静脉滴注。","is_gold":false},{"letter":"C","text":"暂停放疗，继续按计划执行化疗，给予联苯双酯口服及静脉营养支持。","is_gold":false},{"letter":"D","text":"维持治疗节奏，暂不加用保肝药物，1周后常规复查肝肾功能。","is_gold":false},{"letter":"E","text":"加用恩替卡韦口服抗病毒治疗，并维持放化疗方案不变。","is_gold":false},{"letter":"F","text":"安排肝脏病灶穿刺活检，明确病理性质前暂停所有抗肿瘤治疗。","is_gold":false},{"letter":"G","text":"给予重组人粒细胞集落刺激因子皮下注射，辅以静脉营养支持。","is_gold":false},{"letter":"H","text":"给予联苯双酯等保肝降酶药物，辅以静脉营养支持，并密切复查肝功能。","is_gold":true},{"letter":"I","text":"给予重组人血小板生成素皮下注射，并推迟下一疗程化疗。","is_gold":false},{"letter":"J","text":"给予头孢哌酮舒巴坦静脉滴注抗感染，并密切复查肝功能。","is_gold":false},{"letter":"K","text":"给予保肝降酶药物治疗，并按比例降低后续颈部放疗靶区处方剂量。","is_gold":false},{"letter":"L","text":"立即行血浆置换治疗，暂停放疗及化疗。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：鼻腔。\n文本分期信息：N0，M0。\n综合TNM状态：T1N0M0。\n综合分期：IA。\n\n【已知病史与当前主诉】\n- [全程D6] 入院记录: 主诉: 涕血2月；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血；既往史: “胃溃疡”病史22年，于某次就诊时间、某次就诊时间发生2次“胃出血”，经“输血”、“药物”治疗后好转，具体不详。某次就诊时间发现“胃底息肉”，行“内镜下胃底息肉切除术”。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：114/69mmHg,Ht：157cm，Wt：53kg，BSA：1.52m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽左侧壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D7] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- [全程D7] 检验组合: 平均红细胞体积(MCV)-静脉血: 91.1fL；总钙(Ca)-静脉血: 2.21mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24.2U/L；碱性磷酸酶(ALP)-静脉血: 74.3U/L；IV型胶原(C-IV)-静脉血: 12.97ng/ml；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 35.9U/L；钾离子(K+)-静脉血: 3.76mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；D-二聚体(D-Dimer)-静脉血: 0.07ug/ml；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；淀粉样蛋白A(SAA)-静脉血: 2.44mg/L；C-反应蛋白(CRP)-静脉血: 1.92mg/L；凝血酶原时间活动度(PTA)-静脉血: 120%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.67；载脂蛋白B(apoB)-静脉血: 1.07g/L；球蛋白(GLO)-静脉血: 26.18g/L；磷(P)-静脉血: 1.03mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；胱抑素(Cys-C)-静脉血: 0.79mg/L；红细胞计数(RBC#)-静脉血: 5.2710E12/L；单核细胞计数(Mono#)-静脉血: 110E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.6sec.；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.87；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.411ng/ml（参考: <0.584）；尿素氮(BUN)-静脉血: 4.7mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；血小板计数(PLT#)-静脉血: 21810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.578；凝血酶原时间(PT)-静脉血: 10.1sec.；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.05mmol/L；尿酸(UA)-静脉血: 331.5umol/L；阴离子间隙(AG)-静脉血: 15.7；层粘……\n- [全程D10] 内镜；胃镜: 检查类型: 内镜；检查名称: 胃镜；检查部位:；检查所见: 插镜情况：顺利 送达部位：十二指肠降部。 食 管：粘膜光滑, 舒缩好。 贲 门：开闭好, E-G线清楚。 胃 底：粘液湖清亮，粘膜光滑，无静脉曲张。 胃 体：花斑样充血，未见溃疡肿物。 胃 角：弧形， 光滑。 胃 窦：蠕动好，粘膜呈花斑样充血，未见溃疡肿物。 幽 门：圆， 开闭好。 球 部：球腔变形，后壁可见霜斑样溃疡，表面附着白苔。 降 部：十二指肠乳头及降部粘膜未见异常。 请4个工作日后到病理科（5楼）取活检结果。；检查结论: 十二指肠球部霜斑样溃疡 慢性浅表性胃炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D24] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽左侧顶后壁及左侧壁局部粘膜增厚形成软组织影放射性浓聚，SUV约21.0，堵塞左侧鼻后孔，鼻咽腔变窄，累及左侧翼突基底部及犁骨。左侧咽隐窝变，右侧咽隐窝未见明显异常，双侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。口咽及喉咽结构及放射性分布未见明显异常。额窦、蝶窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双上颈小淋巴结放射性分布未见明显异常。 双上肺尖、右中肺内侧段及左下肺后基底段少许条索影放射性分布未见明显异常；其余双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏S4低密度影放射性分布未见明显异常，大小约0.6×0.6cm，边界尚清，密度欠均匀，CT值约26Hu；其余肝脏密度减低，CT值约50Hu，结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。盆腔盆底静脉内多发点状/小结节状高密度影放射性缺损。 所见颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，侵犯左侧鼻后孔，累及颅底骨。 肝S4低密度影代谢未见明显异常，建议随诊。 脂肪肝。\n- [全程D29] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.013；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 6.5\n- [全程D30] 检验组合: 浊度(TRUB)-尿液: 清亮；白细胞计数(WBC#)-尿液: 3/μL；白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.023；酮体(KET)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 13/μL；颜色-尿液: Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；隐血(OB)-尿液: 1+ 0.6mg（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D31] 检验组合: 红细胞计数(RBC#)-静脉血: 4.6210E12/L；血小板计数(PLT#)-静脉血: 22810E9/L；大血小板百分比(P-LCR%)-静脉血: 21.2%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.61mmol/L；白蛋白(ALB)-静脉血: 38.5g/L；间接胆红素(IBIL)-静脉血: 8.4umolL；球蛋白(GLO)-静脉血: 25.82g/L；单核细胞百分比(Mono%)-静脉血: 0.093；血小板分布宽度(PDW)-静脉血: 10.8%；红细胞比容(Hct)-静脉血: 41.4%；总蛋白(TP)-静脉血: 64.32g/L；单核细胞计数(Mono#)-静脉血: 1.510E9/L；葡萄糖(Glu)-静脉血: 5.98mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.6；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；总胆红素(TBIL)-静脉血: 12.9umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 176.9U/L；甘油三酯(TG)-静脉血: 1.4mmol/L；乳酸脱氢酶(LDH)-静脉血: 239U/L；总胆汁酸(TBA)-静脉血: 3umol/L；直接胆红素(DBIL)-静脉血: 4.5umol/L；肌酐(Crea)-静脉血: 70umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.7；尿素氮(BUN)-静脉血: 6.02mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 136.5U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；天门冬氨酸氨基转移酶(AST)-静脉血: 104.5U/L；磷(P)-静脉血: 1.34mmol/L；钠离子(Na+)-静脉血: 138.8mmol/L；平均红细胞体积(MCV)-静脉血: 89.6fL；白细胞计数(WBC#)-静脉血: 15.9910E9/L；载脂蛋白AI(apoAI)-静脉血: 1.29g/L；阴离子间隙(AG)-静脉血: 14；C-反应蛋白(CRP)-静脉血: 1.98mg/L；钾离子(K+)-静脉血: 3.5mmol/L；碱性磷酸酶(ALP)-静脉血:……\n- [全程D32] 检验组合: 胱抑素(Cys-C)-静脉血: 0.73mg/L；乳酸脱氢酶(LDH)-静脉血: 162.4U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.51mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；淋巴细胞百分比(Lymph%)-静脉血: 0.05；平均红细胞血红蛋白含量(MCH)-静脉血: 29.9pg；血红蛋白(Hb)-静脉血: 137.4g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 5.43mmol/L；白蛋白(ALB)-静脉血: 43.2g/L；肌酐(Crea)-静脉血: 86.7umol/L；氯离子(Cl-)-静脉血: 97.6mmol/L；C-反应蛋白(CRP)-静脉血: 6.52mg/L；钾离子(K+)-静脉血: 4.2mmol/L；尿酸(UA)-静脉血: 298.5umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.15mmolL；载脂蛋白B(apoB)-静脉血: 1.3g/L；血小板比容-静脉血: 14.7%；血小板分布宽度(PDW)-静脉血: 8.7%；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.41mmolL；有核红细胞百分比(NRBC%)-静脉血: 0；血小板比容-静脉血: 14%；总胆固醇(TC)-静脉血: 7.5mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；甘油三酯(TG)-静脉血: 1.38mmol/L；平均血小板体积(MPV)-静脉血: 8.9fL；平均红细胞体积(MCV)-静脉血: 90.2fL；γ-谷氨酰基转移酶(GGT)-静脉血: 97.8U/L；阴离子间隙(AG)-静脉血: 17；胱抑素(Cys-C)-静脉血: 1.03mg/L；氯离子(Cl-)-静脉血: 96.7mmol/L；血小板分布宽度(PDW)-静脉血: 16.1%；平均血小板体积(MPV)-静脉血: 6.78fL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；球蛋白(GLO)-静脉血: 35.61g/L；镁离子(Mg2+)-静脉血: 0.66mmol/L；间接胆红素(IBIL)-静脉血: 6.3umolL；γ-谷氨酰基转移酶(GGT)-静脉血: 151U/L；阴离子间隙(AG)-静脉血: 17；单核细胞计数(Mono#)-……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D8] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者相关检查完善中，请假未回病房。\n- [全程D13] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者相关检查完善中，请假未回病房。\n- [全程D19] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者元旦假期请假中。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D29] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者无明显不适主诉，查体情况：一般情况可，余同入院。放疗计划已完善。[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，向患者及其家属交代病情及化疗风险，表示理解并已签署知情同意书，同意入组三周/单周DDP同时期化疗临床试验，抽签入三周组，可于今日执行第1程顺铂方案同时期化疗，注意化疗不良反应，开始放疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗与化疗，给予异甘草酸镁静脉滴注，待转氨酶降至正常水平后重启治疗。\nB. 终止顺铂化疗，后续疗程替换为卡铂，并加用甲泼尼龙静脉滴注。\nC. 暂停放疗，继续按计划执行化疗，给予联苯双酯口服及静脉营养支持。\nD. 维持治疗节奏，暂不加用保肝药物，1周后常规复查肝肾功能。\nE. 加用恩替卡韦口服抗病毒治疗，并维持放化疗方案不变。\nF. 安排肝脏病灶穿刺活检，明确病理性质前暂停所有抗肿瘤治疗。\nG. 给予重组人粒细胞集落刺激因子皮下注射，辅以静脉营养支持。\nH. 给予联苯双酯等保肝降酶药物，辅以静脉营养支持，并密切复查肝功能。\nI. 给予重组人血小板生成素皮下注射，并推迟下一疗程化疗。\nJ. 给予头孢哌酮舒巴坦静脉滴注抗感染，并密切复查肝功能。\nK. 给予保肝降酶药物治疗，并按比例降低后续颈部放疗靶区处方剂量。\nL. 立即行血浆置换治疗，暂停放疗及化疗。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D32] 检验组合: 胱抑素(Cys-C)-静脉血: 0.73mg/L；乳酸脱氢酶(LDH)-静脉血: 162.4U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.51mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；淋巴细胞百分比(Lymph%)-静脉血: 0.05；平均红细胞血红蛋白含量(MCH)-静脉血: 29.9pg；血红蛋白(Hb)-静脉血: 137.4g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 5.43mmol/L；白蛋白(ALB)-静脉血: 43.2g/L；肌酐(Crea)-静脉血: 86.7umol/L；氯离子(Cl-)-静脉血: 97.6mmol/L；C-反应蛋白(CRP)-静脉血: 6.52mg/L；钾离子(K+)-静脉血: 4.2mmol/L；尿酸(UA)-静脉血: 298.5umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.15mmolL；载脂蛋白B(apoB)-静脉血: 1.3g/L；血小板比容-静脉血: 14.7%；血小板分布宽度(PDW)-静脉血: 8.7%；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.41mmolL；有核红细胞百分比(NRBC%)-静脉血: 0；血小板比容-静脉血: 14%；总胆固醇(TC)-静脉血: 7.5mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；甘油三酯(TG)-静脉血: 1.38mmol/L；平均血小板体积(MPV)-静脉血: 8.9fL；平均红细胞体积(MCV)-静脉血: 90.2fL；γ-谷氨酰基转移酶(GGT)-静脉血: 97.8U/L；阴离子间隙(AG)-静脉血: 17；胱抑素(Cys-C)-静脉血: 1.03mg/L；氯离子(Cl-)-静脉血: 96.7mmol/L；血小板分布宽度(PDW)-静脉血: 16.1%；平均血小板体积(MPV)-静脉血: 6.78fL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；球蛋白(GLO)-静脉血: 35.61g/L；镁离子(Mg2+)-静脉血: 0.66mmol/L；间接胆红素(IBIL)-静脉血: 6.3umolL；γ-谷氨酰基转移酶(GGT)-静脉血: 151U/L；阴离子间隙(AG)-静脉血: 17；单核细胞计数(Mono#)-……\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗与化疗，给予异甘草酸镁静脉滴注，待转氨酶降至正常水平后重启治疗。\nB. 终止顺铂化疗，后续疗程替换为卡铂，并加用甲泼尼龙静脉滴注。\nC. 暂停放疗，继续按计划执行化疗，给予联苯双酯口服及静脉营养支持。\nD. 维持治疗节奏，暂不加用保肝药物，1周后常规复查肝肾功能。\nE. 加用恩替卡韦口服抗病毒治疗，并维持放化疗方案不变。\nF. 安排肝脏病灶穿刺活检，明确病理性质前暂停所有抗肿瘤治疗。\nG. 给予重组人粒细胞集落刺激因子皮下注射，辅以静脉营养支持。\nH. 给予联苯双酯等保肝降酶药物，辅以静脉营养支持，并密切复查肝功能。\nI. 给予重组人血小板生成素皮下注射，并推迟下一疗程化疗。\nJ. 给予头孢哌酮舒巴坦静脉滴注抗感染，并密切复查肝功能。\nK. 给予保肝降酶药物治疗，并按比例降低后续颈部放疗靶区处方剂量。\nL. 立即行血浆置换治疗，暂停放疗及化疗。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：鼻腔。\n文本分期信息：N0，M0。\n综合TNM状态：T1N0M0。\n综合分期：IA。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D32] 检验组合: 胱抑素(Cys-C)-静脉血: 0.73mg/L；乳酸脱氢酶(LDH)-静脉血: 162.4U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.51mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；淋巴细胞百分比(Lymph%)-静脉血: 0.05；平均红细胞血红蛋白含量(MCH)-静脉血: 29.9pg；血红蛋白(Hb)-静脉血: 137.4g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 5.43mmol/L；白蛋白(ALB)-静脉血: 43.2g/L；肌酐(Crea)-静脉血: 86.7umol/L；氯离子(Cl-)-静脉血: 97.6mmol/L；C-反应蛋白(CRP)-静脉血: 6.52mg/L；钾离子(K+)-静脉血: 4.2mmol/L；尿酸(UA)-静脉血: 298.5umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.15mmolL；载脂蛋白B(apoB)-静脉血: 1.3g/L；血小板比容-静脉血: 14.7%；血小板分布宽度(PDW)-静脉血: 8.7%；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.41mmolL；有核红细胞百分比(NRBC%)-静脉血: 0；血小板比容-静脉血: 14%；总胆固醇(TC)-静脉血: 7.5mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；甘油三酯(TG)-静脉血: 1.38mmol/L；平均血小板体积(MPV)-静脉血: 8.9fL；平均红细胞体积(MCV)-静脉血: 90.2fL；γ-谷氨酰基转移酶(GGT)-静脉血: 97.8U/L；阴离子间隙(AG)-静脉血: 17；胱抑素(Cys-C)-静脉血: 1.03mg/L；氯离子(Cl-)-静脉血: 96.7mmol/L；血小板分布宽度(PDW)-静脉血: 16.1%；平均血小板体积(MPV)-静脉血: 6.78fL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；球蛋白(GLO)-静脉血: 35.61g/L；镁离子(Mg2+)-静脉血: 0.66mmol/L；间接胆红素(IBIL)-静脉血: 6.3umolL；γ-谷氨酰基转移酶(GGT)-静脉血: 151U/L；阴离子间隙(AG)-静脉血: 17；单核细胞计数(Mono#)-……\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗与化疗，给予异甘草酸镁静脉滴注，待转氨酶降至正常水平后重启治疗。\nB. 终止顺铂化疗，后续疗程替换为卡铂，并加用甲泼尼龙静脉滴注。\nC. 暂停放疗，继续按计划执行化疗，给予联苯双酯口服及静脉营养支持。\nD. 维持治疗节奏，暂不加用保肝药物，1周后常规复查肝肾功能。\nE. 加用恩替卡韦口服抗病毒治疗，并维持放化疗方案不变。\nF. 安排肝脏病灶穿刺活检，明确病理性质前暂停所有抗肿瘤治疗。\nG. 给予重组人粒细胞集落刺激因子皮下注射，辅以静脉营养支持。\nH. 给予联苯双酯等保肝降酶药物，辅以静脉营养支持，并密切复查肝功能。\nI. 给予重组人血小板生成素皮下注射，并推迟下一疗程化疗。\nJ. 给予头孢哌酮舒巴坦静脉滴注抗感染，并密切复查肝功能。\nK. 给予保肝降酶药物治疗，并按比例降低后续颈部放疗靶区处方剂量。\nL. 立即行血浆置换治疗，暂停放疗及化疗。\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-5eba0030ab5d024288a0d69d","patient_id":"patient-51e6f99c527367bbd97aebd8","turn_id":"turn07","turn_position":5,"turn_type":"response_assessment_decision","gold_letter":"I","gold_action":"继续根治性放疗，给予雾化吸入氨溴索与地塞米松，并局部外用三乙醇胺乳膏。","options":[{"letter":"A","text":"暂停放疗，给予静脉滴注广谱抗菌药物及大剂量糖皮质激素。","is_gold":false},{"letter":"B","text":"暂停放疗，行肝脏穿刺活检明确肝脏病灶性质后调整全身系统性化疗方案。","is_gold":false},{"letter":"C","text":"继续根治性放疗，给予重组人粒细胞集落刺激因子（G-CSF）皮下注射。","is_gold":false},{"letter":"D","text":"继续根治性放疗，加用第3程顺铂同期化疗，并给予静脉保肝药物。","is_gold":false},{"letter":"E","text":"终止放疗，转为TPF方案全身系统性化疗。","is_gold":false},{"letter":"F","text":"继续根治性放疗，局部外用强效糖皮质激素软膏，并口服非甾体抗炎药。","is_gold":false},{"letter":"G","text":"暂停放疗，复查鼻咽及颈部MRI以决定是否降低后续放疗靶区剂量。","is_gold":false},{"letter":"H","text":"继续根治性放疗，给予静脉异甘草酸镁及还原型谷胱甘肽保肝治疗。","is_gold":false},{"letter":"I","text":"继续根治性放疗，给予雾化吸入氨溴索与地塞米松，并局部外用三乙醇胺乳膏。","is_gold":true},{"letter":"J","text":"继续根治性放疗，联合靶向药物尼妥珠单抗及PD-1抑制剂治疗。","is_gold":false},{"letter":"K","text":"继续根治性放疗，给予静脉滴注地塞米松，并局部外用莫匹罗星软膏。","is_gold":false},{"letter":"L","text":"结束放化疗综合治疗，进入随访观察期，定期复查鼻咽MRI及颈部超声。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：鼻腔。\n文本分期信息：N0，M0。\n综合TNM状态：T1N0M0。\n综合分期：IA。\n\n【已知病史与当前主诉】\n- [全程D6] 入院记录: 主诉: 涕血2月；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血；既往史: “胃溃疡”病史22年，于某次就诊时间、某次就诊时间发生2次“胃出血”，经“输血”、“药物”治疗后好转，具体不详。某次就诊时间发现“胃底息肉”，行“内镜下胃底息肉切除术”。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：114/69mmHg,Ht：157cm，Wt：53kg，BSA：1.52m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽左侧壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D7] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- [全程D7] 检验组合: 平均红细胞体积(MCV)-静脉血: 91.1fL；总钙(Ca)-静脉血: 2.21mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24.2U/L；碱性磷酸酶(ALP)-静脉血: 74.3U/L；IV型胶原(C-IV)-静脉血: 12.97ng/ml；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 35.9U/L；钾离子(K+)-静脉血: 3.76mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；D-二聚体(D-Dimer)-静脉血: 0.07ug/ml；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；淀粉样蛋白A(SAA)-静脉血: 2.44mg/L；C-反应蛋白(CRP)-静脉血: 1.92mg/L；凝血酶原时间活动度(PTA)-静脉血: 120%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.67；载脂蛋白B(apoB)-静脉血: 1.07g/L；球蛋白(GLO)-静脉血: 26.18g/L；磷(P)-静脉血: 1.03mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；胱抑素(Cys-C)-静脉血: 0.79mg/L；红细胞计数(RBC#)-静脉血: 5.2710E12/L；单核细胞计数(Mono#)-静脉血: 110E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.6sec.；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.87；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.411ng/ml（参考: <0.584）；尿素氮(BUN)-静脉血: 4.7mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；血小板计数(PLT#)-静脉血: 21810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.578；凝血酶原时间(PT)-静脉血: 10.1sec.；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.05mmol/L；尿酸(UA)-静脉血: 331.5umol/L；阴离子间隙(AG)-静脉血: 15.7；层粘……\n- [全程D10] 内镜；胃镜: 检查类型: 内镜；检查名称: 胃镜；检查部位:；检查所见: 插镜情况：顺利 送达部位：十二指肠降部。 食 管：粘膜光滑, 舒缩好。 贲 门：开闭好, E-G线清楚。 胃 底：粘液湖清亮，粘膜光滑，无静脉曲张。 胃 体：花斑样充血，未见溃疡肿物。 胃 角：弧形， 光滑。 胃 窦：蠕动好，粘膜呈花斑样充血，未见溃疡肿物。 幽 门：圆， 开闭好。 球 部：球腔变形，后壁可见霜斑样溃疡，表面附着白苔。 降 部：十二指肠乳头及降部粘膜未见异常。 请4个工作日后到病理科（5楼）取活检结果。；检查结论: 十二指肠球部霜斑样溃疡 慢性浅表性胃炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D24] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽左侧顶后壁及左侧壁局部粘膜增厚形成软组织影放射性浓聚，SUV约21.0，堵塞左侧鼻后孔，鼻咽腔变窄，累及左侧翼突基底部及犁骨。左侧咽隐窝变，右侧咽隐窝未见明显异常，双侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。口咽及喉咽结构及放射性分布未见明显异常。额窦、蝶窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双上颈小淋巴结放射性分布未见明显异常。 双上肺尖、右中肺内侧段及左下肺后基底段少许条索影放射性分布未见明显异常；其余双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏S4低密度影放射性分布未见明显异常，大小约0.6×0.6cm，边界尚清，密度欠均匀，CT值约26Hu；其余肝脏密度减低，CT值约50Hu，结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。盆腔盆底静脉内多发点状/小结节状高密度影放射性缺损。 所见颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，侵犯左侧鼻后孔，累及颅底骨。 肝S4低密度影代谢未见明显异常，建议随诊。 脂肪肝。\n- [全程D29] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.013；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 6.5\n- [全程D30] 检验组合: 浊度(TRUB)-尿液: 清亮；白细胞计数(WBC#)-尿液: 3/μL；白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.023；酮体(KET)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 13/μL；颜色-尿液: Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；隐血(OB)-尿液: 1+ 0.6mg（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D31] 检验组合: 红细胞计数(RBC#)-静脉血: 4.6210E12/L；血小板计数(PLT#)-静脉血: 22810E9/L；大血小板百分比(P-LCR%)-静脉血: 21.2%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.61mmol/L；白蛋白(ALB)-静脉血: 38.5g/L；间接胆红素(IBIL)-静脉血: 8.4umolL；球蛋白(GLO)-静脉血: 25.82g/L；单核细胞百分比(Mono%)-静脉血: 0.093；血小板分布宽度(PDW)-静脉血: 10.8%；红细胞比容(Hct)-静脉血: 41.4%；总蛋白(TP)-静脉血: 64.32g/L；单核细胞计数(Mono#)-静脉血: 1.510E9/L；葡萄糖(Glu)-静脉血: 5.98mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.6；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；总胆红素(TBIL)-静脉血: 12.9umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 176.9U/L；甘油三酯(TG)-静脉血: 1.4mmol/L；乳酸脱氢酶(LDH)-静脉血: 239U/L；总胆汁酸(TBA)-静脉血: 3umol/L；直接胆红素(DBIL)-静脉血: 4.5umol/L；肌酐(Crea)-静脉血: 70umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.7；尿素氮(BUN)-静脉血: 6.02mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 136.5U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；天门冬氨酸氨基转移酶(AST)-静脉血: 104.5U/L；磷(P)-静脉血: 1.34mmol/L；钠离子(Na+)-静脉血: 138.8mmol/L；平均红细胞体积(MCV)-静脉血: 89.6fL；白细胞计数(WBC#)-静脉血: 15.9910E9/L；载脂蛋白AI(apoAI)-静脉血: 1.29g/L；阴离子间隙(AG)-静脉血: 14；C-反应蛋白(CRP)-静脉血: 1.98mg/L；钾离子(K+)-静脉血: 3.5mmol/L；碱性磷酸酶(ALP)-静脉血:……\n- [全程D32] 检验组合: 胱抑素(Cys-C)-静脉血: 0.73mg/L；乳酸脱氢酶(LDH)-静脉血: 162.4U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.51mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；淋巴细胞百分比(Lymph%)-静脉血: 0.05；平均红细胞血红蛋白含量(MCH)-静脉血: 29.9pg；血红蛋白(Hb)-静脉血: 137.4g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 5.43mmol/L；白蛋白(ALB)-静脉血: 43.2g/L；肌酐(Crea)-静脉血: 86.7umol/L；氯离子(Cl-)-静脉血: 97.6mmol/L；C-反应蛋白(CRP)-静脉血: 6.52mg/L；钾离子(K+)-静脉血: 4.2mmol/L；尿酸(UA)-静脉血: 298.5umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.15mmolL；载脂蛋白B(apoB)-静脉血: 1.3g/L；血小板比容-静脉血: 14.7%；血小板分布宽度(PDW)-静脉血: 8.7%；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.41mmolL；有核红细胞百分比(NRBC%)-静脉血: 0；血小板比容-静脉血: 14%；总胆固醇(TC)-静脉血: 7.5mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；甘油三酯(TG)-静脉血: 1.38mmol/L；平均血小板体积(MPV)-静脉血: 8.9fL；平均红细胞体积(MCV)-静脉血: 90.2fL；γ-谷氨酰基转移酶(GGT)-静脉血: 97.8U/L；阴离子间隙(AG)-静脉血: 17；胱抑素(Cys-C)-静脉血: 1.03mg/L；氯离子(Cl-)-静脉血: 96.7mmol/L；血小板分布宽度(PDW)-静脉血: 16.1%；平均血小板体积(MPV)-静脉血: 6.78fL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；球蛋白(GLO)-静脉血: 35.61g/L；镁离子(Mg2+)-静脉血: 0.66mmol/L；间接胆红素(IBIL)-静脉血: 6.3umolL；γ-谷氨酰基转移酶(GGT)-静脉血: 151U/L；阴离子间隙(AG)-静脉血: 17；单核细胞计数(Mono#)-……\n- [全程D41] 检验组合: 中性粒细胞计数(Neut#)-静脉血: 6.110E9/L；钠离子(Na+)-静脉血: 139.4mmol/L；尿素氮(BUN)-静脉血: 7.2mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.53；淋巴细胞计数(Lymph#)-静脉血: 0.910E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 42.7U/L；丙氨酸氨基转移酶(ALT)-静脉血: 35.4U/L；甘油三酯(TG)-静脉血: 1.71mmol/L；白细胞计数(WBC#)-静脉血: 7.7810E9/L；总蛋白(TP)-静脉血: 62.51g/L；血红蛋白(Hb)-静脉血: 131g/L；总钙(Ca)-静脉血: 2.05mmol/L；肌酐(Crea)-静脉血: 81.5umol/L；载脂蛋白B(apoB)-静脉血: 1.23g/L；白蛋白(ALB)-静脉血: 36.6g/L；中性粒细胞百分比(Neut%)-静脉血: 0.79；红细胞比容(Hct)-静脉血: 38.9%；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.6；淋巴细胞百分比(Lymph%)-静脉血: 0.113；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.006；大血小板百分比(P-LCR%)-静脉血: 15.3%；乳酸脱氢酶(LDH)-静脉血: 185.9U/L；间接胆红素(IBIL)-静脉血: 6.7umolL；氯离子(Cl-)-静脉血: 100.4mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.8U/L；血小板计数(PLT#)-静脉血: 15410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.3g/L；平均血小板体积(MPV)-静脉血: 8.9fL；胱抑素(Cys-C)-静脉血: 0.86mg/L；γ-谷氨酰基转移酶(GGT)-静脉血: 268.3U/L；总胆红素(TBIL)-静脉血: 8umol/L；葡萄糖(Glu)-静脉血: 5.28mmol/L；红细胞计数(RBC#)-静脉血: 4.3510E12/L；总胆汁酸(TBA)-静脉血: 2.7umol/L；血小板分……\n- [全程D49] 检验组合: 红细胞计数(RBC#)-尿液: 6/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；白细胞计数(WBC#)-尿液: 1/μL；比重(SG)-尿液: 1.009；胆红素(BIL)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: 无色；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮\n- [全程D50] 检验组合: 浊度(TRUB)-尿液: clear；酮体(KET)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 13/μL；比重(SG)-尿液: 1.017；白细胞计数(WBC#)-尿液: 10/μL；隐血(OB)-尿液: 1+0.6mg（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；总蛋白(TP)-尿液: -（参考: 阴性）；非鳞状上皮细胞计数-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 3/μL；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow\n- [全程D51] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；比重(SG)-尿液: 1.013；白细胞计数(WBC#)-尿液: 13/μL；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 8/μL；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；白细胞(LEU)-尿液: -（参考: 阴性）\n- [全程D52] 检验组合: 淋巴细胞百分比(Lymph%)-静脉血: 0.1；镁离子(Mg2+)-静脉血: 0.52mmol/L；尿素氮(BUN)-静脉血: 6.1mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.14mmolL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；总蛋白(TP)-静脉血: 64.42g/L；磷(P)-静脉血: 1.33mmol/L；总胆红素(TBIL)-静脉血: 6umol/L；氯离子(Cl-)-静脉血: 99.5mmol/L；红细胞比容(Hct)-静脉血: 36.9%；平均红细胞体积(MCV)-静脉血: 89.1fL；红细胞计数(RBC#)-静脉血: 4.1410E12/L；C-反应蛋白(CRP)-静脉血: 4.91mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；白细胞计数(WBC#)-静脉血: 3.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.253；血小板比容-静脉血: 20%；丙氨酸氨基转移酶(ALT)-静脉血: 42.9U/L；血液二氧化碳含量ctCO2(B)-静脉血: 26.2mmol/L；胱抑素(Cys-C)-静脉血: 1.28mg/L；球蛋白(GLO)-静脉血: 29.62g/L；甘油三酯(TG)-静脉血: 1.61mmol/L；尿酸(UA)-静脉血: 292.8umol/L；血小板分布宽度(PDW)-静脉血: 8.6%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.8；单核细胞计数(Mono#)-静脉血: 0.910E9/L；肌酐(Crea)-静脉血: 109.5umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.015；总胆固醇(TC)-静脉血: 5.96mmol/L；阴离子间隙(AG)-静脉血: 12；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 47U/L；平均血小板体积(MPV)-静脉血: 8.8fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.4；中性粒细胞百分比(Neut%)-静脉血: 0.626；总钙(Ca)-静脉血: 1.94mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.……\n- [全程D61] 超声；肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声不均匀，肝S5可见2个无回声灶，直径约3-4mm，边界清,内透声可，后方回声增强。血管走行清晰、自然，肝内胆管不扩张，门静脉内径约7mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约28cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约43×27×32mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝S5囊性灶，考虑肝囊肿可能性大。 胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D61] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，走行自然，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D8] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者相关检查完善中，请假未回病房。\n- [全程D13] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者相关检查完善中，请假未回病房。\n- [全程D19] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者元旦假期请假中。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D29] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者无明显不适主诉，查体情况：一般情况可，余同入院。放疗计划已完善。[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，向患者及其家属交代病情及化疗风险，表示理解并已签署知情同意书，同意入组三周/单周DDP同时期化疗临床试验，抽签入三周组，可于今日执行第1程顺铂方案同时期化疗，注意化疗不良反应，开始放疗。\n- [全程D41] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者放疗中，诉口感、咽痛，余无不适。查体同前。复查血常规：基本正常，生化常规：正常。[姓名已隐去]医生信息已隐藏：患者DDP化疗后出现肝酶升高，考虑为药物性肝损害，经多种滑竿药物治疗后肝功能恢复正常，今日可办理出院，继续门诊放疗。\n- [全程D50] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，向患者及其家属交代病情及化疗风险，表示理解并已签署知情同意书，可于今日水化，明日执行第2程DDP方案同时期化疗，注意化疗不良反应。\n- [全程D51] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程DDP方案同时期化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D52] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第二程DDP单药同期化疗结束，诉咽痛、恶心、食欲下降，呕吐1次，伴头晕，无腹痛、腹泻等不适。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者同时期化疗结束，一般情况可，可以今日结账出院，门诊继续放疗。嘱定期复查血常规及肝肾功能，行放疗结束前常规检查。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，给予静脉滴注广谱抗菌药物及大剂量糖皮质激素。\nB. 暂停放疗，行肝脏穿刺活检明确肝脏病灶性质后调整全身系统性化疗方案。\nC. 继续根治性放疗，给予重组人粒细胞集落刺激因子（G-CSF）皮下注射。\nD. 继续根治性放疗，加用第3程顺铂同期化疗，并给予静脉保肝药物。\nE. 终止放疗，转为TPF方案全身系统性化疗。\nF. 继续根治性放疗，局部外用强效糖皮质激素软膏，并口服非甾体抗炎药。\nG. 暂停放疗，复查鼻咽及颈部MRI以决定是否降低后续放疗靶区剂量。\nH. 继续根治性放疗，给予静脉异甘草酸镁及还原型谷胱甘肽保肝治疗。\nI. 继续根治性放疗，给予雾化吸入氨溴索与地塞米松，并局部外用三乙醇胺乳膏。\nJ. 继续根治性放疗，联合靶向药物尼妥珠单抗及PD-1抑制剂治疗。\nK. 继续根治性放疗，给予静脉滴注地塞米松，并局部外用莫匹罗星软膏。\nL. 结束放化疗综合治疗，进入随访观察期，定期复查鼻咽MRI及颈部超声。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D41] 检验组合: 中性粒细胞计数(Neut#)-静脉血: 6.110E9/L；钠离子(Na+)-静脉血: 139.4mmol/L；尿素氮(BUN)-静脉血: 7.2mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.53；淋巴细胞计数(Lymph#)-静脉血: 0.910E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 42.7U/L；丙氨酸氨基转移酶(ALT)-静脉血: 35.4U/L；甘油三酯(TG)-静脉血: 1.71mmol/L；白细胞计数(WBC#)-静脉血: 7.7810E9/L；总蛋白(TP)-静脉血: 62.51g/L；血红蛋白(Hb)-静脉血: 131g/L；总钙(Ca)-静脉血: 2.05mmol/L；肌酐(Crea)-静脉血: 81.5umol/L；载脂蛋白B(apoB)-静脉血: 1.23g/L；白蛋白(ALB)-静脉血: 36.6g/L；中性粒细胞百分比(Neut%)-静脉血: 0.79；红细胞比容(Hct)-静脉血: 38.9%；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.6；淋巴细胞百分比(Lymph%)-静脉血: 0.113；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.006；大血小板百分比(P-LCR%)-静脉血: 15.3%；乳酸脱氢酶(LDH)-静脉血: 185.9U/L；间接胆红素(IBIL)-静脉血: 6.7umolL；氯离子(Cl-)-静脉血: 100.4mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.8U/L；血小板计数(PLT#)-静脉血: 15410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.3g/L；平均血小板体积(MPV)-静脉血: 8.9fL；胱抑素(Cys-C)-静脉血: 0.86mg/L；γ-谷氨酰基转移酶(GGT)-静脉血: 268.3U/L；总胆红素(TBIL)-静脉血: 8umol/L；葡萄糖(Glu)-静脉血: 5.28mmol/L；红细胞计数(RBC#)-静脉血: 4.3510E12/L；总胆汁酸(TBA)-静脉血: 2.7umol/L；血小板分……\n- [全程D49] 检验组合: 红细胞计数(RBC#)-尿液: 6/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；白细胞计数(WBC#)-尿液: 1/μL；比重(SG)-尿液: 1.009；胆红素(BIL)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: 无色；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮\n- [全程D50] 检验组合: 浊度(TRUB)-尿液: clear；酮体(KET)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 13/μL；比重(SG)-尿液: 1.017；白细胞计数(WBC#)-尿液: 10/μL；隐血(OB)-尿液: 1+0.6mg（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；总蛋白(TP)-尿液: -（参考: 阴性）；非鳞状上皮细胞计数-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 3/μL；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow\n- [全程D51] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；比重(SG)-尿液: 1.013；白细胞计数(WBC#)-尿液: 13/μL；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 8/μL；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；白细胞(LEU)-尿液: -（参考: 阴性）\n- [全程D52] 检验组合: 淋巴细胞百分比(Lymph%)-静脉血: 0.1；镁离子(Mg2+)-静脉血: 0.52mmol/L；尿素氮(BUN)-静脉血: 6.1mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.14mmolL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；总蛋白(TP)-静脉血: 64.42g/L；磷(P)-静脉血: 1.33mmol/L；总胆红素(TBIL)-静脉血: 6umol/L；氯离子(Cl-)-静脉血: 99.5mmol/L；红细胞比容(Hct)-静脉血: 36.9%；平均红细胞体积(MCV)-静脉血: 89.1fL；红细胞计数(RBC#)-静脉血: 4.1410E12/L；C-反应蛋白(CRP)-静脉血: 4.91mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；白细胞计数(WBC#)-静脉血: 3.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.253；血小板比容-静脉血: 20%；丙氨酸氨基转移酶(ALT)-静脉血: 42.9U/L；血液二氧化碳含量ctCO2(B)-静脉血: 26.2mmol/L；胱抑素(Cys-C)-静脉血: 1.28mg/L；球蛋白(GLO)-静脉血: 29.62g/L；甘油三酯(TG)-静脉血: 1.61mmol/L；尿酸(UA)-静脉血: 292.8umol/L；血小板分布宽度(PDW)-静脉血: 8.6%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.8；单核细胞计数(Mono#)-静脉血: 0.910E9/L；肌酐(Crea)-静脉血: 109.5umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.015；总胆固醇(TC)-静脉血: 5.96mmol/L；阴离子间隙(AG)-静脉血: 12；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 47U/L；平均血小板体积(MPV)-静脉血: 8.8fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.4；中性粒细胞百分比(Neut%)-静脉血: 0.626；总钙(Ca)-静脉血: 1.94mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.……\n- [全程D61] 超声；肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声不均匀，肝S5可见2个无回声灶，直径约3-4mm，边界清,内透声可，后方回声增强。血管走行清晰、自然，肝内胆管不扩张，门静脉内径约7mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约28cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约43×27×32mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝S5囊性灶，考虑肝囊肿可能性大。 胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D61] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，走行自然，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n\n【既往治疗与反应】\n- [全程D41] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者放疗中，诉口感、咽痛，余无不适。查体同前。复查血常规：基本正常，生化常规：正常。[姓名已隐去]医生信息已隐藏：患者DDP化疗后出现肝酶升高，考虑为药物性肝损害，经多种滑竿药物治疗后肝功能恢复正常，今日可办理出院，继续门诊放疗。\n- [全程D50] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，向患者及其家属交代病情及化疗风险，表示理解并已签署知情同意书，可于今日水化，明日执行第2程DDP方案同时期化疗，注意化疗不良反应。\n- [全程D51] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程DDP方案同时期化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D52] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第二程DDP单药同期化疗结束，诉咽痛、恶心、食欲下降，呕吐1次，伴头晕，无腹痛、腹泻等不适。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者同时期化疗结束，一般情况可，可以今日结账出院，门诊继续放疗。嘱定期复查血常规及肝肾功能，行放疗结束前常规检查。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，给予静脉滴注广谱抗菌药物及大剂量糖皮质激素。\nB. 暂停放疗，行肝脏穿刺活检明确肝脏病灶性质后调整全身系统性化疗方案。\nC. 继续根治性放疗，给予重组人粒细胞集落刺激因子（G-CSF）皮下注射。\nD. 继续根治性放疗，加用第3程顺铂同期化疗，并给予静脉保肝药物。\nE. 终止放疗，转为TPF方案全身系统性化疗。\nF. 继续根治性放疗，局部外用强效糖皮质激素软膏，并口服非甾体抗炎药。\nG. 暂停放疗，复查鼻咽及颈部MRI以决定是否降低后续放疗靶区剂量。\nH. 继续根治性放疗，给予静脉异甘草酸镁及还原型谷胱甘肽保肝治疗。\nI. 继续根治性放疗，给予雾化吸入氨溴索与地塞米松，并局部外用三乙醇胺乳膏。\nJ. 继续根治性放疗，联合靶向药物尼妥珠单抗及PD-1抑制剂治疗。\nK. 继续根治性放疗，给予静脉滴注地塞米松，并局部外用莫匹罗星软膏。\nL. 结束放化疗综合治疗，进入随访观察期，定期复查鼻咽MRI及颈部超声。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：鼻腔。\n文本分期信息：N0，M0。\n综合TNM状态：T1N0M0。\n综合分期：IA。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D41] 检验组合: 中性粒细胞计数(Neut#)-静脉血: 6.110E9/L；钠离子(Na+)-静脉血: 139.4mmol/L；尿素氮(BUN)-静脉血: 7.2mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.53；淋巴细胞计数(Lymph#)-静脉血: 0.910E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 42.7U/L；丙氨酸氨基转移酶(ALT)-静脉血: 35.4U/L；甘油三酯(TG)-静脉血: 1.71mmol/L；白细胞计数(WBC#)-静脉血: 7.7810E9/L；总蛋白(TP)-静脉血: 62.51g/L；血红蛋白(Hb)-静脉血: 131g/L；总钙(Ca)-静脉血: 2.05mmol/L；肌酐(Crea)-静脉血: 81.5umol/L；载脂蛋白B(apoB)-静脉血: 1.23g/L；白蛋白(ALB)-静脉血: 36.6g/L；中性粒细胞百分比(Neut%)-静脉血: 0.79；红细胞比容(Hct)-静脉血: 38.9%；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.6；淋巴细胞百分比(Lymph%)-静脉血: 0.113；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.006；大血小板百分比(P-LCR%)-静脉血: 15.3%；乳酸脱氢酶(LDH)-静脉血: 185.9U/L；间接胆红素(IBIL)-静脉血: 6.7umolL；氯离子(Cl-)-静脉血: 100.4mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.8U/L；血小板计数(PLT#)-静脉血: 15410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.3g/L；平均血小板体积(MPV)-静脉血: 8.9fL；胱抑素(Cys-C)-静脉血: 0.86mg/L；γ-谷氨酰基转移酶(GGT)-静脉血: 268.3U/L；总胆红素(TBIL)-静脉血: 8umol/L；葡萄糖(Glu)-静脉血: 5.28mmol/L；红细胞计数(RBC#)-静脉血: 4.3510E12/L；总胆汁酸(TBA)-静脉血: 2.7umol/L；血小板分……\n- [全程D49] 检验组合: 红细胞计数(RBC#)-尿液: 6/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；白细胞计数(WBC#)-尿液: 1/μL；比重(SG)-尿液: 1.009；胆红素(BIL)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: 无色；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮\n- [全程D50] 检验组合: 浊度(TRUB)-尿液: clear；酮体(KET)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 13/μL；比重(SG)-尿液: 1.017；白细胞计数(WBC#)-尿液: 10/μL；隐血(OB)-尿液: 1+0.6mg（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；总蛋白(TP)-尿液: -（参考: 阴性）；非鳞状上皮细胞计数-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 3/μL；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow\n- [全程D51] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；比重(SG)-尿液: 1.013；白细胞计数(WBC#)-尿液: 13/μL；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 8/μL；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；白细胞(LEU)-尿液: -（参考: 阴性）\n- [全程D52] 检验组合: 淋巴细胞百分比(Lymph%)-静脉血: 0.1；镁离子(Mg2+)-静脉血: 0.52mmol/L；尿素氮(BUN)-静脉血: 6.1mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.14mmolL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；总蛋白(TP)-静脉血: 64.42g/L；磷(P)-静脉血: 1.33mmol/L；总胆红素(TBIL)-静脉血: 6umol/L；氯离子(Cl-)-静脉血: 99.5mmol/L；红细胞比容(Hct)-静脉血: 36.9%；平均红细胞体积(MCV)-静脉血: 89.1fL；红细胞计数(RBC#)-静脉血: 4.1410E12/L；C-反应蛋白(CRP)-静脉血: 4.91mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；白细胞计数(WBC#)-静脉血: 3.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.253；血小板比容-静脉血: 20%；丙氨酸氨基转移酶(ALT)-静脉血: 42.9U/L；血液二氧化碳含量ctCO2(B)-静脉血: 26.2mmol/L；胱抑素(Cys-C)-静脉血: 1.28mg/L；球蛋白(GLO)-静脉血: 29.62g/L；甘油三酯(TG)-静脉血: 1.61mmol/L；尿酸(UA)-静脉血: 292.8umol/L；血小板分布宽度(PDW)-静脉血: 8.6%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.8；单核细胞计数(Mono#)-静脉血: 0.910E9/L；肌酐(Crea)-静脉血: 109.5umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.015；总胆固醇(TC)-静脉血: 5.96mmol/L；阴离子间隙(AG)-静脉血: 12；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 47U/L；平均血小板体积(MPV)-静脉血: 8.8fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.4；中性粒细胞百分比(Neut%)-静脉血: 0.626；总钙(Ca)-静脉血: 1.94mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.……\n- [全程D61] 超声；肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声不均匀，肝S5可见2个无回声灶，直径约3-4mm，边界清,内透声可，后方回声增强。血管走行清晰、自然，肝内胆管不扩张，门静脉内径约7mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约28cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约43×27×32mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝S5囊性灶，考虑肝囊肿可能性大。 胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D61] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，走行自然，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n\n【既往治疗与反应】\n- [全程D41] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者放疗中，诉口感、咽痛，余无不适。查体同前。复查血常规：基本正常，生化常规：正常。[姓名已隐去]医生信息已隐藏：患者DDP化疗后出现肝酶升高，考虑为药物性肝损害，经多种滑竿药物治疗后肝功能恢复正常，今日可办理出院，继续门诊放疗。\n- [全程D50] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，向患者及其家属交代病情及化疗风险，表示理解并已签署知情同意书，可于今日水化，明日执行第2程DDP方案同时期化疗，注意化疗不良反应。\n- [全程D51] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程DDP方案同时期化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D52] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第二程DDP单药同期化疗结束，诉咽痛、恶心、食欲下降，呕吐1次，伴头晕，无腹痛、腹泻等不适。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者同时期化疗结束，一般情况可，可以今日结账出院，门诊继续放疗。嘱定期复查血常规及肝肾功能，行放疗结束前常规检查。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，给予静脉滴注广谱抗菌药物及大剂量糖皮质激素。\nB. 暂停放疗，行肝脏穿刺活检明确肝脏病灶性质后调整全身系统性化疗方案。\nC. 继续根治性放疗，给予重组人粒细胞集落刺激因子（G-CSF）皮下注射。\nD. 继续根治性放疗，加用第3程顺铂同期化疗，并给予静脉保肝药物。\nE. 终止放疗，转为TPF方案全身系统性化疗。\nF. 继续根治性放疗，局部外用强效糖皮质激素软膏，并口服非甾体抗炎药。\nG. 暂停放疗，复查鼻咽及颈部MRI以决定是否降低后续放疗靶区剂量。\nH. 继续根治性放疗，给予静脉异甘草酸镁及还原型谷胱甘肽保肝治疗。\nI. 继续根治性放疗，给予雾化吸入氨溴索与地塞米松，并局部外用三乙醇胺乳膏。\nJ. 继续根治性放疗，联合靶向药物尼妥珠单抗及PD-1抑制剂治疗。\nK. 继续根治性放疗，给予静脉滴注地塞米松，并局部外用莫匹罗星软膏。\nL. 结束放化疗综合治疗，进入随访观察期，定期复查鼻咽MRI及颈部超声。\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-24c04c80074ea3aab5465600","patient_id":"patient-51e6f99c527367bbd97aebd8","turn_id":"turn08","turn_position":6,"turn_type":"response_assessment_decision","gold_letter":"J","gold_action":"继续根治性放疗，给予雾化吸入（氨溴索、地塞米松）及局部外用药（三乙醇胺乳膏）处理急性放射性黏膜炎和皮炎。","options":[{"letter":"A","text":"暂停放疗，行腹部增强MRI或穿刺活检明确肝脏囊性病灶性质，待明确性质后再决定后续治疗方案。","is_gold":false},{"letter":"B","text":"继续根治性放疗，启动第三程顺铂单药同期化疗，并给予保肝、止吐及水化等预防性对症支持治疗。","is_gold":false},{"letter":"C","text":"继续根治性放疗，加用卡培他滨口服节拍化疗，并给予雾化吸入及局部外用药处理放疗反应。","is_gold":false},{"letter":"D","text":"提前结束放疗，给予静脉滴注大剂量糖皮质激素及广谱抗生素处理放射性黏膜炎和皮炎。","is_gold":false},{"letter":"E","text":"继续根治性放疗，给予静脉高营养支持处理急性放射性黏膜炎，并预防性使用重组人粒细胞刺激因子。","is_gold":false},{"letter":"F","text":"暂停放疗，复查鼻咽及颈部MRI，重新定位并缩减原发灶及颈部放疗靶区。","is_gold":false},{"letter":"G","text":"继续根治性放疗，行肝脏囊性灶局部射频消融治疗，并给予雾化吸入及局部外用药处理放疗反应。","is_gold":false},{"letter":"H","text":"继续根治性放疗，继续给予静脉双环醇等保肝药物强化治疗，并给予局部外用药处理放疗反应。","is_gold":false},{"letter":"I","text":"暂停放疗，给予局部清创换药，待皮肤及黏膜反应恢复至1级以下再恢复根治性放疗。","is_gold":false},{"letter":"J","text":"继续根治性放疗，给予雾化吸入（氨溴索、地塞米松）及局部外用药（三乙醇胺乳膏）处理急性放射性黏膜炎和皮炎。","is_gold":true},{"letter":"K","text":"继续根治性放疗，给予口服非甾体抗炎药缓解黏膜疼痛，并在局部皮炎处预防性涂抹抗生素软膏。","is_gold":false},{"letter":"L","text":"结束根治性放疗，进入定期随访阶段，给予雾化吸入及局部外用药处理急性放射性黏膜炎和皮炎。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：鼻腔。\n文本分期信息：N0，M0。\n综合TNM状态：T1N0M0。\n综合分期：IA。\n\n【已知病史与当前主诉】\n- [全程D6] 入院记录: 主诉: 涕血2月；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血；既往史: “胃溃疡”病史22年，于某次就诊时间、某次就诊时间发生2次“胃出血”，经“输血”、“药物”治疗后好转，具体不详。某次就诊时间发现“胃底息肉”，行“内镜下胃底息肉切除术”。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：114/69mmHg,Ht：157cm，Wt：53kg，BSA：1.52m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽左侧壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D7] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- [全程D7] 检验组合: 平均红细胞体积(MCV)-静脉血: 91.1fL；总钙(Ca)-静脉血: 2.21mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24.2U/L；碱性磷酸酶(ALP)-静脉血: 74.3U/L；IV型胶原(C-IV)-静脉血: 12.97ng/ml；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 35.9U/L；钾离子(K+)-静脉血: 3.76mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；D-二聚体(D-Dimer)-静脉血: 0.07ug/ml；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；淀粉样蛋白A(SAA)-静脉血: 2.44mg/L；C-反应蛋白(CRP)-静脉血: 1.92mg/L；凝血酶原时间活动度(PTA)-静脉血: 120%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.67；载脂蛋白B(apoB)-静脉血: 1.07g/L；球蛋白(GLO)-静脉血: 26.18g/L；磷(P)-静脉血: 1.03mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；胱抑素(Cys-C)-静脉血: 0.79mg/L；红细胞计数(RBC#)-静脉血: 5.2710E12/L；单核细胞计数(Mono#)-静脉血: 110E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.6sec.；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.87；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.411ng/ml（参考: <0.584）；尿素氮(BUN)-静脉血: 4.7mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；血小板计数(PLT#)-静脉血: 21810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.578；凝血酶原时间(PT)-静脉血: 10.1sec.；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.05mmol/L；尿酸(UA)-静脉血: 331.5umol/L；阴离子间隙(AG)-静脉血: 15.7；层粘……\n- [全程D10] 内镜；胃镜: 检查类型: 内镜；检查名称: 胃镜；检查部位:；检查所见: 插镜情况：顺利 送达部位：十二指肠降部。 食 管：粘膜光滑, 舒缩好。 贲 门：开闭好, E-G线清楚。 胃 底：粘液湖清亮，粘膜光滑，无静脉曲张。 胃 体：花斑样充血，未见溃疡肿物。 胃 角：弧形， 光滑。 胃 窦：蠕动好，粘膜呈花斑样充血，未见溃疡肿物。 幽 门：圆， 开闭好。 球 部：球腔变形，后壁可见霜斑样溃疡，表面附着白苔。 降 部：十二指肠乳头及降部粘膜未见异常。 请4个工作日后到病理科（5楼）取活检结果。；检查结论: 十二指肠球部霜斑样溃疡 慢性浅表性胃炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D24] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽左侧顶后壁及左侧壁局部粘膜增厚形成软组织影放射性浓聚，SUV约21.0，堵塞左侧鼻后孔，鼻咽腔变窄，累及左侧翼突基底部及犁骨。左侧咽隐窝变，右侧咽隐窝未见明显异常，双侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。口咽及喉咽结构及放射性分布未见明显异常。额窦、蝶窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双上颈小淋巴结放射性分布未见明显异常。 双上肺尖、右中肺内侧段及左下肺后基底段少许条索影放射性分布未见明显异常；其余双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏S4低密度影放射性分布未见明显异常，大小约0.6×0.6cm，边界尚清，密度欠均匀，CT值约26Hu；其余肝脏密度减低，CT值约50Hu，结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。盆腔盆底静脉内多发点状/小结节状高密度影放射性缺损。 所见颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，侵犯左侧鼻后孔，累及颅底骨。 肝S4低密度影代谢未见明显异常，建议随诊。 脂肪肝。\n- [全程D29] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.013；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 6.5\n- [全程D30] 检验组合: 浊度(TRUB)-尿液: 清亮；白细胞计数(WBC#)-尿液: 3/μL；白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.023；酮体(KET)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 13/μL；颜色-尿液: Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；隐血(OB)-尿液: 1+ 0.6mg（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D31] 检验组合: 红细胞计数(RBC#)-静脉血: 4.6210E12/L；血小板计数(PLT#)-静脉血: 22810E9/L；大血小板百分比(P-LCR%)-静脉血: 21.2%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.61mmol/L；白蛋白(ALB)-静脉血: 38.5g/L；间接胆红素(IBIL)-静脉血: 8.4umolL；球蛋白(GLO)-静脉血: 25.82g/L；单核细胞百分比(Mono%)-静脉血: 0.093；血小板分布宽度(PDW)-静脉血: 10.8%；红细胞比容(Hct)-静脉血: 41.4%；总蛋白(TP)-静脉血: 64.32g/L；单核细胞计数(Mono#)-静脉血: 1.510E9/L；葡萄糖(Glu)-静脉血: 5.98mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.6；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；总胆红素(TBIL)-静脉血: 12.9umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 176.9U/L；甘油三酯(TG)-静脉血: 1.4mmol/L；乳酸脱氢酶(LDH)-静脉血: 239U/L；总胆汁酸(TBA)-静脉血: 3umol/L；直接胆红素(DBIL)-静脉血: 4.5umol/L；肌酐(Crea)-静脉血: 70umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.7；尿素氮(BUN)-静脉血: 6.02mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 136.5U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；天门冬氨酸氨基转移酶(AST)-静脉血: 104.5U/L；磷(P)-静脉血: 1.34mmol/L；钠离子(Na+)-静脉血: 138.8mmol/L；平均红细胞体积(MCV)-静脉血: 89.6fL；白细胞计数(WBC#)-静脉血: 15.9910E9/L；载脂蛋白AI(apoAI)-静脉血: 1.29g/L；阴离子间隙(AG)-静脉血: 14；C-反应蛋白(CRP)-静脉血: 1.98mg/L；钾离子(K+)-静脉血: 3.5mmol/L；碱性磷酸酶(ALP)-静脉血:……\n- [全程D32] 检验组合: 胱抑素(Cys-C)-静脉血: 0.73mg/L；乳酸脱氢酶(LDH)-静脉血: 162.4U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.51mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；淋巴细胞百分比(Lymph%)-静脉血: 0.05；平均红细胞血红蛋白含量(MCH)-静脉血: 29.9pg；血红蛋白(Hb)-静脉血: 137.4g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 5.43mmol/L；白蛋白(ALB)-静脉血: 43.2g/L；肌酐(Crea)-静脉血: 86.7umol/L；氯离子(Cl-)-静脉血: 97.6mmol/L；C-反应蛋白(CRP)-静脉血: 6.52mg/L；钾离子(K+)-静脉血: 4.2mmol/L；尿酸(UA)-静脉血: 298.5umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.15mmolL；载脂蛋白B(apoB)-静脉血: 1.3g/L；血小板比容-静脉血: 14.7%；血小板分布宽度(PDW)-静脉血: 8.7%；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.41mmolL；有核红细胞百分比(NRBC%)-静脉血: 0；血小板比容-静脉血: 14%；总胆固醇(TC)-静脉血: 7.5mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；甘油三酯(TG)-静脉血: 1.38mmol/L；平均血小板体积(MPV)-静脉血: 8.9fL；平均红细胞体积(MCV)-静脉血: 90.2fL；γ-谷氨酰基转移酶(GGT)-静脉血: 97.8U/L；阴离子间隙(AG)-静脉血: 17；胱抑素(Cys-C)-静脉血: 1.03mg/L；氯离子(Cl-)-静脉血: 96.7mmol/L；血小板分布宽度(PDW)-静脉血: 16.1%；平均血小板体积(MPV)-静脉血: 6.78fL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；球蛋白(GLO)-静脉血: 35.61g/L；镁离子(Mg2+)-静脉血: 0.66mmol/L；间接胆红素(IBIL)-静脉血: 6.3umolL；γ-谷氨酰基转移酶(GGT)-静脉血: 151U/L；阴离子间隙(AG)-静脉血: 17；单核细胞计数(Mono#)-……\n- [全程D41] 检验组合: 中性粒细胞计数(Neut#)-静脉血: 6.110E9/L；钠离子(Na+)-静脉血: 139.4mmol/L；尿素氮(BUN)-静脉血: 7.2mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.53；淋巴细胞计数(Lymph#)-静脉血: 0.910E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 42.7U/L；丙氨酸氨基转移酶(ALT)-静脉血: 35.4U/L；甘油三酯(TG)-静脉血: 1.71mmol/L；白细胞计数(WBC#)-静脉血: 7.7810E9/L；总蛋白(TP)-静脉血: 62.51g/L；血红蛋白(Hb)-静脉血: 131g/L；总钙(Ca)-静脉血: 2.05mmol/L；肌酐(Crea)-静脉血: 81.5umol/L；载脂蛋白B(apoB)-静脉血: 1.23g/L；白蛋白(ALB)-静脉血: 36.6g/L；中性粒细胞百分比(Neut%)-静脉血: 0.79；红细胞比容(Hct)-静脉血: 38.9%；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.6；淋巴细胞百分比(Lymph%)-静脉血: 0.113；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.006；大血小板百分比(P-LCR%)-静脉血: 15.3%；乳酸脱氢酶(LDH)-静脉血: 185.9U/L；间接胆红素(IBIL)-静脉血: 6.7umolL；氯离子(Cl-)-静脉血: 100.4mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.8U/L；血小板计数(PLT#)-静脉血: 15410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.3g/L；平均血小板体积(MPV)-静脉血: 8.9fL；胱抑素(Cys-C)-静脉血: 0.86mg/L；γ-谷氨酰基转移酶(GGT)-静脉血: 268.3U/L；总胆红素(TBIL)-静脉血: 8umol/L；葡萄糖(Glu)-静脉血: 5.28mmol/L；红细胞计数(RBC#)-静脉血: 4.3510E12/L；总胆汁酸(TBA)-静脉血: 2.7umol/L；血小板分……\n- [全程D49] 检验组合: 红细胞计数(RBC#)-尿液: 6/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；白细胞计数(WBC#)-尿液: 1/μL；比重(SG)-尿液: 1.009；胆红素(BIL)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: 无色；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮\n- [全程D50] 检验组合: 浊度(TRUB)-尿液: clear；酮体(KET)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 13/μL；比重(SG)-尿液: 1.017；白细胞计数(WBC#)-尿液: 10/μL；隐血(OB)-尿液: 1+0.6mg（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；总蛋白(TP)-尿液: -（参考: 阴性）；非鳞状上皮细胞计数-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 3/μL；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow\n- [全程D51] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；比重(SG)-尿液: 1.013；白细胞计数(WBC#)-尿液: 13/μL；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 8/μL；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；白细胞(LEU)-尿液: -（参考: 阴性）\n- [全程D52] 检验组合: 淋巴细胞百分比(Lymph%)-静脉血: 0.1；镁离子(Mg2+)-静脉血: 0.52mmol/L；尿素氮(BUN)-静脉血: 6.1mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.14mmolL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；总蛋白(TP)-静脉血: 64.42g/L；磷(P)-静脉血: 1.33mmol/L；总胆红素(TBIL)-静脉血: 6umol/L；氯离子(Cl-)-静脉血: 99.5mmol/L；红细胞比容(Hct)-静脉血: 36.9%；平均红细胞体积(MCV)-静脉血: 89.1fL；红细胞计数(RBC#)-静脉血: 4.1410E12/L；C-反应蛋白(CRP)-静脉血: 4.91mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；白细胞计数(WBC#)-静脉血: 3.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.253；血小板比容-静脉血: 20%；丙氨酸氨基转移酶(ALT)-静脉血: 42.9U/L；血液二氧化碳含量ctCO2(B)-静脉血: 26.2mmol/L；胱抑素(Cys-C)-静脉血: 1.28mg/L；球蛋白(GLO)-静脉血: 29.62g/L；甘油三酯(TG)-静脉血: 1.61mmol/L；尿酸(UA)-静脉血: 292.8umol/L；血小板分布宽度(PDW)-静脉血: 8.6%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.8；单核细胞计数(Mono#)-静脉血: 0.910E9/L；肌酐(Crea)-静脉血: 109.5umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.015；总胆固醇(TC)-静脉血: 5.96mmol/L；阴离子间隙(AG)-静脉血: 12；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 47U/L；平均血小板体积(MPV)-静脉血: 8.8fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.4；中性粒细胞百分比(Neut%)-静脉血: 0.626；总钙(Ca)-静脉血: 1.94mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.……\n- [全程D61] 超声；肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声不均匀，肝S5可见2个无回声灶，直径约3-4mm，边界清,内透声可，后方回声增强。血管走行清晰、自然，肝内胆管不扩张，门静脉内径约7mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约28cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约43×27×32mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝S5囊性灶，考虑肝囊肿可能性大。 胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D61] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，走行自然，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D8] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者相关检查完善中，请假未回病房。\n- [全程D13] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者相关检查完善中，请假未回病房。\n- [全程D19] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者元旦假期请假中。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D29] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者无明显不适主诉，查体情况：一般情况可，余同入院。放疗计划已完善。[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，向患者及其家属交代病情及化疗风险，表示理解并已签署知情同意书，同意入组三周/单周DDP同时期化疗临床试验，抽签入三周组，可于今日执行第1程顺铂方案同时期化疗，注意化疗不良反应，开始放疗。\n- [全程D41] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者放疗中，诉口感、咽痛，余无不适。查体同前。复查血常规：基本正常，生化常规：正常。[姓名已隐去]医生信息已隐藏：患者DDP化疗后出现肝酶升高，考虑为药物性肝损害，经多种滑竿药物治疗后肝功能恢复正常，今日可办理出院，继续门诊放疗。\n- [全程D50] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，向患者及其家属交代病情及化疗风险，表示理解并已签署知情同意书，可于今日水化，明日执行第2程DDP方案同时期化疗，注意化疗不良反应。\n- [全程D51] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程DDP方案同时期化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D52] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第二程DDP单药同期化疗结束，诉咽痛、恶心、食欲下降，呕吐1次，伴头晕，无腹痛、腹泻等不适。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者同时期化疗结束，一般情况可，可以今日结账出院，门诊继续放疗。嘱定期复查血常规及肝肾功能，行放疗结束前常规检查。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，行腹部增强MRI或穿刺活检明确肝脏囊性病灶性质，待明确性质后再决定后续治疗方案。\nB. 继续根治性放疗，启动第三程顺铂单药同期化疗，并给予保肝、止吐及水化等预防性对症支持治疗。\nC. 继续根治性放疗，加用卡培他滨口服节拍化疗，并给予雾化吸入及局部外用药处理放疗反应。\nD. 提前结束放疗，给予静脉滴注大剂量糖皮质激素及广谱抗生素处理放射性黏膜炎和皮炎。\nE. 继续根治性放疗，给予静脉高营养支持处理急性放射性黏膜炎，并预防性使用重组人粒细胞刺激因子。\nF. 暂停放疗，复查鼻咽及颈部MRI，重新定位并缩减原发灶及颈部放疗靶区。\nG. 继续根治性放疗，行肝脏囊性灶局部射频消融治疗，并给予雾化吸入及局部外用药处理放疗反应。\nH. 继续根治性放疗，继续给予静脉双环醇等保肝药物强化治疗，并给予局部外用药处理放疗反应。\nI. 暂停放疗，给予局部清创换药，待皮肤及黏膜反应恢复至1级以下再恢复根治性放疗。\nJ. 继续根治性放疗，给予雾化吸入（氨溴索、地塞米松）及局部外用药（三乙醇胺乳膏）处理急性放射性黏膜炎和皮炎。\nK. 继续根治性放疗，给予口服非甾体抗炎药缓解黏膜疼痛，并在局部皮炎处预防性涂抹抗生素软膏。\nL. 结束根治性放疗，进入定期随访阶段，给予雾化吸入及局部外用药处理急性放射性黏膜炎和皮炎。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- 无可展示记录。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，行腹部增强MRI或穿刺活检明确肝脏囊性病灶性质，待明确性质后再决定后续治疗方案。\nB. 继续根治性放疗，启动第三程顺铂单药同期化疗，并给予保肝、止吐及水化等预防性对症支持治疗。\nC. 继续根治性放疗，加用卡培他滨口服节拍化疗，并给予雾化吸入及局部外用药处理放疗反应。\nD. 提前结束放疗，给予静脉滴注大剂量糖皮质激素及广谱抗生素处理放射性黏膜炎和皮炎。\nE. 继续根治性放疗，给予静脉高营养支持处理急性放射性黏膜炎，并预防性使用重组人粒细胞刺激因子。\nF. 暂停放疗，复查鼻咽及颈部MRI，重新定位并缩减原发灶及颈部放疗靶区。\nG. 继续根治性放疗，行肝脏囊性灶局部射频消融治疗，并给予雾化吸入及局部外用药处理放疗反应。\nH. 继续根治性放疗，继续给予静脉双环醇等保肝药物强化治疗，并给予局部外用药处理放疗反应。\nI. 暂停放疗，给予局部清创换药，待皮肤及黏膜反应恢复至1级以下再恢复根治性放疗。\nJ. 继续根治性放疗，给予雾化吸入（氨溴索、地塞米松）及局部外用药（三乙醇胺乳膏）处理急性放射性黏膜炎和皮炎。\nK. 继续根治性放疗，给予口服非甾体抗炎药缓解黏膜疼痛，并在局部皮炎处预防性涂抹抗生素软膏。\nL. 结束根治性放疗，进入定期随访阶段，给予雾化吸入及局部外用药处理急性放射性黏膜炎和皮炎。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：鼻腔。\n文本分期信息：N0，M0。\n综合TNM状态：T1N0M0。\n综合分期：IA。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- 无可展示记录。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，行腹部增强MRI或穿刺活检明确肝脏囊性病灶性质，待明确性质后再决定后续治疗方案。\nB. 继续根治性放疗，启动第三程顺铂单药同期化疗，并给予保肝、止吐及水化等预防性对症支持治疗。\nC. 继续根治性放疗，加用卡培他滨口服节拍化疗，并给予雾化吸入及局部外用药处理放疗反应。\nD. 提前结束放疗，给予静脉滴注大剂量糖皮质激素及广谱抗生素处理放射性黏膜炎和皮炎。\nE. 继续根治性放疗，给予静脉高营养支持处理急性放射性黏膜炎，并预防性使用重组人粒细胞刺激因子。\nF. 暂停放疗，复查鼻咽及颈部MRI，重新定位并缩减原发灶及颈部放疗靶区。\nG. 继续根治性放疗，行肝脏囊性灶局部射频消融治疗，并给予雾化吸入及局部外用药处理放疗反应。\nH. 继续根治性放疗，继续给予静脉双环醇等保肝药物强化治疗，并给予局部外用药处理放疗反应。\nI. 暂停放疗，给予局部清创换药，待皮肤及黏膜反应恢复至1级以下再恢复根治性放疗。\nJ. 继续根治性放疗，给予雾化吸入（氨溴索、地塞米松）及局部外用药（三乙醇胺乳膏）处理急性放射性黏膜炎和皮炎。\nK. 继续根治性放疗，给予口服非甾体抗炎药缓解黏膜疼痛，并在局部皮炎处预防性涂抹抗生素软膏。\nL. 结束根治性放疗，进入定期随访阶段，给予雾化吸入及局部外用药处理急性放射性黏膜炎和皮炎。\n\n请仅输出一个选项字母（A-L）。"}]}
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full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、鼻腔、翼外肌、斜坡、海绵窦、翼突基底部等。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1750] 入院记录: 主诉: 间断性涕血3月，面麻、复视1月，耳鸣20天；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 复视,涕血,双面麻；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟1包，30年，不嗜酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：88次/分，R：20次/分，BP：114/69mmHg,Ht：170cm，Wt：62kg，BSA：1.71m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 电子鼻咽镜下活检，鼻咽及颈部CT平扫加增强，常规血液学检查\nB. 鼻咽及颈部MRI平扫加增强，全身PET-CT检查，常规血液学检查\nC. 电子鼻咽镜下活检，鼻咽MRI平扫加增强，常规血液学检查\nD. 电子鼻咽镜下活检，鼻咽及颈部MRI平扫，常规血液学检查\nE. 鼻咽及颈部CT平扫加增强，全身骨扫描，常规血液学检查\nF. 电子鼻咽镜下活检，鼻咽及颈部MRI平扫加增强，腰椎穿刺脑脊液检查\nG. 电子鼻咽镜下活检，全身PET-CT检查，常规血液学检查\nH. 鼻咽刷片细胞学检查，鼻咽及颈部MRI平扫加增强，常规血液学检查\nI. 电子鼻咽镜下活检，鼻咽及颈部MRI平扫加增强，颈部淋巴结穿刺活检\nJ. 电子鼻咽镜下活检，鼻咽及颈部超声检查，常规血液学检查\nK. 电子鼻咽镜下活检，鼻咽及颈部MRI平扫加增强，常规血液学检查\nL. 鼻咽及颈部MRI平扫加增强，常规血液学检查，择期行鼻咽肿物切除术\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、鼻腔、翼外肌、斜坡、海绵窦、翼突基底部等。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1750] 入院记录: 主诉: 间断性涕血3月，面麻、复视1月，耳鸣20天；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 复视,涕血,双面麻；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟1包，30年，不嗜酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：88次/分，R：20次/分，BP：114/69mmHg,Ht：170cm，Wt：62kg，BSA：1.71m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 电子鼻咽镜下活检，鼻咽及颈部CT平扫加增强，常规血液学检查\nB. 鼻咽及颈部MRI平扫加增强，全身PET-CT检查，常规血液学检查\nC. 电子鼻咽镜下活检，鼻咽MRI平扫加增强，常规血液学检查\nD. 电子鼻咽镜下活检，鼻咽及颈部MRI平扫，常规血液学检查\nE. 鼻咽及颈部CT平扫加增强，全身骨扫描，常规血液学检查\nF. 电子鼻咽镜下活检，鼻咽及颈部MRI平扫加增强，腰椎穿刺脑脊液检查\nG. 电子鼻咽镜下活检，全身PET-CT检查，常规血液学检查\nH. 鼻咽刷片细胞学检查，鼻咽及颈部MRI平扫加增强，常规血液学检查\nI. 电子鼻咽镜下活检，鼻咽及颈部MRI平扫加增强，颈部淋巴结穿刺活检\nJ. 电子鼻咽镜下活检，鼻咽及颈部超声检查，常规血液学检查\nK. 电子鼻咽镜下活检，鼻咽及颈部MRI平扫加增强，常规血液学检查\nL. 鼻咽及颈部MRI平扫加增强，常规血液学检查，择期行鼻咽肿物切除术\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、鼻腔、翼外肌、斜坡、海绵窦、翼突基底部等。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1750] 入院记录: 主诉: 间断性涕血3月，面麻、复视1月，耳鸣20天；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 复视,涕血,双面麻；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟1包，30年，不嗜酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：88次/分，R：20次/分，BP：114/69mmHg,Ht：170cm，Wt：62kg，BSA：1.71m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 电子鼻咽镜下活检，鼻咽及颈部CT平扫加增强，常规血液学检查\nB. 鼻咽及颈部MRI平扫加增强，全身PET-CT检查，常规血液学检查\nC. 电子鼻咽镜下活检，鼻咽MRI平扫加增强，常规血液学检查\nD. 电子鼻咽镜下活检，鼻咽及颈部MRI平扫，常规血液学检查\nE. 鼻咽及颈部CT平扫加增强，全身骨扫描，常规血液学检查\nF. 电子鼻咽镜下活检，鼻咽及颈部MRI平扫加增强，腰椎穿刺脑脊液检查\nG. 电子鼻咽镜下活检，全身PET-CT检查，常规血液学检查\nH. 鼻咽刷片细胞学检查，鼻咽及颈部MRI平扫加增强，常规血液学检查\nI. 电子鼻咽镜下活检，鼻咽及颈部MRI平扫加增强，颈部淋巴结穿刺活检\nJ. 电子鼻咽镜下活检，鼻咽及颈部超声检查，常规血液学检查\nK. 电子鼻咽镜下活检，鼻咽及颈部MRI平扫加增强，常规血液学检查\nL. 鼻咽及颈部MRI平扫加增强，常规血液学检查，择期行鼻咽肿物切除术\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-31a839b9f99ab6bf0a218575","patient_id":"patient-867f2373fc1b04e0b8b80452","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"L","gold_action":"完善全身远处转移排查（如PET-CT或胸腹部CT联合骨扫描）及血浆EBV-DNA检测，并行超声引导下中心静脉穿刺置管及X线定位，为全身化疗做准备。","options":[{"letter":"A","text":"完善全身远处转移排查及血浆EBV-DNA检测，并直接安排单纯根治性放射治疗定位。","is_gold":false},{"letter":"B","text":"完善全身远处转移排查及血浆EBV-DNA检测，并请头颈外科会诊评估鼻咽及颈部病灶根治性切除可能。","is_gold":false},{"letter":"C","text":"完善胸部X线、腹部超声及血浆EBV-DNA检测进行分期，并行超声引导下中心静脉穿刺置管及X线定位，为全身化疗做准备。","is_gold":false},{"letter":"D","text":"完善全身远处转移排查及血浆EBV-DNA检测，并预防性行经皮内镜下胃造瘘术（PEG）以保障放化疗期间营养。","is_gold":false},{"letter":"E","text":"安排鼻咽镜下再次活检以明确组织学亚型，暂缓全身远处转移排查及静脉置管，待病理亚型确诊后再行后续安排。","is_gold":false},{"letter":"F","text":"完善全身远处转移排查及血浆EBV-DNA检测，并直接通过外周静脉留置针（PIV）启动全身化疗。","is_gold":false},{"letter":"G","text":"完善全身骨扫描及血浆EBV-DNA检测，并行超声引导下中心静脉穿刺置管及X线定位，为全身化疗做准备。","is_gold":false},{"letter":"H","text":"完善全身远处转移排查及血浆EBV-DNA检测，并先行双侧颈部淋巴结清扫术，术后行全身化疗。","is_gold":false},{"letter":"I","text":"完善全身远处转移排查及血浆EBV-DNA检测，并安排单药免疫治疗作为诱导治疗，无需中心静脉置管。","is_gold":false},{"letter":"J","text":"完善全身远处转移排查及血浆EBV-DNA检测，并安排超声引导下颈部淋巴结穿刺活检以病理确诊N分期。","is_gold":false},{"letter":"K","text":"完善全身远处转移排查及血浆EBV-DNA检测，并常规安排腰椎穿刺脑脊液检查以排除脑膜转移。","is_gold":false},{"letter":"L","text":"完善全身远处转移排查（如PET-CT或胸腹部CT联合骨扫描）及血浆EBV-DNA检测，并行超声引导下中心静脉穿刺置管及X线定位，为全身化疗做准备。","is_gold":true}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、鼻腔、翼外肌、斜坡、海绵窦、翼突基底部等。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1750] 入院记录: 主诉: 间断性涕血3月，面麻、复视1月，耳鸣20天；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 复视,涕血,双面麻；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟1包，30年，不嗜酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：88次/分，R：20次/分，BP：114/69mmHg,Ht：170cm，Wt：62kg，BSA：1.71m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1751] 检验组合: 阴离子间隙(AG)-静脉血: 18.2；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；平均血小板体积(MPV)-静脉血: 9.8fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.8；白细胞计数(WBC#)-静脉血: 6.2310E9/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 64.8umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阳性(+)（参考: 阴性）；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.92mmol/L；透明质酸(HA)-静脉血: 91.434ng/ml；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.4U/L；氯离子(Cl-)-静脉血: 101.8mmol/L；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 1.43ng/ml（参考: <0.704）；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；血小板比容-静脉血: 20%；活化部分凝血活酶时间(APTT)-静脉血: 27.5sec.；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.62；梅毒非特异性抗体甲苯胺红不加热血清试验(TRUST)-静脉血: 阴性(-)（参考: 阴性）；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；总钙(Ca)-静脉血: 2.27mmol/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.43；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；凝血酶时间(TT)-静脉血: 17.6sec.；间接胆红素(IBIL)-静脉血: 6.6umolL；凝血酶原时间活动度(PTA)-静脉血: 97.9%；降钙素(CT)-静脉血: 25.774pg/ml；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 44.9U/L……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善全身远处转移排查及血浆EBV-DNA检测，并直接安排单纯根治性放射治疗定位。\nB. 完善全身远处转移排查及血浆EBV-DNA检测，并请头颈外科会诊评估鼻咽及颈部病灶根治性切除可能。\nC. 完善胸部X线、腹部超声及血浆EBV-DNA检测进行分期，并行超声引导下中心静脉穿刺置管及X线定位，为全身化疗做准备。\nD. 完善全身远处转移排查及血浆EBV-DNA检测，并预防性行经皮内镜下胃造瘘术（PEG）以保障放化疗期间营养。\nE. 安排鼻咽镜下再次活检以明确组织学亚型，暂缓全身远处转移排查及静脉置管，待病理亚型确诊后再行后续安排。\nF. 完善全身远处转移排查及血浆EBV-DNA检测，并直接通过外周静脉留置针（PIV）启动全身化疗。\nG. 完善全身骨扫描及血浆EBV-DNA检测，并行超声引导下中心静脉穿刺置管及X线定位，为全身化疗做准备。\nH. 完善全身远处转移排查及血浆EBV-DNA检测，并先行双侧颈部淋巴结清扫术，术后行全身化疗。\nI. 完善全身远处转移排查及血浆EBV-DNA检测，并安排单药免疫治疗作为诱导治疗，无需中心静脉置管。\nJ. 完善全身远处转移排查及血浆EBV-DNA检测，并安排超声引导下颈部淋巴结穿刺活检以病理确诊N分期。\nK. 完善全身远处转移排查及血浆EBV-DNA检测，并常规安排腰椎穿刺脑脊液检查以排除脑膜转移。\nL. 完善全身远处转移排查（如PET-CT或胸腹部CT联合骨扫描）及血浆EBV-DNA检测，并行超声引导下中心静脉穿刺置管及X线定位，为全身化疗做准备。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D1751] 检验组合: 阴离子间隙(AG)-静脉血: 18.2；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；平均血小板体积(MPV)-静脉血: 9.8fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.8；白细胞计数(WBC#)-静脉血: 6.2310E9/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 64.8umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阳性(+)（参考: 阴性）；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.92mmol/L；透明质酸(HA)-静脉血: 91.434ng/ml；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.4U/L；氯离子(Cl-)-静脉血: 101.8mmol/L；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 1.43ng/ml（参考: <0.704）；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；血小板比容-静脉血: 20%；活化部分凝血活酶时间(APTT)-静脉血: 27.5sec.；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.62；梅毒非特异性抗体甲苯胺红不加热血清试验(TRUST)-静脉血: 阴性(-)（参考: 阴性）；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；总钙(Ca)-静脉血: 2.27mmol/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.43；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；凝血酶时间(TT)-静脉血: 17.6sec.；间接胆红素(IBIL)-静脉血: 6.6umolL；凝血酶原时间活动度(PTA)-静脉血: 97.9%；降钙素(CT)-静脉血: 25.774pg/ml；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 44.9U/L……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善全身远处转移排查及血浆EBV-DNA检测，并直接安排单纯根治性放射治疗定位。\nB. 完善全身远处转移排查及血浆EBV-DNA检测，并请头颈外科会诊评估鼻咽及颈部病灶根治性切除可能。\nC. 完善胸部X线、腹部超声及血浆EBV-DNA检测进行分期，并行超声引导下中心静脉穿刺置管及X线定位，为全身化疗做准备。\nD. 完善全身远处转移排查及血浆EBV-DNA检测，并预防性行经皮内镜下胃造瘘术（PEG）以保障放化疗期间营养。\nE. 安排鼻咽镜下再次活检以明确组织学亚型，暂缓全身远处转移排查及静脉置管，待病理亚型确诊后再行后续安排。\nF. 完善全身远处转移排查及血浆EBV-DNA检测，并直接通过外周静脉留置针（PIV）启动全身化疗。\nG. 完善全身骨扫描及血浆EBV-DNA检测，并行超声引导下中心静脉穿刺置管及X线定位，为全身化疗做准备。\nH. 完善全身远处转移排查及血浆EBV-DNA检测，并先行双侧颈部淋巴结清扫术，术后行全身化疗。\nI. 完善全身远处转移排查及血浆EBV-DNA检测，并安排单药免疫治疗作为诱导治疗，无需中心静脉置管。\nJ. 完善全身远处转移排查及血浆EBV-DNA检测，并安排超声引导下颈部淋巴结穿刺活检以病理确诊N分期。\nK. 完善全身远处转移排查及血浆EBV-DNA检测，并常规安排腰椎穿刺脑脊液检查以排除脑膜转移。\nL. 完善全身远处转移排查（如PET-CT或胸腹部CT联合骨扫描）及血浆EBV-DNA检测，并行超声引导下中心静脉穿刺置管及X线定位，为全身化疗做准备。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、鼻腔、翼外肌、斜坡、海绵窦、翼突基底部等。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D1751] 检验组合: 阴离子间隙(AG)-静脉血: 18.2；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；平均血小板体积(MPV)-静脉血: 9.8fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.8；白细胞计数(WBC#)-静脉血: 6.2310E9/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 64.8umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阳性(+)（参考: 阴性）；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.92mmol/L；透明质酸(HA)-静脉血: 91.434ng/ml；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.4U/L；氯离子(Cl-)-静脉血: 101.8mmol/L；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 1.43ng/ml（参考: <0.704）；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；血小板比容-静脉血: 20%；活化部分凝血活酶时间(APTT)-静脉血: 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完善全身远处转移排查及血浆EBV-DNA检测，并先行双侧颈部淋巴结清扫术，术后行全身化疗。\nI. 完善全身远处转移排查及血浆EBV-DNA检测，并安排单药免疫治疗作为诱导治疗，无需中心静脉置管。\nJ. 完善全身远处转移排查及血浆EBV-DNA检测，并安排超声引导下颈部淋巴结穿刺活检以病理确诊N分期。\nK. 完善全身远处转移排查及血浆EBV-DNA检测，并常规安排腰椎穿刺脑脊液检查以排除脑膜转移。\nL. 完善全身远处转移排查（如PET-CT或胸腹部CT联合骨扫描）及血浆EBV-DNA检测，并行超声引导下中心静脉穿刺置管及X线定位，为全身化疗做准备。\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-9833293530ca96a9a65dbbb8","patient_id":"patient-867f2373fc1b04e0b8b80452","turn_id":"turn04","turn_position":3,"turn_type":"initial_treatment_selection","gold_letter":"B","gold_action":"诱导化疗（洛铂+氟尿嘧啶）序贯同期放化疗","options":[{"letter":"A","text":"诱导化疗（吉西他滨+顺铂）序贯单纯根治性放疗","is_gold":false},{"letter":"B","text":"诱导化疗（洛铂+氟尿嘧啶）序贯同期放化疗","is_gold":true},{"letter":"C","text":"同期放化疗（顺铂单药）序贯辅助化疗","is_gold":false},{"letter":"D","text":"诱导化疗（多西他赛+顺铂+氟尿嘧啶）序贯单纯根治性放疗","is_gold":false},{"letter":"E","text":"诱导化疗（紫杉醇+卡铂）序贯同期放化疗","is_gold":false},{"letter":"F","text":"靶向治疗（西妥昔单抗）联合根治性放疗","is_gold":false},{"letter":"G","text":"诱导化疗（洛铂+氟尿嘧啶）联合特瑞普利单抗序贯同期放化疗","is_gold":false},{"letter":"H","text":"诱导化疗（依托泊苷+顺铂）序贯同期放化疗","is_gold":false},{"letter":"I","text":"单纯根治性放疗序贯辅助化疗","is_gold":false},{"letter":"J","text":"诱导化疗（顺铂+氟尿嘧啶）序贯单纯根治性放疗","is_gold":false},{"letter":"K","text":"诱导化疗（吉西他滨+卡培他滨）序贯同期放化疗","is_gold":false},{"letter":"L","text":"姑息性化疗（洛铂+氟尿嘧啶）序贯姑息性放疗","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、鼻腔、翼外肌、斜坡、海绵窦、翼突基底部等。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1750] 入院记录: 主诉: 间断性涕血3月，面麻、复视1月，耳鸣20天；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 复视,涕血,双面麻；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟1包，30年，不嗜酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：88次/分，R：20次/分，BP：114/69mmHg,Ht：170cm，Wt：62kg，BSA：1.71m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。；KPS: 90；ECOG:\n- [全程D1750] 入院记录: 主诉: 间断性涕血3月，面麻、复视1月，耳鸣20天；现病史: 缘于3月余前患者无明显诱因出现间断性回吸性涕血，未予重视，一月前患者出现双侧面麻、复视，无鼻塞、头痛、视力下降等不适，遂就诊当地医院行鼻咽活检病理确诊鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 复视,涕血,双面麻；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟1包，30年，不嗜酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：88次/分，R：20次/分，BP：114/69mmHg,Ht：170cm，Wt：62kg，BSA：1.71m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率88次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1751] 检验组合: 阴离子间隙(AG)-静脉血: 18.2；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；平均血小板体积(MPV)-静脉血: 9.8fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.8；白细胞计数(WBC#)-静脉血: 6.2310E9/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 64.8umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阳性(+)（参考: 阴性）；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.92mmol/L；透明质酸(HA)-静脉血: 91.434ng/ml；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.4U/L；氯离子(Cl-)-静脉血: 101.8mmol/L；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 1.43ng/ml（参考: <0.704）；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；血小板比容-静脉血: 20%；活化部分凝血活酶时间(APTT)-静脉血: 27.5sec.；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.62；梅毒非特异性抗体甲苯胺红不加热血清试验(TRUST)-静脉血: 阴性(-)（参考: 阴性）；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；总钙(Ca)-静脉血: 2.27mmol/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.43；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；凝血酶时间(TT)-静脉血: 17.6sec.；间接胆红素(IBIL)-静脉血: 6.6umolL；凝血酶原时间活动度(PTA)-静脉血: 97.9%；降钙素(CT)-静脉血: 25.774pg/ml；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 44.9U/L……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 诱导化疗（吉西他滨+顺铂）序贯单纯根治性放疗\nB. 诱导化疗（洛铂+氟尿嘧啶）序贯同期放化疗\nC. 同期放化疗（顺铂单药）序贯辅助化疗\nD. 诱导化疗（多西他赛+顺铂+氟尿嘧啶）序贯单纯根治性放疗\nE. 诱导化疗（紫杉醇+卡铂）序贯同期放化疗\nF. 靶向治疗（西妥昔单抗）联合根治性放疗\nG. 诱导化疗（洛铂+氟尿嘧啶）联合特瑞普利单抗序贯同期放化疗\nH. 诱导化疗（依托泊苷+顺铂）序贯同期放化疗\nI. 单纯根治性放疗序贯辅助化疗\nJ. 诱导化疗（顺铂+氟尿嘧啶）序贯单纯根治性放疗\nK. 诱导化疗（吉西他滨+卡培他滨）序贯同期放化疗\nL. 姑息性化疗（洛铂+氟尿嘧啶）序贯姑息性放疗\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- [全程D1750] 入院记录: 主诉: 间断性涕血3月，面麻、复视1月，耳鸣20天；现病史: 缘于3月余前患者无明显诱因出现间断性回吸性涕血，未予重视，一月前患者出现双侧面麻、复视，无鼻塞、头痛、视力下降等不适，遂就诊当地医院行鼻咽活检病理确诊鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 复视,涕血,双面麻；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟1包，30年，不嗜酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：88次/分，R：20次/分，BP：114/69mmHg,Ht：170cm，Wt：62kg，BSA：1.71m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率88次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 无可展示记录。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 诱导化疗（吉西他滨+顺铂）序贯单纯根治性放疗\nB. 诱导化疗（洛铂+氟尿嘧啶）序贯同期放化疗\nC. 同期放化疗（顺铂单药）序贯辅助化疗\nD. 诱导化疗（多西他赛+顺铂+氟尿嘧啶）序贯单纯根治性放疗\nE. 诱导化疗（紫杉醇+卡铂）序贯同期放化疗\nF. 靶向治疗（西妥昔单抗）联合根治性放疗\nG. 诱导化疗（洛铂+氟尿嘧啶）联合特瑞普利单抗序贯同期放化疗\nH. 诱导化疗（依托泊苷+顺铂）序贯同期放化疗\nI. 单纯根治性放疗序贯辅助化疗\nJ. 诱导化疗（顺铂+氟尿嘧啶）序贯单纯根治性放疗\nK. 诱导化疗（吉西他滨+卡培他滨）序贯同期放化疗\nL. 姑息性化疗（洛铂+氟尿嘧啶）序贯姑息性放疗\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、鼻腔、翼外肌、斜坡、海绵窦、翼突基底部等。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1750] 入院记录: 主诉: 间断性涕血3月，面麻、复视1月，耳鸣20天；现病史: 缘于3月余前患者无明显诱因出现间断性回吸性涕血，未予重视，一月前患者出现双侧面麻、复视，无鼻塞、头痛、视力下降等不适，遂就诊当地医院行鼻咽活检病理确诊鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 复视,涕血,双面麻；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟1包，30年，不嗜酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：88次/分，R：20次/分，BP：114/69mmHg,Ht：170cm，Wt：62kg，BSA：1.71m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率88次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 无可展示记录。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 诱导化疗（吉西他滨+顺铂）序贯单纯根治性放疗\nB. 诱导化疗（洛铂+氟尿嘧啶）序贯同期放化疗\nC. 同期放化疗（顺铂单药）序贯辅助化疗\nD. 诱导化疗（多西他赛+顺铂+氟尿嘧啶）序贯单纯根治性放疗\nE. 诱导化疗（紫杉醇+卡铂）序贯同期放化疗\nF. 靶向治疗（西妥昔单抗）联合根治性放疗\nG. 诱导化疗（洛铂+氟尿嘧啶）联合特瑞普利单抗序贯同期放化疗\nH. 诱导化疗（依托泊苷+顺铂）序贯同期放化疗\nI. 单纯根治性放疗序贯辅助化疗\nJ. 诱导化疗（顺铂+氟尿嘧啶）序贯单纯根治性放疗\nK. 诱导化疗（吉西他滨+卡培他滨）序贯同期放化疗\nL. 姑息性化疗（洛铂+氟尿嘧啶）序贯姑息性放疗\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-5d0eff95cd33597017422fc5","patient_id":"patient-867f2373fc1b04e0b8b80452","turn_id":"turn05","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"C","gold_action":"予以止呕、护胃等对症支持，办理出院；嘱院外每周复查血常规及肝肾功能，定期进行PICC导管维护，按期返院行下一程治疗。","options":[{"letter":"A","text":"予以止呕、护胃等对症支持，继续住院观察至消化道反应完全缓解后再予出院，出院后按期返院行下一程治疗。","is_gold":false},{"letter":"B","text":"予以止呕、护胃等对症支持，办理出院；下一程化疗将洛铂及5-FU剂量下调20%，嘱院外每周复查血常规及肝肾功能。","is_gold":false},{"letter":"C","text":"予以止呕、护胃等对症支持，办理出院；嘱院外每周复查血常规及肝肾功能，定期进行PICC导管维护，按期返院行下一程治疗。","is_gold":true},{"letter":"D","text":"予以止呕、护胃等对症支持，办理出院；嘱院外预防性皮下注射重组人粒细胞刺激因子（G-CSF），每周复查血常规。","is_gold":false},{"letter":"E","text":"予以止呕、护胃等对症支持，办理出院；下一程化疗方案更改为吉西他滨+顺铂（GP方案），嘱院外每周复查血常规。","is_gold":false},{"letter":"F","text":"予以止呕、护胃等对症支持，办理出院；嘱院外每周复查血常规及肝肾功能，并拔除PICC导管以防感染。","is_gold":false},{"letter":"G","text":"予以止呕、护胃等对症支持，办理出院；嘱院外每月复查一次血常规及肝肾功能，按期返院行下一程治疗。","is_gold":false},{"letter":"H","text":"予以止呕、护胃等对症支持，办理出院；上报严重不良事件（SAE）并暂停临床试验入组治疗，转为常规放化疗。","is_gold":false},{"letter":"I","text":"予以止呕、护胃等对症支持，办理出院；嘱院外口服卡培他滨维持治疗，按期返院行下一程静脉化疗。","is_gold":false},{"letter":"J","text":"予以止呕、护胃等对症支持，办理出院；嘱院外每周复查血常规及肝肾功能，并于院外立即开始同步放射治疗。","is_gold":false},{"letter":"K","text":"予以止呕、护胃等对症支持，常规留取大便隐血及行腹部CT检查排除消化道并发症后，再办理出院。","is_gold":false},{"letter":"L","text":"予以止呕、护胃等对症支持，办理出院；嘱院外每周复查血常规及肝肾功能，若出现发热则自行口服抗生素观察。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、鼻腔、翼外肌、斜坡、海绵窦、翼突基底部等。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1750] 入院记录: 主诉: 间断性涕血3月，面麻、复视1月，耳鸣20天；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 复视,涕血,双面麻；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟1包，30年，不嗜酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：88次/分，R：20次/分，BP：114/69mmHg,Ht：170cm，Wt：62kg，BSA：1.71m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。；KPS: 90；ECOG:\n- [全程D1750] 入院记录: 主诉: 间断性涕血3月，面麻、复视1月，耳鸣20天；现病史: 缘于3月余前患者无明显诱因出现间断性回吸性涕血，未予重视，一月前患者出现双侧面麻、复视，无鼻塞、头痛、视力下降等不适，遂就诊当地医院行鼻咽活检病理确诊鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 复视,涕血,双面麻；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟1包，30年，不嗜酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：88次/分，R：20次/分，BP：114/69mmHg,Ht：170cm，Wt：62kg，BSA：1.71m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率88次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1751] 检验组合: 阴离子间隙(AG)-静脉血: 18.2；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；平均血小板体积(MPV)-静脉血: 9.8fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.8；白细胞计数(WBC#)-静脉血: 6.2310E9/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 64.8umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阳性(+)（参考: 阴性）；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.92mmol/L；透明质酸(HA)-静脉血: 91.434ng/ml；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.4U/L；氯离子(Cl-)-静脉血: 101.8mmol/L；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 1.43ng/ml（参考: <0.704）；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；血小板比容-静脉血: 20%；活化部分凝血活酶时间(APTT)-静脉血: 27.5sec.；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.62；梅毒非特异性抗体甲苯胺红不加热血清试验(TRUST)-静脉血: 阴性(-)（参考: 阴性）；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；总钙(Ca)-静脉血: 2.27mmol/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.43；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；凝血酶时间(TT)-静脉血: 17.6sec.；间接胆红素(IBIL)-静脉血: 6.6umolL；凝血酶原时间活动度(PTA)-静脉血: 97.9%；降钙素(CT)-静脉血: 25.774pg/ml；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 44.9U/L……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1754] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右旁T7椎体上缘水平，估计位于上腔静脉内。；检查结论: PICC管位置如上所述。\n- [全程D1758] 检验组合: 红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.410E9/L；总胆红素(TBIL)-静脉血: 15.3umol/L；葡萄糖(Glu)-静脉血: 4.9mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.6pg；间接胆红素(IBIL)-静脉血: 10.2umolL；肌酐(Crea)-静脉血: 67.1umol/L；血小板计数(PLT#)-静脉血: 159.110E9/L；中性粒细胞计数(Neut#)-静脉血: 5.210E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；血小板比容-静脉血: 13.7%；氯离子(Cl-)-静脉血: 100.4mmol/L；尿素氮(BUN)-静脉血: 5.1mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；平均血小板体积(MPV)-静脉血: 8.66fL；白蛋白(ALB)-静脉血: 36.6g/L；载脂蛋白B(apoB)-静脉血: 0.97g/L；C-反应蛋白(CRP)-静脉血: 17.22mg/L；乳酸脱氢酶(LDH)-静脉血: 196.7U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.69mmol/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；尿酸(UA)-静脉血: 195.2umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.759；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.37；总胆固醇(TC)-静脉血: 4.18mmol/L；钾离子(K+)-静脉血: 4.29mmol/L；单核细胞百分比(Mono%)-静脉血: 0.062；α-L-岩藻糖苷酶(AFU)-静脉血: 34.2U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.97；直接胆红素(DBIL)-静脉血: 5.1umol/L；碱性磷酸酶(ALP)-静脉血: 54.4U/L；有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞体积(MCV)-静脉血: 90.4fL；白细胞计数(WBC#)-静脉血: 6.810E9/L；总蛋白(TP)-静脉血: 63.4g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15U/L；甘油三酯(TG)-静脉血: 0.61mmol/L；球蛋白(……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1751] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者入院第二天，无特殊不适主诉，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。复查血常规、生化常规结果无异常。[姓名已隐去]副医生信息已隐藏：现等待患者鼻咽颈部影像学检查结果，明确分期后再行进一步诊治，病情继观。\n- [全程D1752] 上级查房记录；[姓名已隐去]医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医师查房记录；病程内容: 患者入院第三天，无诉，体查情况基本同前，[姓名已隐去]医师查房后示：等待患者影像学检查结果，明确分期后再行进一步诊治，余治疗同前，继观。\n- [全程D1758] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者处于一程洛铂+5FU方案诱导化疗中，诉恶心、呕吐，一般情况可，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。复查血常规、生化常规结果基本正常，[姓名已隐去]副医生信息已隐藏：现患者已完成一程诱导化疗，情况尚可，予以止呕、护胃等对症支持，嘱今日可予以出院，按期返院，不适随诊。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 予以止呕、护胃等对症支持，继续住院观察至消化道反应完全缓解后再予出院，出院后按期返院行下一程治疗。\nB. 予以止呕、护胃等对症支持，办理出院；下一程化疗将洛铂及5-FU剂量下调20%，嘱院外每周复查血常规及肝肾功能。\nC. 予以止呕、护胃等对症支持，办理出院；嘱院外每周复查血常规及肝肾功能，定期进行PICC导管维护，按期返院行下一程治疗。\nD. 予以止呕、护胃等对症支持，办理出院；嘱院外预防性皮下注射重组人粒细胞刺激因子（G-CSF），每周复查血常规。\nE. 予以止呕、护胃等对症支持，办理出院；下一程化疗方案更改为吉西他滨+顺铂（GP方案），嘱院外每周复查血常规。\nF. 予以止呕、护胃等对症支持，办理出院；嘱院外每周复查血常规及肝肾功能，并拔除PICC导管以防感染。\nG. 予以止呕、护胃等对症支持，办理出院；嘱院外每月复查一次血常规及肝肾功能，按期返院行下一程治疗。\nH. 予以止呕、护胃等对症支持，办理出院；上报严重不良事件（SAE）并暂停临床试验入组治疗，转为常规放化疗。\nI. 予以止呕、护胃等对症支持，办理出院；嘱院外口服卡培他滨维持治疗，按期返院行下一程静脉化疗。\nJ. 予以止呕、护胃等对症支持，办理出院；嘱院外每周复查血常规及肝肾功能，并于院外立即开始同步放射治疗。\nK. 予以止呕、护胃等对症支持，常规留取大便隐血及行腹部CT检查排除消化道并发症后，再办理出院。\nL. 予以止呕、护胃等对症支持，办理出院；嘱院外每周复查血常规及肝肾功能，若出现发热则自行口服抗生素观察。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D1754] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右旁T7椎体上缘水平，估计位于上腔静脉内。；检查结论: PICC管位置如上所述。\n- [全程D1758] 检验组合: 红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.410E9/L；总胆红素(TBIL)-静脉血: 15.3umol/L；葡萄糖(Glu)-静脉血: 4.9mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.6pg；间接胆红素(IBIL)-静脉血: 10.2umolL；肌酐(Crea)-静脉血: 67.1umol/L；血小板计数(PLT#)-静脉血: 159.110E9/L；中性粒细胞计数(Neut#)-静脉血: 5.210E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；血小板比容-静脉血: 13.7%；氯离子(Cl-)-静脉血: 100.4mmol/L；尿素氮(BUN)-静脉血: 5.1mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；平均血小板体积(MPV)-静脉血: 8.66fL；白蛋白(ALB)-静脉血: 36.6g/L；载脂蛋白B(apoB)-静脉血: 0.97g/L；C-反应蛋白(CRP)-静脉血: 17.22mg/L；乳酸脱氢酶(LDH)-静脉血: 196.7U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.69mmol/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；尿酸(UA)-静脉血: 195.2umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.759；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.37；总胆固醇(TC)-静脉血: 4.18mmol/L；钾离子(K+)-静脉血: 4.29mmol/L；单核细胞百分比(Mono%)-静脉血: 0.062；α-L-岩藻糖苷酶(AFU)-静脉血: 34.2U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.97；直接胆红素(DBIL)-静脉血: 5.1umol/L；碱性磷酸酶(ALP)-静脉血: 54.4U/L；有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞体积(MCV)-静脉血: 90.4fL；白细胞计数(WBC#)-静脉血: 6.810E9/L；总蛋白(TP)-静脉血: 63.4g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15U/L；甘油三酯(TG)-静脉血: 0.61mmol/L；球蛋白(……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1751] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者入院第二天，无特殊不适主诉，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。复查血常规、生化常规结果无异常。[姓名已隐去]副医生信息已隐藏：现等待患者鼻咽颈部影像学检查结果，明确分期后再行进一步诊治，病情继观。\n- [全程D1752] 上级查房记录；[姓名已隐去]医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医师查房记录；病程内容: 患者入院第三天，无诉，体查情况基本同前，[姓名已隐去]医师查房后示：等待患者影像学检查结果，明确分期后再行进一步诊治，余治疗同前，继观。\n- [全程D1758] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者处于一程洛铂+5FU方案诱导化疗中，诉恶心、呕吐，一般情况可，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。复查血常规、生化常规结果基本正常，[姓名已隐去]副医生信息已隐藏：现患者已完成一程诱导化疗，情况尚可，予以止呕、护胃等对症支持，嘱今日可予以出院，按期返院，不适随诊。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 予以止呕、护胃等对症支持，继续住院观察至消化道反应完全缓解后再予出院，出院后按期返院行下一程治疗。\nB. 予以止呕、护胃等对症支持，办理出院；下一程化疗将洛铂及5-FU剂量下调20%，嘱院外每周复查血常规及肝肾功能。\nC. 予以止呕、护胃等对症支持，办理出院；嘱院外每周复查血常规及肝肾功能，定期进行PICC导管维护，按期返院行下一程治疗。\nD. 予以止呕、护胃等对症支持，办理出院；嘱院外预防性皮下注射重组人粒细胞刺激因子（G-CSF），每周复查血常规。\nE. 予以止呕、护胃等对症支持，办理出院；下一程化疗方案更改为吉西他滨+顺铂（GP方案），嘱院外每周复查血常规。\nF. 予以止呕、护胃等对症支持，办理出院；嘱院外每周复查血常规及肝肾功能，并拔除PICC导管以防感染。\nG. 予以止呕、护胃等对症支持，办理出院；嘱院外每月复查一次血常规及肝肾功能，按期返院行下一程治疗。\nH. 予以止呕、护胃等对症支持，办理出院；上报严重不良事件（SAE）并暂停临床试验入组治疗，转为常规放化疗。\nI. 予以止呕、护胃等对症支持，办理出院；嘱院外口服卡培他滨维持治疗，按期返院行下一程静脉化疗。\nJ. 予以止呕、护胃等对症支持，办理出院；嘱院外每周复查血常规及肝肾功能，并于院外立即开始同步放射治疗。\nK. 予以止呕、护胃等对症支持，常规留取大便隐血及行腹部CT检查排除消化道并发症后，再办理出院。\nL. 予以止呕、护胃等对症支持，办理出院；嘱院外每周复查血常规及肝肾功能，若出现发热则自行口服抗生素观察。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、鼻腔、翼外肌、斜坡、海绵窦、翼突基底部等。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D1754] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右旁T7椎体上缘水平，估计位于上腔静脉内。；检查结论: PICC管位置如上所述。\n- [全程D1758] 检验组合: 红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.410E9/L；总胆红素(TBIL)-静脉血: 15.3umol/L；葡萄糖(Glu)-静脉血: 4.9mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.6pg；间接胆红素(IBIL)-静脉血: 10.2umolL；肌酐(Crea)-静脉血: 67.1umol/L；血小板计数(PLT#)-静脉血: 159.110E9/L；中性粒细胞计数(Neut#)-静脉血: 5.210E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；血小板比容-静脉血: 13.7%；氯离子(Cl-)-静脉血: 100.4mmol/L；尿素氮(BUN)-静脉血: 5.1mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；平均血小板体积(MPV)-静脉血: 8.66fL；白蛋白(ALB)-静脉血: 36.6g/L；载脂蛋白B(apoB)-静脉血: 0.97g/L；C-反应蛋白(CRP)-静脉血: 17.22mg/L；乳酸脱氢酶(LDH)-静脉血: 196.7U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.69mmol/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；尿酸(UA)-静脉血: 195.2umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.759；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.37；总胆固醇(TC)-静脉血: 4.18mmol/L；钾离子(K+)-静脉血: 4.29mmol/L；单核细胞百分比(Mono%)-静脉血: 0.062；α-L-岩藻糖苷酶(AFU)-静脉血: 34.2U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.97；直接胆红素(DBIL)-静脉血: 5.1umol/L；碱性磷酸酶(ALP)-静脉血: 54.4U/L；有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞体积(MCV)-静脉血: 90.4fL；白细胞计数(WBC#)-静脉血: 6.810E9/L；总蛋白(TP)-静脉血: 63.4g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15U/L；甘油三酯(TG)-静脉血: 0.61mmol/L；球蛋白(……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1751] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者入院第二天，无特殊不适主诉，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。复查血常规、生化常规结果无异常。[姓名已隐去]副医生信息已隐藏：现等待患者鼻咽颈部影像学检查结果，明确分期后再行进一步诊治，病情继观。\n- [全程D1752] 上级查房记录；[姓名已隐去]医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医师查房记录；病程内容: 患者入院第三天，无诉，体查情况基本同前，[姓名已隐去]医师查房后示：等待患者影像学检查结果，明确分期后再行进一步诊治，余治疗同前，继观。\n- [全程D1758] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者处于一程洛铂+5FU方案诱导化疗中，诉恶心、呕吐，一般情况可，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。复查血常规、生化常规结果基本正常，[姓名已隐去]副医生信息已隐藏：现患者已完成一程诱导化疗，情况尚可，予以止呕、护胃等对症支持，嘱今日可予以出院，按期返院，不适随诊。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 予以止呕、护胃等对症支持，继续住院观察至消化道反应完全缓解后再予出院，出院后按期返院行下一程治疗。\nB. 予以止呕、护胃等对症支持，办理出院；下一程化疗将洛铂及5-FU剂量下调20%，嘱院外每周复查血常规及肝肾功能。\nC. 予以止呕、护胃等对症支持，办理出院；嘱院外每周复查血常规及肝肾功能，定期进行PICC导管维护，按期返院行下一程治疗。\nD. 予以止呕、护胃等对症支持，办理出院；嘱院外预防性皮下注射重组人粒细胞刺激因子（G-CSF），每周复查血常规。\nE. 予以止呕、护胃等对症支持，办理出院；下一程化疗方案更改为吉西他滨+顺铂（GP方案），嘱院外每周复查血常规。\nF. 予以止呕、护胃等对症支持，办理出院；嘱院外每周复查血常规及肝肾功能，并拔除PICC导管以防感染。\nG. 予以止呕、护胃等对症支持，办理出院；嘱院外每月复查一次血常规及肝肾功能，按期返院行下一程治疗。\nH. 予以止呕、护胃等对症支持，办理出院；上报严重不良事件（SAE）并暂停临床试验入组治疗，转为常规放化疗。\nI. 予以止呕、护胃等对症支持，办理出院；嘱院外口服卡培他滨维持治疗，按期返院行下一程静脉化疗。\nJ. 予以止呕、护胃等对症支持，办理出院；嘱院外每周复查血常规及肝肾功能，并于院外立即开始同步放射治疗。\nK. 予以止呕、护胃等对症支持，常规留取大便隐血及行腹部CT检查排除消化道并发症后，再办理出院。\nL. 予以止呕、护胃等对症支持，办理出院；嘱院外每周复查血常规及肝肾功能，若出现发热则自行口服抗生素观察。\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-be610c2d167fae3585440ece","patient_id":"patient-867f2373fc1b04e0b8b80452","turn_id":"turn06","turn_position":5,"turn_type":"toxicity_or_support_decision","gold_letter":"D","gold_action":"按计划开展第二周期洛铂+5-FU诱导化疗，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗","options":[{"letter":"A","text":"暂缓化疗，予以重组人粒细胞集落刺激因子升白治疗，待中性粒细胞绝对值恢复至2.0×10^9/L以上再行第二周期化疗","is_gold":false},{"letter":"B","text":"开展第二周期洛铂+5-FU诱导化疗，将洛铂剂量下调20%，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃","is_gold":false},{"letter":"C","text":"终止诱导化疗，直接进入同期放化疗阶段，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗","is_gold":false},{"letter":"D","text":"按计划开展第二周期洛铂+5-FU诱导化疗，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗","is_gold":true},{"letter":"E","text":"开展第二周期洛铂+5-FU诱导化疗，暂不予以预防性止吐，待出现恶心呕吐症状时再予以甲氧氯普胺解痉止吐","is_gold":false},{"letter":"F","text":"更改化疗方案为紫杉醇+顺铂方案进行第二周期诱导化疗，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃","is_gold":false},{"letter":"G","text":"开展第二周期洛铂+5-FU诱导化疗，并预防性予以阿瑞匹坦、地塞米松联合5-HT3受体拮抗剂三联强效止吐","is_gold":false},{"letter":"H","text":"暂缓化疗，复查鼻咽颈部MRI评估一程化疗疗效，若肿瘤缩小则继续原方案，否则更改为紫杉醇+顺铂方案","is_gold":false},{"letter":"I","text":"开展第二周期洛铂+5-FU诱导化疗，将5-FU剂量下调25%，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃","is_gold":false},{"letter":"J","text":"暂缓化疗，予以静脉高营养支持及补液治疗，待消化道症状完全缓解、体重增加后再行第二周期诱导化疗","is_gold":false},{"letter":"K","text":"退出临床试验，更改为顺铂+5-FU方案进行第二周期诱导化疗，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃","is_gold":false},{"letter":"L","text":"开展第二周期洛铂+5-FU诱导化疗，并预防性予以奥氮平联合地塞米松双联止吐及质子泵抑制剂护胃支持治疗","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、鼻腔、翼外肌、斜坡、海绵窦、翼突基底部等。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1750] 入院记录: 主诉: 间断性涕血3月，面麻、复视1月，耳鸣20天；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 复视,涕血,双面麻；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟1包，30年，不嗜酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：88次/分，R：20次/分，BP：114/69mmHg,Ht：170cm，Wt：62kg，BSA：1.71m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。；KPS: 90；ECOG:\n- [全程D1750] 入院记录: 主诉: 间断性涕血3月，面麻、复视1月，耳鸣20天；现病史: 缘于3月余前患者无明显诱因出现间断性回吸性涕血，未予重视，一月前患者出现双侧面麻、复视，无鼻塞、头痛、视力下降等不适，遂就诊当地医院行鼻咽活检病理确诊鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 复视,涕血,双面麻；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟1包，30年，不嗜酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：88次/分，R：20次/分，BP：114/69mmHg,Ht：170cm，Wt：62kg，BSA：1.71m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率88次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1751] 检验组合: 阴离子间隙(AG)-静脉血: 18.2；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；平均血小板体积(MPV)-静脉血: 9.8fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.8；白细胞计数(WBC#)-静脉血: 6.2310E9/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 64.8umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阳性(+)（参考: 阴性）；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.92mmol/L；透明质酸(HA)-静脉血: 91.434ng/ml；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.4U/L；氯离子(Cl-)-静脉血: 101.8mmol/L；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 1.43ng/ml（参考: <0.704）；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；血小板比容-静脉血: 20%；活化部分凝血活酶时间(APTT)-静脉血: 27.5sec.；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.62；梅毒非特异性抗体甲苯胺红不加热血清试验(TRUST)-静脉血: 阴性(-)（参考: 阴性）；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；总钙(Ca)-静脉血: 2.27mmol/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.43；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；凝血酶时间(TT)-静脉血: 17.6sec.；间接胆红素(IBIL)-静脉血: 6.6umolL；凝血酶原时间活动度(PTA)-静脉血: 97.9%；降钙素(CT)-静脉血: 25.774pg/ml；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 44.9U/L……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1754] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右旁T7椎体上缘水平，估计位于上腔静脉内。；检查结论: PICC管位置如上所述。\n- [全程D1758] 检验组合: 红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.410E9/L；总胆红素(TBIL)-静脉血: 15.3umol/L；葡萄糖(Glu)-静脉血: 4.9mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.6pg；间接胆红素(IBIL)-静脉血: 10.2umolL；肌酐(Crea)-静脉血: 67.1umol/L；血小板计数(PLT#)-静脉血: 159.110E9/L；中性粒细胞计数(Neut#)-静脉血: 5.210E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；血小板比容-静脉血: 13.7%；氯离子(Cl-)-静脉血: 100.4mmol/L；尿素氮(BUN)-静脉血: 5.1mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；平均血小板体积(MPV)-静脉血: 8.66fL；白蛋白(ALB)-静脉血: 36.6g/L；载脂蛋白B(apoB)-静脉血: 0.97g/L；C-反应蛋白(CRP)-静脉血: 17.22mg/L；乳酸脱氢酶(LDH)-静脉血: 196.7U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.69mmol/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；尿酸(UA)-静脉血: 195.2umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.759；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.37；总胆固醇(TC)-静脉血: 4.18mmol/L；钾离子(K+)-静脉血: 4.29mmol/L；单核细胞百分比(Mono%)-静脉血: 0.062；α-L-岩藻糖苷酶(AFU)-静脉血: 34.2U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.97；直接胆红素(DBIL)-静脉血: 5.1umol/L；碱性磷酸酶(ALP)-静脉血: 54.4U/L；有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞体积(MCV)-静脉血: 90.4fL；白细胞计数(WBC#)-静脉血: 6.810E9/L；总蛋白(TP)-静脉血: 63.4g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15U/L；甘油三酯(TG)-静脉血: 0.61mmol/L；球蛋白(……\n- [全程D1772] 检验组合: 总胆红素(TBIL)-静脉血: 7.6umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.472；红细胞计数(RBC#)-静脉血: 4.2810E12/L；直接胆红素(DBIL)-静脉血: 1.4umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.281；中性粒细胞计数(Neut#)-静脉血: 1.810E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.07；载脂蛋白B(apoB)-静脉血: 1.11g/L；血小板比容-静脉血: 18%；磷(P)-静脉血: 1.23mmol/L；总蛋白(TP)-静脉血: 70.84g/L；平均红细胞体积(MCV)-静脉血: 93.5fL；间接胆红素(IBIL)-静脉血: 6.2umolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.78；丙氨酸氨基转移酶(ALT)-静脉血: 20.8U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.6pg；乳酸脱氢酶(LDH)-静脉血: 173.8U/L；白蛋白(ALB)-静脉血: 41.6g/L；钾离子(K+)-静脉血: 4.12mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 20.8mmol/L；钠离子(Na+)-静脉血: 140.8mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.55mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.33g/L；尿素氮(BUN)-静脉血: 5.1mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.42；甘油三酯(TG)-静脉血: 0.99mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.2；碱性磷酸酶(ALP)-静脉血: 67.2U/L；肌酐(Crea)-静脉血: 68.4umol/L；C-反应蛋白(CRP)-静脉血: 1.24mg/L；血小板计数(PLT#)-静脉血: 18110E9/L；红细胞比容(Hct)-静脉血: 40%；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 30.4U/L；血红蛋白(Hb)-静脉血: 131g/L；镁离子(Mg2+)-静脉血: 0.92mmol/L；平均红细胞血红蛋白……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1751] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者入院第二天，无特殊不适主诉，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。复查血常规、生化常规结果无异常。[姓名已隐去]副医生信息已隐藏：现等待患者鼻咽颈部影像学检查结果，明确分期后再行进一步诊治，病情继观。\n- [全程D1752] 上级查房记录；[姓名已隐去]医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医师查房记录；病程内容: 患者入院第三天，无诉，体查情况基本同前，[姓名已隐去]医师查房后示：等待患者影像学检查结果，明确分期后再行进一步诊治，余治疗同前，继观。\n- [全程D1758] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者处于一程洛铂+5FU方案诱导化疗中，诉恶心、呕吐，一般情况可，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。复查血常规、生化常规结果基本正常，[姓名已隐去]副医生信息已隐藏：现患者已完成一程诱导化疗，情况尚可，予以止呕、护胃等对症支持，嘱今日可予以出院，按期返院，不适随诊。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂缓化疗，予以重组人粒细胞集落刺激因子升白治疗，待中性粒细胞绝对值恢复至2.0×10^9/L以上再行第二周期化疗\nB. 开展第二周期洛铂+5-FU诱导化疗，将洛铂剂量下调20%，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃\nC. 终止诱导化疗，直接进入同期放化疗阶段，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nD. 按计划开展第二周期洛铂+5-FU诱导化疗，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nE. 开展第二周期洛铂+5-FU诱导化疗，暂不予以预防性止吐，待出现恶心呕吐症状时再予以甲氧氯普胺解痉止吐\nF. 更改化疗方案为紫杉醇+顺铂方案进行第二周期诱导化疗，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃\nG. 开展第二周期洛铂+5-FU诱导化疗，并预防性予以阿瑞匹坦、地塞米松联合5-HT3受体拮抗剂三联强效止吐\nH. 暂缓化疗，复查鼻咽颈部MRI评估一程化疗疗效，若肿瘤缩小则继续原方案，否则更改为紫杉醇+顺铂方案\nI. 开展第二周期洛铂+5-FU诱导化疗，将5-FU剂量下调25%，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃\nJ. 暂缓化疗，予以静脉高营养支持及补液治疗，待消化道症状完全缓解、体重增加后再行第二周期诱导化疗\nK. 退出临床试验，更改为顺铂+5-FU方案进行第二周期诱导化疗，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃\nL. 开展第二周期洛铂+5-FU诱导化疗，并预防性予以奥氮平联合地塞米松双联止吐及质子泵抑制剂护胃支持治疗\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D1772] 检验组合: 总胆红素(TBIL)-静脉血: 7.6umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.472；红细胞计数(RBC#)-静脉血: 4.2810E12/L；直接胆红素(DBIL)-静脉血: 1.4umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.281；中性粒细胞计数(Neut#)-静脉血: 1.810E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.07；载脂蛋白B(apoB)-静脉血: 1.11g/L；血小板比容-静脉血: 18%；磷(P)-静脉血: 1.23mmol/L；总蛋白(TP)-静脉血: 70.84g/L；平均红细胞体积(MCV)-静脉血: 93.5fL；间接胆红素(IBIL)-静脉血: 6.2umolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.78；丙氨酸氨基转移酶(ALT)-静脉血: 20.8U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.6pg；乳酸脱氢酶(LDH)-静脉血: 173.8U/L；白蛋白(ALB)-静脉血: 41.6g/L；钾离子(K+)-静脉血: 4.12mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 20.8mmol/L；钠离子(Na+)-静脉血: 140.8mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.55mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.33g/L；尿素氮(BUN)-静脉血: 5.1mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.42；甘油三酯(TG)-静脉血: 0.99mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.2；碱性磷酸酶(ALP)-静脉血: 67.2U/L；肌酐(Crea)-静脉血: 68.4umol/L；C-反应蛋白(CRP)-静脉血: 1.24mg/L；血小板计数(PLT#)-静脉血: 18110E9/L；红细胞比容(Hct)-静脉血: 40%；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 30.4U/L；血红蛋白(Hb)-静脉血: 131g/L；镁离子(Mg2+)-静脉血: 0.92mmol/L；平均红细胞血红蛋白……\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂缓化疗，予以重组人粒细胞集落刺激因子升白治疗，待中性粒细胞绝对值恢复至2.0×10^9/L以上再行第二周期化疗\nB. 开展第二周期洛铂+5-FU诱导化疗，将洛铂剂量下调20%，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃\nC. 终止诱导化疗，直接进入同期放化疗阶段，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nD. 按计划开展第二周期洛铂+5-FU诱导化疗，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nE. 开展第二周期洛铂+5-FU诱导化疗，暂不予以预防性止吐，待出现恶心呕吐症状时再予以甲氧氯普胺解痉止吐\nF. 更改化疗方案为紫杉醇+顺铂方案进行第二周期诱导化疗，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃\nG. 开展第二周期洛铂+5-FU诱导化疗，并预防性予以阿瑞匹坦、地塞米松联合5-HT3受体拮抗剂三联强效止吐\nH. 暂缓化疗，复查鼻咽颈部MRI评估一程化疗疗效，若肿瘤缩小则继续原方案，否则更改为紫杉醇+顺铂方案\nI. 开展第二周期洛铂+5-FU诱导化疗，将5-FU剂量下调25%，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃\nJ. 暂缓化疗，予以静脉高营养支持及补液治疗，待消化道症状完全缓解、体重增加后再行第二周期诱导化疗\nK. 退出临床试验，更改为顺铂+5-FU方案进行第二周期诱导化疗，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃\nL. 开展第二周期洛铂+5-FU诱导化疗，并预防性予以奥氮平联合地塞米松双联止吐及质子泵抑制剂护胃支持治疗\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、鼻腔、翼外肌、斜坡、海绵窦、翼突基底部等。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D1772] 检验组合: 总胆红素(TBIL)-静脉血: 7.6umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.472；红细胞计数(RBC#)-静脉血: 4.2810E12/L；直接胆红素(DBIL)-静脉血: 1.4umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.281；中性粒细胞计数(Neut#)-静脉血: 1.810E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.07；载脂蛋白B(apoB)-静脉血: 1.11g/L；血小板比容-静脉血: 18%；磷(P)-静脉血: 1.23mmol/L；总蛋白(TP)-静脉血: 70.84g/L；平均红细胞体积(MCV)-静脉血: 93.5fL；间接胆红素(IBIL)-静脉血: 6.2umolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.78；丙氨酸氨基转移酶(ALT)-静脉血: 20.8U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.6pg；乳酸脱氢酶(LDH)-静脉血: 173.8U/L；白蛋白(ALB)-静脉血: 41.6g/L；钾离子(K+)-静脉血: 4.12mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 20.8mmol/L；钠离子(Na+)-静脉血: 140.8mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.55mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.33g/L；尿素氮(BUN)-静脉血: 5.1mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.42；甘油三酯(TG)-静脉血: 0.99mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.2；碱性磷酸酶(ALP)-静脉血: 67.2U/L；肌酐(Crea)-静脉血: 68.4umol/L；C-反应蛋白(CRP)-静脉血: 1.24mg/L；血小板计数(PLT#)-静脉血: 18110E9/L；红细胞比容(Hct)-静脉血: 40%；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 30.4U/L；血红蛋白(Hb)-静脉血: 131g/L；镁离子(Mg2+)-静脉血: 0.92mmol/L；平均红细胞血红蛋白……\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂缓化疗，予以重组人粒细胞集落刺激因子升白治疗，待中性粒细胞绝对值恢复至2.0×10^9/L以上再行第二周期化疗\nB. 开展第二周期洛铂+5-FU诱导化疗，将洛铂剂量下调20%，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃\nC. 终止诱导化疗，直接进入同期放化疗阶段，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nD. 按计划开展第二周期洛铂+5-FU诱导化疗，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nE. 开展第二周期洛铂+5-FU诱导化疗，暂不予以预防性止吐，待出现恶心呕吐症状时再予以甲氧氯普胺解痉止吐\nF. 更改化疗方案为紫杉醇+顺铂方案进行第二周期诱导化疗，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃\nG. 开展第二周期洛铂+5-FU诱导化疗，并预防性予以阿瑞匹坦、地塞米松联合5-HT3受体拮抗剂三联强效止吐\nH. 暂缓化疗，复查鼻咽颈部MRI评估一程化疗疗效，若肿瘤缩小则继续原方案，否则更改为紫杉醇+顺铂方案\nI. 开展第二周期洛铂+5-FU诱导化疗，将5-FU剂量下调25%，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃\nJ. 暂缓化疗，予以静脉高营养支持及补液治疗，待消化道症状完全缓解、体重增加后再行第二周期诱导化疗\nK. 退出临床试验，更改为顺铂+5-FU方案进行第二周期诱导化疗，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃\nL. 开展第二周期洛铂+5-FU诱导化疗，并预防性予以奥氮平联合地塞米松双联止吐及质子泵抑制剂护胃支持治疗\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-08c11518d363599b5511b9c9","patient_id":"patient-867f2373fc1b04e0b8b80452","turn_id":"turn07","turn_position":6,"turn_type":"recurrence_or_salvage_decision","gold_letter":"B","gold_action":"启动根治性放疗及同步化疗，每周复查血常规，暂不予以重组人白介素-11及粒细胞刺激因子。","options":[{"letter":"A","text":"继续行洛铂联合5-FU方案第3程诱导化疗，予以重组人粒细胞刺激因子支持治疗，暂缓放疗。","is_gold":false},{"letter":"B","text":"启动根治性放疗及同步化疗，每周复查血常规，暂不予以重组人白介素-11及粒细胞刺激因子。","is_gold":true},{"letter":"C","text":"准备行根治性放疗及同步化疗，予以重组人促红素及重组人粒细胞刺激因子支持治疗，动态复查血常规。","is_gold":false},{"letter":"D","text":"更改化疗方案为吉西他滨联合顺铂诱导化疗，予以重组人白介素-11支持治疗，暂缓放疗。","is_gold":false},{"letter":"E","text":"准备行根治性放疗及同步化疗，予以输注单采血小板及红细胞悬液支持治疗，动态复查血常规。","is_gold":false},{"letter":"F","text":"准备行根治性放疗及同步化疗，因骨髓抑制降低同步化疗药物剂量，予以重组人粒细胞刺激因子支持治疗。","is_gold":false},{"letter":"G","text":"继续行洛铂联合5-FU方案第3程诱导化疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗。","is_gold":false},{"letter":"H","text":"准备行单纯根治性放疗，取消同步化疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗。","is_gold":false},{"letter":"I","text":"转为姑息性放疗及最佳支持治疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗。","is_gold":false},{"letter":"J","text":"准备行根治性放疗及同步化疗，予以重组人血小板生成素支持治疗，暂不使用粒细胞刺激因子。","is_gold":false},{"letter":"K","text":"暂停抗肿瘤治疗，待血象自然恢复后，再行第3程洛铂联合5-FU方案诱导化疗，暂缓放疗。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、鼻腔、翼外肌、斜坡、海绵窦、翼突基底部等。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1750] 入院记录: 主诉: 间断性涕血3月，面麻、复视1月，耳鸣20天；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 复视,涕血,双面麻；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟1包，30年，不嗜酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：88次/分，R：20次/分，BP：114/69mmHg,Ht：170cm，Wt：62kg，BSA：1.71m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。；KPS: 90；ECOG:\n- [全程D1750] 入院记录: 主诉: 间断性涕血3月，面麻、复视1月，耳鸣20天；现病史: 缘于3月余前患者无明显诱因出现间断性回吸性涕血，未予重视，一月前患者出现双侧面麻、复视，无鼻塞、头痛、视力下降等不适，遂就诊当地医院行鼻咽活检病理确诊鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 复视,涕血,双面麻；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟1包，30年，不嗜酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：88次/分，R：20次/分，BP：114/69mmHg,Ht：170cm，Wt：62kg，BSA：1.71m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率88次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1751] 检验组合: 阴离子间隙(AG)-静脉血: 18.2；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；平均血小板体积(MPV)-静脉血: 9.8fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.8；白细胞计数(WBC#)-静脉血: 6.2310E9/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 64.8umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阳性(+)（参考: 阴性）；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.92mmol/L；透明质酸(HA)-静脉血: 91.434ng/ml；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.4U/L；氯离子(Cl-)-静脉血: 101.8mmol/L；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 1.43ng/ml（参考: <0.704）；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；血小板比容-静脉血: 20%；活化部分凝血活酶时间(APTT)-静脉血: 27.5sec.；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.62；梅毒非特异性抗体甲苯胺红不加热血清试验(TRUST)-静脉血: 阴性(-)（参考: 阴性）；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；总钙(Ca)-静脉血: 2.27mmol/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.43；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；凝血酶时间(TT)-静脉血: 17.6sec.；间接胆红素(IBIL)-静脉血: 6.6umolL；凝血酶原时间活动度(PTA)-静脉血: 97.9%；降钙素(CT)-静脉血: 25.774pg/ml；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 44.9U/L……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1754] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右旁T7椎体上缘水平，估计位于上腔静脉内。；检查结论: PICC管位置如上所述。\n- [全程D1758] 检验组合: 红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.410E9/L；总胆红素(TBIL)-静脉血: 15.3umol/L；葡萄糖(Glu)-静脉血: 4.9mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.6pg；间接胆红素(IBIL)-静脉血: 10.2umolL；肌酐(Crea)-静脉血: 67.1umol/L；血小板计数(PLT#)-静脉血: 159.110E9/L；中性粒细胞计数(Neut#)-静脉血: 5.210E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；血小板比容-静脉血: 13.7%；氯离子(Cl-)-静脉血: 100.4mmol/L；尿素氮(BUN)-静脉血: 5.1mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；平均血小板体积(MPV)-静脉血: 8.66fL；白蛋白(ALB)-静脉血: 36.6g/L；载脂蛋白B(apoB)-静脉血: 0.97g/L；C-反应蛋白(CRP)-静脉血: 17.22mg/L；乳酸脱氢酶(LDH)-静脉血: 196.7U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.69mmol/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；尿酸(UA)-静脉血: 195.2umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.759；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.37；总胆固醇(TC)-静脉血: 4.18mmol/L；钾离子(K+)-静脉血: 4.29mmol/L；单核细胞百分比(Mono%)-静脉血: 0.062；α-L-岩藻糖苷酶(AFU)-静脉血: 34.2U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.97；直接胆红素(DBIL)-静脉血: 5.1umol/L；碱性磷酸酶(ALP)-静脉血: 54.4U/L；有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞体积(MCV)-静脉血: 90.4fL；白细胞计数(WBC#)-静脉血: 6.810E9/L；总蛋白(TP)-静脉血: 63.4g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15U/L；甘油三酯(TG)-静脉血: 0.61mmol/L；球蛋白(……\n- [全程D1772] 检验组合: 总胆红素(TBIL)-静脉血: 7.6umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.472；红细胞计数(RBC#)-静脉血: 4.2810E12/L；直接胆红素(DBIL)-静脉血: 1.4umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.281；中性粒细胞计数(Neut#)-静脉血: 1.810E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.07；载脂蛋白B(apoB)-静脉血: 1.11g/L；血小板比容-静脉血: 18%；磷(P)-静脉血: 1.23mmol/L；总蛋白(TP)-静脉血: 70.84g/L；平均红细胞体积(MCV)-静脉血: 93.5fL；间接胆红素(IBIL)-静脉血: 6.2umolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.78；丙氨酸氨基转移酶(ALT)-静脉血: 20.8U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.6pg；乳酸脱氢酶(LDH)-静脉血: 173.8U/L；白蛋白(ALB)-静脉血: 41.6g/L；钾离子(K+)-静脉血: 4.12mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 20.8mmol/L；钠离子(Na+)-静脉血: 140.8mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.55mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.33g/L；尿素氮(BUN)-静脉血: 5.1mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.42；甘油三酯(TG)-静脉血: 0.99mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.2；碱性磷酸酶(ALP)-静脉血: 67.2U/L；肌酐(Crea)-静脉血: 68.4umol/L；C-反应蛋白(CRP)-静脉血: 1.24mg/L；血小板计数(PLT#)-静脉血: 18110E9/L；红细胞比容(Hct)-静脉血: 40%；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 30.4U/L；血红蛋白(Hb)-静脉血: 131g/L；镁离子(Mg2+)-静脉血: 0.92mmol/L；平均红细胞血红蛋白……\n- [全程D1777] 检验组合: 低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.92mmol/L；尿素氮(BUN)-静脉血: 5.65mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；载脂蛋白B(apoB)-静脉血: 1.12g/L；平均红细胞体积(MCV)-静脉血: 91.7fL；中性粒细胞计数(Neut#)-静脉血: 3.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.108；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336.6g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.8；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.23mmolL；血小板比容-静脉血: 11.1%；血红蛋白(Hb)-静脉血: 131.2g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.6mmol/L；甘油三酯(TG)-静脉血: 0.96mmol/L；镁离子(Mg2+)-静脉血: 1.02mmol/L；总胆固醇(TC)-静脉血: 5.75mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.510E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；直接胆红素(DBIL)-静脉血: 5.7umol/L；总蛋白(TP)-静脉血: 68.83g/L；白蛋白(ALB)-静脉血: 37.6g/L；钾离子(K+)-静脉血: 4.1mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；尿酸(UA)-静脉血: 299.7umol/L；碱性磷酸酶(ALP)-静脉血: 64.4U/L；阴离子间隙(AG)-静脉血: 13；氯离子(Cl-)-静脉血: 101.5mmol/L；球蛋白(GLO)-静脉血: 31.23g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1%；血小板分布宽度(PDW)-静脉血: 17.9%；间接胆红素(IBIL)-静脉血: 12.7umolL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；丙氨酸氨基转移酶(ALT)-静脉血: 23.7U/L；C-反……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1751] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者入院第二天，无特殊不适主诉，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。复查血常规、生化常规结果无异常。[姓名已隐去]副医生信息已隐藏：现等待患者鼻咽颈部影像学检查结果，明确分期后再行进一步诊治，病情继观。\n- [全程D1752] 上级查房记录；[姓名已隐去]医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医师查房记录；病程内容: 患者入院第三天，无诉，体查情况基本同前，[姓名已隐去]医师查房后示：等待患者影像学检查结果，明确分期后再行进一步诊治，余治疗同前，继观。\n- [全程D1758] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者处于一程洛铂+5FU方案诱导化疗中，诉恶心、呕吐，一般情况可，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。复查血常规、生化常规结果基本正常，[姓名已隐去]副医生信息已隐藏：现患者已完成一程诱导化疗，情况尚可，予以止呕、护胃等对症支持，嘱今日可予以出院，按期返院，不适随诊。\n- [全程D1774] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者入院第二天，诉复视、面麻未见好转，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经（-）。复查血常规、生化常规结果无异常。[姓名已隐去]副医生信息已隐藏：现患者入院行第一程洛铂+5FU方案诱导化疗中，目前患者情况尚可，继续予以止呕、护胃、加强营养等对症支持治疗，病情继观。\n- [全程D1775] 上级查房记录；[姓名已隐去]医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医师查房记录；病程内容: 患者入院第三天，无诉，体查情况基本同前，[姓名已隐去]医师查房后示：现患者第一程洛铂+5FU方案诱导化疗中，目前患者情况尚可，继续予以对症支持治疗，病情继观。\n- [全程D1779] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现基本完成一程诱导化疗，诉恶心，一般情况尚可，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经（-）。复查血常规、生化常规结果基本正常，[姓名已隐去]副医生信息已隐藏：现患者情况尚可，嘱今日可予以出院，按期返院，不适随诊。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 继续行洛铂联合5-FU方案第3程诱导化疗，予以重组人粒细胞刺激因子支持治疗，暂缓放疗。\nB. 启动根治性放疗及同步化疗，每周复查血常规，暂不予以重组人白介素-11及粒细胞刺激因子。\nC. 准备行根治性放疗及同步化疗，予以重组人促红素及重组人粒细胞刺激因子支持治疗，动态复查血常规。\nD. 更改化疗方案为吉西他滨联合顺铂诱导化疗，予以重组人白介素-11支持治疗，暂缓放疗。\nE. 准备行根治性放疗及同步化疗，予以输注单采血小板及红细胞悬液支持治疗，动态复查血常规。\nF. 准备行根治性放疗及同步化疗，因骨髓抑制降低同步化疗药物剂量，予以重组人粒细胞刺激因子支持治疗。\nG. 继续行洛铂联合5-FU方案第3程诱导化疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗。\nH. 准备行单纯根治性放疗，取消同步化疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗。\nI. 转为姑息性放疗及最佳支持治疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗。\nJ. 准备行根治性放疗及同步化疗，予以重组人血小板生成素支持治疗，暂不使用粒细胞刺激因子。\nK. 暂停抗肿瘤治疗，待血象自然恢复后，再行第3程洛铂联合5-FU方案诱导化疗，暂缓放疗。\n\n请仅输出一个选项字母（A-K）。","incremental_user_message":"【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D1777] 检验组合: 低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.92mmol/L；尿素氮(BUN)-静脉血: 5.65mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；载脂蛋白B(apoB)-静脉血: 1.12g/L；平均红细胞体积(MCV)-静脉血: 91.7fL；中性粒细胞计数(Neut#)-静脉血: 3.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.108；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336.6g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.8；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.23mmolL；血小板比容-静脉血: 11.1%；血红蛋白(Hb)-静脉血: 131.2g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.6mmol/L；甘油三酯(TG)-静脉血: 0.96mmol/L；镁离子(Mg2+)-静脉血: 1.02mmol/L；总胆固醇(TC)-静脉血: 5.75mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.510E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；直接胆红素(DBIL)-静脉血: 5.7umol/L；总蛋白(TP)-静脉血: 68.83g/L；白蛋白(ALB)-静脉血: 37.6g/L；钾离子(K+)-静脉血: 4.1mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；尿酸(UA)-静脉血: 299.7umol/L；碱性磷酸酶(ALP)-静脉血: 64.4U/L；阴离子间隙(AG)-静脉血: 13；氯离子(Cl-)-静脉血: 101.5mmol/L；球蛋白(GLO)-静脉血: 31.23g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1%；血小板分布宽度(PDW)-静脉血: 17.9%；间接胆红素(IBIL)-静脉血: 12.7umolL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；丙氨酸氨基转移酶(ALT)-静脉血: 23.7U/L；C-反……\n\n【既往治疗与反应】\n- [全程D1774] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者入院第二天，诉复视、面麻未见好转，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经（-）。复查血常规、生化常规结果无异常。[姓名已隐去]副医生信息已隐藏：现患者入院行第一程洛铂+5FU方案诱导化疗中，目前患者情况尚可，继续予以止呕、护胃、加强营养等对症支持治疗，病情继观。\n- [全程D1775] 上级查房记录；[姓名已隐去]医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医师查房记录；病程内容: 患者入院第三天，无诉，体查情况基本同前，[姓名已隐去]医师查房后示：现患者第一程洛铂+5FU方案诱导化疗中，目前患者情况尚可，继续予以对症支持治疗，病情继观。\n- [全程D1779] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现基本完成一程诱导化疗，诉恶心，一般情况尚可，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经（-）。复查血常规、生化常规结果基本正常，[姓名已隐去]副医生信息已隐藏：现患者情况尚可，嘱今日可予以出院，按期返院，不适随诊。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 继续行洛铂联合5-FU方案第3程诱导化疗，予以重组人粒细胞刺激因子支持治疗，暂缓放疗。\nB. 启动根治性放疗及同步化疗，每周复查血常规，暂不予以重组人白介素-11及粒细胞刺激因子。\nC. 准备行根治性放疗及同步化疗，予以重组人促红素及重组人粒细胞刺激因子支持治疗，动态复查血常规。\nD. 更改化疗方案为吉西他滨联合顺铂诱导化疗，予以重组人白介素-11支持治疗，暂缓放疗。\nE. 准备行根治性放疗及同步化疗，予以输注单采血小板及红细胞悬液支持治疗，动态复查血常规。\nF. 准备行根治性放疗及同步化疗，因骨髓抑制降低同步化疗药物剂量，予以重组人粒细胞刺激因子支持治疗。\nG. 继续行洛铂联合5-FU方案第3程诱导化疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗。\nH. 准备行单纯根治性放疗，取消同步化疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗。\nI. 转为姑息性放疗及最佳支持治疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗。\nJ. 准备行根治性放疗及同步化疗，予以重组人血小板生成素支持治疗，暂不使用粒细胞刺激因子。\nK. 暂停抗肿瘤治疗，待血象自然恢复后，再行第3程洛铂联合5-FU方案诱导化疗，暂缓放疗。\n\n请仅输出一个选项字母（A-K）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、鼻腔、翼外肌、斜坡、海绵窦、翼突基底部等。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D1777] 检验组合: 低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.92mmol/L；尿素氮(BUN)-静脉血: 5.65mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；载脂蛋白B(apoB)-静脉血: 1.12g/L；平均红细胞体积(MCV)-静脉血: 91.7fL；中性粒细胞计数(Neut#)-静脉血: 3.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.108；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336.6g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.8；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.23mmolL；血小板比容-静脉血: 11.1%；血红蛋白(Hb)-静脉血: 131.2g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.6mmol/L；甘油三酯(TG)-静脉血: 0.96mmol/L；镁离子(Mg2+)-静脉血: 1.02mmol/L；总胆固醇(TC)-静脉血: 5.75mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.510E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；直接胆红素(DBIL)-静脉血: 5.7umol/L；总蛋白(TP)-静脉血: 68.83g/L；白蛋白(ALB)-静脉血: 37.6g/L；钾离子(K+)-静脉血: 4.1mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；尿酸(UA)-静脉血: 299.7umol/L；碱性磷酸酶(ALP)-静脉血: 64.4U/L；阴离子间隙(AG)-静脉血: 13；氯离子(Cl-)-静脉血: 101.5mmol/L；球蛋白(GLO)-静脉血: 31.23g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1%；血小板分布宽度(PDW)-静脉血: 17.9%；间接胆红素(IBIL)-静脉血: 12.7umolL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；丙氨酸氨基转移酶(ALT)-静脉血: 23.7U/L；C-反……\n\n【既往治疗与反应】\n- [全程D1774] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者入院第二天，诉复视、面麻未见好转，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经（-）。复查血常规、生化常规结果无异常。[姓名已隐去]副医生信息已隐藏：现患者入院行第一程洛铂+5FU方案诱导化疗中，目前患者情况尚可，继续予以止呕、护胃、加强营养等对症支持治疗，病情继观。\n- [全程D1775] 上级查房记录；[姓名已隐去]医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医师查房记录；病程内容: 患者入院第三天，无诉，体查情况基本同前，[姓名已隐去]医师查房后示：现患者第一程洛铂+5FU方案诱导化疗中，目前患者情况尚可，继续予以对症支持治疗，病情继观。\n- [全程D1779] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现基本完成一程诱导化疗，诉恶心，一般情况尚可，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经（-）。复查血常规、生化常规结果基本正常，[姓名已隐去]副医生信息已隐藏：现患者情况尚可，嘱今日可予以出院，按期返院，不适随诊。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 继续行洛铂联合5-FU方案第3程诱导化疗，予以重组人粒细胞刺激因子支持治疗，暂缓放疗。\nB. 启动根治性放疗及同步化疗，每周复查血常规，暂不予以重组人白介素-11及粒细胞刺激因子。\nC. 准备行根治性放疗及同步化疗，予以重组人促红素及重组人粒细胞刺激因子支持治疗，动态复查血常规。\nD. 更改化疗方案为吉西他滨联合顺铂诱导化疗，予以重组人白介素-11支持治疗，暂缓放疗。\nE. 准备行根治性放疗及同步化疗，予以输注单采血小板及红细胞悬液支持治疗，动态复查血常规。\nF. 准备行根治性放疗及同步化疗，因骨髓抑制降低同步化疗药物剂量，予以重组人粒细胞刺激因子支持治疗。\nG. 继续行洛铂联合5-FU方案第3程诱导化疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗。\nH. 准备行单纯根治性放疗，取消同步化疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗。\nI. 转为姑息性放疗及最佳支持治疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗。\nJ. 准备行根治性放疗及同步化疗，予以重组人血小板生成素支持治疗，暂不使用粒细胞刺激因子。\nK. 暂停抗肿瘤治疗，待血象自然恢复后，再行第3程洛铂联合5-FU方案诱导化疗，暂缓放疗。\n\n请仅输出一个选项字母（A-K）。"},{"sample_id":"sample-070df43e0c39a4c5f77b459e","patient_id":"patient-867f2373fc1b04e0b8b80452","turn_id":"turn08","turn_position":7,"turn_type":"recurrence_or_salvage_decision","gold_letter":"D","gold_action":"立即开展根治性放疗及洛铂同步化疗，期间定期监测血常规，暂不予造血生长因子干预。","options":[{"letter":"A","text":"立即开展根治性放疗及顺铂同步化疗，期间定期监测血常规，暂不予造血生长因子干预。","is_gold":false},{"letter":"B","text":"予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及顺铂同步化疗。","is_gold":false},{"letter":"C","text":"仅予以重组人白介素-11升血小板治疗，动态复查血常规，并序贯开展根治性放疗及顺铂同步化疗。","is_gold":false},{"letter":"D","text":"立即开展根治性放疗及洛铂同步化疗，期间定期监测血常规，暂不予造血生长因子干预。","is_gold":true},{"letter":"E","text":"仅予以重组人粒细胞刺激因子升白细胞治疗，动态复查血常规，并序贯开展根治性放疗及洛铂同步化疗。","is_gold":false},{"letter":"F","text":"予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及洛铂同步化疗。","is_gold":false},{"letter":"G","text":"予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并转为洛铂单药姑息性化疗。","is_gold":false},{"letter":"H","text":"予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展开放性手术切除原发灶及颈部淋巴结。","is_gold":false},{"letter":"I","text":"予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及西妥昔单抗靶向治疗。","is_gold":false},{"letter":"J","text":"予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及PD-1抑制剂免疫治疗。","is_gold":false},{"letter":"K","text":"暂暂停抗肿瘤治疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，待血象恢复后继续行第三程洛铂+5FU诱导化疗。","is_gold":false},{"letter":"L","text":"予以输注单采血小板及洗涤红细胞支持治疗，动态复查血常规，并序贯开展根治性放疗及洛铂同步化疗。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、鼻腔、翼外肌、斜坡、海绵窦、翼突基底部等。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1750] 入院记录: 主诉: 间断性涕血3月，面麻、复视1月，耳鸣20天；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 复视,涕血,双面麻；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟1包，30年，不嗜酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：88次/分，R：20次/分，BP：114/69mmHg,Ht：170cm，Wt：62kg，BSA：1.71m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。；KPS: 90；ECOG:\n- [全程D1750] 入院记录: 主诉: 间断性涕血3月，面麻、复视1月，耳鸣20天；现病史: 缘于3月余前患者无明显诱因出现间断性回吸性涕血，未予重视，一月前患者出现双侧面麻、复视，无鼻塞、头痛、视力下降等不适，遂就诊当地医院行鼻咽活检病理确诊鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 复视,涕血,双面麻；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟1包，30年，不嗜酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：88次/分，R：20次/分，BP：114/69mmHg,Ht：170cm，Wt：62kg，BSA：1.71m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率88次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1751] 检验组合: 阴离子间隙(AG)-静脉血: 18.2；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；平均血小板体积(MPV)-静脉血: 9.8fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.8；白细胞计数(WBC#)-静脉血: 6.2310E9/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 64.8umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阳性(+)（参考: 阴性）；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.92mmol/L；透明质酸(HA)-静脉血: 91.434ng/ml；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.4U/L；氯离子(Cl-)-静脉血: 101.8mmol/L；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 1.43ng/ml（参考: <0.704）；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；血小板比容-静脉血: 20%；活化部分凝血活酶时间(APTT)-静脉血: 27.5sec.；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.62；梅毒非特异性抗体甲苯胺红不加热血清试验(TRUST)-静脉血: 阴性(-)（参考: 阴性）；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；总钙(Ca)-静脉血: 2.27mmol/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.43；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；凝血酶时间(TT)-静脉血: 17.6sec.；间接胆红素(IBIL)-静脉血: 6.6umolL；凝血酶原时间活动度(PTA)-静脉血: 97.9%；降钙素(CT)-静脉血: 25.774pg/ml；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 44.9U/L……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1754] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右旁T7椎体上缘水平，估计位于上腔静脉内。；检查结论: PICC管位置如上所述。\n- [全程D1758] 检验组合: 红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.410E9/L；总胆红素(TBIL)-静脉血: 15.3umol/L；葡萄糖(Glu)-静脉血: 4.9mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.6pg；间接胆红素(IBIL)-静脉血: 10.2umolL；肌酐(Crea)-静脉血: 67.1umol/L；血小板计数(PLT#)-静脉血: 159.110E9/L；中性粒细胞计数(Neut#)-静脉血: 5.210E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；血小板比容-静脉血: 13.7%；氯离子(Cl-)-静脉血: 100.4mmol/L；尿素氮(BUN)-静脉血: 5.1mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；平均血小板体积(MPV)-静脉血: 8.66fL；白蛋白(ALB)-静脉血: 36.6g/L；载脂蛋白B(apoB)-静脉血: 0.97g/L；C-反应蛋白(CRP)-静脉血: 17.22mg/L；乳酸脱氢酶(LDH)-静脉血: 196.7U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.69mmol/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；尿酸(UA)-静脉血: 195.2umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.759；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.37；总胆固醇(TC)-静脉血: 4.18mmol/L；钾离子(K+)-静脉血: 4.29mmol/L；单核细胞百分比(Mono%)-静脉血: 0.062；α-L-岩藻糖苷酶(AFU)-静脉血: 34.2U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.97；直接胆红素(DBIL)-静脉血: 5.1umol/L；碱性磷酸酶(ALP)-静脉血: 54.4U/L；有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞体积(MCV)-静脉血: 90.4fL；白细胞计数(WBC#)-静脉血: 6.810E9/L；总蛋白(TP)-静脉血: 63.4g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15U/L；甘油三酯(TG)-静脉血: 0.61mmol/L；球蛋白(……\n- [全程D1772] 检验组合: 总胆红素(TBIL)-静脉血: 7.6umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.472；红细胞计数(RBC#)-静脉血: 4.2810E12/L；直接胆红素(DBIL)-静脉血: 1.4umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.281；中性粒细胞计数(Neut#)-静脉血: 1.810E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.07；载脂蛋白B(apoB)-静脉血: 1.11g/L；血小板比容-静脉血: 18%；磷(P)-静脉血: 1.23mmol/L；总蛋白(TP)-静脉血: 70.84g/L；平均红细胞体积(MCV)-静脉血: 93.5fL；间接胆红素(IBIL)-静脉血: 6.2umolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.78；丙氨酸氨基转移酶(ALT)-静脉血: 20.8U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.6pg；乳酸脱氢酶(LDH)-静脉血: 173.8U/L；白蛋白(ALB)-静脉血: 41.6g/L；钾离子(K+)-静脉血: 4.12mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 20.8mmol/L；钠离子(Na+)-静脉血: 140.8mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.55mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.33g/L；尿素氮(BUN)-静脉血: 5.1mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.42；甘油三酯(TG)-静脉血: 0.99mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.2；碱性磷酸酶(ALP)-静脉血: 67.2U/L；肌酐(Crea)-静脉血: 68.4umol/L；C-反应蛋白(CRP)-静脉血: 1.24mg/L；血小板计数(PLT#)-静脉血: 18110E9/L；红细胞比容(Hct)-静脉血: 40%；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 30.4U/L；血红蛋白(Hb)-静脉血: 131g/L；镁离子(Mg2+)-静脉血: 0.92mmol/L；平均红细胞血红蛋白……\n- [全程D1777] 检验组合: 低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.92mmol/L；尿素氮(BUN)-静脉血: 5.65mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；载脂蛋白B(apoB)-静脉血: 1.12g/L；平均红细胞体积(MCV)-静脉血: 91.7fL；中性粒细胞计数(Neut#)-静脉血: 3.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.108；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336.6g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.8；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.23mmolL；血小板比容-静脉血: 11.1%；血红蛋白(Hb)-静脉血: 131.2g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.6mmol/L；甘油三酯(TG)-静脉血: 0.96mmol/L；镁离子(Mg2+)-静脉血: 1.02mmol/L；总胆固醇(TC)-静脉血: 5.75mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.510E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；直接胆红素(DBIL)-静脉血: 5.7umol/L；总蛋白(TP)-静脉血: 68.83g/L；白蛋白(ALB)-静脉血: 37.6g/L；钾离子(K+)-静脉血: 4.1mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；尿酸(UA)-静脉血: 299.7umol/L；碱性磷酸酶(ALP)-静脉血: 64.4U/L；阴离子间隙(AG)-静脉血: 13；氯离子(Cl-)-静脉血: 101.5mmol/L；球蛋白(GLO)-静脉血: 31.23g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1%；血小板分布宽度(PDW)-静脉血: 17.9%；间接胆红素(IBIL)-静脉血: 12.7umolL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；丙氨酸氨基转移酶(ALT)-静脉血: 23.7U/L；C-反……\n- [全程D1782] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及双侧壁粘膜增厚形成软组织影放射性浓聚，SUV约15.6，病灶侵犯蝶窦、蝶骨体、右侧蝶骨翼、蝶骨基底部、枕骨基底部、枕骨斜坡、右侧颈动脉孔、右侧破裂孔、右侧岩枕裂、右侧桥小脑角、右侧颞骨岩尖、双侧翼突基底部、右翼突内/外板、双侧鼻后孔、右翼腭窝、鼻中隔后份、双侧中鼻甲后份、左侧下鼻甲后份、右侧咽旁/咽后间隙、右侧头长肌、右侧腭帆张/提肌及右翼内肌，累及左侧翼腭窝，堵塞鼻咽腔。双侧咽隐窝消失。双侧咽后小淋巴结放射性较浓密，SUV约4.1，大者约0.8×0.9cm。口咽、喉咽未见异常。蝶窦、筛窦、双侧上颌窦及双侧乳突内低密度影放射性分布未见明显异常。双侧海绵窦放射性分布未见明显异常。甲状腺放射性分布未见明显异常。左颈II区数个淋巴结放射性浓聚，SUV约21.9，大者约1.1×1.5cm；右颈II区数个小淋巴结放射性较浓密，SUV约2.7，大者约0.6×0.7cm；余双颈未见肿大淋巴结及异常放射性分布。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺多发条片影放射性分布未见明显异常；余双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔右下气管旁及右肺门数个小淋巴结放射性略浓密。左肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏形态、结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺、膀胱、肠管等形态、结构及放射性分布未见明显异常。双侧髂血管旁及双侧腹股沟未见肿大淋巴结及异常放射性分布。 L5棘突局部放射性略浓密（良性病变）。左髂骨小片状低密度影放射性稀疏（良性病变）。所见颅盖骨、余躯干骨及四肢骨结构及放射性分布未见明显异常。 鼻咽局部代谢较活跃，双侧扁桃体代谢较活跃，双颈II区小淋巴结代谢稍活跃，考虑炎性病变。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，侵犯范围如上述；双侧咽后小淋巴结代谢较活跃，左颈II区数个淋巴结……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1751] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者入院第二天，无特殊不适主诉，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。复查血常规、生化常规结果无异常。[姓名已隐去]副医生信息已隐藏：现等待患者鼻咽颈部影像学检查结果，明确分期后再行进一步诊治，病情继观。\n- [全程D1752] 上级查房记录；[姓名已隐去]医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医师查房记录；病程内容: 患者入院第三天，无诉，体查情况基本同前，[姓名已隐去]医师查房后示：等待患者影像学检查结果，明确分期后再行进一步诊治，余治疗同前，继观。\n- [全程D1758] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者处于一程洛铂+5FU方案诱导化疗中，诉恶心、呕吐，一般情况可，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。复查血常规、生化常规结果基本正常，[姓名已隐去]副医生信息已隐藏：现患者已完成一程诱导化疗，情况尚可，予以止呕、护胃等对症支持，嘱今日可予以出院，按期返院，不适随诊。\n- [全程D1774] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者入院第二天，诉复视、面麻未见好转，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经（-）。复查血常规、生化常规结果无异常。[姓名已隐去]副医生信息已隐藏：现患者入院行第一程洛铂+5FU方案诱导化疗中，目前患者情况尚可，继续予以止呕、护胃、加强营养等对症支持治疗，病情继观。\n- [全程D1775] 上级查房记录；[姓名已隐去]医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医师查房记录；病程内容: 患者入院第三天，无诉，体查情况基本同前，[姓名已隐去]医师查房后示：现患者第一程洛铂+5FU方案诱导化疗中，目前患者情况尚可，继续予以对症支持治疗，病情继观。\n- [全程D1779] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现基本完成一程诱导化疗，诉恶心，一般情况尚可，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经（-）。复查血常规、生化常规结果基本正常，[姓名已隐去]副医生信息已隐藏：现患者情况尚可，嘱今日可予以出院，按期返院，不适随诊。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即开展根治性放疗及顺铂同步化疗，期间定期监测血常规，暂不予造血生长因子干预。\nB. 予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及顺铂同步化疗。\nC. 仅予以重组人白介素-11升血小板治疗，动态复查血常规，并序贯开展根治性放疗及顺铂同步化疗。\nD. 立即开展根治性放疗及洛铂同步化疗，期间定期监测血常规，暂不予造血生长因子干预。\nE. 仅予以重组人粒细胞刺激因子升白细胞治疗，动态复查血常规，并序贯开展根治性放疗及洛铂同步化疗。\nF. 予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及洛铂同步化疗。\nG. 予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并转为洛铂单药姑息性化疗。\nH. 予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展开放性手术切除原发灶及颈部淋巴结。\nI. 予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及西妥昔单抗靶向治疗。\nJ. 予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及PD-1抑制剂免疫治疗。\nK. 暂暂停抗肿瘤治疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，待血象恢复后继续行第三程洛铂+5FU诱导化疗。\nL. 予以输注单采血小板及洗涤红细胞支持治疗，动态复查血常规，并序贯开展根治性放疗及洛铂同步化疗。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D1782] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及双侧壁粘膜增厚形成软组织影放射性浓聚，SUV约15.6，病灶侵犯蝶窦、蝶骨体、右侧蝶骨翼、蝶骨基底部、枕骨基底部、枕骨斜坡、右侧颈动脉孔、右侧破裂孔、右侧岩枕裂、右侧桥小脑角、右侧颞骨岩尖、双侧翼突基底部、右翼突内/外板、双侧鼻后孔、右翼腭窝、鼻中隔后份、双侧中鼻甲后份、左侧下鼻甲后份、右侧咽旁/咽后间隙、右侧头长肌、右侧腭帆张/提肌及右翼内肌，累及左侧翼腭窝，堵塞鼻咽腔。双侧咽隐窝消失。双侧咽后小淋巴结放射性较浓密，SUV约4.1，大者约0.8×0.9cm。口咽、喉咽未见异常。蝶窦、筛窦、双侧上颌窦及双侧乳突内低密度影放射性分布未见明显异常。双侧海绵窦放射性分布未见明显异常。甲状腺放射性分布未见明显异常。左颈II区数个淋巴结放射性浓聚，SUV约21.9，大者约1.1×1.5cm；右颈II区数个小淋巴结放射性较浓密，SUV约2.7，大者约0.6×0.7cm；余双颈未见肿大淋巴结及异常放射性分布。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺多发条片影放射性分布未见明显异常；余双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔右下气管旁及右肺门数个小淋巴结放射性略浓密。左肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏形态、结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺、膀胱、肠管等形态、结构及放射性分布未见明显异常。双侧髂血管旁及双侧腹股沟未见肿大淋巴结及异常放射性分布。 L5棘突局部放射性略浓密（良性病变）。左髂骨小片状低密度影放射性稀疏（良性病变）。所见颅盖骨、余躯干骨及四肢骨结构及放射性分布未见明显异常。 鼻咽局部代谢较活跃，双侧扁桃体代谢较活跃，双颈II区小淋巴结代谢稍活跃，考虑炎性病变。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，侵犯范围如上述；双侧咽后小淋巴结代谢较活跃，左颈II区数个淋巴结……\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即开展根治性放疗及顺铂同步化疗，期间定期监测血常规，暂不予造血生长因子干预。\nB. 予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及顺铂同步化疗。\nC. 仅予以重组人白介素-11升血小板治疗，动态复查血常规，并序贯开展根治性放疗及顺铂同步化疗。\nD. 立即开展根治性放疗及洛铂同步化疗，期间定期监测血常规，暂不予造血生长因子干预。\nE. 仅予以重组人粒细胞刺激因子升白细胞治疗，动态复查血常规，并序贯开展根治性放疗及洛铂同步化疗。\nF. 予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及洛铂同步化疗。\nG. 予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并转为洛铂单药姑息性化疗。\nH. 予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展开放性手术切除原发灶及颈部淋巴结。\nI. 予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及西妥昔单抗靶向治疗。\nJ. 予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及PD-1抑制剂免疫治疗。\nK. 暂暂停抗肿瘤治疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，待血象恢复后继续行第三程洛铂+5FU诱导化疗。\nL. 予以输注单采血小板及洗涤红细胞支持治疗，动态复查血常规，并序贯开展根治性放疗及洛铂同步化疗。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、鼻腔、翼外肌、斜坡、海绵窦、翼突基底部等。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D1782] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及双侧壁粘膜增厚形成软组织影放射性浓聚，SUV约15.6，病灶侵犯蝶窦、蝶骨体、右侧蝶骨翼、蝶骨基底部、枕骨基底部、枕骨斜坡、右侧颈动脉孔、右侧破裂孔、右侧岩枕裂、右侧桥小脑角、右侧颞骨岩尖、双侧翼突基底部、右翼突内/外板、双侧鼻后孔、右翼腭窝、鼻中隔后份、双侧中鼻甲后份、左侧下鼻甲后份、右侧咽旁/咽后间隙、右侧头长肌、右侧腭帆张/提肌及右翼内肌，累及左侧翼腭窝，堵塞鼻咽腔。双侧咽隐窝消失。双侧咽后小淋巴结放射性较浓密，SUV约4.1，大者约0.8×0.9cm。口咽、喉咽未见异常。蝶窦、筛窦、双侧上颌窦及双侧乳突内低密度影放射性分布未见明显异常。双侧海绵窦放射性分布未见明显异常。甲状腺放射性分布未见明显异常。左颈II区数个淋巴结放射性浓聚，SUV约21.9，大者约1.1×1.5cm；右颈II区数个小淋巴结放射性较浓密，SUV约2.7，大者约0.6×0.7cm；余双颈未见肿大淋巴结及异常放射性分布。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺多发条片影放射性分布未见明显异常；余双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔右下气管旁及右肺门数个小淋巴结放射性略浓密。左肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏形态、结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺、膀胱、肠管等形态、结构及放射性分布未见明显异常。双侧髂血管旁及双侧腹股沟未见肿大淋巴结及异常放射性分布。 L5棘突局部放射性略浓密（良性病变）。左髂骨小片状低密度影放射性稀疏（良性病变）。所见颅盖骨、余躯干骨及四肢骨结构及放射性分布未见明显异常。 鼻咽局部代谢较活跃，双侧扁桃体代谢较活跃，双颈II区小淋巴结代谢稍活跃，考虑炎性病变。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，侵犯范围如上述；双侧咽后小淋巴结代谢较活跃，左颈II区数个淋巴结……\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即开展根治性放疗及顺铂同步化疗，期间定期监测血常规，暂不予造血生长因子干预。\nB. 予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及顺铂同步化疗。\nC. 仅予以重组人白介素-11升血小板治疗，动态复查血常规，并序贯开展根治性放疗及顺铂同步化疗。\nD. 立即开展根治性放疗及洛铂同步化疗，期间定期监测血常规，暂不予造血生长因子干预。\nE. 仅予以重组人粒细胞刺激因子升白细胞治疗，动态复查血常规，并序贯开展根治性放疗及洛铂同步化疗。\nF. 予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及洛铂同步化疗。\nG. 予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并转为洛铂单药姑息性化疗。\nH. 予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展开放性手术切除原发灶及颈部淋巴结。\nI. 予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及西妥昔单抗靶向治疗。\nJ. 予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及PD-1抑制剂免疫治疗。\nK. 暂暂停抗肿瘤治疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，待血象恢复后继续行第三程洛铂+5FU诱导化疗。\nL. 予以输注单采血小板及洗涤红细胞支持治疗，动态复查血常规，并序贯开展根治性放疗及洛铂同步化疗。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"episode_id":"episode-33e7f203c7713f19fed30ae8","patient_id":"patient-5731cc38ced94b2ee39c442a","care_turn_count":6,"turns":[{"sample_id":"sample-ce0b8b89ec8b1d9a2405353d","patient_id":"patient-5731cc38ced94b2ee39c442a","turn_id":"turn01","turn_position":1,"turn_type":"initial_workup_choice","gold_letter":"G","gold_action":"完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描（或PET-CT），EBV-DNA及抗体检测，常规血液学检查。","options":[{"letter":"A","text":"完善鼻咽+颈部增强CT，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查，择期行颈部淋巴结穿刺活检。","is_gold":false},{"letter":"B","text":"完善鼻咽镜及活检，鼻咽+颈部增强CT，胸腹部超声及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。","is_gold":false},{"letter":"C","text":"完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，常规血液学检查，暂缓EBV相关检测。","is_gold":false},{"letter":"D","text":"完善鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查，若影像典型直接开始放化疗。","is_gold":false},{"letter":"E","text":"完善鼻咽镜及活检，头颅增强MRI，颈部超声，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。","is_gold":false},{"letter":"F","text":"完善鼻咽镜及活检，鼻咽+颈部平扫MRI，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。","is_gold":false},{"letter":"G","text":"完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描（或PET-CT），EBV-DNA及抗体检测，常规血液学检查。","is_gold":true},{"letter":"H","text":"完善鼻咽镜及活检，鼻咽+颈部增强MRI，EBV-DNA及抗体检测，常规血液学检查，待局部放疗结束后再行全身转移排查。","is_gold":false},{"letter":"I","text":"完善颈部淋巴结切除活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。","is_gold":false},{"letter":"J","text":"完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，常规血液学检查，并立即行诱导化疗。","is_gold":false},{"letter":"K","text":"完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸部X线，腹部超声，全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。","is_gold":false},{"letter":"L","text":"完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查，并预防性行气管切开。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、蝶窦、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 左耳闷涉不适1年，涕血2月。；某次就诊时间特来我院门诊进一步诊治，完善相关检查，诊断明确后，今日入院系统治疗。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,左耳闷胀感,涕血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。有吸烟史1年，日7支；少量饮酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：90次/分，R：20次/分，BP：131/86mmHg,Ht：171cm，Wt：76.5kg，BSA1.89m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶壁、顶后壁、双侧壁结节状肿物；左侧颈部II区可扪及1个淋巴结，最大径2cm×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善鼻咽+颈部增强CT，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查，择期行颈部淋巴结穿刺活检。\nB. 完善鼻咽镜及活检，鼻咽+颈部增强CT，胸腹部超声及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。\nC. 完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，常规血液学检查，暂缓EBV相关检测。\nD. 完善鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查，若影像典型直接开始放化疗。\nE. 完善鼻咽镜及活检，头颅增强MRI，颈部超声，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。\nF. 完善鼻咽镜及活检，鼻咽+颈部平扫MRI，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。\nG. 完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描（或PET-CT），EBV-DNA及抗体检测，常规血液学检查。\nH. 完善鼻咽镜及活检，鼻咽+颈部增强MRI，EBV-DNA及抗体检测，常规血液学检查，待局部放疗结束后再行全身转移排查。\nI. 完善颈部淋巴结切除活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。\nJ. 完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，常规血液学检查，并立即行诱导化疗。\nK. 完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸部X线，腹部超声，全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。\nL. 完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查，并预防性行气管切开。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、蝶窦、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 左耳闷涉不适1年，涕血2月。；某次就诊时间特来我院门诊进一步诊治，完善相关检查，诊断明确后，今日入院系统治疗。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,左耳闷胀感,涕血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。有吸烟史1年，日7支；少量饮酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：90次/分，R：20次/分，BP：131/86mmHg,Ht：171cm，Wt：76.5kg，BSA1.89m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶壁、顶后壁、双侧壁结节状肿物；左侧颈部II区可扪及1个淋巴结，最大径2cm×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善鼻咽+颈部增强CT，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查，择期行颈部淋巴结穿刺活检。\nB. 完善鼻咽镜及活检，鼻咽+颈部增强CT，胸腹部超声及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。\nC. 完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，常规血液学检查，暂缓EBV相关检测。\nD. 完善鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查，若影像典型直接开始放化疗。\nE. 完善鼻咽镜及活检，头颅增强MRI，颈部超声，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。\nF. 完善鼻咽镜及活检，鼻咽+颈部平扫MRI，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。\nG. 完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描（或PET-CT），EBV-DNA及抗体检测，常规血液学检查。\nH. 完善鼻咽镜及活检，鼻咽+颈部增强MRI，EBV-DNA及抗体检测，常规血液学检查，待局部放疗结束后再行全身转移排查。\nI. 完善颈部淋巴结切除活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。\nJ. 完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，常规血液学检查，并立即行诱导化疗。\nK. 完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸部X线，腹部超声，全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。\nL. 完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查，并预防性行气管切开。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、蝶窦、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 左耳闷涉不适1年，涕血2月。；某次就诊时间特来我院门诊进一步诊治，完善相关检查，诊断明确后，今日入院系统治疗。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,左耳闷胀感,涕血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。有吸烟史1年，日7支；少量饮酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：90次/分，R：20次/分，BP：131/86mmHg,Ht：171cm，Wt：76.5kg，BSA1.89m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶壁、顶后壁、双侧壁结节状肿物；左侧颈部II区可扪及1个淋巴结，最大径2cm×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善鼻咽+颈部增强CT，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查，择期行颈部淋巴结穿刺活检。\nB. 完善鼻咽镜及活检，鼻咽+颈部增强CT，胸腹部超声及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。\nC. 完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，常规血液学检查，暂缓EBV相关检测。\nD. 完善鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查，若影像典型直接开始放化疗。\nE. 完善鼻咽镜及活检，头颅增强MRI，颈部超声，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。\nF. 完善鼻咽镜及活检，鼻咽+颈部平扫MRI，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。\nG. 完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描（或PET-CT），EBV-DNA及抗体检测，常规血液学检查。\nH. 完善鼻咽镜及活检，鼻咽+颈部增强MRI，EBV-DNA及抗体检测，常规血液学检查，待局部放疗结束后再行全身转移排查。\nI. 完善颈部淋巴结切除活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。\nJ. 完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，常规血液学检查，并立即行诱导化疗。\nK. 完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸部X线，腹部超声，全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。\nL. 完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查，并预防性行气管切开。\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-e3ed1270448c84eefbda9f61","patient_id":"patient-5731cc38ced94b2ee39c442a","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"H","gold_action":"完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充血浆EBV DNA定量检测","options":[{"letter":"A","text":"完善胸部CT、腹部CT及全身骨扫描，并补充颈部淋巴结切除活检","is_gold":false},{"letter":"B","text":"完善全身PET-CT检查，并补充颈部淋巴结穿刺活检","is_gold":false},{"letter":"C","text":"完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充头颈部CTA检查","is_gold":false},{"letter":"D","text":"完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充颈部淋巴结穿刺活检","is_gold":false},{"letter":"E","text":"完善胸部CT、腹部CT，并补充脑部MRI平扫及增强","is_gold":false},{"letter":"F","text":"完善全身骨扫描及脑部MRI增强，并补充血浆EBV DNA定量检测","is_gold":false},{"letter":"G","text":"完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充鼻咽脱落细胞学检查","is_gold":false},{"letter":"H","text":"完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充血浆EBV DNA定量检测","is_gold":true},{"letter":"I","text":"完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充骨髓穿刺活检","is_gold":false},{"letter":"J","text":"完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充EBV抗体滴度复查","is_gold":false},{"letter":"K","text":"完善胸部CT、腹部CT及全身骨扫描，并补充头颅PET-MR检查","is_gold":false},{"letter":"L","text":"完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并立即开始诱导化疗","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、蝶窦、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 左耳闷涉不适1年，涕血2月。；某次就诊时间特来我院门诊进一步诊治，完善相关检查，诊断明确后，今日入院系统治疗。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,左耳闷胀感,涕血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。有吸烟史1年，日7支；少量饮酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：90次/分，R：20次/分，BP：131/86mmHg,Ht：171cm，Wt：76.5kg，BSA1.89m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶壁、顶后壁、双侧壁结节状肿物；左侧颈部II区可扪及1个淋巴结，最大径2cm×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.51；平均红细胞血红蛋白含量(MCH)-静脉血: 27.4pg；磷(P)-静脉血: 0.9mmol/L；直接胆红素(DBIL)-静脉血: 4.7umol/L；凝血酶时间(TT)-静脉血: 22.7sec.；D-二聚体(D-Dimer)-静脉血: 0.29ug/ml；活化部分凝血活酶时间(APTT)-静脉血: 38.5sec.；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.04S/CO；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.82mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.6；单核细胞百分比(Mono%)-静脉血: 0.047；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；间接胆红素(IBIL)-静脉血: 10.5umolL；白蛋白(ALB)-静脉血: 48g/L；氯离子(Cl-)-静脉血: 101.7mmol/L；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.718；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.1COI；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；白细胞计数(WBC#)-静脉血: 6.9510E9/L；红细胞比容(Hct)-静脉血: 46.8%；尿酸(UA)-静脉血: 431.8umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 81.8umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 26mmol/L；血小板分布宽度(PDW)-静脉血: 11.2%；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.04S/CO；平均血小板体积(MPV)-静脉血: 9.7fL；中性粒细胞计数(Neut#)-静脉血: 510E9/L；载脂蛋白B(apoB)-静脉血: 0.96g/L；凝血酶原时间(PT)-静脉血: 11.8sec.；钠离子(Na+)-静脉血: 138.7mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；甘油三酯(TG)-静脉血: 2.2mmol/L；总胆红素(TBIL)-……\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 Ⅱ、Ⅲ、aVF、V5、V6导联T波低平\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、后壁及双侧壁增厚，见软组织肿物向鼻咽腔内突出，在T1WI上呈等信号，在T2WI上呈稍高信号，增强扫描明显强化。双侧咽隐窝变浅，见软组织肿物填充。病灶侵犯左侧后鼻孔，侵犯左侧腭帆张提肌、左侧翼内肌头部、左侧咽旁脂肪间隙，侵犯蝶窦左侧份及左侧翼腭窝，侵犯左侧破裂孔、左侧海绵窦。 右侧咽旁间隙及双侧颈动脉鞘区血管未见明显异常。右侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常。口咽双侧壁未见增厚。 斜坡、左侧岩尖、蝶骨基底部、左侧翼突区骨质信号减低，增强扫描明显强化。 右侧海绵窦形态正常，未见增宽。 双侧筛窦、左侧上颌窦、蝶窦及右侧乳突粘膜增厚，左侧乳突内见大量长分期信息见历史辅助诊断节点长分期信息见历史辅助诊断节点信号分泌物。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变。 左侧咽后可见数个小淋巴结，较大短径约4mm；右侧咽后可见小淋巴结，短径约2mm。左颈II、III区可见数个淋巴结，最大约21mm×15mm，部分呈相互融合改变，边界欠清，增强扫描可见明显强化。右颈II、III区可见数个淋巴结，最大约12mm×7mm，边界清。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 左颈II、III区淋巴结肿大，考虑转移。 左侧咽后、右颈II、III区淋巴结，不排除转移。 右侧咽后小淋巴结。 鼻窦炎。双侧乳突炎。\n- [全程D5] 检验组合: EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；Rh血型-静脉血: 阳性；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；ABO血型-静脉血: O\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善胸部CT、腹部CT及全身骨扫描，并补充颈部淋巴结切除活检\nB. 完善全身PET-CT检查，并补充颈部淋巴结穿刺活检\nC. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充头颈部CTA检查\nD. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充颈部淋巴结穿刺活检\nE. 完善胸部CT、腹部CT，并补充脑部MRI平扫及增强\nF. 完善全身骨扫描及脑部MRI增强，并补充血浆EBV DNA定量检测\nG. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充鼻咽脱落细胞学检查\nH. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充血浆EBV DNA定量检测\nI. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充骨髓穿刺活检\nJ. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充EBV抗体滴度复查\nK. 完善胸部CT、腹部CT及全身骨扫描，并补充头颅PET-MR检查\nL. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并立即开始诱导化疗\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D0] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.51；平均红细胞血红蛋白含量(MCH)-静脉血: 27.4pg；磷(P)-静脉血: 0.9mmol/L；直接胆红素(DBIL)-静脉血: 4.7umol/L；凝血酶时间(TT)-静脉血: 22.7sec.；D-二聚体(D-Dimer)-静脉血: 0.29ug/ml；活化部分凝血活酶时间(APTT)-静脉血: 38.5sec.；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.04S/CO；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.82mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.6；单核细胞百分比(Mono%)-静脉血: 0.047；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；间接胆红素(IBIL)-静脉血: 10.5umolL；白蛋白(ALB)-静脉血: 48g/L；氯离子(Cl-)-静脉血: 101.7mmol/L；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.718；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.1COI；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；白细胞计数(WBC#)-静脉血: 6.9510E9/L；红细胞比容(Hct)-静脉血: 46.8%；尿酸(UA)-静脉血: 431.8umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 81.8umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 26mmol/L；血小板分布宽度(PDW)-静脉血: 11.2%；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.04S/CO；平均血小板体积(MPV)-静脉血: 9.7fL；中性粒细胞计数(Neut#)-静脉血: 510E9/L；载脂蛋白B(apoB)-静脉血: 0.96g/L；凝血酶原时间(PT)-静脉血: 11.8sec.；钠离子(Na+)-静脉血: 138.7mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；甘油三酯(TG)-静脉血: 2.2mmol/L；总胆红素(TBIL)-……\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 Ⅱ、Ⅲ、aVF、V5、V6导联T波低平\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、后壁及双侧壁增厚，见软组织肿物向鼻咽腔内突出，在T1WI上呈等信号，在T2WI上呈稍高信号，增强扫描明显强化。双侧咽隐窝变浅，见软组织肿物填充。病灶侵犯左侧后鼻孔，侵犯左侧腭帆张提肌、左侧翼内肌头部、左侧咽旁脂肪间隙，侵犯蝶窦左侧份及左侧翼腭窝，侵犯左侧破裂孔、左侧海绵窦。 右侧咽旁间隙及双侧颈动脉鞘区血管未见明显异常。右侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常。口咽双侧壁未见增厚。 斜坡、左侧岩尖、蝶骨基底部、左侧翼突区骨质信号减低，增强扫描明显强化。 右侧海绵窦形态正常，未见增宽。 双侧筛窦、左侧上颌窦、蝶窦及右侧乳突粘膜增厚，左侧乳突内见大量长分期信息见历史辅助诊断节点长分期信息见历史辅助诊断节点信号分泌物。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变。 左侧咽后可见数个小淋巴结，较大短径约4mm；右侧咽后可见小淋巴结，短径约2mm。左颈II、III区可见数个淋巴结，最大约21mm×15mm，部分呈相互融合改变，边界欠清，增强扫描可见明显强化。右颈II、III区可见数个淋巴结，最大约12mm×7mm，边界清。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 左颈II、III区淋巴结肿大，考虑转移。 左侧咽后、右颈II、III区淋巴结，不排除转移。 右侧咽后小淋巴结。 鼻窦炎。双侧乳突炎。\n- [全程D5] 检验组合: EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；Rh血型-静脉血: 阳性；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；ABO血型-静脉血: O\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善胸部CT、腹部CT及全身骨扫描，并补充颈部淋巴结切除活检\nB. 完善全身PET-CT检查，并补充颈部淋巴结穿刺活检\nC. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充头颈部CTA检查\nD. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充颈部淋巴结穿刺活检\nE. 完善胸部CT、腹部CT，并补充脑部MRI平扫及增强\nF. 完善全身骨扫描及脑部MRI增强，并补充血浆EBV DNA定量检测\nG. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充鼻咽脱落细胞学检查\nH. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充血浆EBV DNA定量检测\nI. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充骨髓穿刺活检\nJ. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充EBV抗体滴度复查\nK. 完善胸部CT、腹部CT及全身骨扫描，并补充头颅PET-MR检查\nL. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并立即开始诱导化疗\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、蝶窦、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D0] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.51；平均红细胞血红蛋白含量(MCH)-静脉血: 27.4pg；磷(P)-静脉血: 0.9mmol/L；直接胆红素(DBIL)-静脉血: 4.7umol/L；凝血酶时间(TT)-静脉血: 22.7sec.；D-二聚体(D-Dimer)-静脉血: 0.29ug/ml；活化部分凝血活酶时间(APTT)-静脉血: 38.5sec.；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.04S/CO；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.82mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.6；单核细胞百分比(Mono%)-静脉血: 0.047；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；间接胆红素(IBIL)-静脉血: 10.5umolL；白蛋白(ALB)-静脉血: 48g/L；氯离子(Cl-)-静脉血: 101.7mmol/L；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.718；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.1COI；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；白细胞计数(WBC#)-静脉血: 6.9510E9/L；红细胞比容(Hct)-静脉血: 46.8%；尿酸(UA)-静脉血: 431.8umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 81.8umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 26mmol/L；血小板分布宽度(PDW)-静脉血: 11.2%；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.04S/CO；平均血小板体积(MPV)-静脉血: 9.7fL；中性粒细胞计数(Neut#)-静脉血: 510E9/L；载脂蛋白B(apoB)-静脉血: 0.96g/L；凝血酶原时间(PT)-静脉血: 11.8sec.；钠离子(Na+)-静脉血: 138.7mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；甘油三酯(TG)-静脉血: 2.2mmol/L；总胆红素(TBIL)-……\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 Ⅱ、Ⅲ、aVF、V5、V6导联T波低平\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、后壁及双侧壁增厚，见软组织肿物向鼻咽腔内突出，在T1WI上呈等信号，在T2WI上呈稍高信号，增强扫描明显强化。双侧咽隐窝变浅，见软组织肿物填充。病灶侵犯左侧后鼻孔，侵犯左侧腭帆张提肌、左侧翼内肌头部、左侧咽旁脂肪间隙，侵犯蝶窦左侧份及左侧翼腭窝，侵犯左侧破裂孔、左侧海绵窦。 右侧咽旁间隙及双侧颈动脉鞘区血管未见明显异常。右侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常。口咽双侧壁未见增厚。 斜坡、左侧岩尖、蝶骨基底部、左侧翼突区骨质信号减低，增强扫描明显强化。 右侧海绵窦形态正常，未见增宽。 双侧筛窦、左侧上颌窦、蝶窦及右侧乳突粘膜增厚，左侧乳突内见大量长分期信息见历史辅助诊断节点长分期信息见历史辅助诊断节点信号分泌物。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变。 左侧咽后可见数个小淋巴结，较大短径约4mm；右侧咽后可见小淋巴结，短径约2mm。左颈II、III区可见数个淋巴结，最大约21mm×15mm，部分呈相互融合改变，边界欠清，增强扫描可见明显强化。右颈II、III区可见数个淋巴结，最大约12mm×7mm，边界清。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 左颈II、III区淋巴结肿大，考虑转移。 左侧咽后、右颈II、III区淋巴结，不排除转移。 右侧咽后小淋巴结。 鼻窦炎。双侧乳突炎。\n- [全程D5] 检验组合: EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；Rh血型-静脉血: 阳性；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；ABO血型-静脉血: O\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善胸部CT、腹部CT及全身骨扫描，并补充颈部淋巴结切除活检\nB. 完善全身PET-CT检查，并补充颈部淋巴结穿刺活检\nC. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充头颈部CTA检查\nD. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充颈部淋巴结穿刺活检\nE. 完善胸部CT、腹部CT，并补充脑部MRI平扫及增强\nF. 完善全身骨扫描及脑部MRI增强，并补充血浆EBV DNA定量检测\nG. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充鼻咽脱落细胞学检查\nH. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充血浆EBV DNA定量检测\nI. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充骨髓穿刺活检\nJ. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充EBV抗体滴度复查\nK. 完善胸部CT、腹部CT及全身骨扫描，并补充头颅PET-MR检查\nL. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并立即开始诱导化疗\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-cd1385d4e13dda199ba81658","patient_id":"patient-5731cc38ced94b2ee39c442a","turn_id":"turn05","turn_position":3,"turn_type":"toxicity_or_support_decision","gold_letter":"K","gold_action":"办理出院，开具口服保肝药物（如多烯磷脂酰胆碱等），嘱每周复查血常规和生化，按期返院行下一程诱导化疗。","options":[{"letter":"A","text":"办理出院，暂不予保肝药物干预，嘱每周复查血常规和生化，按期返院行下一程诱导化疗。","is_gold":false},{"letter":"B","text":"暂缓出院，予静脉滴注保肝降酶药物，待转氨酶及胆红素完全恢复正常后出院，按期行下一程诱导化疗。","is_gold":false},{"letter":"C","text":"办理出院，开具口服保肝药物，终止后续诱导化疗计划，择期直接开始根治性同期放化疗。","is_gold":false},{"letter":"D","text":"办理出院，开具口服保肝药物，下一程诱导化疗直接将多西他赛及顺铂剂量下调20%。","is_gold":false},{"letter":"E","text":"办理出院，开具口服保肝药物，下一程诱导化疗方案更改为吉西他滨联合顺铂（GP方案）。","is_gold":false},{"letter":"F","text":"暂缓出院，请感染内科会诊排除乙肝病毒再激活，待专科意见明确后再决定后续抗肿瘤治疗计划。","is_gold":false},{"letter":"G","text":"办理出院，开具口服保肝药物，嘱每周复查血常规和生化，将下一程诱导化疗推迟1至2周进行。","is_gold":false},{"letter":"H","text":"办理出院，开具口服保肝药物，并预防性给予长效G-CSF支持，按期返院行下一程诱导化疗。","is_gold":false},{"letter":"I","text":"暂缓出院，按重度药物性肝损伤启动多学科联合诊疗，待肝功能好转后，按期行下一程诱导化疗。","is_gold":false},{"letter":"J","text":"办理出院，开具口服保肝药物，下一程治疗停用尼妥珠单抗，仅行TPF方案诱导化疗。","is_gold":false},{"letter":"K","text":"办理出院，开具口服保肝药物（如多烯磷脂酰胆碱等），嘱每周复查血常规和生化，按期返院行下一程诱导化疗。","is_gold":true},{"letter":"L","text":"办理出院，开具口服保肝药物，下一程诱导化疗剔除氟尿嘧啶，改为多西他赛联合顺铂双药方案。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、蝶窦、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 左耳闷涉不适1年，涕血2月。；某次就诊时间特来我院门诊进一步诊治，完善相关检查，诊断明确后，今日入院系统治疗。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,左耳闷胀感,涕血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。有吸烟史1年，日7支；少量饮酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：90次/分，R：20次/分，BP：131/86mmHg,Ht：171cm，Wt：76.5kg，BSA1.89m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶壁、顶后壁、双侧壁结节状肿物；左侧颈部II区可扪及1个淋巴结，最大径2cm×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.51；平均红细胞血红蛋白含量(MCH)-静脉血: 27.4pg；磷(P)-静脉血: 0.9mmol/L；直接胆红素(DBIL)-静脉血: 4.7umol/L；凝血酶时间(TT)-静脉血: 22.7sec.；D-二聚体(D-Dimer)-静脉血: 0.29ug/ml；活化部分凝血活酶时间(APTT)-静脉血: 38.5sec.；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.04S/CO；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.82mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.6；单核细胞百分比(Mono%)-静脉血: 0.047；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；间接胆红素(IBIL)-静脉血: 10.5umolL；白蛋白(ALB)-静脉血: 48g/L；氯离子(Cl-)-静脉血: 101.7mmol/L；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.718；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.1COI；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；白细胞计数(WBC#)-静脉血: 6.9510E9/L；红细胞比容(Hct)-静脉血: 46.8%；尿酸(UA)-静脉血: 431.8umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 81.8umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 26mmol/L；血小板分布宽度(PDW)-静脉血: 11.2%；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.04S/CO；平均血小板体积(MPV)-静脉血: 9.7fL；中性粒细胞计数(Neut#)-静脉血: 510E9/L；载脂蛋白B(apoB)-静脉血: 0.96g/L；凝血酶原时间(PT)-静脉血: 11.8sec.；钠离子(Na+)-静脉血: 138.7mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；甘油三酯(TG)-静脉血: 2.2mmol/L；总胆红素(TBIL)-……\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 Ⅱ、Ⅲ、aVF、V5、V6导联T波低平\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、后壁及双侧壁增厚，见软组织肿物向鼻咽腔内突出，在T1WI上呈等信号，在T2WI上呈稍高信号，增强扫描明显强化。双侧咽隐窝变浅，见软组织肿物填充。病灶侵犯左侧后鼻孔，侵犯左侧腭帆张提肌、左侧翼内肌头部、左侧咽旁脂肪间隙，侵犯蝶窦左侧份及左侧翼腭窝，侵犯左侧破裂孔、左侧海绵窦。 右侧咽旁间隙及双侧颈动脉鞘区血管未见明显异常。右侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常。口咽双侧壁未见增厚。 斜坡、左侧岩尖、蝶骨基底部、左侧翼突区骨质信号减低，增强扫描明显强化。 右侧海绵窦形态正常，未见增宽。 双侧筛窦、左侧上颌窦、蝶窦及右侧乳突粘膜增厚，左侧乳突内见大量长分期信息见历史辅助诊断节点长分期信息见历史辅助诊断节点信号分泌物。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变。 左侧咽后可见数个小淋巴结，较大短径约4mm；右侧咽后可见小淋巴结，短径约2mm。左颈II、III区可见数个淋巴结，最大约21mm×15mm，部分呈相互融合改变，边界欠清，增强扫描可见明显强化。右颈II、III区可见数个淋巴结，最大约12mm×7mm，边界清。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 左颈II、III区淋巴结肿大，考虑转移。 左侧咽后、右颈II、III区淋巴结，不排除转移。 右侧咽后小淋巴结。 鼻窦炎。双侧乳突炎。\n- [全程D5] 检验组合: EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；Rh血型-静脉血: 阳性；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；ABO血型-静脉血: O\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D24] 检验组合: 天门冬氨酸氨基转移酶(AST)-静脉血: 20.1U/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；血小板分布宽度(PDW)-静脉血: 11.9%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.1；尿素氮(BUN)-静脉血: 3.6mmol/L；磷(P)-静脉血: 0.97mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21.8U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.55；丙氨酸氨基转移酶(ALT)-静脉血: 41U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.19mmol/L；葡萄糖(Glu)-静脉血: 5.41mmol/L；白蛋白(ALB)-静脉血: 46.9g/L；白细胞计数(WBC#)-静脉血: 5.2810E9/L；红细胞计数(RBC#)-静脉血: 5.3910E12/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.6；尿酸(UA)-静脉血: 386.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 27U/L；C-反应蛋白(CRP)-静脉血: 4.25mg/L；钾离子(K+)-静脉血: 4.08mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.051；载脂蛋白B(apoB)-静脉血: 1.1g/L；球蛋白(GLO)-静脉血: 30.3g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；平均血小板体积(MPV)-静脉血: 10.3fL；总胆汁酸(TBA)-静脉血: 1.8umol/L；总蛋白(TP)-静脉血: 77.2g/L；间接胆红素(IBIL)-静脉血: 11.1umolL；甘油三酯(TG)-静脉血: 1.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.08g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.310E9/L；氯离子(Cl-)-静脉血: 102.2mmol/L；单核细胞百分比(Mono%)-静脉血: 0.072；碱性磷酸酶(ALP)-静脉血: 82.4U/L；总胆红素(TBIL)-静脉血: 15.1umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.49；总胆固醇(TC)-静脉血: 4.74mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.237；血小板比容……\n- [全程D25] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右侧约平T6椎体下缘水平，估计导管末端位于上腔静脉下段内。；检查结论: PICC管位置如上所述。\n- [全程D25] 检验组合: 浊度(TRUB)-尿液: clear；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 5.5；葡萄糖(Glu)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；虫卵-粪便: 未见虫卵（参考: 未见虫卵）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 30/μL；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；隐血(OB)-粪便: 阴性（参考: 阴性）；比重(SG)-尿液: 1.021；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-粪便: 棕色；酮体(KET)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D29] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；磷(P)-静脉血: 1.54mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.4U/L；总胆固醇(TC)-静脉血: 6.28mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.3pg；镁离子(Mg2+)-静脉血: 1.06mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=2.00)（参考: 阴性）；肌酐(Crea)-静脉血: 76.5umol/L；球蛋白(GLO)-静脉血: 31.62g/L；白蛋白(ALB)-静脉血: 48.1g/L；白细胞计数(WBC#)-静脉血: 5.310E9/L；血小板分布宽度(PDW)-静脉血: 14.3%；单核细胞百分比(Mono%)-静脉血: 0.011；淋巴细胞百分比(Lymph%)-静脉血: 0.128；血小板计数(PLT#)-静脉血: 18310E9/L；甘油三酯(TG)-静脉血: 1.83mmol/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；碱性磷酸酶(ALP)-静脉血: 76.4U/L；总胆汁酸(TBA)-静脉血: 14.5umol/L；总蛋白(TP)-静脉血: 79.72g/L；有核红细胞百分比(NRBC%)-静脉血: 0；红细胞比容(Hct)-静脉血: 44.3%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.7；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.42mmolL；胱抑素(Cys-C)-静脉血: 1.15mg/L；尿酸(UA)-静脉血: 254.8umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；间接胆红素(IBIL)-静脉血: 27.2umolL；钾离子(K+)-静脉血: 4.43mmol/L；乳酸脱氢酶(LDH)-静脉血: 200.6U/L；C-反应蛋白(CRP)-静脉血: 1.97mg/L；浊度(TRUB)-尿液: clear；酸碱度(pH)-尿液: 5.5；平均红细胞体积(MCV……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D26] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 化疗第2天，患者一般情况可，未诉特殊不适。查体：左侧颈部II区可扪及1个淋巴结，最大径2cm×2.5cm2，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]医生信息已隐藏示：目前暂未出现明显副反应，继续行化疗，密切观察病情。\n- [全程D29] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 化疗第5天，患者一般情况可。体查：KPS90分，张口门齿距4.5cm。鼻咽顶壁、顶后壁、双侧壁结节状肿物；左侧颈部II区可扪及1个淋巴结，最大径2cm×2cm2，无融合，质中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。复查血常规无明显异常。生化示：ALT 77.8U/L↑、IBIL27.20 umolL↑、TBIL35.1umol/L↑。[姓名已隐去]医生信息已隐藏示:第1程化疗结束，病情稳定，今日予办理出院。嘱其注意休息及营养支持，保持口腔清洁；出院后每周复查血常规2次，生化1次常规；按时[计划性表述已隐藏]下一程诱导化疗；若有不适，及时就诊。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 办理出院，暂不予保肝药物干预，嘱每周复查血常规和生化，按期返院行下一程诱导化疗。\nB. 暂缓出院，予静脉滴注保肝降酶药物，待转氨酶及胆红素完全恢复正常后出院，按期行下一程诱导化疗。\nC. 办理出院，开具口服保肝药物，终止后续诱导化疗计划，择期直接开始根治性同期放化疗。\nD. 办理出院，开具口服保肝药物，下一程诱导化疗直接将多西他赛及顺铂剂量下调20%。\nE. 办理出院，开具口服保肝药物，下一程诱导化疗方案更改为吉西他滨联合顺铂（GP方案）。\nF. 暂缓出院，请感染内科会诊排除乙肝病毒再激活，待专科意见明确后再决定后续抗肿瘤治疗计划。\nG. 办理出院，开具口服保肝药物，嘱每周复查血常规和生化，将下一程诱导化疗推迟1至2周进行。\nH. 办理出院，开具口服保肝药物，并预防性给予长效G-CSF支持，按期返院行下一程诱导化疗。\nI. 暂缓出院，按重度药物性肝损伤启动多学科联合诊疗，待肝功能好转后，按期行下一程诱导化疗。\nJ. 办理出院，开具口服保肝药物，下一程治疗停用尼妥珠单抗，仅行TPF方案诱导化疗。\nK. 办理出院，开具口服保肝药物（如多烯磷脂酰胆碱等），嘱每周复查血常规和生化，按期返院行下一程诱导化疗。\nL. 办理出院，开具口服保肝药物，下一程诱导化疗剔除氟尿嘧啶，改为多西他赛联合顺铂双药方案。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D24] 检验组合: 天门冬氨酸氨基转移酶(AST)-静脉血: 20.1U/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；血小板分布宽度(PDW)-静脉血: 11.9%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.1；尿素氮(BUN)-静脉血: 3.6mmol/L；磷(P)-静脉血: 0.97mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21.8U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.55；丙氨酸氨基转移酶(ALT)-静脉血: 41U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.19mmol/L；葡萄糖(Glu)-静脉血: 5.41mmol/L；白蛋白(ALB)-静脉血: 46.9g/L；白细胞计数(WBC#)-静脉血: 5.2810E9/L；红细胞计数(RBC#)-静脉血: 5.3910E12/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.6；尿酸(UA)-静脉血: 386.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 27U/L；C-反应蛋白(CRP)-静脉血: 4.25mg/L；钾离子(K+)-静脉血: 4.08mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.051；载脂蛋白B(apoB)-静脉血: 1.1g/L；球蛋白(GLO)-静脉血: 30.3g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；平均血小板体积(MPV)-静脉血: 10.3fL；总胆汁酸(TBA)-静脉血: 1.8umol/L；总蛋白(TP)-静脉血: 77.2g/L；间接胆红素(IBIL)-静脉血: 11.1umolL；甘油三酯(TG)-静脉血: 1.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.08g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.310E9/L；氯离子(Cl-)-静脉血: 102.2mmol/L；单核细胞百分比(Mono%)-静脉血: 0.072；碱性磷酸酶(ALP)-静脉血: 82.4U/L；总胆红素(TBIL)-静脉血: 15.1umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.49；总胆固醇(TC)-静脉血: 4.74mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.237；血小板比容……\n- [全程D25] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右侧约平T6椎体下缘水平，估计导管末端位于上腔静脉下段内。；检查结论: PICC管位置如上所述。\n- [全程D25] 检验组合: 浊度(TRUB)-尿液: clear；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 5.5；葡萄糖(Glu)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；虫卵-粪便: 未见虫卵（参考: 未见虫卵）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 30/μL；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；隐血(OB)-粪便: 阴性（参考: 阴性）；比重(SG)-尿液: 1.021；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-粪便: 棕色；酮体(KET)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D29] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；磷(P)-静脉血: 1.54mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.4U/L；总胆固醇(TC)-静脉血: 6.28mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.3pg；镁离子(Mg2+)-静脉血: 1.06mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=2.00)（参考: 阴性）；肌酐(Crea)-静脉血: 76.5umol/L；球蛋白(GLO)-静脉血: 31.62g/L；白蛋白(ALB)-静脉血: 48.1g/L；白细胞计数(WBC#)-静脉血: 5.310E9/L；血小板分布宽度(PDW)-静脉血: 14.3%；单核细胞百分比(Mono%)-静脉血: 0.011；淋巴细胞百分比(Lymph%)-静脉血: 0.128；血小板计数(PLT#)-静脉血: 18310E9/L；甘油三酯(TG)-静脉血: 1.83mmol/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；碱性磷酸酶(ALP)-静脉血: 76.4U/L；总胆汁酸(TBA)-静脉血: 14.5umol/L；总蛋白(TP)-静脉血: 79.72g/L；有核红细胞百分比(NRBC%)-静脉血: 0；红细胞比容(Hct)-静脉血: 44.3%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.7；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.42mmolL；胱抑素(Cys-C)-静脉血: 1.15mg/L；尿酸(UA)-静脉血: 254.8umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；间接胆红素(IBIL)-静脉血: 27.2umolL；钾离子(K+)-静脉血: 4.43mmol/L；乳酸脱氢酶(LDH)-静脉血: 200.6U/L；C-反应蛋白(CRP)-静脉血: 1.97mg/L；浊度(TRUB)-尿液: clear；酸碱度(pH)-尿液: 5.5；平均红细胞体积(MCV……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D26] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 化疗第2天，患者一般情况可，未诉特殊不适。查体：左侧颈部II区可扪及1个淋巴结，最大径2cm×2.5cm2，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]医生信息已隐藏示：目前暂未出现明显副反应，继续行化疗，密切观察病情。\n- [全程D29] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 化疗第5天，患者一般情况可。体查：KPS90分，张口门齿距4.5cm。鼻咽顶壁、顶后壁、双侧壁结节状肿物；左侧颈部II区可扪及1个淋巴结，最大径2cm×2cm2，无融合，质中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。复查血常规无明显异常。生化示：ALT 77.8U/L↑、IBIL27.20 umolL↑、TBIL35.1umol/L↑。[姓名已隐去]医生信息已隐藏示:第1程化疗结束，病情稳定，今日予办理出院。嘱其注意休息及营养支持，保持口腔清洁；出院后每周复查血常规2次，生化1次常规；按时[计划性表述已隐藏]下一程诱导化疗；若有不适，及时就诊。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 办理出院，暂不予保肝药物干预，嘱每周复查血常规和生化，按期返院行下一程诱导化疗。\nB. 暂缓出院，予静脉滴注保肝降酶药物，待转氨酶及胆红素完全恢复正常后出院，按期行下一程诱导化疗。\nC. 办理出院，开具口服保肝药物，终止后续诱导化疗计划，择期直接开始根治性同期放化疗。\nD. 办理出院，开具口服保肝药物，下一程诱导化疗直接将多西他赛及顺铂剂量下调20%。\nE. 办理出院，开具口服保肝药物，下一程诱导化疗方案更改为吉西他滨联合顺铂（GP方案）。\nF. 暂缓出院，请感染内科会诊排除乙肝病毒再激活，待专科意见明确后再决定后续抗肿瘤治疗计划。\nG. 办理出院，开具口服保肝药物，嘱每周复查血常规和生化，将下一程诱导化疗推迟1至2周进行。\nH. 办理出院，开具口服保肝药物，并预防性给予长效G-CSF支持，按期返院行下一程诱导化疗。\nI. 暂缓出院，按重度药物性肝损伤启动多学科联合诊疗，待肝功能好转后，按期行下一程诱导化疗。\nJ. 办理出院，开具口服保肝药物，下一程治疗停用尼妥珠单抗，仅行TPF方案诱导化疗。\nK. 办理出院，开具口服保肝药物（如多烯磷脂酰胆碱等），嘱每周复查血常规和生化，按期返院行下一程诱导化疗。\nL. 办理出院，开具口服保肝药物，下一程诱导化疗剔除氟尿嘧啶，改为多西他赛联合顺铂双药方案。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、蝶窦、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D24] 检验组合: 天门冬氨酸氨基转移酶(AST)-静脉血: 20.1U/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；血小板分布宽度(PDW)-静脉血: 11.9%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.1；尿素氮(BUN)-静脉血: 3.6mmol/L；磷(P)-静脉血: 0.97mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21.8U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.55；丙氨酸氨基转移酶(ALT)-静脉血: 41U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.19mmol/L；葡萄糖(Glu)-静脉血: 5.41mmol/L；白蛋白(ALB)-静脉血: 46.9g/L；白细胞计数(WBC#)-静脉血: 5.2810E9/L；红细胞计数(RBC#)-静脉血: 5.3910E12/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.6；尿酸(UA)-静脉血: 386.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 27U/L；C-反应蛋白(CRP)-静脉血: 4.25mg/L；钾离子(K+)-静脉血: 4.08mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.051；载脂蛋白B(apoB)-静脉血: 1.1g/L；球蛋白(GLO)-静脉血: 30.3g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；平均血小板体积(MPV)-静脉血: 10.3fL；总胆汁酸(TBA)-静脉血: 1.8umol/L；总蛋白(TP)-静脉血: 77.2g/L；间接胆红素(IBIL)-静脉血: 11.1umolL；甘油三酯(TG)-静脉血: 1.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.08g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.310E9/L；氯离子(Cl-)-静脉血: 102.2mmol/L；单核细胞百分比(Mono%)-静脉血: 0.072；碱性磷酸酶(ALP)-静脉血: 82.4U/L；总胆红素(TBIL)-静脉血: 15.1umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.49；总胆固醇(TC)-静脉血: 4.74mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.237；血小板比容……\n- [全程D25] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右侧约平T6椎体下缘水平，估计导管末端位于上腔静脉下段内。；检查结论: PICC管位置如上所述。\n- [全程D25] 检验组合: 浊度(TRUB)-尿液: clear；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 5.5；葡萄糖(Glu)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；虫卵-粪便: 未见虫卵（参考: 未见虫卵）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 30/μL；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；隐血(OB)-粪便: 阴性（参考: 阴性）；比重(SG)-尿液: 1.021；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-粪便: 棕色；酮体(KET)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D29] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；磷(P)-静脉血: 1.54mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.4U/L；总胆固醇(TC)-静脉血: 6.28mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.3pg；镁离子(Mg2+)-静脉血: 1.06mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=2.00)（参考: 阴性）；肌酐(Crea)-静脉血: 76.5umol/L；球蛋白(GLO)-静脉血: 31.62g/L；白蛋白(ALB)-静脉血: 48.1g/L；白细胞计数(WBC#)-静脉血: 5.310E9/L；血小板分布宽度(PDW)-静脉血: 14.3%；单核细胞百分比(Mono%)-静脉血: 0.011；淋巴细胞百分比(Lymph%)-静脉血: 0.128；血小板计数(PLT#)-静脉血: 18310E9/L；甘油三酯(TG)-静脉血: 1.83mmol/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；碱性磷酸酶(ALP)-静脉血: 76.4U/L；总胆汁酸(TBA)-静脉血: 14.5umol/L；总蛋白(TP)-静脉血: 79.72g/L；有核红细胞百分比(NRBC%)-静脉血: 0；红细胞比容(Hct)-静脉血: 44.3%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.7；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.42mmolL；胱抑素(Cys-C)-静脉血: 1.15mg/L；尿酸(UA)-静脉血: 254.8umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；间接胆红素(IBIL)-静脉血: 27.2umolL；钾离子(K+)-静脉血: 4.43mmol/L；乳酸脱氢酶(LDH)-静脉血: 200.6U/L；C-反应蛋白(CRP)-静脉血: 1.97mg/L；浊度(TRUB)-尿液: clear；酸碱度(pH)-尿液: 5.5；平均红细胞体积(MCV……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D26] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 化疗第2天，患者一般情况可，未诉特殊不适。查体：左侧颈部II区可扪及1个淋巴结，最大径2cm×2.5cm2，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]医生信息已隐藏示：目前暂未出现明显副反应，继续行化疗，密切观察病情。\n- [全程D29] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 化疗第5天，患者一般情况可。体查：KPS90分，张口门齿距4.5cm。鼻咽顶壁、顶后壁、双侧壁结节状肿物；左侧颈部II区可扪及1个淋巴结，最大径2cm×2cm2，无融合，质中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。复查血常规无明显异常。生化示：ALT 77.8U/L↑、IBIL27.20 umolL↑、TBIL35.1umol/L↑。[姓名已隐去]医生信息已隐藏示:第1程化疗结束，病情稳定，今日予办理出院。嘱其注意休息及营养支持，保持口腔清洁；出院后每周复查血常规2次，生化1次常规；按时[计划性表述已隐藏]下一程诱导化疗；若有不适，及时就诊。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 办理出院，暂不予保肝药物干预，嘱每周复查血常规和生化，按期返院行下一程诱导化疗。\nB. 暂缓出院，予静脉滴注保肝降酶药物，待转氨酶及胆红素完全恢复正常后出院，按期行下一程诱导化疗。\nC. 办理出院，开具口服保肝药物，终止后续诱导化疗计划，择期直接开始根治性同期放化疗。\nD. 办理出院，开具口服保肝药物，下一程诱导化疗直接将多西他赛及顺铂剂量下调20%。\nE. 办理出院，开具口服保肝药物，下一程诱导化疗方案更改为吉西他滨联合顺铂（GP方案）。\nF. 暂缓出院，请感染内科会诊排除乙肝病毒再激活，待专科意见明确后再决定后续抗肿瘤治疗计划。\nG. 办理出院，开具口服保肝药物，嘱每周复查血常规和生化，将下一程诱导化疗推迟1至2周进行。\nH. 办理出院，开具口服保肝药物，并预防性给予长效G-CSF支持，按期返院行下一程诱导化疗。\nI. 暂缓出院，按重度药物性肝损伤启动多学科联合诊疗，待肝功能好转后，按期行下一程诱导化疗。\nJ. 办理出院，开具口服保肝药物，下一程治疗停用尼妥珠单抗，仅行TPF方案诱导化疗。\nK. 办理出院，开具口服保肝药物（如多烯磷脂酰胆碱等），嘱每周复查血常规和生化，按期返院行下一程诱导化疗。\nL. 办理出院，开具口服保肝药物，下一程诱导化疗剔除氟尿嘧啶，改为多西他赛联合顺铂双药方案。\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-ad5a1060b6801c87debff9d0","patient_id":"patient-5731cc38ced94b2ee39c442a","turn_id":"turn06","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"L","gold_action":"开具口服升白细胞药物（如咖啡酸片）、保肝药物（如复方甘草酸苷）及抑酸护胃、促动力药物进行对症支持。","options":[{"letter":"A","text":"予以皮下注射重组人粒细胞集落刺激因子（G-CSF），并静脉滴注异甘草酸镁进行保肝治疗。","is_gold":false},{"letter":"B","text":"嘱多饮水及注意休息，暂不予药物干预，定期门诊复查血常规及肝肾功能以评估毒性。","is_gold":false},{"letter":"C","text":"开具口服升白细胞药物（如咖啡酸片）及保肝药物（如复方甘草酸苷），暂不使用护胃止吐药物。","is_gold":false},{"letter":"D","text":"立即收治入院，予以静脉滴注质子泵抑制剂、止吐药及保肝药物，并密切监测血常规变化。","is_gold":false},{"letter":"E","text":"开具口服抑酸护胃及促胃动力药物（如艾司奥美拉唑、多潘立酮），暂不处理白细胞及肝功能异常。","is_gold":false},{"letter":"F","text":"提前开始第二周期TPF诱导化疗，并预防性给予长效G-CSF及静脉保肝药物支持治疗。","is_gold":false},{"letter":"G","text":"开具口服保肝药物（如复方甘草酸苷）及护胃止吐药物，暂不予口服升白细胞药物进行干预。","is_gold":false},{"letter":"H","text":"予以皮下注射重组人促红素（EPO），并开具口服保肝、护胃及促动力药物进行对症支持。","is_gold":false},{"letter":"I","text":"开具口服升白细胞药物（如咖啡酸片）、抑酸护胃及促胃动力药物，暂不予保肝药物治疗。","is_gold":false},{"letter":"J","text":"安排骨髓穿刺检查以明确白细胞减少原因，同时开具口服保肝及护胃药物进行对症支持。","is_gold":false},{"letter":"K","text":"门诊静脉推注地塞米松及昂丹司琼强化止吐，并开具口服保肝及升白药物进行对症支持。","is_gold":false},{"letter":"L","text":"开具口服升白细胞药物（如咖啡酸片）、保肝药物（如复方甘草酸苷）及抑酸护胃、促动力药物进行对症支持。","is_gold":true}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、蝶窦、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 左耳闷涉不适1年，涕血2月。；某次就诊时间特来我院门诊进一步诊治，完善相关检查，诊断明确后，今日入院系统治疗。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,左耳闷胀感,涕血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。有吸烟史1年，日7支；少量饮酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：90次/分，R：20次/分，BP：131/86mmHg,Ht：171cm，Wt：76.5kg，BSA1.89m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶壁、顶后壁、双侧壁结节状肿物；左侧颈部II区可扪及1个淋巴结，最大径2cm×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.51；平均红细胞血红蛋白含量(MCH)-静脉血: 27.4pg；磷(P)-静脉血: 0.9mmol/L；直接胆红素(DBIL)-静脉血: 4.7umol/L；凝血酶时间(TT)-静脉血: 22.7sec.；D-二聚体(D-Dimer)-静脉血: 0.29ug/ml；活化部分凝血活酶时间(APTT)-静脉血: 38.5sec.；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.04S/CO；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.82mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.6；单核细胞百分比(Mono%)-静脉血: 0.047；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；间接胆红素(IBIL)-静脉血: 10.5umolL；白蛋白(ALB)-静脉血: 48g/L；氯离子(Cl-)-静脉血: 101.7mmol/L；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.718；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.1COI；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；白细胞计数(WBC#)-静脉血: 6.9510E9/L；红细胞比容(Hct)-静脉血: 46.8%；尿酸(UA)-静脉血: 431.8umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 81.8umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 26mmol/L；血小板分布宽度(PDW)-静脉血: 11.2%；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.04S/CO；平均血小板体积(MPV)-静脉血: 9.7fL；中性粒细胞计数(Neut#)-静脉血: 510E9/L；载脂蛋白B(apoB)-静脉血: 0.96g/L；凝血酶原时间(PT)-静脉血: 11.8sec.；钠离子(Na+)-静脉血: 138.7mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；甘油三酯(TG)-静脉血: 2.2mmol/L；总胆红素(TBIL)-……\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 Ⅱ、Ⅲ、aVF、V5、V6导联T波低平\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、后壁及双侧壁增厚，见软组织肿物向鼻咽腔内突出，在T1WI上呈等信号，在T2WI上呈稍高信号，增强扫描明显强化。双侧咽隐窝变浅，见软组织肿物填充。病灶侵犯左侧后鼻孔，侵犯左侧腭帆张提肌、左侧翼内肌头部、左侧咽旁脂肪间隙，侵犯蝶窦左侧份及左侧翼腭窝，侵犯左侧破裂孔、左侧海绵窦。 右侧咽旁间隙及双侧颈动脉鞘区血管未见明显异常。右侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常。口咽双侧壁未见增厚。 斜坡、左侧岩尖、蝶骨基底部、左侧翼突区骨质信号减低，增强扫描明显强化。 右侧海绵窦形态正常，未见增宽。 双侧筛窦、左侧上颌窦、蝶窦及右侧乳突粘膜增厚，左侧乳突内见大量长分期信息见历史辅助诊断节点长分期信息见历史辅助诊断节点信号分泌物。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变。 左侧咽后可见数个小淋巴结，较大短径约4mm；右侧咽后可见小淋巴结，短径约2mm。左颈II、III区可见数个淋巴结，最大约21mm×15mm，部分呈相互融合改变，边界欠清，增强扫描可见明显强化。右颈II、III区可见数个淋巴结，最大约12mm×7mm，边界清。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 左颈II、III区淋巴结肿大，考虑转移。 左侧咽后、右颈II、III区淋巴结，不排除转移。 右侧咽后小淋巴结。 鼻窦炎。双侧乳突炎。\n- [全程D5] 检验组合: EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；Rh血型-静脉血: 阳性；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；ABO血型-静脉血: O\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D24] 检验组合: 天门冬氨酸氨基转移酶(AST)-静脉血: 20.1U/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；血小板分布宽度(PDW)-静脉血: 11.9%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.1；尿素氮(BUN)-静脉血: 3.6mmol/L；磷(P)-静脉血: 0.97mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21.8U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.55；丙氨酸氨基转移酶(ALT)-静脉血: 41U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.19mmol/L；葡萄糖(Glu)-静脉血: 5.41mmol/L；白蛋白(ALB)-静脉血: 46.9g/L；白细胞计数(WBC#)-静脉血: 5.2810E9/L；红细胞计数(RBC#)-静脉血: 5.3910E12/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.6；尿酸(UA)-静脉血: 386.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 27U/L；C-反应蛋白(CRP)-静脉血: 4.25mg/L；钾离子(K+)-静脉血: 4.08mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.051；载脂蛋白B(apoB)-静脉血: 1.1g/L；球蛋白(GLO)-静脉血: 30.3g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；平均血小板体积(MPV)-静脉血: 10.3fL；总胆汁酸(TBA)-静脉血: 1.8umol/L；总蛋白(TP)-静脉血: 77.2g/L；间接胆红素(IBIL)-静脉血: 11.1umolL；甘油三酯(TG)-静脉血: 1.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.08g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.310E9/L；氯离子(Cl-)-静脉血: 102.2mmol/L；单核细胞百分比(Mono%)-静脉血: 0.072；碱性磷酸酶(ALP)-静脉血: 82.4U/L；总胆红素(TBIL)-静脉血: 15.1umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.49；总胆固醇(TC)-静脉血: 4.74mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.237；血小板比容……\n- [全程D25] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右侧约平T6椎体下缘水平，估计导管末端位于上腔静脉下段内。；检查结论: PICC管位置如上所述。\n- [全程D25] 检验组合: 浊度(TRUB)-尿液: clear；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 5.5；葡萄糖(Glu)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；虫卵-粪便: 未见虫卵（参考: 未见虫卵）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 30/μL；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；隐血(OB)-粪便: 阴性（参考: 阴性）；比重(SG)-尿液: 1.021；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-粪便: 棕色；酮体(KET)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D29] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；磷(P)-静脉血: 1.54mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.4U/L；总胆固醇(TC)-静脉血: 6.28mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.3pg；镁离子(Mg2+)-静脉血: 1.06mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=2.00)（参考: 阴性）；肌酐(Crea)-静脉血: 76.5umol/L；球蛋白(GLO)-静脉血: 31.62g/L；白蛋白(ALB)-静脉血: 48.1g/L；白细胞计数(WBC#)-静脉血: 5.310E9/L；血小板分布宽度(PDW)-静脉血: 14.3%；单核细胞百分比(Mono%)-静脉血: 0.011；淋巴细胞百分比(Lymph%)-静脉血: 0.128；血小板计数(PLT#)-静脉血: 18310E9/L；甘油三酯(TG)-静脉血: 1.83mmol/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；碱性磷酸酶(ALP)-静脉血: 76.4U/L；总胆汁酸(TBA)-静脉血: 14.5umol/L；总蛋白(TP)-静脉血: 79.72g/L；有核红细胞百分比(NRBC%)-静脉血: 0；红细胞比容(Hct)-静脉血: 44.3%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.7；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.42mmolL；胱抑素(Cys-C)-静脉血: 1.15mg/L；尿酸(UA)-静脉血: 254.8umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；间接胆红素(IBIL)-静脉血: 27.2umolL；钾离子(K+)-静脉血: 4.43mmol/L；乳酸脱氢酶(LDH)-静脉血: 200.6U/L；C-反应蛋白(CRP)-静脉血: 1.97mg/L；浊度(TRUB)-尿液: clear；酸碱度(pH)-尿液: 5.5；平均红细胞体积(MCV……\n- [全程D32] 检验组合: 间接胆红素(IBIL)-静脉血: 13.9umolL；肌酐(Crea)-静脉血: 83.3umol/L；碱性磷酸酶(ALP)-静脉血: 80.7U/L；镁离子(Mg2+)-静脉血: 1.02mmol/L；总胆红素(TBIL)-静脉血: 19.3umol/L；胱抑素(Cys-C)-静脉血: 0.87mg/L；尿素氮(BUN)-静脉血: 4.5mmol/L；载脂蛋白B(apoB)-静脉血: 1.13g/L；白细胞计数(WBC#)-静脉血: 3.0510E9/L；总胆汁酸(TBA)-静脉血: 1.7umol/L；血小板分布宽度(PDW)-静脉血: 12.5%；血小板比容-静脉血: 17%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.01；单核细胞百分比(Mono%)-静脉血: 0.013；平均血小板体积(MPV)-静脉血: 10.9fL；乳酸脱氢酶(LDH)-静脉血: 186U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.36；平均红细胞血红蛋白含量(MCH)-静脉血: 27.7pg；平均红细胞体积(MCV)-静脉血: 81.7fL；单核细胞计数(Mono#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 15410E9/L；氯离子(Cl-)-静脉血: 96.9mmol/L；钾离子(K+)-静脉血: 3.58mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.4mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 28U/L；甘油三酯(TG)-静脉血: 1.46mmol/L；红细胞比容(Hct)-静脉血: 44.3%；中性粒细胞百分比(Neut%)-静脉血: 0.748；总钙(Ca)-静脉血: 2.27mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 34.1；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 25.5U/L；葡萄糖(Glu)-静脉血: 5.55mmol/L；尿酸(UA)-静脉血: 325.7umol/L；直接胆红素(DBIL)-静脉血: 5.4umol/L；钠离子(Na+)-静脉血: 133.9mmol/L；大血小板百分比(P-LCR%)-静脉血: 31.7%；红细胞体积分布宽度CV(RDW-CV)-静……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D26] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 化疗第2天，患者一般情况可，未诉特殊不适。查体：左侧颈部II区可扪及1个淋巴结，最大径2cm×2.5cm2，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]医生信息已隐藏示：目前暂未出现明显副反应，继续行化疗，密切观察病情。\n- [全程D29] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 化疗第5天，患者一般情况可。体查：KPS90分，张口门齿距4.5cm。鼻咽顶壁、顶后壁、双侧壁结节状肿物；左侧颈部II区可扪及1个淋巴结，最大径2cm×2cm2，无融合，质中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。复查血常规无明显异常。生化示：ALT 77.8U/L↑、IBIL27.20 umolL↑、TBIL35.1umol/L↑。[姓名已隐去]医生信息已隐藏示:第1程化疗结束，病情稳定，今日予办理出院。嘱其注意休息及营养支持，保持口腔清洁；出院后每周复查血常规2次，生化1次常规；按时[计划性表述已隐藏]下一程诱导化疗；若有不适，及时就诊。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 予以皮下注射重组人粒细胞集落刺激因子（G-CSF），并静脉滴注异甘草酸镁进行保肝治疗。\nB. 嘱多饮水及注意休息，暂不予药物干预，定期门诊复查血常规及肝肾功能以评估毒性。\nC. 开具口服升白细胞药物（如咖啡酸片）及保肝药物（如复方甘草酸苷），暂不使用护胃止吐药物。\nD. 立即收治入院，予以静脉滴注质子泵抑制剂、止吐药及保肝药物，并密切监测血常规变化。\nE. 开具口服抑酸护胃及促胃动力药物（如艾司奥美拉唑、多潘立酮），暂不处理白细胞及肝功能异常。\nF. 提前开始第二周期TPF诱导化疗，并预防性给予长效G-CSF及静脉保肝药物支持治疗。\nG. 开具口服保肝药物（如复方甘草酸苷）及护胃止吐药物，暂不予口服升白细胞药物进行干预。\nH. 予以皮下注射重组人促红素（EPO），并开具口服保肝、护胃及促动力药物进行对症支持。\nI. 开具口服升白细胞药物（如咖啡酸片）、抑酸护胃及促胃动力药物，暂不予保肝药物治疗。\nJ. 安排骨髓穿刺检查以明确白细胞减少原因，同时开具口服保肝及护胃药物进行对症支持。\nK. 门诊静脉推注地塞米松及昂丹司琼强化止吐，并开具口服保肝及升白药物进行对症支持。\nL. 开具口服升白细胞药物（如咖啡酸片）、保肝药物（如复方甘草酸苷）及抑酸护胃、促动力药物进行对症支持。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D32] 检验组合: 间接胆红素(IBIL)-静脉血: 13.9umolL；肌酐(Crea)-静脉血: 83.3umol/L；碱性磷酸酶(ALP)-静脉血: 80.7U/L；镁离子(Mg2+)-静脉血: 1.02mmol/L；总胆红素(TBIL)-静脉血: 19.3umol/L；胱抑素(Cys-C)-静脉血: 0.87mg/L；尿素氮(BUN)-静脉血: 4.5mmol/L；载脂蛋白B(apoB)-静脉血: 1.13g/L；白细胞计数(WBC#)-静脉血: 3.0510E9/L；总胆汁酸(TBA)-静脉血: 1.7umol/L；血小板分布宽度(PDW)-静脉血: 12.5%；血小板比容-静脉血: 17%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.01；单核细胞百分比(Mono%)-静脉血: 0.013；平均血小板体积(MPV)-静脉血: 10.9fL；乳酸脱氢酶(LDH)-静脉血: 186U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.36；平均红细胞血红蛋白含量(MCH)-静脉血: 27.7pg；平均红细胞体积(MCV)-静脉血: 81.7fL；单核细胞计数(Mono#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 15410E9/L；氯离子(Cl-)-静脉血: 96.9mmol/L；钾离子(K+)-静脉血: 3.58mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.4mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 28U/L；甘油三酯(TG)-静脉血: 1.46mmol/L；红细胞比容(Hct)-静脉血: 44.3%；中性粒细胞百分比(Neut%)-静脉血: 0.748；总钙(Ca)-静脉血: 2.27mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 34.1；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 25.5U/L；葡萄糖(Glu)-静脉血: 5.55mmol/L；尿酸(UA)-静脉血: 325.7umol/L；直接胆红素(DBIL)-静脉血: 5.4umol/L；钠离子(Na+)-静脉血: 133.9mmol/L；大血小板百分比(P-LCR%)-静脉血: 31.7%；红细胞体积分布宽度CV(RDW-CV)-静……\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 予以皮下注射重组人粒细胞集落刺激因子（G-CSF），并静脉滴注异甘草酸镁进行保肝治疗。\nB. 嘱多饮水及注意休息，暂不予药物干预，定期门诊复查血常规及肝肾功能以评估毒性。\nC. 开具口服升白细胞药物（如咖啡酸片）及保肝药物（如复方甘草酸苷），暂不使用护胃止吐药物。\nD. 立即收治入院，予以静脉滴注质子泵抑制剂、止吐药及保肝药物，并密切监测血常规变化。\nE. 开具口服抑酸护胃及促胃动力药物（如艾司奥美拉唑、多潘立酮），暂不处理白细胞及肝功能异常。\nF. 提前开始第二周期TPF诱导化疗，并预防性给予长效G-CSF及静脉保肝药物支持治疗。\nG. 开具口服保肝药物（如复方甘草酸苷）及护胃止吐药物，暂不予口服升白细胞药物进行干预。\nH. 予以皮下注射重组人促红素（EPO），并开具口服保肝、护胃及促动力药物进行对症支持。\nI. 开具口服升白细胞药物（如咖啡酸片）、抑酸护胃及促胃动力药物，暂不予保肝药物治疗。\nJ. 安排骨髓穿刺检查以明确白细胞减少原因，同时开具口服保肝及护胃药物进行对症支持。\nK. 门诊静脉推注地塞米松及昂丹司琼强化止吐，并开具口服保肝及升白药物进行对症支持。\nL. 开具口服升白细胞药物（如咖啡酸片）、保肝药物（如复方甘草酸苷）及抑酸护胃、促动力药物进行对症支持。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、蝶窦、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D32] 检验组合: 间接胆红素(IBIL)-静脉血: 13.9umolL；肌酐(Crea)-静脉血: 83.3umol/L；碱性磷酸酶(ALP)-静脉血: 80.7U/L；镁离子(Mg2+)-静脉血: 1.02mmol/L；总胆红素(TBIL)-静脉血: 19.3umol/L；胱抑素(Cys-C)-静脉血: 0.87mg/L；尿素氮(BUN)-静脉血: 4.5mmol/L；载脂蛋白B(apoB)-静脉血: 1.13g/L；白细胞计数(WBC#)-静脉血: 3.0510E9/L；总胆汁酸(TBA)-静脉血: 1.7umol/L；血小板分布宽度(PDW)-静脉血: 12.5%；血小板比容-静脉血: 17%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.01；单核细胞百分比(Mono%)-静脉血: 0.013；平均血小板体积(MPV)-静脉血: 10.9fL；乳酸脱氢酶(LDH)-静脉血: 186U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.36；平均红细胞血红蛋白含量(MCH)-静脉血: 27.7pg；平均红细胞体积(MCV)-静脉血: 81.7fL；单核细胞计数(Mono#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 15410E9/L；氯离子(Cl-)-静脉血: 96.9mmol/L；钾离子(K+)-静脉血: 3.58mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.4mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 28U/L；甘油三酯(TG)-静脉血: 1.46mmol/L；红细胞比容(Hct)-静脉血: 44.3%；中性粒细胞百分比(Neut%)-静脉血: 0.748；总钙(Ca)-静脉血: 2.27mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 34.1；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 25.5U/L；葡萄糖(Glu)-静脉血: 5.55mmol/L；尿酸(UA)-静脉血: 325.7umol/L；直接胆红素(DBIL)-静脉血: 5.4umol/L；钠离子(Na+)-静脉血: 133.9mmol/L；大血小板百分比(P-LCR%)-静脉血: 31.7%；红细胞体积分布宽度CV(RDW-CV)-静……\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 予以皮下注射重组人粒细胞集落刺激因子（G-CSF），并静脉滴注异甘草酸镁进行保肝治疗。\nB. 嘱多饮水及注意休息，暂不予药物干预，定期门诊复查血常规及肝肾功能以评估毒性。\nC. 开具口服升白细胞药物（如咖啡酸片）及保肝药物（如复方甘草酸苷），暂不使用护胃止吐药物。\nD. 立即收治入院，予以静脉滴注质子泵抑制剂、止吐药及保肝药物，并密切监测血常规变化。\nE. 开具口服抑酸护胃及促胃动力药物（如艾司奥美拉唑、多潘立酮），暂不处理白细胞及肝功能异常。\nF. 提前开始第二周期TPF诱导化疗，并预防性给予长效G-CSF及静脉保肝药物支持治疗。\nG. 开具口服保肝药物（如复方甘草酸苷）及护胃止吐药物，暂不予口服升白细胞药物进行干预。\nH. 予以皮下注射重组人促红素（EPO），并开具口服保肝、护胃及促动力药物进行对症支持。\nI. 开具口服升白细胞药物（如咖啡酸片）、抑酸护胃及促胃动力药物，暂不予保肝药物治疗。\nJ. 安排骨髓穿刺检查以明确白细胞减少原因，同时开具口服保肝及护胃药物进行对症支持。\nK. 门诊静脉推注地塞米松及昂丹司琼强化止吐，并开具口服保肝及升白药物进行对症支持。\nL. 开具口服升白细胞药物（如咖啡酸片）、保肝药物（如复方甘草酸苷）及抑酸护胃、促动力药物进行对症支持。\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-b10ed2b10a17f1626353b252","patient_id":"patient-5731cc38ced94b2ee39c442a","turn_id":"turn07","turn_position":5,"turn_type":"recurrence_or_salvage_decision","gold_letter":"A","gold_action":"结束诱导化疗，序贯开展根治性放射治疗。","options":[{"letter":"A","text":"结束诱导化疗，序贯开展根治性放射治疗","is_gold":true},{"letter":"B","text":"继续原方案（TPF联合尼妥珠单抗）诱导化疗至第6周期后再行放射治疗","is_gold":false},{"letter":"C","text":"更换为GP方案（吉西他滨联合顺铂）继续诱导化疗2个周期","is_gold":false},{"letter":"D","text":"行鼻咽原发灶及双侧颈部淋巴结根治性切除术","is_gold":false},{"letter":"E","text":"行双侧颈部淋巴结清扫术，术后序贯鼻咽局部放射治疗","is_gold":false},{"letter":"F","text":"加用PD-1抑制剂联合原方案继续诱导化疗2个周期","is_gold":false},{"letter":"G","text":"暂停抗肿瘤治疗，进入定期随访观察阶段","is_gold":false},{"letter":"H","text":"完善全身PET-CT重新分期后再决定后续局部治疗方案","is_gold":false},{"letter":"I","text":"仅行根治性放射治疗，处理鼻咽原发灶，颈部病灶继续随访观察","is_gold":false},{"letter":"J","text":"结束诱导化疗，序贯开展尼妥珠单抗单药靶向维持治疗","is_gold":false},{"letter":"K","text":"行放射性粒子植入术，处理鼻咽及颈部残留病灶直接","is_gold":false},{"letter":"L","text":"采用卡培他滨单药维持化疗，推迟局部放射治疗","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、蝶窦、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 左耳闷涉不适1年，涕血2月。；某次就诊时间特来我院门诊进一步诊治，完善相关检查，诊断明确后，今日入院系统治疗。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,左耳闷胀感,涕血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。有吸烟史1年，日7支；少量饮酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：90次/分，R：20次/分，BP：131/86mmHg,Ht：171cm，Wt：76.5kg，BSA1.89m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶壁、顶后壁、双侧壁结节状肿物；左侧颈部II区可扪及1个淋巴结，最大径2cm×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.51；平均红细胞血红蛋白含量(MCH)-静脉血: 27.4pg；磷(P)-静脉血: 0.9mmol/L；直接胆红素(DBIL)-静脉血: 4.7umol/L；凝血酶时间(TT)-静脉血: 22.7sec.；D-二聚体(D-Dimer)-静脉血: 0.29ug/ml；活化部分凝血活酶时间(APTT)-静脉血: 38.5sec.；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.04S/CO；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.82mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.6；单核细胞百分比(Mono%)-静脉血: 0.047；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；间接胆红素(IBIL)-静脉血: 10.5umolL；白蛋白(ALB)-静脉血: 48g/L；氯离子(Cl-)-静脉血: 101.7mmol/L；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.718；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.1COI；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；白细胞计数(WBC#)-静脉血: 6.9510E9/L；红细胞比容(Hct)-静脉血: 46.8%；尿酸(UA)-静脉血: 431.8umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 81.8umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 26mmol/L；血小板分布宽度(PDW)-静脉血: 11.2%；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.04S/CO；平均血小板体积(MPV)-静脉血: 9.7fL；中性粒细胞计数(Neut#)-静脉血: 510E9/L；载脂蛋白B(apoB)-静脉血: 0.96g/L；凝血酶原时间(PT)-静脉血: 11.8sec.；钠离子(Na+)-静脉血: 138.7mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；甘油三酯(TG)-静脉血: 2.2mmol/L；总胆红素(TBIL)-……\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 Ⅱ、Ⅲ、aVF、V5、V6导联T波低平\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、后壁及双侧壁增厚，见软组织肿物向鼻咽腔内突出，在T1WI上呈等信号，在T2WI上呈稍高信号，增强扫描明显强化。双侧咽隐窝变浅，见软组织肿物填充。病灶侵犯左侧后鼻孔，侵犯左侧腭帆张提肌、左侧翼内肌头部、左侧咽旁脂肪间隙，侵犯蝶窦左侧份及左侧翼腭窝，侵犯左侧破裂孔、左侧海绵窦。 右侧咽旁间隙及双侧颈动脉鞘区血管未见明显异常。右侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常。口咽双侧壁未见增厚。 斜坡、左侧岩尖、蝶骨基底部、左侧翼突区骨质信号减低，增强扫描明显强化。 右侧海绵窦形态正常，未见增宽。 双侧筛窦、左侧上颌窦、蝶窦及右侧乳突粘膜增厚，左侧乳突内见大量长分期信息见历史辅助诊断节点长分期信息见历史辅助诊断节点信号分泌物。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变。 左侧咽后可见数个小淋巴结，较大短径约4mm；右侧咽后可见小淋巴结，短径约2mm。左颈II、III区可见数个淋巴结，最大约21mm×15mm，部分呈相互融合改变，边界欠清，增强扫描可见明显强化。右颈II、III区可见数个淋巴结，最大约12mm×7mm，边界清。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 左颈II、III区淋巴结肿大，考虑转移。 左侧咽后、右颈II、III区淋巴结，不排除转移。 右侧咽后小淋巴结。 鼻窦炎。双侧乳突炎。\n- [全程D5] 检验组合: EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；Rh血型-静脉血: 阳性；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；ABO血型-静脉血: O\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D24] 检验组合: 天门冬氨酸氨基转移酶(AST)-静脉血: 20.1U/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；血小板分布宽度(PDW)-静脉血: 11.9%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.1；尿素氮(BUN)-静脉血: 3.6mmol/L；磷(P)-静脉血: 0.97mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21.8U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.55；丙氨酸氨基转移酶(ALT)-静脉血: 41U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.19mmol/L；葡萄糖(Glu)-静脉血: 5.41mmol/L；白蛋白(ALB)-静脉血: 46.9g/L；白细胞计数(WBC#)-静脉血: 5.2810E9/L；红细胞计数(RBC#)-静脉血: 5.3910E12/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.6；尿酸(UA)-静脉血: 386.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 27U/L；C-反应蛋白(CRP)-静脉血: 4.25mg/L；钾离子(K+)-静脉血: 4.08mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.051；载脂蛋白B(apoB)-静脉血: 1.1g/L；球蛋白(GLO)-静脉血: 30.3g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；平均血小板体积(MPV)-静脉血: 10.3fL；总胆汁酸(TBA)-静脉血: 1.8umol/L；总蛋白(TP)-静脉血: 77.2g/L；间接胆红素(IBIL)-静脉血: 11.1umolL；甘油三酯(TG)-静脉血: 1.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.08g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.310E9/L；氯离子(Cl-)-静脉血: 102.2mmol/L；单核细胞百分比(Mono%)-静脉血: 0.072；碱性磷酸酶(ALP)-静脉血: 82.4U/L；总胆红素(TBIL)-静脉血: 15.1umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.49；总胆固醇(TC)-静脉血: 4.74mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.237；血小板比容……\n- [全程D25] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右侧约平T6椎体下缘水平，估计导管末端位于上腔静脉下段内。；检查结论: PICC管位置如上所述。\n- [全程D25] 检验组合: 浊度(TRUB)-尿液: clear；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 5.5；葡萄糖(Glu)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；虫卵-粪便: 未见虫卵（参考: 未见虫卵）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 30/μL；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；隐血(OB)-粪便: 阴性（参考: 阴性）；比重(SG)-尿液: 1.021；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-粪便: 棕色；酮体(KET)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D29] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；磷(P)-静脉血: 1.54mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.4U/L；总胆固醇(TC)-静脉血: 6.28mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.3pg；镁离子(Mg2+)-静脉血: 1.06mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=2.00)（参考: 阴性）；肌酐(Crea)-静脉血: 76.5umol/L；球蛋白(GLO)-静脉血: 31.62g/L；白蛋白(ALB)-静脉血: 48.1g/L；白细胞计数(WBC#)-静脉血: 5.310E9/L；血小板分布宽度(PDW)-静脉血: 14.3%；单核细胞百分比(Mono%)-静脉血: 0.011；淋巴细胞百分比(Lymph%)-静脉血: 0.128；血小板计数(PLT#)-静脉血: 18310E9/L；甘油三酯(TG)-静脉血: 1.83mmol/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；碱性磷酸酶(ALP)-静脉血: 76.4U/L；总胆汁酸(TBA)-静脉血: 14.5umol/L；总蛋白(TP)-静脉血: 79.72g/L；有核红细胞百分比(NRBC%)-静脉血: 0；红细胞比容(Hct)-静脉血: 44.3%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.7；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.42mmolL；胱抑素(Cys-C)-静脉血: 1.15mg/L；尿酸(UA)-静脉血: 254.8umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；间接胆红素(IBIL)-静脉血: 27.2umolL；钾离子(K+)-静脉血: 4.43mmol/L；乳酸脱氢酶(LDH)-静脉血: 200.6U/L；C-反应蛋白(CRP)-静脉血: 1.97mg/L；浊度(TRUB)-尿液: clear；酸碱度(pH)-尿液: 5.5；平均红细胞体积(MCV……\n- [全程D32] 检验组合: 间接胆红素(IBIL)-静脉血: 13.9umolL；肌酐(Crea)-静脉血: 83.3umol/L；碱性磷酸酶(ALP)-静脉血: 80.7U/L；镁离子(Mg2+)-静脉血: 1.02mmol/L；总胆红素(TBIL)-静脉血: 19.3umol/L；胱抑素(Cys-C)-静脉血: 0.87mg/L；尿素氮(BUN)-静脉血: 4.5mmol/L；载脂蛋白B(apoB)-静脉血: 1.13g/L；白细胞计数(WBC#)-静脉血: 3.0510E9/L；总胆汁酸(TBA)-静脉血: 1.7umol/L；血小板分布宽度(PDW)-静脉血: 12.5%；血小板比容-静脉血: 17%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.01；单核细胞百分比(Mono%)-静脉血: 0.013；平均血小板体积(MPV)-静脉血: 10.9fL；乳酸脱氢酶(LDH)-静脉血: 186U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.36；平均红细胞血红蛋白含量(MCH)-静脉血: 27.7pg；平均红细胞体积(MCV)-静脉血: 81.7fL；单核细胞计数(Mono#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 15410E9/L；氯离子(Cl-)-静脉血: 96.9mmol/L；钾离子(K+)-静脉血: 3.58mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.4mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 28U/L；甘油三酯(TG)-静脉血: 1.46mmol/L；红细胞比容(Hct)-静脉血: 44.3%；中性粒细胞百分比(Neut%)-静脉血: 0.748；总钙(Ca)-静脉血: 2.27mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 34.1；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 25.5U/L；葡萄糖(Glu)-静脉血: 5.55mmol/L；尿酸(UA)-静脉血: 325.7umol/L；直接胆红素(DBIL)-静脉血: 5.4umol/L；钠离子(Na+)-静脉血: 133.9mmol/L；大血小板百分比(P-LCR%)-静脉血: 31.7%；红细胞体积分布宽度CV(RDW-CV)-静……\n- [全程D50] 检验组合: 碱性磷酸酶(ALP)-静脉血: 79.1U/L；总胆红素(TBIL)-静脉血: 18.4umol/L；血小板比容-静脉血: 24%；磷(P)-静脉血: 1.77mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=4.50)（参考: 阴性）；白蛋白(ALB)-静脉血: 44g/L；C-反应蛋白(CRP)-静脉血: 2.48mg/L；球蛋白(GLO)-静脉血: 30.07g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 5.18mmol/L；总胆汁酸(TBA)-静脉血: 3umol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.9；平均红细胞血红蛋白浓度(MCHC)-静脉血: 332g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0；淋巴细胞百分比(Lymph%)-静脉血: 0.212；胱抑素(Cys-C)-静脉血: 1.1mg/L；乳酸脱氢酶(LDH)-静脉血: 209.6U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 51.1U/L；氯离子(Cl-)-静脉血: 99.5mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 45.8U/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.7mmol/L；载脂蛋白B(apoB)-静脉血: 1.54g/L；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.726；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.18mmolL；镁离子(Mg2+)-静脉血: 0.94mmol/L；钾离子(K+)-静脉血: 4.21mmol/L；阴离子间隙(AG)-静脉血: 15；单核细胞百分比(Mono%)-静脉血: 0.06；直接胆红素(DBIL)-静脉血: 3.3umol/L；总蛋白(TP)-静脉血: 74.07g/L；红细胞比容(Hct)-静脉血: 41.9%；血小板计数(PLT#)-静脉血: 24410E9/L；EB病毒Zta蛋白抗体IgA(EBV-Zta-IgA)-静脉血: 阳性(SCO=5.00)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 32.5U/L；载脂蛋白AI(ap……\n- [全程D53] 检验组合: 单核细胞计数(Mono#)-静脉血: 0.210E9/L；平均血小板体积(MPV)-静脉血: 10.1fL；平均红细胞血红蛋白含量(MCH)-静脉血: 27.5pg；氯离子(Cl-)-静脉血: 102.2mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；血小板分布宽度(PDW)-静脉血: 11.6%；钾离子(K+)-静脉血: 4.44mmol/L；血红蛋白(Hb)-静脉血: 146g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.4U/L；血小板比容-静脉血: 24%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 23610E9/L；肌酐(Crea)-静脉血: 78umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.97mmolL；直接胆红素(DBIL)-静脉血: 2.9umol/L；镁离子(Mg2+)-静脉血: 0.89mmol/L；白细胞计数(WBC#)-静脉血: 4.8410E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.9；有核红细胞计数(NRBC#)-静脉血: 010E9/L；尿酸(UA)-静脉血: 396.5umol/L；白蛋白(ALB)-静脉血: 43.6g/L；有核红细胞百分比(NRBC%)-静脉血: 0；单核细胞百分比(Mono%)-静脉血: 0.041；甘油三酯(TG)-静脉血: 1.5mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.5；总胆汁酸(TBA)-静脉血: 3.2umol/L；总钙(Ca)-静脉血: 2.29mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 29.4U/L；碱性磷酸酶(ALP)-静脉血: 88.9U/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.5mmol/L；平均红细胞体积(MCV)-静脉血: 84fL；丙氨酸氨基转移酶(ALT)-静脉血: 34.7U/L；红细胞比容(Hct)-静脉血: 44.5%；尿素氮(BUN)-静脉血: 6.4mmol/L；胱抑素(Cys-C)-……\n- [全程D64] 检验组合: 磷(P)-静脉血: 1.1mmol/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；平均红细胞血红蛋白含量(MCH)-静脉血: 27.3pg；平均血小板体积(MPV)-静脉血: 9.4fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.4；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；总钙(Ca)-静脉血: 2.24mmol/L；总蛋白(TP)-静脉血: 73.3g/L；氯离子(Cl-)-静脉血: 104.7mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 46.1U/L；单核细胞百分比(Mono%)-静脉血: 0.094；α-L-岩藻糖苷酶(AFU)-静脉血: 31.3U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.93mmol/L；尿素氮(BUN)-静脉血: 6.4mmol/L；总胆固醇(TC)-静脉血: 5.7mmol/L；血小板计数(PLT#)-静脉血: 15510E9/L；球蛋白(GLO)-静脉血: 28g/L；直接胆红素(DBIL)-静脉血: 2.3umol/L；总胆汁酸(TBA)-静脉血: 1.8umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.09mmolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.74；载脂蛋白B(apoB)-静脉血: 1.34g/L；钠离子(Na+)-静脉血: 141.6mmol/L；C-反应蛋白(CRP)-静脉血: 4.1mg/L；血小板比容-静脉血: 15%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；葡萄糖(Glu)-静脉血: 5.4mmol/L；白蛋白(ALB)-静脉血: 45.3g/L；有核红细胞计数(NRBC#)-静脉血: 0.0110E9/L；尿酸(UA)-静脉血: 511.6umol/L；甘油三酯(TG)-静脉血: 1.82mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.5mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 26.8U/L；大血小板百分比(P-LCR%)-静脉血: 19.5%；中性粒细胞计数(Neut#)-静脉血: 3.110E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 319g/L；乳酸脱氢酶(……\n- [全程D71] 检验组合: γ-谷氨酰基转移酶(GGT)-静脉血: 47U/L；尿酸(UA)-静脉血: 339.1umol/L；阴离子间隙(AG)-静脉血: 16.7；白细胞计数(WBC#)-静脉血: 5.8510E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 27.4pg；有核红细胞计数(NRBC#)-静脉血: 010E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.156；EB病毒Zta蛋白抗体IgA(EBV-Zta-IgA)-静脉血: 阳性(SCO=4.00)（参考: 阴性）；磷(P)-静脉血: 1.25mmol/L；肌酐(Crea)-静脉血: 80.9umol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:20（参考: 阴性）；单核细胞百分比(Mono%)-静脉血: 0.029；中性粒细胞计数(Neut#)-静脉血: 4.810E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.7mmol/L；红细胞比容(Hct)-静脉血: 43.3%；总胆红素(TBIL)-静脉血: 18.3umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 6.04mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；平均血小板体积(MPV)-静脉血: 10.9fL；碱性磷酸酶(ALP)-静脉血: 81.8U/L；葡萄糖(Glu)-静脉血: 5.79mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.6；间接胆红素(IBIL)-静脉血: 15umolL；α-L-岩藻糖苷酶(AFU)-静脉血: 41.6U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.48mmolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.3；载脂蛋白AI(apoAI)-静脉血: 1.28g/L；甘油三酯(TG)-静脉血: 2.29mmol/L；平均红细胞体积(MCV)-静脉血: 83.1fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板比容-静脉血: 17%；球蛋白(GLO)-静脉血: 29.1g/L；载脂蛋白B(apoB)-静脉血: 1.64g/L；乳酸脱氢酶(LDH)-静脉血: 229.2U/L；镁离子(Mg2+)-静脉血: 0.76mmol……\n- [全程D75] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后，对比某次就诊时间片： 鼻咽腔稍狭窄，鼻咽左顶壁及左侧壁增厚，在T1WI上呈等信号，在T2WI上呈稍高信号，增强扫描明显强化，较前明显缩小，左侧破裂孔、海绵窦、翼腭窝及蝶窦左份仍可见软组织灶，边界欠清，明显强化。右侧咽隐窝存在，左侧咽隐窝变浅 左侧腭帆张提肌、左侧翼内肌上缘信号不均匀，可见强化。 左侧咽旁间隙变窄，右侧咽旁间隙及双侧颈动脉鞘区血管未见明显异常。 右侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常。口咽双侧壁未见增厚。 斜坡、左侧岩尖、蝶骨基底部、左侧翼突区骨质信号减低，增强扫描明显强化。 右侧海绵窦形态正常，未见增宽。 双侧筛窦、左侧上颌窦、蝶窦粘膜增厚，左侧乳突内见少量信号分泌物。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变。 双侧咽后未见明确肿大淋巴结。 双颈II区及左颈III区可见数个淋巴结，最大约14mm×5mm，边界欠清，增强扫描可见明显强化。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。 所示脑实质未见明确异常。；检查结论: 鼻咽癌化疗后，范围较前明显缩小。 颅底骨质破坏。 双颈淋巴结，考虑转移，较前缩小、减少。 双侧咽后未见肿大淋巴结。 鼻窦炎。 左侧乳突炎。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D26] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 化疗第2天，患者一般情况可，未诉特殊不适。查体：左侧颈部II区可扪及1个淋巴结，最大径2cm×2.5cm2，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]医生信息已隐藏示：目前暂未出现明显副反应，继续行化疗，密切观察病情。\n- [全程D29] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 化疗第5天，患者一般情况可。体查：KPS90分，张口门齿距4.5cm。鼻咽顶壁、顶后壁、双侧壁结节状肿物；左侧颈部II区可扪及1个淋巴结，最大径2cm×2cm2，无融合，质中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。复查血常规无明显异常。生化示：ALT 77.8U/L↑、IBIL27.20 umolL↑、TBIL35.1umol/L↑。[姓名已隐去]医生信息已隐藏示:第1程化疗结束，病情稳定，今日予办理出院。嘱其注意休息及营养支持，保持口腔清洁；出院后每周复查血常规2次，生化1次常规；按时[计划性表述已隐藏]下一程诱导化疗；若有不适，及时就诊。\n- [全程D65] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日患者症状体征基本同前，无诉其余特殊不适。[姓名已隐去]医生信息已隐藏示：患者诊断明确，复查血常规、生化常规无明显化疗禁忌症，拟按期于某次就诊时间开始行TPF诱导化疗， 具体用药：DOC60mg/㎡d1+DDP60mg/㎡ d2+5-FU2.5g/㎡civ48hQ3w，并指示化疗期间给予护肝、护胃、止吐及营养支持治疗，昨日已行泰欣生靶向治疗，密切观察患者病情变化。\n- [全程D66] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，未诉恶心、呕吐、腹痛、腹泻等不适，大小便正常。[姓名已隐去]医生信息已隐藏出，患者目前一般情况可，予明日按TPF方案行第3周期化疗，注意化疗结束后复查血、生化常规，及时对症处理。\n- [全程D69] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日为化疗第3天，诉间有恶心，无呕吐，无咳嗽、咳痰，无头痛、头晕，大小便正常。[姓名已隐去]医生信息已隐藏出，患者化疗后出现胃肠道反应I度，予继续对症处理，减轻化疗后反应。\n- [全程D71] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日患者症状体征基本同前，无诉其余特殊不适。今日复查血常规及生化常规未见明显异常。[姓名已隐去]医生信息已隐藏示：患者病情平稳，一般情况良好，目前予完善相关放疗前准备，今日予办理出院。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 结束诱导化疗，序贯开展根治性放射治疗\nB. 继续原方案（TPF联合尼妥珠单抗）诱导化疗至第6周期后再行放射治疗\nC. 更换为GP方案（吉西他滨联合顺铂）继续诱导化疗2个周期\nD. 行鼻咽原发灶及双侧颈部淋巴结根治性切除术\nE. 行双侧颈部淋巴结清扫术，术后序贯鼻咽局部放射治疗\nF. 加用PD-1抑制剂联合原方案继续诱导化疗2个周期\nG. 暂停抗肿瘤治疗，进入定期随访观察阶段\nH. 完善全身PET-CT重新分期后再决定后续局部治疗方案\nI. 仅行根治性放射治疗，处理鼻咽原发灶，颈部病灶继续随访观察\nJ. 结束诱导化疗，序贯开展尼妥珠单抗单药靶向维持治疗\nK. 行放射性粒子植入术，处理鼻咽及颈部残留病灶直接\nL. 采用卡培他滨单药维持化疗，推迟局部放射治疗\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D50] 检验组合: 碱性磷酸酶(ALP)-静脉血: 79.1U/L；总胆红素(TBIL)-静脉血: 18.4umol/L；血小板比容-静脉血: 24%；磷(P)-静脉血: 1.77mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=4.50)（参考: 阴性）；白蛋白(ALB)-静脉血: 44g/L；C-反应蛋白(CRP)-静脉血: 2.48mg/L；球蛋白(GLO)-静脉血: 30.07g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 5.18mmol/L；总胆汁酸(TBA)-静脉血: 3umol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.9；平均红细胞血红蛋白浓度(MCHC)-静脉血: 332g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0；淋巴细胞百分比(Lymph%)-静脉血: 0.212；胱抑素(Cys-C)-静脉血: 1.1mg/L；乳酸脱氢酶(LDH)-静脉血: 209.6U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 51.1U/L；氯离子(Cl-)-静脉血: 99.5mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 45.8U/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.7mmol/L；载脂蛋白B(apoB)-静脉血: 1.54g/L；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.726；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.18mmolL；镁离子(Mg2+)-静脉血: 0.94mmol/L；钾离子(K+)-静脉血: 4.21mmol/L；阴离子间隙(AG)-静脉血: 15；单核细胞百分比(Mono%)-静脉血: 0.06；直接胆红素(DBIL)-静脉血: 3.3umol/L；总蛋白(TP)-静脉血: 74.07g/L；红细胞比容(Hct)-静脉血: 41.9%；血小板计数(PLT#)-静脉血: 24410E9/L；EB病毒Zta蛋白抗体IgA(EBV-Zta-IgA)-静脉血: 阳性(SCO=5.00)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 32.5U/L；载脂蛋白AI(ap……\n- [全程D53] 检验组合: 单核细胞计数(Mono#)-静脉血: 0.210E9/L；平均血小板体积(MPV)-静脉血: 10.1fL；平均红细胞血红蛋白含量(MCH)-静脉血: 27.5pg；氯离子(Cl-)-静脉血: 102.2mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；血小板分布宽度(PDW)-静脉血: 11.6%；钾离子(K+)-静脉血: 4.44mmol/L；血红蛋白(Hb)-静脉血: 146g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.4U/L；血小板比容-静脉血: 24%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 23610E9/L；肌酐(Crea)-静脉血: 78umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.97mmolL；直接胆红素(DBIL)-静脉血: 2.9umol/L；镁离子(Mg2+)-静脉血: 0.89mmol/L；白细胞计数(WBC#)-静脉血: 4.8410E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.9；有核红细胞计数(NRBC#)-静脉血: 010E9/L；尿酸(UA)-静脉血: 396.5umol/L；白蛋白(ALB)-静脉血: 43.6g/L；有核红细胞百分比(NRBC%)-静脉血: 0；单核细胞百分比(Mono%)-静脉血: 0.041；甘油三酯(TG)-静脉血: 1.5mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.5；总胆汁酸(TBA)-静脉血: 3.2umol/L；总钙(Ca)-静脉血: 2.29mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 29.4U/L；碱性磷酸酶(ALP)-静脉血: 88.9U/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.5mmol/L；平均红细胞体积(MCV)-静脉血: 84fL；丙氨酸氨基转移酶(ALT)-静脉血: 34.7U/L；红细胞比容(Hct)-静脉血: 44.5%；尿素氮(BUN)-静脉血: 6.4mmol/L；胱抑素(Cys-C)-……\n- [全程D64] 检验组合: 磷(P)-静脉血: 1.1mmol/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；平均红细胞血红蛋白含量(MCH)-静脉血: 27.3pg；平均血小板体积(MPV)-静脉血: 9.4fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.4；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；总钙(Ca)-静脉血: 2.24mmol/L；总蛋白(TP)-静脉血: 73.3g/L；氯离子(Cl-)-静脉血: 104.7mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 46.1U/L；单核细胞百分比(Mono%)-静脉血: 0.094；α-L-岩藻糖苷酶(AFU)-静脉血: 31.3U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.93mmol/L；尿素氮(BUN)-静脉血: 6.4mmol/L；总胆固醇(TC)-静脉血: 5.7mmol/L；血小板计数(PLT#)-静脉血: 15510E9/L；球蛋白(GLO)-静脉血: 28g/L；直接胆红素(DBIL)-静脉血: 2.3umol/L；总胆汁酸(TBA)-静脉血: 1.8umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.09mmolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.74；载脂蛋白B(apoB)-静脉血: 1.34g/L；钠离子(Na+)-静脉血: 141.6mmol/L；C-反应蛋白(CRP)-静脉血: 4.1mg/L；血小板比容-静脉血: 15%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；葡萄糖(Glu)-静脉血: 5.4mmol/L；白蛋白(ALB)-静脉血: 45.3g/L；有核红细胞计数(NRBC#)-静脉血: 0.0110E9/L；尿酸(UA)-静脉血: 511.6umol/L；甘油三酯(TG)-静脉血: 1.82mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.5mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 26.8U/L；大血小板百分比(P-LCR%)-静脉血: 19.5%；中性粒细胞计数(Neut#)-静脉血: 3.110E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 319g/L；乳酸脱氢酶(……\n- [全程D71] 检验组合: γ-谷氨酰基转移酶(GGT)-静脉血: 47U/L；尿酸(UA)-静脉血: 339.1umol/L；阴离子间隙(AG)-静脉血: 16.7；白细胞计数(WBC#)-静脉血: 5.8510E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 27.4pg；有核红细胞计数(NRBC#)-静脉血: 010E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.156；EB病毒Zta蛋白抗体IgA(EBV-Zta-IgA)-静脉血: 阳性(SCO=4.00)（参考: 阴性）；磷(P)-静脉血: 1.25mmol/L；肌酐(Crea)-静脉血: 80.9umol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:20（参考: 阴性）；单核细胞百分比(Mono%)-静脉血: 0.029；中性粒细胞计数(Neut#)-静脉血: 4.810E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.7mmol/L；红细胞比容(Hct)-静脉血: 43.3%；总胆红素(TBIL)-静脉血: 18.3umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 6.04mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；平均血小板体积(MPV)-静脉血: 10.9fL；碱性磷酸酶(ALP)-静脉血: 81.8U/L；葡萄糖(Glu)-静脉血: 5.79mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.6；间接胆红素(IBIL)-静脉血: 15umolL；α-L-岩藻糖苷酶(AFU)-静脉血: 41.6U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.48mmolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.3；载脂蛋白AI(apoAI)-静脉血: 1.28g/L；甘油三酯(TG)-静脉血: 2.29mmol/L；平均红细胞体积(MCV)-静脉血: 83.1fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板比容-静脉血: 17%；球蛋白(GLO)-静脉血: 29.1g/L；载脂蛋白B(apoB)-静脉血: 1.64g/L；乳酸脱氢酶(LDH)-静脉血: 229.2U/L；镁离子(Mg2+)-静脉血: 0.76mmol……\n- [全程D75] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后，对比某次就诊时间片： 鼻咽腔稍狭窄，鼻咽左顶壁及左侧壁增厚，在T1WI上呈等信号，在T2WI上呈稍高信号，增强扫描明显强化，较前明显缩小，左侧破裂孔、海绵窦、翼腭窝及蝶窦左份仍可见软组织灶，边界欠清，明显强化。右侧咽隐窝存在，左侧咽隐窝变浅 左侧腭帆张提肌、左侧翼内肌上缘信号不均匀，可见强化。 左侧咽旁间隙变窄，右侧咽旁间隙及双侧颈动脉鞘区血管未见明显异常。 右侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常。口咽双侧壁未见增厚。 斜坡、左侧岩尖、蝶骨基底部、左侧翼突区骨质信号减低，增强扫描明显强化。 右侧海绵窦形态正常，未见增宽。 双侧筛窦、左侧上颌窦、蝶窦粘膜增厚，左侧乳突内见少量信号分泌物。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变。 双侧咽后未见明确肿大淋巴结。 双颈II区及左颈III区可见数个淋巴结，最大约14mm×5mm，边界欠清，增强扫描可见明显强化。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。 所示脑实质未见明确异常。；检查结论: 鼻咽癌化疗后，范围较前明显缩小。 颅底骨质破坏。 双颈淋巴结，考虑转移，较前缩小、减少。 双侧咽后未见肿大淋巴结。 鼻窦炎。 左侧乳突炎。\n\n【既往治疗与反应】\n- [全程D65] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日患者症状体征基本同前，无诉其余特殊不适。[姓名已隐去]医生信息已隐藏示：患者诊断明确，复查血常规、生化常规无明显化疗禁忌症，拟按期于某次就诊时间开始行TPF诱导化疗， 具体用药：DOC60mg/㎡d1+DDP60mg/㎡ d2+5-FU2.5g/㎡civ48hQ3w，并指示化疗期间给予护肝、护胃、止吐及营养支持治疗，昨日已行泰欣生靶向治疗，密切观察患者病情变化。\n- [全程D66] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，未诉恶心、呕吐、腹痛、腹泻等不适，大小便正常。[姓名已隐去]医生信息已隐藏出，患者目前一般情况可，予明日按TPF方案行第3周期化疗，注意化疗结束后复查血、生化常规，及时对症处理。\n- [全程D69] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日为化疗第3天，诉间有恶心，无呕吐，无咳嗽、咳痰，无头痛、头晕，大小便正常。[姓名已隐去]医生信息已隐藏出，患者化疗后出现胃肠道反应I度，予继续对症处理，减轻化疗后反应。\n- [全程D71] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日患者症状体征基本同前，无诉其余特殊不适。今日复查血常规及生化常规未见明显异常。[姓名已隐去]医生信息已隐藏示：患者病情平稳，一般情况良好，目前予完善相关放疗前准备，今日予办理出院。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 结束诱导化疗，序贯开展根治性放射治疗\nB. 继续原方案（TPF联合尼妥珠单抗）诱导化疗至第6周期后再行放射治疗\nC. 更换为GP方案（吉西他滨联合顺铂）继续诱导化疗2个周期\nD. 行鼻咽原发灶及双侧颈部淋巴结根治性切除术\nE. 行双侧颈部淋巴结清扫术，术后序贯鼻咽局部放射治疗\nF. 加用PD-1抑制剂联合原方案继续诱导化疗2个周期\nG. 暂停抗肿瘤治疗，进入定期随访观察阶段\nH. 完善全身PET-CT重新分期后再决定后续局部治疗方案\nI. 仅行根治性放射治疗，处理鼻咽原发灶，颈部病灶继续随访观察\nJ. 结束诱导化疗，序贯开展尼妥珠单抗单药靶向维持治疗\nK. 行放射性粒子植入术，处理鼻咽及颈部残留病灶直接\nL. 采用卡培他滨单药维持化疗，推迟局部放射治疗\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、蝶窦、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D50] 检验组合: 碱性磷酸酶(ALP)-静脉血: 79.1U/L；总胆红素(TBIL)-静脉血: 18.4umol/L；血小板比容-静脉血: 24%；磷(P)-静脉血: 1.77mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=4.50)（参考: 阴性）；白蛋白(ALB)-静脉血: 44g/L；C-反应蛋白(CRP)-静脉血: 2.48mg/L；球蛋白(GLO)-静脉血: 30.07g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 5.18mmol/L；总胆汁酸(TBA)-静脉血: 3umol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.9；平均红细胞血红蛋白浓度(MCHC)-静脉血: 332g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0；淋巴细胞百分比(Lymph%)-静脉血: 0.212；胱抑素(Cys-C)-静脉血: 1.1mg/L；乳酸脱氢酶(LDH)-静脉血: 209.6U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 51.1U/L；氯离子(Cl-)-静脉血: 99.5mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 45.8U/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.7mmol/L；载脂蛋白B(apoB)-静脉血: 1.54g/L；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.726；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.18mmolL；镁离子(Mg2+)-静脉血: 0.94mmol/L；钾离子(K+)-静脉血: 4.21mmol/L；阴离子间隙(AG)-静脉血: 15；单核细胞百分比(Mono%)-静脉血: 0.06；直接胆红素(DBIL)-静脉血: 3.3umol/L；总蛋白(TP)-静脉血: 74.07g/L；红细胞比容(Hct)-静脉血: 41.9%；血小板计数(PLT#)-静脉血: 24410E9/L；EB病毒Zta蛋白抗体IgA(EBV-Zta-IgA)-静脉血: 阳性(SCO=5.00)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 32.5U/L；载脂蛋白AI(ap……\n- [全程D53] 检验组合: 单核细胞计数(Mono#)-静脉血: 0.210E9/L；平均血小板体积(MPV)-静脉血: 10.1fL；平均红细胞血红蛋白含量(MCH)-静脉血: 27.5pg；氯离子(Cl-)-静脉血: 102.2mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；血小板分布宽度(PDW)-静脉血: 11.6%；钾离子(K+)-静脉血: 4.44mmol/L；血红蛋白(Hb)-静脉血: 146g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.4U/L；血小板比容-静脉血: 24%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 23610E9/L；肌酐(Crea)-静脉血: 78umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.97mmolL；直接胆红素(DBIL)-静脉血: 2.9umol/L；镁离子(Mg2+)-静脉血: 0.89mmol/L；白细胞计数(WBC#)-静脉血: 4.8410E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.9；有核红细胞计数(NRBC#)-静脉血: 010E9/L；尿酸(UA)-静脉血: 396.5umol/L；白蛋白(ALB)-静脉血: 43.6g/L；有核红细胞百分比(NRBC%)-静脉血: 0；单核细胞百分比(Mono%)-静脉血: 0.041；甘油三酯(TG)-静脉血: 1.5mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.5；总胆汁酸(TBA)-静脉血: 3.2umol/L；总钙(Ca)-静脉血: 2.29mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 29.4U/L；碱性磷酸酶(ALP)-静脉血: 88.9U/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.5mmol/L；平均红细胞体积(MCV)-静脉血: 84fL；丙氨酸氨基转移酶(ALT)-静脉血: 34.7U/L；红细胞比容(Hct)-静脉血: 44.5%；尿素氮(BUN)-静脉血: 6.4mmol/L；胱抑素(Cys-C)-……\n- [全程D64] 检验组合: 磷(P)-静脉血: 1.1mmol/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；平均红细胞血红蛋白含量(MCH)-静脉血: 27.3pg；平均血小板体积(MPV)-静脉血: 9.4fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.4；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；总钙(Ca)-静脉血: 2.24mmol/L；总蛋白(TP)-静脉血: 73.3g/L；氯离子(Cl-)-静脉血: 104.7mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 46.1U/L；单核细胞百分比(Mono%)-静脉血: 0.094；α-L-岩藻糖苷酶(AFU)-静脉血: 31.3U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.93mmol/L；尿素氮(BUN)-静脉血: 6.4mmol/L；总胆固醇(TC)-静脉血: 5.7mmol/L；血小板计数(PLT#)-静脉血: 15510E9/L；球蛋白(GLO)-静脉血: 28g/L；直接胆红素(DBIL)-静脉血: 2.3umol/L；总胆汁酸(TBA)-静脉血: 1.8umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.09mmolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.74；载脂蛋白B(apoB)-静脉血: 1.34g/L；钠离子(Na+)-静脉血: 141.6mmol/L；C-反应蛋白(CRP)-静脉血: 4.1mg/L；血小板比容-静脉血: 15%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；葡萄糖(Glu)-静脉血: 5.4mmol/L；白蛋白(ALB)-静脉血: 45.3g/L；有核红细胞计数(NRBC#)-静脉血: 0.0110E9/L；尿酸(UA)-静脉血: 511.6umol/L；甘油三酯(TG)-静脉血: 1.82mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.5mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 26.8U/L；大血小板百分比(P-LCR%)-静脉血: 19.5%；中性粒细胞计数(Neut#)-静脉血: 3.110E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 319g/L；乳酸脱氢酶(……\n- [全程D71] 检验组合: γ-谷氨酰基转移酶(GGT)-静脉血: 47U/L；尿酸(UA)-静脉血: 339.1umol/L；阴离子间隙(AG)-静脉血: 16.7；白细胞计数(WBC#)-静脉血: 5.8510E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 27.4pg；有核红细胞计数(NRBC#)-静脉血: 010E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.156；EB病毒Zta蛋白抗体IgA(EBV-Zta-IgA)-静脉血: 阳性(SCO=4.00)（参考: 阴性）；磷(P)-静脉血: 1.25mmol/L；肌酐(Crea)-静脉血: 80.9umol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:20（参考: 阴性）；单核细胞百分比(Mono%)-静脉血: 0.029；中性粒细胞计数(Neut#)-静脉血: 4.810E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.7mmol/L；红细胞比容(Hct)-静脉血: 43.3%；总胆红素(TBIL)-静脉血: 18.3umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 6.04mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；平均血小板体积(MPV)-静脉血: 10.9fL；碱性磷酸酶(ALP)-静脉血: 81.8U/L；葡萄糖(Glu)-静脉血: 5.79mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.6；间接胆红素(IBIL)-静脉血: 15umolL；α-L-岩藻糖苷酶(AFU)-静脉血: 41.6U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.48mmolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.3；载脂蛋白AI(apoAI)-静脉血: 1.28g/L；甘油三酯(TG)-静脉血: 2.29mmol/L；平均红细胞体积(MCV)-静脉血: 83.1fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板比容-静脉血: 17%；球蛋白(GLO)-静脉血: 29.1g/L；载脂蛋白B(apoB)-静脉血: 1.64g/L；乳酸脱氢酶(LDH)-静脉血: 229.2U/L；镁离子(Mg2+)-静脉血: 0.76mmol……\n- [全程D75] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后，对比某次就诊时间片： 鼻咽腔稍狭窄，鼻咽左顶壁及左侧壁增厚，在T1WI上呈等信号，在T2WI上呈稍高信号，增强扫描明显强化，较前明显缩小，左侧破裂孔、海绵窦、翼腭窝及蝶窦左份仍可见软组织灶，边界欠清，明显强化。右侧咽隐窝存在，左侧咽隐窝变浅 左侧腭帆张提肌、左侧翼内肌上缘信号不均匀，可见强化。 左侧咽旁间隙变窄，右侧咽旁间隙及双侧颈动脉鞘区血管未见明显异常。 右侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常。口咽双侧壁未见增厚。 斜坡、左侧岩尖、蝶骨基底部、左侧翼突区骨质信号减低，增强扫描明显强化。 右侧海绵窦形态正常，未见增宽。 双侧筛窦、左侧上颌窦、蝶窦粘膜增厚，左侧乳突内见少量信号分泌物。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变。 双侧咽后未见明确肿大淋巴结。 双颈II区及左颈III区可见数个淋巴结，最大约14mm×5mm，边界欠清，增强扫描可见明显强化。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。 所示脑实质未见明确异常。；检查结论: 鼻咽癌化疗后，范围较前明显缩小。 颅底骨质破坏。 双颈淋巴结，考虑转移，较前缩小、减少。 双侧咽后未见肿大淋巴结。 鼻窦炎。 左侧乳突炎。\n\n【既往治疗与反应】\n- [全程D65] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日患者症状体征基本同前，无诉其余特殊不适。[姓名已隐去]医生信息已隐藏示：患者诊断明确，复查血常规、生化常规无明显化疗禁忌症，拟按期于某次就诊时间开始行TPF诱导化疗， 具体用药：DOC60mg/㎡d1+DDP60mg/㎡ d2+5-FU2.5g/㎡civ48hQ3w，并指示化疗期间给予护肝、护胃、止吐及营养支持治疗，昨日已行泰欣生靶向治疗，密切观察患者病情变化。\n- [全程D66] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，未诉恶心、呕吐、腹痛、腹泻等不适，大小便正常。[姓名已隐去]医生信息已隐藏出，患者目前一般情况可，予明日按TPF方案行第3周期化疗，注意化疗结束后复查血、生化常规，及时对症处理。\n- [全程D69] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日为化疗第3天，诉间有恶心，无呕吐，无咳嗽、咳痰，无头痛、头晕，大小便正常。[姓名已隐去]医生信息已隐藏出，患者化疗后出现胃肠道反应I度，予继续对症处理，减轻化疗后反应。\n- [全程D71] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日患者症状体征基本同前，无诉其余特殊不适。今日复查血常规及生化常规未见明显异常。[姓名已隐去]医生信息已隐藏示：患者病情平稳，一般情况良好，目前予完善相关放疗前准备，今日予办理出院。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 结束诱导化疗，序贯开展根治性放射治疗\nB. 继续原方案（TPF联合尼妥珠单抗）诱导化疗至第6周期后再行放射治疗\nC. 更换为GP方案（吉西他滨联合顺铂）继续诱导化疗2个周期\nD. 行鼻咽原发灶及双侧颈部淋巴结根治性切除术\nE. 行双侧颈部淋巴结清扫术，术后序贯鼻咽局部放射治疗\nF. 加用PD-1抑制剂联合原方案继续诱导化疗2个周期\nG. 暂停抗肿瘤治疗，进入定期随访观察阶段\nH. 完善全身PET-CT重新分期后再决定后续局部治疗方案\nI. 仅行根治性放射治疗，处理鼻咽原发灶，颈部病灶继续随访观察\nJ. 结束诱导化疗，序贯开展尼妥珠单抗单药靶向维持治疗\nK. 行放射性粒子植入术，处理鼻咽及颈部残留病灶直接\nL. 采用卡培他滨单药维持化疗，推迟局部放射治疗\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-95ccde5ff1e164e8d7edc6f5","patient_id":"patient-5731cc38ced94b2ee39c442a","turn_id":"turn08","turn_position":6,"turn_type":"recurrence_or_salvage_decision","gold_letter":"B","gold_action":"行鼻咽及颈部MRI增强扫描评估近期疗效，继续定期随访","options":[{"letter":"A","text":"行全身PET-CT扫描评估全身肿瘤负荷及近期疗效","is_gold":false},{"letter":"B","text":"行鼻咽及颈部MRI增强扫描评估近期疗效，继续定期随访","is_gold":true},{"letter":"C","text":"行鼻咽镜检查并对原发灶区域进行常规多点活检排除残留","is_gold":false},{"letter":"D","text":"启动卡培他滨节拍性维持化疗降低远处转移风险","is_gold":false},{"letter":"E","text":"启动PD-1抑制剂维持治疗巩固靶向联合放疗的近期疗效","is_gold":false},{"letter":"F","text":"仅定期复查血常规、生化及EBV-DNA，暂不复查局部影像学","is_gold":false},{"letter":"G","text":"直接安排鼻咽原发灶内镜下挽救性切除手术","is_gold":false},{"letter":"H","text":"直接安排鼻咽原发灶挽救性立体定向放疗","is_gold":false},{"letter":"I","text":"行胸部及全腹部增强CT扫描，暂缓头颈部局部影像学复查","is_gold":false},{"letter":"J","text":"行全身骨扫描及头颅MRI排除无症状的远处器官转移风险","is_gold":false},{"letter":"K","text":"启动吉西他滨联合顺铂方案全身化疗清除潜在微小转移灶","is_gold":false},{"letter":"L","text":"继续使用尼妥珠单抗单药维持治疗至满一年巩固局部疗效","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、蝶窦、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 左耳闷涉不适1年，涕血2月。；某次就诊时间特来我院门诊进一步诊治，完善相关检查，诊断明确后，今日入院系统治疗。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,左耳闷胀感,涕血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。有吸烟史1年，日7支；少量饮酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：90次/分，R：20次/分，BP：131/86mmHg,Ht：171cm，Wt：76.5kg，BSA1.89m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶壁、顶后壁、双侧壁结节状肿物；左侧颈部II区可扪及1个淋巴结，最大径2cm×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.51；平均红细胞血红蛋白含量(MCH)-静脉血: 27.4pg；磷(P)-静脉血: 0.9mmol/L；直接胆红素(DBIL)-静脉血: 4.7umol/L；凝血酶时间(TT)-静脉血: 22.7sec.；D-二聚体(D-Dimer)-静脉血: 0.29ug/ml；活化部分凝血活酶时间(APTT)-静脉血: 38.5sec.；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.04S/CO；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.82mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.6；单核细胞百分比(Mono%)-静脉血: 0.047；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；间接胆红素(IBIL)-静脉血: 10.5umolL；白蛋白(ALB)-静脉血: 48g/L；氯离子(Cl-)-静脉血: 101.7mmol/L；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.718；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.1COI；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；白细胞计数(WBC#)-静脉血: 6.9510E9/L；红细胞比容(Hct)-静脉血: 46.8%；尿酸(UA)-静脉血: 431.8umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 81.8umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 26mmol/L；血小板分布宽度(PDW)-静脉血: 11.2%；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.04S/CO；平均血小板体积(MPV)-静脉血: 9.7fL；中性粒细胞计数(Neut#)-静脉血: 510E9/L；载脂蛋白B(apoB)-静脉血: 0.96g/L；凝血酶原时间(PT)-静脉血: 11.8sec.；钠离子(Na+)-静脉血: 138.7mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；甘油三酯(TG)-静脉血: 2.2mmol/L；总胆红素(TBIL)-……\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 Ⅱ、Ⅲ、aVF、V5、V6导联T波低平\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、后壁及双侧壁增厚，见软组织肿物向鼻咽腔内突出，在T1WI上呈等信号，在T2WI上呈稍高信号，增强扫描明显强化。双侧咽隐窝变浅，见软组织肿物填充。病灶侵犯左侧后鼻孔，侵犯左侧腭帆张提肌、左侧翼内肌头部、左侧咽旁脂肪间隙，侵犯蝶窦左侧份及左侧翼腭窝，侵犯左侧破裂孔、左侧海绵窦。 右侧咽旁间隙及双侧颈动脉鞘区血管未见明显异常。右侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常。口咽双侧壁未见增厚。 斜坡、左侧岩尖、蝶骨基底部、左侧翼突区骨质信号减低，增强扫描明显强化。 右侧海绵窦形态正常，未见增宽。 双侧筛窦、左侧上颌窦、蝶窦及右侧乳突粘膜增厚，左侧乳突内见大量长分期信息见历史辅助诊断节点长分期信息见历史辅助诊断节点信号分泌物。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变。 左侧咽后可见数个小淋巴结，较大短径约4mm；右侧咽后可见小淋巴结，短径约2mm。左颈II、III区可见数个淋巴结，最大约21mm×15mm，部分呈相互融合改变，边界欠清，增强扫描可见明显强化。右颈II、III区可见数个淋巴结，最大约12mm×7mm，边界清。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 左颈II、III区淋巴结肿大，考虑转移。 左侧咽后、右颈II、III区淋巴结，不排除转移。 右侧咽后小淋巴结。 鼻窦炎。双侧乳突炎。\n- [全程D5] 检验组合: EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；Rh血型-静脉血: 阳性；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；ABO血型-静脉血: O\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D24] 检验组合: 天门冬氨酸氨基转移酶(AST)-静脉血: 20.1U/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；血小板分布宽度(PDW)-静脉血: 11.9%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.1；尿素氮(BUN)-静脉血: 3.6mmol/L；磷(P)-静脉血: 0.97mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21.8U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.55；丙氨酸氨基转移酶(ALT)-静脉血: 41U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.19mmol/L；葡萄糖(Glu)-静脉血: 5.41mmol/L；白蛋白(ALB)-静脉血: 46.9g/L；白细胞计数(WBC#)-静脉血: 5.2810E9/L；红细胞计数(RBC#)-静脉血: 5.3910E12/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.6；尿酸(UA)-静脉血: 386.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 27U/L；C-反应蛋白(CRP)-静脉血: 4.25mg/L；钾离子(K+)-静脉血: 4.08mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.051；载脂蛋白B(apoB)-静脉血: 1.1g/L；球蛋白(GLO)-静脉血: 30.3g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；平均血小板体积(MPV)-静脉血: 10.3fL；总胆汁酸(TBA)-静脉血: 1.8umol/L；总蛋白(TP)-静脉血: 77.2g/L；间接胆红素(IBIL)-静脉血: 11.1umolL；甘油三酯(TG)-静脉血: 1.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.08g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.310E9/L；氯离子(Cl-)-静脉血: 102.2mmol/L；单核细胞百分比(Mono%)-静脉血: 0.072；碱性磷酸酶(ALP)-静脉血: 82.4U/L；总胆红素(TBIL)-静脉血: 15.1umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.49；总胆固醇(TC)-静脉血: 4.74mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.237；血小板比容……\n- [全程D25] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右侧约平T6椎体下缘水平，估计导管末端位于上腔静脉下段内。；检查结论: PICC管位置如上所述。\n- [全程D25] 检验组合: 浊度(TRUB)-尿液: clear；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 5.5；葡萄糖(Glu)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；虫卵-粪便: 未见虫卵（参考: 未见虫卵）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 30/μL；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；隐血(OB)-粪便: 阴性（参考: 阴性）；比重(SG)-尿液: 1.021；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-粪便: 棕色；酮体(KET)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D29] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；磷(P)-静脉血: 1.54mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.4U/L；总胆固醇(TC)-静脉血: 6.28mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.3pg；镁离子(Mg2+)-静脉血: 1.06mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=2.00)（参考: 阴性）；肌酐(Crea)-静脉血: 76.5umol/L；球蛋白(GLO)-静脉血: 31.62g/L；白蛋白(ALB)-静脉血: 48.1g/L；白细胞计数(WBC#)-静脉血: 5.310E9/L；血小板分布宽度(PDW)-静脉血: 14.3%；单核细胞百分比(Mono%)-静脉血: 0.011；淋巴细胞百分比(Lymph%)-静脉血: 0.128；血小板计数(PLT#)-静脉血: 18310E9/L；甘油三酯(TG)-静脉血: 1.83mmol/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；碱性磷酸酶(ALP)-静脉血: 76.4U/L；总胆汁酸(TBA)-静脉血: 14.5umol/L；总蛋白(TP)-静脉血: 79.72g/L；有核红细胞百分比(NRBC%)-静脉血: 0；红细胞比容(Hct)-静脉血: 44.3%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.7；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.42mmolL；胱抑素(Cys-C)-静脉血: 1.15mg/L；尿酸(UA)-静脉血: 254.8umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；间接胆红素(IBIL)-静脉血: 27.2umolL；钾离子(K+)-静脉血: 4.43mmol/L；乳酸脱氢酶(LDH)-静脉血: 200.6U/L；C-反应蛋白(CRP)-静脉血: 1.97mg/L；浊度(TRUB)-尿液: clear；酸碱度(pH)-尿液: 5.5；平均红细胞体积(MCV……\n- [全程D32] 检验组合: 间接胆红素(IBIL)-静脉血: 13.9umolL；肌酐(Crea)-静脉血: 83.3umol/L；碱性磷酸酶(ALP)-静脉血: 80.7U/L；镁离子(Mg2+)-静脉血: 1.02mmol/L；总胆红素(TBIL)-静脉血: 19.3umol/L；胱抑素(Cys-C)-静脉血: 0.87mg/L；尿素氮(BUN)-静脉血: 4.5mmol/L；载脂蛋白B(apoB)-静脉血: 1.13g/L；白细胞计数(WBC#)-静脉血: 3.0510E9/L；总胆汁酸(TBA)-静脉血: 1.7umol/L；血小板分布宽度(PDW)-静脉血: 12.5%；血小板比容-静脉血: 17%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.01；单核细胞百分比(Mono%)-静脉血: 0.013；平均血小板体积(MPV)-静脉血: 10.9fL；乳酸脱氢酶(LDH)-静脉血: 186U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.36；平均红细胞血红蛋白含量(MCH)-静脉血: 27.7pg；平均红细胞体积(MCV)-静脉血: 81.7fL；单核细胞计数(Mono#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 15410E9/L；氯离子(Cl-)-静脉血: 96.9mmol/L；钾离子(K+)-静脉血: 3.58mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.4mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 28U/L；甘油三酯(TG)-静脉血: 1.46mmol/L；红细胞比容(Hct)-静脉血: 44.3%；中性粒细胞百分比(Neut%)-静脉血: 0.748；总钙(Ca)-静脉血: 2.27mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 34.1；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 25.5U/L；葡萄糖(Glu)-静脉血: 5.55mmol/L；尿酸(UA)-静脉血: 325.7umol/L；直接胆红素(DBIL)-静脉血: 5.4umol/L；钠离子(Na+)-静脉血: 133.9mmol/L；大血小板百分比(P-LCR%)-静脉血: 31.7%；红细胞体积分布宽度CV(RDW-CV)-静……\n- [全程D50] 检验组合: 碱性磷酸酶(ALP)-静脉血: 79.1U/L；总胆红素(TBIL)-静脉血: 18.4umol/L；血小板比容-静脉血: 24%；磷(P)-静脉血: 1.77mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=4.50)（参考: 阴性）；白蛋白(ALB)-静脉血: 44g/L；C-反应蛋白(CRP)-静脉血: 2.48mg/L；球蛋白(GLO)-静脉血: 30.07g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 5.18mmol/L；总胆汁酸(TBA)-静脉血: 3umol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.9；平均红细胞血红蛋白浓度(MCHC)-静脉血: 332g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0；淋巴细胞百分比(Lymph%)-静脉血: 0.212；胱抑素(Cys-C)-静脉血: 1.1mg/L；乳酸脱氢酶(LDH)-静脉血: 209.6U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 51.1U/L；氯离子(Cl-)-静脉血: 99.5mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 45.8U/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.7mmol/L；载脂蛋白B(apoB)-静脉血: 1.54g/L；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.726；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.18mmolL；镁离子(Mg2+)-静脉血: 0.94mmol/L；钾离子(K+)-静脉血: 4.21mmol/L；阴离子间隙(AG)-静脉血: 15；单核细胞百分比(Mono%)-静脉血: 0.06；直接胆红素(DBIL)-静脉血: 3.3umol/L；总蛋白(TP)-静脉血: 74.07g/L；红细胞比容(Hct)-静脉血: 41.9%；血小板计数(PLT#)-静脉血: 24410E9/L；EB病毒Zta蛋白抗体IgA(EBV-Zta-IgA)-静脉血: 阳性(SCO=5.00)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 32.5U/L；载脂蛋白AI(ap……\n- [全程D53] 检验组合: 单核细胞计数(Mono#)-静脉血: 0.210E9/L；平均血小板体积(MPV)-静脉血: 10.1fL；平均红细胞血红蛋白含量(MCH)-静脉血: 27.5pg；氯离子(Cl-)-静脉血: 102.2mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；血小板分布宽度(PDW)-静脉血: 11.6%；钾离子(K+)-静脉血: 4.44mmol/L；血红蛋白(Hb)-静脉血: 146g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.4U/L；血小板比容-静脉血: 24%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 23610E9/L；肌酐(Crea)-静脉血: 78umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.97mmolL；直接胆红素(DBIL)-静脉血: 2.9umol/L；镁离子(Mg2+)-静脉血: 0.89mmol/L；白细胞计数(WBC#)-静脉血: 4.8410E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.9；有核红细胞计数(NRBC#)-静脉血: 010E9/L；尿酸(UA)-静脉血: 396.5umol/L；白蛋白(ALB)-静脉血: 43.6g/L；有核红细胞百分比(NRBC%)-静脉血: 0；单核细胞百分比(Mono%)-静脉血: 0.041；甘油三酯(TG)-静脉血: 1.5mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.5；总胆汁酸(TBA)-静脉血: 3.2umol/L；总钙(Ca)-静脉血: 2.29mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 29.4U/L；碱性磷酸酶(ALP)-静脉血: 88.9U/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.5mmol/L；平均红细胞体积(MCV)-静脉血: 84fL；丙氨酸氨基转移酶(ALT)-静脉血: 34.7U/L；红细胞比容(Hct)-静脉血: 44.5%；尿素氮(BUN)-静脉血: 6.4mmol/L；胱抑素(Cys-C)-……\n- [全程D64] 检验组合: 磷(P)-静脉血: 1.1mmol/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；平均红细胞血红蛋白含量(MCH)-静脉血: 27.3pg；平均血小板体积(MPV)-静脉血: 9.4fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.4；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；总钙(Ca)-静脉血: 2.24mmol/L；总蛋白(TP)-静脉血: 73.3g/L；氯离子(Cl-)-静脉血: 104.7mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 46.1U/L；单核细胞百分比(Mono%)-静脉血: 0.094；α-L-岩藻糖苷酶(AFU)-静脉血: 31.3U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.93mmol/L；尿素氮(BUN)-静脉血: 6.4mmol/L；总胆固醇(TC)-静脉血: 5.7mmol/L；血小板计数(PLT#)-静脉血: 15510E9/L；球蛋白(GLO)-静脉血: 28g/L；直接胆红素(DBIL)-静脉血: 2.3umol/L；总胆汁酸(TBA)-静脉血: 1.8umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.09mmolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.74；载脂蛋白B(apoB)-静脉血: 1.34g/L；钠离子(Na+)-静脉血: 141.6mmol/L；C-反应蛋白(CRP)-静脉血: 4.1mg/L；血小板比容-静脉血: 15%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；葡萄糖(Glu)-静脉血: 5.4mmol/L；白蛋白(ALB)-静脉血: 45.3g/L；有核红细胞计数(NRBC#)-静脉血: 0.0110E9/L；尿酸(UA)-静脉血: 511.6umol/L；甘油三酯(TG)-静脉血: 1.82mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.5mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 26.8U/L；大血小板百分比(P-LCR%)-静脉血: 19.5%；中性粒细胞计数(Neut#)-静脉血: 3.110E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 319g/L；乳酸脱氢酶(……\n- [全程D71] 检验组合: γ-谷氨酰基转移酶(GGT)-静脉血: 47U/L；尿酸(UA)-静脉血: 339.1umol/L；阴离子间隙(AG)-静脉血: 16.7；白细胞计数(WBC#)-静脉血: 5.8510E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 27.4pg；有核红细胞计数(NRBC#)-静脉血: 010E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.156；EB病毒Zta蛋白抗体IgA(EBV-Zta-IgA)-静脉血: 阳性(SCO=4.00)（参考: 阴性）；磷(P)-静脉血: 1.25mmol/L；肌酐(Crea)-静脉血: 80.9umol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:20（参考: 阴性）；单核细胞百分比(Mono%)-静脉血: 0.029；中性粒细胞计数(Neut#)-静脉血: 4.810E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.7mmol/L；红细胞比容(Hct)-静脉血: 43.3%；总胆红素(TBIL)-静脉血: 18.3umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 6.04mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；平均血小板体积(MPV)-静脉血: 10.9fL；碱性磷酸酶(ALP)-静脉血: 81.8U/L；葡萄糖(Glu)-静脉血: 5.79mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.6；间接胆红素(IBIL)-静脉血: 15umolL；α-L-岩藻糖苷酶(AFU)-静脉血: 41.6U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.48mmolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.3；载脂蛋白AI(apoAI)-静脉血: 1.28g/L；甘油三酯(TG)-静脉血: 2.29mmol/L；平均红细胞体积(MCV)-静脉血: 83.1fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板比容-静脉血: 17%；球蛋白(GLO)-静脉血: 29.1g/L；载脂蛋白B(apoB)-静脉血: 1.64g/L；乳酸脱氢酶(LDH)-静脉血: 229.2U/L；镁离子(Mg2+)-静脉血: 0.76mmol……\n- [全程D75] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后，对比某次就诊时间片： 鼻咽腔稍狭窄，鼻咽左顶壁及左侧壁增厚，在T1WI上呈等信号，在T2WI上呈稍高信号，增强扫描明显强化，较前明显缩小，左侧破裂孔、海绵窦、翼腭窝及蝶窦左份仍可见软组织灶，边界欠清，明显强化。右侧咽隐窝存在，左侧咽隐窝变浅 左侧腭帆张提肌、左侧翼内肌上缘信号不均匀，可见强化。 左侧咽旁间隙变窄，右侧咽旁间隙及双侧颈动脉鞘区血管未见明显异常。 右侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常。口咽双侧壁未见增厚。 斜坡、左侧岩尖、蝶骨基底部、左侧翼突区骨质信号减低，增强扫描明显强化。 右侧海绵窦形态正常，未见增宽。 双侧筛窦、左侧上颌窦、蝶窦粘膜增厚，左侧乳突内见少量信号分泌物。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变。 双侧咽后未见明确肿大淋巴结。 双颈II区及左颈III区可见数个淋巴结，最大约14mm×5mm，边界欠清，增强扫描可见明显强化。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。 所示脑实质未见明确异常。；检查结论: 鼻咽癌化疗后，范围较前明显缩小。 颅底骨质破坏。 双颈淋巴结，考虑转移，较前缩小、减少。 双侧咽后未见肿大淋巴结。 鼻窦炎。 左侧乳突炎。\n- [全程D120] 检验组合: 尿酸(UA)-静脉血: 409.8umol/L；球蛋白(GLO)-静脉血: 27.4g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.63；总钙(Ca)-静脉血: 2.24mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 25U/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；γ-谷氨酰基转移酶(GGT)-静脉血: 55.3U/L；中性粒细胞百分比(Neut%)-静脉血: 0.859；白细胞计数(WBC#)-静脉血: 5.710E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.058；间接胆红素(IBIL)-静脉血: 6.28umolL；C-反应蛋白(CRP)-静脉血: 88.14mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 48；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；碱性磷酸酶(ALP)-静脉血: 82.1U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15.7U/L；磷(P)-静脉血: 1.36mmol/L；白蛋白(ALB)-静脉血: 41.7g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.78mmolL；镁离子(Mg2+)-静脉血: 0.9mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.79mmol/L；钠离子(Na+)-静脉血: 139.5mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 15.1；中性粒细胞计数(Neut#)-静脉血: 4.910E9/L；血红蛋白(Hb)-静脉血: 113g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.3fL；氯离子(Cl-)-静脉血: 101.6mmol/L；红细胞比容(Hct)-静脉血: 34.4%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；乳酸脱氢酶(LDH)-静脉血: 163.4U/L；总胆汁酸(TBA)-静脉血: 5.6umol/L；尿素氮(BUN)-静脉血: 6mmol/L；血小板比容-静脉血: 10%；大血小板百分比(P-LCR%)-静脉血: 25%；葡萄糖(Glu)-静脉……\n- [全程D127] 检验组合: 红细胞比容(Hct)-静脉血: 27.7%；血红蛋白(Hb)-静脉血: 88g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.005；尿酸(UA)-静脉血: 268.3umol/L；直接胆红素(DBIL)-静脉血: 2.1umol/L；乳酸脱氢酶(LDH)-静脉血: 105.9U/L；碱性磷酸酶(ALP)-静脉血: 82.3U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.72；中性粒细胞百分比(Neut%)-静脉血: 0.798；尿素氮(BUN)-静脉血: 4.9mmol/L；载脂蛋白B(apoB)-静脉血: 1.41g/L；C-反应蛋白(CRP)-静脉血: 198.52mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.26；总胆汁酸(TBA)-静脉血: 1.1umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 9.6U/L；球蛋白(GLO)-静脉血: 27.52g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.03；总钙(Ca)-静脉血: 2.35mmol/L；甘油三酯(TG)-静脉血: 2.27mmol/L；氯离子(Cl-)-静脉血: 102.6mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28pg；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.74mmolL；白蛋白(ALB)-静脉血: 34.8g/L；载脂蛋白AI(apoAI)-静脉血: 0.71g/L；单核细胞百分比(Mono%)-静脉血: 0.167；淋巴细胞计数(Lymph#)-静脉血: 0.110E9/L；血小板比容-静脉血: 11%；肌酐(Crea)-静脉血: 68.7umol/L；总胆固醇(TC)-静脉血: 5.14mmol/L；胱抑素(Cys-C)-静脉血: 0.91mg/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 60.6U/L；镁离子(Mg2+)-静脉血: 0.81mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 12610E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.2mmol/L；大血小板百分比(P-LCR%)-静脉血: 16.5%；丙氨酸氨基转移酶(ALT)-静脉血:……\n- [全程D132] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）\n- [全程D167] 检验组合: EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:80（参考: 阴性）\n- [全程D222] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:80（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）\n- [全程D222] 检验组合: 氯离子(Cl-)-静脉血: 103.6mmol/L；血小板分布宽度(PDW)-静脉血: 10.7%；C-反应蛋白(CRP)-静脉血: 1.07mg/L；甘油三酯(TG)-静脉血: 1.41mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.89；白蛋白(ALB)-静脉血: 46.7g/L；葡萄糖(Glu)-静脉血: 5.1mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.68；血小板比容-静脉血: 17%；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L；直接胆红素(DBIL)-静脉血: 2.1umol/L；磷(P)-静脉血: 1.27mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 317g/L；大血小板百分比(P-LCR%)-静脉血: 24.8%；丙氨酸氨基转移酶(ALT)-静脉血: 19.3U/L；总蛋白(TP)-静脉血: 74.5g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 18.4U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.2U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.63mmol/L；总胆固醇(TC)-静脉血: 5.21mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 15.7U/L；乳酸脱氢酶(LDH)-静脉血: 168.2U/L；间接胆红素(IBIL)-静脉血: 6.8umolL；平均红细胞体积(MCV)-静脉血: 87.3fL；红细胞比容(Hct)-静脉血: 39.7%；中性粒细胞百分比(Neut%)-静脉血: 0.657；钠离子(Na+)-静脉血: 139.4mmol/L；碱性磷酸酶(ALP)-静脉血: 72U/L；单核细胞百分比(Mono%)-静脉血: 0.101；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.05；阴离子间隙(AG)-静脉血: 13.3；总胆汁酸(TBA)-静脉血: 2.7umol/L；镁离子(Mg2+)-静脉血: 0.92mmol/L；总胆红素(TBIL)-静脉血: 8.9umol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 42.4；肌酐(Crea)-静脉血: 74.3um……\n- [全程D223] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理清晰，未见明确实质性病变。双侧肺门未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D26] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 化疗第2天，患者一般情况可，未诉特殊不适。查体：左侧颈部II区可扪及1个淋巴结，最大径2cm×2.5cm2，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]医生信息已隐藏示：目前暂未出现明显副反应，继续行化疗，密切观察病情。\n- [全程D29] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 化疗第5天，患者一般情况可。体查：KPS90分，张口门齿距4.5cm。鼻咽顶壁、顶后壁、双侧壁结节状肿物；左侧颈部II区可扪及1个淋巴结，最大径2cm×2cm2，无融合，质中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。复查血常规无明显异常。生化示：ALT 77.8U/L↑、IBIL27.20 umolL↑、TBIL35.1umol/L↑。[姓名已隐去]医生信息已隐藏示:第1程化疗结束，病情稳定，今日予办理出院。嘱其注意休息及营养支持，保持口腔清洁；出院后每周复查血常规2次，生化1次常规；按时[计划性表述已隐藏]下一程诱导化疗；若有不适，及时就诊。\n- [全程D65] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日患者症状体征基本同前，无诉其余特殊不适。[姓名已隐去]医生信息已隐藏示：患者诊断明确，复查血常规、生化常规无明显化疗禁忌症，拟按期于某次就诊时间开始行TPF诱导化疗， 具体用药：DOC60mg/㎡d1+DDP60mg/㎡ d2+5-FU2.5g/㎡civ48hQ3w，并指示化疗期间给予护肝、护胃、止吐及营养支持治疗，昨日已行泰欣生靶向治疗，密切观察患者病情变化。\n- [全程D66] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，未诉恶心、呕吐、腹痛、腹泻等不适，大小便正常。[姓名已隐去]医生信息已隐藏出，患者目前一般情况可，予明日按TPF方案行第3周期化疗，注意化疗结束后复查血、生化常规，及时对症处理。\n- [全程D69] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日为化疗第3天，诉间有恶心，无呕吐，无咳嗽、咳痰，无头痛、头晕，大小便正常。[姓名已隐去]医生信息已隐藏出，患者化疗后出现胃肠道反应I度，予继续对症处理，减轻化疗后反应。\n- [全程D71] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日患者症状体征基本同前，无诉其余特殊不适。今日复查血常规及生化常规未见明显异常。[姓名已隐去]医生信息已隐藏示：患者病情平稳，一般情况良好，目前予完善相关放疗前准备，今日予办理出院。\n- [全程D121] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今天完成放疗24次，仍有轻度口干，口咽疼痛NRS1分，无恶心、呕吐，无头晕、头痛。查体：口咽部放射性粘膜炎Ⅱ°，颈部放射性皮炎Ⅰ°。某次就诊时间血常规HGB113g/L，生化大致正常。[姓名已隐去]医生信息已隐藏：继续予加强止痛、营养、改善贫血等对症支持治疗，密切观察病情变化。\n- [全程D124] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者昨天行第6次泰欣生分子靶向治疗，今天完成放疗26次，仍有轻度口干，口咽疼痛NRS1分，无恶心、呕吐，无发热、畏寒，查体：口咽部放射性粘膜炎Ⅱ°，颈部放射性皮炎Ⅰ°。[姓名已隐去]医生信息已隐藏示：患者放射性口咽炎仍明显，需加强局部冲洗、止痛等支持治疗，继续予按计划放疗。\n- [全程D127] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今天完成放疗29次，仍有轻度口干，口咽疼痛NRS1分，无发热、畏寒，无恶心、呕吐，查体：口咽部放射性粘膜炎Ⅰ°，颈部放射性皮炎Ⅰ°。某次就诊时间血常规示WBC3.6510E9/L， NE#2.9*10E9/L， HGB88.0g/L，PLT126.0*10E9/L，[姓名已隐去]医生信息已隐藏：患者白细胞稍低，但血红蛋白较前下降，考虑营养摄入不足和放化疗后骨髓抑制所致，予口服升白、改善贫血药治疗，加强口腔局部冲洗，密切观察病情变化。\n- [全程D130] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今天完成放疗30次，仍有轻度口干，口咽疼痛NRS2分，无发热、畏寒，无恶心、呕吐，查体：口咽部放射性粘膜炎Ⅱ°，颈部放射性皮炎Ⅰ°。[姓名已隐去]医生信息已隐藏：患者今天予第7次泰欣生分子靶向治疗。患者口咽痛反复，继续加强止痛治疗，辅以局部冲洗等护理，观察病情变化。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行全身PET-CT扫描评估全身肿瘤负荷及近期疗效\nB. 行鼻咽及颈部MRI增强扫描评估近期疗效，继续定期随访\nC. 行鼻咽镜检查并对原发灶区域进行常规多点活检排除残留\nD. 启动卡培他滨节拍性维持化疗降低远处转移风险\nE. 启动PD-1抑制剂维持治疗巩固靶向联合放疗的近期疗效\nF. 仅定期复查血常规、生化及EBV-DNA，暂不复查局部影像学\nG. 直接安排鼻咽原发灶内镜下挽救性切除手术\nH. 直接安排鼻咽原发灶挽救性立体定向放疗\nI. 行胸部及全腹部增强CT扫描，暂缓头颈部局部影像学复查\nJ. 行全身骨扫描及头颅MRI排除无症状的远处器官转移风险\nK. 启动吉西他滨联合顺铂方案全身化疗清除潜在微小转移灶\nL. 继续使用尼妥珠单抗单药维持治疗至满一年巩固局部疗效\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D120] 检验组合: 尿酸(UA)-静脉血: 409.8umol/L；球蛋白(GLO)-静脉血: 27.4g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.63；总钙(Ca)-静脉血: 2.24mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 25U/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；γ-谷氨酰基转移酶(GGT)-静脉血: 55.3U/L；中性粒细胞百分比(Neut%)-静脉血: 0.859；白细胞计数(WBC#)-静脉血: 5.710E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.058；间接胆红素(IBIL)-静脉血: 6.28umolL；C-反应蛋白(CRP)-静脉血: 88.14mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 48；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；碱性磷酸酶(ALP)-静脉血: 82.1U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15.7U/L；磷(P)-静脉血: 1.36mmol/L；白蛋白(ALB)-静脉血: 41.7g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.78mmolL；镁离子(Mg2+)-静脉血: 0.9mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.79mmol/L；钠离子(Na+)-静脉血: 139.5mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 15.1；中性粒细胞计数(Neut#)-静脉血: 4.910E9/L；血红蛋白(Hb)-静脉血: 113g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.3fL；氯离子(Cl-)-静脉血: 101.6mmol/L；红细胞比容(Hct)-静脉血: 34.4%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；乳酸脱氢酶(LDH)-静脉血: 163.4U/L；总胆汁酸(TBA)-静脉血: 5.6umol/L；尿素氮(BUN)-静脉血: 6mmol/L；血小板比容-静脉血: 10%；大血小板百分比(P-LCR%)-静脉血: 25%；葡萄糖(Glu)-静脉……\n- [全程D127] 检验组合: 红细胞比容(Hct)-静脉血: 27.7%；血红蛋白(Hb)-静脉血: 88g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.005；尿酸(UA)-静脉血: 268.3umol/L；直接胆红素(DBIL)-静脉血: 2.1umol/L；乳酸脱氢酶(LDH)-静脉血: 105.9U/L；碱性磷酸酶(ALP)-静脉血: 82.3U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.72；中性粒细胞百分比(Neut%)-静脉血: 0.798；尿素氮(BUN)-静脉血: 4.9mmol/L；载脂蛋白B(apoB)-静脉血: 1.41g/L；C-反应蛋白(CRP)-静脉血: 198.52mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.26；总胆汁酸(TBA)-静脉血: 1.1umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 9.6U/L；球蛋白(GLO)-静脉血: 27.52g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.03；总钙(Ca)-静脉血: 2.35mmol/L；甘油三酯(TG)-静脉血: 2.27mmol/L；氯离子(Cl-)-静脉血: 102.6mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28pg；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.74mmolL；白蛋白(ALB)-静脉血: 34.8g/L；载脂蛋白AI(apoAI)-静脉血: 0.71g/L；单核细胞百分比(Mono%)-静脉血: 0.167；淋巴细胞计数(Lymph#)-静脉血: 0.110E9/L；血小板比容-静脉血: 11%；肌酐(Crea)-静脉血: 68.7umol/L；总胆固醇(TC)-静脉血: 5.14mmol/L；胱抑素(Cys-C)-静脉血: 0.91mg/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 60.6U/L；镁离子(Mg2+)-静脉血: 0.81mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 12610E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.2mmol/L；大血小板百分比(P-LCR%)-静脉血: 16.5%；丙氨酸氨基转移酶(ALT)-静脉血:……\n- [全程D132] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）\n- [全程D167] 检验组合: EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:80（参考: 阴性）\n- [全程D222] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:80（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）\n- [全程D222] 检验组合: 氯离子(Cl-)-静脉血: 103.6mmol/L；血小板分布宽度(PDW)-静脉血: 10.7%；C-反应蛋白(CRP)-静脉血: 1.07mg/L；甘油三酯(TG)-静脉血: 1.41mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.89；白蛋白(ALB)-静脉血: 46.7g/L；葡萄糖(Glu)-静脉血: 5.1mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.68；血小板比容-静脉血: 17%；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L；直接胆红素(DBIL)-静脉血: 2.1umol/L；磷(P)-静脉血: 1.27mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 317g/L；大血小板百分比(P-LCR%)-静脉血: 24.8%；丙氨酸氨基转移酶(ALT)-静脉血: 19.3U/L；总蛋白(TP)-静脉血: 74.5g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 18.4U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.2U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.63mmol/L；总胆固醇(TC)-静脉血: 5.21mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 15.7U/L；乳酸脱氢酶(LDH)-静脉血: 168.2U/L；间接胆红素(IBIL)-静脉血: 6.8umolL；平均红细胞体积(MCV)-静脉血: 87.3fL；红细胞比容(Hct)-静脉血: 39.7%；中性粒细胞百分比(Neut%)-静脉血: 0.657；钠离子(Na+)-静脉血: 139.4mmol/L；碱性磷酸酶(ALP)-静脉血: 72U/L；单核细胞百分比(Mono%)-静脉血: 0.101；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.05；阴离子间隙(AG)-静脉血: 13.3；总胆汁酸(TBA)-静脉血: 2.7umol/L；镁离子(Mg2+)-静脉血: 0.92mmol/L；总胆红素(TBIL)-静脉血: 8.9umol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 42.4；肌酐(Crea)-静脉血: 74.3um……\n- [全程D223] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理清晰，未见明确实质性病变。双侧肺门未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n\n【既往治疗与反应】\n- [全程D121] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今天完成放疗24次，仍有轻度口干，口咽疼痛NRS1分，无恶心、呕吐，无头晕、头痛。查体：口咽部放射性粘膜炎Ⅱ°，颈部放射性皮炎Ⅰ°。某次就诊时间血常规HGB113g/L，生化大致正常。[姓名已隐去]医生信息已隐藏：继续予加强止痛、营养、改善贫血等对症支持治疗，密切观察病情变化。\n- [全程D124] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者昨天行第6次泰欣生分子靶向治疗，今天完成放疗26次，仍有轻度口干，口咽疼痛NRS1分，无恶心、呕吐，无发热、畏寒，查体：口咽部放射性粘膜炎Ⅱ°，颈部放射性皮炎Ⅰ°。[姓名已隐去]医生信息已隐藏示：患者放射性口咽炎仍明显，需加强局部冲洗、止痛等支持治疗，继续予按计划放疗。\n- [全程D127] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今天完成放疗29次，仍有轻度口干，口咽疼痛NRS1分，无发热、畏寒，无恶心、呕吐，查体：口咽部放射性粘膜炎Ⅰ°，颈部放射性皮炎Ⅰ°。某次就诊时间血常规示WBC3.6510E9/L， NE#2.9*10E9/L， HGB88.0g/L，PLT126.0*10E9/L，[姓名已隐去]医生信息已隐藏：患者白细胞稍低，但血红蛋白较前下降，考虑营养摄入不足和放化疗后骨髓抑制所致，予口服升白、改善贫血药治疗，加强口腔局部冲洗，密切观察病情变化。\n- [全程D130] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今天完成放疗30次，仍有轻度口干，口咽疼痛NRS2分，无发热、畏寒，无恶心、呕吐，查体：口咽部放射性粘膜炎Ⅱ°，颈部放射性皮炎Ⅰ°。[姓名已隐去]医生信息已隐藏：患者今天予第7次泰欣生分子靶向治疗。患者口咽痛反复，继续加强止痛治疗，辅以局部冲洗等护理，观察病情变化。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行全身PET-CT扫描评估全身肿瘤负荷及近期疗效\nB. 行鼻咽及颈部MRI增强扫描评估近期疗效，继续定期随访\nC. 行鼻咽镜检查并对原发灶区域进行常规多点活检排除残留\nD. 启动卡培他滨节拍性维持化疗降低远处转移风险\nE. 启动PD-1抑制剂维持治疗巩固靶向联合放疗的近期疗效\nF. 仅定期复查血常规、生化及EBV-DNA，暂不复查局部影像学\nG. 直接安排鼻咽原发灶内镜下挽救性切除手术\nH. 直接安排鼻咽原发灶挽救性立体定向放疗\nI. 行胸部及全腹部增强CT扫描，暂缓头颈部局部影像学复查\nJ. 行全身骨扫描及头颅MRI排除无症状的远处器官转移风险\nK. 启动吉西他滨联合顺铂方案全身化疗清除潜在微小转移灶\nL. 继续使用尼妥珠单抗单药维持治疗至满一年巩固局部疗效\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、蝶窦、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D120] 检验组合: 尿酸(UA)-静脉血: 409.8umol/L；球蛋白(GLO)-静脉血: 27.4g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.63；总钙(Ca)-静脉血: 2.24mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 25U/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；γ-谷氨酰基转移酶(GGT)-静脉血: 55.3U/L；中性粒细胞百分比(Neut%)-静脉血: 0.859；白细胞计数(WBC#)-静脉血: 5.710E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.058；间接胆红素(IBIL)-静脉血: 6.28umolL；C-反应蛋白(CRP)-静脉血: 88.14mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 48；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；碱性磷酸酶(ALP)-静脉血: 82.1U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15.7U/L；磷(P)-静脉血: 1.36mmol/L；白蛋白(ALB)-静脉血: 41.7g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.78mmolL；镁离子(Mg2+)-静脉血: 0.9mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.79mmol/L；钠离子(Na+)-静脉血: 139.5mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 15.1；中性粒细胞计数(Neut#)-静脉血: 4.910E9/L；血红蛋白(Hb)-静脉血: 113g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.3fL；氯离子(Cl-)-静脉血: 101.6mmol/L；红细胞比容(Hct)-静脉血: 34.4%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；乳酸脱氢酶(LDH)-静脉血: 163.4U/L；总胆汁酸(TBA)-静脉血: 5.6umol/L；尿素氮(BUN)-静脉血: 6mmol/L；血小板比容-静脉血: 10%；大血小板百分比(P-LCR%)-静脉血: 25%；葡萄糖(Glu)-静脉……\n- [全程D127] 检验组合: 红细胞比容(Hct)-静脉血: 27.7%；血红蛋白(Hb)-静脉血: 88g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.005；尿酸(UA)-静脉血: 268.3umol/L；直接胆红素(DBIL)-静脉血: 2.1umol/L；乳酸脱氢酶(LDH)-静脉血: 105.9U/L；碱性磷酸酶(ALP)-静脉血: 82.3U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.72；中性粒细胞百分比(Neut%)-静脉血: 0.798；尿素氮(BUN)-静脉血: 4.9mmol/L；载脂蛋白B(apoB)-静脉血: 1.41g/L；C-反应蛋白(CRP)-静脉血: 198.52mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.26；总胆汁酸(TBA)-静脉血: 1.1umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 9.6U/L；球蛋白(GLO)-静脉血: 27.52g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.03；总钙(Ca)-静脉血: 2.35mmol/L；甘油三酯(TG)-静脉血: 2.27mmol/L；氯离子(Cl-)-静脉血: 102.6mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28pg；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.74mmolL；白蛋白(ALB)-静脉血: 34.8g/L；载脂蛋白AI(apoAI)-静脉血: 0.71g/L；单核细胞百分比(Mono%)-静脉血: 0.167；淋巴细胞计数(Lymph#)-静脉血: 0.110E9/L；血小板比容-静脉血: 11%；肌酐(Crea)-静脉血: 68.7umol/L；总胆固醇(TC)-静脉血: 5.14mmol/L；胱抑素(Cys-C)-静脉血: 0.91mg/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 60.6U/L；镁离子(Mg2+)-静脉血: 0.81mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 12610E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.2mmol/L；大血小板百分比(P-LCR%)-静脉血: 16.5%；丙氨酸氨基转移酶(ALT)-静脉血:……\n- [全程D132] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）\n- [全程D167] 检验组合: EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:80（参考: 阴性）\n- [全程D222] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:80（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）\n- [全程D222] 检验组合: 氯离子(Cl-)-静脉血: 103.6mmol/L；血小板分布宽度(PDW)-静脉血: 10.7%；C-反应蛋白(CRP)-静脉血: 1.07mg/L；甘油三酯(TG)-静脉血: 1.41mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.89；白蛋白(ALB)-静脉血: 46.7g/L；葡萄糖(Glu)-静脉血: 5.1mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.68；血小板比容-静脉血: 17%；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L；直接胆红素(DBIL)-静脉血: 2.1umol/L；磷(P)-静脉血: 1.27mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 317g/L；大血小板百分比(P-LCR%)-静脉血: 24.8%；丙氨酸氨基转移酶(ALT)-静脉血: 19.3U/L；总蛋白(TP)-静脉血: 74.5g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 18.4U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.2U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.63mmol/L；总胆固醇(TC)-静脉血: 5.21mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 15.7U/L；乳酸脱氢酶(LDH)-静脉血: 168.2U/L；间接胆红素(IBIL)-静脉血: 6.8umolL；平均红细胞体积(MCV)-静脉血: 87.3fL；红细胞比容(Hct)-静脉血: 39.7%；中性粒细胞百分比(Neut%)-静脉血: 0.657；钠离子(Na+)-静脉血: 139.4mmol/L；碱性磷酸酶(ALP)-静脉血: 72U/L；单核细胞百分比(Mono%)-静脉血: 0.101；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.05；阴离子间隙(AG)-静脉血: 13.3；总胆汁酸(TBA)-静脉血: 2.7umol/L；镁离子(Mg2+)-静脉血: 0.92mmol/L；总胆红素(TBIL)-静脉血: 8.9umol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 42.4；肌酐(Crea)-静脉血: 74.3um……\n- [全程D223] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理清晰，未见明确实质性病变。双侧肺门未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n\n【既往治疗与反应】\n- [全程D121] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今天完成放疗24次，仍有轻度口干，口咽疼痛NRS1分，无恶心、呕吐，无头晕、头痛。查体：口咽部放射性粘膜炎Ⅱ°，颈部放射性皮炎Ⅰ°。某次就诊时间血常规HGB113g/L，生化大致正常。[姓名已隐去]医生信息已隐藏：继续予加强止痛、营养、改善贫血等对症支持治疗，密切观察病情变化。\n- [全程D124] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者昨天行第6次泰欣生分子靶向治疗，今天完成放疗26次，仍有轻度口干，口咽疼痛NRS1分，无恶心、呕吐，无发热、畏寒，查体：口咽部放射性粘膜炎Ⅱ°，颈部放射性皮炎Ⅰ°。[姓名已隐去]医生信息已隐藏示：患者放射性口咽炎仍明显，需加强局部冲洗、止痛等支持治疗，继续予按计划放疗。\n- [全程D127] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今天完成放疗29次，仍有轻度口干，口咽疼痛NRS1分，无发热、畏寒，无恶心、呕吐，查体：口咽部放射性粘膜炎Ⅰ°，颈部放射性皮炎Ⅰ°。某次就诊时间血常规示WBC3.6510E9/L， NE#2.9*10E9/L， HGB88.0g/L，PLT126.0*10E9/L，[姓名已隐去]医生信息已隐藏：患者白细胞稍低，但血红蛋白较前下降，考虑营养摄入不足和放化疗后骨髓抑制所致，予口服升白、改善贫血药治疗，加强口腔局部冲洗，密切观察病情变化。\n- [全程D130] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今天完成放疗30次，仍有轻度口干，口咽疼痛NRS2分，无发热、畏寒，无恶心、呕吐，查体：口咽部放射性粘膜炎Ⅱ°，颈部放射性皮炎Ⅰ°。[姓名已隐去]医生信息已隐藏：患者今天予第7次泰欣生分子靶向治疗。患者口咽痛反复，继续加强止痛治疗，辅以局部冲洗等护理，观察病情变化。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行全身PET-CT扫描评估全身肿瘤负荷及近期疗效\nB. 行鼻咽及颈部MRI增强扫描评估近期疗效，继续定期随访\nC. 行鼻咽镜检查并对原发灶区域进行常规多点活检排除残留\nD. 启动卡培他滨节拍性维持化疗降低远处转移风险\nE. 启动PD-1抑制剂维持治疗巩固靶向联合放疗的近期疗效\nF. 仅定期复查血常规、生化及EBV-DNA，暂不复查局部影像学\nG. 直接安排鼻咽原发灶内镜下挽救性切除手术\nH. 直接安排鼻咽原发灶挽救性立体定向放疗\nI. 行胸部及全腹部增强CT扫描，暂缓头颈部局部影像学复查\nJ. 行全身骨扫描及头颅MRI排除无症状的远处器官转移风险\nK. 启动吉西他滨联合顺铂方案全身化疗清除潜在微小转移灶\nL. 继续使用尼妥珠单抗单药维持治疗至满一年巩固局部疗效\n\n请仅输出一个选项字母（A-L）。"}]}
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鼻咽及颈部MRI平扫+增强，胸部及上腹部CT平扫+增强，全身骨显像，暂不安排内镜活检\nF. 颈部淋巴结切除活检，鼻咽及颈部MRI平扫+增强，胸部及上腹部CT平扫+增强，全身骨显像\nG. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫，胸部及上腹部CT平扫，全身骨显像\nH. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部CT平扫+增强，腹部超声\nI. 电子鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸部及上腹部CT平扫+增强，全身骨显像\nJ. 颈部淋巴结细针穿刺活检，鼻咽及颈部MRI平扫+增强，胸部及上腹部CT平扫+增强，全身骨显像\nK. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身骨显像，头颅MRI平扫+增强\nL. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部及上腹部CT平扫+增强，骨髓穿刺活检\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现双颈肿物半年余；现病史: 者半年余前无明显诱因出现左侧颈部肿物，无疼痛，逐渐增大，伴有鼻塞、流涕，至当地医院予抗炎对症治疗后，肿物能减小；2月前患者始出现右侧颈部肿物，逐渐增大，伴有鼻塞、流涕，间中有涕血，无发热、畏寒，无头晕、头痛，无周身骨痛等，于当地医院检查ＣＴ示：鼻咽肿物，遂转至我院进一步诊治。门诊拟诊“鼻咽肿物”收入我科进一步治疗。患者起病以来精神、睡眠欠佳，胃纳尚可，二便正常，体重无明显下降。；阳性症状体征: 鼻塞,睡眠欠佳,鼻咽肿物,涕血,右颈部肿物,左颈部肿物,流涕；既往史: 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电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部及上腹部CT平扫+增强，骨髓穿刺活检\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-ebeecf0887be3e478e385ec0","patient_id":"patient-9149023ec8599161ec3e5cfd","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"D","gold_action":"行鼻咽镜下活检明确病理，并完善胸腹部及骨骼等远处转移排查","options":[{"letter":"A","text":"安排根治性放化疗并完善胸腹部及骨骼等远处转移排查","is_gold":false},{"letter":"B","text":"行颈部淋巴结切除活检明确病理并完善胸腹部及骨骼等远处转移排查","is_gold":false},{"letter":"C","text":"行鼻咽镜下活检明确病理并暂缓远处转移排查直至病理确诊","is_gold":false},{"letter":"D","text":"行鼻咽镜下活检明确病理并完善胸腹部及骨骼等远处转移排查","is_gold":true},{"letter":"E","text":"行鼻咽镜下活检明确病理并安排诱导化疗联合同步放化疗","is_gold":false},{"letter":"F","text":"完善全身PET-CT检查排查远处转移并安排根治性放疗","is_gold":false},{"letter":"G","text":"行鼻咽镜下活检明确病理并完善头颅CT进一步评估颅底骨质破坏","is_gold":false},{"letter":"H","text":"行鼻咽镜下活检明确病理并完善EBV-DNA定量检测暂缓影像学排查","is_gold":false},{"letter":"I","text":"行颈部淋巴结穿刺活检明确病理并完善胸腹部及骨骼等远处转移排查","is_gold":false},{"letter":"J","text":"完善胸部CT和腹部超声排查远处转移并暂缓鼻咽原发灶活检","is_gold":false},{"letter":"K","text":"行鼻咽镜下活检明确病理并完善全身骨扫描暂缓胸腹部影像学检查","is_gold":false},{"letter":"L","text":"安排鼻咽部肿物切除术明确病理并完善胸腹部及骨骼等远处转移排查","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现双颈肿物半年余；现病史: 者半年余前无明显诱因出现左侧颈部肿物，无疼痛，逐渐增大，伴有鼻塞、流涕，至当地医院予抗炎对症治疗后，肿物能减小；2月前患者始出现右侧颈部肿物，逐渐增大，伴有鼻塞、流涕，间中有涕血，无发热、畏寒，无头晕、头痛，无周身骨痛等，于当地医院检查ＣＴ示：鼻咽肿物，遂转至我院进一步诊治。门诊拟诊“鼻咽肿物”收入我科进一步治疗。患者起病以来精神、睡眠欠佳，胃纳尚可，二便正常，体重无明显下降。；阳性症状体征: 鼻塞,睡眠欠佳,鼻咽肿物,涕血,右颈部肿物,左颈部肿物,流涕；既往史: 体健，无高血压、心脏病等慢性病，无糖尿病、肾病等全身性疾病，无乙肝、结核等传染病，无外伤史。；个人史: 生于原籍，有吸烟史30年,无饮酒，无其他嗜好，否认冶游史。；家族史: 家族中无类似患者，无家族性遗传病患者，无重大精神病患者。；体格检查:；专科检查:；KPS:；ECOG:\n- [时间未明] 门急诊记录: 主诉:；现病史: 者半年余前无明显诱因出现左侧颈部肿物，无疼痛，逐渐增大，伴有鼻塞、流涕，至当地医院予抗炎对症治疗后，肿物能减小；2月前患者始出现右侧颈部肿物，逐渐增大，伴有鼻塞、流涕，间中有涕血，无发热、畏寒，无头晕、头痛，无周身骨痛等，于当地医院检查ＣＴ示：鼻咽肿物，遂转至我院进一步诊治。门诊拟诊“鼻咽肿物”收入我科进一步治疗。患者起病以来精神、睡眠欠佳，胃纳尚可，二便正常，体重无明显下降。；既往史: 否认高血压、糖尿病及心脏病史，否认结核等传染病史、否认手术、外伤及输血史。；个人史:；家族史: 家族中无类似患者，无家族性遗传病患者，无重大精神病患者。；体格检查: KPS90，一般状况可，鼻咽左侧壁、顶后壁肿物，双颈扪及肿大淋巴结，右颈多枚肿大淋巴结，较大者约6*4及2*2cm,质硬，活动差，左上颈可及一淋巴结，约3*3cm，质中，活动度可，无融合，无皮肤浸润等，左中颈可及一大小约1*1cm质硬淋巴结；张口门齿距约4cm，颅神经征阴性。。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D0] 检验组合: 磷(P)-静脉血: 1.15mmol/L；平均红细胞体积(MCV)-静脉血: 87fL；肌酐(Crea)-静脉血: 58.2umol/L；C-反应蛋白(CRP)-静脉血: 1.11mg/L；尿酸(UA)-静脉血: 148.1umol/L；葡萄糖(Glu)-静脉血: 5.38mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.29；总胆红素(TBIL)-静脉血: 7.6umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.39mmolL；凝血酶时间(TT)-静脉血: 19.1sec.；钾离子(K+)-静脉血: 4.25mmol/L；阴离子间隙(AG)-静脉血: 10.3；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；白细胞计数(WBC#)-静脉血: 710E9/L；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阳性(169.39U/mL)（参考: 阴性）；载脂蛋白AI(apoAI)-静脉血: 1.57g/L；纤维蛋白原(Fbg)-静脉血: 3.35g/L；中性粒细胞计数(Neut#)-静脉血: 4.210E9/L；平均血小板体积(MPV)-静脉血: 9.6fL；有核红细胞百分比(NRBC%)-静脉血: 0；血小板比容-静脉血: 29%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 27mmol/L；凝血酶原时间活动度(PTA)-静脉血: 85.4%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；ABO血型-静脉血: O；甘油三酯(TG)-静脉血: 1.43mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.04S/CO；球蛋白(GLO)-静脉血: 33.45g/L；总钙(Ca)-静脉血: 2.26mmol/L；血小板分布宽度(PDW)-静脉血: 9.7%；间接胆红素(IBIL)-静脉血: 5.8umolL；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0IU/mL；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 安排根治性放化疗并完善胸腹部及骨骼等远处转移排查\nB. 行颈部淋巴结切除活检明确病理并完善胸腹部及骨骼等远处转移排查\nC. 行鼻咽镜下活检明确病理并暂缓远处转移排查直至病理确诊\nD. 行鼻咽镜下活检明确病理并完善胸腹部及骨骼等远处转移排查\nE. 行鼻咽镜下活检明确病理并安排诱导化疗联合同步放化疗\nF. 完善全身PET-CT检查排查远处转移并安排根治性放疗\nG. 行鼻咽镜下活检明确病理并完善头颅CT进一步评估颅底骨质破坏\nH. 行鼻咽镜下活检明确病理并完善EBV-DNA定量检测暂缓影像学排查\nI. 行颈部淋巴结穿刺活检明确病理并完善胸腹部及骨骼等远处转移排查\nJ. 完善胸部CT和腹部超声排查远处转移并暂缓鼻咽原发灶活检\nK. 行鼻咽镜下活检明确病理并完善全身骨扫描暂缓胸腹部影像学检查\nL. 安排鼻咽部肿物切除术明确病理并完善胸腹部及骨骼等远处转移排查\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- [时间未明] 门急诊记录: 主诉:；现病史: 者半年余前无明显诱因出现左侧颈部肿物，无疼痛，逐渐增大，伴有鼻塞、流涕，至当地医院予抗炎对症治疗后，肿物能减小；2月前患者始出现右侧颈部肿物，逐渐增大，伴有鼻塞、流涕，间中有涕血，无发热、畏寒，无头晕、头痛，无周身骨痛等，于当地医院检查ＣＴ示：鼻咽肿物，遂转至我院进一步诊治。门诊拟诊“鼻咽肿物”收入我科进一步治疗。患者起病以来精神、睡眠欠佳，胃纳尚可，二便正常，体重无明显下降。；既往史: 否认高血压、糖尿病及心脏病史，否认结核等传染病史、否认手术、外伤及输血史。；个人史:；家族史: 家族中无类似患者，无家族性遗传病患者，无重大精神病患者。；体格检查: KPS90，一般状况可，鼻咽左侧壁、顶后壁肿物，双颈扪及肿大淋巴结，右颈多枚肿大淋巴结，较大者约6*4及2*2cm,质硬，活动差，左上颈可及一淋巴结，约3*3cm，质中，活动度可，无融合，无皮肤浸润等，左中颈可及一大小约1*1cm质硬淋巴结；张口门齿距约4cm，颅神经征阴性。。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D0] 检验组合: 磷(P)-静脉血: 1.15mmol/L；平均红细胞体积(MCV)-静脉血: 87fL；肌酐(Crea)-静脉血: 58.2umol/L；C-反应蛋白(CRP)-静脉血: 1.11mg/L；尿酸(UA)-静脉血: 148.1umol/L；葡萄糖(Glu)-静脉血: 5.38mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.29；总胆红素(TBIL)-静脉血: 7.6umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.39mmolL；凝血酶时间(TT)-静脉血: 19.1sec.；钾离子(K+)-静脉血: 4.25mmol/L；阴离子间隙(AG)-静脉血: 10.3；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；白细胞计数(WBC#)-静脉血: 710E9/L；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阳性(169.39U/mL)（参考: 阴性）；载脂蛋白AI(apoAI)-静脉血: 1.57g/L；纤维蛋白原(Fbg)-静脉血: 3.35g/L；中性粒细胞计数(Neut#)-静脉血: 4.210E9/L；平均血小板体积(MPV)-静脉血: 9.6fL；有核红细胞百分比(NRBC%)-静脉血: 0；血小板比容-静脉血: 29%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 27mmol/L；凝血酶原时间活动度(PTA)-静脉血: 85.4%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；ABO血型-静脉血: O；甘油三酯(TG)-静脉血: 1.43mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.04S/CO；球蛋白(GLO)-静脉血: 33.45g/L；总钙(Ca)-静脉血: 2.26mmol/L；血小板分布宽度(PDW)-静脉血: 9.7%；间接胆红素(IBIL)-静脉血: 5.8umolL；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0IU/mL；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)……\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 安排根治性放化疗并完善胸腹部及骨骼等远处转移排查\nB. 行颈部淋巴结切除活检明确病理并完善胸腹部及骨骼等远处转移排查\nC. 行鼻咽镜下活检明确病理并暂缓远处转移排查直至病理确诊\nD. 行鼻咽镜下活检明确病理并完善胸腹部及骨骼等远处转移排查\nE. 行鼻咽镜下活检明确病理并安排诱导化疗联合同步放化疗\nF. 完善全身PET-CT检查排查远处转移并安排根治性放疗\nG. 行鼻咽镜下活检明确病理并完善头颅CT进一步评估颅底骨质破坏\nH. 行鼻咽镜下活检明确病理并完善EBV-DNA定量检测暂缓影像学排查\nI. 行颈部淋巴结穿刺活检明确病理并完善胸腹部及骨骼等远处转移排查\nJ. 完善胸部CT和腹部超声排查远处转移并暂缓鼻咽原发灶活检\nK. 行鼻咽镜下活检明确病理并完善全身骨扫描暂缓胸腹部影像学检查\nL. 安排鼻咽部肿物切除术明确病理并完善胸腹部及骨骼等远处转移排查\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [时间未明] 门急诊记录: 主诉:；现病史: 者半年余前无明显诱因出现左侧颈部肿物，无疼痛，逐渐增大，伴有鼻塞、流涕，至当地医院予抗炎对症治疗后，肿物能减小；2月前患者始出现右侧颈部肿物，逐渐增大，伴有鼻塞、流涕，间中有涕血，无发热、畏寒，无头晕、头痛，无周身骨痛等，于当地医院检查ＣＴ示：鼻咽肿物，遂转至我院进一步诊治。门诊拟诊“鼻咽肿物”收入我科进一步治疗。患者起病以来精神、睡眠欠佳，胃纳尚可，二便正常，体重无明显下降。；既往史: 否认高血压、糖尿病及心脏病史，否认结核等传染病史、否认手术、外伤及输血史。；个人史:；家族史: 家族中无类似患者，无家族性遗传病患者，无重大精神病患者。；体格检查: KPS90，一般状况可，鼻咽左侧壁、顶后壁肿物，双颈扪及肿大淋巴结，右颈多枚肿大淋巴结，较大者约6*4及2*2cm,质硬，活动差，左上颈可及一淋巴结，约3*3cm，质中，活动度可，无融合，无皮肤浸润等，左中颈可及一大小约1*1cm质硬淋巴结；张口门齿距约4cm，颅神经征阴性。。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D0] 检验组合: 磷(P)-静脉血: 1.15mmol/L；平均红细胞体积(MCV)-静脉血: 87fL；肌酐(Crea)-静脉血: 58.2umol/L；C-反应蛋白(CRP)-静脉血: 1.11mg/L；尿酸(UA)-静脉血: 148.1umol/L；葡萄糖(Glu)-静脉血: 5.38mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.29；总胆红素(TBIL)-静脉血: 7.6umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.39mmolL；凝血酶时间(TT)-静脉血: 19.1sec.；钾离子(K+)-静脉血: 4.25mmol/L；阴离子间隙(AG)-静脉血: 10.3；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；白细胞计数(WBC#)-静脉血: 710E9/L；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阳性(169.39U/mL)（参考: 阴性）；载脂蛋白AI(apoAI)-静脉血: 1.57g/L；纤维蛋白原(Fbg)-静脉血: 3.35g/L；中性粒细胞计数(Neut#)-静脉血: 4.210E9/L；平均血小板体积(MPV)-静脉血: 9.6fL；有核红细胞百分比(NRBC%)-静脉血: 0；血小板比容-静脉血: 29%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 27mmol/L；凝血酶原时间活动度(PTA)-静脉血: 85.4%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；ABO血型-静脉血: O；甘油三酯(TG)-静脉血: 1.43mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.04S/CO；球蛋白(GLO)-静脉血: 33.45g/L；总钙(Ca)-静脉血: 2.26mmol/L；血小板分布宽度(PDW)-静脉血: 9.7%；间接胆红素(IBIL)-静脉血: 5.8umolL；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0IU/mL；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)……\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 安排根治性放化疗并完善胸腹部及骨骼等远处转移排查\nB. 行颈部淋巴结切除活检明确病理并完善胸腹部及骨骼等远处转移排查\nC. 行鼻咽镜下活检明确病理并暂缓远处转移排查直至病理确诊\nD. 行鼻咽镜下活检明确病理并完善胸腹部及骨骼等远处转移排查\nE. 行鼻咽镜下活检明确病理并安排诱导化疗联合同步放化疗\nF. 完善全身PET-CT检查排查远处转移并安排根治性放疗\nG. 行鼻咽镜下活检明确病理并完善头颅CT进一步评估颅底骨质破坏\nH. 行鼻咽镜下活检明确病理并完善EBV-DNA定量检测暂缓影像学排查\nI. 行颈部淋巴结穿刺活检明确病理并完善胸腹部及骨骼等远处转移排查\nJ. 完善胸部CT和腹部超声排查远处转移并暂缓鼻咽原发灶活检\nK. 行鼻咽镜下活检明确病理并完善全身骨扫描暂缓胸腹部影像学检查\nL. 安排鼻咽部肿物切除术明确病理并完善胸腹部及骨骼等远处转移排查\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-220f428c46f369e75a66e1ab","patient_id":"patient-9149023ec8599161ec3e5cfd","turn_id":"turn04","turn_position":3,"turn_type":"initial_treatment_selection","gold_letter":"F","gold_action":"诱导化疗序贯同步放化疗","options":[{"letter":"A","text":"单纯根治性放疗","is_gold":false},{"letter":"B","text":"同步放化疗","is_gold":false},{"letter":"C","text":"诱导化疗序贯单纯根治性放疗","is_gold":false},{"letter":"D","text":"同步放化疗序贯辅助化疗","is_gold":false},{"letter":"E","text":"诱导化疗联合靶向治疗序贯放疗","is_gold":false},{"letter":"F","text":"诱导化疗序贯同步放化疗","is_gold":true},{"letter":"G","text":"根治性放疗序贯辅助化疗","is_gold":false},{"letter":"H","text":"诱导化疗序贯免疫联合同步放化疗","is_gold":false},{"letter":"I","text":"姑息性化疗联合免疫治疗","is_gold":false},{"letter":"J","text":"鼻咽放疗联合颈部淋巴结清扫术","is_gold":false},{"letter":"K","text":"靶向治疗联合同步放化疗","is_gold":false},{"letter":"L","text":"诱导化疗序贯颈部淋巴结清扫术","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现双颈肿物半年余；现病史: 者半年余前无明显诱因出现左侧颈部肿物，无疼痛，逐渐增大，伴有鼻塞、流涕，至当地医院予抗炎对症治疗后，肿物能减小；2月前患者始出现右侧颈部肿物，逐渐增大，伴有鼻塞、流涕，间中有涕血，无发热、畏寒，无头晕、头痛，无周身骨痛等，于当地医院检查ＣＴ示：鼻咽肿物，遂转至我院进一步诊治。门诊拟诊“鼻咽肿物”收入我科进一步治疗。患者起病以来精神、睡眠欠佳，胃纳尚可，二便正常，体重无明显下降。；阳性症状体征: 鼻塞,睡眠欠佳,鼻咽肿物,涕血,右颈部肿物,左颈部肿物,流涕；既往史: 体健，无高血压、心脏病等慢性病，无糖尿病、肾病等全身性疾病，无乙肝、结核等传染病，无外伤史。；个人史: 生于原籍，有吸烟史30年,无饮酒，无其他嗜好，否认冶游史。；家族史: 家族中无类似患者，无家族性遗传病患者，无重大精神病患者。；体格检查:；专科检查:；KPS:；ECOG:\n- [时间未明] 门急诊记录: 主诉:；现病史: 者半年余前无明显诱因出现左侧颈部肿物，无疼痛，逐渐增大，伴有鼻塞、流涕，至当地医院予抗炎对症治疗后，肿物能减小；2月前患者始出现右侧颈部肿物，逐渐增大，伴有鼻塞、流涕，间中有涕血，无发热、畏寒，无头晕、头痛，无周身骨痛等，于当地医院检查ＣＴ示：鼻咽肿物，遂转至我院进一步诊治。门诊拟诊“鼻咽肿物”收入我科进一步治疗。患者起病以来精神、睡眠欠佳，胃纳尚可，二便正常，体重无明显下降。；既往史: 否认高血压、糖尿病及心脏病史，否认结核等传染病史、否认手术、外伤及输血史。；个人史:；家族史: 家族中无类似患者，无家族性遗传病患者，无重大精神病患者。；体格检查: KPS90，一般状况可，鼻咽左侧壁、顶后壁肿物，双颈扪及肿大淋巴结，右颈多枚肿大淋巴结，较大者约6*4及2*2cm,质硬，活动差，左上颈可及一淋巴结，约3*3cm，质中，活动度可，无融合，无皮肤浸润等，左中颈可及一大小约1*1cm质硬淋巴结；张口门齿距约4cm，颅神经征阴性。。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D0] 检验组合: 磷(P)-静脉血: 1.15mmol/L；平均红细胞体积(MCV)-静脉血: 87fL；肌酐(Crea)-静脉血: 58.2umol/L；C-反应蛋白(CRP)-静脉血: 1.11mg/L；尿酸(UA)-静脉血: 148.1umol/L；葡萄糖(Glu)-静脉血: 5.38mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.29；总胆红素(TBIL)-静脉血: 7.6umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.39mmolL；凝血酶时间(TT)-静脉血: 19.1sec.；钾离子(K+)-静脉血: 4.25mmol/L；阴离子间隙(AG)-静脉血: 10.3；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；白细胞计数(WBC#)-静脉血: 710E9/L；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阳性(169.39U/mL)（参考: 阴性）；载脂蛋白AI(apoAI)-静脉血: 1.57g/L；纤维蛋白原(Fbg)-静脉血: 3.35g/L；中性粒细胞计数(Neut#)-静脉血: 4.210E9/L；平均血小板体积(MPV)-静脉血: 9.6fL；有核红细胞百分比(NRBC%)-静脉血: 0；血小板比容-静脉血: 29%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 27mmol/L；凝血酶原时间活动度(PTA)-静脉血: 85.4%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；ABO血型-静脉血: O；甘油三酯(TG)-静脉血: 1.43mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.04S/CO；球蛋白(GLO)-静脉血: 33.45g/L；总钙(Ca)-静脉血: 2.26mmol/L；血小板分布宽度(PDW)-静脉血: 9.7%；间接胆红素(IBIL)-静脉血: 5.8umolL；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0IU/mL；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)……\n- [全程D1] CT；胸、上腹CT平扫+增强: 检查类型: CT；检查名称: 胸、上腹CT平扫+增强；检查部位:；检查所见: 双肺纹理清晰，左肺下叶外基底段见条索状高密度影，边界清；余双肺内未见明显实质性病变。 气管及支气管分支通畅。 双肺门及纵隔未见明显肿大淋巴结。 双侧胸腔未见积液。双侧胸膜未见增厚、粘连。 肝脏形态未见异常，轮廓光整，各叶比例在正常范围以内，密度均匀。 肝内胆管未见明显异常。胆囊不大、壁不厚，其内未见结石。胆总管未见扩张，其内未见结石。 肝门区结构清晰。门静脉未见明显异常。 脾脏大小、形态未见明显异常，密度均匀。 胰腺大小、形态未见明显异常，密度均匀。 所示双肾及双侧肾上腺大小、形态未见明显异常，密度均匀。 膈脚后、肝门区、腹主动脉旁、腹腔干周围未见明显肿大淋巴结。 扫描层面内未见明显骨质破坏。；检查结论: 左肺下叶外基底段条索影，考虑纤维灶。 上腹部未见明显异常。\n- [全程D2] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 鼻咽部见片状放射性浓密影。胸骨、锁骨、肩胛骨、肋骨、颈椎、胸椎、腰椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 鼻咽部代谢活跃，考虑鼻咽癌所致。 余全身骨骼未见明显异常。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 单纯根治性放疗\nB. 同步放化疗\nC. 诱导化疗序贯单纯根治性放疗\nD. 同步放化疗序贯辅助化疗\nE. 诱导化疗联合靶向治疗序贯放疗\nF. 诱导化疗序贯同步放化疗\nG. 根治性放疗序贯辅助化疗\nH. 诱导化疗序贯免疫联合同步放化疗\nI. 姑息性化疗联合免疫治疗\nJ. 鼻咽放疗联合颈部淋巴结清扫术\nK. 靶向治疗联合同步放化疗\nL. 诱导化疗序贯颈部淋巴结清扫术\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D1] CT；胸、上腹CT平扫+增强: 检查类型: CT；检查名称: 胸、上腹CT平扫+增强；检查部位:；检查所见: 双肺纹理清晰，左肺下叶外基底段见条索状高密度影，边界清；余双肺内未见明显实质性病变。 气管及支气管分支通畅。 双肺门及纵隔未见明显肿大淋巴结。 双侧胸腔未见积液。双侧胸膜未见增厚、粘连。 肝脏形态未见异常，轮廓光整，各叶比例在正常范围以内，密度均匀。 肝内胆管未见明显异常。胆囊不大、壁不厚，其内未见结石。胆总管未见扩张，其内未见结石。 肝门区结构清晰。门静脉未见明显异常。 脾脏大小、形态未见明显异常，密度均匀。 胰腺大小、形态未见明显异常，密度均匀。 所示双肾及双侧肾上腺大小、形态未见明显异常，密度均匀。 膈脚后、肝门区、腹主动脉旁、腹腔干周围未见明显肿大淋巴结。 扫描层面内未见明显骨质破坏。；检查结论: 左肺下叶外基底段条索影，考虑纤维灶。 上腹部未见明显异常。\n- [全程D2] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 鼻咽部见片状放射性浓密影。胸骨、锁骨、肩胛骨、肋骨、颈椎、胸椎、腰椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 鼻咽部代谢活跃，考虑鼻咽癌所致。 余全身骨骼未见明显异常。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 单纯根治性放疗\nB. 同步放化疗\nC. 诱导化疗序贯单纯根治性放疗\nD. 同步放化疗序贯辅助化疗\nE. 诱导化疗联合靶向治疗序贯放疗\nF. 诱导化疗序贯同步放化疗\nG. 根治性放疗序贯辅助化疗\nH. 诱导化疗序贯免疫联合同步放化疗\nI. 姑息性化疗联合免疫治疗\nJ. 鼻咽放疗联合颈部淋巴结清扫术\nK. 靶向治疗联合同步放化疗\nL. 诱导化疗序贯颈部淋巴结清扫术\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D1] CT；胸、上腹CT平扫+增强: 检查类型: CT；检查名称: 胸、上腹CT平扫+增强；检查部位:；检查所见: 双肺纹理清晰，左肺下叶外基底段见条索状高密度影，边界清；余双肺内未见明显实质性病变。 气管及支气管分支通畅。 双肺门及纵隔未见明显肿大淋巴结。 双侧胸腔未见积液。双侧胸膜未见增厚、粘连。 肝脏形态未见异常，轮廓光整，各叶比例在正常范围以内，密度均匀。 肝内胆管未见明显异常。胆囊不大、壁不厚，其内未见结石。胆总管未见扩张，其内未见结石。 肝门区结构清晰。门静脉未见明显异常。 脾脏大小、形态未见明显异常，密度均匀。 胰腺大小、形态未见明显异常，密度均匀。 所示双肾及双侧肾上腺大小、形态未见明显异常，密度均匀。 膈脚后、肝门区、腹主动脉旁、腹腔干周围未见明显肿大淋巴结。 扫描层面内未见明显骨质破坏。；检查结论: 左肺下叶外基底段条索影，考虑纤维灶。 上腹部未见明显异常。\n- [全程D2] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 鼻咽部见片状放射性浓密影。胸骨、锁骨、肩胛骨、肋骨、颈椎、胸椎、腰椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 鼻咽部代谢活跃，考虑鼻咽癌所致。 余全身骨骼未见明显异常。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 单纯根治性放疗\nB. 同步放化疗\nC. 诱导化疗序贯单纯根治性放疗\nD. 同步放化疗序贯辅助化疗\nE. 诱导化疗联合靶向治疗序贯放疗\nF. 诱导化疗序贯同步放化疗\nG. 根治性放疗序贯辅助化疗\nH. 诱导化疗序贯免疫联合同步放化疗\nI. 姑息性化疗联合免疫治疗\nJ. 鼻咽放疗联合颈部淋巴结清扫术\nK. 靶向治疗联合同步放化疗\nL. 诱导化疗序贯颈部淋巴结清扫术\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-ed1b449691d94cea18e7b28b","patient_id":"patient-9149023ec8599161ec3e5cfd","turn_id":"turn05","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"K","gold_action":"安排鼻咽及颈部MRI平扫+增强、头颅MRI平扫+增强，暂缓胸部X线及腹部彩超检查，作为当前时点针对左侧颞叶新发病灶的重点影像随访；常规胸片、腹部彩超、EBV-DNA及甲功等全身随访可在下一随访窗口期再行安排。","options":[{"letter":"A","text":"给予大剂量糖皮质激素冲击治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超","is_gold":false},{"letter":"B","text":"给予贝伐珠单抗靶向治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项","is_gold":false},{"letter":"C","text":"安排头颅PET-CT检查鉴别左侧颞叶病变性质，并安排胸部X线、腹部彩超、甲功五项","is_gold":false},{"letter":"D","text":"安排立体定向脑活检明确左侧颞叶病变性质，并安排胸部X线、腹部彩超、甲功五项","is_gold":false},{"letter":"E","text":"给予高压氧治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项","is_gold":false},{"letter":"F","text":"给予甘露醇静脉滴注脱水降颅压，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超","is_gold":false},{"letter":"G","text":"安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项及EBV-DNA定量检测","is_gold":false},{"letter":"H","text":"给予神经营养药物治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项","is_gold":false},{"letter":"I","text":"安排鼻咽及颈部CT平扫+增强、胸部CT平扫、腹部CT平扫、甲功五项及EBV-DNA定量检测","is_gold":false},{"letter":"J","text":"安排立体定向放射外科治疗左侧颞叶病变，并安排胸部X线、腹部彩超、甲功五项","is_gold":false},{"letter":"K","text":"安排鼻咽及颈部MRI平扫+增强、头颅MRI平扫+增强，暂缓胸部X线及腹部彩超检查","is_gold":true},{"letter":"L","text":"给予抗癫痫药物预防性治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现双颈肿物半年余；现病史: 者半年余前无明显诱因出现左侧颈部肿物，无疼痛，逐渐增大，伴有鼻塞、流涕，至当地医院予抗炎对症治疗后，肿物能减小；2月前患者始出现右侧颈部肿物，逐渐增大，伴有鼻塞、流涕，间中有涕血，无发热、畏寒，无头晕、头痛，无周身骨痛等，于当地医院检查ＣＴ示：鼻咽肿物，遂转至我院进一步诊治。门诊拟诊“鼻咽肿物”收入我科进一步治疗。患者起病以来精神、睡眠欠佳，胃纳尚可，二便正常，体重无明显下降。；阳性症状体征: 鼻塞,睡眠欠佳,鼻咽肿物,涕血,右颈部肿物,左颈部肿物,流涕；既往史: 体健，无高血压、心脏病等慢性病，无糖尿病、肾病等全身性疾病，无乙肝、结核等传染病，无外伤史。；个人史: 生于原籍，有吸烟史30年,无饮酒，无其他嗜好，否认冶游史。；家族史: 家族中无类似患者，无家族性遗传病患者，无重大精神病患者。；体格检查:；专科检查:；KPS:；ECOG:\n- [时间未明] 门急诊记录: 主诉:；现病史: 者半年余前无明显诱因出现左侧颈部肿物，无疼痛，逐渐增大，伴有鼻塞、流涕，至当地医院予抗炎对症治疗后，肿物能减小；2月前患者始出现右侧颈部肿物，逐渐增大，伴有鼻塞、流涕，间中有涕血，无发热、畏寒，无头晕、头痛，无周身骨痛等，于当地医院检查ＣＴ示：鼻咽肿物，遂转至我院进一步诊治。门诊拟诊“鼻咽肿物”收入我科进一步治疗。患者起病以来精神、睡眠欠佳，胃纳尚可，二便正常，体重无明显下降。；既往史: 否认高血压、糖尿病及心脏病史，否认结核等传染病史、否认手术、外伤及输血史。；个人史:；家族史: 家族中无类似患者，无家族性遗传病患者，无重大精神病患者。；体格检查: KPS90，一般状况可，鼻咽左侧壁、顶后壁肿物，双颈扪及肿大淋巴结，右颈多枚肿大淋巴结，较大者约6*4及2*2cm,质硬，活动差，左上颈可及一淋巴结，约3*3cm，质中，活动度可，无融合，无皮肤浸润等，左中颈可及一大小约1*1cm质硬淋巴结；张口门齿距约4cm，颅神经征阴性。。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D986] 门急诊记录: 主诉: 鼻咽癌放化疗结束2年，诉轻度口干，听力视力正常，无头晕、头痛。体查：鼻咽未见明确肿物，双颈未扪及明显肿大淋巴结，颅神经（-）甲功五项示正常。鼻咽MRI未见明确复发，腹部B超、胸片未见明确转移。EBV-DNA:0；现病史:；既往史:；个人史:；家族史:；体格检查:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D0] 检验组合: 磷(P)-静脉血: 1.15mmol/L；平均红细胞体积(MCV)-静脉血: 87fL；肌酐(Crea)-静脉血: 58.2umol/L；C-反应蛋白(CRP)-静脉血: 1.11mg/L；尿酸(UA)-静脉血: 148.1umol/L；葡萄糖(Glu)-静脉血: 5.38mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.29；总胆红素(TBIL)-静脉血: 7.6umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.39mmolL；凝血酶时间(TT)-静脉血: 19.1sec.；钾离子(K+)-静脉血: 4.25mmol/L；阴离子间隙(AG)-静脉血: 10.3；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；白细胞计数(WBC#)-静脉血: 710E9/L；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阳性(169.39U/mL)（参考: 阴性）；载脂蛋白AI(apoAI)-静脉血: 1.57g/L；纤维蛋白原(Fbg)-静脉血: 3.35g/L；中性粒细胞计数(Neut#)-静脉血: 4.210E9/L；平均血小板体积(MPV)-静脉血: 9.6fL；有核红细胞百分比(NRBC%)-静脉血: 0；血小板比容-静脉血: 29%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 27mmol/L；凝血酶原时间活动度(PTA)-静脉血: 85.4%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；ABO血型-静脉血: O；甘油三酯(TG)-静脉血: 1.43mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.04S/CO；球蛋白(GLO)-静脉血: 33.45g/L；总钙(Ca)-静脉血: 2.26mmol/L；血小板分布宽度(PDW)-静脉血: 9.7%；间接胆红素(IBIL)-静脉血: 5.8umolL；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0IU/mL；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)……\n- [全程D1] CT；胸、上腹CT平扫+增强: 检查类型: CT；检查名称: 胸、上腹CT平扫+增强；检查部位:；检查所见: 双肺纹理清晰，左肺下叶外基底段见条索状高密度影，边界清；余双肺内未见明显实质性病变。 气管及支气管分支通畅。 双肺门及纵隔未见明显肿大淋巴结。 双侧胸腔未见积液。双侧胸膜未见增厚、粘连。 肝脏形态未见异常，轮廓光整，各叶比例在正常范围以内，密度均匀。 肝内胆管未见明显异常。胆囊不大、壁不厚，其内未见结石。胆总管未见扩张，其内未见结石。 肝门区结构清晰。门静脉未见明显异常。 脾脏大小、形态未见明显异常，密度均匀。 胰腺大小、形态未见明显异常，密度均匀。 所示双肾及双侧肾上腺大小、形态未见明显异常，密度均匀。 膈脚后、肝门区、腹主动脉旁、腹腔干周围未见明显肿大淋巴结。 扫描层面内未见明显骨质破坏。；检查结论: 左肺下叶外基底段条索影，考虑纤维灶。 上腹部未见明显异常。\n- [全程D2] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 鼻咽部见片状放射性浓密影。胸骨、锁骨、肩胛骨、肋骨、颈椎、胸椎、腰椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 鼻咽部代谢活跃，考虑鼻咽癌所致。 余全身骨骼未见明显异常。\n- [全程D985] MRI；鼻咽部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部MR平扫+增强；检查部位:；检查所见: 鼻咽癌放疗后复查，对比某次就诊时间片： 鼻咽腔未见狭窄，鼻咽顶壁、顶后壁、右侧壁轻度增厚，均匀强化，右侧咽隐窝变浅，考虑放疗后改变，较前相仿。 蝶骨基底部、左侧枕骨基底部、左侧岩尖、左侧翼突基底部骨质信号下降，增强扫描轻度不均匀强化，较前相仿。 左侧破裂孔见少许软组织影，增强扫描轻度强化，较前相仿。 双侧咽后间隙见小淋巴结，大者短径约3mm，较前相仿。 右颈II区见多个淋巴结，最大短径约为5mm，部分边界欠清，增强扫描不均匀强化，较前稍缩小。 双侧上颌窦、筛窦、额窦粘膜增厚，考虑副鼻窦炎，较前相仿。 扫描所见颅脑未见明确异常。；检查结论:\n- [全程D985] MRI；颈部MR平扫+增强: 检查类型: MRI；检查名称: 颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌放疗后复查，对比某次就诊时间片： 鼻咽腔未见狭窄，鼻咽顶壁、顶后壁、右侧壁轻度增厚，均匀强化，右侧咽隐窝变浅，考虑放疗后改变，较前相仿。 蝶骨基底部、左侧枕骨基底部、左侧岩尖、左侧翼突基底部骨质信号下降，增强扫描轻度不均匀强化，较前相仿。 左侧破裂孔见少许软组织影，增强扫描轻度强化，较前相仿。 双侧咽后间隙见小淋巴结，大者短径约3mm，较前相仿。 右颈II区见多个淋巴结，最大短径约为5mm，部分边界欠清，增强扫描不均匀强化，较前稍缩小。 双侧上颌窦、筛窦、额窦粘膜增厚，考虑副鼻窦炎，较前相仿。 扫描所见颅脑未见明确异常。；检查结论:\n- [全程D1168] 检验组合: 游离甲状腺素(FT4)-静脉血: 14.91pmol/L；甲状腺过氧化物酶抗体(TPO-Ab)-静脉血: 12.55U/ml；游离三碘甲状腺原氨酸(FT3)-静脉血: 4.97pmol/L；甲状腺球蛋白(TG)-静脉血: 1.12ng/ml；促甲状腺激素(TSH)-静脉血: 1.59uIU/ml\n- [全程D1169] 超声；肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径不宽，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。\n- [全程D1170] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，走行自然，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n- [全程D1380] 检验组合: 游离三碘甲状腺原氨酸(FT3)-静脉血: 5.27pmol/L；游离甲状腺素(FT4)-静脉血: 13.84pmol/L；胆碱酯酶(ChE)-静脉血: 10374U/L；总钙(Ca)-静脉血: 2.33mmol/L；中性粒细胞百分比(Neut%)-静脉血: 56.6%；γ-谷氨酰基转移酶(GGT)-静脉血: 25.6U/L；肌酸激酶(CK)-静脉血: 80U/L；肌酐(Crea)-静脉血: 59.7umol/L；总蛋白(TP)-静脉血: 72.07g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 27.9pg；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.29mmol/L；淋巴细胞计数(Lymph#)-静脉血: 2.110E9/L；镁离子(Mg2+)-静脉血: 1.02mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.3mmol/L；碱性磷酸酶(ALP)-静脉血: 75.5U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.2510E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.2%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.1fL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；大血小板百分比(P-LCR%)-静脉血: 21.4%；白蛋白(ALB)-静脉血: 43.8g/L；载脂蛋白AI(apoAI)-静脉血: 1.52g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.55；总胆固醇(TC)-静脉血: 6.32mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.7U/L；阴离子间隙(AG)-静脉血: 18.4；血红蛋白(Hb)-静脉血: 131g/L；甲状腺球蛋白(TG)-静脉血: 1.4ng/ml；平均红细胞血红蛋白浓度(MCHC)-静脉血: 300g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.34mmolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 2.4；钾离子(K+)-静脉血: 3.9mmol/L；红细胞比容(Hct)-静脉血: 43.7%；未成熟粒细胞百分比(IG%)-静脉血: 0.5%；磷(P)-静脉血: 1.39mmol/L；钠离子(Na+)-静脉血: 141.4mmol/L；间接胆红素(IBIL)-静脉血:……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D986] 门急诊记录: 主诉: 鼻咽癌放化疗结束2年，诉轻度口干，听力视力正常，无头晕、头痛。体查：鼻咽未见明确肿物，双颈未扪及明显肿大淋巴结，颅神经（-）甲功五项示正常。鼻咽MRI未见明确复发，腹部B超、胸片未见明确转移。EBV-DNA:0；现病史:；既往史:；个人史:；家族史:；体格检查:\n- [全程D1174] 门急诊记录: 主诉: 鼻咽癌放化疗结束2年，诉轻度口干，听力视力正常，无头晕、头痛。体查：鼻咽未见明确肿物，双颈未扪及明显肿大淋巴结，颅神经（-）甲功五项示正常。鼻咽MRI未见明确复发，腹部B超、胸片未见明确转移。EBV-DNA:0；现病史:；既往史:；个人史:；家族史:；体格检查:\n- [时间未明] 门急诊记录: 主诉:；现病史: 者半年余前无明显诱因出现左侧颈部肿物，无疼痛，逐渐增大，伴有鼻塞、流涕，至当地医院予抗炎对症治疗后，肿物能减小；2月前患者始出现右侧颈部肿物，逐渐增大，伴有鼻塞、流涕，间中有涕血，无发热、畏寒，无头晕、头痛，无周身骨痛等，于当地医院检查ＣＴ示：鼻咽肿物，遂转至我院进一步诊治。门诊拟诊“鼻咽肿物”收入我科进一步治疗。患者起病以来精神、睡眠欠佳，胃纳尚可，二便正常，体重无明显下降。；既往史: 否认高血压、糖尿病及心脏病史，否认结核等传染病史、否认手术、外伤及输血史。；个人史:；家族史: 家族中无类似患者，无家族性遗传病患者，无重大精神病患者。；体格检查: KPS90，一般状况可，鼻咽左侧壁、顶后壁肿物，双颈扪及肿大淋巴结，右颈多枚肿大淋巴结，较大者约6*4及2*2cm,质硬，活动差，左上颈可及一淋巴结，约3*3cm，质中，活动度可，无融合，无皮肤浸润等，左中颈可及一大小约1*1cm质硬淋巴结；张口门齿距约4cm，颅神经征阴性。。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 给予大剂量糖皮质激素冲击治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超\nB. 给予贝伐珠单抗靶向治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项\nC. 安排头颅PET-CT检查鉴别左侧颞叶病变性质，并安排胸部X线、腹部彩超、甲功五项\nD. 安排立体定向脑活检明确左侧颞叶病变性质，并安排胸部X线、腹部彩超、甲功五项\nE. 给予高压氧治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项\nF. 给予甘露醇静脉滴注脱水降颅压，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超\nG. 安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项及EBV-DNA定量检测\nH. 给予神经营养药物治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项\nI. 安排鼻咽及颈部CT平扫+增强、胸部CT平扫、腹部CT平扫、甲功五项及EBV-DNA定量检测\nJ. 安排立体定向放射外科治疗左侧颞叶病变，并安排胸部X线、腹部彩超、甲功五项\nK. 安排鼻咽及颈部MRI平扫+增强、头颅MRI平扫+增强，暂缓胸部X线及腹部彩超检查\nL. 给予抗癫痫药物预防性治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- [全程D986] 门急诊记录: 主诉: 鼻咽癌放化疗结束2年，诉轻度口干，听力视力正常，无头晕、头痛。体查：鼻咽未见明确肿物，双颈未扪及明显肿大淋巴结，颅神经（-）甲功五项示正常。鼻咽MRI未见明确复发，腹部B超、胸片未见明确转移。EBV-DNA:0；现病史:；既往史:；个人史:；家族史:；体格检查:\n\n【已完成检查与客观结果】\n- [全程D985] MRI；鼻咽部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部MR平扫+增强；检查部位:；检查所见: 鼻咽癌放疗后复查，对比某次就诊时间片： 鼻咽腔未见狭窄，鼻咽顶壁、顶后壁、右侧壁轻度增厚，均匀强化，右侧咽隐窝变浅，考虑放疗后改变，较前相仿。 蝶骨基底部、左侧枕骨基底部、左侧岩尖、左侧翼突基底部骨质信号下降，增强扫描轻度不均匀强化，较前相仿。 左侧破裂孔见少许软组织影，增强扫描轻度强化，较前相仿。 双侧咽后间隙见小淋巴结，大者短径约3mm，较前相仿。 右颈II区见多个淋巴结，最大短径约为5mm，部分边界欠清，增强扫描不均匀强化，较前稍缩小。 双侧上颌窦、筛窦、额窦粘膜增厚，考虑副鼻窦炎，较前相仿。 扫描所见颅脑未见明确异常。；检查结论:\n- [全程D985] MRI；颈部MR平扫+增强: 检查类型: MRI；检查名称: 颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌放疗后复查，对比某次就诊时间片： 鼻咽腔未见狭窄，鼻咽顶壁、顶后壁、右侧壁轻度增厚，均匀强化，右侧咽隐窝变浅，考虑放疗后改变，较前相仿。 蝶骨基底部、左侧枕骨基底部、左侧岩尖、左侧翼突基底部骨质信号下降，增强扫描轻度不均匀强化，较前相仿。 左侧破裂孔见少许软组织影，增强扫描轻度强化，较前相仿。 双侧咽后间隙见小淋巴结，大者短径约3mm，较前相仿。 右颈II区见多个淋巴结，最大短径约为5mm，部分边界欠清，增强扫描不均匀强化，较前稍缩小。 双侧上颌窦、筛窦、额窦粘膜增厚，考虑副鼻窦炎，较前相仿。 扫描所见颅脑未见明确异常。；检查结论:\n- [全程D1168] 检验组合: 游离甲状腺素(FT4)-静脉血: 14.91pmol/L；甲状腺过氧化物酶抗体(TPO-Ab)-静脉血: 12.55U/ml；游离三碘甲状腺原氨酸(FT3)-静脉血: 4.97pmol/L；甲状腺球蛋白(TG)-静脉血: 1.12ng/ml；促甲状腺激素(TSH)-静脉血: 1.59uIU/ml\n- [全程D1169] 超声；肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径不宽，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。\n- [全程D1170] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，走行自然，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n- [全程D1380] 检验组合: 游离三碘甲状腺原氨酸(FT3)-静脉血: 5.27pmol/L；游离甲状腺素(FT4)-静脉血: 13.84pmol/L；胆碱酯酶(ChE)-静脉血: 10374U/L；总钙(Ca)-静脉血: 2.33mmol/L；中性粒细胞百分比(Neut%)-静脉血: 56.6%；γ-谷氨酰基转移酶(GGT)-静脉血: 25.6U/L；肌酸激酶(CK)-静脉血: 80U/L；肌酐(Crea)-静脉血: 59.7umol/L；总蛋白(TP)-静脉血: 72.07g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 27.9pg；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.29mmol/L；淋巴细胞计数(Lymph#)-静脉血: 2.110E9/L；镁离子(Mg2+)-静脉血: 1.02mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.3mmol/L；碱性磷酸酶(ALP)-静脉血: 75.5U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.2510E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.2%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.1fL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；大血小板百分比(P-LCR%)-静脉血: 21.4%；白蛋白(ALB)-静脉血: 43.8g/L；载脂蛋白AI(apoAI)-静脉血: 1.52g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.55；总胆固醇(TC)-静脉血: 6.32mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.7U/L；阴离子间隙(AG)-静脉血: 18.4；血红蛋白(Hb)-静脉血: 131g/L；甲状腺球蛋白(TG)-静脉血: 1.4ng/ml；平均红细胞血红蛋白浓度(MCHC)-静脉血: 300g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.34mmolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 2.4；钾离子(K+)-静脉血: 3.9mmol/L；红细胞比容(Hct)-静脉血: 43.7%；未成熟粒细胞百分比(IG%)-静脉血: 0.5%；磷(P)-静脉血: 1.39mmol/L；钠离子(Na+)-静脉血: 141.4mmol/L；间接胆红素(IBIL)-静脉血:……\n\n【既往治疗与反应】\n- [全程D986] 门急诊记录: 主诉: 鼻咽癌放化疗结束2年，诉轻度口干，听力视力正常，无头晕、头痛。体查：鼻咽未见明确肿物，双颈未扪及明显肿大淋巴结，颅神经（-）甲功五项示正常。鼻咽MRI未见明确复发，腹部B超、胸片未见明确转移。EBV-DNA:0；现病史:；既往史:；个人史:；家族史:；体格检查:\n- [全程D1174] 门急诊记录: 主诉: 鼻咽癌放化疗结束2年，诉轻度口干，听力视力正常，无头晕、头痛。体查：鼻咽未见明确肿物，双颈未扪及明显肿大淋巴结，颅神经（-）甲功五项示正常。鼻咽MRI未见明确复发，腹部B超、胸片未见明确转移。EBV-DNA:0；现病史:；既往史:；个人史:；家族史:；体格检查:\n- [时间未明] 门急诊记录: 主诉:；现病史: 者半年余前无明显诱因出现左侧颈部肿物，无疼痛，逐渐增大，伴有鼻塞、流涕，至当地医院予抗炎对症治疗后，肿物能减小；2月前患者始出现右侧颈部肿物，逐渐增大，伴有鼻塞、流涕，间中有涕血，无发热、畏寒，无头晕、头痛，无周身骨痛等，于当地医院检查ＣＴ示：鼻咽肿物，遂转至我院进一步诊治。门诊拟诊“鼻咽肿物”收入我科进一步治疗。患者起病以来精神、睡眠欠佳，胃纳尚可，二便正常，体重无明显下降。；既往史: 否认高血压、糖尿病及心脏病史，否认结核等传染病史、否认手术、外伤及输血史。；个人史:；家族史: 家族中无类似患者，无家族性遗传病患者，无重大精神病患者。；体格检查: KPS90，一般状况可，鼻咽左侧壁、顶后壁肿物，双颈扪及肿大淋巴结，右颈多枚肿大淋巴结，较大者约6*4及2*2cm,质硬，活动差，左上颈可及一淋巴结，约3*3cm，质中，活动度可，无融合，无皮肤浸润等，左中颈可及一大小约1*1cm质硬淋巴结；张口门齿距约4cm，颅神经征阴性。。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 给予大剂量糖皮质激素冲击治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超\nB. 给予贝伐珠单抗靶向治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项\nC. 安排头颅PET-CT检查鉴别左侧颞叶病变性质，并安排胸部X线、腹部彩超、甲功五项\nD. 安排立体定向脑活检明确左侧颞叶病变性质，并安排胸部X线、腹部彩超、甲功五项\nE. 给予高压氧治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项\nF. 给予甘露醇静脉滴注脱水降颅压，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超\nG. 安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项及EBV-DNA定量检测\nH. 给予神经营养药物治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项\nI. 安排鼻咽及颈部CT平扫+增强、胸部CT平扫、腹部CT平扫、甲功五项及EBV-DNA定量检测\nJ. 安排立体定向放射外科治疗左侧颞叶病变，并安排胸部X线、腹部彩超、甲功五项\nK. 安排鼻咽及颈部MRI平扫+增强、头颅MRI平扫+增强，暂缓胸部X线及腹部彩超检查\nL. 给予抗癫痫药物预防性治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D986] 门急诊记录: 主诉: 鼻咽癌放化疗结束2年，诉轻度口干，听力视力正常，无头晕、头痛。体查：鼻咽未见明确肿物，双颈未扪及明显肿大淋巴结，颅神经（-）甲功五项示正常。鼻咽MRI未见明确复发，腹部B超、胸片未见明确转移。EBV-DNA:0；现病史:；既往史:；个人史:；家族史:；体格检查:\n\n【已完成检查与客观结果】\n- [全程D985] MRI；鼻咽部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部MR平扫+增强；检查部位:；检查所见: 鼻咽癌放疗后复查，对比某次就诊时间片： 鼻咽腔未见狭窄，鼻咽顶壁、顶后壁、右侧壁轻度增厚，均匀强化，右侧咽隐窝变浅，考虑放疗后改变，较前相仿。 蝶骨基底部、左侧枕骨基底部、左侧岩尖、左侧翼突基底部骨质信号下降，增强扫描轻度不均匀强化，较前相仿。 左侧破裂孔见少许软组织影，增强扫描轻度强化，较前相仿。 双侧咽后间隙见小淋巴结，大者短径约3mm，较前相仿。 右颈II区见多个淋巴结，最大短径约为5mm，部分边界欠清，增强扫描不均匀强化，较前稍缩小。 双侧上颌窦、筛窦、额窦粘膜增厚，考虑副鼻窦炎，较前相仿。 扫描所见颅脑未见明确异常。；检查结论:\n- [全程D985] MRI；颈部MR平扫+增强: 检查类型: MRI；检查名称: 颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌放疗后复查，对比某次就诊时间片： 鼻咽腔未见狭窄，鼻咽顶壁、顶后壁、右侧壁轻度增厚，均匀强化，右侧咽隐窝变浅，考虑放疗后改变，较前相仿。 蝶骨基底部、左侧枕骨基底部、左侧岩尖、左侧翼突基底部骨质信号下降，增强扫描轻度不均匀强化，较前相仿。 左侧破裂孔见少许软组织影，增强扫描轻度强化，较前相仿。 双侧咽后间隙见小淋巴结，大者短径约3mm，较前相仿。 右颈II区见多个淋巴结，最大短径约为5mm，部分边界欠清，增强扫描不均匀强化，较前稍缩小。 双侧上颌窦、筛窦、额窦粘膜增厚，考虑副鼻窦炎，较前相仿。 扫描所见颅脑未见明确异常。；检查结论:\n- [全程D1168] 检验组合: 游离甲状腺素(FT4)-静脉血: 14.91pmol/L；甲状腺过氧化物酶抗体(TPO-Ab)-静脉血: 12.55U/ml；游离三碘甲状腺原氨酸(FT3)-静脉血: 4.97pmol/L；甲状腺球蛋白(TG)-静脉血: 1.12ng/ml；促甲状腺激素(TSH)-静脉血: 1.59uIU/ml\n- [全程D1169] 超声；肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径不宽，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。\n- [全程D1170] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，走行自然，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n- [全程D1380] 检验组合: 游离三碘甲状腺原氨酸(FT3)-静脉血: 5.27pmol/L；游离甲状腺素(FT4)-静脉血: 13.84pmol/L；胆碱酯酶(ChE)-静脉血: 10374U/L；总钙(Ca)-静脉血: 2.33mmol/L；中性粒细胞百分比(Neut%)-静脉血: 56.6%；γ-谷氨酰基转移酶(GGT)-静脉血: 25.6U/L；肌酸激酶(CK)-静脉血: 80U/L；肌酐(Crea)-静脉血: 59.7umol/L；总蛋白(TP)-静脉血: 72.07g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 27.9pg；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.29mmol/L；淋巴细胞计数(Lymph#)-静脉血: 2.110E9/L；镁离子(Mg2+)-静脉血: 1.02mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.3mmol/L；碱性磷酸酶(ALP)-静脉血: 75.5U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.2510E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.2%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.1fL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；大血小板百分比(P-LCR%)-静脉血: 21.4%；白蛋白(ALB)-静脉血: 43.8g/L；载脂蛋白AI(apoAI)-静脉血: 1.52g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.55；总胆固醇(TC)-静脉血: 6.32mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.7U/L；阴离子间隙(AG)-静脉血: 18.4；血红蛋白(Hb)-静脉血: 131g/L；甲状腺球蛋白(TG)-静脉血: 1.4ng/ml；平均红细胞血红蛋白浓度(MCHC)-静脉血: 300g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.34mmolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 2.4；钾离子(K+)-静脉血: 3.9mmol/L；红细胞比容(Hct)-静脉血: 43.7%；未成熟粒细胞百分比(IG%)-静脉血: 0.5%；磷(P)-静脉血: 1.39mmol/L；钠离子(Na+)-静脉血: 141.4mmol/L；间接胆红素(IBIL)-静脉血:……\n\n【既往治疗与反应】\n- [全程D986] 门急诊记录: 主诉: 鼻咽癌放化疗结束2年，诉轻度口干，听力视力正常，无头晕、头痛。体查：鼻咽未见明确肿物，双颈未扪及明显肿大淋巴结，颅神经（-）甲功五项示正常。鼻咽MRI未见明确复发，腹部B超、胸片未见明确转移。EBV-DNA:0；现病史:；既往史:；个人史:；家族史:；体格检查:\n- [全程D1174] 门急诊记录: 主诉: 鼻咽癌放化疗结束2年，诉轻度口干，听力视力正常，无头晕、头痛。体查：鼻咽未见明确肿物，双颈未扪及明显肿大淋巴结，颅神经（-）甲功五项示正常。鼻咽MRI未见明确复发，腹部B超、胸片未见明确转移。EBV-DNA:0；现病史:；既往史:；个人史:；家族史:；体格检查:\n- [时间未明] 门急诊记录: 主诉:；现病史: 者半年余前无明显诱因出现左侧颈部肿物，无疼痛，逐渐增大，伴有鼻塞、流涕，至当地医院予抗炎对症治疗后，肿物能减小；2月前患者始出现右侧颈部肿物，逐渐增大，伴有鼻塞、流涕，间中有涕血，无发热、畏寒，无头晕、头痛，无周身骨痛等，于当地医院检查ＣＴ示：鼻咽肿物，遂转至我院进一步诊治。门诊拟诊“鼻咽肿物”收入我科进一步治疗。患者起病以来精神、睡眠欠佳，胃纳尚可，二便正常，体重无明显下降。；既往史: 否认高血压、糖尿病及心脏病史，否认结核等传染病史、否认手术、外伤及输血史。；个人史:；家族史: 家族中无类似患者，无家族性遗传病患者，无重大精神病患者。；体格检查: KPS90，一般状况可，鼻咽左侧壁、顶后壁肿物，双颈扪及肿大淋巴结，右颈多枚肿大淋巴结，较大者约6*4及2*2cm,质硬，活动差，左上颈可及一淋巴结，约3*3cm，质中，活动度可，无融合，无皮肤浸润等，左中颈可及一大小约1*1cm质硬淋巴结；张口门齿距约4cm，颅神经征阴性。。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 给予大剂量糖皮质激素冲击治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超\nB. 给予贝伐珠单抗靶向治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项\nC. 安排头颅PET-CT检查鉴别左侧颞叶病变性质，并安排胸部X线、腹部彩超、甲功五项\nD. 安排立体定向脑活检明确左侧颞叶病变性质，并安排胸部X线、腹部彩超、甲功五项\nE. 给予高压氧治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项\nF. 给予甘露醇静脉滴注脱水降颅压，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超\nG. 安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项及EBV-DNA定量检测\nH. 给予神经营养药物治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项\nI. 安排鼻咽及颈部CT平扫+增强、胸部CT平扫、腹部CT平扫、甲功五项及EBV-DNA定量检测\nJ. 安排立体定向放射外科治疗左侧颞叶病变，并安排胸部X线、腹部彩超、甲功五项\nK. 安排鼻咽及颈部MRI平扫+增强、头颅MRI平扫+增强，暂缓胸部X线及腹部彩超检查\nL. 给予抗癫痫药物预防性治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-2fc2bca32acf3eb67f65396b","patient_id":"patient-9149023ec8599161ec3e5cfd","turn_id":"turn07","turn_position":5,"turn_type":"recurrence_or_salvage_decision","gold_letter":"I","gold_action":"继续行第3周期GP方案第8天化疗（吉西他滨），辅以肠内营养支持，并安排出院。","options":[{"letter":"A","text":"提前终止第3周期诱导化疗，直接进入根治性同步放化疗阶段。","is_gold":false},{"letter":"B","text":"暂停第8天化疗，予重组人粒细胞集落刺激因子升白治疗后复查血常规。","is_gold":false},{"letter":"C","text":"更改诱导化疗方案为TP（多西他赛+顺铂）进行第4周期治疗。","is_gold":false},{"letter":"D","text":"继续行第3周期GP方案第8天化疗（吉西他滨联合顺铂），并安排出院。","is_gold":false},{"letter":"E","text":"计划在第3周期结束后，继续行第4周期GP方案诱导化疗。","is_gold":false},{"letter":"F","text":"暂停化疗，行双侧颈部淋巴结清扫术及鼻咽原发灶切除术。","is_gold":false},{"letter":"G","text":"终止后续放疗计划，按完全缓解（CR）状态进入定期随访观察。","is_gold":false},{"letter":"H","text":"将第8天吉西他滨剂量下调25%后给药，并密切监测血常规。","is_gold":false},{"letter":"I","text":"继续行第3周期GP方案第8天化疗（吉西他滨），辅以肠内营养支持，并安排出院。","is_gold":true},{"letter":"J","text":"暂停治疗，行全身PET-CT检查以重新评估全身肿瘤负荷。","is_gold":false},{"letter":"K","text":"在第8天化疗基础上加用PD-1抑制剂（如特瑞普利单抗）进行联合治疗。","is_gold":false},{"letter":"L","text":"立即启动根治性调强放疗，并同步给予吉西他滨单药化疗。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现双颈肿物半年余；现病史: 者半年余前无明显诱因出现左侧颈部肿物，无疼痛，逐渐增大，伴有鼻塞、流涕，至当地医院予抗炎对症治疗后，肿物能减小；2月前患者始出现右侧颈部肿物，逐渐增大，伴有鼻塞、流涕，间中有涕血，无发热、畏寒，无头晕、头痛，无周身骨痛等，于当地医院检查ＣＴ示：鼻咽肿物，遂转至我院进一步诊治。门诊拟诊“鼻咽肿物”收入我科进一步治疗。患者起病以来精神、睡眠欠佳，胃纳尚可，二便正常，体重无明显下降。；阳性症状体征: 鼻塞,睡眠欠佳,鼻咽肿物,涕血,右颈部肿物,左颈部肿物,流涕；既往史: 体健，无高血压、心脏病等慢性病，无糖尿病、肾病等全身性疾病，无乙肝、结核等传染病，无外伤史。；个人史: 生于原籍，有吸烟史30年,无饮酒，无其他嗜好，否认冶游史。；家族史: 家族中无类似患者，无家族性遗传病患者，无重大精神病患者。；体格检查:；专科检查:；KPS:；ECOG:\n- [时间未明] 门急诊记录: 主诉:；现病史: 者半年余前无明显诱因出现左侧颈部肿物，无疼痛，逐渐增大，伴有鼻塞、流涕，至当地医院予抗炎对症治疗后，肿物能减小；2月前患者始出现右侧颈部肿物，逐渐增大，伴有鼻塞、流涕，间中有涕血，无发热、畏寒，无头晕、头痛，无周身骨痛等，于当地医院检查ＣＴ示：鼻咽肿物，遂转至我院进一步诊治。门诊拟诊“鼻咽肿物”收入我科进一步治疗。患者起病以来精神、睡眠欠佳，胃纳尚可，二便正常，体重无明显下降。；既往史: 否认高血压、糖尿病及心脏病史，否认结核等传染病史、否认手术、外伤及输血史。；个人史:；家族史: 家族中无类似患者，无家族性遗传病患者，无重大精神病患者。；体格检查: KPS90，一般状况可，鼻咽左侧壁、顶后壁肿物，双颈扪及肿大淋巴结，右颈多枚肿大淋巴结，较大者约6*4及2*2cm,质硬，活动差，左上颈可及一淋巴结，约3*3cm，质中，活动度可，无融合，无皮肤浸润等，左中颈可及一大小约1*1cm质硬淋巴结；张口门齿距约4cm，颅神经征阴性。。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D986] 门急诊记录: 主诉: 鼻咽癌放化疗结束2年，诉轻度口干，听力视力正常，无头晕、头痛。体查：鼻咽未见明确肿物，双颈未扪及明显肿大淋巴结，颅神经（-）甲功五项示正常。鼻咽MRI未见明确复发，腹部B超、胸片未见明确转移。EBV-DNA:0；现病史:；既往史:；个人史:；家族史:；体格检查:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D0] 检验组合: 磷(P)-静脉血: 1.15mmol/L；平均红细胞体积(MCV)-静脉血: 87fL；肌酐(Crea)-静脉血: 58.2umol/L；C-反应蛋白(CRP)-静脉血: 1.11mg/L；尿酸(UA)-静脉血: 148.1umol/L；葡萄糖(Glu)-静脉血: 5.38mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.29；总胆红素(TBIL)-静脉血: 7.6umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.39mmolL；凝血酶时间(TT)-静脉血: 19.1sec.；钾离子(K+)-静脉血: 4.25mmol/L；阴离子间隙(AG)-静脉血: 10.3；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；白细胞计数(WBC#)-静脉血: 710E9/L；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阳性(169.39U/mL)（参考: 阴性）；载脂蛋白AI(apoAI)-静脉血: 1.57g/L；纤维蛋白原(Fbg)-静脉血: 3.35g/L；中性粒细胞计数(Neut#)-静脉血: 4.210E9/L；平均血小板体积(MPV)-静脉血: 9.6fL；有核红细胞百分比(NRBC%)-静脉血: 0；血小板比容-静脉血: 29%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 27mmol/L；凝血酶原时间活动度(PTA)-静脉血: 85.4%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；ABO血型-静脉血: O；甘油三酯(TG)-静脉血: 1.43mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.04S/CO；球蛋白(GLO)-静脉血: 33.45g/L；总钙(Ca)-静脉血: 2.26mmol/L；血小板分布宽度(PDW)-静脉血: 9.7%；间接胆红素(IBIL)-静脉血: 5.8umolL；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0IU/mL；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)……\n- [全程D1] CT；胸、上腹CT平扫+增强: 检查类型: CT；检查名称: 胸、上腹CT平扫+增强；检查部位:；检查所见: 双肺纹理清晰，左肺下叶外基底段见条索状高密度影，边界清；余双肺内未见明显实质性病变。 气管及支气管分支通畅。 双肺门及纵隔未见明显肿大淋巴结。 双侧胸腔未见积液。双侧胸膜未见增厚、粘连。 肝脏形态未见异常，轮廓光整，各叶比例在正常范围以内，密度均匀。 肝内胆管未见明显异常。胆囊不大、壁不厚，其内未见结石。胆总管未见扩张，其内未见结石。 肝门区结构清晰。门静脉未见明显异常。 脾脏大小、形态未见明显异常，密度均匀。 胰腺大小、形态未见明显异常，密度均匀。 所示双肾及双侧肾上腺大小、形态未见明显异常，密度均匀。 膈脚后、肝门区、腹主动脉旁、腹腔干周围未见明显肿大淋巴结。 扫描层面内未见明显骨质破坏。；检查结论: 左肺下叶外基底段条索影，考虑纤维灶。 上腹部未见明显异常。\n- [全程D2] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 鼻咽部见片状放射性浓密影。胸骨、锁骨、肩胛骨、肋骨、颈椎、胸椎、腰椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 鼻咽部代谢活跃，考虑鼻咽癌所致。 余全身骨骼未见明显异常。\n- [全程D985] MRI；鼻咽部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部MR平扫+增强；检查部位:；检查所见: 鼻咽癌放疗后复查，对比某次就诊时间片： 鼻咽腔未见狭窄，鼻咽顶壁、顶后壁、右侧壁轻度增厚，均匀强化，右侧咽隐窝变浅，考虑放疗后改变，较前相仿。 蝶骨基底部、左侧枕骨基底部、左侧岩尖、左侧翼突基底部骨质信号下降，增强扫描轻度不均匀强化，较前相仿。 左侧破裂孔见少许软组织影，增强扫描轻度强化，较前相仿。 双侧咽后间隙见小淋巴结，大者短径约3mm，较前相仿。 右颈II区见多个淋巴结，最大短径约为5mm，部分边界欠清，增强扫描不均匀强化，较前稍缩小。 双侧上颌窦、筛窦、额窦粘膜增厚，考虑副鼻窦炎，较前相仿。 扫描所见颅脑未见明确异常。；检查结论:\n- [全程D985] MRI；颈部MR平扫+增强: 检查类型: MRI；检查名称: 颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌放疗后复查，对比某次就诊时间片： 鼻咽腔未见狭窄，鼻咽顶壁、顶后壁、右侧壁轻度增厚，均匀强化，右侧咽隐窝变浅，考虑放疗后改变，较前相仿。 蝶骨基底部、左侧枕骨基底部、左侧岩尖、左侧翼突基底部骨质信号下降，增强扫描轻度不均匀强化，较前相仿。 左侧破裂孔见少许软组织影，增强扫描轻度强化，较前相仿。 双侧咽后间隙见小淋巴结，大者短径约3mm，较前相仿。 右颈II区见多个淋巴结，最大短径约为5mm，部分边界欠清，增强扫描不均匀强化，较前稍缩小。 双侧上颌窦、筛窦、额窦粘膜增厚，考虑副鼻窦炎，较前相仿。 扫描所见颅脑未见明确异常。；检查结论:\n- [全程D1168] 检验组合: 游离甲状腺素(FT4)-静脉血: 14.91pmol/L；甲状腺过氧化物酶抗体(TPO-Ab)-静脉血: 12.55U/ml；游离三碘甲状腺原氨酸(FT3)-静脉血: 4.97pmol/L；甲状腺球蛋白(TG)-静脉血: 1.12ng/ml；促甲状腺激素(TSH)-静脉血: 1.59uIU/ml\n- [全程D1169] 超声；肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径不宽，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。\n- [全程D1170] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，走行自然，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n- [全程D1380] 检验组合: 游离三碘甲状腺原氨酸(FT3)-静脉血: 5.27pmol/L；游离甲状腺素(FT4)-静脉血: 13.84pmol/L；胆碱酯酶(ChE)-静脉血: 10374U/L；总钙(Ca)-静脉血: 2.33mmol/L；中性粒细胞百分比(Neut%)-静脉血: 56.6%；γ-谷氨酰基转移酶(GGT)-静脉血: 25.6U/L；肌酸激酶(CK)-静脉血: 80U/L；肌酐(Crea)-静脉血: 59.7umol/L；总蛋白(TP)-静脉血: 72.07g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 27.9pg；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.29mmol/L；淋巴细胞计数(Lymph#)-静脉血: 2.110E9/L；镁离子(Mg2+)-静脉血: 1.02mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.3mmol/L；碱性磷酸酶(ALP)-静脉血: 75.5U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.2510E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.2%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.1fL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；大血小板百分比(P-LCR%)-静脉血: 21.4%；白蛋白(ALB)-静脉血: 43.8g/L；载脂蛋白AI(apoAI)-静脉血: 1.52g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.55；总胆固醇(TC)-静脉血: 6.32mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.7U/L；阴离子间隙(AG)-静脉血: 18.4；血红蛋白(Hb)-静脉血: 131g/L；甲状腺球蛋白(TG)-静脉血: 1.4ng/ml；平均红细胞血红蛋白浓度(MCHC)-静脉血: 300g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.34mmolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 2.4；钾离子(K+)-静脉血: 3.9mmol/L；红细胞比容(Hct)-静脉血: 43.7%；未成熟粒细胞百分比(IG%)-静脉血: 0.5%；磷(P)-静脉血: 1.39mmol/L；钠离子(Na+)-静脉血: 141.4mmol/L；间接胆红素(IBIL)-静脉血:……\n- [全程D46] 检验组合: 中性粒细胞百分比(Neut%)-静脉血: 0.568；血液二氧化碳含量ctCO2(B)-静脉血: 23mmol/L；钾离子(K+)-静脉血: 3.97mmol/L；镁离子(Mg2+)-静脉血: 0.79mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.383；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.55；钠离子(Na+)-静脉血: 130mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；平均红细胞体积(MCV)-静脉血: 82.6fL；单核细胞百分比(Mono%)-静脉血: 0.042；肌酐(Crea)-静脉血: 46.6umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 44U/L；血红蛋白(Hb)-静脉血: 118g/L；磷(P)-静脉血: 1.18mmol/L；总胆红素(TBIL)-静脉血: 7.2umol/L；平均血小板体积(MPV)-静脉血: 9fL；总蛋白(TP)-静脉血: 67.1g/L；乳酸脱氢酶(LDH)-静脉血: 137.5U/L；间接胆红素(IBIL)-静脉血: 5.3umolL；球蛋白(GLO)-静脉血: 28.1g/L；尿酸(UA)-静脉血: 102.4umol/L；白蛋白(ALB)-静脉血: 39g/L；有核红细胞百分比(NRBC%)-静脉血: 0；单核细胞计数(Mono#)-静脉血: 0.210E9/L；红细胞比容(Hct)-静脉血: 36%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血小板分布宽度(PDW)-静脉血: 9%；阴离子间隙(AG)-静脉血: 14.1；直接胆红素(DBIL)-静脉血: 1.9umol/L；总胆汁酸(TBA)-静脉血: 1.5umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.4；有核红细胞计数(NRBC#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.710E9/L；大血小板百分比(P-LCR%)-静脉血: 16.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 27.1pg；γ-谷氨酰基转移酶(GGT)-静脉血: 62.8U/L；尿素氮(BUN)-静脉血: 3.4mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.39；红细胞计数(RBC#……\n- [全程D55] 检验组合: 平均红细胞血红蛋白含量(MCH)-静脉血: 27.3pg；天门冬氨酸氨基转移酶(AST)-静脉血: 14.5U/L；碱性磷酸酶(ALP)-静脉血: 103.1U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；淋巴细胞计数(Lymph#)-静脉血: 2.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.145；红细胞计数(RBC#)-静脉血: 3.7410E12/L；有核红细胞百分比(NRBC%)-静脉血: 0；大血小板百分比(P-LCR%)-静脉血: 18.5%；红细胞比容(Hct)-静脉血: 32.5%；淋巴细胞百分比(Lymph%)-静脉血: 0.531；丙氨酸氨基转移酶(ALT)-静脉血: 7.8U/L；氯离子(Cl-)-静脉血: 102mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；间接胆红素(IBIL)-静脉血: 1.7umolL；平均血小板体积(MPV)-静脉血: 9.3fL；总钙(Ca)-静脉血: 2.22mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；总蛋白(TP)-静脉血: 64.51g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.6mmol/L；血红蛋白(Hb)-静脉血: 102g/L；血小板比容-静脉血: 15%；中性粒细胞计数(Neut#)-静脉血: 1.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.318；白细胞计数(WBC#)-静脉血: 4.4810E9/L；镁离子(Mg2+)-静脉血: 0.78mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 35.3U/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 314g/L；乳酸脱氢酶(LDH)-静脉血: 139.5U/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；钠离子(Na+)-静脉血: 137.5mmol/L；总胆红素(TBIL)-静脉血: 2.4umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.86；尿素氮(BUN)-静脉血: 3.4mmol/L；肌酐(Crea)-静脉血: 64.6umol/L；总胆汁酸(TBA)-静脉血: 3.8umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 55.2U/L；单核细……\n- [全程D61] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- [全程D61] 检验组合: 碱性磷酸酶(ALP)-静脉血: 108.3U/L；丙氨酸氨基转移酶(ALT)-静脉血: 14.3U/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；直接胆红素(DBIL)-静脉血: 0.6umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24U/L；中性粒细胞百分比(Neut%)-静脉血: 0.512；α-L-岩藻糖苷酶(AFU)-静脉血: 44.3U/L；钾离子(K+)-静脉血: 4.3mmol/L；平均红细胞体积(MCV)-静脉血: 87.2fL；白细胞计数(WBC#)-静脉血: 7.6610E9/L；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；血小板比容-静脉血: 24%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；平均红细胞血红蛋白含量(MCH)-静脉血: 27.2pg；乳酸脱氢酶(LDH)-静脉血: 151.5U/L；阴离子间隙(AG)-静脉血: 16.2；肌酐(Crea)-静脉血: 58.2umol/L；总胆汁酸(TBA)-静脉血: 12.2umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.9mmol/L；球蛋白(GLO)-静脉血: 28.8g/L；淋巴细胞计数(Lymph#)-静脉血: 2.710E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 312g/L；氯离子(Cl-)-静脉血: 100.7mmol/L；尿酸(UA)-静脉血: 217.3umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.47；总钙(Ca)-静脉血: 2.18mmol/L；白蛋白(ALB)-静脉血: 42.2g/L；大血小板百分比(P-LCR%)-静脉血: 17.6%；γ-谷氨酰基转移酶(GGT)-静脉血: 62.4U/L；平均血小板体积(MPV)-静脉血: 9.1fL；磷(P)-静脉血: 1.45mmol/L；间接胆红素(IBIL)-静脉血: 2.4umolL；血小板计数(PLT#)-静脉血: 26810E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；血小板分布宽度(PDW)-静脉血: 9.4%；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.68；总胆红素(TBIL)-静脉血: 3umol/L；单核细胞百分比(Mono%)-静脉血:……\n- [全程D68] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后，对比某次就诊时间片： 鼻咽腔狭窄，鼻咽顶壁、顶后壁、左侧壁见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强后明显强化，肿物占据左侧咽隐窝，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，向前累及双侧后鼻孔，范围较前缩小，右侧咽隐窝变浅，右侧咽旁脂肪间隙及颈动脉鞘区未见异常。 左侧腭帆张提肌、左侧翼内肌上缘及双侧头长肌受侵，右侧腭帆提肌、腭帆张肌未见受侵征象。左侧翼腭窝可见软组织稍增厚，大致同前，右侧翼腭窝、右侧颞下窝未见异常；口咽双侧壁未见增厚。 斜坡、蝶骨基底部、左侧枕骨基底部、左侧岩尖、左侧翼突基底部、左侧翼突内外板、左侧蝶骨大翼骨质破坏，增强扫描后明显强化，大致同前。 左侧破裂孔及左侧海绵窦下份见少许软组织影，增强扫描后明显强化，较前变化不大，右侧海绵窦形态正常。 左侧上颌窦、筛窦、蝶窦、双侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 双侧咽后间隙见小淋巴结，最大短径约3mm，较前稍缩小；双颈II区见肿大淋巴结，最大约为20mm×30mm，边界清楚，信号不均匀，部分见囊变坏死，增强后不均匀强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗后，对比某次就诊时间片： 鼻咽病灶较前范围稍缩小。 颅底骨质破坏，大致同前。 双侧咽后淋巴结小淋巴结，较前稍缩小；双颈II区淋巴结肿大，考虑转移，部分较前缩小。 鼻窦炎、双侧乳突炎。\n- [全程D68] 检验组合: 阴离子间隙(AG)-静脉血: 14.8；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.75；白蛋白(ALB)-静脉血: 42.2g/L；间接胆红素(IBIL)-静脉血: 6.1umolL；总胆红素(TBIL)-静脉血: 8umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.6；血小板分布宽度(PDW)-静脉血: 8.4%；平均红细胞血红蛋白含量(MCH)-静脉血: 27.1pg；钠离子(Na+)-静脉血: 132.5mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 323g/L；直接胆红素(DBIL)-静脉血: 1.9umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 65.5U/L；钾离子(K+)-静脉血: 4.64mmol/L；碱性磷酸酶(ALP)-静脉血: 83.1U/L；白细胞计数(WBC#)-静脉血: 3.3810E9/L；血红蛋白(Hb)-静脉血: 107g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞比容(Hct)-静脉血: 33.1%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44.7；α-L-岩藻糖苷酶(AFU)-静脉血: 49.8U/L；中性粒细胞百分比(Neut%)-静脉血: 0.558；乳酸脱氢酶(LDH)-静脉血: 136.8U/L；尿素氮(BUN)-静脉血: 2.6mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.3mmol/L；单核细胞计数(Mono#)-静脉血: 0.110E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.033；氯离子(Cl-)-静脉血: 94.4mmol/L；肌酐(Crea)-静脉血: 53.8umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.9U/L；球蛋白(GLO)-静脉血: 28.48g/L；平均血小板体积(MPV)-静脉血: 8.3fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；中性粒细胞计数(Neut#)-静脉血: 1.910E9/L；总胆汁酸(TBA)-静脉血: 2.7umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.373；血小板比容-静脉血: 31%；总蛋白(TP)-静脉……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D986] 门急诊记录: 主诉: 鼻咽癌放化疗结束2年，诉轻度口干，听力视力正常，无头晕、头痛。体查：鼻咽未见明确肿物，双颈未扪及明显肿大淋巴结，颅神经（-）甲功五项示正常。鼻咽MRI未见明确复发，腹部B超、胸片未见明确转移。EBV-DNA:0；现病史:；既往史:；个人史:；家族史:；体格检查:\n- [全程D1174] 门急诊记录: 主诉: 鼻咽癌放化疗结束2年，诉轻度口干，听力视力正常，无头晕、头痛。体查：鼻咽未见明确肿物，双颈未扪及明显肿大淋巴结，颅神经（-）甲功五项示正常。鼻咽MRI未见明确复发，腹部B超、胸片未见明确转移。EBV-DNA:0；现病史:；既往史:；个人史:；家族史:；体格检查:\n- [时间未明] 门急诊记录: 主诉:；现病史: 者半年余前无明显诱因出现左侧颈部肿物，无疼痛，逐渐增大，伴有鼻塞、流涕，至当地医院予抗炎对症治疗后，肿物能减小；2月前患者始出现右侧颈部肿物，逐渐增大，伴有鼻塞、流涕，间中有涕血，无发热、畏寒，无头晕、头痛，无周身骨痛等，于当地医院检查ＣＴ示：鼻咽肿物，遂转至我院进一步诊治。门诊拟诊“鼻咽肿物”收入我科进一步治疗。患者起病以来精神、睡眠欠佳，胃纳尚可，二便正常，体重无明显下降。；既往史: 否认高血压、糖尿病及心脏病史，否认结核等传染病史、否认手术、外伤及输血史。；个人史:；家族史: 家族中无类似患者，无家族性遗传病患者，无重大精神病患者。；体格检查: KPS90，一般状况可，鼻咽左侧壁、顶后壁肿物，双颈扪及肿大淋巴结，右颈多枚肿大淋巴结，较大者约6*4及2*2cm,质硬，活动差，左上颈可及一淋巴结，约3*3cm，质中，活动度可，无融合，无皮肤浸润等，左中颈可及一大小约1*1cm质硬淋巴结；张口门齿距约4cm，颅神经征阴性。。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D62] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日查房时自述精神食欲可，睡眠休息好。查体：KPS 90，一般状况可，鼻咽左侧壁、顶后壁肿物，双颈扪及肿大淋巴结，右颈多枚肿大淋巴结，较大者约6*4及2*2cm,质硬，活动差，左上颈可及一淋巴结，约3*3cm，质中，活动度可，无融合，无皮肤浸润等，左中颈可及一大小约1*1cm质硬淋巴结；张口门齿距约4cm，颅神经征阴性。[姓名已隐去]医生信息已隐藏：该病人为鼻咽癌，已接受GP方案诱导化疗2周期。目前排除化疗禁忌症，今日水化，明日再予GP方案行第三周期化疗，遵执。\n- [全程D63] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日查房时无特殊不适主诉，精神食欲可，昨日水化顺利。查体大致同前。[姓名已隐去]医生信息已隐藏：该病人继续按原方案（吉西他滨 1g/m2d1、d8+顺铂 80mg/m2d1）化疗，注意护胃、止吐等对症支持处理，遵执。\n- [全程D66] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 患者化疗输液顺利完成。今日查房时自诉精神食欲可，二便通畅。今继续对症支持治疗，择期复查血常规及血生化。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 提前终止第3周期诱导化疗，直接进入根治性同步放化疗阶段。\nB. 暂停第8天化疗，予重组人粒细胞集落刺激因子升白治疗后复查血常规。\nC. 更改诱导化疗方案为TP（多西他赛+顺铂）进行第4周期治疗。\nD. 继续行第3周期GP方案第8天化疗（吉西他滨联合顺铂），并安排出院。\nE. 计划在第3周期结束后，继续行第4周期GP方案诱导化疗。\nF. 暂停化疗，行双侧颈部淋巴结清扫术及鼻咽原发灶切除术。\nG. 终止后续放疗计划，按完全缓解（CR）状态进入定期随访观察。\nH. 将第8天吉西他滨剂量下调25%后给药，并密切监测血常规。\nI. 继续行第3周期GP方案第8天化疗（吉西他滨），辅以肠内营养支持，并安排出院。\nJ. 暂停治疗，行全身PET-CT检查以重新评估全身肿瘤负荷。\nK. 在第8天化疗基础上加用PD-1抑制剂（如特瑞普利单抗）进行联合治疗。\nL. 立即启动根治性调强放疗，并同步给予吉西他滨单药化疗。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D46] 检验组合: 中性粒细胞百分比(Neut%)-静脉血: 0.568；血液二氧化碳含量ctCO2(B)-静脉血: 23mmol/L；钾离子(K+)-静脉血: 3.97mmol/L；镁离子(Mg2+)-静脉血: 0.79mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.383；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.55；钠离子(Na+)-静脉血: 130mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；平均红细胞体积(MCV)-静脉血: 82.6fL；单核细胞百分比(Mono%)-静脉血: 0.042；肌酐(Crea)-静脉血: 46.6umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 44U/L；血红蛋白(Hb)-静脉血: 118g/L；磷(P)-静脉血: 1.18mmol/L；总胆红素(TBIL)-静脉血: 7.2umol/L；平均血小板体积(MPV)-静脉血: 9fL；总蛋白(TP)-静脉血: 67.1g/L；乳酸脱氢酶(LDH)-静脉血: 137.5U/L；间接胆红素(IBIL)-静脉血: 5.3umolL；球蛋白(GLO)-静脉血: 28.1g/L；尿酸(UA)-静脉血: 102.4umol/L；白蛋白(ALB)-静脉血: 39g/L；有核红细胞百分比(NRBC%)-静脉血: 0；单核细胞计数(Mono#)-静脉血: 0.210E9/L；红细胞比容(Hct)-静脉血: 36%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血小板分布宽度(PDW)-静脉血: 9%；阴离子间隙(AG)-静脉血: 14.1；直接胆红素(DBIL)-静脉血: 1.9umol/L；总胆汁酸(TBA)-静脉血: 1.5umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.4；有核红细胞计数(NRBC#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.710E9/L；大血小板百分比(P-LCR%)-静脉血: 16.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 27.1pg；γ-谷氨酰基转移酶(GGT)-静脉血: 62.8U/L；尿素氮(BUN)-静脉血: 3.4mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.39；红细胞计数(RBC#……\n- [全程D55] 检验组合: 平均红细胞血红蛋白含量(MCH)-静脉血: 27.3pg；天门冬氨酸氨基转移酶(AST)-静脉血: 14.5U/L；碱性磷酸酶(ALP)-静脉血: 103.1U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；淋巴细胞计数(Lymph#)-静脉血: 2.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.145；红细胞计数(RBC#)-静脉血: 3.7410E12/L；有核红细胞百分比(NRBC%)-静脉血: 0；大血小板百分比(P-LCR%)-静脉血: 18.5%；红细胞比容(Hct)-静脉血: 32.5%；淋巴细胞百分比(Lymph%)-静脉血: 0.531；丙氨酸氨基转移酶(ALT)-静脉血: 7.8U/L；氯离子(Cl-)-静脉血: 102mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；间接胆红素(IBIL)-静脉血: 1.7umolL；平均血小板体积(MPV)-静脉血: 9.3fL；总钙(Ca)-静脉血: 2.22mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；总蛋白(TP)-静脉血: 64.51g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.6mmol/L；血红蛋白(Hb)-静脉血: 102g/L；血小板比容-静脉血: 15%；中性粒细胞计数(Neut#)-静脉血: 1.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.318；白细胞计数(WBC#)-静脉血: 4.4810E9/L；镁离子(Mg2+)-静脉血: 0.78mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 35.3U/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 314g/L；乳酸脱氢酶(LDH)-静脉血: 139.5U/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；钠离子(Na+)-静脉血: 137.5mmol/L；总胆红素(TBIL)-静脉血: 2.4umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.86；尿素氮(BUN)-静脉血: 3.4mmol/L；肌酐(Crea)-静脉血: 64.6umol/L；总胆汁酸(TBA)-静脉血: 3.8umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 55.2U/L；单核细……\n- [全程D61] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- [全程D61] 检验组合: 碱性磷酸酶(ALP)-静脉血: 108.3U/L；丙氨酸氨基转移酶(ALT)-静脉血: 14.3U/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；直接胆红素(DBIL)-静脉血: 0.6umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24U/L；中性粒细胞百分比(Neut%)-静脉血: 0.512；α-L-岩藻糖苷酶(AFU)-静脉血: 44.3U/L；钾离子(K+)-静脉血: 4.3mmol/L；平均红细胞体积(MCV)-静脉血: 87.2fL；白细胞计数(WBC#)-静脉血: 7.6610E9/L；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；血小板比容-静脉血: 24%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；平均红细胞血红蛋白含量(MCH)-静脉血: 27.2pg；乳酸脱氢酶(LDH)-静脉血: 151.5U/L；阴离子间隙(AG)-静脉血: 16.2；肌酐(Crea)-静脉血: 58.2umol/L；总胆汁酸(TBA)-静脉血: 12.2umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.9mmol/L；球蛋白(GLO)-静脉血: 28.8g/L；淋巴细胞计数(Lymph#)-静脉血: 2.710E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 312g/L；氯离子(Cl-)-静脉血: 100.7mmol/L；尿酸(UA)-静脉血: 217.3umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.47；总钙(Ca)-静脉血: 2.18mmol/L；白蛋白(ALB)-静脉血: 42.2g/L；大血小板百分比(P-LCR%)-静脉血: 17.6%；γ-谷氨酰基转移酶(GGT)-静脉血: 62.4U/L；平均血小板体积(MPV)-静脉血: 9.1fL；磷(P)-静脉血: 1.45mmol/L；间接胆红素(IBIL)-静脉血: 2.4umolL；血小板计数(PLT#)-静脉血: 26810E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；血小板分布宽度(PDW)-静脉血: 9.4%；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.68；总胆红素(TBIL)-静脉血: 3umol/L；单核细胞百分比(Mono%)-静脉血:……\n- [全程D68] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后，对比某次就诊时间片： 鼻咽腔狭窄，鼻咽顶壁、顶后壁、左侧壁见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强后明显强化，肿物占据左侧咽隐窝，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，向前累及双侧后鼻孔，范围较前缩小，右侧咽隐窝变浅，右侧咽旁脂肪间隙及颈动脉鞘区未见异常。 左侧腭帆张提肌、左侧翼内肌上缘及双侧头长肌受侵，右侧腭帆提肌、腭帆张肌未见受侵征象。左侧翼腭窝可见软组织稍增厚，大致同前，右侧翼腭窝、右侧颞下窝未见异常；口咽双侧壁未见增厚。 斜坡、蝶骨基底部、左侧枕骨基底部、左侧岩尖、左侧翼突基底部、左侧翼突内外板、左侧蝶骨大翼骨质破坏，增强扫描后明显强化，大致同前。 左侧破裂孔及左侧海绵窦下份见少许软组织影，增强扫描后明显强化，较前变化不大，右侧海绵窦形态正常。 左侧上颌窦、筛窦、蝶窦、双侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 双侧咽后间隙见小淋巴结，最大短径约3mm，较前稍缩小；双颈II区见肿大淋巴结，最大约为20mm×30mm，边界清楚，信号不均匀，部分见囊变坏死，增强后不均匀强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗后，对比某次就诊时间片： 鼻咽病灶较前范围稍缩小。 颅底骨质破坏，大致同前。 双侧咽后淋巴结小淋巴结，较前稍缩小；双颈II区淋巴结肿大，考虑转移，部分较前缩小。 鼻窦炎、双侧乳突炎。\n- [全程D68] 检验组合: 阴离子间隙(AG)-静脉血: 14.8；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.75；白蛋白(ALB)-静脉血: 42.2g/L；间接胆红素(IBIL)-静脉血: 6.1umolL；总胆红素(TBIL)-静脉血: 8umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.6；血小板分布宽度(PDW)-静脉血: 8.4%；平均红细胞血红蛋白含量(MCH)-静脉血: 27.1pg；钠离子(Na+)-静脉血: 132.5mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 323g/L；直接胆红素(DBIL)-静脉血: 1.9umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 65.5U/L；钾离子(K+)-静脉血: 4.64mmol/L；碱性磷酸酶(ALP)-静脉血: 83.1U/L；白细胞计数(WBC#)-静脉血: 3.3810E9/L；血红蛋白(Hb)-静脉血: 107g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞比容(Hct)-静脉血: 33.1%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44.7；α-L-岩藻糖苷酶(AFU)-静脉血: 49.8U/L；中性粒细胞百分比(Neut%)-静脉血: 0.558；乳酸脱氢酶(LDH)-静脉血: 136.8U/L；尿素氮(BUN)-静脉血: 2.6mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.3mmol/L；单核细胞计数(Mono#)-静脉血: 0.110E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.033；氯离子(Cl-)-静脉血: 94.4mmol/L；肌酐(Crea)-静脉血: 53.8umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.9U/L；球蛋白(GLO)-静脉血: 28.48g/L；平均血小板体积(MPV)-静脉血: 8.3fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；中性粒细胞计数(Neut#)-静脉血: 1.910E9/L；总胆汁酸(TBA)-静脉血: 2.7umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.373；血小板比容-静脉血: 31%；总蛋白(TP)-静脉……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D62] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日查房时自述精神食欲可，睡眠休息好。查体：KPS 90，一般状况可，鼻咽左侧壁、顶后壁肿物，双颈扪及肿大淋巴结，右颈多枚肿大淋巴结，较大者约6*4及2*2cm,质硬，活动差，左上颈可及一淋巴结，约3*3cm，质中，活动度可，无融合，无皮肤浸润等，左中颈可及一大小约1*1cm质硬淋巴结；张口门齿距约4cm，颅神经征阴性。[姓名已隐去]医生信息已隐藏：该病人为鼻咽癌，已接受GP方案诱导化疗2周期。目前排除化疗禁忌症，今日水化，明日再予GP方案行第三周期化疗，遵执。\n- [全程D63] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日查房时无特殊不适主诉，精神食欲可，昨日水化顺利。查体大致同前。[姓名已隐去]医生信息已隐藏：该病人继续按原方案（吉西他滨 1g/m2d1、d8+顺铂 80mg/m2d1）化疗，注意护胃、止吐等对症支持处理，遵执。\n- [全程D66] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 患者化疗输液顺利完成。今日查房时自诉精神食欲可，二便通畅。今继续对症支持治疗，择期复查血常规及血生化。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 提前终止第3周期诱导化疗，直接进入根治性同步放化疗阶段。\nB. 暂停第8天化疗，予重组人粒细胞集落刺激因子升白治疗后复查血常规。\nC. 更改诱导化疗方案为TP（多西他赛+顺铂）进行第4周期治疗。\nD. 继续行第3周期GP方案第8天化疗（吉西他滨联合顺铂），并安排出院。\nE. 计划在第3周期结束后，继续行第4周期GP方案诱导化疗。\nF. 暂停化疗，行双侧颈部淋巴结清扫术及鼻咽原发灶切除术。\nG. 终止后续放疗计划，按完全缓解（CR）状态进入定期随访观察。\nH. 将第8天吉西他滨剂量下调25%后给药，并密切监测血常规。\nI. 继续行第3周期GP方案第8天化疗（吉西他滨），辅以肠内营养支持，并安排出院。\nJ. 暂停治疗，行全身PET-CT检查以重新评估全身肿瘤负荷。\nK. 在第8天化疗基础上加用PD-1抑制剂（如特瑞普利单抗）进行联合治疗。\nL. 立即启动根治性调强放疗，并同步给予吉西他滨单药化疗。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D46] 检验组合: 中性粒细胞百分比(Neut%)-静脉血: 0.568；血液二氧化碳含量ctCO2(B)-静脉血: 23mmol/L；钾离子(K+)-静脉血: 3.97mmol/L；镁离子(Mg2+)-静脉血: 0.79mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.383；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.55；钠离子(Na+)-静脉血: 130mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；平均红细胞体积(MCV)-静脉血: 82.6fL；单核细胞百分比(Mono%)-静脉血: 0.042；肌酐(Crea)-静脉血: 46.6umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 44U/L；血红蛋白(Hb)-静脉血: 118g/L；磷(P)-静脉血: 1.18mmol/L；总胆红素(TBIL)-静脉血: 7.2umol/L；平均血小板体积(MPV)-静脉血: 9fL；总蛋白(TP)-静脉血: 67.1g/L；乳酸脱氢酶(LDH)-静脉血: 137.5U/L；间接胆红素(IBIL)-静脉血: 5.3umolL；球蛋白(GLO)-静脉血: 28.1g/L；尿酸(UA)-静脉血: 102.4umol/L；白蛋白(ALB)-静脉血: 39g/L；有核红细胞百分比(NRBC%)-静脉血: 0；单核细胞计数(Mono#)-静脉血: 0.210E9/L；红细胞比容(Hct)-静脉血: 36%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血小板分布宽度(PDW)-静脉血: 9%；阴离子间隙(AG)-静脉血: 14.1；直接胆红素(DBIL)-静脉血: 1.9umol/L；总胆汁酸(TBA)-静脉血: 1.5umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.4；有核红细胞计数(NRBC#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.710E9/L；大血小板百分比(P-LCR%)-静脉血: 16.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 27.1pg；γ-谷氨酰基转移酶(GGT)-静脉血: 62.8U/L；尿素氮(BUN)-静脉血: 3.4mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.39；红细胞计数(RBC#……\n- [全程D55] 检验组合: 平均红细胞血红蛋白含量(MCH)-静脉血: 27.3pg；天门冬氨酸氨基转移酶(AST)-静脉血: 14.5U/L；碱性磷酸酶(ALP)-静脉血: 103.1U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；淋巴细胞计数(Lymph#)-静脉血: 2.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.145；红细胞计数(RBC#)-静脉血: 3.7410E12/L；有核红细胞百分比(NRBC%)-静脉血: 0；大血小板百分比(P-LCR%)-静脉血: 18.5%；红细胞比容(Hct)-静脉血: 32.5%；淋巴细胞百分比(Lymph%)-静脉血: 0.531；丙氨酸氨基转移酶(ALT)-静脉血: 7.8U/L；氯离子(Cl-)-静脉血: 102mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；间接胆红素(IBIL)-静脉血: 1.7umolL；平均血小板体积(MPV)-静脉血: 9.3fL；总钙(Ca)-静脉血: 2.22mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；总蛋白(TP)-静脉血: 64.51g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.6mmol/L；血红蛋白(Hb)-静脉血: 102g/L；血小板比容-静脉血: 15%；中性粒细胞计数(Neut#)-静脉血: 1.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.318；白细胞计数(WBC#)-静脉血: 4.4810E9/L；镁离子(Mg2+)-静脉血: 0.78mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 35.3U/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 314g/L；乳酸脱氢酶(LDH)-静脉血: 139.5U/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；钠离子(Na+)-静脉血: 137.5mmol/L；总胆红素(TBIL)-静脉血: 2.4umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.86；尿素氮(BUN)-静脉血: 3.4mmol/L；肌酐(Crea)-静脉血: 64.6umol/L；总胆汁酸(TBA)-静脉血: 3.8umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 55.2U/L；单核细……\n- [全程D61] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- [全程D61] 检验组合: 碱性磷酸酶(ALP)-静脉血: 108.3U/L；丙氨酸氨基转移酶(ALT)-静脉血: 14.3U/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；直接胆红素(DBIL)-静脉血: 0.6umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24U/L；中性粒细胞百分比(Neut%)-静脉血: 0.512；α-L-岩藻糖苷酶(AFU)-静脉血: 44.3U/L；钾离子(K+)-静脉血: 4.3mmol/L；平均红细胞体积(MCV)-静脉血: 87.2fL；白细胞计数(WBC#)-静脉血: 7.6610E9/L；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；血小板比容-静脉血: 24%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；平均红细胞血红蛋白含量(MCH)-静脉血: 27.2pg；乳酸脱氢酶(LDH)-静脉血: 151.5U/L；阴离子间隙(AG)-静脉血: 16.2；肌酐(Crea)-静脉血: 58.2umol/L；总胆汁酸(TBA)-静脉血: 12.2umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.9mmol/L；球蛋白(GLO)-静脉血: 28.8g/L；淋巴细胞计数(Lymph#)-静脉血: 2.710E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 312g/L；氯离子(Cl-)-静脉血: 100.7mmol/L；尿酸(UA)-静脉血: 217.3umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.47；总钙(Ca)-静脉血: 2.18mmol/L；白蛋白(ALB)-静脉血: 42.2g/L；大血小板百分比(P-LCR%)-静脉血: 17.6%；γ-谷氨酰基转移酶(GGT)-静脉血: 62.4U/L；平均血小板体积(MPV)-静脉血: 9.1fL；磷(P)-静脉血: 1.45mmol/L；间接胆红素(IBIL)-静脉血: 2.4umolL；血小板计数(PLT#)-静脉血: 26810E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；血小板分布宽度(PDW)-静脉血: 9.4%；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.68；总胆红素(TBIL)-静脉血: 3umol/L；单核细胞百分比(Mono%)-静脉血:……\n- [全程D68] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后，对比某次就诊时间片： 鼻咽腔狭窄，鼻咽顶壁、顶后壁、左侧壁见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强后明显强化，肿物占据左侧咽隐窝，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，向前累及双侧后鼻孔，范围较前缩小，右侧咽隐窝变浅，右侧咽旁脂肪间隙及颈动脉鞘区未见异常。 左侧腭帆张提肌、左侧翼内肌上缘及双侧头长肌受侵，右侧腭帆提肌、腭帆张肌未见受侵征象。左侧翼腭窝可见软组织稍增厚，大致同前，右侧翼腭窝、右侧颞下窝未见异常；口咽双侧壁未见增厚。 斜坡、蝶骨基底部、左侧枕骨基底部、左侧岩尖、左侧翼突基底部、左侧翼突内外板、左侧蝶骨大翼骨质破坏，增强扫描后明显强化，大致同前。 左侧破裂孔及左侧海绵窦下份见少许软组织影，增强扫描后明显强化，较前变化不大，右侧海绵窦形态正常。 左侧上颌窦、筛窦、蝶窦、双侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 双侧咽后间隙见小淋巴结，最大短径约3mm，较前稍缩小；双颈II区见肿大淋巴结，最大约为20mm×30mm，边界清楚，信号不均匀，部分见囊变坏死，增强后不均匀强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗后，对比某次就诊时间片： 鼻咽病灶较前范围稍缩小。 颅底骨质破坏，大致同前。 双侧咽后淋巴结小淋巴结，较前稍缩小；双颈II区淋巴结肿大，考虑转移，部分较前缩小。 鼻窦炎、双侧乳突炎。\n- [全程D68] 检验组合: 阴离子间隙(AG)-静脉血: 14.8；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.75；白蛋白(ALB)-静脉血: 42.2g/L；间接胆红素(IBIL)-静脉血: 6.1umolL；总胆红素(TBIL)-静脉血: 8umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.6；血小板分布宽度(PDW)-静脉血: 8.4%；平均红细胞血红蛋白含量(MCH)-静脉血: 27.1pg；钠离子(Na+)-静脉血: 132.5mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 323g/L；直接胆红素(DBIL)-静脉血: 1.9umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 65.5U/L；钾离子(K+)-静脉血: 4.64mmol/L；碱性磷酸酶(ALP)-静脉血: 83.1U/L；白细胞计数(WBC#)-静脉血: 3.3810E9/L；血红蛋白(Hb)-静脉血: 107g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞比容(Hct)-静脉血: 33.1%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44.7；α-L-岩藻糖苷酶(AFU)-静脉血: 49.8U/L；中性粒细胞百分比(Neut%)-静脉血: 0.558；乳酸脱氢酶(LDH)-静脉血: 136.8U/L；尿素氮(BUN)-静脉血: 2.6mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.3mmol/L；单核细胞计数(Mono#)-静脉血: 0.110E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.033；氯离子(Cl-)-静脉血: 94.4mmol/L；肌酐(Crea)-静脉血: 53.8umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.9U/L；球蛋白(GLO)-静脉血: 28.48g/L；平均血小板体积(MPV)-静脉血: 8.3fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；中性粒细胞计数(Neut#)-静脉血: 1.910E9/L；总胆汁酸(TBA)-静脉血: 2.7umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.373；血小板比容-静脉血: 31%；总蛋白(TP)-静脉……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D62] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日查房时自述精神食欲可，睡眠休息好。查体：KPS 90，一般状况可，鼻咽左侧壁、顶后壁肿物，双颈扪及肿大淋巴结，右颈多枚肿大淋巴结，较大者约6*4及2*2cm,质硬，活动差，左上颈可及一淋巴结，约3*3cm，质中，活动度可，无融合，无皮肤浸润等，左中颈可及一大小约1*1cm质硬淋巴结；张口门齿距约4cm，颅神经征阴性。[姓名已隐去]医生信息已隐藏：该病人为鼻咽癌，已接受GP方案诱导化疗2周期。目前排除化疗禁忌症，今日水化，明日再予GP方案行第三周期化疗，遵执。\n- [全程D63] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日查房时无特殊不适主诉，精神食欲可，昨日水化顺利。查体大致同前。[姓名已隐去]医生信息已隐藏：该病人继续按原方案（吉西他滨 1g/m2d1、d8+顺铂 80mg/m2d1）化疗，注意护胃、止吐等对症支持处理，遵执。\n- [全程D66] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 患者化疗输液顺利完成。今日查房时自诉精神食欲可，二便通畅。今继续对症支持治疗，择期复查血常规及血生化。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 提前终止第3周期诱导化疗，直接进入根治性同步放化疗阶段。\nB. 暂停第8天化疗，予重组人粒细胞集落刺激因子升白治疗后复查血常规。\nC. 更改诱导化疗方案为TP（多西他赛+顺铂）进行第4周期治疗。\nD. 继续行第3周期GP方案第8天化疗（吉西他滨联合顺铂），并安排出院。\nE. 计划在第3周期结束后，继续行第4周期GP方案诱导化疗。\nF. 暂停化疗，行双侧颈部淋巴结清扫术及鼻咽原发灶切除术。\nG. 终止后续放疗计划，按完全缓解（CR）状态进入定期随访观察。\nH. 将第8天吉西他滨剂量下调25%后给药，并密切监测血常规。\nI. 继续行第3周期GP方案第8天化疗（吉西他滨），辅以肠内营养支持，并安排出院。\nJ. 暂停治疗，行全身PET-CT检查以重新评估全身肿瘤负荷。\nK. 在第8天化疗基础上加用PD-1抑制剂（如特瑞普利单抗）进行联合治疗。\nL. 立即启动根治性调强放疗，并同步给予吉西他滨单药化疗。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"episode_id":"episode-7bbcafea1a05c9887d6c0a33","patient_id":"patient-4e3ac84b9e1451cea981f98e","care_turn_count":5,"turns":[{"sample_id":"sample-655ad2033595c09c6c4ce571","patient_id":"patient-4e3ac84b9e1451cea981f98e","turn_id":"turn01","turn_position":1,"turn_type":"initial_workup_choice","gold_letter":"B","gold_action":"完善血常规、肝肾功能、凝血功能，并安排鼻咽部活检。","options":[{"letter":"A","text":"完善血常规、肝肾功能、EBV-DNA检测，并安排全身PET-CT。","is_gold":false},{"letter":"B","text":"完善血常规、肝肾功能、凝血功能，并安排鼻咽部活检。","is_gold":true},{"letter":"C","text":"完善血常规、肝功能、EBV-DNA检测，并直接开始诱导化疗。","is_gold":false},{"letter":"D","text":"完善血常规、肝功能、甲状腺功能检测，并安排胸部CT和腹部增强CT。","is_gold":false},{"letter":"E","text":"完善血常规、肝功能、肾功能及心电图检查，暂不检测内分泌功能。","is_gold":false},{"letter":"F","text":"完善血常规、肝功能、脑垂体激素五项检测，暂不检测甲状腺功能。","is_gold":false},{"letter":"G","text":"完善血常规、肝功能、甲状腺功能及性激素六项检测。","is_gold":false},{"letter":"H","text":"完善血常规、肝功能检测，并安排骨扫描。","is_gold":false},{"letter":"I","text":"完善血常规、肝功能、甲状腺功能及肾上腺皮质激素检测。","is_gold":false},{"letter":"J","text":"完善血常规、肝功能、甲状腺功能及脑垂体激素五项检测。","is_gold":false},{"letter":"K","text":"完善血常规、肝功能、甲状腺功能及脑垂体激素五项检测，并立即行胸椎穿刺活检。","is_gold":false},{"letter":"L","text":"完善血常规、肝功能检测，并安排全身骨髓穿刺。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、头长肌。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D37] 入院记录: 主诉: 回吸性涕血3月；现病史: 患者于某次就诊时间无明显诱因出现涕中带血，量少，色鲜红，呈间歇性，未引起重视。近2个月间歇性出现耳鸣，伴左颈肿物，遂就诊我院。患者无头痛、面麻、复视、听力下降等症状。左侧腭帆提肌、头长肌受侵，右侧腭帆提肌、双侧腭帆张肌及右侧头长肌未见受侵征象。颅底骨质未见破坏征象。右侧咽后淋巴结、左颈II区淋巴肿大。第3、7胸椎局部代谢活跃，建议随诊。胸部平片、腹部彩超未见明显异常。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,涕中带血,左颈肿物,淋巴肿大；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.8℃，P：18次/分，R: 76次/分，BP：116/68mmHg,Ht：165cm，Wt：56.5kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；双侧顶后壁，左侧隐窝可见结节状肿物，左颈II区可扪及肿大淋巴结，大小约10*15mm,质韧，无压痛，活动度可，与周围组织分界清楚。颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善血常规、肝肾功能、EBV-DNA检测，并安排全身PET-CT。\nB. 完善血常规、肝肾功能、凝血功能，并安排鼻咽部活检。\nC. 完善血常规、肝功能、EBV-DNA检测，并直接开始诱导化疗。\nD. 完善血常规、肝功能、甲状腺功能检测，并安排胸部CT和腹部增强CT。\nE. 完善血常规、肝功能、肾功能及心电图检查，暂不检测内分泌功能。\nF. 完善血常规、肝功能、脑垂体激素五项检测，暂不检测甲状腺功能。\nG. 完善血常规、肝功能、甲状腺功能及性激素六项检测。\nH. 完善血常规、肝功能检测，并安排骨扫描。\nI. 完善血常规、肝功能、甲状腺功能及肾上腺皮质激素检测。\nJ. 完善血常规、肝功能、甲状腺功能及脑垂体激素五项检测。\nK. 完善血常规、肝功能、甲状腺功能及脑垂体激素五项检测，并立即行胸椎穿刺活检。\nL. 完善血常规、肝功能检测，并安排全身骨髓穿刺。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、头长肌。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D37] 入院记录: 主诉: 回吸性涕血3月；现病史: 患者于某次就诊时间无明显诱因出现涕中带血，量少，色鲜红，呈间歇性，未引起重视。近2个月间歇性出现耳鸣，伴左颈肿物，遂就诊我院。患者无头痛、面麻、复视、听力下降等症状。左侧腭帆提肌、头长肌受侵，右侧腭帆提肌、双侧腭帆张肌及右侧头长肌未见受侵征象。颅底骨质未见破坏征象。右侧咽后淋巴结、左颈II区淋巴肿大。第3、7胸椎局部代谢活跃，建议随诊。胸部平片、腹部彩超未见明显异常。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,涕中带血,左颈肿物,淋巴肿大；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.8℃，P：18次/分，R: 76次/分，BP：116/68mmHg,Ht：165cm，Wt：56.5kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；双侧顶后壁，左侧隐窝可见结节状肿物，左颈II区可扪及肿大淋巴结，大小约10*15mm,质韧，无压痛，活动度可，与周围组织分界清楚。颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善血常规、肝肾功能、EBV-DNA检测，并安排全身PET-CT。\nB. 完善血常规、肝肾功能、凝血功能，并安排鼻咽部活检。\nC. 完善血常规、肝功能、EBV-DNA检测，并直接开始诱导化疗。\nD. 完善血常规、肝功能、甲状腺功能检测，并安排胸部CT和腹部增强CT。\nE. 完善血常规、肝功能、肾功能及心电图检查，暂不检测内分泌功能。\nF. 完善血常规、肝功能、脑垂体激素五项检测，暂不检测甲状腺功能。\nG. 完善血常规、肝功能、甲状腺功能及性激素六项检测。\nH. 完善血常规、肝功能检测，并安排骨扫描。\nI. 完善血常规、肝功能、甲状腺功能及肾上腺皮质激素检测。\nJ. 完善血常规、肝功能、甲状腺功能及脑垂体激素五项检测。\nK. 完善血常规、肝功能、甲状腺功能及脑垂体激素五项检测，并立即行胸椎穿刺活检。\nL. 完善血常规、肝功能检测，并安排全身骨髓穿刺。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、头长肌。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D37] 入院记录: 主诉: 回吸性涕血3月；现病史: 患者于某次就诊时间无明显诱因出现涕中带血，量少，色鲜红，呈间歇性，未引起重视。近2个月间歇性出现耳鸣，伴左颈肿物，遂就诊我院。患者无头痛、面麻、复视、听力下降等症状。左侧腭帆提肌、头长肌受侵，右侧腭帆提肌、双侧腭帆张肌及右侧头长肌未见受侵征象。颅底骨质未见破坏征象。右侧咽后淋巴结、左颈II区淋巴肿大。第3、7胸椎局部代谢活跃，建议随诊。胸部平片、腹部彩超未见明显异常。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,涕中带血,左颈肿物,淋巴肿大；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.8℃，P：18次/分，R: 76次/分，BP：116/68mmHg,Ht：165cm，Wt：56.5kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；双侧顶后壁，左侧隐窝可见结节状肿物，左颈II区可扪及肿大淋巴结，大小约10*15mm,质韧，无压痛，活动度可，与周围组织分界清楚。颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善血常规、肝肾功能、EBV-DNA检测，并安排全身PET-CT。\nB. 完善血常规、肝肾功能、凝血功能，并安排鼻咽部活检。\nC. 完善血常规、肝功能、EBV-DNA检测，并直接开始诱导化疗。\nD. 完善血常规、肝功能、甲状腺功能检测，并安排胸部CT和腹部增强CT。\nE. 完善血常规、肝功能、肾功能及心电图检查，暂不检测内分泌功能。\nF. 完善血常规、肝功能、脑垂体激素五项检测，暂不检测甲状腺功能。\nG. 完善血常规、肝功能、甲状腺功能及性激素六项检测。\nH. 完善血常规、肝功能检测，并安排骨扫描。\nI. 完善血常规、肝功能、甲状腺功能及肾上腺皮质激素检测。\nJ. 完善血常规、肝功能、甲状腺功能及脑垂体激素五项检测。\nK. 完善血常规、肝功能、甲状腺功能及脑垂体激素五项检测，并立即行胸椎穿刺活检。\nL. 完善血常规、肝功能检测，并安排全身骨髓穿刺。\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-49bfe4582a9d9a75f21d4be4","patient_id":"patient-4e3ac84b9e1451cea981f98e","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"K","gold_action":"临床分期为 cT2N1M0（AJCC v9 IB期），头长肌受侵定为T2，双侧咽后及单侧颈部淋巴结转移定为N1，骨显像异常考虑良性暂定M0。","options":[{"letter":"A","text":"临床分期为 cT1N1M0（AJCC v9 IB期），病变局限于鼻咽腔及咽隐窝，未见明确周围软组织受侵，骨显像异常考虑良性。","is_gold":false},{"letter":"B","text":"临床分期为 cT2N2M0（AJCC v9 II期），双侧咽后淋巴结受累按分期规则应评为N2，骨显像异常考虑良性。","is_gold":false},{"letter":"C","text":"临床分期为 cT2N1M1（AJCC v9 IVB期），骨显像胸椎及股骨代谢活跃表现已达到多发骨转移诊断标准。","is_gold":false},{"letter":"D","text":"临床分期为 cT3N1M0（AJCC v9 II期），病灶堵塞后鼻孔已构成鼻腔侵犯，按分期规则应评为T3。","is_gold":false},{"letter":"E","text":"临床分期为 cT2N1M0（AJCC v9 II期），头长肌受侵定为T2，单侧颈部淋巴结转移定为N1，综合评为II期。","is_gold":false},{"letter":"F","text":"临床分期暂定 cT2N1Mx，骨显像异常代谢灶性质未明，需常规补充全身PET-CT或骨活检明确M分期。","is_gold":false},{"letter":"G","text":"临床分期为 cT1N2M0（AJCC v9 II期），左侧咽后及左颈II区淋巴结转移评为N2，未见明确T2结构受侵。","is_gold":false},{"letter":"H","text":"临床分期为 cT3N1M0（AJCC v9 II期），腭帆提肌受侵代表侵犯咽旁间隙以外结构，按分期规则应评为T3。","is_gold":false},{"letter":"I","text":"临床分期为 cT2N0M0（AJCC v9 IB期），咽后及颈部淋巴结短径均小于15mm，未达转移诊断标准，应评为N0。","is_gold":false},{"letter":"J","text":"临床分期为 cT4N1M0（AJCC v9 III期），病变侵犯头长肌属于广泛软组织受侵，按分期规则应评为T4。","is_gold":false},{"letter":"K","text":"临床分期为 cT2N1M0（AJCC v9 IB期），头长肌受侵定为T2，双侧咽后及单侧颈部淋巴结转移定为N1，骨显像异常考虑良性暂定M0。","is_gold":true},{"letter":"L","text":"临床分期为 cT2N1M0（AJCC v9 IB期），腭帆提肌受侵定为T2，建议加做全身PET-CT以排除隐匿性转移。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、头长肌。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D37] 入院记录: 主诉: 回吸性涕血3月；现病史: 患者于某次就诊时间无明显诱因出现涕中带血，量少，色鲜红，呈间歇性，未引起重视。近2个月间歇性出现耳鸣，伴左颈肿物，遂就诊我院。患者无头痛、面麻、复视、听力下降等症状。左侧腭帆提肌、头长肌受侵，右侧腭帆提肌、双侧腭帆张肌及右侧头长肌未见受侵征象。颅底骨质未见破坏征象。右侧咽后淋巴结、左颈II区淋巴肿大。第3、7胸椎局部代谢活跃，建议随诊。胸部平片、腹部彩超未见明显异常。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,涕中带血,左颈肿物,淋巴肿大；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.8℃，P：18次/分，R: 76次/分，BP：116/68mmHg,Ht：165cm，Wt：56.5kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；双侧顶后壁，左侧隐窝可见结节状肿物，左颈II区可扪及肿大淋巴结，大小约10*15mm,质韧，无压痛，活动度可，与周围组织分界清楚。颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] 检验组合: 尿酸(UA)-静脉血: 316.2umol/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 5.28mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 7.2umol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；球蛋白(GLO)-静脉血: 32.53g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.54mmol/L；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；磷(P)-静脉血: 1.06mmol/L；总胆汁酸(TBA)-静脉血: 2.6umol/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；Rh血型-静脉血: 阳性；血红蛋白(Hb)-静脉血: 153g/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.94；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.93mg/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；血小板分布宽度(PDW)-静脉血: 11.2%；血小板计数(PLT#)-静脉血: 29810E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；白蛋白(ALB)-静脉血: 48g/L；直接胆红素(DBIL)-静脉血: 1.8umol/L；活化部分凝血活酶时间(APTT)-静脉血: 24.9sec.；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；钠离子(Na+)-静脉血: 139.1mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.39；尿素氮(BUN)-静脉血: 5.9mmol/L；钾离子(K+)-静脉血: 4.04mmol/L；C-反应蛋白(CRP)-静脉血: 9.58mg/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22.5U/L；纤维蛋白原(Fbg)-静脉血: 4.77g/L；凝血酶原时间活动度(PTA)-静脉血: 125.5%；淋巴细胞……\n- [全程D18] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- [全程D18] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约25cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约45×26×26mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D19] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显斑片或结节影。双侧肺门影未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见病变。\n- [全程D20] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 第3、7胸椎及右股骨上段见片状放射性浓聚影。颅骨、胸骨、锁骨、肩胛骨、肋骨、颈椎、腰椎、骶尾骨、髋骨及上肢骨骼放射性分布未见明显异常。；检查结论: 右股骨上段局部代谢活跃，疑良性病变，缺血性坏死待排。 第3、7胸椎局部代谢活跃，建议随诊。\n- [全程D20] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁及左侧壁明显增厚，见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。左侧咽隐窝见肿物占据，右侧咽隐窝存在。左侧腭帆提肌、头长肌受侵，右侧腭帆提肌、双侧腭帆张肌及右侧头长肌未见受侵征象。病灶堵塞左侧后鼻孔。 双侧翼腭窝、双侧颞下窝未见异常；口咽未见异常。 颅底骨质未见破坏征象。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦粘膜未见增厚，双侧乳突充气良好，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 左侧咽后间隙见肿大淋巴结，大小约11mm×14mm；右侧咽后间隙见淋巴结，边界欠清，较大者短径约5mm。 左颈II区见数个淋巴结，部分信号不均匀，较大者大小约10mm×13mm，不均匀强化。颈部双侧Ⅰ、ⅡI区见小淋巴结，边界清，较大者短径约5mm，孤立散在。 甲状腺未见异常信号灶。喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 扫描范围颈椎未见明确骨质破坏。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质未见破坏征象。 左侧咽后淋巴结，考虑转移。右侧咽后淋巴结，考虑转移可能性大。 左颈II区淋巴结，考虑转移可能性大。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 临床分期为 cT1N1M0（AJCC v9 IB期），病变局限于鼻咽腔及咽隐窝，未见明确周围软组织受侵，骨显像异常考虑良性。\nB. 临床分期为 cT2N2M0（AJCC v9 II期），双侧咽后淋巴结受累按分期规则应评为N2，骨显像异常考虑良性。\nC. 临床分期为 cT2N1M1（AJCC v9 IVB期），骨显像胸椎及股骨代谢活跃表现已达到多发骨转移诊断标准。\nD. 临床分期为 cT3N1M0（AJCC v9 II期），病灶堵塞后鼻孔已构成鼻腔侵犯，按分期规则应评为T3。\nE. 临床分期为 cT2N1M0（AJCC v9 II期），头长肌受侵定为T2，单侧颈部淋巴结转移定为N1，综合评为II期。\nF. 临床分期暂定 cT2N1Mx，骨显像异常代谢灶性质未明，需常规补充全身PET-CT或骨活检明确M分期。\nG. 临床分期为 cT1N2M0（AJCC v9 II期），左侧咽后及左颈II区淋巴结转移评为N2，未见明确T2结构受侵。\nH. 临床分期为 cT3N1M0（AJCC v9 II期），腭帆提肌受侵代表侵犯咽旁间隙以外结构，按分期规则应评为T3。\nI. 临床分期为 cT2N0M0（AJCC v9 IB期），咽后及颈部淋巴结短径均小于15mm，未达转移诊断标准，应评为N0。\nJ. 临床分期为 cT4N1M0（AJCC v9 III期），病变侵犯头长肌属于广泛软组织受侵，按分期规则应评为T4。\nK. 临床分期为 cT2N1M0（AJCC v9 IB期），头长肌受侵定为T2，双侧咽后及单侧颈部淋巴结转移定为N1，骨显像异常考虑良性暂定M0。\nL. 临床分期为 cT2N1M0（AJCC v9 IB期），腭帆提肌受侵定为T2，建议加做全身PET-CT以排除隐匿性转移。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D1] 检验组合: 尿酸(UA)-静脉血: 316.2umol/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 5.28mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 7.2umol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；球蛋白(GLO)-静脉血: 32.53g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.54mmol/L；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；磷(P)-静脉血: 1.06mmol/L；总胆汁酸(TBA)-静脉血: 2.6umol/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；Rh血型-静脉血: 阳性；血红蛋白(Hb)-静脉血: 153g/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.94；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.93mg/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；血小板分布宽度(PDW)-静脉血: 11.2%；血小板计数(PLT#)-静脉血: 29810E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；白蛋白(ALB)-静脉血: 48g/L；直接胆红素(DBIL)-静脉血: 1.8umol/L；活化部分凝血活酶时间(APTT)-静脉血: 24.9sec.；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；钠离子(Na+)-静脉血: 139.1mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.39；尿素氮(BUN)-静脉血: 5.9mmol/L；钾离子(K+)-静脉血: 4.04mmol/L；C-反应蛋白(CRP)-静脉血: 9.58mg/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22.5U/L；纤维蛋白原(Fbg)-静脉血: 4.77g/L；凝血酶原时间活动度(PTA)-静脉血: 125.5%；淋巴细胞……\n- [全程D18] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- [全程D18] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约25cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约45×26×26mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D19] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显斑片或结节影。双侧肺门影未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见病变。\n- [全程D20] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 第3、7胸椎及右股骨上段见片状放射性浓聚影。颅骨、胸骨、锁骨、肩胛骨、肋骨、颈椎、腰椎、骶尾骨、髋骨及上肢骨骼放射性分布未见明显异常。；检查结论: 右股骨上段局部代谢活跃，疑良性病变，缺血性坏死待排。 第3、7胸椎局部代谢活跃，建议随诊。\n- [全程D20] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁及左侧壁明显增厚，见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。左侧咽隐窝见肿物占据，右侧咽隐窝存在。左侧腭帆提肌、头长肌受侵，右侧腭帆提肌、双侧腭帆张肌及右侧头长肌未见受侵征象。病灶堵塞左侧后鼻孔。 双侧翼腭窝、双侧颞下窝未见异常；口咽未见异常。 颅底骨质未见破坏征象。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦粘膜未见增厚，双侧乳突充气良好，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 左侧咽后间隙见肿大淋巴结，大小约11mm×14mm；右侧咽后间隙见淋巴结，边界欠清，较大者短径约5mm。 左颈II区见数个淋巴结，部分信号不均匀，较大者大小约10mm×13mm，不均匀强化。颈部双侧Ⅰ、ⅡI区见小淋巴结，边界清，较大者短径约5mm，孤立散在。 甲状腺未见异常信号灶。喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 扫描范围颈椎未见明确骨质破坏。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质未见破坏征象。 左侧咽后淋巴结，考虑转移。右侧咽后淋巴结，考虑转移可能性大。 左颈II区淋巴结，考虑转移可能性大。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 临床分期为 cT1N1M0（AJCC v9 IB期），病变局限于鼻咽腔及咽隐窝，未见明确周围软组织受侵，骨显像异常考虑良性。\nB. 临床分期为 cT2N2M0（AJCC v9 II期），双侧咽后淋巴结受累按分期规则应评为N2，骨显像异常考虑良性。\nC. 临床分期为 cT2N1M1（AJCC v9 IVB期），骨显像胸椎及股骨代谢活跃表现已达到多发骨转移诊断标准。\nD. 临床分期为 cT3N1M0（AJCC v9 II期），病灶堵塞后鼻孔已构成鼻腔侵犯，按分期规则应评为T3。\nE. 临床分期为 cT2N1M0（AJCC v9 II期），头长肌受侵定为T2，单侧颈部淋巴结转移定为N1，综合评为II期。\nF. 临床分期暂定 cT2N1Mx，骨显像异常代谢灶性质未明，需常规补充全身PET-CT或骨活检明确M分期。\nG. 临床分期为 cT1N2M0（AJCC v9 II期），左侧咽后及左颈II区淋巴结转移评为N2，未见明确T2结构受侵。\nH. 临床分期为 cT3N1M0（AJCC v9 II期），腭帆提肌受侵代表侵犯咽旁间隙以外结构，按分期规则应评为T3。\nI. 临床分期为 cT2N0M0（AJCC v9 IB期），咽后及颈部淋巴结短径均小于15mm，未达转移诊断标准，应评为N0。\nJ. 临床分期为 cT4N1M0（AJCC v9 III期），病变侵犯头长肌属于广泛软组织受侵，按分期规则应评为T4。\nK. 临床分期为 cT2N1M0（AJCC v9 IB期），头长肌受侵定为T2，双侧咽后及单侧颈部淋巴结转移定为N1，骨显像异常考虑良性暂定M0。\nL. 临床分期为 cT2N1M0（AJCC v9 IB期），腭帆提肌受侵定为T2，建议加做全身PET-CT以排除隐匿性转移。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、头长肌。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D1] 检验组合: 尿酸(UA)-静脉血: 316.2umol/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 5.28mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 7.2umol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；球蛋白(GLO)-静脉血: 32.53g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.54mmol/L；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；磷(P)-静脉血: 1.06mmol/L；总胆汁酸(TBA)-静脉血: 2.6umol/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；Rh血型-静脉血: 阳性；血红蛋白(Hb)-静脉血: 153g/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.94；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.93mg/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；血小板分布宽度(PDW)-静脉血: 11.2%；血小板计数(PLT#)-静脉血: 29810E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；白蛋白(ALB)-静脉血: 48g/L；直接胆红素(DBIL)-静脉血: 1.8umol/L；活化部分凝血活酶时间(APTT)-静脉血: 24.9sec.；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；钠离子(Na+)-静脉血: 139.1mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.39；尿素氮(BUN)-静脉血: 5.9mmol/L；钾离子(K+)-静脉血: 4.04mmol/L；C-反应蛋白(CRP)-静脉血: 9.58mg/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22.5U/L；纤维蛋白原(Fbg)-静脉血: 4.77g/L；凝血酶原时间活动度(PTA)-静脉血: 125.5%；淋巴细胞……\n- [全程D18] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- [全程D18] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约25cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约45×26×26mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D19] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显斑片或结节影。双侧肺门影未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见病变。\n- [全程D20] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 第3、7胸椎及右股骨上段见片状放射性浓聚影。颅骨、胸骨、锁骨、肩胛骨、肋骨、颈椎、腰椎、骶尾骨、髋骨及上肢骨骼放射性分布未见明显异常。；检查结论: 右股骨上段局部代谢活跃，疑良性病变，缺血性坏死待排。 第3、7胸椎局部代谢活跃，建议随诊。\n- [全程D20] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁及左侧壁明显增厚，见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。左侧咽隐窝见肿物占据，右侧咽隐窝存在。左侧腭帆提肌、头长肌受侵，右侧腭帆提肌、双侧腭帆张肌及右侧头长肌未见受侵征象。病灶堵塞左侧后鼻孔。 双侧翼腭窝、双侧颞下窝未见异常；口咽未见异常。 颅底骨质未见破坏征象。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦粘膜未见增厚，双侧乳突充气良好，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 左侧咽后间隙见肿大淋巴结，大小约11mm×14mm；右侧咽后间隙见淋巴结，边界欠清，较大者短径约5mm。 左颈II区见数个淋巴结，部分信号不均匀，较大者大小约10mm×13mm，不均匀强化。颈部双侧Ⅰ、ⅡI区见小淋巴结，边界清，较大者短径约5mm，孤立散在。 甲状腺未见异常信号灶。喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 扫描范围颈椎未见明确骨质破坏。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质未见破坏征象。 左侧咽后淋巴结，考虑转移。右侧咽后淋巴结，考虑转移可能性大。 左颈II区淋巴结，考虑转移可能性大。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 临床分期为 cT1N1M0（AJCC v9 IB期），病变局限于鼻咽腔及咽隐窝，未见明确周围软组织受侵，骨显像异常考虑良性。\nB. 临床分期为 cT2N2M0（AJCC v9 II期），双侧咽后淋巴结受累按分期规则应评为N2，骨显像异常考虑良性。\nC. 临床分期为 cT2N1M1（AJCC v9 IVB期），骨显像胸椎及股骨代谢活跃表现已达到多发骨转移诊断标准。\nD. 临床分期为 cT3N1M0（AJCC v9 II期），病灶堵塞后鼻孔已构成鼻腔侵犯，按分期规则应评为T3。\nE. 临床分期为 cT2N1M0（AJCC v9 II期），头长肌受侵定为T2，单侧颈部淋巴结转移定为N1，综合评为II期。\nF. 临床分期暂定 cT2N1Mx，骨显像异常代谢灶性质未明，需常规补充全身PET-CT或骨活检明确M分期。\nG. 临床分期为 cT1N2M0（AJCC v9 II期），左侧咽后及左颈II区淋巴结转移评为N2，未见明确T2结构受侵。\nH. 临床分期为 cT3N1M0（AJCC v9 II期），腭帆提肌受侵代表侵犯咽旁间隙以外结构，按分期规则应评为T3。\nI. 临床分期为 cT2N0M0（AJCC v9 IB期），咽后及颈部淋巴结短径均小于15mm，未达转移诊断标准，应评为N0。\nJ. 临床分期为 cT4N1M0（AJCC v9 III期），病变侵犯头长肌属于广泛软组织受侵，按分期规则应评为T4。\nK. 临床分期为 cT2N1M0（AJCC v9 IB期），头长肌受侵定为T2，双侧咽后及单侧颈部淋巴结转移定为N1，骨显像异常考虑良性暂定M0。\nL. 临床分期为 cT2N1M0（AJCC v9 IB期），腭帆提肌受侵定为T2，建议加做全身PET-CT以排除隐匿性转移。\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-04c8674f03cec4de991fcf32","patient_id":"patient-4e3ac84b9e1451cea981f98e","turn_id":"turn04","turn_position":3,"turn_type":"initial_treatment_selection","gold_letter":"A","gold_action":"单纯根治性放射治疗或根治性放化疗","options":[{"letter":"A","text":"单纯根治性放射治疗或根治性放化疗","is_gold":true},{"letter":"B","text":"诱导化疗后序贯单纯根治性放射治疗","is_gold":false},{"letter":"C","text":"诱导化疗后序贯根治性放化疗","is_gold":false},{"letter":"D","text":"单纯根治性放射治疗后序贯辅助化疗","is_gold":false},{"letter":"E","text":"根治性放化疗后序贯辅助化疗","is_gold":false},{"letter":"F","text":"诱导化疗后序贯根治性放化疗及辅助化疗","is_gold":false},{"letter":"G","text":"姑息性放射治疗联合全身系统性化疗","is_gold":false},{"letter":"H","text":"单纯根治性放射治疗联合EGFR靶向治疗","is_gold":false},{"letter":"I","text":"诱导化疗联合EGFR靶向治疗后序贯放疗","is_gold":false},{"letter":"J","text":"根治性放化疗联合PD-1抑制剂治疗","is_gold":false},{"letter":"K","text":"诱导化疗联合PD-1抑制剂后序贯放化疗","is_gold":false},{"letter":"L","text":"单纯全身系统性化疗","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、头长肌。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D37] 入院记录: 主诉: 回吸性涕血3月；现病史: 患者于某次就诊时间无明显诱因出现涕中带血，量少，色鲜红，呈间歇性，未引起重视。近2个月间歇性出现耳鸣，伴左颈肿物，遂就诊我院。患者无头痛、面麻、复视、听力下降等症状。左侧腭帆提肌、头长肌受侵，右侧腭帆提肌、双侧腭帆张肌及右侧头长肌未见受侵征象。颅底骨质未见破坏征象。右侧咽后淋巴结、左颈II区淋巴肿大。第3、7胸椎局部代谢活跃，建议随诊。胸部平片、腹部彩超未见明显异常。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,涕中带血,左颈肿物,淋巴肿大；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.8℃，P：18次/分，R: 76次/分，BP：116/68mmHg,Ht：165cm，Wt：56.5kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；双侧顶后壁，左侧隐窝可见结节状肿物，左颈II区可扪及肿大淋巴结，大小约10*15mm,质韧，无压痛，活动度可，与周围组织分界清楚。颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] 检验组合: 尿酸(UA)-静脉血: 316.2umol/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 5.28mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 7.2umol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；球蛋白(GLO)-静脉血: 32.53g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.54mmol/L；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；磷(P)-静脉血: 1.06mmol/L；总胆汁酸(TBA)-静脉血: 2.6umol/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；Rh血型-静脉血: 阳性；血红蛋白(Hb)-静脉血: 153g/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.94；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.93mg/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；血小板分布宽度(PDW)-静脉血: 11.2%；血小板计数(PLT#)-静脉血: 29810E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；白蛋白(ALB)-静脉血: 48g/L；直接胆红素(DBIL)-静脉血: 1.8umol/L；活化部分凝血活酶时间(APTT)-静脉血: 24.9sec.；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；钠离子(Na+)-静脉血: 139.1mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.39；尿素氮(BUN)-静脉血: 5.9mmol/L；钾离子(K+)-静脉血: 4.04mmol/L；C-反应蛋白(CRP)-静脉血: 9.58mg/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22.5U/L；纤维蛋白原(Fbg)-静脉血: 4.77g/L；凝血酶原时间活动度(PTA)-静脉血: 125.5%；淋巴细胞……\n- [全程D18] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- [全程D18] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约25cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约45×26×26mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D19] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显斑片或结节影。双侧肺门影未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见病变。\n- [全程D20] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 第3、7胸椎及右股骨上段见片状放射性浓聚影。颅骨、胸骨、锁骨、肩胛骨、肋骨、颈椎、腰椎、骶尾骨、髋骨及上肢骨骼放射性分布未见明显异常。；检查结论: 右股骨上段局部代谢活跃，疑良性病变，缺血性坏死待排。 第3、7胸椎局部代谢活跃，建议随诊。\n- [全程D20] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁及左侧壁明显增厚，见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。左侧咽隐窝见肿物占据，右侧咽隐窝存在。左侧腭帆提肌、头长肌受侵，右侧腭帆提肌、双侧腭帆张肌及右侧头长肌未见受侵征象。病灶堵塞左侧后鼻孔。 双侧翼腭窝、双侧颞下窝未见异常；口咽未见异常。 颅底骨质未见破坏征象。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦粘膜未见增厚，双侧乳突充气良好，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 左侧咽后间隙见肿大淋巴结，大小约11mm×14mm；右侧咽后间隙见淋巴结，边界欠清，较大者短径约5mm。 左颈II区见数个淋巴结，部分信号不均匀，较大者大小约10mm×13mm，不均匀强化。颈部双侧Ⅰ、ⅡI区见小淋巴结，边界清，较大者短径约5mm，孤立散在。 甲状腺未见异常信号灶。喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 扫描范围颈椎未见明确骨质破坏。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质未见破坏征象。 左侧咽后淋巴结，考虑转移。右侧咽后淋巴结，考虑转移可能性大。 左颈II区淋巴结，考虑转移可能性大。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D23] 检验组合: 天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.75；乳酸脱氢酶(LDH)-静脉血: 285.9U/L；总胆汁酸(TBA)-静脉血: 12.7umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 220U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 20.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 249.9U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 165.4U/L；碱性磷酸酶(ALP)-静脉血: 161.1U/L\n- [全程D37] 检验组合: 甲状腺球蛋白(TG)-静脉血: 13.08ng/ml；平均血小板体积(MPV)-静脉血: 9.9fL；α-L-岩藻糖苷酶(AFU)-静脉血: 21.1U/L；促卵泡刺激素(FSH)-静脉血: 6.26mIU/ml；血小板比容-静脉血: 29%；血小板分布宽度(PDW)-静脉血: 11.3%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.2；催乳素(PRL)-静脉血: 277.6uIU/ml；大血小板百分比(P-LCR%)-静脉血: 23.9%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；促黄体生成素(LH)-静脉血: 9.22mIU/ml；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；血小板计数(PLT#)-静脉血: 29710E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.262；γ-谷氨酰基转移酶(GGT)-静脉血: 227.5U/L；生长激素(GH)-静脉血: 0.54ng/ml；碱性磷酸酶(ALP)-静脉血: 164.9U/L；乳酸脱氢酶(LDH)-静脉血: 170.2U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 38.5；平均红细胞体积(MCV)-静脉血: 94fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；血红蛋白(Hb)-静脉血: 140g/L；中性粒细胞计数(Neut#)-静脉血: 4.410E9/L；促甲状腺激素(TSH)-静脉血: 4.45uIU/ml；有核红细胞计数(NRBC#)-静脉血: 010E9/L；单核细胞百分比(Mono%)-静脉血: 0.105；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.619；红细胞计数(RBC#)-静脉血: 4.5110E12/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；红细胞比容(Hct)-静脉血: 42.4%；总胆汁酸(TBA)-静脉血: 2umol/L；甲状腺过氧化物酶抗体(TPO-Ab)-静脉血: 14.45U/ml；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.58；丙氨酸氨基转移酶(ALT)-静脉血:……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 单纯根治性放射治疗或根治性放化疗\nB. 诱导化疗后序贯单纯根治性放射治疗\nC. 诱导化疗后序贯根治性放化疗\nD. 单纯根治性放射治疗后序贯辅助化疗\nE. 根治性放化疗后序贯辅助化疗\nF. 诱导化疗后序贯根治性放化疗及辅助化疗\nG. 姑息性放射治疗联合全身系统性化疗\nH. 单纯根治性放射治疗联合EGFR靶向治疗\nI. 诱导化疗联合EGFR靶向治疗后序贯放疗\nJ. 根治性放化疗联合PD-1抑制剂治疗\nK. 诱导化疗联合PD-1抑制剂后序贯放化疗\nL. 单纯全身系统性化疗\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D23] 检验组合: 天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.75；乳酸脱氢酶(LDH)-静脉血: 285.9U/L；总胆汁酸(TBA)-静脉血: 12.7umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 220U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 20.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 249.9U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 165.4U/L；碱性磷酸酶(ALP)-静脉血: 161.1U/L\n- [全程D37] 检验组合: 甲状腺球蛋白(TG)-静脉血: 13.08ng/ml；平均血小板体积(MPV)-静脉血: 9.9fL；α-L-岩藻糖苷酶(AFU)-静脉血: 21.1U/L；促卵泡刺激素(FSH)-静脉血: 6.26mIU/ml；血小板比容-静脉血: 29%；血小板分布宽度(PDW)-静脉血: 11.3%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.2；催乳素(PRL)-静脉血: 277.6uIU/ml；大血小板百分比(P-LCR%)-静脉血: 23.9%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；促黄体生成素(LH)-静脉血: 9.22mIU/ml；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；血小板计数(PLT#)-静脉血: 29710E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.262；γ-谷氨酰基转移酶(GGT)-静脉血: 227.5U/L；生长激素(GH)-静脉血: 0.54ng/ml；碱性磷酸酶(ALP)-静脉血: 164.9U/L；乳酸脱氢酶(LDH)-静脉血: 170.2U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 38.5；平均红细胞体积(MCV)-静脉血: 94fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；血红蛋白(Hb)-静脉血: 140g/L；中性粒细胞计数(Neut#)-静脉血: 4.410E9/L；促甲状腺激素(TSH)-静脉血: 4.45uIU/ml；有核红细胞计数(NRBC#)-静脉血: 010E9/L；单核细胞百分比(Mono%)-静脉血: 0.105；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.619；红细胞计数(RBC#)-静脉血: 4.5110E12/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；红细胞比容(Hct)-静脉血: 42.4%；总胆汁酸(TBA)-静脉血: 2umol/L；甲状腺过氧化物酶抗体(TPO-Ab)-静脉血: 14.45U/ml；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.58；丙氨酸氨基转移酶(ALT)-静脉血:……\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 单纯根治性放射治疗或根治性放化疗\nB. 诱导化疗后序贯单纯根治性放射治疗\nC. 诱导化疗后序贯根治性放化疗\nD. 单纯根治性放射治疗后序贯辅助化疗\nE. 根治性放化疗后序贯辅助化疗\nF. 诱导化疗后序贯根治性放化疗及辅助化疗\nG. 姑息性放射治疗联合全身系统性化疗\nH. 单纯根治性放射治疗联合EGFR靶向治疗\nI. 诱导化疗联合EGFR靶向治疗后序贯放疗\nJ. 根治性放化疗联合PD-1抑制剂治疗\nK. 诱导化疗联合PD-1抑制剂后序贯放化疗\nL. 单纯全身系统性化疗\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、头长肌。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D23] 检验组合: 天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.75；乳酸脱氢酶(LDH)-静脉血: 285.9U/L；总胆汁酸(TBA)-静脉血: 12.7umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 220U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 20.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 249.9U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 165.4U/L；碱性磷酸酶(ALP)-静脉血: 161.1U/L\n- [全程D37] 检验组合: 甲状腺球蛋白(TG)-静脉血: 13.08ng/ml；平均血小板体积(MPV)-静脉血: 9.9fL；α-L-岩藻糖苷酶(AFU)-静脉血: 21.1U/L；促卵泡刺激素(FSH)-静脉血: 6.26mIU/ml；血小板比容-静脉血: 29%；血小板分布宽度(PDW)-静脉血: 11.3%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.2；催乳素(PRL)-静脉血: 277.6uIU/ml；大血小板百分比(P-LCR%)-静脉血: 23.9%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；促黄体生成素(LH)-静脉血: 9.22mIU/ml；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；血小板计数(PLT#)-静脉血: 29710E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.262；γ-谷氨酰基转移酶(GGT)-静脉血: 227.5U/L；生长激素(GH)-静脉血: 0.54ng/ml；碱性磷酸酶(ALP)-静脉血: 164.9U/L；乳酸脱氢酶(LDH)-静脉血: 170.2U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 38.5；平均红细胞体积(MCV)-静脉血: 94fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；血红蛋白(Hb)-静脉血: 140g/L；中性粒细胞计数(Neut#)-静脉血: 4.410E9/L；促甲状腺激素(TSH)-静脉血: 4.45uIU/ml；有核红细胞计数(NRBC#)-静脉血: 010E9/L；单核细胞百分比(Mono%)-静脉血: 0.105；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.619；红细胞计数(RBC#)-静脉血: 4.5110E12/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；红细胞比容(Hct)-静脉血: 42.4%；总胆汁酸(TBA)-静脉血: 2umol/L；甲状腺过氧化物酶抗体(TPO-Ab)-静脉血: 14.45U/ml；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.58；丙氨酸氨基转移酶(ALT)-静脉血:……\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 单纯根治性放射治疗或根治性放化疗\nB. 诱导化疗后序贯单纯根治性放射治疗\nC. 诱导化疗后序贯根治性放化疗\nD. 单纯根治性放射治疗后序贯辅助化疗\nE. 根治性放化疗后序贯辅助化疗\nF. 诱导化疗后序贯根治性放化疗及辅助化疗\nG. 姑息性放射治疗联合全身系统性化疗\nH. 单纯根治性放射治疗联合EGFR靶向治疗\nI. 诱导化疗联合EGFR靶向治疗后序贯放疗\nJ. 根治性放化疗联合PD-1抑制剂治疗\nK. 诱导化疗联合PD-1抑制剂后序贯放化疗\nL. 单纯全身系统性化疗\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-453547f6b6c780c6834cd926","patient_id":"patient-4e3ac84b9e1451cea981f98e","turn_id":"turn05","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"B","gold_action":"继续当前调强放疗，定期监测血常规及肝肾功能，暂不予特殊药物干预。","options":[{"letter":"A","text":"暂停放疗，给予静脉保肝降酶药物，待转氨酶正常后重启放疗","is_gold":false},{"letter":"B","text":"继续调强放疗，定期监测血常规及肝肾功能，暂不予特殊药物干预","is_gold":true},{"letter":"C","text":"暂停放疗，经验性静脉滴注广谱抗生素，待中性粒细胞正常后重启放疗","is_gold":false},{"letter":"D","text":"继续调强放疗，皮下注射重组人粒细胞集落刺激因子","is_gold":false},{"letter":"E","text":"暂停放疗，给予大剂量静脉水化及利尿治疗","is_gold":false},{"letter":"F","text":"继续调强放疗，计划在下一周期将顺铂剂量下调20%","is_gold":false},{"letter":"G","text":"暂停放疗，完善血培养及降钙素原检查","is_gold":false},{"letter":"H","text":"继续调强放疗，静脉滴注大剂量糖皮质激素","is_gold":false},{"letter":"I","text":"暂停放疗，给予静脉输注人血白蛋白及肠外营养支持","is_gold":false},{"letter":"J","text":"继续调强放疗，计划将下一周期同期化疗药物替换为卡铂","is_gold":false},{"letter":"K","text":"暂停放疗，复查鼻咽及颈部增强MRI","is_gold":false},{"letter":"L","text":"继续调强放疗，取消后续同期化疗周期","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、头长肌。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D37] 入院记录: 主诉: 回吸性涕血3月；现病史: 患者于某次就诊时间无明显诱因出现涕中带血，量少，色鲜红，呈间歇性，未引起重视。近2个月间歇性出现耳鸣，伴左颈肿物，遂就诊我院。患者无头痛、面麻、复视、听力下降等症状。左侧腭帆提肌、头长肌受侵，右侧腭帆提肌、双侧腭帆张肌及右侧头长肌未见受侵征象。颅底骨质未见破坏征象。右侧咽后淋巴结、左颈II区淋巴肿大。第3、7胸椎局部代谢活跃，建议随诊。胸部平片、腹部彩超未见明显异常。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,涕中带血,左颈肿物,淋巴肿大；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.8℃，P：18次/分，R: 76次/分，BP：116/68mmHg,Ht：165cm，Wt：56.5kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；双侧顶后壁，左侧隐窝可见结节状肿物，左颈II区可扪及肿大淋巴结，大小约10*15mm,质韧，无压痛，活动度可，与周围组织分界清楚。颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] 检验组合: 尿酸(UA)-静脉血: 316.2umol/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 5.28mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 7.2umol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；球蛋白(GLO)-静脉血: 32.53g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.54mmol/L；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；磷(P)-静脉血: 1.06mmol/L；总胆汁酸(TBA)-静脉血: 2.6umol/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；Rh血型-静脉血: 阳性；血红蛋白(Hb)-静脉血: 153g/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.94；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.93mg/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；血小板分布宽度(PDW)-静脉血: 11.2%；血小板计数(PLT#)-静脉血: 29810E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；白蛋白(ALB)-静脉血: 48g/L；直接胆红素(DBIL)-静脉血: 1.8umol/L；活化部分凝血活酶时间(APTT)-静脉血: 24.9sec.；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；钠离子(Na+)-静脉血: 139.1mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.39；尿素氮(BUN)-静脉血: 5.9mmol/L；钾离子(K+)-静脉血: 4.04mmol/L；C-反应蛋白(CRP)-静脉血: 9.58mg/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22.5U/L；纤维蛋白原(Fbg)-静脉血: 4.77g/L；凝血酶原时间活动度(PTA)-静脉血: 125.5%；淋巴细胞……\n- [全程D18] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- [全程D18] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约25cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约45×26×26mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D19] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显斑片或结节影。双侧肺门影未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见病变。\n- [全程D20] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 第3、7胸椎及右股骨上段见片状放射性浓聚影。颅骨、胸骨、锁骨、肩胛骨、肋骨、颈椎、腰椎、骶尾骨、髋骨及上肢骨骼放射性分布未见明显异常。；检查结论: 右股骨上段局部代谢活跃，疑良性病变，缺血性坏死待排。 第3、7胸椎局部代谢活跃，建议随诊。\n- [全程D20] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁及左侧壁明显增厚，见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。左侧咽隐窝见肿物占据，右侧咽隐窝存在。左侧腭帆提肌、头长肌受侵，右侧腭帆提肌、双侧腭帆张肌及右侧头长肌未见受侵征象。病灶堵塞左侧后鼻孔。 双侧翼腭窝、双侧颞下窝未见异常；口咽未见异常。 颅底骨质未见破坏征象。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦粘膜未见增厚，双侧乳突充气良好，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 左侧咽后间隙见肿大淋巴结，大小约11mm×14mm；右侧咽后间隙见淋巴结，边界欠清，较大者短径约5mm。 左颈II区见数个淋巴结，部分信号不均匀，较大者大小约10mm×13mm，不均匀强化。颈部双侧Ⅰ、ⅡI区见小淋巴结，边界清，较大者短径约5mm，孤立散在。 甲状腺未见异常信号灶。喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 扫描范围颈椎未见明确骨质破坏。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质未见破坏征象。 左侧咽后淋巴结，考虑转移。右侧咽后淋巴结，考虑转移可能性大。 左颈II区淋巴结，考虑转移可能性大。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D23] 检验组合: 天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.75；乳酸脱氢酶(LDH)-静脉血: 285.9U/L；总胆汁酸(TBA)-静脉血: 12.7umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 220U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 20.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 249.9U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 165.4U/L；碱性磷酸酶(ALP)-静脉血: 161.1U/L\n- [全程D37] 检验组合: 甲状腺球蛋白(TG)-静脉血: 13.08ng/ml；平均血小板体积(MPV)-静脉血: 9.9fL；α-L-岩藻糖苷酶(AFU)-静脉血: 21.1U/L；促卵泡刺激素(FSH)-静脉血: 6.26mIU/ml；血小板比容-静脉血: 29%；血小板分布宽度(PDW)-静脉血: 11.3%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.2；催乳素(PRL)-静脉血: 277.6uIU/ml；大血小板百分比(P-LCR%)-静脉血: 23.9%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；促黄体生成素(LH)-静脉血: 9.22mIU/ml；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；血小板计数(PLT#)-静脉血: 29710E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.262；γ-谷氨酰基转移酶(GGT)-静脉血: 227.5U/L；生长激素(GH)-静脉血: 0.54ng/ml；碱性磷酸酶(ALP)-静脉血: 164.9U/L；乳酸脱氢酶(LDH)-静脉血: 170.2U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 38.5；平均红细胞体积(MCV)-静脉血: 94fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；血红蛋白(Hb)-静脉血: 140g/L；中性粒细胞计数(Neut#)-静脉血: 4.410E9/L；促甲状腺激素(TSH)-静脉血: 4.45uIU/ml；有核红细胞计数(NRBC#)-静脉血: 010E9/L；单核细胞百分比(Mono%)-静脉血: 0.105；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.619；红细胞计数(RBC#)-静脉血: 4.5110E12/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；红细胞比容(Hct)-静脉血: 42.4%；总胆汁酸(TBA)-静脉血: 2umol/L；甲状腺过氧化物酶抗体(TPO-Ab)-静脉血: 14.45U/ml；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.58；丙氨酸氨基转移酶(ALT)-静脉血:……\n- [全程D44] 检验组合: 平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；单核细胞百分比(Mono%)-静脉血: 0.084；载脂蛋白B(apoB)-静脉血: 1.02g/L；磷(P)-静脉血: 1.54mmol/L；钠离子(Na+)-静脉血: 137mmol/L；白蛋白(ALB)-静脉血: 41.2g/L；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 38.1U/L；总胆固醇(TC)-静脉血: 5.9mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；中性粒细胞百分比(Neut%)-静脉血: 0.789；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.65mmol/L；间接胆红素(IBIL)-静脉血: 5.6umolL；尿素氮(BUN)-静脉血: 7.73mmol/L；总胆红素(TBIL)-静脉血: 7.4umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.4mmol/L；C-反应蛋白(CRP)-静脉血: 9.62mg/L；血小板比容-静脉血: 27%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；大血小板百分比(P-LCR%)-静脉血: 26.8%；α-L-岩藻糖苷酶(AFU)-静脉血: 35U/L；钾离子(K+)-静脉血: 4.2mmol/L；直接胆红素(DBIL)-静脉血: 1.8umol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.6；尿酸(UA)-静脉血: 288.4umol/L；碱性磷酸酶(ALP)-静脉血: 138.4U/L；中性粒细胞计数(Neut#)-静脉血: 11.910E9/L；总钙(Ca)-静脉血: 2.25mmol/L；肌酐(Crea)-静脉血: 84umol/L；总胆汁酸(TBA)-静脉血: 4.1umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.24；球蛋白(GLO)-静脉血: 33.12g/L；氯离子(Cl-)-静脉血: 97.5mmol/L；甘油三酯(TG)-静脉血: 2.9mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；丙氨酸氨基转移酶(ALT)-静脉血:……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D39] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者一般情况可，未诉特殊不适。按[计划性表述已隐藏]同期放化疗，放疗技术采用调强放疗9野，处方剂量：PTVp 7029cGy/33F， PTVn_L 6600cGy/33F,PTVn_R 6000cGy/33F,PTV1 6000cGy/33F,PTV2 5400cGy/33F。目前放疗计划已完善，予以今日复位验证后执行放疗。\n- [全程D40] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者精神食欲可，放疗2次，无特殊不适，查体无特殊。今日按[计划性表述已隐藏]第一程DDP同期化疗（顺铂 80mg/m2），若无特殊不适，今日化疗结束后予以出院。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，给予静脉保肝降酶药物，待转氨酶正常后重启放疗\nB. 继续调强放疗，定期监测血常规及肝肾功能，暂不予特殊药物干预\nC. 暂停放疗，经验性静脉滴注广谱抗生素，待中性粒细胞正常后重启放疗\nD. 继续调强放疗，皮下注射重组人粒细胞集落刺激因子\nE. 暂停放疗，给予大剂量静脉水化及利尿治疗\nF. 继续调强放疗，计划在下一周期将顺铂剂量下调20%\nG. 暂停放疗，完善血培养及降钙素原检查\nH. 继续调强放疗，静脉滴注大剂量糖皮质激素\nI. 暂停放疗，给予静脉输注人血白蛋白及肠外营养支持\nJ. 继续调强放疗，计划将下一周期同期化疗药物替换为卡铂\nK. 暂停放疗，复查鼻咽及颈部增强MRI\nL. 继续调强放疗，取消后续同期化疗周期\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D44] 检验组合: 平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；单核细胞百分比(Mono%)-静脉血: 0.084；载脂蛋白B(apoB)-静脉血: 1.02g/L；磷(P)-静脉血: 1.54mmol/L；钠离子(Na+)-静脉血: 137mmol/L；白蛋白(ALB)-静脉血: 41.2g/L；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 38.1U/L；总胆固醇(TC)-静脉血: 5.9mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；中性粒细胞百分比(Neut%)-静脉血: 0.789；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.65mmol/L；间接胆红素(IBIL)-静脉血: 5.6umolL；尿素氮(BUN)-静脉血: 7.73mmol/L；总胆红素(TBIL)-静脉血: 7.4umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.4mmol/L；C-反应蛋白(CRP)-静脉血: 9.62mg/L；血小板比容-静脉血: 27%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；大血小板百分比(P-LCR%)-静脉血: 26.8%；α-L-岩藻糖苷酶(AFU)-静脉血: 35U/L；钾离子(K+)-静脉血: 4.2mmol/L；直接胆红素(DBIL)-静脉血: 1.8umol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.6；尿酸(UA)-静脉血: 288.4umol/L；碱性磷酸酶(ALP)-静脉血: 138.4U/L；中性粒细胞计数(Neut#)-静脉血: 11.910E9/L；总钙(Ca)-静脉血: 2.25mmol/L；肌酐(Crea)-静脉血: 84umol/L；总胆汁酸(TBA)-静脉血: 4.1umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.24；球蛋白(GLO)-静脉血: 33.12g/L；氯离子(Cl-)-静脉血: 97.5mmol/L；甘油三酯(TG)-静脉血: 2.9mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；丙氨酸氨基转移酶(ALT)-静脉血:……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D39] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者一般情况可，未诉特殊不适。按[计划性表述已隐藏]同期放化疗，放疗技术采用调强放疗9野，处方剂量：PTVp 7029cGy/33F， PTVn_L 6600cGy/33F,PTVn_R 6000cGy/33F,PTV1 6000cGy/33F,PTV2 5400cGy/33F。目前放疗计划已完善，予以今日复位验证后执行放疗。\n- [全程D40] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者精神食欲可，放疗2次，无特殊不适，查体无特殊。今日按[计划性表述已隐藏]第一程DDP同期化疗（顺铂 80mg/m2），若无特殊不适，今日化疗结束后予以出院。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，给予静脉保肝降酶药物，待转氨酶正常后重启放疗\nB. 继续调强放疗，定期监测血常规及肝肾功能，暂不予特殊药物干预\nC. 暂停放疗，经验性静脉滴注广谱抗生素，待中性粒细胞正常后重启放疗\nD. 继续调强放疗，皮下注射重组人粒细胞集落刺激因子\nE. 暂停放疗，给予大剂量静脉水化及利尿治疗\nF. 继续调强放疗，计划在下一周期将顺铂剂量下调20%\nG. 暂停放疗，完善血培养及降钙素原检查\nH. 继续调强放疗，静脉滴注大剂量糖皮质激素\nI. 暂停放疗，给予静脉输注人血白蛋白及肠外营养支持\nJ. 继续调强放疗，计划将下一周期同期化疗药物替换为卡铂\nK. 暂停放疗，复查鼻咽及颈部增强MRI\nL. 继续调强放疗，取消后续同期化疗周期\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、头长肌。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D44] 检验组合: 平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；单核细胞百分比(Mono%)-静脉血: 0.084；载脂蛋白B(apoB)-静脉血: 1.02g/L；磷(P)-静脉血: 1.54mmol/L；钠离子(Na+)-静脉血: 137mmol/L；白蛋白(ALB)-静脉血: 41.2g/L；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 38.1U/L；总胆固醇(TC)-静脉血: 5.9mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；中性粒细胞百分比(Neut%)-静脉血: 0.789；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.65mmol/L；间接胆红素(IBIL)-静脉血: 5.6umolL；尿素氮(BUN)-静脉血: 7.73mmol/L；总胆红素(TBIL)-静脉血: 7.4umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.4mmol/L；C-反应蛋白(CRP)-静脉血: 9.62mg/L；血小板比容-静脉血: 27%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；大血小板百分比(P-LCR%)-静脉血: 26.8%；α-L-岩藻糖苷酶(AFU)-静脉血: 35U/L；钾离子(K+)-静脉血: 4.2mmol/L；直接胆红素(DBIL)-静脉血: 1.8umol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.6；尿酸(UA)-静脉血: 288.4umol/L；碱性磷酸酶(ALP)-静脉血: 138.4U/L；中性粒细胞计数(Neut#)-静脉血: 11.910E9/L；总钙(Ca)-静脉血: 2.25mmol/L；肌酐(Crea)-静脉血: 84umol/L；总胆汁酸(TBA)-静脉血: 4.1umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.24；球蛋白(GLO)-静脉血: 33.12g/L；氯离子(Cl-)-静脉血: 97.5mmol/L；甘油三酯(TG)-静脉血: 2.9mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；丙氨酸氨基转移酶(ALT)-静脉血:……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D39] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者一般情况可，未诉特殊不适。按[计划性表述已隐藏]同期放化疗，放疗技术采用调强放疗9野，处方剂量：PTVp 7029cGy/33F， PTVn_L 6600cGy/33F,PTVn_R 6000cGy/33F,PTV1 6000cGy/33F,PTV2 5400cGy/33F。目前放疗计划已完善，予以今日复位验证后执行放疗。\n- [全程D40] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者精神食欲可，放疗2次，无特殊不适，查体无特殊。今日按[计划性表述已隐藏]第一程DDP同期化疗（顺铂 80mg/m2），若无特殊不适，今日化疗结束后予以出院。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，给予静脉保肝降酶药物，待转氨酶正常后重启放疗\nB. 继续调强放疗，定期监测血常规及肝肾功能，暂不予特殊药物干预\nC. 暂停放疗，经验性静脉滴注广谱抗生素，待中性粒细胞正常后重启放疗\nD. 继续调强放疗，皮下注射重组人粒细胞集落刺激因子\nE. 暂停放疗，给予大剂量静脉水化及利尿治疗\nF. 继续调强放疗，计划在下一周期将顺铂剂量下调20%\nG. 暂停放疗，完善血培养及降钙素原检查\nH. 继续调强放疗，静脉滴注大剂量糖皮质激素\nI. 暂停放疗，给予静脉输注人血白蛋白及肠外营养支持\nJ. 继续调强放疗，计划将下一周期同期化疗药物替换为卡铂\nK. 暂停放疗，复查鼻咽及颈部增强MRI\nL. 继续调强放疗，取消后续同期化疗周期\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-192932039e740110f5fb9ae6","patient_id":"patient-4e3ac84b9e1451cea981f98e","turn_id":"turn06","turn_position":5,"turn_type":"toxicity_or_support_decision","gold_letter":"C","gold_action":"继续按计划执行调强放疗，定期复查血常规及肝肾功能","options":[{"letter":"A","text":"暂停放疗，给予重组人粒细胞刺激因子皮下注射","is_gold":false},{"letter":"B","text":"继续放疗，给予重组人血小板生成素皮下注射","is_gold":false},{"letter":"C","text":"继续按计划执行调强放疗，定期复查血常规及肝肾功能","is_gold":true},{"letter":"D","text":"暂停放疗，给予静脉保肝降酶治疗并密切监测","is_gold":false},{"letter":"E","text":"继续放疗，立即启动第二周期顺铂同期化疗","is_gold":false},{"letter":"F","text":"继续放疗，将第二周期顺铂同期化疗剂量下调20%","is_gold":false},{"letter":"G","text":"继续放疗，将第二周期同期化疗药物更换为卡铂","is_gold":false},{"letter":"H","text":"暂停放疗，完善鼻咽及颈部MRI评估近期疗效","is_gold":false},{"letter":"I","text":"继续放疗，给予大剂量静脉水化及利尿促排治疗","is_gold":false},{"letter":"J","text":"继续放疗，联合尼妥珠单抗靶向治疗以增强疗效","is_gold":false},{"letter":"K","text":"继续放疗，给予促红细胞生成素皮下注射纠正贫血","is_gold":false},{"letter":"L","text":"终止放疗，转为全身静脉化疗并评估后续方案","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、头长肌。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D37] 入院记录: 主诉: 回吸性涕血3月；现病史: 患者于某次就诊时间无明显诱因出现涕中带血，量少，色鲜红，呈间歇性，未引起重视。近2个月间歇性出现耳鸣，伴左颈肿物，遂就诊我院。患者无头痛、面麻、复视、听力下降等症状。左侧腭帆提肌、头长肌受侵，右侧腭帆提肌、双侧腭帆张肌及右侧头长肌未见受侵征象。颅底骨质未见破坏征象。右侧咽后淋巴结、左颈II区淋巴肿大。第3、7胸椎局部代谢活跃，建议随诊。胸部平片、腹部彩超未见明显异常。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,涕中带血,左颈肿物,淋巴肿大；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.8℃，P：18次/分，R: 76次/分，BP：116/68mmHg,Ht：165cm，Wt：56.5kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；双侧顶后壁，左侧隐窝可见结节状肿物，左颈II区可扪及肿大淋巴结，大小约10*15mm,质韧，无压痛，活动度可，与周围组织分界清楚。颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] 检验组合: 尿酸(UA)-静脉血: 316.2umol/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 5.28mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 7.2umol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；球蛋白(GLO)-静脉血: 32.53g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.54mmol/L；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；磷(P)-静脉血: 1.06mmol/L；总胆汁酸(TBA)-静脉血: 2.6umol/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；Rh血型-静脉血: 阳性；血红蛋白(Hb)-静脉血: 153g/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.94；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.93mg/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；血小板分布宽度(PDW)-静脉血: 11.2%；血小板计数(PLT#)-静脉血: 29810E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；白蛋白(ALB)-静脉血: 48g/L；直接胆红素(DBIL)-静脉血: 1.8umol/L；活化部分凝血活酶时间(APTT)-静脉血: 24.9sec.；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；钠离子(Na+)-静脉血: 139.1mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.39；尿素氮(BUN)-静脉血: 5.9mmol/L；钾离子(K+)-静脉血: 4.04mmol/L；C-反应蛋白(CRP)-静脉血: 9.58mg/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22.5U/L；纤维蛋白原(Fbg)-静脉血: 4.77g/L；凝血酶原时间活动度(PTA)-静脉血: 125.5%；淋巴细胞……\n- [全程D18] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- [全程D18] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约25cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约45×26×26mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D19] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显斑片或结节影。双侧肺门影未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见病变。\n- [全程D20] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 第3、7胸椎及右股骨上段见片状放射性浓聚影。颅骨、胸骨、锁骨、肩胛骨、肋骨、颈椎、腰椎、骶尾骨、髋骨及上肢骨骼放射性分布未见明显异常。；检查结论: 右股骨上段局部代谢活跃，疑良性病变，缺血性坏死待排。 第3、7胸椎局部代谢活跃，建议随诊。\n- [全程D20] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁及左侧壁明显增厚，见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。左侧咽隐窝见肿物占据，右侧咽隐窝存在。左侧腭帆提肌、头长肌受侵，右侧腭帆提肌、双侧腭帆张肌及右侧头长肌未见受侵征象。病灶堵塞左侧后鼻孔。 双侧翼腭窝、双侧颞下窝未见异常；口咽未见异常。 颅底骨质未见破坏征象。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦粘膜未见增厚，双侧乳突充气良好，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 左侧咽后间隙见肿大淋巴结，大小约11mm×14mm；右侧咽后间隙见淋巴结，边界欠清，较大者短径约5mm。 左颈II区见数个淋巴结，部分信号不均匀，较大者大小约10mm×13mm，不均匀强化。颈部双侧Ⅰ、ⅡI区见小淋巴结，边界清，较大者短径约5mm，孤立散在。 甲状腺未见异常信号灶。喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 扫描范围颈椎未见明确骨质破坏。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质未见破坏征象。 左侧咽后淋巴结，考虑转移。右侧咽后淋巴结，考虑转移可能性大。 左颈II区淋巴结，考虑转移可能性大。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D23] 检验组合: 天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.75；乳酸脱氢酶(LDH)-静脉血: 285.9U/L；总胆汁酸(TBA)-静脉血: 12.7umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 220U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 20.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 249.9U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 165.4U/L；碱性磷酸酶(ALP)-静脉血: 161.1U/L\n- [全程D37] 检验组合: 甲状腺球蛋白(TG)-静脉血: 13.08ng/ml；平均血小板体积(MPV)-静脉血: 9.9fL；α-L-岩藻糖苷酶(AFU)-静脉血: 21.1U/L；促卵泡刺激素(FSH)-静脉血: 6.26mIU/ml；血小板比容-静脉血: 29%；血小板分布宽度(PDW)-静脉血: 11.3%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.2；催乳素(PRL)-静脉血: 277.6uIU/ml；大血小板百分比(P-LCR%)-静脉血: 23.9%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；促黄体生成素(LH)-静脉血: 9.22mIU/ml；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；血小板计数(PLT#)-静脉血: 29710E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.262；γ-谷氨酰基转移酶(GGT)-静脉血: 227.5U/L；生长激素(GH)-静脉血: 0.54ng/ml；碱性磷酸酶(ALP)-静脉血: 164.9U/L；乳酸脱氢酶(LDH)-静脉血: 170.2U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 38.5；平均红细胞体积(MCV)-静脉血: 94fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；血红蛋白(Hb)-静脉血: 140g/L；中性粒细胞计数(Neut#)-静脉血: 4.410E9/L；促甲状腺激素(TSH)-静脉血: 4.45uIU/ml；有核红细胞计数(NRBC#)-静脉血: 010E9/L；单核细胞百分比(Mono%)-静脉血: 0.105；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.619；红细胞计数(RBC#)-静脉血: 4.5110E12/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；红细胞比容(Hct)-静脉血: 42.4%；总胆汁酸(TBA)-静脉血: 2umol/L；甲状腺过氧化物酶抗体(TPO-Ab)-静脉血: 14.45U/ml；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.58；丙氨酸氨基转移酶(ALT)-静脉血:……\n- [全程D44] 检验组合: 平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；单核细胞百分比(Mono%)-静脉血: 0.084；载脂蛋白B(apoB)-静脉血: 1.02g/L；磷(P)-静脉血: 1.54mmol/L；钠离子(Na+)-静脉血: 137mmol/L；白蛋白(ALB)-静脉血: 41.2g/L；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 38.1U/L；总胆固醇(TC)-静脉血: 5.9mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；中性粒细胞百分比(Neut%)-静脉血: 0.789；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.65mmol/L；间接胆红素(IBIL)-静脉血: 5.6umolL；尿素氮(BUN)-静脉血: 7.73mmol/L；总胆红素(TBIL)-静脉血: 7.4umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.4mmol/L；C-反应蛋白(CRP)-静脉血: 9.62mg/L；血小板比容-静脉血: 27%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；大血小板百分比(P-LCR%)-静脉血: 26.8%；α-L-岩藻糖苷酶(AFU)-静脉血: 35U/L；钾离子(K+)-静脉血: 4.2mmol/L；直接胆红素(DBIL)-静脉血: 1.8umol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.6；尿酸(UA)-静脉血: 288.4umol/L；碱性磷酸酶(ALP)-静脉血: 138.4U/L；中性粒细胞计数(Neut#)-静脉血: 11.910E9/L；总钙(Ca)-静脉血: 2.25mmol/L；肌酐(Crea)-静脉血: 84umol/L；总胆汁酸(TBA)-静脉血: 4.1umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.24；球蛋白(GLO)-静脉血: 33.12g/L；氯离子(Cl-)-静脉血: 97.5mmol/L；甘油三酯(TG)-静脉血: 2.9mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；丙氨酸氨基转移酶(ALT)-静脉血:……\n- [全程D47] 检验组合: 血小板分布宽度(PDW)-静脉血: 13.9%；白细胞计数(WBC#)-静脉血: 6.3810E9/L；单核细胞计数(Mono#)-静脉血: 1.410E9/L；红细胞比容(Hct)-静脉血: 43.9%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 38.1；平均红细胞血红蛋白浓度(MCHC)-静脉血: 333g/L；血小板计数(PLT#)-静脉血: 26510E9/L；平均红细胞体积(MCV)-静脉血: 93.6fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；大血小板百分比(P-LCR%)-静脉血: 34.5%；血小板比容-静脉血: 30%；平均血小板体积(MPV)-静脉血: 11.2fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 146g/L；中性粒细胞百分比(Neut%)-静脉血: 0.569；单核细胞百分比(Mono%)-静脉血: 0.216；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；红细胞计数(RBC#)-静脉血: 4.6910E12/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；中性粒细胞计数(Neut#)-静脉血: 3.610E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.205；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.5；平均红细胞血红蛋白含量(MCH)-静脉血: 31.1pg\n- [全程D54] 检验组合: 直接胆红素(DBIL)-静脉血: 1.3umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 337g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.173；血小板计数(PLT#)-静脉血: 14810E9/L；碱性磷酸酶(ALP)-静脉血: 120.1U/L；氯离子(Cl-)-静脉血: 101.8mmol/L；总胆固醇(TC)-静脉血: 5.93mmol/L；钾离子(K+)-静脉血: 3.93mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 127.6U/L；有核红细胞百分比(NRBC%)-静脉血: 0；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.51；甘油三酯(TG)-静脉血: 2.02mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 38.4；单核细胞计数(Mono#)-静脉血: 0.710E9/L；平均血小板体积(MPV)-静脉血: 10.1fL；白细胞计数(WBC#)-静脉血: 5.910E9/L；钠离子(Na+)-静脉血: 140.2mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；中性粒细胞计数(Neut#)-静脉血: 4.110E9/L；红细胞比容(Hct)-静脉血: 40.7%；尿素氮(BUN)-静脉血: 3.9mmol/L；平均红细胞体积(MCV)-静脉血: 91.3fL；总胆红素(TBIL)-静脉血: 9.5umol/L；总胆汁酸(TBA)-静脉血: 6.5umol/L；C-反应蛋白(CRP)-静脉血: 5.08mg/L；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.7pg；总蛋白(TP)-静脉血: 72.34g/L；总钙(Ca)-静脉血: 2.35mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.6mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.2mmolL；载脂蛋白AI(apoAI)-静脉血: 1.36g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 36.9U/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.9；红细胞计数(RBC#)-静脉血: 4.4610E12/L；嗜碱性粒细胞百分比(Baso%)-静脉血……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D39] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者一般情况可，未诉特殊不适。按[计划性表述已隐藏]同期放化疗，放疗技术采用调强放疗9野，处方剂量：PTVp 7029cGy/33F， PTVn_L 6600cGy/33F,PTVn_R 6000cGy/33F,PTV1 6000cGy/33F,PTV2 5400cGy/33F。目前放疗计划已完善，予以今日复位验证后执行放疗。\n- [全程D40] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者精神食欲可，放疗2次，无特殊不适，查体无特殊。今日按[计划性表述已隐藏]第一程DDP同期化疗（顺铂 80mg/m2），若无特殊不适，今日化疗结束后予以出院。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，给予重组人粒细胞刺激因子皮下注射\nB. 继续放疗，给予重组人血小板生成素皮下注射\nC. 继续按计划执行调强放疗，定期复查血常规及肝肾功能\nD. 暂停放疗，给予静脉保肝降酶治疗并密切监测\nE. 继续放疗，立即启动第二周期顺铂同期化疗\nF. 继续放疗，将第二周期顺铂同期化疗剂量下调20%\nG. 继续放疗，将第二周期同期化疗药物更换为卡铂\nH. 暂停放疗，完善鼻咽及颈部MRI评估近期疗效\nI. 继续放疗，给予大剂量静脉水化及利尿促排治疗\nJ. 继续放疗，联合尼妥珠单抗靶向治疗以增强疗效\nK. 继续放疗，给予促红细胞生成素皮下注射纠正贫血\nL. 终止放疗，转为全身静脉化疗并评估后续方案\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D47] 检验组合: 血小板分布宽度(PDW)-静脉血: 13.9%；白细胞计数(WBC#)-静脉血: 6.3810E9/L；单核细胞计数(Mono#)-静脉血: 1.410E9/L；红细胞比容(Hct)-静脉血: 43.9%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 38.1；平均红细胞血红蛋白浓度(MCHC)-静脉血: 333g/L；血小板计数(PLT#)-静脉血: 26510E9/L；平均红细胞体积(MCV)-静脉血: 93.6fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；大血小板百分比(P-LCR%)-静脉血: 34.5%；血小板比容-静脉血: 30%；平均血小板体积(MPV)-静脉血: 11.2fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 146g/L；中性粒细胞百分比(Neut%)-静脉血: 0.569；单核细胞百分比(Mono%)-静脉血: 0.216；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；红细胞计数(RBC#)-静脉血: 4.6910E12/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；中性粒细胞计数(Neut#)-静脉血: 3.610E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.205；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.5；平均红细胞血红蛋白含量(MCH)-静脉血: 31.1pg\n- [全程D54] 检验组合: 直接胆红素(DBIL)-静脉血: 1.3umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 337g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.173；血小板计数(PLT#)-静脉血: 14810E9/L；碱性磷酸酶(ALP)-静脉血: 120.1U/L；氯离子(Cl-)-静脉血: 101.8mmol/L；总胆固醇(TC)-静脉血: 5.93mmol/L；钾离子(K+)-静脉血: 3.93mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 127.6U/L；有核红细胞百分比(NRBC%)-静脉血: 0；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.51；甘油三酯(TG)-静脉血: 2.02mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 38.4；单核细胞计数(Mono#)-静脉血: 0.710E9/L；平均血小板体积(MPV)-静脉血: 10.1fL；白细胞计数(WBC#)-静脉血: 5.910E9/L；钠离子(Na+)-静脉血: 140.2mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；中性粒细胞计数(Neut#)-静脉血: 4.110E9/L；红细胞比容(Hct)-静脉血: 40.7%；尿素氮(BUN)-静脉血: 3.9mmol/L；平均红细胞体积(MCV)-静脉血: 91.3fL；总胆红素(TBIL)-静脉血: 9.5umol/L；总胆汁酸(TBA)-静脉血: 6.5umol/L；C-反应蛋白(CRP)-静脉血: 5.08mg/L；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.7pg；总蛋白(TP)-静脉血: 72.34g/L；总钙(Ca)-静脉血: 2.35mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.6mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.2mmolL；载脂蛋白AI(apoAI)-静脉血: 1.36g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 36.9U/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.9；红细胞计数(RBC#)-静脉血: 4.4610E12/L；嗜碱性粒细胞百分比(Baso%)-静脉血……\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，给予重组人粒细胞刺激因子皮下注射\nB. 继续放疗，给予重组人血小板生成素皮下注射\nC. 继续按计划执行调强放疗，定期复查血常规及肝肾功能\nD. 暂停放疗，给予静脉保肝降酶治疗并密切监测\nE. 继续放疗，立即启动第二周期顺铂同期化疗\nF. 继续放疗，将第二周期顺铂同期化疗剂量下调20%\nG. 继续放疗，将第二周期同期化疗药物更换为卡铂\nH. 暂停放疗，完善鼻咽及颈部MRI评估近期疗效\nI. 继续放疗，给予大剂量静脉水化及利尿促排治疗\nJ. 继续放疗，联合尼妥珠单抗靶向治疗以增强疗效\nK. 继续放疗，给予促红细胞生成素皮下注射纠正贫血\nL. 终止放疗，转为全身静脉化疗并评估后续方案\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、头长肌。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D47] 检验组合: 血小板分布宽度(PDW)-静脉血: 13.9%；白细胞计数(WBC#)-静脉血: 6.3810E9/L；单核细胞计数(Mono#)-静脉血: 1.410E9/L；红细胞比容(Hct)-静脉血: 43.9%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 38.1；平均红细胞血红蛋白浓度(MCHC)-静脉血: 333g/L；血小板计数(PLT#)-静脉血: 26510E9/L；平均红细胞体积(MCV)-静脉血: 93.6fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；大血小板百分比(P-LCR%)-静脉血: 34.5%；血小板比容-静脉血: 30%；平均血小板体积(MPV)-静脉血: 11.2fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 146g/L；中性粒细胞百分比(Neut%)-静脉血: 0.569；单核细胞百分比(Mono%)-静脉血: 0.216；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；红细胞计数(RBC#)-静脉血: 4.6910E12/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；中性粒细胞计数(Neut#)-静脉血: 3.610E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.205；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.5；平均红细胞血红蛋白含量(MCH)-静脉血: 31.1pg\n- [全程D54] 检验组合: 直接胆红素(DBIL)-静脉血: 1.3umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 337g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.173；血小板计数(PLT#)-静脉血: 14810E9/L；碱性磷酸酶(ALP)-静脉血: 120.1U/L；氯离子(Cl-)-静脉血: 101.8mmol/L；总胆固醇(TC)-静脉血: 5.93mmol/L；钾离子(K+)-静脉血: 3.93mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 127.6U/L；有核红细胞百分比(NRBC%)-静脉血: 0；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.51；甘油三酯(TG)-静脉血: 2.02mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 38.4；单核细胞计数(Mono#)-静脉血: 0.710E9/L；平均血小板体积(MPV)-静脉血: 10.1fL；白细胞计数(WBC#)-静脉血: 5.910E9/L；钠离子(Na+)-静脉血: 140.2mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；中性粒细胞计数(Neut#)-静脉血: 4.110E9/L；红细胞比容(Hct)-静脉血: 40.7%；尿素氮(BUN)-静脉血: 3.9mmol/L；平均红细胞体积(MCV)-静脉血: 91.3fL；总胆红素(TBIL)-静脉血: 9.5umol/L；总胆汁酸(TBA)-静脉血: 6.5umol/L；C-反应蛋白(CRP)-静脉血: 5.08mg/L；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.7pg；总蛋白(TP)-静脉血: 72.34g/L；总钙(Ca)-静脉血: 2.35mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.6mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.2mmolL；载脂蛋白AI(apoAI)-静脉血: 1.36g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 36.9U/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.9；红细胞计数(RBC#)-静脉血: 4.4610E12/L；嗜碱性粒细胞百分比(Baso%)-静脉血……\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，给予重组人粒细胞刺激因子皮下注射\nB. 继续放疗，给予重组人血小板生成素皮下注射\nC. 继续按计划执行调强放疗，定期复查血常规及肝肾功能\nD. 暂停放疗，给予静脉保肝降酶治疗并密切监测\nE. 继续放疗，立即启动第二周期顺铂同期化疗\nF. 继续放疗，将第二周期顺铂同期化疗剂量下调20%\nG. 继续放疗，将第二周期同期化疗药物更换为卡铂\nH. 暂停放疗，完善鼻咽及颈部MRI评估近期疗效\nI. 继续放疗，给予大剂量静脉水化及利尿促排治疗\nJ. 继续放疗，联合尼妥珠单抗靶向治疗以增强疗效\nK. 继续放疗，给予促红细胞生成素皮下注射纠正贫血\nL. 终止放疗，转为全身静脉化疗并评估后续方案\n\n请仅输出一个选项字母（A-L）。"}]}
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多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 回吸性涕血1月余。；现病史: 缘于1月前患者无意中出现抽吸性血涕，痰中带血；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻咽角化,涕血,痰中带血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：78次/分，R：20次/分，BP：125/80mmHg,Ht：162cm，Wt：61kg，BSA：1.6483m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善鼻咽及颈部CT平扫+增强、胸腹部CT、全身骨扫描、电子鼻咽镜检查及活检。\nB. 完善鼻咽及颈部MRI平扫+增强、胸腹部CT、全身骨扫描、电子鼻咽镜检查及活检。\nC. 完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像、电子鼻咽镜检查及活检。\nD. 完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像、电子鼻咽镜检查及病理会诊。\nE. 完善鼻咽及颈部MRI平扫+增强、胸腹部CT、全身骨扫描、电子鼻咽镜检查及病理会诊。\nF. 完善鼻咽及颈部CT平扫+增强、PET/CT全身显像、电子鼻咽镜检查及病理会诊。\nG. 完善鼻咽MRI平扫+增强、颈部超声、PET/CT全身显像、电子鼻咽镜检查及病理会诊。\nH. 完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像、直接安排诱导化疗。\nI. 完善鼻咽及颈部MRI平扫+增强、胸腹部CT、全身骨扫描、直接安排根治性放疗。\nJ. 完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像、鼻内镜下鼻咽肿物切除术。\nK. 完善鼻咽及颈部CT平扫+增强、胸腹部CT、全身骨扫描、电子鼻咽镜检查及病理会诊。\nL. 完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像、EBV-DNA检测、暂缓病理确诊。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 回吸性涕血1月余。；现病史: 缘于1月前患者无意中出现抽吸性血涕，痰中带血；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻咽角化,涕血,痰中带血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：78次/分，R：20次/分，BP：125/80mmHg,Ht：162cm，Wt：61kg，BSA：1.6483m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善鼻咽及颈部CT平扫+增强、胸腹部CT、全身骨扫描、电子鼻咽镜检查及活检。\nB. 完善鼻咽及颈部MRI平扫+增强、胸腹部CT、全身骨扫描、电子鼻咽镜检查及活检。\nC. 完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像、电子鼻咽镜检查及活检。\nD. 完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像、电子鼻咽镜检查及病理会诊。\nE. 完善鼻咽及颈部MRI平扫+增强、胸腹部CT、全身骨扫描、电子鼻咽镜检查及病理会诊。\nF. 完善鼻咽及颈部CT平扫+增强、PET/CT全身显像、电子鼻咽镜检查及病理会诊。\nG. 完善鼻咽MRI平扫+增强、颈部超声、PET/CT全身显像、电子鼻咽镜检查及病理会诊。\nH. 完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像、直接安排诱导化疗。\nI. 完善鼻咽及颈部MRI平扫+增强、胸腹部CT、全身骨扫描、直接安排根治性放疗。\nJ. 完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像、鼻内镜下鼻咽肿物切除术。\nK. 完善鼻咽及颈部CT平扫+增强、胸腹部CT、全身骨扫描、电子鼻咽镜检查及病理会诊。\nL. 完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像、EBV-DNA检测、暂缓病理确诊。\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-bc7a956bb6d6b0bc48992292","patient_id":"patient-e5fcd31b4b8b85194b146991","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"E","gold_action":"安排电子鼻咽镜及鼻咽肿物活检，并完善胸腹部CT及骨扫描（或PET-CT）","options":[{"letter":"A","text":"安排颈部淋巴结切除活检，并完善全身PET-CT检查","is_gold":false},{"letter":"B","text":"安排鼻咽镜下活检，并完善头颅CT检查","is_gold":false},{"letter":"C","text":"安排颈部淋巴结细针穿刺活检，并完善胸腹部CT及骨扫描","is_gold":false},{"letter":"D","text":"安排鼻咽镜下活检，并完善EBV-DNA定量检测，暂缓全身影像学检查","is_gold":false},{"letter":"E","text":"安排电子鼻咽镜及鼻咽肿物活检，并完善胸腹部CT及骨扫描（或PET-CT）","is_gold":true},{"letter":"F","text":"安排鼻咽肿物及颈部淋巴结双重活检，并完善胸腹部MRI检查","is_gold":false},{"letter":"G","text":"安排鼻咽镜下活检，并完善颈部超声检查","is_gold":false},{"letter":"H","text":"安排全身PET-CT检查，并直接开始根治性放化疗","is_gold":false},{"letter":"I","text":"安排电子鼻咽镜检查，并直接进入放疗定位阶段","is_gold":false},{"letter":"J","text":"安排鼻咽镜下活检，并直接开始根治性放疗","is_gold":false},{"letter":"K","text":"安排鼻咽肿物活检，并直接进入诱导化疗阶段","is_gold":false},{"letter":"L","text":"安排鼻咽镜下活检，并完善全身骨髓穿刺检查","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 回吸性涕血1月余。；现病史: 缘于1月前患者无意中出现抽吸性血涕，痰中带血；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻咽角化,涕血,痰中带血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：78次/分，R：20次/分，BP：125/80mmHg,Ht：162cm，Wt：61kg，BSA：1.6483m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 胱抑素(Cys-C)-静脉血: 0.77mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.69mmol/L；阴离子间隙(AG)-静脉血: 13；磷(P)-静脉血: 0.92mmol/L；总胆红素(TBIL)-静脉血: 12.4umol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；肌酐(Crea)-静脉血: 80.5umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.58；Rh血型-静脉血: 阳性；总钙(Ca)-静脉血: 2.44mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；血小板计数(PLT#)-静脉血: 21910E9/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 4.81mmol/L；直接胆红素(DBIL)-静脉血: 4.2umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.64mmolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.013；载脂蛋白B(apoB)-静脉血: 0.73g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.3pg；α-L-岩藻糖苷酶(AFU)-静脉血: 24U/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 8.2umolL；白蛋白(ALB)-静脉血: 45.8g/L；血小板比容-静脉血: 21%；ABO血型-静脉血: O；尿素氮(BUN)-静脉血: 3.6mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；凝血酶时间(TT)-静脉血: 20.2sec.；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；载脂蛋白AI(apoAI)-静脉血: 1.33g/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；C-反应蛋白(CRP)-静脉血: 0.36mg/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血:……\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔稍狭窄，鼻咽左侧壁明显增厚，左侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。肿物侵犯左侧腭帆张提肌，左侧咽旁脂肪间隙变窄。鼻咽顶后壁稍增厚，右侧壁未见明显增厚，右侧咽隐窝清晰。 右侧腭帆张提肌、双侧头长肌、翼内外肌未见明显异常。 双侧翼腭窝、上颌后脂肪间隙、咀嚼肌间隙未见异常。 口咽各壁未见增厚。鼻腔内未见肿物。 蝶骨基底部、左侧翼突基底部及内侧板骨质信号降低，增强扫描可见强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦粘膜稍增厚，双侧乳突未见明显异常。 左侧咽后见几个淋巴结，最大者约8mm×5mm，边界欠清，明显强化。双颈II区见多个淋巴结，最大者约16mm×8mm，边界尚清，较均匀明显强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽左侧壁增厚，左侧咽隐窝肿物，考虑鼻咽癌。 颅底骨质破坏。 左侧咽后、双颈II区淋巴结，可疑转移。 轻度鼻窦炎。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 安排颈部淋巴结切除活检，并完善全身PET-CT检查\nB. 安排鼻咽镜下活检，并完善头颅CT检查\nC. 安排颈部淋巴结细针穿刺活检，并完善胸腹部CT及骨扫描\nD. 安排鼻咽镜下活检，并完善EBV-DNA定量检测，暂缓全身影像学检查\nE. 安排电子鼻咽镜及鼻咽肿物活检，并完善胸腹部CT及骨扫描（或PET-CT）\nF. 安排鼻咽肿物及颈部淋巴结双重活检，并完善胸腹部MRI检查\nG. 安排鼻咽镜下活检，并完善颈部超声检查\nH. 安排全身PET-CT检查，并直接开始根治性放化疗\nI. 安排电子鼻咽镜检查，并直接进入放疗定位阶段\nJ. 安排鼻咽镜下活检，并直接开始根治性放疗\nK. 安排鼻咽肿物活检，并直接进入诱导化疗阶段\nL. 安排鼻咽镜下活检，并完善全身骨髓穿刺检查\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 胱抑素(Cys-C)-静脉血: 0.77mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.69mmol/L；阴离子间隙(AG)-静脉血: 13；磷(P)-静脉血: 0.92mmol/L；总胆红素(TBIL)-静脉血: 12.4umol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；肌酐(Crea)-静脉血: 80.5umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.58；Rh血型-静脉血: 阳性；总钙(Ca)-静脉血: 2.44mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；血小板计数(PLT#)-静脉血: 21910E9/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 4.81mmol/L；直接胆红素(DBIL)-静脉血: 4.2umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.64mmolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.013；载脂蛋白B(apoB)-静脉血: 0.73g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.3pg；α-L-岩藻糖苷酶(AFU)-静脉血: 24U/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 8.2umolL；白蛋白(ALB)-静脉血: 45.8g/L；血小板比容-静脉血: 21%；ABO血型-静脉血: O；尿素氮(BUN)-静脉血: 3.6mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；凝血酶时间(TT)-静脉血: 20.2sec.；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；载脂蛋白AI(apoAI)-静脉血: 1.33g/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；C-反应蛋白(CRP)-静脉血: 0.36mg/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血:……\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔稍狭窄，鼻咽左侧壁明显增厚，左侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。肿物侵犯左侧腭帆张提肌，左侧咽旁脂肪间隙变窄。鼻咽顶后壁稍增厚，右侧壁未见明显增厚，右侧咽隐窝清晰。 右侧腭帆张提肌、双侧头长肌、翼内外肌未见明显异常。 双侧翼腭窝、上颌后脂肪间隙、咀嚼肌间隙未见异常。 口咽各壁未见增厚。鼻腔内未见肿物。 蝶骨基底部、左侧翼突基底部及内侧板骨质信号降低，增强扫描可见强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦粘膜稍增厚，双侧乳突未见明显异常。 左侧咽后见几个淋巴结，最大者约8mm×5mm，边界欠清，明显强化。双颈II区见多个淋巴结，最大者约16mm×8mm，边界尚清，较均匀明显强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽左侧壁增厚，左侧咽隐窝肿物，考虑鼻咽癌。 颅底骨质破坏。 左侧咽后、双颈II区淋巴结，可疑转移。 轻度鼻窦炎。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 安排颈部淋巴结切除活检，并完善全身PET-CT检查\nB. 安排鼻咽镜下活检，并完善头颅CT检查\nC. 安排颈部淋巴结细针穿刺活检，并完善胸腹部CT及骨扫描\nD. 安排鼻咽镜下活检，并完善EBV-DNA定量检测，暂缓全身影像学检查\nE. 安排电子鼻咽镜及鼻咽肿物活检，并完善胸腹部CT及骨扫描（或PET-CT）\nF. 安排鼻咽肿物及颈部淋巴结双重活检，并完善胸腹部MRI检查\nG. 安排鼻咽镜下活检，并完善颈部超声检查\nH. 安排全身PET-CT检查，并直接开始根治性放化疗\nI. 安排电子鼻咽镜检查，并直接进入放疗定位阶段\nJ. 安排鼻咽镜下活检，并直接开始根治性放疗\nK. 安排鼻咽肿物活检，并直接进入诱导化疗阶段\nL. 安排鼻咽镜下活检，并完善全身骨髓穿刺检查\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 胱抑素(Cys-C)-静脉血: 0.77mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.69mmol/L；阴离子间隙(AG)-静脉血: 13；磷(P)-静脉血: 0.92mmol/L；总胆红素(TBIL)-静脉血: 12.4umol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；肌酐(Crea)-静脉血: 80.5umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.58；Rh血型-静脉血: 阳性；总钙(Ca)-静脉血: 2.44mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；血小板计数(PLT#)-静脉血: 21910E9/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 4.81mmol/L；直接胆红素(DBIL)-静脉血: 4.2umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.64mmolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.013；载脂蛋白B(apoB)-静脉血: 0.73g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.3pg；α-L-岩藻糖苷酶(AFU)-静脉血: 24U/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 8.2umolL；白蛋白(ALB)-静脉血: 45.8g/L；血小板比容-静脉血: 21%；ABO血型-静脉血: O；尿素氮(BUN)-静脉血: 3.6mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；凝血酶时间(TT)-静脉血: 20.2sec.；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；载脂蛋白AI(apoAI)-静脉血: 1.33g/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；C-反应蛋白(CRP)-静脉血: 0.36mg/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血:……\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔稍狭窄，鼻咽左侧壁明显增厚，左侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。肿物侵犯左侧腭帆张提肌，左侧咽旁脂肪间隙变窄。鼻咽顶后壁稍增厚，右侧壁未见明显增厚，右侧咽隐窝清晰。 右侧腭帆张提肌、双侧头长肌、翼内外肌未见明显异常。 双侧翼腭窝、上颌后脂肪间隙、咀嚼肌间隙未见异常。 口咽各壁未见增厚。鼻腔内未见肿物。 蝶骨基底部、左侧翼突基底部及内侧板骨质信号降低，增强扫描可见强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦粘膜稍增厚，双侧乳突未见明显异常。 左侧咽后见几个淋巴结，最大者约8mm×5mm，边界欠清，明显强化。双颈II区见多个淋巴结，最大者约16mm×8mm，边界尚清，较均匀明显强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽左侧壁增厚，左侧咽隐窝肿物，考虑鼻咽癌。 颅底骨质破坏。 左侧咽后、双颈II区淋巴结，可疑转移。 轻度鼻窦炎。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 安排颈部淋巴结切除活检，并完善全身PET-CT检查\nB. 安排鼻咽镜下活检，并完善头颅CT检查\nC. 安排颈部淋巴结细针穿刺活检，并完善胸腹部CT及骨扫描\nD. 安排鼻咽镜下活检，并完善EBV-DNA定量检测，暂缓全身影像学检查\nE. 安排电子鼻咽镜及鼻咽肿物活检，并完善胸腹部CT及骨扫描（或PET-CT）\nF. 安排鼻咽肿物及颈部淋巴结双重活检，并完善胸腹部MRI检查\nG. 安排鼻咽镜下活检，并完善颈部超声检查\nH. 安排全身PET-CT检查，并直接开始根治性放化疗\nI. 安排电子鼻咽镜检查，并直接进入放疗定位阶段\nJ. 安排鼻咽镜下活检，并直接开始根治性放疗\nK. 安排鼻咽肿物活检，并直接进入诱导化疗阶段\nL. 安排鼻咽镜下活检，并完善全身骨髓穿刺检查\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-49519c2b08d621c382f2a093","patient_id":"patient-e5fcd31b4b8b85194b146991","turn_id":"turn04","turn_position":3,"turn_type":"initial_treatment_selection","gold_letter":"G","gold_action":"诱导化疗（顺铂+氟尿嘧啶，PF方案）","options":[{"letter":"A","text":"根治性单纯放疗","is_gold":false},{"letter":"B","text":"诱导化疗（紫杉醇+卡铂）","is_gold":false},{"letter":"C","text":"诱导化疗（吉西他滨+奥沙利铂）","is_gold":false},{"letter":"D","text":"同期放化疗（顺铂）","is_gold":false},{"letter":"E","text":"诱导化疗（依托泊苷+顺铂）","is_gold":false},{"letter":"F","text":"诱导化疗（长春瑞滨+顺铂）","is_gold":false},{"letter":"G","text":"诱导化疗（顺铂+氟尿嘧啶）","is_gold":true},{"letter":"H","text":"靶向单药治疗（西妥昔单抗）","is_gold":false},{"letter":"I","text":"诱导化疗（多柔比星+环磷酰胺）","is_gold":false},{"letter":"J","text":"姑息性单药化疗（卡培他滨）","is_gold":false},{"letter":"K","text":"免疫单药治疗（帕博利珠单抗）","is_gold":false},{"letter":"L","text":"鼻咽及颈部淋巴结根治性切除术","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 回吸性涕血1月余。；现病史: 缘于1月前患者无意中出现抽吸性血涕，痰中带血；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻咽角化,涕血,痰中带血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：78次/分，R：20次/分，BP：125/80mmHg,Ht：162cm，Wt：61kg，BSA：1.6483m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 回吸性涕血1月余。；现病史: 缘于1月前患者无意中出现抽吸性血涕，痰中带血；无头痛、面麻，无视力下降、复视，无听力下降、耳鸣等不适，于当地乡镇医院予滴鼻治疗，具体药物不详，未见好转，遂于某次就诊时间往[地点已隐去]人民医院检查，某次就诊时间病理活检示：鼻咽未分化型角化性癌。某次就诊时间鼻咽MRI示：左侧鼻咽部占位病变，考虑鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻咽角化,涕血,痰中带血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：78次/分，R：20次/分，BP：125/80mmHg,Ht：162cm，Wt：61kg，BSA：1.6483m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率100次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 胱抑素(Cys-C)-静脉血: 0.77mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.69mmol/L；阴离子间隙(AG)-静脉血: 13；磷(P)-静脉血: 0.92mmol/L；总胆红素(TBIL)-静脉血: 12.4umol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；肌酐(Crea)-静脉血: 80.5umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.58；Rh血型-静脉血: 阳性；总钙(Ca)-静脉血: 2.44mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；血小板计数(PLT#)-静脉血: 21910E9/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 4.81mmol/L；直接胆红素(DBIL)-静脉血: 4.2umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.64mmolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.013；载脂蛋白B(apoB)-静脉血: 0.73g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.3pg；α-L-岩藻糖苷酶(AFU)-静脉血: 24U/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 8.2umolL；白蛋白(ALB)-静脉血: 45.8g/L；血小板比容-静脉血: 21%；ABO血型-静脉血: O；尿素氮(BUN)-静脉血: 3.6mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；凝血酶时间(TT)-静脉血: 20.2sec.；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；载脂蛋白AI(apoAI)-静脉血: 1.33g/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；C-反应蛋白(CRP)-静脉血: 0.36mg/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血:……\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔稍狭窄，鼻咽左侧壁明显增厚，左侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。肿物侵犯左侧腭帆张提肌，左侧咽旁脂肪间隙变窄。鼻咽顶后壁稍增厚，右侧壁未见明显增厚，右侧咽隐窝清晰。 右侧腭帆张提肌、双侧头长肌、翼内外肌未见明显异常。 双侧翼腭窝、上颌后脂肪间隙、咀嚼肌间隙未见异常。 口咽各壁未见增厚。鼻腔内未见肿物。 蝶骨基底部、左侧翼突基底部及内侧板骨质信号降低，增强扫描可见强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦粘膜稍增厚，双侧乳突未见明显异常。 左侧咽后见几个淋巴结，最大者约8mm×5mm，边界欠清，明显强化。双颈II区见多个淋巴结，最大者约16mm×8mm，边界尚清，较均匀明显强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽左侧壁增厚，左侧咽隐窝肿物，考虑鼻咽癌。 颅底骨质破坏。 左侧咽后、双颈II区淋巴结，可疑转移。 轻度鼻窦炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右侧约平T6椎体水平，估计导管末端位于上腔静脉上段内。；检查结论: PICC管位置如上所述。\n- [全程D13] 检验组合: 酸碱度(pH)-尿液: 5.5；粘液丝计数(MUCS#)-尿液: 11/μL；酮体(KET)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 1/μL；红细胞计数(RBC#)-尿液: 3/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: colorless；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；比重(SG)-尿液: 1.008\n- [全程D14] 检验组合: 总蛋白(TP)-尿液: +- 0.2g（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；红细胞计数(RBC#)-尿液: 1/μL；葡萄糖(Glu)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.02；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；粘液丝计数(MUCS#)-尿液: 4/μL；白细胞(LEU)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；胆红素(BIL)-尿液: -（参考: 阴性）\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 根治性单纯放疗\nB. 诱导化疗（紫杉醇+卡铂）\nC. 诱导化疗（吉西他滨+奥沙利铂）\nD. 同期放化疗（顺铂）\nE. 诱导化疗（依托泊苷+顺铂）\nF. 诱导化疗（长春瑞滨+顺铂）\nG. 诱导化疗（顺铂+氟尿嘧啶）\nH. 靶向单药治疗（西妥昔单抗）\nI. 诱导化疗（多柔比星+环磷酰胺）\nJ. 姑息性单药化疗（卡培他滨）\nK. 免疫单药治疗（帕博利珠单抗）\nL. 鼻咽及颈部淋巴结根治性切除术\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 回吸性涕血1月余。；现病史: 缘于1月前患者无意中出现抽吸性血涕，痰中带血；无头痛、面麻，无视力下降、复视，无听力下降、耳鸣等不适，于当地乡镇医院予滴鼻治疗，具体药物不详，未见好转，遂于某次就诊时间往[地点已隐去]人民医院检查，某次就诊时间病理活检示：鼻咽未分化型角化性癌。某次就诊时间鼻咽MRI示：左侧鼻咽部占位病变，考虑鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻咽角化,涕血,痰中带血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：78次/分，R：20次/分，BP：125/80mmHg,Ht：162cm，Wt：61kg，BSA：1.6483m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率100次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右侧约平T6椎体水平，估计导管末端位于上腔静脉上段内。；检查结论: PICC管位置如上所述。\n- [全程D13] 检验组合: 酸碱度(pH)-尿液: 5.5；粘液丝计数(MUCS#)-尿液: 11/μL；酮体(KET)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 1/μL；红细胞计数(RBC#)-尿液: 3/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: colorless；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；比重(SG)-尿液: 1.008\n- [全程D14] 检验组合: 总蛋白(TP)-尿液: +- 0.2g（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；红细胞计数(RBC#)-尿液: 1/μL；葡萄糖(Glu)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.02；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；粘液丝计数(MUCS#)-尿液: 4/μL；白细胞(LEU)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；胆红素(BIL)-尿液: -（参考: 阴性）\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 根治性单纯放疗\nB. 诱导化疗（紫杉醇+卡铂）\nC. 诱导化疗（吉西他滨+奥沙利铂）\nD. 同期放化疗（顺铂）\nE. 诱导化疗（依托泊苷+顺铂）\nF. 诱导化疗（长春瑞滨+顺铂）\nG. 诱导化疗（顺铂+氟尿嘧啶）\nH. 靶向单药治疗（西妥昔单抗）\nI. 诱导化疗（多柔比星+环磷酰胺）\nJ. 姑息性单药化疗（卡培他滨）\nK. 免疫单药治疗（帕博利珠单抗）\nL. 鼻咽及颈部淋巴结根治性切除术\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 回吸性涕血1月余。；现病史: 缘于1月前患者无意中出现抽吸性血涕，痰中带血；无头痛、面麻，无视力下降、复视，无听力下降、耳鸣等不适，于当地乡镇医院予滴鼻治疗，具体药物不详，未见好转，遂于某次就诊时间往[地点已隐去]人民医院检查，某次就诊时间病理活检示：鼻咽未分化型角化性癌。某次就诊时间鼻咽MRI示：左侧鼻咽部占位病变，考虑鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻咽角化,涕血,痰中带血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：78次/分，R：20次/分，BP：125/80mmHg,Ht：162cm，Wt：61kg，BSA：1.6483m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率100次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右侧约平T6椎体水平，估计导管末端位于上腔静脉上段内。；检查结论: PICC管位置如上所述。\n- [全程D13] 检验组合: 酸碱度(pH)-尿液: 5.5；粘液丝计数(MUCS#)-尿液: 11/μL；酮体(KET)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 1/μL；红细胞计数(RBC#)-尿液: 3/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: colorless；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；比重(SG)-尿液: 1.008\n- [全程D14] 检验组合: 总蛋白(TP)-尿液: +- 0.2g（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；红细胞计数(RBC#)-尿液: 1/μL；葡萄糖(Glu)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.02；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；粘液丝计数(MUCS#)-尿液: 4/μL；白细胞(LEU)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；胆红素(BIL)-尿液: -（参考: 阴性）\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 根治性单纯放疗\nB. 诱导化疗（紫杉醇+卡铂）\nC. 诱导化疗（吉西他滨+奥沙利铂）\nD. 同期放化疗（顺铂）\nE. 诱导化疗（依托泊苷+顺铂）\nF. 诱导化疗（长春瑞滨+顺铂）\nG. 诱导化疗（顺铂+氟尿嘧啶）\nH. 靶向单药治疗（西妥昔单抗）\nI. 诱导化疗（多柔比星+环磷酰胺）\nJ. 姑息性单药化疗（卡培他滨）\nK. 免疫单药治疗（帕博利珠单抗）\nL. 鼻咽及颈部淋巴结根治性切除术\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-ba0bc8aff143756f9ee645b5","patient_id":"patient-e5fcd31b4b8b85194b146991","turn_id":"turn05","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"H","gold_action":"办理出院，予以帕洛诺司琼等止吐处理，嘱出院后每周复查血常规及肝肾功能，按计划返院行下一程化疗。","options":[{"letter":"A","text":"办理出院，无需特殊用药，嘱出院后每2周复查血常规及肝肾功能，按计划返院行下一程诱导化疗。","is_gold":false},{"letter":"B","text":"暂缓出院，予以静脉营养支持及强效止吐治疗，待恶心症状完全缓解后出院，按计划返院行下一程化疗。","is_gold":false},{"letter":"C","text":"办理出院，予以止吐处理并预防性给予长效G-CSF支持，嘱出院后每周复查血常规，按计划返院行下一程化疗。","is_gold":false},{"letter":"D","text":"办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，下一程化疗方案需减量20%并延迟1周进行。","is_gold":false},{"letter":"E","text":"暂缓出院，予以保肝降酶及护胃治疗，待复查肝功能及消化道症状好转后出院，按计划返院行下一程化疗。","is_gold":false},{"letter":"F","text":"办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，下一阶段直接转入同期放化疗。","is_gold":false},{"letter":"G","text":"办理出院，予以止吐处理，嘱出院后每3天复查肾功能及电解质，按计划返院行下一程诱导化疗。","is_gold":false},{"letter":"H","text":"办理出院，予以帕洛诺司琼等止吐处理，嘱出院后每周复查血常规及肝肾功能，按计划返院行下一程化疗。","is_gold":true},{"letter":"I","text":"暂缓出院，予以静脉补液及纠正电解质紊乱治疗，复查生化指标正常后出院，按计划返院行下一程化疗。","is_gold":false},{"letter":"J","text":"办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，下一程化疗更改为单药方案以减轻反应。","is_gold":false},{"letter":"K","text":"办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，按计划返院行靶向治疗联合放疗。","is_gold":false},{"letter":"L","text":"暂缓出院，予以质子泵抑制剂静脉滴注预防应激性溃疡，观察3天后出院，按计划返院行下一程化疗。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 回吸性涕血1月余。；现病史: 缘于1月前患者无意中出现抽吸性血涕，痰中带血；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻咽角化,涕血,痰中带血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：78次/分，R：20次/分，BP：125/80mmHg,Ht：162cm，Wt：61kg，BSA：1.6483m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 回吸性涕血1月余。；现病史: 缘于1月前患者无意中出现抽吸性血涕，痰中带血；无头痛、面麻，无视力下降、复视，无听力下降、耳鸣等不适，于当地乡镇医院予滴鼻治疗，具体药物不详，未见好转，遂于某次就诊时间往[地点已隐去]人民医院检查，某次就诊时间病理活检示：鼻咽未分化型角化性癌。某次就诊时间鼻咽MRI示：左侧鼻咽部占位病变，考虑鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻咽角化,涕血,痰中带血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：78次/分，R：20次/分，BP：125/80mmHg,Ht：162cm，Wt：61kg，BSA：1.6483m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率100次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 胱抑素(Cys-C)-静脉血: 0.77mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.69mmol/L；阴离子间隙(AG)-静脉血: 13；磷(P)-静脉血: 0.92mmol/L；总胆红素(TBIL)-静脉血: 12.4umol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；肌酐(Crea)-静脉血: 80.5umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.58；Rh血型-静脉血: 阳性；总钙(Ca)-静脉血: 2.44mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；血小板计数(PLT#)-静脉血: 21910E9/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 4.81mmol/L；直接胆红素(DBIL)-静脉血: 4.2umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.64mmolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.013；载脂蛋白B(apoB)-静脉血: 0.73g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.3pg；α-L-岩藻糖苷酶(AFU)-静脉血: 24U/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 8.2umolL；白蛋白(ALB)-静脉血: 45.8g/L；血小板比容-静脉血: 21%；ABO血型-静脉血: O；尿素氮(BUN)-静脉血: 3.6mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；凝血酶时间(TT)-静脉血: 20.2sec.；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；载脂蛋白AI(apoAI)-静脉血: 1.33g/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；C-反应蛋白(CRP)-静脉血: 0.36mg/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血:……\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔稍狭窄，鼻咽左侧壁明显增厚，左侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。肿物侵犯左侧腭帆张提肌，左侧咽旁脂肪间隙变窄。鼻咽顶后壁稍增厚，右侧壁未见明显增厚，右侧咽隐窝清晰。 右侧腭帆张提肌、双侧头长肌、翼内外肌未见明显异常。 双侧翼腭窝、上颌后脂肪间隙、咀嚼肌间隙未见异常。 口咽各壁未见增厚。鼻腔内未见肿物。 蝶骨基底部、左侧翼突基底部及内侧板骨质信号降低，增强扫描可见强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦粘膜稍增厚，双侧乳突未见明显异常。 左侧咽后见几个淋巴结，最大者约8mm×5mm，边界欠清，明显强化。双颈II区见多个淋巴结，最大者约16mm×8mm，边界尚清，较均匀明显强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽左侧壁增厚，左侧咽隐窝肿物，考虑鼻咽癌。 颅底骨质破坏。 左侧咽后、双颈II区淋巴结，可疑转移。 轻度鼻窦炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右侧约平T6椎体水平，估计导管末端位于上腔静脉上段内。；检查结论: PICC管位置如上所述。\n- [全程D13] 检验组合: 酸碱度(pH)-尿液: 5.5；粘液丝计数(MUCS#)-尿液: 11/μL；酮体(KET)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 1/μL；红细胞计数(RBC#)-尿液: 3/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: colorless；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；比重(SG)-尿液: 1.008\n- [全程D14] 检验组合: 总蛋白(TP)-尿液: +- 0.2g（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；红细胞计数(RBC#)-尿液: 1/μL；葡萄糖(Glu)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.02；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；粘液丝计数(MUCS#)-尿液: 4/μL；白细胞(LEU)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D15] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 11/μL；酮体(KET)-尿液: -（参考: 阴性）；酵母菌(YEAST)-尿液: 1/μL；白细胞(LEU)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 1/μL；比重(SG)-尿液: 1.019；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 7/μL；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；酸碱度(pH)-尿液: 6.5；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D19] 检验组合: 氯离子(Cl-)-静脉血: 96.7mmol/L；总蛋白(TP)-静脉血: 73.8g/L；甘油三酯(TG)-静脉血: 1mmol/L；血小板计数(PLT#)-静脉血: 18410E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.2；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.27；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.44mmolL；球蛋白(GLO)-静脉血: 27.4g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；丙氨酸氨基转移酶(ALT)-静脉血: 16.1U/L；总钙(Ca)-静脉血: 2.31mmol/L；血小板比容-静脉血: 18%；血红蛋白(Hb)-静脉血: 144g/L；血液二氧化碳含量ctCO2(B)-静脉血: 26.5mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 356g/L；胱抑素(Cys-C)-静脉血: 0.75mg/L；γ-谷氨酰基转移酶(GGT)-静脉血: 18.1U/L；红细胞计数(RBC#)-静脉血: 4.5310E12/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.1；淋巴细胞百分比(Lymph%)-静脉血: 0.277；平均红细胞血红蛋白含量(MCH)-静脉血: 31.8pg；尿酸(UA)-静脉血: 231.9umol/L；乳酸脱氢酶(LDH)-静脉血: 158.8U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；载脂蛋白B(apoB)-静脉血: 0.78g/L；中性粒细胞百分比(Neut%)-静脉血: 0.597；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；血小板分布宽度(PDW)-静脉血: 10.5%；间接胆红素(IBIL)-静脉血: 11.1umolL；单核细胞百分比(Mono%)-静脉血: 0.101；天门冬氨酸氨基转移酶(AST)-静脉血: 20.5U/L；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L；白细胞计数(WBC#)-静脉血: 4.8310E9/L；镁离子(Mg2+)-静脉血: 0.93mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.36g/L；总胆红素(TBIL)-静脉血: 16.1umol/……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D17] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者第一程诱导化疗后，诉轻度恶心呕吐，精神睡眠尚可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。钱医生信息已隐藏：患者03-02开始予5-Fu6.6g,DDP130mg化疗，患者未诉特殊不适，注意观察不良反应。\n- [全程D19] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者化疗后，诉轻度恶心，精神睡眠尚可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。医生信息已隐藏：患者第一程诱导化疗顺利，一般情况可，予出院。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 办理出院，无需特殊用药，嘱出院后每2周复查血常规及肝肾功能，按计划返院行下一程诱导化疗。\nB. 暂缓出院，予以静脉营养支持及强效止吐治疗，待恶心症状完全缓解后出院，按计划返院行下一程化疗。\nC. 办理出院，予以止吐处理并预防性给予长效G-CSF支持，嘱出院后每周复查血常规，按计划返院行下一程化疗。\nD. 办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，下一程化疗方案需减量20%并延迟1周进行。\nE. 暂缓出院，予以保肝降酶及护胃治疗，待复查肝功能及消化道症状好转后出院，按计划返院行下一程化疗。\nF. 办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，下一阶段直接转入同期放化疗。\nG. 办理出院，予以止吐处理，嘱出院后每3天复查肾功能及电解质，按计划返院行下一程诱导化疗。\nH. 办理出院，予以帕洛诺司琼等止吐处理，嘱出院后每周复查血常规及肝肾功能，按计划返院行下一程化疗。\nI. 暂缓出院，予以静脉补液及纠正电解质紊乱治疗，复查生化指标正常后出院，按计划返院行下一程化疗。\nJ. 办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，下一程化疗更改为单药方案以减轻反应。\nK. 办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，按计划返院行靶向治疗联合放疗。\nL. 暂缓出院，予以质子泵抑制剂静脉滴注预防应激性溃疡，观察3天后出院，按计划返院行下一程化疗。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D15] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 11/μL；酮体(KET)-尿液: -（参考: 阴性）；酵母菌(YEAST)-尿液: 1/μL；白细胞(LEU)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 1/μL；比重(SG)-尿液: 1.019；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 7/μL；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；酸碱度(pH)-尿液: 6.5；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D19] 检验组合: 氯离子(Cl-)-静脉血: 96.7mmol/L；总蛋白(TP)-静脉血: 73.8g/L；甘油三酯(TG)-静脉血: 1mmol/L；血小板计数(PLT#)-静脉血: 18410E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.2；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.27；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.44mmolL；球蛋白(GLO)-静脉血: 27.4g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；丙氨酸氨基转移酶(ALT)-静脉血: 16.1U/L；总钙(Ca)-静脉血: 2.31mmol/L；血小板比容-静脉血: 18%；血红蛋白(Hb)-静脉血: 144g/L；血液二氧化碳含量ctCO2(B)-静脉血: 26.5mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 356g/L；胱抑素(Cys-C)-静脉血: 0.75mg/L；γ-谷氨酰基转移酶(GGT)-静脉血: 18.1U/L；红细胞计数(RBC#)-静脉血: 4.5310E12/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.1；淋巴细胞百分比(Lymph%)-静脉血: 0.277；平均红细胞血红蛋白含量(MCH)-静脉血: 31.8pg；尿酸(UA)-静脉血: 231.9umol/L；乳酸脱氢酶(LDH)-静脉血: 158.8U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；载脂蛋白B(apoB)-静脉血: 0.78g/L；中性粒细胞百分比(Neut%)-静脉血: 0.597；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；血小板分布宽度(PDW)-静脉血: 10.5%；间接胆红素(IBIL)-静脉血: 11.1umolL；单核细胞百分比(Mono%)-静脉血: 0.101；天门冬氨酸氨基转移酶(AST)-静脉血: 20.5U/L；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L；白细胞计数(WBC#)-静脉血: 4.8310E9/L；镁离子(Mg2+)-静脉血: 0.93mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.36g/L；总胆红素(TBIL)-静脉血: 16.1umol/……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D17] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者第一程诱导化疗后，诉轻度恶心呕吐，精神睡眠尚可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。钱医生信息已隐藏：患者03-02开始予5-Fu6.6g,DDP130mg化疗，患者未诉特殊不适，注意观察不良反应。\n- [全程D19] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者化疗后，诉轻度恶心，精神睡眠尚可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。医生信息已隐藏：患者第一程诱导化疗顺利，一般情况可，予出院。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 办理出院，无需特殊用药，嘱出院后每2周复查血常规及肝肾功能，按计划返院行下一程诱导化疗。\nB. 暂缓出院，予以静脉营养支持及强效止吐治疗，待恶心症状完全缓解后出院，按计划返院行下一程化疗。\nC. 办理出院，予以止吐处理并预防性给予长效G-CSF支持，嘱出院后每周复查血常规，按计划返院行下一程化疗。\nD. 办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，下一程化疗方案需减量20%并延迟1周进行。\nE. 暂缓出院，予以保肝降酶及护胃治疗，待复查肝功能及消化道症状好转后出院，按计划返院行下一程化疗。\nF. 办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，下一阶段直接转入同期放化疗。\nG. 办理出院，予以止吐处理，嘱出院后每3天复查肾功能及电解质，按计划返院行下一程诱导化疗。\nH. 办理出院，予以帕洛诺司琼等止吐处理，嘱出院后每周复查血常规及肝肾功能，按计划返院行下一程化疗。\nI. 暂缓出院，予以静脉补液及纠正电解质紊乱治疗，复查生化指标正常后出院，按计划返院行下一程化疗。\nJ. 办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，下一程化疗更改为单药方案以减轻反应。\nK. 办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，按计划返院行靶向治疗联合放疗。\nL. 暂缓出院，予以质子泵抑制剂静脉滴注预防应激性溃疡，观察3天后出院，按计划返院行下一程化疗。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D15] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 11/μL；酮体(KET)-尿液: -（参考: 阴性）；酵母菌(YEAST)-尿液: 1/μL；白细胞(LEU)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 1/μL；比重(SG)-尿液: 1.019；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 7/μL；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；酸碱度(pH)-尿液: 6.5；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D19] 检验组合: 氯离子(Cl-)-静脉血: 96.7mmol/L；总蛋白(TP)-静脉血: 73.8g/L；甘油三酯(TG)-静脉血: 1mmol/L；血小板计数(PLT#)-静脉血: 18410E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.2；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.27；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.44mmolL；球蛋白(GLO)-静脉血: 27.4g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；丙氨酸氨基转移酶(ALT)-静脉血: 16.1U/L；总钙(Ca)-静脉血: 2.31mmol/L；血小板比容-静脉血: 18%；血红蛋白(Hb)-静脉血: 144g/L；血液二氧化碳含量ctCO2(B)-静脉血: 26.5mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 356g/L；胱抑素(Cys-C)-静脉血: 0.75mg/L；γ-谷氨酰基转移酶(GGT)-静脉血: 18.1U/L；红细胞计数(RBC#)-静脉血: 4.5310E12/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.1；淋巴细胞百分比(Lymph%)-静脉血: 0.277；平均红细胞血红蛋白含量(MCH)-静脉血: 31.8pg；尿酸(UA)-静脉血: 231.9umol/L；乳酸脱氢酶(LDH)-静脉血: 158.8U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；载脂蛋白B(apoB)-静脉血: 0.78g/L；中性粒细胞百分比(Neut%)-静脉血: 0.597；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；血小板分布宽度(PDW)-静脉血: 10.5%；间接胆红素(IBIL)-静脉血: 11.1umolL；单核细胞百分比(Mono%)-静脉血: 0.101；天门冬氨酸氨基转移酶(AST)-静脉血: 20.5U/L；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L；白细胞计数(WBC#)-静脉血: 4.8310E9/L；镁离子(Mg2+)-静脉血: 0.93mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.36g/L；总胆红素(TBIL)-静脉血: 16.1umol/……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D17] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者第一程诱导化疗后，诉轻度恶心呕吐，精神睡眠尚可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。钱医生信息已隐藏：患者03-02开始予5-Fu6.6g,DDP130mg化疗，患者未诉特殊不适，注意观察不良反应。\n- [全程D19] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者化疗后，诉轻度恶心，精神睡眠尚可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。医生信息已隐藏：患者第一程诱导化疗顺利，一般情况可，予出院。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 办理出院，无需特殊用药，嘱出院后每2周复查血常规及肝肾功能，按计划返院行下一程诱导化疗。\nB. 暂缓出院，予以静脉营养支持及强效止吐治疗，待恶心症状完全缓解后出院，按计划返院行下一程化疗。\nC. 办理出院，予以止吐处理并预防性给予长效G-CSF支持，嘱出院后每周复查血常规，按计划返院行下一程化疗。\nD. 办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，下一程化疗方案需减量20%并延迟1周进行。\nE. 暂缓出院，予以保肝降酶及护胃治疗，待复查肝功能及消化道症状好转后出院，按计划返院行下一程化疗。\nF. 办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，下一阶段直接转入同期放化疗。\nG. 办理出院，予以止吐处理，嘱出院后每3天复查肾功能及电解质，按计划返院行下一程诱导化疗。\nH. 办理出院，予以帕洛诺司琼等止吐处理，嘱出院后每周复查血常规及肝肾功能，按计划返院行下一程化疗。\nI. 暂缓出院，予以静脉补液及纠正电解质紊乱治疗，复查生化指标正常后出院，按计划返院行下一程化疗。\nJ. 办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，下一程化疗更改为单药方案以减轻反应。\nK. 办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，按计划返院行靶向治疗联合放疗。\nL. 暂缓出院，予以质子泵抑制剂静脉滴注预防应激性溃疡，观察3天后出院，按计划返院行下一程化疗。\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-f5ab8fe6b2ae40df32eed56b","patient_id":"patient-e5fcd31b4b8b85194b146991","turn_id":"turn06","turn_position":5,"turn_type":"toxicity_or_support_decision","gold_letter":"I","gold_action":"行PICC导管常规维护（更换敷料与正压接头），并完善间接鼻咽镜检查准备下一周期治疗。","options":[{"letter":"A","text":"拔除PICC导管改行外周静脉穿刺，并完善间接鼻咽镜检查准备下一周期治疗。","is_gold":false},{"letter":"B","text":"予重组人粒细胞刺激因子皮下注射，并行动静脉置管常规护理准备下一周期治疗。","is_gold":false},{"letter":"C","text":"予静脉补钾、补镁及水化利尿治疗，并行动静脉置管常规护理准备下一周期治疗。","is_gold":false},{"letter":"D","text":"予静脉输注红细胞悬液，并行动静脉置管常规护理准备下一周期治疗。","is_gold":false},{"letter":"E","text":"予静脉滴注广谱抗菌药物，并完善间接鼻咽镜检查准备下一周期治疗。","is_gold":false},{"letter":"F","text":"拔除PICC导管更换为锁骨下静脉置管，并完善间接鼻咽镜检查准备下一周期治疗。","is_gold":false},{"letter":"G","text":"予静脉滴注5-HT3受体拮抗剂，并行动静脉置管常规护理准备下一周期治疗。","is_gold":false},{"letter":"H","text":"予静脉输注肠外营养液，并完善间接鼻咽镜检查准备下一周期治疗。","is_gold":false},{"letter":"I","text":"行PICC导管常规维护（更换敷料与正压接头），并完善间接鼻咽镜检查准备下一周期治疗。","is_gold":true},{"letter":"J","text":"行鼻咽内镜下组织活检，并行动静脉置管常规护理准备下一周期治疗。","is_gold":false},{"letter":"K","text":"予静脉输注人血白蛋白，并行动静脉置管常规护理准备下一周期治疗。","is_gold":false},{"letter":"L","text":"予口服保肝药物，并完善间接鼻咽镜检查准备下一周期治疗。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 回吸性涕血1月余。；现病史: 缘于1月前患者无意中出现抽吸性血涕，痰中带血；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻咽角化,涕血,痰中带血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：78次/分，R：20次/分，BP：125/80mmHg,Ht：162cm，Wt：61kg，BSA：1.6483m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 回吸性涕血1月余。；现病史: 缘于1月前患者无意中出现抽吸性血涕，痰中带血；无头痛、面麻，无视力下降、复视，无听力下降、耳鸣等不适，于当地乡镇医院予滴鼻治疗，具体药物不详，未见好转，遂于某次就诊时间往[地点已隐去]人民医院检查，某次就诊时间病理活检示：鼻咽未分化型角化性癌。某次就诊时间鼻咽MRI示：左侧鼻咽部占位病变，考虑鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻咽角化,涕血,痰中带血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：78次/分，R：20次/分，BP：125/80mmHg,Ht：162cm，Wt：61kg，BSA：1.6483m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率100次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 胱抑素(Cys-C)-静脉血: 0.77mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.69mmol/L；阴离子间隙(AG)-静脉血: 13；磷(P)-静脉血: 0.92mmol/L；总胆红素(TBIL)-静脉血: 12.4umol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；肌酐(Crea)-静脉血: 80.5umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.58；Rh血型-静脉血: 阳性；总钙(Ca)-静脉血: 2.44mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；血小板计数(PLT#)-静脉血: 21910E9/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 4.81mmol/L；直接胆红素(DBIL)-静脉血: 4.2umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.64mmolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.013；载脂蛋白B(apoB)-静脉血: 0.73g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.3pg；α-L-岩藻糖苷酶(AFU)-静脉血: 24U/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 8.2umolL；白蛋白(ALB)-静脉血: 45.8g/L；血小板比容-静脉血: 21%；ABO血型-静脉血: O；尿素氮(BUN)-静脉血: 3.6mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；凝血酶时间(TT)-静脉血: 20.2sec.；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；载脂蛋白AI(apoAI)-静脉血: 1.33g/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；C-反应蛋白(CRP)-静脉血: 0.36mg/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血:……\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔稍狭窄，鼻咽左侧壁明显增厚，左侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。肿物侵犯左侧腭帆张提肌，左侧咽旁脂肪间隙变窄。鼻咽顶后壁稍增厚，右侧壁未见明显增厚，右侧咽隐窝清晰。 右侧腭帆张提肌、双侧头长肌、翼内外肌未见明显异常。 双侧翼腭窝、上颌后脂肪间隙、咀嚼肌间隙未见异常。 口咽各壁未见增厚。鼻腔内未见肿物。 蝶骨基底部、左侧翼突基底部及内侧板骨质信号降低，增强扫描可见强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦粘膜稍增厚，双侧乳突未见明显异常。 左侧咽后见几个淋巴结，最大者约8mm×5mm，边界欠清，明显强化。双颈II区见多个淋巴结，最大者约16mm×8mm，边界尚清，较均匀明显强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽左侧壁增厚，左侧咽隐窝肿物，考虑鼻咽癌。 颅底骨质破坏。 左侧咽后、双颈II区淋巴结，可疑转移。 轻度鼻窦炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右侧约平T6椎体水平，估计导管末端位于上腔静脉上段内。；检查结论: PICC管位置如上所述。\n- [全程D13] 检验组合: 酸碱度(pH)-尿液: 5.5；粘液丝计数(MUCS#)-尿液: 11/μL；酮体(KET)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 1/μL；红细胞计数(RBC#)-尿液: 3/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: colorless；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；比重(SG)-尿液: 1.008\n- [全程D14] 检验组合: 总蛋白(TP)-尿液: +- 0.2g（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；红细胞计数(RBC#)-尿液: 1/μL；葡萄糖(Glu)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.02；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；粘液丝计数(MUCS#)-尿液: 4/μL；白细胞(LEU)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D15] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 11/μL；酮体(KET)-尿液: -（参考: 阴性）；酵母菌(YEAST)-尿液: 1/μL；白细胞(LEU)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 1/μL；比重(SG)-尿液: 1.019；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 7/μL；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；酸碱度(pH)-尿液: 6.5；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D19] 检验组合: 氯离子(Cl-)-静脉血: 96.7mmol/L；总蛋白(TP)-静脉血: 73.8g/L；甘油三酯(TG)-静脉血: 1mmol/L；血小板计数(PLT#)-静脉血: 18410E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.2；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.27；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.44mmolL；球蛋白(GLO)-静脉血: 27.4g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；丙氨酸氨基转移酶(ALT)-静脉血: 16.1U/L；总钙(Ca)-静脉血: 2.31mmol/L；血小板比容-静脉血: 18%；血红蛋白(Hb)-静脉血: 144g/L；血液二氧化碳含量ctCO2(B)-静脉血: 26.5mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 356g/L；胱抑素(Cys-C)-静脉血: 0.75mg/L；γ-谷氨酰基转移酶(GGT)-静脉血: 18.1U/L；红细胞计数(RBC#)-静脉血: 4.5310E12/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.1；淋巴细胞百分比(Lymph%)-静脉血: 0.277；平均红细胞血红蛋白含量(MCH)-静脉血: 31.8pg；尿酸(UA)-静脉血: 231.9umol/L；乳酸脱氢酶(LDH)-静脉血: 158.8U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；载脂蛋白B(apoB)-静脉血: 0.78g/L；中性粒细胞百分比(Neut%)-静脉血: 0.597；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；血小板分布宽度(PDW)-静脉血: 10.5%；间接胆红素(IBIL)-静脉血: 11.1umolL；单核细胞百分比(Mono%)-静脉血: 0.101；天门冬氨酸氨基转移酶(AST)-静脉血: 20.5U/L；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L；白细胞计数(WBC#)-静脉血: 4.8310E9/L；镁离子(Mg2+)-静脉血: 0.93mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.36g/L；总胆红素(TBIL)-静脉血: 16.1umol/……\n- [全程D34] 检验组合: 阴离子间隙(AG)-静脉血: 10.5；乳酸脱氢酶(LDH)-静脉血: 175.1U/L；肌酐(Crea)-静脉血: 86umol/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；钾离子(K+)-静脉血: 3.9mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.43；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.18；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；甘油三酯(TG)-静脉血: 0.79mmol/L；总蛋白(TP)-静脉血: 76.5g/L；大血小板百分比(P-LCR%)-静脉血: 15.9%；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.537；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；总钙(Ca)-静脉血: 2.39mmol/L；尿酸(UA)-静脉血: 334.3umol/L；钠离子(Na+)-静脉血: 142.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.53g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；单核细胞百分比(Mono%)-静脉血: 0.102；有核红细胞百分比(NRBC%)-静脉血: 0；单核细胞计数(Mono#)-静脉血: 0.510E9/L；碱性磷酸酶(ALP)-静脉血: 63.6U/L；间接胆红素(IBIL)-静脉血: 6.8umolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.028；平均红细胞体积(MCV)-静脉血: 90.7fL；淋巴细胞百分比(Lymph%)-静脉血: 0.325；血液二氧化碳含量ctCO2(B)-静脉血: 29.6mmol/L；血小板分布宽度(PDW)-静脉血: 8.8%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.3；平均血小板体积(MPV)-静脉血: 8.9fL；球蛋白(GLO)-静脉血: 31.5g/L；血红蛋白(Hb)-静脉血: 130g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 29U/L；白蛋白(ALB)-静脉血: 45g/L；总胆汁酸(TBA)-静脉血: 5.6umol/L；总胆固醇(TC)-静脉血: 5.01mmol/L……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D17] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者第一程诱导化疗后，诉轻度恶心呕吐，精神睡眠尚可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。钱医生信息已隐藏：患者03-02开始予5-Fu6.6g,DDP130mg化疗，患者未诉特殊不适，注意观察不良反应。\n- [全程D19] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者化疗后，诉轻度恶心，精神睡眠尚可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。医生信息已隐藏：患者第一程诱导化疗顺利，一般情况可，予出院。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 拔除PICC导管改行外周静脉穿刺，并完善间接鼻咽镜检查准备下一周期治疗。\nB. 予重组人粒细胞刺激因子皮下注射，并行动静脉置管常规护理准备下一周期治疗。\nC. 予静脉补钾、补镁及水化利尿治疗，并行动静脉置管常规护理准备下一周期治疗。\nD. 予静脉输注红细胞悬液，并行动静脉置管常规护理准备下一周期治疗。\nE. 予静脉滴注广谱抗菌药物，并完善间接鼻咽镜检查准备下一周期治疗。\nF. 拔除PICC导管更换为锁骨下静脉置管，并完善间接鼻咽镜检查准备下一周期治疗。\nG. 予静脉滴注5-HT3受体拮抗剂，并行动静脉置管常规护理准备下一周期治疗。\nH. 予静脉输注肠外营养液，并完善间接鼻咽镜检查准备下一周期治疗。\nI. 行PICC导管常规维护（更换敷料与正压接头），并完善间接鼻咽镜检查准备下一周期治疗。\nJ. 行鼻咽内镜下组织活检，并行动静脉置管常规护理准备下一周期治疗。\nK. 予静脉输注人血白蛋白，并行动静脉置管常规护理准备下一周期治疗。\nL. 予口服保肝药物，并完善间接鼻咽镜检查准备下一周期治疗。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D34] 检验组合: 阴离子间隙(AG)-静脉血: 10.5；乳酸脱氢酶(LDH)-静脉血: 175.1U/L；肌酐(Crea)-静脉血: 86umol/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；钾离子(K+)-静脉血: 3.9mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.43；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.18；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；甘油三酯(TG)-静脉血: 0.79mmol/L；总蛋白(TP)-静脉血: 76.5g/L；大血小板百分比(P-LCR%)-静脉血: 15.9%；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.537；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；总钙(Ca)-静脉血: 2.39mmol/L；尿酸(UA)-静脉血: 334.3umol/L；钠离子(Na+)-静脉血: 142.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.53g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；单核细胞百分比(Mono%)-静脉血: 0.102；有核红细胞百分比(NRBC%)-静脉血: 0；单核细胞计数(Mono#)-静脉血: 0.510E9/L；碱性磷酸酶(ALP)-静脉血: 63.6U/L；间接胆红素(IBIL)-静脉血: 6.8umolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.028；平均红细胞体积(MCV)-静脉血: 90.7fL；淋巴细胞百分比(Lymph%)-静脉血: 0.325；血液二氧化碳含量ctCO2(B)-静脉血: 29.6mmol/L；血小板分布宽度(PDW)-静脉血: 8.8%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.3；平均血小板体积(MPV)-静脉血: 8.9fL；球蛋白(GLO)-静脉血: 31.5g/L；血红蛋白(Hb)-静脉血: 130g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 29U/L；白蛋白(ALB)-静脉血: 45g/L；总胆汁酸(TBA)-静脉血: 5.6umol/L；总胆固醇(TC)-静脉血: 5.01mmol/L……\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 拔除PICC导管改行外周静脉穿刺，并完善间接鼻咽镜检查准备下一周期治疗。\nB. 予重组人粒细胞刺激因子皮下注射，并行动静脉置管常规护理准备下一周期治疗。\nC. 予静脉补钾、补镁及水化利尿治疗，并行动静脉置管常规护理准备下一周期治疗。\nD. 予静脉输注红细胞悬液，并行动静脉置管常规护理准备下一周期治疗。\nE. 予静脉滴注广谱抗菌药物，并完善间接鼻咽镜检查准备下一周期治疗。\nF. 拔除PICC导管更换为锁骨下静脉置管，并完善间接鼻咽镜检查准备下一周期治疗。\nG. 予静脉滴注5-HT3受体拮抗剂，并行动静脉置管常规护理准备下一周期治疗。\nH. 予静脉输注肠外营养液，并完善间接鼻咽镜检查准备下一周期治疗。\nI. 行PICC导管常规维护（更换敷料与正压接头），并完善间接鼻咽镜检查准备下一周期治疗。\nJ. 行鼻咽内镜下组织活检，并行动静脉置管常规护理准备下一周期治疗。\nK. 予静脉输注人血白蛋白，并行动静脉置管常规护理准备下一周期治疗。\nL. 予口服保肝药物，并完善间接鼻咽镜检查准备下一周期治疗。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D34] 检验组合: 阴离子间隙(AG)-静脉血: 10.5；乳酸脱氢酶(LDH)-静脉血: 175.1U/L；肌酐(Crea)-静脉血: 86umol/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；钾离子(K+)-静脉血: 3.9mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.43；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.18；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；甘油三酯(TG)-静脉血: 0.79mmol/L；总蛋白(TP)-静脉血: 76.5g/L；大血小板百分比(P-LCR%)-静脉血: 15.9%；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.537；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；总钙(Ca)-静脉血: 2.39mmol/L；尿酸(UA)-静脉血: 334.3umol/L；钠离子(Na+)-静脉血: 142.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.53g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；单核细胞百分比(Mono%)-静脉血: 0.102；有核红细胞百分比(NRBC%)-静脉血: 0；单核细胞计数(Mono#)-静脉血: 0.510E9/L；碱性磷酸酶(ALP)-静脉血: 63.6U/L；间接胆红素(IBIL)-静脉血: 6.8umolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.028；平均红细胞体积(MCV)-静脉血: 90.7fL；淋巴细胞百分比(Lymph%)-静脉血: 0.325；血液二氧化碳含量ctCO2(B)-静脉血: 29.6mmol/L；血小板分布宽度(PDW)-静脉血: 8.8%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.3；平均血小板体积(MPV)-静脉血: 8.9fL；球蛋白(GLO)-静脉血: 31.5g/L；血红蛋白(Hb)-静脉血: 130g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 29U/L；白蛋白(ALB)-静脉血: 45g/L；总胆汁酸(TBA)-静脉血: 5.6umol/L；总胆固醇(TC)-静脉血: 5.01mmol/L……\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 拔除PICC导管改行外周静脉穿刺，并完善间接鼻咽镜检查准备下一周期治疗。\nB. 予重组人粒细胞刺激因子皮下注射，并行动静脉置管常规护理准备下一周期治疗。\nC. 予静脉补钾、补镁及水化利尿治疗，并行动静脉置管常规护理准备下一周期治疗。\nD. 予静脉输注红细胞悬液，并行动静脉置管常规护理准备下一周期治疗。\nE. 予静脉滴注广谱抗菌药物，并完善间接鼻咽镜检查准备下一周期治疗。\nF. 拔除PICC导管更换为锁骨下静脉置管，并完善间接鼻咽镜检查准备下一周期治疗。\nG. 予静脉滴注5-HT3受体拮抗剂，并行动静脉置管常规护理准备下一周期治疗。\nH. 予静脉输注肠外营养液，并完善间接鼻咽镜检查准备下一周期治疗。\nI. 行PICC导管常规维护（更换敷料与正压接头），并完善间接鼻咽镜检查准备下一周期治疗。\nJ. 行鼻咽内镜下组织活检，并行动静脉置管常规护理准备下一周期治疗。\nK. 予静脉输注人血白蛋白，并行动静脉置管常规护理准备下一周期治疗。\nL. 予口服保肝药物，并完善间接鼻咽镜检查准备下一周期治疗。\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-dd7067359645093ab08b6c16","patient_id":"patient-e5fcd31b4b8b85194b146991","turn_id":"turn07","turn_position":6,"turn_type":"recurrence_or_salvage_decision","gold_letter":"J","gold_action":"出院休养并对症处理化疗副反应，定期复查血常规及肝肾功能，按计划返院行根治性放射治疗。","options":[{"letter":"A","text":"立即启动第三程PF方案诱导化疗，随后再行根治性放射治疗。","is_gold":false},{"letter":"B","text":"更改化疗方案为TP或GP方案继续诱导化疗，随后再行根治性放射治疗。","is_gold":false},{"letter":"C","text":"立即行鼻咽及颈部根治性手术切除，术后辅以根治性放射治疗。","is_gold":false},{"letter":"D","text":"出院休养，待化疗副反应恢复后，行右颈部淋巴结清扫术，再行根治性放疗。","is_gold":false},{"letter":"E","text":"立即予以全量根治性放射治疗，并联合靶向药物如西妥昔单抗。","is_gold":false},{"letter":"F","text":"出院休养，行颈部淋巴结穿刺活检明确病理，再决定后续放疗方案。","is_gold":false},{"letter":"G","text":"立即启动根治性放射治疗，暂缓处理骨髓抑制及胃肠道反应。","is_gold":false},{"letter":"H","text":"出院休养，待化疗副反应恢复后，行姑息性放射治疗联合免疫治疗。","is_gold":false},{"letter":"I","text":"行全身PET-CT重新评估远处转移情况，再决定是否启动根治性放疗。","is_gold":false},{"letter":"J","text":"出院休养并对症处理化疗副反应，定期复查血常规及肝肾功能，按计划返院行根治性放射治疗。","is_gold":true},{"letter":"K","text":"出院休养，定期复查血常规及肝肾功能，待恢复后返院行第三程PF方案诱导化疗。","is_gold":false},{"letter":"L","text":"立即予以同期放化疗，并对右颈淋巴结局部推量加量放疗。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 回吸性涕血1月余。；现病史: 缘于1月前患者无意中出现抽吸性血涕，痰中带血；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻咽角化,涕血,痰中带血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：78次/分，R：20次/分，BP：125/80mmHg,Ht：162cm，Wt：61kg，BSA：1.6483m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 回吸性涕血1月余。；现病史: 缘于1月前患者无意中出现抽吸性血涕，痰中带血；无头痛、面麻，无视力下降、复视，无听力下降、耳鸣等不适，于当地乡镇医院予滴鼻治疗，具体药物不详，未见好转，遂于某次就诊时间往[地点已隐去]人民医院检查，某次就诊时间病理活检示：鼻咽未分化型角化性癌。某次就诊时间鼻咽MRI示：左侧鼻咽部占位病变，考虑鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻咽角化,涕血,痰中带血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：78次/分，R：20次/分，BP：125/80mmHg,Ht：162cm，Wt：61kg，BSA：1.6483m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率100次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 胱抑素(Cys-C)-静脉血: 0.77mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.69mmol/L；阴离子间隙(AG)-静脉血: 13；磷(P)-静脉血: 0.92mmol/L；总胆红素(TBIL)-静脉血: 12.4umol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；肌酐(Crea)-静脉血: 80.5umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.58；Rh血型-静脉血: 阳性；总钙(Ca)-静脉血: 2.44mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；血小板计数(PLT#)-静脉血: 21910E9/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 4.81mmol/L；直接胆红素(DBIL)-静脉血: 4.2umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.64mmolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.013；载脂蛋白B(apoB)-静脉血: 0.73g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.3pg；α-L-岩藻糖苷酶(AFU)-静脉血: 24U/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 8.2umolL；白蛋白(ALB)-静脉血: 45.8g/L；血小板比容-静脉血: 21%；ABO血型-静脉血: O；尿素氮(BUN)-静脉血: 3.6mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；凝血酶时间(TT)-静脉血: 20.2sec.；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；载脂蛋白AI(apoAI)-静脉血: 1.33g/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；C-反应蛋白(CRP)-静脉血: 0.36mg/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血:……\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔稍狭窄，鼻咽左侧壁明显增厚，左侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。肿物侵犯左侧腭帆张提肌，左侧咽旁脂肪间隙变窄。鼻咽顶后壁稍增厚，右侧壁未见明显增厚，右侧咽隐窝清晰。 右侧腭帆张提肌、双侧头长肌、翼内外肌未见明显异常。 双侧翼腭窝、上颌后脂肪间隙、咀嚼肌间隙未见异常。 口咽各壁未见增厚。鼻腔内未见肿物。 蝶骨基底部、左侧翼突基底部及内侧板骨质信号降低，增强扫描可见强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦粘膜稍增厚，双侧乳突未见明显异常。 左侧咽后见几个淋巴结，最大者约8mm×5mm，边界欠清，明显强化。双颈II区见多个淋巴结，最大者约16mm×8mm，边界尚清，较均匀明显强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽左侧壁增厚，左侧咽隐窝肿物，考虑鼻咽癌。 颅底骨质破坏。 左侧咽后、双颈II区淋巴结，可疑转移。 轻度鼻窦炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右侧约平T6椎体水平，估计导管末端位于上腔静脉上段内。；检查结论: PICC管位置如上所述。\n- [全程D13] 检验组合: 酸碱度(pH)-尿液: 5.5；粘液丝计数(MUCS#)-尿液: 11/μL；酮体(KET)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 1/μL；红细胞计数(RBC#)-尿液: 3/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: colorless；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；比重(SG)-尿液: 1.008\n- [全程D14] 检验组合: 总蛋白(TP)-尿液: +- 0.2g（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；红细胞计数(RBC#)-尿液: 1/μL；葡萄糖(Glu)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.02；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；粘液丝计数(MUCS#)-尿液: 4/μL；白细胞(LEU)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D15] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 11/μL；酮体(KET)-尿液: -（参考: 阴性）；酵母菌(YEAST)-尿液: 1/μL；白细胞(LEU)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 1/μL；比重(SG)-尿液: 1.019；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 7/μL；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；酸碱度(pH)-尿液: 6.5；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D19] 检验组合: 氯离子(Cl-)-静脉血: 96.7mmol/L；总蛋白(TP)-静脉血: 73.8g/L；甘油三酯(TG)-静脉血: 1mmol/L；血小板计数(PLT#)-静脉血: 18410E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.2；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.27；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.44mmolL；球蛋白(GLO)-静脉血: 27.4g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；丙氨酸氨基转移酶(ALT)-静脉血: 16.1U/L；总钙(Ca)-静脉血: 2.31mmol/L；血小板比容-静脉血: 18%；血红蛋白(Hb)-静脉血: 144g/L；血液二氧化碳含量ctCO2(B)-静脉血: 26.5mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 356g/L；胱抑素(Cys-C)-静脉血: 0.75mg/L；γ-谷氨酰基转移酶(GGT)-静脉血: 18.1U/L；红细胞计数(RBC#)-静脉血: 4.5310E12/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.1；淋巴细胞百分比(Lymph%)-静脉血: 0.277；平均红细胞血红蛋白含量(MCH)-静脉血: 31.8pg；尿酸(UA)-静脉血: 231.9umol/L；乳酸脱氢酶(LDH)-静脉血: 158.8U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；载脂蛋白B(apoB)-静脉血: 0.78g/L；中性粒细胞百分比(Neut%)-静脉血: 0.597；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；血小板分布宽度(PDW)-静脉血: 10.5%；间接胆红素(IBIL)-静脉血: 11.1umolL；单核细胞百分比(Mono%)-静脉血: 0.101；天门冬氨酸氨基转移酶(AST)-静脉血: 20.5U/L；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L；白细胞计数(WBC#)-静脉血: 4.8310E9/L；镁离子(Mg2+)-静脉血: 0.93mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.36g/L；总胆红素(TBIL)-静脉血: 16.1umol/……\n- [全程D34] 检验组合: 阴离子间隙(AG)-静脉血: 10.5；乳酸脱氢酶(LDH)-静脉血: 175.1U/L；肌酐(Crea)-静脉血: 86umol/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；钾离子(K+)-静脉血: 3.9mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.43；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.18；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；甘油三酯(TG)-静脉血: 0.79mmol/L；总蛋白(TP)-静脉血: 76.5g/L；大血小板百分比(P-LCR%)-静脉血: 15.9%；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.537；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；总钙(Ca)-静脉血: 2.39mmol/L；尿酸(UA)-静脉血: 334.3umol/L；钠离子(Na+)-静脉血: 142.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.53g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；单核细胞百分比(Mono%)-静脉血: 0.102；有核红细胞百分比(NRBC%)-静脉血: 0；单核细胞计数(Mono#)-静脉血: 0.510E9/L；碱性磷酸酶(ALP)-静脉血: 63.6U/L；间接胆红素(IBIL)-静脉血: 6.8umolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.028；平均红细胞体积(MCV)-静脉血: 90.7fL；淋巴细胞百分比(Lymph%)-静脉血: 0.325；血液二氧化碳含量ctCO2(B)-静脉血: 29.6mmol/L；血小板分布宽度(PDW)-静脉血: 8.8%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.3；平均血小板体积(MPV)-静脉血: 8.9fL；球蛋白(GLO)-静脉血: 31.5g/L；血红蛋白(Hb)-静脉血: 130g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 29U/L；白蛋白(ALB)-静脉血: 45g/L；总胆汁酸(TBA)-静脉血: 5.6umol/L；总胆固醇(TC)-静脉血: 5.01mmol/L……\n- [全程D35] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；比重(SG)-尿液: 1.015；白细胞计数(WBC#)-尿液: 2/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 6.5；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）\n- [全程D36] 检验组合: 浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 7.5；隐血(OB)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；胆红素(BIL)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.022；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）\n- [全程D37] 检验组合: 颜色-尿液: Yellow；葡萄糖(Glu)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.018；隐血(OB)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 3/μL；酸碱度(pH)-尿液: 7；酮体(KET)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D41] 检验组合: 总胆固醇(TC)-静脉血: 4.84mmol/L；红细胞计数(RBC#)-静脉血: 4.2110E12/L；红细胞比容(Hct)-静脉血: 36.6%；血小板分布宽度(PDW)-静脉血: 7.9%；白蛋白(ALB)-静脉血: 42.1g/L；尿素氮(BUN)-静脉血: 4.8mmol/L；总钙(Ca)-静脉血: 2.25mmol/L；乳酸脱氢酶(LDH)-静脉血: 148.6U/L；钾离子(K+)-静脉血: 3.3mmol/L；阴离子间隙(AG)-静脉血: 14.2；血液二氧化碳含量ctCO2(B)-静脉血: 25mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；胱抑素(Cys-C)-静脉血: 0.8mg/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 350g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.4pg；平均红细胞体积(MCV)-静脉血: 86.9fL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；氯离子(Cl-)-静脉血: 97.5mmol/L；葡萄糖(Glu)-静脉血: 5.35mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.89；镁离子(Mg2+)-静脉血: 0.78mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.34mmolL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；中性粒细胞计数(Neut#)-静脉血: 1.710E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.13mmol/L；直接胆红素(DBIL)-静脉血: 2.5umol/L；磷(P)-静脉血: 1.18mmol/L；球蛋白(GLO)-静脉血: 28.13g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.01；白细胞计数(WBC#)-静脉血: 3.0210E9/L；平均血小板体积(MPV)-静脉血: 8.8fL；总胆红素(TBIL)-静脉血: 9.3umol/L；碱性磷酸酶(ALP)-静脉血: 57.9U/L；中性粒细胞百分比(Neut%)-静脉血: 0.55；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；血小板计数(PLT#)-静脉血: 13810E9/L；肌酐(Crea)-静脉血: 90.1umol/L；血红蛋白(Hb)-静……\n- [全程D42] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后复查： 鼻咽腔稍狭窄，鼻咽双侧壁、顶后壁增厚，左侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。右侧咽隐窝变窄。肿物侵犯左侧腭帆张提肌，右侧腭帆提肌结构稍模糊，右侧腭帆张提肌间隙稍模糊。 双侧头长肌、翼内外肌未见明显异常。 双侧翼腭窝、上颌后脂肪间隙、咀嚼肌间隙未见异常。 口咽各壁未见增厚。鼻腔内未见肿物。 蝶骨基底部、左侧翼突基底部及内侧板骨质信号降低，增强扫描可见强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦粘膜稍增厚，双侧乳突未见明显异常。 左侧咽后见几个淋巴结，最大者约8mm×5mm，边界欠清，明显强化。双颈II区见多个淋巴结，最大者约15mm×12mm，边界尚清，较均匀明显强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗后复查，对比某次就诊时间片： 鼻咽部肿物，较前明显缩小。 颅底骨质破坏，较前未见明显变化。 左侧咽后、双颈II区淋巴结，可疑转移，其中右颈IIa区淋巴结较前增大，余较前未见明显变化。 轻度鼻窦炎。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D17] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者第一程诱导化疗后，诉轻度恶心呕吐，精神睡眠尚可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。钱医生信息已隐藏：患者03-02开始予5-Fu6.6g,DDP130mg化疗，患者未诉特殊不适，注意观察不良反应。\n- [全程D19] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者化疗后，诉轻度恶心，精神睡眠尚可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。医生信息已隐藏：患者第一程诱导化疗顺利，一般情况可，予出院。\n- [全程D35] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者未诉特殊不适，精神睡眠可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。03-22血生化常规未见异常。[姓名已隐去]医生信息已隐藏：患者1程PF方案诱导化疗后，一般情况可，已排除化疗禁忌症，今日水化，明日开始化疗（DDP 130mg d1 ; 5-Fu6.5g civ）。并予对症支持治疗。\n- [全程D36] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉稍恶心呕吐，无头痛、头晕，精神睡眠可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]副医生信息已隐藏：加强对症治疗，患者一般情况可，继续完成化疗，注意休息，加强营养。\n- [全程D37] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉稍恶心，无明显呕吐，无头痛、头晕，精神睡眠可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]副医生信息已隐藏：患者一般情况可继续完成化疗，\n- [全程D41] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者诉恶心呕吐，盗汗，头晕鼻塞，精神睡眠可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。03-29血常规示：WBC3.0*109/L NE1.7*109/L 生化示：血钾 3.3mmol/L[姓名已隐去]医生信息已隐藏：患者第二程诱导化疗，出现I度骨髓抑制，予香伏益血。胃肠道反应相比上次稍重，嘱少食多餐，加强营养。今日化疗结束，嘱明日出院。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即启动第三程PF方案诱导化疗，随后再行根治性放射治疗。\nB. 更改化疗方案为TP或GP方案继续诱导化疗，随后再行根治性放射治疗。\nC. 立即行鼻咽及颈部根治性手术切除，术后辅以根治性放射治疗。\nD. 出院休养，待化疗副反应恢复后，行右颈部淋巴结清扫术，再行根治性放疗。\nE. 立即予以全量根治性放射治疗，并联合靶向药物如西妥昔单抗。\nF. 出院休养，行颈部淋巴结穿刺活检明确病理，再决定后续放疗方案。\nG. 立即启动根治性放射治疗，暂缓处理骨髓抑制及胃肠道反应。\nH. 出院休养，待化疗副反应恢复后，行姑息性放射治疗联合免疫治疗。\nI. 行全身PET-CT重新评估远处转移情况，再决定是否启动根治性放疗。\nJ. 出院休养并对症处理化疗副反应，定期复查血常规及肝肾功能，按计划返院行根治性放射治疗。\nK. 出院休养，定期复查血常规及肝肾功能，待恢复后返院行第三程PF方案诱导化疗。\nL. 立即予以同期放化疗，并对右颈淋巴结局部推量加量放疗。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D35] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；比重(SG)-尿液: 1.015；白细胞计数(WBC#)-尿液: 2/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 6.5；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）\n- [全程D36] 检验组合: 浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 7.5；隐血(OB)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；胆红素(BIL)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.022；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）\n- [全程D37] 检验组合: 颜色-尿液: Yellow；葡萄糖(Glu)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.018；隐血(OB)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 3/μL；酸碱度(pH)-尿液: 7；酮体(KET)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D41] 检验组合: 总胆固醇(TC)-静脉血: 4.84mmol/L；红细胞计数(RBC#)-静脉血: 4.2110E12/L；红细胞比容(Hct)-静脉血: 36.6%；血小板分布宽度(PDW)-静脉血: 7.9%；白蛋白(ALB)-静脉血: 42.1g/L；尿素氮(BUN)-静脉血: 4.8mmol/L；总钙(Ca)-静脉血: 2.25mmol/L；乳酸脱氢酶(LDH)-静脉血: 148.6U/L；钾离子(K+)-静脉血: 3.3mmol/L；阴离子间隙(AG)-静脉血: 14.2；血液二氧化碳含量ctCO2(B)-静脉血: 25mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；胱抑素(Cys-C)-静脉血: 0.8mg/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 350g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.4pg；平均红细胞体积(MCV)-静脉血: 86.9fL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；氯离子(Cl-)-静脉血: 97.5mmol/L；葡萄糖(Glu)-静脉血: 5.35mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.89；镁离子(Mg2+)-静脉血: 0.78mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.34mmolL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；中性粒细胞计数(Neut#)-静脉血: 1.710E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.13mmol/L；直接胆红素(DBIL)-静脉血: 2.5umol/L；磷(P)-静脉血: 1.18mmol/L；球蛋白(GLO)-静脉血: 28.13g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.01；白细胞计数(WBC#)-静脉血: 3.0210E9/L；平均血小板体积(MPV)-静脉血: 8.8fL；总胆红素(TBIL)-静脉血: 9.3umol/L；碱性磷酸酶(ALP)-静脉血: 57.9U/L；中性粒细胞百分比(Neut%)-静脉血: 0.55；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；血小板计数(PLT#)-静脉血: 13810E9/L；肌酐(Crea)-静脉血: 90.1umol/L；血红蛋白(Hb)-静……\n- [全程D42] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后复查： 鼻咽腔稍狭窄，鼻咽双侧壁、顶后壁增厚，左侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。右侧咽隐窝变窄。肿物侵犯左侧腭帆张提肌，右侧腭帆提肌结构稍模糊，右侧腭帆张提肌间隙稍模糊。 双侧头长肌、翼内外肌未见明显异常。 双侧翼腭窝、上颌后脂肪间隙、咀嚼肌间隙未见异常。 口咽各壁未见增厚。鼻腔内未见肿物。 蝶骨基底部、左侧翼突基底部及内侧板骨质信号降低，增强扫描可见强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦粘膜稍增厚，双侧乳突未见明显异常。 左侧咽后见几个淋巴结，最大者约8mm×5mm，边界欠清，明显强化。双颈II区见多个淋巴结，最大者约15mm×12mm，边界尚清，较均匀明显强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗后复查，对比某次就诊时间片： 鼻咽部肿物，较前明显缩小。 颅底骨质破坏，较前未见明显变化。 左侧咽后、双颈II区淋巴结，可疑转移，其中右颈IIa区淋巴结较前增大，余较前未见明显变化。 轻度鼻窦炎。\n\n【既往治疗与反应】\n- [全程D35] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者未诉特殊不适，精神睡眠可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。03-22血生化常规未见异常。[姓名已隐去]医生信息已隐藏：患者1程PF方案诱导化疗后，一般情况可，已排除化疗禁忌症，今日水化，明日开始化疗（DDP 130mg d1 ; 5-Fu6.5g civ）。并予对症支持治疗。\n- [全程D36] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉稍恶心呕吐，无头痛、头晕，精神睡眠可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]副医生信息已隐藏：加强对症治疗，患者一般情况可，继续完成化疗，注意休息，加强营养。\n- [全程D37] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉稍恶心，无明显呕吐，无头痛、头晕，精神睡眠可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]副医生信息已隐藏：患者一般情况可继续完成化疗，\n- [全程D41] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者诉恶心呕吐，盗汗，头晕鼻塞，精神睡眠可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。03-29血常规示：WBC3.0*109/L NE1.7*109/L 生化示：血钾 3.3mmol/L[姓名已隐去]医生信息已隐藏：患者第二程诱导化疗，出现I度骨髓抑制，予香伏益血。胃肠道反应相比上次稍重，嘱少食多餐，加强营养。今日化疗结束，嘱明日出院。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即启动第三程PF方案诱导化疗，随后再行根治性放射治疗。\nB. 更改化疗方案为TP或GP方案继续诱导化疗，随后再行根治性放射治疗。\nC. 立即行鼻咽及颈部根治性手术切除，术后辅以根治性放射治疗。\nD. 出院休养，待化疗副反应恢复后，行右颈部淋巴结清扫术，再行根治性放疗。\nE. 立即予以全量根治性放射治疗，并联合靶向药物如西妥昔单抗。\nF. 出院休养，行颈部淋巴结穿刺活检明确病理，再决定后续放疗方案。\nG. 立即启动根治性放射治疗，暂缓处理骨髓抑制及胃肠道反应。\nH. 出院休养，待化疗副反应恢复后，行姑息性放射治疗联合免疫治疗。\nI. 行全身PET-CT重新评估远处转移情况，再决定是否启动根治性放疗。\nJ. 出院休养并对症处理化疗副反应，定期复查血常规及肝肾功能，按计划返院行根治性放射治疗。\nK. 出院休养，定期复查血常规及肝肾功能，待恢复后返院行第三程PF方案诱导化疗。\nL. 立即予以同期放化疗，并对右颈淋巴结局部推量加量放疗。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D35] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；比重(SG)-尿液: 1.015；白细胞计数(WBC#)-尿液: 2/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 6.5；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）\n- [全程D36] 检验组合: 浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 7.5；隐血(OB)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；胆红素(BIL)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.022；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）\n- [全程D37] 检验组合: 颜色-尿液: Yellow；葡萄糖(Glu)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.018；隐血(OB)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 3/μL；酸碱度(pH)-尿液: 7；酮体(KET)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D41] 检验组合: 总胆固醇(TC)-静脉血: 4.84mmol/L；红细胞计数(RBC#)-静脉血: 4.2110E12/L；红细胞比容(Hct)-静脉血: 36.6%；血小板分布宽度(PDW)-静脉血: 7.9%；白蛋白(ALB)-静脉血: 42.1g/L；尿素氮(BUN)-静脉血: 4.8mmol/L；总钙(Ca)-静脉血: 2.25mmol/L；乳酸脱氢酶(LDH)-静脉血: 148.6U/L；钾离子(K+)-静脉血: 3.3mmol/L；阴离子间隙(AG)-静脉血: 14.2；血液二氧化碳含量ctCO2(B)-静脉血: 25mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；胱抑素(Cys-C)-静脉血: 0.8mg/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 350g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.4pg；平均红细胞体积(MCV)-静脉血: 86.9fL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；氯离子(Cl-)-静脉血: 97.5mmol/L；葡萄糖(Glu)-静脉血: 5.35mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.89；镁离子(Mg2+)-静脉血: 0.78mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.34mmolL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；中性粒细胞计数(Neut#)-静脉血: 1.710E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.13mmol/L；直接胆红素(DBIL)-静脉血: 2.5umol/L；磷(P)-静脉血: 1.18mmol/L；球蛋白(GLO)-静脉血: 28.13g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.01；白细胞计数(WBC#)-静脉血: 3.0210E9/L；平均血小板体积(MPV)-静脉血: 8.8fL；总胆红素(TBIL)-静脉血: 9.3umol/L；碱性磷酸酶(ALP)-静脉血: 57.9U/L；中性粒细胞百分比(Neut%)-静脉血: 0.55；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；血小板计数(PLT#)-静脉血: 13810E9/L；肌酐(Crea)-静脉血: 90.1umol/L；血红蛋白(Hb)-静……\n- [全程D42] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后复查： 鼻咽腔稍狭窄，鼻咽双侧壁、顶后壁增厚，左侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。右侧咽隐窝变窄。肿物侵犯左侧腭帆张提肌，右侧腭帆提肌结构稍模糊，右侧腭帆张提肌间隙稍模糊。 双侧头长肌、翼内外肌未见明显异常。 双侧翼腭窝、上颌后脂肪间隙、咀嚼肌间隙未见异常。 口咽各壁未见增厚。鼻腔内未见肿物。 蝶骨基底部、左侧翼突基底部及内侧板骨质信号降低，增强扫描可见强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦粘膜稍增厚，双侧乳突未见明显异常。 左侧咽后见几个淋巴结，最大者约8mm×5mm，边界欠清，明显强化。双颈II区见多个淋巴结，最大者约15mm×12mm，边界尚清，较均匀明显强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗后复查，对比某次就诊时间片： 鼻咽部肿物，较前明显缩小。 颅底骨质破坏，较前未见明显变化。 左侧咽后、双颈II区淋巴结，可疑转移，其中右颈IIa区淋巴结较前增大，余较前未见明显变化。 轻度鼻窦炎。\n\n【既往治疗与反应】\n- [全程D35] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者未诉特殊不适，精神睡眠可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。03-22血生化常规未见异常。[姓名已隐去]医生信息已隐藏：患者1程PF方案诱导化疗后，一般情况可，已排除化疗禁忌症，今日水化，明日开始化疗（DDP 130mg d1 ; 5-Fu6.5g civ）。并予对症支持治疗。\n- [全程D36] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉稍恶心呕吐，无头痛、头晕，精神睡眠可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]副医生信息已隐藏：加强对症治疗，患者一般情况可，继续完成化疗，注意休息，加强营养。\n- [全程D37] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉稍恶心，无明显呕吐，无头痛、头晕，精神睡眠可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]副医生信息已隐藏：患者一般情况可继续完成化疗，\n- [全程D41] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者诉恶心呕吐，盗汗，头晕鼻塞，精神睡眠可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。03-29血常规示：WBC3.0*109/L NE1.7*109/L 生化示：血钾 3.3mmol/L[姓名已隐去]医生信息已隐藏：患者第二程诱导化疗，出现I度骨髓抑制，予香伏益血。胃肠道反应相比上次稍重，嘱少食多餐，加强营养。今日化疗结束，嘱明日出院。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即启动第三程PF方案诱导化疗，随后再行根治性放射治疗。\nB. 更改化疗方案为TP或GP方案继续诱导化疗，随后再行根治性放射治疗。\nC. 立即行鼻咽及颈部根治性手术切除，术后辅以根治性放射治疗。\nD. 出院休养，待化疗副反应恢复后，行右颈部淋巴结清扫术，再行根治性放疗。\nE. 立即予以全量根治性放射治疗，并联合靶向药物如西妥昔单抗。\nF. 出院休养，行颈部淋巴结穿刺活检明确病理，再决定后续放疗方案。\nG. 立即启动根治性放射治疗，暂缓处理骨髓抑制及胃肠道反应。\nH. 出院休养，待化疗副反应恢复后，行姑息性放射治疗联合免疫治疗。\nI. 行全身PET-CT重新评估远处转移情况，再决定是否启动根治性放疗。\nJ. 出院休养并对症处理化疗副反应，定期复查血常规及肝肾功能，按计划返院行根治性放射治疗。\nK. 出院休养，定期复查血常规及肝肾功能，待恢复后返院行第三程PF方案诱导化疗。\nL. 立即予以同期放化疗，并对右颈淋巴结局部推量加量放疗。\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-9cd68a6b9c75f1d90e6a9dbe","patient_id":"patient-e5fcd31b4b8b85194b146991","turn_id":"turn08","turn_position":7,"turn_type":"response_assessment_decision","gold_letter":"K","gold_action":"评估为放化疗后临床缓解，按计划结疗出院，嘱鼻腔冲洗、张口及颈部功能锻炼，定期随访复查。","options":[{"letter":"A","text":"评估为原发灶缓解但颈部淋巴结残留，行双侧颈部淋巴结清扫术，术后定期随访复查。","is_gold":false},{"letter":"B","text":"评估为颅底骨质破坏未缓解，局部追加立体定向放射治疗推量，并定期随访复查。","is_gold":false},{"letter":"C","text":"评估为放化疗后部分缓解，继续原方案辅助化疗2个周期以巩固疗效。","is_gold":false},{"letter":"D","text":"评估为放化疗后临床缓解，按计划结疗出院，序贯PD-1抑制剂维持治疗1年。","is_gold":false},{"letter":"E","text":"评估为原发灶残留，行鼻咽内镜下挽救性切除术，术后配合张口及颈部功能锻炼。","is_gold":false},{"letter":"F","text":"评估为放化疗后临床缓解，按计划结疗出院，3个月后行PET-CT评估，期间无需特殊干预。","is_gold":false},{"letter":"G","text":"评估为放化疗后病情稳定，更改化疗方案为吉西他滨联合顺铂进行二线化疗。","is_gold":false},{"letter":"H","text":"评估为放化疗后临床缓解，按计划结疗出院，预防性给予全脑放射治疗。","is_gold":false},{"letter":"I","text":"评估为颈部淋巴结残留，局部追加电子线放射治疗推量，并加强营养支持。","is_gold":false},{"letter":"J","text":"评估为放化疗后临床缓解，按计划结疗出院，序贯口服卡培他滨节拍维持治疗1年。","is_gold":false},{"letter":"K","text":"评估为放化疗后临床缓解，按计划结疗出院，嘱鼻腔冲洗、张口及颈部功能锻炼，定期随访复查。","is_gold":true},{"letter":"L","text":"评估为颅底病灶残留，转诊行质子重离子放射治疗以提高局部控制率。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 回吸性涕血1月余。；现病史: 缘于1月前患者无意中出现抽吸性血涕，痰中带血；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻咽角化,涕血,痰中带血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：78次/分，R：20次/分，BP：125/80mmHg,Ht：162cm，Wt：61kg，BSA：1.6483m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 回吸性涕血1月余。；现病史: 缘于1月前患者无意中出现抽吸性血涕，痰中带血；无头痛、面麻，无视力下降、复视，无听力下降、耳鸣等不适，于当地乡镇医院予滴鼻治疗，具体药物不详，未见好转，遂于某次就诊时间往[地点已隐去]人民医院检查，某次就诊时间病理活检示：鼻咽未分化型角化性癌。某次就诊时间鼻咽MRI示：左侧鼻咽部占位病变，考虑鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻咽角化,涕血,痰中带血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：78次/分，R：20次/分，BP：125/80mmHg,Ht：162cm，Wt：61kg，BSA：1.6483m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率100次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 胱抑素(Cys-C)-静脉血: 0.77mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.69mmol/L；阴离子间隙(AG)-静脉血: 13；磷(P)-静脉血: 0.92mmol/L；总胆红素(TBIL)-静脉血: 12.4umol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；肌酐(Crea)-静脉血: 80.5umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.58；Rh血型-静脉血: 阳性；总钙(Ca)-静脉血: 2.44mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；血小板计数(PLT#)-静脉血: 21910E9/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 4.81mmol/L；直接胆红素(DBIL)-静脉血: 4.2umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.64mmolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.013；载脂蛋白B(apoB)-静脉血: 0.73g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.3pg；α-L-岩藻糖苷酶(AFU)-静脉血: 24U/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 8.2umolL；白蛋白(ALB)-静脉血: 45.8g/L；血小板比容-静脉血: 21%；ABO血型-静脉血: O；尿素氮(BUN)-静脉血: 3.6mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；凝血酶时间(TT)-静脉血: 20.2sec.；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；载脂蛋白AI(apoAI)-静脉血: 1.33g/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；C-反应蛋白(CRP)-静脉血: 0.36mg/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血:……\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔稍狭窄，鼻咽左侧壁明显增厚，左侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。肿物侵犯左侧腭帆张提肌，左侧咽旁脂肪间隙变窄。鼻咽顶后壁稍增厚，右侧壁未见明显增厚，右侧咽隐窝清晰。 右侧腭帆张提肌、双侧头长肌、翼内外肌未见明显异常。 双侧翼腭窝、上颌后脂肪间隙、咀嚼肌间隙未见异常。 口咽各壁未见增厚。鼻腔内未见肿物。 蝶骨基底部、左侧翼突基底部及内侧板骨质信号降低，增强扫描可见强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦粘膜稍增厚，双侧乳突未见明显异常。 左侧咽后见几个淋巴结，最大者约8mm×5mm，边界欠清，明显强化。双颈II区见多个淋巴结，最大者约16mm×8mm，边界尚清，较均匀明显强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽左侧壁增厚，左侧咽隐窝肿物，考虑鼻咽癌。 颅底骨质破坏。 左侧咽后、双颈II区淋巴结，可疑转移。 轻度鼻窦炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右侧约平T6椎体水平，估计导管末端位于上腔静脉上段内。；检查结论: PICC管位置如上所述。\n- [全程D13] 检验组合: 酸碱度(pH)-尿液: 5.5；粘液丝计数(MUCS#)-尿液: 11/μL；酮体(KET)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 1/μL；红细胞计数(RBC#)-尿液: 3/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: colorless；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；比重(SG)-尿液: 1.008\n- [全程D14] 检验组合: 总蛋白(TP)-尿液: +- 0.2g（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；红细胞计数(RBC#)-尿液: 1/μL；葡萄糖(Glu)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.02；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；粘液丝计数(MUCS#)-尿液: 4/μL；白细胞(LEU)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D15] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 11/μL；酮体(KET)-尿液: -（参考: 阴性）；酵母菌(YEAST)-尿液: 1/μL；白细胞(LEU)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 1/μL；比重(SG)-尿液: 1.019；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 7/μL；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；酸碱度(pH)-尿液: 6.5；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D19] 检验组合: 氯离子(Cl-)-静脉血: 96.7mmol/L；总蛋白(TP)-静脉血: 73.8g/L；甘油三酯(TG)-静脉血: 1mmol/L；血小板计数(PLT#)-静脉血: 18410E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.2；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.27；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.44mmolL；球蛋白(GLO)-静脉血: 27.4g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；丙氨酸氨基转移酶(ALT)-静脉血: 16.1U/L；总钙(Ca)-静脉血: 2.31mmol/L；血小板比容-静脉血: 18%；血红蛋白(Hb)-静脉血: 144g/L；血液二氧化碳含量ctCO2(B)-静脉血: 26.5mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 356g/L；胱抑素(Cys-C)-静脉血: 0.75mg/L；γ-谷氨酰基转移酶(GGT)-静脉血: 18.1U/L；红细胞计数(RBC#)-静脉血: 4.5310E12/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.1；淋巴细胞百分比(Lymph%)-静脉血: 0.277；平均红细胞血红蛋白含量(MCH)-静脉血: 31.8pg；尿酸(UA)-静脉血: 231.9umol/L；乳酸脱氢酶(LDH)-静脉血: 158.8U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；载脂蛋白B(apoB)-静脉血: 0.78g/L；中性粒细胞百分比(Neut%)-静脉血: 0.597；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；血小板分布宽度(PDW)-静脉血: 10.5%；间接胆红素(IBIL)-静脉血: 11.1umolL；单核细胞百分比(Mono%)-静脉血: 0.101；天门冬氨酸氨基转移酶(AST)-静脉血: 20.5U/L；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L；白细胞计数(WBC#)-静脉血: 4.8310E9/L；镁离子(Mg2+)-静脉血: 0.93mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.36g/L；总胆红素(TBIL)-静脉血: 16.1umol/……\n- [全程D34] 检验组合: 阴离子间隙(AG)-静脉血: 10.5；乳酸脱氢酶(LDH)-静脉血: 175.1U/L；肌酐(Crea)-静脉血: 86umol/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；钾离子(K+)-静脉血: 3.9mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.43；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.18；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；甘油三酯(TG)-静脉血: 0.79mmol/L；总蛋白(TP)-静脉血: 76.5g/L；大血小板百分比(P-LCR%)-静脉血: 15.9%；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.537；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；总钙(Ca)-静脉血: 2.39mmol/L；尿酸(UA)-静脉血: 334.3umol/L；钠离子(Na+)-静脉血: 142.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.53g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；单核细胞百分比(Mono%)-静脉血: 0.102；有核红细胞百分比(NRBC%)-静脉血: 0；单核细胞计数(Mono#)-静脉血: 0.510E9/L；碱性磷酸酶(ALP)-静脉血: 63.6U/L；间接胆红素(IBIL)-静脉血: 6.8umolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.028；平均红细胞体积(MCV)-静脉血: 90.7fL；淋巴细胞百分比(Lymph%)-静脉血: 0.325；血液二氧化碳含量ctCO2(B)-静脉血: 29.6mmol/L；血小板分布宽度(PDW)-静脉血: 8.8%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.3；平均血小板体积(MPV)-静脉血: 8.9fL；球蛋白(GLO)-静脉血: 31.5g/L；血红蛋白(Hb)-静脉血: 130g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 29U/L；白蛋白(ALB)-静脉血: 45g/L；总胆汁酸(TBA)-静脉血: 5.6umol/L；总胆固醇(TC)-静脉血: 5.01mmol/L……\n- [全程D35] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；比重(SG)-尿液: 1.015；白细胞计数(WBC#)-尿液: 2/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 6.5；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）\n- [全程D36] 检验组合: 浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 7.5；隐血(OB)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；胆红素(BIL)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.022；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）\n- [全程D37] 检验组合: 颜色-尿液: Yellow；葡萄糖(Glu)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.018；隐血(OB)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 3/μL；酸碱度(pH)-尿液: 7；酮体(KET)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D41] 检验组合: 总胆固醇(TC)-静脉血: 4.84mmol/L；红细胞计数(RBC#)-静脉血: 4.2110E12/L；红细胞比容(Hct)-静脉血: 36.6%；血小板分布宽度(PDW)-静脉血: 7.9%；白蛋白(ALB)-静脉血: 42.1g/L；尿素氮(BUN)-静脉血: 4.8mmol/L；总钙(Ca)-静脉血: 2.25mmol/L；乳酸脱氢酶(LDH)-静脉血: 148.6U/L；钾离子(K+)-静脉血: 3.3mmol/L；阴离子间隙(AG)-静脉血: 14.2；血液二氧化碳含量ctCO2(B)-静脉血: 25mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；胱抑素(Cys-C)-静脉血: 0.8mg/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 350g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.4pg；平均红细胞体积(MCV)-静脉血: 86.9fL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；氯离子(Cl-)-静脉血: 97.5mmol/L；葡萄糖(Glu)-静脉血: 5.35mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.89；镁离子(Mg2+)-静脉血: 0.78mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.34mmolL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；中性粒细胞计数(Neut#)-静脉血: 1.710E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.13mmol/L；直接胆红素(DBIL)-静脉血: 2.5umol/L；磷(P)-静脉血: 1.18mmol/L；球蛋白(GLO)-静脉血: 28.13g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.01；白细胞计数(WBC#)-静脉血: 3.0210E9/L；平均血小板体积(MPV)-静脉血: 8.8fL；总胆红素(TBIL)-静脉血: 9.3umol/L；碱性磷酸酶(ALP)-静脉血: 57.9U/L；中性粒细胞百分比(Neut%)-静脉血: 0.55；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；血小板计数(PLT#)-静脉血: 13810E9/L；肌酐(Crea)-静脉血: 90.1umol/L；血红蛋白(Hb)-静……\n- [全程D42] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后复查： 鼻咽腔稍狭窄，鼻咽双侧壁、顶后壁增厚，左侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。右侧咽隐窝变窄。肿物侵犯左侧腭帆张提肌，右侧腭帆提肌结构稍模糊，右侧腭帆张提肌间隙稍模糊。 双侧头长肌、翼内外肌未见明显异常。 双侧翼腭窝、上颌后脂肪间隙、咀嚼肌间隙未见异常。 口咽各壁未见增厚。鼻腔内未见肿物。 蝶骨基底部、左侧翼突基底部及内侧板骨质信号降低，增强扫描可见强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦粘膜稍增厚，双侧乳突未见明显异常。 左侧咽后见几个淋巴结，最大者约8mm×5mm，边界欠清，明显强化。双颈II区见多个淋巴结，最大者约15mm×12mm，边界尚清，较均匀明显强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗后复查，对比某次就诊时间片： 鼻咽部肿物，较前明显缩小。 颅底骨质破坏，较前未见明显变化。 左侧咽后、双颈II区淋巴结，可疑转移，其中右颈IIa区淋巴结较前增大，余较前未见明显变化。 轻度鼻窦炎。\n- [全程D76] 检验组合: 钠离子(Na+)-静脉血: 138.3mmol/L；球蛋白(GLO)-静脉血: 27.6g/L；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 14.1U/L；碱性磷酸酶(ALP)-静脉血: 64.9U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 26.4U/L；平均血小板体积(MPV)-静脉血: 9fL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；红细胞比容(Hct)-静脉血: 29.5%；白蛋白(ALB)-静脉血: 44.6g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.62；α-L-岩藻糖苷酶(AFU)-静脉血: 24U/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；尿酸(UA)-静脉血: 284.2umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 8.7U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.73mmol/L；平均红细胞体积(MCV)-静脉血: 87.5fL；血小板比容-静脉血: 14%；单核细胞百分比(Mono%)-静脉血: 0.136；间接胆红素(IBIL)-静脉血: 7.16umolL；血液二氧化碳含量ctCO2(B)-静脉血: 23.6mmol/L；尿素氮(BUN)-静脉血: 5.4mmol/L；乳酸脱氢酶(LDH)-静脉血: 140.2U/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 104g/L；直接胆红素(DBIL)-静脉血: 3.72umol/L；载脂蛋白B(apoB)-静脉血: 0.86g/L；钾离子(K+)-静脉血: 4.1mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.129；中性粒细胞百分比(Neut%)-静脉血: 0.713；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.2；平均红细胞血红蛋白浓度(MCHC)-静脉血: 353g/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L；红细胞计数(RBC#)-静脉血: 3.3710E12/L；C-反应蛋白(CRP)-静脉……\n- [全程D83] 检验组合: 碱性磷酸酶(ALP)-静脉血: 52.7U/L；血红蛋白(Hb)-静脉血: 96g/L；总胆汁酸(TBA)-静脉血: 2.4umol/L；磷(P)-静脉血: 1.26mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.41mmol/L；尿酸(UA)-静脉血: 329.6umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.76；血小板比容-静脉血: 11%；淋巴细胞计数(Lymph#)-静脉血: 0.410E9/L；红细胞计数(RBC#)-静脉血: 3.0610E12/L；间接胆红素(IBIL)-静脉血: 6.3umolL；血液二氧化碳含量ctCO2(B)-静脉血: 24.5mmol/L；钾离子(K+)-静脉血: 3.83mmol/L；葡萄糖(Glu)-静脉血: 4.88mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 356g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.56；氯离子(Cl-)-静脉血: 102.9mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总胆固醇(TC)-静脉血: 3.96mmol/L；平均红细胞体积(MCV)-静脉血: 88.2fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.9；中性粒细胞计数(Neut#)-静脉血: 1.310E9/L；阴离子间隙(AG)-静脉血: 12.6；尿素氮(BUN)-静脉血: 5.9mmol/L；肌酐(Crea)-静脉血: 89.8umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 20.3U/L；球蛋白(GLO)-静脉血: 25.51g/L；镁离子(Mg2+)-静脉血: 0.77mmol/L；乳酸脱氢酶(LDH)-静脉血: 128.5U/L；C-反应蛋白(CRP)-静脉血: 0.49mg/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.4pg；总蛋白(TP)-静脉血: 65.31g/L；红细胞比容(Hct)-静脉血: 27%；单核细胞计数(Mono#)-静脉血: 0.310E9/L；血小板分布宽度(PDW)-静脉血: 8.1%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.009；单核细胞百分比(Mono%)-静脉血: 0.156；嗜碱性粒细胞计数(Baso#)-静脉血:……\n- [全程D90] 检验组合: 尿素氮(BUN)-静脉血: 5.1mmol/L；总胆汁酸(TBA)-静脉血: 3.6umol/L；总钙(Ca)-静脉血: 2.27mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 21.5U/L；总胆红素(TBIL)-静脉血: 11.71umol/L；载脂蛋白AI(apoAI)-静脉血: 1.59g/L；载脂蛋白B(apoB)-静脉血: 0.85g/L；氯离子(Cl-)-静脉血: 99.7mmol/L；白蛋白(ALB)-静脉血: 46.3g/L；有核红细胞百分比(NRBC%)-静脉血: 0；血小板计数(PLT#)-静脉血: 14210E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；血小板比容-静脉血: 13%；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.58；嗜酸性粒细胞计数(Eos#)-静脉血: 0.410E9/L；血小板分布宽度(PDW)-静脉血: 9%；磷(P)-静脉血: 1.33mmol/L；尿酸(UA)-静脉血: 467.8umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.78；甘油三酯(TG)-静脉血: 0.58mmol/L；C-反应蛋白(CRP)-静脉血: 0.4mg/L；平均红细胞体积(MCV)-静脉血: 91.4fL；α-L-岩藻糖苷酶(AFU)-静脉血: 22.5U/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1；中性粒细胞计数(Neut#)-静脉血: 2.210E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 346g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；白细胞计数(WBC#)-静脉血: 3.4910E9/L；钾离子(K+)-静脉血: 3.89mmol/L；血红蛋白(Hb)-静脉血: 118g/L；平均血小板体积(MPV)-静脉血: 9fL；中性粒细胞百分比(Neut%)-静脉血: 0.636；红细胞计数(RBC#)-静脉血: 3.7310E12/L；肌酐(Crea)-静脉血: 91.5umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.132；总胆固醇(TC)-静脉血: 4.55mmol/L；阴离子间隙(AG)-静脉血: 14.7……\n- [全程D91] 检验组合: 比重(SG)-尿液: 1.011；酮体(KET)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5；隐血(OB)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；总蛋白(TP)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；白细胞计数(WBC#)-尿液: 3/μL\n- [全程D92] 检验组合: 亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；隐血(OB)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 2/μL；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；比重(SG)-尿液: 1.018；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）\n- [全程D94] 检验组合: 亚硝酸盐(NIT)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 11/μL；颜色-尿液: Yellow；白细胞计数(WBC#)-尿液: 5/μL；酮体(KET)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 28/μL；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.014；酸碱度(pH)-尿液: 6\n- [全程D97] 检验组合: 低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.8mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；平均红细胞体积(MCV)-静脉血: 86.8fL；载脂蛋白AI(apoAI)-静脉血: 1.3g/L；甘油三酯(TG)-静脉血: 0.75mmol/L；钠离子(Na+)-静脉血: 139mmol/L；总钙(Ca)-静脉血: 2.24mmol/L；氯离子(Cl-)-静脉血: 98.2mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 13.3U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.65；α-L-岩藻糖苷酶(AFU)-静脉血: 24.8U/L；碱性磷酸酶(ALP)-静脉血: 57U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 21.5U/L；血小板比容-静脉血: 12%；直接胆红素(DBIL)-静脉血: 4.61umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.642；白细胞计数(WBC#)-静脉血: 2.0410E9/L；大血小板百分比(P-LCR%)-静脉血: 11.5%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.127；血液二氧化碳含量ctCO2(B)-静脉血: 27.4mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 357g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.5；总蛋白(TP)-静脉血: 67.8g/L；血红蛋白(Hb)-静脉血: 96g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.310E9/L；尿酸(UA)-静脉血: 356.9umol/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；血小板计数(PLT#)-静脉血: 14210E9/L；钾离子(K+)-静脉血: 3.77mmol/L；载脂蛋白B(apoB)-静脉血: 0.86g/L；单核细胞百分比(Mono%)-静脉血: 0.083；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.37；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.02；胱抑素(Cys-C)-静脉血: 0.71mg/L；白蛋白(ALB)-静脉血: 42.2g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞计数(Neut#)-静脉血: 1.310E9/L……\n- [全程D98] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗放疗后复查： 鼻咽腔无狭窄，鼻咽壁无增厚，粘膜规整无增厚，双侧咽隐窝、咽旁脂肪间隙未见异常。双侧腭帆张、提肌、双侧头长肌、翼内外肌未见明显异常。 双侧翼腭窝、上颌后脂肪间隙、咀嚼肌间隙未见异常。 口咽各壁未见增厚。鼻腔内未见肿物。 蝶骨基底部左份、左侧翼突基底部及内侧骨质信号降低，增强扫描可见强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦粘膜稍增厚，骨壁完整。左乳头见少许渗出影。 双侧咽后未见肿大淋巴结。双颈II区见多个淋巴结，最大者约8mm×5mm，边界尚清，较均匀明显强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗放疗后复查，对比某次就诊时间片： 鼻咽未见明显病灶。 颅底骨质破坏，较前未见明显变化。 左侧咽后淋巴结消失，双颈II区淋巴结缩小。 鼻窦炎，左乳突炎。\n- [全程D98] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称。双肺纹理清晰；双肺野未见明显实质性病变；双侧肺门无增大。纵隔未见增宽。心影大小、形态正常。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D17] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者第一程诱导化疗后，诉轻度恶心呕吐，精神睡眠尚可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。钱医生信息已隐藏：患者03-02开始予5-Fu6.6g,DDP130mg化疗，患者未诉特殊不适，注意观察不良反应。\n- [全程D19] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者化疗后，诉轻度恶心，精神睡眠尚可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。医生信息已隐藏：患者第一程诱导化疗顺利，一般情况可，予出院。\n- [全程D35] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者未诉特殊不适，精神睡眠可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。03-22血生化常规未见异常。[姓名已隐去]医生信息已隐藏：患者1程PF方案诱导化疗后，一般情况可，已排除化疗禁忌症，今日水化，明日开始化疗（DDP 130mg d1 ; 5-Fu6.5g civ）。并予对症支持治疗。\n- [全程D36] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉稍恶心呕吐，无头痛、头晕，精神睡眠可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]副医生信息已隐藏：加强对症治疗，患者一般情况可，继续完成化疗，注意休息，加强营养。\n- [全程D37] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉稍恶心，无明显呕吐，无头痛、头晕，精神睡眠可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]副医生信息已隐藏：患者一般情况可继续完成化疗，\n- [全程D41] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者诉恶心呕吐，盗汗，头晕鼻塞，精神睡眠可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。03-29血常规示：WBC3.0*109/L NE1.7*109/L 生化示：血钾 3.3mmol/L[姓名已隐去]医生信息已隐藏：患者第二程诱导化疗，出现I度骨髓抑制，予香伏益血。胃肠道反应相比上次稍重，嘱少食多餐，加强营养。今日化疗结束，嘱明日出院。\n- [全程D77] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 今行放疗第15次，患者口干咽痛，稍恶心、呕吐，食纳、睡眠欠佳。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。某次就诊时间日查血常规、肝肾功能电解质无明显异常。[姓名已隐去]副医生信息已隐藏：予口腔粘膜保护等对症治疗，加强营养支持治疗，继续完成放疗。\n- [全程D82] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今行放疗第18次，患者口干咽痛，稍恶心、呕吐，食纳、睡眠欠佳。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物，较前缩小；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]医生信息已隐藏：予口腔粘膜保护等对症治疗，加强营养支持治疗，明日复查血常规、肝肾功能，继续完成放疗。\n- [全程D91] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今行放疗第25次，患者口干咽痛，稍恶心、呕吐，食纳、睡眠欠佳。查体：张口门齿距4.5cm；鼻咽肿物不明显；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。昨日查血常规、肝肾功能未见明显异常。[姓名已隐去]医生信息已隐藏：予口腔粘膜保护等对症治疗，加强营养支持治疗，明日予同期DDP化疗，密切观察放化疗反应，继续完成放疗。\n- [全程D96] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 今行放疗第28次，患者口干咽痛，稍恶心、呕吐，食纳、睡眠欠佳。查体：张口门齿距4.5cm；鼻咽肿物不明显；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]医生信息已隐藏：予口腔粘膜保护等对症治疗，加强营养支持治疗，明日复查血常规、肝肾功能，继续完成放疗。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估为原发灶缓解但颈部淋巴结残留，行双侧颈部淋巴结清扫术，术后定期随访复查。\nB. 评估为颅底骨质破坏未缓解，局部追加立体定向放射治疗推量，并定期随访复查。\nC. 评估为放化疗后部分缓解，继续原方案辅助化疗2个周期以巩固疗效。\nD. 评估为放化疗后临床缓解，按计划结疗出院，序贯PD-1抑制剂维持治疗1年。\nE. 评估为原发灶残留，行鼻咽内镜下挽救性切除术，术后配合张口及颈部功能锻炼。\nF. 评估为放化疗后临床缓解，按计划结疗出院，3个月后行PET-CT评估，期间无需特殊干预。\nG. 评估为放化疗后病情稳定，更改化疗方案为吉西他滨联合顺铂进行二线化疗。\nH. 评估为放化疗后临床缓解，按计划结疗出院，预防性给予全脑放射治疗。\nI. 评估为颈部淋巴结残留，局部追加电子线放射治疗推量，并加强营养支持。\nJ. 评估为放化疗后临床缓解，按计划结疗出院，序贯口服卡培他滨节拍维持治疗1年。\nK. 评估为放化疗后临床缓解，按计划结疗出院，嘱鼻腔冲洗、张口及颈部功能锻炼，定期随访复查。\nL. 评估为颅底病灶残留，转诊行质子重离子放射治疗以提高局部控制率。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D76] 检验组合: 钠离子(Na+)-静脉血: 138.3mmol/L；球蛋白(GLO)-静脉血: 27.6g/L；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 14.1U/L；碱性磷酸酶(ALP)-静脉血: 64.9U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 26.4U/L；平均血小板体积(MPV)-静脉血: 9fL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；红细胞比容(Hct)-静脉血: 29.5%；白蛋白(ALB)-静脉血: 44.6g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.62；α-L-岩藻糖苷酶(AFU)-静脉血: 24U/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；尿酸(UA)-静脉血: 284.2umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 8.7U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.73mmol/L；平均红细胞体积(MCV)-静脉血: 87.5fL；血小板比容-静脉血: 14%；单核细胞百分比(Mono%)-静脉血: 0.136；间接胆红素(IBIL)-静脉血: 7.16umolL；血液二氧化碳含量ctCO2(B)-静脉血: 23.6mmol/L；尿素氮(BUN)-静脉血: 5.4mmol/L；乳酸脱氢酶(LDH)-静脉血: 140.2U/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 104g/L；直接胆红素(DBIL)-静脉血: 3.72umol/L；载脂蛋白B(apoB)-静脉血: 0.86g/L；钾离子(K+)-静脉血: 4.1mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.129；中性粒细胞百分比(Neut%)-静脉血: 0.713；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.2；平均红细胞血红蛋白浓度(MCHC)-静脉血: 353g/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L；红细胞计数(RBC#)-静脉血: 3.3710E12/L；C-反应蛋白(CRP)-静脉……\n- [全程D83] 检验组合: 碱性磷酸酶(ALP)-静脉血: 52.7U/L；血红蛋白(Hb)-静脉血: 96g/L；总胆汁酸(TBA)-静脉血: 2.4umol/L；磷(P)-静脉血: 1.26mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.41mmol/L；尿酸(UA)-静脉血: 329.6umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.76；血小板比容-静脉血: 11%；淋巴细胞计数(Lymph#)-静脉血: 0.410E9/L；红细胞计数(RBC#)-静脉血: 3.0610E12/L；间接胆红素(IBIL)-静脉血: 6.3umolL；血液二氧化碳含量ctCO2(B)-静脉血: 24.5mmol/L；钾离子(K+)-静脉血: 3.83mmol/L；葡萄糖(Glu)-静脉血: 4.88mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 356g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.56；氯离子(Cl-)-静脉血: 102.9mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总胆固醇(TC)-静脉血: 3.96mmol/L；平均红细胞体积(MCV)-静脉血: 88.2fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.9；中性粒细胞计数(Neut#)-静脉血: 1.310E9/L；阴离子间隙(AG)-静脉血: 12.6；尿素氮(BUN)-静脉血: 5.9mmol/L；肌酐(Crea)-静脉血: 89.8umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 20.3U/L；球蛋白(GLO)-静脉血: 25.51g/L；镁离子(Mg2+)-静脉血: 0.77mmol/L；乳酸脱氢酶(LDH)-静脉血: 128.5U/L；C-反应蛋白(CRP)-静脉血: 0.49mg/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.4pg；总蛋白(TP)-静脉血: 65.31g/L；红细胞比容(Hct)-静脉血: 27%；单核细胞计数(Mono#)-静脉血: 0.310E9/L；血小板分布宽度(PDW)-静脉血: 8.1%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.009；单核细胞百分比(Mono%)-静脉血: 0.156；嗜碱性粒细胞计数(Baso#)-静脉血:……\n- [全程D90] 检验组合: 尿素氮(BUN)-静脉血: 5.1mmol/L；总胆汁酸(TBA)-静脉血: 3.6umol/L；总钙(Ca)-静脉血: 2.27mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 21.5U/L；总胆红素(TBIL)-静脉血: 11.71umol/L；载脂蛋白AI(apoAI)-静脉血: 1.59g/L；载脂蛋白B(apoB)-静脉血: 0.85g/L；氯离子(Cl-)-静脉血: 99.7mmol/L；白蛋白(ALB)-静脉血: 46.3g/L；有核红细胞百分比(NRBC%)-静脉血: 0；血小板计数(PLT#)-静脉血: 14210E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；血小板比容-静脉血: 13%；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.58；嗜酸性粒细胞计数(Eos#)-静脉血: 0.410E9/L；血小板分布宽度(PDW)-静脉血: 9%；磷(P)-静脉血: 1.33mmol/L；尿酸(UA)-静脉血: 467.8umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.78；甘油三酯(TG)-静脉血: 0.58mmol/L；C-反应蛋白(CRP)-静脉血: 0.4mg/L；平均红细胞体积(MCV)-静脉血: 91.4fL；α-L-岩藻糖苷酶(AFU)-静脉血: 22.5U/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1；中性粒细胞计数(Neut#)-静脉血: 2.210E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 346g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；白细胞计数(WBC#)-静脉血: 3.4910E9/L；钾离子(K+)-静脉血: 3.89mmol/L；血红蛋白(Hb)-静脉血: 118g/L；平均血小板体积(MPV)-静脉血: 9fL；中性粒细胞百分比(Neut%)-静脉血: 0.636；红细胞计数(RBC#)-静脉血: 3.7310E12/L；肌酐(Crea)-静脉血: 91.5umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.132；总胆固醇(TC)-静脉血: 4.55mmol/L；阴离子间隙(AG)-静脉血: 14.7……\n- [全程D91] 检验组合: 比重(SG)-尿液: 1.011；酮体(KET)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5；隐血(OB)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；总蛋白(TP)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；白细胞计数(WBC#)-尿液: 3/μL\n- [全程D92] 检验组合: 亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；隐血(OB)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 2/μL；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；比重(SG)-尿液: 1.018；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）\n- [全程D94] 检验组合: 亚硝酸盐(NIT)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 11/μL；颜色-尿液: Yellow；白细胞计数(WBC#)-尿液: 5/μL；酮体(KET)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 28/μL；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.014；酸碱度(pH)-尿液: 6\n- [全程D97] 检验组合: 低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.8mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；平均红细胞体积(MCV)-静脉血: 86.8fL；载脂蛋白AI(apoAI)-静脉血: 1.3g/L；甘油三酯(TG)-静脉血: 0.75mmol/L；钠离子(Na+)-静脉血: 139mmol/L；总钙(Ca)-静脉血: 2.24mmol/L；氯离子(Cl-)-静脉血: 98.2mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 13.3U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.65；α-L-岩藻糖苷酶(AFU)-静脉血: 24.8U/L；碱性磷酸酶(ALP)-静脉血: 57U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 21.5U/L；血小板比容-静脉血: 12%；直接胆红素(DBIL)-静脉血: 4.61umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.642；白细胞计数(WBC#)-静脉血: 2.0410E9/L；大血小板百分比(P-LCR%)-静脉血: 11.5%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.127；血液二氧化碳含量ctCO2(B)-静脉血: 27.4mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 357g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.5；总蛋白(TP)-静脉血: 67.8g/L；血红蛋白(Hb)-静脉血: 96g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.310E9/L；尿酸(UA)-静脉血: 356.9umol/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；血小板计数(PLT#)-静脉血: 14210E9/L；钾离子(K+)-静脉血: 3.77mmol/L；载脂蛋白B(apoB)-静脉血: 0.86g/L；单核细胞百分比(Mono%)-静脉血: 0.083；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.37；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.02；胱抑素(Cys-C)-静脉血: 0.71mg/L；白蛋白(ALB)-静脉血: 42.2g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞计数(Neut#)-静脉血: 1.310E9/L……\n- [全程D98] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗放疗后复查： 鼻咽腔无狭窄，鼻咽壁无增厚，粘膜规整无增厚，双侧咽隐窝、咽旁脂肪间隙未见异常。双侧腭帆张、提肌、双侧头长肌、翼内外肌未见明显异常。 双侧翼腭窝、上颌后脂肪间隙、咀嚼肌间隙未见异常。 口咽各壁未见增厚。鼻腔内未见肿物。 蝶骨基底部左份、左侧翼突基底部及内侧骨质信号降低，增强扫描可见强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦粘膜稍增厚，骨壁完整。左乳头见少许渗出影。 双侧咽后未见肿大淋巴结。双颈II区见多个淋巴结，最大者约8mm×5mm，边界尚清，较均匀明显强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗放疗后复查，对比某次就诊时间片： 鼻咽未见明显病灶。 颅底骨质破坏，较前未见明显变化。 左侧咽后淋巴结消失，双颈II区淋巴结缩小。 鼻窦炎，左乳突炎。\n- [全程D98] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称。双肺纹理清晰；双肺野未见明显实质性病变；双侧肺门无增大。纵隔未见增宽。心影大小、形态正常。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n\n【既往治疗与反应】\n- [全程D77] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 今行放疗第15次，患者口干咽痛，稍恶心、呕吐，食纳、睡眠欠佳。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。某次就诊时间日查血常规、肝肾功能电解质无明显异常。[姓名已隐去]副医生信息已隐藏：予口腔粘膜保护等对症治疗，加强营养支持治疗，继续完成放疗。\n- [全程D82] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今行放疗第18次，患者口干咽痛，稍恶心、呕吐，食纳、睡眠欠佳。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物，较前缩小；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]医生信息已隐藏：予口腔粘膜保护等对症治疗，加强营养支持治疗，明日复查血常规、肝肾功能，继续完成放疗。\n- [全程D91] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今行放疗第25次，患者口干咽痛，稍恶心、呕吐，食纳、睡眠欠佳。查体：张口门齿距4.5cm；鼻咽肿物不明显；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。昨日查血常规、肝肾功能未见明显异常。[姓名已隐去]医生信息已隐藏：予口腔粘膜保护等对症治疗，加强营养支持治疗，明日予同期DDP化疗，密切观察放化疗反应，继续完成放疗。\n- [全程D96] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 今行放疗第28次，患者口干咽痛，稍恶心、呕吐，食纳、睡眠欠佳。查体：张口门齿距4.5cm；鼻咽肿物不明显；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]医生信息已隐藏：予口腔粘膜保护等对症治疗，加强营养支持治疗，明日复查血常规、肝肾功能，继续完成放疗。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估为原发灶缓解但颈部淋巴结残留，行双侧颈部淋巴结清扫术，术后定期随访复查。\nB. 评估为颅底骨质破坏未缓解，局部追加立体定向放射治疗推量，并定期随访复查。\nC. 评估为放化疗后部分缓解，继续原方案辅助化疗2个周期以巩固疗效。\nD. 评估为放化疗后临床缓解，按计划结疗出院，序贯PD-1抑制剂维持治疗1年。\nE. 评估为原发灶残留，行鼻咽内镜下挽救性切除术，术后配合张口及颈部功能锻炼。\nF. 评估为放化疗后临床缓解，按计划结疗出院，3个月后行PET-CT评估，期间无需特殊干预。\nG. 评估为放化疗后病情稳定，更改化疗方案为吉西他滨联合顺铂进行二线化疗。\nH. 评估为放化疗后临床缓解，按计划结疗出院，预防性给予全脑放射治疗。\nI. 评估为颈部淋巴结残留，局部追加电子线放射治疗推量，并加强营养支持。\nJ. 评估为放化疗后临床缓解，按计划结疗出院，序贯口服卡培他滨节拍维持治疗1年。\nK. 评估为放化疗后临床缓解，按计划结疗出院，嘱鼻腔冲洗、张口及颈部功能锻炼，定期随访复查。\nL. 评估为颅底病灶残留，转诊行质子重离子放射治疗以提高局部控制率。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D76] 检验组合: 钠离子(Na+)-静脉血: 138.3mmol/L；球蛋白(GLO)-静脉血: 27.6g/L；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 14.1U/L；碱性磷酸酶(ALP)-静脉血: 64.9U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 26.4U/L；平均血小板体积(MPV)-静脉血: 9fL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；红细胞比容(Hct)-静脉血: 29.5%；白蛋白(ALB)-静脉血: 44.6g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.62；α-L-岩藻糖苷酶(AFU)-静脉血: 24U/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；尿酸(UA)-静脉血: 284.2umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 8.7U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.73mmol/L；平均红细胞体积(MCV)-静脉血: 87.5fL；血小板比容-静脉血: 14%；单核细胞百分比(Mono%)-静脉血: 0.136；间接胆红素(IBIL)-静脉血: 7.16umolL；血液二氧化碳含量ctCO2(B)-静脉血: 23.6mmol/L；尿素氮(BUN)-静脉血: 5.4mmol/L；乳酸脱氢酶(LDH)-静脉血: 140.2U/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 104g/L；直接胆红素(DBIL)-静脉血: 3.72umol/L；载脂蛋白B(apoB)-静脉血: 0.86g/L；钾离子(K+)-静脉血: 4.1mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.129；中性粒细胞百分比(Neut%)-静脉血: 0.713；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.2；平均红细胞血红蛋白浓度(MCHC)-静脉血: 353g/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L；红细胞计数(RBC#)-静脉血: 3.3710E12/L；C-反应蛋白(CRP)-静脉……\n- [全程D83] 检验组合: 碱性磷酸酶(ALP)-静脉血: 52.7U/L；血红蛋白(Hb)-静脉血: 96g/L；总胆汁酸(TBA)-静脉血: 2.4umol/L；磷(P)-静脉血: 1.26mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.41mmol/L；尿酸(UA)-静脉血: 329.6umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.76；血小板比容-静脉血: 11%；淋巴细胞计数(Lymph#)-静脉血: 0.410E9/L；红细胞计数(RBC#)-静脉血: 3.0610E12/L；间接胆红素(IBIL)-静脉血: 6.3umolL；血液二氧化碳含量ctCO2(B)-静脉血: 24.5mmol/L；钾离子(K+)-静脉血: 3.83mmol/L；葡萄糖(Glu)-静脉血: 4.88mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 356g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.56；氯离子(Cl-)-静脉血: 102.9mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总胆固醇(TC)-静脉血: 3.96mmol/L；平均红细胞体积(MCV)-静脉血: 88.2fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.9；中性粒细胞计数(Neut#)-静脉血: 1.310E9/L；阴离子间隙(AG)-静脉血: 12.6；尿素氮(BUN)-静脉血: 5.9mmol/L；肌酐(Crea)-静脉血: 89.8umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 20.3U/L；球蛋白(GLO)-静脉血: 25.51g/L；镁离子(Mg2+)-静脉血: 0.77mmol/L；乳酸脱氢酶(LDH)-静脉血: 128.5U/L；C-反应蛋白(CRP)-静脉血: 0.49mg/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.4pg；总蛋白(TP)-静脉血: 65.31g/L；红细胞比容(Hct)-静脉血: 27%；单核细胞计数(Mono#)-静脉血: 0.310E9/L；血小板分布宽度(PDW)-静脉血: 8.1%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.009；单核细胞百分比(Mono%)-静脉血: 0.156；嗜碱性粒细胞计数(Baso#)-静脉血:……\n- [全程D90] 检验组合: 尿素氮(BUN)-静脉血: 5.1mmol/L；总胆汁酸(TBA)-静脉血: 3.6umol/L；总钙(Ca)-静脉血: 2.27mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 21.5U/L；总胆红素(TBIL)-静脉血: 11.71umol/L；载脂蛋白AI(apoAI)-静脉血: 1.59g/L；载脂蛋白B(apoB)-静脉血: 0.85g/L；氯离子(Cl-)-静脉血: 99.7mmol/L；白蛋白(ALB)-静脉血: 46.3g/L；有核红细胞百分比(NRBC%)-静脉血: 0；血小板计数(PLT#)-静脉血: 14210E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；血小板比容-静脉血: 13%；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.58；嗜酸性粒细胞计数(Eos#)-静脉血: 0.410E9/L；血小板分布宽度(PDW)-静脉血: 9%；磷(P)-静脉血: 1.33mmol/L；尿酸(UA)-静脉血: 467.8umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.78；甘油三酯(TG)-静脉血: 0.58mmol/L；C-反应蛋白(CRP)-静脉血: 0.4mg/L；平均红细胞体积(MCV)-静脉血: 91.4fL；α-L-岩藻糖苷酶(AFU)-静脉血: 22.5U/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1；中性粒细胞计数(Neut#)-静脉血: 2.210E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 346g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；白细胞计数(WBC#)-静脉血: 3.4910E9/L；钾离子(K+)-静脉血: 3.89mmol/L；血红蛋白(Hb)-静脉血: 118g/L；平均血小板体积(MPV)-静脉血: 9fL；中性粒细胞百分比(Neut%)-静脉血: 0.636；红细胞计数(RBC#)-静脉血: 3.7310E12/L；肌酐(Crea)-静脉血: 91.5umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.132；总胆固醇(TC)-静脉血: 4.55mmol/L；阴离子间隙(AG)-静脉血: 14.7……\n- [全程D91] 检验组合: 比重(SG)-尿液: 1.011；酮体(KET)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5；隐血(OB)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；总蛋白(TP)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；白细胞计数(WBC#)-尿液: 3/μL\n- [全程D92] 检验组合: 亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；隐血(OB)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 2/μL；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；比重(SG)-尿液: 1.018；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）\n- [全程D94] 检验组合: 亚硝酸盐(NIT)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 11/μL；颜色-尿液: Yellow；白细胞计数(WBC#)-尿液: 5/μL；酮体(KET)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 28/μL；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.014；酸碱度(pH)-尿液: 6\n- [全程D97] 检验组合: 低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.8mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；平均红细胞体积(MCV)-静脉血: 86.8fL；载脂蛋白AI(apoAI)-静脉血: 1.3g/L；甘油三酯(TG)-静脉血: 0.75mmol/L；钠离子(Na+)-静脉血: 139mmol/L；总钙(Ca)-静脉血: 2.24mmol/L；氯离子(Cl-)-静脉血: 98.2mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 13.3U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.65；α-L-岩藻糖苷酶(AFU)-静脉血: 24.8U/L；碱性磷酸酶(ALP)-静脉血: 57U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 21.5U/L；血小板比容-静脉血: 12%；直接胆红素(DBIL)-静脉血: 4.61umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.642；白细胞计数(WBC#)-静脉血: 2.0410E9/L；大血小板百分比(P-LCR%)-静脉血: 11.5%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.127；血液二氧化碳含量ctCO2(B)-静脉血: 27.4mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 357g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.5；总蛋白(TP)-静脉血: 67.8g/L；血红蛋白(Hb)-静脉血: 96g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.310E9/L；尿酸(UA)-静脉血: 356.9umol/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；血小板计数(PLT#)-静脉血: 14210E9/L；钾离子(K+)-静脉血: 3.77mmol/L；载脂蛋白B(apoB)-静脉血: 0.86g/L；单核细胞百分比(Mono%)-静脉血: 0.083；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.37；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.02；胱抑素(Cys-C)-静脉血: 0.71mg/L；白蛋白(ALB)-静脉血: 42.2g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞计数(Neut#)-静脉血: 1.310E9/L……\n- [全程D98] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗放疗后复查： 鼻咽腔无狭窄，鼻咽壁无增厚，粘膜规整无增厚，双侧咽隐窝、咽旁脂肪间隙未见异常。双侧腭帆张、提肌、双侧头长肌、翼内外肌未见明显异常。 双侧翼腭窝、上颌后脂肪间隙、咀嚼肌间隙未见异常。 口咽各壁未见增厚。鼻腔内未见肿物。 蝶骨基底部左份、左侧翼突基底部及内侧骨质信号降低，增强扫描可见强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦粘膜稍增厚，骨壁完整。左乳头见少许渗出影。 双侧咽后未见肿大淋巴结。双颈II区见多个淋巴结，最大者约8mm×5mm，边界尚清，较均匀明显强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗放疗后复查，对比某次就诊时间片： 鼻咽未见明显病灶。 颅底骨质破坏，较前未见明显变化。 左侧咽后淋巴结消失，双颈II区淋巴结缩小。 鼻窦炎，左乳突炎。\n- [全程D98] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称。双肺纹理清晰；双肺野未见明显实质性病变；双侧肺门无增大。纵隔未见增宽。心影大小、形态正常。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n\n【既往治疗与反应】\n- [全程D77] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 今行放疗第15次，患者口干咽痛，稍恶心、呕吐，食纳、睡眠欠佳。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。某次就诊时间日查血常规、肝肾功能电解质无明显异常。[姓名已隐去]副医生信息已隐藏：予口腔粘膜保护等对症治疗，加强营养支持治疗，继续完成放疗。\n- [全程D82] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今行放疗第18次，患者口干咽痛，稍恶心、呕吐，食纳、睡眠欠佳。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物，较前缩小；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]医生信息已隐藏：予口腔粘膜保护等对症治疗，加强营养支持治疗，明日复查血常规、肝肾功能，继续完成放疗。\n- [全程D91] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今行放疗第25次，患者口干咽痛，稍恶心、呕吐，食纳、睡眠欠佳。查体：张口门齿距4.5cm；鼻咽肿物不明显；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。昨日查血常规、肝肾功能未见明显异常。[姓名已隐去]医生信息已隐藏：予口腔粘膜保护等对症治疗，加强营养支持治疗，明日予同期DDP化疗，密切观察放化疗反应，继续完成放疗。\n- [全程D96] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 今行放疗第28次，患者口干咽痛，稍恶心、呕吐，食纳、睡眠欠佳。查体：张口门齿距4.5cm；鼻咽肿物不明显；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]医生信息已隐藏：予口腔粘膜保护等对症治疗，加强营养支持治疗，明日复查血常规、肝肾功能，继续完成放疗。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估为原发灶缓解但颈部淋巴结残留，行双侧颈部淋巴结清扫术，术后定期随访复查。\nB. 评估为颅底骨质破坏未缓解，局部追加立体定向放射治疗推量，并定期随访复查。\nC. 评估为放化疗后部分缓解，继续原方案辅助化疗2个周期以巩固疗效。\nD. 评估为放化疗后临床缓解，按计划结疗出院，序贯PD-1抑制剂维持治疗1年。\nE. 评估为原发灶残留，行鼻咽内镜下挽救性切除术，术后配合张口及颈部功能锻炼。\nF. 评估为放化疗后临床缓解，按计划结疗出院，3个月后行PET-CT评估，期间无需特殊干预。\nG. 评估为放化疗后病情稳定，更改化疗方案为吉西他滨联合顺铂进行二线化疗。\nH. 评估为放化疗后临床缓解，按计划结疗出院，预防性给予全脑放射治疗。\nI. 评估为颈部淋巴结残留，局部追加电子线放射治疗推量，并加强营养支持。\nJ. 评估为放化疗后临床缓解，按计划结疗出院，序贯口服卡培他滨节拍维持治疗1年。\nK. 评估为放化疗后临床缓解，按计划结疗出院，嘱鼻腔冲洗、张口及颈部功能锻炼，定期随访复查。\nL. 评估为颅底病灶残留，转诊行质子重离子放射治疗以提高局部控制率。\n\n请仅输出一个选项字母（A-L）。"}]}
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full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 右侧耳鸣、鼻塞3月余，加重1周。；现病史: 缘于某次就诊时间11月下旬患者无意中出现右侧耳鸣、鼻塞，伴有右耳听力下降、头痛症状，无鼻出血，无面麻，无视物模糊、复视，无呛咳等症状；未予重视，逐渐加重，于某次就诊时间在[机构已隐去]就诊；建议患者住院治疗，患者及家属不同意。近1周来，耳鸣、鼻塞及头痛症状加重，今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,听力下降,右耳鸣,头痛；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：75次/分，R：20次/分，BP：110/65mmHg,Ht：150cm，Wt：41kg，BSA：1.316m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 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情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶壁、顶后壁、右侧壁明显增厚，左侧壁稍增厚，并见结节状肿物突出；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸部X线，腹部彩超\nB. 鼻咽及颈部MRI平扫+增强，全身PET-CT检查，暂缓鼻咽活检\nC. 鼻咽镜检查及活检，仅行鼻咽MRI平扫+增强，胸部CT，腹部彩超\nD. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部X线，腹部彩超及心电图\nE. 鼻咽镜检查及活检，全身PET-CT检查，头颅MRI平扫+增强\nF. 鼻咽及颈部根治性放疗，同步行胸部及腹部影像学检查\nG. 鼻咽肿物切除活检，鼻咽及颈部MRI平扫+增强，胸部X线，腹部彩超\nH. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，暂不进行胸腹部影像学检查\nI. 鼻咽镜检查及活检，鼻咽CT平扫+增强，颈部超声，胸部X线，腹部彩超\nJ. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身骨扫描，头颅CT\nK. 鼻咽脱落细胞学检查，鼻咽及颈部MRI平扫+增强，胸部CT，腹部彩超\nL. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，预防性颈部淋巴结清扫术\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 右侧耳鸣、鼻塞3月余，加重1周。；现病史: 缘于某次就诊时间11月下旬患者无意中出现右侧耳鸣、鼻塞，伴有右耳听力下降、头痛症状，无鼻出血，无面麻，无视物模糊、复视，无呛咳等症状；未予重视，逐渐加重，于某次就诊时间在[机构已隐去]就诊；建议患者住院治疗，患者及家属不同意。近1周来，耳鸣、鼻塞及头痛症状加重，今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,听力下降,右耳鸣,头痛；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：75次/分，R：20次/分，BP：110/65mmHg,Ht：150cm，Wt：41kg，BSA：1.316m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶壁、顶后壁、右侧壁明显增厚，左侧壁稍增厚，并见结节状肿物突出；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸部X线，腹部彩超\nB. 鼻咽及颈部MRI平扫+增强，全身PET-CT检查，暂缓鼻咽活检\nC. 鼻咽镜检查及活检，仅行鼻咽MRI平扫+增强，胸部CT，腹部彩超\nD. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部X线，腹部彩超及心电图\nE. 鼻咽镜检查及活检，全身PET-CT检查，头颅MRI平扫+增强\nF. 鼻咽及颈部根治性放疗，同步行胸部及腹部影像学检查\nG. 鼻咽肿物切除活检，鼻咽及颈部MRI平扫+增强，胸部X线，腹部彩超\nH. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，暂不进行胸腹部影像学检查\nI. 鼻咽镜检查及活检，鼻咽CT平扫+增强，颈部超声，胸部X线，腹部彩超\nJ. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身骨扫描，头颅CT\nK. 鼻咽脱落细胞学检查，鼻咽及颈部MRI平扫+增强，胸部CT，腹部彩超\nL. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，预防性颈部淋巴结清扫术\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-76e183c8ae4202bcecbc9d87","patient_id":"patient-d6812a1c46ed21fda9ebb9f8","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"E","gold_action":"行鼻咽肿物活检明确病理诊断，并安排甲状腺超声检查。","options":[{"letter":"A","text":"行鼻咽肿物活检明确病理诊断，并安排全身PET-CT检查","is_gold":false},{"letter":"B","text":"行鼻咽肿物活检明确病理诊断，并安排全身骨扫描检查","is_gold":false},{"letter":"C","text":"行颈部淋巴结细针穿刺活检明确病理诊断，并安排甲状腺超声检查","is_gold":false},{"letter":"D","text":"行鼻咽肿物活检明确病理诊断，并直接安排甲状腺结节细针穿刺活检","is_gold":false},{"letter":"E","text":"行鼻咽肿物活检明确病理诊断，并安排甲状腺超声检查","is_gold":true},{"letter":"F","text":"行鼻咽肿物活检明确病理诊断，并安排胸部增强CT检查","is_gold":false},{"letter":"G","text":"行鼻咽肿物活检明确病理诊断，并安排头颅增强MRI检查","is_gold":false},{"letter":"H","text":"行鼻咽肿物活检明确病理诊断，并安排甲状腺功能生化检查","is_gold":false},{"letter":"I","text":"行鼻咽肿物活检明确病理诊断，并安排颈部超声检查","is_gold":false},{"letter":"J","text":"行鼻咽肿物活检明确病理诊断，并安排肝脏增强MRI检查","is_gold":false},{"letter":"K","text":"行鼻咽肿物活检明确病理诊断，并安排甲状腺核素扫描检查","is_gold":false},{"letter":"L","text":"暂缓活检操作，先行诊断性抗炎治疗两周后复查鼻咽部MRI","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 右侧耳鸣、鼻塞3月余，加重1周。；现病史: 缘于某次就诊时间11月下旬患者无意中出现右侧耳鸣、鼻塞，伴有右耳听力下降、头痛症状，无鼻出血，无面麻，无视物模糊、复视，无呛咳等症状；未予重视，逐渐加重，于某次就诊时间在[机构已隐去]就诊；建议患者住院治疗，患者及家属不同意。近1周来，耳鸣、鼻塞及头痛症状加重，今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,听力下降,右耳鸣,头痛；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：75次/分，R：20次/分，BP：110/65mmHg,Ht：150cm，Wt：41kg，BSA：1.316m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶壁、顶后壁、右侧壁明显增厚，左侧壁稍增厚，并见结节状肿物突出；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见: 轻度ST段下移；检查结论: 窦性心律 轻度ST段下移\n- [全程D1] 检验组合: 淋巴细胞百分比(Lymph%)-静脉血: 0.35；平均红细胞血红蛋白含量(MCH)-静脉血: 28.7pg；总钙(Ca)-静脉血: 2.32mmol/L；凝血酶时间(TT)-静脉血: 19.8sec.；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阳性(+)（参考: 阴性）；总胆汁酸(TBA)-静脉血: 4.1umol/L；钾离子(K+)-静脉血: 3.82mmol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；红细胞计数(RBC#)-静脉血: 5.0210E12/L；钠离子(Na+)-静脉血: 142.9mmol/L；尿素氮(BUN)-静脉血: 4.2mmol/L；葡萄糖(Glu)-静脉血: 5.36mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.66mmolL；球蛋白(GLO)-静脉血: 25.7g/L；尿酸(UA)-静脉血: 214.3umol/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；ABO血型-静脉血: O；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.98mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.76；中性粒细胞百分比(Neut%)-静脉血: 0.579；阴离子间隙(AG)-静脉血: 11.5；γ-谷氨酰基转移酶(GGT)-静脉血: 12.3U/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 23.4U/L；载脂蛋白B(apoB)-静脉血: 0.98g/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 6.4umolL；中性粒细胞计数(Neut#)-静脉血: 3.710E9/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；载脂蛋白AI(apoAI)-静脉血: 1.79g/L；肌酐(Crea)-静脉血: 50.2umol/L；总蛋白(TP)-静脉血: 70.9g/L；总胆固醇(TC)-静脉血: 5.02mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)……\n- [全程D2] 超声；双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声欠均匀，肝内可见多个无回声灶，较大者约43×29mm，椭圆形，边界清，内透声好，部分可见高回声分隔，后方回声增强。血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：上述病灶内未见明确血流信号。肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声欠均匀，右肾多个无回声灶，较大者约15×13mm，类圆形，边界清，内透声好，后方回声增强。左肾未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确肿物回声。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。；检查结论: 肝多发囊肿。 右肾多发囊肿。 胆囊、脾脏、胰腺、左肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D2] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对侧，双肺野纹理稍增多、增粗，未见明显实质性病变。双侧肺门不大，纵隔不宽，心影形态、大小、位置未见异常。双膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明确病变。\n- [全程D7] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、右侧壁明显增厚，左侧壁稍增厚，并见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号增强扫描明显强化，肿物占据右侧咽隐窝。双侧鼻腔及口咽各壁未见异常。 右侧腭帆张提肌、右侧头长肌及右侧翼内肌受侵，病变包绕右侧颈内动静脉。 右侧腭帆提肌、腭帆张肌、双侧头长肌受侵；左侧腭帆提肌、腭帆张肌未见受侵征象。 双侧翼腭窝、颞下窝未见异常；口咽侧壁未见受累增厚。 蝶骨基底部右份及右侧翼突基底部内侧、右侧翼突内板骨质信号减低，增强扫描不均匀强化。余颅底骨质未见明确异常。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、右侧乳突粘膜增厚，双侧上颌窦、蝶窦、左侧乳突充气良好，骨壁完整；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 右侧咽后见多个肿大淋巴结，最大者短径13mm，增强后明显强化，融合。左侧咽后及双颈II区见多发小淋巴结，最大者短径约7mm，未见坏死及包膜外侵。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺左叶见一结节，大小约11mm×11mm，边界尚清， T1WI及T2WI均呈混杂高信号，增强扫描部分区域强化较明显。甲状腺右叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。；检查结论: 鼻咽病变侵犯右侧咽旁间隙、椎前间隙右份及右侧翼内肌，考虑鼻咽癌可能性大。 蝶骨基底部右份、右侧翼突基底部内侧及右侧翼突内板骨质信号异常，考虑肿瘤浸润可能性大。 右侧咽后肿大淋巴结，考虑转移瘤。 左侧咽后及双颈II区小淋巴结，未排除转移可能。 鼻窦炎；右侧乳突炎。 甲状腺左叶结节灶，建议超声检查。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行鼻咽肿物活检明确病理诊断，并安排全身PET-CT检查\nB. 行鼻咽肿物活检明确病理诊断，并安排全身骨扫描检查\nC. 行颈部淋巴结细针穿刺活检明确病理诊断，并安排甲状腺超声检查\nD. 行鼻咽肿物活检明确病理诊断，并直接安排甲状腺结节细针穿刺活检\nE. 行鼻咽肿物活检明确病理诊断，并安排甲状腺超声检查\nF. 行鼻咽肿物活检明确病理诊断，并安排胸部增强CT检查\nG. 行鼻咽肿物活检明确病理诊断，并安排头颅增强MRI检查\nH. 行鼻咽肿物活检明确病理诊断，并安排甲状腺功能生化检查\nI. 行鼻咽肿物活检明确病理诊断，并安排颈部超声检查\nJ. 行鼻咽肿物活检明确病理诊断，并安排肝脏增强MRI检查\nK. 行鼻咽肿物活检明确病理诊断，并安排甲状腺核素扫描检查\nL. 暂缓活检操作，先行诊断性抗炎治疗两周后复查鼻咽部MRI\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见: 轻度ST段下移；检查结论: 窦性心律 轻度ST段下移\n- [全程D1] 检验组合: 淋巴细胞百分比(Lymph%)-静脉血: 0.35；平均红细胞血红蛋白含量(MCH)-静脉血: 28.7pg；总钙(Ca)-静脉血: 2.32mmol/L；凝血酶时间(TT)-静脉血: 19.8sec.；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阳性(+)（参考: 阴性）；总胆汁酸(TBA)-静脉血: 4.1umol/L；钾离子(K+)-静脉血: 3.82mmol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；红细胞计数(RBC#)-静脉血: 5.0210E12/L；钠离子(Na+)-静脉血: 142.9mmol/L；尿素氮(BUN)-静脉血: 4.2mmol/L；葡萄糖(Glu)-静脉血: 5.36mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.66mmolL；球蛋白(GLO)-静脉血: 25.7g/L；尿酸(UA)-静脉血: 214.3umol/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；ABO血型-静脉血: O；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.98mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.76；中性粒细胞百分比(Neut%)-静脉血: 0.579；阴离子间隙(AG)-静脉血: 11.5；γ-谷氨酰基转移酶(GGT)-静脉血: 12.3U/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 23.4U/L；载脂蛋白B(apoB)-静脉血: 0.98g/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 6.4umolL；中性粒细胞计数(Neut#)-静脉血: 3.710E9/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；载脂蛋白AI(apoAI)-静脉血: 1.79g/L；肌酐(Crea)-静脉血: 50.2umol/L；总蛋白(TP)-静脉血: 70.9g/L；总胆固醇(TC)-静脉血: 5.02mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)……\n- [全程D2] 超声；双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声欠均匀，肝内可见多个无回声灶，较大者约43×29mm，椭圆形，边界清，内透声好，部分可见高回声分隔，后方回声增强。血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：上述病灶内未见明确血流信号。肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声欠均匀，右肾多个无回声灶，较大者约15×13mm，类圆形，边界清，内透声好，后方回声增强。左肾未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确肿物回声。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。；检查结论: 肝多发囊肿。 右肾多发囊肿。 胆囊、脾脏、胰腺、左肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D2] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对侧，双肺野纹理稍增多、增粗，未见明显实质性病变。双侧肺门不大，纵隔不宽，心影形态、大小、位置未见异常。双膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明确病变。\n- [全程D7] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、右侧壁明显增厚，左侧壁稍增厚，并见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号增强扫描明显强化，肿物占据右侧咽隐窝。双侧鼻腔及口咽各壁未见异常。 右侧腭帆张提肌、右侧头长肌及右侧翼内肌受侵，病变包绕右侧颈内动静脉。 右侧腭帆提肌、腭帆张肌、双侧头长肌受侵；左侧腭帆提肌、腭帆张肌未见受侵征象。 双侧翼腭窝、颞下窝未见异常；口咽侧壁未见受累增厚。 蝶骨基底部右份及右侧翼突基底部内侧、右侧翼突内板骨质信号减低，增强扫描不均匀强化。余颅底骨质未见明确异常。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、右侧乳突粘膜增厚，双侧上颌窦、蝶窦、左侧乳突充气良好，骨壁完整；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 右侧咽后见多个肿大淋巴结，最大者短径13mm，增强后明显强化，融合。左侧咽后及双颈II区见多发小淋巴结，最大者短径约7mm，未见坏死及包膜外侵。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺左叶见一结节，大小约11mm×11mm，边界尚清， T1WI及T2WI均呈混杂高信号，增强扫描部分区域强化较明显。甲状腺右叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。；检查结论: 鼻咽病变侵犯右侧咽旁间隙、椎前间隙右份及右侧翼内肌，考虑鼻咽癌可能性大。 蝶骨基底部右份、右侧翼突基底部内侧及右侧翼突内板骨质信号异常，考虑肿瘤浸润可能性大。 右侧咽后肿大淋巴结，考虑转移瘤。 左侧咽后及双颈II区小淋巴结，未排除转移可能。 鼻窦炎；右侧乳突炎。 甲状腺左叶结节灶，建议超声检查。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行鼻咽肿物活检明确病理诊断，并安排全身PET-CT检查\nB. 行鼻咽肿物活检明确病理诊断，并安排全身骨扫描检查\nC. 行颈部淋巴结细针穿刺活检明确病理诊断，并安排甲状腺超声检查\nD. 行鼻咽肿物活检明确病理诊断，并直接安排甲状腺结节细针穿刺活检\nE. 行鼻咽肿物活检明确病理诊断，并安排甲状腺超声检查\nF. 行鼻咽肿物活检明确病理诊断，并安排胸部增强CT检查\nG. 行鼻咽肿物活检明确病理诊断，并安排头颅增强MRI检查\nH. 行鼻咽肿物活检明确病理诊断，并安排甲状腺功能生化检查\nI. 行鼻咽肿物活检明确病理诊断，并安排颈部超声检查\nJ. 行鼻咽肿物活检明确病理诊断，并安排肝脏增强MRI检查\nK. 行鼻咽肿物活检明确病理诊断，并安排甲状腺核素扫描检查\nL. 暂缓活检操作，先行诊断性抗炎治疗两周后复查鼻咽部MRI\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见: 轻度ST段下移；检查结论: 窦性心律 轻度ST段下移\n- [全程D1] 检验组合: 淋巴细胞百分比(Lymph%)-静脉血: 0.35；平均红细胞血红蛋白含量(MCH)-静脉血: 28.7pg；总钙(Ca)-静脉血: 2.32mmol/L；凝血酶时间(TT)-静脉血: 19.8sec.；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阳性(+)（参考: 阴性）；总胆汁酸(TBA)-静脉血: 4.1umol/L；钾离子(K+)-静脉血: 3.82mmol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；红细胞计数(RBC#)-静脉血: 5.0210E12/L；钠离子(Na+)-静脉血: 142.9mmol/L；尿素氮(BUN)-静脉血: 4.2mmol/L；葡萄糖(Glu)-静脉血: 5.36mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.66mmolL；球蛋白(GLO)-静脉血: 25.7g/L；尿酸(UA)-静脉血: 214.3umol/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；ABO血型-静脉血: O；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.98mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.76；中性粒细胞百分比(Neut%)-静脉血: 0.579；阴离子间隙(AG)-静脉血: 11.5；γ-谷氨酰基转移酶(GGT)-静脉血: 12.3U/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 23.4U/L；载脂蛋白B(apoB)-静脉血: 0.98g/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 6.4umolL；中性粒细胞计数(Neut#)-静脉血: 3.710E9/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；载脂蛋白AI(apoAI)-静脉血: 1.79g/L；肌酐(Crea)-静脉血: 50.2umol/L；总蛋白(TP)-静脉血: 70.9g/L；总胆固醇(TC)-静脉血: 5.02mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)……\n- [全程D2] 超声；双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声欠均匀，肝内可见多个无回声灶，较大者约43×29mm，椭圆形，边界清，内透声好，部分可见高回声分隔，后方回声增强。血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：上述病灶内未见明确血流信号。肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声欠均匀，右肾多个无回声灶，较大者约15×13mm，类圆形，边界清，内透声好，后方回声增强。左肾未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确肿物回声。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。；检查结论: 肝多发囊肿。 右肾多发囊肿。 胆囊、脾脏、胰腺、左肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D2] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对侧，双肺野纹理稍增多、增粗，未见明显实质性病变。双侧肺门不大，纵隔不宽，心影形态、大小、位置未见异常。双膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明确病变。\n- [全程D7] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、右侧壁明显增厚，左侧壁稍增厚，并见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号增强扫描明显强化，肿物占据右侧咽隐窝。双侧鼻腔及口咽各壁未见异常。 右侧腭帆张提肌、右侧头长肌及右侧翼内肌受侵，病变包绕右侧颈内动静脉。 右侧腭帆提肌、腭帆张肌、双侧头长肌受侵；左侧腭帆提肌、腭帆张肌未见受侵征象。 双侧翼腭窝、颞下窝未见异常；口咽侧壁未见受累增厚。 蝶骨基底部右份及右侧翼突基底部内侧、右侧翼突内板骨质信号减低，增强扫描不均匀强化。余颅底骨质未见明确异常。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、右侧乳突粘膜增厚，双侧上颌窦、蝶窦、左侧乳突充气良好，骨壁完整；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 右侧咽后见多个肿大淋巴结，最大者短径13mm，增强后明显强化，融合。左侧咽后及双颈II区见多发小淋巴结，最大者短径约7mm，未见坏死及包膜外侵。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺左叶见一结节，大小约11mm×11mm，边界尚清， T1WI及T2WI均呈混杂高信号，增强扫描部分区域强化较明显。甲状腺右叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。；检查结论: 鼻咽病变侵犯右侧咽旁间隙、椎前间隙右份及右侧翼内肌，考虑鼻咽癌可能性大。 蝶骨基底部右份、右侧翼突基底部内侧及右侧翼突内板骨质信号异常，考虑肿瘤浸润可能性大。 右侧咽后肿大淋巴结，考虑转移瘤。 左侧咽后及双颈II区小淋巴结，未排除转移可能。 鼻窦炎；右侧乳突炎。 甲状腺左叶结节灶，建议超声检查。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行鼻咽肿物活检明确病理诊断，并安排全身PET-CT检查\nB. 行鼻咽肿物活检明确病理诊断，并安排全身骨扫描检查\nC. 行颈部淋巴结细针穿刺活检明确病理诊断，并安排甲状腺超声检查\nD. 行鼻咽肿物活检明确病理诊断，并直接安排甲状腺结节细针穿刺活检\nE. 行鼻咽肿物活检明确病理诊断，并安排甲状腺超声检查\nF. 行鼻咽肿物活检明确病理诊断，并安排胸部增强CT检查\nG. 行鼻咽肿物活检明确病理诊断，并安排头颅增强MRI检查\nH. 行鼻咽肿物活检明确病理诊断，并安排甲状腺功能生化检查\nI. 行鼻咽肿物活检明确病理诊断，并安排颈部超声检查\nJ. 行鼻咽肿物活检明确病理诊断，并安排肝脏增强MRI检查\nK. 行鼻咽肿物活检明确病理诊断，并安排甲状腺核素扫描检查\nL. 暂缓活检操作，先行诊断性抗炎治疗两周后复查鼻咽部MRI\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-bf94c856279752df44d2b5a5","patient_id":"patient-d6812a1c46ed21fda9ebb9f8","turn_id":"turn05","turn_position":3,"turn_type":"toxicity_or_support_decision","gold_letter":"H","gold_action":"停止静脉输液，予以口服氯化钾缓释片维持补钾，行PICC导管常规护理，安排出院休养。","options":[{"letter":"A","text":"继续静脉滴注氯化钾及氯化钠注射液，暂缓出院继续住院观察。","is_gold":false},{"letter":"B","text":"停止静脉输液，停用所有补钾药物，拔除PICC导管，安排出院休养。","is_gold":false},{"letter":"C","text":"停止静脉输液，予以口服氯化钾缓释片，拔除PICC导管，安排出院休养。","is_gold":false},{"letter":"D","text":"继续静脉滴注氯化钾，行PICC导管常规护理，暂缓出院继续住院观察。","is_gold":false},{"letter":"E","text":"停止静脉输液，停用所有补钾药物，行PICC导管常规护理，安排出院休养。","is_gold":false},{"letter":"F","text":"予以静脉推注氯化钾注射液，行PICC导管常规护理，暂缓出院继续住院观察。","is_gold":false},{"letter":"G","text":"停止静脉输液，予以口服氯化钾缓释片及螺内酯，行PICC导管常规护理，安排出院休养。","is_gold":false},{"letter":"H","text":"停止静脉输液，予以口服氯化钾缓释片，行PICC导管常规护理，安排出院休养。","is_gold":true},{"letter":"I","text":"继续静脉滴注氯化钠注射液，予以口服氯化钾缓释片，行PICC导管常规护理，暂缓出院。","is_gold":false},{"letter":"J","text":"停止静脉输液，予以口服聚苯乙烯磺酸钙散，行PICC导管常规护理，安排出院休养。","is_gold":false},{"letter":"K","text":"停止静脉输液，予以静脉泵入氯化钾注射液，行PICC导管常规护理，暂缓出院。","is_gold":false},{"letter":"L","text":"继续静脉滴注氯化钾及氯化钠注射液，行PICC导管常规护理，带静脉输液装置出院。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 右侧耳鸣、鼻塞3月余，加重1周。；现病史: 缘于某次就诊时间11月下旬患者无意中出现右侧耳鸣、鼻塞，伴有右耳听力下降、头痛症状，无鼻出血，无面麻，无视物模糊、复视，无呛咳等症状；未予重视，逐渐加重，于某次就诊时间在[机构已隐去]就诊；建议患者住院治疗，患者及家属不同意。近1周来，耳鸣、鼻塞及头痛症状加重，今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,听力下降,右耳鸣,头痛；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：75次/分，R：20次/分，BP：110/65mmHg,Ht：150cm，Wt：41kg，BSA：1.316m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶壁、顶后壁、右侧壁明显增厚，左侧壁稍增厚，并见结节状肿物突出；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见: 轻度ST段下移；检查结论: 窦性心律 轻度ST段下移\n- [全程D1] 检验组合: 淋巴细胞百分比(Lymph%)-静脉血: 0.35；平均红细胞血红蛋白含量(MCH)-静脉血: 28.7pg；总钙(Ca)-静脉血: 2.32mmol/L；凝血酶时间(TT)-静脉血: 19.8sec.；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阳性(+)（参考: 阴性）；总胆汁酸(TBA)-静脉血: 4.1umol/L；钾离子(K+)-静脉血: 3.82mmol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；红细胞计数(RBC#)-静脉血: 5.0210E12/L；钠离子(Na+)-静脉血: 142.9mmol/L；尿素氮(BUN)-静脉血: 4.2mmol/L；葡萄糖(Glu)-静脉血: 5.36mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.66mmolL；球蛋白(GLO)-静脉血: 25.7g/L；尿酸(UA)-静脉血: 214.3umol/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；ABO血型-静脉血: O；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.98mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.76；中性粒细胞百分比(Neut%)-静脉血: 0.579；阴离子间隙(AG)-静脉血: 11.5；γ-谷氨酰基转移酶(GGT)-静脉血: 12.3U/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 23.4U/L；载脂蛋白B(apoB)-静脉血: 0.98g/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 6.4umolL；中性粒细胞计数(Neut#)-静脉血: 3.710E9/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；载脂蛋白AI(apoAI)-静脉血: 1.79g/L；肌酐(Crea)-静脉血: 50.2umol/L；总蛋白(TP)-静脉血: 70.9g/L；总胆固醇(TC)-静脉血: 5.02mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)……\n- [全程D2] 超声；双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声欠均匀，肝内可见多个无回声灶，较大者约43×29mm，椭圆形，边界清，内透声好，部分可见高回声分隔，后方回声增强。血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：上述病灶内未见明确血流信号。肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声欠均匀，右肾多个无回声灶，较大者约15×13mm，类圆形，边界清，内透声好，后方回声增强。左肾未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确肿物回声。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。；检查结论: 肝多发囊肿。 右肾多发囊肿。 胆囊、脾脏、胰腺、左肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D2] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对侧，双肺野纹理稍增多、增粗，未见明显实质性病变。双侧肺门不大，纵隔不宽，心影形态、大小、位置未见异常。双膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明确病变。\n- [全程D7] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、右侧壁明显增厚，左侧壁稍增厚，并见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号增强扫描明显强化，肿物占据右侧咽隐窝。双侧鼻腔及口咽各壁未见异常。 右侧腭帆张提肌、右侧头长肌及右侧翼内肌受侵，病变包绕右侧颈内动静脉。 右侧腭帆提肌、腭帆张肌、双侧头长肌受侵；左侧腭帆提肌、腭帆张肌未见受侵征象。 双侧翼腭窝、颞下窝未见异常；口咽侧壁未见受累增厚。 蝶骨基底部右份及右侧翼突基底部内侧、右侧翼突内板骨质信号减低，增强扫描不均匀强化。余颅底骨质未见明确异常。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、右侧乳突粘膜增厚，双侧上颌窦、蝶窦、左侧乳突充气良好，骨壁完整；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 右侧咽后见多个肿大淋巴结，最大者短径13mm，增强后明显强化，融合。左侧咽后及双颈II区见多发小淋巴结，最大者短径约7mm，未见坏死及包膜外侵。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺左叶见一结节，大小约11mm×11mm，边界尚清， T1WI及T2WI均呈混杂高信号，增强扫描部分区域强化较明显。甲状腺右叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。；检查结论: 鼻咽病变侵犯右侧咽旁间隙、椎前间隙右份及右侧翼内肌，考虑鼻咽癌可能性大。 蝶骨基底部右份、右侧翼突基底部内侧及右侧翼突内板骨质信号异常，考虑肿瘤浸润可能性大。 右侧咽后肿大淋巴结，考虑转移瘤。 左侧咽后及双颈II区小淋巴结，未排除转移可能。 鼻窦炎；右侧乳突炎。 甲状腺左叶结节灶，建议超声检查。\n- [全程D42] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位置位于第5胸椎体下缘，估计位于上腔静脉上段。；检查结论: PICC管末端位置如上所述。\n- [全程D42] 检验组合: 阴离子间隙(AG)-静脉血: 11；丙氨酸氨基转移酶(ALT)-静脉血: 12.8U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；钠离子(Na+)-静脉血: 143.3mmol/L；总钙(Ca)-静脉血: 2.2mmol/L；总胆红素(TBIL)-静脉血: 8.4umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.3U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.86；C-反应蛋白(CRP)-静脉血: 0.85mg/L；胱抑素(Cys-C)-静脉血: 0.61mg/L；磷(P)-静脉血: 1.14mmol/L；总胆固醇(TC)-静脉血: 4.61mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.292；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；载脂蛋白B(apoB)-静脉血: 0.93g/L；间接胆红素(IBIL)-静脉血: 6.4umolL；甘油三酯(TG)-静脉血: 0.64mmol/L；碱性磷酸酶(ALP)-静脉血: 87.2U/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 2umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；尿酸(UA)-静脉血: 194.8umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.02mmol/L；总胆汁酸(TBA)-静脉血: 2.1umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.96；钾离子(K+)-静脉血: 3.83mmol/L；红细胞比容(Hct)-静脉血: 40.7%；氯离子(Cl-)-静脉血: 107.6mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；肌酐(Crea)-静脉血: 46.2umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.810E9/L；血小板分布宽度(PDW)-静脉血: 10.6%；平均血小板体积(MPV)-静脉血: 9.5fL；白蛋白(ALB)-静脉血: 43.5g/L；尿素氮(BUN)-静脉血: 3.6mmol/L；白细胞计数(WBC#)-静脉血: 6.3110……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D43] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.016；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: 1+ 0.6mg（参考: 阴性）；浊度(TRUB)-尿液: 清亮；葡萄糖(Glu)-尿液: +- 1.7mmol（参考: 阴性）；酸碱度(pH)-尿液: 6.5；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；红细胞计数(RBC#)-尿液: 8/μL；酮体(KET)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 7/μL；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D44] 检验组合: 白蛋白(ALB)-静脉血: 37.7g/L；总胆红素(TBIL)-静脉血: 9umol/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；钠离子(Na+)-静脉血: 133.7mmol/L；直接胆红素(DBIL)-静脉血: 2.1umol/L；总胆汁酸(TBA)-静脉血: 1.4umol/L；尿酸(UA)-静脉血: 164.1umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.6U/L；总蛋白(TP)-静脉血: 58.49g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 23.7U/L；碱性磷酸酶(ALP)-静脉血: 72.8U/L；肌酐(Crea)-静脉血: 44.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.95；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.81；尿素氮(BUN)-静脉血: 4.4mmol/L；磷(P)-静脉血: 0.93mmol/L；总钙(Ca)-静脉血: 2.02mmol/L；乳酸脱氢酶(LDH)-静脉血: 210.9U/L；氯离子(Cl-)-静脉血: 100.2mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 12.3U/L；间接胆红素(IBIL)-静脉血: 6.9umolL；钾离子(K+)-静脉血: 2.94mmol/L；阴离子间隙(AG)-静脉血: 12.1；血液二氧化碳含量ctCO2(B)-静脉血: 21.4mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.3U/L；球蛋白(GLO)-静脉血: 20.79g/L\n- [全程D45] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 1/μL；钠离子(Na+)-静脉血: 131.1mmol/L；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；阴离子间隙(AG)-静脉血: 14.5；浊度(TRUB)-尿液: clear；胆红素(BIL)-尿液: -（参考: 阴性）；镁离子(Mg2+)-静脉血: 0.79mmol/L；钾离子(K+)-静脉血: 3.17mmol/L；红细胞计数(RBC#)-尿液: 17/μL；磷(P)-静脉血: 0.95mmol/L；氯离子(Cl-)-静脉血: 96.2mmol/L；白细胞计数(WBC#)-尿液: 5/μL；总钙(Ca)-静脉血: 1.92mmol/L；颜色-尿液: Light-Yellow；比重(SG)-尿液: 1.011；葡萄糖(Glu)-尿液: 1+ 5.6mmol（参考: 阴性）；隐血(OB)-尿液: +-0.3mg（参考: 阴性）；未分类结晶计数(UNCX#)-尿液: 5/μL；血液二氧化碳含量ctCO2(B)-静脉血: 20.4mmol/L；酸碱度(pH)-尿液: 6.5；尿胆原(URO)-尿液: -（参考: 阴性）\n- [全程D46] 检验组合: 阴离子间隙(AG)-静脉血: 17.7；血液二氧化碳含量ctCO2(B)-静脉血: 19.3mmol/L；氯离子(Cl-)-静脉血: 85.6mmol/L；总钙(Ca)-静脉血: 2.04mmol/L；钠离子(Na+)-静脉血: 122.6mmol/L；钾离子(K+)-静脉血: 3.26mmol/L；镁离子(Mg2+)-静脉血: 0.77mmol/L；磷(P)-静脉血: 0.51mmol/L\n- [全程D47] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 20.9mmol/L；总钙(Ca)-静脉血: 2.12mmol/L；阴离子间隙(AG)-静脉血: 14.5；磷(P)-静脉血: 0.67mmol/L；钾离子(K+)-静脉血: 4.06mmol/L；氯离子(Cl-)-静脉血: 89.8mmol/L；钠离子(Na+)-静脉血: 125.2mmol/L；镁离子(Mg2+)-静脉血: 0.93mmol/L\n- [全程D49] 检验组合: 镁离子(Mg2+)-静脉血: 0.89mmol/L；血小板分布宽度(PDW)-静脉血: 11.2%；有核红细胞百分比(NRBC%)-静脉血: 0；白蛋白(ALB)-静脉血: 44.2g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 33.1U/L；丙氨酸氨基转移酶(ALT)-静脉血: 22.6U/L；葡萄糖(Glu)-静脉血: 5.17mmol/L；间接胆红素(IBIL)-静脉血: 8.9umolL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.09mmolL；载脂蛋白B(apoB)-静脉血: 0.78g/L；总胆汁酸(TBA)-静脉血: 7.4umol/L；磷(P)-静脉血: 0.8mmol/L；肌酐(Crea)-静脉血: 38.9umol/L；甘油三酯(TG)-静脉血: 1.35mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29pg；平均红细胞体积(MCV)-静脉血: 83.3fL；单核细胞计数(Mono#)-静脉血: 0.710E9/L；总胆固醇(TC)-静脉血: 3.61mmol/L；总蛋白(TP)-静脉血: 67.8g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.003；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；总胆红素(TBIL)-静脉血: 12.8umol/L；血小板计数(PLT#)-静脉血: 19410E9/L；血小板比容-静脉血: 20%；天门冬氨酸氨基转移酶(AST)-静脉血: 12.9U/L；阴离子间隙(AG)-静脉血: 14.6；直接胆红素(DBIL)-静脉血: 3.9umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.05mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.2mmol/L；大血小板百分比(P-LCR%)-静脉血: 25.6%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 35.8；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.87；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；C-反应蛋白(CRP)-静脉血: 0.28mg/L；尿酸(UA)-静脉血: 110.7umol/L；单核细胞百分比(Mono%)-静脉血: 0……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D11] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者检查完善，已完成放疗预约，嘱今日出院，按期行放疗前准备及放疗前口腔检查。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 继续静脉滴注氯化钾及氯化钠注射液，暂缓出院继续住院观察。\nB. 停止静脉输液，停用所有补钾药物，拔除PICC导管，安排出院休养。\nC. 停止静脉输液，予以口服氯化钾缓释片，拔除PICC导管，安排出院休养。\nD. 继续静脉滴注氯化钾，行PICC导管常规护理，暂缓出院继续住院观察。\nE. 停止静脉输液，停用所有补钾药物，行PICC导管常规护理，安排出院休养。\nF. 予以静脉推注氯化钾注射液，行PICC导管常规护理，暂缓出院继续住院观察。\nG. 停止静脉输液，予以口服氯化钾缓释片及螺内酯，行PICC导管常规护理，安排出院休养。\nH. 停止静脉输液，予以口服氯化钾缓释片，行PICC导管常规护理，安排出院休养。\nI. 继续静脉滴注氯化钠注射液，予以口服氯化钾缓释片，行PICC导管常规护理，暂缓出院。\nJ. 停止静脉输液，予以口服聚苯乙烯磺酸钙散，行PICC导管常规护理，安排出院休养。\nK. 停止静脉输液，予以静脉泵入氯化钾注射液，行PICC导管常规护理，暂缓出院。\nL. 继续静脉滴注氯化钾及氯化钠注射液，行PICC导管常规护理，带静脉输液装置出院。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D42] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位置位于第5胸椎体下缘，估计位于上腔静脉上段。；检查结论: PICC管末端位置如上所述。\n- [全程D42] 检验组合: 阴离子间隙(AG)-静脉血: 11；丙氨酸氨基转移酶(ALT)-静脉血: 12.8U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；钠离子(Na+)-静脉血: 143.3mmol/L；总钙(Ca)-静脉血: 2.2mmol/L；总胆红素(TBIL)-静脉血: 8.4umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.3U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.86；C-反应蛋白(CRP)-静脉血: 0.85mg/L；胱抑素(Cys-C)-静脉血: 0.61mg/L；磷(P)-静脉血: 1.14mmol/L；总胆固醇(TC)-静脉血: 4.61mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.292；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；载脂蛋白B(apoB)-静脉血: 0.93g/L；间接胆红素(IBIL)-静脉血: 6.4umolL；甘油三酯(TG)-静脉血: 0.64mmol/L；碱性磷酸酶(ALP)-静脉血: 87.2U/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 2umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；尿酸(UA)-静脉血: 194.8umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.02mmol/L；总胆汁酸(TBA)-静脉血: 2.1umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.96；钾离子(K+)-静脉血: 3.83mmol/L；红细胞比容(Hct)-静脉血: 40.7%；氯离子(Cl-)-静脉血: 107.6mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；肌酐(Crea)-静脉血: 46.2umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.810E9/L；血小板分布宽度(PDW)-静脉血: 10.6%；平均血小板体积(MPV)-静脉血: 9.5fL；白蛋白(ALB)-静脉血: 43.5g/L；尿素氮(BUN)-静脉血: 3.6mmol/L；白细胞计数(WBC#)-静脉血: 6.3110……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D43] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.016；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: 1+ 0.6mg（参考: 阴性）；浊度(TRUB)-尿液: 清亮；葡萄糖(Glu)-尿液: +- 1.7mmol（参考: 阴性）；酸碱度(pH)-尿液: 6.5；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；红细胞计数(RBC#)-尿液: 8/μL；酮体(KET)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 7/μL；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D44] 检验组合: 白蛋白(ALB)-静脉血: 37.7g/L；总胆红素(TBIL)-静脉血: 9umol/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；钠离子(Na+)-静脉血: 133.7mmol/L；直接胆红素(DBIL)-静脉血: 2.1umol/L；总胆汁酸(TBA)-静脉血: 1.4umol/L；尿酸(UA)-静脉血: 164.1umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.6U/L；总蛋白(TP)-静脉血: 58.49g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 23.7U/L；碱性磷酸酶(ALP)-静脉血: 72.8U/L；肌酐(Crea)-静脉血: 44.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.95；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.81；尿素氮(BUN)-静脉血: 4.4mmol/L；磷(P)-静脉血: 0.93mmol/L；总钙(Ca)-静脉血: 2.02mmol/L；乳酸脱氢酶(LDH)-静脉血: 210.9U/L；氯离子(Cl-)-静脉血: 100.2mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 12.3U/L；间接胆红素(IBIL)-静脉血: 6.9umolL；钾离子(K+)-静脉血: 2.94mmol/L；阴离子间隙(AG)-静脉血: 12.1；血液二氧化碳含量ctCO2(B)-静脉血: 21.4mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.3U/L；球蛋白(GLO)-静脉血: 20.79g/L\n- [全程D45] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 1/μL；钠离子(Na+)-静脉血: 131.1mmol/L；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；阴离子间隙(AG)-静脉血: 14.5；浊度(TRUB)-尿液: clear；胆红素(BIL)-尿液: -（参考: 阴性）；镁离子(Mg2+)-静脉血: 0.79mmol/L；钾离子(K+)-静脉血: 3.17mmol/L；红细胞计数(RBC#)-尿液: 17/μL；磷(P)-静脉血: 0.95mmol/L；氯离子(Cl-)-静脉血: 96.2mmol/L；白细胞计数(WBC#)-尿液: 5/μL；总钙(Ca)-静脉血: 1.92mmol/L；颜色-尿液: Light-Yellow；比重(SG)-尿液: 1.011；葡萄糖(Glu)-尿液: 1+ 5.6mmol（参考: 阴性）；隐血(OB)-尿液: +-0.3mg（参考: 阴性）；未分类结晶计数(UNCX#)-尿液: 5/μL；血液二氧化碳含量ctCO2(B)-静脉血: 20.4mmol/L；酸碱度(pH)-尿液: 6.5；尿胆原(URO)-尿液: -（参考: 阴性）\n- [全程D46] 检验组合: 阴离子间隙(AG)-静脉血: 17.7；血液二氧化碳含量ctCO2(B)-静脉血: 19.3mmol/L；氯离子(Cl-)-静脉血: 85.6mmol/L；总钙(Ca)-静脉血: 2.04mmol/L；钠离子(Na+)-静脉血: 122.6mmol/L；钾离子(K+)-静脉血: 3.26mmol/L；镁离子(Mg2+)-静脉血: 0.77mmol/L；磷(P)-静脉血: 0.51mmol/L\n- [全程D47] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 20.9mmol/L；总钙(Ca)-静脉血: 2.12mmol/L；阴离子间隙(AG)-静脉血: 14.5；磷(P)-静脉血: 0.67mmol/L；钾离子(K+)-静脉血: 4.06mmol/L；氯离子(Cl-)-静脉血: 89.8mmol/L；钠离子(Na+)-静脉血: 125.2mmol/L；镁离子(Mg2+)-静脉血: 0.93mmol/L\n- [全程D49] 检验组合: 镁离子(Mg2+)-静脉血: 0.89mmol/L；血小板分布宽度(PDW)-静脉血: 11.2%；有核红细胞百分比(NRBC%)-静脉血: 0；白蛋白(ALB)-静脉血: 44.2g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 33.1U/L；丙氨酸氨基转移酶(ALT)-静脉血: 22.6U/L；葡萄糖(Glu)-静脉血: 5.17mmol/L；间接胆红素(IBIL)-静脉血: 8.9umolL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.09mmolL；载脂蛋白B(apoB)-静脉血: 0.78g/L；总胆汁酸(TBA)-静脉血: 7.4umol/L；磷(P)-静脉血: 0.8mmol/L；肌酐(Crea)-静脉血: 38.9umol/L；甘油三酯(TG)-静脉血: 1.35mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29pg；平均红细胞体积(MCV)-静脉血: 83.3fL；单核细胞计数(Mono#)-静脉血: 0.710E9/L；总胆固醇(TC)-静脉血: 3.61mmol/L；总蛋白(TP)-静脉血: 67.8g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.003；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；总胆红素(TBIL)-静脉血: 12.8umol/L；血小板计数(PLT#)-静脉血: 19410E9/L；血小板比容-静脉血: 20%；天门冬氨酸氨基转移酶(AST)-静脉血: 12.9U/L；阴离子间隙(AG)-静脉血: 14.6；直接胆红素(DBIL)-静脉血: 3.9umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.05mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.2mmol/L；大血小板百分比(P-LCR%)-静脉血: 25.6%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 35.8；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.87；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；C-反应蛋白(CRP)-静脉血: 0.28mg/L；尿酸(UA)-静脉血: 110.7umol/L；单核细胞百分比(Mono%)-静脉血: 0……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D11] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者检查完善，已完成放疗预约，嘱今日出院，按期行放疗前准备及放疗前口腔检查。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 继续静脉滴注氯化钾及氯化钠注射液，暂缓出院继续住院观察。\nB. 停止静脉输液，停用所有补钾药物，拔除PICC导管，安排出院休养。\nC. 停止静脉输液，予以口服氯化钾缓释片，拔除PICC导管，安排出院休养。\nD. 继续静脉滴注氯化钾，行PICC导管常规护理，暂缓出院继续住院观察。\nE. 停止静脉输液，停用所有补钾药物，行PICC导管常规护理，安排出院休养。\nF. 予以静脉推注氯化钾注射液，行PICC导管常规护理，暂缓出院继续住院观察。\nG. 停止静脉输液，予以口服氯化钾缓释片及螺内酯，行PICC导管常规护理，安排出院休养。\nH. 停止静脉输液，予以口服氯化钾缓释片，行PICC导管常规护理，安排出院休养。\nI. 继续静脉滴注氯化钠注射液，予以口服氯化钾缓释片，行PICC导管常规护理，暂缓出院。\nJ. 停止静脉输液，予以口服聚苯乙烯磺酸钙散，行PICC导管常规护理，安排出院休养。\nK. 停止静脉输液，予以静脉泵入氯化钾注射液，行PICC导管常规护理，暂缓出院。\nL. 继续静脉滴注氯化钾及氯化钠注射液，行PICC导管常规护理，带静脉输液装置出院。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D42] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位置位于第5胸椎体下缘，估计位于上腔静脉上段。；检查结论: PICC管末端位置如上所述。\n- [全程D42] 检验组合: 阴离子间隙(AG)-静脉血: 11；丙氨酸氨基转移酶(ALT)-静脉血: 12.8U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；钠离子(Na+)-静脉血: 143.3mmol/L；总钙(Ca)-静脉血: 2.2mmol/L；总胆红素(TBIL)-静脉血: 8.4umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.3U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.86；C-反应蛋白(CRP)-静脉血: 0.85mg/L；胱抑素(Cys-C)-静脉血: 0.61mg/L；磷(P)-静脉血: 1.14mmol/L；总胆固醇(TC)-静脉血: 4.61mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.292；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；载脂蛋白B(apoB)-静脉血: 0.93g/L；间接胆红素(IBIL)-静脉血: 6.4umolL；甘油三酯(TG)-静脉血: 0.64mmol/L；碱性磷酸酶(ALP)-静脉血: 87.2U/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 2umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；尿酸(UA)-静脉血: 194.8umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.02mmol/L；总胆汁酸(TBA)-静脉血: 2.1umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.96；钾离子(K+)-静脉血: 3.83mmol/L；红细胞比容(Hct)-静脉血: 40.7%；氯离子(Cl-)-静脉血: 107.6mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；肌酐(Crea)-静脉血: 46.2umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.810E9/L；血小板分布宽度(PDW)-静脉血: 10.6%；平均血小板体积(MPV)-静脉血: 9.5fL；白蛋白(ALB)-静脉血: 43.5g/L；尿素氮(BUN)-静脉血: 3.6mmol/L；白细胞计数(WBC#)-静脉血: 6.3110……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D43] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.016；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: 1+ 0.6mg（参考: 阴性）；浊度(TRUB)-尿液: 清亮；葡萄糖(Glu)-尿液: +- 1.7mmol（参考: 阴性）；酸碱度(pH)-尿液: 6.5；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；红细胞计数(RBC#)-尿液: 8/μL；酮体(KET)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 7/μL；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D44] 检验组合: 白蛋白(ALB)-静脉血: 37.7g/L；总胆红素(TBIL)-静脉血: 9umol/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；钠离子(Na+)-静脉血: 133.7mmol/L；直接胆红素(DBIL)-静脉血: 2.1umol/L；总胆汁酸(TBA)-静脉血: 1.4umol/L；尿酸(UA)-静脉血: 164.1umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.6U/L；总蛋白(TP)-静脉血: 58.49g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 23.7U/L；碱性磷酸酶(ALP)-静脉血: 72.8U/L；肌酐(Crea)-静脉血: 44.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.95；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.81；尿素氮(BUN)-静脉血: 4.4mmol/L；磷(P)-静脉血: 0.93mmol/L；总钙(Ca)-静脉血: 2.02mmol/L；乳酸脱氢酶(LDH)-静脉血: 210.9U/L；氯离子(Cl-)-静脉血: 100.2mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 12.3U/L；间接胆红素(IBIL)-静脉血: 6.9umolL；钾离子(K+)-静脉血: 2.94mmol/L；阴离子间隙(AG)-静脉血: 12.1；血液二氧化碳含量ctCO2(B)-静脉血: 21.4mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.3U/L；球蛋白(GLO)-静脉血: 20.79g/L\n- [全程D45] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 1/μL；钠离子(Na+)-静脉血: 131.1mmol/L；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；阴离子间隙(AG)-静脉血: 14.5；浊度(TRUB)-尿液: clear；胆红素(BIL)-尿液: -（参考: 阴性）；镁离子(Mg2+)-静脉血: 0.79mmol/L；钾离子(K+)-静脉血: 3.17mmol/L；红细胞计数(RBC#)-尿液: 17/μL；磷(P)-静脉血: 0.95mmol/L；氯离子(Cl-)-静脉血: 96.2mmol/L；白细胞计数(WBC#)-尿液: 5/μL；总钙(Ca)-静脉血: 1.92mmol/L；颜色-尿液: Light-Yellow；比重(SG)-尿液: 1.011；葡萄糖(Glu)-尿液: 1+ 5.6mmol（参考: 阴性）；隐血(OB)-尿液: +-0.3mg（参考: 阴性）；未分类结晶计数(UNCX#)-尿液: 5/μL；血液二氧化碳含量ctCO2(B)-静脉血: 20.4mmol/L；酸碱度(pH)-尿液: 6.5；尿胆原(URO)-尿液: -（参考: 阴性）\n- [全程D46] 检验组合: 阴离子间隙(AG)-静脉血: 17.7；血液二氧化碳含量ctCO2(B)-静脉血: 19.3mmol/L；氯离子(Cl-)-静脉血: 85.6mmol/L；总钙(Ca)-静脉血: 2.04mmol/L；钠离子(Na+)-静脉血: 122.6mmol/L；钾离子(K+)-静脉血: 3.26mmol/L；镁离子(Mg2+)-静脉血: 0.77mmol/L；磷(P)-静脉血: 0.51mmol/L\n- [全程D47] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 20.9mmol/L；总钙(Ca)-静脉血: 2.12mmol/L；阴离子间隙(AG)-静脉血: 14.5；磷(P)-静脉血: 0.67mmol/L；钾离子(K+)-静脉血: 4.06mmol/L；氯离子(Cl-)-静脉血: 89.8mmol/L；钠离子(Na+)-静脉血: 125.2mmol/L；镁离子(Mg2+)-静脉血: 0.93mmol/L\n- [全程D49] 检验组合: 镁离子(Mg2+)-静脉血: 0.89mmol/L；血小板分布宽度(PDW)-静脉血: 11.2%；有核红细胞百分比(NRBC%)-静脉血: 0；白蛋白(ALB)-静脉血: 44.2g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 33.1U/L；丙氨酸氨基转移酶(ALT)-静脉血: 22.6U/L；葡萄糖(Glu)-静脉血: 5.17mmol/L；间接胆红素(IBIL)-静脉血: 8.9umolL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.09mmolL；载脂蛋白B(apoB)-静脉血: 0.78g/L；总胆汁酸(TBA)-静脉血: 7.4umol/L；磷(P)-静脉血: 0.8mmol/L；肌酐(Crea)-静脉血: 38.9umol/L；甘油三酯(TG)-静脉血: 1.35mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29pg；平均红细胞体积(MCV)-静脉血: 83.3fL；单核细胞计数(Mono#)-静脉血: 0.710E9/L；总胆固醇(TC)-静脉血: 3.61mmol/L；总蛋白(TP)-静脉血: 67.8g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.003；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；总胆红素(TBIL)-静脉血: 12.8umol/L；血小板计数(PLT#)-静脉血: 19410E9/L；血小板比容-静脉血: 20%；天门冬氨酸氨基转移酶(AST)-静脉血: 12.9U/L；阴离子间隙(AG)-静脉血: 14.6；直接胆红素(DBIL)-静脉血: 3.9umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.05mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.2mmol/L；大血小板百分比(P-LCR%)-静脉血: 25.6%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 35.8；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.87；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；C-反应蛋白(CRP)-静脉血: 0.28mg/L；尿酸(UA)-静脉血: 110.7umol/L；单核细胞百分比(Mono%)-静脉血: 0……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D11] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者检查完善，已完成放疗预约，嘱今日出院，按期行放疗前准备及放疗前口腔检查。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 继续静脉滴注氯化钾及氯化钠注射液，暂缓出院继续住院观察。\nB. 停止静脉输液，停用所有补钾药物，拔除PICC导管，安排出院休养。\nC. 停止静脉输液，予以口服氯化钾缓释片，拔除PICC导管，安排出院休养。\nD. 继续静脉滴注氯化钾，行PICC导管常规护理，暂缓出院继续住院观察。\nE. 停止静脉输液，停用所有补钾药物，行PICC导管常规护理，安排出院休养。\nF. 予以静脉推注氯化钾注射液，行PICC导管常规护理，暂缓出院继续住院观察。\nG. 停止静脉输液，予以口服氯化钾缓释片及螺内酯，行PICC导管常规护理，安排出院休养。\nH. 停止静脉输液，予以口服氯化钾缓释片，行PICC导管常规护理，安排出院休养。\nI. 继续静脉滴注氯化钠注射液，予以口服氯化钾缓释片，行PICC导管常规护理，暂缓出院。\nJ. 停止静脉输液，予以口服聚苯乙烯磺酸钙散，行PICC导管常规护理，安排出院休养。\nK. 停止静脉输液，予以静脉泵入氯化钾注射液，行PICC导管常规护理，暂缓出院。\nL. 继续静脉滴注氯化钾及氯化钠注射液，行PICC导管常规护理，带静脉输液装置出院。\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-9549c3c98f10ace802cbb08b","patient_id":"patient-d6812a1c46ed21fda9ebb9f8","turn_id":"turn06","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"I","gold_action":"继续顺铂单药化疗，并给予地塞米松、甲氧氯普胺、奥美拉唑止吐，辅以静脉水化及补钾支持治疗。","options":[{"letter":"A","text":"暂停化疗，给予重组人粒细胞集落刺激因子升白细胞治疗，待白细胞恢复后继续顺铂化疗。","is_gold":false},{"letter":"B","text":"暂停化疗，给予3%氯化钠注射液强化纠正低钠血症，待血钠持续稳定正常后再考虑恢复顺铂化疗。","is_gold":false},{"letter":"C","text":"将化疗方案调整为卡铂单药，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化支持治疗。","is_gold":false},{"letter":"D","text":"继续顺铂化疗，并给予地塞米松、甲氧氯普胺、奥美拉唑止吐，无需常规静脉水化及补钾。","is_gold":false},{"letter":"E","text":"继续顺铂化疗，并给予昂丹司琼单药止吐，辅以静脉水化及补钾支持治疗。","is_gold":false},{"letter":"F","text":"继续顺铂联合5-氟尿嘧啶化疗，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化支持治疗。","is_gold":false},{"letter":"G","text":"继续顺铂化疗，并给予地塞米松、甲氧氯普胺、奥美拉唑止吐，同时预防性使用重组人粒细胞集落刺激因子。","is_gold":false},{"letter":"H","text":"终止化疗，仅行单纯放射治疗，并给予静脉水化及营养支持。","is_gold":false},{"letter":"I","text":"继续顺铂化疗，并给予地塞米松、甲氧氯普胺、奥美拉唑止吐，辅以静脉水化及补钾支持治疗。","is_gold":true},{"letter":"J","text":"继续顺铂化疗，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化，同时加用呋塞米强迫利尿且不补钾。","is_gold":false},{"letter":"K","text":"暂停化疗，给予保肝降酶治疗，待肝功能恢复后继续顺铂化疗。","is_gold":false},{"letter":"L","text":"将化疗方案调整为紫杉醇单药，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化支持治疗。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 右侧耳鸣、鼻塞3月余，加重1周。；现病史: 缘于某次就诊时间11月下旬患者无意中出现右侧耳鸣、鼻塞，伴有右耳听力下降、头痛症状，无鼻出血，无面麻，无视物模糊、复视，无呛咳等症状；未予重视，逐渐加重，于某次就诊时间在[机构已隐去]就诊；建议患者住院治疗，患者及家属不同意。近1周来，耳鸣、鼻塞及头痛症状加重，今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,听力下降,右耳鸣,头痛；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：75次/分，R：20次/分，BP：110/65mmHg,Ht：150cm，Wt：41kg，BSA：1.316m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶壁、顶后壁、右侧壁明显增厚，左侧壁稍增厚，并见结节状肿物突出；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见: 轻度ST段下移；检查结论: 窦性心律 轻度ST段下移\n- [全程D1] 检验组合: 淋巴细胞百分比(Lymph%)-静脉血: 0.35；平均红细胞血红蛋白含量(MCH)-静脉血: 28.7pg；总钙(Ca)-静脉血: 2.32mmol/L；凝血酶时间(TT)-静脉血: 19.8sec.；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阳性(+)（参考: 阴性）；总胆汁酸(TBA)-静脉血: 4.1umol/L；钾离子(K+)-静脉血: 3.82mmol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；红细胞计数(RBC#)-静脉血: 5.0210E12/L；钠离子(Na+)-静脉血: 142.9mmol/L；尿素氮(BUN)-静脉血: 4.2mmol/L；葡萄糖(Glu)-静脉血: 5.36mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.66mmolL；球蛋白(GLO)-静脉血: 25.7g/L；尿酸(UA)-静脉血: 214.3umol/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；ABO血型-静脉血: O；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.98mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.76；中性粒细胞百分比(Neut%)-静脉血: 0.579；阴离子间隙(AG)-静脉血: 11.5；γ-谷氨酰基转移酶(GGT)-静脉血: 12.3U/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 23.4U/L；载脂蛋白B(apoB)-静脉血: 0.98g/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 6.4umolL；中性粒细胞计数(Neut#)-静脉血: 3.710E9/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；载脂蛋白AI(apoAI)-静脉血: 1.79g/L；肌酐(Crea)-静脉血: 50.2umol/L；总蛋白(TP)-静脉血: 70.9g/L；总胆固醇(TC)-静脉血: 5.02mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)……\n- [全程D2] 超声；双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声欠均匀，肝内可见多个无回声灶，较大者约43×29mm，椭圆形，边界清，内透声好，部分可见高回声分隔，后方回声增强。血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：上述病灶内未见明确血流信号。肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声欠均匀，右肾多个无回声灶，较大者约15×13mm，类圆形，边界清，内透声好，后方回声增强。左肾未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确肿物回声。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。；检查结论: 肝多发囊肿。 右肾多发囊肿。 胆囊、脾脏、胰腺、左肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D2] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对侧，双肺野纹理稍增多、增粗，未见明显实质性病变。双侧肺门不大，纵隔不宽，心影形态、大小、位置未见异常。双膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明确病变。\n- [全程D7] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、右侧壁明显增厚，左侧壁稍增厚，并见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号增强扫描明显强化，肿物占据右侧咽隐窝。双侧鼻腔及口咽各壁未见异常。 右侧腭帆张提肌、右侧头长肌及右侧翼内肌受侵，病变包绕右侧颈内动静脉。 右侧腭帆提肌、腭帆张肌、双侧头长肌受侵；左侧腭帆提肌、腭帆张肌未见受侵征象。 双侧翼腭窝、颞下窝未见异常；口咽侧壁未见受累增厚。 蝶骨基底部右份及右侧翼突基底部内侧、右侧翼突内板骨质信号减低，增强扫描不均匀强化。余颅底骨质未见明确异常。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、右侧乳突粘膜增厚，双侧上颌窦、蝶窦、左侧乳突充气良好，骨壁完整；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 右侧咽后见多个肿大淋巴结，最大者短径13mm，增强后明显强化，融合。左侧咽后及双颈II区见多发小淋巴结，最大者短径约7mm，未见坏死及包膜外侵。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺左叶见一结节，大小约11mm×11mm，边界尚清， T1WI及T2WI均呈混杂高信号，增强扫描部分区域强化较明显。甲状腺右叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。；检查结论: 鼻咽病变侵犯右侧咽旁间隙、椎前间隙右份及右侧翼内肌，考虑鼻咽癌可能性大。 蝶骨基底部右份、右侧翼突基底部内侧及右侧翼突内板骨质信号异常，考虑肿瘤浸润可能性大。 右侧咽后肿大淋巴结，考虑转移瘤。 左侧咽后及双颈II区小淋巴结，未排除转移可能。 鼻窦炎；右侧乳突炎。 甲状腺左叶结节灶，建议超声检查。\n- [全程D42] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位置位于第5胸椎体下缘，估计位于上腔静脉上段。；检查结论: PICC管末端位置如上所述。\n- [全程D42] 检验组合: 阴离子间隙(AG)-静脉血: 11；丙氨酸氨基转移酶(ALT)-静脉血: 12.8U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；钠离子(Na+)-静脉血: 143.3mmol/L；总钙(Ca)-静脉血: 2.2mmol/L；总胆红素(TBIL)-静脉血: 8.4umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.3U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.86；C-反应蛋白(CRP)-静脉血: 0.85mg/L；胱抑素(Cys-C)-静脉血: 0.61mg/L；磷(P)-静脉血: 1.14mmol/L；总胆固醇(TC)-静脉血: 4.61mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.292；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；载脂蛋白B(apoB)-静脉血: 0.93g/L；间接胆红素(IBIL)-静脉血: 6.4umolL；甘油三酯(TG)-静脉血: 0.64mmol/L；碱性磷酸酶(ALP)-静脉血: 87.2U/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 2umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；尿酸(UA)-静脉血: 194.8umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.02mmol/L；总胆汁酸(TBA)-静脉血: 2.1umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.96；钾离子(K+)-静脉血: 3.83mmol/L；红细胞比容(Hct)-静脉血: 40.7%；氯离子(Cl-)-静脉血: 107.6mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；肌酐(Crea)-静脉血: 46.2umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.810E9/L；血小板分布宽度(PDW)-静脉血: 10.6%；平均血小板体积(MPV)-静脉血: 9.5fL；白蛋白(ALB)-静脉血: 43.5g/L；尿素氮(BUN)-静脉血: 3.6mmol/L；白细胞计数(WBC#)-静脉血: 6.3110……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D43] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.016；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: 1+ 0.6mg（参考: 阴性）；浊度(TRUB)-尿液: 清亮；葡萄糖(Glu)-尿液: +- 1.7mmol（参考: 阴性）；酸碱度(pH)-尿液: 6.5；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；红细胞计数(RBC#)-尿液: 8/μL；酮体(KET)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 7/μL；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D44] 检验组合: 白蛋白(ALB)-静脉血: 37.7g/L；总胆红素(TBIL)-静脉血: 9umol/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；钠离子(Na+)-静脉血: 133.7mmol/L；直接胆红素(DBIL)-静脉血: 2.1umol/L；总胆汁酸(TBA)-静脉血: 1.4umol/L；尿酸(UA)-静脉血: 164.1umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.6U/L；总蛋白(TP)-静脉血: 58.49g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 23.7U/L；碱性磷酸酶(ALP)-静脉血: 72.8U/L；肌酐(Crea)-静脉血: 44.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.95；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.81；尿素氮(BUN)-静脉血: 4.4mmol/L；磷(P)-静脉血: 0.93mmol/L；总钙(Ca)-静脉血: 2.02mmol/L；乳酸脱氢酶(LDH)-静脉血: 210.9U/L；氯离子(Cl-)-静脉血: 100.2mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 12.3U/L；间接胆红素(IBIL)-静脉血: 6.9umolL；钾离子(K+)-静脉血: 2.94mmol/L；阴离子间隙(AG)-静脉血: 12.1；血液二氧化碳含量ctCO2(B)-静脉血: 21.4mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.3U/L；球蛋白(GLO)-静脉血: 20.79g/L\n- [全程D45] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 1/μL；钠离子(Na+)-静脉血: 131.1mmol/L；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；阴离子间隙(AG)-静脉血: 14.5；浊度(TRUB)-尿液: clear；胆红素(BIL)-尿液: -（参考: 阴性）；镁离子(Mg2+)-静脉血: 0.79mmol/L；钾离子(K+)-静脉血: 3.17mmol/L；红细胞计数(RBC#)-尿液: 17/μL；磷(P)-静脉血: 0.95mmol/L；氯离子(Cl-)-静脉血: 96.2mmol/L；白细胞计数(WBC#)-尿液: 5/μL；总钙(Ca)-静脉血: 1.92mmol/L；颜色-尿液: Light-Yellow；比重(SG)-尿液: 1.011；葡萄糖(Glu)-尿液: 1+ 5.6mmol（参考: 阴性）；隐血(OB)-尿液: +-0.3mg（参考: 阴性）；未分类结晶计数(UNCX#)-尿液: 5/μL；血液二氧化碳含量ctCO2(B)-静脉血: 20.4mmol/L；酸碱度(pH)-尿液: 6.5；尿胆原(URO)-尿液: -（参考: 阴性）\n- [全程D46] 检验组合: 阴离子间隙(AG)-静脉血: 17.7；血液二氧化碳含量ctCO2(B)-静脉血: 19.3mmol/L；氯离子(Cl-)-静脉血: 85.6mmol/L；总钙(Ca)-静脉血: 2.04mmol/L；钠离子(Na+)-静脉血: 122.6mmol/L；钾离子(K+)-静脉血: 3.26mmol/L；镁离子(Mg2+)-静脉血: 0.77mmol/L；磷(P)-静脉血: 0.51mmol/L\n- [全程D47] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 20.9mmol/L；总钙(Ca)-静脉血: 2.12mmol/L；阴离子间隙(AG)-静脉血: 14.5；磷(P)-静脉血: 0.67mmol/L；钾离子(K+)-静脉血: 4.06mmol/L；氯离子(Cl-)-静脉血: 89.8mmol/L；钠离子(Na+)-静脉血: 125.2mmol/L；镁离子(Mg2+)-静脉血: 0.93mmol/L\n- [全程D49] 检验组合: 镁离子(Mg2+)-静脉血: 0.89mmol/L；血小板分布宽度(PDW)-静脉血: 11.2%；有核红细胞百分比(NRBC%)-静脉血: 0；白蛋白(ALB)-静脉血: 44.2g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 33.1U/L；丙氨酸氨基转移酶(ALT)-静脉血: 22.6U/L；葡萄糖(Glu)-静脉血: 5.17mmol/L；间接胆红素(IBIL)-静脉血: 8.9umolL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.09mmolL；载脂蛋白B(apoB)-静脉血: 0.78g/L；总胆汁酸(TBA)-静脉血: 7.4umol/L；磷(P)-静脉血: 0.8mmol/L；肌酐(Crea)-静脉血: 38.9umol/L；甘油三酯(TG)-静脉血: 1.35mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29pg；平均红细胞体积(MCV)-静脉血: 83.3fL；单核细胞计数(Mono#)-静脉血: 0.710E9/L；总胆固醇(TC)-静脉血: 3.61mmol/L；总蛋白(TP)-静脉血: 67.8g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.003；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；总胆红素(TBIL)-静脉血: 12.8umol/L；血小板计数(PLT#)-静脉血: 19410E9/L；血小板比容-静脉血: 20%；天门冬氨酸氨基转移酶(AST)-静脉血: 12.9U/L；阴离子间隙(AG)-静脉血: 14.6；直接胆红素(DBIL)-静脉血: 3.9umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.05mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.2mmol/L；大血小板百分比(P-LCR%)-静脉血: 25.6%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 35.8；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.87；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；C-反应蛋白(CRP)-静脉血: 0.28mg/L；尿酸(UA)-静脉血: 110.7umol/L；单核细胞百分比(Mono%)-静脉血: 0……\n- [全程D60] 检验组合: α-L-岩藻糖苷酶(AFU)-静脉血: 20.3U/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；总胆固醇(TC)-静脉血: 3.99mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.68；天门冬氨酸氨基转移酶(AST)-静脉血: 11.8U/L；总钙(Ca)-静脉血: 2.22mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.05；有核红细胞计数(NRBC#)-静脉血: 010E9/L；白细胞计数(WBC#)-静脉血: 3.5710E9/L；钾离子(K+)-静脉血: 3.88mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.14；碱性磷酸酶(ALP)-静脉血: 52.6U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.62mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.89mmolL；氯离子(Cl-)-静脉血: 103mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；阴离子间隙(AG)-静脉血: 11；球蛋白(GLO)-静脉血: 22.9g/L；总胆汁酸(TBA)-静脉血: 0.9umol/L；镁离子(Mg2+)-静脉血: 0.9mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336g/L；血红蛋白(Hb)-静脉血: 115g/L；红细胞计数(RBC#)-静脉血: 3.910E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；甘油三酯(TG)-静脉血: 0.63mmol/L；磷(P)-静脉血: 1.02mmol/L；直接胆红素(DBIL)-静脉血: 2.86umol/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；单核细胞百分比(Mono%)-静脉血: 0.101；红细胞比容(Hct)-静脉血: 34.2%；血小板比容-静脉血: 17%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.5pg；平均血小板体积(MPV)-静脉血: 9.5fL；尿酸(UA)-静脉血: 152.4umol/L；肌酐(Crea)-静脉血: 43umol/L；丙氨酸氨基转移酶(ALT……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D11] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者检查完善，已完成放疗预约，嘱今日出院，按期行放疗前准备及放疗前口腔检查。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停化疗，给予重组人粒细胞集落刺激因子升白细胞治疗，待白细胞恢复后继续顺铂化疗。\nB. 暂停化疗，给予3%氯化钠注射液强化纠正低钠血症，待血钠持续稳定正常后再考虑恢复顺铂化疗。\nC. 将化疗方案调整为卡铂单药，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化支持治疗。\nD. 继续顺铂化疗，并给予地塞米松、甲氧氯普胺、奥美拉唑止吐，无需常规静脉水化及补钾。\nE. 继续顺铂化疗，并给予昂丹司琼单药止吐，辅以静脉水化及补钾支持治疗。\nF. 继续顺铂联合5-氟尿嘧啶化疗，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化支持治疗。\nG. 继续顺铂化疗，并给予地塞米松、甲氧氯普胺、奥美拉唑止吐，同时预防性使用重组人粒细胞集落刺激因子。\nH. 终止化疗，仅行单纯放射治疗，并给予静脉水化及营养支持。\nI. 继续顺铂化疗，并给予地塞米松、甲氧氯普胺、奥美拉唑止吐，辅以静脉水化及补钾支持治疗。\nJ. 继续顺铂化疗，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化，同时加用呋塞米强迫利尿且不补钾。\nK. 暂停化疗，给予保肝降酶治疗，待肝功能恢复后继续顺铂化疗。\nL. 将化疗方案调整为紫杉醇单药，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化支持治疗。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D60] 检验组合: α-L-岩藻糖苷酶(AFU)-静脉血: 20.3U/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；总胆固醇(TC)-静脉血: 3.99mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.68；天门冬氨酸氨基转移酶(AST)-静脉血: 11.8U/L；总钙(Ca)-静脉血: 2.22mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.05；有核红细胞计数(NRBC#)-静脉血: 010E9/L；白细胞计数(WBC#)-静脉血: 3.5710E9/L；钾离子(K+)-静脉血: 3.88mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.14；碱性磷酸酶(ALP)-静脉血: 52.6U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.62mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.89mmolL；氯离子(Cl-)-静脉血: 103mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；阴离子间隙(AG)-静脉血: 11；球蛋白(GLO)-静脉血: 22.9g/L；总胆汁酸(TBA)-静脉血: 0.9umol/L；镁离子(Mg2+)-静脉血: 0.9mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336g/L；血红蛋白(Hb)-静脉血: 115g/L；红细胞计数(RBC#)-静脉血: 3.910E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；甘油三酯(TG)-静脉血: 0.63mmol/L；磷(P)-静脉血: 1.02mmol/L；直接胆红素(DBIL)-静脉血: 2.86umol/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；单核细胞百分比(Mono%)-静脉血: 0.101；红细胞比容(Hct)-静脉血: 34.2%；血小板比容-静脉血: 17%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.5pg；平均血小板体积(MPV)-静脉血: 9.5fL；尿酸(UA)-静脉血: 152.4umol/L；肌酐(Crea)-静脉血: 43umol/L；丙氨酸氨基转移酶(ALT……\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停化疗，给予重组人粒细胞集落刺激因子升白细胞治疗，待白细胞恢复后继续顺铂化疗。\nB. 暂停化疗，给予3%氯化钠注射液强化纠正低钠血症，待血钠持续稳定正常后再考虑恢复顺铂化疗。\nC. 将化疗方案调整为卡铂单药，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化支持治疗。\nD. 继续顺铂化疗，并给予地塞米松、甲氧氯普胺、奥美拉唑止吐，无需常规静脉水化及补钾。\nE. 继续顺铂化疗，并给予昂丹司琼单药止吐，辅以静脉水化及补钾支持治疗。\nF. 继续顺铂联合5-氟尿嘧啶化疗，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化支持治疗。\nG. 继续顺铂化疗，并给予地塞米松、甲氧氯普胺、奥美拉唑止吐，同时预防性使用重组人粒细胞集落刺激因子。\nH. 终止化疗，仅行单纯放射治疗，并给予静脉水化及营养支持。\nI. 继续顺铂化疗，并给予地塞米松、甲氧氯普胺、奥美拉唑止吐，辅以静脉水化及补钾支持治疗。\nJ. 继续顺铂化疗，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化，同时加用呋塞米强迫利尿且不补钾。\nK. 暂停化疗，给予保肝降酶治疗，待肝功能恢复后继续顺铂化疗。\nL. 将化疗方案调整为紫杉醇单药，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化支持治疗。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D60] 检验组合: α-L-岩藻糖苷酶(AFU)-静脉血: 20.3U/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；总胆固醇(TC)-静脉血: 3.99mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.68；天门冬氨酸氨基转移酶(AST)-静脉血: 11.8U/L；总钙(Ca)-静脉血: 2.22mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.05；有核红细胞计数(NRBC#)-静脉血: 010E9/L；白细胞计数(WBC#)-静脉血: 3.5710E9/L；钾离子(K+)-静脉血: 3.88mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.14；碱性磷酸酶(ALP)-静脉血: 52.6U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.62mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.89mmolL；氯离子(Cl-)-静脉血: 103mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；阴离子间隙(AG)-静脉血: 11；球蛋白(GLO)-静脉血: 22.9g/L；总胆汁酸(TBA)-静脉血: 0.9umol/L；镁离子(Mg2+)-静脉血: 0.9mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336g/L；血红蛋白(Hb)-静脉血: 115g/L；红细胞计数(RBC#)-静脉血: 3.910E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；甘油三酯(TG)-静脉血: 0.63mmol/L；磷(P)-静脉血: 1.02mmol/L；直接胆红素(DBIL)-静脉血: 2.86umol/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；单核细胞百分比(Mono%)-静脉血: 0.101；红细胞比容(Hct)-静脉血: 34.2%；血小板比容-静脉血: 17%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.5pg；平均血小板体积(MPV)-静脉血: 9.5fL；尿酸(UA)-静脉血: 152.4umol/L；肌酐(Crea)-静脉血: 43umol/L；丙氨酸氨基转移酶(ALT……\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停化疗，给予重组人粒细胞集落刺激因子升白细胞治疗，待白细胞恢复后继续顺铂化疗。\nB. 暂停化疗，给予3%氯化钠注射液强化纠正低钠血症，待血钠持续稳定正常后再考虑恢复顺铂化疗。\nC. 将化疗方案调整为卡铂单药，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化支持治疗。\nD. 继续顺铂化疗，并给予地塞米松、甲氧氯普胺、奥美拉唑止吐，无需常规静脉水化及补钾。\nE. 继续顺铂化疗，并给予昂丹司琼单药止吐，辅以静脉水化及补钾支持治疗。\nF. 继续顺铂联合5-氟尿嘧啶化疗，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化支持治疗。\nG. 继续顺铂化疗，并给予地塞米松、甲氧氯普胺、奥美拉唑止吐，同时预防性使用重组人粒细胞集落刺激因子。\nH. 终止化疗，仅行单纯放射治疗，并给予静脉水化及营养支持。\nI. 继续顺铂化疗，并给予地塞米松、甲氧氯普胺、奥美拉唑止吐，辅以静脉水化及补钾支持治疗。\nJ. 继续顺铂化疗，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化，同时加用呋塞米强迫利尿且不补钾。\nK. 暂停化疗，给予保肝降酶治疗，待肝功能恢复后继续顺铂化疗。\nL. 将化疗方案调整为紫杉醇单药，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化支持治疗。\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-5acaafa7f13a3c4be08160aa","patient_id":"patient-d6812a1c46ed21fda9ebb9f8","turn_id":"turn07","turn_position":5,"turn_type":"response_assessment_decision","gold_letter":"J","gold_action":"疗效评估为放化疗有效，针对进食差及低钾血症予以静脉营养支持及补钾，继续根治性放疗并按期行第三程同期化疗。","options":[{"letter":"A","text":"疗效评估为疾病进展，存在低钾血症，暂停放疗，改为单药靶向治疗并静脉补钾。","is_gold":false},{"letter":"B","text":"疗效评估为放化疗有效，存在低钾血症及进食差，终止同期化疗，仅继续单纯放疗及口服补钾。","is_gold":false},{"letter":"C","text":"疗效评估为放化疗有效，存在低钾血症，暂停放疗及化疗，待血钾恢复正常后再恢复原方案。","is_gold":false},{"letter":"D","text":"疗效评估为疾病稳定，存在骨髓抑制，给予重组人血小板生成素并推迟后续化疗。","is_gold":false},{"letter":"E","text":"疗效评估为放化疗有效，右肾多发囊肿，请泌尿外科急会诊行囊肿穿刺引流，暂缓化疗。","is_gold":false},{"letter":"F","text":"疗效评估为疾病进展，复查鼻咽 MRI 及全身 PET-CT，更改化疗方案为吉西他滨联合顺铂。","is_gold":false},{"letter":"G","text":"疗效评估为放化疗有效，进食差，行经皮胃造瘘术进行肠内营养，继续放化疗。","is_gold":false},{"letter":"H","text":"疗效评估为放化疗有效，存在低钾血症，门诊口服氯化钾缓释片，继续放疗，取消第三程化疗。","is_gold":false},{"letter":"I","text":"疗效评估为放化疗有效，存在肝功能损害，停用顺铂，改为西妥昔单抗靶向治疗并保肝处理。","is_gold":false},{"letter":"J","text":"疗效评估为放化疗有效，予以静脉营养支持及补钾，处理进食差及低钾血症，继续根治性放疗并按期行第三程同期化疗。","is_gold":true},{"letter":"K","text":"疗效评估为放化疗有效，予以静脉补钾，处理低钾血症，结束同期化疗阶段，后续仅需完成单纯放疗。","is_gold":false},{"letter":"L","text":"疗效评估为疾病稳定，存在恶心呕吐，预防性给予三联止吐方案，提前结束放疗并转为辅助化疗。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 右侧耳鸣、鼻塞3月余，加重1周。；现病史: 缘于某次就诊时间11月下旬患者无意中出现右侧耳鸣、鼻塞，伴有右耳听力下降、头痛症状，无鼻出血，无面麻，无视物模糊、复视，无呛咳等症状；未予重视，逐渐加重，于某次就诊时间在[机构已隐去]就诊；建议患者住院治疗，患者及家属不同意。近1周来，耳鸣、鼻塞及头痛症状加重，今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,听力下降,右耳鸣,头痛；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：75次/分，R：20次/分，BP：110/65mmHg,Ht：150cm，Wt：41kg，BSA：1.316m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶壁、顶后壁、右侧壁明显增厚，左侧壁稍增厚，并见结节状肿物突出；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见: 轻度ST段下移；检查结论: 窦性心律 轻度ST段下移\n- [全程D1] 检验组合: 淋巴细胞百分比(Lymph%)-静脉血: 0.35；平均红细胞血红蛋白含量(MCH)-静脉血: 28.7pg；总钙(Ca)-静脉血: 2.32mmol/L；凝血酶时间(TT)-静脉血: 19.8sec.；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阳性(+)（参考: 阴性）；总胆汁酸(TBA)-静脉血: 4.1umol/L；钾离子(K+)-静脉血: 3.82mmol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；红细胞计数(RBC#)-静脉血: 5.0210E12/L；钠离子(Na+)-静脉血: 142.9mmol/L；尿素氮(BUN)-静脉血: 4.2mmol/L；葡萄糖(Glu)-静脉血: 5.36mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.66mmolL；球蛋白(GLO)-静脉血: 25.7g/L；尿酸(UA)-静脉血: 214.3umol/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；ABO血型-静脉血: O；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.98mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.76；中性粒细胞百分比(Neut%)-静脉血: 0.579；阴离子间隙(AG)-静脉血: 11.5；γ-谷氨酰基转移酶(GGT)-静脉血: 12.3U/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 23.4U/L；载脂蛋白B(apoB)-静脉血: 0.98g/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 6.4umolL；中性粒细胞计数(Neut#)-静脉血: 3.710E9/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；载脂蛋白AI(apoAI)-静脉血: 1.79g/L；肌酐(Crea)-静脉血: 50.2umol/L；总蛋白(TP)-静脉血: 70.9g/L；总胆固醇(TC)-静脉血: 5.02mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)……\n- [全程D2] 超声；双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声欠均匀，肝内可见多个无回声灶，较大者约43×29mm，椭圆形，边界清，内透声好，部分可见高回声分隔，后方回声增强。血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：上述病灶内未见明确血流信号。肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声欠均匀，右肾多个无回声灶，较大者约15×13mm，类圆形，边界清，内透声好，后方回声增强。左肾未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确肿物回声。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。；检查结论: 肝多发囊肿。 右肾多发囊肿。 胆囊、脾脏、胰腺、左肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D2] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对侧，双肺野纹理稍增多、增粗，未见明显实质性病变。双侧肺门不大，纵隔不宽，心影形态、大小、位置未见异常。双膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明确病变。\n- [全程D7] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、右侧壁明显增厚，左侧壁稍增厚，并见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号增强扫描明显强化，肿物占据右侧咽隐窝。双侧鼻腔及口咽各壁未见异常。 右侧腭帆张提肌、右侧头长肌及右侧翼内肌受侵，病变包绕右侧颈内动静脉。 右侧腭帆提肌、腭帆张肌、双侧头长肌受侵；左侧腭帆提肌、腭帆张肌未见受侵征象。 双侧翼腭窝、颞下窝未见异常；口咽侧壁未见受累增厚。 蝶骨基底部右份及右侧翼突基底部内侧、右侧翼突内板骨质信号减低，增强扫描不均匀强化。余颅底骨质未见明确异常。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、右侧乳突粘膜增厚，双侧上颌窦、蝶窦、左侧乳突充气良好，骨壁完整；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 右侧咽后见多个肿大淋巴结，最大者短径13mm，增强后明显强化，融合。左侧咽后及双颈II区见多发小淋巴结，最大者短径约7mm，未见坏死及包膜外侵。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺左叶见一结节，大小约11mm×11mm，边界尚清， T1WI及T2WI均呈混杂高信号，增强扫描部分区域强化较明显。甲状腺右叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。；检查结论: 鼻咽病变侵犯右侧咽旁间隙、椎前间隙右份及右侧翼内肌，考虑鼻咽癌可能性大。 蝶骨基底部右份、右侧翼突基底部内侧及右侧翼突内板骨质信号异常，考虑肿瘤浸润可能性大。 右侧咽后肿大淋巴结，考虑转移瘤。 左侧咽后及双颈II区小淋巴结，未排除转移可能。 鼻窦炎；右侧乳突炎。 甲状腺左叶结节灶，建议超声检查。\n- [全程D42] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位置位于第5胸椎体下缘，估计位于上腔静脉上段。；检查结论: PICC管末端位置如上所述。\n- [全程D42] 检验组合: 阴离子间隙(AG)-静脉血: 11；丙氨酸氨基转移酶(ALT)-静脉血: 12.8U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；钠离子(Na+)-静脉血: 143.3mmol/L；总钙(Ca)-静脉血: 2.2mmol/L；总胆红素(TBIL)-静脉血: 8.4umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.3U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.86；C-反应蛋白(CRP)-静脉血: 0.85mg/L；胱抑素(Cys-C)-静脉血: 0.61mg/L；磷(P)-静脉血: 1.14mmol/L；总胆固醇(TC)-静脉血: 4.61mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.292；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；载脂蛋白B(apoB)-静脉血: 0.93g/L；间接胆红素(IBIL)-静脉血: 6.4umolL；甘油三酯(TG)-静脉血: 0.64mmol/L；碱性磷酸酶(ALP)-静脉血: 87.2U/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 2umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；尿酸(UA)-静脉血: 194.8umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.02mmol/L；总胆汁酸(TBA)-静脉血: 2.1umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.96；钾离子(K+)-静脉血: 3.83mmol/L；红细胞比容(Hct)-静脉血: 40.7%；氯离子(Cl-)-静脉血: 107.6mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；肌酐(Crea)-静脉血: 46.2umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.810E9/L；血小板分布宽度(PDW)-静脉血: 10.6%；平均血小板体积(MPV)-静脉血: 9.5fL；白蛋白(ALB)-静脉血: 43.5g/L；尿素氮(BUN)-静脉血: 3.6mmol/L；白细胞计数(WBC#)-静脉血: 6.3110……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D43] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.016；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: 1+ 0.6mg（参考: 阴性）；浊度(TRUB)-尿液: 清亮；葡萄糖(Glu)-尿液: +- 1.7mmol（参考: 阴性）；酸碱度(pH)-尿液: 6.5；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；红细胞计数(RBC#)-尿液: 8/μL；酮体(KET)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 7/μL；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D44] 检验组合: 白蛋白(ALB)-静脉血: 37.7g/L；总胆红素(TBIL)-静脉血: 9umol/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；钠离子(Na+)-静脉血: 133.7mmol/L；直接胆红素(DBIL)-静脉血: 2.1umol/L；总胆汁酸(TBA)-静脉血: 1.4umol/L；尿酸(UA)-静脉血: 164.1umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.6U/L；总蛋白(TP)-静脉血: 58.49g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 23.7U/L；碱性磷酸酶(ALP)-静脉血: 72.8U/L；肌酐(Crea)-静脉血: 44.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.95；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.81；尿素氮(BUN)-静脉血: 4.4mmol/L；磷(P)-静脉血: 0.93mmol/L；总钙(Ca)-静脉血: 2.02mmol/L；乳酸脱氢酶(LDH)-静脉血: 210.9U/L；氯离子(Cl-)-静脉血: 100.2mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 12.3U/L；间接胆红素(IBIL)-静脉血: 6.9umolL；钾离子(K+)-静脉血: 2.94mmol/L；阴离子间隙(AG)-静脉血: 12.1；血液二氧化碳含量ctCO2(B)-静脉血: 21.4mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.3U/L；球蛋白(GLO)-静脉血: 20.79g/L\n- [全程D45] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 1/μL；钠离子(Na+)-静脉血: 131.1mmol/L；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；阴离子间隙(AG)-静脉血: 14.5；浊度(TRUB)-尿液: clear；胆红素(BIL)-尿液: -（参考: 阴性）；镁离子(Mg2+)-静脉血: 0.79mmol/L；钾离子(K+)-静脉血: 3.17mmol/L；红细胞计数(RBC#)-尿液: 17/μL；磷(P)-静脉血: 0.95mmol/L；氯离子(Cl-)-静脉血: 96.2mmol/L；白细胞计数(WBC#)-尿液: 5/μL；总钙(Ca)-静脉血: 1.92mmol/L；颜色-尿液: Light-Yellow；比重(SG)-尿液: 1.011；葡萄糖(Glu)-尿液: 1+ 5.6mmol（参考: 阴性）；隐血(OB)-尿液: +-0.3mg（参考: 阴性）；未分类结晶计数(UNCX#)-尿液: 5/μL；血液二氧化碳含量ctCO2(B)-静脉血: 20.4mmol/L；酸碱度(pH)-尿液: 6.5；尿胆原(URO)-尿液: -（参考: 阴性）\n- [全程D46] 检验组合: 阴离子间隙(AG)-静脉血: 17.7；血液二氧化碳含量ctCO2(B)-静脉血: 19.3mmol/L；氯离子(Cl-)-静脉血: 85.6mmol/L；总钙(Ca)-静脉血: 2.04mmol/L；钠离子(Na+)-静脉血: 122.6mmol/L；钾离子(K+)-静脉血: 3.26mmol/L；镁离子(Mg2+)-静脉血: 0.77mmol/L；磷(P)-静脉血: 0.51mmol/L\n- [全程D47] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 20.9mmol/L；总钙(Ca)-静脉血: 2.12mmol/L；阴离子间隙(AG)-静脉血: 14.5；磷(P)-静脉血: 0.67mmol/L；钾离子(K+)-静脉血: 4.06mmol/L；氯离子(Cl-)-静脉血: 89.8mmol/L；钠离子(Na+)-静脉血: 125.2mmol/L；镁离子(Mg2+)-静脉血: 0.93mmol/L\n- [全程D49] 检验组合: 镁离子(Mg2+)-静脉血: 0.89mmol/L；血小板分布宽度(PDW)-静脉血: 11.2%；有核红细胞百分比(NRBC%)-静脉血: 0；白蛋白(ALB)-静脉血: 44.2g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 33.1U/L；丙氨酸氨基转移酶(ALT)-静脉血: 22.6U/L；葡萄糖(Glu)-静脉血: 5.17mmol/L；间接胆红素(IBIL)-静脉血: 8.9umolL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.09mmolL；载脂蛋白B(apoB)-静脉血: 0.78g/L；总胆汁酸(TBA)-静脉血: 7.4umol/L；磷(P)-静脉血: 0.8mmol/L；肌酐(Crea)-静脉血: 38.9umol/L；甘油三酯(TG)-静脉血: 1.35mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29pg；平均红细胞体积(MCV)-静脉血: 83.3fL；单核细胞计数(Mono#)-静脉血: 0.710E9/L；总胆固醇(TC)-静脉血: 3.61mmol/L；总蛋白(TP)-静脉血: 67.8g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.003；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；总胆红素(TBIL)-静脉血: 12.8umol/L；血小板计数(PLT#)-静脉血: 19410E9/L；血小板比容-静脉血: 20%；天门冬氨酸氨基转移酶(AST)-静脉血: 12.9U/L；阴离子间隙(AG)-静脉血: 14.6；直接胆红素(DBIL)-静脉血: 3.9umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.05mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.2mmol/L；大血小板百分比(P-LCR%)-静脉血: 25.6%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 35.8；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.87；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；C-反应蛋白(CRP)-静脉血: 0.28mg/L；尿酸(UA)-静脉血: 110.7umol/L；单核细胞百分比(Mono%)-静脉血: 0……\n- [全程D60] 检验组合: α-L-岩藻糖苷酶(AFU)-静脉血: 20.3U/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；总胆固醇(TC)-静脉血: 3.99mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.68；天门冬氨酸氨基转移酶(AST)-静脉血: 11.8U/L；总钙(Ca)-静脉血: 2.22mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.05；有核红细胞计数(NRBC#)-静脉血: 010E9/L；白细胞计数(WBC#)-静脉血: 3.5710E9/L；钾离子(K+)-静脉血: 3.88mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.14；碱性磷酸酶(ALP)-静脉血: 52.6U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.62mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.89mmolL；氯离子(Cl-)-静脉血: 103mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；阴离子间隙(AG)-静脉血: 11；球蛋白(GLO)-静脉血: 22.9g/L；总胆汁酸(TBA)-静脉血: 0.9umol/L；镁离子(Mg2+)-静脉血: 0.9mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336g/L；血红蛋白(Hb)-静脉血: 115g/L；红细胞计数(RBC#)-静脉血: 3.910E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；甘油三酯(TG)-静脉血: 0.63mmol/L；磷(P)-静脉血: 1.02mmol/L；直接胆红素(DBIL)-静脉血: 2.86umol/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；单核细胞百分比(Mono%)-静脉血: 0.101；红细胞比容(Hct)-静脉血: 34.2%；血小板比容-静脉血: 17%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.5pg；平均血小板体积(MPV)-静脉血: 9.5fL；尿酸(UA)-静脉血: 152.4umol/L；肌酐(Crea)-静脉血: 43umol/L；丙氨酸氨基转移酶(ALT……\n- [全程D68] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0；有核红细胞计数(NRBC#)-静脉血: 010E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0；大血小板百分比(P-LCR%)-静脉血: 20.1%；尿酸(UA)-静脉血: 120.2umol/L；总胆固醇(TC)-静脉血: 4.11mmol/L；总钙(Ca)-静脉血: 2.22mmol/L；平均红细胞体积(MCV)-静脉血: 84.4fL；单核细胞百分比(Mono%)-静脉血: 0.155；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；淋巴细胞百分比(Lymph%)-静脉血: 0.088；总胆汁酸(TBA)-静脉血: 2.6umol/L；白蛋白(ALB)-静脉血: 40.1g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.22mmolL；总蛋白(TP)-静脉血: 62.7g/L；载脂蛋白AI(apoAI)-静脉血: 1.32g/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.5U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.77；中性粒细胞百分比(Neut%)-静脉血: 0.757；α-L-岩藻糖苷酶(AFU)-静脉血: 42.2U/L；C-反应蛋白(CRP)-静脉血: 0.25mg/L；阴离子间隙(AG)-静脉血: 13.4；肌酐(Crea)-静脉血: 43.4umol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.7；中性粒细胞计数(Neut#)-静脉血: 4.210E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.9U/L；钠离子(Na+)-静脉血: 134mmol/L；单核细胞计数(Mono#)-静脉血: 0.910E9/L；血小板分布宽度(PDW)-静脉血: 10.6%；镁离子(Mg2+)-静脉血: 0.72mmol/L；血小板比容-静脉血: 19%；白细胞计数(WBC#)-静脉血: 5.4810E9/L；胱抑素(Cys-C)-静脉血: 0.92mg/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.3；葡萄糖(Glu)-静脉血: 4.71mmol/L；直接胆红素(DBIL)-静脉血: 2.12umol/L；血红蛋白(Hb)-静脉血: 123g/L；碱性磷酸酶(……\n- [全程D70] 检验组合: 淋巴细胞百分比(Lymph%)-静脉血: 0.097；血小板分布宽度(PDW)-静脉血: 10.4%；白细胞计数(WBC#)-静脉血: 5.3710E9/L；平均血小板体积(MPV)-静脉血: 9.5fL；乳酸脱氢酶(LDH)-静脉血: 191.8U/L；直接胆红素(DBIL)-静脉血: 2.52umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20.6U/L；氯离子(Cl-)-静脉血: 92.5mmol/L；尿素氮(BUN)-静脉血: 5mmol/L；血小板比容-静脉血: 21%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总钙(Ca)-静脉血: 2.25mmol/L；尿酸(UA)-静脉血: 198umol/L；总胆红素(TBIL)-静脉血: 9.15umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 37.3U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.006；中性粒细胞计数(Neut#)-静脉血: 4.110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.77；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；间接胆红素(IBIL)-静脉血: 6.63umolL；碱性磷酸酶(ALP)-静脉血: 58U/L；单核细胞百分比(Mono%)-静脉血: 0.125；载脂蛋白B(apoB)-静脉血: 1.02g/L；C-反应蛋白(CRP)-静脉血: 1.01mg/L；γ-谷氨酰基转移酶(GGT)-静脉血: 27.6U/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.3mmol/L；甘油三酯(TG)-静脉血: 1.4mmol/L；总胆汁酸(TBA)-静脉血: 3.6umol/L；球蛋白(GLO)-静脉血: 24.2g/L；白蛋白(ALB)-静脉血: 41.8g/L；葡萄糖(Glu)-静脉血: 5.35mmol/L；平均红细胞体积(MCV)-静脉血: 83.5fL；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 348g/L；胱抑素(Cys-C)-静脉血: 0.79mg/L；丙氨酸氨基转移酶(ALT)-静脉血: 24U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.88mmol/L；红细……\n- [全程D77] 检验组合: 总胆红素(TBIL)-静脉血: 9.1umol/L；血小板分布宽度(PDW)-静脉血: 10.7%；乳酸脱氢酶(LDH)-静脉血: 184.4U/L；直接胆红素(DBIL)-静脉血: 2.92umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.9mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 24U/L；总胆固醇(TC)-静脉血: 4.36mmol/L；平均血小板体积(MPV)-静脉血: 9.7fL；白细胞计数(WBC#)-静脉血: 6.0610E9/L；氯离子(Cl-)-静脉血: 97.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 9.2U/L；阴离子间隙(AG)-静脉血: 15.2；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞计数(RBC#)-静脉血: 4.0510E12/L；总胆汁酸(TBA)-静脉血: 1.1umol/L；C-反应蛋白(CRP)-静脉血: 6.66mg/L；磷(P)-静脉血: 1.11mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.012；中性粒细胞百分比(Neut%)-静脉血: 0.799；淋巴细胞计数(Lymph#)-静脉血: 0.410E9/L；总钙(Ca)-静脉血: 2.14mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.03mmol/L；球蛋白(GLO)-静脉血: 22g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.99mmolL；淋巴细胞百分比(Lymph%)-静脉血: 0.064；血小板计数(PLT#)-静脉血: 12010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.2；钾离子(K+)-静脉血: 3.15mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.09；碱性磷酸酶(ALP)-静脉血: 49.9U/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 44.5umol/L；中性粒细胞计数(Neut#)-静脉血: 4.810E9/L；间接胆红素(IBIL)-静脉血: 6.18umolL；尿素氮(BUN)-静脉血: 5.3mmol/L；红细胞体积分布宽度CV(RDW-CV)-……\n- [全程D79] 超声；双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 双肾大小形态正常，右肾探及几个无回声灶，大者约16×13mm，边界清，内透声可，后方回声增强。左肾实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确肿物回声。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。；检查结论: 右肾多发囊性灶，考虑肾囊肿。 左肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位性病变。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D11] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者检查完善，已完成放疗预约，嘱今日出院，按期行放疗前准备及放疗前口腔检查。\n- [全程D66] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者诉恶心，食欲差，于未诉特殊不适，查体基本同前。患者第二程DDP同时期化疗。予加强止呕及营养支持治疗，防治放化毒副反应。续观。\n- [全程D70] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者诉恶心，进食差，余未诉特殊不适，查体基本同前。今日[姓名已隐去]医生信息已隐藏后示：患者已完成第二程DDP同时期化疗，予加强营养支持治疗。一般情况平稳，嘱今日补液结束后出院，于门诊继续放疗。按期返院继续治疗。遵嘱。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 疗效评估为疾病进展，存在低钾血症，暂停放疗，改为单药靶向治疗并静脉补钾。\nB. 疗效评估为放化疗有效，存在低钾血症及进食差，终止同期化疗，仅继续单纯放疗及口服补钾。\nC. 疗效评估为放化疗有效，存在低钾血症，暂停放疗及化疗，待血钾恢复正常后再恢复原方案。\nD. 疗效评估为疾病稳定，存在骨髓抑制，给予重组人血小板生成素并推迟后续化疗。\nE. 疗效评估为放化疗有效，右肾多发囊肿，请泌尿外科急会诊行囊肿穿刺引流，暂缓化疗。\nF. 疗效评估为疾病进展，复查鼻咽 MRI 及全身 PET-CT，更改化疗方案为吉西他滨联合顺铂。\nG. 疗效评估为放化疗有效，进食差，行经皮胃造瘘术进行肠内营养，继续放化疗。\nH. 疗效评估为放化疗有效，存在低钾血症，门诊口服氯化钾缓释片，继续放疗，取消第三程化疗。\nI. 疗效评估为放化疗有效，存在肝功能损害，停用顺铂，改为西妥昔单抗靶向治疗并保肝处理。\nJ. 疗效评估为放化疗有效，予以静脉营养支持及补钾，处理进食差及低钾血症，继续根治性放疗并按期行第三程同期化疗。\nK. 疗效评估为放化疗有效，予以静脉补钾，处理低钾血症，结束同期化疗阶段，后续仅需完成单纯放疗。\nL. 疗效评估为疾病稳定，存在恶心呕吐，预防性给予三联止吐方案，提前结束放疗并转为辅助化疗。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D68] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0；有核红细胞计数(NRBC#)-静脉血: 010E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0；大血小板百分比(P-LCR%)-静脉血: 20.1%；尿酸(UA)-静脉血: 120.2umol/L；总胆固醇(TC)-静脉血: 4.11mmol/L；总钙(Ca)-静脉血: 2.22mmol/L；平均红细胞体积(MCV)-静脉血: 84.4fL；单核细胞百分比(Mono%)-静脉血: 0.155；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；淋巴细胞百分比(Lymph%)-静脉血: 0.088；总胆汁酸(TBA)-静脉血: 2.6umol/L；白蛋白(ALB)-静脉血: 40.1g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.22mmolL；总蛋白(TP)-静脉血: 62.7g/L；载脂蛋白AI(apoAI)-静脉血: 1.32g/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.5U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.77；中性粒细胞百分比(Neut%)-静脉血: 0.757；α-L-岩藻糖苷酶(AFU)-静脉血: 42.2U/L；C-反应蛋白(CRP)-静脉血: 0.25mg/L；阴离子间隙(AG)-静脉血: 13.4；肌酐(Crea)-静脉血: 43.4umol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.7；中性粒细胞计数(Neut#)-静脉血: 4.210E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.9U/L；钠离子(Na+)-静脉血: 134mmol/L；单核细胞计数(Mono#)-静脉血: 0.910E9/L；血小板分布宽度(PDW)-静脉血: 10.6%；镁离子(Mg2+)-静脉血: 0.72mmol/L；血小板比容-静脉血: 19%；白细胞计数(WBC#)-静脉血: 5.4810E9/L；胱抑素(Cys-C)-静脉血: 0.92mg/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.3；葡萄糖(Glu)-静脉血: 4.71mmol/L；直接胆红素(DBIL)-静脉血: 2.12umol/L；血红蛋白(Hb)-静脉血: 123g/L；碱性磷酸酶(……\n- [全程D70] 检验组合: 淋巴细胞百分比(Lymph%)-静脉血: 0.097；血小板分布宽度(PDW)-静脉血: 10.4%；白细胞计数(WBC#)-静脉血: 5.3710E9/L；平均血小板体积(MPV)-静脉血: 9.5fL；乳酸脱氢酶(LDH)-静脉血: 191.8U/L；直接胆红素(DBIL)-静脉血: 2.52umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20.6U/L；氯离子(Cl-)-静脉血: 92.5mmol/L；尿素氮(BUN)-静脉血: 5mmol/L；血小板比容-静脉血: 21%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总钙(Ca)-静脉血: 2.25mmol/L；尿酸(UA)-静脉血: 198umol/L；总胆红素(TBIL)-静脉血: 9.15umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 37.3U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.006；中性粒细胞计数(Neut#)-静脉血: 4.110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.77；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；间接胆红素(IBIL)-静脉血: 6.63umolL；碱性磷酸酶(ALP)-静脉血: 58U/L；单核细胞百分比(Mono%)-静脉血: 0.125；载脂蛋白B(apoB)-静脉血: 1.02g/L；C-反应蛋白(CRP)-静脉血: 1.01mg/L；γ-谷氨酰基转移酶(GGT)-静脉血: 27.6U/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.3mmol/L；甘油三酯(TG)-静脉血: 1.4mmol/L；总胆汁酸(TBA)-静脉血: 3.6umol/L；球蛋白(GLO)-静脉血: 24.2g/L；白蛋白(ALB)-静脉血: 41.8g/L；葡萄糖(Glu)-静脉血: 5.35mmol/L；平均红细胞体积(MCV)-静脉血: 83.5fL；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 348g/L；胱抑素(Cys-C)-静脉血: 0.79mg/L；丙氨酸氨基转移酶(ALT)-静脉血: 24U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.88mmol/L；红细……\n- [全程D77] 检验组合: 总胆红素(TBIL)-静脉血: 9.1umol/L；血小板分布宽度(PDW)-静脉血: 10.7%；乳酸脱氢酶(LDH)-静脉血: 184.4U/L；直接胆红素(DBIL)-静脉血: 2.92umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.9mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 24U/L；总胆固醇(TC)-静脉血: 4.36mmol/L；平均血小板体积(MPV)-静脉血: 9.7fL；白细胞计数(WBC#)-静脉血: 6.0610E9/L；氯离子(Cl-)-静脉血: 97.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 9.2U/L；阴离子间隙(AG)-静脉血: 15.2；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞计数(RBC#)-静脉血: 4.0510E12/L；总胆汁酸(TBA)-静脉血: 1.1umol/L；C-反应蛋白(CRP)-静脉血: 6.66mg/L；磷(P)-静脉血: 1.11mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.012；中性粒细胞百分比(Neut%)-静脉血: 0.799；淋巴细胞计数(Lymph#)-静脉血: 0.410E9/L；总钙(Ca)-静脉血: 2.14mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.03mmol/L；球蛋白(GLO)-静脉血: 22g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.99mmolL；淋巴细胞百分比(Lymph%)-静脉血: 0.064；血小板计数(PLT#)-静脉血: 12010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.2；钾离子(K+)-静脉血: 3.15mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.09；碱性磷酸酶(ALP)-静脉血: 49.9U/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 44.5umol/L；中性粒细胞计数(Neut#)-静脉血: 4.810E9/L；间接胆红素(IBIL)-静脉血: 6.18umolL；尿素氮(BUN)-静脉血: 5.3mmol/L；红细胞体积分布宽度CV(RDW-CV)-……\n- [全程D79] 超声；双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 双肾大小形态正常，右肾探及几个无回声灶，大者约16×13mm，边界清，内透声可，后方回声增强。左肾实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确肿物回声。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。；检查结论: 右肾多发囊性灶，考虑肾囊肿。 左肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位性病变。\n\n【既往治疗与反应】\n- [全程D66] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者诉恶心，食欲差，于未诉特殊不适，查体基本同前。患者第二程DDP同时期化疗。予加强止呕及营养支持治疗，防治放化毒副反应。续观。\n- [全程D70] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者诉恶心，进食差，余未诉特殊不适，查体基本同前。今日[姓名已隐去]医生信息已隐藏后示：患者已完成第二程DDP同时期化疗，予加强营养支持治疗。一般情况平稳，嘱今日补液结束后出院，于门诊继续放疗。按期返院继续治疗。遵嘱。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 疗效评估为疾病进展，存在低钾血症，暂停放疗，改为单药靶向治疗并静脉补钾。\nB. 疗效评估为放化疗有效，存在低钾血症及进食差，终止同期化疗，仅继续单纯放疗及口服补钾。\nC. 疗效评估为放化疗有效，存在低钾血症，暂停放疗及化疗，待血钾恢复正常后再恢复原方案。\nD. 疗效评估为疾病稳定，存在骨髓抑制，给予重组人血小板生成素并推迟后续化疗。\nE. 疗效评估为放化疗有效，右肾多发囊肿，请泌尿外科急会诊行囊肿穿刺引流，暂缓化疗。\nF. 疗效评估为疾病进展，复查鼻咽 MRI 及全身 PET-CT，更改化疗方案为吉西他滨联合顺铂。\nG. 疗效评估为放化疗有效，进食差，行经皮胃造瘘术进行肠内营养，继续放化疗。\nH. 疗效评估为放化疗有效，存在低钾血症，门诊口服氯化钾缓释片，继续放疗，取消第三程化疗。\nI. 疗效评估为放化疗有效，存在肝功能损害，停用顺铂，改为西妥昔单抗靶向治疗并保肝处理。\nJ. 疗效评估为放化疗有效，予以静脉营养支持及补钾，处理进食差及低钾血症，继续根治性放疗并按期行第三程同期化疗。\nK. 疗效评估为放化疗有效，予以静脉补钾，处理低钾血症，结束同期化疗阶段，后续仅需完成单纯放疗。\nL. 疗效评估为疾病稳定，存在恶心呕吐，预防性给予三联止吐方案，提前结束放疗并转为辅助化疗。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D68] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0；有核红细胞计数(NRBC#)-静脉血: 010E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0；大血小板百分比(P-LCR%)-静脉血: 20.1%；尿酸(UA)-静脉血: 120.2umol/L；总胆固醇(TC)-静脉血: 4.11mmol/L；总钙(Ca)-静脉血: 2.22mmol/L；平均红细胞体积(MCV)-静脉血: 84.4fL；单核细胞百分比(Mono%)-静脉血: 0.155；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；淋巴细胞百分比(Lymph%)-静脉血: 0.088；总胆汁酸(TBA)-静脉血: 2.6umol/L；白蛋白(ALB)-静脉血: 40.1g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.22mmolL；总蛋白(TP)-静脉血: 62.7g/L；载脂蛋白AI(apoAI)-静脉血: 1.32g/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.5U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.77；中性粒细胞百分比(Neut%)-静脉血: 0.757；α-L-岩藻糖苷酶(AFU)-静脉血: 42.2U/L；C-反应蛋白(CRP)-静脉血: 0.25mg/L；阴离子间隙(AG)-静脉血: 13.4；肌酐(Crea)-静脉血: 43.4umol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.7；中性粒细胞计数(Neut#)-静脉血: 4.210E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.9U/L；钠离子(Na+)-静脉血: 134mmol/L；单核细胞计数(Mono#)-静脉血: 0.910E9/L；血小板分布宽度(PDW)-静脉血: 10.6%；镁离子(Mg2+)-静脉血: 0.72mmol/L；血小板比容-静脉血: 19%；白细胞计数(WBC#)-静脉血: 5.4810E9/L；胱抑素(Cys-C)-静脉血: 0.92mg/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.3；葡萄糖(Glu)-静脉血: 4.71mmol/L；直接胆红素(DBIL)-静脉血: 2.12umol/L；血红蛋白(Hb)-静脉血: 123g/L；碱性磷酸酶(……\n- [全程D70] 检验组合: 淋巴细胞百分比(Lymph%)-静脉血: 0.097；血小板分布宽度(PDW)-静脉血: 10.4%；白细胞计数(WBC#)-静脉血: 5.3710E9/L；平均血小板体积(MPV)-静脉血: 9.5fL；乳酸脱氢酶(LDH)-静脉血: 191.8U/L；直接胆红素(DBIL)-静脉血: 2.52umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20.6U/L；氯离子(Cl-)-静脉血: 92.5mmol/L；尿素氮(BUN)-静脉血: 5mmol/L；血小板比容-静脉血: 21%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总钙(Ca)-静脉血: 2.25mmol/L；尿酸(UA)-静脉血: 198umol/L；总胆红素(TBIL)-静脉血: 9.15umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 37.3U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.006；中性粒细胞计数(Neut#)-静脉血: 4.110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.77；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；间接胆红素(IBIL)-静脉血: 6.63umolL；碱性磷酸酶(ALP)-静脉血: 58U/L；单核细胞百分比(Mono%)-静脉血: 0.125；载脂蛋白B(apoB)-静脉血: 1.02g/L；C-反应蛋白(CRP)-静脉血: 1.01mg/L；γ-谷氨酰基转移酶(GGT)-静脉血: 27.6U/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.3mmol/L；甘油三酯(TG)-静脉血: 1.4mmol/L；总胆汁酸(TBA)-静脉血: 3.6umol/L；球蛋白(GLO)-静脉血: 24.2g/L；白蛋白(ALB)-静脉血: 41.8g/L；葡萄糖(Glu)-静脉血: 5.35mmol/L；平均红细胞体积(MCV)-静脉血: 83.5fL；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 348g/L；胱抑素(Cys-C)-静脉血: 0.79mg/L；丙氨酸氨基转移酶(ALT)-静脉血: 24U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.88mmol/L；红细……\n- [全程D77] 检验组合: 总胆红素(TBIL)-静脉血: 9.1umol/L；血小板分布宽度(PDW)-静脉血: 10.7%；乳酸脱氢酶(LDH)-静脉血: 184.4U/L；直接胆红素(DBIL)-静脉血: 2.92umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.9mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 24U/L；总胆固醇(TC)-静脉血: 4.36mmol/L；平均血小板体积(MPV)-静脉血: 9.7fL；白细胞计数(WBC#)-静脉血: 6.0610E9/L；氯离子(Cl-)-静脉血: 97.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 9.2U/L；阴离子间隙(AG)-静脉血: 15.2；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞计数(RBC#)-静脉血: 4.0510E12/L；总胆汁酸(TBA)-静脉血: 1.1umol/L；C-反应蛋白(CRP)-静脉血: 6.66mg/L；磷(P)-静脉血: 1.11mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.012；中性粒细胞百分比(Neut%)-静脉血: 0.799；淋巴细胞计数(Lymph#)-静脉血: 0.410E9/L；总钙(Ca)-静脉血: 2.14mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.03mmol/L；球蛋白(GLO)-静脉血: 22g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.99mmolL；淋巴细胞百分比(Lymph%)-静脉血: 0.064；血小板计数(PLT#)-静脉血: 12010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.2；钾离子(K+)-静脉血: 3.15mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.09；碱性磷酸酶(ALP)-静脉血: 49.9U/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 44.5umol/L；中性粒细胞计数(Neut#)-静脉血: 4.810E9/L；间接胆红素(IBIL)-静脉血: 6.18umolL；尿素氮(BUN)-静脉血: 5.3mmol/L；红细胞体积分布宽度CV(RDW-CV)-……\n- [全程D79] 超声；双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 双肾大小形态正常，右肾探及几个无回声灶，大者约16×13mm，边界清，内透声可，后方回声增强。左肾实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确肿物回声。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。；检查结论: 右肾多发囊性灶，考虑肾囊肿。 左肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位性病变。\n\n【既往治疗与反应】\n- [全程D66] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者诉恶心，食欲差，于未诉特殊不适，查体基本同前。患者第二程DDP同时期化疗。予加强止呕及营养支持治疗，防治放化毒副反应。续观。\n- [全程D70] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者诉恶心，进食差，余未诉特殊不适，查体基本同前。今日[姓名已隐去]医生信息已隐藏后示：患者已完成第二程DDP同时期化疗，予加强营养支持治疗。一般情况平稳，嘱今日补液结束后出院，于门诊继续放疗。按期返院继续治疗。遵嘱。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 疗效评估为疾病进展，存在低钾血症，暂停放疗，改为单药靶向治疗并静脉补钾。\nB. 疗效评估为放化疗有效，存在低钾血症及进食差，终止同期化疗，仅继续单纯放疗及口服补钾。\nC. 疗效评估为放化疗有效，存在低钾血症，暂停放疗及化疗，待血钾恢复正常后再恢复原方案。\nD. 疗效评估为疾病稳定，存在骨髓抑制，给予重组人血小板生成素并推迟后续化疗。\nE. 疗效评估为放化疗有效，右肾多发囊肿，请泌尿外科急会诊行囊肿穿刺引流，暂缓化疗。\nF. 疗效评估为疾病进展，复查鼻咽 MRI 及全身 PET-CT，更改化疗方案为吉西他滨联合顺铂。\nG. 疗效评估为放化疗有效，进食差，行经皮胃造瘘术进行肠内营养，继续放化疗。\nH. 疗效评估为放化疗有效，存在低钾血症，门诊口服氯化钾缓释片，继续放疗，取消第三程化疗。\nI. 疗效评估为放化疗有效，存在肝功能损害，停用顺铂，改为西妥昔单抗靶向治疗并保肝处理。\nJ. 疗效评估为放化疗有效，予以静脉营养支持及补钾，处理进食差及低钾血症，继续根治性放疗并按期行第三程同期化疗。\nK. 疗效评估为放化疗有效，予以静脉补钾，处理低钾血症，结束同期化疗阶段，后续仅需完成单纯放疗。\nL. 疗效评估为疾病稳定，存在恶心呕吐，预防性给予三联止吐方案，提前结束放疗并转为辅助化疗。\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-47e9b2e315a805773d669325","patient_id":"patient-d6812a1c46ed21fda9ebb9f8","turn_id":"turn08","turn_position":6,"turn_type":"response_assessment_decision","gold_letter":"K","gold_action":"疗效评估为部分缓解（PR），继续完成根治性放疗及既定化疗计划，并加强静脉营养支持与补钾等对症处理。","options":[{"letter":"A","text":"疗效评估为疾病进展（PD），终止放化疗计划，改行鼻咽及颈部挽救性手术切除。","is_gold":false},{"letter":"B","text":"疗效评估为疾病进展（PD），停用顺铂，更改化疗方案为吉西他滨联合氟尿嘧啶并继续放疗。","is_gold":false},{"letter":"C","text":"疗效评估为部分缓解（PR），继续完成根治性放疗，对鼻咽及颈部残留病灶局部加量至76Gy。","is_gold":false},{"letter":"D","text":"疗效评估为部分缓解（PR），继续完成根治性放疗，取消后续化疗计划，仅予口服补钾与营养支持。","is_gold":false},{"letter":"E","text":"疗效评估为部分缓解（PR），继续完成根治性放疗及既定化疗计划，并加用尼妥珠单抗靶向治疗。","is_gold":false},{"letter":"F","text":"疗效评估为完全缓解（CR），提前终止放疗与化疗，拔除静脉通道，转入定期门诊随访观察阶段。","is_gold":false},{"letter":"G","text":"疗效评估为部分缓解（PR），继续完成根治性放疗，并行局部清扫术，处理右侧咽旁及咽后残留病灶。","is_gold":false},{"letter":"H","text":"疗效评估为疾病稳定（SD），继续放疗，并联合PD-1抑制剂以增强局部控制与全身抗肿瘤反应。","is_gold":false},{"letter":"I","text":"疗效评估为部分缓解（PR），暂停放疗优先纠正低钾血症与营养不良，待电解质完全恢复后重启放疗。","is_gold":false},{"letter":"J","text":"疗效评估为部分缓解（PR），继续完成根治性放疗及既定化疗计划，无需特殊支持治疗，定期复查即可。","is_gold":false},{"letter":"K","text":"疗效评估为部分缓解（PR），继续完成根治性放疗及既定化疗计划，并加强静脉营养支持与补钾等对症处理。","is_gold":true},{"letter":"L","text":"疗效评估为疾病稳定（SD），继续完成根治性放疗，将后续化疗方案调整为紫杉醇联合卡铂以克服耐药。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 右侧耳鸣、鼻塞3月余，加重1周。；现病史: 缘于某次就诊时间11月下旬患者无意中出现右侧耳鸣、鼻塞，伴有右耳听力下降、头痛症状，无鼻出血，无面麻，无视物模糊、复视，无呛咳等症状；未予重视，逐渐加重，于某次就诊时间在[机构已隐去]就诊；建议患者住院治疗，患者及家属不同意。近1周来，耳鸣、鼻塞及头痛症状加重，今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,听力下降,右耳鸣,头痛；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：75次/分，R：20次/分，BP：110/65mmHg,Ht：150cm，Wt：41kg，BSA：1.316m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶壁、顶后壁、右侧壁明显增厚，左侧壁稍增厚，并见结节状肿物突出；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见: 轻度ST段下移；检查结论: 窦性心律 轻度ST段下移\n- [全程D1] 检验组合: 淋巴细胞百分比(Lymph%)-静脉血: 0.35；平均红细胞血红蛋白含量(MCH)-静脉血: 28.7pg；总钙(Ca)-静脉血: 2.32mmol/L；凝血酶时间(TT)-静脉血: 19.8sec.；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阳性(+)（参考: 阴性）；总胆汁酸(TBA)-静脉血: 4.1umol/L；钾离子(K+)-静脉血: 3.82mmol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；红细胞计数(RBC#)-静脉血: 5.0210E12/L；钠离子(Na+)-静脉血: 142.9mmol/L；尿素氮(BUN)-静脉血: 4.2mmol/L；葡萄糖(Glu)-静脉血: 5.36mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.66mmolL；球蛋白(GLO)-静脉血: 25.7g/L；尿酸(UA)-静脉血: 214.3umol/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；ABO血型-静脉血: O；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.98mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.76；中性粒细胞百分比(Neut%)-静脉血: 0.579；阴离子间隙(AG)-静脉血: 11.5；γ-谷氨酰基转移酶(GGT)-静脉血: 12.3U/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 23.4U/L；载脂蛋白B(apoB)-静脉血: 0.98g/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 6.4umolL；中性粒细胞计数(Neut#)-静脉血: 3.710E9/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；载脂蛋白AI(apoAI)-静脉血: 1.79g/L；肌酐(Crea)-静脉血: 50.2umol/L；总蛋白(TP)-静脉血: 70.9g/L；总胆固醇(TC)-静脉血: 5.02mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)……\n- [全程D2] 超声；双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声欠均匀，肝内可见多个无回声灶，较大者约43×29mm，椭圆形，边界清，内透声好，部分可见高回声分隔，后方回声增强。血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：上述病灶内未见明确血流信号。肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声欠均匀，右肾多个无回声灶，较大者约15×13mm，类圆形，边界清，内透声好，后方回声增强。左肾未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确肿物回声。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。；检查结论: 肝多发囊肿。 右肾多发囊肿。 胆囊、脾脏、胰腺、左肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D2] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对侧，双肺野纹理稍增多、增粗，未见明显实质性病变。双侧肺门不大，纵隔不宽，心影形态、大小、位置未见异常。双膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明确病变。\n- [全程D7] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、右侧壁明显增厚，左侧壁稍增厚，并见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号增强扫描明显强化，肿物占据右侧咽隐窝。双侧鼻腔及口咽各壁未见异常。 右侧腭帆张提肌、右侧头长肌及右侧翼内肌受侵，病变包绕右侧颈内动静脉。 右侧腭帆提肌、腭帆张肌、双侧头长肌受侵；左侧腭帆提肌、腭帆张肌未见受侵征象。 双侧翼腭窝、颞下窝未见异常；口咽侧壁未见受累增厚。 蝶骨基底部右份及右侧翼突基底部内侧、右侧翼突内板骨质信号减低，增强扫描不均匀强化。余颅底骨质未见明确异常。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、右侧乳突粘膜增厚，双侧上颌窦、蝶窦、左侧乳突充气良好，骨壁完整；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 右侧咽后见多个肿大淋巴结，最大者短径13mm，增强后明显强化，融合。左侧咽后及双颈II区见多发小淋巴结，最大者短径约7mm，未见坏死及包膜外侵。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺左叶见一结节，大小约11mm×11mm，边界尚清， T1WI及T2WI均呈混杂高信号，增强扫描部分区域强化较明显。甲状腺右叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。；检查结论: 鼻咽病变侵犯右侧咽旁间隙、椎前间隙右份及右侧翼内肌，考虑鼻咽癌可能性大。 蝶骨基底部右份、右侧翼突基底部内侧及右侧翼突内板骨质信号异常，考虑肿瘤浸润可能性大。 右侧咽后肿大淋巴结，考虑转移瘤。 左侧咽后及双颈II区小淋巴结，未排除转移可能。 鼻窦炎；右侧乳突炎。 甲状腺左叶结节灶，建议超声检查。\n- [全程D42] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位置位于第5胸椎体下缘，估计位于上腔静脉上段。；检查结论: PICC管末端位置如上所述。\n- [全程D42] 检验组合: 阴离子间隙(AG)-静脉血: 11；丙氨酸氨基转移酶(ALT)-静脉血: 12.8U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；钠离子(Na+)-静脉血: 143.3mmol/L；总钙(Ca)-静脉血: 2.2mmol/L；总胆红素(TBIL)-静脉血: 8.4umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.3U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.86；C-反应蛋白(CRP)-静脉血: 0.85mg/L；胱抑素(Cys-C)-静脉血: 0.61mg/L；磷(P)-静脉血: 1.14mmol/L；总胆固醇(TC)-静脉血: 4.61mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.292；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；载脂蛋白B(apoB)-静脉血: 0.93g/L；间接胆红素(IBIL)-静脉血: 6.4umolL；甘油三酯(TG)-静脉血: 0.64mmol/L；碱性磷酸酶(ALP)-静脉血: 87.2U/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 2umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；尿酸(UA)-静脉血: 194.8umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.02mmol/L；总胆汁酸(TBA)-静脉血: 2.1umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.96；钾离子(K+)-静脉血: 3.83mmol/L；红细胞比容(Hct)-静脉血: 40.7%；氯离子(Cl-)-静脉血: 107.6mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；肌酐(Crea)-静脉血: 46.2umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.810E9/L；血小板分布宽度(PDW)-静脉血: 10.6%；平均血小板体积(MPV)-静脉血: 9.5fL；白蛋白(ALB)-静脉血: 43.5g/L；尿素氮(BUN)-静脉血: 3.6mmol/L；白细胞计数(WBC#)-静脉血: 6.3110……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D43] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.016；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: 1+ 0.6mg（参考: 阴性）；浊度(TRUB)-尿液: 清亮；葡萄糖(Glu)-尿液: +- 1.7mmol（参考: 阴性）；酸碱度(pH)-尿液: 6.5；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；红细胞计数(RBC#)-尿液: 8/μL；酮体(KET)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 7/μL；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D44] 检验组合: 白蛋白(ALB)-静脉血: 37.7g/L；总胆红素(TBIL)-静脉血: 9umol/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；钠离子(Na+)-静脉血: 133.7mmol/L；直接胆红素(DBIL)-静脉血: 2.1umol/L；总胆汁酸(TBA)-静脉血: 1.4umol/L；尿酸(UA)-静脉血: 164.1umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.6U/L；总蛋白(TP)-静脉血: 58.49g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 23.7U/L；碱性磷酸酶(ALP)-静脉血: 72.8U/L；肌酐(Crea)-静脉血: 44.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.95；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.81；尿素氮(BUN)-静脉血: 4.4mmol/L；磷(P)-静脉血: 0.93mmol/L；总钙(Ca)-静脉血: 2.02mmol/L；乳酸脱氢酶(LDH)-静脉血: 210.9U/L；氯离子(Cl-)-静脉血: 100.2mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 12.3U/L；间接胆红素(IBIL)-静脉血: 6.9umolL；钾离子(K+)-静脉血: 2.94mmol/L；阴离子间隙(AG)-静脉血: 12.1；血液二氧化碳含量ctCO2(B)-静脉血: 21.4mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.3U/L；球蛋白(GLO)-静脉血: 20.79g/L\n- [全程D45] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 1/μL；钠离子(Na+)-静脉血: 131.1mmol/L；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；阴离子间隙(AG)-静脉血: 14.5；浊度(TRUB)-尿液: clear；胆红素(BIL)-尿液: -（参考: 阴性）；镁离子(Mg2+)-静脉血: 0.79mmol/L；钾离子(K+)-静脉血: 3.17mmol/L；红细胞计数(RBC#)-尿液: 17/μL；磷(P)-静脉血: 0.95mmol/L；氯离子(Cl-)-静脉血: 96.2mmol/L；白细胞计数(WBC#)-尿液: 5/μL；总钙(Ca)-静脉血: 1.92mmol/L；颜色-尿液: Light-Yellow；比重(SG)-尿液: 1.011；葡萄糖(Glu)-尿液: 1+ 5.6mmol（参考: 阴性）；隐血(OB)-尿液: +-0.3mg（参考: 阴性）；未分类结晶计数(UNCX#)-尿液: 5/μL；血液二氧化碳含量ctCO2(B)-静脉血: 20.4mmol/L；酸碱度(pH)-尿液: 6.5；尿胆原(URO)-尿液: -（参考: 阴性）\n- [全程D46] 检验组合: 阴离子间隙(AG)-静脉血: 17.7；血液二氧化碳含量ctCO2(B)-静脉血: 19.3mmol/L；氯离子(Cl-)-静脉血: 85.6mmol/L；总钙(Ca)-静脉血: 2.04mmol/L；钠离子(Na+)-静脉血: 122.6mmol/L；钾离子(K+)-静脉血: 3.26mmol/L；镁离子(Mg2+)-静脉血: 0.77mmol/L；磷(P)-静脉血: 0.51mmol/L\n- [全程D47] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 20.9mmol/L；总钙(Ca)-静脉血: 2.12mmol/L；阴离子间隙(AG)-静脉血: 14.5；磷(P)-静脉血: 0.67mmol/L；钾离子(K+)-静脉血: 4.06mmol/L；氯离子(Cl-)-静脉血: 89.8mmol/L；钠离子(Na+)-静脉血: 125.2mmol/L；镁离子(Mg2+)-静脉血: 0.93mmol/L\n- [全程D49] 检验组合: 镁离子(Mg2+)-静脉血: 0.89mmol/L；血小板分布宽度(PDW)-静脉血: 11.2%；有核红细胞百分比(NRBC%)-静脉血: 0；白蛋白(ALB)-静脉血: 44.2g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 33.1U/L；丙氨酸氨基转移酶(ALT)-静脉血: 22.6U/L；葡萄糖(Glu)-静脉血: 5.17mmol/L；间接胆红素(IBIL)-静脉血: 8.9umolL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.09mmolL；载脂蛋白B(apoB)-静脉血: 0.78g/L；总胆汁酸(TBA)-静脉血: 7.4umol/L；磷(P)-静脉血: 0.8mmol/L；肌酐(Crea)-静脉血: 38.9umol/L；甘油三酯(TG)-静脉血: 1.35mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29pg；平均红细胞体积(MCV)-静脉血: 83.3fL；单核细胞计数(Mono#)-静脉血: 0.710E9/L；总胆固醇(TC)-静脉血: 3.61mmol/L；总蛋白(TP)-静脉血: 67.8g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.003；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；总胆红素(TBIL)-静脉血: 12.8umol/L；血小板计数(PLT#)-静脉血: 19410E9/L；血小板比容-静脉血: 20%；天门冬氨酸氨基转移酶(AST)-静脉血: 12.9U/L；阴离子间隙(AG)-静脉血: 14.6；直接胆红素(DBIL)-静脉血: 3.9umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.05mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.2mmol/L；大血小板百分比(P-LCR%)-静脉血: 25.6%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 35.8；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.87；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；C-反应蛋白(CRP)-静脉血: 0.28mg/L；尿酸(UA)-静脉血: 110.7umol/L；单核细胞百分比(Mono%)-静脉血: 0……\n- [全程D60] 检验组合: α-L-岩藻糖苷酶(AFU)-静脉血: 20.3U/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；总胆固醇(TC)-静脉血: 3.99mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.68；天门冬氨酸氨基转移酶(AST)-静脉血: 11.8U/L；总钙(Ca)-静脉血: 2.22mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.05；有核红细胞计数(NRBC#)-静脉血: 010E9/L；白细胞计数(WBC#)-静脉血: 3.5710E9/L；钾离子(K+)-静脉血: 3.88mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.14；碱性磷酸酶(ALP)-静脉血: 52.6U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.62mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.89mmolL；氯离子(Cl-)-静脉血: 103mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；阴离子间隙(AG)-静脉血: 11；球蛋白(GLO)-静脉血: 22.9g/L；总胆汁酸(TBA)-静脉血: 0.9umol/L；镁离子(Mg2+)-静脉血: 0.9mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336g/L；血红蛋白(Hb)-静脉血: 115g/L；红细胞计数(RBC#)-静脉血: 3.910E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；甘油三酯(TG)-静脉血: 0.63mmol/L；磷(P)-静脉血: 1.02mmol/L；直接胆红素(DBIL)-静脉血: 2.86umol/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；单核细胞百分比(Mono%)-静脉血: 0.101；红细胞比容(Hct)-静脉血: 34.2%；血小板比容-静脉血: 17%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.5pg；平均血小板体积(MPV)-静脉血: 9.5fL；尿酸(UA)-静脉血: 152.4umol/L；肌酐(Crea)-静脉血: 43umol/L；丙氨酸氨基转移酶(ALT……\n- [全程D68] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0；有核红细胞计数(NRBC#)-静脉血: 010E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0；大血小板百分比(P-LCR%)-静脉血: 20.1%；尿酸(UA)-静脉血: 120.2umol/L；总胆固醇(TC)-静脉血: 4.11mmol/L；总钙(Ca)-静脉血: 2.22mmol/L；平均红细胞体积(MCV)-静脉血: 84.4fL；单核细胞百分比(Mono%)-静脉血: 0.155；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；淋巴细胞百分比(Lymph%)-静脉血: 0.088；总胆汁酸(TBA)-静脉血: 2.6umol/L；白蛋白(ALB)-静脉血: 40.1g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.22mmolL；总蛋白(TP)-静脉血: 62.7g/L；载脂蛋白AI(apoAI)-静脉血: 1.32g/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.5U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.77；中性粒细胞百分比(Neut%)-静脉血: 0.757；α-L-岩藻糖苷酶(AFU)-静脉血: 42.2U/L；C-反应蛋白(CRP)-静脉血: 0.25mg/L；阴离子间隙(AG)-静脉血: 13.4；肌酐(Crea)-静脉血: 43.4umol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.7；中性粒细胞计数(Neut#)-静脉血: 4.210E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.9U/L；钠离子(Na+)-静脉血: 134mmol/L；单核细胞计数(Mono#)-静脉血: 0.910E9/L；血小板分布宽度(PDW)-静脉血: 10.6%；镁离子(Mg2+)-静脉血: 0.72mmol/L；血小板比容-静脉血: 19%；白细胞计数(WBC#)-静脉血: 5.4810E9/L；胱抑素(Cys-C)-静脉血: 0.92mg/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.3；葡萄糖(Glu)-静脉血: 4.71mmol/L；直接胆红素(DBIL)-静脉血: 2.12umol/L；血红蛋白(Hb)-静脉血: 123g/L；碱性磷酸酶(……\n- [全程D70] 检验组合: 淋巴细胞百分比(Lymph%)-静脉血: 0.097；血小板分布宽度(PDW)-静脉血: 10.4%；白细胞计数(WBC#)-静脉血: 5.3710E9/L；平均血小板体积(MPV)-静脉血: 9.5fL；乳酸脱氢酶(LDH)-静脉血: 191.8U/L；直接胆红素(DBIL)-静脉血: 2.52umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20.6U/L；氯离子(Cl-)-静脉血: 92.5mmol/L；尿素氮(BUN)-静脉血: 5mmol/L；血小板比容-静脉血: 21%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总钙(Ca)-静脉血: 2.25mmol/L；尿酸(UA)-静脉血: 198umol/L；总胆红素(TBIL)-静脉血: 9.15umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 37.3U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.006；中性粒细胞计数(Neut#)-静脉血: 4.110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.77；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；间接胆红素(IBIL)-静脉血: 6.63umolL；碱性磷酸酶(ALP)-静脉血: 58U/L；单核细胞百分比(Mono%)-静脉血: 0.125；载脂蛋白B(apoB)-静脉血: 1.02g/L；C-反应蛋白(CRP)-静脉血: 1.01mg/L；γ-谷氨酰基转移酶(GGT)-静脉血: 27.6U/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.3mmol/L；甘油三酯(TG)-静脉血: 1.4mmol/L；总胆汁酸(TBA)-静脉血: 3.6umol/L；球蛋白(GLO)-静脉血: 24.2g/L；白蛋白(ALB)-静脉血: 41.8g/L；葡萄糖(Glu)-静脉血: 5.35mmol/L；平均红细胞体积(MCV)-静脉血: 83.5fL；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 348g/L；胱抑素(Cys-C)-静脉血: 0.79mg/L；丙氨酸氨基转移酶(ALT)-静脉血: 24U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.88mmol/L；红细……\n- [全程D77] 检验组合: 总胆红素(TBIL)-静脉血: 9.1umol/L；血小板分布宽度(PDW)-静脉血: 10.7%；乳酸脱氢酶(LDH)-静脉血: 184.4U/L；直接胆红素(DBIL)-静脉血: 2.92umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.9mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 24U/L；总胆固醇(TC)-静脉血: 4.36mmol/L；平均血小板体积(MPV)-静脉血: 9.7fL；白细胞计数(WBC#)-静脉血: 6.0610E9/L；氯离子(Cl-)-静脉血: 97.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 9.2U/L；阴离子间隙(AG)-静脉血: 15.2；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞计数(RBC#)-静脉血: 4.0510E12/L；总胆汁酸(TBA)-静脉血: 1.1umol/L；C-反应蛋白(CRP)-静脉血: 6.66mg/L；磷(P)-静脉血: 1.11mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.012；中性粒细胞百分比(Neut%)-静脉血: 0.799；淋巴细胞计数(Lymph#)-静脉血: 0.410E9/L；总钙(Ca)-静脉血: 2.14mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.03mmol/L；球蛋白(GLO)-静脉血: 22g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.99mmolL；淋巴细胞百分比(Lymph%)-静脉血: 0.064；血小板计数(PLT#)-静脉血: 12010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.2；钾离子(K+)-静脉血: 3.15mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.09；碱性磷酸酶(ALP)-静脉血: 49.9U/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 44.5umol/L；中性粒细胞计数(Neut#)-静脉血: 4.810E9/L；间接胆红素(IBIL)-静脉血: 6.18umolL；尿素氮(BUN)-静脉血: 5.3mmol/L；红细胞体积分布宽度CV(RDW-CV)-……\n- [全程D79] 超声；双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 双肾大小形态正常，右肾探及几个无回声灶，大者约16×13mm，边界清，内透声可，后方回声增强。左肾实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确肿物回声。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。；检查结论: 右肾多发囊性灶，考虑肾囊肿。 左肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位性病变。\n- [全程D80] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌放疗后，对比某次就诊时间日MR： 鼻咽腔狭窄，鼻咽顶壁、顶后壁、右侧壁明显增厚，并见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化，肿物占据右侧咽隐窝。鼻咽左侧壁未见增厚，左侧咽隐窝正常，左侧咽旁及颈动脉鞘区未见异常。双侧鼻腔及口咽各壁未见异常。 右侧腭帆张提肌、右侧头长肌及右侧翼内肌受侵，病变包绕右侧颈内动静脉。 左侧腭帆提肌、腭帆张肌、头长肌未见受侵征象。 双侧翼腭窝、颞下窝未见异常；口咽侧壁未见增厚。 蝶骨基底部右份及右侧翼突基底部内侧、右侧翼突内板骨质信号减低，增强扫描不均匀强化。余颅底骨质未见明确异常。双侧海绵窦形态正常，未见增宽。 双侧筛窦、上颌窦、蝶窦及双侧乳突粘膜增厚，可见大量分泌物，骨壁完整；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 右侧咽后见多个肿大淋巴结，最大者短径9mm，增强后明显强化，融合。左侧咽后及双颈II区见多发小淋巴结，最大者短径约7mm，未见坏死及包膜外侵。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺左叶见一结节，大小约11mm×11mm，边界尚清， T1WI及T2WI均呈混杂高信号，增强扫描部分区域强化较明显。甲状腺右叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。；检查结论: 鼻咽癌放疗后，右侧咽旁见肿瘤残留，病变范围较前缩小。 颅底骨质破坏，范围大致同前。 右侧咽后肿大淋巴结，考虑转移，较前缩小。 左侧咽后及双颈II区小淋巴结，较前未见明显变化。 鼻窦炎；乳突炎，较前明显。 甲状腺左叶结节灶，大致同前。\n- [全程D80] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理稍粗，走行自然，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显病变。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D11] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者检查完善，已完成放疗预约，嘱今日出院，按期行放疗前准备及放疗前口腔检查。\n- [全程D66] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者诉恶心，食欲差，于未诉特殊不适，查体基本同前。患者第二程DDP同时期化疗。予加强止呕及营养支持治疗，防治放化毒副反应。续观。\n- [全程D70] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者诉恶心，进食差，余未诉特殊不适，查体基本同前。今日[姓名已隐去]医生信息已隐藏后示：患者已完成第二程DDP同时期化疗，予加强营养支持治疗。一般情况平稳，嘱今日补液结束后出院，于门诊继续放疗。按期返院继续治疗。遵嘱。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 疗效评估为疾病进展（PD），终止放化疗计划，改行鼻咽及颈部挽救性手术切除。\nB. 疗效评估为疾病进展（PD），停用顺铂，更改化疗方案为吉西他滨联合氟尿嘧啶并继续放疗。\nC. 疗效评估为部分缓解（PR），继续完成根治性放疗，对鼻咽及颈部残留病灶局部加量至76Gy。\nD. 疗效评估为部分缓解（PR），继续完成根治性放疗，取消后续化疗计划，仅予口服补钾与营养支持。\nE. 疗效评估为部分缓解（PR），继续完成根治性放疗及既定化疗计划，并加用尼妥珠单抗靶向治疗。\nF. 疗效评估为完全缓解（CR），提前终止放疗与化疗，拔除静脉通道，转入定期门诊随访观察阶段。\nG. 疗效评估为部分缓解（PR），继续完成根治性放疗，并行局部清扫术，处理右侧咽旁及咽后残留病灶。\nH. 疗效评估为疾病稳定（SD），继续放疗，并联合PD-1抑制剂以增强局部控制与全身抗肿瘤反应。\nI. 疗效评估为部分缓解（PR），暂停放疗优先纠正低钾血症与营养不良，待电解质完全恢复后重启放疗。\nJ. 疗效评估为部分缓解（PR），继续完成根治性放疗及既定化疗计划，无需特殊支持治疗，定期复查即可。\nK. 疗效评估为部分缓解（PR），继续完成根治性放疗及既定化疗计划，并加强静脉营养支持与补钾等对症处理。\nL. 疗效评估为疾病稳定（SD），继续完成根治性放疗，将后续化疗方案调整为紫杉醇联合卡铂以克服耐药。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D80] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌放疗后，对比某次就诊时间日MR： 鼻咽腔狭窄，鼻咽顶壁、顶后壁、右侧壁明显增厚，并见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化，肿物占据右侧咽隐窝。鼻咽左侧壁未见增厚，左侧咽隐窝正常，左侧咽旁及颈动脉鞘区未见异常。双侧鼻腔及口咽各壁未见异常。 右侧腭帆张提肌、右侧头长肌及右侧翼内肌受侵，病变包绕右侧颈内动静脉。 左侧腭帆提肌、腭帆张肌、头长肌未见受侵征象。 双侧翼腭窝、颞下窝未见异常；口咽侧壁未见增厚。 蝶骨基底部右份及右侧翼突基底部内侧、右侧翼突内板骨质信号减低，增强扫描不均匀强化。余颅底骨质未见明确异常。双侧海绵窦形态正常，未见增宽。 双侧筛窦、上颌窦、蝶窦及双侧乳突粘膜增厚，可见大量分泌物，骨壁完整；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 右侧咽后见多个肿大淋巴结，最大者短径9mm，增强后明显强化，融合。左侧咽后及双颈II区见多发小淋巴结，最大者短径约7mm，未见坏死及包膜外侵。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺左叶见一结节，大小约11mm×11mm，边界尚清， T1WI及T2WI均呈混杂高信号，增强扫描部分区域强化较明显。甲状腺右叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。；检查结论: 鼻咽癌放疗后，右侧咽旁见肿瘤残留，病变范围较前缩小。 颅底骨质破坏，范围大致同前。 右侧咽后肿大淋巴结，考虑转移，较前缩小。 左侧咽后及双颈II区小淋巴结，较前未见明显变化。 鼻窦炎；乳突炎，较前明显。 甲状腺左叶结节灶，大致同前。\n- [全程D80] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理稍粗，走行自然，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显病变。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 疗效评估为疾病进展（PD），终止放化疗计划，改行鼻咽及颈部挽救性手术切除。\nB. 疗效评估为疾病进展（PD），停用顺铂，更改化疗方案为吉西他滨联合氟尿嘧啶并继续放疗。\nC. 疗效评估为部分缓解（PR），继续完成根治性放疗，对鼻咽及颈部残留病灶局部加量至76Gy。\nD. 疗效评估为部分缓解（PR），继续完成根治性放疗，取消后续化疗计划，仅予口服补钾与营养支持。\nE. 疗效评估为部分缓解（PR），继续完成根治性放疗及既定化疗计划，并加用尼妥珠单抗靶向治疗。\nF. 疗效评估为完全缓解（CR），提前终止放疗与化疗，拔除静脉通道，转入定期门诊随访观察阶段。\nG. 疗效评估为部分缓解（PR），继续完成根治性放疗，并行局部清扫术，处理右侧咽旁及咽后残留病灶。\nH. 疗效评估为疾病稳定（SD），继续放疗，并联合PD-1抑制剂以增强局部控制与全身抗肿瘤反应。\nI. 疗效评估为部分缓解（PR），暂停放疗优先纠正低钾血症与营养不良，待电解质完全恢复后重启放疗。\nJ. 疗效评估为部分缓解（PR），继续完成根治性放疗及既定化疗计划，无需特殊支持治疗，定期复查即可。\nK. 疗效评估为部分缓解（PR），继续完成根治性放疗及既定化疗计划，并加强静脉营养支持与补钾等对症处理。\nL. 疗效评估为疾病稳定（SD），继续完成根治性放疗，将后续化疗方案调整为紫杉醇联合卡铂以克服耐药。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D80] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌放疗后，对比某次就诊时间日MR： 鼻咽腔狭窄，鼻咽顶壁、顶后壁、右侧壁明显增厚，并见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化，肿物占据右侧咽隐窝。鼻咽左侧壁未见增厚，左侧咽隐窝正常，左侧咽旁及颈动脉鞘区未见异常。双侧鼻腔及口咽各壁未见异常。 右侧腭帆张提肌、右侧头长肌及右侧翼内肌受侵，病变包绕右侧颈内动静脉。 左侧腭帆提肌、腭帆张肌、头长肌未见受侵征象。 双侧翼腭窝、颞下窝未见异常；口咽侧壁未见增厚。 蝶骨基底部右份及右侧翼突基底部内侧、右侧翼突内板骨质信号减低，增强扫描不均匀强化。余颅底骨质未见明确异常。双侧海绵窦形态正常，未见增宽。 双侧筛窦、上颌窦、蝶窦及双侧乳突粘膜增厚，可见大量分泌物，骨壁完整；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 右侧咽后见多个肿大淋巴结，最大者短径9mm，增强后明显强化，融合。左侧咽后及双颈II区见多发小淋巴结，最大者短径约7mm，未见坏死及包膜外侵。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺左叶见一结节，大小约11mm×11mm，边界尚清， T1WI及T2WI均呈混杂高信号，增强扫描部分区域强化较明显。甲状腺右叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。；检查结论: 鼻咽癌放疗后，右侧咽旁见肿瘤残留，病变范围较前缩小。 颅底骨质破坏，范围大致同前。 右侧咽后肿大淋巴结，考虑转移，较前缩小。 左侧咽后及双颈II区小淋巴结，较前未见明显变化。 鼻窦炎；乳突炎，较前明显。 甲状腺左叶结节灶，大致同前。\n- [全程D80] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理稍粗，走行自然，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显病变。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 疗效评估为疾病进展（PD），终止放化疗计划，改行鼻咽及颈部挽救性手术切除。\nB. 疗效评估为疾病进展（PD），停用顺铂，更改化疗方案为吉西他滨联合氟尿嘧啶并继续放疗。\nC. 疗效评估为部分缓解（PR），继续完成根治性放疗，对鼻咽及颈部残留病灶局部加量至76Gy。\nD. 疗效评估为部分缓解（PR），继续完成根治性放疗，取消后续化疗计划，仅予口服补钾与营养支持。\nE. 疗效评估为部分缓解（PR），继续完成根治性放疗及既定化疗计划，并加用尼妥珠单抗靶向治疗。\nF. 疗效评估为完全缓解（CR），提前终止放疗与化疗，拔除静脉通道，转入定期门诊随访观察阶段。\nG. 疗效评估为部分缓解（PR），继续完成根治性放疗，并行局部清扫术，处理右侧咽旁及咽后残留病灶。\nH. 疗效评估为疾病稳定（SD），继续放疗，并联合PD-1抑制剂以增强局部控制与全身抗肿瘤反应。\nI. 疗效评估为部分缓解（PR），暂停放疗优先纠正低钾血症与营养不良，待电解质完全恢复后重启放疗。\nJ. 疗效评估为部分缓解（PR），继续完成根治性放疗及既定化疗计划，无需特殊支持治疗，定期复查即可。\nK. 疗效评估为部分缓解（PR），继续完成根治性放疗及既定化疗计划，并加强静脉营养支持与补钾等对症处理。\nL. 疗效评估为疾病稳定（SD），继续完成根治性放疗，将后续化疗方案调整为紫杉醇联合卡铂以克服耐药。\n\n请仅输出一个选项字母（A-L）。"}]}
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多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N1，M0。\n综合TNM状态：T4N1M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D7] 入院记录: 主诉: 头痛伴耳鸣、听力下降3月余。；颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。今患者为进一步诊治，予收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,双咽后淋巴结肿大,头痛；既往史: 否认\"乙肝、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认饮酒史。否认不洁性生活史。；家族史: 患者叔叔因肺癌死亡。；体格检查: T：36.2℃，P：82次/分，R：20次/分，BP：128/74mmHg,Ht：172cm，Wt：80kg，BSA：1.92m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无叩痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约1cm*0.8cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 直接安排根治性同步放化疗，暂缓病理活检及血液学检查\nB. 行鼻咽及颈部增强CT评估局部病变，暂缓病理活检及血液学检查\nC. 行颈部淋巴结切除活检明确病理，并完善全身PET-CT及基线血液学检查\nD. 行鼻咽镜下活检明确病理，并直接开始诱导化疗，暂缓基线血液学检查\nE. 抽血查EBV-DNA及肿瘤标志物，若阳性则直接开始根治性放疗\nF. 行全身骨扫描及头颅增强MRI，待排除远处转移后再行鼻咽局部活检\nG. 行鼻咽镜下活检明确病理，并预防性行双侧颈部淋巴结清扫术\nH. 行鼻咽镜下活检明确病理，并抽血查血常规、生化、EBV-DNA等基线指标\nI. 行鼻咽脱落细胞学检查明确病理，并抽血查血常规、生化、EBV-DNA等基线指标\nJ. 行胸腹部增强CT及全身骨扫描，待排除远处转移后再行鼻咽活检及血液学检查\nK. 行鼻咽镜下活检明确病理，并立即给予大剂量甲氨蝶呤静脉化疗\nL. 行颈部淋巴结细针穿刺活检明确病理，并抽血查血常规、生化、EBV-DNA等基线指标\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N1，M0。\n综合TNM状态：T4N1M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D7] 入院记录: 主诉: 头痛伴耳鸣、听力下降3月余。；颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。今患者为进一步诊治，予收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,双咽后淋巴结肿大,头痛；既往史: 否认\"乙肝、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认饮酒史。否认不洁性生活史。；家族史: 患者叔叔因肺癌死亡。；体格检查: T：36.2℃，P：82次/分，R：20次/分，BP：128/74mmHg,Ht：172cm，Wt：80kg，BSA：1.92m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无叩痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约1cm*0.8cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 直接安排根治性同步放化疗，暂缓病理活检及血液学检查\nB. 行鼻咽及颈部增强CT评估局部病变，暂缓病理活检及血液学检查\nC. 行颈部淋巴结切除活检明确病理，并完善全身PET-CT及基线血液学检查\nD. 行鼻咽镜下活检明确病理，并直接开始诱导化疗，暂缓基线血液学检查\nE. 抽血查EBV-DNA及肿瘤标志物，若阳性则直接开始根治性放疗\nF. 行全身骨扫描及头颅增强MRI，待排除远处转移后再行鼻咽局部活检\nG. 行鼻咽镜下活检明确病理，并预防性行双侧颈部淋巴结清扫术\nH. 行鼻咽镜下活检明确病理，并抽血查血常规、生化、EBV-DNA等基线指标\nI. 行鼻咽脱落细胞学检查明确病理，并抽血查血常规、生化、EBV-DNA等基线指标\nJ. 行胸腹部增强CT及全身骨扫描，待排除远处转移后再行鼻咽活检及血液学检查\nK. 行鼻咽镜下活检明确病理，并立即给予大剂量甲氨蝶呤静脉化疗\nL. 行颈部淋巴结细针穿刺活检明确病理，并抽血查血常规、生化、EBV-DNA等基线指标\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-fd63f0707132f4eb9174ab3e","patient_id":"patient-eecadcdf172a1efe8947b052","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"I","gold_action":"明确临床分期为T4N1M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。","options":[{"letter":"A","text":"明确临床分期为T3N1M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。","is_gold":false},{"letter":"B","text":"明确临床分期为T4N2M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。","is_gold":false},{"letter":"C","text":"明确临床分期为T4N1M0，并直接安排鼻咽及颈部根治性放疗，暂不留置静脉导管。","is_gold":false},{"letter":"D","text":"明确临床分期为T4N1M0，并安排全身PET-CT以进一步明确双颈部淋巴结性质。","is_gold":false},{"letter":"E","text":"明确临床分期为T4N0M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。","is_gold":false},{"letter":"F","text":"明确临床分期为T3N2M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。","is_gold":false},{"letter":"G","text":"明确临床分期为T4N1M0，并安排垂体MRI动态增强扫描以明确垂体受累情况。","is_gold":false},{"letter":"H","text":"明确临床分期为T4N1M0，并安排颈部淋巴结穿刺活检以明确N分期。","is_gold":false},{"letter":"I","text":"明确临床分期为T4N1M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。","is_gold":true},{"letter":"J","text":"明确临床分期为T4N1M0，并安排骨扫描及头颅CT以排除远处转移。","is_gold":false},{"letter":"K","text":"明确临床分期为T4N1M0，并安排鼻咽肿物再次活检以进行EBV相关基因检测。","is_gold":false},{"letter":"L","text":"明确临床分期为T4N1M0，并留置CVC导管及行胸部CT确认管端位置，为后续静脉给药做准备。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N1，M0。\n综合TNM状态：T4N1M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D7] 入院记录: 主诉: 头痛伴耳鸣、听力下降3月余。；颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。今患者为进一步诊治，予收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,双咽后淋巴结肿大,头痛；既往史: 否认\"乙肝、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认饮酒史。否认不洁性生活史。；家族史: 患者叔叔因肺癌死亡。；体格检查: T：36.2℃，P：82次/分，R：20次/分，BP：128/74mmHg,Ht：172cm，Wt：80kg，BSA：1.92m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无叩痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约1cm*0.8cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 早期复极改变\n- [全程D0] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.6；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:20（参考: 阴性）；活化部分凝血活酶时间(APTT)-静脉血: 23.1sec.；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；血红蛋白(Hb)-静脉血: 158g/L；血小板比容-静脉血: 26%；氯离子(Cl-)-静脉血: 105.3mmol/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 1.04；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；尿酸(UA)-静脉血: 341umol/L；甘油三酯(TG)-静脉血: 1.27mmol/L；总蛋白(TP)-静脉血: 73.53g/L；尿素氮(BUN)-静脉血: 6.35mmol/L；C-反应蛋白(CRP)-静脉血: 1.45mg/L；载脂蛋白B(apoB)-静脉血: 0.8g/L；总胆汁酸(TBA)-静脉血: 4.7umol/L；葡萄糖(Glu)-静脉血: 4.78mmol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；乳酸脱氢酶(LDH)-静脉血: 160.3U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；大血小板百分比(P-LCR%)-静脉血: 30.4%；中性粒细胞计数(Neut#)-静脉血: 6.410E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；丙氨酸氨基转移酶(ALT)-静脉血: 12.1U/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；ABO血型-静脉血: B；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.7fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；球蛋白(GLO)-静脉血: 28.23g/L；凝血酶时间(TT)-静脉血: 17.5sec.；红细胞计数(RBC#)-静脉血: 5.3710E12/L；平均红细胞体积(MCV)-静脉血: 87fL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.17mmolL；磷(P)-静脉血: 1.03mmol/L；总钙(Ca)-……\n- [全程D3] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理稍粗，未见明确实质性病变。双侧肺门不大，纵隔居中、无增宽。双膈形态正常。双侧肋膈角锐利。心影形态、大小、位置未见异常。；检查结论: 心肺未见明显异常。\n- [全程D3] 超声；双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约11cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约37×31×26mm，包膜光滑，实质回声不均匀，可见强回声斑。 腹主动脉旁未见明确肿物回声。；检查结论: 前列腺钙化。 肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、左侧壁见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强后明显强化，肿物占据鼻咽顶壁、左侧咽隐窝、左侧咽后间隙，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，右侧咽隐窝变浅，右侧咽旁脂肪间隙及颈动脉鞘区未见异常。 左侧腭帆张提肌及左侧头长肌受侵，右侧腭帆提肌、腭帆张肌、头长肌未见受侵征象。 双侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽双侧壁未见增厚。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部、翼突内外板、左侧枕骨基底部及左侧枕骨髁骨质信号减低，增强扫描后明显强化，斜坡局部见不规则软组织肿物影累及斜坡后份脑膜及蝶鞍后份，部分层面与垂体后叶分界欠清。双侧海绵窦形态正常，未见增宽。筛窦、蝶窦、左侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 左侧咽后间隙见肿大淋巴结，大小约为11mm ×9 mm，右侧咽后见肿大淋巴结，短径约6mm，均匀强化。 双颈I、II区见多个淋巴结，边界清，信号均匀，最大短径约8mm，均匀强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。 颅底骨质破坏。 双侧咽后淋巴结肿大，考虑转移。 双颈Ib、II区小淋巴结，性质待定。 副鼻窦炎、左侧乳突炎。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 明确临床分期为T3N1M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。\nB. 明确临床分期为T4N2M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。\nC. 明确临床分期为T4N1M0，并直接安排鼻咽及颈部根治性放疗，暂不留置静脉导管。\nD. 明确临床分期为T4N1M0，并安排全身PET-CT以进一步明确双颈部淋巴结性质。\nE. 明确临床分期为T4N0M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。\nF. 明确临床分期为T3N2M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。\nG. 明确临床分期为T4N1M0，并安排垂体MRI动态增强扫描以明确垂体受累情况。\nH. 明确临床分期为T4N1M0，并安排颈部淋巴结穿刺活检以明确N分期。\nI. 明确临床分期为T4N1M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。\nJ. 明确临床分期为T4N1M0，并安排骨扫描及头颅CT以排除远处转移。\nK. 明确临床分期为T4N1M0，并安排鼻咽肿物再次活检以进行EBV相关基因检测。\nL. 明确临床分期为T4N1M0，并留置CVC导管及行胸部CT确认管端位置，为后续静脉给药做准备。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 早期复极改变\n- [全程D0] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.6；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:20（参考: 阴性）；活化部分凝血活酶时间(APTT)-静脉血: 23.1sec.；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；血红蛋白(Hb)-静脉血: 158g/L；血小板比容-静脉血: 26%；氯离子(Cl-)-静脉血: 105.3mmol/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 1.04；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；尿酸(UA)-静脉血: 341umol/L；甘油三酯(TG)-静脉血: 1.27mmol/L；总蛋白(TP)-静脉血: 73.53g/L；尿素氮(BUN)-静脉血: 6.35mmol/L；C-反应蛋白(CRP)-静脉血: 1.45mg/L；载脂蛋白B(apoB)-静脉血: 0.8g/L；总胆汁酸(TBA)-静脉血: 4.7umol/L；葡萄糖(Glu)-静脉血: 4.78mmol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；乳酸脱氢酶(LDH)-静脉血: 160.3U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；大血小板百分比(P-LCR%)-静脉血: 30.4%；中性粒细胞计数(Neut#)-静脉血: 6.410E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；丙氨酸氨基转移酶(ALT)-静脉血: 12.1U/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；ABO血型-静脉血: B；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.7fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；球蛋白(GLO)-静脉血: 28.23g/L；凝血酶时间(TT)-静脉血: 17.5sec.；红细胞计数(RBC#)-静脉血: 5.3710E12/L；平均红细胞体积(MCV)-静脉血: 87fL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.17mmolL；磷(P)-静脉血: 1.03mmol/L；总钙(Ca)-……\n- [全程D3] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理稍粗，未见明确实质性病变。双侧肺门不大，纵隔居中、无增宽。双膈形态正常。双侧肋膈角锐利。心影形态、大小、位置未见异常。；检查结论: 心肺未见明显异常。\n- [全程D3] 超声；双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约11cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约37×31×26mm，包膜光滑，实质回声不均匀，可见强回声斑。 腹主动脉旁未见明确肿物回声。；检查结论: 前列腺钙化。 肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、左侧壁见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强后明显强化，肿物占据鼻咽顶壁、左侧咽隐窝、左侧咽后间隙，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，右侧咽隐窝变浅，右侧咽旁脂肪间隙及颈动脉鞘区未见异常。 左侧腭帆张提肌及左侧头长肌受侵，右侧腭帆提肌、腭帆张肌、头长肌未见受侵征象。 双侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽双侧壁未见增厚。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部、翼突内外板、左侧枕骨基底部及左侧枕骨髁骨质信号减低，增强扫描后明显强化，斜坡局部见不规则软组织肿物影累及斜坡后份脑膜及蝶鞍后份，部分层面与垂体后叶分界欠清。双侧海绵窦形态正常，未见增宽。筛窦、蝶窦、左侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 左侧咽后间隙见肿大淋巴结，大小约为11mm ×9 mm，右侧咽后见肿大淋巴结，短径约6mm，均匀强化。 双颈I、II区见多个淋巴结，边界清，信号均匀，最大短径约8mm，均匀强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。 颅底骨质破坏。 双侧咽后淋巴结肿大，考虑转移。 双颈Ib、II区小淋巴结，性质待定。 副鼻窦炎、左侧乳突炎。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 明确临床分期为T3N1M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。\nB. 明确临床分期为T4N2M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。\nC. 明确临床分期为T4N1M0，并直接安排鼻咽及颈部根治性放疗，暂不留置静脉导管。\nD. 明确临床分期为T4N1M0，并安排全身PET-CT以进一步明确双颈部淋巴结性质。\nE. 明确临床分期为T4N0M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。\nF. 明确临床分期为T3N2M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。\nG. 明确临床分期为T4N1M0，并安排垂体MRI动态增强扫描以明确垂体受累情况。\nH. 明确临床分期为T4N1M0，并安排颈部淋巴结穿刺活检以明确N分期。\nI. 明确临床分期为T4N1M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。\nJ. 明确临床分期为T4N1M0，并安排骨扫描及头颅CT以排除远处转移。\nK. 明确临床分期为T4N1M0，并安排鼻咽肿物再次活检以进行EBV相关基因检测。\nL. 明确临床分期为T4N1M0，并留置CVC导管及行胸部CT确认管端位置，为后续静脉给药做准备。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N1，M0。\n综合TNM状态：T4N1M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 早期复极改变\n- [全程D0] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.6；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:20（参考: 阴性）；活化部分凝血活酶时间(APTT)-静脉血: 23.1sec.；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；血红蛋白(Hb)-静脉血: 158g/L；血小板比容-静脉血: 26%；氯离子(Cl-)-静脉血: 105.3mmol/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 1.04；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；尿酸(UA)-静脉血: 341umol/L；甘油三酯(TG)-静脉血: 1.27mmol/L；总蛋白(TP)-静脉血: 73.53g/L；尿素氮(BUN)-静脉血: 6.35mmol/L；C-反应蛋白(CRP)-静脉血: 1.45mg/L；载脂蛋白B(apoB)-静脉血: 0.8g/L；总胆汁酸(TBA)-静脉血: 4.7umol/L；葡萄糖(Glu)-静脉血: 4.78mmol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；乳酸脱氢酶(LDH)-静脉血: 160.3U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；大血小板百分比(P-LCR%)-静脉血: 30.4%；中性粒细胞计数(Neut#)-静脉血: 6.410E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；丙氨酸氨基转移酶(ALT)-静脉血: 12.1U/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；ABO血型-静脉血: B；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.7fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；球蛋白(GLO)-静脉血: 28.23g/L；凝血酶时间(TT)-静脉血: 17.5sec.；红细胞计数(RBC#)-静脉血: 5.3710E12/L；平均红细胞体积(MCV)-静脉血: 87fL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.17mmolL；磷(P)-静脉血: 1.03mmol/L；总钙(Ca)-……\n- [全程D3] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理稍粗，未见明确实质性病变。双侧肺门不大，纵隔居中、无增宽。双膈形态正常。双侧肋膈角锐利。心影形态、大小、位置未见异常。；检查结论: 心肺未见明显异常。\n- [全程D3] 超声；双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约11cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约37×31×26mm，包膜光滑，实质回声不均匀，可见强回声斑。 腹主动脉旁未见明确肿物回声。；检查结论: 前列腺钙化。 肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、左侧壁见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强后明显强化，肿物占据鼻咽顶壁、左侧咽隐窝、左侧咽后间隙，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，右侧咽隐窝变浅，右侧咽旁脂肪间隙及颈动脉鞘区未见异常。 左侧腭帆张提肌及左侧头长肌受侵，右侧腭帆提肌、腭帆张肌、头长肌未见受侵征象。 双侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽双侧壁未见增厚。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部、翼突内外板、左侧枕骨基底部及左侧枕骨髁骨质信号减低，增强扫描后明显强化，斜坡局部见不规则软组织肿物影累及斜坡后份脑膜及蝶鞍后份，部分层面与垂体后叶分界欠清。双侧海绵窦形态正常，未见增宽。筛窦、蝶窦、左侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 左侧咽后间隙见肿大淋巴结，大小约为11mm ×9 mm，右侧咽后见肿大淋巴结，短径约6mm，均匀强化。 双颈I、II区见多个淋巴结，边界清，信号均匀，最大短径约8mm，均匀强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。 颅底骨质破坏。 双侧咽后淋巴结肿大，考虑转移。 双颈Ib、II区小淋巴结，性质待定。 副鼻窦炎、左侧乳突炎。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 明确临床分期为T3N1M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。\nB. 明确临床分期为T4N2M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。\nC. 明确临床分期为T4N1M0，并直接安排鼻咽及颈部根治性放疗，暂不留置静脉导管。\nD. 明确临床分期为T4N1M0，并安排全身PET-CT以进一步明确双颈部淋巴结性质。\nE. 明确临床分期为T4N0M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。\nF. 明确临床分期为T3N2M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。\nG. 明确临床分期为T4N1M0，并安排垂体MRI动态增强扫描以明确垂体受累情况。\nH. 明确临床分期为T4N1M0，并安排颈部淋巴结穿刺活检以明确N分期。\nI. 明确临床分期为T4N1M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。\nJ. 明确临床分期为T4N1M0，并安排骨扫描及头颅CT以排除远处转移。\nK. 明确临床分期为T4N1M0，并安排鼻咽肿物再次活检以进行EBV相关基因检测。\nL. 明确临床分期为T4N1M0，并留置CVC导管及行胸部CT确认管端位置，为后续静脉给药做准备。\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-1a0c7a960fe6a9b60533da3d","patient_id":"patient-eecadcdf172a1efe8947b052","turn_id":"turn05","turn_position":3,"turn_type":"toxicity_or_support_decision","gold_letter":"L","gold_action":"继续本周期化疗，给予止吐、护肝及静脉营养等支持治疗，并完善脑垂体激素五项检查。","options":[{"letter":"A","text":"停止本周期化疗，给予粒细胞集落刺激因子及抗感染支持治疗，并完善脑垂体激素五项检查。","is_gold":false},{"letter":"B","text":"继续本周期化疗，给予止吐、护肝及静脉营养等支持治疗，并完善甲状腺功能及皮质醇检查。","is_gold":false},{"letter":"C","text":"停止本周期化疗，给予大剂量水化、碱化尿液及利尿处理，并完善脑垂体激素五项检查。","is_gold":false},{"letter":"D","text":"继续本周期化疗，给予止吐、护胃及静脉营养支持治疗，暂不进行内分泌功能相关检查。","is_gold":false},{"letter":"E","text":"提前结束本周期化疗，给予全静脉营养支持及强效止吐治疗，并完善脑垂体激素五项检查。","is_gold":false},{"letter":"F","text":"继续本周期化疗，给予止吐、护肝及静脉营养支持治疗，同时行腰椎穿刺脑脊液常规及生化检查。","is_gold":false},{"letter":"G","text":"结束本周期化疗，给予预防性抗感染及护肝支持治疗，并完善脑垂体激素五项检查。","is_gold":false},{"letter":"H","text":"继续本周期化疗，给予止吐及肠内营养支持治疗，避免静脉营养，并复查鼻咽及垂体增强MRI。","is_gold":false},{"letter":"I","text":"暂停氟尿嘧啶持续静脉滴注，给予口腔局部镇痛及促进黏膜愈合处理，并完善脑垂体激素五项检查。","is_gold":false},{"letter":"J","text":"继续本周期化疗，给予止吐、护肝支持治疗，暂不予静脉营养，并请内分泌科急会诊。","is_gold":false},{"letter":"K","text":"结束本周期化疗，给予止吐、护肝及静脉营养支持治疗，并于次日开始局部区域调强放疗。","is_gold":false},{"letter":"L","text":"继续本周期化疗，给予止吐、护肝及静脉营养等支持治疗，并完善脑垂体激素五项检查。","is_gold":true}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N1，M0。\n综合TNM状态：T4N1M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D7] 入院记录: 主诉: 头痛伴耳鸣、听力下降3月余。；颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。今患者为进一步诊治，予收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,双咽后淋巴结肿大,头痛；既往史: 否认\"乙肝、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认饮酒史。否认不洁性生活史。；家族史: 患者叔叔因肺癌死亡。；体格检查: T：36.2℃，P：82次/分，R：20次/分，BP：128/74mmHg,Ht：172cm，Wt：80kg，BSA：1.92m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无叩痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约1cm*0.8cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）；KPS: 90；ECOG:\n- [全程D7] 入院记录: 主诉: 头痛伴耳鸣、听力下降3月余。；现病史: 患者于某次就诊时间1月无明显诱因下出现头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，患者于至[机构已隐去]就诊，行鼻咽活检病理，并送我院病理会诊示鼻咽分化型非角化性癌。某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。今患者为进一步诊治，予收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,双咽后淋巴结肿大,头痛；既往史: 否认\"乙肝、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认饮酒史。否认不洁性生活史。；家族史: 患者叔叔因肺癌死亡。；体格检查: T：36.2℃，P：82次/分，R：20次/分，BP：128/74mmHg,Ht：172cm，Wt：80kg，BSA：1.92m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率82次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无叩痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约1cm*0.8cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 早期复极改变\n- [全程D0] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.6；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:20（参考: 阴性）；活化部分凝血活酶时间(APTT)-静脉血: 23.1sec.；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；血红蛋白(Hb)-静脉血: 158g/L；血小板比容-静脉血: 26%；氯离子(Cl-)-静脉血: 105.3mmol/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 1.04；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；尿酸(UA)-静脉血: 341umol/L；甘油三酯(TG)-静脉血: 1.27mmol/L；总蛋白(TP)-静脉血: 73.53g/L；尿素氮(BUN)-静脉血: 6.35mmol/L；C-反应蛋白(CRP)-静脉血: 1.45mg/L；载脂蛋白B(apoB)-静脉血: 0.8g/L；总胆汁酸(TBA)-静脉血: 4.7umol/L；葡萄糖(Glu)-静脉血: 4.78mmol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；乳酸脱氢酶(LDH)-静脉血: 160.3U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；大血小板百分比(P-LCR%)-静脉血: 30.4%；中性粒细胞计数(Neut#)-静脉血: 6.410E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；丙氨酸氨基转移酶(ALT)-静脉血: 12.1U/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；ABO血型-静脉血: B；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.7fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；球蛋白(GLO)-静脉血: 28.23g/L；凝血酶时间(TT)-静脉血: 17.5sec.；红细胞计数(RBC#)-静脉血: 5.3710E12/L；平均红细胞体积(MCV)-静脉血: 87fL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.17mmolL；磷(P)-静脉血: 1.03mmol/L；总钙(Ca)-……\n- [全程D3] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理稍粗，未见明确实质性病变。双侧肺门不大，纵隔居中、无增宽。双膈形态正常。双侧肋膈角锐利。心影形态、大小、位置未见异常。；检查结论: 心肺未见明显异常。\n- [全程D3] 超声；双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约11cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约37×31×26mm，包膜光滑，实质回声不均匀，可见强回声斑。 腹主动脉旁未见明确肿物回声。；检查结论: 前列腺钙化。 肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、左侧壁见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强后明显强化，肿物占据鼻咽顶壁、左侧咽隐窝、左侧咽后间隙，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，右侧咽隐窝变浅，右侧咽旁脂肪间隙及颈动脉鞘区未见异常。 左侧腭帆张提肌及左侧头长肌受侵，右侧腭帆提肌、腭帆张肌、头长肌未见受侵征象。 双侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽双侧壁未见增厚。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部、翼突内外板、左侧枕骨基底部及左侧枕骨髁骨质信号减低，增强扫描后明显强化，斜坡局部见不规则软组织肿物影累及斜坡后份脑膜及蝶鞍后份，部分层面与垂体后叶分界欠清。双侧海绵窦形态正常，未见增宽。筛窦、蝶窦、左侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 左侧咽后间隙见肿大淋巴结，大小约为11mm ×9 mm，右侧咽后见肿大淋巴结，短径约6mm，均匀强化。 双颈I、II区见多个淋巴结，边界清，信号均匀，最大短径约8mm，均匀强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。 颅底骨质破坏。 双侧咽后淋巴结肿大，考虑转移。 双颈Ib、II区小淋巴结，性质待定。 副鼻窦炎、左侧乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D7] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；载脂蛋白AI(apoAI)-静脉血: 1.41g/L；总蛋白(TP)-静脉血: 72.8g/L；肌酐(Crea)-静脉血: 96.4umol/L；总胆红素(TBIL)-静脉血: 10.3umol/L；血小板比容-静脉血: 26%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；尿素氮(BUN)-静脉血: 5.6mmol/L；白细胞计数(WBC#)-尿液: 1/μL；钠离子(Na+)-静脉血: 140.2mmol/L；颜色-尿液: Light-Yellow；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.2mmolL；C-反应蛋白(CRP)-静脉血: 1.6mg/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；乳酸脱氢酶(LDH)-静脉血: 148.2U/L；总胆固醇(TC)-静脉血: 4.78mmol/L；总蛋白(TP)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 5/μL；平均血小板体积(MPV)-静脉血: 10.8fL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 345g/L；总钙(Ca)-静脉血: 2.34mmol/L；甘油三酯(TG)-静脉血: 1.84mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.34；胱抑素(Cys-C)-静脉血: 0.97mg/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.8U/L；红细胞计数(RBC#)-静脉血: 5.3810E12/L；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；单核细胞百分比(Mono%)-静脉血: 0.065；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.76；血液二氧化碳含量ctCO2(B)-静脉血: 24.3mmol/L；红细胞计数(RBC#)-尿液: 4/μL；间接胆红素(IBIL)-静脉血: 7umolL；浊度(TRUB)-尿液: clear；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.026；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；血小板计数(PLT#)-静脉血: 24610E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；颜色-粪便: 棕色；载脂蛋白……\n- [全程D11] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于第7胸椎椎体右侧水平，估计导管末端位于上腔静脉中-下段交界处。；检查结论: 导管末端位置如上述。\n- [全程D14] 检验组合: α-L-岩藻糖苷酶(AFU)-静脉血: 38.9U/L；载脂蛋白AI(apoAI)-静脉血: 1.64g/L；血红蛋白(Hb)-静脉血: 158g/L；有核红细胞百分比(NRBC%)-静脉血: 0；促黄体生成素(LH)-静脉血: 6.12mIU/ml；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.87mmol/L；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 弱阳性(±)（参考: 阴性）；天门冬氨酸氨基转移酶(AST)-静脉血: 17.6U/L；总胆汁酸(TBA)-静脉血: 1umol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.4pg；大血小板百分比(P-LCR%)-静脉血: 35.7%；胱抑素(Cys-C)-静脉血: 1.56mg/L；白蛋白(ALB)-静脉血: 45.2g/L；甘油三酯(TG)-静脉血: 1.3mmol/L；白细胞计数(WBC#)-静脉血: 9.310E9/L；红细胞计数(RBC#)-静脉血: 5.3710E12/L；单核细胞百分比(Mono%)-静脉血: 0.008；中性粒细胞计数(Neut#)-静脉血: 8.710E9/L；乳酸脱氢酶(LDH)-静脉血: 181.6U/L；总蛋白(TP)-静脉血: 70.8g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.9mmolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.02；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；催乳素(PRL)-静脉血: 308.5uIU/ml；中性粒细胞百分比(Neut%)-静脉血: 0.939；有核红细胞计数(NRBC#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 33.6；促卵泡刺激素(FSH)-静脉血: 9.93mIU/ml；钾离子(K+)-静脉血: 4.53mmol/L；镁离子(Mg2+)-静脉血: 0.89mmol/L；平均血小板体积(MPV)-静脉血: 11.3fL；碱性磷酸酶(ALP)-静脉血: 87.4U/L；总胆红素(TBIL)-静脉血: 22.5umol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=1.50)（参考: 阴性）；尿酸(UA)-静脉血: 385.9umol/L；EB……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D7] 首次病程记录；首次病程记录: 病程类型: 首次病程记录；病程主题: 首次病程记录；病程内容: 病历特点：1、患者中年男性。2、患者于某次就诊时间1月无明显诱因下出现头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，患者于至[机构已隐去]就诊，行鼻咽活检病理，并送我院病理会诊示鼻咽分化型非角化性癌。某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。现患者为进一步诊治，予收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。3、体查：张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约1cm*0.8cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）示图：4、辅助检查：（1） 某次就诊时间在我医院（病理号：[记录编号已隐去]）鼻咽活检病理示：（鼻咽肿物）镜检为分化型非角化性癌（2） 某次就诊时间在我院胸片检查：心肺未见异常。（3） 某次就诊时间在我院腹部B超检查：肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。（4） 某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。副鼻窦炎、左侧乳突炎。（6）某次就诊时间我院：VCA-IgA 1:160 EA-IgA 1:20EBV-DNA定性检测：2.14E102copy/ml。 诊断依据： 初步诊断： 鉴别诊断：患者诊断明确，无需鉴别诊断。 诊疗计划：1、完善相关检查如全身骨扫描、血常规、生化等。2、诱导化疗及同期化放疗。\n- [全程D8] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者诉间有头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，无面麻、声嘶。[姓名已隐去]医生信息已隐藏示：嘱患者今日完善全身骨扫描检查，排除骨转移征象，治疗上暂给予对症处理，继续观察病情。\n- [全程D9] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日患者症状体征基本同前，无诉其余特殊不适。[姓名已隐去]医生信息已隐藏后指示：某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，最大短径约8mm，均匀强化。骨ECT示鼻咽部、颅底骨代谢较活跃，考虑NPC所致。胸片、腹部B超排除远处转移。故目前临床诊断明确为“鼻咽分化型非角化性癌[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)，治疗方案定为TPF（多西紫杉醇 60mg/m2 + 顺铂 60mg/m2 + 5-FU 2.5g/m2， q21d）诱导化疗3程后再行同期放化疗，放疗采用IMRT技术，同期化疗采用顺铂 60mg/m2（q21d）2程。并指示化疗期间给予护肝、护胃、止吐及营养支持治疗。已向患者及家属交代病情及治疗相关不良反应后，其表示理解，并同意上述治疗方案。拟明日开始行多西紫杉醇化疗，密切观察患者病情变化。\n- [全程D12] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 患者今日TPF方案化疗第3天，现一般情况可，未诉恶心、呕吐、腹痛、腹泻等不适，大小便正常。[姓名已隐去]医生信息已隐藏出，患者目前一般情况可，可继续化疗。注意化疗结束后复查血、生化常规，及时对症处理。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 停止本周期化疗，给予粒细胞集落刺激因子及抗感染支持治疗，并完善脑垂体激素五项检查。\nB. 继续本周期化疗，给予止吐、护肝及静脉营养等支持治疗，并完善甲状腺功能及皮质醇检查。\nC. 停止本周期化疗，给予大剂量水化、碱化尿液及利尿处理，并完善脑垂体激素五项检查。\nD. 继续本周期化疗，给予止吐、护胃及静脉营养支持治疗，暂不进行内分泌功能相关检查。\nE. 提前结束本周期化疗，给予全静脉营养支持及强效止吐治疗，并完善脑垂体激素五项检查。\nF. 继续本周期化疗，给予止吐、护肝及静脉营养支持治疗，同时行腰椎穿刺脑脊液常规及生化检查。\nG. 结束本周期化疗，给予预防性抗感染及护肝支持治疗，并完善脑垂体激素五项检查。\nH. 继续本周期化疗，给予止吐及肠内营养支持治疗，避免静脉营养，并复查鼻咽及垂体增强MRI。\nI. 暂停氟尿嘧啶持续静脉滴注，给予口腔局部镇痛及促进黏膜愈合处理，并完善脑垂体激素五项检查。\nJ. 继续本周期化疗，给予止吐、护肝支持治疗，暂不予静脉营养，并请内分泌科急会诊。\nK. 结束本周期化疗，给予止吐、护肝及静脉营养支持治疗，并于次日开始局部区域调强放疗。\nL. 继续本周期化疗，给予止吐、护肝及静脉营养等支持治疗，并完善脑垂体激素五项检查。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- [全程D7] 入院记录: 主诉: 头痛伴耳鸣、听力下降3月余。；现病史: 患者于某次就诊时间1月无明显诱因下出现头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，患者于至[机构已隐去]就诊，行鼻咽活检病理，并送我院病理会诊示鼻咽分化型非角化性癌。某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。今患者为进一步诊治，予收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,双咽后淋巴结肿大,头痛；既往史: 否认\"乙肝、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认饮酒史。否认不洁性生活史。；家族史: 患者叔叔因肺癌死亡。；体格检查: T：36.2℃，P：82次/分，R：20次/分，BP：128/74mmHg,Ht：172cm，Wt：80kg，BSA：1.92m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率82次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无叩痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约1cm*0.8cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D7] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；载脂蛋白AI(apoAI)-静脉血: 1.41g/L；总蛋白(TP)-静脉血: 72.8g/L；肌酐(Crea)-静脉血: 96.4umol/L；总胆红素(TBIL)-静脉血: 10.3umol/L；血小板比容-静脉血: 26%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；尿素氮(BUN)-静脉血: 5.6mmol/L；白细胞计数(WBC#)-尿液: 1/μL；钠离子(Na+)-静脉血: 140.2mmol/L；颜色-尿液: Light-Yellow；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.2mmolL；C-反应蛋白(CRP)-静脉血: 1.6mg/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；乳酸脱氢酶(LDH)-静脉血: 148.2U/L；总胆固醇(TC)-静脉血: 4.78mmol/L；总蛋白(TP)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 5/μL；平均血小板体积(MPV)-静脉血: 10.8fL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 345g/L；总钙(Ca)-静脉血: 2.34mmol/L；甘油三酯(TG)-静脉血: 1.84mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.34；胱抑素(Cys-C)-静脉血: 0.97mg/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.8U/L；红细胞计数(RBC#)-静脉血: 5.3810E12/L；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；单核细胞百分比(Mono%)-静脉血: 0.065；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.76；血液二氧化碳含量ctCO2(B)-静脉血: 24.3mmol/L；红细胞计数(RBC#)-尿液: 4/μL；间接胆红素(IBIL)-静脉血: 7umolL；浊度(TRUB)-尿液: clear；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.026；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；血小板计数(PLT#)-静脉血: 24610E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；颜色-粪便: 棕色；载脂蛋白……\n- [全程D11] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于第7胸椎椎体右侧水平，估计导管末端位于上腔静脉中-下段交界处。；检查结论: 导管末端位置如上述。\n- [全程D14] 检验组合: α-L-岩藻糖苷酶(AFU)-静脉血: 38.9U/L；载脂蛋白AI(apoAI)-静脉血: 1.64g/L；血红蛋白(Hb)-静脉血: 158g/L；有核红细胞百分比(NRBC%)-静脉血: 0；促黄体生成素(LH)-静脉血: 6.12mIU/ml；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.87mmol/L；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 弱阳性(±)（参考: 阴性）；天门冬氨酸氨基转移酶(AST)-静脉血: 17.6U/L；总胆汁酸(TBA)-静脉血: 1umol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.4pg；大血小板百分比(P-LCR%)-静脉血: 35.7%；胱抑素(Cys-C)-静脉血: 1.56mg/L；白蛋白(ALB)-静脉血: 45.2g/L；甘油三酯(TG)-静脉血: 1.3mmol/L；白细胞计数(WBC#)-静脉血: 9.310E9/L；红细胞计数(RBC#)-静脉血: 5.3710E12/L；单核细胞百分比(Mono%)-静脉血: 0.008；中性粒细胞计数(Neut#)-静脉血: 8.710E9/L；乳酸脱氢酶(LDH)-静脉血: 181.6U/L；总蛋白(TP)-静脉血: 70.8g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.9mmolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.02；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；催乳素(PRL)-静脉血: 308.5uIU/ml；中性粒细胞百分比(Neut%)-静脉血: 0.939；有核红细胞计数(NRBC#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 33.6；促卵泡刺激素(FSH)-静脉血: 9.93mIU/ml；钾离子(K+)-静脉血: 4.53mmol/L；镁离子(Mg2+)-静脉血: 0.89mmol/L；平均血小板体积(MPV)-静脉血: 11.3fL；碱性磷酸酶(ALP)-静脉血: 87.4U/L；总胆红素(TBIL)-静脉血: 22.5umol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=1.50)（参考: 阴性）；尿酸(UA)-静脉血: 385.9umol/L；EB……\n\n【既往治疗与反应】\n- [全程D7] 首次病程记录；首次病程记录: 病程类型: 首次病程记录；病程主题: 首次病程记录；病程内容: 病历特点：1、患者中年男性。2、患者于某次就诊时间1月无明显诱因下出现头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，患者于至[机构已隐去]就诊，行鼻咽活检病理，并送我院病理会诊示鼻咽分化型非角化性癌。某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。现患者为进一步诊治，予收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。3、体查：张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约1cm*0.8cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）示图：4、辅助检查：（1） 某次就诊时间在我医院（病理号：[记录编号已隐去]）鼻咽活检病理示：（鼻咽肿物）镜检为分化型非角化性癌（2） 某次就诊时间在我院胸片检查：心肺未见异常。（3） 某次就诊时间在我院腹部B超检查：肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。（4） 某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。副鼻窦炎、左侧乳突炎。（6）某次就诊时间我院：VCA-IgA 1:160 EA-IgA 1:20EBV-DNA定性检测：2.14E102copy/ml。 诊断依据： 初步诊断： 鉴别诊断：患者诊断明确，无需鉴别诊断。 诊疗计划：1、完善相关检查如全身骨扫描、血常规、生化等。2、诱导化疗及同期化放疗。\n- [全程D8] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者诉间有头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，无面麻、声嘶。[姓名已隐去]医生信息已隐藏示：嘱患者今日完善全身骨扫描检查，排除骨转移征象，治疗上暂给予对症处理，继续观察病情。\n- [全程D9] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日患者症状体征基本同前，无诉其余特殊不适。[姓名已隐去]医生信息已隐藏后指示：某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，最大短径约8mm，均匀强化。骨ECT示鼻咽部、颅底骨代谢较活跃，考虑NPC所致。胸片、腹部B超排除远处转移。故目前临床诊断明确为“鼻咽分化型非角化性癌[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)，治疗方案定为TPF（多西紫杉醇 60mg/m2 + 顺铂 60mg/m2 + 5-FU 2.5g/m2， q21d）诱导化疗3程后再行同期放化疗，放疗采用IMRT技术，同期化疗采用顺铂 60mg/m2（q21d）2程。并指示化疗期间给予护肝、护胃、止吐及营养支持治疗。已向患者及家属交代病情及治疗相关不良反应后，其表示理解，并同意上述治疗方案。拟明日开始行多西紫杉醇化疗，密切观察患者病情变化。\n- [全程D12] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 患者今日TPF方案化疗第3天，现一般情况可，未诉恶心、呕吐、腹痛、腹泻等不适，大小便正常。[姓名已隐去]医生信息已隐藏出，患者目前一般情况可，可继续化疗。注意化疗结束后复查血、生化常规，及时对症处理。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 停止本周期化疗，给予粒细胞集落刺激因子及抗感染支持治疗，并完善脑垂体激素五项检查。\nB. 继续本周期化疗，给予止吐、护肝及静脉营养等支持治疗，并完善甲状腺功能及皮质醇检查。\nC. 停止本周期化疗，给予大剂量水化、碱化尿液及利尿处理，并完善脑垂体激素五项检查。\nD. 继续本周期化疗，给予止吐、护胃及静脉营养支持治疗，暂不进行内分泌功能相关检查。\nE. 提前结束本周期化疗，给予全静脉营养支持及强效止吐治疗，并完善脑垂体激素五项检查。\nF. 继续本周期化疗，给予止吐、护肝及静脉营养支持治疗，同时行腰椎穿刺脑脊液常规及生化检查。\nG. 结束本周期化疗，给予预防性抗感染及护肝支持治疗，并完善脑垂体激素五项检查。\nH. 继续本周期化疗，给予止吐及肠内营养支持治疗，避免静脉营养，并复查鼻咽及垂体增强MRI。\nI. 暂停氟尿嘧啶持续静脉滴注，给予口腔局部镇痛及促进黏膜愈合处理，并完善脑垂体激素五项检查。\nJ. 继续本周期化疗，给予止吐、护肝支持治疗，暂不予静脉营养，并请内分泌科急会诊。\nK. 结束本周期化疗，给予止吐、护肝及静脉营养支持治疗，并于次日开始局部区域调强放疗。\nL. 继续本周期化疗，给予止吐、护肝及静脉营养等支持治疗，并完善脑垂体激素五项检查。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N1，M0。\n综合TNM状态：T4N1M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D7] 入院记录: 主诉: 头痛伴耳鸣、听力下降3月余。；现病史: 患者于某次就诊时间1月无明显诱因下出现头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，患者于至[机构已隐去]就诊，行鼻咽活检病理，并送我院病理会诊示鼻咽分化型非角化性癌。某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。今患者为进一步诊治，予收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,双咽后淋巴结肿大,头痛；既往史: 否认\"乙肝、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认饮酒史。否认不洁性生活史。；家族史: 患者叔叔因肺癌死亡。；体格检查: T：36.2℃，P：82次/分，R：20次/分，BP：128/74mmHg,Ht：172cm，Wt：80kg，BSA：1.92m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率82次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无叩痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约1cm*0.8cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D7] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；载脂蛋白AI(apoAI)-静脉血: 1.41g/L；总蛋白(TP)-静脉血: 72.8g/L；肌酐(Crea)-静脉血: 96.4umol/L；总胆红素(TBIL)-静脉血: 10.3umol/L；血小板比容-静脉血: 26%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；尿素氮(BUN)-静脉血: 5.6mmol/L；白细胞计数(WBC#)-尿液: 1/μL；钠离子(Na+)-静脉血: 140.2mmol/L；颜色-尿液: Light-Yellow；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.2mmolL；C-反应蛋白(CRP)-静脉血: 1.6mg/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；乳酸脱氢酶(LDH)-静脉血: 148.2U/L；总胆固醇(TC)-静脉血: 4.78mmol/L；总蛋白(TP)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 5/μL；平均血小板体积(MPV)-静脉血: 10.8fL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 345g/L；总钙(Ca)-静脉血: 2.34mmol/L；甘油三酯(TG)-静脉血: 1.84mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.34；胱抑素(Cys-C)-静脉血: 0.97mg/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.8U/L；红细胞计数(RBC#)-静脉血: 5.3810E12/L；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；单核细胞百分比(Mono%)-静脉血: 0.065；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.76；血液二氧化碳含量ctCO2(B)-静脉血: 24.3mmol/L；红细胞计数(RBC#)-尿液: 4/μL；间接胆红素(IBIL)-静脉血: 7umolL；浊度(TRUB)-尿液: clear；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.026；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；血小板计数(PLT#)-静脉血: 24610E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；颜色-粪便: 棕色；载脂蛋白……\n- [全程D11] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于第7胸椎椎体右侧水平，估计导管末端位于上腔静脉中-下段交界处。；检查结论: 导管末端位置如上述。\n- [全程D14] 检验组合: α-L-岩藻糖苷酶(AFU)-静脉血: 38.9U/L；载脂蛋白AI(apoAI)-静脉血: 1.64g/L；血红蛋白(Hb)-静脉血: 158g/L；有核红细胞百分比(NRBC%)-静脉血: 0；促黄体生成素(LH)-静脉血: 6.12mIU/ml；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.87mmol/L；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 弱阳性(±)（参考: 阴性）；天门冬氨酸氨基转移酶(AST)-静脉血: 17.6U/L；总胆汁酸(TBA)-静脉血: 1umol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.4pg；大血小板百分比(P-LCR%)-静脉血: 35.7%；胱抑素(Cys-C)-静脉血: 1.56mg/L；白蛋白(ALB)-静脉血: 45.2g/L；甘油三酯(TG)-静脉血: 1.3mmol/L；白细胞计数(WBC#)-静脉血: 9.310E9/L；红细胞计数(RBC#)-静脉血: 5.3710E12/L；单核细胞百分比(Mono%)-静脉血: 0.008；中性粒细胞计数(Neut#)-静脉血: 8.710E9/L；乳酸脱氢酶(LDH)-静脉血: 181.6U/L；总蛋白(TP)-静脉血: 70.8g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.9mmolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.02；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；催乳素(PRL)-静脉血: 308.5uIU/ml；中性粒细胞百分比(Neut%)-静脉血: 0.939；有核红细胞计数(NRBC#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 33.6；促卵泡刺激素(FSH)-静脉血: 9.93mIU/ml；钾离子(K+)-静脉血: 4.53mmol/L；镁离子(Mg2+)-静脉血: 0.89mmol/L；平均血小板体积(MPV)-静脉血: 11.3fL；碱性磷酸酶(ALP)-静脉血: 87.4U/L；总胆红素(TBIL)-静脉血: 22.5umol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=1.50)（参考: 阴性）；尿酸(UA)-静脉血: 385.9umol/L；EB……\n\n【既往治疗与反应】\n- [全程D7] 首次病程记录；首次病程记录: 病程类型: 首次病程记录；病程主题: 首次病程记录；病程内容: 病历特点：1、患者中年男性。2、患者于某次就诊时间1月无明显诱因下出现头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，患者于至[机构已隐去]就诊，行鼻咽活检病理，并送我院病理会诊示鼻咽分化型非角化性癌。某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。现患者为进一步诊治，予收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。3、体查：张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约1cm*0.8cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）示图：4、辅助检查：（1） 某次就诊时间在我医院（病理号：[记录编号已隐去]）鼻咽活检病理示：（鼻咽肿物）镜检为分化型非角化性癌（2） 某次就诊时间在我院胸片检查：心肺未见异常。（3） 某次就诊时间在我院腹部B超检查：肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。（4） 某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。副鼻窦炎、左侧乳突炎。（6）某次就诊时间我院：VCA-IgA 1:160 EA-IgA 1:20EBV-DNA定性检测：2.14E102copy/ml。 诊断依据： 初步诊断： 鉴别诊断：患者诊断明确，无需鉴别诊断。 诊疗计划：1、完善相关检查如全身骨扫描、血常规、生化等。2、诱导化疗及同期化放疗。\n- [全程D8] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者诉间有头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，无面麻、声嘶。[姓名已隐去]医生信息已隐藏示：嘱患者今日完善全身骨扫描检查，排除骨转移征象，治疗上暂给予对症处理，继续观察病情。\n- [全程D9] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日患者症状体征基本同前，无诉其余特殊不适。[姓名已隐去]医生信息已隐藏后指示：某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，最大短径约8mm，均匀强化。骨ECT示鼻咽部、颅底骨代谢较活跃，考虑NPC所致。胸片、腹部B超排除远处转移。故目前临床诊断明确为“鼻咽分化型非角化性癌[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)，治疗方案定为TPF（多西紫杉醇 60mg/m2 + 顺铂 60mg/m2 + 5-FU 2.5g/m2， q21d）诱导化疗3程后再行同期放化疗，放疗采用IMRT技术，同期化疗采用顺铂 60mg/m2（q21d）2程。并指示化疗期间给予护肝、护胃、止吐及营养支持治疗。已向患者及家属交代病情及治疗相关不良反应后，其表示理解，并同意上述治疗方案。拟明日开始行多西紫杉醇化疗，密切观察患者病情变化。\n- [全程D12] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 患者今日TPF方案化疗第3天，现一般情况可，未诉恶心、呕吐、腹痛、腹泻等不适，大小便正常。[姓名已隐去]医生信息已隐藏出，患者目前一般情况可，可继续化疗。注意化疗结束后复查血、生化常规，及时对症处理。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 停止本周期化疗，给予粒细胞集落刺激因子及抗感染支持治疗，并完善脑垂体激素五项检查。\nB. 继续本周期化疗，给予止吐、护肝及静脉营养等支持治疗，并完善甲状腺功能及皮质醇检查。\nC. 停止本周期化疗，给予大剂量水化、碱化尿液及利尿处理，并完善脑垂体激素五项检查。\nD. 继续本周期化疗，给予止吐、护胃及静脉营养支持治疗，暂不进行内分泌功能相关检查。\nE. 提前结束本周期化疗，给予全静脉营养支持及强效止吐治疗，并完善脑垂体激素五项检查。\nF. 继续本周期化疗，给予止吐、护肝及静脉营养支持治疗，同时行腰椎穿刺脑脊液常规及生化检查。\nG. 结束本周期化疗，给予预防性抗感染及护肝支持治疗，并完善脑垂体激素五项检查。\nH. 继续本周期化疗，给予止吐及肠内营养支持治疗，避免静脉营养，并复查鼻咽及垂体增强MRI。\nI. 暂停氟尿嘧啶持续静脉滴注，给予口腔局部镇痛及促进黏膜愈合处理，并完善脑垂体激素五项检查。\nJ. 继续本周期化疗，给予止吐、护肝支持治疗，暂不予静脉营养，并请内分泌科急会诊。\nK. 结束本周期化疗，给予止吐、护肝及静脉营养支持治疗，并于次日开始局部区域调强放疗。\nL. 继续本周期化疗，给予止吐、护肝及静脉营养等支持治疗，并完善脑垂体激素五项检查。\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-efbe1e2a6ec0abf3be38883f","patient_id":"patient-eecadcdf172a1efe8947b052","turn_id":"turn07","turn_position":4,"turn_type":"response_assessment_decision","gold_letter":"B","gold_action":"评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行根治性同期放化疗。","options":[{"letter":"A","text":"评估诱导化疗疗效为疾病稳定，继续原方案第4程诱导化疗，并予以静脉补钾、补钠及护肾治疗后出院。","is_gold":false},{"letter":"B","text":"评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行根治性同期放化疗。","is_gold":true},{"letter":"C","text":"评估诱导化疗疗效为完全缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行单纯根治性放疗。","is_gold":false},{"letter":"D","text":"评估诱导化疗疗效为部分缓解，予以静脉补钾、补钠及护肾治疗，待电解质及肾功能恢复正常后立即开始第4程诱导化疗。","is_gold":false},{"letter":"E","text":"评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行单纯根治性放疗。","is_gold":false},{"letter":"F","text":"评估诱导化疗疗效为疾病进展，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院更改为GP方案化疗。","is_gold":false},{"letter":"G","text":"评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行根治性放疗联合靶向治疗。","is_gold":false},{"letter":"H","text":"评估诱导化疗疗效为部分缓解，因出现肾功能损害，予以护肾治疗后出院，并安排按期返院行单纯根治性放疗，取消同期化疗。","is_gold":false},{"letter":"I","text":"评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行姑息性放化疗。","is_gold":false},{"letter":"J","text":"评估诱导化疗疗效为部分缓解，予以静脉补钾、补钠及护肾治疗，住院期间直接开始根治性同期放化疗。","is_gold":false},{"letter":"K","text":"评估诱导化疗疗效为疾病稳定，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行根治性同期放化疗。","is_gold":false},{"letter":"L","text":"评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行鼻咽及颈部淋巴结清扫术。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N1，M0。\n综合TNM状态：T4N1M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D7] 入院记录: 主诉: 头痛伴耳鸣、听力下降3月余。；颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。今患者为进一步诊治，予收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,双咽后淋巴结肿大,头痛；既往史: 否认\"乙肝、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认饮酒史。否认不洁性生活史。；家族史: 患者叔叔因肺癌死亡。；体格检查: T：36.2℃，P：82次/分，R：20次/分，BP：128/74mmHg,Ht：172cm，Wt：80kg，BSA：1.92m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无叩痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约1cm*0.8cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）；KPS: 90；ECOG:\n- [全程D7] 入院记录: 主诉: 头痛伴耳鸣、听力下降3月余。；现病史: 患者于某次就诊时间1月无明显诱因下出现头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，患者于至[机构已隐去]就诊，行鼻咽活检病理，并送我院病理会诊示鼻咽分化型非角化性癌。某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。今患者为进一步诊治，予收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,双咽后淋巴结肿大,头痛；既往史: 否认\"乙肝、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认饮酒史。否认不洁性生活史。；家族史: 患者叔叔因肺癌死亡。；体格检查: T：36.2℃，P：82次/分，R：20次/分，BP：128/74mmHg,Ht：172cm，Wt：80kg，BSA：1.92m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率82次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无叩痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约1cm*0.8cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）；KPS: 90；ECOG:\n- [全程D53] 入院记录: 主诉: 鼻咽癌2程诱导化疗后20天。；现病史: 患者于某次就诊时间1月无明显诱因下出现头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，患者于至[机构已隐去]就诊，行鼻咽活检，并送我院病理会诊示鼻咽分化型非角化性癌。某次就诊时间在我院行鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶；颅底骨质破坏；双侧咽后淋巴结肿大，考虑转移；双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。明确诊断为鼻咽分化型非角化性癌，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)。于某次就诊时间、某次就诊时间行TPF化疗（DOC 60mg/m2+DDP 60mg/m2+5-FU 2.5g/m2civ48h）2程诱导化疗，化疗过程顺利。今患者为行第3程诱导化疗收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,双咽后淋巴结肿大,头痛；既往史: 否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认饮酒史。否认不洁性生活史。；家族史: 患者叔叔因肺癌死亡。；体格检查: T：36.5℃，P：88次/分，R：20次/分，BP：134/63mmHg,Ht：172cm，Wt：76kg，BSA：1.88m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率88次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无叩痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射……\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 早期复极改变\n- [全程D0] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.6；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:20（参考: 阴性）；活化部分凝血活酶时间(APTT)-静脉血: 23.1sec.；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；血红蛋白(Hb)-静脉血: 158g/L；血小板比容-静脉血: 26%；氯离子(Cl-)-静脉血: 105.3mmol/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 1.04；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；尿酸(UA)-静脉血: 341umol/L；甘油三酯(TG)-静脉血: 1.27mmol/L；总蛋白(TP)-静脉血: 73.53g/L；尿素氮(BUN)-静脉血: 6.35mmol/L；C-反应蛋白(CRP)-静脉血: 1.45mg/L；载脂蛋白B(apoB)-静脉血: 0.8g/L；总胆汁酸(TBA)-静脉血: 4.7umol/L；葡萄糖(Glu)-静脉血: 4.78mmol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；乳酸脱氢酶(LDH)-静脉血: 160.3U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；大血小板百分比(P-LCR%)-静脉血: 30.4%；中性粒细胞计数(Neut#)-静脉血: 6.410E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；丙氨酸氨基转移酶(ALT)-静脉血: 12.1U/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；ABO血型-静脉血: B；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.7fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；球蛋白(GLO)-静脉血: 28.23g/L；凝血酶时间(TT)-静脉血: 17.5sec.；红细胞计数(RBC#)-静脉血: 5.3710E12/L；平均红细胞体积(MCV)-静脉血: 87fL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.17mmolL；磷(P)-静脉血: 1.03mmol/L；总钙(Ca)-……\n- [全程D3] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理稍粗，未见明确实质性病变。双侧肺门不大，纵隔居中、无增宽。双膈形态正常。双侧肋膈角锐利。心影形态、大小、位置未见异常。；检查结论: 心肺未见明显异常。\n- [全程D3] 超声；双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约11cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约37×31×26mm，包膜光滑，实质回声不均匀，可见强回声斑。 腹主动脉旁未见明确肿物回声。；检查结论: 前列腺钙化。 肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、左侧壁见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强后明显强化，肿物占据鼻咽顶壁、左侧咽隐窝、左侧咽后间隙，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，右侧咽隐窝变浅，右侧咽旁脂肪间隙及颈动脉鞘区未见异常。 左侧腭帆张提肌及左侧头长肌受侵，右侧腭帆提肌、腭帆张肌、头长肌未见受侵征象。 双侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽双侧壁未见增厚。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部、翼突内外板、左侧枕骨基底部及左侧枕骨髁骨质信号减低，增强扫描后明显强化，斜坡局部见不规则软组织肿物影累及斜坡后份脑膜及蝶鞍后份，部分层面与垂体后叶分界欠清。双侧海绵窦形态正常，未见增宽。筛窦、蝶窦、左侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 左侧咽后间隙见肿大淋巴结，大小约为11mm ×9 mm，右侧咽后见肿大淋巴结，短径约6mm，均匀强化。 双颈I、II区见多个淋巴结，边界清，信号均匀，最大短径约8mm，均匀强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。 颅底骨质破坏。 双侧咽后淋巴结肿大，考虑转移。 双颈Ib、II区小淋巴结，性质待定。 副鼻窦炎、左侧乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D7] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；载脂蛋白AI(apoAI)-静脉血: 1.41g/L；总蛋白(TP)-静脉血: 72.8g/L；肌酐(Crea)-静脉血: 96.4umol/L；总胆红素(TBIL)-静脉血: 10.3umol/L；血小板比容-静脉血: 26%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；尿素氮(BUN)-静脉血: 5.6mmol/L；白细胞计数(WBC#)-尿液: 1/μL；钠离子(Na+)-静脉血: 140.2mmol/L；颜色-尿液: Light-Yellow；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.2mmolL；C-反应蛋白(CRP)-静脉血: 1.6mg/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；乳酸脱氢酶(LDH)-静脉血: 148.2U/L；总胆固醇(TC)-静脉血: 4.78mmol/L；总蛋白(TP)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 5/μL；平均血小板体积(MPV)-静脉血: 10.8fL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 345g/L；总钙(Ca)-静脉血: 2.34mmol/L；甘油三酯(TG)-静脉血: 1.84mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.34；胱抑素(Cys-C)-静脉血: 0.97mg/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.8U/L；红细胞计数(RBC#)-静脉血: 5.3810E12/L；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；单核细胞百分比(Mono%)-静脉血: 0.065；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.76；血液二氧化碳含量ctCO2(B)-静脉血: 24.3mmol/L；红细胞计数(RBC#)-尿液: 4/μL；间接胆红素(IBIL)-静脉血: 7umolL；浊度(TRUB)-尿液: clear；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.026；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；血小板计数(PLT#)-静脉血: 24610E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；颜色-粪便: 棕色；载脂蛋白……\n- [全程D11] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于第7胸椎椎体右侧水平，估计导管末端位于上腔静脉中-下段交界处。；检查结论: 导管末端位置如上述。\n- [全程D14] 检验组合: α-L-岩藻糖苷酶(AFU)-静脉血: 38.9U/L；载脂蛋白AI(apoAI)-静脉血: 1.64g/L；血红蛋白(Hb)-静脉血: 158g/L；有核红细胞百分比(NRBC%)-静脉血: 0；促黄体生成素(LH)-静脉血: 6.12mIU/ml；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.87mmol/L；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 弱阳性(±)（参考: 阴性）；天门冬氨酸氨基转移酶(AST)-静脉血: 17.6U/L；总胆汁酸(TBA)-静脉血: 1umol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.4pg；大血小板百分比(P-LCR%)-静脉血: 35.7%；胱抑素(Cys-C)-静脉血: 1.56mg/L；白蛋白(ALB)-静脉血: 45.2g/L；甘油三酯(TG)-静脉血: 1.3mmol/L；白细胞计数(WBC#)-静脉血: 9.310E9/L；红细胞计数(RBC#)-静脉血: 5.3710E12/L；单核细胞百分比(Mono%)-静脉血: 0.008；中性粒细胞计数(Neut#)-静脉血: 8.710E9/L；乳酸脱氢酶(LDH)-静脉血: 181.6U/L；总蛋白(TP)-静脉血: 70.8g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.9mmolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.02；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；催乳素(PRL)-静脉血: 308.5uIU/ml；中性粒细胞百分比(Neut%)-静脉血: 0.939；有核红细胞计数(NRBC#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 33.6；促卵泡刺激素(FSH)-静脉血: 9.93mIU/ml；钾离子(K+)-静脉血: 4.53mmol/L；镁离子(Mg2+)-静脉血: 0.89mmol/L；平均血小板体积(MPV)-静脉血: 11.3fL；碱性磷酸酶(ALP)-静脉血: 87.4U/L；总胆红素(TBIL)-静脉血: 22.5umol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=1.50)（参考: 阴性）；尿酸(UA)-静脉血: 385.9umol/L；EB……\n- [全程D38] 检验组合: α-L-岩藻糖苷酶(AFU)-静脉血: 31.3U/L；氯离子(Cl-)-静脉血: 90.1mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.85mmol/L；胱抑素(Cys-C)-静脉血: 1.22mg/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.8mmol/L；钾离子(K+)-静脉血: 3.66mmol/L；总胆汁酸(TBA)-静脉血: 2.2umol/L；甘油三酯(TG)-静脉血: 2.25mmol/L；肌酐(Crea)-静脉血: 108.2umol/L；总钙(Ca)-静脉血: 2.23mmol/L；C-反应蛋白(CRP)-静脉血: 0.28mg/L；钠离子(Na+)-静脉血: 129.2mmol/L；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阴性(-)（参考: 阴性）；球蛋白(GLO)-静脉血: 21.3g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.69mmolL；间接胆红素(IBIL)-静脉血: 16umolL；总胆固醇(TC)-静脉血: 6.95mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 27.8U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.73；白蛋白(ALB)-静脉血: 40.8g/L；总蛋白(TP)-静脉血: 62.1g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.92；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；尿素氮(BUN)-静脉血: 11.7mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=1.25)（参考: 阴性）；尿酸(UA)-静脉血: 368.1umol/L；总胆红素(TBIL)-静脉血: 20.1umol/L；乳酸脱氢酶(LDH)-静脉血: 167U/L；阴离子间隙(AG)-静脉血: 16.3；载脂蛋白B(apoB)-静脉血: 1.3g/L；EB病毒Zta蛋白抗体IgA(EBV-Zta-IgA)-静脉血: 阴性(-)（参考: 阴性）；葡萄糖(Glu)-静脉血: 4.91mmol/L；磷(P)-静脉血: 1.13mmol/L；直接胆……\n- [全程D53] 检验组合: 钠离子(Na+)-静脉血: 142.5mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 29.9U/L；乳酸脱氢酶(LDH)-静脉血: 207.9U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.6；血小板分布宽度(PDW)-静脉血: 10.8%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.035；间接胆红素(IBIL)-静脉血: 5.54umolL；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；天门冬氨酸氨基转移酶(AST)-静脉血: 18.5U/L；磷(P)-静脉血: 0.96mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.04；肌酐(Crea)-静脉血: 102umol/L；甘油三酯(TG)-静脉血: 1.26mmol/L；单核细胞百分比(Mono%)-静脉血: 0.09；大血小板百分比(P-LCR%)-静脉血: 22.6%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；C-反应蛋白(CRP)-静脉血: 0.69mg/L；血红蛋白(Hb)-静脉血: 134g/L；平均红细胞体积(MCV)-静脉血: 86.7fL；平均血小板体积(MPV)-静脉血: 9.7fL；单核细胞计数(Mono#)-静脉血: 0.610E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.009；有核红细胞计数(NRBC#)-静脉血: 010E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.13mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.22；葡萄糖(Glu)-静脉血: 4.43mmol/L；载脂蛋白B(apoB)-静脉血: 1.26g/L；载脂蛋白AI(apoAI)-静脉血: 1.74g/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 332g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.3mmol/L；氯离子(Cl-)-静脉血: 99.6mmol/L；尿酸(UA)-静脉血: 362.4umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.53mmolL；直接胆红素(DBIL)-静脉血: 1.88umol/L；红细胞比容(Hct)-静脉血: 40.4%；总胆固醇(TC)-静脉血: 6.07mmol/L；总钙(Ca)-静脉血:……\n- [全程D59] 检验组合: 平均红细胞体积(MCV)-静脉血: 82fL；大血小板百分比(P-LCR%)-静脉血: 36.3%；有核红细胞百分比(NRBC%)-静脉血: 0；血小板分布宽度(PDW)-静脉血: 15.9%；血小板比容-静脉血: 15%；白细胞计数(WBC#)-静脉血: 4.2710E9/L；血小板计数(PLT#)-静脉血: 13510E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.351；红细胞比容(Hct)-静脉血: 37.9%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.002；有核红细胞计数(NRBC#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 133g/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.631；单核细胞计数(Mono#)-静脉血: 0.110E9/L；红细胞计数(RBC#)-静脉血: 4.6210E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；平均红细胞血红蛋白浓度(MCHC)-静脉血: 351g/L；平均血小板体积(MPV)-静脉血: 11.4fL；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.7；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；单核细胞百分比(Mono%)-静脉血: 0.014；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L\n- [全程D60] 检验组合: 阴离子间隙(AG)-静脉血: 17.3；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=1.25)（参考: 阴性）；胱抑素(Cys-C)-静脉血: 1.21mg/L；氯离子(Cl-)-静脉血: 90.7mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 35.4U/L；载脂蛋白AI(apoAI)-静脉血: 1.83g/L；钠离子(Na+)-静脉血: 130.8mmol/L；总胆红素(TBIL)-静脉血: 20.2umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.8mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；球蛋白(GLO)-静脉血: 22.01g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.03；丙氨酸氨基转移酶(ALT)-静脉血: 24.3U/L；白蛋白(ALB)-静脉血: 44.6g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.5U/L；载脂蛋白B(apoB)-静脉血: 1.33g/L；碱性磷酸酶(ALP)-静脉血: 78.3U/L；葡萄糖(Glu)-静脉血: 5.06mmol/L；磷(P)-静脉血: 1mmol/L；总钙(Ca)-静脉血: 2.29mmol/L；尿酸(UA)-静脉血: 326.1umol/L；总胆汁酸(TBA)-静脉血: 2.7umol/L；总胆固醇(TC)-静脉血: 7.06mmol/L；C-反应蛋白(CRP)-静脉血: 0.2mg/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.72；直接胆红素(DBIL)-静脉血: 4.4umol/L；镁离子(Mg2+)-静脉血: 0.72mmol/L；EB病毒Zta蛋白抗体IgA(EBV-Zta-IgA)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.71mmolL；总蛋白(TP)-静脉血: 66.61g/L；甘油三酯(TG)-静脉血: 2.92mmol/L；肌酐(Crea)-静脉血: 112.8umol/L；尿素氮(BUN)-静脉血: 10.2mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.……\n- [全程D61] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后复查，较某次就诊时间片对比： 鼻咽腔未见明显狭窄，鼻咽左侧壁粘膜稍增厚，T1WI呈等信号，T2WI呈稍高信号，增强后明显强化，左侧咽隐窝变浅，右侧咽隐窝清晰，双侧咽旁脂肪间隙及颈动脉鞘区未见异常。鼻咽肿物较前明显缩小好转。 左侧腭帆张提肌及左侧头长肌稍肿胀，右侧腭帆提肌、腭帆张肌、头长肌未见受侵征象。 双侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽双侧壁未见增厚，双侧后鼻孔未见肿物。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部、翼突内外板、左侧枕骨基底部及左侧枕骨髁骨质信号减低，增强扫描后明显强化。双侧海绵窦形态正常，未见增宽。左侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧咽后见小淋巴结，最大短径约5 mm。 双颈I、II区见多个淋巴结，边界清，信号均匀，最大短径约7mm，均匀强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗后复查，较某次就诊时间片对比： 鼻咽肿物较前明显缩小好转，累及范围较前缩小。 颅底骨质破坏同前。 双侧咽后淋巴结较前缩小。 双颈I、II区小淋巴结，较前稍缩小。 左侧乳突炎。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D7] 首次病程记录；首次病程记录: 病程类型: 首次病程记录；病程主题: 首次病程记录；病程内容: 病历特点：1、患者中年男性。2、患者于某次就诊时间1月无明显诱因下出现头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，患者于至[机构已隐去]就诊，行鼻咽活检病理，并送我院病理会诊示鼻咽分化型非角化性癌。某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。现患者为进一步诊治，予收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。3、体查：张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约1cm*0.8cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）示图：4、辅助检查：（1） 某次就诊时间在我医院（病理号：[记录编号已隐去]）鼻咽活检病理示：（鼻咽肿物）镜检为分化型非角化性癌（2） 某次就诊时间在我院胸片检查：心肺未见异常。（3） 某次就诊时间在我院腹部B超检查：肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。（4） 某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。副鼻窦炎、左侧乳突炎。（6）某次就诊时间我院：VCA-IgA 1:160 EA-IgA 1:20EBV-DNA定性检测：2.14E102copy/ml。 诊断依据： 初步诊断： 鉴别诊断：患者诊断明确，无需鉴别诊断。 诊疗计划：1、完善相关检查如全身骨扫描、血常规、生化等。2、诱导化疗及同期化放疗。\n- [全程D8] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者诉间有头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，无面麻、声嘶。[姓名已隐去]医生信息已隐藏示：嘱患者今日完善全身骨扫描检查，排除骨转移征象，治疗上暂给予对症处理，继续观察病情。\n- [全程D9] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日患者症状体征基本同前，无诉其余特殊不适。[姓名已隐去]医生信息已隐藏后指示：某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，最大短径约8mm，均匀强化。骨ECT示鼻咽部、颅底骨代谢较活跃，考虑NPC所致。胸片、腹部B超排除远处转移。故目前临床诊断明确为“鼻咽分化型非角化性癌[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)，治疗方案定为TPF（多西紫杉醇 60mg/m2 + 顺铂 60mg/m2 + 5-FU 2.5g/m2， q21d）诱导化疗3程后再行同期放化疗，放疗采用IMRT技术，同期化疗采用顺铂 60mg/m2（q21d）2程。并指示化疗期间给予护肝、护胃、止吐及营养支持治疗。已向患者及家属交代病情及治疗相关不良反应后，其表示理解，并同意上述治疗方案。拟明日开始行多西紫杉醇化疗，密切观察患者病情变化。\n- [全程D12] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 患者今日TPF方案化疗第3天，现一般情况可，未诉恶心、呕吐、腹痛、腹泻等不适，大小便正常。[姓名已隐去]医生信息已隐藏出，患者目前一般情况可，可继续化疗。注意化疗结束后复查血、生化常规，及时对症处理。\n- [全程D53] 首次病程记录；首次病程记录: 病程类型: 首次病程记录；病程主题: 首次病程记录；病程内容: 病历特点：1、患者中年男性。2、患者于某次就诊时间1月无明显诱因下出现头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，患者于至[机构已隐去]就诊，行鼻咽活检，并送我院病理会诊示鼻咽分化型非角化性癌。某次就诊时间在我院行鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶；颅底骨质破坏；双侧咽后淋巴结肿大，考虑转移；双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。明确诊断为鼻咽分化型非角化性癌，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)。于某次就诊时间、某次就诊时间行TPF化疗（DOC 60mg/m2+DDP 60mg/m2+5-FU 2.5g/m2civ48h）2程诱导化疗，化疗过程顺利。今患者为行第3程诱导化疗收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。3、体查：张口门齿距5cm；鼻咽肿物较前明显消退；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约0.8cm*0.5cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）。4、辅助检查：（1） 某次就诊时间在我医院（病理号：[记录编号已隐去]）鼻咽活检病理示：（鼻咽肿物）镜检为分化型非角化性癌（2） 某次就诊时间在我院胸片检查：心肺未见异常。（3） 某次就诊时间在我院腹部B超检查：肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。（4） 某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。副鼻窦炎、左侧乳突炎。（6） 某次就诊时间我院：VCA-IgA 1:160 EA-IgA 1:20 EBV-DNA定性检测：2.14E102copy/ml 诊断依据： 初步诊断： 鉴别诊断：诊断明确，暂无需鉴别。 诊疗计划：1、完善相关检查如三大常规、电子鼻咽镜等。2、综合治疗。\n- [全程D54] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日随[姓名已隐去]医生信息已隐藏，详细询问病史并查体后，分析病情如下：1、患者中年男性，因“鼻咽癌2程诱导化疗后20天”入院。2、查体：张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约0.8cm*0.5cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）。3、辅助检查：某次就诊时间在我医院（病理号：[记录编号已隐去]）鼻咽活检病理示：（鼻咽肿物）镜检为分化型非角化性癌。某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。副鼻窦炎、左侧乳突炎。综上述，患者诊断鼻咽分化型非角化性癌，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)。[姓名已隐去]医生信息已隐藏，患者现一般情况可。昨日复查血常规及生化常规未见明显异常，拟今日开始行第3程诱导化疗，注意防治化疗相关毒副反应。\n- [全程D55] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日随[姓名已隐去]医生信息已隐藏，详细询问病史并查体后，分析病情如下：1、患者中年男性，因“鼻咽癌2程诱导化疗后20天”入院。2、查体：张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约0.8cm*0.5cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）。3、辅助检查：某次就诊时间在我医院（病理号：[记录编号已隐去]）鼻咽活检病理示：（鼻咽肿物）镜检为分化型非角化性癌。某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。副鼻窦炎、左侧乳突炎。综上述，患者诊断鼻咽分化型非角化性癌，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)。[姓名已隐去]医生信息已隐藏，患者现一般情况可。化疗前复查血常规及生化常规未见明显异常，于昨日开始行第3程诱导化疗，注意水化、护胃止呕、营养补液等对症支持治疗。\n- [全程D58] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日TPF方案化疗第5天，现一般情况可，未诉恶心、呕吐、腹痛、腹泻等不适，大小便正常。[姓名已隐去]主治医师，患者目前一般情况可，可继续化疗。注意化疗结束后复查血、生化常规，及时对症处理。\n- [全程D60] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日已完成第3程TPF方案（多西紫杉醇 60mg/m2 + DDP 60mg/m2 + 5-Fu 2.5g/m2）诱导化疗，未诉特殊不适。2/5复查血常规结果基本正常，今日复查血生化结果示：K+ 3.13↓ mmol/L，Na+ 130.8↓ mmol/L，IBIL 15.80 ↑ umolL，CRE 112.8↑ umol/L。[姓名已隐去]医生信息已隐藏示：患者现已完成化疗，今日可带口服补钾、护肝及护肾药物出院。嘱患者注意休息，加强营养，口服补钠，每周复查血常规、肝肾功能。按期返院开始同期放化疗，不适时随诊。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估诱导化疗疗效为疾病稳定，继续原方案第4程诱导化疗，并予以静脉补钾、补钠及护肾治疗后出院。\nB. 评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行根治性同期放化疗。\nC. 评估诱导化疗疗效为完全缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行单纯根治性放疗。\nD. 评估诱导化疗疗效为部分缓解，予以静脉补钾、补钠及护肾治疗，待电解质及肾功能恢复正常后立即开始第4程诱导化疗。\nE. 评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行单纯根治性放疗。\nF. 评估诱导化疗疗效为疾病进展，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院更改为GP方案化疗。\nG. 评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行根治性放疗联合靶向治疗。\nH. 评估诱导化疗疗效为部分缓解，因出现肾功能损害，予以护肾治疗后出院，并安排按期返院行单纯根治性放疗，取消同期化疗。\nI. 评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行姑息性放化疗。\nJ. 评估诱导化疗疗效为部分缓解，予以静脉补钾、补钠及护肾治疗，住院期间直接开始根治性同期放化疗。\nK. 评估诱导化疗疗效为疾病稳定，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行根治性同期放化疗。\nL. 评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行鼻咽及颈部淋巴结清扫术。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- [全程D53] 入院记录: 主诉: 鼻咽癌2程诱导化疗后20天。；现病史: 患者于某次就诊时间1月无明显诱因下出现头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，患者于至[机构已隐去]就诊，行鼻咽活检，并送我院病理会诊示鼻咽分化型非角化性癌。某次就诊时间在我院行鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶；颅底骨质破坏；双侧咽后淋巴结肿大，考虑转移；双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。明确诊断为鼻咽分化型非角化性癌，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)。于某次就诊时间、某次就诊时间行TPF化疗（DOC 60mg/m2+DDP 60mg/m2+5-FU 2.5g/m2civ48h）2程诱导化疗，化疗过程顺利。今患者为行第3程诱导化疗收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,双咽后淋巴结肿大,头痛；既往史: 否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认饮酒史。否认不洁性生活史。；家族史: 患者叔叔因肺癌死亡。；体格检查: T：36.5℃，P：88次/分，R：20次/分，BP：134/63mmHg,Ht：172cm，Wt：76kg，BSA：1.88m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率88次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无叩痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射……\n\n【已完成检查与客观结果】\n- [全程D38] 检验组合: α-L-岩藻糖苷酶(AFU)-静脉血: 31.3U/L；氯离子(Cl-)-静脉血: 90.1mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.85mmol/L；胱抑素(Cys-C)-静脉血: 1.22mg/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.8mmol/L；钾离子(K+)-静脉血: 3.66mmol/L；总胆汁酸(TBA)-静脉血: 2.2umol/L；甘油三酯(TG)-静脉血: 2.25mmol/L；肌酐(Crea)-静脉血: 108.2umol/L；总钙(Ca)-静脉血: 2.23mmol/L；C-反应蛋白(CRP)-静脉血: 0.28mg/L；钠离子(Na+)-静脉血: 129.2mmol/L；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阴性(-)（参考: 阴性）；球蛋白(GLO)-静脉血: 21.3g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.69mmolL；间接胆红素(IBIL)-静脉血: 16umolL；总胆固醇(TC)-静脉血: 6.95mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 27.8U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.73；白蛋白(ALB)-静脉血: 40.8g/L；总蛋白(TP)-静脉血: 62.1g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.92；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；尿素氮(BUN)-静脉血: 11.7mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=1.25)（参考: 阴性）；尿酸(UA)-静脉血: 368.1umol/L；总胆红素(TBIL)-静脉血: 20.1umol/L；乳酸脱氢酶(LDH)-静脉血: 167U/L；阴离子间隙(AG)-静脉血: 16.3；载脂蛋白B(apoB)-静脉血: 1.3g/L；EB病毒Zta蛋白抗体IgA(EBV-Zta-IgA)-静脉血: 阴性(-)（参考: 阴性）；葡萄糖(Glu)-静脉血: 4.91mmol/L；磷(P)-静脉血: 1.13mmol/L；直接胆……\n- [全程D53] 检验组合: 钠离子(Na+)-静脉血: 142.5mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 29.9U/L；乳酸脱氢酶(LDH)-静脉血: 207.9U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.6；血小板分布宽度(PDW)-静脉血: 10.8%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.035；间接胆红素(IBIL)-静脉血: 5.54umolL；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；天门冬氨酸氨基转移酶(AST)-静脉血: 18.5U/L；磷(P)-静脉血: 0.96mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.04；肌酐(Crea)-静脉血: 102umol/L；甘油三酯(TG)-静脉血: 1.26mmol/L；单核细胞百分比(Mono%)-静脉血: 0.09；大血小板百分比(P-LCR%)-静脉血: 22.6%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；C-反应蛋白(CRP)-静脉血: 0.69mg/L；血红蛋白(Hb)-静脉血: 134g/L；平均红细胞体积(MCV)-静脉血: 86.7fL；平均血小板体积(MPV)-静脉血: 9.7fL；单核细胞计数(Mono#)-静脉血: 0.610E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.009；有核红细胞计数(NRBC#)-静脉血: 010E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.13mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.22；葡萄糖(Glu)-静脉血: 4.43mmol/L；载脂蛋白B(apoB)-静脉血: 1.26g/L；载脂蛋白AI(apoAI)-静脉血: 1.74g/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 332g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.3mmol/L；氯离子(Cl-)-静脉血: 99.6mmol/L；尿酸(UA)-静脉血: 362.4umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.53mmolL；直接胆红素(DBIL)-静脉血: 1.88umol/L；红细胞比容(Hct)-静脉血: 40.4%；总胆固醇(TC)-静脉血: 6.07mmol/L；总钙(Ca)-静脉血:……\n- [全程D59] 检验组合: 平均红细胞体积(MCV)-静脉血: 82fL；大血小板百分比(P-LCR%)-静脉血: 36.3%；有核红细胞百分比(NRBC%)-静脉血: 0；血小板分布宽度(PDW)-静脉血: 15.9%；血小板比容-静脉血: 15%；白细胞计数(WBC#)-静脉血: 4.2710E9/L；血小板计数(PLT#)-静脉血: 13510E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.351；红细胞比容(Hct)-静脉血: 37.9%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.002；有核红细胞计数(NRBC#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 133g/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.631；单核细胞计数(Mono#)-静脉血: 0.110E9/L；红细胞计数(RBC#)-静脉血: 4.6210E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；平均红细胞血红蛋白浓度(MCHC)-静脉血: 351g/L；平均血小板体积(MPV)-静脉血: 11.4fL；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.7；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；单核细胞百分比(Mono%)-静脉血: 0.014；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L\n- [全程D60] 检验组合: 阴离子间隙(AG)-静脉血: 17.3；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=1.25)（参考: 阴性）；胱抑素(Cys-C)-静脉血: 1.21mg/L；氯离子(Cl-)-静脉血: 90.7mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 35.4U/L；载脂蛋白AI(apoAI)-静脉血: 1.83g/L；钠离子(Na+)-静脉血: 130.8mmol/L；总胆红素(TBIL)-静脉血: 20.2umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.8mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；球蛋白(GLO)-静脉血: 22.01g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.03；丙氨酸氨基转移酶(ALT)-静脉血: 24.3U/L；白蛋白(ALB)-静脉血: 44.6g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.5U/L；载脂蛋白B(apoB)-静脉血: 1.33g/L；碱性磷酸酶(ALP)-静脉血: 78.3U/L；葡萄糖(Glu)-静脉血: 5.06mmol/L；磷(P)-静脉血: 1mmol/L；总钙(Ca)-静脉血: 2.29mmol/L；尿酸(UA)-静脉血: 326.1umol/L；总胆汁酸(TBA)-静脉血: 2.7umol/L；总胆固醇(TC)-静脉血: 7.06mmol/L；C-反应蛋白(CRP)-静脉血: 0.2mg/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.72；直接胆红素(DBIL)-静脉血: 4.4umol/L；镁离子(Mg2+)-静脉血: 0.72mmol/L；EB病毒Zta蛋白抗体IgA(EBV-Zta-IgA)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.71mmolL；总蛋白(TP)-静脉血: 66.61g/L；甘油三酯(TG)-静脉血: 2.92mmol/L；肌酐(Crea)-静脉血: 112.8umol/L；尿素氮(BUN)-静脉血: 10.2mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.……\n- [全程D61] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后复查，较某次就诊时间片对比： 鼻咽腔未见明显狭窄，鼻咽左侧壁粘膜稍增厚，T1WI呈等信号，T2WI呈稍高信号，增强后明显强化，左侧咽隐窝变浅，右侧咽隐窝清晰，双侧咽旁脂肪间隙及颈动脉鞘区未见异常。鼻咽肿物较前明显缩小好转。 左侧腭帆张提肌及左侧头长肌稍肿胀，右侧腭帆提肌、腭帆张肌、头长肌未见受侵征象。 双侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽双侧壁未见增厚，双侧后鼻孔未见肿物。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部、翼突内外板、左侧枕骨基底部及左侧枕骨髁骨质信号减低，增强扫描后明显强化。双侧海绵窦形态正常，未见增宽。左侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧咽后见小淋巴结，最大短径约5 mm。 双颈I、II区见多个淋巴结，边界清，信号均匀，最大短径约7mm，均匀强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗后复查，较某次就诊时间片对比： 鼻咽肿物较前明显缩小好转，累及范围较前缩小。 颅底骨质破坏同前。 双侧咽后淋巴结较前缩小。 双颈I、II区小淋巴结，较前稍缩小。 左侧乳突炎。\n\n【既往治疗与反应】\n- [全程D53] 首次病程记录；首次病程记录: 病程类型: 首次病程记录；病程主题: 首次病程记录；病程内容: 病历特点：1、患者中年男性。2、患者于某次就诊时间1月无明显诱因下出现头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，患者于至[机构已隐去]就诊，行鼻咽活检，并送我院病理会诊示鼻咽分化型非角化性癌。某次就诊时间在我院行鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶；颅底骨质破坏；双侧咽后淋巴结肿大，考虑转移；双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。明确诊断为鼻咽分化型非角化性癌，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)。于某次就诊时间、某次就诊时间行TPF化疗（DOC 60mg/m2+DDP 60mg/m2+5-FU 2.5g/m2civ48h）2程诱导化疗，化疗过程顺利。今患者为行第3程诱导化疗收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。3、体查：张口门齿距5cm；鼻咽肿物较前明显消退；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约0.8cm*0.5cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）。4、辅助检查：（1） 某次就诊时间在我医院（病理号：[记录编号已隐去]）鼻咽活检病理示：（鼻咽肿物）镜检为分化型非角化性癌（2） 某次就诊时间在我院胸片检查：心肺未见异常。（3） 某次就诊时间在我院腹部B超检查：肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。（4） 某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。副鼻窦炎、左侧乳突炎。（6） 某次就诊时间我院：VCA-IgA 1:160 EA-IgA 1:20 EBV-DNA定性检测：2.14E102copy/ml 诊断依据： 初步诊断： 鉴别诊断：诊断明确，暂无需鉴别。 诊疗计划：1、完善相关检查如三大常规、电子鼻咽镜等。2、综合治疗。\n- [全程D54] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日随[姓名已隐去]医生信息已隐藏，详细询问病史并查体后，分析病情如下：1、患者中年男性，因“鼻咽癌2程诱导化疗后20天”入院。2、查体：张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约0.8cm*0.5cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）。3、辅助检查：某次就诊时间在我医院（病理号：[记录编号已隐去]）鼻咽活检病理示：（鼻咽肿物）镜检为分化型非角化性癌。某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。副鼻窦炎、左侧乳突炎。综上述，患者诊断鼻咽分化型非角化性癌，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)。[姓名已隐去]医生信息已隐藏，患者现一般情况可。昨日复查血常规及生化常规未见明显异常，拟今日开始行第3程诱导化疗，注意防治化疗相关毒副反应。\n- [全程D55] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日随[姓名已隐去]医生信息已隐藏，详细询问病史并查体后，分析病情如下：1、患者中年男性，因“鼻咽癌2程诱导化疗后20天”入院。2、查体：张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约0.8cm*0.5cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）。3、辅助检查：某次就诊时间在我医院（病理号：[记录编号已隐去]）鼻咽活检病理示：（鼻咽肿物）镜检为分化型非角化性癌。某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。副鼻窦炎、左侧乳突炎。综上述，患者诊断鼻咽分化型非角化性癌，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)。[姓名已隐去]医生信息已隐藏，患者现一般情况可。化疗前复查血常规及生化常规未见明显异常，于昨日开始行第3程诱导化疗，注意水化、护胃止呕、营养补液等对症支持治疗。\n- [全程D58] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日TPF方案化疗第5天，现一般情况可，未诉恶心、呕吐、腹痛、腹泻等不适，大小便正常。[姓名已隐去]主治医师，患者目前一般情况可，可继续化疗。注意化疗结束后复查血、生化常规，及时对症处理。\n- [全程D60] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日已完成第3程TPF方案（多西紫杉醇 60mg/m2 + DDP 60mg/m2 + 5-Fu 2.5g/m2）诱导化疗，未诉特殊不适。2/5复查血常规结果基本正常，今日复查血生化结果示：K+ 3.13↓ mmol/L，Na+ 130.8↓ mmol/L，IBIL 15.80 ↑ umolL，CRE 112.8↑ umol/L。[姓名已隐去]医生信息已隐藏示：患者现已完成化疗，今日可带口服补钾、护肝及护肾药物出院。嘱患者注意休息，加强营养，口服补钠，每周复查血常规、肝肾功能。按期返院开始同期放化疗，不适时随诊。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估诱导化疗疗效为疾病稳定，继续原方案第4程诱导化疗，并予以静脉补钾、补钠及护肾治疗后出院。\nB. 评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行根治性同期放化疗。\nC. 评估诱导化疗疗效为完全缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行单纯根治性放疗。\nD. 评估诱导化疗疗效为部分缓解，予以静脉补钾、补钠及护肾治疗，待电解质及肾功能恢复正常后立即开始第4程诱导化疗。\nE. 评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行单纯根治性放疗。\nF. 评估诱导化疗疗效为疾病进展，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院更改为GP方案化疗。\nG. 评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行根治性放疗联合靶向治疗。\nH. 评估诱导化疗疗效为部分缓解，因出现肾功能损害，予以护肾治疗后出院，并安排按期返院行单纯根治性放疗，取消同期化疗。\nI. 评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行姑息性放化疗。\nJ. 评估诱导化疗疗效为部分缓解，予以静脉补钾、补钠及护肾治疗，住院期间直接开始根治性同期放化疗。\nK. 评估诱导化疗疗效为疾病稳定，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行根治性同期放化疗。\nL. 评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行鼻咽及颈部淋巴结清扫术。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N1，M0。\n综合TNM状态：T4N1M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D53] 入院记录: 主诉: 鼻咽癌2程诱导化疗后20天。；现病史: 患者于某次就诊时间1月无明显诱因下出现头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，患者于至[机构已隐去]就诊，行鼻咽活检，并送我院病理会诊示鼻咽分化型非角化性癌。某次就诊时间在我院行鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶；颅底骨质破坏；双侧咽后淋巴结肿大，考虑转移；双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。明确诊断为鼻咽分化型非角化性癌，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)。于某次就诊时间、某次就诊时间行TPF化疗（DOC 60mg/m2+DDP 60mg/m2+5-FU 2.5g/m2civ48h）2程诱导化疗，化疗过程顺利。今患者为行第3程诱导化疗收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,双咽后淋巴结肿大,头痛；既往史: 否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认饮酒史。否认不洁性生活史。；家族史: 患者叔叔因肺癌死亡。；体格检查: T：36.5℃，P：88次/分，R：20次/分，BP：134/63mmHg,Ht：172cm，Wt：76kg，BSA：1.88m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率88次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无叩痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射……\n\n【已完成检查与客观结果】\n- [全程D38] 检验组合: α-L-岩藻糖苷酶(AFU)-静脉血: 31.3U/L；氯离子(Cl-)-静脉血: 90.1mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.85mmol/L；胱抑素(Cys-C)-静脉血: 1.22mg/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.8mmol/L；钾离子(K+)-静脉血: 3.66mmol/L；总胆汁酸(TBA)-静脉血: 2.2umol/L；甘油三酯(TG)-静脉血: 2.25mmol/L；肌酐(Crea)-静脉血: 108.2umol/L；总钙(Ca)-静脉血: 2.23mmol/L；C-反应蛋白(CRP)-静脉血: 0.28mg/L；钠离子(Na+)-静脉血: 129.2mmol/L；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阴性(-)（参考: 阴性）；球蛋白(GLO)-静脉血: 21.3g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.69mmolL；间接胆红素(IBIL)-静脉血: 16umolL；总胆固醇(TC)-静脉血: 6.95mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 27.8U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.73；白蛋白(ALB)-静脉血: 40.8g/L；总蛋白(TP)-静脉血: 62.1g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.92；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；尿素氮(BUN)-静脉血: 11.7mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=1.25)（参考: 阴性）；尿酸(UA)-静脉血: 368.1umol/L；总胆红素(TBIL)-静脉血: 20.1umol/L；乳酸脱氢酶(LDH)-静脉血: 167U/L；阴离子间隙(AG)-静脉血: 16.3；载脂蛋白B(apoB)-静脉血: 1.3g/L；EB病毒Zta蛋白抗体IgA(EBV-Zta-IgA)-静脉血: 阴性(-)（参考: 阴性）；葡萄糖(Glu)-静脉血: 4.91mmol/L；磷(P)-静脉血: 1.13mmol/L；直接胆……\n- [全程D53] 检验组合: 钠离子(Na+)-静脉血: 142.5mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 29.9U/L；乳酸脱氢酶(LDH)-静脉血: 207.9U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.6；血小板分布宽度(PDW)-静脉血: 10.8%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.035；间接胆红素(IBIL)-静脉血: 5.54umolL；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；天门冬氨酸氨基转移酶(AST)-静脉血: 18.5U/L；磷(P)-静脉血: 0.96mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.04；肌酐(Crea)-静脉血: 102umol/L；甘油三酯(TG)-静脉血: 1.26mmol/L；单核细胞百分比(Mono%)-静脉血: 0.09；大血小板百分比(P-LCR%)-静脉血: 22.6%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；C-反应蛋白(CRP)-静脉血: 0.69mg/L；血红蛋白(Hb)-静脉血: 134g/L；平均红细胞体积(MCV)-静脉血: 86.7fL；平均血小板体积(MPV)-静脉血: 9.7fL；单核细胞计数(Mono#)-静脉血: 0.610E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.009；有核红细胞计数(NRBC#)-静脉血: 010E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.13mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.22；葡萄糖(Glu)-静脉血: 4.43mmol/L；载脂蛋白B(apoB)-静脉血: 1.26g/L；载脂蛋白AI(apoAI)-静脉血: 1.74g/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 332g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.3mmol/L；氯离子(Cl-)-静脉血: 99.6mmol/L；尿酸(UA)-静脉血: 362.4umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.53mmolL；直接胆红素(DBIL)-静脉血: 1.88umol/L；红细胞比容(Hct)-静脉血: 40.4%；总胆固醇(TC)-静脉血: 6.07mmol/L；总钙(Ca)-静脉血:……\n- [全程D59] 检验组合: 平均红细胞体积(MCV)-静脉血: 82fL；大血小板百分比(P-LCR%)-静脉血: 36.3%；有核红细胞百分比(NRBC%)-静脉血: 0；血小板分布宽度(PDW)-静脉血: 15.9%；血小板比容-静脉血: 15%；白细胞计数(WBC#)-静脉血: 4.2710E9/L；血小板计数(PLT#)-静脉血: 13510E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.351；红细胞比容(Hct)-静脉血: 37.9%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.002；有核红细胞计数(NRBC#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 133g/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.631；单核细胞计数(Mono#)-静脉血: 0.110E9/L；红细胞计数(RBC#)-静脉血: 4.6210E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；平均红细胞血红蛋白浓度(MCHC)-静脉血: 351g/L；平均血小板体积(MPV)-静脉血: 11.4fL；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.7；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；单核细胞百分比(Mono%)-静脉血: 0.014；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L\n- [全程D60] 检验组合: 阴离子间隙(AG)-静脉血: 17.3；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=1.25)（参考: 阴性）；胱抑素(Cys-C)-静脉血: 1.21mg/L；氯离子(Cl-)-静脉血: 90.7mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 35.4U/L；载脂蛋白AI(apoAI)-静脉血: 1.83g/L；钠离子(Na+)-静脉血: 130.8mmol/L；总胆红素(TBIL)-静脉血: 20.2umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.8mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；球蛋白(GLO)-静脉血: 22.01g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.03；丙氨酸氨基转移酶(ALT)-静脉血: 24.3U/L；白蛋白(ALB)-静脉血: 44.6g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.5U/L；载脂蛋白B(apoB)-静脉血: 1.33g/L；碱性磷酸酶(ALP)-静脉血: 78.3U/L；葡萄糖(Glu)-静脉血: 5.06mmol/L；磷(P)-静脉血: 1mmol/L；总钙(Ca)-静脉血: 2.29mmol/L；尿酸(UA)-静脉血: 326.1umol/L；总胆汁酸(TBA)-静脉血: 2.7umol/L；总胆固醇(TC)-静脉血: 7.06mmol/L；C-反应蛋白(CRP)-静脉血: 0.2mg/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.72；直接胆红素(DBIL)-静脉血: 4.4umol/L；镁离子(Mg2+)-静脉血: 0.72mmol/L；EB病毒Zta蛋白抗体IgA(EBV-Zta-IgA)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.71mmolL；总蛋白(TP)-静脉血: 66.61g/L；甘油三酯(TG)-静脉血: 2.92mmol/L；肌酐(Crea)-静脉血: 112.8umol/L；尿素氮(BUN)-静脉血: 10.2mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.……\n- [全程D61] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后复查，较某次就诊时间片对比： 鼻咽腔未见明显狭窄，鼻咽左侧壁粘膜稍增厚，T1WI呈等信号，T2WI呈稍高信号，增强后明显强化，左侧咽隐窝变浅，右侧咽隐窝清晰，双侧咽旁脂肪间隙及颈动脉鞘区未见异常。鼻咽肿物较前明显缩小好转。 左侧腭帆张提肌及左侧头长肌稍肿胀，右侧腭帆提肌、腭帆张肌、头长肌未见受侵征象。 双侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽双侧壁未见增厚，双侧后鼻孔未见肿物。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部、翼突内外板、左侧枕骨基底部及左侧枕骨髁骨质信号减低，增强扫描后明显强化。双侧海绵窦形态正常，未见增宽。左侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧咽后见小淋巴结，最大短径约5 mm。 双颈I、II区见多个淋巴结，边界清，信号均匀，最大短径约7mm，均匀强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗后复查，较某次就诊时间片对比： 鼻咽肿物较前明显缩小好转，累及范围较前缩小。 颅底骨质破坏同前。 双侧咽后淋巴结较前缩小。 双颈I、II区小淋巴结，较前稍缩小。 左侧乳突炎。\n\n【既往治疗与反应】\n- [全程D53] 首次病程记录；首次病程记录: 病程类型: 首次病程记录；病程主题: 首次病程记录；病程内容: 病历特点：1、患者中年男性。2、患者于某次就诊时间1月无明显诱因下出现头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，患者于至[机构已隐去]就诊，行鼻咽活检，并送我院病理会诊示鼻咽分化型非角化性癌。某次就诊时间在我院行鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶；颅底骨质破坏；双侧咽后淋巴结肿大，考虑转移；双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。明确诊断为鼻咽分化型非角化性癌，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)。于某次就诊时间、某次就诊时间行TPF化疗（DOC 60mg/m2+DDP 60mg/m2+5-FU 2.5g/m2civ48h）2程诱导化疗，化疗过程顺利。今患者为行第3程诱导化疗收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。3、体查：张口门齿距5cm；鼻咽肿物较前明显消退；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约0.8cm*0.5cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）。4、辅助检查：（1） 某次就诊时间在我医院（病理号：[记录编号已隐去]）鼻咽活检病理示：（鼻咽肿物）镜检为分化型非角化性癌（2） 某次就诊时间在我院胸片检查：心肺未见异常。（3） 某次就诊时间在我院腹部B超检查：肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。（4） 某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。副鼻窦炎、左侧乳突炎。（6） 某次就诊时间我院：VCA-IgA 1:160 EA-IgA 1:20 EBV-DNA定性检测：2.14E102copy/ml 诊断依据： 初步诊断： 鉴别诊断：诊断明确，暂无需鉴别。 诊疗计划：1、完善相关检查如三大常规、电子鼻咽镜等。2、综合治疗。\n- [全程D54] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日随[姓名已隐去]医生信息已隐藏，详细询问病史并查体后，分析病情如下：1、患者中年男性，因“鼻咽癌2程诱导化疗后20天”入院。2、查体：张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约0.8cm*0.5cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）。3、辅助检查：某次就诊时间在我医院（病理号：[记录编号已隐去]）鼻咽活检病理示：（鼻咽肿物）镜检为分化型非角化性癌。某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。副鼻窦炎、左侧乳突炎。综上述，患者诊断鼻咽分化型非角化性癌，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)。[姓名已隐去]医生信息已隐藏，患者现一般情况可。昨日复查血常规及生化常规未见明显异常，拟今日开始行第3程诱导化疗，注意防治化疗相关毒副反应。\n- [全程D55] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日随[姓名已隐去]医生信息已隐藏，详细询问病史并查体后，分析病情如下：1、患者中年男性，因“鼻咽癌2程诱导化疗后20天”入院。2、查体：张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约0.8cm*0.5cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）。3、辅助检查：某次就诊时间在我医院（病理号：[记录编号已隐去]）鼻咽活检病理示：（鼻咽肿物）镜检为分化型非角化性癌。某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。副鼻窦炎、左侧乳突炎。综上述，患者诊断鼻咽分化型非角化性癌，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)。[姓名已隐去]医生信息已隐藏，患者现一般情况可。化疗前复查血常规及生化常规未见明显异常，于昨日开始行第3程诱导化疗，注意水化、护胃止呕、营养补液等对症支持治疗。\n- [全程D58] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日TPF方案化疗第5天，现一般情况可，未诉恶心、呕吐、腹痛、腹泻等不适，大小便正常。[姓名已隐去]主治医师，患者目前一般情况可，可继续化疗。注意化疗结束后复查血、生化常规，及时对症处理。\n- [全程D60] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日已完成第3程TPF方案（多西紫杉醇 60mg/m2 + DDP 60mg/m2 + 5-Fu 2.5g/m2）诱导化疗，未诉特殊不适。2/5复查血常规结果基本正常，今日复查血生化结果示：K+ 3.13↓ mmol/L，Na+ 130.8↓ mmol/L，IBIL 15.80 ↑ umolL，CRE 112.8↑ umol/L。[姓名已隐去]医生信息已隐藏示：患者现已完成化疗，今日可带口服补钾、护肝及护肾药物出院。嘱患者注意休息，加强营养，口服补钠，每周复查血常规、肝肾功能。按期返院开始同期放化疗，不适时随诊。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估诱导化疗疗效为疾病稳定，继续原方案第4程诱导化疗，并予以静脉补钾、补钠及护肾治疗后出院。\nB. 评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行根治性同期放化疗。\nC. 评估诱导化疗疗效为完全缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行单纯根治性放疗。\nD. 评估诱导化疗疗效为部分缓解，予以静脉补钾、补钠及护肾治疗，待电解质及肾功能恢复正常后立即开始第4程诱导化疗。\nE. 评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行单纯根治性放疗。\nF. 评估诱导化疗疗效为疾病进展，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院更改为GP方案化疗。\nG. 评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行根治性放疗联合靶向治疗。\nH. 评估诱导化疗疗效为部分缓解，因出现肾功能损害，予以护肾治疗后出院，并安排按期返院行单纯根治性放疗，取消同期化疗。\nI. 评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行姑息性放化疗。\nJ. 评估诱导化疗疗效为部分缓解，予以静脉补钾、补钠及护肾治疗，住院期间直接开始根治性同期放化疗。\nK. 评估诱导化疗疗效为疾病稳定，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行根治性同期放化疗。\nL. 评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行鼻咽及颈部淋巴结清扫术。\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-a1bcb1dd845b682149871b63","patient_id":"patient-eecadcdf172a1efe8947b052","turn_id":"turn08","turn_position":5,"turn_type":"response_assessment_decision","gold_letter":"C","gold_action":"完善EB病毒DNA定量及EBV抗体（VCA-IgA、EA-IgA）检测，继续定期随访观察。","options":[{"letter":"A","text":"完善鼻咽及颈部MRI检查，暂缓EB病毒DNA及抗体检测。","is_gold":false},{"letter":"B","text":"安排全身PET-CT检查，替代常规影像学及EB病毒相关指标随访。","is_gold":false},{"letter":"C","text":"完善EB病毒DNA定量及EBV抗体（VCA-IgA、EA-IgA）检测，继续定期随访观察。","is_gold":true},{"letter":"D","text":"完善胸部增强CT及全身骨扫描，暂缓EB病毒DNA定量检测。","is_gold":false},{"letter":"E","text":"延长随访间隔至每半年一次，仅复查腹部彩超及血常规。","is_gold":false},{"letter":"F","text":"安排鼻内镜检查并常规行鼻咽部组织活检，复查EB病毒DNA。","is_gold":false},{"letter":"G","text":"给予抗病毒药物治疗以降低EBV-VCA-IgA滴度，继续随访观察。","is_gold":false},{"letter":"H","text":"启动卡培他滨节拍维持治疗，并每半年复查EB病毒DNA定量。","is_gold":false},{"letter":"I","text":"完善鼻咽及颈部CT平扫，替代MRI及EB病毒DNA定量检测。","is_gold":false},{"letter":"J","text":"安排双侧颈部淋巴结彩超检查，暂缓EB病毒相关指标检测。","is_gold":false},{"letter":"K","text":"启动PD-1抑制剂免疫维持治疗，并定期复查EB病毒DNA定量。","is_gold":false},{"letter":"L","text":"完善头颅增强MRI检查，暂缓鼻咽部及颈部影像学评估。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N1，M0。\n综合TNM状态：T4N1M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D7] 入院记录: 主诉: 头痛伴耳鸣、听力下降3月余。；颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。今患者为进一步诊治，予收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,双咽后淋巴结肿大,头痛；既往史: 否认\"乙肝、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认饮酒史。否认不洁性生活史。；家族史: 患者叔叔因肺癌死亡。；体格检查: T：36.2℃，P：82次/分，R：20次/分，BP：128/74mmHg,Ht：172cm，Wt：80kg，BSA：1.92m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无叩痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约1cm*0.8cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）；KPS: 90；ECOG:\n- [全程D7] 入院记录: 主诉: 头痛伴耳鸣、听力下降3月余。；现病史: 患者于某次就诊时间1月无明显诱因下出现头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，患者于至[机构已隐去]就诊，行鼻咽活检病理，并送我院病理会诊示鼻咽分化型非角化性癌。某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。今患者为进一步诊治，予收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,双咽后淋巴结肿大,头痛；既往史: 否认\"乙肝、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认饮酒史。否认不洁性生活史。；家族史: 患者叔叔因肺癌死亡。；体格检查: T：36.2℃，P：82次/分，R：20次/分，BP：128/74mmHg,Ht：172cm，Wt：80kg，BSA：1.92m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率82次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无叩痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约1cm*0.8cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）；KPS: 90；ECOG:\n- [全程D53] 入院记录: 主诉: 鼻咽癌2程诱导化疗后20天。；现病史: 患者于某次就诊时间1月无明显诱因下出现头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，患者于至[机构已隐去]就诊，行鼻咽活检，并送我院病理会诊示鼻咽分化型非角化性癌。某次就诊时间在我院行鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶；颅底骨质破坏；双侧咽后淋巴结肿大，考虑转移；双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。明确诊断为鼻咽分化型非角化性癌，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)。于某次就诊时间、某次就诊时间行TPF化疗（DOC 60mg/m2+DDP 60mg/m2+5-FU 2.5g/m2civ48h）2程诱导化疗，化疗过程顺利。今患者为行第3程诱导化疗收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,双咽后淋巴结肿大,头痛；既往史: 否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认饮酒史。否认不洁性生活史。；家族史: 患者叔叔因肺癌死亡。；体格检查: T：36.5℃，P：88次/分，R：20次/分，BP：134/63mmHg,Ht：172cm，Wt：76kg，BSA：1.88m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率88次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无叩痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射……\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 早期复极改变\n- [全程D0] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.6；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:20（参考: 阴性）；活化部分凝血活酶时间(APTT)-静脉血: 23.1sec.；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；血红蛋白(Hb)-静脉血: 158g/L；血小板比容-静脉血: 26%；氯离子(Cl-)-静脉血: 105.3mmol/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 1.04；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；尿酸(UA)-静脉血: 341umol/L；甘油三酯(TG)-静脉血: 1.27mmol/L；总蛋白(TP)-静脉血: 73.53g/L；尿素氮(BUN)-静脉血: 6.35mmol/L；C-反应蛋白(CRP)-静脉血: 1.45mg/L；载脂蛋白B(apoB)-静脉血: 0.8g/L；总胆汁酸(TBA)-静脉血: 4.7umol/L；葡萄糖(Glu)-静脉血: 4.78mmol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；乳酸脱氢酶(LDH)-静脉血: 160.3U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；大血小板百分比(P-LCR%)-静脉血: 30.4%；中性粒细胞计数(Neut#)-静脉血: 6.410E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；丙氨酸氨基转移酶(ALT)-静脉血: 12.1U/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；ABO血型-静脉血: B；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.7fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；球蛋白(GLO)-静脉血: 28.23g/L；凝血酶时间(TT)-静脉血: 17.5sec.；红细胞计数(RBC#)-静脉血: 5.3710E12/L；平均红细胞体积(MCV)-静脉血: 87fL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.17mmolL；磷(P)-静脉血: 1.03mmol/L；总钙(Ca)-……\n- [全程D3] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理稍粗，未见明确实质性病变。双侧肺门不大，纵隔居中、无增宽。双膈形态正常。双侧肋膈角锐利。心影形态、大小、位置未见异常。；检查结论: 心肺未见明显异常。\n- [全程D3] 超声；双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约11cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约37×31×26mm，包膜光滑，实质回声不均匀，可见强回声斑。 腹主动脉旁未见明确肿物回声。；检查结论: 前列腺钙化。 肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、左侧壁见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强后明显强化，肿物占据鼻咽顶壁、左侧咽隐窝、左侧咽后间隙，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，右侧咽隐窝变浅，右侧咽旁脂肪间隙及颈动脉鞘区未见异常。 左侧腭帆张提肌及左侧头长肌受侵，右侧腭帆提肌、腭帆张肌、头长肌未见受侵征象。 双侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽双侧壁未见增厚。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部、翼突内外板、左侧枕骨基底部及左侧枕骨髁骨质信号减低，增强扫描后明显强化，斜坡局部见不规则软组织肿物影累及斜坡后份脑膜及蝶鞍后份，部分层面与垂体后叶分界欠清。双侧海绵窦形态正常，未见增宽。筛窦、蝶窦、左侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 左侧咽后间隙见肿大淋巴结，大小约为11mm ×9 mm，右侧咽后见肿大淋巴结，短径约6mm，均匀强化。 双颈I、II区见多个淋巴结，边界清，信号均匀，最大短径约8mm，均匀强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。 颅底骨质破坏。 双侧咽后淋巴结肿大，考虑转移。 双颈Ib、II区小淋巴结，性质待定。 副鼻窦炎、左侧乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D7] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；载脂蛋白AI(apoAI)-静脉血: 1.41g/L；总蛋白(TP)-静脉血: 72.8g/L；肌酐(Crea)-静脉血: 96.4umol/L；总胆红素(TBIL)-静脉血: 10.3umol/L；血小板比容-静脉血: 26%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；尿素氮(BUN)-静脉血: 5.6mmol/L；白细胞计数(WBC#)-尿液: 1/μL；钠离子(Na+)-静脉血: 140.2mmol/L；颜色-尿液: Light-Yellow；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.2mmolL；C-反应蛋白(CRP)-静脉血: 1.6mg/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；乳酸脱氢酶(LDH)-静脉血: 148.2U/L；总胆固醇(TC)-静脉血: 4.78mmol/L；总蛋白(TP)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 5/μL；平均血小板体积(MPV)-静脉血: 10.8fL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 345g/L；总钙(Ca)-静脉血: 2.34mmol/L；甘油三酯(TG)-静脉血: 1.84mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.34；胱抑素(Cys-C)-静脉血: 0.97mg/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.8U/L；红细胞计数(RBC#)-静脉血: 5.3810E12/L；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；单核细胞百分比(Mono%)-静脉血: 0.065；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.76；血液二氧化碳含量ctCO2(B)-静脉血: 24.3mmol/L；红细胞计数(RBC#)-尿液: 4/μL；间接胆红素(IBIL)-静脉血: 7umolL；浊度(TRUB)-尿液: clear；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.026；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；血小板计数(PLT#)-静脉血: 24610E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；颜色-粪便: 棕色；载脂蛋白……\n- [全程D11] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于第7胸椎椎体右侧水平，估计导管末端位于上腔静脉中-下段交界处。；检查结论: 导管末端位置如上述。\n- [全程D14] 检验组合: α-L-岩藻糖苷酶(AFU)-静脉血: 38.9U/L；载脂蛋白AI(apoAI)-静脉血: 1.64g/L；血红蛋白(Hb)-静脉血: 158g/L；有核红细胞百分比(NRBC%)-静脉血: 0；促黄体生成素(LH)-静脉血: 6.12mIU/ml；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.87mmol/L；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 弱阳性(±)（参考: 阴性）；天门冬氨酸氨基转移酶(AST)-静脉血: 17.6U/L；总胆汁酸(TBA)-静脉血: 1umol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.4pg；大血小板百分比(P-LCR%)-静脉血: 35.7%；胱抑素(Cys-C)-静脉血: 1.56mg/L；白蛋白(ALB)-静脉血: 45.2g/L；甘油三酯(TG)-静脉血: 1.3mmol/L；白细胞计数(WBC#)-静脉血: 9.310E9/L；红细胞计数(RBC#)-静脉血: 5.3710E12/L；单核细胞百分比(Mono%)-静脉血: 0.008；中性粒细胞计数(Neut#)-静脉血: 8.710E9/L；乳酸脱氢酶(LDH)-静脉血: 181.6U/L；总蛋白(TP)-静脉血: 70.8g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.9mmolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.02；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；催乳素(PRL)-静脉血: 308.5uIU/ml；中性粒细胞百分比(Neut%)-静脉血: 0.939；有核红细胞计数(NRBC#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 33.6；促卵泡刺激素(FSH)-静脉血: 9.93mIU/ml；钾离子(K+)-静脉血: 4.53mmol/L；镁离子(Mg2+)-静脉血: 0.89mmol/L；平均血小板体积(MPV)-静脉血: 11.3fL；碱性磷酸酶(ALP)-静脉血: 87.4U/L；总胆红素(TBIL)-静脉血: 22.5umol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=1.50)（参考: 阴性）；尿酸(UA)-静脉血: 385.9umol/L；EB……\n- [全程D38] 检验组合: α-L-岩藻糖苷酶(AFU)-静脉血: 31.3U/L；氯离子(Cl-)-静脉血: 90.1mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.85mmol/L；胱抑素(Cys-C)-静脉血: 1.22mg/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.8mmol/L；钾离子(K+)-静脉血: 3.66mmol/L；总胆汁酸(TBA)-静脉血: 2.2umol/L；甘油三酯(TG)-静脉血: 2.25mmol/L；肌酐(Crea)-静脉血: 108.2umol/L；总钙(Ca)-静脉血: 2.23mmol/L；C-反应蛋白(CRP)-静脉血: 0.28mg/L；钠离子(Na+)-静脉血: 129.2mmol/L；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阴性(-)（参考: 阴性）；球蛋白(GLO)-静脉血: 21.3g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.69mmolL；间接胆红素(IBIL)-静脉血: 16umolL；总胆固醇(TC)-静脉血: 6.95mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 27.8U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.73；白蛋白(ALB)-静脉血: 40.8g/L；总蛋白(TP)-静脉血: 62.1g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.92；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；尿素氮(BUN)-静脉血: 11.7mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=1.25)（参考: 阴性）；尿酸(UA)-静脉血: 368.1umol/L；总胆红素(TBIL)-静脉血: 20.1umol/L；乳酸脱氢酶(LDH)-静脉血: 167U/L；阴离子间隙(AG)-静脉血: 16.3；载脂蛋白B(apoB)-静脉血: 1.3g/L；EB病毒Zta蛋白抗体IgA(EBV-Zta-IgA)-静脉血: 阴性(-)（参考: 阴性）；葡萄糖(Glu)-静脉血: 4.91mmol/L；磷(P)-静脉血: 1.13mmol/L；直接胆……\n- [全程D53] 检验组合: 钠离子(Na+)-静脉血: 142.5mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 29.9U/L；乳酸脱氢酶(LDH)-静脉血: 207.9U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.6；血小板分布宽度(PDW)-静脉血: 10.8%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.035；间接胆红素(IBIL)-静脉血: 5.54umolL；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；天门冬氨酸氨基转移酶(AST)-静脉血: 18.5U/L；磷(P)-静脉血: 0.96mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.04；肌酐(Crea)-静脉血: 102umol/L；甘油三酯(TG)-静脉血: 1.26mmol/L；单核细胞百分比(Mono%)-静脉血: 0.09；大血小板百分比(P-LCR%)-静脉血: 22.6%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；C-反应蛋白(CRP)-静脉血: 0.69mg/L；血红蛋白(Hb)-静脉血: 134g/L；平均红细胞体积(MCV)-静脉血: 86.7fL；平均血小板体积(MPV)-静脉血: 9.7fL；单核细胞计数(Mono#)-静脉血: 0.610E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.009；有核红细胞计数(NRBC#)-静脉血: 010E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.13mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.22；葡萄糖(Glu)-静脉血: 4.43mmol/L；载脂蛋白B(apoB)-静脉血: 1.26g/L；载脂蛋白AI(apoAI)-静脉血: 1.74g/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 332g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.3mmol/L；氯离子(Cl-)-静脉血: 99.6mmol/L；尿酸(UA)-静脉血: 362.4umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.53mmolL；直接胆红素(DBIL)-静脉血: 1.88umol/L；红细胞比容(Hct)-静脉血: 40.4%；总胆固醇(TC)-静脉血: 6.07mmol/L；总钙(Ca)-静脉血:……\n- [全程D59] 检验组合: 平均红细胞体积(MCV)-静脉血: 82fL；大血小板百分比(P-LCR%)-静脉血: 36.3%；有核红细胞百分比(NRBC%)-静脉血: 0；血小板分布宽度(PDW)-静脉血: 15.9%；血小板比容-静脉血: 15%；白细胞计数(WBC#)-静脉血: 4.2710E9/L；血小板计数(PLT#)-静脉血: 13510E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.351；红细胞比容(Hct)-静脉血: 37.9%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.002；有核红细胞计数(NRBC#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 133g/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.631；单核细胞计数(Mono#)-静脉血: 0.110E9/L；红细胞计数(RBC#)-静脉血: 4.6210E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；平均红细胞血红蛋白浓度(MCHC)-静脉血: 351g/L；平均血小板体积(MPV)-静脉血: 11.4fL；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.7；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；单核细胞百分比(Mono%)-静脉血: 0.014；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L\n- [全程D60] 检验组合: 阴离子间隙(AG)-静脉血: 17.3；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=1.25)（参考: 阴性）；胱抑素(Cys-C)-静脉血: 1.21mg/L；氯离子(Cl-)-静脉血: 90.7mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 35.4U/L；载脂蛋白AI(apoAI)-静脉血: 1.83g/L；钠离子(Na+)-静脉血: 130.8mmol/L；总胆红素(TBIL)-静脉血: 20.2umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.8mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；球蛋白(GLO)-静脉血: 22.01g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.03；丙氨酸氨基转移酶(ALT)-静脉血: 24.3U/L；白蛋白(ALB)-静脉血: 44.6g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.5U/L；载脂蛋白B(apoB)-静脉血: 1.33g/L；碱性磷酸酶(ALP)-静脉血: 78.3U/L；葡萄糖(Glu)-静脉血: 5.06mmol/L；磷(P)-静脉血: 1mmol/L；总钙(Ca)-静脉血: 2.29mmol/L；尿酸(UA)-静脉血: 326.1umol/L；总胆汁酸(TBA)-静脉血: 2.7umol/L；总胆固醇(TC)-静脉血: 7.06mmol/L；C-反应蛋白(CRP)-静脉血: 0.2mg/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.72；直接胆红素(DBIL)-静脉血: 4.4umol/L；镁离子(Mg2+)-静脉血: 0.72mmol/L；EB病毒Zta蛋白抗体IgA(EBV-Zta-IgA)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.71mmolL；总蛋白(TP)-静脉血: 66.61g/L；甘油三酯(TG)-静脉血: 2.92mmol/L；肌酐(Crea)-静脉血: 112.8umol/L；尿素氮(BUN)-静脉血: 10.2mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.……\n- [全程D61] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后复查，较某次就诊时间片对比： 鼻咽腔未见明显狭窄，鼻咽左侧壁粘膜稍增厚，T1WI呈等信号，T2WI呈稍高信号，增强后明显强化，左侧咽隐窝变浅，右侧咽隐窝清晰，双侧咽旁脂肪间隙及颈动脉鞘区未见异常。鼻咽肿物较前明显缩小好转。 左侧腭帆张提肌及左侧头长肌稍肿胀，右侧腭帆提肌、腭帆张肌、头长肌未见受侵征象。 双侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽双侧壁未见增厚，双侧后鼻孔未见肿物。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部、翼突内外板、左侧枕骨基底部及左侧枕骨髁骨质信号减低，增强扫描后明显强化。双侧海绵窦形态正常，未见增宽。左侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧咽后见小淋巴结，最大短径约5 mm。 双颈I、II区见多个淋巴结，边界清，信号均匀，最大短径约7mm，均匀强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗后复查，较某次就诊时间片对比： 鼻咽肿物较前明显缩小好转，累及范围较前缩小。 颅底骨质破坏同前。 双侧咽后淋巴结较前缩小。 双颈I、II区小淋巴结，较前稍缩小。 左侧乳突炎。\n- [全程D99] 检验组合: 单核细胞计数(Mono#)-静脉血: 1.710E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；血小板分布宽度(PDW)-静脉血: 11.4%；大血小板百分比(P-LCR%)-静脉血: 29.1%；单核细胞百分比(Mono%)-静脉血: 0.093；平均红细胞体积(MCV)-静脉血: 88.1fL；红细胞比容(Hct)-静脉血: 29%；有核红细胞百分比(NRBC%)-静脉血: 0.1；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.9；嗜酸性粒细胞计数(Eos#)-静脉血: 0.410E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.022；白细胞计数(WBC#)-静脉血: 18.7210E9/L；红细胞计数(RBC#)-静脉血: 3.2910E12/L；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；血小板比容-静脉血: 12%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 48；血小板计数(PLT#)-静脉血: 11710E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 345g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.034；平均红细胞血红蛋白含量(MCH)-静脉血: 30.4pg；中性粒细胞计数(Neut#)-静脉血: 15.910E9/L；血红蛋白(Hb)-静脉血: 100g/L；中性粒细胞百分比(Neut%)-静脉血: 0.848；平均血小板体积(MPV)-静脉血: 10.7fL；有核红细胞计数(NRBC#)-静脉血: 0.0210E9/L\n- [全程D104] 检验组合: 钠离子(Na+)-静脉血: 136.2mmol/L；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；血小板分布宽度(PDW)-静脉血: 11.8%；葡萄糖(Glu)-静脉血: 6mmol/L；碱性磷酸酶(ALP)-静脉血: 59.8U/L；尿酸(UA)-静脉血: 486.4umol/L；尿素氮(BUN)-静脉血: 15mmol/L；直接胆红素(DBIL)-静脉血: 2.5umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；间接胆红素(IBIL)-静脉血: 7.3umolL；镁离子(Mg2+)-静脉血: 0.75mmol/L；血小板计数(PLT#)-静脉血: 15910E9/L；单核细胞百分比(Mono%)-静脉血: 0.081；平均血小板体积(MPV)-静脉血: 10.5fL；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.08mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.6；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；总胆固醇(TC)-静脉血: 6.02mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.899；血红蛋白(Hb)-静脉血: 107g/L；红细胞计数(RBC#)-静脉血: 3.5110E12/L；球蛋白(GLO)-静脉血: 20.38g/L；甘油三酯(TG)-静脉血: 1.26mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；大血小板百分比(P-LCR%)-静脉血: 29.3%；总钙(Ca)-静脉血: 2.37mmol/L；总胆汁酸(TBA)-静脉血: 0.8umol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.1；胱抑素(Cys-C)-静脉血: 1.67mg/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 358g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.01；α-L-岩藻糖苷酶(AFU)-静脉血: 31.2U/L；钾离子(K+)-静脉血: 3.53mmol/L；总蛋白(TP)-静脉血: 61.28g/L；天门冬氨酸氨基转移酶(AST)-静……\n- [全程D108] 检验组合: 总胆红素(TBIL)-静脉血: 13.8umol/L；总蛋白(TP)-静脉血: 57.11g/L；单核细胞百分比(Mono%)-静脉血: 0.048；球蛋白(GLO)-静脉血: 18.41g/L；尿素氮(BUN)-静脉血: 9.7mmol/L；间接胆红素(IBIL)-静脉血: 10.2umolL；碱性磷酸酶(ALP)-静脉血: 52.2U/L；胱抑素(Cys-C)-静脉血: 1.26mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.2mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1；肌酐(Crea)-静脉血: 85umol/L；尿酸(UA)-静脉血: 283umol/L；乳酸脱氢酶(LDH)-静脉血: 131.8U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 9.3U/L；红细胞计数(RBC#)-静脉血: 3.4610E12/L；C-反应蛋白(CRP)-静脉血: 1.53mg/L；阴离子间隙(AG)-静脉血: 15.1；平均血小板体积(MPV)-静脉血: 9.8fL；淋巴细胞百分比(Lymph%)-静脉血: 0.039；γ-谷氨酰基转移酶(GGT)-静脉血: 27.7U/L；镁离子(Mg2+)-静脉血: 0.65mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 367g/L；大血小板百分比(P-LCR%)-静脉血: 24.8%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 42.5；载脂蛋白AI(apoAI)-静脉血: 1.09g/L；白蛋白(ALB)-静脉血: 38.7g/L；总胆汁酸(TBA)-静脉血: 1.5umol/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；白细胞计数(WBC#)-静脉血: 8.2710E9/L；总胆固醇(TC)-静脉血: 6.03mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.21；氯离子(Cl-)-静脉血: 90.9mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 7.7U/L；血小板分布宽度(PDW)-静脉血: 11.2%；血液二氧化碳含量ctCO2(B)-静脉血: 21.1mmol/L；红细胞比容(Hct)-静脉血: 28.3%；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；中性粒细胞百……\n- [全程D116] 检验组合: 大血小板百分比(P-LCR%)-静脉血: 28.7%；载脂蛋白B(apoB)-静脉血: 1.55g/L；钠离子(Na+)-静脉血: 133.3mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 32.4U/L；胱抑素(Cys-C)-静脉血: 0.84mg/L；直接胆红素(DBIL)-静脉血: 3.2umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 348g/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；血小板比容-静脉血: 13%；平均红细胞体积(MCV)-静脉血: 86.3fL；尿素氮(BUN)-静脉血: 6.6mmol/L；磷(P)-静脉血: 1.15mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.4mmolL；有核红细胞百分比(NRBC%)-静脉血: 0；有核红细胞计数(NRBC#)-静脉血: 010E9/L；载脂蛋白AI(apoAI)-静脉血: 1.2g/L；总胆固醇(TC)-静脉血: 7.16mmol/L；甘油三酯(TG)-静脉血: 1.74mmol/L；总钙(Ca)-静脉血: 2.28mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 76.6umol/L；钾离子(K+)-静脉血: 3.01mmol/L；间接胆红素(IBIL)-静脉血: 10.4umolL；尿酸(UA)-静脉血: 216umol/L；镁离子(Mg2+)-静脉血: 0.56mmol/L；单核细胞百分比(Mono%)-静脉血: 0.065；红细胞计数(RBC#)-静脉血: 3.3610E12/L；天门冬氨酸氨基转移酶(AST)-静脉血: 9.4U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.053；血小板计数(PLT#)-静脉血: 12210E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.6；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；乳酸脱氢酶(LDH)-静脉血: 130.3U/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；中性粒细胞计数(Neut#)-静脉血: 4.410E9/L；C-反应蛋白(CRP)-静脉血: 6.72mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 5.32mmol/L；丙氨酸氨基转移酶(ALT)……\n- [全程D152] 检验组合: EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）\n- [全程D222] 超声；腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约21cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D222] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:80（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D7] 首次病程记录；首次病程记录: 病程类型: 首次病程记录；病程主题: 首次病程记录；病程内容: 病历特点：1、患者中年男性。2、患者于某次就诊时间1月无明显诱因下出现头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，患者于至[机构已隐去]就诊，行鼻咽活检病理，并送我院病理会诊示鼻咽分化型非角化性癌。某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。现患者为进一步诊治，予收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。3、体查：张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约1cm*0.8cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）示图：4、辅助检查：（1） 某次就诊时间在我医院（病理号：[记录编号已隐去]）鼻咽活检病理示：（鼻咽肿物）镜检为分化型非角化性癌（2） 某次就诊时间在我院胸片检查：心肺未见异常。（3） 某次就诊时间在我院腹部B超检查：肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。（4） 某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。副鼻窦炎、左侧乳突炎。（6）某次就诊时间我院：VCA-IgA 1:160 EA-IgA 1:20EBV-DNA定性检测：2.14E102copy/ml。 诊断依据： 初步诊断： 鉴别诊断：患者诊断明确，无需鉴别诊断。 诊疗计划：1、完善相关检查如全身骨扫描、血常规、生化等。2、诱导化疗及同期化放疗。\n- [全程D8] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者诉间有头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，无面麻、声嘶。[姓名已隐去]医生信息已隐藏示：嘱患者今日完善全身骨扫描检查，排除骨转移征象，治疗上暂给予对症处理，继续观察病情。\n- [全程D9] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日患者症状体征基本同前，无诉其余特殊不适。[姓名已隐去]医生信息已隐藏后指示：某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，最大短径约8mm，均匀强化。骨ECT示鼻咽部、颅底骨代谢较活跃，考虑NPC所致。胸片、腹部B超排除远处转移。故目前临床诊断明确为“鼻咽分化型非角化性癌[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)，治疗方案定为TPF（多西紫杉醇 60mg/m2 + 顺铂 60mg/m2 + 5-FU 2.5g/m2， q21d）诱导化疗3程后再行同期放化疗，放疗采用IMRT技术，同期化疗采用顺铂 60mg/m2（q21d）2程。并指示化疗期间给予护肝、护胃、止吐及营养支持治疗。已向患者及家属交代病情及治疗相关不良反应后，其表示理解，并同意上述治疗方案。拟明日开始行多西紫杉醇化疗，密切观察患者病情变化。\n- [全程D12] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 患者今日TPF方案化疗第3天，现一般情况可，未诉恶心、呕吐、腹痛、腹泻等不适，大小便正常。[姓名已隐去]医生信息已隐藏出，患者目前一般情况可，可继续化疗。注意化疗结束后复查血、生化常规，及时对症处理。\n- [全程D53] 首次病程记录；首次病程记录: 病程类型: 首次病程记录；病程主题: 首次病程记录；病程内容: 病历特点：1、患者中年男性。2、患者于某次就诊时间1月无明显诱因下出现头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，患者于至[机构已隐去]就诊，行鼻咽活检，并送我院病理会诊示鼻咽分化型非角化性癌。某次就诊时间在我院行鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶；颅底骨质破坏；双侧咽后淋巴结肿大，考虑转移；双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。明确诊断为鼻咽分化型非角化性癌，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)。于某次就诊时间、某次就诊时间行TPF化疗（DOC 60mg/m2+DDP 60mg/m2+5-FU 2.5g/m2civ48h）2程诱导化疗，化疗过程顺利。今患者为行第3程诱导化疗收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。3、体查：张口门齿距5cm；鼻咽肿物较前明显消退；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约0.8cm*0.5cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）。4、辅助检查：（1） 某次就诊时间在我医院（病理号：[记录编号已隐去]）鼻咽活检病理示：（鼻咽肿物）镜检为分化型非角化性癌（2） 某次就诊时间在我院胸片检查：心肺未见异常。（3） 某次就诊时间在我院腹部B超检查：肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。（4） 某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。副鼻窦炎、左侧乳突炎。（6） 某次就诊时间我院：VCA-IgA 1:160 EA-IgA 1:20 EBV-DNA定性检测：2.14E102copy/ml 诊断依据： 初步诊断： 鉴别诊断：诊断明确，暂无需鉴别。 诊疗计划：1、完善相关检查如三大常规、电子鼻咽镜等。2、综合治疗。\n- [全程D54] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日随[姓名已隐去]医生信息已隐藏，详细询问病史并查体后，分析病情如下：1、患者中年男性，因“鼻咽癌2程诱导化疗后20天”入院。2、查体：张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约0.8cm*0.5cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）。3、辅助检查：某次就诊时间在我医院（病理号：[记录编号已隐去]）鼻咽活检病理示：（鼻咽肿物）镜检为分化型非角化性癌。某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。副鼻窦炎、左侧乳突炎。综上述，患者诊断鼻咽分化型非角化性癌，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)。[姓名已隐去]医生信息已隐藏，患者现一般情况可。昨日复查血常规及生化常规未见明显异常，拟今日开始行第3程诱导化疗，注意防治化疗相关毒副反应。\n- [全程D55] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日随[姓名已隐去]医生信息已隐藏，详细询问病史并查体后，分析病情如下：1、患者中年男性，因“鼻咽癌2程诱导化疗后20天”入院。2、查体：张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约0.8cm*0.5cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）。3、辅助检查：某次就诊时间在我医院（病理号：[记录编号已隐去]）鼻咽活检病理示：（鼻咽肿物）镜检为分化型非角化性癌。某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。副鼻窦炎、左侧乳突炎。综上述，患者诊断鼻咽分化型非角化性癌，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)。[姓名已隐去]医生信息已隐藏，患者现一般情况可。化疗前复查血常规及生化常规未见明显异常，于昨日开始行第3程诱导化疗，注意水化、护胃止呕、营养补液等对症支持治疗。\n- [全程D58] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日TPF方案化疗第5天，现一般情况可，未诉恶心、呕吐、腹痛、腹泻等不适，大小便正常。[姓名已隐去]主治医师，患者目前一般情况可，可继续化疗。注意化疗结束后复查血、生化常规，及时对症处理。\n- [全程D60] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日已完成第3程TPF方案（多西紫杉醇 60mg/m2 + DDP 60mg/m2 + 5-Fu 2.5g/m2）诱导化疗，未诉特殊不适。2/5复查血常规结果基本正常，今日复查血生化结果示：K+ 3.13↓ mmol/L，Na+ 130.8↓ mmol/L，IBIL 15.80 ↑ umolL，CRE 112.8↑ umol/L。[姓名已隐去]医生信息已隐藏示：患者现已完成化疗，今日可带口服补钾、护肝及护肾药物出院。嘱患者注意休息，加强营养，口服补钠，每周复查血常规、肝肾功能。按期返院开始同期放化疗，不适时随诊。\n- [全程D104] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者放疗22次，诉中度咽痛，有干咳，感恶心，无呕吐，无畏寒、发热。查体大致同前。今日查血常规生化未见异常。[姓名已隐去]医生信息已隐藏，患者放化疗顺利，现继续予以加强护胃、护肝等营养支持对症治疗，定期复查血生化常规，严密观察病情变化。\n- [全程D108] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者诉乏力，无恶心、呕吐，仍有便秘。查体大致同前。今日查血生化提示：血钾3.06mmol/L，血钠127.1mmol/L。血常规提示血红蛋白稍低。[姓名已隐去]医生信息已隐藏后指示：患者放疗过程中，现血钾、血钠低，可予以加强补钾、补钠治疗，现继续放疗，加强支持对症治疗，严密观察病情变化。\n- [全程D111] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者放疗27次，诉有咳嗽、咳痰，大便未解。查体大致同前。[姓名已隐去]医生信息已隐藏，患者放疗进行中，现有咳嗽，予以加强祛痰处理，大便未解加强通便治疗。继续加强支持对症治疗，严密观察病情变化。\n- [全程D116] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者放疗30次，患者诉感乏力，咳嗽、咳痰症状较前改善，无畏寒、发热。查体大致同前。今日查血常规大致正常。生化提示血钠低、血钾低、血镁低。[姓名已隐去]医生信息已隐藏，患者生化提示血钾、血钠、血镁低，加强支持对症治疗，严密观察病情变化。\n- [全程D118] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日完成放疗。今日[姓名已隐去]医生信息已隐藏者诉轻度咽痛，胃纳一般，无恶心、呕吐，无发热、咳嗽、咳痰等，精神、睡眠一般，大小便正常。体查：张口门齿距4.5cm；鼻咽顶壁见肿物，较前明显消退；浅表淋巴结未及肿大，颅神经检查：（-）。口腔黏膜反应Ⅱ度，皮肤反应Ⅰ度。[姓名已隐去]医生信息已隐藏示：患者已结束放疗及同期化疗，过程顺利，现病情平稳，可予以出院，嘱患者注意休息，加强营养，出院后一个月内每周复查血常规、肝肾功能，出院后一个月返院复查，不适时随诊。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善鼻咽及颈部MRI检查，暂缓EB病毒DNA及抗体检测。\nB. 安排全身PET-CT检查，替代常规影像学及EB病毒相关指标随访。\nC. 完善EB病毒DNA定量及EBV抗体（VCA-IgA、EA-IgA）检测，继续定期随访观察。\nD. 完善胸部增强CT及全身骨扫描，暂缓EB病毒DNA定量检测。\nE. 延长随访间隔至每半年一次，仅复查腹部彩超及血常规。\nF. 安排鼻内镜检查并常规行鼻咽部组织活检，复查EB病毒DNA。\nG. 给予抗病毒药物治疗以降低EBV-VCA-IgA滴度，继续随访观察。\nH. 启动卡培他滨节拍维持治疗，并每半年复查EB病毒DNA定量。\nI. 完善鼻咽及颈部CT平扫，替代MRI及EB病毒DNA定量检测。\nJ. 安排双侧颈部淋巴结彩超检查，暂缓EB病毒相关指标检测。\nK. 启动PD-1抑制剂免疫维持治疗，并定期复查EB病毒DNA定量。\nL. 完善头颅增强MRI检查，暂缓鼻咽部及颈部影像学评估。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D99] 检验组合: 单核细胞计数(Mono#)-静脉血: 1.710E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；血小板分布宽度(PDW)-静脉血: 11.4%；大血小板百分比(P-LCR%)-静脉血: 29.1%；单核细胞百分比(Mono%)-静脉血: 0.093；平均红细胞体积(MCV)-静脉血: 88.1fL；红细胞比容(Hct)-静脉血: 29%；有核红细胞百分比(NRBC%)-静脉血: 0.1；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.9；嗜酸性粒细胞计数(Eos#)-静脉血: 0.410E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.022；白细胞计数(WBC#)-静脉血: 18.7210E9/L；红细胞计数(RBC#)-静脉血: 3.2910E12/L；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；血小板比容-静脉血: 12%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 48；血小板计数(PLT#)-静脉血: 11710E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 345g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.034；平均红细胞血红蛋白含量(MCH)-静脉血: 30.4pg；中性粒细胞计数(Neut#)-静脉血: 15.910E9/L；血红蛋白(Hb)-静脉血: 100g/L；中性粒细胞百分比(Neut%)-静脉血: 0.848；平均血小板体积(MPV)-静脉血: 10.7fL；有核红细胞计数(NRBC#)-静脉血: 0.0210E9/L\n- [全程D104] 检验组合: 钠离子(Na+)-静脉血: 136.2mmol/L；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；血小板分布宽度(PDW)-静脉血: 11.8%；葡萄糖(Glu)-静脉血: 6mmol/L；碱性磷酸酶(ALP)-静脉血: 59.8U/L；尿酸(UA)-静脉血: 486.4umol/L；尿素氮(BUN)-静脉血: 15mmol/L；直接胆红素(DBIL)-静脉血: 2.5umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；间接胆红素(IBIL)-静脉血: 7.3umolL；镁离子(Mg2+)-静脉血: 0.75mmol/L；血小板计数(PLT#)-静脉血: 15910E9/L；单核细胞百分比(Mono%)-静脉血: 0.081；平均血小板体积(MPV)-静脉血: 10.5fL；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.08mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.6；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；总胆固醇(TC)-静脉血: 6.02mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.899；血红蛋白(Hb)-静脉血: 107g/L；红细胞计数(RBC#)-静脉血: 3.5110E12/L；球蛋白(GLO)-静脉血: 20.38g/L；甘油三酯(TG)-静脉血: 1.26mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；大血小板百分比(P-LCR%)-静脉血: 29.3%；总钙(Ca)-静脉血: 2.37mmol/L；总胆汁酸(TBA)-静脉血: 0.8umol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.1；胱抑素(Cys-C)-静脉血: 1.67mg/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 358g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.01；α-L-岩藻糖苷酶(AFU)-静脉血: 31.2U/L；钾离子(K+)-静脉血: 3.53mmol/L；总蛋白(TP)-静脉血: 61.28g/L；天门冬氨酸氨基转移酶(AST)-静……\n- [全程D108] 检验组合: 总胆红素(TBIL)-静脉血: 13.8umol/L；总蛋白(TP)-静脉血: 57.11g/L；单核细胞百分比(Mono%)-静脉血: 0.048；球蛋白(GLO)-静脉血: 18.41g/L；尿素氮(BUN)-静脉血: 9.7mmol/L；间接胆红素(IBIL)-静脉血: 10.2umolL；碱性磷酸酶(ALP)-静脉血: 52.2U/L；胱抑素(Cys-C)-静脉血: 1.26mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.2mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1；肌酐(Crea)-静脉血: 85umol/L；尿酸(UA)-静脉血: 283umol/L；乳酸脱氢酶(LDH)-静脉血: 131.8U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 9.3U/L；红细胞计数(RBC#)-静脉血: 3.4610E12/L；C-反应蛋白(CRP)-静脉血: 1.53mg/L；阴离子间隙(AG)-静脉血: 15.1；平均血小板体积(MPV)-静脉血: 9.8fL；淋巴细胞百分比(Lymph%)-静脉血: 0.039；γ-谷氨酰基转移酶(GGT)-静脉血: 27.7U/L；镁离子(Mg2+)-静脉血: 0.65mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 367g/L；大血小板百分比(P-LCR%)-静脉血: 24.8%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 42.5；载脂蛋白AI(apoAI)-静脉血: 1.09g/L；白蛋白(ALB)-静脉血: 38.7g/L；总胆汁酸(TBA)-静脉血: 1.5umol/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；白细胞计数(WBC#)-静脉血: 8.2710E9/L；总胆固醇(TC)-静脉血: 6.03mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.21；氯离子(Cl-)-静脉血: 90.9mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 7.7U/L；血小板分布宽度(PDW)-静脉血: 11.2%；血液二氧化碳含量ctCO2(B)-静脉血: 21.1mmol/L；红细胞比容(Hct)-静脉血: 28.3%；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；中性粒细胞百……\n- [全程D116] 检验组合: 大血小板百分比(P-LCR%)-静脉血: 28.7%；载脂蛋白B(apoB)-静脉血: 1.55g/L；钠离子(Na+)-静脉血: 133.3mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 32.4U/L；胱抑素(Cys-C)-静脉血: 0.84mg/L；直接胆红素(DBIL)-静脉血: 3.2umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 348g/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；血小板比容-静脉血: 13%；平均红细胞体积(MCV)-静脉血: 86.3fL；尿素氮(BUN)-静脉血: 6.6mmol/L；磷(P)-静脉血: 1.15mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.4mmolL；有核红细胞百分比(NRBC%)-静脉血: 0；有核红细胞计数(NRBC#)-静脉血: 010E9/L；载脂蛋白AI(apoAI)-静脉血: 1.2g/L；总胆固醇(TC)-静脉血: 7.16mmol/L；甘油三酯(TG)-静脉血: 1.74mmol/L；总钙(Ca)-静脉血: 2.28mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 76.6umol/L；钾离子(K+)-静脉血: 3.01mmol/L；间接胆红素(IBIL)-静脉血: 10.4umolL；尿酸(UA)-静脉血: 216umol/L；镁离子(Mg2+)-静脉血: 0.56mmol/L；单核细胞百分比(Mono%)-静脉血: 0.065；红细胞计数(RBC#)-静脉血: 3.3610E12/L；天门冬氨酸氨基转移酶(AST)-静脉血: 9.4U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.053；血小板计数(PLT#)-静脉血: 12210E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.6；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；乳酸脱氢酶(LDH)-静脉血: 130.3U/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；中性粒细胞计数(Neut#)-静脉血: 4.410E9/L；C-反应蛋白(CRP)-静脉血: 6.72mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 5.32mmol/L；丙氨酸氨基转移酶(ALT)……\n- [全程D152] 检验组合: EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）\n- [全程D222] 超声；腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约21cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D222] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:80（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）\n\n【既往治疗与反应】\n- [全程D104] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者放疗22次，诉中度咽痛，有干咳，感恶心，无呕吐，无畏寒、发热。查体大致同前。今日查血常规生化未见异常。[姓名已隐去]医生信息已隐藏，患者放化疗顺利，现继续予以加强护胃、护肝等营养支持对症治疗，定期复查血生化常规，严密观察病情变化。\n- [全程D108] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者诉乏力，无恶心、呕吐，仍有便秘。查体大致同前。今日查血生化提示：血钾3.06mmol/L，血钠127.1mmol/L。血常规提示血红蛋白稍低。[姓名已隐去]医生信息已隐藏后指示：患者放疗过程中，现血钾、血钠低，可予以加强补钾、补钠治疗，现继续放疗，加强支持对症治疗，严密观察病情变化。\n- [全程D111] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者放疗27次，诉有咳嗽、咳痰，大便未解。查体大致同前。[姓名已隐去]医生信息已隐藏，患者放疗进行中，现有咳嗽，予以加强祛痰处理，大便未解加强通便治疗。继续加强支持对症治疗，严密观察病情变化。\n- [全程D116] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者放疗30次，患者诉感乏力，咳嗽、咳痰症状较前改善，无畏寒、发热。查体大致同前。今日查血常规大致正常。生化提示血钠低、血钾低、血镁低。[姓名已隐去]医生信息已隐藏，患者生化提示血钾、血钠、血镁低，加强支持对症治疗，严密观察病情变化。\n- [全程D118] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日完成放疗。今日[姓名已隐去]医生信息已隐藏者诉轻度咽痛，胃纳一般，无恶心、呕吐，无发热、咳嗽、咳痰等，精神、睡眠一般，大小便正常。体查：张口门齿距4.5cm；鼻咽顶壁见肿物，较前明显消退；浅表淋巴结未及肿大，颅神经检查：（-）。口腔黏膜反应Ⅱ度，皮肤反应Ⅰ度。[姓名已隐去]医生信息已隐藏示：患者已结束放疗及同期化疗，过程顺利，现病情平稳，可予以出院，嘱患者注意休息，加强营养，出院后一个月内每周复查血常规、肝肾功能，出院后一个月返院复查，不适时随诊。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善鼻咽及颈部MRI检查，暂缓EB病毒DNA及抗体检测。\nB. 安排全身PET-CT检查，替代常规影像学及EB病毒相关指标随访。\nC. 完善EB病毒DNA定量及EBV抗体（VCA-IgA、EA-IgA）检测，继续定期随访观察。\nD. 完善胸部增强CT及全身骨扫描，暂缓EB病毒DNA定量检测。\nE. 延长随访间隔至每半年一次，仅复查腹部彩超及血常规。\nF. 安排鼻内镜检查并常规行鼻咽部组织活检，复查EB病毒DNA。\nG. 给予抗病毒药物治疗以降低EBV-VCA-IgA滴度，继续随访观察。\nH. 启动卡培他滨节拍维持治疗，并每半年复查EB病毒DNA定量。\nI. 完善鼻咽及颈部CT平扫，替代MRI及EB病毒DNA定量检测。\nJ. 安排双侧颈部淋巴结彩超检查，暂缓EB病毒相关指标检测。\nK. 启动PD-1抑制剂免疫维持治疗，并定期复查EB病毒DNA定量。\nL. 完善头颅增强MRI检查，暂缓鼻咽部及颈部影像学评估。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N1，M0。\n综合TNM状态：T4N1M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D99] 检验组合: 单核细胞计数(Mono#)-静脉血: 1.710E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；血小板分布宽度(PDW)-静脉血: 11.4%；大血小板百分比(P-LCR%)-静脉血: 29.1%；单核细胞百分比(Mono%)-静脉血: 0.093；平均红细胞体积(MCV)-静脉血: 88.1fL；红细胞比容(Hct)-静脉血: 29%；有核红细胞百分比(NRBC%)-静脉血: 0.1；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.9；嗜酸性粒细胞计数(Eos#)-静脉血: 0.410E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.022；白细胞计数(WBC#)-静脉血: 18.7210E9/L；红细胞计数(RBC#)-静脉血: 3.2910E12/L；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；血小板比容-静脉血: 12%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 48；血小板计数(PLT#)-静脉血: 11710E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 345g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.034；平均红细胞血红蛋白含量(MCH)-静脉血: 30.4pg；中性粒细胞计数(Neut#)-静脉血: 15.910E9/L；血红蛋白(Hb)-静脉血: 100g/L；中性粒细胞百分比(Neut%)-静脉血: 0.848；平均血小板体积(MPV)-静脉血: 10.7fL；有核红细胞计数(NRBC#)-静脉血: 0.0210E9/L\n- [全程D104] 检验组合: 钠离子(Na+)-静脉血: 136.2mmol/L；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；血小板分布宽度(PDW)-静脉血: 11.8%；葡萄糖(Glu)-静脉血: 6mmol/L；碱性磷酸酶(ALP)-静脉血: 59.8U/L；尿酸(UA)-静脉血: 486.4umol/L；尿素氮(BUN)-静脉血: 15mmol/L；直接胆红素(DBIL)-静脉血: 2.5umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；间接胆红素(IBIL)-静脉血: 7.3umolL；镁离子(Mg2+)-静脉血: 0.75mmol/L；血小板计数(PLT#)-静脉血: 15910E9/L；单核细胞百分比(Mono%)-静脉血: 0.081；平均血小板体积(MPV)-静脉血: 10.5fL；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.08mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.6；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；总胆固醇(TC)-静脉血: 6.02mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.899；血红蛋白(Hb)-静脉血: 107g/L；红细胞计数(RBC#)-静脉血: 3.5110E12/L；球蛋白(GLO)-静脉血: 20.38g/L；甘油三酯(TG)-静脉血: 1.26mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；大血小板百分比(P-LCR%)-静脉血: 29.3%；总钙(Ca)-静脉血: 2.37mmol/L；总胆汁酸(TBA)-静脉血: 0.8umol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.1；胱抑素(Cys-C)-静脉血: 1.67mg/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 358g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.01；α-L-岩藻糖苷酶(AFU)-静脉血: 31.2U/L；钾离子(K+)-静脉血: 3.53mmol/L；总蛋白(TP)-静脉血: 61.28g/L；天门冬氨酸氨基转移酶(AST)-静……\n- [全程D108] 检验组合: 总胆红素(TBIL)-静脉血: 13.8umol/L；总蛋白(TP)-静脉血: 57.11g/L；单核细胞百分比(Mono%)-静脉血: 0.048；球蛋白(GLO)-静脉血: 18.41g/L；尿素氮(BUN)-静脉血: 9.7mmol/L；间接胆红素(IBIL)-静脉血: 10.2umolL；碱性磷酸酶(ALP)-静脉血: 52.2U/L；胱抑素(Cys-C)-静脉血: 1.26mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.2mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1；肌酐(Crea)-静脉血: 85umol/L；尿酸(UA)-静脉血: 283umol/L；乳酸脱氢酶(LDH)-静脉血: 131.8U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 9.3U/L；红细胞计数(RBC#)-静脉血: 3.4610E12/L；C-反应蛋白(CRP)-静脉血: 1.53mg/L；阴离子间隙(AG)-静脉血: 15.1；平均血小板体积(MPV)-静脉血: 9.8fL；淋巴细胞百分比(Lymph%)-静脉血: 0.039；γ-谷氨酰基转移酶(GGT)-静脉血: 27.7U/L；镁离子(Mg2+)-静脉血: 0.65mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 367g/L；大血小板百分比(P-LCR%)-静脉血: 24.8%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 42.5；载脂蛋白AI(apoAI)-静脉血: 1.09g/L；白蛋白(ALB)-静脉血: 38.7g/L；总胆汁酸(TBA)-静脉血: 1.5umol/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；白细胞计数(WBC#)-静脉血: 8.2710E9/L；总胆固醇(TC)-静脉血: 6.03mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.21；氯离子(Cl-)-静脉血: 90.9mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 7.7U/L；血小板分布宽度(PDW)-静脉血: 11.2%；血液二氧化碳含量ctCO2(B)-静脉血: 21.1mmol/L；红细胞比容(Hct)-静脉血: 28.3%；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；中性粒细胞百……\n- [全程D116] 检验组合: 大血小板百分比(P-LCR%)-静脉血: 28.7%；载脂蛋白B(apoB)-静脉血: 1.55g/L；钠离子(Na+)-静脉血: 133.3mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 32.4U/L；胱抑素(Cys-C)-静脉血: 0.84mg/L；直接胆红素(DBIL)-静脉血: 3.2umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 348g/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；血小板比容-静脉血: 13%；平均红细胞体积(MCV)-静脉血: 86.3fL；尿素氮(BUN)-静脉血: 6.6mmol/L；磷(P)-静脉血: 1.15mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.4mmolL；有核红细胞百分比(NRBC%)-静脉血: 0；有核红细胞计数(NRBC#)-静脉血: 010E9/L；载脂蛋白AI(apoAI)-静脉血: 1.2g/L；总胆固醇(TC)-静脉血: 7.16mmol/L；甘油三酯(TG)-静脉血: 1.74mmol/L；总钙(Ca)-静脉血: 2.28mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 76.6umol/L；钾离子(K+)-静脉血: 3.01mmol/L；间接胆红素(IBIL)-静脉血: 10.4umolL；尿酸(UA)-静脉血: 216umol/L；镁离子(Mg2+)-静脉血: 0.56mmol/L；单核细胞百分比(Mono%)-静脉血: 0.065；红细胞计数(RBC#)-静脉血: 3.3610E12/L；天门冬氨酸氨基转移酶(AST)-静脉血: 9.4U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.053；血小板计数(PLT#)-静脉血: 12210E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.6；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；乳酸脱氢酶(LDH)-静脉血: 130.3U/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；中性粒细胞计数(Neut#)-静脉血: 4.410E9/L；C-反应蛋白(CRP)-静脉血: 6.72mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 5.32mmol/L；丙氨酸氨基转移酶(ALT)……\n- [全程D152] 检验组合: EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）\n- [全程D222] 超声；腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约21cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D222] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:80（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）\n\n【既往治疗与反应】\n- [全程D104] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者放疗22次，诉中度咽痛，有干咳，感恶心，无呕吐，无畏寒、发热。查体大致同前。今日查血常规生化未见异常。[姓名已隐去]医生信息已隐藏，患者放化疗顺利，现继续予以加强护胃、护肝等营养支持对症治疗，定期复查血生化常规，严密观察病情变化。\n- [全程D108] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者诉乏力，无恶心、呕吐，仍有便秘。查体大致同前。今日查血生化提示：血钾3.06mmol/L，血钠127.1mmol/L。血常规提示血红蛋白稍低。[姓名已隐去]医生信息已隐藏后指示：患者放疗过程中，现血钾、血钠低，可予以加强补钾、补钠治疗，现继续放疗，加强支持对症治疗，严密观察病情变化。\n- [全程D111] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者放疗27次，诉有咳嗽、咳痰，大便未解。查体大致同前。[姓名已隐去]医生信息已隐藏，患者放疗进行中，现有咳嗽，予以加强祛痰处理，大便未解加强通便治疗。继续加强支持对症治疗，严密观察病情变化。\n- [全程D116] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者放疗30次，患者诉感乏力，咳嗽、咳痰症状较前改善，无畏寒、发热。查体大致同前。今日查血常规大致正常。生化提示血钠低、血钾低、血镁低。[姓名已隐去]医生信息已隐藏，患者生化提示血钾、血钠、血镁低，加强支持对症治疗，严密观察病情变化。\n- [全程D118] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日完成放疗。今日[姓名已隐去]医生信息已隐藏者诉轻度咽痛，胃纳一般，无恶心、呕吐，无发热、咳嗽、咳痰等，精神、睡眠一般，大小便正常。体查：张口门齿距4.5cm；鼻咽顶壁见肿物，较前明显消退；浅表淋巴结未及肿大，颅神经检查：（-）。口腔黏膜反应Ⅱ度，皮肤反应Ⅰ度。[姓名已隐去]医生信息已隐藏示：患者已结束放疗及同期化疗，过程顺利，现病情平稳，可予以出院，嘱患者注意休息，加强营养，出院后一个月内每周复查血常规、肝肾功能，出院后一个月返院复查，不适时随诊。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善鼻咽及颈部MRI检查，暂缓EB病毒DNA及抗体检测。\nB. 安排全身PET-CT检查，替代常规影像学及EB病毒相关指标随访。\nC. 完善EB病毒DNA定量及EBV抗体（VCA-IgA、EA-IgA）检测，继续定期随访观察。\nD. 完善胸部增强CT及全身骨扫描，暂缓EB病毒DNA定量检测。\nE. 延长随访间隔至每半年一次，仅复查腹部彩超及血常规。\nF. 安排鼻内镜检查并常规行鼻咽部组织活检，复查EB病毒DNA。\nG. 给予抗病毒药物治疗以降低EBV-VCA-IgA滴度，继续随访观察。\nH. 启动卡培他滨节拍维持治疗，并每半年复查EB病毒DNA定量。\nI. 完善鼻咽及颈部CT平扫，替代MRI及EB病毒DNA定量检测。\nJ. 安排双侧颈部淋巴结彩超检查，暂缓EB病毒相关指标检测。\nK. 启动PD-1抑制剂免疫维持治疗，并定期复查EB病毒DNA定量。\nL. 完善头颅增强MRI检查，暂缓鼻咽部及颈部影像学评估。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"episode_id":"episode-45cfeb8667f4a4f88ede40e7","patient_id":"patient-290a042206ccfe67e72f9a19","care_turn_count":4,"turns":[{"sample_id":"sample-32fca5d8e1da4de5e54c5c0b","patient_id":"patient-290a042206ccfe67e72f9a19","turn_id":"turn01","turn_position":1,"turn_type":"initial_workup_choice","gold_letter":"D","gold_action":"行电子鼻咽镜检查及活检，并完善鼻咽及颈部MRI平扫+增强，常规心电图检查","options":[{"letter":"A","text":"行电子鼻咽镜检查（不活检），并完善鼻咽及颈部CT平扫+增强，常规心电图检查","is_gold":false},{"letter":"B","text":"行颈部淋巴结切除活检，并完善鼻咽及颈部MRI平扫+增强，常规心电图检查","is_gold":false},{"letter":"C","text":"行电子鼻咽镜检查及活检，并完善鼻咽及颈部MRI平扫（不增强），常规心电图检查","is_gold":false},{"letter":"D","text":"行电子鼻咽镜检查及活检，并完善鼻咽及颈部MRI平扫+增强，常规心电图检查","is_gold":true},{"letter":"E","text":"行电子鼻咽镜检查及活检，并完善鼻咽MRI平扫+增强，暂缓颈部影像学检查","is_gold":false},{"letter":"F","text":"直接行全身PET-CT检查，暂缓电子鼻咽镜及活检与局部MRI","is_gold":false},{"letter":"G","text":"行电子鼻咽镜检查及活检，并完善胸部及腹部CT平扫+增强，暂缓头颈部MRI","is_gold":false},{"letter":"H","text":"行鼻咽及颈部MRI平扫+增强，常规心电图检查，暂缓鼻咽镜检查及活检","is_gold":false},{"letter":"I","text":"行电子鼻咽镜检查及活检，并完善鼻咽及颈部CT平扫，常规心电图检查","is_gold":false},{"letter":"J","text":"行颈部淋巴结穿刺活检，并完善鼻咽及颈部MRI平扫+增强，常规心电图检查","is_gold":false},{"letter":"K","text":"行电子鼻咽镜检查（不活检），并完善全身PET-CT检查，常规心电图检查","is_gold":false},{"letter":"L","text":"行电子鼻咽镜检查及活检，并完善鼻咽及颈部超声检查，常规心电图检查","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现颈部肿物1月余；当地诊断：鼻咽癌。于某次就诊时间在[机构已隐去]行力扑素270mgd1+奈达铂120mgd1+泰欣生200mgd1化疗一程，化疗后出现四度中性粒细胞减少，无发热、腹泻、寒战等，予升白处理后中性粒细胞恢复。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物,中性粒细胞减少,颈部肿物；既往史: 颈椎病史10年，既往有慢性肠炎病史。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：362.℃，P：100次/分，R：20次/分，BP：126/74mmHg,Ht：168cm，Wt：63kg，BSA：1.72m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；双侧颈部IIa区各可扪及1个淋巴结，左颈2×3cm，右颈2×2cm,无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行电子鼻咽镜检查（不活检），并完善鼻咽及颈部CT平扫+增强，常规心电图检查\nB. 行颈部淋巴结切除活检，并完善鼻咽及颈部MRI平扫+增强，常规心电图检查\nC. 行电子鼻咽镜检查及活检，并完善鼻咽及颈部MRI平扫（不增强），常规心电图检查\nD. 行电子鼻咽镜检查及活检，并完善鼻咽及颈部MRI平扫+增强，常规心电图检查\nE. 行电子鼻咽镜检查及活检，并完善鼻咽MRI平扫+增强，暂缓颈部影像学检查\nF. 直接行全身PET-CT检查，暂缓电子鼻咽镜及活检与局部MRI\nG. 行电子鼻咽镜检查及活检，并完善胸部及腹部CT平扫+增强，暂缓头颈部MRI\nH. 行鼻咽及颈部MRI平扫+增强，常规心电图检查，暂缓鼻咽镜检查及活检\nI. 行电子鼻咽镜检查及活检，并完善鼻咽及颈部CT平扫，常规心电图检查\nJ. 行颈部淋巴结穿刺活检，并完善鼻咽及颈部MRI平扫+增强，常规心电图检查\nK. 行电子鼻咽镜检查（不活检），并完善全身PET-CT检查，常规心电图检查\nL. 行电子鼻咽镜检查及活检，并完善鼻咽及颈部超声检查，常规心电图检查\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现颈部肿物1月余；当地诊断：鼻咽癌。于某次就诊时间在[机构已隐去]行力扑素270mgd1+奈达铂120mgd1+泰欣生200mgd1化疗一程，化疗后出现四度中性粒细胞减少，无发热、腹泻、寒战等，予升白处理后中性粒细胞恢复。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物,中性粒细胞减少,颈部肿物；既往史: 颈椎病史10年，既往有慢性肠炎病史。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：362.℃，P：100次/分，R：20次/分，BP：126/74mmHg,Ht：168cm，Wt：63kg，BSA：1.72m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；双侧颈部IIa区各可扪及1个淋巴结，左颈2×3cm，右颈2×2cm,无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行电子鼻咽镜检查（不活检），并完善鼻咽及颈部CT平扫+增强，常规心电图检查\nB. 行颈部淋巴结切除活检，并完善鼻咽及颈部MRI平扫+增强，常规心电图检查\nC. 行电子鼻咽镜检查及活检，并完善鼻咽及颈部MRI平扫（不增强），常规心电图检查\nD. 行电子鼻咽镜检查及活检，并完善鼻咽及颈部MRI平扫+增强，常规心电图检查\nE. 行电子鼻咽镜检查及活检，并完善鼻咽MRI平扫+增强，暂缓颈部影像学检查\nF. 直接行全身PET-CT检查，暂缓电子鼻咽镜及活检与局部MRI\nG. 行电子鼻咽镜检查及活检，并完善胸部及腹部CT平扫+增强，暂缓头颈部MRI\nH. 行鼻咽及颈部MRI平扫+增强，常规心电图检查，暂缓鼻咽镜检查及活检\nI. 行电子鼻咽镜检查及活检，并完善鼻咽及颈部CT平扫，常规心电图检查\nJ. 行颈部淋巴结穿刺活检，并完善鼻咽及颈部MRI平扫+增强，常规心电图检查\nK. 行电子鼻咽镜检查（不活检），并完善全身PET-CT检查，常规心电图检查\nL. 行电子鼻咽镜检查及活检，并完善鼻咽及颈部超声检查，常规心电图检查\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现颈部肿物1月余；当地诊断：鼻咽癌。于某次就诊时间在[机构已隐去]行力扑素270mgd1+奈达铂120mgd1+泰欣生200mgd1化疗一程，化疗后出现四度中性粒细胞减少，无发热、腹泻、寒战等，予升白处理后中性粒细胞恢复。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物,中性粒细胞减少,颈部肿物；既往史: 颈椎病史10年，既往有慢性肠炎病史。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：362.℃，P：100次/分，R：20次/分，BP：126/74mmHg,Ht：168cm，Wt：63kg，BSA：1.72m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；双侧颈部IIa区各可扪及1个淋巴结，左颈2×3cm，右颈2×2cm,无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行电子鼻咽镜检查（不活检），并完善鼻咽及颈部CT平扫+增强，常规心电图检查\nB. 行颈部淋巴结切除活检，并完善鼻咽及颈部MRI平扫+增强，常规心电图检查\nC. 行电子鼻咽镜检查及活检，并完善鼻咽及颈部MRI平扫（不增强），常规心电图检查\nD. 行电子鼻咽镜检查及活检，并完善鼻咽及颈部MRI平扫+增强，常规心电图检查\nE. 行电子鼻咽镜检查及活检，并完善鼻咽MRI平扫+增强，暂缓颈部影像学检查\nF. 直接行全身PET-CT检查，暂缓电子鼻咽镜及活检与局部MRI\nG. 行电子鼻咽镜检查及活检，并完善胸部及腹部CT平扫+增强，暂缓头颈部MRI\nH. 行鼻咽及颈部MRI平扫+增强，常规心电图检查，暂缓鼻咽镜检查及活检\nI. 行电子鼻咽镜检查及活检，并完善鼻咽及颈部CT平扫，常规心电图检查\nJ. 行颈部淋巴结穿刺活检，并完善鼻咽及颈部MRI平扫+增强，常规心电图检查\nK. 行电子鼻咽镜检查（不活检），并完善全身PET-CT检查，常规心电图检查\nL. 行电子鼻咽镜检查及活检，并完善鼻咽及颈部超声检查，常规心电图检查\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-95b51d663e429afb86c572e7","patient_id":"patient-290a042206ccfe67e72f9a19","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"E","gold_action":"行外院疑难病理会诊，完善PET/CT全身显像及血浆EBV DNA检测","options":[{"letter":"A","text":"行鼻咽镜下重新活检，完善胸部CT、腹部超声及全身骨扫描，检测血浆EBV DNA","is_gold":false},{"letter":"B","text":"行外院疑难病理会诊，完善胸部CT、腹部超声，暂缓全身骨扫描，检测血浆EBV DNA","is_gold":false},{"letter":"C","text":"沿用外院病理诊断，完善PET/CT全身显像及血浆EBV DNA检测","is_gold":false},{"letter":"D","text":"行外院疑难病理会诊，完善胸部增强CT及腹部增强CT，暂缓全身骨扫描","is_gold":false},{"letter":"E","text":"行外院疑难病理会诊，完善PET/CT全身显像及血浆EBV DNA检测","is_gold":true},{"letter":"F","text":"行鼻咽镜下重新活检，完善PET/CT全身显像及血浆EBV DNA检测","is_gold":false},{"letter":"G","text":"行外院疑难病理会诊，完善PET/CT全身显像，暂缓血浆EBV DNA检测","is_gold":false},{"letter":"H","text":"行外院疑难病理会诊，完善胸部CT及腹部CT，暂缓全身骨扫描及血浆EBV DNA检测","is_gold":false},{"letter":"I","text":"沿用外院病理诊断，完善PET/CT全身显像，暂缓血浆EBV DNA检测","is_gold":false},{"letter":"J","text":"行外院疑难病理会诊，完善头颈部局部PET/CT及血浆EBV DNA检测","is_gold":false},{"letter":"K","text":"行鼻咽镜下重新活检，完善胸部CT及腹部CT，暂缓血浆EBV DNA检测","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现颈部肿物1月余；当地诊断：鼻咽癌。于某次就诊时间在[机构已隐去]行力扑素270mgd1+奈达铂120mgd1+泰欣生200mgd1化疗一程，化疗后出现四度中性粒细胞减少，无发热、腹泻、寒战等，予升白处理后中性粒细胞恢复。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物,中性粒细胞减少,颈部肿物；既往史: 颈椎病史10年，既往有慢性肠炎病史。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：362.℃，P：100次/分，R：20次/分，BP：126/74mmHg,Ht：168cm，Wt：63kg，BSA：1.72m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；双侧颈部IIa区各可扪及1个淋巴结，左颈2×3cm，右颈2×2cm,无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 电轴左偏(轻度) 心电图大致正常\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1] 检验组合: 纤维蛋白原降解产物(FDP)-静脉血: 2ug/ml；平均红细胞体积(MCV)-静脉血: 93.5fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6；甘油三酯(TG)-静脉血: 2.17mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 51.4U/L；胱抑素(Cys-C)-静脉血: 0.91mg/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.08COI；总钙(Ca)-静脉血: 2.24mmol/L；淋巴细胞计数(Lymph#)-静脉血: 2.610E9/L；葡萄糖(Glu)-静脉血: 5.18mmol/L；球蛋白(GLO)-静脉血: 26.59g/L；有核红细胞计数(NRBC#)-静脉血: 0.0410E9/L；平均血小板体积(MPV)-静脉血: 9.5fL；大血小板百分比(P-LCR%)-静脉血: 20.5%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.003；红细胞计数(RBC#)-静脉血: 4.1410E12/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.07S/CO；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.55mmol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0IU/mL；血小板分布宽度(PDW)-静脉血: 9.8%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.014；载脂蛋白B(apoB)-静脉血: 0.91g/L；C-反应蛋白(CRP)-静脉血: 2.8mg/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；镁离子(Mg2+)-静脉血: 0.83mmol/L；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；肌酐(Crea)-静脉血: 77umol/L；钾离子(K+)-静脉血: 4mmol/L；白蛋白(ALB)-静脉血: 40.9g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；凝血酶原时间活动度(PTA)-静脉血: 90.4%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.54；阴离子间隙(AG)-静脉血: 12……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 行鼻咽镜下重新活检，完善胸部CT、腹部超声及全身骨扫描，检测血浆EBV DNA\nB. 行外院疑难病理会诊，完善胸部CT、腹部超声，暂缓全身骨扫描，检测血浆EBV DNA\nC. 沿用外院病理诊断，完善PET/CT全身显像及血浆EBV DNA检测\nD. 行外院疑难病理会诊，完善胸部增强CT及腹部增强CT，暂缓全身骨扫描\nE. 行外院疑难病理会诊，完善PET/CT全身显像及血浆EBV DNA检测\nF. 行鼻咽镜下重新活检，完善PET/CT全身显像及血浆EBV DNA检测\nG. 行外院疑难病理会诊，完善PET/CT全身显像，暂缓血浆EBV DNA检测\nH. 行外院疑难病理会诊，完善胸部CT及腹部CT，暂缓全身骨扫描及血浆EBV DNA检测\nI. 沿用外院病理诊断，完善PET/CT全身显像，暂缓血浆EBV DNA检测\nJ. 行外院疑难病理会诊，完善头颈部局部PET/CT及血浆EBV DNA检测\nK. 行鼻咽镜下重新活检，完善胸部CT及腹部CT，暂缓血浆EBV DNA检测\n\n请仅输出一个选项字母（A-K）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 电轴左偏(轻度) 心电图大致正常\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1] 检验组合: 纤维蛋白原降解产物(FDP)-静脉血: 2ug/ml；平均红细胞体积(MCV)-静脉血: 93.5fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6；甘油三酯(TG)-静脉血: 2.17mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 51.4U/L；胱抑素(Cys-C)-静脉血: 0.91mg/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.08COI；总钙(Ca)-静脉血: 2.24mmol/L；淋巴细胞计数(Lymph#)-静脉血: 2.610E9/L；葡萄糖(Glu)-静脉血: 5.18mmol/L；球蛋白(GLO)-静脉血: 26.59g/L；有核红细胞计数(NRBC#)-静脉血: 0.0410E9/L；平均血小板体积(MPV)-静脉血: 9.5fL；大血小板百分比(P-LCR%)-静脉血: 20.5%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.003；红细胞计数(RBC#)-静脉血: 4.1410E12/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.07S/CO；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.55mmol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0IU/mL；血小板分布宽度(PDW)-静脉血: 9.8%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.014；载脂蛋白B(apoB)-静脉血: 0.91g/L；C-反应蛋白(CRP)-静脉血: 2.8mg/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；镁离子(Mg2+)-静脉血: 0.83mmol/L；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；肌酐(Crea)-静脉血: 77umol/L；钾离子(K+)-静脉血: 4mmol/L；白蛋白(ALB)-静脉血: 40.9g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；凝血酶原时间活动度(PTA)-静脉血: 90.4%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.54；阴离子间隙(AG)-静脉血: 12……\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 行鼻咽镜下重新活检，完善胸部CT、腹部超声及全身骨扫描，检测血浆EBV DNA\nB. 行外院疑难病理会诊，完善胸部CT、腹部超声，暂缓全身骨扫描，检测血浆EBV DNA\nC. 沿用外院病理诊断，完善PET/CT全身显像及血浆EBV DNA检测\nD. 行外院疑难病理会诊，完善胸部增强CT及腹部增强CT，暂缓全身骨扫描\nE. 行外院疑难病理会诊，完善PET/CT全身显像及血浆EBV DNA检测\nF. 行鼻咽镜下重新活检，完善PET/CT全身显像及血浆EBV DNA检测\nG. 行外院疑难病理会诊，完善PET/CT全身显像，暂缓血浆EBV DNA检测\nH. 行外院疑难病理会诊，完善胸部CT及腹部CT，暂缓全身骨扫描及血浆EBV DNA检测\nI. 沿用外院病理诊断，完善PET/CT全身显像，暂缓血浆EBV DNA检测\nJ. 行外院疑难病理会诊，完善头颈部局部PET/CT及血浆EBV DNA检测\nK. 行鼻咽镜下重新活检，完善胸部CT及腹部CT，暂缓血浆EBV DNA检测\n\n请仅输出一个选项字母（A-K）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 电轴左偏(轻度) 心电图大致正常\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1] 检验组合: 纤维蛋白原降解产物(FDP)-静脉血: 2ug/ml；平均红细胞体积(MCV)-静脉血: 93.5fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6；甘油三酯(TG)-静脉血: 2.17mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 51.4U/L；胱抑素(Cys-C)-静脉血: 0.91mg/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.08COI；总钙(Ca)-静脉血: 2.24mmol/L；淋巴细胞计数(Lymph#)-静脉血: 2.610E9/L；葡萄糖(Glu)-静脉血: 5.18mmol/L；球蛋白(GLO)-静脉血: 26.59g/L；有核红细胞计数(NRBC#)-静脉血: 0.0410E9/L；平均血小板体积(MPV)-静脉血: 9.5fL；大血小板百分比(P-LCR%)-静脉血: 20.5%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.003；红细胞计数(RBC#)-静脉血: 4.1410E12/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.07S/CO；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.55mmol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0IU/mL；血小板分布宽度(PDW)-静脉血: 9.8%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.014；载脂蛋白B(apoB)-静脉血: 0.91g/L；C-反应蛋白(CRP)-静脉血: 2.8mg/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；镁离子(Mg2+)-静脉血: 0.83mmol/L；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；肌酐(Crea)-静脉血: 77umol/L；钾离子(K+)-静脉血: 4mmol/L；白蛋白(ALB)-静脉血: 40.9g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；凝血酶原时间活动度(PTA)-静脉血: 90.4%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.54；阴离子间隙(AG)-静脉血: 12……\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 行鼻咽镜下重新活检，完善胸部CT、腹部超声及全身骨扫描，检测血浆EBV DNA\nB. 行外院疑难病理会诊，完善胸部CT、腹部超声，暂缓全身骨扫描，检测血浆EBV DNA\nC. 沿用外院病理诊断，完善PET/CT全身显像及血浆EBV DNA检测\nD. 行外院疑难病理会诊，完善胸部增强CT及腹部增强CT，暂缓全身骨扫描\nE. 行外院疑难病理会诊，完善PET/CT全身显像及血浆EBV DNA检测\nF. 行鼻咽镜下重新活检，完善PET/CT全身显像及血浆EBV DNA检测\nG. 行外院疑难病理会诊，完善PET/CT全身显像，暂缓血浆EBV DNA检测\nH. 行外院疑难病理会诊，完善胸部CT及腹部CT，暂缓全身骨扫描及血浆EBV DNA检测\nI. 沿用外院病理诊断，完善PET/CT全身显像，暂缓血浆EBV DNA检测\nJ. 行外院疑难病理会诊，完善头颈部局部PET/CT及血浆EBV DNA检测\nK. 行鼻咽镜下重新活检，完善胸部CT及腹部CT，暂缓血浆EBV DNA检测\n\n请仅输出一个选项字母（A-K）。"},{"sample_id":"sample-ac55ce5273aeb2587f3051e7","patient_id":"patient-290a042206ccfe67e72f9a19","turn_id":"turn05","turn_position":3,"turn_type":"toxicity_or_support_decision","gold_letter":"I","gold_action":"予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，暂不予口服保肝药物治疗，并复查血常规及生化后安排出院。","options":[{"letter":"A","text":"予以短效重组人粒细胞刺激因子（rhG-CSF）皮下注射，暂不予口服保肝药物治疗，并复查血常规及生化后继续住院观察。","is_gold":false},{"letter":"B","text":"暂不予粒细胞集落刺激因子预防，仅口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。","is_gold":false},{"letter":"C","text":"予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，静脉滴注头孢菌素预防感染，并复查血常规及生化后安排出院。","is_gold":false},{"letter":"D","text":"予以短效重组人粒细胞刺激因子（rhG-CSF）皮下注射，静脉滴注异甘草酸镁强效保肝，并复查血常规及生化后继续住院观察。","is_gold":false},{"letter":"E","text":"暂不予粒细胞集落刺激因子预防，暂不予口服保肝药物治疗，直接安排出院并嘱院外定期复查血常规及生化。","is_gold":false},{"letter":"F","text":"予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，口服恩替卡韦抗病毒治疗，并复查血常规及生化后安排出院。","is_gold":false},{"letter":"G","text":"予以短效重组人粒细胞刺激因子（rhG-CSF）皮下注射，口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。","is_gold":false},{"letter":"H","text":"予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。","is_gold":false},{"letter":"I","text":"予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，暂不予口服保肝药物治疗，并复查血常规及生化后安排出院。","is_gold":true},{"letter":"J","text":"予以重组人促血小板生成素（rhTPO）皮下注射，口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。","is_gold":false},{"letter":"K","text":"予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，静脉滴注还原型谷胱甘肽保肝，并复查血常规及生化后继续住院观察。","is_gold":false},{"letter":"L","text":"暂不予任何药物处理，直接安排出院，嘱院外定期复查血常规及生化，若出现发热再返院使用粒细胞集落刺激因子。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现颈部肿物1月余；当地诊断：鼻咽癌。于某次就诊时间在[机构已隐去]行力扑素270mgd1+奈达铂120mgd1+泰欣生200mgd1化疗一程，化疗后出现四度中性粒细胞减少，无发热、腹泻、寒战等，予升白处理后中性粒细胞恢复。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物,中性粒细胞减少,颈部肿物；既往史: 颈椎病史10年，既往有慢性肠炎病史。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：362.℃，P：100次/分，R：20次/分，BP：126/74mmHg,Ht：168cm，Wt：63kg，BSA：1.72m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；双侧颈部IIa区各可扪及1个淋巴结，左颈2×3cm，右颈2×2cm,无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 电轴左偏(轻度) 心电图大致正常\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1] 检验组合: 纤维蛋白原降解产物(FDP)-静脉血: 2ug/ml；平均红细胞体积(MCV)-静脉血: 93.5fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6；甘油三酯(TG)-静脉血: 2.17mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 51.4U/L；胱抑素(Cys-C)-静脉血: 0.91mg/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.08COI；总钙(Ca)-静脉血: 2.24mmol/L；淋巴细胞计数(Lymph#)-静脉血: 2.610E9/L；葡萄糖(Glu)-静脉血: 5.18mmol/L；球蛋白(GLO)-静脉血: 26.59g/L；有核红细胞计数(NRBC#)-静脉血: 0.0410E9/L；平均血小板体积(MPV)-静脉血: 9.5fL；大血小板百分比(P-LCR%)-静脉血: 20.5%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.003；红细胞计数(RBC#)-静脉血: 4.1410E12/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.07S/CO；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.55mmol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0IU/mL；血小板分布宽度(PDW)-静脉血: 9.8%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.014；载脂蛋白B(apoB)-静脉血: 0.91g/L；C-反应蛋白(CRP)-静脉血: 2.8mg/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；镁离子(Mg2+)-静脉血: 0.83mmol/L；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；肌酐(Crea)-静脉血: 77umol/L；钾离子(K+)-静脉血: 4mmol/L；白蛋白(ALB)-静脉血: 40.9g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；凝血酶原时间活动度(PTA)-静脉血: 90.4%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.54；阴离子间隙(AG)-静脉血: 12……\n- [全程D8] 检验组合: 单核细胞百分比(Mono%)-静脉血: 0.065；血红蛋白(Hb)-静脉血: 129g/L；淋巴细胞计数(Lymph#)-静脉血: 2.110E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；大血小板百分比(P-LCR%)-静脉血: 22%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.013；平均红细胞体积(MCV)-静脉血: 93.8fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.2；红细胞比容(Hct)-静脉血: 39.2%；中性粒细胞百分比(Neut%)-静脉血: 0.53；单核细胞计数(Mono#)-静脉血: 0.410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；白细胞计数(WBC#)-静脉血: 5.3910E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血小板分布宽度(PDW)-静脉血: 10.3%；平均红细胞血红蛋白含量(MCH)-静脉血: 30.9pg；血小板计数(PLT#)-静脉血: 14810E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.8；淋巴细胞百分比(Lymph%)-静脉血: 0.39；有核红细胞计数(NRBC#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.002；血小板比容-静脉血: 14%；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；红细胞计数(RBC#)-静脉血: 4.1810E12/L；平均血小板体积(MPV)-静脉血: 9.7fL；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L\n- [全程D9] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: 输液港走行于右锁骨下静脉，导管末端位于脊柱右旁T6椎体下缘水平，估计位于上腔静脉上段。；检查结论: 导管末端位置如上述。\n- [全程D9] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；非鳞状上皮细胞计数-尿液: 1/μL；颜色-尿液: Light-Yellow；粘液丝计数(MUCS#)-尿液: 5/μL；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-尿液: colorless；比重(SG)-尿液: 1.013；白细胞(LEU)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；白细胞(LEU)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 1/μL；酸碱度(pH)-尿液: 6.5；浊度(TRUB)-尿液: clear；比重(SG)-尿液: 1.016；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D10] 检验组合: 红细胞计数(RBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 6；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 7/μL；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.017；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 1/μL；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow\n- [全程D14] 检验组合: 总胆固醇(TC)-静脉血: 5.88mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜碱性粒细胞百分比(Baso%)-静脉血: 0；单核细胞百分比(Mono%)-静脉血: 0.008；丙氨酸氨基转移酶(ALT)-静脉血: 65.5U/L；血小板分布宽度(PDW)-静脉血: 13.8%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.9；白蛋白(ALB)-静脉血: 42.5g/L；球蛋白(GLO)-静脉血: 26g/L；胱抑素(Cys-C)-静脉血: 1.11mg/L；总蛋白(TP)-静脉血: 68.5g/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.7mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞计数(RBC#)-静脉血: 4.4510E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；总胆红素(TBIL)-静脉血: 15.4umol/L；钾离子(K+)-静脉血: 4.03mmol/L；葡萄糖(Glu)-静脉血: 5.74mmol/L；乳酸脱氢酶(LDH)-静脉血: 175U/L；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；肌酐(Crea)-静脉血: 80umol/L；总钙(Ca)-静脉血: 2.18mmol/L；钠离子(Na+)-静脉血: 132.2mmol/L；大血小板百分比(P-LCR%)-静脉血: 34.4%；红细胞比容(Hct)-静脉血: 39.3%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；阴离子间隙(AG)-静脉血: 17.8；γ-谷氨酰基转移酶(GGT)-静脉血: 26.8U/L；白细胞计数(WBC#)-静脉血: 5.2310E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.83mmol/L；平均血小板体积(MPV)-静脉血: 11.2fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.01；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.51mmolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.35；碱性磷酸酶(ALP)-静脉血: 57.4U/L；直接胆红素(DBIL)-静脉血: 4.1umol/L；镁离子(Mg2+)-静脉血: 0.93mmol/L；血红蛋白(Hb)-静脉血: 1……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者各项检查继续完善中。\n- [全程D10] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程多西紫杉醇＋DDP+5-FU方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 予以短效重组人粒细胞刺激因子（rhG-CSF）皮下注射，暂不予口服保肝药物治疗，并复查血常规及生化后继续住院观察。\nB. 暂不予粒细胞集落刺激因子预防，仅口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。\nC. 予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，静脉滴注头孢菌素预防感染，并复查血常规及生化后安排出院。\nD. 予以短效重组人粒细胞刺激因子（rhG-CSF）皮下注射，静脉滴注异甘草酸镁强效保肝，并复查血常规及生化后继续住院观察。\nE. 暂不予粒细胞集落刺激因子预防，暂不予口服保肝药物治疗，直接安排出院并嘱院外定期复查血常规及生化。\nF. 予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，口服恩替卡韦抗病毒治疗，并复查血常规及生化后安排出院。\nG. 予以短效重组人粒细胞刺激因子（rhG-CSF）皮下注射，口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。\nH. 予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。\nI. 予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，暂不予口服保肝药物治疗，并复查血常规及生化后安排出院。\nJ. 予以重组人促血小板生成素（rhTPO）皮下注射，口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。\nK. 予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，静脉滴注还原型谷胱甘肽保肝，并复查血常规及生化后继续住院观察。\nL. 暂不予任何药物处理，直接安排出院，嘱院外定期复查血常规及生化，若出现发热再返院使用粒细胞集落刺激因子。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D8] 检验组合: 单核细胞百分比(Mono%)-静脉血: 0.065；血红蛋白(Hb)-静脉血: 129g/L；淋巴细胞计数(Lymph#)-静脉血: 2.110E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；大血小板百分比(P-LCR%)-静脉血: 22%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.013；平均红细胞体积(MCV)-静脉血: 93.8fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.2；红细胞比容(Hct)-静脉血: 39.2%；中性粒细胞百分比(Neut%)-静脉血: 0.53；单核细胞计数(Mono#)-静脉血: 0.410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；白细胞计数(WBC#)-静脉血: 5.3910E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血小板分布宽度(PDW)-静脉血: 10.3%；平均红细胞血红蛋白含量(MCH)-静脉血: 30.9pg；血小板计数(PLT#)-静脉血: 14810E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.8；淋巴细胞百分比(Lymph%)-静脉血: 0.39；有核红细胞计数(NRBC#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.002；血小板比容-静脉血: 14%；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；红细胞计数(RBC#)-静脉血: 4.1810E12/L；平均血小板体积(MPV)-静脉血: 9.7fL；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L\n- [全程D9] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: 输液港走行于右锁骨下静脉，导管末端位于脊柱右旁T6椎体下缘水平，估计位于上腔静脉上段。；检查结论: 导管末端位置如上述。\n- [全程D9] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；非鳞状上皮细胞计数-尿液: 1/μL；颜色-尿液: Light-Yellow；粘液丝计数(MUCS#)-尿液: 5/μL；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-尿液: colorless；比重(SG)-尿液: 1.013；白细胞(LEU)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；白细胞(LEU)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 1/μL；酸碱度(pH)-尿液: 6.5；浊度(TRUB)-尿液: clear；比重(SG)-尿液: 1.016；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D10] 检验组合: 红细胞计数(RBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 6；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 7/μL；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.017；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 1/μL；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow\n- [全程D14] 检验组合: 总胆固醇(TC)-静脉血: 5.88mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜碱性粒细胞百分比(Baso%)-静脉血: 0；单核细胞百分比(Mono%)-静脉血: 0.008；丙氨酸氨基转移酶(ALT)-静脉血: 65.5U/L；血小板分布宽度(PDW)-静脉血: 13.8%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.9；白蛋白(ALB)-静脉血: 42.5g/L；球蛋白(GLO)-静脉血: 26g/L；胱抑素(Cys-C)-静脉血: 1.11mg/L；总蛋白(TP)-静脉血: 68.5g/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.7mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞计数(RBC#)-静脉血: 4.4510E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；总胆红素(TBIL)-静脉血: 15.4umol/L；钾离子(K+)-静脉血: 4.03mmol/L；葡萄糖(Glu)-静脉血: 5.74mmol/L；乳酸脱氢酶(LDH)-静脉血: 175U/L；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；肌酐(Crea)-静脉血: 80umol/L；总钙(Ca)-静脉血: 2.18mmol/L；钠离子(Na+)-静脉血: 132.2mmol/L；大血小板百分比(P-LCR%)-静脉血: 34.4%；红细胞比容(Hct)-静脉血: 39.3%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；阴离子间隙(AG)-静脉血: 17.8；γ-谷氨酰基转移酶(GGT)-静脉血: 26.8U/L；白细胞计数(WBC#)-静脉血: 5.2310E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.83mmol/L；平均血小板体积(MPV)-静脉血: 11.2fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.01；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.51mmolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.35；碱性磷酸酶(ALP)-静脉血: 57.4U/L；直接胆红素(DBIL)-静脉血: 4.1umol/L；镁离子(Mg2+)-静脉血: 0.93mmol/L；血红蛋白(Hb)-静脉血: 1……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者各项检查继续完善中。\n- [全程D10] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程多西紫杉醇＋DDP+5-FU方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 予以短效重组人粒细胞刺激因子（rhG-CSF）皮下注射，暂不予口服保肝药物治疗，并复查血常规及生化后继续住院观察。\nB. 暂不予粒细胞集落刺激因子预防，仅口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。\nC. 予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，静脉滴注头孢菌素预防感染，并复查血常规及生化后安排出院。\nD. 予以短效重组人粒细胞刺激因子（rhG-CSF）皮下注射，静脉滴注异甘草酸镁强效保肝，并复查血常规及生化后继续住院观察。\nE. 暂不予粒细胞集落刺激因子预防，暂不予口服保肝药物治疗，直接安排出院并嘱院外定期复查血常规及生化。\nF. 予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，口服恩替卡韦抗病毒治疗，并复查血常规及生化后安排出院。\nG. 予以短效重组人粒细胞刺激因子（rhG-CSF）皮下注射，口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。\nH. 予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。\nI. 予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，暂不予口服保肝药物治疗，并复查血常规及生化后安排出院。\nJ. 予以重组人促血小板生成素（rhTPO）皮下注射，口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。\nK. 予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，静脉滴注还原型谷胱甘肽保肝，并复查血常规及生化后继续住院观察。\nL. 暂不予任何药物处理，直接安排出院，嘱院外定期复查血常规及生化，若出现发热再返院使用粒细胞集落刺激因子。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D8] 检验组合: 单核细胞百分比(Mono%)-静脉血: 0.065；血红蛋白(Hb)-静脉血: 129g/L；淋巴细胞计数(Lymph#)-静脉血: 2.110E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；大血小板百分比(P-LCR%)-静脉血: 22%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.013；平均红细胞体积(MCV)-静脉血: 93.8fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.2；红细胞比容(Hct)-静脉血: 39.2%；中性粒细胞百分比(Neut%)-静脉血: 0.53；单核细胞计数(Mono#)-静脉血: 0.410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；白细胞计数(WBC#)-静脉血: 5.3910E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血小板分布宽度(PDW)-静脉血: 10.3%；平均红细胞血红蛋白含量(MCH)-静脉血: 30.9pg；血小板计数(PLT#)-静脉血: 14810E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.8；淋巴细胞百分比(Lymph%)-静脉血: 0.39；有核红细胞计数(NRBC#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.002；血小板比容-静脉血: 14%；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；红细胞计数(RBC#)-静脉血: 4.1810E12/L；平均血小板体积(MPV)-静脉血: 9.7fL；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L\n- [全程D9] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: 输液港走行于右锁骨下静脉，导管末端位于脊柱右旁T6椎体下缘水平，估计位于上腔静脉上段。；检查结论: 导管末端位置如上述。\n- [全程D9] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；非鳞状上皮细胞计数-尿液: 1/μL；颜色-尿液: Light-Yellow；粘液丝计数(MUCS#)-尿液: 5/μL；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-尿液: colorless；比重(SG)-尿液: 1.013；白细胞(LEU)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；白细胞(LEU)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 1/μL；酸碱度(pH)-尿液: 6.5；浊度(TRUB)-尿液: clear；比重(SG)-尿液: 1.016；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D10] 检验组合: 红细胞计数(RBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 6；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 7/μL；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.017；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 1/μL；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow\n- [全程D14] 检验组合: 总胆固醇(TC)-静脉血: 5.88mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜碱性粒细胞百分比(Baso%)-静脉血: 0；单核细胞百分比(Mono%)-静脉血: 0.008；丙氨酸氨基转移酶(ALT)-静脉血: 65.5U/L；血小板分布宽度(PDW)-静脉血: 13.8%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.9；白蛋白(ALB)-静脉血: 42.5g/L；球蛋白(GLO)-静脉血: 26g/L；胱抑素(Cys-C)-静脉血: 1.11mg/L；总蛋白(TP)-静脉血: 68.5g/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.7mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞计数(RBC#)-静脉血: 4.4510E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；总胆红素(TBIL)-静脉血: 15.4umol/L；钾离子(K+)-静脉血: 4.03mmol/L；葡萄糖(Glu)-静脉血: 5.74mmol/L；乳酸脱氢酶(LDH)-静脉血: 175U/L；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；肌酐(Crea)-静脉血: 80umol/L；总钙(Ca)-静脉血: 2.18mmol/L；钠离子(Na+)-静脉血: 132.2mmol/L；大血小板百分比(P-LCR%)-静脉血: 34.4%；红细胞比容(Hct)-静脉血: 39.3%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；阴离子间隙(AG)-静脉血: 17.8；γ-谷氨酰基转移酶(GGT)-静脉血: 26.8U/L；白细胞计数(WBC#)-静脉血: 5.2310E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.83mmol/L；平均血小板体积(MPV)-静脉血: 11.2fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.01；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.51mmolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.35；碱性磷酸酶(ALP)-静脉血: 57.4U/L；直接胆红素(DBIL)-静脉血: 4.1umol/L；镁离子(Mg2+)-静脉血: 0.93mmol/L；血红蛋白(Hb)-静脉血: 1……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者各项检查继续完善中。\n- [全程D10] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程多西紫杉醇＋DDP+5-FU方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 予以短效重组人粒细胞刺激因子（rhG-CSF）皮下注射，暂不予口服保肝药物治疗，并复查血常规及生化后继续住院观察。\nB. 暂不予粒细胞集落刺激因子预防，仅口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。\nC. 予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，静脉滴注头孢菌素预防感染，并复查血常规及生化后安排出院。\nD. 予以短效重组人粒细胞刺激因子（rhG-CSF）皮下注射，静脉滴注异甘草酸镁强效保肝，并复查血常规及生化后继续住院观察。\nE. 暂不予粒细胞集落刺激因子预防，暂不予口服保肝药物治疗，直接安排出院并嘱院外定期复查血常规及生化。\nF. 予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，口服恩替卡韦抗病毒治疗，并复查血常规及生化后安排出院。\nG. 予以短效重组人粒细胞刺激因子（rhG-CSF）皮下注射，口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。\nH. 予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。\nI. 予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，暂不予口服保肝药物治疗，并复查血常规及生化后安排出院。\nJ. 予以重组人促血小板生成素（rhTPO）皮下注射，口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。\nK. 予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，静脉滴注还原型谷胱甘肽保肝，并复查血常规及生化后继续住院观察。\nL. 暂不予任何药物处理，直接安排出院，嘱院外定期复查血常规及生化，若出现发热再返院使用粒细胞集落刺激因子。\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-6d1ca43d48e1d74031505487","patient_id":"patient-290a042206ccfe67e72f9a19","turn_id":"turn07","turn_position":4,"turn_type":"recurrence_or_salvage_decision","gold_letter":"J","gold_action":"继续予以抑酸护胃及静脉高营养等对症支持治疗，待体能恢复后序贯开展根治性放疗或同步放化疗。","options":[{"letter":"A","text":"立即启动根治性调强放疗联合同步顺铂化疗，停止静脉高营养以避免导管相关感染。","is_gold":false},{"letter":"B","text":"更换为吉西他滨联合顺铂方案进行第四周期诱导化疗，并继续抑酸护胃治疗。","is_gold":false},{"letter":"C","text":"安排鼻咽原发灶及双侧颈部淋巴结根治性切除术，术后辅以静脉营养支持。","is_gold":false},{"letter":"D","text":"维持静脉营养支持，并立即启动根治性放疗联合PD-1抑制剂及靶向治疗。","is_gold":false},{"letter":"E","text":"继续原方案（多西紫杉醇+顺铂+5-FU）进行第四周期诱导化疗，并辅以抑酸护胃治疗。","is_gold":false},{"letter":"F","text":"暂停所有抗肿瘤治疗，仅维持静脉营养支持及抑酸治疗，1个月后复查MRI决定后续方案。","is_gold":false},{"letter":"G","text":"安排全身PET-CT检查评估全身情况，若无远处转移则继续原方案诱导化疗两周期。","is_gold":false},{"letter":"H","text":"行局部清扫术，处理颈部残留淋巴结，术后序贯鼻咽部根治性放疗及静脉营养支持。","is_gold":false},{"letter":"I","text":"调整为卡培他滨节拍化疗联合静脉营养支持，待消化道反应完全缓解后启动放疗。","is_gold":false},{"letter":"J","text":"继续予以抑酸护胃及静脉高营养等对症支持治疗，待体能恢复后序贯开展根治性放疗或同步放化疗。","is_gold":true},{"letter":"K","text":"启动姑息性放疗控制局部及颈部病灶，并联合阿帕替尼等抗血管生成药物治疗。","is_gold":false},{"letter":"L","text":"维持静脉营养支持，并安排鼻咽镜下局部病灶再次活检以病理确认肿瘤退缩程度。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现颈部肿物1月余；当地诊断：鼻咽癌。于某次就诊时间在[机构已隐去]行力扑素270mgd1+奈达铂120mgd1+泰欣生200mgd1化疗一程，化疗后出现四度中性粒细胞减少，无发热、腹泻、寒战等，予升白处理后中性粒细胞恢复。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物,中性粒细胞减少,颈部肿物；既往史: 颈椎病史10年，既往有慢性肠炎病史。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：362.℃，P：100次/分，R：20次/分，BP：126/74mmHg,Ht：168cm，Wt：63kg，BSA：1.72m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；双侧颈部IIa区各可扪及1个淋巴结，左颈2×3cm，右颈2×2cm,无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 电轴左偏(轻度) 心电图大致正常\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1] 检验组合: 纤维蛋白原降解产物(FDP)-静脉血: 2ug/ml；平均红细胞体积(MCV)-静脉血: 93.5fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6；甘油三酯(TG)-静脉血: 2.17mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 51.4U/L；胱抑素(Cys-C)-静脉血: 0.91mg/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.08COI；总钙(Ca)-静脉血: 2.24mmol/L；淋巴细胞计数(Lymph#)-静脉血: 2.610E9/L；葡萄糖(Glu)-静脉血: 5.18mmol/L；球蛋白(GLO)-静脉血: 26.59g/L；有核红细胞计数(NRBC#)-静脉血: 0.0410E9/L；平均血小板体积(MPV)-静脉血: 9.5fL；大血小板百分比(P-LCR%)-静脉血: 20.5%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.003；红细胞计数(RBC#)-静脉血: 4.1410E12/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.07S/CO；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.55mmol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0IU/mL；血小板分布宽度(PDW)-静脉血: 9.8%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.014；载脂蛋白B(apoB)-静脉血: 0.91g/L；C-反应蛋白(CRP)-静脉血: 2.8mg/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；镁离子(Mg2+)-静脉血: 0.83mmol/L；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；肌酐(Crea)-静脉血: 77umol/L；钾离子(K+)-静脉血: 4mmol/L；白蛋白(ALB)-静脉血: 40.9g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；凝血酶原时间活动度(PTA)-静脉血: 90.4%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.54；阴离子间隙(AG)-静脉血: 12……\n- [全程D8] 检验组合: 单核细胞百分比(Mono%)-静脉血: 0.065；血红蛋白(Hb)-静脉血: 129g/L；淋巴细胞计数(Lymph#)-静脉血: 2.110E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；大血小板百分比(P-LCR%)-静脉血: 22%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.013；平均红细胞体积(MCV)-静脉血: 93.8fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.2；红细胞比容(Hct)-静脉血: 39.2%；中性粒细胞百分比(Neut%)-静脉血: 0.53；单核细胞计数(Mono#)-静脉血: 0.410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；白细胞计数(WBC#)-静脉血: 5.3910E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血小板分布宽度(PDW)-静脉血: 10.3%；平均红细胞血红蛋白含量(MCH)-静脉血: 30.9pg；血小板计数(PLT#)-静脉血: 14810E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.8；淋巴细胞百分比(Lymph%)-静脉血: 0.39；有核红细胞计数(NRBC#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.002；血小板比容-静脉血: 14%；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；红细胞计数(RBC#)-静脉血: 4.1810E12/L；平均血小板体积(MPV)-静脉血: 9.7fL；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L\n- [全程D9] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: 输液港走行于右锁骨下静脉，导管末端位于脊柱右旁T6椎体下缘水平，估计位于上腔静脉上段。；检查结论: 导管末端位置如上述。\n- [全程D9] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；非鳞状上皮细胞计数-尿液: 1/μL；颜色-尿液: Light-Yellow；粘液丝计数(MUCS#)-尿液: 5/μL；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-尿液: colorless；比重(SG)-尿液: 1.013；白细胞(LEU)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；白细胞(LEU)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 1/μL；酸碱度(pH)-尿液: 6.5；浊度(TRUB)-尿液: clear；比重(SG)-尿液: 1.016；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D10] 检验组合: 红细胞计数(RBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 6；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 7/μL；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.017；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 1/μL；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow\n- [全程D14] 检验组合: 总胆固醇(TC)-静脉血: 5.88mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜碱性粒细胞百分比(Baso%)-静脉血: 0；单核细胞百分比(Mono%)-静脉血: 0.008；丙氨酸氨基转移酶(ALT)-静脉血: 65.5U/L；血小板分布宽度(PDW)-静脉血: 13.8%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.9；白蛋白(ALB)-静脉血: 42.5g/L；球蛋白(GLO)-静脉血: 26g/L；胱抑素(Cys-C)-静脉血: 1.11mg/L；总蛋白(TP)-静脉血: 68.5g/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.7mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞计数(RBC#)-静脉血: 4.4510E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；总胆红素(TBIL)-静脉血: 15.4umol/L；钾离子(K+)-静脉血: 4.03mmol/L；葡萄糖(Glu)-静脉血: 5.74mmol/L；乳酸脱氢酶(LDH)-静脉血: 175U/L；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；肌酐(Crea)-静脉血: 80umol/L；总钙(Ca)-静脉血: 2.18mmol/L；钠离子(Na+)-静脉血: 132.2mmol/L；大血小板百分比(P-LCR%)-静脉血: 34.4%；红细胞比容(Hct)-静脉血: 39.3%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；阴离子间隙(AG)-静脉血: 17.8；γ-谷氨酰基转移酶(GGT)-静脉血: 26.8U/L；白细胞计数(WBC#)-静脉血: 5.2310E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.83mmol/L；平均血小板体积(MPV)-静脉血: 11.2fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.01；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.51mmolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.35；碱性磷酸酶(ALP)-静脉血: 57.4U/L；直接胆红素(DBIL)-静脉血: 4.1umol/L；镁离子(Mg2+)-静脉血: 0.93mmol/L；血红蛋白(Hb)-静脉血: 1……\n- [全程D29] 检验组合: γ-谷氨酰基转移酶(GGT)-静脉血: 24.3U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.69；中性粒细胞计数(Neut#)-静脉血: 5.710E9/L；载脂蛋白AI(apoAI)-静脉血: 1.44g/L；血红蛋白(Hb)-静脉血: 117g/L；总胆固醇(TC)-静脉血: 5.21mmol/L；血小板分布宽度(PDW)-静脉血: 9.2%；乳酸脱氢酶(LDH)-静脉血: 181.3U/L；总胆汁酸(TBA)-静脉血: 3.1umol/L；直接胆红素(DBIL)-静脉血: 2umol/L；白蛋白(ALB)-静脉血: 39.2g/L；总胆红素(TBIL)-静脉血: 7.9umol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；平均红细胞体积(MCV)-静脉血: 92.9fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.647；C-反应蛋白(CRP)-静脉血: 1.01mg/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.3；红细胞计数(RBC#)-静脉血: 3.9410E12/L；白细胞计数(WBC#)-静脉血: 8.7310E9/L；肌酐(Crea)-静脉血: 102.7umol/L；钠离子(Na+)-静脉血: 141.8mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.56；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.32mmolL；总钙(Ca)-静脉血: 2.29mmol/L；胱抑素(Cys-C)-静脉血: 1.08mg/L；血液二氧化碳含量ctCO2(B)-静脉血: 26.3mmol/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；碱性磷酸酶(ALP)-静脉血: 61.9U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.5U/L；甘油三酯(TG)-静脉血: 1.82mmol/L；氯离子(Cl-)-静脉血: 103.6mmol/L；间接胆红素(IBIL)-静脉血: 5.9umolL；大血小板百分比(P-LCR%)-静脉血: 13.5%；淋巴细胞百分比(Lymph%)-静脉血: 0.282；葡萄糖(Glu)-静脉血: 5.18mmol/L；尿素氮(BUN)-静脉血: 6.……\n- [全程D31] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 2/μL；胆红素(BIL)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.011；比重(SG)-尿液: 1.017；隐血(OB)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 1/μL；胆红素(BIL)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 10/μL；白细胞(LEU)-尿液: -（参考: 阴性）；颜色-尿液: 无色；浊度(TRUB)-尿液: clear；总蛋白(TP)-尿液: -（参考: 阴性）\n- [全程D33] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.016；浊度(TRUB)-尿液: 清亮；总蛋白(TP)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；隐血(OB)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7；白细胞计数(WBC#)-尿液: 1/μL；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）\n- [全程D34] 检验组合: 隐血(OB)-粪便: 阴性（参考: 阴性）；阴离子间隙(AG)-静脉血: 10.6；颜色-粪便: 棕色；钠离子(Na+)-静脉血: 136.7mmol/L；虫卵-粪便: 未见虫卵（参考: 未见虫卵）；血液二氧化碳含量ctCO2(B)-静脉血: 26.2mmol/L；氯离子(Cl-)-静脉血: 99.9mmol/L；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；磷(P)-静脉血: 1.16mmol/L；总钙(Ca)-静脉血: 1.98mmol/L；镁离子(Mg2+)-静脉血: 0.59mmol/L；钾离子(K+)-静脉血: 3.49mmol/L；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）\n- [全程D36] 检验组合: 钾离子(K+)-静脉血: 4.1mmol/L；碱性磷酸酶(ALP)-静脉血: 51.9U/L；球蛋白(GLO)-静脉血: 20.23g/L；钠离子(Na+)-静脉血: 136.6mmol/L；阴离子间隙(AG)-静脉血: 13；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.82mmol/L；总胆红素(TBIL)-静脉血: 15.3umol/L；镁离子(Mg2+)-静脉血: 0.51mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.14g/L；氯离子(Cl-)-静脉血: 99mmol/L；单核细胞计数(Mono#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.3；乳酸脱氢酶(LDH)-静脉血: 169.8U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15.6U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.78；磷(P)-静脉血: 1.11mmol/L；葡萄糖(Glu)-静脉血: 5.25mmol/L；总钙(Ca)-静脉血: 2.08mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 27.3U/L；血小板计数(PLT#)-静脉血: 10410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 327g/L；单核细胞百分比(Mono%)-静脉血: 0.005；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；总胆固醇(TC)-静脉血: 5.03mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 28U/L；平均红细胞体积(MCV)-静脉血: 90.6fL；血红蛋白(Hb)-静脉血: 110g/L；血小板分布宽度(PDW)-静脉血: 11.8%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.6pg；白蛋白(ALB)-静脉血: 36g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1；血液二氧化碳含量ctCO2(B)-静脉血: 24.8mmol/L；总蛋白(TP)-静脉血: 56.23g/L；间接胆红素(IBIL)-静脉血: 10umolL；总胆汁酸(TBA)-静脉血: 4.4umol/L；载脂蛋白B(apoB)-静脉血: 0.9g/L；C-反应蛋白(CRP)-静脉血: 1.75mg/L；嗜酸性粒细胞百分……\n- [全程D37] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后复查，与某次就诊时间对比： 鼻咽腔稍狭窄，鼻咽顶壁、顶后壁、后壁及双侧壁稍增厚，T1WI呈等信号，T2WI呈稍高信号，增强扫描强化明显，粘膜表面不光整。双侧咽隐窝变浅。双侧咽旁间隙未见明显狭窄。双侧腭帆张提肌、头长肌信号不均匀，增强后不均匀强化。双侧翼内外肌未见受侵。 口咽双侧壁未见增厚，左侧鼻甲明显肿大，气道狭窄。双侧鼻腔未见肿物。 双侧翼腭窝、上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 斜坡、枕骨基底部、蝶骨基底部、双侧翼突基底、翼内板、右侧岩尖骨质信号降低，增强扫描强化明显。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶窦、筛窦及右侧乳突气房内见积液，双侧上颌窦及左侧乳突充气良好，骨壁完整。 左侧咽后见淋巴结，大小约4mm×7mm，较前缩小；右侧咽后见小淋巴结，大小约3mm×4mm，较前缩小。双颈II、III区见数个淋巴结，大者大小约8mm×14mm，边界欠清，信号不均匀，增强扫描不均匀明显强化，较前缩小。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗后复查，与某次就诊时间对比： 鼻咽病变，较前明显好转。 颅底骨质破坏，较前好转。 双侧咽后淋巴结，较前缩小。 双颈II、III区淋巴结，考虑转移，较前缩小。 鼻窦炎，右侧乳突炎。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者各项检查继续完善中。\n- [全程D10] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程多西紫杉醇＋DDP+5-FU方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D15] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程TPF方案诱导化疗结束，诉呕吐1次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部IIa区各可扪及1个淋巴结，左颈2×2cm，右颈1.5×1.5cm,无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程TPF方案诱导化疗结束，无诉特殊不适，可予出院，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n- [全程D30] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，可于今日水化，明日执行第2程多西紫杉醇＋DDP+5-FU方案诱导化疗，注意化疗不良反应。\n- [全程D31] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程多西紫杉醇＋DDP+5-FU方案诱导化疗第一天，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D35] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程多西紫杉醇＋DDP+5-FU方案诱导化疗结束，诉反酸、恶心，无发热、腹痛、腹泻，无关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第2程多西紫杉醇＋DDP+5-FU方案诱导化疗结束后出现反酸、恶心现象，予抑酸护胃、补液等对症处理，继观。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即启动根治性调强放疗联合同步顺铂化疗，停止静脉高营养以避免导管相关感染。\nB. 更换为吉西他滨联合顺铂方案进行第四周期诱导化疗，并继续抑酸护胃治疗。\nC. 安排鼻咽原发灶及双侧颈部淋巴结根治性切除术，术后辅以静脉营养支持。\nD. 维持静脉营养支持，并立即启动根治性放疗联合PD-1抑制剂及靶向治疗。\nE. 继续原方案（多西紫杉醇+顺铂+5-FU）进行第四周期诱导化疗，并辅以抑酸护胃治疗。\nF. 暂停所有抗肿瘤治疗，仅维持静脉营养支持及抑酸治疗，1个月后复查MRI决定后续方案。\nG. 安排全身PET-CT检查评估全身情况，若无远处转移则继续原方案诱导化疗两周期。\nH. 行局部清扫术，处理颈部残留淋巴结，术后序贯鼻咽部根治性放疗及静脉营养支持。\nI. 调整为卡培他滨节拍化疗联合静脉营养支持，待消化道反应完全缓解后启动放疗。\nJ. 继续予以抑酸护胃及静脉高营养等对症支持治疗，待体能恢复后序贯开展根治性放疗或同步放化疗。\nK. 启动姑息性放疗控制局部及颈部病灶，并联合阿帕替尼等抗血管生成药物治疗。\nL. 维持静脉营养支持，并安排鼻咽镜下局部病灶再次活检以病理确认肿瘤退缩程度。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D29] 检验组合: γ-谷氨酰基转移酶(GGT)-静脉血: 24.3U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.69；中性粒细胞计数(Neut#)-静脉血: 5.710E9/L；载脂蛋白AI(apoAI)-静脉血: 1.44g/L；血红蛋白(Hb)-静脉血: 117g/L；总胆固醇(TC)-静脉血: 5.21mmol/L；血小板分布宽度(PDW)-静脉血: 9.2%；乳酸脱氢酶(LDH)-静脉血: 181.3U/L；总胆汁酸(TBA)-静脉血: 3.1umol/L；直接胆红素(DBIL)-静脉血: 2umol/L；白蛋白(ALB)-静脉血: 39.2g/L；总胆红素(TBIL)-静脉血: 7.9umol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；平均红细胞体积(MCV)-静脉血: 92.9fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.647；C-反应蛋白(CRP)-静脉血: 1.01mg/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.3；红细胞计数(RBC#)-静脉血: 3.9410E12/L；白细胞计数(WBC#)-静脉血: 8.7310E9/L；肌酐(Crea)-静脉血: 102.7umol/L；钠离子(Na+)-静脉血: 141.8mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.56；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.32mmolL；总钙(Ca)-静脉血: 2.29mmol/L；胱抑素(Cys-C)-静脉血: 1.08mg/L；血液二氧化碳含量ctCO2(B)-静脉血: 26.3mmol/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；碱性磷酸酶(ALP)-静脉血: 61.9U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.5U/L；甘油三酯(TG)-静脉血: 1.82mmol/L；氯离子(Cl-)-静脉血: 103.6mmol/L；间接胆红素(IBIL)-静脉血: 5.9umolL；大血小板百分比(P-LCR%)-静脉血: 13.5%；淋巴细胞百分比(Lymph%)-静脉血: 0.282；葡萄糖(Glu)-静脉血: 5.18mmol/L；尿素氮(BUN)-静脉血: 6.……\n- [全程D31] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 2/μL；胆红素(BIL)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.011；比重(SG)-尿液: 1.017；隐血(OB)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 1/μL；胆红素(BIL)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 10/μL；白细胞(LEU)-尿液: -（参考: 阴性）；颜色-尿液: 无色；浊度(TRUB)-尿液: clear；总蛋白(TP)-尿液: -（参考: 阴性）\n- [全程D33] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.016；浊度(TRUB)-尿液: 清亮；总蛋白(TP)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；隐血(OB)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7；白细胞计数(WBC#)-尿液: 1/μL；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）\n- [全程D34] 检验组合: 隐血(OB)-粪便: 阴性（参考: 阴性）；阴离子间隙(AG)-静脉血: 10.6；颜色-粪便: 棕色；钠离子(Na+)-静脉血: 136.7mmol/L；虫卵-粪便: 未见虫卵（参考: 未见虫卵）；血液二氧化碳含量ctCO2(B)-静脉血: 26.2mmol/L；氯离子(Cl-)-静脉血: 99.9mmol/L；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；磷(P)-静脉血: 1.16mmol/L；总钙(Ca)-静脉血: 1.98mmol/L；镁离子(Mg2+)-静脉血: 0.59mmol/L；钾离子(K+)-静脉血: 3.49mmol/L；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）\n- [全程D36] 检验组合: 钾离子(K+)-静脉血: 4.1mmol/L；碱性磷酸酶(ALP)-静脉血: 51.9U/L；球蛋白(GLO)-静脉血: 20.23g/L；钠离子(Na+)-静脉血: 136.6mmol/L；阴离子间隙(AG)-静脉血: 13；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.82mmol/L；总胆红素(TBIL)-静脉血: 15.3umol/L；镁离子(Mg2+)-静脉血: 0.51mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.14g/L；氯离子(Cl-)-静脉血: 99mmol/L；单核细胞计数(Mono#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.3；乳酸脱氢酶(LDH)-静脉血: 169.8U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15.6U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.78；磷(P)-静脉血: 1.11mmol/L；葡萄糖(Glu)-静脉血: 5.25mmol/L；总钙(Ca)-静脉血: 2.08mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 27.3U/L；血小板计数(PLT#)-静脉血: 10410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 327g/L；单核细胞百分比(Mono%)-静脉血: 0.005；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；总胆固醇(TC)-静脉血: 5.03mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 28U/L；平均红细胞体积(MCV)-静脉血: 90.6fL；血红蛋白(Hb)-静脉血: 110g/L；血小板分布宽度(PDW)-静脉血: 11.8%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.6pg；白蛋白(ALB)-静脉血: 36g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1；血液二氧化碳含量ctCO2(B)-静脉血: 24.8mmol/L；总蛋白(TP)-静脉血: 56.23g/L；间接胆红素(IBIL)-静脉血: 10umolL；总胆汁酸(TBA)-静脉血: 4.4umol/L；载脂蛋白B(apoB)-静脉血: 0.9g/L；C-反应蛋白(CRP)-静脉血: 1.75mg/L；嗜酸性粒细胞百分……\n- [全程D37] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后复查，与某次就诊时间对比： 鼻咽腔稍狭窄，鼻咽顶壁、顶后壁、后壁及双侧壁稍增厚，T1WI呈等信号，T2WI呈稍高信号，增强扫描强化明显，粘膜表面不光整。双侧咽隐窝变浅。双侧咽旁间隙未见明显狭窄。双侧腭帆张提肌、头长肌信号不均匀，增强后不均匀强化。双侧翼内外肌未见受侵。 口咽双侧壁未见增厚，左侧鼻甲明显肿大，气道狭窄。双侧鼻腔未见肿物。 双侧翼腭窝、上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 斜坡、枕骨基底部、蝶骨基底部、双侧翼突基底、翼内板、右侧岩尖骨质信号降低，增强扫描强化明显。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶窦、筛窦及右侧乳突气房内见积液，双侧上颌窦及左侧乳突充气良好，骨壁完整。 左侧咽后见淋巴结，大小约4mm×7mm，较前缩小；右侧咽后见小淋巴结，大小约3mm×4mm，较前缩小。双颈II、III区见数个淋巴结，大者大小约8mm×14mm，边界欠清，信号不均匀，增强扫描不均匀明显强化，较前缩小。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗后复查，与某次就诊时间对比： 鼻咽病变，较前明显好转。 颅底骨质破坏，较前好转。 双侧咽后淋巴结，较前缩小。 双颈II、III区淋巴结，考虑转移，较前缩小。 鼻窦炎，右侧乳突炎。\n\n【既往治疗与反应】\n- [全程D15] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程TPF方案诱导化疗结束，诉呕吐1次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部IIa区各可扪及1个淋巴结，左颈2×2cm，右颈1.5×1.5cm,无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程TPF方案诱导化疗结束，无诉特殊不适，可予出院，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n- [全程D30] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，可于今日水化，明日执行第2程多西紫杉醇＋DDP+5-FU方案诱导化疗，注意化疗不良反应。\n- [全程D31] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程多西紫杉醇＋DDP+5-FU方案诱导化疗第一天，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D35] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程多西紫杉醇＋DDP+5-FU方案诱导化疗结束，诉反酸、恶心，无发热、腹痛、腹泻，无关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第2程多西紫杉醇＋DDP+5-FU方案诱导化疗结束后出现反酸、恶心现象，予抑酸护胃、补液等对症处理，继观。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即启动根治性调强放疗联合同步顺铂化疗，停止静脉高营养以避免导管相关感染。\nB. 更换为吉西他滨联合顺铂方案进行第四周期诱导化疗，并继续抑酸护胃治疗。\nC. 安排鼻咽原发灶及双侧颈部淋巴结根治性切除术，术后辅以静脉营养支持。\nD. 维持静脉营养支持，并立即启动根治性放疗联合PD-1抑制剂及靶向治疗。\nE. 继续原方案（多西紫杉醇+顺铂+5-FU）进行第四周期诱导化疗，并辅以抑酸护胃治疗。\nF. 暂停所有抗肿瘤治疗，仅维持静脉营养支持及抑酸治疗，1个月后复查MRI决定后续方案。\nG. 安排全身PET-CT检查评估全身情况，若无远处转移则继续原方案诱导化疗两周期。\nH. 行局部清扫术，处理颈部残留淋巴结，术后序贯鼻咽部根治性放疗及静脉营养支持。\nI. 调整为卡培他滨节拍化疗联合静脉营养支持，待消化道反应完全缓解后启动放疗。\nJ. 继续予以抑酸护胃及静脉高营养等对症支持治疗，待体能恢复后序贯开展根治性放疗或同步放化疗。\nK. 启动姑息性放疗控制局部及颈部病灶，并联合阿帕替尼等抗血管生成药物治疗。\nL. 维持静脉营养支持，并安排鼻咽镜下局部病灶再次活检以病理确认肿瘤退缩程度。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D29] 检验组合: γ-谷氨酰基转移酶(GGT)-静脉血: 24.3U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.69；中性粒细胞计数(Neut#)-静脉血: 5.710E9/L；载脂蛋白AI(apoAI)-静脉血: 1.44g/L；血红蛋白(Hb)-静脉血: 117g/L；总胆固醇(TC)-静脉血: 5.21mmol/L；血小板分布宽度(PDW)-静脉血: 9.2%；乳酸脱氢酶(LDH)-静脉血: 181.3U/L；总胆汁酸(TBA)-静脉血: 3.1umol/L；直接胆红素(DBIL)-静脉血: 2umol/L；白蛋白(ALB)-静脉血: 39.2g/L；总胆红素(TBIL)-静脉血: 7.9umol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；平均红细胞体积(MCV)-静脉血: 92.9fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.647；C-反应蛋白(CRP)-静脉血: 1.01mg/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.3；红细胞计数(RBC#)-静脉血: 3.9410E12/L；白细胞计数(WBC#)-静脉血: 8.7310E9/L；肌酐(Crea)-静脉血: 102.7umol/L；钠离子(Na+)-静脉血: 141.8mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.56；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.32mmolL；总钙(Ca)-静脉血: 2.29mmol/L；胱抑素(Cys-C)-静脉血: 1.08mg/L；血液二氧化碳含量ctCO2(B)-静脉血: 26.3mmol/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；碱性磷酸酶(ALP)-静脉血: 61.9U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.5U/L；甘油三酯(TG)-静脉血: 1.82mmol/L；氯离子(Cl-)-静脉血: 103.6mmol/L；间接胆红素(IBIL)-静脉血: 5.9umolL；大血小板百分比(P-LCR%)-静脉血: 13.5%；淋巴细胞百分比(Lymph%)-静脉血: 0.282；葡萄糖(Glu)-静脉血: 5.18mmol/L；尿素氮(BUN)-静脉血: 6.……\n- [全程D31] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 2/μL；胆红素(BIL)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.011；比重(SG)-尿液: 1.017；隐血(OB)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 1/μL；胆红素(BIL)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 10/μL；白细胞(LEU)-尿液: -（参考: 阴性）；颜色-尿液: 无色；浊度(TRUB)-尿液: clear；总蛋白(TP)-尿液: -（参考: 阴性）\n- [全程D33] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.016；浊度(TRUB)-尿液: 清亮；总蛋白(TP)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；隐血(OB)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7；白细胞计数(WBC#)-尿液: 1/μL；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）\n- [全程D34] 检验组合: 隐血(OB)-粪便: 阴性（参考: 阴性）；阴离子间隙(AG)-静脉血: 10.6；颜色-粪便: 棕色；钠离子(Na+)-静脉血: 136.7mmol/L；虫卵-粪便: 未见虫卵（参考: 未见虫卵）；血液二氧化碳含量ctCO2(B)-静脉血: 26.2mmol/L；氯离子(Cl-)-静脉血: 99.9mmol/L；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；磷(P)-静脉血: 1.16mmol/L；总钙(Ca)-静脉血: 1.98mmol/L；镁离子(Mg2+)-静脉血: 0.59mmol/L；钾离子(K+)-静脉血: 3.49mmol/L；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）\n- [全程D36] 检验组合: 钾离子(K+)-静脉血: 4.1mmol/L；碱性磷酸酶(ALP)-静脉血: 51.9U/L；球蛋白(GLO)-静脉血: 20.23g/L；钠离子(Na+)-静脉血: 136.6mmol/L；阴离子间隙(AG)-静脉血: 13；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.82mmol/L；总胆红素(TBIL)-静脉血: 15.3umol/L；镁离子(Mg2+)-静脉血: 0.51mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.14g/L；氯离子(Cl-)-静脉血: 99mmol/L；单核细胞计数(Mono#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.3；乳酸脱氢酶(LDH)-静脉血: 169.8U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15.6U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.78；磷(P)-静脉血: 1.11mmol/L；葡萄糖(Glu)-静脉血: 5.25mmol/L；总钙(Ca)-静脉血: 2.08mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 27.3U/L；血小板计数(PLT#)-静脉血: 10410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 327g/L；单核细胞百分比(Mono%)-静脉血: 0.005；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；总胆固醇(TC)-静脉血: 5.03mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 28U/L；平均红细胞体积(MCV)-静脉血: 90.6fL；血红蛋白(Hb)-静脉血: 110g/L；血小板分布宽度(PDW)-静脉血: 11.8%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.6pg；白蛋白(ALB)-静脉血: 36g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1；血液二氧化碳含量ctCO2(B)-静脉血: 24.8mmol/L；总蛋白(TP)-静脉血: 56.23g/L；间接胆红素(IBIL)-静脉血: 10umolL；总胆汁酸(TBA)-静脉血: 4.4umol/L；载脂蛋白B(apoB)-静脉血: 0.9g/L；C-反应蛋白(CRP)-静脉血: 1.75mg/L；嗜酸性粒细胞百分……\n- [全程D37] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后复查，与某次就诊时间对比： 鼻咽腔稍狭窄，鼻咽顶壁、顶后壁、后壁及双侧壁稍增厚，T1WI呈等信号，T2WI呈稍高信号，增强扫描强化明显，粘膜表面不光整。双侧咽隐窝变浅。双侧咽旁间隙未见明显狭窄。双侧腭帆张提肌、头长肌信号不均匀，增强后不均匀强化。双侧翼内外肌未见受侵。 口咽双侧壁未见增厚，左侧鼻甲明显肿大，气道狭窄。双侧鼻腔未见肿物。 双侧翼腭窝、上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 斜坡、枕骨基底部、蝶骨基底部、双侧翼突基底、翼内板、右侧岩尖骨质信号降低，增强扫描强化明显。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶窦、筛窦及右侧乳突气房内见积液，双侧上颌窦及左侧乳突充气良好，骨壁完整。 左侧咽后见淋巴结，大小约4mm×7mm，较前缩小；右侧咽后见小淋巴结，大小约3mm×4mm，较前缩小。双颈II、III区见数个淋巴结，大者大小约8mm×14mm，边界欠清，信号不均匀，增强扫描不均匀明显强化，较前缩小。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗后复查，与某次就诊时间对比： 鼻咽病变，较前明显好转。 颅底骨质破坏，较前好转。 双侧咽后淋巴结，较前缩小。 双颈II、III区淋巴结，考虑转移，较前缩小。 鼻窦炎，右侧乳突炎。\n\n【既往治疗与反应】\n- [全程D15] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程TPF方案诱导化疗结束，诉呕吐1次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部IIa区各可扪及1个淋巴结，左颈2×2cm，右颈1.5×1.5cm,无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程TPF方案诱导化疗结束，无诉特殊不适，可予出院，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n- [全程D30] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，可于今日水化，明日执行第2程多西紫杉醇＋DDP+5-FU方案诱导化疗，注意化疗不良反应。\n- [全程D31] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程多西紫杉醇＋DDP+5-FU方案诱导化疗第一天，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D35] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程多西紫杉醇＋DDP+5-FU方案诱导化疗结束，诉反酸、恶心，无发热、腹痛、腹泻，无关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第2程多西紫杉醇＋DDP+5-FU方案诱导化疗结束后出现反酸、恶心现象，予抑酸护胃、补液等对症处理，继观。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即启动根治性调强放疗联合同步顺铂化疗，停止静脉高营养以避免导管相关感染。\nB. 更换为吉西他滨联合顺铂方案进行第四周期诱导化疗，并继续抑酸护胃治疗。\nC. 安排鼻咽原发灶及双侧颈部淋巴结根治性切除术，术后辅以静脉营养支持。\nD. 维持静脉营养支持，并立即启动根治性放疗联合PD-1抑制剂及靶向治疗。\nE. 继续原方案（多西紫杉醇+顺铂+5-FU）进行第四周期诱导化疗，并辅以抑酸护胃治疗。\nF. 暂停所有抗肿瘤治疗，仅维持静脉营养支持及抑酸治疗，1个月后复查MRI决定后续方案。\nG. 安排全身PET-CT检查评估全身情况，若无远处转移则继续原方案诱导化疗两周期。\nH. 行局部清扫术，处理颈部残留淋巴结，术后序贯鼻咽部根治性放疗及静脉营养支持。\nI. 调整为卡培他滨节拍化疗联合静脉营养支持，待消化道反应完全缓解后启动放疗。\nJ. 继续予以抑酸护胃及静脉高营养等对症支持治疗，待体能恢复后序贯开展根治性放疗或同步放化疗。\nK. 启动姑息性放疗控制局部及颈部病灶，并联合阿帕替尼等抗血管生成药物治疗。\nL. 维持静脉营养支持，并安排鼻咽镜下局部病灶再次活检以病理确认肿瘤退缩程度。\n\n请仅输出一个选项字母（A-L）。"}]}
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鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部及腹部MRI平扫+增强。\nL. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身骨显像、腹部彩超及心电图等基线检查。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：不支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、颈动脉鞘、斜坡、翼突基底部、蝶骨基底部、岩尖等。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D2] 入院记录: 主诉: 发现右颈部肿物5月余；现病史: 患者于入院前5月前（某次就诊时间10月）高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；阳性症状体征: 体重下降,疼痛,高热,右颈部肿物,颈部酸痛；既往史: 既往有“肾病综合征”病史，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。；家族史: 否认肿瘤家族史。；体格检查: T：36℃，P：68次/分，R：20次/分，BP：91/58mmHg,Ht：144cm，Wt：31kg，BSA：1.135m2，KPS：KPS 90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，暂缓全身影像学分期检查。\nB. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，PET-CT全身显像。\nC. 右颈部肿物切除活检，鼻咽及颈部MRI平扫+增强，全身骨显像，腹部彩超。\nD. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫，全身骨显像，腹部彩超，心电图。\nE. 鼻咽镜检查及活检，头颅MRI平扫+增强，颈部彩超，全身骨显像，腹部彩超。\nF. 鼻咽刷片细胞学检查，鼻咽及颈部MRI平扫+增强，全身骨显像，腹部彩超。\nG. 鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，全身骨显像，腹部彩超，心电图。\nH. 右颈部肿物细针穿刺活检，鼻咽及颈部MRI平扫+增强，全身骨显像，腹部彩超。\nI. 鼻咽镜检查及活检，鼻咽MRI平扫+增强，全身骨显像，腹部彩超，心电图。\nJ. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，骨髓穿刺活检，腹部彩超。\nK. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部及腹部MRI平扫+增强。\nL. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身骨显像、腹部彩超及心电图等基线检查。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：不支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、颈动脉鞘、斜坡、翼突基底部、蝶骨基底部、岩尖等。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D2] 入院记录: 主诉: 发现右颈部肿物5月余；现病史: 患者于入院前5月前（某次就诊时间10月）高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；阳性症状体征: 体重下降,疼痛,高热,右颈部肿物,颈部酸痛；既往史: 既往有“肾病综合征”病史，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。；家族史: 否认肿瘤家族史。；体格检查: T：36℃，P：68次/分，R：20次/分，BP：91/58mmHg,Ht：144cm，Wt：31kg，BSA：1.135m2，KPS：KPS 90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，暂缓全身影像学分期检查。\nB. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，PET-CT全身显像。\nC. 右颈部肿物切除活检，鼻咽及颈部MRI平扫+增强，全身骨显像，腹部彩超。\nD. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫，全身骨显像，腹部彩超，心电图。\nE. 鼻咽镜检查及活检，头颅MRI平扫+增强，颈部彩超，全身骨显像，腹部彩超。\nF. 鼻咽刷片细胞学检查，鼻咽及颈部MRI平扫+增强，全身骨显像，腹部彩超。\nG. 鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，全身骨显像，腹部彩超，心电图。\nH. 右颈部肿物细针穿刺活检，鼻咽及颈部MRI平扫+增强，全身骨显像，腹部彩超。\nI. 鼻咽镜检查及活检，鼻咽MRI平扫+增强，全身骨显像，腹部彩超，心电图。\nJ. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，骨髓穿刺活检，腹部彩超。\nK. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部及腹部MRI平扫+增强。\nL. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身骨显像、腹部彩超及心电图等基线检查。\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-6cb68b4fe11abd5f5e27ea88","patient_id":"patient-e45c55cc63c050892e6b2467","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"A","gold_action":"行鼻咽镜检查及活检，并完善胸片或胸部CT检查。","options":[{"letter":"A","text":"行鼻咽镜检查及活检，并完善胸片或胸部CT检查。","is_gold":true},{"letter":"B","text":"行右颈部肿大淋巴结切除活检，并完善胸片或胸部CT检查。","is_gold":false},{"letter":"C","text":"行鼻咽镜检查及活检，并完善头颅增强MRI检查。","is_gold":false},{"letter":"D","text":"行右颈部肿大淋巴结细针穿刺活检，并完善全身骨扫描。","is_gold":false},{"letter":"E","text":"行全身PET-CT检查，暂缓鼻咽及颈部活检。","is_gold":false},{"letter":"F","text":"行鼻咽镜检查及活检，暂不安排其他部位影像学检查。","is_gold":false},{"letter":"G","text":"完善胸部及全腹部增强CT检查，待结果回报后再行活检。","is_gold":false},{"letter":"H","text":"行鼻咽镜检查及活检，并复查颈部彩超评估淋巴结。","is_gold":false},{"letter":"I","text":"安排鼻咽及颈部根治性放疗，同步完善胸片或胸部CT检查。","is_gold":false},{"letter":"J","text":"行鼻咽镜检查及活检，并完善全身骨扫描检查。","is_gold":false},{"letter":"K","text":"给予抗炎治疗2周后复查鼻咽MRI，再决定是否行鼻咽活检。","is_gold":false},{"letter":"L","text":"行鼻咽镜检查及活检，并完善血浆EBV-DNA检测，暂缓胸部影像学检查。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：不支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、颈动脉鞘、斜坡、翼突基底部、蝶骨基底部、岩尖等。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D2] 入院记录: 主诉: 发现右颈部肿物5月余；现病史: 患者于入院前5月前（某次就诊时间10月）高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；阳性症状体征: 体重下降,疼痛,高热,右颈部肿物,颈部酸痛；既往史: 既往有“肾病综合征”病史，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。；家族史: 否认肿瘤家族史。；体格检查: T：36℃，P：68次/分，R：20次/分，BP：91/58mmHg,Ht：144cm，Wt：31kg，BSA：1.135m2，KPS：KPS 90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。；KPS: 90；ECOG:\n- [全程D1] 门急诊记录: 主诉: 右颈部肿物6月余；现病史: 患者某次就诊时间10月份高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；既往史: 肾病综合征。否认高血压、糖尿病、冠心病、肾病等慢性病史，否认乙肝、结核等传染病史，否认重大外伤史，否认献血输血及使用血制品史，否认食物药物过敏史。；个人史: 原籍出生长大，否认疫区疫水接触史，否认化学毒性及放射性物质接触史。；家族史: 否认家族类似病史及肿瘤病史。；体格检查: KPS90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D3] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见: 心电图大致正常；检查结论: 窦性心律不齐 心电图大致正常\n- [全程D3] 检验组合: 乳酸脱氢酶(LDH)-静脉血: 198.2U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 10.4U/L；总胆红素(TBIL)-静脉血: 4.2umol/L；葡萄糖(Glu)-静脉血: 4.55mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.495COI；α-L-岩藻糖苷酶(AFU)-静脉血: 35U/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；铁蛋白(Ferr)-静脉血: 91.44ng/ml；磷(P)-静脉血: 1.76mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阴性(-)（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.21ug/ml；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阳性(129.78U/mL)（参考: 阴性）；淋巴细胞百分比(Lymph%)-静脉血: 0.426；碱性磷酸酶(ALP)-静脉血: 130.2U/L；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；纤维蛋白原(Fbg)-静脉血: 2.78g/L；钾离子(K+)-静脉血: 3.5mmol/L；免疫球蛋白游离λ轻链(F-Lambda)-静脉血: 阴性(-)（参考: 阴性(-)）；平均血小板体积(MPV)-静脉血: 8.8fL；尿酸(UA)-静脉血: 200umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.24mmolL；天门冬氨酸氨基转移酶(AST)-静脉血: 18.5U/L；尿素氮(BUN)-静脉血: 3.59mmol/L；总胆固醇(TC)-静脉血: 3.29mmol/L；直接胆红素(DBIL)-静脉血: 1.6umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 11.9U/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.98；中性粒细胞百分比(Neut%)-静脉血: 0.516；肌酐(Crea)-静脉血: 35.7umol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞体积(MCV)-静脉血……\n- [全程D4] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约24cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行鼻咽镜检查及活检，并完善胸片或胸部CT检查。\nB. 行右颈部肿大淋巴结切除活检，并完善胸片或胸部CT检查。\nC. 行鼻咽镜检查及活检，并完善头颅增强MRI检查。\nD. 行右颈部肿大淋巴结细针穿刺活检，并完善全身骨扫描。\nE. 行全身PET-CT检查，暂缓鼻咽及颈部活检。\nF. 行鼻咽镜检查及活检，暂不安排其他部位影像学检查。\nG. 完善胸部及全腹部增强CT检查，待结果回报后再行活检。\nH. 行鼻咽镜检查及活检，并复查颈部彩超评估淋巴结。\nI. 安排鼻咽及颈部根治性放疗，同步完善胸片或胸部CT检查。\nJ. 行鼻咽镜检查及活检，并完善全身骨扫描检查。\nK. 给予抗炎治疗2周后复查鼻咽MRI，再决定是否行鼻咽活检。\nL. 行鼻咽镜检查及活检，并完善血浆EBV-DNA检测，暂缓胸部影像学检查。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- [全程D1] 门急诊记录: 主诉: 右颈部肿物6月余；现病史: 患者某次就诊时间10月份高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；既往史: 肾病综合征。否认高血压、糖尿病、冠心病、肾病等慢性病史，否认乙肝、结核等传染病史，否认重大外伤史，否认献血输血及使用血制品史，否认食物药物过敏史。；个人史: 原籍出生长大，否认疫区疫水接触史，否认化学毒性及放射性物质接触史。；家族史: 否认家族类似病史及肿瘤病史。；体格检查: KPS90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。\n\n【已完成检查与客观结果】\n- [全程D3] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见: 心电图大致正常；检查结论: 窦性心律不齐 心电图大致正常\n- [全程D3] 检验组合: 乳酸脱氢酶(LDH)-静脉血: 198.2U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 10.4U/L；总胆红素(TBIL)-静脉血: 4.2umol/L；葡萄糖(Glu)-静脉血: 4.55mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.495COI；α-L-岩藻糖苷酶(AFU)-静脉血: 35U/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；铁蛋白(Ferr)-静脉血: 91.44ng/ml；磷(P)-静脉血: 1.76mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阴性(-)（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.21ug/ml；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阳性(129.78U/mL)（参考: 阴性）；淋巴细胞百分比(Lymph%)-静脉血: 0.426；碱性磷酸酶(ALP)-静脉血: 130.2U/L；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；纤维蛋白原(Fbg)-静脉血: 2.78g/L；钾离子(K+)-静脉血: 3.5mmol/L；免疫球蛋白游离λ轻链(F-Lambda)-静脉血: 阴性(-)（参考: 阴性(-)）；平均血小板体积(MPV)-静脉血: 8.8fL；尿酸(UA)-静脉血: 200umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.24mmolL；天门冬氨酸氨基转移酶(AST)-静脉血: 18.5U/L；尿素氮(BUN)-静脉血: 3.59mmol/L；总胆固醇(TC)-静脉血: 3.29mmol/L；直接胆红素(DBIL)-静脉血: 1.6umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 11.9U/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.98；中性粒细胞百分比(Neut%)-静脉血: 0.516；肌酐(Crea)-静脉血: 35.7umol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞体积(MCV)-静脉血……\n- [全程D4] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约24cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行鼻咽镜检查及活检，并完善胸片或胸部CT检查。\nB. 行右颈部肿大淋巴结切除活检，并完善胸片或胸部CT检查。\nC. 行鼻咽镜检查及活检，并完善头颅增强MRI检查。\nD. 行右颈部肿大淋巴结细针穿刺活检，并完善全身骨扫描。\nE. 行全身PET-CT检查，暂缓鼻咽及颈部活检。\nF. 行鼻咽镜检查及活检，暂不安排其他部位影像学检查。\nG. 完善胸部及全腹部增强CT检查，待结果回报后再行活检。\nH. 行鼻咽镜检查及活检，并复查颈部彩超评估淋巴结。\nI. 安排鼻咽及颈部根治性放疗，同步完善胸片或胸部CT检查。\nJ. 行鼻咽镜检查及活检，并完善全身骨扫描检查。\nK. 给予抗炎治疗2周后复查鼻咽MRI，再决定是否行鼻咽活检。\nL. 行鼻咽镜检查及活检，并完善血浆EBV-DNA检测，暂缓胸部影像学检查。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：不支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、颈动脉鞘、斜坡、翼突基底部、蝶骨基底部、岩尖等。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D1] 门急诊记录: 主诉: 右颈部肿物6月余；现病史: 患者某次就诊时间10月份高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；既往史: 肾病综合征。否认高血压、糖尿病、冠心病、肾病等慢性病史，否认乙肝、结核等传染病史，否认重大外伤史，否认献血输血及使用血制品史，否认食物药物过敏史。；个人史: 原籍出生长大，否认疫区疫水接触史，否认化学毒性及放射性物质接触史。；家族史: 否认家族类似病史及肿瘤病史。；体格检查: KPS90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。\n\n【已完成检查与客观结果】\n- [全程D3] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见: 心电图大致正常；检查结论: 窦性心律不齐 心电图大致正常\n- [全程D3] 检验组合: 乳酸脱氢酶(LDH)-静脉血: 198.2U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 10.4U/L；总胆红素(TBIL)-静脉血: 4.2umol/L；葡萄糖(Glu)-静脉血: 4.55mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.495COI；α-L-岩藻糖苷酶(AFU)-静脉血: 35U/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；铁蛋白(Ferr)-静脉血: 91.44ng/ml；磷(P)-静脉血: 1.76mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阴性(-)（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.21ug/ml；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阳性(129.78U/mL)（参考: 阴性）；淋巴细胞百分比(Lymph%)-静脉血: 0.426；碱性磷酸酶(ALP)-静脉血: 130.2U/L；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；纤维蛋白原(Fbg)-静脉血: 2.78g/L；钾离子(K+)-静脉血: 3.5mmol/L；免疫球蛋白游离λ轻链(F-Lambda)-静脉血: 阴性(-)（参考: 阴性(-)）；平均血小板体积(MPV)-静脉血: 8.8fL；尿酸(UA)-静脉血: 200umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.24mmolL；天门冬氨酸氨基转移酶(AST)-静脉血: 18.5U/L；尿素氮(BUN)-静脉血: 3.59mmol/L；总胆固醇(TC)-静脉血: 3.29mmol/L；直接胆红素(DBIL)-静脉血: 1.6umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 11.9U/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.98；中性粒细胞百分比(Neut%)-静脉血: 0.516；肌酐(Crea)-静脉血: 35.7umol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞体积(MCV)-静脉血……\n- [全程D4] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约24cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行鼻咽镜检查及活检，并完善胸片或胸部CT检查。\nB. 行右颈部肿大淋巴结切除活检，并完善胸片或胸部CT检查。\nC. 行鼻咽镜检查及活检，并完善头颅增强MRI检查。\nD. 行右颈部肿大淋巴结细针穿刺活检，并完善全身骨扫描。\nE. 行全身PET-CT检查，暂缓鼻咽及颈部活检。\nF. 行鼻咽镜检查及活检，暂不安排其他部位影像学检查。\nG. 完善胸部及全腹部增强CT检查，待结果回报后再行活检。\nH. 行鼻咽镜检查及活检，并复查颈部彩超评估淋巴结。\nI. 安排鼻咽及颈部根治性放疗，同步完善胸片或胸部CT检查。\nJ. 行鼻咽镜检查及活检，并完善全身骨扫描检查。\nK. 给予抗炎治疗2周后复查鼻咽MRI，再决定是否行鼻咽活检。\nL. 行鼻咽镜检查及活检，并完善血浆EBV-DNA检测，暂缓胸部影像学检查。\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-51ced222567a8eb77bc8161d","patient_id":"patient-e45c55cc63c050892e6b2467","turn_id":"turn04","turn_position":3,"turn_type":"initial_treatment_selection","gold_letter":"B","gold_action":"予以诱导化疗序贯同期放化疗","options":[{"letter":"A","text":"予以根治性单纯放疗","is_gold":false},{"letter":"B","text":"予以诱导化疗序贯同期放化疗","is_gold":true},{"letter":"C","text":"予以诱导化疗序贯单纯放疗","is_gold":false},{"letter":"D","text":"予以同期放化疗序贯辅助化疗","is_gold":false},{"letter":"E","text":"予以靶向治疗联合同期放化疗","is_gold":false},{"letter":"F","text":"予以免疫治疗联合同期放化疗","is_gold":false},{"letter":"G","text":"予以诱导化疗序贯靶向治疗联合放疗","is_gold":false},{"letter":"H","text":"行颈部淋巴结清扫术序贯根治性放疗","is_gold":false},{"letter":"I","text":"行鼻咽原发灶切除联合颈部淋巴结清扫术","is_gold":false},{"letter":"J","text":"予以姑息性化疗联合局部姑息性放疗","is_gold":false},{"letter":"K","text":"予以诱导化疗序贯根治性手术切除","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：不支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、颈动脉鞘、斜坡、翼突基底部、蝶骨基底部、岩尖等。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D2] 入院记录: 主诉: 发现右颈部肿物5月余；现病史: 患者于入院前5月前（某次就诊时间10月）高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；阳性症状体征: 体重下降,疼痛,高热,右颈部肿物,颈部酸痛；既往史: 既往有“肾病综合征”病史，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。；家族史: 否认肿瘤家族史。；体格检查: T：36℃，P：68次/分，R：20次/分，BP：91/58mmHg,Ht：144cm，Wt：31kg，BSA：1.135m2，KPS：KPS 90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。；KPS: 90；ECOG:\n- [全程D1] 门急诊记录: 主诉: 右颈部肿物6月余；现病史: 患者某次就诊时间10月份高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；既往史: 肾病综合征。否认高血压、糖尿病、冠心病、肾病等慢性病史，否认乙肝、结核等传染病史，否认重大外伤史，否认献血输血及使用血制品史，否认食物药物过敏史。；个人史: 原籍出生长大，否认疫区疫水接触史，否认化学毒性及放射性物质接触史。；家族史: 否认家族类似病史及肿瘤病史。；体格检查: KPS90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 入院记录: 主诉: 发现右颈部肿物5月余；现病史: 患者于入院前5月前（某次就诊时间10月）高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。行右颈部肿物活检病理回报：提示鼻咽部鳞癌转移。鼻咽部MR示：鼻咽顶后壁及两侧壁粘膜增厚，右侧翼内肌、咽鼓管、头长肌受侵，右侧斜坡，颞骨岩部，寰椎前弓骨质破坏。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；阳性症状体征: 体重下降,疼痛,高热,右颈部肿物,颈部酸痛；既往史: 既往有“肾病综合征”病史，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。；家族史: 否认肿瘤家族史。；体格检查: T：36℃，P：68次/分，R：20次/分，BP：91/58mmHg,Ht：144cm，Wt：31kg，BSA：1.135m2，KPS：KPS 90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率{数值}次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。右颈扪及肿物，约4*3cm,无压痛，质硬，活动差，边界尚清，未扪及明显融合，活检伤口愈合良好。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D3] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见: 心电图大致正常；检查结论: 窦性心律不齐 心电图大致正常\n- [全程D3] 检验组合: 乳酸脱氢酶(LDH)-静脉血: 198.2U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 10.4U/L；总胆红素(TBIL)-静脉血: 4.2umol/L；葡萄糖(Glu)-静脉血: 4.55mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.495COI；α-L-岩藻糖苷酶(AFU)-静脉血: 35U/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；铁蛋白(Ferr)-静脉血: 91.44ng/ml；磷(P)-静脉血: 1.76mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阴性(-)（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.21ug/ml；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阳性(129.78U/mL)（参考: 阴性）；淋巴细胞百分比(Lymph%)-静脉血: 0.426；碱性磷酸酶(ALP)-静脉血: 130.2U/L；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；纤维蛋白原(Fbg)-静脉血: 2.78g/L；钾离子(K+)-静脉血: 3.5mmol/L；免疫球蛋白游离λ轻链(F-Lambda)-静脉血: 阴性(-)（参考: 阴性(-)）；平均血小板体积(MPV)-静脉血: 8.8fL；尿酸(UA)-静脉血: 200umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.24mmolL；天门冬氨酸氨基转移酶(AST)-静脉血: 18.5U/L；尿素氮(BUN)-静脉血: 3.59mmol/L；总胆固醇(TC)-静脉血: 3.29mmol/L；直接胆红素(DBIL)-静脉血: 1.6umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 11.9U/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.98；中性粒细胞百分比(Neut%)-静脉血: 0.516；肌酐(Crea)-静脉血: 35.7umol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞体积(MCV)-静脉血……\n- [全程D4] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约24cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 予以根治性单纯放疗\nB. 予以诱导化疗序贯同期放化疗\nC. 予以诱导化疗序贯单纯放疗\nD. 予以同期放化疗序贯辅助化疗\nE. 予以靶向治疗联合同期放化疗\nF. 予以免疫治疗联合同期放化疗\nG. 予以诱导化疗序贯靶向治疗联合放疗\nH. 行颈部淋巴结清扫术序贯根治性放疗\nI. 行鼻咽原发灶切除联合颈部淋巴结清扫术\nJ. 予以姑息性化疗联合局部姑息性放疗\nK. 予以诱导化疗序贯根治性手术切除\n\n请仅输出一个选项字母（A-K）。","incremental_user_message":"【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 入院记录: 主诉: 发现右颈部肿物5月余；现病史: 患者于入院前5月前（某次就诊时间10月）高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。行右颈部肿物活检病理回报：提示鼻咽部鳞癌转移。鼻咽部MR示：鼻咽顶后壁及两侧壁粘膜增厚，右侧翼内肌、咽鼓管、头长肌受侵，右侧斜坡，颞骨岩部，寰椎前弓骨质破坏。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；阳性症状体征: 体重下降,疼痛,高热,右颈部肿物,颈部酸痛；既往史: 既往有“肾病综合征”病史，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。；家族史: 否认肿瘤家族史。；体格检查: T：36℃，P：68次/分，R：20次/分，BP：91/58mmHg,Ht：144cm，Wt：31kg，BSA：1.135m2，KPS：KPS 90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率{数值}次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。右颈扪及肿物，约4*3cm,无压痛，质硬，活动差，边界尚清，未扪及明显融合，活检伤口愈合良好。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 无可展示记录。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 予以根治性单纯放疗\nB. 予以诱导化疗序贯同期放化疗\nC. 予以诱导化疗序贯单纯放疗\nD. 予以同期放化疗序贯辅助化疗\nE. 予以靶向治疗联合同期放化疗\nF. 予以免疫治疗联合同期放化疗\nG. 予以诱导化疗序贯靶向治疗联合放疗\nH. 行颈部淋巴结清扫术序贯根治性放疗\nI. 行鼻咽原发灶切除联合颈部淋巴结清扫术\nJ. 予以姑息性化疗联合局部姑息性放疗\nK. 予以诱导化疗序贯根治性手术切除\n\n请仅输出一个选项字母（A-K）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：不支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、颈动脉鞘、斜坡、翼突基底部、蝶骨基底部、岩尖等。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 入院记录: 主诉: 发现右颈部肿物5月余；现病史: 患者于入院前5月前（某次就诊时间10月）高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。行右颈部肿物活检病理回报：提示鼻咽部鳞癌转移。鼻咽部MR示：鼻咽顶后壁及两侧壁粘膜增厚，右侧翼内肌、咽鼓管、头长肌受侵，右侧斜坡，颞骨岩部，寰椎前弓骨质破坏。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；阳性症状体征: 体重下降,疼痛,高热,右颈部肿物,颈部酸痛；既往史: 既往有“肾病综合征”病史，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。；家族史: 否认肿瘤家族史。；体格检查: T：36℃，P：68次/分，R：20次/分，BP：91/58mmHg,Ht：144cm，Wt：31kg，BSA：1.135m2，KPS：KPS 90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率{数值}次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。右颈扪及肿物，约4*3cm,无压痛，质硬，活动差，边界尚清，未扪及明显融合，活检伤口愈合良好。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 无可展示记录。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 予以根治性单纯放疗\nB. 予以诱导化疗序贯同期放化疗\nC. 予以诱导化疗序贯单纯放疗\nD. 予以同期放化疗序贯辅助化疗\nE. 予以靶向治疗联合同期放化疗\nF. 予以免疫治疗联合同期放化疗\nG. 予以诱导化疗序贯靶向治疗联合放疗\nH. 行颈部淋巴结清扫术序贯根治性放疗\nI. 行鼻咽原发灶切除联合颈部淋巴结清扫术\nJ. 予以姑息性化疗联合局部姑息性放疗\nK. 予以诱导化疗序贯根治性手术切除\n\n请仅输出一个选项字母（A-K）。"},{"sample_id":"sample-31164fa636b978a86d54f0c9","patient_id":"patient-e45c55cc63c050892e6b2467","turn_id":"turn05","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"D","gold_action":"完善全麻下鼻咽及颈部肿物活检术前准备，予以配血备用及口服地西泮镇静。","options":[{"letter":"A","text":"完善局麻下鼻咽及颈部肿物活检术前准备，予以口服地西泮镇静及配血备用。","is_gold":false},{"letter":"B","text":"完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注头孢类抗生素预防感染。","is_gold":false},{"letter":"C","text":"完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注氨甲环酸预防术中出血。","is_gold":false},{"letter":"D","text":"完善全麻下鼻咽及颈部肿物活检术前准备，予以配血备用及口服地西泮镇静。","is_gold":true},{"letter":"E","text":"完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注人血白蛋白及复方氨基酸。","is_gold":false},{"letter":"F","text":"完善全麻下鼻咽及颈部肿物活检术前准备，予以皮下注射低分子肝素及下肢气压治疗。","is_gold":false},{"letter":"G","text":"完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉滴注地塞米松及雾化吸入。","is_gold":false},{"letter":"H","text":"完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉补充氯化钾及晶体液扩容。","is_gold":false},{"letter":"I","text":"暂缓活检手术，予以静脉输注广谱抗生素及补液支持治疗。","is_gold":false},{"letter":"J","text":"暂缓活检手术，予以口服非甾体类抗炎药及局部热敷理疗。","is_gold":false},{"letter":"K","text":"完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注单采血小板及冷沉淀。","is_gold":false},{"letter":"L","text":"完善全麻下鼻咽及颈部肿物活检术前准备，予以口服氯雷他定及局部涂抹糖皮质激素。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：不支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、颈动脉鞘、斜坡、翼突基底部、蝶骨基底部、岩尖等。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D2] 入院记录: 主诉: 发现右颈部肿物5月余；现病史: 患者于入院前5月前（某次就诊时间10月）高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；阳性症状体征: 体重下降,疼痛,高热,右颈部肿物,颈部酸痛；既往史: 既往有“肾病综合征”病史，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。；家族史: 否认肿瘤家族史。；体格检查: T：36℃，P：68次/分，R：20次/分，BP：91/58mmHg,Ht：144cm，Wt：31kg，BSA：1.135m2，KPS：KPS 90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。；KPS: 90；ECOG:\n- [全程D1] 门急诊记录: 主诉: 右颈部肿物6月余；现病史: 患者某次就诊时间10月份高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；既往史: 肾病综合征。否认高血压、糖尿病、冠心病、肾病等慢性病史，否认乙肝、结核等传染病史，否认重大外伤史，否认献血输血及使用血制品史，否认食物药物过敏史。；个人史: 原籍出生长大，否认疫区疫水接触史，否认化学毒性及放射性物质接触史。；家族史: 否认家族类似病史及肿瘤病史。；体格检查: KPS90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 入院记录: 主诉: 发现右颈部肿物5月余；现病史: 患者于入院前5月前（某次就诊时间10月）高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。行右颈部肿物活检病理回报：提示鼻咽部鳞癌转移。鼻咽部MR示：鼻咽顶后壁及两侧壁粘膜增厚，右侧翼内肌、咽鼓管、头长肌受侵，右侧斜坡，颞骨岩部，寰椎前弓骨质破坏。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；阳性症状体征: 体重下降,疼痛,高热,右颈部肿物,颈部酸痛；既往史: 既往有“肾病综合征”病史，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。；家族史: 否认肿瘤家族史。；体格检查: T：36℃，P：68次/分，R：20次/分，BP：91/58mmHg,Ht：144cm，Wt：31kg，BSA：1.135m2，KPS：KPS 90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率{数值}次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。右颈扪及肿物，约4*3cm,无压痛，质硬，活动差，边界尚清，未扪及明显融合，活检伤口愈合良好。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D3] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见: 心电图大致正常；检查结论: 窦性心律不齐 心电图大致正常\n- [全程D3] 检验组合: 乳酸脱氢酶(LDH)-静脉血: 198.2U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 10.4U/L；总胆红素(TBIL)-静脉血: 4.2umol/L；葡萄糖(Glu)-静脉血: 4.55mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.495COI；α-L-岩藻糖苷酶(AFU)-静脉血: 35U/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；铁蛋白(Ferr)-静脉血: 91.44ng/ml；磷(P)-静脉血: 1.76mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阴性(-)（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.21ug/ml；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阳性(129.78U/mL)（参考: 阴性）；淋巴细胞百分比(Lymph%)-静脉血: 0.426；碱性磷酸酶(ALP)-静脉血: 130.2U/L；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；纤维蛋白原(Fbg)-静脉血: 2.78g/L；钾离子(K+)-静脉血: 3.5mmol/L；免疫球蛋白游离λ轻链(F-Lambda)-静脉血: 阴性(-)（参考: 阴性(-)）；平均血小板体积(MPV)-静脉血: 8.8fL；尿酸(UA)-静脉血: 200umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.24mmolL；天门冬氨酸氨基转移酶(AST)-静脉血: 18.5U/L；尿素氮(BUN)-静脉血: 3.59mmol/L；总胆固醇(TC)-静脉血: 3.29mmol/L；直接胆红素(DBIL)-静脉血: 1.6umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 11.9U/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.98；中性粒细胞百分比(Neut%)-静脉血: 0.516；肌酐(Crea)-静脉血: 35.7umol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞体积(MCV)-静脉血……\n- [全程D4] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约24cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D21] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显占位病变，肺门纵隔未见明显增宽，心影无增大，双侧肋膈角锐利。；检查结论: 心肺未见病变。\n- [全程D21] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 23mmol/L；总胆红素(TBIL)-静脉血: 7.6umol/L；C-反应蛋白(CRP)-静脉血: 4.9mg/L；总胆固醇(TC)-静脉血: 4.18mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.5mmolL；总胆汁酸(TBA)-静脉血: 2.5umol/L；血型抗体筛查-静脉血: 阴性；ABO血型-静脉血: B；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；大血小板百分比(P-LCR%)-静脉血: 24.7%；血小板比容-静脉血: 32%；血小板分布宽度(PDW)-静脉血: 11.1%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；总蛋白(TP)-静脉血: 74.14g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.011；平均红细胞血红蛋白含量(MCH)-静脉血: 28.1pg；白蛋白(ALB)-静脉血: 38.9g/L；甘油三酯(TG)-静脉血: 0.81mmol/L；磷(P)-静脉血: 1.55mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.1；直接胆红素(DBIL)-静脉血: 2.5umol/L；平均红细胞体积(MCV)-静脉血: 84.5fL；平均血小板体积(MPV)-静脉血: 10.1fL；钠离子(Na+)-静脉血: 136.6mmol/L；氯离子(Cl-)-静脉血: 101.1mmol/L；镁离子(Mg2+)-静脉血: 0.72mmol/L；肌酐(Crea)-静脉血: 33.8umol/L；Rh血型-静脉血: 阳性；载脂蛋白AI(apoAI)-静脉血: 1.34g/L；尿素氮(BUN)-静脉血: 5.75mmol/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；淋巴细胞计数(Lymph#)-静脉血: 2.810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.591；白细胞计数(WBC#)-静脉血: 8.5610E9/L；钾离子(K+)-静脉血: 4.3mmol/L；总钙(Ca)-静脉血: 2.26mmol/L；尿酸(UA)-静脉血: 204.9umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24.5U/L；有核红细胞计数(NRBC……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D3] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日随夏医生信息已隐藏，患者颈背部酸痛较前有好转，无发热畏寒，无恶心呕吐，无胸闷心悸，胃纳睡眠尚可，二便未见明显异常，体查：KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。右颈扪及肿物，约4*3cm,无压痛，质硬，活动差，边界尚清，未扪及明显融合，活检伤口愈合良好。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。右颈部肿物活检病理回报：提示鼻咽部鳞癌转移。鼻咽部MR示：鼻咽顶后壁及两侧壁粘膜增厚，右侧翼内肌、咽鼓管、头长肌受侵，右侧斜坡，颞骨岩部，寰椎前弓骨质破坏。目前患者诊断：鼻咽癌，患者病理活检部位为右颈部肿物，提示转移性鳞癌，建议其行鼻咽部肿物病理活检，患者家属不同意，有放疗适应症，无相对放疗禁忌症，告知患者放疗风险及副反应，患者家属表示理解病情，现治疗后患者要求出院，予以办理，嘱注意休息合理饮食，定期复诊，不适随诊。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D19] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。凝血、乙肝两对半、肝炎四项、HIV/梅毒等检验结果无明显异常。[姓名已隐去]主任查房后，患者因年龄较小，完成活检等操作不配合，家属要求全麻下行活检明确病理，完善相关检查后择期手术，遵嘱执行。\n- [全程D20] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。[姓名已隐去]主任查房后示，完善术前相关检验检查，做好术前准备，遵嘱执行。\n- [全程D21] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。血常规、生化常规回报无明显异常。输血三项回报：B型、RH阳性、抗体筛选阴性。[姓名已隐去]主任查房后示，结合患者各项检查，未见明显手术禁忌，拟明日在气管内吸入全麻下经鼻内镜行鼻咽肿物活检+颈部肿物活检术，做好术前准备，遵嘱执行。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善局麻下鼻咽及颈部肿物活检术前准备，予以口服地西泮镇静及配血备用。\nB. 完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注头孢类抗生素预防感染。\nC. 完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注氨甲环酸预防术中出血。\nD. 完善全麻下鼻咽及颈部肿物活检术前准备，予以配血备用及口服地西泮镇静。\nE. 完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注人血白蛋白及复方氨基酸。\nF. 完善全麻下鼻咽及颈部肿物活检术前准备，予以皮下注射低分子肝素及下肢气压治疗。\nG. 完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉滴注地塞米松及雾化吸入。\nH. 完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉补充氯化钾及晶体液扩容。\nI. 暂缓活检手术，予以静脉输注广谱抗生素及补液支持治疗。\nJ. 暂缓活检手术，予以口服非甾体类抗炎药及局部热敷理疗。\nK. 完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注单采血小板及冷沉淀。\nL. 完善全麻下鼻咽及颈部肿物活检术前准备，予以口服氯雷他定及局部涂抹糖皮质激素。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D21] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显占位病变，肺门纵隔未见明显增宽，心影无增大，双侧肋膈角锐利。；检查结论: 心肺未见病变。\n- [全程D21] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 23mmol/L；总胆红素(TBIL)-静脉血: 7.6umol/L；C-反应蛋白(CRP)-静脉血: 4.9mg/L；总胆固醇(TC)-静脉血: 4.18mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.5mmolL；总胆汁酸(TBA)-静脉血: 2.5umol/L；血型抗体筛查-静脉血: 阴性；ABO血型-静脉血: B；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；大血小板百分比(P-LCR%)-静脉血: 24.7%；血小板比容-静脉血: 32%；血小板分布宽度(PDW)-静脉血: 11.1%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；总蛋白(TP)-静脉血: 74.14g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.011；平均红细胞血红蛋白含量(MCH)-静脉血: 28.1pg；白蛋白(ALB)-静脉血: 38.9g/L；甘油三酯(TG)-静脉血: 0.81mmol/L；磷(P)-静脉血: 1.55mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.1；直接胆红素(DBIL)-静脉血: 2.5umol/L；平均红细胞体积(MCV)-静脉血: 84.5fL；平均血小板体积(MPV)-静脉血: 10.1fL；钠离子(Na+)-静脉血: 136.6mmol/L；氯离子(Cl-)-静脉血: 101.1mmol/L；镁离子(Mg2+)-静脉血: 0.72mmol/L；肌酐(Crea)-静脉血: 33.8umol/L；Rh血型-静脉血: 阳性；载脂蛋白AI(apoAI)-静脉血: 1.34g/L；尿素氮(BUN)-静脉血: 5.75mmol/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；淋巴细胞计数(Lymph#)-静脉血: 2.810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.591；白细胞计数(WBC#)-静脉血: 8.5610E9/L；钾离子(K+)-静脉血: 4.3mmol/L；总钙(Ca)-静脉血: 2.26mmol/L；尿酸(UA)-静脉血: 204.9umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24.5U/L；有核红细胞计数(NRBC……\n\n【既往治疗与反应】\n- [全程D3] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日随夏医生信息已隐藏，患者颈背部酸痛较前有好转，无发热畏寒，无恶心呕吐，无胸闷心悸，胃纳睡眠尚可，二便未见明显异常，体查：KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。右颈扪及肿物，约4*3cm,无压痛，质硬，活动差，边界尚清，未扪及明显融合，活检伤口愈合良好。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。右颈部肿物活检病理回报：提示鼻咽部鳞癌转移。鼻咽部MR示：鼻咽顶后壁及两侧壁粘膜增厚，右侧翼内肌、咽鼓管、头长肌受侵，右侧斜坡，颞骨岩部，寰椎前弓骨质破坏。目前患者诊断：鼻咽癌，患者病理活检部位为右颈部肿物，提示转移性鳞癌，建议其行鼻咽部肿物病理活检，患者家属不同意，有放疗适应症，无相对放疗禁忌症，告知患者放疗风险及副反应，患者家属表示理解病情，现治疗后患者要求出院，予以办理，嘱注意休息合理饮食，定期复诊，不适随诊。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D19] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。凝血、乙肝两对半、肝炎四项、HIV/梅毒等检验结果无明显异常。[姓名已隐去]主任查房后，患者因年龄较小，完成活检等操作不配合，家属要求全麻下行活检明确病理，完善相关检查后择期手术，遵嘱执行。\n- [全程D20] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。[姓名已隐去]主任查房后示，完善术前相关检验检查，做好术前准备，遵嘱执行。\n- [全程D21] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。血常规、生化常规回报无明显异常。输血三项回报：B型、RH阳性、抗体筛选阴性。[姓名已隐去]主任查房后示，结合患者各项检查，未见明显手术禁忌，拟明日在气管内吸入全麻下经鼻内镜行鼻咽肿物活检+颈部肿物活检术，做好术前准备，遵嘱执行。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善局麻下鼻咽及颈部肿物活检术前准备，予以口服地西泮镇静及配血备用。\nB. 完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注头孢类抗生素预防感染。\nC. 完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注氨甲环酸预防术中出血。\nD. 完善全麻下鼻咽及颈部肿物活检术前准备，予以配血备用及口服地西泮镇静。\nE. 完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注人血白蛋白及复方氨基酸。\nF. 完善全麻下鼻咽及颈部肿物活检术前准备，予以皮下注射低分子肝素及下肢气压治疗。\nG. 完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉滴注地塞米松及雾化吸入。\nH. 完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉补充氯化钾及晶体液扩容。\nI. 暂缓活检手术，予以静脉输注广谱抗生素及补液支持治疗。\nJ. 暂缓活检手术，予以口服非甾体类抗炎药及局部热敷理疗。\nK. 完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注单采血小板及冷沉淀。\nL. 完善全麻下鼻咽及颈部肿物活检术前准备，予以口服氯雷他定及局部涂抹糖皮质激素。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：不支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、颈动脉鞘、斜坡、翼突基底部、蝶骨基底部、岩尖等。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D21] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显占位病变，肺门纵隔未见明显增宽，心影无增大，双侧肋膈角锐利。；检查结论: 心肺未见病变。\n- [全程D21] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 23mmol/L；总胆红素(TBIL)-静脉血: 7.6umol/L；C-反应蛋白(CRP)-静脉血: 4.9mg/L；总胆固醇(TC)-静脉血: 4.18mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.5mmolL；总胆汁酸(TBA)-静脉血: 2.5umol/L；血型抗体筛查-静脉血: 阴性；ABO血型-静脉血: B；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；大血小板百分比(P-LCR%)-静脉血: 24.7%；血小板比容-静脉血: 32%；血小板分布宽度(PDW)-静脉血: 11.1%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；总蛋白(TP)-静脉血: 74.14g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.011；平均红细胞血红蛋白含量(MCH)-静脉血: 28.1pg；白蛋白(ALB)-静脉血: 38.9g/L；甘油三酯(TG)-静脉血: 0.81mmol/L；磷(P)-静脉血: 1.55mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.1；直接胆红素(DBIL)-静脉血: 2.5umol/L；平均红细胞体积(MCV)-静脉血: 84.5fL；平均血小板体积(MPV)-静脉血: 10.1fL；钠离子(Na+)-静脉血: 136.6mmol/L；氯离子(Cl-)-静脉血: 101.1mmol/L；镁离子(Mg2+)-静脉血: 0.72mmol/L；肌酐(Crea)-静脉血: 33.8umol/L；Rh血型-静脉血: 阳性；载脂蛋白AI(apoAI)-静脉血: 1.34g/L；尿素氮(BUN)-静脉血: 5.75mmol/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；淋巴细胞计数(Lymph#)-静脉血: 2.810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.591；白细胞计数(WBC#)-静脉血: 8.5610E9/L；钾离子(K+)-静脉血: 4.3mmol/L；总钙(Ca)-静脉血: 2.26mmol/L；尿酸(UA)-静脉血: 204.9umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24.5U/L；有核红细胞计数(NRBC……\n\n【既往治疗与反应】\n- [全程D3] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日随夏医生信息已隐藏，患者颈背部酸痛较前有好转，无发热畏寒，无恶心呕吐，无胸闷心悸，胃纳睡眠尚可，二便未见明显异常，体查：KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。右颈扪及肿物，约4*3cm,无压痛，质硬，活动差，边界尚清，未扪及明显融合，活检伤口愈合良好。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。右颈部肿物活检病理回报：提示鼻咽部鳞癌转移。鼻咽部MR示：鼻咽顶后壁及两侧壁粘膜增厚，右侧翼内肌、咽鼓管、头长肌受侵，右侧斜坡，颞骨岩部，寰椎前弓骨质破坏。目前患者诊断：鼻咽癌，患者病理活检部位为右颈部肿物，提示转移性鳞癌，建议其行鼻咽部肿物病理活检，患者家属不同意，有放疗适应症，无相对放疗禁忌症，告知患者放疗风险及副反应，患者家属表示理解病情，现治疗后患者要求出院，予以办理，嘱注意休息合理饮食，定期复诊，不适随诊。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D19] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。凝血、乙肝两对半、肝炎四项、HIV/梅毒等检验结果无明显异常。[姓名已隐去]主任查房后，患者因年龄较小，完成活检等操作不配合，家属要求全麻下行活检明确病理，完善相关检查后择期手术，遵嘱执行。\n- [全程D20] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。[姓名已隐去]主任查房后示，完善术前相关检验检查，做好术前准备，遵嘱执行。\n- [全程D21] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。血常规、生化常规回报无明显异常。输血三项回报：B型、RH阳性、抗体筛选阴性。[姓名已隐去]主任查房后示，结合患者各项检查，未见明显手术禁忌，拟明日在气管内吸入全麻下经鼻内镜行鼻咽肿物活检+颈部肿物活检术，做好术前准备，遵嘱执行。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善局麻下鼻咽及颈部肿物活检术前准备，予以口服地西泮镇静及配血备用。\nB. 完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注头孢类抗生素预防感染。\nC. 完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注氨甲环酸预防术中出血。\nD. 完善全麻下鼻咽及颈部肿物活检术前准备，予以配血备用及口服地西泮镇静。\nE. 完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注人血白蛋白及复方氨基酸。\nF. 完善全麻下鼻咽及颈部肿物活检术前准备，予以皮下注射低分子肝素及下肢气压治疗。\nG. 完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉滴注地塞米松及雾化吸入。\nH. 完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉补充氯化钾及晶体液扩容。\nI. 暂缓活检手术，予以静脉输注广谱抗生素及补液支持治疗。\nJ. 暂缓活检手术，予以口服非甾体类抗炎药及局部热敷理疗。\nK. 完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注单采血小板及冷沉淀。\nL. 完善全麻下鼻咽及颈部肿物活检术前准备，予以口服氯雷他定及局部涂抹糖皮质激素。\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-e79a5ee2227343d5e15dc4d1","patient_id":"patient-e45c55cc63c050892e6b2467","turn_id":"turn06","turn_position":5,"turn_type":"toxicity_or_support_decision","gold_letter":"E","gold_action":"继续抗炎及支持治疗，完善血常规、尿常规及生化常规检查。","options":[{"letter":"A","text":"立即启动含铂双药诱导化疗，并完善心电图及超声心动图检查。","is_gold":false},{"letter":"B","text":"予以静脉输注氨甲环酸，并完善凝血常规及D-二聚体检查。","is_gold":false},{"letter":"C","text":"安排右颈部淋巴结清扫术，并静脉使用广谱抗生素抗感染。","is_gold":false},{"letter":"D","text":"予以阿片类药物滴定止痛，并完善全身骨扫描检查。","is_gold":false},{"letter":"E","text":"继续抗炎及支持治疗，完善血常规、尿常规及生化常规检查。","is_gold":true},{"letter":"F","text":"启动根治性调强放射治疗，并复查鼻咽及颈部增强MRI。","is_gold":false},{"letter":"G","text":"予以静脉高营养支持治疗，并复查血浆EBV-DNA定量。","is_gold":false},{"letter":"H","text":"预防性皮下注射低分子肝素，并完善双下肢深静脉彩超。","is_gold":false},{"letter":"I","text":"予以静脉滴注地塞米松，并复查头颈部增强CT。","is_gold":false},{"letter":"J","text":"拔除静脉留置针，仅予以口服非甾体抗炎药，并继续留院观察。","is_gold":false},{"letter":"K","text":"停止静脉用药，改为口服头孢类抗生素，并立即办理出院。","is_gold":false},{"letter":"L","text":"予以颈部局部姑息性放疗，并完善甲状腺功能检查。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：不支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、颈动脉鞘、斜坡、翼突基底部、蝶骨基底部、岩尖等。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D2] 入院记录: 主诉: 发现右颈部肿物5月余；现病史: 患者于入院前5月前（某次就诊时间10月）高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；阳性症状体征: 体重下降,疼痛,高热,右颈部肿物,颈部酸痛；既往史: 既往有“肾病综合征”病史，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。；家族史: 否认肿瘤家族史。；体格检查: T：36℃，P：68次/分，R：20次/分，BP：91/58mmHg,Ht：144cm，Wt：31kg，BSA：1.135m2，KPS：KPS 90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。；KPS: 90；ECOG:\n- [全程D1] 门急诊记录: 主诉: 右颈部肿物6月余；现病史: 患者某次就诊时间10月份高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；既往史: 肾病综合征。否认高血压、糖尿病、冠心病、肾病等慢性病史，否认乙肝、结核等传染病史，否认重大外伤史，否认献血输血及使用血制品史，否认食物药物过敏史。；个人史: 原籍出生长大，否认疫区疫水接触史，否认化学毒性及放射性物质接触史。；家族史: 否认家族类似病史及肿瘤病史。；体格检查: KPS90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 入院记录: 主诉: 发现右颈部肿物5月余；现病史: 患者于入院前5月前（某次就诊时间10月）高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。行右颈部肿物活检病理回报：提示鼻咽部鳞癌转移。鼻咽部MR示：鼻咽顶后壁及两侧壁粘膜增厚，右侧翼内肌、咽鼓管、头长肌受侵，右侧斜坡，颞骨岩部，寰椎前弓骨质破坏。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；阳性症状体征: 体重下降,疼痛,高热,右颈部肿物,颈部酸痛；既往史: 既往有“肾病综合征”病史，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。；家族史: 否认肿瘤家族史。；体格检查: T：36℃，P：68次/分，R：20次/分，BP：91/58mmHg,Ht：144cm，Wt：31kg，BSA：1.135m2，KPS：KPS 90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率{数值}次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。右颈扪及肿物，约4*3cm,无压痛，质硬，活动差，边界尚清，未扪及明显融合，活检伤口愈合良好。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D3] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见: 心电图大致正常；检查结论: 窦性心律不齐 心电图大致正常\n- [全程D3] 检验组合: 乳酸脱氢酶(LDH)-静脉血: 198.2U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 10.4U/L；总胆红素(TBIL)-静脉血: 4.2umol/L；葡萄糖(Glu)-静脉血: 4.55mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.495COI；α-L-岩藻糖苷酶(AFU)-静脉血: 35U/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；铁蛋白(Ferr)-静脉血: 91.44ng/ml；磷(P)-静脉血: 1.76mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阴性(-)（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.21ug/ml；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阳性(129.78U/mL)（参考: 阴性）；淋巴细胞百分比(Lymph%)-静脉血: 0.426；碱性磷酸酶(ALP)-静脉血: 130.2U/L；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；纤维蛋白原(Fbg)-静脉血: 2.78g/L；钾离子(K+)-静脉血: 3.5mmol/L；免疫球蛋白游离λ轻链(F-Lambda)-静脉血: 阴性(-)（参考: 阴性(-)）；平均血小板体积(MPV)-静脉血: 8.8fL；尿酸(UA)-静脉血: 200umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.24mmolL；天门冬氨酸氨基转移酶(AST)-静脉血: 18.5U/L；尿素氮(BUN)-静脉血: 3.59mmol/L；总胆固醇(TC)-静脉血: 3.29mmol/L；直接胆红素(DBIL)-静脉血: 1.6umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 11.9U/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.98；中性粒细胞百分比(Neut%)-静脉血: 0.516；肌酐(Crea)-静脉血: 35.7umol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞体积(MCV)-静脉血……\n- [全程D4] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约24cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D21] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显占位病变，肺门纵隔未见明显增宽，心影无增大，双侧肋膈角锐利。；检查结论: 心肺未见病变。\n- [全程D21] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 23mmol/L；总胆红素(TBIL)-静脉血: 7.6umol/L；C-反应蛋白(CRP)-静脉血: 4.9mg/L；总胆固醇(TC)-静脉血: 4.18mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.5mmolL；总胆汁酸(TBA)-静脉血: 2.5umol/L；血型抗体筛查-静脉血: 阴性；ABO血型-静脉血: B；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；大血小板百分比(P-LCR%)-静脉血: 24.7%；血小板比容-静脉血: 32%；血小板分布宽度(PDW)-静脉血: 11.1%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；总蛋白(TP)-静脉血: 74.14g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.011；平均红细胞血红蛋白含量(MCH)-静脉血: 28.1pg；白蛋白(ALB)-静脉血: 38.9g/L；甘油三酯(TG)-静脉血: 0.81mmol/L；磷(P)-静脉血: 1.55mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.1；直接胆红素(DBIL)-静脉血: 2.5umol/L；平均红细胞体积(MCV)-静脉血: 84.5fL；平均血小板体积(MPV)-静脉血: 10.1fL；钠离子(Na+)-静脉血: 136.6mmol/L；氯离子(Cl-)-静脉血: 101.1mmol/L；镁离子(Mg2+)-静脉血: 0.72mmol/L；肌酐(Crea)-静脉血: 33.8umol/L；Rh血型-静脉血: 阳性；载脂蛋白AI(apoAI)-静脉血: 1.34g/L；尿素氮(BUN)-静脉血: 5.75mmol/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；淋巴细胞计数(Lymph#)-静脉血: 2.810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.591；白细胞计数(WBC#)-静脉血: 8.5610E9/L；钾离子(K+)-静脉血: 4.3mmol/L；总钙(Ca)-静脉血: 2.26mmol/L；尿酸(UA)-静脉血: 204.9umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24.5U/L；有核红细胞计数(NRBC……\n- [全程D22] 检验组合: 乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D25] 检验组合: 血小板分布宽度(PDW)-静脉血: 10.3%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；比重(SG)-尿液: 1.028；甘油三酯(TG)-静脉血: 1.05mmol/L；红细胞计数(RBC#)-静脉血: 3.4910E12/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.86mmolL；平均红细胞体积(MCV)-静脉血: 84.8fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 42.4；丙氨酸氨基转移酶(ALT)-静脉血: 14.8U/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.001；尿酸(UA)-静脉血: 132.3umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.910E9/L；大血小板百分比(P-LCR%)-静脉血: 21.8%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；粘液丝计数(MUCS#)-尿液: 28/μL；红细胞计数(RBC#)-尿液: 1/μL；浊度(TRUB)-尿液: 清亮；血小板计数(PLT#)-静脉血: 31810E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.218；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7；天门冬氨酸氨基转移酶(AST)-静脉血: 11.2U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.1；载脂蛋白AI(apoAI)-静脉血: 1.14g/L；单核细胞百分比(Mono%)-静脉血: 0.084；总钙(Ca)-静脉血: 2.2mmol/L；总胆汁酸(TBA)-静脉血: 4.4umol/L；白蛋白(ALB)-静脉血: 35.7g/L；红细胞比容(Hct)-静脉血: 29.6%；单核细胞计数(Mono#)-静脉血: 0.710E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 10.9U/L；平均血小板体积(MPV)-静脉血: 9.7fL；中性粒细胞计数(Neut#)-静脉血: 6.110E9/L；胆红素(BIL)-尿液: -（参考: 阴性）；血红蛋白(Hb)-静脉血: 100g/L；C-反应蛋白(CRP)-静脉血: 66.11mg/L；葡萄糖(Glu)-静脉血: 4.89mmol/L；磷(P)-静脉血: 1.26mmol/L；直接胆红素(DBIL……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D3] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日随夏医生信息已隐藏，患者颈背部酸痛较前有好转，无发热畏寒，无恶心呕吐，无胸闷心悸，胃纳睡眠尚可，二便未见明显异常，体查：KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。右颈扪及肿物，约4*3cm,无压痛，质硬，活动差，边界尚清，未扪及明显融合，活检伤口愈合良好。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。右颈部肿物活检病理回报：提示鼻咽部鳞癌转移。鼻咽部MR示：鼻咽顶后壁及两侧壁粘膜增厚，右侧翼内肌、咽鼓管、头长肌受侵，右侧斜坡，颞骨岩部，寰椎前弓骨质破坏。目前患者诊断：鼻咽癌，患者病理活检部位为右颈部肿物，提示转移性鳞癌，建议其行鼻咽部肿物病理活检，患者家属不同意，有放疗适应症，无相对放疗禁忌症，告知患者放疗风险及副反应，患者家属表示理解病情，现治疗后患者要求出院，予以办理，嘱注意休息合理饮食，定期复诊，不适随诊。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D19] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。凝血、乙肝两对半、肝炎四项、HIV/梅毒等检验结果无明显异常。[姓名已隐去]主任查房后，患者因年龄较小，完成活检等操作不配合，家属要求全麻下行活检明确病理，完善相关检查后择期手术，遵嘱执行。\n- [全程D20] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。[姓名已隐去]主任查房后示，完善术前相关检验检查，做好术前准备，遵嘱执行。\n- [全程D21] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。血常规、生化常规回报无明显异常。输血三项回报：B型、RH阳性、抗体筛选阴性。[姓名已隐去]主任查房后示，结合患者各项检查，未见明显手术禁忌，拟明日在气管内吸入全麻下经鼻内镜行鼻咽肿物活检+颈部肿物活检术，做好术前准备，遵嘱执行。\n- [全程D22] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日在气管内全麻下行左颈淋巴结切除活检+经鼻内镜鼻咽肿物切开活检术。术程顺利，术后麻醉复苏顺利，安返病房，生命体征平稳，未见口鼻活动性出血。[姓名已隐去]主任查房后，指示予抗炎、止血和支持对症治疗，并注意：1、呼吸情况；2、出血情况，遵嘱执行。\n- [全程D23] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者昨日在气管内全麻下行左颈淋巴结切除活检+经鼻内镜鼻咽肿物切开活检术，目前生命体征平稳，未见口鼻活动性出血，颈部伤口少许渗出，引流条固定在位，诉头痛、颈部肿物痛、鼻部不适。[姓名已隐去]主任查房后，指示继续抗炎、支持治疗，遵嘱执行。\n- [全程D24] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者前日在气管内全麻下行左颈淋巴结切除活检+经鼻内镜鼻咽肿物切开活检术，目前生命体征平稳，未见口鼻活动性出血，颈部伤口已无明显渗出，诉头痛、颈部肿物痛。[姓名已隐去]主任查房后，拔出引流条，指示继续抗炎、止痛、支持治疗，遵嘱执行。\n- [全程D25] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者前3日在气管内全麻下行左颈淋巴结切除活检+经鼻内镜鼻咽肿物切开活检术，目前生命体征平稳，未见口鼻活动性出血，诉头痛、颈部肿物痛。[姓名已隐去]主任查房后，指示继续抗炎、支持治疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即启动含铂双药诱导化疗，并完善心电图及超声心动图检查。\nB. 予以静脉输注氨甲环酸，并完善凝血常规及D-二聚体检查。\nC. 安排右颈部淋巴结清扫术，并静脉使用广谱抗生素抗感染。\nD. 予以阿片类药物滴定止痛，并完善全身骨扫描检查。\nE. 继续抗炎及支持治疗，完善血常规、尿常规及生化常规检查。\nF. 启动根治性调强放射治疗，并复查鼻咽及颈部增强MRI。\nG. 予以静脉高营养支持治疗，并复查血浆EBV-DNA定量。\nH. 预防性皮下注射低分子肝素，并完善双下肢深静脉彩超。\nI. 予以静脉滴注地塞米松，并复查头颈部增强CT。\nJ. 拔除静脉留置针，仅予以口服非甾体抗炎药，并继续留院观察。\nK. 停止静脉用药，改为口服头孢类抗生素，并立即办理出院。\nL. 予以颈部局部姑息性放疗，并完善甲状腺功能检查。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D22] 检验组合: 乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D25] 检验组合: 血小板分布宽度(PDW)-静脉血: 10.3%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；比重(SG)-尿液: 1.028；甘油三酯(TG)-静脉血: 1.05mmol/L；红细胞计数(RBC#)-静脉血: 3.4910E12/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.86mmolL；平均红细胞体积(MCV)-静脉血: 84.8fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 42.4；丙氨酸氨基转移酶(ALT)-静脉血: 14.8U/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.001；尿酸(UA)-静脉血: 132.3umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.910E9/L；大血小板百分比(P-LCR%)-静脉血: 21.8%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；粘液丝计数(MUCS#)-尿液: 28/μL；红细胞计数(RBC#)-尿液: 1/μL；浊度(TRUB)-尿液: 清亮；血小板计数(PLT#)-静脉血: 31810E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.218；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7；天门冬氨酸氨基转移酶(AST)-静脉血: 11.2U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.1；载脂蛋白AI(apoAI)-静脉血: 1.14g/L；单核细胞百分比(Mono%)-静脉血: 0.084；总钙(Ca)-静脉血: 2.2mmol/L；总胆汁酸(TBA)-静脉血: 4.4umol/L；白蛋白(ALB)-静脉血: 35.7g/L；红细胞比容(Hct)-静脉血: 29.6%；单核细胞计数(Mono#)-静脉血: 0.710E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 10.9U/L；平均血小板体积(MPV)-静脉血: 9.7fL；中性粒细胞计数(Neut#)-静脉血: 6.110E9/L；胆红素(BIL)-尿液: -（参考: 阴性）；血红蛋白(Hb)-静脉血: 100g/L；C-反应蛋白(CRP)-静脉血: 66.11mg/L；葡萄糖(Glu)-静脉血: 4.89mmol/L；磷(P)-静脉血: 1.26mmol/L；直接胆红素(DBIL……\n\n【既往治疗与反应】\n- [全程D22] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日在气管内全麻下行左颈淋巴结切除活检+经鼻内镜鼻咽肿物切开活检术。术程顺利，术后麻醉复苏顺利，安返病房，生命体征平稳，未见口鼻活动性出血。[姓名已隐去]主任查房后，指示予抗炎、止血和支持对症治疗，并注意：1、呼吸情况；2、出血情况，遵嘱执行。\n- [全程D23] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者昨日在气管内全麻下行左颈淋巴结切除活检+经鼻内镜鼻咽肿物切开活检术，目前生命体征平稳，未见口鼻活动性出血，颈部伤口少许渗出，引流条固定在位，诉头痛、颈部肿物痛、鼻部不适。[姓名已隐去]主任查房后，指示继续抗炎、支持治疗，遵嘱执行。\n- [全程D24] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者前日在气管内全麻下行左颈淋巴结切除活检+经鼻内镜鼻咽肿物切开活检术，目前生命体征平稳，未见口鼻活动性出血，颈部伤口已无明显渗出，诉头痛、颈部肿物痛。[姓名已隐去]主任查房后，拔出引流条，指示继续抗炎、止痛、支持治疗，遵嘱执行。\n- [全程D25] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者前3日在气管内全麻下行左颈淋巴结切除活检+经鼻内镜鼻咽肿物切开活检术，目前生命体征平稳，未见口鼻活动性出血，诉头痛、颈部肿物痛。[姓名已隐去]主任查房后，指示继续抗炎、支持治疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即启动含铂双药诱导化疗，并完善心电图及超声心动图检查。\nB. 予以静脉输注氨甲环酸，并完善凝血常规及D-二聚体检查。\nC. 安排右颈部淋巴结清扫术，并静脉使用广谱抗生素抗感染。\nD. 予以阿片类药物滴定止痛，并完善全身骨扫描检查。\nE. 继续抗炎及支持治疗，完善血常规、尿常规及生化常规检查。\nF. 启动根治性调强放射治疗，并复查鼻咽及颈部增强MRI。\nG. 予以静脉高营养支持治疗，并复查血浆EBV-DNA定量。\nH. 预防性皮下注射低分子肝素，并完善双下肢深静脉彩超。\nI. 予以静脉滴注地塞米松，并复查头颈部增强CT。\nJ. 拔除静脉留置针，仅予以口服非甾体抗炎药，并继续留院观察。\nK. 停止静脉用药，改为口服头孢类抗生素，并立即办理出院。\nL. 予以颈部局部姑息性放疗，并完善甲状腺功能检查。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：不支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、颈动脉鞘、斜坡、翼突基底部、蝶骨基底部、岩尖等。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D22] 检验组合: 乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D25] 检验组合: 血小板分布宽度(PDW)-静脉血: 10.3%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；比重(SG)-尿液: 1.028；甘油三酯(TG)-静脉血: 1.05mmol/L；红细胞计数(RBC#)-静脉血: 3.4910E12/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.86mmolL；平均红细胞体积(MCV)-静脉血: 84.8fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 42.4；丙氨酸氨基转移酶(ALT)-静脉血: 14.8U/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.001；尿酸(UA)-静脉血: 132.3umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.910E9/L；大血小板百分比(P-LCR%)-静脉血: 21.8%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；粘液丝计数(MUCS#)-尿液: 28/μL；红细胞计数(RBC#)-尿液: 1/μL；浊度(TRUB)-尿液: 清亮；血小板计数(PLT#)-静脉血: 31810E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.218；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7；天门冬氨酸氨基转移酶(AST)-静脉血: 11.2U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.1；载脂蛋白AI(apoAI)-静脉血: 1.14g/L；单核细胞百分比(Mono%)-静脉血: 0.084；总钙(Ca)-静脉血: 2.2mmol/L；总胆汁酸(TBA)-静脉血: 4.4umol/L；白蛋白(ALB)-静脉血: 35.7g/L；红细胞比容(Hct)-静脉血: 29.6%；单核细胞计数(Mono#)-静脉血: 0.710E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 10.9U/L；平均血小板体积(MPV)-静脉血: 9.7fL；中性粒细胞计数(Neut#)-静脉血: 6.110E9/L；胆红素(BIL)-尿液: -（参考: 阴性）；血红蛋白(Hb)-静脉血: 100g/L；C-反应蛋白(CRP)-静脉血: 66.11mg/L；葡萄糖(Glu)-静脉血: 4.89mmol/L；磷(P)-静脉血: 1.26mmol/L；直接胆红素(DBIL……\n\n【既往治疗与反应】\n- [全程D22] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日在气管内全麻下行左颈淋巴结切除活检+经鼻内镜鼻咽肿物切开活检术。术程顺利，术后麻醉复苏顺利，安返病房，生命体征平稳，未见口鼻活动性出血。[姓名已隐去]主任查房后，指示予抗炎、止血和支持对症治疗，并注意：1、呼吸情况；2、出血情况，遵嘱执行。\n- [全程D23] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者昨日在气管内全麻下行左颈淋巴结切除活检+经鼻内镜鼻咽肿物切开活检术，目前生命体征平稳，未见口鼻活动性出血，颈部伤口少许渗出，引流条固定在位，诉头痛、颈部肿物痛、鼻部不适。[姓名已隐去]主任查房后，指示继续抗炎、支持治疗，遵嘱执行。\n- [全程D24] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者前日在气管内全麻下行左颈淋巴结切除活检+经鼻内镜鼻咽肿物切开活检术，目前生命体征平稳，未见口鼻活动性出血，颈部伤口已无明显渗出，诉头痛、颈部肿物痛。[姓名已隐去]主任查房后，拔出引流条，指示继续抗炎、止痛、支持治疗，遵嘱执行。\n- [全程D25] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者前3日在气管内全麻下行左颈淋巴结切除活检+经鼻内镜鼻咽肿物切开活检术，目前生命体征平稳，未见口鼻活动性出血，诉头痛、颈部肿物痛。[姓名已隐去]主任查房后，指示继续抗炎、支持治疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即启动含铂双药诱导化疗，并完善心电图及超声心动图检查。\nB. 予以静脉输注氨甲环酸，并完善凝血常规及D-二聚体检查。\nC. 安排右颈部淋巴结清扫术，并静脉使用广谱抗生素抗感染。\nD. 予以阿片类药物滴定止痛，并完善全身骨扫描检查。\nE. 继续抗炎及支持治疗，完善血常规、尿常规及生化常规检查。\nF. 启动根治性调强放射治疗，并复查鼻咽及颈部增强MRI。\nG. 予以静脉高营养支持治疗，并复查血浆EBV-DNA定量。\nH. 预防性皮下注射低分子肝素，并完善双下肢深静脉彩超。\nI. 予以静脉滴注地塞米松，并复查头颈部增强CT。\nJ. 拔除静脉留置针，仅予以口服非甾体抗炎药，并继续留院观察。\nK. 停止静脉用药，改为口服头孢类抗生素，并立即办理出院。\nL. 予以颈部局部姑息性放疗，并完善甲状腺功能检查。\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-3246297632d882a392dfe20a","patient_id":"patient-e45c55cc63c050892e6b2467","turn_id":"turn07","turn_position":6,"turn_type":"recurrence_or_salvage_decision","gold_letter":"F","gold_action":"完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检及颈部肿物活检术。","options":[{"letter":"A","text":"完善术前准备，在局麻下行经鼻内镜鼻咽肿物活检及颈部肿物活检术。","is_gold":false},{"letter":"B","text":"直接以颈部淋巴结转移性鳞癌及影像学表现为依据，开始诱导化疗。","is_gold":false},{"letter":"C","text":"完善术前准备，在全麻下仅行经鼻内镜鼻咽肿物活检术。","is_gold":false},{"letter":"D","text":"完善术前准备，在全麻下仅行颈部肿物切除活检术。","is_gold":false},{"letter":"E","text":"完善术前准备，在全麻下行鼻咽肿物活检术，并预防性切除双侧扁桃体。","is_gold":false},{"letter":"F","text":"完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检及颈部肿物活检术。","is_gold":true},{"letter":"G","text":"完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检，若为阴性则行颈部淋巴结清扫术。","is_gold":false},{"letter":"H","text":"暂缓活检，先行EBV-DNA及鼻咽部PET-CT检查，结果决定是否再次活检。","is_gold":false},{"letter":"I","text":"完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检及颈部肿物细针穿刺活检术。","is_gold":false},{"letter":"J","text":"完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检，并同期行鼻咽部及颈部放疗定位。","is_gold":false},{"letter":"K","text":"完善术前准备，在局麻下行颈部肿物切除活检，待病理确诊后再行鼻咽活检。","is_gold":false},{"letter":"L","text":"完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检及右侧颈部淋巴结清扫术。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：不支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、颈动脉鞘、斜坡、翼突基底部、蝶骨基底部、岩尖等。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D2] 入院记录: 主诉: 发现右颈部肿物5月余；现病史: 患者于入院前5月前（某次就诊时间10月）高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；阳性症状体征: 体重下降,疼痛,高热,右颈部肿物,颈部酸痛；既往史: 既往有“肾病综合征”病史，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。；家族史: 否认肿瘤家族史。；体格检查: T：36℃，P：68次/分，R：20次/分，BP：91/58mmHg,Ht：144cm，Wt：31kg，BSA：1.135m2，KPS：KPS 90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。；KPS: 90；ECOG:\n- [全程D1] 门急诊记录: 主诉: 右颈部肿物6月余；现病史: 患者某次就诊时间10月份高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；既往史: 肾病综合征。否认高血压、糖尿病、冠心病、肾病等慢性病史，否认乙肝、结核等传染病史，否认重大外伤史，否认献血输血及使用血制品史，否认食物药物过敏史。；个人史: 原籍出生长大，否认疫区疫水接触史，否认化学毒性及放射性物质接触史。；家族史: 否认家族类似病史及肿瘤病史。；体格检查: KPS90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 入院记录: 主诉: 发现右颈部肿物5月余；现病史: 患者于入院前5月前（某次就诊时间10月）高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。行右颈部肿物活检病理回报：提示鼻咽部鳞癌转移。鼻咽部MR示：鼻咽顶后壁及两侧壁粘膜增厚，右侧翼内肌、咽鼓管、头长肌受侵，右侧斜坡，颞骨岩部，寰椎前弓骨质破坏。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；阳性症状体征: 体重下降,疼痛,高热,右颈部肿物,颈部酸痛；既往史: 既往有“肾病综合征”病史，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。；家族史: 否认肿瘤家族史。；体格检查: T：36℃，P：68次/分，R：20次/分，BP：91/58mmHg,Ht：144cm，Wt：31kg，BSA：1.135m2，KPS：KPS 90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率{数值}次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。右颈扪及肿物，约4*3cm,无压痛，质硬，活动差，边界尚清，未扪及明显融合，活检伤口愈合良好。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D3] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见: 心电图大致正常；检查结论: 窦性心律不齐 心电图大致正常\n- [全程D3] 检验组合: 乳酸脱氢酶(LDH)-静脉血: 198.2U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 10.4U/L；总胆红素(TBIL)-静脉血: 4.2umol/L；葡萄糖(Glu)-静脉血: 4.55mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.495COI；α-L-岩藻糖苷酶(AFU)-静脉血: 35U/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；铁蛋白(Ferr)-静脉血: 91.44ng/ml；磷(P)-静脉血: 1.76mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阴性(-)（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.21ug/ml；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阳性(129.78U/mL)（参考: 阴性）；淋巴细胞百分比(Lymph%)-静脉血: 0.426；碱性磷酸酶(ALP)-静脉血: 130.2U/L；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；纤维蛋白原(Fbg)-静脉血: 2.78g/L；钾离子(K+)-静脉血: 3.5mmol/L；免疫球蛋白游离λ轻链(F-Lambda)-静脉血: 阴性(-)（参考: 阴性(-)）；平均血小板体积(MPV)-静脉血: 8.8fL；尿酸(UA)-静脉血: 200umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.24mmolL；天门冬氨酸氨基转移酶(AST)-静脉血: 18.5U/L；尿素氮(BUN)-静脉血: 3.59mmol/L；总胆固醇(TC)-静脉血: 3.29mmol/L；直接胆红素(DBIL)-静脉血: 1.6umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 11.9U/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.98；中性粒细胞百分比(Neut%)-静脉血: 0.516；肌酐(Crea)-静脉血: 35.7umol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞体积(MCV)-静脉血……\n- [全程D4] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约24cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D21] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显占位病变，肺门纵隔未见明显增宽，心影无增大，双侧肋膈角锐利。；检查结论: 心肺未见病变。\n- [全程D21] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 23mmol/L；总胆红素(TBIL)-静脉血: 7.6umol/L；C-反应蛋白(CRP)-静脉血: 4.9mg/L；总胆固醇(TC)-静脉血: 4.18mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.5mmolL；总胆汁酸(TBA)-静脉血: 2.5umol/L；血型抗体筛查-静脉血: 阴性；ABO血型-静脉血: B；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；大血小板百分比(P-LCR%)-静脉血: 24.7%；血小板比容-静脉血: 32%；血小板分布宽度(PDW)-静脉血: 11.1%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；总蛋白(TP)-静脉血: 74.14g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.011；平均红细胞血红蛋白含量(MCH)-静脉血: 28.1pg；白蛋白(ALB)-静脉血: 38.9g/L；甘油三酯(TG)-静脉血: 0.81mmol/L；磷(P)-静脉血: 1.55mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.1；直接胆红素(DBIL)-静脉血: 2.5umol/L；平均红细胞体积(MCV)-静脉血: 84.5fL；平均血小板体积(MPV)-静脉血: 10.1fL；钠离子(Na+)-静脉血: 136.6mmol/L；氯离子(Cl-)-静脉血: 101.1mmol/L；镁离子(Mg2+)-静脉血: 0.72mmol/L；肌酐(Crea)-静脉血: 33.8umol/L；Rh血型-静脉血: 阳性；载脂蛋白AI(apoAI)-静脉血: 1.34g/L；尿素氮(BUN)-静脉血: 5.75mmol/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；淋巴细胞计数(Lymph#)-静脉血: 2.810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.591；白细胞计数(WBC#)-静脉血: 8.5610E9/L；钾离子(K+)-静脉血: 4.3mmol/L；总钙(Ca)-静脉血: 2.26mmol/L；尿酸(UA)-静脉血: 204.9umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24.5U/L；有核红细胞计数(NRBC……\n- [全程D22] 检验组合: 乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D25] 检验组合: 血小板分布宽度(PDW)-静脉血: 10.3%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；比重(SG)-尿液: 1.028；甘油三酯(TG)-静脉血: 1.05mmol/L；红细胞计数(RBC#)-静脉血: 3.4910E12/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.86mmolL；平均红细胞体积(MCV)-静脉血: 84.8fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 42.4；丙氨酸氨基转移酶(ALT)-静脉血: 14.8U/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.001；尿酸(UA)-静脉血: 132.3umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.910E9/L；大血小板百分比(P-LCR%)-静脉血: 21.8%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；粘液丝计数(MUCS#)-尿液: 28/μL；红细胞计数(RBC#)-尿液: 1/μL；浊度(TRUB)-尿液: 清亮；血小板计数(PLT#)-静脉血: 31810E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.218；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7；天门冬氨酸氨基转移酶(AST)-静脉血: 11.2U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.1；载脂蛋白AI(apoAI)-静脉血: 1.14g/L；单核细胞百分比(Mono%)-静脉血: 0.084；总钙(Ca)-静脉血: 2.2mmol/L；总胆汁酸(TBA)-静脉血: 4.4umol/L；白蛋白(ALB)-静脉血: 35.7g/L；红细胞比容(Hct)-静脉血: 29.6%；单核细胞计数(Mono#)-静脉血: 0.710E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 10.9U/L；平均血小板体积(MPV)-静脉血: 9.7fL；中性粒细胞计数(Neut#)-静脉血: 6.110E9/L；胆红素(BIL)-尿液: -（参考: 阴性）；血红蛋白(Hb)-静脉血: 100g/L；C-反应蛋白(CRP)-静脉血: 66.11mg/L；葡萄糖(Glu)-静脉血: 4.89mmol/L；磷(P)-静脉血: 1.26mmol/L；直接胆红素(DBIL……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D3] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日随夏医生信息已隐藏，患者颈背部酸痛较前有好转，无发热畏寒，无恶心呕吐，无胸闷心悸，胃纳睡眠尚可，二便未见明显异常，体查：KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。右颈扪及肿物，约4*3cm,无压痛，质硬，活动差，边界尚清，未扪及明显融合，活检伤口愈合良好。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。右颈部肿物活检病理回报：提示鼻咽部鳞癌转移。鼻咽部MR示：鼻咽顶后壁及两侧壁粘膜增厚，右侧翼内肌、咽鼓管、头长肌受侵，右侧斜坡，颞骨岩部，寰椎前弓骨质破坏。目前患者诊断：鼻咽癌，患者病理活检部位为右颈部肿物，提示转移性鳞癌，建议其行鼻咽部肿物病理活检，患者家属不同意，有放疗适应症，无相对放疗禁忌症，告知患者放疗风险及副反应，患者家属表示理解病情，现治疗后患者要求出院，予以办理，嘱注意休息合理饮食，定期复诊，不适随诊。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D19] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。凝血、乙肝两对半、肝炎四项、HIV/梅毒等检验结果无明显异常。[姓名已隐去]主任查房后，患者因年龄较小，完成活检等操作不配合，家属要求全麻下行活检明确病理，完善相关检查后择期手术，遵嘱执行。\n- [全程D20] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。[姓名已隐去]主任查房后示，完善术前相关检验检查，做好术前准备，遵嘱执行。\n- [全程D21] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。血常规、生化常规回报无明显异常。输血三项回报：B型、RH阳性、抗体筛选阴性。[姓名已隐去]主任查房后示，结合患者各项检查，未见明显手术禁忌，拟明日在气管内吸入全麻下经鼻内镜行鼻咽肿物活检+颈部肿物活检术，做好术前准备，遵嘱执行。\n- [全程D22] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日在气管内全麻下行左颈淋巴结切除活检+经鼻内镜鼻咽肿物切开活检术。术程顺利，术后麻醉复苏顺利，安返病房，生命体征平稳，未见口鼻活动性出血。[姓名已隐去]主任查房后，指示予抗炎、止血和支持对症治疗，并注意：1、呼吸情况；2、出血情况，遵嘱执行。\n- [全程D23] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者昨日在气管内全麻下行左颈淋巴结切除活检+经鼻内镜鼻咽肿物切开活检术，目前生命体征平稳，未见口鼻活动性出血，颈部伤口少许渗出，引流条固定在位，诉头痛、颈部肿物痛、鼻部不适。[姓名已隐去]主任查房后，指示继续抗炎、支持治疗，遵嘱执行。\n- [全程D24] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者前日在气管内全麻下行左颈淋巴结切除活检+经鼻内镜鼻咽肿物切开活检术，目前生命体征平稳，未见口鼻活动性出血，颈部伤口已无明显渗出，诉头痛、颈部肿物痛。[姓名已隐去]主任查房后，拔出引流条，指示继续抗炎、止痛、支持治疗，遵嘱执行。\n- [全程D25] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者前3日在气管内全麻下行左颈淋巴结切除活检+经鼻内镜鼻咽肿物切开活检术，目前生命体征平稳，未见口鼻活动性出血，诉头痛、颈部肿物痛。[姓名已隐去]主任查房后，指示继续抗炎、支持治疗。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善术前准备，在局麻下行经鼻内镜鼻咽肿物活检及颈部肿物活检术。\nB. 直接以颈部淋巴结转移性鳞癌及影像学表现为依据，开始诱导化疗。\nC. 完善术前准备，在全麻下仅行经鼻内镜鼻咽肿物活检术。\nD. 完善术前准备，在全麻下仅行颈部肿物切除活检术。\nE. 完善术前准备，在全麻下行鼻咽肿物活检术，并预防性切除双侧扁桃体。\nF. 完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检及颈部肿物活检术。\nG. 完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检，若为阴性则行颈部淋巴结清扫术。\nH. 暂缓活检，先行EBV-DNA及鼻咽部PET-CT检查，结果决定是否再次活检。\nI. 完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检及颈部肿物细针穿刺活检术。\nJ. 完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检，并同期行鼻咽部及颈部放疗定位。\nK. 完善术前准备，在局麻下行颈部肿物切除活检，待病理确诊后再行鼻咽活检。\nL. 完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检及右侧颈部淋巴结清扫术。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- 无可展示记录。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善术前准备，在局麻下行经鼻内镜鼻咽肿物活检及颈部肿物活检术。\nB. 直接以颈部淋巴结转移性鳞癌及影像学表现为依据，开始诱导化疗。\nC. 完善术前准备，在全麻下仅行经鼻内镜鼻咽肿物活检术。\nD. 完善术前准备，在全麻下仅行颈部肿物切除活检术。\nE. 完善术前准备，在全麻下行鼻咽肿物活检术，并预防性切除双侧扁桃体。\nF. 完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检及颈部肿物活检术。\nG. 完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检，若为阴性则行颈部淋巴结清扫术。\nH. 暂缓活检，先行EBV-DNA及鼻咽部PET-CT检查，结果决定是否再次活检。\nI. 完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检及颈部肿物细针穿刺活检术。\nJ. 完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检，并同期行鼻咽部及颈部放疗定位。\nK. 完善术前准备，在局麻下行颈部肿物切除活检，待病理确诊后再行鼻咽活检。\nL. 完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检及右侧颈部淋巴结清扫术。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：不支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、颈动脉鞘、斜坡、翼突基底部、蝶骨基底部、岩尖等。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- 无可展示记录。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善术前准备，在局麻下行经鼻内镜鼻咽肿物活检及颈部肿物活检术。\nB. 直接以颈部淋巴结转移性鳞癌及影像学表现为依据，开始诱导化疗。\nC. 完善术前准备，在全麻下仅行经鼻内镜鼻咽肿物活检术。\nD. 完善术前准备，在全麻下仅行颈部肿物切除活检术。\nE. 完善术前准备，在全麻下行鼻咽肿物活检术，并预防性切除双侧扁桃体。\nF. 完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检及颈部肿物活检术。\nG. 完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检，若为阴性则行颈部淋巴结清扫术。\nH. 暂缓活检，先行EBV-DNA及鼻咽部PET-CT检查，结果决定是否再次活检。\nI. 完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检及颈部肿物细针穿刺活检术。\nJ. 完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检，并同期行鼻咽部及颈部放疗定位。\nK. 完善术前准备，在局麻下行颈部肿物切除活检，待病理确诊后再行鼻咽活检。\nL. 完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检及右侧颈部淋巴结清扫术。\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-da812d38ab5771a5dbc8fc87","patient_id":"patient-e45c55cc63c050892e6b2467","turn_id":"turn08","turn_position":7,"turn_type":"recurrence_or_salvage_decision","gold_letter":"G","gold_action":"继续根治性放疗，完善电子鼻咽镜检查，并予以肠内营养支持及定期复查血常规。","options":[{"letter":"A","text":"终止放化疗，转为手术切除鼻咽原发灶及颈部残留淋巴结。","is_gold":false},{"letter":"B","text":"暂停放疗，予以静脉抗感染治疗，2周后恢复放疗。","is_gold":false},{"letter":"C","text":"重新定位并修改放疗计划，缩减原发灶及颈部淋巴结的照射靶区，继续放疗。","is_gold":false},{"letter":"D","text":"提前结束放疗，改为单药靶向治疗或PD-1抑制剂维持治疗。","is_gold":false},{"letter":"E","text":"继续根治性放疗，停用原化疗方案，改用吉西他滨联合顺铂方案化疗。","is_gold":false},{"letter":"F","text":"暂停治疗，完善全身PET-CT检查评估远处转移情况，再决定后续方案。","is_gold":false},{"letter":"G","text":"继续根治性放疗，完善电子鼻咽镜检查，并予以肠内营养支持及定期复查血常规。","is_gold":true},{"letter":"H","text":"终止放化疗，转为定期随访观察，3个月后复查鼻咽及颈部MRI。","is_gold":false},{"letter":"I","text":"继续根治性放疗，常规加用大剂量地塞米松以减轻局部黏膜炎症反应。","is_gold":false},{"letter":"J","text":"暂停放疗，行右颈部残留淋巴结穿刺活检明确病理，再制定后续治疗计划。","is_gold":false},{"letter":"K","text":"继续根治性放疗，并择期行右侧颈部淋巴结清扫术。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：不支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、颈动脉鞘、斜坡、翼突基底部、蝶骨基底部、岩尖等。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D2] 入院记录: 主诉: 发现右颈部肿物5月余；现病史: 患者于入院前5月前（某次就诊时间10月）高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；阳性症状体征: 体重下降,疼痛,高热,右颈部肿物,颈部酸痛；既往史: 既往有“肾病综合征”病史，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。；家族史: 否认肿瘤家族史。；体格检查: T：36℃，P：68次/分，R：20次/分，BP：91/58mmHg,Ht：144cm，Wt：31kg，BSA：1.135m2，KPS：KPS 90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。；KPS: 90；ECOG:\n- [全程D1] 门急诊记录: 主诉: 右颈部肿物6月余；现病史: 患者某次就诊时间10月份高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；既往史: 肾病综合征。否认高血压、糖尿病、冠心病、肾病等慢性病史，否认乙肝、结核等传染病史，否认重大外伤史，否认献血输血及使用血制品史，否认食物药物过敏史。；个人史: 原籍出生长大，否认疫区疫水接触史，否认化学毒性及放射性物质接触史。；家族史: 否认家族类似病史及肿瘤病史。；体格检查: KPS90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 入院记录: 主诉: 发现右颈部肿物5月余；现病史: 患者于入院前5月前（某次就诊时间10月）高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。行右颈部肿物活检病理回报：提示鼻咽部鳞癌转移。鼻咽部MR示：鼻咽顶后壁及两侧壁粘膜增厚，右侧翼内肌、咽鼓管、头长肌受侵，右侧斜坡，颞骨岩部，寰椎前弓骨质破坏。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；阳性症状体征: 体重下降,疼痛,高热,右颈部肿物,颈部酸痛；既往史: 既往有“肾病综合征”病史，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。；家族史: 否认肿瘤家族史。；体格检查: T：36℃，P：68次/分，R：20次/分，BP：91/58mmHg,Ht：144cm，Wt：31kg，BSA：1.135m2，KPS：KPS 90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率{数值}次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。右颈扪及肿物，约4*3cm,无压痛，质硬，活动差，边界尚清，未扪及明显融合，活检伤口愈合良好。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D3] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见: 心电图大致正常；检查结论: 窦性心律不齐 心电图大致正常\n- [全程D3] 检验组合: 乳酸脱氢酶(LDH)-静脉血: 198.2U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 10.4U/L；总胆红素(TBIL)-静脉血: 4.2umol/L；葡萄糖(Glu)-静脉血: 4.55mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.495COI；α-L-岩藻糖苷酶(AFU)-静脉血: 35U/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；铁蛋白(Ferr)-静脉血: 91.44ng/ml；磷(P)-静脉血: 1.76mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阴性(-)（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.21ug/ml；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阳性(129.78U/mL)（参考: 阴性）；淋巴细胞百分比(Lymph%)-静脉血: 0.426；碱性磷酸酶(ALP)-静脉血: 130.2U/L；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；纤维蛋白原(Fbg)-静脉血: 2.78g/L；钾离子(K+)-静脉血: 3.5mmol/L；免疫球蛋白游离λ轻链(F-Lambda)-静脉血: 阴性(-)（参考: 阴性(-)）；平均血小板体积(MPV)-静脉血: 8.8fL；尿酸(UA)-静脉血: 200umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.24mmolL；天门冬氨酸氨基转移酶(AST)-静脉血: 18.5U/L；尿素氮(BUN)-静脉血: 3.59mmol/L；总胆固醇(TC)-静脉血: 3.29mmol/L；直接胆红素(DBIL)-静脉血: 1.6umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 11.9U/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.98；中性粒细胞百分比(Neut%)-静脉血: 0.516；肌酐(Crea)-静脉血: 35.7umol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞体积(MCV)-静脉血……\n- [全程D4] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约24cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D21] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显占位病变，肺门纵隔未见明显增宽，心影无增大，双侧肋膈角锐利。；检查结论: 心肺未见病变。\n- [全程D21] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 23mmol/L；总胆红素(TBIL)-静脉血: 7.6umol/L；C-反应蛋白(CRP)-静脉血: 4.9mg/L；总胆固醇(TC)-静脉血: 4.18mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.5mmolL；总胆汁酸(TBA)-静脉血: 2.5umol/L；血型抗体筛查-静脉血: 阴性；ABO血型-静脉血: B；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；大血小板百分比(P-LCR%)-静脉血: 24.7%；血小板比容-静脉血: 32%；血小板分布宽度(PDW)-静脉血: 11.1%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；总蛋白(TP)-静脉血: 74.14g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.011；平均红细胞血红蛋白含量(MCH)-静脉血: 28.1pg；白蛋白(ALB)-静脉血: 38.9g/L；甘油三酯(TG)-静脉血: 0.81mmol/L；磷(P)-静脉血: 1.55mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.1；直接胆红素(DBIL)-静脉血: 2.5umol/L；平均红细胞体积(MCV)-静脉血: 84.5fL；平均血小板体积(MPV)-静脉血: 10.1fL；钠离子(Na+)-静脉血: 136.6mmol/L；氯离子(Cl-)-静脉血: 101.1mmol/L；镁离子(Mg2+)-静脉血: 0.72mmol/L；肌酐(Crea)-静脉血: 33.8umol/L；Rh血型-静脉血: 阳性；载脂蛋白AI(apoAI)-静脉血: 1.34g/L；尿素氮(BUN)-静脉血: 5.75mmol/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；淋巴细胞计数(Lymph#)-静脉血: 2.810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.591；白细胞计数(WBC#)-静脉血: 8.5610E9/L；钾离子(K+)-静脉血: 4.3mmol/L；总钙(Ca)-静脉血: 2.26mmol/L；尿酸(UA)-静脉血: 204.9umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24.5U/L；有核红细胞计数(NRBC……\n- [全程D22] 检验组合: 乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D25] 检验组合: 血小板分布宽度(PDW)-静脉血: 10.3%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；比重(SG)-尿液: 1.028；甘油三酯(TG)-静脉血: 1.05mmol/L；红细胞计数(RBC#)-静脉血: 3.4910E12/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.86mmolL；平均红细胞体积(MCV)-静脉血: 84.8fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 42.4；丙氨酸氨基转移酶(ALT)-静脉血: 14.8U/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.001；尿酸(UA)-静脉血: 132.3umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.910E9/L；大血小板百分比(P-LCR%)-静脉血: 21.8%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；粘液丝计数(MUCS#)-尿液: 28/μL；红细胞计数(RBC#)-尿液: 1/μL；浊度(TRUB)-尿液: 清亮；血小板计数(PLT#)-静脉血: 31810E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.218；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7；天门冬氨酸氨基转移酶(AST)-静脉血: 11.2U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.1；载脂蛋白AI(apoAI)-静脉血: 1.14g/L；单核细胞百分比(Mono%)-静脉血: 0.084；总钙(Ca)-静脉血: 2.2mmol/L；总胆汁酸(TBA)-静脉血: 4.4umol/L；白蛋白(ALB)-静脉血: 35.7g/L；红细胞比容(Hct)-静脉血: 29.6%；单核细胞计数(Mono#)-静脉血: 0.710E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 10.9U/L；平均血小板体积(MPV)-静脉血: 9.7fL；中性粒细胞计数(Neut#)-静脉血: 6.110E9/L；胆红素(BIL)-尿液: -（参考: 阴性）；血红蛋白(Hb)-静脉血: 100g/L；C-反应蛋白(CRP)-静脉血: 66.11mg/L；葡萄糖(Glu)-静脉血: 4.89mmol/L；磷(P)-静脉血: 1.26mmol/L；直接胆红素(DBIL……\n- [全程D45] 检验组合: 红细胞计数(RBC#)-静脉血: 4.0510E12/L；淋巴细胞百分比(Lymph%)-静脉血: 0.347；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.42mmolL；磷(P)-静脉血: 1.77mmol/L；肌酐(Crea)-静脉血: 30.1umol/L；总胆红素(TBIL)-静脉血: 3.5umol/L；白蛋白(ALB)-静脉血: 41.3g/L；钾离子(K+)-静脉血: 4.49mmol/L；总胆固醇(TC)-静脉血: 4.9mmol/L；直接胆红素(DBIL)-静脉血: 1.1umol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；碱性磷酸酶(ALP)-静脉血: 147.1U/L；镁离子(Mg2+)-静脉血: 0.84mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 16.5U/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.1mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 15；淋巴细胞计数(Lymph#)-静脉血: 2.210E9/L；球蛋白(GLO)-静脉血: 35g/L；血红蛋白(Hb)-静脉血: 115g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.4pg；总蛋白(TP)-静脉血: 76.3g/L；H2U:U-静脉血: 2.1；尿酸(UA)-静脉血: 236.8umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.18；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.36；白细胞计数(WBC#)-静脉血: 6.4610E9/L；血小板分布宽度(PDW)-静脉血: 8.7%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；乳酸脱氢酶(LDH)-静脉血: 195.6U/L；间接胆红素(IBIL)-静脉血: 2.4umolL；葡萄糖(Glu)-静脉血: 4.66mmol/L；总胆汁酸(TBA)-静脉血: 6.1umol/L；阴离子间隙(AG)-静脉血: 14.5；总钙(Ca)-静脉血: 2.36mmol/L；平均红细胞体积(MCV)-静脉血: 85.9fL；α-L-岩藻糖苷酶(AFU)-静脉血: 35.1U/L；甘油三酯(TG)-静脉血: 1.29mmol/L；大血小板百分比(P-LCR%)-静脉血: 14.3%；嗜碱性……\n- [全程D52] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 25mmol/L；总胆红素(TBIL)-静脉血: 7.6umol/L；磷(P)-静脉血: 1.66mmol/L；阴离子间隙(AG)-静脉血: 13.5；肌酐(Crea)-静脉血: 31.2umol/L；载脂蛋白B(apoB)-静脉血: 0.98g/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞计数(Neut#)-静脉血: 210E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 16.5U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.048；单核细胞百分比(Mono%)-静脉血: 0.082；总蛋白(TP)-静脉血: 76.7g/L；甘油三酯(TG)-静脉血: 0.86mmol/L；直接胆红素(DBIL)-静脉血: 2.21umol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；钾离子(K+)-静脉血: 4.11mmol/L；红细胞比容(Hct)-静脉血: 35.1%；葡萄糖(Glu)-静脉血: 4.64mmol/L；血红蛋白(Hb)-静脉血: 117g/L；乳酸脱氢酶(LDH)-静脉血: 217.1U/L；总胆固醇(TC)-静脉血: 5.39mmol/L；白蛋白(ALB)-静脉血: 42.7g/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；钠离子(Na+)-静脉血: 138.9mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 43.6U/L；淋巴细胞计数(Lymph#)-静脉血: 1.210E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.7pg；血小板计数(PLT#)-静脉血: 19610E9/L；白细胞计数(WBC#)-静脉血: 3.7710E9/L；平均血小板体积(MPV)-静脉血: 9.2fL；中性粒细胞百分比(Neut%)-静脉血: 0.536；H2U:U-静脉血: 1.99；间接胆红素(IBIL)-静脉血: 5.39umolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 15.7；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.6mmolL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 49.1；平均……\n- [全程D58] 检验组合: 总钙(Ca)-静脉血: 2.42mmol/L；乳酸脱氢酶(LDH)-静脉血: 177.8U/L；总蛋白(TP)-静脉血: 73.37g/L；C-反应蛋白(CRP)-静脉血: 0.68mg/L；血红蛋白(Hb)-静脉血: 111g/L；尿素氮(BUN)-静脉血: 3.6mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.38mmol/L；总胆固醇(TC)-静脉血: 5.13mmol/L；总胆汁酸(TBA)-静脉血: 5.2umol/L；直接胆红素(DBIL)-静脉血: 0.2umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.323；大血小板百分比(P-LCR%)-静脉血: 15.4%；载脂蛋白AI(apoAI)-静脉血: 1.42g/L；白蛋白(ALB)-静脉血: 42.1g/L；磷(P)-静脉血: 1.65mmol/L；淋巴细胞计数(Lymph#)-静脉血: 0.910E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.16；钠离子(Na+)-静脉血: 140.4mmol/L；血小板分布宽度(PDW)-静脉血: 9.2%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；中性粒细胞百分比(Neut%)-静脉血: 0.516；单核细胞计数(Mono#)-静脉血: 0.310E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 22.6U/L；丙氨酸氨基转移酶(ALT)-静脉血: 19.4U/L；红细胞计数(RBC#)-静脉血: 3.7910E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 15.6；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.069；血小板比容-静脉血: 16%；钾离子(K+)-静脉血: 4.5mmol/L；阴离子间隙(AG)-静脉血: 13.5；肌酐(Crea)-静脉血: 35.9umol/L；球蛋白(GLO)-静脉血: 31.27g/L；氯离子(Cl-)-静脉血: 103.5mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；间接胆红素(IBIL)-静脉血: 5umolL；白细胞计数(WBC#)-静脉血: 2.9110E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.35mmolL；α-L-岩藻糖苷酶(AFU)-静脉血: 30……\n- [全程D60] 检验组合: H2U:U-静脉血: 2.1；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.011；淋巴细胞百分比(Lymph%)-静脉血: 0.214；单核细胞计数(Mono#)-静脉血: 0.510E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 50；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 333g/L；红细胞计数(RBC#)-静脉血: 3.4910E12/L；血小板比容-静脉血: 17%；白细胞计数(WBC#)-静脉血: 3.610E9/L；血小板分布宽度(PDW)-静脉血: 9.6%；单核细胞百分比(Mono%)-静脉血: 0.136；血小板计数(PLT#)-静脉血: 18110E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；红细胞比容(Hct)-静脉血: 30.9%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 15.8；平均红细胞血红蛋白含量(MCH)-静脉血: 29.5pg；平均血小板体积(MPV)-静脉血: 9.3fL；大血小板百分比(P-LCR%)-静脉血: 18.6%；中性粒细胞计数(Neut#)-静脉血: 2.310E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；血红蛋白(Hb)-静脉血: 103g/L；平均红细胞体积(MCV)-静脉血: 88.5fL；中性粒细胞百分比(Neut%)-静脉血: 0.636\n- [全程D62] 检验组合: 血红蛋白(Hb)-静脉血: 113g/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；白细胞计数(WBC#)-静脉血: 1.910E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.032；中性粒细胞百分比(Neut%)-静脉血: 0.532；血小板计数(PLT#)-静脉血: 21510E9/L；红细胞计数(RBC#)-静脉血: 3.7810E12/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 49.3；平均红细胞血红蛋白含量(MCH)-静脉血: 29.9pg；淋巴细胞百分比(Lymph%)-静脉血: 0.284；有核红细胞计数(NRBC#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 15.4；中性粒细胞计数(Neut#)-静脉血: 110E9/L；血小板比容-静脉血: 20%；大血小板百分比(P-LCR%)-静脉血: 17.6%；单核细胞百分比(Mono%)-静脉血: 0.147；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；红细胞比容(Hct)-静脉血: 33.1%；血小板分布宽度(PDW)-静脉血: 9.4%；平均红细胞体积(MCV)-静脉血: 87.6fL；平均血小板体积(MPV)-静脉血: 9.1fL\n- [全程D65] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔稍狭窄，原鼻咽肿物现明显缩小，病变累及右侧咽隐窝，侵犯右侧咽旁脂肪间隙、右颈动脉鞘区、右侧咽后脂肪间隙及椎前间隙。右侧腭帆提肌、头长肌、颈长肌、右侧腭帆张肌及右侧翼内肌。 双侧翼腭窝、咀嚼肌间隙未见异常。口咽双侧壁未见受累增厚，双侧后鼻孔未见受累。双侧扁桃体未见明显异常。 右侧破裂孔、卵圆孔、舌下神经管内见少许软组织影，增强扫描明显强化。斜坡后缘脑膜增厚，增强扫描明显强化。双侧海绵窦未见增宽。 斜坡、蝶骨基底部、枕骨基底部、蝶骨基底部、右侧蝶骨大翼、寰椎右侧侧块、右侧枕骨髁、右侧翼突、右侧岩尖骨髓信号减低，增强扫描明显强化。 双侧筛窦、蝶窦及双侧乳突粘膜增厚。双侧乳突可见分泌物。双侧上颌窦充气良好。 双眼大小、形态、位置及信号未见异常，球后未见占位性病变。蝶鞍形态未见异常，其内未见占位性病变。 左侧咽后可见小淋巴结，短径约4mm，边界较清，增强扫描明显强化。右侧咽后可见肿大淋巴结，与鼻咽病变分界不清，增强扫描明显强化。颈右侧II、III区可见多个淋巴结，部分融合，较大范围约14mm×17mm，增强扫描明显强化。颈左侧II区、双侧Ⅲ、Ⅳ区可见多发小淋巴结，增强扫描轻度强化。 甲状腺双叶及峡部形态未见异常，信号均匀，未见占位性病变。喉咽腔形态未见异常，未见占位性病变。双侧颌下腺、腮腺大小、形态未见异常，信号均匀，未见占位性病变。 所见脑内未见明显异常。；检查结论: 鼻咽癌放疗后，与某次就诊时间MR相比： 鼻咽肿物较前明显缩小。 颅底骨质破坏，大致同前。 右侧咽后、颈右侧II、III区多个肿大淋巴结，考虑转移，较前缩小。 左侧咽后、颈左侧II区、双侧III、IV区小淋巴结，较前缩小。 双侧筛窦、蝶窦及双侧乳突炎。\n- [全程D65] 检验组合: 平均红细胞血红蛋白浓度(MCHC)-静脉血: 337g/L；大血小板百分比(P-LCR%)-静脉血: 18.8%；单核细胞计数(Mono#)-静脉血: 1.410E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；平均红细胞血红蛋白含量(MCH)-静脉血: 29.8pg；血小板计数(PLT#)-静脉血: 19110E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 16.2；红细胞比容(Hct)-静脉血: 33.8%；中性粒细胞计数(Neut#)-静脉血: 10.510E9/L；白细胞计数(WBC#)-静脉血: 13.2210E9/L；血红蛋白(Hb)-静脉血: 114g/L；红细胞计数(RBC#)-静脉血: 3.8210E12/L；血小板分布宽度(PDW)-静脉血: 10.3%；淋巴细胞百分比(Lymph%)-静脉血: 0.091；中性粒细胞百分比(Neut%)-静脉血: 0.796；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.007；红细胞体积分布宽度SD(RDW-SD)-静脉血: 49.5；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.210E9/L；平均红细胞体积(MCV)-静脉血: 88.5fL；血小板比容-静脉血: 18%；单核细胞百分比(Mono%)-静脉血: 0.104；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均血小板体积(MPV)-静脉血: 9.2fL\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D3] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日随夏医生信息已隐藏，患者颈背部酸痛较前有好转，无发热畏寒，无恶心呕吐，无胸闷心悸，胃纳睡眠尚可，二便未见明显异常，体查：KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。右颈扪及肿物，约4*3cm,无压痛，质硬，活动差，边界尚清，未扪及明显融合，活检伤口愈合良好。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。右颈部肿物活检病理回报：提示鼻咽部鳞癌转移。鼻咽部MR示：鼻咽顶后壁及两侧壁粘膜增厚，右侧翼内肌、咽鼓管、头长肌受侵，右侧斜坡，颞骨岩部，寰椎前弓骨质破坏。目前患者诊断：鼻咽癌，患者病理活检部位为右颈部肿物，提示转移性鳞癌，建议其行鼻咽部肿物病理活检，患者家属不同意，有放疗适应症，无相对放疗禁忌症，告知患者放疗风险及副反应，患者家属表示理解病情，现治疗后患者要求出院，予以办理，嘱注意休息合理饮食，定期复诊，不适随诊。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D19] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。凝血、乙肝两对半、肝炎四项、HIV/梅毒等检验结果无明显异常。[姓名已隐去]主任查房后，患者因年龄较小，完成活检等操作不配合，家属要求全麻下行活检明确病理，完善相关检查后择期手术，遵嘱执行。\n- [全程D20] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。[姓名已隐去]主任查房后示，完善术前相关检验检查，做好术前准备，遵嘱执行。\n- [全程D21] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。血常规、生化常规回报无明显异常。输血三项回报：B型、RH阳性、抗体筛选阴性。[姓名已隐去]主任查房后示，结合患者各项检查，未见明显手术禁忌，拟明日在气管内吸入全麻下经鼻内镜行鼻咽肿物活检+颈部肿物活检术，做好术前准备，遵嘱执行。\n- [全程D22] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日在气管内全麻下行左颈淋巴结切除活检+经鼻内镜鼻咽肿物切开活检术。术程顺利，术后麻醉复苏顺利，安返病房，生命体征平稳，未见口鼻活动性出血。[姓名已隐去]主任查房后，指示予抗炎、止血和支持对症治疗，并注意：1、呼吸情况；2、出血情况，遵嘱执行。\n- [全程D23] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者昨日在气管内全麻下行左颈淋巴结切除活检+经鼻内镜鼻咽肿物切开活检术，目前生命体征平稳，未见口鼻活动性出血，颈部伤口少许渗出，引流条固定在位，诉头痛、颈部肿物痛、鼻部不适。[姓名已隐去]主任查房后，指示继续抗炎、支持治疗，遵嘱执行。\n- [全程D24] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者前日在气管内全麻下行左颈淋巴结切除活检+经鼻内镜鼻咽肿物切开活检术，目前生命体征平稳，未见口鼻活动性出血，颈部伤口已无明显渗出，诉头痛、颈部肿物痛。[姓名已隐去]主任查房后，拔出引流条，指示继续抗炎、止痛、支持治疗，遵嘱执行。\n- [全程D25] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者前3日在气管内全麻下行左颈淋巴结切除活检+经鼻内镜鼻咽肿物切开活检术，目前生命体征平稳，未见口鼻活动性出血，诉头痛、颈部肿物痛。[姓名已隐去]主任查房后，指示继续抗炎、支持治疗。\n- [全程D52] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 现患者局部放疗3次，同期PF30d 化疗第19日，无特殊不适主诉。查体大致同前。复查生化常规未见异常，血常规示白细胞I度降低。[姓名已隐去]医生信息已隐藏示，患者一般状况好，继续放化疗。\n- [全程D55] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 现患者局部放疗4次，同期PF30d 化疗第22日，无特殊不适主诉。查体见颈部淋巴结较前缩小。血常规、生化未见异常。继续放化疗。\n- [全程D58] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 现患者局部放疗6次，同期PF30d 化疗第25日，无特殊不适主诉。查体见颈部淋巴结较前缩小。血常规示：白细胞计数(白细胞计数(WBC)) 2.91 10E9/L；[姓名已隐去]医生信息已隐藏示：予纠正白细胞治疗，继续放化疗。\n- [全程D64] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 现患者局部放疗10次，无特殊不适主诉。查体见颈部淋巴结较前缩小。血常规示：白细胞计数(白细胞计数(WBC)) 1.90 10E9/L；予升白细胞治疗，继续放疗。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 终止放化疗，转为手术切除鼻咽原发灶及颈部残留淋巴结。\nB. 暂停放疗，予以静脉抗感染治疗，2周后恢复放疗。\nC. 重新定位并修改放疗计划，缩减原发灶及颈部淋巴结的照射靶区，继续放疗。\nD. 提前结束放疗，改为单药靶向治疗或PD-1抑制剂维持治疗。\nE. 继续根治性放疗，停用原化疗方案，改用吉西他滨联合顺铂方案化疗。\nF. 暂停治疗，完善全身PET-CT检查评估远处转移情况，再决定后续方案。\nG. 继续根治性放疗，完善电子鼻咽镜检查，并予以肠内营养支持及定期复查血常规。\nH. 终止放化疗，转为定期随访观察，3个月后复查鼻咽及颈部MRI。\nI. 继续根治性放疗，常规加用大剂量地塞米松以减轻局部黏膜炎症反应。\nJ. 暂停放疗，行右颈部残留淋巴结穿刺活检明确病理，再制定后续治疗计划。\nK. 继续根治性放疗，并择期行右侧颈部淋巴结清扫术。\n\n请仅输出一个选项字母（A-K）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D45] 检验组合: 红细胞计数(RBC#)-静脉血: 4.0510E12/L；淋巴细胞百分比(Lymph%)-静脉血: 0.347；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.42mmolL；磷(P)-静脉血: 1.77mmol/L；肌酐(Crea)-静脉血: 30.1umol/L；总胆红素(TBIL)-静脉血: 3.5umol/L；白蛋白(ALB)-静脉血: 41.3g/L；钾离子(K+)-静脉血: 4.49mmol/L；总胆固醇(TC)-静脉血: 4.9mmol/L；直接胆红素(DBIL)-静脉血: 1.1umol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；碱性磷酸酶(ALP)-静脉血: 147.1U/L；镁离子(Mg2+)-静脉血: 0.84mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 16.5U/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.1mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 15；淋巴细胞计数(Lymph#)-静脉血: 2.210E9/L；球蛋白(GLO)-静脉血: 35g/L；血红蛋白(Hb)-静脉血: 115g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.4pg；总蛋白(TP)-静脉血: 76.3g/L；H2U:U-静脉血: 2.1；尿酸(UA)-静脉血: 236.8umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.18；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.36；白细胞计数(WBC#)-静脉血: 6.4610E9/L；血小板分布宽度(PDW)-静脉血: 8.7%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；乳酸脱氢酶(LDH)-静脉血: 195.6U/L；间接胆红素(IBIL)-静脉血: 2.4umolL；葡萄糖(Glu)-静脉血: 4.66mmol/L；总胆汁酸(TBA)-静脉血: 6.1umol/L；阴离子间隙(AG)-静脉血: 14.5；总钙(Ca)-静脉血: 2.36mmol/L；平均红细胞体积(MCV)-静脉血: 85.9fL；α-L-岩藻糖苷酶(AFU)-静脉血: 35.1U/L；甘油三酯(TG)-静脉血: 1.29mmol/L；大血小板百分比(P-LCR%)-静脉血: 14.3%；嗜碱性……\n- [全程D52] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 25mmol/L；总胆红素(TBIL)-静脉血: 7.6umol/L；磷(P)-静脉血: 1.66mmol/L；阴离子间隙(AG)-静脉血: 13.5；肌酐(Crea)-静脉血: 31.2umol/L；载脂蛋白B(apoB)-静脉血: 0.98g/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞计数(Neut#)-静脉血: 210E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 16.5U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.048；单核细胞百分比(Mono%)-静脉血: 0.082；总蛋白(TP)-静脉血: 76.7g/L；甘油三酯(TG)-静脉血: 0.86mmol/L；直接胆红素(DBIL)-静脉血: 2.21umol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；钾离子(K+)-静脉血: 4.11mmol/L；红细胞比容(Hct)-静脉血: 35.1%；葡萄糖(Glu)-静脉血: 4.64mmol/L；血红蛋白(Hb)-静脉血: 117g/L；乳酸脱氢酶(LDH)-静脉血: 217.1U/L；总胆固醇(TC)-静脉血: 5.39mmol/L；白蛋白(ALB)-静脉血: 42.7g/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；钠离子(Na+)-静脉血: 138.9mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 43.6U/L；淋巴细胞计数(Lymph#)-静脉血: 1.210E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.7pg；血小板计数(PLT#)-静脉血: 19610E9/L；白细胞计数(WBC#)-静脉血: 3.7710E9/L；平均血小板体积(MPV)-静脉血: 9.2fL；中性粒细胞百分比(Neut%)-静脉血: 0.536；H2U:U-静脉血: 1.99；间接胆红素(IBIL)-静脉血: 5.39umolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 15.7；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.6mmolL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 49.1；平均……\n- [全程D58] 检验组合: 总钙(Ca)-静脉血: 2.42mmol/L；乳酸脱氢酶(LDH)-静脉血: 177.8U/L；总蛋白(TP)-静脉血: 73.37g/L；C-反应蛋白(CRP)-静脉血: 0.68mg/L；血红蛋白(Hb)-静脉血: 111g/L；尿素氮(BUN)-静脉血: 3.6mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.38mmol/L；总胆固醇(TC)-静脉血: 5.13mmol/L；总胆汁酸(TBA)-静脉血: 5.2umol/L；直接胆红素(DBIL)-静脉血: 0.2umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.323；大血小板百分比(P-LCR%)-静脉血: 15.4%；载脂蛋白AI(apoAI)-静脉血: 1.42g/L；白蛋白(ALB)-静脉血: 42.1g/L；磷(P)-静脉血: 1.65mmol/L；淋巴细胞计数(Lymph#)-静脉血: 0.910E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.16；钠离子(Na+)-静脉血: 140.4mmol/L；血小板分布宽度(PDW)-静脉血: 9.2%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；中性粒细胞百分比(Neut%)-静脉血: 0.516；单核细胞计数(Mono#)-静脉血: 0.310E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 22.6U/L；丙氨酸氨基转移酶(ALT)-静脉血: 19.4U/L；红细胞计数(RBC#)-静脉血: 3.7910E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 15.6；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.069；血小板比容-静脉血: 16%；钾离子(K+)-静脉血: 4.5mmol/L；阴离子间隙(AG)-静脉血: 13.5；肌酐(Crea)-静脉血: 35.9umol/L；球蛋白(GLO)-静脉血: 31.27g/L；氯离子(Cl-)-静脉血: 103.5mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；间接胆红素(IBIL)-静脉血: 5umolL；白细胞计数(WBC#)-静脉血: 2.9110E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.35mmolL；α-L-岩藻糖苷酶(AFU)-静脉血: 30……\n- [全程D60] 检验组合: H2U:U-静脉血: 2.1；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.011；淋巴细胞百分比(Lymph%)-静脉血: 0.214；单核细胞计数(Mono#)-静脉血: 0.510E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 50；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 333g/L；红细胞计数(RBC#)-静脉血: 3.4910E12/L；血小板比容-静脉血: 17%；白细胞计数(WBC#)-静脉血: 3.610E9/L；血小板分布宽度(PDW)-静脉血: 9.6%；单核细胞百分比(Mono%)-静脉血: 0.136；血小板计数(PLT#)-静脉血: 18110E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；红细胞比容(Hct)-静脉血: 30.9%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 15.8；平均红细胞血红蛋白含量(MCH)-静脉血: 29.5pg；平均血小板体积(MPV)-静脉血: 9.3fL；大血小板百分比(P-LCR%)-静脉血: 18.6%；中性粒细胞计数(Neut#)-静脉血: 2.310E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；血红蛋白(Hb)-静脉血: 103g/L；平均红细胞体积(MCV)-静脉血: 88.5fL；中性粒细胞百分比(Neut%)-静脉血: 0.636\n- [全程D62] 检验组合: 血红蛋白(Hb)-静脉血: 113g/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；白细胞计数(WBC#)-静脉血: 1.910E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.032；中性粒细胞百分比(Neut%)-静脉血: 0.532；血小板计数(PLT#)-静脉血: 21510E9/L；红细胞计数(RBC#)-静脉血: 3.7810E12/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 49.3；平均红细胞血红蛋白含量(MCH)-静脉血: 29.9pg；淋巴细胞百分比(Lymph%)-静脉血: 0.284；有核红细胞计数(NRBC#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 15.4；中性粒细胞计数(Neut#)-静脉血: 110E9/L；血小板比容-静脉血: 20%；大血小板百分比(P-LCR%)-静脉血: 17.6%；单核细胞百分比(Mono%)-静脉血: 0.147；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；红细胞比容(Hct)-静脉血: 33.1%；血小板分布宽度(PDW)-静脉血: 9.4%；平均红细胞体积(MCV)-静脉血: 87.6fL；平均血小板体积(MPV)-静脉血: 9.1fL\n- [全程D65] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔稍狭窄，原鼻咽肿物现明显缩小，病变累及右侧咽隐窝，侵犯右侧咽旁脂肪间隙、右颈动脉鞘区、右侧咽后脂肪间隙及椎前间隙。右侧腭帆提肌、头长肌、颈长肌、右侧腭帆张肌及右侧翼内肌。 双侧翼腭窝、咀嚼肌间隙未见异常。口咽双侧壁未见受累增厚，双侧后鼻孔未见受累。双侧扁桃体未见明显异常。 右侧破裂孔、卵圆孔、舌下神经管内见少许软组织影，增强扫描明显强化。斜坡后缘脑膜增厚，增强扫描明显强化。双侧海绵窦未见增宽。 斜坡、蝶骨基底部、枕骨基底部、蝶骨基底部、右侧蝶骨大翼、寰椎右侧侧块、右侧枕骨髁、右侧翼突、右侧岩尖骨髓信号减低，增强扫描明显强化。 双侧筛窦、蝶窦及双侧乳突粘膜增厚。双侧乳突可见分泌物。双侧上颌窦充气良好。 双眼大小、形态、位置及信号未见异常，球后未见占位性病变。蝶鞍形态未见异常，其内未见占位性病变。 左侧咽后可见小淋巴结，短径约4mm，边界较清，增强扫描明显强化。右侧咽后可见肿大淋巴结，与鼻咽病变分界不清，增强扫描明显强化。颈右侧II、III区可见多个淋巴结，部分融合，较大范围约14mm×17mm，增强扫描明显强化。颈左侧II区、双侧Ⅲ、Ⅳ区可见多发小淋巴结，增强扫描轻度强化。 甲状腺双叶及峡部形态未见异常，信号均匀，未见占位性病变。喉咽腔形态未见异常，未见占位性病变。双侧颌下腺、腮腺大小、形态未见异常，信号均匀，未见占位性病变。 所见脑内未见明显异常。；检查结论: 鼻咽癌放疗后，与某次就诊时间MR相比： 鼻咽肿物较前明显缩小。 颅底骨质破坏，大致同前。 右侧咽后、颈右侧II、III区多个肿大淋巴结，考虑转移，较前缩小。 左侧咽后、颈左侧II区、双侧III、IV区小淋巴结，较前缩小。 双侧筛窦、蝶窦及双侧乳突炎。\n- [全程D65] 检验组合: 平均红细胞血红蛋白浓度(MCHC)-静脉血: 337g/L；大血小板百分比(P-LCR%)-静脉血: 18.8%；单核细胞计数(Mono#)-静脉血: 1.410E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；平均红细胞血红蛋白含量(MCH)-静脉血: 29.8pg；血小板计数(PLT#)-静脉血: 19110E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 16.2；红细胞比容(Hct)-静脉血: 33.8%；中性粒细胞计数(Neut#)-静脉血: 10.510E9/L；白细胞计数(WBC#)-静脉血: 13.2210E9/L；血红蛋白(Hb)-静脉血: 114g/L；红细胞计数(RBC#)-静脉血: 3.8210E12/L；血小板分布宽度(PDW)-静脉血: 10.3%；淋巴细胞百分比(Lymph%)-静脉血: 0.091；中性粒细胞百分比(Neut%)-静脉血: 0.796；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.007；红细胞体积分布宽度SD(RDW-SD)-静脉血: 49.5；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.210E9/L；平均红细胞体积(MCV)-静脉血: 88.5fL；血小板比容-静脉血: 18%；单核细胞百分比(Mono%)-静脉血: 0.104；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均血小板体积(MPV)-静脉血: 9.2fL\n\n【既往治疗与反应】\n- [全程D52] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 现患者局部放疗3次，同期PF30d 化疗第19日，无特殊不适主诉。查体大致同前。复查生化常规未见异常，血常规示白细胞I度降低。[姓名已隐去]医生信息已隐藏示，患者一般状况好，继续放化疗。\n- [全程D55] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 现患者局部放疗4次，同期PF30d 化疗第22日，无特殊不适主诉。查体见颈部淋巴结较前缩小。血常规、生化未见异常。继续放化疗。\n- [全程D58] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 现患者局部放疗6次，同期PF30d 化疗第25日，无特殊不适主诉。查体见颈部淋巴结较前缩小。血常规示：白细胞计数(白细胞计数(WBC)) 2.91 10E9/L；[姓名已隐去]医生信息已隐藏示：予纠正白细胞治疗，继续放化疗。\n- [全程D64] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 现患者局部放疗10次，无特殊不适主诉。查体见颈部淋巴结较前缩小。血常规示：白细胞计数(白细胞计数(WBC)) 1.90 10E9/L；予升白细胞治疗，继续放疗。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 终止放化疗，转为手术切除鼻咽原发灶及颈部残留淋巴结。\nB. 暂停放疗，予以静脉抗感染治疗，2周后恢复放疗。\nC. 重新定位并修改放疗计划，缩减原发灶及颈部淋巴结的照射靶区，继续放疗。\nD. 提前结束放疗，改为单药靶向治疗或PD-1抑制剂维持治疗。\nE. 继续根治性放疗，停用原化疗方案，改用吉西他滨联合顺铂方案化疗。\nF. 暂停治疗，完善全身PET-CT检查评估远处转移情况，再决定后续方案。\nG. 继续根治性放疗，完善电子鼻咽镜检查，并予以肠内营养支持及定期复查血常规。\nH. 终止放化疗，转为定期随访观察，3个月后复查鼻咽及颈部MRI。\nI. 继续根治性放疗，常规加用大剂量地塞米松以减轻局部黏膜炎症反应。\nJ. 暂停放疗，行右颈部残留淋巴结穿刺活检明确病理，再制定后续治疗计划。\nK. 继续根治性放疗，并择期行右侧颈部淋巴结清扫术。\n\n请仅输出一个选项字母（A-K）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：不支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、颈动脉鞘、斜坡、翼突基底部、蝶骨基底部、岩尖等。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D45] 检验组合: 红细胞计数(RBC#)-静脉血: 4.0510E12/L；淋巴细胞百分比(Lymph%)-静脉血: 0.347；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.42mmolL；磷(P)-静脉血: 1.77mmol/L；肌酐(Crea)-静脉血: 30.1umol/L；总胆红素(TBIL)-静脉血: 3.5umol/L；白蛋白(ALB)-静脉血: 41.3g/L；钾离子(K+)-静脉血: 4.49mmol/L；总胆固醇(TC)-静脉血: 4.9mmol/L；直接胆红素(DBIL)-静脉血: 1.1umol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；碱性磷酸酶(ALP)-静脉血: 147.1U/L；镁离子(Mg2+)-静脉血: 0.84mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 16.5U/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.1mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 15；淋巴细胞计数(Lymph#)-静脉血: 2.210E9/L；球蛋白(GLO)-静脉血: 35g/L；血红蛋白(Hb)-静脉血: 115g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.4pg；总蛋白(TP)-静脉血: 76.3g/L；H2U:U-静脉血: 2.1；尿酸(UA)-静脉血: 236.8umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.18；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.36；白细胞计数(WBC#)-静脉血: 6.4610E9/L；血小板分布宽度(PDW)-静脉血: 8.7%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；乳酸脱氢酶(LDH)-静脉血: 195.6U/L；间接胆红素(IBIL)-静脉血: 2.4umolL；葡萄糖(Glu)-静脉血: 4.66mmol/L；总胆汁酸(TBA)-静脉血: 6.1umol/L；阴离子间隙(AG)-静脉血: 14.5；总钙(Ca)-静脉血: 2.36mmol/L；平均红细胞体积(MCV)-静脉血: 85.9fL；α-L-岩藻糖苷酶(AFU)-静脉血: 35.1U/L；甘油三酯(TG)-静脉血: 1.29mmol/L；大血小板百分比(P-LCR%)-静脉血: 14.3%；嗜碱性……\n- [全程D52] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 25mmol/L；总胆红素(TBIL)-静脉血: 7.6umol/L；磷(P)-静脉血: 1.66mmol/L；阴离子间隙(AG)-静脉血: 13.5；肌酐(Crea)-静脉血: 31.2umol/L；载脂蛋白B(apoB)-静脉血: 0.98g/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞计数(Neut#)-静脉血: 210E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 16.5U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.048；单核细胞百分比(Mono%)-静脉血: 0.082；总蛋白(TP)-静脉血: 76.7g/L；甘油三酯(TG)-静脉血: 0.86mmol/L；直接胆红素(DBIL)-静脉血: 2.21umol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；钾离子(K+)-静脉血: 4.11mmol/L；红细胞比容(Hct)-静脉血: 35.1%；葡萄糖(Glu)-静脉血: 4.64mmol/L；血红蛋白(Hb)-静脉血: 117g/L；乳酸脱氢酶(LDH)-静脉血: 217.1U/L；总胆固醇(TC)-静脉血: 5.39mmol/L；白蛋白(ALB)-静脉血: 42.7g/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；钠离子(Na+)-静脉血: 138.9mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 43.6U/L；淋巴细胞计数(Lymph#)-静脉血: 1.210E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.7pg；血小板计数(PLT#)-静脉血: 19610E9/L；白细胞计数(WBC#)-静脉血: 3.7710E9/L；平均血小板体积(MPV)-静脉血: 9.2fL；中性粒细胞百分比(Neut%)-静脉血: 0.536；H2U:U-静脉血: 1.99；间接胆红素(IBIL)-静脉血: 5.39umolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 15.7；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.6mmolL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 49.1；平均……\n- [全程D58] 检验组合: 总钙(Ca)-静脉血: 2.42mmol/L；乳酸脱氢酶(LDH)-静脉血: 177.8U/L；总蛋白(TP)-静脉血: 73.37g/L；C-反应蛋白(CRP)-静脉血: 0.68mg/L；血红蛋白(Hb)-静脉血: 111g/L；尿素氮(BUN)-静脉血: 3.6mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.38mmol/L；总胆固醇(TC)-静脉血: 5.13mmol/L；总胆汁酸(TBA)-静脉血: 5.2umol/L；直接胆红素(DBIL)-静脉血: 0.2umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.323；大血小板百分比(P-LCR%)-静脉血: 15.4%；载脂蛋白AI(apoAI)-静脉血: 1.42g/L；白蛋白(ALB)-静脉血: 42.1g/L；磷(P)-静脉血: 1.65mmol/L；淋巴细胞计数(Lymph#)-静脉血: 0.910E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.16；钠离子(Na+)-静脉血: 140.4mmol/L；血小板分布宽度(PDW)-静脉血: 9.2%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；中性粒细胞百分比(Neut%)-静脉血: 0.516；单核细胞计数(Mono#)-静脉血: 0.310E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 22.6U/L；丙氨酸氨基转移酶(ALT)-静脉血: 19.4U/L；红细胞计数(RBC#)-静脉血: 3.7910E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 15.6；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.069；血小板比容-静脉血: 16%；钾离子(K+)-静脉血: 4.5mmol/L；阴离子间隙(AG)-静脉血: 13.5；肌酐(Crea)-静脉血: 35.9umol/L；球蛋白(GLO)-静脉血: 31.27g/L；氯离子(Cl-)-静脉血: 103.5mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；间接胆红素(IBIL)-静脉血: 5umolL；白细胞计数(WBC#)-静脉血: 2.9110E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.35mmolL；α-L-岩藻糖苷酶(AFU)-静脉血: 30……\n- [全程D60] 检验组合: H2U:U-静脉血: 2.1；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.011；淋巴细胞百分比(Lymph%)-静脉血: 0.214；单核细胞计数(Mono#)-静脉血: 0.510E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 50；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 333g/L；红细胞计数(RBC#)-静脉血: 3.4910E12/L；血小板比容-静脉血: 17%；白细胞计数(WBC#)-静脉血: 3.610E9/L；血小板分布宽度(PDW)-静脉血: 9.6%；单核细胞百分比(Mono%)-静脉血: 0.136；血小板计数(PLT#)-静脉血: 18110E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；红细胞比容(Hct)-静脉血: 30.9%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 15.8；平均红细胞血红蛋白含量(MCH)-静脉血: 29.5pg；平均血小板体积(MPV)-静脉血: 9.3fL；大血小板百分比(P-LCR%)-静脉血: 18.6%；中性粒细胞计数(Neut#)-静脉血: 2.310E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；血红蛋白(Hb)-静脉血: 103g/L；平均红细胞体积(MCV)-静脉血: 88.5fL；中性粒细胞百分比(Neut%)-静脉血: 0.636\n- [全程D62] 检验组合: 血红蛋白(Hb)-静脉血: 113g/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；白细胞计数(WBC#)-静脉血: 1.910E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.032；中性粒细胞百分比(Neut%)-静脉血: 0.532；血小板计数(PLT#)-静脉血: 21510E9/L；红细胞计数(RBC#)-静脉血: 3.7810E12/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 49.3；平均红细胞血红蛋白含量(MCH)-静脉血: 29.9pg；淋巴细胞百分比(Lymph%)-静脉血: 0.284；有核红细胞计数(NRBC#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 15.4；中性粒细胞计数(Neut#)-静脉血: 110E9/L；血小板比容-静脉血: 20%；大血小板百分比(P-LCR%)-静脉血: 17.6%；单核细胞百分比(Mono%)-静脉血: 0.147；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；红细胞比容(Hct)-静脉血: 33.1%；血小板分布宽度(PDW)-静脉血: 9.4%；平均红细胞体积(MCV)-静脉血: 87.6fL；平均血小板体积(MPV)-静脉血: 9.1fL\n- [全程D65] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔稍狭窄，原鼻咽肿物现明显缩小，病变累及右侧咽隐窝，侵犯右侧咽旁脂肪间隙、右颈动脉鞘区、右侧咽后脂肪间隙及椎前间隙。右侧腭帆提肌、头长肌、颈长肌、右侧腭帆张肌及右侧翼内肌。 双侧翼腭窝、咀嚼肌间隙未见异常。口咽双侧壁未见受累增厚，双侧后鼻孔未见受累。双侧扁桃体未见明显异常。 右侧破裂孔、卵圆孔、舌下神经管内见少许软组织影，增强扫描明显强化。斜坡后缘脑膜增厚，增强扫描明显强化。双侧海绵窦未见增宽。 斜坡、蝶骨基底部、枕骨基底部、蝶骨基底部、右侧蝶骨大翼、寰椎右侧侧块、右侧枕骨髁、右侧翼突、右侧岩尖骨髓信号减低，增强扫描明显强化。 双侧筛窦、蝶窦及双侧乳突粘膜增厚。双侧乳突可见分泌物。双侧上颌窦充气良好。 双眼大小、形态、位置及信号未见异常，球后未见占位性病变。蝶鞍形态未见异常，其内未见占位性病变。 左侧咽后可见小淋巴结，短径约4mm，边界较清，增强扫描明显强化。右侧咽后可见肿大淋巴结，与鼻咽病变分界不清，增强扫描明显强化。颈右侧II、III区可见多个淋巴结，部分融合，较大范围约14mm×17mm，增强扫描明显强化。颈左侧II区、双侧Ⅲ、Ⅳ区可见多发小淋巴结，增强扫描轻度强化。 甲状腺双叶及峡部形态未见异常，信号均匀，未见占位性病变。喉咽腔形态未见异常，未见占位性病变。双侧颌下腺、腮腺大小、形态未见异常，信号均匀，未见占位性病变。 所见脑内未见明显异常。；检查结论: 鼻咽癌放疗后，与某次就诊时间MR相比： 鼻咽肿物较前明显缩小。 颅底骨质破坏，大致同前。 右侧咽后、颈右侧II、III区多个肿大淋巴结，考虑转移，较前缩小。 左侧咽后、颈左侧II区、双侧III、IV区小淋巴结，较前缩小。 双侧筛窦、蝶窦及双侧乳突炎。\n- [全程D65] 检验组合: 平均红细胞血红蛋白浓度(MCHC)-静脉血: 337g/L；大血小板百分比(P-LCR%)-静脉血: 18.8%；单核细胞计数(Mono#)-静脉血: 1.410E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；平均红细胞血红蛋白含量(MCH)-静脉血: 29.8pg；血小板计数(PLT#)-静脉血: 19110E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 16.2；红细胞比容(Hct)-静脉血: 33.8%；中性粒细胞计数(Neut#)-静脉血: 10.510E9/L；白细胞计数(WBC#)-静脉血: 13.2210E9/L；血红蛋白(Hb)-静脉血: 114g/L；红细胞计数(RBC#)-静脉血: 3.8210E12/L；血小板分布宽度(PDW)-静脉血: 10.3%；淋巴细胞百分比(Lymph%)-静脉血: 0.091；中性粒细胞百分比(Neut%)-静脉血: 0.796；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.007；红细胞体积分布宽度SD(RDW-SD)-静脉血: 49.5；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.210E9/L；平均红细胞体积(MCV)-静脉血: 88.5fL；血小板比容-静脉血: 18%；单核细胞百分比(Mono%)-静脉血: 0.104；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均血小板体积(MPV)-静脉血: 9.2fL\n\n【既往治疗与反应】\n- [全程D52] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 现患者局部放疗3次，同期PF30d 化疗第19日，无特殊不适主诉。查体大致同前。复查生化常规未见异常，血常规示白细胞I度降低。[姓名已隐去]医生信息已隐藏示，患者一般状况好，继续放化疗。\n- [全程D55] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 现患者局部放疗4次，同期PF30d 化疗第22日，无特殊不适主诉。查体见颈部淋巴结较前缩小。血常规、生化未见异常。继续放化疗。\n- [全程D58] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 现患者局部放疗6次，同期PF30d 化疗第25日，无特殊不适主诉。查体见颈部淋巴结较前缩小。血常规示：白细胞计数(白细胞计数(WBC)) 2.91 10E9/L；[姓名已隐去]医生信息已隐藏示：予纠正白细胞治疗，继续放化疗。\n- [全程D64] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 现患者局部放疗10次，无特殊不适主诉。查体见颈部淋巴结较前缩小。血常规示：白细胞计数(白细胞计数(WBC)) 1.90 10E9/L；予升白细胞治疗，继续放疗。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 终止放化疗，转为手术切除鼻咽原发灶及颈部残留淋巴结。\nB. 暂停放疗，予以静脉抗感染治疗，2周后恢复放疗。\nC. 重新定位并修改放疗计划，缩减原发灶及颈部淋巴结的照射靶区，继续放疗。\nD. 提前结束放疗，改为单药靶向治疗或PD-1抑制剂维持治疗。\nE. 继续根治性放疗，停用原化疗方案，改用吉西他滨联合顺铂方案化疗。\nF. 暂停治疗，完善全身PET-CT检查评估远处转移情况，再决定后续方案。\nG. 继续根治性放疗，完善电子鼻咽镜检查，并予以肠内营养支持及定期复查血常规。\nH. 终止放化疗，转为定期随访观察，3个月后复查鼻咽及颈部MRI。\nI. 继续根治性放疗，常规加用大剂量地塞米松以减轻局部黏膜炎症反应。\nJ. 暂停放疗，行右颈部残留淋巴结穿刺活检明确病理，再制定后续治疗计划。\nK. 继续根治性放疗，并择期行右侧颈部淋巴结清扫术。\n\n请仅输出一个选项字母（A-K）。"}]}
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full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、筛窦、斜坡、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现颈部肿物伴涕血、鼻塞2月；患者未予相关诊治，转至我院就诊。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,涕血,颈部肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。偶伴吸烟、饮酒15年，3两/天，。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：90次/分，R：20次/分，BP：120/70mmHg,Ht：172cm，Wt：73kg，BSA：1.85m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.0cm；鼻咽双侧顶后壁结节状肿物；双侧颈部IIa区可扪及1个淋巴结，最大径2×2cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸腹部CT平扫\nB. 颈部淋巴结切除活检，鼻咽及颈部MRI平扫+增强，全身PET/CT检查\nC. 鼻咽镜检查及活检，鼻咽部MRI平扫+增强，胸部X线，腹部B超\nD. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，暂不进行全身分期检查\nE. 颈部淋巴结细针穿刺活检，鼻咽及颈部CT平扫+增强，全身骨扫描\nF. 鼻咽镜检查及活检，鼻咽部MRI平扫+增强，全身PET/CT检查\nG. 鼻咽及颈部MRI平扫+增强，全身PET/CT检查，直接安排根治性放疗\nH. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT检查\nI. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫，胸腹部CT平扫+增强，全身骨扫描\nJ. 鼻咽脱落细胞学涂片，鼻咽及颈部MRI平扫+增强，全身PET/CT检查\nK. 鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，全身PET/CT检查\nL. 鼻咽及颈部MRI平扫+增强，EBV-DNA检测，胸腹部CT平扫+增强\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"你正在参与一名鼻咽癌相关患者的 full-care 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张口门齿距4.0cm；鼻咽双侧顶后壁结节状肿物；双侧颈部IIa区可扪及1个淋巴结，最大径2×2cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸腹部CT平扫\nB. 颈部淋巴结切除活检，鼻咽及颈部MRI平扫+增强，全身PET/CT检查\nC. 鼻咽镜检查及活检，鼻咽部MRI平扫+增强，胸部X线，腹部B超\nD. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，暂不进行全身分期检查\nE. 颈部淋巴结细针穿刺活检，鼻咽及颈部CT平扫+增强，全身骨扫描\nF. 鼻咽镜检查及活检，鼻咽部MRI平扫+增强，全身PET/CT检查\nG. 鼻咽及颈部MRI平扫+增强，全身PET/CT检查，直接安排根治性放疗\nH. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT检查\nI. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫，胸腹部CT平扫+增强，全身骨扫描\nJ. 鼻咽脱落细胞学涂片，鼻咽及颈部MRI平扫+增强，全身PET/CT检查\nK. 鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，全身PET/CT检查\nL. 鼻咽及颈部MRI平扫+增强，EBV-DNA检测，胸腹部CT平扫+增强\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、筛窦、斜坡、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现颈部肿物伴涕血、鼻塞2月；患者未予相关诊治，转至我院就诊。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,涕血,颈部肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。偶伴吸烟、饮酒15年，3两/天，。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：90次/分，R：20次/分，BP：120/70mmHg,Ht：172cm，Wt：73kg，BSA：1.85m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.0cm；鼻咽双侧顶后壁结节状肿物；双侧颈部IIa区可扪及1个淋巴结，最大径2×2cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸腹部CT平扫\nB. 颈部淋巴结切除活检，鼻咽及颈部MRI平扫+增强，全身PET/CT检查\nC. 鼻咽镜检查及活检，鼻咽部MRI平扫+增强，胸部X线，腹部B超\nD. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，暂不进行全身分期检查\nE. 颈部淋巴结细针穿刺活检，鼻咽及颈部CT平扫+增强，全身骨扫描\nF. 鼻咽镜检查及活检，鼻咽部MRI平扫+增强，全身PET/CT检查\nG. 鼻咽及颈部MRI平扫+增强，全身PET/CT检查，直接安排根治性放疗\nH. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT检查\nI. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫，胸腹部CT平扫+增强，全身骨扫描\nJ. 鼻咽脱落细胞学涂片，鼻咽及颈部MRI平扫+增强，全身PET/CT检查\nK. 鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，全身PET/CT检查\nL. 鼻咽及颈部MRI平扫+增强，EBV-DNA检测，胸腹部CT平扫+增强\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-11ca3bd9dd2a5877fa6a6b49","patient_id":"patient-a48d1d72efa6c4217cf5b79c","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"I","gold_action":"影像评估为 cT3N2，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期","options":[{"letter":"A","text":"影像评估为 cT4N2，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期","is_gold":false},{"letter":"B","text":"影像评估为 cT3N1，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期","is_gold":false},{"letter":"C","text":"影像评估为 cT3N2，需完善鼻咽镜及活检明确病理，无需常规进行胸腹部及骨骼的远处转移筛查","is_gold":false},{"letter":"D","text":"影像评估为 cT4N3，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期","is_gold":false},{"letter":"E","text":"影像评估为 cT2N2，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期","is_gold":false},{"letter":"F","text":"影像评估为 cT3N2，需完善颈部淋巴结穿刺活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期","is_gold":false},{"letter":"G","text":"影像评估为 cT3N2，已具备影像学确诊条件，直接安排诱导化疗及后续根治性放疗","is_gold":false},{"letter":"H","text":"影像评估为 cT4N2，需完善颈部淋巴结穿刺活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期","is_gold":false},{"letter":"I","text":"影像评估为 cT3N2，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期","is_gold":true},{"letter":"J","text":"影像评估为 cT3N3，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期","is_gold":false},{"letter":"K","text":"影像评估为 cT2N1，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期","is_gold":false},{"letter":"L","text":"影像评估为 cT3N2，需完善鼻咽镜及活检明确病理，并完善头颅MRI及脑脊液检查以排除中枢神经系统转移","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、筛窦、斜坡、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现颈部肿物伴涕血、鼻塞2月；患者未予相关诊治，转至我院就诊。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,涕血,颈部肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。偶伴吸烟、饮酒15年，3两/天，。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：90次/分，R：20次/分，BP：120/70mmHg,Ht：172cm，Wt：73kg，BSA：1.85m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.0cm；鼻咽双侧顶后壁结节状肿物；双侧颈部IIa区可扪及1个淋巴结，最大径2×2cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 甘油三酯(TG)-静脉血: 1.1mmol/L；透明质酸(HA)-静脉血: 34.26ng/ml；中性粒细胞计数(Neut#)-静脉血: 3.710E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；层粘连蛋白(LN)-静脉血: 11.97ng/ml；凝血酶原时间活动度(PTA)-静脉血: 125.5%；总胆固醇(TC)-静脉血: 4.12mmol/L；凝血酶原时间(PT)-静脉血: 10.8sec.；碱性磷酸酶(ALP)-静脉血: 83.4U/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；ABO血型-静脉血: O；镁离子(Mg2+)-静脉血: 0.88mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.005；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 65.2umol/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；尿素氮(BUN)-静脉血: 5.1mmol/L；总蛋白(TP)-静脉血: 75.4g/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 22.8U/L；钾离子(K+)-静脉血: 3.71mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 17.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 18.1U/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；乳酸脱氢酶(LDH)-静脉血: 142.3U/L；III型前胶原氨基端肽(PIIINP)-静脉血: 17.25ng/ml；尿酸(UA)-静脉血: 293.9umol/L；血小板计数(PLT#)-静脉血: 18910E9/L；Rh血型-静脉血: 阳性；总胆汁酸(TBA)-静脉血: 2.8umol/L；IV型胶原(C-IV)-静脉血: 21.48ng/ml；天门冬氨酸氨基转移酶(AST)-静脉血: 15.4U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；氯离子(Cl-)-静脉血: 103.6mmol/L；磷(P)-静脉血: 0.78m……\n- [全程D2] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D8] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、右侧壁见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。肿物占据双侧咽隐窝，向后外推移右侧咽旁脂肪间隙，前方浸润右侧筛窦及上鼻道，左侧咽旁脂肪间隙及左侧颈动脉鞘区未见异常。 右侧腭帆提肌、腭帆张肌受侵；左侧腭帆提肌、腭帆张肌、头长肌未见受累征象。 右侧翼腭窝及右侧上颌后脂肪间隙稍变窄；左侧翼腭窝、左上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽未见明显异常。 斜坡、蝶骨基底部、右侧翼突基底部及右侧蝶骨大翼信号降低，增强后强化。 双侧海绵窦未见明显异常。 双侧上颌窦、筛窦、右侧蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，无强化，骨壁完整。双眼大小、形态、位置均属正常、信号均匀。蝶鞍形态正常，其内未见占位性病变。 右侧咽后间隙见淋巴结，较大者约11mm×10mm；左侧咽后间隙未见肿大淋巴结。双颈Ⅱ区、右颈Ⅲ区见多个淋巴结，部分融合，边界清，不均匀明显强化，较大者约大小约24mm×13mm。 所见甲状腺双叶形态正常、喉咽腔、双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 符合鼻咽癌。 颅底骨质破坏。 左侧咽后、双颈Ⅱ区及右颈Ⅲ区肿大淋巴结，考虑转移。 副鼻窦炎、乳突炎。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 影像评估为 cT4N2，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nB. 影像评估为 cT3N1，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nC. 影像评估为 cT3N2，需完善鼻咽镜及活检明确病理，无需常规进行胸腹部及骨骼的远处转移筛查\nD. 影像评估为 cT4N3，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nE. 影像评估为 cT2N2，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nF. 影像评估为 cT3N2，需完善颈部淋巴结穿刺活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nG. 影像评估为 cT3N2，已具备影像学确诊条件，直接安排诱导化疗及后续根治性放疗\nH. 影像评估为 cT4N2，需完善颈部淋巴结穿刺活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nI. 影像评估为 cT3N2，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nJ. 影像评估为 cT3N3，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nK. 影像评估为 cT2N1，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nL. 影像评估为 cT3N2，需完善鼻咽镜及活检明确病理，并完善头颅MRI及脑脊液检查以排除中枢神经系统转移\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 甘油三酯(TG)-静脉血: 1.1mmol/L；透明质酸(HA)-静脉血: 34.26ng/ml；中性粒细胞计数(Neut#)-静脉血: 3.710E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；层粘连蛋白(LN)-静脉血: 11.97ng/ml；凝血酶原时间活动度(PTA)-静脉血: 125.5%；总胆固醇(TC)-静脉血: 4.12mmol/L；凝血酶原时间(PT)-静脉血: 10.8sec.；碱性磷酸酶(ALP)-静脉血: 83.4U/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；ABO血型-静脉血: O；镁离子(Mg2+)-静脉血: 0.88mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.005；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 65.2umol/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；尿素氮(BUN)-静脉血: 5.1mmol/L；总蛋白(TP)-静脉血: 75.4g/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 22.8U/L；钾离子(K+)-静脉血: 3.71mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 17.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 18.1U/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；乳酸脱氢酶(LDH)-静脉血: 142.3U/L；III型前胶原氨基端肽(PIIINP)-静脉血: 17.25ng/ml；尿酸(UA)-静脉血: 293.9umol/L；血小板计数(PLT#)-静脉血: 18910E9/L；Rh血型-静脉血: 阳性；总胆汁酸(TBA)-静脉血: 2.8umol/L；IV型胶原(C-IV)-静脉血: 21.48ng/ml；天门冬氨酸氨基转移酶(AST)-静脉血: 15.4U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；氯离子(Cl-)-静脉血: 103.6mmol/L；磷(P)-静脉血: 0.78m……\n- [全程D2] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D8] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、右侧壁见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。肿物占据双侧咽隐窝，向后外推移右侧咽旁脂肪间隙，前方浸润右侧筛窦及上鼻道，左侧咽旁脂肪间隙及左侧颈动脉鞘区未见异常。 右侧腭帆提肌、腭帆张肌受侵；左侧腭帆提肌、腭帆张肌、头长肌未见受累征象。 右侧翼腭窝及右侧上颌后脂肪间隙稍变窄；左侧翼腭窝、左上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽未见明显异常。 斜坡、蝶骨基底部、右侧翼突基底部及右侧蝶骨大翼信号降低，增强后强化。 双侧海绵窦未见明显异常。 双侧上颌窦、筛窦、右侧蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，无强化，骨壁完整。双眼大小、形态、位置均属正常、信号均匀。蝶鞍形态正常，其内未见占位性病变。 右侧咽后间隙见淋巴结，较大者约11mm×10mm；左侧咽后间隙未见肿大淋巴结。双颈Ⅱ区、右颈Ⅲ区见多个淋巴结，部分融合，边界清，不均匀明显强化，较大者约大小约24mm×13mm。 所见甲状腺双叶形态正常、喉咽腔、双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 符合鼻咽癌。 颅底骨质破坏。 左侧咽后、双颈Ⅱ区及右颈Ⅲ区肿大淋巴结，考虑转移。 副鼻窦炎、乳突炎。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 影像评估为 cT4N2，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nB. 影像评估为 cT3N1，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nC. 影像评估为 cT3N2，需完善鼻咽镜及活检明确病理，无需常规进行胸腹部及骨骼的远处转移筛查\nD. 影像评估为 cT4N3，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nE. 影像评估为 cT2N2，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nF. 影像评估为 cT3N2，需完善颈部淋巴结穿刺活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nG. 影像评估为 cT3N2，已具备影像学确诊条件，直接安排诱导化疗及后续根治性放疗\nH. 影像评估为 cT4N2，需完善颈部淋巴结穿刺活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nI. 影像评估为 cT3N2，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nJ. 影像评估为 cT3N3，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nK. 影像评估为 cT2N1，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nL. 影像评估为 cT3N2，需完善鼻咽镜及活检明确病理，并完善头颅MRI及脑脊液检查以排除中枢神经系统转移\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、筛窦、斜坡、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 甘油三酯(TG)-静脉血: 1.1mmol/L；透明质酸(HA)-静脉血: 34.26ng/ml；中性粒细胞计数(Neut#)-静脉血: 3.710E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；层粘连蛋白(LN)-静脉血: 11.97ng/ml；凝血酶原时间活动度(PTA)-静脉血: 125.5%；总胆固醇(TC)-静脉血: 4.12mmol/L；凝血酶原时间(PT)-静脉血: 10.8sec.；碱性磷酸酶(ALP)-静脉血: 83.4U/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；ABO血型-静脉血: O；镁离子(Mg2+)-静脉血: 0.88mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.005；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 65.2umol/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；尿素氮(BUN)-静脉血: 5.1mmol/L；总蛋白(TP)-静脉血: 75.4g/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 22.8U/L；钾离子(K+)-静脉血: 3.71mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 17.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 18.1U/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；乳酸脱氢酶(LDH)-静脉血: 142.3U/L；III型前胶原氨基端肽(PIIINP)-静脉血: 17.25ng/ml；尿酸(UA)-静脉血: 293.9umol/L；血小板计数(PLT#)-静脉血: 18910E9/L；Rh血型-静脉血: 阳性；总胆汁酸(TBA)-静脉血: 2.8umol/L；IV型胶原(C-IV)-静脉血: 21.48ng/ml；天门冬氨酸氨基转移酶(AST)-静脉血: 15.4U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；氯离子(Cl-)-静脉血: 103.6mmol/L；磷(P)-静脉血: 0.78m……\n- [全程D2] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D8] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、右侧壁见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。肿物占据双侧咽隐窝，向后外推移右侧咽旁脂肪间隙，前方浸润右侧筛窦及上鼻道，左侧咽旁脂肪间隙及左侧颈动脉鞘区未见异常。 右侧腭帆提肌、腭帆张肌受侵；左侧腭帆提肌、腭帆张肌、头长肌未见受累征象。 右侧翼腭窝及右侧上颌后脂肪间隙稍变窄；左侧翼腭窝、左上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽未见明显异常。 斜坡、蝶骨基底部、右侧翼突基底部及右侧蝶骨大翼信号降低，增强后强化。 双侧海绵窦未见明显异常。 双侧上颌窦、筛窦、右侧蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，无强化，骨壁完整。双眼大小、形态、位置均属正常、信号均匀。蝶鞍形态正常，其内未见占位性病变。 右侧咽后间隙见淋巴结，较大者约11mm×10mm；左侧咽后间隙未见肿大淋巴结。双颈Ⅱ区、右颈Ⅲ区见多个淋巴结，部分融合，边界清，不均匀明显强化，较大者约大小约24mm×13mm。 所见甲状腺双叶形态正常、喉咽腔、双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 符合鼻咽癌。 颅底骨质破坏。 左侧咽后、双颈Ⅱ区及右颈Ⅲ区肿大淋巴结，考虑转移。 副鼻窦炎、乳突炎。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 影像评估为 cT4N2，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nB. 影像评估为 cT3N1，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nC. 影像评估为 cT3N2，需完善鼻咽镜及活检明确病理，无需常规进行胸腹部及骨骼的远处转移筛查\nD. 影像评估为 cT4N3，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nE. 影像评估为 cT2N2，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nF. 影像评估为 cT3N2，需完善颈部淋巴结穿刺活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nG. 影像评估为 cT3N2，已具备影像学确诊条件，直接安排诱导化疗及后续根治性放疗\nH. 影像评估为 cT4N2，需完善颈部淋巴结穿刺活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nI. 影像评估为 cT3N2，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nJ. 影像评估为 cT3N3，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nK. 影像评估为 cT2N1，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nL. 影像评估为 cT3N2，需完善鼻咽镜及活检明确病理，并完善头颅MRI及脑脊液检查以排除中枢神经系统转移\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-b061f796c98789c2958f0baf","patient_id":"patient-a48d1d72efa6c4217cf5b79c","turn_id":"turn04","turn_position":3,"turn_type":"initial_treatment_selection","gold_letter":"K","gold_action":"启动首周期诱导化疗（辅以水化、止吐预处理），计划序贯根治性同步放化疗","options":[{"letter":"A","text":"启动首周期同步放化疗（辅以水化、止吐预处理），不考虑诱导化疗","is_gold":false},{"letter":"B","text":"启动首周期诱导化疗，计划序贯根治性单纯放疗","is_gold":false},{"letter":"C","text":"启动首周期诱导化疗联合PD-1抑制剂，计划序贯根治性同步放化疗","is_gold":false},{"letter":"D","text":"启动首周期诱导化疗，计划序贯手术切除原发灶及颈部淋巴结","is_gold":false},{"letter":"E","text":"启动根治性单纯放疗，计划放疗结束后行多周期辅助化疗","is_gold":false},{"letter":"F","text":"启动根治性放疗联合EGFR靶向治疗，免除全身静脉化疗","is_gold":false},{"letter":"G","text":"优先行双侧颈部淋巴结清扫术，术后行根治性同步放化疗","is_gold":false},{"letter":"H","text":"优先行鼻咽原发灶内镜下切除术，术后行根治性同步放化疗","is_gold":false},{"letter":"I","text":"启动首周期姑息性化疗，计划化疗后行局部姑息性放疗","is_gold":false},{"letter":"J","text":"启动首周期诱导化疗，若疗效达完全缓解（CR）则免除后续放疗","is_gold":false},{"letter":"K","text":"启动首周期诱导化疗（辅以水化、止吐预处理），计划序贯根治性同步放化疗","is_gold":true},{"letter":"L","text":"启动首周期同步放化疗，计划放疗结束后行多周期辅助化疗","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、筛窦、斜坡、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现颈部肿物伴涕血、鼻塞2月；患者未予相关诊治，转至我院就诊。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,涕血,颈部肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。偶伴吸烟、饮酒15年，3两/天，。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：90次/分，R：20次/分，BP：120/70mmHg,Ht：172cm，Wt：73kg，BSA：1.85m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.0cm；鼻咽双侧顶后壁结节状肿物；双侧颈部IIa区可扪及1个淋巴结，最大径2×2cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 发现颈部肿物伴涕血、鼻塞2月；现病史: 患者2月前无明显诱因出现颈部肿物，拇指大小，偶伴涕血、鼻塞，右侧明显，无面麻、复视等其他不适，未予重视，逐渐加重，患者遂于某次就诊时间行颈部彩超示：右侧颈部低回声，行鼻咽镜示：鼻咽肿物，建议活检。患者未予相关诊治，转至我院就诊。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,涕血,颈部肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。偶伴吸烟、饮酒15年，3两/天，。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：90次/分，R：20次/分，BP：120/70mmHg,Ht：172cm，Wt：73kg，BSA：1.85m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率90次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.0cm；鼻咽双侧顶后壁结节状肿物；双侧颈部IIa区可扪及1个淋巴结，最大径2×2cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 甘油三酯(TG)-静脉血: 1.1mmol/L；透明质酸(HA)-静脉血: 34.26ng/ml；中性粒细胞计数(Neut#)-静脉血: 3.710E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；层粘连蛋白(LN)-静脉血: 11.97ng/ml；凝血酶原时间活动度(PTA)-静脉血: 125.5%；总胆固醇(TC)-静脉血: 4.12mmol/L；凝血酶原时间(PT)-静脉血: 10.8sec.；碱性磷酸酶(ALP)-静脉血: 83.4U/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；ABO血型-静脉血: O；镁离子(Mg2+)-静脉血: 0.88mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.005；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 65.2umol/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；尿素氮(BUN)-静脉血: 5.1mmol/L；总蛋白(TP)-静脉血: 75.4g/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 22.8U/L；钾离子(K+)-静脉血: 3.71mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 17.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 18.1U/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；乳酸脱氢酶(LDH)-静脉血: 142.3U/L；III型前胶原氨基端肽(PIIINP)-静脉血: 17.25ng/ml；尿酸(UA)-静脉血: 293.9umol/L；血小板计数(PLT#)-静脉血: 18910E9/L；Rh血型-静脉血: 阳性；总胆汁酸(TBA)-静脉血: 2.8umol/L；IV型胶原(C-IV)-静脉血: 21.48ng/ml；天门冬氨酸氨基转移酶(AST)-静脉血: 15.4U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；氯离子(Cl-)-静脉血: 103.6mmol/L；磷(P)-静脉血: 0.78m……\n- [全程D2] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D8] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、右侧壁见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。肿物占据双侧咽隐窝，向后外推移右侧咽旁脂肪间隙，前方浸润右侧筛窦及上鼻道，左侧咽旁脂肪间隙及左侧颈动脉鞘区未见异常。 右侧腭帆提肌、腭帆张肌受侵；左侧腭帆提肌、腭帆张肌、头长肌未见受累征象。 右侧翼腭窝及右侧上颌后脂肪间隙稍变窄；左侧翼腭窝、左上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽未见明显异常。 斜坡、蝶骨基底部、右侧翼突基底部及右侧蝶骨大翼信号降低，增强后强化。 双侧海绵窦未见明显异常。 双侧上颌窦、筛窦、右侧蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，无强化，骨壁完整。双眼大小、形态、位置均属正常、信号均匀。蝶鞍形态正常，其内未见占位性病变。 右侧咽后间隙见淋巴结，较大者约11mm×10mm；左侧咽后间隙未见肿大淋巴结。双颈Ⅱ区、右颈Ⅲ区见多个淋巴结，部分融合，边界清，不均匀明显强化，较大者约大小约24mm×13mm。 所见甲状腺双叶形态正常、喉咽腔、双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 符合鼻咽癌。 颅底骨质破坏。 左侧咽后、双颈Ⅱ区及右颈Ⅲ区肿大淋巴结，考虑转移。 副鼻窦炎、乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 启动首周期同步放化疗（辅以水化、止吐预处理），不考虑诱导化疗\nB. 启动首周期诱导化疗，计划序贯根治性单纯放疗\nC. 启动首周期诱导化疗联合PD-1抑制剂，计划序贯根治性同步放化疗\nD. 启动首周期诱导化疗，计划序贯手术切除原发灶及颈部淋巴结\nE. 启动根治性单纯放疗，计划放疗结束后行多周期辅助化疗\nF. 启动根治性放疗联合EGFR靶向治疗，免除全身静脉化疗\nG. 优先行双侧颈部淋巴结清扫术，术后行根治性同步放化疗\nH. 优先行鼻咽原发灶内镜下切除术，术后行根治性同步放化疗\nI. 启动首周期姑息性化疗，计划化疗后行局部姑息性放疗\nJ. 启动首周期诱导化疗，若疗效达完全缓解（CR）则免除后续放疗\nK. 启动首周期诱导化疗（辅以水化、止吐预处理），计划序贯根治性同步放化疗\nL. 启动首周期同步放化疗，计划放疗结束后行多周期辅助化疗\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现颈部肿物伴涕血、鼻塞2月；现病史: 患者2月前无明显诱因出现颈部肿物，拇指大小，偶伴涕血、鼻塞，右侧明显，无面麻、复视等其他不适，未予重视，逐渐加重，患者遂于某次就诊时间行颈部彩超示：右侧颈部低回声，行鼻咽镜示：鼻咽肿物，建议活检。患者未予相关诊治，转至我院就诊。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,涕血,颈部肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。偶伴吸烟、饮酒15年，3两/天，。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：90次/分，R：20次/分，BP：120/70mmHg,Ht：172cm，Wt：73kg，BSA：1.85m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率90次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.0cm；鼻咽双侧顶后壁结节状肿物；双侧颈部IIa区可扪及1个淋巴结，最大径2×2cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 启动首周期同步放化疗（辅以水化、止吐预处理），不考虑诱导化疗\nB. 启动首周期诱导化疗，计划序贯根治性单纯放疗\nC. 启动首周期诱导化疗联合PD-1抑制剂，计划序贯根治性同步放化疗\nD. 启动首周期诱导化疗，计划序贯手术切除原发灶及颈部淋巴结\nE. 启动根治性单纯放疗，计划放疗结束后行多周期辅助化疗\nF. 启动根治性放疗联合EGFR靶向治疗，免除全身静脉化疗\nG. 优先行双侧颈部淋巴结清扫术，术后行根治性同步放化疗\nH. 优先行鼻咽原发灶内镜下切除术，术后行根治性同步放化疗\nI. 启动首周期姑息性化疗，计划化疗后行局部姑息性放疗\nJ. 启动首周期诱导化疗，若疗效达完全缓解（CR）则免除后续放疗\nK. 启动首周期诱导化疗（辅以水化、止吐预处理），计划序贯根治性同步放化疗\nL. 启动首周期同步放化疗，计划放疗结束后行多周期辅助化疗\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、筛窦、斜坡、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现颈部肿物伴涕血、鼻塞2月；现病史: 患者2月前无明显诱因出现颈部肿物，拇指大小，偶伴涕血、鼻塞，右侧明显，无面麻、复视等其他不适，未予重视，逐渐加重，患者遂于某次就诊时间行颈部彩超示：右侧颈部低回声，行鼻咽镜示：鼻咽肿物，建议活检。患者未予相关诊治，转至我院就诊。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,涕血,颈部肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。偶伴吸烟、饮酒15年，3两/天，。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：90次/分，R：20次/分，BP：120/70mmHg,Ht：172cm，Wt：73kg，BSA：1.85m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率90次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.0cm；鼻咽双侧顶后壁结节状肿物；双侧颈部IIa区可扪及1个淋巴结，最大径2×2cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 启动首周期同步放化疗（辅以水化、止吐预处理），不考虑诱导化疗\nB. 启动首周期诱导化疗，计划序贯根治性单纯放疗\nC. 启动首周期诱导化疗联合PD-1抑制剂，计划序贯根治性同步放化疗\nD. 启动首周期诱导化疗，计划序贯手术切除原发灶及颈部淋巴结\nE. 启动根治性单纯放疗，计划放疗结束后行多周期辅助化疗\nF. 启动根治性放疗联合EGFR靶向治疗，免除全身静脉化疗\nG. 优先行双侧颈部淋巴结清扫术，术后行根治性同步放化疗\nH. 优先行鼻咽原发灶内镜下切除术，术后行根治性同步放化疗\nI. 启动首周期姑息性化疗，计划化疗后行局部姑息性放疗\nJ. 启动首周期诱导化疗，若疗效达完全缓解（CR）则免除后续放疗\nK. 启动首周期诱导化疗（辅以水化、止吐预处理），计划序贯根治性同步放化疗\nL. 启动首周期同步放化疗，计划放疗结束后行多周期辅助化疗\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-b024e6abb04a58aab366631a","patient_id":"patient-a48d1d72efa6c4217cf5b79c","turn_id":"turn07","turn_position":4,"turn_type":"response_assessment_decision","gold_letter":"B","gold_action":"继续完成既定根治性放疗计划；加用重组人表皮生长因子、GM-CSF含漱液局部治疗，并予以静脉营养支持及抗感染治疗。","options":[{"letter":"A","text":"提前终止放疗；给予重组人表皮生长因子、GM-CSF含漱液局部促修复及静脉营养支持治疗。","is_gold":false},{"letter":"B","text":"继续完成既定根治性放疗计划；加用重组人表皮生长因子、GM-CSF含漱液局部治疗，并予以静脉营养支持及抗感染治疗。","is_gold":true},{"letter":"C","text":"暂停放疗及靶向治疗直至黏膜炎好转；给予重组人表皮生长因子、GM-CSF含漱液局部治疗及静脉营养支持。","is_gold":false},{"letter":"D","text":"继续完成既定根治性放疗计划；仅给予氯化钠含漱液及常规饮食指导，避免使用生长因子类药物及静脉营养。","is_gold":false},{"letter":"E","text":"继续完成既定根治性放疗计划；加用氟康唑等广谱抗真菌药物静脉滴注，并予以静脉营养支持治疗。","is_gold":false},{"letter":"F","text":"继续完成既定根治性放疗计划并立即安排鼻咽部局部加量放疗；给予重组人表皮生长因子含漱液及静脉营养支持。","is_gold":false},{"letter":"G","text":"继续完成既定根治性放疗计划；行预防性经皮内镜下胃造瘘术（PEG）替代静脉营养支持。","is_gold":false},{"letter":"H","text":"暂停放疗计划；复查鼻咽及颈部MRI以明确肿瘤退缩情况，再决定后续放疗靶区及剂量。","is_gold":false},{"letter":"I","text":"继续完成既定根治性放疗计划；给予大剂量静脉糖皮质激素冲击治疗，暂缓静脉营养支持。","is_gold":false},{"letter":"J","text":"继续完成既定根治性放疗计划；立即给予聚乙二醇化重组人粒细胞刺激因子皮下注射及静脉营养支持。","is_gold":false},{"letter":"K","text":"提前结束放疗，转为维持性靶向治疗及免疫治疗；给予重组人表皮生长因子及静脉营养支持。","is_gold":false},{"letter":"L","text":"继续完成既定根治性放疗计划；行预防性气管切开术，并予以静脉营养支持及抗感染治疗。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、筛窦、斜坡、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现颈部肿物伴涕血、鼻塞2月；患者未予相关诊治，转至我院就诊。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,涕血,颈部肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。偶伴吸烟、饮酒15年，3两/天，。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：90次/分，R：20次/分，BP：120/70mmHg,Ht：172cm，Wt：73kg，BSA：1.85m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.0cm；鼻咽双侧顶后壁结节状肿物；双侧颈部IIa区可扪及1个淋巴结，最大径2×2cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 发现颈部肿物伴涕血、鼻塞2月；现病史: 患者2月前无明显诱因出现颈部肿物，拇指大小，偶伴涕血、鼻塞，右侧明显，无面麻、复视等其他不适，未予重视，逐渐加重，患者遂于某次就诊时间行颈部彩超示：右侧颈部低回声，行鼻咽镜示：鼻咽肿物，建议活检。患者未予相关诊治，转至我院就诊。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,涕血,颈部肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。偶伴吸烟、饮酒15年，3两/天，。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：90次/分，R：20次/分，BP：120/70mmHg,Ht：172cm，Wt：73kg，BSA：1.85m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率90次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.0cm；鼻咽双侧顶后壁结节状肿物；双侧颈部IIa区可扪及1个淋巴结，最大径2×2cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 甘油三酯(TG)-静脉血: 1.1mmol/L；透明质酸(HA)-静脉血: 34.26ng/ml；中性粒细胞计数(Neut#)-静脉血: 3.710E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；层粘连蛋白(LN)-静脉血: 11.97ng/ml；凝血酶原时间活动度(PTA)-静脉血: 125.5%；总胆固醇(TC)-静脉血: 4.12mmol/L；凝血酶原时间(PT)-静脉血: 10.8sec.；碱性磷酸酶(ALP)-静脉血: 83.4U/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；ABO血型-静脉血: O；镁离子(Mg2+)-静脉血: 0.88mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.005；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 65.2umol/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；尿素氮(BUN)-静脉血: 5.1mmol/L；总蛋白(TP)-静脉血: 75.4g/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 22.8U/L；钾离子(K+)-静脉血: 3.71mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 17.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 18.1U/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；乳酸脱氢酶(LDH)-静脉血: 142.3U/L；III型前胶原氨基端肽(PIIINP)-静脉血: 17.25ng/ml；尿酸(UA)-静脉血: 293.9umol/L；血小板计数(PLT#)-静脉血: 18910E9/L；Rh血型-静脉血: 阳性；总胆汁酸(TBA)-静脉血: 2.8umol/L；IV型胶原(C-IV)-静脉血: 21.48ng/ml；天门冬氨酸氨基转移酶(AST)-静脉血: 15.4U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；氯离子(Cl-)-静脉血: 103.6mmol/L；磷(P)-静脉血: 0.78m……\n- [全程D2] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D8] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、右侧壁见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。肿物占据双侧咽隐窝，向后外推移右侧咽旁脂肪间隙，前方浸润右侧筛窦及上鼻道，左侧咽旁脂肪间隙及左侧颈动脉鞘区未见异常。 右侧腭帆提肌、腭帆张肌受侵；左侧腭帆提肌、腭帆张肌、头长肌未见受累征象。 右侧翼腭窝及右侧上颌后脂肪间隙稍变窄；左侧翼腭窝、左上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽未见明显异常。 斜坡、蝶骨基底部、右侧翼突基底部及右侧蝶骨大翼信号降低，增强后强化。 双侧海绵窦未见明显异常。 双侧上颌窦、筛窦、右侧蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，无强化，骨壁完整。双眼大小、形态、位置均属正常、信号均匀。蝶鞍形态正常，其内未见占位性病变。 右侧咽后间隙见淋巴结，较大者约11mm×10mm；左侧咽后间隙未见肿大淋巴结。双颈Ⅱ区、右颈Ⅲ区见多个淋巴结，部分融合，边界清，不均匀明显强化，较大者约大小约24mm×13mm。 所见甲状腺双叶形态正常、喉咽腔、双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 符合鼻咽癌。 颅底骨质破坏。 左侧咽后、双颈Ⅱ区及右颈Ⅲ区肿大淋巴结，考虑转移。 副鼻窦炎、乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D25] 检验组合: 间接胆红素(IBIL)-静脉血: 4.41umolL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.41；肌酐(Crea)-静脉血: 102.2umol/L；尿酸(UA)-静脉血: 315.6umol/L；总蛋白(TP)-静脉血: 63.4g/L；直接胆红素(DBIL)-静脉血: 2.3umol/L；白蛋白(ALB)-静脉血: 37.1g/L；总胆红素(TBIL)-静脉血: 6.71umol/L；尿素氮(BUN)-静脉血: 7.1mmol/L；球蛋白(GLO)-静脉血: 26.3g/L\n- [全程D29] 检验组合: 碱性磷酸酶(ALP)-静脉血: 72.7U/L；钠离子(Na+)-静脉血: 140.9mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0.3；大血小板百分比(P-LCR%)-静脉血: 28.3%；葡萄糖(Glu)-静脉血: 4.98mmol/L；载脂蛋白B(apoB)-静脉血: 0.9g/L；磷(P)-静脉血: 0.95mmol/L；球蛋白(GLO)-静脉血: 26.2g/L；氯离子(Cl-)-静脉血: 102.9mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.9U/L；镁离子(Mg2+)-静脉血: 0.81mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.67mmol/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；红细胞计数(RBC#)-静脉血: 4.2510E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.9；总蛋白(TP)-静脉血: 63.5g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 88.7fL；红细胞比容(Hct)-静脉血: 37.7%；总胆固醇(TC)-静脉血: 3.9mmol/L；乳酸脱氢酶(LDH)-静脉血: 144.8U/L；载脂蛋白AI(apoAI)-静脉血: 1.05g/L；丙氨酸氨基转移酶(ALT)-静脉血: 18.8U/L；甘油三酯(TG)-静脉血: 1mmol/L；尿酸(UA)-静脉血: 351.4umol/L；尿素氮(BUN)-静脉血: 6mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；单核细胞百分比(Mono%)-静脉血: 0.077；胱抑素(Cys-C)-静脉血: 0.99mg/L；血小板分布宽度(PDW)-静脉血: 11.5%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；有核红细胞计数(NRBC#)-静脉血: 0.0110E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 38；白细胞计数(WBC#)-静脉血: 3.6610E9/L；平均血小板体积(MPV)-静脉血: 10.5fL；血小板比容-静脉血: 20%；单核细胞计数(Mono#)-静脉血: 0.310E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；总胆汁酸……\n- [全程D36] 检验组合: 酸碱度(pH)-尿液: 6.5；丙氨酸氨基转移酶(ALT)-静脉血: 18.7U/L；阴离子间隙(AG)-静脉血: 12.9；钾离子(K+)-静脉血: 3.75mmol/L；磷(P)-静脉血: 0.98mmol/L；球蛋白(GLO)-静脉血: 29.5g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；酮体(KET)-尿液: -（参考: 阴性）；总胆固醇(TC)-静脉血: 4.56mmol/L；尿素氮(BUN)-静脉血: 4.6mmol/L；红细胞计数(RBC#)-静脉血: 4.4810E12/L；比重(SG)-尿液: 1.008；γ-谷氨酰基转移酶(GGT)-静脉血: 28U/L；红细胞比容(Hct)-静脉血: 39.4%；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.755；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.4；总胆红素(TBIL)-静脉血: 9.28umol/L；葡萄糖(Glu)-静脉血: 5.08mmol/L；钠离子(Na+)-静脉血: 141.1mmol/L；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 25.4mmol/L；颜色-尿液: colorless；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.046；乳酸脱氢酶(LDH)-静脉血: 144U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22.6U/L；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.37；C-反应蛋白(CRP)-静脉血: 7.02mg/L；间接胆红素(IBIL)-静脉血: 6.27umolL；血红蛋白(Hb)-静脉血: 135g/L；单核细胞百分比(Mono%)-静脉血: 0.08；淋巴细胞百分比(Lymph%)-静脉血: 0.113；总钙(Ca)-静脉血: 2.18mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.68；平均血小板体积(MPV)-静脉血: 10fL；淋巴细胞计数(Lymph#……\n- [全程D37] 检验组合: 亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 1/μL；酸碱度(pH)-尿液: 6.5；白细胞计数(WBC#)-尿液: 8/μL；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 1/μL；颜色-尿液: colorless；尿胆原(URO)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；胆红素(BIL)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.006；酮体(KET)-尿液: -（参考: 阴性）\n- [全程D38] 检验组合: 白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.006；尿胆原(URO)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；细菌计数(BACT#)-尿液: 2/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 1/μL；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；颜色-尿液: colorless；浊度(TRUB)-尿液: clear；隐血(OB)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 6.5\n- [全程D43] 检验组合: 尿素氮(BUN)-静脉血: 7.4mmol/L；直接胆红素(DBIL)-静脉血: 3.4umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.3mmol/L；白蛋白(ALB)-静脉血: 41.2g/L；磷(P)-静脉血: 1.12mmol/L；氯离子(Cl-)-静脉血: 97.6mmol/L；总蛋白(TP)-静脉血: 72.16g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 45.7U/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；血小板分布宽度(PDW)-静脉血: 11.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；碱性磷酸酶(ALP)-静脉血: 88.2U/L；C-反应蛋白(CRP)-静脉血: 1.75mg/L；红细胞计数(RBC#)-静脉血: 4.4910E12/L；白细胞计数(WBC#)-静脉血: 3.910E9/L；血小板比容-静脉血: 15%；淋巴细胞百分比(Lymph%)-静脉血: 0.062；总胆固醇(TC)-静脉血: 4.41mmol/L；球蛋白(GLO)-静脉血: 30.96g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.55；α-L-岩藻糖苷酶(AFU)-静脉血: 38.6U/L；钠离子(Na+)-静脉血: 138mmol/L；总胆红素(TBIL)-静脉血: 10.5umol/L；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；血小板计数(PLT#)-静脉血: 15010E9/L；平均血小板体积(MPV)-静脉血: 10.3fL；葡萄糖(Glu)-静脉血: 5.12mmol/L；载脂蛋白B(apoB)-静脉血: 0.95g/L；甘油三酯(TG)-静脉血: 1.59mmol/L；血红蛋白(Hb)-静脉血: 139g/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；胱抑素(Cys-C)-静脉血: 1.23mg/L；载脂蛋白AI(apoAI)-静脉血: 1.33g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.07mmolL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.33；乳酸脱氢酶(LDH)-静脉血: 158.1U/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜酸性粒细胞计数(Eos#)-静脉血: 0.1……\n- [全程D50] 检验组合: 乳酸脱氢酶(LDH)-静脉血: 164U/L；葡萄糖(Glu)-静脉血: 5.3mmol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；肌酐(Crea)-静脉血: 108.9umol/L；平均红细胞体积(MCV)-静脉血: 85.7fL；间接胆红素(IBIL)-静脉血: 7.8umolL；磷(P)-静脉血: 1.01mmol/L；球蛋白(GLO)-静脉血: 29.5g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；总胆固醇(TC)-静脉血: 4.57mmol/L；总蛋白(TP)-静脉血: 69g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15.2U/L；大血小板百分比(P-LCR%)-静脉血: 20.1%；钾离子(K+)-静脉血: 3.73mmol/L；碱性磷酸酶(ALP)-静脉血: 81.5U/L；阴离子间隙(AG)-静脉血: 16.9；胱抑素(Cys-C)-静脉血: 1.07mg/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；直接胆红素(DBIL)-静脉血: 3.9umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；血小板计数(PLT#)-静脉血: 18610E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 25.2U/L；细菌名称-咽拭子: 细菌涂片3；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.03；平均红细胞血红蛋白含量(MCH)-静脉血: 29.8pg；白细胞计数(WBC#)-静脉血: 3.6610E9/L；尿素氮(BUN)-静脉血: 4.8mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 24U/L；氯离子(Cl-)-静脉血: 97.1mmol/L；血小板分布宽度(PDW)-静脉血: 10.4%；淋巴细胞百分比(Lymph%)-静脉血: 0.085；血液二氧化碳含量ctCO2(B)-静脉血: 23.3mmol/L；钠离子(Na+)-静脉血: 137.3mmol/L；总胆红素(TBIL)-静脉血: 11.7umol/L；C-反应蛋白(CRP)-静脉血: 11.52mg/L；总胆汁酸(TBA)-静脉血: 1.4umol/L；中性粒细胞计……\n- [全程D55] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约12mm，肝S5可见一无回声灶，大小约11×9mm,椭圆形，边界清，内透声可，后方回声增强。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约19cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱不充盈。 前列腺大小形态正常，大小约38×30×37mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝囊肿。 胆囊、脾脏、胰腺、双肾、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D32] 阶段小结；阶段小结: 病程类型: 阶段小结；病程主题: 阶段小结；病程内容: 患者[姓名已隐去]，男，51岁，因“颈部肿物，偶伴涕血、鼻塞2月”于某次就诊时间入院。征求患者同意并签字入住顺铂三周/单周方案联合IMRT治疗局部中晚期鼻咽癌三期临床试验，抽签入三周顺铂100mg/m2组。目前放疗14次，同时期化疗1次。3次靶向治疗，继续原方案治疗，并予患者营养支持治疗。\n- [全程D37] 上级查房记录；[姓名已隐去]主任医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者诉咽喉疼痛，目前放疗17次，今日行第2次顺铂同时期化疗，查体：患者鼻咽壁肿物明显缩小，双颈未扪及淋巴结，面部、双颈部皮肤色素沉着。[姓名已隐去]医生信息已隐藏：密切关注患者放化疗副反应，遵嘱执行。\n- [全程D42] 上级查房记录；[姓名已隐去]主任医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者诉咽喉疼痛，目前放疗20次，已行2次顺铂同时期化疗，4次靶向治疗，诉食欲不佳，查体：患者鼻咽顶后壁肿物明显缩小，双颈未扪及淋巴结，面部、双颈部皮肤色素沉着。[姓名已隐去]医生信息已隐藏：嘱患者加强营养及日常休息。密切关注患者放化疗副反应。 遵嘱。\n- [全程D47] 上级查房记录；[姓名已隐去]主任医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者目前放疗24次，已行2次顺铂同时期化疗，5次靶向治疗，诉咽喉疼痛，纳差，乏力。查体：患者鼻咽顶后壁稍增厚，双颈未扪及淋巴结，面部、双颈部皮肤色素沉着。[姓名已隐去]医生信息已隐藏：予以抗炎对症处理，并予患者行营养支持治疗，并密切关注患者血象变化。\n- [全程D52] 上级查房记录；[姓名已隐去]主任医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者目前放疗27次，已行2次顺铂同时期化疗，6次靶向治疗，诉咽喉疼痛，纳差，乏力。查体：患者鼻咽右侧壁肿物已基本消退，双颈未扪及淋巴结，面部、双颈部皮肤色素沉着。[姓名已隐去]医生信息已隐藏：予患者行营养支持治疗，并密切关注患者血象变化。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 提前终止放疗；给予重组人表皮生长因子、GM-CSF含漱液局部促修复及静脉营养支持治疗。\nB. 继续完成既定根治性放疗计划；加用重组人表皮生长因子、GM-CSF含漱液局部治疗，并予以静脉营养支持及抗感染治疗。\nC. 暂停放疗及靶向治疗直至黏膜炎好转；给予重组人表皮生长因子、GM-CSF含漱液局部治疗及静脉营养支持。\nD. 继续完成既定根治性放疗计划；仅给予氯化钠含漱液及常规饮食指导，避免使用生长因子类药物及静脉营养。\nE. 继续完成既定根治性放疗计划；加用氟康唑等广谱抗真菌药物静脉滴注，并予以静脉营养支持治疗。\nF. 继续完成既定根治性放疗计划并立即安排鼻咽部局部加量放疗；给予重组人表皮生长因子含漱液及静脉营养支持。\nG. 继续完成既定根治性放疗计划；行预防性经皮内镜下胃造瘘术（PEG）替代静脉营养支持。\nH. 暂停放疗计划；复查鼻咽及颈部MRI以明确肿瘤退缩情况，再决定后续放疗靶区及剂量。\nI. 继续完成既定根治性放疗计划；给予大剂量静脉糖皮质激素冲击治疗，暂缓静脉营养支持。\nJ. 继续完成既定根治性放疗计划；立即给予聚乙二醇化重组人粒细胞刺激因子皮下注射及静脉营养支持。\nK. 提前结束放疗，转为维持性靶向治疗及免疫治疗；给予重组人表皮生长因子及静脉营养支持。\nL. 继续完成既定根治性放疗计划；行预防性气管切开术，并予以静脉营养支持及抗感染治疗。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D25] 检验组合: 间接胆红素(IBIL)-静脉血: 4.41umolL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.41；肌酐(Crea)-静脉血: 102.2umol/L；尿酸(UA)-静脉血: 315.6umol/L；总蛋白(TP)-静脉血: 63.4g/L；直接胆红素(DBIL)-静脉血: 2.3umol/L；白蛋白(ALB)-静脉血: 37.1g/L；总胆红素(TBIL)-静脉血: 6.71umol/L；尿素氮(BUN)-静脉血: 7.1mmol/L；球蛋白(GLO)-静脉血: 26.3g/L\n- [全程D29] 检验组合: 碱性磷酸酶(ALP)-静脉血: 72.7U/L；钠离子(Na+)-静脉血: 140.9mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0.3；大血小板百分比(P-LCR%)-静脉血: 28.3%；葡萄糖(Glu)-静脉血: 4.98mmol/L；载脂蛋白B(apoB)-静脉血: 0.9g/L；磷(P)-静脉血: 0.95mmol/L；球蛋白(GLO)-静脉血: 26.2g/L；氯离子(Cl-)-静脉血: 102.9mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.9U/L；镁离子(Mg2+)-静脉血: 0.81mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.67mmol/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；红细胞计数(RBC#)-静脉血: 4.2510E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.9；总蛋白(TP)-静脉血: 63.5g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 88.7fL；红细胞比容(Hct)-静脉血: 37.7%；总胆固醇(TC)-静脉血: 3.9mmol/L；乳酸脱氢酶(LDH)-静脉血: 144.8U/L；载脂蛋白AI(apoAI)-静脉血: 1.05g/L；丙氨酸氨基转移酶(ALT)-静脉血: 18.8U/L；甘油三酯(TG)-静脉血: 1mmol/L；尿酸(UA)-静脉血: 351.4umol/L；尿素氮(BUN)-静脉血: 6mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；单核细胞百分比(Mono%)-静脉血: 0.077；胱抑素(Cys-C)-静脉血: 0.99mg/L；血小板分布宽度(PDW)-静脉血: 11.5%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；有核红细胞计数(NRBC#)-静脉血: 0.0110E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 38；白细胞计数(WBC#)-静脉血: 3.6610E9/L；平均血小板体积(MPV)-静脉血: 10.5fL；血小板比容-静脉血: 20%；单核细胞计数(Mono#)-静脉血: 0.310E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；总胆汁酸……\n- [全程D36] 检验组合: 酸碱度(pH)-尿液: 6.5；丙氨酸氨基转移酶(ALT)-静脉血: 18.7U/L；阴离子间隙(AG)-静脉血: 12.9；钾离子(K+)-静脉血: 3.75mmol/L；磷(P)-静脉血: 0.98mmol/L；球蛋白(GLO)-静脉血: 29.5g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；酮体(KET)-尿液: -（参考: 阴性）；总胆固醇(TC)-静脉血: 4.56mmol/L；尿素氮(BUN)-静脉血: 4.6mmol/L；红细胞计数(RBC#)-静脉血: 4.4810E12/L；比重(SG)-尿液: 1.008；γ-谷氨酰基转移酶(GGT)-静脉血: 28U/L；红细胞比容(Hct)-静脉血: 39.4%；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.755；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.4；总胆红素(TBIL)-静脉血: 9.28umol/L；葡萄糖(Glu)-静脉血: 5.08mmol/L；钠离子(Na+)-静脉血: 141.1mmol/L；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 25.4mmol/L；颜色-尿液: colorless；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.046；乳酸脱氢酶(LDH)-静脉血: 144U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22.6U/L；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.37；C-反应蛋白(CRP)-静脉血: 7.02mg/L；间接胆红素(IBIL)-静脉血: 6.27umolL；血红蛋白(Hb)-静脉血: 135g/L；单核细胞百分比(Mono%)-静脉血: 0.08；淋巴细胞百分比(Lymph%)-静脉血: 0.113；总钙(Ca)-静脉血: 2.18mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.68；平均血小板体积(MPV)-静脉血: 10fL；淋巴细胞计数(Lymph#……\n- [全程D37] 检验组合: 亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 1/μL；酸碱度(pH)-尿液: 6.5；白细胞计数(WBC#)-尿液: 8/μL；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 1/μL；颜色-尿液: colorless；尿胆原(URO)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；胆红素(BIL)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.006；酮体(KET)-尿液: -（参考: 阴性）\n- [全程D38] 检验组合: 白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.006；尿胆原(URO)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；细菌计数(BACT#)-尿液: 2/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 1/μL；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；颜色-尿液: colorless；浊度(TRUB)-尿液: clear；隐血(OB)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 6.5\n- [全程D43] 检验组合: 尿素氮(BUN)-静脉血: 7.4mmol/L；直接胆红素(DBIL)-静脉血: 3.4umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.3mmol/L；白蛋白(ALB)-静脉血: 41.2g/L；磷(P)-静脉血: 1.12mmol/L；氯离子(Cl-)-静脉血: 97.6mmol/L；总蛋白(TP)-静脉血: 72.16g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 45.7U/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；血小板分布宽度(PDW)-静脉血: 11.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；碱性磷酸酶(ALP)-静脉血: 88.2U/L；C-反应蛋白(CRP)-静脉血: 1.75mg/L；红细胞计数(RBC#)-静脉血: 4.4910E12/L；白细胞计数(WBC#)-静脉血: 3.910E9/L；血小板比容-静脉血: 15%；淋巴细胞百分比(Lymph%)-静脉血: 0.062；总胆固醇(TC)-静脉血: 4.41mmol/L；球蛋白(GLO)-静脉血: 30.96g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.55；α-L-岩藻糖苷酶(AFU)-静脉血: 38.6U/L；钠离子(Na+)-静脉血: 138mmol/L；总胆红素(TBIL)-静脉血: 10.5umol/L；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；血小板计数(PLT#)-静脉血: 15010E9/L；平均血小板体积(MPV)-静脉血: 10.3fL；葡萄糖(Glu)-静脉血: 5.12mmol/L；载脂蛋白B(apoB)-静脉血: 0.95g/L；甘油三酯(TG)-静脉血: 1.59mmol/L；血红蛋白(Hb)-静脉血: 139g/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；胱抑素(Cys-C)-静脉血: 1.23mg/L；载脂蛋白AI(apoAI)-静脉血: 1.33g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.07mmolL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.33；乳酸脱氢酶(LDH)-静脉血: 158.1U/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜酸性粒细胞计数(Eos#)-静脉血: 0.1……\n- [全程D50] 检验组合: 乳酸脱氢酶(LDH)-静脉血: 164U/L；葡萄糖(Glu)-静脉血: 5.3mmol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；肌酐(Crea)-静脉血: 108.9umol/L；平均红细胞体积(MCV)-静脉血: 85.7fL；间接胆红素(IBIL)-静脉血: 7.8umolL；磷(P)-静脉血: 1.01mmol/L；球蛋白(GLO)-静脉血: 29.5g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；总胆固醇(TC)-静脉血: 4.57mmol/L；总蛋白(TP)-静脉血: 69g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15.2U/L；大血小板百分比(P-LCR%)-静脉血: 20.1%；钾离子(K+)-静脉血: 3.73mmol/L；碱性磷酸酶(ALP)-静脉血: 81.5U/L；阴离子间隙(AG)-静脉血: 16.9；胱抑素(Cys-C)-静脉血: 1.07mg/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；直接胆红素(DBIL)-静脉血: 3.9umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；血小板计数(PLT#)-静脉血: 18610E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 25.2U/L；细菌名称-咽拭子: 细菌涂片3；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.03；平均红细胞血红蛋白含量(MCH)-静脉血: 29.8pg；白细胞计数(WBC#)-静脉血: 3.6610E9/L；尿素氮(BUN)-静脉血: 4.8mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 24U/L；氯离子(Cl-)-静脉血: 97.1mmol/L；血小板分布宽度(PDW)-静脉血: 10.4%；淋巴细胞百分比(Lymph%)-静脉血: 0.085；血液二氧化碳含量ctCO2(B)-静脉血: 23.3mmol/L；钠离子(Na+)-静脉血: 137.3mmol/L；总胆红素(TBIL)-静脉血: 11.7umol/L；C-反应蛋白(CRP)-静脉血: 11.52mg/L；总胆汁酸(TBA)-静脉血: 1.4umol/L；中性粒细胞计……\n- [全程D55] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约12mm，肝S5可见一无回声灶，大小约11×9mm,椭圆形，边界清，内透声可，后方回声增强。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约19cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱不充盈。 前列腺大小形态正常，大小约38×30×37mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝囊肿。 胆囊、脾脏、胰腺、双肾、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n\n【既往治疗与反应】\n- [全程D32] 阶段小结；阶段小结: 病程类型: 阶段小结；病程主题: 阶段小结；病程内容: 患者[姓名已隐去]，男，51岁，因“颈部肿物，偶伴涕血、鼻塞2月”于某次就诊时间入院。征求患者同意并签字入住顺铂三周/单周方案联合IMRT治疗局部中晚期鼻咽癌三期临床试验，抽签入三周顺铂100mg/m2组。目前放疗14次，同时期化疗1次。3次靶向治疗，继续原方案治疗，并予患者营养支持治疗。\n- [全程D37] 上级查房记录；[姓名已隐去]主任医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者诉咽喉疼痛，目前放疗17次，今日行第2次顺铂同时期化疗，查体：患者鼻咽壁肿物明显缩小，双颈未扪及淋巴结，面部、双颈部皮肤色素沉着。[姓名已隐去]医生信息已隐藏：密切关注患者放化疗副反应，遵嘱执行。\n- [全程D42] 上级查房记录；[姓名已隐去]主任医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者诉咽喉疼痛，目前放疗20次，已行2次顺铂同时期化疗，4次靶向治疗，诉食欲不佳，查体：患者鼻咽顶后壁肿物明显缩小，双颈未扪及淋巴结，面部、双颈部皮肤色素沉着。[姓名已隐去]医生信息已隐藏：嘱患者加强营养及日常休息。密切关注患者放化疗副反应。 遵嘱。\n- [全程D47] 上级查房记录；[姓名已隐去]主任医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者目前放疗24次，已行2次顺铂同时期化疗，5次靶向治疗，诉咽喉疼痛，纳差，乏力。查体：患者鼻咽顶后壁稍增厚，双颈未扪及淋巴结，面部、双颈部皮肤色素沉着。[姓名已隐去]医生信息已隐藏：予以抗炎对症处理，并予患者行营养支持治疗，并密切关注患者血象变化。\n- [全程D52] 上级查房记录；[姓名已隐去]主任医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者目前放疗27次，已行2次顺铂同时期化疗，6次靶向治疗，诉咽喉疼痛，纳差，乏力。查体：患者鼻咽右侧壁肿物已基本消退，双颈未扪及淋巴结，面部、双颈部皮肤色素沉着。[姓名已隐去]医生信息已隐藏：予患者行营养支持治疗，并密切关注患者血象变化。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 提前终止放疗；给予重组人表皮生长因子、GM-CSF含漱液局部促修复及静脉营养支持治疗。\nB. 继续完成既定根治性放疗计划；加用重组人表皮生长因子、GM-CSF含漱液局部治疗，并予以静脉营养支持及抗感染治疗。\nC. 暂停放疗及靶向治疗直至黏膜炎好转；给予重组人表皮生长因子、GM-CSF含漱液局部治疗及静脉营养支持。\nD. 继续完成既定根治性放疗计划；仅给予氯化钠含漱液及常规饮食指导，避免使用生长因子类药物及静脉营养。\nE. 继续完成既定根治性放疗计划；加用氟康唑等广谱抗真菌药物静脉滴注，并予以静脉营养支持治疗。\nF. 继续完成既定根治性放疗计划并立即安排鼻咽部局部加量放疗；给予重组人表皮生长因子含漱液及静脉营养支持。\nG. 继续完成既定根治性放疗计划；行预防性经皮内镜下胃造瘘术（PEG）替代静脉营养支持。\nH. 暂停放疗计划；复查鼻咽及颈部MRI以明确肿瘤退缩情况，再决定后续放疗靶区及剂量。\nI. 继续完成既定根治性放疗计划；给予大剂量静脉糖皮质激素冲击治疗，暂缓静脉营养支持。\nJ. 继续完成既定根治性放疗计划；立即给予聚乙二醇化重组人粒细胞刺激因子皮下注射及静脉营养支持。\nK. 提前结束放疗，转为维持性靶向治疗及免疫治疗；给予重组人表皮生长因子及静脉营养支持。\nL. 继续完成既定根治性放疗计划；行预防性气管切开术，并予以静脉营养支持及抗感染治疗。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、筛窦、斜坡、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D25] 检验组合: 间接胆红素(IBIL)-静脉血: 4.41umolL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.41；肌酐(Crea)-静脉血: 102.2umol/L；尿酸(UA)-静脉血: 315.6umol/L；总蛋白(TP)-静脉血: 63.4g/L；直接胆红素(DBIL)-静脉血: 2.3umol/L；白蛋白(ALB)-静脉血: 37.1g/L；总胆红素(TBIL)-静脉血: 6.71umol/L；尿素氮(BUN)-静脉血: 7.1mmol/L；球蛋白(GLO)-静脉血: 26.3g/L\n- [全程D29] 检验组合: 碱性磷酸酶(ALP)-静脉血: 72.7U/L；钠离子(Na+)-静脉血: 140.9mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0.3；大血小板百分比(P-LCR%)-静脉血: 28.3%；葡萄糖(Glu)-静脉血: 4.98mmol/L；载脂蛋白B(apoB)-静脉血: 0.9g/L；磷(P)-静脉血: 0.95mmol/L；球蛋白(GLO)-静脉血: 26.2g/L；氯离子(Cl-)-静脉血: 102.9mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.9U/L；镁离子(Mg2+)-静脉血: 0.81mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.67mmol/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；红细胞计数(RBC#)-静脉血: 4.2510E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.9；总蛋白(TP)-静脉血: 63.5g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 88.7fL；红细胞比容(Hct)-静脉血: 37.7%；总胆固醇(TC)-静脉血: 3.9mmol/L；乳酸脱氢酶(LDH)-静脉血: 144.8U/L；载脂蛋白AI(apoAI)-静脉血: 1.05g/L；丙氨酸氨基转移酶(ALT)-静脉血: 18.8U/L；甘油三酯(TG)-静脉血: 1mmol/L；尿酸(UA)-静脉血: 351.4umol/L；尿素氮(BUN)-静脉血: 6mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；单核细胞百分比(Mono%)-静脉血: 0.077；胱抑素(Cys-C)-静脉血: 0.99mg/L；血小板分布宽度(PDW)-静脉血: 11.5%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；有核红细胞计数(NRBC#)-静脉血: 0.0110E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 38；白细胞计数(WBC#)-静脉血: 3.6610E9/L；平均血小板体积(MPV)-静脉血: 10.5fL；血小板比容-静脉血: 20%；单核细胞计数(Mono#)-静脉血: 0.310E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；总胆汁酸……\n- [全程D36] 检验组合: 酸碱度(pH)-尿液: 6.5；丙氨酸氨基转移酶(ALT)-静脉血: 18.7U/L；阴离子间隙(AG)-静脉血: 12.9；钾离子(K+)-静脉血: 3.75mmol/L；磷(P)-静脉血: 0.98mmol/L；球蛋白(GLO)-静脉血: 29.5g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；酮体(KET)-尿液: -（参考: 阴性）；总胆固醇(TC)-静脉血: 4.56mmol/L；尿素氮(BUN)-静脉血: 4.6mmol/L；红细胞计数(RBC#)-静脉血: 4.4810E12/L；比重(SG)-尿液: 1.008；γ-谷氨酰基转移酶(GGT)-静脉血: 28U/L；红细胞比容(Hct)-静脉血: 39.4%；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.755；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.4；总胆红素(TBIL)-静脉血: 9.28umol/L；葡萄糖(Glu)-静脉血: 5.08mmol/L；钠离子(Na+)-静脉血: 141.1mmol/L；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 25.4mmol/L；颜色-尿液: colorless；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.046；乳酸脱氢酶(LDH)-静脉血: 144U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22.6U/L；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.37；C-反应蛋白(CRP)-静脉血: 7.02mg/L；间接胆红素(IBIL)-静脉血: 6.27umolL；血红蛋白(Hb)-静脉血: 135g/L；单核细胞百分比(Mono%)-静脉血: 0.08；淋巴细胞百分比(Lymph%)-静脉血: 0.113；总钙(Ca)-静脉血: 2.18mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.68；平均血小板体积(MPV)-静脉血: 10fL；淋巴细胞计数(Lymph#……\n- [全程D37] 检验组合: 亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 1/μL；酸碱度(pH)-尿液: 6.5；白细胞计数(WBC#)-尿液: 8/μL；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 1/μL；颜色-尿液: colorless；尿胆原(URO)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；胆红素(BIL)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.006；酮体(KET)-尿液: -（参考: 阴性）\n- [全程D38] 检验组合: 白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.006；尿胆原(URO)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；细菌计数(BACT#)-尿液: 2/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 1/μL；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；颜色-尿液: colorless；浊度(TRUB)-尿液: clear；隐血(OB)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 6.5\n- [全程D43] 检验组合: 尿素氮(BUN)-静脉血: 7.4mmol/L；直接胆红素(DBIL)-静脉血: 3.4umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.3mmol/L；白蛋白(ALB)-静脉血: 41.2g/L；磷(P)-静脉血: 1.12mmol/L；氯离子(Cl-)-静脉血: 97.6mmol/L；总蛋白(TP)-静脉血: 72.16g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 45.7U/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；血小板分布宽度(PDW)-静脉血: 11.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；碱性磷酸酶(ALP)-静脉血: 88.2U/L；C-反应蛋白(CRP)-静脉血: 1.75mg/L；红细胞计数(RBC#)-静脉血: 4.4910E12/L；白细胞计数(WBC#)-静脉血: 3.910E9/L；血小板比容-静脉血: 15%；淋巴细胞百分比(Lymph%)-静脉血: 0.062；总胆固醇(TC)-静脉血: 4.41mmol/L；球蛋白(GLO)-静脉血: 30.96g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.55；α-L-岩藻糖苷酶(AFU)-静脉血: 38.6U/L；钠离子(Na+)-静脉血: 138mmol/L；总胆红素(TBIL)-静脉血: 10.5umol/L；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；血小板计数(PLT#)-静脉血: 15010E9/L；平均血小板体积(MPV)-静脉血: 10.3fL；葡萄糖(Glu)-静脉血: 5.12mmol/L；载脂蛋白B(apoB)-静脉血: 0.95g/L；甘油三酯(TG)-静脉血: 1.59mmol/L；血红蛋白(Hb)-静脉血: 139g/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；胱抑素(Cys-C)-静脉血: 1.23mg/L；载脂蛋白AI(apoAI)-静脉血: 1.33g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.07mmolL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.33；乳酸脱氢酶(LDH)-静脉血: 158.1U/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜酸性粒细胞计数(Eos#)-静脉血: 0.1……\n- [全程D50] 检验组合: 乳酸脱氢酶(LDH)-静脉血: 164U/L；葡萄糖(Glu)-静脉血: 5.3mmol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；肌酐(Crea)-静脉血: 108.9umol/L；平均红细胞体积(MCV)-静脉血: 85.7fL；间接胆红素(IBIL)-静脉血: 7.8umolL；磷(P)-静脉血: 1.01mmol/L；球蛋白(GLO)-静脉血: 29.5g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；总胆固醇(TC)-静脉血: 4.57mmol/L；总蛋白(TP)-静脉血: 69g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15.2U/L；大血小板百分比(P-LCR%)-静脉血: 20.1%；钾离子(K+)-静脉血: 3.73mmol/L；碱性磷酸酶(ALP)-静脉血: 81.5U/L；阴离子间隙(AG)-静脉血: 16.9；胱抑素(Cys-C)-静脉血: 1.07mg/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；直接胆红素(DBIL)-静脉血: 3.9umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；血小板计数(PLT#)-静脉血: 18610E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 25.2U/L；细菌名称-咽拭子: 细菌涂片3；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.03；平均红细胞血红蛋白含量(MCH)-静脉血: 29.8pg；白细胞计数(WBC#)-静脉血: 3.6610E9/L；尿素氮(BUN)-静脉血: 4.8mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 24U/L；氯离子(Cl-)-静脉血: 97.1mmol/L；血小板分布宽度(PDW)-静脉血: 10.4%；淋巴细胞百分比(Lymph%)-静脉血: 0.085；血液二氧化碳含量ctCO2(B)-静脉血: 23.3mmol/L；钠离子(Na+)-静脉血: 137.3mmol/L；总胆红素(TBIL)-静脉血: 11.7umol/L；C-反应蛋白(CRP)-静脉血: 11.52mg/L；总胆汁酸(TBA)-静脉血: 1.4umol/L；中性粒细胞计……\n- [全程D55] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约12mm，肝S5可见一无回声灶，大小约11×9mm,椭圆形，边界清，内透声可，后方回声增强。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约19cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱不充盈。 前列腺大小形态正常，大小约38×30×37mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝囊肿。 胆囊、脾脏、胰腺、双肾、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n\n【既往治疗与反应】\n- [全程D32] 阶段小结；阶段小结: 病程类型: 阶段小结；病程主题: 阶段小结；病程内容: 患者[姓名已隐去]，男，51岁，因“颈部肿物，偶伴涕血、鼻塞2月”于某次就诊时间入院。征求患者同意并签字入住顺铂三周/单周方案联合IMRT治疗局部中晚期鼻咽癌三期临床试验，抽签入三周顺铂100mg/m2组。目前放疗14次，同时期化疗1次。3次靶向治疗，继续原方案治疗，并予患者营养支持治疗。\n- [全程D37] 上级查房记录；[姓名已隐去]主任医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者诉咽喉疼痛，目前放疗17次，今日行第2次顺铂同时期化疗，查体：患者鼻咽壁肿物明显缩小，双颈未扪及淋巴结，面部、双颈部皮肤色素沉着。[姓名已隐去]医生信息已隐藏：密切关注患者放化疗副反应，遵嘱执行。\n- [全程D42] 上级查房记录；[姓名已隐去]主任医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者诉咽喉疼痛，目前放疗20次，已行2次顺铂同时期化疗，4次靶向治疗，诉食欲不佳，查体：患者鼻咽顶后壁肿物明显缩小，双颈未扪及淋巴结，面部、双颈部皮肤色素沉着。[姓名已隐去]医生信息已隐藏：嘱患者加强营养及日常休息。密切关注患者放化疗副反应。 遵嘱。\n- [全程D47] 上级查房记录；[姓名已隐去]主任医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者目前放疗24次，已行2次顺铂同时期化疗，5次靶向治疗，诉咽喉疼痛，纳差，乏力。查体：患者鼻咽顶后壁稍增厚，双颈未扪及淋巴结，面部、双颈部皮肤色素沉着。[姓名已隐去]医生信息已隐藏：予以抗炎对症处理，并予患者行营养支持治疗，并密切关注患者血象变化。\n- [全程D52] 上级查房记录；[姓名已隐去]主任医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者目前放疗27次，已行2次顺铂同时期化疗，6次靶向治疗，诉咽喉疼痛，纳差，乏力。查体：患者鼻咽右侧壁肿物已基本消退，双颈未扪及淋巴结，面部、双颈部皮肤色素沉着。[姓名已隐去]医生信息已隐藏：予患者行营养支持治疗，并密切关注患者血象变化。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 提前终止放疗；给予重组人表皮生长因子、GM-CSF含漱液局部促修复及静脉营养支持治疗。\nB. 继续完成既定根治性放疗计划；加用重组人表皮生长因子、GM-CSF含漱液局部治疗，并予以静脉营养支持及抗感染治疗。\nC. 暂停放疗及靶向治疗直至黏膜炎好转；给予重组人表皮生长因子、GM-CSF含漱液局部治疗及静脉营养支持。\nD. 继续完成既定根治性放疗计划；仅给予氯化钠含漱液及常规饮食指导，避免使用生长因子类药物及静脉营养。\nE. 继续完成既定根治性放疗计划；加用氟康唑等广谱抗真菌药物静脉滴注，并予以静脉营养支持治疗。\nF. 继续完成既定根治性放疗计划并立即安排鼻咽部局部加量放疗；给予重组人表皮生长因子含漱液及静脉营养支持。\nG. 继续完成既定根治性放疗计划；行预防性经皮内镜下胃造瘘术（PEG）替代静脉营养支持。\nH. 暂停放疗计划；复查鼻咽及颈部MRI以明确肿瘤退缩情况，再决定后续放疗靶区及剂量。\nI. 继续完成既定根治性放疗计划；给予大剂量静脉糖皮质激素冲击治疗，暂缓静脉营养支持。\nJ. 继续完成既定根治性放疗计划；立即给予聚乙二醇化重组人粒细胞刺激因子皮下注射及静脉营养支持。\nK. 提前结束放疗，转为维持性靶向治疗及免疫治疗；给予重组人表皮生长因子及静脉营养支持。\nL. 继续完成既定根治性放疗计划；行预防性气管切开术，并予以静脉营养支持及抗感染治疗。\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-c54efc446616b72b81ae7555","patient_id":"patient-a48d1d72efa6c4217cf5b79c","turn_id":"turn08","turn_position":5,"turn_type":"recurrence_or_salvage_decision","gold_letter":"C","gold_action":"行电子鼻咽镜检查评估局部肿瘤退缩情况，并继续使用重组人表皮生长因子、重组人粒细胞巨噬细胞刺激因子等含漱药物促进粘膜修复。","options":[{"letter":"A","text":"行电子鼻咽镜检查并在可疑残留区域取活检，继续静脉滴注莫西沙星及地塞米松预防感染与水肿，暂不予抗肿瘤治疗。","is_gold":false},{"letter":"B","text":"安排全身PET-CT检查评估放化疗后全身代谢缓解情况，并继续静脉滴注脂肪乳及氨基酸等营养支持治疗。","is_gold":false},{"letter":"C","text":"行电子鼻咽镜检查评估局部肿瘤退缩情况，并继续使用重组人表皮生长因子、重组人粒细胞巨噬细胞刺激因子等含漱药物促进粘膜修复。","is_gold":true},{"letter":"D","text":"对右侧咽后及颈部残留淋巴结行局部追加放疗推量，并继续使用重组人表皮生长因子等含漱药物促进粘膜修复。","is_gold":false},{"letter":"E","text":"行电子鼻咽镜检查评估局部疗效，并启动吉西他滨联合顺铂方案进行2至3个周期的辅助化疗以巩固全身疗效。","is_gold":false},{"letter":"F","text":"行右侧颈部淋巴结清扫术处理残留淋巴结，术后继续使用重组人表皮生长因子外用溶液促进局部创面愈合。","is_gold":false},{"letter":"G","text":"行鼻咽及颈部超声检查评估淋巴结结构，并加用卡培他滨口服进行为期1年的节拍化疗作为维持治疗。","is_gold":false},{"letter":"H","text":"暂不进行鼻咽镜检查，直接出院，嘱1个月后返院行鼻咽部活检及MRI复查，期间继续静脉营养支持。","is_gold":false},{"letter":"I","text":"行电子鼻咽镜检查评估局部疗效，并继续静脉滴注脂肪乳、氨基酸及复方氯化钠注射液加强全身营养支持。","is_gold":false},{"letter":"J","text":"安排头颅增强MRI及全身骨扫描排除远处转移，并继续原方案靶向治疗至满1年，辅以局部含漱药物治疗。","is_gold":false},{"letter":"K","text":"行电子鼻咽镜检查评估局部疗效，若发现粘膜坏死则立即行内镜下清创术，并静脉滴注大剂量抗生素抗感染。","is_gold":false},{"letter":"L","text":"继续静脉滴注莫西沙星及地塞米松抗炎治疗2周以控制鼻窦炎及乳突炎，并定期复查鼻窦CT评估炎症吸收情况。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、筛窦、斜坡、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现颈部肿物伴涕血、鼻塞2月；患者未予相关诊治，转至我院就诊。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,涕血,颈部肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。偶伴吸烟、饮酒15年，3两/天，。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：90次/分，R：20次/分，BP：120/70mmHg,Ht：172cm，Wt：73kg，BSA：1.85m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.0cm；鼻咽双侧顶后壁结节状肿物；双侧颈部IIa区可扪及1个淋巴结，最大径2×2cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 发现颈部肿物伴涕血、鼻塞2月；现病史: 患者2月前无明显诱因出现颈部肿物，拇指大小，偶伴涕血、鼻塞，右侧明显，无面麻、复视等其他不适，未予重视，逐渐加重，患者遂于某次就诊时间行颈部彩超示：右侧颈部低回声，行鼻咽镜示：鼻咽肿物，建议活检。患者未予相关诊治，转至我院就诊。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,涕血,颈部肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。偶伴吸烟、饮酒15年，3两/天，。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：90次/分，R：20次/分，BP：120/70mmHg,Ht：172cm，Wt：73kg，BSA：1.85m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率90次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.0cm；鼻咽双侧顶后壁结节状肿物；双侧颈部IIa区可扪及1个淋巴结，最大径2×2cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 甘油三酯(TG)-静脉血: 1.1mmol/L；透明质酸(HA)-静脉血: 34.26ng/ml；中性粒细胞计数(Neut#)-静脉血: 3.710E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；层粘连蛋白(LN)-静脉血: 11.97ng/ml；凝血酶原时间活动度(PTA)-静脉血: 125.5%；总胆固醇(TC)-静脉血: 4.12mmol/L；凝血酶原时间(PT)-静脉血: 10.8sec.；碱性磷酸酶(ALP)-静脉血: 83.4U/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；ABO血型-静脉血: O；镁离子(Mg2+)-静脉血: 0.88mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.005；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 65.2umol/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；尿素氮(BUN)-静脉血: 5.1mmol/L；总蛋白(TP)-静脉血: 75.4g/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 22.8U/L；钾离子(K+)-静脉血: 3.71mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 17.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 18.1U/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；乳酸脱氢酶(LDH)-静脉血: 142.3U/L；III型前胶原氨基端肽(PIIINP)-静脉血: 17.25ng/ml；尿酸(UA)-静脉血: 293.9umol/L；血小板计数(PLT#)-静脉血: 18910E9/L；Rh血型-静脉血: 阳性；总胆汁酸(TBA)-静脉血: 2.8umol/L；IV型胶原(C-IV)-静脉血: 21.48ng/ml；天门冬氨酸氨基转移酶(AST)-静脉血: 15.4U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；氯离子(Cl-)-静脉血: 103.6mmol/L；磷(P)-静脉血: 0.78m……\n- [全程D2] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D8] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、右侧壁见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。肿物占据双侧咽隐窝，向后外推移右侧咽旁脂肪间隙，前方浸润右侧筛窦及上鼻道，左侧咽旁脂肪间隙及左侧颈动脉鞘区未见异常。 右侧腭帆提肌、腭帆张肌受侵；左侧腭帆提肌、腭帆张肌、头长肌未见受累征象。 右侧翼腭窝及右侧上颌后脂肪间隙稍变窄；左侧翼腭窝、左上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽未见明显异常。 斜坡、蝶骨基底部、右侧翼突基底部及右侧蝶骨大翼信号降低，增强后强化。 双侧海绵窦未见明显异常。 双侧上颌窦、筛窦、右侧蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，无强化，骨壁完整。双眼大小、形态、位置均属正常、信号均匀。蝶鞍形态正常，其内未见占位性病变。 右侧咽后间隙见淋巴结，较大者约11mm×10mm；左侧咽后间隙未见肿大淋巴结。双颈Ⅱ区、右颈Ⅲ区见多个淋巴结，部分融合，边界清，不均匀明显强化，较大者约大小约24mm×13mm。 所见甲状腺双叶形态正常、喉咽腔、双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 符合鼻咽癌。 颅底骨质破坏。 左侧咽后、双颈Ⅱ区及右颈Ⅲ区肿大淋巴结，考虑转移。 副鼻窦炎、乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D25] 检验组合: 间接胆红素(IBIL)-静脉血: 4.41umolL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.41；肌酐(Crea)-静脉血: 102.2umol/L；尿酸(UA)-静脉血: 315.6umol/L；总蛋白(TP)-静脉血: 63.4g/L；直接胆红素(DBIL)-静脉血: 2.3umol/L；白蛋白(ALB)-静脉血: 37.1g/L；总胆红素(TBIL)-静脉血: 6.71umol/L；尿素氮(BUN)-静脉血: 7.1mmol/L；球蛋白(GLO)-静脉血: 26.3g/L\n- [全程D29] 检验组合: 碱性磷酸酶(ALP)-静脉血: 72.7U/L；钠离子(Na+)-静脉血: 140.9mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0.3；大血小板百分比(P-LCR%)-静脉血: 28.3%；葡萄糖(Glu)-静脉血: 4.98mmol/L；载脂蛋白B(apoB)-静脉血: 0.9g/L；磷(P)-静脉血: 0.95mmol/L；球蛋白(GLO)-静脉血: 26.2g/L；氯离子(Cl-)-静脉血: 102.9mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.9U/L；镁离子(Mg2+)-静脉血: 0.81mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.67mmol/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；红细胞计数(RBC#)-静脉血: 4.2510E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.9；总蛋白(TP)-静脉血: 63.5g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 88.7fL；红细胞比容(Hct)-静脉血: 37.7%；总胆固醇(TC)-静脉血: 3.9mmol/L；乳酸脱氢酶(LDH)-静脉血: 144.8U/L；载脂蛋白AI(apoAI)-静脉血: 1.05g/L；丙氨酸氨基转移酶(ALT)-静脉血: 18.8U/L；甘油三酯(TG)-静脉血: 1mmol/L；尿酸(UA)-静脉血: 351.4umol/L；尿素氮(BUN)-静脉血: 6mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；单核细胞百分比(Mono%)-静脉血: 0.077；胱抑素(Cys-C)-静脉血: 0.99mg/L；血小板分布宽度(PDW)-静脉血: 11.5%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；有核红细胞计数(NRBC#)-静脉血: 0.0110E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 38；白细胞计数(WBC#)-静脉血: 3.6610E9/L；平均血小板体积(MPV)-静脉血: 10.5fL；血小板比容-静脉血: 20%；单核细胞计数(Mono#)-静脉血: 0.310E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；总胆汁酸……\n- [全程D36] 检验组合: 酸碱度(pH)-尿液: 6.5；丙氨酸氨基转移酶(ALT)-静脉血: 18.7U/L；阴离子间隙(AG)-静脉血: 12.9；钾离子(K+)-静脉血: 3.75mmol/L；磷(P)-静脉血: 0.98mmol/L；球蛋白(GLO)-静脉血: 29.5g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；酮体(KET)-尿液: -（参考: 阴性）；总胆固醇(TC)-静脉血: 4.56mmol/L；尿素氮(BUN)-静脉血: 4.6mmol/L；红细胞计数(RBC#)-静脉血: 4.4810E12/L；比重(SG)-尿液: 1.008；γ-谷氨酰基转移酶(GGT)-静脉血: 28U/L；红细胞比容(Hct)-静脉血: 39.4%；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.755；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.4；总胆红素(TBIL)-静脉血: 9.28umol/L；葡萄糖(Glu)-静脉血: 5.08mmol/L；钠离子(Na+)-静脉血: 141.1mmol/L；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 25.4mmol/L；颜色-尿液: colorless；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.046；乳酸脱氢酶(LDH)-静脉血: 144U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22.6U/L；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.37；C-反应蛋白(CRP)-静脉血: 7.02mg/L；间接胆红素(IBIL)-静脉血: 6.27umolL；血红蛋白(Hb)-静脉血: 135g/L；单核细胞百分比(Mono%)-静脉血: 0.08；淋巴细胞百分比(Lymph%)-静脉血: 0.113；总钙(Ca)-静脉血: 2.18mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.68；平均血小板体积(MPV)-静脉血: 10fL；淋巴细胞计数(Lymph#……\n- [全程D37] 检验组合: 亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 1/μL；酸碱度(pH)-尿液: 6.5；白细胞计数(WBC#)-尿液: 8/μL；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 1/μL；颜色-尿液: colorless；尿胆原(URO)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；胆红素(BIL)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.006；酮体(KET)-尿液: -（参考: 阴性）\n- [全程D38] 检验组合: 白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.006；尿胆原(URO)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；细菌计数(BACT#)-尿液: 2/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 1/μL；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；颜色-尿液: colorless；浊度(TRUB)-尿液: clear；隐血(OB)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 6.5\n- [全程D43] 检验组合: 尿素氮(BUN)-静脉血: 7.4mmol/L；直接胆红素(DBIL)-静脉血: 3.4umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.3mmol/L；白蛋白(ALB)-静脉血: 41.2g/L；磷(P)-静脉血: 1.12mmol/L；氯离子(Cl-)-静脉血: 97.6mmol/L；总蛋白(TP)-静脉血: 72.16g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 45.7U/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；血小板分布宽度(PDW)-静脉血: 11.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；碱性磷酸酶(ALP)-静脉血: 88.2U/L；C-反应蛋白(CRP)-静脉血: 1.75mg/L；红细胞计数(RBC#)-静脉血: 4.4910E12/L；白细胞计数(WBC#)-静脉血: 3.910E9/L；血小板比容-静脉血: 15%；淋巴细胞百分比(Lymph%)-静脉血: 0.062；总胆固醇(TC)-静脉血: 4.41mmol/L；球蛋白(GLO)-静脉血: 30.96g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.55；α-L-岩藻糖苷酶(AFU)-静脉血: 38.6U/L；钠离子(Na+)-静脉血: 138mmol/L；总胆红素(TBIL)-静脉血: 10.5umol/L；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；血小板计数(PLT#)-静脉血: 15010E9/L；平均血小板体积(MPV)-静脉血: 10.3fL；葡萄糖(Glu)-静脉血: 5.12mmol/L；载脂蛋白B(apoB)-静脉血: 0.95g/L；甘油三酯(TG)-静脉血: 1.59mmol/L；血红蛋白(Hb)-静脉血: 139g/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；胱抑素(Cys-C)-静脉血: 1.23mg/L；载脂蛋白AI(apoAI)-静脉血: 1.33g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.07mmolL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.33；乳酸脱氢酶(LDH)-静脉血: 158.1U/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜酸性粒细胞计数(Eos#)-静脉血: 0.1……\n- [全程D50] 检验组合: 乳酸脱氢酶(LDH)-静脉血: 164U/L；葡萄糖(Glu)-静脉血: 5.3mmol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；肌酐(Crea)-静脉血: 108.9umol/L；平均红细胞体积(MCV)-静脉血: 85.7fL；间接胆红素(IBIL)-静脉血: 7.8umolL；磷(P)-静脉血: 1.01mmol/L；球蛋白(GLO)-静脉血: 29.5g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；总胆固醇(TC)-静脉血: 4.57mmol/L；总蛋白(TP)-静脉血: 69g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15.2U/L；大血小板百分比(P-LCR%)-静脉血: 20.1%；钾离子(K+)-静脉血: 3.73mmol/L；碱性磷酸酶(ALP)-静脉血: 81.5U/L；阴离子间隙(AG)-静脉血: 16.9；胱抑素(Cys-C)-静脉血: 1.07mg/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；直接胆红素(DBIL)-静脉血: 3.9umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；血小板计数(PLT#)-静脉血: 18610E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 25.2U/L；细菌名称-咽拭子: 细菌涂片3；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.03；平均红细胞血红蛋白含量(MCH)-静脉血: 29.8pg；白细胞计数(WBC#)-静脉血: 3.6610E9/L；尿素氮(BUN)-静脉血: 4.8mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 24U/L；氯离子(Cl-)-静脉血: 97.1mmol/L；血小板分布宽度(PDW)-静脉血: 10.4%；淋巴细胞百分比(Lymph%)-静脉血: 0.085；血液二氧化碳含量ctCO2(B)-静脉血: 23.3mmol/L；钠离子(Na+)-静脉血: 137.3mmol/L；总胆红素(TBIL)-静脉血: 11.7umol/L；C-反应蛋白(CRP)-静脉血: 11.52mg/L；总胆汁酸(TBA)-静脉血: 1.4umol/L；中性粒细胞计……\n- [全程D55] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约12mm，肝S5可见一无回声灶，大小约11×9mm,椭圆形，边界清，内透声可，后方回声增强。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约19cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱不充盈。 前列腺大小形态正常，大小约38×30×37mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝囊肿。 胆囊、脾脏、胰腺、双肾、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D56] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理清晰，双肺野内未见明显实质性病变。双侧肺门未见增大，纵隔未见增宽，心影形态、大小未见异常。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见异常。\n- [全程D56] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌治疗后，对比某次就诊时间片： 鼻咽腔狭窄，鼻咽顶壁、顶后壁、右侧壁稍增厚，粘膜表面欠光滑，增强后较明显强化，较前明显缩小，双侧咽隐窝稍变浅，鼻中隔后缘见少许软组织，增强后较明显强化，右侧咽旁间隙稍变窄，左侧咽旁脂肪间隙及左侧颈动脉鞘区未见异常。 右侧腭帆提肌稍模糊；左侧腭帆提肌、腭帆张肌、头长肌未见受累征象。 左侧中下鼻甲明显肥厚。 双侧翼腭窝、双上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽未见明显异常。 斜坡、蝶骨基底部、右侧翼突基底部信号降低，增强后强化，较前范围稍缩小。 双侧海绵窦未见明显异常。 双侧上颌窦、筛窦、右侧蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，无强化，骨壁完整。双眼大小、形态、位置均属正常、信号均匀。蝶鞍形态正常，其内未见占位性病变。 右侧咽后间隙见淋巴结，较大者约7mm×6mm，信号欠均匀，增强后明显强化，较前缩小；左侧咽后间隙未见肿大淋巴结。双颈Ⅱ区、右颈Ⅲ区见多个淋巴结，边界欠清，最大约10mm×7mm，增强后不均匀强化，较前缩小、数目减少。 所见甲状腺双叶形态正常、喉咽腔、双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌治疗后，对比某次就诊时间片： 鼻咽病灶较前明显缩小。 颅底骨质破坏，较前修复。 右侧咽后淋巴结肿大，较前明显缩小。 双颈II区、右颈III区小淋巴结，较前明显缩小、数目减少。 鼻窦炎及右侧乳突炎。 左侧中下鼻甲肥厚。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D32] 阶段小结；阶段小结: 病程类型: 阶段小结；病程主题: 阶段小结；病程内容: 患者[姓名已隐去]，男，51岁，因“颈部肿物，偶伴涕血、鼻塞2月”于某次就诊时间入院。征求患者同意并签字入住顺铂三周/单周方案联合IMRT治疗局部中晚期鼻咽癌三期临床试验，抽签入三周顺铂100mg/m2组。目前放疗14次，同时期化疗1次。3次靶向治疗，继续原方案治疗，并予患者营养支持治疗。\n- [全程D37] 上级查房记录；[姓名已隐去]主任医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者诉咽喉疼痛，目前放疗17次，今日行第2次顺铂同时期化疗，查体：患者鼻咽壁肿物明显缩小，双颈未扪及淋巴结，面部、双颈部皮肤色素沉着。[姓名已隐去]医生信息已隐藏：密切关注患者放化疗副反应，遵嘱执行。\n- [全程D42] 上级查房记录；[姓名已隐去]主任医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者诉咽喉疼痛，目前放疗20次，已行2次顺铂同时期化疗，4次靶向治疗，诉食欲不佳，查体：患者鼻咽顶后壁肿物明显缩小，双颈未扪及淋巴结，面部、双颈部皮肤色素沉着。[姓名已隐去]医生信息已隐藏：嘱患者加强营养及日常休息。密切关注患者放化疗副反应。 遵嘱。\n- [全程D47] 上级查房记录；[姓名已隐去]主任医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者目前放疗24次，已行2次顺铂同时期化疗，5次靶向治疗，诉咽喉疼痛，纳差，乏力。查体：患者鼻咽顶后壁稍增厚，双颈未扪及淋巴结，面部、双颈部皮肤色素沉着。[姓名已隐去]医生信息已隐藏：予以抗炎对症处理，并予患者行营养支持治疗，并密切关注患者血象变化。\n- [全程D52] 上级查房记录；[姓名已隐去]主任医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者目前放疗27次，已行2次顺铂同时期化疗，6次靶向治疗，诉咽喉疼痛，纳差，乏力。查体：患者鼻咽右侧壁肿物已基本消退，双颈未扪及淋巴结，面部、双颈部皮肤色素沉着。[姓名已隐去]医生信息已隐藏：予患者行营养支持治疗，并密切关注患者血象变化。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行电子鼻咽镜检查并在可疑残留区域取活检，继续静脉滴注莫西沙星及地塞米松预防感染与水肿，暂不予抗肿瘤治疗。\nB. 安排全身PET-CT检查评估放化疗后全身代谢缓解情况，并继续静脉滴注脂肪乳及氨基酸等营养支持治疗。\nC. 行电子鼻咽镜检查评估局部肿瘤退缩情况，并继续使用重组人表皮生长因子、重组人粒细胞巨噬细胞刺激因子等含漱药物促进粘膜修复。\nD. 对右侧咽后及颈部残留淋巴结行局部追加放疗推量，并继续使用重组人表皮生长因子等含漱药物促进粘膜修复。\nE. 行电子鼻咽镜检查评估局部疗效，并启动吉西他滨联合顺铂方案进行2至3个周期的辅助化疗以巩固全身疗效。\nF. 行右侧颈部淋巴结清扫术处理残留淋巴结，术后继续使用重组人表皮生长因子外用溶液促进局部创面愈合。\nG. 行鼻咽及颈部超声检查评估淋巴结结构，并加用卡培他滨口服进行为期1年的节拍化疗作为维持治疗。\nH. 暂不进行鼻咽镜检查，直接出院，嘱1个月后返院行鼻咽部活检及MRI复查，期间继续静脉营养支持。\nI. 行电子鼻咽镜检查评估局部疗效，并继续静脉滴注脂肪乳、氨基酸及复方氯化钠注射液加强全身营养支持。\nJ. 安排头颅增强MRI及全身骨扫描排除远处转移，并继续原方案靶向治疗至满1年，辅以局部含漱药物治疗。\nK. 行电子鼻咽镜检查评估局部疗效，若发现粘膜坏死则立即行内镜下清创术，并静脉滴注大剂量抗生素抗感染。\nL. 继续静脉滴注莫西沙星及地塞米松抗炎治疗2周以控制鼻窦炎及乳突炎，并定期复查鼻窦CT评估炎症吸收情况。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D56] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理清晰，双肺野内未见明显实质性病变。双侧肺门未见增大，纵隔未见增宽，心影形态、大小未见异常。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见异常。\n- [全程D56] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌治疗后，对比某次就诊时间片： 鼻咽腔狭窄，鼻咽顶壁、顶后壁、右侧壁稍增厚，粘膜表面欠光滑，增强后较明显强化，较前明显缩小，双侧咽隐窝稍变浅，鼻中隔后缘见少许软组织，增强后较明显强化，右侧咽旁间隙稍变窄，左侧咽旁脂肪间隙及左侧颈动脉鞘区未见异常。 右侧腭帆提肌稍模糊；左侧腭帆提肌、腭帆张肌、头长肌未见受累征象。 左侧中下鼻甲明显肥厚。 双侧翼腭窝、双上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽未见明显异常。 斜坡、蝶骨基底部、右侧翼突基底部信号降低，增强后强化，较前范围稍缩小。 双侧海绵窦未见明显异常。 双侧上颌窦、筛窦、右侧蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，无强化，骨壁完整。双眼大小、形态、位置均属正常、信号均匀。蝶鞍形态正常，其内未见占位性病变。 右侧咽后间隙见淋巴结，较大者约7mm×6mm，信号欠均匀，增强后明显强化，较前缩小；左侧咽后间隙未见肿大淋巴结。双颈Ⅱ区、右颈Ⅲ区见多个淋巴结，边界欠清，最大约10mm×7mm，增强后不均匀强化，较前缩小、数目减少。 所见甲状腺双叶形态正常、喉咽腔、双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌治疗后，对比某次就诊时间片： 鼻咽病灶较前明显缩小。 颅底骨质破坏，较前修复。 右侧咽后淋巴结肿大，较前明显缩小。 双颈II区、右颈III区小淋巴结，较前明显缩小、数目减少。 鼻窦炎及右侧乳突炎。 左侧中下鼻甲肥厚。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行电子鼻咽镜检查并在可疑残留区域取活检，继续静脉滴注莫西沙星及地塞米松预防感染与水肿，暂不予抗肿瘤治疗。\nB. 安排全身PET-CT检查评估放化疗后全身代谢缓解情况，并继续静脉滴注脂肪乳及氨基酸等营养支持治疗。\nC. 行电子鼻咽镜检查评估局部肿瘤退缩情况，并继续使用重组人表皮生长因子、重组人粒细胞巨噬细胞刺激因子等含漱药物促进粘膜修复。\nD. 对右侧咽后及颈部残留淋巴结行局部追加放疗推量，并继续使用重组人表皮生长因子等含漱药物促进粘膜修复。\nE. 行电子鼻咽镜检查评估局部疗效，并启动吉西他滨联合顺铂方案进行2至3个周期的辅助化疗以巩固全身疗效。\nF. 行右侧颈部淋巴结清扫术处理残留淋巴结，术后继续使用重组人表皮生长因子外用溶液促进局部创面愈合。\nG. 行鼻咽及颈部超声检查评估淋巴结结构，并加用卡培他滨口服进行为期1年的节拍化疗作为维持治疗。\nH. 暂不进行鼻咽镜检查，直接出院，嘱1个月后返院行鼻咽部活检及MRI复查，期间继续静脉营养支持。\nI. 行电子鼻咽镜检查评估局部疗效，并继续静脉滴注脂肪乳、氨基酸及复方氯化钠注射液加强全身营养支持。\nJ. 安排头颅增强MRI及全身骨扫描排除远处转移，并继续原方案靶向治疗至满1年，辅以局部含漱药物治疗。\nK. 行电子鼻咽镜检查评估局部疗效，若发现粘膜坏死则立即行内镜下清创术，并静脉滴注大剂量抗生素抗感染。\nL. 继续静脉滴注莫西沙星及地塞米松抗炎治疗2周以控制鼻窦炎及乳突炎，并定期复查鼻窦CT评估炎症吸收情况。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、筛窦、斜坡、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D56] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理清晰，双肺野内未见明显实质性病变。双侧肺门未见增大，纵隔未见增宽，心影形态、大小未见异常。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见异常。\n- [全程D56] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌治疗后，对比某次就诊时间片： 鼻咽腔狭窄，鼻咽顶壁、顶后壁、右侧壁稍增厚，粘膜表面欠光滑，增强后较明显强化，较前明显缩小，双侧咽隐窝稍变浅，鼻中隔后缘见少许软组织，增强后较明显强化，右侧咽旁间隙稍变窄，左侧咽旁脂肪间隙及左侧颈动脉鞘区未见异常。 右侧腭帆提肌稍模糊；左侧腭帆提肌、腭帆张肌、头长肌未见受累征象。 左侧中下鼻甲明显肥厚。 双侧翼腭窝、双上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽未见明显异常。 斜坡、蝶骨基底部、右侧翼突基底部信号降低，增强后强化，较前范围稍缩小。 双侧海绵窦未见明显异常。 双侧上颌窦、筛窦、右侧蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，无强化，骨壁完整。双眼大小、形态、位置均属正常、信号均匀。蝶鞍形态正常，其内未见占位性病变。 右侧咽后间隙见淋巴结，较大者约7mm×6mm，信号欠均匀，增强后明显强化，较前缩小；左侧咽后间隙未见肿大淋巴结。双颈Ⅱ区、右颈Ⅲ区见多个淋巴结，边界欠清，最大约10mm×7mm，增强后不均匀强化，较前缩小、数目减少。 所见甲状腺双叶形态正常、喉咽腔、双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌治疗后，对比某次就诊时间片： 鼻咽病灶较前明显缩小。 颅底骨质破坏，较前修复。 右侧咽后淋巴结肿大，较前明显缩小。 双颈II区、右颈III区小淋巴结，较前明显缩小、数目减少。 鼻窦炎及右侧乳突炎。 左侧中下鼻甲肥厚。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行电子鼻咽镜检查并在可疑残留区域取活检，继续静脉滴注莫西沙星及地塞米松预防感染与水肿，暂不予抗肿瘤治疗。\nB. 安排全身PET-CT检查评估放化疗后全身代谢缓解情况，并继续静脉滴注脂肪乳及氨基酸等营养支持治疗。\nC. 行电子鼻咽镜检查评估局部肿瘤退缩情况，并继续使用重组人表皮生长因子、重组人粒细胞巨噬细胞刺激因子等含漱药物促进粘膜修复。\nD. 对右侧咽后及颈部残留淋巴结行局部追加放疗推量，并继续使用重组人表皮生长因子等含漱药物促进粘膜修复。\nE. 行电子鼻咽镜检查评估局部疗效，并启动吉西他滨联合顺铂方案进行2至3个周期的辅助化疗以巩固全身疗效。\nF. 行右侧颈部淋巴结清扫术处理残留淋巴结，术后继续使用重组人表皮生长因子外用溶液促进局部创面愈合。\nG. 行鼻咽及颈部超声检查评估淋巴结结构，并加用卡培他滨口服进行为期1年的节拍化疗作为维持治疗。\nH. 暂不进行鼻咽镜检查，直接出院，嘱1个月后返院行鼻咽部活检及MRI复查，期间继续静脉营养支持。\nI. 行电子鼻咽镜检查评估局部疗效，并继续静脉滴注脂肪乳、氨基酸及复方氯化钠注射液加强全身营养支持。\nJ. 安排头颅增强MRI及全身骨扫描排除远处转移，并继续原方案靶向治疗至满1年，辅以局部含漱药物治疗。\nK. 行电子鼻咽镜检查评估局部疗效，若发现粘膜坏死则立即行内镜下清创术，并静脉滴注大剂量抗生素抗感染。\nL. 继续静脉滴注莫西沙星及地塞米松抗炎治疗2周以控制鼻窦炎及乳突炎，并定期复查鼻窦CT评估炎症吸收情况。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"episode_id":"episode-a331f1b0756e2927d0dedc36","patient_id":"patient-e90c2443e271b2e927262653","care_turn_count":7,"turns":[{"sample_id":"sample-37f31044df5e45295b88793a","patient_id":"patient-e90c2443e271b2e927262653","turn_id":"turn01","turn_position":1,"turn_type":"initial_workup_choice","gold_letter":"D","gold_action":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部DR、腹部彩超、全身骨显像","options":[{"letter":"A","text":"电子鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸部DR、腹部彩超、全身骨显像","is_gold":false},{"letter":"B","text":"鼻咽及颈部MRI平扫+增强，胸部DR、腹部彩超、全身骨显像，暂缓鼻咽镜及活检","is_gold":false},{"letter":"C","text":"颈部淋巴结切除活检，鼻咽及颈部MRI平扫+增强，胸部DR、腹部彩超、全身骨显像","is_gold":false},{"letter":"D","text":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部DR、腹部彩超、全身骨显像","is_gold":true},{"letter":"E","text":"电子鼻咽镜检查及活检，鼻咽MRI平扫+增强，胸部DR、腹部彩超、全身骨显像","is_gold":false},{"letter":"F","text":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，暂缓胸腹部及骨骼影像学筛查","is_gold":false},{"letter":"G","text":"全身PET-CT检查，颈部淋巴结细针穿刺活检，暂缓电子鼻咽镜检查及活检","is_gold":false},{"letter":"H","text":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫，胸部DR、腹部彩超、全身骨显像","is_gold":false},{"letter":"I","text":"电子鼻咽镜检查，鼻咽及颈部MRI平扫+增强，胸部CT、腹部CT，暂缓组织活检","is_gold":false},{"letter":"J","text":"颈部淋巴结穿刺活检，鼻咽及颈部CT平扫+增强，胸部DR、腹部彩超、全身骨显像","is_gold":false},{"letter":"K","text":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，头颅CT平扫，暂缓远处转移筛查","is_gold":false},{"letter":"L","text":"电子鼻咽镜检查及活检，鼻咽及颈部超声检查，胸部DR、腹部彩超、全身骨显像","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、颈动脉鞘、斜坡、海绵窦、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 间断性回吸性涕血1年余。；现病史: 患者近一年以来无明显原因出现回吸性涕血、近一个月左侧鼻塞明显，间断鼻衄。双侧耳鸣伴左耳听力下降，左侧头痛，双颈肿块。无面麻、张口困难、软腭麻痹，无咳嗽咳痰、呼吸困难。伴双侧咽后、颈部淋巴结转移。现为进一步诊治入院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重下降1Kg。；阳性症状体征: 体重下降,听力下降,双颈肿物,双耳鸣,涕血,鼻衄,左鼻塞,左侧头痛；既往史: 既往体健。4年前妊娠期间高血糖。3年前剖宫产。否认肝炎、结核等传染病史。否认心脏病、高血压史。预防接种史不详。过敏史:无药物及食物过敏史。；个人史: 出生于原籍，无烟酒药物等嗜好，无疫水接触史，否认不洁性生活史。无工业毒物，粉尘，放射性物质接触史。；家族史: 否认家族其他成员中有类似病患者或肿瘤患者。；体格检查: T36.5℃P78次/分R19次/分BP115/70mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。无鼻翼扇动、鼻衄。牙龈无肿胀、出血。气管居中，甲状腺不大。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率70bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。；专科检查: KPS 90。双颈II区触及多枚肿大淋巴结，直径约1.0cm，质韧、固定、相互融合。颅神经（-）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 电子鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸部DR、腹部彩超、全身骨显像\nB. 鼻咽及颈部MRI平扫+增强，胸部DR、腹部彩超、全身骨显像，暂缓鼻咽镜及活检\nC. 颈部淋巴结切除活检，鼻咽及颈部MRI平扫+增强，胸部DR、腹部彩超、全身骨显像\nD. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部DR、腹部彩超、全身骨显像\nE. 电子鼻咽镜检查及活检，鼻咽MRI平扫+增强，胸部DR、腹部彩超、全身骨显像\nF. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，暂缓胸腹部及骨骼影像学筛查\nG. 全身PET-CT检查，颈部淋巴结细针穿刺活检，暂缓电子鼻咽镜检查及活检\nH. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫，胸部DR、腹部彩超、全身骨显像\nI. 电子鼻咽镜检查，鼻咽及颈部MRI平扫+增强，胸部CT、腹部CT，暂缓组织活检\nJ. 颈部淋巴结穿刺活检，鼻咽及颈部CT平扫+增强，胸部DR、腹部彩超、全身骨显像\nK. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，头颅CT平扫，暂缓远处转移筛查\nL. 电子鼻咽镜检查及活检，鼻咽及颈部超声检查，胸部DR、腹部彩超、全身骨显像\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、颈动脉鞘、斜坡、海绵窦、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 间断性回吸性涕血1年余。；现病史: 患者近一年以来无明显原因出现回吸性涕血、近一个月左侧鼻塞明显，间断鼻衄。双侧耳鸣伴左耳听力下降，左侧头痛，双颈肿块。无面麻、张口困难、软腭麻痹，无咳嗽咳痰、呼吸困难。伴双侧咽后、颈部淋巴结转移。现为进一步诊治入院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重下降1Kg。；阳性症状体征: 体重下降,听力下降,双颈肿物,双耳鸣,涕血,鼻衄,左鼻塞,左侧头痛；既往史: 既往体健。4年前妊娠期间高血糖。3年前剖宫产。否认肝炎、结核等传染病史。否认心脏病、高血压史。预防接种史不详。过敏史:无药物及食物过敏史。；个人史: 出生于原籍，无烟酒药物等嗜好，无疫水接触史，否认不洁性生活史。无工业毒物，粉尘，放射性物质接触史。；家族史: 否认家族其他成员中有类似病患者或肿瘤患者。；体格检查: T36.5℃P78次/分R19次/分BP115/70mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。无鼻翼扇动、鼻衄。牙龈无肿胀、出血。气管居中，甲状腺不大。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率70bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。；专科检查: KPS 90。双颈II区触及多枚肿大淋巴结，直径约1.0cm，质韧、固定、相互融合。颅神经（-）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 电子鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸部DR、腹部彩超、全身骨显像\nB. 鼻咽及颈部MRI平扫+增强，胸部DR、腹部彩超、全身骨显像，暂缓鼻咽镜及活检\nC. 颈部淋巴结切除活检，鼻咽及颈部MRI平扫+增强，胸部DR、腹部彩超、全身骨显像\nD. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部DR、腹部彩超、全身骨显像\nE. 电子鼻咽镜检查及活检，鼻咽MRI平扫+增强，胸部DR、腹部彩超、全身骨显像\nF. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，暂缓胸腹部及骨骼影像学筛查\nG. 全身PET-CT检查，颈部淋巴结细针穿刺活检，暂缓电子鼻咽镜检查及活检\nH. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫，胸部DR、腹部彩超、全身骨显像\nI. 电子鼻咽镜检查，鼻咽及颈部MRI平扫+增强，胸部CT、腹部CT，暂缓组织活检\nJ. 颈部淋巴结穿刺活检，鼻咽及颈部CT平扫+增强，胸部DR、腹部彩超、全身骨显像\nK. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，头颅CT平扫，暂缓远处转移筛查\nL. 电子鼻咽镜检查及活检，鼻咽及颈部超声检查，胸部DR、腹部彩超、全身骨显像\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、颈动脉鞘、斜坡、海绵窦、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 间断性回吸性涕血1年余。；现病史: 患者近一年以来无明显原因出现回吸性涕血、近一个月左侧鼻塞明显，间断鼻衄。双侧耳鸣伴左耳听力下降，左侧头痛，双颈肿块。无面麻、张口困难、软腭麻痹，无咳嗽咳痰、呼吸困难。伴双侧咽后、颈部淋巴结转移。现为进一步诊治入院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重下降1Kg。；阳性症状体征: 体重下降,听力下降,双颈肿物,双耳鸣,涕血,鼻衄,左鼻塞,左侧头痛；既往史: 既往体健。4年前妊娠期间高血糖。3年前剖宫产。否认肝炎、结核等传染病史。否认心脏病、高血压史。预防接种史不详。过敏史:无药物及食物过敏史。；个人史: 出生于原籍，无烟酒药物等嗜好，无疫水接触史，否认不洁性生活史。无工业毒物，粉尘，放射性物质接触史。；家族史: 否认家族其他成员中有类似病患者或肿瘤患者。；体格检查: T36.5℃P78次/分R19次/分BP115/70mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。无鼻翼扇动、鼻衄。牙龈无肿胀、出血。气管居中，甲状腺不大。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率70bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。；专科检查: KPS 90。双颈II区触及多枚肿大淋巴结，直径约1.0cm，质韧、固定、相互融合。颅神经（-）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 电子鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸部DR、腹部彩超、全身骨显像\nB. 鼻咽及颈部MRI平扫+增强，胸部DR、腹部彩超、全身骨显像，暂缓鼻咽镜及活检\nC. 颈部淋巴结切除活检，鼻咽及颈部MRI平扫+增强，胸部DR、腹部彩超、全身骨显像\nD. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部DR、腹部彩超、全身骨显像\nE. 电子鼻咽镜检查及活检，鼻咽MRI平扫+增强，胸部DR、腹部彩超、全身骨显像\nF. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，暂缓胸腹部及骨骼影像学筛查\nG. 全身PET-CT检查，颈部淋巴结细针穿刺活检，暂缓电子鼻咽镜检查及活检\nH. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫，胸部DR、腹部彩超、全身骨显像\nI. 电子鼻咽镜检查，鼻咽及颈部MRI平扫+增强，胸部CT、腹部CT，暂缓组织活检\nJ. 颈部淋巴结穿刺活检，鼻咽及颈部CT平扫+增强，胸部DR、腹部彩超、全身骨显像\nK. 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电子鼻咽镜检查及活检，鼻咽及颈部超声检查，胸部DR、腹部彩超、全身骨显像\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-6fba8e9f22d1b7d086664e36","patient_id":"patient-e90c2443e271b2e927262653","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"E","gold_action":"完善电子鼻咽镜检查及鼻咽肿物活检。","options":[{"letter":"A","text":"完善颈部淋巴结细针穿刺活检及全身骨扫描","is_gold":false},{"letter":"B","text":"完善颈部淋巴结切除活检及全身PET-CT","is_gold":false},{"letter":"C","text":"完善电子鼻咽镜检查及鼻咽脱落细胞学检查","is_gold":false},{"letter":"D","text":"完善鼻咽肿物切除活检及全身骨扫描检查","is_gold":false},{"letter":"E","text":"完善电子鼻咽镜检查及鼻咽肿物活检","is_gold":true},{"letter":"F","text":"完善全身骨扫描检查并直接启动根治性放疗","is_gold":false},{"letter":"G","text":"完善鼻内镜下鼻咽肿物扩大切除及组织活检","is_gold":false},{"letter":"H","text":"完善颈部淋巴结切除活检及EB病毒DNA检测","is_gold":false},{"letter":"I","text":"完善电子鼻咽镜检查及鼻咽部多点盲取活检","is_gold":false},{"letter":"J","text":"完善电子鼻咽镜检查及鼻咽肿物细针穿刺活检","is_gold":false},{"letter":"K","text":"完善脑部增强MRI检查及颈部淋巴结穿刺活检","is_gold":false},{"letter":"L","text":"完善电子鼻咽镜检查及活检并立即启动化疗","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、颈动脉鞘、斜坡、海绵窦、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 间断性回吸性涕血1年余。；现病史: 患者近一年以来无明显原因出现回吸性涕血、近一个月左侧鼻塞明显，间断鼻衄。双侧耳鸣伴左耳听力下降，左侧头痛，双颈肿块。无面麻、张口困难、软腭麻痹，无咳嗽咳痰、呼吸困难。伴双侧咽后、颈部淋巴结转移。现为进一步诊治入院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重下降1Kg。；阳性症状体征: 体重下降,听力下降,双颈肿物,双耳鸣,涕血,鼻衄,左鼻塞,左侧头痛；既往史: 既往体健。4年前妊娠期间高血糖。3年前剖宫产。否认肝炎、结核等传染病史。否认心脏病、高血压史。预防接种史不详。过敏史:无药物及食物过敏史。；个人史: 出生于原籍，无烟酒药物等嗜好，无疫水接触史，否认不洁性生活史。无工业毒物，粉尘，放射性物质接触史。；家族史: 否认家族其他成员中有类似病患者或肿瘤患者。；体格检查: T36.5℃P78次/分R19次/分BP115/70mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。无鼻翼扇动、鼻衄。牙龈无肿胀、出血。气管居中，甲状腺不大。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率70bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。；专科检查: KPS 90。双颈II区触及多枚肿大淋巴结，直径约1.0cm，质韧、固定、相互融合。颅神经（-）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 正常范围心电图\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理清晰，走行自然，双肺野内未见明确实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。双上胸膜略厚。；检查结论: 心肺未见明显病变。\n- [全程D1] 检验组合: 胱抑素(Cys-C)-静脉血: 0.8mg/L；钾离子(K+)-静脉血: 4.14mmol/L；肌酐(Crea)-静脉血: 65umol/L；葡萄糖(Glu)-静脉血: 5.25mmol/L；载脂蛋白B(apoB)-静脉血: 0.81g/L；碱性磷酸酶(ALP)-静脉血: 47U/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:20（参考: 阴性）；乳酸脱氢酶(LDH)-静脉血: 210.4U/L；纤维蛋白原(Fbg)-静脉血: 2.89g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.62；天门冬氨酸氨基转移酶(AST)-静脉血: 19.6U/L；阴离子间隙(AG)-静脉血: 14.7；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.376COI；总胆固醇(TC)-静脉血: 4.58mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.7mmolL；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.56g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.5mmol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 1.79COI；总胆汁酸(TBA)-静脉血: 2umol/L；平均血小板体积(MPV)-静脉血: 10.5fL；磷(P)-静脉血: 1.23mmol/L；单核细胞百分比(Mono%)-静脉血: 0.042；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 0.009COI；甘油三酯(TG)-静脉血: 0.86mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.1mmol/L；平均红细胞体积(MCV)-静脉血: 96.1fL；丙氨酸氨基转移酶(ALT)-静脉血: 15U/L；血小板分布宽度(PDW)-静脉血: 12.1%；C-反应蛋白(CRP)-静脉血: 0.28mg/L；α-L-岩藻糖苷酶(AFU)-静脉血: 33.2U/L；尿素氮(BUN)-静脉血: 4.7mmol/L；球蛋白(GLO)-静脉血: 28.21g/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 0.109……\n- [全程D2] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁 、顶后壁、左侧壁增厚，见软组织肿物影。左侧咽隐窝消失，右侧咽隐窝变浅；病灶呈稍长分期信息见历史辅助诊断节点稍长分期信息见历史辅助诊断节点信号，增强扫描强化明显。 口咽双侧壁未见增厚。鼻腔未见肿物影。 左侧咽旁脂肪间隙变窄，左侧颈动脉鞘区见肿物占据。左侧腭帆张提肌及左侧头长肌受侵。 左侧翼腭窝见软组织影；右侧翼腭窝、双侧颞下窝未见异常。 斜坡、左侧岩尖、左侧破裂孔，左侧蝶骨大翼、左侧翼突、左侧翼管、左侧圆孔、蝶骨基底部骨质破坏。 蝶窦见软组织肿物；右侧乳突、双侧上颌窦充气良好；蝶窦、筛窦及左侧乳突见分泌物。 双眼未见异常。 左侧海绵窦见可疑肿物侵犯。 双侧咽后淋巴结肿大，左侧短径大小约为15mm，见包膜外侵；右侧短径大小约为11mm。双侧II区见多个肿大淋巴结，相互融合，最大短径大小约为18mm。 右侧腮腺见小淋巴结，短径约为7mm。 双侧腮腺。颌下腺、甲状腺未见异常。；检查结论: 考虑鼻咽癌，左侧咽旁间隙、颅底骨质； 可疑左侧海绵窦受侵。 双侧咽后淋巴结，双侧II区淋巴结肿大，考虑转移。 右侧腮腺小淋巴结，性质待定。 副鼻窦炎症。 左侧乳突炎症。\n- [全程D2] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，肝内血管走行自然，门静脉内径约10mm，未见明确肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约26cm/s。 胆囊大小正常，壁不厚，光滑，其内未见异常回声。 脾脏大小正常，包膜光滑，实质回声均匀。 胰腺大小正常，包膜光滑，实质回声均匀，胰管无扩张。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位性病变。 腹主动脉旁未见明确占位病变。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善颈部淋巴结细针穿刺活检及全身骨扫描\nB. 完善颈部淋巴结切除活检及全身PET-CT\nC. 完善电子鼻咽镜检查及鼻咽脱落细胞学检查\nD. 完善鼻咽肿物切除活检及全身骨扫描检查\nE. 完善电子鼻咽镜检查及鼻咽肿物活检\nF. 完善全身骨扫描检查并直接启动根治性放疗\nG. 完善鼻内镜下鼻咽肿物扩大切除及组织活检\nH. 完善颈部淋巴结切除活检及EB病毒DNA检测\nI. 完善电子鼻咽镜检查及鼻咽部多点盲取活检\nJ. 完善电子鼻咽镜检查及鼻咽肿物细针穿刺活检\nK. 完善脑部增强MRI检查及颈部淋巴结穿刺活检\nL. 完善电子鼻咽镜检查及活检并立即启动化疗\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 正常范围心电图\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理清晰，走行自然，双肺野内未见明确实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。双上胸膜略厚。；检查结论: 心肺未见明显病变。\n- [全程D1] 检验组合: 胱抑素(Cys-C)-静脉血: 0.8mg/L；钾离子(K+)-静脉血: 4.14mmol/L；肌酐(Crea)-静脉血: 65umol/L；葡萄糖(Glu)-静脉血: 5.25mmol/L；载脂蛋白B(apoB)-静脉血: 0.81g/L；碱性磷酸酶(ALP)-静脉血: 47U/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:20（参考: 阴性）；乳酸脱氢酶(LDH)-静脉血: 210.4U/L；纤维蛋白原(Fbg)-静脉血: 2.89g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.62；天门冬氨酸氨基转移酶(AST)-静脉血: 19.6U/L；阴离子间隙(AG)-静脉血: 14.7；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.376COI；总胆固醇(TC)-静脉血: 4.58mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.7mmolL；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.56g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.5mmol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 1.79COI；总胆汁酸(TBA)-静脉血: 2umol/L；平均血小板体积(MPV)-静脉血: 10.5fL；磷(P)-静脉血: 1.23mmol/L；单核细胞百分比(Mono%)-静脉血: 0.042；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 0.009COI；甘油三酯(TG)-静脉血: 0.86mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.1mmol/L；平均红细胞体积(MCV)-静脉血: 96.1fL；丙氨酸氨基转移酶(ALT)-静脉血: 15U/L；血小板分布宽度(PDW)-静脉血: 12.1%；C-反应蛋白(CRP)-静脉血: 0.28mg/L；α-L-岩藻糖苷酶(AFU)-静脉血: 33.2U/L；尿素氮(BUN)-静脉血: 4.7mmol/L；球蛋白(GLO)-静脉血: 28.21g/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 0.109……\n- [全程D2] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁 、顶后壁、左侧壁增厚，见软组织肿物影。左侧咽隐窝消失，右侧咽隐窝变浅；病灶呈稍长分期信息见历史辅助诊断节点稍长分期信息见历史辅助诊断节点信号，增强扫描强化明显。 口咽双侧壁未见增厚。鼻腔未见肿物影。 左侧咽旁脂肪间隙变窄，左侧颈动脉鞘区见肿物占据。左侧腭帆张提肌及左侧头长肌受侵。 左侧翼腭窝见软组织影；右侧翼腭窝、双侧颞下窝未见异常。 斜坡、左侧岩尖、左侧破裂孔，左侧蝶骨大翼、左侧翼突、左侧翼管、左侧圆孔、蝶骨基底部骨质破坏。 蝶窦见软组织肿物；右侧乳突、双侧上颌窦充气良好；蝶窦、筛窦及左侧乳突见分泌物。 双眼未见异常。 左侧海绵窦见可疑肿物侵犯。 双侧咽后淋巴结肿大，左侧短径大小约为15mm，见包膜外侵；右侧短径大小约为11mm。双侧II区见多个肿大淋巴结，相互融合，最大短径大小约为18mm。 右侧腮腺见小淋巴结，短径约为7mm。 双侧腮腺。颌下腺、甲状腺未见异常。；检查结论: 考虑鼻咽癌，左侧咽旁间隙、颅底骨质； 可疑左侧海绵窦受侵。 双侧咽后淋巴结，双侧II区淋巴结肿大，考虑转移。 右侧腮腺小淋巴结，性质待定。 副鼻窦炎症。 左侧乳突炎症。\n- [全程D2] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，肝内血管走行自然，门静脉内径约10mm，未见明确肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约26cm/s。 胆囊大小正常，壁不厚，光滑，其内未见异常回声。 脾脏大小正常，包膜光滑，实质回声均匀。 胰腺大小正常，包膜光滑，实质回声均匀，胰管无扩张。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位性病变。 腹主动脉旁未见明确占位病变。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善颈部淋巴结细针穿刺活检及全身骨扫描\nB. 完善颈部淋巴结切除活检及全身PET-CT\nC. 完善电子鼻咽镜检查及鼻咽脱落细胞学检查\nD. 完善鼻咽肿物切除活检及全身骨扫描检查\nE. 完善电子鼻咽镜检查及鼻咽肿物活检\nF. 完善全身骨扫描检查并直接启动根治性放疗\nG. 完善鼻内镜下鼻咽肿物扩大切除及组织活检\nH. 完善颈部淋巴结切除活检及EB病毒DNA检测\nI. 完善电子鼻咽镜检查及鼻咽部多点盲取活检\nJ. 完善电子鼻咽镜检查及鼻咽肿物细针穿刺活检\nK. 完善脑部增强MRI检查及颈部淋巴结穿刺活检\nL. 完善电子鼻咽镜检查及活检并立即启动化疗\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、颈动脉鞘、斜坡、海绵窦、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 正常范围心电图\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理清晰，走行自然，双肺野内未见明确实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。双上胸膜略厚。；检查结论: 心肺未见明显病变。\n- [全程D1] 检验组合: 胱抑素(Cys-C)-静脉血: 0.8mg/L；钾离子(K+)-静脉血: 4.14mmol/L；肌酐(Crea)-静脉血: 65umol/L；葡萄糖(Glu)-静脉血: 5.25mmol/L；载脂蛋白B(apoB)-静脉血: 0.81g/L；碱性磷酸酶(ALP)-静脉血: 47U/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:20（参考: 阴性）；乳酸脱氢酶(LDH)-静脉血: 210.4U/L；纤维蛋白原(Fbg)-静脉血: 2.89g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.62；天门冬氨酸氨基转移酶(AST)-静脉血: 19.6U/L；阴离子间隙(AG)-静脉血: 14.7；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.376COI；总胆固醇(TC)-静脉血: 4.58mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.7mmolL；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.56g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.5mmol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 1.79COI；总胆汁酸(TBA)-静脉血: 2umol/L；平均血小板体积(MPV)-静脉血: 10.5fL；磷(P)-静脉血: 1.23mmol/L；单核细胞百分比(Mono%)-静脉血: 0.042；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 0.009COI；甘油三酯(TG)-静脉血: 0.86mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.1mmol/L；平均红细胞体积(MCV)-静脉血: 96.1fL；丙氨酸氨基转移酶(ALT)-静脉血: 15U/L；血小板分布宽度(PDW)-静脉血: 12.1%；C-反应蛋白(CRP)-静脉血: 0.28mg/L；α-L-岩藻糖苷酶(AFU)-静脉血: 33.2U/L；尿素氮(BUN)-静脉血: 4.7mmol/L；球蛋白(GLO)-静脉血: 28.21g/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 0.109……\n- [全程D2] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁 、顶后壁、左侧壁增厚，见软组织肿物影。左侧咽隐窝消失，右侧咽隐窝变浅；病灶呈稍长分期信息见历史辅助诊断节点稍长分期信息见历史辅助诊断节点信号，增强扫描强化明显。 口咽双侧壁未见增厚。鼻腔未见肿物影。 左侧咽旁脂肪间隙变窄，左侧颈动脉鞘区见肿物占据。左侧腭帆张提肌及左侧头长肌受侵。 左侧翼腭窝见软组织影；右侧翼腭窝、双侧颞下窝未见异常。 斜坡、左侧岩尖、左侧破裂孔，左侧蝶骨大翼、左侧翼突、左侧翼管、左侧圆孔、蝶骨基底部骨质破坏。 蝶窦见软组织肿物；右侧乳突、双侧上颌窦充气良好；蝶窦、筛窦及左侧乳突见分泌物。 双眼未见异常。 左侧海绵窦见可疑肿物侵犯。 双侧咽后淋巴结肿大，左侧短径大小约为15mm，见包膜外侵；右侧短径大小约为11mm。双侧II区见多个肿大淋巴结，相互融合，最大短径大小约为18mm。 右侧腮腺见小淋巴结，短径约为7mm。 双侧腮腺。颌下腺、甲状腺未见异常。；检查结论: 考虑鼻咽癌，左侧咽旁间隙、颅底骨质； 可疑左侧海绵窦受侵。 双侧咽后淋巴结，双侧II区淋巴结肿大，考虑转移。 右侧腮腺小淋巴结，性质待定。 副鼻窦炎症。 左侧乳突炎症。\n- [全程D2] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，肝内血管走行自然，门静脉内径约10mm，未见明确肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约26cm/s。 胆囊大小正常，壁不厚，光滑，其内未见异常回声。 脾脏大小正常，包膜光滑，实质回声均匀。 胰腺大小正常，包膜光滑，实质回声均匀，胰管无扩张。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位性病变。 腹主动脉旁未见明确占位病变。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善颈部淋巴结细针穿刺活检及全身骨扫描\nB. 完善颈部淋巴结切除活检及全身PET-CT\nC. 完善电子鼻咽镜检查及鼻咽脱落细胞学检查\nD. 完善鼻咽肿物切除活检及全身骨扫描检查\nE. 完善电子鼻咽镜检查及鼻咽肿物活检\nF. 完善全身骨扫描检查并直接启动根治性放疗\nG. 完善鼻内镜下鼻咽肿物扩大切除及组织活检\nH. 完善颈部淋巴结切除活检及EB病毒DNA检测\nI. 完善电子鼻咽镜检查及鼻咽部多点盲取活检\nJ. 完善电子鼻咽镜检查及鼻咽肿物细针穿刺活检\nK. 完善脑部增强MRI检查及颈部淋巴结穿刺活检\nL. 完善电子鼻咽镜检查及活检并立即启动化疗\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-4caf9a9989bff46283725cce","patient_id":"patient-e90c2443e271b2e927262653","turn_id":"turn04","turn_position":3,"turn_type":"initial_treatment_selection","gold_letter":"G","gold_action":"诱导化疗序贯同步放化疗","options":[{"letter":"A","text":"单纯根治性放疗","is_gold":false},{"letter":"B","text":"同步放化疗序贯辅助化疗","is_gold":false},{"letter":"C","text":"诱导化疗序贯单纯根治性放疗","is_gold":false},{"letter":"D","text":"根治性手术切除序贯术后放化疗","is_gold":false},{"letter":"E","text":"诱导化疗序贯靶向治疗联合放疗","is_gold":false},{"letter":"F","text":"姑息性化疗联合免疫治疗","is_gold":false},{"letter":"G","text":"诱导化疗序贯同步放化疗","is_gold":true},{"letter":"H","text":"同步放化疗联合靶向治疗","is_gold":false},{"letter":"I","text":"诱导化疗序贯根治性颈清扫术","is_gold":false},{"letter":"J","text":"单纯同步放化疗","is_gold":false},{"letter":"K","text":"靶向治疗联合同步放化疗","is_gold":false},{"letter":"L","text":"诱导化疗联合免疫治疗序贯单纯放疗","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、颈动脉鞘、斜坡、海绵窦、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 间断性回吸性涕血1年余。；现病史: 患者近一年以来无明显原因出现回吸性涕血、近一个月左侧鼻塞明显，间断鼻衄。双侧耳鸣伴左耳听力下降，左侧头痛，双颈肿块。无面麻、张口困难、软腭麻痹，无咳嗽咳痰、呼吸困难。伴双侧咽后、颈部淋巴结转移。现为进一步诊治入院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重下降1Kg。；阳性症状体征: 体重下降,听力下降,双颈肿物,双耳鸣,涕血,鼻衄,左鼻塞,左侧头痛；既往史: 既往体健。4年前妊娠期间高血糖。3年前剖宫产。否认肝炎、结核等传染病史。否认心脏病、高血压史。预防接种史不详。过敏史:无药物及食物过敏史。；个人史: 出生于原籍，无烟酒药物等嗜好，无疫水接触史，否认不洁性生活史。无工业毒物，粉尘，放射性物质接触史。；家族史: 否认家族其他成员中有类似病患者或肿瘤患者。；体格检查: T36.5℃P78次/分R19次/分BP115/70mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。无鼻翼扇动、鼻衄。牙龈无肿胀、出血。气管居中，甲状腺不大。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率70bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。；专科检查: KPS 90。双颈II区触及多枚肿大淋巴结，直径约1.0cm，质韧、固定、相互融合。颅神经（-）。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 间断性回吸性涕血1年余。；现病史: 患者近一年以来无明显原因出现回吸性涕血、近一个月左侧鼻塞明显，间断鼻衄。双侧耳鸣伴左耳听力下降，左侧头痛，双颈肿块。无面麻、张口困难、软腭麻痹，无咳嗽咳痰、呼吸困难。当地医院CT提示：鼻咽癌侵犯枕斜坡双侧蝶窦。伴双侧咽后、颈部淋巴结转移。现为进一步诊治入院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重下降1Kg。；阳性症状体征: 体重下降,听力下降,双颈肿物,双耳鸣,涕血,鼻衄,左鼻塞,左侧头痛；既往史: 既往体健。4年前妊娠期间高血糖。3年前剖宫产。否认肝炎、结核等传染病史。否认心脏病、高血压史。预防接种史不详。过敏史:无药物及食物过敏史。；个人史: 出生于原籍，无烟酒药物等嗜好，无疫水接触史，否认不洁性生活史。无工业毒物，粉尘，放射性物质接触史。；家族史: 否认家族其他成员中有类似病患者或肿瘤患者。；体格检查: T36.5℃P78次/分R19次/分BP115/70mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。无鼻翼扇动、鼻衄。牙龈无肿胀、出血。气管居中，甲状腺不大。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率70bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。肛门外生殖器未见异常，生理反射存在，病理反射未引出。；专科检查: KPS 90。张口门齿距4.5cm，间接鼻咽镜：见鼻咽左侧壁肿物肿物；双颈II区触及多枚肿大淋巴结，直径约1.0cm，质韧、固定、相互融合。颅神经（-）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 正常范围心电图\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理清晰，走行自然，双肺野内未见明确实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。双上胸膜略厚。；检查结论: 心肺未见明显病变。\n- [全程D1] 检验组合: 胱抑素(Cys-C)-静脉血: 0.8mg/L；钾离子(K+)-静脉血: 4.14mmol/L；肌酐(Crea)-静脉血: 65umol/L；葡萄糖(Glu)-静脉血: 5.25mmol/L；载脂蛋白B(apoB)-静脉血: 0.81g/L；碱性磷酸酶(ALP)-静脉血: 47U/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:20（参考: 阴性）；乳酸脱氢酶(LDH)-静脉血: 210.4U/L；纤维蛋白原(Fbg)-静脉血: 2.89g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.62；天门冬氨酸氨基转移酶(AST)-静脉血: 19.6U/L；阴离子间隙(AG)-静脉血: 14.7；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.376COI；总胆固醇(TC)-静脉血: 4.58mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.7mmolL；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.56g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.5mmol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 1.79COI；总胆汁酸(TBA)-静脉血: 2umol/L；平均血小板体积(MPV)-静脉血: 10.5fL；磷(P)-静脉血: 1.23mmol/L；单核细胞百分比(Mono%)-静脉血: 0.042；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 0.009COI；甘油三酯(TG)-静脉血: 0.86mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.1mmol/L；平均红细胞体积(MCV)-静脉血: 96.1fL；丙氨酸氨基转移酶(ALT)-静脉血: 15U/L；血小板分布宽度(PDW)-静脉血: 12.1%；C-反应蛋白(CRP)-静脉血: 0.28mg/L；α-L-岩藻糖苷酶(AFU)-静脉血: 33.2U/L；尿素氮(BUN)-静脉血: 4.7mmol/L；球蛋白(GLO)-静脉血: 28.21g/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 0.109……\n- [全程D2] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁 、顶后壁、左侧壁增厚，见软组织肿物影。左侧咽隐窝消失，右侧咽隐窝变浅；病灶呈稍长分期信息见历史辅助诊断节点稍长分期信息见历史辅助诊断节点信号，增强扫描强化明显。 口咽双侧壁未见增厚。鼻腔未见肿物影。 左侧咽旁脂肪间隙变窄，左侧颈动脉鞘区见肿物占据。左侧腭帆张提肌及左侧头长肌受侵。 左侧翼腭窝见软组织影；右侧翼腭窝、双侧颞下窝未见异常。 斜坡、左侧岩尖、左侧破裂孔，左侧蝶骨大翼、左侧翼突、左侧翼管、左侧圆孔、蝶骨基底部骨质破坏。 蝶窦见软组织肿物；右侧乳突、双侧上颌窦充气良好；蝶窦、筛窦及左侧乳突见分泌物。 双眼未见异常。 左侧海绵窦见可疑肿物侵犯。 双侧咽后淋巴结肿大，左侧短径大小约为15mm，见包膜外侵；右侧短径大小约为11mm。双侧II区见多个肿大淋巴结，相互融合，最大短径大小约为18mm。 右侧腮腺见小淋巴结，短径约为7mm。 双侧腮腺。颌下腺、甲状腺未见异常。；检查结论: 考虑鼻咽癌，左侧咽旁间隙、颅底骨质； 可疑左侧海绵窦受侵。 双侧咽后淋巴结，双侧II区淋巴结肿大，考虑转移。 右侧腮腺小淋巴结，性质待定。 副鼻窦炎症。 左侧乳突炎症。\n- [全程D2] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，肝内血管走行自然，门静脉内径约10mm，未见明确肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约26cm/s。 胆囊大小正常，壁不厚，光滑，其内未见异常回声。 脾脏大小正常，包膜光滑，实质回声均匀。 胰腺大小正常，包膜光滑，实质回声均匀，胰管无扩张。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位性病变。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 单纯根治性放疗\nB. 同步放化疗序贯辅助化疗\nC. 诱导化疗序贯单纯根治性放疗\nD. 根治性手术切除序贯术后放化疗\nE. 诱导化疗序贯靶向治疗联合放疗\nF. 姑息性化疗联合免疫治疗\nG. 诱导化疗序贯同步放化疗\nH. 同步放化疗联合靶向治疗\nI. 诱导化疗序贯根治性颈清扫术\nJ. 单纯同步放化疗\nK. 靶向治疗联合同步放化疗\nL. 诱导化疗联合免疫治疗序贯单纯放疗\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 间断性回吸性涕血1年余。；现病史: 患者近一年以来无明显原因出现回吸性涕血、近一个月左侧鼻塞明显，间断鼻衄。双侧耳鸣伴左耳听力下降，左侧头痛，双颈肿块。无面麻、张口困难、软腭麻痹，无咳嗽咳痰、呼吸困难。当地医院CT提示：鼻咽癌侵犯枕斜坡双侧蝶窦。伴双侧咽后、颈部淋巴结转移。现为进一步诊治入院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重下降1Kg。；阳性症状体征: 体重下降,听力下降,双颈肿物,双耳鸣,涕血,鼻衄,左鼻塞,左侧头痛；既往史: 既往体健。4年前妊娠期间高血糖。3年前剖宫产。否认肝炎、结核等传染病史。否认心脏病、高血压史。预防接种史不详。过敏史:无药物及食物过敏史。；个人史: 出生于原籍，无烟酒药物等嗜好，无疫水接触史，否认不洁性生活史。无工业毒物，粉尘，放射性物质接触史。；家族史: 否认家族其他成员中有类似病患者或肿瘤患者。；体格检查: T36.5℃P78次/分R19次/分BP115/70mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。无鼻翼扇动、鼻衄。牙龈无肿胀、出血。气管居中，甲状腺不大。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率70bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。肛门外生殖器未见异常，生理反射存在，病理反射未引出。；专科检查: KPS 90。张口门齿距4.5cm，间接鼻咽镜：见鼻咽左侧壁肿物肿物；双颈II区触及多枚肿大淋巴结，直径约1.0cm，质韧、固定、相互融合。颅神经（-）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 单纯根治性放疗\nB. 同步放化疗序贯辅助化疗\nC. 诱导化疗序贯单纯根治性放疗\nD. 根治性手术切除序贯术后放化疗\nE. 诱导化疗序贯靶向治疗联合放疗\nF. 姑息性化疗联合免疫治疗\nG. 诱导化疗序贯同步放化疗\nH. 同步放化疗联合靶向治疗\nI. 诱导化疗序贯根治性颈清扫术\nJ. 单纯同步放化疗\nK. 靶向治疗联合同步放化疗\nL. 诱导化疗联合免疫治疗序贯单纯放疗\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、颈动脉鞘、斜坡、海绵窦、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 间断性回吸性涕血1年余。；现病史: 患者近一年以来无明显原因出现回吸性涕血、近一个月左侧鼻塞明显，间断鼻衄。双侧耳鸣伴左耳听力下降，左侧头痛，双颈肿块。无面麻、张口困难、软腭麻痹，无咳嗽咳痰、呼吸困难。当地医院CT提示：鼻咽癌侵犯枕斜坡双侧蝶窦。伴双侧咽后、颈部淋巴结转移。现为进一步诊治入院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重下降1Kg。；阳性症状体征: 体重下降,听力下降,双颈肿物,双耳鸣,涕血,鼻衄,左鼻塞,左侧头痛；既往史: 既往体健。4年前妊娠期间高血糖。3年前剖宫产。否认肝炎、结核等传染病史。否认心脏病、高血压史。预防接种史不详。过敏史:无药物及食物过敏史。；个人史: 出生于原籍，无烟酒药物等嗜好，无疫水接触史，否认不洁性生活史。无工业毒物，粉尘，放射性物质接触史。；家族史: 否认家族其他成员中有类似病患者或肿瘤患者。；体格检查: T36.5℃P78次/分R19次/分BP115/70mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。无鼻翼扇动、鼻衄。牙龈无肿胀、出血。气管居中，甲状腺不大。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率70bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。肛门外生殖器未见异常，生理反射存在，病理反射未引出。；专科检查: KPS 90。张口门齿距4.5cm，间接鼻咽镜：见鼻咽左侧壁肿物肿物；双颈II区触及多枚肿大淋巴结，直径约1.0cm，质韧、固定、相互融合。颅神经（-）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 单纯根治性放疗\nB. 同步放化疗序贯辅助化疗\nC. 诱导化疗序贯单纯根治性放疗\nD. 根治性手术切除序贯术后放化疗\nE. 诱导化疗序贯靶向治疗联合放疗\nF. 姑息性化疗联合免疫治疗\nG. 诱导化疗序贯同步放化疗\nH. 同步放化疗联合靶向治疗\nI. 诱导化疗序贯根治性颈清扫术\nJ. 单纯同步放化疗\nK. 靶向治疗联合同步放化疗\nL. 诱导化疗联合免疫治疗序贯单纯放疗\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-9253a0b82814c8e2231522e6","patient_id":"patient-e90c2443e271b2e927262653","turn_id":"turn05","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"H","gold_action":"不额外给予预防性升白、保肝或抗凝等支持治疗，继续完善乙肝定量、凝血功能、HIV/梅毒筛查及其他治疗前基线血液学和感染学检查。","options":[{"letter":"A","text":"给予重组人粒细胞集落刺激因子（rhG-CSF）皮下注射，并完善基线心电图及超声心动图检查。","is_gold":false},{"letter":"B","text":"给予地塞米松及20%甘露醇注射液静脉滴注，并紧急行头颅CT平扫。","is_gold":false},{"letter":"C","text":"给予异甘草酸镁注射液静脉滴注进行预防性保肝治疗。","is_gold":false},{"letter":"D","text":"给予唑来膦酸静脉滴注，并完善全身骨骼核素扫描（ECT）。","is_gold":false},{"letter":"E","text":"给予肠内营养粉剂口服进行营养支持，并留置鼻胃管。","is_gold":false},{"letter":"F","text":"给予静脉铁剂及重组人促红素（rhEPO）皮下注射，并复查血常规及网织红细胞。","is_gold":false},{"letter":"G","text":"给予头孢曲松钠静脉滴注进行预防性抗感染治疗，并完善血培养及药敏试验。","is_gold":false},{"letter":"H","text":"不额外给予预防性升白、保肝或抗凝等支持治疗，继续完善乙肝定量、凝血功能及其他治疗前基线血液学和感染学筛查。","is_gold":true},{"letter":"I","text":"给予塞来昔布胶囊常规口服进行镇痛治疗，并局部外用氟比洛芬凝胶贴膏。","is_gold":false},{"letter":"J","text":"给予低分子量肝素钙皮下注射进行抗凝治疗，并完善双下肢深静脉彩超。","is_gold":false},{"letter":"K","text":"给予奥美拉唑肠溶胶囊口服进行抑酸护胃治疗，并完善胃镜检查。","is_gold":false},{"letter":"L","text":"给予安替可及硒酵母口服进行辅助治疗，并暂缓乙肝及梅毒等传染病筛查。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、颈动脉鞘、斜坡、海绵窦、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 间断性回吸性涕血1年余。；现病史: 患者近一年以来无明显原因出现回吸性涕血、近一个月左侧鼻塞明显，间断鼻衄。双侧耳鸣伴左耳听力下降，左侧头痛，双颈肿块。无面麻、张口困难、软腭麻痹，无咳嗽咳痰、呼吸困难。伴双侧咽后、颈部淋巴结转移。现为进一步诊治入院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重下降1Kg。；阳性症状体征: 体重下降,听力下降,双颈肿物,双耳鸣,涕血,鼻衄,左鼻塞,左侧头痛；既往史: 既往体健。4年前妊娠期间高血糖。3年前剖宫产。否认肝炎、结核等传染病史。否认心脏病、高血压史。预防接种史不详。过敏史:无药物及食物过敏史。；个人史: 出生于原籍，无烟酒药物等嗜好，无疫水接触史，否认不洁性生活史。无工业毒物，粉尘，放射性物质接触史。；家族史: 否认家族其他成员中有类似病患者或肿瘤患者。；体格检查: T36.5℃P78次/分R19次/分BP115/70mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。无鼻翼扇动、鼻衄。牙龈无肿胀、出血。气管居中，甲状腺不大。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率70bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。；专科检查: KPS 90。双颈II区触及多枚肿大淋巴结，直径约1.0cm，质韧、固定、相互融合。颅神经（-）。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 间断性回吸性涕血1年余。；现病史: 患者近一年以来无明显原因出现回吸性涕血、近一个月左侧鼻塞明显，间断鼻衄。双侧耳鸣伴左耳听力下降，左侧头痛，双颈肿块。无面麻、张口困难、软腭麻痹，无咳嗽咳痰、呼吸困难。当地医院CT提示：鼻咽癌侵犯枕斜坡双侧蝶窦。伴双侧咽后、颈部淋巴结转移。现为进一步诊治入院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重下降1Kg。；阳性症状体征: 体重下降,听力下降,双颈肿物,双耳鸣,涕血,鼻衄,左鼻塞,左侧头痛；既往史: 既往体健。4年前妊娠期间高血糖。3年前剖宫产。否认肝炎、结核等传染病史。否认心脏病、高血压史。预防接种史不详。过敏史:无药物及食物过敏史。；个人史: 出生于原籍，无烟酒药物等嗜好，无疫水接触史，否认不洁性生活史。无工业毒物，粉尘，放射性物质接触史。；家族史: 否认家族其他成员中有类似病患者或肿瘤患者。；体格检查: T36.5℃P78次/分R19次/分BP115/70mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。无鼻翼扇动、鼻衄。牙龈无肿胀、出血。气管居中，甲状腺不大。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率70bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。肛门外生殖器未见异常，生理反射存在，病理反射未引出。；专科检查: KPS 90。张口门齿距4.5cm，间接鼻咽镜：见鼻咽左侧壁肿物肿物；双颈II区触及多枚肿大淋巴结，直径约1.0cm，质韧、固定、相互融合。颅神经（-）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 正常范围心电图\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理清晰，走行自然，双肺野内未见明确实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。双上胸膜略厚。；检查结论: 心肺未见明显病变。\n- [全程D1] 检验组合: 胱抑素(Cys-C)-静脉血: 0.8mg/L；钾离子(K+)-静脉血: 4.14mmol/L；肌酐(Crea)-静脉血: 65umol/L；葡萄糖(Glu)-静脉血: 5.25mmol/L；载脂蛋白B(apoB)-静脉血: 0.81g/L；碱性磷酸酶(ALP)-静脉血: 47U/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:20（参考: 阴性）；乳酸脱氢酶(LDH)-静脉血: 210.4U/L；纤维蛋白原(Fbg)-静脉血: 2.89g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.62；天门冬氨酸氨基转移酶(AST)-静脉血: 19.6U/L；阴离子间隙(AG)-静脉血: 14.7；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.376COI；总胆固醇(TC)-静脉血: 4.58mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.7mmolL；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.56g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.5mmol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 1.79COI；总胆汁酸(TBA)-静脉血: 2umol/L；平均血小板体积(MPV)-静脉血: 10.5fL；磷(P)-静脉血: 1.23mmol/L；单核细胞百分比(Mono%)-静脉血: 0.042；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 0.009COI；甘油三酯(TG)-静脉血: 0.86mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.1mmol/L；平均红细胞体积(MCV)-静脉血: 96.1fL；丙氨酸氨基转移酶(ALT)-静脉血: 15U/L；血小板分布宽度(PDW)-静脉血: 12.1%；C-反应蛋白(CRP)-静脉血: 0.28mg/L；α-L-岩藻糖苷酶(AFU)-静脉血: 33.2U/L；尿素氮(BUN)-静脉血: 4.7mmol/L；球蛋白(GLO)-静脉血: 28.21g/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 0.109……\n- [全程D2] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁 、顶后壁、左侧壁增厚，见软组织肿物影。左侧咽隐窝消失，右侧咽隐窝变浅；病灶呈稍长分期信息见历史辅助诊断节点稍长分期信息见历史辅助诊断节点信号，增强扫描强化明显。 口咽双侧壁未见增厚。鼻腔未见肿物影。 左侧咽旁脂肪间隙变窄，左侧颈动脉鞘区见肿物占据。左侧腭帆张提肌及左侧头长肌受侵。 左侧翼腭窝见软组织影；右侧翼腭窝、双侧颞下窝未见异常。 斜坡、左侧岩尖、左侧破裂孔，左侧蝶骨大翼、左侧翼突、左侧翼管、左侧圆孔、蝶骨基底部骨质破坏。 蝶窦见软组织肿物；右侧乳突、双侧上颌窦充气良好；蝶窦、筛窦及左侧乳突见分泌物。 双眼未见异常。 左侧海绵窦见可疑肿物侵犯。 双侧咽后淋巴结肿大，左侧短径大小约为15mm，见包膜外侵；右侧短径大小约为11mm。双侧II区见多个肿大淋巴结，相互融合，最大短径大小约为18mm。 右侧腮腺见小淋巴结，短径约为7mm。 双侧腮腺。颌下腺、甲状腺未见异常。；检查结论: 考虑鼻咽癌，左侧咽旁间隙、颅底骨质； 可疑左侧海绵窦受侵。 双侧咽后淋巴结，双侧II区淋巴结肿大，考虑转移。 右侧腮腺小淋巴结，性质待定。 副鼻窦炎症。 左侧乳突炎症。\n- [全程D2] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，肝内血管走行自然，门静脉内径约10mm，未见明确肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约26cm/s。 胆囊大小正常，壁不厚，光滑，其内未见异常回声。 脾脏大小正常，包膜光滑，实质回声均匀。 胰腺大小正常，包膜光滑，实质回声均匀，胰管无扩张。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位性病变。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者入院第2天，一般情况可，今日[姓名已隐去]医生信息已隐藏，详细听取病情汇报、检查患者后指示：尽快完善各项治疗前检查，明确诊断及分期，并了解有无合并其他基础疾病，待分期明确后再定治疗方案。遵嘱执行。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 给予重组人粒细胞集落刺激因子（rhG-CSF）皮下注射，并完善基线心电图及超声心动图检查。\nB. 给予地塞米松及20%甘露醇注射液静脉滴注，并紧急行头颅CT平扫。\nC. 给予异甘草酸镁注射液静脉滴注进行预防性保肝治疗。\nD. 给予唑来膦酸静脉滴注，并完善全身骨骼核素扫描（ECT）。\nE. 给予肠内营养粉剂口服进行营养支持，并留置鼻胃管。\nF. 给予静脉铁剂及重组人促红素（rhEPO）皮下注射，并复查血常规及网织红细胞。\nG. 给予头孢曲松钠静脉滴注进行预防性抗感染治疗，并完善血培养及药敏试验。\nH. 不额外给予预防性升白、保肝或抗凝等支持治疗，继续完善乙肝定量、凝血功能及其他治疗前基线血液学和感染学筛查。\nI. 给予塞来昔布胶囊常规口服进行镇痛治疗，并局部外用氟比洛芬凝胶贴膏。\nJ. 给予低分子量肝素钙皮下注射进行抗凝治疗，并完善双下肢深静脉彩超。\nK. 给予奥美拉唑肠溶胶囊口服进行抑酸护胃治疗，并完善胃镜检查。\nL. 给予安替可及硒酵母口服进行辅助治疗，并暂缓乙肝及梅毒等传染病筛查。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- 无可展示记录。\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者入院第2天，一般情况可，今日[姓名已隐去]医生信息已隐藏，详细听取病情汇报、检查患者后指示：尽快完善各项治疗前检查，明确诊断及分期，并了解有无合并其他基础疾病，待分期明确后再定治疗方案。遵嘱执行。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 给予重组人粒细胞集落刺激因子（rhG-CSF）皮下注射，并完善基线心电图及超声心动图检查。\nB. 给予地塞米松及20%甘露醇注射液静脉滴注，并紧急行头颅CT平扫。\nC. 给予异甘草酸镁注射液静脉滴注进行预防性保肝治疗。\nD. 给予唑来膦酸静脉滴注，并完善全身骨骼核素扫描（ECT）。\nE. 给予肠内营养粉剂口服进行营养支持，并留置鼻胃管。\nF. 给予静脉铁剂及重组人促红素（rhEPO）皮下注射，并复查血常规及网织红细胞。\nG. 给予头孢曲松钠静脉滴注进行预防性抗感染治疗，并完善血培养及药敏试验。\nH. 不额外给予预防性升白、保肝或抗凝等支持治疗，继续完善乙肝定量、凝血功能及其他治疗前基线血液学和感染学筛查。\nI. 给予塞来昔布胶囊常规口服进行镇痛治疗，并局部外用氟比洛芬凝胶贴膏。\nJ. 给予低分子量肝素钙皮下注射进行抗凝治疗，并完善双下肢深静脉彩超。\nK. 给予奥美拉唑肠溶胶囊口服进行抑酸护胃治疗，并完善胃镜检查。\nL. 给予安替可及硒酵母口服进行辅助治疗，并暂缓乙肝及梅毒等传染病筛查。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、颈动脉鞘、斜坡、海绵窦、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- 无可展示记录。\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者入院第2天，一般情况可，今日[姓名已隐去]医生信息已隐藏，详细听取病情汇报、检查患者后指示：尽快完善各项治疗前检查，明确诊断及分期，并了解有无合并其他基础疾病，待分期明确后再定治疗方案。遵嘱执行。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 给予重组人粒细胞集落刺激因子（rhG-CSF）皮下注射，并完善基线心电图及超声心动图检查。\nB. 给予地塞米松及20%甘露醇注射液静脉滴注，并紧急行头颅CT平扫。\nC. 给予异甘草酸镁注射液静脉滴注进行预防性保肝治疗。\nD. 给予唑来膦酸静脉滴注，并完善全身骨骼核素扫描（ECT）。\nE. 给予肠内营养粉剂口服进行营养支持，并留置鼻胃管。\nF. 给予静脉铁剂及重组人促红素（rhEPO）皮下注射，并复查血常规及网织红细胞。\nG. 给予头孢曲松钠静脉滴注进行预防性抗感染治疗，并完善血培养及药敏试验。\nH. 不额外给予预防性升白、保肝或抗凝等支持治疗，继续完善乙肝定量、凝血功能及其他治疗前基线血液学和感染学筛查。\nI. 给予塞来昔布胶囊常规口服进行镇痛治疗，并局部外用氟比洛芬凝胶贴膏。\nJ. 给予低分子量肝素钙皮下注射进行抗凝治疗，并完善双下肢深静脉彩超。\nK. 给予奥美拉唑肠溶胶囊口服进行抑酸护胃治疗，并完善胃镜检查。\nL. 给予安替可及硒酵母口服进行辅助治疗，并暂缓乙肝及梅毒等传染病筛查。\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-3b37bb5b3505f87a241c1a6f","patient_id":"patient-e90c2443e271b2e927262653","turn_id":"turn06","turn_position":5,"turn_type":"toxicity_or_support_decision","gold_letter":"I","gold_action":"暂不需集落刺激因子支持，予以复方氨基酸及转化糖电解质静脉营养支持，并进行动静脉置管护理。","options":[{"letter":"A","text":"预防性给予重组人粒细胞集落刺激因子（G-CSF）皮下注射，并推迟后续抗肿瘤治疗。","is_gold":false},{"letter":"B","text":"立即输注红细胞悬液2U，并皮下注射促红细胞生成素（EPO）纠正贫血。","is_gold":false},{"letter":"C","text":"启动异甘草酸镁及多烯磷脂酰胆碱静脉滴注，进行双靶点强化保肝治疗。","is_gold":false},{"letter":"D","text":"建立中心静脉通道，给予10%氯化钾注射液微量泵持续静脉泵入补钾。","is_gold":false},{"letter":"E","text":"留取血培养后，经验性静脉滴注头孢哌酮舒巴坦等广谱抗菌药物抗感染。","is_gold":false},{"letter":"F","text":"每日静脉输注人血白蛋白10g，并配合静脉推注呋塞米进行利尿消肿。","is_gold":false},{"letter":"G","text":"给予碳酸氢钠静脉滴注碱化尿液，并进行每日3000ml以上大剂量水化。","is_gold":false},{"letter":"H","text":"启动胰岛素泵持续皮下泵入强化降糖治疗，并严格限制碳水化合物摄入。","is_gold":false},{"letter":"I","text":"暂不需集落刺激因子支持，予以复方氨基酸及转化糖电解质静脉营养支持，并进行动静脉置管护理。","is_gold":true},{"letter":"J","text":"持续静脉泵入质子泵抑制剂及5-HT3受体拮抗剂，进行强化抑酸止吐。","is_gold":false},{"letter":"K","text":"预防性输注单采血小板1个治疗量，并皮下注射重组人血小板生成素。","is_gold":false},{"letter":"L","text":"给予拉布立酶静脉滴注，并配合大剂量静脉水化预防肿瘤溶解综合征。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、颈动脉鞘、斜坡、海绵窦、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 间断性回吸性涕血1年余。；现病史: 患者近一年以来无明显原因出现回吸性涕血、近一个月左侧鼻塞明显，间断鼻衄。双侧耳鸣伴左耳听力下降，左侧头痛，双颈肿块。无面麻、张口困难、软腭麻痹，无咳嗽咳痰、呼吸困难。伴双侧咽后、颈部淋巴结转移。现为进一步诊治入院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重下降1Kg。；阳性症状体征: 体重下降,听力下降,双颈肿物,双耳鸣,涕血,鼻衄,左鼻塞,左侧头痛；既往史: 既往体健。4年前妊娠期间高血糖。3年前剖宫产。否认肝炎、结核等传染病史。否认心脏病、高血压史。预防接种史不详。过敏史:无药物及食物过敏史。；个人史: 出生于原籍，无烟酒药物等嗜好，无疫水接触史，否认不洁性生活史。无工业毒物，粉尘，放射性物质接触史。；家族史: 否认家族其他成员中有类似病患者或肿瘤患者。；体格检查: T36.5℃P78次/分R19次/分BP115/70mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。无鼻翼扇动、鼻衄。牙龈无肿胀、出血。气管居中，甲状腺不大。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率70bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。；专科检查: KPS 90。双颈II区触及多枚肿大淋巴结，直径约1.0cm，质韧、固定、相互融合。颅神经（-）。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 间断性回吸性涕血1年余。；现病史: 患者近一年以来无明显原因出现回吸性涕血、近一个月左侧鼻塞明显，间断鼻衄。双侧耳鸣伴左耳听力下降，左侧头痛，双颈肿块。无面麻、张口困难、软腭麻痹，无咳嗽咳痰、呼吸困难。当地医院CT提示：鼻咽癌侵犯枕斜坡双侧蝶窦。伴双侧咽后、颈部淋巴结转移。现为进一步诊治入院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重下降1Kg。；阳性症状体征: 体重下降,听力下降,双颈肿物,双耳鸣,涕血,鼻衄,左鼻塞,左侧头痛；既往史: 既往体健。4年前妊娠期间高血糖。3年前剖宫产。否认肝炎、结核等传染病史。否认心脏病、高血压史。预防接种史不详。过敏史:无药物及食物过敏史。；个人史: 出生于原籍，无烟酒药物等嗜好，无疫水接触史，否认不洁性生活史。无工业毒物，粉尘，放射性物质接触史。；家族史: 否认家族其他成员中有类似病患者或肿瘤患者。；体格检查: T36.5℃P78次/分R19次/分BP115/70mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。无鼻翼扇动、鼻衄。牙龈无肿胀、出血。气管居中，甲状腺不大。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率70bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。肛门外生殖器未见异常，生理反射存在，病理反射未引出。；专科检查: KPS 90。张口门齿距4.5cm，间接鼻咽镜：见鼻咽左侧壁肿物肿物；双颈II区触及多枚肿大淋巴结，直径约1.0cm，质韧、固定、相互融合。颅神经（-）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 正常范围心电图\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理清晰，走行自然，双肺野内未见明确实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。双上胸膜略厚。；检查结论: 心肺未见明显病变。\n- [全程D1] 检验组合: 胱抑素(Cys-C)-静脉血: 0.8mg/L；钾离子(K+)-静脉血: 4.14mmol/L；肌酐(Crea)-静脉血: 65umol/L；葡萄糖(Glu)-静脉血: 5.25mmol/L；载脂蛋白B(apoB)-静脉血: 0.81g/L；碱性磷酸酶(ALP)-静脉血: 47U/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:20（参考: 阴性）；乳酸脱氢酶(LDH)-静脉血: 210.4U/L；纤维蛋白原(Fbg)-静脉血: 2.89g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.62；天门冬氨酸氨基转移酶(AST)-静脉血: 19.6U/L；阴离子间隙(AG)-静脉血: 14.7；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.376COI；总胆固醇(TC)-静脉血: 4.58mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.7mmolL；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.56g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.5mmol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 1.79COI；总胆汁酸(TBA)-静脉血: 2umol/L；平均血小板体积(MPV)-静脉血: 10.5fL；磷(P)-静脉血: 1.23mmol/L；单核细胞百分比(Mono%)-静脉血: 0.042；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 0.009COI；甘油三酯(TG)-静脉血: 0.86mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.1mmol/L；平均红细胞体积(MCV)-静脉血: 96.1fL；丙氨酸氨基转移酶(ALT)-静脉血: 15U/L；血小板分布宽度(PDW)-静脉血: 12.1%；C-反应蛋白(CRP)-静脉血: 0.28mg/L；α-L-岩藻糖苷酶(AFU)-静脉血: 33.2U/L；尿素氮(BUN)-静脉血: 4.7mmol/L；球蛋白(GLO)-静脉血: 28.21g/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 0.109……\n- [全程D2] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁 、顶后壁、左侧壁增厚，见软组织肿物影。左侧咽隐窝消失，右侧咽隐窝变浅；病灶呈稍长分期信息见历史辅助诊断节点稍长分期信息见历史辅助诊断节点信号，增强扫描强化明显。 口咽双侧壁未见增厚。鼻腔未见肿物影。 左侧咽旁脂肪间隙变窄，左侧颈动脉鞘区见肿物占据。左侧腭帆张提肌及左侧头长肌受侵。 左侧翼腭窝见软组织影；右侧翼腭窝、双侧颞下窝未见异常。 斜坡、左侧岩尖、左侧破裂孔，左侧蝶骨大翼、左侧翼突、左侧翼管、左侧圆孔、蝶骨基底部骨质破坏。 蝶窦见软组织肿物；右侧乳突、双侧上颌窦充气良好；蝶窦、筛窦及左侧乳突见分泌物。 双眼未见异常。 左侧海绵窦见可疑肿物侵犯。 双侧咽后淋巴结肿大，左侧短径大小约为15mm，见包膜外侵；右侧短径大小约为11mm。双侧II区见多个肿大淋巴结，相互融合，最大短径大小约为18mm。 右侧腮腺见小淋巴结，短径约为7mm。 双侧腮腺。颌下腺、甲状腺未见异常。；检查结论: 考虑鼻咽癌，左侧咽旁间隙、颅底骨质； 可疑左侧海绵窦受侵。 双侧咽后淋巴结，双侧II区淋巴结肿大，考虑转移。 右侧腮腺小淋巴结，性质待定。 副鼻窦炎症。 左侧乳突炎症。\n- [全程D2] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，肝内血管走行自然，门静脉内径约10mm，未见明确肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约26cm/s。 胆囊大小正常，壁不厚，光滑，其内未见异常回声。 脾脏大小正常，包膜光滑，实质回声均匀。 胰腺大小正常，包膜光滑，实质回声均匀，胰管无扩张。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位性病变。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D9] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；白细胞计数(WBC#)-静脉血: 9.210E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.812；单核细胞百分比(Mono%)-静脉血: 0.005；平均血小板体积(MPV)-静脉血: 11.2fL；平均红细胞体积(MCV)-静脉血: 95.5fL；血小板比容-静脉血: 21%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.1；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339g/L；大血小板百分比(P-LCR%)-静脉血: 36.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.178；平均红细胞血红蛋白含量(MCH)-静脉血: 32.4pg；单核细胞计数(Mono#)-静脉血: 0.110E9/L；红细胞计数(RBC#)-静脉血: 3.5210E12/L；血小板分布宽度(PDW)-静脉血: 13.8%；血小板计数(PLT#)-静脉血: 19010E9/L；红细胞比容(Hct)-静脉血: 33.6%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 114g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.4；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；中性粒细胞计数(Neut#)-静脉血: 7.410E9/L\n- [全程D13] 检验组合: 嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；大血小板百分比(P-LCR%)-静脉血: 33.8%；淋巴细胞百分比(Lymph%)-静脉血: 0.645；平均红细胞血红蛋白含量(MCH)-静脉血: 32.1pg；血红蛋白(Hb)-静脉血: 130g/L；白细胞计数(WBC#)-静脉血: 1.710E9/L；平均红细胞体积(MCV)-静脉血: 92.6fL；红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；单核细胞百分比(Mono%)-静脉血: 0.114；血小板分布宽度(PDW)-静脉血: 13%；中性粒细胞百分比(Neut%)-静脉血: 0.229；红细胞比容(Hct)-静脉血: 37.5%；单核细胞计数(Mono#)-静脉血: 0.210E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 35.6；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；血小板比容-静脉血: 27%；中性粒细胞计数(Neut#)-静脉血: 0.410E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.006；血小板计数(PLT#)-静脉血: 24210E9/L；平均血小板体积(MPV)-静脉血: 11fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 10.6；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L\n- [全程D14] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；淋巴细胞百分比(Lymph%)-静脉血: 0.51；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板比容-静脉血: 23%；红细胞计数(RBC#)-静脉血: 3.8110E12/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.8pg；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.8；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；白细胞计数(WBC#)-静脉血: 2.510E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.151；大血小板百分比(P-LCR%)-静脉血: 28.8%；红细胞比容(Hct)-静脉血: 34.9%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 121g/L；平均红细胞体积(MCV)-静脉血: 91.6fL；血小板分布宽度(PDW)-静脉血: 12.4%；单核细胞百分比(Mono%)-静脉血: 0.291；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；中性粒细胞计数(Neut#)-静脉血: 0.410E9/L；平均血小板体积(MPV)-静脉血: 10.4fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.3；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；血小板计数(PLT#)-静脉血: 22010E9/L\n- [全程D15] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；红细胞计数(RBC#)-静脉血: 3.8910E12/L；血小板分布宽度(PDW)-静脉血: 12.8%；平均红细胞体积(MCV)-静脉血: 94.6fL；中性粒细胞计数(Neut#)-静脉血: 2.610E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 35.8；平均血小板体积(MPV)-静脉血: 10.4fL；中性粒细胞百分比(Neut%)-静脉血: 0.496；淋巴细胞百分比(Lymph%)-静脉血: 0.292；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 334g/L；血红蛋白(Hb)-静脉血: 123g/L；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.202；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 10.8；白细胞计数(WBC#)-静脉血: 5.210E9/L；血小板计数(PLT#)-静脉血: 25410E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.6pg；血小板比容-静脉血: 26%；大血小板百分比(P-LCR%)-静脉血: 29%；红细胞比容(Hct)-静脉血: 36.8%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；单核细胞计数(Mono#)-静脉血: 1.110E9/L\n- [全程D16] 检验组合: 红细胞体积分布宽度SD(RDW-SD)-静脉血: 37；大血小板百分比(P-LCR%)-静脉血: 29.9%；红细胞比容(Hct)-静脉血: 34.2%；血小板计数(PLT#)-静脉血: 26510E9/L；单核细胞计数(Mono#)-静脉血: 1.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.128；血小板比容-静脉血: 28%；白细胞计数(WBC#)-静脉血: 11.810E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；血红蛋白(Hb)-静脉血: 113g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.8pg；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11；中性粒细胞计数(Neut#)-静脉血: 7.910E9/L；血小板分布宽度(PDW)-静脉血: 12.3%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；红细胞计数(RBC#)-静脉血: 3.5510E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.667；平均血小板体积(MPV)-静脉血: 10.5fL；淋巴细胞计数(Lymph#)-静脉血: 2.310E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.197；平均红细胞体积(MCV)-静脉血: 96.3fL\n- [全程D26] 检验组合: 直接胆红素(DBIL)-静脉血: 1.5umol/L；C-反应蛋白(CRP)-静脉血: 6.47mg/L；红细胞比容(Hct)-静脉血: 35.4%；阴离子间隙(AG)-静脉血: 8；血小板分布宽度(PDW)-静脉血: 10.3%；总钙(Ca)-静脉血: 2.27mmol/L；甘油三酯(TG)-静脉血: 0.74mmol/L；尿素氮(BUN)-静脉血: 4.68mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 32.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 32.4U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；葡萄糖(Glu)-静脉血: 5.39mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；白细胞计数(WBC#)-静脉血: 410E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 34U/L；磷(P)-静脉血: 1.35mmol/L；乳酸脱氢酶(LDH)-静脉血: 198.6U/L；血小板计数(PLT#)-静脉血: 25510E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.4；碱性磷酸酶(ALP)-静脉血: 92.4U/L；钾离子(K+)-静脉血: 3.9mmol/L；总蛋白(TP)-静脉血: 64.1g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.435；钠离子(Na+)-静脉血: 140.2mmol/L；胱抑素(Cys-C)-静脉血: 0.82mg/L；大血小板百分比(P-LCR%)-静脉血: 19.1%；间接胆红素(IBIL)-静脉血: 3.9umolL；红细胞计数(RBC#)-静脉血: 3.710E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.6pg；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；平均血小板体积(MPV)-静脉血: 9.3fL；氯离子(Cl-)-静脉血: 100.2mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.23g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.9；淋巴细胞百分比(Lymph%)-静脉血: 0.481；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.9；中性粒细胞计数(Neut#)-静脉……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者入院第2天，一般情况可，今日[姓名已隐去]医生信息已隐藏，详细听取病情汇报、检查患者后指示：尽快完善各项治疗前检查，明确诊断及分期，并了解有无合并其他基础疾病，待分期明确后再定治疗方案。遵嘱执行。\n- [全程D13] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。胡医生信息已隐藏：患者予复查血象变化，密切观察患者病情变化。遵嘱。\n- [全程D16] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。检查回报：白细胞 2.5×109/L 。胡医生信息已隐藏：患者出现II度骨髓抑制，考虑化疗引起的副反应，予升白等对症处理，密切观察患者病情变化。遵嘱。\n- [全程D19] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。检查结果回报：白细胞 11.8×109/L。胡医生信息已隐藏：患者血象已恢复正常，密切观察患者病情变化。遵嘱。\n- [全程D22] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。胡医生信息已隐藏：患者予对症处理，密切观察患者病情变化。遵嘱。\n- [全程D25] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。胡医生信息已隐藏：患者予对症处理，密切观察患者病情变化。遵嘱。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 预防性给予重组人粒细胞集落刺激因子（G-CSF）皮下注射，并推迟后续抗肿瘤治疗。\nB. 立即输注红细胞悬液2U，并皮下注射促红细胞生成素（EPO）纠正贫血。\nC. 启动异甘草酸镁及多烯磷脂酰胆碱静脉滴注，进行双靶点强化保肝治疗。\nD. 建立中心静脉通道，给予10%氯化钾注射液微量泵持续静脉泵入补钾。\nE. 留取血培养后，经验性静脉滴注头孢哌酮舒巴坦等广谱抗菌药物抗感染。\nF. 每日静脉输注人血白蛋白10g，并配合静脉推注呋塞米进行利尿消肿。\nG. 给予碳酸氢钠静脉滴注碱化尿液，并进行每日3000ml以上大剂量水化。\nH. 启动胰岛素泵持续皮下泵入强化降糖治疗，并严格限制碳水化合物摄入。\nI. 暂不需集落刺激因子支持，予以复方氨基酸及转化糖电解质静脉营养支持，并进行动静脉置管护理。\nJ. 持续静脉泵入质子泵抑制剂及5-HT3受体拮抗剂，进行强化抑酸止吐。\nK. 预防性输注单采血小板1个治疗量，并皮下注射重组人血小板生成素。\nL. 给予拉布立酶静脉滴注，并配合大剂量静脉水化预防肿瘤溶解综合征。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D9] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；白细胞计数(WBC#)-静脉血: 9.210E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.812；单核细胞百分比(Mono%)-静脉血: 0.005；平均血小板体积(MPV)-静脉血: 11.2fL；平均红细胞体积(MCV)-静脉血: 95.5fL；血小板比容-静脉血: 21%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.1；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339g/L；大血小板百分比(P-LCR%)-静脉血: 36.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.178；平均红细胞血红蛋白含量(MCH)-静脉血: 32.4pg；单核细胞计数(Mono#)-静脉血: 0.110E9/L；红细胞计数(RBC#)-静脉血: 3.5210E12/L；血小板分布宽度(PDW)-静脉血: 13.8%；血小板计数(PLT#)-静脉血: 19010E9/L；红细胞比容(Hct)-静脉血: 33.6%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 114g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.4；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；中性粒细胞计数(Neut#)-静脉血: 7.410E9/L\n- [全程D13] 检验组合: 嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；大血小板百分比(P-LCR%)-静脉血: 33.8%；淋巴细胞百分比(Lymph%)-静脉血: 0.645；平均红细胞血红蛋白含量(MCH)-静脉血: 32.1pg；血红蛋白(Hb)-静脉血: 130g/L；白细胞计数(WBC#)-静脉血: 1.710E9/L；平均红细胞体积(MCV)-静脉血: 92.6fL；红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；单核细胞百分比(Mono%)-静脉血: 0.114；血小板分布宽度(PDW)-静脉血: 13%；中性粒细胞百分比(Neut%)-静脉血: 0.229；红细胞比容(Hct)-静脉血: 37.5%；单核细胞计数(Mono#)-静脉血: 0.210E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 35.6；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；血小板比容-静脉血: 27%；中性粒细胞计数(Neut#)-静脉血: 0.410E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.006；血小板计数(PLT#)-静脉血: 24210E9/L；平均血小板体积(MPV)-静脉血: 11fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 10.6；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L\n- [全程D14] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；淋巴细胞百分比(Lymph%)-静脉血: 0.51；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板比容-静脉血: 23%；红细胞计数(RBC#)-静脉血: 3.8110E12/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.8pg；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.8；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；白细胞计数(WBC#)-静脉血: 2.510E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.151；大血小板百分比(P-LCR%)-静脉血: 28.8%；红细胞比容(Hct)-静脉血: 34.9%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 121g/L；平均红细胞体积(MCV)-静脉血: 91.6fL；血小板分布宽度(PDW)-静脉血: 12.4%；单核细胞百分比(Mono%)-静脉血: 0.291；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；中性粒细胞计数(Neut#)-静脉血: 0.410E9/L；平均血小板体积(MPV)-静脉血: 10.4fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.3；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；血小板计数(PLT#)-静脉血: 22010E9/L\n- [全程D15] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；红细胞计数(RBC#)-静脉血: 3.8910E12/L；血小板分布宽度(PDW)-静脉血: 12.8%；平均红细胞体积(MCV)-静脉血: 94.6fL；中性粒细胞计数(Neut#)-静脉血: 2.610E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 35.8；平均血小板体积(MPV)-静脉血: 10.4fL；中性粒细胞百分比(Neut%)-静脉血: 0.496；淋巴细胞百分比(Lymph%)-静脉血: 0.292；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 334g/L；血红蛋白(Hb)-静脉血: 123g/L；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.202；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 10.8；白细胞计数(WBC#)-静脉血: 5.210E9/L；血小板计数(PLT#)-静脉血: 25410E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.6pg；血小板比容-静脉血: 26%；大血小板百分比(P-LCR%)-静脉血: 29%；红细胞比容(Hct)-静脉血: 36.8%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；单核细胞计数(Mono#)-静脉血: 1.110E9/L\n- [全程D16] 检验组合: 红细胞体积分布宽度SD(RDW-SD)-静脉血: 37；大血小板百分比(P-LCR%)-静脉血: 29.9%；红细胞比容(Hct)-静脉血: 34.2%；血小板计数(PLT#)-静脉血: 26510E9/L；单核细胞计数(Mono#)-静脉血: 1.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.128；血小板比容-静脉血: 28%；白细胞计数(WBC#)-静脉血: 11.810E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；血红蛋白(Hb)-静脉血: 113g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.8pg；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11；中性粒细胞计数(Neut#)-静脉血: 7.910E9/L；血小板分布宽度(PDW)-静脉血: 12.3%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；红细胞计数(RBC#)-静脉血: 3.5510E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.667；平均血小板体积(MPV)-静脉血: 10.5fL；淋巴细胞计数(Lymph#)-静脉血: 2.310E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.197；平均红细胞体积(MCV)-静脉血: 96.3fL\n- [全程D26] 检验组合: 直接胆红素(DBIL)-静脉血: 1.5umol/L；C-反应蛋白(CRP)-静脉血: 6.47mg/L；红细胞比容(Hct)-静脉血: 35.4%；阴离子间隙(AG)-静脉血: 8；血小板分布宽度(PDW)-静脉血: 10.3%；总钙(Ca)-静脉血: 2.27mmol/L；甘油三酯(TG)-静脉血: 0.74mmol/L；尿素氮(BUN)-静脉血: 4.68mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 32.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 32.4U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；葡萄糖(Glu)-静脉血: 5.39mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；白细胞计数(WBC#)-静脉血: 410E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 34U/L；磷(P)-静脉血: 1.35mmol/L；乳酸脱氢酶(LDH)-静脉血: 198.6U/L；血小板计数(PLT#)-静脉血: 25510E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.4；碱性磷酸酶(ALP)-静脉血: 92.4U/L；钾离子(K+)-静脉血: 3.9mmol/L；总蛋白(TP)-静脉血: 64.1g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.435；钠离子(Na+)-静脉血: 140.2mmol/L；胱抑素(Cys-C)-静脉血: 0.82mg/L；大血小板百分比(P-LCR%)-静脉血: 19.1%；间接胆红素(IBIL)-静脉血: 3.9umolL；红细胞计数(RBC#)-静脉血: 3.710E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.6pg；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；平均血小板体积(MPV)-静脉血: 9.3fL；氯离子(Cl-)-静脉血: 100.2mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.23g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.9；淋巴细胞百分比(Lymph%)-静脉血: 0.481；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.9；中性粒细胞计数(Neut#)-静脉……\n\n【既往治疗与反应】\n- [全程D13] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。胡医生信息已隐藏：患者予复查血象变化，密切观察患者病情变化。遵嘱。\n- [全程D16] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。检查回报：白细胞 2.5×109/L 。胡医生信息已隐藏：患者出现II度骨髓抑制，考虑化疗引起的副反应，予升白等对症处理，密切观察患者病情变化。遵嘱。\n- [全程D19] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。检查结果回报：白细胞 11.8×109/L。胡医生信息已隐藏：患者血象已恢复正常，密切观察患者病情变化。遵嘱。\n- [全程D22] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。胡医生信息已隐藏：患者予对症处理，密切观察患者病情变化。遵嘱。\n- [全程D25] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。胡医生信息已隐藏：患者予对症处理，密切观察患者病情变化。遵嘱。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 预防性给予重组人粒细胞集落刺激因子（G-CSF）皮下注射，并推迟后续抗肿瘤治疗。\nB. 立即输注红细胞悬液2U，并皮下注射促红细胞生成素（EPO）纠正贫血。\nC. 启动异甘草酸镁及多烯磷脂酰胆碱静脉滴注，进行双靶点强化保肝治疗。\nD. 建立中心静脉通道，给予10%氯化钾注射液微量泵持续静脉泵入补钾。\nE. 留取血培养后，经验性静脉滴注头孢哌酮舒巴坦等广谱抗菌药物抗感染。\nF. 每日静脉输注人血白蛋白10g，并配合静脉推注呋塞米进行利尿消肿。\nG. 给予碳酸氢钠静脉滴注碱化尿液，并进行每日3000ml以上大剂量水化。\nH. 启动胰岛素泵持续皮下泵入强化降糖治疗，并严格限制碳水化合物摄入。\nI. 暂不需集落刺激因子支持，予以复方氨基酸及转化糖电解质静脉营养支持，并进行动静脉置管护理。\nJ. 持续静脉泵入质子泵抑制剂及5-HT3受体拮抗剂，进行强化抑酸止吐。\nK. 预防性输注单采血小板1个治疗量，并皮下注射重组人血小板生成素。\nL. 给予拉布立酶静脉滴注，并配合大剂量静脉水化预防肿瘤溶解综合征。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、颈动脉鞘、斜坡、海绵窦、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D9] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；白细胞计数(WBC#)-静脉血: 9.210E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.812；单核细胞百分比(Mono%)-静脉血: 0.005；平均血小板体积(MPV)-静脉血: 11.2fL；平均红细胞体积(MCV)-静脉血: 95.5fL；血小板比容-静脉血: 21%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.1；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339g/L；大血小板百分比(P-LCR%)-静脉血: 36.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.178；平均红细胞血红蛋白含量(MCH)-静脉血: 32.4pg；单核细胞计数(Mono#)-静脉血: 0.110E9/L；红细胞计数(RBC#)-静脉血: 3.5210E12/L；血小板分布宽度(PDW)-静脉血: 13.8%；血小板计数(PLT#)-静脉血: 19010E9/L；红细胞比容(Hct)-静脉血: 33.6%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 114g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.4；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；中性粒细胞计数(Neut#)-静脉血: 7.410E9/L\n- [全程D13] 检验组合: 嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；大血小板百分比(P-LCR%)-静脉血: 33.8%；淋巴细胞百分比(Lymph%)-静脉血: 0.645；平均红细胞血红蛋白含量(MCH)-静脉血: 32.1pg；血红蛋白(Hb)-静脉血: 130g/L；白细胞计数(WBC#)-静脉血: 1.710E9/L；平均红细胞体积(MCV)-静脉血: 92.6fL；红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；单核细胞百分比(Mono%)-静脉血: 0.114；血小板分布宽度(PDW)-静脉血: 13%；中性粒细胞百分比(Neut%)-静脉血: 0.229；红细胞比容(Hct)-静脉血: 37.5%；单核细胞计数(Mono#)-静脉血: 0.210E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 35.6；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；血小板比容-静脉血: 27%；中性粒细胞计数(Neut#)-静脉血: 0.410E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.006；血小板计数(PLT#)-静脉血: 24210E9/L；平均血小板体积(MPV)-静脉血: 11fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 10.6；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L\n- [全程D14] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；淋巴细胞百分比(Lymph%)-静脉血: 0.51；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板比容-静脉血: 23%；红细胞计数(RBC#)-静脉血: 3.8110E12/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.8pg；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.8；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；白细胞计数(WBC#)-静脉血: 2.510E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.151；大血小板百分比(P-LCR%)-静脉血: 28.8%；红细胞比容(Hct)-静脉血: 34.9%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 121g/L；平均红细胞体积(MCV)-静脉血: 91.6fL；血小板分布宽度(PDW)-静脉血: 12.4%；单核细胞百分比(Mono%)-静脉血: 0.291；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；中性粒细胞计数(Neut#)-静脉血: 0.410E9/L；平均血小板体积(MPV)-静脉血: 10.4fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.3；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；血小板计数(PLT#)-静脉血: 22010E9/L\n- [全程D15] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；红细胞计数(RBC#)-静脉血: 3.8910E12/L；血小板分布宽度(PDW)-静脉血: 12.8%；平均红细胞体积(MCV)-静脉血: 94.6fL；中性粒细胞计数(Neut#)-静脉血: 2.610E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 35.8；平均血小板体积(MPV)-静脉血: 10.4fL；中性粒细胞百分比(Neut%)-静脉血: 0.496；淋巴细胞百分比(Lymph%)-静脉血: 0.292；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 334g/L；血红蛋白(Hb)-静脉血: 123g/L；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.202；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 10.8；白细胞计数(WBC#)-静脉血: 5.210E9/L；血小板计数(PLT#)-静脉血: 25410E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.6pg；血小板比容-静脉血: 26%；大血小板百分比(P-LCR%)-静脉血: 29%；红细胞比容(Hct)-静脉血: 36.8%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；单核细胞计数(Mono#)-静脉血: 1.110E9/L\n- [全程D16] 检验组合: 红细胞体积分布宽度SD(RDW-SD)-静脉血: 37；大血小板百分比(P-LCR%)-静脉血: 29.9%；红细胞比容(Hct)-静脉血: 34.2%；血小板计数(PLT#)-静脉血: 26510E9/L；单核细胞计数(Mono#)-静脉血: 1.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.128；血小板比容-静脉血: 28%；白细胞计数(WBC#)-静脉血: 11.810E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；血红蛋白(Hb)-静脉血: 113g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.8pg；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11；中性粒细胞计数(Neut#)-静脉血: 7.910E9/L；血小板分布宽度(PDW)-静脉血: 12.3%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；红细胞计数(RBC#)-静脉血: 3.5510E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.667；平均血小板体积(MPV)-静脉血: 10.5fL；淋巴细胞计数(Lymph#)-静脉血: 2.310E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.197；平均红细胞体积(MCV)-静脉血: 96.3fL\n- [全程D26] 检验组合: 直接胆红素(DBIL)-静脉血: 1.5umol/L；C-反应蛋白(CRP)-静脉血: 6.47mg/L；红细胞比容(Hct)-静脉血: 35.4%；阴离子间隙(AG)-静脉血: 8；血小板分布宽度(PDW)-静脉血: 10.3%；总钙(Ca)-静脉血: 2.27mmol/L；甘油三酯(TG)-静脉血: 0.74mmol/L；尿素氮(BUN)-静脉血: 4.68mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 32.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 32.4U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；葡萄糖(Glu)-静脉血: 5.39mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；白细胞计数(WBC#)-静脉血: 410E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 34U/L；磷(P)-静脉血: 1.35mmol/L；乳酸脱氢酶(LDH)-静脉血: 198.6U/L；血小板计数(PLT#)-静脉血: 25510E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.4；碱性磷酸酶(ALP)-静脉血: 92.4U/L；钾离子(K+)-静脉血: 3.9mmol/L；总蛋白(TP)-静脉血: 64.1g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.435；钠离子(Na+)-静脉血: 140.2mmol/L；胱抑素(Cys-C)-静脉血: 0.82mg/L；大血小板百分比(P-LCR%)-静脉血: 19.1%；间接胆红素(IBIL)-静脉血: 3.9umolL；红细胞计数(RBC#)-静脉血: 3.710E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.6pg；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；平均血小板体积(MPV)-静脉血: 9.3fL；氯离子(Cl-)-静脉血: 100.2mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.23g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.9；淋巴细胞百分比(Lymph%)-静脉血: 0.481；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.9；中性粒细胞计数(Neut#)-静脉……\n\n【既往治疗与反应】\n- [全程D13] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。胡医生信息已隐藏：患者予复查血象变化，密切观察患者病情变化。遵嘱。\n- [全程D16] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。检查回报：白细胞 2.5×109/L 。胡医生信息已隐藏：患者出现II度骨髓抑制，考虑化疗引起的副反应，予升白等对症处理，密切观察患者病情变化。遵嘱。\n- [全程D19] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。检查结果回报：白细胞 11.8×109/L。胡医生信息已隐藏：患者血象已恢复正常，密切观察患者病情变化。遵嘱。\n- [全程D22] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。胡医生信息已隐藏：患者予对症处理，密切观察患者病情变化。遵嘱。\n- [全程D25] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。胡医生信息已隐藏：患者予对症处理，密切观察患者病情变化。遵嘱。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 预防性给予重组人粒细胞集落刺激因子（G-CSF）皮下注射，并推迟后续抗肿瘤治疗。\nB. 立即输注红细胞悬液2U，并皮下注射促红细胞生成素（EPO）纠正贫血。\nC. 启动异甘草酸镁及多烯磷脂酰胆碱静脉滴注，进行双靶点强化保肝治疗。\nD. 建立中心静脉通道，给予10%氯化钾注射液微量泵持续静脉泵入补钾。\nE. 留取血培养后，经验性静脉滴注头孢哌酮舒巴坦等广谱抗菌药物抗感染。\nF. 每日静脉输注人血白蛋白10g，并配合静脉推注呋塞米进行利尿消肿。\nG. 给予碳酸氢钠静脉滴注碱化尿液，并进行每日3000ml以上大剂量水化。\nH. 启动胰岛素泵持续皮下泵入强化降糖治疗，并严格限制碳水化合物摄入。\nI. 暂不需集落刺激因子支持，予以复方氨基酸及转化糖电解质静脉营养支持，并进行动静脉置管护理。\nJ. 持续静脉泵入质子泵抑制剂及5-HT3受体拮抗剂，进行强化抑酸止吐。\nK. 预防性输注单采血小板1个治疗量，并皮下注射重组人血小板生成素。\nL. 给予拉布立酶静脉滴注，并配合大剂量静脉水化预防肿瘤溶解综合征。\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-00fdb85efc65b944f8959fc3","patient_id":"patient-e90c2443e271b2e927262653","turn_id":"turn07","turn_position":6,"turn_type":"response_assessment_decision","gold_letter":"J","gold_action":"评估为部分缓解（PR），结束诱导化疗，出院休养并定期监测血象，择期行根治性放疗及同期化疗。","options":[{"letter":"A","text":"评估为完全缓解（CR），结束诱导化疗，直接进入随访观察阶段，定期复查鼻咽及颈部MRI。","is_gold":false},{"letter":"B","text":"评估为疾病稳定（SD），更换为吉西他滨联合顺铂方案继续化疗2周期。","is_gold":false},{"letter":"C","text":"评估为疾病进展（PD），转为姑息性放疗及靶向治疗。","is_gold":false},{"letter":"D","text":"评估为部分缓解（PR），继续原方案（多西他赛联合顺铂）诱导化疗第4-6周期。","is_gold":false},{"letter":"E","text":"评估为部分缓解（PR），先行双侧颈部淋巴结清扫术，术后行根治性放疗。","is_gold":false},{"letter":"F","text":"评估为部分缓解（PR），结束诱导化疗，择期行单纯根治性放疗。","is_gold":false},{"letter":"G","text":"评估为部分缓解（PR），行鼻咽内镜下颅底肿瘤切除术联合术后放疗。","is_gold":false},{"letter":"H","text":"评估为部分缓解（PR），结束诱导化疗，择期行根治性放疗及同期靶向治疗。","is_gold":false},{"letter":"I","text":"评估为疾病稳定（SD），提前终止化疗，立即开始根治性放疗及同期化疗。","is_gold":false},{"letter":"J","text":"评估为部分缓解（PR），结束诱导化疗，出院休养并定期监测血象，择期行根治性放疗及同期化疗。","is_gold":true},{"letter":"K","text":"评估为部分缓解（PR），结束诱导化疗，行全身PET-CT检查排除远处转移后再决定后续治疗。","is_gold":false},{"letter":"L","text":"评估为完全缓解（CR），结束诱导化疗，择期行预防性低剂量放疗。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、颈动脉鞘、斜坡、海绵窦、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 间断性回吸性涕血1年余。；现病史: 患者近一年以来无明显原因出现回吸性涕血、近一个月左侧鼻塞明显，间断鼻衄。双侧耳鸣伴左耳听力下降，左侧头痛，双颈肿块。无面麻、张口困难、软腭麻痹，无咳嗽咳痰、呼吸困难。伴双侧咽后、颈部淋巴结转移。现为进一步诊治入院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重下降1Kg。；阳性症状体征: 体重下降,听力下降,双颈肿物,双耳鸣,涕血,鼻衄,左鼻塞,左侧头痛；既往史: 既往体健。4年前妊娠期间高血糖。3年前剖宫产。否认肝炎、结核等传染病史。否认心脏病、高血压史。预防接种史不详。过敏史:无药物及食物过敏史。；个人史: 出生于原籍，无烟酒药物等嗜好，无疫水接触史，否认不洁性生活史。无工业毒物，粉尘，放射性物质接触史。；家族史: 否认家族其他成员中有类似病患者或肿瘤患者。；体格检查: T36.5℃P78次/分R19次/分BP115/70mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。无鼻翼扇动、鼻衄。牙龈无肿胀、出血。气管居中，甲状腺不大。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率70bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。；专科检查: KPS 90。双颈II区触及多枚肿大淋巴结，直径约1.0cm，质韧、固定、相互融合。颅神经（-）。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 间断性回吸性涕血1年余。；现病史: 患者近一年以来无明显原因出现回吸性涕血、近一个月左侧鼻塞明显，间断鼻衄。双侧耳鸣伴左耳听力下降，左侧头痛，双颈肿块。无面麻、张口困难、软腭麻痹，无咳嗽咳痰、呼吸困难。当地医院CT提示：鼻咽癌侵犯枕斜坡双侧蝶窦。伴双侧咽后、颈部淋巴结转移。现为进一步诊治入院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重下降1Kg。；阳性症状体征: 体重下降,听力下降,双颈肿物,双耳鸣,涕血,鼻衄,左鼻塞,左侧头痛；既往史: 既往体健。4年前妊娠期间高血糖。3年前剖宫产。否认肝炎、结核等传染病史。否认心脏病、高血压史。预防接种史不详。过敏史:无药物及食物过敏史。；个人史: 出生于原籍，无烟酒药物等嗜好，无疫水接触史，否认不洁性生活史。无工业毒物，粉尘，放射性物质接触史。；家族史: 否认家族其他成员中有类似病患者或肿瘤患者。；体格检查: T36.5℃P78次/分R19次/分BP115/70mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。无鼻翼扇动、鼻衄。牙龈无肿胀、出血。气管居中，甲状腺不大。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率70bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。肛门外生殖器未见异常，生理反射存在，病理反射未引出。；专科检查: KPS 90。张口门齿距4.5cm，间接鼻咽镜：见鼻咽左侧壁肿物肿物；双颈II区触及多枚肿大淋巴结，直径约1.0cm，质韧、固定、相互融合。颅神经（-）。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 正常范围心电图\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理清晰，走行自然，双肺野内未见明确实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。双上胸膜略厚。；检查结论: 心肺未见明显病变。\n- [全程D1] 检验组合: 胱抑素(Cys-C)-静脉血: 0.8mg/L；钾离子(K+)-静脉血: 4.14mmol/L；肌酐(Crea)-静脉血: 65umol/L；葡萄糖(Glu)-静脉血: 5.25mmol/L；载脂蛋白B(apoB)-静脉血: 0.81g/L；碱性磷酸酶(ALP)-静脉血: 47U/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:20（参考: 阴性）；乳酸脱氢酶(LDH)-静脉血: 210.4U/L；纤维蛋白原(Fbg)-静脉血: 2.89g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.62；天门冬氨酸氨基转移酶(AST)-静脉血: 19.6U/L；阴离子间隙(AG)-静脉血: 14.7；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.376COI；总胆固醇(TC)-静脉血: 4.58mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.7mmolL；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.56g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.5mmol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 1.79COI；总胆汁酸(TBA)-静脉血: 2umol/L；平均血小板体积(MPV)-静脉血: 10.5fL；磷(P)-静脉血: 1.23mmol/L；单核细胞百分比(Mono%)-静脉血: 0.042；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 0.009COI；甘油三酯(TG)-静脉血: 0.86mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.1mmol/L；平均红细胞体积(MCV)-静脉血: 96.1fL；丙氨酸氨基转移酶(ALT)-静脉血: 15U/L；血小板分布宽度(PDW)-静脉血: 12.1%；C-反应蛋白(CRP)-静脉血: 0.28mg/L；α-L-岩藻糖苷酶(AFU)-静脉血: 33.2U/L；尿素氮(BUN)-静脉血: 4.7mmol/L；球蛋白(GLO)-静脉血: 28.21g/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 0.109……\n- [全程D2] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁 、顶后壁、左侧壁增厚，见软组织肿物影。左侧咽隐窝消失，右侧咽隐窝变浅；病灶呈稍长分期信息见历史辅助诊断节点稍长分期信息见历史辅助诊断节点信号，增强扫描强化明显。 口咽双侧壁未见增厚。鼻腔未见肿物影。 左侧咽旁脂肪间隙变窄，左侧颈动脉鞘区见肿物占据。左侧腭帆张提肌及左侧头长肌受侵。 左侧翼腭窝见软组织影；右侧翼腭窝、双侧颞下窝未见异常。 斜坡、左侧岩尖、左侧破裂孔，左侧蝶骨大翼、左侧翼突、左侧翼管、左侧圆孔、蝶骨基底部骨质破坏。 蝶窦见软组织肿物；右侧乳突、双侧上颌窦充气良好；蝶窦、筛窦及左侧乳突见分泌物。 双眼未见异常。 左侧海绵窦见可疑肿物侵犯。 双侧咽后淋巴结肿大，左侧短径大小约为15mm，见包膜外侵；右侧短径大小约为11mm。双侧II区见多个肿大淋巴结，相互融合，最大短径大小约为18mm。 右侧腮腺见小淋巴结，短径约为7mm。 双侧腮腺。颌下腺、甲状腺未见异常。；检查结论: 考虑鼻咽癌，左侧咽旁间隙、颅底骨质； 可疑左侧海绵窦受侵。 双侧咽后淋巴结，双侧II区淋巴结肿大，考虑转移。 右侧腮腺小淋巴结，性质待定。 副鼻窦炎症。 左侧乳突炎症。\n- [全程D2] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，肝内血管走行自然，门静脉内径约10mm，未见明确肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约26cm/s。 胆囊大小正常，壁不厚，光滑，其内未见异常回声。 脾脏大小正常，包膜光滑，实质回声均匀。 胰腺大小正常，包膜光滑，实质回声均匀，胰管无扩张。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位性病变。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D9] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；白细胞计数(WBC#)-静脉血: 9.210E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.812；单核细胞百分比(Mono%)-静脉血: 0.005；平均血小板体积(MPV)-静脉血: 11.2fL；平均红细胞体积(MCV)-静脉血: 95.5fL；血小板比容-静脉血: 21%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.1；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339g/L；大血小板百分比(P-LCR%)-静脉血: 36.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.178；平均红细胞血红蛋白含量(MCH)-静脉血: 32.4pg；单核细胞计数(Mono#)-静脉血: 0.110E9/L；红细胞计数(RBC#)-静脉血: 3.5210E12/L；血小板分布宽度(PDW)-静脉血: 13.8%；血小板计数(PLT#)-静脉血: 19010E9/L；红细胞比容(Hct)-静脉血: 33.6%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 114g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.4；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；中性粒细胞计数(Neut#)-静脉血: 7.410E9/L\n- [全程D13] 检验组合: 嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；大血小板百分比(P-LCR%)-静脉血: 33.8%；淋巴细胞百分比(Lymph%)-静脉血: 0.645；平均红细胞血红蛋白含量(MCH)-静脉血: 32.1pg；血红蛋白(Hb)-静脉血: 130g/L；白细胞计数(WBC#)-静脉血: 1.710E9/L；平均红细胞体积(MCV)-静脉血: 92.6fL；红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；单核细胞百分比(Mono%)-静脉血: 0.114；血小板分布宽度(PDW)-静脉血: 13%；中性粒细胞百分比(Neut%)-静脉血: 0.229；红细胞比容(Hct)-静脉血: 37.5%；单核细胞计数(Mono#)-静脉血: 0.210E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 35.6；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；血小板比容-静脉血: 27%；中性粒细胞计数(Neut#)-静脉血: 0.410E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.006；血小板计数(PLT#)-静脉血: 24210E9/L；平均血小板体积(MPV)-静脉血: 11fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 10.6；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L\n- [全程D14] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；淋巴细胞百分比(Lymph%)-静脉血: 0.51；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板比容-静脉血: 23%；红细胞计数(RBC#)-静脉血: 3.8110E12/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.8pg；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.8；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；白细胞计数(WBC#)-静脉血: 2.510E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.151；大血小板百分比(P-LCR%)-静脉血: 28.8%；红细胞比容(Hct)-静脉血: 34.9%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 121g/L；平均红细胞体积(MCV)-静脉血: 91.6fL；血小板分布宽度(PDW)-静脉血: 12.4%；单核细胞百分比(Mono%)-静脉血: 0.291；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；中性粒细胞计数(Neut#)-静脉血: 0.410E9/L；平均血小板体积(MPV)-静脉血: 10.4fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.3；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；血小板计数(PLT#)-静脉血: 22010E9/L\n- [全程D15] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；红细胞计数(RBC#)-静脉血: 3.8910E12/L；血小板分布宽度(PDW)-静脉血: 12.8%；平均红细胞体积(MCV)-静脉血: 94.6fL；中性粒细胞计数(Neut#)-静脉血: 2.610E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 35.8；平均血小板体积(MPV)-静脉血: 10.4fL；中性粒细胞百分比(Neut%)-静脉血: 0.496；淋巴细胞百分比(Lymph%)-静脉血: 0.292；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 334g/L；血红蛋白(Hb)-静脉血: 123g/L；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.202；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 10.8；白细胞计数(WBC#)-静脉血: 5.210E9/L；血小板计数(PLT#)-静脉血: 25410E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.6pg；血小板比容-静脉血: 26%；大血小板百分比(P-LCR%)-静脉血: 29%；红细胞比容(Hct)-静脉血: 36.8%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；单核细胞计数(Mono#)-静脉血: 1.110E9/L\n- [全程D16] 检验组合: 红细胞体积分布宽度SD(RDW-SD)-静脉血: 37；大血小板百分比(P-LCR%)-静脉血: 29.9%；红细胞比容(Hct)-静脉血: 34.2%；血小板计数(PLT#)-静脉血: 26510E9/L；单核细胞计数(Mono#)-静脉血: 1.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.128；血小板比容-静脉血: 28%；白细胞计数(WBC#)-静脉血: 11.810E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；血红蛋白(Hb)-静脉血: 113g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.8pg；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11；中性粒细胞计数(Neut#)-静脉血: 7.910E9/L；血小板分布宽度(PDW)-静脉血: 12.3%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；红细胞计数(RBC#)-静脉血: 3.5510E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.667；平均血小板体积(MPV)-静脉血: 10.5fL；淋巴细胞计数(Lymph#)-静脉血: 2.310E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.197；平均红细胞体积(MCV)-静脉血: 96.3fL\n- [全程D26] 检验组合: 直接胆红素(DBIL)-静脉血: 1.5umol/L；C-反应蛋白(CRP)-静脉血: 6.47mg/L；红细胞比容(Hct)-静脉血: 35.4%；阴离子间隙(AG)-静脉血: 8；血小板分布宽度(PDW)-静脉血: 10.3%；总钙(Ca)-静脉血: 2.27mmol/L；甘油三酯(TG)-静脉血: 0.74mmol/L；尿素氮(BUN)-静脉血: 4.68mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 32.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 32.4U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；葡萄糖(Glu)-静脉血: 5.39mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；白细胞计数(WBC#)-静脉血: 410E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 34U/L；磷(P)-静脉血: 1.35mmol/L；乳酸脱氢酶(LDH)-静脉血: 198.6U/L；血小板计数(PLT#)-静脉血: 25510E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.4；碱性磷酸酶(ALP)-静脉血: 92.4U/L；钾离子(K+)-静脉血: 3.9mmol/L；总蛋白(TP)-静脉血: 64.1g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.435；钠离子(Na+)-静脉血: 140.2mmol/L；胱抑素(Cys-C)-静脉血: 0.82mg/L；大血小板百分比(P-LCR%)-静脉血: 19.1%；间接胆红素(IBIL)-静脉血: 3.9umolL；红细胞计数(RBC#)-静脉血: 3.710E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.6pg；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；平均血小板体积(MPV)-静脉血: 9.3fL；氯离子(Cl-)-静脉血: 100.2mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.23g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.9；淋巴细胞百分比(Lymph%)-静脉血: 0.481；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.9；中性粒细胞计数(Neut#)-静脉……\n- [全程D36] 检验组合: 总胆固醇(TC)-静脉血: 4.01mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.55；γ-谷氨酰基转移酶(GGT)-静脉血: 22.5U/L；平均血小板体积(MPV)-静脉血: 10.1fL；淋巴细胞计数(Lymph#)-静脉血: 0.910E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.04；丙氨酸氨基转移酶(ALT)-静脉血: 42.3U/L；尿素氮(BUN)-静脉血: 6.2mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 26.3U/L；总胆红素(TBIL)-静脉血: 14.1umol/L；钠离子(Na+)-静脉血: 136mmol/L；碱性磷酸酶(ALP)-静脉血: 68U/L；白细胞计数(WBC#)-静脉血: 4.310E9/L；直接胆红素(DBIL)-静脉血: 4.6umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；单核细胞计数(Mono#)-静脉血: 0.110E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；磷(P)-静脉血: 0.99mmol/L；血红蛋白(Hb)-静脉血: 122g/L；氯离子(Cl-)-静脉血: 95mmol/L；血小板分布宽度(PDW)-静脉血: 12.3%；平均红细胞体积(MCV)-静脉血: 93.9fL；α-L-岩藻糖苷酶(AFU)-静脉血: 48.7U/L；阴离子间隙(AG)-静脉血: 14.1；钾离子(K+)-静脉血: 4.06mmol/L；红细胞比容(Hct)-静脉血: 35.7%；血小板比容-静脉血: 23%；白蛋白(ALB)-静脉血: 40.7g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；C-反应蛋白(CRP)-静脉血: 3.19mg/L；球蛋白(GLO)-静脉血: 26.19g/L；胱抑素(Cys-C)-静脉血: 0.64mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.04mmol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；载脂蛋白B(apoB)-静脉血: 0.72g/L；间接胆红素(IBIL)-静脉血: 9.5umolL；中性粒细胞百分比(Neut%)-静脉血: 0.729；尿酸(UA)-静脉血: 258.1umol/L；单核细胞百分比(Mono%)-静脉血: 0……\n- [全程D49] 检验组合: 单核细胞百分比(Mono%)-静脉血: 0.066；C-反应蛋白(CRP)-静脉血: 0.26mg/L；乳酸脱氢酶(LDH)-静脉血: 257.7U/L；氯离子(Cl-)-静脉血: 105.6mmol/L；总蛋白(TP)-静脉血: 65.51g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.002；甘油三酯(TG)-静脉血: 0.97mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.25mmolL；红细胞比容(Hct)-静脉血: 34.7%；间接胆红素(IBIL)-静脉血: 5.5umolL；单核细胞计数(Mono#)-静脉血: 0.310E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.5U/L；红细胞计数(RBC#)-静脉血: 3.5110E12/L；总钙(Ca)-静脉血: 2.08mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.94；葡萄糖(Glu)-静脉血: 4.89mmol/L；直接胆红素(DBIL)-静脉血: 2.4umol/L；镁离子(Mg2+)-静脉血: 1.09mmol/L；胱抑素(Cys-C)-静脉血: 0.69mg/L；总胆汁酸(TBA)-静脉血: 1.9umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 35.4U/L；肌酐(Crea)-静脉血: 52.4umol/L；载脂蛋白B(apoB)-静脉血: 0.81g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 48.8；平均红细胞血红蛋白含量(MCH)-静脉血: 32.5pg；钠离子(Na+)-静脉血: 141.4mmol/L；白蛋白(ALB)-静脉血: 40.9g/L；血小板分布宽度(PDW)-静脉血: 11%；血小板计数(PLT#)-静脉血: 19910E9/L；磷(P)-静脉血: 1.21mmol/L；钾离子(K+)-静脉血: 3.94mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.66；总胆固醇(TC)-静脉血: 4.19mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.55mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.465……\n- [全程D57] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后复查，对比某次就诊时间片： 鼻咽腔稍狭窄，鼻咽肿物较前明显缩小，鼻咽顶壁及双侧壁粘膜欠光滑，双侧咽隐窝变浅，鼻咽未见明显肿物，左侧腭帆提肌张肌及头长肌轮廓不清，其内及左侧咽后区见异常信号灶，增强扫描轻度强化，病灶范围较前明显缩小，强化程度较前降低。 左侧咽旁脂肪间隙变窄，左侧颈动脉鞘区见肿物占据，范围较前缩小，强化程度较前降低。左侧腭帆张提肌及左侧头长肌受侵。 口咽双侧壁未见增厚。鼻腔未见肿物。 左侧翼腭窝见少许软组织影，大致同前。右侧翼腭窝、双侧颞下窝未见异常。 斜坡、左侧岩尖、左侧破裂孔，左侧蝶骨大翼、左侧翼突、左侧翼管、左侧圆孔、蝶骨基底部骨质破坏，大致同前。 蝶窦见软组织肿物，较前明显缩小。 双侧上颌窦、蝶窦、筛窦粘膜增厚，左侧乳突少量分泌物。 双侧眼眶未见异常。左侧海绵窦未见明显右侧。 左侧咽后淋巴结肿大，短径约10mm，较前稍缩小。右侧咽后见小淋巴结，短径约4mm，较前明显缩小。双侧II区见多个淋巴结，相互融合，边界不清，较前明显缩小。右侧腮腺见小淋巴结，短径约为4mm。明显强化 左侧腮腺及双侧颌下腺未见异常。所示甲状腺未见异常。 所示脑实质常规MR及DTI未见明显异常信号灶。；检查结论: 鼻咽癌化疗后，鼻咽未见明显肿物，左侧咽旁、蝶窦肿物较前明显缩小。 颅底骨质破坏，大致同前。 双侧咽后及双颈II区淋巴结，较前缩小。 右侧腮腺小淋巴结。 鼻窦炎，左侧乳突炎症。\n- [全程D57] MRI；脑功能成像、DTI: 检查类型: MRI；检查名称: 脑功能成像、DTI；检查部位:；检查所见: 鼻咽癌化疗后复查，对比某次就诊时间片： 鼻咽腔稍狭窄，鼻咽肿物较前明显缩小，鼻咽顶壁及双侧壁粘膜欠光滑，双侧咽隐窝变浅，鼻咽未见明显肿物，左侧腭帆提肌张肌及头长肌轮廓不清，其内及左侧咽后区见异常信号灶，增强扫描轻度强化，病灶范围较前明显缩小，强化程度较前降低。 左侧咽旁脂肪间隙变窄，左侧颈动脉鞘区见肿物占据，范围较前缩小，强化程度较前降低。左侧腭帆张提肌及左侧头长肌受侵。 口咽双侧壁未见增厚。鼻腔未见肿物。 左侧翼腭窝见少许软组织影，大致同前。右侧翼腭窝、双侧颞下窝未见异常。 斜坡、左侧岩尖、左侧破裂孔，左侧蝶骨大翼、左侧翼突、左侧翼管、左侧圆孔、蝶骨基底部骨质破坏，大致同前。 蝶窦见软组织肿物，较前明显缩小。 双侧上颌窦、蝶窦、筛窦粘膜增厚，左侧乳突少量分泌物。 双侧眼眶未见异常。左侧海绵窦未见明显右侧。 左侧咽后淋巴结肿大，短径约10mm，较前稍缩小。右侧咽后见小淋巴结，短径约4mm，较前明显缩小。双侧II区见多个淋巴结，相互融合，边界不清，较前明显缩小。右侧腮腺见小淋巴结，短径约为4mm。明显强化 左侧腮腺及双侧颌下腺未见异常。所示甲状腺未见异常。 所示脑实质常规MR及DTI未见明显异常信号灶。；检查结论: 鼻咽癌化疗后，鼻咽未见明显肿物，左侧咽旁、蝶窦肿物较前明显缩小。 颅底骨质破坏，大致同前。 双侧咽后及双颈II区淋巴结，较前缩小。 右侧腮腺小淋巴结。 鼻窦炎，左侧乳突炎症。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者入院第2天，一般情况可，今日[姓名已隐去]医生信息已隐藏，详细听取病情汇报、检查患者后指示：尽快完善各项治疗前检查，明确诊断及分期，并了解有无合并其他基础疾病，待分期明确后再定治疗方案。遵嘱执行。\n- [全程D13] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。胡医生信息已隐藏：患者予复查血象变化，密切观察患者病情变化。遵嘱。\n- [全程D16] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。检查回报：白细胞 2.5×109/L 。胡医生信息已隐藏：患者出现II度骨髓抑制，考虑化疗引起的副反应，予升白等对症处理，密切观察患者病情变化。遵嘱。\n- [全程D19] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。检查结果回报：白细胞 11.8×109/L。胡医生信息已隐藏：患者血象已恢复正常，密切观察患者病情变化。遵嘱。\n- [全程D22] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。胡医生信息已隐藏：患者予对症处理，密切观察患者病情变化。遵嘱。\n- [全程D25] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。胡医生信息已隐藏：患者予对症处理，密切观察患者病情变化。遵嘱。\n- [全程D51] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者入院第2天，一般情况可，血常规、生化检查无明显异常。[姓名已隐去]医生信息已隐藏示：目前患者诊断明确，今日水化，明日开始第三程诱导化疗。\n- [全程D52] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，血常规、生化检查无明显异常。今日开始予多西他赛90mg/d1+PDD35mg/d1-3方案化疗。[姓名已隐去]医生信息已隐藏示：目前患者诊断明确，今日开始化疗，密切观察病情变化。\n- [全程D55] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，未诉特殊不适。[姓名已隐去]医生信息已隐藏示：目前患者今日化疗结束，密切观病情变化，如有不适，及时对症处理。\n- [全程D57] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，未诉特殊不适。[姓名已隐去]医生信息已隐藏示：目前患者化疗结束，病情稳定，可予出院。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估为完全缓解（CR），结束诱导化疗，直接进入随访观察阶段，定期复查鼻咽及颈部MRI。\nB. 评估为疾病稳定（SD），更换为吉西他滨联合顺铂方案继续化疗2周期。\nC. 评估为疾病进展（PD），转为姑息性放疗及靶向治疗。\nD. 评估为部分缓解（PR），继续原方案（多西他赛联合顺铂）诱导化疗第4-6周期。\nE. 评估为部分缓解（PR），先行双侧颈部淋巴结清扫术，术后行根治性放疗。\nF. 评估为部分缓解（PR），结束诱导化疗，择期行单纯根治性放疗。\nG. 评估为部分缓解（PR），行鼻咽内镜下颅底肿瘤切除术联合术后放疗。\nH. 评估为部分缓解（PR），结束诱导化疗，择期行根治性放疗及同期靶向治疗。\nI. 评估为疾病稳定（SD），提前终止化疗，立即开始根治性放疗及同期化疗。\nJ. 评估为部分缓解（PR），结束诱导化疗，出院休养并定期监测血象，择期行根治性放疗及同期化疗。\nK. 评估为部分缓解（PR），结束诱导化疗，行全身PET-CT检查排除远处转移后再决定后续治疗。\nL. 评估为完全缓解（CR），结束诱导化疗，择期行预防性低剂量放疗。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D36] 检验组合: 总胆固醇(TC)-静脉血: 4.01mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.55；γ-谷氨酰基转移酶(GGT)-静脉血: 22.5U/L；平均血小板体积(MPV)-静脉血: 10.1fL；淋巴细胞计数(Lymph#)-静脉血: 0.910E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.04；丙氨酸氨基转移酶(ALT)-静脉血: 42.3U/L；尿素氮(BUN)-静脉血: 6.2mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 26.3U/L；总胆红素(TBIL)-静脉血: 14.1umol/L；钠离子(Na+)-静脉血: 136mmol/L；碱性磷酸酶(ALP)-静脉血: 68U/L；白细胞计数(WBC#)-静脉血: 4.310E9/L；直接胆红素(DBIL)-静脉血: 4.6umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；单核细胞计数(Mono#)-静脉血: 0.110E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；磷(P)-静脉血: 0.99mmol/L；血红蛋白(Hb)-静脉血: 122g/L；氯离子(Cl-)-静脉血: 95mmol/L；血小板分布宽度(PDW)-静脉血: 12.3%；平均红细胞体积(MCV)-静脉血: 93.9fL；α-L-岩藻糖苷酶(AFU)-静脉血: 48.7U/L；阴离子间隙(AG)-静脉血: 14.1；钾离子(K+)-静脉血: 4.06mmol/L；红细胞比容(Hct)-静脉血: 35.7%；血小板比容-静脉血: 23%；白蛋白(ALB)-静脉血: 40.7g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；C-反应蛋白(CRP)-静脉血: 3.19mg/L；球蛋白(GLO)-静脉血: 26.19g/L；胱抑素(Cys-C)-静脉血: 0.64mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.04mmol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；载脂蛋白B(apoB)-静脉血: 0.72g/L；间接胆红素(IBIL)-静脉血: 9.5umolL；中性粒细胞百分比(Neut%)-静脉血: 0.729；尿酸(UA)-静脉血: 258.1umol/L；单核细胞百分比(Mono%)-静脉血: 0……\n- [全程D49] 检验组合: 单核细胞百分比(Mono%)-静脉血: 0.066；C-反应蛋白(CRP)-静脉血: 0.26mg/L；乳酸脱氢酶(LDH)-静脉血: 257.7U/L；氯离子(Cl-)-静脉血: 105.6mmol/L；总蛋白(TP)-静脉血: 65.51g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.002；甘油三酯(TG)-静脉血: 0.97mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.25mmolL；红细胞比容(Hct)-静脉血: 34.7%；间接胆红素(IBIL)-静脉血: 5.5umolL；单核细胞计数(Mono#)-静脉血: 0.310E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.5U/L；红细胞计数(RBC#)-静脉血: 3.5110E12/L；总钙(Ca)-静脉血: 2.08mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.94；葡萄糖(Glu)-静脉血: 4.89mmol/L；直接胆红素(DBIL)-静脉血: 2.4umol/L；镁离子(Mg2+)-静脉血: 1.09mmol/L；胱抑素(Cys-C)-静脉血: 0.69mg/L；总胆汁酸(TBA)-静脉血: 1.9umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 35.4U/L；肌酐(Crea)-静脉血: 52.4umol/L；载脂蛋白B(apoB)-静脉血: 0.81g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 48.8；平均红细胞血红蛋白含量(MCH)-静脉血: 32.5pg；钠离子(Na+)-静脉血: 141.4mmol/L；白蛋白(ALB)-静脉血: 40.9g/L；血小板分布宽度(PDW)-静脉血: 11%；血小板计数(PLT#)-静脉血: 19910E9/L；磷(P)-静脉血: 1.21mmol/L；钾离子(K+)-静脉血: 3.94mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.66；总胆固醇(TC)-静脉血: 4.19mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.55mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.465……\n- [全程D57] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后复查，对比某次就诊时间片： 鼻咽腔稍狭窄，鼻咽肿物较前明显缩小，鼻咽顶壁及双侧壁粘膜欠光滑，双侧咽隐窝变浅，鼻咽未见明显肿物，左侧腭帆提肌张肌及头长肌轮廓不清，其内及左侧咽后区见异常信号灶，增强扫描轻度强化，病灶范围较前明显缩小，强化程度较前降低。 左侧咽旁脂肪间隙变窄，左侧颈动脉鞘区见肿物占据，范围较前缩小，强化程度较前降低。左侧腭帆张提肌及左侧头长肌受侵。 口咽双侧壁未见增厚。鼻腔未见肿物。 左侧翼腭窝见少许软组织影，大致同前。右侧翼腭窝、双侧颞下窝未见异常。 斜坡、左侧岩尖、左侧破裂孔，左侧蝶骨大翼、左侧翼突、左侧翼管、左侧圆孔、蝶骨基底部骨质破坏，大致同前。 蝶窦见软组织肿物，较前明显缩小。 双侧上颌窦、蝶窦、筛窦粘膜增厚，左侧乳突少量分泌物。 双侧眼眶未见异常。左侧海绵窦未见明显右侧。 左侧咽后淋巴结肿大，短径约10mm，较前稍缩小。右侧咽后见小淋巴结，短径约4mm，较前明显缩小。双侧II区见多个淋巴结，相互融合，边界不清，较前明显缩小。右侧腮腺见小淋巴结，短径约为4mm。明显强化 左侧腮腺及双侧颌下腺未见异常。所示甲状腺未见异常。 所示脑实质常规MR及DTI未见明显异常信号灶。；检查结论: 鼻咽癌化疗后，鼻咽未见明显肿物，左侧咽旁、蝶窦肿物较前明显缩小。 颅底骨质破坏，大致同前。 双侧咽后及双颈II区淋巴结，较前缩小。 右侧腮腺小淋巴结。 鼻窦炎，左侧乳突炎症。\n- [全程D57] MRI；脑功能成像、DTI: 检查类型: MRI；检查名称: 脑功能成像、DTI；检查部位:；检查所见: 鼻咽癌化疗后复查，对比某次就诊时间片： 鼻咽腔稍狭窄，鼻咽肿物较前明显缩小，鼻咽顶壁及双侧壁粘膜欠光滑，双侧咽隐窝变浅，鼻咽未见明显肿物，左侧腭帆提肌张肌及头长肌轮廓不清，其内及左侧咽后区见异常信号灶，增强扫描轻度强化，病灶范围较前明显缩小，强化程度较前降低。 左侧咽旁脂肪间隙变窄，左侧颈动脉鞘区见肿物占据，范围较前缩小，强化程度较前降低。左侧腭帆张提肌及左侧头长肌受侵。 口咽双侧壁未见增厚。鼻腔未见肿物。 左侧翼腭窝见少许软组织影，大致同前。右侧翼腭窝、双侧颞下窝未见异常。 斜坡、左侧岩尖、左侧破裂孔，左侧蝶骨大翼、左侧翼突、左侧翼管、左侧圆孔、蝶骨基底部骨质破坏，大致同前。 蝶窦见软组织肿物，较前明显缩小。 双侧上颌窦、蝶窦、筛窦粘膜增厚，左侧乳突少量分泌物。 双侧眼眶未见异常。左侧海绵窦未见明显右侧。 左侧咽后淋巴结肿大，短径约10mm，较前稍缩小。右侧咽后见小淋巴结，短径约4mm，较前明显缩小。双侧II区见多个淋巴结，相互融合，边界不清，较前明显缩小。右侧腮腺见小淋巴结，短径约为4mm。明显强化 左侧腮腺及双侧颌下腺未见异常。所示甲状腺未见异常。 所示脑实质常规MR及DTI未见明显异常信号灶。；检查结论: 鼻咽癌化疗后，鼻咽未见明显肿物，左侧咽旁、蝶窦肿物较前明显缩小。 颅底骨质破坏，大致同前。 双侧咽后及双颈II区淋巴结，较前缩小。 右侧腮腺小淋巴结。 鼻窦炎，左侧乳突炎症。\n\n【既往治疗与反应】\n- [全程D51] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者入院第2天，一般情况可，血常规、生化检查无明显异常。[姓名已隐去]医生信息已隐藏示：目前患者诊断明确，今日水化，明日开始第三程诱导化疗。\n- [全程D52] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，血常规、生化检查无明显异常。今日开始予多西他赛90mg/d1+PDD35mg/d1-3方案化疗。[姓名已隐去]医生信息已隐藏示：目前患者诊断明确，今日开始化疗，密切观察病情变化。\n- [全程D55] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，未诉特殊不适。[姓名已隐去]医生信息已隐藏示：目前患者今日化疗结束，密切观病情变化，如有不适，及时对症处理。\n- [全程D57] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，未诉特殊不适。[姓名已隐去]医生信息已隐藏示：目前患者化疗结束，病情稳定，可予出院。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估为完全缓解（CR），结束诱导化疗，直接进入随访观察阶段，定期复查鼻咽及颈部MRI。\nB. 评估为疾病稳定（SD），更换为吉西他滨联合顺铂方案继续化疗2周期。\nC. 评估为疾病进展（PD），转为姑息性放疗及靶向治疗。\nD. 评估为部分缓解（PR），继续原方案（多西他赛联合顺铂）诱导化疗第4-6周期。\nE. 评估为部分缓解（PR），先行双侧颈部淋巴结清扫术，术后行根治性放疗。\nF. 评估为部分缓解（PR），结束诱导化疗，择期行单纯根治性放疗。\nG. 评估为部分缓解（PR），行鼻咽内镜下颅底肿瘤切除术联合术后放疗。\nH. 评估为部分缓解（PR），结束诱导化疗，择期行根治性放疗及同期靶向治疗。\nI. 评估为疾病稳定（SD），提前终止化疗，立即开始根治性放疗及同期化疗。\nJ. 评估为部分缓解（PR），结束诱导化疗，出院休养并定期监测血象，择期行根治性放疗及同期化疗。\nK. 评估为部分缓解（PR），结束诱导化疗，行全身PET-CT检查排除远处转移后再决定后续治疗。\nL. 评估为完全缓解（CR），结束诱导化疗，择期行预防性低剂量放疗。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、颈动脉鞘、斜坡、海绵窦、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D36] 检验组合: 总胆固醇(TC)-静脉血: 4.01mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.55；γ-谷氨酰基转移酶(GGT)-静脉血: 22.5U/L；平均血小板体积(MPV)-静脉血: 10.1fL；淋巴细胞计数(Lymph#)-静脉血: 0.910E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.04；丙氨酸氨基转移酶(ALT)-静脉血: 42.3U/L；尿素氮(BUN)-静脉血: 6.2mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 26.3U/L；总胆红素(TBIL)-静脉血: 14.1umol/L；钠离子(Na+)-静脉血: 136mmol/L；碱性磷酸酶(ALP)-静脉血: 68U/L；白细胞计数(WBC#)-静脉血: 4.310E9/L；直接胆红素(DBIL)-静脉血: 4.6umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；单核细胞计数(Mono#)-静脉血: 0.110E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；磷(P)-静脉血: 0.99mmol/L；血红蛋白(Hb)-静脉血: 122g/L；氯离子(Cl-)-静脉血: 95mmol/L；血小板分布宽度(PDW)-静脉血: 12.3%；平均红细胞体积(MCV)-静脉血: 93.9fL；α-L-岩藻糖苷酶(AFU)-静脉血: 48.7U/L；阴离子间隙(AG)-静脉血: 14.1；钾离子(K+)-静脉血: 4.06mmol/L；红细胞比容(Hct)-静脉血: 35.7%；血小板比容-静脉血: 23%；白蛋白(ALB)-静脉血: 40.7g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；C-反应蛋白(CRP)-静脉血: 3.19mg/L；球蛋白(GLO)-静脉血: 26.19g/L；胱抑素(Cys-C)-静脉血: 0.64mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.04mmol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；载脂蛋白B(apoB)-静脉血: 0.72g/L；间接胆红素(IBIL)-静脉血: 9.5umolL；中性粒细胞百分比(Neut%)-静脉血: 0.729；尿酸(UA)-静脉血: 258.1umol/L；单核细胞百分比(Mono%)-静脉血: 0……\n- [全程D49] 检验组合: 单核细胞百分比(Mono%)-静脉血: 0.066；C-反应蛋白(CRP)-静脉血: 0.26mg/L；乳酸脱氢酶(LDH)-静脉血: 257.7U/L；氯离子(Cl-)-静脉血: 105.6mmol/L；总蛋白(TP)-静脉血: 65.51g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.002；甘油三酯(TG)-静脉血: 0.97mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.25mmolL；红细胞比容(Hct)-静脉血: 34.7%；间接胆红素(IBIL)-静脉血: 5.5umolL；单核细胞计数(Mono#)-静脉血: 0.310E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.5U/L；红细胞计数(RBC#)-静脉血: 3.5110E12/L；总钙(Ca)-静脉血: 2.08mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.94；葡萄糖(Glu)-静脉血: 4.89mmol/L；直接胆红素(DBIL)-静脉血: 2.4umol/L；镁离子(Mg2+)-静脉血: 1.09mmol/L；胱抑素(Cys-C)-静脉血: 0.69mg/L；总胆汁酸(TBA)-静脉血: 1.9umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 35.4U/L；肌酐(Crea)-静脉血: 52.4umol/L；载脂蛋白B(apoB)-静脉血: 0.81g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 48.8；平均红细胞血红蛋白含量(MCH)-静脉血: 32.5pg；钠离子(Na+)-静脉血: 141.4mmol/L；白蛋白(ALB)-静脉血: 40.9g/L；血小板分布宽度(PDW)-静脉血: 11%；血小板计数(PLT#)-静脉血: 19910E9/L；磷(P)-静脉血: 1.21mmol/L；钾离子(K+)-静脉血: 3.94mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.66；总胆固醇(TC)-静脉血: 4.19mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.55mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.465……\n- [全程D57] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后复查，对比某次就诊时间片： 鼻咽腔稍狭窄，鼻咽肿物较前明显缩小，鼻咽顶壁及双侧壁粘膜欠光滑，双侧咽隐窝变浅，鼻咽未见明显肿物，左侧腭帆提肌张肌及头长肌轮廓不清，其内及左侧咽后区见异常信号灶，增强扫描轻度强化，病灶范围较前明显缩小，强化程度较前降低。 左侧咽旁脂肪间隙变窄，左侧颈动脉鞘区见肿物占据，范围较前缩小，强化程度较前降低。左侧腭帆张提肌及左侧头长肌受侵。 口咽双侧壁未见增厚。鼻腔未见肿物。 左侧翼腭窝见少许软组织影，大致同前。右侧翼腭窝、双侧颞下窝未见异常。 斜坡、左侧岩尖、左侧破裂孔，左侧蝶骨大翼、左侧翼突、左侧翼管、左侧圆孔、蝶骨基底部骨质破坏，大致同前。 蝶窦见软组织肿物，较前明显缩小。 双侧上颌窦、蝶窦、筛窦粘膜增厚，左侧乳突少量分泌物。 双侧眼眶未见异常。左侧海绵窦未见明显右侧。 左侧咽后淋巴结肿大，短径约10mm，较前稍缩小。右侧咽后见小淋巴结，短径约4mm，较前明显缩小。双侧II区见多个淋巴结，相互融合，边界不清，较前明显缩小。右侧腮腺见小淋巴结，短径约为4mm。明显强化 左侧腮腺及双侧颌下腺未见异常。所示甲状腺未见异常。 所示脑实质常规MR及DTI未见明显异常信号灶。；检查结论: 鼻咽癌化疗后，鼻咽未见明显肿物，左侧咽旁、蝶窦肿物较前明显缩小。 颅底骨质破坏，大致同前。 双侧咽后及双颈II区淋巴结，较前缩小。 右侧腮腺小淋巴结。 鼻窦炎，左侧乳突炎症。\n- [全程D57] MRI；脑功能成像、DTI: 检查类型: MRI；检查名称: 脑功能成像、DTI；检查部位:；检查所见: 鼻咽癌化疗后复查，对比某次就诊时间片： 鼻咽腔稍狭窄，鼻咽肿物较前明显缩小，鼻咽顶壁及双侧壁粘膜欠光滑，双侧咽隐窝变浅，鼻咽未见明显肿物，左侧腭帆提肌张肌及头长肌轮廓不清，其内及左侧咽后区见异常信号灶，增强扫描轻度强化，病灶范围较前明显缩小，强化程度较前降低。 左侧咽旁脂肪间隙变窄，左侧颈动脉鞘区见肿物占据，范围较前缩小，强化程度较前降低。左侧腭帆张提肌及左侧头长肌受侵。 口咽双侧壁未见增厚。鼻腔未见肿物。 左侧翼腭窝见少许软组织影，大致同前。右侧翼腭窝、双侧颞下窝未见异常。 斜坡、左侧岩尖、左侧破裂孔，左侧蝶骨大翼、左侧翼突、左侧翼管、左侧圆孔、蝶骨基底部骨质破坏，大致同前。 蝶窦见软组织肿物，较前明显缩小。 双侧上颌窦、蝶窦、筛窦粘膜增厚，左侧乳突少量分泌物。 双侧眼眶未见异常。左侧海绵窦未见明显右侧。 左侧咽后淋巴结肿大，短径约10mm，较前稍缩小。右侧咽后见小淋巴结，短径约4mm，较前明显缩小。双侧II区见多个淋巴结，相互融合，边界不清，较前明显缩小。右侧腮腺见小淋巴结，短径约为4mm。明显强化 左侧腮腺及双侧颌下腺未见异常。所示甲状腺未见异常。 所示脑实质常规MR及DTI未见明显异常信号灶。；检查结论: 鼻咽癌化疗后，鼻咽未见明显肿物，左侧咽旁、蝶窦肿物较前明显缩小。 颅底骨质破坏，大致同前。 双侧咽后及双颈II区淋巴结，较前缩小。 右侧腮腺小淋巴结。 鼻窦炎，左侧乳突炎症。\n\n【既往治疗与反应】\n- [全程D51] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者入院第2天，一般情况可，血常规、生化检查无明显异常。[姓名已隐去]医生信息已隐藏示：目前患者诊断明确，今日水化，明日开始第三程诱导化疗。\n- [全程D52] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，血常规、生化检查无明显异常。今日开始予多西他赛90mg/d1+PDD35mg/d1-3方案化疗。[姓名已隐去]医生信息已隐藏示：目前患者诊断明确，今日开始化疗，密切观察病情变化。\n- [全程D55] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，未诉特殊不适。[姓名已隐去]医生信息已隐藏示：目前患者今日化疗结束，密切观病情变化，如有不适，及时对症处理。\n- [全程D57] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，未诉特殊不适。[姓名已隐去]医生信息已隐藏示：目前患者化疗结束，病情稳定，可予出院。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估为完全缓解（CR），结束诱导化疗，直接进入随访观察阶段，定期复查鼻咽及颈部MRI。\nB. 评估为疾病稳定（SD），更换为吉西他滨联合顺铂方案继续化疗2周期。\nC. 评估为疾病进展（PD），转为姑息性放疗及靶向治疗。\nD. 评估为部分缓解（PR），继续原方案（多西他赛联合顺铂）诱导化疗第4-6周期。\nE. 评估为部分缓解（PR），先行双侧颈部淋巴结清扫术，术后行根治性放疗。\nF. 评估为部分缓解（PR），结束诱导化疗，择期行单纯根治性放疗。\nG. 评估为部分缓解（PR），行鼻咽内镜下颅底肿瘤切除术联合术后放疗。\nH. 评估为部分缓解（PR），结束诱导化疗，择期行根治性放疗及同期靶向治疗。\nI. 评估为疾病稳定（SD），提前终止化疗，立即开始根治性放疗及同期化疗。\nJ. 评估为部分缓解（PR），结束诱导化疗，出院休养并定期监测血象，择期行根治性放疗及同期化疗。\nK. 评估为部分缓解（PR），结束诱导化疗，行全身PET-CT检查排除远处转移后再决定后续治疗。\nL. 评估为完全缓解（CR），结束诱导化疗，择期行预防性低剂量放疗。\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-c754017abe0842c4e67e064f","patient_id":"patient-e90c2443e271b2e927262653","turn_id":"turn08","turn_position":7,"turn_type":"response_assessment_decision","gold_letter":"K","gold_action":"评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排根治性放疗及同期化疗。","options":[{"letter":"A","text":"评估为诱导化疗后完全缓解（CR），予以出院并定期随访观察，暂缓后续放化疗。","is_gold":false},{"letter":"B","text":"评估为诱导化疗后部分缓解（PR），继续原方案（多西他赛+顺铂）行第4周期诱导化疗。","is_gold":false},{"letter":"C","text":"评估为诱导化疗后疾病稳定（SD），更改化疗方案为吉西他滨+顺铂继续诱导化疗。","is_gold":false},{"letter":"D","text":"评估为诱导化疗后疾病进展（PD），建议行姑息性放疗及靶向治疗。","is_gold":false},{"letter":"E","text":"评估为诱导化疗后部分缓解（PR），立即行双侧颈部淋巴结清扫术及鼻咽原发灶切除术。","is_gold":false},{"letter":"F","text":"评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排单纯根治性放疗。","is_gold":false},{"letter":"G","text":"评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排根治性放疗及靶向治疗。","is_gold":false},{"letter":"H","text":"评估为诱导化疗后完全缓解（CR），予以出院及对症支持治疗，并择期安排根治性放疗及同期化疗。","is_gold":false},{"letter":"I","text":"评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排根治性放疗及免疫治疗。","is_gold":false},{"letter":"J","text":"评估为诱导化疗后部分缓解（PR），继续住院观察，待血象恢复后立即行第4周期诱导化疗。","is_gold":false},{"letter":"K","text":"评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排根治性放疗及同期化疗。","is_gold":true},{"letter":"L","text":"评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排姑息性放疗。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、颈动脉鞘、斜坡、海绵窦、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 间断性回吸性涕血1年余。；现病史: 患者近一年以来无明显原因出现回吸性涕血、近一个月左侧鼻塞明显，间断鼻衄。双侧耳鸣伴左耳听力下降，左侧头痛，双颈肿块。无面麻、张口困难、软腭麻痹，无咳嗽咳痰、呼吸困难。伴双侧咽后、颈部淋巴结转移。现为进一步诊治入院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重下降1Kg。；阳性症状体征: 体重下降,听力下降,双颈肿物,双耳鸣,涕血,鼻衄,左鼻塞,左侧头痛；既往史: 既往体健。4年前妊娠期间高血糖。3年前剖宫产。否认肝炎、结核等传染病史。否认心脏病、高血压史。预防接种史不详。过敏史:无药物及食物过敏史。；个人史: 出生于原籍，无烟酒药物等嗜好，无疫水接触史，否认不洁性生活史。无工业毒物，粉尘，放射性物质接触史。；家族史: 否认家族其他成员中有类似病患者或肿瘤患者。；体格检查: T36.5℃P78次/分R19次/分BP115/70mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。无鼻翼扇动、鼻衄。牙龈无肿胀、出血。气管居中，甲状腺不大。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率70bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。；专科检查: KPS 90。双颈II区触及多枚肿大淋巴结，直径约1.0cm，质韧、固定、相互融合。颅神经（-）。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 间断性回吸性涕血1年余。；现病史: 患者近一年以来无明显原因出现回吸性涕血、近一个月左侧鼻塞明显，间断鼻衄。双侧耳鸣伴左耳听力下降，左侧头痛，双颈肿块。无面麻、张口困难、软腭麻痹，无咳嗽咳痰、呼吸困难。当地医院CT提示：鼻咽癌侵犯枕斜坡双侧蝶窦。伴双侧咽后、颈部淋巴结转移。现为进一步诊治入院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重下降1Kg。；阳性症状体征: 体重下降,听力下降,双颈肿物,双耳鸣,涕血,鼻衄,左鼻塞,左侧头痛；既往史: 既往体健。4年前妊娠期间高血糖。3年前剖宫产。否认肝炎、结核等传染病史。否认心脏病、高血压史。预防接种史不详。过敏史:无药物及食物过敏史。；个人史: 出生于原籍，无烟酒药物等嗜好，无疫水接触史，否认不洁性生活史。无工业毒物，粉尘，放射性物质接触史。；家族史: 否认家族其他成员中有类似病患者或肿瘤患者。；体格检查: T36.5℃P78次/分R19次/分BP115/70mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。无鼻翼扇动、鼻衄。牙龈无肿胀、出血。气管居中，甲状腺不大。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率70bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。肛门外生殖器未见异常，生理反射存在，病理反射未引出。；专科检查: KPS 90。张口门齿距4.5cm，间接鼻咽镜：见鼻咽左侧壁肿物肿物；双颈II区触及多枚肿大淋巴结，直径约1.0cm，质韧、固定、相互融合。颅神经（-）。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 正常范围心电图\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理清晰，走行自然，双肺野内未见明确实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。双上胸膜略厚。；检查结论: 心肺未见明显病变。\n- [全程D1] 检验组合: 胱抑素(Cys-C)-静脉血: 0.8mg/L；钾离子(K+)-静脉血: 4.14mmol/L；肌酐(Crea)-静脉血: 65umol/L；葡萄糖(Glu)-静脉血: 5.25mmol/L；载脂蛋白B(apoB)-静脉血: 0.81g/L；碱性磷酸酶(ALP)-静脉血: 47U/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:20（参考: 阴性）；乳酸脱氢酶(LDH)-静脉血: 210.4U/L；纤维蛋白原(Fbg)-静脉血: 2.89g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.62；天门冬氨酸氨基转移酶(AST)-静脉血: 19.6U/L；阴离子间隙(AG)-静脉血: 14.7；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.376COI；总胆固醇(TC)-静脉血: 4.58mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.7mmolL；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.56g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.5mmol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 1.79COI；总胆汁酸(TBA)-静脉血: 2umol/L；平均血小板体积(MPV)-静脉血: 10.5fL；磷(P)-静脉血: 1.23mmol/L；单核细胞百分比(Mono%)-静脉血: 0.042；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 0.009COI；甘油三酯(TG)-静脉血: 0.86mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.1mmol/L；平均红细胞体积(MCV)-静脉血: 96.1fL；丙氨酸氨基转移酶(ALT)-静脉血: 15U/L；血小板分布宽度(PDW)-静脉血: 12.1%；C-反应蛋白(CRP)-静脉血: 0.28mg/L；α-L-岩藻糖苷酶(AFU)-静脉血: 33.2U/L；尿素氮(BUN)-静脉血: 4.7mmol/L；球蛋白(GLO)-静脉血: 28.21g/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 0.109……\n- [全程D2] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁 、顶后壁、左侧壁增厚，见软组织肿物影。左侧咽隐窝消失，右侧咽隐窝变浅；病灶呈稍长分期信息见历史辅助诊断节点稍长分期信息见历史辅助诊断节点信号，增强扫描强化明显。 口咽双侧壁未见增厚。鼻腔未见肿物影。 左侧咽旁脂肪间隙变窄，左侧颈动脉鞘区见肿物占据。左侧腭帆张提肌及左侧头长肌受侵。 左侧翼腭窝见软组织影；右侧翼腭窝、双侧颞下窝未见异常。 斜坡、左侧岩尖、左侧破裂孔，左侧蝶骨大翼、左侧翼突、左侧翼管、左侧圆孔、蝶骨基底部骨质破坏。 蝶窦见软组织肿物；右侧乳突、双侧上颌窦充气良好；蝶窦、筛窦及左侧乳突见分泌物。 双眼未见异常。 左侧海绵窦见可疑肿物侵犯。 双侧咽后淋巴结肿大，左侧短径大小约为15mm，见包膜外侵；右侧短径大小约为11mm。双侧II区见多个肿大淋巴结，相互融合，最大短径大小约为18mm。 右侧腮腺见小淋巴结，短径约为7mm。 双侧腮腺。颌下腺、甲状腺未见异常。；检查结论: 考虑鼻咽癌，左侧咽旁间隙、颅底骨质； 可疑左侧海绵窦受侵。 双侧咽后淋巴结，双侧II区淋巴结肿大，考虑转移。 右侧腮腺小淋巴结，性质待定。 副鼻窦炎症。 左侧乳突炎症。\n- [全程D2] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，肝内血管走行自然，门静脉内径约10mm，未见明确肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约26cm/s。 胆囊大小正常，壁不厚，光滑，其内未见异常回声。 脾脏大小正常，包膜光滑，实质回声均匀。 胰腺大小正常，包膜光滑，实质回声均匀，胰管无扩张。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位性病变。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D9] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；白细胞计数(WBC#)-静脉血: 9.210E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.812；单核细胞百分比(Mono%)-静脉血: 0.005；平均血小板体积(MPV)-静脉血: 11.2fL；平均红细胞体积(MCV)-静脉血: 95.5fL；血小板比容-静脉血: 21%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.1；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339g/L；大血小板百分比(P-LCR%)-静脉血: 36.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.178；平均红细胞血红蛋白含量(MCH)-静脉血: 32.4pg；单核细胞计数(Mono#)-静脉血: 0.110E9/L；红细胞计数(RBC#)-静脉血: 3.5210E12/L；血小板分布宽度(PDW)-静脉血: 13.8%；血小板计数(PLT#)-静脉血: 19010E9/L；红细胞比容(Hct)-静脉血: 33.6%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 114g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.4；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；中性粒细胞计数(Neut#)-静脉血: 7.410E9/L\n- [全程D13] 检验组合: 嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；大血小板百分比(P-LCR%)-静脉血: 33.8%；淋巴细胞百分比(Lymph%)-静脉血: 0.645；平均红细胞血红蛋白含量(MCH)-静脉血: 32.1pg；血红蛋白(Hb)-静脉血: 130g/L；白细胞计数(WBC#)-静脉血: 1.710E9/L；平均红细胞体积(MCV)-静脉血: 92.6fL；红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；单核细胞百分比(Mono%)-静脉血: 0.114；血小板分布宽度(PDW)-静脉血: 13%；中性粒细胞百分比(Neut%)-静脉血: 0.229；红细胞比容(Hct)-静脉血: 37.5%；单核细胞计数(Mono#)-静脉血: 0.210E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 35.6；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；血小板比容-静脉血: 27%；中性粒细胞计数(Neut#)-静脉血: 0.410E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.006；血小板计数(PLT#)-静脉血: 24210E9/L；平均血小板体积(MPV)-静脉血: 11fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 10.6；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L\n- [全程D14] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；淋巴细胞百分比(Lymph%)-静脉血: 0.51；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板比容-静脉血: 23%；红细胞计数(RBC#)-静脉血: 3.8110E12/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.8pg；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.8；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；白细胞计数(WBC#)-静脉血: 2.510E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.151；大血小板百分比(P-LCR%)-静脉血: 28.8%；红细胞比容(Hct)-静脉血: 34.9%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 121g/L；平均红细胞体积(MCV)-静脉血: 91.6fL；血小板分布宽度(PDW)-静脉血: 12.4%；单核细胞百分比(Mono%)-静脉血: 0.291；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；中性粒细胞计数(Neut#)-静脉血: 0.410E9/L；平均血小板体积(MPV)-静脉血: 10.4fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.3；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；血小板计数(PLT#)-静脉血: 22010E9/L\n- [全程D15] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；红细胞计数(RBC#)-静脉血: 3.8910E12/L；血小板分布宽度(PDW)-静脉血: 12.8%；平均红细胞体积(MCV)-静脉血: 94.6fL；中性粒细胞计数(Neut#)-静脉血: 2.610E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 35.8；平均血小板体积(MPV)-静脉血: 10.4fL；中性粒细胞百分比(Neut%)-静脉血: 0.496；淋巴细胞百分比(Lymph%)-静脉血: 0.292；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 334g/L；血红蛋白(Hb)-静脉血: 123g/L；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.202；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 10.8；白细胞计数(WBC#)-静脉血: 5.210E9/L；血小板计数(PLT#)-静脉血: 25410E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.6pg；血小板比容-静脉血: 26%；大血小板百分比(P-LCR%)-静脉血: 29%；红细胞比容(Hct)-静脉血: 36.8%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；单核细胞计数(Mono#)-静脉血: 1.110E9/L\n- [全程D16] 检验组合: 红细胞体积分布宽度SD(RDW-SD)-静脉血: 37；大血小板百分比(P-LCR%)-静脉血: 29.9%；红细胞比容(Hct)-静脉血: 34.2%；血小板计数(PLT#)-静脉血: 26510E9/L；单核细胞计数(Mono#)-静脉血: 1.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.128；血小板比容-静脉血: 28%；白细胞计数(WBC#)-静脉血: 11.810E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；血红蛋白(Hb)-静脉血: 113g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.8pg；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11；中性粒细胞计数(Neut#)-静脉血: 7.910E9/L；血小板分布宽度(PDW)-静脉血: 12.3%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；红细胞计数(RBC#)-静脉血: 3.5510E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.667；平均血小板体积(MPV)-静脉血: 10.5fL；淋巴细胞计数(Lymph#)-静脉血: 2.310E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.197；平均红细胞体积(MCV)-静脉血: 96.3fL\n- [全程D26] 检验组合: 直接胆红素(DBIL)-静脉血: 1.5umol/L；C-反应蛋白(CRP)-静脉血: 6.47mg/L；红细胞比容(Hct)-静脉血: 35.4%；阴离子间隙(AG)-静脉血: 8；血小板分布宽度(PDW)-静脉血: 10.3%；总钙(Ca)-静脉血: 2.27mmol/L；甘油三酯(TG)-静脉血: 0.74mmol/L；尿素氮(BUN)-静脉血: 4.68mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 32.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 32.4U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；葡萄糖(Glu)-静脉血: 5.39mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；白细胞计数(WBC#)-静脉血: 410E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 34U/L；磷(P)-静脉血: 1.35mmol/L；乳酸脱氢酶(LDH)-静脉血: 198.6U/L；血小板计数(PLT#)-静脉血: 25510E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.4；碱性磷酸酶(ALP)-静脉血: 92.4U/L；钾离子(K+)-静脉血: 3.9mmol/L；总蛋白(TP)-静脉血: 64.1g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.435；钠离子(Na+)-静脉血: 140.2mmol/L；胱抑素(Cys-C)-静脉血: 0.82mg/L；大血小板百分比(P-LCR%)-静脉血: 19.1%；间接胆红素(IBIL)-静脉血: 3.9umolL；红细胞计数(RBC#)-静脉血: 3.710E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.6pg；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；平均血小板体积(MPV)-静脉血: 9.3fL；氯离子(Cl-)-静脉血: 100.2mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.23g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.9；淋巴细胞百分比(Lymph%)-静脉血: 0.481；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.9；中性粒细胞计数(Neut#)-静脉……\n- [全程D36] 检验组合: 总胆固醇(TC)-静脉血: 4.01mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.55；γ-谷氨酰基转移酶(GGT)-静脉血: 22.5U/L；平均血小板体积(MPV)-静脉血: 10.1fL；淋巴细胞计数(Lymph#)-静脉血: 0.910E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.04；丙氨酸氨基转移酶(ALT)-静脉血: 42.3U/L；尿素氮(BUN)-静脉血: 6.2mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 26.3U/L；总胆红素(TBIL)-静脉血: 14.1umol/L；钠离子(Na+)-静脉血: 136mmol/L；碱性磷酸酶(ALP)-静脉血: 68U/L；白细胞计数(WBC#)-静脉血: 4.310E9/L；直接胆红素(DBIL)-静脉血: 4.6umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；单核细胞计数(Mono#)-静脉血: 0.110E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；磷(P)-静脉血: 0.99mmol/L；血红蛋白(Hb)-静脉血: 122g/L；氯离子(Cl-)-静脉血: 95mmol/L；血小板分布宽度(PDW)-静脉血: 12.3%；平均红细胞体积(MCV)-静脉血: 93.9fL；α-L-岩藻糖苷酶(AFU)-静脉血: 48.7U/L；阴离子间隙(AG)-静脉血: 14.1；钾离子(K+)-静脉血: 4.06mmol/L；红细胞比容(Hct)-静脉血: 35.7%；血小板比容-静脉血: 23%；白蛋白(ALB)-静脉血: 40.7g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；C-反应蛋白(CRP)-静脉血: 3.19mg/L；球蛋白(GLO)-静脉血: 26.19g/L；胱抑素(Cys-C)-静脉血: 0.64mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.04mmol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；载脂蛋白B(apoB)-静脉血: 0.72g/L；间接胆红素(IBIL)-静脉血: 9.5umolL；中性粒细胞百分比(Neut%)-静脉血: 0.729；尿酸(UA)-静脉血: 258.1umol/L；单核细胞百分比(Mono%)-静脉血: 0……\n- [全程D49] 检验组合: 单核细胞百分比(Mono%)-静脉血: 0.066；C-反应蛋白(CRP)-静脉血: 0.26mg/L；乳酸脱氢酶(LDH)-静脉血: 257.7U/L；氯离子(Cl-)-静脉血: 105.6mmol/L；总蛋白(TP)-静脉血: 65.51g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.002；甘油三酯(TG)-静脉血: 0.97mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.25mmolL；红细胞比容(Hct)-静脉血: 34.7%；间接胆红素(IBIL)-静脉血: 5.5umolL；单核细胞计数(Mono#)-静脉血: 0.310E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.5U/L；红细胞计数(RBC#)-静脉血: 3.5110E12/L；总钙(Ca)-静脉血: 2.08mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.94；葡萄糖(Glu)-静脉血: 4.89mmol/L；直接胆红素(DBIL)-静脉血: 2.4umol/L；镁离子(Mg2+)-静脉血: 1.09mmol/L；胱抑素(Cys-C)-静脉血: 0.69mg/L；总胆汁酸(TBA)-静脉血: 1.9umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 35.4U/L；肌酐(Crea)-静脉血: 52.4umol/L；载脂蛋白B(apoB)-静脉血: 0.81g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 48.8；平均红细胞血红蛋白含量(MCH)-静脉血: 32.5pg；钠离子(Na+)-静脉血: 141.4mmol/L；白蛋白(ALB)-静脉血: 40.9g/L；血小板分布宽度(PDW)-静脉血: 11%；血小板计数(PLT#)-静脉血: 19910E9/L；磷(P)-静脉血: 1.21mmol/L；钾离子(K+)-静脉血: 3.94mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.66；总胆固醇(TC)-静脉血: 4.19mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.55mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.465……\n- [全程D57] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后复查，对比某次就诊时间片： 鼻咽腔稍狭窄，鼻咽肿物较前明显缩小，鼻咽顶壁及双侧壁粘膜欠光滑，双侧咽隐窝变浅，鼻咽未见明显肿物，左侧腭帆提肌张肌及头长肌轮廓不清，其内及左侧咽后区见异常信号灶，增强扫描轻度强化，病灶范围较前明显缩小，强化程度较前降低。 左侧咽旁脂肪间隙变窄，左侧颈动脉鞘区见肿物占据，范围较前缩小，强化程度较前降低。左侧腭帆张提肌及左侧头长肌受侵。 口咽双侧壁未见增厚。鼻腔未见肿物。 左侧翼腭窝见少许软组织影，大致同前。右侧翼腭窝、双侧颞下窝未见异常。 斜坡、左侧岩尖、左侧破裂孔，左侧蝶骨大翼、左侧翼突、左侧翼管、左侧圆孔、蝶骨基底部骨质破坏，大致同前。 蝶窦见软组织肿物，较前明显缩小。 双侧上颌窦、蝶窦、筛窦粘膜增厚，左侧乳突少量分泌物。 双侧眼眶未见异常。左侧海绵窦未见明显右侧。 左侧咽后淋巴结肿大，短径约10mm，较前稍缩小。右侧咽后见小淋巴结，短径约4mm，较前明显缩小。双侧II区见多个淋巴结，相互融合，边界不清，较前明显缩小。右侧腮腺见小淋巴结，短径约为4mm。明显强化 左侧腮腺及双侧颌下腺未见异常。所示甲状腺未见异常。 所示脑实质常规MR及DTI未见明显异常信号灶。；检查结论: 鼻咽癌化疗后，鼻咽未见明显肿物，左侧咽旁、蝶窦肿物较前明显缩小。 颅底骨质破坏，大致同前。 双侧咽后及双颈II区淋巴结，较前缩小。 右侧腮腺小淋巴结。 鼻窦炎，左侧乳突炎症。\n- [全程D57] MRI；脑功能成像、DTI: 检查类型: MRI；检查名称: 脑功能成像、DTI；检查部位:；检查所见: 鼻咽癌化疗后复查，对比某次就诊时间片： 鼻咽腔稍狭窄，鼻咽肿物较前明显缩小，鼻咽顶壁及双侧壁粘膜欠光滑，双侧咽隐窝变浅，鼻咽未见明显肿物，左侧腭帆提肌张肌及头长肌轮廓不清，其内及左侧咽后区见异常信号灶，增强扫描轻度强化，病灶范围较前明显缩小，强化程度较前降低。 左侧咽旁脂肪间隙变窄，左侧颈动脉鞘区见肿物占据，范围较前缩小，强化程度较前降低。左侧腭帆张提肌及左侧头长肌受侵。 口咽双侧壁未见增厚。鼻腔未见肿物。 左侧翼腭窝见少许软组织影，大致同前。右侧翼腭窝、双侧颞下窝未见异常。 斜坡、左侧岩尖、左侧破裂孔，左侧蝶骨大翼、左侧翼突、左侧翼管、左侧圆孔、蝶骨基底部骨质破坏，大致同前。 蝶窦见软组织肿物，较前明显缩小。 双侧上颌窦、蝶窦、筛窦粘膜增厚，左侧乳突少量分泌物。 双侧眼眶未见异常。左侧海绵窦未见明显右侧。 左侧咽后淋巴结肿大，短径约10mm，较前稍缩小。右侧咽后见小淋巴结，短径约4mm，较前明显缩小。双侧II区见多个淋巴结，相互融合，边界不清，较前明显缩小。右侧腮腺见小淋巴结，短径约为4mm。明显强化 左侧腮腺及双侧颌下腺未见异常。所示甲状腺未见异常。 所示脑实质常规MR及DTI未见明显异常信号灶。；检查结论: 鼻咽癌化疗后，鼻咽未见明显肿物，左侧咽旁、蝶窦肿物较前明显缩小。 颅底骨质破坏，大致同前。 双侧咽后及双颈II区淋巴结，较前缩小。 右侧腮腺小淋巴结。 鼻窦炎，左侧乳突炎症。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者入院第2天，一般情况可，今日[姓名已隐去]医生信息已隐藏，详细听取病情汇报、检查患者后指示：尽快完善各项治疗前检查，明确诊断及分期，并了解有无合并其他基础疾病，待分期明确后再定治疗方案。遵嘱执行。\n- [全程D13] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。胡医生信息已隐藏：患者予复查血象变化，密切观察患者病情变化。遵嘱。\n- [全程D16] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。检查回报：白细胞 2.5×109/L 。胡医生信息已隐藏：患者出现II度骨髓抑制，考虑化疗引起的副反应，予升白等对症处理，密切观察患者病情变化。遵嘱。\n- [全程D19] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。检查结果回报：白细胞 11.8×109/L。胡医生信息已隐藏：患者血象已恢复正常，密切观察患者病情变化。遵嘱。\n- [全程D22] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。胡医生信息已隐藏：患者予对症处理，密切观察患者病情变化。遵嘱。\n- [全程D25] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。胡医生信息已隐藏：患者予对症处理，密切观察患者病情变化。遵嘱。\n- [全程D51] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者入院第2天，一般情况可，血常规、生化检查无明显异常。[姓名已隐去]医生信息已隐藏示：目前患者诊断明确，今日水化，明日开始第三程诱导化疗。\n- [全程D52] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，血常规、生化检查无明显异常。今日开始予多西他赛90mg/d1+PDD35mg/d1-3方案化疗。[姓名已隐去]医生信息已隐藏示：目前患者诊断明确，今日开始化疗，密切观察病情变化。\n- [全程D55] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，未诉特殊不适。[姓名已隐去]医生信息已隐藏示：目前患者今日化疗结束，密切观病情变化，如有不适，及时对症处理。\n- [全程D57] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，未诉特殊不适。[姓名已隐去]医生信息已隐藏示：目前患者化疗结束，病情稳定，可予出院。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估为诱导化疗后完全缓解（CR），予以出院并定期随访观察，暂缓后续放化疗。\nB. 评估为诱导化疗后部分缓解（PR），继续原方案（多西他赛+顺铂）行第4周期诱导化疗。\nC. 评估为诱导化疗后疾病稳定（SD），更改化疗方案为吉西他滨+顺铂继续诱导化疗。\nD. 评估为诱导化疗后疾病进展（PD），建议行姑息性放疗及靶向治疗。\nE. 评估为诱导化疗后部分缓解（PR），立即行双侧颈部淋巴结清扫术及鼻咽原发灶切除术。\nF. 评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排单纯根治性放疗。\nG. 评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排根治性放疗及靶向治疗。\nH. 评估为诱导化疗后完全缓解（CR），予以出院及对症支持治疗，并择期安排根治性放疗及同期化疗。\nI. 评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排根治性放疗及免疫治疗。\nJ. 评估为诱导化疗后部分缓解（PR），继续住院观察，待血象恢复后立即行第4周期诱导化疗。\nK. 评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排根治性放疗及同期化疗。\nL. 评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排姑息性放疗。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- 无可展示记录。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估为诱导化疗后完全缓解（CR），予以出院并定期随访观察，暂缓后续放化疗。\nB. 评估为诱导化疗后部分缓解（PR），继续原方案（多西他赛+顺铂）行第4周期诱导化疗。\nC. 评估为诱导化疗后疾病稳定（SD），更改化疗方案为吉西他滨+顺铂继续诱导化疗。\nD. 评估为诱导化疗后疾病进展（PD），建议行姑息性放疗及靶向治疗。\nE. 评估为诱导化疗后部分缓解（PR），立即行双侧颈部淋巴结清扫术及鼻咽原发灶切除术。\nF. 评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排单纯根治性放疗。\nG. 评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排根治性放疗及靶向治疗。\nH. 评估为诱导化疗后完全缓解（CR），予以出院及对症支持治疗，并择期安排根治性放疗及同期化疗。\nI. 评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排根治性放疗及免疫治疗。\nJ. 评估为诱导化疗后部分缓解（PR），继续住院观察，待血象恢复后立即行第4周期诱导化疗。\nK. 评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排根治性放疗及同期化疗。\nL. 评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排姑息性放疗。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、颈动脉鞘、斜坡、海绵窦、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- 无可展示记录。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估为诱导化疗后完全缓解（CR），予以出院并定期随访观察，暂缓后续放化疗。\nB. 评估为诱导化疗后部分缓解（PR），继续原方案（多西他赛+顺铂）行第4周期诱导化疗。\nC. 评估为诱导化疗后疾病稳定（SD），更改化疗方案为吉西他滨+顺铂继续诱导化疗。\nD. 评估为诱导化疗后疾病进展（PD），建议行姑息性放疗及靶向治疗。\nE. 评估为诱导化疗后部分缓解（PR），立即行双侧颈部淋巴结清扫术及鼻咽原发灶切除术。\nF. 评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排单纯根治性放疗。\nG. 评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排根治性放疗及靶向治疗。\nH. 评估为诱导化疗后完全缓解（CR），予以出院及对症支持治疗，并择期安排根治性放疗及同期化疗。\nI. 评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排根治性放疗及免疫治疗。\nJ. 评估为诱导化疗后部分缓解（PR），继续住院观察，待血象恢复后立即行第4周期诱导化疗。\nK. 评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排根治性放疗及同期化疗。\nL. 评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排姑息性放疗。\n\n请仅输出一个选项字母（A-L）。"}]}
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颈部MRI平扫+增强、电子鼻咽镜下活检、腹部超声检查\nD. 颈部超声、电子鼻咽镜检查、胸腹部CT平扫\nE. 颈部CT平扫、电子鼻咽镜检查、腹部超声检查\nF. 颈部MRI平扫+增强、间接鼻咽镜检查、胸部X线片\nG. 鼻咽及颈部CT平扫+增强、电子鼻咽镜检查、全身骨扫描\nH. 颈部MRI平扫、电子鼻咽镜检查、腹部超声检查\nI. 颈部MRI平扫+增强、鼻咽活检、全身骨扫描\nJ. 鼻咽部CT平扫、电子鼻咽镜检查、全身PET-CT检查\nK. 颈部MRI平扫+增强、电子鼻咽镜检查、全身骨扫描\nL. 颈部MRI平扫+增强、电子鼻咽镜检查、腹部超声检查\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-72b57dbdb0633da918062d61","patient_id":"patient-7c0941dbdd4694260fd4de38","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"A","gold_action":"行电子鼻咽镜检查及鼻咽肿物活检，并辅以颈部淋巴结彩超及穿刺活检，以明确病理诊断及淋巴结分期。","options":[{"letter":"A","text":"行电子鼻咽镜检查及鼻咽肿物活检，并辅以颈部淋巴结彩超及穿刺活检","is_gold":true},{"letter":"B","text":"行电子鼻咽镜检查及鼻咽肿物活检，颈部淋巴结仅作临床触诊及随访","is_gold":false},{"letter":"C","text":"行颈部淋巴结切除活检明确病理，暂缓鼻咽部有创检查及活检","is_gold":false},{"letter":"D","text":"行鼻内镜下鼻咽肿物扩大切除术，同步完成病理诊断与局部治疗","is_gold":false},{"letter":"E","text":"行颈部淋巴结彩超及穿刺活检，若确诊转移则免于鼻咽部活检","is_gold":false},{"letter":"F","text":"行鼻咽部脱落细胞学涂片及血浆EBV-DNA检测，替代组织学活检","is_gold":false},{"letter":"G","text":"启动根治性放化疗，免于组织学活检及颈部淋巴结穿刺评估","is_gold":false},{"letter":"H","text":"行电子鼻咽镜检查及活检，并预防性行双侧颈部淋巴结清扫术","is_gold":false},{"letter":"I","text":"补充全身骨扫描及头颅增强MRI，暂缓鼻咽及颈部组织学活检","is_gold":false},{"letter":"J","text":"行电子鼻咽镜评估局部侵犯范围，免于鼻咽肿物组织学活检","is_gold":false},{"letter":"K","text":"优先行鼓膜穿刺置管术缓解中耳积液，暂缓鼻咽部及颈部检查","is_gold":false},{"letter":"L","text":"予以诊断性抗炎治疗2周，随后复查PET/CT评估局部代谢变化","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、口咽。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 反复右中耳积液半年余。；现病史: 简要入院病史:患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；阳性症状体征:；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史: 吸烟2包/日×20年，否认疫区接触史，否认冶游史，否认嗜酒。；家族史: 无特殊。；体格检查:；专科检查:；KPS: 90；ECOG:\n- [时间未明] 门急诊记录: 主诉: 反复右中耳积液半年余。；现病史: 患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史:；家族史: 无特殊。；体格检查: KPS90分，DG4.0cm，鼻咽右侧隆突肿物，接近右侧后鼻孔，双颈未触及肿大淋巴结，颅神经检查阴性，心肺腹未及异常，全身骨无压痛。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D8] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽右侧咽隐窝区软组织影放射性浓聚，SUV41.8，病灶侵犯右腭帆肌群、右头长肌，病灶与蝶骨基底部右份及右翼突内板分界不清。右咽旁间隙变浅，右咽隐窝消失，左侧咽隐窝未见明显异常。口咽及喉咽结构及放射性分布未见明显异常。双侧上颌窦低密度影放射性分布未见异常；额窦、蝶窦、筛窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双颈多个小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 右中肺小片状影放射性分布未见异常；余双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏弥漫性密度减低，CT值约46Hu（脾脏CT值约58Hu），形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 盆腔放射性分布均匀，膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 右乳突气房内低密度影放射性分布未见异常；余颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽右咽隐窝病灶代谢活跃，符合鼻咽癌，病灶疑累及蝶骨基底部右份及右翼突内板。 双上颌窦炎症；右乳突炎症。 右中肺小片状影代谢未见异常，考虑增殖灶。 轻度脂肪肝。\n- [全程D8] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 早期复极改变 其余未见异常\n- [全程D8] 检验组合: 红细胞计数(RBC#)-静脉血: 5.2310E12/L；血液二氧化碳含量ctCO2(B)-静脉血: 25mmol/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.766COI；血小板分布宽度(PDW)-静脉血: 16.4%；单核细胞百分比(Mono%)-静脉血: 0.077；红细胞比容(Hct)-静脉血: 48.4%；凝血酶时间(TT)-静脉血: 19.8sec.；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 32.8U/L；凝血酶原时间(PT)-静脉血: 9.9sec.；淋巴细胞计数(Lymph#)-静脉血: 2.310E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.025；白蛋白(ALB)-静脉血: 46g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.61；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.08；胱抑素(Cys-C)-静脉血: 0.98mg/L；尿素氮(BUN)-静脉血: 5.5mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.597；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 6.1umolL；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；碱性磷酸酶(ALP)-静脉血: 60.9U/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 0.006COI；C-反应蛋白(CRP)-静脉血: 1.86mg/L；Rh血型-静脉血: 阳性；总钙(Ca)-静脉血: 2.14mmol/L；总胆汁酸(TBA)-静脉血: 8.3umol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.1ug/ml；丙氨酸氨基转移酶(ALT)-静脉血: 46.9U/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；氯离子(Cl-)-静脉血: 104.3mmol/L；低密度脂蛋白胆固醇……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行电子鼻咽镜检查及鼻咽肿物活检，并辅以颈部淋巴结彩超及穿刺活检\nB. 行电子鼻咽镜检查及鼻咽肿物活检，颈部淋巴结仅作临床触诊及随访\nC. 行颈部淋巴结切除活检明确病理，暂缓鼻咽部有创检查及活检\nD. 行鼻内镜下鼻咽肿物扩大切除术，同步完成病理诊断与局部治疗\nE. 行颈部淋巴结彩超及穿刺活检，若确诊转移则免于鼻咽部活检\nF. 行鼻咽部脱落细胞学涂片及血浆EBV-DNA检测，替代组织学活检\nG. 启动根治性放化疗，免于组织学活检及颈部淋巴结穿刺评估\nH. 行电子鼻咽镜检查及活检，并预防性行双侧颈部淋巴结清扫术\nI. 补充全身骨扫描及头颅增强MRI，暂缓鼻咽及颈部组织学活检\nJ. 行电子鼻咽镜评估局部侵犯范围，免于鼻咽肿物组织学活检\nK. 优先行鼓膜穿刺置管术缓解中耳积液，暂缓鼻咽部及颈部检查\nL. 予以诊断性抗炎治疗2周，随后复查PET/CT评估局部代谢变化\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- [时间未明] 门急诊记录: 主诉: 反复右中耳积液半年余。；现病史: 患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史:；家族史: 无特殊。；体格检查: KPS90分，DG4.0cm，鼻咽右侧隆突肿物，接近右侧后鼻孔，双颈未触及肿大淋巴结，颅神经检查阴性，心肺腹未及异常，全身骨无压痛。\n\n【已完成检查与客观结果】\n- [全程D8] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽右侧咽隐窝区软组织影放射性浓聚，SUV41.8，病灶侵犯右腭帆肌群、右头长肌，病灶与蝶骨基底部右份及右翼突内板分界不清。右咽旁间隙变浅，右咽隐窝消失，左侧咽隐窝未见明显异常。口咽及喉咽结构及放射性分布未见明显异常。双侧上颌窦低密度影放射性分布未见异常；额窦、蝶窦、筛窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双颈多个小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 右中肺小片状影放射性分布未见异常；余双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏弥漫性密度减低，CT值约46Hu（脾脏CT值约58Hu），形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 盆腔放射性分布均匀，膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 右乳突气房内低密度影放射性分布未见异常；余颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽右咽隐窝病灶代谢活跃，符合鼻咽癌，病灶疑累及蝶骨基底部右份及右翼突内板。 双上颌窦炎症；右乳突炎症。 右中肺小片状影代谢未见异常，考虑增殖灶。 轻度脂肪肝。\n- [全程D8] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 早期复极改变 其余未见异常\n- [全程D8] 检验组合: 红细胞计数(RBC#)-静脉血: 5.2310E12/L；血液二氧化碳含量ctCO2(B)-静脉血: 25mmol/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.766COI；血小板分布宽度(PDW)-静脉血: 16.4%；单核细胞百分比(Mono%)-静脉血: 0.077；红细胞比容(Hct)-静脉血: 48.4%；凝血酶时间(TT)-静脉血: 19.8sec.；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 32.8U/L；凝血酶原时间(PT)-静脉血: 9.9sec.；淋巴细胞计数(Lymph#)-静脉血: 2.310E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.025；白蛋白(ALB)-静脉血: 46g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.61；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.08；胱抑素(Cys-C)-静脉血: 0.98mg/L；尿素氮(BUN)-静脉血: 5.5mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.597；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 6.1umolL；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；碱性磷酸酶(ALP)-静脉血: 60.9U/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 0.006COI；C-反应蛋白(CRP)-静脉血: 1.86mg/L；Rh血型-静脉血: 阳性；总钙(Ca)-静脉血: 2.14mmol/L；总胆汁酸(TBA)-静脉血: 8.3umol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.1ug/ml；丙氨酸氨基转移酶(ALT)-静脉血: 46.9U/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；氯离子(Cl-)-静脉血: 104.3mmol/L；低密度脂蛋白胆固醇……\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行电子鼻咽镜检查及鼻咽肿物活检，并辅以颈部淋巴结彩超及穿刺活检\nB. 行电子鼻咽镜检查及鼻咽肿物活检，颈部淋巴结仅作临床触诊及随访\nC. 行颈部淋巴结切除活检明确病理，暂缓鼻咽部有创检查及活检\nD. 行鼻内镜下鼻咽肿物扩大切除术，同步完成病理诊断与局部治疗\nE. 行颈部淋巴结彩超及穿刺活检，若确诊转移则免于鼻咽部活检\nF. 行鼻咽部脱落细胞学涂片及血浆EBV-DNA检测，替代组织学活检\nG. 启动根治性放化疗，免于组织学活检及颈部淋巴结穿刺评估\nH. 行电子鼻咽镜检查及活检，并预防性行双侧颈部淋巴结清扫术\nI. 补充全身骨扫描及头颅增强MRI，暂缓鼻咽及颈部组织学活检\nJ. 行电子鼻咽镜评估局部侵犯范围，免于鼻咽肿物组织学活检\nK. 优先行鼓膜穿刺置管术缓解中耳积液，暂缓鼻咽部及颈部检查\nL. 予以诊断性抗炎治疗2周，随后复查PET/CT评估局部代谢变化\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、口咽。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [时间未明] 门急诊记录: 主诉: 反复右中耳积液半年余。；现病史: 患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史:；家族史: 无特殊。；体格检查: KPS90分，DG4.0cm，鼻咽右侧隆突肿物，接近右侧后鼻孔，双颈未触及肿大淋巴结，颅神经检查阴性，心肺腹未及异常，全身骨无压痛。\n\n【已完成检查与客观结果】\n- [全程D8] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽右侧咽隐窝区软组织影放射性浓聚，SUV41.8，病灶侵犯右腭帆肌群、右头长肌，病灶与蝶骨基底部右份及右翼突内板分界不清。右咽旁间隙变浅，右咽隐窝消失，左侧咽隐窝未见明显异常。口咽及喉咽结构及放射性分布未见明显异常。双侧上颌窦低密度影放射性分布未见异常；额窦、蝶窦、筛窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双颈多个小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 右中肺小片状影放射性分布未见异常；余双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏弥漫性密度减低，CT值约46Hu（脾脏CT值约58Hu），形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 盆腔放射性分布均匀，膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 右乳突气房内低密度影放射性分布未见异常；余颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽右咽隐窝病灶代谢活跃，符合鼻咽癌，病灶疑累及蝶骨基底部右份及右翼突内板。 双上颌窦炎症；右乳突炎症。 右中肺小片状影代谢未见异常，考虑增殖灶。 轻度脂肪肝。\n- [全程D8] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 早期复极改变 其余未见异常\n- [全程D8] 检验组合: 红细胞计数(RBC#)-静脉血: 5.2310E12/L；血液二氧化碳含量ctCO2(B)-静脉血: 25mmol/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.766COI；血小板分布宽度(PDW)-静脉血: 16.4%；单核细胞百分比(Mono%)-静脉血: 0.077；红细胞比容(Hct)-静脉血: 48.4%；凝血酶时间(TT)-静脉血: 19.8sec.；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 32.8U/L；凝血酶原时间(PT)-静脉血: 9.9sec.；淋巴细胞计数(Lymph#)-静脉血: 2.310E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.025；白蛋白(ALB)-静脉血: 46g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.61；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.08；胱抑素(Cys-C)-静脉血: 0.98mg/L；尿素氮(BUN)-静脉血: 5.5mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.597；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 6.1umolL；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；碱性磷酸酶(ALP)-静脉血: 60.9U/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 0.006COI；C-反应蛋白(CRP)-静脉血: 1.86mg/L；Rh血型-静脉血: 阳性；总钙(Ca)-静脉血: 2.14mmol/L；总胆汁酸(TBA)-静脉血: 8.3umol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.1ug/ml；丙氨酸氨基转移酶(ALT)-静脉血: 46.9U/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；氯离子(Cl-)-静脉血: 104.3mmol/L；低密度脂蛋白胆固醇……\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行电子鼻咽镜检查及鼻咽肿物活检，并辅以颈部淋巴结彩超及穿刺活检\nB. 行电子鼻咽镜检查及鼻咽肿物活检，颈部淋巴结仅作临床触诊及随访\nC. 行颈部淋巴结切除活检明确病理，暂缓鼻咽部有创检查及活检\nD. 行鼻内镜下鼻咽肿物扩大切除术，同步完成病理诊断与局部治疗\nE. 行颈部淋巴结彩超及穿刺活检，若确诊转移则免于鼻咽部活检\nF. 行鼻咽部脱落细胞学涂片及血浆EBV-DNA检测，替代组织学活检\nG. 启动根治性放化疗，免于组织学活检及颈部淋巴结穿刺评估\nH. 行电子鼻咽镜检查及活检，并预防性行双侧颈部淋巴结清扫术\nI. 补充全身骨扫描及头颅增强MRI，暂缓鼻咽及颈部组织学活检\nJ. 行电子鼻咽镜评估局部侵犯范围，免于鼻咽肿物组织学活检\nK. 优先行鼓膜穿刺置管术缓解中耳积液，暂缓鼻咽部及颈部检查\nL. 予以诊断性抗炎治疗2周，随后复查PET/CT评估局部代谢变化\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-3ed269e9b5e894b444089bf3","patient_id":"patient-7c0941dbdd4694260fd4de38","turn_id":"turn04","turn_position":3,"turn_type":"initial_treatment_selection","gold_letter":"C","gold_action":"单纯根治性放疗（鼻咽及双侧颈部）","options":[{"letter":"A","text":"诱导化疗序贯单纯根治性放疗（鼻咽及双侧颈部）","is_gold":false},{"letter":"B","text":"同期放化疗（鼻咽及双侧颈部）","is_gold":false},{"letter":"C","text":"单纯根治性放疗（鼻咽及双侧颈部）","is_gold":true},{"letter":"D","text":"诱导化疗序贯同期放化疗（鼻咽及双侧颈部）","is_gold":false},{"letter":"E","text":"鼻咽原发灶切除术联合术后辅助放疗","is_gold":false},{"letter":"F","text":"靶向治疗联合单纯根治性放疗（鼻咽及双侧颈部）","is_gold":false},{"letter":"G","text":"免疫治疗联合单纯根治性放疗（鼻咽及双侧颈部）","is_gold":false},{"letter":"H","text":"诱导化疗联合免疫治疗序贯同期放化疗","is_gold":false},{"letter":"I","text":"单纯根治性放疗（仅照射鼻咽及右侧颈部）","is_gold":false},{"letter":"J","text":"姑息性全身化疗联合鼻咽局部减症放疗","is_gold":false},{"letter":"K","text":"诱导化疗后肿瘤退缩情况决定是否行根治性放疗","is_gold":false},{"letter":"L","text":"同期放化疗序贯全身辅助化疗","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、口咽。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 反复右中耳积液半年余。；现病史: 简要入院病史:患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；阳性症状体征:；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史: 吸烟2包/日×20年，否认疫区接触史，否认冶游史，否认嗜酒。；家族史: 无特殊。；体格检查:；专科检查:；KPS: 90；ECOG:\n- [时间未明] 门急诊记录: 主诉: 反复右中耳积液半年余。；现病史: 患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史:；家族史: 无特殊。；体格检查: KPS90分，DG4.0cm，鼻咽右侧隆突肿物，接近右侧后鼻孔，双颈未触及肿大淋巴结，颅神经检查阴性，心肺腹未及异常，全身骨无压痛。\n- [全程D24] 入院记录: 主诉: 反复右中耳积液半年余。；现病史: 简要入院病史:患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。后来我院，我院病理示未分化非角化性癌。我院鼻咽+颈部MR：鼻咽部肿物，考虑鼻咽癌。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；阳性症状体征:；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史: 吸烟2包/日×20年，否认疫区接触史，否认冶游史，否认嗜酒。；家族史: 无特殊。；体格检查:；专科检查:；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D8] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽右侧咽隐窝区软组织影放射性浓聚，SUV41.8，病灶侵犯右腭帆肌群、右头长肌，病灶与蝶骨基底部右份及右翼突内板分界不清。右咽旁间隙变浅，右咽隐窝消失，左侧咽隐窝未见明显异常。口咽及喉咽结构及放射性分布未见明显异常。双侧上颌窦低密度影放射性分布未见异常；额窦、蝶窦、筛窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双颈多个小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 右中肺小片状影放射性分布未见异常；余双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏弥漫性密度减低，CT值约46Hu（脾脏CT值约58Hu），形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 盆腔放射性分布均匀，膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 右乳突气房内低密度影放射性分布未见异常；余颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽右咽隐窝病灶代谢活跃，符合鼻咽癌，病灶疑累及蝶骨基底部右份及右翼突内板。 双上颌窦炎症；右乳突炎症。 右中肺小片状影代谢未见异常，考虑增殖灶。 轻度脂肪肝。\n- [全程D8] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 早期复极改变 其余未见异常\n- [全程D8] 检验组合: 红细胞计数(RBC#)-静脉血: 5.2310E12/L；血液二氧化碳含量ctCO2(B)-静脉血: 25mmol/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.766COI；血小板分布宽度(PDW)-静脉血: 16.4%；单核细胞百分比(Mono%)-静脉血: 0.077；红细胞比容(Hct)-静脉血: 48.4%；凝血酶时间(TT)-静脉血: 19.8sec.；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 32.8U/L；凝血酶原时间(PT)-静脉血: 9.9sec.；淋巴细胞计数(Lymph#)-静脉血: 2.310E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.025；白蛋白(ALB)-静脉血: 46g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.61；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.08；胱抑素(Cys-C)-静脉血: 0.98mg/L；尿素氮(BUN)-静脉血: 5.5mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.597；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 6.1umolL；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；碱性磷酸酶(ALP)-静脉血: 60.9U/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 0.006COI；C-反应蛋白(CRP)-静脉血: 1.86mg/L；Rh血型-静脉血: 阳性；总钙(Ca)-静脉血: 2.14mmol/L；总胆汁酸(TBA)-静脉血: 8.3umol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.1ug/ml；丙氨酸氨基转移酶(ALT)-静脉血: 46.9U/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；氯离子(Cl-)-静脉血: 104.3mmol/L；低密度脂蛋白胆固醇……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D9] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁明显增厚，右侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描强化较明显。左侧咽隐窝存在。肿块累及右侧口咽壁。 右侧咽旁脂肪间隙变窄；左侧咽旁间隙未见明显狭窄。右侧腭帆张提肌受侵，左侧腭帆张提肌、双侧头长肌、双侧翼内外肌未见受侵。 鼻腔内未见肿物。 双侧翼腭窝、双侧上颌后脂肪间隙及咀嚼肌间隙未见异常。 颅底骨质信号均匀，增强扫描未见异常强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧上颌窦内见囊性灶，最大长径约27mm，边界清，无强化。右侧乳突见分泌物。左乳突充气良好，骨壁完整。 右侧咽后见一肿大淋巴结，大小约6mm×9mm，增强扫描明显强化。左侧咽后未见肿大淋巴结。颈部双侧见多个小淋巴结，最大者约8mm×11mm，未见坏死及包膜外侵。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。 扫描范围脑实质信号未见异常。；检查结论: 鼻咽肿物，考虑鼻咽癌。 颅底骨质未见破坏。 右侧咽后肿大淋巴结，考虑转移。 颈部小淋巴结。 双侧上颌窦囊肿，右侧乳突炎。\n- [全程D13] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见: 双颈II区可见几个小淋巴结，最大约11mm×4mm（右），12mm×5mm（左），边界清，椭圆形，皮髓质分界清，淋巴门可见。 CDFI:上述淋巴结内可见点状血流信号。 双侧颈部淋巴结穿刺活检： （1）右侧颈部淋巴结穿刺活检：常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以16G穿刺针穿刺入右颈淋巴结内，进针2次，取出长约0.5-1cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。 （2）左侧颈部淋巴结穿刺活检：常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以18G穿刺针穿刺入左颈淋巴结内，进针2次，取出长约0.8-1cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。；检查结论: 双侧颈部淋巴结穿刺活检。 不适随诊。 4个工作日后凭发票到2号楼6楼病理科取结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 诱导化疗序贯单纯根治性放疗（鼻咽及双侧颈部）\nB. 同期放化疗（鼻咽及双侧颈部）\nC. 单纯根治性放疗（鼻咽及双侧颈部）\nD. 诱导化疗序贯同期放化疗（鼻咽及双侧颈部）\nE. 鼻咽原发灶切除术联合术后辅助放疗\nF. 靶向治疗联合单纯根治性放疗（鼻咽及双侧颈部）\nG. 免疫治疗联合单纯根治性放疗（鼻咽及双侧颈部）\nH. 诱导化疗联合免疫治疗序贯同期放化疗\nI. 单纯根治性放疗（仅照射鼻咽及右侧颈部）\nJ. 姑息性全身化疗联合鼻咽局部减症放疗\nK. 诱导化疗后肿瘤退缩情况决定是否行根治性放疗\nL. 同期放化疗序贯全身辅助化疗\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 反复右中耳积液半年余。；现病史: 简要入院病史:患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。后来我院，我院病理示未分化非角化性癌。我院鼻咽+颈部MR：鼻咽部肿物，考虑鼻咽癌。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；阳性症状体征:；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史: 吸烟2包/日×20年，否认疫区接触史，否认冶游史，否认嗜酒。；家族史: 无特殊。；体格检查:；专科检查:；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D9] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁明显增厚，右侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描强化较明显。左侧咽隐窝存在。肿块累及右侧口咽壁。 右侧咽旁脂肪间隙变窄；左侧咽旁间隙未见明显狭窄。右侧腭帆张提肌受侵，左侧腭帆张提肌、双侧头长肌、双侧翼内外肌未见受侵。 鼻腔内未见肿物。 双侧翼腭窝、双侧上颌后脂肪间隙及咀嚼肌间隙未见异常。 颅底骨质信号均匀，增强扫描未见异常强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧上颌窦内见囊性灶，最大长径约27mm，边界清，无强化。右侧乳突见分泌物。左乳突充气良好，骨壁完整。 右侧咽后见一肿大淋巴结，大小约6mm×9mm，增强扫描明显强化。左侧咽后未见肿大淋巴结。颈部双侧见多个小淋巴结，最大者约8mm×11mm，未见坏死及包膜外侵。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。 扫描范围脑实质信号未见异常。；检查结论: 鼻咽肿物，考虑鼻咽癌。 颅底骨质未见破坏。 右侧咽后肿大淋巴结，考虑转移。 颈部小淋巴结。 双侧上颌窦囊肿，右侧乳突炎。\n- [全程D13] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见: 双颈II区可见几个小淋巴结，最大约11mm×4mm（右），12mm×5mm（左），边界清，椭圆形，皮髓质分界清，淋巴门可见。 CDFI:上述淋巴结内可见点状血流信号。 双侧颈部淋巴结穿刺活检： （1）右侧颈部淋巴结穿刺活检：常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以16G穿刺针穿刺入右颈淋巴结内，进针2次，取出长约0.5-1cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。 （2）左侧颈部淋巴结穿刺活检：常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以18G穿刺针穿刺入左颈淋巴结内，进针2次，取出长约0.8-1cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。；检查结论: 双侧颈部淋巴结穿刺活检。 不适随诊。 4个工作日后凭发票到2号楼6楼病理科取结果。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 诱导化疗序贯单纯根治性放疗（鼻咽及双侧颈部）\nB. 同期放化疗（鼻咽及双侧颈部）\nC. 单纯根治性放疗（鼻咽及双侧颈部）\nD. 诱导化疗序贯同期放化疗（鼻咽及双侧颈部）\nE. 鼻咽原发灶切除术联合术后辅助放疗\nF. 靶向治疗联合单纯根治性放疗（鼻咽及双侧颈部）\nG. 免疫治疗联合单纯根治性放疗（鼻咽及双侧颈部）\nH. 诱导化疗联合免疫治疗序贯同期放化疗\nI. 单纯根治性放疗（仅照射鼻咽及右侧颈部）\nJ. 姑息性全身化疗联合鼻咽局部减症放疗\nK. 诱导化疗后肿瘤退缩情况决定是否行根治性放疗\nL. 同期放化疗序贯全身辅助化疗\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、口咽。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 反复右中耳积液半年余。；现病史: 简要入院病史:患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。后来我院，我院病理示未分化非角化性癌。我院鼻咽+颈部MR：鼻咽部肿物，考虑鼻咽癌。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；阳性症状体征:；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史: 吸烟2包/日×20年，否认疫区接触史，否认冶游史，否认嗜酒。；家族史: 无特殊。；体格检查:；专科检查:；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D9] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁明显增厚，右侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描强化较明显。左侧咽隐窝存在。肿块累及右侧口咽壁。 右侧咽旁脂肪间隙变窄；左侧咽旁间隙未见明显狭窄。右侧腭帆张提肌受侵，左侧腭帆张提肌、双侧头长肌、双侧翼内外肌未见受侵。 鼻腔内未见肿物。 双侧翼腭窝、双侧上颌后脂肪间隙及咀嚼肌间隙未见异常。 颅底骨质信号均匀，增强扫描未见异常强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧上颌窦内见囊性灶，最大长径约27mm，边界清，无强化。右侧乳突见分泌物。左乳突充气良好，骨壁完整。 右侧咽后见一肿大淋巴结，大小约6mm×9mm，增强扫描明显强化。左侧咽后未见肿大淋巴结。颈部双侧见多个小淋巴结，最大者约8mm×11mm，未见坏死及包膜外侵。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。 扫描范围脑实质信号未见异常。；检查结论: 鼻咽肿物，考虑鼻咽癌。 颅底骨质未见破坏。 右侧咽后肿大淋巴结，考虑转移。 颈部小淋巴结。 双侧上颌窦囊肿，右侧乳突炎。\n- [全程D13] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见: 双颈II区可见几个小淋巴结，最大约11mm×4mm（右），12mm×5mm（左），边界清，椭圆形，皮髓质分界清，淋巴门可见。 CDFI:上述淋巴结内可见点状血流信号。 双侧颈部淋巴结穿刺活检： （1）右侧颈部淋巴结穿刺活检：常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以16G穿刺针穿刺入右颈淋巴结内，进针2次，取出长约0.5-1cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。 （2）左侧颈部淋巴结穿刺活检：常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以18G穿刺针穿刺入左颈淋巴结内，进针2次，取出长约0.8-1cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。；检查结论: 双侧颈部淋巴结穿刺活检。 不适随诊。 4个工作日后凭发票到2号楼6楼病理科取结果。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 诱导化疗序贯单纯根治性放疗（鼻咽及双侧颈部）\nB. 同期放化疗（鼻咽及双侧颈部）\nC. 单纯根治性放疗（鼻咽及双侧颈部）\nD. 诱导化疗序贯同期放化疗（鼻咽及双侧颈部）\nE. 鼻咽原发灶切除术联合术后辅助放疗\nF. 靶向治疗联合单纯根治性放疗（鼻咽及双侧颈部）\nG. 免疫治疗联合单纯根治性放疗（鼻咽及双侧颈部）\nH. 诱导化疗联合免疫治疗序贯同期放化疗\nI. 单纯根治性放疗（仅照射鼻咽及右侧颈部）\nJ. 姑息性全身化疗联合鼻咽局部减症放疗\nK. 诱导化疗后肿瘤退缩情况决定是否行根治性放疗\nL. 同期放化疗序贯全身辅助化疗\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-f6df1555c3bac7ae4b972cd4","patient_id":"patient-7c0941dbdd4694260fd4de38","turn_id":"turn05","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"D","gold_action":"继续当前根治性放疗计划，定期常规监测血象及生化。","options":[{"letter":"A","text":"继续放疗，加用多烯磷脂酰胆碱等保肝药物。","is_gold":false},{"letter":"B","text":"继续放疗，皮下注射重组人粒细胞刺激因子。","is_gold":false},{"letter":"C","text":"暂停放疗，完善超声心动图及动态心电图检查。","is_gold":false},{"letter":"D","text":"继续根治性放疗计划，定期常规监测血象及生化。","is_gold":true},{"letter":"E","text":"继续放疗，加用阿托伐他汀等降脂药物。","is_gold":false},{"letter":"F","text":"继续放疗，给予静脉补液及利尿治疗。","is_gold":false},{"letter":"G","text":"暂停放疗，静脉滴注广谱抗生素抗感染治疗。","is_gold":false},{"letter":"H","text":"继续放疗，口服头孢类抗生素及促排痰药物。","is_gold":false},{"letter":"I","text":"继续放疗，静脉滴注地塞米松及甘露醇。","is_gold":false},{"letter":"J","text":"调整放疗计划，降低右侧中耳及乳突区的照射剂量。","is_gold":false},{"letter":"K","text":"继续放疗，皮下注射促红细胞生成素。","is_gold":false},{"letter":"L","text":"暂停放疗，行鼻内镜下鼓膜穿刺置管引流术。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、口咽。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 反复右中耳积液半年余。；现病史: 简要入院病史:患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；阳性症状体征:；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史: 吸烟2包/日×20年，否认疫区接触史，否认冶游史，否认嗜酒。；家族史: 无特殊。；体格检查:；专科检查:；KPS: 90；ECOG:\n- [时间未明] 门急诊记录: 主诉: 反复右中耳积液半年余。；现病史: 患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史:；家族史: 无特殊。；体格检查: KPS90分，DG4.0cm，鼻咽右侧隆突肿物，接近右侧后鼻孔，双颈未触及肿大淋巴结，颅神经检查阴性，心肺腹未及异常，全身骨无压痛。\n- [全程D24] 入院记录: 主诉: 反复右中耳积液半年余。；现病史: 简要入院病史:患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。后来我院，我院病理示未分化非角化性癌。我院鼻咽+颈部MR：鼻咽部肿物，考虑鼻咽癌。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；阳性症状体征:；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史: 吸烟2包/日×20年，否认疫区接触史，否认冶游史，否认嗜酒。；家族史: 无特殊。；体格检查:；专科检查:；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D8] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽右侧咽隐窝区软组织影放射性浓聚，SUV41.8，病灶侵犯右腭帆肌群、右头长肌，病灶与蝶骨基底部右份及右翼突内板分界不清。右咽旁间隙变浅，右咽隐窝消失，左侧咽隐窝未见明显异常。口咽及喉咽结构及放射性分布未见明显异常。双侧上颌窦低密度影放射性分布未见异常；额窦、蝶窦、筛窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双颈多个小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 右中肺小片状影放射性分布未见异常；余双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏弥漫性密度减低，CT值约46Hu（脾脏CT值约58Hu），形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 盆腔放射性分布均匀，膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 右乳突气房内低密度影放射性分布未见异常；余颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽右咽隐窝病灶代谢活跃，符合鼻咽癌，病灶疑累及蝶骨基底部右份及右翼突内板。 双上颌窦炎症；右乳突炎症。 右中肺小片状影代谢未见异常，考虑增殖灶。 轻度脂肪肝。\n- [全程D8] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 早期复极改变 其余未见异常\n- [全程D8] 检验组合: 红细胞计数(RBC#)-静脉血: 5.2310E12/L；血液二氧化碳含量ctCO2(B)-静脉血: 25mmol/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.766COI；血小板分布宽度(PDW)-静脉血: 16.4%；单核细胞百分比(Mono%)-静脉血: 0.077；红细胞比容(Hct)-静脉血: 48.4%；凝血酶时间(TT)-静脉血: 19.8sec.；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 32.8U/L；凝血酶原时间(PT)-静脉血: 9.9sec.；淋巴细胞计数(Lymph#)-静脉血: 2.310E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.025；白蛋白(ALB)-静脉血: 46g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.61；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.08；胱抑素(Cys-C)-静脉血: 0.98mg/L；尿素氮(BUN)-静脉血: 5.5mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.597；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 6.1umolL；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；碱性磷酸酶(ALP)-静脉血: 60.9U/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 0.006COI；C-反应蛋白(CRP)-静脉血: 1.86mg/L；Rh血型-静脉血: 阳性；总钙(Ca)-静脉血: 2.14mmol/L；总胆汁酸(TBA)-静脉血: 8.3umol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.1ug/ml；丙氨酸氨基转移酶(ALT)-静脉血: 46.9U/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；氯离子(Cl-)-静脉血: 104.3mmol/L；低密度脂蛋白胆固醇……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D9] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁明显增厚，右侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描强化较明显。左侧咽隐窝存在。肿块累及右侧口咽壁。 右侧咽旁脂肪间隙变窄；左侧咽旁间隙未见明显狭窄。右侧腭帆张提肌受侵，左侧腭帆张提肌、双侧头长肌、双侧翼内外肌未见受侵。 鼻腔内未见肿物。 双侧翼腭窝、双侧上颌后脂肪间隙及咀嚼肌间隙未见异常。 颅底骨质信号均匀，增强扫描未见异常强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧上颌窦内见囊性灶，最大长径约27mm，边界清，无强化。右侧乳突见分泌物。左乳突充气良好，骨壁完整。 右侧咽后见一肿大淋巴结，大小约6mm×9mm，增强扫描明显强化。左侧咽后未见肿大淋巴结。颈部双侧见多个小淋巴结，最大者约8mm×11mm，未见坏死及包膜外侵。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。 扫描范围脑实质信号未见异常。；检查结论: 鼻咽肿物，考虑鼻咽癌。 颅底骨质未见破坏。 右侧咽后肿大淋巴结，考虑转移。 颈部小淋巴结。 双侧上颌窦囊肿，右侧乳突炎。\n- [全程D13] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见: 双颈II区可见几个小淋巴结，最大约11mm×4mm（右），12mm×5mm（左），边界清，椭圆形，皮髓质分界清，淋巴门可见。 CDFI:上述淋巴结内可见点状血流信号。 双侧颈部淋巴结穿刺活检： （1）右侧颈部淋巴结穿刺活检：常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以16G穿刺针穿刺入右颈淋巴结内，进针2次，取出长约0.5-1cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。 （2）左侧颈部淋巴结穿刺活检：常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以18G穿刺针穿刺入左颈淋巴结内，进针2次，取出长约0.8-1cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。；检查结论: 双侧颈部淋巴结穿刺活检。 不适随诊。 4个工作日后凭发票到2号楼6楼病理科取结果。\n- [全程D28] 检验组合: 总蛋白(TP)-静脉血: 67.97g/L；总胆红素(TBIL)-静脉血: 13.8umol/L；载脂蛋白B(apoB)-静脉血: 1.32g/L；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.99mmolL；大血小板百分比(P-LCR%)-静脉血: 25.7%；球蛋白(GLO)-静脉血: 23.97g/L；总钙(Ca)-静脉血: 2.26mmol/L；红细胞比容(Hct)-静脉血: 46.8%；血小板计数(PLT#)-静脉血: 20110E9/L；磷(P)-静脉血: 1.5mmol/L；血小板比容-静脉血: 20%；肌酐(Crea)-静脉血: 84.5umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.3；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；总胆汁酸(TBA)-静脉血: 3.5umol/L；钾离子(K+)-静脉血: 4mmol/L；C-反应蛋白(CRP)-静脉血: 2.01mg/L；间接胆红素(IBIL)-静脉血: 9.7umolL；胱抑素(Cys-C)-静脉血: 1.04mg/L；尿素氮(BUN)-静脉血: 6.93mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.6；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.11mmol/L；碱性磷酸酶(ALP)-静脉血: 50.9U/L；平均红细胞体积(MCV)-静脉血: 91.4fL；单核细胞计数(Mono#)-静脉血: 0.710E9/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；单核细胞百分比(Mono%)-静脉血: 0.081；红细胞计数(RBC#)-静脉血: 5.1210E12/L；白细胞计数(WBC#)-静脉血: 8.4210E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；平均血小板体积(MPV)-静脉血: 10.2fL；总胆固醇(TC)-静脉血: 5.98mmol/L；血红蛋白(Hb)-静脉血: 159g/L；直接胆红素(DBIL)-静脉血: 4.1umol/L；氯离子(Cl-)-静脉血: 105.9mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 340g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D27] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗1次，无特殊主诉。Rx：1.继续放疗。2.定期复查血常规等。3.对症支持。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 继续放疗，加用多烯磷脂酰胆碱等保肝药物。\nB. 继续放疗，皮下注射重组人粒细胞刺激因子。\nC. 暂停放疗，完善超声心动图及动态心电图检查。\nD. 继续根治性放疗计划，定期常规监测血象及生化。\nE. 继续放疗，加用阿托伐他汀等降脂药物。\nF. 继续放疗，给予静脉补液及利尿治疗。\nG. 暂停放疗，静脉滴注广谱抗生素抗感染治疗。\nH. 继续放疗，口服头孢类抗生素及促排痰药物。\nI. 继续放疗，静脉滴注地塞米松及甘露醇。\nJ. 调整放疗计划，降低右侧中耳及乳突区的照射剂量。\nK. 继续放疗，皮下注射促红细胞生成素。\nL. 暂停放疗，行鼻内镜下鼓膜穿刺置管引流术。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D28] 检验组合: 总蛋白(TP)-静脉血: 67.97g/L；总胆红素(TBIL)-静脉血: 13.8umol/L；载脂蛋白B(apoB)-静脉血: 1.32g/L；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.99mmolL；大血小板百分比(P-LCR%)-静脉血: 25.7%；球蛋白(GLO)-静脉血: 23.97g/L；总钙(Ca)-静脉血: 2.26mmol/L；红细胞比容(Hct)-静脉血: 46.8%；血小板计数(PLT#)-静脉血: 20110E9/L；磷(P)-静脉血: 1.5mmol/L；血小板比容-静脉血: 20%；肌酐(Crea)-静脉血: 84.5umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.3；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；总胆汁酸(TBA)-静脉血: 3.5umol/L；钾离子(K+)-静脉血: 4mmol/L；C-反应蛋白(CRP)-静脉血: 2.01mg/L；间接胆红素(IBIL)-静脉血: 9.7umolL；胱抑素(Cys-C)-静脉血: 1.04mg/L；尿素氮(BUN)-静脉血: 6.93mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.6；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.11mmol/L；碱性磷酸酶(ALP)-静脉血: 50.9U/L；平均红细胞体积(MCV)-静脉血: 91.4fL；单核细胞计数(Mono#)-静脉血: 0.710E9/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；单核细胞百分比(Mono%)-静脉血: 0.081；红细胞计数(RBC#)-静脉血: 5.1210E12/L；白细胞计数(WBC#)-静脉血: 8.4210E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；平均血小板体积(MPV)-静脉血: 10.2fL；总胆固醇(TC)-静脉血: 5.98mmol/L；血红蛋白(Hb)-静脉血: 159g/L；直接胆红素(DBIL)-静脉血: 4.1umol/L；氯离子(Cl-)-静脉血: 105.9mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 340g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D27] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗1次，无特殊主诉。Rx：1.继续放疗。2.定期复查血常规等。3.对症支持。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 继续放疗，加用多烯磷脂酰胆碱等保肝药物。\nB. 继续放疗，皮下注射重组人粒细胞刺激因子。\nC. 暂停放疗，完善超声心动图及动态心电图检查。\nD. 继续根治性放疗计划，定期常规监测血象及生化。\nE. 继续放疗，加用阿托伐他汀等降脂药物。\nF. 继续放疗，给予静脉补液及利尿治疗。\nG. 暂停放疗，静脉滴注广谱抗生素抗感染治疗。\nH. 继续放疗，口服头孢类抗生素及促排痰药物。\nI. 继续放疗，静脉滴注地塞米松及甘露醇。\nJ. 调整放疗计划，降低右侧中耳及乳突区的照射剂量。\nK. 继续放疗，皮下注射促红细胞生成素。\nL. 暂停放疗，行鼻内镜下鼓膜穿刺置管引流术。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、口咽。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D28] 检验组合: 总蛋白(TP)-静脉血: 67.97g/L；总胆红素(TBIL)-静脉血: 13.8umol/L；载脂蛋白B(apoB)-静脉血: 1.32g/L；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.99mmolL；大血小板百分比(P-LCR%)-静脉血: 25.7%；球蛋白(GLO)-静脉血: 23.97g/L；总钙(Ca)-静脉血: 2.26mmol/L；红细胞比容(Hct)-静脉血: 46.8%；血小板计数(PLT#)-静脉血: 20110E9/L；磷(P)-静脉血: 1.5mmol/L；血小板比容-静脉血: 20%；肌酐(Crea)-静脉血: 84.5umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.3；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；总胆汁酸(TBA)-静脉血: 3.5umol/L；钾离子(K+)-静脉血: 4mmol/L；C-反应蛋白(CRP)-静脉血: 2.01mg/L；间接胆红素(IBIL)-静脉血: 9.7umolL；胱抑素(Cys-C)-静脉血: 1.04mg/L；尿素氮(BUN)-静脉血: 6.93mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.6；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.11mmol/L；碱性磷酸酶(ALP)-静脉血: 50.9U/L；平均红细胞体积(MCV)-静脉血: 91.4fL；单核细胞计数(Mono#)-静脉血: 0.710E9/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；单核细胞百分比(Mono%)-静脉血: 0.081；红细胞计数(RBC#)-静脉血: 5.1210E12/L；白细胞计数(WBC#)-静脉血: 8.4210E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；平均血小板体积(MPV)-静脉血: 10.2fL；总胆固醇(TC)-静脉血: 5.98mmol/L；血红蛋白(Hb)-静脉血: 159g/L；直接胆红素(DBIL)-静脉血: 4.1umol/L；氯离子(Cl-)-静脉血: 105.9mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 340g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D27] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗1次，无特殊主诉。Rx：1.继续放疗。2.定期复查血常规等。3.对症支持。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 继续放疗，加用多烯磷脂酰胆碱等保肝药物。\nB. 继续放疗，皮下注射重组人粒细胞刺激因子。\nC. 暂停放疗，完善超声心动图及动态心电图检查。\nD. 继续根治性放疗计划，定期常规监测血象及生化。\nE. 继续放疗，加用阿托伐他汀等降脂药物。\nF. 继续放疗，给予静脉补液及利尿治疗。\nG. 暂停放疗，静脉滴注广谱抗生素抗感染治疗。\nH. 继续放疗，口服头孢类抗生素及促排痰药物。\nI. 继续放疗，静脉滴注地塞米松及甘露醇。\nJ. 调整放疗计划，降低右侧中耳及乳突区的照射剂量。\nK. 继续放疗，皮下注射促红细胞生成素。\nL. 暂停放疗，行鼻内镜下鼓膜穿刺置管引流术。\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-f1eec05ca151dc9bde0f1f55","patient_id":"patient-7c0941dbdd4694260fd4de38","turn_id":"turn06","turn_position":5,"turn_type":"toxicity_or_support_decision","gold_letter":"E","gold_action":"继续调强放疗，给予局部含漱等对症处理，定期复查血常规及生化。","options":[{"letter":"A","text":"暂停调强放疗，待口腔黏膜炎恢复至Ⅰ度后恢复放疗，期间加强静脉营养支持。","is_gold":false},{"letter":"B","text":"继续调强放疗，加用全身静脉广谱抗生素，定期复查血常规及生化。","is_gold":false},{"letter":"C","text":"继续调强放疗，降低单次靶区照射剂量，给予局部含漱等对症处理。","is_gold":false},{"letter":"D","text":"继续调强放疗，加用静脉糖皮质激素，定期复查血常规及生化。","is_gold":false},{"letter":"E","text":"继续调强放疗，给予局部含漱等对症处理，定期复查血常规及生化。","is_gold":true},{"letter":"F","text":"暂停调强放疗，加用全身抗真菌药物，待黏膜白膜消退后恢复放疗。","is_gold":false},{"letter":"G","text":"继续调强放疗，加用顺铂单药同步化疗，给予局部含漱等对症处理。","is_gold":false},{"letter":"H","text":"继续调强放疗，给予重组人粒细胞刺激因子皮下注射，定期复查血常规。","is_gold":false},{"letter":"I","text":"暂停调强放疗，行鼻咽黏膜活检明确白膜性质，给予局部含漱等对症处理。","is_gold":false},{"letter":"J","text":"继续调强放疗，加用尼妥珠单抗靶向治疗，给予局部含漱等对症处理。","is_gold":false},{"letter":"K","text":"终止根治性放疗，转为姑息性放疗，加强镇痛及口腔局部护理。","is_gold":false},{"letter":"L","text":"继续调强放疗，预防性留置胃管，给予局部含漱等对症处理。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、口咽。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 反复右中耳积液半年余。；现病史: 简要入院病史:患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；阳性症状体征:；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史: 吸烟2包/日×20年，否认疫区接触史，否认冶游史，否认嗜酒。；家族史: 无特殊。；体格检查:；专科检查:；KPS: 90；ECOG:\n- [时间未明] 门急诊记录: 主诉: 反复右中耳积液半年余。；现病史: 患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史:；家族史: 无特殊。；体格检查: KPS90分，DG4.0cm，鼻咽右侧隆突肿物，接近右侧后鼻孔，双颈未触及肿大淋巴结，颅神经检查阴性，心肺腹未及异常，全身骨无压痛。\n- [全程D24] 入院记录: 主诉: 反复右中耳积液半年余。；现病史: 简要入院病史:患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。后来我院，我院病理示未分化非角化性癌。我院鼻咽+颈部MR：鼻咽部肿物，考虑鼻咽癌。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；阳性症状体征:；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史: 吸烟2包/日×20年，否认疫区接触史，否认冶游史，否认嗜酒。；家族史: 无特殊。；体格检查:；专科检查:；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D8] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽右侧咽隐窝区软组织影放射性浓聚，SUV41.8，病灶侵犯右腭帆肌群、右头长肌，病灶与蝶骨基底部右份及右翼突内板分界不清。右咽旁间隙变浅，右咽隐窝消失，左侧咽隐窝未见明显异常。口咽及喉咽结构及放射性分布未见明显异常。双侧上颌窦低密度影放射性分布未见异常；额窦、蝶窦、筛窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双颈多个小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 右中肺小片状影放射性分布未见异常；余双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏弥漫性密度减低，CT值约46Hu（脾脏CT值约58Hu），形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 盆腔放射性分布均匀，膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 右乳突气房内低密度影放射性分布未见异常；余颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽右咽隐窝病灶代谢活跃，符合鼻咽癌，病灶疑累及蝶骨基底部右份及右翼突内板。 双上颌窦炎症；右乳突炎症。 右中肺小片状影代谢未见异常，考虑增殖灶。 轻度脂肪肝。\n- [全程D8] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 早期复极改变 其余未见异常\n- [全程D8] 检验组合: 红细胞计数(RBC#)-静脉血: 5.2310E12/L；血液二氧化碳含量ctCO2(B)-静脉血: 25mmol/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.766COI；血小板分布宽度(PDW)-静脉血: 16.4%；单核细胞百分比(Mono%)-静脉血: 0.077；红细胞比容(Hct)-静脉血: 48.4%；凝血酶时间(TT)-静脉血: 19.8sec.；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 32.8U/L；凝血酶原时间(PT)-静脉血: 9.9sec.；淋巴细胞计数(Lymph#)-静脉血: 2.310E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.025；白蛋白(ALB)-静脉血: 46g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.61；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.08；胱抑素(Cys-C)-静脉血: 0.98mg/L；尿素氮(BUN)-静脉血: 5.5mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.597；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 6.1umolL；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；碱性磷酸酶(ALP)-静脉血: 60.9U/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 0.006COI；C-反应蛋白(CRP)-静脉血: 1.86mg/L；Rh血型-静脉血: 阳性；总钙(Ca)-静脉血: 2.14mmol/L；总胆汁酸(TBA)-静脉血: 8.3umol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.1ug/ml；丙氨酸氨基转移酶(ALT)-静脉血: 46.9U/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；氯离子(Cl-)-静脉血: 104.3mmol/L；低密度脂蛋白胆固醇……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D9] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁明显增厚，右侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描强化较明显。左侧咽隐窝存在。肿块累及右侧口咽壁。 右侧咽旁脂肪间隙变窄；左侧咽旁间隙未见明显狭窄。右侧腭帆张提肌受侵，左侧腭帆张提肌、双侧头长肌、双侧翼内外肌未见受侵。 鼻腔内未见肿物。 双侧翼腭窝、双侧上颌后脂肪间隙及咀嚼肌间隙未见异常。 颅底骨质信号均匀，增强扫描未见异常强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧上颌窦内见囊性灶，最大长径约27mm，边界清，无强化。右侧乳突见分泌物。左乳突充气良好，骨壁完整。 右侧咽后见一肿大淋巴结，大小约6mm×9mm，增强扫描明显强化。左侧咽后未见肿大淋巴结。颈部双侧见多个小淋巴结，最大者约8mm×11mm，未见坏死及包膜外侵。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。 扫描范围脑实质信号未见异常。；检查结论: 鼻咽肿物，考虑鼻咽癌。 颅底骨质未见破坏。 右侧咽后肿大淋巴结，考虑转移。 颈部小淋巴结。 双侧上颌窦囊肿，右侧乳突炎。\n- [全程D13] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见: 双颈II区可见几个小淋巴结，最大约11mm×4mm（右），12mm×5mm（左），边界清，椭圆形，皮髓质分界清，淋巴门可见。 CDFI:上述淋巴结内可见点状血流信号。 双侧颈部淋巴结穿刺活检： （1）右侧颈部淋巴结穿刺活检：常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以16G穿刺针穿刺入右颈淋巴结内，进针2次，取出长约0.5-1cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。 （2）左侧颈部淋巴结穿刺活检：常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以18G穿刺针穿刺入左颈淋巴结内，进针2次，取出长约0.8-1cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。；检查结论: 双侧颈部淋巴结穿刺活检。 不适随诊。 4个工作日后凭发票到2号楼6楼病理科取结果。\n- [全程D28] 检验组合: 总蛋白(TP)-静脉血: 67.97g/L；总胆红素(TBIL)-静脉血: 13.8umol/L；载脂蛋白B(apoB)-静脉血: 1.32g/L；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.99mmolL；大血小板百分比(P-LCR%)-静脉血: 25.7%；球蛋白(GLO)-静脉血: 23.97g/L；总钙(Ca)-静脉血: 2.26mmol/L；红细胞比容(Hct)-静脉血: 46.8%；血小板计数(PLT#)-静脉血: 20110E9/L；磷(P)-静脉血: 1.5mmol/L；血小板比容-静脉血: 20%；肌酐(Crea)-静脉血: 84.5umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.3；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；总胆汁酸(TBA)-静脉血: 3.5umol/L；钾离子(K+)-静脉血: 4mmol/L；C-反应蛋白(CRP)-静脉血: 2.01mg/L；间接胆红素(IBIL)-静脉血: 9.7umolL；胱抑素(Cys-C)-静脉血: 1.04mg/L；尿素氮(BUN)-静脉血: 6.93mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.6；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.11mmol/L；碱性磷酸酶(ALP)-静脉血: 50.9U/L；平均红细胞体积(MCV)-静脉血: 91.4fL；单核细胞计数(Mono#)-静脉血: 0.710E9/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；单核细胞百分比(Mono%)-静脉血: 0.081；红细胞计数(RBC#)-静脉血: 5.1210E12/L；白细胞计数(WBC#)-静脉血: 8.4210E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；平均血小板体积(MPV)-静脉血: 10.2fL；总胆固醇(TC)-静脉血: 5.98mmol/L；血红蛋白(Hb)-静脉血: 159g/L；直接胆红素(DBIL)-静脉血: 4.1umol/L；氯离子(Cl-)-静脉血: 105.9mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 340g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0……\n- [全程D36] 检验组合: 血小板比容-静脉血: 21%；红细胞计数(RBC#)-静脉血: 5.3510E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 327g/L；血小板计数(PLT#)-静脉血: 20710E9/L；大血小板百分比(P-LCR%)-静脉血: 25.9%；单核细胞计数(Mono#)-静脉血: 0.410E9/L；白细胞计数(WBC#)-静脉血: 5.9110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.654；血小板分布宽度(PDW)-静脉血: 11.9%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4；红细胞比容(Hct)-静脉血: 49.8%；单核细胞百分比(Mono%)-静脉血: 0.059；平均血小板体积(MPV)-静脉血: 10.1fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.9；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.262；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.022；平均红细胞体积(MCV)-静脉血: 93.1fL；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；血红蛋白(Hb)-静脉血: 163g/L\n- [全程D41] 检验组合: 红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.3%；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；血小板比容-静脉血: 15.7%；γ-谷氨酰基转移酶(GGT)-静脉血: 29.2U/L；红细胞计数(RBC#)-静脉血: 4.9510E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.024；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 338.3g/L；钠离子(Na+)-静脉血: 141.9mmol/L；单核细胞百分比(Mono%)-静脉血: 0.068；尿酸(UA)-静脉血: 478.3umol/L；钾离子(K+)-静脉血: 4.3mmol/L；间接胆红素(IBIL)-静脉血: 16.8umolL；乳酸脱氢酶(LDH)-静脉血: 152.4U/L；平均红细胞体积(MCV)-静脉血: 91.7fL；碱性磷酸酶(ALP)-静脉血: 56.1U/L；白蛋白(ALB)-静脉血: 45.9g/L；白细胞计数(WBC#)-静脉血: 8.1810E9/L；葡萄糖(Glu)-静脉血: 4.49mmol/L；阴离子间隙(AG)-静脉血: 17；血小板计数(PLT#)-静脉血: 193.210E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；总蛋白(TP)-静脉血: 70.66g/L；总钙(Ca)-静脉血: 2.29mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.9；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；中性粒细胞计数(Neut#)-静脉血: 610E9/L；胱抑素(Cys-C)-静脉血: 0.96mg/L；C-反应蛋白(CRP)-静脉血: 5.9mg/L；载脂蛋白B(apoB)-静脉血: 1.37g/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.5mmol/L；红细胞比容(Hct)-静脉血: 45.4%；丙氨酸氨基转移酶(ALT)-静脉血: 37.9U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.77mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 25.2U/……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D27] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗1次，无特殊主诉。Rx：1.继续放疗。2.定期复查血常规等。3.对症支持。\n- [全程D34] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗6次，无特殊主诉。复查血常规、生化未见明显异常。Rx：1.继续放疗。2.定期复查血常规等。3.对症支持。\n- [全程D41] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗11次，无特殊主诉。查体见鼻咽顶壁、右顶侧壁可见多个小结节，较前有所缩小，粘膜可见小片状白膜，双颈淋巴结未触及肿大，颅神经检查阴性，全身骨无压痛。和11-10复查血常规、血生化均未见明显异常。皮肤反应：0 Rx：1.继续放疗。粘膜反应：Ⅱ° 2.定期复查血常规等。3.对症支持。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停调强放疗，待口腔黏膜炎恢复至Ⅰ度后恢复放疗，期间加强静脉营养支持。\nB. 继续调强放疗，加用全身静脉广谱抗生素，定期复查血常规及生化。\nC. 继续调强放疗，降低单次靶区照射剂量，给予局部含漱等对症处理。\nD. 继续调强放疗，加用静脉糖皮质激素，定期复查血常规及生化。\nE. 继续调强放疗，给予局部含漱等对症处理，定期复查血常规及生化。\nF. 暂停调强放疗，加用全身抗真菌药物，待黏膜白膜消退后恢复放疗。\nG. 继续调强放疗，加用顺铂单药同步化疗，给予局部含漱等对症处理。\nH. 继续调强放疗，给予重组人粒细胞刺激因子皮下注射，定期复查血常规。\nI. 暂停调强放疗，行鼻咽黏膜活检明确白膜性质，给予局部含漱等对症处理。\nJ. 继续调强放疗，加用尼妥珠单抗靶向治疗，给予局部含漱等对症处理。\nK. 终止根治性放疗，转为姑息性放疗，加强镇痛及口腔局部护理。\nL. 继续调强放疗，预防性留置胃管，给予局部含漱等对症处理。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D36] 检验组合: 血小板比容-静脉血: 21%；红细胞计数(RBC#)-静脉血: 5.3510E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 327g/L；血小板计数(PLT#)-静脉血: 20710E9/L；大血小板百分比(P-LCR%)-静脉血: 25.9%；单核细胞计数(Mono#)-静脉血: 0.410E9/L；白细胞计数(WBC#)-静脉血: 5.9110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.654；血小板分布宽度(PDW)-静脉血: 11.9%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4；红细胞比容(Hct)-静脉血: 49.8%；单核细胞百分比(Mono%)-静脉血: 0.059；平均血小板体积(MPV)-静脉血: 10.1fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.9；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.262；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.022；平均红细胞体积(MCV)-静脉血: 93.1fL；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；血红蛋白(Hb)-静脉血: 163g/L\n- [全程D41] 检验组合: 红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.3%；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；血小板比容-静脉血: 15.7%；γ-谷氨酰基转移酶(GGT)-静脉血: 29.2U/L；红细胞计数(RBC#)-静脉血: 4.9510E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.024；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 338.3g/L；钠离子(Na+)-静脉血: 141.9mmol/L；单核细胞百分比(Mono%)-静脉血: 0.068；尿酸(UA)-静脉血: 478.3umol/L；钾离子(K+)-静脉血: 4.3mmol/L；间接胆红素(IBIL)-静脉血: 16.8umolL；乳酸脱氢酶(LDH)-静脉血: 152.4U/L；平均红细胞体积(MCV)-静脉血: 91.7fL；碱性磷酸酶(ALP)-静脉血: 56.1U/L；白蛋白(ALB)-静脉血: 45.9g/L；白细胞计数(WBC#)-静脉血: 8.1810E9/L；葡萄糖(Glu)-静脉血: 4.49mmol/L；阴离子间隙(AG)-静脉血: 17；血小板计数(PLT#)-静脉血: 193.210E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；总蛋白(TP)-静脉血: 70.66g/L；总钙(Ca)-静脉血: 2.29mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.9；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；中性粒细胞计数(Neut#)-静脉血: 610E9/L；胱抑素(Cys-C)-静脉血: 0.96mg/L；C-反应蛋白(CRP)-静脉血: 5.9mg/L；载脂蛋白B(apoB)-静脉血: 1.37g/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.5mmol/L；红细胞比容(Hct)-静脉血: 45.4%；丙氨酸氨基转移酶(ALT)-静脉血: 37.9U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.77mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 25.2U/……\n\n【既往治疗与反应】\n- [全程D34] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗6次，无特殊主诉。复查血常规、生化未见明显异常。Rx：1.继续放疗。2.定期复查血常规等。3.对症支持。\n- [全程D41] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗11次，无特殊主诉。查体见鼻咽顶壁、右顶侧壁可见多个小结节，较前有所缩小，粘膜可见小片状白膜，双颈淋巴结未触及肿大，颅神经检查阴性，全身骨无压痛。和11-10复查血常规、血生化均未见明显异常。皮肤反应：0 Rx：1.继续放疗。粘膜反应：Ⅱ° 2.定期复查血常规等。3.对症支持。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停调强放疗，待口腔黏膜炎恢复至Ⅰ度后恢复放疗，期间加强静脉营养支持。\nB. 继续调强放疗，加用全身静脉广谱抗生素，定期复查血常规及生化。\nC. 继续调强放疗，降低单次靶区照射剂量，给予局部含漱等对症处理。\nD. 继续调强放疗，加用静脉糖皮质激素，定期复查血常规及生化。\nE. 继续调强放疗，给予局部含漱等对症处理，定期复查血常规及生化。\nF. 暂停调强放疗，加用全身抗真菌药物，待黏膜白膜消退后恢复放疗。\nG. 继续调强放疗，加用顺铂单药同步化疗，给予局部含漱等对症处理。\nH. 继续调强放疗，给予重组人粒细胞刺激因子皮下注射，定期复查血常规。\nI. 暂停调强放疗，行鼻咽黏膜活检明确白膜性质，给予局部含漱等对症处理。\nJ. 继续调强放疗，加用尼妥珠单抗靶向治疗，给予局部含漱等对症处理。\nK. 终止根治性放疗，转为姑息性放疗，加强镇痛及口腔局部护理。\nL. 继续调强放疗，预防性留置胃管，给予局部含漱等对症处理。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、口咽。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D36] 检验组合: 血小板比容-静脉血: 21%；红细胞计数(RBC#)-静脉血: 5.3510E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 327g/L；血小板计数(PLT#)-静脉血: 20710E9/L；大血小板百分比(P-LCR%)-静脉血: 25.9%；单核细胞计数(Mono#)-静脉血: 0.410E9/L；白细胞计数(WBC#)-静脉血: 5.9110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.654；血小板分布宽度(PDW)-静脉血: 11.9%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4；红细胞比容(Hct)-静脉血: 49.8%；单核细胞百分比(Mono%)-静脉血: 0.059；平均血小板体积(MPV)-静脉血: 10.1fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.9；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.262；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.022；平均红细胞体积(MCV)-静脉血: 93.1fL；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；血红蛋白(Hb)-静脉血: 163g/L\n- [全程D41] 检验组合: 红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.3%；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；血小板比容-静脉血: 15.7%；γ-谷氨酰基转移酶(GGT)-静脉血: 29.2U/L；红细胞计数(RBC#)-静脉血: 4.9510E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.024；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 338.3g/L；钠离子(Na+)-静脉血: 141.9mmol/L；单核细胞百分比(Mono%)-静脉血: 0.068；尿酸(UA)-静脉血: 478.3umol/L；钾离子(K+)-静脉血: 4.3mmol/L；间接胆红素(IBIL)-静脉血: 16.8umolL；乳酸脱氢酶(LDH)-静脉血: 152.4U/L；平均红细胞体积(MCV)-静脉血: 91.7fL；碱性磷酸酶(ALP)-静脉血: 56.1U/L；白蛋白(ALB)-静脉血: 45.9g/L；白细胞计数(WBC#)-静脉血: 8.1810E9/L；葡萄糖(Glu)-静脉血: 4.49mmol/L；阴离子间隙(AG)-静脉血: 17；血小板计数(PLT#)-静脉血: 193.210E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；总蛋白(TP)-静脉血: 70.66g/L；总钙(Ca)-静脉血: 2.29mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.9；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；中性粒细胞计数(Neut#)-静脉血: 610E9/L；胱抑素(Cys-C)-静脉血: 0.96mg/L；C-反应蛋白(CRP)-静脉血: 5.9mg/L；载脂蛋白B(apoB)-静脉血: 1.37g/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.5mmol/L；红细胞比容(Hct)-静脉血: 45.4%；丙氨酸氨基转移酶(ALT)-静脉血: 37.9U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.77mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 25.2U/……\n\n【既往治疗与反应】\n- [全程D34] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗6次，无特殊主诉。复查血常规、生化未见明显异常。Rx：1.继续放疗。2.定期复查血常规等。3.对症支持。\n- [全程D41] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗11次，无特殊主诉。查体见鼻咽顶壁、右顶侧壁可见多个小结节，较前有所缩小，粘膜可见小片状白膜，双颈淋巴结未触及肿大，颅神经检查阴性，全身骨无压痛。和11-10复查血常规、血生化均未见明显异常。皮肤反应：0 Rx：1.继续放疗。粘膜反应：Ⅱ° 2.定期复查血常规等。3.对症支持。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停调强放疗，待口腔黏膜炎恢复至Ⅰ度后恢复放疗，期间加强静脉营养支持。\nB. 继续调强放疗，加用全身静脉广谱抗生素，定期复查血常规及生化。\nC. 继续调强放疗，降低单次靶区照射剂量，给予局部含漱等对症处理。\nD. 继续调强放疗，加用静脉糖皮质激素，定期复查血常规及生化。\nE. 继续调强放疗，给予局部含漱等对症处理，定期复查血常规及生化。\nF. 暂停调强放疗，加用全身抗真菌药物，待黏膜白膜消退后恢复放疗。\nG. 继续调强放疗，加用顺铂单药同步化疗，给予局部含漱等对症处理。\nH. 继续调强放疗，给予重组人粒细胞刺激因子皮下注射，定期复查血常规。\nI. 暂停调强放疗，行鼻咽黏膜活检明确白膜性质，给予局部含漱等对症处理。\nJ. 继续调强放疗，加用尼妥珠单抗靶向治疗，给予局部含漱等对症处理。\nK. 终止根治性放疗，转为姑息性放疗，加强镇痛及口腔局部护理。\nL. 继续调强放疗，预防性留置胃管，给予局部含漱等对症处理。\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-be3624e29a98e9da91fced75","patient_id":"patient-7c0941dbdd4694260fd4de38","turn_id":"turn07","turn_position":6,"turn_type":"recurrence_or_salvage_decision","gold_letter":"F","gold_action":"维持规范随访观察，可根据症状给予一般对症及支持治疗，不启动挽救性局部治疗或全身抗肿瘤治疗。","options":[{"letter":"A","text":"安排鼻咽及颈部活检，准备行挽救性内镜下鼻咽切除术。","is_gold":false},{"letter":"B","text":"启动含铂双药方案全身化疗4-6个周期。","is_gold":false},{"letter":"C","text":"行全身PET/CT评估，若有局部高代谢灶则行挽救性放疗。","is_gold":false},{"letter":"D","text":"予以原发灶及颈部引流区局部推量补照4-6Gy。","is_gold":false},{"letter":"E","text":"给予卡培他滨单药口服维持治疗半年至一年。","is_gold":false},{"letter":"F","text":"维持规范随访观察，可症状给予一般对症及支持治疗。","is_gold":true},{"letter":"G","text":"行鼻咽及颈部MRI增强扫描，若有可疑残留则行诱导化疗。","is_gold":false},{"letter":"H","text":"启动PD-1抑制剂联合含铂双药全身化疗。","is_gold":false},{"letter":"I","text":"安排鼻咽内镜活检，若病理阳性则行双侧颈部淋巴结清扫术。","is_gold":false},{"letter":"J","text":"补充顺铂单药全身化疗2个周期以强化局部控制。","is_gold":false},{"letter":"K","text":"行全身骨扫描及头颅MRI，排除远处转移后行局部挽救性放疗。","is_gold":false},{"letter":"L","text":"予以吉西他滨联合顺铂全身化疗4-6个周期。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、口咽。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 反复右中耳积液半年余。；现病史: 简要入院病史:患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；阳性症状体征:；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史: 吸烟2包/日×20年，否认疫区接触史，否认冶游史，否认嗜酒。；家族史: 无特殊。；体格检查:；专科检查:；KPS: 90；ECOG:\n- [时间未明] 门急诊记录: 主诉: 反复右中耳积液半年余。；现病史: 患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史:；家族史: 无特殊。；体格检查: KPS90分，DG4.0cm，鼻咽右侧隆突肿物，接近右侧后鼻孔，双颈未触及肿大淋巴结，颅神经检查阴性，心肺腹未及异常，全身骨无压痛。\n- [全程D24] 入院记录: 主诉: 反复右中耳积液半年余。；现病史: 简要入院病史:患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。后来我院，我院病理示未分化非角化性癌。我院鼻咽+颈部MR：鼻咽部肿物，考虑鼻咽癌。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；阳性症状体征:；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史: 吸烟2包/日×20年，否认疫区接触史，否认冶游史，否认嗜酒。；家族史: 无特殊。；体格检查:；专科检查:；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D8] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽右侧咽隐窝区软组织影放射性浓聚，SUV41.8，病灶侵犯右腭帆肌群、右头长肌，病灶与蝶骨基底部右份及右翼突内板分界不清。右咽旁间隙变浅，右咽隐窝消失，左侧咽隐窝未见明显异常。口咽及喉咽结构及放射性分布未见明显异常。双侧上颌窦低密度影放射性分布未见异常；额窦、蝶窦、筛窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双颈多个小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 右中肺小片状影放射性分布未见异常；余双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏弥漫性密度减低，CT值约46Hu（脾脏CT值约58Hu），形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 盆腔放射性分布均匀，膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 右乳突气房内低密度影放射性分布未见异常；余颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽右咽隐窝病灶代谢活跃，符合鼻咽癌，病灶疑累及蝶骨基底部右份及右翼突内板。 双上颌窦炎症；右乳突炎症。 右中肺小片状影代谢未见异常，考虑增殖灶。 轻度脂肪肝。\n- [全程D8] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 早期复极改变 其余未见异常\n- [全程D8] 检验组合: 红细胞计数(RBC#)-静脉血: 5.2310E12/L；血液二氧化碳含量ctCO2(B)-静脉血: 25mmol/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.766COI；血小板分布宽度(PDW)-静脉血: 16.4%；单核细胞百分比(Mono%)-静脉血: 0.077；红细胞比容(Hct)-静脉血: 48.4%；凝血酶时间(TT)-静脉血: 19.8sec.；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 32.8U/L；凝血酶原时间(PT)-静脉血: 9.9sec.；淋巴细胞计数(Lymph#)-静脉血: 2.310E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.025；白蛋白(ALB)-静脉血: 46g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.61；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.08；胱抑素(Cys-C)-静脉血: 0.98mg/L；尿素氮(BUN)-静脉血: 5.5mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.597；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 6.1umolL；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；碱性磷酸酶(ALP)-静脉血: 60.9U/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 0.006COI；C-反应蛋白(CRP)-静脉血: 1.86mg/L；Rh血型-静脉血: 阳性；总钙(Ca)-静脉血: 2.14mmol/L；总胆汁酸(TBA)-静脉血: 8.3umol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.1ug/ml；丙氨酸氨基转移酶(ALT)-静脉血: 46.9U/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；氯离子(Cl-)-静脉血: 104.3mmol/L；低密度脂蛋白胆固醇……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D9] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁明显增厚，右侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描强化较明显。左侧咽隐窝存在。肿块累及右侧口咽壁。 右侧咽旁脂肪间隙变窄；左侧咽旁间隙未见明显狭窄。右侧腭帆张提肌受侵，左侧腭帆张提肌、双侧头长肌、双侧翼内外肌未见受侵。 鼻腔内未见肿物。 双侧翼腭窝、双侧上颌后脂肪间隙及咀嚼肌间隙未见异常。 颅底骨质信号均匀，增强扫描未见异常强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧上颌窦内见囊性灶，最大长径约27mm，边界清，无强化。右侧乳突见分泌物。左乳突充气良好，骨壁完整。 右侧咽后见一肿大淋巴结，大小约6mm×9mm，增强扫描明显强化。左侧咽后未见肿大淋巴结。颈部双侧见多个小淋巴结，最大者约8mm×11mm，未见坏死及包膜外侵。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。 扫描范围脑实质信号未见异常。；检查结论: 鼻咽肿物，考虑鼻咽癌。 颅底骨质未见破坏。 右侧咽后肿大淋巴结，考虑转移。 颈部小淋巴结。 双侧上颌窦囊肿，右侧乳突炎。\n- [全程D13] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见: 双颈II区可见几个小淋巴结，最大约11mm×4mm（右），12mm×5mm（左），边界清，椭圆形，皮髓质分界清，淋巴门可见。 CDFI:上述淋巴结内可见点状血流信号。 双侧颈部淋巴结穿刺活检： （1）右侧颈部淋巴结穿刺活检：常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以16G穿刺针穿刺入右颈淋巴结内，进针2次，取出长约0.5-1cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。 （2）左侧颈部淋巴结穿刺活检：常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以18G穿刺针穿刺入左颈淋巴结内，进针2次，取出长约0.8-1cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。；检查结论: 双侧颈部淋巴结穿刺活检。 不适随诊。 4个工作日后凭发票到2号楼6楼病理科取结果。\n- [全程D28] 检验组合: 总蛋白(TP)-静脉血: 67.97g/L；总胆红素(TBIL)-静脉血: 13.8umol/L；载脂蛋白B(apoB)-静脉血: 1.32g/L；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.99mmolL；大血小板百分比(P-LCR%)-静脉血: 25.7%；球蛋白(GLO)-静脉血: 23.97g/L；总钙(Ca)-静脉血: 2.26mmol/L；红细胞比容(Hct)-静脉血: 46.8%；血小板计数(PLT#)-静脉血: 20110E9/L；磷(P)-静脉血: 1.5mmol/L；血小板比容-静脉血: 20%；肌酐(Crea)-静脉血: 84.5umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.3；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；总胆汁酸(TBA)-静脉血: 3.5umol/L；钾离子(K+)-静脉血: 4mmol/L；C-反应蛋白(CRP)-静脉血: 2.01mg/L；间接胆红素(IBIL)-静脉血: 9.7umolL；胱抑素(Cys-C)-静脉血: 1.04mg/L；尿素氮(BUN)-静脉血: 6.93mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.6；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.11mmol/L；碱性磷酸酶(ALP)-静脉血: 50.9U/L；平均红细胞体积(MCV)-静脉血: 91.4fL；单核细胞计数(Mono#)-静脉血: 0.710E9/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；单核细胞百分比(Mono%)-静脉血: 0.081；红细胞计数(RBC#)-静脉血: 5.1210E12/L；白细胞计数(WBC#)-静脉血: 8.4210E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；平均血小板体积(MPV)-静脉血: 10.2fL；总胆固醇(TC)-静脉血: 5.98mmol/L；血红蛋白(Hb)-静脉血: 159g/L；直接胆红素(DBIL)-静脉血: 4.1umol/L；氯离子(Cl-)-静脉血: 105.9mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 340g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0……\n- [全程D36] 检验组合: 血小板比容-静脉血: 21%；红细胞计数(RBC#)-静脉血: 5.3510E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 327g/L；血小板计数(PLT#)-静脉血: 20710E9/L；大血小板百分比(P-LCR%)-静脉血: 25.9%；单核细胞计数(Mono#)-静脉血: 0.410E9/L；白细胞计数(WBC#)-静脉血: 5.9110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.654；血小板分布宽度(PDW)-静脉血: 11.9%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4；红细胞比容(Hct)-静脉血: 49.8%；单核细胞百分比(Mono%)-静脉血: 0.059；平均血小板体积(MPV)-静脉血: 10.1fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.9；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.262；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.022；平均红细胞体积(MCV)-静脉血: 93.1fL；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；血红蛋白(Hb)-静脉血: 163g/L\n- [全程D41] 检验组合: 红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.3%；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；血小板比容-静脉血: 15.7%；γ-谷氨酰基转移酶(GGT)-静脉血: 29.2U/L；红细胞计数(RBC#)-静脉血: 4.9510E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.024；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 338.3g/L；钠离子(Na+)-静脉血: 141.9mmol/L；单核细胞百分比(Mono%)-静脉血: 0.068；尿酸(UA)-静脉血: 478.3umol/L；钾离子(K+)-静脉血: 4.3mmol/L；间接胆红素(IBIL)-静脉血: 16.8umolL；乳酸脱氢酶(LDH)-静脉血: 152.4U/L；平均红细胞体积(MCV)-静脉血: 91.7fL；碱性磷酸酶(ALP)-静脉血: 56.1U/L；白蛋白(ALB)-静脉血: 45.9g/L；白细胞计数(WBC#)-静脉血: 8.1810E9/L；葡萄糖(Glu)-静脉血: 4.49mmol/L；阴离子间隙(AG)-静脉血: 17；血小板计数(PLT#)-静脉血: 193.210E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；总蛋白(TP)-静脉血: 70.66g/L；总钙(Ca)-静脉血: 2.29mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.9；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；中性粒细胞计数(Neut#)-静脉血: 610E9/L；胱抑素(Cys-C)-静脉血: 0.96mg/L；C-反应蛋白(CRP)-静脉血: 5.9mg/L；载脂蛋白B(apoB)-静脉血: 1.37g/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.5mmol/L；红细胞比容(Hct)-静脉血: 45.4%；丙氨酸氨基转移酶(ALT)-静脉血: 37.9U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.77mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 25.2U/……\n- [全程D50] 检验组合: 平均红细胞体积(MCV)-静脉血: 92.2fL；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.727；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.033；血小板计数(PLT#)-静脉血: 15910E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.165；单核细胞百分比(Mono%)-静脉血: 0.073；血红蛋白(Hb)-静脉血: 162g/L；平均血小板体积(MPV)-静脉血: 10.6fL；白细胞计数(WBC#)-静脉血: 4.210E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.9；红细胞计数(RBC#)-静脉血: 5.2310E12/L；中性粒细胞计数(Neut#)-静脉血: 3.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；大血小板百分比(P-LCR%)-静脉血: 28.7%；血小板分布宽度(PDW)-静脉血: 11.3%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.4；血小板比容-静脉血: 17%；单核细胞计数(Mono#)-静脉血: 0.310E9/L；红细胞比容(Hct)-静脉血: 48.2%\n- [全程D56] 检验组合: 血小板分布宽度(PDW)-静脉血: 12.4%；中性粒细胞百分比(Neut%)-静脉血: 0.84；单核细胞计数(Mono#)-静脉血: 0.410E9/L；血小板比容-静脉血: 19%；血红蛋白(Hb)-静脉血: 158g/L；红细胞计数(RBC#)-静脉血: 5.2110E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.7；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均血小板体积(MPV)-静脉血: 10.5fL；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；红细胞比容(Hct)-静脉血: 47.9%；血小板计数(PLT#)-静脉血: 17710E9/L；平均红细胞体积(MCV)-静脉血: 91.9fL；淋巴细胞百分比(Lymph%)-静脉血: 0.077；平均红细胞血红蛋白含量(MCH)-静脉血: 30.3pg；中性粒细胞计数(Neut#)-静脉血: 5.310E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；单核细胞百分比(Mono%)-静脉血: 0.061；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.9；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；大血小板百分比(P-LCR%)-静脉血: 28.7%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.016；白细胞计数(WBC#)-静脉血: 6.3510E9/L\n- [全程D62] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；血小板分布宽度(PDW)-静脉血: 13.6%；单核细胞计数(Mono#)-静脉血: 0.310E9/L；白细胞计数(WBC#)-静脉血: 5.1610E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.798；红细胞比容(Hct)-静脉血: 47.9%；单核细胞百分比(Mono%)-静脉血: 0.066；大血小板百分比(P-LCR%)-静脉血: 30.3%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.7；血小板计数(PLT#)-静脉血: 21110E9/L；血小板比容-静脉血: 22%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.7；平均红细胞体积(MCV)-静脉血: 91.6fL；平均红细胞血红蛋白含量(MCH)-静脉血: 30.4pg；红细胞计数(RBC#)-静脉血: 5.2310E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞计数(Neut#)-静脉血: 4.110E9/L；血红蛋白(Hb)-静脉血: 159g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；淋巴细胞百分比(Lymph%)-静脉血: 0.109；平均红细胞血红蛋白浓度(MCHC)-静脉血: 332g/L；平均血小板体积(MPV)-静脉血: 10.5fL；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L\n- [全程D63] 检验组合: 低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.79mmol/L；总蛋白(TP)-静脉血: 66.06g/L；乳酸脱氢酶(LDH)-静脉血: 190U/L；葡萄糖(Glu)-静脉血: 4.43mmol/L；C-反应蛋白(CRP)-静脉血: 8.61mg/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.48；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.01mmolL；γ-谷氨酰基转移酶(GGT)-静脉血: 16.1U/L；镁离子(Mg2+)-静脉血: 0.98mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21U/L；总胆固醇(TC)-静脉血: 5.22mmol/L；阴离子间隙(AG)-静脉血: 15.7；氯离子(Cl-)-静脉血: 99.4mmol/L；碱性磷酸酶(ALP)-静脉血: 59.5U/L；磷(P)-静脉血: 1.2mmol/L；钾离子(K+)-静脉血: 3.7mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.11；甘油三酯(TG)-静脉血: 1.21mmol/L；肌酐(Crea)-静脉血: 80.4umol/L；总胆红素(TBIL)-静脉血: 23.7umol/L；载脂蛋白B(apoB)-静脉血: 1.27g/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.4mmol/L；总钙(Ca)-静脉血: 2.2mmol/L；尿素氮(BUN)-静脉血: 6.6mmol/L；钠离子(Na+)-静脉血: 142.5mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 14.2U/L；载脂蛋白AI(apoAI)-静脉血: 0.95g/L；间接胆红素(IBIL)-静脉血: 17.2umolL；直接胆红素(DBIL)-静脉血: 6.5umol/L；尿酸(UA)-静脉血: 490.3umol/L；总胆汁酸(TBA)-静脉血: 3.4umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 15.5U/L；球蛋白(GLO)-静脉血: 21.26g/L；白蛋白(ALB)-静脉血: 44.8g/L；胱抑素(Cys-C)-静脉血: 0.81mg/L\n- [全程D65] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:80（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:20（参考: 阴性）\n- [全程D160] 超声；腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约12cm/s。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、脾脏未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D160] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺野纹理清晰，双肺野未见明显实质性病变。双侧肺门无增大，纵隔未见增宽，心影形态、大小、位置未见异常。双膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n- [全程D160] 检验组合: EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D27] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗1次，无特殊主诉。Rx：1.继续放疗。2.定期复查血常规等。3.对症支持。\n- [全程D34] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗6次，无特殊主诉。复查血常规、生化未见明显异常。Rx：1.继续放疗。2.定期复查血常规等。3.对症支持。\n- [全程D41] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗11次，无特殊主诉。查体见鼻咽顶壁、右顶侧壁可见多个小结节，较前有所缩小，粘膜可见小片状白膜，双颈淋巴结未触及肿大，颅神经检查阴性，全身骨无压痛。和11-10复查血常规、血生化均未见明显异常。皮肤反应：0 Rx：1.继续放疗。粘膜反应：Ⅱ° 2.定期复查血常规等。3.对症支持。\n- [全程D55] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗21次，诉口干、咽痛较前明显，乏力，余无特殊主诉。查体见鼻咽右顶侧壁稍增厚，炎性分泌物较多，粘膜充血水肿，双颈淋巴结未触及肿大，颅神经检查阴性，全身骨无压痛。复查血常规未见明显异常。皮肤反应：I°Rx：1.继续放疗。粘膜反应：Ⅱ° 2.定期复查血常规等。3.抗炎、止痛、营养对症支持。\n- [全程D62] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗26次，诉口干、咽痛较前缓解，仍觉乏力，无特殊主诉。和12-01复查血常规、生化均未见明显异常。皮肤反应：Ⅰ°Rx：1.继续放疗。粘膜反应：Ⅱ° 2.定期复查血常规等。3.营养对症支持。\n- [全程D65] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗28次，诉口干、咽痛好转，自觉体力虚弱，并拒绝最后2次放疗。皮肤反应：Ⅰ° Rx：1.定期复查。粘膜反应：Ⅰ° 2.不适随诊。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 安排鼻咽及颈部活检，准备行挽救性内镜下鼻咽切除术。\nB. 启动含铂双药方案全身化疗4-6个周期。\nC. 行全身PET/CT评估，若有局部高代谢灶则行挽救性放疗。\nD. 予以原发灶及颈部引流区局部推量补照4-6Gy。\nE. 给予卡培他滨单药口服维持治疗半年至一年。\nF. 维持规范随访观察，可症状给予一般对症及支持治疗。\nG. 行鼻咽及颈部MRI增强扫描，若有可疑残留则行诱导化疗。\nH. 启动PD-1抑制剂联合含铂双药全身化疗。\nI. 安排鼻咽内镜活检，若病理阳性则行双侧颈部淋巴结清扫术。\nJ. 补充顺铂单药全身化疗2个周期以强化局部控制。\nK. 行全身骨扫描及头颅MRI，排除远处转移后行局部挽救性放疗。\nL. 予以吉西他滨联合顺铂全身化疗4-6个周期。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D50] 检验组合: 平均红细胞体积(MCV)-静脉血: 92.2fL；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.727；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.033；血小板计数(PLT#)-静脉血: 15910E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.165；单核细胞百分比(Mono%)-静脉血: 0.073；血红蛋白(Hb)-静脉血: 162g/L；平均血小板体积(MPV)-静脉血: 10.6fL；白细胞计数(WBC#)-静脉血: 4.210E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.9；红细胞计数(RBC#)-静脉血: 5.2310E12/L；中性粒细胞计数(Neut#)-静脉血: 3.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；大血小板百分比(P-LCR%)-静脉血: 28.7%；血小板分布宽度(PDW)-静脉血: 11.3%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.4；血小板比容-静脉血: 17%；单核细胞计数(Mono#)-静脉血: 0.310E9/L；红细胞比容(Hct)-静脉血: 48.2%\n- [全程D56] 检验组合: 血小板分布宽度(PDW)-静脉血: 12.4%；中性粒细胞百分比(Neut%)-静脉血: 0.84；单核细胞计数(Mono#)-静脉血: 0.410E9/L；血小板比容-静脉血: 19%；血红蛋白(Hb)-静脉血: 158g/L；红细胞计数(RBC#)-静脉血: 5.2110E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.7；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均血小板体积(MPV)-静脉血: 10.5fL；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；红细胞比容(Hct)-静脉血: 47.9%；血小板计数(PLT#)-静脉血: 17710E9/L；平均红细胞体积(MCV)-静脉血: 91.9fL；淋巴细胞百分比(Lymph%)-静脉血: 0.077；平均红细胞血红蛋白含量(MCH)-静脉血: 30.3pg；中性粒细胞计数(Neut#)-静脉血: 5.310E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；单核细胞百分比(Mono%)-静脉血: 0.061；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.9；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；大血小板百分比(P-LCR%)-静脉血: 28.7%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.016；白细胞计数(WBC#)-静脉血: 6.3510E9/L\n- [全程D62] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；血小板分布宽度(PDW)-静脉血: 13.6%；单核细胞计数(Mono#)-静脉血: 0.310E9/L；白细胞计数(WBC#)-静脉血: 5.1610E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.798；红细胞比容(Hct)-静脉血: 47.9%；单核细胞百分比(Mono%)-静脉血: 0.066；大血小板百分比(P-LCR%)-静脉血: 30.3%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.7；血小板计数(PLT#)-静脉血: 21110E9/L；血小板比容-静脉血: 22%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.7；平均红细胞体积(MCV)-静脉血: 91.6fL；平均红细胞血红蛋白含量(MCH)-静脉血: 30.4pg；红细胞计数(RBC#)-静脉血: 5.2310E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞计数(Neut#)-静脉血: 4.110E9/L；血红蛋白(Hb)-静脉血: 159g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；淋巴细胞百分比(Lymph%)-静脉血: 0.109；平均红细胞血红蛋白浓度(MCHC)-静脉血: 332g/L；平均血小板体积(MPV)-静脉血: 10.5fL；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L\n- [全程D63] 检验组合: 低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.79mmol/L；总蛋白(TP)-静脉血: 66.06g/L；乳酸脱氢酶(LDH)-静脉血: 190U/L；葡萄糖(Glu)-静脉血: 4.43mmol/L；C-反应蛋白(CRP)-静脉血: 8.61mg/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.48；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.01mmolL；γ-谷氨酰基转移酶(GGT)-静脉血: 16.1U/L；镁离子(Mg2+)-静脉血: 0.98mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21U/L；总胆固醇(TC)-静脉血: 5.22mmol/L；阴离子间隙(AG)-静脉血: 15.7；氯离子(Cl-)-静脉血: 99.4mmol/L；碱性磷酸酶(ALP)-静脉血: 59.5U/L；磷(P)-静脉血: 1.2mmol/L；钾离子(K+)-静脉血: 3.7mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.11；甘油三酯(TG)-静脉血: 1.21mmol/L；肌酐(Crea)-静脉血: 80.4umol/L；总胆红素(TBIL)-静脉血: 23.7umol/L；载脂蛋白B(apoB)-静脉血: 1.27g/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.4mmol/L；总钙(Ca)-静脉血: 2.2mmol/L；尿素氮(BUN)-静脉血: 6.6mmol/L；钠离子(Na+)-静脉血: 142.5mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 14.2U/L；载脂蛋白AI(apoAI)-静脉血: 0.95g/L；间接胆红素(IBIL)-静脉血: 17.2umolL；直接胆红素(DBIL)-静脉血: 6.5umol/L；尿酸(UA)-静脉血: 490.3umol/L；总胆汁酸(TBA)-静脉血: 3.4umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 15.5U/L；球蛋白(GLO)-静脉血: 21.26g/L；白蛋白(ALB)-静脉血: 44.8g/L；胱抑素(Cys-C)-静脉血: 0.81mg/L\n- [全程D65] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:80（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:20（参考: 阴性）\n- [全程D160] 超声；腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约12cm/s。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、脾脏未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D160] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺野纹理清晰，双肺野未见明显实质性病变。双侧肺门无增大，纵隔未见增宽，心影形态、大小、位置未见异常。双膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n- [全程D160] 检验组合: EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）\n\n【既往治疗与反应】\n- [全程D55] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗21次，诉口干、咽痛较前明显，乏力，余无特殊主诉。查体见鼻咽右顶侧壁稍增厚，炎性分泌物较多，粘膜充血水肿，双颈淋巴结未触及肿大，颅神经检查阴性，全身骨无压痛。复查血常规未见明显异常。皮肤反应：I°Rx：1.继续放疗。粘膜反应：Ⅱ° 2.定期复查血常规等。3.抗炎、止痛、营养对症支持。\n- [全程D62] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗26次，诉口干、咽痛较前缓解，仍觉乏力，无特殊主诉。和12-01复查血常规、生化均未见明显异常。皮肤反应：Ⅰ°Rx：1.继续放疗。粘膜反应：Ⅱ° 2.定期复查血常规等。3.营养对症支持。\n- [全程D65] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗28次，诉口干、咽痛好转，自觉体力虚弱，并拒绝最后2次放疗。皮肤反应：Ⅰ° Rx：1.定期复查。粘膜反应：Ⅰ° 2.不适随诊。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 安排鼻咽及颈部活检，准备行挽救性内镜下鼻咽切除术。\nB. 启动含铂双药方案全身化疗4-6个周期。\nC. 行全身PET/CT评估，若有局部高代谢灶则行挽救性放疗。\nD. 予以原发灶及颈部引流区局部推量补照4-6Gy。\nE. 给予卡培他滨单药口服维持治疗半年至一年。\nF. 维持规范随访观察，可症状给予一般对症及支持治疗。\nG. 行鼻咽及颈部MRI增强扫描，若有可疑残留则行诱导化疗。\nH. 启动PD-1抑制剂联合含铂双药全身化疗。\nI. 安排鼻咽内镜活检，若病理阳性则行双侧颈部淋巴结清扫术。\nJ. 补充顺铂单药全身化疗2个周期以强化局部控制。\nK. 行全身骨扫描及头颅MRI，排除远处转移后行局部挽救性放疗。\nL. 予以吉西他滨联合顺铂全身化疗4-6个周期。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、口咽。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D50] 检验组合: 平均红细胞体积(MCV)-静脉血: 92.2fL；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.727；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.033；血小板计数(PLT#)-静脉血: 15910E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.165；单核细胞百分比(Mono%)-静脉血: 0.073；血红蛋白(Hb)-静脉血: 162g/L；平均血小板体积(MPV)-静脉血: 10.6fL；白细胞计数(WBC#)-静脉血: 4.210E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.9；红细胞计数(RBC#)-静脉血: 5.2310E12/L；中性粒细胞计数(Neut#)-静脉血: 3.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；大血小板百分比(P-LCR%)-静脉血: 28.7%；血小板分布宽度(PDW)-静脉血: 11.3%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.4；血小板比容-静脉血: 17%；单核细胞计数(Mono#)-静脉血: 0.310E9/L；红细胞比容(Hct)-静脉血: 48.2%\n- [全程D56] 检验组合: 血小板分布宽度(PDW)-静脉血: 12.4%；中性粒细胞百分比(Neut%)-静脉血: 0.84；单核细胞计数(Mono#)-静脉血: 0.410E9/L；血小板比容-静脉血: 19%；血红蛋白(Hb)-静脉血: 158g/L；红细胞计数(RBC#)-静脉血: 5.2110E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.7；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均血小板体积(MPV)-静脉血: 10.5fL；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；红细胞比容(Hct)-静脉血: 47.9%；血小板计数(PLT#)-静脉血: 17710E9/L；平均红细胞体积(MCV)-静脉血: 91.9fL；淋巴细胞百分比(Lymph%)-静脉血: 0.077；平均红细胞血红蛋白含量(MCH)-静脉血: 30.3pg；中性粒细胞计数(Neut#)-静脉血: 5.310E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；单核细胞百分比(Mono%)-静脉血: 0.061；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.9；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；大血小板百分比(P-LCR%)-静脉血: 28.7%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.016；白细胞计数(WBC#)-静脉血: 6.3510E9/L\n- [全程D62] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；血小板分布宽度(PDW)-静脉血: 13.6%；单核细胞计数(Mono#)-静脉血: 0.310E9/L；白细胞计数(WBC#)-静脉血: 5.1610E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.798；红细胞比容(Hct)-静脉血: 47.9%；单核细胞百分比(Mono%)-静脉血: 0.066；大血小板百分比(P-LCR%)-静脉血: 30.3%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.7；血小板计数(PLT#)-静脉血: 21110E9/L；血小板比容-静脉血: 22%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.7；平均红细胞体积(MCV)-静脉血: 91.6fL；平均红细胞血红蛋白含量(MCH)-静脉血: 30.4pg；红细胞计数(RBC#)-静脉血: 5.2310E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞计数(Neut#)-静脉血: 4.110E9/L；血红蛋白(Hb)-静脉血: 159g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；淋巴细胞百分比(Lymph%)-静脉血: 0.109；平均红细胞血红蛋白浓度(MCHC)-静脉血: 332g/L；平均血小板体积(MPV)-静脉血: 10.5fL；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L\n- [全程D63] 检验组合: 低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.79mmol/L；总蛋白(TP)-静脉血: 66.06g/L；乳酸脱氢酶(LDH)-静脉血: 190U/L；葡萄糖(Glu)-静脉血: 4.43mmol/L；C-反应蛋白(CRP)-静脉血: 8.61mg/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.48；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.01mmolL；γ-谷氨酰基转移酶(GGT)-静脉血: 16.1U/L；镁离子(Mg2+)-静脉血: 0.98mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21U/L；总胆固醇(TC)-静脉血: 5.22mmol/L；阴离子间隙(AG)-静脉血: 15.7；氯离子(Cl-)-静脉血: 99.4mmol/L；碱性磷酸酶(ALP)-静脉血: 59.5U/L；磷(P)-静脉血: 1.2mmol/L；钾离子(K+)-静脉血: 3.7mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.11；甘油三酯(TG)-静脉血: 1.21mmol/L；肌酐(Crea)-静脉血: 80.4umol/L；总胆红素(TBIL)-静脉血: 23.7umol/L；载脂蛋白B(apoB)-静脉血: 1.27g/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.4mmol/L；总钙(Ca)-静脉血: 2.2mmol/L；尿素氮(BUN)-静脉血: 6.6mmol/L；钠离子(Na+)-静脉血: 142.5mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 14.2U/L；载脂蛋白AI(apoAI)-静脉血: 0.95g/L；间接胆红素(IBIL)-静脉血: 17.2umolL；直接胆红素(DBIL)-静脉血: 6.5umol/L；尿酸(UA)-静脉血: 490.3umol/L；总胆汁酸(TBA)-静脉血: 3.4umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 15.5U/L；球蛋白(GLO)-静脉血: 21.26g/L；白蛋白(ALB)-静脉血: 44.8g/L；胱抑素(Cys-C)-静脉血: 0.81mg/L\n- [全程D65] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:80（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:20（参考: 阴性）\n- [全程D160] 超声；腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约12cm/s。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、脾脏未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D160] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺野纹理清晰，双肺野未见明显实质性病变。双侧肺门无增大，纵隔未见增宽，心影形态、大小、位置未见异常。双膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n- [全程D160] 检验组合: EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）\n\n【既往治疗与反应】\n- [全程D55] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗21次，诉口干、咽痛较前明显，乏力，余无特殊主诉。查体见鼻咽右顶侧壁稍增厚，炎性分泌物较多，粘膜充血水肿，双颈淋巴结未触及肿大，颅神经检查阴性，全身骨无压痛。复查血常规未见明显异常。皮肤反应：I°Rx：1.继续放疗。粘膜反应：Ⅱ° 2.定期复查血常规等。3.抗炎、止痛、营养对症支持。\n- [全程D62] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗26次，诉口干、咽痛较前缓解，仍觉乏力，无特殊主诉。和12-01复查血常规、生化均未见明显异常。皮肤反应：Ⅰ°Rx：1.继续放疗。粘膜反应：Ⅱ° 2.定期复查血常规等。3.营养对症支持。\n- [全程D65] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗28次，诉口干、咽痛好转，自觉体力虚弱，并拒绝最后2次放疗。皮肤反应：Ⅰ° Rx：1.定期复查。粘膜反应：Ⅰ° 2.不适随诊。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 安排鼻咽及颈部活检，准备行挽救性内镜下鼻咽切除术。\nB. 启动含铂双药方案全身化疗4-6个周期。\nC. 行全身PET/CT评估，若有局部高代谢灶则行挽救性放疗。\nD. 予以原发灶及颈部引流区局部推量补照4-6Gy。\nE. 给予卡培他滨单药口服维持治疗半年至一年。\nF. 维持规范随访观察，可症状给予一般对症及支持治疗。\nG. 行鼻咽及颈部MRI增强扫描，若有可疑残留则行诱导化疗。\nH. 启动PD-1抑制剂联合含铂双药全身化疗。\nI. 安排鼻咽内镜活检，若病理阳性则行双侧颈部淋巴结清扫术。\nJ. 补充顺铂单药全身化疗2个周期以强化局部控制。\nK. 行全身骨扫描及头颅MRI，排除远处转移后行局部挽救性放疗。\nL. 予以吉西他滨联合顺铂全身化疗4-6个周期。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"episode_id":"episode-fdc6ea48c4f81540436a7ca7","patient_id":"patient-02ca51eed4fedbb13e4db76d","care_turn_count":4,"turns":[{"sample_id":"sample-5737526b7d92f1b3d5423663","patient_id":"patient-02ca51eed4fedbb13e4db76d","turn_id":"turn01","turn_position":1,"turn_type":"initial_workup_choice","gold_letter":"H","gold_action":"完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。","options":[{"letter":"A","text":"完善电子鼻咽镜检查及活检，行鼻咽及颈部CT平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。","is_gold":false},{"letter":"B","text":"完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，并直接行全身PET-CT评估远处转移。","is_gold":false},{"letter":"C","text":"完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，暂不进行胸腹部影像学检查待病理确诊。","is_gold":false},{"letter":"D","text":"完善间接鼻咽镜检查，行鼻咽及颈部MRI平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。","is_gold":false},{"letter":"E","text":"完善颈部淋巴结细针穿刺活检，行鼻咽及颈部MRI平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。","is_gold":false},{"letter":"F","text":"完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。","is_gold":false},{"letter":"G","text":"完善电子鼻咽镜检查及活检，行鼻咽及颈部CT平扫，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。","is_gold":false},{"letter":"H","text":"完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。","is_gold":true},{"letter":"I","text":"完善颈部淋巴结切除活检，行鼻咽及颈部MRI平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。","is_gold":false},{"letter":"J","text":"完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，并完善骨扫描及头颅MRI检查。","is_gold":false},{"letter":"K","text":"完善电子鼻咽镜检查及活检，仅行鼻咽MRI平扫+增强，颈部行彩超评估，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。","is_gold":false},{"letter":"L","text":"完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，并完善全身骨髓穿刺活检。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、鼻腔。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左颈肿物20天；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物；既往史: 20余年前患“血吸虫”病行脾脏切除术，当地医院检查示“早期肝硬化”，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：37.3℃，P：62次/分，R：20次/分，BP：121/75mmHg,Ht：165cm，Wt：58kg，BSA：1.63m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽左侧顶后壁粘膜稍隆起；左侧颈部II区可扪及1个淋巴结，最大径1×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善电子鼻咽镜检查及活检，行鼻咽及颈部CT平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。\nB. 完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，并直接行全身PET-CT评估远处转移。\nC. 完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，暂不进行胸腹部影像学检查待病理确诊。\nD. 完善间接鼻咽镜检查，行鼻咽及颈部MRI平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。\nE. 完善颈部淋巴结细针穿刺活检，行鼻咽及颈部MRI平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。\nF. 完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。\nG. 完善电子鼻咽镜检查及活检，行鼻咽及颈部CT平扫，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。\nH. 完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。\nI. 完善颈部淋巴结切除活检，行鼻咽及颈部MRI平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。\nJ. 完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，并完善骨扫描及头颅MRI检查。\nK. 完善电子鼻咽镜检查及活检，仅行鼻咽MRI平扫+增强，颈部行彩超评估，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。\nL. 完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，并完善全身骨髓穿刺活检。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"你正在参与一名鼻咽癌相关患者的 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张口门齿距4.5cm；鼻咽左侧顶后壁粘膜稍隆起；左侧颈部II区可扪及1个淋巴结，最大径1×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善电子鼻咽镜检查及活检，行鼻咽及颈部CT平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。\nB. 完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，并直接行全身PET-CT评估远处转移。\nC. 完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，暂不进行胸腹部影像学检查待病理确诊。\nD. 完善间接鼻咽镜检查，行鼻咽及颈部MRI平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。\nE. 完善颈部淋巴结细针穿刺活检，行鼻咽及颈部MRI平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。\nF. 完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。\nG. 完善电子鼻咽镜检查及活检，行鼻咽及颈部CT平扫，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。\nH. 完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。\nI. 完善颈部淋巴结切除活检，行鼻咽及颈部MRI平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。\nJ. 完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，并完善骨扫描及头颅MRI检查。\nK. 完善电子鼻咽镜检查及活检，仅行鼻咽MRI平扫+增强，颈部行彩超评估，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。\nL. 完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，并完善全身骨髓穿刺活检。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、鼻腔。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左颈肿物20天；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物；既往史: 20余年前患“血吸虫”病行脾脏切除术，当地医院检查示“早期肝硬化”，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：37.3℃，P：62次/分，R：20次/分，BP：121/75mmHg,Ht：165cm，Wt：58kg，BSA：1.63m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽左侧顶后壁粘膜稍隆起；左侧颈部II区可扪及1个淋巴结，最大径1×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善电子鼻咽镜检查及活检，行鼻咽及颈部CT平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。\nB. 完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，并直接行全身PET-CT评估远处转移。\nC. 完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，暂不进行胸腹部影像学检查待病理确诊。\nD. 完善间接鼻咽镜检查，行鼻咽及颈部MRI平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。\nE. 完善颈部淋巴结细针穿刺活检，行鼻咽及颈部MRI平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。\nF. 完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。\nG. 完善电子鼻咽镜检查及活检，行鼻咽及颈部CT平扫，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。\nH. 完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。\nI. 完善颈部淋巴结切除活检，行鼻咽及颈部MRI平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。\nJ. 完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，并完善骨扫描及头颅MRI检查。\nK. 完善电子鼻咽镜检查及活检，仅行鼻咽MRI平扫+增强，颈部行彩超评估，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。\nL. 完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，并完善全身骨髓穿刺活检。\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-84b4eab1f1613c7517fd613a","patient_id":"patient-02ca51eed4fedbb13e4db76d","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"I","gold_action":"行鼻咽镜下鼻咽原发灶活检以明确病理诊断","options":[{"letter":"A","text":"行PET-CT检查以重新评估全身分期","is_gold":false},{"letter":"B","text":"行左侧颈部淋巴结切除活检以明确病理诊断","is_gold":false},{"letter":"C","text":"行左侧颈部淋巴结细针穿刺活检(FNAC)以明确病理诊断","is_gold":false},{"letter":"D","text":"行鼻咽脱落细胞涂片检查以替代组织活检","is_gold":false},{"letter":"E","text":"行肝脏增强MRI检查以进一步排查肝脏转移灶","is_gold":false},{"letter":"F","text":"行右侧颈部II区小淋巴结切除活检以明确对侧转移情况","is_gold":false},{"letter":"G","text":"行外周血EB病毒DNA定量检测作为确诊依据","is_gold":false},{"letter":"H","text":"行左上颌骨病灶穿刺活检以明确骨扫描异常灶性质","is_gold":false},{"letter":"I","text":"行鼻咽镜下鼻咽原发灶活检以明确病理诊断","is_gold":true},{"letter":"J","text":"行鼻咽肿物广泛切除术以达到诊断与治疗目的","is_gold":false},{"letter":"K","text":"行颈部超声造影检查以进一步评估右颈淋巴结性质","is_gold":false},{"letter":"L","text":"行鼻咽及颈部CT平扫加增强以补充评估颅底骨质破坏","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、鼻腔。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左颈肿物20天；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物；既往史: 20余年前患“血吸虫”病行脾脏切除术，当地医院检查示“早期肝硬化”，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：37.3℃，P：62次/分，R：20次/分，BP：121/75mmHg,Ht：165cm，Wt：58kg，BSA：1.63m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽左侧顶后壁粘膜稍隆起；左侧颈部II区可扪及1个淋巴结，最大径1×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 逆钟向转位 正常范围心电图\n- [全程D1] 检验组合: 肌酐(Crea)-静脉血: 56.1umol/L；阴离子间隙(AG)-静脉血: 11.1；α-L-岩藻糖苷酶(AFU)-静脉血: 35.5U/L；凝血酶原时间(PT)-静脉血: 11.7sec.；胱抑素(Cys-C)-静脉血: 0.85mg/L；淋巴细胞百分比(Lymph%)-静脉血: 0.428；骨钙素N端中分子片段(N-MID)-静脉血: 19.3ng/ml；纤维蛋白原(Fbg)-静脉血: 2.07g/L；钠离子(Na+)-静脉血: 140.5mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；总钙(Ca)-静脉血: 2.29mmol/L；乳酸脱氢酶(LDH)-静脉血: 164U/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.44；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.35mmol/L；血小板分布宽度(PDW)-静脉血: 15.9%；平均红细胞血红蛋白含量(MCH)-静脉血: 31.5pg；总胆固醇(TC)-静脉血: 4.12mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；Rh血型-静脉血: 阳性；红细胞比容(Hct)-静脉血: 41.2%；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 9.9umolL；D-二聚体(D-Dimer)-静脉血: 5.09ug/ml；钾离子(K+)-静脉血: 4.24mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.424；直接胆红素(DBIL)-静脉血: 5.8umol/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；天门冬氨酸氨基转移酶(AST)-静脉血: 18.6U/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；透明质酸(HA)-静脉血: 71.337ng/ml；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.5；纤维蛋白原降解产物(FDP)-静脉血:……\n- [全程D2] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双下肺纹理稍粗，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n- [全程D4] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏形态失常，表面凸凹不平，边缘钝，肝实质回声不均匀，明显增强、粗糙，肝内未见明确肿块回声。门静脉主干内径约15mm。肝静脉、门静脉内未见异常回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约14cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏术后缺如。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约35×24×23mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝硬化声像。 脾脏术后缺如。 胆囊、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D7] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 左上颌骨可见片状放射性浓集灶。胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 左上颌骨炎症。 余全身骨骼未见明显异常。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行PET-CT检查以重新评估全身分期\nB. 行左侧颈部淋巴结切除活检以明确病理诊断\nC. 行左侧颈部淋巴结细针穿刺活检(FNAC)以明确病理诊断\nD. 行鼻咽脱落细胞涂片检查以替代组织活检\nE. 行肝脏增强MRI检查以进一步排查肝脏转移灶\nF. 行右侧颈部II区小淋巴结切除活检以明确对侧转移情况\nG. 行外周血EB病毒DNA定量检测作为确诊依据\nH. 行左上颌骨病灶穿刺活检以明确骨扫描异常灶性质\nI. 行鼻咽镜下鼻咽原发灶活检以明确病理诊断\nJ. 行鼻咽肿物广泛切除术以达到诊断与治疗目的\nK. 行颈部超声造影检查以进一步评估右颈淋巴结性质\nL. 行鼻咽及颈部CT平扫加增强以补充评估颅底骨质破坏\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 逆钟向转位 正常范围心电图\n- [全程D1] 检验组合: 肌酐(Crea)-静脉血: 56.1umol/L；阴离子间隙(AG)-静脉血: 11.1；α-L-岩藻糖苷酶(AFU)-静脉血: 35.5U/L；凝血酶原时间(PT)-静脉血: 11.7sec.；胱抑素(Cys-C)-静脉血: 0.85mg/L；淋巴细胞百分比(Lymph%)-静脉血: 0.428；骨钙素N端中分子片段(N-MID)-静脉血: 19.3ng/ml；纤维蛋白原(Fbg)-静脉血: 2.07g/L；钠离子(Na+)-静脉血: 140.5mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；总钙(Ca)-静脉血: 2.29mmol/L；乳酸脱氢酶(LDH)-静脉血: 164U/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.44；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.35mmol/L；血小板分布宽度(PDW)-静脉血: 15.9%；平均红细胞血红蛋白含量(MCH)-静脉血: 31.5pg；总胆固醇(TC)-静脉血: 4.12mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；Rh血型-静脉血: 阳性；红细胞比容(Hct)-静脉血: 41.2%；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 9.9umolL；D-二聚体(D-Dimer)-静脉血: 5.09ug/ml；钾离子(K+)-静脉血: 4.24mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.424；直接胆红素(DBIL)-静脉血: 5.8umol/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；天门冬氨酸氨基转移酶(AST)-静脉血: 18.6U/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；透明质酸(HA)-静脉血: 71.337ng/ml；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.5；纤维蛋白原降解产物(FDP)-静脉血:……\n- [全程D2] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双下肺纹理稍粗，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n- [全程D4] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏形态失常，表面凸凹不平，边缘钝，肝实质回声不均匀，明显增强、粗糙，肝内未见明确肿块回声。门静脉主干内径约15mm。肝静脉、门静脉内未见异常回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约14cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏术后缺如。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约35×24×23mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝硬化声像。 脾脏术后缺如。 胆囊、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D7] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 左上颌骨可见片状放射性浓集灶。胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 左上颌骨炎症。 余全身骨骼未见明显异常。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行PET-CT检查以重新评估全身分期\nB. 行左侧颈部淋巴结切除活检以明确病理诊断\nC. 行左侧颈部淋巴结细针穿刺活检(FNAC)以明确病理诊断\nD. 行鼻咽脱落细胞涂片检查以替代组织活检\nE. 行肝脏增强MRI检查以进一步排查肝脏转移灶\nF. 行右侧颈部II区小淋巴结切除活检以明确对侧转移情况\nG. 行外周血EB病毒DNA定量检测作为确诊依据\nH. 行左上颌骨病灶穿刺活检以明确骨扫描异常灶性质\nI. 行鼻咽镜下鼻咽原发灶活检以明确病理诊断\nJ. 行鼻咽肿物广泛切除术以达到诊断与治疗目的\nK. 行颈部超声造影检查以进一步评估右颈淋巴结性质\nL. 行鼻咽及颈部CT平扫加增强以补充评估颅底骨质破坏\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、鼻腔。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 逆钟向转位 正常范围心电图\n- [全程D1] 检验组合: 肌酐(Crea)-静脉血: 56.1umol/L；阴离子间隙(AG)-静脉血: 11.1；α-L-岩藻糖苷酶(AFU)-静脉血: 35.5U/L；凝血酶原时间(PT)-静脉血: 11.7sec.；胱抑素(Cys-C)-静脉血: 0.85mg/L；淋巴细胞百分比(Lymph%)-静脉血: 0.428；骨钙素N端中分子片段(N-MID)-静脉血: 19.3ng/ml；纤维蛋白原(Fbg)-静脉血: 2.07g/L；钠离子(Na+)-静脉血: 140.5mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；总钙(Ca)-静脉血: 2.29mmol/L；乳酸脱氢酶(LDH)-静脉血: 164U/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.44；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.35mmol/L；血小板分布宽度(PDW)-静脉血: 15.9%；平均红细胞血红蛋白含量(MCH)-静脉血: 31.5pg；总胆固醇(TC)-静脉血: 4.12mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；Rh血型-静脉血: 阳性；红细胞比容(Hct)-静脉血: 41.2%；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 9.9umolL；D-二聚体(D-Dimer)-静脉血: 5.09ug/ml；钾离子(K+)-静脉血: 4.24mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.424；直接胆红素(DBIL)-静脉血: 5.8umol/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；天门冬氨酸氨基转移酶(AST)-静脉血: 18.6U/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；透明质酸(HA)-静脉血: 71.337ng/ml；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.5；纤维蛋白原降解产物(FDP)-静脉血:……\n- [全程D2] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双下肺纹理稍粗，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n- [全程D4] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏形态失常，表面凸凹不平，边缘钝，肝实质回声不均匀，明显增强、粗糙，肝内未见明确肿块回声。门静脉主干内径约15mm。肝静脉、门静脉内未见异常回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约14cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏术后缺如。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约35×24×23mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝硬化声像。 脾脏术后缺如。 胆囊、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D7] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 左上颌骨可见片状放射性浓集灶。胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 左上颌骨炎症。 余全身骨骼未见明显异常。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行PET-CT检查以重新评估全身分期\nB. 行左侧颈部淋巴结切除活检以明确病理诊断\nC. 行左侧颈部淋巴结细针穿刺活检(FNAC)以明确病理诊断\nD. 行鼻咽脱落细胞涂片检查以替代组织活检\nE. 行肝脏增强MRI检查以进一步排查肝脏转移灶\nF. 行右侧颈部II区小淋巴结切除活检以明确对侧转移情况\nG. 行外周血EB病毒DNA定量检测作为确诊依据\nH. 行左上颌骨病灶穿刺活检以明确骨扫描异常灶性质\nI. 行鼻咽镜下鼻咽原发灶活检以明确病理诊断\nJ. 行鼻咽肿物广泛切除术以达到诊断与治疗目的\nK. 行颈部超声造影检查以进一步评估右颈淋巴结性质\nL. 行鼻咽及颈部CT平扫加增强以补充评估颅底骨质破坏\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-9895c4d0f7c600fd0c046a50","patient_id":"patient-02ca51eed4fedbb13e4db76d","turn_id":"turn05","turn_position":3,"turn_type":"toxicity_or_support_decision","gold_letter":"L","gold_action":"继续行第2程同期化疗，化疗后复查血象视情况予以升白细胞治疗，并给予静脉营养、补液及通便等对症支持。","options":[{"letter":"A","text":"暂停同期化疗，单纯行根治性放疗，立即予以重组人粒细胞集落刺激因子升白细胞治疗。","is_gold":false},{"letter":"B","text":"暂停放化疗，立即予以重组人粒细胞集落刺激因子，待白细胞恢复正常后再恢复放化综合治疗。","is_gold":false},{"letter":"C","text":"延迟第2程同期化疗，继续放疗，观察3天后复查血常规，若中性粒细胞达标再行化疗。","is_gold":false},{"letter":"D","text":"继续行第2程同期化疗，化疗前予以长效聚乙二醇化重组人粒细胞集落刺激因子预防性升白细胞。","is_gold":false},{"letter":"E","text":"继续行第2程同期化疗，化疗期间同步予以口服抗生素预防感染及静脉营养支持。","is_gold":false},{"letter":"F","text":"继续行第2程同期化疗，将顺铂剂量下调20%，并给予静脉营养、补液及通便等对症支持。","is_gold":false},{"letter":"G","text":"终止同期化疗，改为单纯放疗联合西妥昔单抗靶向治疗，并予以静脉营养支持。","is_gold":false},{"letter":"H","text":"继续行第2程同期化疗，化疗后立即常规予以重组人粒细胞集落刺激因子连续升白细胞治疗3天。","is_gold":false},{"letter":"I","text":"暂停放疗，按计划行第2程同期化疗，化疗后复查血象视情况予以升白细胞治疗。","is_gold":false},{"letter":"J","text":"继续行第2程同期化疗，将顺铂更换为卡铂，并给予静脉营养、补液及通便等对症支持。","is_gold":false},{"letter":"K","text":"延迟第2程同期化疗，予以静脉营养、补液及通便等对症支持，待1周后复查血象再决定是否化疗。","is_gold":false},{"letter":"L","text":"继续行第2程同期化疗，化疗后复查血象视情况予以升白细胞治疗，并给予静脉营养、补液及通便等对症支持。","is_gold":true}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、鼻腔。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左颈肿物20天；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物；既往史: 20余年前患“血吸虫”病行脾脏切除术，当地医院检查示“早期肝硬化”，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：37.3℃，P：62次/分，R：20次/分，BP：121/75mmHg,Ht：165cm，Wt：58kg，BSA：1.63m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽左侧顶后壁粘膜稍隆起；左侧颈部II区可扪及1个淋巴结，最大径1×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 左颈肿物20天；现病史: 缘于20天前患者无意中出现左颈肿物，未伴涕血、耳鸣、听力下降、头痛、面麻等不适，某次就诊时间在当地医院行左颈淋巴结穿刺，病理示未见癌，某次就诊时间行鼻咽活检病理示鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物；既往史: 20余年前患“血吸虫”病行脾脏切除术，当地医院检查示“早期肝硬化”，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：37.3℃，P：62次/分，R：20次/分，BP：121/75mmHg,Ht：165cm，Wt：58kg，BSA：1.63m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率62次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽左侧顶后壁粘膜稍隆起；左侧颈部II区可扪及1个淋巴结，最大径1×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D27] 入院记录: 主诉: 确诊鼻咽癌1月余；现病史: 缘于某次就诊时间9月下旬患者无意中出现左颈肿物，未伴涕血、耳鸣、听力下降、头痛、面麻等不适，某次就诊时间在当地医院行左颈淋巴结穿刺，病理示未见癌，某次就诊时间行鼻咽活检病理示分化非角化癌。某次就诊时间日入院予以治疗前相关检查，明确诊断为鼻咽分化非角化癌，[分期信息见历史辅助诊断节点],III期，予以行放疗计划设计，现放疗计划设计完成，入院行放化综合治疗。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物；既往史: 20余年前患“血吸虫”病行脾脏切除术，当地医院检查示“早期肝硬化”，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：37.3℃，P：62次/分，R：20次/分，BP：121/75mmHg,Ht：165cm，Wt：58kg，BSA：1.63m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率62次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽左侧顶后壁粘膜稍隆起；左侧颈部II区可扪及1个淋巴结，最大径1×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 逆钟向转位 正常范围心电图\n- [全程D1] 检验组合: 肌酐(Crea)-静脉血: 56.1umol/L；阴离子间隙(AG)-静脉血: 11.1；α-L-岩藻糖苷酶(AFU)-静脉血: 35.5U/L；凝血酶原时间(PT)-静脉血: 11.7sec.；胱抑素(Cys-C)-静脉血: 0.85mg/L；淋巴细胞百分比(Lymph%)-静脉血: 0.428；骨钙素N端中分子片段(N-MID)-静脉血: 19.3ng/ml；纤维蛋白原(Fbg)-静脉血: 2.07g/L；钠离子(Na+)-静脉血: 140.5mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；总钙(Ca)-静脉血: 2.29mmol/L；乳酸脱氢酶(LDH)-静脉血: 164U/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.44；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.35mmol/L；血小板分布宽度(PDW)-静脉血: 15.9%；平均红细胞血红蛋白含量(MCH)-静脉血: 31.5pg；总胆固醇(TC)-静脉血: 4.12mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；Rh血型-静脉血: 阳性；红细胞比容(Hct)-静脉血: 41.2%；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 9.9umolL；D-二聚体(D-Dimer)-静脉血: 5.09ug/ml；钾离子(K+)-静脉血: 4.24mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.424；直接胆红素(DBIL)-静脉血: 5.8umol/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；天门冬氨酸氨基转移酶(AST)-静脉血: 18.6U/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；透明质酸(HA)-静脉血: 71.337ng/ml；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.5；纤维蛋白原降解产物(FDP)-静脉血:……\n- [全程D2] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双下肺纹理稍粗，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n- [全程D4] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏形态失常，表面凸凹不平，边缘钝，肝实质回声不均匀，明显增强、粗糙，肝内未见明确肿块回声。门静脉主干内径约15mm。肝静脉、门静脉内未见异常回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约14cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏术后缺如。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约35×24×23mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝硬化声像。 脾脏术后缺如。 胆囊、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D7] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 左上颌骨可见片状放射性浓集灶。胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 左上颌骨炎症。 余全身骨骼未见明显异常。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D35] 检验组合: 碱性磷酸酶(ALP)-静脉血: 93.6U/L；丙氨酸氨基转移酶(ALT)-静脉血: 26.3U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.2U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 34.4U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.73；α-L-岩藻糖苷酶(AFU)-静脉血: 38.5U/L；乳酸脱氢酶(LDH)-静脉血: 195.7U/L；总胆汁酸(TBA)-静脉血: 2.9umol/L\n- [全程D39] 检验组合: 胱抑素(Cys-C)-静脉血: 0.84mg/L；肌酐(Crea)-静脉血: 62.7umol/L；阴离子间隙(AG)-静脉血: 11；单核细胞计数(Mono#)-静脉血: 0.510E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.8mmol/L；载脂蛋白B(apoB)-静脉血: 0.81g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.8U/L；平均红细胞体积(MCV)-静脉血: 93.8fL；单核细胞百分比(Mono%)-静脉血: 0.149；C-反应蛋白(CRP)-静脉血: 0.37mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；淋巴细胞百分比(Lymph%)-静脉血: 0.352；有核红细胞百分比(NRBC%)-静脉血: 0；尿素氮(BUN)-静脉血: 7.54mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.17g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 40U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；直接胆红素(DBIL)-静脉血: 6.9umol/L；平均血小板体积(MPV)-静脉血: 9.04fL；红细胞计数(RBC#)-静脉血: 4.2310E12/L；总胆固醇(TC)-静脉血: 4.39mmol/L；总钙(Ca)-静脉血: 2.39mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.21mmolL；丙氨酸氨基转移酶(ALT)-静脉血: 28.6U/L；间接胆红素(IBIL)-静脉血: 11.6umolL；甘油三酯(TG)-静脉血: 0.5mmol/L；尿酸(UA)-静脉血: 332.9umol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32.2pg；中性粒细胞计数(Neut#)-静脉血: 1.510E9/L；总胆红素(TBIL)-静脉血: 18.5umol/L；乳酸脱氢酶(LDH)-静脉血: 145.6U/L；磷(P)-静脉血: 1.34mmol/L；碱性磷酸酶(ALP)-静脉血: 93.2U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D28] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者今日返院，一般情况可，无明显不适主诉，体查情况基本同前，患者现放疗计划已设计完成并通过全科会诊，NPDT70Gy/30F,CTV1:60Gy/30F,CTV2：54Gy/30F，靶区剂量分布均匀，正常组织剂量在可接受范围内。[姓名已隐去]副医生信息已隐藏，患者放疗计划设计完成，可行放疗前复位及验证等准备，开始放疗，患者既往血吸虫肝硬化病史，患者化疗后可能出现肝功能损伤，肝衰竭，严重者可危及生命，与患者及家属沟通后，患者及家属表示愿意承担化疗风险，予以择期行DDP单药每周同时期化疗。\n- [全程D29] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 今日查房，患者一般情况可，无明显不适主诉，体查同入院。[姓名已隐去]副医生信息已隐藏示：依约开始放疗，嘱患者注意营养与休息。\n- [全程D34] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者已开始行根治性放疗，现放疗2F，昨日完成一程同期化疗，诉额、双侧颞部头痛，一般情况尚可，体查情况基本同前。[姓名已隐去]副医生信息已隐藏：现患者已开始放疗，一程化疗结束，针对患者主诉，考虑放疗引起不良反应，予以止痛等对症处理，病情继观。\n- [全程D39] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现处于放化综合治疗中，放疗3F，无诉，体查情况基本同前，血常规、生化常规结果示：WBC3.33*10E9/L、中性粒1.5*10E9/L；[姓名已隐去]副医生信息已隐藏：现患者血象稍低，明日予以行同期化疗二程，化疗后予以复查血象后再予以升白等对症处理，密观病情。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停同期化疗，单纯行根治性放疗，立即予以重组人粒细胞集落刺激因子升白细胞治疗。\nB. 暂停放化疗，立即予以重组人粒细胞集落刺激因子，待白细胞恢复正常后再恢复放化综合治疗。\nC. 延迟第2程同期化疗，继续放疗，观察3天后复查血常规，若中性粒细胞达标再行化疗。\nD. 继续行第2程同期化疗，化疗前予以长效聚乙二醇化重组人粒细胞集落刺激因子预防性升白细胞。\nE. 继续行第2程同期化疗，化疗期间同步予以口服抗生素预防感染及静脉营养支持。\nF. 继续行第2程同期化疗，将顺铂剂量下调20%，并给予静脉营养、补液及通便等对症支持。\nG. 终止同期化疗，改为单纯放疗联合西妥昔单抗靶向治疗，并予以静脉营养支持。\nH. 继续行第2程同期化疗，化疗后立即常规予以重组人粒细胞集落刺激因子连续升白细胞治疗3天。\nI. 暂停放疗，按计划行第2程同期化疗，化疗后复查血象视情况予以升白细胞治疗。\nJ. 继续行第2程同期化疗，将顺铂更换为卡铂，并给予静脉营养、补液及通便等对症支持。\nK. 延迟第2程同期化疗，予以静脉营养、补液及通便等对症支持，待1周后复查血象再决定是否化疗。\nL. 继续行第2程同期化疗，化疗后复查血象视情况予以升白细胞治疗，并给予静脉营养、补液及通便等对症支持。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左颈肿物20天；现病史: 缘于20天前患者无意中出现左颈肿物，未伴涕血、耳鸣、听力下降、头痛、面麻等不适，某次就诊时间在当地医院行左颈淋巴结穿刺，病理示未见癌，某次就诊时间行鼻咽活检病理示鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物；既往史: 20余年前患“血吸虫”病行脾脏切除术，当地医院检查示“早期肝硬化”，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：37.3℃，P：62次/分，R：20次/分，BP：121/75mmHg,Ht：165cm，Wt：58kg，BSA：1.63m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率62次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽左侧顶后壁粘膜稍隆起；左侧颈部II区可扪及1个淋巴结，最大径1×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D27] 入院记录: 主诉: 确诊鼻咽癌1月余；现病史: 缘于某次就诊时间9月下旬患者无意中出现左颈肿物，未伴涕血、耳鸣、听力下降、头痛、面麻等不适，某次就诊时间在当地医院行左颈淋巴结穿刺，病理示未见癌，某次就诊时间行鼻咽活检病理示分化非角化癌。某次就诊时间日入院予以治疗前相关检查，明确诊断为鼻咽分化非角化癌，[分期信息见历史辅助诊断节点],III期，予以行放疗计划设计，现放疗计划设计完成，入院行放化综合治疗。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物；既往史: 20余年前患“血吸虫”病行脾脏切除术，当地医院检查示“早期肝硬化”，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：37.3℃，P：62次/分，R：20次/分，BP：121/75mmHg,Ht：165cm，Wt：58kg，BSA：1.63m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率62次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽左侧顶后壁粘膜稍隆起；左侧颈部II区可扪及1个淋巴结，最大径1×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D35] 检验组合: 碱性磷酸酶(ALP)-静脉血: 93.6U/L；丙氨酸氨基转移酶(ALT)-静脉血: 26.3U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.2U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 34.4U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.73；α-L-岩藻糖苷酶(AFU)-静脉血: 38.5U/L；乳酸脱氢酶(LDH)-静脉血: 195.7U/L；总胆汁酸(TBA)-静脉血: 2.9umol/L\n- [全程D39] 检验组合: 胱抑素(Cys-C)-静脉血: 0.84mg/L；肌酐(Crea)-静脉血: 62.7umol/L；阴离子间隙(AG)-静脉血: 11；单核细胞计数(Mono#)-静脉血: 0.510E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.8mmol/L；载脂蛋白B(apoB)-静脉血: 0.81g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.8U/L；平均红细胞体积(MCV)-静脉血: 93.8fL；单核细胞百分比(Mono%)-静脉血: 0.149；C-反应蛋白(CRP)-静脉血: 0.37mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；淋巴细胞百分比(Lymph%)-静脉血: 0.352；有核红细胞百分比(NRBC%)-静脉血: 0；尿素氮(BUN)-静脉血: 7.54mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.17g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 40U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；直接胆红素(DBIL)-静脉血: 6.9umol/L；平均血小板体积(MPV)-静脉血: 9.04fL；红细胞计数(RBC#)-静脉血: 4.2310E12/L；总胆固醇(TC)-静脉血: 4.39mmol/L；总钙(Ca)-静脉血: 2.39mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.21mmolL；丙氨酸氨基转移酶(ALT)-静脉血: 28.6U/L；间接胆红素(IBIL)-静脉血: 11.6umolL；甘油三酯(TG)-静脉血: 0.5mmol/L；尿酸(UA)-静脉血: 332.9umol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32.2pg；中性粒细胞计数(Neut#)-静脉血: 1.510E9/L；总胆红素(TBIL)-静脉血: 18.5umol/L；乳酸脱氢酶(LDH)-静脉血: 145.6U/L；磷(P)-静脉血: 1.34mmol/L；碱性磷酸酶(ALP)-静脉血: 93.2U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D28] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者今日返院，一般情况可，无明显不适主诉，体查情况基本同前，患者现放疗计划已设计完成并通过全科会诊，NPDT70Gy/30F,CTV1:60Gy/30F,CTV2：54Gy/30F，靶区剂量分布均匀，正常组织剂量在可接受范围内。[姓名已隐去]副医生信息已隐藏，患者放疗计划设计完成，可行放疗前复位及验证等准备，开始放疗，患者既往血吸虫肝硬化病史，患者化疗后可能出现肝功能损伤，肝衰竭，严重者可危及生命，与患者及家属沟通后，患者及家属表示愿意承担化疗风险，予以择期行DDP单药每周同时期化疗。\n- [全程D29] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 今日查房，患者一般情况可，无明显不适主诉，体查同入院。[姓名已隐去]副医生信息已隐藏示：依约开始放疗，嘱患者注意营养与休息。\n- [全程D34] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者已开始行根治性放疗，现放疗2F，昨日完成一程同期化疗，诉额、双侧颞部头痛，一般情况尚可，体查情况基本同前。[姓名已隐去]副医生信息已隐藏：现患者已开始放疗，一程化疗结束，针对患者主诉，考虑放疗引起不良反应，予以止痛等对症处理，病情继观。\n- [全程D39] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现处于放化综合治疗中，放疗3F，无诉，体查情况基本同前，血常规、生化常规结果示：WBC3.33*10E9/L、中性粒1.5*10E9/L；[姓名已隐去]副医生信息已隐藏：现患者血象稍低，明日予以行同期化疗二程，化疗后予以复查血象后再予以升白等对症处理，密观病情。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停同期化疗，单纯行根治性放疗，立即予以重组人粒细胞集落刺激因子升白细胞治疗。\nB. 暂停放化疗，立即予以重组人粒细胞集落刺激因子，待白细胞恢复正常后再恢复放化综合治疗。\nC. 延迟第2程同期化疗，继续放疗，观察3天后复查血常规，若中性粒细胞达标再行化疗。\nD. 继续行第2程同期化疗，化疗前予以长效聚乙二醇化重组人粒细胞集落刺激因子预防性升白细胞。\nE. 继续行第2程同期化疗，化疗期间同步予以口服抗生素预防感染及静脉营养支持。\nF. 继续行第2程同期化疗，将顺铂剂量下调20%，并给予静脉营养、补液及通便等对症支持。\nG. 终止同期化疗，改为单纯放疗联合西妥昔单抗靶向治疗，并予以静脉营养支持。\nH. 继续行第2程同期化疗，化疗后立即常规予以重组人粒细胞集落刺激因子连续升白细胞治疗3天。\nI. 暂停放疗，按计划行第2程同期化疗，化疗后复查血象视情况予以升白细胞治疗。\nJ. 继续行第2程同期化疗，将顺铂更换为卡铂，并给予静脉营养、补液及通便等对症支持。\nK. 延迟第2程同期化疗，予以静脉营养、补液及通便等对症支持，待1周后复查血象再决定是否化疗。\nL. 继续行第2程同期化疗，化疗后复查血象视情况予以升白细胞治疗，并给予静脉营养、补液及通便等对症支持。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、鼻腔。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左颈肿物20天；现病史: 缘于20天前患者无意中出现左颈肿物，未伴涕血、耳鸣、听力下降、头痛、面麻等不适，某次就诊时间在当地医院行左颈淋巴结穿刺，病理示未见癌，某次就诊时间行鼻咽活检病理示鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物；既往史: 20余年前患“血吸虫”病行脾脏切除术，当地医院检查示“早期肝硬化”，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：37.3℃，P：62次/分，R：20次/分，BP：121/75mmHg,Ht：165cm，Wt：58kg，BSA：1.63m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率62次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽左侧顶后壁粘膜稍隆起；左侧颈部II区可扪及1个淋巴结，最大径1×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D27] 入院记录: 主诉: 确诊鼻咽癌1月余；现病史: 缘于某次就诊时间9月下旬患者无意中出现左颈肿物，未伴涕血、耳鸣、听力下降、头痛、面麻等不适，某次就诊时间在当地医院行左颈淋巴结穿刺，病理示未见癌，某次就诊时间行鼻咽活检病理示分化非角化癌。某次就诊时间日入院予以治疗前相关检查，明确诊断为鼻咽分化非角化癌，[分期信息见历史辅助诊断节点],III期，予以行放疗计划设计，现放疗计划设计完成，入院行放化综合治疗。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物；既往史: 20余年前患“血吸虫”病行脾脏切除术，当地医院检查示“早期肝硬化”，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：37.3℃，P：62次/分，R：20次/分，BP：121/75mmHg,Ht：165cm，Wt：58kg，BSA：1.63m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率62次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽左侧顶后壁粘膜稍隆起；左侧颈部II区可扪及1个淋巴结，最大径1×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D35] 检验组合: 碱性磷酸酶(ALP)-静脉血: 93.6U/L；丙氨酸氨基转移酶(ALT)-静脉血: 26.3U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.2U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 34.4U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.73；α-L-岩藻糖苷酶(AFU)-静脉血: 38.5U/L；乳酸脱氢酶(LDH)-静脉血: 195.7U/L；总胆汁酸(TBA)-静脉血: 2.9umol/L\n- [全程D39] 检验组合: 胱抑素(Cys-C)-静脉血: 0.84mg/L；肌酐(Crea)-静脉血: 62.7umol/L；阴离子间隙(AG)-静脉血: 11；单核细胞计数(Mono#)-静脉血: 0.510E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.8mmol/L；载脂蛋白B(apoB)-静脉血: 0.81g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.8U/L；平均红细胞体积(MCV)-静脉血: 93.8fL；单核细胞百分比(Mono%)-静脉血: 0.149；C-反应蛋白(CRP)-静脉血: 0.37mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；淋巴细胞百分比(Lymph%)-静脉血: 0.352；有核红细胞百分比(NRBC%)-静脉血: 0；尿素氮(BUN)-静脉血: 7.54mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.17g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 40U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；直接胆红素(DBIL)-静脉血: 6.9umol/L；平均血小板体积(MPV)-静脉血: 9.04fL；红细胞计数(RBC#)-静脉血: 4.2310E12/L；总胆固醇(TC)-静脉血: 4.39mmol/L；总钙(Ca)-静脉血: 2.39mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.21mmolL；丙氨酸氨基转移酶(ALT)-静脉血: 28.6U/L；间接胆红素(IBIL)-静脉血: 11.6umolL；甘油三酯(TG)-静脉血: 0.5mmol/L；尿酸(UA)-静脉血: 332.9umol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32.2pg；中性粒细胞计数(Neut#)-静脉血: 1.510E9/L；总胆红素(TBIL)-静脉血: 18.5umol/L；乳酸脱氢酶(LDH)-静脉血: 145.6U/L；磷(P)-静脉血: 1.34mmol/L；碱性磷酸酶(ALP)-静脉血: 93.2U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D28] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者今日返院，一般情况可，无明显不适主诉，体查情况基本同前，患者现放疗计划已设计完成并通过全科会诊，NPDT70Gy/30F,CTV1:60Gy/30F,CTV2：54Gy/30F，靶区剂量分布均匀，正常组织剂量在可接受范围内。[姓名已隐去]副医生信息已隐藏，患者放疗计划设计完成，可行放疗前复位及验证等准备，开始放疗，患者既往血吸虫肝硬化病史，患者化疗后可能出现肝功能损伤，肝衰竭，严重者可危及生命，与患者及家属沟通后，患者及家属表示愿意承担化疗风险，予以择期行DDP单药每周同时期化疗。\n- [全程D29] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 今日查房，患者一般情况可，无明显不适主诉，体查同入院。[姓名已隐去]副医生信息已隐藏示：依约开始放疗，嘱患者注意营养与休息。\n- [全程D34] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者已开始行根治性放疗，现放疗2F，昨日完成一程同期化疗，诉额、双侧颞部头痛，一般情况尚可，体查情况基本同前。[姓名已隐去]副医生信息已隐藏：现患者已开始放疗，一程化疗结束，针对患者主诉，考虑放疗引起不良反应，予以止痛等对症处理，病情继观。\n- [全程D39] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现处于放化综合治疗中，放疗3F，无诉，体查情况基本同前，血常规、生化常规结果示：WBC3.33*10E9/L、中性粒1.5*10E9/L；[姓名已隐去]副医生信息已隐藏：现患者血象稍低，明日予以行同期化疗二程，化疗后予以复查血象后再予以升白等对症处理，密观病情。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停同期化疗，单纯行根治性放疗，立即予以重组人粒细胞集落刺激因子升白细胞治疗。\nB. 暂停放化疗，立即予以重组人粒细胞集落刺激因子，待白细胞恢复正常后再恢复放化综合治疗。\nC. 延迟第2程同期化疗，继续放疗，观察3天后复查血常规，若中性粒细胞达标再行化疗。\nD. 继续行第2程同期化疗，化疗前予以长效聚乙二醇化重组人粒细胞集落刺激因子预防性升白细胞。\nE. 继续行第2程同期化疗，化疗期间同步予以口服抗生素预防感染及静脉营养支持。\nF. 继续行第2程同期化疗，将顺铂剂量下调20%，并给予静脉营养、补液及通便等对症支持。\nG. 终止同期化疗，改为单纯放疗联合西妥昔单抗靶向治疗，并予以静脉营养支持。\nH. 继续行第2程同期化疗，化疗后立即常规予以重组人粒细胞集落刺激因子连续升白细胞治疗3天。\nI. 暂停放疗，按计划行第2程同期化疗，化疗后复查血象视情况予以升白细胞治疗。\nJ. 继续行第2程同期化疗，将顺铂更换为卡铂，并给予静脉营养、补液及通便等对症支持。\nK. 延迟第2程同期化疗，予以静脉营养、补液及通便等对症支持，待1周后复查血象再决定是否化疗。\nL. 继续行第2程同期化疗，化疗后复查血象视情况予以升白细胞治疗，并给予静脉营养、补液及通便等对症支持。\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-5f99c90d4e8627eaecab64fc","patient_id":"patient-02ca51eed4fedbb13e4db76d","turn_id":"turn06","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"A","gold_action":"继续按计划行放化综合治疗，并进行静脉导管常规维护。","options":[{"letter":"A","text":"继续按计划行放化综合治疗，并进行静脉导管常规维护。","is_gold":true},{"letter":"B","text":"暂停放化疗，再次给予粒细胞集落刺激因子（G-CSF）升白治疗。","is_gold":false},{"letter":"C","text":"暂停同期化疗，仅继续单纯放射治疗，并进行静脉导管常规维护。","is_gold":false},{"letter":"D","text":"继续按计划行放化综合治疗，并预防性输注单采血小板。","is_gold":false},{"letter":"E","text":"暂停放化疗，经验性给予广谱静脉抗生素抗感染治疗。","is_gold":false},{"letter":"F","text":"继续按计划行放化综合治疗，并预防性给予重组人促红素（EPO）治疗。","is_gold":false},{"letter":"G","text":"继续按计划行放化综合治疗，并拔除静脉留置导管改为口服给药。","is_gold":false},{"letter":"H","text":"继续按计划行放化综合治疗，但将后续同期化疗剂量减量20%。","is_gold":false},{"letter":"I","text":"提前结束同期化疗，仅继续完成剩余放射治疗。","is_gold":false},{"letter":"J","text":"暂停放化疗，给予保肝降酶药物静脉滴注。","is_gold":false},{"letter":"K","text":"继续按计划行放化综合治疗，并预防性给予白介素-11（IL-11）治疗。","is_gold":false},{"letter":"L","text":"继续按计划行放化综合治疗，并加用大剂量静脉糖皮质激素治疗。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、鼻腔。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左颈肿物20天；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物；既往史: 20余年前患“血吸虫”病行脾脏切除术，当地医院检查示“早期肝硬化”，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：37.3℃，P：62次/分，R：20次/分，BP：121/75mmHg,Ht：165cm，Wt：58kg，BSA：1.63m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽左侧顶后壁粘膜稍隆起；左侧颈部II区可扪及1个淋巴结，最大径1×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 左颈肿物20天；现病史: 缘于20天前患者无意中出现左颈肿物，未伴涕血、耳鸣、听力下降、头痛、面麻等不适，某次就诊时间在当地医院行左颈淋巴结穿刺，病理示未见癌，某次就诊时间行鼻咽活检病理示鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物；既往史: 20余年前患“血吸虫”病行脾脏切除术，当地医院检查示“早期肝硬化”，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：37.3℃，P：62次/分，R：20次/分，BP：121/75mmHg,Ht：165cm，Wt：58kg，BSA：1.63m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率62次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽左侧顶后壁粘膜稍隆起；左侧颈部II区可扪及1个淋巴结，最大径1×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D27] 入院记录: 主诉: 确诊鼻咽癌1月余；现病史: 缘于某次就诊时间9月下旬患者无意中出现左颈肿物，未伴涕血、耳鸣、听力下降、头痛、面麻等不适，某次就诊时间在当地医院行左颈淋巴结穿刺，病理示未见癌，某次就诊时间行鼻咽活检病理示分化非角化癌。某次就诊时间日入院予以治疗前相关检查，明确诊断为鼻咽分化非角化癌，[分期信息见历史辅助诊断节点],III期，予以行放疗计划设计，现放疗计划设计完成，入院行放化综合治疗。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物；既往史: 20余年前患“血吸虫”病行脾脏切除术，当地医院检查示“早期肝硬化”，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：37.3℃，P：62次/分，R：20次/分，BP：121/75mmHg,Ht：165cm，Wt：58kg，BSA：1.63m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率62次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽左侧顶后壁粘膜稍隆起；左侧颈部II区可扪及1个淋巴结，最大径1×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 逆钟向转位 正常范围心电图\n- [全程D1] 检验组合: 肌酐(Crea)-静脉血: 56.1umol/L；阴离子间隙(AG)-静脉血: 11.1；α-L-岩藻糖苷酶(AFU)-静脉血: 35.5U/L；凝血酶原时间(PT)-静脉血: 11.7sec.；胱抑素(Cys-C)-静脉血: 0.85mg/L；淋巴细胞百分比(Lymph%)-静脉血: 0.428；骨钙素N端中分子片段(N-MID)-静脉血: 19.3ng/ml；纤维蛋白原(Fbg)-静脉血: 2.07g/L；钠离子(Na+)-静脉血: 140.5mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；总钙(Ca)-静脉血: 2.29mmol/L；乳酸脱氢酶(LDH)-静脉血: 164U/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.44；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.35mmol/L；血小板分布宽度(PDW)-静脉血: 15.9%；平均红细胞血红蛋白含量(MCH)-静脉血: 31.5pg；总胆固醇(TC)-静脉血: 4.12mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；Rh血型-静脉血: 阳性；红细胞比容(Hct)-静脉血: 41.2%；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 9.9umolL；D-二聚体(D-Dimer)-静脉血: 5.09ug/ml；钾离子(K+)-静脉血: 4.24mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.424；直接胆红素(DBIL)-静脉血: 5.8umol/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；天门冬氨酸氨基转移酶(AST)-静脉血: 18.6U/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；透明质酸(HA)-静脉血: 71.337ng/ml；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.5；纤维蛋白原降解产物(FDP)-静脉血:……\n- [全程D2] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双下肺纹理稍粗，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n- [全程D4] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏形态失常，表面凸凹不平，边缘钝，肝实质回声不均匀，明显增强、粗糙，肝内未见明确肿块回声。门静脉主干内径约15mm。肝静脉、门静脉内未见异常回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约14cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏术后缺如。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约35×24×23mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝硬化声像。 脾脏术后缺如。 胆囊、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D7] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 左上颌骨可见片状放射性浓集灶。胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 左上颌骨炎症。 余全身骨骼未见明显异常。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D35] 检验组合: 碱性磷酸酶(ALP)-静脉血: 93.6U/L；丙氨酸氨基转移酶(ALT)-静脉血: 26.3U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.2U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 34.4U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.73；α-L-岩藻糖苷酶(AFU)-静脉血: 38.5U/L；乳酸脱氢酶(LDH)-静脉血: 195.7U/L；总胆汁酸(TBA)-静脉血: 2.9umol/L\n- [全程D39] 检验组合: 胱抑素(Cys-C)-静脉血: 0.84mg/L；肌酐(Crea)-静脉血: 62.7umol/L；阴离子间隙(AG)-静脉血: 11；单核细胞计数(Mono#)-静脉血: 0.510E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.8mmol/L；载脂蛋白B(apoB)-静脉血: 0.81g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.8U/L；平均红细胞体积(MCV)-静脉血: 93.8fL；单核细胞百分比(Mono%)-静脉血: 0.149；C-反应蛋白(CRP)-静脉血: 0.37mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；淋巴细胞百分比(Lymph%)-静脉血: 0.352；有核红细胞百分比(NRBC%)-静脉血: 0；尿素氮(BUN)-静脉血: 7.54mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.17g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 40U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；直接胆红素(DBIL)-静脉血: 6.9umol/L；平均血小板体积(MPV)-静脉血: 9.04fL；红细胞计数(RBC#)-静脉血: 4.2310E12/L；总胆固醇(TC)-静脉血: 4.39mmol/L；总钙(Ca)-静脉血: 2.39mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.21mmolL；丙氨酸氨基转移酶(ALT)-静脉血: 28.6U/L；间接胆红素(IBIL)-静脉血: 11.6umolL；甘油三酯(TG)-静脉血: 0.5mmol/L；尿酸(UA)-静脉血: 332.9umol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32.2pg；中性粒细胞计数(Neut#)-静脉血: 1.510E9/L；总胆红素(TBIL)-静脉血: 18.5umol/L；乳酸脱氢酶(LDH)-静脉血: 145.6U/L；磷(P)-静脉血: 1.34mmol/L；碱性磷酸酶(ALP)-静脉血: 93.2U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0……\n- [全程D42] 检验组合: 红细胞比容(Hct)-静脉血: 38.5%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 335g/L；红细胞计数(RBC#)-静脉血: 4.1110E12/L；平均红细胞体积(MCV)-静脉血: 93.7fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；血小板计数(PLT#)-静脉血: 26910E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；碱性磷酸酶(ALP)-静脉血: 88U/L；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18U/L；中性粒细胞百分比(Neut%)-静脉血: 0.659；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.019；乳酸脱氢酶(LDH)-静脉血: 139.5U/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6；α-L-岩藻糖苷酶(AFU)-静脉血: 41U/L；血小板分布宽度(PDW)-静脉血: 11.5%；中性粒细胞计数(Neut#)-静脉血: 2.110E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 24.4U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；平均红细胞血红蛋白含量(MCH)-静脉血: 31.4pg；总胆汁酸(TBA)-静脉血: 1umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 33.2U/L；平均血小板体积(MPV)-静脉血: 10.3fL；白细胞计数(WBC#)-静脉血: 3.1410E9/L；大血小板百分比(P-LCR%)-静脉血: 26.3%；单核细胞计数(Mono#)-静脉血: 0.410E9/L；血红蛋白(Hb)-静脉血: 129g/L；单核细胞百分比(Mono%)-静脉血: 0.134；血小板比容-静脉血: 28%；淋巴细胞百分比(Lymph%)-静脉血: 0.185；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43\n- [全程D46] 检验组合: 平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；C-反应蛋白(CRP)-静脉血: 0.38mg/L；γ-谷氨酰基转移酶(GGT)-静脉血: 34.2U/L；尿酸(UA)-静脉血: 292.5umol/L；红细胞计数(RBC#)-静脉血: 4.0510E12/L；总蛋白(TP)-静脉血: 70.3g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞计数(Neut#)-静脉血: 1.410E9/L；磷(P)-静脉血: 1.21mmol/L；总胆固醇(TC)-静脉血: 3.73mmol/L；单核细胞百分比(Mono%)-静脉血: 0.167；总钙(Ca)-静脉血: 2.2mmol/L；胱抑素(Cys-C)-静脉血: 0.68mg/L；葡萄糖(Glu)-静脉血: 4.54mmol/L；白细胞计数(WBC#)-静脉血: 2.3910E9/L；载脂蛋白B(apoB)-静脉血: 0.82g/L；直接胆红素(DBIL)-静脉血: 4.6umol/L；镁离子(Mg2+)-静脉血: 0.76mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.89；氯离子(Cl-)-静脉血: 100.1mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.197；肌酐(Crea)-静脉血: 56.4umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；血小板比容-静脉血: 22%；碱性磷酸酶(ALP)-静脉血: 81.9U/L；钾离子(K+)-静脉血: 4.1mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.1；球蛋白(GLO)-静脉血: 29.4g/L；总胆汁酸(TBA)-静脉血: 1.4umol/L；尿素氮(BUN)-静脉血: 6.3mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.4pg；天门冬氨酸氨基转移酶(AST)-静脉血: 17.1U/L；血小板计数(PLT#)-静脉血: 21610E9/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.09g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；钠离子(Na+)-静脉血: 138.5mmol/L；淋巴细胞计数(Lymph#)……\n- [全程D49] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；白细胞计数(WBC#)-静脉血: 28.910E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0；平均红细胞体积(MCV)-静脉血: 96.4fL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.77；α-L-岩藻糖苷酶(AFU)-静脉血: 37.1U/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.003；平均血小板体积(MPV)-静脉血: 8.48fL；血小板计数(PLT#)-静脉血: 16710E9/L；红细胞计数(RBC#)-静脉血: 3.9610E12/L；碱性磷酸酶(ALP)-静脉血: 119.8U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32.2pg；中性粒细胞百分比(Neut%)-静脉血: 0.933；血小板分布宽度(PDW)-静脉血: 15.7%；血小板比容-静脉血: 14.1%；中性粒细胞计数(Neut#)-静脉血: 2710E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 13.5U/L；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；红细胞比容(Hct)-静脉血: 38.2%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 334.1g/L；总胆汁酸(TBA)-静脉血: 1.5umol/L；单核细胞百分比(Mono%)-静脉血: 0.035；单核细胞计数(Mono#)-静脉血: 110E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 17.5U/L；血红蛋白(Hb)-静脉血: 127.7g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.028；乳酸脱氢酶(LDH)-静脉血: 177U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 34.4U/L\n- [全程D53] 检验组合: 总胆固醇(TC)-静脉血: 4.04mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 17.7U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.8；血小板计数(PLT#)-静脉血: 199.710E9/L；镁离子(Mg2+)-静脉血: 0.73mmol/L；红细胞比容(Hct)-静脉血: 38.2%；总蛋白(TP)-静脉血: 70.35g/L；载脂蛋白B(apoB)-静脉血: 0.83g/L；尿酸(UA)-静脉血: 359.2umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.133；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.6；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；血小板分布宽度(PDW)-静脉血: 15.6%；中性粒细胞百分比(Neut%)-静脉血: 0.671；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；球蛋白(GLO)-静脉血: 26.85g/L；氯离子(Cl-)-静脉血: 102.6mmol/L；肌酐(Crea)-静脉血: 59umol/L；平均红细胞体积(MCV)-静脉血: 95.9fL；血小板比容-静脉血: 16.6%；红细胞计数(RBC#)-静脉血: 3.9810E12/L；C-反应蛋白(CRP)-静脉血: 0.91mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.69mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 337.3g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.11mmolL；白蛋白(ALB)-静脉血: 43.5g/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32.3pg；白细胞计数(WBC#)-静脉血: 3.9610E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 38U/L；甘油三酯(TG)-静脉血: 0.67mmol/L；平均血小板体积(MPV)-静脉血: 8.31fL；葡萄糖(Glu)-静脉血: 4.61mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.6%；单核细胞百分比(Mono%)-静脉血: 0.143；总钙(Ca)-静脉血: 2.28mmol/L；血……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D28] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者今日返院，一般情况可，无明显不适主诉，体查情况基本同前，患者现放疗计划已设计完成并通过全科会诊，NPDT70Gy/30F,CTV1:60Gy/30F,CTV2：54Gy/30F，靶区剂量分布均匀，正常组织剂量在可接受范围内。[姓名已隐去]副医生信息已隐藏，患者放疗计划设计完成，可行放疗前复位及验证等准备，开始放疗，患者既往血吸虫肝硬化病史，患者化疗后可能出现肝功能损伤，肝衰竭，严重者可危及生命，与患者及家属沟通后，患者及家属表示愿意承担化疗风险，予以择期行DDP单药每周同时期化疗。\n- [全程D29] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 今日查房，患者一般情况可，无明显不适主诉，体查同入院。[姓名已隐去]副医生信息已隐藏示：依约开始放疗，嘱患者注意营养与休息。\n- [全程D34] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者已开始行根治性放疗，现放疗2F，昨日完成一程同期化疗，诉额、双侧颞部头痛，一般情况尚可，体查情况基本同前。[姓名已隐去]副医生信息已隐藏：现患者已开始放疗，一程化疗结束，针对患者主诉，考虑放疗引起不良反应，予以止痛等对症处理，病情继观。\n- [全程D39] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现处于放化综合治疗中，放疗3F，无诉，体查情况基本同前，血常规、生化常规结果示：WBC3.33*10E9/L、中性粒1.5*10E9/L；[姓名已隐去]副医生信息已隐藏：现患者血象稍低，明日予以行同期化疗二程，化疗后予以复查血象后再予以升白等对症处理，密观病情。\n- [全程D44] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现处于放化综合治疗中，放疗8F，诉口苦，体查情况基本同前，21号复查血常规、生化常规结果基本正常；[姓名已隐去]副医生信息已隐藏：现患者已完成同期化疗二程，继续放疗，余治疗不变，密观病情。\n- [全程D49] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现处于放化综合治疗中，放疗10F，诉喉咙疼痛，体查情况基本同前，25号血常规、生化常规结果示：WBC2.39*10E9/L、中性粒1.4*10E9/L，今日复查血常规、肝肾功能结果基本正常；[姓名已隐去]副医生信息已隐藏：患者25号血象示2度骨髓抑制，予以升白等对症处理，并于26号予以三程同期化疗，今日复查血象已恢复，继续予以放化综合治疗，密观病情。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 继续按计划行放化综合治疗，并进行静脉导管常规维护。\nB. 暂停放化疗，再次给予粒细胞集落刺激因子（G-CSF）升白治疗。\nC. 暂停同期化疗，仅继续单纯放射治疗，并进行静脉导管常规维护。\nD. 继续按计划行放化综合治疗，并预防性输注单采血小板。\nE. 暂停放化疗，经验性给予广谱静脉抗生素抗感染治疗。\nF. 继续按计划行放化综合治疗，并预防性给予重组人促红素（EPO）治疗。\nG. 继续按计划行放化综合治疗，并拔除静脉留置导管改为口服给药。\nH. 继续按计划行放化综合治疗，但将后续同期化疗剂量减量20%。\nI. 提前结束同期化疗，仅继续完成剩余放射治疗。\nJ. 暂停放化疗，给予保肝降酶药物静脉滴注。\nK. 继续按计划行放化综合治疗，并预防性给予白介素-11（IL-11）治疗。\nL. 继续按计划行放化综合治疗，并加用大剂量静脉糖皮质激素治疗。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D42] 检验组合: 红细胞比容(Hct)-静脉血: 38.5%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 335g/L；红细胞计数(RBC#)-静脉血: 4.1110E12/L；平均红细胞体积(MCV)-静脉血: 93.7fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；血小板计数(PLT#)-静脉血: 26910E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；碱性磷酸酶(ALP)-静脉血: 88U/L；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18U/L；中性粒细胞百分比(Neut%)-静脉血: 0.659；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.019；乳酸脱氢酶(LDH)-静脉血: 139.5U/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6；α-L-岩藻糖苷酶(AFU)-静脉血: 41U/L；血小板分布宽度(PDW)-静脉血: 11.5%；中性粒细胞计数(Neut#)-静脉血: 2.110E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 24.4U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；平均红细胞血红蛋白含量(MCH)-静脉血: 31.4pg；总胆汁酸(TBA)-静脉血: 1umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 33.2U/L；平均血小板体积(MPV)-静脉血: 10.3fL；白细胞计数(WBC#)-静脉血: 3.1410E9/L；大血小板百分比(P-LCR%)-静脉血: 26.3%；单核细胞计数(Mono#)-静脉血: 0.410E9/L；血红蛋白(Hb)-静脉血: 129g/L；单核细胞百分比(Mono%)-静脉血: 0.134；血小板比容-静脉血: 28%；淋巴细胞百分比(Lymph%)-静脉血: 0.185；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43\n- [全程D46] 检验组合: 平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；C-反应蛋白(CRP)-静脉血: 0.38mg/L；γ-谷氨酰基转移酶(GGT)-静脉血: 34.2U/L；尿酸(UA)-静脉血: 292.5umol/L；红细胞计数(RBC#)-静脉血: 4.0510E12/L；总蛋白(TP)-静脉血: 70.3g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞计数(Neut#)-静脉血: 1.410E9/L；磷(P)-静脉血: 1.21mmol/L；总胆固醇(TC)-静脉血: 3.73mmol/L；单核细胞百分比(Mono%)-静脉血: 0.167；总钙(Ca)-静脉血: 2.2mmol/L；胱抑素(Cys-C)-静脉血: 0.68mg/L；葡萄糖(Glu)-静脉血: 4.54mmol/L；白细胞计数(WBC#)-静脉血: 2.3910E9/L；载脂蛋白B(apoB)-静脉血: 0.82g/L；直接胆红素(DBIL)-静脉血: 4.6umol/L；镁离子(Mg2+)-静脉血: 0.76mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.89；氯离子(Cl-)-静脉血: 100.1mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.197；肌酐(Crea)-静脉血: 56.4umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；血小板比容-静脉血: 22%；碱性磷酸酶(ALP)-静脉血: 81.9U/L；钾离子(K+)-静脉血: 4.1mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.1；球蛋白(GLO)-静脉血: 29.4g/L；总胆汁酸(TBA)-静脉血: 1.4umol/L；尿素氮(BUN)-静脉血: 6.3mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.4pg；天门冬氨酸氨基转移酶(AST)-静脉血: 17.1U/L；血小板计数(PLT#)-静脉血: 21610E9/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.09g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；钠离子(Na+)-静脉血: 138.5mmol/L；淋巴细胞计数(Lymph#)……\n- [全程D49] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；白细胞计数(WBC#)-静脉血: 28.910E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0；平均红细胞体积(MCV)-静脉血: 96.4fL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.77；α-L-岩藻糖苷酶(AFU)-静脉血: 37.1U/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.003；平均血小板体积(MPV)-静脉血: 8.48fL；血小板计数(PLT#)-静脉血: 16710E9/L；红细胞计数(RBC#)-静脉血: 3.9610E12/L；碱性磷酸酶(ALP)-静脉血: 119.8U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32.2pg；中性粒细胞百分比(Neut%)-静脉血: 0.933；血小板分布宽度(PDW)-静脉血: 15.7%；血小板比容-静脉血: 14.1%；中性粒细胞计数(Neut#)-静脉血: 2710E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 13.5U/L；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；红细胞比容(Hct)-静脉血: 38.2%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 334.1g/L；总胆汁酸(TBA)-静脉血: 1.5umol/L；单核细胞百分比(Mono%)-静脉血: 0.035；单核细胞计数(Mono#)-静脉血: 110E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 17.5U/L；血红蛋白(Hb)-静脉血: 127.7g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.028；乳酸脱氢酶(LDH)-静脉血: 177U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 34.4U/L\n- [全程D53] 检验组合: 总胆固醇(TC)-静脉血: 4.04mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 17.7U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.8；血小板计数(PLT#)-静脉血: 199.710E9/L；镁离子(Mg2+)-静脉血: 0.73mmol/L；红细胞比容(Hct)-静脉血: 38.2%；总蛋白(TP)-静脉血: 70.35g/L；载脂蛋白B(apoB)-静脉血: 0.83g/L；尿酸(UA)-静脉血: 359.2umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.133；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.6；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；血小板分布宽度(PDW)-静脉血: 15.6%；中性粒细胞百分比(Neut%)-静脉血: 0.671；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；球蛋白(GLO)-静脉血: 26.85g/L；氯离子(Cl-)-静脉血: 102.6mmol/L；肌酐(Crea)-静脉血: 59umol/L；平均红细胞体积(MCV)-静脉血: 95.9fL；血小板比容-静脉血: 16.6%；红细胞计数(RBC#)-静脉血: 3.9810E12/L；C-反应蛋白(CRP)-静脉血: 0.91mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.69mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 337.3g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.11mmolL；白蛋白(ALB)-静脉血: 43.5g/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32.3pg；白细胞计数(WBC#)-静脉血: 3.9610E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 38U/L；甘油三酯(TG)-静脉血: 0.67mmol/L；平均血小板体积(MPV)-静脉血: 8.31fL；葡萄糖(Glu)-静脉血: 4.61mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.6%；单核细胞百分比(Mono%)-静脉血: 0.143；总钙(Ca)-静脉血: 2.28mmol/L；血……\n\n【既往治疗与反应】\n- [全程D44] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现处于放化综合治疗中，放疗8F，诉口苦，体查情况基本同前，21号复查血常规、生化常规结果基本正常；[姓名已隐去]副医生信息已隐藏：现患者已完成同期化疗二程，继续放疗，余治疗不变，密观病情。\n- [全程D49] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现处于放化综合治疗中，放疗10F，诉喉咙疼痛，体查情况基本同前，25号血常规、生化常规结果示：WBC2.39*10E9/L、中性粒1.4*10E9/L，今日复查血常规、肝肾功能结果基本正常；[姓名已隐去]副医生信息已隐藏：患者25号血象示2度骨髓抑制，予以升白等对症处理，并于26号予以三程同期化疗，今日复查血象已恢复，继续予以放化综合治疗，密观病情。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 继续按计划行放化综合治疗，并进行静脉导管常规维护。\nB. 暂停放化疗，再次给予粒细胞集落刺激因子（G-CSF）升白治疗。\nC. 暂停同期化疗，仅继续单纯放射治疗，并进行静脉导管常规维护。\nD. 继续按计划行放化综合治疗，并预防性输注单采血小板。\nE. 暂停放化疗，经验性给予广谱静脉抗生素抗感染治疗。\nF. 继续按计划行放化综合治疗，并预防性给予重组人促红素（EPO）治疗。\nG. 继续按计划行放化综合治疗，并拔除静脉留置导管改为口服给药。\nH. 继续按计划行放化综合治疗，但将后续同期化疗剂量减量20%。\nI. 提前结束同期化疗，仅继续完成剩余放射治疗。\nJ. 暂停放化疗，给予保肝降酶药物静脉滴注。\nK. 继续按计划行放化综合治疗，并预防性给予白介素-11（IL-11）治疗。\nL. 继续按计划行放化综合治疗，并加用大剂量静脉糖皮质激素治疗。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、鼻腔。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D42] 检验组合: 红细胞比容(Hct)-静脉血: 38.5%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 335g/L；红细胞计数(RBC#)-静脉血: 4.1110E12/L；平均红细胞体积(MCV)-静脉血: 93.7fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；血小板计数(PLT#)-静脉血: 26910E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；碱性磷酸酶(ALP)-静脉血: 88U/L；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18U/L；中性粒细胞百分比(Neut%)-静脉血: 0.659；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.019；乳酸脱氢酶(LDH)-静脉血: 139.5U/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6；α-L-岩藻糖苷酶(AFU)-静脉血: 41U/L；血小板分布宽度(PDW)-静脉血: 11.5%；中性粒细胞计数(Neut#)-静脉血: 2.110E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 24.4U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；平均红细胞血红蛋白含量(MCH)-静脉血: 31.4pg；总胆汁酸(TBA)-静脉血: 1umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 33.2U/L；平均血小板体积(MPV)-静脉血: 10.3fL；白细胞计数(WBC#)-静脉血: 3.1410E9/L；大血小板百分比(P-LCR%)-静脉血: 26.3%；单核细胞计数(Mono#)-静脉血: 0.410E9/L；血红蛋白(Hb)-静脉血: 129g/L；单核细胞百分比(Mono%)-静脉血: 0.134；血小板比容-静脉血: 28%；淋巴细胞百分比(Lymph%)-静脉血: 0.185；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43\n- [全程D46] 检验组合: 平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；C-反应蛋白(CRP)-静脉血: 0.38mg/L；γ-谷氨酰基转移酶(GGT)-静脉血: 34.2U/L；尿酸(UA)-静脉血: 292.5umol/L；红细胞计数(RBC#)-静脉血: 4.0510E12/L；总蛋白(TP)-静脉血: 70.3g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞计数(Neut#)-静脉血: 1.410E9/L；磷(P)-静脉血: 1.21mmol/L；总胆固醇(TC)-静脉血: 3.73mmol/L；单核细胞百分比(Mono%)-静脉血: 0.167；总钙(Ca)-静脉血: 2.2mmol/L；胱抑素(Cys-C)-静脉血: 0.68mg/L；葡萄糖(Glu)-静脉血: 4.54mmol/L；白细胞计数(WBC#)-静脉血: 2.3910E9/L；载脂蛋白B(apoB)-静脉血: 0.82g/L；直接胆红素(DBIL)-静脉血: 4.6umol/L；镁离子(Mg2+)-静脉血: 0.76mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.89；氯离子(Cl-)-静脉血: 100.1mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.197；肌酐(Crea)-静脉血: 56.4umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；血小板比容-静脉血: 22%；碱性磷酸酶(ALP)-静脉血: 81.9U/L；钾离子(K+)-静脉血: 4.1mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.1；球蛋白(GLO)-静脉血: 29.4g/L；总胆汁酸(TBA)-静脉血: 1.4umol/L；尿素氮(BUN)-静脉血: 6.3mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.4pg；天门冬氨酸氨基转移酶(AST)-静脉血: 17.1U/L；血小板计数(PLT#)-静脉血: 21610E9/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.09g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；钠离子(Na+)-静脉血: 138.5mmol/L；淋巴细胞计数(Lymph#)……\n- [全程D49] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；白细胞计数(WBC#)-静脉血: 28.910E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0；平均红细胞体积(MCV)-静脉血: 96.4fL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.77；α-L-岩藻糖苷酶(AFU)-静脉血: 37.1U/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.003；平均血小板体积(MPV)-静脉血: 8.48fL；血小板计数(PLT#)-静脉血: 16710E9/L；红细胞计数(RBC#)-静脉血: 3.9610E12/L；碱性磷酸酶(ALP)-静脉血: 119.8U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32.2pg；中性粒细胞百分比(Neut%)-静脉血: 0.933；血小板分布宽度(PDW)-静脉血: 15.7%；血小板比容-静脉血: 14.1%；中性粒细胞计数(Neut#)-静脉血: 2710E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 13.5U/L；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；红细胞比容(Hct)-静脉血: 38.2%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 334.1g/L；总胆汁酸(TBA)-静脉血: 1.5umol/L；单核细胞百分比(Mono%)-静脉血: 0.035；单核细胞计数(Mono#)-静脉血: 110E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 17.5U/L；血红蛋白(Hb)-静脉血: 127.7g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.028；乳酸脱氢酶(LDH)-静脉血: 177U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 34.4U/L\n- [全程D53] 检验组合: 总胆固醇(TC)-静脉血: 4.04mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 17.7U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.8；血小板计数(PLT#)-静脉血: 199.710E9/L；镁离子(Mg2+)-静脉血: 0.73mmol/L；红细胞比容(Hct)-静脉血: 38.2%；总蛋白(TP)-静脉血: 70.35g/L；载脂蛋白B(apoB)-静脉血: 0.83g/L；尿酸(UA)-静脉血: 359.2umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.133；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.6；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；血小板分布宽度(PDW)-静脉血: 15.6%；中性粒细胞百分比(Neut%)-静脉血: 0.671；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；球蛋白(GLO)-静脉血: 26.85g/L；氯离子(Cl-)-静脉血: 102.6mmol/L；肌酐(Crea)-静脉血: 59umol/L；平均红细胞体积(MCV)-静脉血: 95.9fL；血小板比容-静脉血: 16.6%；红细胞计数(RBC#)-静脉血: 3.9810E12/L；C-反应蛋白(CRP)-静脉血: 0.91mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.69mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 337.3g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.11mmolL；白蛋白(ALB)-静脉血: 43.5g/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32.3pg；白细胞计数(WBC#)-静脉血: 3.9610E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 38U/L；甘油三酯(TG)-静脉血: 0.67mmol/L；平均血小板体积(MPV)-静脉血: 8.31fL；葡萄糖(Glu)-静脉血: 4.61mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.6%；单核细胞百分比(Mono%)-静脉血: 0.143；总钙(Ca)-静脉血: 2.28mmol/L；血……\n\n【既往治疗与反应】\n- [全程D44] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现处于放化综合治疗中，放疗8F，诉口苦，体查情况基本同前，21号复查血常规、生化常规结果基本正常；[姓名已隐去]副医生信息已隐藏：现患者已完成同期化疗二程，继续放疗，余治疗不变，密观病情。\n- [全程D49] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现处于放化综合治疗中，放疗10F，诉喉咙疼痛，体查情况基本同前，25号血常规、生化常规结果示：WBC2.39*10E9/L、中性粒1.4*10E9/L，今日复查血常规、肝肾功能结果基本正常；[姓名已隐去]副医生信息已隐藏：患者25号血象示2度骨髓抑制，予以升白等对症处理，并于26号予以三程同期化疗，今日复查血象已恢复，继续予以放化综合治疗，密观病情。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 继续按计划行放化综合治疗，并进行静脉导管常规维护。\nB. 暂停放化疗，再次给予粒细胞集落刺激因子（G-CSF）升白治疗。\nC. 暂停同期化疗，仅继续单纯放射治疗，并进行静脉导管常规维护。\nD. 继续按计划行放化综合治疗，并预防性输注单采血小板。\nE. 暂停放化疗，经验性给予广谱静脉抗生素抗感染治疗。\nF. 继续按计划行放化综合治疗，并预防性给予重组人促红素（EPO）治疗。\nG. 继续按计划行放化综合治疗，并拔除静脉留置导管改为口服给药。\nH. 继续按计划行放化综合治疗，但将后续同期化疗剂量减量20%。\nI. 提前结束同期化疗，仅继续完成剩余放射治疗。\nJ. 暂停放化疗，给予保肝降酶药物静脉滴注。\nK. 继续按计划行放化综合治疗，并预防性给予白介素-11（IL-11）治疗。\nL. 继续按计划行放化综合治疗，并加用大剂量静脉糖皮质激素治疗。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"episode_id":"episode-49430ca00123363359b32fc0","patient_id":"patient-36d433557e63f939b878347d","care_turn_count":6,"turns":[{"sample_id":"sample-46fc2f7bd9dd0872ef1b356e","patient_id":"patient-36d433557e63f939b878347d","turn_id":"turn02","turn_position":1,"turn_type":"imaging_release_workup","gold_letter":"E","gold_action":"行鼻咽镜下肿物活检以明确病理诊断；当前影像学评估为 cT4N2M0","options":[{"letter":"A","text":"行鼻咽镜下肿物活检；影像学评估为 cT3N2M0","is_gold":false},{"letter":"B","text":"行鼻咽镜下肿物活检；影像学评估为 cT4N1M0","is_gold":false},{"letter":"C","text":"行颈部淋巴结穿刺活检；影像学评估为 cT4N2M0","is_gold":false},{"letter":"D","text":"完善血浆EBV-DNA检测；影像学评估为 cT4N2M0","is_gold":false},{"letter":"E","text":"行鼻咽镜下肿物活检；影像学评估为 cT4N2M0","is_gold":true},{"letter":"F","text":"安排诱导化疗联合根治性放疗；影像学评估为 cT4N2M0","is_gold":false},{"letter":"G","text":"行鼻咽镜下肿物活检；影像学评估为 cT4N3M0","is_gold":false},{"letter":"H","text":"行鼻咽镜下肿物活检；影像学评估为 cT3N1M0","is_gold":false},{"letter":"I","text":"行全身PET-CT检查；影像学评估为 cT4N2M0","is_gold":false},{"letter":"J","text":"行鼻咽镜下肿物活检；影像学评估为 cT2N2M0","is_gold":false},{"letter":"K","text":"行鼻咽镜下肿物活检；影像学评估为 cT4N0M0","is_gold":false},{"letter":"L","text":"行鼻咽镜下肿物活检；影像学评估为 cT1N2M0","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、海绵窦、翼突基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1078] 入院记录: 主诉: 外院可疑鼻咽癌；现病史: 简要入院病史:患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n- [全程D1081] 入院记录: 主诉: 回吸性涕血3月余；现病史: 患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：70次/分，R：14次/分，BP：126/71mmHg,Ht：155cm，Wt：48kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左颈Ⅱ区触及肿大淋巴结，约2×1.5cm，无融合，质地硬，边界尚清，活动度中等，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- [全程D1078] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 Ⅱ、Ⅲ、aVF、V4～V6导联ST段下移\n- [全程D1078] 检验组合: 镁离子(Mg2+)-静脉血: 0.96mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.6；Rh血型-静脉血: 阳性；直接胆红素(DBIL)-静脉血: 2umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.61COI；白蛋白(ALB)-静脉血: 45.5g/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 0.085COI；γ-谷氨酰基转移酶(GGT)-静脉血: 13.6U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.2fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；葡萄糖(Glu)-静脉血: 4.67mmol/L；总胆红素(TBIL)-静脉血: 8.3umol/L；单核细胞百分比(Mono%)-静脉血: 0.074；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.5U/L；红细胞比容(Hct)-静脉血: 41%；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 1.56COI；单核细胞计数(Mono#)-静脉血: 0.310E9/L；中性粒细胞计数(Neut#)-静脉血: 2.510E9/L；胱抑素(Cys-C)-静脉血: 0.84mg/L；碱性磷酸酶(ALP)-静脉血: 80.5U/L；钠离子(Na+)-静脉血: 143.8mmol/L；乳酸脱氢酶(LDH)-静脉血: 194.4U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；平均红细胞血红蛋白浓度(MCHC)-静脉血: 324g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21.7U/L；氯离子(Cl-)-静脉血: 105.2mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.74；平均红细胞体积(MCV)-静脉血: 92.8fL；C-反应蛋白(CRP)-静脉血: 1.78mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.4；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: >1000IU/L；总胆固醇(TC)-静脉血: 5.98mmol/L；血红蛋白(Hb)-静脉血: 133g/L；大血小板百分比(P-LCR%)-静脉血: 26.1%；间接胆红素(I……\n- [全程D1079] 检验组合: 梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）\n- [全程D1081] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 多个颈腰椎、双侧膝关节可见片状放射性浓集灶。余颅骨、胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 考虑多个颈腰椎、双侧膝关节骨质退行性变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行鼻咽镜下肿物活检；影像学评估为 cT3N2M0\nB. 行鼻咽镜下肿物活检；影像学评估为 cT4N1M0\nC. 行颈部淋巴结穿刺活检；影像学评估为 cT4N2M0\nD. 完善血浆EBV-DNA检测；影像学评估为 cT4N2M0\nE. 行鼻咽镜下肿物活检；影像学评估为 cT4N2M0\nF. 安排诱导化疗联合根治性放疗；影像学评估为 cT4N2M0\nG. 行鼻咽镜下肿物活检；影像学评估为 cT4N3M0\nH. 行鼻咽镜下肿物活检；影像学评估为 cT3N1M0\nI. 行全身PET-CT检查；影像学评估为 cT4N2M0\nJ. 行鼻咽镜下肿物活检；影像学评估为 cT2N2M0\nK. 行鼻咽镜下肿物活检；影像学评估为 cT4N0M0\nL. 行鼻咽镜下肿物活检；影像学评估为 cT1N2M0\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、海绵窦、翼突基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1078] 入院记录: 主诉: 外院可疑鼻咽癌；现病史: 简要入院病史:患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n- [全程D1081] 入院记录: 主诉: 回吸性涕血3月余；现病史: 患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：70次/分，R：14次/分，BP：126/71mmHg,Ht：155cm，Wt：48kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左颈Ⅱ区触及肿大淋巴结，约2×1.5cm，无融合，质地硬，边界尚清，活动度中等，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- [全程D1078] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 Ⅱ、Ⅲ、aVF、V4～V6导联ST段下移\n- [全程D1078] 检验组合: 镁离子(Mg2+)-静脉血: 0.96mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.6；Rh血型-静脉血: 阳性；直接胆红素(DBIL)-静脉血: 2umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.61COI；白蛋白(ALB)-静脉血: 45.5g/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 0.085COI；γ-谷氨酰基转移酶(GGT)-静脉血: 13.6U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.2fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；葡萄糖(Glu)-静脉血: 4.67mmol/L；总胆红素(TBIL)-静脉血: 8.3umol/L；单核细胞百分比(Mono%)-静脉血: 0.074；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.5U/L；红细胞比容(Hct)-静脉血: 41%；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 1.56COI；单核细胞计数(Mono#)-静脉血: 0.310E9/L；中性粒细胞计数(Neut#)-静脉血: 2.510E9/L；胱抑素(Cys-C)-静脉血: 0.84mg/L；碱性磷酸酶(ALP)-静脉血: 80.5U/L；钠离子(Na+)-静脉血: 143.8mmol/L；乳酸脱氢酶(LDH)-静脉血: 194.4U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；平均红细胞血红蛋白浓度(MCHC)-静脉血: 324g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21.7U/L；氯离子(Cl-)-静脉血: 105.2mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.74；平均红细胞体积(MCV)-静脉血: 92.8fL；C-反应蛋白(CRP)-静脉血: 1.78mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.4；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: >1000IU/L；总胆固醇(TC)-静脉血: 5.98mmol/L；血红蛋白(Hb)-静脉血: 133g/L；大血小板百分比(P-LCR%)-静脉血: 26.1%；间接胆红素(I……\n- [全程D1079] 检验组合: 梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）\n- [全程D1081] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 多个颈腰椎、双侧膝关节可见片状放射性浓集灶。余颅骨、胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 考虑多个颈腰椎、双侧膝关节骨质退行性变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行鼻咽镜下肿物活检；影像学评估为 cT3N2M0\nB. 行鼻咽镜下肿物活检；影像学评估为 cT4N1M0\nC. 行颈部淋巴结穿刺活检；影像学评估为 cT4N2M0\nD. 完善血浆EBV-DNA检测；影像学评估为 cT4N2M0\nE. 行鼻咽镜下肿物活检；影像学评估为 cT4N2M0\nF. 安排诱导化疗联合根治性放疗；影像学评估为 cT4N2M0\nG. 行鼻咽镜下肿物活检；影像学评估为 cT4N3M0\nH. 行鼻咽镜下肿物活检；影像学评估为 cT3N1M0\nI. 行全身PET-CT检查；影像学评估为 cT4N2M0\nJ. 行鼻咽镜下肿物活检；影像学评估为 cT2N2M0\nK. 行鼻咽镜下肿物活检；影像学评估为 cT4N0M0\nL. 行鼻咽镜下肿物活检；影像学评估为 cT1N2M0\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、海绵窦、翼突基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1078] 入院记录: 主诉: 外院可疑鼻咽癌；现病史: 简要入院病史:患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n- [全程D1081] 入院记录: 主诉: 回吸性涕血3月余；现病史: 患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：70次/分，R：14次/分，BP：126/71mmHg,Ht：155cm，Wt：48kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左颈Ⅱ区触及肿大淋巴结，约2×1.5cm，无融合，质地硬，边界尚清，活动度中等，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- [全程D1078] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 Ⅱ、Ⅲ、aVF、V4～V6导联ST段下移\n- [全程D1078] 检验组合: 镁离子(Mg2+)-静脉血: 0.96mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.6；Rh血型-静脉血: 阳性；直接胆红素(DBIL)-静脉血: 2umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.61COI；白蛋白(ALB)-静脉血: 45.5g/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 0.085COI；γ-谷氨酰基转移酶(GGT)-静脉血: 13.6U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.2fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；葡萄糖(Glu)-静脉血: 4.67mmol/L；总胆红素(TBIL)-静脉血: 8.3umol/L；单核细胞百分比(Mono%)-静脉血: 0.074；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.5U/L；红细胞比容(Hct)-静脉血: 41%；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 1.56COI；单核细胞计数(Mono#)-静脉血: 0.310E9/L；中性粒细胞计数(Neut#)-静脉血: 2.510E9/L；胱抑素(Cys-C)-静脉血: 0.84mg/L；碱性磷酸酶(ALP)-静脉血: 80.5U/L；钠离子(Na+)-静脉血: 143.8mmol/L；乳酸脱氢酶(LDH)-静脉血: 194.4U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；平均红细胞血红蛋白浓度(MCHC)-静脉血: 324g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21.7U/L；氯离子(Cl-)-静脉血: 105.2mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.74；平均红细胞体积(MCV)-静脉血: 92.8fL；C-反应蛋白(CRP)-静脉血: 1.78mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.4；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: >1000IU/L；总胆固醇(TC)-静脉血: 5.98mmol/L；血红蛋白(Hb)-静脉血: 133g/L；大血小板百分比(P-LCR%)-静脉血: 26.1%；间接胆红素(I……\n- [全程D1079] 检验组合: 梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）\n- [全程D1081] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 多个颈腰椎、双侧膝关节可见片状放射性浓集灶。余颅骨、胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 考虑多个颈腰椎、双侧膝关节骨质退行性变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行鼻咽镜下肿物活检；影像学评估为 cT3N2M0\nB. 行鼻咽镜下肿物活检；影像学评估为 cT4N1M0\nC. 行颈部淋巴结穿刺活检；影像学评估为 cT4N2M0\nD. 完善血浆EBV-DNA检测；影像学评估为 cT4N2M0\nE. 行鼻咽镜下肿物活检；影像学评估为 cT4N2M0\nF. 安排诱导化疗联合根治性放疗；影像学评估为 cT4N2M0\nG. 行鼻咽镜下肿物活检；影像学评估为 cT4N3M0\nH. 行鼻咽镜下肿物活检；影像学评估为 cT3N1M0\nI. 行全身PET-CT检查；影像学评估为 cT4N2M0\nJ. 行鼻咽镜下肿物活检；影像学评估为 cT2N2M0\nK. 行鼻咽镜下肿物活检；影像学评估为 cT4N0M0\nL. 行鼻咽镜下肿物活检；影像学评估为 cT1N2M0\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-7c52866e0776802e0c94516f","patient_id":"patient-36d433557e63f939b878347d","turn_id":"turn04","turn_position":2,"turn_type":"initial_treatment_selection","gold_letter":"G","gold_action":"完善头颈部MRI及全身分期检查，若评估为局部晚期，行诱导化疗序贯同步放化疗","options":[{"letter":"A","text":"暂缓影像学分期检查，直接启动根治性同步放化疗","is_gold":false},{"letter":"B","text":"完善头颈部MRI及全身分期检查，若评估为局部晚期，行单纯根治性放疗","is_gold":false},{"letter":"C","text":"完善头颈部MRI及全身分期检查，若评估为局部晚期，行诱导化疗序贯单纯根治性放疗","is_gold":false},{"letter":"D","text":"完善头颈部MRI及全身分期检查，若评估为局部晚期，行根治性手术切除序贯术后放疗","is_gold":false},{"letter":"E","text":"完善头颈部增强CT及全身分期检查，若评估为局部晚期，行诱导化疗序贯同步放化疗","is_gold":false},{"letter":"F","text":"完善头颈部MRI及全身分期检查，若评估为早期（I期），行诱导化疗序贯同步放化疗","is_gold":false},{"letter":"G","text":"完善头颈部MRI及全身分期检查，若评估为局部晚期，行诱导化疗序贯同步放化疗","is_gold":true},{"letter":"H","text":"完善头颈部MRI及全身分期检查，无论分期结果，均行诱导化疗序贯同步放化疗","is_gold":false},{"letter":"I","text":"仅行全身PET-CT替代所有常规分期检查，若评估为局部晚期，行诱导化疗序贯同步放化疗","is_gold":false},{"letter":"J","text":"完善头颈部MRI及全身分期检查，若评估为局部晚期，行抗EGFR单抗靶向治疗替代放疗","is_gold":false},{"letter":"K","text":"完善头颈部MRI及全身分期检查，若评估为局部晚期，行PD-1抑制剂单药根治性治疗","is_gold":false},{"letter":"L","text":"完善头颈部MRI及全身分期检查，若评估为局部晚期，行姑息性化疗联合最佳支持治疗","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、海绵窦、翼突基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1078] 入院记录: 主诉: 外院可疑鼻咽癌；现病史: 简要入院病史:患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n- [全程D1081] 入院记录: 主诉: 回吸性涕血3月余；现病史: 患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：70次/分，R：14次/分，BP：126/71mmHg,Ht：155cm，Wt：48kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左颈Ⅱ区触及肿大淋巴结，约2×1.5cm，无融合，质地硬，边界尚清，活动度中等，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS:；ECOG:\n- [全程D1078] 入院记录: 主诉: 外院可疑鼻咽癌；现病史: 简要入院病史:患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。某次就诊时间再次出现回吸性涕血，遂行鼻咽镜检查，活检示：鼻咽炎性渗出。行鼻咽部CT示：鼻咽左侧可见软组织占位。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- [全程D1078] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 Ⅱ、Ⅲ、aVF、V4～V6导联ST段下移\n- [全程D1078] 检验组合: 镁离子(Mg2+)-静脉血: 0.96mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.6；Rh血型-静脉血: 阳性；直接胆红素(DBIL)-静脉血: 2umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.61COI；白蛋白(ALB)-静脉血: 45.5g/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 0.085COI；γ-谷氨酰基转移酶(GGT)-静脉血: 13.6U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.2fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；葡萄糖(Glu)-静脉血: 4.67mmol/L；总胆红素(TBIL)-静脉血: 8.3umol/L；单核细胞百分比(Mono%)-静脉血: 0.074；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.5U/L；红细胞比容(Hct)-静脉血: 41%；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 1.56COI；单核细胞计数(Mono#)-静脉血: 0.310E9/L；中性粒细胞计数(Neut#)-静脉血: 2.510E9/L；胱抑素(Cys-C)-静脉血: 0.84mg/L；碱性磷酸酶(ALP)-静脉血: 80.5U/L；钠离子(Na+)-静脉血: 143.8mmol/L；乳酸脱氢酶(LDH)-静脉血: 194.4U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；平均红细胞血红蛋白浓度(MCHC)-静脉血: 324g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21.7U/L；氯离子(Cl-)-静脉血: 105.2mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.74；平均红细胞体积(MCV)-静脉血: 92.8fL；C-反应蛋白(CRP)-静脉血: 1.78mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.4；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: >1000IU/L；总胆固醇(TC)-静脉血: 5.98mmol/L；血红蛋白(Hb)-静脉血: 133g/L；大血小板百分比(P-LCR%)-静脉血: 26.1%；间接胆红素(I……\n- [全程D1079] 检验组合: 梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）\n- [全程D1081] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 多个颈腰椎、双侧膝关节可见片状放射性浓集灶。余颅骨、胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 考虑多个颈腰椎、双侧膝关节骨质退行性变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂缓影像学分期检查，直接启动根治性同步放化疗\nB. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行单纯根治性放疗\nC. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行诱导化疗序贯单纯根治性放疗\nD. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行根治性手术切除序贯术后放疗\nE. 完善头颈部增强CT及全身分期检查，若评估为局部晚期，行诱导化疗序贯同步放化疗\nF. 完善头颈部MRI及全身分期检查，若评估为早期（I期），行诱导化疗序贯同步放化疗\nG. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行诱导化疗序贯同步放化疗\nH. 完善头颈部MRI及全身分期检查，无论分期结果，均行诱导化疗序贯同步放化疗\nI. 仅行全身PET-CT替代所有常规分期检查，若评估为局部晚期，行诱导化疗序贯同步放化疗\nJ. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行抗EGFR单抗靶向治疗替代放疗\nK. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行PD-1抑制剂单药根治性治疗\nL. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行姑息性化疗联合最佳支持治疗\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- [全程D1078] 入院记录: 主诉: 外院可疑鼻咽癌；现病史: 简要入院病史:患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。某次就诊时间再次出现回吸性涕血，遂行鼻咽镜检查，活检示：鼻咽炎性渗出。行鼻咽部CT示：鼻咽左侧可见软组织占位。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- 无可展示记录。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂缓影像学分期检查，直接启动根治性同步放化疗\nB. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行单纯根治性放疗\nC. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行诱导化疗序贯单纯根治性放疗\nD. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行根治性手术切除序贯术后放疗\nE. 完善头颈部增强CT及全身分期检查，若评估为局部晚期，行诱导化疗序贯同步放化疗\nF. 完善头颈部MRI及全身分期检查，若评估为早期（I期），行诱导化疗序贯同步放化疗\nG. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行诱导化疗序贯同步放化疗\nH. 完善头颈部MRI及全身分期检查，无论分期结果，均行诱导化疗序贯同步放化疗\nI. 仅行全身PET-CT替代所有常规分期检查，若评估为局部晚期，行诱导化疗序贯同步放化疗\nJ. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行抗EGFR单抗靶向治疗替代放疗\nK. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行PD-1抑制剂单药根治性治疗\nL. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行姑息性化疗联合最佳支持治疗\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、海绵窦、翼突基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1078] 入院记录: 主诉: 外院可疑鼻咽癌；现病史: 简要入院病史:患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。某次就诊时间再次出现回吸性涕血，遂行鼻咽镜检查，活检示：鼻咽炎性渗出。行鼻咽部CT示：鼻咽左侧可见软组织占位。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- 无可展示记录。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂缓影像学分期检查，直接启动根治性同步放化疗\nB. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行单纯根治性放疗\nC. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行诱导化疗序贯单纯根治性放疗\nD. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行根治性手术切除序贯术后放疗\nE. 完善头颈部增强CT及全身分期检查，若评估为局部晚期，行诱导化疗序贯同步放化疗\nF. 完善头颈部MRI及全身分期检查，若评估为早期（I期），行诱导化疗序贯同步放化疗\nG. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行诱导化疗序贯同步放化疗\nH. 完善头颈部MRI及全身分期检查，无论分期结果，均行诱导化疗序贯同步放化疗\nI. 仅行全身PET-CT替代所有常规分期检查，若评估为局部晚期，行诱导化疗序贯同步放化疗\nJ. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行抗EGFR单抗靶向治疗替代放疗\nK. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行PD-1抑制剂单药根治性治疗\nL. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行姑息性化疗联合最佳支持治疗\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-ce21ad4c82d0349356f5fbb9","patient_id":"patient-36d433557e63f939b878347d","turn_id":"turn05","turn_position":3,"turn_type":"toxicity_or_support_decision","gold_letter":"H","gold_action":"给予口服保肝药物（如复方甘草酸苷、葡醛内酯），按原计划执行顺铂同期化疗，并动态复查肝功能。","options":[{"letter":"A","text":"暂停同期化疗，给予静脉保肝药物治疗，待转氨酶降至正常后再启动顺铂化疗","is_gold":false},{"letter":"B","text":"按原计划执行顺铂同期化疗，暂不予特殊保肝处理，常规监测肝功能","is_gold":false},{"letter":"C","text":"给予口服保肝药物，将顺铂剂量下调20%后执行同期化疗","is_gold":false},{"letter":"D","text":"给予静脉双重保肝药物，按原计划执行顺铂同期化疗，并动态复查肝功能","is_gold":false},{"letter":"E","text":"停用顺铂，更改为卡铂方案执行同期化疗，并给予口服保肝药物","is_gold":false},{"letter":"F","text":"给予口服保肝药物，推迟顺铂化疗1周，期间正常进行放疗","is_gold":false},{"letter":"G","text":"停用顺铂，更改为西妥昔单抗靶向治疗联合放疗，并给予口服保肝药物","is_gold":false},{"letter":"H","text":"给予口服保肝药物（如复方甘草酸苷、葡醛内酯），按原计划执行顺铂同期化疗，并动态复查肝功能","is_gold":true},{"letter":"I","text":"暂停放化疗，行腹部增强CT排查肝脏转移，并给予静脉保肝治疗","is_gold":false},{"letter":"J","text":"给予口服保肝药物，按原计划执行顺铂同期化疗，并预防性使用重组人粒细胞刺激因子","is_gold":false},{"letter":"K","text":"给予口服保肝药物，按原计划执行顺铂同期化疗，并预防性使用广谱抗生素","is_gold":false},{"letter":"L","text":"给予口服保肝药物，将顺铂方案更改为奈达铂方案执行同期化疗","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、海绵窦、翼突基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1078] 入院记录: 主诉: 外院可疑鼻咽癌；现病史: 简要入院病史:患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n- [全程D1081] 入院记录: 主诉: 回吸性涕血3月余；现病史: 患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：70次/分，R：14次/分，BP：126/71mmHg,Ht：155cm，Wt：48kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左颈Ⅱ区触及肿大淋巴结，约2×1.5cm，无融合，质地硬，边界尚清，活动度中等，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS:；ECOG:\n- [全程D1078] 入院记录: 主诉: 外院可疑鼻咽癌；现病史: 简要入院病史:患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。某次就诊时间再次出现回吸性涕血，遂行鼻咽镜检查，活检示：鼻咽炎性渗出。行鼻咽部CT示：鼻咽左侧可见软组织占位。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n- [全程D1081] 入院记录: 主诉: 回吸性涕血3月余；现病史: 患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。某次就诊时间再次出现回吸性涕血，遂行鼻咽镜检查，活检示：鼻咽炎性渗出。行鼻咽部CT示：鼻咽左侧可见软组织占位。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：70次/分，R：14次/分，BP：126/71mmHg,Ht：155cm，Wt：48kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率70次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左颈Ⅱ区触及肿大淋巴结，约2×1.5cm，无融合，质地硬，边界尚清，活动度中等，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- [全程D1078] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 Ⅱ、Ⅲ、aVF、V4～V6导联ST段下移\n- [全程D1078] 检验组合: 镁离子(Mg2+)-静脉血: 0.96mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.6；Rh血型-静脉血: 阳性；直接胆红素(DBIL)-静脉血: 2umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.61COI；白蛋白(ALB)-静脉血: 45.5g/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 0.085COI；γ-谷氨酰基转移酶(GGT)-静脉血: 13.6U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.2fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；葡萄糖(Glu)-静脉血: 4.67mmol/L；总胆红素(TBIL)-静脉血: 8.3umol/L；单核细胞百分比(Mono%)-静脉血: 0.074；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.5U/L；红细胞比容(Hct)-静脉血: 41%；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 1.56COI；单核细胞计数(Mono#)-静脉血: 0.310E9/L；中性粒细胞计数(Neut#)-静脉血: 2.510E9/L；胱抑素(Cys-C)-静脉血: 0.84mg/L；碱性磷酸酶(ALP)-静脉血: 80.5U/L；钠离子(Na+)-静脉血: 143.8mmol/L；乳酸脱氢酶(LDH)-静脉血: 194.4U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；平均红细胞血红蛋白浓度(MCHC)-静脉血: 324g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21.7U/L；氯离子(Cl-)-静脉血: 105.2mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.74；平均红细胞体积(MCV)-静脉血: 92.8fL；C-反应蛋白(CRP)-静脉血: 1.78mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.4；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: >1000IU/L；总胆固醇(TC)-静脉血: 5.98mmol/L；血红蛋白(Hb)-静脉血: 133g/L；大血小板百分比(P-LCR%)-静脉血: 26.1%；间接胆红素(I……\n- [全程D1079] 检验组合: 梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）\n- [全程D1081] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 多个颈腰椎、双侧膝关节可见片状放射性浓集灶。余颅骨、胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 考虑多个颈腰椎、双侧膝关节骨质退行性变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1092] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.006；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；颜色-尿液: 无色；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮\n- [全程D1094] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 28/μL；比重(SG)-尿液: 1.025；葡萄糖(Glu)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 36/μL；白细胞计数(WBC#)-尿液: 5/μL；酸碱度(pH)-尿液: 6.5；颜色-尿液: Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D1095] 检验组合: 白蛋白(ALB)-静脉血: 40.5g/L；镁离子(Mg2+)-静脉血: 0.84mmol/L；碱性磷酸酶(ALP)-静脉血: 63.2U/L；载脂蛋白B(apoB)-静脉血: 0.8g/L；葡萄糖(Glu)-静脉血: 5.31mmol/L；血小板比容-静脉血: 19%；直接胆红素(DBIL)-静脉血: 2.3umol/L；载脂蛋白AI(apoAI)-静脉血: 1.4g/L；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；总胆固醇(TC)-静脉血: 5.3mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.69mmolL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 325g/L；红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.9pg；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；γ-谷氨酰基转移酶(GGT)-静脉血: 16.8U/L；间接胆红素(IBIL)-静脉血: 5.6umolL；红细胞比容(Hct)-静脉血: 37.2%；钠离子(Na+)-静脉血: 141.6mmol/L；尿酸(UA)-静脉血: 219.2umol/L；总钙(Ca)-静脉血: 2.16mmol/L；尿素氮(BUN)-静脉血: 4.72mmol/L；平均红细胞体积(MCV)-静脉血: 91.9fL；球蛋白(GLO)-静脉血: 22.71g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.1；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14；乳酸脱氢酶(LDH)-静脉血: 179.4U/L；总胆红素(TBIL)-静脉血: 7.9umol/L；阴离子间隙(AG)-静脉血: 12；中性粒细胞百分比(Neut%)-静脉血: 0.814；血红蛋白(Hb)-静脉血: 121g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.1；丙氨酸氨基转移酶(ALT)-静脉血: 55.1U/L；白细胞计数(WBC#)-静脉血: 6.1210E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 36.2U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.58mmol/L；胱抑素(Cys-C)-静脉血: 0.95mg/L；大血小板……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1082] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者目前诊断明确，[计划性表述已隐藏]根治性放疗及同期化疗。向患者及其家属交代病情，治疗方案及治疗风险，做好治疗前准备工作。\n- [全程D1083] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者入院第三天，无明显不适主诉，查体情况：一般情况可，余同入院。预约放疗。\n- [全程D1088] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 今日查房，患者无明显不适主诉，生命体征平稳。已予预约放疗。候治疗。\n- [全程D1093] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 今日查房，患者无明显不适主诉，生命体征平稳。查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常。患者现放疗计划已设计完成并通过全科会诊，靶区剂量分布均匀，正常组织剂量在可接受范围内。[姓名已隐去]医生信息已隐藏示：患者无明显放化疗禁忌症，拟于今日开始行根治性放疗+同时期化疗。向患者及其家属交代病情及化疗风险，表示理解并已签署知情同意书，可于今日执行第1程顺铂方案同时期化疗，注意化疗不良反应。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停同期化疗，给予静脉保肝药物治疗，待转氨酶降至正常后再启动顺铂化疗\nB. 按原计划执行顺铂同期化疗，暂不予特殊保肝处理，常规监测肝功能\nC. 给予口服保肝药物，将顺铂剂量下调20%后执行同期化疗\nD. 给予静脉双重保肝药物，按原计划执行顺铂同期化疗，并动态复查肝功能\nE. 停用顺铂，更改为卡铂方案执行同期化疗，并给予口服保肝药物\nF. 给予口服保肝药物，推迟顺铂化疗1周，期间正常进行放疗\nG. 停用顺铂，更改为西妥昔单抗靶向治疗联合放疗，并给予口服保肝药物\nH. 给予口服保肝药物（如复方甘草酸苷、葡醛内酯），按原计划执行顺铂同期化疗，并动态复查肝功能\nI. 暂停放化疗，行腹部增强CT排查肝脏转移，并给予静脉保肝治疗\nJ. 给予口服保肝药物，按原计划执行顺铂同期化疗，并预防性使用重组人粒细胞刺激因子\nK. 给予口服保肝药物，按原计划执行顺铂同期化疗，并预防性使用广谱抗生素\nL. 给予口服保肝药物，将顺铂方案更改为奈达铂方案执行同期化疗\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- [全程D1081] 入院记录: 主诉: 回吸性涕血3月余；现病史: 患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。某次就诊时间再次出现回吸性涕血，遂行鼻咽镜检查，活检示：鼻咽炎性渗出。行鼻咽部CT示：鼻咽左侧可见软组织占位。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：70次/分，R：14次/分，BP：126/71mmHg,Ht：155cm，Wt：48kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率70次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左颈Ⅱ区触及肿大淋巴结，约2×1.5cm，无融合，质地硬，边界尚清，活动度中等，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- [全程D1092] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.006；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；颜色-尿液: 无色；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮\n- [全程D1094] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 28/μL；比重(SG)-尿液: 1.025；葡萄糖(Glu)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 36/μL；白细胞计数(WBC#)-尿液: 5/μL；酸碱度(pH)-尿液: 6.5；颜色-尿液: Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D1095] 检验组合: 白蛋白(ALB)-静脉血: 40.5g/L；镁离子(Mg2+)-静脉血: 0.84mmol/L；碱性磷酸酶(ALP)-静脉血: 63.2U/L；载脂蛋白B(apoB)-静脉血: 0.8g/L；葡萄糖(Glu)-静脉血: 5.31mmol/L；血小板比容-静脉血: 19%；直接胆红素(DBIL)-静脉血: 2.3umol/L；载脂蛋白AI(apoAI)-静脉血: 1.4g/L；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；总胆固醇(TC)-静脉血: 5.3mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.69mmolL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 325g/L；红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.9pg；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；γ-谷氨酰基转移酶(GGT)-静脉血: 16.8U/L；间接胆红素(IBIL)-静脉血: 5.6umolL；红细胞比容(Hct)-静脉血: 37.2%；钠离子(Na+)-静脉血: 141.6mmol/L；尿酸(UA)-静脉血: 219.2umol/L；总钙(Ca)-静脉血: 2.16mmol/L；尿素氮(BUN)-静脉血: 4.72mmol/L；平均红细胞体积(MCV)-静脉血: 91.9fL；球蛋白(GLO)-静脉血: 22.71g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.1；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14；乳酸脱氢酶(LDH)-静脉血: 179.4U/L；总胆红素(TBIL)-静脉血: 7.9umol/L；阴离子间隙(AG)-静脉血: 12；中性粒细胞百分比(Neut%)-静脉血: 0.814；血红蛋白(Hb)-静脉血: 121g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.1；丙氨酸氨基转移酶(ALT)-静脉血: 55.1U/L；白细胞计数(WBC#)-静脉血: 6.1210E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 36.2U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.58mmol/L；胱抑素(Cys-C)-静脉血: 0.95mg/L；大血小板……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1082] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者目前诊断明确，[计划性表述已隐藏]根治性放疗及同期化疗。向患者及其家属交代病情，治疗方案及治疗风险，做好治疗前准备工作。\n- [全程D1083] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者入院第三天，无明显不适主诉，查体情况：一般情况可，余同入院。预约放疗。\n- [全程D1088] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 今日查房，患者无明显不适主诉，生命体征平稳。已予预约放疗。候治疗。\n- [全程D1093] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 今日查房，患者无明显不适主诉，生命体征平稳。查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常。患者现放疗计划已设计完成并通过全科会诊，靶区剂量分布均匀，正常组织剂量在可接受范围内。[姓名已隐去]医生信息已隐藏示：患者无明显放化疗禁忌症，拟于今日开始行根治性放疗+同时期化疗。向患者及其家属交代病情及化疗风险，表示理解并已签署知情同意书，可于今日执行第1程顺铂方案同时期化疗，注意化疗不良反应。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停同期化疗，给予静脉保肝药物治疗，待转氨酶降至正常后再启动顺铂化疗\nB. 按原计划执行顺铂同期化疗，暂不予特殊保肝处理，常规监测肝功能\nC. 给予口服保肝药物，将顺铂剂量下调20%后执行同期化疗\nD. 给予静脉双重保肝药物，按原计划执行顺铂同期化疗，并动态复查肝功能\nE. 停用顺铂，更改为卡铂方案执行同期化疗，并给予口服保肝药物\nF. 给予口服保肝药物，推迟顺铂化疗1周，期间正常进行放疗\nG. 停用顺铂，更改为西妥昔单抗靶向治疗联合放疗，并给予口服保肝药物\nH. 给予口服保肝药物（如复方甘草酸苷、葡醛内酯），按原计划执行顺铂同期化疗，并动态复查肝功能\nI. 暂停放化疗，行腹部增强CT排查肝脏转移，并给予静脉保肝治疗\nJ. 给予口服保肝药物，按原计划执行顺铂同期化疗，并预防性使用重组人粒细胞刺激因子\nK. 给予口服保肝药物，按原计划执行顺铂同期化疗，并预防性使用广谱抗生素\nL. 给予口服保肝药物，将顺铂方案更改为奈达铂方案执行同期化疗\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、海绵窦、翼突基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1081] 入院记录: 主诉: 回吸性涕血3月余；现病史: 患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。某次就诊时间再次出现回吸性涕血，遂行鼻咽镜检查，活检示：鼻咽炎性渗出。行鼻咽部CT示：鼻咽左侧可见软组织占位。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：70次/分，R：14次/分，BP：126/71mmHg,Ht：155cm，Wt：48kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率70次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左颈Ⅱ区触及肿大淋巴结，约2×1.5cm，无融合，质地硬，边界尚清，活动度中等，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- [全程D1092] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.006；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；颜色-尿液: 无色；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮\n- [全程D1094] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 28/μL；比重(SG)-尿液: 1.025；葡萄糖(Glu)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 36/μL；白细胞计数(WBC#)-尿液: 5/μL；酸碱度(pH)-尿液: 6.5；颜色-尿液: Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D1095] 检验组合: 白蛋白(ALB)-静脉血: 40.5g/L；镁离子(Mg2+)-静脉血: 0.84mmol/L；碱性磷酸酶(ALP)-静脉血: 63.2U/L；载脂蛋白B(apoB)-静脉血: 0.8g/L；葡萄糖(Glu)-静脉血: 5.31mmol/L；血小板比容-静脉血: 19%；直接胆红素(DBIL)-静脉血: 2.3umol/L；载脂蛋白AI(apoAI)-静脉血: 1.4g/L；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；总胆固醇(TC)-静脉血: 5.3mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.69mmolL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 325g/L；红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.9pg；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；γ-谷氨酰基转移酶(GGT)-静脉血: 16.8U/L；间接胆红素(IBIL)-静脉血: 5.6umolL；红细胞比容(Hct)-静脉血: 37.2%；钠离子(Na+)-静脉血: 141.6mmol/L；尿酸(UA)-静脉血: 219.2umol/L；总钙(Ca)-静脉血: 2.16mmol/L；尿素氮(BUN)-静脉血: 4.72mmol/L；平均红细胞体积(MCV)-静脉血: 91.9fL；球蛋白(GLO)-静脉血: 22.71g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.1；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14；乳酸脱氢酶(LDH)-静脉血: 179.4U/L；总胆红素(TBIL)-静脉血: 7.9umol/L；阴离子间隙(AG)-静脉血: 12；中性粒细胞百分比(Neut%)-静脉血: 0.814；血红蛋白(Hb)-静脉血: 121g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.1；丙氨酸氨基转移酶(ALT)-静脉血: 55.1U/L；白细胞计数(WBC#)-静脉血: 6.1210E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 36.2U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.58mmol/L；胱抑素(Cys-C)-静脉血: 0.95mg/L；大血小板……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1082] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者目前诊断明确，[计划性表述已隐藏]根治性放疗及同期化疗。向患者及其家属交代病情，治疗方案及治疗风险，做好治疗前准备工作。\n- [全程D1083] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者入院第三天，无明显不适主诉，查体情况：一般情况可，余同入院。预约放疗。\n- [全程D1088] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 今日查房，患者无明显不适主诉，生命体征平稳。已予预约放疗。候治疗。\n- [全程D1093] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 今日查房，患者无明显不适主诉，生命体征平稳。查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常。患者现放疗计划已设计完成并通过全科会诊，靶区剂量分布均匀，正常组织剂量在可接受范围内。[姓名已隐去]医生信息已隐藏示：患者无明显放化疗禁忌症，拟于今日开始行根治性放疗+同时期化疗。向患者及其家属交代病情及化疗风险，表示理解并已签署知情同意书，可于今日执行第1程顺铂方案同时期化疗，注意化疗不良反应。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停同期化疗，给予静脉保肝药物治疗，待转氨酶降至正常后再启动顺铂化疗\nB. 按原计划执行顺铂同期化疗，暂不予特殊保肝处理，常规监测肝功能\nC. 给予口服保肝药物，将顺铂剂量下调20%后执行同期化疗\nD. 给予静脉双重保肝药物，按原计划执行顺铂同期化疗，并动态复查肝功能\nE. 停用顺铂，更改为卡铂方案执行同期化疗，并给予口服保肝药物\nF. 给予口服保肝药物，推迟顺铂化疗1周，期间正常进行放疗\nG. 停用顺铂，更改为西妥昔单抗靶向治疗联合放疗，并给予口服保肝药物\nH. 给予口服保肝药物（如复方甘草酸苷、葡醛内酯），按原计划执行顺铂同期化疗，并动态复查肝功能\nI. 暂停放化疗，行腹部增强CT排查肝脏转移，并给予静脉保肝治疗\nJ. 给予口服保肝药物，按原计划执行顺铂同期化疗，并预防性使用重组人粒细胞刺激因子\nK. 给予口服保肝药物，按原计划执行顺铂同期化疗，并预防性使用广谱抗生素\nL. 给予口服保肝药物，将顺铂方案更改为奈达铂方案执行同期化疗\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-c47048c6a3961cfb24a6bb12","patient_id":"patient-36d433557e63f939b878347d","turn_id":"turn06","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"I","gold_action":"继续根治性放疗及同期化疗，暂不予集落刺激因子支持，密切监测血常规","options":[{"letter":"A","text":"暂停放化疗，给予重组人粒细胞集落刺激因子治疗，待白细胞恢复后继续","is_gold":false},{"letter":"B","text":"暂停同期化疗，仅继续根治性放疗，并给予重组人粒细胞集落刺激因子","is_gold":false},{"letter":"C","text":"继续根治性放疗及同期化疗，下一疗程顺铂剂量减量20%","is_gold":false},{"letter":"D","text":"继续根治性放疗及同期化疗，加用重组人粒细胞集落刺激因子","is_gold":false},{"letter":"E","text":"暂停放化疗，给予静脉高营养及强效止吐、补液支持，暂缓抗肿瘤治疗","is_gold":false},{"letter":"F","text":"继续根治性放疗及同期化疗，加用重组人血小板生成素","is_gold":false},{"letter":"G","text":"暂停同期化疗，将后续全身治疗更换为尼妥珠单抗靶向治疗","is_gold":false},{"letter":"H","text":"继续根治性放疗及同期化疗，加用促红细胞生成素及铁剂","is_gold":false},{"letter":"I","text":"继续根治性放疗及同期化疗，暂不予集落刺激因子支持，密切监测血常规","is_gold":true},{"letter":"J","text":"暂停放化疗，行骨髓穿刺评估造血功能后再决定后续治疗","is_gold":false},{"letter":"K","text":"继续根治性放疗，终止同期化疗，放疗结束后改为辅助化疗","is_gold":false},{"letter":"L","text":"继续根治性放疗及同期化疗，降低放疗靶区处方剂量","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、海绵窦、翼突基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1078] 入院记录: 主诉: 外院可疑鼻咽癌；现病史: 简要入院病史:患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n- [全程D1081] 入院记录: 主诉: 回吸性涕血3月余；现病史: 患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：70次/分，R：14次/分，BP：126/71mmHg,Ht：155cm，Wt：48kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左颈Ⅱ区触及肿大淋巴结，约2×1.5cm，无融合，质地硬，边界尚清，活动度中等，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS:；ECOG:\n- [全程D1078] 入院记录: 主诉: 外院可疑鼻咽癌；现病史: 简要入院病史:患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。某次就诊时间再次出现回吸性涕血，遂行鼻咽镜检查，活检示：鼻咽炎性渗出。行鼻咽部CT示：鼻咽左侧可见软组织占位。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n- [全程D1081] 入院记录: 主诉: 回吸性涕血3月余；现病史: 患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。某次就诊时间再次出现回吸性涕血，遂行鼻咽镜检查，活检示：鼻咽炎性渗出。行鼻咽部CT示：鼻咽左侧可见软组织占位。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：70次/分，R：14次/分，BP：126/71mmHg,Ht：155cm，Wt：48kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率70次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左颈Ⅱ区触及肿大淋巴结，约2×1.5cm，无融合，质地硬，边界尚清，活动度中等，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- [全程D1078] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 Ⅱ、Ⅲ、aVF、V4～V6导联ST段下移\n- [全程D1078] 检验组合: 镁离子(Mg2+)-静脉血: 0.96mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.6；Rh血型-静脉血: 阳性；直接胆红素(DBIL)-静脉血: 2umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.61COI；白蛋白(ALB)-静脉血: 45.5g/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 0.085COI；γ-谷氨酰基转移酶(GGT)-静脉血: 13.6U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.2fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；葡萄糖(Glu)-静脉血: 4.67mmol/L；总胆红素(TBIL)-静脉血: 8.3umol/L；单核细胞百分比(Mono%)-静脉血: 0.074；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.5U/L；红细胞比容(Hct)-静脉血: 41%；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 1.56COI；单核细胞计数(Mono#)-静脉血: 0.310E9/L；中性粒细胞计数(Neut#)-静脉血: 2.510E9/L；胱抑素(Cys-C)-静脉血: 0.84mg/L；碱性磷酸酶(ALP)-静脉血: 80.5U/L；钠离子(Na+)-静脉血: 143.8mmol/L；乳酸脱氢酶(LDH)-静脉血: 194.4U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；平均红细胞血红蛋白浓度(MCHC)-静脉血: 324g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21.7U/L；氯离子(Cl-)-静脉血: 105.2mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.74；平均红细胞体积(MCV)-静脉血: 92.8fL；C-反应蛋白(CRP)-静脉血: 1.78mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.4；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: >1000IU/L；总胆固醇(TC)-静脉血: 5.98mmol/L；血红蛋白(Hb)-静脉血: 133g/L；大血小板百分比(P-LCR%)-静脉血: 26.1%；间接胆红素(I……\n- [全程D1079] 检验组合: 梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）\n- [全程D1081] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 多个颈腰椎、双侧膝关节可见片状放射性浓集灶。余颅骨、胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 考虑多个颈腰椎、双侧膝关节骨质退行性变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1092] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.006；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；颜色-尿液: 无色；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮\n- [全程D1094] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 28/μL；比重(SG)-尿液: 1.025；葡萄糖(Glu)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 36/μL；白细胞计数(WBC#)-尿液: 5/μL；酸碱度(pH)-尿液: 6.5；颜色-尿液: Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D1095] 检验组合: 白蛋白(ALB)-静脉血: 40.5g/L；镁离子(Mg2+)-静脉血: 0.84mmol/L；碱性磷酸酶(ALP)-静脉血: 63.2U/L；载脂蛋白B(apoB)-静脉血: 0.8g/L；葡萄糖(Glu)-静脉血: 5.31mmol/L；血小板比容-静脉血: 19%；直接胆红素(DBIL)-静脉血: 2.3umol/L；载脂蛋白AI(apoAI)-静脉血: 1.4g/L；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；总胆固醇(TC)-静脉血: 5.3mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.69mmolL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 325g/L；红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.9pg；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；γ-谷氨酰基转移酶(GGT)-静脉血: 16.8U/L；间接胆红素(IBIL)-静脉血: 5.6umolL；红细胞比容(Hct)-静脉血: 37.2%；钠离子(Na+)-静脉血: 141.6mmol/L；尿酸(UA)-静脉血: 219.2umol/L；总钙(Ca)-静脉血: 2.16mmol/L；尿素氮(BUN)-静脉血: 4.72mmol/L；平均红细胞体积(MCV)-静脉血: 91.9fL；球蛋白(GLO)-静脉血: 22.71g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.1；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14；乳酸脱氢酶(LDH)-静脉血: 179.4U/L；总胆红素(TBIL)-静脉血: 7.9umol/L；阴离子间隙(AG)-静脉血: 12；中性粒细胞百分比(Neut%)-静脉血: 0.814；血红蛋白(Hb)-静脉血: 121g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.1；丙氨酸氨基转移酶(ALT)-静脉血: 55.1U/L；白细胞计数(WBC#)-静脉血: 6.1210E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 36.2U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.58mmol/L；胱抑素(Cys-C)-静脉血: 0.95mg/L；大血小板……\n- [全程D1102] 检验组合: 尿酸(UA)-静脉血: 238.2umol/L；总胆红素(TBIL)-静脉血: 6.2umol/L；白细胞计数(WBC#)-静脉血: 3.5310E9/L；间接胆红素(IBIL)-静脉血: 4.8umolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.3；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.02；阴离子间隙(AG)-静脉血: 15.1；磷(P)-静脉血: 1.08mmol/L；钠离子(Na+)-静脉血: 137.5mmol/L；总钙(Ca)-静脉血: 2.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 26.7U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.8；直接胆红素(DBIL)-静脉血: 1.4umol/L；球蛋白(GLO)-静脉血: 27.56g/L；载脂蛋白AI(apoAI)-静脉血: 1.46g/L；红细胞计数(RBC#)-静脉血: 4.6610E12/L；载脂蛋白B(apoB)-静脉血: 1.09g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；血红蛋白(Hb)-静脉血: 142g/L；葡萄糖(Glu)-静脉血: 5.62mmol/L；甘油三酯(TG)-静脉血: 0.98mmol/L；镁离子(Mg2+)-静脉血: 0.97mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；血小板分布宽度(PDW)-静脉血: 9.2%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；总胆固醇(TC)-静脉血: 5.85mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336g/L；平均血小板体积(MPV)-静脉血: 9fL；血小板计数(PLT#)-静脉血: 19010E9/L；血小板比容-静脉血: 17%；红细胞比容(Hct)-静脉血: 42.3%；总胆汁酸(TBA)-静脉血: 1.8umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.76mmolL；胱抑素(Cys-C)-静脉血: 0.89mg/L；肌酐(Crea)-静脉血: 54.9umol/L；白蛋白(ALB)-静脉血: 46.6g/L；氯离子(Cl-)-静脉血: 97.8mmol/L；钾离子(K+)-静脉血: 3.78mmol/……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1082] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者目前诊断明确，[计划性表述已隐藏]根治性放疗及同期化疗。向患者及其家属交代病情，治疗方案及治疗风险，做好治疗前准备工作。\n- [全程D1083] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者入院第三天，无明显不适主诉，查体情况：一般情况可，余同入院。预约放疗。\n- [全程D1088] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 今日查房，患者无明显不适主诉，生命体征平稳。已予预约放疗。候治疗。\n- [全程D1093] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 今日查房，患者无明显不适主诉，生命体征平稳。查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常。患者现放疗计划已设计完成并通过全科会诊，靶区剂量分布均匀，正常组织剂量在可接受范围内。[姓名已隐去]医生信息已隐藏示：患者无明显放化疗禁忌症，拟于今日开始行根治性放疗+同时期化疗。向患者及其家属交代病情及化疗风险，表示理解并已签署知情同意书，可于今日执行第1程顺铂方案同时期化疗，注意化疗不良反应。\n- [全程D1098] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中，第1程顺铂方案同时期化疗结束。今日查房，患者诉呕吐2次，咽痛、恶心、食欲下降，伴头晕，无腹痛、腹泻等不适。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放化疗，给予重组人粒细胞集落刺激因子治疗，待白细胞恢复后继续\nB. 暂停同期化疗，仅继续根治性放疗，并给予重组人粒细胞集落刺激因子\nC. 继续根治性放疗及同期化疗，下一疗程顺铂剂量减量20%\nD. 继续根治性放疗及同期化疗，加用重组人粒细胞集落刺激因子\nE. 暂停放化疗，给予静脉高营养及强效止吐、补液支持，暂缓抗肿瘤治疗\nF. 继续根治性放疗及同期化疗，加用重组人血小板生成素\nG. 暂停同期化疗，将后续全身治疗更换为尼妥珠单抗靶向治疗\nH. 继续根治性放疗及同期化疗，加用促红细胞生成素及铁剂\nI. 继续根治性放疗及同期化疗，暂不予集落刺激因子支持，密切监测血常规\nJ. 暂停放化疗，行骨髓穿刺评估造血功能后再决定后续治疗\nK. 继续根治性放疗，终止同期化疗，放疗结束后改为辅助化疗\nL. 继续根治性放疗及同期化疗，降低放疗靶区处方剂量\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D1102] 检验组合: 尿酸(UA)-静脉血: 238.2umol/L；总胆红素(TBIL)-静脉血: 6.2umol/L；白细胞计数(WBC#)-静脉血: 3.5310E9/L；间接胆红素(IBIL)-静脉血: 4.8umolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.3；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.02；阴离子间隙(AG)-静脉血: 15.1；磷(P)-静脉血: 1.08mmol/L；钠离子(Na+)-静脉血: 137.5mmol/L；总钙(Ca)-静脉血: 2.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 26.7U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.8；直接胆红素(DBIL)-静脉血: 1.4umol/L；球蛋白(GLO)-静脉血: 27.56g/L；载脂蛋白AI(apoAI)-静脉血: 1.46g/L；红细胞计数(RBC#)-静脉血: 4.6610E12/L；载脂蛋白B(apoB)-静脉血: 1.09g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；血红蛋白(Hb)-静脉血: 142g/L；葡萄糖(Glu)-静脉血: 5.62mmol/L；甘油三酯(TG)-静脉血: 0.98mmol/L；镁离子(Mg2+)-静脉血: 0.97mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；血小板分布宽度(PDW)-静脉血: 9.2%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；总胆固醇(TC)-静脉血: 5.85mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336g/L；平均血小板体积(MPV)-静脉血: 9fL；血小板计数(PLT#)-静脉血: 19010E9/L；血小板比容-静脉血: 17%；红细胞比容(Hct)-静脉血: 42.3%；总胆汁酸(TBA)-静脉血: 1.8umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.76mmolL；胱抑素(Cys-C)-静脉血: 0.89mg/L；肌酐(Crea)-静脉血: 54.9umol/L；白蛋白(ALB)-静脉血: 46.6g/L；氯离子(Cl-)-静脉血: 97.8mmol/L；钾离子(K+)-静脉血: 3.78mmol/……\n\n【既往治疗与反应】\n- [全程D1098] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中，第1程顺铂方案同时期化疗结束。今日查房，患者诉呕吐2次，咽痛、恶心、食欲下降，伴头晕，无腹痛、腹泻等不适。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放化疗，给予重组人粒细胞集落刺激因子治疗，待白细胞恢复后继续\nB. 暂停同期化疗，仅继续根治性放疗，并给予重组人粒细胞集落刺激因子\nC. 继续根治性放疗及同期化疗，下一疗程顺铂剂量减量20%\nD. 继续根治性放疗及同期化疗，加用重组人粒细胞集落刺激因子\nE. 暂停放化疗，给予静脉高营养及强效止吐、补液支持，暂缓抗肿瘤治疗\nF. 继续根治性放疗及同期化疗，加用重组人血小板生成素\nG. 暂停同期化疗，将后续全身治疗更换为尼妥珠单抗靶向治疗\nH. 继续根治性放疗及同期化疗，加用促红细胞生成素及铁剂\nI. 继续根治性放疗及同期化疗，暂不予集落刺激因子支持，密切监测血常规\nJ. 暂停放化疗，行骨髓穿刺评估造血功能后再决定后续治疗\nK. 继续根治性放疗，终止同期化疗，放疗结束后改为辅助化疗\nL. 继续根治性放疗及同期化疗，降低放疗靶区处方剂量\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、海绵窦、翼突基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D1102] 检验组合: 尿酸(UA)-静脉血: 238.2umol/L；总胆红素(TBIL)-静脉血: 6.2umol/L；白细胞计数(WBC#)-静脉血: 3.5310E9/L；间接胆红素(IBIL)-静脉血: 4.8umolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.3；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.02；阴离子间隙(AG)-静脉血: 15.1；磷(P)-静脉血: 1.08mmol/L；钠离子(Na+)-静脉血: 137.5mmol/L；总钙(Ca)-静脉血: 2.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 26.7U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.8；直接胆红素(DBIL)-静脉血: 1.4umol/L；球蛋白(GLO)-静脉血: 27.56g/L；载脂蛋白AI(apoAI)-静脉血: 1.46g/L；红细胞计数(RBC#)-静脉血: 4.6610E12/L；载脂蛋白B(apoB)-静脉血: 1.09g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；血红蛋白(Hb)-静脉血: 142g/L；葡萄糖(Glu)-静脉血: 5.62mmol/L；甘油三酯(TG)-静脉血: 0.98mmol/L；镁离子(Mg2+)-静脉血: 0.97mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；血小板分布宽度(PDW)-静脉血: 9.2%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；总胆固醇(TC)-静脉血: 5.85mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336g/L；平均血小板体积(MPV)-静脉血: 9fL；血小板计数(PLT#)-静脉血: 19010E9/L；血小板比容-静脉血: 17%；红细胞比容(Hct)-静脉血: 42.3%；总胆汁酸(TBA)-静脉血: 1.8umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.76mmolL；胱抑素(Cys-C)-静脉血: 0.89mg/L；肌酐(Crea)-静脉血: 54.9umol/L；白蛋白(ALB)-静脉血: 46.6g/L；氯离子(Cl-)-静脉血: 97.8mmol/L；钾离子(K+)-静脉血: 3.78mmol/……\n\n【既往治疗与反应】\n- [全程D1098] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中，第1程顺铂方案同时期化疗结束。今日查房，患者诉呕吐2次，咽痛、恶心、食欲下降，伴头晕，无腹痛、腹泻等不适。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放化疗，给予重组人粒细胞集落刺激因子治疗，待白细胞恢复后继续\nB. 暂停同期化疗，仅继续根治性放疗，并给予重组人粒细胞集落刺激因子\nC. 继续根治性放疗及同期化疗，下一疗程顺铂剂量减量20%\nD. 继续根治性放疗及同期化疗，加用重组人粒细胞集落刺激因子\nE. 暂停放化疗，给予静脉高营养及强效止吐、补液支持，暂缓抗肿瘤治疗\nF. 继续根治性放疗及同期化疗，加用重组人血小板生成素\nG. 暂停同期化疗，将后续全身治疗更换为尼妥珠单抗靶向治疗\nH. 继续根治性放疗及同期化疗，加用促红细胞生成素及铁剂\nI. 继续根治性放疗及同期化疗，暂不予集落刺激因子支持，密切监测血常规\nJ. 暂停放化疗，行骨髓穿刺评估造血功能后再决定后续治疗\nK. 继续根治性放疗，终止同期化疗，放疗结束后改为辅助化疗\nL. 继续根治性放疗及同期化疗，降低放疗靶区处方剂量\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-28a13cf2b32abdc303bbad45","patient_id":"patient-36d433557e63f939b878347d","turn_id":"turn07","turn_position":5,"turn_type":"response_assessment_decision","gold_letter":"I","gold_action":"评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，每周复查血常规及生化，指导功能锻炼。","options":[{"letter":"A","text":"评估临床症状完全缓解，提前终止放疗，办理出院并进入定期随访阶段，1个月后复查头颈部MRI。","is_gold":false},{"letter":"B","text":"评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，并口服替吉奥单药维持化疗。","is_gold":false},{"letter":"C","text":"评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，期间无需定期复查血液学指标。","is_gold":false},{"letter":"D","text":"评估肿瘤退缩缓慢，继续住院，将放疗方案调整为超分割放疗，并加用西妥昔单抗靶向治疗。","is_gold":false},{"letter":"E","text":"评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，期间暂停放疗2周以促进粘膜修复。","is_gold":false},{"letter":"F","text":"评估肿瘤部分缓解，继续住院完成根治性放疗，并每周行鼻咽部MRI以动态监测肿瘤退缩情况。","is_gold":false},{"letter":"G","text":"评估临床症状缓解且毒副反应可耐受，转外科行鼻咽及颈部残留病灶切除术，术后在门诊继续完成剩余放疗。","is_gold":false},{"letter":"H","text":"评估疑似疾病进展，停止放疗，改为吉西他滨联合顺铂方案全身姑息化疗并办理出院。","is_gold":false},{"letter":"I","text":"评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，每周复查血常规及生化，指导功能锻炼。","is_gold":true},{"letter":"J","text":"评估临床症状缓解且毒副反应可耐受，继续住院完成剩余根治性放疗，期间常规给予静脉高营养支持及预防性抗感染。","is_gold":false},{"letter":"K","text":"评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，并立即安排全身PET-CT确认疗效。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、海绵窦、翼突基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1078] 入院记录: 主诉: 外院可疑鼻咽癌；现病史: 简要入院病史:患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n- [全程D1081] 入院记录: 主诉: 回吸性涕血3月余；现病史: 患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：70次/分，R：14次/分，BP：126/71mmHg,Ht：155cm，Wt：48kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左颈Ⅱ区触及肿大淋巴结，约2×1.5cm，无融合，质地硬，边界尚清，活动度中等，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS:；ECOG:\n- [全程D1078] 入院记录: 主诉: 外院可疑鼻咽癌；现病史: 简要入院病史:患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。某次就诊时间再次出现回吸性涕血，遂行鼻咽镜检查，活检示：鼻咽炎性渗出。行鼻咽部CT示：鼻咽左侧可见软组织占位。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n- [全程D1081] 入院记录: 主诉: 回吸性涕血3月余；现病史: 患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。某次就诊时间再次出现回吸性涕血，遂行鼻咽镜检查，活检示：鼻咽炎性渗出。行鼻咽部CT示：鼻咽左侧可见软组织占位。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：70次/分，R：14次/分，BP：126/71mmHg,Ht：155cm，Wt：48kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率70次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左颈Ⅱ区触及肿大淋巴结，约2×1.5cm，无融合，质地硬，边界尚清，活动度中等，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- [全程D1078] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 Ⅱ、Ⅲ、aVF、V4～V6导联ST段下移\n- [全程D1078] 检验组合: 镁离子(Mg2+)-静脉血: 0.96mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.6；Rh血型-静脉血: 阳性；直接胆红素(DBIL)-静脉血: 2umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.61COI；白蛋白(ALB)-静脉血: 45.5g/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 0.085COI；γ-谷氨酰基转移酶(GGT)-静脉血: 13.6U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.2fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；葡萄糖(Glu)-静脉血: 4.67mmol/L；总胆红素(TBIL)-静脉血: 8.3umol/L；单核细胞百分比(Mono%)-静脉血: 0.074；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.5U/L；红细胞比容(Hct)-静脉血: 41%；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 1.56COI；单核细胞计数(Mono#)-静脉血: 0.310E9/L；中性粒细胞计数(Neut#)-静脉血: 2.510E9/L；胱抑素(Cys-C)-静脉血: 0.84mg/L；碱性磷酸酶(ALP)-静脉血: 80.5U/L；钠离子(Na+)-静脉血: 143.8mmol/L；乳酸脱氢酶(LDH)-静脉血: 194.4U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；平均红细胞血红蛋白浓度(MCHC)-静脉血: 324g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21.7U/L；氯离子(Cl-)-静脉血: 105.2mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.74；平均红细胞体积(MCV)-静脉血: 92.8fL；C-反应蛋白(CRP)-静脉血: 1.78mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.4；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: >1000IU/L；总胆固醇(TC)-静脉血: 5.98mmol/L；血红蛋白(Hb)-静脉血: 133g/L；大血小板百分比(P-LCR%)-静脉血: 26.1%；间接胆红素(I……\n- [全程D1079] 检验组合: 梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）\n- [全程D1081] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 多个颈腰椎、双侧膝关节可见片状放射性浓集灶。余颅骨、胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 考虑多个颈腰椎、双侧膝关节骨质退行性变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1092] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.006；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；颜色-尿液: 无色；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮\n- [全程D1094] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 28/μL；比重(SG)-尿液: 1.025；葡萄糖(Glu)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 36/μL；白细胞计数(WBC#)-尿液: 5/μL；酸碱度(pH)-尿液: 6.5；颜色-尿液: Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D1095] 检验组合: 白蛋白(ALB)-静脉血: 40.5g/L；镁离子(Mg2+)-静脉血: 0.84mmol/L；碱性磷酸酶(ALP)-静脉血: 63.2U/L；载脂蛋白B(apoB)-静脉血: 0.8g/L；葡萄糖(Glu)-静脉血: 5.31mmol/L；血小板比容-静脉血: 19%；直接胆红素(DBIL)-静脉血: 2.3umol/L；载脂蛋白AI(apoAI)-静脉血: 1.4g/L；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；总胆固醇(TC)-静脉血: 5.3mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.69mmolL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 325g/L；红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.9pg；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；γ-谷氨酰基转移酶(GGT)-静脉血: 16.8U/L；间接胆红素(IBIL)-静脉血: 5.6umolL；红细胞比容(Hct)-静脉血: 37.2%；钠离子(Na+)-静脉血: 141.6mmol/L；尿酸(UA)-静脉血: 219.2umol/L；总钙(Ca)-静脉血: 2.16mmol/L；尿素氮(BUN)-静脉血: 4.72mmol/L；平均红细胞体积(MCV)-静脉血: 91.9fL；球蛋白(GLO)-静脉血: 22.71g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.1；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14；乳酸脱氢酶(LDH)-静脉血: 179.4U/L；总胆红素(TBIL)-静脉血: 7.9umol/L；阴离子间隙(AG)-静脉血: 12；中性粒细胞百分比(Neut%)-静脉血: 0.814；血红蛋白(Hb)-静脉血: 121g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.1；丙氨酸氨基转移酶(ALT)-静脉血: 55.1U/L；白细胞计数(WBC#)-静脉血: 6.1210E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 36.2U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.58mmol/L；胱抑素(Cys-C)-静脉血: 0.95mg/L；大血小板……\n- [全程D1102] 检验组合: 尿酸(UA)-静脉血: 238.2umol/L；总胆红素(TBIL)-静脉血: 6.2umol/L；白细胞计数(WBC#)-静脉血: 3.5310E9/L；间接胆红素(IBIL)-静脉血: 4.8umolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.3；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.02；阴离子间隙(AG)-静脉血: 15.1；磷(P)-静脉血: 1.08mmol/L；钠离子(Na+)-静脉血: 137.5mmol/L；总钙(Ca)-静脉血: 2.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 26.7U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.8；直接胆红素(DBIL)-静脉血: 1.4umol/L；球蛋白(GLO)-静脉血: 27.56g/L；载脂蛋白AI(apoAI)-静脉血: 1.46g/L；红细胞计数(RBC#)-静脉血: 4.6610E12/L；载脂蛋白B(apoB)-静脉血: 1.09g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；血红蛋白(Hb)-静脉血: 142g/L；葡萄糖(Glu)-静脉血: 5.62mmol/L；甘油三酯(TG)-静脉血: 0.98mmol/L；镁离子(Mg2+)-静脉血: 0.97mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；血小板分布宽度(PDW)-静脉血: 9.2%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；总胆固醇(TC)-静脉血: 5.85mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336g/L；平均血小板体积(MPV)-静脉血: 9fL；血小板计数(PLT#)-静脉血: 19010E9/L；血小板比容-静脉血: 17%；红细胞比容(Hct)-静脉血: 42.3%；总胆汁酸(TBA)-静脉血: 1.8umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.76mmolL；胱抑素(Cys-C)-静脉血: 0.89mg/L；肌酐(Crea)-静脉血: 54.9umol/L；白蛋白(ALB)-静脉血: 46.6g/L；氯离子(Cl-)-静脉血: 97.8mmol/L；钾离子(K+)-静脉血: 3.78mmol/……\n- [全程D1109] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 28.2mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；钾离子(K+)-静脉血: 3.77mmol/L；甘油三酯(TG)-静脉血: 0.8mmol/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；红细胞计数(RBC#)-静脉血: 4.2410E12/L；总胆固醇(TC)-静脉血: 5.21mmol/L；镁离子(Mg2+)-静脉血: 0.97mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.6；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；总胆汁酸(TBA)-静脉血: 0.6umol/L；总胆红素(TBIL)-静脉血: 8.6umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.119；红细胞比容(Hct)-静脉血: 38.7%；尿素氮(BUN)-静脉血: 4.1mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；间接胆红素(IBIL)-静脉血: 6.5umolL；C-反应蛋白(CRP)-静脉血: 2.85mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.53mmolL；血小板分布宽度(PDW)-静脉血: 17.4%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.29mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；阴离子间隙(AG)-静脉血: 15；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；血小板计数(PLT#)-静脉血: 204.310E9/L；平均红细胞体积(MCV)-静脉血: 91.1fL；丙氨酸氨基转移酶(ALT)-静脉血: 12.3U/L；总蛋白(TP)-静脉血: 69.21g/L；直接胆红素(DBIL)-静脉血: 2.1umol/L；氯离子(Cl-)-静脉血: 95.7mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.784；中性粒细胞计数(Neut#)-静脉血: 2.310E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22.8U/L；平均血小板体积(MPV)-静脉血: 6.38fL；γ-谷氨酰基转移酶(GGT)-静脉血: 23.6U/L；总钙(Ca)-静脉血: 2.22mmol/L；单核……\n- [全程D1113] 检验组合: 血小板比容-静脉血: 15%；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 6.5；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.734；平均红细胞体积(MCV)-静脉血: 91.5fL；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；隐血(OB)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；中性粒细胞计数(Neut#)-静脉血: 2.310E9/L；总蛋白(TP)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 1/μL；红细胞计数(RBC#)-静脉血: 4.1310E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；血小板计数(PLT#)-静脉血: 16810E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；比重(SG)-尿液: 1.009；浊度(TRUB)-尿液: 清亮；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.05；大血小板百分比(P-LCR%)-静脉血: 18%；单核细胞计数(Mono#)-静脉血: 0.410E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.5；酮体(KET)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 13/μL；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-静脉血: 3.210E9/L；白细胞(LEU)-尿液: -（参考: 阴性）；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；红细胞比容(Hct)-静脉血: 37.8%；血红蛋白(Hb)-静脉血: 126g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.5；血小板分布宽度(PDW)-静脉血: 9.3%；淋巴细胞百分比(Lymph%)-静脉血: 0.103；平均红细胞血红蛋白浓度(MCHC)-静脉血: 333g/L；平均血小板体积(MPV)-静脉血: 8.9fL；单核细胞百分比(Mono%)-静脉血: 0.11\n- [全程D1114] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 16/μL；颜色-尿液: Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: +- 0.1g（参考: 阴性）；酮体(KET)-尿液: 1+ 1mmol（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 6.5；比重(SG)-尿液: 1.022；白细胞计数(WBC#)-尿液: 10/μL；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）\n- [全程D1116] 检验组合: 亚硝酸盐(NIT)-尿液: -（参考: 阴性）；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336.3g/L；阴离子间隙(AG)-静脉血: 12；总蛋白(TP)-尿液: -（参考: 阴性）；磷(P)-静脉血: 0.93mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20U/L；尿酸(UA)-静脉血: 199.4umol/L；平均红细胞体积(MCV)-静脉血: 92.9fL；碱性磷酸酶(ALP)-静脉血: 61.6U/L；酸碱度(pH)-尿液: 6.5；血小板分布宽度(PDW)-静脉血: 17%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.032；隐血(OB)-尿液: -（参考: 阴性）；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.44mmolL；肌酐(Crea)-静脉血: 67.5umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.2；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；氯离子(Cl-)-静脉血: 102.9mmol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；总胆红素(TBIL)-静脉血: 6.7umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14%；血小板计数(PLT#)-静脉血: 176.710E9/L；总蛋白(TP)-静脉血: 65.51g/L；尿素氮(BUN)-静脉血: 3.95mmol/L；红细胞计数(RBC#)-静脉血: 3.8510E12/L；甘油三酯(TG)-静脉血: 1.05mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；α-L-岩藻糖苷酶(AFU)-静脉血: 30U/L；间接胆红素(IBIL)-静脉血: 4.4umolL；总胆固醇(TC)-静脉血: 5.25mmol/L；浊度(TRUB)-尿液: 清亮；平均血小板体积(MPV)-静脉血: 6.6fL；胆红素(BIL)-尿液: -（参考: 阴性）；总胆汁酸(TBA)-静脉血: 0.2umol/L；载脂蛋白B(apoB)-静脉血: 0.98g/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；中性粒细胞计数(Neut#)-静脉血: 2.81……\n- [全程D1123] 检验组合: 红细胞计数(RBC#)-静脉血: 4.3710E12/L；中性粒细胞计数(Neut#)-静脉血: 310E9/L；平均红细胞体积(MCV)-静脉血: 90fL；甘油三酯(TG)-静脉血: 1.06mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.55；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.072；白蛋白(ALB)-静脉血: 44.8g/L；单核细胞百分比(Mono%)-静脉血: 0.081；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；红细胞比容(Hct)-静脉血: 39.4%；总钙(Ca)-静脉血: 2.44mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.8pg；血小板比容-静脉血: 10%；氯离子(Cl-)-静脉血: 92.5mmol/L；血小板计数(PLT#)-静脉血: 143.810E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.98mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4%；中性粒细胞百分比(Neut%)-静脉血: 0.841；总胆固醇(TC)-静脉血: 6.12mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 343.2g/L；间接胆红素(IBIL)-静脉血: 6.2umolL；尿素氮(BUN)-静脉血: 7.4mmol/L；平均血小板体积(MPV)-静脉血: 6.98fL；总胆红素(TBIL)-静脉血: 8.2umol/L；胱抑素(Cys-C)-静脉血: 0.86mg/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；载脂蛋白B(apoB)-静脉血: 1.37g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.9U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；C-反应蛋白(CRP)-静脉血: 10.49mg/L；球蛋白(GLO)-静脉血: 30.65g/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.46；葡萄糖(Glu)-静脉血: 5.64mmol/L；磷(P)-静脉血: 1.16mmol/L……\n- [全程D1125] 检验组合: 总钙(Ca)-静脉血: 2.38mmol/L；阴离子间隙(AG)-静脉血: 12.7；磷(P)-静脉血: 0.81mmol/L；氯离子(Cl-)-静脉血: 92.5mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 28.7mmol/L；钾离子(K+)-静脉血: 3.68mmol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；钠离子(Na+)-静脉血: 133.9mmol/L\n- [全程D1130] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对侧，双肺野纹理清晰，未见明显实质性病变。双侧肺门不大，纵隔不宽，心影形态、大小、位置未见异常。双膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见异常。\n- [全程D1130] 超声；肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。\n- [全程D1130] 检验组合: 有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞血红蛋白含量(MCH)-静脉血: 31.3pg；淋巴细胞百分比(Lymph%)-静脉血: 0.09；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4%；单核细胞计数(Mono#)-静脉血: 0.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.184；白蛋白(ALB)-静脉血: 43.5g/L；球蛋白(GLO)-静脉血: 29.66g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.32mmolL；总胆固醇(TC)-静脉血: 5.82mmol/L；葡萄糖(Glu)-静脉血: 5.74mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21U/L；中性粒细胞计数(Neut#)-静脉血: 1.510E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.9U/L；中性粒细胞百分比(Neut%)-静脉血: 0.715；尿酸(UA)-静脉血: 242.7umol/L；总胆汁酸(TBA)-静脉血: 0.2umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.005；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；血红蛋白(Hb)-静脉血: 125g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血小板分布宽度(PDW)-静脉血: 17.2%；总胆红素(TBIL)-静脉血: 6.6umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 28.4mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 344.5g/L；钾离子(K+)-静脉血: 3.7mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.8U/L；载脂蛋白B(apoB)-静脉血: 1.31g/L；红细胞计数(RBC#)-静脉血: 3.9910E12/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.4；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 90.9fL；总蛋白(TP)-静脉血: 73.16g/L；平均血小板体积(MPV)-静脉血: 6.84fL；血小板计数(PLT#)-静脉血: 181.410E9/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；低密度脂蛋白胆固醇(LDL-C)……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1082] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者目前诊断明确，[计划性表述已隐藏]根治性放疗及同期化疗。向患者及其家属交代病情，治疗方案及治疗风险，做好治疗前准备工作。\n- [全程D1083] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者入院第三天，无明显不适主诉，查体情况：一般情况可，余同入院。预约放疗。\n- [全程D1088] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 今日查房，患者无明显不适主诉，生命体征平稳。已予预约放疗。候治疗。\n- [全程D1093] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 今日查房，患者无明显不适主诉，生命体征平稳。查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常。患者现放疗计划已设计完成并通过全科会诊，靶区剂量分布均匀，正常组织剂量在可接受范围内。[姓名已隐去]医生信息已隐藏示：患者无明显放化疗禁忌症，拟于今日开始行根治性放疗+同时期化疗。向患者及其家属交代病情及化疗风险，表示理解并已签署知情同意书，可于今日执行第1程顺铂方案同时期化疗，注意化疗不良反应。\n- [全程D1098] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中，第1程顺铂方案同时期化疗结束。今日查房，患者诉呕吐2次，咽痛、恶心、食欲下降，伴头晕，无腹痛、腹泻等不适。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D1108] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中。今日查房，患者无明显不适主诉，生命体征平稳。[姓名已隐去]医生信息已隐藏：继续治疗。\n- [全程D1113] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中。今日查房，患者无明显不适主诉，生命体征平稳。查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：可于今日水化，明日执行第2程DDP方案同时期化疗，注意化疗不良反应。\n- [全程D1118] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中，第2程顺铂方案同时期化疗结束。诉咽痛、恶心、食欲下降，呕吐1次，伴头晕，无腹痛、腹泻等不适。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D1123] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中。今日查房，患者无明显不适主诉，生命体征平稳。[姓名已隐去]医生信息已隐藏：患者治疗疗程过半，予预约治疗结束后影像学复查。继续治疗。\n- [全程D1129] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中。今日查房，患者无明显不适主诉，生命体征平稳。[姓名已隐去]医生信息已隐藏：嘱患者冲洗鼻咽，保持鼻咽清洁。继续治疗。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 评估临床症状完全缓解，提前终止放疗，办理出院并进入定期随访阶段，1个月后复查头颈部MRI。\nB. 评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，并口服替吉奥单药维持化疗。\nC. 评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，期间无需定期复查血液学指标。\nD. 评估肿瘤退缩缓慢，继续住院，将放疗方案调整为超分割放疗，并加用西妥昔单抗靶向治疗。\nE. 评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，期间暂停放疗2周以促进粘膜修复。\nF. 评估肿瘤部分缓解，继续住院完成根治性放疗，并每周行鼻咽部MRI以动态监测肿瘤退缩情况。\nG. 评估临床症状缓解且毒副反应可耐受，转外科行鼻咽及颈部残留病灶切除术，术后在门诊继续完成剩余放疗。\nH. 评估疑似疾病进展，停止放疗，改为吉西他滨联合顺铂方案全身姑息化疗并办理出院。\nI. 评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，每周复查血常规及生化，指导功能锻炼。\nJ. 评估临床症状缓解且毒副反应可耐受，继续住院完成剩余根治性放疗，期间常规给予静脉高营养支持及预防性抗感染。\nK. 评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，并立即安排全身PET-CT确认疗效。\n\n请仅输出一个选项字母（A-K）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D1109] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 28.2mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；钾离子(K+)-静脉血: 3.77mmol/L；甘油三酯(TG)-静脉血: 0.8mmol/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；红细胞计数(RBC#)-静脉血: 4.2410E12/L；总胆固醇(TC)-静脉血: 5.21mmol/L；镁离子(Mg2+)-静脉血: 0.97mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.6；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；总胆汁酸(TBA)-静脉血: 0.6umol/L；总胆红素(TBIL)-静脉血: 8.6umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.119；红细胞比容(Hct)-静脉血: 38.7%；尿素氮(BUN)-静脉血: 4.1mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；间接胆红素(IBIL)-静脉血: 6.5umolL；C-反应蛋白(CRP)-静脉血: 2.85mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.53mmolL；血小板分布宽度(PDW)-静脉血: 17.4%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.29mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；阴离子间隙(AG)-静脉血: 15；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；血小板计数(PLT#)-静脉血: 204.310E9/L；平均红细胞体积(MCV)-静脉血: 91.1fL；丙氨酸氨基转移酶(ALT)-静脉血: 12.3U/L；总蛋白(TP)-静脉血: 69.21g/L；直接胆红素(DBIL)-静脉血: 2.1umol/L；氯离子(Cl-)-静脉血: 95.7mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.784；中性粒细胞计数(Neut#)-静脉血: 2.310E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22.8U/L；平均血小板体积(MPV)-静脉血: 6.38fL；γ-谷氨酰基转移酶(GGT)-静脉血: 23.6U/L；总钙(Ca)-静脉血: 2.22mmol/L；单核……\n- [全程D1113] 检验组合: 血小板比容-静脉血: 15%；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 6.5；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.734；平均红细胞体积(MCV)-静脉血: 91.5fL；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；隐血(OB)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；中性粒细胞计数(Neut#)-静脉血: 2.310E9/L；总蛋白(TP)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 1/μL；红细胞计数(RBC#)-静脉血: 4.1310E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；血小板计数(PLT#)-静脉血: 16810E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；比重(SG)-尿液: 1.009；浊度(TRUB)-尿液: 清亮；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.05；大血小板百分比(P-LCR%)-静脉血: 18%；单核细胞计数(Mono#)-静脉血: 0.410E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.5；酮体(KET)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 13/μL；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-静脉血: 3.210E9/L；白细胞(LEU)-尿液: -（参考: 阴性）；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；红细胞比容(Hct)-静脉血: 37.8%；血红蛋白(Hb)-静脉血: 126g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.5；血小板分布宽度(PDW)-静脉血: 9.3%；淋巴细胞百分比(Lymph%)-静脉血: 0.103；平均红细胞血红蛋白浓度(MCHC)-静脉血: 333g/L；平均血小板体积(MPV)-静脉血: 8.9fL；单核细胞百分比(Mono%)-静脉血: 0.11\n- [全程D1114] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 16/μL；颜色-尿液: Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: +- 0.1g（参考: 阴性）；酮体(KET)-尿液: 1+ 1mmol（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 6.5；比重(SG)-尿液: 1.022；白细胞计数(WBC#)-尿液: 10/μL；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）\n- [全程D1116] 检验组合: 亚硝酸盐(NIT)-尿液: -（参考: 阴性）；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336.3g/L；阴离子间隙(AG)-静脉血: 12；总蛋白(TP)-尿液: -（参考: 阴性）；磷(P)-静脉血: 0.93mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20U/L；尿酸(UA)-静脉血: 199.4umol/L；平均红细胞体积(MCV)-静脉血: 92.9fL；碱性磷酸酶(ALP)-静脉血: 61.6U/L；酸碱度(pH)-尿液: 6.5；血小板分布宽度(PDW)-静脉血: 17%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.032；隐血(OB)-尿液: -（参考: 阴性）；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.44mmolL；肌酐(Crea)-静脉血: 67.5umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.2；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；氯离子(Cl-)-静脉血: 102.9mmol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；总胆红素(TBIL)-静脉血: 6.7umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14%；血小板计数(PLT#)-静脉血: 176.710E9/L；总蛋白(TP)-静脉血: 65.51g/L；尿素氮(BUN)-静脉血: 3.95mmol/L；红细胞计数(RBC#)-静脉血: 3.8510E12/L；甘油三酯(TG)-静脉血: 1.05mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；α-L-岩藻糖苷酶(AFU)-静脉血: 30U/L；间接胆红素(IBIL)-静脉血: 4.4umolL；总胆固醇(TC)-静脉血: 5.25mmol/L；浊度(TRUB)-尿液: 清亮；平均血小板体积(MPV)-静脉血: 6.6fL；胆红素(BIL)-尿液: -（参考: 阴性）；总胆汁酸(TBA)-静脉血: 0.2umol/L；载脂蛋白B(apoB)-静脉血: 0.98g/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；中性粒细胞计数(Neut#)-静脉血: 2.81……\n- [全程D1123] 检验组合: 红细胞计数(RBC#)-静脉血: 4.3710E12/L；中性粒细胞计数(Neut#)-静脉血: 310E9/L；平均红细胞体积(MCV)-静脉血: 90fL；甘油三酯(TG)-静脉血: 1.06mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.55；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.072；白蛋白(ALB)-静脉血: 44.8g/L；单核细胞百分比(Mono%)-静脉血: 0.081；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；红细胞比容(Hct)-静脉血: 39.4%；总钙(Ca)-静脉血: 2.44mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.8pg；血小板比容-静脉血: 10%；氯离子(Cl-)-静脉血: 92.5mmol/L；血小板计数(PLT#)-静脉血: 143.810E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.98mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4%；中性粒细胞百分比(Neut%)-静脉血: 0.841；总胆固醇(TC)-静脉血: 6.12mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 343.2g/L；间接胆红素(IBIL)-静脉血: 6.2umolL；尿素氮(BUN)-静脉血: 7.4mmol/L；平均血小板体积(MPV)-静脉血: 6.98fL；总胆红素(TBIL)-静脉血: 8.2umol/L；胱抑素(Cys-C)-静脉血: 0.86mg/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；载脂蛋白B(apoB)-静脉血: 1.37g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.9U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；C-反应蛋白(CRP)-静脉血: 10.49mg/L；球蛋白(GLO)-静脉血: 30.65g/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.46；葡萄糖(Glu)-静脉血: 5.64mmol/L；磷(P)-静脉血: 1.16mmol/L……\n- [全程D1125] 检验组合: 总钙(Ca)-静脉血: 2.38mmol/L；阴离子间隙(AG)-静脉血: 12.7；磷(P)-静脉血: 0.81mmol/L；氯离子(Cl-)-静脉血: 92.5mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 28.7mmol/L；钾离子(K+)-静脉血: 3.68mmol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；钠离子(Na+)-静脉血: 133.9mmol/L\n- [全程D1130] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对侧，双肺野纹理清晰，未见明显实质性病变。双侧肺门不大，纵隔不宽，心影形态、大小、位置未见异常。双膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见异常。\n- [全程D1130] 超声；肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。\n- [全程D1130] 检验组合: 有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞血红蛋白含量(MCH)-静脉血: 31.3pg；淋巴细胞百分比(Lymph%)-静脉血: 0.09；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4%；单核细胞计数(Mono#)-静脉血: 0.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.184；白蛋白(ALB)-静脉血: 43.5g/L；球蛋白(GLO)-静脉血: 29.66g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.32mmolL；总胆固醇(TC)-静脉血: 5.82mmol/L；葡萄糖(Glu)-静脉血: 5.74mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21U/L；中性粒细胞计数(Neut#)-静脉血: 1.510E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.9U/L；中性粒细胞百分比(Neut%)-静脉血: 0.715；尿酸(UA)-静脉血: 242.7umol/L；总胆汁酸(TBA)-静脉血: 0.2umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.005；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；血红蛋白(Hb)-静脉血: 125g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血小板分布宽度(PDW)-静脉血: 17.2%；总胆红素(TBIL)-静脉血: 6.6umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 28.4mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 344.5g/L；钾离子(K+)-静脉血: 3.7mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.8U/L；载脂蛋白B(apoB)-静脉血: 1.31g/L；红细胞计数(RBC#)-静脉血: 3.9910E12/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.4；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 90.9fL；总蛋白(TP)-静脉血: 73.16g/L；平均血小板体积(MPV)-静脉血: 6.84fL；血小板计数(PLT#)-静脉血: 181.410E9/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；低密度脂蛋白胆固醇(LDL-C)……\n\n【既往治疗与反应】\n- [全程D1108] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中。今日查房，患者无明显不适主诉，生命体征平稳。[姓名已隐去]医生信息已隐藏：继续治疗。\n- [全程D1113] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中。今日查房，患者无明显不适主诉，生命体征平稳。查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：可于今日水化，明日执行第2程DDP方案同时期化疗，注意化疗不良反应。\n- [全程D1118] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中，第2程顺铂方案同时期化疗结束。诉咽痛、恶心、食欲下降，呕吐1次，伴头晕，无腹痛、腹泻等不适。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D1123] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中。今日查房，患者无明显不适主诉，生命体征平稳。[姓名已隐去]医生信息已隐藏：患者治疗疗程过半，予预约治疗结束后影像学复查。继续治疗。\n- [全程D1129] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中。今日查房，患者无明显不适主诉，生命体征平稳。[姓名已隐去]医生信息已隐藏：嘱患者冲洗鼻咽，保持鼻咽清洁。继续治疗。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 评估临床症状完全缓解，提前终止放疗，办理出院并进入定期随访阶段，1个月后复查头颈部MRI。\nB. 评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，并口服替吉奥单药维持化疗。\nC. 评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，期间无需定期复查血液学指标。\nD. 评估肿瘤退缩缓慢，继续住院，将放疗方案调整为超分割放疗，并加用西妥昔单抗靶向治疗。\nE. 评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，期间暂停放疗2周以促进粘膜修复。\nF. 评估肿瘤部分缓解，继续住院完成根治性放疗，并每周行鼻咽部MRI以动态监测肿瘤退缩情况。\nG. 评估临床症状缓解且毒副反应可耐受，转外科行鼻咽及颈部残留病灶切除术，术后在门诊继续完成剩余放疗。\nH. 评估疑似疾病进展，停止放疗，改为吉西他滨联合顺铂方案全身姑息化疗并办理出院。\nI. 评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，每周复查血常规及生化，指导功能锻炼。\nJ. 评估临床症状缓解且毒副反应可耐受，继续住院完成剩余根治性放疗，期间常规给予静脉高营养支持及预防性抗感染。\nK. 评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，并立即安排全身PET-CT确认疗效。\n\n请仅输出一个选项字母（A-K）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、海绵窦、翼突基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D1109] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 28.2mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；钾离子(K+)-静脉血: 3.77mmol/L；甘油三酯(TG)-静脉血: 0.8mmol/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；红细胞计数(RBC#)-静脉血: 4.2410E12/L；总胆固醇(TC)-静脉血: 5.21mmol/L；镁离子(Mg2+)-静脉血: 0.97mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.6；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；总胆汁酸(TBA)-静脉血: 0.6umol/L；总胆红素(TBIL)-静脉血: 8.6umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.119；红细胞比容(Hct)-静脉血: 38.7%；尿素氮(BUN)-静脉血: 4.1mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；间接胆红素(IBIL)-静脉血: 6.5umolL；C-反应蛋白(CRP)-静脉血: 2.85mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.53mmolL；血小板分布宽度(PDW)-静脉血: 17.4%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.29mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；阴离子间隙(AG)-静脉血: 15；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；血小板计数(PLT#)-静脉血: 204.310E9/L；平均红细胞体积(MCV)-静脉血: 91.1fL；丙氨酸氨基转移酶(ALT)-静脉血: 12.3U/L；总蛋白(TP)-静脉血: 69.21g/L；直接胆红素(DBIL)-静脉血: 2.1umol/L；氯离子(Cl-)-静脉血: 95.7mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.784；中性粒细胞计数(Neut#)-静脉血: 2.310E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22.8U/L；平均血小板体积(MPV)-静脉血: 6.38fL；γ-谷氨酰基转移酶(GGT)-静脉血: 23.6U/L；总钙(Ca)-静脉血: 2.22mmol/L；单核……\n- [全程D1113] 检验组合: 血小板比容-静脉血: 15%；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 6.5；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.734；平均红细胞体积(MCV)-静脉血: 91.5fL；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；隐血(OB)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；中性粒细胞计数(Neut#)-静脉血: 2.310E9/L；总蛋白(TP)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 1/μL；红细胞计数(RBC#)-静脉血: 4.1310E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；血小板计数(PLT#)-静脉血: 16810E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；比重(SG)-尿液: 1.009；浊度(TRUB)-尿液: 清亮；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.05；大血小板百分比(P-LCR%)-静脉血: 18%；单核细胞计数(Mono#)-静脉血: 0.410E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.5；酮体(KET)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 13/μL；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-静脉血: 3.210E9/L；白细胞(LEU)-尿液: -（参考: 阴性）；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；红细胞比容(Hct)-静脉血: 37.8%；血红蛋白(Hb)-静脉血: 126g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.5；血小板分布宽度(PDW)-静脉血: 9.3%；淋巴细胞百分比(Lymph%)-静脉血: 0.103；平均红细胞血红蛋白浓度(MCHC)-静脉血: 333g/L；平均血小板体积(MPV)-静脉血: 8.9fL；单核细胞百分比(Mono%)-静脉血: 0.11\n- [全程D1114] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 16/μL；颜色-尿液: Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: +- 0.1g（参考: 阴性）；酮体(KET)-尿液: 1+ 1mmol（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 6.5；比重(SG)-尿液: 1.022；白细胞计数(WBC#)-尿液: 10/μL；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）\n- [全程D1116] 检验组合: 亚硝酸盐(NIT)-尿液: -（参考: 阴性）；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336.3g/L；阴离子间隙(AG)-静脉血: 12；总蛋白(TP)-尿液: -（参考: 阴性）；磷(P)-静脉血: 0.93mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20U/L；尿酸(UA)-静脉血: 199.4umol/L；平均红细胞体积(MCV)-静脉血: 92.9fL；碱性磷酸酶(ALP)-静脉血: 61.6U/L；酸碱度(pH)-尿液: 6.5；血小板分布宽度(PDW)-静脉血: 17%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.032；隐血(OB)-尿液: -（参考: 阴性）；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.44mmolL；肌酐(Crea)-静脉血: 67.5umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.2；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；氯离子(Cl-)-静脉血: 102.9mmol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；总胆红素(TBIL)-静脉血: 6.7umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14%；血小板计数(PLT#)-静脉血: 176.710E9/L；总蛋白(TP)-静脉血: 65.51g/L；尿素氮(BUN)-静脉血: 3.95mmol/L；红细胞计数(RBC#)-静脉血: 3.8510E12/L；甘油三酯(TG)-静脉血: 1.05mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；α-L-岩藻糖苷酶(AFU)-静脉血: 30U/L；间接胆红素(IBIL)-静脉血: 4.4umolL；总胆固醇(TC)-静脉血: 5.25mmol/L；浊度(TRUB)-尿液: 清亮；平均血小板体积(MPV)-静脉血: 6.6fL；胆红素(BIL)-尿液: -（参考: 阴性）；总胆汁酸(TBA)-静脉血: 0.2umol/L；载脂蛋白B(apoB)-静脉血: 0.98g/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；中性粒细胞计数(Neut#)-静脉血: 2.81……\n- [全程D1123] 检验组合: 红细胞计数(RBC#)-静脉血: 4.3710E12/L；中性粒细胞计数(Neut#)-静脉血: 310E9/L；平均红细胞体积(MCV)-静脉血: 90fL；甘油三酯(TG)-静脉血: 1.06mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.55；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.072；白蛋白(ALB)-静脉血: 44.8g/L；单核细胞百分比(Mono%)-静脉血: 0.081；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；红细胞比容(Hct)-静脉血: 39.4%；总钙(Ca)-静脉血: 2.44mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.8pg；血小板比容-静脉血: 10%；氯离子(Cl-)-静脉血: 92.5mmol/L；血小板计数(PLT#)-静脉血: 143.810E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.98mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4%；中性粒细胞百分比(Neut%)-静脉血: 0.841；总胆固醇(TC)-静脉血: 6.12mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 343.2g/L；间接胆红素(IBIL)-静脉血: 6.2umolL；尿素氮(BUN)-静脉血: 7.4mmol/L；平均血小板体积(MPV)-静脉血: 6.98fL；总胆红素(TBIL)-静脉血: 8.2umol/L；胱抑素(Cys-C)-静脉血: 0.86mg/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；载脂蛋白B(apoB)-静脉血: 1.37g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.9U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；C-反应蛋白(CRP)-静脉血: 10.49mg/L；球蛋白(GLO)-静脉血: 30.65g/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.46；葡萄糖(Glu)-静脉血: 5.64mmol/L；磷(P)-静脉血: 1.16mmol/L……\n- [全程D1125] 检验组合: 总钙(Ca)-静脉血: 2.38mmol/L；阴离子间隙(AG)-静脉血: 12.7；磷(P)-静脉血: 0.81mmol/L；氯离子(Cl-)-静脉血: 92.5mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 28.7mmol/L；钾离子(K+)-静脉血: 3.68mmol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；钠离子(Na+)-静脉血: 133.9mmol/L\n- [全程D1130] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对侧，双肺野纹理清晰，未见明显实质性病变。双侧肺门不大，纵隔不宽，心影形态、大小、位置未见异常。双膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见异常。\n- [全程D1130] 超声；肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。\n- [全程D1130] 检验组合: 有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞血红蛋白含量(MCH)-静脉血: 31.3pg；淋巴细胞百分比(Lymph%)-静脉血: 0.09；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4%；单核细胞计数(Mono#)-静脉血: 0.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.184；白蛋白(ALB)-静脉血: 43.5g/L；球蛋白(GLO)-静脉血: 29.66g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.32mmolL；总胆固醇(TC)-静脉血: 5.82mmol/L；葡萄糖(Glu)-静脉血: 5.74mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21U/L；中性粒细胞计数(Neut#)-静脉血: 1.510E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.9U/L；中性粒细胞百分比(Neut%)-静脉血: 0.715；尿酸(UA)-静脉血: 242.7umol/L；总胆汁酸(TBA)-静脉血: 0.2umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.005；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；血红蛋白(Hb)-静脉血: 125g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血小板分布宽度(PDW)-静脉血: 17.2%；总胆红素(TBIL)-静脉血: 6.6umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 28.4mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 344.5g/L；钾离子(K+)-静脉血: 3.7mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.8U/L；载脂蛋白B(apoB)-静脉血: 1.31g/L；红细胞计数(RBC#)-静脉血: 3.9910E12/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.4；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 90.9fL；总蛋白(TP)-静脉血: 73.16g/L；平均血小板体积(MPV)-静脉血: 6.84fL；血小板计数(PLT#)-静脉血: 181.410E9/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；低密度脂蛋白胆固醇(LDL-C)……\n\n【既往治疗与反应】\n- [全程D1108] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中。今日查房，患者无明显不适主诉，生命体征平稳。[姓名已隐去]医生信息已隐藏：继续治疗。\n- [全程D1113] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中。今日查房，患者无明显不适主诉，生命体征平稳。查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：可于今日水化，明日执行第2程DDP方案同时期化疗，注意化疗不良反应。\n- [全程D1118] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中，第2程顺铂方案同时期化疗结束。诉咽痛、恶心、食欲下降，呕吐1次，伴头晕，无腹痛、腹泻等不适。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D1123] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中。今日查房，患者无明显不适主诉，生命体征平稳。[姓名已隐去]医生信息已隐藏：患者治疗疗程过半，予预约治疗结束后影像学复查。继续治疗。\n- [全程D1129] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中。今日查房，患者无明显不适主诉，生命体征平稳。[姓名已隐去]医生信息已隐藏：嘱患者冲洗鼻咽，保持鼻咽清洁。继续治疗。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 评估临床症状完全缓解，提前终止放疗，办理出院并进入定期随访阶段，1个月后复查头颈部MRI。\nB. 评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，并口服替吉奥单药维持化疗。\nC. 评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，期间无需定期复查血液学指标。\nD. 评估肿瘤退缩缓慢，继续住院，将放疗方案调整为超分割放疗，并加用西妥昔单抗靶向治疗。\nE. 评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，期间暂停放疗2周以促进粘膜修复。\nF. 评估肿瘤部分缓解，继续住院完成根治性放疗，并每周行鼻咽部MRI以动态监测肿瘤退缩情况。\nG. 评估临床症状缓解且毒副反应可耐受，转外科行鼻咽及颈部残留病灶切除术，术后在门诊继续完成剩余放疗。\nH. 评估疑似疾病进展，停止放疗，改为吉西他滨联合顺铂方案全身姑息化疗并办理出院。\nI. 评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，每周复查血常规及生化，指导功能锻炼。\nJ. 评估临床症状缓解且毒副反应可耐受，继续住院完成剩余根治性放疗，期间常规给予静脉高营养支持及预防性抗感染。\nK. 评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，并立即安排全身PET-CT确认疗效。\n\n请仅输出一个选项字母（A-K）。"},{"sample_id":"sample-40b7a6f655350cf46e9ce33c","patient_id":"patient-36d433557e63f939b878347d","turn_id":"turn08","turn_position":6,"turn_type":"response_assessment_decision","gold_letter":"K","gold_action":"办理出院，转门诊继续完成根治性放疗，每周复查血常规及生化，指导鼻腔冲洗与功能锻炼。","options":[{"letter":"A","text":"立即行鼻咽及颈部MRI复查，视近期疗效评估结果调整放疗靶区及剂量。","is_gold":false},{"letter":"B","text":"安排第3程顺铂同期化疗，并继续住院完成剩余根治性放疗疗程。","is_gold":false},{"letter":"C","text":"暂停放疗，行全身PET-CT检查以排除远处转移，待结果回报后决定后续方案。","is_gold":false},{"letter":"D","text":"办理出院，结束所有抗肿瘤治疗，进入定期随访阶段，1个月后复查MRI。","is_gold":false},{"letter":"E","text":"调整化疗方案为紫杉醇+顺铂，继续住院行第3程同期化疗及放疗。","is_gold":false},{"letter":"F","text":"立即行鼻咽镜检查及活检，视病理退缩情况调整后续放疗方案。","is_gold":false},{"letter":"G","text":"办理出院，转门诊继续放疗，并加用西妥昔单抗靶向治疗。","is_gold":false},{"letter":"H","text":"继续住院完成剩余放疗，期间每周复查血常规及生化，待放疗结束后出院。","is_gold":false},{"letter":"I","text":"办理出院，转门诊继续放疗，并立即启动顺铂+氟尿嘧啶方案辅助化疗。","is_gold":false},{"letter":"J","text":"立即行胸部CT及腹部增强CT，视全面评估结果决定是否继续门诊放疗。","is_gold":false},{"letter":"K","text":"办理出院，转门诊继续完成根治性放疗，每周复查血常规及生化，指导鼻腔冲洗与功能锻炼。","is_gold":true},{"letter":"L","text":"暂停放疗，给予重组人粒细胞刺激因子及升血小板治疗，待血象完全恢复正常后继续放疗。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、海绵窦、翼突基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1078] 入院记录: 主诉: 外院可疑鼻咽癌；现病史: 简要入院病史:患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n- [全程D1081] 入院记录: 主诉: 回吸性涕血3月余；现病史: 患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：70次/分，R：14次/分，BP：126/71mmHg,Ht：155cm，Wt：48kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左颈Ⅱ区触及肿大淋巴结，约2×1.5cm，无融合，质地硬，边界尚清，活动度中等，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS:；ECOG:\n- [全程D1078] 入院记录: 主诉: 外院可疑鼻咽癌；现病史: 简要入院病史:患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。某次就诊时间再次出现回吸性涕血，遂行鼻咽镜检查，活检示：鼻咽炎性渗出。行鼻咽部CT示：鼻咽左侧可见软组织占位。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n- [全程D1081] 入院记录: 主诉: 回吸性涕血3月余；现病史: 患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。某次就诊时间再次出现回吸性涕血，遂行鼻咽镜检查，活检示：鼻咽炎性渗出。行鼻咽部CT示：鼻咽左侧可见软组织占位。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：70次/分，R：14次/分，BP：126/71mmHg,Ht：155cm，Wt：48kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率70次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左颈Ⅱ区触及肿大淋巴结，约2×1.5cm，无融合，质地硬，边界尚清，活动度中等，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- [全程D1078] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 Ⅱ、Ⅲ、aVF、V4～V6导联ST段下移\n- [全程D1078] 检验组合: 镁离子(Mg2+)-静脉血: 0.96mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.6；Rh血型-静脉血: 阳性；直接胆红素(DBIL)-静脉血: 2umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.61COI；白蛋白(ALB)-静脉血: 45.5g/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 0.085COI；γ-谷氨酰基转移酶(GGT)-静脉血: 13.6U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.2fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；葡萄糖(Glu)-静脉血: 4.67mmol/L；总胆红素(TBIL)-静脉血: 8.3umol/L；单核细胞百分比(Mono%)-静脉血: 0.074；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.5U/L；红细胞比容(Hct)-静脉血: 41%；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 1.56COI；单核细胞计数(Mono#)-静脉血: 0.310E9/L；中性粒细胞计数(Neut#)-静脉血: 2.510E9/L；胱抑素(Cys-C)-静脉血: 0.84mg/L；碱性磷酸酶(ALP)-静脉血: 80.5U/L；钠离子(Na+)-静脉血: 143.8mmol/L；乳酸脱氢酶(LDH)-静脉血: 194.4U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；平均红细胞血红蛋白浓度(MCHC)-静脉血: 324g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21.7U/L；氯离子(Cl-)-静脉血: 105.2mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.74；平均红细胞体积(MCV)-静脉血: 92.8fL；C-反应蛋白(CRP)-静脉血: 1.78mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.4；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: >1000IU/L；总胆固醇(TC)-静脉血: 5.98mmol/L；血红蛋白(Hb)-静脉血: 133g/L；大血小板百分比(P-LCR%)-静脉血: 26.1%；间接胆红素(I……\n- [全程D1079] 检验组合: 梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）\n- [全程D1081] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 多个颈腰椎、双侧膝关节可见片状放射性浓集灶。余颅骨、胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 考虑多个颈腰椎、双侧膝关节骨质退行性变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1092] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.006；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；颜色-尿液: 无色；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮\n- [全程D1094] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 28/μL；比重(SG)-尿液: 1.025；葡萄糖(Glu)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 36/μL；白细胞计数(WBC#)-尿液: 5/μL；酸碱度(pH)-尿液: 6.5；颜色-尿液: Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D1095] 检验组合: 白蛋白(ALB)-静脉血: 40.5g/L；镁离子(Mg2+)-静脉血: 0.84mmol/L；碱性磷酸酶(ALP)-静脉血: 63.2U/L；载脂蛋白B(apoB)-静脉血: 0.8g/L；葡萄糖(Glu)-静脉血: 5.31mmol/L；血小板比容-静脉血: 19%；直接胆红素(DBIL)-静脉血: 2.3umol/L；载脂蛋白AI(apoAI)-静脉血: 1.4g/L；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；总胆固醇(TC)-静脉血: 5.3mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.69mmolL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 325g/L；红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.9pg；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；γ-谷氨酰基转移酶(GGT)-静脉血: 16.8U/L；间接胆红素(IBIL)-静脉血: 5.6umolL；红细胞比容(Hct)-静脉血: 37.2%；钠离子(Na+)-静脉血: 141.6mmol/L；尿酸(UA)-静脉血: 219.2umol/L；总钙(Ca)-静脉血: 2.16mmol/L；尿素氮(BUN)-静脉血: 4.72mmol/L；平均红细胞体积(MCV)-静脉血: 91.9fL；球蛋白(GLO)-静脉血: 22.71g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.1；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14；乳酸脱氢酶(LDH)-静脉血: 179.4U/L；总胆红素(TBIL)-静脉血: 7.9umol/L；阴离子间隙(AG)-静脉血: 12；中性粒细胞百分比(Neut%)-静脉血: 0.814；血红蛋白(Hb)-静脉血: 121g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.1；丙氨酸氨基转移酶(ALT)-静脉血: 55.1U/L；白细胞计数(WBC#)-静脉血: 6.1210E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 36.2U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.58mmol/L；胱抑素(Cys-C)-静脉血: 0.95mg/L；大血小板……\n- [全程D1102] 检验组合: 尿酸(UA)-静脉血: 238.2umol/L；总胆红素(TBIL)-静脉血: 6.2umol/L；白细胞计数(WBC#)-静脉血: 3.5310E9/L；间接胆红素(IBIL)-静脉血: 4.8umolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.3；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.02；阴离子间隙(AG)-静脉血: 15.1；磷(P)-静脉血: 1.08mmol/L；钠离子(Na+)-静脉血: 137.5mmol/L；总钙(Ca)-静脉血: 2.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 26.7U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.8；直接胆红素(DBIL)-静脉血: 1.4umol/L；球蛋白(GLO)-静脉血: 27.56g/L；载脂蛋白AI(apoAI)-静脉血: 1.46g/L；红细胞计数(RBC#)-静脉血: 4.6610E12/L；载脂蛋白B(apoB)-静脉血: 1.09g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；血红蛋白(Hb)-静脉血: 142g/L；葡萄糖(Glu)-静脉血: 5.62mmol/L；甘油三酯(TG)-静脉血: 0.98mmol/L；镁离子(Mg2+)-静脉血: 0.97mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；血小板分布宽度(PDW)-静脉血: 9.2%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；总胆固醇(TC)-静脉血: 5.85mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336g/L；平均血小板体积(MPV)-静脉血: 9fL；血小板计数(PLT#)-静脉血: 19010E9/L；血小板比容-静脉血: 17%；红细胞比容(Hct)-静脉血: 42.3%；总胆汁酸(TBA)-静脉血: 1.8umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.76mmolL；胱抑素(Cys-C)-静脉血: 0.89mg/L；肌酐(Crea)-静脉血: 54.9umol/L；白蛋白(ALB)-静脉血: 46.6g/L；氯离子(Cl-)-静脉血: 97.8mmol/L；钾离子(K+)-静脉血: 3.78mmol/……\n- [全程D1109] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 28.2mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；钾离子(K+)-静脉血: 3.77mmol/L；甘油三酯(TG)-静脉血: 0.8mmol/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；红细胞计数(RBC#)-静脉血: 4.2410E12/L；总胆固醇(TC)-静脉血: 5.21mmol/L；镁离子(Mg2+)-静脉血: 0.97mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.6；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；总胆汁酸(TBA)-静脉血: 0.6umol/L；总胆红素(TBIL)-静脉血: 8.6umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.119；红细胞比容(Hct)-静脉血: 38.7%；尿素氮(BUN)-静脉血: 4.1mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；间接胆红素(IBIL)-静脉血: 6.5umolL；C-反应蛋白(CRP)-静脉血: 2.85mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.53mmolL；血小板分布宽度(PDW)-静脉血: 17.4%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.29mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；阴离子间隙(AG)-静脉血: 15；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；血小板计数(PLT#)-静脉血: 204.310E9/L；平均红细胞体积(MCV)-静脉血: 91.1fL；丙氨酸氨基转移酶(ALT)-静脉血: 12.3U/L；总蛋白(TP)-静脉血: 69.21g/L；直接胆红素(DBIL)-静脉血: 2.1umol/L；氯离子(Cl-)-静脉血: 95.7mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.784；中性粒细胞计数(Neut#)-静脉血: 2.310E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22.8U/L；平均血小板体积(MPV)-静脉血: 6.38fL；γ-谷氨酰基转移酶(GGT)-静脉血: 23.6U/L；总钙(Ca)-静脉血: 2.22mmol/L；单核……\n- [全程D1113] 检验组合: 血小板比容-静脉血: 15%；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 6.5；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.734；平均红细胞体积(MCV)-静脉血: 91.5fL；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；隐血(OB)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；中性粒细胞计数(Neut#)-静脉血: 2.310E9/L；总蛋白(TP)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 1/μL；红细胞计数(RBC#)-静脉血: 4.1310E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；血小板计数(PLT#)-静脉血: 16810E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；比重(SG)-尿液: 1.009；浊度(TRUB)-尿液: 清亮；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.05；大血小板百分比(P-LCR%)-静脉血: 18%；单核细胞计数(Mono#)-静脉血: 0.410E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.5；酮体(KET)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 13/μL；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-静脉血: 3.210E9/L；白细胞(LEU)-尿液: -（参考: 阴性）；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；红细胞比容(Hct)-静脉血: 37.8%；血红蛋白(Hb)-静脉血: 126g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.5；血小板分布宽度(PDW)-静脉血: 9.3%；淋巴细胞百分比(Lymph%)-静脉血: 0.103；平均红细胞血红蛋白浓度(MCHC)-静脉血: 333g/L；平均血小板体积(MPV)-静脉血: 8.9fL；单核细胞百分比(Mono%)-静脉血: 0.11\n- [全程D1114] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 16/μL；颜色-尿液: Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: +- 0.1g（参考: 阴性）；酮体(KET)-尿液: 1+ 1mmol（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 6.5；比重(SG)-尿液: 1.022；白细胞计数(WBC#)-尿液: 10/μL；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）\n- [全程D1116] 检验组合: 亚硝酸盐(NIT)-尿液: -（参考: 阴性）；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336.3g/L；阴离子间隙(AG)-静脉血: 12；总蛋白(TP)-尿液: -（参考: 阴性）；磷(P)-静脉血: 0.93mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20U/L；尿酸(UA)-静脉血: 199.4umol/L；平均红细胞体积(MCV)-静脉血: 92.9fL；碱性磷酸酶(ALP)-静脉血: 61.6U/L；酸碱度(pH)-尿液: 6.5；血小板分布宽度(PDW)-静脉血: 17%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.032；隐血(OB)-尿液: -（参考: 阴性）；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.44mmolL；肌酐(Crea)-静脉血: 67.5umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.2；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；氯离子(Cl-)-静脉血: 102.9mmol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；总胆红素(TBIL)-静脉血: 6.7umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14%；血小板计数(PLT#)-静脉血: 176.710E9/L；总蛋白(TP)-静脉血: 65.51g/L；尿素氮(BUN)-静脉血: 3.95mmol/L；红细胞计数(RBC#)-静脉血: 3.8510E12/L；甘油三酯(TG)-静脉血: 1.05mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；α-L-岩藻糖苷酶(AFU)-静脉血: 30U/L；间接胆红素(IBIL)-静脉血: 4.4umolL；总胆固醇(TC)-静脉血: 5.25mmol/L；浊度(TRUB)-尿液: 清亮；平均血小板体积(MPV)-静脉血: 6.6fL；胆红素(BIL)-尿液: -（参考: 阴性）；总胆汁酸(TBA)-静脉血: 0.2umol/L；载脂蛋白B(apoB)-静脉血: 0.98g/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；中性粒细胞计数(Neut#)-静脉血: 2.81……\n- [全程D1123] 检验组合: 红细胞计数(RBC#)-静脉血: 4.3710E12/L；中性粒细胞计数(Neut#)-静脉血: 310E9/L；平均红细胞体积(MCV)-静脉血: 90fL；甘油三酯(TG)-静脉血: 1.06mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.55；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.072；白蛋白(ALB)-静脉血: 44.8g/L；单核细胞百分比(Mono%)-静脉血: 0.081；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；红细胞比容(Hct)-静脉血: 39.4%；总钙(Ca)-静脉血: 2.44mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.8pg；血小板比容-静脉血: 10%；氯离子(Cl-)-静脉血: 92.5mmol/L；血小板计数(PLT#)-静脉血: 143.810E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.98mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4%；中性粒细胞百分比(Neut%)-静脉血: 0.841；总胆固醇(TC)-静脉血: 6.12mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 343.2g/L；间接胆红素(IBIL)-静脉血: 6.2umolL；尿素氮(BUN)-静脉血: 7.4mmol/L；平均血小板体积(MPV)-静脉血: 6.98fL；总胆红素(TBIL)-静脉血: 8.2umol/L；胱抑素(Cys-C)-静脉血: 0.86mg/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；载脂蛋白B(apoB)-静脉血: 1.37g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.9U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；C-反应蛋白(CRP)-静脉血: 10.49mg/L；球蛋白(GLO)-静脉血: 30.65g/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.46；葡萄糖(Glu)-静脉血: 5.64mmol/L；磷(P)-静脉血: 1.16mmol/L……\n- [全程D1125] 检验组合: 总钙(Ca)-静脉血: 2.38mmol/L；阴离子间隙(AG)-静脉血: 12.7；磷(P)-静脉血: 0.81mmol/L；氯离子(Cl-)-静脉血: 92.5mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 28.7mmol/L；钾离子(K+)-静脉血: 3.68mmol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；钠离子(Na+)-静脉血: 133.9mmol/L\n- [全程D1130] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对侧，双肺野纹理清晰，未见明显实质性病变。双侧肺门不大，纵隔不宽，心影形态、大小、位置未见异常。双膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见异常。\n- [全程D1130] 超声；肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。\n- [全程D1130] 检验组合: 有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞血红蛋白含量(MCH)-静脉血: 31.3pg；淋巴细胞百分比(Lymph%)-静脉血: 0.09；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4%；单核细胞计数(Mono#)-静脉血: 0.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.184；白蛋白(ALB)-静脉血: 43.5g/L；球蛋白(GLO)-静脉血: 29.66g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.32mmolL；总胆固醇(TC)-静脉血: 5.82mmol/L；葡萄糖(Glu)-静脉血: 5.74mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21U/L；中性粒细胞计数(Neut#)-静脉血: 1.510E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.9U/L；中性粒细胞百分比(Neut%)-静脉血: 0.715；尿酸(UA)-静脉血: 242.7umol/L；总胆汁酸(TBA)-静脉血: 0.2umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.005；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；血红蛋白(Hb)-静脉血: 125g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血小板分布宽度(PDW)-静脉血: 17.2%；总胆红素(TBIL)-静脉血: 6.6umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 28.4mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 344.5g/L；钾离子(K+)-静脉血: 3.7mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.8U/L；载脂蛋白B(apoB)-静脉血: 1.31g/L；红细胞计数(RBC#)-静脉血: 3.9910E12/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.4；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 90.9fL；总蛋白(TP)-静脉血: 73.16g/L；平均血小板体积(MPV)-静脉血: 6.84fL；血小板计数(PLT#)-静脉血: 181.410E9/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；低密度脂蛋白胆固醇(LDL-C)……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1082] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者目前诊断明确，[计划性表述已隐藏]根治性放疗及同期化疗。向患者及其家属交代病情，治疗方案及治疗风险，做好治疗前准备工作。\n- [全程D1083] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者入院第三天，无明显不适主诉，查体情况：一般情况可，余同入院。预约放疗。\n- [全程D1088] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 今日查房，患者无明显不适主诉，生命体征平稳。已予预约放疗。候治疗。\n- [全程D1093] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 今日查房，患者无明显不适主诉，生命体征平稳。查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常。患者现放疗计划已设计完成并通过全科会诊，靶区剂量分布均匀，正常组织剂量在可接受范围内。[姓名已隐去]医生信息已隐藏示：患者无明显放化疗禁忌症，拟于今日开始行根治性放疗+同时期化疗。向患者及其家属交代病情及化疗风险，表示理解并已签署知情同意书，可于今日执行第1程顺铂方案同时期化疗，注意化疗不良反应。\n- [全程D1098] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中，第1程顺铂方案同时期化疗结束。今日查房，患者诉呕吐2次，咽痛、恶心、食欲下降，伴头晕，无腹痛、腹泻等不适。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D1108] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中。今日查房，患者无明显不适主诉，生命体征平稳。[姓名已隐去]医生信息已隐藏：继续治疗。\n- [全程D1113] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中。今日查房，患者无明显不适主诉，生命体征平稳。查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：可于今日水化，明日执行第2程DDP方案同时期化疗，注意化疗不良反应。\n- [全程D1118] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中，第2程顺铂方案同时期化疗结束。诉咽痛、恶心、食欲下降，呕吐1次，伴头晕，无腹痛、腹泻等不适。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D1123] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中。今日查房，患者无明显不适主诉，生命体征平稳。[姓名已隐去]医生信息已隐藏：患者治疗疗程过半，予预约治疗结束后影像学复查。继续治疗。\n- [全程D1129] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中。今日查房，患者无明显不适主诉，生命体征平稳。[姓名已隐去]医生信息已隐藏：嘱患者冲洗鼻咽，保持鼻咽清洁。继续治疗。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即行鼻咽及颈部MRI复查，视近期疗效评估结果调整放疗靶区及剂量。\nB. 安排第3程顺铂同期化疗，并继续住院完成剩余根治性放疗疗程。\nC. 暂停放疗，行全身PET-CT检查以排除远处转移，待结果回报后决定后续方案。\nD. 办理出院，结束所有抗肿瘤治疗，进入定期随访阶段，1个月后复查MRI。\nE. 调整化疗方案为紫杉醇+顺铂，继续住院行第3程同期化疗及放疗。\nF. 立即行鼻咽镜检查及活检，视病理退缩情况调整后续放疗方案。\nG. 办理出院，转门诊继续放疗，并加用西妥昔单抗靶向治疗。\nH. 继续住院完成剩余放疗，期间每周复查血常规及生化，待放疗结束后出院。\nI. 办理出院，转门诊继续放疗，并立即启动顺铂+氟尿嘧啶方案辅助化疗。\nJ. 立即行胸部CT及腹部增强CT，视全面评估结果决定是否继续门诊放疗。\nK. 办理出院，转门诊继续完成根治性放疗，每周复查血常规及生化，指导鼻腔冲洗与功能锻炼。\nL. 暂停放疗，给予重组人粒细胞刺激因子及升血小板治疗，待血象完全恢复正常后继续放疗。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- 无可展示记录。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即行鼻咽及颈部MRI复查，视近期疗效评估结果调整放疗靶区及剂量。\nB. 安排第3程顺铂同期化疗，并继续住院完成剩余根治性放疗疗程。\nC. 暂停放疗，行全身PET-CT检查以排除远处转移，待结果回报后决定后续方案。\nD. 办理出院，结束所有抗肿瘤治疗，进入定期随访阶段，1个月后复查MRI。\nE. 调整化疗方案为紫杉醇+顺铂，继续住院行第3程同期化疗及放疗。\nF. 立即行鼻咽镜检查及活检，视病理退缩情况调整后续放疗方案。\nG. 办理出院，转门诊继续放疗，并加用西妥昔单抗靶向治疗。\nH. 继续住院完成剩余放疗，期间每周复查血常规及生化，待放疗结束后出院。\nI. 办理出院，转门诊继续放疗，并立即启动顺铂+氟尿嘧啶方案辅助化疗。\nJ. 立即行胸部CT及腹部增强CT，视全面评估结果决定是否继续门诊放疗。\nK. 办理出院，转门诊继续完成根治性放疗，每周复查血常规及生化，指导鼻腔冲洗与功能锻炼。\nL. 暂停放疗，给予重组人粒细胞刺激因子及升血小板治疗，待血象完全恢复正常后继续放疗。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、海绵窦、翼突基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- 无可展示记录。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即行鼻咽及颈部MRI复查，视近期疗效评估结果调整放疗靶区及剂量。\nB. 安排第3程顺铂同期化疗，并继续住院完成剩余根治性放疗疗程。\nC. 暂停放疗，行全身PET-CT检查以排除远处转移，待结果回报后决定后续方案。\nD. 办理出院，结束所有抗肿瘤治疗，进入定期随访阶段，1个月后复查MRI。\nE. 调整化疗方案为紫杉醇+顺铂，继续住院行第3程同期化疗及放疗。\nF. 立即行鼻咽镜检查及活检，视病理退缩情况调整后续放疗方案。\nG. 办理出院，转门诊继续放疗，并加用西妥昔单抗靶向治疗。\nH. 继续住院完成剩余放疗，期间每周复查血常规及生化，待放疗结束后出院。\nI. 办理出院，转门诊继续放疗，并立即启动顺铂+氟尿嘧啶方案辅助化疗。\nJ. 立即行胸部CT及腹部增强CT，视全面评估结果决定是否继续门诊放疗。\nK. 办理出院，转门诊继续完成根治性放疗，每周复查血常规及生化，指导鼻腔冲洗与功能锻炼。\nL. 暂停放疗，给予重组人粒细胞刺激因子及升血小板治疗，待血象完全恢复正常后继续放疗。\n\n请仅输出一个选项字母（A-L）。"}]}
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90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 鼻咽及颈部增强CT，胸部CT、腹部超声及全身骨扫描，以及包含EBV-DNA的基线血液学检查\nB. 鼻咽镜检查及活检，鼻咽及颈部增强CT，胸部CT、腹部超声及全身骨扫描，以及常规血液学检查\nC. 鼻咽镜检查及活检，鼻咽及颈部增强MRI，常规血液学检查，暂缓全身远处转移筛查\nD. 鼻咽及颈部增强MRI，全身PET-CT，包含EBV-DNA的基线血液学检查，直接安排诱导化疗\nE. 鼻咽镜检查及活检，鼻咽及颈部增强MRI，胸部X线、腹部超声，以及常规血液学检查\nF. 鼻咽及颈部增强MRI，颈部淋巴结穿刺活检，胸部CT、腹部超声及全身骨扫描，以及包含EBV-DNA的基线血液学检查\nG. 鼻咽镜检查及活检，鼻咽及颈部增强MRI，全身PET-CT，随后行鼻咽肿物切除术\nH. 鼻咽镜检查及活检，鼻咽及颈部平扫MRI，胸部CT、腹部超声及全身骨扫描，以及包含EBV-DNA的基线血液学检查\nI. 鼻咽镜检查及活检，鼻咽及颈部增强MRI，胸部CT、腹部超声及全身骨扫描，暂缓基线血液学及EBV-DNA检测\nJ. 鼻咽镜检查及活检，鼻咽及颈部增强CT，全身PET-CT，以及包含EBV-DNA的基线血液学检查\nK. 鼻咽及颈部增强MRI，胸部CT、腹部超声及全身骨扫描，包含EBV-DNA的基线血液学检查，随后行根治性放疗\nL. 鼻咽镜检查及活检，鼻咽及颈部增强MRI，胸部CT、腹部超声及全身骨扫描，以及包含EBV-DNA的基线血液学检查\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"你正在参与一名鼻咽癌相关患者的 full-care 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90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 鼻咽及颈部增强CT，胸部CT、腹部超声及全身骨扫描，以及包含EBV-DNA的基线血液学检查\nB. 鼻咽镜检查及活检，鼻咽及颈部增强CT，胸部CT、腹部超声及全身骨扫描，以及常规血液学检查\nC. 鼻咽镜检查及活检，鼻咽及颈部增强MRI，常规血液学检查，暂缓全身远处转移筛查\nD. 鼻咽及颈部增强MRI，全身PET-CT，包含EBV-DNA的基线血液学检查，直接安排诱导化疗\nE. 鼻咽镜检查及活检，鼻咽及颈部增强MRI，胸部X线、腹部超声，以及常规血液学检查\nF. 鼻咽及颈部增强MRI，颈部淋巴结穿刺活检，胸部CT、腹部超声及全身骨扫描，以及包含EBV-DNA的基线血液学检查\nG. 鼻咽镜检查及活检，鼻咽及颈部增强MRI，全身PET-CT，随后行鼻咽肿物切除术\nH. 鼻咽镜检查及活检，鼻咽及颈部平扫MRI，胸部CT、腹部超声及全身骨扫描，以及包含EBV-DNA的基线血液学检查\nI. 鼻咽镜检查及活检，鼻咽及颈部增强MRI，胸部CT、腹部超声及全身骨扫描，暂缓基线血液学及EBV-DNA检测\nJ. 鼻咽镜检查及活检，鼻咽及颈部增强CT，全身PET-CT，以及包含EBV-DNA的基线血液学检查\nK. 鼻咽及颈部增强MRI，胸部CT、腹部超声及全身骨扫描，包含EBV-DNA的基线血液学检查，随后行根治性放疗\nL. 鼻咽镜检查及活检，鼻咽及颈部增强MRI，胸部CT、腹部超声及全身骨扫描，以及包含EBV-DNA的基线血液学检查\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 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90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 鼻咽及颈部增强CT，胸部CT、腹部超声及全身骨扫描，以及包含EBV-DNA的基线血液学检查\nB. 鼻咽镜检查及活检，鼻咽及颈部增强CT，胸部CT、腹部超声及全身骨扫描，以及常规血液学检查\nC. 鼻咽镜检查及活检，鼻咽及颈部增强MRI，常规血液学检查，暂缓全身远处转移筛查\nD. 鼻咽及颈部增强MRI，全身PET-CT，包含EBV-DNA的基线血液学检查，直接安排诱导化疗\nE. 鼻咽镜检查及活检，鼻咽及颈部增强MRI，胸部X线、腹部超声，以及常规血液学检查\nF. 鼻咽及颈部增强MRI，颈部淋巴结穿刺活检，胸部CT、腹部超声及全身骨扫描，以及包含EBV-DNA的基线血液学检查\nG. 鼻咽镜检查及活检，鼻咽及颈部增强MRI，全身PET-CT，随后行鼻咽肿物切除术\nH. 鼻咽镜检查及活检，鼻咽及颈部平扫MRI，胸部CT、腹部超声及全身骨扫描，以及包含EBV-DNA的基线血液学检查\nI. 鼻咽镜检查及活检，鼻咽及颈部增强MRI，胸部CT、腹部超声及全身骨扫描，暂缓基线血液学及EBV-DNA检测\nJ. 鼻咽镜检查及活检，鼻咽及颈部增强CT，全身PET-CT，以及包含EBV-DNA的基线血液学检查\nK. 鼻咽及颈部增强MRI，胸部CT、腹部超声及全身骨扫描，包含EBV-DNA的基线血液学检查，随后行根治性放疗\nL. 鼻咽镜检查及活检，鼻咽及颈部增强MRI，胸部CT、腹部超声及全身骨扫描，以及包含EBV-DNA的基线血液学检查\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-58cbc880ddd38089d56cda8c","patient_id":"patient-79fa00752e4405e2980f6292","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"A","gold_action":"行鼻咽镜检查及局部活检，并完善鼻咽及颈部增强MRI","options":[{"letter":"A","text":"行鼻咽镜检查及局部活检，并完善鼻咽及颈部增强MRI","is_gold":true},{"letter":"B","text":"行鼻咽镜检查及局部活检，并完善鼻咽及颈部平扫CT","is_gold":false},{"letter":"C","text":"行鼻咽镜检查及局部活检，无需补充其他局部影像学检查","is_gold":false},{"letter":"D","text":"完善鼻咽及颈部增强MRI，并直接开始根治性放疗","is_gold":false},{"letter":"E","text":"行鼻咽镜检查及局部活检，并完善全身骨扫描及胸部平扫CT","is_gold":false},{"letter":"F","text":"行鼻咽镜检查及局部活检，并完善头颅增强MRI及颈部超声","is_gold":false},{"letter":"G","text":"完善鼻咽及颈部增强MRI，并择期行鼻咽部肿物切除术","is_gold":false},{"letter":"H","text":"行鼻咽镜检查及局部活检，并完善颈部淋巴结穿刺活检","is_gold":false},{"letter":"I","text":"行鼻咽镜检查及局部活检，并完善鼻咽及颈部增强CT","is_gold":false},{"letter":"J","text":"完善鼻咽及颈部增强MRI，并完善外周血EBV-DNA定量检测","is_gold":false},{"letter":"K","text":"行鼻咽镜检查及局部活检，并完善盆腔增强MRI及妇科超声","is_gold":false},{"letter":"L","text":"行鼻咽镜检查及局部活检，并完善脑脊液脱落细胞学检查","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 涕血1年余，头痛3月；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 额部疼痛,涕血；既往史: 高血压10年余服药治疗中，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.9℃，P：72次/分，R：20次/分，BP：127/91mmHg,Ht：160cm，Wt：62.5kg，BSA：1.65m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽右侧顶后壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 Ⅰ、Ⅱ、Ⅲ、aVF、V4～V6导联ST段下移\n- [全程D1] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；球蛋白(GLO)-静脉血: 30.03g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.9mmol/L；D-二聚体(D-Dimer)-静脉血: 0.13ug/ml；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；氯离子(Cl-)-静脉血: 98.1mmol/L；平均红细胞体积(MCV)-静脉血: 87.2fL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.91；大血小板百分比(P-LCR%)-静脉血: 33.4%；甘油三酯(TG)-静脉血: 1.01mmol/L；总钙(Ca)-静脉血: 2.28mmol/L；总胆固醇(TC)-静脉血: 5.44mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 25.2U/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 40.9umol/L；纤维蛋白原(Fbg)-静脉血: 2.51g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 20U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.34mmolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.58mmol/L；白细胞计数(WBC#)-静脉血: 6.9810E9/L；凝血酶时间(TT)-静脉血: 17.5sec.；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.013；红细胞计数(RBC#)-静脉血: 4.6710E12/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.98；直接胆红素(DBIL)-静脉血: 3.4umol/L；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 26.3mmol/L；磷(P)-静脉血: 1.03mmol/L；尿酸(UA)-静脉血: 391.1umol/L；碱性磷酸酶(ALP)-静脉血……\n- [全程D5] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁及右侧壁粘膜增厚放射性浓聚，SUV约7.3，病灶疑累及蝶骨基底部；右侧咽隐窝变浅；双侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见明显异常。口咽及喉咽结构及放射性分布未见明显异常。额窦、蝶窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双上颈小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。双乳腺结构及放射性分布未见明显异常。 肝S7点状高密度影放射性缺损，CT值约124Hu；其余肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 子宫边缘弧形改变，见结节状稍高密度影放射性分布未见明显异常，大小约3.8×4.3cm；左附件囊性低密度影放射性稀疏，大小约2.2×2.3cm，CT值约22Hu。膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 所见颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽顶壁及右侧壁粘膜增厚代谢活跃，考虑鼻咽癌，疑累及蝶骨基底部。 肝S7肝内胆管结石。 子宫肌瘤。 左附件囊肿。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行鼻咽镜检查及局部活检，并完善鼻咽及颈部增强MRI\nB. 行鼻咽镜检查及局部活检，并完善鼻咽及颈部平扫CT\nC. 行鼻咽镜检查及局部活检，无需补充其他局部影像学检查\nD. 完善鼻咽及颈部增强MRI，并直接开始根治性放疗\nE. 行鼻咽镜检查及局部活检，并完善全身骨扫描及胸部平扫CT\nF. 行鼻咽镜检查及局部活检，并完善头颅增强MRI及颈部超声\nG. 完善鼻咽及颈部增强MRI，并择期行鼻咽部肿物切除术\nH. 行鼻咽镜检查及局部活检，并完善颈部淋巴结穿刺活检\nI. 行鼻咽镜检查及局部活检，并完善鼻咽及颈部增强CT\nJ. 完善鼻咽及颈部增强MRI，并完善外周血EBV-DNA定量检测\nK. 行鼻咽镜检查及局部活检，并完善盆腔增强MRI及妇科超声\nL. 行鼻咽镜检查及局部活检，并完善脑脊液脱落细胞学检查\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 Ⅰ、Ⅱ、Ⅲ、aVF、V4～V6导联ST段下移\n- [全程D1] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；球蛋白(GLO)-静脉血: 30.03g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.9mmol/L；D-二聚体(D-Dimer)-静脉血: 0.13ug/ml；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；氯离子(Cl-)-静脉血: 98.1mmol/L；平均红细胞体积(MCV)-静脉血: 87.2fL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.91；大血小板百分比(P-LCR%)-静脉血: 33.4%；甘油三酯(TG)-静脉血: 1.01mmol/L；总钙(Ca)-静脉血: 2.28mmol/L；总胆固醇(TC)-静脉血: 5.44mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 25.2U/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 40.9umol/L；纤维蛋白原(Fbg)-静脉血: 2.51g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 20U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.34mmolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.58mmol/L；白细胞计数(WBC#)-静脉血: 6.9810E9/L；凝血酶时间(TT)-静脉血: 17.5sec.；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.013；红细胞计数(RBC#)-静脉血: 4.6710E12/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.98；直接胆红素(DBIL)-静脉血: 3.4umol/L；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 26.3mmol/L；磷(P)-静脉血: 1.03mmol/L；尿酸(UA)-静脉血: 391.1umol/L；碱性磷酸酶(ALP)-静脉血……\n- [全程D5] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁及右侧壁粘膜增厚放射性浓聚，SUV约7.3，病灶疑累及蝶骨基底部；右侧咽隐窝变浅；双侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见明显异常。口咽及喉咽结构及放射性分布未见明显异常。额窦、蝶窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双上颈小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。双乳腺结构及放射性分布未见明显异常。 肝S7点状高密度影放射性缺损，CT值约124Hu；其余肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 子宫边缘弧形改变，见结节状稍高密度影放射性分布未见明显异常，大小约3.8×4.3cm；左附件囊性低密度影放射性稀疏，大小约2.2×2.3cm，CT值约22Hu。膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 所见颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽顶壁及右侧壁粘膜增厚代谢活跃，考虑鼻咽癌，疑累及蝶骨基底部。 肝S7肝内胆管结石。 子宫肌瘤。 左附件囊肿。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行鼻咽镜检查及局部活检，并完善鼻咽及颈部增强MRI\nB. 行鼻咽镜检查及局部活检，并完善鼻咽及颈部平扫CT\nC. 行鼻咽镜检查及局部活检，无需补充其他局部影像学检查\nD. 完善鼻咽及颈部增强MRI，并直接开始根治性放疗\nE. 行鼻咽镜检查及局部活检，并完善全身骨扫描及胸部平扫CT\nF. 行鼻咽镜检查及局部活检，并完善头颅增强MRI及颈部超声\nG. 完善鼻咽及颈部增强MRI，并择期行鼻咽部肿物切除术\nH. 行鼻咽镜检查及局部活检，并完善颈部淋巴结穿刺活检\nI. 行鼻咽镜检查及局部活检，并完善鼻咽及颈部增强CT\nJ. 完善鼻咽及颈部增强MRI，并完善外周血EBV-DNA定量检测\nK. 行鼻咽镜检查及局部活检，并完善盆腔增强MRI及妇科超声\nL. 行鼻咽镜检查及局部活检，并完善脑脊液脱落细胞学检查\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 Ⅰ、Ⅱ、Ⅲ、aVF、V4～V6导联ST段下移\n- [全程D1] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；球蛋白(GLO)-静脉血: 30.03g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.9mmol/L；D-二聚体(D-Dimer)-静脉血: 0.13ug/ml；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；氯离子(Cl-)-静脉血: 98.1mmol/L；平均红细胞体积(MCV)-静脉血: 87.2fL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.91；大血小板百分比(P-LCR%)-静脉血: 33.4%；甘油三酯(TG)-静脉血: 1.01mmol/L；总钙(Ca)-静脉血: 2.28mmol/L；总胆固醇(TC)-静脉血: 5.44mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 25.2U/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 40.9umol/L；纤维蛋白原(Fbg)-静脉血: 2.51g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 20U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.34mmolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.58mmol/L；白细胞计数(WBC#)-静脉血: 6.9810E9/L；凝血酶时间(TT)-静脉血: 17.5sec.；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.013；红细胞计数(RBC#)-静脉血: 4.6710E12/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.98；直接胆红素(DBIL)-静脉血: 3.4umol/L；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 26.3mmol/L；磷(P)-静脉血: 1.03mmol/L；尿酸(UA)-静脉血: 391.1umol/L；碱性磷酸酶(ALP)-静脉血……\n- [全程D5] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁及右侧壁粘膜增厚放射性浓聚，SUV约7.3，病灶疑累及蝶骨基底部；右侧咽隐窝变浅；双侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见明显异常。口咽及喉咽结构及放射性分布未见明显异常。额窦、蝶窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双上颈小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。双乳腺结构及放射性分布未见明显异常。 肝S7点状高密度影放射性缺损，CT值约124Hu；其余肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 子宫边缘弧形改变，见结节状稍高密度影放射性分布未见明显异常，大小约3.8×4.3cm；左附件囊性低密度影放射性稀疏，大小约2.2×2.3cm，CT值约22Hu。膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 所见颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽顶壁及右侧壁粘膜增厚代谢活跃，考虑鼻咽癌，疑累及蝶骨基底部。 肝S7肝内胆管结石。 子宫肌瘤。 左附件囊肿。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行鼻咽镜检查及局部活检，并完善鼻咽及颈部增强MRI\nB. 行鼻咽镜检查及局部活检，并完善鼻咽及颈部平扫CT\nC. 行鼻咽镜检查及局部活检，无需补充其他局部影像学检查\nD. 完善鼻咽及颈部增强MRI，并直接开始根治性放疗\nE. 行鼻咽镜检查及局部活检，并完善全身骨扫描及胸部平扫CT\nF. 行鼻咽镜检查及局部活检，并完善头颅增强MRI及颈部超声\nG. 完善鼻咽及颈部增强MRI，并择期行鼻咽部肿物切除术\nH. 行鼻咽镜检查及局部活检，并完善颈部淋巴结穿刺活检\nI. 行鼻咽镜检查及局部活检，并完善鼻咽及颈部增强CT\nJ. 完善鼻咽及颈部增强MRI，并完善外周血EBV-DNA定量检测\nK. 行鼻咽镜检查及局部活检，并完善盆腔增强MRI及妇科超声\nL. 行鼻咽镜检查及局部活检，并完善脑脊液脱落细胞学检查\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-75c75fa1e197461f4b0d7395","patient_id":"patient-79fa00752e4405e2980f6292","turn_id":"turn06","turn_position":3,"turn_type":"toxicity_or_support_decision","gold_letter":"E","gold_action":"继续根治性放疗与顺铂同期化疗，予以止呕、护胃、补液及补钾等支持治疗，并安排放疗中段MRI评估。","options":[{"letter":"A","text":"暂停顺铂同期化疗，继续根治性放疗，予以止呕、补液、补钾等支持治疗，并安排放疗中段MRI评估。","is_gold":false},{"letter":"B","text":"顺铂减量20%继续同期化疗，继续根治性放疗，予以止呕、补液等支持治疗，暂不复查MRI。","is_gold":false},{"letter":"C","text":"继续根治性放疗与顺铂同期化疗，予以止呕、护胃治疗，暂不予补液及补钾，并安排放疗中段MRI评估。","is_gold":false},{"letter":"D","text":"暂停根治性放疗与顺铂同期化疗，予以积极补液、补钾治疗，暂不安排影像学评估。","is_gold":false},{"letter":"E","text":"继续根治性放疗与顺铂同期化疗，予以止呕、护胃、补液及补钾等支持治疗，并安排放疗中段MRI评估。","is_gold":true},{"letter":"F","text":"继续根治性放疗与顺铂同期化疗，予以止呕、护胃、补液及补钾等支持治疗，并安排PET-CT评估全身疗效。","is_gold":false},{"letter":"G","text":"暂停顺铂同期化疗，改为替加氟口服化疗，继续根治性放疗，予以止呕、补钾等支持治疗。","is_gold":false},{"letter":"H","text":"继续根治性放疗与顺铂同期化疗，予以止呕、护胃、补液及补钾等支持治疗，并安排鼻咽镜活检评估疗效。","is_gold":false},{"letter":"I","text":"顺铂减量50%继续同期化疗，继续根治性放疗，予以止呕、补液及补钾等支持治疗，并安排放疗中段MRI评估。","is_gold":false},{"letter":"J","text":"继续根治性放疗，取消后续化疗，予以止呕、补液及补钾等支持治疗，并安排放疗中段MRI评估。","is_gold":false},{"letter":"K","text":"继续根治性放疗与顺铂同期化疗，予以止呕、护胃、补液治疗，暂不予补钾，并安排放疗中段MRI评估。","is_gold":false},{"letter":"L","text":"暂停根治性放疗，继续顺铂同期化疗，予以止呕、补液及补钾等支持治疗，并安排放疗中段MRI评估。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 涕血1年余，头痛3月；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 额部疼痛,涕血；既往史: 高血压10年余服药治疗中，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.9℃，P：72次/分，R：20次/分，BP：127/91mmHg,Ht：160cm，Wt：62.5kg，BSA：1.65m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽右侧顶后壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D52] 入院记录: 主诉: 鼻咽癌一程化疗后两周余；现病史: 缘于1年前患者无明显诱因出现回吸性涕血，无头痛、鼻塞、耳鸣、复视、面麻等不适，未予重视，3个月前出现前额部疼痛，伴鼻衅，并于当地医院行鼻咽活检病理考虑鼻咽低分化型癌可能性大。于某次就诊时间10月底来我科就诊，并行根治性放疗计划设计，于某次就诊时间开始行根治性放疗，同时期予以DDP化疗1程，治疗过程顺利。今同期化疗到期来我科继续治疗，患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 额部疼痛,涕血；既往史: 高血压10年余服药治疗中，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.9℃，P：72次/分，R：20次/分，BP：127/91mmHg,Ht：160cm，Wt：62.5kg，BSA：1.65m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率72次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽右侧顶后壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 Ⅰ、Ⅱ、Ⅲ、aVF、V4～V6导联ST段下移\n- [全程D1] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；球蛋白(GLO)-静脉血: 30.03g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.9mmol/L；D-二聚体(D-Dimer)-静脉血: 0.13ug/ml；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；氯离子(Cl-)-静脉血: 98.1mmol/L；平均红细胞体积(MCV)-静脉血: 87.2fL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.91；大血小板百分比(P-LCR%)-静脉血: 33.4%；甘油三酯(TG)-静脉血: 1.01mmol/L；总钙(Ca)-静脉血: 2.28mmol/L；总胆固醇(TC)-静脉血: 5.44mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 25.2U/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 40.9umol/L；纤维蛋白原(Fbg)-静脉血: 2.51g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 20U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.34mmolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.58mmol/L；白细胞计数(WBC#)-静脉血: 6.9810E9/L；凝血酶时间(TT)-静脉血: 17.5sec.；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.013；红细胞计数(RBC#)-静脉血: 4.6710E12/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.98；直接胆红素(DBIL)-静脉血: 3.4umol/L；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 26.3mmol/L；磷(P)-静脉血: 1.03mmol/L；尿酸(UA)-静脉血: 391.1umol/L；碱性磷酸酶(ALP)-静脉血……\n- [全程D5] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁及右侧壁粘膜增厚放射性浓聚，SUV约7.3，病灶疑累及蝶骨基底部；右侧咽隐窝变浅；双侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见明显异常。口咽及喉咽结构及放射性分布未见明显异常。额窦、蝶窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双上颈小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。双乳腺结构及放射性分布未见明显异常。 肝S7点状高密度影放射性缺损，CT值约124Hu；其余肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 子宫边缘弧形改变，见结节状稍高密度影放射性分布未见明显异常，大小约3.8×4.3cm；左附件囊性低密度影放射性稀疏，大小约2.2×2.3cm，CT值约22Hu。膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 所见颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽顶壁及右侧壁粘膜增厚代谢活跃，考虑鼻咽癌，疑累及蝶骨基底部。 肝S7肝内胆管结石。 子宫肌瘤。 左附件囊肿。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D26] 检验组合: 比重(SG)-尿液: 1.019；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；酮体(KET)-尿液: +-（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: Turbid；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 82/μL；总蛋白(TP)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；白细胞计数(WBC#)-尿液: 17/μL\n- [全程D27] 检验组合: 血小板分布宽度(PDW)-静脉血: 12.2%；平均血小板体积(MPV)-静脉血: 11.2fL；红细胞比容(Hct)-静脉血: 37.5%；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；红细胞比容(Hct)-静脉血: 35.5%；碱性磷酸酶(ALP)-静脉血: 91.7U/L；白蛋白(ALB)-静脉血: 45.5g/L；C-反应蛋白(CRP)-静脉血: 1.15mg/L；血红蛋白(Hb)-静脉血: 121g/L；直接胆红素(DBIL)-静脉血: 3.7umol/L；血红蛋白(Hb)-静脉血: 111g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.4；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；葡萄糖(Glu)-静脉血: 5.1mmol/L；白细胞计数(WBC#)-静脉血: 13.710E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.51mmolL；红细胞计数(RBC#)-静脉血: 3.8810E12/L；颜色-尿液: Light-Orange；尿素氮(BUN)-静脉血: 5.77mmol/L；胱抑素(Cys-C)-静脉血: 0.99mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.59；钾离子(K+)-静脉血: 4.2mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 19U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 266.5U/L；磷(P)-静脉血: 1.03mmol/L；中性粒细胞计数(Neut#)-静脉血: 4.110E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.241；平均红细胞体积(MCV)-静脉血: 82.9fL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.81mmol/L；大血小板百分比(P-LCR%)-静脉血: 27.5%；红细胞计数(RBC#)-静脉血: 4.1410E12/L；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；甘油三酯(TG)-静脉血: 1.02mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.9；尿酸(UA)-静脉血: 295.4umol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.……\n- [全程D31] 检验组合: 丙氨酸氨基转移酶(ALT)-静脉血: 91.9U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 30.5U/L；碱性磷酸酶(ALP)-静脉血: 104.1U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 114U/L；乳酸脱氢酶(LDH)-静脉血: 159.5U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 23.5U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.33；总胆汁酸(TBA)-静脉血: 2umol/L\n- [全程D42] 检验组合: 磷(P)-静脉血: 1.12mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.66；钠离子(Na+)-静脉血: 139.9mmol/L；白蛋白(ALB)-静脉血: 43.7g/L；镁离子(Mg2+)-静脉血: 0.74mmol/L；钾离子(K+)-静脉血: 4.14mmol/L；氯离子(Cl-)-静脉血: 98mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 91.5U/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.5U/L；总胆红素(TBIL)-静脉血: 10.2umol/L；尿素氮(BUN)-静脉血: 5.7mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.7mmol/L；阴离子间隙(AG)-静脉血: 16.2；直接胆红素(DBIL)-静脉血: 3.2umol/L；尿酸(UA)-静脉血: 335.2umol/L；碱性磷酸酶(ALP)-静脉血: 75.1U/L；间接胆红素(IBIL)-静脉血: 7umolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.28；α-L-岩藻糖苷酶(AFU)-静脉血: 18.2U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.3U/L；球蛋白(GLO)-静脉血: 26.28g/L；总钙(Ca)-静脉血: 2.33mmol/L；肌酐(Crea)-静脉血: 77.8umol/L；总蛋白(TP)-静脉血: 69.98g/L；乳酸脱氢酶(LDH)-静脉血: 203.7U/L；总胆汁酸(TBA)-静脉血: 1.9umol/L\n- [全程D52] 检验组合: 白细胞计数(WBC#)-尿液: 2/μL；非鳞状上皮细胞计数-尿液: 3/μL；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；酸碱度(pH)-尿液: 6.5；红细胞计数(RBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；隐血(OB)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.014；尿胆原(URO)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 28/μL；总蛋白(TP)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 26/μL；白细胞(LEU)-尿液: -（参考: 阴性）\n- [全程D54] 检验组合: 红细胞计数(RBC#)-静脉血: 3.9510E12/L；血小板分布宽度(PDW)-静脉血: 12.5%；载脂蛋白B(apoB)-静脉血: 1.08g/L；酸碱度(pH)-尿液: 6.5；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.002；丙氨酸氨基转移酶(ALT)-静脉血: 12.3U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.092；尿素氮(BUN)-静脉血: 4.3mmol/L；酮体(KET)-尿液: 1+ 2mmol（参考: 阴性）；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.6；阴离子间隙(AG)-静脉血: 13.6；浊度(TRUB)-尿液: Turbid；颜色-尿液: Yellow；隐血(OB)-尿液: -（参考: 阴性）；镁离子(Mg2+)-静脉血: 0.61mmol/L；透明管型计数(HYAL#)-尿液: 1/μL；总胆红素(TBIL)-静脉血: 12umol/L；磷(P)-静脉血: 1.12mmol/L；浊度(TRUB)-尿液: Turbid；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿酸(UA)-静脉血: 317.3umol/L；总蛋白(TP)-尿液: 1+ 0.3g（参考: 阴性）；白蛋白(ALB)-静脉血: 42.2g/L；平均血小板体积(MPV)-静脉血: 10.8fL；中性粒细胞计数(Neut#)-静脉血: 3.410E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.1U/L；透明管型计数(HYAL#)-尿液: 2/μL；直接胆红素(DBIL)-静脉血: 3.8umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.67；白细胞计数(WBC#)-尿液: 25/μL；钾离子(K+)-静脉血: 3.33mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.6；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.08mmolL；比重(SG)-尿液: 1.024；未分类管型计数(UNCC#)-尿液: 2/μL；载脂蛋白AI(apoAI)-静脉血: 1.1g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.6pg；未分类管型计数(UNCC#)-尿液: 4/μL；隐血(OB)-尿液: -（参考: 阴性）；球蛋白(GLO)-静脉血: 25.25g/L；红细胞比容(H……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D26] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者入院第三天，无特殊不适主诉，体查情况基本同前，患者现一般情况尚可，今日开始行根治性放疗，同时期予以DDP方案化疗，并予以护胃、止呕等对症支持处理，密观患者病情。\n- [全程D31] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现处于放化综合治疗中，放疗4F，现已基本完成一程同期化疗，诉口干、腹胀、纳差，体查：张口门齿距4.5cm；鼻咽右侧顶后壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。复查生化常规结果示：ALT87.0U/L，[姓名已隐去]副医生信息已隐藏：患者在院行一程同期化疗期间，出现肝功轻度损伤，期间予以护肝等对症处理，现患者复查生化示肝功指标仍有轻度升高，继续予以护肝等对症处理，今日可出院，每周定期复查血常规、生化常规，定期门诊复诊，门诊继续放疗，按期[计划性表述已隐藏]下程治疗，不适随诊。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D53] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者入院第二天，现处于放化综合治疗中，放疗21F，诉口苦，体查情况：张口门齿距4.5cm；鼻咽右侧顶后壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。复查血常规、生化常规结果基本正常。[姓名已隐去]副医生信息已隐藏：现患者入院[计划性表述已隐藏]第二程顺铂同期方案化疗，昨日开始予以水化，目前患者情况尚可，今日可行化疗，并予以止呕、护胃、加强营养等对症支持治疗，针对患者口苦症状，为放疗引起常见急性不良反应，予以对症处理，病情继观。\n- [全程D54] 上级查房记录；[姓名已隐去]医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医师查房记录；病程内容: 患者入院第三天，现处于放化综合治疗中，放疗22F，诉恶心、呕吐，体查情况基本同前。[姓名已隐去]医师查房后示：现患者处于DDP方案同期化疗中，目前患者情况尚可，继续予以止呕、护胃、加强营养等对症支持治疗，病情继观。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停顺铂同期化疗，继续根治性放疗，予以止呕、补液、补钾等支持治疗，并安排放疗中段MRI评估。\nB. 顺铂减量20%继续同期化疗，继续根治性放疗，予以止呕、补液等支持治疗，暂不复查MRI。\nC. 继续根治性放疗与顺铂同期化疗，予以止呕、护胃治疗，暂不予补液及补钾，并安排放疗中段MRI评估。\nD. 暂停根治性放疗与顺铂同期化疗，予以积极补液、补钾治疗，暂不安排影像学评估。\nE. 继续根治性放疗与顺铂同期化疗，予以止呕、护胃、补液及补钾等支持治疗，并安排放疗中段MRI评估。\nF. 继续根治性放疗与顺铂同期化疗，予以止呕、护胃、补液及补钾等支持治疗，并安排PET-CT评估全身疗效。\nG. 暂停顺铂同期化疗，改为替加氟口服化疗，继续根治性放疗，予以止呕、补钾等支持治疗。\nH. 继续根治性放疗与顺铂同期化疗，予以止呕、护胃、补液及补钾等支持治疗，并安排鼻咽镜活检评估疗效。\nI. 顺铂减量50%继续同期化疗，继续根治性放疗，予以止呕、补液及补钾等支持治疗，并安排放疗中段MRI评估。\nJ. 继续根治性放疗，取消后续化疗，予以止呕、补液及补钾等支持治疗，并安排放疗中段MRI评估。\nK. 继续根治性放疗与顺铂同期化疗，予以止呕、护胃、补液治疗，暂不予补钾，并安排放疗中段MRI评估。\nL. 暂停根治性放疗，继续顺铂同期化疗，予以止呕、补液及补钾等支持治疗，并安排放疗中段MRI评估。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- [全程D52] 入院记录: 主诉: 鼻咽癌一程化疗后两周余；现病史: 缘于1年前患者无明显诱因出现回吸性涕血，无头痛、鼻塞、耳鸣、复视、面麻等不适，未予重视，3个月前出现前额部疼痛，伴鼻衅，并于当地医院行鼻咽活检病理考虑鼻咽低分化型癌可能性大。于某次就诊时间10月底来我科就诊，并行根治性放疗计划设计，于某次就诊时间开始行根治性放疗，同时期予以DDP化疗1程，治疗过程顺利。今同期化疗到期来我科继续治疗，患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 额部疼痛,涕血；既往史: 高血压10年余服药治疗中，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.9℃，P：72次/分，R：20次/分，BP：127/91mmHg,Ht：160cm，Wt：62.5kg，BSA：1.65m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率72次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽右侧顶后壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D26] 检验组合: 比重(SG)-尿液: 1.019；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；酮体(KET)-尿液: +-（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: Turbid；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 82/μL；总蛋白(TP)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；白细胞计数(WBC#)-尿液: 17/μL\n- [全程D27] 检验组合: 血小板分布宽度(PDW)-静脉血: 12.2%；平均血小板体积(MPV)-静脉血: 11.2fL；红细胞比容(Hct)-静脉血: 37.5%；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；红细胞比容(Hct)-静脉血: 35.5%；碱性磷酸酶(ALP)-静脉血: 91.7U/L；白蛋白(ALB)-静脉血: 45.5g/L；C-反应蛋白(CRP)-静脉血: 1.15mg/L；血红蛋白(Hb)-静脉血: 121g/L；直接胆红素(DBIL)-静脉血: 3.7umol/L；血红蛋白(Hb)-静脉血: 111g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.4；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；葡萄糖(Glu)-静脉血: 5.1mmol/L；白细胞计数(WBC#)-静脉血: 13.710E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.51mmolL；红细胞计数(RBC#)-静脉血: 3.8810E12/L；颜色-尿液: Light-Orange；尿素氮(BUN)-静脉血: 5.77mmol/L；胱抑素(Cys-C)-静脉血: 0.99mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.59；钾离子(K+)-静脉血: 4.2mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 19U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 266.5U/L；磷(P)-静脉血: 1.03mmol/L；中性粒细胞计数(Neut#)-静脉血: 4.110E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.241；平均红细胞体积(MCV)-静脉血: 82.9fL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.81mmol/L；大血小板百分比(P-LCR%)-静脉血: 27.5%；红细胞计数(RBC#)-静脉血: 4.1410E12/L；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；甘油三酯(TG)-静脉血: 1.02mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.9；尿酸(UA)-静脉血: 295.4umol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.……\n- [全程D31] 检验组合: 丙氨酸氨基转移酶(ALT)-静脉血: 91.9U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 30.5U/L；碱性磷酸酶(ALP)-静脉血: 104.1U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 114U/L；乳酸脱氢酶(LDH)-静脉血: 159.5U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 23.5U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.33；总胆汁酸(TBA)-静脉血: 2umol/L\n- [全程D42] 检验组合: 磷(P)-静脉血: 1.12mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.66；钠离子(Na+)-静脉血: 139.9mmol/L；白蛋白(ALB)-静脉血: 43.7g/L；镁离子(Mg2+)-静脉血: 0.74mmol/L；钾离子(K+)-静脉血: 4.14mmol/L；氯离子(Cl-)-静脉血: 98mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 91.5U/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.5U/L；总胆红素(TBIL)-静脉血: 10.2umol/L；尿素氮(BUN)-静脉血: 5.7mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.7mmol/L；阴离子间隙(AG)-静脉血: 16.2；直接胆红素(DBIL)-静脉血: 3.2umol/L；尿酸(UA)-静脉血: 335.2umol/L；碱性磷酸酶(ALP)-静脉血: 75.1U/L；间接胆红素(IBIL)-静脉血: 7umolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.28；α-L-岩藻糖苷酶(AFU)-静脉血: 18.2U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.3U/L；球蛋白(GLO)-静脉血: 26.28g/L；总钙(Ca)-静脉血: 2.33mmol/L；肌酐(Crea)-静脉血: 77.8umol/L；总蛋白(TP)-静脉血: 69.98g/L；乳酸脱氢酶(LDH)-静脉血: 203.7U/L；总胆汁酸(TBA)-静脉血: 1.9umol/L\n- [全程D52] 检验组合: 白细胞计数(WBC#)-尿液: 2/μL；非鳞状上皮细胞计数-尿液: 3/μL；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；酸碱度(pH)-尿液: 6.5；红细胞计数(RBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；隐血(OB)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.014；尿胆原(URO)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 28/μL；总蛋白(TP)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 26/μL；白细胞(LEU)-尿液: -（参考: 阴性）\n- [全程D54] 检验组合: 红细胞计数(RBC#)-静脉血: 3.9510E12/L；血小板分布宽度(PDW)-静脉血: 12.5%；载脂蛋白B(apoB)-静脉血: 1.08g/L；酸碱度(pH)-尿液: 6.5；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.002；丙氨酸氨基转移酶(ALT)-静脉血: 12.3U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.092；尿素氮(BUN)-静脉血: 4.3mmol/L；酮体(KET)-尿液: 1+ 2mmol（参考: 阴性）；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.6；阴离子间隙(AG)-静脉血: 13.6；浊度(TRUB)-尿液: Turbid；颜色-尿液: Yellow；隐血(OB)-尿液: -（参考: 阴性）；镁离子(Mg2+)-静脉血: 0.61mmol/L；透明管型计数(HYAL#)-尿液: 1/μL；总胆红素(TBIL)-静脉血: 12umol/L；磷(P)-静脉血: 1.12mmol/L；浊度(TRUB)-尿液: Turbid；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿酸(UA)-静脉血: 317.3umol/L；总蛋白(TP)-尿液: 1+ 0.3g（参考: 阴性）；白蛋白(ALB)-静脉血: 42.2g/L；平均血小板体积(MPV)-静脉血: 10.8fL；中性粒细胞计数(Neut#)-静脉血: 3.410E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.1U/L；透明管型计数(HYAL#)-尿液: 2/μL；直接胆红素(DBIL)-静脉血: 3.8umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.67；白细胞计数(WBC#)-尿液: 25/μL；钾离子(K+)-静脉血: 3.33mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.6；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.08mmolL；比重(SG)-尿液: 1.024；未分类管型计数(UNCC#)-尿液: 2/μL；载脂蛋白AI(apoAI)-静脉血: 1.1g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.6pg；未分类管型计数(UNCC#)-尿液: 4/μL；隐血(OB)-尿液: -（参考: 阴性）；球蛋白(GLO)-静脉血: 25.25g/L；红细胞比容(H……\n\n【既往治疗与反应】\n- [全程D26] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者入院第三天，无特殊不适主诉，体查情况基本同前，患者现一般情况尚可，今日开始行根治性放疗，同时期予以DDP方案化疗，并予以护胃、止呕等对症支持处理，密观患者病情。\n- [全程D31] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现处于放化综合治疗中，放疗4F，现已基本完成一程同期化疗，诉口干、腹胀、纳差，体查：张口门齿距4.5cm；鼻咽右侧顶后壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。复查生化常规结果示：ALT87.0U/L，[姓名已隐去]副医生信息已隐藏：患者在院行一程同期化疗期间，出现肝功轻度损伤，期间予以护肝等对症处理，现患者复查生化示肝功指标仍有轻度升高，继续予以护肝等对症处理，今日可出院，每周定期复查血常规、生化常规，定期门诊复诊，门诊继续放疗，按期[计划性表述已隐藏]下程治疗，不适随诊。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D53] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者入院第二天，现处于放化综合治疗中，放疗21F，诉口苦，体查情况：张口门齿距4.5cm；鼻咽右侧顶后壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。复查血常规、生化常规结果基本正常。[姓名已隐去]副医生信息已隐藏：现患者入院[计划性表述已隐藏]第二程顺铂同期方案化疗，昨日开始予以水化，目前患者情况尚可，今日可行化疗，并予以止呕、护胃、加强营养等对症支持治疗，针对患者口苦症状，为放疗引起常见急性不良反应，予以对症处理，病情继观。\n- [全程D54] 上级查房记录；[姓名已隐去]医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医师查房记录；病程内容: 患者入院第三天，现处于放化综合治疗中，放疗22F，诉恶心、呕吐，体查情况基本同前。[姓名已隐去]医师查房后示：现患者处于DDP方案同期化疗中，目前患者情况尚可，继续予以止呕、护胃、加强营养等对症支持治疗，病情继观。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停顺铂同期化疗，继续根治性放疗，予以止呕、补液、补钾等支持治疗，并安排放疗中段MRI评估。\nB. 顺铂减量20%继续同期化疗，继续根治性放疗，予以止呕、补液等支持治疗，暂不复查MRI。\nC. 继续根治性放疗与顺铂同期化疗，予以止呕、护胃治疗，暂不予补液及补钾，并安排放疗中段MRI评估。\nD. 暂停根治性放疗与顺铂同期化疗，予以积极补液、补钾治疗，暂不安排影像学评估。\nE. 继续根治性放疗与顺铂同期化疗，予以止呕、护胃、补液及补钾等支持治疗，并安排放疗中段MRI评估。\nF. 继续根治性放疗与顺铂同期化疗，予以止呕、护胃、补液及补钾等支持治疗，并安排PET-CT评估全身疗效。\nG. 暂停顺铂同期化疗，改为替加氟口服化疗，继续根治性放疗，予以止呕、补钾等支持治疗。\nH. 继续根治性放疗与顺铂同期化疗，予以止呕、护胃、补液及补钾等支持治疗，并安排鼻咽镜活检评估疗效。\nI. 顺铂减量50%继续同期化疗，继续根治性放疗，予以止呕、补液及补钾等支持治疗，并安排放疗中段MRI评估。\nJ. 继续根治性放疗，取消后续化疗，予以止呕、补液及补钾等支持治疗，并安排放疗中段MRI评估。\nK. 继续根治性放疗与顺铂同期化疗，予以止呕、护胃、补液治疗，暂不予补钾，并安排放疗中段MRI评估。\nL. 暂停根治性放疗，继续顺铂同期化疗，予以止呕、补液及补钾等支持治疗，并安排放疗中段MRI评估。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D52] 入院记录: 主诉: 鼻咽癌一程化疗后两周余；现病史: 缘于1年前患者无明显诱因出现回吸性涕血，无头痛、鼻塞、耳鸣、复视、面麻等不适，未予重视，3个月前出现前额部疼痛，伴鼻衅，并于当地医院行鼻咽活检病理考虑鼻咽低分化型癌可能性大。于某次就诊时间10月底来我科就诊，并行根治性放疗计划设计，于某次就诊时间开始行根治性放疗，同时期予以DDP化疗1程，治疗过程顺利。今同期化疗到期来我科继续治疗，患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 额部疼痛,涕血；既往史: 高血压10年余服药治疗中，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.9℃，P：72次/分，R：20次/分，BP：127/91mmHg,Ht：160cm，Wt：62.5kg，BSA：1.65m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率72次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽右侧顶后壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D26] 检验组合: 比重(SG)-尿液: 1.019；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；酮体(KET)-尿液: +-（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: Turbid；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 82/μL；总蛋白(TP)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；白细胞计数(WBC#)-尿液: 17/μL\n- [全程D27] 检验组合: 血小板分布宽度(PDW)-静脉血: 12.2%；平均血小板体积(MPV)-静脉血: 11.2fL；红细胞比容(Hct)-静脉血: 37.5%；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；红细胞比容(Hct)-静脉血: 35.5%；碱性磷酸酶(ALP)-静脉血: 91.7U/L；白蛋白(ALB)-静脉血: 45.5g/L；C-反应蛋白(CRP)-静脉血: 1.15mg/L；血红蛋白(Hb)-静脉血: 121g/L；直接胆红素(DBIL)-静脉血: 3.7umol/L；血红蛋白(Hb)-静脉血: 111g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.4；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；葡萄糖(Glu)-静脉血: 5.1mmol/L；白细胞计数(WBC#)-静脉血: 13.710E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.51mmolL；红细胞计数(RBC#)-静脉血: 3.8810E12/L；颜色-尿液: Light-Orange；尿素氮(BUN)-静脉血: 5.77mmol/L；胱抑素(Cys-C)-静脉血: 0.99mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.59；钾离子(K+)-静脉血: 4.2mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 19U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 266.5U/L；磷(P)-静脉血: 1.03mmol/L；中性粒细胞计数(Neut#)-静脉血: 4.110E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.241；平均红细胞体积(MCV)-静脉血: 82.9fL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.81mmol/L；大血小板百分比(P-LCR%)-静脉血: 27.5%；红细胞计数(RBC#)-静脉血: 4.1410E12/L；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；甘油三酯(TG)-静脉血: 1.02mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.9；尿酸(UA)-静脉血: 295.4umol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.……\n- [全程D31] 检验组合: 丙氨酸氨基转移酶(ALT)-静脉血: 91.9U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 30.5U/L；碱性磷酸酶(ALP)-静脉血: 104.1U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 114U/L；乳酸脱氢酶(LDH)-静脉血: 159.5U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 23.5U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.33；总胆汁酸(TBA)-静脉血: 2umol/L\n- [全程D42] 检验组合: 磷(P)-静脉血: 1.12mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.66；钠离子(Na+)-静脉血: 139.9mmol/L；白蛋白(ALB)-静脉血: 43.7g/L；镁离子(Mg2+)-静脉血: 0.74mmol/L；钾离子(K+)-静脉血: 4.14mmol/L；氯离子(Cl-)-静脉血: 98mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 91.5U/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.5U/L；总胆红素(TBIL)-静脉血: 10.2umol/L；尿素氮(BUN)-静脉血: 5.7mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.7mmol/L；阴离子间隙(AG)-静脉血: 16.2；直接胆红素(DBIL)-静脉血: 3.2umol/L；尿酸(UA)-静脉血: 335.2umol/L；碱性磷酸酶(ALP)-静脉血: 75.1U/L；间接胆红素(IBIL)-静脉血: 7umolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.28；α-L-岩藻糖苷酶(AFU)-静脉血: 18.2U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.3U/L；球蛋白(GLO)-静脉血: 26.28g/L；总钙(Ca)-静脉血: 2.33mmol/L；肌酐(Crea)-静脉血: 77.8umol/L；总蛋白(TP)-静脉血: 69.98g/L；乳酸脱氢酶(LDH)-静脉血: 203.7U/L；总胆汁酸(TBA)-静脉血: 1.9umol/L\n- [全程D52] 检验组合: 白细胞计数(WBC#)-尿液: 2/μL；非鳞状上皮细胞计数-尿液: 3/μL；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；酸碱度(pH)-尿液: 6.5；红细胞计数(RBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；隐血(OB)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.014；尿胆原(URO)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 28/μL；总蛋白(TP)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 26/μL；白细胞(LEU)-尿液: -（参考: 阴性）\n- [全程D54] 检验组合: 红细胞计数(RBC#)-静脉血: 3.9510E12/L；血小板分布宽度(PDW)-静脉血: 12.5%；载脂蛋白B(apoB)-静脉血: 1.08g/L；酸碱度(pH)-尿液: 6.5；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.002；丙氨酸氨基转移酶(ALT)-静脉血: 12.3U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.092；尿素氮(BUN)-静脉血: 4.3mmol/L；酮体(KET)-尿液: 1+ 2mmol（参考: 阴性）；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.6；阴离子间隙(AG)-静脉血: 13.6；浊度(TRUB)-尿液: Turbid；颜色-尿液: Yellow；隐血(OB)-尿液: -（参考: 阴性）；镁离子(Mg2+)-静脉血: 0.61mmol/L；透明管型计数(HYAL#)-尿液: 1/μL；总胆红素(TBIL)-静脉血: 12umol/L；磷(P)-静脉血: 1.12mmol/L；浊度(TRUB)-尿液: Turbid；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿酸(UA)-静脉血: 317.3umol/L；总蛋白(TP)-尿液: 1+ 0.3g（参考: 阴性）；白蛋白(ALB)-静脉血: 42.2g/L；平均血小板体积(MPV)-静脉血: 10.8fL；中性粒细胞计数(Neut#)-静脉血: 3.410E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.1U/L；透明管型计数(HYAL#)-尿液: 2/μL；直接胆红素(DBIL)-静脉血: 3.8umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.67；白细胞计数(WBC#)-尿液: 25/μL；钾离子(K+)-静脉血: 3.33mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.6；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.08mmolL；比重(SG)-尿液: 1.024；未分类管型计数(UNCC#)-尿液: 2/μL；载脂蛋白AI(apoAI)-静脉血: 1.1g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.6pg；未分类管型计数(UNCC#)-尿液: 4/μL；隐血(OB)-尿液: -（参考: 阴性）；球蛋白(GLO)-静脉血: 25.25g/L；红细胞比容(H……\n\n【既往治疗与反应】\n- [全程D26] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者入院第三天，无特殊不适主诉，体查情况基本同前，患者现一般情况尚可，今日开始行根治性放疗，同时期予以DDP方案化疗，并予以护胃、止呕等对症支持处理，密观患者病情。\n- [全程D31] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现处于放化综合治疗中，放疗4F，现已基本完成一程同期化疗，诉口干、腹胀、纳差，体查：张口门齿距4.5cm；鼻咽右侧顶后壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。复查生化常规结果示：ALT87.0U/L，[姓名已隐去]副医生信息已隐藏：患者在院行一程同期化疗期间，出现肝功轻度损伤，期间予以护肝等对症处理，现患者复查生化示肝功指标仍有轻度升高，继续予以护肝等对症处理，今日可出院，每周定期复查血常规、生化常规，定期门诊复诊，门诊继续放疗，按期[计划性表述已隐藏]下程治疗，不适随诊。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D53] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者入院第二天，现处于放化综合治疗中，放疗21F，诉口苦，体查情况：张口门齿距4.5cm；鼻咽右侧顶后壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。复查血常规、生化常规结果基本正常。[姓名已隐去]副医生信息已隐藏：现患者入院[计划性表述已隐藏]第二程顺铂同期方案化疗，昨日开始予以水化，目前患者情况尚可，今日可行化疗，并予以止呕、护胃、加强营养等对症支持治疗，针对患者口苦症状，为放疗引起常见急性不良反应，予以对症处理，病情继观。\n- [全程D54] 上级查房记录；[姓名已隐去]医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医师查房记录；病程内容: 患者入院第三天，现处于放化综合治疗中，放疗22F，诉恶心、呕吐，体查情况基本同前。[姓名已隐去]医师查房后示：现患者处于DDP方案同期化疗中，目前患者情况尚可，继续予以止呕、护胃、加强营养等对症支持治疗，病情继观。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停顺铂同期化疗，继续根治性放疗，予以止呕、补液、补钾等支持治疗，并安排放疗中段MRI评估。\nB. 顺铂减量20%继续同期化疗，继续根治性放疗，予以止呕、补液等支持治疗，暂不复查MRI。\nC. 继续根治性放疗与顺铂同期化疗，予以止呕、护胃治疗，暂不予补液及补钾，并安排放疗中段MRI评估。\nD. 暂停根治性放疗与顺铂同期化疗，予以积极补液、补钾治疗，暂不安排影像学评估。\nE. 继续根治性放疗与顺铂同期化疗，予以止呕、护胃、补液及补钾等支持治疗，并安排放疗中段MRI评估。\nF. 继续根治性放疗与顺铂同期化疗，予以止呕、护胃、补液及补钾等支持治疗，并安排PET-CT评估全身疗效。\nG. 暂停顺铂同期化疗，改为替加氟口服化疗，继续根治性放疗，予以止呕、补钾等支持治疗。\nH. 继续根治性放疗与顺铂同期化疗，予以止呕、护胃、补液及补钾等支持治疗，并安排鼻咽镜活检评估疗效。\nI. 顺铂减量50%继续同期化疗，继续根治性放疗，予以止呕、补液及补钾等支持治疗，并安排放疗中段MRI评估。\nJ. 继续根治性放疗，取消后续化疗，予以止呕、补液及补钾等支持治疗，并安排放疗中段MRI评估。\nK. 继续根治性放疗与顺铂同期化疗，予以止呕、护胃、补液治疗，暂不予补钾，并安排放疗中段MRI评估。\nL. 暂停根治性放疗，继续顺铂同期化疗，予以止呕、补液及补钾等支持治疗，并安排放疗中段MRI评估。\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-cc72c6bbde9abe2a112ce0fc","patient_id":"patient-79fa00752e4405e2980f6292","turn_id":"turn07","turn_position":4,"turn_type":"response_assessment_decision","gold_letter":"B","gold_action":"评估腹部无转移征象，继续根治性放疗，予以重组人促红素皮下注射改善贫血，并动态复查血常规。","options":[{"letter":"A","text":"评估腹部无转移征象，继续根治性放疗，予以重组人粒细胞刺激因子皮下注射，待血常规恢复后重启化疗。","is_gold":false},{"letter":"B","text":"评估腹部无转移征象，继续根治性放疗，予以重组人促红素皮下注射改善贫血，并动态复查血常规。","is_gold":true},{"letter":"C","text":"腹部彩超见可疑占位，暂停放疗，行肝脏MRI平扫+增强以明确病变性质。","is_gold":false},{"letter":"D","text":"评估腹部无转移征象，继续根治性放疗，并即刻启动第三程顺铂同期化疗。","is_gold":false},{"letter":"E","text":"评估腹部无转移征象，提前结束放疗，转为顺铂联合氟尿嘧啶方案辅助化疗。","is_gold":false},{"letter":"F","text":"评估腹部无转移征象，继续根治性放疗，予以利可君口服改善骨髓抑制，并动态复查血常规。","is_gold":false},{"letter":"G","text":"评估腹部无转移征象，继续根治性放疗，予以异甘草酸镁静脉滴注强化保肝治疗。","is_gold":false},{"letter":"H","text":"评估腹部无转移征象，继续根治性放疗，予以输注单采血小板预防出血，并动态复查血常规。","is_gold":false},{"letter":"I","text":"评估腹部无转移征象，暂停放疗，行全身PET/CT检查以全面评估近期疗效。","is_gold":false},{"letter":"J","text":"评估腹部无转移征象，继续根治性放疗，予以昂丹司琼强化止吐，并预防性放置胃管。","is_gold":false},{"letter":"K","text":"评估腹部无转移征象，继续根治性放疗，加用尼妥珠单抗靶向治疗以提高局部控制率。","is_gold":false},{"letter":"L","text":"评估腹部无转移征象，继续根治性放疗，予以地塞米松口服改善骨髓抑制，并动态复查血常规。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 涕血1年余，头痛3月；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 额部疼痛,涕血；既往史: 高血压10年余服药治疗中，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.9℃，P：72次/分，R：20次/分，BP：127/91mmHg,Ht：160cm，Wt：62.5kg，BSA：1.65m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽右侧顶后壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D52] 入院记录: 主诉: 鼻咽癌一程化疗后两周余；现病史: 缘于1年前患者无明显诱因出现回吸性涕血，无头痛、鼻塞、耳鸣、复视、面麻等不适，未予重视，3个月前出现前额部疼痛，伴鼻衅，并于当地医院行鼻咽活检病理考虑鼻咽低分化型癌可能性大。于某次就诊时间10月底来我科就诊，并行根治性放疗计划设计，于某次就诊时间开始行根治性放疗，同时期予以DDP化疗1程，治疗过程顺利。今同期化疗到期来我科继续治疗，患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 额部疼痛,涕血；既往史: 高血压10年余服药治疗中，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.9℃，P：72次/分，R：20次/分，BP：127/91mmHg,Ht：160cm，Wt：62.5kg，BSA：1.65m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率72次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽右侧顶后壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 Ⅰ、Ⅱ、Ⅲ、aVF、V4～V6导联ST段下移\n- [全程D1] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；球蛋白(GLO)-静脉血: 30.03g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.9mmol/L；D-二聚体(D-Dimer)-静脉血: 0.13ug/ml；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；氯离子(Cl-)-静脉血: 98.1mmol/L；平均红细胞体积(MCV)-静脉血: 87.2fL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.91；大血小板百分比(P-LCR%)-静脉血: 33.4%；甘油三酯(TG)-静脉血: 1.01mmol/L；总钙(Ca)-静脉血: 2.28mmol/L；总胆固醇(TC)-静脉血: 5.44mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 25.2U/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 40.9umol/L；纤维蛋白原(Fbg)-静脉血: 2.51g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 20U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.34mmolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.58mmol/L；白细胞计数(WBC#)-静脉血: 6.9810E9/L；凝血酶时间(TT)-静脉血: 17.5sec.；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.013；红细胞计数(RBC#)-静脉血: 4.6710E12/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.98；直接胆红素(DBIL)-静脉血: 3.4umol/L；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 26.3mmol/L；磷(P)-静脉血: 1.03mmol/L；尿酸(UA)-静脉血: 391.1umol/L；碱性磷酸酶(ALP)-静脉血……\n- [全程D5] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁及右侧壁粘膜增厚放射性浓聚，SUV约7.3，病灶疑累及蝶骨基底部；右侧咽隐窝变浅；双侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见明显异常。口咽及喉咽结构及放射性分布未见明显异常。额窦、蝶窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双上颈小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。双乳腺结构及放射性分布未见明显异常。 肝S7点状高密度影放射性缺损，CT值约124Hu；其余肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 子宫边缘弧形改变，见结节状稍高密度影放射性分布未见明显异常，大小约3.8×4.3cm；左附件囊性低密度影放射性稀疏，大小约2.2×2.3cm，CT值约22Hu。膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 所见颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽顶壁及右侧壁粘膜增厚代谢活跃，考虑鼻咽癌，疑累及蝶骨基底部。 肝S7肝内胆管结石。 子宫肌瘤。 左附件囊肿。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D26] 检验组合: 比重(SG)-尿液: 1.019；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；酮体(KET)-尿液: +-（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: Turbid；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 82/μL；总蛋白(TP)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；白细胞计数(WBC#)-尿液: 17/μL\n- [全程D27] 检验组合: 血小板分布宽度(PDW)-静脉血: 12.2%；平均血小板体积(MPV)-静脉血: 11.2fL；红细胞比容(Hct)-静脉血: 37.5%；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；红细胞比容(Hct)-静脉血: 35.5%；碱性磷酸酶(ALP)-静脉血: 91.7U/L；白蛋白(ALB)-静脉血: 45.5g/L；C-反应蛋白(CRP)-静脉血: 1.15mg/L；血红蛋白(Hb)-静脉血: 121g/L；直接胆红素(DBIL)-静脉血: 3.7umol/L；血红蛋白(Hb)-静脉血: 111g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.4；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；葡萄糖(Glu)-静脉血: 5.1mmol/L；白细胞计数(WBC#)-静脉血: 13.710E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.51mmolL；红细胞计数(RBC#)-静脉血: 3.8810E12/L；颜色-尿液: Light-Orange；尿素氮(BUN)-静脉血: 5.77mmol/L；胱抑素(Cys-C)-静脉血: 0.99mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.59；钾离子(K+)-静脉血: 4.2mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 19U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 266.5U/L；磷(P)-静脉血: 1.03mmol/L；中性粒细胞计数(Neut#)-静脉血: 4.110E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.241；平均红细胞体积(MCV)-静脉血: 82.9fL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.81mmol/L；大血小板百分比(P-LCR%)-静脉血: 27.5%；红细胞计数(RBC#)-静脉血: 4.1410E12/L；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；甘油三酯(TG)-静脉血: 1.02mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.9；尿酸(UA)-静脉血: 295.4umol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.……\n- [全程D31] 检验组合: 丙氨酸氨基转移酶(ALT)-静脉血: 91.9U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 30.5U/L；碱性磷酸酶(ALP)-静脉血: 104.1U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 114U/L；乳酸脱氢酶(LDH)-静脉血: 159.5U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 23.5U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.33；总胆汁酸(TBA)-静脉血: 2umol/L\n- [全程D42] 检验组合: 磷(P)-静脉血: 1.12mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.66；钠离子(Na+)-静脉血: 139.9mmol/L；白蛋白(ALB)-静脉血: 43.7g/L；镁离子(Mg2+)-静脉血: 0.74mmol/L；钾离子(K+)-静脉血: 4.14mmol/L；氯离子(Cl-)-静脉血: 98mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 91.5U/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.5U/L；总胆红素(TBIL)-静脉血: 10.2umol/L；尿素氮(BUN)-静脉血: 5.7mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.7mmol/L；阴离子间隙(AG)-静脉血: 16.2；直接胆红素(DBIL)-静脉血: 3.2umol/L；尿酸(UA)-静脉血: 335.2umol/L；碱性磷酸酶(ALP)-静脉血: 75.1U/L；间接胆红素(IBIL)-静脉血: 7umolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.28；α-L-岩藻糖苷酶(AFU)-静脉血: 18.2U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.3U/L；球蛋白(GLO)-静脉血: 26.28g/L；总钙(Ca)-静脉血: 2.33mmol/L；肌酐(Crea)-静脉血: 77.8umol/L；总蛋白(TP)-静脉血: 69.98g/L；乳酸脱氢酶(LDH)-静脉血: 203.7U/L；总胆汁酸(TBA)-静脉血: 1.9umol/L\n- [全程D52] 检验组合: 白细胞计数(WBC#)-尿液: 2/μL；非鳞状上皮细胞计数-尿液: 3/μL；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；酸碱度(pH)-尿液: 6.5；红细胞计数(RBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；隐血(OB)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.014；尿胆原(URO)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 28/μL；总蛋白(TP)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 26/μL；白细胞(LEU)-尿液: -（参考: 阴性）\n- [全程D54] 检验组合: 红细胞计数(RBC#)-静脉血: 3.9510E12/L；血小板分布宽度(PDW)-静脉血: 12.5%；载脂蛋白B(apoB)-静脉血: 1.08g/L；酸碱度(pH)-尿液: 6.5；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.002；丙氨酸氨基转移酶(ALT)-静脉血: 12.3U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.092；尿素氮(BUN)-静脉血: 4.3mmol/L；酮体(KET)-尿液: 1+ 2mmol（参考: 阴性）；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.6；阴离子间隙(AG)-静脉血: 13.6；浊度(TRUB)-尿液: Turbid；颜色-尿液: Yellow；隐血(OB)-尿液: -（参考: 阴性）；镁离子(Mg2+)-静脉血: 0.61mmol/L；透明管型计数(HYAL#)-尿液: 1/μL；总胆红素(TBIL)-静脉血: 12umol/L；磷(P)-静脉血: 1.12mmol/L；浊度(TRUB)-尿液: Turbid；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿酸(UA)-静脉血: 317.3umol/L；总蛋白(TP)-尿液: 1+ 0.3g（参考: 阴性）；白蛋白(ALB)-静脉血: 42.2g/L；平均血小板体积(MPV)-静脉血: 10.8fL；中性粒细胞计数(Neut#)-静脉血: 3.410E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.1U/L；透明管型计数(HYAL#)-尿液: 2/μL；直接胆红素(DBIL)-静脉血: 3.8umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.67；白细胞计数(WBC#)-尿液: 25/μL；钾离子(K+)-静脉血: 3.33mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.6；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.08mmolL；比重(SG)-尿液: 1.024；未分类管型计数(UNCC#)-尿液: 2/μL；载脂蛋白AI(apoAI)-静脉血: 1.1g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.6pg；未分类管型计数(UNCC#)-尿液: 4/μL；隐血(OB)-尿液: -（参考: 阴性）；球蛋白(GLO)-静脉血: 25.25g/L；红细胞比容(H……\n- [全程D55] 检验组合: 中性粒细胞计数(Neut#)-静脉血: 8.410E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；直接胆红素(DBIL)-静脉血: 7umol/L；血小板计数(PLT#)-静脉血: 16910E9/L；红细胞计数(RBC#)-静脉血: 3.2710E12/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0；血小板比容-静脉血: 17%；碱性磷酸酶(ALP)-静脉血: 79.8U/L；阴离子间隙(AG)-静脉血: 13；天门冬氨酸氨基转移酶(AST)-静脉血: 19.5U/L；碱性磷酸酶(ALP)-静脉血: 58.6U/L；载脂蛋白AI(apoAI)-静脉血: 0.97g/L；丙氨酸氨基转移酶(ALT)-静脉血: 31.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；钾离子(K+)-静脉血: 3.14mmol/L；胱抑素(Cys-C)-静脉血: 1.36mg/L；血红蛋白(Hb)-静脉血: 96g/L；平均血小板体积(MPV)-静脉血: 9.9fL；血小板分布宽度(PDW)-静脉血: 16.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 30.3pg；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.66；载脂蛋白B(apoB)-静脉血: 1.48g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.5U/L；白细胞计数(WBC#)-静脉血: 9.3910E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.48mmolL；淋巴细胞百分比(Lymph%)-静脉血: 0.064；总钙(Ca)-静脉血: 2.53mmol/L；甘油三酯(TG)-静脉血: 1.31mmol/L；尿酸(UA)-静脉血: 560.6umol/L；阴离子间隙(AG)-静脉血: 17；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.81mmol/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；尿素氮(BUN)-静脉血: 4.58mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.04mmolL；尿酸(UA)-静脉血: 415.9umol/L；白蛋白(ALB)-静脉血: 47.6g/L；红细胞比容(Hct)-静脉血: 28.4%；球蛋白(GLO)-静脉血: 28.72g/L；肌酐(Crea)-静脉血: 10……\n- [全程D64] 超声；腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径9mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约22cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确肿物回声。 膀胱未充盈。；检查结论: 肝脏、胆囊、脾脏、胰腺、双肾未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D26] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者入院第三天，无特殊不适主诉，体查情况基本同前，患者现一般情况尚可，今日开始行根治性放疗，同时期予以DDP方案化疗，并予以护胃、止呕等对症支持处理，密观患者病情。\n- [全程D31] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现处于放化综合治疗中，放疗4F，现已基本完成一程同期化疗，诉口干、腹胀、纳差，体查：张口门齿距4.5cm；鼻咽右侧顶后壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。复查生化常规结果示：ALT87.0U/L，[姓名已隐去]副医生信息已隐藏：患者在院行一程同期化疗期间，出现肝功轻度损伤，期间予以护肝等对症处理，现患者复查生化示肝功指标仍有轻度升高，继续予以护肝等对症处理，今日可出院，每周定期复查血常规、生化常规，定期门诊复诊，门诊继续放疗，按期[计划性表述已隐藏]下程治疗，不适随诊。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D53] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者入院第二天，现处于放化综合治疗中，放疗21F，诉口苦，体查情况：张口门齿距4.5cm；鼻咽右侧顶后壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。复查血常规、生化常规结果基本正常。[姓名已隐去]副医生信息已隐藏：现患者入院[计划性表述已隐藏]第二程顺铂同期方案化疗，昨日开始予以水化，目前患者情况尚可，今日可行化疗，并予以止呕、护胃、加强营养等对症支持治疗，针对患者口苦症状，为放疗引起常见急性不良反应，予以对症处理，病情继观。\n- [全程D54] 上级查房记录；[姓名已隐去]医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医师查房记录；病程内容: 患者入院第三天，现处于放化综合治疗中，放疗22F，诉恶心、呕吐，体查情况基本同前。[姓名已隐去]医师查房后示：现患者处于DDP方案同期化疗中，目前患者情况尚可，继续予以止呕、护胃、加强营养等对症支持治疗，病情继观。\n- [全程D56] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现处于放化综合治疗中，放疗24F，诉恶心、呕吐较前好转，体查情况：KPS 90分；鼻咽部右侧壁肿物，双颈部淋巴结未触及；颅神经检查：阴性。[姓名已隐去]副医生信息已隐藏：现患者基本完成二程DDP方案同期化疗，目前患者情况尚可，继续予以对症支持，今日可予以出院，并嘱按时[计划性表述已隐藏]治疗后复查，不适随诊。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估腹部无转移征象，继续根治性放疗，予以重组人粒细胞刺激因子皮下注射，待血常规恢复后重启化疗。\nB. 评估腹部无转移征象，继续根治性放疗，予以重组人促红素皮下注射改善贫血，并动态复查血常规。\nC. 腹部彩超见可疑占位，暂停放疗，行肝脏MRI平扫+增强以明确病变性质。\nD. 评估腹部无转移征象，继续根治性放疗，并即刻启动第三程顺铂同期化疗。\nE. 评估腹部无转移征象，提前结束放疗，转为顺铂联合氟尿嘧啶方案辅助化疗。\nF. 评估腹部无转移征象，继续根治性放疗，予以利可君口服改善骨髓抑制，并动态复查血常规。\nG. 评估腹部无转移征象，继续根治性放疗，予以异甘草酸镁静脉滴注强化保肝治疗。\nH. 评估腹部无转移征象，继续根治性放疗，予以输注单采血小板预防出血，并动态复查血常规。\nI. 评估腹部无转移征象，暂停放疗，行全身PET/CT检查以全面评估近期疗效。\nJ. 评估腹部无转移征象，继续根治性放疗，予以昂丹司琼强化止吐，并预防性放置胃管。\nK. 评估腹部无转移征象，继续根治性放疗，加用尼妥珠单抗靶向治疗以提高局部控制率。\nL. 评估腹部无转移征象，继续根治性放疗，予以地塞米松口服改善骨髓抑制，并动态复查血常规。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D55] 检验组合: 中性粒细胞计数(Neut#)-静脉血: 8.410E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；直接胆红素(DBIL)-静脉血: 7umol/L；血小板计数(PLT#)-静脉血: 16910E9/L；红细胞计数(RBC#)-静脉血: 3.2710E12/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0；血小板比容-静脉血: 17%；碱性磷酸酶(ALP)-静脉血: 79.8U/L；阴离子间隙(AG)-静脉血: 13；天门冬氨酸氨基转移酶(AST)-静脉血: 19.5U/L；碱性磷酸酶(ALP)-静脉血: 58.6U/L；载脂蛋白AI(apoAI)-静脉血: 0.97g/L；丙氨酸氨基转移酶(ALT)-静脉血: 31.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；钾离子(K+)-静脉血: 3.14mmol/L；胱抑素(Cys-C)-静脉血: 1.36mg/L；血红蛋白(Hb)-静脉血: 96g/L；平均血小板体积(MPV)-静脉血: 9.9fL；血小板分布宽度(PDW)-静脉血: 16.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 30.3pg；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.66；载脂蛋白B(apoB)-静脉血: 1.48g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.5U/L；白细胞计数(WBC#)-静脉血: 9.3910E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.48mmolL；淋巴细胞百分比(Lymph%)-静脉血: 0.064；总钙(Ca)-静脉血: 2.53mmol/L；甘油三酯(TG)-静脉血: 1.31mmol/L；尿酸(UA)-静脉血: 560.6umol/L；阴离子间隙(AG)-静脉血: 17；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.81mmol/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；尿素氮(BUN)-静脉血: 4.58mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.04mmolL；尿酸(UA)-静脉血: 415.9umol/L；白蛋白(ALB)-静脉血: 47.6g/L；红细胞比容(Hct)-静脉血: 28.4%；球蛋白(GLO)-静脉血: 28.72g/L；肌酐(Crea)-静脉血: 10……\n- [全程D64] 超声；腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径9mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约22cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确肿物回声。 膀胱未充盈。；检查结论: 肝脏、胆囊、脾脏、胰腺、双肾未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n\n【既往治疗与反应】\n- [全程D56] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现处于放化综合治疗中，放疗24F，诉恶心、呕吐较前好转，体查情况：KPS 90分；鼻咽部右侧壁肿物，双颈部淋巴结未触及；颅神经检查：阴性。[姓名已隐去]副医生信息已隐藏：现患者基本完成二程DDP方案同期化疗，目前患者情况尚可，继续予以对症支持，今日可予以出院，并嘱按时[计划性表述已隐藏]治疗后复查，不适随诊。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估腹部无转移征象，继续根治性放疗，予以重组人粒细胞刺激因子皮下注射，待血常规恢复后重启化疗。\nB. 评估腹部无转移征象，继续根治性放疗，予以重组人促红素皮下注射改善贫血，并动态复查血常规。\nC. 腹部彩超见可疑占位，暂停放疗，行肝脏MRI平扫+增强以明确病变性质。\nD. 评估腹部无转移征象，继续根治性放疗，并即刻启动第三程顺铂同期化疗。\nE. 评估腹部无转移征象，提前结束放疗，转为顺铂联合氟尿嘧啶方案辅助化疗。\nF. 评估腹部无转移征象，继续根治性放疗，予以利可君口服改善骨髓抑制，并动态复查血常规。\nG. 评估腹部无转移征象，继续根治性放疗，予以异甘草酸镁静脉滴注强化保肝治疗。\nH. 评估腹部无转移征象，继续根治性放疗，予以输注单采血小板预防出血，并动态复查血常规。\nI. 评估腹部无转移征象，暂停放疗，行全身PET/CT检查以全面评估近期疗效。\nJ. 评估腹部无转移征象，继续根治性放疗，予以昂丹司琼强化止吐，并预防性放置胃管。\nK. 评估腹部无转移征象，继续根治性放疗，加用尼妥珠单抗靶向治疗以提高局部控制率。\nL. 评估腹部无转移征象，继续根治性放疗，予以地塞米松口服改善骨髓抑制，并动态复查血常规。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D55] 检验组合: 中性粒细胞计数(Neut#)-静脉血: 8.410E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；直接胆红素(DBIL)-静脉血: 7umol/L；血小板计数(PLT#)-静脉血: 16910E9/L；红细胞计数(RBC#)-静脉血: 3.2710E12/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0；血小板比容-静脉血: 17%；碱性磷酸酶(ALP)-静脉血: 79.8U/L；阴离子间隙(AG)-静脉血: 13；天门冬氨酸氨基转移酶(AST)-静脉血: 19.5U/L；碱性磷酸酶(ALP)-静脉血: 58.6U/L；载脂蛋白AI(apoAI)-静脉血: 0.97g/L；丙氨酸氨基转移酶(ALT)-静脉血: 31.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；钾离子(K+)-静脉血: 3.14mmol/L；胱抑素(Cys-C)-静脉血: 1.36mg/L；血红蛋白(Hb)-静脉血: 96g/L；平均血小板体积(MPV)-静脉血: 9.9fL；血小板分布宽度(PDW)-静脉血: 16.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 30.3pg；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.66；载脂蛋白B(apoB)-静脉血: 1.48g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.5U/L；白细胞计数(WBC#)-静脉血: 9.3910E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.48mmolL；淋巴细胞百分比(Lymph%)-静脉血: 0.064；总钙(Ca)-静脉血: 2.53mmol/L；甘油三酯(TG)-静脉血: 1.31mmol/L；尿酸(UA)-静脉血: 560.6umol/L；阴离子间隙(AG)-静脉血: 17；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.81mmol/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；尿素氮(BUN)-静脉血: 4.58mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.04mmolL；尿酸(UA)-静脉血: 415.9umol/L；白蛋白(ALB)-静脉血: 47.6g/L；红细胞比容(Hct)-静脉血: 28.4%；球蛋白(GLO)-静脉血: 28.72g/L；肌酐(Crea)-静脉血: 10……\n- [全程D64] 超声；腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径9mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约22cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确肿物回声。 膀胱未充盈。；检查结论: 肝脏、胆囊、脾脏、胰腺、双肾未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n\n【既往治疗与反应】\n- [全程D56] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现处于放化综合治疗中，放疗24F，诉恶心、呕吐较前好转，体查情况：KPS 90分；鼻咽部右侧壁肿物，双颈部淋巴结未触及；颅神经检查：阴性。[姓名已隐去]副医生信息已隐藏：现患者基本完成二程DDP方案同期化疗，目前患者情况尚可，继续予以对症支持，今日可予以出院，并嘱按时[计划性表述已隐藏]治疗后复查，不适随诊。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估腹部无转移征象，继续根治性放疗，予以重组人粒细胞刺激因子皮下注射，待血常规恢复后重启化疗。\nB. 评估腹部无转移征象，继续根治性放疗，予以重组人促红素皮下注射改善贫血，并动态复查血常规。\nC. 腹部彩超见可疑占位，暂停放疗，行肝脏MRI平扫+增强以明确病变性质。\nD. 评估腹部无转移征象，继续根治性放疗，并即刻启动第三程顺铂同期化疗。\nE. 评估腹部无转移征象，提前结束放疗，转为顺铂联合氟尿嘧啶方案辅助化疗。\nF. 评估腹部无转移征象，继续根治性放疗，予以利可君口服改善骨髓抑制，并动态复查血常规。\nG. 评估腹部无转移征象，继续根治性放疗，予以异甘草酸镁静脉滴注强化保肝治疗。\nH. 评估腹部无转移征象，继续根治性放疗，予以输注单采血小板预防出血，并动态复查血常规。\nI. 评估腹部无转移征象，暂停放疗，行全身PET/CT检查以全面评估近期疗效。\nJ. 评估腹部无转移征象，继续根治性放疗，予以昂丹司琼强化止吐，并预防性放置胃管。\nK. 评估腹部无转移征象，继续根治性放疗，加用尼妥珠单抗靶向治疗以提高局部控制率。\nL. 评估腹部无转移征象，继续根治性放疗，予以地塞米松口服改善骨髓抑制，并动态复查血常规。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"episode_id":"episode-66c27d32c6506e0f45f13aaa","patient_id":"patient-e7eec542502a097814d58d8a","care_turn_count":6,"turns":[{"sample_id":"sample-38fe8a3260ea673c5c5ddb90","patient_id":"patient-e7eec542502a097814d58d8a","turn_id":"turn01","turn_position":1,"turn_type":"initial_workup_choice","gold_letter":"H","gold_action":"完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部及腹部彩超，全身骨显像，常规血液学与心电图检查。","options":[{"letter":"A","text":"完善鼻咽镜检查及活检，行头颈部CT平扫+增强，颈部及腹部彩超，常规血液学与心电图检查。","is_gold":false},{"letter":"B","text":"行右颈部肿物切除活检，待病理确诊后再行头颈部MRI平扫+增强，颈部及腹部彩超，全身骨显像。","is_gold":false},{"letter":"C","text":"完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，全身PET-CT显像，常规血液学与心电图检查。","is_gold":false},{"letter":"D","text":"完善鼻咽镜检查及活检，行头颈部MRI平扫，颈部及腹部彩超，全身骨显像，常规血液学与心电图检查。","is_gold":false},{"letter":"E","text":"行右颈部肿物细针穿刺活检，待病理确诊后再行鼻咽镜检查，头颈部MRI平扫+增强，全身骨显像。","is_gold":false},{"letter":"F","text":"完善鼻咽镜检查及活检，行头颈部CT平扫，颈部及腹部彩超，全身骨显像，常规血液学与心电图检查。","is_gold":false},{"letter":"G","text":"完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部彩超，常规血液学与心电图检查，暂缓全身骨显像。","is_gold":false},{"letter":"H","text":"完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部及腹部彩超，全身骨显像，常规血液学与心电图检查。","is_gold":true},{"letter":"I","text":"完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部彩超，全身骨显像，常规血液学与心电图检查。","is_gold":false},{"letter":"J","text":"完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部及腹部彩超，头颅MRI平扫+增强，常规血液学检查。","is_gold":false},{"letter":"K","text":"完善鼻咽镜检查及活检，行头颈部CT平扫+增强，颈部及腹部彩超，全身骨显像，常规血液学与心电图检查。","is_gold":false},{"letter":"L","text":"完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部及腹部彩超，全身骨显像，骨髓穿刺活检。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 双侧耳鸣2年，发现右颈肿物3天；现病史: 患者2年前无明显诱因间断出现双侧耳鸣，近2周自觉右侧耳鸣症状加重，无鼻塞、涕血等不适。今为进一步诊治收入我院。起病以来，患者无发热、咳嗽，无胸闷、胸痛，无恶心、呕吐，胃纳、睡眠、精神可，大小便正常，体重无明显变化。；阳性症状体征: 双耳鸣,右颈部肿物,右耳鸣；既往史: 10+年前因“腰椎间盘突出”行手术治疗，并予输血，无“输血反应”。否认\"肝炎\"、\"结核\"、\"高血压\"、\"糖尿病\"等疾病史；无外伤病史。过敏史:否认药物、食物过敏史。；个人史: 原籍出生、长大，无疫水、疫区暴露史；无吸烟、酗酒等不良嗜好。；家族史: 否认家族其他成员有肿瘤病史及遗传病史。；体格检查: T：36.0℃ P：81bpm R：18bpm BP：111/76mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。牙龈无肿胀、出血，咽无充血，双扁桃体无肿大。颈部检查详见肿瘤专科 检查。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率81bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善鼻咽镜检查及活检，行头颈部CT平扫+增强，颈部及腹部彩超，常规血液学与心电图检查。\nB. 行右颈部肿物切除活检，待病理确诊后再行头颈部MRI平扫+增强，颈部及腹部彩超，全身骨显像。\nC. 完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，全身PET-CT显像，常规血液学与心电图检查。\nD. 完善鼻咽镜检查及活检，行头颈部MRI平扫，颈部及腹部彩超，全身骨显像，常规血液学与心电图检查。\nE. 行右颈部肿物细针穿刺活检，待病理确诊后再行鼻咽镜检查，头颈部MRI平扫+增强，全身骨显像。\nF. 完善鼻咽镜检查及活检，行头颈部CT平扫，颈部及腹部彩超，全身骨显像，常规血液学与心电图检查。\nG. 完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部彩超，常规血液学与心电图检查，暂缓全身骨显像。\nH. 完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部及腹部彩超，全身骨显像，常规血液学与心电图检查。\nI. 完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部彩超，全身骨显像，常规血液学与心电图检查。\nJ. 完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部及腹部彩超，头颅MRI平扫+增强，常规血液学检查。\nK. 完善鼻咽镜检查及活检，行头颈部CT平扫+增强，颈部及腹部彩超，全身骨显像，常规血液学与心电图检查。\nL. 完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部及腹部彩超，全身骨显像，骨髓穿刺活检。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"你正在参与一名鼻咽癌相关患者的 full-care 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当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善鼻咽镜检查及活检，行头颈部CT平扫+增强，颈部及腹部彩超，常规血液学与心电图检查。\nB. 行右颈部肿物切除活检，待病理确诊后再行头颈部MRI平扫+增强，颈部及腹部彩超，全身骨显像。\nC. 完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，全身PET-CT显像，常规血液学与心电图检查。\nD. 完善鼻咽镜检查及活检，行头颈部MRI平扫，颈部及腹部彩超，全身骨显像，常规血液学与心电图检查。\nE. 行右颈部肿物细针穿刺活检，待病理确诊后再行鼻咽镜检查，头颈部MRI平扫+增强，全身骨显像。\nF. 完善鼻咽镜检查及活检，行头颈部CT平扫，颈部及腹部彩超，全身骨显像，常规血液学与心电图检查。\nG. 完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部彩超，常规血液学与心电图检查，暂缓全身骨显像。\nH. 完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部及腹部彩超，全身骨显像，常规血液学与心电图检查。\nI. 完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部彩超，全身骨显像，常规血液学与心电图检查。\nJ. 完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部及腹部彩超，头颅MRI平扫+增强，常规血液学检查。\nK. 完善鼻咽镜检查及活检，行头颈部CT平扫+增强，颈部及腹部彩超，全身骨显像，常规血液学与心电图检查。\nL. 完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部及腹部彩超，全身骨显像，骨髓穿刺活检。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 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当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善鼻咽镜检查及活检，行头颈部CT平扫+增强，颈部及腹部彩超，常规血液学与心电图检查。\nB. 行右颈部肿物切除活检，待病理确诊后再行头颈部MRI平扫+增强，颈部及腹部彩超，全身骨显像。\nC. 完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，全身PET-CT显像，常规血液学与心电图检查。\nD. 完善鼻咽镜检查及活检，行头颈部MRI平扫，颈部及腹部彩超，全身骨显像，常规血液学与心电图检查。\nE. 行右颈部肿物细针穿刺活检，待病理确诊后再行鼻咽镜检查，头颈部MRI平扫+增强，全身骨显像。\nF. 完善鼻咽镜检查及活检，行头颈部CT平扫，颈部及腹部彩超，全身骨显像，常规血液学与心电图检查。\nG. 完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部彩超，常规血液学与心电图检查，暂缓全身骨显像。\nH. 完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部及腹部彩超，全身骨显像，常规血液学与心电图检查。\nI. 完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部彩超，全身骨显像，常规血液学与心电图检查。\nJ. 完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部及腹部彩超，头颅MRI平扫+增强，常规血液学检查。\nK. 完善鼻咽镜检查及活检，行头颈部CT平扫+增强，颈部及腹部彩超，全身骨显像，常规血液学与心电图检查。\nL. 完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部及腹部彩超，全身骨显像，骨髓穿刺活检。\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-06aacdbb23f806198bd0b70c","patient_id":"patient-e7eec542502a097814d58d8a","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"I","gold_action":"行鼻咽镜检查并取鼻咽部肿物活检。","options":[{"letter":"A","text":"行右侧颈部淋巴结切除活检术","is_gold":false},{"letter":"B","text":"行右侧颈部淋巴结细针穿刺抽吸活检","is_gold":false},{"letter":"C","text":"安排诱导化疗联合同期放化疗","is_gold":false},{"letter":"D","text":"行全身PET-CT检查","is_gold":false},{"letter":"E","text":"行全身骨显像检查","is_gold":false},{"letter":"F","text":"行鼻内镜下鼻咽部肿物切除术","is_gold":false},{"letter":"G","text":"行鼻咽部高分辨率CT检查","is_gold":false},{"letter":"H","text":"行右侧颈部淋巴结微创旋切活检术","is_gold":false},{"letter":"I","text":"行鼻咽镜检查并取鼻咽部肿物活检","is_gold":true},{"letter":"J","text":"行胸部增强CT及腹部增强CT检查","is_gold":false},{"letter":"K","text":"抽取外周血行血浆EBV-DNA定量检测","is_gold":false},{"letter":"L","text":"密切观察随访，1个月后复查鼻咽部MRI","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 双侧耳鸣2年，发现右颈肿物3天；现病史: 患者2年前无明显诱因间断出现双侧耳鸣，近2周自觉右侧耳鸣症状加重，无鼻塞、涕血等不适。今为进一步诊治收入我院。起病以来，患者无发热、咳嗽，无胸闷、胸痛，无恶心、呕吐，胃纳、睡眠、精神可，大小便正常，体重无明显变化。；阳性症状体征: 双耳鸣,右颈部肿物,右耳鸣；既往史: 10+年前因“腰椎间盘突出”行手术治疗，并予输血，无“输血反应”。否认\"肝炎\"、\"结核\"、\"高血压\"、\"糖尿病\"等疾病史；无外伤病史。过敏史:否认药物、食物过敏史。；个人史: 原籍出生、长大，无疫水、疫区暴露史；无吸烟、酗酒等不良嗜好。；家族史: 否认家族其他成员有肿瘤病史及遗传病史。；体格检查: T：36.0℃ P：81bpm R：18bpm BP：111/76mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。牙龈无肿胀、出血，咽无充血，双扁桃体无肿大。颈部检查详见肿瘤专科 检查。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率81bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显斑片或结节影。双侧肺门影未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见明显病变。\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 间接胆红素(IBIL)-静脉血: 9.6umolL；尿胆原(URO)-尿液: -（参考: 阴性）；钾离子(K+)-静脉血: 4mmol/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；总胆固醇(TC)-静脉血: 6.89mmol/L；肿瘤特异性生长因子(TSGF)-静脉血: 32U/mL；红细胞计数(RBC#)-静脉血: 4.9610E12/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.5U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.3pg；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 13.4umol/L；总蛋白(TP)-尿液: -（参考: 阴性）；血小板计数(PLT#)-静脉血: 319.310E9/L；比重(SG)-尿液: LAMPL.；凝血酶原时间活动度(PTA)-静脉血: 113.8%；直接胆红素(DBIL)-静脉血: 3.8umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-静脉血: 10.310E9/L；平均血小板体积(MPV)-静脉血: 7.46fL；镁离子(Mg2+)-静脉血: 0.98mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.310E9/L；鳞状细胞癌相关抗原(SCC)-静脉血: 0.4ng/ml；低密度脂蛋白胆固醇(LDL-C)-静脉血: 5.13mmol/L；血小板比容-静脉血: 23.8%；Rh血型-静脉血: 阳性；总前列腺特异性抗原(TPSA)-静脉血: 1ng/ml；神经元特异性烯醇化酶(NSE)-静脉血: 12.85ng/ml；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；游……\n- [全程D2] 检验组合: CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 0.8%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 3%；CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 24.9%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 9.8%；CD3+T淋巴细胞百分比-静脉血: 60.3%；CD4+/CD8+辅助/抑制T淋巴细胞比值(Th/Ts比值)-静脉血: 1.7；CD3-CD16+CD56+自然杀伤细胞百分比(NK%)-静脉血: 15.5%；CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 3.1%；CD3+CD4+辅助/诱导T淋巴细胞百分比(Th/Ti%)-静脉血: 29%；CD19+B淋巴细胞百分比-静脉血: 23%；CD3+CD8+抑制/细胞毒T淋巴细胞百分比(Ts/Tc%)-静脉血: 18.4%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 27.7%\n- [全程D7] 超声；双侧颈部、锁骨上区淋巴结彩超(套): 检查类型: 超声；检查名称: 双侧颈部、锁骨上区淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉内径约14mm，门静脉最大血流速度约17cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约44×36×33mm，包膜光滑，实质回声不均匀，可见强回声斑。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 前列腺钙化。 胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D7] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 右侧颈部II区可见数个淋巴结回声，最大约23×12mm，椭圆形，边界清，皮髓质分界不清，未见淋巴门。余右侧颈部未见明确异常淋巴结。 CDFI：上述最大淋巴结内可见周边型血流信号。 左侧颈部及锁骨上区未见明确异常淋巴结回声。；检查结论: 右侧颈部II区淋巴结，恶性待排，建议穿刺活检。 左侧颈部及锁骨上区未见明确异常淋巴结声像。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行右侧颈部淋巴结切除活检术\nB. 行右侧颈部淋巴结细针穿刺抽吸活检\nC. 安排诱导化疗联合同期放化疗\nD. 行全身PET-CT检查\nE. 行全身骨显像检查\nF. 行鼻内镜下鼻咽部肿物切除术\nG. 行鼻咽部高分辨率CT检查\nH. 行右侧颈部淋巴结微创旋切活检术\nI. 行鼻咽镜检查并取鼻咽部肿物活检\nJ. 行胸部增强CT及腹部增强CT检查\nK. 抽取外周血行血浆EBV-DNA定量检测\nL. 密切观察随访，1个月后复查鼻咽部MRI\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显斑片或结节影。双侧肺门影未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见明显病变。\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 间接胆红素(IBIL)-静脉血: 9.6umolL；尿胆原(URO)-尿液: -（参考: 阴性）；钾离子(K+)-静脉血: 4mmol/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；总胆固醇(TC)-静脉血: 6.89mmol/L；肿瘤特异性生长因子(TSGF)-静脉血: 32U/mL；红细胞计数(RBC#)-静脉血: 4.9610E12/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.5U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.3pg；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 13.4umol/L；总蛋白(TP)-尿液: -（参考: 阴性）；血小板计数(PLT#)-静脉血: 319.310E9/L；比重(SG)-尿液: LAMPL.；凝血酶原时间活动度(PTA)-静脉血: 113.8%；直接胆红素(DBIL)-静脉血: 3.8umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-静脉血: 10.310E9/L；平均血小板体积(MPV)-静脉血: 7.46fL；镁离子(Mg2+)-静脉血: 0.98mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.310E9/L；鳞状细胞癌相关抗原(SCC)-静脉血: 0.4ng/ml；低密度脂蛋白胆固醇(LDL-C)-静脉血: 5.13mmol/L；血小板比容-静脉血: 23.8%；Rh血型-静脉血: 阳性；总前列腺特异性抗原(TPSA)-静脉血: 1ng/ml；神经元特异性烯醇化酶(NSE)-静脉血: 12.85ng/ml；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；游……\n- [全程D2] 检验组合: CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 0.8%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 3%；CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 24.9%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 9.8%；CD3+T淋巴细胞百分比-静脉血: 60.3%；CD4+/CD8+辅助/抑制T淋巴细胞比值(Th/Ts比值)-静脉血: 1.7；CD3-CD16+CD56+自然杀伤细胞百分比(NK%)-静脉血: 15.5%；CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 3.1%；CD3+CD4+辅助/诱导T淋巴细胞百分比(Th/Ti%)-静脉血: 29%；CD19+B淋巴细胞百分比-静脉血: 23%；CD3+CD8+抑制/细胞毒T淋巴细胞百分比(Ts/Tc%)-静脉血: 18.4%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 27.7%\n- [全程D7] 超声；双侧颈部、锁骨上区淋巴结彩超(套): 检查类型: 超声；检查名称: 双侧颈部、锁骨上区淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉内径约14mm，门静脉最大血流速度约17cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约44×36×33mm，包膜光滑，实质回声不均匀，可见强回声斑。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 前列腺钙化。 胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D7] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 右侧颈部II区可见数个淋巴结回声，最大约23×12mm，椭圆形，边界清，皮髓质分界不清，未见淋巴门。余右侧颈部未见明确异常淋巴结。 CDFI：上述最大淋巴结内可见周边型血流信号。 左侧颈部及锁骨上区未见明确异常淋巴结回声。；检查结论: 右侧颈部II区淋巴结，恶性待排，建议穿刺活检。 左侧颈部及锁骨上区未见明确异常淋巴结声像。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行右侧颈部淋巴结切除活检术\nB. 行右侧颈部淋巴结细针穿刺抽吸活检\nC. 安排诱导化疗联合同期放化疗\nD. 行全身PET-CT检查\nE. 行全身骨显像检查\nF. 行鼻内镜下鼻咽部肿物切除术\nG. 行鼻咽部高分辨率CT检查\nH. 行右侧颈部淋巴结微创旋切活检术\nI. 行鼻咽镜检查并取鼻咽部肿物活检\nJ. 行胸部增强CT及腹部增强CT检查\nK. 抽取外周血行血浆EBV-DNA定量检测\nL. 密切观察随访，1个月后复查鼻咽部MRI\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显斑片或结节影。双侧肺门影未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见明显病变。\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 间接胆红素(IBIL)-静脉血: 9.6umolL；尿胆原(URO)-尿液: -（参考: 阴性）；钾离子(K+)-静脉血: 4mmol/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；总胆固醇(TC)-静脉血: 6.89mmol/L；肿瘤特异性生长因子(TSGF)-静脉血: 32U/mL；红细胞计数(RBC#)-静脉血: 4.9610E12/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.5U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.3pg；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 13.4umol/L；总蛋白(TP)-尿液: -（参考: 阴性）；血小板计数(PLT#)-静脉血: 319.310E9/L；比重(SG)-尿液: LAMPL.；凝血酶原时间活动度(PTA)-静脉血: 113.8%；直接胆红素(DBIL)-静脉血: 3.8umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-静脉血: 10.310E9/L；平均血小板体积(MPV)-静脉血: 7.46fL；镁离子(Mg2+)-静脉血: 0.98mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.310E9/L；鳞状细胞癌相关抗原(SCC)-静脉血: 0.4ng/ml；低密度脂蛋白胆固醇(LDL-C)-静脉血: 5.13mmol/L；血小板比容-静脉血: 23.8%；Rh血型-静脉血: 阳性；总前列腺特异性抗原(TPSA)-静脉血: 1ng/ml；神经元特异性烯醇化酶(NSE)-静脉血: 12.85ng/ml；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；游……\n- [全程D2] 检验组合: CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 0.8%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 3%；CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 24.9%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 9.8%；CD3+T淋巴细胞百分比-静脉血: 60.3%；CD4+/CD8+辅助/抑制T淋巴细胞比值(Th/Ts比值)-静脉血: 1.7；CD3-CD16+CD56+自然杀伤细胞百分比(NK%)-静脉血: 15.5%；CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 3.1%；CD3+CD4+辅助/诱导T淋巴细胞百分比(Th/Ti%)-静脉血: 29%；CD19+B淋巴细胞百分比-静脉血: 23%；CD3+CD8+抑制/细胞毒T淋巴细胞百分比(Ts/Tc%)-静脉血: 18.4%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 27.7%\n- [全程D7] 超声；双侧颈部、锁骨上区淋巴结彩超(套): 检查类型: 超声；检查名称: 双侧颈部、锁骨上区淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉内径约14mm，门静脉最大血流速度约17cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约44×36×33mm，包膜光滑，实质回声不均匀，可见强回声斑。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 前列腺钙化。 胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D7] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 右侧颈部II区可见数个淋巴结回声，最大约23×12mm，椭圆形，边界清，皮髓质分界不清，未见淋巴门。余右侧颈部未见明确异常淋巴结。 CDFI：上述最大淋巴结内可见周边型血流信号。 左侧颈部及锁骨上区未见明确异常淋巴结回声。；检查结论: 右侧颈部II区淋巴结，恶性待排，建议穿刺活检。 左侧颈部及锁骨上区未见明确异常淋巴结声像。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行右侧颈部淋巴结切除活检术\nB. 行右侧颈部淋巴结细针穿刺抽吸活检\nC. 安排诱导化疗联合同期放化疗\nD. 行全身PET-CT检查\nE. 行全身骨显像检查\nF. 行鼻内镜下鼻咽部肿物切除术\nG. 行鼻咽部高分辨率CT检查\nH. 行右侧颈部淋巴结微创旋切活检术\nI. 行鼻咽镜检查并取鼻咽部肿物活检\nJ. 行胸部增强CT及腹部增强CT检查\nK. 抽取外周血行血浆EBV-DNA定量检测\nL. 密切观察随访，1个月后复查鼻咽部MRI\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-9713cef7ba61651ea6a5f02e","patient_id":"patient-e7eec542502a097814d58d8a","turn_id":"turn05","turn_position":3,"turn_type":"toxicity_or_support_decision","gold_letter":"L","gold_action":"予以静脉水化及电解质（含钾）补充，嘱计24小时尿量，并常规行PICC导管护理。","options":[{"letter":"A","text":"暂不予静脉水化及电解质补充，待明日行顺铂化疗时同步予以补液支持。","is_gold":false},{"letter":"B","text":"予以静脉水化，暂不补充钾离子，嘱计24小时尿量，并常规行PICC导管护理。","is_gold":false},{"letter":"C","text":"予以静脉水化及电解质补充，常规静脉推注呋塞米强效利尿，并计24小时尿量。","is_gold":false},{"letter":"D","text":"予以静脉水化及电解质补充，皮下注射重组人粒细胞集落刺激因子预防骨髓抑制。","is_gold":false},{"letter":"E","text":"予以静脉水化及电解质补充，静脉滴注右丙亚胺预防大剂量顺铂相关心脏毒性。","is_gold":false},{"letter":"F","text":"予以静脉水化及电解质补充，静脉滴注阿米福汀预防大剂量顺铂相关肾毒性。","is_gold":false},{"letter":"G","text":"予以静脉水化及电解质补充，嘱计24小时尿量，并静脉滴注头孢菌素预防感染。","is_gold":false},{"letter":"H","text":"予以静脉水化及电解质补充，静脉滴注地塞米松及帕洛诺司琼进行止吐预处理。","is_gold":false},{"letter":"I","text":"予以静脉水化及电解质补充，静脉输注人血白蛋白以预防大剂量化疗后低蛋白血症。","is_gold":false},{"letter":"J","text":"予以静脉水化及电解质补充，静脉滴注异甘草酸镁预防大剂量顺铂相关肝损伤。","is_gold":false},{"letter":"K","text":"予以静脉水化及电解质补充，嘱计24小时尿量，并皮下注射促红细胞生成素。","is_gold":false},{"letter":"L","text":"予以静脉水化及电解质（含钾）补充，嘱计24小时尿量，并常规行PICC导管护理。","is_gold":true}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 双侧耳鸣2年，发现右颈肿物3天；现病史: 患者2年前无明显诱因间断出现双侧耳鸣，近2周自觉右侧耳鸣症状加重，无鼻塞、涕血等不适。今为进一步诊治收入我院。起病以来，患者无发热、咳嗽，无胸闷、胸痛，无恶心、呕吐，胃纳、睡眠、精神可，大小便正常，体重无明显变化。；阳性症状体征: 双耳鸣,右颈部肿物,右耳鸣；既往史: 10+年前因“腰椎间盘突出”行手术治疗，并予输血，无“输血反应”。否认\"肝炎\"、\"结核\"、\"高血压\"、\"糖尿病\"等疾病史；无外伤病史。过敏史:否认药物、食物过敏史。；个人史: 原籍出生、长大，无疫水、疫区暴露史；无吸烟、酗酒等不良嗜好。；家族史: 否认家族其他成员有肿瘤病史及遗传病史。；体格检查: T：36.0℃ P：81bpm R：18bpm BP：111/76mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。牙龈无肿胀、出血，咽无充血，双扁桃体无肿大。颈部检查详见肿瘤专科 检查。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率81bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 双侧耳鸣2年，发现右颈肿物3天；现病史: 患者2年前无明显诱因间断出现双侧耳鸣，近2周自觉右侧耳鸣症状加重，无鼻塞、涕血等不适。3天前无明显诱因发现右颈部肿物，遂就诊外院行CT检查示：鼻咽右侧壁增厚，考虑鼻咽癌可能，伴右侧乳突阻塞性炎症。今为进一步诊治收入我院。起病以来，患者无发热、咳嗽，无胸闷、胸痛，无恶心、呕吐，胃纳、睡眠、精神可，大小便正常，体重无明显变化。；阳性症状体征: 双耳鸣,右颈部肿物,右耳鸣；既往史: 10+年前因“腰椎间盘突出”行手术治疗，并予输血，无“输血反应”。否认\"肝炎\"、\"结核\"、\"高血压\"、\"糖尿病\"等疾病史；无外伤病史。过敏史:否认药物、食物过敏史。；个人史: 原籍出生、长大，无疫水、疫区暴露史；无吸烟、酗酒等不良嗜好。；家族史: 否认家族其他成员有肿瘤病史及遗传病史。；体格检查: T：36.0℃ P：81bpm R：18bpm BP：111/76mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。牙龈无肿胀、出血，咽无充血，双扁桃体无肿大。颈部检查详见肿瘤专科 检查。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率81bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。肛门外生殖器未见异常，生理反射存在，病理反射未引出。；专科检查: 间接鼻咽镜检查见双侧鼻腔通畅，内未窥及明显肿物；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显斑片或结节影。双侧肺门影未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见明显病变。\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 间接胆红素(IBIL)-静脉血: 9.6umolL；尿胆原(URO)-尿液: -（参考: 阴性）；钾离子(K+)-静脉血: 4mmol/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；总胆固醇(TC)-静脉血: 6.89mmol/L；肿瘤特异性生长因子(TSGF)-静脉血: 32U/mL；红细胞计数(RBC#)-静脉血: 4.9610E12/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.5U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.3pg；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 13.4umol/L；总蛋白(TP)-尿液: -（参考: 阴性）；血小板计数(PLT#)-静脉血: 319.310E9/L；比重(SG)-尿液: LAMPL.；凝血酶原时间活动度(PTA)-静脉血: 113.8%；直接胆红素(DBIL)-静脉血: 3.8umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-静脉血: 10.310E9/L；平均血小板体积(MPV)-静脉血: 7.46fL；镁离子(Mg2+)-静脉血: 0.98mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.310E9/L；鳞状细胞癌相关抗原(SCC)-静脉血: 0.4ng/ml；低密度脂蛋白胆固醇(LDL-C)-静脉血: 5.13mmol/L；血小板比容-静脉血: 23.8%；Rh血型-静脉血: 阳性；总前列腺特异性抗原(TPSA)-静脉血: 1ng/ml；神经元特异性烯醇化酶(NSE)-静脉血: 12.85ng/ml；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；游……\n- [全程D2] 检验组合: CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 0.8%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 3%；CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 24.9%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 9.8%；CD3+T淋巴细胞百分比-静脉血: 60.3%；CD4+/CD8+辅助/抑制T淋巴细胞比值(Th/Ts比值)-静脉血: 1.7；CD3-CD16+CD56+自然杀伤细胞百分比(NK%)-静脉血: 15.5%；CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 3.1%；CD3+CD4+辅助/诱导T淋巴细胞百分比(Th/Ti%)-静脉血: 29%；CD19+B淋巴细胞百分比-静脉血: 23%；CD3+CD8+抑制/细胞毒T淋巴细胞百分比(Ts/Tc%)-静脉血: 18.4%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 27.7%\n- [全程D7] 超声；双侧颈部、锁骨上区淋巴结彩超(套): 检查类型: 超声；检查名称: 双侧颈部、锁骨上区淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉内径约14mm，门静脉最大血流速度约17cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约44×36×33mm，包膜光滑，实质回声不均匀，可见强回声斑。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 前列腺钙化。 胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D7] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 右侧颈部II区可见数个淋巴结回声，最大约23×12mm，椭圆形，边界清，皮髓质分界不清，未见淋巴门。余右侧颈部未见明确异常淋巴结。 CDFI：上述最大淋巴结内可见周边型血流信号。 左侧颈部及锁骨上区未见明确异常淋巴结回声。；检查结论: 右侧颈部II区淋巴结，恶性待排，建议穿刺活检。 左侧颈部及锁骨上区未见明确异常淋巴结声像。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D24] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽右顶壁及右侧壁粘膜增厚放射性浓聚，SUV约16.7，病灶累及右翼突基底部及内侧板、右侧腭帆张提肌。右侧咽隐窝消失，左侧咽隐窝存在。双侧咽后未见肿大淋巴结及异常放射性分布。口咽、喉咽未见异常。筛窦、左上颌窦及右乳突内低密度影放射性稀疏；额窦、蝶窦、右上颌窦及左乳突结构及放射性分布未见明显异常。双侧海绵窦放射性分布未见明显异常。甲状腺结构及放射性分布未见明显异常。右颈II区数个淋巴结放射性浓聚，SUV约18.0，大者约1.5×2.2cm；余双颈小淋巴结放射性分布未见异常。 所见脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔主肺动脉窗小淋巴结放射性分布未见明显异常，大小约0.9×1.0cm。双肺门未见肿大淋巴结及异常放射性分布。双侧腋窝小淋巴结放射性未见明显异常。 肝脏密度减低，CT值约36Hu（脾脏CT值约56Hu），结构及放射性分布未见异常；肝门区未见占位及异常放射性分布。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。左肾上腺体部小结节影放射性略浓密，大小约1.0×1.1cm。脾脏、双肾、右肾上腺及胰腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺大小正常，内见数个点状钙化灶。膀胱及肠管形态、结构及放射性分布未见明显异常。双髂血管旁及双侧腹股沟未见肿大淋巴结及异常放射性分布。 颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，病灶累及右翼突基底部及内侧板、右侧腭帆张提肌；右颈II区数个淋巴结代谢活跃，考虑转移。 左肾上腺体部小结节代谢稍活跃，疑良性增生病变。 前列腺多发钙化灶。 脂肪肝。 副鼻窦炎症；右乳突炎症。\n- [全程D28] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T6上缘水平，估计导管末端位于上腔静脉上段内。；检查结论: PICC管末端位置如上述。\n- [全程D28] 检验组合: 红细胞计数(RBC#)-静脉血: 4.710E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7；钾离子(K+)-静脉血: 4.2mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 32.3U/L；尿素氮(BUN)-静脉血: 8.2mmol/L；间接胆红素(IBIL)-静脉血: 6.2umolL；氯离子(Cl-)-静脉血: 100.2mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 326g/L；红细胞比容(Hct)-静脉血: 43.5%；总胆固醇(TC)-静脉血: 5.88mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 22.9U/L；载脂蛋白AI(apoAI)-静脉血: 1.32g/L；血小板比容-静脉血: 32%；葡萄糖(Glu)-静脉血: 5.95mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.8mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.2pg；乳酸脱氢酶(LDH)-静脉血: 159.8U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.279；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.67；白细胞计数(WBC#)-静脉血: 10.7710E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 16.9U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.99mmol/L；中性粒细胞计数(Neut#)-静脉血: 6.410E9/L；平均红细胞体积(MCV)-静脉血: 92.6fL；平均血小板体积(MPV)-静脉血: 9.2fL；总胆红素(TBIL)-静脉血: 8.6umol/L；血小板分布宽度(PDW)-静脉血: 10%；磷(P)-静脉血: 1.6mmol/L；肌酐(Crea)-静脉血: 64.4umol/L；血小板计数(PLT#)-静脉血: 34410E9/L；C-反应蛋白(CRP)-静脉血: 3.29mg/L；碱性磷酸酶(ALP)-静脉血: 102.6U/L；白蛋白(ALB)-静脉血: 46.3g/L；淋巴细胞计数(Lymph#)-静脉血: 310E9/L；单核细胞计数(Mono#)-静脉血: 0.810E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 54U/L；大血小板百分比(P-LCR%)-静脉血: 18.4%；单核细胞百分比(Mono%)-静……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D9] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，无发热、涕血等不适症状。查体：生命体征平稳。电子喉镜检查示：鼻咽右隆突肿物，符合鼻咽癌。并取肿物活检，等待病理结果。[姓名已隐去]副教授示，结合患者病情及相关检查，诊断考虑鼻咽癌可能性大，明确诊断，予鼻咽科进一步诊治。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D15] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：KPS 90分；鼻咽右侧壁、顶后壁结节状肿物，右颈Ⅱ区可扪及已肿大淋巴结，大小约2*1cm，颅神经检查（-）。今日[姓名已隐去]医生信息已隐藏后示：患者已完善相关检查，并预约放疗，今日可结账出院，嘱出院后按时[计划性表述已隐藏]放化综合治疗，不适随诊。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂不予静脉水化及电解质补充，待明日行顺铂化疗时同步予以补液支持。\nB. 予以静脉水化，暂不补充钾离子，嘱计24小时尿量，并常规行PICC导管护理。\nC. 予以静脉水化及电解质补充，常规静脉推注呋塞米强效利尿，并计24小时尿量。\nD. 予以静脉水化及电解质补充，皮下注射重组人粒细胞集落刺激因子预防骨髓抑制。\nE. 予以静脉水化及电解质补充，静脉滴注右丙亚胺预防大剂量顺铂相关心脏毒性。\nF. 予以静脉水化及电解质补充，静脉滴注阿米福汀预防大剂量顺铂相关肾毒性。\nG. 予以静脉水化及电解质补充，嘱计24小时尿量，并静脉滴注头孢菌素预防感染。\nH. 予以静脉水化及电解质补充，静脉滴注地塞米松及帕洛诺司琼进行止吐预处理。\nI. 予以静脉水化及电解质补充，静脉输注人血白蛋白以预防大剂量化疗后低蛋白血症。\nJ. 予以静脉水化及电解质补充，静脉滴注异甘草酸镁预防大剂量顺铂相关肝损伤。\nK. 予以静脉水化及电解质补充，嘱计24小时尿量，并皮下注射促红细胞生成素。\nL. 予以静脉水化及电解质（含钾）补充，嘱计24小时尿量，并常规行PICC导管护理。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 双侧耳鸣2年，发现右颈肿物3天；现病史: 患者2年前无明显诱因间断出现双侧耳鸣，近2周自觉右侧耳鸣症状加重，无鼻塞、涕血等不适。3天前无明显诱因发现右颈部肿物，遂就诊外院行CT检查示：鼻咽右侧壁增厚，考虑鼻咽癌可能，伴右侧乳突阻塞性炎症。今为进一步诊治收入我院。起病以来，患者无发热、咳嗽，无胸闷、胸痛，无恶心、呕吐，胃纳、睡眠、精神可，大小便正常，体重无明显变化。；阳性症状体征: 双耳鸣,右颈部肿物,右耳鸣；既往史: 10+年前因“腰椎间盘突出”行手术治疗，并予输血，无“输血反应”。否认\"肝炎\"、\"结核\"、\"高血压\"、\"糖尿病\"等疾病史；无外伤病史。过敏史:否认药物、食物过敏史。；个人史: 原籍出生、长大，无疫水、疫区暴露史；无吸烟、酗酒等不良嗜好。；家族史: 否认家族其他成员有肿瘤病史及遗传病史。；体格检查: T：36.0℃ P：81bpm R：18bpm BP：111/76mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。牙龈无肿胀、出血，咽无充血，双扁桃体无肿大。颈部检查详见肿瘤专科 检查。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率81bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。肛门外生殖器未见异常，生理反射存在，病理反射未引出。；专科检查: 间接鼻咽镜检查见双侧鼻腔通畅，内未窥及明显肿物；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D24] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽右顶壁及右侧壁粘膜增厚放射性浓聚，SUV约16.7，病灶累及右翼突基底部及内侧板、右侧腭帆张提肌。右侧咽隐窝消失，左侧咽隐窝存在。双侧咽后未见肿大淋巴结及异常放射性分布。口咽、喉咽未见异常。筛窦、左上颌窦及右乳突内低密度影放射性稀疏；额窦、蝶窦、右上颌窦及左乳突结构及放射性分布未见明显异常。双侧海绵窦放射性分布未见明显异常。甲状腺结构及放射性分布未见明显异常。右颈II区数个淋巴结放射性浓聚，SUV约18.0，大者约1.5×2.2cm；余双颈小淋巴结放射性分布未见异常。 所见脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔主肺动脉窗小淋巴结放射性分布未见明显异常，大小约0.9×1.0cm。双肺门未见肿大淋巴结及异常放射性分布。双侧腋窝小淋巴结放射性未见明显异常。 肝脏密度减低，CT值约36Hu（脾脏CT值约56Hu），结构及放射性分布未见异常；肝门区未见占位及异常放射性分布。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。左肾上腺体部小结节影放射性略浓密，大小约1.0×1.1cm。脾脏、双肾、右肾上腺及胰腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺大小正常，内见数个点状钙化灶。膀胱及肠管形态、结构及放射性分布未见明显异常。双髂血管旁及双侧腹股沟未见肿大淋巴结及异常放射性分布。 颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，病灶累及右翼突基底部及内侧板、右侧腭帆张提肌；右颈II区数个淋巴结代谢活跃，考虑转移。 左肾上腺体部小结节代谢稍活跃，疑良性增生病变。 前列腺多发钙化灶。 脂肪肝。 副鼻窦炎症；右乳突炎症。\n- [全程D28] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T6上缘水平，估计导管末端位于上腔静脉上段内。；检查结论: PICC管末端位置如上述。\n- [全程D28] 检验组合: 红细胞计数(RBC#)-静脉血: 4.710E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7；钾离子(K+)-静脉血: 4.2mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 32.3U/L；尿素氮(BUN)-静脉血: 8.2mmol/L；间接胆红素(IBIL)-静脉血: 6.2umolL；氯离子(Cl-)-静脉血: 100.2mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 326g/L；红细胞比容(Hct)-静脉血: 43.5%；总胆固醇(TC)-静脉血: 5.88mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 22.9U/L；载脂蛋白AI(apoAI)-静脉血: 1.32g/L；血小板比容-静脉血: 32%；葡萄糖(Glu)-静脉血: 5.95mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.8mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.2pg；乳酸脱氢酶(LDH)-静脉血: 159.8U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.279；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.67；白细胞计数(WBC#)-静脉血: 10.7710E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 16.9U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.99mmol/L；中性粒细胞计数(Neut#)-静脉血: 6.410E9/L；平均红细胞体积(MCV)-静脉血: 92.6fL；平均血小板体积(MPV)-静脉血: 9.2fL；总胆红素(TBIL)-静脉血: 8.6umol/L；血小板分布宽度(PDW)-静脉血: 10%；磷(P)-静脉血: 1.6mmol/L；肌酐(Crea)-静脉血: 64.4umol/L；血小板计数(PLT#)-静脉血: 34410E9/L；C-反应蛋白(CRP)-静脉血: 3.29mg/L；碱性磷酸酶(ALP)-静脉血: 102.6U/L；白蛋白(ALB)-静脉血: 46.3g/L；淋巴细胞计数(Lymph#)-静脉血: 310E9/L；单核细胞计数(Mono#)-静脉血: 0.810E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 54U/L；大血小板百分比(P-LCR%)-静脉血: 18.4%；单核细胞百分比(Mono%)-静……\n\n【既往治疗与反应】\n- [全程D9] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，无发热、涕血等不适症状。查体：生命体征平稳。电子喉镜检查示：鼻咽右隆突肿物，符合鼻咽癌。并取肿物活检，等待病理结果。[姓名已隐去]副教授示，结合患者病情及相关检查，诊断考虑鼻咽癌可能性大，明确诊断，予鼻咽科进一步诊治。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D15] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：KPS 90分；鼻咽右侧壁、顶后壁结节状肿物，右颈Ⅱ区可扪及已肿大淋巴结，大小约2*1cm，颅神经检查（-）。今日[姓名已隐去]医生信息已隐藏后示：患者已完善相关检查，并预约放疗，今日可结账出院，嘱出院后按时[计划性表述已隐藏]放化综合治疗，不适随诊。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂不予静脉水化及电解质补充，待明日行顺铂化疗时同步予以补液支持。\nB. 予以静脉水化，暂不补充钾离子，嘱计24小时尿量，并常规行PICC导管护理。\nC. 予以静脉水化及电解质补充，常规静脉推注呋塞米强效利尿，并计24小时尿量。\nD. 予以静脉水化及电解质补充，皮下注射重组人粒细胞集落刺激因子预防骨髓抑制。\nE. 予以静脉水化及电解质补充，静脉滴注右丙亚胺预防大剂量顺铂相关心脏毒性。\nF. 予以静脉水化及电解质补充，静脉滴注阿米福汀预防大剂量顺铂相关肾毒性。\nG. 予以静脉水化及电解质补充，嘱计24小时尿量，并静脉滴注头孢菌素预防感染。\nH. 予以静脉水化及电解质补充，静脉滴注地塞米松及帕洛诺司琼进行止吐预处理。\nI. 予以静脉水化及电解质补充，静脉输注人血白蛋白以预防大剂量化疗后低蛋白血症。\nJ. 予以静脉水化及电解质补充，静脉滴注异甘草酸镁预防大剂量顺铂相关肝损伤。\nK. 予以静脉水化及电解质补充，嘱计24小时尿量，并皮下注射促红细胞生成素。\nL. 予以静脉水化及电解质（含钾）补充，嘱计24小时尿量，并常规行PICC导管护理。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 双侧耳鸣2年，发现右颈肿物3天；现病史: 患者2年前无明显诱因间断出现双侧耳鸣，近2周自觉右侧耳鸣症状加重，无鼻塞、涕血等不适。3天前无明显诱因发现右颈部肿物，遂就诊外院行CT检查示：鼻咽右侧壁增厚，考虑鼻咽癌可能，伴右侧乳突阻塞性炎症。今为进一步诊治收入我院。起病以来，患者无发热、咳嗽，无胸闷、胸痛，无恶心、呕吐，胃纳、睡眠、精神可，大小便正常，体重无明显变化。；阳性症状体征: 双耳鸣,右颈部肿物,右耳鸣；既往史: 10+年前因“腰椎间盘突出”行手术治疗，并予输血，无“输血反应”。否认\"肝炎\"、\"结核\"、\"高血压\"、\"糖尿病\"等疾病史；无外伤病史。过敏史:否认药物、食物过敏史。；个人史: 原籍出生、长大，无疫水、疫区暴露史；无吸烟、酗酒等不良嗜好。；家族史: 否认家族其他成员有肿瘤病史及遗传病史。；体格检查: T：36.0℃ P：81bpm R：18bpm BP：111/76mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。牙龈无肿胀、出血，咽无充血，双扁桃体无肿大。颈部检查详见肿瘤专科 检查。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率81bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。肛门外生殖器未见异常，生理反射存在，病理反射未引出。；专科检查: 间接鼻咽镜检查见双侧鼻腔通畅，内未窥及明显肿物；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D24] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽右顶壁及右侧壁粘膜增厚放射性浓聚，SUV约16.7，病灶累及右翼突基底部及内侧板、右侧腭帆张提肌。右侧咽隐窝消失，左侧咽隐窝存在。双侧咽后未见肿大淋巴结及异常放射性分布。口咽、喉咽未见异常。筛窦、左上颌窦及右乳突内低密度影放射性稀疏；额窦、蝶窦、右上颌窦及左乳突结构及放射性分布未见明显异常。双侧海绵窦放射性分布未见明显异常。甲状腺结构及放射性分布未见明显异常。右颈II区数个淋巴结放射性浓聚，SUV约18.0，大者约1.5×2.2cm；余双颈小淋巴结放射性分布未见异常。 所见脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔主肺动脉窗小淋巴结放射性分布未见明显异常，大小约0.9×1.0cm。双肺门未见肿大淋巴结及异常放射性分布。双侧腋窝小淋巴结放射性未见明显异常。 肝脏密度减低，CT值约36Hu（脾脏CT值约56Hu），结构及放射性分布未见异常；肝门区未见占位及异常放射性分布。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。左肾上腺体部小结节影放射性略浓密，大小约1.0×1.1cm。脾脏、双肾、右肾上腺及胰腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺大小正常，内见数个点状钙化灶。膀胱及肠管形态、结构及放射性分布未见明显异常。双髂血管旁及双侧腹股沟未见肿大淋巴结及异常放射性分布。 颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，病灶累及右翼突基底部及内侧板、右侧腭帆张提肌；右颈II区数个淋巴结代谢活跃，考虑转移。 左肾上腺体部小结节代谢稍活跃，疑良性增生病变。 前列腺多发钙化灶。 脂肪肝。 副鼻窦炎症；右乳突炎症。\n- [全程D28] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T6上缘水平，估计导管末端位于上腔静脉上段内。；检查结论: PICC管末端位置如上述。\n- [全程D28] 检验组合: 红细胞计数(RBC#)-静脉血: 4.710E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7；钾离子(K+)-静脉血: 4.2mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 32.3U/L；尿素氮(BUN)-静脉血: 8.2mmol/L；间接胆红素(IBIL)-静脉血: 6.2umolL；氯离子(Cl-)-静脉血: 100.2mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 326g/L；红细胞比容(Hct)-静脉血: 43.5%；总胆固醇(TC)-静脉血: 5.88mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 22.9U/L；载脂蛋白AI(apoAI)-静脉血: 1.32g/L；血小板比容-静脉血: 32%；葡萄糖(Glu)-静脉血: 5.95mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.8mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.2pg；乳酸脱氢酶(LDH)-静脉血: 159.8U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.279；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.67；白细胞计数(WBC#)-静脉血: 10.7710E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 16.9U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.99mmol/L；中性粒细胞计数(Neut#)-静脉血: 6.410E9/L；平均红细胞体积(MCV)-静脉血: 92.6fL；平均血小板体积(MPV)-静脉血: 9.2fL；总胆红素(TBIL)-静脉血: 8.6umol/L；血小板分布宽度(PDW)-静脉血: 10%；磷(P)-静脉血: 1.6mmol/L；肌酐(Crea)-静脉血: 64.4umol/L；血小板计数(PLT#)-静脉血: 34410E9/L；C-反应蛋白(CRP)-静脉血: 3.29mg/L；碱性磷酸酶(ALP)-静脉血: 102.6U/L；白蛋白(ALB)-静脉血: 46.3g/L；淋巴细胞计数(Lymph#)-静脉血: 310E9/L；单核细胞计数(Mono#)-静脉血: 0.810E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 54U/L；大血小板百分比(P-LCR%)-静脉血: 18.4%；单核细胞百分比(Mono%)-静……\n\n【既往治疗与反应】\n- [全程D9] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，无发热、涕血等不适症状。查体：生命体征平稳。电子喉镜检查示：鼻咽右隆突肿物，符合鼻咽癌。并取肿物活检，等待病理结果。[姓名已隐去]副教授示，结合患者病情及相关检查，诊断考虑鼻咽癌可能性大，明确诊断，予鼻咽科进一步诊治。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D15] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：KPS 90分；鼻咽右侧壁、顶后壁结节状肿物，右颈Ⅱ区可扪及已肿大淋巴结，大小约2*1cm，颅神经检查（-）。今日[姓名已隐去]医生信息已隐藏后示：患者已完善相关检查，并预约放疗，今日可结账出院，嘱出院后按时[计划性表述已隐藏]放化综合治疗，不适随诊。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂不予静脉水化及电解质补充，待明日行顺铂化疗时同步予以补液支持。\nB. 予以静脉水化，暂不补充钾离子，嘱计24小时尿量，并常规行PICC导管护理。\nC. 予以静脉水化及电解质补充，常规静脉推注呋塞米强效利尿，并计24小时尿量。\nD. 予以静脉水化及电解质补充，皮下注射重组人粒细胞集落刺激因子预防骨髓抑制。\nE. 予以静脉水化及电解质补充，静脉滴注右丙亚胺预防大剂量顺铂相关心脏毒性。\nF. 予以静脉水化及电解质补充，静脉滴注阿米福汀预防大剂量顺铂相关肾毒性。\nG. 予以静脉水化及电解质补充，嘱计24小时尿量，并静脉滴注头孢菌素预防感染。\nH. 予以静脉水化及电解质补充，静脉滴注地塞米松及帕洛诺司琼进行止吐预处理。\nI. 予以静脉水化及电解质补充，静脉输注人血白蛋白以预防大剂量化疗后低蛋白血症。\nJ. 予以静脉水化及电解质补充，静脉滴注异甘草酸镁预防大剂量顺铂相关肝损伤。\nK. 予以静脉水化及电解质补充，嘱计24小时尿量，并皮下注射促红细胞生成素。\nL. 予以静脉水化及电解质（含钾）补充，嘱计24小时尿量，并常规行PICC导管护理。\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-e0f912ad55b7b1f092a1b468","patient_id":"patient-e7eec542502a097814d58d8a","turn_id":"turn06","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"L","gold_action":"仅常规复查血常规、生化常规及EBV-DNA定量，暂不予特殊药物干预","options":[{"letter":"A","text":"在无明显感染或疼痛症状的情况下经验性给予阿莫西林口服抗感染及酚咖片止痛，并复查血常规、生化常规及EBV-DNA定量","is_gold":false},{"letter":"B","text":"在无明显感染或疼痛症状的情况下静脉滴注头孢类抗生素并酚咖片止痛，同时复查血常规、生化常规及EBV-DNA定量","is_gold":false},{"letter":"C","text":"经验性给予阿莫西林口服抗感染及酚咖片止痛，并暂停放疗直至症状完全缓解","is_gold":false},{"letter":"D","text":"经验性给予酚咖片对症止痛，暂不予抗感染治疗，并复查血常规、生化常规及EBV-DNA定量","is_gold":false},{"letter":"E","text":"经验性给予阿莫西林口服抗感染，暂不予止痛治疗，并复查血常规、生化常规及EBV-DNA定量","is_gold":false},{"letter":"F","text":"经验性给予阿莫西林口服抗感染及酚咖片止痛，并提前安排第二程顺铂化疗","is_gold":false},{"letter":"G","text":"经验性给予阿莫西林口服抗感染及酚咖片止痛，并加用静脉地塞米松减轻局部水肿","is_gold":false},{"letter":"H","text":"经验性给予静脉滴注广谱抗生素及曲马多止痛，并复查血常规、生化常规及EBV-DNA定量","is_gold":false},{"letter":"I","text":"经验性给予阿莫西林口服抗感染及酚咖片止痛，并取消后续顺铂化疗计划","is_gold":false},{"letter":"J","text":"经验性给予阿莫西林口服抗感染及酚咖片止痛，并复查鼻咽颈部MRI评估近期疗效","is_gold":false},{"letter":"K","text":"经验性给予口服抗真菌药物及酚咖片止痛，并复查血常规、生化常规及EBV-DNA定量","is_gold":false},{"letter":"L","text":"仅常规复查血常规、生化常规及EBV-DNA定量，暂不予特殊药物干预","is_gold":true}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 双侧耳鸣2年，发现右颈肿物3天；现病史: 患者2年前无明显诱因间断出现双侧耳鸣，近2周自觉右侧耳鸣症状加重，无鼻塞、涕血等不适。今为进一步诊治收入我院。起病以来，患者无发热、咳嗽，无胸闷、胸痛，无恶心、呕吐，胃纳、睡眠、精神可，大小便正常，体重无明显变化。；阳性症状体征: 双耳鸣,右颈部肿物,右耳鸣；既往史: 10+年前因“腰椎间盘突出”行手术治疗，并予输血，无“输血反应”。否认\"肝炎\"、\"结核\"、\"高血压\"、\"糖尿病\"等疾病史；无外伤病史。过敏史:否认药物、食物过敏史。；个人史: 原籍出生、长大，无疫水、疫区暴露史；无吸烟、酗酒等不良嗜好。；家族史: 否认家族其他成员有肿瘤病史及遗传病史。；体格检查: T：36.0℃ P：81bpm R：18bpm BP：111/76mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。牙龈无肿胀、出血，咽无充血，双扁桃体无肿大。颈部检查详见肿瘤专科 检查。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率81bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 双侧耳鸣2年，发现右颈肿物3天；现病史: 患者2年前无明显诱因间断出现双侧耳鸣，近2周自觉右侧耳鸣症状加重，无鼻塞、涕血等不适。3天前无明显诱因发现右颈部肿物，遂就诊外院行CT检查示：鼻咽右侧壁增厚，考虑鼻咽癌可能，伴右侧乳突阻塞性炎症。今为进一步诊治收入我院。起病以来，患者无发热、咳嗽，无胸闷、胸痛，无恶心、呕吐，胃纳、睡眠、精神可，大小便正常，体重无明显变化。；阳性症状体征: 双耳鸣,右颈部肿物,右耳鸣；既往史: 10+年前因“腰椎间盘突出”行手术治疗，并予输血，无“输血反应”。否认\"肝炎\"、\"结核\"、\"高血压\"、\"糖尿病\"等疾病史；无外伤病史。过敏史:否认药物、食物过敏史。；个人史: 原籍出生、长大，无疫水、疫区暴露史；无吸烟、酗酒等不良嗜好。；家族史: 否认家族其他成员有肿瘤病史及遗传病史。；体格检查: T：36.0℃ P：81bpm R：18bpm BP：111/76mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。牙龈无肿胀、出血，咽无充血，双扁桃体无肿大。颈部检查详见肿瘤专科 检查。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率81bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。肛门外生殖器未见异常，生理反射存在，病理反射未引出。；专科检查: 间接鼻咽镜检查见双侧鼻腔通畅，内未窥及明显肿物；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显斑片或结节影。双侧肺门影未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见明显病变。\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 间接胆红素(IBIL)-静脉血: 9.6umolL；尿胆原(URO)-尿液: -（参考: 阴性）；钾离子(K+)-静脉血: 4mmol/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；总胆固醇(TC)-静脉血: 6.89mmol/L；肿瘤特异性生长因子(TSGF)-静脉血: 32U/mL；红细胞计数(RBC#)-静脉血: 4.9610E12/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.5U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.3pg；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 13.4umol/L；总蛋白(TP)-尿液: -（参考: 阴性）；血小板计数(PLT#)-静脉血: 319.310E9/L；比重(SG)-尿液: LAMPL.；凝血酶原时间活动度(PTA)-静脉血: 113.8%；直接胆红素(DBIL)-静脉血: 3.8umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-静脉血: 10.310E9/L；平均血小板体积(MPV)-静脉血: 7.46fL；镁离子(Mg2+)-静脉血: 0.98mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.310E9/L；鳞状细胞癌相关抗原(SCC)-静脉血: 0.4ng/ml；低密度脂蛋白胆固醇(LDL-C)-静脉血: 5.13mmol/L；血小板比容-静脉血: 23.8%；Rh血型-静脉血: 阳性；总前列腺特异性抗原(TPSA)-静脉血: 1ng/ml；神经元特异性烯醇化酶(NSE)-静脉血: 12.85ng/ml；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；游……\n- [全程D2] 检验组合: CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 0.8%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 3%；CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 24.9%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 9.8%；CD3+T淋巴细胞百分比-静脉血: 60.3%；CD4+/CD8+辅助/抑制T淋巴细胞比值(Th/Ts比值)-静脉血: 1.7；CD3-CD16+CD56+自然杀伤细胞百分比(NK%)-静脉血: 15.5%；CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 3.1%；CD3+CD4+辅助/诱导T淋巴细胞百分比(Th/Ti%)-静脉血: 29%；CD19+B淋巴细胞百分比-静脉血: 23%；CD3+CD8+抑制/细胞毒T淋巴细胞百分比(Ts/Tc%)-静脉血: 18.4%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 27.7%\n- [全程D7] 超声；双侧颈部、锁骨上区淋巴结彩超(套): 检查类型: 超声；检查名称: 双侧颈部、锁骨上区淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉内径约14mm，门静脉最大血流速度约17cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约44×36×33mm，包膜光滑，实质回声不均匀，可见强回声斑。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 前列腺钙化。 胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D7] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 右侧颈部II区可见数个淋巴结回声，最大约23×12mm，椭圆形，边界清，皮髓质分界不清，未见淋巴门。余右侧颈部未见明确异常淋巴结。 CDFI：上述最大淋巴结内可见周边型血流信号。 左侧颈部及锁骨上区未见明确异常淋巴结回声。；检查结论: 右侧颈部II区淋巴结，恶性待排，建议穿刺活检。 左侧颈部及锁骨上区未见明确异常淋巴结声像。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D24] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽右顶壁及右侧壁粘膜增厚放射性浓聚，SUV约16.7，病灶累及右翼突基底部及内侧板、右侧腭帆张提肌。右侧咽隐窝消失，左侧咽隐窝存在。双侧咽后未见肿大淋巴结及异常放射性分布。口咽、喉咽未见异常。筛窦、左上颌窦及右乳突内低密度影放射性稀疏；额窦、蝶窦、右上颌窦及左乳突结构及放射性分布未见明显异常。双侧海绵窦放射性分布未见明显异常。甲状腺结构及放射性分布未见明显异常。右颈II区数个淋巴结放射性浓聚，SUV约18.0，大者约1.5×2.2cm；余双颈小淋巴结放射性分布未见异常。 所见脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔主肺动脉窗小淋巴结放射性分布未见明显异常，大小约0.9×1.0cm。双肺门未见肿大淋巴结及异常放射性分布。双侧腋窝小淋巴结放射性未见明显异常。 肝脏密度减低，CT值约36Hu（脾脏CT值约56Hu），结构及放射性分布未见异常；肝门区未见占位及异常放射性分布。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。左肾上腺体部小结节影放射性略浓密，大小约1.0×1.1cm。脾脏、双肾、右肾上腺及胰腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺大小正常，内见数个点状钙化灶。膀胱及肠管形态、结构及放射性分布未见明显异常。双髂血管旁及双侧腹股沟未见肿大淋巴结及异常放射性分布。 颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，病灶累及右翼突基底部及内侧板、右侧腭帆张提肌；右颈II区数个淋巴结代谢活跃，考虑转移。 左肾上腺体部小结节代谢稍活跃，疑良性增生病变。 前列腺多发钙化灶。 脂肪肝。 副鼻窦炎症；右乳突炎症。\n- [全程D28] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T6上缘水平，估计导管末端位于上腔静脉上段内。；检查结论: PICC管末端位置如上述。\n- [全程D28] 检验组合: 红细胞计数(RBC#)-静脉血: 4.710E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7；钾离子(K+)-静脉血: 4.2mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 32.3U/L；尿素氮(BUN)-静脉血: 8.2mmol/L；间接胆红素(IBIL)-静脉血: 6.2umolL；氯离子(Cl-)-静脉血: 100.2mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 326g/L；红细胞比容(Hct)-静脉血: 43.5%；总胆固醇(TC)-静脉血: 5.88mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 22.9U/L；载脂蛋白AI(apoAI)-静脉血: 1.32g/L；血小板比容-静脉血: 32%；葡萄糖(Glu)-静脉血: 5.95mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.8mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.2pg；乳酸脱氢酶(LDH)-静脉血: 159.8U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.279；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.67；白细胞计数(WBC#)-静脉血: 10.7710E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 16.9U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.99mmol/L；中性粒细胞计数(Neut#)-静脉血: 6.410E9/L；平均红细胞体积(MCV)-静脉血: 92.6fL；平均血小板体积(MPV)-静脉血: 9.2fL；总胆红素(TBIL)-静脉血: 8.6umol/L；血小板分布宽度(PDW)-静脉血: 10%；磷(P)-静脉血: 1.6mmol/L；肌酐(Crea)-静脉血: 64.4umol/L；血小板计数(PLT#)-静脉血: 34410E9/L；C-反应蛋白(CRP)-静脉血: 3.29mg/L；碱性磷酸酶(ALP)-静脉血: 102.6U/L；白蛋白(ALB)-静脉血: 46.3g/L；淋巴细胞计数(Lymph#)-静脉血: 310E9/L；单核细胞计数(Mono#)-静脉血: 0.810E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 54U/L；大血小板百分比(P-LCR%)-静脉血: 18.4%；单核细胞百分比(Mono%)-静……\n- [全程D29] 检验组合: 隐血(OB)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；淀粉样蛋白A(SAA)-静脉血: 3.65mg/L；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；白细胞计数(WBC#)-尿液: 7/μL；比重(SG)-尿液: 1.027；总蛋白(TP)-尿液: +- 0.2g（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；葡萄糖(Glu)-尿液: 3+ 17mmol（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 80/μL\n- [全程D30] 检验组合: 颜色-尿液: Yellow；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 13/μL；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 6；总蛋白(TP)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.023\n- [全程D35] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.7；单核细胞计数(Mono#)-静脉血: 0.810E9/L；甘油三酯(TG)-静脉血: 2.15mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；载脂蛋白AI(apoAI)-静脉血: 1.26g/L；中性粒细胞百分比(Neut%)-静脉血: 0.702；葡萄糖(Glu)-静脉血: 6.03mmol/L；尿素氮(BUN)-静脉血: 7.02mmol/L；直接胆红素(DBIL)-静脉血: 4.8umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20U/L；C-反应蛋白(CRP)-静脉血: 2.65mg/L；乳酸脱氢酶(LDH)-静脉血: 166.9U/L；红细胞计数(RBC#)-静脉血: 4.7510E12/L；总胆汁酸(TBA)-静脉血: 1.5umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；总蛋白(TP)-静脉血: 71.69g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；肌酐(Crea)-静脉血: 69.7umol/L；总钙(Ca)-静脉血: 2.31mmol/L；白细胞计数(WBC#)-静脉血: 7.4610E9/L；镁离子(Mg2+)-静脉血: 1mmol/L；平均红细胞体积(MCV)-静脉血: 88.8fL；总胆固醇(TC)-静脉血: 5.15mmol/L；磷(P)-静脉血: 1.3mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；总胆红素(TBIL)-静脉血: 15umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；阴离子间隙(AG)-静脉血: 17；间接胆红素(IBIL)-静脉血: 10.2umolL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.18mmolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4；球蛋白(GLO)-静脉血: 26.39g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.168；血小板分布宽度(PDW)-静脉血: 9.8%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.015；血红蛋白(Hb)-静脉血: 141g/L；淋巴细胞计数(L……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D9] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，无发热、涕血等不适症状。查体：生命体征平稳。电子喉镜检查示：鼻咽右隆突肿物，符合鼻咽癌。并取肿物活检，等待病理结果。[姓名已隐去]副教授示，结合患者病情及相关检查，诊断考虑鼻咽癌可能性大，明确诊断，予鼻咽科进一步诊治。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D15] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：KPS 90分；鼻咽右侧壁、顶后壁结节状肿物，右颈Ⅱ区可扪及已肿大淋巴结，大小约2*1cm，颅神经检查（-）。今日[姓名已隐去]医生信息已隐藏后示：患者已完善相关检查，并预约放疗，今日可结账出院，嘱出院后按时[计划性表述已隐藏]放化综合治疗，不适随诊。\n- [全程D29] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者放疗1次。患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：基本同前。今日[姓名已隐去]副医生信息已隐藏后示：患于今日行第一程DDP方案化疗（100mg/m2）。继续放疗，续观。\n- [全程D34] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：KPS 90分； 间接鼻咽镜检查见双侧鼻腔通畅，内未窥及明显肿物；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。复查血常规、生化常规未见明显异常。今日[姓名已隐去]医生信息已隐藏后示：患者已结束第一程同时期DDP方案化疗（100mg/m2），治疗过程顺利，今日可结账出院，嘱出院后继续在门诊放疗，每周复查血常规、肝肾功能，并按时[计划性表述已隐藏]下一程治疗，不适随诊。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 在无明显感染或疼痛症状的情况下经验性给予阿莫西林口服抗感染及酚咖片止痛，并复查血常规、生化常规及EBV-DNA定量\nB. 在无明显感染或疼痛症状的情况下静脉滴注头孢类抗生素并酚咖片止痛，同时复查血常规、生化常规及EBV-DNA定量\nC. 经验性给予阿莫西林口服抗感染及酚咖片止痛，并暂停放疗直至症状完全缓解\nD. 经验性给予酚咖片对症止痛，暂不予抗感染治疗，并复查血常规、生化常规及EBV-DNA定量\nE. 经验性给予阿莫西林口服抗感染，暂不予止痛治疗，并复查血常规、生化常规及EBV-DNA定量\nF. 经验性给予阿莫西林口服抗感染及酚咖片止痛，并提前安排第二程顺铂化疗\nG. 经验性给予阿莫西林口服抗感染及酚咖片止痛，并加用静脉地塞米松减轻局部水肿\nH. 经验性给予静脉滴注广谱抗生素及曲马多止痛，并复查血常规、生化常规及EBV-DNA定量\nI. 经验性给予阿莫西林口服抗感染及酚咖片止痛，并取消后续顺铂化疗计划\nJ. 经验性给予阿莫西林口服抗感染及酚咖片止痛，并复查鼻咽颈部MRI评估近期疗效\nK. 经验性给予口服抗真菌药物及酚咖片止痛，并复查血常规、生化常规及EBV-DNA定量\nL. 仅常规复查血常规、生化常规及EBV-DNA定量，暂不予特殊药物干预\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D29] 检验组合: 隐血(OB)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；淀粉样蛋白A(SAA)-静脉血: 3.65mg/L；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；白细胞计数(WBC#)-尿液: 7/μL；比重(SG)-尿液: 1.027；总蛋白(TP)-尿液: +- 0.2g（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；葡萄糖(Glu)-尿液: 3+ 17mmol（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 80/μL\n- [全程D30] 检验组合: 颜色-尿液: Yellow；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 13/μL；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 6；总蛋白(TP)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.023\n- [全程D35] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.7；单核细胞计数(Mono#)-静脉血: 0.810E9/L；甘油三酯(TG)-静脉血: 2.15mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；载脂蛋白AI(apoAI)-静脉血: 1.26g/L；中性粒细胞百分比(Neut%)-静脉血: 0.702；葡萄糖(Glu)-静脉血: 6.03mmol/L；尿素氮(BUN)-静脉血: 7.02mmol/L；直接胆红素(DBIL)-静脉血: 4.8umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20U/L；C-反应蛋白(CRP)-静脉血: 2.65mg/L；乳酸脱氢酶(LDH)-静脉血: 166.9U/L；红细胞计数(RBC#)-静脉血: 4.7510E12/L；总胆汁酸(TBA)-静脉血: 1.5umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；总蛋白(TP)-静脉血: 71.69g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；肌酐(Crea)-静脉血: 69.7umol/L；总钙(Ca)-静脉血: 2.31mmol/L；白细胞计数(WBC#)-静脉血: 7.4610E9/L；镁离子(Mg2+)-静脉血: 1mmol/L；平均红细胞体积(MCV)-静脉血: 88.8fL；总胆固醇(TC)-静脉血: 5.15mmol/L；磷(P)-静脉血: 1.3mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；总胆红素(TBIL)-静脉血: 15umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；阴离子间隙(AG)-静脉血: 17；间接胆红素(IBIL)-静脉血: 10.2umolL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.18mmolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4；球蛋白(GLO)-静脉血: 26.39g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.168；血小板分布宽度(PDW)-静脉血: 9.8%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.015；血红蛋白(Hb)-静脉血: 141g/L；淋巴细胞计数(L……\n\n【既往治疗与反应】\n- [全程D29] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者放疗1次。患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：基本同前。今日[姓名已隐去]副医生信息已隐藏后示：患于今日行第一程DDP方案化疗（100mg/m2）。继续放疗，续观。\n- [全程D34] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：KPS 90分； 间接鼻咽镜检查见双侧鼻腔通畅，内未窥及明显肿物；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。复查血常规、生化常规未见明显异常。今日[姓名已隐去]医生信息已隐藏后示：患者已结束第一程同时期DDP方案化疗（100mg/m2），治疗过程顺利，今日可结账出院，嘱出院后继续在门诊放疗，每周复查血常规、肝肾功能，并按时[计划性表述已隐藏]下一程治疗，不适随诊。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 在无明显感染或疼痛症状的情况下经验性给予阿莫西林口服抗感染及酚咖片止痛，并复查血常规、生化常规及EBV-DNA定量\nB. 在无明显感染或疼痛症状的情况下静脉滴注头孢类抗生素并酚咖片止痛，同时复查血常规、生化常规及EBV-DNA定量\nC. 经验性给予阿莫西林口服抗感染及酚咖片止痛，并暂停放疗直至症状完全缓解\nD. 经验性给予酚咖片对症止痛，暂不予抗感染治疗，并复查血常规、生化常规及EBV-DNA定量\nE. 经验性给予阿莫西林口服抗感染，暂不予止痛治疗，并复查血常规、生化常规及EBV-DNA定量\nF. 经验性给予阿莫西林口服抗感染及酚咖片止痛，并提前安排第二程顺铂化疗\nG. 经验性给予阿莫西林口服抗感染及酚咖片止痛，并加用静脉地塞米松减轻局部水肿\nH. 经验性给予静脉滴注广谱抗生素及曲马多止痛，并复查血常规、生化常规及EBV-DNA定量\nI. 经验性给予阿莫西林口服抗感染及酚咖片止痛，并取消后续顺铂化疗计划\nJ. 经验性给予阿莫西林口服抗感染及酚咖片止痛，并复查鼻咽颈部MRI评估近期疗效\nK. 经验性给予口服抗真菌药物及酚咖片止痛，并复查血常规、生化常规及EBV-DNA定量\nL. 仅常规复查血常规、生化常规及EBV-DNA定量，暂不予特殊药物干预\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D29] 检验组合: 隐血(OB)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；淀粉样蛋白A(SAA)-静脉血: 3.65mg/L；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；白细胞计数(WBC#)-尿液: 7/μL；比重(SG)-尿液: 1.027；总蛋白(TP)-尿液: +- 0.2g（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；葡萄糖(Glu)-尿液: 3+ 17mmol（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 80/μL\n- [全程D30] 检验组合: 颜色-尿液: Yellow；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 13/μL；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 6；总蛋白(TP)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.023\n- [全程D35] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.7；单核细胞计数(Mono#)-静脉血: 0.810E9/L；甘油三酯(TG)-静脉血: 2.15mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；载脂蛋白AI(apoAI)-静脉血: 1.26g/L；中性粒细胞百分比(Neut%)-静脉血: 0.702；葡萄糖(Glu)-静脉血: 6.03mmol/L；尿素氮(BUN)-静脉血: 7.02mmol/L；直接胆红素(DBIL)-静脉血: 4.8umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20U/L；C-反应蛋白(CRP)-静脉血: 2.65mg/L；乳酸脱氢酶(LDH)-静脉血: 166.9U/L；红细胞计数(RBC#)-静脉血: 4.7510E12/L；总胆汁酸(TBA)-静脉血: 1.5umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；总蛋白(TP)-静脉血: 71.69g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；肌酐(Crea)-静脉血: 69.7umol/L；总钙(Ca)-静脉血: 2.31mmol/L；白细胞计数(WBC#)-静脉血: 7.4610E9/L；镁离子(Mg2+)-静脉血: 1mmol/L；平均红细胞体积(MCV)-静脉血: 88.8fL；总胆固醇(TC)-静脉血: 5.15mmol/L；磷(P)-静脉血: 1.3mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；总胆红素(TBIL)-静脉血: 15umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；阴离子间隙(AG)-静脉血: 17；间接胆红素(IBIL)-静脉血: 10.2umolL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.18mmolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4；球蛋白(GLO)-静脉血: 26.39g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.168；血小板分布宽度(PDW)-静脉血: 9.8%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.015；血红蛋白(Hb)-静脉血: 141g/L；淋巴细胞计数(L……\n\n【既往治疗与反应】\n- [全程D29] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者放疗1次。患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：基本同前。今日[姓名已隐去]副医生信息已隐藏后示：患于今日行第一程DDP方案化疗（100mg/m2）。继续放疗，续观。\n- [全程D34] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：KPS 90分； 间接鼻咽镜检查见双侧鼻腔通畅，内未窥及明显肿物；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。复查血常规、生化常规未见明显异常。今日[姓名已隐去]医生信息已隐藏后示：患者已结束第一程同时期DDP方案化疗（100mg/m2），治疗过程顺利，今日可结账出院，嘱出院后继续在门诊放疗，每周复查血常规、肝肾功能，并按时[计划性表述已隐藏]下一程治疗，不适随诊。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 在无明显感染或疼痛症状的情况下经验性给予阿莫西林口服抗感染及酚咖片止痛，并复查血常规、生化常规及EBV-DNA定量\nB. 在无明显感染或疼痛症状的情况下静脉滴注头孢类抗生素并酚咖片止痛，同时复查血常规、生化常规及EBV-DNA定量\nC. 经验性给予阿莫西林口服抗感染及酚咖片止痛，并暂停放疗直至症状完全缓解\nD. 经验性给予酚咖片对症止痛，暂不予抗感染治疗，并复查血常规、生化常规及EBV-DNA定量\nE. 经验性给予阿莫西林口服抗感染，暂不予止痛治疗，并复查血常规、生化常规及EBV-DNA定量\nF. 经验性给予阿莫西林口服抗感染及酚咖片止痛，并提前安排第二程顺铂化疗\nG. 经验性给予阿莫西林口服抗感染及酚咖片止痛，并加用静脉地塞米松减轻局部水肿\nH. 经验性给予静脉滴注广谱抗生素及曲马多止痛，并复查血常规、生化常规及EBV-DNA定量\nI. 经验性给予阿莫西林口服抗感染及酚咖片止痛，并取消后续顺铂化疗计划\nJ. 经验性给予阿莫西林口服抗感染及酚咖片止痛，并复查鼻咽颈部MRI评估近期疗效\nK. 经验性给予口服抗真菌药物及酚咖片止痛，并复查血常规、生化常规及EBV-DNA定量\nL. 仅常规复查血常规、生化常规及EBV-DNA定量，暂不予特殊药物干预\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-67a2318574aada2f5af690c0","patient_id":"patient-e7eec542502a097814d58d8a","turn_id":"turn07","turn_position":5,"turn_type":"recurrence_or_salvage_decision","gold_letter":"B","gold_action":"继续完成原计划的根治性放疗，给予阿片类药物镇痛及静脉补液与营养支持治疗。","options":[{"letter":"A","text":"提前终止放疗，转为单纯全身化疗或靶向治疗，并给予静脉营养支持。","is_gold":false},{"letter":"B","text":"继续完成原计划的根治性放疗，给予阿片类药物镇痛及静脉补液与营养支持治疗。","is_gold":true},{"letter":"C","text":"暂停放疗直至口腔黏膜反应降至1度，期间给予广谱抗生素及静脉糖皮质激素治疗。","is_gold":false},{"letter":"D","text":"继续放疗，重新定位并缩减放疗靶区及处方剂量，同时给予非甾体类抗炎药镇痛。","is_gold":false},{"letter":"E","text":"暂停放疗，更改全身治疗方案为TPF方案化疗，待局部症状好转后择期恢复放疗。","is_gold":false},{"letter":"F","text":"继续完成根治性放疗，给予局部利多卡因含漱液及非甾体类抗炎药镇痛，并仅口服营养支持，无需静脉补液。","is_gold":false},{"letter":"G","text":"终止放疗，行右侧颈部淋巴结清扫术及鼻咽原发灶挽救性切除术。","is_gold":false},{"letter":"H","text":"继续放疗并同步行第3程大剂量顺铂化疗，给予阿片类药物镇痛，暂不予静脉补液。","is_gold":false},{"letter":"I","text":"暂停放疗，行鼻咽部内镜下微创手术切除残留病灶，术后继续静脉补液支持。","is_gold":false},{"letter":"J","text":"继续完成根治性放疗，行经皮内镜下胃造瘘术（PEG）以建立长期肠内营养途径。","is_gold":false},{"letter":"K","text":"提前终止放疗，改为PD-1抑制剂联合化疗的全身系统性维持治疗。","is_gold":false},{"letter":"L","text":"继续放疗，给予大剂量静脉糖皮质激素冲击治疗缓解黏膜反应，并继续口服营养液。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 双侧耳鸣2年，发现右颈肿物3天；现病史: 患者2年前无明显诱因间断出现双侧耳鸣，近2周自觉右侧耳鸣症状加重，无鼻塞、涕血等不适。今为进一步诊治收入我院。起病以来，患者无发热、咳嗽，无胸闷、胸痛，无恶心、呕吐，胃纳、睡眠、精神可，大小便正常，体重无明显变化。；阳性症状体征: 双耳鸣,右颈部肿物,右耳鸣；既往史: 10+年前因“腰椎间盘突出”行手术治疗，并予输血，无“输血反应”。否认\"肝炎\"、\"结核\"、\"高血压\"、\"糖尿病\"等疾病史；无外伤病史。过敏史:否认药物、食物过敏史。；个人史: 原籍出生、长大，无疫水、疫区暴露史；无吸烟、酗酒等不良嗜好。；家族史: 否认家族其他成员有肿瘤病史及遗传病史。；体格检查: T：36.0℃ P：81bpm R：18bpm BP：111/76mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。牙龈无肿胀、出血，咽无充血，双扁桃体无肿大。颈部检查详见肿瘤专科 检查。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率81bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 双侧耳鸣2年，发现右颈肿物3天；现病史: 患者2年前无明显诱因间断出现双侧耳鸣，近2周自觉右侧耳鸣症状加重，无鼻塞、涕血等不适。3天前无明显诱因发现右颈部肿物，遂就诊外院行CT检查示：鼻咽右侧壁增厚，考虑鼻咽癌可能，伴右侧乳突阻塞性炎症。今为进一步诊治收入我院。起病以来，患者无发热、咳嗽，无胸闷、胸痛，无恶心、呕吐，胃纳、睡眠、精神可，大小便正常，体重无明显变化。；阳性症状体征: 双耳鸣,右颈部肿物,右耳鸣；既往史: 10+年前因“腰椎间盘突出”行手术治疗，并予输血，无“输血反应”。否认\"肝炎\"、\"结核\"、\"高血压\"、\"糖尿病\"等疾病史；无外伤病史。过敏史:否认药物、食物过敏史。；个人史: 原籍出生、长大，无疫水、疫区暴露史；无吸烟、酗酒等不良嗜好。；家族史: 否认家族其他成员有肿瘤病史及遗传病史。；体格检查: T：36.0℃ P：81bpm R：18bpm BP：111/76mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。牙龈无肿胀、出血，咽无充血，双扁桃体无肿大。颈部检查详见肿瘤专科 检查。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率81bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。肛门外生殖器未见异常，生理反射存在，病理反射未引出。；专科检查: 间接鼻咽镜检查见双侧鼻腔通畅，内未窥及明显肿物；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显斑片或结节影。双侧肺门影未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见明显病变。\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 间接胆红素(IBIL)-静脉血: 9.6umolL；尿胆原(URO)-尿液: -（参考: 阴性）；钾离子(K+)-静脉血: 4mmol/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；总胆固醇(TC)-静脉血: 6.89mmol/L；肿瘤特异性生长因子(TSGF)-静脉血: 32U/mL；红细胞计数(RBC#)-静脉血: 4.9610E12/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.5U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.3pg；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 13.4umol/L；总蛋白(TP)-尿液: -（参考: 阴性）；血小板计数(PLT#)-静脉血: 319.310E9/L；比重(SG)-尿液: LAMPL.；凝血酶原时间活动度(PTA)-静脉血: 113.8%；直接胆红素(DBIL)-静脉血: 3.8umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-静脉血: 10.310E9/L；平均血小板体积(MPV)-静脉血: 7.46fL；镁离子(Mg2+)-静脉血: 0.98mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.310E9/L；鳞状细胞癌相关抗原(SCC)-静脉血: 0.4ng/ml；低密度脂蛋白胆固醇(LDL-C)-静脉血: 5.13mmol/L；血小板比容-静脉血: 23.8%；Rh血型-静脉血: 阳性；总前列腺特异性抗原(TPSA)-静脉血: 1ng/ml；神经元特异性烯醇化酶(NSE)-静脉血: 12.85ng/ml；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；游……\n- [全程D2] 检验组合: CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 0.8%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 3%；CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 24.9%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 9.8%；CD3+T淋巴细胞百分比-静脉血: 60.3%；CD4+/CD8+辅助/抑制T淋巴细胞比值(Th/Ts比值)-静脉血: 1.7；CD3-CD16+CD56+自然杀伤细胞百分比(NK%)-静脉血: 15.5%；CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 3.1%；CD3+CD4+辅助/诱导T淋巴细胞百分比(Th/Ti%)-静脉血: 29%；CD19+B淋巴细胞百分比-静脉血: 23%；CD3+CD8+抑制/细胞毒T淋巴细胞百分比(Ts/Tc%)-静脉血: 18.4%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 27.7%\n- [全程D7] 超声；双侧颈部、锁骨上区淋巴结彩超(套): 检查类型: 超声；检查名称: 双侧颈部、锁骨上区淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉内径约14mm，门静脉最大血流速度约17cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约44×36×33mm，包膜光滑，实质回声不均匀，可见强回声斑。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 前列腺钙化。 胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D7] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 右侧颈部II区可见数个淋巴结回声，最大约23×12mm，椭圆形，边界清，皮髓质分界不清，未见淋巴门。余右侧颈部未见明确异常淋巴结。 CDFI：上述最大淋巴结内可见周边型血流信号。 左侧颈部及锁骨上区未见明确异常淋巴结回声。；检查结论: 右侧颈部II区淋巴结，恶性待排，建议穿刺活检。 左侧颈部及锁骨上区未见明确异常淋巴结声像。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D24] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽右顶壁及右侧壁粘膜增厚放射性浓聚，SUV约16.7，病灶累及右翼突基底部及内侧板、右侧腭帆张提肌。右侧咽隐窝消失，左侧咽隐窝存在。双侧咽后未见肿大淋巴结及异常放射性分布。口咽、喉咽未见异常。筛窦、左上颌窦及右乳突内低密度影放射性稀疏；额窦、蝶窦、右上颌窦及左乳突结构及放射性分布未见明显异常。双侧海绵窦放射性分布未见明显异常。甲状腺结构及放射性分布未见明显异常。右颈II区数个淋巴结放射性浓聚，SUV约18.0，大者约1.5×2.2cm；余双颈小淋巴结放射性分布未见异常。 所见脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔主肺动脉窗小淋巴结放射性分布未见明显异常，大小约0.9×1.0cm。双肺门未见肿大淋巴结及异常放射性分布。双侧腋窝小淋巴结放射性未见明显异常。 肝脏密度减低，CT值约36Hu（脾脏CT值约56Hu），结构及放射性分布未见异常；肝门区未见占位及异常放射性分布。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。左肾上腺体部小结节影放射性略浓密，大小约1.0×1.1cm。脾脏、双肾、右肾上腺及胰腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺大小正常，内见数个点状钙化灶。膀胱及肠管形态、结构及放射性分布未见明显异常。双髂血管旁及双侧腹股沟未见肿大淋巴结及异常放射性分布。 颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，病灶累及右翼突基底部及内侧板、右侧腭帆张提肌；右颈II区数个淋巴结代谢活跃，考虑转移。 左肾上腺体部小结节代谢稍活跃，疑良性增生病变。 前列腺多发钙化灶。 脂肪肝。 副鼻窦炎症；右乳突炎症。\n- [全程D28] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T6上缘水平，估计导管末端位于上腔静脉上段内。；检查结论: PICC管末端位置如上述。\n- [全程D28] 检验组合: 红细胞计数(RBC#)-静脉血: 4.710E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7；钾离子(K+)-静脉血: 4.2mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 32.3U/L；尿素氮(BUN)-静脉血: 8.2mmol/L；间接胆红素(IBIL)-静脉血: 6.2umolL；氯离子(Cl-)-静脉血: 100.2mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 326g/L；红细胞比容(Hct)-静脉血: 43.5%；总胆固醇(TC)-静脉血: 5.88mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 22.9U/L；载脂蛋白AI(apoAI)-静脉血: 1.32g/L；血小板比容-静脉血: 32%；葡萄糖(Glu)-静脉血: 5.95mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.8mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.2pg；乳酸脱氢酶(LDH)-静脉血: 159.8U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.279；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.67；白细胞计数(WBC#)-静脉血: 10.7710E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 16.9U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.99mmol/L；中性粒细胞计数(Neut#)-静脉血: 6.410E9/L；平均红细胞体积(MCV)-静脉血: 92.6fL；平均血小板体积(MPV)-静脉血: 9.2fL；总胆红素(TBIL)-静脉血: 8.6umol/L；血小板分布宽度(PDW)-静脉血: 10%；磷(P)-静脉血: 1.6mmol/L；肌酐(Crea)-静脉血: 64.4umol/L；血小板计数(PLT#)-静脉血: 34410E9/L；C-反应蛋白(CRP)-静脉血: 3.29mg/L；碱性磷酸酶(ALP)-静脉血: 102.6U/L；白蛋白(ALB)-静脉血: 46.3g/L；淋巴细胞计数(Lymph#)-静脉血: 310E9/L；单核细胞计数(Mono#)-静脉血: 0.810E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 54U/L；大血小板百分比(P-LCR%)-静脉血: 18.4%；单核细胞百分比(Mono%)-静……\n- [全程D29] 检验组合: 隐血(OB)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；淀粉样蛋白A(SAA)-静脉血: 3.65mg/L；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；白细胞计数(WBC#)-尿液: 7/μL；比重(SG)-尿液: 1.027；总蛋白(TP)-尿液: +- 0.2g（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；葡萄糖(Glu)-尿液: 3+ 17mmol（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 80/μL\n- [全程D30] 检验组合: 颜色-尿液: Yellow；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 13/μL；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 6；总蛋白(TP)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.023\n- [全程D35] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.7；单核细胞计数(Mono#)-静脉血: 0.810E9/L；甘油三酯(TG)-静脉血: 2.15mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；载脂蛋白AI(apoAI)-静脉血: 1.26g/L；中性粒细胞百分比(Neut%)-静脉血: 0.702；葡萄糖(Glu)-静脉血: 6.03mmol/L；尿素氮(BUN)-静脉血: 7.02mmol/L；直接胆红素(DBIL)-静脉血: 4.8umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20U/L；C-反应蛋白(CRP)-静脉血: 2.65mg/L；乳酸脱氢酶(LDH)-静脉血: 166.9U/L；红细胞计数(RBC#)-静脉血: 4.7510E12/L；总胆汁酸(TBA)-静脉血: 1.5umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；总蛋白(TP)-静脉血: 71.69g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；肌酐(Crea)-静脉血: 69.7umol/L；总钙(Ca)-静脉血: 2.31mmol/L；白细胞计数(WBC#)-静脉血: 7.4610E9/L；镁离子(Mg2+)-静脉血: 1mmol/L；平均红细胞体积(MCV)-静脉血: 88.8fL；总胆固醇(TC)-静脉血: 5.15mmol/L；磷(P)-静脉血: 1.3mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；总胆红素(TBIL)-静脉血: 15umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；阴离子间隙(AG)-静脉血: 17；间接胆红素(IBIL)-静脉血: 10.2umolL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.18mmolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4；球蛋白(GLO)-静脉血: 26.39g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.168；血小板分布宽度(PDW)-静脉血: 9.8%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.015；血红蛋白(Hb)-静脉血: 141g/L；淋巴细胞计数(L……\n- [全程D49] 检验组合: 丙氨酸氨基转移酶(ALT)-静脉血: 18.4U/L；球蛋白(GLO)-静脉血: 27.24g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；γ-谷氨酰基转移酶(GGT)-静脉血: 42U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 16.9U/L；平均红细胞体积(MCV)-静脉血: 90.3fL；血小板比容-静脉血: 11.8%；血小板分布宽度(PDW)-静脉血: 16.8%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；钠离子(Na+)-静脉血: 138mmol/L；平均血小板体积(MPV)-静脉血: 6.76fL；总胆汁酸(TBA)-静脉血: 2.9umol/L；载脂蛋白B(apoB)-静脉血: 1.36g/L；总钙(Ca)-静脉血: 2.22mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.16g/L；红细胞计数(RBC#)-静脉血: 4.3410E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.019；血红蛋白(Hb)-静脉血: 133.6g/L；阴离子间隙(AG)-静脉血: 15.6；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；C-反应蛋白(CRP)-静脉血: 10.3mg/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.6mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.17；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.87mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9%；淀粉样蛋白A(SAA)-静脉血: 24.6mg/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.7pg；甘油三酯(TG)-静脉血: 2.36mmol/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；总蛋白(TP)-静脉血: 71.04g/L；碱性磷酸酶(ALP)-静脉血: 108.1U/L；总胆固醇(TC)-静脉血: 5.6mmol/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.104；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.92；平均红细胞血红蛋白浓度(MCHC)-静脉血: 340.7g/……\n- [全程D55] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位置位于第3胸椎体右下缘，估计位于右侧头臂静脉内。；检查结论: PICC管末端位置如上所述。\n- [全程D55] 检验组合: 葡萄糖(Glu)-尿液: +- 2.8mmol（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: 1+ 0.3g（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 3/μL；白细胞计数(WBC#)-尿液: 20/μL；酸碱度(pH)-尿液: 5.5；颜色-尿液: Yellow；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: +- 0.1g（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；比重(SG)-尿液: 1.021；红细胞计数(RBC#)-尿液: 2/μL；红细胞计数(RBC#)-尿液: 2/μL；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.025；浊度(TRUB)-尿液: 清亮；粘液丝计数(MUCS#)-尿液: 80/μL；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；葡萄糖(Glu)-尿液: 3+ 17mmol（参考: 阴性）；白细胞计数(WBC#)-尿液: 4/μL\n- [全程D63] 检验组合: 红细胞计数(RBC#)-静脉血: 3.910E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞计数(Neut#)-静脉血: 5.210E9/L；阴离子间隙(AG)-静脉血: 16.2；尿酸(UA)-静脉血: 364.7umol/L；钠离子(Na+)-静脉血: 132.6mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；球蛋白(GLO)-静脉血: 26.68g/L；单核细胞计数(Mono#)-静脉血: 1.110E9/L；葡萄糖(Glu)-静脉血: 4.06mmol/L；单核细胞百分比(Mono%)-静脉血: 0.166；平均血小板体积(MPV)-静脉血: 8.1fL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；尿素氮(BUN)-静脉血: 7.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 20.7U/L；白细胞计数(WBC#)-静脉血: 6.6710E9/L；甘油三酯(TG)-静脉血: 1.04mmol/L；氯离子(Cl-)-静脉血: 93.2mmol/L；磷(P)-静脉血: 1.24mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.2mmol/L；平均红细胞体积(MCV)-静脉血: 89.2fL；总胆汁酸(TBA)-静脉血: 0.9umol/L；载脂蛋白B(apoB)-静脉血: 1.28g/L；总钙(Ca)-静脉血: 2.2mmol/L；镁离子(Mg2+)-静脉血: 1.01mmol/L；红细胞比容(Hct)-静脉血: 34.8%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；乳酸脱氢酶(LDH)-静脉血: 151.8U/L；间接胆红素(IBIL)-静脉血: 9umolL；载脂蛋白AI(apoAI)-静脉血: 0.91g/L；总胆红素(TBIL)-静脉血: 12.8umol/L；大血小板百分比(P-LCR%)-静脉血: 9.3%；中性粒细胞百分比(Neut%)-静脉血: 0.782；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；血小板分布宽度(PDW)-静脉血: 8%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.1；碱性磷酸酶(ALP)-静脉血: 113.9U/L；平均红……\n- [全程D69] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌治疗后，与某次就诊时间0日片对比: 鼻咽腔未见明显狭窄，鼻咽顶后壁、右侧壁轻度增厚，见少许软组织影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，右侧咽隐窝消失。鼻咽左侧壁未见明显增厚，左侧咽隐窝稍浅。右侧咽旁脂肪间隙稍变窄，左侧咽旁脂肪间隙未见异常。 右侧腭帆提张肌信号不均匀，左侧腭帆提张肌、双侧头长肌未见受侵征象。 双侧翼腭窝、上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 口咽双侧壁未见受累增厚，病变未累及双侧后鼻孔。 右侧翼突内份及内板、蝶骨基底部右份骨质信号减低，增强扫描轻度强化，范围较前缩小。余颅底未见明确骨质破坏征象。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦、右侧乳突粘膜增厚，双侧上颌窦见少量分泌物，蝶窦、左侧乳突充气良好，骨壁完整。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 右侧咽后淋巴结短径约6mm，较前缩小。左侧咽后未见肿大淋巴结。 右颈IIb区见稍大淋巴结，较大者短径约7mm，增强扫描明显强化，较前缩小。双颈IIa区见数个小淋巴结，较大者短径约5mm，增强扫描轻度强化，大致同前。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 扫描所见脑实质未见明显异常。；检查结论: 鼻咽癌治疗后，与某次就诊时间0日片对比: 鼻咽病变较前缩小。 颅底骨质破坏，较前有修复。 右侧咽后肿大淋巴结，考虑转移，较前缩小。 右颈IIb区淋巴结肿大，考虑转移，较前缩小。 双颈IIa区小淋巴结。 副鼻窦炎，右侧乳突炎。\n- [全程D69] 检验组合: 直接胆红素(DBIL)-静脉血: 3.2umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.033；阴离子间隙(AG)-静脉血: 16.9；白细胞计数(WBC#)-静脉血: 3.510E9/L；总胆红素(TBIL)-静脉血: 11.7umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 24.1U/L；尿酸(UA)-静脉血: 468.3umol/L；白蛋白(ALB)-静脉血: 39.4g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.016；红细胞比容(Hct)-静脉血: 33.6%；磷(P)-静脉血: 1.09mmol/L；C-反应蛋白(CRP)-静脉血: 20.73mg/L；载脂蛋白B(apoB)-静脉血: 1.37g/L；葡萄糖(Glu)-静脉血: 4.3mmol/L；单核细胞百分比(Mono%)-静脉血: 0.112；血小板比容-静脉血: 15.3%；肌酐(Crea)-静脉血: 62.2umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4%；碱性磷酸酶(ALP)-静脉血: 92.8U/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.9mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.57；总蛋白(TP)-静脉血: 64.43g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.86；淋巴细胞计数(Lymph#)-静脉血: 0.110E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；球蛋白(GLO)-静脉血: 25.03g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 36.2U/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.839；甘油三酯(TG)-静脉血: 1.02mmol/L；间接胆红素(IBIL)-静脉血: 8.5umolL；丙氨酸氨基转移酶(ALT)-静脉血: 16.3U/L；血小板计数(PLT#)-静脉血: 266.210E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.27mmol/L；平均血小板体积(MPV)-静脉血: 5.77fL；胱抑素(Cys-C)-静脉血: 0.73mg/L；尿素氮(BUN)-静脉血: 5mmol/L；血小板分布宽度(PDW)-静脉……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D9] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，无发热、涕血等不适症状。查体：生命体征平稳。电子喉镜检查示：鼻咽右隆突肿物，符合鼻咽癌。并取肿物活检，等待病理结果。[姓名已隐去]副教授示，结合患者病情及相关检查，诊断考虑鼻咽癌可能性大，明确诊断，予鼻咽科进一步诊治。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D15] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：KPS 90分；鼻咽右侧壁、顶后壁结节状肿物，右颈Ⅱ区可扪及已肿大淋巴结，大小约2*1cm，颅神经检查（-）。今日[姓名已隐去]医生信息已隐藏后示：患者已完善相关检查，并预约放疗，今日可结账出院，嘱出院后按时[计划性表述已隐藏]放化综合治疗，不适随诊。\n- [全程D29] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者放疗1次。患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：基本同前。今日[姓名已隐去]副医生信息已隐藏后示：患于今日行第一程DDP方案化疗（100mg/m2）。继续放疗，续观。\n- [全程D34] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：KPS 90分； 间接鼻咽镜检查见双侧鼻腔通畅，内未窥及明显肿物；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。复查血常规、生化常规未见明显异常。今日[姓名已隐去]医生信息已隐藏后示：患者已结束第一程同时期DDP方案化疗（100mg/m2），治疗过程顺利，今日可结账出院，嘱出院后继续在门诊放疗，每周复查血常规、肝肾功能，并按时[计划性表述已隐藏]下一程治疗，不适随诊。\n- [全程D54] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者放疗16次，口腔黏膜反应2度，放射性皮炎1度，患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：KPS 90分；张口门齿距4.5cm，鼻咽顶后壁、右侧壁肿物，较前缩小；右颈II区扪及一肿大淋巴结，大小约1X1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。颅神经检查：阴性。今日[姓名已隐去]副医生信息已隐藏后示：今日开始行第2程同时期DDP方案（DDP100mg/m2）化疗，继续放疗，续观。\n- [全程D64] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者放疗22次，口腔黏膜反应2度，放射性皮炎1度，患者诉喉痛，余未诉特殊不适。生命体征平稳。查体：KPS 90分；张口门齿距4.5cm，鼻咽顶后壁、右侧壁肿物，较前缩小；双颈未触及肿大淋巴结；颅神经检查：阴性。今日[姓名已隐去]副医生信息已隐藏后示：患者诉喉痛，予患者奥施康定止痛，继续放疗，续观。\n- [全程D69] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者放疗26次，口腔黏膜反应3度，放射性皮炎2度，患者诉喉痛，余未诉特殊不适。生命体征平稳。查体：KPS 90分；张口门齿距4.5cm，鼻咽肿物已不明显；双颈未触及肿大淋巴结；颅神经检查：阴性。今日[姓名已隐去]医生信息已隐藏后示：患者诉喉痛，继续予患者奥施康定止痛，继续放疗，续观。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 提前终止放疗，转为单纯全身化疗或靶向治疗，并给予静脉营养支持。\nB. 继续完成原计划的根治性放疗，给予阿片类药物镇痛及静脉补液与营养支持治疗。\nC. 暂停放疗直至口腔黏膜反应降至1度，期间给予广谱抗生素及静脉糖皮质激素治疗。\nD. 继续放疗，重新定位并缩减放疗靶区及处方剂量，同时给予非甾体类抗炎药镇痛。\nE. 暂停放疗，更改全身治疗方案为TPF方案化疗，待局部症状好转后择期恢复放疗。\nF. 继续完成根治性放疗，给予局部利多卡因含漱液及非甾体类抗炎药镇痛，并仅口服营养支持，无需静脉补液。\nG. 终止放疗，行右侧颈部淋巴结清扫术及鼻咽原发灶挽救性切除术。\nH. 继续放疗并同步行第3程大剂量顺铂化疗，给予阿片类药物镇痛，暂不予静脉补液。\nI. 暂停放疗，行鼻咽部内镜下微创手术切除残留病灶，术后继续静脉补液支持。\nJ. 继续完成根治性放疗，行经皮内镜下胃造瘘术（PEG）以建立长期肠内营养途径。\nK. 提前终止放疗，改为PD-1抑制剂联合化疗的全身系统性维持治疗。\nL. 继续放疗，给予大剂量静脉糖皮质激素冲击治疗缓解黏膜反应，并继续口服营养液。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D49] 检验组合: 丙氨酸氨基转移酶(ALT)-静脉血: 18.4U/L；球蛋白(GLO)-静脉血: 27.24g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；γ-谷氨酰基转移酶(GGT)-静脉血: 42U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 16.9U/L；平均红细胞体积(MCV)-静脉血: 90.3fL；血小板比容-静脉血: 11.8%；血小板分布宽度(PDW)-静脉血: 16.8%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；钠离子(Na+)-静脉血: 138mmol/L；平均血小板体积(MPV)-静脉血: 6.76fL；总胆汁酸(TBA)-静脉血: 2.9umol/L；载脂蛋白B(apoB)-静脉血: 1.36g/L；总钙(Ca)-静脉血: 2.22mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.16g/L；红细胞计数(RBC#)-静脉血: 4.3410E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.019；血红蛋白(Hb)-静脉血: 133.6g/L；阴离子间隙(AG)-静脉血: 15.6；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；C-反应蛋白(CRP)-静脉血: 10.3mg/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.6mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.17；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.87mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9%；淀粉样蛋白A(SAA)-静脉血: 24.6mg/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.7pg；甘油三酯(TG)-静脉血: 2.36mmol/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；总蛋白(TP)-静脉血: 71.04g/L；碱性磷酸酶(ALP)-静脉血: 108.1U/L；总胆固醇(TC)-静脉血: 5.6mmol/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.104；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.92；平均红细胞血红蛋白浓度(MCHC)-静脉血: 340.7g/……\n- [全程D55] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位置位于第3胸椎体右下缘，估计位于右侧头臂静脉内。；检查结论: PICC管末端位置如上所述。\n- [全程D55] 检验组合: 葡萄糖(Glu)-尿液: +- 2.8mmol（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: 1+ 0.3g（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 3/μL；白细胞计数(WBC#)-尿液: 20/μL；酸碱度(pH)-尿液: 5.5；颜色-尿液: Yellow；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: +- 0.1g（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；比重(SG)-尿液: 1.021；红细胞计数(RBC#)-尿液: 2/μL；红细胞计数(RBC#)-尿液: 2/μL；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.025；浊度(TRUB)-尿液: 清亮；粘液丝计数(MUCS#)-尿液: 80/μL；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；葡萄糖(Glu)-尿液: 3+ 17mmol（参考: 阴性）；白细胞计数(WBC#)-尿液: 4/μL\n- [全程D63] 检验组合: 红细胞计数(RBC#)-静脉血: 3.910E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞计数(Neut#)-静脉血: 5.210E9/L；阴离子间隙(AG)-静脉血: 16.2；尿酸(UA)-静脉血: 364.7umol/L；钠离子(Na+)-静脉血: 132.6mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；球蛋白(GLO)-静脉血: 26.68g/L；单核细胞计数(Mono#)-静脉血: 1.110E9/L；葡萄糖(Glu)-静脉血: 4.06mmol/L；单核细胞百分比(Mono%)-静脉血: 0.166；平均血小板体积(MPV)-静脉血: 8.1fL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；尿素氮(BUN)-静脉血: 7.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 20.7U/L；白细胞计数(WBC#)-静脉血: 6.6710E9/L；甘油三酯(TG)-静脉血: 1.04mmol/L；氯离子(Cl-)-静脉血: 93.2mmol/L；磷(P)-静脉血: 1.24mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.2mmol/L；平均红细胞体积(MCV)-静脉血: 89.2fL；总胆汁酸(TBA)-静脉血: 0.9umol/L；载脂蛋白B(apoB)-静脉血: 1.28g/L；总钙(Ca)-静脉血: 2.2mmol/L；镁离子(Mg2+)-静脉血: 1.01mmol/L；红细胞比容(Hct)-静脉血: 34.8%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；乳酸脱氢酶(LDH)-静脉血: 151.8U/L；间接胆红素(IBIL)-静脉血: 9umolL；载脂蛋白AI(apoAI)-静脉血: 0.91g/L；总胆红素(TBIL)-静脉血: 12.8umol/L；大血小板百分比(P-LCR%)-静脉血: 9.3%；中性粒细胞百分比(Neut%)-静脉血: 0.782；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；血小板分布宽度(PDW)-静脉血: 8%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.1；碱性磷酸酶(ALP)-静脉血: 113.9U/L；平均红……\n- [全程D69] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌治疗后，与某次就诊时间0日片对比: 鼻咽腔未见明显狭窄，鼻咽顶后壁、右侧壁轻度增厚，见少许软组织影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，右侧咽隐窝消失。鼻咽左侧壁未见明显增厚，左侧咽隐窝稍浅。右侧咽旁脂肪间隙稍变窄，左侧咽旁脂肪间隙未见异常。 右侧腭帆提张肌信号不均匀，左侧腭帆提张肌、双侧头长肌未见受侵征象。 双侧翼腭窝、上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 口咽双侧壁未见受累增厚，病变未累及双侧后鼻孔。 右侧翼突内份及内板、蝶骨基底部右份骨质信号减低，增强扫描轻度强化，范围较前缩小。余颅底未见明确骨质破坏征象。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦、右侧乳突粘膜增厚，双侧上颌窦见少量分泌物，蝶窦、左侧乳突充气良好，骨壁完整。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 右侧咽后淋巴结短径约6mm，较前缩小。左侧咽后未见肿大淋巴结。 右颈IIb区见稍大淋巴结，较大者短径约7mm，增强扫描明显强化，较前缩小。双颈IIa区见数个小淋巴结，较大者短径约5mm，增强扫描轻度强化，大致同前。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 扫描所见脑实质未见明显异常。；检查结论: 鼻咽癌治疗后，与某次就诊时间0日片对比: 鼻咽病变较前缩小。 颅底骨质破坏，较前有修复。 右侧咽后肿大淋巴结，考虑转移，较前缩小。 右颈IIb区淋巴结肿大，考虑转移，较前缩小。 双颈IIa区小淋巴结。 副鼻窦炎，右侧乳突炎。\n- [全程D69] 检验组合: 直接胆红素(DBIL)-静脉血: 3.2umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.033；阴离子间隙(AG)-静脉血: 16.9；白细胞计数(WBC#)-静脉血: 3.510E9/L；总胆红素(TBIL)-静脉血: 11.7umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 24.1U/L；尿酸(UA)-静脉血: 468.3umol/L；白蛋白(ALB)-静脉血: 39.4g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.016；红细胞比容(Hct)-静脉血: 33.6%；磷(P)-静脉血: 1.09mmol/L；C-反应蛋白(CRP)-静脉血: 20.73mg/L；载脂蛋白B(apoB)-静脉血: 1.37g/L；葡萄糖(Glu)-静脉血: 4.3mmol/L；单核细胞百分比(Mono%)-静脉血: 0.112；血小板比容-静脉血: 15.3%；肌酐(Crea)-静脉血: 62.2umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4%；碱性磷酸酶(ALP)-静脉血: 92.8U/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.9mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.57；总蛋白(TP)-静脉血: 64.43g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.86；淋巴细胞计数(Lymph#)-静脉血: 0.110E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；球蛋白(GLO)-静脉血: 25.03g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 36.2U/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.839；甘油三酯(TG)-静脉血: 1.02mmol/L；间接胆红素(IBIL)-静脉血: 8.5umolL；丙氨酸氨基转移酶(ALT)-静脉血: 16.3U/L；血小板计数(PLT#)-静脉血: 266.210E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.27mmol/L；平均血小板体积(MPV)-静脉血: 5.77fL；胱抑素(Cys-C)-静脉血: 0.73mg/L；尿素氮(BUN)-静脉血: 5mmol/L；血小板分布宽度(PDW)-静脉……\n\n【既往治疗与反应】\n- [全程D54] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者放疗16次，口腔黏膜反应2度，放射性皮炎1度，患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：KPS 90分；张口门齿距4.5cm，鼻咽顶后壁、右侧壁肿物，较前缩小；右颈II区扪及一肿大淋巴结，大小约1X1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。颅神经检查：阴性。今日[姓名已隐去]副医生信息已隐藏后示：今日开始行第2程同时期DDP方案（DDP100mg/m2）化疗，继续放疗，续观。\n- [全程D64] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者放疗22次，口腔黏膜反应2度，放射性皮炎1度，患者诉喉痛，余未诉特殊不适。生命体征平稳。查体：KPS 90分；张口门齿距4.5cm，鼻咽顶后壁、右侧壁肿物，较前缩小；双颈未触及肿大淋巴结；颅神经检查：阴性。今日[姓名已隐去]副医生信息已隐藏后示：患者诉喉痛，予患者奥施康定止痛，继续放疗，续观。\n- [全程D69] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者放疗26次，口腔黏膜反应3度，放射性皮炎2度，患者诉喉痛，余未诉特殊不适。生命体征平稳。查体：KPS 90分；张口门齿距4.5cm，鼻咽肿物已不明显；双颈未触及肿大淋巴结；颅神经检查：阴性。今日[姓名已隐去]医生信息已隐藏后示：患者诉喉痛，继续予患者奥施康定止痛，继续放疗，续观。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 提前终止放疗，转为单纯全身化疗或靶向治疗，并给予静脉营养支持。\nB. 继续完成原计划的根治性放疗，给予阿片类药物镇痛及静脉补液与营养支持治疗。\nC. 暂停放疗直至口腔黏膜反应降至1度，期间给予广谱抗生素及静脉糖皮质激素治疗。\nD. 继续放疗，重新定位并缩减放疗靶区及处方剂量，同时给予非甾体类抗炎药镇痛。\nE. 暂停放疗，更改全身治疗方案为TPF方案化疗，待局部症状好转后择期恢复放疗。\nF. 继续完成根治性放疗，给予局部利多卡因含漱液及非甾体类抗炎药镇痛，并仅口服营养支持，无需静脉补液。\nG. 终止放疗，行右侧颈部淋巴结清扫术及鼻咽原发灶挽救性切除术。\nH. 继续放疗并同步行第3程大剂量顺铂化疗，给予阿片类药物镇痛，暂不予静脉补液。\nI. 暂停放疗，行鼻咽部内镜下微创手术切除残留病灶，术后继续静脉补液支持。\nJ. 继续完成根治性放疗，行经皮内镜下胃造瘘术（PEG）以建立长期肠内营养途径。\nK. 提前终止放疗，改为PD-1抑制剂联合化疗的全身系统性维持治疗。\nL. 继续放疗，给予大剂量静脉糖皮质激素冲击治疗缓解黏膜反应，并继续口服营养液。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D49] 检验组合: 丙氨酸氨基转移酶(ALT)-静脉血: 18.4U/L；球蛋白(GLO)-静脉血: 27.24g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；γ-谷氨酰基转移酶(GGT)-静脉血: 42U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 16.9U/L；平均红细胞体积(MCV)-静脉血: 90.3fL；血小板比容-静脉血: 11.8%；血小板分布宽度(PDW)-静脉血: 16.8%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；钠离子(Na+)-静脉血: 138mmol/L；平均血小板体积(MPV)-静脉血: 6.76fL；总胆汁酸(TBA)-静脉血: 2.9umol/L；载脂蛋白B(apoB)-静脉血: 1.36g/L；总钙(Ca)-静脉血: 2.22mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.16g/L；红细胞计数(RBC#)-静脉血: 4.3410E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.019；血红蛋白(Hb)-静脉血: 133.6g/L；阴离子间隙(AG)-静脉血: 15.6；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；C-反应蛋白(CRP)-静脉血: 10.3mg/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.6mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.17；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.87mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9%；淀粉样蛋白A(SAA)-静脉血: 24.6mg/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.7pg；甘油三酯(TG)-静脉血: 2.36mmol/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；总蛋白(TP)-静脉血: 71.04g/L；碱性磷酸酶(ALP)-静脉血: 108.1U/L；总胆固醇(TC)-静脉血: 5.6mmol/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.104；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.92；平均红细胞血红蛋白浓度(MCHC)-静脉血: 340.7g/……\n- [全程D55] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位置位于第3胸椎体右下缘，估计位于右侧头臂静脉内。；检查结论: PICC管末端位置如上所述。\n- [全程D55] 检验组合: 葡萄糖(Glu)-尿液: +- 2.8mmol（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: 1+ 0.3g（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 3/μL；白细胞计数(WBC#)-尿液: 20/μL；酸碱度(pH)-尿液: 5.5；颜色-尿液: Yellow；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: +- 0.1g（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；比重(SG)-尿液: 1.021；红细胞计数(RBC#)-尿液: 2/μL；红细胞计数(RBC#)-尿液: 2/μL；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.025；浊度(TRUB)-尿液: 清亮；粘液丝计数(MUCS#)-尿液: 80/μL；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；葡萄糖(Glu)-尿液: 3+ 17mmol（参考: 阴性）；白细胞计数(WBC#)-尿液: 4/μL\n- [全程D63] 检验组合: 红细胞计数(RBC#)-静脉血: 3.910E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞计数(Neut#)-静脉血: 5.210E9/L；阴离子间隙(AG)-静脉血: 16.2；尿酸(UA)-静脉血: 364.7umol/L；钠离子(Na+)-静脉血: 132.6mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；球蛋白(GLO)-静脉血: 26.68g/L；单核细胞计数(Mono#)-静脉血: 1.110E9/L；葡萄糖(Glu)-静脉血: 4.06mmol/L；单核细胞百分比(Mono%)-静脉血: 0.166；平均血小板体积(MPV)-静脉血: 8.1fL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；尿素氮(BUN)-静脉血: 7.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 20.7U/L；白细胞计数(WBC#)-静脉血: 6.6710E9/L；甘油三酯(TG)-静脉血: 1.04mmol/L；氯离子(Cl-)-静脉血: 93.2mmol/L；磷(P)-静脉血: 1.24mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.2mmol/L；平均红细胞体积(MCV)-静脉血: 89.2fL；总胆汁酸(TBA)-静脉血: 0.9umol/L；载脂蛋白B(apoB)-静脉血: 1.28g/L；总钙(Ca)-静脉血: 2.2mmol/L；镁离子(Mg2+)-静脉血: 1.01mmol/L；红细胞比容(Hct)-静脉血: 34.8%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；乳酸脱氢酶(LDH)-静脉血: 151.8U/L；间接胆红素(IBIL)-静脉血: 9umolL；载脂蛋白AI(apoAI)-静脉血: 0.91g/L；总胆红素(TBIL)-静脉血: 12.8umol/L；大血小板百分比(P-LCR%)-静脉血: 9.3%；中性粒细胞百分比(Neut%)-静脉血: 0.782；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；血小板分布宽度(PDW)-静脉血: 8%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.1；碱性磷酸酶(ALP)-静脉血: 113.9U/L；平均红……\n- [全程D69] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌治疗后，与某次就诊时间0日片对比: 鼻咽腔未见明显狭窄，鼻咽顶后壁、右侧壁轻度增厚，见少许软组织影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，右侧咽隐窝消失。鼻咽左侧壁未见明显增厚，左侧咽隐窝稍浅。右侧咽旁脂肪间隙稍变窄，左侧咽旁脂肪间隙未见异常。 右侧腭帆提张肌信号不均匀，左侧腭帆提张肌、双侧头长肌未见受侵征象。 双侧翼腭窝、上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 口咽双侧壁未见受累增厚，病变未累及双侧后鼻孔。 右侧翼突内份及内板、蝶骨基底部右份骨质信号减低，增强扫描轻度强化，范围较前缩小。余颅底未见明确骨质破坏征象。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦、右侧乳突粘膜增厚，双侧上颌窦见少量分泌物，蝶窦、左侧乳突充气良好，骨壁完整。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 右侧咽后淋巴结短径约6mm，较前缩小。左侧咽后未见肿大淋巴结。 右颈IIb区见稍大淋巴结，较大者短径约7mm，增强扫描明显强化，较前缩小。双颈IIa区见数个小淋巴结，较大者短径约5mm，增强扫描轻度强化，大致同前。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 扫描所见脑实质未见明显异常。；检查结论: 鼻咽癌治疗后，与某次就诊时间0日片对比: 鼻咽病变较前缩小。 颅底骨质破坏，较前有修复。 右侧咽后肿大淋巴结，考虑转移，较前缩小。 右颈IIb区淋巴结肿大，考虑转移，较前缩小。 双颈IIa区小淋巴结。 副鼻窦炎，右侧乳突炎。\n- [全程D69] 检验组合: 直接胆红素(DBIL)-静脉血: 3.2umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.033；阴离子间隙(AG)-静脉血: 16.9；白细胞计数(WBC#)-静脉血: 3.510E9/L；总胆红素(TBIL)-静脉血: 11.7umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 24.1U/L；尿酸(UA)-静脉血: 468.3umol/L；白蛋白(ALB)-静脉血: 39.4g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.016；红细胞比容(Hct)-静脉血: 33.6%；磷(P)-静脉血: 1.09mmol/L；C-反应蛋白(CRP)-静脉血: 20.73mg/L；载脂蛋白B(apoB)-静脉血: 1.37g/L；葡萄糖(Glu)-静脉血: 4.3mmol/L；单核细胞百分比(Mono%)-静脉血: 0.112；血小板比容-静脉血: 15.3%；肌酐(Crea)-静脉血: 62.2umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4%；碱性磷酸酶(ALP)-静脉血: 92.8U/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.9mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.57；总蛋白(TP)-静脉血: 64.43g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.86；淋巴细胞计数(Lymph#)-静脉血: 0.110E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；球蛋白(GLO)-静脉血: 25.03g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 36.2U/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.839；甘油三酯(TG)-静脉血: 1.02mmol/L；间接胆红素(IBIL)-静脉血: 8.5umolL；丙氨酸氨基转移酶(ALT)-静脉血: 16.3U/L；血小板计数(PLT#)-静脉血: 266.210E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.27mmol/L；平均血小板体积(MPV)-静脉血: 5.77fL；胱抑素(Cys-C)-静脉血: 0.73mg/L；尿素氮(BUN)-静脉血: 5mmol/L；血小板分布宽度(PDW)-静脉……\n\n【既往治疗与反应】\n- [全程D54] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者放疗16次，口腔黏膜反应2度，放射性皮炎1度，患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：KPS 90分；张口门齿距4.5cm，鼻咽顶后壁、右侧壁肿物，较前缩小；右颈II区扪及一肿大淋巴结，大小约1X1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。颅神经检查：阴性。今日[姓名已隐去]副医生信息已隐藏后示：今日开始行第2程同时期DDP方案（DDP100mg/m2）化疗，继续放疗，续观。\n- [全程D64] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者放疗22次，口腔黏膜反应2度，放射性皮炎1度，患者诉喉痛，余未诉特殊不适。生命体征平稳。查体：KPS 90分；张口门齿距4.5cm，鼻咽顶后壁、右侧壁肿物，较前缩小；双颈未触及肿大淋巴结；颅神经检查：阴性。今日[姓名已隐去]副医生信息已隐藏后示：患者诉喉痛，予患者奥施康定止痛，继续放疗，续观。\n- [全程D69] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者放疗26次，口腔黏膜反应3度，放射性皮炎2度，患者诉喉痛，余未诉特殊不适。生命体征平稳。查体：KPS 90分；张口门齿距4.5cm，鼻咽肿物已不明显；双颈未触及肿大淋巴结；颅神经检查：阴性。今日[姓名已隐去]医生信息已隐藏后示：患者诉喉痛，继续予患者奥施康定止痛，继续放疗，续观。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 提前终止放疗，转为单纯全身化疗或靶向治疗，并给予静脉营养支持。\nB. 继续完成原计划的根治性放疗，给予阿片类药物镇痛及静脉补液与营养支持治疗。\nC. 暂停放疗直至口腔黏膜反应降至1度，期间给予广谱抗生素及静脉糖皮质激素治疗。\nD. 继续放疗，重新定位并缩减放疗靶区及处方剂量，同时给予非甾体类抗炎药镇痛。\nE. 暂停放疗，更改全身治疗方案为TPF方案化疗，待局部症状好转后择期恢复放疗。\nF. 继续完成根治性放疗，给予局部利多卡因含漱液及非甾体类抗炎药镇痛，并仅口服营养支持，无需静脉补液。\nG. 终止放疗，行右侧颈部淋巴结清扫术及鼻咽原发灶挽救性切除术。\nH. 继续放疗并同步行第3程大剂量顺铂化疗，给予阿片类药物镇痛，暂不予静脉补液。\nI. 暂停放疗，行鼻咽部内镜下微创手术切除残留病灶，术后继续静脉补液支持。\nJ. 继续完成根治性放疗，行经皮内镜下胃造瘘术（PEG）以建立长期肠内营养途径。\nK. 提前终止放疗，改为PD-1抑制剂联合化疗的全身系统性维持治疗。\nL. 继续放疗，给予大剂量静脉糖皮质激素冲击治疗缓解黏膜反应，并继续口服营养液。\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-5549469386bb20d944ce932b","patient_id":"patient-e7eec542502a097814d58d8a","turn_id":"turn08","turn_position":6,"turn_type":"response_assessment_decision","gold_letter":"C","gold_action":"影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；针对3度放射性口腔黏膜炎伴咽痛，继续予羟考酮镇痛及静脉营养支持，并常规行PICC导管护理。","options":[{"letter":"A","text":"影像学评估病灶较前缩小，疗效肯定，需暂停放疗，待3度放射性口腔黏膜炎恢复至1度后再恢复放疗，期间予静脉营养支持。","is_gold":false},{"letter":"B","text":"影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，局部使用含漱液及非甾体类抗炎药镇痛，停用阿片类药物。","is_gold":false},{"letter":"C","text":"影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎伴咽痛，继续予羟考酮镇痛及静脉营养支持，并常规行PICC导管护理。","is_gold":true},{"letter":"D","text":"影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，行预防性气管切开以防气道水肿梗阻，并予静脉营养支持。","is_gold":false},{"letter":"E","text":"影像学评估病灶较前缩小，疗效肯定，已完成26次放疗且出现3度黏膜炎，提前结束放疗并转为辅助化疗，同时予羟考酮镇痛。","is_gold":false},{"letter":"F","text":"影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，拔除PICC导管以预防导管相关性血流感染，改用外周静脉营养。","is_gold":false},{"letter":"G","text":"影像学评估病灶未见明显缩小，疗效评价为疾病稳定（SD），重新定位更改放疗靶区并提高局部照射剂量，同时予羟考酮镇痛及静脉营养支持。","is_gold":false},{"letter":"H","text":"影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，立即行经皮内镜下胃造瘘术（PEG）以保证肠内营养。","is_gold":false},{"letter":"I","text":"影像学评估病灶完全消失，疗效评价为完全缓解（CR），提前终止放疗，进入随访观察期，对咽痛继续予羟考酮镇痛。","is_gold":false},{"letter":"J","text":"影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；放疗已达26次且肿瘤退缩，同步加用西妥昔单抗以增强局部控制，并予静脉营养支持。","is_gold":false},{"letter":"K","text":"影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，静脉大剂量使用糖皮质激素以快速减轻炎症反应。","is_gold":false},{"letter":"L","text":"影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；出现3度放射性口腔黏膜炎，将后续放疗改为姑息性低剂量放疗，并予羟考酮镇痛。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 双侧耳鸣2年，发现右颈肿物3天；现病史: 患者2年前无明显诱因间断出现双侧耳鸣，近2周自觉右侧耳鸣症状加重，无鼻塞、涕血等不适。今为进一步诊治收入我院。起病以来，患者无发热、咳嗽，无胸闷、胸痛，无恶心、呕吐，胃纳、睡眠、精神可，大小便正常，体重无明显变化。；阳性症状体征: 双耳鸣,右颈部肿物,右耳鸣；既往史: 10+年前因“腰椎间盘突出”行手术治疗，并予输血，无“输血反应”。否认\"肝炎\"、\"结核\"、\"高血压\"、\"糖尿病\"等疾病史；无外伤病史。过敏史:否认药物、食物过敏史。；个人史: 原籍出生、长大，无疫水、疫区暴露史；无吸烟、酗酒等不良嗜好。；家族史: 否认家族其他成员有肿瘤病史及遗传病史。；体格检查: T：36.0℃ P：81bpm R：18bpm BP：111/76mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。牙龈无肿胀、出血，咽无充血，双扁桃体无肿大。颈部检查详见肿瘤专科 检查。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率81bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。；KPS: 90；ECOG:\n- [全程D0] 入院记录: 主诉: 双侧耳鸣2年，发现右颈肿物3天；现病史: 患者2年前无明显诱因间断出现双侧耳鸣，近2周自觉右侧耳鸣症状加重，无鼻塞、涕血等不适。3天前无明显诱因发现右颈部肿物，遂就诊外院行CT检查示：鼻咽右侧壁增厚，考虑鼻咽癌可能，伴右侧乳突阻塞性炎症。今为进一步诊治收入我院。起病以来，患者无发热、咳嗽，无胸闷、胸痛，无恶心、呕吐，胃纳、睡眠、精神可，大小便正常，体重无明显变化。；阳性症状体征: 双耳鸣,右颈部肿物,右耳鸣；既往史: 10+年前因“腰椎间盘突出”行手术治疗，并予输血，无“输血反应”。否认\"肝炎\"、\"结核\"、\"高血压\"、\"糖尿病\"等疾病史；无外伤病史。过敏史:否认药物、食物过敏史。；个人史: 原籍出生、长大，无疫水、疫区暴露史；无吸烟、酗酒等不良嗜好。；家族史: 否认家族其他成员有肿瘤病史及遗传病史。；体格检查: T：36.0℃ P：81bpm R：18bpm BP：111/76mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。牙龈无肿胀、出血，咽无充血，双扁桃体无肿大。颈部检查详见肿瘤专科 检查。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率81bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。肛门外生殖器未见异常，生理反射存在，病理反射未引出。；专科检查: 间接鼻咽镜检查见双侧鼻腔通畅，内未窥及明显肿物；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显斑片或结节影。双侧肺门影未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见明显病变。\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 间接胆红素(IBIL)-静脉血: 9.6umolL；尿胆原(URO)-尿液: -（参考: 阴性）；钾离子(K+)-静脉血: 4mmol/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；总胆固醇(TC)-静脉血: 6.89mmol/L；肿瘤特异性生长因子(TSGF)-静脉血: 32U/mL；红细胞计数(RBC#)-静脉血: 4.9610E12/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.5U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.3pg；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 13.4umol/L；总蛋白(TP)-尿液: -（参考: 阴性）；血小板计数(PLT#)-静脉血: 319.310E9/L；比重(SG)-尿液: LAMPL.；凝血酶原时间活动度(PTA)-静脉血: 113.8%；直接胆红素(DBIL)-静脉血: 3.8umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-静脉血: 10.310E9/L；平均血小板体积(MPV)-静脉血: 7.46fL；镁离子(Mg2+)-静脉血: 0.98mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.310E9/L；鳞状细胞癌相关抗原(SCC)-静脉血: 0.4ng/ml；低密度脂蛋白胆固醇(LDL-C)-静脉血: 5.13mmol/L；血小板比容-静脉血: 23.8%；Rh血型-静脉血: 阳性；总前列腺特异性抗原(TPSA)-静脉血: 1ng/ml；神经元特异性烯醇化酶(NSE)-静脉血: 12.85ng/ml；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；游……\n- [全程D2] 检验组合: CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 0.8%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 3%；CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 24.9%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 9.8%；CD3+T淋巴细胞百分比-静脉血: 60.3%；CD4+/CD8+辅助/抑制T淋巴细胞比值(Th/Ts比值)-静脉血: 1.7；CD3-CD16+CD56+自然杀伤细胞百分比(NK%)-静脉血: 15.5%；CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 3.1%；CD3+CD4+辅助/诱导T淋巴细胞百分比(Th/Ti%)-静脉血: 29%；CD19+B淋巴细胞百分比-静脉血: 23%；CD3+CD8+抑制/细胞毒T淋巴细胞百分比(Ts/Tc%)-静脉血: 18.4%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 27.7%\n- [全程D7] 超声；双侧颈部、锁骨上区淋巴结彩超(套): 检查类型: 超声；检查名称: 双侧颈部、锁骨上区淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉内径约14mm，门静脉最大血流速度约17cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约44×36×33mm，包膜光滑，实质回声不均匀，可见强回声斑。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 前列腺钙化。 胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D7] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 右侧颈部II区可见数个淋巴结回声，最大约23×12mm，椭圆形，边界清，皮髓质分界不清，未见淋巴门。余右侧颈部未见明确异常淋巴结。 CDFI：上述最大淋巴结内可见周边型血流信号。 左侧颈部及锁骨上区未见明确异常淋巴结回声。；检查结论: 右侧颈部II区淋巴结，恶性待排，建议穿刺活检。 左侧颈部及锁骨上区未见明确异常淋巴结声像。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D24] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽右顶壁及右侧壁粘膜增厚放射性浓聚，SUV约16.7，病灶累及右翼突基底部及内侧板、右侧腭帆张提肌。右侧咽隐窝消失，左侧咽隐窝存在。双侧咽后未见肿大淋巴结及异常放射性分布。口咽、喉咽未见异常。筛窦、左上颌窦及右乳突内低密度影放射性稀疏；额窦、蝶窦、右上颌窦及左乳突结构及放射性分布未见明显异常。双侧海绵窦放射性分布未见明显异常。甲状腺结构及放射性分布未见明显异常。右颈II区数个淋巴结放射性浓聚，SUV约18.0，大者约1.5×2.2cm；余双颈小淋巴结放射性分布未见异常。 所见脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔主肺动脉窗小淋巴结放射性分布未见明显异常，大小约0.9×1.0cm。双肺门未见肿大淋巴结及异常放射性分布。双侧腋窝小淋巴结放射性未见明显异常。 肝脏密度减低，CT值约36Hu（脾脏CT值约56Hu），结构及放射性分布未见异常；肝门区未见占位及异常放射性分布。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。左肾上腺体部小结节影放射性略浓密，大小约1.0×1.1cm。脾脏、双肾、右肾上腺及胰腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺大小正常，内见数个点状钙化灶。膀胱及肠管形态、结构及放射性分布未见明显异常。双髂血管旁及双侧腹股沟未见肿大淋巴结及异常放射性分布。 颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，病灶累及右翼突基底部及内侧板、右侧腭帆张提肌；右颈II区数个淋巴结代谢活跃，考虑转移。 左肾上腺体部小结节代谢稍活跃，疑良性增生病变。 前列腺多发钙化灶。 脂肪肝。 副鼻窦炎症；右乳突炎症。\n- [全程D28] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T6上缘水平，估计导管末端位于上腔静脉上段内。；检查结论: PICC管末端位置如上述。\n- [全程D28] 检验组合: 红细胞计数(RBC#)-静脉血: 4.710E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7；钾离子(K+)-静脉血: 4.2mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 32.3U/L；尿素氮(BUN)-静脉血: 8.2mmol/L；间接胆红素(IBIL)-静脉血: 6.2umolL；氯离子(Cl-)-静脉血: 100.2mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 326g/L；红细胞比容(Hct)-静脉血: 43.5%；总胆固醇(TC)-静脉血: 5.88mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 22.9U/L；载脂蛋白AI(apoAI)-静脉血: 1.32g/L；血小板比容-静脉血: 32%；葡萄糖(Glu)-静脉血: 5.95mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.8mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.2pg；乳酸脱氢酶(LDH)-静脉血: 159.8U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.279；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.67；白细胞计数(WBC#)-静脉血: 10.7710E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 16.9U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.99mmol/L；中性粒细胞计数(Neut#)-静脉血: 6.410E9/L；平均红细胞体积(MCV)-静脉血: 92.6fL；平均血小板体积(MPV)-静脉血: 9.2fL；总胆红素(TBIL)-静脉血: 8.6umol/L；血小板分布宽度(PDW)-静脉血: 10%；磷(P)-静脉血: 1.6mmol/L；肌酐(Crea)-静脉血: 64.4umol/L；血小板计数(PLT#)-静脉血: 34410E9/L；C-反应蛋白(CRP)-静脉血: 3.29mg/L；碱性磷酸酶(ALP)-静脉血: 102.6U/L；白蛋白(ALB)-静脉血: 46.3g/L；淋巴细胞计数(Lymph#)-静脉血: 310E9/L；单核细胞计数(Mono#)-静脉血: 0.810E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 54U/L；大血小板百分比(P-LCR%)-静脉血: 18.4%；单核细胞百分比(Mono%)-静……\n- [全程D29] 检验组合: 隐血(OB)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；淀粉样蛋白A(SAA)-静脉血: 3.65mg/L；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；白细胞计数(WBC#)-尿液: 7/μL；比重(SG)-尿液: 1.027；总蛋白(TP)-尿液: +- 0.2g（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；葡萄糖(Glu)-尿液: 3+ 17mmol（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 80/μL\n- [全程D30] 检验组合: 颜色-尿液: Yellow；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 13/μL；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 6；总蛋白(TP)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.023\n- [全程D35] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.7；单核细胞计数(Mono#)-静脉血: 0.810E9/L；甘油三酯(TG)-静脉血: 2.15mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；载脂蛋白AI(apoAI)-静脉血: 1.26g/L；中性粒细胞百分比(Neut%)-静脉血: 0.702；葡萄糖(Glu)-静脉血: 6.03mmol/L；尿素氮(BUN)-静脉血: 7.02mmol/L；直接胆红素(DBIL)-静脉血: 4.8umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20U/L；C-反应蛋白(CRP)-静脉血: 2.65mg/L；乳酸脱氢酶(LDH)-静脉血: 166.9U/L；红细胞计数(RBC#)-静脉血: 4.7510E12/L；总胆汁酸(TBA)-静脉血: 1.5umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；总蛋白(TP)-静脉血: 71.69g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；肌酐(Crea)-静脉血: 69.7umol/L；总钙(Ca)-静脉血: 2.31mmol/L；白细胞计数(WBC#)-静脉血: 7.4610E9/L；镁离子(Mg2+)-静脉血: 1mmol/L；平均红细胞体积(MCV)-静脉血: 88.8fL；总胆固醇(TC)-静脉血: 5.15mmol/L；磷(P)-静脉血: 1.3mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；总胆红素(TBIL)-静脉血: 15umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；阴离子间隙(AG)-静脉血: 17；间接胆红素(IBIL)-静脉血: 10.2umolL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.18mmolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4；球蛋白(GLO)-静脉血: 26.39g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.168；血小板分布宽度(PDW)-静脉血: 9.8%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.015；血红蛋白(Hb)-静脉血: 141g/L；淋巴细胞计数(L……\n- [全程D49] 检验组合: 丙氨酸氨基转移酶(ALT)-静脉血: 18.4U/L；球蛋白(GLO)-静脉血: 27.24g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；γ-谷氨酰基转移酶(GGT)-静脉血: 42U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 16.9U/L；平均红细胞体积(MCV)-静脉血: 90.3fL；血小板比容-静脉血: 11.8%；血小板分布宽度(PDW)-静脉血: 16.8%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；钠离子(Na+)-静脉血: 138mmol/L；平均血小板体积(MPV)-静脉血: 6.76fL；总胆汁酸(TBA)-静脉血: 2.9umol/L；载脂蛋白B(apoB)-静脉血: 1.36g/L；总钙(Ca)-静脉血: 2.22mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.16g/L；红细胞计数(RBC#)-静脉血: 4.3410E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.019；血红蛋白(Hb)-静脉血: 133.6g/L；阴离子间隙(AG)-静脉血: 15.6；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；C-反应蛋白(CRP)-静脉血: 10.3mg/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.6mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.17；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.87mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9%；淀粉样蛋白A(SAA)-静脉血: 24.6mg/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.7pg；甘油三酯(TG)-静脉血: 2.36mmol/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；总蛋白(TP)-静脉血: 71.04g/L；碱性磷酸酶(ALP)-静脉血: 108.1U/L；总胆固醇(TC)-静脉血: 5.6mmol/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.104；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.92；平均红细胞血红蛋白浓度(MCHC)-静脉血: 340.7g/……\n- [全程D55] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位置位于第3胸椎体右下缘，估计位于右侧头臂静脉内。；检查结论: PICC管末端位置如上所述。\n- [全程D55] 检验组合: 葡萄糖(Glu)-尿液: +- 2.8mmol（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: 1+ 0.3g（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 3/μL；白细胞计数(WBC#)-尿液: 20/μL；酸碱度(pH)-尿液: 5.5；颜色-尿液: Yellow；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: +- 0.1g（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；比重(SG)-尿液: 1.021；红细胞计数(RBC#)-尿液: 2/μL；红细胞计数(RBC#)-尿液: 2/μL；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.025；浊度(TRUB)-尿液: 清亮；粘液丝计数(MUCS#)-尿液: 80/μL；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；葡萄糖(Glu)-尿液: 3+ 17mmol（参考: 阴性）；白细胞计数(WBC#)-尿液: 4/μL\n- [全程D63] 检验组合: 红细胞计数(RBC#)-静脉血: 3.910E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞计数(Neut#)-静脉血: 5.210E9/L；阴离子间隙(AG)-静脉血: 16.2；尿酸(UA)-静脉血: 364.7umol/L；钠离子(Na+)-静脉血: 132.6mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；球蛋白(GLO)-静脉血: 26.68g/L；单核细胞计数(Mono#)-静脉血: 1.110E9/L；葡萄糖(Glu)-静脉血: 4.06mmol/L；单核细胞百分比(Mono%)-静脉血: 0.166；平均血小板体积(MPV)-静脉血: 8.1fL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；尿素氮(BUN)-静脉血: 7.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 20.7U/L；白细胞计数(WBC#)-静脉血: 6.6710E9/L；甘油三酯(TG)-静脉血: 1.04mmol/L；氯离子(Cl-)-静脉血: 93.2mmol/L；磷(P)-静脉血: 1.24mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.2mmol/L；平均红细胞体积(MCV)-静脉血: 89.2fL；总胆汁酸(TBA)-静脉血: 0.9umol/L；载脂蛋白B(apoB)-静脉血: 1.28g/L；总钙(Ca)-静脉血: 2.2mmol/L；镁离子(Mg2+)-静脉血: 1.01mmol/L；红细胞比容(Hct)-静脉血: 34.8%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；乳酸脱氢酶(LDH)-静脉血: 151.8U/L；间接胆红素(IBIL)-静脉血: 9umolL；载脂蛋白AI(apoAI)-静脉血: 0.91g/L；总胆红素(TBIL)-静脉血: 12.8umol/L；大血小板百分比(P-LCR%)-静脉血: 9.3%；中性粒细胞百分比(Neut%)-静脉血: 0.782；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；血小板分布宽度(PDW)-静脉血: 8%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.1；碱性磷酸酶(ALP)-静脉血: 113.9U/L；平均红……\n- [全程D69] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌治疗后，与某次就诊时间0日片对比: 鼻咽腔未见明显狭窄，鼻咽顶后壁、右侧壁轻度增厚，见少许软组织影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，右侧咽隐窝消失。鼻咽左侧壁未见明显增厚，左侧咽隐窝稍浅。右侧咽旁脂肪间隙稍变窄，左侧咽旁脂肪间隙未见异常。 右侧腭帆提张肌信号不均匀，左侧腭帆提张肌、双侧头长肌未见受侵征象。 双侧翼腭窝、上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 口咽双侧壁未见受累增厚，病变未累及双侧后鼻孔。 右侧翼突内份及内板、蝶骨基底部右份骨质信号减低，增强扫描轻度强化，范围较前缩小。余颅底未见明确骨质破坏征象。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦、右侧乳突粘膜增厚，双侧上颌窦见少量分泌物，蝶窦、左侧乳突充气良好，骨壁完整。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 右侧咽后淋巴结短径约6mm，较前缩小。左侧咽后未见肿大淋巴结。 右颈IIb区见稍大淋巴结，较大者短径约7mm，增强扫描明显强化，较前缩小。双颈IIa区见数个小淋巴结，较大者短径约5mm，增强扫描轻度强化，大致同前。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 扫描所见脑实质未见明显异常。；检查结论: 鼻咽癌治疗后，与某次就诊时间0日片对比: 鼻咽病变较前缩小。 颅底骨质破坏，较前有修复。 右侧咽后肿大淋巴结，考虑转移，较前缩小。 右颈IIb区淋巴结肿大，考虑转移，较前缩小。 双颈IIa区小淋巴结。 副鼻窦炎，右侧乳突炎。\n- [全程D69] 检验组合: 直接胆红素(DBIL)-静脉血: 3.2umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.033；阴离子间隙(AG)-静脉血: 16.9；白细胞计数(WBC#)-静脉血: 3.510E9/L；总胆红素(TBIL)-静脉血: 11.7umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 24.1U/L；尿酸(UA)-静脉血: 468.3umol/L；白蛋白(ALB)-静脉血: 39.4g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.016；红细胞比容(Hct)-静脉血: 33.6%；磷(P)-静脉血: 1.09mmol/L；C-反应蛋白(CRP)-静脉血: 20.73mg/L；载脂蛋白B(apoB)-静脉血: 1.37g/L；葡萄糖(Glu)-静脉血: 4.3mmol/L；单核细胞百分比(Mono%)-静脉血: 0.112；血小板比容-静脉血: 15.3%；肌酐(Crea)-静脉血: 62.2umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4%；碱性磷酸酶(ALP)-静脉血: 92.8U/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.9mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.57；总蛋白(TP)-静脉血: 64.43g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.86；淋巴细胞计数(Lymph#)-静脉血: 0.110E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；球蛋白(GLO)-静脉血: 25.03g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 36.2U/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.839；甘油三酯(TG)-静脉血: 1.02mmol/L；间接胆红素(IBIL)-静脉血: 8.5umolL；丙氨酸氨基转移酶(ALT)-静脉血: 16.3U/L；血小板计数(PLT#)-静脉血: 266.210E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.27mmol/L；平均血小板体积(MPV)-静脉血: 5.77fL；胱抑素(Cys-C)-静脉血: 0.73mg/L；尿素氮(BUN)-静脉血: 5mmol/L；血小板分布宽度(PDW)-静脉……\n- [全程D70] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质回声均匀，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉内径约11mm，门静脉最大血流速度约23cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约40×35×31mm，包膜光滑，实质回声不均匀，可见强回声斑。 腹主动脉旁未见明确肿物回声。；检查结论: 前列腺钙化。 肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D9] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，无发热、涕血等不适症状。查体：生命体征平稳。电子喉镜检查示：鼻咽右隆突肿物，符合鼻咽癌。并取肿物活检，等待病理结果。[姓名已隐去]副教授示，结合患者病情及相关检查，诊断考虑鼻咽癌可能性大，明确诊断，予鼻咽科进一步诊治。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D15] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：KPS 90分；鼻咽右侧壁、顶后壁结节状肿物，右颈Ⅱ区可扪及已肿大淋巴结，大小约2*1cm，颅神经检查（-）。今日[姓名已隐去]医生信息已隐藏后示：患者已完善相关检查，并预约放疗，今日可结账出院，嘱出院后按时[计划性表述已隐藏]放化综合治疗，不适随诊。\n- [全程D29] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者放疗1次。患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：基本同前。今日[姓名已隐去]副医生信息已隐藏后示：患于今日行第一程DDP方案化疗（100mg/m2）。继续放疗，续观。\n- [全程D34] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：KPS 90分； 间接鼻咽镜检查见双侧鼻腔通畅，内未窥及明显肿物；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。复查血常规、生化常规未见明显异常。今日[姓名已隐去]医生信息已隐藏后示：患者已结束第一程同时期DDP方案化疗（100mg/m2），治疗过程顺利，今日可结账出院，嘱出院后继续在门诊放疗，每周复查血常规、肝肾功能，并按时[计划性表述已隐藏]下一程治疗，不适随诊。\n- [全程D54] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者放疗16次，口腔黏膜反应2度，放射性皮炎1度，患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：KPS 90分；张口门齿距4.5cm，鼻咽顶后壁、右侧壁肿物，较前缩小；右颈II区扪及一肿大淋巴结，大小约1X1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。颅神经检查：阴性。今日[姓名已隐去]副医生信息已隐藏后示：今日开始行第2程同时期DDP方案（DDP100mg/m2）化疗，继续放疗，续观。\n- [全程D64] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者放疗22次，口腔黏膜反应2度，放射性皮炎1度，患者诉喉痛，余未诉特殊不适。生命体征平稳。查体：KPS 90分；张口门齿距4.5cm，鼻咽顶后壁、右侧壁肿物，较前缩小；双颈未触及肿大淋巴结；颅神经检查：阴性。今日[姓名已隐去]副医生信息已隐藏后示：患者诉喉痛，予患者奥施康定止痛，继续放疗，续观。\n- [全程D69] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者放疗26次，口腔黏膜反应3度，放射性皮炎2度，患者诉喉痛，余未诉特殊不适。生命体征平稳。查体：KPS 90分；张口门齿距4.5cm，鼻咽肿物已不明显；双颈未触及肿大淋巴结；颅神经检查：阴性。今日[姓名已隐去]医生信息已隐藏后示：患者诉喉痛，继续予患者奥施康定止痛，继续放疗，续观。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 影像学评估病灶较前缩小，疗效肯定，需暂停放疗，待3度放射性口腔黏膜炎恢复至1度后再恢复放疗，期间予静脉营养支持。\nB. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，局部使用含漱液及非甾体类抗炎药镇痛，停用阿片类药物。\nC. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎伴咽痛，继续予羟考酮镇痛及静脉营养支持，并常规行PICC导管护理。\nD. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，行预防性气管切开以防气道水肿梗阻，并予静脉营养支持。\nE. 影像学评估病灶较前缩小，疗效肯定，已完成26次放疗且出现3度黏膜炎，提前结束放疗并转为辅助化疗，同时予羟考酮镇痛。\nF. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，拔除PICC导管以预防导管相关性血流感染，改用外周静脉营养。\nG. 影像学评估病灶未见明显缩小，疗效评价为疾病稳定（SD），重新定位更改放疗靶区并提高局部照射剂量，同时予羟考酮镇痛及静脉营养支持。\nH. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，立即行经皮内镜下胃造瘘术（PEG）以保证肠内营养。\nI. 影像学评估病灶完全消失，疗效评价为完全缓解（CR），提前终止放疗，进入随访观察期，对咽痛继续予羟考酮镇痛。\nJ. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；放疗已达26次且肿瘤退缩，同步加用西妥昔单抗以增强局部控制，并予静脉营养支持。\nK. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，静脉大剂量使用糖皮质激素以快速减轻炎症反应。\nL. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；出现3度放射性口腔黏膜炎，将后续放疗改为姑息性低剂量放疗，并予羟考酮镇痛。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D70] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质回声均匀，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉内径约11mm，门静脉最大血流速度约23cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约40×35×31mm，包膜光滑，实质回声不均匀，可见强回声斑。 腹主动脉旁未见明确肿物回声。；检查结论: 前列腺钙化。 肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 影像学评估病灶较前缩小，疗效肯定，需暂停放疗，待3度放射性口腔黏膜炎恢复至1度后再恢复放疗，期间予静脉营养支持。\nB. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，局部使用含漱液及非甾体类抗炎药镇痛，停用阿片类药物。\nC. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎伴咽痛，继续予羟考酮镇痛及静脉营养支持，并常规行PICC导管护理。\nD. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，行预防性气管切开以防气道水肿梗阻，并予静脉营养支持。\nE. 影像学评估病灶较前缩小，疗效肯定，已完成26次放疗且出现3度黏膜炎，提前结束放疗并转为辅助化疗，同时予羟考酮镇痛。\nF. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，拔除PICC导管以预防导管相关性血流感染，改用外周静脉营养。\nG. 影像学评估病灶未见明显缩小，疗效评价为疾病稳定（SD），重新定位更改放疗靶区并提高局部照射剂量，同时予羟考酮镇痛及静脉营养支持。\nH. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，立即行经皮内镜下胃造瘘术（PEG）以保证肠内营养。\nI. 影像学评估病灶完全消失，疗效评价为完全缓解（CR），提前终止放疗，进入随访观察期，对咽痛继续予羟考酮镇痛。\nJ. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；放疗已达26次且肿瘤退缩，同步加用西妥昔单抗以增强局部控制，并予静脉营养支持。\nK. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，静脉大剂量使用糖皮质激素以快速减轻炎症反应。\nL. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；出现3度放射性口腔黏膜炎，将后续放疗改为姑息性低剂量放疗，并予羟考酮镇痛。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 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电子鼻咽镜及鼻咽活检，鼻咽及颈部MRI平扫，腹部彩超，胸部CT平扫，基线血液学检查。\nH. 颈部淋巴结切除活检，鼻咽及颈部CT平扫+增强，腹部彩超，心电图，包含EBV抗体的基线血液学检查。\nI. 电子鼻咽镜及鼻咽活检，头颈部PET-CT，腹部及盆腔MRI平扫+增强，心电图，基线血液学检查。\nJ. 电子鼻咽镜及鼻咽活检，鼻咽及颈部MRI平扫+增强，常规心电图及血液学检查，并直接安排诱导化疗。\nK. 鼻咽刷片细胞学检查，鼻咽及颈部MRI平扫+增强，胸腹部彩超，全身骨扫描，基线血液学检查。\nL. 电子鼻咽镜及鼻咽活检，鼻咽及颈部CT平扫，全身骨扫描，腹部彩超，心电图，基线血液学检查。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、鼻腔、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现右颈部肿块伴耳鸣、听力下降4个月。；现病史: 缘于4个月前患者无意中发现右颈部包块，如拇指大小，无压痛，伴耳鸣、听力下降，颈部包块后逐渐增大，近1周偶发头痛，白天明显，视物如常，无鼻塞、鼻血、面麻、等不适。为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,鼻咽肿物,右颈部包块,头痛；既往史: 4年前患痔疮，已治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:青霉素皮试阳性。；个人史: 长期居于原籍，无疫区居住史。吸烟3-4支/天*10年，饮酒1-2次/月。否认不洁性生活史。；家族史: 舅舅患鼻咽癌，舅妈患肺癌。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：103/73mmHg,Ht：174cm，Wt：79kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；右颈IIa区可扪及1个淋巴结，最大径2.5×2.5cm，左颈IIa区扪及1个淋巴结，最大径约3*3cm，无融合，质地韧，边界模糊，活动度好，无压痛，无皮肤浸润，无溃疡，右颈III区可见一长约4cm手术疤痕；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 电子鼻咽镜及鼻咽活检，鼻咽及颈部CT平扫+增强，胸部X线片，腹部彩超，基线血液学检查。\nB. 颈部淋巴结细针穿刺活检，鼻咽及颈部MRI平扫+增强，胸腹部CT平扫+增强，全身骨扫描。\nC. 全身PET-CT检查，电子鼻咽镜及鼻咽活检，头颅MRI平扫+增强，常规心电图及血液学检查。\nD. 电子鼻咽镜及鼻咽活检，鼻咽及颈部MRI平扫+增强，腹部及浅表淋巴结彩超，心电图，包含EBV抗体的基线血液学检查。\nE. 电子鼻咽镜检查，鼻咽及颈部MRI平扫+增强，胸腹部CT平扫+增强，待影像学评估后再决定是否活检。\nF. 鼻咽及颈部MRI平扫+增强，胸腹部CT平扫+增强，全身骨扫描，基线血液学检查。\nG. 电子鼻咽镜及鼻咽活检，鼻咽及颈部MRI平扫，腹部彩超，胸部CT平扫，基线血液学检查。\nH. 颈部淋巴结切除活检，鼻咽及颈部CT平扫+增强，腹部彩超，心电图，包含EBV抗体的基线血液学检查。\nI. 电子鼻咽镜及鼻咽活检，头颈部PET-CT，腹部及盆腔MRI平扫+增强，心电图，基线血液学检查。\nJ. 电子鼻咽镜及鼻咽活检，鼻咽及颈部MRI平扫+增强，常规心电图及血液学检查，并直接安排诱导化疗。\nK. 鼻咽刷片细胞学检查，鼻咽及颈部MRI平扫+增强，胸腹部彩超，全身骨扫描，基线血液学检查。\nL. 电子鼻咽镜及鼻咽活检，鼻咽及颈部CT平扫，全身骨扫描，腹部彩超，心电图，基线血液学检查。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、鼻腔、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现右颈部肿块伴耳鸣、听力下降4个月。；现病史: 缘于4个月前患者无意中发现右颈部包块，如拇指大小，无压痛，伴耳鸣、听力下降，颈部包块后逐渐增大，近1周偶发头痛，白天明显，视物如常，无鼻塞、鼻血、面麻、等不适。为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,鼻咽肿物,右颈部包块,头痛；既往史: 4年前患痔疮，已治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:青霉素皮试阳性。；个人史: 长期居于原籍，无疫区居住史。吸烟3-4支/天*10年，饮酒1-2次/月。否认不洁性生活史。；家族史: 舅舅患鼻咽癌，舅妈患肺癌。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：103/73mmHg,Ht：174cm，Wt：79kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；右颈IIa区可扪及1个淋巴结，最大径2.5×2.5cm，左颈IIa区扪及1个淋巴结，最大径约3*3cm，无融合，质地韧，边界模糊，活动度好，无压痛，无皮肤浸润，无溃疡，右颈III区可见一长约4cm手术疤痕；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 电子鼻咽镜及鼻咽活检，鼻咽及颈部CT平扫+增强，胸部X线片，腹部彩超，基线血液学检查。\nB. 颈部淋巴结细针穿刺活检，鼻咽及颈部MRI平扫+增强，胸腹部CT平扫+增强，全身骨扫描。\nC. 全身PET-CT检查，电子鼻咽镜及鼻咽活检，头颅MRI平扫+增强，常规心电图及血液学检查。\nD. 电子鼻咽镜及鼻咽活检，鼻咽及颈部MRI平扫+增强，腹部及浅表淋巴结彩超，心电图，包含EBV抗体的基线血液学检查。\nE. 电子鼻咽镜检查，鼻咽及颈部MRI平扫+增强，胸腹部CT平扫+增强，待影像学评估后再决定是否活检。\nF. 鼻咽及颈部MRI平扫+增强，胸腹部CT平扫+增强，全身骨扫描，基线血液学检查。\nG. 电子鼻咽镜及鼻咽活检，鼻咽及颈部MRI平扫，腹部彩超，胸部CT平扫，基线血液学检查。\nH. 颈部淋巴结切除活检，鼻咽及颈部CT平扫+增强，腹部彩超，心电图，包含EBV抗体的基线血液学检查。\nI. 电子鼻咽镜及鼻咽活检，头颈部PET-CT，腹部及盆腔MRI平扫+增强，心电图，基线血液学检查。\nJ. 电子鼻咽镜及鼻咽活检，鼻咽及颈部MRI平扫+增强，常规心电图及血液学检查，并直接安排诱导化疗。\nK. 鼻咽刷片细胞学检查，鼻咽及颈部MRI平扫+增强，胸腹部彩超，全身骨扫描，基线血液学检查。\nL. 电子鼻咽镜及鼻咽活检，鼻咽及颈部CT平扫，全身骨扫描，腹部彩超，心电图，基线血液学检查。\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-cef4654d5f291c72b760bfcf","patient_id":"patient-f25e20b1e5c6eea840d4cc21","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"E","gold_action":"行鼻咽镜下活检明确病理，并补充胸部CT、全身骨扫描及血清EBV DNA检测。","options":[{"letter":"A","text":"安排适形调强放射治疗（IMRT）及同步化疗","is_gold":false},{"letter":"B","text":"行鼻咽镜下活检，并补充头颅PET-MR评估颅底受侵范围","is_gold":false},{"letter":"C","text":"行右颈部淋巴结细针穿刺活检，并补充胸部CT及全身骨扫描","is_gold":false},{"letter":"D","text":"行鼻咽镜下活检，并补充腹部增强CT排查肝脏转移","is_gold":false},{"letter":"E","text":"行鼻咽镜下活检，并补充胸部CT、全身骨扫描及血清EBV DNA检测","is_gold":true},{"letter":"F","text":"行鼻咽镜下活检，直接进行放疗定位及靶区勾画","is_gold":false},{"letter":"G","text":"行全身PET-CT进行分期，随后开始诱导化疗","is_gold":false},{"letter":"H","text":"行鼻咽镜下活检，并补充颈部超声评估淋巴结包膜外侵犯","is_gold":false},{"letter":"I","text":"行鼻咽镜下活检，并补充胸部X线及头颅CT平扫","is_gold":false},{"letter":"J","text":"行鼻咽镜下活检，并补充骨髓穿刺排除骨髓转移","is_gold":false},{"letter":"K","text":"行鼻咽镜下活检，并补充全身骨扫描，暂缓胸部影像学检查","is_gold":false},{"letter":"L","text":"行右颈部淋巴结切除活检，并补充胸部CT及血清EBV DNA检测","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、鼻腔、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现右颈部肿块伴耳鸣、听力下降4个月。；现病史: 缘于4个月前患者无意中发现右颈部包块，如拇指大小，无压痛，伴耳鸣、听力下降，颈部包块后逐渐增大，近1周偶发头痛，白天明显，视物如常，无鼻塞、鼻血、面麻、等不适。为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,鼻咽肿物,右颈部包块,头痛；既往史: 4年前患痔疮，已治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:青霉素皮试阳性。；个人史: 长期居于原籍，无疫区居住史。吸烟3-4支/天*10年，饮酒1-2次/月。否认不洁性生活史。；家族史: 舅舅患鼻咽癌，舅妈患肺癌。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：103/73mmHg,Ht：174cm，Wt：79kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；右颈IIa区可扪及1个淋巴结，最大径2.5×2.5cm，左颈IIa区扪及1个淋巴结，最大径约3*3cm，无融合，质地韧，边界模糊，活动度好，无压痛，无皮肤浸润，无溃疡，右颈III区可见一长约4cm手术疤痕；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 电轴左偏(轻度) 正常范围心电图\n- [全程D1] 检验组合: 血小板比容-静脉血: 19%；载脂蛋白B(apoB)-静脉血: 1.03g/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；肌酐(Crea)-静脉血: 66.2umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.1；球蛋白(GLO)-静脉血: 31.61g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.011；尿胆原(URO)-尿液: -（参考: 阴性）；红细胞比容(Hct)-静脉血: 48.9%；凝血酶原时间活动度(PTA)-静脉血: 111.2%；隐血(OB)-粪便: 阴性（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.91mg/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；碱性磷酸酶(ALP)-静脉血: 76.3U/L；载脂蛋白AI(apoAI)-静脉血: 1.04g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；葡萄糖(Glu)-静脉血: 4.96mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.5；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；血小板分布宽度(PDW)-静脉血: 13.9%；淋巴细胞百分比(Lymph%)-静脉血: 0.315；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；总胆红素(TBIL)-静脉血: 7umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.910E9/L；Rh血型-静脉血: 阳性；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.2sec.；酮体(KET)-尿液: -（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 21.9mmol/L；浊度(TRUB)-尿液: 清亮；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 4.88mmol/L；C-反应蛋白(C……\n- [全程D3] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D7] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及双侧壁增厚，以右侧为著，T1WI呈等信号，T2WI呈稍高信号，增强扫描强化明显，右侧咽隐窝消失，见增厚组织占据，左侧咽隐窝变浅。病变与右侧中鼻甲分界不清，口咽双侧壁未见增厚。 右侧咽旁间隙及右侧咽后间隙见不规则肿物突入。双侧腭帆提肌、右侧腭帆张肌、右侧头长肌受侵。左侧腭帆张肌、双侧翼内肌及双侧翼外肌未见受侵。 右侧翼腭窝内见少许软组织信号，增强扫描明显强化。 左侧翼腭窝、双侧上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 斜坡、蝶骨基底部、右侧翼突基底部及内外板、右侧蝶骨大翼及右侧岩尖骨质信号减低，增强扫描见不均匀强化。 右侧破裂扩大，右侧海绵窦增宽，内见不规则软组织信号灶，右侧蝶窦内见软组织信号灶突入，增强扫描上述病变强化明显。 左侧海绵窦未见增宽。蝶鞍形态正常，其内未见占位性病变。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧上颌窦、筛窦及蝶窦粘膜增厚。右侧乳突内见大量分泌物。 右侧咽后见肿大淋巴结，大者约12mm×17mm，增强扫描强化明显。双颈II、III、V区见多个肿大淋巴结，最大者约23mm×29mm，部分边界欠清晰，包膜不完整，信号欠均匀，增强扫描明显不均匀强化。双侧腮腺内及腮腺旁见数个淋巴结，大者短径约6mm，增强扫描强化明显。双颈I区见数个淋巴结，大者短径约7mm，信号尚均匀。 甲状腺双叶及峡部、喉咽、双侧颌下腺信号均匀，未见占位性病变。；检查结论: 鼻咽病变，考虑鼻咽癌，侵犯范围如上述。 颅底骨质破坏。 右侧咽后、双颈II、III、V区多发肿大淋巴结，考虑转移。 双侧腮腺内及腮腺旁数个淋巴结，性质待定。 鼻窦炎、右侧乳突炎。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 安排适形调强放射治疗（IMRT）及同步化疗\nB. 行鼻咽镜下活检，并补充头颅PET-MR评估颅底受侵范围\nC. 行右颈部淋巴结细针穿刺活检，并补充胸部CT及全身骨扫描\nD. 行鼻咽镜下活检，并补充腹部增强CT排查肝脏转移\nE. 行鼻咽镜下活检，并补充胸部CT、全身骨扫描及血清EBV DNA检测\nF. 行鼻咽镜下活检，直接进行放疗定位及靶区勾画\nG. 行全身PET-CT进行分期，随后开始诱导化疗\nH. 行鼻咽镜下活检，并补充颈部超声评估淋巴结包膜外侵犯\nI. 行鼻咽镜下活检，并补充胸部X线及头颅CT平扫\nJ. 行鼻咽镜下活检，并补充骨髓穿刺排除骨髓转移\nK. 行鼻咽镜下活检，并补充全身骨扫描，暂缓胸部影像学检查\nL. 行右颈部淋巴结切除活检，并补充胸部CT及血清EBV DNA检测\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 电轴左偏(轻度) 正常范围心电图\n- [全程D1] 检验组合: 血小板比容-静脉血: 19%；载脂蛋白B(apoB)-静脉血: 1.03g/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；肌酐(Crea)-静脉血: 66.2umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.1；球蛋白(GLO)-静脉血: 31.61g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.011；尿胆原(URO)-尿液: -（参考: 阴性）；红细胞比容(Hct)-静脉血: 48.9%；凝血酶原时间活动度(PTA)-静脉血: 111.2%；隐血(OB)-粪便: 阴性（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.91mg/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；碱性磷酸酶(ALP)-静脉血: 76.3U/L；载脂蛋白AI(apoAI)-静脉血: 1.04g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；葡萄糖(Glu)-静脉血: 4.96mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.5；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；血小板分布宽度(PDW)-静脉血: 13.9%；淋巴细胞百分比(Lymph%)-静脉血: 0.315；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；总胆红素(TBIL)-静脉血: 7umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.910E9/L；Rh血型-静脉血: 阳性；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.2sec.；酮体(KET)-尿液: -（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 21.9mmol/L；浊度(TRUB)-尿液: 清亮；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 4.88mmol/L；C-反应蛋白(C……\n- [全程D3] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D7] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及双侧壁增厚，以右侧为著，T1WI呈等信号，T2WI呈稍高信号，增强扫描强化明显，右侧咽隐窝消失，见增厚组织占据，左侧咽隐窝变浅。病变与右侧中鼻甲分界不清，口咽双侧壁未见增厚。 右侧咽旁间隙及右侧咽后间隙见不规则肿物突入。双侧腭帆提肌、右侧腭帆张肌、右侧头长肌受侵。左侧腭帆张肌、双侧翼内肌及双侧翼外肌未见受侵。 右侧翼腭窝内见少许软组织信号，增强扫描明显强化。 左侧翼腭窝、双侧上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 斜坡、蝶骨基底部、右侧翼突基底部及内外板、右侧蝶骨大翼及右侧岩尖骨质信号减低，增强扫描见不均匀强化。 右侧破裂扩大，右侧海绵窦增宽，内见不规则软组织信号灶，右侧蝶窦内见软组织信号灶突入，增强扫描上述病变强化明显。 左侧海绵窦未见增宽。蝶鞍形态正常，其内未见占位性病变。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧上颌窦、筛窦及蝶窦粘膜增厚。右侧乳突内见大量分泌物。 右侧咽后见肿大淋巴结，大者约12mm×17mm，增强扫描强化明显。双颈II、III、V区见多个肿大淋巴结，最大者约23mm×29mm，部分边界欠清晰，包膜不完整，信号欠均匀，增强扫描明显不均匀强化。双侧腮腺内及腮腺旁见数个淋巴结，大者短径约6mm，增强扫描强化明显。双颈I区见数个淋巴结，大者短径约7mm，信号尚均匀。 甲状腺双叶及峡部、喉咽、双侧颌下腺信号均匀，未见占位性病变。；检查结论: 鼻咽病变，考虑鼻咽癌，侵犯范围如上述。 颅底骨质破坏。 右侧咽后、双颈II、III、V区多发肿大淋巴结，考虑转移。 双侧腮腺内及腮腺旁数个淋巴结，性质待定。 鼻窦炎、右侧乳突炎。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 安排适形调强放射治疗（IMRT）及同步化疗\nB. 行鼻咽镜下活检，并补充头颅PET-MR评估颅底受侵范围\nC. 行右颈部淋巴结细针穿刺活检，并补充胸部CT及全身骨扫描\nD. 行鼻咽镜下活检，并补充腹部增强CT排查肝脏转移\nE. 行鼻咽镜下活检，并补充胸部CT、全身骨扫描及血清EBV DNA检测\nF. 行鼻咽镜下活检，直接进行放疗定位及靶区勾画\nG. 行全身PET-CT进行分期，随后开始诱导化疗\nH. 行鼻咽镜下活检，并补充颈部超声评估淋巴结包膜外侵犯\nI. 行鼻咽镜下活检，并补充胸部X线及头颅CT平扫\nJ. 行鼻咽镜下活检，并补充骨髓穿刺排除骨髓转移\nK. 行鼻咽镜下活检，并补充全身骨扫描，暂缓胸部影像学检查\nL. 行右颈部淋巴结切除活检，并补充胸部CT及血清EBV DNA检测\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、鼻腔、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 电轴左偏(轻度) 正常范围心电图\n- [全程D1] 检验组合: 血小板比容-静脉血: 19%；载脂蛋白B(apoB)-静脉血: 1.03g/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；肌酐(Crea)-静脉血: 66.2umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.1；球蛋白(GLO)-静脉血: 31.61g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.011；尿胆原(URO)-尿液: -（参考: 阴性）；红细胞比容(Hct)-静脉血: 48.9%；凝血酶原时间活动度(PTA)-静脉血: 111.2%；隐血(OB)-粪便: 阴性（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.91mg/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；碱性磷酸酶(ALP)-静脉血: 76.3U/L；载脂蛋白AI(apoAI)-静脉血: 1.04g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；葡萄糖(Glu)-静脉血: 4.96mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.5；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；血小板分布宽度(PDW)-静脉血: 13.9%；淋巴细胞百分比(Lymph%)-静脉血: 0.315；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；总胆红素(TBIL)-静脉血: 7umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.910E9/L；Rh血型-静脉血: 阳性；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.2sec.；酮体(KET)-尿液: -（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 21.9mmol/L；浊度(TRUB)-尿液: 清亮；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 4.88mmol/L；C-反应蛋白(C……\n- [全程D3] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D7] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及双侧壁增厚，以右侧为著，T1WI呈等信号，T2WI呈稍高信号，增强扫描强化明显，右侧咽隐窝消失，见增厚组织占据，左侧咽隐窝变浅。病变与右侧中鼻甲分界不清，口咽双侧壁未见增厚。 右侧咽旁间隙及右侧咽后间隙见不规则肿物突入。双侧腭帆提肌、右侧腭帆张肌、右侧头长肌受侵。左侧腭帆张肌、双侧翼内肌及双侧翼外肌未见受侵。 右侧翼腭窝内见少许软组织信号，增强扫描明显强化。 左侧翼腭窝、双侧上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 斜坡、蝶骨基底部、右侧翼突基底部及内外板、右侧蝶骨大翼及右侧岩尖骨质信号减低，增强扫描见不均匀强化。 右侧破裂扩大，右侧海绵窦增宽，内见不规则软组织信号灶，右侧蝶窦内见软组织信号灶突入，增强扫描上述病变强化明显。 左侧海绵窦未见增宽。蝶鞍形态正常，其内未见占位性病变。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧上颌窦、筛窦及蝶窦粘膜增厚。右侧乳突内见大量分泌物。 右侧咽后见肿大淋巴结，大者约12mm×17mm，增强扫描强化明显。双颈II、III、V区见多个肿大淋巴结，最大者约23mm×29mm，部分边界欠清晰，包膜不完整，信号欠均匀，增强扫描明显不均匀强化。双侧腮腺内及腮腺旁见数个淋巴结，大者短径约6mm，增强扫描强化明显。双颈I区见数个淋巴结，大者短径约7mm，信号尚均匀。 甲状腺双叶及峡部、喉咽、双侧颌下腺信号均匀，未见占位性病变。；检查结论: 鼻咽病变，考虑鼻咽癌，侵犯范围如上述。 颅底骨质破坏。 右侧咽后、双颈II、III、V区多发肿大淋巴结，考虑转移。 双侧腮腺内及腮腺旁数个淋巴结，性质待定。 鼻窦炎、右侧乳突炎。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 安排适形调强放射治疗（IMRT）及同步化疗\nB. 行鼻咽镜下活检，并补充头颅PET-MR评估颅底受侵范围\nC. 行右颈部淋巴结细针穿刺活检，并补充胸部CT及全身骨扫描\nD. 行鼻咽镜下活检，并补充腹部增强CT排查肝脏转移\nE. 行鼻咽镜下活检，并补充胸部CT、全身骨扫描及血清EBV DNA检测\nF. 行鼻咽镜下活检，直接进行放疗定位及靶区勾画\nG. 行全身PET-CT进行分期，随后开始诱导化疗\nH. 行鼻咽镜下活检，并补充颈部超声评估淋巴结包膜外侵犯\nI. 行鼻咽镜下活检，并补充胸部X线及头颅CT平扫\nJ. 行鼻咽镜下活检，并补充骨髓穿刺排除骨髓转移\nK. 行鼻咽镜下活检，并补充全身骨扫描，暂缓胸部影像学检查\nL. 行右颈部淋巴结切除活检，并补充胸部CT及血清EBV DNA检测\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-5ae78b6dca4ce8a61a44d0ca","patient_id":"patient-f25e20b1e5c6eea840d4cc21","turn_id":"turn04","turn_position":3,"turn_type":"initial_treatment_selection","gold_letter":"G","gold_action":"诱导化疗序贯同步放化疗","options":[{"letter":"A","text":"单纯根治性放疗","is_gold":false},{"letter":"B","text":"诱导化疗序贯单纯根治性放疗","is_gold":false},{"letter":"C","text":"同步放化疗序贯辅助化疗","is_gold":false},{"letter":"D","text":"根治性颈淋巴结清扫术序贯辅助放化疗","is_gold":false},{"letter":"E","text":"姑息性全身化疗联合靶向治疗","is_gold":false},{"letter":"F","text":"诱导化疗序贯根治性手术","is_gold":false},{"letter":"G","text":"诱导化疗序贯同步放化疗","is_gold":true},{"letter":"H","text":"免疫治疗联合同步放化疗","is_gold":false},{"letter":"I","text":"靶向治疗联合同步放化疗","is_gold":false},{"letter":"J","text":"诱导化疗序贯同步放化疗联合辅助化疗","is_gold":false},{"letter":"K","text":"根治性放疗序贯辅助化疗","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、鼻腔、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现右颈部肿块伴耳鸣、听力下降4个月。；现病史: 缘于4个月前患者无意中发现右颈部包块，如拇指大小，无压痛，伴耳鸣、听力下降，颈部包块后逐渐增大，近1周偶发头痛，白天明显，视物如常，无鼻塞、鼻血、面麻、等不适。为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,鼻咽肿物,右颈部包块,头痛；既往史: 4年前患痔疮，已治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:青霉素皮试阳性。；个人史: 长期居于原籍，无疫区居住史。吸烟3-4支/天*10年，饮酒1-2次/月。否认不洁性生活史。；家族史: 舅舅患鼻咽癌，舅妈患肺癌。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：103/73mmHg,Ht：174cm，Wt：79kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；右颈IIa区可扪及1个淋巴结，最大径2.5×2.5cm，左颈IIa区扪及1个淋巴结，最大径约3*3cm，无融合，质地韧，边界模糊，活动度好，无压痛，无皮肤浸润，无溃疡，右颈III区可见一长约4cm手术疤痕；颅神经检查：阴性。；KPS:；ECOG:\n- [全程D0] 入院记录: 主诉: 发现右颈部肿块伴耳鸣、听力下降4个月。；现病史: 缘于4个月前患者无意中发现右颈部包块，如拇指大小，无压痛，伴耳鸣、听力下降，颈部包块后逐渐增大，近1周偶发头痛，白天明显，视物如常，无鼻塞、鼻血、面麻、等不适。就诊[机构已隐去]，行右颈部淋巴结活检术，病理示转移性低分化鳞癌，行电子鼻咽镜检查见鼻咽肿物，取活检病理示可疑癌。为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,鼻咽肿物,右颈部包块,头痛；既往史: 4年前患痔疮，已治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:青霉素皮试阳性。；个人史: 长期居于原籍，无疫区居住史。吸烟3-4支/天*10年，饮酒1-2次/月。否认不洁性生活史。；家族史: 舅舅患鼻咽癌，舅妈患肺癌。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：103/73mmHg,Ht：174cm，Wt：79kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；右颈IIa区可扪及1个淋巴结，最大径2.5×2.5cm，左颈IIa区扪及1个淋巴结，最大径约3*3cm，无融合，质地韧，边界模糊，活动度好，无压痛，无皮肤浸润，无溃疡，右颈III区可见一长约4cm手术疤痕；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 电轴左偏(轻度) 正常范围心电图\n- [全程D1] 检验组合: 血小板比容-静脉血: 19%；载脂蛋白B(apoB)-静脉血: 1.03g/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；肌酐(Crea)-静脉血: 66.2umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.1；球蛋白(GLO)-静脉血: 31.61g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.011；尿胆原(URO)-尿液: -（参考: 阴性）；红细胞比容(Hct)-静脉血: 48.9%；凝血酶原时间活动度(PTA)-静脉血: 111.2%；隐血(OB)-粪便: 阴性（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.91mg/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；碱性磷酸酶(ALP)-静脉血: 76.3U/L；载脂蛋白AI(apoAI)-静脉血: 1.04g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；葡萄糖(Glu)-静脉血: 4.96mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.5；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；血小板分布宽度(PDW)-静脉血: 13.9%；淋巴细胞百分比(Lymph%)-静脉血: 0.315；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；总胆红素(TBIL)-静脉血: 7umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.910E9/L；Rh血型-静脉血: 阳性；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.2sec.；酮体(KET)-尿液: -（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 21.9mmol/L；浊度(TRUB)-尿液: 清亮；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 4.88mmol/L；C-反应蛋白(C……\n- [全程D3] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D7] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及双侧壁增厚，以右侧为著，T1WI呈等信号，T2WI呈稍高信号，增强扫描强化明显，右侧咽隐窝消失，见增厚组织占据，左侧咽隐窝变浅。病变与右侧中鼻甲分界不清，口咽双侧壁未见增厚。 右侧咽旁间隙及右侧咽后间隙见不规则肿物突入。双侧腭帆提肌、右侧腭帆张肌、右侧头长肌受侵。左侧腭帆张肌、双侧翼内肌及双侧翼外肌未见受侵。 右侧翼腭窝内见少许软组织信号，增强扫描明显强化。 左侧翼腭窝、双侧上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 斜坡、蝶骨基底部、右侧翼突基底部及内外板、右侧蝶骨大翼及右侧岩尖骨质信号减低，增强扫描见不均匀强化。 右侧破裂扩大，右侧海绵窦增宽，内见不规则软组织信号灶，右侧蝶窦内见软组织信号灶突入，增强扫描上述病变强化明显。 左侧海绵窦未见增宽。蝶鞍形态正常，其内未见占位性病变。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧上颌窦、筛窦及蝶窦粘膜增厚。右侧乳突内见大量分泌物。 右侧咽后见肿大淋巴结，大者约12mm×17mm，增强扫描强化明显。双颈II、III、V区见多个肿大淋巴结，最大者约23mm×29mm，部分边界欠清晰，包膜不完整，信号欠均匀，增强扫描明显不均匀强化。双侧腮腺内及腮腺旁见数个淋巴结，大者短径约6mm，增强扫描强化明显。双颈I区见数个淋巴结，大者短径约7mm，信号尚均匀。 甲状腺双叶及峡部、喉咽、双侧颌下腺信号均匀，未见占位性病变。；检查结论: 鼻咽病变，考虑鼻咽癌，侵犯范围如上述。 颅底骨质破坏。 右侧咽后、双颈II、III、V区多发肿大淋巴结，考虑转移。 双侧腮腺内及腮腺旁数个淋巴结，性质待定。 鼻窦炎、右侧乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 单纯根治性放疗\nB. 诱导化疗序贯单纯根治性放疗\nC. 同步放化疗序贯辅助化疗\nD. 根治性颈淋巴结清扫术序贯辅助放化疗\nE. 姑息性全身化疗联合靶向治疗\nF. 诱导化疗序贯根治性手术\nG. 诱导化疗序贯同步放化疗\nH. 免疫治疗联合同步放化疗\nI. 靶向治疗联合同步放化疗\nJ. 诱导化疗序贯同步放化疗联合辅助化疗\nK. 根治性放疗序贯辅助化疗\n\n请仅输出一个选项字母（A-K）。","incremental_user_message":"【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现右颈部肿块伴耳鸣、听力下降4个月。；现病史: 缘于4个月前患者无意中发现右颈部包块，如拇指大小，无压痛，伴耳鸣、听力下降，颈部包块后逐渐增大，近1周偶发头痛，白天明显，视物如常，无鼻塞、鼻血、面麻、等不适。就诊[机构已隐去]，行右颈部淋巴结活检术，病理示转移性低分化鳞癌，行电子鼻咽镜检查见鼻咽肿物，取活检病理示可疑癌。为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,鼻咽肿物,右颈部包块,头痛；既往史: 4年前患痔疮，已治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:青霉素皮试阳性。；个人史: 长期居于原籍，无疫区居住史。吸烟3-4支/天*10年，饮酒1-2次/月。否认不洁性生活史。；家族史: 舅舅患鼻咽癌，舅妈患肺癌。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：103/73mmHg,Ht：174cm，Wt：79kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；右颈IIa区可扪及1个淋巴结，最大径2.5×2.5cm，左颈IIa区扪及1个淋巴结，最大径约3*3cm，无融合，质地韧，边界模糊，活动度好，无压痛，无皮肤浸润，无溃疡，右颈III区可见一长约4cm手术疤痕；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 单纯根治性放疗\nB. 诱导化疗序贯单纯根治性放疗\nC. 同步放化疗序贯辅助化疗\nD. 根治性颈淋巴结清扫术序贯辅助放化疗\nE. 姑息性全身化疗联合靶向治疗\nF. 诱导化疗序贯根治性手术\nG. 诱导化疗序贯同步放化疗\nH. 免疫治疗联合同步放化疗\nI. 靶向治疗联合同步放化疗\nJ. 诱导化疗序贯同步放化疗联合辅助化疗\nK. 根治性放疗序贯辅助化疗\n\n请仅输出一个选项字母（A-K）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、鼻腔、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现右颈部肿块伴耳鸣、听力下降4个月。；现病史: 缘于4个月前患者无意中发现右颈部包块，如拇指大小，无压痛，伴耳鸣、听力下降，颈部包块后逐渐增大，近1周偶发头痛，白天明显，视物如常，无鼻塞、鼻血、面麻、等不适。就诊[机构已隐去]，行右颈部淋巴结活检术，病理示转移性低分化鳞癌，行电子鼻咽镜检查见鼻咽肿物，取活检病理示可疑癌。为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,鼻咽肿物,右颈部包块,头痛；既往史: 4年前患痔疮，已治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:青霉素皮试阳性。；个人史: 长期居于原籍，无疫区居住史。吸烟3-4支/天*10年，饮酒1-2次/月。否认不洁性生活史。；家族史: 舅舅患鼻咽癌，舅妈患肺癌。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：103/73mmHg,Ht：174cm，Wt：79kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；右颈IIa区可扪及1个淋巴结，最大径2.5×2.5cm，左颈IIa区扪及1个淋巴结，最大径约3*3cm，无融合，质地韧，边界模糊，活动度好，无压痛，无皮肤浸润，无溃疡，右颈III区可见一长约4cm手术疤痕；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 单纯根治性放疗\nB. 诱导化疗序贯单纯根治性放疗\nC. 同步放化疗序贯辅助化疗\nD. 根治性颈淋巴结清扫术序贯辅助放化疗\nE. 姑息性全身化疗联合靶向治疗\nF. 诱导化疗序贯根治性手术\nG. 诱导化疗序贯同步放化疗\nH. 免疫治疗联合同步放化疗\nI. 靶向治疗联合同步放化疗\nJ. 诱导化疗序贯同步放化疗联合辅助化疗\nK. 根治性放疗序贯辅助化疗\n\n请仅输出一个选项字母（A-K）。"},{"sample_id":"sample-a4cf25bef13a63de3e012971","patient_id":"patient-f25e20b1e5c6eea840d4cc21","turn_id":"turn05","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"H","gold_action":"完善放化疗前基线检验（血常规、生化、凝血、传染病、EBV等），全面评估器官功能。","options":[{"letter":"A","text":"完善放化疗前基线检验，若肌酐清除率>30ml/min即可启动大剂量顺铂同步化疗。","is_gold":false},{"letter":"B","text":"完善放化疗前基线检验，并预防性给予质子泵抑制剂和双环醇保肝治疗。","is_gold":false},{"letter":"C","text":"完善放化疗前基线检验，若中性粒细胞绝对值>1.0×10^9/L即可启动全身化疗。","is_gold":false},{"letter":"D","text":"完善放化疗前基线检验，并预防性给予长效重组人粒细胞集落刺激因子。","is_gold":false},{"letter":"E","text":"完善放化疗前基线检验，仅需心电图和血常规正常即可启动诱导化疗。","is_gold":false},{"letter":"F","text":"完善放化疗前基线检验，并常规预防性使用头孢类抗生素以防中耳炎加重。","is_gold":false},{"letter":"G","text":"完善放化疗前基线检验，若转氨酶升高超过正常上限1倍则直接放弃化疗。","is_gold":false},{"letter":"H","text":"完善放化疗前基线检验（血常规、生化、凝血、传染病、EBV等），全面评估器官功能。","is_gold":true},{"letter":"I","text":"完善放化疗前基线检验，并预防性给予地塞米松以减轻放疗引起的脑水肿。","is_gold":false},{"letter":"J","text":"完善放化疗前基线检验，若伴有右侧中耳乳突炎则需先完成乳突根治术再行放疗。","is_gold":false},{"letter":"K","text":"完善放化疗前基线检验，并常规行深静脉置管及低分子肝素预防性抗凝治疗。","is_gold":false},{"letter":"L","text":"完善放化疗前基线检验，若存在感音神经性听力下降则绝对禁忌使用任何含铂方案。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、鼻腔、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现右颈部肿块伴耳鸣、听力下降4个月。；现病史: 缘于4个月前患者无意中发现右颈部包块，如拇指大小，无压痛，伴耳鸣、听力下降，颈部包块后逐渐增大，近1周偶发头痛，白天明显，视物如常，无鼻塞、鼻血、面麻、等不适。为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,鼻咽肿物,右颈部包块,头痛；既往史: 4年前患痔疮，已治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:青霉素皮试阳性。；个人史: 长期居于原籍，无疫区居住史。吸烟3-4支/天*10年，饮酒1-2次/月。否认不洁性生活史。；家族史: 舅舅患鼻咽癌，舅妈患肺癌。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：103/73mmHg,Ht：174cm，Wt：79kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；右颈IIa区可扪及1个淋巴结，最大径2.5×2.5cm，左颈IIa区扪及1个淋巴结，最大径约3*3cm，无融合，质地韧，边界模糊，活动度好，无压痛，无皮肤浸润，无溃疡，右颈III区可见一长约4cm手术疤痕；颅神经检查：阴性。；KPS:；ECOG:\n- [全程D0] 入院记录: 主诉: 发现右颈部肿块伴耳鸣、听力下降4个月。；现病史: 缘于4个月前患者无意中发现右颈部包块，如拇指大小，无压痛，伴耳鸣、听力下降，颈部包块后逐渐增大，近1周偶发头痛，白天明显，视物如常，无鼻塞、鼻血、面麻、等不适。就诊[机构已隐去]，行右颈部淋巴结活检术，病理示转移性低分化鳞癌，行电子鼻咽镜检查见鼻咽肿物，取活检病理示可疑癌。为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,鼻咽肿物,右颈部包块,头痛；既往史: 4年前患痔疮，已治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:青霉素皮试阳性。；个人史: 长期居于原籍，无疫区居住史。吸烟3-4支/天*10年，饮酒1-2次/月。否认不洁性生活史。；家族史: 舅舅患鼻咽癌，舅妈患肺癌。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：103/73mmHg,Ht：174cm，Wt：79kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；右颈IIa区可扪及1个淋巴结，最大径2.5×2.5cm，左颈IIa区扪及1个淋巴结，最大径约3*3cm，无融合，质地韧，边界模糊，活动度好，无压痛，无皮肤浸润，无溃疡，右颈III区可见一长约4cm手术疤痕；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 电轴左偏(轻度) 正常范围心电图\n- [全程D1] 检验组合: 血小板比容-静脉血: 19%；载脂蛋白B(apoB)-静脉血: 1.03g/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；肌酐(Crea)-静脉血: 66.2umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.1；球蛋白(GLO)-静脉血: 31.61g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.011；尿胆原(URO)-尿液: -（参考: 阴性）；红细胞比容(Hct)-静脉血: 48.9%；凝血酶原时间活动度(PTA)-静脉血: 111.2%；隐血(OB)-粪便: 阴性（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.91mg/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；碱性磷酸酶(ALP)-静脉血: 76.3U/L；载脂蛋白AI(apoAI)-静脉血: 1.04g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；葡萄糖(Glu)-静脉血: 4.96mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.5；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；血小板分布宽度(PDW)-静脉血: 13.9%；淋巴细胞百分比(Lymph%)-静脉血: 0.315；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；总胆红素(TBIL)-静脉血: 7umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.910E9/L；Rh血型-静脉血: 阳性；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.2sec.；酮体(KET)-尿液: -（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 21.9mmol/L；浊度(TRUB)-尿液: 清亮；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 4.88mmol/L；C-反应蛋白(C……\n- [全程D3] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D7] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及双侧壁增厚，以右侧为著，T1WI呈等信号，T2WI呈稍高信号，增强扫描强化明显，右侧咽隐窝消失，见增厚组织占据，左侧咽隐窝变浅。病变与右侧中鼻甲分界不清，口咽双侧壁未见增厚。 右侧咽旁间隙及右侧咽后间隙见不规则肿物突入。双侧腭帆提肌、右侧腭帆张肌、右侧头长肌受侵。左侧腭帆张肌、双侧翼内肌及双侧翼外肌未见受侵。 右侧翼腭窝内见少许软组织信号，增强扫描明显强化。 左侧翼腭窝、双侧上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 斜坡、蝶骨基底部、右侧翼突基底部及内外板、右侧蝶骨大翼及右侧岩尖骨质信号减低，增强扫描见不均匀强化。 右侧破裂扩大，右侧海绵窦增宽，内见不规则软组织信号灶，右侧蝶窦内见软组织信号灶突入，增强扫描上述病变强化明显。 左侧海绵窦未见增宽。蝶鞍形态正常，其内未见占位性病变。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧上颌窦、筛窦及蝶窦粘膜增厚。右侧乳突内见大量分泌物。 右侧咽后见肿大淋巴结，大者约12mm×17mm，增强扫描强化明显。双颈II、III、V区见多个肿大淋巴结，最大者约23mm×29mm，部分边界欠清晰，包膜不完整，信号欠均匀，增强扫描明显不均匀强化。双侧腮腺内及腮腺旁见数个淋巴结，大者短径约6mm，增强扫描强化明显。双颈I区见数个淋巴结，大者短径约7mm，信号尚均匀。 甲状腺双叶及峡部、喉咽、双侧颌下腺信号均匀，未见占位性病变。；检查结论: 鼻咽病变，考虑鼻咽癌，侵犯范围如上述。 颅底骨质破坏。 右侧咽后、双颈II、III、V区多发肿大淋巴结，考虑转移。 双侧腮腺内及腮腺旁数个淋巴结，性质待定。 鼻窦炎、右侧乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。仍有听力下降，请[姓名已隐去]医生信息已隐藏出：根据患者外院鼻咽部检查提示鼻咽部病灶侵犯右侧海绵窦，颅底骨质等，分为分期信息见历史辅助诊断节点，双侧颈部淋巴结肿大，最大径＜6cm，分为分期信息见历史辅助诊断节点，未见远处转移，分为[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点，[计划性表述已隐藏]放疗及同步增敏化疗控制病情，目前行放疗前准备。.\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善放化疗前基线检验，若肌酐清除率>30ml/min即可启动大剂量顺铂同步化疗。\nB. 完善放化疗前基线检验，并预防性给予质子泵抑制剂和双环醇保肝治疗。\nC. 完善放化疗前基线检验，若中性粒细胞绝对值>1.0×10^9/L即可启动全身化疗。\nD. 完善放化疗前基线检验，并预防性给予长效重组人粒细胞集落刺激因子。\nE. 完善放化疗前基线检验，仅需心电图和血常规正常即可启动诱导化疗。\nF. 完善放化疗前基线检验，并常规预防性使用头孢类抗生素以防中耳炎加重。\nG. 完善放化疗前基线检验，若转氨酶升高超过正常上限1倍则直接放弃化疗。\nH. 完善放化疗前基线检验（血常规、生化、凝血、传染病、EBV等），全面评估器官功能。\nI. 完善放化疗前基线检验，并预防性给予地塞米松以减轻放疗引起的脑水肿。\nJ. 完善放化疗前基线检验，若伴有右侧中耳乳突炎则需先完成乳突根治术再行放疗。\nK. 完善放化疗前基线检验，并常规行深静脉置管及低分子肝素预防性抗凝治疗。\nL. 完善放化疗前基线检验，若存在感音神经性听力下降则绝对禁忌使用任何含铂方案。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- 无可展示记录。\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。仍有听力下降，请[姓名已隐去]医生信息已隐藏出：根据患者外院鼻咽部检查提示鼻咽部病灶侵犯右侧海绵窦，颅底骨质等，分为分期信息见历史辅助诊断节点，双侧颈部淋巴结肿大，最大径＜6cm，分为分期信息见历史辅助诊断节点，未见远处转移，分为[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点，[计划性表述已隐藏]放疗及同步增敏化疗控制病情，目前行放疗前准备。.\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善放化疗前基线检验，若肌酐清除率>30ml/min即可启动大剂量顺铂同步化疗。\nB. 完善放化疗前基线检验，并预防性给予质子泵抑制剂和双环醇保肝治疗。\nC. 完善放化疗前基线检验，若中性粒细胞绝对值>1.0×10^9/L即可启动全身化疗。\nD. 完善放化疗前基线检验，并预防性给予长效重组人粒细胞集落刺激因子。\nE. 完善放化疗前基线检验，仅需心电图和血常规正常即可启动诱导化疗。\nF. 完善放化疗前基线检验，并常规预防性使用头孢类抗生素以防中耳炎加重。\nG. 完善放化疗前基线检验，若转氨酶升高超过正常上限1倍则直接放弃化疗。\nH. 完善放化疗前基线检验（血常规、生化、凝血、传染病、EBV等），全面评估器官功能。\nI. 完善放化疗前基线检验，并预防性给予地塞米松以减轻放疗引起的脑水肿。\nJ. 完善放化疗前基线检验，若伴有右侧中耳乳突炎则需先完成乳突根治术再行放疗。\nK. 完善放化疗前基线检验，并常规行深静脉置管及低分子肝素预防性抗凝治疗。\nL. 完善放化疗前基线检验，若存在感音神经性听力下降则绝对禁忌使用任何含铂方案。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、鼻腔、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- 无可展示记录。\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。仍有听力下降，请[姓名已隐去]医生信息已隐藏出：根据患者外院鼻咽部检查提示鼻咽部病灶侵犯右侧海绵窦，颅底骨质等，分为分期信息见历史辅助诊断节点，双侧颈部淋巴结肿大，最大径＜6cm，分为分期信息见历史辅助诊断节点，未见远处转移，分为[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点，[计划性表述已隐藏]放疗及同步增敏化疗控制病情，目前行放疗前准备。.\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善放化疗前基线检验，若肌酐清除率>30ml/min即可启动大剂量顺铂同步化疗。\nB. 完善放化疗前基线检验，并预防性给予质子泵抑制剂和双环醇保肝治疗。\nC. 完善放化疗前基线检验，若中性粒细胞绝对值>1.0×10^9/L即可启动全身化疗。\nD. 完善放化疗前基线检验，并预防性给予长效重组人粒细胞集落刺激因子。\nE. 完善放化疗前基线检验，仅需心电图和血常规正常即可启动诱导化疗。\nF. 完善放化疗前基线检验，并常规预防性使用头孢类抗生素以防中耳炎加重。\nG. 完善放化疗前基线检验，若转氨酶升高超过正常上限1倍则直接放弃化疗。\nH. 完善放化疗前基线检验（血常规、生化、凝血、传染病、EBV等），全面评估器官功能。\nI. 完善放化疗前基线检验，并预防性给予地塞米松以减轻放疗引起的脑水肿。\nJ. 完善放化疗前基线检验，若伴有右侧中耳乳突炎则需先完成乳突根治术再行放疗。\nK. 完善放化疗前基线检验，并常规行深静脉置管及低分子肝素预防性抗凝治疗。\nL. 完善放化疗前基线检验，若存在感音神经性听力下降则绝对禁忌使用任何含铂方案。\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-44b84e88a5f0beade51ae0ca","patient_id":"patient-f25e20b1e5c6eea840d4cc21","turn_id":"turn06","turn_position":5,"turn_type":"toxicity_or_support_decision","gold_letter":"I","gold_action":"按计划启动放疗，并为顺铂（100mg/㎡）同期化疗行充分的静脉水化、甘露醇利尿及电解质补充，同时给予放疗局部保护用药。","options":[{"letter":"A","text":"按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗当天给予常规静脉补液，无需特殊水化与利尿处理。","is_gold":false},{"letter":"B","text":"暂缓放化疗，先静脉补充硫酸镁及氯化钾纠正电解质异常，待复查正常后再启动顺铂同期化疗。","is_gold":false},{"letter":"C","text":"按计划启动放疗，将顺铂剂量调整为40mg/㎡周疗，化疗期间仅需常规止吐，无需使用甘露醇利尿。","is_gold":false},{"letter":"D","text":"按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗前给予呋塞米静脉推注利尿，并预防性注射G-CSF。","is_gold":false},{"letter":"E","text":"按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗期间采用口服补液替代静脉水化，并外用三乙醇胺乳膏。","is_gold":false},{"letter":"F","text":"暂缓顺铂化疗，先行单纯根治性放疗，待放疗剂量达到40Gy后再评估并启动顺铂同期化疗。","is_gold":false},{"letter":"G","text":"按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗前给予大剂量糖皮质激素及NK-1受体拮抗剂，免除静脉水化。","is_gold":false},{"letter":"H","text":"按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗当天给予等渗盐水静脉滴注，避免使用甘露醇。","is_gold":false},{"letter":"I","text":"按计划启动放疗，并为顺铂（100mg/㎡）同期化疗行充分的静脉水化、甘露醇利尿及电解质补充，同时给予放疗局部保护用药。","is_gold":true},{"letter":"J","text":"按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗后连续3天静脉输注人血白蛋白以预防低蛋白血症。","is_gold":false},{"letter":"K","text":"暂缓放疗，先给予顺铂联合氟尿嘧啶方案诱导化疗2个周期，期间常规给予静脉水化及止吐处理。","is_gold":false},{"letter":"L","text":"按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗期间常规预防性静脉滴注广谱抗菌药物。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、鼻腔、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现右颈部肿块伴耳鸣、听力下降4个月。；现病史: 缘于4个月前患者无意中发现右颈部包块，如拇指大小，无压痛，伴耳鸣、听力下降，颈部包块后逐渐增大，近1周偶发头痛，白天明显，视物如常，无鼻塞、鼻血、面麻、等不适。为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,鼻咽肿物,右颈部包块,头痛；既往史: 4年前患痔疮，已治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:青霉素皮试阳性。；个人史: 长期居于原籍，无疫区居住史。吸烟3-4支/天*10年，饮酒1-2次/月。否认不洁性生活史。；家族史: 舅舅患鼻咽癌，舅妈患肺癌。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：103/73mmHg,Ht：174cm，Wt：79kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；右颈IIa区可扪及1个淋巴结，最大径2.5×2.5cm，左颈IIa区扪及1个淋巴结，最大径约3*3cm，无融合，质地韧，边界模糊，活动度好，无压痛，无皮肤浸润，无溃疡，右颈III区可见一长约4cm手术疤痕；颅神经检查：阴性。；KPS:；ECOG:\n- [全程D0] 入院记录: 主诉: 发现右颈部肿块伴耳鸣、听力下降4个月。；现病史: 缘于4个月前患者无意中发现右颈部包块，如拇指大小，无压痛，伴耳鸣、听力下降，颈部包块后逐渐增大，近1周偶发头痛，白天明显，视物如常，无鼻塞、鼻血、面麻、等不适。就诊[机构已隐去]，行右颈部淋巴结活检术，病理示转移性低分化鳞癌，行电子鼻咽镜检查见鼻咽肿物，取活检病理示可疑癌。为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,鼻咽肿物,右颈部包块,头痛；既往史: 4年前患痔疮，已治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:青霉素皮试阳性。；个人史: 长期居于原籍，无疫区居住史。吸烟3-4支/天*10年，饮酒1-2次/月。否认不洁性生活史。；家族史: 舅舅患鼻咽癌，舅妈患肺癌。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：103/73mmHg,Ht：174cm，Wt：79kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；右颈IIa区可扪及1个淋巴结，最大径2.5×2.5cm，左颈IIa区扪及1个淋巴结，最大径约3*3cm，无融合，质地韧，边界模糊，活动度好，无压痛，无皮肤浸润，无溃疡，右颈III区可见一长约4cm手术疤痕；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 电轴左偏(轻度) 正常范围心电图\n- [全程D1] 检验组合: 血小板比容-静脉血: 19%；载脂蛋白B(apoB)-静脉血: 1.03g/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；肌酐(Crea)-静脉血: 66.2umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.1；球蛋白(GLO)-静脉血: 31.61g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.011；尿胆原(URO)-尿液: -（参考: 阴性）；红细胞比容(Hct)-静脉血: 48.9%；凝血酶原时间活动度(PTA)-静脉血: 111.2%；隐血(OB)-粪便: 阴性（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.91mg/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；碱性磷酸酶(ALP)-静脉血: 76.3U/L；载脂蛋白AI(apoAI)-静脉血: 1.04g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；葡萄糖(Glu)-静脉血: 4.96mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.5；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；血小板分布宽度(PDW)-静脉血: 13.9%；淋巴细胞百分比(Lymph%)-静脉血: 0.315；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；总胆红素(TBIL)-静脉血: 7umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.910E9/L；Rh血型-静脉血: 阳性；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.2sec.；酮体(KET)-尿液: -（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 21.9mmol/L；浊度(TRUB)-尿液: 清亮；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 4.88mmol/L；C-反应蛋白(C……\n- [全程D3] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D7] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及双侧壁增厚，以右侧为著，T1WI呈等信号，T2WI呈稍高信号，增强扫描强化明显，右侧咽隐窝消失，见增厚组织占据，左侧咽隐窝变浅。病变与右侧中鼻甲分界不清，口咽双侧壁未见增厚。 右侧咽旁间隙及右侧咽后间隙见不规则肿物突入。双侧腭帆提肌、右侧腭帆张肌、右侧头长肌受侵。左侧腭帆张肌、双侧翼内肌及双侧翼外肌未见受侵。 右侧翼腭窝内见少许软组织信号，增强扫描明显强化。 左侧翼腭窝、双侧上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 斜坡、蝶骨基底部、右侧翼突基底部及内外板、右侧蝶骨大翼及右侧岩尖骨质信号减低，增强扫描见不均匀强化。 右侧破裂扩大，右侧海绵窦增宽，内见不规则软组织信号灶，右侧蝶窦内见软组织信号灶突入，增强扫描上述病变强化明显。 左侧海绵窦未见增宽。蝶鞍形态正常，其内未见占位性病变。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧上颌窦、筛窦及蝶窦粘膜增厚。右侧乳突内见大量分泌物。 右侧咽后见肿大淋巴结，大者约12mm×17mm，增强扫描强化明显。双颈II、III、V区见多个肿大淋巴结，最大者约23mm×29mm，部分边界欠清晰，包膜不完整，信号欠均匀，增强扫描明显不均匀强化。双侧腮腺内及腮腺旁见数个淋巴结，大者短径约6mm，增强扫描强化明显。双颈I区见数个淋巴结，大者短径约7mm，信号尚均匀。 甲状腺双叶及峡部、喉咽、双侧颌下腺信号均匀，未见占位性病变。；检查结论: 鼻咽病变，考虑鼻咽癌，侵犯范围如上述。 颅底骨质破坏。 右侧咽后、双颈II、III、V区多发肿大淋巴结，考虑转移。 双侧腮腺内及腮腺旁数个淋巴结，性质待定。 鼻窦炎、右侧乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D26] 检验组合: 镁离子(Mg2+)-静脉血: 0.88mmol/L；阴离子间隙(AG)-静脉血: 13.2；血小板比容-静脉血: 18%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；乳酸脱氢酶(LDH)-静脉血: 177.9U/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.7U/L；血小板分布宽度(PDW)-静脉血: 13.2%；钾离子(K+)-静脉血: 4.02mmol/L；白蛋白(ALB)-静脉血: 44.5g/L；直接胆红素(DBIL)-静脉血: 3.8umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.58mmol/L；大血小板百分比(P-LCR%)-静脉血: 28.9%；单核细胞计数(Mono#)-静脉血: 0.610E9/L；钠离子(Na+)-静脉血: 143.5mmol/L；总胆固醇(TC)-静脉血: 5.13mmol/L；总胆红素(TBIL)-静脉血: 11.7umol/L；甘油三酯(TG)-静脉血: 1.44mmol/L；红细胞比容(Hct)-静脉血: 48.1%；中性粒细胞计数(Neut#)-静脉血: 3.310E9/L；白细胞计数(WBC#)-静脉血: 6.2110E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.86；中性粒细胞百分比(Neut%)-静脉血: 0.528；总钙(Ca)-静脉血: 2.18mmol/L；总蛋白(TP)-静脉血: 76.63g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.38；α-L-岩藻糖苷酶(AFU)-静脉血: 35.5U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.97mmolL；淋巴细胞计数(Lymph#)-静脉血: 2.110E9/L；间接胆红素(IBIL)-静脉血: 7.9umolL；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；尿素氮(BUN)-静脉血: 4.1mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 333g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.9；单核细胞百分比(Mono%)-静脉血: 0.103；血液二氧化碳含量ctCO2(B)-静脉血: 26.……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。仍有听力下降，请[姓名已隐去]医生信息已隐藏出：根据患者外院鼻咽部检查提示鼻咽部病灶侵犯右侧海绵窦，颅底骨质等，分为分期信息见历史辅助诊断节点，双侧颈部淋巴结肿大，最大径＜6cm，分为分期信息见历史辅助诊断节点，未见远处转移，分为[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点，[计划性表述已隐藏]放疗及同步增敏化疗控制病情，目前行放疗前准备。.\n- [全程D14] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，继续行放化疗前准备，余无特殊。.\n- [全程D17] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，请[姓名已隐去]医生信息已隐藏出：患者目前无特殊，继续行放化疗前准备，继续观察病情。.\n- [全程D20] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，患者放疗计划准备完成，[计划性表述已隐藏]GTV70Gy/32f，GTVnd68Gy/32f，CTV1 60Gy/32f，CTV2 56Gy/32f。拟本周开始放疗，因患者分期晚，病变范围大，视神经、眼球、颞叶剂量较高，已与患者沟通不良反应，患者及时家属表示理解并同意治疗，继续观察病情。.\n- [全程D23] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，患者目前继续行放疗前准备，[姓名已隐去]医生信息已隐藏出：患者继续行放疗前准备，[计划性表述已隐藏]顺铂同期化疗，继续观察病情。.\n- [全程D26] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，患者目前无特殊，拟周一开始行放疗，周二行顺铂100mg/㎡同期化疗，继续行放化疗前准备，继续观察病情。.\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗当天给予常规静脉补液，无需特殊水化与利尿处理。\nB. 暂缓放化疗，先静脉补充硫酸镁及氯化钾纠正电解质异常，待复查正常后再启动顺铂同期化疗。\nC. 按计划启动放疗，将顺铂剂量调整为40mg/㎡周疗，化疗期间仅需常规止吐，无需使用甘露醇利尿。\nD. 按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗前给予呋塞米静脉推注利尿，并预防性注射G-CSF。\nE. 按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗期间采用口服补液替代静脉水化，并外用三乙醇胺乳膏。\nF. 暂缓顺铂化疗，先行单纯根治性放疗，待放疗剂量达到40Gy后再评估并启动顺铂同期化疗。\nG. 按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗前给予大剂量糖皮质激素及NK-1受体拮抗剂，免除静脉水化。\nH. 按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗当天给予等渗盐水静脉滴注，避免使用甘露醇。\nI. 按计划启动放疗，并为顺铂（100mg/㎡）同期化疗行充分的静脉水化、甘露醇利尿及电解质补充，同时给予放疗局部保护用药。\nJ. 按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗后连续3天静脉输注人血白蛋白以预防低蛋白血症。\nK. 暂缓放疗，先给予顺铂联合氟尿嘧啶方案诱导化疗2个周期，期间常规给予静脉水化及止吐处理。\nL. 按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗期间常规预防性静脉滴注广谱抗菌药物。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D26] 检验组合: 镁离子(Mg2+)-静脉血: 0.88mmol/L；阴离子间隙(AG)-静脉血: 13.2；血小板比容-静脉血: 18%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；乳酸脱氢酶(LDH)-静脉血: 177.9U/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.7U/L；血小板分布宽度(PDW)-静脉血: 13.2%；钾离子(K+)-静脉血: 4.02mmol/L；白蛋白(ALB)-静脉血: 44.5g/L；直接胆红素(DBIL)-静脉血: 3.8umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.58mmol/L；大血小板百分比(P-LCR%)-静脉血: 28.9%；单核细胞计数(Mono#)-静脉血: 0.610E9/L；钠离子(Na+)-静脉血: 143.5mmol/L；总胆固醇(TC)-静脉血: 5.13mmol/L；总胆红素(TBIL)-静脉血: 11.7umol/L；甘油三酯(TG)-静脉血: 1.44mmol/L；红细胞比容(Hct)-静脉血: 48.1%；中性粒细胞计数(Neut#)-静脉血: 3.310E9/L；白细胞计数(WBC#)-静脉血: 6.2110E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.86；中性粒细胞百分比(Neut%)-静脉血: 0.528；总钙(Ca)-静脉血: 2.18mmol/L；总蛋白(TP)-静脉血: 76.63g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.38；α-L-岩藻糖苷酶(AFU)-静脉血: 35.5U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.97mmolL；淋巴细胞计数(Lymph#)-静脉血: 2.110E9/L；间接胆红素(IBIL)-静脉血: 7.9umolL；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；尿素氮(BUN)-静脉血: 4.1mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 333g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.9；单核细胞百分比(Mono%)-静脉血: 0.103；血液二氧化碳含量ctCO2(B)-静脉血: 26.……\n\n【既往治疗与反应】\n- [全程D14] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，继续行放化疗前准备，余无特殊。.\n- [全程D17] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，请[姓名已隐去]医生信息已隐藏出：患者目前无特殊，继续行放化疗前准备，继续观察病情。.\n- [全程D20] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，患者放疗计划准备完成，[计划性表述已隐藏]GTV70Gy/32f，GTVnd68Gy/32f，CTV1 60Gy/32f，CTV2 56Gy/32f。拟本周开始放疗，因患者分期晚，病变范围大，视神经、眼球、颞叶剂量较高，已与患者沟通不良反应，患者及时家属表示理解并同意治疗，继续观察病情。.\n- [全程D23] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，患者目前继续行放疗前准备，[姓名已隐去]医生信息已隐藏出：患者继续行放疗前准备，[计划性表述已隐藏]顺铂同期化疗，继续观察病情。.\n- [全程D26] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，患者目前无特殊，拟周一开始行放疗，周二行顺铂100mg/㎡同期化疗，继续行放化疗前准备，继续观察病情。.\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗当天给予常规静脉补液，无需特殊水化与利尿处理。\nB. 暂缓放化疗，先静脉补充硫酸镁及氯化钾纠正电解质异常，待复查正常后再启动顺铂同期化疗。\nC. 按计划启动放疗，将顺铂剂量调整为40mg/㎡周疗，化疗期间仅需常规止吐，无需使用甘露醇利尿。\nD. 按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗前给予呋塞米静脉推注利尿，并预防性注射G-CSF。\nE. 按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗期间采用口服补液替代静脉水化，并外用三乙醇胺乳膏。\nF. 暂缓顺铂化疗，先行单纯根治性放疗，待放疗剂量达到40Gy后再评估并启动顺铂同期化疗。\nG. 按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗前给予大剂量糖皮质激素及NK-1受体拮抗剂，免除静脉水化。\nH. 按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗当天给予等渗盐水静脉滴注，避免使用甘露醇。\nI. 按计划启动放疗，并为顺铂（100mg/㎡）同期化疗行充分的静脉水化、甘露醇利尿及电解质补充，同时给予放疗局部保护用药。\nJ. 按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗后连续3天静脉输注人血白蛋白以预防低蛋白血症。\nK. 暂缓放疗，先给予顺铂联合氟尿嘧啶方案诱导化疗2个周期，期间常规给予静脉水化及止吐处理。\nL. 按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗期间常规预防性静脉滴注广谱抗菌药物。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、鼻腔、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D26] 检验组合: 镁离子(Mg2+)-静脉血: 0.88mmol/L；阴离子间隙(AG)-静脉血: 13.2；血小板比容-静脉血: 18%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；乳酸脱氢酶(LDH)-静脉血: 177.9U/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.7U/L；血小板分布宽度(PDW)-静脉血: 13.2%；钾离子(K+)-静脉血: 4.02mmol/L；白蛋白(ALB)-静脉血: 44.5g/L；直接胆红素(DBIL)-静脉血: 3.8umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.58mmol/L；大血小板百分比(P-LCR%)-静脉血: 28.9%；单核细胞计数(Mono#)-静脉血: 0.610E9/L；钠离子(Na+)-静脉血: 143.5mmol/L；总胆固醇(TC)-静脉血: 5.13mmol/L；总胆红素(TBIL)-静脉血: 11.7umol/L；甘油三酯(TG)-静脉血: 1.44mmol/L；红细胞比容(Hct)-静脉血: 48.1%；中性粒细胞计数(Neut#)-静脉血: 3.310E9/L；白细胞计数(WBC#)-静脉血: 6.2110E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.86；中性粒细胞百分比(Neut%)-静脉血: 0.528；总钙(Ca)-静脉血: 2.18mmol/L；总蛋白(TP)-静脉血: 76.63g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.38；α-L-岩藻糖苷酶(AFU)-静脉血: 35.5U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.97mmolL；淋巴细胞计数(Lymph#)-静脉血: 2.110E9/L；间接胆红素(IBIL)-静脉血: 7.9umolL；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；尿素氮(BUN)-静脉血: 4.1mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 333g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.9；单核细胞百分比(Mono%)-静脉血: 0.103；血液二氧化碳含量ctCO2(B)-静脉血: 26.……\n\n【既往治疗与反应】\n- [全程D14] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，继续行放化疗前准备，余无特殊。.\n- [全程D17] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，请[姓名已隐去]医生信息已隐藏出：患者目前无特殊，继续行放化疗前准备，继续观察病情。.\n- [全程D20] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，患者放疗计划准备完成，[计划性表述已隐藏]GTV70Gy/32f，GTVnd68Gy/32f，CTV1 60Gy/32f，CTV2 56Gy/32f。拟本周开始放疗，因患者分期晚，病变范围大，视神经、眼球、颞叶剂量较高，已与患者沟通不良反应，患者及时家属表示理解并同意治疗，继续观察病情。.\n- [全程D23] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，患者目前继续行放疗前准备，[姓名已隐去]医生信息已隐藏出：患者继续行放疗前准备，[计划性表述已隐藏]顺铂同期化疗，继续观察病情。.\n- [全程D26] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，患者目前无特殊，拟周一开始行放疗，周二行顺铂100mg/㎡同期化疗，继续行放化疗前准备，继续观察病情。.\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗当天给予常规静脉补液，无需特殊水化与利尿处理。\nB. 暂缓放化疗，先静脉补充硫酸镁及氯化钾纠正电解质异常，待复查正常后再启动顺铂同期化疗。\nC. 按计划启动放疗，将顺铂剂量调整为40mg/㎡周疗，化疗期间仅需常规止吐，无需使用甘露醇利尿。\nD. 按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗前给予呋塞米静脉推注利尿，并预防性注射G-CSF。\nE. 按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗期间采用口服补液替代静脉水化，并外用三乙醇胺乳膏。\nF. 暂缓顺铂化疗，先行单纯根治性放疗，待放疗剂量达到40Gy后再评估并启动顺铂同期化疗。\nG. 按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗前给予大剂量糖皮质激素及NK-1受体拮抗剂，免除静脉水化。\nH. 按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗当天给予等渗盐水静脉滴注，避免使用甘露醇。\nI. 按计划启动放疗，并为顺铂（100mg/㎡）同期化疗行充分的静脉水化、甘露醇利尿及电解质补充，同时给予放疗局部保护用药。\nJ. 按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗后连续3天静脉输注人血白蛋白以预防低蛋白血症。\nK. 暂缓放疗，先给予顺铂联合氟尿嘧啶方案诱导化疗2个周期，期间常规给予静脉水化及止吐处理。\nL. 按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗期间常规预防性静脉滴注广谱抗菌药物。\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-0534c4bc264d81d07f7ff87c","patient_id":"patient-f25e20b1e5c6eea840d4cc21","turn_id":"turn07","turn_position":6,"turn_type":"response_assessment_decision","gold_letter":"J","gold_action":"结束住院诊疗办理出院，嘱定期返院复查以评估近期疗效。","options":[{"letter":"A","text":"立即行颈部淋巴结清扫术处理未完全消退的残存淋巴结。","is_gold":false},{"letter":"B","text":"立即安排鼻咽及颈部MRI与全身PET-CT检查全面评估近期疗效。","is_gold":false},{"letter":"C","text":"立即启动PF方案（顺铂+氟尿嘧啶）辅助化疗以巩固局部及全身控制。","is_gold":false},{"letter":"D","text":"继续住院给予静脉高营养及广谱抗生素治疗直至口腔黏膜反应完全消失。","is_gold":false},{"letter":"E","text":"立即行电子鼻咽镜下原发灶活检以明确是否达到病理完全缓解。","is_gold":false},{"letter":"F","text":"预防性给予长效G-CSF并口服抗生素后办理出院。","is_gold":false},{"letter":"G","text":"立即启动西妥昔单抗靶向维持治疗以降低局部复发风险。","is_gold":false},{"letter":"H","text":"对颈部残存淋巴结局部追加外照射放疗推量至75-80Gy。","is_gold":false},{"letter":"I","text":"立即复查血浆EBV-DNA，若阳性则继续给予单药顺铂化疗。","is_gold":false},{"letter":"J","text":"结束住院诊疗办理出院，嘱定期返院复查以评估近期疗效。","is_gold":true},{"letter":"K","text":"立即行胸腹部增强CT及骨ECT检查排除放化疗期间的远处转移。","is_gold":false},{"letter":"L","text":"立即请耳鼻喉科会诊行鼓膜穿刺抽液或置管术处理听力下降。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、鼻腔、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现右颈部肿块伴耳鸣、听力下降4个月。；现病史: 缘于4个月前患者无意中发现右颈部包块，如拇指大小，无压痛，伴耳鸣、听力下降，颈部包块后逐渐增大，近1周偶发头痛，白天明显，视物如常，无鼻塞、鼻血、面麻、等不适。为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,鼻咽肿物,右颈部包块,头痛；既往史: 4年前患痔疮，已治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:青霉素皮试阳性。；个人史: 长期居于原籍，无疫区居住史。吸烟3-4支/天*10年，饮酒1-2次/月。否认不洁性生活史。；家族史: 舅舅患鼻咽癌，舅妈患肺癌。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：103/73mmHg,Ht：174cm，Wt：79kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；右颈IIa区可扪及1个淋巴结，最大径2.5×2.5cm，左颈IIa区扪及1个淋巴结，最大径约3*3cm，无融合，质地韧，边界模糊，活动度好，无压痛，无皮肤浸润，无溃疡，右颈III区可见一长约4cm手术疤痕；颅神经检查：阴性。；KPS:；ECOG:\n- [全程D0] 入院记录: 主诉: 发现右颈部肿块伴耳鸣、听力下降4个月。；现病史: 缘于4个月前患者无意中发现右颈部包块，如拇指大小，无压痛，伴耳鸣、听力下降，颈部包块后逐渐增大，近1周偶发头痛，白天明显，视物如常，无鼻塞、鼻血、面麻、等不适。就诊[机构已隐去]，行右颈部淋巴结活检术，病理示转移性低分化鳞癌，行电子鼻咽镜检查见鼻咽肿物，取活检病理示可疑癌。为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,鼻咽肿物,右颈部包块,头痛；既往史: 4年前患痔疮，已治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:青霉素皮试阳性。；个人史: 长期居于原籍，无疫区居住史。吸烟3-4支/天*10年，饮酒1-2次/月。否认不洁性生活史。；家族史: 舅舅患鼻咽癌，舅妈患肺癌。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：103/73mmHg,Ht：174cm，Wt：79kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；右颈IIa区可扪及1个淋巴结，最大径2.5×2.5cm，左颈IIa区扪及1个淋巴结，最大径约3*3cm，无融合，质地韧，边界模糊，活动度好，无压痛，无皮肤浸润，无溃疡，右颈III区可见一长约4cm手术疤痕；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 电轴左偏(轻度) 正常范围心电图\n- [全程D1] 检验组合: 血小板比容-静脉血: 19%；载脂蛋白B(apoB)-静脉血: 1.03g/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；肌酐(Crea)-静脉血: 66.2umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.1；球蛋白(GLO)-静脉血: 31.61g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.011；尿胆原(URO)-尿液: -（参考: 阴性）；红细胞比容(Hct)-静脉血: 48.9%；凝血酶原时间活动度(PTA)-静脉血: 111.2%；隐血(OB)-粪便: 阴性（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.91mg/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；碱性磷酸酶(ALP)-静脉血: 76.3U/L；载脂蛋白AI(apoAI)-静脉血: 1.04g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；葡萄糖(Glu)-静脉血: 4.96mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.5；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；血小板分布宽度(PDW)-静脉血: 13.9%；淋巴细胞百分比(Lymph%)-静脉血: 0.315；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；总胆红素(TBIL)-静脉血: 7umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.910E9/L；Rh血型-静脉血: 阳性；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.2sec.；酮体(KET)-尿液: -（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 21.9mmol/L；浊度(TRUB)-尿液: 清亮；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 4.88mmol/L；C-反应蛋白(C……\n- [全程D3] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D7] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及双侧壁增厚，以右侧为著，T1WI呈等信号，T2WI呈稍高信号，增强扫描强化明显，右侧咽隐窝消失，见增厚组织占据，左侧咽隐窝变浅。病变与右侧中鼻甲分界不清，口咽双侧壁未见增厚。 右侧咽旁间隙及右侧咽后间隙见不规则肿物突入。双侧腭帆提肌、右侧腭帆张肌、右侧头长肌受侵。左侧腭帆张肌、双侧翼内肌及双侧翼外肌未见受侵。 右侧翼腭窝内见少许软组织信号，增强扫描明显强化。 左侧翼腭窝、双侧上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 斜坡、蝶骨基底部、右侧翼突基底部及内外板、右侧蝶骨大翼及右侧岩尖骨质信号减低，增强扫描见不均匀强化。 右侧破裂扩大，右侧海绵窦增宽，内见不规则软组织信号灶，右侧蝶窦内见软组织信号灶突入，增强扫描上述病变强化明显。 左侧海绵窦未见增宽。蝶鞍形态正常，其内未见占位性病变。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧上颌窦、筛窦及蝶窦粘膜增厚。右侧乳突内见大量分泌物。 右侧咽后见肿大淋巴结，大者约12mm×17mm，增强扫描强化明显。双颈II、III、V区见多个肿大淋巴结，最大者约23mm×29mm，部分边界欠清晰，包膜不完整，信号欠均匀，增强扫描明显不均匀强化。双侧腮腺内及腮腺旁见数个淋巴结，大者短径约6mm，增强扫描强化明显。双颈I区见数个淋巴结，大者短径约7mm，信号尚均匀。 甲状腺双叶及峡部、喉咽、双侧颌下腺信号均匀，未见占位性病变。；检查结论: 鼻咽病变，考虑鼻咽癌，侵犯范围如上述。 颅底骨质破坏。 右侧咽后、双颈II、III、V区多发肿大淋巴结，考虑转移。 双侧腮腺内及腮腺旁数个淋巴结，性质待定。 鼻窦炎、右侧乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D26] 检验组合: 镁离子(Mg2+)-静脉血: 0.88mmol/L；阴离子间隙(AG)-静脉血: 13.2；血小板比容-静脉血: 18%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；乳酸脱氢酶(LDH)-静脉血: 177.9U/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.7U/L；血小板分布宽度(PDW)-静脉血: 13.2%；钾离子(K+)-静脉血: 4.02mmol/L；白蛋白(ALB)-静脉血: 44.5g/L；直接胆红素(DBIL)-静脉血: 3.8umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.58mmol/L；大血小板百分比(P-LCR%)-静脉血: 28.9%；单核细胞计数(Mono#)-静脉血: 0.610E9/L；钠离子(Na+)-静脉血: 143.5mmol/L；总胆固醇(TC)-静脉血: 5.13mmol/L；总胆红素(TBIL)-静脉血: 11.7umol/L；甘油三酯(TG)-静脉血: 1.44mmol/L；红细胞比容(Hct)-静脉血: 48.1%；中性粒细胞计数(Neut#)-静脉血: 3.310E9/L；白细胞计数(WBC#)-静脉血: 6.2110E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.86；中性粒细胞百分比(Neut%)-静脉血: 0.528；总钙(Ca)-静脉血: 2.18mmol/L；总蛋白(TP)-静脉血: 76.63g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.38；α-L-岩藻糖苷酶(AFU)-静脉血: 35.5U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.97mmolL；淋巴细胞计数(Lymph#)-静脉血: 2.110E9/L；间接胆红素(IBIL)-静脉血: 7.9umolL；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；尿素氮(BUN)-静脉血: 4.1mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 333g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.9；单核细胞百分比(Mono%)-静脉血: 0.103；血液二氧化碳含量ctCO2(B)-静脉血: 26.……\n- [全程D44] 检验组合: 白细胞计数(WBC#)-静脉血: 4.4610E9/L；镁离子(Mg2+)-静脉血: 0.96mmol/L；葡萄糖(Glu)-静脉血: 4.12mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；丙氨酸氨基转移酶(ALT)-静脉血: 16U/L；总蛋白(TP)-静脉血: 72.33g/L；胱抑素(Cys-C)-静脉血: 0.78mg/L；血小板分布宽度(PDW)-静脉血: 11.6%；中性粒细胞计数(Neut#)-静脉血: 3.110E9/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.910E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 35.8U/L；C-反应蛋白(CRP)-静脉血: 3.43mg/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.1；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.32mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.9；氯离子(Cl-)-静脉血: 103mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 29mmol/L；乳酸脱氢酶(LDH)-静脉血: 172.3U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.195；直接胆红素(DBIL)-静脉血: 4.2umol/L；球蛋白(GLO)-静脉血: 29.23g/L；甘油三酯(TG)-静脉血: 1.13mmol/L；血小板计数(PLT#)-静脉血: 16510E9/L；钾离子(K+)-静脉血: 4.12mmol/L；肌酐(Crea)-静脉血: 67.7umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.3U/L；白蛋白(ALB)-静脉血: 43.1g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均血小板体积(MPV)-静脉血: 9.8fL；载脂蛋白AI(apoAI)-静脉血: 1.11g/L；总胆红素(TBIL)-静脉血: 12.6umol/L；单核细胞百分比(Mono%)-静脉血: 0.09；间接胆红素(IBIL)-静脉血: 8.4umolL；血红蛋白(Hb)-静脉血: 148g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 32.8U/L；红细胞……\n- [全程D51] 检验组合: 磷(P)-静脉血: 1.15mmol/L；氯离子(Cl-)-静脉血: 103.1mmol/L；球蛋白(GLO)-静脉血: 31.65g/L；中性粒细胞计数(Neut#)-静脉血: 1.110E9/L；钠离子(Na+)-静脉血: 141.8mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；中性粒细胞百分比(Neut%)-静脉血: 0.466；单核细胞百分比(Mono%)-静脉血: 0.221；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.03；血小板比容-静脉血: 15%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；乳酸脱氢酶(LDH)-静脉血: 170.6U/L；总胆红素(TBIL)-静脉血: 9.8umol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.2pg；肌酐(Crea)-静脉血: 72.4umol/L；尿素氮(BUN)-静脉血: 4.2mmol/L；尿酸(UA)-静脉血: 346.6umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.04；红细胞计数(RBC#)-静脉血: 5.1710E12/L；总蛋白(TP)-静脉血: 75.85g/L；平均血小板体积(MPV)-静脉血: 10fL；平均红细胞体积(MCV)-静脉血: 85.7fL；红细胞比容(Hct)-静脉血: 44.3%；白蛋白(ALB)-静脉血: 44.2g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.09mmolL；总胆固醇(TC)-静脉血: 5.11mmol/L；间接胆红素(IBIL)-静脉血: 6.3umolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.51mmol/L；胱抑素(Cys-C)-静脉血: 0.82mg/L；葡萄糖(Glu)-静脉血: 4.91mmol/L；C-反应蛋白(CRP)-静脉血: 2.13mg/L；碱性磷酸酶(ALP)-静脉血: 77.4U/L；总胆汁酸(TBA)-静脉血: 4.3umol/L；载脂蛋白AI(apoAI)-静脉血: 1.23g/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；直接胆红素(DBIL)-静脉血: 3.5umol/L；血小板分布宽度(PDW)-静脉血: 10.8%；血液二氧化碳含量ctCO2(B)-静脉血: 24.1m……\n- [全程D56] 检验组合: 血红蛋白(Hb)-静脉血: 154g/L；白细胞计数(WBC#)-静脉血: 510E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.28；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 48.1；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.6；中性粒细胞计数(Neut#)-静脉血: 3.110E9/L；大血小板百分比(P-LCR%)-静脉血: 28.9%；红细胞比容(Hct)-静脉血: 49.1%；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.612；单核细胞百分比(Mono%)-静脉血: 0.09；平均红细胞血红蛋白含量(MCH)-静脉血: 29.4pg；平均血小板体积(MPV)-静脉血: 10.4fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 11910E9/L；平均红细胞体积(MCV)-静脉血: 93.7fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0；血小板比容-静脉血: 12%；单核细胞计数(Mono#)-静脉血: 0.510E9/L；血小板分布宽度(PDW)-静脉血: 12.6%；红细胞计数(RBC#)-静脉血: 5.2410E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；平均红细胞血红蛋白浓度(MCHC)-静脉血: 314g/L\n- [全程D58] 检验组合: 白蛋白(ALB)-静脉血: 44.1g/L；血液二氧化碳含量ctCO2(B)-静脉血: 29.5mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 342.3g/L；尿酸(UA)-静脉血: 336.4umol/L；平均红细胞体积(MCV)-静脉血: 87.6fL；氯离子(Cl-)-静脉血: 101.4mmol/L；血小板计数(PLT#)-静脉血: 119.610E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.51；球蛋白(GLO)-静脉血: 30.98g/L；碱性磷酸酶(ALP)-静脉血: 84.6U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；天门冬氨酸氨基转移酶(AST)-静脉血: 16.5U/L；有核红细胞百分比(NRBC%)-静脉血: 0；间接胆红素(IBIL)-静脉血: 6umolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.02；载脂蛋白AI(apoAI)-静脉血: 1.07g/L；钠离子(Na+)-静脉血: 140.4mmol/L；葡萄糖(Glu)-静脉血: 4.22mmol/L；直接胆红素(DBIL)-静脉血: 2.9umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.71mmol/L；尿素氮(BUN)-静脉血: 5.4mmol/L；总胆固醇(TC)-静脉血: 5.2mmol/L；单核细胞百分比(Mono%)-静脉血: 0.141；胱抑素(Cys-C)-静脉血: 0.86mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.89mmolL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总胆汁酸(TBA)-静脉血: 7.2umol/L；总胆红素(TBIL)-静脉血: 8.9umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 27U/L；红细胞比容(Hct)-静脉血: 44.8%；淋巴细胞百分比(Lymph%)-静脉血: 0.143；乳酸脱氢酶(LDH)-静脉血: 185U/L；钾离子(K+)-静脉血: 3.96mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 34.8U/L；白细胞计数(WBC#)-静脉血: 4.5310E9/L；平均血小板体积(MPV)-静脉血: 8.57fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.……\n- [全程D64] 超声；腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约19cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D64] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对侧，双肺野纹理清晰，双肺野未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影形态、大小、位置未见异常。双膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。仍有听力下降，请[姓名已隐去]医生信息已隐藏出：根据患者外院鼻咽部检查提示鼻咽部病灶侵犯右侧海绵窦，颅底骨质等，分为分期信息见历史辅助诊断节点，双侧颈部淋巴结肿大，最大径＜6cm，分为分期信息见历史辅助诊断节点，未见远处转移，分为[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点，[计划性表述已隐藏]放疗及同步增敏化疗控制病情，目前行放疗前准备。.\n- [全程D14] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，继续行放化疗前准备，余无特殊。.\n- [全程D17] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，请[姓名已隐去]医生信息已隐藏出：患者目前无特殊，继续行放化疗前准备，继续观察病情。.\n- [全程D20] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，患者放疗计划准备完成，[计划性表述已隐藏]GTV70Gy/32f，GTVnd68Gy/32f，CTV1 60Gy/32f，CTV2 56Gy/32f。拟本周开始放疗，因患者分期晚，病变范围大，视神经、眼球、颞叶剂量较高，已与患者沟通不良反应，患者及时家属表示理解并同意治疗，继续观察病情。.\n- [全程D23] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，患者目前继续行放疗前准备，[姓名已隐去]医生信息已隐藏出：患者继续行放疗前准备，[计划性表述已隐藏]顺铂同期化疗，继续观察病情。.\n- [全程D26] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，患者目前无特殊，拟周一开始行放疗，周二行顺铂100mg/㎡同期化疗，继续行放化疗前准备，继续观察病情。.\n- [全程D52] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。诉吞咽稍有疼痛，体查:I度口腔粘膜反应。昨日查血常规示白细胞计数2.26*10E9/L ↓,中性粒细胞1.1*10E9/L↓，予以升白针对症治疗。下周复查血常规。继续当前放疗。\n- [全程D55] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。诉口干，吞咽稍有疼痛，体查:I度口腔粘膜反应。已予以升白针治疗三天，明日复查血常规，[计划性表述已隐藏]同期DDP第二程化疗。继续放疗治疗。\n- [全程D58] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。诉口干，吞咽稍有疼痛，体查:I度口腔粘膜反应。今日行同期DDP第二程化疗，予以护肝、护胃、制酸、止吐对症治疗。继续放疗治疗。\n- [全程D61] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。诉口干，吞咽稍有疼痛，体查:I度口腔粘膜反应。继续放疗治疗。\n- [全程D64] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者一般情况可，诉耳鸣、听力下降有所缓解，口干及轻微咽痛，无发热、咳嗽、咳痰等不适。查体：I度口腔粘膜反应，张口门齿距4.5cm；颈部淋巴结较前明显缩小，右颈III区可见一长约4cm手术疤痕，颈部皮肤呈放疗后改变。[姓名已隐去]医生信息已隐藏：患者一般情况良好，予以明天出院，嘱患者出院后定期返院复查。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即行颈部淋巴结清扫术处理未完全消退的残存淋巴结。\nB. 立即安排鼻咽及颈部MRI与全身PET-CT检查全面评估近期疗效。\nC. 立即启动PF方案（顺铂+氟尿嘧啶）辅助化疗以巩固局部及全身控制。\nD. 继续住院给予静脉高营养及广谱抗生素治疗直至口腔黏膜反应完全消失。\nE. 立即行电子鼻咽镜下原发灶活检以明确是否达到病理完全缓解。\nF. 预防性给予长效G-CSF并口服抗生素后办理出院。\nG. 立即启动西妥昔单抗靶向维持治疗以降低局部复发风险。\nH. 对颈部残存淋巴结局部追加外照射放疗推量至75-80Gy。\nI. 立即复查血浆EBV-DNA，若阳性则继续给予单药顺铂化疗。\nJ. 结束住院诊疗办理出院，嘱定期返院复查以评估近期疗效。\nK. 立即行胸腹部增强CT及骨ECT检查排除放化疗期间的远处转移。\nL. 立即请耳鼻喉科会诊行鼓膜穿刺抽液或置管术处理听力下降。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D44] 检验组合: 白细胞计数(WBC#)-静脉血: 4.4610E9/L；镁离子(Mg2+)-静脉血: 0.96mmol/L；葡萄糖(Glu)-静脉血: 4.12mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；丙氨酸氨基转移酶(ALT)-静脉血: 16U/L；总蛋白(TP)-静脉血: 72.33g/L；胱抑素(Cys-C)-静脉血: 0.78mg/L；血小板分布宽度(PDW)-静脉血: 11.6%；中性粒细胞计数(Neut#)-静脉血: 3.110E9/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.910E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 35.8U/L；C-反应蛋白(CRP)-静脉血: 3.43mg/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.1；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.32mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.9；氯离子(Cl-)-静脉血: 103mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 29mmol/L；乳酸脱氢酶(LDH)-静脉血: 172.3U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.195；直接胆红素(DBIL)-静脉血: 4.2umol/L；球蛋白(GLO)-静脉血: 29.23g/L；甘油三酯(TG)-静脉血: 1.13mmol/L；血小板计数(PLT#)-静脉血: 16510E9/L；钾离子(K+)-静脉血: 4.12mmol/L；肌酐(Crea)-静脉血: 67.7umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.3U/L；白蛋白(ALB)-静脉血: 43.1g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均血小板体积(MPV)-静脉血: 9.8fL；载脂蛋白AI(apoAI)-静脉血: 1.11g/L；总胆红素(TBIL)-静脉血: 12.6umol/L；单核细胞百分比(Mono%)-静脉血: 0.09；间接胆红素(IBIL)-静脉血: 8.4umolL；血红蛋白(Hb)-静脉血: 148g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 32.8U/L；红细胞……\n- [全程D51] 检验组合: 磷(P)-静脉血: 1.15mmol/L；氯离子(Cl-)-静脉血: 103.1mmol/L；球蛋白(GLO)-静脉血: 31.65g/L；中性粒细胞计数(Neut#)-静脉血: 1.110E9/L；钠离子(Na+)-静脉血: 141.8mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；中性粒细胞百分比(Neut%)-静脉血: 0.466；单核细胞百分比(Mono%)-静脉血: 0.221；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.03；血小板比容-静脉血: 15%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；乳酸脱氢酶(LDH)-静脉血: 170.6U/L；总胆红素(TBIL)-静脉血: 9.8umol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.2pg；肌酐(Crea)-静脉血: 72.4umol/L；尿素氮(BUN)-静脉血: 4.2mmol/L；尿酸(UA)-静脉血: 346.6umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.04；红细胞计数(RBC#)-静脉血: 5.1710E12/L；总蛋白(TP)-静脉血: 75.85g/L；平均血小板体积(MPV)-静脉血: 10fL；平均红细胞体积(MCV)-静脉血: 85.7fL；红细胞比容(Hct)-静脉血: 44.3%；白蛋白(ALB)-静脉血: 44.2g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.09mmolL；总胆固醇(TC)-静脉血: 5.11mmol/L；间接胆红素(IBIL)-静脉血: 6.3umolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.51mmol/L；胱抑素(Cys-C)-静脉血: 0.82mg/L；葡萄糖(Glu)-静脉血: 4.91mmol/L；C-反应蛋白(CRP)-静脉血: 2.13mg/L；碱性磷酸酶(ALP)-静脉血: 77.4U/L；总胆汁酸(TBA)-静脉血: 4.3umol/L；载脂蛋白AI(apoAI)-静脉血: 1.23g/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；直接胆红素(DBIL)-静脉血: 3.5umol/L；血小板分布宽度(PDW)-静脉血: 10.8%；血液二氧化碳含量ctCO2(B)-静脉血: 24.1m……\n- [全程D56] 检验组合: 血红蛋白(Hb)-静脉血: 154g/L；白细胞计数(WBC#)-静脉血: 510E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.28；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 48.1；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.6；中性粒细胞计数(Neut#)-静脉血: 3.110E9/L；大血小板百分比(P-LCR%)-静脉血: 28.9%；红细胞比容(Hct)-静脉血: 49.1%；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.612；单核细胞百分比(Mono%)-静脉血: 0.09；平均红细胞血红蛋白含量(MCH)-静脉血: 29.4pg；平均血小板体积(MPV)-静脉血: 10.4fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 11910E9/L；平均红细胞体积(MCV)-静脉血: 93.7fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0；血小板比容-静脉血: 12%；单核细胞计数(Mono#)-静脉血: 0.510E9/L；血小板分布宽度(PDW)-静脉血: 12.6%；红细胞计数(RBC#)-静脉血: 5.2410E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；平均红细胞血红蛋白浓度(MCHC)-静脉血: 314g/L\n- [全程D58] 检验组合: 白蛋白(ALB)-静脉血: 44.1g/L；血液二氧化碳含量ctCO2(B)-静脉血: 29.5mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 342.3g/L；尿酸(UA)-静脉血: 336.4umol/L；平均红细胞体积(MCV)-静脉血: 87.6fL；氯离子(Cl-)-静脉血: 101.4mmol/L；血小板计数(PLT#)-静脉血: 119.610E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.51；球蛋白(GLO)-静脉血: 30.98g/L；碱性磷酸酶(ALP)-静脉血: 84.6U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；天门冬氨酸氨基转移酶(AST)-静脉血: 16.5U/L；有核红细胞百分比(NRBC%)-静脉血: 0；间接胆红素(IBIL)-静脉血: 6umolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.02；载脂蛋白AI(apoAI)-静脉血: 1.07g/L；钠离子(Na+)-静脉血: 140.4mmol/L；葡萄糖(Glu)-静脉血: 4.22mmol/L；直接胆红素(DBIL)-静脉血: 2.9umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.71mmol/L；尿素氮(BUN)-静脉血: 5.4mmol/L；总胆固醇(TC)-静脉血: 5.2mmol/L；单核细胞百分比(Mono%)-静脉血: 0.141；胱抑素(Cys-C)-静脉血: 0.86mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.89mmolL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总胆汁酸(TBA)-静脉血: 7.2umol/L；总胆红素(TBIL)-静脉血: 8.9umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 27U/L；红细胞比容(Hct)-静脉血: 44.8%；淋巴细胞百分比(Lymph%)-静脉血: 0.143；乳酸脱氢酶(LDH)-静脉血: 185U/L；钾离子(K+)-静脉血: 3.96mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 34.8U/L；白细胞计数(WBC#)-静脉血: 4.5310E9/L；平均血小板体积(MPV)-静脉血: 8.57fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.……\n- [全程D64] 超声；腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约19cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D64] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对侧，双肺野纹理清晰，双肺野未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影形态、大小、位置未见异常。双膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n\n【既往治疗与反应】\n- [全程D52] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。诉吞咽稍有疼痛，体查:I度口腔粘膜反应。昨日查血常规示白细胞计数2.26*10E9/L ↓,中性粒细胞1.1*10E9/L↓，予以升白针对症治疗。下周复查血常规。继续当前放疗。\n- [全程D55] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。诉口干，吞咽稍有疼痛，体查:I度口腔粘膜反应。已予以升白针治疗三天，明日复查血常规，[计划性表述已隐藏]同期DDP第二程化疗。继续放疗治疗。\n- [全程D58] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。诉口干，吞咽稍有疼痛，体查:I度口腔粘膜反应。今日行同期DDP第二程化疗，予以护肝、护胃、制酸、止吐对症治疗。继续放疗治疗。\n- [全程D61] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。诉口干，吞咽稍有疼痛，体查:I度口腔粘膜反应。继续放疗治疗。\n- [全程D64] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者一般情况可，诉耳鸣、听力下降有所缓解，口干及轻微咽痛，无发热、咳嗽、咳痰等不适。查体：I度口腔粘膜反应，张口门齿距4.5cm；颈部淋巴结较前明显缩小，右颈III区可见一长约4cm手术疤痕，颈部皮肤呈放疗后改变。[姓名已隐去]医生信息已隐藏：患者一般情况良好，予以明天出院，嘱患者出院后定期返院复查。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即行颈部淋巴结清扫术处理未完全消退的残存淋巴结。\nB. 立即安排鼻咽及颈部MRI与全身PET-CT检查全面评估近期疗效。\nC. 立即启动PF方案（顺铂+氟尿嘧啶）辅助化疗以巩固局部及全身控制。\nD. 继续住院给予静脉高营养及广谱抗生素治疗直至口腔黏膜反应完全消失。\nE. 立即行电子鼻咽镜下原发灶活检以明确是否达到病理完全缓解。\nF. 预防性给予长效G-CSF并口服抗生素后办理出院。\nG. 立即启动西妥昔单抗靶向维持治疗以降低局部复发风险。\nH. 对颈部残存淋巴结局部追加外照射放疗推量至75-80Gy。\nI. 立即复查血浆EBV-DNA，若阳性则继续给予单药顺铂化疗。\nJ. 结束住院诊疗办理出院，嘱定期返院复查以评估近期疗效。\nK. 立即行胸腹部增强CT及骨ECT检查排除放化疗期间的远处转移。\nL. 立即请耳鼻喉科会诊行鼓膜穿刺抽液或置管术处理听力下降。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、鼻腔、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D44] 检验组合: 白细胞计数(WBC#)-静脉血: 4.4610E9/L；镁离子(Mg2+)-静脉血: 0.96mmol/L；葡萄糖(Glu)-静脉血: 4.12mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；丙氨酸氨基转移酶(ALT)-静脉血: 16U/L；总蛋白(TP)-静脉血: 72.33g/L；胱抑素(Cys-C)-静脉血: 0.78mg/L；血小板分布宽度(PDW)-静脉血: 11.6%；中性粒细胞计数(Neut#)-静脉血: 3.110E9/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.910E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 35.8U/L；C-反应蛋白(CRP)-静脉血: 3.43mg/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.1；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.32mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.9；氯离子(Cl-)-静脉血: 103mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 29mmol/L；乳酸脱氢酶(LDH)-静脉血: 172.3U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.195；直接胆红素(DBIL)-静脉血: 4.2umol/L；球蛋白(GLO)-静脉血: 29.23g/L；甘油三酯(TG)-静脉血: 1.13mmol/L；血小板计数(PLT#)-静脉血: 16510E9/L；钾离子(K+)-静脉血: 4.12mmol/L；肌酐(Crea)-静脉血: 67.7umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.3U/L；白蛋白(ALB)-静脉血: 43.1g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均血小板体积(MPV)-静脉血: 9.8fL；载脂蛋白AI(apoAI)-静脉血: 1.11g/L；总胆红素(TBIL)-静脉血: 12.6umol/L；单核细胞百分比(Mono%)-静脉血: 0.09；间接胆红素(IBIL)-静脉血: 8.4umolL；血红蛋白(Hb)-静脉血: 148g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 32.8U/L；红细胞……\n- [全程D51] 检验组合: 磷(P)-静脉血: 1.15mmol/L；氯离子(Cl-)-静脉血: 103.1mmol/L；球蛋白(GLO)-静脉血: 31.65g/L；中性粒细胞计数(Neut#)-静脉血: 1.110E9/L；钠离子(Na+)-静脉血: 141.8mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；中性粒细胞百分比(Neut%)-静脉血: 0.466；单核细胞百分比(Mono%)-静脉血: 0.221；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.03；血小板比容-静脉血: 15%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；乳酸脱氢酶(LDH)-静脉血: 170.6U/L；总胆红素(TBIL)-静脉血: 9.8umol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.2pg；肌酐(Crea)-静脉血: 72.4umol/L；尿素氮(BUN)-静脉血: 4.2mmol/L；尿酸(UA)-静脉血: 346.6umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.04；红细胞计数(RBC#)-静脉血: 5.1710E12/L；总蛋白(TP)-静脉血: 75.85g/L；平均血小板体积(MPV)-静脉血: 10fL；平均红细胞体积(MCV)-静脉血: 85.7fL；红细胞比容(Hct)-静脉血: 44.3%；白蛋白(ALB)-静脉血: 44.2g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.09mmolL；总胆固醇(TC)-静脉血: 5.11mmol/L；间接胆红素(IBIL)-静脉血: 6.3umolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.51mmol/L；胱抑素(Cys-C)-静脉血: 0.82mg/L；葡萄糖(Glu)-静脉血: 4.91mmol/L；C-反应蛋白(CRP)-静脉血: 2.13mg/L；碱性磷酸酶(ALP)-静脉血: 77.4U/L；总胆汁酸(TBA)-静脉血: 4.3umol/L；载脂蛋白AI(apoAI)-静脉血: 1.23g/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；直接胆红素(DBIL)-静脉血: 3.5umol/L；血小板分布宽度(PDW)-静脉血: 10.8%；血液二氧化碳含量ctCO2(B)-静脉血: 24.1m……\n- [全程D56] 检验组合: 血红蛋白(Hb)-静脉血: 154g/L；白细胞计数(WBC#)-静脉血: 510E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.28；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 48.1；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.6；中性粒细胞计数(Neut#)-静脉血: 3.110E9/L；大血小板百分比(P-LCR%)-静脉血: 28.9%；红细胞比容(Hct)-静脉血: 49.1%；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.612；单核细胞百分比(Mono%)-静脉血: 0.09；平均红细胞血红蛋白含量(MCH)-静脉血: 29.4pg；平均血小板体积(MPV)-静脉血: 10.4fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 11910E9/L；平均红细胞体积(MCV)-静脉血: 93.7fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0；血小板比容-静脉血: 12%；单核细胞计数(Mono#)-静脉血: 0.510E9/L；血小板分布宽度(PDW)-静脉血: 12.6%；红细胞计数(RBC#)-静脉血: 5.2410E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；平均红细胞血红蛋白浓度(MCHC)-静脉血: 314g/L\n- [全程D58] 检验组合: 白蛋白(ALB)-静脉血: 44.1g/L；血液二氧化碳含量ctCO2(B)-静脉血: 29.5mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 342.3g/L；尿酸(UA)-静脉血: 336.4umol/L；平均红细胞体积(MCV)-静脉血: 87.6fL；氯离子(Cl-)-静脉血: 101.4mmol/L；血小板计数(PLT#)-静脉血: 119.610E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.51；球蛋白(GLO)-静脉血: 30.98g/L；碱性磷酸酶(ALP)-静脉血: 84.6U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；天门冬氨酸氨基转移酶(AST)-静脉血: 16.5U/L；有核红细胞百分比(NRBC%)-静脉血: 0；间接胆红素(IBIL)-静脉血: 6umolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.02；载脂蛋白AI(apoAI)-静脉血: 1.07g/L；钠离子(Na+)-静脉血: 140.4mmol/L；葡萄糖(Glu)-静脉血: 4.22mmol/L；直接胆红素(DBIL)-静脉血: 2.9umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.71mmol/L；尿素氮(BUN)-静脉血: 5.4mmol/L；总胆固醇(TC)-静脉血: 5.2mmol/L；单核细胞百分比(Mono%)-静脉血: 0.141；胱抑素(Cys-C)-静脉血: 0.86mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.89mmolL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总胆汁酸(TBA)-静脉血: 7.2umol/L；总胆红素(TBIL)-静脉血: 8.9umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 27U/L；红细胞比容(Hct)-静脉血: 44.8%；淋巴细胞百分比(Lymph%)-静脉血: 0.143；乳酸脱氢酶(LDH)-静脉血: 185U/L；钾离子(K+)-静脉血: 3.96mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 34.8U/L；白细胞计数(WBC#)-静脉血: 4.5310E9/L；平均血小板体积(MPV)-静脉血: 8.57fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.……\n- [全程D64] 超声；腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约19cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D64] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对侧，双肺野纹理清晰，双肺野未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影形态、大小、位置未见异常。双膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n\n【既往治疗与反应】\n- [全程D52] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。诉吞咽稍有疼痛，体查:I度口腔粘膜反应。昨日查血常规示白细胞计数2.26*10E9/L ↓,中性粒细胞1.1*10E9/L↓，予以升白针对症治疗。下周复查血常规。继续当前放疗。\n- [全程D55] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。诉口干，吞咽稍有疼痛，体查:I度口腔粘膜反应。已予以升白针治疗三天，明日复查血常规，[计划性表述已隐藏]同期DDP第二程化疗。继续放疗治疗。\n- [全程D58] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。诉口干，吞咽稍有疼痛，体查:I度口腔粘膜反应。今日行同期DDP第二程化疗，予以护肝、护胃、制酸、止吐对症治疗。继续放疗治疗。\n- [全程D61] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。诉口干，吞咽稍有疼痛，体查:I度口腔粘膜反应。继续放疗治疗。\n- [全程D64] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者一般情况可，诉耳鸣、听力下降有所缓解，口干及轻微咽痛，无发热、咳嗽、咳痰等不适。查体：I度口腔粘膜反应，张口门齿距4.5cm；颈部淋巴结较前明显缩小，右颈III区可见一长约4cm手术疤痕，颈部皮肤呈放疗后改变。[姓名已隐去]医生信息已隐藏：患者一般情况良好，予以明天出院，嘱患者出院后定期返院复查。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即行颈部淋巴结清扫术处理未完全消退的残存淋巴结。\nB. 立即安排鼻咽及颈部MRI与全身PET-CT检查全面评估近期疗效。\nC. 立即启动PF方案（顺铂+氟尿嘧啶）辅助化疗以巩固局部及全身控制。\nD. 继续住院给予静脉高营养及广谱抗生素治疗直至口腔黏膜反应完全消失。\nE. 立即行电子鼻咽镜下原发灶活检以明确是否达到病理完全缓解。\nF. 预防性给予长效G-CSF并口服抗生素后办理出院。\nG. 立即启动西妥昔单抗靶向维持治疗以降低局部复发风险。\nH. 对颈部残存淋巴结局部追加外照射放疗推量至75-80Gy。\nI. 立即复查血浆EBV-DNA，若阳性则继续给予单药顺铂化疗。\nJ. 结束住院诊疗办理出院，嘱定期返院复查以评估近期疗效。\nK. 立即行胸腹部增强CT及骨ECT检查排除放化疗期间的远处转移。\nL. 立即请耳鼻喉科会诊行鼓膜穿刺抽液或置管术处理听力下降。\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-03e671c4e9fab822b9938832","patient_id":"patient-f25e20b1e5c6eea840d4cc21","turn_id":"turn08","turn_position":7,"turn_type":"response_assessment_decision","gold_letter":"K","gold_action":"评估为有效，结束根治性放化疗，予以办理出院并嘱定期门诊随访复查。","options":[{"letter":"A","text":"评估为疾病进展，停用放疗，改行吉西他滨联合顺铂姑息性化疗。","is_gold":false},{"letter":"B","text":"评估为部分缓解，继续住院行第3周期顺铂单药同期化疗。","is_gold":false},{"letter":"C","text":"评估为部分缓解，序贯启动顺铂联合氟尿嘧啶方案辅助化疗3个周期。","is_gold":false},{"letter":"D","text":"评估为完全缓解，转入头颈外科行右侧颈部淋巴结清扫术。","is_gold":false},{"letter":"E","text":"评估为部分缓解，对右颈部残留淋巴结追加局部外照射放疗至74Gy。","is_gold":false},{"letter":"F","text":"评估为疾病稳定，加用西妥昔单抗靶向治疗并延长原发灶放疗疗程。","is_gold":false},{"letter":"G","text":"评估为部分缓解，转入头颈外科行内镜下鼻咽原发灶切除术。","is_gold":false},{"letter":"H","text":"评估为有效，继续住院静脉使用抗生素及营养支持以治疗口腔黏膜反应。","is_gold":false},{"letter":"I","text":"评估为有效，立即安排鼻咽及颈部增强MRI复查以确认靶区消退情况。","is_gold":false},{"letter":"J","text":"评估为有效，办理出院，并序贯启动PD-1抑制剂维持治疗1年。","is_gold":false},{"letter":"K","text":"评估为有效，结束根治性放化疗，予以办理出院并嘱定期门诊随访复查。","is_gold":true},{"letter":"L","text":"评估为有效，办理出院，并嘱出院后1个月常规行全身PET-CT检查。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、鼻腔、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现右颈部肿块伴耳鸣、听力下降4个月。；现病史: 缘于4个月前患者无意中发现右颈部包块，如拇指大小，无压痛，伴耳鸣、听力下降，颈部包块后逐渐增大，近1周偶发头痛，白天明显，视物如常，无鼻塞、鼻血、面麻、等不适。为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,鼻咽肿物,右颈部包块,头痛；既往史: 4年前患痔疮，已治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:青霉素皮试阳性。；个人史: 长期居于原籍，无疫区居住史。吸烟3-4支/天*10年，饮酒1-2次/月。否认不洁性生活史。；家族史: 舅舅患鼻咽癌，舅妈患肺癌。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：103/73mmHg,Ht：174cm，Wt：79kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；右颈IIa区可扪及1个淋巴结，最大径2.5×2.5cm，左颈IIa区扪及1个淋巴结，最大径约3*3cm，无融合，质地韧，边界模糊，活动度好，无压痛，无皮肤浸润，无溃疡，右颈III区可见一长约4cm手术疤痕；颅神经检查：阴性。；KPS:；ECOG:\n- [全程D0] 入院记录: 主诉: 发现右颈部肿块伴耳鸣、听力下降4个月。；现病史: 缘于4个月前患者无意中发现右颈部包块，如拇指大小，无压痛，伴耳鸣、听力下降，颈部包块后逐渐增大，近1周偶发头痛，白天明显，视物如常，无鼻塞、鼻血、面麻、等不适。就诊[机构已隐去]，行右颈部淋巴结活检术，病理示转移性低分化鳞癌，行电子鼻咽镜检查见鼻咽肿物，取活检病理示可疑癌。为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,鼻咽肿物,右颈部包块,头痛；既往史: 4年前患痔疮，已治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:青霉素皮试阳性。；个人史: 长期居于原籍，无疫区居住史。吸烟3-4支/天*10年，饮酒1-2次/月。否认不洁性生活史。；家族史: 舅舅患鼻咽癌，舅妈患肺癌。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：103/73mmHg,Ht：174cm，Wt：79kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；右颈IIa区可扪及1个淋巴结，最大径2.5×2.5cm，左颈IIa区扪及1个淋巴结，最大径约3*3cm，无融合，质地韧，边界模糊，活动度好，无压痛，无皮肤浸润，无溃疡，右颈III区可见一长约4cm手术疤痕；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 电轴左偏(轻度) 正常范围心电图\n- [全程D1] 检验组合: 血小板比容-静脉血: 19%；载脂蛋白B(apoB)-静脉血: 1.03g/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；肌酐(Crea)-静脉血: 66.2umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.1；球蛋白(GLO)-静脉血: 31.61g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.011；尿胆原(URO)-尿液: -（参考: 阴性）；红细胞比容(Hct)-静脉血: 48.9%；凝血酶原时间活动度(PTA)-静脉血: 111.2%；隐血(OB)-粪便: 阴性（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.91mg/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；碱性磷酸酶(ALP)-静脉血: 76.3U/L；载脂蛋白AI(apoAI)-静脉血: 1.04g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；葡萄糖(Glu)-静脉血: 4.96mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.5；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；血小板分布宽度(PDW)-静脉血: 13.9%；淋巴细胞百分比(Lymph%)-静脉血: 0.315；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；总胆红素(TBIL)-静脉血: 7umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.910E9/L；Rh血型-静脉血: 阳性；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.2sec.；酮体(KET)-尿液: -（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 21.9mmol/L；浊度(TRUB)-尿液: 清亮；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 4.88mmol/L；C-反应蛋白(C……\n- [全程D3] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D7] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及双侧壁增厚，以右侧为著，T1WI呈等信号，T2WI呈稍高信号，增强扫描强化明显，右侧咽隐窝消失，见增厚组织占据，左侧咽隐窝变浅。病变与右侧中鼻甲分界不清，口咽双侧壁未见增厚。 右侧咽旁间隙及右侧咽后间隙见不规则肿物突入。双侧腭帆提肌、右侧腭帆张肌、右侧头长肌受侵。左侧腭帆张肌、双侧翼内肌及双侧翼外肌未见受侵。 右侧翼腭窝内见少许软组织信号，增强扫描明显强化。 左侧翼腭窝、双侧上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 斜坡、蝶骨基底部、右侧翼突基底部及内外板、右侧蝶骨大翼及右侧岩尖骨质信号减低，增强扫描见不均匀强化。 右侧破裂扩大，右侧海绵窦增宽，内见不规则软组织信号灶，右侧蝶窦内见软组织信号灶突入，增强扫描上述病变强化明显。 左侧海绵窦未见增宽。蝶鞍形态正常，其内未见占位性病变。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧上颌窦、筛窦及蝶窦粘膜增厚。右侧乳突内见大量分泌物。 右侧咽后见肿大淋巴结，大者约12mm×17mm，增强扫描强化明显。双颈II、III、V区见多个肿大淋巴结，最大者约23mm×29mm，部分边界欠清晰，包膜不完整，信号欠均匀，增强扫描明显不均匀强化。双侧腮腺内及腮腺旁见数个淋巴结，大者短径约6mm，增强扫描强化明显。双颈I区见数个淋巴结，大者短径约7mm，信号尚均匀。 甲状腺双叶及峡部、喉咽、双侧颌下腺信号均匀，未见占位性病变。；检查结论: 鼻咽病变，考虑鼻咽癌，侵犯范围如上述。 颅底骨质破坏。 右侧咽后、双颈II、III、V区多发肿大淋巴结，考虑转移。 双侧腮腺内及腮腺旁数个淋巴结，性质待定。 鼻窦炎、右侧乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D26] 检验组合: 镁离子(Mg2+)-静脉血: 0.88mmol/L；阴离子间隙(AG)-静脉血: 13.2；血小板比容-静脉血: 18%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；乳酸脱氢酶(LDH)-静脉血: 177.9U/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.7U/L；血小板分布宽度(PDW)-静脉血: 13.2%；钾离子(K+)-静脉血: 4.02mmol/L；白蛋白(ALB)-静脉血: 44.5g/L；直接胆红素(DBIL)-静脉血: 3.8umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.58mmol/L；大血小板百分比(P-LCR%)-静脉血: 28.9%；单核细胞计数(Mono#)-静脉血: 0.610E9/L；钠离子(Na+)-静脉血: 143.5mmol/L；总胆固醇(TC)-静脉血: 5.13mmol/L；总胆红素(TBIL)-静脉血: 11.7umol/L；甘油三酯(TG)-静脉血: 1.44mmol/L；红细胞比容(Hct)-静脉血: 48.1%；中性粒细胞计数(Neut#)-静脉血: 3.310E9/L；白细胞计数(WBC#)-静脉血: 6.2110E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.86；中性粒细胞百分比(Neut%)-静脉血: 0.528；总钙(Ca)-静脉血: 2.18mmol/L；总蛋白(TP)-静脉血: 76.63g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.38；α-L-岩藻糖苷酶(AFU)-静脉血: 35.5U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.97mmolL；淋巴细胞计数(Lymph#)-静脉血: 2.110E9/L；间接胆红素(IBIL)-静脉血: 7.9umolL；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；尿素氮(BUN)-静脉血: 4.1mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 333g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.9；单核细胞百分比(Mono%)-静脉血: 0.103；血液二氧化碳含量ctCO2(B)-静脉血: 26.……\n- [全程D44] 检验组合: 白细胞计数(WBC#)-静脉血: 4.4610E9/L；镁离子(Mg2+)-静脉血: 0.96mmol/L；葡萄糖(Glu)-静脉血: 4.12mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；丙氨酸氨基转移酶(ALT)-静脉血: 16U/L；总蛋白(TP)-静脉血: 72.33g/L；胱抑素(Cys-C)-静脉血: 0.78mg/L；血小板分布宽度(PDW)-静脉血: 11.6%；中性粒细胞计数(Neut#)-静脉血: 3.110E9/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.910E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 35.8U/L；C-反应蛋白(CRP)-静脉血: 3.43mg/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.1；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.32mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.9；氯离子(Cl-)-静脉血: 103mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 29mmol/L；乳酸脱氢酶(LDH)-静脉血: 172.3U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.195；直接胆红素(DBIL)-静脉血: 4.2umol/L；球蛋白(GLO)-静脉血: 29.23g/L；甘油三酯(TG)-静脉血: 1.13mmol/L；血小板计数(PLT#)-静脉血: 16510E9/L；钾离子(K+)-静脉血: 4.12mmol/L；肌酐(Crea)-静脉血: 67.7umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.3U/L；白蛋白(ALB)-静脉血: 43.1g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均血小板体积(MPV)-静脉血: 9.8fL；载脂蛋白AI(apoAI)-静脉血: 1.11g/L；总胆红素(TBIL)-静脉血: 12.6umol/L；单核细胞百分比(Mono%)-静脉血: 0.09；间接胆红素(IBIL)-静脉血: 8.4umolL；血红蛋白(Hb)-静脉血: 148g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 32.8U/L；红细胞……\n- [全程D51] 检验组合: 磷(P)-静脉血: 1.15mmol/L；氯离子(Cl-)-静脉血: 103.1mmol/L；球蛋白(GLO)-静脉血: 31.65g/L；中性粒细胞计数(Neut#)-静脉血: 1.110E9/L；钠离子(Na+)-静脉血: 141.8mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；中性粒细胞百分比(Neut%)-静脉血: 0.466；单核细胞百分比(Mono%)-静脉血: 0.221；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.03；血小板比容-静脉血: 15%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；乳酸脱氢酶(LDH)-静脉血: 170.6U/L；总胆红素(TBIL)-静脉血: 9.8umol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.2pg；肌酐(Crea)-静脉血: 72.4umol/L；尿素氮(BUN)-静脉血: 4.2mmol/L；尿酸(UA)-静脉血: 346.6umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.04；红细胞计数(RBC#)-静脉血: 5.1710E12/L；总蛋白(TP)-静脉血: 75.85g/L；平均血小板体积(MPV)-静脉血: 10fL；平均红细胞体积(MCV)-静脉血: 85.7fL；红细胞比容(Hct)-静脉血: 44.3%；白蛋白(ALB)-静脉血: 44.2g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.09mmolL；总胆固醇(TC)-静脉血: 5.11mmol/L；间接胆红素(IBIL)-静脉血: 6.3umolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.51mmol/L；胱抑素(Cys-C)-静脉血: 0.82mg/L；葡萄糖(Glu)-静脉血: 4.91mmol/L；C-反应蛋白(CRP)-静脉血: 2.13mg/L；碱性磷酸酶(ALP)-静脉血: 77.4U/L；总胆汁酸(TBA)-静脉血: 4.3umol/L；载脂蛋白AI(apoAI)-静脉血: 1.23g/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；直接胆红素(DBIL)-静脉血: 3.5umol/L；血小板分布宽度(PDW)-静脉血: 10.8%；血液二氧化碳含量ctCO2(B)-静脉血: 24.1m……\n- [全程D56] 检验组合: 血红蛋白(Hb)-静脉血: 154g/L；白细胞计数(WBC#)-静脉血: 510E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.28；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 48.1；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.6；中性粒细胞计数(Neut#)-静脉血: 3.110E9/L；大血小板百分比(P-LCR%)-静脉血: 28.9%；红细胞比容(Hct)-静脉血: 49.1%；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.612；单核细胞百分比(Mono%)-静脉血: 0.09；平均红细胞血红蛋白含量(MCH)-静脉血: 29.4pg；平均血小板体积(MPV)-静脉血: 10.4fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 11910E9/L；平均红细胞体积(MCV)-静脉血: 93.7fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0；血小板比容-静脉血: 12%；单核细胞计数(Mono#)-静脉血: 0.510E9/L；血小板分布宽度(PDW)-静脉血: 12.6%；红细胞计数(RBC#)-静脉血: 5.2410E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；平均红细胞血红蛋白浓度(MCHC)-静脉血: 314g/L\n- [全程D58] 检验组合: 白蛋白(ALB)-静脉血: 44.1g/L；血液二氧化碳含量ctCO2(B)-静脉血: 29.5mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 342.3g/L；尿酸(UA)-静脉血: 336.4umol/L；平均红细胞体积(MCV)-静脉血: 87.6fL；氯离子(Cl-)-静脉血: 101.4mmol/L；血小板计数(PLT#)-静脉血: 119.610E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.51；球蛋白(GLO)-静脉血: 30.98g/L；碱性磷酸酶(ALP)-静脉血: 84.6U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；天门冬氨酸氨基转移酶(AST)-静脉血: 16.5U/L；有核红细胞百分比(NRBC%)-静脉血: 0；间接胆红素(IBIL)-静脉血: 6umolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.02；载脂蛋白AI(apoAI)-静脉血: 1.07g/L；钠离子(Na+)-静脉血: 140.4mmol/L；葡萄糖(Glu)-静脉血: 4.22mmol/L；直接胆红素(DBIL)-静脉血: 2.9umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.71mmol/L；尿素氮(BUN)-静脉血: 5.4mmol/L；总胆固醇(TC)-静脉血: 5.2mmol/L；单核细胞百分比(Mono%)-静脉血: 0.141；胱抑素(Cys-C)-静脉血: 0.86mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.89mmolL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总胆汁酸(TBA)-静脉血: 7.2umol/L；总胆红素(TBIL)-静脉血: 8.9umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 27U/L；红细胞比容(Hct)-静脉血: 44.8%；淋巴细胞百分比(Lymph%)-静脉血: 0.143；乳酸脱氢酶(LDH)-静脉血: 185U/L；钾离子(K+)-静脉血: 3.96mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 34.8U/L；白细胞计数(WBC#)-静脉血: 4.5310E9/L；平均血小板体积(MPV)-静脉血: 8.57fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.……\n- [全程D64] 超声；腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约19cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D64] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对侧，双肺野纹理清晰，双肺野未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影形态、大小、位置未见异常。双膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。仍有听力下降，请[姓名已隐去]医生信息已隐藏出：根据患者外院鼻咽部检查提示鼻咽部病灶侵犯右侧海绵窦，颅底骨质等，分为分期信息见历史辅助诊断节点，双侧颈部淋巴结肿大，最大径＜6cm，分为分期信息见历史辅助诊断节点，未见远处转移，分为[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点，[计划性表述已隐藏]放疗及同步增敏化疗控制病情，目前行放疗前准备。.\n- [全程D14] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，继续行放化疗前准备，余无特殊。.\n- [全程D17] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，请[姓名已隐去]医生信息已隐藏出：患者目前无特殊，继续行放化疗前准备，继续观察病情。.\n- [全程D20] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，患者放疗计划准备完成，[计划性表述已隐藏]GTV70Gy/32f，GTVnd68Gy/32f，CTV1 60Gy/32f，CTV2 56Gy/32f。拟本周开始放疗，因患者分期晚，病变范围大，视神经、眼球、颞叶剂量较高，已与患者沟通不良反应，患者及时家属表示理解并同意治疗，继续观察病情。.\n- [全程D23] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，患者目前继续行放疗前准备，[姓名已隐去]医生信息已隐藏出：患者继续行放疗前准备，[计划性表述已隐藏]顺铂同期化疗，继续观察病情。.\n- [全程D26] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，患者目前无特殊，拟周一开始行放疗，周二行顺铂100mg/㎡同期化疗，继续行放化疗前准备，继续观察病情。.\n- [全程D52] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。诉吞咽稍有疼痛，体查:I度口腔粘膜反应。昨日查血常规示白细胞计数2.26*10E9/L ↓,中性粒细胞1.1*10E9/L↓，予以升白针对症治疗。下周复查血常规。继续当前放疗。\n- [全程D55] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。诉口干，吞咽稍有疼痛，体查:I度口腔粘膜反应。已予以升白针治疗三天，明日复查血常规，[计划性表述已隐藏]同期DDP第二程化疗。继续放疗治疗。\n- [全程D58] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。诉口干，吞咽稍有疼痛，体查:I度口腔粘膜反应。今日行同期DDP第二程化疗，予以护肝、护胃、制酸、止吐对症治疗。继续放疗治疗。\n- [全程D61] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。诉口干，吞咽稍有疼痛，体查:I度口腔粘膜反应。继续放疗治疗。\n- [全程D64] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者一般情况可，诉耳鸣、听力下降有所缓解，口干及轻微咽痛，无发热、咳嗽、咳痰等不适。查体：I度口腔粘膜反应，张口门齿距4.5cm；颈部淋巴结较前明显缩小，右颈III区可见一长约4cm手术疤痕，颈部皮肤呈放疗后改变。[姓名已隐去]医生信息已隐藏：患者一般情况良好，予以明天出院，嘱患者出院后定期返院复查。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估为疾病进展，停用放疗，改行吉西他滨联合顺铂姑息性化疗。\nB. 评估为部分缓解，继续住院行第3周期顺铂单药同期化疗。\nC. 评估为部分缓解，序贯启动顺铂联合氟尿嘧啶方案辅助化疗3个周期。\nD. 评估为完全缓解，转入头颈外科行右侧颈部淋巴结清扫术。\nE. 评估为部分缓解，对右颈部残留淋巴结追加局部外照射放疗至74Gy。\nF. 评估为疾病稳定，加用西妥昔单抗靶向治疗并延长原发灶放疗疗程。\nG. 评估为部分缓解，转入头颈外科行内镜下鼻咽原发灶切除术。\nH. 评估为有效，继续住院静脉使用抗生素及营养支持以治疗口腔黏膜反应。\nI. 评估为有效，立即安排鼻咽及颈部增强MRI复查以确认靶区消退情况。\nJ. 评估为有效，办理出院，并序贯启动PD-1抑制剂维持治疗1年。\nK. 评估为有效，结束根治性放化疗，予以办理出院并嘱定期门诊随访复查。\nL. 评估为有效，办理出院，并嘱出院后1个月常规行全身PET-CT检查。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- 无可展示记录。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估为疾病进展，停用放疗，改行吉西他滨联合顺铂姑息性化疗。\nB. 评估为部分缓解，继续住院行第3周期顺铂单药同期化疗。\nC. 评估为部分缓解，序贯启动顺铂联合氟尿嘧啶方案辅助化疗3个周期。\nD. 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full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：咽旁间隙、斜坡、蝶骨基底部、岩尖。\n文本分期信息：N3，M0。\n综合TNM状态：T3N3M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1] 入院记录: 主诉: 右颈肿物半年，右耳听力下降半月；现病史: 缘于6月前患者无意中出现右颈肿物，未予重视，进行性增大，半月前出现右耳听力下降，无头痛、复视，无涕血、面麻等，就诊于当地医院，发现鼻咽肿物。今为求进一步诊治来我院。患者发病以来,精神、饮食、睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟20支/日*5年，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.3℃，P：79次/分，R：20次/分，BP：105/65mmHg,Ht：168cm，Wt：56kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 行鼻咽及颈部CT平扫+增强、间接鼻咽镜检查，并完善心电图及基线抽血化验。\nB. 行鼻咽及颈部MRI平扫（不加增强）、间接鼻咽镜检查，并完善心电图及基线抽血化验。\nC. 行鼻咽及颈部MRI平扫+增强，暂缓鼻咽镜检查，先行颈部淋巴结细针穿刺活检。\nD. 行鼻咽及颈部CT平扫+增强，暂缓鼻咽镜检查，先行颈部淋巴结切除活检。\nE. 行鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查，并直接安排全身骨扫描及肝脏超声。\nF. 行鼻咽及颈部MRI平扫+增强、鼻内镜下鼻腔扩宽术，并完善心电图及基线抽血化验。\nG. 行鼻咽及颈部超声检查、间接鼻咽镜检查，并完善心电图及基线抽血化验。\nH. 行鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查，并完善心电图，暂缓抽血化验。\nI. 行鼻咽及颈部MRI平扫+增强、直接喉镜检查，并完善心电图及基线抽血化验。\nJ. 行鼻咽及颈部CT平扫+增强、间接鼻咽镜检查，并直接安排胸腹部CT平扫+增强。\nK. 行鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查，并完善心电图及基线抽血化验。\n\n请仅输出一个选项字母（A-K）。","incremental_user_message":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：咽旁间隙、斜坡、蝶骨基底部、岩尖。\n文本分期信息：N3，M0。\n综合TNM状态：T3N3M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1] 入院记录: 主诉: 右颈肿物半年，右耳听力下降半月；现病史: 缘于6月前患者无意中出现右颈肿物，未予重视，进行性增大，半月前出现右耳听力下降，无头痛、复视，无涕血、面麻等，就诊于当地医院，发现鼻咽肿物。今为求进一步诊治来我院。患者发病以来,精神、饮食、睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟20支/日*5年，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.3℃，P：79次/分，R：20次/分，BP：105/65mmHg,Ht：168cm，Wt：56kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 行鼻咽及颈部CT平扫+增强、间接鼻咽镜检查，并完善心电图及基线抽血化验。\nB. 行鼻咽及颈部MRI平扫（不加增强）、间接鼻咽镜检查，并完善心电图及基线抽血化验。\nC. 行鼻咽及颈部MRI平扫+增强，暂缓鼻咽镜检查，先行颈部淋巴结细针穿刺活检。\nD. 行鼻咽及颈部CT平扫+增强，暂缓鼻咽镜检查，先行颈部淋巴结切除活检。\nE. 行鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查，并直接安排全身骨扫描及肝脏超声。\nF. 行鼻咽及颈部MRI平扫+增强、鼻内镜下鼻腔扩宽术，并完善心电图及基线抽血化验。\nG. 行鼻咽及颈部超声检查、间接鼻咽镜检查，并完善心电图及基线抽血化验。\nH. 行鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查，并完善心电图，暂缓抽血化验。\nI. 行鼻咽及颈部MRI平扫+增强、直接喉镜检查，并完善心电图及基线抽血化验。\nJ. 行鼻咽及颈部CT平扫+增强、间接鼻咽镜检查，并直接安排胸腹部CT平扫+增强。\nK. 行鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查，并完善心电图及基线抽血化验。\n\n请仅输出一个选项字母（A-K）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：咽旁间隙、斜坡、蝶骨基底部、岩尖。\n文本分期信息：N3，M0。\n综合TNM状态：T3N3M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1] 入院记录: 主诉: 右颈肿物半年，右耳听力下降半月；现病史: 缘于6月前患者无意中出现右颈肿物，未予重视，进行性增大，半月前出现右耳听力下降，无头痛、复视，无涕血、面麻等，就诊于当地医院，发现鼻咽肿物。今为求进一步诊治来我院。患者发病以来,精神、饮食、睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟20支/日*5年，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.3℃，P：79次/分，R：20次/分，BP：105/65mmHg,Ht：168cm，Wt：56kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 行鼻咽及颈部CT平扫+增强、间接鼻咽镜检查，并完善心电图及基线抽血化验。\nB. 行鼻咽及颈部MRI平扫（不加增强）、间接鼻咽镜检查，并完善心电图及基线抽血化验。\nC. 行鼻咽及颈部MRI平扫+增强，暂缓鼻咽镜检查，先行颈部淋巴结细针穿刺活检。\nD. 行鼻咽及颈部CT平扫+增强，暂缓鼻咽镜检查，先行颈部淋巴结切除活检。\nE. 行鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查，并直接安排全身骨扫描及肝脏超声。\nF. 行鼻咽及颈部MRI平扫+增强、鼻内镜下鼻腔扩宽术，并完善心电图及基线抽血化验。\nG. 行鼻咽及颈部超声检查、间接鼻咽镜检查，并完善心电图及基线抽血化验。\nH. 行鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查，并完善心电图，暂缓抽血化验。\nI. 行鼻咽及颈部MRI平扫+增强、直接喉镜检查，并完善心电图及基线抽血化验。\nJ. 行鼻咽及颈部CT平扫+增强、间接鼻咽镜检查，并直接安排胸腹部CT平扫+增强。\nK. 行鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查，并完善心电图及基线抽血化验。\n\n请仅输出一个选项字母（A-K）。"},{"sample_id":"sample-057bee25fe3533856610d5c8","patient_id":"patient-9fcde7a95f4d57501ecbf7b2","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"A","gold_action":"行电子鼻咽镜检查及鼻咽肿物活检以明确病理诊断。","options":[{"letter":"A","text":"电子鼻咽镜检查及鼻咽肿物活检","is_gold":true},{"letter":"B","text":"颈部淋巴结切开活检术","is_gold":false},{"letter":"C","text":"超声引导下颈部淋巴结细针穿刺活检","is_gold":false},{"letter":"D","text":"全身PET-CT检查","is_gold":false},{"letter":"E","text":"胸部CT、腹部超声及全身骨扫描","is_gold":false},{"letter":"F","text":"鼻内镜下鼻咽肿物切除术","is_gold":false},{"letter":"G","text":"诊断性抗炎治疗2周后复查MRI","is_gold":false},{"letter":"H","text":"外周血EBV-DNA定量检测","is_gold":false},{"letter":"I","text":"鼻咽脱落细胞学检查","is_gold":false},{"letter":"J","text":"鼻咽及颈部CT平扫+增强","is_gold":false},{"letter":"K","text":"鼻咽颅底三维CT重建","is_gold":false},{"letter":"L","text":"颈部淋巴结清扫术","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：咽旁间隙、斜坡、蝶骨基底部、岩尖。\n文本分期信息：N3，M0。\n综合TNM状态：T3N3M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1] 入院记录: 主诉: 右颈肿物半年，右耳听力下降半月；现病史: 缘于6月前患者无意中出现右颈肿物，未予重视，进行性增大，半月前出现右耳听力下降，无头痛、复视，无涕血、面麻等，就诊于当地医院，发现鼻咽肿物。今为求进一步诊治来我院。患者发病以来,精神、饮食、睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟20支/日*5年，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.3℃，P：79次/分，R：20次/分，BP：105/65mmHg,Ht：168cm，Wt：56kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D4] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 V5～V6导联低电压 V1～V3导联r波递增不良\n- [全程D4] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 25.6U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.341；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；平均红细胞体积(MCV)-静脉血: 94.7fL；白细胞计数(WBC#)-静脉血: 4.5110E9/L；平均血小板体积(MPV)-静脉血: 12fL；D-二聚体(D-Dimer)-静脉血: 0.1ug/ml；单核细胞计数(Mono#)-静脉血: 0.510E9/L；磷(P)-静脉血: 1.36mmol/L；甘油三酯(TG)-静脉血: 2.22mmol/L；间接胆红素(IBIL)-静脉血: 5.2umolL；白蛋白(ALB)-静脉血: 44.8g/L；碱性磷酸酶(ALP)-静脉血: 81.9U/L；凝血酶时间(TT)-静脉血: 18.5sec.；载脂蛋白B(apoB)-静脉血: 0.57g/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.1U/L；阴离子间隙(AG)-静脉血: 11；血小板比容-静脉血: 15%；凝血酶原时间(PT)-静脉血: 11.7sec.；肌酐(Crea)-静脉血: 82.7umol/L；总胆红素(TBIL)-静脉血: 8.2umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.503；球蛋白(GLO)-静脉血: 25.56g/L；红细胞计数(RBC#)-静脉血: 4.5210E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；大血小板百分比(P-LCR%)-静脉血: 40%；血小板分布宽度(PDW)-静脉血: 14.2%；凝血酶原时间活动度(PTA)-静脉血: 90.4%；乳酸脱氢酶(LDH)-静脉血: 359.7U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32.3pg；ABO血型-静脉血: B；总钙(Ca)-静脉血: 2.3mmol/L；镁离子(Mg2+)-静脉血: 0.99mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 146g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；γ-谷氨酰基转移酶(GGT)-静脉血: 14.6U/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.1mmol/L……\n- [全程D5] 检验组合: 乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阳性(+)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D6] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、双侧壁明显不均匀增厚，平扫T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，双侧咽隐窝变浅，双侧咽旁脂肪间隙稍狭窄；双侧腭帆提肌、腭帆张肌、头长肌受压。双侧咽后见肿大淋巴结，左侧较大者短径11mm，右侧较大者短径12mm。 双侧后鼻孔堵塞，口咽双侧壁未见受累增厚。 双侧翼腭窝、颞下窝未见异常。 蝶骨基底部、斜坡、双侧岩尖、双侧枕骨基底部骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽；双侧筛窦、蝶窦，右乳突内见积液；上颌窦、左乳突充气良好，骨壁完整；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双颈II区、右颈III、IV区见淋巴结肿大，部分融合，较大者短径28mm，信号欠均匀，增强较明显不均匀强化。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。；检查结论: 鼻咽顶壁、顶后壁、双侧壁明显不均匀增厚，考虑鼻咽癌。 颅底骨质破坏。 双侧咽后、双颈部多发淋巴结肿大，考虑转移瘤。 副鼻窦炎；右乳突炎。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 电子鼻咽镜检查及鼻咽肿物活检\nB. 颈部淋巴结切开活检术\nC. 超声引导下颈部淋巴结细针穿刺活检\nD. 全身PET-CT检查\nE. 胸部CT、腹部超声及全身骨扫描\nF. 鼻内镜下鼻咽肿物切除术\nG. 诊断性抗炎治疗2周后复查MRI\nH. 外周血EBV-DNA定量检测\nI. 鼻咽脱落细胞学检查\nJ. 鼻咽及颈部CT平扫+增强\nK. 鼻咽颅底三维CT重建\nL. 颈部淋巴结清扫术\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D4] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 V5～V6导联低电压 V1～V3导联r波递增不良\n- [全程D4] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 25.6U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.341；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；平均红细胞体积(MCV)-静脉血: 94.7fL；白细胞计数(WBC#)-静脉血: 4.5110E9/L；平均血小板体积(MPV)-静脉血: 12fL；D-二聚体(D-Dimer)-静脉血: 0.1ug/ml；单核细胞计数(Mono#)-静脉血: 0.510E9/L；磷(P)-静脉血: 1.36mmol/L；甘油三酯(TG)-静脉血: 2.22mmol/L；间接胆红素(IBIL)-静脉血: 5.2umolL；白蛋白(ALB)-静脉血: 44.8g/L；碱性磷酸酶(ALP)-静脉血: 81.9U/L；凝血酶时间(TT)-静脉血: 18.5sec.；载脂蛋白B(apoB)-静脉血: 0.57g/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.1U/L；阴离子间隙(AG)-静脉血: 11；血小板比容-静脉血: 15%；凝血酶原时间(PT)-静脉血: 11.7sec.；肌酐(Crea)-静脉血: 82.7umol/L；总胆红素(TBIL)-静脉血: 8.2umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.503；球蛋白(GLO)-静脉血: 25.56g/L；红细胞计数(RBC#)-静脉血: 4.5210E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；大血小板百分比(P-LCR%)-静脉血: 40%；血小板分布宽度(PDW)-静脉血: 14.2%；凝血酶原时间活动度(PTA)-静脉血: 90.4%；乳酸脱氢酶(LDH)-静脉血: 359.7U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32.3pg；ABO血型-静脉血: B；总钙(Ca)-静脉血: 2.3mmol/L；镁离子(Mg2+)-静脉血: 0.99mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 146g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；γ-谷氨酰基转移酶(GGT)-静脉血: 14.6U/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.1mmol/L……\n- [全程D5] 检验组合: 乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阳性(+)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D6] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、双侧壁明显不均匀增厚，平扫T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，双侧咽隐窝变浅，双侧咽旁脂肪间隙稍狭窄；双侧腭帆提肌、腭帆张肌、头长肌受压。双侧咽后见肿大淋巴结，左侧较大者短径11mm，右侧较大者短径12mm。 双侧后鼻孔堵塞，口咽双侧壁未见受累增厚。 双侧翼腭窝、颞下窝未见异常。 蝶骨基底部、斜坡、双侧岩尖、双侧枕骨基底部骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽；双侧筛窦、蝶窦，右乳突内见积液；上颌窦、左乳突充气良好，骨壁完整；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双颈II区、右颈III、IV区见淋巴结肿大，部分融合，较大者短径28mm，信号欠均匀，增强较明显不均匀强化。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。；检查结论: 鼻咽顶壁、顶后壁、双侧壁明显不均匀增厚，考虑鼻咽癌。 颅底骨质破坏。 双侧咽后、双颈部多发淋巴结肿大，考虑转移瘤。 副鼻窦炎；右乳突炎。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 电子鼻咽镜检查及鼻咽肿物活检\nB. 颈部淋巴结切开活检术\nC. 超声引导下颈部淋巴结细针穿刺活检\nD. 全身PET-CT检查\nE. 胸部CT、腹部超声及全身骨扫描\nF. 鼻内镜下鼻咽肿物切除术\nG. 诊断性抗炎治疗2周后复查MRI\nH. 外周血EBV-DNA定量检测\nI. 鼻咽脱落细胞学检查\nJ. 鼻咽及颈部CT平扫+增强\nK. 鼻咽颅底三维CT重建\nL. 颈部淋巴结清扫术\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：咽旁间隙、斜坡、蝶骨基底部、岩尖。\n文本分期信息：N3，M0。\n综合TNM状态：T3N3M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D4] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 V5～V6导联低电压 V1～V3导联r波递增不良\n- [全程D4] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 25.6U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.341；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；平均红细胞体积(MCV)-静脉血: 94.7fL；白细胞计数(WBC#)-静脉血: 4.5110E9/L；平均血小板体积(MPV)-静脉血: 12fL；D-二聚体(D-Dimer)-静脉血: 0.1ug/ml；单核细胞计数(Mono#)-静脉血: 0.510E9/L；磷(P)-静脉血: 1.36mmol/L；甘油三酯(TG)-静脉血: 2.22mmol/L；间接胆红素(IBIL)-静脉血: 5.2umolL；白蛋白(ALB)-静脉血: 44.8g/L；碱性磷酸酶(ALP)-静脉血: 81.9U/L；凝血酶时间(TT)-静脉血: 18.5sec.；载脂蛋白B(apoB)-静脉血: 0.57g/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.1U/L；阴离子间隙(AG)-静脉血: 11；血小板比容-静脉血: 15%；凝血酶原时间(PT)-静脉血: 11.7sec.；肌酐(Crea)-静脉血: 82.7umol/L；总胆红素(TBIL)-静脉血: 8.2umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.503；球蛋白(GLO)-静脉血: 25.56g/L；红细胞计数(RBC#)-静脉血: 4.5210E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；大血小板百分比(P-LCR%)-静脉血: 40%；血小板分布宽度(PDW)-静脉血: 14.2%；凝血酶原时间活动度(PTA)-静脉血: 90.4%；乳酸脱氢酶(LDH)-静脉血: 359.7U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32.3pg；ABO血型-静脉血: B；总钙(Ca)-静脉血: 2.3mmol/L；镁离子(Mg2+)-静脉血: 0.99mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 146g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；γ-谷氨酰基转移酶(GGT)-静脉血: 14.6U/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.1mmol/L……\n- [全程D5] 检验组合: 乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阳性(+)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D6] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、双侧壁明显不均匀增厚，平扫T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，双侧咽隐窝变浅，双侧咽旁脂肪间隙稍狭窄；双侧腭帆提肌、腭帆张肌、头长肌受压。双侧咽后见肿大淋巴结，左侧较大者短径11mm，右侧较大者短径12mm。 双侧后鼻孔堵塞，口咽双侧壁未见受累增厚。 双侧翼腭窝、颞下窝未见异常。 蝶骨基底部、斜坡、双侧岩尖、双侧枕骨基底部骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽；双侧筛窦、蝶窦，右乳突内见积液；上颌窦、左乳突充气良好，骨壁完整；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双颈II区、右颈III、IV区见淋巴结肿大，部分融合，较大者短径28mm，信号欠均匀，增强较明显不均匀强化。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。；检查结论: 鼻咽顶壁、顶后壁、双侧壁明显不均匀增厚，考虑鼻咽癌。 颅底骨质破坏。 双侧咽后、双颈部多发淋巴结肿大，考虑转移瘤。 副鼻窦炎；右乳突炎。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 电子鼻咽镜检查及鼻咽肿物活检\nB. 颈部淋巴结切开活检术\nC. 超声引导下颈部淋巴结细针穿刺活检\nD. 全身PET-CT检查\nE. 胸部CT、腹部超声及全身骨扫描\nF. 鼻内镜下鼻咽肿物切除术\nG. 诊断性抗炎治疗2周后复查MRI\nH. 外周血EBV-DNA定量检测\nI. 鼻咽脱落细胞学检查\nJ. 鼻咽及颈部CT平扫+增强\nK. 鼻咽颅底三维CT重建\nL. 颈部淋巴结清扫术\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-ea63b7a358722be15870f84c","patient_id":"patient-9fcde7a95f4d57501ecbf7b2","turn_id":"turn04","turn_position":3,"turn_type":"initial_treatment_selection","gold_letter":"C","gold_action":"完善中心静脉置管，行诱导化疗序贯根治性同期放化疗。","options":[{"letter":"A","text":"完善中心静脉置管，直接行根治性同期放化疗","is_gold":false},{"letter":"B","text":"完善中心静脉置管，行诱导化疗序贯单纯根治性放疗","is_gold":false},{"letter":"C","text":"完善中心静脉置管，行诱导化疗序贯根治性同期放化疗","is_gold":true},{"letter":"D","text":"完善中心静脉置管，行诱导化疗序贯根治性同期放化疗及辅助化疗","is_gold":false},{"letter":"E","text":"完善中心静脉置管，行诱导化疗联合PD-1单抗序贯根治性同期放化疗","is_gold":false},{"letter":"F","text":"完善中心静脉置管，直接行根治性同期放化疗及辅助化疗","is_gold":false},{"letter":"G","text":"完善中心静脉置管，行诱导化疗序贯根治性放疗联合EGFR单抗","is_gold":false},{"letter":"H","text":"完善中心静脉置管，行诱导化疗，放疗前行右颈部淋巴结清扫术","is_gold":false},{"letter":"I","text":"完善中心静脉置管，行姑息性化疗，视颈部淋巴结退缩情况决定放疗时机","is_gold":false},{"letter":"J","text":"完善中心静脉置管，直接行根治性放疗联合EGFR单抗","is_gold":false},{"letter":"K","text":"完善中心静脉置管，行诱导化疗序贯根治性放疗及辅助化疗","is_gold":false},{"letter":"L","text":"完善中心静脉置管，行诱导化疗联合EGFR单抗序贯单纯根治性放疗","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：咽旁间隙、斜坡、蝶骨基底部、岩尖。\n文本分期信息：N3，M0。\n综合TNM状态：T3N3M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1] 入院记录: 主诉: 右颈肿物半年，右耳听力下降半月；现病史: 缘于6月前患者无意中出现右颈肿物，未予重视，进行性增大，半月前出现右耳听力下降，无头痛、复视，无涕血、面麻等，就诊于当地医院，发现鼻咽肿物。今为求进一步诊治来我院。患者发病以来,精神、饮食、睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟20支/日*5年，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.3℃，P：79次/分，R：20次/分，BP：105/65mmHg,Ht：168cm，Wt：56kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D1] 入院记录: 主诉: 右颈肿物半年，右耳听力下降半月；现病史: 缘于6月前患者无意中出现右颈肿物，未予重视，进行性增大，半月前出现右耳听力下降，无头痛、复视，无涕血、面麻等，就诊于当地医院，发现鼻咽肿物。今为求进一步诊治来我院。患者发病以来,精神、饮食、睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟20支/日*5年，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.3℃，P：79次/分，R：20次/分，BP：105/65mmHg,Ht：168cm，Wt：56kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率79次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D4] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 V5～V6导联低电压 V1～V3导联r波递增不良\n- [全程D4] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 25.6U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.341；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；平均红细胞体积(MCV)-静脉血: 94.7fL；白细胞计数(WBC#)-静脉血: 4.5110E9/L；平均血小板体积(MPV)-静脉血: 12fL；D-二聚体(D-Dimer)-静脉血: 0.1ug/ml；单核细胞计数(Mono#)-静脉血: 0.510E9/L；磷(P)-静脉血: 1.36mmol/L；甘油三酯(TG)-静脉血: 2.22mmol/L；间接胆红素(IBIL)-静脉血: 5.2umolL；白蛋白(ALB)-静脉血: 44.8g/L；碱性磷酸酶(ALP)-静脉血: 81.9U/L；凝血酶时间(TT)-静脉血: 18.5sec.；载脂蛋白B(apoB)-静脉血: 0.57g/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.1U/L；阴离子间隙(AG)-静脉血: 11；血小板比容-静脉血: 15%；凝血酶原时间(PT)-静脉血: 11.7sec.；肌酐(Crea)-静脉血: 82.7umol/L；总胆红素(TBIL)-静脉血: 8.2umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.503；球蛋白(GLO)-静脉血: 25.56g/L；红细胞计数(RBC#)-静脉血: 4.5210E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；大血小板百分比(P-LCR%)-静脉血: 40%；血小板分布宽度(PDW)-静脉血: 14.2%；凝血酶原时间活动度(PTA)-静脉血: 90.4%；乳酸脱氢酶(LDH)-静脉血: 359.7U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32.3pg；ABO血型-静脉血: B；总钙(Ca)-静脉血: 2.3mmol/L；镁离子(Mg2+)-静脉血: 0.99mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 146g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；γ-谷氨酰基转移酶(GGT)-静脉血: 14.6U/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.1mmol/L……\n- [全程D5] 检验组合: 乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阳性(+)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D6] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、双侧壁明显不均匀增厚，平扫T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，双侧咽隐窝变浅，双侧咽旁脂肪间隙稍狭窄；双侧腭帆提肌、腭帆张肌、头长肌受压。双侧咽后见肿大淋巴结，左侧较大者短径11mm，右侧较大者短径12mm。 双侧后鼻孔堵塞，口咽双侧壁未见受累增厚。 双侧翼腭窝、颞下窝未见异常。 蝶骨基底部、斜坡、双侧岩尖、双侧枕骨基底部骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽；双侧筛窦、蝶窦，右乳突内见积液；上颌窦、左乳突充气良好，骨壁完整；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双颈II区、右颈III、IV区见淋巴结肿大，部分融合，较大者短径28mm，信号欠均匀，增强较明显不均匀强化。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。；检查结论: 鼻咽顶壁、顶后壁、双侧壁明显不均匀增厚，考虑鼻咽癌。 颅底骨质破坏。 双侧咽后、双颈部多发淋巴结肿大，考虑转移瘤。 副鼻窦炎；右乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见: 左颈II区可见多个大小不一肿大淋巴结，最大约22mm×12mm，边界清，椭圆形，内部回声均匀，后方回声稍增强，淋巴门未探及。 CDFI:上述淋巴结内可见周边型血流信号。 左颈淋巴结穿刺活检： 常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以16G穿刺针穿刺入左颈肿物内，进针2次，取出长约2cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。；检查结论: 左侧颈部肿大淋巴结穿刺活检。 不适随诊。 4个工作日后凭发票到2号楼6楼病理科取结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善中心静脉置管，直接行根治性同期放化疗\nB. 完善中心静脉置管，行诱导化疗序贯单纯根治性放疗\nC. 完善中心静脉置管，行诱导化疗序贯根治性同期放化疗\nD. 完善中心静脉置管，行诱导化疗序贯根治性同期放化疗及辅助化疗\nE. 完善中心静脉置管，行诱导化疗联合PD-1单抗序贯根治性同期放化疗\nF. 完善中心静脉置管，直接行根治性同期放化疗及辅助化疗\nG. 完善中心静脉置管，行诱导化疗序贯根治性放疗联合EGFR单抗\nH. 完善中心静脉置管，行诱导化疗，放疗前行右颈部淋巴结清扫术\nI. 完善中心静脉置管，行姑息性化疗，视颈部淋巴结退缩情况决定放疗时机\nJ. 完善中心静脉置管，直接行根治性放疗联合EGFR单抗\nK. 完善中心静脉置管，行诱导化疗序贯根治性放疗及辅助化疗\nL. 完善中心静脉置管，行诱导化疗联合EGFR单抗序贯单纯根治性放疗\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- [全程D1] 入院记录: 主诉: 右颈肿物半年，右耳听力下降半月；现病史: 缘于6月前患者无意中出现右颈肿物，未予重视，进行性增大，半月前出现右耳听力下降，无头痛、复视，无涕血、面麻等，就诊于当地医院，发现鼻咽肿物。今为求进一步诊治来我院。患者发病以来,精神、饮食、睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟20支/日*5年，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.3℃，P：79次/分，R：20次/分，BP：105/65mmHg,Ht：168cm，Wt：56kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率79次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见: 左颈II区可见多个大小不一肿大淋巴结，最大约22mm×12mm，边界清，椭圆形，内部回声均匀，后方回声稍增强，淋巴门未探及。 CDFI:上述淋巴结内可见周边型血流信号。 左颈淋巴结穿刺活检： 常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以16G穿刺针穿刺入左颈肿物内，进针2次，取出长约2cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。；检查结论: 左侧颈部肿大淋巴结穿刺活检。 不适随诊。 4个工作日后凭发票到2号楼6楼病理科取结果。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善中心静脉置管，直接行根治性同期放化疗\nB. 完善中心静脉置管，行诱导化疗序贯单纯根治性放疗\nC. 完善中心静脉置管，行诱导化疗序贯根治性同期放化疗\nD. 完善中心静脉置管，行诱导化疗序贯根治性同期放化疗及辅助化疗\nE. 完善中心静脉置管，行诱导化疗联合PD-1单抗序贯根治性同期放化疗\nF. 完善中心静脉置管，直接行根治性同期放化疗及辅助化疗\nG. 完善中心静脉置管，行诱导化疗序贯根治性放疗联合EGFR单抗\nH. 完善中心静脉置管，行诱导化疗，放疗前行右颈部淋巴结清扫术\nI. 完善中心静脉置管，行姑息性化疗，视颈部淋巴结退缩情况决定放疗时机\nJ. 完善中心静脉置管，直接行根治性放疗联合EGFR单抗\nK. 完善中心静脉置管，行诱导化疗序贯根治性放疗及辅助化疗\nL. 完善中心静脉置管，行诱导化疗联合EGFR单抗序贯单纯根治性放疗\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：咽旁间隙、斜坡、蝶骨基底部、岩尖。\n文本分期信息：N3，M0。\n综合TNM状态：T3N3M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1] 入院记录: 主诉: 右颈肿物半年，右耳听力下降半月；现病史: 缘于6月前患者无意中出现右颈肿物，未予重视，进行性增大，半月前出现右耳听力下降，无头痛、复视，无涕血、面麻等，就诊于当地医院，发现鼻咽肿物。今为求进一步诊治来我院。患者发病以来,精神、饮食、睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟20支/日*5年，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.3℃，P：79次/分，R：20次/分，BP：105/65mmHg,Ht：168cm，Wt：56kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率79次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见: 左颈II区可见多个大小不一肿大淋巴结，最大约22mm×12mm，边界清，椭圆形，内部回声均匀，后方回声稍增强，淋巴门未探及。 CDFI:上述淋巴结内可见周边型血流信号。 左颈淋巴结穿刺活检： 常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以16G穿刺针穿刺入左颈肿物内，进针2次，取出长约2cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。；检查结论: 左侧颈部肿大淋巴结穿刺活检。 不适随诊。 4个工作日后凭发票到2号楼6楼病理科取结果。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善中心静脉置管，直接行根治性同期放化疗\nB. 完善中心静脉置管，行诱导化疗序贯单纯根治性放疗\nC. 完善中心静脉置管，行诱导化疗序贯根治性同期放化疗\nD. 完善中心静脉置管，行诱导化疗序贯根治性同期放化疗及辅助化疗\nE. 完善中心静脉置管，行诱导化疗联合PD-1单抗序贯根治性同期放化疗\nF. 完善中心静脉置管，直接行根治性同期放化疗及辅助化疗\nG. 完善中心静脉置管，行诱导化疗序贯根治性放疗联合EGFR单抗\nH. 完善中心静脉置管，行诱导化疗，放疗前行右颈部淋巴结清扫术\nI. 完善中心静脉置管，行姑息性化疗，视颈部淋巴结退缩情况决定放疗时机\nJ. 完善中心静脉置管，直接行根治性放疗联合EGFR单抗\nK. 完善中心静脉置管，行诱导化疗序贯根治性放疗及辅助化疗\nL. 完善中心静脉置管，行诱导化疗联合EGFR单抗序贯单纯根治性放疗\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-077ecf4aba208fcc4f66c309","patient_id":"patient-9fcde7a95f4d57501ecbf7b2","turn_id":"turn05","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"D","gold_action":"继续放疗，针对轻度恶心给予常规止吐对症处理，按规范进行PICC导管维护，并定期复查血常规与生化。","options":[{"letter":"A","text":"暂停放疗，给予重组人粒细胞集落刺激因子皮下注射，处理淋巴细胞减少，待血象恢复后恢复放疗。","is_gold":false},{"letter":"B","text":"暂停放疗，给予静脉营养支持及补液，处理恶心症状，待胃肠道反应缓解后重新评估放疗计划。","is_gold":false},{"letter":"C","text":"继续放疗，对淋巴细胞减少预防性静脉滴注广谱抗生素，并常规进行PICC导管维护。","is_gold":false},{"letter":"D","text":"继续放疗，给予常规止吐对症处理，处理轻度恶心，按规范进行PICC导管维护，并定期复查血常规与生化。","is_gold":true},{"letter":"E","text":"继续放疗，对出现的骨髓抑制，将下一周期顺铂化疗剂量减量20%，并常规进行PICC导管维护。","is_gold":false},{"letter":"F","text":"暂停放疗，拔除PICC导管改用外周静脉留置针，继续常规止吐对症支持与定期复查。","is_gold":false},{"letter":"G","text":"继续放疗，给予重组人白介素-2免疫支持治疗，处理淋巴细胞减少，并定期复查血常规与生化。","is_gold":false},{"letter":"H","text":"暂停放疗，立即行鼻咽及颈部MRI复查以评估放化疗疗效，并决定后续放疗剂量。","is_gold":false},{"letter":"I","text":"继续放疗，终止同期化疗计划，后续仅行单纯放射治疗，并常规进行PICC导管维护。","is_gold":false},{"letter":"J","text":"继续放疗，加用大剂量糖皮质激素冲击止吐，处理恶心症状，并预防性使用抗真菌药物。","is_gold":false},{"letter":"K","text":"暂停放疗，转入重症监护室进行严密生命体征监测与器官功能支持，暂缓抗肿瘤治疗。","is_gold":false},{"letter":"L","text":"继续放疗，立即启动第二周期顺铂同期化疗，并给予5-HT3受体拮抗剂联合NK-1受体拮抗剂。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：咽旁间隙、斜坡、蝶骨基底部、岩尖。\n文本分期信息：N3，M0。\n综合TNM状态：T3N3M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1] 入院记录: 主诉: 右颈肿物半年，右耳听力下降半月；现病史: 缘于6月前患者无意中出现右颈肿物，未予重视，进行性增大，半月前出现右耳听力下降，无头痛、复视，无涕血、面麻等，就诊于当地医院，发现鼻咽肿物。今为求进一步诊治来我院。患者发病以来,精神、饮食、睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟20支/日*5年，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.3℃，P：79次/分，R：20次/分，BP：105/65mmHg,Ht：168cm，Wt：56kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D1] 入院记录: 主诉: 右颈肿物半年，右耳听力下降半月；现病史: 缘于6月前患者无意中出现右颈肿物，未予重视，进行性增大，半月前出现右耳听力下降，无头痛、复视，无涕血、面麻等，就诊于当地医院，发现鼻咽肿物。今为求进一步诊治来我院。患者发病以来,精神、饮食、睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟20支/日*5年，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.3℃，P：79次/分，R：20次/分，BP：105/65mmHg,Ht：168cm，Wt：56kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率79次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D4] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 V5～V6导联低电压 V1～V3导联r波递增不良\n- [全程D4] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 25.6U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.341；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；平均红细胞体积(MCV)-静脉血: 94.7fL；白细胞计数(WBC#)-静脉血: 4.5110E9/L；平均血小板体积(MPV)-静脉血: 12fL；D-二聚体(D-Dimer)-静脉血: 0.1ug/ml；单核细胞计数(Mono#)-静脉血: 0.510E9/L；磷(P)-静脉血: 1.36mmol/L；甘油三酯(TG)-静脉血: 2.22mmol/L；间接胆红素(IBIL)-静脉血: 5.2umolL；白蛋白(ALB)-静脉血: 44.8g/L；碱性磷酸酶(ALP)-静脉血: 81.9U/L；凝血酶时间(TT)-静脉血: 18.5sec.；载脂蛋白B(apoB)-静脉血: 0.57g/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.1U/L；阴离子间隙(AG)-静脉血: 11；血小板比容-静脉血: 15%；凝血酶原时间(PT)-静脉血: 11.7sec.；肌酐(Crea)-静脉血: 82.7umol/L；总胆红素(TBIL)-静脉血: 8.2umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.503；球蛋白(GLO)-静脉血: 25.56g/L；红细胞计数(RBC#)-静脉血: 4.5210E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；大血小板百分比(P-LCR%)-静脉血: 40%；血小板分布宽度(PDW)-静脉血: 14.2%；凝血酶原时间活动度(PTA)-静脉血: 90.4%；乳酸脱氢酶(LDH)-静脉血: 359.7U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32.3pg；ABO血型-静脉血: B；总钙(Ca)-静脉血: 2.3mmol/L；镁离子(Mg2+)-静脉血: 0.99mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 146g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；γ-谷氨酰基转移酶(GGT)-静脉血: 14.6U/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.1mmol/L……\n- [全程D5] 检验组合: 乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阳性(+)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D6] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、双侧壁明显不均匀增厚，平扫T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，双侧咽隐窝变浅，双侧咽旁脂肪间隙稍狭窄；双侧腭帆提肌、腭帆张肌、头长肌受压。双侧咽后见肿大淋巴结，左侧较大者短径11mm，右侧较大者短径12mm。 双侧后鼻孔堵塞，口咽双侧壁未见受累增厚。 双侧翼腭窝、颞下窝未见异常。 蝶骨基底部、斜坡、双侧岩尖、双侧枕骨基底部骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽；双侧筛窦、蝶窦，右乳突内见积液；上颌窦、左乳突充气良好，骨壁完整；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双颈II区、右颈III、IV区见淋巴结肿大，部分融合，较大者短径28mm，信号欠均匀，增强较明显不均匀强化。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。；检查结论: 鼻咽顶壁、顶后壁、双侧壁明显不均匀增厚，考虑鼻咽癌。 颅底骨质破坏。 双侧咽后、双颈部多发淋巴结肿大，考虑转移瘤。 副鼻窦炎；右乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见: 左颈II区可见多个大小不一肿大淋巴结，最大约22mm×12mm，边界清，椭圆形，内部回声均匀，后方回声稍增强，淋巴门未探及。 CDFI:上述淋巴结内可见周边型血流信号。 左颈淋巴结穿刺活检： 常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以16G穿刺针穿刺入左颈肿物内，进针2次，取出长约2cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。；检查结论: 左侧颈部肿大淋巴结穿刺活检。 不适随诊。 4个工作日后凭发票到2号楼6楼病理科取结果。\n- [全程D20] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右旁T7椎体横突水平，估计位于上腔静脉内。；检查结论: PICC管位置如上所述。\n- [全程D20] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 24mm AO 28mm MV E 0.53m/s EF 63% LV 37mm IVS 8mm A 0.41m/s FS 34% RA 35mm LVPW 6mm RV 16mm PA 14mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 心脏结构及运动未见异常 各房室腔及大血管未探及异常血流信号 心功能正常\n- [全程D21] 检验组合: 隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；酮体(KET)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；比重(SG)-尿液: 1.021；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D22] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 5.5；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.012；颜色-尿液: Light-Yellow；隐血(OB)-尿液: -（参考: 阴性）\n- [全程D28] 检验组合: 钠离子(Na+)-静脉血: 138.4mmol/L；胱抑素(Cys-C)-静脉血: 0.85mg/L；葡萄糖(Glu)-静脉血: 4.19mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；碱性磷酸酶(ALP)-静脉血: 77.2U/L；尿素氮(BUN)-静脉血: 4.1mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 32.5pg；淋巴细胞百分比(Lymph%)-静脉血: 0.13；C-反应蛋白(CRP)-静脉血: 2.54mg/L；氯离子(Cl-)-静脉血: 98.1mmol/L；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.64；阴离子间隙(AG)-静脉血: 16；红细胞比容(Hct)-静脉血: 43.3%；磷(P)-静脉血: 1.38mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.695；血液二氧化碳含量ctCO2(B)-静脉血: 24.3mmol/L；总胆汁酸(TBA)-静脉血: 2.1umol/L；总钙(Ca)-静脉血: 2.12mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 32.1U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.86；γ-谷氨酰基转移酶(GGT)-静脉血: 21.1U/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；甘油三酯(TG)-静脉血: 0.75mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；载脂蛋白B(apoB)-静脉血: 0.58g/L；直接胆红素(DBIL)-静脉血: 4.7umol/L；乳酸脱氢酶(LDH)-静脉血: 269.3U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 36.1U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；平均红细胞体积(MCV)-静脉血: 95.9fL；单核细胞百分比(Mono%)-静脉血: 0.13；总胆固醇(TC)-静脉血: 2.75mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339g/L；球蛋白(GLO)-静脉血: 21.89g/……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D2] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉右耳听力下降，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，结合患者检查，认为患者鼻咽癌可能性大，指示完善相关检查后在决定下一步治疗方案，遵嘱执行。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D14] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉右耳听力下降，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，指示尽快完成放疗计划，遵嘱执行。\n- [全程D19] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉右耳听力下降，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，考虑患者放疗计划即将完成，指示可提前2天先予以化疗，指示今日予以DDP方案化疗第1程，做好水化、护胃、止呕等对症支持处理，密切观察化疗中副反应，遵嘱执行。\n- [全程D24] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉恶心，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，较前缩小，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，认为患者化疗顺利完成，指示继续放疗，密切观察放疗中副反应，遵嘱执行。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，给予重组人粒细胞集落刺激因子皮下注射，处理淋巴细胞减少，待血象恢复后恢复放疗。\nB. 暂停放疗，给予静脉营养支持及补液，处理恶心症状，待胃肠道反应缓解后重新评估放疗计划。\nC. 继续放疗，对淋巴细胞减少预防性静脉滴注广谱抗生素，并常规进行PICC导管维护。\nD. 继续放疗，给予常规止吐对症处理，处理轻度恶心，按规范进行PICC导管维护，并定期复查血常规与生化。\nE. 继续放疗，对出现的骨髓抑制，将下一周期顺铂化疗剂量减量20%，并常规进行PICC导管维护。\nF. 暂停放疗，拔除PICC导管改用外周静脉留置针，继续常规止吐对症支持与定期复查。\nG. 继续放疗，给予重组人白介素-2免疫支持治疗，处理淋巴细胞减少，并定期复查血常规与生化。\nH. 暂停放疗，立即行鼻咽及颈部MRI复查以评估放化疗疗效，并决定后续放疗剂量。\nI. 继续放疗，终止同期化疗计划，后续仅行单纯放射治疗，并常规进行PICC导管维护。\nJ. 继续放疗，加用大剂量糖皮质激素冲击止吐，处理恶心症状，并预防性使用抗真菌药物。\nK. 暂停放疗，转入重症监护室进行严密生命体征监测与器官功能支持，暂缓抗肿瘤治疗。\nL. 继续放疗，立即启动第二周期顺铂同期化疗，并给予5-HT3受体拮抗剂联合NK-1受体拮抗剂。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D20] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右旁T7椎体横突水平，估计位于上腔静脉内。；检查结论: PICC管位置如上所述。\n- [全程D20] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 24mm AO 28mm MV E 0.53m/s EF 63% LV 37mm IVS 8mm A 0.41m/s FS 34% RA 35mm LVPW 6mm RV 16mm PA 14mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 心脏结构及运动未见异常 各房室腔及大血管未探及异常血流信号 心功能正常\n- [全程D21] 检验组合: 隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；酮体(KET)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；比重(SG)-尿液: 1.021；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D22] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 5.5；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.012；颜色-尿液: Light-Yellow；隐血(OB)-尿液: -（参考: 阴性）\n- [全程D28] 检验组合: 钠离子(Na+)-静脉血: 138.4mmol/L；胱抑素(Cys-C)-静脉血: 0.85mg/L；葡萄糖(Glu)-静脉血: 4.19mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；碱性磷酸酶(ALP)-静脉血: 77.2U/L；尿素氮(BUN)-静脉血: 4.1mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 32.5pg；淋巴细胞百分比(Lymph%)-静脉血: 0.13；C-反应蛋白(CRP)-静脉血: 2.54mg/L；氯离子(Cl-)-静脉血: 98.1mmol/L；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.64；阴离子间隙(AG)-静脉血: 16；红细胞比容(Hct)-静脉血: 43.3%；磷(P)-静脉血: 1.38mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.695；血液二氧化碳含量ctCO2(B)-静脉血: 24.3mmol/L；总胆汁酸(TBA)-静脉血: 2.1umol/L；总钙(Ca)-静脉血: 2.12mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 32.1U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.86；γ-谷氨酰基转移酶(GGT)-静脉血: 21.1U/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；甘油三酯(TG)-静脉血: 0.75mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；载脂蛋白B(apoB)-静脉血: 0.58g/L；直接胆红素(DBIL)-静脉血: 4.7umol/L；乳酸脱氢酶(LDH)-静脉血: 269.3U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 36.1U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；平均红细胞体积(MCV)-静脉血: 95.9fL；单核细胞百分比(Mono%)-静脉血: 0.13；总胆固醇(TC)-静脉血: 2.75mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339g/L；球蛋白(GLO)-静脉血: 21.89g/……\n\n【既往治疗与反应】\n- [全程D2] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉右耳听力下降，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，结合患者检查，认为患者鼻咽癌可能性大，指示完善相关检查后在决定下一步治疗方案，遵嘱执行。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D14] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉右耳听力下降，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，指示尽快完成放疗计划，遵嘱执行。\n- [全程D19] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉右耳听力下降，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，考虑患者放疗计划即将完成，指示可提前2天先予以化疗，指示今日予以DDP方案化疗第1程，做好水化、护胃、止呕等对症支持处理，密切观察化疗中副反应，遵嘱执行。\n- [全程D24] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉恶心，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，较前缩小，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，认为患者化疗顺利完成，指示继续放疗，密切观察放疗中副反应，遵嘱执行。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，给予重组人粒细胞集落刺激因子皮下注射，处理淋巴细胞减少，待血象恢复后恢复放疗。\nB. 暂停放疗，给予静脉营养支持及补液，处理恶心症状，待胃肠道反应缓解后重新评估放疗计划。\nC. 继续放疗，对淋巴细胞减少预防性静脉滴注广谱抗生素，并常规进行PICC导管维护。\nD. 继续放疗，给予常规止吐对症处理，处理轻度恶心，按规范进行PICC导管维护，并定期复查血常规与生化。\nE. 继续放疗，对出现的骨髓抑制，将下一周期顺铂化疗剂量减量20%，并常规进行PICC导管维护。\nF. 暂停放疗，拔除PICC导管改用外周静脉留置针，继续常规止吐对症支持与定期复查。\nG. 继续放疗，给予重组人白介素-2免疫支持治疗，处理淋巴细胞减少，并定期复查血常规与生化。\nH. 暂停放疗，立即行鼻咽及颈部MRI复查以评估放化疗疗效，并决定后续放疗剂量。\nI. 继续放疗，终止同期化疗计划，后续仅行单纯放射治疗，并常规进行PICC导管维护。\nJ. 继续放疗，加用大剂量糖皮质激素冲击止吐，处理恶心症状，并预防性使用抗真菌药物。\nK. 暂停放疗，转入重症监护室进行严密生命体征监测与器官功能支持，暂缓抗肿瘤治疗。\nL. 继续放疗，立即启动第二周期顺铂同期化疗，并给予5-HT3受体拮抗剂联合NK-1受体拮抗剂。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：咽旁间隙、斜坡、蝶骨基底部、岩尖。\n文本分期信息：N3，M0。\n综合TNM状态：T3N3M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D20] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右旁T7椎体横突水平，估计位于上腔静脉内。；检查结论: PICC管位置如上所述。\n- [全程D20] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 24mm AO 28mm MV E 0.53m/s EF 63% LV 37mm IVS 8mm A 0.41m/s FS 34% RA 35mm LVPW 6mm RV 16mm PA 14mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 心脏结构及运动未见异常 各房室腔及大血管未探及异常血流信号 心功能正常\n- [全程D21] 检验组合: 隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；酮体(KET)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；比重(SG)-尿液: 1.021；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D22] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 5.5；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.012；颜色-尿液: Light-Yellow；隐血(OB)-尿液: -（参考: 阴性）\n- [全程D28] 检验组合: 钠离子(Na+)-静脉血: 138.4mmol/L；胱抑素(Cys-C)-静脉血: 0.85mg/L；葡萄糖(Glu)-静脉血: 4.19mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；碱性磷酸酶(ALP)-静脉血: 77.2U/L；尿素氮(BUN)-静脉血: 4.1mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 32.5pg；淋巴细胞百分比(Lymph%)-静脉血: 0.13；C-反应蛋白(CRP)-静脉血: 2.54mg/L；氯离子(Cl-)-静脉血: 98.1mmol/L；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.64；阴离子间隙(AG)-静脉血: 16；红细胞比容(Hct)-静脉血: 43.3%；磷(P)-静脉血: 1.38mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.695；血液二氧化碳含量ctCO2(B)-静脉血: 24.3mmol/L；总胆汁酸(TBA)-静脉血: 2.1umol/L；总钙(Ca)-静脉血: 2.12mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 32.1U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.86；γ-谷氨酰基转移酶(GGT)-静脉血: 21.1U/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；甘油三酯(TG)-静脉血: 0.75mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；载脂蛋白B(apoB)-静脉血: 0.58g/L；直接胆红素(DBIL)-静脉血: 4.7umol/L；乳酸脱氢酶(LDH)-静脉血: 269.3U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 36.1U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；平均红细胞体积(MCV)-静脉血: 95.9fL；单核细胞百分比(Mono%)-静脉血: 0.13；总胆固醇(TC)-静脉血: 2.75mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339g/L；球蛋白(GLO)-静脉血: 21.89g/……\n\n【既往治疗与反应】\n- [全程D2] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉右耳听力下降，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，结合患者检查，认为患者鼻咽癌可能性大，指示完善相关检查后在决定下一步治疗方案，遵嘱执行。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D14] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉右耳听力下降，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，指示尽快完成放疗计划，遵嘱执行。\n- [全程D19] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉右耳听力下降，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，考虑患者放疗计划即将完成，指示可提前2天先予以化疗，指示今日予以DDP方案化疗第1程，做好水化、护胃、止呕等对症支持处理，密切观察化疗中副反应，遵嘱执行。\n- [全程D24] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉恶心，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，较前缩小，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，认为患者化疗顺利完成，指示继续放疗，密切观察放疗中副反应，遵嘱执行。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，给予重组人粒细胞集落刺激因子皮下注射，处理淋巴细胞减少，待血象恢复后恢复放疗。\nB. 暂停放疗，给予静脉营养支持及补液，处理恶心症状，待胃肠道反应缓解后重新评估放疗计划。\nC. 继续放疗，对淋巴细胞减少预防性静脉滴注广谱抗生素，并常规进行PICC导管维护。\nD. 继续放疗，给予常规止吐对症处理，处理轻度恶心，按规范进行PICC导管维护，并定期复查血常规与生化。\nE. 继续放疗，对出现的骨髓抑制，将下一周期顺铂化疗剂量减量20%，并常规进行PICC导管维护。\nF. 暂停放疗，拔除PICC导管改用外周静脉留置针，继续常规止吐对症支持与定期复查。\nG. 继续放疗，给予重组人白介素-2免疫支持治疗，处理淋巴细胞减少，并定期复查血常规与生化。\nH. 暂停放疗，立即行鼻咽及颈部MRI复查以评估放化疗疗效，并决定后续放疗剂量。\nI. 继续放疗，终止同期化疗计划，后续仅行单纯放射治疗，并常规进行PICC导管维护。\nJ. 继续放疗，加用大剂量糖皮质激素冲击止吐，处理恶心症状，并预防性使用抗真菌药物。\nK. 暂停放疗，转入重症监护室进行严密生命体征监测与器官功能支持，暂缓抗肿瘤治疗。\nL. 继续放疗，立即启动第二周期顺铂同期化疗，并给予5-HT3受体拮抗剂联合NK-1受体拮抗剂。\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-6fc96ea65282f416f15f852e","patient_id":"patient-9fcde7a95f4d57501ecbf7b2","turn_id":"turn06","turn_position":5,"turn_type":"toxicity_or_support_decision","gold_letter":"E","gold_action":"继续放疗，予以洗鼻、免疫调节/辅助支持（如香菇多糖）及动静脉置管护理，复查血常规与生化常规。","options":[{"letter":"A","text":"暂停放疗，予以重组人血小板生成素（rhTPO）皮下注射，待血小板恢复后继续放疗。","is_gold":false},{"letter":"B","text":"继续放疗，予以重组人白介素-11（rhIL-11）皮下注射，复查血常规与生化常规。","is_gold":false},{"letter":"C","text":"暂停放疗，输注单采血小板1个治疗量，复查血常规与生化常规。","is_gold":false},{"letter":"D","text":"继续放疗，予以重组人粒细胞集落刺激因子（rhG-CSF）皮下注射，复查血常规。","is_gold":false},{"letter":"E","text":"继续放疗，予以洗鼻、免疫调节/辅助支持（如香菇多糖）及动静脉置管护理，复查血常规与生化常规。","is_gold":true},{"letter":"F","text":"暂停放疗，予以促红细胞生成素（EPO）皮下注射，待血红蛋白恢复后继续放疗。","is_gold":false},{"letter":"G","text":"继续放疗，予以低分子肝素皮下注射预防血栓，复查凝血功能与血常规。","is_gold":false},{"letter":"H","text":"暂停放疗，予以甲泼尼龙静脉滴注提升血小板，复查血常规与生化常规。","is_gold":false},{"letter":"I","text":"继续放疗，予以静脉输注人免疫球蛋白（IVIG），复查血常规与生化常规。","is_gold":false},{"letter":"J","text":"终止放疗，予以单药化疗维持，配合洗鼻及动静脉置管护理。","is_gold":false},{"letter":"K","text":"继续放疗，予以重组人血小板生成素与重组人粒细胞集落刺激因子联合皮下注射。","is_gold":false},{"letter":"L","text":"暂停放疗，予以洗鼻及动静脉置管护理，暂不予升血小板药物干预。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：咽旁间隙、斜坡、蝶骨基底部、岩尖。\n文本分期信息：N3，M0。\n综合TNM状态：T3N3M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1] 入院记录: 主诉: 右颈肿物半年，右耳听力下降半月；现病史: 缘于6月前患者无意中出现右颈肿物，未予重视，进行性增大，半月前出现右耳听力下降，无头痛、复视，无涕血、面麻等，就诊于当地医院，发现鼻咽肿物。今为求进一步诊治来我院。患者发病以来,精神、饮食、睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟20支/日*5年，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.3℃，P：79次/分，R：20次/分，BP：105/65mmHg,Ht：168cm，Wt：56kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D1] 入院记录: 主诉: 右颈肿物半年，右耳听力下降半月；现病史: 缘于6月前患者无意中出现右颈肿物，未予重视，进行性增大，半月前出现右耳听力下降，无头痛、复视，无涕血、面麻等，就诊于当地医院，发现鼻咽肿物。今为求进一步诊治来我院。患者发病以来,精神、饮食、睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟20支/日*5年，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.3℃，P：79次/分，R：20次/分，BP：105/65mmHg,Ht：168cm，Wt：56kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率79次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D4] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 V5～V6导联低电压 V1～V3导联r波递增不良\n- [全程D4] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 25.6U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.341；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；平均红细胞体积(MCV)-静脉血: 94.7fL；白细胞计数(WBC#)-静脉血: 4.5110E9/L；平均血小板体积(MPV)-静脉血: 12fL；D-二聚体(D-Dimer)-静脉血: 0.1ug/ml；单核细胞计数(Mono#)-静脉血: 0.510E9/L；磷(P)-静脉血: 1.36mmol/L；甘油三酯(TG)-静脉血: 2.22mmol/L；间接胆红素(IBIL)-静脉血: 5.2umolL；白蛋白(ALB)-静脉血: 44.8g/L；碱性磷酸酶(ALP)-静脉血: 81.9U/L；凝血酶时间(TT)-静脉血: 18.5sec.；载脂蛋白B(apoB)-静脉血: 0.57g/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.1U/L；阴离子间隙(AG)-静脉血: 11；血小板比容-静脉血: 15%；凝血酶原时间(PT)-静脉血: 11.7sec.；肌酐(Crea)-静脉血: 82.7umol/L；总胆红素(TBIL)-静脉血: 8.2umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.503；球蛋白(GLO)-静脉血: 25.56g/L；红细胞计数(RBC#)-静脉血: 4.5210E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；大血小板百分比(P-LCR%)-静脉血: 40%；血小板分布宽度(PDW)-静脉血: 14.2%；凝血酶原时间活动度(PTA)-静脉血: 90.4%；乳酸脱氢酶(LDH)-静脉血: 359.7U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32.3pg；ABO血型-静脉血: B；总钙(Ca)-静脉血: 2.3mmol/L；镁离子(Mg2+)-静脉血: 0.99mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 146g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；γ-谷氨酰基转移酶(GGT)-静脉血: 14.6U/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.1mmol/L……\n- [全程D5] 检验组合: 乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阳性(+)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D6] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、双侧壁明显不均匀增厚，平扫T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，双侧咽隐窝变浅，双侧咽旁脂肪间隙稍狭窄；双侧腭帆提肌、腭帆张肌、头长肌受压。双侧咽后见肿大淋巴结，左侧较大者短径11mm，右侧较大者短径12mm。 双侧后鼻孔堵塞，口咽双侧壁未见受累增厚。 双侧翼腭窝、颞下窝未见异常。 蝶骨基底部、斜坡、双侧岩尖、双侧枕骨基底部骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽；双侧筛窦、蝶窦，右乳突内见积液；上颌窦、左乳突充气良好，骨壁完整；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双颈II区、右颈III、IV区见淋巴结肿大，部分融合，较大者短径28mm，信号欠均匀，增强较明显不均匀强化。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。；检查结论: 鼻咽顶壁、顶后壁、双侧壁明显不均匀增厚，考虑鼻咽癌。 颅底骨质破坏。 双侧咽后、双颈部多发淋巴结肿大，考虑转移瘤。 副鼻窦炎；右乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见: 左颈II区可见多个大小不一肿大淋巴结，最大约22mm×12mm，边界清，椭圆形，内部回声均匀，后方回声稍增强，淋巴门未探及。 CDFI:上述淋巴结内可见周边型血流信号。 左颈淋巴结穿刺活检： 常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以16G穿刺针穿刺入左颈肿物内，进针2次，取出长约2cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。；检查结论: 左侧颈部肿大淋巴结穿刺活检。 不适随诊。 4个工作日后凭发票到2号楼6楼病理科取结果。\n- [全程D20] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右旁T7椎体横突水平，估计位于上腔静脉内。；检查结论: PICC管位置如上所述。\n- [全程D20] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 24mm AO 28mm MV E 0.53m/s EF 63% LV 37mm IVS 8mm A 0.41m/s FS 34% RA 35mm LVPW 6mm RV 16mm PA 14mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 心脏结构及运动未见异常 各房室腔及大血管未探及异常血流信号 心功能正常\n- [全程D21] 检验组合: 隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；酮体(KET)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；比重(SG)-尿液: 1.021；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D22] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 5.5；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.012；颜色-尿液: Light-Yellow；隐血(OB)-尿液: -（参考: 阴性）\n- [全程D28] 检验组合: 钠离子(Na+)-静脉血: 138.4mmol/L；胱抑素(Cys-C)-静脉血: 0.85mg/L；葡萄糖(Glu)-静脉血: 4.19mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；碱性磷酸酶(ALP)-静脉血: 77.2U/L；尿素氮(BUN)-静脉血: 4.1mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 32.5pg；淋巴细胞百分比(Lymph%)-静脉血: 0.13；C-反应蛋白(CRP)-静脉血: 2.54mg/L；氯离子(Cl-)-静脉血: 98.1mmol/L；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.64；阴离子间隙(AG)-静脉血: 16；红细胞比容(Hct)-静脉血: 43.3%；磷(P)-静脉血: 1.38mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.695；血液二氧化碳含量ctCO2(B)-静脉血: 24.3mmol/L；总胆汁酸(TBA)-静脉血: 2.1umol/L；总钙(Ca)-静脉血: 2.12mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 32.1U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.86；γ-谷氨酰基转移酶(GGT)-静脉血: 21.1U/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；甘油三酯(TG)-静脉血: 0.75mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；载脂蛋白B(apoB)-静脉血: 0.58g/L；直接胆红素(DBIL)-静脉血: 4.7umol/L；乳酸脱氢酶(LDH)-静脉血: 269.3U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 36.1U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；平均红细胞体积(MCV)-静脉血: 95.9fL；单核细胞百分比(Mono%)-静脉血: 0.13；总胆固醇(TC)-静脉血: 2.75mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339g/L；球蛋白(GLO)-静脉血: 21.89g/……\n- [全程D35] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；镁离子(Mg2+)-静脉血: 0.88mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44；载脂蛋白B(apoB)-静脉血: 0.56g/L；钠离子(Na+)-静脉血: 143.1mmol/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞比容(Hct)-静脉血: 37.1%；甘油三酯(TG)-静脉血: 0.68mmol/L；葡萄糖(Glu)-静脉血: 4.35mmol/L；C-反应蛋白(CRP)-静脉血: 16.07mg/L；平均血小板体积(MPV)-静脉血: 11.3fL；血红蛋白(Hb)-静脉血: 125g/L；载脂蛋白AI(apoAI)-静脉血: 0.89g/L；红细胞计数(RBC#)-静脉血: 3.9410E12/L；血小板比容-静脉血: 10%；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；血小板计数(PLT#)-静脉血: 8910E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.14；天门冬氨酸氨基转移酶(AST)-静脉血: 16U/L；丙氨酸氨基转移酶(ALT)-静脉血: 16.4U/L；总钙(Ca)-静脉血: 2.03mmol/L；钾离子(K+)-静脉血: 3.4mmol/L；磷(P)-静脉血: 1.05mmol/L；白蛋白(ALB)-静脉血: 36.3g/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 337g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；直接胆红素(DBIL)-静脉血: 5.4umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 94.2fL；氯离子(Cl-)-静脉血: 105.6mmol/L；肌酐(Crea)-静脉血: 70umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；胱抑素(Cys-C)-静脉血: 0.85mg/L；球蛋白(GLO)-静脉血: 21.19g/L；间接胆红素(IBIL)-静脉血: 5.9umolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D2] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉右耳听力下降，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，结合患者检查，认为患者鼻咽癌可能性大，指示完善相关检查后在决定下一步治疗方案，遵嘱执行。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D14] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉右耳听力下降，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，指示尽快完成放疗计划，遵嘱执行。\n- [全程D19] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉右耳听力下降，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，考虑患者放疗计划即将完成，指示可提前2天先予以化疗，指示今日予以DDP方案化疗第1程，做好水化、护胃、止呕等对症支持处理，密切观察化疗中副反应，遵嘱执行。\n- [全程D24] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉恶心，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，较前缩小，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，认为患者化疗顺利完成，指示继续放疗，密切观察放疗中副反应，遵嘱执行。\n- [全程D29] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，未诉特殊不适，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，较前缩小，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，指示继续放疗，密切观察放疗中副反应，遵嘱执行。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，予以重组人血小板生成素（rhTPO）皮下注射，待血小板恢复后继续放疗。\nB. 继续放疗，予以重组人白介素-11（rhIL-11）皮下注射，复查血常规与生化常规。\nC. 暂停放疗，输注单采血小板1个治疗量，复查血常规与生化常规。\nD. 继续放疗，予以重组人粒细胞集落刺激因子（rhG-CSF）皮下注射，复查血常规。\nE. 继续放疗，予以洗鼻、免疫调节/辅助支持（如香菇多糖）及动静脉置管护理，复查血常规与生化常规。\nF. 暂停放疗，予以促红细胞生成素（EPO）皮下注射，待血红蛋白恢复后继续放疗。\nG. 继续放疗，予以低分子肝素皮下注射预防血栓，复查凝血功能与血常规。\nH. 暂停放疗，予以甲泼尼龙静脉滴注提升血小板，复查血常规与生化常规。\nI. 继续放疗，予以静脉输注人免疫球蛋白（IVIG），复查血常规与生化常规。\nJ. 终止放疗，予以单药化疗维持，配合洗鼻及动静脉置管护理。\nK. 继续放疗，予以重组人血小板生成素与重组人粒细胞集落刺激因子联合皮下注射。\nL. 暂停放疗，予以洗鼻及动静脉置管护理，暂不予升血小板药物干预。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D35] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；镁离子(Mg2+)-静脉血: 0.88mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44；载脂蛋白B(apoB)-静脉血: 0.56g/L；钠离子(Na+)-静脉血: 143.1mmol/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞比容(Hct)-静脉血: 37.1%；甘油三酯(TG)-静脉血: 0.68mmol/L；葡萄糖(Glu)-静脉血: 4.35mmol/L；C-反应蛋白(CRP)-静脉血: 16.07mg/L；平均血小板体积(MPV)-静脉血: 11.3fL；血红蛋白(Hb)-静脉血: 125g/L；载脂蛋白AI(apoAI)-静脉血: 0.89g/L；红细胞计数(RBC#)-静脉血: 3.9410E12/L；血小板比容-静脉血: 10%；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；血小板计数(PLT#)-静脉血: 8910E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.14；天门冬氨酸氨基转移酶(AST)-静脉血: 16U/L；丙氨酸氨基转移酶(ALT)-静脉血: 16.4U/L；总钙(Ca)-静脉血: 2.03mmol/L；钾离子(K+)-静脉血: 3.4mmol/L；磷(P)-静脉血: 1.05mmol/L；白蛋白(ALB)-静脉血: 36.3g/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 337g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；直接胆红素(DBIL)-静脉血: 5.4umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 94.2fL；氯离子(Cl-)-静脉血: 105.6mmol/L；肌酐(Crea)-静脉血: 70umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；胱抑素(Cys-C)-静脉血: 0.85mg/L；球蛋白(GLO)-静脉血: 21.19g/L；间接胆红素(IBIL)-静脉血: 5.9umolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.……\n\n【既往治疗与反应】\n- [全程D29] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，未诉特殊不适，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，较前缩小，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，指示继续放疗，密切观察放疗中副反应，遵嘱执行。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，予以重组人血小板生成素（rhTPO）皮下注射，待血小板恢复后继续放疗。\nB. 继续放疗，予以重组人白介素-11（rhIL-11）皮下注射，复查血常规与生化常规。\nC. 暂停放疗，输注单采血小板1个治疗量，复查血常规与生化常规。\nD. 继续放疗，予以重组人粒细胞集落刺激因子（rhG-CSF）皮下注射，复查血常规。\nE. 继续放疗，予以洗鼻、免疫调节/辅助支持（如香菇多糖）及动静脉置管护理，复查血常规与生化常规。\nF. 暂停放疗，予以促红细胞生成素（EPO）皮下注射，待血红蛋白恢复后继续放疗。\nG. 继续放疗，予以低分子肝素皮下注射预防血栓，复查凝血功能与血常规。\nH. 暂停放疗，予以甲泼尼龙静脉滴注提升血小板，复查血常规与生化常规。\nI. 继续放疗，予以静脉输注人免疫球蛋白（IVIG），复查血常规与生化常规。\nJ. 终止放疗，予以单药化疗维持，配合洗鼻及动静脉置管护理。\nK. 继续放疗，予以重组人血小板生成素与重组人粒细胞集落刺激因子联合皮下注射。\nL. 暂停放疗，予以洗鼻及动静脉置管护理，暂不予升血小板药物干预。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：咽旁间隙、斜坡、蝶骨基底部、岩尖。\n文本分期信息：N3，M0。\n综合TNM状态：T3N3M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D35] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；镁离子(Mg2+)-静脉血: 0.88mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44；载脂蛋白B(apoB)-静脉血: 0.56g/L；钠离子(Na+)-静脉血: 143.1mmol/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞比容(Hct)-静脉血: 37.1%；甘油三酯(TG)-静脉血: 0.68mmol/L；葡萄糖(Glu)-静脉血: 4.35mmol/L；C-反应蛋白(CRP)-静脉血: 16.07mg/L；平均血小板体积(MPV)-静脉血: 11.3fL；血红蛋白(Hb)-静脉血: 125g/L；载脂蛋白AI(apoAI)-静脉血: 0.89g/L；红细胞计数(RBC#)-静脉血: 3.9410E12/L；血小板比容-静脉血: 10%；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；血小板计数(PLT#)-静脉血: 8910E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.14；天门冬氨酸氨基转移酶(AST)-静脉血: 16U/L；丙氨酸氨基转移酶(ALT)-静脉血: 16.4U/L；总钙(Ca)-静脉血: 2.03mmol/L；钾离子(K+)-静脉血: 3.4mmol/L；磷(P)-静脉血: 1.05mmol/L；白蛋白(ALB)-静脉血: 36.3g/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 337g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；直接胆红素(DBIL)-静脉血: 5.4umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 94.2fL；氯离子(Cl-)-静脉血: 105.6mmol/L；肌酐(Crea)-静脉血: 70umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；胱抑素(Cys-C)-静脉血: 0.85mg/L；球蛋白(GLO)-静脉血: 21.19g/L；间接胆红素(IBIL)-静脉血: 5.9umolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.……\n\n【既往治疗与反应】\n- [全程D29] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，未诉特殊不适，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，较前缩小，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，指示继续放疗，密切观察放疗中副反应，遵嘱执行。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，予以重组人血小板生成素（rhTPO）皮下注射，待血小板恢复后继续放疗。\nB. 继续放疗，予以重组人白介素-11（rhIL-11）皮下注射，复查血常规与生化常规。\nC. 暂停放疗，输注单采血小板1个治疗量，复查血常规与生化常规。\nD. 继续放疗，予以重组人粒细胞集落刺激因子（rhG-CSF）皮下注射，复查血常规。\nE. 继续放疗，予以洗鼻、免疫调节/辅助支持（如香菇多糖）及动静脉置管护理，复查血常规与生化常规。\nF. 暂停放疗，予以促红细胞生成素（EPO）皮下注射，待血红蛋白恢复后继续放疗。\nG. 继续放疗，予以低分子肝素皮下注射预防血栓，复查凝血功能与血常规。\nH. 暂停放疗，予以甲泼尼龙静脉滴注提升血小板，复查血常规与生化常规。\nI. 继续放疗，予以静脉输注人免疫球蛋白（IVIG），复查血常规与生化常规。\nJ. 终止放疗，予以单药化疗维持，配合洗鼻及动静脉置管护理。\nK. 继续放疗，予以重组人血小板生成素与重组人粒细胞集落刺激因子联合皮下注射。\nL. 暂停放疗，予以洗鼻及动静脉置管护理，暂不予升血小板药物干预。\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-08d32abcf26a92c62d1dc762","patient_id":"patient-9fcde7a95f4d57501ecbf7b2","turn_id":"turn07","turn_position":6,"turn_type":"response_assessment_decision","gold_letter":"F","gold_action":"取消第三程同期化疗，按原计划完成根治性放疗，胆囊结石暂予观察，放疗结束后择期行全面疗效评估。","options":[{"letter":"A","text":"强制收治入院完成第三程同期化疗，期间暂停放疗，待化疗结束后恢复放疗。","is_gold":false},{"letter":"B","text":"取消第三程同期化疗，加用西妥昔单抗靶向治疗联合放疗，放疗结束后行疗效评估。","is_gold":false},{"letter":"C","text":"提前终止放疗，行全身PET-CT及头颈部MRI评估，视肿瘤退缩情况决定后续辅助化疗方案。","is_gold":false},{"letter":"D","text":"取消第三程同期化疗，下调原定放疗处方剂量以减轻黏膜反应，放疗结束后即刻行鼻咽镜活检。","is_gold":false},{"letter":"E","text":"安排入院行TPF方案补充化疗，同时继续放疗，放疗结束后行全面疗效评估。","is_gold":false},{"letter":"F","text":"取消第三程同期化疗，按原计划完成根治性放疗，胆囊结石暂予观察，放疗结束后择期行全面疗效评估。","is_gold":true},{"letter":"G","text":"请普外科急会诊行腹腔镜胆囊切除术，术后择期恢复放疗，并取消后续化疗。","is_gold":false},{"letter":"H","text":"改用口服卡培他滨单药替代静脉化疗，继续门诊放疗，放疗结束后行辅助化疗。","is_gold":false},{"letter":"I","text":"立即行鼻咽及颈部MRI复查，若肿瘤已完全消退则提前结束放疗，进入随访阶段。","is_gold":false},{"letter":"J","text":"取消第三程同期化疗，增加放疗靶区外扩范围及处方剂量，放疗结束后择期行全面疗效评估。","is_gold":false},{"letter":"K","text":"暂停放疗，待咽痛及口腔黏膜反应完全缓解后再恢复放疗，并补充第三程化疗。","is_gold":false},{"letter":"L","text":"采用中药及针灸治疗替代第三程化疗，继续门诊放疗，放疗结束后常规行全身骨扫描。","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：咽旁间隙、斜坡、蝶骨基底部、岩尖。\n文本分期信息：N3，M0。\n综合TNM状态：T3N3M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1] 入院记录: 主诉: 右颈肿物半年，右耳听力下降半月；现病史: 缘于6月前患者无意中出现右颈肿物，未予重视，进行性增大，半月前出现右耳听力下降，无头痛、复视，无涕血、面麻等，就诊于当地医院，发现鼻咽肿物。今为求进一步诊治来我院。患者发病以来,精神、饮食、睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟20支/日*5年，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.3℃，P：79次/分，R：20次/分，BP：105/65mmHg,Ht：168cm，Wt：56kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D1] 入院记录: 主诉: 右颈肿物半年，右耳听力下降半月；现病史: 缘于6月前患者无意中出现右颈肿物，未予重视，进行性增大，半月前出现右耳听力下降，无头痛、复视，无涕血、面麻等，就诊于当地医院，发现鼻咽肿物。今为求进一步诊治来我院。患者发病以来,精神、饮食、睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟20支/日*5年，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.3℃，P：79次/分，R：20次/分，BP：105/65mmHg,Ht：168cm，Wt：56kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率79次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D4] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 V5～V6导联低电压 V1～V3导联r波递增不良\n- [全程D4] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 25.6U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.341；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；平均红细胞体积(MCV)-静脉血: 94.7fL；白细胞计数(WBC#)-静脉血: 4.5110E9/L；平均血小板体积(MPV)-静脉血: 12fL；D-二聚体(D-Dimer)-静脉血: 0.1ug/ml；单核细胞计数(Mono#)-静脉血: 0.510E9/L；磷(P)-静脉血: 1.36mmol/L；甘油三酯(TG)-静脉血: 2.22mmol/L；间接胆红素(IBIL)-静脉血: 5.2umolL；白蛋白(ALB)-静脉血: 44.8g/L；碱性磷酸酶(ALP)-静脉血: 81.9U/L；凝血酶时间(TT)-静脉血: 18.5sec.；载脂蛋白B(apoB)-静脉血: 0.57g/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.1U/L；阴离子间隙(AG)-静脉血: 11；血小板比容-静脉血: 15%；凝血酶原时间(PT)-静脉血: 11.7sec.；肌酐(Crea)-静脉血: 82.7umol/L；总胆红素(TBIL)-静脉血: 8.2umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.503；球蛋白(GLO)-静脉血: 25.56g/L；红细胞计数(RBC#)-静脉血: 4.5210E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；大血小板百分比(P-LCR%)-静脉血: 40%；血小板分布宽度(PDW)-静脉血: 14.2%；凝血酶原时间活动度(PTA)-静脉血: 90.4%；乳酸脱氢酶(LDH)-静脉血: 359.7U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32.3pg；ABO血型-静脉血: B；总钙(Ca)-静脉血: 2.3mmol/L；镁离子(Mg2+)-静脉血: 0.99mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 146g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；γ-谷氨酰基转移酶(GGT)-静脉血: 14.6U/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.1mmol/L……\n- [全程D5] 检验组合: 乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阳性(+)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D6] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、双侧壁明显不均匀增厚，平扫T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，双侧咽隐窝变浅，双侧咽旁脂肪间隙稍狭窄；双侧腭帆提肌、腭帆张肌、头长肌受压。双侧咽后见肿大淋巴结，左侧较大者短径11mm，右侧较大者短径12mm。 双侧后鼻孔堵塞，口咽双侧壁未见受累增厚。 双侧翼腭窝、颞下窝未见异常。 蝶骨基底部、斜坡、双侧岩尖、双侧枕骨基底部骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽；双侧筛窦、蝶窦，右乳突内见积液；上颌窦、左乳突充气良好，骨壁完整；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双颈II区、右颈III、IV区见淋巴结肿大，部分融合，较大者短径28mm，信号欠均匀，增强较明显不均匀强化。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。；检查结论: 鼻咽顶壁、顶后壁、双侧壁明显不均匀增厚，考虑鼻咽癌。 颅底骨质破坏。 双侧咽后、双颈部多发淋巴结肿大，考虑转移瘤。 副鼻窦炎；右乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见: 左颈II区可见多个大小不一肿大淋巴结，最大约22mm×12mm，边界清，椭圆形，内部回声均匀，后方回声稍增强，淋巴门未探及。 CDFI:上述淋巴结内可见周边型血流信号。 左颈淋巴结穿刺活检： 常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以16G穿刺针穿刺入左颈肿物内，进针2次，取出长约2cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。；检查结论: 左侧颈部肿大淋巴结穿刺活检。 不适随诊。 4个工作日后凭发票到2号楼6楼病理科取结果。\n- [全程D20] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右旁T7椎体横突水平，估计位于上腔静脉内。；检查结论: PICC管位置如上所述。\n- [全程D20] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 24mm AO 28mm MV E 0.53m/s EF 63% LV 37mm IVS 8mm A 0.41m/s FS 34% RA 35mm LVPW 6mm RV 16mm PA 14mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 心脏结构及运动未见异常 各房室腔及大血管未探及异常血流信号 心功能正常\n- [全程D21] 检验组合: 隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；酮体(KET)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；比重(SG)-尿液: 1.021；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D22] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 5.5；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.012；颜色-尿液: Light-Yellow；隐血(OB)-尿液: -（参考: 阴性）\n- [全程D28] 检验组合: 钠离子(Na+)-静脉血: 138.4mmol/L；胱抑素(Cys-C)-静脉血: 0.85mg/L；葡萄糖(Glu)-静脉血: 4.19mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；碱性磷酸酶(ALP)-静脉血: 77.2U/L；尿素氮(BUN)-静脉血: 4.1mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 32.5pg；淋巴细胞百分比(Lymph%)-静脉血: 0.13；C-反应蛋白(CRP)-静脉血: 2.54mg/L；氯离子(Cl-)-静脉血: 98.1mmol/L；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.64；阴离子间隙(AG)-静脉血: 16；红细胞比容(Hct)-静脉血: 43.3%；磷(P)-静脉血: 1.38mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.695；血液二氧化碳含量ctCO2(B)-静脉血: 24.3mmol/L；总胆汁酸(TBA)-静脉血: 2.1umol/L；总钙(Ca)-静脉血: 2.12mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 32.1U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.86；γ-谷氨酰基转移酶(GGT)-静脉血: 21.1U/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；甘油三酯(TG)-静脉血: 0.75mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；载脂蛋白B(apoB)-静脉血: 0.58g/L；直接胆红素(DBIL)-静脉血: 4.7umol/L；乳酸脱氢酶(LDH)-静脉血: 269.3U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 36.1U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；平均红细胞体积(MCV)-静脉血: 95.9fL；单核细胞百分比(Mono%)-静脉血: 0.13；总胆固醇(TC)-静脉血: 2.75mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339g/L；球蛋白(GLO)-静脉血: 21.89g/……\n- [全程D35] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；镁离子(Mg2+)-静脉血: 0.88mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44；载脂蛋白B(apoB)-静脉血: 0.56g/L；钠离子(Na+)-静脉血: 143.1mmol/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞比容(Hct)-静脉血: 37.1%；甘油三酯(TG)-静脉血: 0.68mmol/L；葡萄糖(Glu)-静脉血: 4.35mmol/L；C-反应蛋白(CRP)-静脉血: 16.07mg/L；平均血小板体积(MPV)-静脉血: 11.3fL；血红蛋白(Hb)-静脉血: 125g/L；载脂蛋白AI(apoAI)-静脉血: 0.89g/L；红细胞计数(RBC#)-静脉血: 3.9410E12/L；血小板比容-静脉血: 10%；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；血小板计数(PLT#)-静脉血: 8910E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.14；天门冬氨酸氨基转移酶(AST)-静脉血: 16U/L；丙氨酸氨基转移酶(ALT)-静脉血: 16.4U/L；总钙(Ca)-静脉血: 2.03mmol/L；钾离子(K+)-静脉血: 3.4mmol/L；磷(P)-静脉血: 1.05mmol/L；白蛋白(ALB)-静脉血: 36.3g/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 337g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；直接胆红素(DBIL)-静脉血: 5.4umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 94.2fL；氯离子(Cl-)-静脉血: 105.6mmol/L；肌酐(Crea)-静脉血: 70umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；胱抑素(Cys-C)-静脉血: 0.85mg/L；球蛋白(GLO)-静脉血: 21.19g/L；间接胆红素(IBIL)-静脉血: 5.9umolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.……\n- [全程D40] 检验组合: 钾离子(K+)-静脉血: 3.64mmol/L；血小板比容-静脉血: 12%；平均红细胞体积(MCV)-静脉血: 94.1fL；乳酸脱氢酶(LDH)-静脉血: 181.7U/L；碱性磷酸酶(ALP)-静脉血: 62.2U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.2；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.83mmolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.7；中性粒细胞计数(Neut#)-静脉血: 1.710E9/L；尿酸(UA)-静脉血: 230.6umol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.9pg；直接胆红素(DBIL)-静脉血: 3.3umol/L；磷(P)-静脉血: 1.27mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 13.3U/L；总胆固醇(TC)-静脉血: 2.44mmol/L；血小板分布宽度(PDW)-静脉血: 12%；平均血小板体积(MPV)-静脉血: 10.9fL；间接胆红素(IBIL)-静脉血: 3.9umolL；阴离子间隙(AG)-静脉血: 10.4；大血小板百分比(P-LCR%)-静脉血: 31.2%；镁离子(Mg2+)-静脉血: 0.87mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.028；低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.25mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 29.7mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.118；白细胞计数(WBC#)-静脉血: 2.4610E9/L；单核细胞百分比(Mono%)-静脉血: 0.179；单核细胞计数(Mono#)-静脉血: 0.410E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.16；丙氨酸氨基转移酶(ALT)-静脉血: 11.5U/L；C-反应蛋白(CRP)-静脉血: 17.05mg/L；白蛋白(ALB)-静脉血: 36.9g/L；总钙(Ca)-静脉血: 2.05mmol/L；总胆汁酸(TBA)-静脉血: 6.7umol/L；红细胞比容(Hct)-静脉血: 36.9%；葡萄糖(Glu)-静脉血: 5.02mmol/L；氯离子(Cl-)-静脉血: 102.1mmol/L；血小板计数(PLT#)……\n- [全程D42] 检验组合: 比重(SG)-尿液: 1.015；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 5；颜色-尿液: Light-Yellow；总蛋白(TP)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）\n- [全程D43] 检验组合: 颜色-尿液: Yellow；总蛋白(TP)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酮体(KET)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 10/μL；酸碱度(pH)-尿液: 5.5；胆红素(BIL)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 2/μL；比重(SG)-尿液: 1.02；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D46] 检验组合: 红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8%；间接胆红素(IBIL)-静脉血: 5.4umolL；尿酸(UA)-静脉血: 292.3umol/L；血小板分布宽度(PDW)-静脉血: 16.6%；磷(P)-静脉血: 1.39mmol/L；白细胞计数(WBC#)-静脉血: 3.2610E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 29.4U/L；中性粒细胞计数(Neut#)-静脉血: 2.510E9/L；总钙(Ca)-静脉血: 2.23mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 33pg；低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.63mmol/L；阴离子间隙(AG)-静脉血: 12；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.7；钠离子(Na+)-静脉血: 142mmol/L；钾离子(K+)-静脉血: 3.3mmol/L；氯离子(Cl-)-静脉血: 97.5mmol/L；白蛋白(ALB)-静脉血: 42.8g/L；总胆汁酸(TBA)-静脉血: 2.9umol/L；单核细胞百分比(Mono%)-静脉血: 0.143；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞比容(Hct)-静脉血: 40.8%；肌酐(Crea)-静脉血: 84.7umol/L；碱性磷酸酶(ALP)-静脉血: 64.7U/L；尿素氮(BUN)-静脉血: 5.06mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；总胆红素(TBIL)-静脉血: 9.3umol/L；载脂蛋白B(apoB)-静脉血: 0.65g/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；葡萄糖(Glu)-静脉血: 5.63mmol/L；球蛋白(GLO)-静脉血: 24.97g/L；C-反应蛋白(CRP)-静脉血: 6.22mg/L；镁离子(Mg2+)-静脉血: 0.97mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；α-L-岩藻糖苷酶(AFU)-静脉血: 40U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.009；平均红细胞血红蛋白浓度(MCHC)-静脉血: 342.2g/L；载脂蛋白AI(apoAI)-静脉血: 0.96g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 28.……\n- [全程D56] 检验组合: 碱性磷酸酶(ALP)-静脉血: 64.1U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；钾离子(K+)-静脉血: 3.65mmol/L；总蛋白(TP)-静脉血: 62.2g/L；血液二氧化碳含量ctCO2(B)-静脉血: 32mmol/L；胱抑素(Cys-C)-静脉血: 0.81mg/L；钠离子(Na+)-静脉血: 139.1mmol/L；红细胞比容(Hct)-静脉血: 38.2%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.5；载脂蛋白B(apoB)-静脉血: 0.72g/L；阴离子间隙(AG)-静脉血: 7.6；平均血小板体积(MPV)-静脉血: 10.7fL；丙氨酸氨基转移酶(ALT)-静脉血: 8.1U/L；中性粒细胞百分比(Neut%)-静脉血: 0.707；低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.56mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 13.8U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.69mmolL；总胆固醇(TC)-静脉血: 2.82mmol/L；总胆红素(TBIL)-静脉血: 9.5umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 14U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；乳酸脱氢酶(LDH)-静脉血: 146.4U/L；单核细胞百分比(Mono%)-静脉血: 0.202；血小板分布宽度(PDW)-静脉血: 12.5%；α-L-岩藻糖苷酶(AFU)-静脉血: 22.8U/L；肌酐(Crea)-静脉血: 73.2umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；磷(P)-静脉血: 1.17mmol/L；氯离子(Cl-)-静脉血: 99.5mmol/L；尿素氮(BUN)-静脉血: 4.3mmol/L；血小板比容-静脉血: 11%；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；总胆汁酸(TBA)-静脉血: 3.7umol/L；甘油三酯(TG)-静脉血: 0.85mmol/L；间接胆红素(IBIL)-静脉血: 5.5umolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.7；直接胆红素(DBIL)-静脉血: 4u……\n- [全程D62] 检验组合: 细菌涂片3-咽拭子: 未发现念珠状菌\n- [全程D63] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径10mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约27cm/s。 胆囊餐后改变，胆囊内可见一强回声团，直径约9mm，后方伴声影。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约33×27×24mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 胆囊结石。 肝脏、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D2] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉右耳听力下降，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，结合患者检查，认为患者鼻咽癌可能性大，指示完善相关检查后在决定下一步治疗方案，遵嘱执行。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D14] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉右耳听力下降，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，指示尽快完成放疗计划，遵嘱执行。\n- [全程D19] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉右耳听力下降，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，考虑患者放疗计划即将完成，指示可提前2天先予以化疗，指示今日予以DDP方案化疗第1程，做好水化、护胃、止呕等对症支持处理，密切观察化疗中副反应，遵嘱执行。\n- [全程D24] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉恶心，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，较前缩小，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，认为患者化疗顺利完成，指示继续放疗，密切观察放疗中副反应，遵嘱执行。\n- [全程D29] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，未诉特殊不适，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，较前缩小，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，指示继续放疗，密切观察放疗中副反应，遵嘱执行。\n- [全程D42] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉咽痛，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。BR、生化常规大致正常。[姓名已隐去]主诊医生信息已隐藏，考虑患者上次化疗已达3周，指示今日按[计划性表述已隐藏]以DDP方案化疗第二程，做好水化、护肝等对症支持处理，继续放疗，密切观察放化疗副反应，遵嘱执行。\n- [全程D47] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉咽痛，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，认为患者化疗顺利完成，指示继续放疗，密切观察放疗副反应，遵嘱执行。\n- [全程D52] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉咽痛，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，指示予以止痛、口腔粘膜保护对症处理，加强营养支持，继续放疗。\n- [全程D57] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，未诉明显特殊不适，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，指示继续放疗，遵嘱执行。\n- [全程D61] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，未诉明显特殊不适，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]医生信息已隐藏，考虑患者化疗即将到期，建议患者行第三程化疗，但患者拒绝，遂指示今日予以出院，于门诊继续放疗，遵嘱执行。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 强制收治入院完成第三程同期化疗，期间暂停放疗，待化疗结束后恢复放疗。\nB. 取消第三程同期化疗，加用西妥昔单抗靶向治疗联合放疗，放疗结束后行疗效评估。\nC. 提前终止放疗，行全身PET-CT及头颈部MRI评估，视肿瘤退缩情况决定后续辅助化疗方案。\nD. 取消第三程同期化疗，下调原定放疗处方剂量以减轻黏膜反应，放疗结束后即刻行鼻咽镜活检。\nE. 安排入院行TPF方案补充化疗，同时继续放疗，放疗结束后行全面疗效评估。\nF. 取消第三程同期化疗，按原计划完成根治性放疗，胆囊结石暂予观察，放疗结束后择期行全面疗效评估。\nG. 请普外科急会诊行腹腔镜胆囊切除术，术后择期恢复放疗，并取消后续化疗。\nH. 改用口服卡培他滨单药替代静脉化疗，继续门诊放疗，放疗结束后行辅助化疗。\nI. 立即行鼻咽及颈部MRI复查，若肿瘤已完全消退则提前结束放疗，进入随访阶段。\nJ. 取消第三程同期化疗，增加放疗靶区外扩范围及处方剂量，放疗结束后择期行全面疗效评估。\nK. 暂停放疗，待咽痛及口腔黏膜反应完全缓解后再恢复放疗，并补充第三程化疗。\nL. 采用中药及针灸治疗替代第三程化疗，继续门诊放疗，放疗结束后常规行全身骨扫描。\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D40] 检验组合: 钾离子(K+)-静脉血: 3.64mmol/L；血小板比容-静脉血: 12%；平均红细胞体积(MCV)-静脉血: 94.1fL；乳酸脱氢酶(LDH)-静脉血: 181.7U/L；碱性磷酸酶(ALP)-静脉血: 62.2U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.2；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.83mmolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.7；中性粒细胞计数(Neut#)-静脉血: 1.710E9/L；尿酸(UA)-静脉血: 230.6umol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.9pg；直接胆红素(DBIL)-静脉血: 3.3umol/L；磷(P)-静脉血: 1.27mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 13.3U/L；总胆固醇(TC)-静脉血: 2.44mmol/L；血小板分布宽度(PDW)-静脉血: 12%；平均血小板体积(MPV)-静脉血: 10.9fL；间接胆红素(IBIL)-静脉血: 3.9umolL；阴离子间隙(AG)-静脉血: 10.4；大血小板百分比(P-LCR%)-静脉血: 31.2%；镁离子(Mg2+)-静脉血: 0.87mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.028；低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.25mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 29.7mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.118；白细胞计数(WBC#)-静脉血: 2.4610E9/L；单核细胞百分比(Mono%)-静脉血: 0.179；单核细胞计数(Mono#)-静脉血: 0.410E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.16；丙氨酸氨基转移酶(ALT)-静脉血: 11.5U/L；C-反应蛋白(CRP)-静脉血: 17.05mg/L；白蛋白(ALB)-静脉血: 36.9g/L；总钙(Ca)-静脉血: 2.05mmol/L；总胆汁酸(TBA)-静脉血: 6.7umol/L；红细胞比容(Hct)-静脉血: 36.9%；葡萄糖(Glu)-静脉血: 5.02mmol/L；氯离子(Cl-)-静脉血: 102.1mmol/L；血小板计数(PLT#)……\n- [全程D42] 检验组合: 比重(SG)-尿液: 1.015；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 5；颜色-尿液: Light-Yellow；总蛋白(TP)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）\n- [全程D43] 检验组合: 颜色-尿液: Yellow；总蛋白(TP)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酮体(KET)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 10/μL；酸碱度(pH)-尿液: 5.5；胆红素(BIL)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 2/μL；比重(SG)-尿液: 1.02；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D46] 检验组合: 红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8%；间接胆红素(IBIL)-静脉血: 5.4umolL；尿酸(UA)-静脉血: 292.3umol/L；血小板分布宽度(PDW)-静脉血: 16.6%；磷(P)-静脉血: 1.39mmol/L；白细胞计数(WBC#)-静脉血: 3.2610E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 29.4U/L；中性粒细胞计数(Neut#)-静脉血: 2.510E9/L；总钙(Ca)-静脉血: 2.23mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 33pg；低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.63mmol/L；阴离子间隙(AG)-静脉血: 12；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.7；钠离子(Na+)-静脉血: 142mmol/L；钾离子(K+)-静脉血: 3.3mmol/L；氯离子(Cl-)-静脉血: 97.5mmol/L；白蛋白(ALB)-静脉血: 42.8g/L；总胆汁酸(TBA)-静脉血: 2.9umol/L；单核细胞百分比(Mono%)-静脉血: 0.143；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞比容(Hct)-静脉血: 40.8%；肌酐(Crea)-静脉血: 84.7umol/L；碱性磷酸酶(ALP)-静脉血: 64.7U/L；尿素氮(BUN)-静脉血: 5.06mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；总胆红素(TBIL)-静脉血: 9.3umol/L；载脂蛋白B(apoB)-静脉血: 0.65g/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；葡萄糖(Glu)-静脉血: 5.63mmol/L；球蛋白(GLO)-静脉血: 24.97g/L；C-反应蛋白(CRP)-静脉血: 6.22mg/L；镁离子(Mg2+)-静脉血: 0.97mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；α-L-岩藻糖苷酶(AFU)-静脉血: 40U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.009；平均红细胞血红蛋白浓度(MCHC)-静脉血: 342.2g/L；载脂蛋白AI(apoAI)-静脉血: 0.96g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 28.……\n- [全程D56] 检验组合: 碱性磷酸酶(ALP)-静脉血: 64.1U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；钾离子(K+)-静脉血: 3.65mmol/L；总蛋白(TP)-静脉血: 62.2g/L；血液二氧化碳含量ctCO2(B)-静脉血: 32mmol/L；胱抑素(Cys-C)-静脉血: 0.81mg/L；钠离子(Na+)-静脉血: 139.1mmol/L；红细胞比容(Hct)-静脉血: 38.2%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.5；载脂蛋白B(apoB)-静脉血: 0.72g/L；阴离子间隙(AG)-静脉血: 7.6；平均血小板体积(MPV)-静脉血: 10.7fL；丙氨酸氨基转移酶(ALT)-静脉血: 8.1U/L；中性粒细胞百分比(Neut%)-静脉血: 0.707；低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.56mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 13.8U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.69mmolL；总胆固醇(TC)-静脉血: 2.82mmol/L；总胆红素(TBIL)-静脉血: 9.5umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 14U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；乳酸脱氢酶(LDH)-静脉血: 146.4U/L；单核细胞百分比(Mono%)-静脉血: 0.202；血小板分布宽度(PDW)-静脉血: 12.5%；α-L-岩藻糖苷酶(AFU)-静脉血: 22.8U/L；肌酐(Crea)-静脉血: 73.2umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；磷(P)-静脉血: 1.17mmol/L；氯离子(Cl-)-静脉血: 99.5mmol/L；尿素氮(BUN)-静脉血: 4.3mmol/L；血小板比容-静脉血: 11%；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；总胆汁酸(TBA)-静脉血: 3.7umol/L；甘油三酯(TG)-静脉血: 0.85mmol/L；间接胆红素(IBIL)-静脉血: 5.5umolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.7；直接胆红素(DBIL)-静脉血: 4u……\n- [全程D62] 检验组合: 细菌涂片3-咽拭子: 未发现念珠状菌\n- [全程D63] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径10mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约27cm/s。 胆囊餐后改变，胆囊内可见一强回声团，直径约9mm，后方伴声影。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约33×27×24mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 胆囊结石。 肝脏、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n\n【既往治疗与反应】\n- [全程D42] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉咽痛，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。BR、生化常规大致正常。[姓名已隐去]主诊医生信息已隐藏，考虑患者上次化疗已达3周，指示今日按[计划性表述已隐藏]以DDP方案化疗第二程，做好水化、护肝等对症支持处理，继续放疗，密切观察放化疗副反应，遵嘱执行。\n- [全程D47] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉咽痛，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，认为患者化疗顺利完成，指示继续放疗，密切观察放疗副反应，遵嘱执行。\n- [全程D52] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉咽痛，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，指示予以止痛、口腔粘膜保护对症处理，加强营养支持，继续放疗。\n- [全程D57] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，未诉明显特殊不适，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，指示继续放疗，遵嘱执行。\n- [全程D61] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，未诉明显特殊不适，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]医生信息已隐藏，考虑患者化疗即将到期，建议患者行第三程化疗，但患者拒绝，遂指示今日予以出院，于门诊继续放疗，遵嘱执行。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 强制收治入院完成第三程同期化疗，期间暂停放疗，待化疗结束后恢复放疗。\nB. 取消第三程同期化疗，加用西妥昔单抗靶向治疗联合放疗，放疗结束后行疗效评估。\nC. 提前终止放疗，行全身PET-CT及头颈部MRI评估，视肿瘤退缩情况决定后续辅助化疗方案。\nD. 取消第三程同期化疗，下调原定放疗处方剂量以减轻黏膜反应，放疗结束后即刻行鼻咽镜活检。\nE. 安排入院行TPF方案补充化疗，同时继续放疗，放疗结束后行全面疗效评估。\nF. 取消第三程同期化疗，按原计划完成根治性放疗，胆囊结石暂予观察，放疗结束后择期行全面疗效评估。\nG. 请普外科急会诊行腹腔镜胆囊切除术，术后择期恢复放疗，并取消后续化疗。\nH. 改用口服卡培他滨单药替代静脉化疗，继续门诊放疗，放疗结束后行辅助化疗。\nI. 立即行鼻咽及颈部MRI复查，若肿瘤已完全消退则提前结束放疗，进入随访阶段。\nJ. 取消第三程同期化疗，增加放疗靶区外扩范围及处方剂量，放疗结束后择期行全面疗效评估。\nK. 暂停放疗，待咽痛及口腔黏膜反应完全缓解后再恢复放疗，并补充第三程化疗。\nL. 采用中药及针灸治疗替代第三程化疗，继续门诊放疗，放疗结束后常规行全身骨扫描。\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：咽旁间隙、斜坡、蝶骨基底部、岩尖。\n文本分期信息：N3，M0。\n综合TNM状态：T3N3M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D40] 检验组合: 钾离子(K+)-静脉血: 3.64mmol/L；血小板比容-静脉血: 12%；平均红细胞体积(MCV)-静脉血: 94.1fL；乳酸脱氢酶(LDH)-静脉血: 181.7U/L；碱性磷酸酶(ALP)-静脉血: 62.2U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.2；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.83mmolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.7；中性粒细胞计数(Neut#)-静脉血: 1.710E9/L；尿酸(UA)-静脉血: 230.6umol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.9pg；直接胆红素(DBIL)-静脉血: 3.3umol/L；磷(P)-静脉血: 1.27mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 13.3U/L；总胆固醇(TC)-静脉血: 2.44mmol/L；血小板分布宽度(PDW)-静脉血: 12%；平均血小板体积(MPV)-静脉血: 10.9fL；间接胆红素(IBIL)-静脉血: 3.9umolL；阴离子间隙(AG)-静脉血: 10.4；大血小板百分比(P-LCR%)-静脉血: 31.2%；镁离子(Mg2+)-静脉血: 0.87mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.028；低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.25mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 29.7mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.118；白细胞计数(WBC#)-静脉血: 2.4610E9/L；单核细胞百分比(Mono%)-静脉血: 0.179；单核细胞计数(Mono#)-静脉血: 0.410E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.16；丙氨酸氨基转移酶(ALT)-静脉血: 11.5U/L；C-反应蛋白(CRP)-静脉血: 17.05mg/L；白蛋白(ALB)-静脉血: 36.9g/L；总钙(Ca)-静脉血: 2.05mmol/L；总胆汁酸(TBA)-静脉血: 6.7umol/L；红细胞比容(Hct)-静脉血: 36.9%；葡萄糖(Glu)-静脉血: 5.02mmol/L；氯离子(Cl-)-静脉血: 102.1mmol/L；血小板计数(PLT#)……\n- [全程D42] 检验组合: 比重(SG)-尿液: 1.015；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 5；颜色-尿液: Light-Yellow；总蛋白(TP)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）\n- [全程D43] 检验组合: 颜色-尿液: Yellow；总蛋白(TP)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酮体(KET)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 10/μL；酸碱度(pH)-尿液: 5.5；胆红素(BIL)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 2/μL；比重(SG)-尿液: 1.02；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D46] 检验组合: 红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8%；间接胆红素(IBIL)-静脉血: 5.4umolL；尿酸(UA)-静脉血: 292.3umol/L；血小板分布宽度(PDW)-静脉血: 16.6%；磷(P)-静脉血: 1.39mmol/L；白细胞计数(WBC#)-静脉血: 3.2610E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 29.4U/L；中性粒细胞计数(Neut#)-静脉血: 2.510E9/L；总钙(Ca)-静脉血: 2.23mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 33pg；低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.63mmol/L；阴离子间隙(AG)-静脉血: 12；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.7；钠离子(Na+)-静脉血: 142mmol/L；钾离子(K+)-静脉血: 3.3mmol/L；氯离子(Cl-)-静脉血: 97.5mmol/L；白蛋白(ALB)-静脉血: 42.8g/L；总胆汁酸(TBA)-静脉血: 2.9umol/L；单核细胞百分比(Mono%)-静脉血: 0.143；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞比容(Hct)-静脉血: 40.8%；肌酐(Crea)-静脉血: 84.7umol/L；碱性磷酸酶(ALP)-静脉血: 64.7U/L；尿素氮(BUN)-静脉血: 5.06mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；总胆红素(TBIL)-静脉血: 9.3umol/L；载脂蛋白B(apoB)-静脉血: 0.65g/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；葡萄糖(Glu)-静脉血: 5.63mmol/L；球蛋白(GLO)-静脉血: 24.97g/L；C-反应蛋白(CRP)-静脉血: 6.22mg/L；镁离子(Mg2+)-静脉血: 0.97mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；α-L-岩藻糖苷酶(AFU)-静脉血: 40U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.009；平均红细胞血红蛋白浓度(MCHC)-静脉血: 342.2g/L；载脂蛋白AI(apoAI)-静脉血: 0.96g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 28.……\n- [全程D56] 检验组合: 碱性磷酸酶(ALP)-静脉血: 64.1U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；钾离子(K+)-静脉血: 3.65mmol/L；总蛋白(TP)-静脉血: 62.2g/L；血液二氧化碳含量ctCO2(B)-静脉血: 32mmol/L；胱抑素(Cys-C)-静脉血: 0.81mg/L；钠离子(Na+)-静脉血: 139.1mmol/L；红细胞比容(Hct)-静脉血: 38.2%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.5；载脂蛋白B(apoB)-静脉血: 0.72g/L；阴离子间隙(AG)-静脉血: 7.6；平均血小板体积(MPV)-静脉血: 10.7fL；丙氨酸氨基转移酶(ALT)-静脉血: 8.1U/L；中性粒细胞百分比(Neut%)-静脉血: 0.707；低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.56mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 13.8U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.69mmolL；总胆固醇(TC)-静脉血: 2.82mmol/L；总胆红素(TBIL)-静脉血: 9.5umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 14U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；乳酸脱氢酶(LDH)-静脉血: 146.4U/L；单核细胞百分比(Mono%)-静脉血: 0.202；血小板分布宽度(PDW)-静脉血: 12.5%；α-L-岩藻糖苷酶(AFU)-静脉血: 22.8U/L；肌酐(Crea)-静脉血: 73.2umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；磷(P)-静脉血: 1.17mmol/L；氯离子(Cl-)-静脉血: 99.5mmol/L；尿素氮(BUN)-静脉血: 4.3mmol/L；血小板比容-静脉血: 11%；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；总胆汁酸(TBA)-静脉血: 3.7umol/L；甘油三酯(TG)-静脉血: 0.85mmol/L；间接胆红素(IBIL)-静脉血: 5.5umolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.7；直接胆红素(DBIL)-静脉血: 4u……\n- [全程D62] 检验组合: 细菌涂片3-咽拭子: 未发现念珠状菌\n- [全程D63] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径10mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约27cm/s。 胆囊餐后改变，胆囊内可见一强回声团，直径约9mm，后方伴声影。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约33×27×24mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 胆囊结石。 肝脏、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n\n【既往治疗与反应】\n- [全程D42] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉咽痛，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。BR、生化常规大致正常。[姓名已隐去]主诊医生信息已隐藏，考虑患者上次化疗已达3周，指示今日按[计划性表述已隐藏]以DDP方案化疗第二程，做好水化、护肝等对症支持处理，继续放疗，密切观察放化疗副反应，遵嘱执行。\n- [全程D47] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉咽痛，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，认为患者化疗顺利完成，指示继续放疗，密切观察放疗副反应，遵嘱执行。\n- [全程D52] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉咽痛，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，指示予以止痛、口腔粘膜保护对症处理，加强营养支持，继续放疗。\n- [全程D57] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，未诉明显特殊不适，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，指示继续放疗，遵嘱执行。\n- [全程D61] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，未诉明显特殊不适，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]医生信息已隐藏，考虑患者化疗即将到期，建议患者行第三程化疗，但患者拒绝，遂指示今日予以出院，于门诊继续放疗，遵嘱执行。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 强制收治入院完成第三程同期化疗，期间暂停放疗，待化疗结束后恢复放疗。\nB. 取消第三程同期化疗，加用西妥昔单抗靶向治疗联合放疗，放疗结束后行疗效评估。\nC. 提前终止放疗，行全身PET-CT及头颈部MRI评估，视肿瘤退缩情况决定后续辅助化疗方案。\nD. 取消第三程同期化疗，下调原定放疗处方剂量以减轻黏膜反应，放疗结束后即刻行鼻咽镜活检。\nE. 安排入院行TPF方案补充化疗，同时继续放疗，放疗结束后行全面疗效评估。\nF. 取消第三程同期化疗，按原计划完成根治性放疗，胆囊结石暂予观察，放疗结束后择期行全面疗效评估。\nG. 请普外科急会诊行腹腔镜胆囊切除术，术后择期恢复放疗，并取消后续化疗。\nH. 改用口服卡培他滨单药替代静脉化疗，继续门诊放疗，放疗结束后行辅助化疗。\nI. 立即行鼻咽及颈部MRI复查，若肿瘤已完全消退则提前结束放疗，进入随访阶段。\nJ. 取消第三程同期化疗，增加放疗靶区外扩范围及处方剂量，放疗结束后择期行全面疗效评估。\nK. 暂停放疗，待咽痛及口腔黏膜反应完全缓解后再恢复放疗，并补充第三程化疗。\nL. 采用中药及针灸治疗替代第三程化疗，继续门诊放疗，放疗结束后常规行全身骨扫描。\n\n请仅输出一个选项字母（A-L）。"},{"sample_id":"sample-bc1decc91eb488b9888718b5","patient_id":"patient-9fcde7a95f4d57501ecbf7b2","turn_id":"turn08","turn_position":7,"turn_type":"recurrence_or_salvage_decision","gold_letter":"G","gold_action":"结束根治性治疗进入随访，放疗后3个月复查影像学评估疗效","options":[{"letter":"A","text":"立即行双侧颈部淋巴结清扫术以彻底清除颈部残留病灶","is_gold":false},{"letter":"B","text":"立即行鼻咽及颈部局部追加外照射放疗10-15Gy推量","is_gold":false},{"letter":"C","text":"立即行全身PET-CT检查评估颈部淋巴结活性及远处转移","is_gold":false},{"letter":"D","text":"立即行鼻咽内镜下活检评估原发灶病理完全缓解情况","is_gold":false},{"letter":"E","text":"立即启动含铂双药方案辅助化疗2-3个周期强化全身控制","is_gold":false},{"letter":"F","text":"予以表皮生长因子受体靶向药物单药维持治疗半年至一年","is_gold":false},{"letter":"G","text":"结束根治性治疗进入随访，放疗后3个月复查影像学评估疗效","is_gold":true},{"letter":"H","text":"立即行颈部残留淋巴结细针穿刺活检以指导后续局部治疗","is_gold":false},{"letter":"I","text":"立即启动PD-1单抗等免疫检查点抑制剂维持治疗1年","is_gold":false},{"letter":"J","text":"予以抗炎及对症支持治疗，放疗后1个月复查鼻咽颈部MRI","is_gold":false},{"letter":"K","text":"立即采用原诱导化疗方案进行2至3个周期全身巩固化疗","is_gold":false},{"letter":"L","text":"立即行颈部残留淋巴结局部微波消融或放射性粒子植入术","is_gold":false}],"packed_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：咽旁间隙、斜坡、蝶骨基底部、岩尖。\n文本分期信息：N3，M0。\n综合TNM状态：T3N3M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1] 入院记录: 主诉: 右颈肿物半年，右耳听力下降半月；现病史: 缘于6月前患者无意中出现右颈肿物，未予重视，进行性增大，半月前出现右耳听力下降，无头痛、复视，无涕血、面麻等，就诊于当地医院，发现鼻咽肿物。今为求进一步诊治来我院。患者发病以来,精神、饮食、睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟20支/日*5年，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.3℃，P：79次/分，R：20次/分，BP：105/65mmHg,Ht：168cm，Wt：56kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D1] 入院记录: 主诉: 右颈肿物半年，右耳听力下降半月；现病史: 缘于6月前患者无意中出现右颈肿物，未予重视，进行性增大，半月前出现右耳听力下降，无头痛、复视，无涕血、面麻等，就诊于当地医院，发现鼻咽肿物。今为求进一步诊治来我院。患者发病以来,精神、饮食、睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟20支/日*5年，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.3℃，P：79次/分，R：20次/分，BP：105/65mmHg,Ht：168cm，Wt：56kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率79次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n- [全程D4] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 V5～V6导联低电压 V1～V3导联r波递增不良\n- [全程D4] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 25.6U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.341；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；平均红细胞体积(MCV)-静脉血: 94.7fL；白细胞计数(WBC#)-静脉血: 4.5110E9/L；平均血小板体积(MPV)-静脉血: 12fL；D-二聚体(D-Dimer)-静脉血: 0.1ug/ml；单核细胞计数(Mono#)-静脉血: 0.510E9/L；磷(P)-静脉血: 1.36mmol/L；甘油三酯(TG)-静脉血: 2.22mmol/L；间接胆红素(IBIL)-静脉血: 5.2umolL；白蛋白(ALB)-静脉血: 44.8g/L；碱性磷酸酶(ALP)-静脉血: 81.9U/L；凝血酶时间(TT)-静脉血: 18.5sec.；载脂蛋白B(apoB)-静脉血: 0.57g/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.1U/L；阴离子间隙(AG)-静脉血: 11；血小板比容-静脉血: 15%；凝血酶原时间(PT)-静脉血: 11.7sec.；肌酐(Crea)-静脉血: 82.7umol/L；总胆红素(TBIL)-静脉血: 8.2umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.503；球蛋白(GLO)-静脉血: 25.56g/L；红细胞计数(RBC#)-静脉血: 4.5210E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；大血小板百分比(P-LCR%)-静脉血: 40%；血小板分布宽度(PDW)-静脉血: 14.2%；凝血酶原时间活动度(PTA)-静脉血: 90.4%；乳酸脱氢酶(LDH)-静脉血: 359.7U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32.3pg；ABO血型-静脉血: B；总钙(Ca)-静脉血: 2.3mmol/L；镁离子(Mg2+)-静脉血: 0.99mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 146g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；γ-谷氨酰基转移酶(GGT)-静脉血: 14.6U/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.1mmol/L……\n- [全程D5] 检验组合: 乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阳性(+)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D6] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、双侧壁明显不均匀增厚，平扫T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，双侧咽隐窝变浅，双侧咽旁脂肪间隙稍狭窄；双侧腭帆提肌、腭帆张肌、头长肌受压。双侧咽后见肿大淋巴结，左侧较大者短径11mm，右侧较大者短径12mm。 双侧后鼻孔堵塞，口咽双侧壁未见受累增厚。 双侧翼腭窝、颞下窝未见异常。 蝶骨基底部、斜坡、双侧岩尖、双侧枕骨基底部骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽；双侧筛窦、蝶窦，右乳突内见积液；上颌窦、左乳突充气良好，骨壁完整；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双颈II区、右颈III、IV区见淋巴结肿大，部分融合，较大者短径28mm，信号欠均匀，增强较明显不均匀强化。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。；检查结论: 鼻咽顶壁、顶后壁、双侧壁明显不均匀增厚，考虑鼻咽癌。 颅底骨质破坏。 双侧咽后、双颈部多发淋巴结肿大，考虑转移瘤。 副鼻窦炎；右乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见: 左颈II区可见多个大小不一肿大淋巴结，最大约22mm×12mm，边界清，椭圆形，内部回声均匀，后方回声稍增强，淋巴门未探及。 CDFI:上述淋巴结内可见周边型血流信号。 左颈淋巴结穿刺活检： 常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以16G穿刺针穿刺入左颈肿物内，进针2次，取出长约2cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。；检查结论: 左侧颈部肿大淋巴结穿刺活检。 不适随诊。 4个工作日后凭发票到2号楼6楼病理科取结果。\n- [全程D20] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右旁T7椎体横突水平，估计位于上腔静脉内。；检查结论: PICC管位置如上所述。\n- [全程D20] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 24mm AO 28mm MV E 0.53m/s EF 63% LV 37mm IVS 8mm A 0.41m/s FS 34% RA 35mm LVPW 6mm RV 16mm PA 14mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 心脏结构及运动未见异常 各房室腔及大血管未探及异常血流信号 心功能正常\n- [全程D21] 检验组合: 隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；酮体(KET)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；比重(SG)-尿液: 1.021；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D22] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 5.5；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.012；颜色-尿液: Light-Yellow；隐血(OB)-尿液: -（参考: 阴性）\n- [全程D28] 检验组合: 钠离子(Na+)-静脉血: 138.4mmol/L；胱抑素(Cys-C)-静脉血: 0.85mg/L；葡萄糖(Glu)-静脉血: 4.19mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；碱性磷酸酶(ALP)-静脉血: 77.2U/L；尿素氮(BUN)-静脉血: 4.1mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 32.5pg；淋巴细胞百分比(Lymph%)-静脉血: 0.13；C-反应蛋白(CRP)-静脉血: 2.54mg/L；氯离子(Cl-)-静脉血: 98.1mmol/L；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.64；阴离子间隙(AG)-静脉血: 16；红细胞比容(Hct)-静脉血: 43.3%；磷(P)-静脉血: 1.38mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.695；血液二氧化碳含量ctCO2(B)-静脉血: 24.3mmol/L；总胆汁酸(TBA)-静脉血: 2.1umol/L；总钙(Ca)-静脉血: 2.12mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 32.1U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.86；γ-谷氨酰基转移酶(GGT)-静脉血: 21.1U/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；甘油三酯(TG)-静脉血: 0.75mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；载脂蛋白B(apoB)-静脉血: 0.58g/L；直接胆红素(DBIL)-静脉血: 4.7umol/L；乳酸脱氢酶(LDH)-静脉血: 269.3U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 36.1U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；平均红细胞体积(MCV)-静脉血: 95.9fL；单核细胞百分比(Mono%)-静脉血: 0.13；总胆固醇(TC)-静脉血: 2.75mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339g/L；球蛋白(GLO)-静脉血: 21.89g/……\n- [全程D35] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；镁离子(Mg2+)-静脉血: 0.88mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44；载脂蛋白B(apoB)-静脉血: 0.56g/L；钠离子(Na+)-静脉血: 143.1mmol/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞比容(Hct)-静脉血: 37.1%；甘油三酯(TG)-静脉血: 0.68mmol/L；葡萄糖(Glu)-静脉血: 4.35mmol/L；C-反应蛋白(CRP)-静脉血: 16.07mg/L；平均血小板体积(MPV)-静脉血: 11.3fL；血红蛋白(Hb)-静脉血: 125g/L；载脂蛋白AI(apoAI)-静脉血: 0.89g/L；红细胞计数(RBC#)-静脉血: 3.9410E12/L；血小板比容-静脉血: 10%；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；血小板计数(PLT#)-静脉血: 8910E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.14；天门冬氨酸氨基转移酶(AST)-静脉血: 16U/L；丙氨酸氨基转移酶(ALT)-静脉血: 16.4U/L；总钙(Ca)-静脉血: 2.03mmol/L；钾离子(K+)-静脉血: 3.4mmol/L；磷(P)-静脉血: 1.05mmol/L；白蛋白(ALB)-静脉血: 36.3g/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 337g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；直接胆红素(DBIL)-静脉血: 5.4umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 94.2fL；氯离子(Cl-)-静脉血: 105.6mmol/L；肌酐(Crea)-静脉血: 70umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；胱抑素(Cys-C)-静脉血: 0.85mg/L；球蛋白(GLO)-静脉血: 21.19g/L；间接胆红素(IBIL)-静脉血: 5.9umolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.……\n- [全程D40] 检验组合: 钾离子(K+)-静脉血: 3.64mmol/L；血小板比容-静脉血: 12%；平均红细胞体积(MCV)-静脉血: 94.1fL；乳酸脱氢酶(LDH)-静脉血: 181.7U/L；碱性磷酸酶(ALP)-静脉血: 62.2U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.2；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.83mmolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.7；中性粒细胞计数(Neut#)-静脉血: 1.710E9/L；尿酸(UA)-静脉血: 230.6umol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.9pg；直接胆红素(DBIL)-静脉血: 3.3umol/L；磷(P)-静脉血: 1.27mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 13.3U/L；总胆固醇(TC)-静脉血: 2.44mmol/L；血小板分布宽度(PDW)-静脉血: 12%；平均血小板体积(MPV)-静脉血: 10.9fL；间接胆红素(IBIL)-静脉血: 3.9umolL；阴离子间隙(AG)-静脉血: 10.4；大血小板百分比(P-LCR%)-静脉血: 31.2%；镁离子(Mg2+)-静脉血: 0.87mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.028；低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.25mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 29.7mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.118；白细胞计数(WBC#)-静脉血: 2.4610E9/L；单核细胞百分比(Mono%)-静脉血: 0.179；单核细胞计数(Mono#)-静脉血: 0.410E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.16；丙氨酸氨基转移酶(ALT)-静脉血: 11.5U/L；C-反应蛋白(CRP)-静脉血: 17.05mg/L；白蛋白(ALB)-静脉血: 36.9g/L；总钙(Ca)-静脉血: 2.05mmol/L；总胆汁酸(TBA)-静脉血: 6.7umol/L；红细胞比容(Hct)-静脉血: 36.9%；葡萄糖(Glu)-静脉血: 5.02mmol/L；氯离子(Cl-)-静脉血: 102.1mmol/L；血小板计数(PLT#)……\n- [全程D42] 检验组合: 比重(SG)-尿液: 1.015；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 5；颜色-尿液: Light-Yellow；总蛋白(TP)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）\n- [全程D43] 检验组合: 颜色-尿液: Yellow；总蛋白(TP)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酮体(KET)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 10/μL；酸碱度(pH)-尿液: 5.5；胆红素(BIL)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 2/μL；比重(SG)-尿液: 1.02；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D46] 检验组合: 红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8%；间接胆红素(IBIL)-静脉血: 5.4umolL；尿酸(UA)-静脉血: 292.3umol/L；血小板分布宽度(PDW)-静脉血: 16.6%；磷(P)-静脉血: 1.39mmol/L；白细胞计数(WBC#)-静脉血: 3.2610E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 29.4U/L；中性粒细胞计数(Neut#)-静脉血: 2.510E9/L；总钙(Ca)-静脉血: 2.23mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 33pg；低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.63mmol/L；阴离子间隙(AG)-静脉血: 12；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.7；钠离子(Na+)-静脉血: 142mmol/L；钾离子(K+)-静脉血: 3.3mmol/L；氯离子(Cl-)-静脉血: 97.5mmol/L；白蛋白(ALB)-静脉血: 42.8g/L；总胆汁酸(TBA)-静脉血: 2.9umol/L；单核细胞百分比(Mono%)-静脉血: 0.143；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞比容(Hct)-静脉血: 40.8%；肌酐(Crea)-静脉血: 84.7umol/L；碱性磷酸酶(ALP)-静脉血: 64.7U/L；尿素氮(BUN)-静脉血: 5.06mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；总胆红素(TBIL)-静脉血: 9.3umol/L；载脂蛋白B(apoB)-静脉血: 0.65g/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；葡萄糖(Glu)-静脉血: 5.63mmol/L；球蛋白(GLO)-静脉血: 24.97g/L；C-反应蛋白(CRP)-静脉血: 6.22mg/L；镁离子(Mg2+)-静脉血: 0.97mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；α-L-岩藻糖苷酶(AFU)-静脉血: 40U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.009；平均红细胞血红蛋白浓度(MCHC)-静脉血: 342.2g/L；载脂蛋白AI(apoAI)-静脉血: 0.96g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 28.……\n- [全程D56] 检验组合: 碱性磷酸酶(ALP)-静脉血: 64.1U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；钾离子(K+)-静脉血: 3.65mmol/L；总蛋白(TP)-静脉血: 62.2g/L；血液二氧化碳含量ctCO2(B)-静脉血: 32mmol/L；胱抑素(Cys-C)-静脉血: 0.81mg/L；钠离子(Na+)-静脉血: 139.1mmol/L；红细胞比容(Hct)-静脉血: 38.2%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.5；载脂蛋白B(apoB)-静脉血: 0.72g/L；阴离子间隙(AG)-静脉血: 7.6；平均血小板体积(MPV)-静脉血: 10.7fL；丙氨酸氨基转移酶(ALT)-静脉血: 8.1U/L；中性粒细胞百分比(Neut%)-静脉血: 0.707；低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.56mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 13.8U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.69mmolL；总胆固醇(TC)-静脉血: 2.82mmol/L；总胆红素(TBIL)-静脉血: 9.5umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 14U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；乳酸脱氢酶(LDH)-静脉血: 146.4U/L；单核细胞百分比(Mono%)-静脉血: 0.202；血小板分布宽度(PDW)-静脉血: 12.5%；α-L-岩藻糖苷酶(AFU)-静脉血: 22.8U/L；肌酐(Crea)-静脉血: 73.2umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；磷(P)-静脉血: 1.17mmol/L；氯离子(Cl-)-静脉血: 99.5mmol/L；尿素氮(BUN)-静脉血: 4.3mmol/L；血小板比容-静脉血: 11%；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；总胆汁酸(TBA)-静脉血: 3.7umol/L；甘油三酯(TG)-静脉血: 0.85mmol/L；间接胆红素(IBIL)-静脉血: 5.5umolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.7；直接胆红素(DBIL)-静脉血: 4u……\n- [全程D62] 检验组合: 细菌涂片3-咽拭子: 未发现念珠状菌\n- [全程D63] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径10mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约27cm/s。 胆囊餐后改变，胆囊内可见一强回声团，直径约9mm，后方伴声影。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约33×27×24mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 胆囊结石。 肝脏、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D64] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双上肺纹理增粗，走行尚自然，双上肺野可见小斑点、条索影，双上胸膜稍增厚，余双肺野内未见明确实质性病变。双侧肺门未见增大，纵隔未见增宽，心影大小形态未见明显异常。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 双上肺少许纤维增殖灶并双上胸膜稍增厚。\n- [全程D64] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌放疗结束，对比某次就诊时间片： 鼻咽腔未见明显狭窄，鼻咽各壁未见明显增厚，粘膜表面尚光滑，增强扫描明显强化。双侧咽隐窝变浅，双侧咽旁脂肪间隙稍狭窄。 双侧腭帆提肌、腭帆张肌、头长肌结构清晰。双侧咽后见小淋巴结，较大者短径约7mm。 双侧后鼻孔未见堵塞，口咽双侧壁未见受累增厚。 双侧翼腭窝、颞下窝未见异常。 蝶骨基底部、斜坡、双侧岩尖、双侧枕骨基底部骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽。双侧筛窦、蝶窦、上颌窦粘膜增厚，双侧乳突内见积液。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。蝶鞍形态未见异常，其内未见占位性病变。 双侧颈II区、右侧颈III、IV区见多发淋巴结，部分融合，较大者短径11mm，信号欠均匀，增强较明显不均匀强化。 双侧颌下腺、腮腺大小、形态未见异常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态未见异常，信号均匀，未见占位性病变。喉咽腔形态未见异常，未见占位性病变。；检查结论: 鼻咽癌放疗后改变，较前明显好转。 颅底骨质破坏。 双侧咽后、双侧颈部多发淋巴结，较前缩小。 鼻窦炎，乳突炎。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n- [全程D2] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉右耳听力下降，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，结合患者检查，认为患者鼻咽癌可能性大，指示完善相关检查后在决定下一步治疗方案，遵嘱执行。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D14] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉右耳听力下降，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，指示尽快完成放疗计划，遵嘱执行。\n- [全程D19] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉右耳听力下降，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，考虑患者放疗计划即将完成，指示可提前2天先予以化疗，指示今日予以DDP方案化疗第1程，做好水化、护胃、止呕等对症支持处理，密切观察化疗中副反应，遵嘱执行。\n- [全程D24] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉恶心，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，较前缩小，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，认为患者化疗顺利完成，指示继续放疗，密切观察放疗中副反应，遵嘱执行。\n- [全程D29] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，未诉特殊不适，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，较前缩小，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，指示继续放疗，密切观察放疗中副反应，遵嘱执行。\n- [全程D42] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉咽痛，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。BR、生化常规大致正常。[姓名已隐去]主诊医生信息已隐藏，考虑患者上次化疗已达3周，指示今日按[计划性表述已隐藏]以DDP方案化疗第二程，做好水化、护肝等对症支持处理，继续放疗，密切观察放化疗副反应，遵嘱执行。\n- [全程D47] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉咽痛，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，认为患者化疗顺利完成，指示继续放疗，密切观察放疗副反应，遵嘱执行。\n- [全程D52] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉咽痛，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，指示予以止痛、口腔粘膜保护对症处理，加强营养支持，继续放疗。\n- [全程D57] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，未诉明显特殊不适，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，指示继续放疗，遵嘱执行。\n- [全程D61] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，未诉明显特殊不适，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]医生信息已隐藏，考虑患者化疗即将到期，建议患者行第三程化疗，但患者拒绝，遂指示今日予以出院，于门诊继续放疗，遵嘱执行。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即行双侧颈部淋巴结清扫术以彻底清除颈部残留病灶\nB. 立即行鼻咽及颈部局部追加外照射放疗10-15Gy推量\nC. 立即行全身PET-CT检查评估颈部淋巴结活性及远处转移\nD. 立即行鼻咽内镜下活检评估原发灶病理完全缓解情况\nE. 立即启动含铂双药方案辅助化疗2-3个周期强化全身控制\nF. 予以表皮生长因子受体靶向药物单药维持治疗半年至一年\nG. 结束根治性治疗进入随访，放疗后3个月复查影像学评估疗效\nH. 立即行颈部残留淋巴结细针穿刺活检以指导后续局部治疗\nI. 立即启动PD-1单抗等免疫检查点抑制剂维持治疗1年\nJ. 予以抗炎及对症支持治疗，放疗后1个月复查鼻咽颈部MRI\nK. 立即采用原诱导化疗方案进行2至3个周期全身巩固化疗\nL. 立即行颈部残留淋巴结局部微波消融或放射性粒子植入术\n\n请仅输出一个选项字母（A-L）。","incremental_user_message":"【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D64] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双上肺纹理增粗，走行尚自然，双上肺野可见小斑点、条索影，双上胸膜稍增厚，余双肺野内未见明确实质性病变。双侧肺门未见增大，纵隔未见增宽，心影大小形态未见明显异常。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 双上肺少许纤维增殖灶并双上胸膜稍增厚。\n- [全程D64] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌放疗结束，对比某次就诊时间片： 鼻咽腔未见明显狭窄，鼻咽各壁未见明显增厚，粘膜表面尚光滑，增强扫描明显强化。双侧咽隐窝变浅，双侧咽旁脂肪间隙稍狭窄。 双侧腭帆提肌、腭帆张肌、头长肌结构清晰。双侧咽后见小淋巴结，较大者短径约7mm。 双侧后鼻孔未见堵塞，口咽双侧壁未见受累增厚。 双侧翼腭窝、颞下窝未见异常。 蝶骨基底部、斜坡、双侧岩尖、双侧枕骨基底部骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽。双侧筛窦、蝶窦、上颌窦粘膜增厚，双侧乳突内见积液。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。蝶鞍形态未见异常，其内未见占位性病变。 双侧颈II区、右侧颈III、IV区见多发淋巴结，部分融合，较大者短径11mm，信号欠均匀，增强较明显不均匀强化。 双侧颌下腺、腮腺大小、形态未见异常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态未见异常，信号均匀，未见占位性病变。喉咽腔形态未见异常，未见占位性病变。；检查结论: 鼻咽癌放疗后改变，较前明显好转。 颅底骨质破坏。 双侧咽后、双侧颈部多发淋巴结，较前缩小。 鼻窦炎，乳突炎。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即行双侧颈部淋巴结清扫术以彻底清除颈部残留病灶\nB. 立即行鼻咽及颈部局部追加外照射放疗10-15Gy推量\nC. 立即行全身PET-CT检查评估颈部淋巴结活性及远处转移\nD. 立即行鼻咽内镜下活检评估原发灶病理完全缓解情况\nE. 立即启动含铂双药方案辅助化疗2-3个周期强化全身控制\nF. 予以表皮生长因子受体靶向药物单药维持治疗半年至一年\nG. 结束根治性治疗进入随访，放疗后3个月复查影像学评估疗效\nH. 立即行颈部残留淋巴结细针穿刺活检以指导后续局部治疗\nI. 立即启动PD-1单抗等免疫检查点抑制剂维持治疗1年\nJ. 予以抗炎及对症支持治疗，放疗后1个月复查鼻咽颈部MRI\nK. 立即采用原诱导化疗方案进行2至3个周期全身巩固化疗\nL. 立即行颈部残留淋巴结局部微波消融或放射性粒子植入术\n\n请仅输出一个选项字母（A-L）。","stateless_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：咽旁间隙、斜坡、蝶骨基底部、岩尖。\n文本分期信息：N3，M0。\n综合TNM状态：T3N3M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D64] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双上肺纹理增粗，走行尚自然，双上肺野可见小斑点、条索影，双上胸膜稍增厚，余双肺野内未见明确实质性病变。双侧肺门未见增大，纵隔未见增宽，心影大小形态未见明显异常。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 双上肺少许纤维增殖灶并双上胸膜稍增厚。\n- [全程D64] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌放疗结束，对比某次就诊时间片： 鼻咽腔未见明显狭窄，鼻咽各壁未见明显增厚，粘膜表面尚光滑，增强扫描明显强化。双侧咽隐窝变浅，双侧咽旁脂肪间隙稍狭窄。 双侧腭帆提肌、腭帆张肌、头长肌结构清晰。双侧咽后见小淋巴结，较大者短径约7mm。 双侧后鼻孔未见堵塞，口咽双侧壁未见受累增厚。 双侧翼腭窝、颞下窝未见异常。 蝶骨基底部、斜坡、双侧岩尖、双侧枕骨基底部骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽。双侧筛窦、蝶窦、上颌窦粘膜增厚，双侧乳突内见积液。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。蝶鞍形态未见异常，其内未见占位性病变。 双侧颈II区、右侧颈III、IV区见多发淋巴结，部分融合，较大者短径11mm，信号欠均匀，增强较明显不均匀强化。 双侧颌下腺、腮腺大小、形态未见异常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态未见异常，信号均匀，未见占位性病变。喉咽腔形态未见异常，未见占位性病变。；检查结论: 鼻咽癌放疗后改变，较前明显好转。 颅底骨质破坏。 双侧咽后、双侧颈部多发淋巴结，较前缩小。 鼻窦炎，乳突炎。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即行双侧颈部淋巴结清扫术以彻底清除颈部残留病灶\nB. 立即行鼻咽及颈部局部追加外照射放疗10-15Gy推量\nC. 立即行全身PET-CT检查评估颈部淋巴结活性及远处转移\nD. 立即行鼻咽内镜下活检评估原发灶病理完全缓解情况\nE. 立即启动含铂双药方案辅助化疗2-3个周期强化全身控制\nF. 予以表皮生长因子受体靶向药物单药维持治疗半年至一年\nG. 结束根治性治疗进入随访，放疗后3个月复查影像学评估疗效\nH. 立即行颈部残留淋巴结细针穿刺活检以指导后续局部治疗\nI. 立即启动PD-1单抗等免疫检查点抑制剂维持治疗1年\nJ. 予以抗炎及对症支持治疗，放疗后1个月复查鼻咽颈部MRI\nK. 立即采用原诱导化疗方案进行2至3个周期全身巩固化疗\nL. 立即行颈部残留淋巴结局部微波消融或放射性粒子植入术\n\n请仅输出一个选项字母（A-L）。"}]}
diff --git a/supplementary/carepath25/episodes.jsonl b/supplementary/carepath25/episodes.jsonl
new file mode 100644
index 0000000000000000000000000000000000000000..d3a314b6798fc3b8e03d3046a47c47547b73c38f
--- /dev/null
+++ b/supplementary/carepath25/episodes.jsonl
@@ -0,0 +1,25 @@
+{"version":"npc_fullcarepath25_episode_v1_pathfix_20260506","episode_id":"episode-5739a21b532ed958ab3756d5","patient_id":"patient-5fa48522b2703f35ead0224b","pathology_sample_id":"sample-e4cdc6e57d3d2abcf1f2d4b6","mri_sample_id":"sample-696d19bff6d991b4bc744712","oracle_tnm_context":"【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、斜坡、口咽、蝶骨基底部、岩尖。\n文本分期信息：N2，Mx 左侧腋窝淋巴结可疑转移。\n综合TNM状态：T3N2Mx 左侧腋窝淋巴结可疑转移。","streaming_tnm_context_template":"【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。","ajcc_v9_gold":{"T":"T3","N":"N2","M":"Mx 左侧腋窝淋巴结可疑转移","overall_stage":null,"overall_stage_evaluable":false},"structure_invasion_19_gold":{"鼻咽":1,"腭帆提肌":1,"咽旁间隙":1,"头长肌":1,"翼内肌":1,"蝶窦":0,"鼻腔":0,"颈动脉鞘":0,"翼外肌":0,"筛窦":0,"上颌窦":0,"斜坡":1,"海绵窦":0,"口咽":1,"翼突基底部":0,"蝶骨基底部":1,"岩尖":1,"寰椎":0,"枢椎":0},"care_turns":[{"sample_id":"sample-c56105087904f0da386b7001","turn_id":"turn02","turn_type":"imaging_release_workup","gold_letter":"J","gold_action":"行颈部淋巴结穿刺活检或鼻咽镜活检以明确病理诊断，并完善全身分期检查（如胸腹部CT、骨扫描或PET-CT）。"},{"sample_id":"sample-9b76347b9a2749777a06cd80","turn_id":"turn04","turn_type":"initial_treatment_selection","gold_letter":"L","gold_action":"诱导化疗（顺铂+氟尿嘧啶方案）"},{"sample_id":"sample-ad9c851cda35b0e3c9061982","turn_id":"turn05","turn_type":"toxicity_or_support_decision","gold_letter":"A","gold_action":"办理出院，予以胸腺五肽皮下注射支持治疗，嘱每周复查血常规及生化，按期返院行第2程诱导化疗。"},{"sample_id":"sample-9acca1b0c829ebdd4e952950","turn_id":"turn06","turn_type":"toxicity_or_support_decision","gold_letter":"B","gold_action":"开始适形调强放射治疗（IMRT），并予以雾化吸入、鼻腔冲洗、皮肤及黏膜保护剂等放疗支持处理。"},{"sample_id":"sample-ba3079ee7b3ef01162117027","turn_id":"turn07","turn_type":"recurrence_or_salvage_decision","gold_letter":"C","gold_action":"暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，动态监测血常规，待中性粒细胞计数恢复后再行下一程化疗。"},{"sample_id":"sample-800192dfaf82bbe4edb2533a","turn_id":"turn08","turn_type":"response_assessment_decision","gold_letter":"A","gold_action":"完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动顺铂同期化放疗"}],"episode_scoring_rule":"pathology_correct AND MRI_T_correct AND all care_turns correct AND no unsafe action; structure invasion is auxiliary and excludes 鼻咽"}
+{"version":"npc_fullcarepath25_episode_v1_pathfix_20260506","episode_id":"episode-e3b491c22dad897d76cb34a0","patient_id":"patient-84fa3d6098d10a1d14b6b19e","pathology_sample_id":"sample-90417dbe5ad9052ef71764ff","mri_sample_id":"sample-8c7b00b765d9c70ed98b27dd","oracle_tnm_context":"【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、斜坡、海绵窦、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。","streaming_tnm_context_template":"【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。","ajcc_v9_gold":{"T":"T4","N":"N2","M":"M0","overall_stage":"III","overall_stage_evaluable":true},"structure_invasion_19_gold":{"鼻咽":1,"腭帆提肌":1,"咽旁间隙":1,"头长肌":0,"翼内肌":1,"蝶窦":0,"鼻腔":0,"颈动脉鞘":0,"翼外肌":0,"筛窦":0,"上颌窦":0,"斜坡":1,"海绵窦":1,"口咽":0,"翼突基底部":1,"蝶骨基底部":1,"岩尖":0,"寰椎":0,"枢椎":0},"care_turns":[{"sample_id":"sample-1a7cec18df1c66d68f69d55f","turn_id":"turn01","turn_type":"initial_workup_choice","gold_letter":"E","gold_action":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT，常规血液学、心电图与超声检查。"},{"sample_id":"sample-13d0893c195434e9115bcbbc","turn_id":"turn02","turn_type":"imaging_release_workup","gold_letter":"F","gold_action":"完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测。"},{"sample_id":"sample-474b60646fc04122e2c1c7ce","turn_id":"turn04","turn_type":"initial_treatment_selection","gold_letter":"H","gold_action":"顺铂+氟尿嘧啶（PF方案）诱导化疗"},{"sample_id":"sample-654cb1177e5cb9c5732eccb0","turn_id":"turn05","turn_type":"toxicity_or_support_decision","gold_letter":"I","gold_action":"继续当前化疗及对症支持治疗，执行动静脉置管常规护理，并常规监测血常规与生化指标。"},{"sample_id":"sample-b094635ac349a10618a48030","turn_id":"turn06","turn_type":"toxicity_or_support_decision","gold_letter":"J","gold_action":"予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，并监测24小时尿量，准备行下一程化疗。"},{"sample_id":"sample-237ee315803b648b5eb4c67f","turn_id":"turn07","turn_type":"response_assessment_decision","gold_letter":"K","gold_action":"评估PET/CT证实双肺结节无代谢活性（排除M1），维持局部晚期诊断；行静脉置管护理与通畅性维护，复查生化常规后，继续行第2程PF方案诱导化疗。"},{"sample_id":"sample-c9510f9db8861176764ecc37","turn_id":"turn08","turn_type":"recurrence_or_salvage_decision","gold_letter":"L","gold_action":"行电子鼻咽镜检查（不活检）进一步评估鼻咽局部疗效，复查血常规与生化常规，并予动静脉置管护理。"}],"episode_scoring_rule":"pathology_correct AND MRI_T_correct AND all care_turns correct AND no unsafe action; structure invasion is auxiliary and excludes 鼻咽"}
+{"version":"npc_fullcarepath25_episode_v1_pathfix_20260506","episode_id":"episode-0ea7d3f279d6b06d9596d94f","patient_id":"patient-34616c327ce5d69194ca7f4d","pathology_sample_id":"sample-7cd9bfaf95a31767ea22e7a9","mri_sample_id":"sample-1124bea189a1759a23ce2ef2","oracle_tnm_context":"【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。","streaming_tnm_context_template":"【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。","ajcc_v9_gold":{"T":"T3","N":"N1","M":"M0","overall_stage":"II","overall_stage_evaluable":true},"structure_invasion_19_gold":{"鼻咽":1,"腭帆提肌":0,"咽旁间隙":0,"头长肌":0,"翼内肌":0,"蝶窦":0,"鼻腔":0,"颈动脉鞘":0,"翼外肌":0,"筛窦":0,"上颌窦":0,"斜坡":0,"海绵窦":0,"口咽":0,"翼突基底部":1,"蝶骨基底部":1,"岩尖":0,"寰椎":0,"枢椎":0},"care_turns":[{"sample_id":"sample-eb32294d1506d6b48368496f","turn_id":"turn01","turn_type":"initial_workup_choice","gold_letter":"A","gold_action":"完善鼻咽镜检查及活检，检测EBV DNA定量、常规血液学指标，并进行胸部DR与腹盆腔彩超检查。"},{"sample_id":"sample-f19200235c8a99467249ed0c","turn_id":"turn02","turn_type":"imaging_release_workup","gold_letter":"B","gold_action":"评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查"},{"sample_id":"sample-2288420a623ad83bf0b0a558","turn_id":"turn04","turn_type":"initial_treatment_selection","gold_letter":"D","gold_action":"含铂方案诱导化疗序贯根治性放化疗，或根治性放疗联合含铂方案同步化疗"},{"sample_id":"sample-258f93513eac99791d84464c","turn_id":"turn05","turn_type":"toxicity_or_support_decision","gold_letter":"E","gold_action":"继续当前放化疗方案，定期复查血常规及生化指标。"},{"sample_id":"sample-5a0d01adf33246131a9f67e1","turn_id":"turn06","turn_type":"toxicity_or_support_decision","gold_letter":"F","gold_action":"继续按计划完成根治性放疗，并维持当前口腔含漱等常规对症支持治疗。"}],"episode_scoring_rule":"pathology_correct AND MRI_T_correct AND all care_turns correct AND no unsafe action; structure invasion is auxiliary and excludes 鼻咽"}
+{"version":"npc_fullcarepath25_episode_v1_pathfix_20260506","episode_id":"episode-c391d6ca07f458f6a2c81b6c","patient_id":"patient-9bf5c8c03860cdf61108611d","pathology_sample_id":"sample-77b632ac2f14b07cede03c5d","mri_sample_id":"sample-58b6ed030d470b20fbd59d48","oracle_tnm_context":"【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：腭帆提肌。\n文本分期信息：N2，M0。\n综合TNM状态：T1N2M0。\n综合分期：II。","streaming_tnm_context_template":"【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。","ajcc_v9_gold":{"T":"T1","N":"N2","M":"M0","overall_stage":"II","overall_stage_evaluable":true},"structure_invasion_19_gold":{"鼻咽":1,"腭帆提肌":1,"咽旁间隙":0,"头长肌":0,"翼内肌":0,"蝶窦":0,"鼻腔":0,"颈动脉鞘":0,"翼外肌":0,"筛窦":0,"上颌窦":0,"斜坡":0,"海绵窦":0,"口咽":0,"翼突基底部":0,"蝶骨基底部":0,"岩尖":0,"寰椎":0,"枢椎":0},"care_turns":[{"sample_id":"sample-a4894f941ebb70f32d9155cc","turn_id":"turn01","turn_type":"initial_workup_choice","gold_letter":"G","gold_action":"电子鼻咽镜检查及活检，鼻咽及颈部增强MRI，胸部X线、腹部彩超、全身骨显像，以及EBV抗体检测。"},{"sample_id":"sample-487e8333de7d37de56947d09","turn_id":"turn02","turn_type":"imaging_release_workup","gold_letter":"H","gold_action":"完善电子鼻咽镜检查并取活检明确病理诊断。"},{"sample_id":"sample-7ff1cd1ea3ebf1a9891b521d","turn_id":"turn05","turn_type":"toxicity_or_support_decision","gold_letter":"K","gold_action":"按原剂量行第二程GP（吉西他滨+顺铂）诱导化疗，并辅以常规止吐、护胃及水化利尿等支持治疗。"},{"sample_id":"sample-9fc5959f48286f0a038d3acb","turn_id":"turn07","turn_type":"response_assessment_decision","gold_letter":"A","gold_action":"完善鼻咽及颈部MRI评估疗效；取消同期顺铂化疗，予以纠正贫血并单纯根治性调强放疗（或联合靶向治疗）。"},{"sample_id":"sample-340a8b44018e54c31bcf1d9c","turn_id":"turn08","turn_type":"response_assessment_decision","gold_letter":"B","gold_action":"判定为放疗后改变或临床完全缓解，进入定期随访观察"}],"episode_scoring_rule":"pathology_correct AND MRI_T_correct AND all care_turns correct AND no unsafe action; structure invasion is auxiliary and excludes 鼻咽"}
+{"version":"npc_fullcarepath25_episode_v1_pathfix_20260506","episode_id":"episode-84ee92caca381be71893520f","patient_id":"patient-5ee5dba6116030961a7a97b5","pathology_sample_id":"sample-49e66b1ba0221a39c00aa767","mri_sample_id":"sample-1207ed9082e2263a1d3782e0","oracle_tnm_context":"【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。","streaming_tnm_context_template":"【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。","ajcc_v9_gold":{"T":"T3","N":"N2","M":"M0","overall_stage":"II","overall_stage_evaluable":true},"structure_invasion_19_gold":{"鼻咽":1,"腭帆提肌":1,"咽旁间隙":1,"头长肌":0,"翼内肌":0,"蝶窦":0,"鼻腔":0,"颈动脉鞘":0,"翼外肌":0,"筛窦":0,"上颌窦":0,"斜坡":0,"海绵窦":0,"口咽":0,"翼突基底部":1,"蝶骨基底部":1,"岩尖":0,"寰椎":0,"枢椎":0},"care_turns":[{"sample_id":"sample-de1b18b9f870f76853282d28","turn_id":"turn01","turn_type":"initial_workup_choice","gold_letter":"K","gold_action":"鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查及活检、PET/CT全身显像、EB病毒DNA定量及常规血液生化检查"},{"sample_id":"sample-2c772b6972f0c7fdbd562b73","turn_id":"turn02","turn_type":"imaging_release_workup","gold_letter":"L","gold_action":"在尚未完成病理确诊和EB病毒DNA定量检测的前提下，下一步应行电子鼻咽镜检查及活检明确病理诊断，并补充EB病毒DNA荧光定量PCR检测"},{"sample_id":"sample-8976031a638416cb5f037a59","turn_id":"turn04","turn_type":"initial_treatment_selection","gold_letter":"A","gold_action":"行吉西他滨+顺铂方案诱导化疗联合PD-1抑制剂"},{"sample_id":"sample-5d943566dde88ca9f3640bc0","turn_id":"turn05","turn_type":"toxicity_or_support_decision","gold_letter":"C","gold_action":"办理出院，嘱每周复查血常规及肝肾功能，2周后返院继续下一阶段治疗。"},{"sample_id":"sample-90c3b83f1d4c9db69ef01572","turn_id":"turn06","turn_type":"toxicity_or_support_decision","gold_letter":"K","gold_action":"继续同期放化疗，予以甲氧氯普胺口服止吐，暂不予静脉营养及免疫调节支持。"},{"sample_id":"sample-d1b602a57ed6c599e7f441cc","turn_id":"turn07","turn_type":"response_assessment_decision","gold_letter":"E","gold_action":"评估为诱导化疗部分缓解（PR），完善放疗前常规血液学检查，启动根治性调强放射治疗（IMRT）及放疗相关支持治疗。"},{"sample_id":"sample-c2aa48d510cb846f4ee51384","turn_id":"turn08","turn_type":"response_assessment_decision","gold_letter":"F","gold_action":"行电子鼻咽镜检查（不活检）评估局部情况，安排出院并予以镇痛、黏膜保护及雾化等对症药物。"}],"episode_scoring_rule":"pathology_correct AND MRI_T_correct AND all care_turns correct AND no unsafe action; structure invasion is auxiliary and excludes 鼻咽"}
+{"version":"npc_fullcarepath25_episode_v1_pathfix_20260506","episode_id":"episode-7187823cea44ad86a069561b","patient_id":"patient-f402aced5926698da3194c37","pathology_sample_id":"sample-c9e5bf8aab19632fb9105469","mri_sample_id":"sample-f8a46b6b13ef0358c5d560f0","oracle_tnm_context":"【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。","streaming_tnm_context_template":"【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。","ajcc_v9_gold":{"T":"T3","N":"N2","M":"M0","overall_stage":"II","overall_stage_evaluable":true},"structure_invasion_19_gold":{"鼻咽":1,"腭帆提肌":1,"咽旁间隙":0,"头长肌":1,"翼内肌":0,"蝶窦":0,"鼻腔":0,"颈动脉鞘":0,"翼外肌":0,"筛窦":0,"上颌窦":0,"斜坡":1,"海绵窦":0,"口咽":0,"翼突基底部":1,"蝶骨基底部":1,"岩尖":1,"寰椎":0,"枢椎":0},"care_turns":[{"sample_id":"sample-6a54e1ca8d841063a11b801b","turn_id":"turn01","turn_type":"initial_workup_choice","gold_letter":"G","gold_action":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT显像，常规血液学、心电图与心脏彩超检查。"},{"sample_id":"sample-1d99d3a2f71afa9bcb3f941a","turn_id":"turn02","turn_type":"imaging_release_workup","gold_letter":"H","gold_action":"行鼻咽内镜组织活检，完善鼻咽及颈部MRI平扫+增强，查乙肝病毒DNA定量"},{"sample_id":"sample-9fa3bde2f5d0ac4e910cb3cb","turn_id":"turn05","turn_type":"toxicity_or_support_decision","gold_letter":"K","gold_action":"按原剂量执行第2程洛铂+5-FU诱导化疗，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗"},{"sample_id":"sample-cc3b58d3bf4229805e8c7b84","turn_id":"turn06","turn_type":"toxicity_or_support_decision","gold_letter":"D","gold_action":"暂不予特殊药物支持治疗，仅常规监测血常规、生化常规"},{"sample_id":"sample-80438584d0b66a199c599a7d","turn_id":"turn07","turn_type":"response_assessment_decision","gold_letter":"A","gold_action":"疗效评估为部分缓解（PR），启动靶向治疗（西妥昔单抗）联合同期放化疗。"},{"sample_id":"sample-8b39359cc6c7b630fd005591","turn_id":"turn08","turn_type":"response_assessment_decision","gold_letter":"B","gold_action":"确认腹部彩超无转移，继续门诊放疗，左肾结石暂予观察，并予乳果糖口服液。"}],"episode_scoring_rule":"pathology_correct AND MRI_T_correct AND all care_turns correct AND no unsafe action; structure invasion is auxiliary and excludes 鼻咽"}
+{"version":"npc_fullcarepath25_episode_v1_pathfix_20260506","episode_id":"episode-78a3e906c0aa20f147f510d1","patient_id":"patient-51e6f99c527367bbd97aebd8","pathology_sample_id":"sample-25054b21769a83c4cc1ef883","mri_sample_id":"sample-c02b01cecfcf0b5cbf78aa88","oracle_tnm_context":"【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：鼻腔。\n文本分期信息：N0，M0。\n综合TNM状态：T1N0M0。\n综合分期：IA。","streaming_tnm_context_template":"【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。","ajcc_v9_gold":{"T":"T1","N":"N0","M":"M0","overall_stage":"IA","overall_stage_evaluable":true},"structure_invasion_19_gold":{"鼻咽":1,"腭帆提肌":0,"咽旁间隙":0,"头长肌":0,"翼内肌":0,"蝶窦":0,"鼻腔":1,"颈动脉鞘":0,"翼外肌":0,"筛窦":0,"上颌窦":0,"斜坡":0,"海绵窦":0,"口咽":0,"翼突基底部":0,"蝶骨基底部":0,"岩尖":0,"寰椎":0,"枢椎":0},"care_turns":[{"sample_id":"sample-9e8ddeeab49a15f0eb3930d7","turn_id":"turn01","turn_type":"initial_workup_choice","gold_letter":"C","gold_action":"完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像，并进行病理会诊或鼻咽活检及心电图等基线检查。"},{"sample_id":"sample-78b27b455a910a93bd013384","turn_id":"turn02","turn_type":"imaging_release_workup","gold_letter":"D","gold_action":"明确鼻咽癌临床分期为 cT1N0M0，IA期（肿瘤累及鼻咽及左侧后鼻孔，无颈部淋巴结转移）"},{"sample_id":"sample-db8d6d3eabcfcb123b0c3cb1","turn_id":"turn05","turn_type":"toxicity_or_support_decision","gold_letter":"F","gold_action":"暂停顺铂化疗，继续单纯放疗，给予静脉保肝治疗，待肝功能恢复后补足化疗周期。"},{"sample_id":"sample-1d71f20ed555c71c5a4de4ee","turn_id":"turn06","turn_type":"toxicity_or_support_decision","gold_letter":"H","gold_action":"给予联苯双酯等保肝降酶药物，辅以静脉营养支持，并密切复查肝功能。"},{"sample_id":"sample-5eba0030ab5d024288a0d69d","turn_id":"turn07","turn_type":"response_assessment_decision","gold_letter":"I","gold_action":"继续根治性放疗，给予雾化吸入氨溴索与地塞米松，并局部外用三乙醇胺乳膏。"},{"sample_id":"sample-24c04c80074ea3aab5465600","turn_id":"turn08","turn_type":"response_assessment_decision","gold_letter":"J","gold_action":"继续根治性放疗，给予雾化吸入（氨溴索、地塞米松）及局部外用药（三乙醇胺乳膏）处理急性放射性黏膜炎和皮炎。"}],"episode_scoring_rule":"pathology_correct AND MRI_T_correct AND all care_turns correct AND no unsafe action; structure invasion is auxiliary and excludes 鼻咽"}
+{"version":"npc_fullcarepath25_episode_v1_pathfix_20260506","episode_id":"episode-f57f5515f382438292f5b3bc","patient_id":"patient-867f2373fc1b04e0b8b80452","pathology_sample_id":"sample-c3fe2d73681610beec27dd74","mri_sample_id":"sample-60fd3a65c7b9461b49e2ad79","oracle_tnm_context":"【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、鼻腔、翼外肌、斜坡、海绵窦、翼突基底部等。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。","streaming_tnm_context_template":"【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。","ajcc_v9_gold":{"T":"T4","N":"N2","M":"M0","overall_stage":"III","overall_stage_evaluable":true},"structure_invasion_19_gold":{"鼻咽":1,"腭帆提肌":1,"咽旁间隙":1,"头长肌":1,"翼内肌":1,"蝶窦":1,"鼻腔":1,"颈动脉鞘":0,"翼外肌":1,"筛窦":0,"上颌窦":0,"斜坡":1,"海绵窦":1,"口咽":0,"翼突基底部":1,"蝶骨基底部":1,"岩尖":1,"寰椎":0,"枢椎":0},"care_turns":[{"sample_id":"sample-6bc929b6a549b509a4ffbecf","turn_id":"turn01","turn_type":"initial_workup_choice","gold_letter":"K","gold_action":"行电子鼻咽镜检查及组织活检以明确病理诊断，同时完善鼻咽及颈部MRI平扫加增强进行局部区域分期，并进行常规血液学检查。"},{"sample_id":"sample-31a839b9f99ab6bf0a218575","turn_id":"turn02","turn_type":"imaging_release_workup","gold_letter":"L","gold_action":"完善全身远处转移排查（如PET-CT或胸腹部CT联合骨扫描）及血浆EBV-DNA检测，并行超声引导下中心静脉穿刺置管及X线定位，为全身化疗做准备。"},{"sample_id":"sample-9833293530ca96a9a65dbbb8","turn_id":"turn04","turn_type":"initial_treatment_selection","gold_letter":"B","gold_action":"诱导化疗（洛铂+氟尿嘧啶）序贯同期放化疗"},{"sample_id":"sample-5d0eff95cd33597017422fc5","turn_id":"turn05","turn_type":"toxicity_or_support_decision","gold_letter":"C","gold_action":"予以止呕、护胃等对症支持，办理出院；嘱院外每周复查血常规及肝肾功能，定期进行PICC导管维护，按期返院行下一程治疗。"},{"sample_id":"sample-be610c2d167fae3585440ece","turn_id":"turn06","turn_type":"toxicity_or_support_decision","gold_letter":"D","gold_action":"按计划开展第二周期洛铂+5-FU诱导化疗，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗"},{"sample_id":"sample-08c11518d363599b5511b9c9","turn_id":"turn07","turn_type":"recurrence_or_salvage_decision","gold_letter":"B","gold_action":"启动根治性放疗及同步化疗，每周复查血常规，暂不予以重组人白介素-11及粒细胞刺激因子。"},{"sample_id":"sample-070df43e0c39a4c5f77b459e","turn_id":"turn08","turn_type":"recurrence_or_salvage_decision","gold_letter":"D","gold_action":"立即开展根治性放疗及洛铂同步化疗，期间定期监测血常规，暂不予造血生长因子干预。"}],"episode_scoring_rule":"pathology_correct AND MRI_T_correct AND all care_turns correct AND no unsafe action; structure invasion is auxiliary and excludes 鼻咽"}
+{"version":"npc_fullcarepath25_episode_v1_pathfix_20260506","episode_id":"episode-33e7f203c7713f19fed30ae8","patient_id":"patient-5731cc38ced94b2ee39c442a","pathology_sample_id":"sample-8711fd42e78381df61ea6558","mri_sample_id":"sample-deb29a86d49bb3474ef49a4f","oracle_tnm_context":"【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、蝶窦、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。","streaming_tnm_context_template":"【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。","ajcc_v9_gold":{"T":"T4","N":"N2","M":"M0","overall_stage":"III","overall_stage_evaluable":true},"structure_invasion_19_gold":{"鼻咽":1,"腭帆提肌":1,"咽旁间隙":1,"头长肌":0,"翼内肌":1,"蝶窦":1,"鼻腔":0,"颈动脉鞘":0,"翼外肌":0,"筛窦":0,"上颌窦":0,"斜坡":1,"海绵窦":1,"口咽":0,"翼突基底部":1,"蝶骨基底部":1,"岩尖":1,"寰椎":0,"枢椎":0},"care_turns":[{"sample_id":"sample-ce0b8b89ec8b1d9a2405353d","turn_id":"turn01","turn_type":"initial_workup_choice","gold_letter":"G","gold_action":"完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描（或PET-CT），EBV-DNA及抗体检测，常规血液学检查。"},{"sample_id":"sample-e3ed1270448c84eefbda9f61","turn_id":"turn02","turn_type":"imaging_release_workup","gold_letter":"H","gold_action":"完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充血浆EBV DNA定量检测"},{"sample_id":"sample-cd1385d4e13dda199ba81658","turn_id":"turn05","turn_type":"toxicity_or_support_decision","gold_letter":"K","gold_action":"办理出院，开具口服保肝药物（如多烯磷脂酰胆碱等），嘱每周复查血常规和生化，按期返院行下一程诱导化疗。"},{"sample_id":"sample-ad5a1060b6801c87debff9d0","turn_id":"turn06","turn_type":"toxicity_or_support_decision","gold_letter":"L","gold_action":"开具口服升白细胞药物（如咖啡酸片）、保肝药物（如复方甘草酸苷）及抑酸护胃、促动力药物进行对症支持。"},{"sample_id":"sample-b10ed2b10a17f1626353b252","turn_id":"turn07","turn_type":"recurrence_or_salvage_decision","gold_letter":"A","gold_action":"结束诱导化疗，序贯开展根治性放射治疗。"},{"sample_id":"sample-95ccde5ff1e164e8d7edc6f5","turn_id":"turn08","turn_type":"recurrence_or_salvage_decision","gold_letter":"B","gold_action":"行鼻咽及颈部MRI增强扫描评估近期疗效，继续定期随访"}],"episode_scoring_rule":"pathology_correct AND MRI_T_correct AND all care_turns correct AND no unsafe action; structure invasion is auxiliary and excludes 鼻咽"}
+{"version":"npc_fullcarepath25_episode_v1_pathfix_20260506","episode_id":"episode-ac4f83ab1feabed32e2bbeb9","patient_id":"patient-9149023ec8599161ec3e5cfd","pathology_sample_id":"sample-1bb43e39142ea1753e756ceb","mri_sample_id":"sample-d181677097153837949be4d8","oracle_tnm_context":"【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。","streaming_tnm_context_template":"【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。","ajcc_v9_gold":{"T":"T4","N":"N2","M":"M0","overall_stage":"III","overall_stage_evaluable":true},"structure_invasion_19_gold":{"鼻咽":1,"腭帆提肌":1,"咽旁间隙":0,"头长肌":1,"翼内肌":0,"蝶窦":0,"鼻腔":0,"颈动脉鞘":0,"翼外肌":0,"筛窦":0,"上颌窦":0,"斜坡":1,"海绵窦":1,"口咽":0,"翼突基底部":1,"蝶骨基底部":1,"岩尖":1,"寰椎":0,"枢椎":0},"care_turns":[{"sample_id":"sample-9d5015177e675883e0c4ec7b","turn_id":"turn01","turn_type":"initial_workup_choice","gold_letter":"C","gold_action":"行电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部及上腹部CT平扫+增强，全身骨显像。"},{"sample_id":"sample-ebeecf0887be3e478e385ec0","turn_id":"turn02","turn_type":"imaging_release_workup","gold_letter":"D","gold_action":"行鼻咽镜下活检明确病理，并完善胸腹部及骨骼等远处转移排查"},{"sample_id":"sample-220f428c46f369e75a66e1ab","turn_id":"turn04","turn_type":"initial_treatment_selection","gold_letter":"F","gold_action":"诱导化疗序贯同步放化疗"},{"sample_id":"sample-ed1b449691d94cea18e7b28b","turn_id":"turn05","turn_type":"toxicity_or_support_decision","gold_letter":"K","gold_action":"安排鼻咽及颈部MRI平扫+增强、头颅MRI平扫+增强，暂缓胸部X线及腹部彩超检查，作为当前时点针对左侧颞叶新发病灶的重点影像随访；常规胸片、腹部彩超、EBV-DNA及甲功等全身随访可在下一随访窗口期再行安排。"},{"sample_id":"sample-2fc2bca32acf3eb67f65396b","turn_id":"turn07","turn_type":"recurrence_or_salvage_decision","gold_letter":"I","gold_action":"继续行第3周期GP方案第8天化疗（吉西他滨），辅以肠内营养支持，并安排出院。"}],"episode_scoring_rule":"pathology_correct AND MRI_T_correct AND all care_turns correct AND no unsafe action; structure invasion is auxiliary and excludes 鼻咽"}
+{"version":"npc_fullcarepath25_episode_v1_pathfix_20260506","episode_id":"episode-7bbcafea1a05c9887d6c0a33","patient_id":"patient-4e3ac84b9e1451cea981f98e","pathology_sample_id":"sample-b47beb4c0df45b5d61a9144b","mri_sample_id":"sample-2e9a500ab730a8b812a30781","oracle_tnm_context":"【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、头长肌。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。","streaming_tnm_context_template":"【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。","ajcc_v9_gold":{"T":"T2","N":"N1","M":"M0","overall_stage":"IB","overall_stage_evaluable":true},"structure_invasion_19_gold":{"鼻咽":1,"腭帆提肌":1,"咽旁间隙":0,"头长肌":1,"翼内肌":0,"蝶窦":0,"鼻腔":0,"颈动脉鞘":0,"翼外肌":0,"筛窦":0,"上颌窦":0,"斜坡":0,"海绵窦":0,"口咽":0,"翼突基底部":0,"蝶骨基底部":0,"岩尖":0,"寰椎":0,"枢椎":0},"care_turns":[{"sample_id":"sample-655ad2033595c09c6c4ce571","turn_id":"turn01","turn_type":"initial_workup_choice","gold_letter":"B","gold_action":"完善血常规、肝肾功能、凝血功能，并安排鼻咽部活检。"},{"sample_id":"sample-49bfe4582a9d9a75f21d4be4","turn_id":"turn02","turn_type":"imaging_release_workup","gold_letter":"K","gold_action":"临床分期为 cT2N1M0（AJCC v9 IB期），头长肌受侵定为T2，双侧咽后及单侧颈部淋巴结转移定为N1，骨显像异常考虑良性暂定M0。"},{"sample_id":"sample-04c8674f03cec4de991fcf32","turn_id":"turn04","turn_type":"initial_treatment_selection","gold_letter":"A","gold_action":"单纯根治性放射治疗或根治性放化疗"},{"sample_id":"sample-453547f6b6c780c6834cd926","turn_id":"turn05","turn_type":"toxicity_or_support_decision","gold_letter":"B","gold_action":"继续当前调强放疗，定期监测血常规及肝肾功能，暂不予特殊药物干预。"},{"sample_id":"sample-192932039e740110f5fb9ae6","turn_id":"turn06","turn_type":"toxicity_or_support_decision","gold_letter":"C","gold_action":"继续按计划执行调强放疗，定期复查血常规及肝肾功能"}],"episode_scoring_rule":"pathology_correct AND MRI_T_correct AND all care_turns correct AND no unsafe action; structure invasion is auxiliary and excludes 鼻咽"}
+{"version":"npc_fullcarepath25_episode_v1_pathfix_20260506","episode_id":"episode-498f55fb43908ee6a0b3eb4c","patient_id":"patient-e5fcd31b4b8b85194b146991","pathology_sample_id":"sample-c7cc381ceb35f31cc42432f6","mri_sample_id":"sample-205f6b3043c596a4d6434ed6","oracle_tnm_context":"【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。","streaming_tnm_context_template":"【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。","ajcc_v9_gold":{"T":"T3","N":"N2","M":"M0","overall_stage":"II","overall_stage_evaluable":true},"structure_invasion_19_gold":{"鼻咽":1,"腭帆提肌":1,"咽旁间隙":1,"头长肌":0,"翼内肌":0,"蝶窦":0,"鼻腔":0,"颈动脉鞘":0,"翼外肌":0,"筛窦":0,"上颌窦":0,"斜坡":0,"海绵窦":0,"口咽":0,"翼突基底部":1,"蝶骨基底部":1,"岩尖":0,"寰椎":0,"枢椎":0},"care_turns":[{"sample_id":"sample-7fddfe1b2a584f133c3b89f7","turn_id":"turn01","turn_type":"initial_workup_choice","gold_letter":"B","gold_action":"完善鼻咽及颈部MRI平扫+增强、胸腹部CT、全身骨扫描、电子鼻咽镜检查及活检。"},{"sample_id":"sample-bc7a956bb6d6b0bc48992292","turn_id":"turn02","turn_type":"imaging_release_workup","gold_letter":"E","gold_action":"安排电子鼻咽镜及鼻咽肿物活检，并完善胸腹部CT及骨扫描（或PET-CT）"},{"sample_id":"sample-49519c2b08d621c382f2a093","turn_id":"turn04","turn_type":"initial_treatment_selection","gold_letter":"G","gold_action":"诱导化疗（顺铂+氟尿嘧啶，PF方案）"},{"sample_id":"sample-ba0bc8aff143756f9ee645b5","turn_id":"turn05","turn_type":"toxicity_or_support_decision","gold_letter":"H","gold_action":"办理出院，予以帕洛诺司琼等止吐处理，嘱出院后每周复查血常规及肝肾功能，按计划返院行下一程化疗。"},{"sample_id":"sample-f5ab8fe6b2ae40df32eed56b","turn_id":"turn06","turn_type":"toxicity_or_support_decision","gold_letter":"I","gold_action":"行PICC导管常规维护（更换敷料与正压接头），并完善间接鼻咽镜检查准备下一周期治疗。"},{"sample_id":"sample-dd7067359645093ab08b6c16","turn_id":"turn07","turn_type":"recurrence_or_salvage_decision","gold_letter":"J","gold_action":"出院休养并对症处理化疗副反应，定期复查血常规及肝肾功能，按计划返院行根治性放射治疗。"},{"sample_id":"sample-9cd68a6b9c75f1d90e6a9dbe","turn_id":"turn08","turn_type":"response_assessment_decision","gold_letter":"K","gold_action":"评估为放化疗后临床缓解，按计划结疗出院，嘱鼻腔冲洗、张口及颈部功能锻炼，定期随访复查。"}],"episode_scoring_rule":"pathology_correct AND MRI_T_correct AND all care_turns correct AND no unsafe action; structure invasion is auxiliary and excludes 鼻咽"}
+{"version":"npc_fullcarepath25_episode_v1_pathfix_20260506","episode_id":"episode-ccfe3abbeeb4d74995c6f6d4","patient_id":"patient-d6812a1c46ed21fda9ebb9f8","pathology_sample_id":"sample-e58f6bf18eeb02a852a96c41","mri_sample_id":"sample-c413de747f5d59b2cbc2317c","oracle_tnm_context":"【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。","streaming_tnm_context_template":"【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。","ajcc_v9_gold":{"T":"T3","N":"N1","M":"M0","overall_stage":"II","overall_stage_evaluable":true},"structure_invasion_19_gold":{"鼻咽":1,"腭帆提肌":1,"咽旁间隙":1,"头长肌":1,"翼内肌":1,"蝶窦":0,"鼻腔":0,"颈动脉鞘":0,"翼外肌":0,"筛窦":0,"上颌窦":0,"斜坡":0,"海绵窦":0,"口咽":0,"翼突基底部":1,"蝶骨基底部":1,"岩尖":0,"寰椎":0,"枢椎":0},"care_turns":[{"sample_id":"sample-deb84ffb5f7c209f58040b0d","turn_id":"turn01","turn_type":"initial_workup_choice","gold_letter":"D","gold_action":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部X线，腹部彩超及心电图"},{"sample_id":"sample-76e183c8ae4202bcecbc9d87","turn_id":"turn02","turn_type":"imaging_release_workup","gold_letter":"E","gold_action":"行鼻咽肿物活检明确病理诊断，并安排甲状腺超声检查。"},{"sample_id":"sample-bf94c856279752df44d2b5a5","turn_id":"turn05","turn_type":"toxicity_or_support_decision","gold_letter":"H","gold_action":"停止静脉输液，予以口服氯化钾缓释片维持补钾，行PICC导管常规护理，安排出院休养。"},{"sample_id":"sample-9549c3c98f10ace802cbb08b","turn_id":"turn06","turn_type":"toxicity_or_support_decision","gold_letter":"I","gold_action":"继续顺铂单药化疗，并给予地塞米松、甲氧氯普胺、奥美拉唑止吐，辅以静脉水化及补钾支持治疗。"},{"sample_id":"sample-5acaafa7f13a3c4be08160aa","turn_id":"turn07","turn_type":"response_assessment_decision","gold_letter":"J","gold_action":"疗效评估为放化疗有效，针对进食差及低钾血症予以静脉营养支持及补钾，继续根治性放疗并按期行第三程同期化疗。"},{"sample_id":"sample-47e9b2e315a805773d669325","turn_id":"turn08","turn_type":"response_assessment_decision","gold_letter":"K","gold_action":"疗效评估为部分缓解（PR），继续完成根治性放疗及既定化疗计划，并加强静脉营养支持与补钾等对症处理。"}],"episode_scoring_rule":"pathology_correct AND MRI_T_correct AND all care_turns correct AND no unsafe action; structure invasion is auxiliary and excludes 鼻咽"}
+{"version":"npc_fullcarepath25_episode_v1_pathfix_20260506","episode_id":"episode-86feccd4bfa02261d135c126","patient_id":"patient-eecadcdf172a1efe8947b052","pathology_sample_id":"sample-5937c5e9598ae837a9c05589","mri_sample_id":"sample-873d91c7abbe2fa373339449","oracle_tnm_context":"【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N1，M0。\n综合TNM状态：T4N1M0。\n综合分期：III。","streaming_tnm_context_template":"【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。","ajcc_v9_gold":{"T":"T4","N":"N1","M":"M0","overall_stage":"III","overall_stage_evaluable":true},"structure_invasion_19_gold":{"鼻咽":1,"腭帆提肌":1,"咽旁间隙":0,"头长肌":1,"翼内肌":0,"蝶窦":0,"鼻腔":0,"颈动脉鞘":0,"翼外肌":0,"筛窦":0,"上颌窦":0,"斜坡":1,"海绵窦":0,"口咽":0,"翼突基底部":1,"蝶骨基底部":1,"岩尖":1,"寰椎":0,"枢椎":0},"care_turns":[{"sample_id":"sample-7a40e0f2bd95183560f7b041","turn_id":"turn01","turn_type":"initial_workup_choice","gold_letter":"H","gold_action":"行鼻咽镜下活检明确病理，并抽血查血常规、生化、EBV-DNA等基线指标。"},{"sample_id":"sample-fd63f0707132f4eb9174ab3e","turn_id":"turn02","turn_type":"imaging_release_workup","gold_letter":"I","gold_action":"明确临床分期为T4N1M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。"},{"sample_id":"sample-1a0c7a960fe6a9b60533da3d","turn_id":"turn05","turn_type":"toxicity_or_support_decision","gold_letter":"L","gold_action":"继续本周期化疗，给予止吐、护肝及静脉营养等支持治疗，并完善脑垂体激素五项检查。"},{"sample_id":"sample-efbe1e2a6ec0abf3be38883f","turn_id":"turn07","turn_type":"response_assessment_decision","gold_letter":"B","gold_action":"评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行根治性同期放化疗。"},{"sample_id":"sample-a1bcb1dd845b682149871b63","turn_id":"turn08","turn_type":"response_assessment_decision","gold_letter":"C","gold_action":"完善EB病毒DNA定量及EBV抗体（VCA-IgA、EA-IgA）检测，继续定期随访观察。"}],"episode_scoring_rule":"pathology_correct AND MRI_T_correct AND all care_turns correct AND no unsafe action; structure invasion is auxiliary and excludes 鼻咽"}
+{"version":"npc_fullcarepath25_episode_v1_pathfix_20260506","episode_id":"episode-45cfeb8667f4a4f88ede40e7","patient_id":"patient-290a042206ccfe67e72f9a19","pathology_sample_id":"sample-0b87b72851fcd4d2ad2b9250","mri_sample_id":"sample-512e0976e07cf5bdef790b77","oracle_tnm_context":"【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。","streaming_tnm_context_template":"【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。","ajcc_v9_gold":{"T":"T3","N":"N2","M":"M0","overall_stage":"II","overall_stage_evaluable":true},"structure_invasion_19_gold":{"鼻咽":1,"腭帆提肌":1,"咽旁间隙":0,"头长肌":1,"翼内肌":0,"蝶窦":0,"鼻腔":0,"颈动脉鞘":0,"翼外肌":0,"筛窦":0,"上颌窦":0,"斜坡":1,"海绵窦":0,"口咽":0,"翼突基底部":1,"蝶骨基底部":1,"岩尖":1,"寰椎":0,"枢椎":0},"care_turns":[{"sample_id":"sample-32fca5d8e1da4de5e54c5c0b","turn_id":"turn01","turn_type":"initial_workup_choice","gold_letter":"D","gold_action":"行电子鼻咽镜检查及活检，并完善鼻咽及颈部MRI平扫+增强，常规心电图检查"},{"sample_id":"sample-95b51d663e429afb86c572e7","turn_id":"turn02","turn_type":"imaging_release_workup","gold_letter":"E","gold_action":"行外院疑难病理会诊，完善PET/CT全身显像及血浆EBV DNA检测"},{"sample_id":"sample-ac55ce5273aeb2587f3051e7","turn_id":"turn05","turn_type":"toxicity_or_support_decision","gold_letter":"I","gold_action":"予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，暂不予口服保肝药物治疗，并复查血常规及生化后安排出院。"},{"sample_id":"sample-6d1ca43d48e1d74031505487","turn_id":"turn07","turn_type":"recurrence_or_salvage_decision","gold_letter":"J","gold_action":"继续予以抑酸护胃及静脉高营养等对症支持治疗，待体能恢复后序贯开展根治性放疗或同步放化疗。"}],"episode_scoring_rule":"pathology_correct AND MRI_T_correct AND all care_turns correct AND no unsafe action; structure invasion is auxiliary and excludes 鼻咽"}
+{"version":"npc_fullcarepath25_episode_v1_pathfix_20260506","episode_id":"episode-db03497f765c418f55e21ef9","patient_id":"patient-e45c55cc63c050892e6b2467","pathology_sample_id":"sample-82d3d16424a96abf08406d23","mri_sample_id":"sample-ec87b3b629d494caa3b0c2f1","oracle_tnm_context":"【历史辅助诊断节点】\n病理图像判断：不支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、颈动脉鞘、斜坡、翼突基底部、蝶骨基底部、岩尖等。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。","streaming_tnm_context_template":"【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。","ajcc_v9_gold":{"T":"T3","N":"N1","M":"M0","overall_stage":"II","overall_stage_evaluable":true},"structure_invasion_19_gold":{"鼻咽":1,"腭帆提肌":1,"咽旁间隙":1,"头长肌":1,"翼内肌":1,"蝶窦":1,"鼻腔":0,"颈动脉鞘":1,"翼外肌":0,"筛窦":0,"上颌窦":0,"斜坡":1,"海绵窦":0,"口咽":0,"翼突基底部":1,"蝶骨基底部":1,"岩尖":1,"寰椎":1,"枢椎":0},"care_turns":[{"sample_id":"sample-23bcdf34802b996618f9500b","turn_id":"turn01","turn_type":"initial_workup_choice","gold_letter":"L","gold_action":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身骨显像、腹部彩超及心电图等基线检查。"},{"sample_id":"sample-6cb68b4fe11abd5f5e27ea88","turn_id":"turn02","turn_type":"imaging_release_workup","gold_letter":"A","gold_action":"行鼻咽镜检查及活检，并完善胸片或胸部CT检查。"},{"sample_id":"sample-51ced222567a8eb77bc8161d","turn_id":"turn04","turn_type":"initial_treatment_selection","gold_letter":"B","gold_action":"予以诱导化疗序贯同期放化疗"},{"sample_id":"sample-31164fa636b978a86d54f0c9","turn_id":"turn05","turn_type":"toxicity_or_support_decision","gold_letter":"D","gold_action":"完善全麻下鼻咽及颈部肿物活检术前准备，予以配血备用及口服地西泮镇静。"},{"sample_id":"sample-e79a5ee2227343d5e15dc4d1","turn_id":"turn06","turn_type":"toxicity_or_support_decision","gold_letter":"E","gold_action":"继续抗炎及支持治疗，完善血常规、尿常规及生化常规检查。"},{"sample_id":"sample-3246297632d882a392dfe20a","turn_id":"turn07","turn_type":"recurrence_or_salvage_decision","gold_letter":"F","gold_action":"完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检及颈部肿物活检术。"},{"sample_id":"sample-da812d38ab5771a5dbc8fc87","turn_id":"turn08","turn_type":"recurrence_or_salvage_decision","gold_letter":"G","gold_action":"继续根治性放疗，完善电子鼻咽镜检查，并予以肠内营养支持及定期复查血常规。"}],"episode_scoring_rule":"pathology_correct AND MRI_T_correct AND all care_turns correct AND no unsafe action; structure invasion is auxiliary and excludes 鼻咽","pathology_label_override":{"version":"l6_pathology_label_overrides_20260506.json","reason":"The selected pathology image shows chronic inflammation and does not support NPC on that specimen. A later pathology report supports the patient's NPC diagnosis, but its image was unavailable for the benchmark.","audit_policy":"no_new_asset_conservative_fix"}}
+{"version":"npc_fullcarepath25_episode_v1_pathfix_20260506","episode_id":"episode-1ac7cea078175808281e5868","patient_id":"patient-a48d1d72efa6c4217cf5b79c","pathology_sample_id":"sample-9d959165696f45b3a22bc3ca","mri_sample_id":"sample-69daf2c670fd11615e125384","oracle_tnm_context":"【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、筛窦、斜坡、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。","streaming_tnm_context_template":"【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。","ajcc_v9_gold":{"T":"T3","N":"N2","M":"M0","overall_stage":"II","overall_stage_evaluable":true},"structure_invasion_19_gold":{"鼻咽":1,"腭帆提肌":1,"咽旁间隙":1,"头长肌":0,"翼内肌":0,"蝶窦":0,"鼻腔":0,"颈动脉鞘":0,"翼外肌":0,"筛窦":1,"上颌窦":0,"斜坡":1,"海绵窦":0,"口咽":0,"翼突基底部":1,"蝶骨基底部":1,"岩尖":0,"寰椎":0,"枢椎":0},"care_turns":[{"sample_id":"sample-6d0ec36f585feac9ee8c0aa5","turn_id":"turn01","turn_type":"initial_workup_choice","gold_letter":"H","gold_action":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT检查"},{"sample_id":"sample-11ca3bd9dd2a5877fa6a6b49","turn_id":"turn02","turn_type":"imaging_release_workup","gold_letter":"I","gold_action":"影像评估为 cT3N2，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期"},{"sample_id":"sample-b061f796c98789c2958f0baf","turn_id":"turn04","turn_type":"initial_treatment_selection","gold_letter":"K","gold_action":"启动首周期诱导化疗（辅以水化、止吐预处理），计划序贯根治性同步放化疗"},{"sample_id":"sample-b024e6abb04a58aab366631a","turn_id":"turn07","turn_type":"response_assessment_decision","gold_letter":"B","gold_action":"继续完成既定根治性放疗计划；加用重组人表皮生长因子、GM-CSF含漱液局部治疗，并予以静脉营养支持及抗感染治疗。"},{"sample_id":"sample-c54efc446616b72b81ae7555","turn_id":"turn08","turn_type":"recurrence_or_salvage_decision","gold_letter":"C","gold_action":"行电子鼻咽镜检查评估局部肿瘤退缩情况，并继续使用重组人表皮生长因子、重组人粒细胞巨噬细胞刺激因子等含漱药物促进粘膜修复。"}],"episode_scoring_rule":"pathology_correct AND MRI_T_correct AND all care_turns correct AND no unsafe action; structure invasion is auxiliary and excludes 鼻咽"}
+{"version":"npc_fullcarepath25_episode_v1_pathfix_20260506","episode_id":"episode-a331f1b0756e2927d0dedc36","patient_id":"patient-e90c2443e271b2e927262653","pathology_sample_id":"sample-0c456ef161d0951b6f098ab6","mri_sample_id":"sample-4e7313af07e4b05947cdb8b4","oracle_tnm_context":"【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、颈动脉鞘、斜坡、海绵窦、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。","streaming_tnm_context_template":"【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。","ajcc_v9_gold":{"T":"T4","N":"N2","M":"M0","overall_stage":"III","overall_stage_evaluable":true},"structure_invasion_19_gold":{"鼻咽":1,"腭帆提肌":1,"咽旁间隙":1,"头长肌":1,"翼内肌":0,"蝶窦":1,"鼻腔":0,"颈动脉鞘":1,"翼外肌":0,"筛窦":0,"上颌窦":0,"斜坡":1,"海绵窦":1,"口咽":0,"翼突基底部":0,"蝶骨基底部":1,"岩尖":1,"寰椎":0,"枢椎":0},"care_turns":[{"sample_id":"sample-37f31044df5e45295b88793a","turn_id":"turn01","turn_type":"initial_workup_choice","gold_letter":"D","gold_action":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部DR、腹部彩超、全身骨显像"},{"sample_id":"sample-6fba8e9f22d1b7d086664e36","turn_id":"turn02","turn_type":"imaging_release_workup","gold_letter":"E","gold_action":"完善电子鼻咽镜检查及鼻咽肿物活检。"},{"sample_id":"sample-4caf9a9989bff46283725cce","turn_id":"turn04","turn_type":"initial_treatment_selection","gold_letter":"G","gold_action":"诱导化疗序贯同步放化疗"},{"sample_id":"sample-9253a0b82814c8e2231522e6","turn_id":"turn05","turn_type":"toxicity_or_support_decision","gold_letter":"H","gold_action":"不额外给予预防性升白、保肝或抗凝等支持治疗，继续完善乙肝定量、凝血功能、HIV/梅毒筛查及其他治疗前基线血液学和感染学检查。"},{"sample_id":"sample-3b37bb5b3505f87a241c1a6f","turn_id":"turn06","turn_type":"toxicity_or_support_decision","gold_letter":"I","gold_action":"暂不需集落刺激因子支持，予以复方氨基酸及转化糖电解质静脉营养支持，并进行动静脉置管护理。"},{"sample_id":"sample-00fdb85efc65b944f8959fc3","turn_id":"turn07","turn_type":"response_assessment_decision","gold_letter":"J","gold_action":"评估为部分缓解（PR），结束诱导化疗，出院休养并定期监测血象，择期行根治性放疗及同期化疗。"},{"sample_id":"sample-c754017abe0842c4e67e064f","turn_id":"turn08","turn_type":"response_assessment_decision","gold_letter":"K","gold_action":"评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排根治性放疗及同期化疗。"}],"episode_scoring_rule":"pathology_correct AND MRI_T_correct AND all care_turns correct AND no unsafe action; structure invasion is auxiliary and excludes 鼻咽"}
+{"version":"npc_fullcarepath25_episode_v1_pathfix_20260506","episode_id":"episode-55c16849c8736723ed259bf5","patient_id":"patient-7c0941dbdd4694260fd4de38","pathology_sample_id":"sample-4cef78a24fff80c88ed756ae","mri_sample_id":"sample-a3d53ddfb29c79a21cedc3e9","oracle_tnm_context":"【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、口咽。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。","streaming_tnm_context_template":"【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。","ajcc_v9_gold":{"T":"T2","N":"N1","M":"M0","overall_stage":"IB","overall_stage_evaluable":true},"structure_invasion_19_gold":{"鼻咽":1,"腭帆提肌":1,"咽旁间隙":1,"头长肌":0,"翼内肌":0,"蝶窦":0,"鼻腔":0,"颈动脉鞘":0,"翼外肌":0,"筛窦":0,"上颌窦":0,"斜坡":0,"海绵窦":0,"口咽":1,"翼突基底部":0,"蝶骨基底部":0,"岩尖":0,"寰椎":0,"枢椎":0},"care_turns":[{"sample_id":"sample-c81d5e1363b1f79117650da1","turn_id":"turn01","turn_type":"initial_workup_choice","gold_letter":"L","gold_action":"颈部MRI平扫+增强、电子鼻咽镜检查、腹部超声检查。"},{"sample_id":"sample-72b57dbdb0633da918062d61","turn_id":"turn02","turn_type":"imaging_release_workup","gold_letter":"A","gold_action":"行电子鼻咽镜检查及鼻咽肿物活检，并辅以颈部淋巴结彩超及穿刺活检，以明确病理诊断及淋巴结分期。"},{"sample_id":"sample-3ed269e9b5e894b444089bf3","turn_id":"turn04","turn_type":"initial_treatment_selection","gold_letter":"C","gold_action":"单纯根治性放疗（鼻咽及双侧颈部）"},{"sample_id":"sample-f6df1555c3bac7ae4b972cd4","turn_id":"turn05","turn_type":"toxicity_or_support_decision","gold_letter":"D","gold_action":"继续当前根治性放疗计划，定期常规监测血象及生化。"},{"sample_id":"sample-f1eec05ca151dc9bde0f1f55","turn_id":"turn06","turn_type":"toxicity_or_support_decision","gold_letter":"E","gold_action":"继续调强放疗，给予局部含漱等对症处理，定期复查血常规及生化。"},{"sample_id":"sample-be3624e29a98e9da91fced75","turn_id":"turn07","turn_type":"recurrence_or_salvage_decision","gold_letter":"F","gold_action":"维持规范随访观察，可根据症状给予一般对症及支持治疗，不启动挽救性局部治疗或全身抗肿瘤治疗。"}],"episode_scoring_rule":"pathology_correct AND MRI_T_correct AND all care_turns correct AND no unsafe action; structure invasion is auxiliary and excludes 鼻咽"}
+{"version":"npc_fullcarepath25_episode_v1_pathfix_20260506","episode_id":"episode-fdc6ea48c4f81540436a7ca7","patient_id":"patient-02ca51eed4fedbb13e4db76d","pathology_sample_id":"sample-621c843ee9d124224e1da39b","mri_sample_id":"sample-82bbc2aaedb84d88ceaa56ac","oracle_tnm_context":"【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、鼻腔。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。","streaming_tnm_context_template":"【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。","ajcc_v9_gold":{"T":"T2","N":"N1","M":"M0","overall_stage":"IB","overall_stage_evaluable":true},"structure_invasion_19_gold":{"鼻咽":1,"腭帆提肌":1,"咽旁间隙":1,"头长肌":0,"翼内肌":0,"蝶窦":0,"鼻腔":1,"颈动脉鞘":0,"翼外肌":0,"筛窦":0,"上颌窦":0,"斜坡":0,"海绵窦":0,"口咽":0,"翼突基底部":0,"蝶骨基底部":0,"岩尖":0,"寰椎":0,"枢椎":0},"care_turns":[{"sample_id":"sample-5737526b7d92f1b3d5423663","turn_id":"turn01","turn_type":"initial_workup_choice","gold_letter":"H","gold_action":"完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。"},{"sample_id":"sample-84b4eab1f1613c7517fd613a","turn_id":"turn02","turn_type":"imaging_release_workup","gold_letter":"I","gold_action":"行鼻咽镜下鼻咽原发灶活检以明确病理诊断"},{"sample_id":"sample-9895c4d0f7c600fd0c046a50","turn_id":"turn05","turn_type":"toxicity_or_support_decision","gold_letter":"L","gold_action":"继续行第2程同期化疗，化疗后复查血象视情况予以升白细胞治疗，并给予静脉营养、补液及通便等对症支持。"},{"sample_id":"sample-5f99c90d4e8627eaecab64fc","turn_id":"turn06","turn_type":"toxicity_or_support_decision","gold_letter":"A","gold_action":"继续按计划行放化综合治疗，并进行静脉导管常规维护。"}],"episode_scoring_rule":"pathology_correct AND MRI_T_correct AND all care_turns correct AND no unsafe action; structure invasion is auxiliary and excludes 鼻咽"}
+{"version":"npc_fullcarepath25_episode_v1_pathfix_20260506","episode_id":"episode-49430ca00123363359b32fc0","patient_id":"patient-36d433557e63f939b878347d","pathology_sample_id":"sample-62b5ed36444890c1199772d5","mri_sample_id":"sample-c8f353e4bb6411158a854549","oracle_tnm_context":"【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、海绵窦、翼突基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。","streaming_tnm_context_template":"【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。","ajcc_v9_gold":{"T":"T4","N":"N2","M":"M0","overall_stage":"III","overall_stage_evaluable":true},"structure_invasion_19_gold":{"鼻咽":1,"腭帆提肌":1,"咽旁间隙":0,"头长肌":0,"翼内肌":0,"蝶窦":0,"鼻腔":0,"颈动脉鞘":0,"翼外肌":0,"筛窦":0,"上颌窦":0,"斜坡":0,"海绵窦":1,"口咽":0,"翼突基底部":1,"蝶骨基底部":0,"岩尖":0,"寰椎":0,"枢椎":0},"care_turns":[{"sample_id":"sample-46fc2f7bd9dd0872ef1b356e","turn_id":"turn02","turn_type":"imaging_release_workup","gold_letter":"E","gold_action":"行鼻咽镜下肿物活检以明确病理诊断；当前影像学评估为 cT4N2M0"},{"sample_id":"sample-7c52866e0776802e0c94516f","turn_id":"turn04","turn_type":"initial_treatment_selection","gold_letter":"G","gold_action":"完善头颈部MRI及全身分期检查，若评估为局部晚期，行诱导化疗序贯同步放化疗"},{"sample_id":"sample-ce21ad4c82d0349356f5fbb9","turn_id":"turn05","turn_type":"toxicity_or_support_decision","gold_letter":"H","gold_action":"给予口服保肝药物（如复方甘草酸苷、葡醛内酯），按原计划执行顺铂同期化疗，并动态复查肝功能。"},{"sample_id":"sample-c47048c6a3961cfb24a6bb12","turn_id":"turn06","turn_type":"toxicity_or_support_decision","gold_letter":"I","gold_action":"继续根治性放疗及同期化疗，暂不予集落刺激因子支持，密切监测血常规"},{"sample_id":"sample-28a13cf2b32abdc303bbad45","turn_id":"turn07","turn_type":"response_assessment_decision","gold_letter":"I","gold_action":"评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，每周复查血常规及生化，指导功能锻炼。"},{"sample_id":"sample-40b7a6f655350cf46e9ce33c","turn_id":"turn08","turn_type":"response_assessment_decision","gold_letter":"K","gold_action":"办理出院，转门诊继续完成根治性放疗，每周复查血常规及生化，指导鼻腔冲洗与功能锻炼。"}],"episode_scoring_rule":"pathology_correct AND MRI_T_correct AND all care_turns correct AND no unsafe action; structure invasion is auxiliary and excludes 鼻咽"}
+{"version":"npc_fullcarepath25_episode_v1_pathfix_20260506","episode_id":"episode-0119d317bb637b051913e662","patient_id":"patient-79fa00752e4405e2980f6292","pathology_sample_id":"sample-654596d529403b99ffb12ccc","mri_sample_id":"sample-ff52fcd72975621572f86d0a","oracle_tnm_context":"【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。","streaming_tnm_context_template":"【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。","ajcc_v9_gold":{"T":"T3","N":"N1","M":"M0","overall_stage":"II","overall_stage_evaluable":true},"structure_invasion_19_gold":{"鼻咽":1,"腭帆提肌":1,"咽旁间隙":0,"头长肌":0,"翼内肌":0,"蝶窦":0,"鼻腔":0,"颈动脉鞘":0,"翼外肌":0,"筛窦":0,"上颌窦":0,"斜坡":0,"海绵窦":0,"口咽":0,"翼突基底部":0,"蝶骨基底部":1,"岩尖":0,"寰椎":0,"枢椎":0},"care_turns":[{"sample_id":"sample-295d4b99725721eb1811c149","turn_id":"turn01","turn_type":"initial_workup_choice","gold_letter":"L","gold_action":"鼻咽镜检查及活检，鼻咽及颈部增强MRI，胸部CT、腹部超声及全身骨扫描，以及包含EBV-DNA的基线血液学检查"},{"sample_id":"sample-58cbc880ddd38089d56cda8c","turn_id":"turn02","turn_type":"imaging_release_workup","gold_letter":"A","gold_action":"行鼻咽镜检查及局部活检，并完善鼻咽及颈部增强MRI"},{"sample_id":"sample-75c75fa1e197461f4b0d7395","turn_id":"turn06","turn_type":"toxicity_or_support_decision","gold_letter":"E","gold_action":"继续根治性放疗与顺铂同期化疗，予以止呕、护胃、补液及补钾等支持治疗，并安排放疗中段MRI评估。"},{"sample_id":"sample-cc72c6bbde9abe2a112ce0fc","turn_id":"turn07","turn_type":"response_assessment_decision","gold_letter":"B","gold_action":"评估腹部无转移征象，继续根治性放疗，予以重组人促红素皮下注射改善贫血，并动态复查血常规。"}],"episode_scoring_rule":"pathology_correct AND MRI_T_correct AND all care_turns correct AND no unsafe action; structure invasion is auxiliary and excludes 鼻咽"}
+{"version":"npc_fullcarepath25_episode_v1_pathfix_20260506","episode_id":"episode-66c27d32c6506e0f45f13aaa","patient_id":"patient-e7eec542502a097814d58d8a","pathology_sample_id":"sample-071c3fc1fb941e7478b4b5ea","mri_sample_id":"sample-6936a30a34ceed215a43ffaf","oracle_tnm_context":"【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。","streaming_tnm_context_template":"【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。","ajcc_v9_gold":{"T":"T3","N":"N1","M":"M0","overall_stage":"II","overall_stage_evaluable":true},"structure_invasion_19_gold":{"鼻咽":1,"腭帆提肌":1,"咽旁间隙":0,"头长肌":0,"翼内肌":0,"蝶窦":0,"鼻腔":0,"颈动脉鞘":0,"翼外肌":0,"筛窦":0,"上颌窦":0,"斜坡":0,"海绵窦":0,"口咽":0,"翼突基底部":1,"蝶骨基底部":1,"岩尖":0,"寰椎":0,"枢椎":0},"care_turns":[{"sample_id":"sample-38fe8a3260ea673c5c5ddb90","turn_id":"turn01","turn_type":"initial_workup_choice","gold_letter":"H","gold_action":"完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部及腹部彩超，全身骨显像，常规血液学与心电图检查。"},{"sample_id":"sample-06aacdbb23f806198bd0b70c","turn_id":"turn02","turn_type":"imaging_release_workup","gold_letter":"I","gold_action":"行鼻咽镜检查并取鼻咽部肿物活检。"},{"sample_id":"sample-9713cef7ba61651ea6a5f02e","turn_id":"turn05","turn_type":"toxicity_or_support_decision","gold_letter":"L","gold_action":"予以静脉水化及电解质（含钾）补充，嘱计24小时尿量，并常规行PICC导管护理。"},{"sample_id":"sample-e0f912ad55b7b1f092a1b468","turn_id":"turn06","turn_type":"toxicity_or_support_decision","gold_letter":"L","gold_action":"仅常规复查血常规、生化常规及EBV-DNA定量，暂不予特殊药物干预"},{"sample_id":"sample-67a2318574aada2f5af690c0","turn_id":"turn07","turn_type":"recurrence_or_salvage_decision","gold_letter":"B","gold_action":"继续完成原计划的根治性放疗，给予阿片类药物镇痛及静脉补液与营养支持治疗。"},{"sample_id":"sample-5549469386bb20d944ce932b","turn_id":"turn08","turn_type":"response_assessment_decision","gold_letter":"C","gold_action":"影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；针对3度放射性口腔黏膜炎伴咽痛，继续予羟考酮镇痛及静脉营养支持，并常规行PICC导管护理。"}],"episode_scoring_rule":"pathology_correct AND MRI_T_correct AND all care_turns correct AND no unsafe action; structure invasion is auxiliary and excludes 鼻咽"}
+{"version":"npc_fullcarepath25_episode_v1_pathfix_20260506","episode_id":"episode-0a0da83f19b2b2fd3983880a","patient_id":"patient-f25e20b1e5c6eea840d4cc21","pathology_sample_id":"sample-7ab9fdfdcc661ba0e31820cc","mri_sample_id":"sample-6eac8e0c62b2116853b28000","oracle_tnm_context":"【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、鼻腔、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。","streaming_tnm_context_template":"【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。","ajcc_v9_gold":{"T":"T4","N":"N2","M":"M0","overall_stage":"III","overall_stage_evaluable":true},"structure_invasion_19_gold":{"鼻咽":1,"腭帆提肌":1,"咽旁间隙":1,"头长肌":1,"翼内肌":0,"蝶窦":1,"鼻腔":1,"颈动脉鞘":0,"翼外肌":0,"筛窦":0,"上颌窦":0,"斜坡":1,"海绵窦":1,"口咽":0,"翼突基底部":1,"蝶骨基底部":1,"岩尖":1,"寰椎":0,"枢椎":0},"care_turns":[{"sample_id":"sample-4da20c3d27d6501be61a2584","turn_id":"turn01","turn_type":"initial_workup_choice","gold_letter":"D","gold_action":"电子鼻咽镜及鼻咽活检，鼻咽及颈部MRI平扫+增强，腹部及浅表淋巴结彩超，心电图，以及包含EBV抗体的基线血液学检查。"},{"sample_id":"sample-cef4654d5f291c72b760bfcf","turn_id":"turn02","turn_type":"imaging_release_workup","gold_letter":"E","gold_action":"行鼻咽镜下活检明确病理，并补充胸部CT、全身骨扫描及血清EBV DNA检测。"},{"sample_id":"sample-5ae78b6dca4ce8a61a44d0ca","turn_id":"turn04","turn_type":"initial_treatment_selection","gold_letter":"G","gold_action":"诱导化疗序贯同步放化疗"},{"sample_id":"sample-a4cf25bef13a63de3e012971","turn_id":"turn05","turn_type":"toxicity_or_support_decision","gold_letter":"H","gold_action":"完善放化疗前基线检验（血常规、生化、凝血、传染病、EBV等），全面评估器官功能。"},{"sample_id":"sample-44b84e88a5f0beade51ae0ca","turn_id":"turn06","turn_type":"toxicity_or_support_decision","gold_letter":"I","gold_action":"按计划启动放疗，并为顺铂（100mg/㎡）同期化疗行充分的静脉水化、甘露醇利尿及电解质补充，同时给予放疗局部保护用药。"},{"sample_id":"sample-0534c4bc264d81d07f7ff87c","turn_id":"turn07","turn_type":"response_assessment_decision","gold_letter":"J","gold_action":"结束住院诊疗办理出院，嘱定期返院复查以评估近期疗效。"},{"sample_id":"sample-03e671c4e9fab822b9938832","turn_id":"turn08","turn_type":"response_assessment_decision","gold_letter":"K","gold_action":"评估为有效，结束根治性放化疗，予以办理出院并嘱定期门诊随访复查。"}],"episode_scoring_rule":"pathology_correct AND MRI_T_correct AND all care_turns correct AND no unsafe action; structure invasion is auxiliary and excludes 鼻咽"}
+{"version":"npc_fullcarepath25_episode_v1_pathfix_20260506","episode_id":"episode-3f505523d4d6a211b44d1e4f","patient_id":"patient-9fcde7a95f4d57501ecbf7b2","pathology_sample_id":"sample-4a50857a0fd27bee87c69197","mri_sample_id":"sample-e4cfe8969392b8172de4cc15","oracle_tnm_context":"【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：咽旁间隙、斜坡、蝶骨基底部、岩尖。\n文本分期信息：N3，M0。\n综合TNM状态：T3N3M0。\n综合分期：III。","streaming_tnm_context_template":"【历史辅助诊断节点】\n病理图像判断：{{PATHOLOGY_RESULT}}。\nMRI影像判断：{{MRI_T_STAGE}}；受侵结构包括：{{MRI_INVOLVED_STRUCTURES}}。\n文本分期信息：{{N_STAGE}}，{{M_STAGE}}。\n综合TNM状态：{{TNM_STATUS}}。\n综合分期：{{OVERALL_STAGE}}。","ajcc_v9_gold":{"T":"T3","N":"N3","M":"M0","overall_stage":"III","overall_stage_evaluable":true},"structure_invasion_19_gold":{"鼻咽":1,"腭帆提肌":0,"咽旁间隙":1,"头长肌":0,"翼内肌":0,"蝶窦":0,"鼻腔":0,"颈动脉鞘":0,"翼外肌":0,"筛窦":0,"上颌窦":0,"斜坡":1,"海绵窦":0,"口咽":0,"翼突基底部":0,"蝶骨基底部":1,"岩尖":1,"寰椎":0,"枢椎":0},"care_turns":[{"sample_id":"sample-b03a0a9310651ef3f13754f1","turn_id":"turn01","turn_type":"initial_workup_choice","gold_letter":"K","gold_action":"行鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查，并完善心电图及基线抽血化验。"},{"sample_id":"sample-057bee25fe3533856610d5c8","turn_id":"turn02","turn_type":"imaging_release_workup","gold_letter":"A","gold_action":"行电子鼻咽镜检查及鼻咽肿物活检以明确病理诊断。"},{"sample_id":"sample-ea63b7a358722be15870f84c","turn_id":"turn04","turn_type":"initial_treatment_selection","gold_letter":"C","gold_action":"完善中心静脉置管，行诱导化疗序贯根治性同期放化疗。"},{"sample_id":"sample-077ecf4aba208fcc4f66c309","turn_id":"turn05","turn_type":"toxicity_or_support_decision","gold_letter":"D","gold_action":"继续放疗，针对轻度恶心给予常规止吐对症处理，按规范进行PICC导管维护，并定期复查血常规与生化。"},{"sample_id":"sample-6fc96ea65282f416f15f852e","turn_id":"turn06","turn_type":"toxicity_or_support_decision","gold_letter":"E","gold_action":"继续放疗，予以洗鼻、免疫调节/辅助支持（如香菇多糖）及动静脉置管护理，复查血常规与生化常规。"},{"sample_id":"sample-08d32abcf26a92c62d1dc762","turn_id":"turn07","turn_type":"response_assessment_decision","gold_letter":"F","gold_action":"取消第三程同期化疗，按原计划完成根治性放疗，胆囊结石暂予观察，放疗结束后择期行全面疗效评估。"},{"sample_id":"sample-bc1decc91eb488b9888718b5","turn_id":"turn08","turn_type":"recurrence_or_salvage_decision","gold_letter":"G","gold_action":"结束根治性治疗进入随访，放疗后3个月复查影像学评估疗效"}],"episode_scoring_rule":"pathology_correct AND MRI_T_correct AND all care_turns correct AND no unsafe action; structure invasion is auxiliary and excludes 鼻咽"}
diff --git a/supplementary/carepath25/stateless_current_delta.jsonl b/supplementary/carepath25/stateless_current_delta.jsonl
new file mode 100644
index 0000000000000000000000000000000000000000..6301f6e5dee1a89c7cc9da9a343cc8a38c2c2ae0
--- /dev/null
+++ b/supplementary/carepath25/stateless_current_delta.jsonl
@@ -0,0 +1,146 @@
+{"sample_id":"sample-c56105087904f0da386b7001","patient_id":"patient-5fa48522b2703f35ead0224b","turn_id":"turn02","turn_position":1,"turn_type":"imaging_release_workup","gold_letter":"J","gold_action":"行颈部淋巴结穿刺活检或鼻咽镜活检以明确病理诊断，并完善全身分期检查（如胸腹部CT、骨扫描或PET-CT）。","options":[{"letter":"A","text":"完善血浆EBV-DNA检测，若结果阳性则临床确诊鼻咽癌并启动根治性放疗","is_gold":false},{"letter":"B","text":"行鼻咽肿物开放性切除活检以明确病理诊断，并完善胸腹部CT及骨扫描","is_gold":false},{"letter":"C","text":"行颈部淋巴结切除活检以明确病理诊断，暂缓全身远处转移排查","is_gold":false},{"letter":"D","text":"行颈部淋巴结细针穿刺细胞学检查（FNAC）作为最终确诊依据，并完善全身分期检查","is_gold":false},{"letter":"E","text":"行鼻咽镜下活检以明确病理诊断，无需常规进行胸腹部影像学分期","is_gold":false},{"letter":"F","text":"优先行全身PET-CT检查，若无远处转移则直接开始诱导化疗","is_gold":false},{"letter":"G","text":"行双侧颈部淋巴结清扫术并送常规病理，确诊后安排术后放疗","is_gold":false},{"letter":"H","text":"行鼻咽镜下活检以明确病理诊断，并仅行头颈部增强CT以补充评估颅底骨质破坏","is_gold":false},{"letter":"I","text":"行鼻咽镜下活检以明确病理诊断，并直接安排诱导化疗，化疗后补充全身分期检查","is_gold":false},{"letter":"J","text":"行颈部淋巴结穿刺活检或鼻咽镜活检以明确病理诊断，并完善全身分期检查","is_gold":true},{"letter":"K","text":"密切观察鼻咽部病灶及颈部淋巴结变化，1个月后复查头颈部MRI决定是否活检","is_gold":false},{"letter":"L","text":"行颈部淋巴结穿刺活检，确诊后直接启动根治性放疗，无需全身分期检查","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、斜坡、口咽、蝶骨基底部、岩尖。\n文本分期信息：N2，Mx 左侧腋窝淋巴结可疑转移。\n综合TNM状态：T3N2Mx 左侧腋窝淋巴结可疑转移。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 正常范围心电图\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽左顶壁、左顶后壁、左侧壁增厚，并见团块状软组织信号影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，鼻咽右侧壁粘膜未见增厚，左侧咽隐窝闭塞，右侧咽隐窝存在，左侧咽旁脂肪间隙狭窄。左侧腭帆提肌、腭帆张肌、头长肌、翼内肌受侵犯，余咽旁诸肌未见异常； 左侧咽后见肿大的淋巴结，短径22mm，右侧咽后见小淋巴结，短径5mm。 病灶向前堵塞左侧后鼻孔，口咽左侧壁受侵增厚。 左侧翼腭窝软组织影稍增多，右侧翼腭窝、双侧颞下窝未见异常。 蝶骨基底部、斜坡左侧份、左侧岩尖骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、上颌窦粘膜增厚；蝶窦、双侧乳突气化良好，未见异常信号影；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。 双颈II区、左颈III区见多个淋巴结，较大者短径24mm，信号欠均匀，增强扫描不均匀强化。；检查结论: 鼻咽左顶后壁、左侧壁病灶，考虑鼻咽癌，侵犯左侧咽旁、口咽左侧壁。 颅底骨质破坏。 双侧咽后、双颈II区、左颈III区淋巴结，考虑转移瘤。 副鼻窦炎。\n- [全程D5] 检验组合: 红细胞比容(Hct)-静脉血: 38.9%；血红蛋白(Hb)-静脉血: 131.6g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.5mmolL；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；总蛋白(TP)-静脉血: 69.64g/L；总钙(Ca)-静脉血: 2.26mmol/L；白蛋白(ALB)-静脉血: 43.1g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.42mmol/L；磷(P)-静脉血: 1.22mmol/L；凝血酶时间(TT)-静脉血: 17.3sec.；淋巴细胞百分比(Lymph%)-静脉血: 0.325；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；钠离子(Na+)-静脉血: 140.5mmol/L；单核细胞百分比(Mono%)-静脉血: 0.0954；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；载脂蛋白AI(apoAI)-静脉血: 1.38g/L；丙氨酸氨基转移酶(ALT)-静脉血: 21.7U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；氯离子(Cl-)-静脉血: 103.9mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；血小板计数(PLT#)-静脉血: 270.910E9/L；总胆固醇(TC)-静脉血: 5.3mmol/L；C-反应蛋白(CRP)-静脉血: 0.37mg/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.69mmol/L；甘油三酯(TG)-静脉血: 0.78mmol/L；淋巴细胞计数(Lymph#)-静脉血: 210E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.568；凝血酶原时间活动度(PTA)-静脉血: 94%；活化部分凝血活酶时间(APTT)-静脉血: 25.3sec.；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；平均红细胞血红蛋白含量(MCH)-静脉血: 30.2pg；凝血酶原时间(PT)-静脉血: 11.4sec.；纤维蛋白原(Fbg)-静脉血: 2.62g/L；天门冬氨酸氨基转移酶/丙氨酸氨……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善血浆EBV-DNA检测，若结果阳性则临床确诊鼻咽癌并启动根治性放疗\nB. 行鼻咽肿物开放性切除活检以明确病理诊断，并完善胸腹部CT及骨扫描\nC. 行颈部淋巴结切除活检以明确病理诊断，暂缓全身远处转移排查\nD. 行颈部淋巴结细针穿刺细胞学检查（FNAC）作为最终确诊依据，并完善全身分期检查\nE. 行鼻咽镜下活检以明确病理诊断，无需常规进行胸腹部影像学分期\nF. 优先行全身PET-CT检查，若无远处转移则直接开始诱导化疗\nG. 行双侧颈部淋巴结清扫术并送常规病理，确诊后安排术后放疗\nH. 行鼻咽镜下活检以明确病理诊断，并仅行头颈部增强CT以补充评估颅底骨质破坏\nI. 行鼻咽镜下活检以明确病理诊断，并直接安排诱导化疗，化疗后补充全身分期检查\nJ. 行颈部淋巴结穿刺活检或鼻咽镜活检以明确病理诊断，并完善全身分期检查\nK. 密切观察鼻咽部病灶及颈部淋巴结变化，1个月后复查头颈部MRI决定是否活检\nL. 行颈部淋巴结穿刺活检，确诊后直接启动根治性放疗，无需全身分期检查\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、斜坡、口咽、蝶骨基底部、岩尖。\n文本分期信息：N2，Mx 左侧腋窝淋巴结可疑转移。\n综合TNM状态：T3N2Mx 左侧腋窝淋巴结可疑转移。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 正常范围心电图\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽左顶壁、左顶后壁、左侧壁增厚，并见团块状软组织信号影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，鼻咽右侧壁粘膜未见增厚，左侧咽隐窝闭塞，右侧咽隐窝存在，左侧咽旁脂肪间隙狭窄。左侧腭帆提肌、腭帆张肌、头长肌、翼内肌受侵犯，余咽旁诸肌未见异常； 左侧咽后见肿大的淋巴结，短径22mm，右侧咽后见小淋巴结，短径5mm。 病灶向前堵塞左侧后鼻孔，口咽左侧壁受侵增厚。 左侧翼腭窝软组织影稍增多，右侧翼腭窝、双侧颞下窝未见异常。 蝶骨基底部、斜坡左侧份、左侧岩尖骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、上颌窦粘膜增厚；蝶窦、双侧乳突气化良好，未见异常信号影；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。 双颈II区、左颈III区见多个淋巴结，较大者短径24mm，信号欠均匀，增强扫描不均匀强化。；检查结论: 鼻咽左顶后壁、左侧壁病灶，考虑鼻咽癌，侵犯左侧咽旁、口咽左侧壁。 颅底骨质破坏。 双侧咽后、双颈II区、左颈III区淋巴结，考虑转移瘤。 副鼻窦炎。\n- [全程D5] 检验组合: 红细胞比容(Hct)-静脉血: 38.9%；血红蛋白(Hb)-静脉血: 131.6g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.5mmolL；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；总蛋白(TP)-静脉血: 69.64g/L；总钙(Ca)-静脉血: 2.26mmol/L；白蛋白(ALB)-静脉血: 43.1g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.42mmol/L；磷(P)-静脉血: 1.22mmol/L；凝血酶时间(TT)-静脉血: 17.3sec.；淋巴细胞百分比(Lymph%)-静脉血: 0.325；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；钠离子(Na+)-静脉血: 140.5mmol/L；单核细胞百分比(Mono%)-静脉血: 0.0954；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；载脂蛋白AI(apoAI)-静脉血: 1.38g/L；丙氨酸氨基转移酶(ALT)-静脉血: 21.7U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；氯离子(Cl-)-静脉血: 103.9mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；血小板计数(PLT#)-静脉血: 270.910E9/L；总胆固醇(TC)-静脉血: 5.3mmol/L；C-反应蛋白(CRP)-静脉血: 0.37mg/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.69mmol/L；甘油三酯(TG)-静脉血: 0.78mmol/L；淋巴细胞计数(Lymph#)-静脉血: 210E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.568；凝血酶原时间活动度(PTA)-静脉血: 94%；活化部分凝血活酶时间(APTT)-静脉血: 25.3sec.；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；平均红细胞血红蛋白含量(MCH)-静脉血: 30.2pg；凝血酶原时间(PT)-静脉血: 11.4sec.；纤维蛋白原(Fbg)-静脉血: 2.62g/L；天门冬氨酸氨基转移酶/丙氨酸氨……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善血浆EBV-DNA检测，若结果阳性则临床确诊鼻咽癌并启动根治性放疗\nB. 行鼻咽肿物开放性切除活检以明确病理诊断，并完善胸腹部CT及骨扫描\nC. 行颈部淋巴结切除活检以明确病理诊断，暂缓全身远处转移排查\nD. 行颈部淋巴结细针穿刺细胞学检查（FNAC）作为最终确诊依据，并完善全身分期检查\nE. 行鼻咽镜下活检以明确病理诊断，无需常规进行胸腹部影像学分期\nF. 优先行全身PET-CT检查，若无远处转移则直接开始诱导化疗\nG. 行双侧颈部淋巴结清扫术并送常规病理，确诊后安排术后放疗\nH. 行鼻咽镜下活检以明确病理诊断，并仅行头颈部增强CT以补充评估颅底骨质破坏\nI. 行鼻咽镜下活检以明确病理诊断，并直接安排诱导化疗，化疗后补充全身分期检查\nJ. 行颈部淋巴结穿刺活检或鼻咽镜活检以明确病理诊断，并完善全身分期检查\nK. 密切观察鼻咽部病灶及颈部淋巴结变化，1个月后复查头颈部MRI决定是否活检\nL. 行颈部淋巴结穿刺活检，确诊后直接启动根治性放疗，无需全身分期检查\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-9b76347b9a2749777a06cd80","patient_id":"patient-5fa48522b2703f35ead0224b","turn_id":"turn04","turn_position":2,"turn_type":"initial_treatment_selection","gold_letter":"L","gold_action":"诱导化疗（顺铂+氟尿嘧啶方案）","options":[{"letter":"A","text":"同步放化疗（顺铂单药方案）","is_gold":false},{"letter":"B","text":"诱导化疗（吉西他滨+顺铂方案）联合PD-1抑制剂","is_gold":false},{"letter":"C","text":"根治性放疗联合辅助化疗（顺铂+氟尿嘧啶方案）","is_gold":false},{"letter":"D","text":"诱导化疗（紫杉醇+卡铂方案）","is_gold":false},{"letter":"E","text":"诱导化疗（多西他赛+顺铂+氟尿嘧啶方案）联合西妥昔单抗","is_gold":false},{"letter":"F","text":"根治性放疗（单纯放疗）","is_gold":false},{"letter":"G","text":"诱导化疗（卡培他滨单药方案）","is_gold":false},{"letter":"H","text":"靶向治疗（尼妥珠单抗）联合同步放化疗","is_gold":false},{"letter":"I","text":"诱导化疗（依托泊苷+顺铂方案）","is_gold":false},{"letter":"J","text":"姑息性化疗（顺铂+氟尿嘧啶方案）","is_gold":false},{"letter":"K","text":"诱导化疗（顺铂单药方案）","is_gold":false},{"letter":"L","text":"诱导化疗（顺铂+氟尿嘧啶方案）","is_gold":true}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、斜坡、口咽、蝶骨基底部、岩尖。\n文本分期信息：N2，Mx 左侧腋窝淋巴结可疑转移。\n综合TNM状态：T3N2Mx 左侧腋窝淋巴结可疑转移。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D8] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见:；检查结论:\n- [全程D14] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；透明质酸(HA)-静脉血: 76.89ng/ml；III型前胶原氨基端肽(PIIINP)-静脉血: 28.08ng/ml；葡萄糖(Glu)-尿液: -（参考: 阴性）；降钙素(CT)-静脉血: 22.05pg/ml；总蛋白(TP)-尿液: -（参考: 阴性）；IV型胶原(C-IV)-静脉血: 28.93ng/ml；比重(SG)-尿液: 1.008；颜色-尿液: 无色；酸碱度(pH)-尿液: 6.5；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；层粘连蛋白(LN)-静脉血: 35.29ng/ml；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮\n- [全程D15] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T6水平，估计导管末端位于上腔静脉内。；检查结论: PICC管末端位置如上述。\n- [全程D15] 检验组合: 骨钙素N端中分子片段(N-MID)-静脉血: 11.9ng/ml；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.318ng/ml\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 同步放化疗（顺铂单药方案）\nB. 诱导化疗（吉西他滨+顺铂方案）联合PD-1抑制剂\nC. 根治性放疗联合辅助化疗（顺铂+氟尿嘧啶方案）\nD. 诱导化疗（紫杉醇+卡铂方案）\nE. 诱导化疗（多西他赛+顺铂+氟尿嘧啶方案）联合西妥昔单抗\nF. 根治性放疗（单纯放疗）\nG. 诱导化疗（卡培他滨单药方案）\nH. 靶向治疗（尼妥珠单抗）联合同步放化疗\nI. 诱导化疗（依托泊苷+顺铂方案）\nJ. 姑息性化疗（顺铂+氟尿嘧啶方案）\nK. 诱导化疗（顺铂单药方案）\nL. 诱导化疗（顺铂+氟尿嘧啶方案）\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、斜坡、口咽、蝶骨基底部、岩尖。\n文本分期信息：N2，Mx 左侧腋窝淋巴结可疑转移。\n综合TNM状态：T3N2Mx 左侧腋窝淋巴结可疑转移。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D8] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见:；检查结论:\n- [全程D14] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；透明质酸(HA)-静脉血: 76.89ng/ml；III型前胶原氨基端肽(PIIINP)-静脉血: 28.08ng/ml；葡萄糖(Glu)-尿液: -（参考: 阴性）；降钙素(CT)-静脉血: 22.05pg/ml；总蛋白(TP)-尿液: -（参考: 阴性）；IV型胶原(C-IV)-静脉血: 28.93ng/ml；比重(SG)-尿液: 1.008；颜色-尿液: 无色；酸碱度(pH)-尿液: 6.5；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；层粘连蛋白(LN)-静脉血: 35.29ng/ml；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮\n- [全程D15] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T6水平，估计导管末端位于上腔静脉内。；检查结论: PICC管末端位置如上述。\n- [全程D15] 检验组合: 骨钙素N端中分子片段(N-MID)-静脉血: 11.9ng/ml；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.318ng/ml\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 同步放化疗（顺铂单药方案）\nB. 诱导化疗（吉西他滨+顺铂方案）联合PD-1抑制剂\nC. 根治性放疗联合辅助化疗（顺铂+氟尿嘧啶方案）\nD. 诱导化疗（紫杉醇+卡铂方案）\nE. 诱导化疗（多西他赛+顺铂+氟尿嘧啶方案）联合西妥昔单抗\nF. 根治性放疗（单纯放疗）\nG. 诱导化疗（卡培他滨单药方案）\nH. 靶向治疗（尼妥珠单抗）联合同步放化疗\nI. 诱导化疗（依托泊苷+顺铂方案）\nJ. 姑息性化疗（顺铂+氟尿嘧啶方案）\nK. 诱导化疗（顺铂单药方案）\nL. 诱导化疗（顺铂+氟尿嘧啶方案）\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-ad9c851cda35b0e3c9061982","patient_id":"patient-5fa48522b2703f35ead0224b","turn_id":"turn05","turn_position":3,"turn_type":"toxicity_or_support_decision","gold_letter":"A","gold_action":"办理出院，予以胸腺五肽皮下注射支持治疗，嘱每周复查血常规及生化，按期返院行第2程诱导化疗。","options":[{"letter":"A","text":"办理出院，予以胸腺五肽皮下注射支持治疗，嘱每周复查血常规及生化，按期返院行第2程诱导化疗。","is_gold":true},{"letter":"B","text":"暂缓出院，继续静脉给予5-HT3受体拮抗剂及补液支持，待恶心呕吐完全缓解后出院。","is_gold":false},{"letter":"C","text":"办理出院，嘱每周复查血常规及生化，第2程诱导化疗将顺铂剂量下调20%。","is_gold":false},{"letter":"D","text":"办理出院，嘱每周复查血常规及生化，第2程诱导化疗更改为吉西他滨+顺铂（GP）方案。","is_gold":false},{"letter":"E","text":"办理出院，予以重组人粒细胞集落刺激因子（G-CSF）皮下注射，按期返院行第2程诱导化疗。","is_gold":false},{"letter":"F","text":"办理出院，予以重组人促红素（EPO）皮下注射，按期返院行第2程诱导化疗。","is_gold":false},{"letter":"G","text":"办理出院，予以胸腺五肽皮下注射支持治疗，并安排左侧腋窝淋巴结穿刺活检。","is_gold":false},{"letter":"H","text":"办理出院，予以胸腺五肽皮下注射支持治疗，嘱返院直接开始根治性放疗及同步化疗。","is_gold":false},{"letter":"I","text":"办理出院，予以口服阿瑞匹坦带药，嘱第2程诱导化疗推迟1周进行。","is_gold":false},{"letter":"J","text":"办理出院，予以重组人血小板生成素（rhTPO）皮下注射，按期返院行第2程诱导化疗。","is_gold":false},{"letter":"K","text":"暂缓出院，复查鼻咽及颈部MRI评估近期疗效，结果决定第2程化疗方案。","is_gold":false},{"letter":"L","text":"办理出院，予以胸腺五肽皮下注射支持治疗，嘱第2程诱导化疗加用尼妥珠单抗。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、斜坡、口咽、蝶骨基底部、岩尖。\n文本分期信息：N2，Mx 左侧腋窝淋巴结可疑转移。\n综合TNM状态：T3N2Mx 左侧腋窝淋巴结可疑转移。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D16] 检验组合: 浊度(TRUB)-尿液: 清亮；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: +-（参考: 阴性）；酸碱度(pH)-尿液: 7；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.016；葡萄糖(Glu)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 3/μL\n- [全程D17] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 31/μL；颜色-尿液: Yellow；鳞状上皮细胞计数(SQEP#)-尿液: 7/μL；白细胞计数(WBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.021；浊度(TRUB)-尿液: 清亮；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D19] 检验组合: 总钙(Ca)-静脉血: 2.15mmol/L；钠离子(Na+)-静脉血: 138.8mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.2mmol/L；钾离子(K+)-静脉血: 3.08mmol/L；氯离子(Cl-)-静脉血: 102.2mmol/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；磷(P)-静脉血: 1.19mmol/L；阴离子间隙(AG)-静脉血: 15.4\n- [全程D20] 超声；双侧腋窝淋巴结彩超(套): 检查类型: 超声；检查名称: 双侧腋窝淋巴结彩超(套)；检查部位:；检查所见: 左侧腋窝腋下组可见1个淋巴结回声，大小约16x4mm，椭圆形，边界清，皮髓质分界清，淋巴门结构可探及。腋上组及腋中组未见明显异常淋巴结回声。 CDFI：上述淋巴结内可见门型血流信号。；检查结论: 左侧腋窝腋下组淋巴结，符合良性淋巴结声像。\n- [全程D20] 检验组合: 血小板计数(PLT#)-静脉血: 250.210E9/L；肌酐(Crea)-静脉血: 54umol/L；总胆红素(TBIL)-静脉血: 13.7umol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；阴离子间隙(AG)-静脉血: 12.4；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；碱性磷酸酶(ALP)-静脉血: 59.5U/L；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；球蛋白(GLO)-静脉血: 25.26g/L；葡萄糖(Glu)-静脉血: 4.81mmol/L；白蛋白(ALB)-静脉血: 40.9g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；尿素氮(BUN)-静脉血: 3.9mmol/L；血小板分布宽度(PDW)-静脉血: 15.8%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.38mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.05mmolL；乳酸脱氢酶(LDH)-静脉血: 275.2U/L；单核细胞百分比(Mono%)-静脉血: 0.0621；中性粒细胞计数(Neut#)-静脉血: 4.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.711；γ-谷氨酰基转移酶(GGT)-静脉血: 19.5U/L；甘油三酯(TG)-静脉血: 1.23mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.5pg；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.0032；磷(P)-静脉血: 1.37mmol/L；总钙(Ca)-静脉血: 2.23mmol/L；间接胆红素(IBIL)-静脉血: 9umolL；血小板比容-静脉血: 20.8%；C-反应蛋白(CRP)-静脉血: 0.65mg/L；载脂蛋白AI(apoAI)-静脉血: 1.12g/L；总蛋白(TP)-静脉血: 66.16g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.62；单核细胞计数(Mono#)-静脉血: 0.410E9/L；钠离子(Na+)-静脉血: 137.8mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 27.7U/L；丙氨酸氨基转移酶(ALT)-静脉……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D15] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D20] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗结束，诉呕吐 次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程5-FU+顺铂方案诱导化疗结束，无诉特殊不适，可予出院，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 办理出院，予以胸腺五肽皮下注射支持治疗，嘱每周复查血常规及生化，按期返院行第2程诱导化疗。\nB. 暂缓出院，继续静脉给予5-HT3受体拮抗剂及补液支持，待恶心呕吐完全缓解后出院。\nC. 办理出院，嘱每周复查血常规及生化，第2程诱导化疗将顺铂剂量下调20%。\nD. 办理出院，嘱每周复查血常规及生化，第2程诱导化疗更改为吉西他滨+顺铂（GP）方案。\nE. 办理出院，予以重组人粒细胞集落刺激因子（G-CSF）皮下注射，按期返院行第2程诱导化疗。\nF. 办理出院，予以重组人促红素（EPO）皮下注射，按期返院行第2程诱导化疗。\nG. 办理出院，予以胸腺五肽皮下注射支持治疗，并安排左侧腋窝淋巴结穿刺活检。\nH. 办理出院，予以胸腺五肽皮下注射支持治疗，嘱返院直接开始根治性放疗及同步化疗。\nI. 办理出院，予以口服阿瑞匹坦带药，嘱第2程诱导化疗推迟1周进行。\nJ. 办理出院，予以重组人血小板生成素（rhTPO）皮下注射，按期返院行第2程诱导化疗。\nK. 暂缓出院，复查鼻咽及颈部MRI评估近期疗效，结果决定第2程化疗方案。\nL. 办理出院，予以胸腺五肽皮下注射支持治疗，嘱第2程诱导化疗加用尼妥珠单抗。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、斜坡、口咽、蝶骨基底部、岩尖。\n文本分期信息：N2，Mx 左侧腋窝淋巴结可疑转移。\n综合TNM状态：T3N2Mx 左侧腋窝淋巴结可疑转移。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D16] 检验组合: 浊度(TRUB)-尿液: 清亮；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: +-（参考: 阴性）；酸碱度(pH)-尿液: 7；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.016；葡萄糖(Glu)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 3/μL\n- [全程D17] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 31/μL；颜色-尿液: Yellow；鳞状上皮细胞计数(SQEP#)-尿液: 7/μL；白细胞计数(WBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.021；浊度(TRUB)-尿液: 清亮；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D19] 检验组合: 总钙(Ca)-静脉血: 2.15mmol/L；钠离子(Na+)-静脉血: 138.8mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.2mmol/L；钾离子(K+)-静脉血: 3.08mmol/L；氯离子(Cl-)-静脉血: 102.2mmol/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；磷(P)-静脉血: 1.19mmol/L；阴离子间隙(AG)-静脉血: 15.4\n- [全程D20] 超声；双侧腋窝淋巴结彩超(套): 检查类型: 超声；检查名称: 双侧腋窝淋巴结彩超(套)；检查部位:；检查所见: 左侧腋窝腋下组可见1个淋巴结回声，大小约16x4mm，椭圆形，边界清，皮髓质分界清，淋巴门结构可探及。腋上组及腋中组未见明显异常淋巴结回声。 CDFI：上述淋巴结内可见门型血流信号。；检查结论: 左侧腋窝腋下组淋巴结，符合良性淋巴结声像。\n- [全程D20] 检验组合: 血小板计数(PLT#)-静脉血: 250.210E9/L；肌酐(Crea)-静脉血: 54umol/L；总胆红素(TBIL)-静脉血: 13.7umol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；阴离子间隙(AG)-静脉血: 12.4；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；碱性磷酸酶(ALP)-静脉血: 59.5U/L；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；球蛋白(GLO)-静脉血: 25.26g/L；葡萄糖(Glu)-静脉血: 4.81mmol/L；白蛋白(ALB)-静脉血: 40.9g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；尿素氮(BUN)-静脉血: 3.9mmol/L；血小板分布宽度(PDW)-静脉血: 15.8%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.38mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.05mmolL；乳酸脱氢酶(LDH)-静脉血: 275.2U/L；单核细胞百分比(Mono%)-静脉血: 0.0621；中性粒细胞计数(Neut#)-静脉血: 4.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.711；γ-谷氨酰基转移酶(GGT)-静脉血: 19.5U/L；甘油三酯(TG)-静脉血: 1.23mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.5pg；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.0032；磷(P)-静脉血: 1.37mmol/L；总钙(Ca)-静脉血: 2.23mmol/L；间接胆红素(IBIL)-静脉血: 9umolL；血小板比容-静脉血: 20.8%；C-反应蛋白(CRP)-静脉血: 0.65mg/L；载脂蛋白AI(apoAI)-静脉血: 1.12g/L；总蛋白(TP)-静脉血: 66.16g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.62；单核细胞计数(Mono#)-静脉血: 0.410E9/L；钠离子(Na+)-静脉血: 137.8mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 27.7U/L；丙氨酸氨基转移酶(ALT)-静脉……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D15] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D20] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗结束，诉呕吐 次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程5-FU+顺铂方案诱导化疗结束，无诉特殊不适，可予出院，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 办理出院，予以胸腺五肽皮下注射支持治疗，嘱每周复查血常规及生化，按期返院行第2程诱导化疗。\nB. 暂缓出院，继续静脉给予5-HT3受体拮抗剂及补液支持，待恶心呕吐完全缓解后出院。\nC. 办理出院，嘱每周复查血常规及生化，第2程诱导化疗将顺铂剂量下调20%。\nD. 办理出院，嘱每周复查血常规及生化，第2程诱导化疗更改为吉西他滨+顺铂（GP）方案。\nE. 办理出院，予以重组人粒细胞集落刺激因子（G-CSF）皮下注射，按期返院行第2程诱导化疗。\nF. 办理出院，予以重组人促红素（EPO）皮下注射，按期返院行第2程诱导化疗。\nG. 办理出院，予以胸腺五肽皮下注射支持治疗，并安排左侧腋窝淋巴结穿刺活检。\nH. 办理出院，予以胸腺五肽皮下注射支持治疗，嘱返院直接开始根治性放疗及同步化疗。\nI. 办理出院，予以口服阿瑞匹坦带药，嘱第2程诱导化疗推迟1周进行。\nJ. 办理出院，予以重组人血小板生成素（rhTPO）皮下注射，按期返院行第2程诱导化疗。\nK. 暂缓出院，复查鼻咽及颈部MRI评估近期疗效，结果决定第2程化疗方案。\nL. 办理出院，予以胸腺五肽皮下注射支持治疗，嘱第2程诱导化疗加用尼妥珠单抗。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-9acca1b0c829ebdd4e952950","patient_id":"patient-5fa48522b2703f35ead0224b","turn_id":"turn06","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"B","gold_action":"开始适形调强放射治疗（IMRT），并予以雾化吸入、鼻腔冲洗、皮肤及黏膜保护剂等放疗支持处理。","options":[{"letter":"A","text":"予以第3程5-FU+顺铂方案诱导化疗，并继续予以护胃、止呕、补液等常规对症支持治疗。","is_gold":false},{"letter":"B","text":"开始适形调强放射治疗（IMRT），并予以雾化吸入、鼻腔冲洗、皮肤及黏膜保护剂等放疗支持处理。","is_gold":true},{"letter":"C","text":"开始适形调强放射治疗（IMRT），待出现III度以上放射性皮炎或黏膜炎时再启动局部保护剂及雾化治疗。","is_gold":false},{"letter":"D","text":"予以第3程5-FU+顺铂方案诱导化疗，并预防性使用长效重组人粒细胞集落刺激因子。","is_gold":false},{"letter":"E","text":"开始适形调强放射治疗（IMRT），并常规预防性静脉滴注头孢类广谱抗生素及抗真菌药物。","is_gold":false},{"letter":"F","text":"暂缓抗肿瘤治疗，继续予以升白细胞及营养支持治疗，观察1-2周后再复查各项生化指标。","is_gold":false},{"letter":"G","text":"开始适形调强放射治疗（IMRT），并常规预防性静脉滴注大剂量糖皮质激素及甘露醇脱水。","is_gold":false},{"letter":"H","text":"开始适形调强放射治疗（IMRT），并预防性给予全胃肠外营养（TPN）及静脉高营养支持。","is_gold":false},{"letter":"I","text":"予以单药顺铂同期化疗，并常规予以水化、利尿及止吐等支持治疗，暂缓启动放射治疗。","is_gold":false},{"letter":"J","text":"开始适形调强放射治疗（IMRT），并常规预防性口服非甾体抗炎药及阿片类镇痛药物。","is_gold":false},{"letter":"K","text":"开始适形调强放射治疗（IMRT），并予以预防性低分子肝素抗凝及深静脉置管常规护理。","is_gold":false},{"letter":"L","text":"予以靶向治疗联合适形调强放射治疗（IMRT），并常规予以抗过敏及皮疹预防对症处理。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、斜坡、口咽、蝶骨基底部、岩尖。\n文本分期信息：N2，Mx 左侧腋窝淋巴结可疑转移。\n综合TNM状态：T3N2Mx 左侧腋窝淋巴结可疑转移。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D37] 检验组合: 嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.4；红细胞比容(Hct)-静脉血: 35.6%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞体积(MCV)-静脉血: 89.9fL；单核细胞百分比(Mono%)-静脉血: 0.046；血小板计数(PLT#)-静脉血: 21310E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.8pg；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.9；平均血小板体积(MPV)-静脉血: 9.2fL；单核细胞计数(Mono#)-静脉血: 0.410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；中性粒细胞百分比(Neut%)-静脉血: 0.79；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；血小板比容-静脉血: 20%；血红蛋白(Hb)-静脉血: 118g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.009；淋巴细胞百分比(Lymph%)-静脉血: 0.147；红细胞计数(RBC#)-静脉血: 3.9610E12/L；血小板分布宽度(PDW)-静脉血: 9.9%；大血小板百分比(P-LCR%)-静脉血: 18.7%；中性粒细胞计数(Neut#)-静脉血: 7.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；白细胞计数(WBC#)-静脉血: 910E9/L\n- [全程D40] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.018；草酸钙结晶计数(CAOX#)-尿液: 10/μL；红细胞计数(RBC#)-尿液: 4/μL；总蛋白(TP)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: 无色；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D41] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；红细胞计数(RBC#)-尿液: 4/μL；白细胞(LEU)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；酮体(KET)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 1/μL；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.024；颜色-尿液: Light-Yellow\n- [全程D42] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 6/μL；隐血(OB)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 4/μL；总蛋白(TP)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7；颜色-尿液: Light-Yellow；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.023；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）；细菌计数(BACT#)-尿液: 8/μL\n- [全程D47] 超声；双侧腋窝淋巴结彩超(套): 检查类型: 超声；检查名称: 双侧腋窝淋巴结彩超(套)；检查部位:；检查所见: 双侧侧腋窝腋下组可见多个淋巴结回声，最大约12x6mm，椭圆形，边界清，皮髓质分界清，淋巴门结构可探及。腋上组及腋中组未见明显异常淋巴结回声。 CDFI：上述淋巴结内可见门型血流信号。；检查结论: 左侧腋窝腋下组淋巴结，符合良性淋巴结声像。\n- [全程D47] 检验组合: 有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 89.5fL；钠离子(Na+)-静脉血: 135.9mmol/L；尿酸(UA)-静脉血: 277.5umol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.0062；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；血红蛋白(Hb)-静脉血: 115.6g/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 332.5g/L；碱性磷酸酶(ALP)-静脉血: 63.1U/L；白蛋白(ALB)-静脉血: 39.9g/L；单核细胞百分比(Mono%)-静脉血: 0.056；α-L-岩藻糖苷酶(AFU)-静脉血: 42.7U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.315；尿素氮(BUN)-静脉血: 5.4mmol/L；白细胞计数(WBC#)-静脉血: 4.0510E9/L；总胆固醇(TC)-静脉血: 4.12mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24U/L；氯离子(Cl-)-静脉血: 99.2mmol/L；载脂蛋白B(apoB)-静脉血: 0.78g/L；丙氨酸氨基转移酶(ALT)-静脉血: 41.3U/L；总胆汁酸(TBA)-静脉血: 0.5umol/L；血小板计数(PLT#)-静脉血: 196.310E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.5%；葡萄糖(Glu)-静脉血: 4.67mmol/L；球蛋白(GLO)-静脉血: 23.82g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.3mmol/L；间接胆红素(IBIL)-静脉血: 7umolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.0051；镁离子(Mg2+)-静脉血: 0.69mmol/L；磷(P)-静脉血: 1.4mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 3.7umol/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；总钙(Ca)-静脉血: 2.27mmol/L；胱抑素(Cys-C)-静脉血: 0.95mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.68；中性粒细胞百分比(……\n- [全程D49] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后： 鼻咽腔轻度狭窄，鼻咽左顶壁、左顶后壁、左侧壁增厚，并见团块状软组织信号影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。鼻咽右侧壁粘膜未见增厚，左侧咽隐窝闭塞，右侧咽隐窝存在，左侧咽旁脂肪间隙狭窄。左侧腭帆提肌、腭帆张肌、头长肌受侵犯，余咽旁诸肌未见异常。 鼻腔未见肿物，口咽左侧壁受侵稍增厚。 双侧翼腭窝、双侧颞下窝未见异常。 蝶骨基底部、斜坡左侧份、左侧岩尖、左侧翼突基底部、左侧翼突内侧板骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、上颌窦、蝶窦、双侧乳突气化良好，未见异常信号影。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。蝶鞍形态正常，其内未见占位性病变。 左侧咽后见肿大的淋巴结，短径17mm，右侧咽后见小淋巴结，短径5mm。左颈II、III区见多个肿大淋巴结，较大者短径13mm，信号欠均匀，增强扫描不均匀强化。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。 扫描所见脑组织未见明确异常。；检查结论: 鼻咽癌化疗后，对比某次就诊时间日片： 鼻咽肿物，较前明显缩小。 颅底骨质破坏，基本同前。 左侧咽后淋巴结、左颈II、III区淋巴结，考虑转移瘤，较前明显缩小。右侧咽后小淋巴结，较前变化不大。\n- [全程D50] 检验组合: 总胆红素(TBIL)-静脉血: 8.1umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 20710E9/L；磷(P)-静脉血: 1.19mmol/L；中性粒细胞计数(Neut#)-静脉血: 2.810E9/L；葡萄糖(Glu)-静脉血: 5.75mmol/L；血红蛋白(Hb)-静脉血: 118g/L；尿酸(UA)-静脉血: 347.3umol/L；平均红细胞体积(MCV)-静脉血: 85.6fL；胱抑素(Cys-C)-静脉血: 1.01mg/L；红细胞比容(Hct)-静脉血: 34%；C-反应蛋白(CRP)-静脉血: 0.45mg/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；白蛋白(ALB)-静脉血: 44.1g/L；肌酐(Crea)-静脉血: 93.9umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 44.6U/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；总钙(Ca)-静脉血: 2.32mmol/L；红细胞计数(RBC#)-静脉血: 3.9710E12/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.1；球蛋白(GLO)-静脉血: 26.11g/L；尿素氮(BUN)-静脉血: 7.9mmol/L；钾离子(K+)-静脉血: 3.55mmol/L；载脂蛋白B(apoB)-静脉血: 0.88g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.72mmol/L；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.592；载脂蛋白AI(apoAI)-静脉血: 1.31g/L；乳酸脱氢酶(LDH)-静脉血: 232.4U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；总胆汁酸(TBA)-静脉血: 2.1umol/L；氯离子(Cl-)-静脉血: 102mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 23.5U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.33mmolL；总蛋白(TP)-静脉血: 70.21g/L；阴离子间隙(AG)-静脉血: 12.8；α-L-岩藻糖苷酶(AFU)-静脉血: 40.7U/L；总胆固醇(TC)-静脉血: 4.57mmol/L；白细胞计数(W……\n\n【既往治疗与反应】\n- [全程D36] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者复查血常规：中性粒细胞1.2×109/L。郭医生信息已隐藏：暂停化疗，予以患者升中西粒细胞处理。\n- [全程D37] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 患者入院第三天，继续升白细胞处理，今日复查血常规，白细胞已经恢复正常，郭医生信息已隐藏：下周一予以患者第二程化疗。\n- [全程D40] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，可于今日执行第2程5-FU+顺铂方案诱导化疗，注意化疗不良反应。\n- [全程D43] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D47] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+顺铂方案诱导化疗结束，诉恶心、食欲下降，无发热、呕吐、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第2程5-FU+顺铂方案诱导化疗结束，无诉特殊不适，嘱其完成鼻咽、颈MRI复查，以及放疗定位扫描，定期返院治疗。遵嘱。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 予以第3程5-FU+顺铂方案诱导化疗，并继续予以护胃、止呕、补液等常规对症支持治疗。\nB. 开始适形调强放射治疗（IMRT），并予以雾化吸入、鼻腔冲洗、皮肤及黏膜保护剂等放疗支持处理。\nC. 开始适形调强放射治疗（IMRT），待出现III度以上放射性皮炎或黏膜炎时再启动局部保护剂及雾化治疗。\nD. 予以第3程5-FU+顺铂方案诱导化疗，并预防性使用长效重组人粒细胞集落刺激因子。\nE. 开始适形调强放射治疗（IMRT），并常规预防性静脉滴注头孢类广谱抗生素及抗真菌药物。\nF. 暂缓抗肿瘤治疗，继续予以升白细胞及营养支持治疗，观察1-2周后再复查各项生化指标。\nG. 开始适形调强放射治疗（IMRT），并常规预防性静脉滴注大剂量糖皮质激素及甘露醇脱水。\nH. 开始适形调强放射治疗（IMRT），并预防性给予全胃肠外营养（TPN）及静脉高营养支持。\nI. 予以单药顺铂同期化疗，并常规予以水化、利尿及止吐等支持治疗，暂缓启动放射治疗。\nJ. 开始适形调强放射治疗（IMRT），并常规预防性口服非甾体抗炎药及阿片类镇痛药物。\nK. 开始适形调强放射治疗（IMRT），并予以预防性低分子肝素抗凝及深静脉置管常规护理。\nL. 予以靶向治疗联合适形调强放射治疗（IMRT），并常规予以抗过敏及皮疹预防对症处理。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、斜坡、口咽、蝶骨基底部、岩尖。\n文本分期信息：N2，Mx 左侧腋窝淋巴结可疑转移。\n综合TNM状态：T3N2Mx 左侧腋窝淋巴结可疑转移。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D37] 检验组合: 嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.4；红细胞比容(Hct)-静脉血: 35.6%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞体积(MCV)-静脉血: 89.9fL；单核细胞百分比(Mono%)-静脉血: 0.046；血小板计数(PLT#)-静脉血: 21310E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.8pg；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.9；平均血小板体积(MPV)-静脉血: 9.2fL；单核细胞计数(Mono#)-静脉血: 0.410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；中性粒细胞百分比(Neut%)-静脉血: 0.79；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；血小板比容-静脉血: 20%；血红蛋白(Hb)-静脉血: 118g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.009；淋巴细胞百分比(Lymph%)-静脉血: 0.147；红细胞计数(RBC#)-静脉血: 3.9610E12/L；血小板分布宽度(PDW)-静脉血: 9.9%；大血小板百分比(P-LCR%)-静脉血: 18.7%；中性粒细胞计数(Neut#)-静脉血: 7.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；白细胞计数(WBC#)-静脉血: 910E9/L\n- [全程D40] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.018；草酸钙结晶计数(CAOX#)-尿液: 10/μL；红细胞计数(RBC#)-尿液: 4/μL；总蛋白(TP)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: 无色；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D41] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；红细胞计数(RBC#)-尿液: 4/μL；白细胞(LEU)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；酮体(KET)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 1/μL；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.024；颜色-尿液: Light-Yellow\n- [全程D42] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 6/μL；隐血(OB)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 4/μL；总蛋白(TP)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7；颜色-尿液: Light-Yellow；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.023；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）；细菌计数(BACT#)-尿液: 8/μL\n- [全程D47] 超声；双侧腋窝淋巴结彩超(套): 检查类型: 超声；检查名称: 双侧腋窝淋巴结彩超(套)；检查部位:；检查所见: 双侧侧腋窝腋下组可见多个淋巴结回声，最大约12x6mm，椭圆形，边界清，皮髓质分界清，淋巴门结构可探及。腋上组及腋中组未见明显异常淋巴结回声。 CDFI：上述淋巴结内可见门型血流信号。；检查结论: 左侧腋窝腋下组淋巴结，符合良性淋巴结声像。\n- [全程D47] 检验组合: 有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 89.5fL；钠离子(Na+)-静脉血: 135.9mmol/L；尿酸(UA)-静脉血: 277.5umol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.0062；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；血红蛋白(Hb)-静脉血: 115.6g/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 332.5g/L；碱性磷酸酶(ALP)-静脉血: 63.1U/L；白蛋白(ALB)-静脉血: 39.9g/L；单核细胞百分比(Mono%)-静脉血: 0.056；α-L-岩藻糖苷酶(AFU)-静脉血: 42.7U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.315；尿素氮(BUN)-静脉血: 5.4mmol/L；白细胞计数(WBC#)-静脉血: 4.0510E9/L；总胆固醇(TC)-静脉血: 4.12mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24U/L；氯离子(Cl-)-静脉血: 99.2mmol/L；载脂蛋白B(apoB)-静脉血: 0.78g/L；丙氨酸氨基转移酶(ALT)-静脉血: 41.3U/L；总胆汁酸(TBA)-静脉血: 0.5umol/L；血小板计数(PLT#)-静脉血: 196.310E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.5%；葡萄糖(Glu)-静脉血: 4.67mmol/L；球蛋白(GLO)-静脉血: 23.82g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.3mmol/L；间接胆红素(IBIL)-静脉血: 7umolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.0051；镁离子(Mg2+)-静脉血: 0.69mmol/L；磷(P)-静脉血: 1.4mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 3.7umol/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；总钙(Ca)-静脉血: 2.27mmol/L；胱抑素(Cys-C)-静脉血: 0.95mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.68；中性粒细胞百分比(……\n- [全程D49] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后： 鼻咽腔轻度狭窄，鼻咽左顶壁、左顶后壁、左侧壁增厚，并见团块状软组织信号影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。鼻咽右侧壁粘膜未见增厚，左侧咽隐窝闭塞，右侧咽隐窝存在，左侧咽旁脂肪间隙狭窄。左侧腭帆提肌、腭帆张肌、头长肌受侵犯，余咽旁诸肌未见异常。 鼻腔未见肿物，口咽左侧壁受侵稍增厚。 双侧翼腭窝、双侧颞下窝未见异常。 蝶骨基底部、斜坡左侧份、左侧岩尖、左侧翼突基底部、左侧翼突内侧板骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、上颌窦、蝶窦、双侧乳突气化良好，未见异常信号影。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。蝶鞍形态正常，其内未见占位性病变。 左侧咽后见肿大的淋巴结，短径17mm，右侧咽后见小淋巴结，短径5mm。左颈II、III区见多个肿大淋巴结，较大者短径13mm，信号欠均匀，增强扫描不均匀强化。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。 扫描所见脑组织未见明确异常。；检查结论: 鼻咽癌化疗后，对比某次就诊时间日片： 鼻咽肿物，较前明显缩小。 颅底骨质破坏，基本同前。 左侧咽后淋巴结、左颈II、III区淋巴结，考虑转移瘤，较前明显缩小。右侧咽后小淋巴结，较前变化不大。\n- [全程D50] 检验组合: 总胆红素(TBIL)-静脉血: 8.1umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 20710E9/L；磷(P)-静脉血: 1.19mmol/L；中性粒细胞计数(Neut#)-静脉血: 2.810E9/L；葡萄糖(Glu)-静脉血: 5.75mmol/L；血红蛋白(Hb)-静脉血: 118g/L；尿酸(UA)-静脉血: 347.3umol/L；平均红细胞体积(MCV)-静脉血: 85.6fL；胱抑素(Cys-C)-静脉血: 1.01mg/L；红细胞比容(Hct)-静脉血: 34%；C-反应蛋白(CRP)-静脉血: 0.45mg/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；白蛋白(ALB)-静脉血: 44.1g/L；肌酐(Crea)-静脉血: 93.9umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 44.6U/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；总钙(Ca)-静脉血: 2.32mmol/L；红细胞计数(RBC#)-静脉血: 3.9710E12/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.1；球蛋白(GLO)-静脉血: 26.11g/L；尿素氮(BUN)-静脉血: 7.9mmol/L；钾离子(K+)-静脉血: 3.55mmol/L；载脂蛋白B(apoB)-静脉血: 0.88g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.72mmol/L；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.592；载脂蛋白AI(apoAI)-静脉血: 1.31g/L；乳酸脱氢酶(LDH)-静脉血: 232.4U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；总胆汁酸(TBA)-静脉血: 2.1umol/L；氯离子(Cl-)-静脉血: 102mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 23.5U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.33mmolL；总蛋白(TP)-静脉血: 70.21g/L；阴离子间隙(AG)-静脉血: 12.8；α-L-岩藻糖苷酶(AFU)-静脉血: 40.7U/L；总胆固醇(TC)-静脉血: 4.57mmol/L；白细胞计数(W……\n\n【既往治疗与反应】\n- [全程D36] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者复查血常规：中性粒细胞1.2×109/L。郭医生信息已隐藏：暂停化疗，予以患者升中西粒细胞处理。\n- [全程D37] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 患者入院第三天，继续升白细胞处理，今日复查血常规，白细胞已经恢复正常，郭医生信息已隐藏：下周一予以患者第二程化疗。\n- [全程D40] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，可于今日执行第2程5-FU+顺铂方案诱导化疗，注意化疗不良反应。\n- [全程D43] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D47] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+顺铂方案诱导化疗结束，诉恶心、食欲下降，无发热、呕吐、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第2程5-FU+顺铂方案诱导化疗结束，无诉特殊不适，嘱其完成鼻咽、颈MRI复查，以及放疗定位扫描，定期返院治疗。遵嘱。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 予以第3程5-FU+顺铂方案诱导化疗，并继续予以护胃、止呕、补液等常规对症支持治疗。\nB. 开始适形调强放射治疗（IMRT），并予以雾化吸入、鼻腔冲洗、皮肤及黏膜保护剂等放疗支持处理。\nC. 开始适形调强放射治疗（IMRT），待出现III度以上放射性皮炎或黏膜炎时再启动局部保护剂及雾化治疗。\nD. 予以第3程5-FU+顺铂方案诱导化疗，并预防性使用长效重组人粒细胞集落刺激因子。\nE. 开始适形调强放射治疗（IMRT），并常规预防性静脉滴注头孢类广谱抗生素及抗真菌药物。\nF. 暂缓抗肿瘤治疗，继续予以升白细胞及营养支持治疗，观察1-2周后再复查各项生化指标。\nG. 开始适形调强放射治疗（IMRT），并常规预防性静脉滴注大剂量糖皮质激素及甘露醇脱水。\nH. 开始适形调强放射治疗（IMRT），并预防性给予全胃肠外营养（TPN）及静脉高营养支持。\nI. 予以单药顺铂同期化疗，并常规予以水化、利尿及止吐等支持治疗，暂缓启动放射治疗。\nJ. 开始适形调强放射治疗（IMRT），并常规预防性口服非甾体抗炎药及阿片类镇痛药物。\nK. 开始适形调强放射治疗（IMRT），并予以预防性低分子肝素抗凝及深静脉置管常规护理。\nL. 予以靶向治疗联合适形调强放射治疗（IMRT），并常规予以抗过敏及皮疹预防对症处理。\n\n请仅输出一个选项字母（A-L）。"}]}
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full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、斜坡、口咽、蝶骨基底部、岩尖。\n文本分期信息：N2，Mx 左侧腋窝淋巴结可疑转移。\n综合TNM状态：T3N2Mx 左侧腋窝淋巴结可疑转移。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D34] 检验组合: 中性粒细胞百分比(Neut%)-静脉血: 0.356；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329.8g/L；中性粒细胞计数(Neut#)-静脉血: 1.210E9/L；载脂蛋白AI(apoAI)-静脉血: 1.23g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 1.9umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.3；平均红细胞体积(MCV)-静脉血: 89.7fL；钾离子(K+)-静脉血: 3.9mmol/L；总蛋白(TP)-静脉血: 68.46g/L；球蛋白(GLO)-静脉血: 29.66g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.5%；血小板分布宽度(PDW)-静脉血: 16%；白细胞计数(WBC#)-静脉血: 3.2410E9/L；磷(P)-静脉血: 1.24mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.0079；间接胆红素(IBIL)-静脉血: 2.8umolL；镁离子(Mg2+)-静脉血: 0.89mmol/L；碱性磷酸酶(ALP)-静脉血: 66.5U/L；红细胞比容(Hct)-静脉血: 36.1%；丙氨酸氨基转移酶(ALT)-静脉血: 18.5U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.51；单核细胞百分比(Mono%)-静脉血: 0.1112；尿素氮(BUN)-静脉血: 5.39mmol/L；红细胞计数(RBC#)-静脉血: 4.0210E12/L；血小板计数(PLT#)-静脉血: 240.610E9/L；胱抑素(Cys-C)-静脉血: 0.87mg/L；天门冬氨酸氨基转移酶(AST)-静脉血: 22.2U/L；C-反应蛋白(CRP)-静脉血: 0.37mg/L；阴离子间隙(AG)-静脉血: 13；总胆汁酸(TBA)-静脉血: 0.8umol/L；葡萄糖(Glu)-静脉血: 4.81mmol/L；总钙(Ca)-静脉血: 2.31mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；总胆红素(TBIL)-静脉血: 4.7umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.2；平均血小板体积(MPV)-静脉血……\n- [全程D35] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁、后壁及左侧壁增厚放射性浓聚，SUV约22.8，病灶向下侵犯软腭及口咽左侧壁；病灶侵犯左头长肌、左侧腭帆提张肌及左咽旁间隙，左侧咽隐窝消失，左侧咽旁间隙消失。左咽后肿大淋巴结放射性浓聚，SUV约19.2，与鼻咽病灶分界不清。喉咽结构及放射性分布未见明显异常。额窦、蝶窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。左颈II、III区数个淋巴结放射性浓聚，SUV约20.2，最大约1.8×3.3cm；右颈II、Va区数个小淋巴结部分放射性分布略浓密，SUV约3.3，最大约0.6×1.1cm；余双颈小淋巴结放射性分布未见异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。心脏及纵隔大血管未见明显异常。左腋窝淋巴结放射性分布浓密，SUV约9.0，大小约0.9×1.5cm；纵隔、双肺门及右侧腋窝未见肿大淋巴结及异常放射性分布。双侧乳腺放射性分布未见明显异常。 肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 子宫体积增大，外形呈波浪状，放射性分布未见异常；子宫旁见高密度节育器影；膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，病灶侵犯软腭、口咽左侧壁及左咽旁间隙；左咽后及左颈II、III区淋巴结代谢活跃，考虑转移；左腋窝淋巴结代谢活跃，不排除转移。 右颈II、Va区小淋巴结部分代谢略活跃，疑炎性病变，请结合临床。 疑子宫肌瘤。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即按原剂量启动第二程5-FU+顺铂方案化疗，并预防性给予长效重组人粒细胞刺激因子皮下注射\nB. 立即按原剂量启动第二程5-FU+顺铂方案化疗，化疗期间同步给予短效重组人粒细胞刺激因子皮下注射\nC. 暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，动态监测血常规，待中性粒细胞计数恢复后再行下一程化疗\nD. 暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射及广谱抗菌药物静脉滴注，待中性粒细胞计数恢复后再行化疗\nE. 终止诱导化疗，直接进入根治性放疗阶段，并给予重组人粒细胞刺激因子皮下注射\nF. 暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，待中性粒细胞恢复后调整下一程化疗方案为单药顺铂\nG. 暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，待中性粒细胞恢复后将5-FU与顺铂剂量均减低20%行下一程化疗\nH. 暂缓本周期化疗，仅予密切观察和口服升白药物，待中性粒细胞计数自然恢复后再行化疗\nI. 暂缓本周期化疗，行左侧腋窝淋巴结穿刺活检，同时给予重组人粒细胞刺激因子皮下注射\nJ. 立即按原剂量启动第二程5-FU+顺铂方案化疗，化疗结束后48小时给予重组人粒细胞刺激因子皮下注射\nK. 暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，并安排全身PET-CT重新评估肿瘤范围\nL. 终止诱导化疗，改为靶向治疗联合重组人粒细胞刺激因子皮下注射，动态监测血常规\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、斜坡、口咽、蝶骨基底部、岩尖。\n文本分期信息：N2，Mx 左侧腋窝淋巴结可疑转移。\n综合TNM状态：T3N2Mx 左侧腋窝淋巴结可疑转移。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D34] 检验组合: 中性粒细胞百分比(Neut%)-静脉血: 0.356；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329.8g/L；中性粒细胞计数(Neut#)-静脉血: 1.210E9/L；载脂蛋白AI(apoAI)-静脉血: 1.23g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 1.9umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.3；平均红细胞体积(MCV)-静脉血: 89.7fL；钾离子(K+)-静脉血: 3.9mmol/L；总蛋白(TP)-静脉血: 68.46g/L；球蛋白(GLO)-静脉血: 29.66g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.5%；血小板分布宽度(PDW)-静脉血: 16%；白细胞计数(WBC#)-静脉血: 3.2410E9/L；磷(P)-静脉血: 1.24mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.0079；间接胆红素(IBIL)-静脉血: 2.8umolL；镁离子(Mg2+)-静脉血: 0.89mmol/L；碱性磷酸酶(ALP)-静脉血: 66.5U/L；红细胞比容(Hct)-静脉血: 36.1%；丙氨酸氨基转移酶(ALT)-静脉血: 18.5U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.51；单核细胞百分比(Mono%)-静脉血: 0.1112；尿素氮(BUN)-静脉血: 5.39mmol/L；红细胞计数(RBC#)-静脉血: 4.0210E12/L；血小板计数(PLT#)-静脉血: 240.610E9/L；胱抑素(Cys-C)-静脉血: 0.87mg/L；天门冬氨酸氨基转移酶(AST)-静脉血: 22.2U/L；C-反应蛋白(CRP)-静脉血: 0.37mg/L；阴离子间隙(AG)-静脉血: 13；总胆汁酸(TBA)-静脉血: 0.8umol/L；葡萄糖(Glu)-静脉血: 4.81mmol/L；总钙(Ca)-静脉血: 2.31mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；总胆红素(TBIL)-静脉血: 4.7umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.2；平均血小板体积(MPV)-静脉血……\n- [全程D35] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁、后壁及左侧壁增厚放射性浓聚，SUV约22.8，病灶向下侵犯软腭及口咽左侧壁；病灶侵犯左头长肌、左侧腭帆提张肌及左咽旁间隙，左侧咽隐窝消失，左侧咽旁间隙消失。左咽后肿大淋巴结放射性浓聚，SUV约19.2，与鼻咽病灶分界不清。喉咽结构及放射性分布未见明显异常。额窦、蝶窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。左颈II、III区数个淋巴结放射性浓聚，SUV约20.2，最大约1.8×3.3cm；右颈II、Va区数个小淋巴结部分放射性分布略浓密，SUV约3.3，最大约0.6×1.1cm；余双颈小淋巴结放射性分布未见异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。心脏及纵隔大血管未见明显异常。左腋窝淋巴结放射性分布浓密，SUV约9.0，大小约0.9×1.5cm；纵隔、双肺门及右侧腋窝未见肿大淋巴结及异常放射性分布。双侧乳腺放射性分布未见明显异常。 肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 子宫体积增大，外形呈波浪状，放射性分布未见异常；子宫旁见高密度节育器影；膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，病灶侵犯软腭、口咽左侧壁及左咽旁间隙；左咽后及左颈II、III区淋巴结代谢活跃，考虑转移；左腋窝淋巴结代谢活跃，不排除转移。 右颈II、Va区小淋巴结部分代谢略活跃，疑炎性病变，请结合临床。 疑子宫肌瘤。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即按原剂量启动第二程5-FU+顺铂方案化疗，并预防性给予长效重组人粒细胞刺激因子皮下注射\nB. 立即按原剂量启动第二程5-FU+顺铂方案化疗，化疗期间同步给予短效重组人粒细胞刺激因子皮下注射\nC. 暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，动态监测血常规，待中性粒细胞计数恢复后再行下一程化疗\nD. 暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射及广谱抗菌药物静脉滴注，待中性粒细胞计数恢复后再行化疗\nE. 终止诱导化疗，直接进入根治性放疗阶段，并给予重组人粒细胞刺激因子皮下注射\nF. 暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，待中性粒细胞恢复后调整下一程化疗方案为单药顺铂\nG. 暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，待中性粒细胞恢复后将5-FU与顺铂剂量均减低20%行下一程化疗\nH. 暂缓本周期化疗，仅予密切观察和口服升白药物，待中性粒细胞计数自然恢复后再行化疗\nI. 暂缓本周期化疗，行左侧腋窝淋巴结穿刺活检，同时给予重组人粒细胞刺激因子皮下注射\nJ. 立即按原剂量启动第二程5-FU+顺铂方案化疗，化疗结束后48小时给予重组人粒细胞刺激因子皮下注射\nK. 暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，并安排全身PET-CT重新评估肿瘤范围\nL. 终止诱导化疗，改为靶向治疗联合重组人粒细胞刺激因子皮下注射，动态监测血常规\n\n请仅输出一个选项字母（A-L）。"}]}
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+{"sample_id":"sample-13d0893c195434e9115bcbbc","patient_id":"patient-84fa3d6098d10a1d14b6b19e","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"F","gold_action":"完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测。","options":[{"letter":"A","text":"完善基线血液学检查，包含血常规、生化常规及凝血功能，暂缓检测EB病毒DNA及骨代谢标志物。","is_gold":false},{"letter":"B","text":"完善基线血液学检查，包含生化常规、凝血功能及传染病筛查，并安排全身PET-CT替代常规影像学分期。","is_gold":false},{"letter":"C","text":"完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能及传染病筛查，暂缓检测骨代谢标志物。","is_gold":false},{"letter":"D","text":"完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查，并安排颈部淋巴结穿刺活检明确病理。","is_gold":false},{"letter":"E","text":"完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查，并安排头颅增强MRI评估颅内侵犯。","is_gold":false},{"letter":"F","text":"完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测。","is_gold":true},{"letter":"G","text":"完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并安排全身PET-CT替代所有常规分期检查。","is_gold":false},{"letter":"H","text":"完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并安排鼻咽部平扫MRI。","is_gold":false},{"letter":"I","text":"完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并安排颈部超声指导淋巴结清扫。","is_gold":false},{"letter":"J","text":"完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并安排鼻咽镜评估治疗疗效。","is_gold":false},{"letter":"K","text":"完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并首选胸部X线片排除肺转移。","is_gold":false},{"letter":"L","text":"完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并常规安排骨髓穿刺排除骨髓转移。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、斜坡、海绵窦、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善基线血液学检查，包含血常规、生化常规及凝血功能，暂缓检测EB病毒DNA及骨代谢标志物。\nB. 完善基线血液学检查，包含生化常规、凝血功能及传染病筛查，并安排全身PET-CT替代常规影像学分期。\nC. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能及传染病筛查，暂缓检测骨代谢标志物。\nD. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查，并安排颈部淋巴结穿刺活检明确病理。\nE. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查，并安排头颅增强MRI评估颅内侵犯。\nF. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测。\nG. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并安排全身PET-CT替代所有常规分期检查。\nH. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并安排鼻咽部平扫MRI。\nI. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并安排颈部超声指导淋巴结清扫。\nJ. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并安排鼻咽镜评估治疗疗效。\nK. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并首选胸部X线片排除肺转移。\nL. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并常规安排骨髓穿刺排除骨髓转移。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、斜坡、海绵窦、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善基线血液学检查，包含血常规、生化常规及凝血功能，暂缓检测EB病毒DNA及骨代谢标志物。\nB. 完善基线血液学检查，包含生化常规、凝血功能及传染病筛查，并安排全身PET-CT替代常规影像学分期。\nC. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能及传染病筛查，暂缓检测骨代谢标志物。\nD. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查，并安排颈部淋巴结穿刺活检明确病理。\nE. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查，并安排头颅增强MRI评估颅内侵犯。\nF. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测。\nG. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并安排全身PET-CT替代所有常规分期检查。\nH. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并安排鼻咽部平扫MRI。\nI. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并安排颈部超声指导淋巴结清扫。\nJ. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并安排鼻咽镜评估治疗疗效。\nK. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并首选胸部X线片排除肺转移。\nL. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并常规安排骨髓穿刺排除骨髓转移。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-474b60646fc04122e2c1c7ce","patient_id":"patient-84fa3d6098d10a1d14b6b19e","turn_id":"turn04","turn_position":3,"turn_type":"initial_treatment_selection","gold_letter":"H","gold_action":"顺铂+氟尿嘧啶（PF方案）诱导化疗","options":[{"letter":"A","text":"顺铂单药同期放化疗","is_gold":false},{"letter":"B","text":"多西他赛+顺铂（TP方案）姑息化疗","is_gold":false},{"letter":"C","text":"鼻咽及颈部根治性放射治疗","is_gold":false},{"letter":"D","text":"顺铂+多西他赛（TP方案）同期放化疗","is_gold":false},{"letter":"E","text":"依托泊苷+顺铂（EP方案）诱导化疗","is_gold":false},{"letter":"F","text":"顺铂+氟尿嘧啶（PF方案）姑息化疗","is_gold":false},{"letter":"G","text":"西妥昔单抗联合根治性放疗","is_gold":false},{"letter":"H","text":"顺铂+氟尿嘧啶（PF方案）诱导化疗","is_gold":true},{"letter":"I","text":"氟尿嘧啶单药诱导化疗","is_gold":false},{"letter":"J","text":"吉西他滨+顺铂（GP方案）姑息化疗","is_gold":false},{"letter":"K","text":"顺铂单药诱导化疗","is_gold":false},{"letter":"L","text":"卡瑞利珠单抗联合PF方案姑息化疗","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、斜坡、海绵窦、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D3] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D3] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 38mm AO 26mm MV E 0.79m/s EF 75% LV 50mm IVS 11mm A 0.67m/s FS 45% RA 33mm LVPW 8mm RV 20mm PA 19mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 左房稍大，余各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 左房稍大 各房室腔及大血管未探及异常血流信号 心功能正常\n- [全程D3] 检验组合: 丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D4] CT；胸部CT平扫＋增强: 检查类型: CT；检查名称: 胸部CT平扫＋增强；检查部位:；检查所见: 右中肺及双下肺见数个类结节影，最大者直径约 5 mm，病灶边界清楚而不规则，密度较高而不均匀；气管及支气管分枝通畅，未见明显软组织肿物或受压变窄；双侧肺门及纵隔未见明确肿大淋巴结；双侧胸腔未见积液；胸膜未见增厚；扫描范围内胸椎、胸壁骨未见骨质破坏征象。；检查结论: 双肺类结节影，转移瘤可能性大。\n- [全程D4] 检验组合: 酮体(KET)-尿液: +-（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；尿胆原(URO)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 4/μL；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；白细胞计数(WBC#)-尿液: 26/μL；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；酸碱度(pH)-尿液: 6；总蛋白(TP)-尿液: -（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性（参考: 阴性）；颜色-尿液: Light-Yellow；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；非鳞状上皮细胞计数-尿液: 2/μL；比重(SG)-尿液: 1.032；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.05；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 顺铂单药同期放化疗\nB. 多西他赛+顺铂（TP方案）姑息化疗\nC. 鼻咽及颈部根治性放射治疗\nD. 顺铂+多西他赛（TP方案）同期放化疗\nE. 依托泊苷+顺铂（EP方案）诱导化疗\nF. 顺铂+氟尿嘧啶（PF方案）姑息化疗\nG. 西妥昔单抗联合根治性放疗\nH. 顺铂+氟尿嘧啶（PF方案）诱导化疗\nI. 氟尿嘧啶单药诱导化疗\nJ. 吉西他滨+顺铂（GP方案）姑息化疗\nK. 顺铂单药诱导化疗\nL. 卡瑞利珠单抗联合PF方案姑息化疗\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、斜坡、海绵窦、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D3] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D3] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 38mm AO 26mm MV E 0.79m/s EF 75% LV 50mm IVS 11mm A 0.67m/s FS 45% RA 33mm LVPW 8mm RV 20mm PA 19mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 左房稍大，余各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 左房稍大 各房室腔及大血管未探及异常血流信号 心功能正常\n- [全程D3] 检验组合: 丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D4] CT；胸部CT平扫＋增强: 检查类型: CT；检查名称: 胸部CT平扫＋增强；检查部位:；检查所见: 右中肺及双下肺见数个类结节影，最大者直径约 5 mm，病灶边界清楚而不规则，密度较高而不均匀；气管及支气管分枝通畅，未见明显软组织肿物或受压变窄；双侧肺门及纵隔未见明确肿大淋巴结；双侧胸腔未见积液；胸膜未见增厚；扫描范围内胸椎、胸壁骨未见骨质破坏征象。；检查结论: 双肺类结节影，转移瘤可能性大。\n- [全程D4] 检验组合: 酮体(KET)-尿液: +-（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；尿胆原(URO)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 4/μL；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；白细胞计数(WBC#)-尿液: 26/μL；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；酸碱度(pH)-尿液: 6；总蛋白(TP)-尿液: -（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性（参考: 阴性）；颜色-尿液: Light-Yellow；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；非鳞状上皮细胞计数-尿液: 2/μL；比重(SG)-尿液: 1.032；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.05；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 顺铂单药同期放化疗\nB. 多西他赛+顺铂（TP方案）姑息化疗\nC. 鼻咽及颈部根治性放射治疗\nD. 顺铂+多西他赛（TP方案）同期放化疗\nE. 依托泊苷+顺铂（EP方案）诱导化疗\nF. 顺铂+氟尿嘧啶（PF方案）姑息化疗\nG. 西妥昔单抗联合根治性放疗\nH. 顺铂+氟尿嘧啶（PF方案）诱导化疗\nI. 氟尿嘧啶单药诱导化疗\nJ. 吉西他滨+顺铂（GP方案）姑息化疗\nK. 顺铂单药诱导化疗\nL. 卡瑞利珠单抗联合PF方案姑息化疗\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-654cb1177e5cb9c5732eccb0","patient_id":"patient-84fa3d6098d10a1d14b6b19e","turn_id":"turn05","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"I","gold_action":"继续当前化疗及对症支持治疗，执行动静脉置管常规护理，并常规监测血常规与生化指标。","options":[{"letter":"A","text":"暂停化疗，静脉滴注还原型谷胱甘肽进行保肝治疗，待肝功能恢复正常后重启化疗。","is_gold":false},{"letter":"B","text":"暂停化疗，静脉滴注头孢类抗生素进行经验性抗感染治疗，待白细胞计数恢复正常后重启化疗。","is_gold":false},{"letter":"C","text":"继续化疗，皮下注射重组人粒细胞集落刺激因子预防中性粒细胞缺乏。","is_gold":false},{"letter":"D","text":"终止诱导化疗，提前进入根治性放疗阶段，并静脉滴注保肝药物。","is_gold":false},{"letter":"E","text":"继续化疗，静脉滴注异甘草酸镁注射液进行保肝治疗，并每日复查肝功能。","is_gold":false},{"letter":"F","text":"暂停化疗，行腹部CT增强扫描以排除肝脏转移或化疗引起的急性肝损伤。","is_gold":false},{"letter":"G","text":"继续化疗，停用所有止吐及护胃药物以减轻肝脏代谢负担。","is_gold":false},{"letter":"H","text":"暂停化疗，静脉推注地塞米松及异丙嗪进行抗过敏治疗。","is_gold":false},{"letter":"I","text":"继续化疗及对症支持治疗，执行动静脉置管常规护理，并常规监测血常规与生化指标。","is_gold":true},{"letter":"J","text":"继续化疗，拔除动静脉置管以预防导管相关性血流感染，改用外周静脉穿刺。","is_gold":false},{"letter":"K","text":"暂停化疗，静脉滴注氯化钾进行补钾治疗，待血钾明显上升后继续化疗。","is_gold":false},{"letter":"L","text":"继续化疗，静脉推注呋塞米促进顺铂排泄，预防急性肾功能损伤。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、斜坡、海绵窦、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D2] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: 右臂静脉插管,导管末端位于T 6右旁，估计位于上腔静脉中段。；检查结论: 导管末端位置如上述。\n- [全程D2] 检验组合: 血小板分布宽度(PDW)-静脉血: 13.8%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；淋巴细胞百分比(Lymph%)-静脉血: 0.262；单核细胞计数(Mono#)-静脉血: 0.510E9/L；胱抑素(Cys-C)-静脉血: 1.01mg/L；总蛋白(TP)-静脉血: 68.46g/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.16COI；透明质酸(HA)-静脉血: 61.97ng/ml；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；大血小板百分比(P-LCR%)-静脉血: 32.4%；白蛋白(ALB)-静脉血: 43.7g/L；总胆固醇(TC)-静脉血: 5.59mmol/L；总胆红素(TBIL)-静脉血: 14.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.84；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.009；丙氨酸氨基转移酶(ALT)-静脉血: 27U/L；氯离子(Cl-)-静脉血: 103.1mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；淋巴细胞计数(Lymph#)-静脉血: 2.510E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.63mmol/L；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.06S/CO；血小板比容-静脉血: 21%；载脂蛋白B(apoB)-静脉血: 1.22g/L；C-反应蛋白(CRP)-静脉血: 4.05mg/L；ABO血型-静脉血: A；载脂蛋白AI(apoAI)-静脉血: 1.2g/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；单核细胞百分比(Mono%)-静脉血: 0.049；钠离子(Na+)-静脉血: 139.6mmol/L；凝血酶原时间(PT)-静脉血: 10.3sec.；球蛋白(GLO)-静脉血: 24.76g/L；纤维蛋白原(Fbg)-静脉血: 2.49g/L；凝血酶时间(TT)-静脉血: 20sec.；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44.6；Rh血型-静脉血: 阳性；平均红细胞体积(MCV)-静脉血: 85.8fL；直接胆红素(DBIL)-静脉血: 3.3umol/L；凝血酶原时间活动度(PTA)-静脉血: 113.8……\n- [全程D5] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: 3+500Leu（参考: 阴性）；白细胞计数(WBC#)-尿液: 18/μL；鳞状上皮细胞计数(SQEP#)-尿液: 5/μL；比重(SG)-尿液: 1.02；总蛋白(TP)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: Turbid；隐血(OB)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；未分类结晶计数(UNCX#)-尿液: 25/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；非鳞状上皮细胞计数-尿液: 5/μL\n- [全程D9] 检验组合: 钾离子(K+)-静脉血: 3.73mmol/L；红细胞比容(Hct)-静脉血: 48.1%；血小板比容-静脉血: 19%；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.94mmolL；尿素氮(BUN)-静脉血: 9.5mmol/L；钠离子(Na+)-静脉血: 137.8mmol/L；血红蛋白(Hb)-静脉血: 159g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.095；总钙(Ca)-静脉血: 1.93mmol/L；血小板分布宽度(PDW)-静脉血: 13.3%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；丙氨酸氨基转移酶(ALT)-静脉血: 94.9U/L；载脂蛋白B(apoB)-静脉血: 1.06g/L；白蛋白(ALB)-静脉血: 40.3g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.46；白细胞计数(WBC#)-静脉血: 14.910E9/L；胱抑素(Cys-C)-静脉血: 1.26mg/L；平均血小板体积(MPV)-静脉血: 10.4fL；中性粒细胞百分比(Neut%)-静脉血: 0.837；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.45mmol/L；血小板计数(PLT#)-静脉血: 17910E9/L；总胆固醇(TC)-静脉血: 5.1mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.4；球蛋白(GLO)-静脉血: 23.17g/L；磷(P)-静脉血: 1.26mmol/L；间接胆红素(IBIL)-静脉血: 13.1umolL；红细胞计数(RBC#)-静脉血: 5.5910E12/L；直接胆红素(DBIL)-静脉血: 5.4umol/L；总胆汁酸(TBA)-静脉血: 0.1umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；单核细胞百分比(Mono%)-静脉血: 0.06；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 42.8U/L；肌酐(Crea)-静脉血: 101.5umol/L；载脂蛋白AI(apoAI)-静脉血: 0.99g/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.4mmol/L；单核细胞计……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者无诉特殊不适，完善各项检查中，体查同入院时，[姓名已隐去]主任查房指示，待各项检查完成明确分期后，再决定下一步治疗。\n- [全程D8] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停化疗，静脉滴注还原型谷胱甘肽进行保肝治疗，待肝功能恢复正常后重启化疗。\nB. 暂停化疗，静脉滴注头孢类抗生素进行经验性抗感染治疗，待白细胞计数恢复正常后重启化疗。\nC. 继续化疗，皮下注射重组人粒细胞集落刺激因子预防中性粒细胞缺乏。\nD. 终止诱导化疗，提前进入根治性放疗阶段，并静脉滴注保肝药物。\nE. 继续化疗，静脉滴注异甘草酸镁注射液进行保肝治疗，并每日复查肝功能。\nF. 暂停化疗，行腹部CT增强扫描以排除肝脏转移或化疗引起的急性肝损伤。\nG. 继续化疗，停用所有止吐及护胃药物以减轻肝脏代谢负担。\nH. 暂停化疗，静脉推注地塞米松及异丙嗪进行抗过敏治疗。\nI. 继续化疗及对症支持治疗，执行动静脉置管常规护理，并常规监测血常规与生化指标。\nJ. 继续化疗，拔除动静脉置管以预防导管相关性血流感染，改用外周静脉穿刺。\nK. 暂停化疗，静脉滴注氯化钾进行补钾治疗，待血钾明显上升后继续化疗。\nL. 继续化疗，静脉推注呋塞米促进顺铂排泄，预防急性肾功能损伤。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、斜坡、海绵窦、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D2] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: 右臂静脉插管,导管末端位于T 6右旁，估计位于上腔静脉中段。；检查结论: 导管末端位置如上述。\n- [全程D2] 检验组合: 血小板分布宽度(PDW)-静脉血: 13.8%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；淋巴细胞百分比(Lymph%)-静脉血: 0.262；单核细胞计数(Mono#)-静脉血: 0.510E9/L；胱抑素(Cys-C)-静脉血: 1.01mg/L；总蛋白(TP)-静脉血: 68.46g/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.16COI；透明质酸(HA)-静脉血: 61.97ng/ml；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；大血小板百分比(P-LCR%)-静脉血: 32.4%；白蛋白(ALB)-静脉血: 43.7g/L；总胆固醇(TC)-静脉血: 5.59mmol/L；总胆红素(TBIL)-静脉血: 14.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.84；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.009；丙氨酸氨基转移酶(ALT)-静脉血: 27U/L；氯离子(Cl-)-静脉血: 103.1mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；淋巴细胞计数(Lymph#)-静脉血: 2.510E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.63mmol/L；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.06S/CO；血小板比容-静脉血: 21%；载脂蛋白B(apoB)-静脉血: 1.22g/L；C-反应蛋白(CRP)-静脉血: 4.05mg/L；ABO血型-静脉血: A；载脂蛋白AI(apoAI)-静脉血: 1.2g/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；单核细胞百分比(Mono%)-静脉血: 0.049；钠离子(Na+)-静脉血: 139.6mmol/L；凝血酶原时间(PT)-静脉血: 10.3sec.；球蛋白(GLO)-静脉血: 24.76g/L；纤维蛋白原(Fbg)-静脉血: 2.49g/L；凝血酶时间(TT)-静脉血: 20sec.；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44.6；Rh血型-静脉血: 阳性；平均红细胞体积(MCV)-静脉血: 85.8fL；直接胆红素(DBIL)-静脉血: 3.3umol/L；凝血酶原时间活动度(PTA)-静脉血: 113.8……\n- [全程D5] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: 3+500Leu（参考: 阴性）；白细胞计数(WBC#)-尿液: 18/μL；鳞状上皮细胞计数(SQEP#)-尿液: 5/μL；比重(SG)-尿液: 1.02；总蛋白(TP)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: Turbid；隐血(OB)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；未分类结晶计数(UNCX#)-尿液: 25/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；非鳞状上皮细胞计数-尿液: 5/μL\n- [全程D9] 检验组合: 钾离子(K+)-静脉血: 3.73mmol/L；红细胞比容(Hct)-静脉血: 48.1%；血小板比容-静脉血: 19%；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.94mmolL；尿素氮(BUN)-静脉血: 9.5mmol/L；钠离子(Na+)-静脉血: 137.8mmol/L；血红蛋白(Hb)-静脉血: 159g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.095；总钙(Ca)-静脉血: 1.93mmol/L；血小板分布宽度(PDW)-静脉血: 13.3%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；丙氨酸氨基转移酶(ALT)-静脉血: 94.9U/L；载脂蛋白B(apoB)-静脉血: 1.06g/L；白蛋白(ALB)-静脉血: 40.3g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.46；白细胞计数(WBC#)-静脉血: 14.910E9/L；胱抑素(Cys-C)-静脉血: 1.26mg/L；平均血小板体积(MPV)-静脉血: 10.4fL；中性粒细胞百分比(Neut%)-静脉血: 0.837；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.45mmol/L；血小板计数(PLT#)-静脉血: 17910E9/L；总胆固醇(TC)-静脉血: 5.1mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.4；球蛋白(GLO)-静脉血: 23.17g/L；磷(P)-静脉血: 1.26mmol/L；间接胆红素(IBIL)-静脉血: 13.1umolL；红细胞计数(RBC#)-静脉血: 5.5910E12/L；直接胆红素(DBIL)-静脉血: 5.4umol/L；总胆汁酸(TBA)-静脉血: 0.1umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；单核细胞百分比(Mono%)-静脉血: 0.06；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 42.8U/L；肌酐(Crea)-静脉血: 101.5umol/L；载脂蛋白AI(apoAI)-静脉血: 0.99g/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.4mmol/L；单核细胞计……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者无诉特殊不适，完善各项检查中，体查同入院时，[姓名已隐去]主任查房指示，待各项检查完成明确分期后，再决定下一步治疗。\n- [全程D8] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停化疗，静脉滴注还原型谷胱甘肽进行保肝治疗，待肝功能恢复正常后重启化疗。\nB. 暂停化疗，静脉滴注头孢类抗生素进行经验性抗感染治疗，待白细胞计数恢复正常后重启化疗。\nC. 继续化疗，皮下注射重组人粒细胞集落刺激因子预防中性粒细胞缺乏。\nD. 终止诱导化疗，提前进入根治性放疗阶段，并静脉滴注保肝药物。\nE. 继续化疗，静脉滴注异甘草酸镁注射液进行保肝治疗，并每日复查肝功能。\nF. 暂停化疗，行腹部CT增强扫描以排除肝脏转移或化疗引起的急性肝损伤。\nG. 继续化疗，停用所有止吐及护胃药物以减轻肝脏代谢负担。\nH. 暂停化疗，静脉推注地塞米松及异丙嗪进行抗过敏治疗。\nI. 继续化疗及对症支持治疗，执行动静脉置管常规护理，并常规监测血常规与生化指标。\nJ. 继续化疗，拔除动静脉置管以预防导管相关性血流感染，改用外周静脉穿刺。\nK. 暂停化疗，静脉滴注氯化钾进行补钾治疗，待血钾明显上升后继续化疗。\nL. 继续化疗，静脉推注呋塞米促进顺铂排泄，预防急性肾功能损伤。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-b094635ac349a10618a48030","patient_id":"patient-84fa3d6098d10a1d14b6b19e","turn_id":"turn06","turn_position":5,"turn_type":"toxicity_or_support_decision","gold_letter":"J","gold_action":"予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，并监测24小时尿量，准备行下一程化疗。","options":[{"letter":"A","text":"予以口服升白细胞药物，静脉水化及补充电解质，皮下注射胸腺法新，并监测24小时尿量，准备行下一程化疗。","is_gold":false},{"letter":"B","text":"予以静脉滴注保肝药物，静脉水化及补充电解质，皮下注射胸腺法新，暂缓化疗待复查指标正常后继续。","is_gold":false},{"letter":"C","text":"予以静脉输注碳酸氢钠碱化尿液及利尿处理，静脉水化及补充电解质，将下一程化疗方案中的顺铂替换为卡铂。","is_gold":false},{"letter":"D","text":"予以静脉营养支持，静脉水化及补充电解质，皮下注射胸腺法新，下一程化疗顺铂剂量下调20%。","is_gold":false},{"letter":"E","text":"予以静脉水化、补充电解质及维生素，预防性皮下注射重组人粒细胞刺激因子，口服止咳药物，准备行下一程化疗。","is_gold":false},{"letter":"F","text":"予以静脉水化、补充电解质及维生素，预防性皮下注射重组人血小板生成素，口服止咳药物，准备行下一程化疗。","is_gold":false},{"letter":"G","text":"予以静脉水化、补充电解质及维生素，口服止咳药物，加用异烟肼预防性抗结核治疗，准备行下一程化疗。","is_gold":false},{"letter":"H","text":"予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，无需监测尿量，准备行下一程化疗。","is_gold":false},{"letter":"I","text":"予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，并监测24小时尿量，准备行单纯放射治疗。","is_gold":false},{"letter":"J","text":"予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，并监测24小时尿量，准备行下一程化疗。","is_gold":true},{"letter":"K","text":"予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，并监测24小时尿量，将下一程化疗方案更改为吉西他滨加顺铂。","is_gold":false},{"letter":"L","text":"予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，并监测24小时尿量，将下一程化疗方案更改为紫杉醇加顺铂。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、斜坡、海绵窦、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D16] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及双侧壁增厚放射性浓聚，SUV约11.9，双侧咽隐窝消失；病灶侵犯双侧腭帆提肌、左侧腭帆张肌、左翼内肌，左咽旁间隙及左咽后间隙消失；病灶向上侵犯蝶骨基底部、左翼突区、左蝶骨大翼、左卵圆孔及左海绵窦；向前侵犯左翼腭窝、左上颌后脂肪间隙、左眶尖及左眶内后份，左框内病灶与视神经分界不清。右咽后小淋巴结放射性分布未见明显异常。双侧扁桃体放射性浓聚，SUV约9.4；喉咽结构及放射性分布未见明显异常。双侧上颌窦低密度影放射性分布未见异常；额窦、蝶窦、筛窦结构及放射性分布未见明显异常。甲状腺双叶密度减低，放射性分布未见异常。双颈多个小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺散在多发结节影放射性分布未见明显异常，最大约0.6×0.8cm；左上肺舌段条索影放射性分布未见异常；气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。心脏及纵隔大血管未见明显异常。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏弥漫性密度减低，CT值约36Hu（脾脏CT值约51Hu），放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾门区结节影放射性分布未见异常，大小约1.1×1.4cm（副脾）；脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 双侧乳突气房内低密度影放射性分布未见异常；余颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌病灶，侵犯左咽后及左咽旁间隙、颅底骨骼、左卵圆孔、左海绵窦、左翼腭窝、左上颌后脂肪间隙、左眶尖及左眶内后份，累及左视神经。 双肺多发小结节影代谢未见异常，疑增殖灶。 双侧上颌窦炎症；双侧乳突炎症。 双侧扁桃体代谢活跃，考虑炎性病变。 脂肪肝。\n- [全程D24] 检验组合: 红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.4%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.71mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.0123；平均血小板体积(MPV)-静脉血: 8.22fL；载脂蛋白B(apoB)-静脉血: 1.13g/L；总胆固醇(TC)-静脉血: 5.18mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.281；有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞血红蛋白浓度(MCHC)-静脉血: 325.6g/L；磷(P)-静脉血: 1.14mmol/L；胱抑素(Cys-C)-静脉血: 1.19mg/L；尿素氮(BUN)-静脉血: 7.71mmol/L；血小板分布宽度(PDW)-静脉血: 16.4%；丙氨酸氨基转移酶(ALT)-静脉血: 28.8U/L；直接胆红素(DBIL)-静脉血: 2.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.8；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.14mmolL；氯离子(Cl-)-静脉血: 105.9mmol/L；血小板计数(PLT#)-静脉血: 18310E9/L；中性粒细胞计数(Neut#)-静脉血: 510E9/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；乳酸脱氢酶(LDH)-静脉血: 159U/L；平均红细胞体积(MCV)-静脉血: 84.3fL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；红细胞计数(RBC#)-静脉血: 5.2310E12/L；球蛋白(GLO)-静脉血: 27.58g/L；葡萄糖(Glu)-静脉血: 4.55mmol/L；肌酐(Crea)-静脉血: 91.9umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；血小板比容-静脉血: 15%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 50.8U/L；白细胞计数(WBC#)-静脉血: 7.810E9/L；单核细胞百分比(Mono%)-静脉血: 0.0665；淋巴细胞计数(Lymph#)-静脉血: 2.210E9/L；C-反应蛋白(CRP)-静脉血: 4.59mg/L；红细胞比容(Hct)-静脉血:……\n\n【既往治疗与反应】\n- [全程D10] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗结束，诉呕吐2次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程5-FU+顺铂方案诱导化疗结束，无诉特殊不适，可予请假至6月13日，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n- [全程D15] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者请假至.吕星\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 予以口服升白细胞药物，静脉水化及补充电解质，皮下注射胸腺法新，并监测24小时尿量，准备行下一程化疗。\nB. 予以静脉滴注保肝药物，静脉水化及补充电解质，皮下注射胸腺法新，暂缓化疗待复查指标正常后继续。\nC. 予以静脉输注碳酸氢钠碱化尿液及利尿处理，静脉水化及补充电解质，将下一程化疗方案中的顺铂替换为卡铂。\nD. 予以静脉营养支持，静脉水化及补充电解质，皮下注射胸腺法新，下一程化疗顺铂剂量下调20%。\nE. 予以静脉水化、补充电解质及维生素，预防性皮下注射重组人粒细胞刺激因子，口服止咳药物，准备行下一程化疗。\nF. 予以静脉水化、补充电解质及维生素，预防性皮下注射重组人血小板生成素，口服止咳药物，准备行下一程化疗。\nG. 予以静脉水化、补充电解质及维生素，口服止咳药物，加用异烟肼预防性抗结核治疗，准备行下一程化疗。\nH. 予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，无需监测尿量，准备行下一程化疗。\nI. 予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，并监测24小时尿量，准备行单纯放射治疗。\nJ. 予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，并监测24小时尿量，准备行下一程化疗。\nK. 予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，并监测24小时尿量，将下一程化疗方案更改为吉西他滨加顺铂。\nL. 予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，并监测24小时尿量，将下一程化疗方案更改为紫杉醇加顺铂。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、斜坡、海绵窦、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D16] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及双侧壁增厚放射性浓聚，SUV约11.9，双侧咽隐窝消失；病灶侵犯双侧腭帆提肌、左侧腭帆张肌、左翼内肌，左咽旁间隙及左咽后间隙消失；病灶向上侵犯蝶骨基底部、左翼突区、左蝶骨大翼、左卵圆孔及左海绵窦；向前侵犯左翼腭窝、左上颌后脂肪间隙、左眶尖及左眶内后份，左框内病灶与视神经分界不清。右咽后小淋巴结放射性分布未见明显异常。双侧扁桃体放射性浓聚，SUV约9.4；喉咽结构及放射性分布未见明显异常。双侧上颌窦低密度影放射性分布未见异常；额窦、蝶窦、筛窦结构及放射性分布未见明显异常。甲状腺双叶密度减低，放射性分布未见异常。双颈多个小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺散在多发结节影放射性分布未见明显异常，最大约0.6×0.8cm；左上肺舌段条索影放射性分布未见异常；气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。心脏及纵隔大血管未见明显异常。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏弥漫性密度减低，CT值约36Hu（脾脏CT值约51Hu），放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾门区结节影放射性分布未见异常，大小约1.1×1.4cm（副脾）；脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 双侧乳突气房内低密度影放射性分布未见异常；余颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌病灶，侵犯左咽后及左咽旁间隙、颅底骨骼、左卵圆孔、左海绵窦、左翼腭窝、左上颌后脂肪间隙、左眶尖及左眶内后份，累及左视神经。 双肺多发小结节影代谢未见异常，疑增殖灶。 双侧上颌窦炎症；双侧乳突炎症。 双侧扁桃体代谢活跃，考虑炎性病变。 脂肪肝。\n- [全程D24] 检验组合: 红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.4%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.71mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.0123；平均血小板体积(MPV)-静脉血: 8.22fL；载脂蛋白B(apoB)-静脉血: 1.13g/L；总胆固醇(TC)-静脉血: 5.18mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.281；有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞血红蛋白浓度(MCHC)-静脉血: 325.6g/L；磷(P)-静脉血: 1.14mmol/L；胱抑素(Cys-C)-静脉血: 1.19mg/L；尿素氮(BUN)-静脉血: 7.71mmol/L；血小板分布宽度(PDW)-静脉血: 16.4%；丙氨酸氨基转移酶(ALT)-静脉血: 28.8U/L；直接胆红素(DBIL)-静脉血: 2.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.8；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.14mmolL；氯离子(Cl-)-静脉血: 105.9mmol/L；血小板计数(PLT#)-静脉血: 18310E9/L；中性粒细胞计数(Neut#)-静脉血: 510E9/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；乳酸脱氢酶(LDH)-静脉血: 159U/L；平均红细胞体积(MCV)-静脉血: 84.3fL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；红细胞计数(RBC#)-静脉血: 5.2310E12/L；球蛋白(GLO)-静脉血: 27.58g/L；葡萄糖(Glu)-静脉血: 4.55mmol/L；肌酐(Crea)-静脉血: 91.9umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；血小板比容-静脉血: 15%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 50.8U/L；白细胞计数(WBC#)-静脉血: 7.810E9/L；单核细胞百分比(Mono%)-静脉血: 0.0665；淋巴细胞计数(Lymph#)-静脉血: 2.210E9/L；C-反应蛋白(CRP)-静脉血: 4.59mg/L；红细胞比容(Hct)-静脉血:……\n\n【既往治疗与反应】\n- [全程D10] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗结束，诉呕吐2次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程5-FU+顺铂方案诱导化疗结束，无诉特殊不适，可予请假至6月13日，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n- [全程D15] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者请假至.吕星\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 予以口服升白细胞药物，静脉水化及补充电解质，皮下注射胸腺法新，并监测24小时尿量，准备行下一程化疗。\nB. 予以静脉滴注保肝药物，静脉水化及补充电解质，皮下注射胸腺法新，暂缓化疗待复查指标正常后继续。\nC. 予以静脉输注碳酸氢钠碱化尿液及利尿处理，静脉水化及补充电解质，将下一程化疗方案中的顺铂替换为卡铂。\nD. 予以静脉营养支持，静脉水化及补充电解质，皮下注射胸腺法新，下一程化疗顺铂剂量下调20%。\nE. 予以静脉水化、补充电解质及维生素，预防性皮下注射重组人粒细胞刺激因子，口服止咳药物，准备行下一程化疗。\nF. 予以静脉水化、补充电解质及维生素，预防性皮下注射重组人血小板生成素，口服止咳药物，准备行下一程化疗。\nG. 予以静脉水化、补充电解质及维生素，口服止咳药物，加用异烟肼预防性抗结核治疗，准备行下一程化疗。\nH. 予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，无需监测尿量，准备行下一程化疗。\nI. 予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，并监测24小时尿量，准备行单纯放射治疗。\nJ. 予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，并监测24小时尿量，准备行下一程化疗。\nK. 予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，并监测24小时尿量，将下一程化疗方案更改为吉西他滨加顺铂。\nL. 予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，并监测24小时尿量，将下一程化疗方案更改为紫杉醇加顺铂。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-237ee315803b648b5eb4c67f","patient_id":"patient-84fa3d6098d10a1d14b6b19e","turn_id":"turn07","turn_position":6,"turn_type":"response_assessment_decision","gold_letter":"K","gold_action":"评估PET/CT证实双肺结节无代谢活性（排除M1），维持局部晚期诊断；行静脉置管护理与通畅性维护，复查生化常规后，继续行第2程PF方案诱导化疗。","options":[{"letter":"A","text":"评估PET/CT双侧扁桃体代谢活跃为淋巴结转移，双肺结节无代谢活性；调整为GP方案（吉西他滨+顺铂）行第2程诱导化疗，并加强静脉导管护理。","is_gold":false},{"letter":"B","text":"评估PET/CT证实双肺结节无代谢活性（排除M1）；已完成1程诱导化疗，直接进入根治性放疗阶段，并辅以同期顺铂化疗，定期复查生化常规。","is_gold":false},{"letter":"C","text":"评估PET/CT见双肺多发结节伴鼻咽病灶广泛侵犯，考虑为IVB期（M1）；调整为姑息性化疗，采用TP方案联合PD-1抑制剂，并维持静脉通路。","is_gold":false},{"letter":"D","text":"评估PET/CT证实双肺结节无代谢活性；病灶侵犯视神经及海绵窦，第2程诱导化疗需升级为TPF方案（多西他赛+顺铂+5-FU），并复查生化。","is_gold":false},{"letter":"E","text":"评估PET/CT证实双肺结节无代谢活性；拔除原有静脉置管以防血栓，复查生化常规后，继续行第2程PF方案（5-FU+顺铂）诱导化疗。","is_gold":false},{"letter":"F","text":"评估PET/CT证实双肺结节无代谢活性；局部病灶侵犯广泛，暂停化疗，优先行局部病灶减瘤术以解除视神经压迫，术后继续PF方案化疗。","is_gold":false},{"letter":"G","text":"评估PET/CT证实双肺结节无代谢活性；为加强局部控制，第2程诱导化疗在PF方案基础上加用西妥昔单抗靶向治疗，并常规维护静脉导管。","is_gold":false},{"letter":"H","text":"评估PET/CT证实双肺结节无代谢活性；第1程化疗后出现胃肠道反应，第2程化疗将顺铂替换为卡铂，行5-FU+卡铂方案，复查生化常规。","is_gold":false},{"letter":"I","text":"评估PET/CT证实双肺结节无代谢活性；行静脉置管护理，复查生化常规后，提前终止诱导化疗，开始单纯根治性放疗，密切监测不良反应。","is_gold":false},{"letter":"J","text":"评估PET/CT证实双肺结节无代谢活性，鼻咽病灶SUV值偏高说明原方案疗效欠佳；换用吉西他滨+顺铂方案行第2程诱导化疗，并复查生化。","is_gold":false},{"letter":"K","text":"评估PET/CT证实双肺结节无代谢活性（排除M1），维持局部晚期诊断；行静脉置管护理与通畅性维护，复查生化常规后，继续行第2程PF方案诱导化疗。","is_gold":true},{"letter":"L","text":"评估PET/CT证实双肺结节无代谢活性；病灶累及颅底及海绵窦，行第2程PF方案诱导化疗的同时，加用局部姑息性放疗，并维护静脉导管。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、斜坡、海绵窦、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- 无可展示记录。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估PET/CT双侧扁桃体代谢活跃为淋巴结转移，双肺结节无代谢活性；调整为GP方案（吉西他滨+顺铂）行第2程诱导化疗，并加强静脉导管护理。\nB. 评估PET/CT证实双肺结节无代谢活性（排除M1）；已完成1程诱导化疗，直接进入根治性放疗阶段，并辅以同期顺铂化疗，定期复查生化常规。\nC. 评估PET/CT见双肺多发结节伴鼻咽病灶广泛侵犯，考虑为IVB期（M1）；调整为姑息性化疗，采用TP方案联合PD-1抑制剂，并维持静脉通路。\nD. 评估PET/CT证实双肺结节无代谢活性；病灶侵犯视神经及海绵窦，第2程诱导化疗需升级为TPF方案（多西他赛+顺铂+5-FU），并复查生化。\nE. 评估PET/CT证实双肺结节无代谢活性；拔除原有静脉置管以防血栓，复查生化常规后，继续行第2程PF方案（5-FU+顺铂）诱导化疗。\nF. 评估PET/CT证实双肺结节无代谢活性；局部病灶侵犯广泛，暂停化疗，优先行局部病灶减瘤术以解除视神经压迫，术后继续PF方案化疗。\nG. 评估PET/CT证实双肺结节无代谢活性；为加强局部控制，第2程诱导化疗在PF方案基础上加用西妥昔单抗靶向治疗，并常规维护静脉导管。\nH. 评估PET/CT证实双肺结节无代谢活性；第1程化疗后出现胃肠道反应，第2程化疗将顺铂替换为卡铂，行5-FU+卡铂方案，复查生化常规。\nI. 评估PET/CT证实双肺结节无代谢活性；行静脉置管护理，复查生化常规后，提前终止诱导化疗，开始单纯根治性放疗，密切监测不良反应。\nJ. 评估PET/CT证实双肺结节无代谢活性，鼻咽病灶SUV值偏高说明原方案疗效欠佳；换用吉西他滨+顺铂方案行第2程诱导化疗，并复查生化。\nK. 评估PET/CT证实双肺结节无代谢活性（排除M1），维持局部晚期诊断；行静脉置管护理与通畅性维护，复查生化常规后，继续行第2程PF方案诱导化疗。\nL. 评估PET/CT证实双肺结节无代谢活性；病灶累及颅底及海绵窦，行第2程PF方案诱导化疗的同时，加用局部姑息性放疗，并维护静脉导管。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、斜坡、海绵窦、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- 无可展示记录。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估PET/CT双侧扁桃体代谢活跃为淋巴结转移，双肺结节无代谢活性；调整为GP方案（吉西他滨+顺铂）行第2程诱导化疗，并加强静脉导管护理。\nB. 评估PET/CT证实双肺结节无代谢活性（排除M1）；已完成1程诱导化疗，直接进入根治性放疗阶段，并辅以同期顺铂化疗，定期复查生化常规。\nC. 评估PET/CT见双肺多发结节伴鼻咽病灶广泛侵犯，考虑为IVB期（M1）；调整为姑息性化疗，采用TP方案联合PD-1抑制剂，并维持静脉通路。\nD. 评估PET/CT证实双肺结节无代谢活性；病灶侵犯视神经及海绵窦，第2程诱导化疗需升级为TPF方案（多西他赛+顺铂+5-FU），并复查生化。\nE. 评估PET/CT证实双肺结节无代谢活性；拔除原有静脉置管以防血栓，复查生化常规后，继续行第2程PF方案（5-FU+顺铂）诱导化疗。\nF. 评估PET/CT证实双肺结节无代谢活性；局部病灶侵犯广泛，暂停化疗，优先行局部病灶减瘤术以解除视神经压迫，术后继续PF方案化疗。\nG. 评估PET/CT证实双肺结节无代谢活性；为加强局部控制，第2程诱导化疗在PF方案基础上加用西妥昔单抗靶向治疗，并常规维护静脉导管。\nH. 评估PET/CT证实双肺结节无代谢活性；第1程化疗后出现胃肠道反应，第2程化疗将顺铂替换为卡铂，行5-FU+卡铂方案，复查生化常规。\nI. 评估PET/CT证实双肺结节无代谢活性；行静脉置管护理，复查生化常规后，提前终止诱导化疗，开始单纯根治性放疗，密切监测不良反应。\nJ. 评估PET/CT证实双肺结节无代谢活性，鼻咽病灶SUV值偏高说明原方案疗效欠佳；换用吉西他滨+顺铂方案行第2程诱导化疗，并复查生化。\nK. 评估PET/CT证实双肺结节无代谢活性（排除M1），维持局部晚期诊断；行静脉置管护理与通畅性维护，复查生化常规后，继续行第2程PF方案诱导化疗。\nL. 评估PET/CT证实双肺结节无代谢活性；病灶累及颅底及海绵窦，行第2程PF方案诱导化疗的同时，加用局部姑息性放疗，并维护静脉导管。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-c9510f9db8861176764ecc37","patient_id":"patient-84fa3d6098d10a1d14b6b19e","turn_id":"turn08","turn_position":7,"turn_type":"recurrence_or_salvage_decision","gold_letter":"L","gold_action":"行电子鼻咽镜检查（不活检）进一步评估鼻咽局部疗效，复查血常规与生化常规，并予动静脉置管护理。","options":[{"letter":"A","text":"立即启动根治性调强放射治疗及同步化疗，暂不安排其他局部影像或内镜检查。","is_gold":false},{"letter":"B","text":"行电子鼻咽镜检查并对残留病灶取活检以明确病理状态，复查血常规与生化常规。","is_gold":false},{"letter":"C","text":"继续予以第3程5-FU+顺铂方案诱导化疗，待化疗结束后再行鼻咽镜评估。","is_gold":false},{"letter":"D","text":"安排全身PET/CT复查以评估全身肿瘤代谢活性变化，随后制定放疗计划。","is_gold":false},{"letter":"E","text":"更改为紫杉醇+顺铂方案行第3程诱导化疗，并予动静脉置管常规护理。","is_gold":false},{"letter":"F","text":"安排鼻咽及颈部CT平扫+增强进一步评估颅底骨质破坏情况，复查血常规。","is_gold":false},{"letter":"G","text":"择期行双侧颈部淋巴结清扫术，术后启动鼻咽局部及颈部放射治疗。","is_gold":false},{"letter":"H","text":"行电子鼻咽镜检查（不活检）评估局部疗效，并拔除动静脉置管准备单纯放疗。","is_gold":false},{"letter":"I","text":"更改为吉西他滨+顺铂方案行第3程诱导化疗，复查血常规与生化常规。","is_gold":false},{"letter":"J","text":"行电子鼻咽镜检查（不活检），若无明显外生型肿物则暂缓放疗并定期随访。","is_gold":false},{"letter":"K","text":"立即启动单纯根治性放射治疗，并予动静脉置管常规护理。","is_gold":false},{"letter":"L","text":"行电子鼻咽镜检查（不活检）进一步评估鼻咽局部疗效，复查血常规与生化常规，并予动静脉置管护理。","is_gold":true}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、斜坡、海绵窦、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D25] 检验组合: 浊度(TRUB)-尿液: 清亮；白细胞计数(WBC#)-尿液: 100/μL；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；红细胞计数(RBC#)-尿液: 4/μL；比重(SG)-尿液: 1.028；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -+25Leu（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow\n- [全程D26] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.027；颜色-尿液: Light-Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；葡萄糖(Glu)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）\n- [全程D27] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 9/μL；酮体(KET)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.026；酸碱度(pH)-尿液: 6.5；颜色-尿液: Light-Yellow；浊度(TRUB)-尿液: 清亮；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）\n- [全程D31] 检验组合: 钠离子(Na+)-静脉血: 137.1mmol/L；直接胆红素(DBIL)-静脉血: 5.1umol/L；磷(P)-静脉血: 1.46mmol/L；红细胞计数(RBC#)-静脉血: 5.0710E12/L；镁离子(Mg2+)-静脉血: 0.64mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.7mmol/L；血小板计数(PLT#)-静脉血: 11810E9/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；胱抑素(Cys-C)-静脉血: 1.51mg/L；间接胆红素(IBIL)-静脉血: 9umolL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.9；中性粒细胞百分比(Neut%)-静脉血: 0.581；甘油三酯(TG)-静脉血: 1.92mmol/L；血小板分布宽度(PDW)-静脉血: 11.5%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.006；氯离子(Cl-)-静脉血: 98.9mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.94mmolL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；总蛋白(TP)-静脉血: 63.22g/L；尿素氮(BUN)-静脉血: 10.16mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 27.6pg；总胆汁酸(TBA)-静脉血: 0.3umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.710E9/L；葡萄糖(Glu)-静脉血: 5.19mmol/L；血红蛋白(Hb)-静脉血: 140g/L；载脂蛋白AI(apoAI)-静脉血: 1.13g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 41.9U/L；总胆固醇(TC)-静脉血: 5.12mmol/L；肌酐(Crea)-静脉血: 132.7umol/L；总钙(Ca)-静脉血: 1.91mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 44U/L；球蛋白(GLO)-静脉血: 24.42g/L；白蛋白(ALB)-静脉血: 38.8g/L；平均红细胞体积(MCV)-静脉血: 83.8fL；乳酸脱氢酶(LDH)-静脉血: 199.2U/L；总胆红素(TBIL)-静脉血: 14.1umol/L；钾离子(K+)……\n- [全程D32] 检验组合: 肌酐(Crea)-静脉血: 122.2umol/L；磷(P)-静脉血: 1.38mmol/L；尿素氮(BUN)-静脉血: 9.9mmol/L；总胆红素(TBIL)-静脉血: 14.5umol/L；尿酸(UA)-静脉血: 496.4umol/L；镁离子(Mg2+)-静脉血: 0.57mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.76；总钙(Ca)-静脉血: 1.79mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.5mmol/L；球蛋白(GLO)-静脉血: 23.74g/L；氯离子(Cl-)-静脉血: 97.6mmol/L；钠离子(Na+)-静脉血: 136.5mmol/L；阴离子间隙(AG)-静脉血: 16.4；间接胆红素(IBIL)-静脉血: 10.3umolL；直接胆红素(DBIL)-静脉血: 4.2umol/L；白蛋白(ALB)-静脉血: 41.9g/L；总蛋白(TP)-静脉血: 65.64g/L；钾离子(K+)-静脉血: 3.56mmol/L\n- [全程D35] 检验组合: 磷(P)-静脉血: 1.32mmol/L；镁离子(Mg2+)-静脉血: 0.53mmol/L；阴离子间隙(AG)-静脉血: 14.8；球蛋白(GLO)-静脉血: 21.96g/L；总钙(Ca)-静脉血: 1.51mmol/L；总胆红素(TBIL)-静脉血: 7.6umol/L；总蛋白(TP)-静脉血: 60.56g/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.2mmol/L；间接胆红素(IBIL)-静脉血: 5umolL；尿素氮(BUN)-静脉血: 11.2mmol/L；钾离子(K+)-静脉血: 3.94mmol/L；白蛋白(ALB)-静脉血: 38.6g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.76；尿酸(UA)-静脉血: 490.1umol/L；肌酐(Crea)-静脉血: 116.6umol/L；直接胆红素(DBIL)-静脉血: 2.6umol/L；氯离子(Cl-)-静脉血: 104.1mmol/L；钠离子(Na+)-静脉血: 140.1mmol/L\n- [全程D36] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌两程诱导化疗后复查：对比某次就诊时间MRI， 鼻咽顶壁、顶后壁、后壁及双侧壁稍增厚，形成软组织肿物向腔内突出，T1WI呈等信号，T2WI呈高信号，增强后明显强化。肿物占据双侧咽隐窝，侵犯双侧腭帆张、提肌及左侧翼内肌。右侧翼外肌未见明显异常。双侧咽旁间隙清晰。 口咽未见明确病变。 蝶骨基底部、左侧岩尖骨质信号减低 ，增强后明显强化。 双侧海绵窦形态正常，未见增宽。 双侧蝶窦、筛窦、额窦粘膜增厚，呈长分期信息见历史辅助诊断节点长分期信息见历史辅助诊断节点信号，增强后边缘轻度强化，双侧乳突内见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点信号分泌物，骨壁完好。 双侧眼球大小、形态、位置均属正常，信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变。 双侧咽后各见一淋巴结，大小分别约为6mm×6mm（左）、7mm×4mm（右），边界清，信号均，增强后可见强化。 双颈II区见数个稍大淋巴结，边缘清，信号欠均，增强后明显强化，孤立散在，未见明显坏死，最大者位于右颈II区，大小约13mm×9mm。 双颈II~IV区可见小淋巴结，边缘清，信号尚均，增强后可见强化。 喉咽腔形态正常，未见占位性病变。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽占位，对比某次就诊时间MRI所见病变明显缩小好转。 颅底骨质破坏。 双颈II区稍大淋巴结，不除外转移。 鼻窦炎、乳突炎。\n\n【既往治疗与反应】\n- [全程D25] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者安返病房，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，可于今日执行第2程5-FU+顺铂方案诱导化疗，注意化疗不良反应。\n- [全程D27] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D36] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者请假至.\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即启动根治性调强放射治疗及同步化疗，暂不安排其他局部影像或内镜检查。\nB. 行电子鼻咽镜检查并对残留病灶取活检以明确病理状态，复查血常规与生化常规。\nC. 继续予以第3程5-FU+顺铂方案诱导化疗，待化疗结束后再行鼻咽镜评估。\nD. 安排全身PET/CT复查以评估全身肿瘤代谢活性变化，随后制定放疗计划。\nE. 更改为紫杉醇+顺铂方案行第3程诱导化疗，并予动静脉置管常规护理。\nF. 安排鼻咽及颈部CT平扫+增强进一步评估颅底骨质破坏情况，复查血常规。\nG. 择期行双侧颈部淋巴结清扫术，术后启动鼻咽局部及颈部放射治疗。\nH. 行电子鼻咽镜检查（不活检）评估局部疗效，并拔除动静脉置管准备单纯放疗。\nI. 更改为吉西他滨+顺铂方案行第3程诱导化疗，复查血常规与生化常规。\nJ. 行电子鼻咽镜检查（不活检），若无明显外生型肿物则暂缓放疗并定期随访。\nK. 立即启动单纯根治性放射治疗，并予动静脉置管常规护理。\nL. 行电子鼻咽镜检查（不活检）进一步评估鼻咽局部疗效，复查血常规与生化常规，并予动静脉置管护理。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、斜坡、海绵窦、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D25] 检验组合: 浊度(TRUB)-尿液: 清亮；白细胞计数(WBC#)-尿液: 100/μL；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；红细胞计数(RBC#)-尿液: 4/μL；比重(SG)-尿液: 1.028；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -+25Leu（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow\n- [全程D26] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.027；颜色-尿液: Light-Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；葡萄糖(Glu)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）\n- [全程D27] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 9/μL；酮体(KET)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.026；酸碱度(pH)-尿液: 6.5；颜色-尿液: Light-Yellow；浊度(TRUB)-尿液: 清亮；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）\n- [全程D31] 检验组合: 钠离子(Na+)-静脉血: 137.1mmol/L；直接胆红素(DBIL)-静脉血: 5.1umol/L；磷(P)-静脉血: 1.46mmol/L；红细胞计数(RBC#)-静脉血: 5.0710E12/L；镁离子(Mg2+)-静脉血: 0.64mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.7mmol/L；血小板计数(PLT#)-静脉血: 11810E9/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；胱抑素(Cys-C)-静脉血: 1.51mg/L；间接胆红素(IBIL)-静脉血: 9umolL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.9；中性粒细胞百分比(Neut%)-静脉血: 0.581；甘油三酯(TG)-静脉血: 1.92mmol/L；血小板分布宽度(PDW)-静脉血: 11.5%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.006；氯离子(Cl-)-静脉血: 98.9mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.94mmolL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；总蛋白(TP)-静脉血: 63.22g/L；尿素氮(BUN)-静脉血: 10.16mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 27.6pg；总胆汁酸(TBA)-静脉血: 0.3umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.710E9/L；葡萄糖(Glu)-静脉血: 5.19mmol/L；血红蛋白(Hb)-静脉血: 140g/L；载脂蛋白AI(apoAI)-静脉血: 1.13g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 41.9U/L；总胆固醇(TC)-静脉血: 5.12mmol/L；肌酐(Crea)-静脉血: 132.7umol/L；总钙(Ca)-静脉血: 1.91mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 44U/L；球蛋白(GLO)-静脉血: 24.42g/L；白蛋白(ALB)-静脉血: 38.8g/L；平均红细胞体积(MCV)-静脉血: 83.8fL；乳酸脱氢酶(LDH)-静脉血: 199.2U/L；总胆红素(TBIL)-静脉血: 14.1umol/L；钾离子(K+)……\n- [全程D32] 检验组合: 肌酐(Crea)-静脉血: 122.2umol/L；磷(P)-静脉血: 1.38mmol/L；尿素氮(BUN)-静脉血: 9.9mmol/L；总胆红素(TBIL)-静脉血: 14.5umol/L；尿酸(UA)-静脉血: 496.4umol/L；镁离子(Mg2+)-静脉血: 0.57mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.76；总钙(Ca)-静脉血: 1.79mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.5mmol/L；球蛋白(GLO)-静脉血: 23.74g/L；氯离子(Cl-)-静脉血: 97.6mmol/L；钠离子(Na+)-静脉血: 136.5mmol/L；阴离子间隙(AG)-静脉血: 16.4；间接胆红素(IBIL)-静脉血: 10.3umolL；直接胆红素(DBIL)-静脉血: 4.2umol/L；白蛋白(ALB)-静脉血: 41.9g/L；总蛋白(TP)-静脉血: 65.64g/L；钾离子(K+)-静脉血: 3.56mmol/L\n- [全程D35] 检验组合: 磷(P)-静脉血: 1.32mmol/L；镁离子(Mg2+)-静脉血: 0.53mmol/L；阴离子间隙(AG)-静脉血: 14.8；球蛋白(GLO)-静脉血: 21.96g/L；总钙(Ca)-静脉血: 1.51mmol/L；总胆红素(TBIL)-静脉血: 7.6umol/L；总蛋白(TP)-静脉血: 60.56g/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.2mmol/L；间接胆红素(IBIL)-静脉血: 5umolL；尿素氮(BUN)-静脉血: 11.2mmol/L；钾离子(K+)-静脉血: 3.94mmol/L；白蛋白(ALB)-静脉血: 38.6g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.76；尿酸(UA)-静脉血: 490.1umol/L；肌酐(Crea)-静脉血: 116.6umol/L；直接胆红素(DBIL)-静脉血: 2.6umol/L；氯离子(Cl-)-静脉血: 104.1mmol/L；钠离子(Na+)-静脉血: 140.1mmol/L\n- [全程D36] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌两程诱导化疗后复查：对比某次就诊时间MRI， 鼻咽顶壁、顶后壁、后壁及双侧壁稍增厚，形成软组织肿物向腔内突出，T1WI呈等信号，T2WI呈高信号，增强后明显强化。肿物占据双侧咽隐窝，侵犯双侧腭帆张、提肌及左侧翼内肌。右侧翼外肌未见明显异常。双侧咽旁间隙清晰。 口咽未见明确病变。 蝶骨基底部、左侧岩尖骨质信号减低 ，增强后明显强化。 双侧海绵窦形态正常，未见增宽。 双侧蝶窦、筛窦、额窦粘膜增厚，呈长分期信息见历史辅助诊断节点长分期信息见历史辅助诊断节点信号，增强后边缘轻度强化，双侧乳突内见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点信号分泌物，骨壁完好。 双侧眼球大小、形态、位置均属正常，信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变。 双侧咽后各见一淋巴结，大小分别约为6mm×6mm（左）、7mm×4mm（右），边界清，信号均，增强后可见强化。 双颈II区见数个稍大淋巴结，边缘清，信号欠均，增强后明显强化，孤立散在，未见明显坏死，最大者位于右颈II区，大小约13mm×9mm。 双颈II~IV区可见小淋巴结，边缘清，信号尚均，增强后可见强化。 喉咽腔形态正常，未见占位性病变。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽占位，对比某次就诊时间MRI所见病变明显缩小好转。 颅底骨质破坏。 双颈II区稍大淋巴结，不除外转移。 鼻窦炎、乳突炎。\n\n【既往治疗与反应】\n- [全程D25] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者安返病房，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，可于今日执行第2程5-FU+顺铂方案诱导化疗，注意化疗不良反应。\n- [全程D27] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D36] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者请假至.\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即启动根治性调强放射治疗及同步化疗，暂不安排其他局部影像或内镜检查。\nB. 行电子鼻咽镜检查并对残留病灶取活检以明确病理状态，复查血常规与生化常规。\nC. 继续予以第3程5-FU+顺铂方案诱导化疗，待化疗结束后再行鼻咽镜评估。\nD. 安排全身PET/CT复查以评估全身肿瘤代谢活性变化，随后制定放疗计划。\nE. 更改为紫杉醇+顺铂方案行第3程诱导化疗，并予动静脉置管常规护理。\nF. 安排鼻咽及颈部CT平扫+增强进一步评估颅底骨质破坏情况，复查血常规。\nG. 择期行双侧颈部淋巴结清扫术，术后启动鼻咽局部及颈部放射治疗。\nH. 行电子鼻咽镜检查（不活检）评估局部疗效，并拔除动静脉置管准备单纯放疗。\nI. 更改为吉西他滨+顺铂方案行第3程诱导化疗，复查血常规与生化常规。\nJ. 行电子鼻咽镜检查（不活检），若无明显外生型肿物则暂缓放疗并定期随访。\nK. 立即启动单纯根治性放射治疗，并予动静脉置管常规护理。\nL. 行电子鼻咽镜检查（不活检）进一步评估鼻咽局部疗效，复查血常规与生化常规，并予动静脉置管护理。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-eb32294d1506d6b48368496f","patient_id":"patient-34616c327ce5d69194ca7f4d","turn_id":"turn01","turn_position":1,"turn_type":"initial_workup_choice","gold_letter":"A","gold_action":"完善鼻咽镜检查及活检，检测EBV DNA定量、常规血液学指标，并进行胸部DR与腹盆腔彩超检查。","options":[{"letter":"A","text":"完善鼻咽镜检查及活检，检测EBV DNA定量、常规血液学指标，并进行胸部DR与腹盆腔彩超检查","is_gold":true},{"letter":"B","text":"完善鼻咽镜检查及活检，检测EBV DNA定量，并进行全身PET-CT检查，暂缓常规血液学指标检测","is_gold":false},{"letter":"C","text":"完善鼻咽镜检查及活检，检测EBV DNA定量，并进行胸腹部增强CT检查，暂缓常规血液学指标检测","is_gold":false},{"letter":"D","text":"行头颈部MRI及颅底薄层CT检查，待影像学显示异常后再行鼻咽镜活检及EBV DNA检测","is_gold":false},{"letter":"E","text":"检测EBV DNA定量及常规血液学指标，待EBV DNA结果阳性后再行鼻咽镜活检及影像学检查","is_gold":false},{"letter":"F","text":"完善鼻咽镜检查及活检，检测常规血液学指标，并进行胸部DR与腹盆腔彩超检查，暂不检测EBV DNA","is_gold":false},{"letter":"G","text":"完善鼻咽镜检查（暂不活检），检测EBV DNA定量、常规血液学指标，并进行胸部DR与腹盆腔彩超检查","is_gold":false},{"letter":"H","text":"行全身骨扫描及头颅增强MRI检查，暂缓鼻咽镜活检及EBV DNA定量检测","is_gold":false},{"letter":"I","text":"完善鼻咽镜检查及活检，检测EBV DNA定量，并进行全身骨扫描，暂缓胸部及腹盆腔影像学检查","is_gold":false},{"letter":"J","text":"完善鼻咽镜检查及活检，检测EBV DNA定量、常规血液学指标，仅行胸部CT检查，暂不进行腹盆腔影像学评估","is_gold":false},{"letter":"K","text":"行常规血液学指标检测及基础影像学检查（胸部DR、腹盆腔彩超），暂缓鼻咽镜活检及EBV DNA检测","is_gold":false},{"letter":"L","text":"完善鼻咽镜检查及活检，检测常规血液学指标，行头颈部PET-CT检查，暂不检测EBV DNA定量","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D3189] 门急诊记录: 主诉: 鼻咽癌治疗后8年；患者家属自述行放疗（具体方案不详）。患者家属来诊，诉近来头后部疼痛，持续二月余，逐渐加重，无其他明显，来诊咨询诊疗意见。；既往史: 是否有过敏史无过敏史。是否有吸烟史吸烟史详情；个人史:；家族史:；体格检查:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善鼻咽镜检查及活检，检测EBV DNA定量、常规血液学指标，并进行胸部DR与腹盆腔彩超检查\nB. 完善鼻咽镜检查及活检，检测EBV DNA定量，并进行全身PET-CT检查，暂缓常规血液学指标检测\nC. 完善鼻咽镜检查及活检，检测EBV DNA定量，并进行胸腹部增强CT检查，暂缓常规血液学指标检测\nD. 行头颈部MRI及颅底薄层CT检查，待影像学显示异常后再行鼻咽镜活检及EBV DNA检测\nE. 检测EBV DNA定量及常规血液学指标，待EBV DNA结果阳性后再行鼻咽镜活检及影像学检查\nF. 完善鼻咽镜检查及活检，检测常规血液学指标，并进行胸部DR与腹盆腔彩超检查，暂不检测EBV DNA\nG. 完善鼻咽镜检查（暂不活检），检测EBV DNA定量、常规血液学指标，并进行胸部DR与腹盆腔彩超检查\nH. 行全身骨扫描及头颅增强MRI检查，暂缓鼻咽镜活检及EBV DNA定量检测\nI. 完善鼻咽镜检查及活检，检测EBV DNA定量，并进行全身骨扫描，暂缓胸部及腹盆腔影像学检查\nJ. 完善鼻咽镜检查及活检，检测EBV DNA定量、常规血液学指标，仅行胸部CT检查，暂不进行腹盆腔影像学评估\nK. 行常规血液学指标检测及基础影像学检查（胸部DR、腹盆腔彩超），暂缓鼻咽镜活检及EBV DNA检测\nL. 完善鼻咽镜检查及活检，检测常规血液学指标，行头颈部PET-CT检查，暂不检测EBV DNA定量\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D3189] 门急诊记录: 主诉: 鼻咽癌治疗后8年；患者家属自述行放疗（具体方案不详）。患者家属来诊，诉近来头后部疼痛，持续二月余，逐渐加重，无其他明显，来诊咨询诊疗意见。；既往史: 是否有过敏史无过敏史。是否有吸烟史吸烟史详情；个人史:；家族史:；体格检查:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善鼻咽镜检查及活检，检测EBV DNA定量、常规血液学指标，并进行胸部DR与腹盆腔彩超检查\nB. 完善鼻咽镜检查及活检，检测EBV DNA定量，并进行全身PET-CT检查，暂缓常规血液学指标检测\nC. 完善鼻咽镜检查及活检，检测EBV DNA定量，并进行胸腹部增强CT检查，暂缓常规血液学指标检测\nD. 行头颈部MRI及颅底薄层CT检查，待影像学显示异常后再行鼻咽镜活检及EBV DNA检测\nE. 检测EBV DNA定量及常规血液学指标，待EBV DNA结果阳性后再行鼻咽镜活检及影像学检查\nF. 完善鼻咽镜检查及活检，检测常规血液学指标，并进行胸部DR与腹盆腔彩超检查，暂不检测EBV DNA\nG. 完善鼻咽镜检查（暂不活检），检测EBV DNA定量、常规血液学指标，并进行胸部DR与腹盆腔彩超检查\nH. 行全身骨扫描及头颅增强MRI检查，暂缓鼻咽镜活检及EBV DNA定量检测\nI. 完善鼻咽镜检查及活检，检测EBV DNA定量，并进行全身骨扫描，暂缓胸部及腹盆腔影像学检查\nJ. 完善鼻咽镜检查及活检，检测EBV DNA定量、常规血液学指标，仅行胸部CT检查，暂不进行腹盆腔影像学评估\nK. 行常规血液学指标检测及基础影像学检查（胸部DR、腹盆腔彩超），暂缓鼻咽镜活检及EBV DNA检测\nL. 完善鼻咽镜检查及活检，检测常规血液学指标，行头颈部PET-CT检查，暂不检测EBV DNA定量\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-f19200235c8a99467249ed0c","patient_id":"patient-34616c327ce5d69194ca7f4d","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"B","gold_action":"评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查","options":[{"letter":"A","text":"评估影像分期为 cT3N1M0（AJCC 第9版 II期），直接安排诱导化疗联合同期放化疗，并补充生化常规检查","is_gold":false},{"letter":"B","text":"评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查","is_gold":true},{"letter":"C","text":"评估影像分期为 cT4N1M0（AJCC 第9版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查","is_gold":false},{"letter":"D","text":"评估影像分期为 cT3N2M0（AJCC 第9版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查","is_gold":false},{"letter":"E","text":"评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽镜及活检以获取病理确诊，并补充全身PET-CT检查","is_gold":false},{"letter":"F","text":"评估影像分期为 cT2N1M0（AJCC 第9版 I期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查","is_gold":false},{"letter":"G","text":"评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽镜及活检以获取病理确诊，并补充头颅增强MRI检查","is_gold":false},{"letter":"H","text":"评估影像分期为 cT3N1M1（AJCC 第9版 IVB期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查","is_gold":false},{"letter":"I","text":"评估影像分期为 cT3N1M0（AJCC 第8版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查","is_gold":false},{"letter":"J","text":"评估影像分期为 cT4N2M0（AJCC 第9版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查","is_gold":false},{"letter":"K","text":"评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽肿物切除活检以获取病理确诊，并补充生化常规检查","is_gold":false},{"letter":"L","text":"评估影像分期为 cT3N1M0（AJCC 第9版 II期），行右颈部淋巴结穿刺活检以获取病理确诊，并补充生化常规检查","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D0] 检验组合: 嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；凝血酶原时间活动度(PTA)-静脉血: 89%；平均血小板体积(MPV)-静脉血: 9.4fL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 334g/L；D-二聚体(D-Dimer)-静脉血: 0.29ug/ml；凝血酶原国际标准化比值(PT-INR)-静脉血: 1.02；纤维蛋白原(Fbg)-静脉血: 3.21g/L；红细胞比容(Hct)-静脉血: 48.2%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；平均红细胞血红蛋白含量(MCH)-静脉血: 32pg；红细胞计数(RBC#)-静脉血: 5.0310E12/L；淋巴细胞百分比(Lymph%)-静脉血: 0.271；中性粒细胞计数(Neut#)-静脉血: 5.910E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.65；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.8；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；大血小板百分比(P-LCR%)-静脉血: 20.8%；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；血小板比容-静脉血: 27%；平均红细胞体积(MCV)-静脉血: 95.8fL；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.06S/CO；血小板分布宽度(PDW)-静脉血: 10.8%；单核细胞计数(Mono#)-静脉血: 0.510E9/L；活化部分凝血活酶时间(APTT)-静脉血: 29.2sec.；凝血酶原时间(PT)-静脉血: 11.4sec.；纤维蛋白原降解产物(FDP)-静脉血: 2.8ug/ml；淋巴细胞计数(Lymph#)-静脉血: 2.510E9/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.01IU/mL；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.13COI；凝血酶时间(TT)-静脉血: 20sec.；血小板计数(PLT#)-静脉血: 28910E9/L；Rh血型-静脉血: 阳性；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.06S/CO；血红蛋白(Hb)-静脉血: 161g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；白细胞计数(WBC……\n- [全程D14] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 左前分支阻滞\n- [全程D14] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理稍增粗，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见重要病变。\n- [全程D15] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 右侧乳突可见片状放射性浓集灶。胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 右侧乳突炎症。 余全身骨骼未见明显异常。\n- [全程D16] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，肝S7可见一强回声斑，直径约5mm，后方伴声影。血管走行清晰、自然，肝内胆管不扩张，门静脉内径14mm。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约21cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约36×26×23mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝S7强回声斑，考虑肝内胆管结石。 胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估影像分期为 cT3N1M0（AJCC 第9版 II期），直接安排诱导化疗联合同期放化疗，并补充生化常规检查\nB. 评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nC. 评估影像分期为 cT4N1M0（AJCC 第9版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nD. 评估影像分期为 cT3N2M0（AJCC 第9版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nE. 评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽镜及活检以获取病理确诊，并补充全身PET-CT检查\nF. 评估影像分期为 cT2N1M0（AJCC 第9版 I期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nG. 评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽镜及活检以获取病理确诊，并补充头颅增强MRI检查\nH. 评估影像分期为 cT3N1M1（AJCC 第9版 IVB期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nI. 评估影像分期为 cT3N1M0（AJCC 第8版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nJ. 评估影像分期为 cT4N2M0（AJCC 第9版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nK. 评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽肿物切除活检以获取病理确诊，并补充生化常规检查\nL. 评估影像分期为 cT3N1M0（AJCC 第9版 II期），行右颈部淋巴结穿刺活检以获取病理确诊，并补充生化常规检查\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D0] 检验组合: 嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；凝血酶原时间活动度(PTA)-静脉血: 89%；平均血小板体积(MPV)-静脉血: 9.4fL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 334g/L；D-二聚体(D-Dimer)-静脉血: 0.29ug/ml；凝血酶原国际标准化比值(PT-INR)-静脉血: 1.02；纤维蛋白原(Fbg)-静脉血: 3.21g/L；红细胞比容(Hct)-静脉血: 48.2%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；平均红细胞血红蛋白含量(MCH)-静脉血: 32pg；红细胞计数(RBC#)-静脉血: 5.0310E12/L；淋巴细胞百分比(Lymph%)-静脉血: 0.271；中性粒细胞计数(Neut#)-静脉血: 5.910E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.65；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.8；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；大血小板百分比(P-LCR%)-静脉血: 20.8%；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；血小板比容-静脉血: 27%；平均红细胞体积(MCV)-静脉血: 95.8fL；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.06S/CO；血小板分布宽度(PDW)-静脉血: 10.8%；单核细胞计数(Mono#)-静脉血: 0.510E9/L；活化部分凝血活酶时间(APTT)-静脉血: 29.2sec.；凝血酶原时间(PT)-静脉血: 11.4sec.；纤维蛋白原降解产物(FDP)-静脉血: 2.8ug/ml；淋巴细胞计数(Lymph#)-静脉血: 2.510E9/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.01IU/mL；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.13COI；凝血酶时间(TT)-静脉血: 20sec.；血小板计数(PLT#)-静脉血: 28910E9/L；Rh血型-静脉血: 阳性；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.06S/CO；血红蛋白(Hb)-静脉血: 161g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；白细胞计数(WBC……\n- [全程D14] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 左前分支阻滞\n- [全程D14] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理稍增粗，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见重要病变。\n- [全程D15] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 右侧乳突可见片状放射性浓集灶。胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 右侧乳突炎症。 余全身骨骼未见明显异常。\n- [全程D16] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，肝S7可见一强回声斑，直径约5mm，后方伴声影。血管走行清晰、自然，肝内胆管不扩张，门静脉内径14mm。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约21cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约36×26×23mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝S7强回声斑，考虑肝内胆管结石。 胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估影像分期为 cT3N1M0（AJCC 第9版 II期），直接安排诱导化疗联合同期放化疗，并补充生化常规检查\nB. 评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nC. 评估影像分期为 cT4N1M0（AJCC 第9版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nD. 评估影像分期为 cT3N2M0（AJCC 第9版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nE. 评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽镜及活检以获取病理确诊，并补充全身PET-CT检查\nF. 评估影像分期为 cT2N1M0（AJCC 第9版 I期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nG. 评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽镜及活检以获取病理确诊，并补充头颅增强MRI检查\nH. 评估影像分期为 cT3N1M1（AJCC 第9版 IVB期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nI. 评估影像分期为 cT3N1M0（AJCC 第8版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nJ. 评估影像分期为 cT4N2M0（AJCC 第9版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nK. 评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽肿物切除活检以获取病理确诊，并补充生化常规检查\nL. 评估影像分期为 cT3N1M0（AJCC 第9版 II期），行右颈部淋巴结穿刺活检以获取病理确诊，并补充生化常规检查\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-2288420a623ad83bf0b0a558","patient_id":"patient-34616c327ce5d69194ca7f4d","turn_id":"turn04","turn_position":3,"turn_type":"initial_treatment_selection","gold_letter":"D","gold_action":"含铂方案诱导化疗序贯根治性放化疗，或根治性放疗联合含铂方案同步化疗","options":[{"letter":"A","text":"单纯根治性调强放射治疗","is_gold":false},{"letter":"B","text":"含铂双药方案诱导化疗序贯单纯根治性放疗","is_gold":false},{"letter":"C","text":"根治性放疗联合含铂方案同步化疗，序贯含铂双药辅助化疗","is_gold":false},{"letter":"D","text":"含铂方案诱导化疗序贯根治性放化疗，或根治性放疗联合含铂方案同步化疗","is_gold":true},{"letter":"E","text":"根治性放疗联合西妥昔单抗等EGFR靶向治疗","is_gold":false},{"letter":"F","text":"根治性放疗联合PD-1抑制剂同步免疫治疗","is_gold":false},{"letter":"G","text":"姑息性全身化疗联合局部病灶姑息性放疗","is_gold":false},{"letter":"H","text":"含铂双药方案诱导化疗序贯鼻咽原发灶切除及颈部淋巴结清扫术","is_gold":false},{"letter":"I","text":"根治性放疗联合大分子抗血管生成靶向治疗","is_gold":false},{"letter":"J","text":"单纯含铂双药方案全身化疗4-6个周期","is_gold":false},{"letter":"K","text":"鼻咽原发灶切除及颈部淋巴结清扫术序贯术后辅助放化疗","is_gold":false},{"letter":"L","text":"含铂双药方案诱导化疗序贯根治性放疗及PD-1抑制剂维持治疗","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D22] 检验组合: 钾离子(K+)-静脉血: 4.18mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 46.8U/L；氯离子(Cl-)-静脉血: 101.7mmol/L；直接胆红素(DBIL)-静脉血: 2.5umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；乳酸脱氢酶(LDH)-静脉血: 172.2U/L；尿酸(UA)-静脉血: 299umol/L；碱性磷酸酶(ALP)-静脉血: 35.4U/L；载脂蛋白B(apoB)-静脉血: 0.71g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.09mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.82；γ-谷氨酰基转移酶(GGT)-静脉血: 23.1U/L；总钙(Ca)-静脉血: 2.31mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.1U/L；间接胆红素(IBIL)-静脉血: 4.8umolL；血液二氧化碳含量ctCO2(B)-静脉血: 22.5mmol/L；总蛋白(TP)-静脉血: 76.15g/L；阴离子间隙(AG)-静脉血: 16.8；总胆固醇(TC)-静脉血: 4.05mmol/L；总胆汁酸(TBA)-静脉血: 3.1umol/L；总胆红素(TBIL)-静脉血: 7.3umol/L；肌酐(Crea)-静脉血: 58.1umol/L；载脂蛋白AI(apoAI)-静脉血: 1.48g/L；球蛋白(GLO)-静脉血: 30.25g/L；C-反应蛋白(CRP)-静脉血: 3.66mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.33mmolL；镁离子(Mg2+)-静脉血: 0.86mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.3U/L；胱抑素(Cys-C)-静脉血: 0.88mg/L；尿素氮(BUN)-静脉血: 3.4mmol/L；葡萄糖(Glu)-静脉血: 5.59mmol/L；甘油三酯(TG)-静脉血: 2.5mmol/L；磷(P)-静脉血: 1.15mmol/L；白蛋白(ALB)-静脉血: 45.9g/L；钠离子(Na+)-静脉血: 141mmol/L\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 单纯根治性调强放射治疗\nB. 含铂双药方案诱导化疗序贯单纯根治性放疗\nC. 根治性放疗联合含铂方案同步化疗，序贯含铂双药辅助化疗\nD. 含铂方案诱导化疗序贯根治性放化疗，或根治性放疗联合含铂方案同步化疗\nE. 根治性放疗联合西妥昔单抗等EGFR靶向治疗\nF. 根治性放疗联合PD-1抑制剂同步免疫治疗\nG. 姑息性全身化疗联合局部病灶姑息性放疗\nH. 含铂双药方案诱导化疗序贯鼻咽原发灶切除及颈部淋巴结清扫术\nI. 根治性放疗联合大分子抗血管生成靶向治疗\nJ. 单纯含铂双药方案全身化疗4-6个周期\nK. 鼻咽原发灶切除及颈部淋巴结清扫术序贯术后辅助放化疗\nL. 含铂双药方案诱导化疗序贯根治性放疗及PD-1抑制剂维持治疗\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D22] 检验组合: 钾离子(K+)-静脉血: 4.18mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 46.8U/L；氯离子(Cl-)-静脉血: 101.7mmol/L；直接胆红素(DBIL)-静脉血: 2.5umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；乳酸脱氢酶(LDH)-静脉血: 172.2U/L；尿酸(UA)-静脉血: 299umol/L；碱性磷酸酶(ALP)-静脉血: 35.4U/L；载脂蛋白B(apoB)-静脉血: 0.71g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.09mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.82；γ-谷氨酰基转移酶(GGT)-静脉血: 23.1U/L；总钙(Ca)-静脉血: 2.31mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.1U/L；间接胆红素(IBIL)-静脉血: 4.8umolL；血液二氧化碳含量ctCO2(B)-静脉血: 22.5mmol/L；总蛋白(TP)-静脉血: 76.15g/L；阴离子间隙(AG)-静脉血: 16.8；总胆固醇(TC)-静脉血: 4.05mmol/L；总胆汁酸(TBA)-静脉血: 3.1umol/L；总胆红素(TBIL)-静脉血: 7.3umol/L；肌酐(Crea)-静脉血: 58.1umol/L；载脂蛋白AI(apoAI)-静脉血: 1.48g/L；球蛋白(GLO)-静脉血: 30.25g/L；C-反应蛋白(CRP)-静脉血: 3.66mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.33mmolL；镁离子(Mg2+)-静脉血: 0.86mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.3U/L；胱抑素(Cys-C)-静脉血: 0.88mg/L；尿素氮(BUN)-静脉血: 3.4mmol/L；葡萄糖(Glu)-静脉血: 5.59mmol/L；甘油三酯(TG)-静脉血: 2.5mmol/L；磷(P)-静脉血: 1.15mmol/L；白蛋白(ALB)-静脉血: 45.9g/L；钠离子(Na+)-静脉血: 141mmol/L\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 单纯根治性调强放射治疗\nB. 含铂双药方案诱导化疗序贯单纯根治性放疗\nC. 根治性放疗联合含铂方案同步化疗，序贯含铂双药辅助化疗\nD. 含铂方案诱导化疗序贯根治性放化疗，或根治性放疗联合含铂方案同步化疗\nE. 根治性放疗联合西妥昔单抗等EGFR靶向治疗\nF. 根治性放疗联合PD-1抑制剂同步免疫治疗\nG. 姑息性全身化疗联合局部病灶姑息性放疗\nH. 含铂双药方案诱导化疗序贯鼻咽原发灶切除及颈部淋巴结清扫术\nI. 根治性放疗联合大分子抗血管生成靶向治疗\nJ. 单纯含铂双药方案全身化疗4-6个周期\nK. 鼻咽原发灶切除及颈部淋巴结清扫术序贯术后辅助放化疗\nL. 含铂双药方案诱导化疗序贯根治性放疗及PD-1抑制剂维持治疗\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-258f93513eac99791d84464c","patient_id":"patient-34616c327ce5d69194ca7f4d","turn_id":"turn05","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"E","gold_action":"继续当前放化疗方案，定期复查血常规及生化指标。","options":[{"letter":"A","text":"暂停同期化疗，继续单纯放疗，并加用保肝药物","is_gold":false},{"letter":"B","text":"暂停放化疗，给予重组人粒细胞刺激因子支持治疗","is_gold":false},{"letter":"C","text":"继续放疗，将同期化疗剂量减低20%","is_gold":false},{"letter":"D","text":"继续放化疗方案，给予重组人血小板生成素","is_gold":false},{"letter":"E","text":"继续放化疗方案，定期复查血常规及生化指标","is_gold":true},{"letter":"F","text":"暂停放化疗，给予还原型谷胱甘肽保肝治疗","is_gold":false},{"letter":"G","text":"继续放化疗方案，加用双环醇保肝治疗","is_gold":false},{"letter":"H","text":"继续放化疗方案，给予重组人粒细胞刺激因子","is_gold":false},{"letter":"I","text":"暂停同期化疗，给予静脉补液及利尿处理","is_gold":false},{"letter":"J","text":"继续放疗，取消同期化疗，改为西妥昔单抗治疗","is_gold":false},{"letter":"K","text":"暂停放疗，继续同期化疗，给予促红细胞生成素治疗","is_gold":false},{"letter":"L","text":"继续放化疗方案，输注单采血小板","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D70] 检验组合: 低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.66mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.6；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32pg；白细胞计数(WBC#)-静脉血: 7.7410E9/L；血红蛋白(Hb)-静脉血: 164g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 27.3U/L；磷(P)-静脉血: 1.31mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 20.8mmol/L；尿酸(UA)-静脉血: 323.7umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 44.8U/L；C-反应蛋白(CRP)-静脉血: 1.33mg/L；血小板比容-静脉血: 22%；血小板计数(PLT#)-静脉血: 23710E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.35mmolL；总胆红素(TBIL)-静脉血: 10.7umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 36.6U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.75；平均红细胞血红蛋白浓度(MCHC)-静脉血: 342g/L；肌酐(Crea)-静脉血: 62.3umol/L；总蛋白(TP)-静脉血: 75.99g/L；单核细胞百分比(Mono%)-静脉血: 0.056；平均红细胞血红蛋白浓度(MCHC)-静脉血: 337g/L；平均血小板体积(MPV)-静脉血: 9.5fL；血小板计数(PLT#)-静脉血: 24810E9/L；甘油三酯(TG)-静脉血: 1.02mmol/L；单核细胞百分比(Mono%)-静脉血: 0.081；球蛋白(GLO)-静脉血: 29.79g/L；平均红细胞体积(MCV)-静脉血: 95.1fL；总钙(Ca)-静脉血: 2.3mmol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；直接胆红素(DBIL)-静脉血: 3.9umol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；载脂蛋白AI(apoAI)-静脉血: 1.36g/L；大血小板百分比(P-LCR%)-静脉血: 17.2%；血红蛋白(Hb)-静脉血: 158g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32pg……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D64] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者近日精神好，胃纳尚可，暂无特殊不适。体查大致同入院。患者目前无放疗禁忌症，开始予以行鼻咽癌放疗。靶区剂量为：GTV70Gy/31F。放疗期间予同期化疗，并予加强对症、支持治疗。注意观察放疗不良反应表现。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停同期化疗，继续单纯放疗，并加用保肝药物\nB. 暂停放化疗，给予重组人粒细胞刺激因子支持治疗\nC. 继续放疗，将同期化疗剂量减低20%\nD. 继续放化疗方案，给予重组人血小板生成素\nE. 继续放化疗方案，定期复查血常规及生化指标\nF. 暂停放化疗，给予还原型谷胱甘肽保肝治疗\nG. 继续放化疗方案，加用双环醇保肝治疗\nH. 继续放化疗方案，给予重组人粒细胞刺激因子\nI. 暂停同期化疗，给予静脉补液及利尿处理\nJ. 继续放疗，取消同期化疗，改为西妥昔单抗治疗\nK. 暂停放疗，继续同期化疗，给予促红细胞生成素治疗\nL. 继续放化疗方案，输注单采血小板\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D70] 检验组合: 低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.66mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.6；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32pg；白细胞计数(WBC#)-静脉血: 7.7410E9/L；血红蛋白(Hb)-静脉血: 164g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 27.3U/L；磷(P)-静脉血: 1.31mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 20.8mmol/L；尿酸(UA)-静脉血: 323.7umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 44.8U/L；C-反应蛋白(CRP)-静脉血: 1.33mg/L；血小板比容-静脉血: 22%；血小板计数(PLT#)-静脉血: 23710E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.35mmolL；总胆红素(TBIL)-静脉血: 10.7umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 36.6U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.75；平均红细胞血红蛋白浓度(MCHC)-静脉血: 342g/L；肌酐(Crea)-静脉血: 62.3umol/L；总蛋白(TP)-静脉血: 75.99g/L；单核细胞百分比(Mono%)-静脉血: 0.056；平均红细胞血红蛋白浓度(MCHC)-静脉血: 337g/L；平均血小板体积(MPV)-静脉血: 9.5fL；血小板计数(PLT#)-静脉血: 24810E9/L；甘油三酯(TG)-静脉血: 1.02mmol/L；单核细胞百分比(Mono%)-静脉血: 0.081；球蛋白(GLO)-静脉血: 29.79g/L；平均红细胞体积(MCV)-静脉血: 95.1fL；总钙(Ca)-静脉血: 2.3mmol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；直接胆红素(DBIL)-静脉血: 3.9umol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；载脂蛋白AI(apoAI)-静脉血: 1.36g/L；大血小板百分比(P-LCR%)-静脉血: 17.2%；血红蛋白(Hb)-静脉血: 158g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32pg……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D64] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者近日精神好，胃纳尚可，暂无特殊不适。体查大致同入院。患者目前无放疗禁忌症，开始予以行鼻咽癌放疗。靶区剂量为：GTV70Gy/31F。放疗期间予同期化疗，并予加强对症、支持治疗。注意观察放疗不良反应表现。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停同期化疗，继续单纯放疗，并加用保肝药物\nB. 暂停放化疗，给予重组人粒细胞刺激因子支持治疗\nC. 继续放疗，将同期化疗剂量减低20%\nD. 继续放化疗方案，给予重组人血小板生成素\nE. 继续放化疗方案，定期复查血常规及生化指标\nF. 暂停放化疗，给予还原型谷胱甘肽保肝治疗\nG. 继续放化疗方案，加用双环醇保肝治疗\nH. 继续放化疗方案，给予重组人粒细胞刺激因子\nI. 暂停同期化疗，给予静脉补液及利尿处理\nJ. 继续放疗，取消同期化疗，改为西妥昔单抗治疗\nK. 暂停放疗，继续同期化疗，给予促红细胞生成素治疗\nL. 继续放化疗方案，输注单采血小板\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-5a0d01adf33246131a9f67e1","patient_id":"patient-34616c327ce5d69194ca7f4d","turn_id":"turn06","turn_position":5,"turn_type":"toxicity_or_support_decision","gold_letter":"F","gold_action":"继续按计划完成根治性放疗，并维持当前口腔含漱等常规对症支持治疗。","options":[{"letter":"A","text":"暂停放疗，给予静脉营养支持及广谱抗生素，待黏膜反应恢复后恢复放疗。","is_gold":false},{"letter":"B","text":"暂停放疗，复查鼻咽颈部MRI评估疗效，若肿瘤完全消退则提前终止放疗。","is_gold":false},{"letter":"C","text":"继续放疗，给予重组人粒细胞集落刺激因子皮下注射以纠正淋巴细胞减少。","is_gold":false},{"letter":"D","text":"继续放疗，加用大剂量糖皮质激素静脉滴注以减轻放射性口腔黏膜炎。","is_gold":false},{"letter":"E","text":"暂停放疗，行经皮内镜下胃造瘘术以保障后续营养摄入及防止体重下降。","is_gold":false},{"letter":"F","text":"继续按计划完成根治性放疗，并维持口腔含漱等常规对症支持治疗。","is_gold":true},{"letter":"G","text":"继续放疗，加用氟康唑口服以预防放疗后期可能出现的真菌性口腔炎。","is_gold":false},{"letter":"H","text":"暂停放疗，给予局部放射性保护剂及高压氧治疗，待口干症状缓解后继续。","is_gold":false},{"letter":"I","text":"继续放疗，降低单次放疗剂量以减少对双侧腮腺及颌下腺的进一步损伤。","is_gold":false},{"letter":"J","text":"提前结束放疗，转为单药辅助化学治疗以控制微小转移灶并减轻局部毒性。","is_gold":false},{"letter":"K","text":"继续放疗，预防性留置鼻胃管以应对放疗末期可能加重的吞咽困难。","is_gold":false},{"letter":"L","text":"暂停放疗，行全身PET-CT排除远处转移后再决定是否完成剩余放疗。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D83] 检验组合: 平均红细胞血红蛋白含量(MCH)-静脉血: 32.2pg；乳酸脱氢酶(LDH)-静脉血: 190.8U/L；直接胆红素(DBIL)-静脉血: 5.3umol/L；血小板计数(PLT#)-静脉血: 22010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.8；中性粒细胞计数(Neut#)-静脉血: 6.310E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.5；白蛋白(ALB)-静脉血: 45.7g/L；大血小板百分比(P-LCR%)-静脉血: 18.3%；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.81；球蛋白(GLO)-静脉血: 30.11g/L；血小板比容-静脉血: 20%；间接胆红素(IBIL)-静脉血: 8.8umolL；淋巴细胞百分比(Lymph%)-静脉血: 0.068；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 27.5U/L；总胆红素(TBIL)-静脉血: 14.1umol/L；单核细胞百分比(Mono%)-静脉血: 0.075；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；碱性磷酸酶(ALP)-静脉血: 31.2U/L；肌酐(Crea)-静脉血: 68.3umol/L；白细胞计数(WBC#)-静脉血: 7.610E9/L；总蛋白(TP)-静脉血: 75.81g/L；尿素氮(BUN)-静脉血: 4.4mmol/L；总胆汁酸(TBA)-静脉血: 1.8umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 343g/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；红细胞计数(RBC#)-静脉血: 4.910E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；红细胞比容(Hct)-静脉血: 46.1%；平均血小板体积(MPV)-静脉血: 9.3fL；平均红细胞体积(MCV)-静脉血: 94.1fL；尿酸(UA)-静脉血: 343.1umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 39U/L；中……\n- [全程D97] 检验组合: 磷(P)-静脉血: 1.26mmol/L；阴离子间隙(AG)-静脉血: 17.4；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；间接胆红素(IBIL)-静脉血: 5.9umolL；白蛋白(ALB)-静脉血: 45.2g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14；镁离子(Mg2+)-静脉血: 0.87mmol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；葡萄糖(Glu)-静脉血: 4.31mmol/L；尿酸(UA)-静脉血: 265.3umol/L；尿素氮(BUN)-静脉血: 3.1mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.6mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；单核细胞百分比(Mono%)-静脉血: 0.093；总胆汁酸(TBA)-静脉血: 0.9umol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；胱抑素(Cys-C)-静脉血: 0.73mg/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20.7U/L；钾离子(K+)-静脉血: 3.7mmol/L；总胆红素(TBIL)-静脉血: 11.1umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.98；载脂蛋白AI(apoAI)-静脉血: 1.29g/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；红细胞计数(RBC#)-静脉血: 4.5510E12/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336g/L；红细胞比容(Hct)-静脉血: 43.4%；球蛋白(GLO)-静脉血: 29.28g/L；肌酐(Crea)-静脉血: 63.8umol/L；中性粒细胞计数(Neut#)-静脉血: 4.910E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.8；大血小板百分比(P-LCR%)-静脉血: 16.8%；血红蛋白(Hb)-静脉血: 146g/L；直接胆红素(DBIL)-静脉血: 5.2umol/L；总胆固醇(TC)-静脉血: 3.12mmol/L；血小板分布宽度(PDW)-静脉血: 9.8%；总钙(Ca)-静脉血: 2.2mmol/L；血小板比容-静脉血: 13%；丙氨酸氨基转移酶(ALT)-静脉血: 21.2U/L……\n\n【既往治疗与反应】\n- [全程D71] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者近1周放疗期间一般情况好，精神好，胃纳佳，无耳鸣、无涕血、无鼻塞，无头痛、面麻，无视物模糊、复视，无声嘶、饮水呛咳、无发热，二便正常。体查大致同前。至今天，患者共完成放疗11F，暂无特殊不良反应表现。继续予以目前放疗及对症治疗。\n- [全程D78] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者至今天已行放疗16F，过程顺利。今患者精神好，胃纳尚可，诉口干、味觉改变，无咽痛，无耳鸣、无涕血、无鼻塞，无头痛、面麻，无视物模糊、复视，无声嘶、饮水呛咳、无发热，二便正常。体查：鼻咽顶后壁及右侧壁结节状肿物，肿物较放疗前稍有缩小，双颈未及明显肿大淋巴结，颅神经（－）。患者放疗期间出现口干、味觉改变，考虑为放疗副作用所致，嘱患者勤含漱，余继续予以放疗对症治疗。\n- [全程D85] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 今患者精神好，胃纳尚可，诉口干、味觉改变，轻微咽痛，无耳鸣、无涕血、无鼻塞，无头痛、面麻，无视物模糊、复视，无声嘶、饮水呛咳、无发热，二便正常。患者至今天已行放疗18F。体查：口咽黏膜充血，无明显破溃，鼻咽顶后壁及右侧壁结节状肿物，肿物较放疗前继续有缩小，双颈未及明显肿大淋巴结，颅神经（－）。患者放疗期间出现轻微咽痛，考虑为放疗所致口咽黏膜反应，予以继续加强含漱对症治疗，余继续予以放疗对症治疗。\n- [全程D92] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者近1周放疗期间一般情况好，精神好，胃纳佳，诉咽痛症状较前好转，仍有口干、味觉改变，无头痛，无发热，二便正常。体查大致同前。至今天，患者共完成放疗22F，继续予以目前放疗及对症治疗。\n- [全程D97] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者近1周放疗期间一般情况好，精神好，胃纳佳，诉咽痛症状较前好转，仍有口干、味觉改变，无头痛，无发热，二便正常。体查大致同前。至今天，患者共完成放疗27F，继续予以目前放疗及对症治疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，给予静脉营养支持及广谱抗生素，待黏膜反应恢复后恢复放疗。\nB. 暂停放疗，复查鼻咽颈部MRI评估疗效，若肿瘤完全消退则提前终止放疗。\nC. 继续放疗，给予重组人粒细胞集落刺激因子皮下注射以纠正淋巴细胞减少。\nD. 继续放疗，加用大剂量糖皮质激素静脉滴注以减轻放射性口腔黏膜炎。\nE. 暂停放疗，行经皮内镜下胃造瘘术以保障后续营养摄入及防止体重下降。\nF. 继续按计划完成根治性放疗，并维持口腔含漱等常规对症支持治疗。\nG. 继续放疗，加用氟康唑口服以预防放疗后期可能出现的真菌性口腔炎。\nH. 暂停放疗，给予局部放射性保护剂及高压氧治疗，待口干症状缓解后继续。\nI. 继续放疗，降低单次放疗剂量以减少对双侧腮腺及颌下腺的进一步损伤。\nJ. 提前结束放疗，转为单药辅助化学治疗以控制微小转移灶并减轻局部毒性。\nK. 继续放疗，预防性留置鼻胃管以应对放疗末期可能加重的吞咽困难。\nL. 暂停放疗，行全身PET-CT排除远处转移后再决定是否完成剩余放疗。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D83] 检验组合: 平均红细胞血红蛋白含量(MCH)-静脉血: 32.2pg；乳酸脱氢酶(LDH)-静脉血: 190.8U/L；直接胆红素(DBIL)-静脉血: 5.3umol/L；血小板计数(PLT#)-静脉血: 22010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.8；中性粒细胞计数(Neut#)-静脉血: 6.310E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.5；白蛋白(ALB)-静脉血: 45.7g/L；大血小板百分比(P-LCR%)-静脉血: 18.3%；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.81；球蛋白(GLO)-静脉血: 30.11g/L；血小板比容-静脉血: 20%；间接胆红素(IBIL)-静脉血: 8.8umolL；淋巴细胞百分比(Lymph%)-静脉血: 0.068；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 27.5U/L；总胆红素(TBIL)-静脉血: 14.1umol/L；单核细胞百分比(Mono%)-静脉血: 0.075；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；碱性磷酸酶(ALP)-静脉血: 31.2U/L；肌酐(Crea)-静脉血: 68.3umol/L；白细胞计数(WBC#)-静脉血: 7.610E9/L；总蛋白(TP)-静脉血: 75.81g/L；尿素氮(BUN)-静脉血: 4.4mmol/L；总胆汁酸(TBA)-静脉血: 1.8umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 343g/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；红细胞计数(RBC#)-静脉血: 4.910E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；红细胞比容(Hct)-静脉血: 46.1%；平均血小板体积(MPV)-静脉血: 9.3fL；平均红细胞体积(MCV)-静脉血: 94.1fL；尿酸(UA)-静脉血: 343.1umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 39U/L；中……\n- [全程D97] 检验组合: 磷(P)-静脉血: 1.26mmol/L；阴离子间隙(AG)-静脉血: 17.4；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；间接胆红素(IBIL)-静脉血: 5.9umolL；白蛋白(ALB)-静脉血: 45.2g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14；镁离子(Mg2+)-静脉血: 0.87mmol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；葡萄糖(Glu)-静脉血: 4.31mmol/L；尿酸(UA)-静脉血: 265.3umol/L；尿素氮(BUN)-静脉血: 3.1mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.6mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；单核细胞百分比(Mono%)-静脉血: 0.093；总胆汁酸(TBA)-静脉血: 0.9umol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；胱抑素(Cys-C)-静脉血: 0.73mg/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20.7U/L；钾离子(K+)-静脉血: 3.7mmol/L；总胆红素(TBIL)-静脉血: 11.1umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.98；载脂蛋白AI(apoAI)-静脉血: 1.29g/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；红细胞计数(RBC#)-静脉血: 4.5510E12/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336g/L；红细胞比容(Hct)-静脉血: 43.4%；球蛋白(GLO)-静脉血: 29.28g/L；肌酐(Crea)-静脉血: 63.8umol/L；中性粒细胞计数(Neut#)-静脉血: 4.910E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.8；大血小板百分比(P-LCR%)-静脉血: 16.8%；血红蛋白(Hb)-静脉血: 146g/L；直接胆红素(DBIL)-静脉血: 5.2umol/L；总胆固醇(TC)-静脉血: 3.12mmol/L；血小板分布宽度(PDW)-静脉血: 9.8%；总钙(Ca)-静脉血: 2.2mmol/L；血小板比容-静脉血: 13%；丙氨酸氨基转移酶(ALT)-静脉血: 21.2U/L……\n\n【既往治疗与反应】\n- [全程D71] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者近1周放疗期间一般情况好，精神好，胃纳佳，无耳鸣、无涕血、无鼻塞，无头痛、面麻，无视物模糊、复视，无声嘶、饮水呛咳、无发热，二便正常。体查大致同前。至今天，患者共完成放疗11F，暂无特殊不良反应表现。继续予以目前放疗及对症治疗。\n- [全程D78] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者至今天已行放疗16F，过程顺利。今患者精神好，胃纳尚可，诉口干、味觉改变，无咽痛，无耳鸣、无涕血、无鼻塞，无头痛、面麻，无视物模糊、复视，无声嘶、饮水呛咳、无发热，二便正常。体查：鼻咽顶后壁及右侧壁结节状肿物，肿物较放疗前稍有缩小，双颈未及明显肿大淋巴结，颅神经（－）。患者放疗期间出现口干、味觉改变，考虑为放疗副作用所致，嘱患者勤含漱，余继续予以放疗对症治疗。\n- [全程D85] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 今患者精神好，胃纳尚可，诉口干、味觉改变，轻微咽痛，无耳鸣、无涕血、无鼻塞，无头痛、面麻，无视物模糊、复视，无声嘶、饮水呛咳、无发热，二便正常。患者至今天已行放疗18F。体查：口咽黏膜充血，无明显破溃，鼻咽顶后壁及右侧壁结节状肿物，肿物较放疗前继续有缩小，双颈未及明显肿大淋巴结，颅神经（－）。患者放疗期间出现轻微咽痛，考虑为放疗所致口咽黏膜反应，予以继续加强含漱对症治疗，余继续予以放疗对症治疗。\n- [全程D92] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者近1周放疗期间一般情况好，精神好，胃纳佳，诉咽痛症状较前好转，仍有口干、味觉改变，无头痛，无发热，二便正常。体查大致同前。至今天，患者共完成放疗22F，继续予以目前放疗及对症治疗。\n- [全程D97] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者近1周放疗期间一般情况好，精神好，胃纳佳，诉咽痛症状较前好转，仍有口干、味觉改变，无头痛，无发热，二便正常。体查大致同前。至今天，患者共完成放疗27F，继续予以目前放疗及对症治疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，给予静脉营养支持及广谱抗生素，待黏膜反应恢复后恢复放疗。\nB. 暂停放疗，复查鼻咽颈部MRI评估疗效，若肿瘤完全消退则提前终止放疗。\nC. 继续放疗，给予重组人粒细胞集落刺激因子皮下注射以纠正淋巴细胞减少。\nD. 继续放疗，加用大剂量糖皮质激素静脉滴注以减轻放射性口腔黏膜炎。\nE. 暂停放疗，行经皮内镜下胃造瘘术以保障后续营养摄入及防止体重下降。\nF. 继续按计划完成根治性放疗，并维持口腔含漱等常规对症支持治疗。\nG. 继续放疗，加用氟康唑口服以预防放疗后期可能出现的真菌性口腔炎。\nH. 暂停放疗，给予局部放射性保护剂及高压氧治疗，待口干症状缓解后继续。\nI. 继续放疗，降低单次放疗剂量以减少对双侧腮腺及颌下腺的进一步损伤。\nJ. 提前结束放疗，转为单药辅助化学治疗以控制微小转移灶并减轻局部毒性。\nK. 继续放疗，预防性留置鼻胃管以应对放疗末期可能加重的吞咽困难。\nL. 暂停放疗，行全身PET-CT排除远处转移后再决定是否完成剩余放疗。\n\n请仅输出一个选项字母（A-L）。"}]}
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full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：腭帆提肌。\n文本分期信息：N2，M0。\n综合TNM状态：T1N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 听力下降8月，发现左颈部包块1月余；现病史: 患者于某次就诊时间初开始无明显诱因出现听力下降，以右侧为著，未予重视。某次就诊时间7月初患者无意中发现左颈部包块，大小约4×4cm，无疼痛，无表面皮肤发红，未就诊，肿物进行性增大。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,左颈部包块,颈部肿物；既往史: 发现血糖升高一年余，未行药物治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟：30－40支/天×30余。否认饮酒史。否认不洁性生活史。；家族史: 两个舅舅分别患有肝癌及骨肿瘤。；体格检查: T：36.4℃，P：83次/分，R：20次/分，BP：100/65mmHg,Ht：164cm，Wt：87kg，BSA：1.93m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 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电子鼻咽镜检查及活检，鼻咽及颈部增强MRI，仅行胸部X线及腹部彩超，无需全身骨显像\nG. 电子鼻咽镜检查及活检，鼻咽及颈部增强MRI，胸部X线、腹部彩超、全身骨显像，以及EBV抗体检测\nH. 电子鼻咽镜检查及活检，鼻咽及颈部增强MRI，头颅增强MRI，全身骨髓穿刺活检及EBV检测\nI. 电子鼻咽镜检查及活检，鼻咽及颈部增强MRI，胸部X线、腹部彩超、全身骨显像，并预防性气管切开\nJ. 电子鼻咽镜检查及活检，鼻咽及颈部平扫MRI，胸部X线、腹部彩超、全身骨显像，以及EBV抗体检测\nK. 鼻咽及颈部增强MRI，胸部X线、腹部彩超、全身骨显像，待影像学出具恶性报告后再行鼻咽镜活检\nL. 电子鼻咽镜检查及活检，鼻咽及颈部增强MRI，直接行全身骨显像及头颅CT，免除胸腹部影像学检查\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-487e8333de7d37de56947d09","patient_id":"patient-9bf5c8c03860cdf61108611d","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"H","gold_action":"完善电子鼻咽镜检查并取活检明确病理诊断。","options":[{"letter":"A","text":"完善颈部淋巴结细针穿刺活检作为首选病理确诊手段。","is_gold":false},{"letter":"B","text":"完善全身PET-CT检查，若无远处转移则直接开始根治性放疗。","is_gold":false},{"letter":"C","text":"完善电子鼻咽镜检查评估局部侵犯范围，暂不取活检以防大出血。","is_gold":false},{"letter":"D","text":"完善鼻咽镜检查并取活检，同时行颈部淋巴结切除活检以明确分期。","is_gold":false},{"letter":"E","text":"完善鼻咽部刷片细胞学检查明确病理诊断。","is_gold":false},{"letter":"F","text":"完善鼻内镜下鼻咽肿物切除术，术后送常规病理。","is_gold":false},{"letter":"G","text":"完善电子鼻咽镜检查并取活检，若首次活检阴性则按临床诊断开始化疗。","is_gold":false},{"letter":"H","text":"完善电子鼻咽镜检查并取活检明确病理诊断。","is_gold":true},{"letter":"I","text":"完善颈部淋巴结切除活检作为首选病理确诊手段。","is_gold":false},{"letter":"J","text":"完善电子鼻咽镜检查并取活检，同时行预防性气管切开。","is_gold":false},{"letter":"K","text":"完善鼻咽镜检查并取活检，同时行扁桃体切除活检排除隐匿原发灶。","is_gold":false},{"letter":"L","text":"完善全身骨扫描及腹部超声，待全身分期明确后再行鼻咽活检。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：腭帆提肌。\n文本分期信息：N2，M0。\n综合TNM状态：T1N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D0] 检验组合: 隐血(OB)-粪便: 阴性（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-粪便: 棕色；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；比重(SG)-尿液: 1.021；浊度(TRUB)-尿液: 清亮；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 5.5；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；白细胞计数(WBC#)-尿液: 3/μL；虫卵-粪便: 未见虫卵（参考: 未见虫卵）\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理增多增粗，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，右肋膈角锐利，左肋膈角模糊。；检查结论: 考虑双肺慢性支气管炎X线改变。 左侧胸膜稍增厚。\n- [全程D1] 检验组合: 人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；载脂蛋白B(apoB)-静脉血: 1.08g/L；间接胆红素(IBIL)-静脉血: 5.9umolL；钾离子(K+)-静脉血: 4.1mmol/L；阴离子间隙(AG)-静脉血: 17.5；血红蛋白(Hb)-静脉血: 151g/L；凝血酶原时间活动度(PTA)-静脉血: 113.8%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；单核细胞计数(Mono#)-静脉血: 0.610E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.99mmol/L；ABO血型-静脉血: O；中性粒细胞百分比(Neut%)-静脉血: 0.578；血小板比容-静脉血: 24%；Rh血型-静脉血: 阳性；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 5.12mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；梅毒非特异性抗体甲苯胺红不加热血清试验(TRUST)-静脉血: 阴性(-)（参考: 阴性）；淋巴细胞百分比(Lymph%)-静脉血: 0.307；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.9；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 7.9umol/L；白细胞计数(WBC#)-静脉血: 7.610E9/L；直接胆红素(DBIL)-静脉血: 2umol/L；红细胞计数(RBC#)-静脉血: 5.2510E12/L；白蛋白(ALB)-静脉血: 42.2g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；红细胞比容(Hct)-静脉血: 44.7%；糖化血红蛋白A1c(HbA1c)-静脉血: 7.2%；总蛋白(TP)-静脉血: 76.24g/L；凝血酶时间(TT)-静脉血: 18.9sec.；纤维蛋白原(Fbg)-静脉血: 2.44g/L；钠离子(Na+)-静脉血……\n- [全程D4] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔变窄，鼻咽各壁粘膜明显增厚，见结节状肿物向鼻咽腔内突出，T1WI呈等信号，T2WI呈稍高信号，增强扫描轻度不均匀强化，双侧咽隐窝见肿物填塞。口咽双侧壁未见受累增厚，病变未累及双侧后鼻孔。 双侧腭帆提肌受侵，双侧腭帆张肌及头长肌、双侧翼内外肌未见受侵征象。 双侧翼腭窝、双侧上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 颅底骨质未见破坏。 双侧海绵窦形态未见异常。 双侧筛窦、双侧上颌窦粘膜增厚，增强扫描呈轻度强化。双侧乳突未见分泌物。 双眼未见异常，球后未见占位性病变。蝶鞍形态未见异常，其内未见占位性病变。 双侧咽后见淋巴结，大小约7mm×9mm，增强扫描明显强化。 双颈II区、左颈III区见多个肿大淋巴结，最大约33mm×27mm，边界欠清，增强扫描呈明显强化。 右颈III区、双颈I区见数个小淋巴结，最大约5mm×11mm，边界清楚，孤立散在。 甲状腺双叶及峡部形态未见异常，信号均匀，未见占位性病变。喉咽腔形态未见异常，未见占位性病变。双侧颌下腺、腮腺大小、形态未见异常，信号均匀，未见占位性病变。 扫描所见脑组织未见明确异常。；检查结论: 鼻咽肿物，考虑鼻咽癌。 颅底骨质未见破坏。 双侧咽后、双颈II区、左颈III区肿大淋巴结，考虑转移。 鼻窦炎。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善颈部淋巴结细针穿刺活检作为首选病理确诊手段。\nB. 完善全身PET-CT检查，若无远处转移则直接开始根治性放疗。\nC. 完善电子鼻咽镜检查评估局部侵犯范围，暂不取活检以防大出血。\nD. 完善鼻咽镜检查并取活检，同时行颈部淋巴结切除活检以明确分期。\nE. 完善鼻咽部刷片细胞学检查明确病理诊断。\nF. 完善鼻内镜下鼻咽肿物切除术，术后送常规病理。\nG. 完善电子鼻咽镜检查并取活检，若首次活检阴性则按临床诊断开始化疗。\nH. 完善电子鼻咽镜检查并取活检明确病理诊断。\nI. 完善颈部淋巴结切除活检作为首选病理确诊手段。\nJ. 完善电子鼻咽镜检查并取活检，同时行预防性气管切开。\nK. 完善鼻咽镜检查并取活检，同时行扁桃体切除活检排除隐匿原发灶。\nL. 完善全身骨扫描及腹部超声，待全身分期明确后再行鼻咽活检。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：腭帆提肌。\n文本分期信息：N2，M0。\n综合TNM状态：T1N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D0] 检验组合: 隐血(OB)-粪便: 阴性（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-粪便: 棕色；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；比重(SG)-尿液: 1.021；浊度(TRUB)-尿液: 清亮；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 5.5；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；白细胞计数(WBC#)-尿液: 3/μL；虫卵-粪便: 未见虫卵（参考: 未见虫卵）\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理增多增粗，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，右肋膈角锐利，左肋膈角模糊。；检查结论: 考虑双肺慢性支气管炎X线改变。 左侧胸膜稍增厚。\n- [全程D1] 检验组合: 人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；载脂蛋白B(apoB)-静脉血: 1.08g/L；间接胆红素(IBIL)-静脉血: 5.9umolL；钾离子(K+)-静脉血: 4.1mmol/L；阴离子间隙(AG)-静脉血: 17.5；血红蛋白(Hb)-静脉血: 151g/L；凝血酶原时间活动度(PTA)-静脉血: 113.8%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；单核细胞计数(Mono#)-静脉血: 0.610E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.99mmol/L；ABO血型-静脉血: O；中性粒细胞百分比(Neut%)-静脉血: 0.578；血小板比容-静脉血: 24%；Rh血型-静脉血: 阳性；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 5.12mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；梅毒非特异性抗体甲苯胺红不加热血清试验(TRUST)-静脉血: 阴性(-)（参考: 阴性）；淋巴细胞百分比(Lymph%)-静脉血: 0.307；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.9；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 7.9umol/L；白细胞计数(WBC#)-静脉血: 7.610E9/L；直接胆红素(DBIL)-静脉血: 2umol/L；红细胞计数(RBC#)-静脉血: 5.2510E12/L；白蛋白(ALB)-静脉血: 42.2g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；红细胞比容(Hct)-静脉血: 44.7%；糖化血红蛋白A1c(HbA1c)-静脉血: 7.2%；总蛋白(TP)-静脉血: 76.24g/L；凝血酶时间(TT)-静脉血: 18.9sec.；纤维蛋白原(Fbg)-静脉血: 2.44g/L；钠离子(Na+)-静脉血……\n- [全程D4] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔变窄，鼻咽各壁粘膜明显增厚，见结节状肿物向鼻咽腔内突出，T1WI呈等信号，T2WI呈稍高信号，增强扫描轻度不均匀强化，双侧咽隐窝见肿物填塞。口咽双侧壁未见受累增厚，病变未累及双侧后鼻孔。 双侧腭帆提肌受侵，双侧腭帆张肌及头长肌、双侧翼内外肌未见受侵征象。 双侧翼腭窝、双侧上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 颅底骨质未见破坏。 双侧海绵窦形态未见异常。 双侧筛窦、双侧上颌窦粘膜增厚，增强扫描呈轻度强化。双侧乳突未见分泌物。 双眼未见异常，球后未见占位性病变。蝶鞍形态未见异常，其内未见占位性病变。 双侧咽后见淋巴结，大小约7mm×9mm，增强扫描明显强化。 双颈II区、左颈III区见多个肿大淋巴结，最大约33mm×27mm，边界欠清，增强扫描呈明显强化。 右颈III区、双颈I区见数个小淋巴结，最大约5mm×11mm，边界清楚，孤立散在。 甲状腺双叶及峡部形态未见异常，信号均匀，未见占位性病变。喉咽腔形态未见异常，未见占位性病变。双侧颌下腺、腮腺大小、形态未见异常，信号均匀，未见占位性病变。 扫描所见脑组织未见明确异常。；检查结论: 鼻咽肿物，考虑鼻咽癌。 颅底骨质未见破坏。 双侧咽后、双颈II区、左颈III区肿大淋巴结，考虑转移。 鼻窦炎。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善颈部淋巴结细针穿刺活检作为首选病理确诊手段。\nB. 完善全身PET-CT检查，若无远处转移则直接开始根治性放疗。\nC. 完善电子鼻咽镜检查评估局部侵犯范围，暂不取活检以防大出血。\nD. 完善鼻咽镜检查并取活检，同时行颈部淋巴结切除活检以明确分期。\nE. 完善鼻咽部刷片细胞学检查明确病理诊断。\nF. 完善鼻内镜下鼻咽肿物切除术，术后送常规病理。\nG. 完善电子鼻咽镜检查并取活检，若首次活检阴性则按临床诊断开始化疗。\nH. 完善电子鼻咽镜检查并取活检明确病理诊断。\nI. 完善颈部淋巴结切除活检作为首选病理确诊手段。\nJ. 完善电子鼻咽镜检查并取活检，同时行预防性气管切开。\nK. 完善鼻咽镜检查并取活检，同时行扁桃体切除活检排除隐匿原发灶。\nL. 完善全身骨扫描及腹部超声，待全身分期明确后再行鼻咽活检。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-7ff1cd1ea3ebf1a9891b521d","patient_id":"patient-9bf5c8c03860cdf61108611d","turn_id":"turn05","turn_position":3,"turn_type":"toxicity_or_support_decision","gold_letter":"K","gold_action":"按原剂量行第二程GP（吉西他滨+顺铂）诱导化疗，并辅以常规止吐、护胃及水化利尿等支持治疗。","options":[{"letter":"A","text":"暂缓化疗，给予重组人血小板生成素升血小板治疗，待血小板恢复至正常范围后原剂量行第二程GP诱导化疗。","is_gold":false},{"letter":"B","text":"行第二程GP诱导化疗，吉西他滨剂量下调25%，顺铂维持原剂量，辅以常规止吐及水化利尿等支持治疗。","is_gold":false},{"letter":"C","text":"停用GP诱导化疗方案，直接转入根治性单纯放疗阶段，并安排心血管专科随访与干预。","is_gold":false},{"letter":"D","text":"更改诱导化疗方案，将第二程方案由GP（吉西他滨+顺铂）调整为TP（多西他赛+顺铂）方案并按原剂量给药。","is_gold":false},{"letter":"E","text":"按原剂量行第二程GP诱导化疗，并于化疗结束后预防性给予聚乙二醇化重组人粒细胞刺激因子支持。","is_gold":false},{"letter":"F","text":"暂缓化疗，请心血管内科会诊并完善超声心动图等检查，待心血管专科评估通过后再行第二程GP化疗。","is_gold":false},{"letter":"G","text":"按原剂量行第二程GP诱导化疗，并同步皮下注射重组人促红细胞生成素以提升血红蛋白水平。","is_gold":false},{"letter":"H","text":"行第二程GP诱导化疗，顺铂剂量下调25%，吉西他滨维持原剂量，辅以常规止吐及水化利尿等支持治疗。","is_gold":false},{"letter":"I","text":"终止诱导化疗，直接进入根治性同步放化疗阶段，同步化疗采用单药顺铂标准剂量方案。","is_gold":false},{"letter":"J","text":"按原剂量行第二程GP诱导化疗，化疗前预防性输注单采血小板1个治疗量以降低出血风险。","is_gold":false},{"letter":"K","text":"按原剂量行第二程GP诱导化疗，并辅以常规止吐、护胃及水化利尿等支持治疗。","is_gold":true},{"letter":"L","text":"按原剂量行第二程GP诱导化疗，并预防性加用异甘草酸镁等保肝药物以防止化疗相关肝损伤。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：腭帆提肌。\n文本分期信息：N2，M0。\n综合TNM状态：T1N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D8] 入院记录: 主诉: 听力下降8月，发现左颈部包块1月余；现病史: 简要入院病史:患者于某次就诊时间初开始无明显诱因出现听力下降，以右侧为著，未予重视。某次就诊时间7月初患者无意中发现左颈部包块，大小约4×4cm，无疼痛，无表面皮肤发红，未就诊，肿物进行性增大。8月初肿物增大至鸡蛋大小，就诊地域信息已隐藏，行颈部肿块穿刺，病理回报：转移癌可能性大。8－11行鼻咽＋颈部MRI提示：鼻咽双侧壁及顶后壁软组织增厚，考虑鼻咽癌并双侧咽后、双颈部多发淋巴结肿大。胸部MRI检查未见异常。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,左颈部包块,颈部肿物；既往史: 发现血糖升高一年余，未行药物治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、肾病”病史；否认手术、外伤、输血史及献血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D5] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约15cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D7] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 双上颌骨可见片状放射性浓集灶。胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 双上颌骨炎症。 余全身骨骼未见明显异常。\n- [全程D12] 检验组合: 平均红细胞血红蛋白浓度(MCHC)-静脉血: 340g/L；血小板比容-静脉血: 24%；单核细胞计数(Mono#)-静脉血: 0.110E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；红细胞比容(Hct)-静脉血: 41.8%；平均红细胞血红蛋白含量(MCH)-静脉血: 29pg；单核细胞百分比(Mono%)-静脉血: 0.016；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.1；平均血小板体积(MPV)-静脉血: 10.3fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.007；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；红细胞计数(RBC#)-静脉血: 4.8910E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；大血小板百分比(P-LCR%)-静脉血: 27%；淋巴细胞百分比(Lymph%)-静脉血: 0.422；血小板计数(PLT#)-静脉血: 23710E9/L；平均红细胞体积(MCV)-静脉血: 85.5fL；淋巴细胞计数(Lymph#)-静脉血: 310E9/L；白细胞计数(WBC#)-静脉血: 710E9/L；血小板分布宽度(PDW)-静脉血: 11.6%；血红蛋白(Hb)-静脉血: 142g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；中性粒细胞百分比(Neut%)-静脉血: 0.552\n- [全程D15] 检验组合: 单核细胞计数(Mono#)-静脉血: 0.310E9/L；血小板计数(PLT#)-静脉血: 19810E9/L；红细胞比容(Hct)-静脉血: 44.3%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13；大血小板百分比(P-LCR%)-静脉血: 22.1%；红细胞计数(RBC#)-静脉血: 5.2510E12/L；淋巴细胞百分比(Lymph%)-静脉血: 0.443；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；血小板比容-静脉血: 19%；血红蛋白(Hb)-静脉血: 151g/L；血小板分布宽度(PDW)-静脉血: 11.5%；平均红细胞体积(MCV)-静脉血: 84.4fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.033；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；单核细胞百分比(Mono%)-静脉血: 0.059；平均血小板体积(MPV)-静脉血: 9.5fL；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.46；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；白细胞计数(WBC#)-静脉血: 5.7610E9/L；淋巴细胞计数(Lymph#)-静脉血: 2.610E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.8\n- [全程D19] 检验组合: 中性粒细胞计数(Neut#)-静脉血: 5.210E9/L；单核细胞计数(Mono#)-静脉血: 0.110E9/L；血红蛋白(Hb)-静脉血: 131g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.231；红细胞计数(RBC#)-静脉血: 4.510E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.742；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；大血小板百分比(P-LCR%)-静脉血: 21.7%；血小板计数(PLT#)-静脉血: 14310E9/L；血小板分布宽度(PDW)-静脉血: 10.7%；平均红细胞体积(MCV)-静脉血: 88.9fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.6；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；血小板比容-静脉血: 14%；白细胞计数(WBC#)-静脉血: 710E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.3；单核细胞百分比(Mono%)-静脉血: 0.01；平均血小板体积(MPV)-静脉血: 9.5fL；红细胞比容(Hct)-静脉血: 40%；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L\n- [全程D27] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 拟不完全性右束支传导阻滞\n- [全程D27] 检验组合: 镁离子(Mg2+)-静脉血: 0.82mmol/L；氯离子(Cl-)-静脉血: 103.6mmol/L；总胆固醇(TC)-静脉血: 5.1mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.25mmol/L；总胆汁酸(TBA)-静脉血: 4.1umol/L；肌酐(Crea)-静脉血: 76.9umol/L；直接胆红素(DBIL)-静脉血: 1.6umol/L；总钙(Ca)-静脉血: 2.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 19.8U/L；总蛋白(TP)-静脉血: 75.08g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.29；尿酸(UA)-静脉血: 440.4umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 19.1mmol/L；磷(P)-静脉血: 1.09mmol/L；胱抑素(Cys-C)-静脉血: 1.21mg/L；C-反应蛋白(CRP)-静脉血: 4.53mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.06mmolL；碱性磷酸酶(ALP)-静脉血: 84.7U/L；白蛋白(ALB)-静脉血: 42.3g/L；载脂蛋白B(apoB)-静脉血: 1.13g/L；球蛋白(GLO)-静脉血: 32.78g/L；尿素氮(BUN)-静脉血: 7.3mmol/L；钠离子(Na+)-静脉血: 138.8mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 47.8U/L；甘油三酯(TG)-静脉血: 2.38mmol/L；乳酸脱氢酶(LDH)-静脉血: 183.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 54U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.2U/L；葡萄糖(Glu)-静脉血: 7.26mmol/L；总胆红素(TBIL)-静脉血: 5.3umol/L；载脂蛋白AI(apoAI)-静脉血: 1.29g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.92；钾离子(K+)-静脉血: 4.48mmol/L；间接胆红素(IBIL)-静脉血: 3.7umolL；阴离子间隙(AG)-静脉血: 16.1\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂缓化疗，给予重组人血小板生成素升血小板治疗，待血小板恢复至正常范围后原剂量行第二程GP诱导化疗。\nB. 行第二程GP诱导化疗，吉西他滨剂量下调25%，顺铂维持原剂量，辅以常规止吐及水化利尿等支持治疗。\nC. 停用GP诱导化疗方案，直接转入根治性单纯放疗阶段，并安排心血管专科随访与干预。\nD. 更改诱导化疗方案，将第二程方案由GP（吉西他滨+顺铂）调整为TP（多西他赛+顺铂）方案并按原剂量给药。\nE. 按原剂量行第二程GP诱导化疗，并于化疗结束后预防性给予聚乙二醇化重组人粒细胞刺激因子支持。\nF. 暂缓化疗，请心血管内科会诊并完善超声心动图等检查，待心血管专科评估通过后再行第二程GP化疗。\nG. 按原剂量行第二程GP诱导化疗，并同步皮下注射重组人促红细胞生成素以提升血红蛋白水平。\nH. 行第二程GP诱导化疗，顺铂剂量下调25%，吉西他滨维持原剂量，辅以常规止吐及水化利尿等支持治疗。\nI. 终止诱导化疗，直接进入根治性同步放化疗阶段，同步化疗采用单药顺铂标准剂量方案。\nJ. 按原剂量行第二程GP诱导化疗，化疗前预防性输注单采血小板1个治疗量以降低出血风险。\nK. 按原剂量行第二程GP诱导化疗，并辅以常规止吐、护胃及水化利尿等支持治疗。\nL. 按原剂量行第二程GP诱导化疗，并预防性加用异甘草酸镁等保肝药物以防止化疗相关肝损伤。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：腭帆提肌。\n文本分期信息：N2，M0。\n综合TNM状态：T1N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D8] 入院记录: 主诉: 听力下降8月，发现左颈部包块1月余；现病史: 简要入院病史:患者于某次就诊时间初开始无明显诱因出现听力下降，以右侧为著，未予重视。某次就诊时间7月初患者无意中发现左颈部包块，大小约4×4cm，无疼痛，无表面皮肤发红，未就诊，肿物进行性增大。8月初肿物增大至鸡蛋大小，就诊地域信息已隐藏，行颈部肿块穿刺，病理回报：转移癌可能性大。8－11行鼻咽＋颈部MRI提示：鼻咽双侧壁及顶后壁软组织增厚，考虑鼻咽癌并双侧咽后、双颈部多发淋巴结肿大。胸部MRI检查未见异常。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,左颈部包块,颈部肿物；既往史: 发现血糖升高一年余，未行药物治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、肾病”病史；否认手术、外伤、输血史及献血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D5] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约15cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D7] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 双上颌骨可见片状放射性浓集灶。胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 双上颌骨炎症。 余全身骨骼未见明显异常。\n- [全程D12] 检验组合: 平均红细胞血红蛋白浓度(MCHC)-静脉血: 340g/L；血小板比容-静脉血: 24%；单核细胞计数(Mono#)-静脉血: 0.110E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；红细胞比容(Hct)-静脉血: 41.8%；平均红细胞血红蛋白含量(MCH)-静脉血: 29pg；单核细胞百分比(Mono%)-静脉血: 0.016；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.1；平均血小板体积(MPV)-静脉血: 10.3fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.007；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；红细胞计数(RBC#)-静脉血: 4.8910E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；大血小板百分比(P-LCR%)-静脉血: 27%；淋巴细胞百分比(Lymph%)-静脉血: 0.422；血小板计数(PLT#)-静脉血: 23710E9/L；平均红细胞体积(MCV)-静脉血: 85.5fL；淋巴细胞计数(Lymph#)-静脉血: 310E9/L；白细胞计数(WBC#)-静脉血: 710E9/L；血小板分布宽度(PDW)-静脉血: 11.6%；血红蛋白(Hb)-静脉血: 142g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；中性粒细胞百分比(Neut%)-静脉血: 0.552\n- [全程D15] 检验组合: 单核细胞计数(Mono#)-静脉血: 0.310E9/L；血小板计数(PLT#)-静脉血: 19810E9/L；红细胞比容(Hct)-静脉血: 44.3%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13；大血小板百分比(P-LCR%)-静脉血: 22.1%；红细胞计数(RBC#)-静脉血: 5.2510E12/L；淋巴细胞百分比(Lymph%)-静脉血: 0.443；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；血小板比容-静脉血: 19%；血红蛋白(Hb)-静脉血: 151g/L；血小板分布宽度(PDW)-静脉血: 11.5%；平均红细胞体积(MCV)-静脉血: 84.4fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.033；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；单核细胞百分比(Mono%)-静脉血: 0.059；平均血小板体积(MPV)-静脉血: 9.5fL；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.46；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；白细胞计数(WBC#)-静脉血: 5.7610E9/L；淋巴细胞计数(Lymph#)-静脉血: 2.610E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.8\n- [全程D19] 检验组合: 中性粒细胞计数(Neut#)-静脉血: 5.210E9/L；单核细胞计数(Mono#)-静脉血: 0.110E9/L；血红蛋白(Hb)-静脉血: 131g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.231；红细胞计数(RBC#)-静脉血: 4.510E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.742；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；大血小板百分比(P-LCR%)-静脉血: 21.7%；血小板计数(PLT#)-静脉血: 14310E9/L；血小板分布宽度(PDW)-静脉血: 10.7%；平均红细胞体积(MCV)-静脉血: 88.9fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.6；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；血小板比容-静脉血: 14%；白细胞计数(WBC#)-静脉血: 710E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.3；单核细胞百分比(Mono%)-静脉血: 0.01；平均血小板体积(MPV)-静脉血: 9.5fL；红细胞比容(Hct)-静脉血: 40%；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L\n- [全程D27] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 拟不完全性右束支传导阻滞\n- [全程D27] 检验组合: 镁离子(Mg2+)-静脉血: 0.82mmol/L；氯离子(Cl-)-静脉血: 103.6mmol/L；总胆固醇(TC)-静脉血: 5.1mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.25mmol/L；总胆汁酸(TBA)-静脉血: 4.1umol/L；肌酐(Crea)-静脉血: 76.9umol/L；直接胆红素(DBIL)-静脉血: 1.6umol/L；总钙(Ca)-静脉血: 2.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 19.8U/L；总蛋白(TP)-静脉血: 75.08g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.29；尿酸(UA)-静脉血: 440.4umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 19.1mmol/L；磷(P)-静脉血: 1.09mmol/L；胱抑素(Cys-C)-静脉血: 1.21mg/L；C-反应蛋白(CRP)-静脉血: 4.53mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.06mmolL；碱性磷酸酶(ALP)-静脉血: 84.7U/L；白蛋白(ALB)-静脉血: 42.3g/L；载脂蛋白B(apoB)-静脉血: 1.13g/L；球蛋白(GLO)-静脉血: 32.78g/L；尿素氮(BUN)-静脉血: 7.3mmol/L；钠离子(Na+)-静脉血: 138.8mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 47.8U/L；甘油三酯(TG)-静脉血: 2.38mmol/L；乳酸脱氢酶(LDH)-静脉血: 183.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 54U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.2U/L；葡萄糖(Glu)-静脉血: 7.26mmol/L；总胆红素(TBIL)-静脉血: 5.3umol/L；载脂蛋白AI(apoAI)-静脉血: 1.29g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.92；钾离子(K+)-静脉血: 4.48mmol/L；间接胆红素(IBIL)-静脉血: 3.7umolL；阴离子间隙(AG)-静脉血: 16.1\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂缓化疗，给予重组人血小板生成素升血小板治疗，待血小板恢复至正常范围后原剂量行第二程GP诱导化疗。\nB. 行第二程GP诱导化疗，吉西他滨剂量下调25%，顺铂维持原剂量，辅以常规止吐及水化利尿等支持治疗。\nC. 停用GP诱导化疗方案，直接转入根治性单纯放疗阶段，并安排心血管专科随访与干预。\nD. 更改诱导化疗方案，将第二程方案由GP（吉西他滨+顺铂）调整为TP（多西他赛+顺铂）方案并按原剂量给药。\nE. 按原剂量行第二程GP诱导化疗，并于化疗结束后预防性给予聚乙二醇化重组人粒细胞刺激因子支持。\nF. 暂缓化疗，请心血管内科会诊并完善超声心动图等检查，待心血管专科评估通过后再行第二程GP化疗。\nG. 按原剂量行第二程GP诱导化疗，并同步皮下注射重组人促红细胞生成素以提升血红蛋白水平。\nH. 行第二程GP诱导化疗，顺铂剂量下调25%，吉西他滨维持原剂量，辅以常规止吐及水化利尿等支持治疗。\nI. 终止诱导化疗，直接进入根治性同步放化疗阶段，同步化疗采用单药顺铂标准剂量方案。\nJ. 按原剂量行第二程GP诱导化疗，化疗前预防性输注单采血小板1个治疗量以降低出血风险。\nK. 按原剂量行第二程GP诱导化疗，并辅以常规止吐、护胃及水化利尿等支持治疗。\nL. 按原剂量行第二程GP诱导化疗，并预防性加用异甘草酸镁等保肝药物以防止化疗相关肝损伤。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-9fc5959f48286f0a038d3acb","patient_id":"patient-9bf5c8c03860cdf61108611d","turn_id":"turn07","turn_position":4,"turn_type":"response_assessment_decision","gold_letter":"A","gold_action":"完善鼻咽及颈部MRI评估疗效；取消同期顺铂化疗，予以纠正贫血并单纯根治性调强放疗（或联合靶向治疗）。","options":[{"letter":"A","text":"完善鼻咽及颈部MRI评估疗效；取消同期顺铂化疗，予以纠正贫血并单纯根治性调强放疗（或联合靶向治疗）。","is_gold":true},{"letter":"B","text":"完善鼻咽及颈部MRI评估疗效；按原计划行同期顺铂化疗联合根治性调强放疗。","is_gold":false},{"letter":"C","text":"完善鼻咽及颈部MRI评估疗效；将同期顺铂减量至40mg/m2周疗，联合根治性调强放疗。","is_gold":false},{"letter":"D","text":"完善鼻咽及颈部MRI评估疗效；将同期化疗方案更换为卡铂，联合根治性调强放疗。","is_gold":false},{"letter":"E","text":"完善鼻咽及颈部MRI评估疗效；暂停抗肿瘤治疗，待血红蛋白恢复至100g/L以上后再行同期放化疗。","is_gold":false},{"letter":"F","text":"完善鼻咽及颈部MRI评估疗效；予以输血支持，待贫血纠正后按原计划行同期顺铂化疗联合调强放疗。","is_gold":false},{"letter":"G","text":"完善鼻咽及颈部MRI评估疗效；取消同期顺铂化疗，直接行根治性调强放疗，暂不予纠正贫血。","is_gold":false},{"letter":"H","text":"完善鼻咽及颈部MRI评估疗效；将同期化疗方案更换为氟尿嘧啶单药，联合根治性调强放疗。","is_gold":false},{"letter":"I","text":"完善鼻咽及颈部MRI评估疗效；取消同期顺铂化疗，予以纠正贫血并联合PD-1抑制剂及调强放疗。","is_gold":false},{"letter":"J","text":"完善鼻咽及颈部MRI评估疗效；将同期化疗方案更换为吉西他滨单药，联合根治性调强放疗。","is_gold":false},{"letter":"K","text":"完善鼻咽及颈部MRI评估疗效；取消放疗，继续行非铂类方案（如紫杉醇单药）化疗。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：腭帆提肌。\n文本分期信息：N2，M0。\n综合TNM状态：T1N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D69] 入院记录: 主诉: 鼻咽癌3程诱导化疗后2周；现病史: 患者于某次就诊时间初开始无明显诱因出现听力下降，以右侧为著，未予重视。某次就诊时间7月初患者无意中发现左颈部包块，大小约4×4cm，无疼痛，无表面皮肤发红，未就诊，肿物进行性增大。8月初肿物增大至鸡蛋大小，就诊地域信息已隐藏，行颈部肿块穿刺，病理回报：转移癌可能性大。8－11行鼻咽＋颈部MRI提示：鼻咽双侧壁及顶后壁软组织增厚，考虑鼻咽癌并双侧咽后、双颈部多发淋巴结肿大。胸部MRI检查未见异常。于某次就诊时间、某次就诊时间、某次就诊时间我院各行一程GP诱导化疗，（剂量：吉西他滨：1g/m^2,d1,d8;顺铂：80mg/m^2,d1），现为同期放化疗入院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,左颈部包块,颈部肿物；既往史: 发现血糖升高一年余，未行药物治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、肾病”病史；否认手术、外伤、输血史及献血史。；个人史: 长期居于原籍，无疫区居住史。吸烟：30－40支/天×30余。否认饮酒史。否认不洁性生活史。；家族史: 两个舅舅分别患有肝癌及骨肿瘤。；体格检查:；专科检查:；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- [全程D64] 检验组合: 肌酐(Crea)-静脉血: 160.7umol/L；葡萄糖(Glu)-静脉血: 8.34mmol/L；碱性磷酸酶(ALP)-静脉血: 72.1U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 55U/L；C-反应蛋白(CRP)-静脉血: 2.43mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.94mmol/L；总胆固醇(TC)-静脉血: 4.9mmol/L；镁离子(Mg2+)-静脉血: 0.61mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；总钙(Ca)-静脉血: 2.32mmol/L；氯离子(Cl-)-静脉血: 96.3mmol/L；甘油三酯(TG)-静脉血: 2.49mmol/L；尿素氮(BUN)-静脉血: 9.9mmol/L；直接胆红素(DBIL)-静脉血: 2.6umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.2mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 23.9U/L；载脂蛋白B(apoB)-静脉血: 1.05g/L；乳酸脱氢酶(LDH)-静脉血: 221.5U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.43；间接胆红素(IBIL)-静脉血: 5.8umolL；尿酸(UA)-静脉血: 602.1umol/L；球蛋白(GLO)-静脉血: 30.83g/L；胱抑素(Cys-C)-静脉血: 1.84mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.13mmolL；γ-谷氨酰基转移酶(GGT)-静脉血: 54.4U/L；总胆红素(TBIL)-静脉血: 8.4umol/L；钾离子(K+)-静脉血: 3.86mmol/L；白蛋白(ALB)-静脉血: 44g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.97；丙氨酸氨基转移酶(ALT)-静脉血: 24.7U/L；磷(P)-静脉血: 1.33mmol/L；总胆汁酸(TBA)-静脉血: 2.2umol/L；钠离子(Na+)-静脉血: 136.5mmol/L；阴离子间隙(AG)-静脉血: 15；总蛋白(TP)-静脉血: 74.83g/L\n- [全程D71] 检验组合: 平均红细胞体积(MCV)-静脉血: 86.5fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.015；中性粒细胞计数(Neut#)-静脉血: 2.210E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.8；血红蛋白(Hb)-静脉血: 111g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.011；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.36；平均红细胞血红蛋白浓度(MCHC)-静脉血: 352g/L；红细胞计数(RBC#)-静脉血: 3.6410E12/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.482；大血小板百分比(P-LCR%)-静脉血: 19.1%；血小板比容-静脉血: 10%；平均血小板体积(MPV)-静脉血: 9.3fL；红细胞比容(Hct)-静脉血: 31.5%；单核细胞百分比(Mono%)-静脉血: 0.132；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；血小板分布宽度(PDW)-静脉血: 9.1%；血小板计数(PLT#)-静脉血: 10910E9/L；白细胞计数(WBC#)-静脉血: 4.610E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.1\n- [全程D78] 检验组合: 嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；红细胞比容(Hct)-静脉血: 31.2%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；血小板计数(PLT#)-静脉血: 22110E9/L；血小板比容-静脉血: 20%；大血小板百分比(P-LCR%)-静脉血: 19.1%；单核细胞百分比(Mono%)-静脉血: 0.108；血红蛋白(Hb)-静脉血: 108g/L；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；血小板分布宽度(PDW)-静脉血: 10%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.02；白细胞计数(WBC#)-静脉血: 4.510E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.653；平均红细胞体积(MCV)-静脉血: 86.9fL；平均血小板体积(MPV)-静脉血: 9.2fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.9；中性粒细胞计数(Neut#)-静脉血: 310E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.215；平均红细胞血红蛋白浓度(MCHC)-静脉血: 346g/L；红细胞计数(RBC#)-静脉血: 3.5910E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；单核细胞计数(Mono#)-静脉血: 0.510E9/L\n- [全程D85] 检验组合: 平均血小板体积(MPV)-静脉血: 9fL；血小板计数(PLT#)-静脉血: 26310E9/L；血小板分布宽度(PDW)-静脉血: 9.9%；淋巴细胞计数(Lymph#)-静脉血: 1.210E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.9；血红蛋白(Hb)-静脉血: 103g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；平均红细胞体积(MCV)-静脉血: 88.5fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.7；白细胞计数(WBC#)-静脉血: 4.2910E9/L；大血小板百分比(P-LCR%)-静脉血: 17.7%；单核细胞百分比(Mono%)-静脉血: 0.191；平均红细胞血红蛋白含量(MCH)-静脉血: 30.3pg；血小板比容-静脉血: 24%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 342g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞计数(RBC#)-静脉血: 3.410E12/L；红细胞比容(Hct)-静脉血: 30.1%；淋巴细胞百分比(Lymph%)-静脉血: 0.27；中性粒细胞百分比(Neut%)-静脉血: 0.513；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.021；单核细胞计数(Mono#)-静脉血: 0.810E9/L；中性粒细胞计数(Neut#)-静脉血: 2.210E9/L\n- [全程D85] 检验组合: 总胆固醇(TC)-静脉血: 5mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 41U/L；球蛋白(GLO)-静脉血: 29.79g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.3；血液二氧化碳含量ctCO2(B)-静脉血: 20.9mmol/L；钠离子(Na+)-静脉血: 137.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.12g/L；载脂蛋白B(apoB)-静脉血: 1.02g/L；丙氨酸氨基转移酶(ALT)-静脉血: 15.3U/L；阴离子间隙(AG)-静脉血: 16；氯离子(Cl-)-静脉血: 100.4mmol/L；磷(P)-静脉血: 1.27mmol/L；总钙(Ca)-静脉血: 2.29mmol/L；总胆红素(TBIL)-静脉血: 10.7umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 32.1U/L；尿酸(UA)-静脉血: 642.2umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.2mmol/L；钾离子(K+)-静脉血: 4.6mmol/L；镁离子(Mg2+)-静脉血: 0.56mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20.5U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；间接胆红素(IBIL)-静脉血: 6.8umolL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；胱抑素(Cys-C)-静脉血: 1.89mg/L；肌酐(Crea)-静脉血: 171.5umol/L；碱性磷酸酶(ALP)-静脉血: 55.8U/L；乳酸脱氢酶(LDH)-静脉血: 182U/L；总胆汁酸(TBA)-静脉血: 1.2umol/L；总蛋白(TP)-静脉血: 72.99g/L；直接胆红素(DBIL)-静脉血: 3.9umol/L；C-反应蛋白(CRP)-静脉血: 2.96mg/L；甘油三酯(TG)-静脉血: 2.22mmol/L；葡萄糖(Glu)-静脉血: 6.63mmol/L；尿素氮(BUN)-静脉血: 10.78mmol/L；白蛋白(ALB)-静脉血: 43.2g/L\n- [全程D92] 检验组合: 嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；单核细胞百分比(Mono%)-静脉血: 0.13；中性粒细胞计数(Neut#)-静脉血: 5.310E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.7pg；血小板比容-静脉血: 24%；红细胞计数(RBC#)-静脉血: 3.3610E12/L；平均红细胞体积(MCV)-静脉血: 89.9fL；血红蛋白(Hb)-静脉血: 103g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.9；单核细胞计数(Mono#)-静脉血: 0.910E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；血小板计数(PLT#)-静脉血: 26210E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；大血小板百分比(P-LCR%)-静脉血: 17.3%；白细胞计数(WBC#)-静脉血: 710E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.103；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.8；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；中性粒细胞百分比(Neut%)-静脉血: 0.757；红细胞比容(Hct)-静脉血: 30.2%；血小板分布宽度(PDW)-静脉血: 9.9%；平均血小板体积(MPV)-静脉血: 9.1fL\n- [全程D99] 检验组合: 球蛋白(GLO)-静脉血: 25.82g/L；血小板比容-静脉血: 12%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 4.5umol/L；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 14.7mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.104；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；总胆红素(TBIL)-静脉血: 11.3umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 33.1U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.1；总钙(Ca)-静脉血: 1.94mmol/L；间接胆红素(IBIL)-静脉血: 6.8umolL；血红蛋白(Hb)-静脉血: 92g/L；肌酐(Crea)-静脉血: 230.6umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.53；单核细胞计数(Mono#)-静脉血: 0.710E9/L；磷(P)-静脉血: 1.43mmol/L；尿素氮(BUN)-静脉血: 14.3mmol/L；尿酸(UA)-静脉血: 664.3umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.5；氯离子(Cl-)-静脉血: 101.4mmol/L；镁离子(Mg2+)-静脉血: 0.39mmol/L；载脂蛋白AI(apoAI)-静脉血: 0.93g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；红细胞比容(Hct)-静脉血: 27.4%；γ-谷氨酰基转移酶(GGT)-静脉血: 32.2U/L；阴离子间隙(AG)-静脉血: 22；血小板分布宽度(PDW)-静脉血: 10.5%；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.41；总蛋白(TP)-静脉血: 65.22g/L；单核细胞百分比(Mono%)-静脉血: 0.138；白蛋白(ALB)-静脉血: 39.4g/L；乳酸脱氢酶(LDH)-静脉血: 174.3U/L；C-反应蛋白(CRP)-静脉血: 5.63mg/L；血小板计数(PLT#)-静脉血: 13410E9/L；总胆汁酸(TBA)-静脉血: 1.9um……\n- [全程D103] 检验组合: 白蛋白(ALB)-静脉血: 38.8g/L；肌酐(Crea)-静脉血: 213.9umol/L；球蛋白(GLO)-静脉血: 26.15g/L；间接胆红素(IBIL)-静脉血: 6.6umolL；总胆红素(TBIL)-静脉血: 10.9umol/L；总蛋白(TP)-静脉血: 64.95g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.48；直接胆红素(DBIL)-静脉血: 4.3umol/L；尿素氮(BUN)-静脉血: 14.5mmol/L；尿酸(UA)-静脉血: 660.5umol/L\n- [全程D106] 检验组合: 平均血小板体积(MPV)-静脉血: 9.5fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44.6；血小板计数(PLT#)-静脉血: 7110E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；血红蛋白(Hb)-静脉血: 75g/L；红细胞比容(Hct)-静脉血: 21.6%；白细胞计数(WBC#)-静脉血: 3.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.089；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；单核细胞计数(Mono#)-静脉血: 0.310E9/L；血小板分布宽度(PDW)-静脉血: 9.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 31.9pg；中性粒细胞百分比(Neut%)-静脉血: 0.784；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；大血小板百分比(P-LCR%)-静脉血: 20.6%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.098；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板比容-静脉血: 6%；红细胞计数(RBC#)-静脉血: 2.3510E12/L；平均红细胞体积(MCV)-静脉血: 91.9fL\n- [全程D109] 检验组合: 红细胞比容(Hct)-静脉血: 21.5%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.7；白细胞计数(WBC#)-静脉血: 4.210E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.4pg；单核细胞百分比(Mono%)-静脉血: 0.057；平均红细胞血红蛋白浓度(MCHC)-静脉血: 335g/L；血红蛋白(Hb)-静脉血: 72g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；红细胞计数(RBC#)-静脉血: 2.2910E12/L；血小板计数(PLT#)-静脉血: 6210E9/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.041；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；大血小板百分比(P-LCR%)-静脉血: 21.1%；平均血小板体积(MPV)-静脉血: 9.4fL；平均红细胞体积(MCV)-静脉血: 93.9fL；血小板比容-静脉血: 6%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；血小板分布宽度(PDW)-静脉血: 10.3%；中性粒细胞百分比(Neut%)-静脉血: 0.847；淋巴细胞百分比(Lymph%)-静脉血: 0.05；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L\n- [全程D113] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.082；血小板分布宽度(PDW)-静脉血: 10.8%；淋巴细胞百分比(Lymph%)-静脉血: 0.114；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；红细胞比容(Hct)-静脉血: 22.8%；平均血小板体积(MPV)-静脉血: 9.8fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 48.1；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；中性粒细胞计数(Neut#)-静脉血: 1.610E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1；白细胞计数(WBC#)-静脉血: 2.210E9/L；血小板计数(PLT#)-静脉血: 11810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.722；大血小板百分比(P-LCR%)-静脉血: 24.7%；单核细胞计数(Mono#)-静脉血: 0.210E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 320g/L；红细胞计数(RBC#)-静脉血: 2.2910E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.9pg；血小板比容-静脉血: 12%；血红蛋白(Hb)-静脉血: 73g/L；平均红细胞体积(MCV)-静脉血: 99.6fL；单核细胞百分比(Mono%)-静脉血: 0.077；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L\n- [全程D117] 检验组合: 天门冬氨酸氨基转移酶(AST)-静脉血: 14.1U/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；镁离子(Mg2+)-静脉血: 0.67mmol/L；血小板计数(PLT#)-静脉血: 23410E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.72mmolL；中性粒细胞计数(Neut#)-静脉血: 2.410E9/L；胱抑素(Cys-C)-静脉血: 2.73mg/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；血小板分布宽度(PDW)-静脉血: 10.4%；总蛋白(TP)-静脉血: 69.47g/L；大血小板百分比(P-LCR%)-静脉血: 22%；球蛋白(GLO)-静脉血: 32.07g/L；氯离子(Cl-)-静脉血: 102.3mmol/L；尿素氮(BUN)-静脉血: 14.7mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.136；丙氨酸氨基转移酶(ALT)-静脉血: 11.2U/L；葡萄糖(Glu)-静脉血: 7.22mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 19.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 0.81g/L；总胆固醇(TC)-静脉血: 4.12mmol/L；血小板比容-静脉血: 22%；C-反应蛋白(CRP)-静脉血: 15.19mg/L；总胆汁酸(TBA)-静脉血: 2.1umol/L；直接胆红素(DBIL)-静脉血: 2.3umol/L；尿酸(UA)-静脉血: 692umol/L；白细胞计数(WBC#)-静脉血: 3.710E9/L；乳酸脱氢酶(LDH)-静脉血: 178.2U/L；中性粒细胞百分比(Neut%)-静脉血: 0.651；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；肌酐(Crea)-静脉血: 220.1umol/L；红细胞计数(RBC#)-静脉血: 2.3510E12/L；钠离子(Na+)-静脉血: 138.8mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.26；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.6mmol/L；红细胞比容(Hct)-静脉血: 23.1%；钾离子(K+)-静脉血: 4.79mmol/L……\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 完善鼻咽及颈部MRI评估疗效；取消同期顺铂化疗，予以纠正贫血并单纯根治性调强放疗（或联合靶向治疗）。\nB. 完善鼻咽及颈部MRI评估疗效；按原计划行同期顺铂化疗联合根治性调强放疗。\nC. 完善鼻咽及颈部MRI评估疗效；将同期顺铂减量至40mg/m2周疗，联合根治性调强放疗。\nD. 完善鼻咽及颈部MRI评估疗效；将同期化疗方案更换为卡铂，联合根治性调强放疗。\nE. 完善鼻咽及颈部MRI评估疗效；暂停抗肿瘤治疗，待血红蛋白恢复至100g/L以上后再行同期放化疗。\nF. 完善鼻咽及颈部MRI评估疗效；予以输血支持，待贫血纠正后按原计划行同期顺铂化疗联合调强放疗。\nG. 完善鼻咽及颈部MRI评估疗效；取消同期顺铂化疗，直接行根治性调强放疗，暂不予纠正贫血。\nH. 完善鼻咽及颈部MRI评估疗效；将同期化疗方案更换为氟尿嘧啶单药，联合根治性调强放疗。\nI. 完善鼻咽及颈部MRI评估疗效；取消同期顺铂化疗，予以纠正贫血并联合PD-1抑制剂及调强放疗。\nJ. 完善鼻咽及颈部MRI评估疗效；将同期化疗方案更换为吉西他滨单药，联合根治性调强放疗。\nK. 完善鼻咽及颈部MRI评估疗效；取消放疗，继续行非铂类方案（如紫杉醇单药）化疗。\n\n请仅输出一个选项字母（A-K）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：腭帆提肌。\n文本分期信息：N2，M0。\n综合TNM状态：T1N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D69] 入院记录: 主诉: 鼻咽癌3程诱导化疗后2周；现病史: 患者于某次就诊时间初开始无明显诱因出现听力下降，以右侧为著，未予重视。某次就诊时间7月初患者无意中发现左颈部包块，大小约4×4cm，无疼痛，无表面皮肤发红，未就诊，肿物进行性增大。8月初肿物增大至鸡蛋大小，就诊地域信息已隐藏，行颈部肿块穿刺，病理回报：转移癌可能性大。8－11行鼻咽＋颈部MRI提示：鼻咽双侧壁及顶后壁软组织增厚，考虑鼻咽癌并双侧咽后、双颈部多发淋巴结肿大。胸部MRI检查未见异常。于某次就诊时间、某次就诊时间、某次就诊时间我院各行一程GP诱导化疗，（剂量：吉西他滨：1g/m^2,d1,d8;顺铂：80mg/m^2,d1），现为同期放化疗入院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,左颈部包块,颈部肿物；既往史: 发现血糖升高一年余，未行药物治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、肾病”病史；否认手术、外伤、输血史及献血史。；个人史: 长期居于原籍，无疫区居住史。吸烟：30－40支/天×30余。否认饮酒史。否认不洁性生活史。；家族史: 两个舅舅分别患有肝癌及骨肿瘤。；体格检查:；专科检查:；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- [全程D64] 检验组合: 肌酐(Crea)-静脉血: 160.7umol/L；葡萄糖(Glu)-静脉血: 8.34mmol/L；碱性磷酸酶(ALP)-静脉血: 72.1U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 55U/L；C-反应蛋白(CRP)-静脉血: 2.43mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.94mmol/L；总胆固醇(TC)-静脉血: 4.9mmol/L；镁离子(Mg2+)-静脉血: 0.61mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；总钙(Ca)-静脉血: 2.32mmol/L；氯离子(Cl-)-静脉血: 96.3mmol/L；甘油三酯(TG)-静脉血: 2.49mmol/L；尿素氮(BUN)-静脉血: 9.9mmol/L；直接胆红素(DBIL)-静脉血: 2.6umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.2mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 23.9U/L；载脂蛋白B(apoB)-静脉血: 1.05g/L；乳酸脱氢酶(LDH)-静脉血: 221.5U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.43；间接胆红素(IBIL)-静脉血: 5.8umolL；尿酸(UA)-静脉血: 602.1umol/L；球蛋白(GLO)-静脉血: 30.83g/L；胱抑素(Cys-C)-静脉血: 1.84mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.13mmolL；γ-谷氨酰基转移酶(GGT)-静脉血: 54.4U/L；总胆红素(TBIL)-静脉血: 8.4umol/L；钾离子(K+)-静脉血: 3.86mmol/L；白蛋白(ALB)-静脉血: 44g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.97；丙氨酸氨基转移酶(ALT)-静脉血: 24.7U/L；磷(P)-静脉血: 1.33mmol/L；总胆汁酸(TBA)-静脉血: 2.2umol/L；钠离子(Na+)-静脉血: 136.5mmol/L；阴离子间隙(AG)-静脉血: 15；总蛋白(TP)-静脉血: 74.83g/L\n- [全程D71] 检验组合: 平均红细胞体积(MCV)-静脉血: 86.5fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.015；中性粒细胞计数(Neut#)-静脉血: 2.210E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.8；血红蛋白(Hb)-静脉血: 111g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.011；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.36；平均红细胞血红蛋白浓度(MCHC)-静脉血: 352g/L；红细胞计数(RBC#)-静脉血: 3.6410E12/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.482；大血小板百分比(P-LCR%)-静脉血: 19.1%；血小板比容-静脉血: 10%；平均血小板体积(MPV)-静脉血: 9.3fL；红细胞比容(Hct)-静脉血: 31.5%；单核细胞百分比(Mono%)-静脉血: 0.132；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；血小板分布宽度(PDW)-静脉血: 9.1%；血小板计数(PLT#)-静脉血: 10910E9/L；白细胞计数(WBC#)-静脉血: 4.610E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.1\n- [全程D78] 检验组合: 嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；红细胞比容(Hct)-静脉血: 31.2%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；血小板计数(PLT#)-静脉血: 22110E9/L；血小板比容-静脉血: 20%；大血小板百分比(P-LCR%)-静脉血: 19.1%；单核细胞百分比(Mono%)-静脉血: 0.108；血红蛋白(Hb)-静脉血: 108g/L；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；血小板分布宽度(PDW)-静脉血: 10%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.02；白细胞计数(WBC#)-静脉血: 4.510E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.653；平均红细胞体积(MCV)-静脉血: 86.9fL；平均血小板体积(MPV)-静脉血: 9.2fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.9；中性粒细胞计数(Neut#)-静脉血: 310E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.215；平均红细胞血红蛋白浓度(MCHC)-静脉血: 346g/L；红细胞计数(RBC#)-静脉血: 3.5910E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；单核细胞计数(Mono#)-静脉血: 0.510E9/L\n- [全程D85] 检验组合: 平均血小板体积(MPV)-静脉血: 9fL；血小板计数(PLT#)-静脉血: 26310E9/L；血小板分布宽度(PDW)-静脉血: 9.9%；淋巴细胞计数(Lymph#)-静脉血: 1.210E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.9；血红蛋白(Hb)-静脉血: 103g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；平均红细胞体积(MCV)-静脉血: 88.5fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.7；白细胞计数(WBC#)-静脉血: 4.2910E9/L；大血小板百分比(P-LCR%)-静脉血: 17.7%；单核细胞百分比(Mono%)-静脉血: 0.191；平均红细胞血红蛋白含量(MCH)-静脉血: 30.3pg；血小板比容-静脉血: 24%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 342g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞计数(RBC#)-静脉血: 3.410E12/L；红细胞比容(Hct)-静脉血: 30.1%；淋巴细胞百分比(Lymph%)-静脉血: 0.27；中性粒细胞百分比(Neut%)-静脉血: 0.513；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.021；单核细胞计数(Mono#)-静脉血: 0.810E9/L；中性粒细胞计数(Neut#)-静脉血: 2.210E9/L\n- [全程D85] 检验组合: 总胆固醇(TC)-静脉血: 5mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 41U/L；球蛋白(GLO)-静脉血: 29.79g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.3；血液二氧化碳含量ctCO2(B)-静脉血: 20.9mmol/L；钠离子(Na+)-静脉血: 137.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.12g/L；载脂蛋白B(apoB)-静脉血: 1.02g/L；丙氨酸氨基转移酶(ALT)-静脉血: 15.3U/L；阴离子间隙(AG)-静脉血: 16；氯离子(Cl-)-静脉血: 100.4mmol/L；磷(P)-静脉血: 1.27mmol/L；总钙(Ca)-静脉血: 2.29mmol/L；总胆红素(TBIL)-静脉血: 10.7umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 32.1U/L；尿酸(UA)-静脉血: 642.2umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.2mmol/L；钾离子(K+)-静脉血: 4.6mmol/L；镁离子(Mg2+)-静脉血: 0.56mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20.5U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；间接胆红素(IBIL)-静脉血: 6.8umolL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；胱抑素(Cys-C)-静脉血: 1.89mg/L；肌酐(Crea)-静脉血: 171.5umol/L；碱性磷酸酶(ALP)-静脉血: 55.8U/L；乳酸脱氢酶(LDH)-静脉血: 182U/L；总胆汁酸(TBA)-静脉血: 1.2umol/L；总蛋白(TP)-静脉血: 72.99g/L；直接胆红素(DBIL)-静脉血: 3.9umol/L；C-反应蛋白(CRP)-静脉血: 2.96mg/L；甘油三酯(TG)-静脉血: 2.22mmol/L；葡萄糖(Glu)-静脉血: 6.63mmol/L；尿素氮(BUN)-静脉血: 10.78mmol/L；白蛋白(ALB)-静脉血: 43.2g/L\n- [全程D92] 检验组合: 嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；单核细胞百分比(Mono%)-静脉血: 0.13；中性粒细胞计数(Neut#)-静脉血: 5.310E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.7pg；血小板比容-静脉血: 24%；红细胞计数(RBC#)-静脉血: 3.3610E12/L；平均红细胞体积(MCV)-静脉血: 89.9fL；血红蛋白(Hb)-静脉血: 103g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.9；单核细胞计数(Mono#)-静脉血: 0.910E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；血小板计数(PLT#)-静脉血: 26210E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；大血小板百分比(P-LCR%)-静脉血: 17.3%；白细胞计数(WBC#)-静脉血: 710E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.103；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.8；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；中性粒细胞百分比(Neut%)-静脉血: 0.757；红细胞比容(Hct)-静脉血: 30.2%；血小板分布宽度(PDW)-静脉血: 9.9%；平均血小板体积(MPV)-静脉血: 9.1fL\n- [全程D99] 检验组合: 球蛋白(GLO)-静脉血: 25.82g/L；血小板比容-静脉血: 12%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 4.5umol/L；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 14.7mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.104；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；总胆红素(TBIL)-静脉血: 11.3umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 33.1U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.1；总钙(Ca)-静脉血: 1.94mmol/L；间接胆红素(IBIL)-静脉血: 6.8umolL；血红蛋白(Hb)-静脉血: 92g/L；肌酐(Crea)-静脉血: 230.6umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.53；单核细胞计数(Mono#)-静脉血: 0.710E9/L；磷(P)-静脉血: 1.43mmol/L；尿素氮(BUN)-静脉血: 14.3mmol/L；尿酸(UA)-静脉血: 664.3umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.5；氯离子(Cl-)-静脉血: 101.4mmol/L；镁离子(Mg2+)-静脉血: 0.39mmol/L；载脂蛋白AI(apoAI)-静脉血: 0.93g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；红细胞比容(Hct)-静脉血: 27.4%；γ-谷氨酰基转移酶(GGT)-静脉血: 32.2U/L；阴离子间隙(AG)-静脉血: 22；血小板分布宽度(PDW)-静脉血: 10.5%；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.41；总蛋白(TP)-静脉血: 65.22g/L；单核细胞百分比(Mono%)-静脉血: 0.138；白蛋白(ALB)-静脉血: 39.4g/L；乳酸脱氢酶(LDH)-静脉血: 174.3U/L；C-反应蛋白(CRP)-静脉血: 5.63mg/L；血小板计数(PLT#)-静脉血: 13410E9/L；总胆汁酸(TBA)-静脉血: 1.9um……\n- [全程D103] 检验组合: 白蛋白(ALB)-静脉血: 38.8g/L；肌酐(Crea)-静脉血: 213.9umol/L；球蛋白(GLO)-静脉血: 26.15g/L；间接胆红素(IBIL)-静脉血: 6.6umolL；总胆红素(TBIL)-静脉血: 10.9umol/L；总蛋白(TP)-静脉血: 64.95g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.48；直接胆红素(DBIL)-静脉血: 4.3umol/L；尿素氮(BUN)-静脉血: 14.5mmol/L；尿酸(UA)-静脉血: 660.5umol/L\n- [全程D106] 检验组合: 平均血小板体积(MPV)-静脉血: 9.5fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44.6；血小板计数(PLT#)-静脉血: 7110E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；血红蛋白(Hb)-静脉血: 75g/L；红细胞比容(Hct)-静脉血: 21.6%；白细胞计数(WBC#)-静脉血: 3.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.089；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；单核细胞计数(Mono#)-静脉血: 0.310E9/L；血小板分布宽度(PDW)-静脉血: 9.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 31.9pg；中性粒细胞百分比(Neut%)-静脉血: 0.784；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；大血小板百分比(P-LCR%)-静脉血: 20.6%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.098；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板比容-静脉血: 6%；红细胞计数(RBC#)-静脉血: 2.3510E12/L；平均红细胞体积(MCV)-静脉血: 91.9fL\n- [全程D109] 检验组合: 红细胞比容(Hct)-静脉血: 21.5%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.7；白细胞计数(WBC#)-静脉血: 4.210E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.4pg；单核细胞百分比(Mono%)-静脉血: 0.057；平均红细胞血红蛋白浓度(MCHC)-静脉血: 335g/L；血红蛋白(Hb)-静脉血: 72g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；红细胞计数(RBC#)-静脉血: 2.2910E12/L；血小板计数(PLT#)-静脉血: 6210E9/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.041；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；大血小板百分比(P-LCR%)-静脉血: 21.1%；平均血小板体积(MPV)-静脉血: 9.4fL；平均红细胞体积(MCV)-静脉血: 93.9fL；血小板比容-静脉血: 6%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；血小板分布宽度(PDW)-静脉血: 10.3%；中性粒细胞百分比(Neut%)-静脉血: 0.847；淋巴细胞百分比(Lymph%)-静脉血: 0.05；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L\n- [全程D113] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.082；血小板分布宽度(PDW)-静脉血: 10.8%；淋巴细胞百分比(Lymph%)-静脉血: 0.114；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；红细胞比容(Hct)-静脉血: 22.8%；平均血小板体积(MPV)-静脉血: 9.8fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 48.1；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；中性粒细胞计数(Neut#)-静脉血: 1.610E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1；白细胞计数(WBC#)-静脉血: 2.210E9/L；血小板计数(PLT#)-静脉血: 11810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.722；大血小板百分比(P-LCR%)-静脉血: 24.7%；单核细胞计数(Mono#)-静脉血: 0.210E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 320g/L；红细胞计数(RBC#)-静脉血: 2.2910E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.9pg；血小板比容-静脉血: 12%；血红蛋白(Hb)-静脉血: 73g/L；平均红细胞体积(MCV)-静脉血: 99.6fL；单核细胞百分比(Mono%)-静脉血: 0.077；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L\n- [全程D117] 检验组合: 天门冬氨酸氨基转移酶(AST)-静脉血: 14.1U/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；镁离子(Mg2+)-静脉血: 0.67mmol/L；血小板计数(PLT#)-静脉血: 23410E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.72mmolL；中性粒细胞计数(Neut#)-静脉血: 2.410E9/L；胱抑素(Cys-C)-静脉血: 2.73mg/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；血小板分布宽度(PDW)-静脉血: 10.4%；总蛋白(TP)-静脉血: 69.47g/L；大血小板百分比(P-LCR%)-静脉血: 22%；球蛋白(GLO)-静脉血: 32.07g/L；氯离子(Cl-)-静脉血: 102.3mmol/L；尿素氮(BUN)-静脉血: 14.7mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.136；丙氨酸氨基转移酶(ALT)-静脉血: 11.2U/L；葡萄糖(Glu)-静脉血: 7.22mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 19.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 0.81g/L；总胆固醇(TC)-静脉血: 4.12mmol/L；血小板比容-静脉血: 22%；C-反应蛋白(CRP)-静脉血: 15.19mg/L；总胆汁酸(TBA)-静脉血: 2.1umol/L；直接胆红素(DBIL)-静脉血: 2.3umol/L；尿酸(UA)-静脉血: 692umol/L；白细胞计数(WBC#)-静脉血: 3.710E9/L；乳酸脱氢酶(LDH)-静脉血: 178.2U/L；中性粒细胞百分比(Neut%)-静脉血: 0.651；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；肌酐(Crea)-静脉血: 220.1umol/L；红细胞计数(RBC#)-静脉血: 2.3510E12/L；钠离子(Na+)-静脉血: 138.8mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.26；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.6mmol/L；红细胞比容(Hct)-静脉血: 23.1%；钾离子(K+)-静脉血: 4.79mmol/L……\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 完善鼻咽及颈部MRI评估疗效；取消同期顺铂化疗，予以纠正贫血并单纯根治性调强放疗（或联合靶向治疗）。\nB. 完善鼻咽及颈部MRI评估疗效；按原计划行同期顺铂化疗联合根治性调强放疗。\nC. 完善鼻咽及颈部MRI评估疗效；将同期顺铂减量至40mg/m2周疗，联合根治性调强放疗。\nD. 完善鼻咽及颈部MRI评估疗效；将同期化疗方案更换为卡铂，联合根治性调强放疗。\nE. 完善鼻咽及颈部MRI评估疗效；暂停抗肿瘤治疗，待血红蛋白恢复至100g/L以上后再行同期放化疗。\nF. 完善鼻咽及颈部MRI评估疗效；予以输血支持，待贫血纠正后按原计划行同期顺铂化疗联合调强放疗。\nG. 完善鼻咽及颈部MRI评估疗效；取消同期顺铂化疗，直接行根治性调强放疗，暂不予纠正贫血。\nH. 完善鼻咽及颈部MRI评估疗效；将同期化疗方案更换为氟尿嘧啶单药，联合根治性调强放疗。\nI. 完善鼻咽及颈部MRI评估疗效；取消同期顺铂化疗，予以纠正贫血并联合PD-1抑制剂及调强放疗。\nJ. 完善鼻咽及颈部MRI评估疗效；将同期化疗方案更换为吉西他滨单药，联合根治性调强放疗。\nK. 完善鼻咽及颈部MRI评估疗效；取消放疗，继续行非铂类方案（如紫杉醇单药）化疗。\n\n请仅输出一个选项字母（A-K）。"}]}
+{"sample_id":"sample-340a8b44018e54c31bcf1d9c","patient_id":"patient-9bf5c8c03860cdf61108611d","turn_id":"turn08","turn_position":5,"turn_type":"response_assessment_decision","gold_letter":"B","gold_action":"判定为放疗后改变或临床完全缓解，进入定期随访观察","options":[{"letter":"A","text":"判定为局部残留，行鼻咽及颈部挽救性手术","is_gold":false},{"letter":"B","text":"判定为放疗后改变或临床完全缓解，进入定期随访观察","is_gold":true},{"letter":"C","text":"判定为局部残留，行鼻咽及颈部局部追加放疗","is_gold":false},{"letter":"D","text":"判定为疾病稳定，启动卡培他滨维持化疗","is_gold":false},{"letter":"E","text":"判定为疾病进展，启动含铂双药联合免疫全身治疗","is_gold":false},{"letter":"F","text":"判定为放疗后改变，启动尼妥珠单抗靶向维持治疗","is_gold":false},{"letter":"G","text":"判定为颈部淋巴结残留，行双侧颈淋巴结清扫术","is_gold":false},{"letter":"H","text":"判定为颅底骨质受侵进展，行颅底病灶切除术","is_gold":false},{"letter":"I","text":"判定为疗效不确定，行全身PET-CT检查明确病灶活性","is_gold":false},{"letter":"J","text":"判定为放疗后改变，行鼻咽黏膜活检排除微小残留","is_gold":false},{"letter":"K","text":"判定为临床完全缓解，启动PD-1抑制剂维持治疗","is_gold":false},{"letter":"L","text":"判定为局部残留，行原全身化疗方案追加2个周期","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：腭帆提肌。\n文本分期信息：N2，M0。\n综合TNM状态：T1N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D209] CT；胸、上腹CT平扫+增强: 检查类型: CT；检查名称: 胸、上腹CT平扫+增强；检查部位:；检查所见: 双肺纹理清晰，未见结节影；气管及支气管分枝通畅，未见明显软组织肿物或受压变窄；双锁上、双腋窝、双肺门及纵隔未见明显肿大淋巴结；双侧胸腔未见积液；胸膜未见增厚。 肝脏形态正常，比例正常，外形轮廓光整，密度均匀，快速注射造影剂后，动脉期未见明确异常强化灶，门脉期及平衡期未见明确低密度区，肝内见数个（约3个）囊肿影，大小约为 4 × 3 mm至 12 × 10 mm，边界清楚，密度均匀，未见强化；肝内胆管未见扩张，胆囊大小正常，内未见结石影，胆总管未见扩张；肝门区未见肿大淋巴结；门静脉未见充盈缺损；脾大小正常，密度均匀；胰腺大小、形态正常，密度均匀；双肾大小、形态正常，排泌功能正常，双肾见多个囊肿影，大小约为 3 × 3 mm 至 60 × 40 mm；双侧肾上腺大小、形态、密度正常；膈脚后、腹主动脉旁未见肿大淋巴结。 扫描范围内胸椎、腰椎、肋骨未见明确骨质破坏征象。；检查结论: 胸部、腹部未见明显占位性病变， 肝、肾囊肿。\n- [全程D210] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌放疗后复查： 鼻咽腔变窄，鼻咽各壁粘膜增厚，T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化，双侧咽隐窝变浅。口咽双侧壁未见受累增厚，病变未累及双侧后鼻孔。 双侧腭帆提肌结构欠清晰，双侧腭帆张肌及头长肌、双侧翼内外肌未见受侵征象。 双侧翼腭窝、双侧上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 双侧翼突基底部及内板骨质信号减低，增强扫描可见轻度强化。 双侧海绵窦形态未见异常。 双侧筛窦、双侧上颌窦粘膜增厚，增强扫描呈轻度强化。双侧乳突内见分泌物。 双眼未见异常，球后未见占位性病变。蝶鞍形态未见异常，其内未见占位性病变。 双侧咽后未见肿大淋巴结。 双颈II区、III区见多个小淋巴结，最大约6mm×13mm，部分边界欠，呈明显强化。 甲状腺双叶及峡部形态未见异常，信号均匀，未见占位性病变。 喉咽腔形态未见异常，未见占位性病变。 双侧颌下腺、腮腺大小、形态未见异常，信号均匀，未见占位性病变。 扫描所见脑组织未见明确异常。；检查结论: 鼻咽癌放疗后复查，与某次就诊时间片比较： 鼻咽肿物已不明显，现鼻咽粘膜增厚，考虑放疗后改变可能，建议随诊。 颅底骨质异常信号，放疗后改变？建议随诊。 双侧咽后未见肿大淋巴结。 双颈II、III区小淋巴结，较前明显缩小。 鼻窦炎；双侧乳突炎。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 判定为局部残留，行鼻咽及颈部挽救性手术\nB. 判定为放疗后改变或临床完全缓解，进入定期随访观察\nC. 判定为局部残留，行鼻咽及颈部局部追加放疗\nD. 判定为疾病稳定，启动卡培他滨维持化疗\nE. 判定为疾病进展，启动含铂双药联合免疫全身治疗\nF. 判定为放疗后改变，启动尼妥珠单抗靶向维持治疗\nG. 判定为颈部淋巴结残留，行双侧颈淋巴结清扫术\nH. 判定为颅底骨质受侵进展，行颅底病灶切除术\nI. 判定为疗效不确定，行全身PET-CT检查明确病灶活性\nJ. 判定为放疗后改变，行鼻咽黏膜活检排除微小残留\nK. 判定为临床完全缓解，启动PD-1抑制剂维持治疗\nL. 判定为局部残留，行原全身化疗方案追加2个周期\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：腭帆提肌。\n文本分期信息：N2，M0。\n综合TNM状态：T1N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D209] CT；胸、上腹CT平扫+增强: 检查类型: CT；检查名称: 胸、上腹CT平扫+增强；检查部位:；检查所见: 双肺纹理清晰，未见结节影；气管及支气管分枝通畅，未见明显软组织肿物或受压变窄；双锁上、双腋窝、双肺门及纵隔未见明显肿大淋巴结；双侧胸腔未见积液；胸膜未见增厚。 肝脏形态正常，比例正常，外形轮廓光整，密度均匀，快速注射造影剂后，动脉期未见明确异常强化灶，门脉期及平衡期未见明确低密度区，肝内见数个（约3个）囊肿影，大小约为 4 × 3 mm至 12 × 10 mm，边界清楚，密度均匀，未见强化；肝内胆管未见扩张，胆囊大小正常，内未见结石影，胆总管未见扩张；肝门区未见肿大淋巴结；门静脉未见充盈缺损；脾大小正常，密度均匀；胰腺大小、形态正常，密度均匀；双肾大小、形态正常，排泌功能正常，双肾见多个囊肿影，大小约为 3 × 3 mm 至 60 × 40 mm；双侧肾上腺大小、形态、密度正常；膈脚后、腹主动脉旁未见肿大淋巴结。 扫描范围内胸椎、腰椎、肋骨未见明确骨质破坏征象。；检查结论: 胸部、腹部未见明显占位性病变， 肝、肾囊肿。\n- [全程D210] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌放疗后复查： 鼻咽腔变窄，鼻咽各壁粘膜增厚，T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化，双侧咽隐窝变浅。口咽双侧壁未见受累增厚，病变未累及双侧后鼻孔。 双侧腭帆提肌结构欠清晰，双侧腭帆张肌及头长肌、双侧翼内外肌未见受侵征象。 双侧翼腭窝、双侧上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 双侧翼突基底部及内板骨质信号减低，增强扫描可见轻度强化。 双侧海绵窦形态未见异常。 双侧筛窦、双侧上颌窦粘膜增厚，增强扫描呈轻度强化。双侧乳突内见分泌物。 双眼未见异常，球后未见占位性病变。蝶鞍形态未见异常，其内未见占位性病变。 双侧咽后未见肿大淋巴结。 双颈II区、III区见多个小淋巴结，最大约6mm×13mm，部分边界欠，呈明显强化。 甲状腺双叶及峡部形态未见异常，信号均匀，未见占位性病变。 喉咽腔形态未见异常，未见占位性病变。 双侧颌下腺、腮腺大小、形态未见异常，信号均匀，未见占位性病变。 扫描所见脑组织未见明确异常。；检查结论: 鼻咽癌放疗后复查，与某次就诊时间片比较： 鼻咽肿物已不明显，现鼻咽粘膜增厚，考虑放疗后改变可能，建议随诊。 颅底骨质异常信号，放疗后改变？建议随诊。 双侧咽后未见肿大淋巴结。 双颈II、III区小淋巴结，较前明显缩小。 鼻窦炎；双侧乳突炎。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 判定为局部残留，行鼻咽及颈部挽救性手术\nB. 判定为放疗后改变或临床完全缓解，进入定期随访观察\nC. 判定为局部残留，行鼻咽及颈部局部追加放疗\nD. 判定为疾病稳定，启动卡培他滨维持化疗\nE. 判定为疾病进展，启动含铂双药联合免疫全身治疗\nF. 判定为放疗后改变，启动尼妥珠单抗靶向维持治疗\nG. 判定为颈部淋巴结残留，行双侧颈淋巴结清扫术\nH. 判定为颅底骨质受侵进展，行颅底病灶切除术\nI. 判定为疗效不确定，行全身PET-CT检查明确病灶活性\nJ. 判定为放疗后改变，行鼻咽黏膜活检排除微小残留\nK. 判定为临床完全缓解，启动PD-1抑制剂维持治疗\nL. 判定为局部残留，行原全身化疗方案追加2个周期\n\n请仅输出一个选项字母（A-L）。"}]}
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张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 鼻咽及颈部CT平扫+增强、间接鼻咽镜检查及活检、PET/CT全身显像、EB病毒DNA定量及常规血液生化检查\nB. 鼻咽及颈部MRI平扫、间接鼻咽镜检查及活检、PET/CT全身显像、EB病毒DNA定量及常规血液生化检查\nC. 鼻咽MRI平扫+增强、间接鼻咽镜检查及活检、PET/CT全身显像、EB病毒DNA定量及常规血液生化检查\nD. 鼻咽及颈部MRI平扫+增强、右颈部肿物穿刺活检、PET/CT全身显像、EB病毒DNA定量及常规血液生化检查\nE. 鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查及活检、胸部X线及腹部B超、EB病毒DNA定量及常规血液生化检查\nF. 鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查及活检、PET/CT全身显像、常规血液生化检查\nG. 鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查及活检、头颅MRI平扫+增强、EB病毒DNA定量及常规血液生化检查\nH. 鼻咽及颈部CT平扫、间接鼻咽镜检查及活检、PET/CT全身显像、EB病毒DNA定量及常规血液生化检查\nI. 鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查及活检、PET/CT全身显像、EB病毒VCA-IgA检测及常规血液生化检查\nJ. 鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查及活检、全身骨扫描、EB病毒DNA定量及常规血液生化检查\nK. 鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查及活检、PET/CT全身显像、EB病毒DNA定量及常规血液生化检查\nL. 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鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查及活检、头颅MRI平扫+增强、EB病毒DNA定量及常规血液生化检查\nH. 鼻咽及颈部CT平扫、间接鼻咽镜检查及活检、PET/CT全身显像、EB病毒DNA定量及常规血液生化检查\nI. 鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查及活检、PET/CT全身显像、EB病毒VCA-IgA检测及常规血液生化检查\nJ. 鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查及活检、全身骨扫描、EB病毒DNA定量及常规血液生化检查\nK. 鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查及活检、PET/CT全身显像、EB病毒DNA定量及常规血液生化检查\nL. 鼻咽及颈部MRI平扫+增强、PET/CT全身显像、EB病毒DNA定量及常规血液生化检查、直接行诱导化疗\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-2c772b6972f0c7fdbd562b73","patient_id":"patient-5ee5dba6116030961a7a97b5","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"L","gold_action":"在尚未完成病理确诊和EB病毒DNA定量检测的前提下，下一步应行电子鼻咽镜检查及活检明确病理诊断，并补充EB病毒DNA荧光定量PCR检测","options":[{"letter":"A","text":"安排颈部淋巴结细针穿刺活检明确病理，并补充全身PET-CT检查","is_gold":false},{"letter":"B","text":"安排右侧颈部肿大淋巴结切除活检，并补充EB病毒DNA荧光定量PCR检测","is_gold":false},{"letter":"C","text":"直接基于MRI及EBV抗体阳性结果启动根治性放化疗","is_gold":false},{"letter":"D","text":"行电子鼻咽镜检查观察肿瘤范围，并补充全身骨扫描及胸腹部CT","is_gold":false},{"letter":"E","text":"行电子鼻咽镜检查及活检明确病理诊断，但不安排任何与EB病毒相关的检查","is_gold":false},{"letter":"F","text":"安排鼻内镜下鼻咽肿物切除术，并补充EB病毒DNA荧光定量PCR检测","is_gold":false},{"letter":"G","text":"安排颈部淋巴结细针穿刺活检，并补充EB病毒DNA荧光定量PCR检测","is_gold":false},{"letter":"H","text":"行电子鼻咽镜检查及活检明确病理诊断，并立即行右颈部淋巴结切除活检","is_gold":false},{"letter":"I","text":"补充EB病毒DNA荧光定量PCR检测，待结果回报后再决定是否行鼻咽活检","is_gold":false},{"letter":"J","text":"行电子鼻咽镜检查及活检明确病理诊断，并预防性行右颈淋巴结清扫术","is_gold":false},{"letter":"K","text":"安排颈部淋巴结穿刺活检及鼻咽镜下活检，并直接启动诱导化疗","is_gold":false},{"letter":"L","text":"行电子鼻咽镜检查及活检明确病理诊断，并补充EB病毒DNA荧光定量PCR检测","is_gold":true}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D3] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁增厚，可见软组织肿块形成，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。双侧咽隐窝见软组织占据，双侧咽旁脂肪间隙受压变窄，病灶侵犯双侧腭帆提肌。双侧腭帆张肌、头长肌未见受侵。 双侧翼腭窝、颞下窝未见异常；口咽双侧壁未见受累增厚，病变未累及后鼻孔。 双侧翼突基底内份、蝶骨基底部右份骨髓信号减低，增强可见轻度强化。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 双侧咽后间隙见肿大淋巴结，右侧大小约为7mm ×8 mm，左侧大小约3mm×4mm。双颈II区、III区见数个淋巴结，最大位于右颈II区，大小约为15mm×27mm。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽肿块，考虑鼻咽癌。 颅底骨质破坏。 右侧咽后及右颈淋巴结肿大，考虑转移瘤。 左侧咽后及左颈小淋巴结。 鼻窦炎、右乳突炎。\n- [全程D3] 检验组合: 平均红细胞体积(MCV)-静脉血: 93.7fL；凝血酶原时间活动度(PTA)-静脉血: 97%；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；中性粒细胞计数(Neut#)-静脉血: 3.610E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.7sec.；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；尿酸(UA)-静脉血: 413.6umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；血小板分布宽度(PDW)-静脉血: 14.7%；间接胆红素(IBIL)-静脉血: 9.7umolL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；丙氨酸氨基转移酶(ALT)-静脉血: 24U/L；碱性磷酸酶(ALP)-静脉血: 84.3U/L；总胆汁酸(TBA)-静脉血: 2.2umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.3mmol/L；葡萄糖(Glu)-静脉血: 4.51mmol/L；磷(P)-静脉血: 1.39mmol/L；C-反应蛋白(CRP)-静脉血: 4.68mg/L；血小板比容-静脉血: 25%；大血小板百分比(P-LCR%)-静脉血: 35.8%；血小板计数(PLT#)-静脉血: 21810E9/L；红细胞计数(RBC#)-静脉血: 4.5910E12/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；阴离子间隙(AG)-静脉血: 18；凝血酶时间(TT)-静脉血: 21.4sec.；红细胞比容(Hct)-静脉血: 43%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 344g/L；纤维蛋白原(Fbg)-静脉血: 3.09g/L；乳酸脱氢酶(LDH)-静脉血: 116.6U/L；总蛋白(TP)-静脉血: 69.58g/L；总钙(Ca)-静脉血: 2.31mmol/L；总胆固醇(TC)-静脉血: 5.94mmol/L；甘油三酯(TG)-静脉血: 1.79mmol/L；总胆红素(TBIL)-静脉血: 13.9umol/L；尿素氮(BUN……\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 安排颈部淋巴结细针穿刺活检明确病理，并补充全身PET-CT检查\nB. 安排右侧颈部肿大淋巴结切除活检，并补充EB病毒DNA荧光定量PCR检测\nC. 直接基于MRI及EBV抗体阳性结果启动根治性放化疗\nD. 行电子鼻咽镜检查观察肿瘤范围，并补充全身骨扫描及胸腹部CT\nE. 行电子鼻咽镜检查及活检明确病理诊断，但不安排任何与EB病毒相关的检查\nF. 安排鼻内镜下鼻咽肿物切除术，并补充EB病毒DNA荧光定量PCR检测\nG. 安排颈部淋巴结细针穿刺活检，并补充EB病毒DNA荧光定量PCR检测\nH. 行电子鼻咽镜检查及活检明确病理诊断，并立即行右颈部淋巴结切除活检\nI. 补充EB病毒DNA荧光定量PCR检测，待结果回报后再决定是否行鼻咽活检\nJ. 行电子鼻咽镜检查及活检明确病理诊断，并预防性行右颈淋巴结清扫术\nK. 安排颈部淋巴结穿刺活检及鼻咽镜下活检，并直接启动诱导化疗\nL. 行电子鼻咽镜检查及活检明确病理诊断，并补充EB病毒DNA荧光定量PCR检测\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D3] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁增厚，可见软组织肿块形成，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。双侧咽隐窝见软组织占据，双侧咽旁脂肪间隙受压变窄，病灶侵犯双侧腭帆提肌。双侧腭帆张肌、头长肌未见受侵。 双侧翼腭窝、颞下窝未见异常；口咽双侧壁未见受累增厚，病变未累及后鼻孔。 双侧翼突基底内份、蝶骨基底部右份骨髓信号减低，增强可见轻度强化。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 双侧咽后间隙见肿大淋巴结，右侧大小约为7mm ×8 mm，左侧大小约3mm×4mm。双颈II区、III区见数个淋巴结，最大位于右颈II区，大小约为15mm×27mm。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽肿块，考虑鼻咽癌。 颅底骨质破坏。 右侧咽后及右颈淋巴结肿大，考虑转移瘤。 左侧咽后及左颈小淋巴结。 鼻窦炎、右乳突炎。\n- [全程D3] 检验组合: 平均红细胞体积(MCV)-静脉血: 93.7fL；凝血酶原时间活动度(PTA)-静脉血: 97%；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；中性粒细胞计数(Neut#)-静脉血: 3.610E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.7sec.；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；尿酸(UA)-静脉血: 413.6umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；血小板分布宽度(PDW)-静脉血: 14.7%；间接胆红素(IBIL)-静脉血: 9.7umolL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；丙氨酸氨基转移酶(ALT)-静脉血: 24U/L；碱性磷酸酶(ALP)-静脉血: 84.3U/L；总胆汁酸(TBA)-静脉血: 2.2umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.3mmol/L；葡萄糖(Glu)-静脉血: 4.51mmol/L；磷(P)-静脉血: 1.39mmol/L；C-反应蛋白(CRP)-静脉血: 4.68mg/L；血小板比容-静脉血: 25%；大血小板百分比(P-LCR%)-静脉血: 35.8%；血小板计数(PLT#)-静脉血: 21810E9/L；红细胞计数(RBC#)-静脉血: 4.5910E12/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；阴离子间隙(AG)-静脉血: 18；凝血酶时间(TT)-静脉血: 21.4sec.；红细胞比容(Hct)-静脉血: 43%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 344g/L；纤维蛋白原(Fbg)-静脉血: 3.09g/L；乳酸脱氢酶(LDH)-静脉血: 116.6U/L；总蛋白(TP)-静脉血: 69.58g/L；总钙(Ca)-静脉血: 2.31mmol/L；总胆固醇(TC)-静脉血: 5.94mmol/L；甘油三酯(TG)-静脉血: 1.79mmol/L；总胆红素(TBIL)-静脉血: 13.9umol/L；尿素氮(BUN……\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 安排颈部淋巴结细针穿刺活检明确病理，并补充全身PET-CT检查\nB. 安排右侧颈部肿大淋巴结切除活检，并补充EB病毒DNA荧光定量PCR检测\nC. 直接基于MRI及EBV抗体阳性结果启动根治性放化疗\nD. 行电子鼻咽镜检查观察肿瘤范围，并补充全身骨扫描及胸腹部CT\nE. 行电子鼻咽镜检查及活检明确病理诊断，但不安排任何与EB病毒相关的检查\nF. 安排鼻内镜下鼻咽肿物切除术，并补充EB病毒DNA荧光定量PCR检测\nG. 安排颈部淋巴结细针穿刺活检，并补充EB病毒DNA荧光定量PCR检测\nH. 行电子鼻咽镜检查及活检明确病理诊断，并立即行右颈部淋巴结切除活检\nI. 补充EB病毒DNA荧光定量PCR检测，待结果回报后再决定是否行鼻咽活检\nJ. 行电子鼻咽镜检查及活检明确病理诊断，并预防性行右颈淋巴结清扫术\nK. 安排颈部淋巴结穿刺活检及鼻咽镜下活检，并直接启动诱导化疗\nL. 行电子鼻咽镜检查及活检明确病理诊断，并补充EB病毒DNA荧光定量PCR检测\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-8976031a638416cb5f037a59","patient_id":"patient-5ee5dba6116030961a7a97b5","turn_id":"turn04","turn_position":3,"turn_type":"initial_treatment_selection","gold_letter":"A","gold_action":"行吉西他滨+顺铂方案诱导化疗联合PD-1抑制剂","options":[{"letter":"A","text":"行吉西他滨+顺铂方案诱导化疗联合PD-1抑制剂","is_gold":true},{"letter":"B","text":"行单纯根治性放射治疗","is_gold":false},{"letter":"C","text":"行紫杉醇+顺铂+氟尿嘧啶方案诱导化疗联合西妥昔单抗","is_gold":false},{"letter":"D","text":"行鼻咽原发灶及颈部淋巴结根治性切除术","is_gold":false},{"letter":"E","text":"行洛铂+氟尿嘧啶方案姑息性化疗","is_gold":false},{"letter":"F","text":"行卡培他滨单药节拍化疗","is_gold":false},{"letter":"G","text":"行洛铂+氟尿嘧啶方案诱导化疗后序贯颈部淋巴结清扫术","is_gold":false},{"letter":"H","text":"行多西他赛+顺铂方案同期放化疗","is_gold":false},{"letter":"I","text":"行吉西他滨单药诱导化疗","is_gold":false},{"letter":"J","text":"行依托泊苷+顺铂方案诱导化疗","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 涕血半年伴右颈肿物2周；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D10] 入院记录: 主诉: 涕血半年伴右颈肿物2周.；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D4] 检验组合: 乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D5] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶后壁及双侧壁粘膜增厚放射性浓聚，SUV约23.1；病灶填塞双侧鼻后孔，向上侵犯蝶骨基底部、双翼突基底部、犁骨及枕骨斜坡，局部骨质稍模糊放射性分布浓密。双侧破裂孔未见明显异常。双侧咽隐窝变浅。双侧咽旁间隙结构尚清。右侧咽后淋巴结放射性浓聚，SUV约11.4，大小约0.7×1.0cm；左侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见异常。筛窦、右上颌窦及右乳突稍低密度影放射性分布未见异常；额窦、蝶窦、左侧上颌窦及左乳突结构及放射性分布未见明显异常。口咽、喉咽未见明显异常。甲状腺放射性分布未见异常。双颈Ⅱ区肿大淋巴结放射性浓聚，SUV约10.2，最大约1.6×2.6cm；余双侧颈部未见肿大淋巴结及异常放射性分布。 双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺纹理清晰，双侧肺野未见确切病灶和异常放射性分布。气管、支气管通畅。心脏及大血管放射性分布未见异常。胸壁未见确切病灶和异常放射性分布。双肺门、纵隔及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏密度不均匀降低，放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管及胆总管未见扩张。胆囊、胃及十二指肠放射性分布未见异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、肠管等形态、结构及放射性分布未见明显异常。前列腺点状高密度影放射性分布未见异常。双侧髂血管旁及腹股沟未见明显肿大淋巴结及异常放射性分布。 余所见颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，病灶侵犯颅底骨；右咽后及双颈Ⅱ区淋巴结代谢较活跃，考虑转移。 鼻窦炎；右乳突炎。 脂肪肝。 前列腺钙化灶。\n- [全程D10] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: 右臂静脉插管, 导管末端位于胸椎右旁T 7上缘水平，估计位于上腔静脉下段。；检查结论: 导管末端位置如上述。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-J 选项中选择唯一最合适的答案。\nA. 行吉西他滨+顺铂方案诱导化疗联合PD-1抑制剂\nB. 行单纯根治性放射治疗\nC. 行紫杉醇+顺铂+氟尿嘧啶方案诱导化疗联合西妥昔单抗\nD. 行鼻咽原发灶及颈部淋巴结根治性切除术\nE. 行洛铂+氟尿嘧啶方案姑息性化疗\nF. 行卡培他滨单药节拍化疗\nG. 行洛铂+氟尿嘧啶方案诱导化疗后序贯颈部淋巴结清扫术\nH. 行多西他赛+顺铂方案同期放化疗\nI. 行吉西他滨单药诱导化疗\nJ. 行依托泊苷+顺铂方案诱导化疗\n\n请仅输出一个选项字母（A-J）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 涕血半年伴右颈肿物2周；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D10] 入院记录: 主诉: 涕血半年伴右颈肿物2周.；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D4] 检验组合: 乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D5] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶后壁及双侧壁粘膜增厚放射性浓聚，SUV约23.1；病灶填塞双侧鼻后孔，向上侵犯蝶骨基底部、双翼突基底部、犁骨及枕骨斜坡，局部骨质稍模糊放射性分布浓密。双侧破裂孔未见明显异常。双侧咽隐窝变浅。双侧咽旁间隙结构尚清。右侧咽后淋巴结放射性浓聚，SUV约11.4，大小约0.7×1.0cm；左侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见异常。筛窦、右上颌窦及右乳突稍低密度影放射性分布未见异常；额窦、蝶窦、左侧上颌窦及左乳突结构及放射性分布未见明显异常。口咽、喉咽未见明显异常。甲状腺放射性分布未见异常。双颈Ⅱ区肿大淋巴结放射性浓聚，SUV约10.2，最大约1.6×2.6cm；余双侧颈部未见肿大淋巴结及异常放射性分布。 双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺纹理清晰，双侧肺野未见确切病灶和异常放射性分布。气管、支气管通畅。心脏及大血管放射性分布未见异常。胸壁未见确切病灶和异常放射性分布。双肺门、纵隔及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏密度不均匀降低，放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管及胆总管未见扩张。胆囊、胃及十二指肠放射性分布未见异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、肠管等形态、结构及放射性分布未见明显异常。前列腺点状高密度影放射性分布未见异常。双侧髂血管旁及腹股沟未见明显肿大淋巴结及异常放射性分布。 余所见颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，病灶侵犯颅底骨；右咽后及双颈Ⅱ区淋巴结代谢较活跃，考虑转移。 鼻窦炎；右乳突炎。 脂肪肝。 前列腺钙化灶。\n- [全程D10] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: 右臂静脉插管, 导管末端位于胸椎右旁T 7上缘水平，估计位于上腔静脉下段。；检查结论: 导管末端位置如上述。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-J 选项中选择唯一最合适的答案。\nA. 行吉西他滨+顺铂方案诱导化疗联合PD-1抑制剂\nB. 行单纯根治性放射治疗\nC. 行紫杉醇+顺铂+氟尿嘧啶方案诱导化疗联合西妥昔单抗\nD. 行鼻咽原发灶及颈部淋巴结根治性切除术\nE. 行洛铂+氟尿嘧啶方案姑息性化疗\nF. 行卡培他滨单药节拍化疗\nG. 行洛铂+氟尿嘧啶方案诱导化疗后序贯颈部淋巴结清扫术\nH. 行多西他赛+顺铂方案同期放化疗\nI. 行吉西他滨单药诱导化疗\nJ. 行依托泊苷+顺铂方案诱导化疗\n\n请仅输出一个选项字母（A-J）。"}]}
+{"sample_id":"sample-5d943566dde88ca9f3640bc0","patient_id":"patient-5ee5dba6116030961a7a97b5","turn_id":"turn05","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"C","gold_action":"办理出院，嘱每周复查血常规及肝肾功能，2周后返院继续下一阶段治疗。","options":[{"letter":"A","text":"办理出院，嘱每3天复查血常规及肝肾功能，1周后返院继续下一阶段治疗","is_gold":false},{"letter":"B","text":"予以重组人粒细胞刺激因子皮下注射后办理出院，嘱每周复查血常规，2周后返院","is_gold":false},{"letter":"C","text":"办理出院，嘱每周复查血常规及肝肾功能，2周后返院继续下一阶段治疗","is_gold":true},{"letter":"D","text":"办理出院，嘱每2周复查血常规及肝肾功能，3周后返院继续下一阶段治疗","is_gold":false},{"letter":"E","text":"暂缓出院，继续住院观察并每日复查血常规，待血液学指标进一步稳定后出院","is_gold":false},{"letter":"F","text":"办理出院，嘱每月复查血常规及肝肾功能，4周后返院评估疗效并决定后续治疗","is_gold":false},{"letter":"G","text":"予以静脉滴注保肝药物治疗，待复查肝功能指标完全正常后办理出院","is_gold":false},{"letter":"H","text":"办理出院，处方口服升血小板药物，嘱每周复查血常规，2周后返院","is_gold":false},{"letter":"I","text":"办理出院，处方口服卡培他滨单药维持，嘱每周复查血常规，3周后返院","is_gold":false},{"letter":"J","text":"办理出院，嘱每周复查血常规及肝肾功能，4周后返院行MRI复查评估疗效","is_gold":false},{"letter":"K","text":"予以口服氯化钾缓释片补钾治疗，每日监测电解质，待血钾水平上升后办理出院","is_gold":false},{"letter":"L","text":"办理出院，无需定期复查化验指标，嘱出现发热或出血症状时急诊就诊，3周后返院","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D39] 检验组合: 胱抑素(Cys-C)-静脉血: 0.78mg/L；血小板比容-静脉血: 14.8%；中性粒细胞百分比(Neut%)-静脉血: 0.61；γ-谷氨酰基转移酶(GGT)-静脉血: 57.8U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；总蛋白(TP)-静脉血: 67.84g/L；平均红细胞体积(MCV)-静脉血: 96.4fL；镁离子(Mg2+)-静脉血: 0.92mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.05mmolL；钠离子(Na+)-静脉血: 139.4mmol/L；磷(P)-静脉血: 1.36mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.302；氯离子(Cl-)-静脉血: 103.4mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.54；平均红细胞血红蛋白含量(MCH)-静脉血: 32.7pg；平均血小板体积(MPV)-静脉血: 8.84fL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.59；钾离子(K+)-静脉血: 3.79mmol/L；单核细胞百分比(Mono%)-静脉血: 0.06；白细胞计数(WBC#)-静脉血: 5.4510E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；α-L-岩藻糖苷酶(AFU)-静脉血: 35.8U/L；血小板分布宽度(PDW)-静脉血: 16.9%；红细胞比容(Hct)-静脉血: 40.3%；乳酸脱氢酶(LDH)-静脉血: 149.5U/L；红细胞计数(RBC#)-静脉血: 4.1810E12/L；C-反应蛋白(CRP)-静脉血: 2.31mg/L；总钙(Ca)-静脉血: 2.19mmol/L；尿素氮(BUN)-静脉血: 3.8mmol/L；尿酸(UA)-静脉血: 285umol/L；阴离子间隙(AG)-静脉血: 11.3；葡萄糖(Glu)-静脉血: 4.38mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339.2g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 32.4U/L；甘油三酯(TG)-静脉血: 2.32mmol/L；白蛋白(ALB)-静脉血: 41.6g/L；血小板计数(PLT#)-静脉血: 167.……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D34] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者今日洛铂+5-FU化疗第2天，诉食欲较差，无恶心、呕吐等不适，精神、睡眠尚可，大小便正常。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者化疗第2日，一般情况可，嘱患者注意饮食，加强营养，续行化疗。密切观察化疗反应，必要时加强处理。现已按查房指示执行。\n- [全程D35] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者今日洛铂+5-FU化疗第3天，诉食欲较差，无恶心、呕吐等不适，精神、睡眠尚可，大小便正常。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者化疗第3日，一般情况可，密切观察化疗反应，必要时加强处理。现已按查房指示执行。\n- [全程D39] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者计划于今日完成第2程洛铂+5-FU方案诱导化疗，未诉特殊不适。[姓名已隐去]主诊医生信息已隐藏：患者现完成第2程洛铂+5-FU方案诱导化疗，一般情况可，予今日出院。嘱患者出院后定期每周复查血常规、肝肾功能，2周后返院续治。现已按查房指示执行。\n- [时间未明] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 现已按查房指示执行。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 办理出院，嘱每3天复查血常规及肝肾功能，1周后返院继续下一阶段治疗\nB. 予以重组人粒细胞刺激因子皮下注射后办理出院，嘱每周复查血常规，2周后返院\nC. 办理出院，嘱每周复查血常规及肝肾功能，2周后返院继续下一阶段治疗\nD. 办理出院，嘱每2周复查血常规及肝肾功能，3周后返院继续下一阶段治疗\nE. 暂缓出院，继续住院观察并每日复查血常规，待血液学指标进一步稳定后出院\nF. 办理出院，嘱每月复查血常规及肝肾功能，4周后返院评估疗效并决定后续治疗\nG. 予以静脉滴注保肝药物治疗，待复查肝功能指标完全正常后办理出院\nH. 办理出院，处方口服升血小板药物，嘱每周复查血常规，2周后返院\nI. 办理出院，处方口服卡培他滨单药维持，嘱每周复查血常规，3周后返院\nJ. 办理出院，嘱每周复查血常规及肝肾功能，4周后返院行MRI复查评估疗效\nK. 予以口服氯化钾缓释片补钾治疗，每日监测电解质，待血钾水平上升后办理出院\nL. 办理出院，无需定期复查化验指标，嘱出现发热或出血症状时急诊就诊，3周后返院\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D39] 检验组合: 胱抑素(Cys-C)-静脉血: 0.78mg/L；血小板比容-静脉血: 14.8%；中性粒细胞百分比(Neut%)-静脉血: 0.61；γ-谷氨酰基转移酶(GGT)-静脉血: 57.8U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；总蛋白(TP)-静脉血: 67.84g/L；平均红细胞体积(MCV)-静脉血: 96.4fL；镁离子(Mg2+)-静脉血: 0.92mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.05mmolL；钠离子(Na+)-静脉血: 139.4mmol/L；磷(P)-静脉血: 1.36mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.302；氯离子(Cl-)-静脉血: 103.4mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.54；平均红细胞血红蛋白含量(MCH)-静脉血: 32.7pg；平均血小板体积(MPV)-静脉血: 8.84fL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.59；钾离子(K+)-静脉血: 3.79mmol/L；单核细胞百分比(Mono%)-静脉血: 0.06；白细胞计数(WBC#)-静脉血: 5.4510E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；α-L-岩藻糖苷酶(AFU)-静脉血: 35.8U/L；血小板分布宽度(PDW)-静脉血: 16.9%；红细胞比容(Hct)-静脉血: 40.3%；乳酸脱氢酶(LDH)-静脉血: 149.5U/L；红细胞计数(RBC#)-静脉血: 4.1810E12/L；C-反应蛋白(CRP)-静脉血: 2.31mg/L；总钙(Ca)-静脉血: 2.19mmol/L；尿素氮(BUN)-静脉血: 3.8mmol/L；尿酸(UA)-静脉血: 285umol/L；阴离子间隙(AG)-静脉血: 11.3；葡萄糖(Glu)-静脉血: 4.38mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339.2g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 32.4U/L；甘油三酯(TG)-静脉血: 2.32mmol/L；白蛋白(ALB)-静脉血: 41.6g/L；血小板计数(PLT#)-静脉血: 167.……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D34] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者今日洛铂+5-FU化疗第2天，诉食欲较差，无恶心、呕吐等不适，精神、睡眠尚可，大小便正常。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者化疗第2日，一般情况可，嘱患者注意饮食，加强营养，续行化疗。密切观察化疗反应，必要时加强处理。现已按查房指示执行。\n- [全程D35] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者今日洛铂+5-FU化疗第3天，诉食欲较差，无恶心、呕吐等不适，精神、睡眠尚可，大小便正常。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者化疗第3日，一般情况可，密切观察化疗反应，必要时加强处理。现已按查房指示执行。\n- [全程D39] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者计划于今日完成第2程洛铂+5-FU方案诱导化疗，未诉特殊不适。[姓名已隐去]主诊医生信息已隐藏：患者现完成第2程洛铂+5-FU方案诱导化疗，一般情况可，予今日出院。嘱患者出院后定期每周复查血常规、肝肾功能，2周后返院续治。现已按查房指示执行。\n- [时间未明] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 现已按查房指示执行。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 办理出院，嘱每3天复查血常规及肝肾功能，1周后返院继续下一阶段治疗\nB. 予以重组人粒细胞刺激因子皮下注射后办理出院，嘱每周复查血常规，2周后返院\nC. 办理出院，嘱每周复查血常规及肝肾功能，2周后返院继续下一阶段治疗\nD. 办理出院，嘱每2周复查血常规及肝肾功能，3周后返院继续下一阶段治疗\nE. 暂缓出院，继续住院观察并每日复查血常规，待血液学指标进一步稳定后出院\nF. 办理出院，嘱每月复查血常规及肝肾功能，4周后返院评估疗效并决定后续治疗\nG. 予以静脉滴注保肝药物治疗，待复查肝功能指标完全正常后办理出院\nH. 办理出院，处方口服升血小板药物，嘱每周复查血常规，2周后返院\nI. 办理出院，处方口服卡培他滨单药维持，嘱每周复查血常规，3周后返院\nJ. 办理出院，嘱每周复查血常规及肝肾功能，4周后返院行MRI复查评估疗效\nK. 予以口服氯化钾缓释片补钾治疗，每日监测电解质，待血钾水平上升后办理出院\nL. 办理出院，无需定期复查化验指标，嘱出现发热或出血症状时急诊就诊，3周后返院\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-90c3b83f1d4c9db69ef01572","patient_id":"patient-5ee5dba6116030961a7a97b5","turn_id":"turn06","turn_position":5,"turn_type":"toxicity_or_support_decision","gold_letter":"K","gold_action":"继续同期放化疗，予以甲氧氯普胺口服止吐，暂不予静脉营养及免疫调节支持。","options":[{"letter":"A","text":"继续同期放化疗，予以重组人粒细胞刺激因子皮下注射及甲氧氯普胺口服止吐。","is_gold":false},{"letter":"B","text":"继续同期放化疗，予以重组人血小板生成素皮下注射及脂肪乳氨基酸葡萄糖静脉营养。","is_gold":false},{"letter":"C","text":"继续同期放化疗，予以多烯磷脂酰胆碱静脉滴注保肝及甲氧氯普胺口服止吐。","is_gold":false},{"letter":"D","text":"继续同期放化疗，予以甲氧氯普胺口服止吐，加用脂肪乳氨基酸葡萄糖静脉营养及胸腺五肽支持治疗。","is_gold":false},{"letter":"E","text":"暂停同期化疗，仅行单纯放疗，予以甲氧氯普胺口服止吐及脂肪乳氨基酸葡萄糖静脉营养。","is_gold":false},{"letter":"F","text":"继续同期放化疗，予以促红细胞生成素皮下注射及胸腺五肽支持治疗。","is_gold":false},{"letter":"G","text":"暂停放化疗，予以静脉输注红细胞悬液及脂肪乳氨基酸葡萄糖静脉营养。","is_gold":false},{"letter":"H","text":"继续同期放化疗，予以5-HT3受体拮抗剂静脉推注强化止吐，暂不予静脉营养支持。","is_gold":false},{"letter":"I","text":"继续同期放化疗，予以水化碱化尿液及甲氧氯普胺口服止吐。","is_gold":false},{"letter":"J","text":"暂停放化疗，予以广谱抗生素静脉滴注抗感染及胸腺五肽支持治疗。","is_gold":false},{"letter":"K","text":"继续同期放化疗，予以甲氧氯普胺口服止吐，暂不予静脉营养及免疫调节支持。","is_gold":true},{"letter":"L","text":"继续同期放化疗，予以重组人粒细胞刺激因子及促红细胞生成素双重支持。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D45] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌2程化疗后，与某次就诊时间片对比： 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁增厚，可见软组织肿块形成，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，对比前片，较前明显缩小。双侧咽隐窝见软组织占据，双侧咽旁脂肪间隙受压变窄，病灶侵犯双侧腭帆提肌，范围较前稍缩小。双侧腭帆张肌、头长肌未见受侵。 双侧翼腭窝、颞下窝未见异常；口咽双侧壁未见受累增厚，病变未累及后鼻孔。 双侧翼突基底内份、蝶骨基底部右份骨髓信号减低，增强可见轻度强化。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 双侧咽后间隙见肿大淋巴结，右侧大小约为6mm ×7 mm，左侧大小约4mm×6mm。双颈II区、III区见数个淋巴结，最大位于右颈II区，大小约为11mm×24mm，较前明显缩小。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌2程化疗后： 鼻咽病灶较前明显缩小。 颅底骨质破坏。 双侧咽后及颈部淋巴结，较前明显缩小。 鼻窦炎、右乳突炎。\n- [全程D60] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 28.3U/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.1g/L；平均红细胞体积(MCV)-静脉血: 97.9fL；血液二氧化碳含量ctCO2(B)-静脉血: 22.6mmol/L；血小板计数(PLT#)-静脉血: 152.910E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；钾离子(K+)-静脉血: 4.2mmol/L；碱性磷酸酶(ALP)-静脉血: 76.4U/L；单核细胞百分比(Mono%)-静脉血: 0.073；γ-谷氨酰基转移酶(GGT)-静脉血: 46.4U/L；血红蛋白(Hb)-静脉血: 145.2g/L；胱抑素(Cys-C)-静脉血: 0.82mg/L；阴离子间隙(AG)-静脉血: 18；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；甘油三酯(TG)-静脉血: 1.57mmol/L；直接胆红素(DBIL)-静脉血: 6.7umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 345.2g/L；间接胆红素(IBIL)-静脉血: 17.9umolL；中性粒细胞百分比(Neut%)-静脉血: 0.676；乳酸脱氢酶(LDH)-静脉血: 132.5U/L；总蛋白(TP)-静脉血: 71.34g/L；总胆固醇(TC)-静脉血: 6.52mmol/L；总钙(Ca)-静脉血: 2.33mmol/L；血小板分布宽度(PDW)-静脉血: 16.9%；血小板比容-静脉血: 13%；尿酸(UA)-静脉血: 305.5umol/L；平均血小板体积(MPV)-静脉血: 8.53fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1%；淋巴细胞百分比(Lymph%)-静脉血: 0.221；钠离子(Na+)-静脉血: 139.5mmol/L；载脂蛋白B(apoB)-静脉血: 1.31g/L；有核红细胞百分比(NRBC%)-静脉血: 0；总胆汁酸(TBA)-静脉血: 3.6umol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总胆红素(TBIL)-静脉血: 24.6umol/L……\n\n【既往治疗与反应】\n- [全程D55] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者未诉特殊不适，饮食、睡眠、精神尚可，大小便正常。查体：基本同前。[姓名已隐去]主诊医生信息已隐藏：患者诊断明确，已完成患者靶区设计，并通过全科会诊，剂量分布均匀，予GTVnx:70Gy/30F,GTVnd(L):66Gy/30F,GTVnd(R):66Gy/30F。考虑联合洛铂同期放化疗，告知患者放疗及化疗的可能获益及相关风险，患者表示已知情并同意。续观。现已按查房指示执行。\n- [全程D56] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现放疗1F，未诉特殊不适。生命体征平稳。查体情况大致同前。[姓名已隐去]主诊医生信息已隐藏：考虑患者一般情况可，继续放疗，密切关注放疗副反应，必要时加强处理。现已按查房指示执行。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 继续同期放化疗，予以重组人粒细胞刺激因子皮下注射及甲氧氯普胺口服止吐。\nB. 继续同期放化疗，予以重组人血小板生成素皮下注射及脂肪乳氨基酸葡萄糖静脉营养。\nC. 继续同期放化疗，予以多烯磷脂酰胆碱静脉滴注保肝及甲氧氯普胺口服止吐。\nD. 继续同期放化疗，予以甲氧氯普胺口服止吐，加用脂肪乳氨基酸葡萄糖静脉营养及胸腺五肽支持治疗。\nE. 暂停同期化疗，仅行单纯放疗，予以甲氧氯普胺口服止吐及脂肪乳氨基酸葡萄糖静脉营养。\nF. 继续同期放化疗，予以促红细胞生成素皮下注射及胸腺五肽支持治疗。\nG. 暂停放化疗，予以静脉输注红细胞悬液及脂肪乳氨基酸葡萄糖静脉营养。\nH. 继续同期放化疗，予以5-HT3受体拮抗剂静脉推注强化止吐，暂不予静脉营养支持。\nI. 继续同期放化疗，予以水化碱化尿液及甲氧氯普胺口服止吐。\nJ. 暂停放化疗，予以广谱抗生素静脉滴注抗感染及胸腺五肽支持治疗。\nK. 继续同期放化疗，予以甲氧氯普胺口服止吐，暂不予静脉营养及免疫调节支持。\nL. 继续同期放化疗，予以重组人粒细胞刺激因子及促红细胞生成素双重支持。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D45] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌2程化疗后，与某次就诊时间片对比： 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁增厚，可见软组织肿块形成，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，对比前片，较前明显缩小。双侧咽隐窝见软组织占据，双侧咽旁脂肪间隙受压变窄，病灶侵犯双侧腭帆提肌，范围较前稍缩小。双侧腭帆张肌、头长肌未见受侵。 双侧翼腭窝、颞下窝未见异常；口咽双侧壁未见受累增厚，病变未累及后鼻孔。 双侧翼突基底内份、蝶骨基底部右份骨髓信号减低，增强可见轻度强化。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 双侧咽后间隙见肿大淋巴结，右侧大小约为6mm ×7 mm，左侧大小约4mm×6mm。双颈II区、III区见数个淋巴结，最大位于右颈II区，大小约为11mm×24mm，较前明显缩小。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌2程化疗后： 鼻咽病灶较前明显缩小。 颅底骨质破坏。 双侧咽后及颈部淋巴结，较前明显缩小。 鼻窦炎、右乳突炎。\n- [全程D60] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 28.3U/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.1g/L；平均红细胞体积(MCV)-静脉血: 97.9fL；血液二氧化碳含量ctCO2(B)-静脉血: 22.6mmol/L；血小板计数(PLT#)-静脉血: 152.910E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；钾离子(K+)-静脉血: 4.2mmol/L；碱性磷酸酶(ALP)-静脉血: 76.4U/L；单核细胞百分比(Mono%)-静脉血: 0.073；γ-谷氨酰基转移酶(GGT)-静脉血: 46.4U/L；血红蛋白(Hb)-静脉血: 145.2g/L；胱抑素(Cys-C)-静脉血: 0.82mg/L；阴离子间隙(AG)-静脉血: 18；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；甘油三酯(TG)-静脉血: 1.57mmol/L；直接胆红素(DBIL)-静脉血: 6.7umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 345.2g/L；间接胆红素(IBIL)-静脉血: 17.9umolL；中性粒细胞百分比(Neut%)-静脉血: 0.676；乳酸脱氢酶(LDH)-静脉血: 132.5U/L；总蛋白(TP)-静脉血: 71.34g/L；总胆固醇(TC)-静脉血: 6.52mmol/L；总钙(Ca)-静脉血: 2.33mmol/L；血小板分布宽度(PDW)-静脉血: 16.9%；血小板比容-静脉血: 13%；尿酸(UA)-静脉血: 305.5umol/L；平均血小板体积(MPV)-静脉血: 8.53fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1%；淋巴细胞百分比(Lymph%)-静脉血: 0.221；钠离子(Na+)-静脉血: 139.5mmol/L；载脂蛋白B(apoB)-静脉血: 1.31g/L；有核红细胞百分比(NRBC%)-静脉血: 0；总胆汁酸(TBA)-静脉血: 3.6umol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总胆红素(TBIL)-静脉血: 24.6umol/L……\n\n【既往治疗与反应】\n- [全程D55] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者未诉特殊不适，饮食、睡眠、精神尚可，大小便正常。查体：基本同前。[姓名已隐去]主诊医生信息已隐藏：患者诊断明确，已完成患者靶区设计，并通过全科会诊，剂量分布均匀，予GTVnx:70Gy/30F,GTVnd(L):66Gy/30F,GTVnd(R):66Gy/30F。考虑联合洛铂同期放化疗，告知患者放疗及化疗的可能获益及相关风险，患者表示已知情并同意。续观。现已按查房指示执行。\n- [全程D56] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现放疗1F，未诉特殊不适。生命体征平稳。查体情况大致同前。[姓名已隐去]主诊医生信息已隐藏：考虑患者一般情况可，继续放疗，密切关注放疗副反应，必要时加强处理。现已按查房指示执行。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 继续同期放化疗，予以重组人粒细胞刺激因子皮下注射及甲氧氯普胺口服止吐。\nB. 继续同期放化疗，予以重组人血小板生成素皮下注射及脂肪乳氨基酸葡萄糖静脉营养。\nC. 继续同期放化疗，予以多烯磷脂酰胆碱静脉滴注保肝及甲氧氯普胺口服止吐。\nD. 继续同期放化疗，予以甲氧氯普胺口服止吐，加用脂肪乳氨基酸葡萄糖静脉营养及胸腺五肽支持治疗。\nE. 暂停同期化疗，仅行单纯放疗，予以甲氧氯普胺口服止吐及脂肪乳氨基酸葡萄糖静脉营养。\nF. 继续同期放化疗，予以促红细胞生成素皮下注射及胸腺五肽支持治疗。\nG. 暂停放化疗，予以静脉输注红细胞悬液及脂肪乳氨基酸葡萄糖静脉营养。\nH. 继续同期放化疗，予以5-HT3受体拮抗剂静脉推注强化止吐，暂不予静脉营养支持。\nI. 继续同期放化疗，予以水化碱化尿液及甲氧氯普胺口服止吐。\nJ. 暂停放化疗，予以广谱抗生素静脉滴注抗感染及胸腺五肽支持治疗。\nK. 继续同期放化疗，予以甲氧氯普胺口服止吐，暂不予静脉营养及免疫调节支持。\nL. 继续同期放化疗，予以重组人粒细胞刺激因子及促红细胞生成素双重支持。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-d1b602a57ed6c599e7f441cc","patient_id":"patient-5ee5dba6116030961a7a97b5","turn_id":"turn07","turn_position":6,"turn_type":"response_assessment_decision","gold_letter":"E","gold_action":"评估为诱导化疗部分缓解（PR），完善放疗前常规血液学检查，启动根治性调强放射治疗（IMRT）及放疗相关支持治疗。","options":[{"letter":"A","text":"评估为诱导化疗疾病稳定（SD），原方案（洛铂+5-FU）继续第3程诱导化疗，随后再评估放疗指征。","is_gold":false},{"letter":"B","text":"评估为诱导化疗部分缓解（PR），原方案（洛铂+5-FU）继续第3程诱导化疗，以期达到完全缓解后放疗。","is_gold":false},{"letter":"C","text":"评估为诱导化疗部分缓解（PR），行鼻咽及颈部病灶根治性手术切除，术后辅助调强放射治疗。","is_gold":false},{"letter":"D","text":"评估为诱导化疗完全缓解（CR），暂缓放射治疗，进入定期随访观察阶段。","is_gold":false},{"letter":"E","text":"评估为诱导化疗部分缓解（PR），完善放疗前常规血液学检查，启动根治性调强放射治疗（IMRT）及放疗相关支持治疗。","is_gold":true},{"letter":"F","text":"评估为诱导化疗部分缓解（PR），启动根治性三维适形放射治疗（3D-CRT）及放疗相关支持治疗。","is_gold":false},{"letter":"G","text":"评估为诱导化疗疾病进展（PD），更改诱导化疗方案为吉西他滨+顺铂（GP），2程后再次评估。","is_gold":false},{"letter":"H","text":"评估为诱导化疗部分缓解（PR），行颈部淋巴结清扫术，术后行鼻咽局部调强放射治疗。","is_gold":false},{"letter":"I","text":"评估为诱导化疗部分缓解（PR），启动姑息性减症放射治疗，剂量控制在40Gy左右。","is_gold":false},{"letter":"J","text":"评估为诱导化疗疾病稳定（SD），加用免疫检查点抑制剂联合原方案化疗。","is_gold":false},{"letter":"K","text":"评估为诱导化疗部分缓解（PR），等待4周后复查PET-CT，视代谢活性决定是否启动放射治疗。","is_gold":false},{"letter":"L","text":"评估为诱导化疗部分缓解（PR），停用化疗，单用靶向药物维持治疗。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- 无可展示记录。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估为诱导化疗疾病稳定（SD），原方案（洛铂+5-FU）继续第3程诱导化疗，随后再评估放疗指征。\nB. 评估为诱导化疗部分缓解（PR），原方案（洛铂+5-FU）继续第3程诱导化疗，以期达到完全缓解后放疗。\nC. 评估为诱导化疗部分缓解（PR），行鼻咽及颈部病灶根治性手术切除，术后辅助调强放射治疗。\nD. 评估为诱导化疗完全缓解（CR），暂缓放射治疗，进入定期随访观察阶段。\nE. 评估为诱导化疗部分缓解（PR），完善放疗前常规血液学检查，启动根治性调强放射治疗（IMRT）及放疗相关支持治疗。\nF. 评估为诱导化疗部分缓解（PR），启动根治性三维适形放射治疗（3D-CRT）及放疗相关支持治疗。\nG. 评估为诱导化疗疾病进展（PD），更改诱导化疗方案为吉西他滨+顺铂（GP），2程后再次评估。\nH. 评估为诱导化疗部分缓解（PR），行颈部淋巴结清扫术，术后行鼻咽局部调强放射治疗。\nI. 评估为诱导化疗部分缓解（PR），启动姑息性减症放射治疗，剂量控制在40Gy左右。\nJ. 评估为诱导化疗疾病稳定（SD），加用免疫检查点抑制剂联合原方案化疗。\nK. 评估为诱导化疗部分缓解（PR），等待4周后复查PET-CT，视代谢活性决定是否启动放射治疗。\nL. 评估为诱导化疗部分缓解（PR），停用化疗，单用靶向药物维持治疗。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- 无可展示记录。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估为诱导化疗疾病稳定（SD），原方案（洛铂+5-FU）继续第3程诱导化疗，随后再评估放疗指征。\nB. 评估为诱导化疗部分缓解（PR），原方案（洛铂+5-FU）继续第3程诱导化疗，以期达到完全缓解后放疗。\nC. 评估为诱导化疗部分缓解（PR），行鼻咽及颈部病灶根治性手术切除，术后辅助调强放射治疗。\nD. 评估为诱导化疗完全缓解（CR），暂缓放射治疗，进入定期随访观察阶段。\nE. 评估为诱导化疗部分缓解（PR），完善放疗前常规血液学检查，启动根治性调强放射治疗（IMRT）及放疗相关支持治疗。\nF. 评估为诱导化疗部分缓解（PR），启动根治性三维适形放射治疗（3D-CRT）及放疗相关支持治疗。\nG. 评估为诱导化疗疾病进展（PD），更改诱导化疗方案为吉西他滨+顺铂（GP），2程后再次评估。\nH. 评估为诱导化疗部分缓解（PR），行颈部淋巴结清扫术，术后行鼻咽局部调强放射治疗。\nI. 评估为诱导化疗部分缓解（PR），启动姑息性减症放射治疗，剂量控制在40Gy左右。\nJ. 评估为诱导化疗疾病稳定（SD），加用免疫检查点抑制剂联合原方案化疗。\nK. 评估为诱导化疗部分缓解（PR），等待4周后复查PET-CT，视代谢活性决定是否启动放射治疗。\nL. 评估为诱导化疗部分缓解（PR），停用化疗，单用靶向药物维持治疗。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-c2aa48d510cb846f4ee51384","patient_id":"patient-5ee5dba6116030961a7a97b5","turn_id":"turn08","turn_position":7,"turn_type":"response_assessment_decision","gold_letter":"F","gold_action":"行电子鼻咽镜检查（不活检）评估局部情况，安排出院并予以镇痛、黏膜保护及雾化等对症药物。","options":[{"letter":"A","text":"行鼻咽部MRI及全身PET-CT全面评估疗效，若疑有残留即刻行局部挽救性手术。","is_gold":false},{"letter":"B","text":"行电子鼻咽镜检查并对原发灶区域行多点活检，明确病理缓解情况后决定是否追加化疗。","is_gold":false},{"letter":"C","text":"暂缓局部内镜检查，继续原方案洛铂单药辅助化疗2个周期后再行全面评估。","is_gold":false},{"letter":"D","text":"行电子鼻咽镜检查评估局部疗效，并继续住院行第3周期洛铂同期化疗。","is_gold":false},{"letter":"E","text":"直接安排出院，嘱3个月后返院行鼻咽镜及MRI检查，期间停用所有处方药物。","is_gold":false},{"letter":"F","text":"行电子鼻咽镜检查（不活检）评估局部情况，安排出院并予以镇痛、黏膜保护及雾化等对症药物。","is_gold":true},{"letter":"G","text":"行鼻咽部及颈部增强CT评估病灶退缩情况，若有残留予以局部追加放疗推量。","is_gold":false},{"letter":"H","text":"行电子鼻咽镜检查评估局部疗效，安排出院并立即开始PD-1抑制剂维持治疗半年。","is_gold":false},{"letter":"I","text":"行全身骨扫描及腹部超声评估远处转移情况，若阴性则安排出院并定期随访。","is_gold":false},{"letter":"J","text":"行电子鼻咽镜检查（不活检）评估局部情况，并转入头颈外科行右颈淋巴结清扫术。","is_gold":false},{"letter":"K","text":"安排出院并予以镇痛药物，1个月后返院行鼻咽镜下活检以明确是否达到病理完全缓解。","is_gold":false},{"letter":"L","text":"行鼻咽部MRI评估局部疗效，若达到完全缓解则安排出院并逐步停用所有镇痛药物。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D67] 检验组合: 平均红细胞血红蛋白浓度(MCHC)-静脉血: 349g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.5；血小板比容-静脉血: 12%；总蛋白(TP)-静脉血: 64.55g/L；镁离子(Mg2+)-静脉血: 0.9mmol/L；乳酸脱氢酶(LDH)-静脉血: 113.1U/L；总胆固醇(TC)-静脉血: 5.45mmol/L；葡萄糖(Glu)-静脉血: 4.72mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.5；钠离子(Na+)-静脉血: 142.5mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 33.4pg；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.022；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；总胆汁酸(TBA)-静脉血: 2.5umol/L；阴离子间隙(AG)-静脉血: 10；胱抑素(Cys-C)-静脉血: 0.75mg/L；间接胆红素(IBIL)-静脉血: 8.9umolL；钾离子(K+)-静脉血: 3.8mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 36.7U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；红细胞比容(Hct)-静脉血: 39%；血小板分布宽度(PDW)-静脉血: 12.4%；中性粒细胞百分比(Neut%)-静脉血: 0.753；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；球蛋白(GLO)-静脉血: 26.65g/L；甘油三酯(TG)-静脉血: 1.38mmol/L；碱性磷酸酶(ALP)-静脉血: 67.5U/L；白细胞计数(WBC#)-静脉血: 5.0810E9/L；总胆红素(TBIL)-静脉血: 13.1umol/L；单核细胞百分比(Mono%)-静脉血: 0.089；α-L-岩藻糖苷酶(AFU)-静脉血: 26U/L；尿酸(UA)-静脉血: 318.1umol/L；尿素氮(BUN)-静脉血: 3.21mmol/L；平均血小板体积(MPV)-静脉血: 10.4fL；载脂蛋白B(apoB)-静脉血: 1.08g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；血红蛋白(Hb)-静脉血: 136g/L；氯离子(Cl-)-静……\n- [全程D74] 检验组合: 有核红细胞计数(NRBC#)-静脉血: 010E9/L；乳酸脱氢酶(LDH)-静脉血: 120.6U/L；磷(P)-静脉血: 1.42mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.111；天门冬氨酸氨基转移酶(AST)-静脉血: 20.1U/L；直接胆红素(DBIL)-静脉血: 5.8umol/L；胱抑素(Cys-C)-静脉血: 0.73mg/L；血小板比容-静脉血: 12.1%；载脂蛋白AI(apoAI)-静脉血: 1.03g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；C-反应蛋白(CRP)-静脉血: 12.33mg/L；血红蛋白(Hb)-静脉血: 131.8g/L；尿素氮(BUN)-静脉血: 4.01mmol/L；载脂蛋白B(apoB)-静脉血: 1.28g/L；甘油三酯(TG)-静脉血: 1.16mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 34pg；单核细胞百分比(Mono%)-静脉血: 0.103；总钙(Ca)-静脉血: 2.21mmol/L；红细胞计数(RBC#)-静脉血: 3.8710E12/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；尿酸(UA)-静脉血: 319.8umol/L；总胆红素(TBIL)-静脉血: 18.5umol/L；钠离子(Na+)-静脉血: 140.1mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.11mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347.8g/L；中性粒细胞百分比(Neut%)-静脉血: 0.746；红细胞比容(Hct)-静脉血: 37.8%；血小板分布宽度(PDW)-静脉血: 16.7%；球蛋白(GLO)-静脉血: 21.96g/L；肌酐(Crea)-静脉血: 61.6umol/L；总胆汁酸(TBA)-静脉血: 3.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 34.1U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.01mmolL；碱性磷酸酶(ALP)-静脉血: 65.6U/L；葡萄糖(Glu)-静脉血: 5.14mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.036；嗜碱性粒细胞计数(B……\n- [全程D81] 检验组合: 红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.6；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.77；平均红细胞体积(MCV)-静脉血: 95.3fL；直接胆红素(DBIL)-静脉血: 6.5umol/L；平均血小板体积(MPV)-静脉血: 10fL；大血小板百分比(P-LCR%)-静脉血: 25.7%；白蛋白(ALB)-静脉血: 41.6g/L；肌酐(Crea)-静脉血: 53.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.75；钠离子(Na+)-静脉血: 137.9mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.7U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7；间接胆红素(IBIL)-静脉血: 17.4umolL；球蛋白(GLO)-静脉血: 23.48g/L；总胆固醇(TC)-静脉血: 5.17mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.833；胱抑素(Cys-C)-静脉血: 0.67mg/L；乳酸脱氢酶(LDH)-静脉血: 137.4U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.51mmol/L；血小板分布宽度(PDW)-静脉血: 11.9%；白细胞计数(WBC#)-静脉血: 3.7810E9/L；载脂蛋白B(apoB)-静脉血: 1.17g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 38.7U/L；中性粒细胞计数(Neut#)-静脉血: 3.210E9/L；总胆红素(TBIL)-静脉血: 23.9umol/L；阴离子间隙(AG)-静脉血: 11.3；α-L-岩藻糖苷酶(AFU)-静脉血: 30.5U/L；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；血小板比容-静脉血: 15%；C-反应蛋白(CRP)-静脉血: 15.45mg/L；氯离子(Cl-)-静脉血: 100.4mmol/L；总胆汁酸(TBA)-静脉血: 1.2umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.024；尿素氮(BUN)-静脉血: 4.4mmol/L；血红蛋白(Hb)-静脉血: 134g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.8U/L；单核细胞计数(……\n- [全程D88] 检验组合: C-反应蛋白(CRP)-静脉血: 7.88mg/L；甘油三酯(TG)-静脉血: 1.18mmol/L；平均红细胞体积(MCV)-静脉血: 96.4fL；载脂蛋白B(apoB)-静脉血: 1.03g/L；血小板计数(PLT#)-静脉血: 92.910E9/L；总胆红素(TBIL)-静脉血: 29umol/L；中性粒细胞计数(Neut#)-静脉血: 2.810E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 30.3U/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；葡萄糖(Glu)-静脉血: 4.55mmol/L；总胆汁酸(TBA)-静脉血: 2.3umol/L；血小板比容-静脉血: 7.5%；红细胞比容(Hct)-静脉血: 32.9%；中性粒细胞百分比(Neut%)-静脉血: 0.784；载脂蛋白AI(apoAI)-静脉血: 0.93g/L；血红蛋白(Hb)-静脉血: 117.2g/L；间接胆红素(IBIL)-静脉血: 20.4umolL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；白细胞计数(WBC#)-静脉血: 3.5310E9/L；总胆固醇(TC)-静脉血: 4.84mmol/L；总钙(Ca)-静脉血: 2.27mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；平均红细胞血红蛋白含量(MCH)-静脉血: 34.2pg；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总蛋白(TP)-静脉血: 62g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.86mmolL；单核细胞计数(Mono#)-静脉血: 0.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.108；直接胆红素(DBIL)-静脉血: 8.6umol/L；钠离子(Na+)-静脉血: 141mmol/L；镁离子(Mg2+)-静脉血: 0.94mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.088；钾离子(K+)-静脉血: 4.2mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 48.3U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；尿酸(UA)-静脉血: 281.5umol/L；白蛋白(ALB)-静……\n- [全程D94] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理清晰，走行自然，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影形态、大小未见异常。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见异常。\n\n【既往治疗与反应】\n- [全程D71] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现放疗13F，诉口干，轻微咽痛，偶有咳嗽，食欲欠佳，无恶心、呕吐等不适，精神、睡眠欠佳，大小便正常。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者放疗初期出现口腔粘膜反应，予止咳、止痛等对症处理，继续放疗，密切关注放疗副反应，定期复查血常规，必要时加强处理。现已按查房指示执行。\n- [全程D76] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现放疗16F，DDP同期化疗第1日，诉咽痛较前加重，偶有咳嗽，食欲欠佳，无恶心、呕吐等不适，精神、睡眠欠佳，大小便正常。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者咽痛较前加重，予加强止痛。患者今日洛铂同期化疗第1日，密切观察化疗反应，加强止呕处理，注意放化疗叠加副反应，继续喷喉、洗鼻等对症处理，续行放疗。现已按查房指示执行。\n- [全程D91] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现放疗26F，诉口干，咽痛较前明显，食欲较前变差，余无不适，精神、睡眠一般。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者现于同时期放化疗中，放射性口腔粘膜反应1度，予止痛、静脉营养支持等加强处理，继续予喷喉、洗鼻等对症处理，定期复查血常规，续行放疗。现已按查房指示执行。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行鼻咽部MRI及全身PET-CT全面评估疗效，若疑有残留即刻行局部挽救性手术。\nB. 行电子鼻咽镜检查并对原发灶区域行多点活检，明确病理缓解情况后决定是否追加化疗。\nC. 暂缓局部内镜检查，继续原方案洛铂单药辅助化疗2个周期后再行全面评估。\nD. 行电子鼻咽镜检查评估局部疗效，并继续住院行第3周期洛铂同期化疗。\nE. 直接安排出院，嘱3个月后返院行鼻咽镜及MRI检查，期间停用所有处方药物。\nF. 行电子鼻咽镜检查（不活检）评估局部情况，安排出院并予以镇痛、黏膜保护及雾化等对症药物。\nG. 行鼻咽部及颈部增强CT评估病灶退缩情况，若有残留予以局部追加放疗推量。\nH. 行电子鼻咽镜检查评估局部疗效，安排出院并立即开始PD-1抑制剂维持治疗半年。\nI. 行全身骨扫描及腹部超声评估远处转移情况，若阴性则安排出院并定期随访。\nJ. 行电子鼻咽镜检查（不活检）评估局部情况，并转入头颈外科行右颈淋巴结清扫术。\nK. 安排出院并予以镇痛药物，1个月后返院行鼻咽镜下活检以明确是否达到病理完全缓解。\nL. 行鼻咽部MRI评估局部疗效，若达到完全缓解则安排出院并逐步停用所有镇痛药物。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D67] 检验组合: 平均红细胞血红蛋白浓度(MCHC)-静脉血: 349g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.5；血小板比容-静脉血: 12%；总蛋白(TP)-静脉血: 64.55g/L；镁离子(Mg2+)-静脉血: 0.9mmol/L；乳酸脱氢酶(LDH)-静脉血: 113.1U/L；总胆固醇(TC)-静脉血: 5.45mmol/L；葡萄糖(Glu)-静脉血: 4.72mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.5；钠离子(Na+)-静脉血: 142.5mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 33.4pg；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.022；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；总胆汁酸(TBA)-静脉血: 2.5umol/L；阴离子间隙(AG)-静脉血: 10；胱抑素(Cys-C)-静脉血: 0.75mg/L；间接胆红素(IBIL)-静脉血: 8.9umolL；钾离子(K+)-静脉血: 3.8mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 36.7U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；红细胞比容(Hct)-静脉血: 39%；血小板分布宽度(PDW)-静脉血: 12.4%；中性粒细胞百分比(Neut%)-静脉血: 0.753；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；球蛋白(GLO)-静脉血: 26.65g/L；甘油三酯(TG)-静脉血: 1.38mmol/L；碱性磷酸酶(ALP)-静脉血: 67.5U/L；白细胞计数(WBC#)-静脉血: 5.0810E9/L；总胆红素(TBIL)-静脉血: 13.1umol/L；单核细胞百分比(Mono%)-静脉血: 0.089；α-L-岩藻糖苷酶(AFU)-静脉血: 26U/L；尿酸(UA)-静脉血: 318.1umol/L；尿素氮(BUN)-静脉血: 3.21mmol/L；平均血小板体积(MPV)-静脉血: 10.4fL；载脂蛋白B(apoB)-静脉血: 1.08g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；血红蛋白(Hb)-静脉血: 136g/L；氯离子(Cl-)-静……\n- [全程D74] 检验组合: 有核红细胞计数(NRBC#)-静脉血: 010E9/L；乳酸脱氢酶(LDH)-静脉血: 120.6U/L；磷(P)-静脉血: 1.42mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.111；天门冬氨酸氨基转移酶(AST)-静脉血: 20.1U/L；直接胆红素(DBIL)-静脉血: 5.8umol/L；胱抑素(Cys-C)-静脉血: 0.73mg/L；血小板比容-静脉血: 12.1%；载脂蛋白AI(apoAI)-静脉血: 1.03g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；C-反应蛋白(CRP)-静脉血: 12.33mg/L；血红蛋白(Hb)-静脉血: 131.8g/L；尿素氮(BUN)-静脉血: 4.01mmol/L；载脂蛋白B(apoB)-静脉血: 1.28g/L；甘油三酯(TG)-静脉血: 1.16mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 34pg；单核细胞百分比(Mono%)-静脉血: 0.103；总钙(Ca)-静脉血: 2.21mmol/L；红细胞计数(RBC#)-静脉血: 3.8710E12/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；尿酸(UA)-静脉血: 319.8umol/L；总胆红素(TBIL)-静脉血: 18.5umol/L；钠离子(Na+)-静脉血: 140.1mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.11mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347.8g/L；中性粒细胞百分比(Neut%)-静脉血: 0.746；红细胞比容(Hct)-静脉血: 37.8%；血小板分布宽度(PDW)-静脉血: 16.7%；球蛋白(GLO)-静脉血: 21.96g/L；肌酐(Crea)-静脉血: 61.6umol/L；总胆汁酸(TBA)-静脉血: 3.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 34.1U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.01mmolL；碱性磷酸酶(ALP)-静脉血: 65.6U/L；葡萄糖(Glu)-静脉血: 5.14mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.036；嗜碱性粒细胞计数(B……\n- [全程D81] 检验组合: 红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.6；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.77；平均红细胞体积(MCV)-静脉血: 95.3fL；直接胆红素(DBIL)-静脉血: 6.5umol/L；平均血小板体积(MPV)-静脉血: 10fL；大血小板百分比(P-LCR%)-静脉血: 25.7%；白蛋白(ALB)-静脉血: 41.6g/L；肌酐(Crea)-静脉血: 53.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.75；钠离子(Na+)-静脉血: 137.9mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.7U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7；间接胆红素(IBIL)-静脉血: 17.4umolL；球蛋白(GLO)-静脉血: 23.48g/L；总胆固醇(TC)-静脉血: 5.17mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.833；胱抑素(Cys-C)-静脉血: 0.67mg/L；乳酸脱氢酶(LDH)-静脉血: 137.4U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.51mmol/L；血小板分布宽度(PDW)-静脉血: 11.9%；白细胞计数(WBC#)-静脉血: 3.7810E9/L；载脂蛋白B(apoB)-静脉血: 1.17g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 38.7U/L；中性粒细胞计数(Neut#)-静脉血: 3.210E9/L；总胆红素(TBIL)-静脉血: 23.9umol/L；阴离子间隙(AG)-静脉血: 11.3；α-L-岩藻糖苷酶(AFU)-静脉血: 30.5U/L；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；血小板比容-静脉血: 15%；C-反应蛋白(CRP)-静脉血: 15.45mg/L；氯离子(Cl-)-静脉血: 100.4mmol/L；总胆汁酸(TBA)-静脉血: 1.2umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.024；尿素氮(BUN)-静脉血: 4.4mmol/L；血红蛋白(Hb)-静脉血: 134g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.8U/L；单核细胞计数(……\n- [全程D88] 检验组合: C-反应蛋白(CRP)-静脉血: 7.88mg/L；甘油三酯(TG)-静脉血: 1.18mmol/L；平均红细胞体积(MCV)-静脉血: 96.4fL；载脂蛋白B(apoB)-静脉血: 1.03g/L；血小板计数(PLT#)-静脉血: 92.910E9/L；总胆红素(TBIL)-静脉血: 29umol/L；中性粒细胞计数(Neut#)-静脉血: 2.810E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 30.3U/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；葡萄糖(Glu)-静脉血: 4.55mmol/L；总胆汁酸(TBA)-静脉血: 2.3umol/L；血小板比容-静脉血: 7.5%；红细胞比容(Hct)-静脉血: 32.9%；中性粒细胞百分比(Neut%)-静脉血: 0.784；载脂蛋白AI(apoAI)-静脉血: 0.93g/L；血红蛋白(Hb)-静脉血: 117.2g/L；间接胆红素(IBIL)-静脉血: 20.4umolL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；白细胞计数(WBC#)-静脉血: 3.5310E9/L；总胆固醇(TC)-静脉血: 4.84mmol/L；总钙(Ca)-静脉血: 2.27mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；平均红细胞血红蛋白含量(MCH)-静脉血: 34.2pg；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总蛋白(TP)-静脉血: 62g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.86mmolL；单核细胞计数(Mono#)-静脉血: 0.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.108；直接胆红素(DBIL)-静脉血: 8.6umol/L；钠离子(Na+)-静脉血: 141mmol/L；镁离子(Mg2+)-静脉血: 0.94mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.088；钾离子(K+)-静脉血: 4.2mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 48.3U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；尿酸(UA)-静脉血: 281.5umol/L；白蛋白(ALB)-静……\n- [全程D94] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理清晰，走行自然，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影形态、大小未见异常。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见异常。\n\n【既往治疗与反应】\n- [全程D71] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现放疗13F，诉口干，轻微咽痛，偶有咳嗽，食欲欠佳，无恶心、呕吐等不适，精神、睡眠欠佳，大小便正常。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者放疗初期出现口腔粘膜反应，予止咳、止痛等对症处理，继续放疗，密切关注放疗副反应，定期复查血常规，必要时加强处理。现已按查房指示执行。\n- [全程D76] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现放疗16F，DDP同期化疗第1日，诉咽痛较前加重，偶有咳嗽，食欲欠佳，无恶心、呕吐等不适，精神、睡眠欠佳，大小便正常。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者咽痛较前加重，予加强止痛。患者今日洛铂同期化疗第1日，密切观察化疗反应，加强止呕处理，注意放化疗叠加副反应，继续喷喉、洗鼻等对症处理，续行放疗。现已按查房指示执行。\n- [全程D91] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现放疗26F，诉口干，咽痛较前明显，食欲较前变差，余无不适，精神、睡眠一般。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者现于同时期放化疗中，放射性口腔粘膜反应1度，予止痛、静脉营养支持等加强处理，继续予喷喉、洗鼻等对症处理，定期复查血常规，续行放疗。现已按查房指示执行。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行鼻咽部MRI及全身PET-CT全面评估疗效，若疑有残留即刻行局部挽救性手术。\nB. 行电子鼻咽镜检查并对原发灶区域行多点活检，明确病理缓解情况后决定是否追加化疗。\nC. 暂缓局部内镜检查，继续原方案洛铂单药辅助化疗2个周期后再行全面评估。\nD. 行电子鼻咽镜检查评估局部疗效，并继续住院行第3周期洛铂同期化疗。\nE. 直接安排出院，嘱3个月后返院行鼻咽镜及MRI检查，期间停用所有处方药物。\nF. 行电子鼻咽镜检查（不活检）评估局部情况，安排出院并予以镇痛、黏膜保护及雾化等对症药物。\nG. 行鼻咽部及颈部增强CT评估病灶退缩情况，若有残留予以局部追加放疗推量。\nH. 行电子鼻咽镜检查评估局部疗效，安排出院并立即开始PD-1抑制剂维持治疗半年。\nI. 行全身骨扫描及腹部超声评估远处转移情况，若阴性则安排出院并定期随访。\nJ. 行电子鼻咽镜检查（不活检）评估局部情况，并转入头颈外科行右颈淋巴结清扫术。\nK. 安排出院并予以镇痛药物，1个月后返院行鼻咽镜下活检以明确是否达到病理完全缓解。\nL. 行鼻咽部MRI评估局部疗效，若达到完全缓解则安排出院并逐步停用所有镇痛药物。\n\n请仅输出一个选项字母（A-L）。"}]}
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full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左颈肿物20余天；现病史: 20余天前患者无明显诱因自觉左颈肿物，无发热、疼痛，伴涕血、左耳堵塞感。无头痛、面麻、鼻塞、复视、张口困难等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左耳闷胀感,涕血,左颈肿物；既往史: 高血压10余年，规律服药，血压控制在130/80mmHg左右。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:穿山甲壳、蜂蛹、伟哥过敏。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 大儿子患“脑胶质瘤”，已病逝。；体格检查: T：36.4℃，P：66次/分，R：20次/分，BP：134/81mmHg,Ht：175cm，Wt：84kg，BSA：2.0m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽顶后壁、左侧壁结节状肿物；双侧颈部II区可扪及1个淋巴结，最大径6×5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 电子鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸部及腹部CT平扫，常规血液学检查。\nB. 颈部淋巴结切除活检，鼻咽及颈部MRI平扫+增强，全身PET/CT显像，常规血液学检查。\nC. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，颈部超声，暂缓全身影像学分期。\nD. 鼻咽及颈部MRI平扫+增强，全身PET/CT显像，先行诱导化疗待肿瘤缩小后行鼻咽活检。\nE. 电子鼻咽镜检查及活检，鼻咽MRI平扫+增强，胸部X线，腹部超声，全身骨显像。\nF. 颈部淋巴结细针穿刺活检，鼻咽及颈部CT平扫+增强，全身PET/CT显像，常规血液学检查。\nG. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT显像，常规血液学、心电图与心脏彩超检查。\nH. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸腹部CT平扫+增强，免除全身骨显像。\nI. 电子鼻咽镜检查及活检，头颅MRI平扫+增强，颈部超声，全身PET/CT显像，常规血液学检查。\nJ. 鼻咽刷片细胞学检查，鼻咽及颈部MRI平扫+增强，全身PET/CT显像，常规血液学检查。\nK. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫，全身PET/CT显像，常规血液学检查。\nL. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT显像，同步安排根治性放疗定位。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左颈肿物20余天；现病史: 20余天前患者无明显诱因自觉左颈肿物，无发热、疼痛，伴涕血、左耳堵塞感。无头痛、面麻、鼻塞、复视、张口困难等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左耳闷胀感,涕血,左颈肿物；既往史: 高血压10余年，规律服药，血压控制在130/80mmHg左右。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:穿山甲壳、蜂蛹、伟哥过敏。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 大儿子患“脑胶质瘤”，已病逝。；体格检查: T：36.4℃，P：66次/分，R：20次/分，BP：134/81mmHg,Ht：175cm，Wt：84kg，BSA：2.0m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 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full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 ST-T轻度改变\n- [全程D1] 检验组合: 梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；有核红细胞计数(NRBC#)-静脉血: 010E9/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；单核细胞计数(Mono#)-静脉血: 0.510E9/L；胱抑素(Cys-C)-静脉血: 0.76mg/L；磷(P)-静脉血: 1.12mmol/L；纤维蛋白原(Fbg)-静脉血: 3.32g/L；Rh血型-静脉血: 阳性；血红蛋白(Hb)-静脉血: 136.2g/L；ABO血型-静脉血: O；骨钙素N端中分子片段(N-MID)-静脉血: 14.08ng/ml；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；直接胆红素(DBIL)-静脉血: 3.1umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 28.5U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；中性粒细胞百分比(Neut%)-静脉血: 0.617；镁离子(Mg2+)-静脉血: 0.88mmol/L；白细胞计数(WBC#)-静脉血: 7.0810E9/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 26.4U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.295ng/ml（参考: <0.704）；凝血酶原时间活动度(PTA)-静脉血: 120%；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.9mmol/L；血小板比容-静脉血: 18.3%；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.05S/CO；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.23mmolL；平均红细胞血红蛋白含量(MCH)-静脉血: 30pg；单核细胞百分比(Mono%)-静脉血: 0.072；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；总蛋白(TP)-静脉血: 71.09g/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40……\n- [全程D3] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及左侧壁粘膜增厚放射性浓聚，SUV约14.5，病灶累及蝶骨基底部、枕骨斜坡、左侧翼突、左岩尖、左侧破裂孔及左侧鼻后孔。双侧咽隐窝消失。双侧咽后未见明显肿大淋巴结及异常放射性分布。口咽及喉咽结构及放射性分布未见明显异常。左侧上颌窦及蝶窦内见低密度影放射性分布未见明显异常，额窦、筛窦及右侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双颈Ⅱ区多发肿大淋巴结放射性浓聚，SUV约14.2，最大约2.2×2.6cm。 双侧苍白球钙化放射性分布缺损，余所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。左肾盂小结石放射性分布缺损。脾脏、胰腺、右肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺小点状钙化灶。余盆腔放射性分布均匀，膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 所见颅盖骨、余躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽顶壁、顶后壁及左侧壁粘膜增厚代谢活跃，考虑鼻咽癌，病灶累及颅底骨、左侧破裂孔及左侧鼻后孔；双颈Ⅱ区多发肿大淋巴结代谢活跃，考虑转移。 左侧上颌窦及蝶窦炎症。 左肾盂小结石。 前列腺钙化。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行颈部淋巴结细针穿刺活检，完善鼻咽及颈部CT平扫+增强，查乙肝病毒DNA定量\nB. 行鼻咽内镜组织活检，完善鼻咽及颈部CT平扫+增强，查乙肝病毒DNA定量\nC. 行鼻咽内镜组织活检，完善鼻咽及颈部MRI平扫+增强，暂不查乙肝病毒DNA定量\nD. 行颈部淋巴结切除活检，完善鼻咽及颈部MRI平扫+增强，查乙肝病毒DNA定量\nE. 行鼻咽内镜组织活检，完善鼻咽及颈部CT平扫+增强，查丙肝病毒RNA定量\nF. 行鼻咽内镜组织活检，完善头颅MRI平扫+增强，查乙肝病毒DNA定量\nG. 行颈部淋巴结细针穿刺活检，完善鼻咽及颈部MRI平扫+增强，暂不查乙肝病毒DNA定量\nH. 行鼻咽内镜组织活检，完善鼻咽及颈部MRI平扫+增强，查乙肝病毒DNA定量\nI. 行鼻咽内镜组织活检及颈部淋巴结穿刺活检，完善鼻咽及颈部MRI平扫+增强\nJ. 行鼻咽内镜组织活检，完善鼻咽及颈部MRI平扫+增强，查丙肝病毒RNA定量\nK. 行鼻咽内镜组织活检，完善颈部超声造影，查乙肝病毒DNA定量\nL. 行鼻咽内镜组织活检，完善全身骨扫描，查乙肝病毒DNA定量\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 ST-T轻度改变\n- [全程D1] 检验组合: 梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；有核红细胞计数(NRBC#)-静脉血: 010E9/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；单核细胞计数(Mono#)-静脉血: 0.510E9/L；胱抑素(Cys-C)-静脉血: 0.76mg/L；磷(P)-静脉血: 1.12mmol/L；纤维蛋白原(Fbg)-静脉血: 3.32g/L；Rh血型-静脉血: 阳性；血红蛋白(Hb)-静脉血: 136.2g/L；ABO血型-静脉血: O；骨钙素N端中分子片段(N-MID)-静脉血: 14.08ng/ml；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；直接胆红素(DBIL)-静脉血: 3.1umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 28.5U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；中性粒细胞百分比(Neut%)-静脉血: 0.617；镁离子(Mg2+)-静脉血: 0.88mmol/L；白细胞计数(WBC#)-静脉血: 7.0810E9/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 26.4U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.295ng/ml（参考: <0.704）；凝血酶原时间活动度(PTA)-静脉血: 120%；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.9mmol/L；血小板比容-静脉血: 18.3%；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.05S/CO；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.23mmolL；平均红细胞血红蛋白含量(MCH)-静脉血: 30pg；单核细胞百分比(Mono%)-静脉血: 0.072；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；总蛋白(TP)-静脉血: 71.09g/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40……\n- [全程D3] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及左侧壁粘膜增厚放射性浓聚，SUV约14.5，病灶累及蝶骨基底部、枕骨斜坡、左侧翼突、左岩尖、左侧破裂孔及左侧鼻后孔。双侧咽隐窝消失。双侧咽后未见明显肿大淋巴结及异常放射性分布。口咽及喉咽结构及放射性分布未见明显异常。左侧上颌窦及蝶窦内见低密度影放射性分布未见明显异常，额窦、筛窦及右侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双颈Ⅱ区多发肿大淋巴结放射性浓聚，SUV约14.2，最大约2.2×2.6cm。 双侧苍白球钙化放射性分布缺损，余所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。左肾盂小结石放射性分布缺损。脾脏、胰腺、右肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺小点状钙化灶。余盆腔放射性分布均匀，膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 所见颅盖骨、余躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽顶壁、顶后壁及左侧壁粘膜增厚代谢活跃，考虑鼻咽癌，病灶累及颅底骨、左侧破裂孔及左侧鼻后孔；双颈Ⅱ区多发肿大淋巴结代谢活跃，考虑转移。 左侧上颌窦及蝶窦炎症。 左肾盂小结石。 前列腺钙化。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行颈部淋巴结细针穿刺活检，完善鼻咽及颈部CT平扫+增强，查乙肝病毒DNA定量\nB. 行鼻咽内镜组织活检，完善鼻咽及颈部CT平扫+增强，查乙肝病毒DNA定量\nC. 行鼻咽内镜组织活检，完善鼻咽及颈部MRI平扫+增强，暂不查乙肝病毒DNA定量\nD. 行颈部淋巴结切除活检，完善鼻咽及颈部MRI平扫+增强，查乙肝病毒DNA定量\nE. 行鼻咽内镜组织活检，完善鼻咽及颈部CT平扫+增强，查丙肝病毒RNA定量\nF. 行鼻咽内镜组织活检，完善头颅MRI平扫+增强，查乙肝病毒DNA定量\nG. 行颈部淋巴结细针穿刺活检，完善鼻咽及颈部MRI平扫+增强，暂不查乙肝病毒DNA定量\nH. 行鼻咽内镜组织活检，完善鼻咽及颈部MRI平扫+增强，查乙肝病毒DNA定量\nI. 行鼻咽内镜组织活检及颈部淋巴结穿刺活检，完善鼻咽及颈部MRI平扫+增强\nJ. 行鼻咽内镜组织活检，完善鼻咽及颈部MRI平扫+增强，查丙肝病毒RNA定量\nK. 行鼻咽内镜组织活检，完善颈部超声造影，查乙肝病毒DNA定量\nL. 行鼻咽内镜组织活检，完善全身骨扫描，查乙肝病毒DNA定量\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-9fa3bde2f5d0ac4e910cb3cb","patient_id":"patient-f402aced5926698da3194c37","turn_id":"turn05","turn_position":3,"turn_type":"toxicity_or_support_decision","gold_letter":"K","gold_action":"按原剂量执行第2程洛铂+5-FU诱导化疗，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗","options":[{"letter":"A","text":"将第2程洛铂+5-FU诱导化疗减量20%，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗","is_gold":false},{"letter":"B","text":"暂停第2程诱导化疗，仅给予肠内营养及护胃支持，待胃肠道症状完全缓解后再评估化疗指征","is_gold":false},{"letter":"C","text":"按原剂量执行第2程洛铂+5-FU诱导化疗，并预防性给予重组人粒细胞集落刺激因子及止吐护胃支持治疗","is_gold":false},{"letter":"D","text":"按原剂量执行第2程洛铂+5-FU诱导化疗，并预防性给予重组人血小板生成素及止吐护胃支持治疗","is_gold":false},{"letter":"E","text":"将第2程诱导化疗方案更改为吉西他滨+顺铂，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗","is_gold":false},{"letter":"F","text":"将第2程诱导化疗方案更改为多西他赛+顺铂，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗","is_gold":false},{"letter":"G","text":"终止诱导化疗直接进入根治性放疗及同期化疗，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗","is_gold":false},{"letter":"H","text":"延迟第2程诱导化疗1周，期间给予护胃及止吐支持，待胃肠道症状完全缓解后再按原剂量化疗","is_gold":false},{"letter":"I","text":"按原剂量执行第2程洛铂+5-FU诱导化疗，取消常规止吐及护胃支持，仅在出现严重呕吐时给予解救治疗","is_gold":false},{"letter":"J","text":"将第2程洛铂+5-FU诱导化疗减量25%，并预防性给予重组人粒细胞集落刺激因子及止吐护胃支持治疗","is_gold":false},{"letter":"K","text":"按原剂量执行第2程洛铂+5-FU诱导化疗，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗","is_gold":true},{"letter":"L","text":"停用静脉化疗，改为口服卡培他滨单药化疗，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D6] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽左侧壁、顶壁及后壁增厚，见软组织灶形成，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，病灶占据左侧咽隐窝，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，右侧咽隐窝稍变浅，右侧咽旁脂肪间隙及颈动脉鞘区未见异常； 左侧腭帆提肌、双侧头长肌直接受侵；病灶累及左侧破裂孔、左侧后鼻孔； 双侧侧翼腭窝、颞下窝未见异常；口咽各壁无受累增厚。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部骨质破坏。 双侧海绵窦形态正常，未见增宽。 左侧上颌窦、蝶窦、左侧乳突粘膜稍增厚，双侧筛窦、右侧乳突气化好，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 左侧咽后间隙见小淋巴结，短径约4mm；双颈II区见肿大淋巴结，较大者短径约25mm；左颈III、V区见多发淋巴结，边界清，信号均匀，较大者短径约7mm。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 考虑鼻咽癌可能性大。 颅底骨质破坏。 左侧咽后小淋巴结。 双颈II区淋巴结肿大。\n- [全程D6] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T7上缘水平，估计导管末端位于上腔静脉下段内。；检查结论: PICC管末端位置如上述。\n- [全程D6] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 28mm AO 29mm MV E 0.51m/s EF 73% LV 49mm IVS 9mm A 0.73m/s FS 42% RA 28mm LVPW 10mm RV 18mm PA 20mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 心脏结构及运动未见异常 各房室腔及大血管未探及异常血流信号 左室舒张功能减低，收缩功能正常\n- [全程D13] 检验组合: 镁离子(Mg2+)-静脉血: 0.89mmol/L；总胆红素(TBIL)-静脉血: 13.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 23.7U/L；丙氨酸氨基转移酶(ALT)-静脉血: 21.4U/L；总钙(Ca)-静脉血: 2.2mmol/L；氯离子(Cl-)-静脉血: 104mmol/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；直接胆红素(DBIL)-静脉血: 5umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6；红细胞比容(Hct)-静脉血: 38.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.358；间接胆红素(IBIL)-静脉血: 8.3umolL；平均红细胞体积(MCV)-静脉血: 87.1fL；载脂蛋白AI(apoAI)-静脉血: 1.11g/L；球蛋白(GLO)-静脉血: 29.01g/L；C-反应蛋白(CRP)-静脉血: 13.69mg/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；白细胞计数(WBC#)-静脉血: 4.8310E9/L；碱性磷酸酶(ALP)-静脉血: 70.4U/L；血小板比容-静脉血: 18%；载脂蛋白B(apoB)-静脉血: 0.67g/L；中性粒细胞百分比(Neut%)-静脉血: 0.566；淋巴细胞计数(Lymph#)-静脉血: 1.710E9/L；钾离子(K+)-静脉血: 4.1mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；乳酸脱氢酶(LDH)-静脉血: 203.5U/L；阴离子间隙(AG)-静脉血: 14；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；甘油三酯(TG)-静脉血: 1.28mmol/L；红细胞计数(RBC#)-静脉血: 4.4310E12/L；血小板分布宽度(PDW)-静脉血: 8.5%；单核细胞百分比(Mono%)-静脉血: 0.058；大血小板百分比(P-LCR%)-静脉血: 11.6%；血液二氧化碳含量ctCO2(B)-静脉血: 25.1mmol/L；白蛋白(ALB)-静脉血: 40.2g/L；尿素氮(BUN)-静脉血: 5.8mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.3U/L；尿酸(UA)-静脉血: 378.8umol/L；总胆固醇(TC)-……\n- [全程D21] 检验组合: 单核细胞百分比(Mono%)-静脉血: 0.062；中性粒细胞百分比(Neut%)-静脉血: 0.67；白细胞计数(WBC#)-静脉血: 5.9710E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.9；平均红细胞血红蛋白含量(MCH)-静脉血: 29.3pg；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 134g/L；红细胞比容(Hct)-静脉血: 41.3%；血小板比容-静脉血: 13%；平均红细胞体积(MCV)-静脉血: 90.4fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；平均血小板体积(MPV)-静脉血: 9.4fL；血小板计数(PLT#)-静脉血: 13810E9/L；中性粒细胞计数(Neut#)-静脉血: 410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 324g/L；血小板分布宽度(PDW)-静脉血: 9.9%；大血小板百分比(P-LCR%)-静脉血: 21.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.255；单核细胞计数(Mono#)-静脉血: 0.410E9/L；红细胞计数(RBC#)-静脉血: 4.5710E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.2\n- [全程D27] 检验组合: 红细胞计数(RBC#)-静脉血: 4.3410E12/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.85mmol/L；血小板计数(PLT#)-静脉血: 255.510E9/L；白细胞计数(WBC#)-静脉血: 6.210E9/L；氯离子(Cl-)-静脉血: 104.9mmol/L；总胆汁酸(TBA)-静脉血: 1umol/L；肌酐(Crea)-静脉血: 96.8umol/L；钾离子(K+)-静脉血: 4.5mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.386；乳酸脱氢酶(LDH)-静脉血: 212.1U/L；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.33mmolL；淋巴细胞计数(Lymph#)-静脉血: 2.410E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21U/L；平均红细胞体积(MCV)-静脉血: 90.1fL；总蛋白(TP)-静脉血: 70.21g/L；丙氨酸氨基转移酶(ALT)-静脉血: 19.6U/L；间接胆红素(IBIL)-静脉血: 4.6umolL；尿酸(UA)-静脉血: 469.1umol/L；血小板比容-静脉血: 15.3%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；甘油三酯(TG)-静脉血: 1.12mmol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白B(apoB)-静脉血: 0.9g/L；平均血小板体积(MPV)-静脉血: 6.02fL；总钙(Ca)-静脉血: 2.25mmol/L；单核细胞百分比(Mono%)-静脉血: 0.066；红细胞比容(Hct)-静脉血: 39.1%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；γ-谷氨酰基转移酶(GGT)-静脉血: 25.5U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.7pg；尿素氮(BUN)-静脉血: 4.22mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341.2g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；中性粒细胞计数(Neut#)-静脉血: 3.310E9/L；有核红细胞计数(NRBC#)-静脉血: 010E……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+洛铂方案诱导化疗结束，诉呕吐1次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程5-FU+洛铂方案诱导化疗结束，无诉特殊不适，可予出院，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 将第2程洛铂+5-FU诱导化疗减量20%，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nB. 暂停第2程诱导化疗，仅给予肠内营养及护胃支持，待胃肠道症状完全缓解后再评估化疗指征\nC. 按原剂量执行第2程洛铂+5-FU诱导化疗，并预防性给予重组人粒细胞集落刺激因子及止吐护胃支持治疗\nD. 按原剂量执行第2程洛铂+5-FU诱导化疗，并预防性给予重组人血小板生成素及止吐护胃支持治疗\nE. 将第2程诱导化疗方案更改为吉西他滨+顺铂，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nF. 将第2程诱导化疗方案更改为多西他赛+顺铂，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nG. 终止诱导化疗直接进入根治性放疗及同期化疗，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nH. 延迟第2程诱导化疗1周，期间给予护胃及止吐支持，待胃肠道症状完全缓解后再按原剂量化疗\nI. 按原剂量执行第2程洛铂+5-FU诱导化疗，取消常规止吐及护胃支持，仅在出现严重呕吐时给予解救治疗\nJ. 将第2程洛铂+5-FU诱导化疗减量25%，并预防性给予重组人粒细胞集落刺激因子及止吐护胃支持治疗\nK. 按原剂量执行第2程洛铂+5-FU诱导化疗，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nL. 停用静脉化疗，改为口服卡培他滨单药化疗，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D6] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽左侧壁、顶壁及后壁增厚，见软组织灶形成，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，病灶占据左侧咽隐窝，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，右侧咽隐窝稍变浅，右侧咽旁脂肪间隙及颈动脉鞘区未见异常； 左侧腭帆提肌、双侧头长肌直接受侵；病灶累及左侧破裂孔、左侧后鼻孔； 双侧侧翼腭窝、颞下窝未见异常；口咽各壁无受累增厚。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部骨质破坏。 双侧海绵窦形态正常，未见增宽。 左侧上颌窦、蝶窦、左侧乳突粘膜稍增厚，双侧筛窦、右侧乳突气化好，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 左侧咽后间隙见小淋巴结，短径约4mm；双颈II区见肿大淋巴结，较大者短径约25mm；左颈III、V区见多发淋巴结，边界清，信号均匀，较大者短径约7mm。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 考虑鼻咽癌可能性大。 颅底骨质破坏。 左侧咽后小淋巴结。 双颈II区淋巴结肿大。\n- [全程D6] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T7上缘水平，估计导管末端位于上腔静脉下段内。；检查结论: PICC管末端位置如上述。\n- [全程D6] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 28mm AO 29mm MV E 0.51m/s EF 73% LV 49mm IVS 9mm A 0.73m/s FS 42% RA 28mm LVPW 10mm RV 18mm PA 20mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 心脏结构及运动未见异常 各房室腔及大血管未探及异常血流信号 左室舒张功能减低，收缩功能正常\n- [全程D13] 检验组合: 镁离子(Mg2+)-静脉血: 0.89mmol/L；总胆红素(TBIL)-静脉血: 13.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 23.7U/L；丙氨酸氨基转移酶(ALT)-静脉血: 21.4U/L；总钙(Ca)-静脉血: 2.2mmol/L；氯离子(Cl-)-静脉血: 104mmol/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；直接胆红素(DBIL)-静脉血: 5umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6；红细胞比容(Hct)-静脉血: 38.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.358；间接胆红素(IBIL)-静脉血: 8.3umolL；平均红细胞体积(MCV)-静脉血: 87.1fL；载脂蛋白AI(apoAI)-静脉血: 1.11g/L；球蛋白(GLO)-静脉血: 29.01g/L；C-反应蛋白(CRP)-静脉血: 13.69mg/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；白细胞计数(WBC#)-静脉血: 4.8310E9/L；碱性磷酸酶(ALP)-静脉血: 70.4U/L；血小板比容-静脉血: 18%；载脂蛋白B(apoB)-静脉血: 0.67g/L；中性粒细胞百分比(Neut%)-静脉血: 0.566；淋巴细胞计数(Lymph#)-静脉血: 1.710E9/L；钾离子(K+)-静脉血: 4.1mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；乳酸脱氢酶(LDH)-静脉血: 203.5U/L；阴离子间隙(AG)-静脉血: 14；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；甘油三酯(TG)-静脉血: 1.28mmol/L；红细胞计数(RBC#)-静脉血: 4.4310E12/L；血小板分布宽度(PDW)-静脉血: 8.5%；单核细胞百分比(Mono%)-静脉血: 0.058；大血小板百分比(P-LCR%)-静脉血: 11.6%；血液二氧化碳含量ctCO2(B)-静脉血: 25.1mmol/L；白蛋白(ALB)-静脉血: 40.2g/L；尿素氮(BUN)-静脉血: 5.8mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.3U/L；尿酸(UA)-静脉血: 378.8umol/L；总胆固醇(TC)-……\n- [全程D21] 检验组合: 单核细胞百分比(Mono%)-静脉血: 0.062；中性粒细胞百分比(Neut%)-静脉血: 0.67；白细胞计数(WBC#)-静脉血: 5.9710E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.9；平均红细胞血红蛋白含量(MCH)-静脉血: 29.3pg；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 134g/L；红细胞比容(Hct)-静脉血: 41.3%；血小板比容-静脉血: 13%；平均红细胞体积(MCV)-静脉血: 90.4fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；平均血小板体积(MPV)-静脉血: 9.4fL；血小板计数(PLT#)-静脉血: 13810E9/L；中性粒细胞计数(Neut#)-静脉血: 410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 324g/L；血小板分布宽度(PDW)-静脉血: 9.9%；大血小板百分比(P-LCR%)-静脉血: 21.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.255；单核细胞计数(Mono#)-静脉血: 0.410E9/L；红细胞计数(RBC#)-静脉血: 4.5710E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.2\n- [全程D27] 检验组合: 红细胞计数(RBC#)-静脉血: 4.3410E12/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.85mmol/L；血小板计数(PLT#)-静脉血: 255.510E9/L；白细胞计数(WBC#)-静脉血: 6.210E9/L；氯离子(Cl-)-静脉血: 104.9mmol/L；总胆汁酸(TBA)-静脉血: 1umol/L；肌酐(Crea)-静脉血: 96.8umol/L；钾离子(K+)-静脉血: 4.5mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.386；乳酸脱氢酶(LDH)-静脉血: 212.1U/L；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.33mmolL；淋巴细胞计数(Lymph#)-静脉血: 2.410E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21U/L；平均红细胞体积(MCV)-静脉血: 90.1fL；总蛋白(TP)-静脉血: 70.21g/L；丙氨酸氨基转移酶(ALT)-静脉血: 19.6U/L；间接胆红素(IBIL)-静脉血: 4.6umolL；尿酸(UA)-静脉血: 469.1umol/L；血小板比容-静脉血: 15.3%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；甘油三酯(TG)-静脉血: 1.12mmol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白B(apoB)-静脉血: 0.9g/L；平均血小板体积(MPV)-静脉血: 6.02fL；总钙(Ca)-静脉血: 2.25mmol/L；单核细胞百分比(Mono%)-静脉血: 0.066；红细胞比容(Hct)-静脉血: 39.1%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；γ-谷氨酰基转移酶(GGT)-静脉血: 25.5U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.7pg；尿素氮(BUN)-静脉血: 4.22mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341.2g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；中性粒细胞计数(Neut#)-静脉血: 3.310E9/L；有核红细胞计数(NRBC#)-静脉血: 010E……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+洛铂方案诱导化疗结束，诉呕吐1次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程5-FU+洛铂方案诱导化疗结束，无诉特殊不适，可予出院，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 将第2程洛铂+5-FU诱导化疗减量20%，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nB. 暂停第2程诱导化疗，仅给予肠内营养及护胃支持，待胃肠道症状完全缓解后再评估化疗指征\nC. 按原剂量执行第2程洛铂+5-FU诱导化疗，并预防性给予重组人粒细胞集落刺激因子及止吐护胃支持治疗\nD. 按原剂量执行第2程洛铂+5-FU诱导化疗，并预防性给予重组人血小板生成素及止吐护胃支持治疗\nE. 将第2程诱导化疗方案更改为吉西他滨+顺铂，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nF. 将第2程诱导化疗方案更改为多西他赛+顺铂，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nG. 终止诱导化疗直接进入根治性放疗及同期化疗，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nH. 延迟第2程诱导化疗1周，期间给予护胃及止吐支持，待胃肠道症状完全缓解后再按原剂量化疗\nI. 按原剂量执行第2程洛铂+5-FU诱导化疗，取消常规止吐及护胃支持，仅在出现严重呕吐时给予解救治疗\nJ. 将第2程洛铂+5-FU诱导化疗减量25%，并预防性给予重组人粒细胞集落刺激因子及止吐护胃支持治疗\nK. 按原剂量执行第2程洛铂+5-FU诱导化疗，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nL. 停用静脉化疗，改为口服卡培他滨单药化疗，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-cc3b58d3bf4229805e8c7b84","patient_id":"patient-f402aced5926698da3194c37","turn_id":"turn06","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"D","gold_action":"暂不予特殊药物支持治疗，仅常规监测血常规、生化常规","options":[{"letter":"A","text":"予以静脉输注红细胞悬液，并常规监测血常规、生化常规","is_gold":false},{"letter":"B","text":"予以重组人促红素（EPO）皮下注射，并常规监测血常规、生化常规","is_gold":false},{"letter":"C","text":"予以静脉滴注蔗糖铁注射液，并常规监测血常规、生化常规","is_gold":false},{"letter":"D","text":"暂不予特殊药物支持治疗，仅常规监测血常规、生化常规","is_gold":true},{"letter":"E","text":"予以粒细胞集落刺激因子（G-CSF）皮下注射，并常规监测血常规、生化常规","is_gold":false},{"letter":"F","text":"予以重组人血小板生成素（rhTPO）皮下注射，并常规监测血常规、生化常规","is_gold":false},{"letter":"G","text":"予以静脉滴注人血白蛋白，并常规监测血常规、生化常规","is_gold":false},{"letter":"H","text":"予以口服叶酸及维生素B12片，并常规监测血常规、生化常规","is_gold":false},{"letter":"I","text":"予以口服利血生及鲨肝醇片，并常规监测血常规、生化常规","is_gold":false},{"letter":"J","text":"予以静脉滴注右旋糖酐铁注射液，并常规监测血常规、生化常规","is_gold":false},{"letter":"K","text":"予以静脉滴注地塞米松及托烷司琼，并常规监测血常规、生化常规","is_gold":false},{"letter":"L","text":"予以口服多糖铁复合物胶囊，并常规监测血常规、生化常规","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D33] 检验组合: 尿素氮(BUN)-静脉血: 3.5mmol/L；直接胆红素(DBIL)-静脉血: 9umol/L；红细胞计数(RBC#)-静脉血: 3.8710E12/L；球蛋白(GLO)-静脉血: 27.06g/L；总胆红素(TBIL)-静脉血: 28.4umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.08mmolL；钾离子(K+)-静脉血: 3.68mmol/L；钠离子(Na+)-静脉血: 140.7mmol/L；肌酐(Crea)-静脉血: 71.4umol/L；红细胞比容(Hct)-静脉血: 34.5%；血小板比容-静脉血: 13.9%；总胆固醇(TC)-静脉血: 3.79mmol/L；磷(P)-静脉血: 1.21mmol/L；阴离子间隙(AG)-静脉血: 14.8；C-反应蛋白(CRP)-静脉血: 15.32mg/L；有核红细胞百分比(NRBC%)-静脉血: 0；乳酸脱氢酶(LDH)-静脉血: 214.8U/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15.3U/L；间接胆红素(IBIL)-静脉血: 19.4umolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.21mmol/L；白蛋白(ALB)-静脉血: 36.4g/L；总钙(Ca)-静脉血: 2.01mmol/L；载脂蛋白B(apoB)-静脉血: 0.79g/L；中性粒细胞计数(Neut#)-静脉血: 3.210E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.308；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.02；平均红细胞血红蛋白含量(MCH)-静脉血: 30.6pg；载脂蛋白AI(apoAI)-静脉血: 1.04g/L；尿酸(UA)-静脉血: 290.1umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.35；平均红细胞体积(MCV)-静脉血: 89.1fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；碱性磷酸酶(ALP)-静脉血: 60.5U/L；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；血小板计数(PLT#)-静脉血: 230.610E9/L；γ-谷氨酰基转移酶(GGT)-静……\n\n【既往治疗与反应】\n- [全程D28] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，可于今日执行第2程5-FU+洛铂方案诱导化疗，注意化疗不良反应。\n- [全程D29] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+洛铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 予以静脉输注红细胞悬液，并常规监测血常规、生化常规\nB. 予以重组人促红素（EPO）皮下注射，并常规监测血常规、生化常规\nC. 予以静脉滴注蔗糖铁注射液，并常规监测血常规、生化常规\nD. 暂不予特殊药物支持治疗，仅常规监测血常规、生化常规\nE. 予以粒细胞集落刺激因子（G-CSF）皮下注射，并常规监测血常规、生化常规\nF. 予以重组人血小板生成素（rhTPO）皮下注射，并常规监测血常规、生化常规\nG. 予以静脉滴注人血白蛋白，并常规监测血常规、生化常规\nH. 予以口服叶酸及维生素B12片，并常规监测血常规、生化常规\nI. 予以口服利血生及鲨肝醇片，并常规监测血常规、生化常规\nJ. 予以静脉滴注右旋糖酐铁注射液，并常规监测血常规、生化常规\nK. 予以静脉滴注地塞米松及托烷司琼，并常规监测血常规、生化常规\nL. 予以口服多糖铁复合物胶囊，并常规监测血常规、生化常规\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D33] 检验组合: 尿素氮(BUN)-静脉血: 3.5mmol/L；直接胆红素(DBIL)-静脉血: 9umol/L；红细胞计数(RBC#)-静脉血: 3.8710E12/L；球蛋白(GLO)-静脉血: 27.06g/L；总胆红素(TBIL)-静脉血: 28.4umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.08mmolL；钾离子(K+)-静脉血: 3.68mmol/L；钠离子(Na+)-静脉血: 140.7mmol/L；肌酐(Crea)-静脉血: 71.4umol/L；红细胞比容(Hct)-静脉血: 34.5%；血小板比容-静脉血: 13.9%；总胆固醇(TC)-静脉血: 3.79mmol/L；磷(P)-静脉血: 1.21mmol/L；阴离子间隙(AG)-静脉血: 14.8；C-反应蛋白(CRP)-静脉血: 15.32mg/L；有核红细胞百分比(NRBC%)-静脉血: 0；乳酸脱氢酶(LDH)-静脉血: 214.8U/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15.3U/L；间接胆红素(IBIL)-静脉血: 19.4umolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.21mmol/L；白蛋白(ALB)-静脉血: 36.4g/L；总钙(Ca)-静脉血: 2.01mmol/L；载脂蛋白B(apoB)-静脉血: 0.79g/L；中性粒细胞计数(Neut#)-静脉血: 3.210E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.308；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.02；平均红细胞血红蛋白含量(MCH)-静脉血: 30.6pg；载脂蛋白AI(apoAI)-静脉血: 1.04g/L；尿酸(UA)-静脉血: 290.1umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.35；平均红细胞体积(MCV)-静脉血: 89.1fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；碱性磷酸酶(ALP)-静脉血: 60.5U/L；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；血小板计数(PLT#)-静脉血: 230.610E9/L；γ-谷氨酰基转移酶(GGT)-静……\n\n【既往治疗与反应】\n- [全程D28] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，可于今日执行第2程5-FU+洛铂方案诱导化疗，注意化疗不良反应。\n- [全程D29] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+洛铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 予以静脉输注红细胞悬液，并常规监测血常规、生化常规\nB. 予以重组人促红素（EPO）皮下注射，并常规监测血常规、生化常规\nC. 予以静脉滴注蔗糖铁注射液，并常规监测血常规、生化常规\nD. 暂不予特殊药物支持治疗，仅常规监测血常规、生化常规\nE. 予以粒细胞集落刺激因子（G-CSF）皮下注射，并常规监测血常规、生化常规\nF. 予以重组人血小板生成素（rhTPO）皮下注射，并常规监测血常规、生化常规\nG. 予以静脉滴注人血白蛋白，并常规监测血常规、生化常规\nH. 予以口服叶酸及维生素B12片，并常规监测血常规、生化常规\nI. 予以口服利血生及鲨肝醇片，并常规监测血常规、生化常规\nJ. 予以静脉滴注右旋糖酐铁注射液，并常规监测血常规、生化常规\nK. 予以静脉滴注地塞米松及托烷司琼，并常规监测血常规、生化常规\nL. 予以口服多糖铁复合物胶囊，并常规监测血常规、生化常规\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-80438584d0b66a199c599a7d","patient_id":"patient-f402aced5926698da3194c37","turn_id":"turn07","turn_position":5,"turn_type":"response_assessment_decision","gold_letter":"A","gold_action":"疗效评估为部分缓解（PR），启动靶向治疗（西妥昔单抗）联合同期放化疗。","options":[{"letter":"A","text":"疗效评估为部分缓解（PR），启动靶向治疗（西妥昔单抗）联合同期放化疗","is_gold":true},{"letter":"B","text":"疗效评估为部分缓解（PR），启动靶向治疗（尼妥珠单抗）联合同期放化疗","is_gold":false},{"letter":"C","text":"疗效评估为部分缓解（PR），继续原方案（洛铂+5-FU）第3程诱导化疗","is_gold":false},{"letter":"D","text":"疗效评估为部分缓解（PR），启动同期放化疗，暂不联合靶向治疗","is_gold":false},{"letter":"E","text":"疗效评估为疾病稳定（SD），启动免疫治疗（卡瑞利珠单抗）联合同期放化疗","is_gold":false},{"letter":"F","text":"疗效评估为疾病进展（PD），更改化疗方案为吉西他滨+顺铂诱导化疗","is_gold":false},{"letter":"G","text":"疗效评估为部分缓解（PR），行鼻咽及颈部根治性放疗，不联合全身治疗","is_gold":false},{"letter":"H","text":"疗效评估为部分缓解（PR），暂停抗肿瘤治疗，单纯行纠正贫血支持治疗","is_gold":false},{"letter":"I","text":"疗效评估为部分缓解（PR），行双侧颈部淋巴结清扫术，术后辅助放疗","is_gold":false},{"letter":"J","text":"疗效评估为完全缓解（CR），启动靶向治疗（西妥昔单抗）联合同期放化疗","is_gold":false},{"letter":"K","text":"疗效评估为部分缓解（PR），启动靶向治疗（贝伐珠单抗）联合同期放化疗","is_gold":false},{"letter":"L","text":"疗效评估为部分缓解（PR），启动免疫治疗（帕博利珠单抗）联合同期放化疗","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D36] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后，与某次就诊时间片对比， 鼻咽腔狭窄，鼻咽左侧壁、顶壁及后壁增厚，见软组织灶形成，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，病灶占据左侧咽隐窝，向前堵塞左侧后鼻孔，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，右侧咽隐窝稍变浅，范围较前缩小，右侧咽旁脂肪间隙及颈动脉鞘区未见异常。 左侧腭帆提肌、双侧头长肌受侵。 双侧翼腭窝、咀嚼肌间隙未见明显异常；口咽各壁无受累增厚。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部骨质破坏。双侧海绵窦形态正常，未见增宽。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。蝶鞍形态正常，其内未见占位性病变。 双侧上颌窦、蝶窦、筛窦、左侧乳突粘膜增厚，见不等量分泌物，右侧乳突气化好，骨壁完整。 左侧咽后间隙见小淋巴结，短径约4mm，较前未见明显变化。 双颈II区见肿大淋巴结，较大者短径约22mm，较前稍缩小。 左颈III、V区见多发小淋巴结，边界清，信号均匀，较大者短径约7mm，较前未见明显变化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。 喉咽腔形态正常，未见占位性病变。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗后，鼻咽肿物较前缩小。 颅底骨质破坏。 左侧咽后小淋巴结，较前未见明显变化。 双颈II区淋巴结肿大，较前稍缩小。 左颈III、V区多发小淋巴结，较前未见明显变化。 副鼻窦炎、左侧乳突炎。\n\n【既往治疗与反应】\n- [全程D34] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+洛铂方案诱导化疗结束，诉恶心、食欲下降，无发热、呕吐、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规示轻度贫血，肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第2程5-FU+洛铂方案诱导化疗结束，无诉特殊不适，血象提示轻度贫血，予铁剂口服等纠正贫血治疗，下周及时监测血常规、肝肾功能，备行同时期放化疗+靶向治疗。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 疗效评估为部分缓解（PR），启动靶向治疗（西妥昔单抗）联合同期放化疗\nB. 疗效评估为部分缓解（PR），启动靶向治疗（尼妥珠单抗）联合同期放化疗\nC. 疗效评估为部分缓解（PR），继续原方案（洛铂+5-FU）第3程诱导化疗\nD. 疗效评估为部分缓解（PR），启动同期放化疗，暂不联合靶向治疗\nE. 疗效评估为疾病稳定（SD），启动免疫治疗（卡瑞利珠单抗）联合同期放化疗\nF. 疗效评估为疾病进展（PD），更改化疗方案为吉西他滨+顺铂诱导化疗\nG. 疗效评估为部分缓解（PR），行鼻咽及颈部根治性放疗，不联合全身治疗\nH. 疗效评估为部分缓解（PR），暂停抗肿瘤治疗，单纯行纠正贫血支持治疗\nI. 疗效评估为部分缓解（PR），行双侧颈部淋巴结清扫术，术后辅助放疗\nJ. 疗效评估为完全缓解（CR），启动靶向治疗（西妥昔单抗）联合同期放化疗\nK. 疗效评估为部分缓解（PR），启动靶向治疗（贝伐珠单抗）联合同期放化疗\nL. 疗效评估为部分缓解（PR），启动免疫治疗（帕博利珠单抗）联合同期放化疗\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D36] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后，与某次就诊时间片对比， 鼻咽腔狭窄，鼻咽左侧壁、顶壁及后壁增厚，见软组织灶形成，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，病灶占据左侧咽隐窝，向前堵塞左侧后鼻孔，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，右侧咽隐窝稍变浅，范围较前缩小，右侧咽旁脂肪间隙及颈动脉鞘区未见异常。 左侧腭帆提肌、双侧头长肌受侵。 双侧翼腭窝、咀嚼肌间隙未见明显异常；口咽各壁无受累增厚。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部骨质破坏。双侧海绵窦形态正常，未见增宽。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。蝶鞍形态正常，其内未见占位性病变。 双侧上颌窦、蝶窦、筛窦、左侧乳突粘膜增厚，见不等量分泌物，右侧乳突气化好，骨壁完整。 左侧咽后间隙见小淋巴结，短径约4mm，较前未见明显变化。 双颈II区见肿大淋巴结，较大者短径约22mm，较前稍缩小。 左颈III、V区见多发小淋巴结，边界清，信号均匀，较大者短径约7mm，较前未见明显变化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。 喉咽腔形态正常，未见占位性病变。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗后，鼻咽肿物较前缩小。 颅底骨质破坏。 左侧咽后小淋巴结，较前未见明显变化。 双颈II区淋巴结肿大，较前稍缩小。 左颈III、V区多发小淋巴结，较前未见明显变化。 副鼻窦炎、左侧乳突炎。\n\n【既往治疗与反应】\n- [全程D34] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+洛铂方案诱导化疗结束，诉恶心、食欲下降，无发热、呕吐、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规示轻度贫血，肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第2程5-FU+洛铂方案诱导化疗结束，无诉特殊不适，血象提示轻度贫血，予铁剂口服等纠正贫血治疗，下周及时监测血常规、肝肾功能，备行同时期放化疗+靶向治疗。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 疗效评估为部分缓解（PR），启动靶向治疗（西妥昔单抗）联合同期放化疗\nB. 疗效评估为部分缓解（PR），启动靶向治疗（尼妥珠单抗）联合同期放化疗\nC. 疗效评估为部分缓解（PR），继续原方案（洛铂+5-FU）第3程诱导化疗\nD. 疗效评估为部分缓解（PR），启动同期放化疗，暂不联合靶向治疗\nE. 疗效评估为疾病稳定（SD），启动免疫治疗（卡瑞利珠单抗）联合同期放化疗\nF. 疗效评估为疾病进展（PD），更改化疗方案为吉西他滨+顺铂诱导化疗\nG. 疗效评估为部分缓解（PR），行鼻咽及颈部根治性放疗，不联合全身治疗\nH. 疗效评估为部分缓解（PR），暂停抗肿瘤治疗，单纯行纠正贫血支持治疗\nI. 疗效评估为部分缓解（PR），行双侧颈部淋巴结清扫术，术后辅助放疗\nJ. 疗效评估为完全缓解（CR），启动靶向治疗（西妥昔单抗）联合同期放化疗\nK. 疗效评估为部分缓解（PR），启动靶向治疗（贝伐珠单抗）联合同期放化疗\nL. 疗效评估为部分缓解（PR），启动免疫治疗（帕博利珠单抗）联合同期放化疗\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-8b39359cc6c7b630fd005591","patient_id":"patient-f402aced5926698da3194c37","turn_id":"turn08","turn_position":6,"turn_type":"response_assessment_decision","gold_letter":"B","gold_action":"确认腹部彩超无转移，继续门诊放疗，左肾结石暂予观察，并予乳果糖口服液。","options":[{"letter":"A","text":"确认腹部彩超无转移，暂停放疗，请泌尿外科会诊行左肾结石碎石治疗，并予乳果糖口服液。","is_gold":false},{"letter":"B","text":"确认腹部彩超无转移，继续门诊放疗，左肾结石暂予观察，并予乳果糖口服液。","is_gold":true},{"letter":"C","text":"确认腹部彩超无转移，继续门诊放疗，左肾结石暂予观察，并加用洛铂行第3程同期化疗。","is_gold":false},{"letter":"D","text":"确认腹部彩超无转移，暂停门诊放疗，复查鼻咽及颈部MRI评估局部疗效，并予乳果糖口服液。","is_gold":false},{"letter":"E","text":"确认腹部彩超无转移，继续门诊放疗，对左肾结石予排石颗粒，并加用西妥昔单抗靶向治疗。","is_gold":false},{"letter":"F","text":"确认腹部彩超无转移，终止放疗，左肾结石暂予观察，转入康复科行便秘治疗。","is_gold":false},{"letter":"G","text":"确认腹部彩超无转移，继续门诊放疗，对左肾结石予留置双J管，并予乳果糖口服液。","is_gold":false},{"letter":"H","text":"确认腹部彩超无转移，暂停门诊放疗，予温肥皂水灌肠处理便秘，左肾结石暂予观察。","is_gold":false},{"letter":"I","text":"确认腹部彩超无转移，继续门诊放疗，左肾结石暂予观察，并予洛哌丁胺口服。","is_gold":false},{"letter":"J","text":"确认腹部彩超无转移，继续门诊放疗，左肾结石暂予观察，并予开塞露联合新斯的明肌注。","is_gold":false},{"letter":"K","text":"确认腹部彩超无转移，暂停门诊放疗，行全身PET-CT评估疗效，左肾结石暂予观察。","is_gold":false},{"letter":"L","text":"确认腹部彩超无转移，继续门诊放疗，行体外冲击波碎石，处理左肾结石，并予乳果糖口服液。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D58] 检验组合: 红细胞比容(Hct)-静脉血: 34.3%；载脂蛋白B(apoB)-静脉血: 0.73g/L；碱性磷酸酶(ALP)-静脉血: 76U/L；肌酐(Crea)-静脉血: 67.8umol/L；胱抑素(Cys-C)-静脉血: 0.64mg/L；中性粒细胞百分比(Neut%)-静脉血: 0.768；血红蛋白(Hb)-静脉血: 116g/L；平均血小板体积(MPV)-静脉血: 8.4fL；总胆红素(TBIL)-静脉血: 15.8umol/L；尿素氮(BUN)-静脉血: 3.79mmol/L；镁离子(Mg2+)-静脉血: 0.9mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 22.5U/L；钾离子(K+)-静脉血: 3.6mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 16U/L；直接胆红素(DBIL)-静脉血: 6.5umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.5mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.5；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.7；白蛋白(ALB)-静脉血: 35.4g/L；钠离子(Na+)-静脉血: 138.1mmol/L；总钙(Ca)-静脉血: 2.12mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.08mmolL；磷(P)-静脉血: 1.18mmol/L；C-反应蛋白(CRP)-静脉血: 30.45mg/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.005；总胆汁酸(TBA)-静脉血: 1.6umol/L；乳酸脱氢酶(LDH)-静脉血: 175.3U/L；甘油三酯(TG)-静脉血: 0.98mmol/L；红细胞计数(RBC#)-静脉血: 3.8810E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血小板比容-静脉血: 13%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.28mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.04g/L；间接胆红素(IBIL)-静脉血: 9.3umolL；平均红细胞血红蛋白含量(MCH)-静脉血: 29.9pg；氯离子(Cl-)-静脉血: 102.7mmol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L……\n- [全程D65] 检验组合: 钾离子(K+)-静脉血: 3.65mmol/L；总胆固醇(TC)-静脉血: 3.47mmol/L；阴离子间隙(AG)-静脉血: 9.1；磷(P)-静脉血: 1.16mmol/L；间接胆红素(IBIL)-静脉血: 7.2umolL；总蛋白(TP)-静脉血: 66.88g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 14.2U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.07mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；红细胞比容(Hct)-静脉血: 35.8%；淋巴细胞百分比(Lymph%)-静脉血: 0.077；红细胞体积分布宽度CV(RDW-CV)-静脉血: 15.7%；丙氨酸氨基转移酶(ALT)-静脉血: 15.7U/L；钠离子(Na+)-静脉血: 141.1mmol/L；乳酸脱氢酶(LDH)-静脉血: 147.8U/L；C-反应蛋白(CRP)-静脉血: 23.42mg/L；甘油三酯(TG)-静脉血: 1.16mmol/L；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；血小板分布宽度(PDW)-静脉血: 17.3%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；肌酐(Crea)-静脉血: 62.8umol/L；镁离子(Mg2+)-静脉血: 0.8mmol/L；总胆红素(TBIL)-静脉血: 12.5umol/L；淋巴细胞计数(Lymph#)-静脉血: 0.410E9/L；直接胆红素(DBIL)-静脉血: 5.3umol/L；球蛋白(GLO)-静脉血: 30.38g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；尿素氮(BUN)-静脉血: 3.1mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 35.9U/L；载脂蛋白AI(apoAI)-静脉血: 0.9g/L；白蛋白(ALB)-静脉血: 36.5g/L；血红蛋白(Hb)-静脉血: 118.5g/L；载脂蛋白B(apoB)-静脉血: 0.74g/L；白细胞计数(WBC#)-静脉血: 4.5110E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 18.3U/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血……\n- [全程D72] 检验组合: 磷(P)-静脉血: 1.31mmol/L；总钙(Ca)-静脉血: 2.11mmol/L；总胆红素(TBIL)-静脉血: 12umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.745；镁离子(Mg2+)-静脉血: 0.8mmol/L；总蛋白(TP)-静脉血: 65.97g/L；单核细胞百分比(Mono%)-静脉血: 0.132；血小板计数(PLT#)-静脉血: 17910E9/L；球蛋白(GLO)-静脉血: 33.37g/L；尿素氮(BUN)-静脉血: 3.82mmol/L；尿酸(UA)-静脉血: 232.9umol/L；间接胆红素(IBIL)-静脉血: 6.9umolL；中性粒细胞计数(Neut#)-静脉血: 2.510E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.9；氯离子(Cl-)-静脉血: 105mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.6；血小板比容-静脉血: 15%；平均红细胞血红蛋白含量(MCH)-静脉血: 29.2pg；总胆固醇(TC)-静脉血: 3.73mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；载脂蛋白AI(apoAI)-静脉血: 0.88g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 36.1U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.026；胱抑素(Cys-C)-静脉血: 0.62mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.91mmolL；乳酸脱氢酶(LDH)-静脉血: 137U/L；肌酐(Crea)-静脉血: 68.5umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 87.7fL；血小板分布宽度(PDW)-静脉血: 7.4%；白蛋白(ALB)-静脉血: 32.6g/L；甘油三酯(TG)-静脉血: 0.96mmol/L；大血小板百分比(P-LCR%)-静脉血: 11.2%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15.9U/L；丙氨酸氨基转移酶(ALT)-静脉血: 17.3U/L；钠离子(Na+)-静脉血: 141.2mmol……\n- [全程D75] 检验组合: 白细胞计数(WBC#)-静脉血: 3.3210E9/L；血小板分布宽度(PDW)-静脉血: 7.9%；钾离子(K+)-静脉血: 3.4mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 18.6U/L；C-反应蛋白(CRP)-静脉血: 56.54mg/L；红细胞比容(Hct)-静脉血: 33.5%；单核细胞百分比(Mono%)-静脉血: 0.117；肌酐(Crea)-静脉血: 63.4umol/L；尿酸(UA)-静脉血: 304umol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；血小板比容-静脉血: 18%；α-L-岩藻糖苷酶(AFU)-静脉血: 22U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.72mmol/L；血小板计数(PLT#)-静脉血: 21110E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.9；中性粒细胞百分比(Neut%)-静脉血: 0.772；淋巴细胞百分比(Lymph%)-静脉血: 0.072；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；总钙(Ca)-静脉血: 2.12mmol/L；药物曲线下面积(AUC)-静脉血: 1；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；总胆固醇(TC)-静脉血: 4.15mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.88mmolL；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 16.7U/L；白蛋白(ALB)-静脉血: 33g/L；平均血小板体积(MPV)-静脉血: 8.3fL；总胆红素(TBIL)-静脉血: 13.6umol/L；磷(P)-静脉血: 1.15mmol/L；球蛋白(GLO)-静脉血: 33.66g/L；阴离子间隙(AG)-静脉血: 14；葡萄糖(Glu)-静脉血: 5.63mmol/L；载脂蛋白AI(apoAI)-静脉血: 0.81g/L；总胆汁酸(TBA)-静脉血: 1.4umol/L；间接胆红素(IBIL)-静脉血: 7.9umolL；尿素氮(BUN)-静脉血: 5.04mmol/L；胱抑素(Cys-C)-静脉血: 0.65mg/L；红细胞计数(RBC#)-静脉血: 3.8110E12/L；红细胞体积分布宽度……\n- [全程D86] 检验组合: 总胆汁酸(TBA)-静脉血: 1.6umol/L；直接胆红素(DBIL)-静脉血: 2.4umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 16U/L；C-反应蛋白(CRP)-静脉血: 15.4mg/L；淋巴细胞百分比(Lymph%)-静脉血: 0.142；总钙(Ca)-静脉血: 2.08mmol/L；阴离子间隙(AG)-静脉血: 10；丙氨酸氨基转移酶(ALT)-静脉血: 27.7U/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；白蛋白(ALB)-静脉血: 30.3g/L；钾离子(K+)-静脉血: 3.2mmol/L；葡萄糖(Glu)-静脉血: 5.56mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.27mmol/L；总胆固醇(TC)-静脉血: 3.75mmol/L；平均红细胞体积(MCV)-静脉血: 89.4fL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.83mmolL；肌酐(Crea)-静脉血: 72.9umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 53U/L；尿酸(UA)-静脉血: 338.6umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.9mmol/L；白细胞计数(WBC#)-静脉血: 2.610E9/L；钠离子(Na+)-静脉血: 140.5mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.4pg；单核细胞百分比(Mono%)-静脉血: 0.281；大血小板百分比(P-LCR%)-静脉血: 12.6%；载脂蛋白B(apoB)-静脉血: 0.76g/L；载脂蛋白AI(apoAI)-静脉血: 0.84g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.6U/L；间接胆红素(IBIL)-静脉血: 3umolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.7；甘油三酯(TG)-静脉血: 1.42mmol/L；磷(P)-静脉血: 1.4mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.8；碱性磷酸酶(ALP)-静脉血: 70.5U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；尿素氮……\n- [全程D88] 检验组合: 血红蛋白(Hb)-静脉血: 118g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.26；平均血小板体积(MPV)-静脉血: 8.5fL；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；红细胞比容(Hct)-静脉血: 35.8%；血小板比容-静脉血: 14%；血小板分布宽度(PDW)-静脉血: 7.6%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.7；平均红细胞体积(MCV)-静脉血: 90.4fL；血小板计数(PLT#)-静脉血: 16910E9/L；红细胞计数(RBC#)-静脉血: 3.9610E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.028；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；单核细胞百分比(Mono%)-静脉血: 0.097；大血小板百分比(P-LCR%)-静脉血: 14.3%；白细胞计数(WBC#)-静脉血: 2.8810E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.8pg；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.5；中性粒细胞计数(Neut#)-静脉血: 1.810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.612\n- [全程D93] 检验组合: 低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.82mmol/L；白蛋白(ALB)-静脉血: 37.8g/L；总胆红素(TBIL)-静脉血: 9.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 39.6U/L；胱抑素(Cys-C)-静脉血: 0.78mg/L；淋巴细胞百分比(Lymph%)-静脉血: 0.15；天门冬氨酸氨基转移酶(AST)-静脉血: 21.3U/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；尿酸(UA)-静脉血: 295.9umol/L；血小板比容-静脉血: 12.1%；中性粒细胞计数(Neut#)-静脉血: 2.410E9/L；氯离子(Cl-)-静脉血: 102mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.7mmol/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；阴离子间隙(AG)-静脉血: 13.1；钠离子(Na+)-静脉血: 142.8mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 16.1%；血小板分布宽度(PDW)-静脉血: 15.9%；红细胞比容(Hct)-静脉血: 36.4%；磷(P)-静脉血: 1.26mmol/L；直接胆红素(DBIL)-静脉血: 3.4umol/L；总蛋白(TP)-静脉血: 70.94g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；葡萄糖(Glu)-静脉血: 6.22mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.019；间接胆红素(IBIL)-静脉血: 5.9umolL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；载脂蛋白B(apoB)-静脉血: 0.94g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.11mmolL；总胆固醇(TC)-静脉血: 4.28mmol/L；碱性磷酸酶(ALP)-静脉血: 88.1U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.5pg；血小板计数(PLT#)-静脉血: 215.910E9/L；钾离子(K+)-静脉血: 3.96mmol/L；单核细胞百分比(Mono%)-静脉血: 0.146；平均血小板体积(MPV)-静脉血: 5.62fL；有核红细胞百分比(NRBC%)-静脉血:……\n- [全程D94] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约28cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，右肾实质回声均匀，未见明显异常回声。左肾下盏可见一强回声团，直径约6mm，边界清。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约28×25×25mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 左肾结石。 肝脏、胆囊、脾脏、胰腺、右肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n\n【既往治疗与反应】\n- [全程D64] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者放疗中，第4程爱必妥靶向治疗后3天，诉口感、咽痛、纳差。查体同前。[姓名已隐去]医生信息已隐藏：予喷喉、洗鼻、保护皮肤处理，加强营养，继续放疗。\n- [全程D69] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者放疗中，今日第5程爱必妥靶向治疗，诉头面部皮疹，口感、咽痛，余无明显不适。查体：头面部散在红疹，无脱皮、水泡，余同前。[姓名已隐去]医生信息已隐藏：予红外线治疗，喷喉、洗鼻、保护皮肤处理，加强营养，继续放疗。\n- [全程D74] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者放疗中，第2程洛铂方案同时期化疗结束，诉恶心、食欲下降，呕吐1次，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规示轻度贫血，肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第2程洛铂方案同时期化疗结束，诉恶心、呕吐，予止呕护胃处理，继续放疗。\n- [全程D78] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者2月18日至2月26日春节请假中。\n- [全程D88] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者放疗中，第6程爱必妥靶向治疗结束，诉头面部皮疹，口感、咽痛，余无明显不适。查体：头面部散在红疹，无脱皮、水泡，余同前。复查血常规、生化插管基本正常。[姓名已隐去]医生信息已隐藏：予喷喉、洗鼻、保护皮肤处理，加强营养，今日可办理出院，继续门诊放疗，按时间行复查。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 确认腹部彩超无转移，暂停放疗，请泌尿外科会诊行左肾结石碎石治疗，并予乳果糖口服液。\nB. 确认腹部彩超无转移，继续门诊放疗，左肾结石暂予观察，并予乳果糖口服液。\nC. 确认腹部彩超无转移，继续门诊放疗，左肾结石暂予观察，并加用洛铂行第3程同期化疗。\nD. 确认腹部彩超无转移，暂停门诊放疗，复查鼻咽及颈部MRI评估局部疗效，并予乳果糖口服液。\nE. 确认腹部彩超无转移，继续门诊放疗，对左肾结石予排石颗粒，并加用西妥昔单抗靶向治疗。\nF. 确认腹部彩超无转移，终止放疗，左肾结石暂予观察，转入康复科行便秘治疗。\nG. 确认腹部彩超无转移，继续门诊放疗，对左肾结石予留置双J管，并予乳果糖口服液。\nH. 确认腹部彩超无转移，暂停门诊放疗，予温肥皂水灌肠处理便秘，左肾结石暂予观察。\nI. 确认腹部彩超无转移，继续门诊放疗，左肾结石暂予观察，并予洛哌丁胺口服。\nJ. 确认腹部彩超无转移，继续门诊放疗，左肾结石暂予观察，并予开塞露联合新斯的明肌注。\nK. 确认腹部彩超无转移，暂停门诊放疗，行全身PET-CT评估疗效，左肾结石暂予观察。\nL. 确认腹部彩超无转移，继续门诊放疗，行体外冲击波碎石，处理左肾结石，并予乳果糖口服液。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D58] 检验组合: 红细胞比容(Hct)-静脉血: 34.3%；载脂蛋白B(apoB)-静脉血: 0.73g/L；碱性磷酸酶(ALP)-静脉血: 76U/L；肌酐(Crea)-静脉血: 67.8umol/L；胱抑素(Cys-C)-静脉血: 0.64mg/L；中性粒细胞百分比(Neut%)-静脉血: 0.768；血红蛋白(Hb)-静脉血: 116g/L；平均血小板体积(MPV)-静脉血: 8.4fL；总胆红素(TBIL)-静脉血: 15.8umol/L；尿素氮(BUN)-静脉血: 3.79mmol/L；镁离子(Mg2+)-静脉血: 0.9mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 22.5U/L；钾离子(K+)-静脉血: 3.6mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 16U/L；直接胆红素(DBIL)-静脉血: 6.5umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.5mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.5；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.7；白蛋白(ALB)-静脉血: 35.4g/L；钠离子(Na+)-静脉血: 138.1mmol/L；总钙(Ca)-静脉血: 2.12mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.08mmolL；磷(P)-静脉血: 1.18mmol/L；C-反应蛋白(CRP)-静脉血: 30.45mg/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.005；总胆汁酸(TBA)-静脉血: 1.6umol/L；乳酸脱氢酶(LDH)-静脉血: 175.3U/L；甘油三酯(TG)-静脉血: 0.98mmol/L；红细胞计数(RBC#)-静脉血: 3.8810E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血小板比容-静脉血: 13%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.28mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.04g/L；间接胆红素(IBIL)-静脉血: 9.3umolL；平均红细胞血红蛋白含量(MCH)-静脉血: 29.9pg；氯离子(Cl-)-静脉血: 102.7mmol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L……\n- [全程D65] 检验组合: 钾离子(K+)-静脉血: 3.65mmol/L；总胆固醇(TC)-静脉血: 3.47mmol/L；阴离子间隙(AG)-静脉血: 9.1；磷(P)-静脉血: 1.16mmol/L；间接胆红素(IBIL)-静脉血: 7.2umolL；总蛋白(TP)-静脉血: 66.88g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 14.2U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.07mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；红细胞比容(Hct)-静脉血: 35.8%；淋巴细胞百分比(Lymph%)-静脉血: 0.077；红细胞体积分布宽度CV(RDW-CV)-静脉血: 15.7%；丙氨酸氨基转移酶(ALT)-静脉血: 15.7U/L；钠离子(Na+)-静脉血: 141.1mmol/L；乳酸脱氢酶(LDH)-静脉血: 147.8U/L；C-反应蛋白(CRP)-静脉血: 23.42mg/L；甘油三酯(TG)-静脉血: 1.16mmol/L；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；血小板分布宽度(PDW)-静脉血: 17.3%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；肌酐(Crea)-静脉血: 62.8umol/L；镁离子(Mg2+)-静脉血: 0.8mmol/L；总胆红素(TBIL)-静脉血: 12.5umol/L；淋巴细胞计数(Lymph#)-静脉血: 0.410E9/L；直接胆红素(DBIL)-静脉血: 5.3umol/L；球蛋白(GLO)-静脉血: 30.38g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；尿素氮(BUN)-静脉血: 3.1mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 35.9U/L；载脂蛋白AI(apoAI)-静脉血: 0.9g/L；白蛋白(ALB)-静脉血: 36.5g/L；血红蛋白(Hb)-静脉血: 118.5g/L；载脂蛋白B(apoB)-静脉血: 0.74g/L；白细胞计数(WBC#)-静脉血: 4.5110E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 18.3U/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血……\n- [全程D72] 检验组合: 磷(P)-静脉血: 1.31mmol/L；总钙(Ca)-静脉血: 2.11mmol/L；总胆红素(TBIL)-静脉血: 12umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.745；镁离子(Mg2+)-静脉血: 0.8mmol/L；总蛋白(TP)-静脉血: 65.97g/L；单核细胞百分比(Mono%)-静脉血: 0.132；血小板计数(PLT#)-静脉血: 17910E9/L；球蛋白(GLO)-静脉血: 33.37g/L；尿素氮(BUN)-静脉血: 3.82mmol/L；尿酸(UA)-静脉血: 232.9umol/L；间接胆红素(IBIL)-静脉血: 6.9umolL；中性粒细胞计数(Neut#)-静脉血: 2.510E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.9；氯离子(Cl-)-静脉血: 105mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.6；血小板比容-静脉血: 15%；平均红细胞血红蛋白含量(MCH)-静脉血: 29.2pg；总胆固醇(TC)-静脉血: 3.73mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；载脂蛋白AI(apoAI)-静脉血: 0.88g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 36.1U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.026；胱抑素(Cys-C)-静脉血: 0.62mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.91mmolL；乳酸脱氢酶(LDH)-静脉血: 137U/L；肌酐(Crea)-静脉血: 68.5umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 87.7fL；血小板分布宽度(PDW)-静脉血: 7.4%；白蛋白(ALB)-静脉血: 32.6g/L；甘油三酯(TG)-静脉血: 0.96mmol/L；大血小板百分比(P-LCR%)-静脉血: 11.2%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15.9U/L；丙氨酸氨基转移酶(ALT)-静脉血: 17.3U/L；钠离子(Na+)-静脉血: 141.2mmol……\n- [全程D75] 检验组合: 白细胞计数(WBC#)-静脉血: 3.3210E9/L；血小板分布宽度(PDW)-静脉血: 7.9%；钾离子(K+)-静脉血: 3.4mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 18.6U/L；C-反应蛋白(CRP)-静脉血: 56.54mg/L；红细胞比容(Hct)-静脉血: 33.5%；单核细胞百分比(Mono%)-静脉血: 0.117；肌酐(Crea)-静脉血: 63.4umol/L；尿酸(UA)-静脉血: 304umol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；血小板比容-静脉血: 18%；α-L-岩藻糖苷酶(AFU)-静脉血: 22U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.72mmol/L；血小板计数(PLT#)-静脉血: 21110E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.9；中性粒细胞百分比(Neut%)-静脉血: 0.772；淋巴细胞百分比(Lymph%)-静脉血: 0.072；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；总钙(Ca)-静脉血: 2.12mmol/L；药物曲线下面积(AUC)-静脉血: 1；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；总胆固醇(TC)-静脉血: 4.15mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.88mmolL；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 16.7U/L；白蛋白(ALB)-静脉血: 33g/L；平均血小板体积(MPV)-静脉血: 8.3fL；总胆红素(TBIL)-静脉血: 13.6umol/L；磷(P)-静脉血: 1.15mmol/L；球蛋白(GLO)-静脉血: 33.66g/L；阴离子间隙(AG)-静脉血: 14；葡萄糖(Glu)-静脉血: 5.63mmol/L；载脂蛋白AI(apoAI)-静脉血: 0.81g/L；总胆汁酸(TBA)-静脉血: 1.4umol/L；间接胆红素(IBIL)-静脉血: 7.9umolL；尿素氮(BUN)-静脉血: 5.04mmol/L；胱抑素(Cys-C)-静脉血: 0.65mg/L；红细胞计数(RBC#)-静脉血: 3.8110E12/L；红细胞体积分布宽度……\n- [全程D86] 检验组合: 总胆汁酸(TBA)-静脉血: 1.6umol/L；直接胆红素(DBIL)-静脉血: 2.4umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 16U/L；C-反应蛋白(CRP)-静脉血: 15.4mg/L；淋巴细胞百分比(Lymph%)-静脉血: 0.142；总钙(Ca)-静脉血: 2.08mmol/L；阴离子间隙(AG)-静脉血: 10；丙氨酸氨基转移酶(ALT)-静脉血: 27.7U/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；白蛋白(ALB)-静脉血: 30.3g/L；钾离子(K+)-静脉血: 3.2mmol/L；葡萄糖(Glu)-静脉血: 5.56mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.27mmol/L；总胆固醇(TC)-静脉血: 3.75mmol/L；平均红细胞体积(MCV)-静脉血: 89.4fL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.83mmolL；肌酐(Crea)-静脉血: 72.9umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 53U/L；尿酸(UA)-静脉血: 338.6umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.9mmol/L；白细胞计数(WBC#)-静脉血: 2.610E9/L；钠离子(Na+)-静脉血: 140.5mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.4pg；单核细胞百分比(Mono%)-静脉血: 0.281；大血小板百分比(P-LCR%)-静脉血: 12.6%；载脂蛋白B(apoB)-静脉血: 0.76g/L；载脂蛋白AI(apoAI)-静脉血: 0.84g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.6U/L；间接胆红素(IBIL)-静脉血: 3umolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.7；甘油三酯(TG)-静脉血: 1.42mmol/L；磷(P)-静脉血: 1.4mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.8；碱性磷酸酶(ALP)-静脉血: 70.5U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；尿素氮……\n- [全程D88] 检验组合: 血红蛋白(Hb)-静脉血: 118g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.26；平均血小板体积(MPV)-静脉血: 8.5fL；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；红细胞比容(Hct)-静脉血: 35.8%；血小板比容-静脉血: 14%；血小板分布宽度(PDW)-静脉血: 7.6%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.7；平均红细胞体积(MCV)-静脉血: 90.4fL；血小板计数(PLT#)-静脉血: 16910E9/L；红细胞计数(RBC#)-静脉血: 3.9610E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.028；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；单核细胞百分比(Mono%)-静脉血: 0.097；大血小板百分比(P-LCR%)-静脉血: 14.3%；白细胞计数(WBC#)-静脉血: 2.8810E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.8pg；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.5；中性粒细胞计数(Neut#)-静脉血: 1.810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.612\n- [全程D93] 检验组合: 低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.82mmol/L；白蛋白(ALB)-静脉血: 37.8g/L；总胆红素(TBIL)-静脉血: 9.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 39.6U/L；胱抑素(Cys-C)-静脉血: 0.78mg/L；淋巴细胞百分比(Lymph%)-静脉血: 0.15；天门冬氨酸氨基转移酶(AST)-静脉血: 21.3U/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；尿酸(UA)-静脉血: 295.9umol/L；血小板比容-静脉血: 12.1%；中性粒细胞计数(Neut#)-静脉血: 2.410E9/L；氯离子(Cl-)-静脉血: 102mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.7mmol/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；阴离子间隙(AG)-静脉血: 13.1；钠离子(Na+)-静脉血: 142.8mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 16.1%；血小板分布宽度(PDW)-静脉血: 15.9%；红细胞比容(Hct)-静脉血: 36.4%；磷(P)-静脉血: 1.26mmol/L；直接胆红素(DBIL)-静脉血: 3.4umol/L；总蛋白(TP)-静脉血: 70.94g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；葡萄糖(Glu)-静脉血: 6.22mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.019；间接胆红素(IBIL)-静脉血: 5.9umolL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；载脂蛋白B(apoB)-静脉血: 0.94g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.11mmolL；总胆固醇(TC)-静脉血: 4.28mmol/L；碱性磷酸酶(ALP)-静脉血: 88.1U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.5pg；血小板计数(PLT#)-静脉血: 215.910E9/L；钾离子(K+)-静脉血: 3.96mmol/L；单核细胞百分比(Mono%)-静脉血: 0.146；平均血小板体积(MPV)-静脉血: 5.62fL；有核红细胞百分比(NRBC%)-静脉血:……\n- [全程D94] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约28cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，右肾实质回声均匀，未见明显异常回声。左肾下盏可见一强回声团，直径约6mm，边界清。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约28×25×25mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 左肾结石。 肝脏、胆囊、脾脏、胰腺、右肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n\n【既往治疗与反应】\n- [全程D64] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者放疗中，第4程爱必妥靶向治疗后3天，诉口感、咽痛、纳差。查体同前。[姓名已隐去]医生信息已隐藏：予喷喉、洗鼻、保护皮肤处理，加强营养，继续放疗。\n- [全程D69] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者放疗中，今日第5程爱必妥靶向治疗，诉头面部皮疹，口感、咽痛，余无明显不适。查体：头面部散在红疹，无脱皮、水泡，余同前。[姓名已隐去]医生信息已隐藏：予红外线治疗，喷喉、洗鼻、保护皮肤处理，加强营养，继续放疗。\n- [全程D74] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者放疗中，第2程洛铂方案同时期化疗结束，诉恶心、食欲下降，呕吐1次，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规示轻度贫血，肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第2程洛铂方案同时期化疗结束，诉恶心、呕吐，予止呕护胃处理，继续放疗。\n- [全程D78] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者2月18日至2月26日春节请假中。\n- [全程D88] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者放疗中，第6程爱必妥靶向治疗结束，诉头面部皮疹，口感、咽痛，余无明显不适。查体：头面部散在红疹，无脱皮、水泡，余同前。复查血常规、生化插管基本正常。[姓名已隐去]医生信息已隐藏：予喷喉、洗鼻、保护皮肤处理，加强营养，今日可办理出院，继续门诊放疗，按时间行复查。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 确认腹部彩超无转移，暂停放疗，请泌尿外科会诊行左肾结石碎石治疗，并予乳果糖口服液。\nB. 确认腹部彩超无转移，继续门诊放疗，左肾结石暂予观察，并予乳果糖口服液。\nC. 确认腹部彩超无转移，继续门诊放疗，左肾结石暂予观察，并加用洛铂行第3程同期化疗。\nD. 确认腹部彩超无转移，暂停门诊放疗，复查鼻咽及颈部MRI评估局部疗效，并予乳果糖口服液。\nE. 确认腹部彩超无转移，继续门诊放疗，对左肾结石予排石颗粒，并加用西妥昔单抗靶向治疗。\nF. 确认腹部彩超无转移，终止放疗，左肾结石暂予观察，转入康复科行便秘治疗。\nG. 确认腹部彩超无转移，继续门诊放疗，对左肾结石予留置双J管，并予乳果糖口服液。\nH. 确认腹部彩超无转移，暂停门诊放疗，予温肥皂水灌肠处理便秘，左肾结石暂予观察。\nI. 确认腹部彩超无转移，继续门诊放疗，左肾结石暂予观察，并予洛哌丁胺口服。\nJ. 确认腹部彩超无转移，继续门诊放疗，左肾结石暂予观察，并予开塞露联合新斯的明肌注。\nK. 确认腹部彩超无转移，暂停门诊放疗，行全身PET-CT评估疗效，左肾结石暂予观察。\nL. 确认腹部彩超无转移，继续门诊放疗，行体外冲击波碎石，处理左肾结石，并予乳果糖口服液。\n\n请仅输出一个选项字母（A-L）。"}]}
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+{"sample_id":"sample-78b27b455a910a93bd013384","patient_id":"patient-51e6f99c527367bbd97aebd8","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"D","gold_action":"明确鼻咽癌临床分期为 cT1N0M0，IA期（肿瘤累及鼻咽及左侧后鼻孔，无颈部淋巴结转移）","options":[{"letter":"A","text":"明确鼻咽癌临床分期为 cT2N0M0，II期（肿瘤累及左侧后鼻孔，无颈部淋巴结转移）","is_gold":false},{"letter":"B","text":"明确鼻咽癌临床分期为 cT1N1M0，II期（肿瘤局限于鼻咽，伴单侧咽后淋巴结转移）","is_gold":false},{"letter":"C","text":"明确鼻咽癌临床分期为 cT2N1M0，II期（肿瘤累及左侧后鼻孔及咽旁间隙，伴单侧颈部淋巴结转移）","is_gold":false},{"letter":"D","text":"明确鼻咽癌临床分期为 cT1N0M0，IA期（肿瘤累及鼻咽及左侧后鼻孔，无颈部淋巴结转移）","is_gold":true},{"letter":"E","text":"明确鼻咽癌临床分期为 cT3N0M0，III期（肿瘤累及颅底骨质，无颈部淋巴结转移）","is_gold":false},{"letter":"F","text":"明确鼻咽癌临床分期为 cT1N0M0，IA期（肿瘤局限于鼻咽，未累及鼻腔及口咽等邻近结构）","is_gold":false},{"letter":"G","text":"明确鼻咽癌临床分期为 cT2N0M0，II期（肿瘤累及鼻咽及口咽，无颈部淋巴结转移）","is_gold":false},{"letter":"H","text":"明确鼻咽癌临床分期为 cT1N2M0，III期（肿瘤累及左侧后鼻孔，伴双侧颈部淋巴结转移）","is_gold":false},{"letter":"I","text":"明确鼻咽癌临床分期为 cT3N1M0，III期（肿瘤累及翼内肌，伴单侧颈部淋巴结转移）","is_gold":false},{"letter":"J","text":"明确鼻咽癌临床分期为 cT4N0M0，IVA期（肿瘤累及海绵窦，无颈部淋巴结转移）","is_gold":false},{"letter":"K","text":"明确鼻咽癌临床分期为 cT1N0M1，IVB期（肿瘤累及左侧后鼻孔，伴远处器官转移）","is_gold":false},{"letter":"L","text":"明确鼻咽癌临床分期为 cT2N2M0，III期（肿瘤累及咽旁间隙，伴双侧颈部淋巴结转移）","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：鼻腔。\n文本分期信息：N0，M0。\n综合TNM状态：T1N0M0。\n综合分期：IA。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D7] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- [全程D7] 检验组合: 平均红细胞体积(MCV)-静脉血: 91.1fL；总钙(Ca)-静脉血: 2.21mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24.2U/L；碱性磷酸酶(ALP)-静脉血: 74.3U/L；IV型胶原(C-IV)-静脉血: 12.97ng/ml；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 35.9U/L；钾离子(K+)-静脉血: 3.76mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；D-二聚体(D-Dimer)-静脉血: 0.07ug/ml；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；淀粉样蛋白A(SAA)-静脉血: 2.44mg/L；C-反应蛋白(CRP)-静脉血: 1.92mg/L；凝血酶原时间活动度(PTA)-静脉血: 120%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.67；载脂蛋白B(apoB)-静脉血: 1.07g/L；球蛋白(GLO)-静脉血: 26.18g/L；磷(P)-静脉血: 1.03mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；胱抑素(Cys-C)-静脉血: 0.79mg/L；红细胞计数(RBC#)-静脉血: 5.2710E12/L；单核细胞计数(Mono#)-静脉血: 110E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.6sec.；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.87；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.411ng/ml（参考: <0.584）；尿素氮(BUN)-静脉血: 4.7mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；血小板计数(PLT#)-静脉血: 21810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.578；凝血酶原时间(PT)-静脉血: 10.1sec.；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.05mmol/L；尿酸(UA)-静脉血: 331.5umol/L；阴离子间隙(AG)-静脉血: 15.7；层粘……\n- [全程D10] 内镜；胃镜: 检查类型: 内镜；检查名称: 胃镜；检查部位:；检查所见: 插镜情况：顺利 送达部位：十二指肠降部。 食 管：粘膜光滑, 舒缩好。 贲 门：开闭好, E-G线清楚。 胃 底：粘液湖清亮，粘膜光滑，无静脉曲张。 胃 体：花斑样充血，未见溃疡肿物。 胃 角：弧形， 光滑。 胃 窦：蠕动好，粘膜呈花斑样充血，未见溃疡肿物。 幽 门：圆， 开闭好。 球 部：球腔变形，后壁可见霜斑样溃疡，表面附着白苔。 降 部：十二指肠乳头及降部粘膜未见异常。 请4个工作日后到病理科（5楼）取活检结果。；检查结论: 十二指肠球部霜斑样溃疡 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多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：鼻腔。\n文本分期信息：N0，M0。\n综合TNM状态：T1N0M0。\n综合分期：IA。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D7] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- [全程D7] 检验组合: 平均红细胞体积(MCV)-静脉血: 91.1fL；总钙(Ca)-静脉血: 2.21mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24.2U/L；碱性磷酸酶(ALP)-静脉血: 74.3U/L；IV型胶原(C-IV)-静脉血: 12.97ng/ml；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 35.9U/L；钾离子(K+)-静脉血: 3.76mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；D-二聚体(D-Dimer)-静脉血: 0.07ug/ml；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；淀粉样蛋白A(SAA)-静脉血: 2.44mg/L；C-反应蛋白(CRP)-静脉血: 1.92mg/L；凝血酶原时间活动度(PTA)-静脉血: 120%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.67；载脂蛋白B(apoB)-静脉血: 1.07g/L；球蛋白(GLO)-静脉血: 26.18g/L；磷(P)-静脉血: 1.03mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；胱抑素(Cys-C)-静脉血: 0.79mg/L；红细胞计数(RBC#)-静脉血: 5.2710E12/L；单核细胞计数(Mono#)-静脉血: 110E9/L；活化部分凝血活酶时间(APTT)-静脉血: 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cT1N0M0，IA期（肿瘤局限于鼻咽，未累及鼻腔及口咽等邻近结构）\nG. 明确鼻咽癌临床分期为 cT2N0M0，II期（肿瘤累及鼻咽及口咽，无颈部淋巴结转移）\nH. 明确鼻咽癌临床分期为 cT1N2M0，III期（肿瘤累及左侧后鼻孔，伴双侧颈部淋巴结转移）\nI. 明确鼻咽癌临床分期为 cT3N1M0，III期（肿瘤累及翼内肌，伴单侧颈部淋巴结转移）\nJ. 明确鼻咽癌临床分期为 cT4N0M0，IVA期（肿瘤累及海绵窦，无颈部淋巴结转移）\nK. 明确鼻咽癌临床分期为 cT1N0M1，IVB期（肿瘤累及左侧后鼻孔，伴远处器官转移）\nL. 明确鼻咽癌临床分期为 cT2N2M0，III期（肿瘤累及咽旁间隙，伴双侧颈部淋巴结转移）\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-db8d6d3eabcfcb123b0c3cb1","patient_id":"patient-51e6f99c527367bbd97aebd8","turn_id":"turn05","turn_position":3,"turn_type":"toxicity_or_support_decision","gold_letter":"F","gold_action":"暂停顺铂化疗，继续单纯放疗，给予静脉保肝治疗，待肝功能恢复后补足化疗周期。","options":[{"letter":"A","text":"暂停放化疗，给予多烯磷脂酰胆碱、还原型谷胱甘肽等静脉保肝治疗，待肝功能恢复正常后恢复放化疗。","is_gold":false},{"letter":"B","text":"继续放化疗，仅密切监测肝功能变化，暂不给予静脉保肝药物干预。","is_gold":false},{"letter":"C","text":"继续放化疗，给予广谱抗生素静脉滴注预防感染，并辅以雾化吸入及止吐等对症支持处理。","is_gold":false},{"letter":"D","text":"将顺铂方案调整为卡铂方案同时期化疗，并给予静脉保肝治疗及止吐等对症支持处理。","is_gold":false},{"letter":"E","text":"顺铂剂量减低25%继续同时期化疗，给予静脉保肝治疗，辅以雾化吸入及止吐等对症支持处理。","is_gold":false},{"letter":"F","text":"暂停顺铂化疗，继续单纯放疗，给予静脉保肝治疗，待肝功能恢复后补足化疗周期。","is_gold":true},{"letter":"G","text":"给予多烯磷脂酰胆碱、还原型谷胱甘肽、复方甘草酸苷等静脉保肝治疗，辅以雾化吸入及止吐等对症支持处理。","is_gold":false},{"letter":"H","text":"给予大剂量质子泵抑制剂静脉滴注预防消化道出血，暂缓保肝治疗，继续放化疗。","is_gold":false},{"letter":"I","text":"暂停放疗，继续顺铂化疗，给予静脉保肝治疗及止吐等对症支持处理。","is_gold":false},{"letter":"J","text":"给予静脉保肝治疗，行骨髓穿刺检查排除血液系统异常，继续放化疗。","is_gold":false},{"letter":"K","text":"终止临床试验，转为常规单药顺铂同时期放化疗，并给予静脉保肝治疗。","is_gold":false},{"letter":"L","text":"给予口服保肝药物治疗，辅以雾化吸入及止吐等对症支持处理，继续放化疗。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：鼻腔。\n文本分期信息：N0，M0。\n综合TNM状态：T1N0M0。\n综合分期：IA。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D24] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽左侧顶后壁及左侧壁局部粘膜增厚形成软组织影放射性浓聚，SUV约21.0，堵塞左侧鼻后孔，鼻咽腔变窄，累及左侧翼突基底部及犁骨。左侧咽隐窝变，右侧咽隐窝未见明显异常，双侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。口咽及喉咽结构及放射性分布未见明显异常。额窦、蝶窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双上颈小淋巴结放射性分布未见明显异常。 双上肺尖、右中肺内侧段及左下肺后基底段少许条索影放射性分布未见明显异常；其余双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏S4低密度影放射性分布未见明显异常，大小约0.6×0.6cm，边界尚清，密度欠均匀，CT值约26Hu；其余肝脏密度减低，CT值约50Hu，结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。盆腔盆底静脉内多发点状/小结节状高密度影放射性缺损。 所见颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，侵犯左侧鼻后孔，累及颅底骨。 肝S4低密度影代谢未见明显异常，建议随诊。 脂肪肝。\n- [全程D29] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.013；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 6.5\n- [全程D30] 检验组合: 浊度(TRUB)-尿液: 清亮；白细胞计数(WBC#)-尿液: 3/μL；白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.023；酮体(KET)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 13/μL；颜色-尿液: Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；隐血(OB)-尿液: 1+ 0.6mg（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D31] 检验组合: 红细胞计数(RBC#)-静脉血: 4.6210E12/L；血小板计数(PLT#)-静脉血: 22810E9/L；大血小板百分比(P-LCR%)-静脉血: 21.2%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.61mmol/L；白蛋白(ALB)-静脉血: 38.5g/L；间接胆红素(IBIL)-静脉血: 8.4umolL；球蛋白(GLO)-静脉血: 25.82g/L；单核细胞百分比(Mono%)-静脉血: 0.093；血小板分布宽度(PDW)-静脉血: 10.8%；红细胞比容(Hct)-静脉血: 41.4%；总蛋白(TP)-静脉血: 64.32g/L；单核细胞计数(Mono#)-静脉血: 1.510E9/L；葡萄糖(Glu)-静脉血: 5.98mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.6；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；总胆红素(TBIL)-静脉血: 12.9umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 176.9U/L；甘油三酯(TG)-静脉血: 1.4mmol/L；乳酸脱氢酶(LDH)-静脉血: 239U/L；总胆汁酸(TBA)-静脉血: 3umol/L；直接胆红素(DBIL)-静脉血: 4.5umol/L；肌酐(Crea)-静脉血: 70umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.7；尿素氮(BUN)-静脉血: 6.02mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 136.5U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；天门冬氨酸氨基转移酶(AST)-静脉血: 104.5U/L；磷(P)-静脉血: 1.34mmol/L；钠离子(Na+)-静脉血: 138.8mmol/L；平均红细胞体积(MCV)-静脉血: 89.6fL；白细胞计数(WBC#)-静脉血: 15.9910E9/L；载脂蛋白AI(apoAI)-静脉血: 1.29g/L；阴离子间隙(AG)-静脉血: 14；C-反应蛋白(CRP)-静脉血: 1.98mg/L；钾离子(K+)-静脉血: 3.5mmol/L；碱性磷酸酶(ALP)-静脉血:……\n\n【既往治疗与反应】\n- [全程D8] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者相关检查完善中，请假未回病房。\n- [全程D13] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者相关检查完善中，请假未回病房。\n- [全程D19] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者元旦假期请假中。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D29] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者无明显不适主诉，查体情况：一般情况可，余同入院。放疗计划已完善。[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，向患者及其家属交代病情及化疗风险，表示理解并已签署知情同意书，同意入组三周/单周DDP同时期化疗临床试验，抽签入三周组，可于今日执行第1程顺铂方案同时期化疗，注意化疗不良反应，开始放疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放化疗，给予多烯磷脂酰胆碱、还原型谷胱甘肽等静脉保肝治疗，待肝功能恢复正常后恢复放化疗。\nB. 继续放化疗，仅密切监测肝功能变化，暂不给予静脉保肝药物干预。\nC. 继续放化疗，给予广谱抗生素静脉滴注预防感染，并辅以雾化吸入及止吐等对症支持处理。\nD. 将顺铂方案调整为卡铂方案同时期化疗，并给予静脉保肝治疗及止吐等对症支持处理。\nE. 顺铂剂量减低25%继续同时期化疗，给予静脉保肝治疗，辅以雾化吸入及止吐等对症支持处理。\nF. 暂停顺铂化疗，继续单纯放疗，给予静脉保肝治疗，待肝功能恢复后补足化疗周期。\nG. 给予多烯磷脂酰胆碱、还原型谷胱甘肽、复方甘草酸苷等静脉保肝治疗，辅以雾化吸入及止吐等对症支持处理。\nH. 给予大剂量质子泵抑制剂静脉滴注预防消化道出血，暂缓保肝治疗，继续放化疗。\nI. 暂停放疗，继续顺铂化疗，给予静脉保肝治疗及止吐等对症支持处理。\nJ. 给予静脉保肝治疗，行骨髓穿刺检查排除血液系统异常，继续放化疗。\nK. 终止临床试验，转为常规单药顺铂同时期放化疗，并给予静脉保肝治疗。\nL. 给予口服保肝药物治疗，辅以雾化吸入及止吐等对症支持处理，继续放化疗。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：鼻腔。\n文本分期信息：N0，M0。\n综合TNM状态：T1N0M0。\n综合分期：IA。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D24] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽左侧顶后壁及左侧壁局部粘膜增厚形成软组织影放射性浓聚，SUV约21.0，堵塞左侧鼻后孔，鼻咽腔变窄，累及左侧翼突基底部及犁骨。左侧咽隐窝变，右侧咽隐窝未见明显异常，双侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。口咽及喉咽结构及放射性分布未见明显异常。额窦、蝶窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双上颈小淋巴结放射性分布未见明显异常。 双上肺尖、右中肺内侧段及左下肺后基底段少许条索影放射性分布未见明显异常；其余双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏S4低密度影放射性分布未见明显异常，大小约0.6×0.6cm，边界尚清，密度欠均匀，CT值约26Hu；其余肝脏密度减低，CT值约50Hu，结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。盆腔盆底静脉内多发点状/小结节状高密度影放射性缺损。 所见颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，侵犯左侧鼻后孔，累及颅底骨。 肝S4低密度影代谢未见明显异常，建议随诊。 脂肪肝。\n- [全程D29] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.013；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 6.5\n- [全程D30] 检验组合: 浊度(TRUB)-尿液: 清亮；白细胞计数(WBC#)-尿液: 3/μL；白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.023；酮体(KET)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 13/μL；颜色-尿液: Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；隐血(OB)-尿液: 1+ 0.6mg（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D31] 检验组合: 红细胞计数(RBC#)-静脉血: 4.6210E12/L；血小板计数(PLT#)-静脉血: 22810E9/L；大血小板百分比(P-LCR%)-静脉血: 21.2%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.61mmol/L；白蛋白(ALB)-静脉血: 38.5g/L；间接胆红素(IBIL)-静脉血: 8.4umolL；球蛋白(GLO)-静脉血: 25.82g/L；单核细胞百分比(Mono%)-静脉血: 0.093；血小板分布宽度(PDW)-静脉血: 10.8%；红细胞比容(Hct)-静脉血: 41.4%；总蛋白(TP)-静脉血: 64.32g/L；单核细胞计数(Mono#)-静脉血: 1.510E9/L；葡萄糖(Glu)-静脉血: 5.98mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.6；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；总胆红素(TBIL)-静脉血: 12.9umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 176.9U/L；甘油三酯(TG)-静脉血: 1.4mmol/L；乳酸脱氢酶(LDH)-静脉血: 239U/L；总胆汁酸(TBA)-静脉血: 3umol/L；直接胆红素(DBIL)-静脉血: 4.5umol/L；肌酐(Crea)-静脉血: 70umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.7；尿素氮(BUN)-静脉血: 6.02mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 136.5U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；天门冬氨酸氨基转移酶(AST)-静脉血: 104.5U/L；磷(P)-静脉血: 1.34mmol/L；钠离子(Na+)-静脉血: 138.8mmol/L；平均红细胞体积(MCV)-静脉血: 89.6fL；白细胞计数(WBC#)-静脉血: 15.9910E9/L；载脂蛋白AI(apoAI)-静脉血: 1.29g/L；阴离子间隙(AG)-静脉血: 14；C-反应蛋白(CRP)-静脉血: 1.98mg/L；钾离子(K+)-静脉血: 3.5mmol/L；碱性磷酸酶(ALP)-静脉血:……\n\n【既往治疗与反应】\n- [全程D8] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者相关检查完善中，请假未回病房。\n- [全程D13] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者相关检查完善中，请假未回病房。\n- [全程D19] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者元旦假期请假中。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D29] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者无明显不适主诉，查体情况：一般情况可，余同入院。放疗计划已完善。[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，向患者及其家属交代病情及化疗风险，表示理解并已签署知情同意书，同意入组三周/单周DDP同时期化疗临床试验，抽签入三周组，可于今日执行第1程顺铂方案同时期化疗，注意化疗不良反应，开始放疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放化疗，给予多烯磷脂酰胆碱、还原型谷胱甘肽等静脉保肝治疗，待肝功能恢复正常后恢复放化疗。\nB. 继续放化疗，仅密切监测肝功能变化，暂不给予静脉保肝药物干预。\nC. 继续放化疗，给予广谱抗生素静脉滴注预防感染，并辅以雾化吸入及止吐等对症支持处理。\nD. 将顺铂方案调整为卡铂方案同时期化疗，并给予静脉保肝治疗及止吐等对症支持处理。\nE. 顺铂剂量减低25%继续同时期化疗，给予静脉保肝治疗，辅以雾化吸入及止吐等对症支持处理。\nF. 暂停顺铂化疗，继续单纯放疗，给予静脉保肝治疗，待肝功能恢复后补足化疗周期。\nG. 给予多烯磷脂酰胆碱、还原型谷胱甘肽、复方甘草酸苷等静脉保肝治疗，辅以雾化吸入及止吐等对症支持处理。\nH. 给予大剂量质子泵抑制剂静脉滴注预防消化道出血，暂缓保肝治疗，继续放化疗。\nI. 暂停放疗，继续顺铂化疗，给予静脉保肝治疗及止吐等对症支持处理。\nJ. 给予静脉保肝治疗，行骨髓穿刺检查排除血液系统异常，继续放化疗。\nK. 终止临床试验，转为常规单药顺铂同时期放化疗，并给予静脉保肝治疗。\nL. 给予口服保肝药物治疗，辅以雾化吸入及止吐等对症支持处理，继续放化疗。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-1d71f20ed555c71c5a4de4ee","patient_id":"patient-51e6f99c527367bbd97aebd8","turn_id":"turn06","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"H","gold_action":"给予联苯双酯等保肝降酶药物，辅以静脉营养支持，并密切复查肝功能。","options":[{"letter":"A","text":"暂停放疗与化疗，给予异甘草酸镁静脉滴注，待转氨酶降至正常水平后重启治疗。","is_gold":false},{"letter":"B","text":"终止顺铂化疗，后续疗程替换为卡铂，并加用甲泼尼龙静脉滴注。","is_gold":false},{"letter":"C","text":"暂停放疗，继续按计划执行化疗，给予联苯双酯口服及静脉营养支持。","is_gold":false},{"letter":"D","text":"维持治疗节奏，暂不加用保肝药物，1周后常规复查肝肾功能。","is_gold":false},{"letter":"E","text":"加用恩替卡韦口服抗病毒治疗，并维持放化疗方案不变。","is_gold":false},{"letter":"F","text":"安排肝脏病灶穿刺活检，明确病理性质前暂停所有抗肿瘤治疗。","is_gold":false},{"letter":"G","text":"给予重组人粒细胞集落刺激因子皮下注射，辅以静脉营养支持。","is_gold":false},{"letter":"H","text":"给予联苯双酯等保肝降酶药物，辅以静脉营养支持，并密切复查肝功能。","is_gold":true},{"letter":"I","text":"给予重组人血小板生成素皮下注射，并推迟下一疗程化疗。","is_gold":false},{"letter":"J","text":"给予头孢哌酮舒巴坦静脉滴注抗感染，并密切复查肝功能。","is_gold":false},{"letter":"K","text":"给予保肝降酶药物治疗，并按比例降低后续颈部放疗靶区处方剂量。","is_gold":false},{"letter":"L","text":"立即行血浆置换治疗，暂停放疗及化疗。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：鼻腔。\n文本分期信息：N0，M0。\n综合TNM状态：T1N0M0。\n综合分期：IA。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D32] 检验组合: 胱抑素(Cys-C)-静脉血: 0.73mg/L；乳酸脱氢酶(LDH)-静脉血: 162.4U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.51mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；淋巴细胞百分比(Lymph%)-静脉血: 0.05；平均红细胞血红蛋白含量(MCH)-静脉血: 29.9pg；血红蛋白(Hb)-静脉血: 137.4g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 5.43mmol/L；白蛋白(ALB)-静脉血: 43.2g/L；肌酐(Crea)-静脉血: 86.7umol/L；氯离子(Cl-)-静脉血: 97.6mmol/L；C-反应蛋白(CRP)-静脉血: 6.52mg/L；钾离子(K+)-静脉血: 4.2mmol/L；尿酸(UA)-静脉血: 298.5umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.15mmolL；载脂蛋白B(apoB)-静脉血: 1.3g/L；血小板比容-静脉血: 14.7%；血小板分布宽度(PDW)-静脉血: 8.7%；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.41mmolL；有核红细胞百分比(NRBC%)-静脉血: 0；血小板比容-静脉血: 14%；总胆固醇(TC)-静脉血: 7.5mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；甘油三酯(TG)-静脉血: 1.38mmol/L；平均血小板体积(MPV)-静脉血: 8.9fL；平均红细胞体积(MCV)-静脉血: 90.2fL；γ-谷氨酰基转移酶(GGT)-静脉血: 97.8U/L；阴离子间隙(AG)-静脉血: 17；胱抑素(Cys-C)-静脉血: 1.03mg/L；氯离子(Cl-)-静脉血: 96.7mmol/L；血小板分布宽度(PDW)-静脉血: 16.1%；平均血小板体积(MPV)-静脉血: 6.78fL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；球蛋白(GLO)-静脉血: 35.61g/L；镁离子(Mg2+)-静脉血: 0.66mmol/L；间接胆红素(IBIL)-静脉血: 6.3umolL；γ-谷氨酰基转移酶(GGT)-静脉血: 151U/L；阴离子间隙(AG)-静脉血: 17；单核细胞计数(Mono#)-……\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗与化疗，给予异甘草酸镁静脉滴注，待转氨酶降至正常水平后重启治疗。\nB. 终止顺铂化疗，后续疗程替换为卡铂，并加用甲泼尼龙静脉滴注。\nC. 暂停放疗，继续按计划执行化疗，给予联苯双酯口服及静脉营养支持。\nD. 维持治疗节奏，暂不加用保肝药物，1周后常规复查肝肾功能。\nE. 加用恩替卡韦口服抗病毒治疗，并维持放化疗方案不变。\nF. 安排肝脏病灶穿刺活检，明确病理性质前暂停所有抗肿瘤治疗。\nG. 给予重组人粒细胞集落刺激因子皮下注射，辅以静脉营养支持。\nH. 给予联苯双酯等保肝降酶药物，辅以静脉营养支持，并密切复查肝功能。\nI. 给予重组人血小板生成素皮下注射，并推迟下一疗程化疗。\nJ. 给予头孢哌酮舒巴坦静脉滴注抗感染，并密切复查肝功能。\nK. 给予保肝降酶药物治疗，并按比例降低后续颈部放疗靶区处方剂量。\nL. 立即行血浆置换治疗，暂停放疗及化疗。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：鼻腔。\n文本分期信息：N0，M0。\n综合TNM状态：T1N0M0。\n综合分期：IA。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D32] 检验组合: 胱抑素(Cys-C)-静脉血: 0.73mg/L；乳酸脱氢酶(LDH)-静脉血: 162.4U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.51mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；淋巴细胞百分比(Lymph%)-静脉血: 0.05；平均红细胞血红蛋白含量(MCH)-静脉血: 29.9pg；血红蛋白(Hb)-静脉血: 137.4g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 5.43mmol/L；白蛋白(ALB)-静脉血: 43.2g/L；肌酐(Crea)-静脉血: 86.7umol/L；氯离子(Cl-)-静脉血: 97.6mmol/L；C-反应蛋白(CRP)-静脉血: 6.52mg/L；钾离子(K+)-静脉血: 4.2mmol/L；尿酸(UA)-静脉血: 298.5umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.15mmolL；载脂蛋白B(apoB)-静脉血: 1.3g/L；血小板比容-静脉血: 14.7%；血小板分布宽度(PDW)-静脉血: 8.7%；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.41mmolL；有核红细胞百分比(NRBC%)-静脉血: 0；血小板比容-静脉血: 14%；总胆固醇(TC)-静脉血: 7.5mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；甘油三酯(TG)-静脉血: 1.38mmol/L；平均血小板体积(MPV)-静脉血: 8.9fL；平均红细胞体积(MCV)-静脉血: 90.2fL；γ-谷氨酰基转移酶(GGT)-静脉血: 97.8U/L；阴离子间隙(AG)-静脉血: 17；胱抑素(Cys-C)-静脉血: 1.03mg/L；氯离子(Cl-)-静脉血: 96.7mmol/L；血小板分布宽度(PDW)-静脉血: 16.1%；平均血小板体积(MPV)-静脉血: 6.78fL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；球蛋白(GLO)-静脉血: 35.61g/L；镁离子(Mg2+)-静脉血: 0.66mmol/L；间接胆红素(IBIL)-静脉血: 6.3umolL；γ-谷氨酰基转移酶(GGT)-静脉血: 151U/L；阴离子间隙(AG)-静脉血: 17；单核细胞计数(Mono#)-……\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗与化疗，给予异甘草酸镁静脉滴注，待转氨酶降至正常水平后重启治疗。\nB. 终止顺铂化疗，后续疗程替换为卡铂，并加用甲泼尼龙静脉滴注。\nC. 暂停放疗，继续按计划执行化疗，给予联苯双酯口服及静脉营养支持。\nD. 维持治疗节奏，暂不加用保肝药物，1周后常规复查肝肾功能。\nE. 加用恩替卡韦口服抗病毒治疗，并维持放化疗方案不变。\nF. 安排肝脏病灶穿刺活检，明确病理性质前暂停所有抗肿瘤治疗。\nG. 给予重组人粒细胞集落刺激因子皮下注射，辅以静脉营养支持。\nH. 给予联苯双酯等保肝降酶药物，辅以静脉营养支持，并密切复查肝功能。\nI. 给予重组人血小板生成素皮下注射，并推迟下一疗程化疗。\nJ. 给予头孢哌酮舒巴坦静脉滴注抗感染，并密切复查肝功能。\nK. 给予保肝降酶药物治疗，并按比例降低后续颈部放疗靶区处方剂量。\nL. 立即行血浆置换治疗，暂停放疗及化疗。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-5eba0030ab5d024288a0d69d","patient_id":"patient-51e6f99c527367bbd97aebd8","turn_id":"turn07","turn_position":5,"turn_type":"response_assessment_decision","gold_letter":"I","gold_action":"继续根治性放疗，给予雾化吸入氨溴索与地塞米松，并局部外用三乙醇胺乳膏。","options":[{"letter":"A","text":"暂停放疗，给予静脉滴注广谱抗菌药物及大剂量糖皮质激素。","is_gold":false},{"letter":"B","text":"暂停放疗，行肝脏穿刺活检明确肝脏病灶性质后调整全身系统性化疗方案。","is_gold":false},{"letter":"C","text":"继续根治性放疗，给予重组人粒细胞集落刺激因子（G-CSF）皮下注射。","is_gold":false},{"letter":"D","text":"继续根治性放疗，加用第3程顺铂同期化疗，并给予静脉保肝药物。","is_gold":false},{"letter":"E","text":"终止放疗，转为TPF方案全身系统性化疗。","is_gold":false},{"letter":"F","text":"继续根治性放疗，局部外用强效糖皮质激素软膏，并口服非甾体抗炎药。","is_gold":false},{"letter":"G","text":"暂停放疗，复查鼻咽及颈部MRI以决定是否降低后续放疗靶区剂量。","is_gold":false},{"letter":"H","text":"继续根治性放疗，给予静脉异甘草酸镁及还原型谷胱甘肽保肝治疗。","is_gold":false},{"letter":"I","text":"继续根治性放疗，给予雾化吸入氨溴索与地塞米松，并局部外用三乙醇胺乳膏。","is_gold":true},{"letter":"J","text":"继续根治性放疗，联合靶向药物尼妥珠单抗及PD-1抑制剂治疗。","is_gold":false},{"letter":"K","text":"继续根治性放疗，给予静脉滴注地塞米松，并局部外用莫匹罗星软膏。","is_gold":false},{"letter":"L","text":"结束放化疗综合治疗，进入随访观察期，定期复查鼻咽MRI及颈部超声。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：鼻腔。\n文本分期信息：N0，M0。\n综合TNM状态：T1N0M0。\n综合分期：IA。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D41] 检验组合: 中性粒细胞计数(Neut#)-静脉血: 6.110E9/L；钠离子(Na+)-静脉血: 139.4mmol/L；尿素氮(BUN)-静脉血: 7.2mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.53；淋巴细胞计数(Lymph#)-静脉血: 0.910E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 42.7U/L；丙氨酸氨基转移酶(ALT)-静脉血: 35.4U/L；甘油三酯(TG)-静脉血: 1.71mmol/L；白细胞计数(WBC#)-静脉血: 7.7810E9/L；总蛋白(TP)-静脉血: 62.51g/L；血红蛋白(Hb)-静脉血: 131g/L；总钙(Ca)-静脉血: 2.05mmol/L；肌酐(Crea)-静脉血: 81.5umol/L；载脂蛋白B(apoB)-静脉血: 1.23g/L；白蛋白(ALB)-静脉血: 36.6g/L；中性粒细胞百分比(Neut%)-静脉血: 0.79；红细胞比容(Hct)-静脉血: 38.9%；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.6；淋巴细胞百分比(Lymph%)-静脉血: 0.113；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.006；大血小板百分比(P-LCR%)-静脉血: 15.3%；乳酸脱氢酶(LDH)-静脉血: 185.9U/L；间接胆红素(IBIL)-静脉血: 6.7umolL；氯离子(Cl-)-静脉血: 100.4mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.8U/L；血小板计数(PLT#)-静脉血: 15410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.3g/L；平均血小板体积(MPV)-静脉血: 8.9fL；胱抑素(Cys-C)-静脉血: 0.86mg/L；γ-谷氨酰基转移酶(GGT)-静脉血: 268.3U/L；总胆红素(TBIL)-静脉血: 8umol/L；葡萄糖(Glu)-静脉血: 5.28mmol/L；红细胞计数(RBC#)-静脉血: 4.3510E12/L；总胆汁酸(TBA)-静脉血: 2.7umol/L；血小板分……\n- [全程D49] 检验组合: 红细胞计数(RBC#)-尿液: 6/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；白细胞计数(WBC#)-尿液: 1/μL；比重(SG)-尿液: 1.009；胆红素(BIL)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: 无色；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮\n- [全程D50] 检验组合: 浊度(TRUB)-尿液: clear；酮体(KET)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 13/μL；比重(SG)-尿液: 1.017；白细胞计数(WBC#)-尿液: 10/μL；隐血(OB)-尿液: 1+0.6mg（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；总蛋白(TP)-尿液: -（参考: 阴性）；非鳞状上皮细胞计数-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 3/μL；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow\n- [全程D51] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；比重(SG)-尿液: 1.013；白细胞计数(WBC#)-尿液: 13/μL；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 8/μL；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；白细胞(LEU)-尿液: -（参考: 阴性）\n- [全程D52] 检验组合: 淋巴细胞百分比(Lymph%)-静脉血: 0.1；镁离子(Mg2+)-静脉血: 0.52mmol/L；尿素氮(BUN)-静脉血: 6.1mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.14mmolL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；总蛋白(TP)-静脉血: 64.42g/L；磷(P)-静脉血: 1.33mmol/L；总胆红素(TBIL)-静脉血: 6umol/L；氯离子(Cl-)-静脉血: 99.5mmol/L；红细胞比容(Hct)-静脉血: 36.9%；平均红细胞体积(MCV)-静脉血: 89.1fL；红细胞计数(RBC#)-静脉血: 4.1410E12/L；C-反应蛋白(CRP)-静脉血: 4.91mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；白细胞计数(WBC#)-静脉血: 3.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.253；血小板比容-静脉血: 20%；丙氨酸氨基转移酶(ALT)-静脉血: 42.9U/L；血液二氧化碳含量ctCO2(B)-静脉血: 26.2mmol/L；胱抑素(Cys-C)-静脉血: 1.28mg/L；球蛋白(GLO)-静脉血: 29.62g/L；甘油三酯(TG)-静脉血: 1.61mmol/L；尿酸(UA)-静脉血: 292.8umol/L；血小板分布宽度(PDW)-静脉血: 8.6%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.8；单核细胞计数(Mono#)-静脉血: 0.910E9/L；肌酐(Crea)-静脉血: 109.5umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.015；总胆固醇(TC)-静脉血: 5.96mmol/L；阴离子间隙(AG)-静脉血: 12；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 47U/L；平均血小板体积(MPV)-静脉血: 8.8fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.4；中性粒细胞百分比(Neut%)-静脉血: 0.626；总钙(Ca)-静脉血: 1.94mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.……\n- [全程D61] 超声；肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声不均匀，肝S5可见2个无回声灶，直径约3-4mm，边界清,内透声可，后方回声增强。血管走行清晰、自然，肝内胆管不扩张，门静脉内径约7mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约28cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约43×27×32mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝S5囊性灶，考虑肝囊肿可能性大。 胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D61] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，走行自然，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n\n【既往治疗与反应】\n- [全程D41] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者放疗中，诉口感、咽痛，余无不适。查体同前。复查血常规：基本正常，生化常规：正常。[姓名已隐去]医生信息已隐藏：患者DDP化疗后出现肝酶升高，考虑为药物性肝损害，经多种滑竿药物治疗后肝功能恢复正常，今日可办理出院，继续门诊放疗。\n- [全程D50] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，向患者及其家属交代病情及化疗风险，表示理解并已签署知情同意书，可于今日水化，明日执行第2程DDP方案同时期化疗，注意化疗不良反应。\n- [全程D51] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程DDP方案同时期化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D52] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第二程DDP单药同期化疗结束，诉咽痛、恶心、食欲下降，呕吐1次，伴头晕，无腹痛、腹泻等不适。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者同时期化疗结束，一般情况可，可以今日结账出院，门诊继续放疗。嘱定期复查血常规及肝肾功能，行放疗结束前常规检查。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，给予静脉滴注广谱抗菌药物及大剂量糖皮质激素。\nB. 暂停放疗，行肝脏穿刺活检明确肝脏病灶性质后调整全身系统性化疗方案。\nC. 继续根治性放疗，给予重组人粒细胞集落刺激因子（G-CSF）皮下注射。\nD. 继续根治性放疗，加用第3程顺铂同期化疗，并给予静脉保肝药物。\nE. 终止放疗，转为TPF方案全身系统性化疗。\nF. 继续根治性放疗，局部外用强效糖皮质激素软膏，并口服非甾体抗炎药。\nG. 暂停放疗，复查鼻咽及颈部MRI以决定是否降低后续放疗靶区剂量。\nH. 继续根治性放疗，给予静脉异甘草酸镁及还原型谷胱甘肽保肝治疗。\nI. 继续根治性放疗，给予雾化吸入氨溴索与地塞米松，并局部外用三乙醇胺乳膏。\nJ. 继续根治性放疗，联合靶向药物尼妥珠单抗及PD-1抑制剂治疗。\nK. 继续根治性放疗，给予静脉滴注地塞米松，并局部外用莫匹罗星软膏。\nL. 结束放化疗综合治疗，进入随访观察期，定期复查鼻咽MRI及颈部超声。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：鼻腔。\n文本分期信息：N0，M0。\n综合TNM状态：T1N0M0。\n综合分期：IA。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D41] 检验组合: 中性粒细胞计数(Neut#)-静脉血: 6.110E9/L；钠离子(Na+)-静脉血: 139.4mmol/L；尿素氮(BUN)-静脉血: 7.2mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.53；淋巴细胞计数(Lymph#)-静脉血: 0.910E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 42.7U/L；丙氨酸氨基转移酶(ALT)-静脉血: 35.4U/L；甘油三酯(TG)-静脉血: 1.71mmol/L；白细胞计数(WBC#)-静脉血: 7.7810E9/L；总蛋白(TP)-静脉血: 62.51g/L；血红蛋白(Hb)-静脉血: 131g/L；总钙(Ca)-静脉血: 2.05mmol/L；肌酐(Crea)-静脉血: 81.5umol/L；载脂蛋白B(apoB)-静脉血: 1.23g/L；白蛋白(ALB)-静脉血: 36.6g/L；中性粒细胞百分比(Neut%)-静脉血: 0.79；红细胞比容(Hct)-静脉血: 38.9%；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.6；淋巴细胞百分比(Lymph%)-静脉血: 0.113；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.006；大血小板百分比(P-LCR%)-静脉血: 15.3%；乳酸脱氢酶(LDH)-静脉血: 185.9U/L；间接胆红素(IBIL)-静脉血: 6.7umolL；氯离子(Cl-)-静脉血: 100.4mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.8U/L；血小板计数(PLT#)-静脉血: 15410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.3g/L；平均血小板体积(MPV)-静脉血: 8.9fL；胱抑素(Cys-C)-静脉血: 0.86mg/L；γ-谷氨酰基转移酶(GGT)-静脉血: 268.3U/L；总胆红素(TBIL)-静脉血: 8umol/L；葡萄糖(Glu)-静脉血: 5.28mmol/L；红细胞计数(RBC#)-静脉血: 4.3510E12/L；总胆汁酸(TBA)-静脉血: 2.7umol/L；血小板分……\n- [全程D49] 检验组合: 红细胞计数(RBC#)-尿液: 6/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；白细胞计数(WBC#)-尿液: 1/μL；比重(SG)-尿液: 1.009；胆红素(BIL)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: 无色；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮\n- [全程D50] 检验组合: 浊度(TRUB)-尿液: clear；酮体(KET)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 13/μL；比重(SG)-尿液: 1.017；白细胞计数(WBC#)-尿液: 10/μL；隐血(OB)-尿液: 1+0.6mg（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；总蛋白(TP)-尿液: -（参考: 阴性）；非鳞状上皮细胞计数-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 3/μL；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow\n- [全程D51] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；比重(SG)-尿液: 1.013；白细胞计数(WBC#)-尿液: 13/μL；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 8/μL；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；白细胞(LEU)-尿液: -（参考: 阴性）\n- [全程D52] 检验组合: 淋巴细胞百分比(Lymph%)-静脉血: 0.1；镁离子(Mg2+)-静脉血: 0.52mmol/L；尿素氮(BUN)-静脉血: 6.1mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.14mmolL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；总蛋白(TP)-静脉血: 64.42g/L；磷(P)-静脉血: 1.33mmol/L；总胆红素(TBIL)-静脉血: 6umol/L；氯离子(Cl-)-静脉血: 99.5mmol/L；红细胞比容(Hct)-静脉血: 36.9%；平均红细胞体积(MCV)-静脉血: 89.1fL；红细胞计数(RBC#)-静脉血: 4.1410E12/L；C-反应蛋白(CRP)-静脉血: 4.91mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；白细胞计数(WBC#)-静脉血: 3.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.253；血小板比容-静脉血: 20%；丙氨酸氨基转移酶(ALT)-静脉血: 42.9U/L；血液二氧化碳含量ctCO2(B)-静脉血: 26.2mmol/L；胱抑素(Cys-C)-静脉血: 1.28mg/L；球蛋白(GLO)-静脉血: 29.62g/L；甘油三酯(TG)-静脉血: 1.61mmol/L；尿酸(UA)-静脉血: 292.8umol/L；血小板分布宽度(PDW)-静脉血: 8.6%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.8；单核细胞计数(Mono#)-静脉血: 0.910E9/L；肌酐(Crea)-静脉血: 109.5umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.015；总胆固醇(TC)-静脉血: 5.96mmol/L；阴离子间隙(AG)-静脉血: 12；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 47U/L；平均血小板体积(MPV)-静脉血: 8.8fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.4；中性粒细胞百分比(Neut%)-静脉血: 0.626；总钙(Ca)-静脉血: 1.94mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.……\n- [全程D61] 超声；肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声不均匀，肝S5可见2个无回声灶，直径约3-4mm，边界清,内透声可，后方回声增强。血管走行清晰、自然，肝内胆管不扩张，门静脉内径约7mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约28cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约43×27×32mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝S5囊性灶，考虑肝囊肿可能性大。 胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D61] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，走行自然，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n\n【既往治疗与反应】\n- [全程D41] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者放疗中，诉口感、咽痛，余无不适。查体同前。复查血常规：基本正常，生化常规：正常。[姓名已隐去]医生信息已隐藏：患者DDP化疗后出现肝酶升高，考虑为药物性肝损害，经多种滑竿药物治疗后肝功能恢复正常，今日可办理出院，继续门诊放疗。\n- [全程D50] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，向患者及其家属交代病情及化疗风险，表示理解并已签署知情同意书，可于今日水化，明日执行第2程DDP方案同时期化疗，注意化疗不良反应。\n- [全程D51] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程DDP方案同时期化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D52] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第二程DDP单药同期化疗结束，诉咽痛、恶心、食欲下降，呕吐1次，伴头晕，无腹痛、腹泻等不适。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者同时期化疗结束，一般情况可，可以今日结账出院，门诊继续放疗。嘱定期复查血常规及肝肾功能，行放疗结束前常规检查。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，给予静脉滴注广谱抗菌药物及大剂量糖皮质激素。\nB. 暂停放疗，行肝脏穿刺活检明确肝脏病灶性质后调整全身系统性化疗方案。\nC. 继续根治性放疗，给予重组人粒细胞集落刺激因子（G-CSF）皮下注射。\nD. 继续根治性放疗，加用第3程顺铂同期化疗，并给予静脉保肝药物。\nE. 终止放疗，转为TPF方案全身系统性化疗。\nF. 继续根治性放疗，局部外用强效糖皮质激素软膏，并口服非甾体抗炎药。\nG. 暂停放疗，复查鼻咽及颈部MRI以决定是否降低后续放疗靶区剂量。\nH. 继续根治性放疗，给予静脉异甘草酸镁及还原型谷胱甘肽保肝治疗。\nI. 继续根治性放疗，给予雾化吸入氨溴索与地塞米松，并局部外用三乙醇胺乳膏。\nJ. 继续根治性放疗，联合靶向药物尼妥珠单抗及PD-1抑制剂治疗。\nK. 继续根治性放疗，给予静脉滴注地塞米松，并局部外用莫匹罗星软膏。\nL. 结束放化疗综合治疗，进入随访观察期，定期复查鼻咽MRI及颈部超声。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-24c04c80074ea3aab5465600","patient_id":"patient-51e6f99c527367bbd97aebd8","turn_id":"turn08","turn_position":6,"turn_type":"response_assessment_decision","gold_letter":"J","gold_action":"继续根治性放疗，给予雾化吸入（氨溴索、地塞米松）及局部外用药（三乙醇胺乳膏）处理急性放射性黏膜炎和皮炎。","options":[{"letter":"A","text":"暂停放疗，行腹部增强MRI或穿刺活检明确肝脏囊性病灶性质，待明确性质后再决定后续治疗方案。","is_gold":false},{"letter":"B","text":"继续根治性放疗，启动第三程顺铂单药同期化疗，并给予保肝、止吐及水化等预防性对症支持治疗。","is_gold":false},{"letter":"C","text":"继续根治性放疗，加用卡培他滨口服节拍化疗，并给予雾化吸入及局部外用药处理放疗反应。","is_gold":false},{"letter":"D","text":"提前结束放疗，给予静脉滴注大剂量糖皮质激素及广谱抗生素处理放射性黏膜炎和皮炎。","is_gold":false},{"letter":"E","text":"继续根治性放疗，给予静脉高营养支持处理急性放射性黏膜炎，并预防性使用重组人粒细胞刺激因子。","is_gold":false},{"letter":"F","text":"暂停放疗，复查鼻咽及颈部MRI，重新定位并缩减原发灶及颈部放疗靶区。","is_gold":false},{"letter":"G","text":"继续根治性放疗，行肝脏囊性灶局部射频消融治疗，并给予雾化吸入及局部外用药处理放疗反应。","is_gold":false},{"letter":"H","text":"继续根治性放疗，继续给予静脉双环醇等保肝药物强化治疗，并给予局部外用药处理放疗反应。","is_gold":false},{"letter":"I","text":"暂停放疗，给予局部清创换药，待皮肤及黏膜反应恢复至1级以下再恢复根治性放疗。","is_gold":false},{"letter":"J","text":"继续根治性放疗，给予雾化吸入（氨溴索、地塞米松）及局部外用药（三乙醇胺乳膏）处理急性放射性黏膜炎和皮炎。","is_gold":true},{"letter":"K","text":"继续根治性放疗，给予口服非甾体抗炎药缓解黏膜疼痛，并在局部皮炎处预防性涂抹抗生素软膏。","is_gold":false},{"letter":"L","text":"结束根治性放疗，进入定期随访阶段，给予雾化吸入及局部外用药处理急性放射性黏膜炎和皮炎。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：鼻腔。\n文本分期信息：N0，M0。\n综合TNM状态：T1N0M0。\n综合分期：IA。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- 无可展示记录。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，行腹部增强MRI或穿刺活检明确肝脏囊性病灶性质，待明确性质后再决定后续治疗方案。\nB. 继续根治性放疗，启动第三程顺铂单药同期化疗，并给予保肝、止吐及水化等预防性对症支持治疗。\nC. 继续根治性放疗，加用卡培他滨口服节拍化疗，并给予雾化吸入及局部外用药处理放疗反应。\nD. 提前结束放疗，给予静脉滴注大剂量糖皮质激素及广谱抗生素处理放射性黏膜炎和皮炎。\nE. 继续根治性放疗，给予静脉高营养支持处理急性放射性黏膜炎，并预防性使用重组人粒细胞刺激因子。\nF. 暂停放疗，复查鼻咽及颈部MRI，重新定位并缩减原发灶及颈部放疗靶区。\nG. 继续根治性放疗，行肝脏囊性灶局部射频消融治疗，并给予雾化吸入及局部外用药处理放疗反应。\nH. 继续根治性放疗，继续给予静脉双环醇等保肝药物强化治疗，并给予局部外用药处理放疗反应。\nI. 暂停放疗，给予局部清创换药，待皮肤及黏膜反应恢复至1级以下再恢复根治性放疗。\nJ. 继续根治性放疗，给予雾化吸入（氨溴索、地塞米松）及局部外用药（三乙醇胺乳膏）处理急性放射性黏膜炎和皮炎。\nK. 继续根治性放疗，给予口服非甾体抗炎药缓解黏膜疼痛，并在局部皮炎处预防性涂抹抗生素软膏。\nL. 结束根治性放疗，进入定期随访阶段，给予雾化吸入及局部外用药处理急性放射性黏膜炎和皮炎。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：鼻腔。\n文本分期信息：N0，M0。\n综合TNM状态：T1N0M0。\n综合分期：IA。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- 无可展示记录。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，行腹部增强MRI或穿刺活检明确肝脏囊性病灶性质，待明确性质后再决定后续治疗方案。\nB. 继续根治性放疗，启动第三程顺铂单药同期化疗，并给予保肝、止吐及水化等预防性对症支持治疗。\nC. 继续根治性放疗，加用卡培他滨口服节拍化疗，并给予雾化吸入及局部外用药处理放疗反应。\nD. 提前结束放疗，给予静脉滴注大剂量糖皮质激素及广谱抗生素处理放射性黏膜炎和皮炎。\nE. 继续根治性放疗，给予静脉高营养支持处理急性放射性黏膜炎，并预防性使用重组人粒细胞刺激因子。\nF. 暂停放疗，复查鼻咽及颈部MRI，重新定位并缩减原发灶及颈部放疗靶区。\nG. 继续根治性放疗，行肝脏囊性灶局部射频消融治疗，并给予雾化吸入及局部外用药处理放疗反应。\nH. 继续根治性放疗，继续给予静脉双环醇等保肝药物强化治疗，并给予局部外用药处理放疗反应。\nI. 暂停放疗，给予局部清创换药，待皮肤及黏膜反应恢复至1级以下再恢复根治性放疗。\nJ. 继续根治性放疗，给予雾化吸入（氨溴索、地塞米松）及局部外用药（三乙醇胺乳膏）处理急性放射性黏膜炎和皮炎。\nK. 继续根治性放疗，给予口服非甾体抗炎药缓解黏膜疼痛，并在局部皮炎处预防性涂抹抗生素软膏。\nL. 结束根治性放疗，进入定期随访阶段，给予雾化吸入及局部外用药处理急性放射性黏膜炎和皮炎。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-6bc929b6a549b509a4ffbecf","patient_id":"patient-867f2373fc1b04e0b8b80452","turn_id":"turn01","turn_position":1,"turn_type":"initial_workup_choice","gold_letter":"K","gold_action":"行电子鼻咽镜检查及组织活检以明确病理诊断，同时完善鼻咽及颈部MRI平扫加增强进行局部区域分期，并进行常规血液学检查。","options":[{"letter":"A","text":"电子鼻咽镜下活检，鼻咽及颈部CT平扫加增强，常规血液学检查","is_gold":false},{"letter":"B","text":"鼻咽及颈部MRI平扫加增强，全身PET-CT检查，常规血液学检查","is_gold":false},{"letter":"C","text":"电子鼻咽镜下活检，鼻咽MRI平扫加增强，常规血液学检查","is_gold":false},{"letter":"D","text":"电子鼻咽镜下活检，鼻咽及颈部MRI平扫，常规血液学检查","is_gold":false},{"letter":"E","text":"鼻咽及颈部CT平扫加增强，全身骨扫描，常规血液学检查","is_gold":false},{"letter":"F","text":"电子鼻咽镜下活检，鼻咽及颈部MRI平扫加增强，腰椎穿刺脑脊液检查","is_gold":false},{"letter":"G","text":"电子鼻咽镜下活检，全身PET-CT检查，常规血液学检查","is_gold":false},{"letter":"H","text":"鼻咽刷片细胞学检查，鼻咽及颈部MRI平扫加增强，常规血液学检查","is_gold":false},{"letter":"I","text":"电子鼻咽镜下活检，鼻咽及颈部MRI平扫加增强，颈部淋巴结穿刺活检","is_gold":false},{"letter":"J","text":"电子鼻咽镜下活检，鼻咽及颈部超声检查，常规血液学检查","is_gold":false},{"letter":"K","text":"电子鼻咽镜下活检，鼻咽及颈部MRI平扫加增强，常规血液学检查","is_gold":true},{"letter":"L","text":"鼻咽及颈部MRI平扫加增强，常规血液学检查，择期行鼻咽肿物切除术","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、鼻腔、翼外肌、斜坡、海绵窦、翼突基底部等。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1750] 入院记录: 主诉: 间断性涕血3月，面麻、复视1月，耳鸣20天；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 复视,涕血,双面麻；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟1包，30年，不嗜酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：88次/分，R：20次/分，BP：114/69mmHg,Ht：170cm，Wt：62kg，BSA：1.71m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 电子鼻咽镜下活检，鼻咽及颈部CT平扫加增强，常规血液学检查\nB. 鼻咽及颈部MRI平扫加增强，全身PET-CT检查，常规血液学检查\nC. 电子鼻咽镜下活检，鼻咽MRI平扫加增强，常规血液学检查\nD. 电子鼻咽镜下活检，鼻咽及颈部MRI平扫，常规血液学检查\nE. 鼻咽及颈部CT平扫加增强，全身骨扫描，常规血液学检查\nF. 电子鼻咽镜下活检，鼻咽及颈部MRI平扫加增强，腰椎穿刺脑脊液检查\nG. 电子鼻咽镜下活检，全身PET-CT检查，常规血液学检查\nH. 鼻咽刷片细胞学检查，鼻咽及颈部MRI平扫加增强，常规血液学检查\nI. 电子鼻咽镜下活检，鼻咽及颈部MRI平扫加增强，颈部淋巴结穿刺活检\nJ. 电子鼻咽镜下活检，鼻咽及颈部超声检查，常规血液学检查\nK. 电子鼻咽镜下活检，鼻咽及颈部MRI平扫加增强，常规血液学检查\nL. 鼻咽及颈部MRI平扫加增强，常规血液学检查，择期行鼻咽肿物切除术\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、鼻腔、翼外肌、斜坡、海绵窦、翼突基底部等。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1750] 入院记录: 主诉: 间断性涕血3月，面麻、复视1月，耳鸣20天；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 复视,涕血,双面麻；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟1包，30年，不嗜酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：88次/分，R：20次/分，BP：114/69mmHg,Ht：170cm，Wt：62kg，BSA：1.71m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 电子鼻咽镜下活检，鼻咽及颈部CT平扫加增强，常规血液学检查\nB. 鼻咽及颈部MRI平扫加增强，全身PET-CT检查，常规血液学检查\nC. 电子鼻咽镜下活检，鼻咽MRI平扫加增强，常规血液学检查\nD. 电子鼻咽镜下活检，鼻咽及颈部MRI平扫，常规血液学检查\nE. 鼻咽及颈部CT平扫加增强，全身骨扫描，常规血液学检查\nF. 电子鼻咽镜下活检，鼻咽及颈部MRI平扫加增强，腰椎穿刺脑脊液检查\nG. 电子鼻咽镜下活检，全身PET-CT检查，常规血液学检查\nH. 鼻咽刷片细胞学检查，鼻咽及颈部MRI平扫加增强，常规血液学检查\nI. 电子鼻咽镜下活检，鼻咽及颈部MRI平扫加增强，颈部淋巴结穿刺活检\nJ. 电子鼻咽镜下活检，鼻咽及颈部超声检查，常规血液学检查\nK. 电子鼻咽镜下活检，鼻咽及颈部MRI平扫加增强，常规血液学检查\nL. 鼻咽及颈部MRI平扫加增强，常规血液学检查，择期行鼻咽肿物切除术\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-31a839b9f99ab6bf0a218575","patient_id":"patient-867f2373fc1b04e0b8b80452","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"L","gold_action":"完善全身远处转移排查（如PET-CT或胸腹部CT联合骨扫描）及血浆EBV-DNA检测，并行超声引导下中心静脉穿刺置管及X线定位，为全身化疗做准备。","options":[{"letter":"A","text":"完善全身远处转移排查及血浆EBV-DNA检测，并直接安排单纯根治性放射治疗定位。","is_gold":false},{"letter":"B","text":"完善全身远处转移排查及血浆EBV-DNA检测，并请头颈外科会诊评估鼻咽及颈部病灶根治性切除可能。","is_gold":false},{"letter":"C","text":"完善胸部X线、腹部超声及血浆EBV-DNA检测进行分期，并行超声引导下中心静脉穿刺置管及X线定位，为全身化疗做准备。","is_gold":false},{"letter":"D","text":"完善全身远处转移排查及血浆EBV-DNA检测，并预防性行经皮内镜下胃造瘘术（PEG）以保障放化疗期间营养。","is_gold":false},{"letter":"E","text":"安排鼻咽镜下再次活检以明确组织学亚型，暂缓全身远处转移排查及静脉置管，待病理亚型确诊后再行后续安排。","is_gold":false},{"letter":"F","text":"完善全身远处转移排查及血浆EBV-DNA检测，并直接通过外周静脉留置针（PIV）启动全身化疗。","is_gold":false},{"letter":"G","text":"完善全身骨扫描及血浆EBV-DNA检测，并行超声引导下中心静脉穿刺置管及X线定位，为全身化疗做准备。","is_gold":false},{"letter":"H","text":"完善全身远处转移排查及血浆EBV-DNA检测，并先行双侧颈部淋巴结清扫术，术后行全身化疗。","is_gold":false},{"letter":"I","text":"完善全身远处转移排查及血浆EBV-DNA检测，并安排单药免疫治疗作为诱导治疗，无需中心静脉置管。","is_gold":false},{"letter":"J","text":"完善全身远处转移排查及血浆EBV-DNA检测，并安排超声引导下颈部淋巴结穿刺活检以病理确诊N分期。","is_gold":false},{"letter":"K","text":"完善全身远处转移排查及血浆EBV-DNA检测，并常规安排腰椎穿刺脑脊液检查以排除脑膜转移。","is_gold":false},{"letter":"L","text":"完善全身远处转移排查（如PET-CT或胸腹部CT联合骨扫描）及血浆EBV-DNA检测，并行超声引导下中心静脉穿刺置管及X线定位，为全身化疗做准备。","is_gold":true}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、鼻腔、翼外肌、斜坡、海绵窦、翼突基底部等。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D1751] 检验组合: 阴离子间隙(AG)-静脉血: 18.2；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；平均血小板体积(MPV)-静脉血: 9.8fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.8；白细胞计数(WBC#)-静脉血: 6.2310E9/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 64.8umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阳性(+)（参考: 阴性）；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.92mmol/L；透明质酸(HA)-静脉血: 91.434ng/ml；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.4U/L；氯离子(Cl-)-静脉血: 101.8mmol/L；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 1.43ng/ml（参考: <0.704）；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；血小板比容-静脉血: 20%；活化部分凝血活酶时间(APTT)-静脉血: 27.5sec.；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.62；梅毒非特异性抗体甲苯胺红不加热血清试验(TRUST)-静脉血: 阴性(-)（参考: 阴性）；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；总钙(Ca)-静脉血: 2.27mmol/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.43；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；凝血酶时间(TT)-静脉血: 17.6sec.；间接胆红素(IBIL)-静脉血: 6.6umolL；凝血酶原时间活动度(PTA)-静脉血: 97.9%；降钙素(CT)-静脉血: 25.774pg/ml；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 44.9U/L……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善全身远处转移排查及血浆EBV-DNA检测，并直接安排单纯根治性放射治疗定位。\nB. 完善全身远处转移排查及血浆EBV-DNA检测，并请头颈外科会诊评估鼻咽及颈部病灶根治性切除可能。\nC. 完善胸部X线、腹部超声及血浆EBV-DNA检测进行分期，并行超声引导下中心静脉穿刺置管及X线定位，为全身化疗做准备。\nD. 完善全身远处转移排查及血浆EBV-DNA检测，并预防性行经皮内镜下胃造瘘术（PEG）以保障放化疗期间营养。\nE. 安排鼻咽镜下再次活检以明确组织学亚型，暂缓全身远处转移排查及静脉置管，待病理亚型确诊后再行后续安排。\nF. 完善全身远处转移排查及血浆EBV-DNA检测，并直接通过外周静脉留置针（PIV）启动全身化疗。\nG. 完善全身骨扫描及血浆EBV-DNA检测，并行超声引导下中心静脉穿刺置管及X线定位，为全身化疗做准备。\nH. 完善全身远处转移排查及血浆EBV-DNA检测，并先行双侧颈部淋巴结清扫术，术后行全身化疗。\nI. 完善全身远处转移排查及血浆EBV-DNA检测，并安排单药免疫治疗作为诱导治疗，无需中心静脉置管。\nJ. 完善全身远处转移排查及血浆EBV-DNA检测，并安排超声引导下颈部淋巴结穿刺活检以病理确诊N分期。\nK. 完善全身远处转移排查及血浆EBV-DNA检测，并常规安排腰椎穿刺脑脊液检查以排除脑膜转移。\nL. 完善全身远处转移排查（如PET-CT或胸腹部CT联合骨扫描）及血浆EBV-DNA检测，并行超声引导下中心静脉穿刺置管及X线定位，为全身化疗做准备。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、鼻腔、翼外肌、斜坡、海绵窦、翼突基底部等。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D1751] 检验组合: 阴离子间隙(AG)-静脉血: 18.2；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；平均血小板体积(MPV)-静脉血: 9.8fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.8；白细胞计数(WBC#)-静脉血: 6.2310E9/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 64.8umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阳性(+)（参考: 阴性）；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.92mmol/L；透明质酸(HA)-静脉血: 91.434ng/ml；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.4U/L；氯离子(Cl-)-静脉血: 101.8mmol/L；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 1.43ng/ml（参考: <0.704）；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；血小板比容-静脉血: 20%；活化部分凝血活酶时间(APTT)-静脉血: 27.5sec.；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.62；梅毒非特异性抗体甲苯胺红不加热血清试验(TRUST)-静脉血: 阴性(-)（参考: 阴性）；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；总钙(Ca)-静脉血: 2.27mmol/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.43；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；凝血酶时间(TT)-静脉血: 17.6sec.；间接胆红素(IBIL)-静脉血: 6.6umolL；凝血酶原时间活动度(PTA)-静脉血: 97.9%；降钙素(CT)-静脉血: 25.774pg/ml；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 44.9U/L……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善全身远处转移排查及血浆EBV-DNA检测，并直接安排单纯根治性放射治疗定位。\nB. 完善全身远处转移排查及血浆EBV-DNA检测，并请头颈外科会诊评估鼻咽及颈部病灶根治性切除可能。\nC. 完善胸部X线、腹部超声及血浆EBV-DNA检测进行分期，并行超声引导下中心静脉穿刺置管及X线定位，为全身化疗做准备。\nD. 完善全身远处转移排查及血浆EBV-DNA检测，并预防性行经皮内镜下胃造瘘术（PEG）以保障放化疗期间营养。\nE. 安排鼻咽镜下再次活检以明确组织学亚型，暂缓全身远处转移排查及静脉置管，待病理亚型确诊后再行后续安排。\nF. 完善全身远处转移排查及血浆EBV-DNA检测，并直接通过外周静脉留置针（PIV）启动全身化疗。\nG. 完善全身骨扫描及血浆EBV-DNA检测，并行超声引导下中心静脉穿刺置管及X线定位，为全身化疗做准备。\nH. 完善全身远处转移排查及血浆EBV-DNA检测，并先行双侧颈部淋巴结清扫术，术后行全身化疗。\nI. 完善全身远处转移排查及血浆EBV-DNA检测，并安排单药免疫治疗作为诱导治疗，无需中心静脉置管。\nJ. 完善全身远处转移排查及血浆EBV-DNA检测，并安排超声引导下颈部淋巴结穿刺活检以病理确诊N分期。\nK. 完善全身远处转移排查及血浆EBV-DNA检测，并常规安排腰椎穿刺脑脊液检查以排除脑膜转移。\nL. 完善全身远处转移排查（如PET-CT或胸腹部CT联合骨扫描）及血浆EBV-DNA检测，并行超声引导下中心静脉穿刺置管及X线定位，为全身化疗做准备。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-9833293530ca96a9a65dbbb8","patient_id":"patient-867f2373fc1b04e0b8b80452","turn_id":"turn04","turn_position":3,"turn_type":"initial_treatment_selection","gold_letter":"B","gold_action":"诱导化疗（洛铂+氟尿嘧啶）序贯同期放化疗","options":[{"letter":"A","text":"诱导化疗（吉西他滨+顺铂）序贯单纯根治性放疗","is_gold":false},{"letter":"B","text":"诱导化疗（洛铂+氟尿嘧啶）序贯同期放化疗","is_gold":true},{"letter":"C","text":"同期放化疗（顺铂单药）序贯辅助化疗","is_gold":false},{"letter":"D","text":"诱导化疗（多西他赛+顺铂+氟尿嘧啶）序贯单纯根治性放疗","is_gold":false},{"letter":"E","text":"诱导化疗（紫杉醇+卡铂）序贯同期放化疗","is_gold":false},{"letter":"F","text":"靶向治疗（西妥昔单抗）联合根治性放疗","is_gold":false},{"letter":"G","text":"诱导化疗（洛铂+氟尿嘧啶）联合特瑞普利单抗序贯同期放化疗","is_gold":false},{"letter":"H","text":"诱导化疗（依托泊苷+顺铂）序贯同期放化疗","is_gold":false},{"letter":"I","text":"单纯根治性放疗序贯辅助化疗","is_gold":false},{"letter":"J","text":"诱导化疗（顺铂+氟尿嘧啶）序贯单纯根治性放疗","is_gold":false},{"letter":"K","text":"诱导化疗（吉西他滨+卡培他滨）序贯同期放化疗","is_gold":false},{"letter":"L","text":"姑息性化疗（洛铂+氟尿嘧啶）序贯姑息性放疗","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、鼻腔、翼外肌、斜坡、海绵窦、翼突基底部等。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1750] 入院记录: 主诉: 间断性涕血3月，面麻、复视1月，耳鸣20天；现病史: 缘于3月余前患者无明显诱因出现间断性回吸性涕血，未予重视，一月前患者出现双侧面麻、复视，无鼻塞、头痛、视力下降等不适，遂就诊当地医院行鼻咽活检病理确诊鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 复视,涕血,双面麻；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟1包，30年，不嗜酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：88次/分，R：20次/分，BP：114/69mmHg,Ht：170cm，Wt：62kg，BSA：1.71m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率88次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 无可展示记录。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 诱导化疗（吉西他滨+顺铂）序贯单纯根治性放疗\nB. 诱导化疗（洛铂+氟尿嘧啶）序贯同期放化疗\nC. 同期放化疗（顺铂单药）序贯辅助化疗\nD. 诱导化疗（多西他赛+顺铂+氟尿嘧啶）序贯单纯根治性放疗\nE. 诱导化疗（紫杉醇+卡铂）序贯同期放化疗\nF. 靶向治疗（西妥昔单抗）联合根治性放疗\nG. 诱导化疗（洛铂+氟尿嘧啶）联合特瑞普利单抗序贯同期放化疗\nH. 诱导化疗（依托泊苷+顺铂）序贯同期放化疗\nI. 单纯根治性放疗序贯辅助化疗\nJ. 诱导化疗（顺铂+氟尿嘧啶）序贯单纯根治性放疗\nK. 诱导化疗（吉西他滨+卡培他滨）序贯同期放化疗\nL. 姑息性化疗（洛铂+氟尿嘧啶）序贯姑息性放疗\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、鼻腔、翼外肌、斜坡、海绵窦、翼突基底部等。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1750] 入院记录: 主诉: 间断性涕血3月，面麻、复视1月，耳鸣20天；现病史: 缘于3月余前患者无明显诱因出现间断性回吸性涕血，未予重视，一月前患者出现双侧面麻、复视，无鼻塞、头痛、视力下降等不适，遂就诊当地医院行鼻咽活检病理确诊鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 复视,涕血,双面麻；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟1包，30年，不嗜酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：88次/分，R：20次/分，BP：114/69mmHg,Ht：170cm，Wt：62kg，BSA：1.71m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率88次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 无可展示记录。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 诱导化疗（吉西他滨+顺铂）序贯单纯根治性放疗\nB. 诱导化疗（洛铂+氟尿嘧啶）序贯同期放化疗\nC. 同期放化疗（顺铂单药）序贯辅助化疗\nD. 诱导化疗（多西他赛+顺铂+氟尿嘧啶）序贯单纯根治性放疗\nE. 诱导化疗（紫杉醇+卡铂）序贯同期放化疗\nF. 靶向治疗（西妥昔单抗）联合根治性放疗\nG. 诱导化疗（洛铂+氟尿嘧啶）联合特瑞普利单抗序贯同期放化疗\nH. 诱导化疗（依托泊苷+顺铂）序贯同期放化疗\nI. 单纯根治性放疗序贯辅助化疗\nJ. 诱导化疗（顺铂+氟尿嘧啶）序贯单纯根治性放疗\nK. 诱导化疗（吉西他滨+卡培他滨）序贯同期放化疗\nL. 姑息性化疗（洛铂+氟尿嘧啶）序贯姑息性放疗\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-5d0eff95cd33597017422fc5","patient_id":"patient-867f2373fc1b04e0b8b80452","turn_id":"turn05","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"C","gold_action":"予以止呕、护胃等对症支持，办理出院；嘱院外每周复查血常规及肝肾功能，定期进行PICC导管维护，按期返院行下一程治疗。","options":[{"letter":"A","text":"予以止呕、护胃等对症支持，继续住院观察至消化道反应完全缓解后再予出院，出院后按期返院行下一程治疗。","is_gold":false},{"letter":"B","text":"予以止呕、护胃等对症支持，办理出院；下一程化疗将洛铂及5-FU剂量下调20%，嘱院外每周复查血常规及肝肾功能。","is_gold":false},{"letter":"C","text":"予以止呕、护胃等对症支持，办理出院；嘱院外每周复查血常规及肝肾功能，定期进行PICC导管维护，按期返院行下一程治疗。","is_gold":true},{"letter":"D","text":"予以止呕、护胃等对症支持，办理出院；嘱院外预防性皮下注射重组人粒细胞刺激因子（G-CSF），每周复查血常规。","is_gold":false},{"letter":"E","text":"予以止呕、护胃等对症支持，办理出院；下一程化疗方案更改为吉西他滨+顺铂（GP方案），嘱院外每周复查血常规。","is_gold":false},{"letter":"F","text":"予以止呕、护胃等对症支持，办理出院；嘱院外每周复查血常规及肝肾功能，并拔除PICC导管以防感染。","is_gold":false},{"letter":"G","text":"予以止呕、护胃等对症支持，办理出院；嘱院外每月复查一次血常规及肝肾功能，按期返院行下一程治疗。","is_gold":false},{"letter":"H","text":"予以止呕、护胃等对症支持，办理出院；上报严重不良事件（SAE）并暂停临床试验入组治疗，转为常规放化疗。","is_gold":false},{"letter":"I","text":"予以止呕、护胃等对症支持，办理出院；嘱院外口服卡培他滨维持治疗，按期返院行下一程静脉化疗。","is_gold":false},{"letter":"J","text":"予以止呕、护胃等对症支持，办理出院；嘱院外每周复查血常规及肝肾功能，并于院外立即开始同步放射治疗。","is_gold":false},{"letter":"K","text":"予以止呕、护胃等对症支持，常规留取大便隐血及行腹部CT检查排除消化道并发症后，再办理出院。","is_gold":false},{"letter":"L","text":"予以止呕、护胃等对症支持，办理出院；嘱院外每周复查血常规及肝肾功能，若出现发热则自行口服抗生素观察。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、鼻腔、翼外肌、斜坡、海绵窦、翼突基底部等。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D1754] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右旁T7椎体上缘水平，估计位于上腔静脉内。；检查结论: PICC管位置如上所述。\n- [全程D1758] 检验组合: 红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.410E9/L；总胆红素(TBIL)-静脉血: 15.3umol/L；葡萄糖(Glu)-静脉血: 4.9mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.6pg；间接胆红素(IBIL)-静脉血: 10.2umolL；肌酐(Crea)-静脉血: 67.1umol/L；血小板计数(PLT#)-静脉血: 159.110E9/L；中性粒细胞计数(Neut#)-静脉血: 5.210E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；血小板比容-静脉血: 13.7%；氯离子(Cl-)-静脉血: 100.4mmol/L；尿素氮(BUN)-静脉血: 5.1mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；平均血小板体积(MPV)-静脉血: 8.66fL；白蛋白(ALB)-静脉血: 36.6g/L；载脂蛋白B(apoB)-静脉血: 0.97g/L；C-反应蛋白(CRP)-静脉血: 17.22mg/L；乳酸脱氢酶(LDH)-静脉血: 196.7U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.69mmol/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；尿酸(UA)-静脉血: 195.2umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.759；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.37；总胆固醇(TC)-静脉血: 4.18mmol/L；钾离子(K+)-静脉血: 4.29mmol/L；单核细胞百分比(Mono%)-静脉血: 0.062；α-L-岩藻糖苷酶(AFU)-静脉血: 34.2U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.97；直接胆红素(DBIL)-静脉血: 5.1umol/L；碱性磷酸酶(ALP)-静脉血: 54.4U/L；有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞体积(MCV)-静脉血: 90.4fL；白细胞计数(WBC#)-静脉血: 6.810E9/L；总蛋白(TP)-静脉血: 63.4g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15U/L；甘油三酯(TG)-静脉血: 0.61mmol/L；球蛋白(……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1751] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者入院第二天，无特殊不适主诉，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。复查血常规、生化常规结果无异常。[姓名已隐去]副医生信息已隐藏：现等待患者鼻咽颈部影像学检查结果，明确分期后再行进一步诊治，病情继观。\n- [全程D1752] 上级查房记录；[姓名已隐去]医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医师查房记录；病程内容: 患者入院第三天，无诉，体查情况基本同前，[姓名已隐去]医师查房后示：等待患者影像学检查结果，明确分期后再行进一步诊治，余治疗同前，继观。\n- [全程D1758] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者处于一程洛铂+5FU方案诱导化疗中，诉恶心、呕吐，一般情况可，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。复查血常规、生化常规结果基本正常，[姓名已隐去]副医生信息已隐藏：现患者已完成一程诱导化疗，情况尚可，予以止呕、护胃等对症支持，嘱今日可予以出院，按期返院，不适随诊。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 予以止呕、护胃等对症支持，继续住院观察至消化道反应完全缓解后再予出院，出院后按期返院行下一程治疗。\nB. 予以止呕、护胃等对症支持，办理出院；下一程化疗将洛铂及5-FU剂量下调20%，嘱院外每周复查血常规及肝肾功能。\nC. 予以止呕、护胃等对症支持，办理出院；嘱院外每周复查血常规及肝肾功能，定期进行PICC导管维护，按期返院行下一程治疗。\nD. 予以止呕、护胃等对症支持，办理出院；嘱院外预防性皮下注射重组人粒细胞刺激因子（G-CSF），每周复查血常规。\nE. 予以止呕、护胃等对症支持，办理出院；下一程化疗方案更改为吉西他滨+顺铂（GP方案），嘱院外每周复查血常规。\nF. 予以止呕、护胃等对症支持，办理出院；嘱院外每周复查血常规及肝肾功能，并拔除PICC导管以防感染。\nG. 予以止呕、护胃等对症支持，办理出院；嘱院外每月复查一次血常规及肝肾功能，按期返院行下一程治疗。\nH. 予以止呕、护胃等对症支持，办理出院；上报严重不良事件（SAE）并暂停临床试验入组治疗，转为常规放化疗。\nI. 予以止呕、护胃等对症支持，办理出院；嘱院外口服卡培他滨维持治疗，按期返院行下一程静脉化疗。\nJ. 予以止呕、护胃等对症支持，办理出院；嘱院外每周复查血常规及肝肾功能，并于院外立即开始同步放射治疗。\nK. 予以止呕、护胃等对症支持，常规留取大便隐血及行腹部CT检查排除消化道并发症后，再办理出院。\nL. 予以止呕、护胃等对症支持，办理出院；嘱院外每周复查血常规及肝肾功能，若出现发热则自行口服抗生素观察。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、鼻腔、翼外肌、斜坡、海绵窦、翼突基底部等。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D1754] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右旁T7椎体上缘水平，估计位于上腔静脉内。；检查结论: PICC管位置如上所述。\n- [全程D1758] 检验组合: 红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.410E9/L；总胆红素(TBIL)-静脉血: 15.3umol/L；葡萄糖(Glu)-静脉血: 4.9mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.6pg；间接胆红素(IBIL)-静脉血: 10.2umolL；肌酐(Crea)-静脉血: 67.1umol/L；血小板计数(PLT#)-静脉血: 159.110E9/L；中性粒细胞计数(Neut#)-静脉血: 5.210E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；血小板比容-静脉血: 13.7%；氯离子(Cl-)-静脉血: 100.4mmol/L；尿素氮(BUN)-静脉血: 5.1mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；平均血小板体积(MPV)-静脉血: 8.66fL；白蛋白(ALB)-静脉血: 36.6g/L；载脂蛋白B(apoB)-静脉血: 0.97g/L；C-反应蛋白(CRP)-静脉血: 17.22mg/L；乳酸脱氢酶(LDH)-静脉血: 196.7U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.69mmol/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；尿酸(UA)-静脉血: 195.2umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.759；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.37；总胆固醇(TC)-静脉血: 4.18mmol/L；钾离子(K+)-静脉血: 4.29mmol/L；单核细胞百分比(Mono%)-静脉血: 0.062；α-L-岩藻糖苷酶(AFU)-静脉血: 34.2U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.97；直接胆红素(DBIL)-静脉血: 5.1umol/L；碱性磷酸酶(ALP)-静脉血: 54.4U/L；有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞体积(MCV)-静脉血: 90.4fL；白细胞计数(WBC#)-静脉血: 6.810E9/L；总蛋白(TP)-静脉血: 63.4g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15U/L；甘油三酯(TG)-静脉血: 0.61mmol/L；球蛋白(……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1751] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者入院第二天，无特殊不适主诉，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。复查血常规、生化常规结果无异常。[姓名已隐去]副医生信息已隐藏：现等待患者鼻咽颈部影像学检查结果，明确分期后再行进一步诊治，病情继观。\n- [全程D1752] 上级查房记录；[姓名已隐去]医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医师查房记录；病程内容: 患者入院第三天，无诉，体查情况基本同前，[姓名已隐去]医师查房后示：等待患者影像学检查结果，明确分期后再行进一步诊治，余治疗同前，继观。\n- [全程D1758] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者处于一程洛铂+5FU方案诱导化疗中，诉恶心、呕吐，一般情况可，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。复查血常规、生化常规结果基本正常，[姓名已隐去]副医生信息已隐藏：现患者已完成一程诱导化疗，情况尚可，予以止呕、护胃等对症支持，嘱今日可予以出院，按期返院，不适随诊。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 予以止呕、护胃等对症支持，继续住院观察至消化道反应完全缓解后再予出院，出院后按期返院行下一程治疗。\nB. 予以止呕、护胃等对症支持，办理出院；下一程化疗将洛铂及5-FU剂量下调20%，嘱院外每周复查血常规及肝肾功能。\nC. 予以止呕、护胃等对症支持，办理出院；嘱院外每周复查血常规及肝肾功能，定期进行PICC导管维护，按期返院行下一程治疗。\nD. 予以止呕、护胃等对症支持，办理出院；嘱院外预防性皮下注射重组人粒细胞刺激因子（G-CSF），每周复查血常规。\nE. 予以止呕、护胃等对症支持，办理出院；下一程化疗方案更改为吉西他滨+顺铂（GP方案），嘱院外每周复查血常规。\nF. 予以止呕、护胃等对症支持，办理出院；嘱院外每周复查血常规及肝肾功能，并拔除PICC导管以防感染。\nG. 予以止呕、护胃等对症支持，办理出院；嘱院外每月复查一次血常规及肝肾功能，按期返院行下一程治疗。\nH. 予以止呕、护胃等对症支持，办理出院；上报严重不良事件（SAE）并暂停临床试验入组治疗，转为常规放化疗。\nI. 予以止呕、护胃等对症支持，办理出院；嘱院外口服卡培他滨维持治疗，按期返院行下一程静脉化疗。\nJ. 予以止呕、护胃等对症支持，办理出院；嘱院外每周复查血常规及肝肾功能，并于院外立即开始同步放射治疗。\nK. 予以止呕、护胃等对症支持，常规留取大便隐血及行腹部CT检查排除消化道并发症后，再办理出院。\nL. 予以止呕、护胃等对症支持，办理出院；嘱院外每周复查血常规及肝肾功能，若出现发热则自行口服抗生素观察。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-be610c2d167fae3585440ece","patient_id":"patient-867f2373fc1b04e0b8b80452","turn_id":"turn06","turn_position":5,"turn_type":"toxicity_or_support_decision","gold_letter":"D","gold_action":"按计划开展第二周期洛铂+5-FU诱导化疗，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗","options":[{"letter":"A","text":"暂缓化疗，予以重组人粒细胞集落刺激因子升白治疗，待中性粒细胞绝对值恢复至2.0×10^9/L以上再行第二周期化疗","is_gold":false},{"letter":"B","text":"开展第二周期洛铂+5-FU诱导化疗，将洛铂剂量下调20%，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃","is_gold":false},{"letter":"C","text":"终止诱导化疗，直接进入同期放化疗阶段，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗","is_gold":false},{"letter":"D","text":"按计划开展第二周期洛铂+5-FU诱导化疗，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗","is_gold":true},{"letter":"E","text":"开展第二周期洛铂+5-FU诱导化疗，暂不予以预防性止吐，待出现恶心呕吐症状时再予以甲氧氯普胺解痉止吐","is_gold":false},{"letter":"F","text":"更改化疗方案为紫杉醇+顺铂方案进行第二周期诱导化疗，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃","is_gold":false},{"letter":"G","text":"开展第二周期洛铂+5-FU诱导化疗，并预防性予以阿瑞匹坦、地塞米松联合5-HT3受体拮抗剂三联强效止吐","is_gold":false},{"letter":"H","text":"暂缓化疗，复查鼻咽颈部MRI评估一程化疗疗效，若肿瘤缩小则继续原方案，否则更改为紫杉醇+顺铂方案","is_gold":false},{"letter":"I","text":"开展第二周期洛铂+5-FU诱导化疗，将5-FU剂量下调25%，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃","is_gold":false},{"letter":"J","text":"暂缓化疗，予以静脉高营养支持及补液治疗，待消化道症状完全缓解、体重增加后再行第二周期诱导化疗","is_gold":false},{"letter":"K","text":"退出临床试验，更改为顺铂+5-FU方案进行第二周期诱导化疗，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃","is_gold":false},{"letter":"L","text":"开展第二周期洛铂+5-FU诱导化疗，并预防性予以奥氮平联合地塞米松双联止吐及质子泵抑制剂护胃支持治疗","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、鼻腔、翼外肌、斜坡、海绵窦、翼突基底部等。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D1772] 检验组合: 总胆红素(TBIL)-静脉血: 7.6umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.472；红细胞计数(RBC#)-静脉血: 4.2810E12/L；直接胆红素(DBIL)-静脉血: 1.4umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.281；中性粒细胞计数(Neut#)-静脉血: 1.810E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.07；载脂蛋白B(apoB)-静脉血: 1.11g/L；血小板比容-静脉血: 18%；磷(P)-静脉血: 1.23mmol/L；总蛋白(TP)-静脉血: 70.84g/L；平均红细胞体积(MCV)-静脉血: 93.5fL；间接胆红素(IBIL)-静脉血: 6.2umolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.78；丙氨酸氨基转移酶(ALT)-静脉血: 20.8U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.6pg；乳酸脱氢酶(LDH)-静脉血: 173.8U/L；白蛋白(ALB)-静脉血: 41.6g/L；钾离子(K+)-静脉血: 4.12mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 20.8mmol/L；钠离子(Na+)-静脉血: 140.8mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.55mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.33g/L；尿素氮(BUN)-静脉血: 5.1mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.42；甘油三酯(TG)-静脉血: 0.99mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.2；碱性磷酸酶(ALP)-静脉血: 67.2U/L；肌酐(Crea)-静脉血: 68.4umol/L；C-反应蛋白(CRP)-静脉血: 1.24mg/L；血小板计数(PLT#)-静脉血: 18110E9/L；红细胞比容(Hct)-静脉血: 40%；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 30.4U/L；血红蛋白(Hb)-静脉血: 131g/L；镁离子(Mg2+)-静脉血: 0.92mmol/L；平均红细胞血红蛋白……\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂缓化疗，予以重组人粒细胞集落刺激因子升白治疗，待中性粒细胞绝对值恢复至2.0×10^9/L以上再行第二周期化疗\nB. 开展第二周期洛铂+5-FU诱导化疗，将洛铂剂量下调20%，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃\nC. 终止诱导化疗，直接进入同期放化疗阶段，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nD. 按计划开展第二周期洛铂+5-FU诱导化疗，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nE. 开展第二周期洛铂+5-FU诱导化疗，暂不予以预防性止吐，待出现恶心呕吐症状时再予以甲氧氯普胺解痉止吐\nF. 更改化疗方案为紫杉醇+顺铂方案进行第二周期诱导化疗，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃\nG. 开展第二周期洛铂+5-FU诱导化疗，并预防性予以阿瑞匹坦、地塞米松联合5-HT3受体拮抗剂三联强效止吐\nH. 暂缓化疗，复查鼻咽颈部MRI评估一程化疗疗效，若肿瘤缩小则继续原方案，否则更改为紫杉醇+顺铂方案\nI. 开展第二周期洛铂+5-FU诱导化疗，将5-FU剂量下调25%，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃\nJ. 暂缓化疗，予以静脉高营养支持及补液治疗，待消化道症状完全缓解、体重增加后再行第二周期诱导化疗\nK. 退出临床试验，更改为顺铂+5-FU方案进行第二周期诱导化疗，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃\nL. 开展第二周期洛铂+5-FU诱导化疗，并预防性予以奥氮平联合地塞米松双联止吐及质子泵抑制剂护胃支持治疗\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、鼻腔、翼外肌、斜坡、海绵窦、翼突基底部等。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D1772] 检验组合: 总胆红素(TBIL)-静脉血: 7.6umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.472；红细胞计数(RBC#)-静脉血: 4.2810E12/L；直接胆红素(DBIL)-静脉血: 1.4umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.281；中性粒细胞计数(Neut#)-静脉血: 1.810E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.07；载脂蛋白B(apoB)-静脉血: 1.11g/L；血小板比容-静脉血: 18%；磷(P)-静脉血: 1.23mmol/L；总蛋白(TP)-静脉血: 70.84g/L；平均红细胞体积(MCV)-静脉血: 93.5fL；间接胆红素(IBIL)-静脉血: 6.2umolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.78；丙氨酸氨基转移酶(ALT)-静脉血: 20.8U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.6pg；乳酸脱氢酶(LDH)-静脉血: 173.8U/L；白蛋白(ALB)-静脉血: 41.6g/L；钾离子(K+)-静脉血: 4.12mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 20.8mmol/L；钠离子(Na+)-静脉血: 140.8mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.55mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.33g/L；尿素氮(BUN)-静脉血: 5.1mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.42；甘油三酯(TG)-静脉血: 0.99mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.2；碱性磷酸酶(ALP)-静脉血: 67.2U/L；肌酐(Crea)-静脉血: 68.4umol/L；C-反应蛋白(CRP)-静脉血: 1.24mg/L；血小板计数(PLT#)-静脉血: 18110E9/L；红细胞比容(Hct)-静脉血: 40%；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 30.4U/L；血红蛋白(Hb)-静脉血: 131g/L；镁离子(Mg2+)-静脉血: 0.92mmol/L；平均红细胞血红蛋白……\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂缓化疗，予以重组人粒细胞集落刺激因子升白治疗，待中性粒细胞绝对值恢复至2.0×10^9/L以上再行第二周期化疗\nB. 开展第二周期洛铂+5-FU诱导化疗，将洛铂剂量下调20%，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃\nC. 终止诱导化疗，直接进入同期放化疗阶段，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nD. 按计划开展第二周期洛铂+5-FU诱导化疗，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nE. 开展第二周期洛铂+5-FU诱导化疗，暂不予以预防性止吐，待出现恶心呕吐症状时再予以甲氧氯普胺解痉止吐\nF. 更改化疗方案为紫杉醇+顺铂方案进行第二周期诱导化疗，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃\nG. 开展第二周期洛铂+5-FU诱导化疗，并预防性予以阿瑞匹坦、地塞米松联合5-HT3受体拮抗剂三联强效止吐\nH. 暂缓化疗，复查鼻咽颈部MRI评估一程化疗疗效，若肿瘤缩小则继续原方案，否则更改为紫杉醇+顺铂方案\nI. 开展第二周期洛铂+5-FU诱导化疗，将5-FU剂量下调25%，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃\nJ. 暂缓化疗，予以静脉高营养支持及补液治疗，待消化道症状完全缓解、体重增加后再行第二周期诱导化疗\nK. 退出临床试验，更改为顺铂+5-FU方案进行第二周期诱导化疗，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃\nL. 开展第二周期洛铂+5-FU诱导化疗，并预防性予以奥氮平联合地塞米松双联止吐及质子泵抑制剂护胃支持治疗\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-08c11518d363599b5511b9c9","patient_id":"patient-867f2373fc1b04e0b8b80452","turn_id":"turn07","turn_position":6,"turn_type":"recurrence_or_salvage_decision","gold_letter":"B","gold_action":"启动根治性放疗及同步化疗，每周复查血常规，暂不予以重组人白介素-11及粒细胞刺激因子。","options":[{"letter":"A","text":"继续行洛铂联合5-FU方案第3程诱导化疗，予以重组人粒细胞刺激因子支持治疗，暂缓放疗。","is_gold":false},{"letter":"B","text":"启动根治性放疗及同步化疗，每周复查血常规，暂不予以重组人白介素-11及粒细胞刺激因子。","is_gold":true},{"letter":"C","text":"准备行根治性放疗及同步化疗，予以重组人促红素及重组人粒细胞刺激因子支持治疗，动态复查血常规。","is_gold":false},{"letter":"D","text":"更改化疗方案为吉西他滨联合顺铂诱导化疗，予以重组人白介素-11支持治疗，暂缓放疗。","is_gold":false},{"letter":"E","text":"准备行根治性放疗及同步化疗，予以输注单采血小板及红细胞悬液支持治疗，动态复查血常规。","is_gold":false},{"letter":"F","text":"准备行根治性放疗及同步化疗，因骨髓抑制降低同步化疗药物剂量，予以重组人粒细胞刺激因子支持治疗。","is_gold":false},{"letter":"G","text":"继续行洛铂联合5-FU方案第3程诱导化疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗。","is_gold":false},{"letter":"H","text":"准备行单纯根治性放疗，取消同步化疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗。","is_gold":false},{"letter":"I","text":"转为姑息性放疗及最佳支持治疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗。","is_gold":false},{"letter":"J","text":"准备行根治性放疗及同步化疗，予以重组人血小板生成素支持治疗，暂不使用粒细胞刺激因子。","is_gold":false},{"letter":"K","text":"暂停抗肿瘤治疗，待血象自然恢复后，再行第3程洛铂联合5-FU方案诱导化疗，暂缓放疗。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、鼻腔、翼外肌、斜坡、海绵窦、翼突基底部等。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D1777] 检验组合: 低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.92mmol/L；尿素氮(BUN)-静脉血: 5.65mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；载脂蛋白B(apoB)-静脉血: 1.12g/L；平均红细胞体积(MCV)-静脉血: 91.7fL；中性粒细胞计数(Neut#)-静脉血: 3.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.108；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336.6g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.8；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.23mmolL；血小板比容-静脉血: 11.1%；血红蛋白(Hb)-静脉血: 131.2g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.6mmol/L；甘油三酯(TG)-静脉血: 0.96mmol/L；镁离子(Mg2+)-静脉血: 1.02mmol/L；总胆固醇(TC)-静脉血: 5.75mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.510E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；直接胆红素(DBIL)-静脉血: 5.7umol/L；总蛋白(TP)-静脉血: 68.83g/L；白蛋白(ALB)-静脉血: 37.6g/L；钾离子(K+)-静脉血: 4.1mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；尿酸(UA)-静脉血: 299.7umol/L；碱性磷酸酶(ALP)-静脉血: 64.4U/L；阴离子间隙(AG)-静脉血: 13；氯离子(Cl-)-静脉血: 101.5mmol/L；球蛋白(GLO)-静脉血: 31.23g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1%；血小板分布宽度(PDW)-静脉血: 17.9%；间接胆红素(IBIL)-静脉血: 12.7umolL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；丙氨酸氨基转移酶(ALT)-静脉血: 23.7U/L；C-反……\n\n【既往治疗与反应】\n- [全程D1774] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者入院第二天，诉复视、面麻未见好转，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经（-）。复查血常规、生化常规结果无异常。[姓名已隐去]副医生信息已隐藏：现患者入院行第一程洛铂+5FU方案诱导化疗中，目前患者情况尚可，继续予以止呕、护胃、加强营养等对症支持治疗，病情继观。\n- [全程D1775] 上级查房记录；[姓名已隐去]医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医师查房记录；病程内容: 患者入院第三天，无诉，体查情况基本同前，[姓名已隐去]医师查房后示：现患者第一程洛铂+5FU方案诱导化疗中，目前患者情况尚可，继续予以对症支持治疗，病情继观。\n- [全程D1779] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现基本完成一程诱导化疗，诉恶心，一般情况尚可，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经（-）。复查血常规、生化常规结果基本正常，[姓名已隐去]副医生信息已隐藏：现患者情况尚可，嘱今日可予以出院，按期返院，不适随诊。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 继续行洛铂联合5-FU方案第3程诱导化疗，予以重组人粒细胞刺激因子支持治疗，暂缓放疗。\nB. 启动根治性放疗及同步化疗，每周复查血常规，暂不予以重组人白介素-11及粒细胞刺激因子。\nC. 准备行根治性放疗及同步化疗，予以重组人促红素及重组人粒细胞刺激因子支持治疗，动态复查血常规。\nD. 更改化疗方案为吉西他滨联合顺铂诱导化疗，予以重组人白介素-11支持治疗，暂缓放疗。\nE. 准备行根治性放疗及同步化疗，予以输注单采血小板及红细胞悬液支持治疗，动态复查血常规。\nF. 准备行根治性放疗及同步化疗，因骨髓抑制降低同步化疗药物剂量，予以重组人粒细胞刺激因子支持治疗。\nG. 继续行洛铂联合5-FU方案第3程诱导化疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗。\nH. 准备行单纯根治性放疗，取消同步化疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗。\nI. 转为姑息性放疗及最佳支持治疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗。\nJ. 准备行根治性放疗及同步化疗，予以重组人血小板生成素支持治疗，暂不使用粒细胞刺激因子。\nK. 暂停抗肿瘤治疗，待血象自然恢复后，再行第3程洛铂联合5-FU方案诱导化疗，暂缓放疗。\n\n请仅输出一个选项字母（A-K）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、鼻腔、翼外肌、斜坡、海绵窦、翼突基底部等。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D1777] 检验组合: 低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.92mmol/L；尿素氮(BUN)-静脉血: 5.65mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；载脂蛋白B(apoB)-静脉血: 1.12g/L；平均红细胞体积(MCV)-静脉血: 91.7fL；中性粒细胞计数(Neut#)-静脉血: 3.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.108；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336.6g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.8；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.23mmolL；血小板比容-静脉血: 11.1%；血红蛋白(Hb)-静脉血: 131.2g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.6mmol/L；甘油三酯(TG)-静脉血: 0.96mmol/L；镁离子(Mg2+)-静脉血: 1.02mmol/L；总胆固醇(TC)-静脉血: 5.75mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.510E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；直接胆红素(DBIL)-静脉血: 5.7umol/L；总蛋白(TP)-静脉血: 68.83g/L；白蛋白(ALB)-静脉血: 37.6g/L；钾离子(K+)-静脉血: 4.1mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；尿酸(UA)-静脉血: 299.7umol/L；碱性磷酸酶(ALP)-静脉血: 64.4U/L；阴离子间隙(AG)-静脉血: 13；氯离子(Cl-)-静脉血: 101.5mmol/L；球蛋白(GLO)-静脉血: 31.23g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1%；血小板分布宽度(PDW)-静脉血: 17.9%；间接胆红素(IBIL)-静脉血: 12.7umolL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；丙氨酸氨基转移酶(ALT)-静脉血: 23.7U/L；C-反……\n\n【既往治疗与反应】\n- [全程D1774] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者入院第二天，诉复视、面麻未见好转，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经（-）。复查血常规、生化常规结果无异常。[姓名已隐去]副医生信息已隐藏：现患者入院行第一程洛铂+5FU方案诱导化疗中，目前患者情况尚可，继续予以止呕、护胃、加强营养等对症支持治疗，病情继观。\n- [全程D1775] 上级查房记录；[姓名已隐去]医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医师查房记录；病程内容: 患者入院第三天，无诉，体查情况基本同前，[姓名已隐去]医师查房后示：现患者第一程洛铂+5FU方案诱导化疗中，目前患者情况尚可，继续予以对症支持治疗，病情继观。\n- [全程D1779] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现基本完成一程诱导化疗，诉恶心，一般情况尚可，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经（-）。复查血常规、生化常规结果基本正常，[姓名已隐去]副医生信息已隐藏：现患者情况尚可，嘱今日可予以出院，按期返院，不适随诊。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 继续行洛铂联合5-FU方案第3程诱导化疗，予以重组人粒细胞刺激因子支持治疗，暂缓放疗。\nB. 启动根治性放疗及同步化疗，每周复查血常规，暂不予以重组人白介素-11及粒细胞刺激因子。\nC. 准备行根治性放疗及同步化疗，予以重组人促红素及重组人粒细胞刺激因子支持治疗，动态复查血常规。\nD. 更改化疗方案为吉西他滨联合顺铂诱导化疗，予以重组人白介素-11支持治疗，暂缓放疗。\nE. 准备行根治性放疗及同步化疗，予以输注单采血小板及红细胞悬液支持治疗，动态复查血常规。\nF. 准备行根治性放疗及同步化疗，因骨髓抑制降低同步化疗药物剂量，予以重组人粒细胞刺激因子支持治疗。\nG. 继续行洛铂联合5-FU方案第3程诱导化疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗。\nH. 准备行单纯根治性放疗，取消同步化疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗。\nI. 转为姑息性放疗及最佳支持治疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗。\nJ. 准备行根治性放疗及同步化疗，予以重组人血小板生成素支持治疗，暂不使用粒细胞刺激因子。\nK. 暂停抗肿瘤治疗，待血象自然恢复后，再行第3程洛铂联合5-FU方案诱导化疗，暂缓放疗。\n\n请仅输出一个选项字母（A-K）。"}]}
+{"sample_id":"sample-070df43e0c39a4c5f77b459e","patient_id":"patient-867f2373fc1b04e0b8b80452","turn_id":"turn08","turn_position":7,"turn_type":"recurrence_or_salvage_decision","gold_letter":"D","gold_action":"立即开展根治性放疗及洛铂同步化疗，期间定期监测血常规，暂不予造血生长因子干预。","options":[{"letter":"A","text":"立即开展根治性放疗及顺铂同步化疗，期间定期监测血常规，暂不予造血生长因子干预。","is_gold":false},{"letter":"B","text":"予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及顺铂同步化疗。","is_gold":false},{"letter":"C","text":"仅予以重组人白介素-11升血小板治疗，动态复查血常规，并序贯开展根治性放疗及顺铂同步化疗。","is_gold":false},{"letter":"D","text":"立即开展根治性放疗及洛铂同步化疗，期间定期监测血常规，暂不予造血生长因子干预。","is_gold":true},{"letter":"E","text":"仅予以重组人粒细胞刺激因子升白细胞治疗，动态复查血常规，并序贯开展根治性放疗及洛铂同步化疗。","is_gold":false},{"letter":"F","text":"予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及洛铂同步化疗。","is_gold":false},{"letter":"G","text":"予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并转为洛铂单药姑息性化疗。","is_gold":false},{"letter":"H","text":"予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展开放性手术切除原发灶及颈部淋巴结。","is_gold":false},{"letter":"I","text":"予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及西妥昔单抗靶向治疗。","is_gold":false},{"letter":"J","text":"予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及PD-1抑制剂免疫治疗。","is_gold":false},{"letter":"K","text":"暂暂停抗肿瘤治疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，待血象恢复后继续行第三程洛铂+5FU诱导化疗。","is_gold":false},{"letter":"L","text":"予以输注单采血小板及洗涤红细胞支持治疗，动态复查血常规，并序贯开展根治性放疗及洛铂同步化疗。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、鼻腔、翼外肌、斜坡、海绵窦、翼突基底部等。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D1782] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及双侧壁粘膜增厚形成软组织影放射性浓聚，SUV约15.6，病灶侵犯蝶窦、蝶骨体、右侧蝶骨翼、蝶骨基底部、枕骨基底部、枕骨斜坡、右侧颈动脉孔、右侧破裂孔、右侧岩枕裂、右侧桥小脑角、右侧颞骨岩尖、双侧翼突基底部、右翼突内/外板、双侧鼻后孔、右翼腭窝、鼻中隔后份、双侧中鼻甲后份、左侧下鼻甲后份、右侧咽旁/咽后间隙、右侧头长肌、右侧腭帆张/提肌及右翼内肌，累及左侧翼腭窝，堵塞鼻咽腔。双侧咽隐窝消失。双侧咽后小淋巴结放射性较浓密，SUV约4.1，大者约0.8×0.9cm。口咽、喉咽未见异常。蝶窦、筛窦、双侧上颌窦及双侧乳突内低密度影放射性分布未见明显异常。双侧海绵窦放射性分布未见明显异常。甲状腺放射性分布未见明显异常。左颈II区数个淋巴结放射性浓聚，SUV约21.9，大者约1.1×1.5cm；右颈II区数个小淋巴结放射性较浓密，SUV约2.7，大者约0.6×0.7cm；余双颈未见肿大淋巴结及异常放射性分布。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺多发条片影放射性分布未见明显异常；余双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔右下气管旁及右肺门数个小淋巴结放射性略浓密。左肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏形态、结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺、膀胱、肠管等形态、结构及放射性分布未见明显异常。双侧髂血管旁及双侧腹股沟未见肿大淋巴结及异常放射性分布。 L5棘突局部放射性略浓密（良性病变）。左髂骨小片状低密度影放射性稀疏（良性病变）。所见颅盖骨、余躯干骨及四肢骨结构及放射性分布未见明显异常。 鼻咽局部代谢较活跃，双侧扁桃体代谢较活跃，双颈II区小淋巴结代谢稍活跃，考虑炎性病变。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，侵犯范围如上述；双侧咽后小淋巴结代谢较活跃，左颈II区数个淋巴结……\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即开展根治性放疗及顺铂同步化疗，期间定期监测血常规，暂不予造血生长因子干预。\nB. 予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及顺铂同步化疗。\nC. 仅予以重组人白介素-11升血小板治疗，动态复查血常规，并序贯开展根治性放疗及顺铂同步化疗。\nD. 立即开展根治性放疗及洛铂同步化疗，期间定期监测血常规，暂不予造血生长因子干预。\nE. 仅予以重组人粒细胞刺激因子升白细胞治疗，动态复查血常规，并序贯开展根治性放疗及洛铂同步化疗。\nF. 予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及洛铂同步化疗。\nG. 予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并转为洛铂单药姑息性化疗。\nH. 予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展开放性手术切除原发灶及颈部淋巴结。\nI. 予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及西妥昔单抗靶向治疗。\nJ. 予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及PD-1抑制剂免疫治疗。\nK. 暂暂停抗肿瘤治疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，待血象恢复后继续行第三程洛铂+5FU诱导化疗。\nL. 予以输注单采血小板及洗涤红细胞支持治疗，动态复查血常规，并序贯开展根治性放疗及洛铂同步化疗。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、鼻腔、翼外肌、斜坡、海绵窦、翼突基底部等。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D1782] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及双侧壁粘膜增厚形成软组织影放射性浓聚，SUV约15.6，病灶侵犯蝶窦、蝶骨体、右侧蝶骨翼、蝶骨基底部、枕骨基底部、枕骨斜坡、右侧颈动脉孔、右侧破裂孔、右侧岩枕裂、右侧桥小脑角、右侧颞骨岩尖、双侧翼突基底部、右翼突内/外板、双侧鼻后孔、右翼腭窝、鼻中隔后份、双侧中鼻甲后份、左侧下鼻甲后份、右侧咽旁/咽后间隙、右侧头长肌、右侧腭帆张/提肌及右翼内肌，累及左侧翼腭窝，堵塞鼻咽腔。双侧咽隐窝消失。双侧咽后小淋巴结放射性较浓密，SUV约4.1，大者约0.8×0.9cm。口咽、喉咽未见异常。蝶窦、筛窦、双侧上颌窦及双侧乳突内低密度影放射性分布未见明显异常。双侧海绵窦放射性分布未见明显异常。甲状腺放射性分布未见明显异常。左颈II区数个淋巴结放射性浓聚，SUV约21.9，大者约1.1×1.5cm；右颈II区数个小淋巴结放射性较浓密，SUV约2.7，大者约0.6×0.7cm；余双颈未见肿大淋巴结及异常放射性分布。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺多发条片影放射性分布未见明显异常；余双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔右下气管旁及右肺门数个小淋巴结放射性略浓密。左肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏形态、结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺、膀胱、肠管等形态、结构及放射性分布未见明显异常。双侧髂血管旁及双侧腹股沟未见肿大淋巴结及异常放射性分布。 L5棘突局部放射性略浓密（良性病变）。左髂骨小片状低密度影放射性稀疏（良性病变）。所见颅盖骨、余躯干骨及四肢骨结构及放射性分布未见明显异常。 鼻咽局部代谢较活跃，双侧扁桃体代谢较活跃，双颈II区小淋巴结代谢稍活跃，考虑炎性病变。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，侵犯范围如上述；双侧咽后小淋巴结代谢较活跃，左颈II区数个淋巴结……\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即开展根治性放疗及顺铂同步化疗，期间定期监测血常规，暂不予造血生长因子干预。\nB. 予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及顺铂同步化疗。\nC. 仅予以重组人白介素-11升血小板治疗，动态复查血常规，并序贯开展根治性放疗及顺铂同步化疗。\nD. 立即开展根治性放疗及洛铂同步化疗，期间定期监测血常规，暂不予造血生长因子干预。\nE. 仅予以重组人粒细胞刺激因子升白细胞治疗，动态复查血常规，并序贯开展根治性放疗及洛铂同步化疗。\nF. 予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及洛铂同步化疗。\nG. 予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并转为洛铂单药姑息性化疗。\nH. 予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展开放性手术切除原发灶及颈部淋巴结。\nI. 予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及西妥昔单抗靶向治疗。\nJ. 予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及PD-1抑制剂免疫治疗。\nK. 暂暂停抗肿瘤治疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，待血象恢复后继续行第三程洛铂+5FU诱导化疗。\nL. 予以输注单采血小板及洗涤红细胞支持治疗，动态复查血常规，并序贯开展根治性放疗及洛铂同步化疗。\n\n请仅输出一个选项字母（A-L）。"}]}
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full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、蝶窦、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 左耳闷涉不适1年，涕血2月。；某次就诊时间特来我院门诊进一步诊治，完善相关检查，诊断明确后，今日入院系统治疗。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,左耳闷胀感,涕血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。有吸烟史1年，日7支；少量饮酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：90次/分，R：20次/分，BP：131/86mmHg,Ht：171cm，Wt：76.5kg，BSA1.89m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶壁、顶后壁、双侧壁结节状肿物；左侧颈部II区可扪及1个淋巴结，最大径2cm×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善鼻咽+颈部增强CT，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查，择期行颈部淋巴结穿刺活检。\nB. 完善鼻咽镜及活检，鼻咽+颈部增强CT，胸腹部超声及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。\nC. 完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，常规血液学检查，暂缓EBV相关检测。\nD. 完善鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查，若影像典型直接开始放化疗。\nE. 完善鼻咽镜及活检，头颅增强MRI，颈部超声，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。\nF. 完善鼻咽镜及活检，鼻咽+颈部平扫MRI，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。\nG. 完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描（或PET-CT），EBV-DNA及抗体检测，常规血液学检查。\nH. 完善鼻咽镜及活检，鼻咽+颈部增强MRI，EBV-DNA及抗体检测，常规血液学检查，待局部放疗结束后再行全身转移排查。\nI. 完善颈部淋巴结切除活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。\nJ. 完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，常规血液学检查，并立即行诱导化疗。\nK. 完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸部X线，腹部超声，全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。\nL. 完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查，并预防性行气管切开。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、蝶窦、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 左耳闷涉不适1年，涕血2月。；某次就诊时间特来我院门诊进一步诊治，完善相关检查，诊断明确后，今日入院系统治疗。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,左耳闷胀感,涕血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。有吸烟史1年，日7支；少量饮酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：90次/分，R：20次/分，BP：131/86mmHg,Ht：171cm，Wt：76.5kg，BSA1.89m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶壁、顶后壁、双侧壁结节状肿物；左侧颈部II区可扪及1个淋巴结，最大径2cm×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善鼻咽+颈部增强CT，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查，择期行颈部淋巴结穿刺活检。\nB. 完善鼻咽镜及活检，鼻咽+颈部增强CT，胸腹部超声及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。\nC. 完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，常规血液学检查，暂缓EBV相关检测。\nD. 完善鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查，若影像典型直接开始放化疗。\nE. 完善鼻咽镜及活检，头颅增强MRI，颈部超声，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。\nF. 完善鼻咽镜及活检，鼻咽+颈部平扫MRI，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。\nG. 完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描（或PET-CT），EBV-DNA及抗体检测，常规血液学检查。\nH. 完善鼻咽镜及活检，鼻咽+颈部增强MRI，EBV-DNA及抗体检测，常规血液学检查，待局部放疗结束后再行全身转移排查。\nI. 完善颈部淋巴结切除活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。\nJ. 完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，常规血液学检查，并立即行诱导化疗。\nK. 完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸部X线，腹部超声，全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。\nL. 完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查，并预防性行气管切开。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-e3ed1270448c84eefbda9f61","patient_id":"patient-5731cc38ced94b2ee39c442a","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"H","gold_action":"完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充血浆EBV DNA定量检测","options":[{"letter":"A","text":"完善胸部CT、腹部CT及全身骨扫描，并补充颈部淋巴结切除活检","is_gold":false},{"letter":"B","text":"完善全身PET-CT检查，并补充颈部淋巴结穿刺活检","is_gold":false},{"letter":"C","text":"完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充头颈部CTA检查","is_gold":false},{"letter":"D","text":"完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充颈部淋巴结穿刺活检","is_gold":false},{"letter":"E","text":"完善胸部CT、腹部CT，并补充脑部MRI平扫及增强","is_gold":false},{"letter":"F","text":"完善全身骨扫描及脑部MRI增强，并补充血浆EBV DNA定量检测","is_gold":false},{"letter":"G","text":"完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充鼻咽脱落细胞学检查","is_gold":false},{"letter":"H","text":"完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充血浆EBV DNA定量检测","is_gold":true},{"letter":"I","text":"完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充骨髓穿刺活检","is_gold":false},{"letter":"J","text":"完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充EBV抗体滴度复查","is_gold":false},{"letter":"K","text":"完善胸部CT、腹部CT及全身骨扫描，并补充头颅PET-MR检查","is_gold":false},{"letter":"L","text":"完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并立即开始诱导化疗","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、蝶窦、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D0] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.51；平均红细胞血红蛋白含量(MCH)-静脉血: 27.4pg；磷(P)-静脉血: 0.9mmol/L；直接胆红素(DBIL)-静脉血: 4.7umol/L；凝血酶时间(TT)-静脉血: 22.7sec.；D-二聚体(D-Dimer)-静脉血: 0.29ug/ml；活化部分凝血活酶时间(APTT)-静脉血: 38.5sec.；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.04S/CO；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.82mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.6；单核细胞百分比(Mono%)-静脉血: 0.047；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；间接胆红素(IBIL)-静脉血: 10.5umolL；白蛋白(ALB)-静脉血: 48g/L；氯离子(Cl-)-静脉血: 101.7mmol/L；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.718；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.1COI；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；白细胞计数(WBC#)-静脉血: 6.9510E9/L；红细胞比容(Hct)-静脉血: 46.8%；尿酸(UA)-静脉血: 431.8umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 81.8umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 26mmol/L；血小板分布宽度(PDW)-静脉血: 11.2%；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.04S/CO；平均血小板体积(MPV)-静脉血: 9.7fL；中性粒细胞计数(Neut#)-静脉血: 510E9/L；载脂蛋白B(apoB)-静脉血: 0.96g/L；凝血酶原时间(PT)-静脉血: 11.8sec.；钠离子(Na+)-静脉血: 138.7mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；甘油三酯(TG)-静脉血: 2.2mmol/L；总胆红素(TBIL)-……\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 Ⅱ、Ⅲ、aVF、V5、V6导联T波低平\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、后壁及双侧壁增厚，见软组织肿物向鼻咽腔内突出，在T1WI上呈等信号，在T2WI上呈稍高信号，增强扫描明显强化。双侧咽隐窝变浅，见软组织肿物填充。病灶侵犯左侧后鼻孔，侵犯左侧腭帆张提肌、左侧翼内肌头部、左侧咽旁脂肪间隙，侵犯蝶窦左侧份及左侧翼腭窝，侵犯左侧破裂孔、左侧海绵窦。 右侧咽旁间隙及双侧颈动脉鞘区血管未见明显异常。右侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常。口咽双侧壁未见增厚。 斜坡、左侧岩尖、蝶骨基底部、左侧翼突区骨质信号减低，增强扫描明显强化。 右侧海绵窦形态正常，未见增宽。 双侧筛窦、左侧上颌窦、蝶窦及右侧乳突粘膜增厚，左侧乳突内见大量长分期信息见历史辅助诊断节点长分期信息见历史辅助诊断节点信号分泌物。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变。 左侧咽后可见数个小淋巴结，较大短径约4mm；右侧咽后可见小淋巴结，短径约2mm。左颈II、III区可见数个淋巴结，最大约21mm×15mm，部分呈相互融合改变，边界欠清，增强扫描可见明显强化。右颈II、III区可见数个淋巴结，最大约12mm×7mm，边界清。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 左颈II、III区淋巴结肿大，考虑转移。 左侧咽后、右颈II、III区淋巴结，不排除转移。 右侧咽后小淋巴结。 鼻窦炎。双侧乳突炎。\n- [全程D5] 检验组合: EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；Rh血型-静脉血: 阳性；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；ABO血型-静脉血: O\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善胸部CT、腹部CT及全身骨扫描，并补充颈部淋巴结切除活检\nB. 完善全身PET-CT检查，并补充颈部淋巴结穿刺活检\nC. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充头颈部CTA检查\nD. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充颈部淋巴结穿刺活检\nE. 完善胸部CT、腹部CT，并补充脑部MRI平扫及增强\nF. 完善全身骨扫描及脑部MRI增强，并补充血浆EBV DNA定量检测\nG. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充鼻咽脱落细胞学检查\nH. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充血浆EBV DNA定量检测\nI. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充骨髓穿刺活检\nJ. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充EBV抗体滴度复查\nK. 完善胸部CT、腹部CT及全身骨扫描，并补充头颅PET-MR检查\nL. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并立即开始诱导化疗\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、蝶窦、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D0] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.51；平均红细胞血红蛋白含量(MCH)-静脉血: 27.4pg；磷(P)-静脉血: 0.9mmol/L；直接胆红素(DBIL)-静脉血: 4.7umol/L；凝血酶时间(TT)-静脉血: 22.7sec.；D-二聚体(D-Dimer)-静脉血: 0.29ug/ml；活化部分凝血活酶时间(APTT)-静脉血: 38.5sec.；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.04S/CO；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.82mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.6；单核细胞百分比(Mono%)-静脉血: 0.047；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；间接胆红素(IBIL)-静脉血: 10.5umolL；白蛋白(ALB)-静脉血: 48g/L；氯离子(Cl-)-静脉血: 101.7mmol/L；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.718；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.1COI；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；白细胞计数(WBC#)-静脉血: 6.9510E9/L；红细胞比容(Hct)-静脉血: 46.8%；尿酸(UA)-静脉血: 431.8umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 81.8umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 26mmol/L；血小板分布宽度(PDW)-静脉血: 11.2%；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.04S/CO；平均血小板体积(MPV)-静脉血: 9.7fL；中性粒细胞计数(Neut#)-静脉血: 510E9/L；载脂蛋白B(apoB)-静脉血: 0.96g/L；凝血酶原时间(PT)-静脉血: 11.8sec.；钠离子(Na+)-静脉血: 138.7mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；甘油三酯(TG)-静脉血: 2.2mmol/L；总胆红素(TBIL)-……\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 Ⅱ、Ⅲ、aVF、V5、V6导联T波低平\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、后壁及双侧壁增厚，见软组织肿物向鼻咽腔内突出，在T1WI上呈等信号，在T2WI上呈稍高信号，增强扫描明显强化。双侧咽隐窝变浅，见软组织肿物填充。病灶侵犯左侧后鼻孔，侵犯左侧腭帆张提肌、左侧翼内肌头部、左侧咽旁脂肪间隙，侵犯蝶窦左侧份及左侧翼腭窝，侵犯左侧破裂孔、左侧海绵窦。 右侧咽旁间隙及双侧颈动脉鞘区血管未见明显异常。右侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常。口咽双侧壁未见增厚。 斜坡、左侧岩尖、蝶骨基底部、左侧翼突区骨质信号减低，增强扫描明显强化。 右侧海绵窦形态正常，未见增宽。 双侧筛窦、左侧上颌窦、蝶窦及右侧乳突粘膜增厚，左侧乳突内见大量长分期信息见历史辅助诊断节点长分期信息见历史辅助诊断节点信号分泌物。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变。 左侧咽后可见数个小淋巴结，较大短径约4mm；右侧咽后可见小淋巴结，短径约2mm。左颈II、III区可见数个淋巴结，最大约21mm×15mm，部分呈相互融合改变，边界欠清，增强扫描可见明显强化。右颈II、III区可见数个淋巴结，最大约12mm×7mm，边界清。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 左颈II、III区淋巴结肿大，考虑转移。 左侧咽后、右颈II、III区淋巴结，不排除转移。 右侧咽后小淋巴结。 鼻窦炎。双侧乳突炎。\n- [全程D5] 检验组合: EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；Rh血型-静脉血: 阳性；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；ABO血型-静脉血: O\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善胸部CT、腹部CT及全身骨扫描，并补充颈部淋巴结切除活检\nB. 完善全身PET-CT检查，并补充颈部淋巴结穿刺活检\nC. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充头颈部CTA检查\nD. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充颈部淋巴结穿刺活检\nE. 完善胸部CT、腹部CT，并补充脑部MRI平扫及增强\nF. 完善全身骨扫描及脑部MRI增强，并补充血浆EBV DNA定量检测\nG. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充鼻咽脱落细胞学检查\nH. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充血浆EBV DNA定量检测\nI. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充骨髓穿刺活检\nJ. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充EBV抗体滴度复查\nK. 完善胸部CT、腹部CT及全身骨扫描，并补充头颅PET-MR检查\nL. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并立即开始诱导化疗\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-cd1385d4e13dda199ba81658","patient_id":"patient-5731cc38ced94b2ee39c442a","turn_id":"turn05","turn_position":3,"turn_type":"toxicity_or_support_decision","gold_letter":"K","gold_action":"办理出院，开具口服保肝药物（如多烯磷脂酰胆碱等），嘱每周复查血常规和生化，按期返院行下一程诱导化疗。","options":[{"letter":"A","text":"办理出院，暂不予保肝药物干预，嘱每周复查血常规和生化，按期返院行下一程诱导化疗。","is_gold":false},{"letter":"B","text":"暂缓出院，予静脉滴注保肝降酶药物，待转氨酶及胆红素完全恢复正常后出院，按期行下一程诱导化疗。","is_gold":false},{"letter":"C","text":"办理出院，开具口服保肝药物，终止后续诱导化疗计划，择期直接开始根治性同期放化疗。","is_gold":false},{"letter":"D","text":"办理出院，开具口服保肝药物，下一程诱导化疗直接将多西他赛及顺铂剂量下调20%。","is_gold":false},{"letter":"E","text":"办理出院，开具口服保肝药物，下一程诱导化疗方案更改为吉西他滨联合顺铂（GP方案）。","is_gold":false},{"letter":"F","text":"暂缓出院，请感染内科会诊排除乙肝病毒再激活，待专科意见明确后再决定后续抗肿瘤治疗计划。","is_gold":false},{"letter":"G","text":"办理出院，开具口服保肝药物，嘱每周复查血常规和生化，将下一程诱导化疗推迟1至2周进行。","is_gold":false},{"letter":"H","text":"办理出院，开具口服保肝药物，并预防性给予长效G-CSF支持，按期返院行下一程诱导化疗。","is_gold":false},{"letter":"I","text":"暂缓出院，按重度药物性肝损伤启动多学科联合诊疗，待肝功能好转后，按期行下一程诱导化疗。","is_gold":false},{"letter":"J","text":"办理出院，开具口服保肝药物，下一程治疗停用尼妥珠单抗，仅行TPF方案诱导化疗。","is_gold":false},{"letter":"K","text":"办理出院，开具口服保肝药物（如多烯磷脂酰胆碱等），嘱每周复查血常规和生化，按期返院行下一程诱导化疗。","is_gold":true},{"letter":"L","text":"办理出院，开具口服保肝药物，下一程诱导化疗剔除氟尿嘧啶，改为多西他赛联合顺铂双药方案。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、蝶窦、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D24] 检验组合: 天门冬氨酸氨基转移酶(AST)-静脉血: 20.1U/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；血小板分布宽度(PDW)-静脉血: 11.9%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.1；尿素氮(BUN)-静脉血: 3.6mmol/L；磷(P)-静脉血: 0.97mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21.8U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.55；丙氨酸氨基转移酶(ALT)-静脉血: 41U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.19mmol/L；葡萄糖(Glu)-静脉血: 5.41mmol/L；白蛋白(ALB)-静脉血: 46.9g/L；白细胞计数(WBC#)-静脉血: 5.2810E9/L；红细胞计数(RBC#)-静脉血: 5.3910E12/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.6；尿酸(UA)-静脉血: 386.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 27U/L；C-反应蛋白(CRP)-静脉血: 4.25mg/L；钾离子(K+)-静脉血: 4.08mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.051；载脂蛋白B(apoB)-静脉血: 1.1g/L；球蛋白(GLO)-静脉血: 30.3g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；平均血小板体积(MPV)-静脉血: 10.3fL；总胆汁酸(TBA)-静脉血: 1.8umol/L；总蛋白(TP)-静脉血: 77.2g/L；间接胆红素(IBIL)-静脉血: 11.1umolL；甘油三酯(TG)-静脉血: 1.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.08g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.310E9/L；氯离子(Cl-)-静脉血: 102.2mmol/L；单核细胞百分比(Mono%)-静脉血: 0.072；碱性磷酸酶(ALP)-静脉血: 82.4U/L；总胆红素(TBIL)-静脉血: 15.1umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.49；总胆固醇(TC)-静脉血: 4.74mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.237；血小板比容……\n- [全程D25] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右侧约平T6椎体下缘水平，估计导管末端位于上腔静脉下段内。；检查结论: PICC管位置如上所述。\n- [全程D25] 检验组合: 浊度(TRUB)-尿液: clear；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 5.5；葡萄糖(Glu)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；虫卵-粪便: 未见虫卵（参考: 未见虫卵）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 30/μL；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；隐血(OB)-粪便: 阴性（参考: 阴性）；比重(SG)-尿液: 1.021；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-粪便: 棕色；酮体(KET)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D29] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；磷(P)-静脉血: 1.54mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.4U/L；总胆固醇(TC)-静脉血: 6.28mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.3pg；镁离子(Mg2+)-静脉血: 1.06mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=2.00)（参考: 阴性）；肌酐(Crea)-静脉血: 76.5umol/L；球蛋白(GLO)-静脉血: 31.62g/L；白蛋白(ALB)-静脉血: 48.1g/L；白细胞计数(WBC#)-静脉血: 5.310E9/L；血小板分布宽度(PDW)-静脉血: 14.3%；单核细胞百分比(Mono%)-静脉血: 0.011；淋巴细胞百分比(Lymph%)-静脉血: 0.128；血小板计数(PLT#)-静脉血: 18310E9/L；甘油三酯(TG)-静脉血: 1.83mmol/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；碱性磷酸酶(ALP)-静脉血: 76.4U/L；总胆汁酸(TBA)-静脉血: 14.5umol/L；总蛋白(TP)-静脉血: 79.72g/L；有核红细胞百分比(NRBC%)-静脉血: 0；红细胞比容(Hct)-静脉血: 44.3%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.7；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.42mmolL；胱抑素(Cys-C)-静脉血: 1.15mg/L；尿酸(UA)-静脉血: 254.8umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；间接胆红素(IBIL)-静脉血: 27.2umolL；钾离子(K+)-静脉血: 4.43mmol/L；乳酸脱氢酶(LDH)-静脉血: 200.6U/L；C-反应蛋白(CRP)-静脉血: 1.97mg/L；浊度(TRUB)-尿液: clear；酸碱度(pH)-尿液: 5.5；平均红细胞体积(MCV……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D26] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 化疗第2天，患者一般情况可，未诉特殊不适。查体：左侧颈部II区可扪及1个淋巴结，最大径2cm×2.5cm2，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]医生信息已隐藏示：目前暂未出现明显副反应，继续行化疗，密切观察病情。\n- [全程D29] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 化疗第5天，患者一般情况可。体查：KPS90分，张口门齿距4.5cm。鼻咽顶壁、顶后壁、双侧壁结节状肿物；左侧颈部II区可扪及1个淋巴结，最大径2cm×2cm2，无融合，质中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。复查血常规无明显异常。生化示：ALT 77.8U/L↑、IBIL27.20 umolL↑、TBIL35.1umol/L↑。[姓名已隐去]医生信息已隐藏示:第1程化疗结束，病情稳定，今日予办理出院。嘱其注意休息及营养支持，保持口腔清洁；出院后每周复查血常规2次，生化1次常规；按时[计划性表述已隐藏]下一程诱导化疗；若有不适，及时就诊。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 办理出院，暂不予保肝药物干预，嘱每周复查血常规和生化，按期返院行下一程诱导化疗。\nB. 暂缓出院，予静脉滴注保肝降酶药物，待转氨酶及胆红素完全恢复正常后出院，按期行下一程诱导化疗。\nC. 办理出院，开具口服保肝药物，终止后续诱导化疗计划，择期直接开始根治性同期放化疗。\nD. 办理出院，开具口服保肝药物，下一程诱导化疗直接将多西他赛及顺铂剂量下调20%。\nE. 办理出院，开具口服保肝药物，下一程诱导化疗方案更改为吉西他滨联合顺铂（GP方案）。\nF. 暂缓出院，请感染内科会诊排除乙肝病毒再激活，待专科意见明确后再决定后续抗肿瘤治疗计划。\nG. 办理出院，开具口服保肝药物，嘱每周复查血常规和生化，将下一程诱导化疗推迟1至2周进行。\nH. 办理出院，开具口服保肝药物，并预防性给予长效G-CSF支持，按期返院行下一程诱导化疗。\nI. 暂缓出院，按重度药物性肝损伤启动多学科联合诊疗，待肝功能好转后，按期行下一程诱导化疗。\nJ. 办理出院，开具口服保肝药物，下一程治疗停用尼妥珠单抗，仅行TPF方案诱导化疗。\nK. 办理出院，开具口服保肝药物（如多烯磷脂酰胆碱等），嘱每周复查血常规和生化，按期返院行下一程诱导化疗。\nL. 办理出院，开具口服保肝药物，下一程诱导化疗剔除氟尿嘧啶，改为多西他赛联合顺铂双药方案。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、蝶窦、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D24] 检验组合: 天门冬氨酸氨基转移酶(AST)-静脉血: 20.1U/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；血小板分布宽度(PDW)-静脉血: 11.9%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.1；尿素氮(BUN)-静脉血: 3.6mmol/L；磷(P)-静脉血: 0.97mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21.8U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.55；丙氨酸氨基转移酶(ALT)-静脉血: 41U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.19mmol/L；葡萄糖(Glu)-静脉血: 5.41mmol/L；白蛋白(ALB)-静脉血: 46.9g/L；白细胞计数(WBC#)-静脉血: 5.2810E9/L；红细胞计数(RBC#)-静脉血: 5.3910E12/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.6；尿酸(UA)-静脉血: 386.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 27U/L；C-反应蛋白(CRP)-静脉血: 4.25mg/L；钾离子(K+)-静脉血: 4.08mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.051；载脂蛋白B(apoB)-静脉血: 1.1g/L；球蛋白(GLO)-静脉血: 30.3g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；平均血小板体积(MPV)-静脉血: 10.3fL；总胆汁酸(TBA)-静脉血: 1.8umol/L；总蛋白(TP)-静脉血: 77.2g/L；间接胆红素(IBIL)-静脉血: 11.1umolL；甘油三酯(TG)-静脉血: 1.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.08g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.310E9/L；氯离子(Cl-)-静脉血: 102.2mmol/L；单核细胞百分比(Mono%)-静脉血: 0.072；碱性磷酸酶(ALP)-静脉血: 82.4U/L；总胆红素(TBIL)-静脉血: 15.1umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.49；总胆固醇(TC)-静脉血: 4.74mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.237；血小板比容……\n- [全程D25] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右侧约平T6椎体下缘水平，估计导管末端位于上腔静脉下段内。；检查结论: PICC管位置如上所述。\n- [全程D25] 检验组合: 浊度(TRUB)-尿液: clear；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 5.5；葡萄糖(Glu)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；虫卵-粪便: 未见虫卵（参考: 未见虫卵）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 30/μL；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；隐血(OB)-粪便: 阴性（参考: 阴性）；比重(SG)-尿液: 1.021；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-粪便: 棕色；酮体(KET)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D29] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；磷(P)-静脉血: 1.54mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.4U/L；总胆固醇(TC)-静脉血: 6.28mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.3pg；镁离子(Mg2+)-静脉血: 1.06mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=2.00)（参考: 阴性）；肌酐(Crea)-静脉血: 76.5umol/L；球蛋白(GLO)-静脉血: 31.62g/L；白蛋白(ALB)-静脉血: 48.1g/L；白细胞计数(WBC#)-静脉血: 5.310E9/L；血小板分布宽度(PDW)-静脉血: 14.3%；单核细胞百分比(Mono%)-静脉血: 0.011；淋巴细胞百分比(Lymph%)-静脉血: 0.128；血小板计数(PLT#)-静脉血: 18310E9/L；甘油三酯(TG)-静脉血: 1.83mmol/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；碱性磷酸酶(ALP)-静脉血: 76.4U/L；总胆汁酸(TBA)-静脉血: 14.5umol/L；总蛋白(TP)-静脉血: 79.72g/L；有核红细胞百分比(NRBC%)-静脉血: 0；红细胞比容(Hct)-静脉血: 44.3%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.7；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.42mmolL；胱抑素(Cys-C)-静脉血: 1.15mg/L；尿酸(UA)-静脉血: 254.8umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；间接胆红素(IBIL)-静脉血: 27.2umolL；钾离子(K+)-静脉血: 4.43mmol/L；乳酸脱氢酶(LDH)-静脉血: 200.6U/L；C-反应蛋白(CRP)-静脉血: 1.97mg/L；浊度(TRUB)-尿液: clear；酸碱度(pH)-尿液: 5.5；平均红细胞体积(MCV……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D26] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 化疗第2天，患者一般情况可，未诉特殊不适。查体：左侧颈部II区可扪及1个淋巴结，最大径2cm×2.5cm2，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]医生信息已隐藏示：目前暂未出现明显副反应，继续行化疗，密切观察病情。\n- [全程D29] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 化疗第5天，患者一般情况可。体查：KPS90分，张口门齿距4.5cm。鼻咽顶壁、顶后壁、双侧壁结节状肿物；左侧颈部II区可扪及1个淋巴结，最大径2cm×2cm2，无融合，质中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。复查血常规无明显异常。生化示：ALT 77.8U/L↑、IBIL27.20 umolL↑、TBIL35.1umol/L↑。[姓名已隐去]医生信息已隐藏示:第1程化疗结束，病情稳定，今日予办理出院。嘱其注意休息及营养支持，保持口腔清洁；出院后每周复查血常规2次，生化1次常规；按时[计划性表述已隐藏]下一程诱导化疗；若有不适，及时就诊。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 办理出院，暂不予保肝药物干预，嘱每周复查血常规和生化，按期返院行下一程诱导化疗。\nB. 暂缓出院，予静脉滴注保肝降酶药物，待转氨酶及胆红素完全恢复正常后出院，按期行下一程诱导化疗。\nC. 办理出院，开具口服保肝药物，终止后续诱导化疗计划，择期直接开始根治性同期放化疗。\nD. 办理出院，开具口服保肝药物，下一程诱导化疗直接将多西他赛及顺铂剂量下调20%。\nE. 办理出院，开具口服保肝药物，下一程诱导化疗方案更改为吉西他滨联合顺铂（GP方案）。\nF. 暂缓出院，请感染内科会诊排除乙肝病毒再激活，待专科意见明确后再决定后续抗肿瘤治疗计划。\nG. 办理出院，开具口服保肝药物，嘱每周复查血常规和生化，将下一程诱导化疗推迟1至2周进行。\nH. 办理出院，开具口服保肝药物，并预防性给予长效G-CSF支持，按期返院行下一程诱导化疗。\nI. 暂缓出院，按重度药物性肝损伤启动多学科联合诊疗，待肝功能好转后，按期行下一程诱导化疗。\nJ. 办理出院，开具口服保肝药物，下一程治疗停用尼妥珠单抗，仅行TPF方案诱导化疗。\nK. 办理出院，开具口服保肝药物（如多烯磷脂酰胆碱等），嘱每周复查血常规和生化，按期返院行下一程诱导化疗。\nL. 办理出院，开具口服保肝药物，下一程诱导化疗剔除氟尿嘧啶，改为多西他赛联合顺铂双药方案。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-ad5a1060b6801c87debff9d0","patient_id":"patient-5731cc38ced94b2ee39c442a","turn_id":"turn06","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"L","gold_action":"开具口服升白细胞药物（如咖啡酸片）、保肝药物（如复方甘草酸苷）及抑酸护胃、促动力药物进行对症支持。","options":[{"letter":"A","text":"予以皮下注射重组人粒细胞集落刺激因子（G-CSF），并静脉滴注异甘草酸镁进行保肝治疗。","is_gold":false},{"letter":"B","text":"嘱多饮水及注意休息，暂不予药物干预，定期门诊复查血常规及肝肾功能以评估毒性。","is_gold":false},{"letter":"C","text":"开具口服升白细胞药物（如咖啡酸片）及保肝药物（如复方甘草酸苷），暂不使用护胃止吐药物。","is_gold":false},{"letter":"D","text":"立即收治入院，予以静脉滴注质子泵抑制剂、止吐药及保肝药物，并密切监测血常规变化。","is_gold":false},{"letter":"E","text":"开具口服抑酸护胃及促胃动力药物（如艾司奥美拉唑、多潘立酮），暂不处理白细胞及肝功能异常。","is_gold":false},{"letter":"F","text":"提前开始第二周期TPF诱导化疗，并预防性给予长效G-CSF及静脉保肝药物支持治疗。","is_gold":false},{"letter":"G","text":"开具口服保肝药物（如复方甘草酸苷）及护胃止吐药物，暂不予口服升白细胞药物进行干预。","is_gold":false},{"letter":"H","text":"予以皮下注射重组人促红素（EPO），并开具口服保肝、护胃及促动力药物进行对症支持。","is_gold":false},{"letter":"I","text":"开具口服升白细胞药物（如咖啡酸片）、抑酸护胃及促胃动力药物，暂不予保肝药物治疗。","is_gold":false},{"letter":"J","text":"安排骨髓穿刺检查以明确白细胞减少原因，同时开具口服保肝及护胃药物进行对症支持。","is_gold":false},{"letter":"K","text":"门诊静脉推注地塞米松及昂丹司琼强化止吐，并开具口服保肝及升白药物进行对症支持。","is_gold":false},{"letter":"L","text":"开具口服升白细胞药物（如咖啡酸片）、保肝药物（如复方甘草酸苷）及抑酸护胃、促动力药物进行对症支持。","is_gold":true}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、蝶窦、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D32] 检验组合: 间接胆红素(IBIL)-静脉血: 13.9umolL；肌酐(Crea)-静脉血: 83.3umol/L；碱性磷酸酶(ALP)-静脉血: 80.7U/L；镁离子(Mg2+)-静脉血: 1.02mmol/L；总胆红素(TBIL)-静脉血: 19.3umol/L；胱抑素(Cys-C)-静脉血: 0.87mg/L；尿素氮(BUN)-静脉血: 4.5mmol/L；载脂蛋白B(apoB)-静脉血: 1.13g/L；白细胞计数(WBC#)-静脉血: 3.0510E9/L；总胆汁酸(TBA)-静脉血: 1.7umol/L；血小板分布宽度(PDW)-静脉血: 12.5%；血小板比容-静脉血: 17%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.01；单核细胞百分比(Mono%)-静脉血: 0.013；平均血小板体积(MPV)-静脉血: 10.9fL；乳酸脱氢酶(LDH)-静脉血: 186U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.36；平均红细胞血红蛋白含量(MCH)-静脉血: 27.7pg；平均红细胞体积(MCV)-静脉血: 81.7fL；单核细胞计数(Mono#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 15410E9/L；氯离子(Cl-)-静脉血: 96.9mmol/L；钾离子(K+)-静脉血: 3.58mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.4mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 28U/L；甘油三酯(TG)-静脉血: 1.46mmol/L；红细胞比容(Hct)-静脉血: 44.3%；中性粒细胞百分比(Neut%)-静脉血: 0.748；总钙(Ca)-静脉血: 2.27mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 34.1；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 25.5U/L；葡萄糖(Glu)-静脉血: 5.55mmol/L；尿酸(UA)-静脉血: 325.7umol/L；直接胆红素(DBIL)-静脉血: 5.4umol/L；钠离子(Na+)-静脉血: 133.9mmol/L；大血小板百分比(P-LCR%)-静脉血: 31.7%；红细胞体积分布宽度CV(RDW-CV)-静……\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 予以皮下注射重组人粒细胞集落刺激因子（G-CSF），并静脉滴注异甘草酸镁进行保肝治疗。\nB. 嘱多饮水及注意休息，暂不予药物干预，定期门诊复查血常规及肝肾功能以评估毒性。\nC. 开具口服升白细胞药物（如咖啡酸片）及保肝药物（如复方甘草酸苷），暂不使用护胃止吐药物。\nD. 立即收治入院，予以静脉滴注质子泵抑制剂、止吐药及保肝药物，并密切监测血常规变化。\nE. 开具口服抑酸护胃及促胃动力药物（如艾司奥美拉唑、多潘立酮），暂不处理白细胞及肝功能异常。\nF. 提前开始第二周期TPF诱导化疗，并预防性给予长效G-CSF及静脉保肝药物支持治疗。\nG. 开具口服保肝药物（如复方甘草酸苷）及护胃止吐药物，暂不予口服升白细胞药物进行干预。\nH. 予以皮下注射重组人促红素（EPO），并开具口服保肝、护胃及促动力药物进行对症支持。\nI. 开具口服升白细胞药物（如咖啡酸片）、抑酸护胃及促胃动力药物，暂不予保肝药物治疗。\nJ. 安排骨髓穿刺检查以明确白细胞减少原因，同时开具口服保肝及护胃药物进行对症支持。\nK. 门诊静脉推注地塞米松及昂丹司琼强化止吐，并开具口服保肝及升白药物进行对症支持。\nL. 开具口服升白细胞药物（如咖啡酸片）、保肝药物（如复方甘草酸苷）及抑酸护胃、促动力药物进行对症支持。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、蝶窦、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D32] 检验组合: 间接胆红素(IBIL)-静脉血: 13.9umolL；肌酐(Crea)-静脉血: 83.3umol/L；碱性磷酸酶(ALP)-静脉血: 80.7U/L；镁离子(Mg2+)-静脉血: 1.02mmol/L；总胆红素(TBIL)-静脉血: 19.3umol/L；胱抑素(Cys-C)-静脉血: 0.87mg/L；尿素氮(BUN)-静脉血: 4.5mmol/L；载脂蛋白B(apoB)-静脉血: 1.13g/L；白细胞计数(WBC#)-静脉血: 3.0510E9/L；总胆汁酸(TBA)-静脉血: 1.7umol/L；血小板分布宽度(PDW)-静脉血: 12.5%；血小板比容-静脉血: 17%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.01；单核细胞百分比(Mono%)-静脉血: 0.013；平均血小板体积(MPV)-静脉血: 10.9fL；乳酸脱氢酶(LDH)-静脉血: 186U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.36；平均红细胞血红蛋白含量(MCH)-静脉血: 27.7pg；平均红细胞体积(MCV)-静脉血: 81.7fL；单核细胞计数(Mono#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 15410E9/L；氯离子(Cl-)-静脉血: 96.9mmol/L；钾离子(K+)-静脉血: 3.58mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.4mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 28U/L；甘油三酯(TG)-静脉血: 1.46mmol/L；红细胞比容(Hct)-静脉血: 44.3%；中性粒细胞百分比(Neut%)-静脉血: 0.748；总钙(Ca)-静脉血: 2.27mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 34.1；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 25.5U/L；葡萄糖(Glu)-静脉血: 5.55mmol/L；尿酸(UA)-静脉血: 325.7umol/L；直接胆红素(DBIL)-静脉血: 5.4umol/L；钠离子(Na+)-静脉血: 133.9mmol/L；大血小板百分比(P-LCR%)-静脉血: 31.7%；红细胞体积分布宽度CV(RDW-CV)-静……\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 予以皮下注射重组人粒细胞集落刺激因子（G-CSF），并静脉滴注异甘草酸镁进行保肝治疗。\nB. 嘱多饮水及注意休息，暂不予药物干预，定期门诊复查血常规及肝肾功能以评估毒性。\nC. 开具口服升白细胞药物（如咖啡酸片）及保肝药物（如复方甘草酸苷），暂不使用护胃止吐药物。\nD. 立即收治入院，予以静脉滴注质子泵抑制剂、止吐药及保肝药物，并密切监测血常规变化。\nE. 开具口服抑酸护胃及促胃动力药物（如艾司奥美拉唑、多潘立酮），暂不处理白细胞及肝功能异常。\nF. 提前开始第二周期TPF诱导化疗，并预防性给予长效G-CSF及静脉保肝药物支持治疗。\nG. 开具口服保肝药物（如复方甘草酸苷）及护胃止吐药物，暂不予口服升白细胞药物进行干预。\nH. 予以皮下注射重组人促红素（EPO），并开具口服保肝、护胃及促动力药物进行对症支持。\nI. 开具口服升白细胞药物（如咖啡酸片）、抑酸护胃及促胃动力药物，暂不予保肝药物治疗。\nJ. 安排骨髓穿刺检查以明确白细胞减少原因，同时开具口服保肝及护胃药物进行对症支持。\nK. 门诊静脉推注地塞米松及昂丹司琼强化止吐，并开具口服保肝及升白药物进行对症支持。\nL. 开具口服升白细胞药物（如咖啡酸片）、保肝药物（如复方甘草酸苷）及抑酸护胃、促动力药物进行对症支持。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-b10ed2b10a17f1626353b252","patient_id":"patient-5731cc38ced94b2ee39c442a","turn_id":"turn07","turn_position":5,"turn_type":"recurrence_or_salvage_decision","gold_letter":"A","gold_action":"结束诱导化疗，序贯开展根治性放射治疗。","options":[{"letter":"A","text":"结束诱导化疗，序贯开展根治性放射治疗","is_gold":true},{"letter":"B","text":"继续原方案（TPF联合尼妥珠单抗）诱导化疗至第6周期后再行放射治疗","is_gold":false},{"letter":"C","text":"更换为GP方案（吉西他滨联合顺铂）继续诱导化疗2个周期","is_gold":false},{"letter":"D","text":"行鼻咽原发灶及双侧颈部淋巴结根治性切除术","is_gold":false},{"letter":"E","text":"行双侧颈部淋巴结清扫术，术后序贯鼻咽局部放射治疗","is_gold":false},{"letter":"F","text":"加用PD-1抑制剂联合原方案继续诱导化疗2个周期","is_gold":false},{"letter":"G","text":"暂停抗肿瘤治疗，进入定期随访观察阶段","is_gold":false},{"letter":"H","text":"完善全身PET-CT重新分期后再决定后续局部治疗方案","is_gold":false},{"letter":"I","text":"仅行根治性放射治疗，处理鼻咽原发灶，颈部病灶继续随访观察","is_gold":false},{"letter":"J","text":"结束诱导化疗，序贯开展尼妥珠单抗单药靶向维持治疗","is_gold":false},{"letter":"K","text":"行放射性粒子植入术，处理鼻咽及颈部残留病灶直接","is_gold":false},{"letter":"L","text":"采用卡培他滨单药维持化疗，推迟局部放射治疗","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、蝶窦、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D50] 检验组合: 碱性磷酸酶(ALP)-静脉血: 79.1U/L；总胆红素(TBIL)-静脉血: 18.4umol/L；血小板比容-静脉血: 24%；磷(P)-静脉血: 1.77mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=4.50)（参考: 阴性）；白蛋白(ALB)-静脉血: 44g/L；C-反应蛋白(CRP)-静脉血: 2.48mg/L；球蛋白(GLO)-静脉血: 30.07g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 5.18mmol/L；总胆汁酸(TBA)-静脉血: 3umol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.9；平均红细胞血红蛋白浓度(MCHC)-静脉血: 332g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0；淋巴细胞百分比(Lymph%)-静脉血: 0.212；胱抑素(Cys-C)-静脉血: 1.1mg/L；乳酸脱氢酶(LDH)-静脉血: 209.6U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 51.1U/L；氯离子(Cl-)-静脉血: 99.5mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 45.8U/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.7mmol/L；载脂蛋白B(apoB)-静脉血: 1.54g/L；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.726；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.18mmolL；镁离子(Mg2+)-静脉血: 0.94mmol/L；钾离子(K+)-静脉血: 4.21mmol/L；阴离子间隙(AG)-静脉血: 15；单核细胞百分比(Mono%)-静脉血: 0.06；直接胆红素(DBIL)-静脉血: 3.3umol/L；总蛋白(TP)-静脉血: 74.07g/L；红细胞比容(Hct)-静脉血: 41.9%；血小板计数(PLT#)-静脉血: 24410E9/L；EB病毒Zta蛋白抗体IgA(EBV-Zta-IgA)-静脉血: 阳性(SCO=5.00)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 32.5U/L；载脂蛋白AI(ap……\n- [全程D53] 检验组合: 单核细胞计数(Mono#)-静脉血: 0.210E9/L；平均血小板体积(MPV)-静脉血: 10.1fL；平均红细胞血红蛋白含量(MCH)-静脉血: 27.5pg；氯离子(Cl-)-静脉血: 102.2mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；血小板分布宽度(PDW)-静脉血: 11.6%；钾离子(K+)-静脉血: 4.44mmol/L；血红蛋白(Hb)-静脉血: 146g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.4U/L；血小板比容-静脉血: 24%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 23610E9/L；肌酐(Crea)-静脉血: 78umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.97mmolL；直接胆红素(DBIL)-静脉血: 2.9umol/L；镁离子(Mg2+)-静脉血: 0.89mmol/L；白细胞计数(WBC#)-静脉血: 4.8410E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.9；有核红细胞计数(NRBC#)-静脉血: 010E9/L；尿酸(UA)-静脉血: 396.5umol/L；白蛋白(ALB)-静脉血: 43.6g/L；有核红细胞百分比(NRBC%)-静脉血: 0；单核细胞百分比(Mono%)-静脉血: 0.041；甘油三酯(TG)-静脉血: 1.5mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.5；总胆汁酸(TBA)-静脉血: 3.2umol/L；总钙(Ca)-静脉血: 2.29mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 29.4U/L；碱性磷酸酶(ALP)-静脉血: 88.9U/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.5mmol/L；平均红细胞体积(MCV)-静脉血: 84fL；丙氨酸氨基转移酶(ALT)-静脉血: 34.7U/L；红细胞比容(Hct)-静脉血: 44.5%；尿素氮(BUN)-静脉血: 6.4mmol/L；胱抑素(Cys-C)-……\n- [全程D64] 检验组合: 磷(P)-静脉血: 1.1mmol/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；平均红细胞血红蛋白含量(MCH)-静脉血: 27.3pg；平均血小板体积(MPV)-静脉血: 9.4fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.4；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；总钙(Ca)-静脉血: 2.24mmol/L；总蛋白(TP)-静脉血: 73.3g/L；氯离子(Cl-)-静脉血: 104.7mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 46.1U/L；单核细胞百分比(Mono%)-静脉血: 0.094；α-L-岩藻糖苷酶(AFU)-静脉血: 31.3U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.93mmol/L；尿素氮(BUN)-静脉血: 6.4mmol/L；总胆固醇(TC)-静脉血: 5.7mmol/L；血小板计数(PLT#)-静脉血: 15510E9/L；球蛋白(GLO)-静脉血: 28g/L；直接胆红素(DBIL)-静脉血: 2.3umol/L；总胆汁酸(TBA)-静脉血: 1.8umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.09mmolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.74；载脂蛋白B(apoB)-静脉血: 1.34g/L；钠离子(Na+)-静脉血: 141.6mmol/L；C-反应蛋白(CRP)-静脉血: 4.1mg/L；血小板比容-静脉血: 15%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；葡萄糖(Glu)-静脉血: 5.4mmol/L；白蛋白(ALB)-静脉血: 45.3g/L；有核红细胞计数(NRBC#)-静脉血: 0.0110E9/L；尿酸(UA)-静脉血: 511.6umol/L；甘油三酯(TG)-静脉血: 1.82mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.5mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 26.8U/L；大血小板百分比(P-LCR%)-静脉血: 19.5%；中性粒细胞计数(Neut#)-静脉血: 3.110E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 319g/L；乳酸脱氢酶(……\n- [全程D71] 检验组合: γ-谷氨酰基转移酶(GGT)-静脉血: 47U/L；尿酸(UA)-静脉血: 339.1umol/L；阴离子间隙(AG)-静脉血: 16.7；白细胞计数(WBC#)-静脉血: 5.8510E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 27.4pg；有核红细胞计数(NRBC#)-静脉血: 010E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.156；EB病毒Zta蛋白抗体IgA(EBV-Zta-IgA)-静脉血: 阳性(SCO=4.00)（参考: 阴性）；磷(P)-静脉血: 1.25mmol/L；肌酐(Crea)-静脉血: 80.9umol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:20（参考: 阴性）；单核细胞百分比(Mono%)-静脉血: 0.029；中性粒细胞计数(Neut#)-静脉血: 4.810E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.7mmol/L；红细胞比容(Hct)-静脉血: 43.3%；总胆红素(TBIL)-静脉血: 18.3umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 6.04mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；平均血小板体积(MPV)-静脉血: 10.9fL；碱性磷酸酶(ALP)-静脉血: 81.8U/L；葡萄糖(Glu)-静脉血: 5.79mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.6；间接胆红素(IBIL)-静脉血: 15umolL；α-L-岩藻糖苷酶(AFU)-静脉血: 41.6U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.48mmolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.3；载脂蛋白AI(apoAI)-静脉血: 1.28g/L；甘油三酯(TG)-静脉血: 2.29mmol/L；平均红细胞体积(MCV)-静脉血: 83.1fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板比容-静脉血: 17%；球蛋白(GLO)-静脉血: 29.1g/L；载脂蛋白B(apoB)-静脉血: 1.64g/L；乳酸脱氢酶(LDH)-静脉血: 229.2U/L；镁离子(Mg2+)-静脉血: 0.76mmol……\n- [全程D75] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后，对比某次就诊时间片： 鼻咽腔稍狭窄，鼻咽左顶壁及左侧壁增厚，在T1WI上呈等信号，在T2WI上呈稍高信号，增强扫描明显强化，较前明显缩小，左侧破裂孔、海绵窦、翼腭窝及蝶窦左份仍可见软组织灶，边界欠清，明显强化。右侧咽隐窝存在，左侧咽隐窝变浅 左侧腭帆张提肌、左侧翼内肌上缘信号不均匀，可见强化。 左侧咽旁间隙变窄，右侧咽旁间隙及双侧颈动脉鞘区血管未见明显异常。 右侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常。口咽双侧壁未见增厚。 斜坡、左侧岩尖、蝶骨基底部、左侧翼突区骨质信号减低，增强扫描明显强化。 右侧海绵窦形态正常，未见增宽。 双侧筛窦、左侧上颌窦、蝶窦粘膜增厚，左侧乳突内见少量信号分泌物。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变。 双侧咽后未见明确肿大淋巴结。 双颈II区及左颈III区可见数个淋巴结，最大约14mm×5mm，边界欠清，增强扫描可见明显强化。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。 所示脑实质未见明确异常。；检查结论: 鼻咽癌化疗后，范围较前明显缩小。 颅底骨质破坏。 双颈淋巴结，考虑转移，较前缩小、减少。 双侧咽后未见肿大淋巴结。 鼻窦炎。 左侧乳突炎。\n\n【既往治疗与反应】\n- [全程D65] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日患者症状体征基本同前，无诉其余特殊不适。[姓名已隐去]医生信息已隐藏示：患者诊断明确，复查血常规、生化常规无明显化疗禁忌症，拟按期于某次就诊时间开始行TPF诱导化疗， 具体用药：DOC60mg/㎡d1+DDP60mg/㎡ d2+5-FU2.5g/㎡civ48hQ3w，并指示化疗期间给予护肝、护胃、止吐及营养支持治疗，昨日已行泰欣生靶向治疗，密切观察患者病情变化。\n- [全程D66] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，未诉恶心、呕吐、腹痛、腹泻等不适，大小便正常。[姓名已隐去]医生信息已隐藏出，患者目前一般情况可，予明日按TPF方案行第3周期化疗，注意化疗结束后复查血、生化常规，及时对症处理。\n- [全程D69] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日为化疗第3天，诉间有恶心，无呕吐，无咳嗽、咳痰，无头痛、头晕，大小便正常。[姓名已隐去]医生信息已隐藏出，患者化疗后出现胃肠道反应I度，予继续对症处理，减轻化疗后反应。\n- [全程D71] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日患者症状体征基本同前，无诉其余特殊不适。今日复查血常规及生化常规未见明显异常。[姓名已隐去]医生信息已隐藏示：患者病情平稳，一般情况良好，目前予完善相关放疗前准备，今日予办理出院。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 结束诱导化疗，序贯开展根治性放射治疗\nB. 继续原方案（TPF联合尼妥珠单抗）诱导化疗至第6周期后再行放射治疗\nC. 更换为GP方案（吉西他滨联合顺铂）继续诱导化疗2个周期\nD. 行鼻咽原发灶及双侧颈部淋巴结根治性切除术\nE. 行双侧颈部淋巴结清扫术，术后序贯鼻咽局部放射治疗\nF. 加用PD-1抑制剂联合原方案继续诱导化疗2个周期\nG. 暂停抗肿瘤治疗，进入定期随访观察阶段\nH. 完善全身PET-CT重新分期后再决定后续局部治疗方案\nI. 仅行根治性放射治疗，处理鼻咽原发灶，颈部病灶继续随访观察\nJ. 结束诱导化疗，序贯开展尼妥珠单抗单药靶向维持治疗\nK. 行放射性粒子植入术，处理鼻咽及颈部残留病灶直接\nL. 采用卡培他滨单药维持化疗，推迟局部放射治疗\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、蝶窦、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D50] 检验组合: 碱性磷酸酶(ALP)-静脉血: 79.1U/L；总胆红素(TBIL)-静脉血: 18.4umol/L；血小板比容-静脉血: 24%；磷(P)-静脉血: 1.77mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=4.50)（参考: 阴性）；白蛋白(ALB)-静脉血: 44g/L；C-反应蛋白(CRP)-静脉血: 2.48mg/L；球蛋白(GLO)-静脉血: 30.07g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 5.18mmol/L；总胆汁酸(TBA)-静脉血: 3umol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.9；平均红细胞血红蛋白浓度(MCHC)-静脉血: 332g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0；淋巴细胞百分比(Lymph%)-静脉血: 0.212；胱抑素(Cys-C)-静脉血: 1.1mg/L；乳酸脱氢酶(LDH)-静脉血: 209.6U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 51.1U/L；氯离子(Cl-)-静脉血: 99.5mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 45.8U/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.7mmol/L；载脂蛋白B(apoB)-静脉血: 1.54g/L；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.726；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.18mmolL；镁离子(Mg2+)-静脉血: 0.94mmol/L；钾离子(K+)-静脉血: 4.21mmol/L；阴离子间隙(AG)-静脉血: 15；单核细胞百分比(Mono%)-静脉血: 0.06；直接胆红素(DBIL)-静脉血: 3.3umol/L；总蛋白(TP)-静脉血: 74.07g/L；红细胞比容(Hct)-静脉血: 41.9%；血小板计数(PLT#)-静脉血: 24410E9/L；EB病毒Zta蛋白抗体IgA(EBV-Zta-IgA)-静脉血: 阳性(SCO=5.00)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 32.5U/L；载脂蛋白AI(ap……\n- [全程D53] 检验组合: 单核细胞计数(Mono#)-静脉血: 0.210E9/L；平均血小板体积(MPV)-静脉血: 10.1fL；平均红细胞血红蛋白含量(MCH)-静脉血: 27.5pg；氯离子(Cl-)-静脉血: 102.2mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；血小板分布宽度(PDW)-静脉血: 11.6%；钾离子(K+)-静脉血: 4.44mmol/L；血红蛋白(Hb)-静脉血: 146g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.4U/L；血小板比容-静脉血: 24%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 23610E9/L；肌酐(Crea)-静脉血: 78umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.97mmolL；直接胆红素(DBIL)-静脉血: 2.9umol/L；镁离子(Mg2+)-静脉血: 0.89mmol/L；白细胞计数(WBC#)-静脉血: 4.8410E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.9；有核红细胞计数(NRBC#)-静脉血: 010E9/L；尿酸(UA)-静脉血: 396.5umol/L；白蛋白(ALB)-静脉血: 43.6g/L；有核红细胞百分比(NRBC%)-静脉血: 0；单核细胞百分比(Mono%)-静脉血: 0.041；甘油三酯(TG)-静脉血: 1.5mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.5；总胆汁酸(TBA)-静脉血: 3.2umol/L；总钙(Ca)-静脉血: 2.29mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 29.4U/L；碱性磷酸酶(ALP)-静脉血: 88.9U/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.5mmol/L；平均红细胞体积(MCV)-静脉血: 84fL；丙氨酸氨基转移酶(ALT)-静脉血: 34.7U/L；红细胞比容(Hct)-静脉血: 44.5%；尿素氮(BUN)-静脉血: 6.4mmol/L；胱抑素(Cys-C)-……\n- [全程D64] 检验组合: 磷(P)-静脉血: 1.1mmol/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；平均红细胞血红蛋白含量(MCH)-静脉血: 27.3pg；平均血小板体积(MPV)-静脉血: 9.4fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.4；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；总钙(Ca)-静脉血: 2.24mmol/L；总蛋白(TP)-静脉血: 73.3g/L；氯离子(Cl-)-静脉血: 104.7mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 46.1U/L；单核细胞百分比(Mono%)-静脉血: 0.094；α-L-岩藻糖苷酶(AFU)-静脉血: 31.3U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.93mmol/L；尿素氮(BUN)-静脉血: 6.4mmol/L；总胆固醇(TC)-静脉血: 5.7mmol/L；血小板计数(PLT#)-静脉血: 15510E9/L；球蛋白(GLO)-静脉血: 28g/L；直接胆红素(DBIL)-静脉血: 2.3umol/L；总胆汁酸(TBA)-静脉血: 1.8umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.09mmolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.74；载脂蛋白B(apoB)-静脉血: 1.34g/L；钠离子(Na+)-静脉血: 141.6mmol/L；C-反应蛋白(CRP)-静脉血: 4.1mg/L；血小板比容-静脉血: 15%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；葡萄糖(Glu)-静脉血: 5.4mmol/L；白蛋白(ALB)-静脉血: 45.3g/L；有核红细胞计数(NRBC#)-静脉血: 0.0110E9/L；尿酸(UA)-静脉血: 511.6umol/L；甘油三酯(TG)-静脉血: 1.82mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.5mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 26.8U/L；大血小板百分比(P-LCR%)-静脉血: 19.5%；中性粒细胞计数(Neut#)-静脉血: 3.110E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 319g/L；乳酸脱氢酶(……\n- [全程D71] 检验组合: γ-谷氨酰基转移酶(GGT)-静脉血: 47U/L；尿酸(UA)-静脉血: 339.1umol/L；阴离子间隙(AG)-静脉血: 16.7；白细胞计数(WBC#)-静脉血: 5.8510E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 27.4pg；有核红细胞计数(NRBC#)-静脉血: 010E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.156；EB病毒Zta蛋白抗体IgA(EBV-Zta-IgA)-静脉血: 阳性(SCO=4.00)（参考: 阴性）；磷(P)-静脉血: 1.25mmol/L；肌酐(Crea)-静脉血: 80.9umol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:20（参考: 阴性）；单核细胞百分比(Mono%)-静脉血: 0.029；中性粒细胞计数(Neut#)-静脉血: 4.810E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.7mmol/L；红细胞比容(Hct)-静脉血: 43.3%；总胆红素(TBIL)-静脉血: 18.3umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 6.04mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；平均血小板体积(MPV)-静脉血: 10.9fL；碱性磷酸酶(ALP)-静脉血: 81.8U/L；葡萄糖(Glu)-静脉血: 5.79mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.6；间接胆红素(IBIL)-静脉血: 15umolL；α-L-岩藻糖苷酶(AFU)-静脉血: 41.6U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.48mmolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.3；载脂蛋白AI(apoAI)-静脉血: 1.28g/L；甘油三酯(TG)-静脉血: 2.29mmol/L；平均红细胞体积(MCV)-静脉血: 83.1fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板比容-静脉血: 17%；球蛋白(GLO)-静脉血: 29.1g/L；载脂蛋白B(apoB)-静脉血: 1.64g/L；乳酸脱氢酶(LDH)-静脉血: 229.2U/L；镁离子(Mg2+)-静脉血: 0.76mmol……\n- [全程D75] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后，对比某次就诊时间片： 鼻咽腔稍狭窄，鼻咽左顶壁及左侧壁增厚，在T1WI上呈等信号，在T2WI上呈稍高信号，增强扫描明显强化，较前明显缩小，左侧破裂孔、海绵窦、翼腭窝及蝶窦左份仍可见软组织灶，边界欠清，明显强化。右侧咽隐窝存在，左侧咽隐窝变浅 左侧腭帆张提肌、左侧翼内肌上缘信号不均匀，可见强化。 左侧咽旁间隙变窄，右侧咽旁间隙及双侧颈动脉鞘区血管未见明显异常。 右侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常。口咽双侧壁未见增厚。 斜坡、左侧岩尖、蝶骨基底部、左侧翼突区骨质信号减低，增强扫描明显强化。 右侧海绵窦形态正常，未见增宽。 双侧筛窦、左侧上颌窦、蝶窦粘膜增厚，左侧乳突内见少量信号分泌物。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变。 双侧咽后未见明确肿大淋巴结。 双颈II区及左颈III区可见数个淋巴结，最大约14mm×5mm，边界欠清，增强扫描可见明显强化。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。 所示脑实质未见明确异常。；检查结论: 鼻咽癌化疗后，范围较前明显缩小。 颅底骨质破坏。 双颈淋巴结，考虑转移，较前缩小、减少。 双侧咽后未见肿大淋巴结。 鼻窦炎。 左侧乳突炎。\n\n【既往治疗与反应】\n- [全程D65] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日患者症状体征基本同前，无诉其余特殊不适。[姓名已隐去]医生信息已隐藏示：患者诊断明确，复查血常规、生化常规无明显化疗禁忌症，拟按期于某次就诊时间开始行TPF诱导化疗， 具体用药：DOC60mg/㎡d1+DDP60mg/㎡ d2+5-FU2.5g/㎡civ48hQ3w，并指示化疗期间给予护肝、护胃、止吐及营养支持治疗，昨日已行泰欣生靶向治疗，密切观察患者病情变化。\n- [全程D66] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，未诉恶心、呕吐、腹痛、腹泻等不适，大小便正常。[姓名已隐去]医生信息已隐藏出，患者目前一般情况可，予明日按TPF方案行第3周期化疗，注意化疗结束后复查血、生化常规，及时对症处理。\n- [全程D69] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日为化疗第3天，诉间有恶心，无呕吐，无咳嗽、咳痰，无头痛、头晕，大小便正常。[姓名已隐去]医生信息已隐藏出，患者化疗后出现胃肠道反应I度，予继续对症处理，减轻化疗后反应。\n- [全程D71] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日患者症状体征基本同前，无诉其余特殊不适。今日复查血常规及生化常规未见明显异常。[姓名已隐去]医生信息已隐藏示：患者病情平稳，一般情况良好，目前予完善相关放疗前准备，今日予办理出院。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 结束诱导化疗，序贯开展根治性放射治疗\nB. 继续原方案（TPF联合尼妥珠单抗）诱导化疗至第6周期后再行放射治疗\nC. 更换为GP方案（吉西他滨联合顺铂）继续诱导化疗2个周期\nD. 行鼻咽原发灶及双侧颈部淋巴结根治性切除术\nE. 行双侧颈部淋巴结清扫术，术后序贯鼻咽局部放射治疗\nF. 加用PD-1抑制剂联合原方案继续诱导化疗2个周期\nG. 暂停抗肿瘤治疗，进入定期随访观察阶段\nH. 完善全身PET-CT重新分期后再决定后续局部治疗方案\nI. 仅行根治性放射治疗，处理鼻咽原发灶，颈部病灶继续随访观察\nJ. 结束诱导化疗，序贯开展尼妥珠单抗单药靶向维持治疗\nK. 行放射性粒子植入术，处理鼻咽及颈部残留病灶直接\nL. 采用卡培他滨单药维持化疗，推迟局部放射治疗\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-95ccde5ff1e164e8d7edc6f5","patient_id":"patient-5731cc38ced94b2ee39c442a","turn_id":"turn08","turn_position":6,"turn_type":"recurrence_or_salvage_decision","gold_letter":"B","gold_action":"行鼻咽及颈部MRI增强扫描评估近期疗效，继续定期随访","options":[{"letter":"A","text":"行全身PET-CT扫描评估全身肿瘤负荷及近期疗效","is_gold":false},{"letter":"B","text":"行鼻咽及颈部MRI增强扫描评估近期疗效，继续定期随访","is_gold":true},{"letter":"C","text":"行鼻咽镜检查并对原发灶区域进行常规多点活检排除残留","is_gold":false},{"letter":"D","text":"启动卡培他滨节拍性维持化疗降低远处转移风险","is_gold":false},{"letter":"E","text":"启动PD-1抑制剂维持治疗巩固靶向联合放疗的近期疗效","is_gold":false},{"letter":"F","text":"仅定期复查血常规、生化及EBV-DNA，暂不复查局部影像学","is_gold":false},{"letter":"G","text":"直接安排鼻咽原发灶内镜下挽救性切除手术","is_gold":false},{"letter":"H","text":"直接安排鼻咽原发灶挽救性立体定向放疗","is_gold":false},{"letter":"I","text":"行胸部及全腹部增强CT扫描，暂缓头颈部局部影像学复查","is_gold":false},{"letter":"J","text":"行全身骨扫描及头颅MRI排除无症状的远处器官转移风险","is_gold":false},{"letter":"K","text":"启动吉西他滨联合顺铂方案全身化疗清除潜在微小转移灶","is_gold":false},{"letter":"L","text":"继续使用尼妥珠单抗单药维持治疗至满一年巩固局部疗效","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、蝶窦、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D120] 检验组合: 尿酸(UA)-静脉血: 409.8umol/L；球蛋白(GLO)-静脉血: 27.4g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.63；总钙(Ca)-静脉血: 2.24mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 25U/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；γ-谷氨酰基转移酶(GGT)-静脉血: 55.3U/L；中性粒细胞百分比(Neut%)-静脉血: 0.859；白细胞计数(WBC#)-静脉血: 5.710E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.058；间接胆红素(IBIL)-静脉血: 6.28umolL；C-反应蛋白(CRP)-静脉血: 88.14mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 48；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；碱性磷酸酶(ALP)-静脉血: 82.1U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15.7U/L；磷(P)-静脉血: 1.36mmol/L；白蛋白(ALB)-静脉血: 41.7g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.78mmolL；镁离子(Mg2+)-静脉血: 0.9mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.79mmol/L；钠离子(Na+)-静脉血: 139.5mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 15.1；中性粒细胞计数(Neut#)-静脉血: 4.910E9/L；血红蛋白(Hb)-静脉血: 113g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.3fL；氯离子(Cl-)-静脉血: 101.6mmol/L；红细胞比容(Hct)-静脉血: 34.4%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；乳酸脱氢酶(LDH)-静脉血: 163.4U/L；总胆汁酸(TBA)-静脉血: 5.6umol/L；尿素氮(BUN)-静脉血: 6mmol/L；血小板比容-静脉血: 10%；大血小板百分比(P-LCR%)-静脉血: 25%；葡萄糖(Glu)-静脉……\n- [全程D127] 检验组合: 红细胞比容(Hct)-静脉血: 27.7%；血红蛋白(Hb)-静脉血: 88g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.005；尿酸(UA)-静脉血: 268.3umol/L；直接胆红素(DBIL)-静脉血: 2.1umol/L；乳酸脱氢酶(LDH)-静脉血: 105.9U/L；碱性磷酸酶(ALP)-静脉血: 82.3U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.72；中性粒细胞百分比(Neut%)-静脉血: 0.798；尿素氮(BUN)-静脉血: 4.9mmol/L；载脂蛋白B(apoB)-静脉血: 1.41g/L；C-反应蛋白(CRP)-静脉血: 198.52mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.26；总胆汁酸(TBA)-静脉血: 1.1umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 9.6U/L；球蛋白(GLO)-静脉血: 27.52g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.03；总钙(Ca)-静脉血: 2.35mmol/L；甘油三酯(TG)-静脉血: 2.27mmol/L；氯离子(Cl-)-静脉血: 102.6mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28pg；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.74mmolL；白蛋白(ALB)-静脉血: 34.8g/L；载脂蛋白AI(apoAI)-静脉血: 0.71g/L；单核细胞百分比(Mono%)-静脉血: 0.167；淋巴细胞计数(Lymph#)-静脉血: 0.110E9/L；血小板比容-静脉血: 11%；肌酐(Crea)-静脉血: 68.7umol/L；总胆固醇(TC)-静脉血: 5.14mmol/L；胱抑素(Cys-C)-静脉血: 0.91mg/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 60.6U/L；镁离子(Mg2+)-静脉血: 0.81mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 12610E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.2mmol/L；大血小板百分比(P-LCR%)-静脉血: 16.5%；丙氨酸氨基转移酶(ALT)-静脉血:……\n- [全程D132] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）\n- [全程D167] 检验组合: EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:80（参考: 阴性）\n- [全程D222] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:80（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）\n- [全程D222] 检验组合: 氯离子(Cl-)-静脉血: 103.6mmol/L；血小板分布宽度(PDW)-静脉血: 10.7%；C-反应蛋白(CRP)-静脉血: 1.07mg/L；甘油三酯(TG)-静脉血: 1.41mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.89；白蛋白(ALB)-静脉血: 46.7g/L；葡萄糖(Glu)-静脉血: 5.1mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.68；血小板比容-静脉血: 17%；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L；直接胆红素(DBIL)-静脉血: 2.1umol/L；磷(P)-静脉血: 1.27mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 317g/L；大血小板百分比(P-LCR%)-静脉血: 24.8%；丙氨酸氨基转移酶(ALT)-静脉血: 19.3U/L；总蛋白(TP)-静脉血: 74.5g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 18.4U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.2U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.63mmol/L；总胆固醇(TC)-静脉血: 5.21mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 15.7U/L；乳酸脱氢酶(LDH)-静脉血: 168.2U/L；间接胆红素(IBIL)-静脉血: 6.8umolL；平均红细胞体积(MCV)-静脉血: 87.3fL；红细胞比容(Hct)-静脉血: 39.7%；中性粒细胞百分比(Neut%)-静脉血: 0.657；钠离子(Na+)-静脉血: 139.4mmol/L；碱性磷酸酶(ALP)-静脉血: 72U/L；单核细胞百分比(Mono%)-静脉血: 0.101；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.05；阴离子间隙(AG)-静脉血: 13.3；总胆汁酸(TBA)-静脉血: 2.7umol/L；镁离子(Mg2+)-静脉血: 0.92mmol/L；总胆红素(TBIL)-静脉血: 8.9umol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 42.4；肌酐(Crea)-静脉血: 74.3um……\n- [全程D223] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理清晰，未见明确实质性病变。双侧肺门未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n\n【既往治疗与反应】\n- [全程D121] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今天完成放疗24次，仍有轻度口干，口咽疼痛NRS1分，无恶心、呕吐，无头晕、头痛。查体：口咽部放射性粘膜炎Ⅱ°，颈部放射性皮炎Ⅰ°。某次就诊时间血常规HGB113g/L，生化大致正常。[姓名已隐去]医生信息已隐藏：继续予加强止痛、营养、改善贫血等对症支持治疗，密切观察病情变化。\n- [全程D124] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者昨天行第6次泰欣生分子靶向治疗，今天完成放疗26次，仍有轻度口干，口咽疼痛NRS1分，无恶心、呕吐，无发热、畏寒，查体：口咽部放射性粘膜炎Ⅱ°，颈部放射性皮炎Ⅰ°。[姓名已隐去]医生信息已隐藏示：患者放射性口咽炎仍明显，需加强局部冲洗、止痛等支持治疗，继续予按计划放疗。\n- [全程D127] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今天完成放疗29次，仍有轻度口干，口咽疼痛NRS1分，无发热、畏寒，无恶心、呕吐，查体：口咽部放射性粘膜炎Ⅰ°，颈部放射性皮炎Ⅰ°。某次就诊时间血常规示WBC3.6510E9/L， NE#2.9*10E9/L， HGB88.0g/L，PLT126.0*10E9/L，[姓名已隐去]医生信息已隐藏：患者白细胞稍低，但血红蛋白较前下降，考虑营养摄入不足和放化疗后骨髓抑制所致，予口服升白、改善贫血药治疗，加强口腔局部冲洗，密切观察病情变化。\n- [全程D130] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今天完成放疗30次，仍有轻度口干，口咽疼痛NRS2分，无发热、畏寒，无恶心、呕吐，查体：口咽部放射性粘膜炎Ⅱ°，颈部放射性皮炎Ⅰ°。[姓名已隐去]医生信息已隐藏：患者今天予第7次泰欣生分子靶向治疗。患者口咽痛反复，继续加强止痛治疗，辅以局部冲洗等护理，观察病情变化。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行全身PET-CT扫描评估全身肿瘤负荷及近期疗效\nB. 行鼻咽及颈部MRI增强扫描评估近期疗效，继续定期随访\nC. 行鼻咽镜检查并对原发灶区域进行常规多点活检排除残留\nD. 启动卡培他滨节拍性维持化疗降低远处转移风险\nE. 启动PD-1抑制剂维持治疗巩固靶向联合放疗的近期疗效\nF. 仅定期复查血常规、生化及EBV-DNA，暂不复查局部影像学\nG. 直接安排鼻咽原发灶内镜下挽救性切除手术\nH. 直接安排鼻咽原发灶挽救性立体定向放疗\nI. 行胸部及全腹部增强CT扫描，暂缓头颈部局部影像学复查\nJ. 行全身骨扫描及头颅MRI排除无症状的远处器官转移风险\nK. 启动吉西他滨联合顺铂方案全身化疗清除潜在微小转移灶\nL. 继续使用尼妥珠单抗单药维持治疗至满一年巩固局部疗效\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、蝶窦、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D120] 检验组合: 尿酸(UA)-静脉血: 409.8umol/L；球蛋白(GLO)-静脉血: 27.4g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.63；总钙(Ca)-静脉血: 2.24mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 25U/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；γ-谷氨酰基转移酶(GGT)-静脉血: 55.3U/L；中性粒细胞百分比(Neut%)-静脉血: 0.859；白细胞计数(WBC#)-静脉血: 5.710E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.058；间接胆红素(IBIL)-静脉血: 6.28umolL；C-反应蛋白(CRP)-静脉血: 88.14mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 48；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；碱性磷酸酶(ALP)-静脉血: 82.1U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15.7U/L；磷(P)-静脉血: 1.36mmol/L；白蛋白(ALB)-静脉血: 41.7g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.78mmolL；镁离子(Mg2+)-静脉血: 0.9mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.79mmol/L；钠离子(Na+)-静脉血: 139.5mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 15.1；中性粒细胞计数(Neut#)-静脉血: 4.910E9/L；血红蛋白(Hb)-静脉血: 113g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.3fL；氯离子(Cl-)-静脉血: 101.6mmol/L；红细胞比容(Hct)-静脉血: 34.4%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；乳酸脱氢酶(LDH)-静脉血: 163.4U/L；总胆汁酸(TBA)-静脉血: 5.6umol/L；尿素氮(BUN)-静脉血: 6mmol/L；血小板比容-静脉血: 10%；大血小板百分比(P-LCR%)-静脉血: 25%；葡萄糖(Glu)-静脉……\n- [全程D127] 检验组合: 红细胞比容(Hct)-静脉血: 27.7%；血红蛋白(Hb)-静脉血: 88g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.005；尿酸(UA)-静脉血: 268.3umol/L；直接胆红素(DBIL)-静脉血: 2.1umol/L；乳酸脱氢酶(LDH)-静脉血: 105.9U/L；碱性磷酸酶(ALP)-静脉血: 82.3U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.72；中性粒细胞百分比(Neut%)-静脉血: 0.798；尿素氮(BUN)-静脉血: 4.9mmol/L；载脂蛋白B(apoB)-静脉血: 1.41g/L；C-反应蛋白(CRP)-静脉血: 198.52mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.26；总胆汁酸(TBA)-静脉血: 1.1umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 9.6U/L；球蛋白(GLO)-静脉血: 27.52g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.03；总钙(Ca)-静脉血: 2.35mmol/L；甘油三酯(TG)-静脉血: 2.27mmol/L；氯离子(Cl-)-静脉血: 102.6mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28pg；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.74mmolL；白蛋白(ALB)-静脉血: 34.8g/L；载脂蛋白AI(apoAI)-静脉血: 0.71g/L；单核细胞百分比(Mono%)-静脉血: 0.167；淋巴细胞计数(Lymph#)-静脉血: 0.110E9/L；血小板比容-静脉血: 11%；肌酐(Crea)-静脉血: 68.7umol/L；总胆固醇(TC)-静脉血: 5.14mmol/L；胱抑素(Cys-C)-静脉血: 0.91mg/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 60.6U/L；镁离子(Mg2+)-静脉血: 0.81mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 12610E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.2mmol/L；大血小板百分比(P-LCR%)-静脉血: 16.5%；丙氨酸氨基转移酶(ALT)-静脉血:……\n- [全程D132] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）\n- [全程D167] 检验组合: EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:80（参考: 阴性）\n- [全程D222] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:80（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）\n- [全程D222] 检验组合: 氯离子(Cl-)-静脉血: 103.6mmol/L；血小板分布宽度(PDW)-静脉血: 10.7%；C-反应蛋白(CRP)-静脉血: 1.07mg/L；甘油三酯(TG)-静脉血: 1.41mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.89；白蛋白(ALB)-静脉血: 46.7g/L；葡萄糖(Glu)-静脉血: 5.1mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.68；血小板比容-静脉血: 17%；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L；直接胆红素(DBIL)-静脉血: 2.1umol/L；磷(P)-静脉血: 1.27mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 317g/L；大血小板百分比(P-LCR%)-静脉血: 24.8%；丙氨酸氨基转移酶(ALT)-静脉血: 19.3U/L；总蛋白(TP)-静脉血: 74.5g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 18.4U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.2U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.63mmol/L；总胆固醇(TC)-静脉血: 5.21mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 15.7U/L；乳酸脱氢酶(LDH)-静脉血: 168.2U/L；间接胆红素(IBIL)-静脉血: 6.8umolL；平均红细胞体积(MCV)-静脉血: 87.3fL；红细胞比容(Hct)-静脉血: 39.7%；中性粒细胞百分比(Neut%)-静脉血: 0.657；钠离子(Na+)-静脉血: 139.4mmol/L；碱性磷酸酶(ALP)-静脉血: 72U/L；单核细胞百分比(Mono%)-静脉血: 0.101；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.05；阴离子间隙(AG)-静脉血: 13.3；总胆汁酸(TBA)-静脉血: 2.7umol/L；镁离子(Mg2+)-静脉血: 0.92mmol/L；总胆红素(TBIL)-静脉血: 8.9umol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 42.4；肌酐(Crea)-静脉血: 74.3um……\n- [全程D223] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理清晰，未见明确实质性病变。双侧肺门未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n\n【既往治疗与反应】\n- [全程D121] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今天完成放疗24次，仍有轻度口干，口咽疼痛NRS1分，无恶心、呕吐，无头晕、头痛。查体：口咽部放射性粘膜炎Ⅱ°，颈部放射性皮炎Ⅰ°。某次就诊时间血常规HGB113g/L，生化大致正常。[姓名已隐去]医生信息已隐藏：继续予加强止痛、营养、改善贫血等对症支持治疗，密切观察病情变化。\n- [全程D124] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者昨天行第6次泰欣生分子靶向治疗，今天完成放疗26次，仍有轻度口干，口咽疼痛NRS1分，无恶心、呕吐，无发热、畏寒，查体：口咽部放射性粘膜炎Ⅱ°，颈部放射性皮炎Ⅰ°。[姓名已隐去]医生信息已隐藏示：患者放射性口咽炎仍明显，需加强局部冲洗、止痛等支持治疗，继续予按计划放疗。\n- [全程D127] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今天完成放疗29次，仍有轻度口干，口咽疼痛NRS1分，无发热、畏寒，无恶心、呕吐，查体：口咽部放射性粘膜炎Ⅰ°，颈部放射性皮炎Ⅰ°。某次就诊时间血常规示WBC3.6510E9/L， NE#2.9*10E9/L， HGB88.0g/L，PLT126.0*10E9/L，[姓名已隐去]医生信息已隐藏：患者白细胞稍低，但血红蛋白较前下降，考虑营养摄入不足和放化疗后骨髓抑制所致，予口服升白、改善贫血药治疗，加强口腔局部冲洗，密切观察病情变化。\n- [全程D130] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今天完成放疗30次，仍有轻度口干，口咽疼痛NRS2分，无发热、畏寒，无恶心、呕吐，查体：口咽部放射性粘膜炎Ⅱ°，颈部放射性皮炎Ⅰ°。[姓名已隐去]医生信息已隐藏：患者今天予第7次泰欣生分子靶向治疗。患者口咽痛反复，继续加强止痛治疗，辅以局部冲洗等护理，观察病情变化。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行全身PET-CT扫描评估全身肿瘤负荷及近期疗效\nB. 行鼻咽及颈部MRI增强扫描评估近期疗效，继续定期随访\nC. 行鼻咽镜检查并对原发灶区域进行常规多点活检排除残留\nD. 启动卡培他滨节拍性维持化疗降低远处转移风险\nE. 启动PD-1抑制剂维持治疗巩固靶向联合放疗的近期疗效\nF. 仅定期复查血常规、生化及EBV-DNA，暂不复查局部影像学\nG. 直接安排鼻咽原发灶内镜下挽救性切除手术\nH. 直接安排鼻咽原发灶挽救性立体定向放疗\nI. 行胸部及全腹部增强CT扫描，暂缓头颈部局部影像学复查\nJ. 行全身骨扫描及头颅MRI排除无症状的远处器官转移风险\nK. 启动吉西他滨联合顺铂方案全身化疗清除潜在微小转移灶\nL. 继续使用尼妥珠单抗单药维持治疗至满一年巩固局部疗效\n\n请仅输出一个选项字母（A-L）。"}]}
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full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [时间未明] 门急诊记录: 主诉:；现病史: 者半年余前无明显诱因出现左侧颈部肿物，无疼痛，逐渐增大，伴有鼻塞、流涕，至当地医院予抗炎对症治疗后，肿物能减小；2月前患者始出现右侧颈部肿物，逐渐增大，伴有鼻塞、流涕，间中有涕血，无发热、畏寒，无头晕、头痛，无周身骨痛等，于当地医院检查ＣＴ示：鼻咽肿物，遂转至我院进一步诊治。门诊拟诊“鼻咽肿物”收入我科进一步治疗。患者起病以来精神、睡眠欠佳，胃纳尚可，二便正常，体重无明显下降。；既往史: 否认高血压、糖尿病及心脏病史，否认结核等传染病史、否认手术、外伤及输血史。；个人史:；家族史: 家族中无类似患者，无家族性遗传病患者，无重大精神病患者。；体格检查: KPS90，一般状况可，鼻咽左侧壁、顶后壁肿物，双颈扪及肿大淋巴结，右颈多枚肿大淋巴结，较大者约6*4及2*2cm,质硬，活动差，左上颈可及一淋巴结，约3*3cm，质中，活动度可，无融合，无皮肤浸润等，左中颈可及一大小约1*1cm质硬淋巴结；张口门齿距约4cm，颅神经征阴性。。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D0] 检验组合: 磷(P)-静脉血: 1.15mmol/L；平均红细胞体积(MCV)-静脉血: 87fL；肌酐(Crea)-静脉血: 58.2umol/L；C-反应蛋白(CRP)-静脉血: 1.11mg/L；尿酸(UA)-静脉血: 148.1umol/L；葡萄糖(Glu)-静脉血: 5.38mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.29；总胆红素(TBIL)-静脉血: 7.6umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.39mmolL；凝血酶时间(TT)-静脉血: 19.1sec.；钾离子(K+)-静脉血: 4.25mmol/L；阴离子间隙(AG)-静脉血: 10.3；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；白细胞计数(WBC#)-静脉血: 710E9/L；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阳性(169.39U/mL)（参考: 阴性）；载脂蛋白AI(apoAI)-静脉血: 1.57g/L；纤维蛋白原(Fbg)-静脉血: 3.35g/L；中性粒细胞计数(Neut#)-静脉血: 4.210E9/L；平均血小板体积(MPV)-静脉血: 9.6fL；有核红细胞百分比(NRBC%)-静脉血: 0；血小板比容-静脉血: 29%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 27mmol/L；凝血酶原时间活动度(PTA)-静脉血: 85.4%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；ABO血型-静脉血: O；甘油三酯(TG)-静脉血: 1.43mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.04S/CO；球蛋白(GLO)-静脉血: 33.45g/L；总钙(Ca)-静脉血: 2.26mmol/L；血小板分布宽度(PDW)-静脉血: 9.7%；间接胆红素(IBIL)-静脉血: 5.8umolL；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0IU/mL；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)……\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 安排根治性放化疗并完善胸腹部及骨骼等远处转移排查\nB. 行颈部淋巴结切除活检明确病理并完善胸腹部及骨骼等远处转移排查\nC. 行鼻咽镜下活检明确病理并暂缓远处转移排查直至病理确诊\nD. 行鼻咽镜下活检明确病理并完善胸腹部及骨骼等远处转移排查\nE. 行鼻咽镜下活检明确病理并安排诱导化疗联合同步放化疗\nF. 完善全身PET-CT检查排查远处转移并安排根治性放疗\nG. 行鼻咽镜下活检明确病理并完善头颅CT进一步评估颅底骨质破坏\nH. 行鼻咽镜下活检明确病理并完善EBV-DNA定量检测暂缓影像学排查\nI. 行颈部淋巴结穿刺活检明确病理并完善胸腹部及骨骼等远处转移排查\nJ. 完善胸部CT和腹部超声排查远处转移并暂缓鼻咽原发灶活检\nK. 行鼻咽镜下活检明确病理并完善全身骨扫描暂缓胸腹部影像学检查\nL. 安排鼻咽部肿物切除术明确病理并完善胸腹部及骨骼等远处转移排查\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [时间未明] 门急诊记录: 主诉:；现病史: 者半年余前无明显诱因出现左侧颈部肿物，无疼痛，逐渐增大，伴有鼻塞、流涕，至当地医院予抗炎对症治疗后，肿物能减小；2月前患者始出现右侧颈部肿物，逐渐增大，伴有鼻塞、流涕，间中有涕血，无发热、畏寒，无头晕、头痛，无周身骨痛等，于当地医院检查ＣＴ示：鼻咽肿物，遂转至我院进一步诊治。门诊拟诊“鼻咽肿物”收入我科进一步治疗。患者起病以来精神、睡眠欠佳，胃纳尚可，二便正常，体重无明显下降。；既往史: 否认高血压、糖尿病及心脏病史，否认结核等传染病史、否认手术、外伤及输血史。；个人史:；家族史: 家族中无类似患者，无家族性遗传病患者，无重大精神病患者。；体格检查: KPS90，一般状况可，鼻咽左侧壁、顶后壁肿物，双颈扪及肿大淋巴结，右颈多枚肿大淋巴结，较大者约6*4及2*2cm,质硬，活动差，左上颈可及一淋巴结，约3*3cm，质中，活动度可，无融合，无皮肤浸润等，左中颈可及一大小约1*1cm质硬淋巴结；张口门齿距约4cm，颅神经征阴性。。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D0] 检验组合: 磷(P)-静脉血: 1.15mmol/L；平均红细胞体积(MCV)-静脉血: 87fL；肌酐(Crea)-静脉血: 58.2umol/L；C-反应蛋白(CRP)-静脉血: 1.11mg/L；尿酸(UA)-静脉血: 148.1umol/L；葡萄糖(Glu)-静脉血: 5.38mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.29；总胆红素(TBIL)-静脉血: 7.6umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.39mmolL；凝血酶时间(TT)-静脉血: 19.1sec.；钾离子(K+)-静脉血: 4.25mmol/L；阴离子间隙(AG)-静脉血: 10.3；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；白细胞计数(WBC#)-静脉血: 710E9/L；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阳性(169.39U/mL)（参考: 阴性）；载脂蛋白AI(apoAI)-静脉血: 1.57g/L；纤维蛋白原(Fbg)-静脉血: 3.35g/L；中性粒细胞计数(Neut#)-静脉血: 4.210E9/L；平均血小板体积(MPV)-静脉血: 9.6fL；有核红细胞百分比(NRBC%)-静脉血: 0；血小板比容-静脉血: 29%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 27mmol/L；凝血酶原时间活动度(PTA)-静脉血: 85.4%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；ABO血型-静脉血: O；甘油三酯(TG)-静脉血: 1.43mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.04S/CO；球蛋白(GLO)-静脉血: 33.45g/L；总钙(Ca)-静脉血: 2.26mmol/L；血小板分布宽度(PDW)-静脉血: 9.7%；间接胆红素(IBIL)-静脉血: 5.8umolL；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0IU/mL；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)……\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 安排根治性放化疗并完善胸腹部及骨骼等远处转移排查\nB. 行颈部淋巴结切除活检明确病理并完善胸腹部及骨骼等远处转移排查\nC. 行鼻咽镜下活检明确病理并暂缓远处转移排查直至病理确诊\nD. 行鼻咽镜下活检明确病理并完善胸腹部及骨骼等远处转移排查\nE. 行鼻咽镜下活检明确病理并安排诱导化疗联合同步放化疗\nF. 完善全身PET-CT检查排查远处转移并安排根治性放疗\nG. 行鼻咽镜下活检明确病理并完善头颅CT进一步评估颅底骨质破坏\nH. 行鼻咽镜下活检明确病理并完善EBV-DNA定量检测暂缓影像学排查\nI. 行颈部淋巴结穿刺活检明确病理并完善胸腹部及骨骼等远处转移排查\nJ. 完善胸部CT和腹部超声排查远处转移并暂缓鼻咽原发灶活检\nK. 行鼻咽镜下活检明确病理并完善全身骨扫描暂缓胸腹部影像学检查\nL. 安排鼻咽部肿物切除术明确病理并完善胸腹部及骨骼等远处转移排查\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-220f428c46f369e75a66e1ab","patient_id":"patient-9149023ec8599161ec3e5cfd","turn_id":"turn04","turn_position":3,"turn_type":"initial_treatment_selection","gold_letter":"F","gold_action":"诱导化疗序贯同步放化疗","options":[{"letter":"A","text":"单纯根治性放疗","is_gold":false},{"letter":"B","text":"同步放化疗","is_gold":false},{"letter":"C","text":"诱导化疗序贯单纯根治性放疗","is_gold":false},{"letter":"D","text":"同步放化疗序贯辅助化疗","is_gold":false},{"letter":"E","text":"诱导化疗联合靶向治疗序贯放疗","is_gold":false},{"letter":"F","text":"诱导化疗序贯同步放化疗","is_gold":true},{"letter":"G","text":"根治性放疗序贯辅助化疗","is_gold":false},{"letter":"H","text":"诱导化疗序贯免疫联合同步放化疗","is_gold":false},{"letter":"I","text":"姑息性化疗联合免疫治疗","is_gold":false},{"letter":"J","text":"鼻咽放疗联合颈部淋巴结清扫术","is_gold":false},{"letter":"K","text":"靶向治疗联合同步放化疗","is_gold":false},{"letter":"L","text":"诱导化疗序贯颈部淋巴结清扫术","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D1] CT；胸、上腹CT平扫+增强: 检查类型: CT；检查名称: 胸、上腹CT平扫+增强；检查部位:；检查所见: 双肺纹理清晰，左肺下叶外基底段见条索状高密度影，边界清；余双肺内未见明显实质性病变。 气管及支气管分支通畅。 双肺门及纵隔未见明显肿大淋巴结。 双侧胸腔未见积液。双侧胸膜未见增厚、粘连。 肝脏形态未见异常，轮廓光整，各叶比例在正常范围以内，密度均匀。 肝内胆管未见明显异常。胆囊不大、壁不厚，其内未见结石。胆总管未见扩张，其内未见结石。 肝门区结构清晰。门静脉未见明显异常。 脾脏大小、形态未见明显异常，密度均匀。 胰腺大小、形态未见明显异常，密度均匀。 所示双肾及双侧肾上腺大小、形态未见明显异常，密度均匀。 膈脚后、肝门区、腹主动脉旁、腹腔干周围未见明显肿大淋巴结。 扫描层面内未见明显骨质破坏。；检查结论: 左肺下叶外基底段条索影，考虑纤维灶。 上腹部未见明显异常。\n- [全程D2] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 鼻咽部见片状放射性浓密影。胸骨、锁骨、肩胛骨、肋骨、颈椎、胸椎、腰椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 鼻咽部代谢活跃，考虑鼻咽癌所致。 余全身骨骼未见明显异常。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 单纯根治性放疗\nB. 同步放化疗\nC. 诱导化疗序贯单纯根治性放疗\nD. 同步放化疗序贯辅助化疗\nE. 诱导化疗联合靶向治疗序贯放疗\nF. 诱导化疗序贯同步放化疗\nG. 根治性放疗序贯辅助化疗\nH. 诱导化疗序贯免疫联合同步放化疗\nI. 姑息性化疗联合免疫治疗\nJ. 鼻咽放疗联合颈部淋巴结清扫术\nK. 靶向治疗联合同步放化疗\nL. 诱导化疗序贯颈部淋巴结清扫术\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D1] CT；胸、上腹CT平扫+增强: 检查类型: CT；检查名称: 胸、上腹CT平扫+增强；检查部位:；检查所见: 双肺纹理清晰，左肺下叶外基底段见条索状高密度影，边界清；余双肺内未见明显实质性病变。 气管及支气管分支通畅。 双肺门及纵隔未见明显肿大淋巴结。 双侧胸腔未见积液。双侧胸膜未见增厚、粘连。 肝脏形态未见异常，轮廓光整，各叶比例在正常范围以内，密度均匀。 肝内胆管未见明显异常。胆囊不大、壁不厚，其内未见结石。胆总管未见扩张，其内未见结石。 肝门区结构清晰。门静脉未见明显异常。 脾脏大小、形态未见明显异常，密度均匀。 胰腺大小、形态未见明显异常，密度均匀。 所示双肾及双侧肾上腺大小、形态未见明显异常，密度均匀。 膈脚后、肝门区、腹主动脉旁、腹腔干周围未见明显肿大淋巴结。 扫描层面内未见明显骨质破坏。；检查结论: 左肺下叶外基底段条索影，考虑纤维灶。 上腹部未见明显异常。\n- [全程D2] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 鼻咽部见片状放射性浓密影。胸骨、锁骨、肩胛骨、肋骨、颈椎、胸椎、腰椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 鼻咽部代谢活跃，考虑鼻咽癌所致。 余全身骨骼未见明显异常。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 单纯根治性放疗\nB. 同步放化疗\nC. 诱导化疗序贯单纯根治性放疗\nD. 同步放化疗序贯辅助化疗\nE. 诱导化疗联合靶向治疗序贯放疗\nF. 诱导化疗序贯同步放化疗\nG. 根治性放疗序贯辅助化疗\nH. 诱导化疗序贯免疫联合同步放化疗\nI. 姑息性化疗联合免疫治疗\nJ. 鼻咽放疗联合颈部淋巴结清扫术\nK. 靶向治疗联合同步放化疗\nL. 诱导化疗序贯颈部淋巴结清扫术\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-ed1b449691d94cea18e7b28b","patient_id":"patient-9149023ec8599161ec3e5cfd","turn_id":"turn05","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"K","gold_action":"安排鼻咽及颈部MRI平扫+增强、头颅MRI平扫+增强，暂缓胸部X线及腹部彩超检查，作为当前时点针对左侧颞叶新发病灶的重点影像随访；常规胸片、腹部彩超、EBV-DNA及甲功等全身随访可在下一随访窗口期再行安排。","options":[{"letter":"A","text":"给予大剂量糖皮质激素冲击治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超","is_gold":false},{"letter":"B","text":"给予贝伐珠单抗靶向治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项","is_gold":false},{"letter":"C","text":"安排头颅PET-CT检查鉴别左侧颞叶病变性质，并安排胸部X线、腹部彩超、甲功五项","is_gold":false},{"letter":"D","text":"安排立体定向脑活检明确左侧颞叶病变性质，并安排胸部X线、腹部彩超、甲功五项","is_gold":false},{"letter":"E","text":"给予高压氧治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项","is_gold":false},{"letter":"F","text":"给予甘露醇静脉滴注脱水降颅压，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超","is_gold":false},{"letter":"G","text":"安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项及EBV-DNA定量检测","is_gold":false},{"letter":"H","text":"给予神经营养药物治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项","is_gold":false},{"letter":"I","text":"安排鼻咽及颈部CT平扫+增强、胸部CT平扫、腹部CT平扫、甲功五项及EBV-DNA定量检测","is_gold":false},{"letter":"J","text":"安排立体定向放射外科治疗左侧颞叶病变，并安排胸部X线、腹部彩超、甲功五项","is_gold":false},{"letter":"K","text":"安排鼻咽及颈部MRI平扫+增强、头颅MRI平扫+增强，暂缓胸部X线及腹部彩超检查","is_gold":true},{"letter":"L","text":"给予抗癫痫药物预防性治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D986] 门急诊记录: 主诉: 鼻咽癌放化疗结束2年，诉轻度口干，听力视力正常，无头晕、头痛。体查：鼻咽未见明确肿物，双颈未扪及明显肿大淋巴结，颅神经（-）甲功五项示正常。鼻咽MRI未见明确复发，腹部B超、胸片未见明确转移。EBV-DNA:0；现病史:；既往史:；个人史:；家族史:；体格检查:\n\n【已完成检查与客观结果】\n- [全程D985] MRI；鼻咽部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部MR平扫+增强；检查部位:；检查所见: 鼻咽癌放疗后复查，对比某次就诊时间片： 鼻咽腔未见狭窄，鼻咽顶壁、顶后壁、右侧壁轻度增厚，均匀强化，右侧咽隐窝变浅，考虑放疗后改变，较前相仿。 蝶骨基底部、左侧枕骨基底部、左侧岩尖、左侧翼突基底部骨质信号下降，增强扫描轻度不均匀强化，较前相仿。 左侧破裂孔见少许软组织影，增强扫描轻度强化，较前相仿。 双侧咽后间隙见小淋巴结，大者短径约3mm，较前相仿。 右颈II区见多个淋巴结，最大短径约为5mm，部分边界欠清，增强扫描不均匀强化，较前稍缩小。 双侧上颌窦、筛窦、额窦粘膜增厚，考虑副鼻窦炎，较前相仿。 扫描所见颅脑未见明确异常。；检查结论:\n- [全程D985] MRI；颈部MR平扫+增强: 检查类型: MRI；检查名称: 颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌放疗后复查，对比某次就诊时间片： 鼻咽腔未见狭窄，鼻咽顶壁、顶后壁、右侧壁轻度增厚，均匀强化，右侧咽隐窝变浅，考虑放疗后改变，较前相仿。 蝶骨基底部、左侧枕骨基底部、左侧岩尖、左侧翼突基底部骨质信号下降，增强扫描轻度不均匀强化，较前相仿。 左侧破裂孔见少许软组织影，增强扫描轻度强化，较前相仿。 双侧咽后间隙见小淋巴结，大者短径约3mm，较前相仿。 右颈II区见多个淋巴结，最大短径约为5mm，部分边界欠清，增强扫描不均匀强化，较前稍缩小。 双侧上颌窦、筛窦、额窦粘膜增厚，考虑副鼻窦炎，较前相仿。 扫描所见颅脑未见明确异常。；检查结论:\n- [全程D1168] 检验组合: 游离甲状腺素(FT4)-静脉血: 14.91pmol/L；甲状腺过氧化物酶抗体(TPO-Ab)-静脉血: 12.55U/ml；游离三碘甲状腺原氨酸(FT3)-静脉血: 4.97pmol/L；甲状腺球蛋白(TG)-静脉血: 1.12ng/ml；促甲状腺激素(TSH)-静脉血: 1.59uIU/ml\n- [全程D1169] 超声；肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径不宽，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。\n- [全程D1170] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，走行自然，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n- [全程D1380] 检验组合: 游离三碘甲状腺原氨酸(FT3)-静脉血: 5.27pmol/L；游离甲状腺素(FT4)-静脉血: 13.84pmol/L；胆碱酯酶(ChE)-静脉血: 10374U/L；总钙(Ca)-静脉血: 2.33mmol/L；中性粒细胞百分比(Neut%)-静脉血: 56.6%；γ-谷氨酰基转移酶(GGT)-静脉血: 25.6U/L；肌酸激酶(CK)-静脉血: 80U/L；肌酐(Crea)-静脉血: 59.7umol/L；总蛋白(TP)-静脉血: 72.07g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 27.9pg；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.29mmol/L；淋巴细胞计数(Lymph#)-静脉血: 2.110E9/L；镁离子(Mg2+)-静脉血: 1.02mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.3mmol/L；碱性磷酸酶(ALP)-静脉血: 75.5U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.2510E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.2%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.1fL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；大血小板百分比(P-LCR%)-静脉血: 21.4%；白蛋白(ALB)-静脉血: 43.8g/L；载脂蛋白AI(apoAI)-静脉血: 1.52g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.55；总胆固醇(TC)-静脉血: 6.32mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.7U/L；阴离子间隙(AG)-静脉血: 18.4；血红蛋白(Hb)-静脉血: 131g/L；甲状腺球蛋白(TG)-静脉血: 1.4ng/ml；平均红细胞血红蛋白浓度(MCHC)-静脉血: 300g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.34mmolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 2.4；钾离子(K+)-静脉血: 3.9mmol/L；红细胞比容(Hct)-静脉血: 43.7%；未成熟粒细胞百分比(IG%)-静脉血: 0.5%；磷(P)-静脉血: 1.39mmol/L；钠离子(Na+)-静脉血: 141.4mmol/L；间接胆红素(IBIL)-静脉血:……\n\n【既往治疗与反应】\n- [全程D986] 门急诊记录: 主诉: 鼻咽癌放化疗结束2年，诉轻度口干，听力视力正常，无头晕、头痛。体查：鼻咽未见明确肿物，双颈未扪及明显肿大淋巴结，颅神经（-）甲功五项示正常。鼻咽MRI未见明确复发，腹部B超、胸片未见明确转移。EBV-DNA:0；现病史:；既往史:；个人史:；家族史:；体格检查:\n- [全程D1174] 门急诊记录: 主诉: 鼻咽癌放化疗结束2年，诉轻度口干，听力视力正常，无头晕、头痛。体查：鼻咽未见明确肿物，双颈未扪及明显肿大淋巴结，颅神经（-）甲功五项示正常。鼻咽MRI未见明确复发，腹部B超、胸片未见明确转移。EBV-DNA:0；现病史:；既往史:；个人史:；家族史:；体格检查:\n- [时间未明] 门急诊记录: 主诉:；现病史: 者半年余前无明显诱因出现左侧颈部肿物，无疼痛，逐渐增大，伴有鼻塞、流涕，至当地医院予抗炎对症治疗后，肿物能减小；2月前患者始出现右侧颈部肿物，逐渐增大，伴有鼻塞、流涕，间中有涕血，无发热、畏寒，无头晕、头痛，无周身骨痛等，于当地医院检查ＣＴ示：鼻咽肿物，遂转至我院进一步诊治。门诊拟诊“鼻咽肿物”收入我科进一步治疗。患者起病以来精神、睡眠欠佳，胃纳尚可，二便正常，体重无明显下降。；既往史: 否认高血压、糖尿病及心脏病史，否认结核等传染病史、否认手术、外伤及输血史。；个人史:；家族史: 家族中无类似患者，无家族性遗传病患者，无重大精神病患者。；体格检查: KPS90，一般状况可，鼻咽左侧壁、顶后壁肿物，双颈扪及肿大淋巴结，右颈多枚肿大淋巴结，较大者约6*4及2*2cm,质硬，活动差，左上颈可及一淋巴结，约3*3cm，质中，活动度可，无融合，无皮肤浸润等，左中颈可及一大小约1*1cm质硬淋巴结；张口门齿距约4cm，颅神经征阴性。。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 给予大剂量糖皮质激素冲击治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超\nB. 给予贝伐珠单抗靶向治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项\nC. 安排头颅PET-CT检查鉴别左侧颞叶病变性质，并安排胸部X线、腹部彩超、甲功五项\nD. 安排立体定向脑活检明确左侧颞叶病变性质，并安排胸部X线、腹部彩超、甲功五项\nE. 给予高压氧治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项\nF. 给予甘露醇静脉滴注脱水降颅压，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超\nG. 安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项及EBV-DNA定量检测\nH. 给予神经营养药物治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项\nI. 安排鼻咽及颈部CT平扫+增强、胸部CT平扫、腹部CT平扫、甲功五项及EBV-DNA定量检测\nJ. 安排立体定向放射外科治疗左侧颞叶病变，并安排胸部X线、腹部彩超、甲功五项\nK. 安排鼻咽及颈部MRI平扫+增强、头颅MRI平扫+增强，暂缓胸部X线及腹部彩超检查\nL. 给予抗癫痫药物预防性治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D986] 门急诊记录: 主诉: 鼻咽癌放化疗结束2年，诉轻度口干，听力视力正常，无头晕、头痛。体查：鼻咽未见明确肿物，双颈未扪及明显肿大淋巴结，颅神经（-）甲功五项示正常。鼻咽MRI未见明确复发，腹部B超、胸片未见明确转移。EBV-DNA:0；现病史:；既往史:；个人史:；家族史:；体格检查:\n\n【已完成检查与客观结果】\n- [全程D985] MRI；鼻咽部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部MR平扫+增强；检查部位:；检查所见: 鼻咽癌放疗后复查，对比某次就诊时间片： 鼻咽腔未见狭窄，鼻咽顶壁、顶后壁、右侧壁轻度增厚，均匀强化，右侧咽隐窝变浅，考虑放疗后改变，较前相仿。 蝶骨基底部、左侧枕骨基底部、左侧岩尖、左侧翼突基底部骨质信号下降，增强扫描轻度不均匀强化，较前相仿。 左侧破裂孔见少许软组织影，增强扫描轻度强化，较前相仿。 双侧咽后间隙见小淋巴结，大者短径约3mm，较前相仿。 右颈II区见多个淋巴结，最大短径约为5mm，部分边界欠清，增强扫描不均匀强化，较前稍缩小。 双侧上颌窦、筛窦、额窦粘膜增厚，考虑副鼻窦炎，较前相仿。 扫描所见颅脑未见明确异常。；检查结论:\n- [全程D985] MRI；颈部MR平扫+增强: 检查类型: MRI；检查名称: 颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌放疗后复查，对比某次就诊时间片： 鼻咽腔未见狭窄，鼻咽顶壁、顶后壁、右侧壁轻度增厚，均匀强化，右侧咽隐窝变浅，考虑放疗后改变，较前相仿。 蝶骨基底部、左侧枕骨基底部、左侧岩尖、左侧翼突基底部骨质信号下降，增强扫描轻度不均匀强化，较前相仿。 左侧破裂孔见少许软组织影，增强扫描轻度强化，较前相仿。 双侧咽后间隙见小淋巴结，大者短径约3mm，较前相仿。 右颈II区见多个淋巴结，最大短径约为5mm，部分边界欠清，增强扫描不均匀强化，较前稍缩小。 双侧上颌窦、筛窦、额窦粘膜增厚，考虑副鼻窦炎，较前相仿。 扫描所见颅脑未见明确异常。；检查结论:\n- [全程D1168] 检验组合: 游离甲状腺素(FT4)-静脉血: 14.91pmol/L；甲状腺过氧化物酶抗体(TPO-Ab)-静脉血: 12.55U/ml；游离三碘甲状腺原氨酸(FT3)-静脉血: 4.97pmol/L；甲状腺球蛋白(TG)-静脉血: 1.12ng/ml；促甲状腺激素(TSH)-静脉血: 1.59uIU/ml\n- [全程D1169] 超声；肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径不宽，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。\n- [全程D1170] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，走行自然，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n- [全程D1380] 检验组合: 游离三碘甲状腺原氨酸(FT3)-静脉血: 5.27pmol/L；游离甲状腺素(FT4)-静脉血: 13.84pmol/L；胆碱酯酶(ChE)-静脉血: 10374U/L；总钙(Ca)-静脉血: 2.33mmol/L；中性粒细胞百分比(Neut%)-静脉血: 56.6%；γ-谷氨酰基转移酶(GGT)-静脉血: 25.6U/L；肌酸激酶(CK)-静脉血: 80U/L；肌酐(Crea)-静脉血: 59.7umol/L；总蛋白(TP)-静脉血: 72.07g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 27.9pg；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.29mmol/L；淋巴细胞计数(Lymph#)-静脉血: 2.110E9/L；镁离子(Mg2+)-静脉血: 1.02mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.3mmol/L；碱性磷酸酶(ALP)-静脉血: 75.5U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.2510E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.2%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.1fL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；大血小板百分比(P-LCR%)-静脉血: 21.4%；白蛋白(ALB)-静脉血: 43.8g/L；载脂蛋白AI(apoAI)-静脉血: 1.52g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.55；总胆固醇(TC)-静脉血: 6.32mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.7U/L；阴离子间隙(AG)-静脉血: 18.4；血红蛋白(Hb)-静脉血: 131g/L；甲状腺球蛋白(TG)-静脉血: 1.4ng/ml；平均红细胞血红蛋白浓度(MCHC)-静脉血: 300g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.34mmolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 2.4；钾离子(K+)-静脉血: 3.9mmol/L；红细胞比容(Hct)-静脉血: 43.7%；未成熟粒细胞百分比(IG%)-静脉血: 0.5%；磷(P)-静脉血: 1.39mmol/L；钠离子(Na+)-静脉血: 141.4mmol/L；间接胆红素(IBIL)-静脉血:……\n\n【既往治疗与反应】\n- [全程D986] 门急诊记录: 主诉: 鼻咽癌放化疗结束2年，诉轻度口干，听力视力正常，无头晕、头痛。体查：鼻咽未见明确肿物，双颈未扪及明显肿大淋巴结，颅神经（-）甲功五项示正常。鼻咽MRI未见明确复发，腹部B超、胸片未见明确转移。EBV-DNA:0；现病史:；既往史:；个人史:；家族史:；体格检查:\n- [全程D1174] 门急诊记录: 主诉: 鼻咽癌放化疗结束2年，诉轻度口干，听力视力正常，无头晕、头痛。体查：鼻咽未见明确肿物，双颈未扪及明显肿大淋巴结，颅神经（-）甲功五项示正常。鼻咽MRI未见明确复发，腹部B超、胸片未见明确转移。EBV-DNA:0；现病史:；既往史:；个人史:；家族史:；体格检查:\n- [时间未明] 门急诊记录: 主诉:；现病史: 者半年余前无明显诱因出现左侧颈部肿物，无疼痛，逐渐增大，伴有鼻塞、流涕，至当地医院予抗炎对症治疗后，肿物能减小；2月前患者始出现右侧颈部肿物，逐渐增大，伴有鼻塞、流涕，间中有涕血，无发热、畏寒，无头晕、头痛，无周身骨痛等，于当地医院检查ＣＴ示：鼻咽肿物，遂转至我院进一步诊治。门诊拟诊“鼻咽肿物”收入我科进一步治疗。患者起病以来精神、睡眠欠佳，胃纳尚可，二便正常，体重无明显下降。；既往史: 否认高血压、糖尿病及心脏病史，否认结核等传染病史、否认手术、外伤及输血史。；个人史:；家族史: 家族中无类似患者，无家族性遗传病患者，无重大精神病患者。；体格检查: KPS90，一般状况可，鼻咽左侧壁、顶后壁肿物，双颈扪及肿大淋巴结，右颈多枚肿大淋巴结，较大者约6*4及2*2cm,质硬，活动差，左上颈可及一淋巴结，约3*3cm，质中，活动度可，无融合，无皮肤浸润等，左中颈可及一大小约1*1cm质硬淋巴结；张口门齿距约4cm，颅神经征阴性。。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 给予大剂量糖皮质激素冲击治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超\nB. 给予贝伐珠单抗靶向治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项\nC. 安排头颅PET-CT检查鉴别左侧颞叶病变性质，并安排胸部X线、腹部彩超、甲功五项\nD. 安排立体定向脑活检明确左侧颞叶病变性质，并安排胸部X线、腹部彩超、甲功五项\nE. 给予高压氧治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项\nF. 给予甘露醇静脉滴注脱水降颅压，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超\nG. 安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项及EBV-DNA定量检测\nH. 给予神经营养药物治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项\nI. 安排鼻咽及颈部CT平扫+增强、胸部CT平扫、腹部CT平扫、甲功五项及EBV-DNA定量检测\nJ. 安排立体定向放射外科治疗左侧颞叶病变，并安排胸部X线、腹部彩超、甲功五项\nK. 安排鼻咽及颈部MRI平扫+增强、头颅MRI平扫+增强，暂缓胸部X线及腹部彩超检查\nL. 给予抗癫痫药物预防性治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-2fc2bca32acf3eb67f65396b","patient_id":"patient-9149023ec8599161ec3e5cfd","turn_id":"turn07","turn_position":5,"turn_type":"recurrence_or_salvage_decision","gold_letter":"I","gold_action":"继续行第3周期GP方案第8天化疗（吉西他滨），辅以肠内营养支持，并安排出院。","options":[{"letter":"A","text":"提前终止第3周期诱导化疗，直接进入根治性同步放化疗阶段。","is_gold":false},{"letter":"B","text":"暂停第8天化疗，予重组人粒细胞集落刺激因子升白治疗后复查血常规。","is_gold":false},{"letter":"C","text":"更改诱导化疗方案为TP（多西他赛+顺铂）进行第4周期治疗。","is_gold":false},{"letter":"D","text":"继续行第3周期GP方案第8天化疗（吉西他滨联合顺铂），并安排出院。","is_gold":false},{"letter":"E","text":"计划在第3周期结束后，继续行第4周期GP方案诱导化疗。","is_gold":false},{"letter":"F","text":"暂停化疗，行双侧颈部淋巴结清扫术及鼻咽原发灶切除术。","is_gold":false},{"letter":"G","text":"终止后续放疗计划，按完全缓解（CR）状态进入定期随访观察。","is_gold":false},{"letter":"H","text":"将第8天吉西他滨剂量下调25%后给药，并密切监测血常规。","is_gold":false},{"letter":"I","text":"继续行第3周期GP方案第8天化疗（吉西他滨），辅以肠内营养支持，并安排出院。","is_gold":true},{"letter":"J","text":"暂停治疗，行全身PET-CT检查以重新评估全身肿瘤负荷。","is_gold":false},{"letter":"K","text":"在第8天化疗基础上加用PD-1抑制剂（如特瑞普利单抗）进行联合治疗。","is_gold":false},{"letter":"L","text":"立即启动根治性调强放疗，并同步给予吉西他滨单药化疗。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D46] 检验组合: 中性粒细胞百分比(Neut%)-静脉血: 0.568；血液二氧化碳含量ctCO2(B)-静脉血: 23mmol/L；钾离子(K+)-静脉血: 3.97mmol/L；镁离子(Mg2+)-静脉血: 0.79mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.383；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.55；钠离子(Na+)-静脉血: 130mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；平均红细胞体积(MCV)-静脉血: 82.6fL；单核细胞百分比(Mono%)-静脉血: 0.042；肌酐(Crea)-静脉血: 46.6umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 44U/L；血红蛋白(Hb)-静脉血: 118g/L；磷(P)-静脉血: 1.18mmol/L；总胆红素(TBIL)-静脉血: 7.2umol/L；平均血小板体积(MPV)-静脉血: 9fL；总蛋白(TP)-静脉血: 67.1g/L；乳酸脱氢酶(LDH)-静脉血: 137.5U/L；间接胆红素(IBIL)-静脉血: 5.3umolL；球蛋白(GLO)-静脉血: 28.1g/L；尿酸(UA)-静脉血: 102.4umol/L；白蛋白(ALB)-静脉血: 39g/L；有核红细胞百分比(NRBC%)-静脉血: 0；单核细胞计数(Mono#)-静脉血: 0.210E9/L；红细胞比容(Hct)-静脉血: 36%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血小板分布宽度(PDW)-静脉血: 9%；阴离子间隙(AG)-静脉血: 14.1；直接胆红素(DBIL)-静脉血: 1.9umol/L；总胆汁酸(TBA)-静脉血: 1.5umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.4；有核红细胞计数(NRBC#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.710E9/L；大血小板百分比(P-LCR%)-静脉血: 16.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 27.1pg；γ-谷氨酰基转移酶(GGT)-静脉血: 62.8U/L；尿素氮(BUN)-静脉血: 3.4mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.39；红细胞计数(RBC#……\n- [全程D55] 检验组合: 平均红细胞血红蛋白含量(MCH)-静脉血: 27.3pg；天门冬氨酸氨基转移酶(AST)-静脉血: 14.5U/L；碱性磷酸酶(ALP)-静脉血: 103.1U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；淋巴细胞计数(Lymph#)-静脉血: 2.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.145；红细胞计数(RBC#)-静脉血: 3.7410E12/L；有核红细胞百分比(NRBC%)-静脉血: 0；大血小板百分比(P-LCR%)-静脉血: 18.5%；红细胞比容(Hct)-静脉血: 32.5%；淋巴细胞百分比(Lymph%)-静脉血: 0.531；丙氨酸氨基转移酶(ALT)-静脉血: 7.8U/L；氯离子(Cl-)-静脉血: 102mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；间接胆红素(IBIL)-静脉血: 1.7umolL；平均血小板体积(MPV)-静脉血: 9.3fL；总钙(Ca)-静脉血: 2.22mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；总蛋白(TP)-静脉血: 64.51g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.6mmol/L；血红蛋白(Hb)-静脉血: 102g/L；血小板比容-静脉血: 15%；中性粒细胞计数(Neut#)-静脉血: 1.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.318；白细胞计数(WBC#)-静脉血: 4.4810E9/L；镁离子(Mg2+)-静脉血: 0.78mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 35.3U/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 314g/L；乳酸脱氢酶(LDH)-静脉血: 139.5U/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；钠离子(Na+)-静脉血: 137.5mmol/L；总胆红素(TBIL)-静脉血: 2.4umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.86；尿素氮(BUN)-静脉血: 3.4mmol/L；肌酐(Crea)-静脉血: 64.6umol/L；总胆汁酸(TBA)-静脉血: 3.8umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 55.2U/L；单核细……\n- [全程D61] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- [全程D61] 检验组合: 碱性磷酸酶(ALP)-静脉血: 108.3U/L；丙氨酸氨基转移酶(ALT)-静脉血: 14.3U/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；直接胆红素(DBIL)-静脉血: 0.6umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24U/L；中性粒细胞百分比(Neut%)-静脉血: 0.512；α-L-岩藻糖苷酶(AFU)-静脉血: 44.3U/L；钾离子(K+)-静脉血: 4.3mmol/L；平均红细胞体积(MCV)-静脉血: 87.2fL；白细胞计数(WBC#)-静脉血: 7.6610E9/L；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；血小板比容-静脉血: 24%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；平均红细胞血红蛋白含量(MCH)-静脉血: 27.2pg；乳酸脱氢酶(LDH)-静脉血: 151.5U/L；阴离子间隙(AG)-静脉血: 16.2；肌酐(Crea)-静脉血: 58.2umol/L；总胆汁酸(TBA)-静脉血: 12.2umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.9mmol/L；球蛋白(GLO)-静脉血: 28.8g/L；淋巴细胞计数(Lymph#)-静脉血: 2.710E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 312g/L；氯离子(Cl-)-静脉血: 100.7mmol/L；尿酸(UA)-静脉血: 217.3umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.47；总钙(Ca)-静脉血: 2.18mmol/L；白蛋白(ALB)-静脉血: 42.2g/L；大血小板百分比(P-LCR%)-静脉血: 17.6%；γ-谷氨酰基转移酶(GGT)-静脉血: 62.4U/L；平均血小板体积(MPV)-静脉血: 9.1fL；磷(P)-静脉血: 1.45mmol/L；间接胆红素(IBIL)-静脉血: 2.4umolL；血小板计数(PLT#)-静脉血: 26810E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；血小板分布宽度(PDW)-静脉血: 9.4%；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.68；总胆红素(TBIL)-静脉血: 3umol/L；单核细胞百分比(Mono%)-静脉血:……\n- [全程D68] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后，对比某次就诊时间片： 鼻咽腔狭窄，鼻咽顶壁、顶后壁、左侧壁见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强后明显强化，肿物占据左侧咽隐窝，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，向前累及双侧后鼻孔，范围较前缩小，右侧咽隐窝变浅，右侧咽旁脂肪间隙及颈动脉鞘区未见异常。 左侧腭帆张提肌、左侧翼内肌上缘及双侧头长肌受侵，右侧腭帆提肌、腭帆张肌未见受侵征象。左侧翼腭窝可见软组织稍增厚，大致同前，右侧翼腭窝、右侧颞下窝未见异常；口咽双侧壁未见增厚。 斜坡、蝶骨基底部、左侧枕骨基底部、左侧岩尖、左侧翼突基底部、左侧翼突内外板、左侧蝶骨大翼骨质破坏，增强扫描后明显强化，大致同前。 左侧破裂孔及左侧海绵窦下份见少许软组织影，增强扫描后明显强化，较前变化不大，右侧海绵窦形态正常。 左侧上颌窦、筛窦、蝶窦、双侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 双侧咽后间隙见小淋巴结，最大短径约3mm，较前稍缩小；双颈II区见肿大淋巴结，最大约为20mm×30mm，边界清楚，信号不均匀，部分见囊变坏死，增强后不均匀强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗后，对比某次就诊时间片： 鼻咽病灶较前范围稍缩小。 颅底骨质破坏，大致同前。 双侧咽后淋巴结小淋巴结，较前稍缩小；双颈II区淋巴结肿大，考虑转移，部分较前缩小。 鼻窦炎、双侧乳突炎。\n- [全程D68] 检验组合: 阴离子间隙(AG)-静脉血: 14.8；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.75；白蛋白(ALB)-静脉血: 42.2g/L；间接胆红素(IBIL)-静脉血: 6.1umolL；总胆红素(TBIL)-静脉血: 8umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.6；血小板分布宽度(PDW)-静脉血: 8.4%；平均红细胞血红蛋白含量(MCH)-静脉血: 27.1pg；钠离子(Na+)-静脉血: 132.5mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 323g/L；直接胆红素(DBIL)-静脉血: 1.9umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 65.5U/L；钾离子(K+)-静脉血: 4.64mmol/L；碱性磷酸酶(ALP)-静脉血: 83.1U/L；白细胞计数(WBC#)-静脉血: 3.3810E9/L；血红蛋白(Hb)-静脉血: 107g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞比容(Hct)-静脉血: 33.1%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44.7；α-L-岩藻糖苷酶(AFU)-静脉血: 49.8U/L；中性粒细胞百分比(Neut%)-静脉血: 0.558；乳酸脱氢酶(LDH)-静脉血: 136.8U/L；尿素氮(BUN)-静脉血: 2.6mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.3mmol/L；单核细胞计数(Mono#)-静脉血: 0.110E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.033；氯离子(Cl-)-静脉血: 94.4mmol/L；肌酐(Crea)-静脉血: 53.8umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.9U/L；球蛋白(GLO)-静脉血: 28.48g/L；平均血小板体积(MPV)-静脉血: 8.3fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；中性粒细胞计数(Neut#)-静脉血: 1.910E9/L；总胆汁酸(TBA)-静脉血: 2.7umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.373；血小板比容-静脉血: 31%；总蛋白(TP)-静脉……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D62] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日查房时自述精神食欲可，睡眠休息好。查体：KPS 90，一般状况可，鼻咽左侧壁、顶后壁肿物，双颈扪及肿大淋巴结，右颈多枚肿大淋巴结，较大者约6*4及2*2cm,质硬，活动差，左上颈可及一淋巴结，约3*3cm，质中，活动度可，无融合，无皮肤浸润等，左中颈可及一大小约1*1cm质硬淋巴结；张口门齿距约4cm，颅神经征阴性。[姓名已隐去]医生信息已隐藏：该病人为鼻咽癌，已接受GP方案诱导化疗2周期。目前排除化疗禁忌症，今日水化，明日再予GP方案行第三周期化疗，遵执。\n- [全程D63] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日查房时无特殊不适主诉，精神食欲可，昨日水化顺利。查体大致同前。[姓名已隐去]医生信息已隐藏：该病人继续按原方案（吉西他滨 1g/m2d1、d8+顺铂 80mg/m2d1）化疗，注意护胃、止吐等对症支持处理，遵执。\n- [全程D66] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 患者化疗输液顺利完成。今日查房时自诉精神食欲可，二便通畅。今继续对症支持治疗，择期复查血常规及血生化。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 提前终止第3周期诱导化疗，直接进入根治性同步放化疗阶段。\nB. 暂停第8天化疗，予重组人粒细胞集落刺激因子升白治疗后复查血常规。\nC. 更改诱导化疗方案为TP（多西他赛+顺铂）进行第4周期治疗。\nD. 继续行第3周期GP方案第8天化疗（吉西他滨联合顺铂），并安排出院。\nE. 计划在第3周期结束后，继续行第4周期GP方案诱导化疗。\nF. 暂停化疗，行双侧颈部淋巴结清扫术及鼻咽原发灶切除术。\nG. 终止后续放疗计划，按完全缓解（CR）状态进入定期随访观察。\nH. 将第8天吉西他滨剂量下调25%后给药，并密切监测血常规。\nI. 继续行第3周期GP方案第8天化疗（吉西他滨），辅以肠内营养支持，并安排出院。\nJ. 暂停治疗，行全身PET-CT检查以重新评估全身肿瘤负荷。\nK. 在第8天化疗基础上加用PD-1抑制剂（如特瑞普利单抗）进行联合治疗。\nL. 立即启动根治性调强放疗，并同步给予吉西他滨单药化疗。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D46] 检验组合: 中性粒细胞百分比(Neut%)-静脉血: 0.568；血液二氧化碳含量ctCO2(B)-静脉血: 23mmol/L；钾离子(K+)-静脉血: 3.97mmol/L；镁离子(Mg2+)-静脉血: 0.79mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.383；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.55；钠离子(Na+)-静脉血: 130mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；平均红细胞体积(MCV)-静脉血: 82.6fL；单核细胞百分比(Mono%)-静脉血: 0.042；肌酐(Crea)-静脉血: 46.6umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 44U/L；血红蛋白(Hb)-静脉血: 118g/L；磷(P)-静脉血: 1.18mmol/L；总胆红素(TBIL)-静脉血: 7.2umol/L；平均血小板体积(MPV)-静脉血: 9fL；总蛋白(TP)-静脉血: 67.1g/L；乳酸脱氢酶(LDH)-静脉血: 137.5U/L；间接胆红素(IBIL)-静脉血: 5.3umolL；球蛋白(GLO)-静脉血: 28.1g/L；尿酸(UA)-静脉血: 102.4umol/L；白蛋白(ALB)-静脉血: 39g/L；有核红细胞百分比(NRBC%)-静脉血: 0；单核细胞计数(Mono#)-静脉血: 0.210E9/L；红细胞比容(Hct)-静脉血: 36%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血小板分布宽度(PDW)-静脉血: 9%；阴离子间隙(AG)-静脉血: 14.1；直接胆红素(DBIL)-静脉血: 1.9umol/L；总胆汁酸(TBA)-静脉血: 1.5umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.4；有核红细胞计数(NRBC#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.710E9/L；大血小板百分比(P-LCR%)-静脉血: 16.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 27.1pg；γ-谷氨酰基转移酶(GGT)-静脉血: 62.8U/L；尿素氮(BUN)-静脉血: 3.4mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.39；红细胞计数(RBC#……\n- [全程D55] 检验组合: 平均红细胞血红蛋白含量(MCH)-静脉血: 27.3pg；天门冬氨酸氨基转移酶(AST)-静脉血: 14.5U/L；碱性磷酸酶(ALP)-静脉血: 103.1U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；淋巴细胞计数(Lymph#)-静脉血: 2.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.145；红细胞计数(RBC#)-静脉血: 3.7410E12/L；有核红细胞百分比(NRBC%)-静脉血: 0；大血小板百分比(P-LCR%)-静脉血: 18.5%；红细胞比容(Hct)-静脉血: 32.5%；淋巴细胞百分比(Lymph%)-静脉血: 0.531；丙氨酸氨基转移酶(ALT)-静脉血: 7.8U/L；氯离子(Cl-)-静脉血: 102mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；间接胆红素(IBIL)-静脉血: 1.7umolL；平均血小板体积(MPV)-静脉血: 9.3fL；总钙(Ca)-静脉血: 2.22mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；总蛋白(TP)-静脉血: 64.51g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.6mmol/L；血红蛋白(Hb)-静脉血: 102g/L；血小板比容-静脉血: 15%；中性粒细胞计数(Neut#)-静脉血: 1.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.318；白细胞计数(WBC#)-静脉血: 4.4810E9/L；镁离子(Mg2+)-静脉血: 0.78mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 35.3U/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 314g/L；乳酸脱氢酶(LDH)-静脉血: 139.5U/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；钠离子(Na+)-静脉血: 137.5mmol/L；总胆红素(TBIL)-静脉血: 2.4umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.86；尿素氮(BUN)-静脉血: 3.4mmol/L；肌酐(Crea)-静脉血: 64.6umol/L；总胆汁酸(TBA)-静脉血: 3.8umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 55.2U/L；单核细……\n- [全程D61] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- [全程D61] 检验组合: 碱性磷酸酶(ALP)-静脉血: 108.3U/L；丙氨酸氨基转移酶(ALT)-静脉血: 14.3U/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；直接胆红素(DBIL)-静脉血: 0.6umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24U/L；中性粒细胞百分比(Neut%)-静脉血: 0.512；α-L-岩藻糖苷酶(AFU)-静脉血: 44.3U/L；钾离子(K+)-静脉血: 4.3mmol/L；平均红细胞体积(MCV)-静脉血: 87.2fL；白细胞计数(WBC#)-静脉血: 7.6610E9/L；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；血小板比容-静脉血: 24%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；平均红细胞血红蛋白含量(MCH)-静脉血: 27.2pg；乳酸脱氢酶(LDH)-静脉血: 151.5U/L；阴离子间隙(AG)-静脉血: 16.2；肌酐(Crea)-静脉血: 58.2umol/L；总胆汁酸(TBA)-静脉血: 12.2umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.9mmol/L；球蛋白(GLO)-静脉血: 28.8g/L；淋巴细胞计数(Lymph#)-静脉血: 2.710E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 312g/L；氯离子(Cl-)-静脉血: 100.7mmol/L；尿酸(UA)-静脉血: 217.3umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.47；总钙(Ca)-静脉血: 2.18mmol/L；白蛋白(ALB)-静脉血: 42.2g/L；大血小板百分比(P-LCR%)-静脉血: 17.6%；γ-谷氨酰基转移酶(GGT)-静脉血: 62.4U/L；平均血小板体积(MPV)-静脉血: 9.1fL；磷(P)-静脉血: 1.45mmol/L；间接胆红素(IBIL)-静脉血: 2.4umolL；血小板计数(PLT#)-静脉血: 26810E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；血小板分布宽度(PDW)-静脉血: 9.4%；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.68；总胆红素(TBIL)-静脉血: 3umol/L；单核细胞百分比(Mono%)-静脉血:……\n- [全程D68] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后，对比某次就诊时间片： 鼻咽腔狭窄，鼻咽顶壁、顶后壁、左侧壁见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强后明显强化，肿物占据左侧咽隐窝，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，向前累及双侧后鼻孔，范围较前缩小，右侧咽隐窝变浅，右侧咽旁脂肪间隙及颈动脉鞘区未见异常。 左侧腭帆张提肌、左侧翼内肌上缘及双侧头长肌受侵，右侧腭帆提肌、腭帆张肌未见受侵征象。左侧翼腭窝可见软组织稍增厚，大致同前，右侧翼腭窝、右侧颞下窝未见异常；口咽双侧壁未见增厚。 斜坡、蝶骨基底部、左侧枕骨基底部、左侧岩尖、左侧翼突基底部、左侧翼突内外板、左侧蝶骨大翼骨质破坏，增强扫描后明显强化，大致同前。 左侧破裂孔及左侧海绵窦下份见少许软组织影，增强扫描后明显强化，较前变化不大，右侧海绵窦形态正常。 左侧上颌窦、筛窦、蝶窦、双侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 双侧咽后间隙见小淋巴结，最大短径约3mm，较前稍缩小；双颈II区见肿大淋巴结，最大约为20mm×30mm，边界清楚，信号不均匀，部分见囊变坏死，增强后不均匀强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗后，对比某次就诊时间片： 鼻咽病灶较前范围稍缩小。 颅底骨质破坏，大致同前。 双侧咽后淋巴结小淋巴结，较前稍缩小；双颈II区淋巴结肿大，考虑转移，部分较前缩小。 鼻窦炎、双侧乳突炎。\n- [全程D68] 检验组合: 阴离子间隙(AG)-静脉血: 14.8；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.75；白蛋白(ALB)-静脉血: 42.2g/L；间接胆红素(IBIL)-静脉血: 6.1umolL；总胆红素(TBIL)-静脉血: 8umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.6；血小板分布宽度(PDW)-静脉血: 8.4%；平均红细胞血红蛋白含量(MCH)-静脉血: 27.1pg；钠离子(Na+)-静脉血: 132.5mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 323g/L；直接胆红素(DBIL)-静脉血: 1.9umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 65.5U/L；钾离子(K+)-静脉血: 4.64mmol/L；碱性磷酸酶(ALP)-静脉血: 83.1U/L；白细胞计数(WBC#)-静脉血: 3.3810E9/L；血红蛋白(Hb)-静脉血: 107g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞比容(Hct)-静脉血: 33.1%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44.7；α-L-岩藻糖苷酶(AFU)-静脉血: 49.8U/L；中性粒细胞百分比(Neut%)-静脉血: 0.558；乳酸脱氢酶(LDH)-静脉血: 136.8U/L；尿素氮(BUN)-静脉血: 2.6mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.3mmol/L；单核细胞计数(Mono#)-静脉血: 0.110E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.033；氯离子(Cl-)-静脉血: 94.4mmol/L；肌酐(Crea)-静脉血: 53.8umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.9U/L；球蛋白(GLO)-静脉血: 28.48g/L；平均血小板体积(MPV)-静脉血: 8.3fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；中性粒细胞计数(Neut#)-静脉血: 1.910E9/L；总胆汁酸(TBA)-静脉血: 2.7umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.373；血小板比容-静脉血: 31%；总蛋白(TP)-静脉……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D62] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日查房时自述精神食欲可，睡眠休息好。查体：KPS 90，一般状况可，鼻咽左侧壁、顶后壁肿物，双颈扪及肿大淋巴结，右颈多枚肿大淋巴结，较大者约6*4及2*2cm,质硬，活动差，左上颈可及一淋巴结，约3*3cm，质中，活动度可，无融合，无皮肤浸润等，左中颈可及一大小约1*1cm质硬淋巴结；张口门齿距约4cm，颅神经征阴性。[姓名已隐去]医生信息已隐藏：该病人为鼻咽癌，已接受GP方案诱导化疗2周期。目前排除化疗禁忌症，今日水化，明日再予GP方案行第三周期化疗，遵执。\n- [全程D63] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日查房时无特殊不适主诉，精神食欲可，昨日水化顺利。查体大致同前。[姓名已隐去]医生信息已隐藏：该病人继续按原方案（吉西他滨 1g/m2d1、d8+顺铂 80mg/m2d1）化疗，注意护胃、止吐等对症支持处理，遵执。\n- [全程D66] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 患者化疗输液顺利完成。今日查房时自诉精神食欲可，二便通畅。今继续对症支持治疗，择期复查血常规及血生化。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 提前终止第3周期诱导化疗，直接进入根治性同步放化疗阶段。\nB. 暂停第8天化疗，予重组人粒细胞集落刺激因子升白治疗后复查血常规。\nC. 更改诱导化疗方案为TP（多西他赛+顺铂）进行第4周期治疗。\nD. 继续行第3周期GP方案第8天化疗（吉西他滨联合顺铂），并安排出院。\nE. 计划在第3周期结束后，继续行第4周期GP方案诱导化疗。\nF. 暂停化疗，行双侧颈部淋巴结清扫术及鼻咽原发灶切除术。\nG. 终止后续放疗计划，按完全缓解（CR）状态进入定期随访观察。\nH. 将第8天吉西他滨剂量下调25%后给药，并密切监测血常规。\nI. 继续行第3周期GP方案第8天化疗（吉西他滨），辅以肠内营养支持，并安排出院。\nJ. 暂停治疗，行全身PET-CT检查以重新评估全身肿瘤负荷。\nK. 在第8天化疗基础上加用PD-1抑制剂（如特瑞普利单抗）进行联合治疗。\nL. 立即启动根治性调强放疗，并同步给予吉西他滨单药化疗。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-655ad2033595c09c6c4ce571","patient_id":"patient-4e3ac84b9e1451cea981f98e","turn_id":"turn01","turn_position":1,"turn_type":"initial_workup_choice","gold_letter":"B","gold_action":"完善血常规、肝肾功能、凝血功能，并安排鼻咽部活检。","options":[{"letter":"A","text":"完善血常规、肝肾功能、EBV-DNA检测，并安排全身PET-CT。","is_gold":false},{"letter":"B","text":"完善血常规、肝肾功能、凝血功能，并安排鼻咽部活检。","is_gold":true},{"letter":"C","text":"完善血常规、肝功能、EBV-DNA检测，并直接开始诱导化疗。","is_gold":false},{"letter":"D","text":"完善血常规、肝功能、甲状腺功能检测，并安排胸部CT和腹部增强CT。","is_gold":false},{"letter":"E","text":"完善血常规、肝功能、肾功能及心电图检查，暂不检测内分泌功能。","is_gold":false},{"letter":"F","text":"完善血常规、肝功能、脑垂体激素五项检测，暂不检测甲状腺功能。","is_gold":false},{"letter":"G","text":"完善血常规、肝功能、甲状腺功能及性激素六项检测。","is_gold":false},{"letter":"H","text":"完善血常规、肝功能检测，并安排骨扫描。","is_gold":false},{"letter":"I","text":"完善血常规、肝功能、甲状腺功能及肾上腺皮质激素检测。","is_gold":false},{"letter":"J","text":"完善血常规、肝功能、甲状腺功能及脑垂体激素五项检测。","is_gold":false},{"letter":"K","text":"完善血常规、肝功能、甲状腺功能及脑垂体激素五项检测，并立即行胸椎穿刺活检。","is_gold":false},{"letter":"L","text":"完善血常规、肝功能检测，并安排全身骨髓穿刺。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、头长肌。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D37] 入院记录: 主诉: 回吸性涕血3月；现病史: 患者于某次就诊时间无明显诱因出现涕中带血，量少，色鲜红，呈间歇性，未引起重视。近2个月间歇性出现耳鸣，伴左颈肿物，遂就诊我院。患者无头痛、面麻、复视、听力下降等症状。左侧腭帆提肌、头长肌受侵，右侧腭帆提肌、双侧腭帆张肌及右侧头长肌未见受侵征象。颅底骨质未见破坏征象。右侧咽后淋巴结、左颈II区淋巴肿大。第3、7胸椎局部代谢活跃，建议随诊。胸部平片、腹部彩超未见明显异常。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,涕中带血,左颈肿物,淋巴肿大；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.8℃，P：18次/分，R: 76次/分，BP：116/68mmHg,Ht：165cm，Wt：56.5kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；双侧顶后壁，左侧隐窝可见结节状肿物，左颈II区可扪及肿大淋巴结，大小约10*15mm,质韧，无压痛，活动度可，与周围组织分界清楚。颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善血常规、肝肾功能、EBV-DNA检测，并安排全身PET-CT。\nB. 完善血常规、肝肾功能、凝血功能，并安排鼻咽部活检。\nC. 完善血常规、肝功能、EBV-DNA检测，并直接开始诱导化疗。\nD. 完善血常规、肝功能、甲状腺功能检测，并安排胸部CT和腹部增强CT。\nE. 完善血常规、肝功能、肾功能及心电图检查，暂不检测内分泌功能。\nF. 完善血常规、肝功能、脑垂体激素五项检测，暂不检测甲状腺功能。\nG. 完善血常规、肝功能、甲状腺功能及性激素六项检测。\nH. 完善血常规、肝功能检测，并安排骨扫描。\nI. 完善血常规、肝功能、甲状腺功能及肾上腺皮质激素检测。\nJ. 完善血常规、肝功能、甲状腺功能及脑垂体激素五项检测。\nK. 完善血常规、肝功能、甲状腺功能及脑垂体激素五项检测，并立即行胸椎穿刺活检。\nL. 完善血常规、肝功能检测，并安排全身骨髓穿刺。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、头长肌。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D37] 入院记录: 主诉: 回吸性涕血3月；现病史: 患者于某次就诊时间无明显诱因出现涕中带血，量少，色鲜红，呈间歇性，未引起重视。近2个月间歇性出现耳鸣，伴左颈肿物，遂就诊我院。患者无头痛、面麻、复视、听力下降等症状。左侧腭帆提肌、头长肌受侵，右侧腭帆提肌、双侧腭帆张肌及右侧头长肌未见受侵征象。颅底骨质未见破坏征象。右侧咽后淋巴结、左颈II区淋巴肿大。第3、7胸椎局部代谢活跃，建议随诊。胸部平片、腹部彩超未见明显异常。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,涕中带血,左颈肿物,淋巴肿大；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.8℃，P：18次/分，R: 76次/分，BP：116/68mmHg,Ht：165cm，Wt：56.5kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；双侧顶后壁，左侧隐窝可见结节状肿物，左颈II区可扪及肿大淋巴结，大小约10*15mm,质韧，无压痛，活动度可，与周围组织分界清楚。颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善血常规、肝肾功能、EBV-DNA检测，并安排全身PET-CT。\nB. 完善血常规、肝肾功能、凝血功能，并安排鼻咽部活检。\nC. 完善血常规、肝功能、EBV-DNA检测，并直接开始诱导化疗。\nD. 完善血常规、肝功能、甲状腺功能检测，并安排胸部CT和腹部增强CT。\nE. 完善血常规、肝功能、肾功能及心电图检查，暂不检测内分泌功能。\nF. 完善血常规、肝功能、脑垂体激素五项检测，暂不检测甲状腺功能。\nG. 完善血常规、肝功能、甲状腺功能及性激素六项检测。\nH. 完善血常规、肝功能检测，并安排骨扫描。\nI. 完善血常规、肝功能、甲状腺功能及肾上腺皮质激素检测。\nJ. 完善血常规、肝功能、甲状腺功能及脑垂体激素五项检测。\nK. 完善血常规、肝功能、甲状腺功能及脑垂体激素五项检测，并立即行胸椎穿刺活检。\nL. 完善血常规、肝功能检测，并安排全身骨髓穿刺。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-49bfe4582a9d9a75f21d4be4","patient_id":"patient-4e3ac84b9e1451cea981f98e","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"K","gold_action":"临床分期为 cT2N1M0（AJCC v9 IB期），头长肌受侵定为T2，双侧咽后及单侧颈部淋巴结转移定为N1，骨显像异常考虑良性暂定M0。","options":[{"letter":"A","text":"临床分期为 cT1N1M0（AJCC v9 IB期），病变局限于鼻咽腔及咽隐窝，未见明确周围软组织受侵，骨显像异常考虑良性。","is_gold":false},{"letter":"B","text":"临床分期为 cT2N2M0（AJCC v9 II期），双侧咽后淋巴结受累按分期规则应评为N2，骨显像异常考虑良性。","is_gold":false},{"letter":"C","text":"临床分期为 cT2N1M1（AJCC v9 IVB期），骨显像胸椎及股骨代谢活跃表现已达到多发骨转移诊断标准。","is_gold":false},{"letter":"D","text":"临床分期为 cT3N1M0（AJCC v9 II期），病灶堵塞后鼻孔已构成鼻腔侵犯，按分期规则应评为T3。","is_gold":false},{"letter":"E","text":"临床分期为 cT2N1M0（AJCC v9 II期），头长肌受侵定为T2，单侧颈部淋巴结转移定为N1，综合评为II期。","is_gold":false},{"letter":"F","text":"临床分期暂定 cT2N1Mx，骨显像异常代谢灶性质未明，需常规补充全身PET-CT或骨活检明确M分期。","is_gold":false},{"letter":"G","text":"临床分期为 cT1N2M0（AJCC v9 II期），左侧咽后及左颈II区淋巴结转移评为N2，未见明确T2结构受侵。","is_gold":false},{"letter":"H","text":"临床分期为 cT3N1M0（AJCC v9 II期），腭帆提肌受侵代表侵犯咽旁间隙以外结构，按分期规则应评为T3。","is_gold":false},{"letter":"I","text":"临床分期为 cT2N0M0（AJCC v9 IB期），咽后及颈部淋巴结短径均小于15mm，未达转移诊断标准，应评为N0。","is_gold":false},{"letter":"J","text":"临床分期为 cT4N1M0（AJCC v9 III期），病变侵犯头长肌属于广泛软组织受侵，按分期规则应评为T4。","is_gold":false},{"letter":"K","text":"临床分期为 cT2N1M0（AJCC v9 IB期），头长肌受侵定为T2，双侧咽后及单侧颈部淋巴结转移定为N1，骨显像异常考虑良性暂定M0。","is_gold":true},{"letter":"L","text":"临床分期为 cT2N1M0（AJCC v9 IB期），腭帆提肌受侵定为T2，建议加做全身PET-CT以排除隐匿性转移。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、头长肌。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D1] 检验组合: 尿酸(UA)-静脉血: 316.2umol/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 5.28mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 7.2umol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；球蛋白(GLO)-静脉血: 32.53g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.54mmol/L；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；磷(P)-静脉血: 1.06mmol/L；总胆汁酸(TBA)-静脉血: 2.6umol/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；Rh血型-静脉血: 阳性；血红蛋白(Hb)-静脉血: 153g/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.94；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.93mg/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；血小板分布宽度(PDW)-静脉血: 11.2%；血小板计数(PLT#)-静脉血: 29810E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；白蛋白(ALB)-静脉血: 48g/L；直接胆红素(DBIL)-静脉血: 1.8umol/L；活化部分凝血活酶时间(APTT)-静脉血: 24.9sec.；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；钠离子(Na+)-静脉血: 139.1mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.39；尿素氮(BUN)-静脉血: 5.9mmol/L；钾离子(K+)-静脉血: 4.04mmol/L；C-反应蛋白(CRP)-静脉血: 9.58mg/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22.5U/L；纤维蛋白原(Fbg)-静脉血: 4.77g/L；凝血酶原时间活动度(PTA)-静脉血: 125.5%；淋巴细胞……\n- [全程D18] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- [全程D18] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约25cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约45×26×26mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D19] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显斑片或结节影。双侧肺门影未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见病变。\n- [全程D20] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 第3、7胸椎及右股骨上段见片状放射性浓聚影。颅骨、胸骨、锁骨、肩胛骨、肋骨、颈椎、腰椎、骶尾骨、髋骨及上肢骨骼放射性分布未见明显异常。；检查结论: 右股骨上段局部代谢活跃，疑良性病变，缺血性坏死待排。 第3、7胸椎局部代谢活跃，建议随诊。\n- [全程D20] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁及左侧壁明显增厚，见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。左侧咽隐窝见肿物占据，右侧咽隐窝存在。左侧腭帆提肌、头长肌受侵，右侧腭帆提肌、双侧腭帆张肌及右侧头长肌未见受侵征象。病灶堵塞左侧后鼻孔。 双侧翼腭窝、双侧颞下窝未见异常；口咽未见异常。 颅底骨质未见破坏征象。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦粘膜未见增厚，双侧乳突充气良好，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 左侧咽后间隙见肿大淋巴结，大小约11mm×14mm；右侧咽后间隙见淋巴结，边界欠清，较大者短径约5mm。 左颈II区见数个淋巴结，部分信号不均匀，较大者大小约10mm×13mm，不均匀强化。颈部双侧Ⅰ、ⅡI区见小淋巴结，边界清，较大者短径约5mm，孤立散在。 甲状腺未见异常信号灶。喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 扫描范围颈椎未见明确骨质破坏。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质未见破坏征象。 左侧咽后淋巴结，考虑转移。右侧咽后淋巴结，考虑转移可能性大。 左颈II区淋巴结，考虑转移可能性大。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 临床分期为 cT1N1M0（AJCC v9 IB期），病变局限于鼻咽腔及咽隐窝，未见明确周围软组织受侵，骨显像异常考虑良性。\nB. 临床分期为 cT2N2M0（AJCC v9 II期），双侧咽后淋巴结受累按分期规则应评为N2，骨显像异常考虑良性。\nC. 临床分期为 cT2N1M1（AJCC v9 IVB期），骨显像胸椎及股骨代谢活跃表现已达到多发骨转移诊断标准。\nD. 临床分期为 cT3N1M0（AJCC v9 II期），病灶堵塞后鼻孔已构成鼻腔侵犯，按分期规则应评为T3。\nE. 临床分期为 cT2N1M0（AJCC v9 II期），头长肌受侵定为T2，单侧颈部淋巴结转移定为N1，综合评为II期。\nF. 临床分期暂定 cT2N1Mx，骨显像异常代谢灶性质未明，需常规补充全身PET-CT或骨活检明确M分期。\nG. 临床分期为 cT1N2M0（AJCC v9 II期），左侧咽后及左颈II区淋巴结转移评为N2，未见明确T2结构受侵。\nH. 临床分期为 cT3N1M0（AJCC v9 II期），腭帆提肌受侵代表侵犯咽旁间隙以外结构，按分期规则应评为T3。\nI. 临床分期为 cT2N0M0（AJCC v9 IB期），咽后及颈部淋巴结短径均小于15mm，未达转移诊断标准，应评为N0。\nJ. 临床分期为 cT4N1M0（AJCC v9 III期），病变侵犯头长肌属于广泛软组织受侵，按分期规则应评为T4。\nK. 临床分期为 cT2N1M0（AJCC v9 IB期），头长肌受侵定为T2，双侧咽后及单侧颈部淋巴结转移定为N1，骨显像异常考虑良性暂定M0。\nL. 临床分期为 cT2N1M0（AJCC v9 IB期），腭帆提肌受侵定为T2，建议加做全身PET-CT以排除隐匿性转移。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、头长肌。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D1] 检验组合: 尿酸(UA)-静脉血: 316.2umol/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 5.28mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 7.2umol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；球蛋白(GLO)-静脉血: 32.53g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.54mmol/L；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；磷(P)-静脉血: 1.06mmol/L；总胆汁酸(TBA)-静脉血: 2.6umol/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；Rh血型-静脉血: 阳性；血红蛋白(Hb)-静脉血: 153g/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.94；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.93mg/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；血小板分布宽度(PDW)-静脉血: 11.2%；血小板计数(PLT#)-静脉血: 29810E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；白蛋白(ALB)-静脉血: 48g/L；直接胆红素(DBIL)-静脉血: 1.8umol/L；活化部分凝血活酶时间(APTT)-静脉血: 24.9sec.；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；钠离子(Na+)-静脉血: 139.1mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.39；尿素氮(BUN)-静脉血: 5.9mmol/L；钾离子(K+)-静脉血: 4.04mmol/L；C-反应蛋白(CRP)-静脉血: 9.58mg/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22.5U/L；纤维蛋白原(Fbg)-静脉血: 4.77g/L；凝血酶原时间活动度(PTA)-静脉血: 125.5%；淋巴细胞……\n- [全程D18] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- [全程D18] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约25cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约45×26×26mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D19] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显斑片或结节影。双侧肺门影未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见病变。\n- [全程D20] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 第3、7胸椎及右股骨上段见片状放射性浓聚影。颅骨、胸骨、锁骨、肩胛骨、肋骨、颈椎、腰椎、骶尾骨、髋骨及上肢骨骼放射性分布未见明显异常。；检查结论: 右股骨上段局部代谢活跃，疑良性病变，缺血性坏死待排。 第3、7胸椎局部代谢活跃，建议随诊。\n- [全程D20] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁及左侧壁明显增厚，见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。左侧咽隐窝见肿物占据，右侧咽隐窝存在。左侧腭帆提肌、头长肌受侵，右侧腭帆提肌、双侧腭帆张肌及右侧头长肌未见受侵征象。病灶堵塞左侧后鼻孔。 双侧翼腭窝、双侧颞下窝未见异常；口咽未见异常。 颅底骨质未见破坏征象。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦粘膜未见增厚，双侧乳突充气良好，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 左侧咽后间隙见肿大淋巴结，大小约11mm×14mm；右侧咽后间隙见淋巴结，边界欠清，较大者短径约5mm。 左颈II区见数个淋巴结，部分信号不均匀，较大者大小约10mm×13mm，不均匀强化。颈部双侧Ⅰ、ⅡI区见小淋巴结，边界清，较大者短径约5mm，孤立散在。 甲状腺未见异常信号灶。喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 扫描范围颈椎未见明确骨质破坏。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质未见破坏征象。 左侧咽后淋巴结，考虑转移。右侧咽后淋巴结，考虑转移可能性大。 左颈II区淋巴结，考虑转移可能性大。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 临床分期为 cT1N1M0（AJCC v9 IB期），病变局限于鼻咽腔及咽隐窝，未见明确周围软组织受侵，骨显像异常考虑良性。\nB. 临床分期为 cT2N2M0（AJCC v9 II期），双侧咽后淋巴结受累按分期规则应评为N2，骨显像异常考虑良性。\nC. 临床分期为 cT2N1M1（AJCC v9 IVB期），骨显像胸椎及股骨代谢活跃表现已达到多发骨转移诊断标准。\nD. 临床分期为 cT3N1M0（AJCC v9 II期），病灶堵塞后鼻孔已构成鼻腔侵犯，按分期规则应评为T3。\nE. 临床分期为 cT2N1M0（AJCC v9 II期），头长肌受侵定为T2，单侧颈部淋巴结转移定为N1，综合评为II期。\nF. 临床分期暂定 cT2N1Mx，骨显像异常代谢灶性质未明，需常规补充全身PET-CT或骨活检明确M分期。\nG. 临床分期为 cT1N2M0（AJCC v9 II期），左侧咽后及左颈II区淋巴结转移评为N2，未见明确T2结构受侵。\nH. 临床分期为 cT3N1M0（AJCC v9 II期），腭帆提肌受侵代表侵犯咽旁间隙以外结构，按分期规则应评为T3。\nI. 临床分期为 cT2N0M0（AJCC v9 IB期），咽后及颈部淋巴结短径均小于15mm，未达转移诊断标准，应评为N0。\nJ. 临床分期为 cT4N1M0（AJCC v9 III期），病变侵犯头长肌属于广泛软组织受侵，按分期规则应评为T4。\nK. 临床分期为 cT2N1M0（AJCC v9 IB期），头长肌受侵定为T2，双侧咽后及单侧颈部淋巴结转移定为N1，骨显像异常考虑良性暂定M0。\nL. 临床分期为 cT2N1M0（AJCC v9 IB期），腭帆提肌受侵定为T2，建议加做全身PET-CT以排除隐匿性转移。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-04c8674f03cec4de991fcf32","patient_id":"patient-4e3ac84b9e1451cea981f98e","turn_id":"turn04","turn_position":3,"turn_type":"initial_treatment_selection","gold_letter":"A","gold_action":"单纯根治性放射治疗或根治性放化疗","options":[{"letter":"A","text":"单纯根治性放射治疗或根治性放化疗","is_gold":true},{"letter":"B","text":"诱导化疗后序贯单纯根治性放射治疗","is_gold":false},{"letter":"C","text":"诱导化疗后序贯根治性放化疗","is_gold":false},{"letter":"D","text":"单纯根治性放射治疗后序贯辅助化疗","is_gold":false},{"letter":"E","text":"根治性放化疗后序贯辅助化疗","is_gold":false},{"letter":"F","text":"诱导化疗后序贯根治性放化疗及辅助化疗","is_gold":false},{"letter":"G","text":"姑息性放射治疗联合全身系统性化疗","is_gold":false},{"letter":"H","text":"单纯根治性放射治疗联合EGFR靶向治疗","is_gold":false},{"letter":"I","text":"诱导化疗联合EGFR靶向治疗后序贯放疗","is_gold":false},{"letter":"J","text":"根治性放化疗联合PD-1抑制剂治疗","is_gold":false},{"letter":"K","text":"诱导化疗联合PD-1抑制剂后序贯放化疗","is_gold":false},{"letter":"L","text":"单纯全身系统性化疗","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、头长肌。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D23] 检验组合: 天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.75；乳酸脱氢酶(LDH)-静脉血: 285.9U/L；总胆汁酸(TBA)-静脉血: 12.7umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 220U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 20.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 249.9U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 165.4U/L；碱性磷酸酶(ALP)-静脉血: 161.1U/L\n- [全程D37] 检验组合: 甲状腺球蛋白(TG)-静脉血: 13.08ng/ml；平均血小板体积(MPV)-静脉血: 9.9fL；α-L-岩藻糖苷酶(AFU)-静脉血: 21.1U/L；促卵泡刺激素(FSH)-静脉血: 6.26mIU/ml；血小板比容-静脉血: 29%；血小板分布宽度(PDW)-静脉血: 11.3%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.2；催乳素(PRL)-静脉血: 277.6uIU/ml；大血小板百分比(P-LCR%)-静脉血: 23.9%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；促黄体生成素(LH)-静脉血: 9.22mIU/ml；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；血小板计数(PLT#)-静脉血: 29710E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.262；γ-谷氨酰基转移酶(GGT)-静脉血: 227.5U/L；生长激素(GH)-静脉血: 0.54ng/ml；碱性磷酸酶(ALP)-静脉血: 164.9U/L；乳酸脱氢酶(LDH)-静脉血: 170.2U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 38.5；平均红细胞体积(MCV)-静脉血: 94fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；血红蛋白(Hb)-静脉血: 140g/L；中性粒细胞计数(Neut#)-静脉血: 4.410E9/L；促甲状腺激素(TSH)-静脉血: 4.45uIU/ml；有核红细胞计数(NRBC#)-静脉血: 010E9/L；单核细胞百分比(Mono%)-静脉血: 0.105；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.619；红细胞计数(RBC#)-静脉血: 4.5110E12/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；红细胞比容(Hct)-静脉血: 42.4%；总胆汁酸(TBA)-静脉血: 2umol/L；甲状腺过氧化物酶抗体(TPO-Ab)-静脉血: 14.45U/ml；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.58；丙氨酸氨基转移酶(ALT)-静脉血:……\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 单纯根治性放射治疗或根治性放化疗\nB. 诱导化疗后序贯单纯根治性放射治疗\nC. 诱导化疗后序贯根治性放化疗\nD. 单纯根治性放射治疗后序贯辅助化疗\nE. 根治性放化疗后序贯辅助化疗\nF. 诱导化疗后序贯根治性放化疗及辅助化疗\nG. 姑息性放射治疗联合全身系统性化疗\nH. 单纯根治性放射治疗联合EGFR靶向治疗\nI. 诱导化疗联合EGFR靶向治疗后序贯放疗\nJ. 根治性放化疗联合PD-1抑制剂治疗\nK. 诱导化疗联合PD-1抑制剂后序贯放化疗\nL. 单纯全身系统性化疗\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、头长肌。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D23] 检验组合: 天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.75；乳酸脱氢酶(LDH)-静脉血: 285.9U/L；总胆汁酸(TBA)-静脉血: 12.7umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 220U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 20.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 249.9U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 165.4U/L；碱性磷酸酶(ALP)-静脉血: 161.1U/L\n- [全程D37] 检验组合: 甲状腺球蛋白(TG)-静脉血: 13.08ng/ml；平均血小板体积(MPV)-静脉血: 9.9fL；α-L-岩藻糖苷酶(AFU)-静脉血: 21.1U/L；促卵泡刺激素(FSH)-静脉血: 6.26mIU/ml；血小板比容-静脉血: 29%；血小板分布宽度(PDW)-静脉血: 11.3%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.2；催乳素(PRL)-静脉血: 277.6uIU/ml；大血小板百分比(P-LCR%)-静脉血: 23.9%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；促黄体生成素(LH)-静脉血: 9.22mIU/ml；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；血小板计数(PLT#)-静脉血: 29710E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.262；γ-谷氨酰基转移酶(GGT)-静脉血: 227.5U/L；生长激素(GH)-静脉血: 0.54ng/ml；碱性磷酸酶(ALP)-静脉血: 164.9U/L；乳酸脱氢酶(LDH)-静脉血: 170.2U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 38.5；平均红细胞体积(MCV)-静脉血: 94fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；血红蛋白(Hb)-静脉血: 140g/L；中性粒细胞计数(Neut#)-静脉血: 4.410E9/L；促甲状腺激素(TSH)-静脉血: 4.45uIU/ml；有核红细胞计数(NRBC#)-静脉血: 010E9/L；单核细胞百分比(Mono%)-静脉血: 0.105；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.619；红细胞计数(RBC#)-静脉血: 4.5110E12/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；红细胞比容(Hct)-静脉血: 42.4%；总胆汁酸(TBA)-静脉血: 2umol/L；甲状腺过氧化物酶抗体(TPO-Ab)-静脉血: 14.45U/ml；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.58；丙氨酸氨基转移酶(ALT)-静脉血:……\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 单纯根治性放射治疗或根治性放化疗\nB. 诱导化疗后序贯单纯根治性放射治疗\nC. 诱导化疗后序贯根治性放化疗\nD. 单纯根治性放射治疗后序贯辅助化疗\nE. 根治性放化疗后序贯辅助化疗\nF. 诱导化疗后序贯根治性放化疗及辅助化疗\nG. 姑息性放射治疗联合全身系统性化疗\nH. 单纯根治性放射治疗联合EGFR靶向治疗\nI. 诱导化疗联合EGFR靶向治疗后序贯放疗\nJ. 根治性放化疗联合PD-1抑制剂治疗\nK. 诱导化疗联合PD-1抑制剂后序贯放化疗\nL. 单纯全身系统性化疗\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-453547f6b6c780c6834cd926","patient_id":"patient-4e3ac84b9e1451cea981f98e","turn_id":"turn05","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"B","gold_action":"继续当前调强放疗，定期监测血常规及肝肾功能，暂不予特殊药物干预。","options":[{"letter":"A","text":"暂停放疗，给予静脉保肝降酶药物，待转氨酶正常后重启放疗","is_gold":false},{"letter":"B","text":"继续调强放疗，定期监测血常规及肝肾功能，暂不予特殊药物干预","is_gold":true},{"letter":"C","text":"暂停放疗，经验性静脉滴注广谱抗生素，待中性粒细胞正常后重启放疗","is_gold":false},{"letter":"D","text":"继续调强放疗，皮下注射重组人粒细胞集落刺激因子","is_gold":false},{"letter":"E","text":"暂停放疗，给予大剂量静脉水化及利尿治疗","is_gold":false},{"letter":"F","text":"继续调强放疗，计划在下一周期将顺铂剂量下调20%","is_gold":false},{"letter":"G","text":"暂停放疗，完善血培养及降钙素原检查","is_gold":false},{"letter":"H","text":"继续调强放疗，静脉滴注大剂量糖皮质激素","is_gold":false},{"letter":"I","text":"暂停放疗，给予静脉输注人血白蛋白及肠外营养支持","is_gold":false},{"letter":"J","text":"继续调强放疗，计划将下一周期同期化疗药物替换为卡铂","is_gold":false},{"letter":"K","text":"暂停放疗，复查鼻咽及颈部增强MRI","is_gold":false},{"letter":"L","text":"继续调强放疗，取消后续同期化疗周期","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、头长肌。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D44] 检验组合: 平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；单核细胞百分比(Mono%)-静脉血: 0.084；载脂蛋白B(apoB)-静脉血: 1.02g/L；磷(P)-静脉血: 1.54mmol/L；钠离子(Na+)-静脉血: 137mmol/L；白蛋白(ALB)-静脉血: 41.2g/L；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 38.1U/L；总胆固醇(TC)-静脉血: 5.9mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；中性粒细胞百分比(Neut%)-静脉血: 0.789；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.65mmol/L；间接胆红素(IBIL)-静脉血: 5.6umolL；尿素氮(BUN)-静脉血: 7.73mmol/L；总胆红素(TBIL)-静脉血: 7.4umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.4mmol/L；C-反应蛋白(CRP)-静脉血: 9.62mg/L；血小板比容-静脉血: 27%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；大血小板百分比(P-LCR%)-静脉血: 26.8%；α-L-岩藻糖苷酶(AFU)-静脉血: 35U/L；钾离子(K+)-静脉血: 4.2mmol/L；直接胆红素(DBIL)-静脉血: 1.8umol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.6；尿酸(UA)-静脉血: 288.4umol/L；碱性磷酸酶(ALP)-静脉血: 138.4U/L；中性粒细胞计数(Neut#)-静脉血: 11.910E9/L；总钙(Ca)-静脉血: 2.25mmol/L；肌酐(Crea)-静脉血: 84umol/L；总胆汁酸(TBA)-静脉血: 4.1umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.24；球蛋白(GLO)-静脉血: 33.12g/L；氯离子(Cl-)-静脉血: 97.5mmol/L；甘油三酯(TG)-静脉血: 2.9mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；丙氨酸氨基转移酶(ALT)-静脉血:……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D39] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者一般情况可，未诉特殊不适。按[计划性表述已隐藏]同期放化疗，放疗技术采用调强放疗9野，处方剂量：PTVp 7029cGy/33F， PTVn_L 6600cGy/33F,PTVn_R 6000cGy/33F,PTV1 6000cGy/33F,PTV2 5400cGy/33F。目前放疗计划已完善，予以今日复位验证后执行放疗。\n- [全程D40] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者精神食欲可，放疗2次，无特殊不适，查体无特殊。今日按[计划性表述已隐藏]第一程DDP同期化疗（顺铂 80mg/m2），若无特殊不适，今日化疗结束后予以出院。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，给予静脉保肝降酶药物，待转氨酶正常后重启放疗\nB. 继续调强放疗，定期监测血常规及肝肾功能，暂不予特殊药物干预\nC. 暂停放疗，经验性静脉滴注广谱抗生素，待中性粒细胞正常后重启放疗\nD. 继续调强放疗，皮下注射重组人粒细胞集落刺激因子\nE. 暂停放疗，给予大剂量静脉水化及利尿治疗\nF. 继续调强放疗，计划在下一周期将顺铂剂量下调20%\nG. 暂停放疗，完善血培养及降钙素原检查\nH. 继续调强放疗，静脉滴注大剂量糖皮质激素\nI. 暂停放疗，给予静脉输注人血白蛋白及肠外营养支持\nJ. 继续调强放疗，计划将下一周期同期化疗药物替换为卡铂\nK. 暂停放疗，复查鼻咽及颈部增强MRI\nL. 继续调强放疗，取消后续同期化疗周期\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、头长肌。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D44] 检验组合: 平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；单核细胞百分比(Mono%)-静脉血: 0.084；载脂蛋白B(apoB)-静脉血: 1.02g/L；磷(P)-静脉血: 1.54mmol/L；钠离子(Na+)-静脉血: 137mmol/L；白蛋白(ALB)-静脉血: 41.2g/L；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 38.1U/L；总胆固醇(TC)-静脉血: 5.9mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；中性粒细胞百分比(Neut%)-静脉血: 0.789；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.65mmol/L；间接胆红素(IBIL)-静脉血: 5.6umolL；尿素氮(BUN)-静脉血: 7.73mmol/L；总胆红素(TBIL)-静脉血: 7.4umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.4mmol/L；C-反应蛋白(CRP)-静脉血: 9.62mg/L；血小板比容-静脉血: 27%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；大血小板百分比(P-LCR%)-静脉血: 26.8%；α-L-岩藻糖苷酶(AFU)-静脉血: 35U/L；钾离子(K+)-静脉血: 4.2mmol/L；直接胆红素(DBIL)-静脉血: 1.8umol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.6；尿酸(UA)-静脉血: 288.4umol/L；碱性磷酸酶(ALP)-静脉血: 138.4U/L；中性粒细胞计数(Neut#)-静脉血: 11.910E9/L；总钙(Ca)-静脉血: 2.25mmol/L；肌酐(Crea)-静脉血: 84umol/L；总胆汁酸(TBA)-静脉血: 4.1umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.24；球蛋白(GLO)-静脉血: 33.12g/L；氯离子(Cl-)-静脉血: 97.5mmol/L；甘油三酯(TG)-静脉血: 2.9mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；丙氨酸氨基转移酶(ALT)-静脉血:……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D39] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者一般情况可，未诉特殊不适。按[计划性表述已隐藏]同期放化疗，放疗技术采用调强放疗9野，处方剂量：PTVp 7029cGy/33F， PTVn_L 6600cGy/33F,PTVn_R 6000cGy/33F,PTV1 6000cGy/33F,PTV2 5400cGy/33F。目前放疗计划已完善，予以今日复位验证后执行放疗。\n- [全程D40] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者精神食欲可，放疗2次，无特殊不适，查体无特殊。今日按[计划性表述已隐藏]第一程DDP同期化疗（顺铂 80mg/m2），若无特殊不适，今日化疗结束后予以出院。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，给予静脉保肝降酶药物，待转氨酶正常后重启放疗\nB. 继续调强放疗，定期监测血常规及肝肾功能，暂不予特殊药物干预\nC. 暂停放疗，经验性静脉滴注广谱抗生素，待中性粒细胞正常后重启放疗\nD. 继续调强放疗，皮下注射重组人粒细胞集落刺激因子\nE. 暂停放疗，给予大剂量静脉水化及利尿治疗\nF. 继续调强放疗，计划在下一周期将顺铂剂量下调20%\nG. 暂停放疗，完善血培养及降钙素原检查\nH. 继续调强放疗，静脉滴注大剂量糖皮质激素\nI. 暂停放疗，给予静脉输注人血白蛋白及肠外营养支持\nJ. 继续调强放疗，计划将下一周期同期化疗药物替换为卡铂\nK. 暂停放疗，复查鼻咽及颈部增强MRI\nL. 继续调强放疗，取消后续同期化疗周期\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-192932039e740110f5fb9ae6","patient_id":"patient-4e3ac84b9e1451cea981f98e","turn_id":"turn06","turn_position":5,"turn_type":"toxicity_or_support_decision","gold_letter":"C","gold_action":"继续按计划执行调强放疗，定期复查血常规及肝肾功能","options":[{"letter":"A","text":"暂停放疗，给予重组人粒细胞刺激因子皮下注射","is_gold":false},{"letter":"B","text":"继续放疗，给予重组人血小板生成素皮下注射","is_gold":false},{"letter":"C","text":"继续按计划执行调强放疗，定期复查血常规及肝肾功能","is_gold":true},{"letter":"D","text":"暂停放疗，给予静脉保肝降酶治疗并密切监测","is_gold":false},{"letter":"E","text":"继续放疗，立即启动第二周期顺铂同期化疗","is_gold":false},{"letter":"F","text":"继续放疗，将第二周期顺铂同期化疗剂量下调20%","is_gold":false},{"letter":"G","text":"继续放疗，将第二周期同期化疗药物更换为卡铂","is_gold":false},{"letter":"H","text":"暂停放疗，完善鼻咽及颈部MRI评估近期疗效","is_gold":false},{"letter":"I","text":"继续放疗，给予大剂量静脉水化及利尿促排治疗","is_gold":false},{"letter":"J","text":"继续放疗，联合尼妥珠单抗靶向治疗以增强疗效","is_gold":false},{"letter":"K","text":"继续放疗，给予促红细胞生成素皮下注射纠正贫血","is_gold":false},{"letter":"L","text":"终止放疗，转为全身静脉化疗并评估后续方案","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、头长肌。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D47] 检验组合: 血小板分布宽度(PDW)-静脉血: 13.9%；白细胞计数(WBC#)-静脉血: 6.3810E9/L；单核细胞计数(Mono#)-静脉血: 1.410E9/L；红细胞比容(Hct)-静脉血: 43.9%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 38.1；平均红细胞血红蛋白浓度(MCHC)-静脉血: 333g/L；血小板计数(PLT#)-静脉血: 26510E9/L；平均红细胞体积(MCV)-静脉血: 93.6fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；大血小板百分比(P-LCR%)-静脉血: 34.5%；血小板比容-静脉血: 30%；平均血小板体积(MPV)-静脉血: 11.2fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 146g/L；中性粒细胞百分比(Neut%)-静脉血: 0.569；单核细胞百分比(Mono%)-静脉血: 0.216；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；红细胞计数(RBC#)-静脉血: 4.6910E12/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；中性粒细胞计数(Neut#)-静脉血: 3.610E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.205；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.5；平均红细胞血红蛋白含量(MCH)-静脉血: 31.1pg\n- [全程D54] 检验组合: 直接胆红素(DBIL)-静脉血: 1.3umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 337g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.173；血小板计数(PLT#)-静脉血: 14810E9/L；碱性磷酸酶(ALP)-静脉血: 120.1U/L；氯离子(Cl-)-静脉血: 101.8mmol/L；总胆固醇(TC)-静脉血: 5.93mmol/L；钾离子(K+)-静脉血: 3.93mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 127.6U/L；有核红细胞百分比(NRBC%)-静脉血: 0；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.51；甘油三酯(TG)-静脉血: 2.02mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 38.4；单核细胞计数(Mono#)-静脉血: 0.710E9/L；平均血小板体积(MPV)-静脉血: 10.1fL；白细胞计数(WBC#)-静脉血: 5.910E9/L；钠离子(Na+)-静脉血: 140.2mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；中性粒细胞计数(Neut#)-静脉血: 4.110E9/L；红细胞比容(Hct)-静脉血: 40.7%；尿素氮(BUN)-静脉血: 3.9mmol/L；平均红细胞体积(MCV)-静脉血: 91.3fL；总胆红素(TBIL)-静脉血: 9.5umol/L；总胆汁酸(TBA)-静脉血: 6.5umol/L；C-反应蛋白(CRP)-静脉血: 5.08mg/L；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.7pg；总蛋白(TP)-静脉血: 72.34g/L；总钙(Ca)-静脉血: 2.35mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.6mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.2mmolL；载脂蛋白AI(apoAI)-静脉血: 1.36g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 36.9U/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.9；红细胞计数(RBC#)-静脉血: 4.4610E12/L；嗜碱性粒细胞百分比(Baso%)-静脉血……\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，给予重组人粒细胞刺激因子皮下注射\nB. 继续放疗，给予重组人血小板生成素皮下注射\nC. 继续按计划执行调强放疗，定期复查血常规及肝肾功能\nD. 暂停放疗，给予静脉保肝降酶治疗并密切监测\nE. 继续放疗，立即启动第二周期顺铂同期化疗\nF. 继续放疗，将第二周期顺铂同期化疗剂量下调20%\nG. 继续放疗，将第二周期同期化疗药物更换为卡铂\nH. 暂停放疗，完善鼻咽及颈部MRI评估近期疗效\nI. 继续放疗，给予大剂量静脉水化及利尿促排治疗\nJ. 继续放疗，联合尼妥珠单抗靶向治疗以增强疗效\nK. 继续放疗，给予促红细胞生成素皮下注射纠正贫血\nL. 终止放疗，转为全身静脉化疗并评估后续方案\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、头长肌。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D47] 检验组合: 血小板分布宽度(PDW)-静脉血: 13.9%；白细胞计数(WBC#)-静脉血: 6.3810E9/L；单核细胞计数(Mono#)-静脉血: 1.410E9/L；红细胞比容(Hct)-静脉血: 43.9%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 38.1；平均红细胞血红蛋白浓度(MCHC)-静脉血: 333g/L；血小板计数(PLT#)-静脉血: 26510E9/L；平均红细胞体积(MCV)-静脉血: 93.6fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；大血小板百分比(P-LCR%)-静脉血: 34.5%；血小板比容-静脉血: 30%；平均血小板体积(MPV)-静脉血: 11.2fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 146g/L；中性粒细胞百分比(Neut%)-静脉血: 0.569；单核细胞百分比(Mono%)-静脉血: 0.216；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；红细胞计数(RBC#)-静脉血: 4.6910E12/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；中性粒细胞计数(Neut#)-静脉血: 3.610E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.205；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.5；平均红细胞血红蛋白含量(MCH)-静脉血: 31.1pg\n- [全程D54] 检验组合: 直接胆红素(DBIL)-静脉血: 1.3umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 337g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.173；血小板计数(PLT#)-静脉血: 14810E9/L；碱性磷酸酶(ALP)-静脉血: 120.1U/L；氯离子(Cl-)-静脉血: 101.8mmol/L；总胆固醇(TC)-静脉血: 5.93mmol/L；钾离子(K+)-静脉血: 3.93mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 127.6U/L；有核红细胞百分比(NRBC%)-静脉血: 0；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.51；甘油三酯(TG)-静脉血: 2.02mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 38.4；单核细胞计数(Mono#)-静脉血: 0.710E9/L；平均血小板体积(MPV)-静脉血: 10.1fL；白细胞计数(WBC#)-静脉血: 5.910E9/L；钠离子(Na+)-静脉血: 140.2mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；中性粒细胞计数(Neut#)-静脉血: 4.110E9/L；红细胞比容(Hct)-静脉血: 40.7%；尿素氮(BUN)-静脉血: 3.9mmol/L；平均红细胞体积(MCV)-静脉血: 91.3fL；总胆红素(TBIL)-静脉血: 9.5umol/L；总胆汁酸(TBA)-静脉血: 6.5umol/L；C-反应蛋白(CRP)-静脉血: 5.08mg/L；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.7pg；总蛋白(TP)-静脉血: 72.34g/L；总钙(Ca)-静脉血: 2.35mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.6mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.2mmolL；载脂蛋白AI(apoAI)-静脉血: 1.36g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 36.9U/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.9；红细胞计数(RBC#)-静脉血: 4.4610E12/L；嗜碱性粒细胞百分比(Baso%)-静脉血……\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，给予重组人粒细胞刺激因子皮下注射\nB. 继续放疗，给予重组人血小板生成素皮下注射\nC. 继续按计划执行调强放疗，定期复查血常规及肝肾功能\nD. 暂停放疗，给予静脉保肝降酶治疗并密切监测\nE. 继续放疗，立即启动第二周期顺铂同期化疗\nF. 继续放疗，将第二周期顺铂同期化疗剂量下调20%\nG. 继续放疗，将第二周期同期化疗药物更换为卡铂\nH. 暂停放疗，完善鼻咽及颈部MRI评估近期疗效\nI. 继续放疗，给予大剂量静脉水化及利尿促排治疗\nJ. 继续放疗，联合尼妥珠单抗靶向治疗以增强疗效\nK. 继续放疗，给予促红细胞生成素皮下注射纠正贫血\nL. 终止放疗，转为全身静脉化疗并评估后续方案\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-7fddfe1b2a584f133c3b89f7","patient_id":"patient-e5fcd31b4b8b85194b146991","turn_id":"turn01","turn_position":1,"turn_type":"initial_workup_choice","gold_letter":"B","gold_action":"完善鼻咽及颈部MRI平扫+增强、胸腹部CT、全身骨扫描、电子鼻咽镜检查及活检。","options":[{"letter":"A","text":"完善鼻咽及颈部CT平扫+增强、胸腹部CT、全身骨扫描、电子鼻咽镜检查及活检。","is_gold":false},{"letter":"B","text":"完善鼻咽及颈部MRI平扫+增强、胸腹部CT、全身骨扫描、电子鼻咽镜检查及活检。","is_gold":true},{"letter":"C","text":"完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像、电子鼻咽镜检查及活检。","is_gold":false},{"letter":"D","text":"完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像、电子鼻咽镜检查及病理会诊。","is_gold":false},{"letter":"E","text":"完善鼻咽及颈部MRI平扫+增强、胸腹部CT、全身骨扫描、电子鼻咽镜检查及病理会诊。","is_gold":false},{"letter":"F","text":"完善鼻咽及颈部CT平扫+增强、PET/CT全身显像、电子鼻咽镜检查及病理会诊。","is_gold":false},{"letter":"G","text":"完善鼻咽MRI平扫+增强、颈部超声、PET/CT全身显像、电子鼻咽镜检查及病理会诊。","is_gold":false},{"letter":"H","text":"完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像、直接安排诱导化疗。","is_gold":false},{"letter":"I","text":"完善鼻咽及颈部MRI平扫+增强、胸腹部CT、全身骨扫描、直接安排根治性放疗。","is_gold":false},{"letter":"J","text":"完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像、鼻内镜下鼻咽肿物切除术。","is_gold":false},{"letter":"K","text":"完善鼻咽及颈部CT平扫+增强、胸腹部CT、全身骨扫描、电子鼻咽镜检查及病理会诊。","is_gold":false},{"letter":"L","text":"完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像、EBV-DNA检测、暂缓病理确诊。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 回吸性涕血1月余。；现病史: 缘于1月前患者无意中出现抽吸性血涕，痰中带血；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻咽角化,涕血,痰中带血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：78次/分，R：20次/分，BP：125/80mmHg,Ht：162cm，Wt：61kg，BSA：1.6483m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善鼻咽及颈部CT平扫+增强、胸腹部CT、全身骨扫描、电子鼻咽镜检查及活检。\nB. 完善鼻咽及颈部MRI平扫+增强、胸腹部CT、全身骨扫描、电子鼻咽镜检查及活检。\nC. 完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像、电子鼻咽镜检查及活检。\nD. 完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像、电子鼻咽镜检查及病理会诊。\nE. 完善鼻咽及颈部MRI平扫+增强、胸腹部CT、全身骨扫描、电子鼻咽镜检查及病理会诊。\nF. 完善鼻咽及颈部CT平扫+增强、PET/CT全身显像、电子鼻咽镜检查及病理会诊。\nG. 完善鼻咽MRI平扫+增强、颈部超声、PET/CT全身显像、电子鼻咽镜检查及病理会诊。\nH. 完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像、直接安排诱导化疗。\nI. 完善鼻咽及颈部MRI平扫+增强、胸腹部CT、全身骨扫描、直接安排根治性放疗。\nJ. 完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像、鼻内镜下鼻咽肿物切除术。\nK. 完善鼻咽及颈部CT平扫+增强、胸腹部CT、全身骨扫描、电子鼻咽镜检查及病理会诊。\nL. 完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像、EBV-DNA检测、暂缓病理确诊。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 回吸性涕血1月余。；现病史: 缘于1月前患者无意中出现抽吸性血涕，痰中带血；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻咽角化,涕血,痰中带血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：78次/分，R：20次/分，BP：125/80mmHg,Ht：162cm，Wt：61kg，BSA：1.6483m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善鼻咽及颈部CT平扫+增强、胸腹部CT、全身骨扫描、电子鼻咽镜检查及活检。\nB. 完善鼻咽及颈部MRI平扫+增强、胸腹部CT、全身骨扫描、电子鼻咽镜检查及活检。\nC. 完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像、电子鼻咽镜检查及活检。\nD. 完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像、电子鼻咽镜检查及病理会诊。\nE. 完善鼻咽及颈部MRI平扫+增强、胸腹部CT、全身骨扫描、电子鼻咽镜检查及病理会诊。\nF. 完善鼻咽及颈部CT平扫+增强、PET/CT全身显像、电子鼻咽镜检查及病理会诊。\nG. 完善鼻咽MRI平扫+增强、颈部超声、PET/CT全身显像、电子鼻咽镜检查及病理会诊。\nH. 完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像、直接安排诱导化疗。\nI. 完善鼻咽及颈部MRI平扫+增强、胸腹部CT、全身骨扫描、直接安排根治性放疗。\nJ. 完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像、鼻内镜下鼻咽肿物切除术。\nK. 完善鼻咽及颈部CT平扫+增强、胸腹部CT、全身骨扫描、电子鼻咽镜检查及病理会诊。\nL. 完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像、EBV-DNA检测、暂缓病理确诊。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-bc7a956bb6d6b0bc48992292","patient_id":"patient-e5fcd31b4b8b85194b146991","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"E","gold_action":"安排电子鼻咽镜及鼻咽肿物活检，并完善胸腹部CT及骨扫描（或PET-CT）","options":[{"letter":"A","text":"安排颈部淋巴结切除活检，并完善全身PET-CT检查","is_gold":false},{"letter":"B","text":"安排鼻咽镜下活检，并完善头颅CT检查","is_gold":false},{"letter":"C","text":"安排颈部淋巴结细针穿刺活检，并完善胸腹部CT及骨扫描","is_gold":false},{"letter":"D","text":"安排鼻咽镜下活检，并完善EBV-DNA定量检测，暂缓全身影像学检查","is_gold":false},{"letter":"E","text":"安排电子鼻咽镜及鼻咽肿物活检，并完善胸腹部CT及骨扫描（或PET-CT）","is_gold":true},{"letter":"F","text":"安排鼻咽肿物及颈部淋巴结双重活检，并完善胸腹部MRI检查","is_gold":false},{"letter":"G","text":"安排鼻咽镜下活检，并完善颈部超声检查","is_gold":false},{"letter":"H","text":"安排全身PET-CT检查，并直接开始根治性放化疗","is_gold":false},{"letter":"I","text":"安排电子鼻咽镜检查，并直接进入放疗定位阶段","is_gold":false},{"letter":"J","text":"安排鼻咽镜下活检，并直接开始根治性放疗","is_gold":false},{"letter":"K","text":"安排鼻咽肿物活检，并直接进入诱导化疗阶段","is_gold":false},{"letter":"L","text":"安排鼻咽镜下活检，并完善全身骨髓穿刺检查","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 胱抑素(Cys-C)-静脉血: 0.77mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.69mmol/L；阴离子间隙(AG)-静脉血: 13；磷(P)-静脉血: 0.92mmol/L；总胆红素(TBIL)-静脉血: 12.4umol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；肌酐(Crea)-静脉血: 80.5umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.58；Rh血型-静脉血: 阳性；总钙(Ca)-静脉血: 2.44mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；血小板计数(PLT#)-静脉血: 21910E9/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 4.81mmol/L；直接胆红素(DBIL)-静脉血: 4.2umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.64mmolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.013；载脂蛋白B(apoB)-静脉血: 0.73g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.3pg；α-L-岩藻糖苷酶(AFU)-静脉血: 24U/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 8.2umolL；白蛋白(ALB)-静脉血: 45.8g/L；血小板比容-静脉血: 21%；ABO血型-静脉血: O；尿素氮(BUN)-静脉血: 3.6mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；凝血酶时间(TT)-静脉血: 20.2sec.；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；载脂蛋白AI(apoAI)-静脉血: 1.33g/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；C-反应蛋白(CRP)-静脉血: 0.36mg/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血:……\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔稍狭窄，鼻咽左侧壁明显增厚，左侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。肿物侵犯左侧腭帆张提肌，左侧咽旁脂肪间隙变窄。鼻咽顶后壁稍增厚，右侧壁未见明显增厚，右侧咽隐窝清晰。 右侧腭帆张提肌、双侧头长肌、翼内外肌未见明显异常。 双侧翼腭窝、上颌后脂肪间隙、咀嚼肌间隙未见异常。 口咽各壁未见增厚。鼻腔内未见肿物。 蝶骨基底部、左侧翼突基底部及内侧板骨质信号降低，增强扫描可见强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦粘膜稍增厚，双侧乳突未见明显异常。 左侧咽后见几个淋巴结，最大者约8mm×5mm，边界欠清，明显强化。双颈II区见多个淋巴结，最大者约16mm×8mm，边界尚清，较均匀明显强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽左侧壁增厚，左侧咽隐窝肿物，考虑鼻咽癌。 颅底骨质破坏。 左侧咽后、双颈II区淋巴结，可疑转移。 轻度鼻窦炎。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 安排颈部淋巴结切除活检，并完善全身PET-CT检查\nB. 安排鼻咽镜下活检，并完善头颅CT检查\nC. 安排颈部淋巴结细针穿刺活检，并完善胸腹部CT及骨扫描\nD. 安排鼻咽镜下活检，并完善EBV-DNA定量检测，暂缓全身影像学检查\nE. 安排电子鼻咽镜及鼻咽肿物活检，并完善胸腹部CT及骨扫描（或PET-CT）\nF. 安排鼻咽肿物及颈部淋巴结双重活检，并完善胸腹部MRI检查\nG. 安排鼻咽镜下活检，并完善颈部超声检查\nH. 安排全身PET-CT检查，并直接开始根治性放化疗\nI. 安排电子鼻咽镜检查，并直接进入放疗定位阶段\nJ. 安排鼻咽镜下活检，并直接开始根治性放疗\nK. 安排鼻咽肿物活检，并直接进入诱导化疗阶段\nL. 安排鼻咽镜下活检，并完善全身骨髓穿刺检查\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 胱抑素(Cys-C)-静脉血: 0.77mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.69mmol/L；阴离子间隙(AG)-静脉血: 13；磷(P)-静脉血: 0.92mmol/L；总胆红素(TBIL)-静脉血: 12.4umol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；肌酐(Crea)-静脉血: 80.5umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.58；Rh血型-静脉血: 阳性；总钙(Ca)-静脉血: 2.44mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；血小板计数(PLT#)-静脉血: 21910E9/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 4.81mmol/L；直接胆红素(DBIL)-静脉血: 4.2umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.64mmolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.013；载脂蛋白B(apoB)-静脉血: 0.73g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.3pg；α-L-岩藻糖苷酶(AFU)-静脉血: 24U/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 8.2umolL；白蛋白(ALB)-静脉血: 45.8g/L；血小板比容-静脉血: 21%；ABO血型-静脉血: O；尿素氮(BUN)-静脉血: 3.6mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；凝血酶时间(TT)-静脉血: 20.2sec.；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；载脂蛋白AI(apoAI)-静脉血: 1.33g/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；C-反应蛋白(CRP)-静脉血: 0.36mg/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血:……\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔稍狭窄，鼻咽左侧壁明显增厚，左侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。肿物侵犯左侧腭帆张提肌，左侧咽旁脂肪间隙变窄。鼻咽顶后壁稍增厚，右侧壁未见明显增厚，右侧咽隐窝清晰。 右侧腭帆张提肌、双侧头长肌、翼内外肌未见明显异常。 双侧翼腭窝、上颌后脂肪间隙、咀嚼肌间隙未见异常。 口咽各壁未见增厚。鼻腔内未见肿物。 蝶骨基底部、左侧翼突基底部及内侧板骨质信号降低，增强扫描可见强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦粘膜稍增厚，双侧乳突未见明显异常。 左侧咽后见几个淋巴结，最大者约8mm×5mm，边界欠清，明显强化。双颈II区见多个淋巴结，最大者约16mm×8mm，边界尚清，较均匀明显强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽左侧壁增厚，左侧咽隐窝肿物，考虑鼻咽癌。 颅底骨质破坏。 左侧咽后、双颈II区淋巴结，可疑转移。 轻度鼻窦炎。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 安排颈部淋巴结切除活检，并完善全身PET-CT检查\nB. 安排鼻咽镜下活检，并完善头颅CT检查\nC. 安排颈部淋巴结细针穿刺活检，并完善胸腹部CT及骨扫描\nD. 安排鼻咽镜下活检，并完善EBV-DNA定量检测，暂缓全身影像学检查\nE. 安排电子鼻咽镜及鼻咽肿物活检，并完善胸腹部CT及骨扫描（或PET-CT）\nF. 安排鼻咽肿物及颈部淋巴结双重活检，并完善胸腹部MRI检查\nG. 安排鼻咽镜下活检，并完善颈部超声检查\nH. 安排全身PET-CT检查，并直接开始根治性放化疗\nI. 安排电子鼻咽镜检查，并直接进入放疗定位阶段\nJ. 安排鼻咽镜下活检，并直接开始根治性放疗\nK. 安排鼻咽肿物活检，并直接进入诱导化疗阶段\nL. 安排鼻咽镜下活检，并完善全身骨髓穿刺检查\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-49519c2b08d621c382f2a093","patient_id":"patient-e5fcd31b4b8b85194b146991","turn_id":"turn04","turn_position":3,"turn_type":"initial_treatment_selection","gold_letter":"G","gold_action":"诱导化疗（顺铂+氟尿嘧啶，PF方案）","options":[{"letter":"A","text":"根治性单纯放疗","is_gold":false},{"letter":"B","text":"诱导化疗（紫杉醇+卡铂）","is_gold":false},{"letter":"C","text":"诱导化疗（吉西他滨+奥沙利铂）","is_gold":false},{"letter":"D","text":"同期放化疗（顺铂）","is_gold":false},{"letter":"E","text":"诱导化疗（依托泊苷+顺铂）","is_gold":false},{"letter":"F","text":"诱导化疗（长春瑞滨+顺铂）","is_gold":false},{"letter":"G","text":"诱导化疗（顺铂+氟尿嘧啶）","is_gold":true},{"letter":"H","text":"靶向单药治疗（西妥昔单抗）","is_gold":false},{"letter":"I","text":"诱导化疗（多柔比星+环磷酰胺）","is_gold":false},{"letter":"J","text":"姑息性单药化疗（卡培他滨）","is_gold":false},{"letter":"K","text":"免疫单药治疗（帕博利珠单抗）","is_gold":false},{"letter":"L","text":"鼻咽及颈部淋巴结根治性切除术","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 回吸性涕血1月余。；现病史: 缘于1月前患者无意中出现抽吸性血涕，痰中带血；无头痛、面麻，无视力下降、复视，无听力下降、耳鸣等不适，于当地乡镇医院予滴鼻治疗，具体药物不详，未见好转，遂于某次就诊时间往[地点已隐去]人民医院检查，某次就诊时间病理活检示：鼻咽未分化型角化性癌。某次就诊时间鼻咽MRI示：左侧鼻咽部占位病变，考虑鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻咽角化,涕血,痰中带血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：78次/分，R：20次/分，BP：125/80mmHg,Ht：162cm，Wt：61kg，BSA：1.6483m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率100次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右侧约平T6椎体水平，估计导管末端位于上腔静脉上段内。；检查结论: PICC管位置如上所述。\n- [全程D13] 检验组合: 酸碱度(pH)-尿液: 5.5；粘液丝计数(MUCS#)-尿液: 11/μL；酮体(KET)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 1/μL；红细胞计数(RBC#)-尿液: 3/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: colorless；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；比重(SG)-尿液: 1.008\n- [全程D14] 检验组合: 总蛋白(TP)-尿液: +- 0.2g（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；红细胞计数(RBC#)-尿液: 1/μL；葡萄糖(Glu)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.02；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；粘液丝计数(MUCS#)-尿液: 4/μL；白细胞(LEU)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；胆红素(BIL)-尿液: -（参考: 阴性）\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 根治性单纯放疗\nB. 诱导化疗（紫杉醇+卡铂）\nC. 诱导化疗（吉西他滨+奥沙利铂）\nD. 同期放化疗（顺铂）\nE. 诱导化疗（依托泊苷+顺铂）\nF. 诱导化疗（长春瑞滨+顺铂）\nG. 诱导化疗（顺铂+氟尿嘧啶）\nH. 靶向单药治疗（西妥昔单抗）\nI. 诱导化疗（多柔比星+环磷酰胺）\nJ. 姑息性单药化疗（卡培他滨）\nK. 免疫单药治疗（帕博利珠单抗）\nL. 鼻咽及颈部淋巴结根治性切除术\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 回吸性涕血1月余。；现病史: 缘于1月前患者无意中出现抽吸性血涕，痰中带血；无头痛、面麻，无视力下降、复视，无听力下降、耳鸣等不适，于当地乡镇医院予滴鼻治疗，具体药物不详，未见好转，遂于某次就诊时间往[地点已隐去]人民医院检查，某次就诊时间病理活检示：鼻咽未分化型角化性癌。某次就诊时间鼻咽MRI示：左侧鼻咽部占位病变，考虑鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻咽角化,涕血,痰中带血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：78次/分，R：20次/分，BP：125/80mmHg,Ht：162cm，Wt：61kg，BSA：1.6483m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率100次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右侧约平T6椎体水平，估计导管末端位于上腔静脉上段内。；检查结论: PICC管位置如上所述。\n- [全程D13] 检验组合: 酸碱度(pH)-尿液: 5.5；粘液丝计数(MUCS#)-尿液: 11/μL；酮体(KET)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 1/μL；红细胞计数(RBC#)-尿液: 3/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: colorless；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；比重(SG)-尿液: 1.008\n- [全程D14] 检验组合: 总蛋白(TP)-尿液: +- 0.2g（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；红细胞计数(RBC#)-尿液: 1/μL；葡萄糖(Glu)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.02；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；粘液丝计数(MUCS#)-尿液: 4/μL；白细胞(LEU)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；胆红素(BIL)-尿液: -（参考: 阴性）\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 根治性单纯放疗\nB. 诱导化疗（紫杉醇+卡铂）\nC. 诱导化疗（吉西他滨+奥沙利铂）\nD. 同期放化疗（顺铂）\nE. 诱导化疗（依托泊苷+顺铂）\nF. 诱导化疗（长春瑞滨+顺铂）\nG. 诱导化疗（顺铂+氟尿嘧啶）\nH. 靶向单药治疗（西妥昔单抗）\nI. 诱导化疗（多柔比星+环磷酰胺）\nJ. 姑息性单药化疗（卡培他滨）\nK. 免疫单药治疗（帕博利珠单抗）\nL. 鼻咽及颈部淋巴结根治性切除术\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-ba0bc8aff143756f9ee645b5","patient_id":"patient-e5fcd31b4b8b85194b146991","turn_id":"turn05","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"H","gold_action":"办理出院，予以帕洛诺司琼等止吐处理，嘱出院后每周复查血常规及肝肾功能，按计划返院行下一程化疗。","options":[{"letter":"A","text":"办理出院，无需特殊用药，嘱出院后每2周复查血常规及肝肾功能，按计划返院行下一程诱导化疗。","is_gold":false},{"letter":"B","text":"暂缓出院，予以静脉营养支持及强效止吐治疗，待恶心症状完全缓解后出院，按计划返院行下一程化疗。","is_gold":false},{"letter":"C","text":"办理出院，予以止吐处理并预防性给予长效G-CSF支持，嘱出院后每周复查血常规，按计划返院行下一程化疗。","is_gold":false},{"letter":"D","text":"办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，下一程化疗方案需减量20%并延迟1周进行。","is_gold":false},{"letter":"E","text":"暂缓出院，予以保肝降酶及护胃治疗，待复查肝功能及消化道症状好转后出院，按计划返院行下一程化疗。","is_gold":false},{"letter":"F","text":"办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，下一阶段直接转入同期放化疗。","is_gold":false},{"letter":"G","text":"办理出院，予以止吐处理，嘱出院后每3天复查肾功能及电解质，按计划返院行下一程诱导化疗。","is_gold":false},{"letter":"H","text":"办理出院，予以帕洛诺司琼等止吐处理，嘱出院后每周复查血常规及肝肾功能，按计划返院行下一程化疗。","is_gold":true},{"letter":"I","text":"暂缓出院，予以静脉补液及纠正电解质紊乱治疗，复查生化指标正常后出院，按计划返院行下一程化疗。","is_gold":false},{"letter":"J","text":"办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，下一程化疗更改为单药方案以减轻反应。","is_gold":false},{"letter":"K","text":"办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，按计划返院行靶向治疗联合放疗。","is_gold":false},{"letter":"L","text":"暂缓出院，予以质子泵抑制剂静脉滴注预防应激性溃疡，观察3天后出院，按计划返院行下一程化疗。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D15] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 11/μL；酮体(KET)-尿液: -（参考: 阴性）；酵母菌(YEAST)-尿液: 1/μL；白细胞(LEU)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 1/μL；比重(SG)-尿液: 1.019；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 7/μL；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；酸碱度(pH)-尿液: 6.5；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D19] 检验组合: 氯离子(Cl-)-静脉血: 96.7mmol/L；总蛋白(TP)-静脉血: 73.8g/L；甘油三酯(TG)-静脉血: 1mmol/L；血小板计数(PLT#)-静脉血: 18410E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.2；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.27；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.44mmolL；球蛋白(GLO)-静脉血: 27.4g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；丙氨酸氨基转移酶(ALT)-静脉血: 16.1U/L；总钙(Ca)-静脉血: 2.31mmol/L；血小板比容-静脉血: 18%；血红蛋白(Hb)-静脉血: 144g/L；血液二氧化碳含量ctCO2(B)-静脉血: 26.5mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 356g/L；胱抑素(Cys-C)-静脉血: 0.75mg/L；γ-谷氨酰基转移酶(GGT)-静脉血: 18.1U/L；红细胞计数(RBC#)-静脉血: 4.5310E12/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.1；淋巴细胞百分比(Lymph%)-静脉血: 0.277；平均红细胞血红蛋白含量(MCH)-静脉血: 31.8pg；尿酸(UA)-静脉血: 231.9umol/L；乳酸脱氢酶(LDH)-静脉血: 158.8U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；载脂蛋白B(apoB)-静脉血: 0.78g/L；中性粒细胞百分比(Neut%)-静脉血: 0.597；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；血小板分布宽度(PDW)-静脉血: 10.5%；间接胆红素(IBIL)-静脉血: 11.1umolL；单核细胞百分比(Mono%)-静脉血: 0.101；天门冬氨酸氨基转移酶(AST)-静脉血: 20.5U/L；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L；白细胞计数(WBC#)-静脉血: 4.8310E9/L；镁离子(Mg2+)-静脉血: 0.93mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.36g/L；总胆红素(TBIL)-静脉血: 16.1umol/……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D17] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者第一程诱导化疗后，诉轻度恶心呕吐，精神睡眠尚可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。钱医生信息已隐藏：患者03-02开始予5-Fu6.6g,DDP130mg化疗，患者未诉特殊不适，注意观察不良反应。\n- [全程D19] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者化疗后，诉轻度恶心，精神睡眠尚可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。医生信息已隐藏：患者第一程诱导化疗顺利，一般情况可，予出院。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 办理出院，无需特殊用药，嘱出院后每2周复查血常规及肝肾功能，按计划返院行下一程诱导化疗。\nB. 暂缓出院，予以静脉营养支持及强效止吐治疗，待恶心症状完全缓解后出院，按计划返院行下一程化疗。\nC. 办理出院，予以止吐处理并预防性给予长效G-CSF支持，嘱出院后每周复查血常规，按计划返院行下一程化疗。\nD. 办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，下一程化疗方案需减量20%并延迟1周进行。\nE. 暂缓出院，予以保肝降酶及护胃治疗，待复查肝功能及消化道症状好转后出院，按计划返院行下一程化疗。\nF. 办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，下一阶段直接转入同期放化疗。\nG. 办理出院，予以止吐处理，嘱出院后每3天复查肾功能及电解质，按计划返院行下一程诱导化疗。\nH. 办理出院，予以帕洛诺司琼等止吐处理，嘱出院后每周复查血常规及肝肾功能，按计划返院行下一程化疗。\nI. 暂缓出院，予以静脉补液及纠正电解质紊乱治疗，复查生化指标正常后出院，按计划返院行下一程化疗。\nJ. 办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，下一程化疗更改为单药方案以减轻反应。\nK. 办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，按计划返院行靶向治疗联合放疗。\nL. 暂缓出院，予以质子泵抑制剂静脉滴注预防应激性溃疡，观察3天后出院，按计划返院行下一程化疗。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D15] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 11/μL；酮体(KET)-尿液: -（参考: 阴性）；酵母菌(YEAST)-尿液: 1/μL；白细胞(LEU)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 1/μL；比重(SG)-尿液: 1.019；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 7/μL；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；酸碱度(pH)-尿液: 6.5；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D19] 检验组合: 氯离子(Cl-)-静脉血: 96.7mmol/L；总蛋白(TP)-静脉血: 73.8g/L；甘油三酯(TG)-静脉血: 1mmol/L；血小板计数(PLT#)-静脉血: 18410E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.2；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.27；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.44mmolL；球蛋白(GLO)-静脉血: 27.4g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；丙氨酸氨基转移酶(ALT)-静脉血: 16.1U/L；总钙(Ca)-静脉血: 2.31mmol/L；血小板比容-静脉血: 18%；血红蛋白(Hb)-静脉血: 144g/L；血液二氧化碳含量ctCO2(B)-静脉血: 26.5mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 356g/L；胱抑素(Cys-C)-静脉血: 0.75mg/L；γ-谷氨酰基转移酶(GGT)-静脉血: 18.1U/L；红细胞计数(RBC#)-静脉血: 4.5310E12/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.1；淋巴细胞百分比(Lymph%)-静脉血: 0.277；平均红细胞血红蛋白含量(MCH)-静脉血: 31.8pg；尿酸(UA)-静脉血: 231.9umol/L；乳酸脱氢酶(LDH)-静脉血: 158.8U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；载脂蛋白B(apoB)-静脉血: 0.78g/L；中性粒细胞百分比(Neut%)-静脉血: 0.597；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；血小板分布宽度(PDW)-静脉血: 10.5%；间接胆红素(IBIL)-静脉血: 11.1umolL；单核细胞百分比(Mono%)-静脉血: 0.101；天门冬氨酸氨基转移酶(AST)-静脉血: 20.5U/L；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L；白细胞计数(WBC#)-静脉血: 4.8310E9/L；镁离子(Mg2+)-静脉血: 0.93mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.36g/L；总胆红素(TBIL)-静脉血: 16.1umol/……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D17] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者第一程诱导化疗后，诉轻度恶心呕吐，精神睡眠尚可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。钱医生信息已隐藏：患者03-02开始予5-Fu6.6g,DDP130mg化疗，患者未诉特殊不适，注意观察不良反应。\n- [全程D19] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者化疗后，诉轻度恶心，精神睡眠尚可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。医生信息已隐藏：患者第一程诱导化疗顺利，一般情况可，予出院。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 办理出院，无需特殊用药，嘱出院后每2周复查血常规及肝肾功能，按计划返院行下一程诱导化疗。\nB. 暂缓出院，予以静脉营养支持及强效止吐治疗，待恶心症状完全缓解后出院，按计划返院行下一程化疗。\nC. 办理出院，予以止吐处理并预防性给予长效G-CSF支持，嘱出院后每周复查血常规，按计划返院行下一程化疗。\nD. 办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，下一程化疗方案需减量20%并延迟1周进行。\nE. 暂缓出院，予以保肝降酶及护胃治疗，待复查肝功能及消化道症状好转后出院，按计划返院行下一程化疗。\nF. 办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，下一阶段直接转入同期放化疗。\nG. 办理出院，予以止吐处理，嘱出院后每3天复查肾功能及电解质，按计划返院行下一程诱导化疗。\nH. 办理出院，予以帕洛诺司琼等止吐处理，嘱出院后每周复查血常规及肝肾功能，按计划返院行下一程化疗。\nI. 暂缓出院，予以静脉补液及纠正电解质紊乱治疗，复查生化指标正常后出院，按计划返院行下一程化疗。\nJ. 办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，下一程化疗更改为单药方案以减轻反应。\nK. 办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，按计划返院行靶向治疗联合放疗。\nL. 暂缓出院，予以质子泵抑制剂静脉滴注预防应激性溃疡，观察3天后出院，按计划返院行下一程化疗。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-f5ab8fe6b2ae40df32eed56b","patient_id":"patient-e5fcd31b4b8b85194b146991","turn_id":"turn06","turn_position":5,"turn_type":"toxicity_or_support_decision","gold_letter":"I","gold_action":"行PICC导管常规维护（更换敷料与正压接头），并完善间接鼻咽镜检查准备下一周期治疗。","options":[{"letter":"A","text":"拔除PICC导管改行外周静脉穿刺，并完善间接鼻咽镜检查准备下一周期治疗。","is_gold":false},{"letter":"B","text":"予重组人粒细胞刺激因子皮下注射，并行动静脉置管常规护理准备下一周期治疗。","is_gold":false},{"letter":"C","text":"予静脉补钾、补镁及水化利尿治疗，并行动静脉置管常规护理准备下一周期治疗。","is_gold":false},{"letter":"D","text":"予静脉输注红细胞悬液，并行动静脉置管常规护理准备下一周期治疗。","is_gold":false},{"letter":"E","text":"予静脉滴注广谱抗菌药物，并完善间接鼻咽镜检查准备下一周期治疗。","is_gold":false},{"letter":"F","text":"拔除PICC导管更换为锁骨下静脉置管，并完善间接鼻咽镜检查准备下一周期治疗。","is_gold":false},{"letter":"G","text":"予静脉滴注5-HT3受体拮抗剂，并行动静脉置管常规护理准备下一周期治疗。","is_gold":false},{"letter":"H","text":"予静脉输注肠外营养液，并完善间接鼻咽镜检查准备下一周期治疗。","is_gold":false},{"letter":"I","text":"行PICC导管常规维护（更换敷料与正压接头），并完善间接鼻咽镜检查准备下一周期治疗。","is_gold":true},{"letter":"J","text":"行鼻咽内镜下组织活检，并行动静脉置管常规护理准备下一周期治疗。","is_gold":false},{"letter":"K","text":"予静脉输注人血白蛋白，并行动静脉置管常规护理准备下一周期治疗。","is_gold":false},{"letter":"L","text":"予口服保肝药物，并完善间接鼻咽镜检查准备下一周期治疗。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D34] 检验组合: 阴离子间隙(AG)-静脉血: 10.5；乳酸脱氢酶(LDH)-静脉血: 175.1U/L；肌酐(Crea)-静脉血: 86umol/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；钾离子(K+)-静脉血: 3.9mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.43；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.18；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；甘油三酯(TG)-静脉血: 0.79mmol/L；总蛋白(TP)-静脉血: 76.5g/L；大血小板百分比(P-LCR%)-静脉血: 15.9%；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.537；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；总钙(Ca)-静脉血: 2.39mmol/L；尿酸(UA)-静脉血: 334.3umol/L；钠离子(Na+)-静脉血: 142.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.53g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；单核细胞百分比(Mono%)-静脉血: 0.102；有核红细胞百分比(NRBC%)-静脉血: 0；单核细胞计数(Mono#)-静脉血: 0.510E9/L；碱性磷酸酶(ALP)-静脉血: 63.6U/L；间接胆红素(IBIL)-静脉血: 6.8umolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.028；平均红细胞体积(MCV)-静脉血: 90.7fL；淋巴细胞百分比(Lymph%)-静脉血: 0.325；血液二氧化碳含量ctCO2(B)-静脉血: 29.6mmol/L；血小板分布宽度(PDW)-静脉血: 8.8%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.3；平均血小板体积(MPV)-静脉血: 8.9fL；球蛋白(GLO)-静脉血: 31.5g/L；血红蛋白(Hb)-静脉血: 130g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 29U/L；白蛋白(ALB)-静脉血: 45g/L；总胆汁酸(TBA)-静脉血: 5.6umol/L；总胆固醇(TC)-静脉血: 5.01mmol/L……\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 拔除PICC导管改行外周静脉穿刺，并完善间接鼻咽镜检查准备下一周期治疗。\nB. 予重组人粒细胞刺激因子皮下注射，并行动静脉置管常规护理准备下一周期治疗。\nC. 予静脉补钾、补镁及水化利尿治疗，并行动静脉置管常规护理准备下一周期治疗。\nD. 予静脉输注红细胞悬液，并行动静脉置管常规护理准备下一周期治疗。\nE. 予静脉滴注广谱抗菌药物，并完善间接鼻咽镜检查准备下一周期治疗。\nF. 拔除PICC导管更换为锁骨下静脉置管，并完善间接鼻咽镜检查准备下一周期治疗。\nG. 予静脉滴注5-HT3受体拮抗剂，并行动静脉置管常规护理准备下一周期治疗。\nH. 予静脉输注肠外营养液，并完善间接鼻咽镜检查准备下一周期治疗。\nI. 行PICC导管常规维护（更换敷料与正压接头），并完善间接鼻咽镜检查准备下一周期治疗。\nJ. 行鼻咽内镜下组织活检，并行动静脉置管常规护理准备下一周期治疗。\nK. 予静脉输注人血白蛋白，并行动静脉置管常规护理准备下一周期治疗。\nL. 予口服保肝药物，并完善间接鼻咽镜检查准备下一周期治疗。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D34] 检验组合: 阴离子间隙(AG)-静脉血: 10.5；乳酸脱氢酶(LDH)-静脉血: 175.1U/L；肌酐(Crea)-静脉血: 86umol/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；钾离子(K+)-静脉血: 3.9mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.43；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.18；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；甘油三酯(TG)-静脉血: 0.79mmol/L；总蛋白(TP)-静脉血: 76.5g/L；大血小板百分比(P-LCR%)-静脉血: 15.9%；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.537；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；总钙(Ca)-静脉血: 2.39mmol/L；尿酸(UA)-静脉血: 334.3umol/L；钠离子(Na+)-静脉血: 142.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.53g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；单核细胞百分比(Mono%)-静脉血: 0.102；有核红细胞百分比(NRBC%)-静脉血: 0；单核细胞计数(Mono#)-静脉血: 0.510E9/L；碱性磷酸酶(ALP)-静脉血: 63.6U/L；间接胆红素(IBIL)-静脉血: 6.8umolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.028；平均红细胞体积(MCV)-静脉血: 90.7fL；淋巴细胞百分比(Lymph%)-静脉血: 0.325；血液二氧化碳含量ctCO2(B)-静脉血: 29.6mmol/L；血小板分布宽度(PDW)-静脉血: 8.8%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.3；平均血小板体积(MPV)-静脉血: 8.9fL；球蛋白(GLO)-静脉血: 31.5g/L；血红蛋白(Hb)-静脉血: 130g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 29U/L；白蛋白(ALB)-静脉血: 45g/L；总胆汁酸(TBA)-静脉血: 5.6umol/L；总胆固醇(TC)-静脉血: 5.01mmol/L……\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 拔除PICC导管改行外周静脉穿刺，并完善间接鼻咽镜检查准备下一周期治疗。\nB. 予重组人粒细胞刺激因子皮下注射，并行动静脉置管常规护理准备下一周期治疗。\nC. 予静脉补钾、补镁及水化利尿治疗，并行动静脉置管常规护理准备下一周期治疗。\nD. 予静脉输注红细胞悬液，并行动静脉置管常规护理准备下一周期治疗。\nE. 予静脉滴注广谱抗菌药物，并完善间接鼻咽镜检查准备下一周期治疗。\nF. 拔除PICC导管更换为锁骨下静脉置管，并完善间接鼻咽镜检查准备下一周期治疗。\nG. 予静脉滴注5-HT3受体拮抗剂，并行动静脉置管常规护理准备下一周期治疗。\nH. 予静脉输注肠外营养液，并完善间接鼻咽镜检查准备下一周期治疗。\nI. 行PICC导管常规维护（更换敷料与正压接头），并完善间接鼻咽镜检查准备下一周期治疗。\nJ. 行鼻咽内镜下组织活检，并行动静脉置管常规护理准备下一周期治疗。\nK. 予静脉输注人血白蛋白，并行动静脉置管常规护理准备下一周期治疗。\nL. 予口服保肝药物，并完善间接鼻咽镜检查准备下一周期治疗。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-dd7067359645093ab08b6c16","patient_id":"patient-e5fcd31b4b8b85194b146991","turn_id":"turn07","turn_position":6,"turn_type":"recurrence_or_salvage_decision","gold_letter":"J","gold_action":"出院休养并对症处理化疗副反应，定期复查血常规及肝肾功能，按计划返院行根治性放射治疗。","options":[{"letter":"A","text":"立即启动第三程PF方案诱导化疗，随后再行根治性放射治疗。","is_gold":false},{"letter":"B","text":"更改化疗方案为TP或GP方案继续诱导化疗，随后再行根治性放射治疗。","is_gold":false},{"letter":"C","text":"立即行鼻咽及颈部根治性手术切除，术后辅以根治性放射治疗。","is_gold":false},{"letter":"D","text":"出院休养，待化疗副反应恢复后，行右颈部淋巴结清扫术，再行根治性放疗。","is_gold":false},{"letter":"E","text":"立即予以全量根治性放射治疗，并联合靶向药物如西妥昔单抗。","is_gold":false},{"letter":"F","text":"出院休养，行颈部淋巴结穿刺活检明确病理，再决定后续放疗方案。","is_gold":false},{"letter":"G","text":"立即启动根治性放射治疗，暂缓处理骨髓抑制及胃肠道反应。","is_gold":false},{"letter":"H","text":"出院休养，待化疗副反应恢复后，行姑息性放射治疗联合免疫治疗。","is_gold":false},{"letter":"I","text":"行全身PET-CT重新评估远处转移情况，再决定是否启动根治性放疗。","is_gold":false},{"letter":"J","text":"出院休养并对症处理化疗副反应，定期复查血常规及肝肾功能，按计划返院行根治性放射治疗。","is_gold":true},{"letter":"K","text":"出院休养，定期复查血常规及肝肾功能，待恢复后返院行第三程PF方案诱导化疗。","is_gold":false},{"letter":"L","text":"立即予以同期放化疗，并对右颈淋巴结局部推量加量放疗。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D35] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；比重(SG)-尿液: 1.015；白细胞计数(WBC#)-尿液: 2/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 6.5；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）\n- [全程D36] 检验组合: 浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 7.5；隐血(OB)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；胆红素(BIL)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.022；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）\n- [全程D37] 检验组合: 颜色-尿液: Yellow；葡萄糖(Glu)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.018；隐血(OB)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 3/μL；酸碱度(pH)-尿液: 7；酮体(KET)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D41] 检验组合: 总胆固醇(TC)-静脉血: 4.84mmol/L；红细胞计数(RBC#)-静脉血: 4.2110E12/L；红细胞比容(Hct)-静脉血: 36.6%；血小板分布宽度(PDW)-静脉血: 7.9%；白蛋白(ALB)-静脉血: 42.1g/L；尿素氮(BUN)-静脉血: 4.8mmol/L；总钙(Ca)-静脉血: 2.25mmol/L；乳酸脱氢酶(LDH)-静脉血: 148.6U/L；钾离子(K+)-静脉血: 3.3mmol/L；阴离子间隙(AG)-静脉血: 14.2；血液二氧化碳含量ctCO2(B)-静脉血: 25mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；胱抑素(Cys-C)-静脉血: 0.8mg/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 350g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.4pg；平均红细胞体积(MCV)-静脉血: 86.9fL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；氯离子(Cl-)-静脉血: 97.5mmol/L；葡萄糖(Glu)-静脉血: 5.35mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.89；镁离子(Mg2+)-静脉血: 0.78mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.34mmolL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；中性粒细胞计数(Neut#)-静脉血: 1.710E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.13mmol/L；直接胆红素(DBIL)-静脉血: 2.5umol/L；磷(P)-静脉血: 1.18mmol/L；球蛋白(GLO)-静脉血: 28.13g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.01；白细胞计数(WBC#)-静脉血: 3.0210E9/L；平均血小板体积(MPV)-静脉血: 8.8fL；总胆红素(TBIL)-静脉血: 9.3umol/L；碱性磷酸酶(ALP)-静脉血: 57.9U/L；中性粒细胞百分比(Neut%)-静脉血: 0.55；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；血小板计数(PLT#)-静脉血: 13810E9/L；肌酐(Crea)-静脉血: 90.1umol/L；血红蛋白(Hb)-静……\n- [全程D42] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后复查： 鼻咽腔稍狭窄，鼻咽双侧壁、顶后壁增厚，左侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。右侧咽隐窝变窄。肿物侵犯左侧腭帆张提肌，右侧腭帆提肌结构稍模糊，右侧腭帆张提肌间隙稍模糊。 双侧头长肌、翼内外肌未见明显异常。 双侧翼腭窝、上颌后脂肪间隙、咀嚼肌间隙未见异常。 口咽各壁未见增厚。鼻腔内未见肿物。 蝶骨基底部、左侧翼突基底部及内侧板骨质信号降低，增强扫描可见强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦粘膜稍增厚，双侧乳突未见明显异常。 左侧咽后见几个淋巴结，最大者约8mm×5mm，边界欠清，明显强化。双颈II区见多个淋巴结，最大者约15mm×12mm，边界尚清，较均匀明显强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗后复查，对比某次就诊时间片： 鼻咽部肿物，较前明显缩小。 颅底骨质破坏，较前未见明显变化。 左侧咽后、双颈II区淋巴结，可疑转移，其中右颈IIa区淋巴结较前增大，余较前未见明显变化。 轻度鼻窦炎。\n\n【既往治疗与反应】\n- [全程D35] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者未诉特殊不适，精神睡眠可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。03-22血生化常规未见异常。[姓名已隐去]医生信息已隐藏：患者1程PF方案诱导化疗后，一般情况可，已排除化疗禁忌症，今日水化，明日开始化疗（DDP 130mg d1 ; 5-Fu6.5g civ）。并予对症支持治疗。\n- [全程D36] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉稍恶心呕吐，无头痛、头晕，精神睡眠可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]副医生信息已隐藏：加强对症治疗，患者一般情况可，继续完成化疗，注意休息，加强营养。\n- [全程D37] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉稍恶心，无明显呕吐，无头痛、头晕，精神睡眠可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]副医生信息已隐藏：患者一般情况可继续完成化疗，\n- [全程D41] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者诉恶心呕吐，盗汗，头晕鼻塞，精神睡眠可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。03-29血常规示：WBC3.0*109/L NE1.7*109/L 生化示：血钾 3.3mmol/L[姓名已隐去]医生信息已隐藏：患者第二程诱导化疗，出现I度骨髓抑制，予香伏益血。胃肠道反应相比上次稍重，嘱少食多餐，加强营养。今日化疗结束，嘱明日出院。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即启动第三程PF方案诱导化疗，随后再行根治性放射治疗。\nB. 更改化疗方案为TP或GP方案继续诱导化疗，随后再行根治性放射治疗。\nC. 立即行鼻咽及颈部根治性手术切除，术后辅以根治性放射治疗。\nD. 出院休养，待化疗副反应恢复后，行右颈部淋巴结清扫术，再行根治性放疗。\nE. 立即予以全量根治性放射治疗，并联合靶向药物如西妥昔单抗。\nF. 出院休养，行颈部淋巴结穿刺活检明确病理，再决定后续放疗方案。\nG. 立即启动根治性放射治疗，暂缓处理骨髓抑制及胃肠道反应。\nH. 出院休养，待化疗副反应恢复后，行姑息性放射治疗联合免疫治疗。\nI. 行全身PET-CT重新评估远处转移情况，再决定是否启动根治性放疗。\nJ. 出院休养并对症处理化疗副反应，定期复查血常规及肝肾功能，按计划返院行根治性放射治疗。\nK. 出院休养，定期复查血常规及肝肾功能，待恢复后返院行第三程PF方案诱导化疗。\nL. 立即予以同期放化疗，并对右颈淋巴结局部推量加量放疗。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D35] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；比重(SG)-尿液: 1.015；白细胞计数(WBC#)-尿液: 2/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 6.5；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）\n- [全程D36] 检验组合: 浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 7.5；隐血(OB)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；胆红素(BIL)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.022；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）\n- [全程D37] 检验组合: 颜色-尿液: Yellow；葡萄糖(Glu)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.018；隐血(OB)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 3/μL；酸碱度(pH)-尿液: 7；酮体(KET)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D41] 检验组合: 总胆固醇(TC)-静脉血: 4.84mmol/L；红细胞计数(RBC#)-静脉血: 4.2110E12/L；红细胞比容(Hct)-静脉血: 36.6%；血小板分布宽度(PDW)-静脉血: 7.9%；白蛋白(ALB)-静脉血: 42.1g/L；尿素氮(BUN)-静脉血: 4.8mmol/L；总钙(Ca)-静脉血: 2.25mmol/L；乳酸脱氢酶(LDH)-静脉血: 148.6U/L；钾离子(K+)-静脉血: 3.3mmol/L；阴离子间隙(AG)-静脉血: 14.2；血液二氧化碳含量ctCO2(B)-静脉血: 25mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；胱抑素(Cys-C)-静脉血: 0.8mg/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 350g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.4pg；平均红细胞体积(MCV)-静脉血: 86.9fL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；氯离子(Cl-)-静脉血: 97.5mmol/L；葡萄糖(Glu)-静脉血: 5.35mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.89；镁离子(Mg2+)-静脉血: 0.78mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.34mmolL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；中性粒细胞计数(Neut#)-静脉血: 1.710E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.13mmol/L；直接胆红素(DBIL)-静脉血: 2.5umol/L；磷(P)-静脉血: 1.18mmol/L；球蛋白(GLO)-静脉血: 28.13g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.01；白细胞计数(WBC#)-静脉血: 3.0210E9/L；平均血小板体积(MPV)-静脉血: 8.8fL；总胆红素(TBIL)-静脉血: 9.3umol/L；碱性磷酸酶(ALP)-静脉血: 57.9U/L；中性粒细胞百分比(Neut%)-静脉血: 0.55；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；血小板计数(PLT#)-静脉血: 13810E9/L；肌酐(Crea)-静脉血: 90.1umol/L；血红蛋白(Hb)-静……\n- [全程D42] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后复查： 鼻咽腔稍狭窄，鼻咽双侧壁、顶后壁增厚，左侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。右侧咽隐窝变窄。肿物侵犯左侧腭帆张提肌，右侧腭帆提肌结构稍模糊，右侧腭帆张提肌间隙稍模糊。 双侧头长肌、翼内外肌未见明显异常。 双侧翼腭窝、上颌后脂肪间隙、咀嚼肌间隙未见异常。 口咽各壁未见增厚。鼻腔内未见肿物。 蝶骨基底部、左侧翼突基底部及内侧板骨质信号降低，增强扫描可见强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦粘膜稍增厚，双侧乳突未见明显异常。 左侧咽后见几个淋巴结，最大者约8mm×5mm，边界欠清，明显强化。双颈II区见多个淋巴结，最大者约15mm×12mm，边界尚清，较均匀明显强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗后复查，对比某次就诊时间片： 鼻咽部肿物，较前明显缩小。 颅底骨质破坏，较前未见明显变化。 左侧咽后、双颈II区淋巴结，可疑转移，其中右颈IIa区淋巴结较前增大，余较前未见明显变化。 轻度鼻窦炎。\n\n【既往治疗与反应】\n- [全程D35] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者未诉特殊不适，精神睡眠可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。03-22血生化常规未见异常。[姓名已隐去]医生信息已隐藏：患者1程PF方案诱导化疗后，一般情况可，已排除化疗禁忌症，今日水化，明日开始化疗（DDP 130mg d1 ; 5-Fu6.5g civ）。并予对症支持治疗。\n- [全程D36] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉稍恶心呕吐，无头痛、头晕，精神睡眠可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]副医生信息已隐藏：加强对症治疗，患者一般情况可，继续完成化疗，注意休息，加强营养。\n- [全程D37] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉稍恶心，无明显呕吐，无头痛、头晕，精神睡眠可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]副医生信息已隐藏：患者一般情况可继续完成化疗，\n- [全程D41] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者诉恶心呕吐，盗汗，头晕鼻塞，精神睡眠可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。03-29血常规示：WBC3.0*109/L NE1.7*109/L 生化示：血钾 3.3mmol/L[姓名已隐去]医生信息已隐藏：患者第二程诱导化疗，出现I度骨髓抑制，予香伏益血。胃肠道反应相比上次稍重，嘱少食多餐，加强营养。今日化疗结束，嘱明日出院。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即启动第三程PF方案诱导化疗，随后再行根治性放射治疗。\nB. 更改化疗方案为TP或GP方案继续诱导化疗，随后再行根治性放射治疗。\nC. 立即行鼻咽及颈部根治性手术切除，术后辅以根治性放射治疗。\nD. 出院休养，待化疗副反应恢复后，行右颈部淋巴结清扫术，再行根治性放疗。\nE. 立即予以全量根治性放射治疗，并联合靶向药物如西妥昔单抗。\nF. 出院休养，行颈部淋巴结穿刺活检明确病理，再决定后续放疗方案。\nG. 立即启动根治性放射治疗，暂缓处理骨髓抑制及胃肠道反应。\nH. 出院休养，待化疗副反应恢复后，行姑息性放射治疗联合免疫治疗。\nI. 行全身PET-CT重新评估远处转移情况，再决定是否启动根治性放疗。\nJ. 出院休养并对症处理化疗副反应，定期复查血常规及肝肾功能，按计划返院行根治性放射治疗。\nK. 出院休养，定期复查血常规及肝肾功能，待恢复后返院行第三程PF方案诱导化疗。\nL. 立即予以同期放化疗，并对右颈淋巴结局部推量加量放疗。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-9cd68a6b9c75f1d90e6a9dbe","patient_id":"patient-e5fcd31b4b8b85194b146991","turn_id":"turn08","turn_position":7,"turn_type":"response_assessment_decision","gold_letter":"K","gold_action":"评估为放化疗后临床缓解，按计划结疗出院，嘱鼻腔冲洗、张口及颈部功能锻炼，定期随访复查。","options":[{"letter":"A","text":"评估为原发灶缓解但颈部淋巴结残留，行双侧颈部淋巴结清扫术，术后定期随访复查。","is_gold":false},{"letter":"B","text":"评估为颅底骨质破坏未缓解，局部追加立体定向放射治疗推量，并定期随访复查。","is_gold":false},{"letter":"C","text":"评估为放化疗后部分缓解，继续原方案辅助化疗2个周期以巩固疗效。","is_gold":false},{"letter":"D","text":"评估为放化疗后临床缓解，按计划结疗出院，序贯PD-1抑制剂维持治疗1年。","is_gold":false},{"letter":"E","text":"评估为原发灶残留，行鼻咽内镜下挽救性切除术，术后配合张口及颈部功能锻炼。","is_gold":false},{"letter":"F","text":"评估为放化疗后临床缓解，按计划结疗出院，3个月后行PET-CT评估，期间无需特殊干预。","is_gold":false},{"letter":"G","text":"评估为放化疗后病情稳定，更改化疗方案为吉西他滨联合顺铂进行二线化疗。","is_gold":false},{"letter":"H","text":"评估为放化疗后临床缓解，按计划结疗出院，预防性给予全脑放射治疗。","is_gold":false},{"letter":"I","text":"评估为颈部淋巴结残留，局部追加电子线放射治疗推量，并加强营养支持。","is_gold":false},{"letter":"J","text":"评估为放化疗后临床缓解，按计划结疗出院，序贯口服卡培他滨节拍维持治疗1年。","is_gold":false},{"letter":"K","text":"评估为放化疗后临床缓解，按计划结疗出院，嘱鼻腔冲洗、张口及颈部功能锻炼，定期随访复查。","is_gold":true},{"letter":"L","text":"评估为颅底病灶残留，转诊行质子重离子放射治疗以提高局部控制率。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D76] 检验组合: 钠离子(Na+)-静脉血: 138.3mmol/L；球蛋白(GLO)-静脉血: 27.6g/L；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 14.1U/L；碱性磷酸酶(ALP)-静脉血: 64.9U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 26.4U/L；平均血小板体积(MPV)-静脉血: 9fL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；红细胞比容(Hct)-静脉血: 29.5%；白蛋白(ALB)-静脉血: 44.6g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.62；α-L-岩藻糖苷酶(AFU)-静脉血: 24U/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；尿酸(UA)-静脉血: 284.2umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 8.7U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.73mmol/L；平均红细胞体积(MCV)-静脉血: 87.5fL；血小板比容-静脉血: 14%；单核细胞百分比(Mono%)-静脉血: 0.136；间接胆红素(IBIL)-静脉血: 7.16umolL；血液二氧化碳含量ctCO2(B)-静脉血: 23.6mmol/L；尿素氮(BUN)-静脉血: 5.4mmol/L；乳酸脱氢酶(LDH)-静脉血: 140.2U/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 104g/L；直接胆红素(DBIL)-静脉血: 3.72umol/L；载脂蛋白B(apoB)-静脉血: 0.86g/L；钾离子(K+)-静脉血: 4.1mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.129；中性粒细胞百分比(Neut%)-静脉血: 0.713；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.2；平均红细胞血红蛋白浓度(MCHC)-静脉血: 353g/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L；红细胞计数(RBC#)-静脉血: 3.3710E12/L；C-反应蛋白(CRP)-静脉……\n- [全程D83] 检验组合: 碱性磷酸酶(ALP)-静脉血: 52.7U/L；血红蛋白(Hb)-静脉血: 96g/L；总胆汁酸(TBA)-静脉血: 2.4umol/L；磷(P)-静脉血: 1.26mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.41mmol/L；尿酸(UA)-静脉血: 329.6umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.76；血小板比容-静脉血: 11%；淋巴细胞计数(Lymph#)-静脉血: 0.410E9/L；红细胞计数(RBC#)-静脉血: 3.0610E12/L；间接胆红素(IBIL)-静脉血: 6.3umolL；血液二氧化碳含量ctCO2(B)-静脉血: 24.5mmol/L；钾离子(K+)-静脉血: 3.83mmol/L；葡萄糖(Glu)-静脉血: 4.88mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 356g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.56；氯离子(Cl-)-静脉血: 102.9mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总胆固醇(TC)-静脉血: 3.96mmol/L；平均红细胞体积(MCV)-静脉血: 88.2fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.9；中性粒细胞计数(Neut#)-静脉血: 1.310E9/L；阴离子间隙(AG)-静脉血: 12.6；尿素氮(BUN)-静脉血: 5.9mmol/L；肌酐(Crea)-静脉血: 89.8umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 20.3U/L；球蛋白(GLO)-静脉血: 25.51g/L；镁离子(Mg2+)-静脉血: 0.77mmol/L；乳酸脱氢酶(LDH)-静脉血: 128.5U/L；C-反应蛋白(CRP)-静脉血: 0.49mg/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.4pg；总蛋白(TP)-静脉血: 65.31g/L；红细胞比容(Hct)-静脉血: 27%；单核细胞计数(Mono#)-静脉血: 0.310E9/L；血小板分布宽度(PDW)-静脉血: 8.1%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.009；单核细胞百分比(Mono%)-静脉血: 0.156；嗜碱性粒细胞计数(Baso#)-静脉血:……\n- [全程D90] 检验组合: 尿素氮(BUN)-静脉血: 5.1mmol/L；总胆汁酸(TBA)-静脉血: 3.6umol/L；总钙(Ca)-静脉血: 2.27mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 21.5U/L；总胆红素(TBIL)-静脉血: 11.71umol/L；载脂蛋白AI(apoAI)-静脉血: 1.59g/L；载脂蛋白B(apoB)-静脉血: 0.85g/L；氯离子(Cl-)-静脉血: 99.7mmol/L；白蛋白(ALB)-静脉血: 46.3g/L；有核红细胞百分比(NRBC%)-静脉血: 0；血小板计数(PLT#)-静脉血: 14210E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；血小板比容-静脉血: 13%；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.58；嗜酸性粒细胞计数(Eos#)-静脉血: 0.410E9/L；血小板分布宽度(PDW)-静脉血: 9%；磷(P)-静脉血: 1.33mmol/L；尿酸(UA)-静脉血: 467.8umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.78；甘油三酯(TG)-静脉血: 0.58mmol/L；C-反应蛋白(CRP)-静脉血: 0.4mg/L；平均红细胞体积(MCV)-静脉血: 91.4fL；α-L-岩藻糖苷酶(AFU)-静脉血: 22.5U/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1；中性粒细胞计数(Neut#)-静脉血: 2.210E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 346g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；白细胞计数(WBC#)-静脉血: 3.4910E9/L；钾离子(K+)-静脉血: 3.89mmol/L；血红蛋白(Hb)-静脉血: 118g/L；平均血小板体积(MPV)-静脉血: 9fL；中性粒细胞百分比(Neut%)-静脉血: 0.636；红细胞计数(RBC#)-静脉血: 3.7310E12/L；肌酐(Crea)-静脉血: 91.5umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.132；总胆固醇(TC)-静脉血: 4.55mmol/L；阴离子间隙(AG)-静脉血: 14.7……\n- [全程D91] 检验组合: 比重(SG)-尿液: 1.011；酮体(KET)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5；隐血(OB)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；总蛋白(TP)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；白细胞计数(WBC#)-尿液: 3/μL\n- [全程D92] 检验组合: 亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；隐血(OB)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 2/μL；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；比重(SG)-尿液: 1.018；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）\n- [全程D94] 检验组合: 亚硝酸盐(NIT)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 11/μL；颜色-尿液: Yellow；白细胞计数(WBC#)-尿液: 5/μL；酮体(KET)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 28/μL；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.014；酸碱度(pH)-尿液: 6\n- [全程D97] 检验组合: 低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.8mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；平均红细胞体积(MCV)-静脉血: 86.8fL；载脂蛋白AI(apoAI)-静脉血: 1.3g/L；甘油三酯(TG)-静脉血: 0.75mmol/L；钠离子(Na+)-静脉血: 139mmol/L；总钙(Ca)-静脉血: 2.24mmol/L；氯离子(Cl-)-静脉血: 98.2mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 13.3U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.65；α-L-岩藻糖苷酶(AFU)-静脉血: 24.8U/L；碱性磷酸酶(ALP)-静脉血: 57U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 21.5U/L；血小板比容-静脉血: 12%；直接胆红素(DBIL)-静脉血: 4.61umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.642；白细胞计数(WBC#)-静脉血: 2.0410E9/L；大血小板百分比(P-LCR%)-静脉血: 11.5%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.127；血液二氧化碳含量ctCO2(B)-静脉血: 27.4mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 357g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.5；总蛋白(TP)-静脉血: 67.8g/L；血红蛋白(Hb)-静脉血: 96g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.310E9/L；尿酸(UA)-静脉血: 356.9umol/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；血小板计数(PLT#)-静脉血: 14210E9/L；钾离子(K+)-静脉血: 3.77mmol/L；载脂蛋白B(apoB)-静脉血: 0.86g/L；单核细胞百分比(Mono%)-静脉血: 0.083；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.37；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.02；胱抑素(Cys-C)-静脉血: 0.71mg/L；白蛋白(ALB)-静脉血: 42.2g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞计数(Neut#)-静脉血: 1.310E9/L……\n- [全程D98] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗放疗后复查： 鼻咽腔无狭窄，鼻咽壁无增厚，粘膜规整无增厚，双侧咽隐窝、咽旁脂肪间隙未见异常。双侧腭帆张、提肌、双侧头长肌、翼内外肌未见明显异常。 双侧翼腭窝、上颌后脂肪间隙、咀嚼肌间隙未见异常。 口咽各壁未见增厚。鼻腔内未见肿物。 蝶骨基底部左份、左侧翼突基底部及内侧骨质信号降低，增强扫描可见强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦粘膜稍增厚，骨壁完整。左乳头见少许渗出影。 双侧咽后未见肿大淋巴结。双颈II区见多个淋巴结，最大者约8mm×5mm，边界尚清，较均匀明显强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗放疗后复查，对比某次就诊时间片： 鼻咽未见明显病灶。 颅底骨质破坏，较前未见明显变化。 左侧咽后淋巴结消失，双颈II区淋巴结缩小。 鼻窦炎，左乳突炎。\n- [全程D98] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称。双肺纹理清晰；双肺野未见明显实质性病变；双侧肺门无增大。纵隔未见增宽。心影大小、形态正常。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n\n【既往治疗与反应】\n- [全程D77] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 今行放疗第15次，患者口干咽痛，稍恶心、呕吐，食纳、睡眠欠佳。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。某次就诊时间日查血常规、肝肾功能电解质无明显异常。[姓名已隐去]副医生信息已隐藏：予口腔粘膜保护等对症治疗，加强营养支持治疗，继续完成放疗。\n- [全程D82] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今行放疗第18次，患者口干咽痛，稍恶心、呕吐，食纳、睡眠欠佳。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物，较前缩小；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]医生信息已隐藏：予口腔粘膜保护等对症治疗，加强营养支持治疗，明日复查血常规、肝肾功能，继续完成放疗。\n- [全程D91] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今行放疗第25次，患者口干咽痛，稍恶心、呕吐，食纳、睡眠欠佳。查体：张口门齿距4.5cm；鼻咽肿物不明显；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。昨日查血常规、肝肾功能未见明显异常。[姓名已隐去]医生信息已隐藏：予口腔粘膜保护等对症治疗，加强营养支持治疗，明日予同期DDP化疗，密切观察放化疗反应，继续完成放疗。\n- [全程D96] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 今行放疗第28次，患者口干咽痛，稍恶心、呕吐，食纳、睡眠欠佳。查体：张口门齿距4.5cm；鼻咽肿物不明显；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]医生信息已隐藏：予口腔粘膜保护等对症治疗，加强营养支持治疗，明日复查血常规、肝肾功能，继续完成放疗。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估为原发灶缓解但颈部淋巴结残留，行双侧颈部淋巴结清扫术，术后定期随访复查。\nB. 评估为颅底骨质破坏未缓解，局部追加立体定向放射治疗推量，并定期随访复查。\nC. 评估为放化疗后部分缓解，继续原方案辅助化疗2个周期以巩固疗效。\nD. 评估为放化疗后临床缓解，按计划结疗出院，序贯PD-1抑制剂维持治疗1年。\nE. 评估为原发灶残留，行鼻咽内镜下挽救性切除术，术后配合张口及颈部功能锻炼。\nF. 评估为放化疗后临床缓解，按计划结疗出院，3个月后行PET-CT评估，期间无需特殊干预。\nG. 评估为放化疗后病情稳定，更改化疗方案为吉西他滨联合顺铂进行二线化疗。\nH. 评估为放化疗后临床缓解，按计划结疗出院，预防性给予全脑放射治疗。\nI. 评估为颈部淋巴结残留，局部追加电子线放射治疗推量，并加强营养支持。\nJ. 评估为放化疗后临床缓解，按计划结疗出院，序贯口服卡培他滨节拍维持治疗1年。\nK. 评估为放化疗后临床缓解，按计划结疗出院，嘱鼻腔冲洗、张口及颈部功能锻炼，定期随访复查。\nL. 评估为颅底病灶残留，转诊行质子重离子放射治疗以提高局部控制率。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D76] 检验组合: 钠离子(Na+)-静脉血: 138.3mmol/L；球蛋白(GLO)-静脉血: 27.6g/L；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 14.1U/L；碱性磷酸酶(ALP)-静脉血: 64.9U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 26.4U/L；平均血小板体积(MPV)-静脉血: 9fL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；红细胞比容(Hct)-静脉血: 29.5%；白蛋白(ALB)-静脉血: 44.6g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.62；α-L-岩藻糖苷酶(AFU)-静脉血: 24U/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；尿酸(UA)-静脉血: 284.2umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 8.7U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.73mmol/L；平均红细胞体积(MCV)-静脉血: 87.5fL；血小板比容-静脉血: 14%；单核细胞百分比(Mono%)-静脉血: 0.136；间接胆红素(IBIL)-静脉血: 7.16umolL；血液二氧化碳含量ctCO2(B)-静脉血: 23.6mmol/L；尿素氮(BUN)-静脉血: 5.4mmol/L；乳酸脱氢酶(LDH)-静脉血: 140.2U/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 104g/L；直接胆红素(DBIL)-静脉血: 3.72umol/L；载脂蛋白B(apoB)-静脉血: 0.86g/L；钾离子(K+)-静脉血: 4.1mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.129；中性粒细胞百分比(Neut%)-静脉血: 0.713；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.2；平均红细胞血红蛋白浓度(MCHC)-静脉血: 353g/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L；红细胞计数(RBC#)-静脉血: 3.3710E12/L；C-反应蛋白(CRP)-静脉……\n- [全程D83] 检验组合: 碱性磷酸酶(ALP)-静脉血: 52.7U/L；血红蛋白(Hb)-静脉血: 96g/L；总胆汁酸(TBA)-静脉血: 2.4umol/L；磷(P)-静脉血: 1.26mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.41mmol/L；尿酸(UA)-静脉血: 329.6umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.76；血小板比容-静脉血: 11%；淋巴细胞计数(Lymph#)-静脉血: 0.410E9/L；红细胞计数(RBC#)-静脉血: 3.0610E12/L；间接胆红素(IBIL)-静脉血: 6.3umolL；血液二氧化碳含量ctCO2(B)-静脉血: 24.5mmol/L；钾离子(K+)-静脉血: 3.83mmol/L；葡萄糖(Glu)-静脉血: 4.88mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 356g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.56；氯离子(Cl-)-静脉血: 102.9mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总胆固醇(TC)-静脉血: 3.96mmol/L；平均红细胞体积(MCV)-静脉血: 88.2fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.9；中性粒细胞计数(Neut#)-静脉血: 1.310E9/L；阴离子间隙(AG)-静脉血: 12.6；尿素氮(BUN)-静脉血: 5.9mmol/L；肌酐(Crea)-静脉血: 89.8umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 20.3U/L；球蛋白(GLO)-静脉血: 25.51g/L；镁离子(Mg2+)-静脉血: 0.77mmol/L；乳酸脱氢酶(LDH)-静脉血: 128.5U/L；C-反应蛋白(CRP)-静脉血: 0.49mg/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.4pg；总蛋白(TP)-静脉血: 65.31g/L；红细胞比容(Hct)-静脉血: 27%；单核细胞计数(Mono#)-静脉血: 0.310E9/L；血小板分布宽度(PDW)-静脉血: 8.1%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.009；单核细胞百分比(Mono%)-静脉血: 0.156；嗜碱性粒细胞计数(Baso#)-静脉血:……\n- [全程D90] 检验组合: 尿素氮(BUN)-静脉血: 5.1mmol/L；总胆汁酸(TBA)-静脉血: 3.6umol/L；总钙(Ca)-静脉血: 2.27mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 21.5U/L；总胆红素(TBIL)-静脉血: 11.71umol/L；载脂蛋白AI(apoAI)-静脉血: 1.59g/L；载脂蛋白B(apoB)-静脉血: 0.85g/L；氯离子(Cl-)-静脉血: 99.7mmol/L；白蛋白(ALB)-静脉血: 46.3g/L；有核红细胞百分比(NRBC%)-静脉血: 0；血小板计数(PLT#)-静脉血: 14210E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；血小板比容-静脉血: 13%；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.58；嗜酸性粒细胞计数(Eos#)-静脉血: 0.410E9/L；血小板分布宽度(PDW)-静脉血: 9%；磷(P)-静脉血: 1.33mmol/L；尿酸(UA)-静脉血: 467.8umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.78；甘油三酯(TG)-静脉血: 0.58mmol/L；C-反应蛋白(CRP)-静脉血: 0.4mg/L；平均红细胞体积(MCV)-静脉血: 91.4fL；α-L-岩藻糖苷酶(AFU)-静脉血: 22.5U/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1；中性粒细胞计数(Neut#)-静脉血: 2.210E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 346g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；白细胞计数(WBC#)-静脉血: 3.4910E9/L；钾离子(K+)-静脉血: 3.89mmol/L；血红蛋白(Hb)-静脉血: 118g/L；平均血小板体积(MPV)-静脉血: 9fL；中性粒细胞百分比(Neut%)-静脉血: 0.636；红细胞计数(RBC#)-静脉血: 3.7310E12/L；肌酐(Crea)-静脉血: 91.5umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.132；总胆固醇(TC)-静脉血: 4.55mmol/L；阴离子间隙(AG)-静脉血: 14.7……\n- [全程D91] 检验组合: 比重(SG)-尿液: 1.011；酮体(KET)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5；隐血(OB)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；总蛋白(TP)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；白细胞计数(WBC#)-尿液: 3/μL\n- [全程D92] 检验组合: 亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；隐血(OB)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 2/μL；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；比重(SG)-尿液: 1.018；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）\n- [全程D94] 检验组合: 亚硝酸盐(NIT)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 11/μL；颜色-尿液: Yellow；白细胞计数(WBC#)-尿液: 5/μL；酮体(KET)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 28/μL；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.014；酸碱度(pH)-尿液: 6\n- [全程D97] 检验组合: 低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.8mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；平均红细胞体积(MCV)-静脉血: 86.8fL；载脂蛋白AI(apoAI)-静脉血: 1.3g/L；甘油三酯(TG)-静脉血: 0.75mmol/L；钠离子(Na+)-静脉血: 139mmol/L；总钙(Ca)-静脉血: 2.24mmol/L；氯离子(Cl-)-静脉血: 98.2mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 13.3U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.65；α-L-岩藻糖苷酶(AFU)-静脉血: 24.8U/L；碱性磷酸酶(ALP)-静脉血: 57U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 21.5U/L；血小板比容-静脉血: 12%；直接胆红素(DBIL)-静脉血: 4.61umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.642；白细胞计数(WBC#)-静脉血: 2.0410E9/L；大血小板百分比(P-LCR%)-静脉血: 11.5%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.127；血液二氧化碳含量ctCO2(B)-静脉血: 27.4mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 357g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.5；总蛋白(TP)-静脉血: 67.8g/L；血红蛋白(Hb)-静脉血: 96g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.310E9/L；尿酸(UA)-静脉血: 356.9umol/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；血小板计数(PLT#)-静脉血: 14210E9/L；钾离子(K+)-静脉血: 3.77mmol/L；载脂蛋白B(apoB)-静脉血: 0.86g/L；单核细胞百分比(Mono%)-静脉血: 0.083；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.37；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.02；胱抑素(Cys-C)-静脉血: 0.71mg/L；白蛋白(ALB)-静脉血: 42.2g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞计数(Neut#)-静脉血: 1.310E9/L……\n- [全程D98] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗放疗后复查： 鼻咽腔无狭窄，鼻咽壁无增厚，粘膜规整无增厚，双侧咽隐窝、咽旁脂肪间隙未见异常。双侧腭帆张、提肌、双侧头长肌、翼内外肌未见明显异常。 双侧翼腭窝、上颌后脂肪间隙、咀嚼肌间隙未见异常。 口咽各壁未见增厚。鼻腔内未见肿物。 蝶骨基底部左份、左侧翼突基底部及内侧骨质信号降低，增强扫描可见强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦粘膜稍增厚，骨壁完整。左乳头见少许渗出影。 双侧咽后未见肿大淋巴结。双颈II区见多个淋巴结，最大者约8mm×5mm，边界尚清，较均匀明显强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗放疗后复查，对比某次就诊时间片： 鼻咽未见明显病灶。 颅底骨质破坏，较前未见明显变化。 左侧咽后淋巴结消失，双颈II区淋巴结缩小。 鼻窦炎，左乳突炎。\n- [全程D98] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称。双肺纹理清晰；双肺野未见明显实质性病变；双侧肺门无增大。纵隔未见增宽。心影大小、形态正常。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n\n【既往治疗与反应】\n- [全程D77] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 今行放疗第15次，患者口干咽痛，稍恶心、呕吐，食纳、睡眠欠佳。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。某次就诊时间日查血常规、肝肾功能电解质无明显异常。[姓名已隐去]副医生信息已隐藏：予口腔粘膜保护等对症治疗，加强营养支持治疗，继续完成放疗。\n- [全程D82] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今行放疗第18次，患者口干咽痛，稍恶心、呕吐，食纳、睡眠欠佳。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物，较前缩小；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]医生信息已隐藏：予口腔粘膜保护等对症治疗，加强营养支持治疗，明日复查血常规、肝肾功能，继续完成放疗。\n- [全程D91] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今行放疗第25次，患者口干咽痛，稍恶心、呕吐，食纳、睡眠欠佳。查体：张口门齿距4.5cm；鼻咽肿物不明显；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。昨日查血常规、肝肾功能未见明显异常。[姓名已隐去]医生信息已隐藏：予口腔粘膜保护等对症治疗，加强营养支持治疗，明日予同期DDP化疗，密切观察放化疗反应，继续完成放疗。\n- [全程D96] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 今行放疗第28次，患者口干咽痛，稍恶心、呕吐，食纳、睡眠欠佳。查体：张口门齿距4.5cm；鼻咽肿物不明显；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]医生信息已隐藏：予口腔粘膜保护等对症治疗，加强营养支持治疗，明日复查血常规、肝肾功能，继续完成放疗。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估为原发灶缓解但颈部淋巴结残留，行双侧颈部淋巴结清扫术，术后定期随访复查。\nB. 评估为颅底骨质破坏未缓解，局部追加立体定向放射治疗推量，并定期随访复查。\nC. 评估为放化疗后部分缓解，继续原方案辅助化疗2个周期以巩固疗效。\nD. 评估为放化疗后临床缓解，按计划结疗出院，序贯PD-1抑制剂维持治疗1年。\nE. 评估为原发灶残留，行鼻咽内镜下挽救性切除术，术后配合张口及颈部功能锻炼。\nF. 评估为放化疗后临床缓解，按计划结疗出院，3个月后行PET-CT评估，期间无需特殊干预。\nG. 评估为放化疗后病情稳定，更改化疗方案为吉西他滨联合顺铂进行二线化疗。\nH. 评估为放化疗后临床缓解，按计划结疗出院，预防性给予全脑放射治疗。\nI. 评估为颈部淋巴结残留，局部追加电子线放射治疗推量，并加强营养支持。\nJ. 评估为放化疗后临床缓解，按计划结疗出院，序贯口服卡培他滨节拍维持治疗1年。\nK. 评估为放化疗后临床缓解，按计划结疗出院，嘱鼻腔冲洗、张口及颈部功能锻炼，定期随访复查。\nL. 评估为颅底病灶残留，转诊行质子重离子放射治疗以提高局部控制率。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-deb84ffb5f7c209f58040b0d","patient_id":"patient-d6812a1c46ed21fda9ebb9f8","turn_id":"turn01","turn_position":1,"turn_type":"initial_workup_choice","gold_letter":"D","gold_action":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部X线，腹部彩超及心电图","options":[{"letter":"A","text":"鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸部X线，腹部彩超","is_gold":false},{"letter":"B","text":"鼻咽及颈部MRI平扫+增强，全身PET-CT检查，暂缓鼻咽活检","is_gold":false},{"letter":"C","text":"鼻咽镜检查及活检，仅行鼻咽MRI平扫+增强，胸部CT，腹部彩超","is_gold":false},{"letter":"D","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部X线，腹部彩超及心电图","is_gold":true},{"letter":"E","text":"鼻咽镜检查及活检，全身PET-CT检查，头颅MRI平扫+增强","is_gold":false},{"letter":"F","text":"鼻咽及颈部根治性放疗，同步行胸部及腹部影像学检查","is_gold":false},{"letter":"G","text":"鼻咽肿物切除活检，鼻咽及颈部MRI平扫+增强，胸部X线，腹部彩超","is_gold":false},{"letter":"H","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，暂不进行胸腹部影像学检查","is_gold":false},{"letter":"I","text":"鼻咽镜检查及活检，鼻咽CT平扫+增强，颈部超声，胸部X线，腹部彩超","is_gold":false},{"letter":"J","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身骨扫描，头颅CT","is_gold":false},{"letter":"K","text":"鼻咽脱落细胞学检查，鼻咽及颈部MRI平扫+增强，胸部CT，腹部彩超","is_gold":false},{"letter":"L","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，预防性颈部淋巴结清扫术","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 右侧耳鸣、鼻塞3月余，加重1周。；现病史: 缘于某次就诊时间11月下旬患者无意中出现右侧耳鸣、鼻塞，伴有右耳听力下降、头痛症状，无鼻出血，无面麻，无视物模糊、复视，无呛咳等症状；未予重视，逐渐加重，于某次就诊时间在[机构已隐去]就诊；建议患者住院治疗，患者及家属不同意。近1周来，耳鸣、鼻塞及头痛症状加重，今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,听力下降,右耳鸣,头痛；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：75次/分，R：20次/分，BP：110/65mmHg,Ht：150cm，Wt：41kg，BSA：1.316m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶壁、顶后壁、右侧壁明显增厚，左侧壁稍增厚，并见结节状肿物突出；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸部X线，腹部彩超\nB. 鼻咽及颈部MRI平扫+增强，全身PET-CT检查，暂缓鼻咽活检\nC. 鼻咽镜检查及活检，仅行鼻咽MRI平扫+增强，胸部CT，腹部彩超\nD. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部X线，腹部彩超及心电图\nE. 鼻咽镜检查及活检，全身PET-CT检查，头颅MRI平扫+增强\nF. 鼻咽及颈部根治性放疗，同步行胸部及腹部影像学检查\nG. 鼻咽肿物切除活检，鼻咽及颈部MRI平扫+增强，胸部X线，腹部彩超\nH. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，暂不进行胸腹部影像学检查\nI. 鼻咽镜检查及活检，鼻咽CT平扫+增强，颈部超声，胸部X线，腹部彩超\nJ. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身骨扫描，头颅CT\nK. 鼻咽脱落细胞学检查，鼻咽及颈部MRI平扫+增强，胸部CT，腹部彩超\nL. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，预防性颈部淋巴结清扫术\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 右侧耳鸣、鼻塞3月余，加重1周。；现病史: 缘于某次就诊时间11月下旬患者无意中出现右侧耳鸣、鼻塞，伴有右耳听力下降、头痛症状，无鼻出血，无面麻，无视物模糊、复视，无呛咳等症状；未予重视，逐渐加重，于某次就诊时间在[机构已隐去]就诊；建议患者住院治疗，患者及家属不同意。近1周来，耳鸣、鼻塞及头痛症状加重，今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,听力下降,右耳鸣,头痛；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：75次/分，R：20次/分，BP：110/65mmHg,Ht：150cm，Wt：41kg，BSA：1.316m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶壁、顶后壁、右侧壁明显增厚，左侧壁稍增厚，并见结节状肿物突出；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸部X线，腹部彩超\nB. 鼻咽及颈部MRI平扫+增强，全身PET-CT检查，暂缓鼻咽活检\nC. 鼻咽镜检查及活检，仅行鼻咽MRI平扫+增强，胸部CT，腹部彩超\nD. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部X线，腹部彩超及心电图\nE. 鼻咽镜检查及活检，全身PET-CT检查，头颅MRI平扫+增强\nF. 鼻咽及颈部根治性放疗，同步行胸部及腹部影像学检查\nG. 鼻咽肿物切除活检，鼻咽及颈部MRI平扫+增强，胸部X线，腹部彩超\nH. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，暂不进行胸腹部影像学检查\nI. 鼻咽镜检查及活检，鼻咽CT平扫+增强，颈部超声，胸部X线，腹部彩超\nJ. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身骨扫描，头颅CT\nK. 鼻咽脱落细胞学检查，鼻咽及颈部MRI平扫+增强，胸部CT，腹部彩超\nL. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，预防性颈部淋巴结清扫术\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-76e183c8ae4202bcecbc9d87","patient_id":"patient-d6812a1c46ed21fda9ebb9f8","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"E","gold_action":"行鼻咽肿物活检明确病理诊断，并安排甲状腺超声检查。","options":[{"letter":"A","text":"行鼻咽肿物活检明确病理诊断，并安排全身PET-CT检查","is_gold":false},{"letter":"B","text":"行鼻咽肿物活检明确病理诊断，并安排全身骨扫描检查","is_gold":false},{"letter":"C","text":"行颈部淋巴结细针穿刺活检明确病理诊断，并安排甲状腺超声检查","is_gold":false},{"letter":"D","text":"行鼻咽肿物活检明确病理诊断，并直接安排甲状腺结节细针穿刺活检","is_gold":false},{"letter":"E","text":"行鼻咽肿物活检明确病理诊断，并安排甲状腺超声检查","is_gold":true},{"letter":"F","text":"行鼻咽肿物活检明确病理诊断，并安排胸部增强CT检查","is_gold":false},{"letter":"G","text":"行鼻咽肿物活检明确病理诊断，并安排头颅增强MRI检查","is_gold":false},{"letter":"H","text":"行鼻咽肿物活检明确病理诊断，并安排甲状腺功能生化检查","is_gold":false},{"letter":"I","text":"行鼻咽肿物活检明确病理诊断，并安排颈部超声检查","is_gold":false},{"letter":"J","text":"行鼻咽肿物活检明确病理诊断，并安排肝脏增强MRI检查","is_gold":false},{"letter":"K","text":"行鼻咽肿物活检明确病理诊断，并安排甲状腺核素扫描检查","is_gold":false},{"letter":"L","text":"暂缓活检操作，先行诊断性抗炎治疗两周后复查鼻咽部MRI","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见: 轻度ST段下移；检查结论: 窦性心律 轻度ST段下移\n- [全程D1] 检验组合: 淋巴细胞百分比(Lymph%)-静脉血: 0.35；平均红细胞血红蛋白含量(MCH)-静脉血: 28.7pg；总钙(Ca)-静脉血: 2.32mmol/L；凝血酶时间(TT)-静脉血: 19.8sec.；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阳性(+)（参考: 阴性）；总胆汁酸(TBA)-静脉血: 4.1umol/L；钾离子(K+)-静脉血: 3.82mmol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；红细胞计数(RBC#)-静脉血: 5.0210E12/L；钠离子(Na+)-静脉血: 142.9mmol/L；尿素氮(BUN)-静脉血: 4.2mmol/L；葡萄糖(Glu)-静脉血: 5.36mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.66mmolL；球蛋白(GLO)-静脉血: 25.7g/L；尿酸(UA)-静脉血: 214.3umol/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；ABO血型-静脉血: O；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.98mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.76；中性粒细胞百分比(Neut%)-静脉血: 0.579；阴离子间隙(AG)-静脉血: 11.5；γ-谷氨酰基转移酶(GGT)-静脉血: 12.3U/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 23.4U/L；载脂蛋白B(apoB)-静脉血: 0.98g/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 6.4umolL；中性粒细胞计数(Neut#)-静脉血: 3.710E9/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；载脂蛋白AI(apoAI)-静脉血: 1.79g/L；肌酐(Crea)-静脉血: 50.2umol/L；总蛋白(TP)-静脉血: 70.9g/L；总胆固醇(TC)-静脉血: 5.02mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)……\n- [全程D2] 超声；双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声欠均匀，肝内可见多个无回声灶，较大者约43×29mm，椭圆形，边界清，内透声好，部分可见高回声分隔，后方回声增强。血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：上述病灶内未见明确血流信号。肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声欠均匀，右肾多个无回声灶，较大者约15×13mm，类圆形，边界清，内透声好，后方回声增强。左肾未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确肿物回声。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。；检查结论: 肝多发囊肿。 右肾多发囊肿。 胆囊、脾脏、胰腺、左肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D2] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对侧，双肺野纹理稍增多、增粗，未见明显实质性病变。双侧肺门不大，纵隔不宽，心影形态、大小、位置未见异常。双膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明确病变。\n- [全程D7] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、右侧壁明显增厚，左侧壁稍增厚，并见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号增强扫描明显强化，肿物占据右侧咽隐窝。双侧鼻腔及口咽各壁未见异常。 右侧腭帆张提肌、右侧头长肌及右侧翼内肌受侵，病变包绕右侧颈内动静脉。 右侧腭帆提肌、腭帆张肌、双侧头长肌受侵；左侧腭帆提肌、腭帆张肌未见受侵征象。 双侧翼腭窝、颞下窝未见异常；口咽侧壁未见受累增厚。 蝶骨基底部右份及右侧翼突基底部内侧、右侧翼突内板骨质信号减低，增强扫描不均匀强化。余颅底骨质未见明确异常。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、右侧乳突粘膜增厚，双侧上颌窦、蝶窦、左侧乳突充气良好，骨壁完整；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 右侧咽后见多个肿大淋巴结，最大者短径13mm，增强后明显强化，融合。左侧咽后及双颈II区见多发小淋巴结，最大者短径约7mm，未见坏死及包膜外侵。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺左叶见一结节，大小约11mm×11mm，边界尚清， T1WI及T2WI均呈混杂高信号，增强扫描部分区域强化较明显。甲状腺右叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。；检查结论: 鼻咽病变侵犯右侧咽旁间隙、椎前间隙右份及右侧翼内肌，考虑鼻咽癌可能性大。 蝶骨基底部右份、右侧翼突基底部内侧及右侧翼突内板骨质信号异常，考虑肿瘤浸润可能性大。 右侧咽后肿大淋巴结，考虑转移瘤。 左侧咽后及双颈II区小淋巴结，未排除转移可能。 鼻窦炎；右侧乳突炎。 甲状腺左叶结节灶，建议超声检查。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行鼻咽肿物活检明确病理诊断，并安排全身PET-CT检查\nB. 行鼻咽肿物活检明确病理诊断，并安排全身骨扫描检查\nC. 行颈部淋巴结细针穿刺活检明确病理诊断，并安排甲状腺超声检查\nD. 行鼻咽肿物活检明确病理诊断，并直接安排甲状腺结节细针穿刺活检\nE. 行鼻咽肿物活检明确病理诊断，并安排甲状腺超声检查\nF. 行鼻咽肿物活检明确病理诊断，并安排胸部增强CT检查\nG. 行鼻咽肿物活检明确病理诊断，并安排头颅增强MRI检查\nH. 行鼻咽肿物活检明确病理诊断，并安排甲状腺功能生化检查\nI. 行鼻咽肿物活检明确病理诊断，并安排颈部超声检查\nJ. 行鼻咽肿物活检明确病理诊断，并安排肝脏增强MRI检查\nK. 行鼻咽肿物活检明确病理诊断，并安排甲状腺核素扫描检查\nL. 暂缓活检操作，先行诊断性抗炎治疗两周后复查鼻咽部MRI\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见: 轻度ST段下移；检查结论: 窦性心律 轻度ST段下移\n- [全程D1] 检验组合: 淋巴细胞百分比(Lymph%)-静脉血: 0.35；平均红细胞血红蛋白含量(MCH)-静脉血: 28.7pg；总钙(Ca)-静脉血: 2.32mmol/L；凝血酶时间(TT)-静脉血: 19.8sec.；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阳性(+)（参考: 阴性）；总胆汁酸(TBA)-静脉血: 4.1umol/L；钾离子(K+)-静脉血: 3.82mmol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；红细胞计数(RBC#)-静脉血: 5.0210E12/L；钠离子(Na+)-静脉血: 142.9mmol/L；尿素氮(BUN)-静脉血: 4.2mmol/L；葡萄糖(Glu)-静脉血: 5.36mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.66mmolL；球蛋白(GLO)-静脉血: 25.7g/L；尿酸(UA)-静脉血: 214.3umol/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；ABO血型-静脉血: O；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.98mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.76；中性粒细胞百分比(Neut%)-静脉血: 0.579；阴离子间隙(AG)-静脉血: 11.5；γ-谷氨酰基转移酶(GGT)-静脉血: 12.3U/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 23.4U/L；载脂蛋白B(apoB)-静脉血: 0.98g/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 6.4umolL；中性粒细胞计数(Neut#)-静脉血: 3.710E9/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；载脂蛋白AI(apoAI)-静脉血: 1.79g/L；肌酐(Crea)-静脉血: 50.2umol/L；总蛋白(TP)-静脉血: 70.9g/L；总胆固醇(TC)-静脉血: 5.02mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)……\n- [全程D2] 超声；双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声欠均匀，肝内可见多个无回声灶，较大者约43×29mm，椭圆形，边界清，内透声好，部分可见高回声分隔，后方回声增强。血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：上述病灶内未见明确血流信号。肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声欠均匀，右肾多个无回声灶，较大者约15×13mm，类圆形，边界清，内透声好，后方回声增强。左肾未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确肿物回声。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。；检查结论: 肝多发囊肿。 右肾多发囊肿。 胆囊、脾脏、胰腺、左肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D2] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对侧，双肺野纹理稍增多、增粗，未见明显实质性病变。双侧肺门不大，纵隔不宽，心影形态、大小、位置未见异常。双膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明确病变。\n- [全程D7] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、右侧壁明显增厚，左侧壁稍增厚，并见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号增强扫描明显强化，肿物占据右侧咽隐窝。双侧鼻腔及口咽各壁未见异常。 右侧腭帆张提肌、右侧头长肌及右侧翼内肌受侵，病变包绕右侧颈内动静脉。 右侧腭帆提肌、腭帆张肌、双侧头长肌受侵；左侧腭帆提肌、腭帆张肌未见受侵征象。 双侧翼腭窝、颞下窝未见异常；口咽侧壁未见受累增厚。 蝶骨基底部右份及右侧翼突基底部内侧、右侧翼突内板骨质信号减低，增强扫描不均匀强化。余颅底骨质未见明确异常。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、右侧乳突粘膜增厚，双侧上颌窦、蝶窦、左侧乳突充气良好，骨壁完整；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 右侧咽后见多个肿大淋巴结，最大者短径13mm，增强后明显强化，融合。左侧咽后及双颈II区见多发小淋巴结，最大者短径约7mm，未见坏死及包膜外侵。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺左叶见一结节，大小约11mm×11mm，边界尚清， T1WI及T2WI均呈混杂高信号，增强扫描部分区域强化较明显。甲状腺右叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。；检查结论: 鼻咽病变侵犯右侧咽旁间隙、椎前间隙右份及右侧翼内肌，考虑鼻咽癌可能性大。 蝶骨基底部右份、右侧翼突基底部内侧及右侧翼突内板骨质信号异常，考虑肿瘤浸润可能性大。 右侧咽后肿大淋巴结，考虑转移瘤。 左侧咽后及双颈II区小淋巴结，未排除转移可能。 鼻窦炎；右侧乳突炎。 甲状腺左叶结节灶，建议超声检查。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行鼻咽肿物活检明确病理诊断，并安排全身PET-CT检查\nB. 行鼻咽肿物活检明确病理诊断，并安排全身骨扫描检查\nC. 行颈部淋巴结细针穿刺活检明确病理诊断，并安排甲状腺超声检查\nD. 行鼻咽肿物活检明确病理诊断，并直接安排甲状腺结节细针穿刺活检\nE. 行鼻咽肿物活检明确病理诊断，并安排甲状腺超声检查\nF. 行鼻咽肿物活检明确病理诊断，并安排胸部增强CT检查\nG. 行鼻咽肿物活检明确病理诊断，并安排头颅增强MRI检查\nH. 行鼻咽肿物活检明确病理诊断，并安排甲状腺功能生化检查\nI. 行鼻咽肿物活检明确病理诊断，并安排颈部超声检查\nJ. 行鼻咽肿物活检明确病理诊断，并安排肝脏增强MRI检查\nK. 行鼻咽肿物活检明确病理诊断，并安排甲状腺核素扫描检查\nL. 暂缓活检操作，先行诊断性抗炎治疗两周后复查鼻咽部MRI\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-bf94c856279752df44d2b5a5","patient_id":"patient-d6812a1c46ed21fda9ebb9f8","turn_id":"turn05","turn_position":3,"turn_type":"toxicity_or_support_decision","gold_letter":"H","gold_action":"停止静脉输液，予以口服氯化钾缓释片维持补钾，行PICC导管常规护理，安排出院休养。","options":[{"letter":"A","text":"继续静脉滴注氯化钾及氯化钠注射液，暂缓出院继续住院观察。","is_gold":false},{"letter":"B","text":"停止静脉输液，停用所有补钾药物，拔除PICC导管，安排出院休养。","is_gold":false},{"letter":"C","text":"停止静脉输液，予以口服氯化钾缓释片，拔除PICC导管，安排出院休养。","is_gold":false},{"letter":"D","text":"继续静脉滴注氯化钾，行PICC导管常规护理，暂缓出院继续住院观察。","is_gold":false},{"letter":"E","text":"停止静脉输液，停用所有补钾药物，行PICC导管常规护理，安排出院休养。","is_gold":false},{"letter":"F","text":"予以静脉推注氯化钾注射液，行PICC导管常规护理，暂缓出院继续住院观察。","is_gold":false},{"letter":"G","text":"停止静脉输液，予以口服氯化钾缓释片及螺内酯，行PICC导管常规护理，安排出院休养。","is_gold":false},{"letter":"H","text":"停止静脉输液，予以口服氯化钾缓释片，行PICC导管常规护理，安排出院休养。","is_gold":true},{"letter":"I","text":"继续静脉滴注氯化钠注射液，予以口服氯化钾缓释片，行PICC导管常规护理，暂缓出院。","is_gold":false},{"letter":"J","text":"停止静脉输液，予以口服聚苯乙烯磺酸钙散，行PICC导管常规护理，安排出院休养。","is_gold":false},{"letter":"K","text":"停止静脉输液，予以静脉泵入氯化钾注射液，行PICC导管常规护理，暂缓出院。","is_gold":false},{"letter":"L","text":"继续静脉滴注氯化钾及氯化钠注射液，行PICC导管常规护理，带静脉输液装置出院。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D42] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位置位于第5胸椎体下缘，估计位于上腔静脉上段。；检查结论: PICC管末端位置如上所述。\n- [全程D42] 检验组合: 阴离子间隙(AG)-静脉血: 11；丙氨酸氨基转移酶(ALT)-静脉血: 12.8U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；钠离子(Na+)-静脉血: 143.3mmol/L；总钙(Ca)-静脉血: 2.2mmol/L；总胆红素(TBIL)-静脉血: 8.4umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.3U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.86；C-反应蛋白(CRP)-静脉血: 0.85mg/L；胱抑素(Cys-C)-静脉血: 0.61mg/L；磷(P)-静脉血: 1.14mmol/L；总胆固醇(TC)-静脉血: 4.61mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.292；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；载脂蛋白B(apoB)-静脉血: 0.93g/L；间接胆红素(IBIL)-静脉血: 6.4umolL；甘油三酯(TG)-静脉血: 0.64mmol/L；碱性磷酸酶(ALP)-静脉血: 87.2U/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 2umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；尿酸(UA)-静脉血: 194.8umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.02mmol/L；总胆汁酸(TBA)-静脉血: 2.1umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.96；钾离子(K+)-静脉血: 3.83mmol/L；红细胞比容(Hct)-静脉血: 40.7%；氯离子(Cl-)-静脉血: 107.6mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；肌酐(Crea)-静脉血: 46.2umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.810E9/L；血小板分布宽度(PDW)-静脉血: 10.6%；平均血小板体积(MPV)-静脉血: 9.5fL；白蛋白(ALB)-静脉血: 43.5g/L；尿素氮(BUN)-静脉血: 3.6mmol/L；白细胞计数(WBC#)-静脉血: 6.3110……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D43] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.016；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: 1+ 0.6mg（参考: 阴性）；浊度(TRUB)-尿液: 清亮；葡萄糖(Glu)-尿液: +- 1.7mmol（参考: 阴性）；酸碱度(pH)-尿液: 6.5；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；红细胞计数(RBC#)-尿液: 8/μL；酮体(KET)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 7/μL；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D44] 检验组合: 白蛋白(ALB)-静脉血: 37.7g/L；总胆红素(TBIL)-静脉血: 9umol/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；钠离子(Na+)-静脉血: 133.7mmol/L；直接胆红素(DBIL)-静脉血: 2.1umol/L；总胆汁酸(TBA)-静脉血: 1.4umol/L；尿酸(UA)-静脉血: 164.1umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.6U/L；总蛋白(TP)-静脉血: 58.49g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 23.7U/L；碱性磷酸酶(ALP)-静脉血: 72.8U/L；肌酐(Crea)-静脉血: 44.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.95；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.81；尿素氮(BUN)-静脉血: 4.4mmol/L；磷(P)-静脉血: 0.93mmol/L；总钙(Ca)-静脉血: 2.02mmol/L；乳酸脱氢酶(LDH)-静脉血: 210.9U/L；氯离子(Cl-)-静脉血: 100.2mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 12.3U/L；间接胆红素(IBIL)-静脉血: 6.9umolL；钾离子(K+)-静脉血: 2.94mmol/L；阴离子间隙(AG)-静脉血: 12.1；血液二氧化碳含量ctCO2(B)-静脉血: 21.4mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.3U/L；球蛋白(GLO)-静脉血: 20.79g/L\n- [全程D45] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 1/μL；钠离子(Na+)-静脉血: 131.1mmol/L；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；阴离子间隙(AG)-静脉血: 14.5；浊度(TRUB)-尿液: clear；胆红素(BIL)-尿液: -（参考: 阴性）；镁离子(Mg2+)-静脉血: 0.79mmol/L；钾离子(K+)-静脉血: 3.17mmol/L；红细胞计数(RBC#)-尿液: 17/μL；磷(P)-静脉血: 0.95mmol/L；氯离子(Cl-)-静脉血: 96.2mmol/L；白细胞计数(WBC#)-尿液: 5/μL；总钙(Ca)-静脉血: 1.92mmol/L；颜色-尿液: Light-Yellow；比重(SG)-尿液: 1.011；葡萄糖(Glu)-尿液: 1+ 5.6mmol（参考: 阴性）；隐血(OB)-尿液: +-0.3mg（参考: 阴性）；未分类结晶计数(UNCX#)-尿液: 5/μL；血液二氧化碳含量ctCO2(B)-静脉血: 20.4mmol/L；酸碱度(pH)-尿液: 6.5；尿胆原(URO)-尿液: -（参考: 阴性）\n- [全程D46] 检验组合: 阴离子间隙(AG)-静脉血: 17.7；血液二氧化碳含量ctCO2(B)-静脉血: 19.3mmol/L；氯离子(Cl-)-静脉血: 85.6mmol/L；总钙(Ca)-静脉血: 2.04mmol/L；钠离子(Na+)-静脉血: 122.6mmol/L；钾离子(K+)-静脉血: 3.26mmol/L；镁离子(Mg2+)-静脉血: 0.77mmol/L；磷(P)-静脉血: 0.51mmol/L\n- [全程D47] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 20.9mmol/L；总钙(Ca)-静脉血: 2.12mmol/L；阴离子间隙(AG)-静脉血: 14.5；磷(P)-静脉血: 0.67mmol/L；钾离子(K+)-静脉血: 4.06mmol/L；氯离子(Cl-)-静脉血: 89.8mmol/L；钠离子(Na+)-静脉血: 125.2mmol/L；镁离子(Mg2+)-静脉血: 0.93mmol/L\n- [全程D49] 检验组合: 镁离子(Mg2+)-静脉血: 0.89mmol/L；血小板分布宽度(PDW)-静脉血: 11.2%；有核红细胞百分比(NRBC%)-静脉血: 0；白蛋白(ALB)-静脉血: 44.2g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 33.1U/L；丙氨酸氨基转移酶(ALT)-静脉血: 22.6U/L；葡萄糖(Glu)-静脉血: 5.17mmol/L；间接胆红素(IBIL)-静脉血: 8.9umolL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.09mmolL；载脂蛋白B(apoB)-静脉血: 0.78g/L；总胆汁酸(TBA)-静脉血: 7.4umol/L；磷(P)-静脉血: 0.8mmol/L；肌酐(Crea)-静脉血: 38.9umol/L；甘油三酯(TG)-静脉血: 1.35mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29pg；平均红细胞体积(MCV)-静脉血: 83.3fL；单核细胞计数(Mono#)-静脉血: 0.710E9/L；总胆固醇(TC)-静脉血: 3.61mmol/L；总蛋白(TP)-静脉血: 67.8g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.003；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；总胆红素(TBIL)-静脉血: 12.8umol/L；血小板计数(PLT#)-静脉血: 19410E9/L；血小板比容-静脉血: 20%；天门冬氨酸氨基转移酶(AST)-静脉血: 12.9U/L；阴离子间隙(AG)-静脉血: 14.6；直接胆红素(DBIL)-静脉血: 3.9umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.05mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.2mmol/L；大血小板百分比(P-LCR%)-静脉血: 25.6%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 35.8；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.87；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；C-反应蛋白(CRP)-静脉血: 0.28mg/L；尿酸(UA)-静脉血: 110.7umol/L；单核细胞百分比(Mono%)-静脉血: 0……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D11] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者检查完善，已完成放疗预约，嘱今日出院，按期行放疗前准备及放疗前口腔检查。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 继续静脉滴注氯化钾及氯化钠注射液，暂缓出院继续住院观察。\nB. 停止静脉输液，停用所有补钾药物，拔除PICC导管，安排出院休养。\nC. 停止静脉输液，予以口服氯化钾缓释片，拔除PICC导管，安排出院休养。\nD. 继续静脉滴注氯化钾，行PICC导管常规护理，暂缓出院继续住院观察。\nE. 停止静脉输液，停用所有补钾药物，行PICC导管常规护理，安排出院休养。\nF. 予以静脉推注氯化钾注射液，行PICC导管常规护理，暂缓出院继续住院观察。\nG. 停止静脉输液，予以口服氯化钾缓释片及螺内酯，行PICC导管常规护理，安排出院休养。\nH. 停止静脉输液，予以口服氯化钾缓释片，行PICC导管常规护理，安排出院休养。\nI. 继续静脉滴注氯化钠注射液，予以口服氯化钾缓释片，行PICC导管常规护理，暂缓出院。\nJ. 停止静脉输液，予以口服聚苯乙烯磺酸钙散，行PICC导管常规护理，安排出院休养。\nK. 停止静脉输液，予以静脉泵入氯化钾注射液，行PICC导管常规护理，暂缓出院。\nL. 继续静脉滴注氯化钾及氯化钠注射液，行PICC导管常规护理，带静脉输液装置出院。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D42] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位置位于第5胸椎体下缘，估计位于上腔静脉上段。；检查结论: PICC管末端位置如上所述。\n- [全程D42] 检验组合: 阴离子间隙(AG)-静脉血: 11；丙氨酸氨基转移酶(ALT)-静脉血: 12.8U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；钠离子(Na+)-静脉血: 143.3mmol/L；总钙(Ca)-静脉血: 2.2mmol/L；总胆红素(TBIL)-静脉血: 8.4umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.3U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.86；C-反应蛋白(CRP)-静脉血: 0.85mg/L；胱抑素(Cys-C)-静脉血: 0.61mg/L；磷(P)-静脉血: 1.14mmol/L；总胆固醇(TC)-静脉血: 4.61mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.292；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；载脂蛋白B(apoB)-静脉血: 0.93g/L；间接胆红素(IBIL)-静脉血: 6.4umolL；甘油三酯(TG)-静脉血: 0.64mmol/L；碱性磷酸酶(ALP)-静脉血: 87.2U/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 2umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；尿酸(UA)-静脉血: 194.8umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.02mmol/L；总胆汁酸(TBA)-静脉血: 2.1umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.96；钾离子(K+)-静脉血: 3.83mmol/L；红细胞比容(Hct)-静脉血: 40.7%；氯离子(Cl-)-静脉血: 107.6mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；肌酐(Crea)-静脉血: 46.2umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.810E9/L；血小板分布宽度(PDW)-静脉血: 10.6%；平均血小板体积(MPV)-静脉血: 9.5fL；白蛋白(ALB)-静脉血: 43.5g/L；尿素氮(BUN)-静脉血: 3.6mmol/L；白细胞计数(WBC#)-静脉血: 6.3110……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D43] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.016；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: 1+ 0.6mg（参考: 阴性）；浊度(TRUB)-尿液: 清亮；葡萄糖(Glu)-尿液: +- 1.7mmol（参考: 阴性）；酸碱度(pH)-尿液: 6.5；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；红细胞计数(RBC#)-尿液: 8/μL；酮体(KET)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 7/μL；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D44] 检验组合: 白蛋白(ALB)-静脉血: 37.7g/L；总胆红素(TBIL)-静脉血: 9umol/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；钠离子(Na+)-静脉血: 133.7mmol/L；直接胆红素(DBIL)-静脉血: 2.1umol/L；总胆汁酸(TBA)-静脉血: 1.4umol/L；尿酸(UA)-静脉血: 164.1umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.6U/L；总蛋白(TP)-静脉血: 58.49g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 23.7U/L；碱性磷酸酶(ALP)-静脉血: 72.8U/L；肌酐(Crea)-静脉血: 44.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.95；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.81；尿素氮(BUN)-静脉血: 4.4mmol/L；磷(P)-静脉血: 0.93mmol/L；总钙(Ca)-静脉血: 2.02mmol/L；乳酸脱氢酶(LDH)-静脉血: 210.9U/L；氯离子(Cl-)-静脉血: 100.2mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 12.3U/L；间接胆红素(IBIL)-静脉血: 6.9umolL；钾离子(K+)-静脉血: 2.94mmol/L；阴离子间隙(AG)-静脉血: 12.1；血液二氧化碳含量ctCO2(B)-静脉血: 21.4mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.3U/L；球蛋白(GLO)-静脉血: 20.79g/L\n- [全程D45] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 1/μL；钠离子(Na+)-静脉血: 131.1mmol/L；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；阴离子间隙(AG)-静脉血: 14.5；浊度(TRUB)-尿液: clear；胆红素(BIL)-尿液: -（参考: 阴性）；镁离子(Mg2+)-静脉血: 0.79mmol/L；钾离子(K+)-静脉血: 3.17mmol/L；红细胞计数(RBC#)-尿液: 17/μL；磷(P)-静脉血: 0.95mmol/L；氯离子(Cl-)-静脉血: 96.2mmol/L；白细胞计数(WBC#)-尿液: 5/μL；总钙(Ca)-静脉血: 1.92mmol/L；颜色-尿液: Light-Yellow；比重(SG)-尿液: 1.011；葡萄糖(Glu)-尿液: 1+ 5.6mmol（参考: 阴性）；隐血(OB)-尿液: +-0.3mg（参考: 阴性）；未分类结晶计数(UNCX#)-尿液: 5/μL；血液二氧化碳含量ctCO2(B)-静脉血: 20.4mmol/L；酸碱度(pH)-尿液: 6.5；尿胆原(URO)-尿液: -（参考: 阴性）\n- [全程D46] 检验组合: 阴离子间隙(AG)-静脉血: 17.7；血液二氧化碳含量ctCO2(B)-静脉血: 19.3mmol/L；氯离子(Cl-)-静脉血: 85.6mmol/L；总钙(Ca)-静脉血: 2.04mmol/L；钠离子(Na+)-静脉血: 122.6mmol/L；钾离子(K+)-静脉血: 3.26mmol/L；镁离子(Mg2+)-静脉血: 0.77mmol/L；磷(P)-静脉血: 0.51mmol/L\n- [全程D47] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 20.9mmol/L；总钙(Ca)-静脉血: 2.12mmol/L；阴离子间隙(AG)-静脉血: 14.5；磷(P)-静脉血: 0.67mmol/L；钾离子(K+)-静脉血: 4.06mmol/L；氯离子(Cl-)-静脉血: 89.8mmol/L；钠离子(Na+)-静脉血: 125.2mmol/L；镁离子(Mg2+)-静脉血: 0.93mmol/L\n- [全程D49] 检验组合: 镁离子(Mg2+)-静脉血: 0.89mmol/L；血小板分布宽度(PDW)-静脉血: 11.2%；有核红细胞百分比(NRBC%)-静脉血: 0；白蛋白(ALB)-静脉血: 44.2g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 33.1U/L；丙氨酸氨基转移酶(ALT)-静脉血: 22.6U/L；葡萄糖(Glu)-静脉血: 5.17mmol/L；间接胆红素(IBIL)-静脉血: 8.9umolL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.09mmolL；载脂蛋白B(apoB)-静脉血: 0.78g/L；总胆汁酸(TBA)-静脉血: 7.4umol/L；磷(P)-静脉血: 0.8mmol/L；肌酐(Crea)-静脉血: 38.9umol/L；甘油三酯(TG)-静脉血: 1.35mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29pg；平均红细胞体积(MCV)-静脉血: 83.3fL；单核细胞计数(Mono#)-静脉血: 0.710E9/L；总胆固醇(TC)-静脉血: 3.61mmol/L；总蛋白(TP)-静脉血: 67.8g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.003；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；总胆红素(TBIL)-静脉血: 12.8umol/L；血小板计数(PLT#)-静脉血: 19410E9/L；血小板比容-静脉血: 20%；天门冬氨酸氨基转移酶(AST)-静脉血: 12.9U/L；阴离子间隙(AG)-静脉血: 14.6；直接胆红素(DBIL)-静脉血: 3.9umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.05mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.2mmol/L；大血小板百分比(P-LCR%)-静脉血: 25.6%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 35.8；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.87；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；C-反应蛋白(CRP)-静脉血: 0.28mg/L；尿酸(UA)-静脉血: 110.7umol/L；单核细胞百分比(Mono%)-静脉血: 0……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D11] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者检查完善，已完成放疗预约，嘱今日出院，按期行放疗前准备及放疗前口腔检查。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 继续静脉滴注氯化钾及氯化钠注射液，暂缓出院继续住院观察。\nB. 停止静脉输液，停用所有补钾药物，拔除PICC导管，安排出院休养。\nC. 停止静脉输液，予以口服氯化钾缓释片，拔除PICC导管，安排出院休养。\nD. 继续静脉滴注氯化钾，行PICC导管常规护理，暂缓出院继续住院观察。\nE. 停止静脉输液，停用所有补钾药物，行PICC导管常规护理，安排出院休养。\nF. 予以静脉推注氯化钾注射液，行PICC导管常规护理，暂缓出院继续住院观察。\nG. 停止静脉输液，予以口服氯化钾缓释片及螺内酯，行PICC导管常规护理，安排出院休养。\nH. 停止静脉输液，予以口服氯化钾缓释片，行PICC导管常规护理，安排出院休养。\nI. 继续静脉滴注氯化钠注射液，予以口服氯化钾缓释片，行PICC导管常规护理，暂缓出院。\nJ. 停止静脉输液，予以口服聚苯乙烯磺酸钙散，行PICC导管常规护理，安排出院休养。\nK. 停止静脉输液，予以静脉泵入氯化钾注射液，行PICC导管常规护理，暂缓出院。\nL. 继续静脉滴注氯化钾及氯化钠注射液，行PICC导管常规护理，带静脉输液装置出院。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-9549c3c98f10ace802cbb08b","patient_id":"patient-d6812a1c46ed21fda9ebb9f8","turn_id":"turn06","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"I","gold_action":"继续顺铂单药化疗，并给予地塞米松、甲氧氯普胺、奥美拉唑止吐，辅以静脉水化及补钾支持治疗。","options":[{"letter":"A","text":"暂停化疗，给予重组人粒细胞集落刺激因子升白细胞治疗，待白细胞恢复后继续顺铂化疗。","is_gold":false},{"letter":"B","text":"暂停化疗，给予3%氯化钠注射液强化纠正低钠血症，待血钠持续稳定正常后再考虑恢复顺铂化疗。","is_gold":false},{"letter":"C","text":"将化疗方案调整为卡铂单药，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化支持治疗。","is_gold":false},{"letter":"D","text":"继续顺铂化疗，并给予地塞米松、甲氧氯普胺、奥美拉唑止吐，无需常规静脉水化及补钾。","is_gold":false},{"letter":"E","text":"继续顺铂化疗，并给予昂丹司琼单药止吐，辅以静脉水化及补钾支持治疗。","is_gold":false},{"letter":"F","text":"继续顺铂联合5-氟尿嘧啶化疗，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化支持治疗。","is_gold":false},{"letter":"G","text":"继续顺铂化疗，并给予地塞米松、甲氧氯普胺、奥美拉唑止吐，同时预防性使用重组人粒细胞集落刺激因子。","is_gold":false},{"letter":"H","text":"终止化疗，仅行单纯放射治疗，并给予静脉水化及营养支持。","is_gold":false},{"letter":"I","text":"继续顺铂化疗，并给予地塞米松、甲氧氯普胺、奥美拉唑止吐，辅以静脉水化及补钾支持治疗。","is_gold":true},{"letter":"J","text":"继续顺铂化疗，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化，同时加用呋塞米强迫利尿且不补钾。","is_gold":false},{"letter":"K","text":"暂停化疗，给予保肝降酶治疗，待肝功能恢复后继续顺铂化疗。","is_gold":false},{"letter":"L","text":"将化疗方案调整为紫杉醇单药，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化支持治疗。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D60] 检验组合: α-L-岩藻糖苷酶(AFU)-静脉血: 20.3U/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；总胆固醇(TC)-静脉血: 3.99mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.68；天门冬氨酸氨基转移酶(AST)-静脉血: 11.8U/L；总钙(Ca)-静脉血: 2.22mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.05；有核红细胞计数(NRBC#)-静脉血: 010E9/L；白细胞计数(WBC#)-静脉血: 3.5710E9/L；钾离子(K+)-静脉血: 3.88mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.14；碱性磷酸酶(ALP)-静脉血: 52.6U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.62mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.89mmolL；氯离子(Cl-)-静脉血: 103mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；阴离子间隙(AG)-静脉血: 11；球蛋白(GLO)-静脉血: 22.9g/L；总胆汁酸(TBA)-静脉血: 0.9umol/L；镁离子(Mg2+)-静脉血: 0.9mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336g/L；血红蛋白(Hb)-静脉血: 115g/L；红细胞计数(RBC#)-静脉血: 3.910E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；甘油三酯(TG)-静脉血: 0.63mmol/L；磷(P)-静脉血: 1.02mmol/L；直接胆红素(DBIL)-静脉血: 2.86umol/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；单核细胞百分比(Mono%)-静脉血: 0.101；红细胞比容(Hct)-静脉血: 34.2%；血小板比容-静脉血: 17%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.5pg；平均血小板体积(MPV)-静脉血: 9.5fL；尿酸(UA)-静脉血: 152.4umol/L；肌酐(Crea)-静脉血: 43umol/L；丙氨酸氨基转移酶(ALT……\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停化疗，给予重组人粒细胞集落刺激因子升白细胞治疗，待白细胞恢复后继续顺铂化疗。\nB. 暂停化疗，给予3%氯化钠注射液强化纠正低钠血症，待血钠持续稳定正常后再考虑恢复顺铂化疗。\nC. 将化疗方案调整为卡铂单药，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化支持治疗。\nD. 继续顺铂化疗，并给予地塞米松、甲氧氯普胺、奥美拉唑止吐，无需常规静脉水化及补钾。\nE. 继续顺铂化疗，并给予昂丹司琼单药止吐，辅以静脉水化及补钾支持治疗。\nF. 继续顺铂联合5-氟尿嘧啶化疗，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化支持治疗。\nG. 继续顺铂化疗，并给予地塞米松、甲氧氯普胺、奥美拉唑止吐，同时预防性使用重组人粒细胞集落刺激因子。\nH. 终止化疗，仅行单纯放射治疗，并给予静脉水化及营养支持。\nI. 继续顺铂化疗，并给予地塞米松、甲氧氯普胺、奥美拉唑止吐，辅以静脉水化及补钾支持治疗。\nJ. 继续顺铂化疗，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化，同时加用呋塞米强迫利尿且不补钾。\nK. 暂停化疗，给予保肝降酶治疗，待肝功能恢复后继续顺铂化疗。\nL. 将化疗方案调整为紫杉醇单药，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化支持治疗。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D60] 检验组合: α-L-岩藻糖苷酶(AFU)-静脉血: 20.3U/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；总胆固醇(TC)-静脉血: 3.99mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.68；天门冬氨酸氨基转移酶(AST)-静脉血: 11.8U/L；总钙(Ca)-静脉血: 2.22mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.05；有核红细胞计数(NRBC#)-静脉血: 010E9/L；白细胞计数(WBC#)-静脉血: 3.5710E9/L；钾离子(K+)-静脉血: 3.88mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.14；碱性磷酸酶(ALP)-静脉血: 52.6U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.62mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.89mmolL；氯离子(Cl-)-静脉血: 103mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；阴离子间隙(AG)-静脉血: 11；球蛋白(GLO)-静脉血: 22.9g/L；总胆汁酸(TBA)-静脉血: 0.9umol/L；镁离子(Mg2+)-静脉血: 0.9mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336g/L；血红蛋白(Hb)-静脉血: 115g/L；红细胞计数(RBC#)-静脉血: 3.910E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；甘油三酯(TG)-静脉血: 0.63mmol/L；磷(P)-静脉血: 1.02mmol/L；直接胆红素(DBIL)-静脉血: 2.86umol/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；单核细胞百分比(Mono%)-静脉血: 0.101；红细胞比容(Hct)-静脉血: 34.2%；血小板比容-静脉血: 17%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.5pg；平均血小板体积(MPV)-静脉血: 9.5fL；尿酸(UA)-静脉血: 152.4umol/L；肌酐(Crea)-静脉血: 43umol/L；丙氨酸氨基转移酶(ALT……\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停化疗，给予重组人粒细胞集落刺激因子升白细胞治疗，待白细胞恢复后继续顺铂化疗。\nB. 暂停化疗，给予3%氯化钠注射液强化纠正低钠血症，待血钠持续稳定正常后再考虑恢复顺铂化疗。\nC. 将化疗方案调整为卡铂单药，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化支持治疗。\nD. 继续顺铂化疗，并给予地塞米松、甲氧氯普胺、奥美拉唑止吐，无需常规静脉水化及补钾。\nE. 继续顺铂化疗，并给予昂丹司琼单药止吐，辅以静脉水化及补钾支持治疗。\nF. 继续顺铂联合5-氟尿嘧啶化疗，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化支持治疗。\nG. 继续顺铂化疗，并给予地塞米松、甲氧氯普胺、奥美拉唑止吐，同时预防性使用重组人粒细胞集落刺激因子。\nH. 终止化疗，仅行单纯放射治疗，并给予静脉水化及营养支持。\nI. 继续顺铂化疗，并给予地塞米松、甲氧氯普胺、奥美拉唑止吐，辅以静脉水化及补钾支持治疗。\nJ. 继续顺铂化疗，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化，同时加用呋塞米强迫利尿且不补钾。\nK. 暂停化疗，给予保肝降酶治疗，待肝功能恢复后继续顺铂化疗。\nL. 将化疗方案调整为紫杉醇单药，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化支持治疗。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-5acaafa7f13a3c4be08160aa","patient_id":"patient-d6812a1c46ed21fda9ebb9f8","turn_id":"turn07","turn_position":5,"turn_type":"response_assessment_decision","gold_letter":"J","gold_action":"疗效评估为放化疗有效，针对进食差及低钾血症予以静脉营养支持及补钾，继续根治性放疗并按期行第三程同期化疗。","options":[{"letter":"A","text":"疗效评估为疾病进展，存在低钾血症，暂停放疗，改为单药靶向治疗并静脉补钾。","is_gold":false},{"letter":"B","text":"疗效评估为放化疗有效，存在低钾血症及进食差，终止同期化疗，仅继续单纯放疗及口服补钾。","is_gold":false},{"letter":"C","text":"疗效评估为放化疗有效，存在低钾血症，暂停放疗及化疗，待血钾恢复正常后再恢复原方案。","is_gold":false},{"letter":"D","text":"疗效评估为疾病稳定，存在骨髓抑制，给予重组人血小板生成素并推迟后续化疗。","is_gold":false},{"letter":"E","text":"疗效评估为放化疗有效，右肾多发囊肿，请泌尿外科急会诊行囊肿穿刺引流，暂缓化疗。","is_gold":false},{"letter":"F","text":"疗效评估为疾病进展，复查鼻咽 MRI 及全身 PET-CT，更改化疗方案为吉西他滨联合顺铂。","is_gold":false},{"letter":"G","text":"疗效评估为放化疗有效，进食差，行经皮胃造瘘术进行肠内营养，继续放化疗。","is_gold":false},{"letter":"H","text":"疗效评估为放化疗有效，存在低钾血症，门诊口服氯化钾缓释片，继续放疗，取消第三程化疗。","is_gold":false},{"letter":"I","text":"疗效评估为放化疗有效，存在肝功能损害，停用顺铂，改为西妥昔单抗靶向治疗并保肝处理。","is_gold":false},{"letter":"J","text":"疗效评估为放化疗有效，予以静脉营养支持及补钾，处理进食差及低钾血症，继续根治性放疗并按期行第三程同期化疗。","is_gold":true},{"letter":"K","text":"疗效评估为放化疗有效，予以静脉补钾，处理低钾血症，结束同期化疗阶段，后续仅需完成单纯放疗。","is_gold":false},{"letter":"L","text":"疗效评估为疾病稳定，存在恶心呕吐，预防性给予三联止吐方案，提前结束放疗并转为辅助化疗。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D68] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0；有核红细胞计数(NRBC#)-静脉血: 010E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0；大血小板百分比(P-LCR%)-静脉血: 20.1%；尿酸(UA)-静脉血: 120.2umol/L；总胆固醇(TC)-静脉血: 4.11mmol/L；总钙(Ca)-静脉血: 2.22mmol/L；平均红细胞体积(MCV)-静脉血: 84.4fL；单核细胞百分比(Mono%)-静脉血: 0.155；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；淋巴细胞百分比(Lymph%)-静脉血: 0.088；总胆汁酸(TBA)-静脉血: 2.6umol/L；白蛋白(ALB)-静脉血: 40.1g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.22mmolL；总蛋白(TP)-静脉血: 62.7g/L；载脂蛋白AI(apoAI)-静脉血: 1.32g/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.5U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.77；中性粒细胞百分比(Neut%)-静脉血: 0.757；α-L-岩藻糖苷酶(AFU)-静脉血: 42.2U/L；C-反应蛋白(CRP)-静脉血: 0.25mg/L；阴离子间隙(AG)-静脉血: 13.4；肌酐(Crea)-静脉血: 43.4umol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.7；中性粒细胞计数(Neut#)-静脉血: 4.210E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.9U/L；钠离子(Na+)-静脉血: 134mmol/L；单核细胞计数(Mono#)-静脉血: 0.910E9/L；血小板分布宽度(PDW)-静脉血: 10.6%；镁离子(Mg2+)-静脉血: 0.72mmol/L；血小板比容-静脉血: 19%；白细胞计数(WBC#)-静脉血: 5.4810E9/L；胱抑素(Cys-C)-静脉血: 0.92mg/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.3；葡萄糖(Glu)-静脉血: 4.71mmol/L；直接胆红素(DBIL)-静脉血: 2.12umol/L；血红蛋白(Hb)-静脉血: 123g/L；碱性磷酸酶(……\n- [全程D70] 检验组合: 淋巴细胞百分比(Lymph%)-静脉血: 0.097；血小板分布宽度(PDW)-静脉血: 10.4%；白细胞计数(WBC#)-静脉血: 5.3710E9/L；平均血小板体积(MPV)-静脉血: 9.5fL；乳酸脱氢酶(LDH)-静脉血: 191.8U/L；直接胆红素(DBIL)-静脉血: 2.52umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20.6U/L；氯离子(Cl-)-静脉血: 92.5mmol/L；尿素氮(BUN)-静脉血: 5mmol/L；血小板比容-静脉血: 21%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总钙(Ca)-静脉血: 2.25mmol/L；尿酸(UA)-静脉血: 198umol/L；总胆红素(TBIL)-静脉血: 9.15umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 37.3U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.006；中性粒细胞计数(Neut#)-静脉血: 4.110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.77；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；间接胆红素(IBIL)-静脉血: 6.63umolL；碱性磷酸酶(ALP)-静脉血: 58U/L；单核细胞百分比(Mono%)-静脉血: 0.125；载脂蛋白B(apoB)-静脉血: 1.02g/L；C-反应蛋白(CRP)-静脉血: 1.01mg/L；γ-谷氨酰基转移酶(GGT)-静脉血: 27.6U/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.3mmol/L；甘油三酯(TG)-静脉血: 1.4mmol/L；总胆汁酸(TBA)-静脉血: 3.6umol/L；球蛋白(GLO)-静脉血: 24.2g/L；白蛋白(ALB)-静脉血: 41.8g/L；葡萄糖(Glu)-静脉血: 5.35mmol/L；平均红细胞体积(MCV)-静脉血: 83.5fL；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 348g/L；胱抑素(Cys-C)-静脉血: 0.79mg/L；丙氨酸氨基转移酶(ALT)-静脉血: 24U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.88mmol/L；红细……\n- [全程D77] 检验组合: 总胆红素(TBIL)-静脉血: 9.1umol/L；血小板分布宽度(PDW)-静脉血: 10.7%；乳酸脱氢酶(LDH)-静脉血: 184.4U/L；直接胆红素(DBIL)-静脉血: 2.92umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.9mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 24U/L；总胆固醇(TC)-静脉血: 4.36mmol/L；平均血小板体积(MPV)-静脉血: 9.7fL；白细胞计数(WBC#)-静脉血: 6.0610E9/L；氯离子(Cl-)-静脉血: 97.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 9.2U/L；阴离子间隙(AG)-静脉血: 15.2；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞计数(RBC#)-静脉血: 4.0510E12/L；总胆汁酸(TBA)-静脉血: 1.1umol/L；C-反应蛋白(CRP)-静脉血: 6.66mg/L；磷(P)-静脉血: 1.11mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.012；中性粒细胞百分比(Neut%)-静脉血: 0.799；淋巴细胞计数(Lymph#)-静脉血: 0.410E9/L；总钙(Ca)-静脉血: 2.14mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.03mmol/L；球蛋白(GLO)-静脉血: 22g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.99mmolL；淋巴细胞百分比(Lymph%)-静脉血: 0.064；血小板计数(PLT#)-静脉血: 12010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.2；钾离子(K+)-静脉血: 3.15mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.09；碱性磷酸酶(ALP)-静脉血: 49.9U/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 44.5umol/L；中性粒细胞计数(Neut#)-静脉血: 4.810E9/L；间接胆红素(IBIL)-静脉血: 6.18umolL；尿素氮(BUN)-静脉血: 5.3mmol/L；红细胞体积分布宽度CV(RDW-CV)-……\n- [全程D79] 超声；双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 双肾大小形态正常，右肾探及几个无回声灶，大者约16×13mm，边界清，内透声可，后方回声增强。左肾实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确肿物回声。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。；检查结论: 右肾多发囊性灶，考虑肾囊肿。 左肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位性病变。\n\n【既往治疗与反应】\n- [全程D66] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者诉恶心，食欲差，于未诉特殊不适，查体基本同前。患者第二程DDP同时期化疗。予加强止呕及营养支持治疗，防治放化毒副反应。续观。\n- [全程D70] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者诉恶心，进食差，余未诉特殊不适，查体基本同前。今日[姓名已隐去]医生信息已隐藏后示：患者已完成第二程DDP同时期化疗，予加强营养支持治疗。一般情况平稳，嘱今日补液结束后出院，于门诊继续放疗。按期返院继续治疗。遵嘱。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 疗效评估为疾病进展，存在低钾血症，暂停放疗，改为单药靶向治疗并静脉补钾。\nB. 疗效评估为放化疗有效，存在低钾血症及进食差，终止同期化疗，仅继续单纯放疗及口服补钾。\nC. 疗效评估为放化疗有效，存在低钾血症，暂停放疗及化疗，待血钾恢复正常后再恢复原方案。\nD. 疗效评估为疾病稳定，存在骨髓抑制，给予重组人血小板生成素并推迟后续化疗。\nE. 疗效评估为放化疗有效，右肾多发囊肿，请泌尿外科急会诊行囊肿穿刺引流，暂缓化疗。\nF. 疗效评估为疾病进展，复查鼻咽 MRI 及全身 PET-CT，更改化疗方案为吉西他滨联合顺铂。\nG. 疗效评估为放化疗有效，进食差，行经皮胃造瘘术进行肠内营养，继续放化疗。\nH. 疗效评估为放化疗有效，存在低钾血症，门诊口服氯化钾缓释片，继续放疗，取消第三程化疗。\nI. 疗效评估为放化疗有效，存在肝功能损害，停用顺铂，改为西妥昔单抗靶向治疗并保肝处理。\nJ. 疗效评估为放化疗有效，予以静脉营养支持及补钾，处理进食差及低钾血症，继续根治性放疗并按期行第三程同期化疗。\nK. 疗效评估为放化疗有效，予以静脉补钾，处理低钾血症，结束同期化疗阶段，后续仅需完成单纯放疗。\nL. 疗效评估为疾病稳定，存在恶心呕吐，预防性给予三联止吐方案，提前结束放疗并转为辅助化疗。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D68] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0；有核红细胞计数(NRBC#)-静脉血: 010E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0；大血小板百分比(P-LCR%)-静脉血: 20.1%；尿酸(UA)-静脉血: 120.2umol/L；总胆固醇(TC)-静脉血: 4.11mmol/L；总钙(Ca)-静脉血: 2.22mmol/L；平均红细胞体积(MCV)-静脉血: 84.4fL；单核细胞百分比(Mono%)-静脉血: 0.155；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；淋巴细胞百分比(Lymph%)-静脉血: 0.088；总胆汁酸(TBA)-静脉血: 2.6umol/L；白蛋白(ALB)-静脉血: 40.1g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.22mmolL；总蛋白(TP)-静脉血: 62.7g/L；载脂蛋白AI(apoAI)-静脉血: 1.32g/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.5U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.77；中性粒细胞百分比(Neut%)-静脉血: 0.757；α-L-岩藻糖苷酶(AFU)-静脉血: 42.2U/L；C-反应蛋白(CRP)-静脉血: 0.25mg/L；阴离子间隙(AG)-静脉血: 13.4；肌酐(Crea)-静脉血: 43.4umol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.7；中性粒细胞计数(Neut#)-静脉血: 4.210E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.9U/L；钠离子(Na+)-静脉血: 134mmol/L；单核细胞计数(Mono#)-静脉血: 0.910E9/L；血小板分布宽度(PDW)-静脉血: 10.6%；镁离子(Mg2+)-静脉血: 0.72mmol/L；血小板比容-静脉血: 19%；白细胞计数(WBC#)-静脉血: 5.4810E9/L；胱抑素(Cys-C)-静脉血: 0.92mg/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.3；葡萄糖(Glu)-静脉血: 4.71mmol/L；直接胆红素(DBIL)-静脉血: 2.12umol/L；血红蛋白(Hb)-静脉血: 123g/L；碱性磷酸酶(……\n- [全程D70] 检验组合: 淋巴细胞百分比(Lymph%)-静脉血: 0.097；血小板分布宽度(PDW)-静脉血: 10.4%；白细胞计数(WBC#)-静脉血: 5.3710E9/L；平均血小板体积(MPV)-静脉血: 9.5fL；乳酸脱氢酶(LDH)-静脉血: 191.8U/L；直接胆红素(DBIL)-静脉血: 2.52umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20.6U/L；氯离子(Cl-)-静脉血: 92.5mmol/L；尿素氮(BUN)-静脉血: 5mmol/L；血小板比容-静脉血: 21%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总钙(Ca)-静脉血: 2.25mmol/L；尿酸(UA)-静脉血: 198umol/L；总胆红素(TBIL)-静脉血: 9.15umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 37.3U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.006；中性粒细胞计数(Neut#)-静脉血: 4.110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.77；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；间接胆红素(IBIL)-静脉血: 6.63umolL；碱性磷酸酶(ALP)-静脉血: 58U/L；单核细胞百分比(Mono%)-静脉血: 0.125；载脂蛋白B(apoB)-静脉血: 1.02g/L；C-反应蛋白(CRP)-静脉血: 1.01mg/L；γ-谷氨酰基转移酶(GGT)-静脉血: 27.6U/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.3mmol/L；甘油三酯(TG)-静脉血: 1.4mmol/L；总胆汁酸(TBA)-静脉血: 3.6umol/L；球蛋白(GLO)-静脉血: 24.2g/L；白蛋白(ALB)-静脉血: 41.8g/L；葡萄糖(Glu)-静脉血: 5.35mmol/L；平均红细胞体积(MCV)-静脉血: 83.5fL；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 348g/L；胱抑素(Cys-C)-静脉血: 0.79mg/L；丙氨酸氨基转移酶(ALT)-静脉血: 24U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.88mmol/L；红细……\n- [全程D77] 检验组合: 总胆红素(TBIL)-静脉血: 9.1umol/L；血小板分布宽度(PDW)-静脉血: 10.7%；乳酸脱氢酶(LDH)-静脉血: 184.4U/L；直接胆红素(DBIL)-静脉血: 2.92umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.9mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 24U/L；总胆固醇(TC)-静脉血: 4.36mmol/L；平均血小板体积(MPV)-静脉血: 9.7fL；白细胞计数(WBC#)-静脉血: 6.0610E9/L；氯离子(Cl-)-静脉血: 97.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 9.2U/L；阴离子间隙(AG)-静脉血: 15.2；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞计数(RBC#)-静脉血: 4.0510E12/L；总胆汁酸(TBA)-静脉血: 1.1umol/L；C-反应蛋白(CRP)-静脉血: 6.66mg/L；磷(P)-静脉血: 1.11mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.012；中性粒细胞百分比(Neut%)-静脉血: 0.799；淋巴细胞计数(Lymph#)-静脉血: 0.410E9/L；总钙(Ca)-静脉血: 2.14mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.03mmol/L；球蛋白(GLO)-静脉血: 22g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.99mmolL；淋巴细胞百分比(Lymph%)-静脉血: 0.064；血小板计数(PLT#)-静脉血: 12010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.2；钾离子(K+)-静脉血: 3.15mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.09；碱性磷酸酶(ALP)-静脉血: 49.9U/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 44.5umol/L；中性粒细胞计数(Neut#)-静脉血: 4.810E9/L；间接胆红素(IBIL)-静脉血: 6.18umolL；尿素氮(BUN)-静脉血: 5.3mmol/L；红细胞体积分布宽度CV(RDW-CV)-……\n- [全程D79] 超声；双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 双肾大小形态正常，右肾探及几个无回声灶，大者约16×13mm，边界清，内透声可，后方回声增强。左肾实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确肿物回声。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。；检查结论: 右肾多发囊性灶，考虑肾囊肿。 左肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位性病变。\n\n【既往治疗与反应】\n- [全程D66] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者诉恶心，食欲差，于未诉特殊不适，查体基本同前。患者第二程DDP同时期化疗。予加强止呕及营养支持治疗，防治放化毒副反应。续观。\n- [全程D70] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者诉恶心，进食差，余未诉特殊不适，查体基本同前。今日[姓名已隐去]医生信息已隐藏后示：患者已完成第二程DDP同时期化疗，予加强营养支持治疗。一般情况平稳，嘱今日补液结束后出院，于门诊继续放疗。按期返院继续治疗。遵嘱。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 疗效评估为疾病进展，存在低钾血症，暂停放疗，改为单药靶向治疗并静脉补钾。\nB. 疗效评估为放化疗有效，存在低钾血症及进食差，终止同期化疗，仅继续单纯放疗及口服补钾。\nC. 疗效评估为放化疗有效，存在低钾血症，暂停放疗及化疗，待血钾恢复正常后再恢复原方案。\nD. 疗效评估为疾病稳定，存在骨髓抑制，给予重组人血小板生成素并推迟后续化疗。\nE. 疗效评估为放化疗有效，右肾多发囊肿，请泌尿外科急会诊行囊肿穿刺引流，暂缓化疗。\nF. 疗效评估为疾病进展，复查鼻咽 MRI 及全身 PET-CT，更改化疗方案为吉西他滨联合顺铂。\nG. 疗效评估为放化疗有效，进食差，行经皮胃造瘘术进行肠内营养，继续放化疗。\nH. 疗效评估为放化疗有效，存在低钾血症，门诊口服氯化钾缓释片，继续放疗，取消第三程化疗。\nI. 疗效评估为放化疗有效，存在肝功能损害，停用顺铂，改为西妥昔单抗靶向治疗并保肝处理。\nJ. 疗效评估为放化疗有效，予以静脉营养支持及补钾，处理进食差及低钾血症，继续根治性放疗并按期行第三程同期化疗。\nK. 疗效评估为放化疗有效，予以静脉补钾，处理低钾血症，结束同期化疗阶段，后续仅需完成单纯放疗。\nL. 疗效评估为疾病稳定，存在恶心呕吐，预防性给予三联止吐方案，提前结束放疗并转为辅助化疗。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-47e9b2e315a805773d669325","patient_id":"patient-d6812a1c46ed21fda9ebb9f8","turn_id":"turn08","turn_position":6,"turn_type":"response_assessment_decision","gold_letter":"K","gold_action":"疗效评估为部分缓解（PR），继续完成根治性放疗及既定化疗计划，并加强静脉营养支持与补钾等对症处理。","options":[{"letter":"A","text":"疗效评估为疾病进展（PD），终止放化疗计划，改行鼻咽及颈部挽救性手术切除。","is_gold":false},{"letter":"B","text":"疗效评估为疾病进展（PD），停用顺铂，更改化疗方案为吉西他滨联合氟尿嘧啶并继续放疗。","is_gold":false},{"letter":"C","text":"疗效评估为部分缓解（PR），继续完成根治性放疗，对鼻咽及颈部残留病灶局部加量至76Gy。","is_gold":false},{"letter":"D","text":"疗效评估为部分缓解（PR），继续完成根治性放疗，取消后续化疗计划，仅予口服补钾与营养支持。","is_gold":false},{"letter":"E","text":"疗效评估为部分缓解（PR），继续完成根治性放疗及既定化疗计划，并加用尼妥珠单抗靶向治疗。","is_gold":false},{"letter":"F","text":"疗效评估为完全缓解（CR），提前终止放疗与化疗，拔除静脉通道，转入定期门诊随访观察阶段。","is_gold":false},{"letter":"G","text":"疗效评估为部分缓解（PR），继续完成根治性放疗，并行局部清扫术，处理右侧咽旁及咽后残留病灶。","is_gold":false},{"letter":"H","text":"疗效评估为疾病稳定（SD），继续放疗，并联合PD-1抑制剂以增强局部控制与全身抗肿瘤反应。","is_gold":false},{"letter":"I","text":"疗效评估为部分缓解（PR），暂停放疗优先纠正低钾血症与营养不良，待电解质完全恢复后重启放疗。","is_gold":false},{"letter":"J","text":"疗效评估为部分缓解（PR），继续完成根治性放疗及既定化疗计划，无需特殊支持治疗，定期复查即可。","is_gold":false},{"letter":"K","text":"疗效评估为部分缓解（PR），继续完成根治性放疗及既定化疗计划，并加强静脉营养支持与补钾等对症处理。","is_gold":true},{"letter":"L","text":"疗效评估为疾病稳定（SD），继续完成根治性放疗，将后续化疗方案调整为紫杉醇联合卡铂以克服耐药。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D80] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌放疗后，对比某次就诊时间日MR： 鼻咽腔狭窄，鼻咽顶壁、顶后壁、右侧壁明显增厚，并见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化，肿物占据右侧咽隐窝。鼻咽左侧壁未见增厚，左侧咽隐窝正常，左侧咽旁及颈动脉鞘区未见异常。双侧鼻腔及口咽各壁未见异常。 右侧腭帆张提肌、右侧头长肌及右侧翼内肌受侵，病变包绕右侧颈内动静脉。 左侧腭帆提肌、腭帆张肌、头长肌未见受侵征象。 双侧翼腭窝、颞下窝未见异常；口咽侧壁未见增厚。 蝶骨基底部右份及右侧翼突基底部内侧、右侧翼突内板骨质信号减低，增强扫描不均匀强化。余颅底骨质未见明确异常。双侧海绵窦形态正常，未见增宽。 双侧筛窦、上颌窦、蝶窦及双侧乳突粘膜增厚，可见大量分泌物，骨壁完整；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 右侧咽后见多个肿大淋巴结，最大者短径9mm，增强后明显强化，融合。左侧咽后及双颈II区见多发小淋巴结，最大者短径约7mm，未见坏死及包膜外侵。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺左叶见一结节，大小约11mm×11mm，边界尚清， T1WI及T2WI均呈混杂高信号，增强扫描部分区域强化较明显。甲状腺右叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。；检查结论: 鼻咽癌放疗后，右侧咽旁见肿瘤残留，病变范围较前缩小。 颅底骨质破坏，范围大致同前。 右侧咽后肿大淋巴结，考虑转移，较前缩小。 左侧咽后及双颈II区小淋巴结，较前未见明显变化。 鼻窦炎；乳突炎，较前明显。 甲状腺左叶结节灶，大致同前。\n- [全程D80] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理稍粗，走行自然，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显病变。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 疗效评估为疾病进展（PD），终止放化疗计划，改行鼻咽及颈部挽救性手术切除。\nB. 疗效评估为疾病进展（PD），停用顺铂，更改化疗方案为吉西他滨联合氟尿嘧啶并继续放疗。\nC. 疗效评估为部分缓解（PR），继续完成根治性放疗，对鼻咽及颈部残留病灶局部加量至76Gy。\nD. 疗效评估为部分缓解（PR），继续完成根治性放疗，取消后续化疗计划，仅予口服补钾与营养支持。\nE. 疗效评估为部分缓解（PR），继续完成根治性放疗及既定化疗计划，并加用尼妥珠单抗靶向治疗。\nF. 疗效评估为完全缓解（CR），提前终止放疗与化疗，拔除静脉通道，转入定期门诊随访观察阶段。\nG. 疗效评估为部分缓解（PR），继续完成根治性放疗，并行局部清扫术，处理右侧咽旁及咽后残留病灶。\nH. 疗效评估为疾病稳定（SD），继续放疗，并联合PD-1抑制剂以增强局部控制与全身抗肿瘤反应。\nI. 疗效评估为部分缓解（PR），暂停放疗优先纠正低钾血症与营养不良，待电解质完全恢复后重启放疗。\nJ. 疗效评估为部分缓解（PR），继续完成根治性放疗及既定化疗计划，无需特殊支持治疗，定期复查即可。\nK. 疗效评估为部分缓解（PR），继续完成根治性放疗及既定化疗计划，并加强静脉营养支持与补钾等对症处理。\nL. 疗效评估为疾病稳定（SD），继续完成根治性放疗，将后续化疗方案调整为紫杉醇联合卡铂以克服耐药。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D80] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌放疗后，对比某次就诊时间日MR： 鼻咽腔狭窄，鼻咽顶壁、顶后壁、右侧壁明显增厚，并见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化，肿物占据右侧咽隐窝。鼻咽左侧壁未见增厚，左侧咽隐窝正常，左侧咽旁及颈动脉鞘区未见异常。双侧鼻腔及口咽各壁未见异常。 右侧腭帆张提肌、右侧头长肌及右侧翼内肌受侵，病变包绕右侧颈内动静脉。 左侧腭帆提肌、腭帆张肌、头长肌未见受侵征象。 双侧翼腭窝、颞下窝未见异常；口咽侧壁未见增厚。 蝶骨基底部右份及右侧翼突基底部内侧、右侧翼突内板骨质信号减低，增强扫描不均匀强化。余颅底骨质未见明确异常。双侧海绵窦形态正常，未见增宽。 双侧筛窦、上颌窦、蝶窦及双侧乳突粘膜增厚，可见大量分泌物，骨壁完整；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 右侧咽后见多个肿大淋巴结，最大者短径9mm，增强后明显强化，融合。左侧咽后及双颈II区见多发小淋巴结，最大者短径约7mm，未见坏死及包膜外侵。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺左叶见一结节，大小约11mm×11mm，边界尚清， T1WI及T2WI均呈混杂高信号，增强扫描部分区域强化较明显。甲状腺右叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。；检查结论: 鼻咽癌放疗后，右侧咽旁见肿瘤残留，病变范围较前缩小。 颅底骨质破坏，范围大致同前。 右侧咽后肿大淋巴结，考虑转移，较前缩小。 左侧咽后及双颈II区小淋巴结，较前未见明显变化。 鼻窦炎；乳突炎，较前明显。 甲状腺左叶结节灶，大致同前。\n- [全程D80] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理稍粗，走行自然，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显病变。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 疗效评估为疾病进展（PD），终止放化疗计划，改行鼻咽及颈部挽救性手术切除。\nB. 疗效评估为疾病进展（PD），停用顺铂，更改化疗方案为吉西他滨联合氟尿嘧啶并继续放疗。\nC. 疗效评估为部分缓解（PR），继续完成根治性放疗，对鼻咽及颈部残留病灶局部加量至76Gy。\nD. 疗效评估为部分缓解（PR），继续完成根治性放疗，取消后续化疗计划，仅予口服补钾与营养支持。\nE. 疗效评估为部分缓解（PR），继续完成根治性放疗及既定化疗计划，并加用尼妥珠单抗靶向治疗。\nF. 疗效评估为完全缓解（CR），提前终止放疗与化疗，拔除静脉通道，转入定期门诊随访观察阶段。\nG. 疗效评估为部分缓解（PR），继续完成根治性放疗，并行局部清扫术，处理右侧咽旁及咽后残留病灶。\nH. 疗效评估为疾病稳定（SD），继续放疗，并联合PD-1抑制剂以增强局部控制与全身抗肿瘤反应。\nI. 疗效评估为部分缓解（PR），暂停放疗优先纠正低钾血症与营养不良，待电解质完全恢复后重启放疗。\nJ. 疗效评估为部分缓解（PR），继续完成根治性放疗及既定化疗计划，无需特殊支持治疗，定期复查即可。\nK. 疗效评估为部分缓解（PR），继续完成根治性放疗及既定化疗计划，并加强静脉营养支持与补钾等对症处理。\nL. 疗效评估为疾病稳定（SD），继续完成根治性放疗，将后续化疗方案调整为紫杉醇联合卡铂以克服耐药。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-7a40e0f2bd95183560f7b041","patient_id":"patient-eecadcdf172a1efe8947b052","turn_id":"turn01","turn_position":1,"turn_type":"initial_workup_choice","gold_letter":"H","gold_action":"行鼻咽镜下活检明确病理，并抽血查血常规、生化、EBV-DNA等基线指标。","options":[{"letter":"A","text":"直接安排根治性同步放化疗，暂缓病理活检及血液学检查","is_gold":false},{"letter":"B","text":"行鼻咽及颈部增强CT评估局部病变，暂缓病理活检及血液学检查","is_gold":false},{"letter":"C","text":"行颈部淋巴结切除活检明确病理，并完善全身PET-CT及基线血液学检查","is_gold":false},{"letter":"D","text":"行鼻咽镜下活检明确病理，并直接开始诱导化疗，暂缓基线血液学检查","is_gold":false},{"letter":"E","text":"抽血查EBV-DNA及肿瘤标志物，若阳性则直接开始根治性放疗","is_gold":false},{"letter":"F","text":"行全身骨扫描及头颅增强MRI，待排除远处转移后再行鼻咽局部活检","is_gold":false},{"letter":"G","text":"行鼻咽镜下活检明确病理，并预防性行双侧颈部淋巴结清扫术","is_gold":false},{"letter":"H","text":"行鼻咽镜下活检明确病理，并抽血查血常规、生化、EBV-DNA等基线指标","is_gold":true},{"letter":"I","text":"行鼻咽脱落细胞学检查明确病理，并抽血查血常规、生化、EBV-DNA等基线指标","is_gold":false},{"letter":"J","text":"行胸腹部增强CT及全身骨扫描，待排除远处转移后再行鼻咽活检及血液学检查","is_gold":false},{"letter":"K","text":"行鼻咽镜下活检明确病理，并立即给予大剂量甲氨蝶呤静脉化疗","is_gold":false},{"letter":"L","text":"行颈部淋巴结细针穿刺活检明确病理，并抽血查血常规、生化、EBV-DNA等基线指标","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N1，M0。\n综合TNM状态：T4N1M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D7] 入院记录: 主诉: 头痛伴耳鸣、听力下降3月余。；颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。今患者为进一步诊治，予收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,双咽后淋巴结肿大,头痛；既往史: 否认\"乙肝、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认饮酒史。否认不洁性生活史。；家族史: 患者叔叔因肺癌死亡。；体格检查: T：36.2℃，P：82次/分，R：20次/分，BP：128/74mmHg,Ht：172cm，Wt：80kg，BSA：1.92m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无叩痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约1cm*0.8cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 直接安排根治性同步放化疗，暂缓病理活检及血液学检查\nB. 行鼻咽及颈部增强CT评估局部病变，暂缓病理活检及血液学检查\nC. 行颈部淋巴结切除活检明确病理，并完善全身PET-CT及基线血液学检查\nD. 行鼻咽镜下活检明确病理，并直接开始诱导化疗，暂缓基线血液学检查\nE. 抽血查EBV-DNA及肿瘤标志物，若阳性则直接开始根治性放疗\nF. 行全身骨扫描及头颅增强MRI，待排除远处转移后再行鼻咽局部活检\nG. 行鼻咽镜下活检明确病理，并预防性行双侧颈部淋巴结清扫术\nH. 行鼻咽镜下活检明确病理，并抽血查血常规、生化、EBV-DNA等基线指标\nI. 行鼻咽脱落细胞学检查明确病理，并抽血查血常规、生化、EBV-DNA等基线指标\nJ. 行胸腹部增强CT及全身骨扫描，待排除远处转移后再行鼻咽活检及血液学检查\nK. 行鼻咽镜下活检明确病理，并立即给予大剂量甲氨蝶呤静脉化疗\nL. 行颈部淋巴结细针穿刺活检明确病理，并抽血查血常规、生化、EBV-DNA等基线指标\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N1，M0。\n综合TNM状态：T4N1M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D7] 入院记录: 主诉: 头痛伴耳鸣、听力下降3月余。；颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。今患者为进一步诊治，予收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,双咽后淋巴结肿大,头痛；既往史: 否认\"乙肝、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认饮酒史。否认不洁性生活史。；家族史: 患者叔叔因肺癌死亡。；体格检查: T：36.2℃，P：82次/分，R：20次/分，BP：128/74mmHg,Ht：172cm，Wt：80kg，BSA：1.92m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无叩痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约1cm*0.8cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 直接安排根治性同步放化疗，暂缓病理活检及血液学检查\nB. 行鼻咽及颈部增强CT评估局部病变，暂缓病理活检及血液学检查\nC. 行颈部淋巴结切除活检明确病理，并完善全身PET-CT及基线血液学检查\nD. 行鼻咽镜下活检明确病理，并直接开始诱导化疗，暂缓基线血液学检查\nE. 抽血查EBV-DNA及肿瘤标志物，若阳性则直接开始根治性放疗\nF. 行全身骨扫描及头颅增强MRI，待排除远处转移后再行鼻咽局部活检\nG. 行鼻咽镜下活检明确病理，并预防性行双侧颈部淋巴结清扫术\nH. 行鼻咽镜下活检明确病理，并抽血查血常规、生化、EBV-DNA等基线指标\nI. 行鼻咽脱落细胞学检查明确病理，并抽血查血常规、生化、EBV-DNA等基线指标\nJ. 行胸腹部增强CT及全身骨扫描，待排除远处转移后再行鼻咽活检及血液学检查\nK. 行鼻咽镜下活检明确病理，并立即给予大剂量甲氨蝶呤静脉化疗\nL. 行颈部淋巴结细针穿刺活检明确病理，并抽血查血常规、生化、EBV-DNA等基线指标\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-fd63f0707132f4eb9174ab3e","patient_id":"patient-eecadcdf172a1efe8947b052","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"I","gold_action":"明确临床分期为T4N1M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。","options":[{"letter":"A","text":"明确临床分期为T3N1M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。","is_gold":false},{"letter":"B","text":"明确临床分期为T4N2M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。","is_gold":false},{"letter":"C","text":"明确临床分期为T4N1M0，并直接安排鼻咽及颈部根治性放疗，暂不留置静脉导管。","is_gold":false},{"letter":"D","text":"明确临床分期为T4N1M0，并安排全身PET-CT以进一步明确双颈部淋巴结性质。","is_gold":false},{"letter":"E","text":"明确临床分期为T4N0M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。","is_gold":false},{"letter":"F","text":"明确临床分期为T3N2M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。","is_gold":false},{"letter":"G","text":"明确临床分期为T4N1M0，并安排垂体MRI动态增强扫描以明确垂体受累情况。","is_gold":false},{"letter":"H","text":"明确临床分期为T4N1M0，并安排颈部淋巴结穿刺活检以明确N分期。","is_gold":false},{"letter":"I","text":"明确临床分期为T4N1M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。","is_gold":true},{"letter":"J","text":"明确临床分期为T4N1M0，并安排骨扫描及头颅CT以排除远处转移。","is_gold":false},{"letter":"K","text":"明确临床分期为T4N1M0，并安排鼻咽肿物再次活检以进行EBV相关基因检测。","is_gold":false},{"letter":"L","text":"明确临床分期为T4N1M0，并留置CVC导管及行胸部CT确认管端位置，为后续静脉给药做准备。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N1，M0。\n综合TNM状态：T4N1M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 早期复极改变\n- [全程D0] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.6；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:20（参考: 阴性）；活化部分凝血活酶时间(APTT)-静脉血: 23.1sec.；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；血红蛋白(Hb)-静脉血: 158g/L；血小板比容-静脉血: 26%；氯离子(Cl-)-静脉血: 105.3mmol/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 1.04；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；尿酸(UA)-静脉血: 341umol/L；甘油三酯(TG)-静脉血: 1.27mmol/L；总蛋白(TP)-静脉血: 73.53g/L；尿素氮(BUN)-静脉血: 6.35mmol/L；C-反应蛋白(CRP)-静脉血: 1.45mg/L；载脂蛋白B(apoB)-静脉血: 0.8g/L；总胆汁酸(TBA)-静脉血: 4.7umol/L；葡萄糖(Glu)-静脉血: 4.78mmol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；乳酸脱氢酶(LDH)-静脉血: 160.3U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；大血小板百分比(P-LCR%)-静脉血: 30.4%；中性粒细胞计数(Neut#)-静脉血: 6.410E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；丙氨酸氨基转移酶(ALT)-静脉血: 12.1U/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；ABO血型-静脉血: B；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.7fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；球蛋白(GLO)-静脉血: 28.23g/L；凝血酶时间(TT)-静脉血: 17.5sec.；红细胞计数(RBC#)-静脉血: 5.3710E12/L；平均红细胞体积(MCV)-静脉血: 87fL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.17mmolL；磷(P)-静脉血: 1.03mmol/L；总钙(Ca)-……\n- [全程D3] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理稍粗，未见明确实质性病变。双侧肺门不大，纵隔居中、无增宽。双膈形态正常。双侧肋膈角锐利。心影形态、大小、位置未见异常。；检查结论: 心肺未见明显异常。\n- [全程D3] 超声；双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约11cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约37×31×26mm，包膜光滑，实质回声不均匀，可见强回声斑。 腹主动脉旁未见明确肿物回声。；检查结论: 前列腺钙化。 肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、左侧壁见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强后明显强化，肿物占据鼻咽顶壁、左侧咽隐窝、左侧咽后间隙，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，右侧咽隐窝变浅，右侧咽旁脂肪间隙及颈动脉鞘区未见异常。 左侧腭帆张提肌及左侧头长肌受侵，右侧腭帆提肌、腭帆张肌、头长肌未见受侵征象。 双侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽双侧壁未见增厚。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部、翼突内外板、左侧枕骨基底部及左侧枕骨髁骨质信号减低，增强扫描后明显强化，斜坡局部见不规则软组织肿物影累及斜坡后份脑膜及蝶鞍后份，部分层面与垂体后叶分界欠清。双侧海绵窦形态正常，未见增宽。筛窦、蝶窦、左侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 左侧咽后间隙见肿大淋巴结，大小约为11mm ×9 mm，右侧咽后见肿大淋巴结，短径约6mm，均匀强化。 双颈I、II区见多个淋巴结，边界清，信号均匀，最大短径约8mm，均匀强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。 颅底骨质破坏。 双侧咽后淋巴结肿大，考虑转移。 双颈Ib、II区小淋巴结，性质待定。 副鼻窦炎、左侧乳突炎。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 明确临床分期为T3N1M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。\nB. 明确临床分期为T4N2M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。\nC. 明确临床分期为T4N1M0，并直接安排鼻咽及颈部根治性放疗，暂不留置静脉导管。\nD. 明确临床分期为T4N1M0，并安排全身PET-CT以进一步明确双颈部淋巴结性质。\nE. 明确临床分期为T4N0M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。\nF. 明确临床分期为T3N2M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。\nG. 明确临床分期为T4N1M0，并安排垂体MRI动态增强扫描以明确垂体受累情况。\nH. 明确临床分期为T4N1M0，并安排颈部淋巴结穿刺活检以明确N分期。\nI. 明确临床分期为T4N1M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。\nJ. 明确临床分期为T4N1M0，并安排骨扫描及头颅CT以排除远处转移。\nK. 明确临床分期为T4N1M0，并安排鼻咽肿物再次活检以进行EBV相关基因检测。\nL. 明确临床分期为T4N1M0，并留置CVC导管及行胸部CT确认管端位置，为后续静脉给药做准备。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N1，M0。\n综合TNM状态：T4N1M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 早期复极改变\n- [全程D0] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.6；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:20（参考: 阴性）；活化部分凝血活酶时间(APTT)-静脉血: 23.1sec.；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；血红蛋白(Hb)-静脉血: 158g/L；血小板比容-静脉血: 26%；氯离子(Cl-)-静脉血: 105.3mmol/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 1.04；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；尿酸(UA)-静脉血: 341umol/L；甘油三酯(TG)-静脉血: 1.27mmol/L；总蛋白(TP)-静脉血: 73.53g/L；尿素氮(BUN)-静脉血: 6.35mmol/L；C-反应蛋白(CRP)-静脉血: 1.45mg/L；载脂蛋白B(apoB)-静脉血: 0.8g/L；总胆汁酸(TBA)-静脉血: 4.7umol/L；葡萄糖(Glu)-静脉血: 4.78mmol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；乳酸脱氢酶(LDH)-静脉血: 160.3U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；大血小板百分比(P-LCR%)-静脉血: 30.4%；中性粒细胞计数(Neut#)-静脉血: 6.410E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；丙氨酸氨基转移酶(ALT)-静脉血: 12.1U/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；ABO血型-静脉血: B；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.7fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；球蛋白(GLO)-静脉血: 28.23g/L；凝血酶时间(TT)-静脉血: 17.5sec.；红细胞计数(RBC#)-静脉血: 5.3710E12/L；平均红细胞体积(MCV)-静脉血: 87fL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.17mmolL；磷(P)-静脉血: 1.03mmol/L；总钙(Ca)-……\n- [全程D3] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理稍粗，未见明确实质性病变。双侧肺门不大，纵隔居中、无增宽。双膈形态正常。双侧肋膈角锐利。心影形态、大小、位置未见异常。；检查结论: 心肺未见明显异常。\n- [全程D3] 超声；双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约11cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约37×31×26mm，包膜光滑，实质回声不均匀，可见强回声斑。 腹主动脉旁未见明确肿物回声。；检查结论: 前列腺钙化。 肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、左侧壁见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强后明显强化，肿物占据鼻咽顶壁、左侧咽隐窝、左侧咽后间隙，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，右侧咽隐窝变浅，右侧咽旁脂肪间隙及颈动脉鞘区未见异常。 左侧腭帆张提肌及左侧头长肌受侵，右侧腭帆提肌、腭帆张肌、头长肌未见受侵征象。 双侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽双侧壁未见增厚。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部、翼突内外板、左侧枕骨基底部及左侧枕骨髁骨质信号减低，增强扫描后明显强化，斜坡局部见不规则软组织肿物影累及斜坡后份脑膜及蝶鞍后份，部分层面与垂体后叶分界欠清。双侧海绵窦形态正常，未见增宽。筛窦、蝶窦、左侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 左侧咽后间隙见肿大淋巴结，大小约为11mm ×9 mm，右侧咽后见肿大淋巴结，短径约6mm，均匀强化。 双颈I、II区见多个淋巴结，边界清，信号均匀，最大短径约8mm，均匀强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。 颅底骨质破坏。 双侧咽后淋巴结肿大，考虑转移。 双颈Ib、II区小淋巴结，性质待定。 副鼻窦炎、左侧乳突炎。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 明确临床分期为T3N1M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。\nB. 明确临床分期为T4N2M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。\nC. 明确临床分期为T4N1M0，并直接安排鼻咽及颈部根治性放疗，暂不留置静脉导管。\nD. 明确临床分期为T4N1M0，并安排全身PET-CT以进一步明确双颈部淋巴结性质。\nE. 明确临床分期为T4N0M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。\nF. 明确临床分期为T3N2M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。\nG. 明确临床分期为T4N1M0，并安排垂体MRI动态增强扫描以明确垂体受累情况。\nH. 明确临床分期为T4N1M0，并安排颈部淋巴结穿刺活检以明确N分期。\nI. 明确临床分期为T4N1M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。\nJ. 明确临床分期为T4N1M0，并安排骨扫描及头颅CT以排除远处转移。\nK. 明确临床分期为T4N1M0，并安排鼻咽肿物再次活检以进行EBV相关基因检测。\nL. 明确临床分期为T4N1M0，并留置CVC导管及行胸部CT确认管端位置，为后续静脉给药做准备。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-1a0c7a960fe6a9b60533da3d","patient_id":"patient-eecadcdf172a1efe8947b052","turn_id":"turn05","turn_position":3,"turn_type":"toxicity_or_support_decision","gold_letter":"L","gold_action":"继续本周期化疗，给予止吐、护肝及静脉营养等支持治疗，并完善脑垂体激素五项检查。","options":[{"letter":"A","text":"停止本周期化疗，给予粒细胞集落刺激因子及抗感染支持治疗，并完善脑垂体激素五项检查。","is_gold":false},{"letter":"B","text":"继续本周期化疗，给予止吐、护肝及静脉营养等支持治疗，并完善甲状腺功能及皮质醇检查。","is_gold":false},{"letter":"C","text":"停止本周期化疗，给予大剂量水化、碱化尿液及利尿处理，并完善脑垂体激素五项检查。","is_gold":false},{"letter":"D","text":"继续本周期化疗，给予止吐、护胃及静脉营养支持治疗，暂不进行内分泌功能相关检查。","is_gold":false},{"letter":"E","text":"提前结束本周期化疗，给予全静脉营养支持及强效止吐治疗，并完善脑垂体激素五项检查。","is_gold":false},{"letter":"F","text":"继续本周期化疗，给予止吐、护肝及静脉营养支持治疗，同时行腰椎穿刺脑脊液常规及生化检查。","is_gold":false},{"letter":"G","text":"结束本周期化疗，给予预防性抗感染及护肝支持治疗，并完善脑垂体激素五项检查。","is_gold":false},{"letter":"H","text":"继续本周期化疗，给予止吐及肠内营养支持治疗，避免静脉营养，并复查鼻咽及垂体增强MRI。","is_gold":false},{"letter":"I","text":"暂停氟尿嘧啶持续静脉滴注，给予口腔局部镇痛及促进黏膜愈合处理，并完善脑垂体激素五项检查。","is_gold":false},{"letter":"J","text":"继续本周期化疗，给予止吐、护肝支持治疗，暂不予静脉营养，并请内分泌科急会诊。","is_gold":false},{"letter":"K","text":"结束本周期化疗，给予止吐、护肝及静脉营养支持治疗，并于次日开始局部区域调强放疗。","is_gold":false},{"letter":"L","text":"继续本周期化疗，给予止吐、护肝及静脉营养等支持治疗，并完善脑垂体激素五项检查。","is_gold":true}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N1，M0。\n综合TNM状态：T4N1M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D7] 入院记录: 主诉: 头痛伴耳鸣、听力下降3月余。；现病史: 患者于某次就诊时间1月无明显诱因下出现头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，患者于至[机构已隐去]就诊，行鼻咽活检病理，并送我院病理会诊示鼻咽分化型非角化性癌。某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。今患者为进一步诊治，予收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,双咽后淋巴结肿大,头痛；既往史: 否认\"乙肝、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认饮酒史。否认不洁性生活史。；家族史: 患者叔叔因肺癌死亡。；体格检查: T：36.2℃，P：82次/分，R：20次/分，BP：128/74mmHg,Ht：172cm，Wt：80kg，BSA：1.92m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率82次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无叩痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约1cm*0.8cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D7] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；载脂蛋白AI(apoAI)-静脉血: 1.41g/L；总蛋白(TP)-静脉血: 72.8g/L；肌酐(Crea)-静脉血: 96.4umol/L；总胆红素(TBIL)-静脉血: 10.3umol/L；血小板比容-静脉血: 26%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；尿素氮(BUN)-静脉血: 5.6mmol/L；白细胞计数(WBC#)-尿液: 1/μL；钠离子(Na+)-静脉血: 140.2mmol/L；颜色-尿液: Light-Yellow；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.2mmolL；C-反应蛋白(CRP)-静脉血: 1.6mg/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；乳酸脱氢酶(LDH)-静脉血: 148.2U/L；总胆固醇(TC)-静脉血: 4.78mmol/L；总蛋白(TP)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 5/μL；平均血小板体积(MPV)-静脉血: 10.8fL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 345g/L；总钙(Ca)-静脉血: 2.34mmol/L；甘油三酯(TG)-静脉血: 1.84mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.34；胱抑素(Cys-C)-静脉血: 0.97mg/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.8U/L；红细胞计数(RBC#)-静脉血: 5.3810E12/L；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；单核细胞百分比(Mono%)-静脉血: 0.065；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.76；血液二氧化碳含量ctCO2(B)-静脉血: 24.3mmol/L；红细胞计数(RBC#)-尿液: 4/μL；间接胆红素(IBIL)-静脉血: 7umolL；浊度(TRUB)-尿液: clear；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.026；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；血小板计数(PLT#)-静脉血: 24610E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；颜色-粪便: 棕色；载脂蛋白……\n- [全程D11] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于第7胸椎椎体右侧水平，估计导管末端位于上腔静脉中-下段交界处。；检查结论: 导管末端位置如上述。\n- [全程D14] 检验组合: α-L-岩藻糖苷酶(AFU)-静脉血: 38.9U/L；载脂蛋白AI(apoAI)-静脉血: 1.64g/L；血红蛋白(Hb)-静脉血: 158g/L；有核红细胞百分比(NRBC%)-静脉血: 0；促黄体生成素(LH)-静脉血: 6.12mIU/ml；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.87mmol/L；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 弱阳性(±)（参考: 阴性）；天门冬氨酸氨基转移酶(AST)-静脉血: 17.6U/L；总胆汁酸(TBA)-静脉血: 1umol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.4pg；大血小板百分比(P-LCR%)-静脉血: 35.7%；胱抑素(Cys-C)-静脉血: 1.56mg/L；白蛋白(ALB)-静脉血: 45.2g/L；甘油三酯(TG)-静脉血: 1.3mmol/L；白细胞计数(WBC#)-静脉血: 9.310E9/L；红细胞计数(RBC#)-静脉血: 5.3710E12/L；单核细胞百分比(Mono%)-静脉血: 0.008；中性粒细胞计数(Neut#)-静脉血: 8.710E9/L；乳酸脱氢酶(LDH)-静脉血: 181.6U/L；总蛋白(TP)-静脉血: 70.8g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.9mmolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.02；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；催乳素(PRL)-静脉血: 308.5uIU/ml；中性粒细胞百分比(Neut%)-静脉血: 0.939；有核红细胞计数(NRBC#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 33.6；促卵泡刺激素(FSH)-静脉血: 9.93mIU/ml；钾离子(K+)-静脉血: 4.53mmol/L；镁离子(Mg2+)-静脉血: 0.89mmol/L；平均血小板体积(MPV)-静脉血: 11.3fL；碱性磷酸酶(ALP)-静脉血: 87.4U/L；总胆红素(TBIL)-静脉血: 22.5umol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=1.50)（参考: 阴性）；尿酸(UA)-静脉血: 385.9umol/L；EB……\n\n【既往治疗与反应】\n- [全程D7] 首次病程记录；首次病程记录: 病程类型: 首次病程记录；病程主题: 首次病程记录；病程内容: 病历特点：1、患者中年男性。2、患者于某次就诊时间1月无明显诱因下出现头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，患者于至[机构已隐去]就诊，行鼻咽活检病理，并送我院病理会诊示鼻咽分化型非角化性癌。某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。现患者为进一步诊治，予收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。3、体查：张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约1cm*0.8cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）示图：4、辅助检查：（1） 某次就诊时间在我医院（病理号：[记录编号已隐去]）鼻咽活检病理示：（鼻咽肿物）镜检为分化型非角化性癌（2） 某次就诊时间在我院胸片检查：心肺未见异常。（3） 某次就诊时间在我院腹部B超检查：肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。（4） 某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。副鼻窦炎、左侧乳突炎。（6）某次就诊时间我院：VCA-IgA 1:160 EA-IgA 1:20EBV-DNA定性检测：2.14E102copy/ml。 诊断依据： 初步诊断： 鉴别诊断：患者诊断明确，无需鉴别诊断。 诊疗计划：1、完善相关检查如全身骨扫描、血常规、生化等。2、诱导化疗及同期化放疗。\n- [全程D8] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者诉间有头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，无面麻、声嘶。[姓名已隐去]医生信息已隐藏示：嘱患者今日完善全身骨扫描检查，排除骨转移征象，治疗上暂给予对症处理，继续观察病情。\n- [全程D9] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日患者症状体征基本同前，无诉其余特殊不适。[姓名已隐去]医生信息已隐藏后指示：某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，最大短径约8mm，均匀强化。骨ECT示鼻咽部、颅底骨代谢较活跃，考虑NPC所致。胸片、腹部B超排除远处转移。故目前临床诊断明确为“鼻咽分化型非角化性癌[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)，治疗方案定为TPF（多西紫杉醇 60mg/m2 + 顺铂 60mg/m2 + 5-FU 2.5g/m2， q21d）诱导化疗3程后再行同期放化疗，放疗采用IMRT技术，同期化疗采用顺铂 60mg/m2（q21d）2程。并指示化疗期间给予护肝、护胃、止吐及营养支持治疗。已向患者及家属交代病情及治疗相关不良反应后，其表示理解，并同意上述治疗方案。拟明日开始行多西紫杉醇化疗，密切观察患者病情变化。\n- [全程D12] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 患者今日TPF方案化疗第3天，现一般情况可，未诉恶心、呕吐、腹痛、腹泻等不适，大小便正常。[姓名已隐去]医生信息已隐藏出，患者目前一般情况可，可继续化疗。注意化疗结束后复查血、生化常规，及时对症处理。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 停止本周期化疗，给予粒细胞集落刺激因子及抗感染支持治疗，并完善脑垂体激素五项检查。\nB. 继续本周期化疗，给予止吐、护肝及静脉营养等支持治疗，并完善甲状腺功能及皮质醇检查。\nC. 停止本周期化疗，给予大剂量水化、碱化尿液及利尿处理，并完善脑垂体激素五项检查。\nD. 继续本周期化疗，给予止吐、护胃及静脉营养支持治疗，暂不进行内分泌功能相关检查。\nE. 提前结束本周期化疗，给予全静脉营养支持及强效止吐治疗，并完善脑垂体激素五项检查。\nF. 继续本周期化疗，给予止吐、护肝及静脉营养支持治疗，同时行腰椎穿刺脑脊液常规及生化检查。\nG. 结束本周期化疗，给予预防性抗感染及护肝支持治疗，并完善脑垂体激素五项检查。\nH. 继续本周期化疗，给予止吐及肠内营养支持治疗，避免静脉营养，并复查鼻咽及垂体增强MRI。\nI. 暂停氟尿嘧啶持续静脉滴注，给予口腔局部镇痛及促进黏膜愈合处理，并完善脑垂体激素五项检查。\nJ. 继续本周期化疗，给予止吐、护肝支持治疗，暂不予静脉营养，并请内分泌科急会诊。\nK. 结束本周期化疗，给予止吐、护肝及静脉营养支持治疗，并于次日开始局部区域调强放疗。\nL. 继续本周期化疗，给予止吐、护肝及静脉营养等支持治疗，并完善脑垂体激素五项检查。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N1，M0。\n综合TNM状态：T4N1M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D7] 入院记录: 主诉: 头痛伴耳鸣、听力下降3月余。；现病史: 患者于某次就诊时间1月无明显诱因下出现头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，患者于至[机构已隐去]就诊，行鼻咽活检病理，并送我院病理会诊示鼻咽分化型非角化性癌。某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。今患者为进一步诊治，予收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,双咽后淋巴结肿大,头痛；既往史: 否认\"乙肝、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认饮酒史。否认不洁性生活史。；家族史: 患者叔叔因肺癌死亡。；体格检查: T：36.2℃，P：82次/分，R：20次/分，BP：128/74mmHg,Ht：172cm，Wt：80kg，BSA：1.92m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率82次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无叩痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约1cm*0.8cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D7] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；载脂蛋白AI(apoAI)-静脉血: 1.41g/L；总蛋白(TP)-静脉血: 72.8g/L；肌酐(Crea)-静脉血: 96.4umol/L；总胆红素(TBIL)-静脉血: 10.3umol/L；血小板比容-静脉血: 26%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；尿素氮(BUN)-静脉血: 5.6mmol/L；白细胞计数(WBC#)-尿液: 1/μL；钠离子(Na+)-静脉血: 140.2mmol/L；颜色-尿液: Light-Yellow；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.2mmolL；C-反应蛋白(CRP)-静脉血: 1.6mg/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；乳酸脱氢酶(LDH)-静脉血: 148.2U/L；总胆固醇(TC)-静脉血: 4.78mmol/L；总蛋白(TP)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 5/μL；平均血小板体积(MPV)-静脉血: 10.8fL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 345g/L；总钙(Ca)-静脉血: 2.34mmol/L；甘油三酯(TG)-静脉血: 1.84mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.34；胱抑素(Cys-C)-静脉血: 0.97mg/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.8U/L；红细胞计数(RBC#)-静脉血: 5.3810E12/L；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；单核细胞百分比(Mono%)-静脉血: 0.065；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.76；血液二氧化碳含量ctCO2(B)-静脉血: 24.3mmol/L；红细胞计数(RBC#)-尿液: 4/μL；间接胆红素(IBIL)-静脉血: 7umolL；浊度(TRUB)-尿液: clear；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.026；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；血小板计数(PLT#)-静脉血: 24610E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；颜色-粪便: 棕色；载脂蛋白……\n- [全程D11] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于第7胸椎椎体右侧水平，估计导管末端位于上腔静脉中-下段交界处。；检查结论: 导管末端位置如上述。\n- [全程D14] 检验组合: α-L-岩藻糖苷酶(AFU)-静脉血: 38.9U/L；载脂蛋白AI(apoAI)-静脉血: 1.64g/L；血红蛋白(Hb)-静脉血: 158g/L；有核红细胞百分比(NRBC%)-静脉血: 0；促黄体生成素(LH)-静脉血: 6.12mIU/ml；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.87mmol/L；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 弱阳性(±)（参考: 阴性）；天门冬氨酸氨基转移酶(AST)-静脉血: 17.6U/L；总胆汁酸(TBA)-静脉血: 1umol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.4pg；大血小板百分比(P-LCR%)-静脉血: 35.7%；胱抑素(Cys-C)-静脉血: 1.56mg/L；白蛋白(ALB)-静脉血: 45.2g/L；甘油三酯(TG)-静脉血: 1.3mmol/L；白细胞计数(WBC#)-静脉血: 9.310E9/L；红细胞计数(RBC#)-静脉血: 5.3710E12/L；单核细胞百分比(Mono%)-静脉血: 0.008；中性粒细胞计数(Neut#)-静脉血: 8.710E9/L；乳酸脱氢酶(LDH)-静脉血: 181.6U/L；总蛋白(TP)-静脉血: 70.8g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.9mmolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.02；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；催乳素(PRL)-静脉血: 308.5uIU/ml；中性粒细胞百分比(Neut%)-静脉血: 0.939；有核红细胞计数(NRBC#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 33.6；促卵泡刺激素(FSH)-静脉血: 9.93mIU/ml；钾离子(K+)-静脉血: 4.53mmol/L；镁离子(Mg2+)-静脉血: 0.89mmol/L；平均血小板体积(MPV)-静脉血: 11.3fL；碱性磷酸酶(ALP)-静脉血: 87.4U/L；总胆红素(TBIL)-静脉血: 22.5umol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=1.50)（参考: 阴性）；尿酸(UA)-静脉血: 385.9umol/L；EB……\n\n【既往治疗与反应】\n- [全程D7] 首次病程记录；首次病程记录: 病程类型: 首次病程记录；病程主题: 首次病程记录；病程内容: 病历特点：1、患者中年男性。2、患者于某次就诊时间1月无明显诱因下出现头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，患者于至[机构已隐去]就诊，行鼻咽活检病理，并送我院病理会诊示鼻咽分化型非角化性癌。某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。现患者为进一步诊治，予收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。3、体查：张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约1cm*0.8cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）示图：4、辅助检查：（1） 某次就诊时间在我医院（病理号：[记录编号已隐去]）鼻咽活检病理示：（鼻咽肿物）镜检为分化型非角化性癌（2） 某次就诊时间在我院胸片检查：心肺未见异常。（3） 某次就诊时间在我院腹部B超检查：肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。（4） 某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。副鼻窦炎、左侧乳突炎。（6）某次就诊时间我院：VCA-IgA 1:160 EA-IgA 1:20EBV-DNA定性检测：2.14E102copy/ml。 诊断依据： 初步诊断： 鉴别诊断：患者诊断明确，无需鉴别诊断。 诊疗计划：1、完善相关检查如全身骨扫描、血常规、生化等。2、诱导化疗及同期化放疗。\n- [全程D8] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者诉间有头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，无面麻、声嘶。[姓名已隐去]医生信息已隐藏示：嘱患者今日完善全身骨扫描检查，排除骨转移征象，治疗上暂给予对症处理，继续观察病情。\n- [全程D9] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日患者症状体征基本同前，无诉其余特殊不适。[姓名已隐去]医生信息已隐藏后指示：某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，最大短径约8mm，均匀强化。骨ECT示鼻咽部、颅底骨代谢较活跃，考虑NPC所致。胸片、腹部B超排除远处转移。故目前临床诊断明确为“鼻咽分化型非角化性癌[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)，治疗方案定为TPF（多西紫杉醇 60mg/m2 + 顺铂 60mg/m2 + 5-FU 2.5g/m2， q21d）诱导化疗3程后再行同期放化疗，放疗采用IMRT技术，同期化疗采用顺铂 60mg/m2（q21d）2程。并指示化疗期间给予护肝、护胃、止吐及营养支持治疗。已向患者及家属交代病情及治疗相关不良反应后，其表示理解，并同意上述治疗方案。拟明日开始行多西紫杉醇化疗，密切观察患者病情变化。\n- [全程D12] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 患者今日TPF方案化疗第3天，现一般情况可，未诉恶心、呕吐、腹痛、腹泻等不适，大小便正常。[姓名已隐去]医生信息已隐藏出，患者目前一般情况可，可继续化疗。注意化疗结束后复查血、生化常规，及时对症处理。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 停止本周期化疗，给予粒细胞集落刺激因子及抗感染支持治疗，并完善脑垂体激素五项检查。\nB. 继续本周期化疗，给予止吐、护肝及静脉营养等支持治疗，并完善甲状腺功能及皮质醇检查。\nC. 停止本周期化疗，给予大剂量水化、碱化尿液及利尿处理，并完善脑垂体激素五项检查。\nD. 继续本周期化疗，给予止吐、护胃及静脉营养支持治疗，暂不进行内分泌功能相关检查。\nE. 提前结束本周期化疗，给予全静脉营养支持及强效止吐治疗，并完善脑垂体激素五项检查。\nF. 继续本周期化疗，给予止吐、护肝及静脉营养支持治疗，同时行腰椎穿刺脑脊液常规及生化检查。\nG. 结束本周期化疗，给予预防性抗感染及护肝支持治疗，并完善脑垂体激素五项检查。\nH. 继续本周期化疗，给予止吐及肠内营养支持治疗，避免静脉营养，并复查鼻咽及垂体增强MRI。\nI. 暂停氟尿嘧啶持续静脉滴注，给予口腔局部镇痛及促进黏膜愈合处理，并完善脑垂体激素五项检查。\nJ. 继续本周期化疗，给予止吐、护肝支持治疗，暂不予静脉营养，并请内分泌科急会诊。\nK. 结束本周期化疗，给予止吐、护肝及静脉营养支持治疗，并于次日开始局部区域调强放疗。\nL. 继续本周期化疗，给予止吐、护肝及静脉营养等支持治疗，并完善脑垂体激素五项检查。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-efbe1e2a6ec0abf3be38883f","patient_id":"patient-eecadcdf172a1efe8947b052","turn_id":"turn07","turn_position":4,"turn_type":"response_assessment_decision","gold_letter":"B","gold_action":"评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行根治性同期放化疗。","options":[{"letter":"A","text":"评估诱导化疗疗效为疾病稳定，继续原方案第4程诱导化疗，并予以静脉补钾、补钠及护肾治疗后出院。","is_gold":false},{"letter":"B","text":"评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行根治性同期放化疗。","is_gold":true},{"letter":"C","text":"评估诱导化疗疗效为完全缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行单纯根治性放疗。","is_gold":false},{"letter":"D","text":"评估诱导化疗疗效为部分缓解，予以静脉补钾、补钠及护肾治疗，待电解质及肾功能恢复正常后立即开始第4程诱导化疗。","is_gold":false},{"letter":"E","text":"评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行单纯根治性放疗。","is_gold":false},{"letter":"F","text":"评估诱导化疗疗效为疾病进展，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院更改为GP方案化疗。","is_gold":false},{"letter":"G","text":"评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行根治性放疗联合靶向治疗。","is_gold":false},{"letter":"H","text":"评估诱导化疗疗效为部分缓解，因出现肾功能损害，予以护肾治疗后出院，并安排按期返院行单纯根治性放疗，取消同期化疗。","is_gold":false},{"letter":"I","text":"评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行姑息性放化疗。","is_gold":false},{"letter":"J","text":"评估诱导化疗疗效为部分缓解，予以静脉补钾、补钠及护肾治疗，住院期间直接开始根治性同期放化疗。","is_gold":false},{"letter":"K","text":"评估诱导化疗疗效为疾病稳定，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行根治性同期放化疗。","is_gold":false},{"letter":"L","text":"评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行鼻咽及颈部淋巴结清扫术。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N1，M0。\n综合TNM状态：T4N1M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D53] 入院记录: 主诉: 鼻咽癌2程诱导化疗后20天。；现病史: 患者于某次就诊时间1月无明显诱因下出现头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，患者于至[机构已隐去]就诊，行鼻咽活检，并送我院病理会诊示鼻咽分化型非角化性癌。某次就诊时间在我院行鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶；颅底骨质破坏；双侧咽后淋巴结肿大，考虑转移；双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。明确诊断为鼻咽分化型非角化性癌，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)。于某次就诊时间、某次就诊时间行TPF化疗（DOC 60mg/m2+DDP 60mg/m2+5-FU 2.5g/m2civ48h）2程诱导化疗，化疗过程顺利。今患者为行第3程诱导化疗收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,双咽后淋巴结肿大,头痛；既往史: 否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认饮酒史。否认不洁性生活史。；家族史: 患者叔叔因肺癌死亡。；体格检查: T：36.5℃，P：88次/分，R：20次/分，BP：134/63mmHg,Ht：172cm，Wt：76kg，BSA：1.88m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率88次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无叩痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射……\n\n【已完成检查与客观结果】\n- [全程D38] 检验组合: α-L-岩藻糖苷酶(AFU)-静脉血: 31.3U/L；氯离子(Cl-)-静脉血: 90.1mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.85mmol/L；胱抑素(Cys-C)-静脉血: 1.22mg/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.8mmol/L；钾离子(K+)-静脉血: 3.66mmol/L；总胆汁酸(TBA)-静脉血: 2.2umol/L；甘油三酯(TG)-静脉血: 2.25mmol/L；肌酐(Crea)-静脉血: 108.2umol/L；总钙(Ca)-静脉血: 2.23mmol/L；C-反应蛋白(CRP)-静脉血: 0.28mg/L；钠离子(Na+)-静脉血: 129.2mmol/L；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阴性(-)（参考: 阴性）；球蛋白(GLO)-静脉血: 21.3g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.69mmolL；间接胆红素(IBIL)-静脉血: 16umolL；总胆固醇(TC)-静脉血: 6.95mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 27.8U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.73；白蛋白(ALB)-静脉血: 40.8g/L；总蛋白(TP)-静脉血: 62.1g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.92；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；尿素氮(BUN)-静脉血: 11.7mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=1.25)（参考: 阴性）；尿酸(UA)-静脉血: 368.1umol/L；总胆红素(TBIL)-静脉血: 20.1umol/L；乳酸脱氢酶(LDH)-静脉血: 167U/L；阴离子间隙(AG)-静脉血: 16.3；载脂蛋白B(apoB)-静脉血: 1.3g/L；EB病毒Zta蛋白抗体IgA(EBV-Zta-IgA)-静脉血: 阴性(-)（参考: 阴性）；葡萄糖(Glu)-静脉血: 4.91mmol/L；磷(P)-静脉血: 1.13mmol/L；直接胆……\n- [全程D53] 检验组合: 钠离子(Na+)-静脉血: 142.5mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 29.9U/L；乳酸脱氢酶(LDH)-静脉血: 207.9U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.6；血小板分布宽度(PDW)-静脉血: 10.8%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.035；间接胆红素(IBIL)-静脉血: 5.54umolL；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；天门冬氨酸氨基转移酶(AST)-静脉血: 18.5U/L；磷(P)-静脉血: 0.96mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.04；肌酐(Crea)-静脉血: 102umol/L；甘油三酯(TG)-静脉血: 1.26mmol/L；单核细胞百分比(Mono%)-静脉血: 0.09；大血小板百分比(P-LCR%)-静脉血: 22.6%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；C-反应蛋白(CRP)-静脉血: 0.69mg/L；血红蛋白(Hb)-静脉血: 134g/L；平均红细胞体积(MCV)-静脉血: 86.7fL；平均血小板体积(MPV)-静脉血: 9.7fL；单核细胞计数(Mono#)-静脉血: 0.610E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.009；有核红细胞计数(NRBC#)-静脉血: 010E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.13mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.22；葡萄糖(Glu)-静脉血: 4.43mmol/L；载脂蛋白B(apoB)-静脉血: 1.26g/L；载脂蛋白AI(apoAI)-静脉血: 1.74g/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 332g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.3mmol/L；氯离子(Cl-)-静脉血: 99.6mmol/L；尿酸(UA)-静脉血: 362.4umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.53mmolL；直接胆红素(DBIL)-静脉血: 1.88umol/L；红细胞比容(Hct)-静脉血: 40.4%；总胆固醇(TC)-静脉血: 6.07mmol/L；总钙(Ca)-静脉血:……\n- [全程D59] 检验组合: 平均红细胞体积(MCV)-静脉血: 82fL；大血小板百分比(P-LCR%)-静脉血: 36.3%；有核红细胞百分比(NRBC%)-静脉血: 0；血小板分布宽度(PDW)-静脉血: 15.9%；血小板比容-静脉血: 15%；白细胞计数(WBC#)-静脉血: 4.2710E9/L；血小板计数(PLT#)-静脉血: 13510E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.351；红细胞比容(Hct)-静脉血: 37.9%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.002；有核红细胞计数(NRBC#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 133g/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.631；单核细胞计数(Mono#)-静脉血: 0.110E9/L；红细胞计数(RBC#)-静脉血: 4.6210E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；平均红细胞血红蛋白浓度(MCHC)-静脉血: 351g/L；平均血小板体积(MPV)-静脉血: 11.4fL；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.7；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；单核细胞百分比(Mono%)-静脉血: 0.014；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L\n- [全程D60] 检验组合: 阴离子间隙(AG)-静脉血: 17.3；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=1.25)（参考: 阴性）；胱抑素(Cys-C)-静脉血: 1.21mg/L；氯离子(Cl-)-静脉血: 90.7mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 35.4U/L；载脂蛋白AI(apoAI)-静脉血: 1.83g/L；钠离子(Na+)-静脉血: 130.8mmol/L；总胆红素(TBIL)-静脉血: 20.2umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.8mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；球蛋白(GLO)-静脉血: 22.01g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.03；丙氨酸氨基转移酶(ALT)-静脉血: 24.3U/L；白蛋白(ALB)-静脉血: 44.6g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.5U/L；载脂蛋白B(apoB)-静脉血: 1.33g/L；碱性磷酸酶(ALP)-静脉血: 78.3U/L；葡萄糖(Glu)-静脉血: 5.06mmol/L；磷(P)-静脉血: 1mmol/L；总钙(Ca)-静脉血: 2.29mmol/L；尿酸(UA)-静脉血: 326.1umol/L；总胆汁酸(TBA)-静脉血: 2.7umol/L；总胆固醇(TC)-静脉血: 7.06mmol/L；C-反应蛋白(CRP)-静脉血: 0.2mg/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.72；直接胆红素(DBIL)-静脉血: 4.4umol/L；镁离子(Mg2+)-静脉血: 0.72mmol/L；EB病毒Zta蛋白抗体IgA(EBV-Zta-IgA)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.71mmolL；总蛋白(TP)-静脉血: 66.61g/L；甘油三酯(TG)-静脉血: 2.92mmol/L；肌酐(Crea)-静脉血: 112.8umol/L；尿素氮(BUN)-静脉血: 10.2mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.……\n- [全程D61] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后复查，较某次就诊时间片对比： 鼻咽腔未见明显狭窄，鼻咽左侧壁粘膜稍增厚，T1WI呈等信号，T2WI呈稍高信号，增强后明显强化，左侧咽隐窝变浅，右侧咽隐窝清晰，双侧咽旁脂肪间隙及颈动脉鞘区未见异常。鼻咽肿物较前明显缩小好转。 左侧腭帆张提肌及左侧头长肌稍肿胀，右侧腭帆提肌、腭帆张肌、头长肌未见受侵征象。 双侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽双侧壁未见增厚，双侧后鼻孔未见肿物。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部、翼突内外板、左侧枕骨基底部及左侧枕骨髁骨质信号减低，增强扫描后明显强化。双侧海绵窦形态正常，未见增宽。左侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧咽后见小淋巴结，最大短径约5 mm。 双颈I、II区见多个淋巴结，边界清，信号均匀，最大短径约7mm，均匀强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗后复查，较某次就诊时间片对比： 鼻咽肿物较前明显缩小好转，累及范围较前缩小。 颅底骨质破坏同前。 双侧咽后淋巴结较前缩小。 双颈I、II区小淋巴结，较前稍缩小。 左侧乳突炎。\n\n【既往治疗与反应】\n- [全程D53] 首次病程记录；首次病程记录: 病程类型: 首次病程记录；病程主题: 首次病程记录；病程内容: 病历特点：1、患者中年男性。2、患者于某次就诊时间1月无明显诱因下出现头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，患者于至[机构已隐去]就诊，行鼻咽活检，并送我院病理会诊示鼻咽分化型非角化性癌。某次就诊时间在我院行鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶；颅底骨质破坏；双侧咽后淋巴结肿大，考虑转移；双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。明确诊断为鼻咽分化型非角化性癌，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)。于某次就诊时间、某次就诊时间行TPF化疗（DOC 60mg/m2+DDP 60mg/m2+5-FU 2.5g/m2civ48h）2程诱导化疗，化疗过程顺利。今患者为行第3程诱导化疗收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。3、体查：张口门齿距5cm；鼻咽肿物较前明显消退；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约0.8cm*0.5cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）。4、辅助检查：（1） 某次就诊时间在我医院（病理号：[记录编号已隐去]）鼻咽活检病理示：（鼻咽肿物）镜检为分化型非角化性癌（2） 某次就诊时间在我院胸片检查：心肺未见异常。（3） 某次就诊时间在我院腹部B超检查：肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。（4） 某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。副鼻窦炎、左侧乳突炎。（6） 某次就诊时间我院：VCA-IgA 1:160 EA-IgA 1:20 EBV-DNA定性检测：2.14E102copy/ml 诊断依据： 初步诊断： 鉴别诊断：诊断明确，暂无需鉴别。 诊疗计划：1、完善相关检查如三大常规、电子鼻咽镜等。2、综合治疗。\n- [全程D54] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日随[姓名已隐去]医生信息已隐藏，详细询问病史并查体后，分析病情如下：1、患者中年男性，因“鼻咽癌2程诱导化疗后20天”入院。2、查体：张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约0.8cm*0.5cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）。3、辅助检查：某次就诊时间在我医院（病理号：[记录编号已隐去]）鼻咽活检病理示：（鼻咽肿物）镜检为分化型非角化性癌。某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。副鼻窦炎、左侧乳突炎。综上述，患者诊断鼻咽分化型非角化性癌，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)。[姓名已隐去]医生信息已隐藏，患者现一般情况可。昨日复查血常规及生化常规未见明显异常，拟今日开始行第3程诱导化疗，注意防治化疗相关毒副反应。\n- [全程D55] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日随[姓名已隐去]医生信息已隐藏，详细询问病史并查体后，分析病情如下：1、患者中年男性，因“鼻咽癌2程诱导化疗后20天”入院。2、查体：张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约0.8cm*0.5cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）。3、辅助检查：某次就诊时间在我医院（病理号：[记录编号已隐去]）鼻咽活检病理示：（鼻咽肿物）镜检为分化型非角化性癌。某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。副鼻窦炎、左侧乳突炎。综上述，患者诊断鼻咽分化型非角化性癌，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)。[姓名已隐去]医生信息已隐藏，患者现一般情况可。化疗前复查血常规及生化常规未见明显异常，于昨日开始行第3程诱导化疗，注意水化、护胃止呕、营养补液等对症支持治疗。\n- [全程D58] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日TPF方案化疗第5天，现一般情况可，未诉恶心、呕吐、腹痛、腹泻等不适，大小便正常。[姓名已隐去]主治医师，患者目前一般情况可，可继续化疗。注意化疗结束后复查血、生化常规，及时对症处理。\n- [全程D60] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日已完成第3程TPF方案（多西紫杉醇 60mg/m2 + DDP 60mg/m2 + 5-Fu 2.5g/m2）诱导化疗，未诉特殊不适。2/5复查血常规结果基本正常，今日复查血生化结果示：K+ 3.13↓ mmol/L，Na+ 130.8↓ mmol/L，IBIL 15.80 ↑ umolL，CRE 112.8↑ umol/L。[姓名已隐去]医生信息已隐藏示：患者现已完成化疗，今日可带口服补钾、护肝及护肾药物出院。嘱患者注意休息，加强营养，口服补钠，每周复查血常规、肝肾功能。按期返院开始同期放化疗，不适时随诊。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估诱导化疗疗效为疾病稳定，继续原方案第4程诱导化疗，并予以静脉补钾、补钠及护肾治疗后出院。\nB. 评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行根治性同期放化疗。\nC. 评估诱导化疗疗效为完全缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行单纯根治性放疗。\nD. 评估诱导化疗疗效为部分缓解，予以静脉补钾、补钠及护肾治疗，待电解质及肾功能恢复正常后立即开始第4程诱导化疗。\nE. 评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行单纯根治性放疗。\nF. 评估诱导化疗疗效为疾病进展，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院更改为GP方案化疗。\nG. 评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行根治性放疗联合靶向治疗。\nH. 评估诱导化疗疗效为部分缓解，因出现肾功能损害，予以护肾治疗后出院，并安排按期返院行单纯根治性放疗，取消同期化疗。\nI. 评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行姑息性放化疗。\nJ. 评估诱导化疗疗效为部分缓解，予以静脉补钾、补钠及护肾治疗，住院期间直接开始根治性同期放化疗。\nK. 评估诱导化疗疗效为疾病稳定，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行根治性同期放化疗。\nL. 评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行鼻咽及颈部淋巴结清扫术。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N1，M0。\n综合TNM状态：T4N1M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D53] 入院记录: 主诉: 鼻咽癌2程诱导化疗后20天。；现病史: 患者于某次就诊时间1月无明显诱因下出现头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，患者于至[机构已隐去]就诊，行鼻咽活检，并送我院病理会诊示鼻咽分化型非角化性癌。某次就诊时间在我院行鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶；颅底骨质破坏；双侧咽后淋巴结肿大，考虑转移；双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。明确诊断为鼻咽分化型非角化性癌，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)。于某次就诊时间、某次就诊时间行TPF化疗（DOC 60mg/m2+DDP 60mg/m2+5-FU 2.5g/m2civ48h）2程诱导化疗，化疗过程顺利。今患者为行第3程诱导化疗收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,双咽后淋巴结肿大,头痛；既往史: 否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认饮酒史。否认不洁性生活史。；家族史: 患者叔叔因肺癌死亡。；体格检查: T：36.5℃，P：88次/分，R：20次/分，BP：134/63mmHg,Ht：172cm，Wt：76kg，BSA：1.88m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率88次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无叩痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射……\n\n【已完成检查与客观结果】\n- [全程D38] 检验组合: α-L-岩藻糖苷酶(AFU)-静脉血: 31.3U/L；氯离子(Cl-)-静脉血: 90.1mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.85mmol/L；胱抑素(Cys-C)-静脉血: 1.22mg/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.8mmol/L；钾离子(K+)-静脉血: 3.66mmol/L；总胆汁酸(TBA)-静脉血: 2.2umol/L；甘油三酯(TG)-静脉血: 2.25mmol/L；肌酐(Crea)-静脉血: 108.2umol/L；总钙(Ca)-静脉血: 2.23mmol/L；C-反应蛋白(CRP)-静脉血: 0.28mg/L；钠离子(Na+)-静脉血: 129.2mmol/L；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阴性(-)（参考: 阴性）；球蛋白(GLO)-静脉血: 21.3g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.69mmolL；间接胆红素(IBIL)-静脉血: 16umolL；总胆固醇(TC)-静脉血: 6.95mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 27.8U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.73；白蛋白(ALB)-静脉血: 40.8g/L；总蛋白(TP)-静脉血: 62.1g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.92；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；尿素氮(BUN)-静脉血: 11.7mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=1.25)（参考: 阴性）；尿酸(UA)-静脉血: 368.1umol/L；总胆红素(TBIL)-静脉血: 20.1umol/L；乳酸脱氢酶(LDH)-静脉血: 167U/L；阴离子间隙(AG)-静脉血: 16.3；载脂蛋白B(apoB)-静脉血: 1.3g/L；EB病毒Zta蛋白抗体IgA(EBV-Zta-IgA)-静脉血: 阴性(-)（参考: 阴性）；葡萄糖(Glu)-静脉血: 4.91mmol/L；磷(P)-静脉血: 1.13mmol/L；直接胆……\n- [全程D53] 检验组合: 钠离子(Na+)-静脉血: 142.5mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 29.9U/L；乳酸脱氢酶(LDH)-静脉血: 207.9U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.6；血小板分布宽度(PDW)-静脉血: 10.8%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.035；间接胆红素(IBIL)-静脉血: 5.54umolL；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；天门冬氨酸氨基转移酶(AST)-静脉血: 18.5U/L；磷(P)-静脉血: 0.96mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.04；肌酐(Crea)-静脉血: 102umol/L；甘油三酯(TG)-静脉血: 1.26mmol/L；单核细胞百分比(Mono%)-静脉血: 0.09；大血小板百分比(P-LCR%)-静脉血: 22.6%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；C-反应蛋白(CRP)-静脉血: 0.69mg/L；血红蛋白(Hb)-静脉血: 134g/L；平均红细胞体积(MCV)-静脉血: 86.7fL；平均血小板体积(MPV)-静脉血: 9.7fL；单核细胞计数(Mono#)-静脉血: 0.610E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.009；有核红细胞计数(NRBC#)-静脉血: 010E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.13mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.22；葡萄糖(Glu)-静脉血: 4.43mmol/L；载脂蛋白B(apoB)-静脉血: 1.26g/L；载脂蛋白AI(apoAI)-静脉血: 1.74g/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 332g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.3mmol/L；氯离子(Cl-)-静脉血: 99.6mmol/L；尿酸(UA)-静脉血: 362.4umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.53mmolL；直接胆红素(DBIL)-静脉血: 1.88umol/L；红细胞比容(Hct)-静脉血: 40.4%；总胆固醇(TC)-静脉血: 6.07mmol/L；总钙(Ca)-静脉血:……\n- [全程D59] 检验组合: 平均红细胞体积(MCV)-静脉血: 82fL；大血小板百分比(P-LCR%)-静脉血: 36.3%；有核红细胞百分比(NRBC%)-静脉血: 0；血小板分布宽度(PDW)-静脉血: 15.9%；血小板比容-静脉血: 15%；白细胞计数(WBC#)-静脉血: 4.2710E9/L；血小板计数(PLT#)-静脉血: 13510E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.351；红细胞比容(Hct)-静脉血: 37.9%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.002；有核红细胞计数(NRBC#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 133g/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.631；单核细胞计数(Mono#)-静脉血: 0.110E9/L；红细胞计数(RBC#)-静脉血: 4.6210E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；平均红细胞血红蛋白浓度(MCHC)-静脉血: 351g/L；平均血小板体积(MPV)-静脉血: 11.4fL；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.7；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；单核细胞百分比(Mono%)-静脉血: 0.014；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L\n- [全程D60] 检验组合: 阴离子间隙(AG)-静脉血: 17.3；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=1.25)（参考: 阴性）；胱抑素(Cys-C)-静脉血: 1.21mg/L；氯离子(Cl-)-静脉血: 90.7mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 35.4U/L；载脂蛋白AI(apoAI)-静脉血: 1.83g/L；钠离子(Na+)-静脉血: 130.8mmol/L；总胆红素(TBIL)-静脉血: 20.2umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.8mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；球蛋白(GLO)-静脉血: 22.01g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.03；丙氨酸氨基转移酶(ALT)-静脉血: 24.3U/L；白蛋白(ALB)-静脉血: 44.6g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.5U/L；载脂蛋白B(apoB)-静脉血: 1.33g/L；碱性磷酸酶(ALP)-静脉血: 78.3U/L；葡萄糖(Glu)-静脉血: 5.06mmol/L；磷(P)-静脉血: 1mmol/L；总钙(Ca)-静脉血: 2.29mmol/L；尿酸(UA)-静脉血: 326.1umol/L；总胆汁酸(TBA)-静脉血: 2.7umol/L；总胆固醇(TC)-静脉血: 7.06mmol/L；C-反应蛋白(CRP)-静脉血: 0.2mg/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.72；直接胆红素(DBIL)-静脉血: 4.4umol/L；镁离子(Mg2+)-静脉血: 0.72mmol/L；EB病毒Zta蛋白抗体IgA(EBV-Zta-IgA)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.71mmolL；总蛋白(TP)-静脉血: 66.61g/L；甘油三酯(TG)-静脉血: 2.92mmol/L；肌酐(Crea)-静脉血: 112.8umol/L；尿素氮(BUN)-静脉血: 10.2mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.……\n- [全程D61] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后复查，较某次就诊时间片对比： 鼻咽腔未见明显狭窄，鼻咽左侧壁粘膜稍增厚，T1WI呈等信号，T2WI呈稍高信号，增强后明显强化，左侧咽隐窝变浅，右侧咽隐窝清晰，双侧咽旁脂肪间隙及颈动脉鞘区未见异常。鼻咽肿物较前明显缩小好转。 左侧腭帆张提肌及左侧头长肌稍肿胀，右侧腭帆提肌、腭帆张肌、头长肌未见受侵征象。 双侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽双侧壁未见增厚，双侧后鼻孔未见肿物。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部、翼突内外板、左侧枕骨基底部及左侧枕骨髁骨质信号减低，增强扫描后明显强化。双侧海绵窦形态正常，未见增宽。左侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧咽后见小淋巴结，最大短径约5 mm。 双颈I、II区见多个淋巴结，边界清，信号均匀，最大短径约7mm，均匀强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗后复查，较某次就诊时间片对比： 鼻咽肿物较前明显缩小好转，累及范围较前缩小。 颅底骨质破坏同前。 双侧咽后淋巴结较前缩小。 双颈I、II区小淋巴结，较前稍缩小。 左侧乳突炎。\n\n【既往治疗与反应】\n- [全程D53] 首次病程记录；首次病程记录: 病程类型: 首次病程记录；病程主题: 首次病程记录；病程内容: 病历特点：1、患者中年男性。2、患者于某次就诊时间1月无明显诱因下出现头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，患者于至[机构已隐去]就诊，行鼻咽活检，并送我院病理会诊示鼻咽分化型非角化性癌。某次就诊时间在我院行鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶；颅底骨质破坏；双侧咽后淋巴结肿大，考虑转移；双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。明确诊断为鼻咽分化型非角化性癌，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)。于某次就诊时间、某次就诊时间行TPF化疗（DOC 60mg/m2+DDP 60mg/m2+5-FU 2.5g/m2civ48h）2程诱导化疗，化疗过程顺利。今患者为行第3程诱导化疗收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。3、体查：张口门齿距5cm；鼻咽肿物较前明显消退；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约0.8cm*0.5cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）。4、辅助检查：（1） 某次就诊时间在我医院（病理号：[记录编号已隐去]）鼻咽活检病理示：（鼻咽肿物）镜检为分化型非角化性癌（2） 某次就诊时间在我院胸片检查：心肺未见异常。（3） 某次就诊时间在我院腹部B超检查：肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。（4） 某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。副鼻窦炎、左侧乳突炎。（6） 某次就诊时间我院：VCA-IgA 1:160 EA-IgA 1:20 EBV-DNA定性检测：2.14E102copy/ml 诊断依据： 初步诊断： 鉴别诊断：诊断明确，暂无需鉴别。 诊疗计划：1、完善相关检查如三大常规、电子鼻咽镜等。2、综合治疗。\n- [全程D54] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日随[姓名已隐去]医生信息已隐藏，详细询问病史并查体后，分析病情如下：1、患者中年男性，因“鼻咽癌2程诱导化疗后20天”入院。2、查体：张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约0.8cm*0.5cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）。3、辅助检查：某次就诊时间在我医院（病理号：[记录编号已隐去]）鼻咽活检病理示：（鼻咽肿物）镜检为分化型非角化性癌。某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。副鼻窦炎、左侧乳突炎。综上述，患者诊断鼻咽分化型非角化性癌，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)。[姓名已隐去]医生信息已隐藏，患者现一般情况可。昨日复查血常规及生化常规未见明显异常，拟今日开始行第3程诱导化疗，注意防治化疗相关毒副反应。\n- [全程D55] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日随[姓名已隐去]医生信息已隐藏，详细询问病史并查体后，分析病情如下：1、患者中年男性，因“鼻咽癌2程诱导化疗后20天”入院。2、查体：张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约0.8cm*0.5cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）。3、辅助检查：某次就诊时间在我医院（病理号：[记录编号已隐去]）鼻咽活检病理示：（鼻咽肿物）镜检为分化型非角化性癌。某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。副鼻窦炎、左侧乳突炎。综上述，患者诊断鼻咽分化型非角化性癌，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)。[姓名已隐去]医生信息已隐藏，患者现一般情况可。化疗前复查血常规及生化常规未见明显异常，于昨日开始行第3程诱导化疗，注意水化、护胃止呕、营养补液等对症支持治疗。\n- [全程D58] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日TPF方案化疗第5天，现一般情况可，未诉恶心、呕吐、腹痛、腹泻等不适，大小便正常。[姓名已隐去]主治医师，患者目前一般情况可，可继续化疗。注意化疗结束后复查血、生化常规，及时对症处理。\n- [全程D60] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日已完成第3程TPF方案（多西紫杉醇 60mg/m2 + DDP 60mg/m2 + 5-Fu 2.5g/m2）诱导化疗，未诉特殊不适。2/5复查血常规结果基本正常，今日复查血生化结果示：K+ 3.13↓ mmol/L，Na+ 130.8↓ mmol/L，IBIL 15.80 ↑ umolL，CRE 112.8↑ umol/L。[姓名已隐去]医生信息已隐藏示：患者现已完成化疗，今日可带口服补钾、护肝及护肾药物出院。嘱患者注意休息，加强营养，口服补钠，每周复查血常规、肝肾功能。按期返院开始同期放化疗，不适时随诊。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估诱导化疗疗效为疾病稳定，继续原方案第4程诱导化疗，并予以静脉补钾、补钠及护肾治疗后出院。\nB. 评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行根治性同期放化疗。\nC. 评估诱导化疗疗效为完全缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行单纯根治性放疗。\nD. 评估诱导化疗疗效为部分缓解，予以静脉补钾、补钠及护肾治疗，待电解质及肾功能恢复正常后立即开始第4程诱导化疗。\nE. 评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行单纯根治性放疗。\nF. 评估诱导化疗疗效为疾病进展，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院更改为GP方案化疗。\nG. 评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行根治性放疗联合靶向治疗。\nH. 评估诱导化疗疗效为部分缓解，因出现肾功能损害，予以护肾治疗后出院，并安排按期返院行单纯根治性放疗，取消同期化疗。\nI. 评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行姑息性放化疗。\nJ. 评估诱导化疗疗效为部分缓解，予以静脉补钾、补钠及护肾治疗，住院期间直接开始根治性同期放化疗。\nK. 评估诱导化疗疗效为疾病稳定，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行根治性同期放化疗。\nL. 评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行鼻咽及颈部淋巴结清扫术。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-a1bcb1dd845b682149871b63","patient_id":"patient-eecadcdf172a1efe8947b052","turn_id":"turn08","turn_position":5,"turn_type":"response_assessment_decision","gold_letter":"C","gold_action":"完善EB病毒DNA定量及EBV抗体（VCA-IgA、EA-IgA）检测，继续定期随访观察。","options":[{"letter":"A","text":"完善鼻咽及颈部MRI检查，暂缓EB病毒DNA及抗体检测。","is_gold":false},{"letter":"B","text":"安排全身PET-CT检查，替代常规影像学及EB病毒相关指标随访。","is_gold":false},{"letter":"C","text":"完善EB病毒DNA定量及EBV抗体（VCA-IgA、EA-IgA）检测，继续定期随访观察。","is_gold":true},{"letter":"D","text":"完善胸部增强CT及全身骨扫描，暂缓EB病毒DNA定量检测。","is_gold":false},{"letter":"E","text":"延长随访间隔至每半年一次，仅复查腹部彩超及血常规。","is_gold":false},{"letter":"F","text":"安排鼻内镜检查并常规行鼻咽部组织活检，复查EB病毒DNA。","is_gold":false},{"letter":"G","text":"给予抗病毒药物治疗以降低EBV-VCA-IgA滴度，继续随访观察。","is_gold":false},{"letter":"H","text":"启动卡培他滨节拍维持治疗，并每半年复查EB病毒DNA定量。","is_gold":false},{"letter":"I","text":"完善鼻咽及颈部CT平扫，替代MRI及EB病毒DNA定量检测。","is_gold":false},{"letter":"J","text":"安排双侧颈部淋巴结彩超检查，暂缓EB病毒相关指标检测。","is_gold":false},{"letter":"K","text":"启动PD-1抑制剂免疫维持治疗，并定期复查EB病毒DNA定量。","is_gold":false},{"letter":"L","text":"完善头颅增强MRI检查，暂缓鼻咽部及颈部影像学评估。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N1，M0。\n综合TNM状态：T4N1M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D99] 检验组合: 单核细胞计数(Mono#)-静脉血: 1.710E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；血小板分布宽度(PDW)-静脉血: 11.4%；大血小板百分比(P-LCR%)-静脉血: 29.1%；单核细胞百分比(Mono%)-静脉血: 0.093；平均红细胞体积(MCV)-静脉血: 88.1fL；红细胞比容(Hct)-静脉血: 29%；有核红细胞百分比(NRBC%)-静脉血: 0.1；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.9；嗜酸性粒细胞计数(Eos#)-静脉血: 0.410E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.022；白细胞计数(WBC#)-静脉血: 18.7210E9/L；红细胞计数(RBC#)-静脉血: 3.2910E12/L；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；血小板比容-静脉血: 12%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 48；血小板计数(PLT#)-静脉血: 11710E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 345g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.034；平均红细胞血红蛋白含量(MCH)-静脉血: 30.4pg；中性粒细胞计数(Neut#)-静脉血: 15.910E9/L；血红蛋白(Hb)-静脉血: 100g/L；中性粒细胞百分比(Neut%)-静脉血: 0.848；平均血小板体积(MPV)-静脉血: 10.7fL；有核红细胞计数(NRBC#)-静脉血: 0.0210E9/L\n- [全程D104] 检验组合: 钠离子(Na+)-静脉血: 136.2mmol/L；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；血小板分布宽度(PDW)-静脉血: 11.8%；葡萄糖(Glu)-静脉血: 6mmol/L；碱性磷酸酶(ALP)-静脉血: 59.8U/L；尿酸(UA)-静脉血: 486.4umol/L；尿素氮(BUN)-静脉血: 15mmol/L；直接胆红素(DBIL)-静脉血: 2.5umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；间接胆红素(IBIL)-静脉血: 7.3umolL；镁离子(Mg2+)-静脉血: 0.75mmol/L；血小板计数(PLT#)-静脉血: 15910E9/L；单核细胞百分比(Mono%)-静脉血: 0.081；平均血小板体积(MPV)-静脉血: 10.5fL；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.08mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.6；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；总胆固醇(TC)-静脉血: 6.02mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.899；血红蛋白(Hb)-静脉血: 107g/L；红细胞计数(RBC#)-静脉血: 3.5110E12/L；球蛋白(GLO)-静脉血: 20.38g/L；甘油三酯(TG)-静脉血: 1.26mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；大血小板百分比(P-LCR%)-静脉血: 29.3%；总钙(Ca)-静脉血: 2.37mmol/L；总胆汁酸(TBA)-静脉血: 0.8umol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.1；胱抑素(Cys-C)-静脉血: 1.67mg/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 358g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.01；α-L-岩藻糖苷酶(AFU)-静脉血: 31.2U/L；钾离子(K+)-静脉血: 3.53mmol/L；总蛋白(TP)-静脉血: 61.28g/L；天门冬氨酸氨基转移酶(AST)-静……\n- [全程D108] 检验组合: 总胆红素(TBIL)-静脉血: 13.8umol/L；总蛋白(TP)-静脉血: 57.11g/L；单核细胞百分比(Mono%)-静脉血: 0.048；球蛋白(GLO)-静脉血: 18.41g/L；尿素氮(BUN)-静脉血: 9.7mmol/L；间接胆红素(IBIL)-静脉血: 10.2umolL；碱性磷酸酶(ALP)-静脉血: 52.2U/L；胱抑素(Cys-C)-静脉血: 1.26mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.2mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1；肌酐(Crea)-静脉血: 85umol/L；尿酸(UA)-静脉血: 283umol/L；乳酸脱氢酶(LDH)-静脉血: 131.8U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 9.3U/L；红细胞计数(RBC#)-静脉血: 3.4610E12/L；C-反应蛋白(CRP)-静脉血: 1.53mg/L；阴离子间隙(AG)-静脉血: 15.1；平均血小板体积(MPV)-静脉血: 9.8fL；淋巴细胞百分比(Lymph%)-静脉血: 0.039；γ-谷氨酰基转移酶(GGT)-静脉血: 27.7U/L；镁离子(Mg2+)-静脉血: 0.65mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 367g/L；大血小板百分比(P-LCR%)-静脉血: 24.8%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 42.5；载脂蛋白AI(apoAI)-静脉血: 1.09g/L；白蛋白(ALB)-静脉血: 38.7g/L；总胆汁酸(TBA)-静脉血: 1.5umol/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；白细胞计数(WBC#)-静脉血: 8.2710E9/L；总胆固醇(TC)-静脉血: 6.03mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.21；氯离子(Cl-)-静脉血: 90.9mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 7.7U/L；血小板分布宽度(PDW)-静脉血: 11.2%；血液二氧化碳含量ctCO2(B)-静脉血: 21.1mmol/L；红细胞比容(Hct)-静脉血: 28.3%；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；中性粒细胞百……\n- [全程D116] 检验组合: 大血小板百分比(P-LCR%)-静脉血: 28.7%；载脂蛋白B(apoB)-静脉血: 1.55g/L；钠离子(Na+)-静脉血: 133.3mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 32.4U/L；胱抑素(Cys-C)-静脉血: 0.84mg/L；直接胆红素(DBIL)-静脉血: 3.2umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 348g/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；血小板比容-静脉血: 13%；平均红细胞体积(MCV)-静脉血: 86.3fL；尿素氮(BUN)-静脉血: 6.6mmol/L；磷(P)-静脉血: 1.15mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.4mmolL；有核红细胞百分比(NRBC%)-静脉血: 0；有核红细胞计数(NRBC#)-静脉血: 010E9/L；载脂蛋白AI(apoAI)-静脉血: 1.2g/L；总胆固醇(TC)-静脉血: 7.16mmol/L；甘油三酯(TG)-静脉血: 1.74mmol/L；总钙(Ca)-静脉血: 2.28mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 76.6umol/L；钾离子(K+)-静脉血: 3.01mmol/L；间接胆红素(IBIL)-静脉血: 10.4umolL；尿酸(UA)-静脉血: 216umol/L；镁离子(Mg2+)-静脉血: 0.56mmol/L；单核细胞百分比(Mono%)-静脉血: 0.065；红细胞计数(RBC#)-静脉血: 3.3610E12/L；天门冬氨酸氨基转移酶(AST)-静脉血: 9.4U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.053；血小板计数(PLT#)-静脉血: 12210E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.6；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；乳酸脱氢酶(LDH)-静脉血: 130.3U/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；中性粒细胞计数(Neut#)-静脉血: 4.410E9/L；C-反应蛋白(CRP)-静脉血: 6.72mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 5.32mmol/L；丙氨酸氨基转移酶(ALT)……\n- [全程D152] 检验组合: EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）\n- [全程D222] 超声；腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约21cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D222] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:80（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）\n\n【既往治疗与反应】\n- [全程D104] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者放疗22次，诉中度咽痛，有干咳，感恶心，无呕吐，无畏寒、发热。查体大致同前。今日查血常规生化未见异常。[姓名已隐去]医生信息已隐藏，患者放化疗顺利，现继续予以加强护胃、护肝等营养支持对症治疗，定期复查血生化常规，严密观察病情变化。\n- [全程D108] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者诉乏力，无恶心、呕吐，仍有便秘。查体大致同前。今日查血生化提示：血钾3.06mmol/L，血钠127.1mmol/L。血常规提示血红蛋白稍低。[姓名已隐去]医生信息已隐藏后指示：患者放疗过程中，现血钾、血钠低，可予以加强补钾、补钠治疗，现继续放疗，加强支持对症治疗，严密观察病情变化。\n- [全程D111] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者放疗27次，诉有咳嗽、咳痰，大便未解。查体大致同前。[姓名已隐去]医生信息已隐藏，患者放疗进行中，现有咳嗽，予以加强祛痰处理，大便未解加强通便治疗。继续加强支持对症治疗，严密观察病情变化。\n- [全程D116] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者放疗30次，患者诉感乏力，咳嗽、咳痰症状较前改善，无畏寒、发热。查体大致同前。今日查血常规大致正常。生化提示血钠低、血钾低、血镁低。[姓名已隐去]医生信息已隐藏，患者生化提示血钾、血钠、血镁低，加强支持对症治疗，严密观察病情变化。\n- [全程D118] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日完成放疗。今日[姓名已隐去]医生信息已隐藏者诉轻度咽痛，胃纳一般，无恶心、呕吐，无发热、咳嗽、咳痰等，精神、睡眠一般，大小便正常。体查：张口门齿距4.5cm；鼻咽顶壁见肿物，较前明显消退；浅表淋巴结未及肿大，颅神经检查：（-）。口腔黏膜反应Ⅱ度，皮肤反应Ⅰ度。[姓名已隐去]医生信息已隐藏示：患者已结束放疗及同期化疗，过程顺利，现病情平稳，可予以出院，嘱患者注意休息，加强营养，出院后一个月内每周复查血常规、肝肾功能，出院后一个月返院复查，不适时随诊。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善鼻咽及颈部MRI检查，暂缓EB病毒DNA及抗体检测。\nB. 安排全身PET-CT检查，替代常规影像学及EB病毒相关指标随访。\nC. 完善EB病毒DNA定量及EBV抗体（VCA-IgA、EA-IgA）检测，继续定期随访观察。\nD. 完善胸部增强CT及全身骨扫描，暂缓EB病毒DNA定量检测。\nE. 延长随访间隔至每半年一次，仅复查腹部彩超及血常规。\nF. 安排鼻内镜检查并常规行鼻咽部组织活检，复查EB病毒DNA。\nG. 给予抗病毒药物治疗以降低EBV-VCA-IgA滴度，继续随访观察。\nH. 启动卡培他滨节拍维持治疗，并每半年复查EB病毒DNA定量。\nI. 完善鼻咽及颈部CT平扫，替代MRI及EB病毒DNA定量检测。\nJ. 安排双侧颈部淋巴结彩超检查，暂缓EB病毒相关指标检测。\nK. 启动PD-1抑制剂免疫维持治疗，并定期复查EB病毒DNA定量。\nL. 完善头颅增强MRI检查，暂缓鼻咽部及颈部影像学评估。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N1，M0。\n综合TNM状态：T4N1M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D99] 检验组合: 单核细胞计数(Mono#)-静脉血: 1.710E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；血小板分布宽度(PDW)-静脉血: 11.4%；大血小板百分比(P-LCR%)-静脉血: 29.1%；单核细胞百分比(Mono%)-静脉血: 0.093；平均红细胞体积(MCV)-静脉血: 88.1fL；红细胞比容(Hct)-静脉血: 29%；有核红细胞百分比(NRBC%)-静脉血: 0.1；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.9；嗜酸性粒细胞计数(Eos#)-静脉血: 0.410E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.022；白细胞计数(WBC#)-静脉血: 18.7210E9/L；红细胞计数(RBC#)-静脉血: 3.2910E12/L；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；血小板比容-静脉血: 12%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 48；血小板计数(PLT#)-静脉血: 11710E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 345g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.034；平均红细胞血红蛋白含量(MCH)-静脉血: 30.4pg；中性粒细胞计数(Neut#)-静脉血: 15.910E9/L；血红蛋白(Hb)-静脉血: 100g/L；中性粒细胞百分比(Neut%)-静脉血: 0.848；平均血小板体积(MPV)-静脉血: 10.7fL；有核红细胞计数(NRBC#)-静脉血: 0.0210E9/L\n- [全程D104] 检验组合: 钠离子(Na+)-静脉血: 136.2mmol/L；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；血小板分布宽度(PDW)-静脉血: 11.8%；葡萄糖(Glu)-静脉血: 6mmol/L；碱性磷酸酶(ALP)-静脉血: 59.8U/L；尿酸(UA)-静脉血: 486.4umol/L；尿素氮(BUN)-静脉血: 15mmol/L；直接胆红素(DBIL)-静脉血: 2.5umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；间接胆红素(IBIL)-静脉血: 7.3umolL；镁离子(Mg2+)-静脉血: 0.75mmol/L；血小板计数(PLT#)-静脉血: 15910E9/L；单核细胞百分比(Mono%)-静脉血: 0.081；平均血小板体积(MPV)-静脉血: 10.5fL；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.08mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.6；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；总胆固醇(TC)-静脉血: 6.02mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.899；血红蛋白(Hb)-静脉血: 107g/L；红细胞计数(RBC#)-静脉血: 3.5110E12/L；球蛋白(GLO)-静脉血: 20.38g/L；甘油三酯(TG)-静脉血: 1.26mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；大血小板百分比(P-LCR%)-静脉血: 29.3%；总钙(Ca)-静脉血: 2.37mmol/L；总胆汁酸(TBA)-静脉血: 0.8umol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.1；胱抑素(Cys-C)-静脉血: 1.67mg/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 358g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.01；α-L-岩藻糖苷酶(AFU)-静脉血: 31.2U/L；钾离子(K+)-静脉血: 3.53mmol/L；总蛋白(TP)-静脉血: 61.28g/L；天门冬氨酸氨基转移酶(AST)-静……\n- [全程D108] 检验组合: 总胆红素(TBIL)-静脉血: 13.8umol/L；总蛋白(TP)-静脉血: 57.11g/L；单核细胞百分比(Mono%)-静脉血: 0.048；球蛋白(GLO)-静脉血: 18.41g/L；尿素氮(BUN)-静脉血: 9.7mmol/L；间接胆红素(IBIL)-静脉血: 10.2umolL；碱性磷酸酶(ALP)-静脉血: 52.2U/L；胱抑素(Cys-C)-静脉血: 1.26mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.2mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1；肌酐(Crea)-静脉血: 85umol/L；尿酸(UA)-静脉血: 283umol/L；乳酸脱氢酶(LDH)-静脉血: 131.8U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 9.3U/L；红细胞计数(RBC#)-静脉血: 3.4610E12/L；C-反应蛋白(CRP)-静脉血: 1.53mg/L；阴离子间隙(AG)-静脉血: 15.1；平均血小板体积(MPV)-静脉血: 9.8fL；淋巴细胞百分比(Lymph%)-静脉血: 0.039；γ-谷氨酰基转移酶(GGT)-静脉血: 27.7U/L；镁离子(Mg2+)-静脉血: 0.65mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 367g/L；大血小板百分比(P-LCR%)-静脉血: 24.8%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 42.5；载脂蛋白AI(apoAI)-静脉血: 1.09g/L；白蛋白(ALB)-静脉血: 38.7g/L；总胆汁酸(TBA)-静脉血: 1.5umol/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；白细胞计数(WBC#)-静脉血: 8.2710E9/L；总胆固醇(TC)-静脉血: 6.03mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.21；氯离子(Cl-)-静脉血: 90.9mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 7.7U/L；血小板分布宽度(PDW)-静脉血: 11.2%；血液二氧化碳含量ctCO2(B)-静脉血: 21.1mmol/L；红细胞比容(Hct)-静脉血: 28.3%；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；中性粒细胞百……\n- [全程D116] 检验组合: 大血小板百分比(P-LCR%)-静脉血: 28.7%；载脂蛋白B(apoB)-静脉血: 1.55g/L；钠离子(Na+)-静脉血: 133.3mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 32.4U/L；胱抑素(Cys-C)-静脉血: 0.84mg/L；直接胆红素(DBIL)-静脉血: 3.2umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 348g/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；血小板比容-静脉血: 13%；平均红细胞体积(MCV)-静脉血: 86.3fL；尿素氮(BUN)-静脉血: 6.6mmol/L；磷(P)-静脉血: 1.15mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.4mmolL；有核红细胞百分比(NRBC%)-静脉血: 0；有核红细胞计数(NRBC#)-静脉血: 010E9/L；载脂蛋白AI(apoAI)-静脉血: 1.2g/L；总胆固醇(TC)-静脉血: 7.16mmol/L；甘油三酯(TG)-静脉血: 1.74mmol/L；总钙(Ca)-静脉血: 2.28mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 76.6umol/L；钾离子(K+)-静脉血: 3.01mmol/L；间接胆红素(IBIL)-静脉血: 10.4umolL；尿酸(UA)-静脉血: 216umol/L；镁离子(Mg2+)-静脉血: 0.56mmol/L；单核细胞百分比(Mono%)-静脉血: 0.065；红细胞计数(RBC#)-静脉血: 3.3610E12/L；天门冬氨酸氨基转移酶(AST)-静脉血: 9.4U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.053；血小板计数(PLT#)-静脉血: 12210E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.6；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；乳酸脱氢酶(LDH)-静脉血: 130.3U/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；中性粒细胞计数(Neut#)-静脉血: 4.410E9/L；C-反应蛋白(CRP)-静脉血: 6.72mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 5.32mmol/L；丙氨酸氨基转移酶(ALT)……\n- [全程D152] 检验组合: EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）\n- [全程D222] 超声；腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约21cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D222] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:80（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）\n\n【既往治疗与反应】\n- [全程D104] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者放疗22次，诉中度咽痛，有干咳，感恶心，无呕吐，无畏寒、发热。查体大致同前。今日查血常规生化未见异常。[姓名已隐去]医生信息已隐藏，患者放化疗顺利，现继续予以加强护胃、护肝等营养支持对症治疗，定期复查血生化常规，严密观察病情变化。\n- [全程D108] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者诉乏力，无恶心、呕吐，仍有便秘。查体大致同前。今日查血生化提示：血钾3.06mmol/L，血钠127.1mmol/L。血常规提示血红蛋白稍低。[姓名已隐去]医生信息已隐藏后指示：患者放疗过程中，现血钾、血钠低，可予以加强补钾、补钠治疗，现继续放疗，加强支持对症治疗，严密观察病情变化。\n- [全程D111] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者放疗27次，诉有咳嗽、咳痰，大便未解。查体大致同前。[姓名已隐去]医生信息已隐藏，患者放疗进行中，现有咳嗽，予以加强祛痰处理，大便未解加强通便治疗。继续加强支持对症治疗，严密观察病情变化。\n- [全程D116] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者放疗30次，患者诉感乏力，咳嗽、咳痰症状较前改善，无畏寒、发热。查体大致同前。今日查血常规大致正常。生化提示血钠低、血钾低、血镁低。[姓名已隐去]医生信息已隐藏，患者生化提示血钾、血钠、血镁低，加强支持对症治疗，严密观察病情变化。\n- [全程D118] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日完成放疗。今日[姓名已隐去]医生信息已隐藏者诉轻度咽痛，胃纳一般，无恶心、呕吐，无发热、咳嗽、咳痰等，精神、睡眠一般，大小便正常。体查：张口门齿距4.5cm；鼻咽顶壁见肿物，较前明显消退；浅表淋巴结未及肿大，颅神经检查：（-）。口腔黏膜反应Ⅱ度，皮肤反应Ⅰ度。[姓名已隐去]医生信息已隐藏示：患者已结束放疗及同期化疗，过程顺利，现病情平稳，可予以出院，嘱患者注意休息，加强营养，出院后一个月内每周复查血常规、肝肾功能，出院后一个月返院复查，不适时随诊。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善鼻咽及颈部MRI检查，暂缓EB病毒DNA及抗体检测。\nB. 安排全身PET-CT检查，替代常规影像学及EB病毒相关指标随访。\nC. 完善EB病毒DNA定量及EBV抗体（VCA-IgA、EA-IgA）检测，继续定期随访观察。\nD. 完善胸部增强CT及全身骨扫描，暂缓EB病毒DNA定量检测。\nE. 延长随访间隔至每半年一次，仅复查腹部彩超及血常规。\nF. 安排鼻内镜检查并常规行鼻咽部组织活检，复查EB病毒DNA。\nG. 给予抗病毒药物治疗以降低EBV-VCA-IgA滴度，继续随访观察。\nH. 启动卡培他滨节拍维持治疗，并每半年复查EB病毒DNA定量。\nI. 完善鼻咽及颈部CT平扫，替代MRI及EB病毒DNA定量检测。\nJ. 安排双侧颈部淋巴结彩超检查，暂缓EB病毒相关指标检测。\nK. 启动PD-1抑制剂免疫维持治疗，并定期复查EB病毒DNA定量。\nL. 完善头颅增强MRI检查，暂缓鼻咽部及颈部影像学评估。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-32fca5d8e1da4de5e54c5c0b","patient_id":"patient-290a042206ccfe67e72f9a19","turn_id":"turn01","turn_position":1,"turn_type":"initial_workup_choice","gold_letter":"D","gold_action":"行电子鼻咽镜检查及活检，并完善鼻咽及颈部MRI平扫+增强，常规心电图检查","options":[{"letter":"A","text":"行电子鼻咽镜检查（不活检），并完善鼻咽及颈部CT平扫+增强，常规心电图检查","is_gold":false},{"letter":"B","text":"行颈部淋巴结切除活检，并完善鼻咽及颈部MRI平扫+增强，常规心电图检查","is_gold":false},{"letter":"C","text":"行电子鼻咽镜检查及活检，并完善鼻咽及颈部MRI平扫（不增强），常规心电图检查","is_gold":false},{"letter":"D","text":"行电子鼻咽镜检查及活检，并完善鼻咽及颈部MRI平扫+增强，常规心电图检查","is_gold":true},{"letter":"E","text":"行电子鼻咽镜检查及活检，并完善鼻咽MRI平扫+增强，暂缓颈部影像学检查","is_gold":false},{"letter":"F","text":"直接行全身PET-CT检查，暂缓电子鼻咽镜及活检与局部MRI","is_gold":false},{"letter":"G","text":"行电子鼻咽镜检查及活检，并完善胸部及腹部CT平扫+增强，暂缓头颈部MRI","is_gold":false},{"letter":"H","text":"行鼻咽及颈部MRI平扫+增强，常规心电图检查，暂缓鼻咽镜检查及活检","is_gold":false},{"letter":"I","text":"行电子鼻咽镜检查及活检，并完善鼻咽及颈部CT平扫，常规心电图检查","is_gold":false},{"letter":"J","text":"行颈部淋巴结穿刺活检，并完善鼻咽及颈部MRI平扫+增强，常规心电图检查","is_gold":false},{"letter":"K","text":"行电子鼻咽镜检查（不活检），并完善全身PET-CT检查，常规心电图检查","is_gold":false},{"letter":"L","text":"行电子鼻咽镜检查及活检，并完善鼻咽及颈部超声检查，常规心电图检查","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现颈部肿物1月余；当地诊断：鼻咽癌。于某次就诊时间在[机构已隐去]行力扑素270mgd1+奈达铂120mgd1+泰欣生200mgd1化疗一程，化疗后出现四度中性粒细胞减少，无发热、腹泻、寒战等，予升白处理后中性粒细胞恢复。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物,中性粒细胞减少,颈部肿物；既往史: 颈椎病史10年，既往有慢性肠炎病史。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：362.℃，P：100次/分，R：20次/分，BP：126/74mmHg,Ht：168cm，Wt：63kg，BSA：1.72m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；双侧颈部IIa区各可扪及1个淋巴结，左颈2×3cm，右颈2×2cm,无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行电子鼻咽镜检查（不活检），并完善鼻咽及颈部CT平扫+增强，常规心电图检查\nB. 行颈部淋巴结切除活检，并完善鼻咽及颈部MRI平扫+增强，常规心电图检查\nC. 行电子鼻咽镜检查及活检，并完善鼻咽及颈部MRI平扫（不增强），常规心电图检查\nD. 行电子鼻咽镜检查及活检，并完善鼻咽及颈部MRI平扫+增强，常规心电图检查\nE. 行电子鼻咽镜检查及活检，并完善鼻咽MRI平扫+增强，暂缓颈部影像学检查\nF. 直接行全身PET-CT检查，暂缓电子鼻咽镜及活检与局部MRI\nG. 行电子鼻咽镜检查及活检，并完善胸部及腹部CT平扫+增强，暂缓头颈部MRI\nH. 行鼻咽及颈部MRI平扫+增强，常规心电图检查，暂缓鼻咽镜检查及活检\nI. 行电子鼻咽镜检查及活检，并完善鼻咽及颈部CT平扫，常规心电图检查\nJ. 行颈部淋巴结穿刺活检，并完善鼻咽及颈部MRI平扫+增强，常规心电图检查\nK. 行电子鼻咽镜检查（不活检），并完善全身PET-CT检查，常规心电图检查\nL. 行电子鼻咽镜检查及活检，并完善鼻咽及颈部超声检查，常规心电图检查\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现颈部肿物1月余；当地诊断：鼻咽癌。于某次就诊时间在[机构已隐去]行力扑素270mgd1+奈达铂120mgd1+泰欣生200mgd1化疗一程，化疗后出现四度中性粒细胞减少，无发热、腹泻、寒战等，予升白处理后中性粒细胞恢复。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物,中性粒细胞减少,颈部肿物；既往史: 颈椎病史10年，既往有慢性肠炎病史。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：362.℃，P：100次/分，R：20次/分，BP：126/74mmHg,Ht：168cm，Wt：63kg，BSA：1.72m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；双侧颈部IIa区各可扪及1个淋巴结，左颈2×3cm，右颈2×2cm,无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行电子鼻咽镜检查（不活检），并完善鼻咽及颈部CT平扫+增强，常规心电图检查\nB. 行颈部淋巴结切除活检，并完善鼻咽及颈部MRI平扫+增强，常规心电图检查\nC. 行电子鼻咽镜检查及活检，并完善鼻咽及颈部MRI平扫（不增强），常规心电图检查\nD. 行电子鼻咽镜检查及活检，并完善鼻咽及颈部MRI平扫+增强，常规心电图检查\nE. 行电子鼻咽镜检查及活检，并完善鼻咽MRI平扫+增强，暂缓颈部影像学检查\nF. 直接行全身PET-CT检查，暂缓电子鼻咽镜及活检与局部MRI\nG. 行电子鼻咽镜检查及活检，并完善胸部及腹部CT平扫+增强，暂缓头颈部MRI\nH. 行鼻咽及颈部MRI平扫+增强，常规心电图检查，暂缓鼻咽镜检查及活检\nI. 行电子鼻咽镜检查及活检，并完善鼻咽及颈部CT平扫，常规心电图检查\nJ. 行颈部淋巴结穿刺活检，并完善鼻咽及颈部MRI平扫+增强，常规心电图检查\nK. 行电子鼻咽镜检查（不活检），并完善全身PET-CT检查，常规心电图检查\nL. 行电子鼻咽镜检查及活检，并完善鼻咽及颈部超声检查，常规心电图检查\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-95b51d663e429afb86c572e7","patient_id":"patient-290a042206ccfe67e72f9a19","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"E","gold_action":"行外院疑难病理会诊，完善PET/CT全身显像及血浆EBV DNA检测","options":[{"letter":"A","text":"行鼻咽镜下重新活检，完善胸部CT、腹部超声及全身骨扫描，检测血浆EBV DNA","is_gold":false},{"letter":"B","text":"行外院疑难病理会诊，完善胸部CT、腹部超声，暂缓全身骨扫描，检测血浆EBV DNA","is_gold":false},{"letter":"C","text":"沿用外院病理诊断，完善PET/CT全身显像及血浆EBV DNA检测","is_gold":false},{"letter":"D","text":"行外院疑难病理会诊，完善胸部增强CT及腹部增强CT，暂缓全身骨扫描","is_gold":false},{"letter":"E","text":"行外院疑难病理会诊，完善PET/CT全身显像及血浆EBV DNA检测","is_gold":true},{"letter":"F","text":"行鼻咽镜下重新活检，完善PET/CT全身显像及血浆EBV DNA检测","is_gold":false},{"letter":"G","text":"行外院疑难病理会诊，完善PET/CT全身显像，暂缓血浆EBV DNA检测","is_gold":false},{"letter":"H","text":"行外院疑难病理会诊，完善胸部CT及腹部CT，暂缓全身骨扫描及血浆EBV DNA检测","is_gold":false},{"letter":"I","text":"沿用外院病理诊断，完善PET/CT全身显像，暂缓血浆EBV DNA检测","is_gold":false},{"letter":"J","text":"行外院疑难病理会诊，完善头颈部局部PET/CT及血浆EBV DNA检测","is_gold":false},{"letter":"K","text":"行鼻咽镜下重新活检，完善胸部CT及腹部CT，暂缓血浆EBV DNA检测","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 电轴左偏(轻度) 心电图大致正常\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1] 检验组合: 纤维蛋白原降解产物(FDP)-静脉血: 2ug/ml；平均红细胞体积(MCV)-静脉血: 93.5fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6；甘油三酯(TG)-静脉血: 2.17mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 51.4U/L；胱抑素(Cys-C)-静脉血: 0.91mg/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.08COI；总钙(Ca)-静脉血: 2.24mmol/L；淋巴细胞计数(Lymph#)-静脉血: 2.610E9/L；葡萄糖(Glu)-静脉血: 5.18mmol/L；球蛋白(GLO)-静脉血: 26.59g/L；有核红细胞计数(NRBC#)-静脉血: 0.0410E9/L；平均血小板体积(MPV)-静脉血: 9.5fL；大血小板百分比(P-LCR%)-静脉血: 20.5%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.003；红细胞计数(RBC#)-静脉血: 4.1410E12/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.07S/CO；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.55mmol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0IU/mL；血小板分布宽度(PDW)-静脉血: 9.8%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.014；载脂蛋白B(apoB)-静脉血: 0.91g/L；C-反应蛋白(CRP)-静脉血: 2.8mg/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；镁离子(Mg2+)-静脉血: 0.83mmol/L；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；肌酐(Crea)-静脉血: 77umol/L；钾离子(K+)-静脉血: 4mmol/L；白蛋白(ALB)-静脉血: 40.9g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；凝血酶原时间活动度(PTA)-静脉血: 90.4%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.54；阴离子间隙(AG)-静脉血: 12……\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 行鼻咽镜下重新活检，完善胸部CT、腹部超声及全身骨扫描，检测血浆EBV DNA\nB. 行外院疑难病理会诊，完善胸部CT、腹部超声，暂缓全身骨扫描，检测血浆EBV DNA\nC. 沿用外院病理诊断，完善PET/CT全身显像及血浆EBV DNA检测\nD. 行外院疑难病理会诊，完善胸部增强CT及腹部增强CT，暂缓全身骨扫描\nE. 行外院疑难病理会诊，完善PET/CT全身显像及血浆EBV DNA检测\nF. 行鼻咽镜下重新活检，完善PET/CT全身显像及血浆EBV DNA检测\nG. 行外院疑难病理会诊，完善PET/CT全身显像，暂缓血浆EBV DNA检测\nH. 行外院疑难病理会诊，完善胸部CT及腹部CT，暂缓全身骨扫描及血浆EBV DNA检测\nI. 沿用外院病理诊断，完善PET/CT全身显像，暂缓血浆EBV DNA检测\nJ. 行外院疑难病理会诊，完善头颈部局部PET/CT及血浆EBV DNA检测\nK. 行鼻咽镜下重新活检，完善胸部CT及腹部CT，暂缓血浆EBV DNA检测\n\n请仅输出一个选项字母（A-K）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 电轴左偏(轻度) 心电图大致正常\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1] 检验组合: 纤维蛋白原降解产物(FDP)-静脉血: 2ug/ml；平均红细胞体积(MCV)-静脉血: 93.5fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6；甘油三酯(TG)-静脉血: 2.17mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 51.4U/L；胱抑素(Cys-C)-静脉血: 0.91mg/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.08COI；总钙(Ca)-静脉血: 2.24mmol/L；淋巴细胞计数(Lymph#)-静脉血: 2.610E9/L；葡萄糖(Glu)-静脉血: 5.18mmol/L；球蛋白(GLO)-静脉血: 26.59g/L；有核红细胞计数(NRBC#)-静脉血: 0.0410E9/L；平均血小板体积(MPV)-静脉血: 9.5fL；大血小板百分比(P-LCR%)-静脉血: 20.5%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.003；红细胞计数(RBC#)-静脉血: 4.1410E12/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.07S/CO；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.55mmol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0IU/mL；血小板分布宽度(PDW)-静脉血: 9.8%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.014；载脂蛋白B(apoB)-静脉血: 0.91g/L；C-反应蛋白(CRP)-静脉血: 2.8mg/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；镁离子(Mg2+)-静脉血: 0.83mmol/L；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；肌酐(Crea)-静脉血: 77umol/L；钾离子(K+)-静脉血: 4mmol/L；白蛋白(ALB)-静脉血: 40.9g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；凝血酶原时间活动度(PTA)-静脉血: 90.4%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.54；阴离子间隙(AG)-静脉血: 12……\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 行鼻咽镜下重新活检，完善胸部CT、腹部超声及全身骨扫描，检测血浆EBV DNA\nB. 行外院疑难病理会诊，完善胸部CT、腹部超声，暂缓全身骨扫描，检测血浆EBV DNA\nC. 沿用外院病理诊断，完善PET/CT全身显像及血浆EBV DNA检测\nD. 行外院疑难病理会诊，完善胸部增强CT及腹部增强CT，暂缓全身骨扫描\nE. 行外院疑难病理会诊，完善PET/CT全身显像及血浆EBV DNA检测\nF. 行鼻咽镜下重新活检，完善PET/CT全身显像及血浆EBV DNA检测\nG. 行外院疑难病理会诊，完善PET/CT全身显像，暂缓血浆EBV DNA检测\nH. 行外院疑难病理会诊，完善胸部CT及腹部CT，暂缓全身骨扫描及血浆EBV DNA检测\nI. 沿用外院病理诊断，完善PET/CT全身显像，暂缓血浆EBV DNA检测\nJ. 行外院疑难病理会诊，完善头颈部局部PET/CT及血浆EBV DNA检测\nK. 行鼻咽镜下重新活检，完善胸部CT及腹部CT，暂缓血浆EBV DNA检测\n\n请仅输出一个选项字母（A-K）。"}]}
+{"sample_id":"sample-ac55ce5273aeb2587f3051e7","patient_id":"patient-290a042206ccfe67e72f9a19","turn_id":"turn05","turn_position":3,"turn_type":"toxicity_or_support_decision","gold_letter":"I","gold_action":"予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，暂不予口服保肝药物治疗，并复查血常规及生化后安排出院。","options":[{"letter":"A","text":"予以短效重组人粒细胞刺激因子（rhG-CSF）皮下注射，暂不予口服保肝药物治疗，并复查血常规及生化后继续住院观察。","is_gold":false},{"letter":"B","text":"暂不予粒细胞集落刺激因子预防，仅口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。","is_gold":false},{"letter":"C","text":"予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，静脉滴注头孢菌素预防感染，并复查血常规及生化后安排出院。","is_gold":false},{"letter":"D","text":"予以短效重组人粒细胞刺激因子（rhG-CSF）皮下注射，静脉滴注异甘草酸镁强效保肝，并复查血常规及生化后继续住院观察。","is_gold":false},{"letter":"E","text":"暂不予粒细胞集落刺激因子预防，暂不予口服保肝药物治疗，直接安排出院并嘱院外定期复查血常规及生化。","is_gold":false},{"letter":"F","text":"予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，口服恩替卡韦抗病毒治疗，并复查血常规及生化后安排出院。","is_gold":false},{"letter":"G","text":"予以短效重组人粒细胞刺激因子（rhG-CSF）皮下注射，口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。","is_gold":false},{"letter":"H","text":"予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。","is_gold":false},{"letter":"I","text":"予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，暂不予口服保肝药物治疗，并复查血常规及生化后安排出院。","is_gold":true},{"letter":"J","text":"予以重组人促血小板生成素（rhTPO）皮下注射，口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。","is_gold":false},{"letter":"K","text":"予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，静脉滴注还原型谷胱甘肽保肝，并复查血常规及生化后继续住院观察。","is_gold":false},{"letter":"L","text":"暂不予任何药物处理，直接安排出院，嘱院外定期复查血常规及生化，若出现发热再返院使用粒细胞集落刺激因子。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D8] 检验组合: 单核细胞百分比(Mono%)-静脉血: 0.065；血红蛋白(Hb)-静脉血: 129g/L；淋巴细胞计数(Lymph#)-静脉血: 2.110E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；大血小板百分比(P-LCR%)-静脉血: 22%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.013；平均红细胞体积(MCV)-静脉血: 93.8fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.2；红细胞比容(Hct)-静脉血: 39.2%；中性粒细胞百分比(Neut%)-静脉血: 0.53；单核细胞计数(Mono#)-静脉血: 0.410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；白细胞计数(WBC#)-静脉血: 5.3910E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血小板分布宽度(PDW)-静脉血: 10.3%；平均红细胞血红蛋白含量(MCH)-静脉血: 30.9pg；血小板计数(PLT#)-静脉血: 14810E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.8；淋巴细胞百分比(Lymph%)-静脉血: 0.39；有核红细胞计数(NRBC#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.002；血小板比容-静脉血: 14%；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；红细胞计数(RBC#)-静脉血: 4.1810E12/L；平均血小板体积(MPV)-静脉血: 9.7fL；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L\n- [全程D9] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: 输液港走行于右锁骨下静脉，导管末端位于脊柱右旁T6椎体下缘水平，估计位于上腔静脉上段。；检查结论: 导管末端位置如上述。\n- [全程D9] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；非鳞状上皮细胞计数-尿液: 1/μL；颜色-尿液: Light-Yellow；粘液丝计数(MUCS#)-尿液: 5/μL；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-尿液: colorless；比重(SG)-尿液: 1.013；白细胞(LEU)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；白细胞(LEU)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 1/μL；酸碱度(pH)-尿液: 6.5；浊度(TRUB)-尿液: clear；比重(SG)-尿液: 1.016；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D10] 检验组合: 红细胞计数(RBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 6；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 7/μL；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.017；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 1/μL；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow\n- [全程D14] 检验组合: 总胆固醇(TC)-静脉血: 5.88mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜碱性粒细胞百分比(Baso%)-静脉血: 0；单核细胞百分比(Mono%)-静脉血: 0.008；丙氨酸氨基转移酶(ALT)-静脉血: 65.5U/L；血小板分布宽度(PDW)-静脉血: 13.8%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.9；白蛋白(ALB)-静脉血: 42.5g/L；球蛋白(GLO)-静脉血: 26g/L；胱抑素(Cys-C)-静脉血: 1.11mg/L；总蛋白(TP)-静脉血: 68.5g/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.7mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞计数(RBC#)-静脉血: 4.4510E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；总胆红素(TBIL)-静脉血: 15.4umol/L；钾离子(K+)-静脉血: 4.03mmol/L；葡萄糖(Glu)-静脉血: 5.74mmol/L；乳酸脱氢酶(LDH)-静脉血: 175U/L；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；肌酐(Crea)-静脉血: 80umol/L；总钙(Ca)-静脉血: 2.18mmol/L；钠离子(Na+)-静脉血: 132.2mmol/L；大血小板百分比(P-LCR%)-静脉血: 34.4%；红细胞比容(Hct)-静脉血: 39.3%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；阴离子间隙(AG)-静脉血: 17.8；γ-谷氨酰基转移酶(GGT)-静脉血: 26.8U/L；白细胞计数(WBC#)-静脉血: 5.2310E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.83mmol/L；平均血小板体积(MPV)-静脉血: 11.2fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.01；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.51mmolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.35；碱性磷酸酶(ALP)-静脉血: 57.4U/L；直接胆红素(DBIL)-静脉血: 4.1umol/L；镁离子(Mg2+)-静脉血: 0.93mmol/L；血红蛋白(Hb)-静脉血: 1……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者各项检查继续完善中。\n- [全程D10] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程多西紫杉醇＋DDP+5-FU方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 予以短效重组人粒细胞刺激因子（rhG-CSF）皮下注射，暂不予口服保肝药物治疗，并复查血常规及生化后继续住院观察。\nB. 暂不予粒细胞集落刺激因子预防，仅口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。\nC. 予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，静脉滴注头孢菌素预防感染，并复查血常规及生化后安排出院。\nD. 予以短效重组人粒细胞刺激因子（rhG-CSF）皮下注射，静脉滴注异甘草酸镁强效保肝，并复查血常规及生化后继续住院观察。\nE. 暂不予粒细胞集落刺激因子预防，暂不予口服保肝药物治疗，直接安排出院并嘱院外定期复查血常规及生化。\nF. 予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，口服恩替卡韦抗病毒治疗，并复查血常规及生化后安排出院。\nG. 予以短效重组人粒细胞刺激因子（rhG-CSF）皮下注射，口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。\nH. 予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。\nI. 予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，暂不予口服保肝药物治疗，并复查血常规及生化后安排出院。\nJ. 予以重组人促血小板生成素（rhTPO）皮下注射，口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。\nK. 予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，静脉滴注还原型谷胱甘肽保肝，并复查血常规及生化后继续住院观察。\nL. 暂不予任何药物处理，直接安排出院，嘱院外定期复查血常规及生化，若出现发热再返院使用粒细胞集落刺激因子。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D8] 检验组合: 单核细胞百分比(Mono%)-静脉血: 0.065；血红蛋白(Hb)-静脉血: 129g/L；淋巴细胞计数(Lymph#)-静脉血: 2.110E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；大血小板百分比(P-LCR%)-静脉血: 22%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.013；平均红细胞体积(MCV)-静脉血: 93.8fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.2；红细胞比容(Hct)-静脉血: 39.2%；中性粒细胞百分比(Neut%)-静脉血: 0.53；单核细胞计数(Mono#)-静脉血: 0.410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；白细胞计数(WBC#)-静脉血: 5.3910E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血小板分布宽度(PDW)-静脉血: 10.3%；平均红细胞血红蛋白含量(MCH)-静脉血: 30.9pg；血小板计数(PLT#)-静脉血: 14810E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.8；淋巴细胞百分比(Lymph%)-静脉血: 0.39；有核红细胞计数(NRBC#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.002；血小板比容-静脉血: 14%；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；红细胞计数(RBC#)-静脉血: 4.1810E12/L；平均血小板体积(MPV)-静脉血: 9.7fL；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L\n- [全程D9] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: 输液港走行于右锁骨下静脉，导管末端位于脊柱右旁T6椎体下缘水平，估计位于上腔静脉上段。；检查结论: 导管末端位置如上述。\n- [全程D9] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；非鳞状上皮细胞计数-尿液: 1/μL；颜色-尿液: Light-Yellow；粘液丝计数(MUCS#)-尿液: 5/μL；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-尿液: colorless；比重(SG)-尿液: 1.013；白细胞(LEU)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；白细胞(LEU)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 1/μL；酸碱度(pH)-尿液: 6.5；浊度(TRUB)-尿液: clear；比重(SG)-尿液: 1.016；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D10] 检验组合: 红细胞计数(RBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 6；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 7/μL；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.017；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 1/μL；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow\n- [全程D14] 检验组合: 总胆固醇(TC)-静脉血: 5.88mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜碱性粒细胞百分比(Baso%)-静脉血: 0；单核细胞百分比(Mono%)-静脉血: 0.008；丙氨酸氨基转移酶(ALT)-静脉血: 65.5U/L；血小板分布宽度(PDW)-静脉血: 13.8%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.9；白蛋白(ALB)-静脉血: 42.5g/L；球蛋白(GLO)-静脉血: 26g/L；胱抑素(Cys-C)-静脉血: 1.11mg/L；总蛋白(TP)-静脉血: 68.5g/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.7mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞计数(RBC#)-静脉血: 4.4510E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；总胆红素(TBIL)-静脉血: 15.4umol/L；钾离子(K+)-静脉血: 4.03mmol/L；葡萄糖(Glu)-静脉血: 5.74mmol/L；乳酸脱氢酶(LDH)-静脉血: 175U/L；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；肌酐(Crea)-静脉血: 80umol/L；总钙(Ca)-静脉血: 2.18mmol/L；钠离子(Na+)-静脉血: 132.2mmol/L；大血小板百分比(P-LCR%)-静脉血: 34.4%；红细胞比容(Hct)-静脉血: 39.3%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；阴离子间隙(AG)-静脉血: 17.8；γ-谷氨酰基转移酶(GGT)-静脉血: 26.8U/L；白细胞计数(WBC#)-静脉血: 5.2310E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.83mmol/L；平均血小板体积(MPV)-静脉血: 11.2fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.01；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.51mmolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.35；碱性磷酸酶(ALP)-静脉血: 57.4U/L；直接胆红素(DBIL)-静脉血: 4.1umol/L；镁离子(Mg2+)-静脉血: 0.93mmol/L；血红蛋白(Hb)-静脉血: 1……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者各项检查继续完善中。\n- [全程D10] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程多西紫杉醇＋DDP+5-FU方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 予以短效重组人粒细胞刺激因子（rhG-CSF）皮下注射，暂不予口服保肝药物治疗，并复查血常规及生化后继续住院观察。\nB. 暂不予粒细胞集落刺激因子预防，仅口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。\nC. 予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，静脉滴注头孢菌素预防感染，并复查血常规及生化后安排出院。\nD. 予以短效重组人粒细胞刺激因子（rhG-CSF）皮下注射，静脉滴注异甘草酸镁强效保肝，并复查血常规及生化后继续住院观察。\nE. 暂不予粒细胞集落刺激因子预防，暂不予口服保肝药物治疗，直接安排出院并嘱院外定期复查血常规及生化。\nF. 予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，口服恩替卡韦抗病毒治疗，并复查血常规及生化后安排出院。\nG. 予以短效重组人粒细胞刺激因子（rhG-CSF）皮下注射，口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。\nH. 予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。\nI. 予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，暂不予口服保肝药物治疗，并复查血常规及生化后安排出院。\nJ. 予以重组人促血小板生成素（rhTPO）皮下注射，口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。\nK. 予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，静脉滴注还原型谷胱甘肽保肝，并复查血常规及生化后继续住院观察。\nL. 暂不予任何药物处理，直接安排出院，嘱院外定期复查血常规及生化，若出现发热再返院使用粒细胞集落刺激因子。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-6d1ca43d48e1d74031505487","patient_id":"patient-290a042206ccfe67e72f9a19","turn_id":"turn07","turn_position":4,"turn_type":"recurrence_or_salvage_decision","gold_letter":"J","gold_action":"继续予以抑酸护胃及静脉高营养等对症支持治疗，待体能恢复后序贯开展根治性放疗或同步放化疗。","options":[{"letter":"A","text":"立即启动根治性调强放疗联合同步顺铂化疗，停止静脉高营养以避免导管相关感染。","is_gold":false},{"letter":"B","text":"更换为吉西他滨联合顺铂方案进行第四周期诱导化疗，并继续抑酸护胃治疗。","is_gold":false},{"letter":"C","text":"安排鼻咽原发灶及双侧颈部淋巴结根治性切除术，术后辅以静脉营养支持。","is_gold":false},{"letter":"D","text":"维持静脉营养支持，并立即启动根治性放疗联合PD-1抑制剂及靶向治疗。","is_gold":false},{"letter":"E","text":"继续原方案（多西紫杉醇+顺铂+5-FU）进行第四周期诱导化疗，并辅以抑酸护胃治疗。","is_gold":false},{"letter":"F","text":"暂停所有抗肿瘤治疗，仅维持静脉营养支持及抑酸治疗，1个月后复查MRI决定后续方案。","is_gold":false},{"letter":"G","text":"安排全身PET-CT检查评估全身情况，若无远处转移则继续原方案诱导化疗两周期。","is_gold":false},{"letter":"H","text":"行局部清扫术，处理颈部残留淋巴结，术后序贯鼻咽部根治性放疗及静脉营养支持。","is_gold":false},{"letter":"I","text":"调整为卡培他滨节拍化疗联合静脉营养支持，待消化道反应完全缓解后启动放疗。","is_gold":false},{"letter":"J","text":"继续予以抑酸护胃及静脉高营养等对症支持治疗，待体能恢复后序贯开展根治性放疗或同步放化疗。","is_gold":true},{"letter":"K","text":"启动姑息性放疗控制局部及颈部病灶，并联合阿帕替尼等抗血管生成药物治疗。","is_gold":false},{"letter":"L","text":"维持静脉营养支持，并安排鼻咽镜下局部病灶再次活检以病理确认肿瘤退缩程度。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D29] 检验组合: γ-谷氨酰基转移酶(GGT)-静脉血: 24.3U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.69；中性粒细胞计数(Neut#)-静脉血: 5.710E9/L；载脂蛋白AI(apoAI)-静脉血: 1.44g/L；血红蛋白(Hb)-静脉血: 117g/L；总胆固醇(TC)-静脉血: 5.21mmol/L；血小板分布宽度(PDW)-静脉血: 9.2%；乳酸脱氢酶(LDH)-静脉血: 181.3U/L；总胆汁酸(TBA)-静脉血: 3.1umol/L；直接胆红素(DBIL)-静脉血: 2umol/L；白蛋白(ALB)-静脉血: 39.2g/L；总胆红素(TBIL)-静脉血: 7.9umol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；平均红细胞体积(MCV)-静脉血: 92.9fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.647；C-反应蛋白(CRP)-静脉血: 1.01mg/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.3；红细胞计数(RBC#)-静脉血: 3.9410E12/L；白细胞计数(WBC#)-静脉血: 8.7310E9/L；肌酐(Crea)-静脉血: 102.7umol/L；钠离子(Na+)-静脉血: 141.8mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.56；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.32mmolL；总钙(Ca)-静脉血: 2.29mmol/L；胱抑素(Cys-C)-静脉血: 1.08mg/L；血液二氧化碳含量ctCO2(B)-静脉血: 26.3mmol/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；碱性磷酸酶(ALP)-静脉血: 61.9U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.5U/L；甘油三酯(TG)-静脉血: 1.82mmol/L；氯离子(Cl-)-静脉血: 103.6mmol/L；间接胆红素(IBIL)-静脉血: 5.9umolL；大血小板百分比(P-LCR%)-静脉血: 13.5%；淋巴细胞百分比(Lymph%)-静脉血: 0.282；葡萄糖(Glu)-静脉血: 5.18mmol/L；尿素氮(BUN)-静脉血: 6.……\n- [全程D31] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 2/μL；胆红素(BIL)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.011；比重(SG)-尿液: 1.017；隐血(OB)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 1/μL；胆红素(BIL)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 10/μL；白细胞(LEU)-尿液: -（参考: 阴性）；颜色-尿液: 无色；浊度(TRUB)-尿液: clear；总蛋白(TP)-尿液: -（参考: 阴性）\n- [全程D33] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.016；浊度(TRUB)-尿液: 清亮；总蛋白(TP)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；隐血(OB)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7；白细胞计数(WBC#)-尿液: 1/μL；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）\n- [全程D34] 检验组合: 隐血(OB)-粪便: 阴性（参考: 阴性）；阴离子间隙(AG)-静脉血: 10.6；颜色-粪便: 棕色；钠离子(Na+)-静脉血: 136.7mmol/L；虫卵-粪便: 未见虫卵（参考: 未见虫卵）；血液二氧化碳含量ctCO2(B)-静脉血: 26.2mmol/L；氯离子(Cl-)-静脉血: 99.9mmol/L；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；磷(P)-静脉血: 1.16mmol/L；总钙(Ca)-静脉血: 1.98mmol/L；镁离子(Mg2+)-静脉血: 0.59mmol/L；钾离子(K+)-静脉血: 3.49mmol/L；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）\n- [全程D36] 检验组合: 钾离子(K+)-静脉血: 4.1mmol/L；碱性磷酸酶(ALP)-静脉血: 51.9U/L；球蛋白(GLO)-静脉血: 20.23g/L；钠离子(Na+)-静脉血: 136.6mmol/L；阴离子间隙(AG)-静脉血: 13；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.82mmol/L；总胆红素(TBIL)-静脉血: 15.3umol/L；镁离子(Mg2+)-静脉血: 0.51mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.14g/L；氯离子(Cl-)-静脉血: 99mmol/L；单核细胞计数(Mono#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.3；乳酸脱氢酶(LDH)-静脉血: 169.8U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15.6U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.78；磷(P)-静脉血: 1.11mmol/L；葡萄糖(Glu)-静脉血: 5.25mmol/L；总钙(Ca)-静脉血: 2.08mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 27.3U/L；血小板计数(PLT#)-静脉血: 10410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 327g/L；单核细胞百分比(Mono%)-静脉血: 0.005；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；总胆固醇(TC)-静脉血: 5.03mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 28U/L；平均红细胞体积(MCV)-静脉血: 90.6fL；血红蛋白(Hb)-静脉血: 110g/L；血小板分布宽度(PDW)-静脉血: 11.8%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.6pg；白蛋白(ALB)-静脉血: 36g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1；血液二氧化碳含量ctCO2(B)-静脉血: 24.8mmol/L；总蛋白(TP)-静脉血: 56.23g/L；间接胆红素(IBIL)-静脉血: 10umolL；总胆汁酸(TBA)-静脉血: 4.4umol/L；载脂蛋白B(apoB)-静脉血: 0.9g/L；C-反应蛋白(CRP)-静脉血: 1.75mg/L；嗜酸性粒细胞百分……\n- [全程D37] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后复查，与某次就诊时间对比： 鼻咽腔稍狭窄，鼻咽顶壁、顶后壁、后壁及双侧壁稍增厚，T1WI呈等信号，T2WI呈稍高信号，增强扫描强化明显，粘膜表面不光整。双侧咽隐窝变浅。双侧咽旁间隙未见明显狭窄。双侧腭帆张提肌、头长肌信号不均匀，增强后不均匀强化。双侧翼内外肌未见受侵。 口咽双侧壁未见增厚，左侧鼻甲明显肿大，气道狭窄。双侧鼻腔未见肿物。 双侧翼腭窝、上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 斜坡、枕骨基底部、蝶骨基底部、双侧翼突基底、翼内板、右侧岩尖骨质信号降低，增强扫描强化明显。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶窦、筛窦及右侧乳突气房内见积液，双侧上颌窦及左侧乳突充气良好，骨壁完整。 左侧咽后见淋巴结，大小约4mm×7mm，较前缩小；右侧咽后见小淋巴结，大小约3mm×4mm，较前缩小。双颈II、III区见数个淋巴结，大者大小约8mm×14mm，边界欠清，信号不均匀，增强扫描不均匀明显强化，较前缩小。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗后复查，与某次就诊时间对比： 鼻咽病变，较前明显好转。 颅底骨质破坏，较前好转。 双侧咽后淋巴结，较前缩小。 双颈II、III区淋巴结，考虑转移，较前缩小。 鼻窦炎，右侧乳突炎。\n\n【既往治疗与反应】\n- [全程D15] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程TPF方案诱导化疗结束，诉呕吐1次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部IIa区各可扪及1个淋巴结，左颈2×2cm，右颈1.5×1.5cm,无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程TPF方案诱导化疗结束，无诉特殊不适，可予出院，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n- [全程D30] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，可于今日水化，明日执行第2程多西紫杉醇＋DDP+5-FU方案诱导化疗，注意化疗不良反应。\n- [全程D31] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程多西紫杉醇＋DDP+5-FU方案诱导化疗第一天，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D35] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程多西紫杉醇＋DDP+5-FU方案诱导化疗结束，诉反酸、恶心，无发热、腹痛、腹泻，无关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第2程多西紫杉醇＋DDP+5-FU方案诱导化疗结束后出现反酸、恶心现象，予抑酸护胃、补液等对症处理，继观。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即启动根治性调强放疗联合同步顺铂化疗，停止静脉高营养以避免导管相关感染。\nB. 更换为吉西他滨联合顺铂方案进行第四周期诱导化疗，并继续抑酸护胃治疗。\nC. 安排鼻咽原发灶及双侧颈部淋巴结根治性切除术，术后辅以静脉营养支持。\nD. 维持静脉营养支持，并立即启动根治性放疗联合PD-1抑制剂及靶向治疗。\nE. 继续原方案（多西紫杉醇+顺铂+5-FU）进行第四周期诱导化疗，并辅以抑酸护胃治疗。\nF. 暂停所有抗肿瘤治疗，仅维持静脉营养支持及抑酸治疗，1个月后复查MRI决定后续方案。\nG. 安排全身PET-CT检查评估全身情况，若无远处转移则继续原方案诱导化疗两周期。\nH. 行局部清扫术，处理颈部残留淋巴结，术后序贯鼻咽部根治性放疗及静脉营养支持。\nI. 调整为卡培他滨节拍化疗联合静脉营养支持，待消化道反应完全缓解后启动放疗。\nJ. 继续予以抑酸护胃及静脉高营养等对症支持治疗，待体能恢复后序贯开展根治性放疗或同步放化疗。\nK. 启动姑息性放疗控制局部及颈部病灶，并联合阿帕替尼等抗血管生成药物治疗。\nL. 维持静脉营养支持，并安排鼻咽镜下局部病灶再次活检以病理确认肿瘤退缩程度。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D29] 检验组合: γ-谷氨酰基转移酶(GGT)-静脉血: 24.3U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.69；中性粒细胞计数(Neut#)-静脉血: 5.710E9/L；载脂蛋白AI(apoAI)-静脉血: 1.44g/L；血红蛋白(Hb)-静脉血: 117g/L；总胆固醇(TC)-静脉血: 5.21mmol/L；血小板分布宽度(PDW)-静脉血: 9.2%；乳酸脱氢酶(LDH)-静脉血: 181.3U/L；总胆汁酸(TBA)-静脉血: 3.1umol/L；直接胆红素(DBIL)-静脉血: 2umol/L；白蛋白(ALB)-静脉血: 39.2g/L；总胆红素(TBIL)-静脉血: 7.9umol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；平均红细胞体积(MCV)-静脉血: 92.9fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.647；C-反应蛋白(CRP)-静脉血: 1.01mg/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.3；红细胞计数(RBC#)-静脉血: 3.9410E12/L；白细胞计数(WBC#)-静脉血: 8.7310E9/L；肌酐(Crea)-静脉血: 102.7umol/L；钠离子(Na+)-静脉血: 141.8mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.56；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.32mmolL；总钙(Ca)-静脉血: 2.29mmol/L；胱抑素(Cys-C)-静脉血: 1.08mg/L；血液二氧化碳含量ctCO2(B)-静脉血: 26.3mmol/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；碱性磷酸酶(ALP)-静脉血: 61.9U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.5U/L；甘油三酯(TG)-静脉血: 1.82mmol/L；氯离子(Cl-)-静脉血: 103.6mmol/L；间接胆红素(IBIL)-静脉血: 5.9umolL；大血小板百分比(P-LCR%)-静脉血: 13.5%；淋巴细胞百分比(Lymph%)-静脉血: 0.282；葡萄糖(Glu)-静脉血: 5.18mmol/L；尿素氮(BUN)-静脉血: 6.……\n- [全程D31] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 2/μL；胆红素(BIL)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.011；比重(SG)-尿液: 1.017；隐血(OB)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 1/μL；胆红素(BIL)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 10/μL；白细胞(LEU)-尿液: -（参考: 阴性）；颜色-尿液: 无色；浊度(TRUB)-尿液: clear；总蛋白(TP)-尿液: -（参考: 阴性）\n- [全程D33] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.016；浊度(TRUB)-尿液: 清亮；总蛋白(TP)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；隐血(OB)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7；白细胞计数(WBC#)-尿液: 1/μL；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）\n- [全程D34] 检验组合: 隐血(OB)-粪便: 阴性（参考: 阴性）；阴离子间隙(AG)-静脉血: 10.6；颜色-粪便: 棕色；钠离子(Na+)-静脉血: 136.7mmol/L；虫卵-粪便: 未见虫卵（参考: 未见虫卵）；血液二氧化碳含量ctCO2(B)-静脉血: 26.2mmol/L；氯离子(Cl-)-静脉血: 99.9mmol/L；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；磷(P)-静脉血: 1.16mmol/L；总钙(Ca)-静脉血: 1.98mmol/L；镁离子(Mg2+)-静脉血: 0.59mmol/L；钾离子(K+)-静脉血: 3.49mmol/L；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）\n- [全程D36] 检验组合: 钾离子(K+)-静脉血: 4.1mmol/L；碱性磷酸酶(ALP)-静脉血: 51.9U/L；球蛋白(GLO)-静脉血: 20.23g/L；钠离子(Na+)-静脉血: 136.6mmol/L；阴离子间隙(AG)-静脉血: 13；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.82mmol/L；总胆红素(TBIL)-静脉血: 15.3umol/L；镁离子(Mg2+)-静脉血: 0.51mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.14g/L；氯离子(Cl-)-静脉血: 99mmol/L；单核细胞计数(Mono#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.3；乳酸脱氢酶(LDH)-静脉血: 169.8U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15.6U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.78；磷(P)-静脉血: 1.11mmol/L；葡萄糖(Glu)-静脉血: 5.25mmol/L；总钙(Ca)-静脉血: 2.08mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 27.3U/L；血小板计数(PLT#)-静脉血: 10410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 327g/L；单核细胞百分比(Mono%)-静脉血: 0.005；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；总胆固醇(TC)-静脉血: 5.03mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 28U/L；平均红细胞体积(MCV)-静脉血: 90.6fL；血红蛋白(Hb)-静脉血: 110g/L；血小板分布宽度(PDW)-静脉血: 11.8%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.6pg；白蛋白(ALB)-静脉血: 36g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1；血液二氧化碳含量ctCO2(B)-静脉血: 24.8mmol/L；总蛋白(TP)-静脉血: 56.23g/L；间接胆红素(IBIL)-静脉血: 10umolL；总胆汁酸(TBA)-静脉血: 4.4umol/L；载脂蛋白B(apoB)-静脉血: 0.9g/L；C-反应蛋白(CRP)-静脉血: 1.75mg/L；嗜酸性粒细胞百分……\n- [全程D37] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后复查，与某次就诊时间对比： 鼻咽腔稍狭窄，鼻咽顶壁、顶后壁、后壁及双侧壁稍增厚，T1WI呈等信号，T2WI呈稍高信号，增强扫描强化明显，粘膜表面不光整。双侧咽隐窝变浅。双侧咽旁间隙未见明显狭窄。双侧腭帆张提肌、头长肌信号不均匀，增强后不均匀强化。双侧翼内外肌未见受侵。 口咽双侧壁未见增厚，左侧鼻甲明显肿大，气道狭窄。双侧鼻腔未见肿物。 双侧翼腭窝、上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 斜坡、枕骨基底部、蝶骨基底部、双侧翼突基底、翼内板、右侧岩尖骨质信号降低，增强扫描强化明显。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶窦、筛窦及右侧乳突气房内见积液，双侧上颌窦及左侧乳突充气良好，骨壁完整。 左侧咽后见淋巴结，大小约4mm×7mm，较前缩小；右侧咽后见小淋巴结，大小约3mm×4mm，较前缩小。双颈II、III区见数个淋巴结，大者大小约8mm×14mm，边界欠清，信号不均匀，增强扫描不均匀明显强化，较前缩小。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗后复查，与某次就诊时间对比： 鼻咽病变，较前明显好转。 颅底骨质破坏，较前好转。 双侧咽后淋巴结，较前缩小。 双颈II、III区淋巴结，考虑转移，较前缩小。 鼻窦炎，右侧乳突炎。\n\n【既往治疗与反应】\n- [全程D15] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程TPF方案诱导化疗结束，诉呕吐1次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部IIa区各可扪及1个淋巴结，左颈2×2cm，右颈1.5×1.5cm,无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程TPF方案诱导化疗结束，无诉特殊不适，可予出院，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n- [全程D30] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，可于今日水化，明日执行第2程多西紫杉醇＋DDP+5-FU方案诱导化疗，注意化疗不良反应。\n- [全程D31] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程多西紫杉醇＋DDP+5-FU方案诱导化疗第一天，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D35] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程多西紫杉醇＋DDP+5-FU方案诱导化疗结束，诉反酸、恶心，无发热、腹痛、腹泻，无关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第2程多西紫杉醇＋DDP+5-FU方案诱导化疗结束后出现反酸、恶心现象，予抑酸护胃、补液等对症处理，继观。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即启动根治性调强放疗联合同步顺铂化疗，停止静脉高营养以避免导管相关感染。\nB. 更换为吉西他滨联合顺铂方案进行第四周期诱导化疗，并继续抑酸护胃治疗。\nC. 安排鼻咽原发灶及双侧颈部淋巴结根治性切除术，术后辅以静脉营养支持。\nD. 维持静脉营养支持，并立即启动根治性放疗联合PD-1抑制剂及靶向治疗。\nE. 继续原方案（多西紫杉醇+顺铂+5-FU）进行第四周期诱导化疗，并辅以抑酸护胃治疗。\nF. 暂停所有抗肿瘤治疗，仅维持静脉营养支持及抑酸治疗，1个月后复查MRI决定后续方案。\nG. 安排全身PET-CT检查评估全身情况，若无远处转移则继续原方案诱导化疗两周期。\nH. 行局部清扫术，处理颈部残留淋巴结，术后序贯鼻咽部根治性放疗及静脉营养支持。\nI. 调整为卡培他滨节拍化疗联合静脉营养支持，待消化道反应完全缓解后启动放疗。\nJ. 继续予以抑酸护胃及静脉高营养等对症支持治疗，待体能恢复后序贯开展根治性放疗或同步放化疗。\nK. 启动姑息性放疗控制局部及颈部病灶，并联合阿帕替尼等抗血管生成药物治疗。\nL. 维持静脉营养支持，并安排鼻咽镜下局部病灶再次活检以病理确认肿瘤退缩程度。\n\n请仅输出一个选项字母（A-L）。"}]}
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full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：不支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、颈动脉鞘、斜坡、翼突基底部、蝶骨基底部、岩尖等。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D2] 入院记录: 主诉: 发现右颈部肿物5月余；现病史: 患者于入院前5月前（某次就诊时间10月）高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；阳性症状体征: 体重下降,疼痛,高热,右颈部肿物,颈部酸痛；既往史: 既往有“肾病综合征”病史，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。；家族史: 否认肿瘤家族史。；体格检查: T：36℃，P：68次/分，R：20次/分，BP：91/58mmHg,Ht：144cm，Wt：31kg，BSA：1.135m2，KPS：KPS 90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，暂缓全身影像学分期检查。\nB. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，PET-CT全身显像。\nC. 右颈部肿物切除活检，鼻咽及颈部MRI平扫+增强，全身骨显像，腹部彩超。\nD. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫，全身骨显像，腹部彩超，心电图。\nE. 鼻咽镜检查及活检，头颅MRI平扫+增强，颈部彩超，全身骨显像，腹部彩超。\nF. 鼻咽刷片细胞学检查，鼻咽及颈部MRI平扫+增强，全身骨显像，腹部彩超。\nG. 鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，全身骨显像，腹部彩超，心电图。\nH. 右颈部肿物细针穿刺活检，鼻咽及颈部MRI平扫+增强，全身骨显像，腹部彩超。\nI. 鼻咽镜检查及活检，鼻咽MRI平扫+增强，全身骨显像，腹部彩超，心电图。\nJ. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，骨髓穿刺活检，腹部彩超。\nK. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部及腹部MRI平扫+增强。\nL. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身骨显像、腹部彩超及心电图等基线检查。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：不支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、颈动脉鞘、斜坡、翼突基底部、蝶骨基底部、岩尖等。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D2] 入院记录: 主诉: 发现右颈部肿物5月余；现病史: 患者于入院前5月前（某次就诊时间10月）高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；阳性症状体征: 体重下降,疼痛,高热,右颈部肿物,颈部酸痛；既往史: 既往有“肾病综合征”病史，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。；家族史: 否认肿瘤家族史。；体格检查: T：36℃，P：68次/分，R：20次/分，BP：91/58mmHg,Ht：144cm，Wt：31kg，BSA：1.135m2，KPS：KPS 90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，暂缓全身影像学分期检查。\nB. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，PET-CT全身显像。\nC. 右颈部肿物切除活检，鼻咽及颈部MRI平扫+增强，全身骨显像，腹部彩超。\nD. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫，全身骨显像，腹部彩超，心电图。\nE. 鼻咽镜检查及活检，头颅MRI平扫+增强，颈部彩超，全身骨显像，腹部彩超。\nF. 鼻咽刷片细胞学检查，鼻咽及颈部MRI平扫+增强，全身骨显像，腹部彩超。\nG. 鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，全身骨显像，腹部彩超，心电图。\nH. 右颈部肿物细针穿刺活检，鼻咽及颈部MRI平扫+增强，全身骨显像，腹部彩超。\nI. 鼻咽镜检查及活检，鼻咽MRI平扫+增强，全身骨显像，腹部彩超，心电图。\nJ. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，骨髓穿刺活检，腹部彩超。\nK. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部及腹部MRI平扫+增强。\nL. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身骨显像、腹部彩超及心电图等基线检查。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-6cb68b4fe11abd5f5e27ea88","patient_id":"patient-e45c55cc63c050892e6b2467","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"A","gold_action":"行鼻咽镜检查及活检，并完善胸片或胸部CT检查。","options":[{"letter":"A","text":"行鼻咽镜检查及活检，并完善胸片或胸部CT检查。","is_gold":true},{"letter":"B","text":"行右颈部肿大淋巴结切除活检，并完善胸片或胸部CT检查。","is_gold":false},{"letter":"C","text":"行鼻咽镜检查及活检，并完善头颅增强MRI检查。","is_gold":false},{"letter":"D","text":"行右颈部肿大淋巴结细针穿刺活检，并完善全身骨扫描。","is_gold":false},{"letter":"E","text":"行全身PET-CT检查，暂缓鼻咽及颈部活检。","is_gold":false},{"letter":"F","text":"行鼻咽镜检查及活检，暂不安排其他部位影像学检查。","is_gold":false},{"letter":"G","text":"完善胸部及全腹部增强CT检查，待结果回报后再行活检。","is_gold":false},{"letter":"H","text":"行鼻咽镜检查及活检，并复查颈部彩超评估淋巴结。","is_gold":false},{"letter":"I","text":"安排鼻咽及颈部根治性放疗，同步完善胸片或胸部CT检查。","is_gold":false},{"letter":"J","text":"行鼻咽镜检查及活检，并完善全身骨扫描检查。","is_gold":false},{"letter":"K","text":"给予抗炎治疗2周后复查鼻咽MRI，再决定是否行鼻咽活检。","is_gold":false},{"letter":"L","text":"行鼻咽镜检查及活检，并完善血浆EBV-DNA检测，暂缓胸部影像学检查。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：不支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、颈动脉鞘、斜坡、翼突基底部、蝶骨基底部、岩尖等。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D1] 门急诊记录: 主诉: 右颈部肿物6月余；现病史: 患者某次就诊时间10月份高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；既往史: 肾病综合征。否认高血压、糖尿病、冠心病、肾病等慢性病史，否认乙肝、结核等传染病史，否认重大外伤史，否认献血输血及使用血制品史，否认食物药物过敏史。；个人史: 原籍出生长大，否认疫区疫水接触史，否认化学毒性及放射性物质接触史。；家族史: 否认家族类似病史及肿瘤病史。；体格检查: KPS90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。\n\n【已完成检查与客观结果】\n- [全程D3] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见: 心电图大致正常；检查结论: 窦性心律不齐 心电图大致正常\n- [全程D3] 检验组合: 乳酸脱氢酶(LDH)-静脉血: 198.2U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 10.4U/L；总胆红素(TBIL)-静脉血: 4.2umol/L；葡萄糖(Glu)-静脉血: 4.55mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.495COI；α-L-岩藻糖苷酶(AFU)-静脉血: 35U/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；铁蛋白(Ferr)-静脉血: 91.44ng/ml；磷(P)-静脉血: 1.76mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阴性(-)（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.21ug/ml；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阳性(129.78U/mL)（参考: 阴性）；淋巴细胞百分比(Lymph%)-静脉血: 0.426；碱性磷酸酶(ALP)-静脉血: 130.2U/L；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；纤维蛋白原(Fbg)-静脉血: 2.78g/L；钾离子(K+)-静脉血: 3.5mmol/L；免疫球蛋白游离λ轻链(F-Lambda)-静脉血: 阴性(-)（参考: 阴性(-)）；平均血小板体积(MPV)-静脉血: 8.8fL；尿酸(UA)-静脉血: 200umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.24mmolL；天门冬氨酸氨基转移酶(AST)-静脉血: 18.5U/L；尿素氮(BUN)-静脉血: 3.59mmol/L；总胆固醇(TC)-静脉血: 3.29mmol/L；直接胆红素(DBIL)-静脉血: 1.6umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 11.9U/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.98；中性粒细胞百分比(Neut%)-静脉血: 0.516；肌酐(Crea)-静脉血: 35.7umol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞体积(MCV)-静脉血……\n- [全程D4] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约24cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行鼻咽镜检查及活检，并完善胸片或胸部CT检查。\nB. 行右颈部肿大淋巴结切除活检，并完善胸片或胸部CT检查。\nC. 行鼻咽镜检查及活检，并完善头颅增强MRI检查。\nD. 行右颈部肿大淋巴结细针穿刺活检，并完善全身骨扫描。\nE. 行全身PET-CT检查，暂缓鼻咽及颈部活检。\nF. 行鼻咽镜检查及活检，暂不安排其他部位影像学检查。\nG. 完善胸部及全腹部增强CT检查，待结果回报后再行活检。\nH. 行鼻咽镜检查及活检，并复查颈部彩超评估淋巴结。\nI. 安排鼻咽及颈部根治性放疗，同步完善胸片或胸部CT检查。\nJ. 行鼻咽镜检查及活检，并完善全身骨扫描检查。\nK. 给予抗炎治疗2周后复查鼻咽MRI，再决定是否行鼻咽活检。\nL. 行鼻咽镜检查及活检，并完善血浆EBV-DNA检测，暂缓胸部影像学检查。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：不支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、颈动脉鞘、斜坡、翼突基底部、蝶骨基底部、岩尖等。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D1] 门急诊记录: 主诉: 右颈部肿物6月余；现病史: 患者某次就诊时间10月份高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；既往史: 肾病综合征。否认高血压、糖尿病、冠心病、肾病等慢性病史，否认乙肝、结核等传染病史，否认重大外伤史，否认献血输血及使用血制品史，否认食物药物过敏史。；个人史: 原籍出生长大，否认疫区疫水接触史，否认化学毒性及放射性物质接触史。；家族史: 否认家族类似病史及肿瘤病史。；体格检查: KPS90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。\n\n【已完成检查与客观结果】\n- [全程D3] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见: 心电图大致正常；检查结论: 窦性心律不齐 心电图大致正常\n- [全程D3] 检验组合: 乳酸脱氢酶(LDH)-静脉血: 198.2U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 10.4U/L；总胆红素(TBIL)-静脉血: 4.2umol/L；葡萄糖(Glu)-静脉血: 4.55mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.495COI；α-L-岩藻糖苷酶(AFU)-静脉血: 35U/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；铁蛋白(Ferr)-静脉血: 91.44ng/ml；磷(P)-静脉血: 1.76mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阴性(-)（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.21ug/ml；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阳性(129.78U/mL)（参考: 阴性）；淋巴细胞百分比(Lymph%)-静脉血: 0.426；碱性磷酸酶(ALP)-静脉血: 130.2U/L；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；纤维蛋白原(Fbg)-静脉血: 2.78g/L；钾离子(K+)-静脉血: 3.5mmol/L；免疫球蛋白游离λ轻链(F-Lambda)-静脉血: 阴性(-)（参考: 阴性(-)）；平均血小板体积(MPV)-静脉血: 8.8fL；尿酸(UA)-静脉血: 200umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.24mmolL；天门冬氨酸氨基转移酶(AST)-静脉血: 18.5U/L；尿素氮(BUN)-静脉血: 3.59mmol/L；总胆固醇(TC)-静脉血: 3.29mmol/L；直接胆红素(DBIL)-静脉血: 1.6umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 11.9U/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.98；中性粒细胞百分比(Neut%)-静脉血: 0.516；肌酐(Crea)-静脉血: 35.7umol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞体积(MCV)-静脉血……\n- [全程D4] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约24cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行鼻咽镜检查及活检，并完善胸片或胸部CT检查。\nB. 行右颈部肿大淋巴结切除活检，并完善胸片或胸部CT检查。\nC. 行鼻咽镜检查及活检，并完善头颅增强MRI检查。\nD. 行右颈部肿大淋巴结细针穿刺活检，并完善全身骨扫描。\nE. 行全身PET-CT检查，暂缓鼻咽及颈部活检。\nF. 行鼻咽镜检查及活检，暂不安排其他部位影像学检查。\nG. 完善胸部及全腹部增强CT检查，待结果回报后再行活检。\nH. 行鼻咽镜检查及活检，并复查颈部彩超评估淋巴结。\nI. 安排鼻咽及颈部根治性放疗，同步完善胸片或胸部CT检查。\nJ. 行鼻咽镜检查及活检，并完善全身骨扫描检查。\nK. 给予抗炎治疗2周后复查鼻咽MRI，再决定是否行鼻咽活检。\nL. 行鼻咽镜检查及活检，并完善血浆EBV-DNA检测，暂缓胸部影像学检查。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-51ced222567a8eb77bc8161d","patient_id":"patient-e45c55cc63c050892e6b2467","turn_id":"turn04","turn_position":3,"turn_type":"initial_treatment_selection","gold_letter":"B","gold_action":"予以诱导化疗序贯同期放化疗","options":[{"letter":"A","text":"予以根治性单纯放疗","is_gold":false},{"letter":"B","text":"予以诱导化疗序贯同期放化疗","is_gold":true},{"letter":"C","text":"予以诱导化疗序贯单纯放疗","is_gold":false},{"letter":"D","text":"予以同期放化疗序贯辅助化疗","is_gold":false},{"letter":"E","text":"予以靶向治疗联合同期放化疗","is_gold":false},{"letter":"F","text":"予以免疫治疗联合同期放化疗","is_gold":false},{"letter":"G","text":"予以诱导化疗序贯靶向治疗联合放疗","is_gold":false},{"letter":"H","text":"行颈部淋巴结清扫术序贯根治性放疗","is_gold":false},{"letter":"I","text":"行鼻咽原发灶切除联合颈部淋巴结清扫术","is_gold":false},{"letter":"J","text":"予以姑息性化疗联合局部姑息性放疗","is_gold":false},{"letter":"K","text":"予以诱导化疗序贯根治性手术切除","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：不支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、颈动脉鞘、斜坡、翼突基底部、蝶骨基底部、岩尖等。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 入院记录: 主诉: 发现右颈部肿物5月余；现病史: 患者于入院前5月前（某次就诊时间10月）高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。行右颈部肿物活检病理回报：提示鼻咽部鳞癌转移。鼻咽部MR示：鼻咽顶后壁及两侧壁粘膜增厚，右侧翼内肌、咽鼓管、头长肌受侵，右侧斜坡，颞骨岩部，寰椎前弓骨质破坏。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；阳性症状体征: 体重下降,疼痛,高热,右颈部肿物,颈部酸痛；既往史: 既往有“肾病综合征”病史，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。；家族史: 否认肿瘤家族史。；体格检查: T：36℃，P：68次/分，R：20次/分，BP：91/58mmHg,Ht：144cm，Wt：31kg，BSA：1.135m2，KPS：KPS 90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率{数值}次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。右颈扪及肿物，约4*3cm,无压痛，质硬，活动差，边界尚清，未扪及明显融合，活检伤口愈合良好。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 无可展示记录。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 予以根治性单纯放疗\nB. 予以诱导化疗序贯同期放化疗\nC. 予以诱导化疗序贯单纯放疗\nD. 予以同期放化疗序贯辅助化疗\nE. 予以靶向治疗联合同期放化疗\nF. 予以免疫治疗联合同期放化疗\nG. 予以诱导化疗序贯靶向治疗联合放疗\nH. 行颈部淋巴结清扫术序贯根治性放疗\nI. 行鼻咽原发灶切除联合颈部淋巴结清扫术\nJ. 予以姑息性化疗联合局部姑息性放疗\nK. 予以诱导化疗序贯根治性手术切除\n\n请仅输出一个选项字母（A-K）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：不支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、颈动脉鞘、斜坡、翼突基底部、蝶骨基底部、岩尖等。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 入院记录: 主诉: 发现右颈部肿物5月余；现病史: 患者于入院前5月前（某次就诊时间10月）高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。行右颈部肿物活检病理回报：提示鼻咽部鳞癌转移。鼻咽部MR示：鼻咽顶后壁及两侧壁粘膜增厚，右侧翼内肌、咽鼓管、头长肌受侵，右侧斜坡，颞骨岩部，寰椎前弓骨质破坏。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；阳性症状体征: 体重下降,疼痛,高热,右颈部肿物,颈部酸痛；既往史: 既往有“肾病综合征”病史，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。；家族史: 否认肿瘤家族史。；体格检查: T：36℃，P：68次/分，R：20次/分，BP：91/58mmHg,Ht：144cm，Wt：31kg，BSA：1.135m2，KPS：KPS 90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率{数值}次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。右颈扪及肿物，约4*3cm,无压痛，质硬，活动差，边界尚清，未扪及明显融合，活检伤口愈合良好。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 无可展示记录。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 予以根治性单纯放疗\nB. 予以诱导化疗序贯同期放化疗\nC. 予以诱导化疗序贯单纯放疗\nD. 予以同期放化疗序贯辅助化疗\nE. 予以靶向治疗联合同期放化疗\nF. 予以免疫治疗联合同期放化疗\nG. 予以诱导化疗序贯靶向治疗联合放疗\nH. 行颈部淋巴结清扫术序贯根治性放疗\nI. 行鼻咽原发灶切除联合颈部淋巴结清扫术\nJ. 予以姑息性化疗联合局部姑息性放疗\nK. 予以诱导化疗序贯根治性手术切除\n\n请仅输出一个选项字母（A-K）。"}]}
+{"sample_id":"sample-31164fa636b978a86d54f0c9","patient_id":"patient-e45c55cc63c050892e6b2467","turn_id":"turn05","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"D","gold_action":"完善全麻下鼻咽及颈部肿物活检术前准备，予以配血备用及口服地西泮镇静。","options":[{"letter":"A","text":"完善局麻下鼻咽及颈部肿物活检术前准备，予以口服地西泮镇静及配血备用。","is_gold":false},{"letter":"B","text":"完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注头孢类抗生素预防感染。","is_gold":false},{"letter":"C","text":"完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注氨甲环酸预防术中出血。","is_gold":false},{"letter":"D","text":"完善全麻下鼻咽及颈部肿物活检术前准备，予以配血备用及口服地西泮镇静。","is_gold":true},{"letter":"E","text":"完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注人血白蛋白及复方氨基酸。","is_gold":false},{"letter":"F","text":"完善全麻下鼻咽及颈部肿物活检术前准备，予以皮下注射低分子肝素及下肢气压治疗。","is_gold":false},{"letter":"G","text":"完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉滴注地塞米松及雾化吸入。","is_gold":false},{"letter":"H","text":"完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉补充氯化钾及晶体液扩容。","is_gold":false},{"letter":"I","text":"暂缓活检手术，予以静脉输注广谱抗生素及补液支持治疗。","is_gold":false},{"letter":"J","text":"暂缓活检手术，予以口服非甾体类抗炎药及局部热敷理疗。","is_gold":false},{"letter":"K","text":"完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注单采血小板及冷沉淀。","is_gold":false},{"letter":"L","text":"完善全麻下鼻咽及颈部肿物活检术前准备，予以口服氯雷他定及局部涂抹糖皮质激素。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：不支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、颈动脉鞘、斜坡、翼突基底部、蝶骨基底部、岩尖等。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D21] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显占位病变，肺门纵隔未见明显增宽，心影无增大，双侧肋膈角锐利。；检查结论: 心肺未见病变。\n- [全程D21] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 23mmol/L；总胆红素(TBIL)-静脉血: 7.6umol/L；C-反应蛋白(CRP)-静脉血: 4.9mg/L；总胆固醇(TC)-静脉血: 4.18mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.5mmolL；总胆汁酸(TBA)-静脉血: 2.5umol/L；血型抗体筛查-静脉血: 阴性；ABO血型-静脉血: B；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；大血小板百分比(P-LCR%)-静脉血: 24.7%；血小板比容-静脉血: 32%；血小板分布宽度(PDW)-静脉血: 11.1%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；总蛋白(TP)-静脉血: 74.14g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.011；平均红细胞血红蛋白含量(MCH)-静脉血: 28.1pg；白蛋白(ALB)-静脉血: 38.9g/L；甘油三酯(TG)-静脉血: 0.81mmol/L；磷(P)-静脉血: 1.55mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.1；直接胆红素(DBIL)-静脉血: 2.5umol/L；平均红细胞体积(MCV)-静脉血: 84.5fL；平均血小板体积(MPV)-静脉血: 10.1fL；钠离子(Na+)-静脉血: 136.6mmol/L；氯离子(Cl-)-静脉血: 101.1mmol/L；镁离子(Mg2+)-静脉血: 0.72mmol/L；肌酐(Crea)-静脉血: 33.8umol/L；Rh血型-静脉血: 阳性；载脂蛋白AI(apoAI)-静脉血: 1.34g/L；尿素氮(BUN)-静脉血: 5.75mmol/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；淋巴细胞计数(Lymph#)-静脉血: 2.810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.591；白细胞计数(WBC#)-静脉血: 8.5610E9/L；钾离子(K+)-静脉血: 4.3mmol/L；总钙(Ca)-静脉血: 2.26mmol/L；尿酸(UA)-静脉血: 204.9umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24.5U/L；有核红细胞计数(NRBC……\n\n【既往治疗与反应】\n- [全程D3] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日随夏医生信息已隐藏，患者颈背部酸痛较前有好转，无发热畏寒，无恶心呕吐，无胸闷心悸，胃纳睡眠尚可，二便未见明显异常，体查：KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。右颈扪及肿物，约4*3cm,无压痛，质硬，活动差，边界尚清，未扪及明显融合，活检伤口愈合良好。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。右颈部肿物活检病理回报：提示鼻咽部鳞癌转移。鼻咽部MR示：鼻咽顶后壁及两侧壁粘膜增厚，右侧翼内肌、咽鼓管、头长肌受侵，右侧斜坡，颞骨岩部，寰椎前弓骨质破坏。目前患者诊断：鼻咽癌，患者病理活检部位为右颈部肿物，提示转移性鳞癌，建议其行鼻咽部肿物病理活检，患者家属不同意，有放疗适应症，无相对放疗禁忌症，告知患者放疗风险及副反应，患者家属表示理解病情，现治疗后患者要求出院，予以办理，嘱注意休息合理饮食，定期复诊，不适随诊。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D19] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。凝血、乙肝两对半、肝炎四项、HIV/梅毒等检验结果无明显异常。[姓名已隐去]主任查房后，患者因年龄较小，完成活检等操作不配合，家属要求全麻下行活检明确病理，完善相关检查后择期手术，遵嘱执行。\n- [全程D20] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。[姓名已隐去]主任查房后示，完善术前相关检验检查，做好术前准备，遵嘱执行。\n- [全程D21] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。血常规、生化常规回报无明显异常。输血三项回报：B型、RH阳性、抗体筛选阴性。[姓名已隐去]主任查房后示，结合患者各项检查，未见明显手术禁忌，拟明日在气管内吸入全麻下经鼻内镜行鼻咽肿物活检+颈部肿物活检术，做好术前准备，遵嘱执行。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善局麻下鼻咽及颈部肿物活检术前准备，予以口服地西泮镇静及配血备用。\nB. 完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注头孢类抗生素预防感染。\nC. 完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注氨甲环酸预防术中出血。\nD. 完善全麻下鼻咽及颈部肿物活检术前准备，予以配血备用及口服地西泮镇静。\nE. 完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注人血白蛋白及复方氨基酸。\nF. 完善全麻下鼻咽及颈部肿物活检术前准备，予以皮下注射低分子肝素及下肢气压治疗。\nG. 完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉滴注地塞米松及雾化吸入。\nH. 完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉补充氯化钾及晶体液扩容。\nI. 暂缓活检手术，予以静脉输注广谱抗生素及补液支持治疗。\nJ. 暂缓活检手术，予以口服非甾体类抗炎药及局部热敷理疗。\nK. 完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注单采血小板及冷沉淀。\nL. 完善全麻下鼻咽及颈部肿物活检术前准备，予以口服氯雷他定及局部涂抹糖皮质激素。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：不支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、颈动脉鞘、斜坡、翼突基底部、蝶骨基底部、岩尖等。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D21] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显占位病变，肺门纵隔未见明显增宽，心影无增大，双侧肋膈角锐利。；检查结论: 心肺未见病变。\n- [全程D21] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 23mmol/L；总胆红素(TBIL)-静脉血: 7.6umol/L；C-反应蛋白(CRP)-静脉血: 4.9mg/L；总胆固醇(TC)-静脉血: 4.18mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.5mmolL；总胆汁酸(TBA)-静脉血: 2.5umol/L；血型抗体筛查-静脉血: 阴性；ABO血型-静脉血: B；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；大血小板百分比(P-LCR%)-静脉血: 24.7%；血小板比容-静脉血: 32%；血小板分布宽度(PDW)-静脉血: 11.1%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；总蛋白(TP)-静脉血: 74.14g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.011；平均红细胞血红蛋白含量(MCH)-静脉血: 28.1pg；白蛋白(ALB)-静脉血: 38.9g/L；甘油三酯(TG)-静脉血: 0.81mmol/L；磷(P)-静脉血: 1.55mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.1；直接胆红素(DBIL)-静脉血: 2.5umol/L；平均红细胞体积(MCV)-静脉血: 84.5fL；平均血小板体积(MPV)-静脉血: 10.1fL；钠离子(Na+)-静脉血: 136.6mmol/L；氯离子(Cl-)-静脉血: 101.1mmol/L；镁离子(Mg2+)-静脉血: 0.72mmol/L；肌酐(Crea)-静脉血: 33.8umol/L；Rh血型-静脉血: 阳性；载脂蛋白AI(apoAI)-静脉血: 1.34g/L；尿素氮(BUN)-静脉血: 5.75mmol/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；淋巴细胞计数(Lymph#)-静脉血: 2.810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.591；白细胞计数(WBC#)-静脉血: 8.5610E9/L；钾离子(K+)-静脉血: 4.3mmol/L；总钙(Ca)-静脉血: 2.26mmol/L；尿酸(UA)-静脉血: 204.9umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24.5U/L；有核红细胞计数(NRBC……\n\n【既往治疗与反应】\n- [全程D3] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日随夏医生信息已隐藏，患者颈背部酸痛较前有好转，无发热畏寒，无恶心呕吐，无胸闷心悸，胃纳睡眠尚可，二便未见明显异常，体查：KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。右颈扪及肿物，约4*3cm,无压痛，质硬，活动差，边界尚清，未扪及明显融合，活检伤口愈合良好。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。右颈部肿物活检病理回报：提示鼻咽部鳞癌转移。鼻咽部MR示：鼻咽顶后壁及两侧壁粘膜增厚，右侧翼内肌、咽鼓管、头长肌受侵，右侧斜坡，颞骨岩部，寰椎前弓骨质破坏。目前患者诊断：鼻咽癌，患者病理活检部位为右颈部肿物，提示转移性鳞癌，建议其行鼻咽部肿物病理活检，患者家属不同意，有放疗适应症，无相对放疗禁忌症，告知患者放疗风险及副反应，患者家属表示理解病情，现治疗后患者要求出院，予以办理，嘱注意休息合理饮食，定期复诊，不适随诊。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D19] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。凝血、乙肝两对半、肝炎四项、HIV/梅毒等检验结果无明显异常。[姓名已隐去]主任查房后，患者因年龄较小，完成活检等操作不配合，家属要求全麻下行活检明确病理，完善相关检查后择期手术，遵嘱执行。\n- [全程D20] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。[姓名已隐去]主任查房后示，完善术前相关检验检查，做好术前准备，遵嘱执行。\n- [全程D21] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。血常规、生化常规回报无明显异常。输血三项回报：B型、RH阳性、抗体筛选阴性。[姓名已隐去]主任查房后示，结合患者各项检查，未见明显手术禁忌，拟明日在气管内吸入全麻下经鼻内镜行鼻咽肿物活检+颈部肿物活检术，做好术前准备，遵嘱执行。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善局麻下鼻咽及颈部肿物活检术前准备，予以口服地西泮镇静及配血备用。\nB. 完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注头孢类抗生素预防感染。\nC. 完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注氨甲环酸预防术中出血。\nD. 完善全麻下鼻咽及颈部肿物活检术前准备，予以配血备用及口服地西泮镇静。\nE. 完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注人血白蛋白及复方氨基酸。\nF. 完善全麻下鼻咽及颈部肿物活检术前准备，予以皮下注射低分子肝素及下肢气压治疗。\nG. 完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉滴注地塞米松及雾化吸入。\nH. 完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉补充氯化钾及晶体液扩容。\nI. 暂缓活检手术，予以静脉输注广谱抗生素及补液支持治疗。\nJ. 暂缓活检手术，予以口服非甾体类抗炎药及局部热敷理疗。\nK. 完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注单采血小板及冷沉淀。\nL. 完善全麻下鼻咽及颈部肿物活检术前准备，予以口服氯雷他定及局部涂抹糖皮质激素。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-e79a5ee2227343d5e15dc4d1","patient_id":"patient-e45c55cc63c050892e6b2467","turn_id":"turn06","turn_position":5,"turn_type":"toxicity_or_support_decision","gold_letter":"E","gold_action":"继续抗炎及支持治疗，完善血常规、尿常规及生化常规检查。","options":[{"letter":"A","text":"立即启动含铂双药诱导化疗，并完善心电图及超声心动图检查。","is_gold":false},{"letter":"B","text":"予以静脉输注氨甲环酸，并完善凝血常规及D-二聚体检查。","is_gold":false},{"letter":"C","text":"安排右颈部淋巴结清扫术，并静脉使用广谱抗生素抗感染。","is_gold":false},{"letter":"D","text":"予以阿片类药物滴定止痛，并完善全身骨扫描检查。","is_gold":false},{"letter":"E","text":"继续抗炎及支持治疗，完善血常规、尿常规及生化常规检查。","is_gold":true},{"letter":"F","text":"启动根治性调强放射治疗，并复查鼻咽及颈部增强MRI。","is_gold":false},{"letter":"G","text":"予以静脉高营养支持治疗，并复查血浆EBV-DNA定量。","is_gold":false},{"letter":"H","text":"预防性皮下注射低分子肝素，并完善双下肢深静脉彩超。","is_gold":false},{"letter":"I","text":"予以静脉滴注地塞米松，并复查头颈部增强CT。","is_gold":false},{"letter":"J","text":"拔除静脉留置针，仅予以口服非甾体抗炎药，并继续留院观察。","is_gold":false},{"letter":"K","text":"停止静脉用药，改为口服头孢类抗生素，并立即办理出院。","is_gold":false},{"letter":"L","text":"予以颈部局部姑息性放疗，并完善甲状腺功能检查。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：不支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、颈动脉鞘、斜坡、翼突基底部、蝶骨基底部、岩尖等。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D22] 检验组合: 乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D25] 检验组合: 血小板分布宽度(PDW)-静脉血: 10.3%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；比重(SG)-尿液: 1.028；甘油三酯(TG)-静脉血: 1.05mmol/L；红细胞计数(RBC#)-静脉血: 3.4910E12/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.86mmolL；平均红细胞体积(MCV)-静脉血: 84.8fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 42.4；丙氨酸氨基转移酶(ALT)-静脉血: 14.8U/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.001；尿酸(UA)-静脉血: 132.3umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.910E9/L；大血小板百分比(P-LCR%)-静脉血: 21.8%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；粘液丝计数(MUCS#)-尿液: 28/μL；红细胞计数(RBC#)-尿液: 1/μL；浊度(TRUB)-尿液: 清亮；血小板计数(PLT#)-静脉血: 31810E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.218；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7；天门冬氨酸氨基转移酶(AST)-静脉血: 11.2U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.1；载脂蛋白AI(apoAI)-静脉血: 1.14g/L；单核细胞百分比(Mono%)-静脉血: 0.084；总钙(Ca)-静脉血: 2.2mmol/L；总胆汁酸(TBA)-静脉血: 4.4umol/L；白蛋白(ALB)-静脉血: 35.7g/L；红细胞比容(Hct)-静脉血: 29.6%；单核细胞计数(Mono#)-静脉血: 0.710E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 10.9U/L；平均血小板体积(MPV)-静脉血: 9.7fL；中性粒细胞计数(Neut#)-静脉血: 6.110E9/L；胆红素(BIL)-尿液: -（参考: 阴性）；血红蛋白(Hb)-静脉血: 100g/L；C-反应蛋白(CRP)-静脉血: 66.11mg/L；葡萄糖(Glu)-静脉血: 4.89mmol/L；磷(P)-静脉血: 1.26mmol/L；直接胆红素(DBIL……\n\n【既往治疗与反应】\n- [全程D22] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日在气管内全麻下行左颈淋巴结切除活检+经鼻内镜鼻咽肿物切开活检术。术程顺利，术后麻醉复苏顺利，安返病房，生命体征平稳，未见口鼻活动性出血。[姓名已隐去]主任查房后，指示予抗炎、止血和支持对症治疗，并注意：1、呼吸情况；2、出血情况，遵嘱执行。\n- [全程D23] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者昨日在气管内全麻下行左颈淋巴结切除活检+经鼻内镜鼻咽肿物切开活检术，目前生命体征平稳，未见口鼻活动性出血，颈部伤口少许渗出，引流条固定在位，诉头痛、颈部肿物痛、鼻部不适。[姓名已隐去]主任查房后，指示继续抗炎、支持治疗，遵嘱执行。\n- [全程D24] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者前日在气管内全麻下行左颈淋巴结切除活检+经鼻内镜鼻咽肿物切开活检术，目前生命体征平稳，未见口鼻活动性出血，颈部伤口已无明显渗出，诉头痛、颈部肿物痛。[姓名已隐去]主任查房后，拔出引流条，指示继续抗炎、止痛、支持治疗，遵嘱执行。\n- [全程D25] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者前3日在气管内全麻下行左颈淋巴结切除活检+经鼻内镜鼻咽肿物切开活检术，目前生命体征平稳，未见口鼻活动性出血，诉头痛、颈部肿物痛。[姓名已隐去]主任查房后，指示继续抗炎、支持治疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即启动含铂双药诱导化疗，并完善心电图及超声心动图检查。\nB. 予以静脉输注氨甲环酸，并完善凝血常规及D-二聚体检查。\nC. 安排右颈部淋巴结清扫术，并静脉使用广谱抗生素抗感染。\nD. 予以阿片类药物滴定止痛，并完善全身骨扫描检查。\nE. 继续抗炎及支持治疗，完善血常规、尿常规及生化常规检查。\nF. 启动根治性调强放射治疗，并复查鼻咽及颈部增强MRI。\nG. 予以静脉高营养支持治疗，并复查血浆EBV-DNA定量。\nH. 预防性皮下注射低分子肝素，并完善双下肢深静脉彩超。\nI. 予以静脉滴注地塞米松，并复查头颈部增强CT。\nJ. 拔除静脉留置针，仅予以口服非甾体抗炎药，并继续留院观察。\nK. 停止静脉用药，改为口服头孢类抗生素，并立即办理出院。\nL. 予以颈部局部姑息性放疗，并完善甲状腺功能检查。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：不支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、颈动脉鞘、斜坡、翼突基底部、蝶骨基底部、岩尖等。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D22] 检验组合: 乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D25] 检验组合: 血小板分布宽度(PDW)-静脉血: 10.3%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；比重(SG)-尿液: 1.028；甘油三酯(TG)-静脉血: 1.05mmol/L；红细胞计数(RBC#)-静脉血: 3.4910E12/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.86mmolL；平均红细胞体积(MCV)-静脉血: 84.8fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 42.4；丙氨酸氨基转移酶(ALT)-静脉血: 14.8U/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.001；尿酸(UA)-静脉血: 132.3umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.910E9/L；大血小板百分比(P-LCR%)-静脉血: 21.8%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；粘液丝计数(MUCS#)-尿液: 28/μL；红细胞计数(RBC#)-尿液: 1/μL；浊度(TRUB)-尿液: 清亮；血小板计数(PLT#)-静脉血: 31810E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.218；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7；天门冬氨酸氨基转移酶(AST)-静脉血: 11.2U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.1；载脂蛋白AI(apoAI)-静脉血: 1.14g/L；单核细胞百分比(Mono%)-静脉血: 0.084；总钙(Ca)-静脉血: 2.2mmol/L；总胆汁酸(TBA)-静脉血: 4.4umol/L；白蛋白(ALB)-静脉血: 35.7g/L；红细胞比容(Hct)-静脉血: 29.6%；单核细胞计数(Mono#)-静脉血: 0.710E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 10.9U/L；平均血小板体积(MPV)-静脉血: 9.7fL；中性粒细胞计数(Neut#)-静脉血: 6.110E9/L；胆红素(BIL)-尿液: -（参考: 阴性）；血红蛋白(Hb)-静脉血: 100g/L；C-反应蛋白(CRP)-静脉血: 66.11mg/L；葡萄糖(Glu)-静脉血: 4.89mmol/L；磷(P)-静脉血: 1.26mmol/L；直接胆红素(DBIL……\n\n【既往治疗与反应】\n- [全程D22] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日在气管内全麻下行左颈淋巴结切除活检+经鼻内镜鼻咽肿物切开活检术。术程顺利，术后麻醉复苏顺利，安返病房，生命体征平稳，未见口鼻活动性出血。[姓名已隐去]主任查房后，指示予抗炎、止血和支持对症治疗，并注意：1、呼吸情况；2、出血情况，遵嘱执行。\n- [全程D23] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者昨日在气管内全麻下行左颈淋巴结切除活检+经鼻内镜鼻咽肿物切开活检术，目前生命体征平稳，未见口鼻活动性出血，颈部伤口少许渗出，引流条固定在位，诉头痛、颈部肿物痛、鼻部不适。[姓名已隐去]主任查房后，指示继续抗炎、支持治疗，遵嘱执行。\n- [全程D24] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者前日在气管内全麻下行左颈淋巴结切除活检+经鼻内镜鼻咽肿物切开活检术，目前生命体征平稳，未见口鼻活动性出血，颈部伤口已无明显渗出，诉头痛、颈部肿物痛。[姓名已隐去]主任查房后，拔出引流条，指示继续抗炎、止痛、支持治疗，遵嘱执行。\n- [全程D25] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者前3日在气管内全麻下行左颈淋巴结切除活检+经鼻内镜鼻咽肿物切开活检术，目前生命体征平稳，未见口鼻活动性出血，诉头痛、颈部肿物痛。[姓名已隐去]主任查房后，指示继续抗炎、支持治疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即启动含铂双药诱导化疗，并完善心电图及超声心动图检查。\nB. 予以静脉输注氨甲环酸，并完善凝血常规及D-二聚体检查。\nC. 安排右颈部淋巴结清扫术，并静脉使用广谱抗生素抗感染。\nD. 予以阿片类药物滴定止痛，并完善全身骨扫描检查。\nE. 继续抗炎及支持治疗，完善血常规、尿常规及生化常规检查。\nF. 启动根治性调强放射治疗，并复查鼻咽及颈部增强MRI。\nG. 予以静脉高营养支持治疗，并复查血浆EBV-DNA定量。\nH. 预防性皮下注射低分子肝素，并完善双下肢深静脉彩超。\nI. 予以静脉滴注地塞米松，并复查头颈部增强CT。\nJ. 拔除静脉留置针，仅予以口服非甾体抗炎药，并继续留院观察。\nK. 停止静脉用药，改为口服头孢类抗生素，并立即办理出院。\nL. 予以颈部局部姑息性放疗，并完善甲状腺功能检查。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-3246297632d882a392dfe20a","patient_id":"patient-e45c55cc63c050892e6b2467","turn_id":"turn07","turn_position":6,"turn_type":"recurrence_or_salvage_decision","gold_letter":"F","gold_action":"完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检及颈部肿物活检术。","options":[{"letter":"A","text":"完善术前准备，在局麻下行经鼻内镜鼻咽肿物活检及颈部肿物活检术。","is_gold":false},{"letter":"B","text":"直接以颈部淋巴结转移性鳞癌及影像学表现为依据，开始诱导化疗。","is_gold":false},{"letter":"C","text":"完善术前准备，在全麻下仅行经鼻内镜鼻咽肿物活检术。","is_gold":false},{"letter":"D","text":"完善术前准备，在全麻下仅行颈部肿物切除活检术。","is_gold":false},{"letter":"E","text":"完善术前准备，在全麻下行鼻咽肿物活检术，并预防性切除双侧扁桃体。","is_gold":false},{"letter":"F","text":"完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检及颈部肿物活检术。","is_gold":true},{"letter":"G","text":"完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检，若为阴性则行颈部淋巴结清扫术。","is_gold":false},{"letter":"H","text":"暂缓活检，先行EBV-DNA及鼻咽部PET-CT检查，结果决定是否再次活检。","is_gold":false},{"letter":"I","text":"完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检及颈部肿物细针穿刺活检术。","is_gold":false},{"letter":"J","text":"完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检，并同期行鼻咽部及颈部放疗定位。","is_gold":false},{"letter":"K","text":"完善术前准备，在局麻下行颈部肿物切除活检，待病理确诊后再行鼻咽活检。","is_gold":false},{"letter":"L","text":"完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检及右侧颈部淋巴结清扫术。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：不支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、颈动脉鞘、斜坡、翼突基底部、蝶骨基底部、岩尖等。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- 无可展示记录。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善术前准备，在局麻下行经鼻内镜鼻咽肿物活检及颈部肿物活检术。\nB. 直接以颈部淋巴结转移性鳞癌及影像学表现为依据，开始诱导化疗。\nC. 完善术前准备，在全麻下仅行经鼻内镜鼻咽肿物活检术。\nD. 完善术前准备，在全麻下仅行颈部肿物切除活检术。\nE. 完善术前准备，在全麻下行鼻咽肿物活检术，并预防性切除双侧扁桃体。\nF. 完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检及颈部肿物活检术。\nG. 完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检，若为阴性则行颈部淋巴结清扫术。\nH. 暂缓活检，先行EBV-DNA及鼻咽部PET-CT检查，结果决定是否再次活检。\nI. 完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检及颈部肿物细针穿刺活检术。\nJ. 完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检，并同期行鼻咽部及颈部放疗定位。\nK. 完善术前准备，在局麻下行颈部肿物切除活检，待病理确诊后再行鼻咽活检。\nL. 完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检及右侧颈部淋巴结清扫术。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：不支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、颈动脉鞘、斜坡、翼突基底部、蝶骨基底部、岩尖等。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- 无可展示记录。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善术前准备，在局麻下行经鼻内镜鼻咽肿物活检及颈部肿物活检术。\nB. 直接以颈部淋巴结转移性鳞癌及影像学表现为依据，开始诱导化疗。\nC. 完善术前准备，在全麻下仅行经鼻内镜鼻咽肿物活检术。\nD. 完善术前准备，在全麻下仅行颈部肿物切除活检术。\nE. 完善术前准备，在全麻下行鼻咽肿物活检术，并预防性切除双侧扁桃体。\nF. 完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检及颈部肿物活检术。\nG. 完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检，若为阴性则行颈部淋巴结清扫术。\nH. 暂缓活检，先行EBV-DNA及鼻咽部PET-CT检查，结果决定是否再次活检。\nI. 完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检及颈部肿物细针穿刺活检术。\nJ. 完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检，并同期行鼻咽部及颈部放疗定位。\nK. 完善术前准备，在局麻下行颈部肿物切除活检，待病理确诊后再行鼻咽活检。\nL. 完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检及右侧颈部淋巴结清扫术。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-da812d38ab5771a5dbc8fc87","patient_id":"patient-e45c55cc63c050892e6b2467","turn_id":"turn08","turn_position":7,"turn_type":"recurrence_or_salvage_decision","gold_letter":"G","gold_action":"继续根治性放疗，完善电子鼻咽镜检查，并予以肠内营养支持及定期复查血常规。","options":[{"letter":"A","text":"终止放化疗，转为手术切除鼻咽原发灶及颈部残留淋巴结。","is_gold":false},{"letter":"B","text":"暂停放疗，予以静脉抗感染治疗，2周后恢复放疗。","is_gold":false},{"letter":"C","text":"重新定位并修改放疗计划，缩减原发灶及颈部淋巴结的照射靶区，继续放疗。","is_gold":false},{"letter":"D","text":"提前结束放疗，改为单药靶向治疗或PD-1抑制剂维持治疗。","is_gold":false},{"letter":"E","text":"继续根治性放疗，停用原化疗方案，改用吉西他滨联合顺铂方案化疗。","is_gold":false},{"letter":"F","text":"暂停治疗，完善全身PET-CT检查评估远处转移情况，再决定后续方案。","is_gold":false},{"letter":"G","text":"继续根治性放疗，完善电子鼻咽镜检查，并予以肠内营养支持及定期复查血常规。","is_gold":true},{"letter":"H","text":"终止放化疗，转为定期随访观察，3个月后复查鼻咽及颈部MRI。","is_gold":false},{"letter":"I","text":"继续根治性放疗，常规加用大剂量地塞米松以减轻局部黏膜炎症反应。","is_gold":false},{"letter":"J","text":"暂停放疗，行右颈部残留淋巴结穿刺活检明确病理，再制定后续治疗计划。","is_gold":false},{"letter":"K","text":"继续根治性放疗，并择期行右侧颈部淋巴结清扫术。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：不支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、颈动脉鞘、斜坡、翼突基底部、蝶骨基底部、岩尖等。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D45] 检验组合: 红细胞计数(RBC#)-静脉血: 4.0510E12/L；淋巴细胞百分比(Lymph%)-静脉血: 0.347；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.42mmolL；磷(P)-静脉血: 1.77mmol/L；肌酐(Crea)-静脉血: 30.1umol/L；总胆红素(TBIL)-静脉血: 3.5umol/L；白蛋白(ALB)-静脉血: 41.3g/L；钾离子(K+)-静脉血: 4.49mmol/L；总胆固醇(TC)-静脉血: 4.9mmol/L；直接胆红素(DBIL)-静脉血: 1.1umol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；碱性磷酸酶(ALP)-静脉血: 147.1U/L；镁离子(Mg2+)-静脉血: 0.84mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 16.5U/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.1mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 15；淋巴细胞计数(Lymph#)-静脉血: 2.210E9/L；球蛋白(GLO)-静脉血: 35g/L；血红蛋白(Hb)-静脉血: 115g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.4pg；总蛋白(TP)-静脉血: 76.3g/L；H2U:U-静脉血: 2.1；尿酸(UA)-静脉血: 236.8umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.18；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.36；白细胞计数(WBC#)-静脉血: 6.4610E9/L；血小板分布宽度(PDW)-静脉血: 8.7%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；乳酸脱氢酶(LDH)-静脉血: 195.6U/L；间接胆红素(IBIL)-静脉血: 2.4umolL；葡萄糖(Glu)-静脉血: 4.66mmol/L；总胆汁酸(TBA)-静脉血: 6.1umol/L；阴离子间隙(AG)-静脉血: 14.5；总钙(Ca)-静脉血: 2.36mmol/L；平均红细胞体积(MCV)-静脉血: 85.9fL；α-L-岩藻糖苷酶(AFU)-静脉血: 35.1U/L；甘油三酯(TG)-静脉血: 1.29mmol/L；大血小板百分比(P-LCR%)-静脉血: 14.3%；嗜碱性……\n- [全程D52] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 25mmol/L；总胆红素(TBIL)-静脉血: 7.6umol/L；磷(P)-静脉血: 1.66mmol/L；阴离子间隙(AG)-静脉血: 13.5；肌酐(Crea)-静脉血: 31.2umol/L；载脂蛋白B(apoB)-静脉血: 0.98g/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞计数(Neut#)-静脉血: 210E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 16.5U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.048；单核细胞百分比(Mono%)-静脉血: 0.082；总蛋白(TP)-静脉血: 76.7g/L；甘油三酯(TG)-静脉血: 0.86mmol/L；直接胆红素(DBIL)-静脉血: 2.21umol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；钾离子(K+)-静脉血: 4.11mmol/L；红细胞比容(Hct)-静脉血: 35.1%；葡萄糖(Glu)-静脉血: 4.64mmol/L；血红蛋白(Hb)-静脉血: 117g/L；乳酸脱氢酶(LDH)-静脉血: 217.1U/L；总胆固醇(TC)-静脉血: 5.39mmol/L；白蛋白(ALB)-静脉血: 42.7g/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；钠离子(Na+)-静脉血: 138.9mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 43.6U/L；淋巴细胞计数(Lymph#)-静脉血: 1.210E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.7pg；血小板计数(PLT#)-静脉血: 19610E9/L；白细胞计数(WBC#)-静脉血: 3.7710E9/L；平均血小板体积(MPV)-静脉血: 9.2fL；中性粒细胞百分比(Neut%)-静脉血: 0.536；H2U:U-静脉血: 1.99；间接胆红素(IBIL)-静脉血: 5.39umolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 15.7；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.6mmolL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 49.1；平均……\n- [全程D58] 检验组合: 总钙(Ca)-静脉血: 2.42mmol/L；乳酸脱氢酶(LDH)-静脉血: 177.8U/L；总蛋白(TP)-静脉血: 73.37g/L；C-反应蛋白(CRP)-静脉血: 0.68mg/L；血红蛋白(Hb)-静脉血: 111g/L；尿素氮(BUN)-静脉血: 3.6mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.38mmol/L；总胆固醇(TC)-静脉血: 5.13mmol/L；总胆汁酸(TBA)-静脉血: 5.2umol/L；直接胆红素(DBIL)-静脉血: 0.2umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.323；大血小板百分比(P-LCR%)-静脉血: 15.4%；载脂蛋白AI(apoAI)-静脉血: 1.42g/L；白蛋白(ALB)-静脉血: 42.1g/L；磷(P)-静脉血: 1.65mmol/L；淋巴细胞计数(Lymph#)-静脉血: 0.910E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.16；钠离子(Na+)-静脉血: 140.4mmol/L；血小板分布宽度(PDW)-静脉血: 9.2%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；中性粒细胞百分比(Neut%)-静脉血: 0.516；单核细胞计数(Mono#)-静脉血: 0.310E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 22.6U/L；丙氨酸氨基转移酶(ALT)-静脉血: 19.4U/L；红细胞计数(RBC#)-静脉血: 3.7910E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 15.6；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.069；血小板比容-静脉血: 16%；钾离子(K+)-静脉血: 4.5mmol/L；阴离子间隙(AG)-静脉血: 13.5；肌酐(Crea)-静脉血: 35.9umol/L；球蛋白(GLO)-静脉血: 31.27g/L；氯离子(Cl-)-静脉血: 103.5mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；间接胆红素(IBIL)-静脉血: 5umolL；白细胞计数(WBC#)-静脉血: 2.9110E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.35mmolL；α-L-岩藻糖苷酶(AFU)-静脉血: 30……\n- [全程D60] 检验组合: H2U:U-静脉血: 2.1；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.011；淋巴细胞百分比(Lymph%)-静脉血: 0.214；单核细胞计数(Mono#)-静脉血: 0.510E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 50；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 333g/L；红细胞计数(RBC#)-静脉血: 3.4910E12/L；血小板比容-静脉血: 17%；白细胞计数(WBC#)-静脉血: 3.610E9/L；血小板分布宽度(PDW)-静脉血: 9.6%；单核细胞百分比(Mono%)-静脉血: 0.136；血小板计数(PLT#)-静脉血: 18110E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；红细胞比容(Hct)-静脉血: 30.9%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 15.8；平均红细胞血红蛋白含量(MCH)-静脉血: 29.5pg；平均血小板体积(MPV)-静脉血: 9.3fL；大血小板百分比(P-LCR%)-静脉血: 18.6%；中性粒细胞计数(Neut#)-静脉血: 2.310E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；血红蛋白(Hb)-静脉血: 103g/L；平均红细胞体积(MCV)-静脉血: 88.5fL；中性粒细胞百分比(Neut%)-静脉血: 0.636\n- [全程D62] 检验组合: 血红蛋白(Hb)-静脉血: 113g/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；白细胞计数(WBC#)-静脉血: 1.910E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.032；中性粒细胞百分比(Neut%)-静脉血: 0.532；血小板计数(PLT#)-静脉血: 21510E9/L；红细胞计数(RBC#)-静脉血: 3.7810E12/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 49.3；平均红细胞血红蛋白含量(MCH)-静脉血: 29.9pg；淋巴细胞百分比(Lymph%)-静脉血: 0.284；有核红细胞计数(NRBC#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 15.4；中性粒细胞计数(Neut#)-静脉血: 110E9/L；血小板比容-静脉血: 20%；大血小板百分比(P-LCR%)-静脉血: 17.6%；单核细胞百分比(Mono%)-静脉血: 0.147；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；红细胞比容(Hct)-静脉血: 33.1%；血小板分布宽度(PDW)-静脉血: 9.4%；平均红细胞体积(MCV)-静脉血: 87.6fL；平均血小板体积(MPV)-静脉血: 9.1fL\n- [全程D65] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔稍狭窄，原鼻咽肿物现明显缩小，病变累及右侧咽隐窝，侵犯右侧咽旁脂肪间隙、右颈动脉鞘区、右侧咽后脂肪间隙及椎前间隙。右侧腭帆提肌、头长肌、颈长肌、右侧腭帆张肌及右侧翼内肌。 双侧翼腭窝、咀嚼肌间隙未见异常。口咽双侧壁未见受累增厚，双侧后鼻孔未见受累。双侧扁桃体未见明显异常。 右侧破裂孔、卵圆孔、舌下神经管内见少许软组织影，增强扫描明显强化。斜坡后缘脑膜增厚，增强扫描明显强化。双侧海绵窦未见增宽。 斜坡、蝶骨基底部、枕骨基底部、蝶骨基底部、右侧蝶骨大翼、寰椎右侧侧块、右侧枕骨髁、右侧翼突、右侧岩尖骨髓信号减低，增强扫描明显强化。 双侧筛窦、蝶窦及双侧乳突粘膜增厚。双侧乳突可见分泌物。双侧上颌窦充气良好。 双眼大小、形态、位置及信号未见异常，球后未见占位性病变。蝶鞍形态未见异常，其内未见占位性病变。 左侧咽后可见小淋巴结，短径约4mm，边界较清，增强扫描明显强化。右侧咽后可见肿大淋巴结，与鼻咽病变分界不清，增强扫描明显强化。颈右侧II、III区可见多个淋巴结，部分融合，较大范围约14mm×17mm，增强扫描明显强化。颈左侧II区、双侧Ⅲ、Ⅳ区可见多发小淋巴结，增强扫描轻度强化。 甲状腺双叶及峡部形态未见异常，信号均匀，未见占位性病变。喉咽腔形态未见异常，未见占位性病变。双侧颌下腺、腮腺大小、形态未见异常，信号均匀，未见占位性病变。 所见脑内未见明显异常。；检查结论: 鼻咽癌放疗后，与某次就诊时间MR相比： 鼻咽肿物较前明显缩小。 颅底骨质破坏，大致同前。 右侧咽后、颈右侧II、III区多个肿大淋巴结，考虑转移，较前缩小。 左侧咽后、颈左侧II区、双侧III、IV区小淋巴结，较前缩小。 双侧筛窦、蝶窦及双侧乳突炎。\n- [全程D65] 检验组合: 平均红细胞血红蛋白浓度(MCHC)-静脉血: 337g/L；大血小板百分比(P-LCR%)-静脉血: 18.8%；单核细胞计数(Mono#)-静脉血: 1.410E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；平均红细胞血红蛋白含量(MCH)-静脉血: 29.8pg；血小板计数(PLT#)-静脉血: 19110E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 16.2；红细胞比容(Hct)-静脉血: 33.8%；中性粒细胞计数(Neut#)-静脉血: 10.510E9/L；白细胞计数(WBC#)-静脉血: 13.2210E9/L；血红蛋白(Hb)-静脉血: 114g/L；红细胞计数(RBC#)-静脉血: 3.8210E12/L；血小板分布宽度(PDW)-静脉血: 10.3%；淋巴细胞百分比(Lymph%)-静脉血: 0.091；中性粒细胞百分比(Neut%)-静脉血: 0.796；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.007；红细胞体积分布宽度SD(RDW-SD)-静脉血: 49.5；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.210E9/L；平均红细胞体积(MCV)-静脉血: 88.5fL；血小板比容-静脉血: 18%；单核细胞百分比(Mono%)-静脉血: 0.104；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均血小板体积(MPV)-静脉血: 9.2fL\n\n【既往治疗与反应】\n- [全程D52] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 现患者局部放疗3次，同期PF30d 化疗第19日，无特殊不适主诉。查体大致同前。复查生化常规未见异常，血常规示白细胞I度降低。[姓名已隐去]医生信息已隐藏示，患者一般状况好，继续放化疗。\n- [全程D55] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 现患者局部放疗4次，同期PF30d 化疗第22日，无特殊不适主诉。查体见颈部淋巴结较前缩小。血常规、生化未见异常。继续放化疗。\n- [全程D58] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 现患者局部放疗6次，同期PF30d 化疗第25日，无特殊不适主诉。查体见颈部淋巴结较前缩小。血常规示：白细胞计数(白细胞计数(WBC)) 2.91 10E9/L；[姓名已隐去]医生信息已隐藏示：予纠正白细胞治疗，继续放化疗。\n- [全程D64] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 现患者局部放疗10次，无特殊不适主诉。查体见颈部淋巴结较前缩小。血常规示：白细胞计数(白细胞计数(WBC)) 1.90 10E9/L；予升白细胞治疗，继续放疗。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 终止放化疗，转为手术切除鼻咽原发灶及颈部残留淋巴结。\nB. 暂停放疗，予以静脉抗感染治疗，2周后恢复放疗。\nC. 重新定位并修改放疗计划，缩减原发灶及颈部淋巴结的照射靶区，继续放疗。\nD. 提前结束放疗，改为单药靶向治疗或PD-1抑制剂维持治疗。\nE. 继续根治性放疗，停用原化疗方案，改用吉西他滨联合顺铂方案化疗。\nF. 暂停治疗，完善全身PET-CT检查评估远处转移情况，再决定后续方案。\nG. 继续根治性放疗，完善电子鼻咽镜检查，并予以肠内营养支持及定期复查血常规。\nH. 终止放化疗，转为定期随访观察，3个月后复查鼻咽及颈部MRI。\nI. 继续根治性放疗，常规加用大剂量地塞米松以减轻局部黏膜炎症反应。\nJ. 暂停放疗，行右颈部残留淋巴结穿刺活检明确病理，再制定后续治疗计划。\nK. 继续根治性放疗，并择期行右侧颈部淋巴结清扫术。\n\n请仅输出一个选项字母（A-K）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：不支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、颈动脉鞘、斜坡、翼突基底部、蝶骨基底部、岩尖等。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D45] 检验组合: 红细胞计数(RBC#)-静脉血: 4.0510E12/L；淋巴细胞百分比(Lymph%)-静脉血: 0.347；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.42mmolL；磷(P)-静脉血: 1.77mmol/L；肌酐(Crea)-静脉血: 30.1umol/L；总胆红素(TBIL)-静脉血: 3.5umol/L；白蛋白(ALB)-静脉血: 41.3g/L；钾离子(K+)-静脉血: 4.49mmol/L；总胆固醇(TC)-静脉血: 4.9mmol/L；直接胆红素(DBIL)-静脉血: 1.1umol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；碱性磷酸酶(ALP)-静脉血: 147.1U/L；镁离子(Mg2+)-静脉血: 0.84mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 16.5U/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.1mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 15；淋巴细胞计数(Lymph#)-静脉血: 2.210E9/L；球蛋白(GLO)-静脉血: 35g/L；血红蛋白(Hb)-静脉血: 115g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.4pg；总蛋白(TP)-静脉血: 76.3g/L；H2U:U-静脉血: 2.1；尿酸(UA)-静脉血: 236.8umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.18；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.36；白细胞计数(WBC#)-静脉血: 6.4610E9/L；血小板分布宽度(PDW)-静脉血: 8.7%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；乳酸脱氢酶(LDH)-静脉血: 195.6U/L；间接胆红素(IBIL)-静脉血: 2.4umolL；葡萄糖(Glu)-静脉血: 4.66mmol/L；总胆汁酸(TBA)-静脉血: 6.1umol/L；阴离子间隙(AG)-静脉血: 14.5；总钙(Ca)-静脉血: 2.36mmol/L；平均红细胞体积(MCV)-静脉血: 85.9fL；α-L-岩藻糖苷酶(AFU)-静脉血: 35.1U/L；甘油三酯(TG)-静脉血: 1.29mmol/L；大血小板百分比(P-LCR%)-静脉血: 14.3%；嗜碱性……\n- [全程D52] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 25mmol/L；总胆红素(TBIL)-静脉血: 7.6umol/L；磷(P)-静脉血: 1.66mmol/L；阴离子间隙(AG)-静脉血: 13.5；肌酐(Crea)-静脉血: 31.2umol/L；载脂蛋白B(apoB)-静脉血: 0.98g/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞计数(Neut#)-静脉血: 210E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 16.5U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.048；单核细胞百分比(Mono%)-静脉血: 0.082；总蛋白(TP)-静脉血: 76.7g/L；甘油三酯(TG)-静脉血: 0.86mmol/L；直接胆红素(DBIL)-静脉血: 2.21umol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；钾离子(K+)-静脉血: 4.11mmol/L；红细胞比容(Hct)-静脉血: 35.1%；葡萄糖(Glu)-静脉血: 4.64mmol/L；血红蛋白(Hb)-静脉血: 117g/L；乳酸脱氢酶(LDH)-静脉血: 217.1U/L；总胆固醇(TC)-静脉血: 5.39mmol/L；白蛋白(ALB)-静脉血: 42.7g/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；钠离子(Na+)-静脉血: 138.9mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 43.6U/L；淋巴细胞计数(Lymph#)-静脉血: 1.210E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.7pg；血小板计数(PLT#)-静脉血: 19610E9/L；白细胞计数(WBC#)-静脉血: 3.7710E9/L；平均血小板体积(MPV)-静脉血: 9.2fL；中性粒细胞百分比(Neut%)-静脉血: 0.536；H2U:U-静脉血: 1.99；间接胆红素(IBIL)-静脉血: 5.39umolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 15.7；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.6mmolL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 49.1；平均……\n- [全程D58] 检验组合: 总钙(Ca)-静脉血: 2.42mmol/L；乳酸脱氢酶(LDH)-静脉血: 177.8U/L；总蛋白(TP)-静脉血: 73.37g/L；C-反应蛋白(CRP)-静脉血: 0.68mg/L；血红蛋白(Hb)-静脉血: 111g/L；尿素氮(BUN)-静脉血: 3.6mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.38mmol/L；总胆固醇(TC)-静脉血: 5.13mmol/L；总胆汁酸(TBA)-静脉血: 5.2umol/L；直接胆红素(DBIL)-静脉血: 0.2umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.323；大血小板百分比(P-LCR%)-静脉血: 15.4%；载脂蛋白AI(apoAI)-静脉血: 1.42g/L；白蛋白(ALB)-静脉血: 42.1g/L；磷(P)-静脉血: 1.65mmol/L；淋巴细胞计数(Lymph#)-静脉血: 0.910E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.16；钠离子(Na+)-静脉血: 140.4mmol/L；血小板分布宽度(PDW)-静脉血: 9.2%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；中性粒细胞百分比(Neut%)-静脉血: 0.516；单核细胞计数(Mono#)-静脉血: 0.310E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 22.6U/L；丙氨酸氨基转移酶(ALT)-静脉血: 19.4U/L；红细胞计数(RBC#)-静脉血: 3.7910E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 15.6；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.069；血小板比容-静脉血: 16%；钾离子(K+)-静脉血: 4.5mmol/L；阴离子间隙(AG)-静脉血: 13.5；肌酐(Crea)-静脉血: 35.9umol/L；球蛋白(GLO)-静脉血: 31.27g/L；氯离子(Cl-)-静脉血: 103.5mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；间接胆红素(IBIL)-静脉血: 5umolL；白细胞计数(WBC#)-静脉血: 2.9110E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.35mmolL；α-L-岩藻糖苷酶(AFU)-静脉血: 30……\n- [全程D60] 检验组合: H2U:U-静脉血: 2.1；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.011；淋巴细胞百分比(Lymph%)-静脉血: 0.214；单核细胞计数(Mono#)-静脉血: 0.510E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 50；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 333g/L；红细胞计数(RBC#)-静脉血: 3.4910E12/L；血小板比容-静脉血: 17%；白细胞计数(WBC#)-静脉血: 3.610E9/L；血小板分布宽度(PDW)-静脉血: 9.6%；单核细胞百分比(Mono%)-静脉血: 0.136；血小板计数(PLT#)-静脉血: 18110E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；红细胞比容(Hct)-静脉血: 30.9%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 15.8；平均红细胞血红蛋白含量(MCH)-静脉血: 29.5pg；平均血小板体积(MPV)-静脉血: 9.3fL；大血小板百分比(P-LCR%)-静脉血: 18.6%；中性粒细胞计数(Neut#)-静脉血: 2.310E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；血红蛋白(Hb)-静脉血: 103g/L；平均红细胞体积(MCV)-静脉血: 88.5fL；中性粒细胞百分比(Neut%)-静脉血: 0.636\n- [全程D62] 检验组合: 血红蛋白(Hb)-静脉血: 113g/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；白细胞计数(WBC#)-静脉血: 1.910E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.032；中性粒细胞百分比(Neut%)-静脉血: 0.532；血小板计数(PLT#)-静脉血: 21510E9/L；红细胞计数(RBC#)-静脉血: 3.7810E12/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 49.3；平均红细胞血红蛋白含量(MCH)-静脉血: 29.9pg；淋巴细胞百分比(Lymph%)-静脉血: 0.284；有核红细胞计数(NRBC#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 15.4；中性粒细胞计数(Neut#)-静脉血: 110E9/L；血小板比容-静脉血: 20%；大血小板百分比(P-LCR%)-静脉血: 17.6%；单核细胞百分比(Mono%)-静脉血: 0.147；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；红细胞比容(Hct)-静脉血: 33.1%；血小板分布宽度(PDW)-静脉血: 9.4%；平均红细胞体积(MCV)-静脉血: 87.6fL；平均血小板体积(MPV)-静脉血: 9.1fL\n- [全程D65] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔稍狭窄，原鼻咽肿物现明显缩小，病变累及右侧咽隐窝，侵犯右侧咽旁脂肪间隙、右颈动脉鞘区、右侧咽后脂肪间隙及椎前间隙。右侧腭帆提肌、头长肌、颈长肌、右侧腭帆张肌及右侧翼内肌。 双侧翼腭窝、咀嚼肌间隙未见异常。口咽双侧壁未见受累增厚，双侧后鼻孔未见受累。双侧扁桃体未见明显异常。 右侧破裂孔、卵圆孔、舌下神经管内见少许软组织影，增强扫描明显强化。斜坡后缘脑膜增厚，增强扫描明显强化。双侧海绵窦未见增宽。 斜坡、蝶骨基底部、枕骨基底部、蝶骨基底部、右侧蝶骨大翼、寰椎右侧侧块、右侧枕骨髁、右侧翼突、右侧岩尖骨髓信号减低，增强扫描明显强化。 双侧筛窦、蝶窦及双侧乳突粘膜增厚。双侧乳突可见分泌物。双侧上颌窦充气良好。 双眼大小、形态、位置及信号未见异常，球后未见占位性病变。蝶鞍形态未见异常，其内未见占位性病变。 左侧咽后可见小淋巴结，短径约4mm，边界较清，增强扫描明显强化。右侧咽后可见肿大淋巴结，与鼻咽病变分界不清，增强扫描明显强化。颈右侧II、III区可见多个淋巴结，部分融合，较大范围约14mm×17mm，增强扫描明显强化。颈左侧II区、双侧Ⅲ、Ⅳ区可见多发小淋巴结，增强扫描轻度强化。 甲状腺双叶及峡部形态未见异常，信号均匀，未见占位性病变。喉咽腔形态未见异常，未见占位性病变。双侧颌下腺、腮腺大小、形态未见异常，信号均匀，未见占位性病变。 所见脑内未见明显异常。；检查结论: 鼻咽癌放疗后，与某次就诊时间MR相比： 鼻咽肿物较前明显缩小。 颅底骨质破坏，大致同前。 右侧咽后、颈右侧II、III区多个肿大淋巴结，考虑转移，较前缩小。 左侧咽后、颈左侧II区、双侧III、IV区小淋巴结，较前缩小。 双侧筛窦、蝶窦及双侧乳突炎。\n- [全程D65] 检验组合: 平均红细胞血红蛋白浓度(MCHC)-静脉血: 337g/L；大血小板百分比(P-LCR%)-静脉血: 18.8%；单核细胞计数(Mono#)-静脉血: 1.410E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；平均红细胞血红蛋白含量(MCH)-静脉血: 29.8pg；血小板计数(PLT#)-静脉血: 19110E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 16.2；红细胞比容(Hct)-静脉血: 33.8%；中性粒细胞计数(Neut#)-静脉血: 10.510E9/L；白细胞计数(WBC#)-静脉血: 13.2210E9/L；血红蛋白(Hb)-静脉血: 114g/L；红细胞计数(RBC#)-静脉血: 3.8210E12/L；血小板分布宽度(PDW)-静脉血: 10.3%；淋巴细胞百分比(Lymph%)-静脉血: 0.091；中性粒细胞百分比(Neut%)-静脉血: 0.796；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.007；红细胞体积分布宽度SD(RDW-SD)-静脉血: 49.5；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.210E9/L；平均红细胞体积(MCV)-静脉血: 88.5fL；血小板比容-静脉血: 18%；单核细胞百分比(Mono%)-静脉血: 0.104；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均血小板体积(MPV)-静脉血: 9.2fL\n\n【既往治疗与反应】\n- [全程D52] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 现患者局部放疗3次，同期PF30d 化疗第19日，无特殊不适主诉。查体大致同前。复查生化常规未见异常，血常规示白细胞I度降低。[姓名已隐去]医生信息已隐藏示，患者一般状况好，继续放化疗。\n- [全程D55] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 现患者局部放疗4次，同期PF30d 化疗第22日，无特殊不适主诉。查体见颈部淋巴结较前缩小。血常规、生化未见异常。继续放化疗。\n- [全程D58] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 现患者局部放疗6次，同期PF30d 化疗第25日，无特殊不适主诉。查体见颈部淋巴结较前缩小。血常规示：白细胞计数(白细胞计数(WBC)) 2.91 10E9/L；[姓名已隐去]医生信息已隐藏示：予纠正白细胞治疗，继续放化疗。\n- [全程D64] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 现患者局部放疗10次，无特殊不适主诉。查体见颈部淋巴结较前缩小。血常规示：白细胞计数(白细胞计数(WBC)) 1.90 10E9/L；予升白细胞治疗，继续放疗。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 终止放化疗，转为手术切除鼻咽原发灶及颈部残留淋巴结。\nB. 暂停放疗，予以静脉抗感染治疗，2周后恢复放疗。\nC. 重新定位并修改放疗计划，缩减原发灶及颈部淋巴结的照射靶区，继续放疗。\nD. 提前结束放疗，改为单药靶向治疗或PD-1抑制剂维持治疗。\nE. 继续根治性放疗，停用原化疗方案，改用吉西他滨联合顺铂方案化疗。\nF. 暂停治疗，完善全身PET-CT检查评估远处转移情况，再决定后续方案。\nG. 继续根治性放疗，完善电子鼻咽镜检查，并予以肠内营养支持及定期复查血常规。\nH. 终止放化疗，转为定期随访观察，3个月后复查鼻咽及颈部MRI。\nI. 继续根治性放疗，常规加用大剂量地塞米松以减轻局部黏膜炎症反应。\nJ. 暂停放疗，行右颈部残留淋巴结穿刺活检明确病理，再制定后续治疗计划。\nK. 继续根治性放疗，并择期行右侧颈部淋巴结清扫术。\n\n请仅输出一个选项字母（A-K）。"}]}
+{"sample_id":"sample-6d0ec36f585feac9ee8c0aa5","patient_id":"patient-a48d1d72efa6c4217cf5b79c","turn_id":"turn01","turn_position":1,"turn_type":"initial_workup_choice","gold_letter":"H","gold_action":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT检查","options":[{"letter":"A","text":"鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸腹部CT平扫","is_gold":false},{"letter":"B","text":"颈部淋巴结切除活检，鼻咽及颈部MRI平扫+增强，全身PET/CT检查","is_gold":false},{"letter":"C","text":"鼻咽镜检查及活检，鼻咽部MRI平扫+增强，胸部X线，腹部B超","is_gold":false},{"letter":"D","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，暂不进行全身分期检查","is_gold":false},{"letter":"E","text":"颈部淋巴结细针穿刺活检，鼻咽及颈部CT平扫+增强，全身骨扫描","is_gold":false},{"letter":"F","text":"鼻咽镜检查及活检，鼻咽部MRI平扫+增强，全身PET/CT检查","is_gold":false},{"letter":"G","text":"鼻咽及颈部MRI平扫+增强，全身PET/CT检查，直接安排根治性放疗","is_gold":false},{"letter":"H","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT检查","is_gold":true},{"letter":"I","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫，胸腹部CT平扫+增强，全身骨扫描","is_gold":false},{"letter":"J","text":"鼻咽脱落细胞学涂片，鼻咽及颈部MRI平扫+增强，全身PET/CT检查","is_gold":false},{"letter":"K","text":"鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，全身PET/CT检查","is_gold":false},{"letter":"L","text":"鼻咽及颈部MRI平扫+增强，EBV-DNA检测，胸腹部CT平扫+增强","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、筛窦、斜坡、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现颈部肿物伴涕血、鼻塞2月；患者未予相关诊治，转至我院就诊。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,涕血,颈部肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。偶伴吸烟、饮酒15年，3两/天，。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：90次/分，R：20次/分，BP：120/70mmHg,Ht：172cm，Wt：73kg，BSA：1.85m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.0cm；鼻咽双侧顶后壁结节状肿物；双侧颈部IIa区可扪及1个淋巴结，最大径2×2cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸腹部CT平扫\nB. 颈部淋巴结切除活检，鼻咽及颈部MRI平扫+增强，全身PET/CT检查\nC. 鼻咽镜检查及活检，鼻咽部MRI平扫+增强，胸部X线，腹部B超\nD. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，暂不进行全身分期检查\nE. 颈部淋巴结细针穿刺活检，鼻咽及颈部CT平扫+增强，全身骨扫描\nF. 鼻咽镜检查及活检，鼻咽部MRI平扫+增强，全身PET/CT检查\nG. 鼻咽及颈部MRI平扫+增强，全身PET/CT检查，直接安排根治性放疗\nH. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT检查\nI. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫，胸腹部CT平扫+增强，全身骨扫描\nJ. 鼻咽脱落细胞学涂片，鼻咽及颈部MRI平扫+增强，全身PET/CT检查\nK. 鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，全身PET/CT检查\nL. 鼻咽及颈部MRI平扫+增强，EBV-DNA检测，胸腹部CT平扫+增强\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、筛窦、斜坡、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现颈部肿物伴涕血、鼻塞2月；患者未予相关诊治，转至我院就诊。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,涕血,颈部肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。偶伴吸烟、饮酒15年，3两/天，。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：90次/分，R：20次/分，BP：120/70mmHg,Ht：172cm，Wt：73kg，BSA：1.85m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.0cm；鼻咽双侧顶后壁结节状肿物；双侧颈部IIa区可扪及1个淋巴结，最大径2×2cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸腹部CT平扫\nB. 颈部淋巴结切除活检，鼻咽及颈部MRI平扫+增强，全身PET/CT检查\nC. 鼻咽镜检查及活检，鼻咽部MRI平扫+增强，胸部X线，腹部B超\nD. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，暂不进行全身分期检查\nE. 颈部淋巴结细针穿刺活检，鼻咽及颈部CT平扫+增强，全身骨扫描\nF. 鼻咽镜检查及活检，鼻咽部MRI平扫+增强，全身PET/CT检查\nG. 鼻咽及颈部MRI平扫+增强，全身PET/CT检查，直接安排根治性放疗\nH. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT检查\nI. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫，胸腹部CT平扫+增强，全身骨扫描\nJ. 鼻咽脱落细胞学涂片，鼻咽及颈部MRI平扫+增强，全身PET/CT检查\nK. 鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，全身PET/CT检查\nL. 鼻咽及颈部MRI平扫+增强，EBV-DNA检测，胸腹部CT平扫+增强\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-11ca3bd9dd2a5877fa6a6b49","patient_id":"patient-a48d1d72efa6c4217cf5b79c","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"I","gold_action":"影像评估为 cT3N2，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期","options":[{"letter":"A","text":"影像评估为 cT4N2，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期","is_gold":false},{"letter":"B","text":"影像评估为 cT3N1，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期","is_gold":false},{"letter":"C","text":"影像评估为 cT3N2，需完善鼻咽镜及活检明确病理，无需常规进行胸腹部及骨骼的远处转移筛查","is_gold":false},{"letter":"D","text":"影像评估为 cT4N3，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期","is_gold":false},{"letter":"E","text":"影像评估为 cT2N2，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期","is_gold":false},{"letter":"F","text":"影像评估为 cT3N2，需完善颈部淋巴结穿刺活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期","is_gold":false},{"letter":"G","text":"影像评估为 cT3N2，已具备影像学确诊条件，直接安排诱导化疗及后续根治性放疗","is_gold":false},{"letter":"H","text":"影像评估为 cT4N2，需完善颈部淋巴结穿刺活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期","is_gold":false},{"letter":"I","text":"影像评估为 cT3N2，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期","is_gold":true},{"letter":"J","text":"影像评估为 cT3N3，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期","is_gold":false},{"letter":"K","text":"影像评估为 cT2N1，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期","is_gold":false},{"letter":"L","text":"影像评估为 cT3N2，需完善鼻咽镜及活检明确病理，并完善头颅MRI及脑脊液检查以排除中枢神经系统转移","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、筛窦、斜坡、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 甘油三酯(TG)-静脉血: 1.1mmol/L；透明质酸(HA)-静脉血: 34.26ng/ml；中性粒细胞计数(Neut#)-静脉血: 3.710E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；层粘连蛋白(LN)-静脉血: 11.97ng/ml；凝血酶原时间活动度(PTA)-静脉血: 125.5%；总胆固醇(TC)-静脉血: 4.12mmol/L；凝血酶原时间(PT)-静脉血: 10.8sec.；碱性磷酸酶(ALP)-静脉血: 83.4U/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；ABO血型-静脉血: O；镁离子(Mg2+)-静脉血: 0.88mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.005；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 65.2umol/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；尿素氮(BUN)-静脉血: 5.1mmol/L；总蛋白(TP)-静脉血: 75.4g/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 22.8U/L；钾离子(K+)-静脉血: 3.71mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 17.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 18.1U/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；乳酸脱氢酶(LDH)-静脉血: 142.3U/L；III型前胶原氨基端肽(PIIINP)-静脉血: 17.25ng/ml；尿酸(UA)-静脉血: 293.9umol/L；血小板计数(PLT#)-静脉血: 18910E9/L；Rh血型-静脉血: 阳性；总胆汁酸(TBA)-静脉血: 2.8umol/L；IV型胶原(C-IV)-静脉血: 21.48ng/ml；天门冬氨酸氨基转移酶(AST)-静脉血: 15.4U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；氯离子(Cl-)-静脉血: 103.6mmol/L；磷(P)-静脉血: 0.78m……\n- [全程D2] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D8] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、右侧壁见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。肿物占据双侧咽隐窝，向后外推移右侧咽旁脂肪间隙，前方浸润右侧筛窦及上鼻道，左侧咽旁脂肪间隙及左侧颈动脉鞘区未见异常。 右侧腭帆提肌、腭帆张肌受侵；左侧腭帆提肌、腭帆张肌、头长肌未见受累征象。 右侧翼腭窝及右侧上颌后脂肪间隙稍变窄；左侧翼腭窝、左上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽未见明显异常。 斜坡、蝶骨基底部、右侧翼突基底部及右侧蝶骨大翼信号降低，增强后强化。 双侧海绵窦未见明显异常。 双侧上颌窦、筛窦、右侧蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，无强化，骨壁完整。双眼大小、形态、位置均属正常、信号均匀。蝶鞍形态正常，其内未见占位性病变。 右侧咽后间隙见淋巴结，较大者约11mm×10mm；左侧咽后间隙未见肿大淋巴结。双颈Ⅱ区、右颈Ⅲ区见多个淋巴结，部分融合，边界清，不均匀明显强化，较大者约大小约24mm×13mm。 所见甲状腺双叶形态正常、喉咽腔、双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 符合鼻咽癌。 颅底骨质破坏。 左侧咽后、双颈Ⅱ区及右颈Ⅲ区肿大淋巴结，考虑转移。 副鼻窦炎、乳突炎。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 影像评估为 cT4N2，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nB. 影像评估为 cT3N1，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nC. 影像评估为 cT3N2，需完善鼻咽镜及活检明确病理，无需常规进行胸腹部及骨骼的远处转移筛查\nD. 影像评估为 cT4N3，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nE. 影像评估为 cT2N2，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nF. 影像评估为 cT3N2，需完善颈部淋巴结穿刺活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nG. 影像评估为 cT3N2，已具备影像学确诊条件，直接安排诱导化疗及后续根治性放疗\nH. 影像评估为 cT4N2，需完善颈部淋巴结穿刺活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nI. 影像评估为 cT3N2，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nJ. 影像评估为 cT3N3，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nK. 影像评估为 cT2N1，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nL. 影像评估为 cT3N2，需完善鼻咽镜及活检明确病理，并完善头颅MRI及脑脊液检查以排除中枢神经系统转移\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、筛窦、斜坡、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 甘油三酯(TG)-静脉血: 1.1mmol/L；透明质酸(HA)-静脉血: 34.26ng/ml；中性粒细胞计数(Neut#)-静脉血: 3.710E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；层粘连蛋白(LN)-静脉血: 11.97ng/ml；凝血酶原时间活动度(PTA)-静脉血: 125.5%；总胆固醇(TC)-静脉血: 4.12mmol/L；凝血酶原时间(PT)-静脉血: 10.8sec.；碱性磷酸酶(ALP)-静脉血: 83.4U/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；ABO血型-静脉血: O；镁离子(Mg2+)-静脉血: 0.88mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.005；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 65.2umol/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；尿素氮(BUN)-静脉血: 5.1mmol/L；总蛋白(TP)-静脉血: 75.4g/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 22.8U/L；钾离子(K+)-静脉血: 3.71mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 17.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 18.1U/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；乳酸脱氢酶(LDH)-静脉血: 142.3U/L；III型前胶原氨基端肽(PIIINP)-静脉血: 17.25ng/ml；尿酸(UA)-静脉血: 293.9umol/L；血小板计数(PLT#)-静脉血: 18910E9/L；Rh血型-静脉血: 阳性；总胆汁酸(TBA)-静脉血: 2.8umol/L；IV型胶原(C-IV)-静脉血: 21.48ng/ml；天门冬氨酸氨基转移酶(AST)-静脉血: 15.4U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；氯离子(Cl-)-静脉血: 103.6mmol/L；磷(P)-静脉血: 0.78m……\n- [全程D2] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D8] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、右侧壁见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。肿物占据双侧咽隐窝，向后外推移右侧咽旁脂肪间隙，前方浸润右侧筛窦及上鼻道，左侧咽旁脂肪间隙及左侧颈动脉鞘区未见异常。 右侧腭帆提肌、腭帆张肌受侵；左侧腭帆提肌、腭帆张肌、头长肌未见受累征象。 右侧翼腭窝及右侧上颌后脂肪间隙稍变窄；左侧翼腭窝、左上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽未见明显异常。 斜坡、蝶骨基底部、右侧翼突基底部及右侧蝶骨大翼信号降低，增强后强化。 双侧海绵窦未见明显异常。 双侧上颌窦、筛窦、右侧蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，无强化，骨壁完整。双眼大小、形态、位置均属正常、信号均匀。蝶鞍形态正常，其内未见占位性病变。 右侧咽后间隙见淋巴结，较大者约11mm×10mm；左侧咽后间隙未见肿大淋巴结。双颈Ⅱ区、右颈Ⅲ区见多个淋巴结，部分融合，边界清，不均匀明显强化，较大者约大小约24mm×13mm。 所见甲状腺双叶形态正常、喉咽腔、双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 符合鼻咽癌。 颅底骨质破坏。 左侧咽后、双颈Ⅱ区及右颈Ⅲ区肿大淋巴结，考虑转移。 副鼻窦炎、乳突炎。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 影像评估为 cT4N2，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nB. 影像评估为 cT3N1，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nC. 影像评估为 cT3N2，需完善鼻咽镜及活检明确病理，无需常规进行胸腹部及骨骼的远处转移筛查\nD. 影像评估为 cT4N3，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nE. 影像评估为 cT2N2，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nF. 影像评估为 cT3N2，需完善颈部淋巴结穿刺活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nG. 影像评估为 cT3N2，已具备影像学确诊条件，直接安排诱导化疗及后续根治性放疗\nH. 影像评估为 cT4N2，需完善颈部淋巴结穿刺活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nI. 影像评估为 cT3N2，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nJ. 影像评估为 cT3N3，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nK. 影像评估为 cT2N1，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nL. 影像评估为 cT3N2，需完善鼻咽镜及活检明确病理，并完善头颅MRI及脑脊液检查以排除中枢神经系统转移\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-b061f796c98789c2958f0baf","patient_id":"patient-a48d1d72efa6c4217cf5b79c","turn_id":"turn04","turn_position":3,"turn_type":"initial_treatment_selection","gold_letter":"K","gold_action":"启动首周期诱导化疗（辅以水化、止吐预处理），计划序贯根治性同步放化疗","options":[{"letter":"A","text":"启动首周期同步放化疗（辅以水化、止吐预处理），不考虑诱导化疗","is_gold":false},{"letter":"B","text":"启动首周期诱导化疗，计划序贯根治性单纯放疗","is_gold":false},{"letter":"C","text":"启动首周期诱导化疗联合PD-1抑制剂，计划序贯根治性同步放化疗","is_gold":false},{"letter":"D","text":"启动首周期诱导化疗，计划序贯手术切除原发灶及颈部淋巴结","is_gold":false},{"letter":"E","text":"启动根治性单纯放疗，计划放疗结束后行多周期辅助化疗","is_gold":false},{"letter":"F","text":"启动根治性放疗联合EGFR靶向治疗，免除全身静脉化疗","is_gold":false},{"letter":"G","text":"优先行双侧颈部淋巴结清扫术，术后行根治性同步放化疗","is_gold":false},{"letter":"H","text":"优先行鼻咽原发灶内镜下切除术，术后行根治性同步放化疗","is_gold":false},{"letter":"I","text":"启动首周期姑息性化疗，计划化疗后行局部姑息性放疗","is_gold":false},{"letter":"J","text":"启动首周期诱导化疗，若疗效达完全缓解（CR）则免除后续放疗","is_gold":false},{"letter":"K","text":"启动首周期诱导化疗（辅以水化、止吐预处理），计划序贯根治性同步放化疗","is_gold":true},{"letter":"L","text":"启动首周期同步放化疗，计划放疗结束后行多周期辅助化疗","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、筛窦、斜坡、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现颈部肿物伴涕血、鼻塞2月；现病史: 患者2月前无明显诱因出现颈部肿物，拇指大小，偶伴涕血、鼻塞，右侧明显，无面麻、复视等其他不适，未予重视，逐渐加重，患者遂于某次就诊时间行颈部彩超示：右侧颈部低回声，行鼻咽镜示：鼻咽肿物，建议活检。患者未予相关诊治，转至我院就诊。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,涕血,颈部肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。偶伴吸烟、饮酒15年，3两/天，。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：90次/分，R：20次/分，BP：120/70mmHg,Ht：172cm，Wt：73kg，BSA：1.85m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率90次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.0cm；鼻咽双侧顶后壁结节状肿物；双侧颈部IIa区可扪及1个淋巴结，最大径2×2cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 启动首周期同步放化疗（辅以水化、止吐预处理），不考虑诱导化疗\nB. 启动首周期诱导化疗，计划序贯根治性单纯放疗\nC. 启动首周期诱导化疗联合PD-1抑制剂，计划序贯根治性同步放化疗\nD. 启动首周期诱导化疗，计划序贯手术切除原发灶及颈部淋巴结\nE. 启动根治性单纯放疗，计划放疗结束后行多周期辅助化疗\nF. 启动根治性放疗联合EGFR靶向治疗，免除全身静脉化疗\nG. 优先行双侧颈部淋巴结清扫术，术后行根治性同步放化疗\nH. 优先行鼻咽原发灶内镜下切除术，术后行根治性同步放化疗\nI. 启动首周期姑息性化疗，计划化疗后行局部姑息性放疗\nJ. 启动首周期诱导化疗，若疗效达完全缓解（CR）则免除后续放疗\nK. 启动首周期诱导化疗（辅以水化、止吐预处理），计划序贯根治性同步放化疗\nL. 启动首周期同步放化疗，计划放疗结束后行多周期辅助化疗\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、筛窦、斜坡、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现颈部肿物伴涕血、鼻塞2月；现病史: 患者2月前无明显诱因出现颈部肿物，拇指大小，偶伴涕血、鼻塞，右侧明显，无面麻、复视等其他不适，未予重视，逐渐加重，患者遂于某次就诊时间行颈部彩超示：右侧颈部低回声，行鼻咽镜示：鼻咽肿物，建议活检。患者未予相关诊治，转至我院就诊。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,涕血,颈部肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。偶伴吸烟、饮酒15年，3两/天，。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：90次/分，R：20次/分，BP：120/70mmHg,Ht：172cm，Wt：73kg，BSA：1.85m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率90次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.0cm；鼻咽双侧顶后壁结节状肿物；双侧颈部IIa区可扪及1个淋巴结，最大径2×2cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 启动首周期同步放化疗（辅以水化、止吐预处理），不考虑诱导化疗\nB. 启动首周期诱导化疗，计划序贯根治性单纯放疗\nC. 启动首周期诱导化疗联合PD-1抑制剂，计划序贯根治性同步放化疗\nD. 启动首周期诱导化疗，计划序贯手术切除原发灶及颈部淋巴结\nE. 启动根治性单纯放疗，计划放疗结束后行多周期辅助化疗\nF. 启动根治性放疗联合EGFR靶向治疗，免除全身静脉化疗\nG. 优先行双侧颈部淋巴结清扫术，术后行根治性同步放化疗\nH. 优先行鼻咽原发灶内镜下切除术，术后行根治性同步放化疗\nI. 启动首周期姑息性化疗，计划化疗后行局部姑息性放疗\nJ. 启动首周期诱导化疗，若疗效达完全缓解（CR）则免除后续放疗\nK. 启动首周期诱导化疗（辅以水化、止吐预处理），计划序贯根治性同步放化疗\nL. 启动首周期同步放化疗，计划放疗结束后行多周期辅助化疗\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-b024e6abb04a58aab366631a","patient_id":"patient-a48d1d72efa6c4217cf5b79c","turn_id":"turn07","turn_position":4,"turn_type":"response_assessment_decision","gold_letter":"B","gold_action":"继续完成既定根治性放疗计划；加用重组人表皮生长因子、GM-CSF含漱液局部治疗，并予以静脉营养支持及抗感染治疗。","options":[{"letter":"A","text":"提前终止放疗；给予重组人表皮生长因子、GM-CSF含漱液局部促修复及静脉营养支持治疗。","is_gold":false},{"letter":"B","text":"继续完成既定根治性放疗计划；加用重组人表皮生长因子、GM-CSF含漱液局部治疗，并予以静脉营养支持及抗感染治疗。","is_gold":true},{"letter":"C","text":"暂停放疗及靶向治疗直至黏膜炎好转；给予重组人表皮生长因子、GM-CSF含漱液局部治疗及静脉营养支持。","is_gold":false},{"letter":"D","text":"继续完成既定根治性放疗计划；仅给予氯化钠含漱液及常规饮食指导，避免使用生长因子类药物及静脉营养。","is_gold":false},{"letter":"E","text":"继续完成既定根治性放疗计划；加用氟康唑等广谱抗真菌药物静脉滴注，并予以静脉营养支持治疗。","is_gold":false},{"letter":"F","text":"继续完成既定根治性放疗计划并立即安排鼻咽部局部加量放疗；给予重组人表皮生长因子含漱液及静脉营养支持。","is_gold":false},{"letter":"G","text":"继续完成既定根治性放疗计划；行预防性经皮内镜下胃造瘘术（PEG）替代静脉营养支持。","is_gold":false},{"letter":"H","text":"暂停放疗计划；复查鼻咽及颈部MRI以明确肿瘤退缩情况，再决定后续放疗靶区及剂量。","is_gold":false},{"letter":"I","text":"继续完成既定根治性放疗计划；给予大剂量静脉糖皮质激素冲击治疗，暂缓静脉营养支持。","is_gold":false},{"letter":"J","text":"继续完成既定根治性放疗计划；立即给予聚乙二醇化重组人粒细胞刺激因子皮下注射及静脉营养支持。","is_gold":false},{"letter":"K","text":"提前结束放疗，转为维持性靶向治疗及免疫治疗；给予重组人表皮生长因子及静脉营养支持。","is_gold":false},{"letter":"L","text":"继续完成既定根治性放疗计划；行预防性气管切开术，并予以静脉营养支持及抗感染治疗。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、筛窦、斜坡、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D25] 检验组合: 间接胆红素(IBIL)-静脉血: 4.41umolL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.41；肌酐(Crea)-静脉血: 102.2umol/L；尿酸(UA)-静脉血: 315.6umol/L；总蛋白(TP)-静脉血: 63.4g/L；直接胆红素(DBIL)-静脉血: 2.3umol/L；白蛋白(ALB)-静脉血: 37.1g/L；总胆红素(TBIL)-静脉血: 6.71umol/L；尿素氮(BUN)-静脉血: 7.1mmol/L；球蛋白(GLO)-静脉血: 26.3g/L\n- [全程D29] 检验组合: 碱性磷酸酶(ALP)-静脉血: 72.7U/L；钠离子(Na+)-静脉血: 140.9mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0.3；大血小板百分比(P-LCR%)-静脉血: 28.3%；葡萄糖(Glu)-静脉血: 4.98mmol/L；载脂蛋白B(apoB)-静脉血: 0.9g/L；磷(P)-静脉血: 0.95mmol/L；球蛋白(GLO)-静脉血: 26.2g/L；氯离子(Cl-)-静脉血: 102.9mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.9U/L；镁离子(Mg2+)-静脉血: 0.81mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.67mmol/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；红细胞计数(RBC#)-静脉血: 4.2510E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.9；总蛋白(TP)-静脉血: 63.5g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 88.7fL；红细胞比容(Hct)-静脉血: 37.7%；总胆固醇(TC)-静脉血: 3.9mmol/L；乳酸脱氢酶(LDH)-静脉血: 144.8U/L；载脂蛋白AI(apoAI)-静脉血: 1.05g/L；丙氨酸氨基转移酶(ALT)-静脉血: 18.8U/L；甘油三酯(TG)-静脉血: 1mmol/L；尿酸(UA)-静脉血: 351.4umol/L；尿素氮(BUN)-静脉血: 6mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；单核细胞百分比(Mono%)-静脉血: 0.077；胱抑素(Cys-C)-静脉血: 0.99mg/L；血小板分布宽度(PDW)-静脉血: 11.5%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；有核红细胞计数(NRBC#)-静脉血: 0.0110E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 38；白细胞计数(WBC#)-静脉血: 3.6610E9/L；平均血小板体积(MPV)-静脉血: 10.5fL；血小板比容-静脉血: 20%；单核细胞计数(Mono#)-静脉血: 0.310E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；总胆汁酸……\n- [全程D36] 检验组合: 酸碱度(pH)-尿液: 6.5；丙氨酸氨基转移酶(ALT)-静脉血: 18.7U/L；阴离子间隙(AG)-静脉血: 12.9；钾离子(K+)-静脉血: 3.75mmol/L；磷(P)-静脉血: 0.98mmol/L；球蛋白(GLO)-静脉血: 29.5g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；酮体(KET)-尿液: -（参考: 阴性）；总胆固醇(TC)-静脉血: 4.56mmol/L；尿素氮(BUN)-静脉血: 4.6mmol/L；红细胞计数(RBC#)-静脉血: 4.4810E12/L；比重(SG)-尿液: 1.008；γ-谷氨酰基转移酶(GGT)-静脉血: 28U/L；红细胞比容(Hct)-静脉血: 39.4%；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.755；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.4；总胆红素(TBIL)-静脉血: 9.28umol/L；葡萄糖(Glu)-静脉血: 5.08mmol/L；钠离子(Na+)-静脉血: 141.1mmol/L；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 25.4mmol/L；颜色-尿液: colorless；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.046；乳酸脱氢酶(LDH)-静脉血: 144U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22.6U/L；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.37；C-反应蛋白(CRP)-静脉血: 7.02mg/L；间接胆红素(IBIL)-静脉血: 6.27umolL；血红蛋白(Hb)-静脉血: 135g/L；单核细胞百分比(Mono%)-静脉血: 0.08；淋巴细胞百分比(Lymph%)-静脉血: 0.113；总钙(Ca)-静脉血: 2.18mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.68；平均血小板体积(MPV)-静脉血: 10fL；淋巴细胞计数(Lymph#……\n- [全程D37] 检验组合: 亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 1/μL；酸碱度(pH)-尿液: 6.5；白细胞计数(WBC#)-尿液: 8/μL；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 1/μL；颜色-尿液: colorless；尿胆原(URO)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；胆红素(BIL)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.006；酮体(KET)-尿液: -（参考: 阴性）\n- [全程D38] 检验组合: 白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.006；尿胆原(URO)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；细菌计数(BACT#)-尿液: 2/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 1/μL；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；颜色-尿液: colorless；浊度(TRUB)-尿液: clear；隐血(OB)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 6.5\n- [全程D43] 检验组合: 尿素氮(BUN)-静脉血: 7.4mmol/L；直接胆红素(DBIL)-静脉血: 3.4umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.3mmol/L；白蛋白(ALB)-静脉血: 41.2g/L；磷(P)-静脉血: 1.12mmol/L；氯离子(Cl-)-静脉血: 97.6mmol/L；总蛋白(TP)-静脉血: 72.16g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 45.7U/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；血小板分布宽度(PDW)-静脉血: 11.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；碱性磷酸酶(ALP)-静脉血: 88.2U/L；C-反应蛋白(CRP)-静脉血: 1.75mg/L；红细胞计数(RBC#)-静脉血: 4.4910E12/L；白细胞计数(WBC#)-静脉血: 3.910E9/L；血小板比容-静脉血: 15%；淋巴细胞百分比(Lymph%)-静脉血: 0.062；总胆固醇(TC)-静脉血: 4.41mmol/L；球蛋白(GLO)-静脉血: 30.96g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.55；α-L-岩藻糖苷酶(AFU)-静脉血: 38.6U/L；钠离子(Na+)-静脉血: 138mmol/L；总胆红素(TBIL)-静脉血: 10.5umol/L；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；血小板计数(PLT#)-静脉血: 15010E9/L；平均血小板体积(MPV)-静脉血: 10.3fL；葡萄糖(Glu)-静脉血: 5.12mmol/L；载脂蛋白B(apoB)-静脉血: 0.95g/L；甘油三酯(TG)-静脉血: 1.59mmol/L；血红蛋白(Hb)-静脉血: 139g/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；胱抑素(Cys-C)-静脉血: 1.23mg/L；载脂蛋白AI(apoAI)-静脉血: 1.33g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.07mmolL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.33；乳酸脱氢酶(LDH)-静脉血: 158.1U/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜酸性粒细胞计数(Eos#)-静脉血: 0.1……\n- [全程D50] 检验组合: 乳酸脱氢酶(LDH)-静脉血: 164U/L；葡萄糖(Glu)-静脉血: 5.3mmol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；肌酐(Crea)-静脉血: 108.9umol/L；平均红细胞体积(MCV)-静脉血: 85.7fL；间接胆红素(IBIL)-静脉血: 7.8umolL；磷(P)-静脉血: 1.01mmol/L；球蛋白(GLO)-静脉血: 29.5g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；总胆固醇(TC)-静脉血: 4.57mmol/L；总蛋白(TP)-静脉血: 69g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15.2U/L；大血小板百分比(P-LCR%)-静脉血: 20.1%；钾离子(K+)-静脉血: 3.73mmol/L；碱性磷酸酶(ALP)-静脉血: 81.5U/L；阴离子间隙(AG)-静脉血: 16.9；胱抑素(Cys-C)-静脉血: 1.07mg/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；直接胆红素(DBIL)-静脉血: 3.9umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；血小板计数(PLT#)-静脉血: 18610E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 25.2U/L；细菌名称-咽拭子: 细菌涂片3；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.03；平均红细胞血红蛋白含量(MCH)-静脉血: 29.8pg；白细胞计数(WBC#)-静脉血: 3.6610E9/L；尿素氮(BUN)-静脉血: 4.8mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 24U/L；氯离子(Cl-)-静脉血: 97.1mmol/L；血小板分布宽度(PDW)-静脉血: 10.4%；淋巴细胞百分比(Lymph%)-静脉血: 0.085；血液二氧化碳含量ctCO2(B)-静脉血: 23.3mmol/L；钠离子(Na+)-静脉血: 137.3mmol/L；总胆红素(TBIL)-静脉血: 11.7umol/L；C-反应蛋白(CRP)-静脉血: 11.52mg/L；总胆汁酸(TBA)-静脉血: 1.4umol/L；中性粒细胞计……\n- [全程D55] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约12mm，肝S5可见一无回声灶，大小约11×9mm,椭圆形，边界清，内透声可，后方回声增强。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约19cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱不充盈。 前列腺大小形态正常，大小约38×30×37mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝囊肿。 胆囊、脾脏、胰腺、双肾、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n\n【既往治疗与反应】\n- [全程D32] 阶段小结；阶段小结: 病程类型: 阶段小结；病程主题: 阶段小结；病程内容: 患者[姓名已隐去]，男，51岁，因“颈部肿物，偶伴涕血、鼻塞2月”于某次就诊时间入院。征求患者同意并签字入住顺铂三周/单周方案联合IMRT治疗局部中晚期鼻咽癌三期临床试验，抽签入三周顺铂100mg/m2组。目前放疗14次，同时期化疗1次。3次靶向治疗，继续原方案治疗，并予患者营养支持治疗。\n- [全程D37] 上级查房记录；[姓名已隐去]主任医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者诉咽喉疼痛，目前放疗17次，今日行第2次顺铂同时期化疗，查体：患者鼻咽壁肿物明显缩小，双颈未扪及淋巴结，面部、双颈部皮肤色素沉着。[姓名已隐去]医生信息已隐藏：密切关注患者放化疗副反应，遵嘱执行。\n- [全程D42] 上级查房记录；[姓名已隐去]主任医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者诉咽喉疼痛，目前放疗20次，已行2次顺铂同时期化疗，4次靶向治疗，诉食欲不佳，查体：患者鼻咽顶后壁肿物明显缩小，双颈未扪及淋巴结，面部、双颈部皮肤色素沉着。[姓名已隐去]医生信息已隐藏：嘱患者加强营养及日常休息。密切关注患者放化疗副反应。 遵嘱。\n- [全程D47] 上级查房记录；[姓名已隐去]主任医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者目前放疗24次，已行2次顺铂同时期化疗，5次靶向治疗，诉咽喉疼痛，纳差，乏力。查体：患者鼻咽顶后壁稍增厚，双颈未扪及淋巴结，面部、双颈部皮肤色素沉着。[姓名已隐去]医生信息已隐藏：予以抗炎对症处理，并予患者行营养支持治疗，并密切关注患者血象变化。\n- [全程D52] 上级查房记录；[姓名已隐去]主任医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者目前放疗27次，已行2次顺铂同时期化疗，6次靶向治疗，诉咽喉疼痛，纳差，乏力。查体：患者鼻咽右侧壁肿物已基本消退，双颈未扪及淋巴结，面部、双颈部皮肤色素沉着。[姓名已隐去]医生信息已隐藏：予患者行营养支持治疗，并密切关注患者血象变化。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 提前终止放疗；给予重组人表皮生长因子、GM-CSF含漱液局部促修复及静脉营养支持治疗。\nB. 继续完成既定根治性放疗计划；加用重组人表皮生长因子、GM-CSF含漱液局部治疗，并予以静脉营养支持及抗感染治疗。\nC. 暂停放疗及靶向治疗直至黏膜炎好转；给予重组人表皮生长因子、GM-CSF含漱液局部治疗及静脉营养支持。\nD. 继续完成既定根治性放疗计划；仅给予氯化钠含漱液及常规饮食指导，避免使用生长因子类药物及静脉营养。\nE. 继续完成既定根治性放疗计划；加用氟康唑等广谱抗真菌药物静脉滴注，并予以静脉营养支持治疗。\nF. 继续完成既定根治性放疗计划并立即安排鼻咽部局部加量放疗；给予重组人表皮生长因子含漱液及静脉营养支持。\nG. 继续完成既定根治性放疗计划；行预防性经皮内镜下胃造瘘术（PEG）替代静脉营养支持。\nH. 暂停放疗计划；复查鼻咽及颈部MRI以明确肿瘤退缩情况，再决定后续放疗靶区及剂量。\nI. 继续完成既定根治性放疗计划；给予大剂量静脉糖皮质激素冲击治疗，暂缓静脉营养支持。\nJ. 继续完成既定根治性放疗计划；立即给予聚乙二醇化重组人粒细胞刺激因子皮下注射及静脉营养支持。\nK. 提前结束放疗，转为维持性靶向治疗及免疫治疗；给予重组人表皮生长因子及静脉营养支持。\nL. 继续完成既定根治性放疗计划；行预防性气管切开术，并予以静脉营养支持及抗感染治疗。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、筛窦、斜坡、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D25] 检验组合: 间接胆红素(IBIL)-静脉血: 4.41umolL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.41；肌酐(Crea)-静脉血: 102.2umol/L；尿酸(UA)-静脉血: 315.6umol/L；总蛋白(TP)-静脉血: 63.4g/L；直接胆红素(DBIL)-静脉血: 2.3umol/L；白蛋白(ALB)-静脉血: 37.1g/L；总胆红素(TBIL)-静脉血: 6.71umol/L；尿素氮(BUN)-静脉血: 7.1mmol/L；球蛋白(GLO)-静脉血: 26.3g/L\n- [全程D29] 检验组合: 碱性磷酸酶(ALP)-静脉血: 72.7U/L；钠离子(Na+)-静脉血: 140.9mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0.3；大血小板百分比(P-LCR%)-静脉血: 28.3%；葡萄糖(Glu)-静脉血: 4.98mmol/L；载脂蛋白B(apoB)-静脉血: 0.9g/L；磷(P)-静脉血: 0.95mmol/L；球蛋白(GLO)-静脉血: 26.2g/L；氯离子(Cl-)-静脉血: 102.9mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.9U/L；镁离子(Mg2+)-静脉血: 0.81mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.67mmol/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；红细胞计数(RBC#)-静脉血: 4.2510E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.9；总蛋白(TP)-静脉血: 63.5g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 88.7fL；红细胞比容(Hct)-静脉血: 37.7%；总胆固醇(TC)-静脉血: 3.9mmol/L；乳酸脱氢酶(LDH)-静脉血: 144.8U/L；载脂蛋白AI(apoAI)-静脉血: 1.05g/L；丙氨酸氨基转移酶(ALT)-静脉血: 18.8U/L；甘油三酯(TG)-静脉血: 1mmol/L；尿酸(UA)-静脉血: 351.4umol/L；尿素氮(BUN)-静脉血: 6mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；单核细胞百分比(Mono%)-静脉血: 0.077；胱抑素(Cys-C)-静脉血: 0.99mg/L；血小板分布宽度(PDW)-静脉血: 11.5%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；有核红细胞计数(NRBC#)-静脉血: 0.0110E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 38；白细胞计数(WBC#)-静脉血: 3.6610E9/L；平均血小板体积(MPV)-静脉血: 10.5fL；血小板比容-静脉血: 20%；单核细胞计数(Mono#)-静脉血: 0.310E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；总胆汁酸……\n- [全程D36] 检验组合: 酸碱度(pH)-尿液: 6.5；丙氨酸氨基转移酶(ALT)-静脉血: 18.7U/L；阴离子间隙(AG)-静脉血: 12.9；钾离子(K+)-静脉血: 3.75mmol/L；磷(P)-静脉血: 0.98mmol/L；球蛋白(GLO)-静脉血: 29.5g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；酮体(KET)-尿液: -（参考: 阴性）；总胆固醇(TC)-静脉血: 4.56mmol/L；尿素氮(BUN)-静脉血: 4.6mmol/L；红细胞计数(RBC#)-静脉血: 4.4810E12/L；比重(SG)-尿液: 1.008；γ-谷氨酰基转移酶(GGT)-静脉血: 28U/L；红细胞比容(Hct)-静脉血: 39.4%；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.755；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.4；总胆红素(TBIL)-静脉血: 9.28umol/L；葡萄糖(Glu)-静脉血: 5.08mmol/L；钠离子(Na+)-静脉血: 141.1mmol/L；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 25.4mmol/L；颜色-尿液: colorless；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.046；乳酸脱氢酶(LDH)-静脉血: 144U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22.6U/L；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.37；C-反应蛋白(CRP)-静脉血: 7.02mg/L；间接胆红素(IBIL)-静脉血: 6.27umolL；血红蛋白(Hb)-静脉血: 135g/L；单核细胞百分比(Mono%)-静脉血: 0.08；淋巴细胞百分比(Lymph%)-静脉血: 0.113；总钙(Ca)-静脉血: 2.18mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.68；平均血小板体积(MPV)-静脉血: 10fL；淋巴细胞计数(Lymph#……\n- [全程D37] 检验组合: 亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 1/μL；酸碱度(pH)-尿液: 6.5；白细胞计数(WBC#)-尿液: 8/μL；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 1/μL；颜色-尿液: colorless；尿胆原(URO)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；胆红素(BIL)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.006；酮体(KET)-尿液: -（参考: 阴性）\n- [全程D38] 检验组合: 白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.006；尿胆原(URO)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；细菌计数(BACT#)-尿液: 2/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 1/μL；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；颜色-尿液: colorless；浊度(TRUB)-尿液: clear；隐血(OB)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 6.5\n- [全程D43] 检验组合: 尿素氮(BUN)-静脉血: 7.4mmol/L；直接胆红素(DBIL)-静脉血: 3.4umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.3mmol/L；白蛋白(ALB)-静脉血: 41.2g/L；磷(P)-静脉血: 1.12mmol/L；氯离子(Cl-)-静脉血: 97.6mmol/L；总蛋白(TP)-静脉血: 72.16g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 45.7U/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；血小板分布宽度(PDW)-静脉血: 11.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；碱性磷酸酶(ALP)-静脉血: 88.2U/L；C-反应蛋白(CRP)-静脉血: 1.75mg/L；红细胞计数(RBC#)-静脉血: 4.4910E12/L；白细胞计数(WBC#)-静脉血: 3.910E9/L；血小板比容-静脉血: 15%；淋巴细胞百分比(Lymph%)-静脉血: 0.062；总胆固醇(TC)-静脉血: 4.41mmol/L；球蛋白(GLO)-静脉血: 30.96g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.55；α-L-岩藻糖苷酶(AFU)-静脉血: 38.6U/L；钠离子(Na+)-静脉血: 138mmol/L；总胆红素(TBIL)-静脉血: 10.5umol/L；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；血小板计数(PLT#)-静脉血: 15010E9/L；平均血小板体积(MPV)-静脉血: 10.3fL；葡萄糖(Glu)-静脉血: 5.12mmol/L；载脂蛋白B(apoB)-静脉血: 0.95g/L；甘油三酯(TG)-静脉血: 1.59mmol/L；血红蛋白(Hb)-静脉血: 139g/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；胱抑素(Cys-C)-静脉血: 1.23mg/L；载脂蛋白AI(apoAI)-静脉血: 1.33g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.07mmolL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.33；乳酸脱氢酶(LDH)-静脉血: 158.1U/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜酸性粒细胞计数(Eos#)-静脉血: 0.1……\n- [全程D50] 检验组合: 乳酸脱氢酶(LDH)-静脉血: 164U/L；葡萄糖(Glu)-静脉血: 5.3mmol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；肌酐(Crea)-静脉血: 108.9umol/L；平均红细胞体积(MCV)-静脉血: 85.7fL；间接胆红素(IBIL)-静脉血: 7.8umolL；磷(P)-静脉血: 1.01mmol/L；球蛋白(GLO)-静脉血: 29.5g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；总胆固醇(TC)-静脉血: 4.57mmol/L；总蛋白(TP)-静脉血: 69g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15.2U/L；大血小板百分比(P-LCR%)-静脉血: 20.1%；钾离子(K+)-静脉血: 3.73mmol/L；碱性磷酸酶(ALP)-静脉血: 81.5U/L；阴离子间隙(AG)-静脉血: 16.9；胱抑素(Cys-C)-静脉血: 1.07mg/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；直接胆红素(DBIL)-静脉血: 3.9umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；血小板计数(PLT#)-静脉血: 18610E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 25.2U/L；细菌名称-咽拭子: 细菌涂片3；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.03；平均红细胞血红蛋白含量(MCH)-静脉血: 29.8pg；白细胞计数(WBC#)-静脉血: 3.6610E9/L；尿素氮(BUN)-静脉血: 4.8mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 24U/L；氯离子(Cl-)-静脉血: 97.1mmol/L；血小板分布宽度(PDW)-静脉血: 10.4%；淋巴细胞百分比(Lymph%)-静脉血: 0.085；血液二氧化碳含量ctCO2(B)-静脉血: 23.3mmol/L；钠离子(Na+)-静脉血: 137.3mmol/L；总胆红素(TBIL)-静脉血: 11.7umol/L；C-反应蛋白(CRP)-静脉血: 11.52mg/L；总胆汁酸(TBA)-静脉血: 1.4umol/L；中性粒细胞计……\n- [全程D55] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约12mm，肝S5可见一无回声灶，大小约11×9mm,椭圆形，边界清，内透声可，后方回声增强。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约19cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱不充盈。 前列腺大小形态正常，大小约38×30×37mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝囊肿。 胆囊、脾脏、胰腺、双肾、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n\n【既往治疗与反应】\n- [全程D32] 阶段小结；阶段小结: 病程类型: 阶段小结；病程主题: 阶段小结；病程内容: 患者[姓名已隐去]，男，51岁，因“颈部肿物，偶伴涕血、鼻塞2月”于某次就诊时间入院。征求患者同意并签字入住顺铂三周/单周方案联合IMRT治疗局部中晚期鼻咽癌三期临床试验，抽签入三周顺铂100mg/m2组。目前放疗14次，同时期化疗1次。3次靶向治疗，继续原方案治疗，并予患者营养支持治疗。\n- [全程D37] 上级查房记录；[姓名已隐去]主任医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者诉咽喉疼痛，目前放疗17次，今日行第2次顺铂同时期化疗，查体：患者鼻咽壁肿物明显缩小，双颈未扪及淋巴结，面部、双颈部皮肤色素沉着。[姓名已隐去]医生信息已隐藏：密切关注患者放化疗副反应，遵嘱执行。\n- [全程D42] 上级查房记录；[姓名已隐去]主任医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者诉咽喉疼痛，目前放疗20次，已行2次顺铂同时期化疗，4次靶向治疗，诉食欲不佳，查体：患者鼻咽顶后壁肿物明显缩小，双颈未扪及淋巴结，面部、双颈部皮肤色素沉着。[姓名已隐去]医生信息已隐藏：嘱患者加强营养及日常休息。密切关注患者放化疗副反应。 遵嘱。\n- [全程D47] 上级查房记录；[姓名已隐去]主任医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者目前放疗24次，已行2次顺铂同时期化疗，5次靶向治疗，诉咽喉疼痛，纳差，乏力。查体：患者鼻咽顶后壁稍增厚，双颈未扪及淋巴结，面部、双颈部皮肤色素沉着。[姓名已隐去]医生信息已隐藏：予以抗炎对症处理，并予患者行营养支持治疗，并密切关注患者血象变化。\n- [全程D52] 上级查房记录；[姓名已隐去]主任医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者目前放疗27次，已行2次顺铂同时期化疗，6次靶向治疗，诉咽喉疼痛，纳差，乏力。查体：患者鼻咽右侧壁肿物已基本消退，双颈未扪及淋巴结，面部、双颈部皮肤色素沉着。[姓名已隐去]医生信息已隐藏：予患者行营养支持治疗，并密切关注患者血象变化。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 提前终止放疗；给予重组人表皮生长因子、GM-CSF含漱液局部促修复及静脉营养支持治疗。\nB. 继续完成既定根治性放疗计划；加用重组人表皮生长因子、GM-CSF含漱液局部治疗，并予以静脉营养支持及抗感染治疗。\nC. 暂停放疗及靶向治疗直至黏膜炎好转；给予重组人表皮生长因子、GM-CSF含漱液局部治疗及静脉营养支持。\nD. 继续完成既定根治性放疗计划；仅给予氯化钠含漱液及常规饮食指导，避免使用生长因子类药物及静脉营养。\nE. 继续完成既定根治性放疗计划；加用氟康唑等广谱抗真菌药物静脉滴注，并予以静脉营养支持治疗。\nF. 继续完成既定根治性放疗计划并立即安排鼻咽部局部加量放疗；给予重组人表皮生长因子含漱液及静脉营养支持。\nG. 继续完成既定根治性放疗计划；行预防性经皮内镜下胃造瘘术（PEG）替代静脉营养支持。\nH. 暂停放疗计划；复查鼻咽及颈部MRI以明确肿瘤退缩情况，再决定后续放疗靶区及剂量。\nI. 继续完成既定根治性放疗计划；给予大剂量静脉糖皮质激素冲击治疗，暂缓静脉营养支持。\nJ. 继续完成既定根治性放疗计划；立即给予聚乙二醇化重组人粒细胞刺激因子皮下注射及静脉营养支持。\nK. 提前结束放疗，转为维持性靶向治疗及免疫治疗；给予重组人表皮生长因子及静脉营养支持。\nL. 继续完成既定根治性放疗计划；行预防性气管切开术，并予以静脉营养支持及抗感染治疗。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-c54efc446616b72b81ae7555","patient_id":"patient-a48d1d72efa6c4217cf5b79c","turn_id":"turn08","turn_position":5,"turn_type":"recurrence_or_salvage_decision","gold_letter":"C","gold_action":"行电子鼻咽镜检查评估局部肿瘤退缩情况，并继续使用重组人表皮生长因子、重组人粒细胞巨噬细胞刺激因子等含漱药物促进粘膜修复。","options":[{"letter":"A","text":"行电子鼻咽镜检查并在可疑残留区域取活检，继续静脉滴注莫西沙星及地塞米松预防感染与水肿，暂不予抗肿瘤治疗。","is_gold":false},{"letter":"B","text":"安排全身PET-CT检查评估放化疗后全身代谢缓解情况，并继续静脉滴注脂肪乳及氨基酸等营养支持治疗。","is_gold":false},{"letter":"C","text":"行电子鼻咽镜检查评估局部肿瘤退缩情况，并继续使用重组人表皮生长因子、重组人粒细胞巨噬细胞刺激因子等含漱药物促进粘膜修复。","is_gold":true},{"letter":"D","text":"对右侧咽后及颈部残留淋巴结行局部追加放疗推量，并继续使用重组人表皮生长因子等含漱药物促进粘膜修复。","is_gold":false},{"letter":"E","text":"行电子鼻咽镜检查评估局部疗效，并启动吉西他滨联合顺铂方案进行2至3个周期的辅助化疗以巩固全身疗效。","is_gold":false},{"letter":"F","text":"行右侧颈部淋巴结清扫术处理残留淋巴结，术后继续使用重组人表皮生长因子外用溶液促进局部创面愈合。","is_gold":false},{"letter":"G","text":"行鼻咽及颈部超声检查评估淋巴结结构，并加用卡培他滨口服进行为期1年的节拍化疗作为维持治疗。","is_gold":false},{"letter":"H","text":"暂不进行鼻咽镜检查，直接出院，嘱1个月后返院行鼻咽部活检及MRI复查，期间继续静脉营养支持。","is_gold":false},{"letter":"I","text":"行电子鼻咽镜检查评估局部疗效，并继续静脉滴注脂肪乳、氨基酸及复方氯化钠注射液加强全身营养支持。","is_gold":false},{"letter":"J","text":"安排头颅增强MRI及全身骨扫描排除远处转移，并继续原方案靶向治疗至满1年，辅以局部含漱药物治疗。","is_gold":false},{"letter":"K","text":"行电子鼻咽镜检查评估局部疗效，若发现粘膜坏死则立即行内镜下清创术，并静脉滴注大剂量抗生素抗感染。","is_gold":false},{"letter":"L","text":"继续静脉滴注莫西沙星及地塞米松抗炎治疗2周以控制鼻窦炎及乳突炎，并定期复查鼻窦CT评估炎症吸收情况。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、筛窦、斜坡、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D56] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理清晰，双肺野内未见明显实质性病变。双侧肺门未见增大，纵隔未见增宽，心影形态、大小未见异常。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见异常。\n- [全程D56] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌治疗后，对比某次就诊时间片： 鼻咽腔狭窄，鼻咽顶壁、顶后壁、右侧壁稍增厚，粘膜表面欠光滑，增强后较明显强化，较前明显缩小，双侧咽隐窝稍变浅，鼻中隔后缘见少许软组织，增强后较明显强化，右侧咽旁间隙稍变窄，左侧咽旁脂肪间隙及左侧颈动脉鞘区未见异常。 右侧腭帆提肌稍模糊；左侧腭帆提肌、腭帆张肌、头长肌未见受累征象。 左侧中下鼻甲明显肥厚。 双侧翼腭窝、双上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽未见明显异常。 斜坡、蝶骨基底部、右侧翼突基底部信号降低，增强后强化，较前范围稍缩小。 双侧海绵窦未见明显异常。 双侧上颌窦、筛窦、右侧蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，无强化，骨壁完整。双眼大小、形态、位置均属正常、信号均匀。蝶鞍形态正常，其内未见占位性病变。 右侧咽后间隙见淋巴结，较大者约7mm×6mm，信号欠均匀，增强后明显强化，较前缩小；左侧咽后间隙未见肿大淋巴结。双颈Ⅱ区、右颈Ⅲ区见多个淋巴结，边界欠清，最大约10mm×7mm，增强后不均匀强化，较前缩小、数目减少。 所见甲状腺双叶形态正常、喉咽腔、双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌治疗后，对比某次就诊时间片： 鼻咽病灶较前明显缩小。 颅底骨质破坏，较前修复。 右侧咽后淋巴结肿大，较前明显缩小。 双颈II区、右颈III区小淋巴结，较前明显缩小、数目减少。 鼻窦炎及右侧乳突炎。 左侧中下鼻甲肥厚。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行电子鼻咽镜检查并在可疑残留区域取活检，继续静脉滴注莫西沙星及地塞米松预防感染与水肿，暂不予抗肿瘤治疗。\nB. 安排全身PET-CT检查评估放化疗后全身代谢缓解情况，并继续静脉滴注脂肪乳及氨基酸等营养支持治疗。\nC. 行电子鼻咽镜检查评估局部肿瘤退缩情况，并继续使用重组人表皮生长因子、重组人粒细胞巨噬细胞刺激因子等含漱药物促进粘膜修复。\nD. 对右侧咽后及颈部残留淋巴结行局部追加放疗推量，并继续使用重组人表皮生长因子等含漱药物促进粘膜修复。\nE. 行电子鼻咽镜检查评估局部疗效，并启动吉西他滨联合顺铂方案进行2至3个周期的辅助化疗以巩固全身疗效。\nF. 行右侧颈部淋巴结清扫术处理残留淋巴结，术后继续使用重组人表皮生长因子外用溶液促进局部创面愈合。\nG. 行鼻咽及颈部超声检查评估淋巴结结构，并加用卡培他滨口服进行为期1年的节拍化疗作为维持治疗。\nH. 暂不进行鼻咽镜检查，直接出院，嘱1个月后返院行鼻咽部活检及MRI复查，期间继续静脉营养支持。\nI. 行电子鼻咽镜检查评估局部疗效，并继续静脉滴注脂肪乳、氨基酸及复方氯化钠注射液加强全身营养支持。\nJ. 安排头颅增强MRI及全身骨扫描排除远处转移，并继续原方案靶向治疗至满1年，辅以局部含漱药物治疗。\nK. 行电子鼻咽镜检查评估局部疗效，若发现粘膜坏死则立即行内镜下清创术，并静脉滴注大剂量抗生素抗感染。\nL. 继续静脉滴注莫西沙星及地塞米松抗炎治疗2周以控制鼻窦炎及乳突炎，并定期复查鼻窦CT评估炎症吸收情况。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、筛窦、斜坡、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D56] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理清晰，双肺野内未见明显实质性病变。双侧肺门未见增大，纵隔未见增宽，心影形态、大小未见异常。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见异常。\n- [全程D56] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌治疗后，对比某次就诊时间片： 鼻咽腔狭窄，鼻咽顶壁、顶后壁、右侧壁稍增厚，粘膜表面欠光滑，增强后较明显强化，较前明显缩小，双侧咽隐窝稍变浅，鼻中隔后缘见少许软组织，增强后较明显强化，右侧咽旁间隙稍变窄，左侧咽旁脂肪间隙及左侧颈动脉鞘区未见异常。 右侧腭帆提肌稍模糊；左侧腭帆提肌、腭帆张肌、头长肌未见受累征象。 左侧中下鼻甲明显肥厚。 双侧翼腭窝、双上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽未见明显异常。 斜坡、蝶骨基底部、右侧翼突基底部信号降低，增强后强化，较前范围稍缩小。 双侧海绵窦未见明显异常。 双侧上颌窦、筛窦、右侧蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，无强化，骨壁完整。双眼大小、形态、位置均属正常、信号均匀。蝶鞍形态正常，其内未见占位性病变。 右侧咽后间隙见淋巴结，较大者约7mm×6mm，信号欠均匀，增强后明显强化，较前缩小；左侧咽后间隙未见肿大淋巴结。双颈Ⅱ区、右颈Ⅲ区见多个淋巴结，边界欠清，最大约10mm×7mm，增强后不均匀强化，较前缩小、数目减少。 所见甲状腺双叶形态正常、喉咽腔、双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌治疗后，对比某次就诊时间片： 鼻咽病灶较前明显缩小。 颅底骨质破坏，较前修复。 右侧咽后淋巴结肿大，较前明显缩小。 双颈II区、右颈III区小淋巴结，较前明显缩小、数目减少。 鼻窦炎及右侧乳突炎。 左侧中下鼻甲肥厚。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行电子鼻咽镜检查并在可疑残留区域取活检，继续静脉滴注莫西沙星及地塞米松预防感染与水肿，暂不予抗肿瘤治疗。\nB. 安排全身PET-CT检查评估放化疗后全身代谢缓解情况，并继续静脉滴注脂肪乳及氨基酸等营养支持治疗。\nC. 行电子鼻咽镜检查评估局部肿瘤退缩情况，并继续使用重组人表皮生长因子、重组人粒细胞巨噬细胞刺激因子等含漱药物促进粘膜修复。\nD. 对右侧咽后及颈部残留淋巴结行局部追加放疗推量，并继续使用重组人表皮生长因子等含漱药物促进粘膜修复。\nE. 行电子鼻咽镜检查评估局部疗效，并启动吉西他滨联合顺铂方案进行2至3个周期的辅助化疗以巩固全身疗效。\nF. 行右侧颈部淋巴结清扫术处理残留淋巴结，术后继续使用重组人表皮生长因子外用溶液促进局部创面愈合。\nG. 行鼻咽及颈部超声检查评估淋巴结结构，并加用卡培他滨口服进行为期1年的节拍化疗作为维持治疗。\nH. 暂不进行鼻咽镜检查，直接出院，嘱1个月后返院行鼻咽部活检及MRI复查，期间继续静脉营养支持。\nI. 行电子鼻咽镜检查评估局部疗效，并继续静脉滴注脂肪乳、氨基酸及复方氯化钠注射液加强全身营养支持。\nJ. 安排头颅增强MRI及全身骨扫描排除远处转移，并继续原方案靶向治疗至满1年，辅以局部含漱药物治疗。\nK. 行电子鼻咽镜检查评估局部疗效，若发现粘膜坏死则立即行内镜下清创术，并静脉滴注大剂量抗生素抗感染。\nL. 继续静脉滴注莫西沙星及地塞米松抗炎治疗2周以控制鼻窦炎及乳突炎，并定期复查鼻窦CT评估炎症吸收情况。\n\n请仅输出一个选项字母（A-L）。"}]}
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+{"sample_id":"sample-6fba8e9f22d1b7d086664e36","patient_id":"patient-e90c2443e271b2e927262653","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"E","gold_action":"完善电子鼻咽镜检查及鼻咽肿物活检。","options":[{"letter":"A","text":"完善颈部淋巴结细针穿刺活检及全身骨扫描","is_gold":false},{"letter":"B","text":"完善颈部淋巴结切除活检及全身PET-CT","is_gold":false},{"letter":"C","text":"完善电子鼻咽镜检查及鼻咽脱落细胞学检查","is_gold":false},{"letter":"D","text":"完善鼻咽肿物切除活检及全身骨扫描检查","is_gold":false},{"letter":"E","text":"完善电子鼻咽镜检查及鼻咽肿物活检","is_gold":true},{"letter":"F","text":"完善全身骨扫描检查并直接启动根治性放疗","is_gold":false},{"letter":"G","text":"完善鼻内镜下鼻咽肿物扩大切除及组织活检","is_gold":false},{"letter":"H","text":"完善颈部淋巴结切除活检及EB病毒DNA检测","is_gold":false},{"letter":"I","text":"完善电子鼻咽镜检查及鼻咽部多点盲取活检","is_gold":false},{"letter":"J","text":"完善电子鼻咽镜检查及鼻咽肿物细针穿刺活检","is_gold":false},{"letter":"K","text":"完善脑部增强MRI检查及颈部淋巴结穿刺活检","is_gold":false},{"letter":"L","text":"完善电子鼻咽镜检查及活检并立即启动化疗","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、颈动脉鞘、斜坡、海绵窦、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 正常范围心电图\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理清晰，走行自然，双肺野内未见明确实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。双上胸膜略厚。；检查结论: 心肺未见明显病变。\n- [全程D1] 检验组合: 胱抑素(Cys-C)-静脉血: 0.8mg/L；钾离子(K+)-静脉血: 4.14mmol/L；肌酐(Crea)-静脉血: 65umol/L；葡萄糖(Glu)-静脉血: 5.25mmol/L；载脂蛋白B(apoB)-静脉血: 0.81g/L；碱性磷酸酶(ALP)-静脉血: 47U/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:20（参考: 阴性）；乳酸脱氢酶(LDH)-静脉血: 210.4U/L；纤维蛋白原(Fbg)-静脉血: 2.89g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.62；天门冬氨酸氨基转移酶(AST)-静脉血: 19.6U/L；阴离子间隙(AG)-静脉血: 14.7；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.376COI；总胆固醇(TC)-静脉血: 4.58mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.7mmolL；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.56g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.5mmol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 1.79COI；总胆汁酸(TBA)-静脉血: 2umol/L；平均血小板体积(MPV)-静脉血: 10.5fL；磷(P)-静脉血: 1.23mmol/L；单核细胞百分比(Mono%)-静脉血: 0.042；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 0.009COI；甘油三酯(TG)-静脉血: 0.86mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.1mmol/L；平均红细胞体积(MCV)-静脉血: 96.1fL；丙氨酸氨基转移酶(ALT)-静脉血: 15U/L；血小板分布宽度(PDW)-静脉血: 12.1%；C-反应蛋白(CRP)-静脉血: 0.28mg/L；α-L-岩藻糖苷酶(AFU)-静脉血: 33.2U/L；尿素氮(BUN)-静脉血: 4.7mmol/L；球蛋白(GLO)-静脉血: 28.21g/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 0.109……\n- [全程D2] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁 、顶后壁、左侧壁增厚，见软组织肿物影。左侧咽隐窝消失，右侧咽隐窝变浅；病灶呈稍长分期信息见历史辅助诊断节点稍长分期信息见历史辅助诊断节点信号，增强扫描强化明显。 口咽双侧壁未见增厚。鼻腔未见肿物影。 左侧咽旁脂肪间隙变窄，左侧颈动脉鞘区见肿物占据。左侧腭帆张提肌及左侧头长肌受侵。 左侧翼腭窝见软组织影；右侧翼腭窝、双侧颞下窝未见异常。 斜坡、左侧岩尖、左侧破裂孔，左侧蝶骨大翼、左侧翼突、左侧翼管、左侧圆孔、蝶骨基底部骨质破坏。 蝶窦见软组织肿物；右侧乳突、双侧上颌窦充气良好；蝶窦、筛窦及左侧乳突见分泌物。 双眼未见异常。 左侧海绵窦见可疑肿物侵犯。 双侧咽后淋巴结肿大，左侧短径大小约为15mm，见包膜外侵；右侧短径大小约为11mm。双侧II区见多个肿大淋巴结，相互融合，最大短径大小约为18mm。 右侧腮腺见小淋巴结，短径约为7mm。 双侧腮腺。颌下腺、甲状腺未见异常。；检查结论: 考虑鼻咽癌，左侧咽旁间隙、颅底骨质； 可疑左侧海绵窦受侵。 双侧咽后淋巴结，双侧II区淋巴结肿大，考虑转移。 右侧腮腺小淋巴结，性质待定。 副鼻窦炎症。 左侧乳突炎症。\n- [全程D2] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，肝内血管走行自然，门静脉内径约10mm，未见明确肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约26cm/s。 胆囊大小正常，壁不厚，光滑，其内未见异常回声。 脾脏大小正常，包膜光滑，实质回声均匀。 胰腺大小正常，包膜光滑，实质回声均匀，胰管无扩张。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位性病变。 腹主动脉旁未见明确占位病变。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善颈部淋巴结细针穿刺活检及全身骨扫描\nB. 完善颈部淋巴结切除活检及全身PET-CT\nC. 完善电子鼻咽镜检查及鼻咽脱落细胞学检查\nD. 完善鼻咽肿物切除活检及全身骨扫描检查\nE. 完善电子鼻咽镜检查及鼻咽肿物活检\nF. 完善全身骨扫描检查并直接启动根治性放疗\nG. 完善鼻内镜下鼻咽肿物扩大切除及组织活检\nH. 完善颈部淋巴结切除活检及EB病毒DNA检测\nI. 完善电子鼻咽镜检查及鼻咽部多点盲取活检\nJ. 完善电子鼻咽镜检查及鼻咽肿物细针穿刺活检\nK. 完善脑部增强MRI检查及颈部淋巴结穿刺活检\nL. 完善电子鼻咽镜检查及活检并立即启动化疗\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、颈动脉鞘、斜坡、海绵窦、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 正常范围心电图\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理清晰，走行自然，双肺野内未见明确实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。双上胸膜略厚。；检查结论: 心肺未见明显病变。\n- [全程D1] 检验组合: 胱抑素(Cys-C)-静脉血: 0.8mg/L；钾离子(K+)-静脉血: 4.14mmol/L；肌酐(Crea)-静脉血: 65umol/L；葡萄糖(Glu)-静脉血: 5.25mmol/L；载脂蛋白B(apoB)-静脉血: 0.81g/L；碱性磷酸酶(ALP)-静脉血: 47U/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:20（参考: 阴性）；乳酸脱氢酶(LDH)-静脉血: 210.4U/L；纤维蛋白原(Fbg)-静脉血: 2.89g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.62；天门冬氨酸氨基转移酶(AST)-静脉血: 19.6U/L；阴离子间隙(AG)-静脉血: 14.7；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.376COI；总胆固醇(TC)-静脉血: 4.58mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.7mmolL；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.56g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.5mmol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 1.79COI；总胆汁酸(TBA)-静脉血: 2umol/L；平均血小板体积(MPV)-静脉血: 10.5fL；磷(P)-静脉血: 1.23mmol/L；单核细胞百分比(Mono%)-静脉血: 0.042；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 0.009COI；甘油三酯(TG)-静脉血: 0.86mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.1mmol/L；平均红细胞体积(MCV)-静脉血: 96.1fL；丙氨酸氨基转移酶(ALT)-静脉血: 15U/L；血小板分布宽度(PDW)-静脉血: 12.1%；C-反应蛋白(CRP)-静脉血: 0.28mg/L；α-L-岩藻糖苷酶(AFU)-静脉血: 33.2U/L；尿素氮(BUN)-静脉血: 4.7mmol/L；球蛋白(GLO)-静脉血: 28.21g/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 0.109……\n- [全程D2] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁 、顶后壁、左侧壁增厚，见软组织肿物影。左侧咽隐窝消失，右侧咽隐窝变浅；病灶呈稍长分期信息见历史辅助诊断节点稍长分期信息见历史辅助诊断节点信号，增强扫描强化明显。 口咽双侧壁未见增厚。鼻腔未见肿物影。 左侧咽旁脂肪间隙变窄，左侧颈动脉鞘区见肿物占据。左侧腭帆张提肌及左侧头长肌受侵。 左侧翼腭窝见软组织影；右侧翼腭窝、双侧颞下窝未见异常。 斜坡、左侧岩尖、左侧破裂孔，左侧蝶骨大翼、左侧翼突、左侧翼管、左侧圆孔、蝶骨基底部骨质破坏。 蝶窦见软组织肿物；右侧乳突、双侧上颌窦充气良好；蝶窦、筛窦及左侧乳突见分泌物。 双眼未见异常。 左侧海绵窦见可疑肿物侵犯。 双侧咽后淋巴结肿大，左侧短径大小约为15mm，见包膜外侵；右侧短径大小约为11mm。双侧II区见多个肿大淋巴结，相互融合，最大短径大小约为18mm。 右侧腮腺见小淋巴结，短径约为7mm。 双侧腮腺。颌下腺、甲状腺未见异常。；检查结论: 考虑鼻咽癌，左侧咽旁间隙、颅底骨质； 可疑左侧海绵窦受侵。 双侧咽后淋巴结，双侧II区淋巴结肿大，考虑转移。 右侧腮腺小淋巴结，性质待定。 副鼻窦炎症。 左侧乳突炎症。\n- [全程D2] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，肝内血管走行自然，门静脉内径约10mm，未见明确肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约26cm/s。 胆囊大小正常，壁不厚，光滑，其内未见异常回声。 脾脏大小正常，包膜光滑，实质回声均匀。 胰腺大小正常，包膜光滑，实质回声均匀，胰管无扩张。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位性病变。 腹主动脉旁未见明确占位病变。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善颈部淋巴结细针穿刺活检及全身骨扫描\nB. 完善颈部淋巴结切除活检及全身PET-CT\nC. 完善电子鼻咽镜检查及鼻咽脱落细胞学检查\nD. 完善鼻咽肿物切除活检及全身骨扫描检查\nE. 完善电子鼻咽镜检查及鼻咽肿物活检\nF. 完善全身骨扫描检查并直接启动根治性放疗\nG. 完善鼻内镜下鼻咽肿物扩大切除及组织活检\nH. 完善颈部淋巴结切除活检及EB病毒DNA检测\nI. 完善电子鼻咽镜检查及鼻咽部多点盲取活检\nJ. 完善电子鼻咽镜检查及鼻咽肿物细针穿刺活检\nK. 完善脑部增强MRI检查及颈部淋巴结穿刺活检\nL. 完善电子鼻咽镜检查及活检并立即启动化疗\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-4caf9a9989bff46283725cce","patient_id":"patient-e90c2443e271b2e927262653","turn_id":"turn04","turn_position":3,"turn_type":"initial_treatment_selection","gold_letter":"G","gold_action":"诱导化疗序贯同步放化疗","options":[{"letter":"A","text":"单纯根治性放疗","is_gold":false},{"letter":"B","text":"同步放化疗序贯辅助化疗","is_gold":false},{"letter":"C","text":"诱导化疗序贯单纯根治性放疗","is_gold":false},{"letter":"D","text":"根治性手术切除序贯术后放化疗","is_gold":false},{"letter":"E","text":"诱导化疗序贯靶向治疗联合放疗","is_gold":false},{"letter":"F","text":"姑息性化疗联合免疫治疗","is_gold":false},{"letter":"G","text":"诱导化疗序贯同步放化疗","is_gold":true},{"letter":"H","text":"同步放化疗联合靶向治疗","is_gold":false},{"letter":"I","text":"诱导化疗序贯根治性颈清扫术","is_gold":false},{"letter":"J","text":"单纯同步放化疗","is_gold":false},{"letter":"K","text":"靶向治疗联合同步放化疗","is_gold":false},{"letter":"L","text":"诱导化疗联合免疫治疗序贯单纯放疗","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、颈动脉鞘、斜坡、海绵窦、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 间断性回吸性涕血1年余。；现病史: 患者近一年以来无明显原因出现回吸性涕血、近一个月左侧鼻塞明显，间断鼻衄。双侧耳鸣伴左耳听力下降，左侧头痛，双颈肿块。无面麻、张口困难、软腭麻痹，无咳嗽咳痰、呼吸困难。当地医院CT提示：鼻咽癌侵犯枕斜坡双侧蝶窦。伴双侧咽后、颈部淋巴结转移。现为进一步诊治入院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重下降1Kg。；阳性症状体征: 体重下降,听力下降,双颈肿物,双耳鸣,涕血,鼻衄,左鼻塞,左侧头痛；既往史: 既往体健。4年前妊娠期间高血糖。3年前剖宫产。否认肝炎、结核等传染病史。否认心脏病、高血压史。预防接种史不详。过敏史:无药物及食物过敏史。；个人史: 出生于原籍，无烟酒药物等嗜好，无疫水接触史，否认不洁性生活史。无工业毒物，粉尘，放射性物质接触史。；家族史: 否认家族其他成员中有类似病患者或肿瘤患者。；体格检查: T36.5℃P78次/分R19次/分BP115/70mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。无鼻翼扇动、鼻衄。牙龈无肿胀、出血。气管居中，甲状腺不大。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率70bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。肛门外生殖器未见异常，生理反射存在，病理反射未引出。；专科检查: KPS 90。张口门齿距4.5cm，间接鼻咽镜：见鼻咽左侧壁肿物肿物；双颈II区触及多枚肿大淋巴结，直径约1.0cm，质韧、固定、相互融合。颅神经（-）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 单纯根治性放疗\nB. 同步放化疗序贯辅助化疗\nC. 诱导化疗序贯单纯根治性放疗\nD. 根治性手术切除序贯术后放化疗\nE. 诱导化疗序贯靶向治疗联合放疗\nF. 姑息性化疗联合免疫治疗\nG. 诱导化疗序贯同步放化疗\nH. 同步放化疗联合靶向治疗\nI. 诱导化疗序贯根治性颈清扫术\nJ. 单纯同步放化疗\nK. 靶向治疗联合同步放化疗\nL. 诱导化疗联合免疫治疗序贯单纯放疗\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、颈动脉鞘、斜坡、海绵窦、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 间断性回吸性涕血1年余。；现病史: 患者近一年以来无明显原因出现回吸性涕血、近一个月左侧鼻塞明显，间断鼻衄。双侧耳鸣伴左耳听力下降，左侧头痛，双颈肿块。无面麻、张口困难、软腭麻痹，无咳嗽咳痰、呼吸困难。当地医院CT提示：鼻咽癌侵犯枕斜坡双侧蝶窦。伴双侧咽后、颈部淋巴结转移。现为进一步诊治入院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重下降1Kg。；阳性症状体征: 体重下降,听力下降,双颈肿物,双耳鸣,涕血,鼻衄,左鼻塞,左侧头痛；既往史: 既往体健。4年前妊娠期间高血糖。3年前剖宫产。否认肝炎、结核等传染病史。否认心脏病、高血压史。预防接种史不详。过敏史:无药物及食物过敏史。；个人史: 出生于原籍，无烟酒药物等嗜好，无疫水接触史，否认不洁性生活史。无工业毒物，粉尘，放射性物质接触史。；家族史: 否认家族其他成员中有类似病患者或肿瘤患者。；体格检查: T36.5℃P78次/分R19次/分BP115/70mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。无鼻翼扇动、鼻衄。牙龈无肿胀、出血。气管居中，甲状腺不大。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率70bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。肛门外生殖器未见异常，生理反射存在，病理反射未引出。；专科检查: KPS 90。张口门齿距4.5cm，间接鼻咽镜：见鼻咽左侧壁肿物肿物；双颈II区触及多枚肿大淋巴结，直径约1.0cm，质韧、固定、相互融合。颅神经（-）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 单纯根治性放疗\nB. 同步放化疗序贯辅助化疗\nC. 诱导化疗序贯单纯根治性放疗\nD. 根治性手术切除序贯术后放化疗\nE. 诱导化疗序贯靶向治疗联合放疗\nF. 姑息性化疗联合免疫治疗\nG. 诱导化疗序贯同步放化疗\nH. 同步放化疗联合靶向治疗\nI. 诱导化疗序贯根治性颈清扫术\nJ. 单纯同步放化疗\nK. 靶向治疗联合同步放化疗\nL. 诱导化疗联合免疫治疗序贯单纯放疗\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-9253a0b82814c8e2231522e6","patient_id":"patient-e90c2443e271b2e927262653","turn_id":"turn05","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"H","gold_action":"不额外给予预防性升白、保肝或抗凝等支持治疗，继续完善乙肝定量、凝血功能、HIV/梅毒筛查及其他治疗前基线血液学和感染学检查。","options":[{"letter":"A","text":"给予重组人粒细胞集落刺激因子（rhG-CSF）皮下注射，并完善基线心电图及超声心动图检查。","is_gold":false},{"letter":"B","text":"给予地塞米松及20%甘露醇注射液静脉滴注，并紧急行头颅CT平扫。","is_gold":false},{"letter":"C","text":"给予异甘草酸镁注射液静脉滴注进行预防性保肝治疗。","is_gold":false},{"letter":"D","text":"给予唑来膦酸静脉滴注，并完善全身骨骼核素扫描（ECT）。","is_gold":false},{"letter":"E","text":"给予肠内营养粉剂口服进行营养支持，并留置鼻胃管。","is_gold":false},{"letter":"F","text":"给予静脉铁剂及重组人促红素（rhEPO）皮下注射，并复查血常规及网织红细胞。","is_gold":false},{"letter":"G","text":"给予头孢曲松钠静脉滴注进行预防性抗感染治疗，并完善血培养及药敏试验。","is_gold":false},{"letter":"H","text":"不额外给予预防性升白、保肝或抗凝等支持治疗，继续完善乙肝定量、凝血功能及其他治疗前基线血液学和感染学筛查。","is_gold":true},{"letter":"I","text":"给予塞来昔布胶囊常规口服进行镇痛治疗，并局部外用氟比洛芬凝胶贴膏。","is_gold":false},{"letter":"J","text":"给予低分子量肝素钙皮下注射进行抗凝治疗，并完善双下肢深静脉彩超。","is_gold":false},{"letter":"K","text":"给予奥美拉唑肠溶胶囊口服进行抑酸护胃治疗，并完善胃镜检查。","is_gold":false},{"letter":"L","text":"给予安替可及硒酵母口服进行辅助治疗，并暂缓乙肝及梅毒等传染病筛查。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、颈动脉鞘、斜坡、海绵窦、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- 无可展示记录。\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者入院第2天，一般情况可，今日[姓名已隐去]医生信息已隐藏，详细听取病情汇报、检查患者后指示：尽快完善各项治疗前检查，明确诊断及分期，并了解有无合并其他基础疾病，待分期明确后再定治疗方案。遵嘱执行。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 给予重组人粒细胞集落刺激因子（rhG-CSF）皮下注射，并完善基线心电图及超声心动图检查。\nB. 给予地塞米松及20%甘露醇注射液静脉滴注，并紧急行头颅CT平扫。\nC. 给予异甘草酸镁注射液静脉滴注进行预防性保肝治疗。\nD. 给予唑来膦酸静脉滴注，并完善全身骨骼核素扫描（ECT）。\nE. 给予肠内营养粉剂口服进行营养支持，并留置鼻胃管。\nF. 给予静脉铁剂及重组人促红素（rhEPO）皮下注射，并复查血常规及网织红细胞。\nG. 给予头孢曲松钠静脉滴注进行预防性抗感染治疗，并完善血培养及药敏试验。\nH. 不额外给予预防性升白、保肝或抗凝等支持治疗，继续完善乙肝定量、凝血功能及其他治疗前基线血液学和感染学筛查。\nI. 给予塞来昔布胶囊常规口服进行镇痛治疗，并局部外用氟比洛芬凝胶贴膏。\nJ. 给予低分子量肝素钙皮下注射进行抗凝治疗，并完善双下肢深静脉彩超。\nK. 给予奥美拉唑肠溶胶囊口服进行抑酸护胃治疗，并完善胃镜检查。\nL. 给予安替可及硒酵母口服进行辅助治疗，并暂缓乙肝及梅毒等传染病筛查。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、颈动脉鞘、斜坡、海绵窦、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- 无可展示记录。\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者入院第2天，一般情况可，今日[姓名已隐去]医生信息已隐藏，详细听取病情汇报、检查患者后指示：尽快完善各项治疗前检查，明确诊断及分期，并了解有无合并其他基础疾病，待分期明确后再定治疗方案。遵嘱执行。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 给予重组人粒细胞集落刺激因子（rhG-CSF）皮下注射，并完善基线心电图及超声心动图检查。\nB. 给予地塞米松及20%甘露醇注射液静脉滴注，并紧急行头颅CT平扫。\nC. 给予异甘草酸镁注射液静脉滴注进行预防性保肝治疗。\nD. 给予唑来膦酸静脉滴注，并完善全身骨骼核素扫描（ECT）。\nE. 给予肠内营养粉剂口服进行营养支持，并留置鼻胃管。\nF. 给予静脉铁剂及重组人促红素（rhEPO）皮下注射，并复查血常规及网织红细胞。\nG. 给予头孢曲松钠静脉滴注进行预防性抗感染治疗，并完善血培养及药敏试验。\nH. 不额外给予预防性升白、保肝或抗凝等支持治疗，继续完善乙肝定量、凝血功能及其他治疗前基线血液学和感染学筛查。\nI. 给予塞来昔布胶囊常规口服进行镇痛治疗，并局部外用氟比洛芬凝胶贴膏。\nJ. 给予低分子量肝素钙皮下注射进行抗凝治疗，并完善双下肢深静脉彩超。\nK. 给予奥美拉唑肠溶胶囊口服进行抑酸护胃治疗，并完善胃镜检查。\nL. 给予安替可及硒酵母口服进行辅助治疗，并暂缓乙肝及梅毒等传染病筛查。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-3b37bb5b3505f87a241c1a6f","patient_id":"patient-e90c2443e271b2e927262653","turn_id":"turn06","turn_position":5,"turn_type":"toxicity_or_support_decision","gold_letter":"I","gold_action":"暂不需集落刺激因子支持，予以复方氨基酸及转化糖电解质静脉营养支持，并进行动静脉置管护理。","options":[{"letter":"A","text":"预防性给予重组人粒细胞集落刺激因子（G-CSF）皮下注射，并推迟后续抗肿瘤治疗。","is_gold":false},{"letter":"B","text":"立即输注红细胞悬液2U，并皮下注射促红细胞生成素（EPO）纠正贫血。","is_gold":false},{"letter":"C","text":"启动异甘草酸镁及多烯磷脂酰胆碱静脉滴注，进行双靶点强化保肝治疗。","is_gold":false},{"letter":"D","text":"建立中心静脉通道，给予10%氯化钾注射液微量泵持续静脉泵入补钾。","is_gold":false},{"letter":"E","text":"留取血培养后，经验性静脉滴注头孢哌酮舒巴坦等广谱抗菌药物抗感染。","is_gold":false},{"letter":"F","text":"每日静脉输注人血白蛋白10g，并配合静脉推注呋塞米进行利尿消肿。","is_gold":false},{"letter":"G","text":"给予碳酸氢钠静脉滴注碱化尿液，并进行每日3000ml以上大剂量水化。","is_gold":false},{"letter":"H","text":"启动胰岛素泵持续皮下泵入强化降糖治疗，并严格限制碳水化合物摄入。","is_gold":false},{"letter":"I","text":"暂不需集落刺激因子支持，予以复方氨基酸及转化糖电解质静脉营养支持，并进行动静脉置管护理。","is_gold":true},{"letter":"J","text":"持续静脉泵入质子泵抑制剂及5-HT3受体拮抗剂，进行强化抑酸止吐。","is_gold":false},{"letter":"K","text":"预防性输注单采血小板1个治疗量，并皮下注射重组人血小板生成素。","is_gold":false},{"letter":"L","text":"给予拉布立酶静脉滴注，并配合大剂量静脉水化预防肿瘤溶解综合征。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、颈动脉鞘、斜坡、海绵窦、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D9] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；白细胞计数(WBC#)-静脉血: 9.210E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.812；单核细胞百分比(Mono%)-静脉血: 0.005；平均血小板体积(MPV)-静脉血: 11.2fL；平均红细胞体积(MCV)-静脉血: 95.5fL；血小板比容-静脉血: 21%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.1；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339g/L；大血小板百分比(P-LCR%)-静脉血: 36.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.178；平均红细胞血红蛋白含量(MCH)-静脉血: 32.4pg；单核细胞计数(Mono#)-静脉血: 0.110E9/L；红细胞计数(RBC#)-静脉血: 3.5210E12/L；血小板分布宽度(PDW)-静脉血: 13.8%；血小板计数(PLT#)-静脉血: 19010E9/L；红细胞比容(Hct)-静脉血: 33.6%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 114g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.4；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；中性粒细胞计数(Neut#)-静脉血: 7.410E9/L\n- [全程D13] 检验组合: 嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；大血小板百分比(P-LCR%)-静脉血: 33.8%；淋巴细胞百分比(Lymph%)-静脉血: 0.645；平均红细胞血红蛋白含量(MCH)-静脉血: 32.1pg；血红蛋白(Hb)-静脉血: 130g/L；白细胞计数(WBC#)-静脉血: 1.710E9/L；平均红细胞体积(MCV)-静脉血: 92.6fL；红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；单核细胞百分比(Mono%)-静脉血: 0.114；血小板分布宽度(PDW)-静脉血: 13%；中性粒细胞百分比(Neut%)-静脉血: 0.229；红细胞比容(Hct)-静脉血: 37.5%；单核细胞计数(Mono#)-静脉血: 0.210E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 35.6；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；血小板比容-静脉血: 27%；中性粒细胞计数(Neut#)-静脉血: 0.410E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.006；血小板计数(PLT#)-静脉血: 24210E9/L；平均血小板体积(MPV)-静脉血: 11fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 10.6；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L\n- [全程D14] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；淋巴细胞百分比(Lymph%)-静脉血: 0.51；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板比容-静脉血: 23%；红细胞计数(RBC#)-静脉血: 3.8110E12/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.8pg；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.8；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；白细胞计数(WBC#)-静脉血: 2.510E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.151；大血小板百分比(P-LCR%)-静脉血: 28.8%；红细胞比容(Hct)-静脉血: 34.9%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 121g/L；平均红细胞体积(MCV)-静脉血: 91.6fL；血小板分布宽度(PDW)-静脉血: 12.4%；单核细胞百分比(Mono%)-静脉血: 0.291；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；中性粒细胞计数(Neut#)-静脉血: 0.410E9/L；平均血小板体积(MPV)-静脉血: 10.4fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.3；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；血小板计数(PLT#)-静脉血: 22010E9/L\n- [全程D15] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；红细胞计数(RBC#)-静脉血: 3.8910E12/L；血小板分布宽度(PDW)-静脉血: 12.8%；平均红细胞体积(MCV)-静脉血: 94.6fL；中性粒细胞计数(Neut#)-静脉血: 2.610E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 35.8；平均血小板体积(MPV)-静脉血: 10.4fL；中性粒细胞百分比(Neut%)-静脉血: 0.496；淋巴细胞百分比(Lymph%)-静脉血: 0.292；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 334g/L；血红蛋白(Hb)-静脉血: 123g/L；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.202；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 10.8；白细胞计数(WBC#)-静脉血: 5.210E9/L；血小板计数(PLT#)-静脉血: 25410E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.6pg；血小板比容-静脉血: 26%；大血小板百分比(P-LCR%)-静脉血: 29%；红细胞比容(Hct)-静脉血: 36.8%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；单核细胞计数(Mono#)-静脉血: 1.110E9/L\n- [全程D16] 检验组合: 红细胞体积分布宽度SD(RDW-SD)-静脉血: 37；大血小板百分比(P-LCR%)-静脉血: 29.9%；红细胞比容(Hct)-静脉血: 34.2%；血小板计数(PLT#)-静脉血: 26510E9/L；单核细胞计数(Mono#)-静脉血: 1.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.128；血小板比容-静脉血: 28%；白细胞计数(WBC#)-静脉血: 11.810E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；血红蛋白(Hb)-静脉血: 113g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.8pg；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11；中性粒细胞计数(Neut#)-静脉血: 7.910E9/L；血小板分布宽度(PDW)-静脉血: 12.3%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；红细胞计数(RBC#)-静脉血: 3.5510E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.667；平均血小板体积(MPV)-静脉血: 10.5fL；淋巴细胞计数(Lymph#)-静脉血: 2.310E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.197；平均红细胞体积(MCV)-静脉血: 96.3fL\n- [全程D26] 检验组合: 直接胆红素(DBIL)-静脉血: 1.5umol/L；C-反应蛋白(CRP)-静脉血: 6.47mg/L；红细胞比容(Hct)-静脉血: 35.4%；阴离子间隙(AG)-静脉血: 8；血小板分布宽度(PDW)-静脉血: 10.3%；总钙(Ca)-静脉血: 2.27mmol/L；甘油三酯(TG)-静脉血: 0.74mmol/L；尿素氮(BUN)-静脉血: 4.68mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 32.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 32.4U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；葡萄糖(Glu)-静脉血: 5.39mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；白细胞计数(WBC#)-静脉血: 410E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 34U/L；磷(P)-静脉血: 1.35mmol/L；乳酸脱氢酶(LDH)-静脉血: 198.6U/L；血小板计数(PLT#)-静脉血: 25510E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.4；碱性磷酸酶(ALP)-静脉血: 92.4U/L；钾离子(K+)-静脉血: 3.9mmol/L；总蛋白(TP)-静脉血: 64.1g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.435；钠离子(Na+)-静脉血: 140.2mmol/L；胱抑素(Cys-C)-静脉血: 0.82mg/L；大血小板百分比(P-LCR%)-静脉血: 19.1%；间接胆红素(IBIL)-静脉血: 3.9umolL；红细胞计数(RBC#)-静脉血: 3.710E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.6pg；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；平均血小板体积(MPV)-静脉血: 9.3fL；氯离子(Cl-)-静脉血: 100.2mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.23g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.9；淋巴细胞百分比(Lymph%)-静脉血: 0.481；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.9；中性粒细胞计数(Neut#)-静脉……\n\n【既往治疗与反应】\n- [全程D13] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。胡医生信息已隐藏：患者予复查血象变化，密切观察患者病情变化。遵嘱。\n- [全程D16] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。检查回报：白细胞 2.5×109/L 。胡医生信息已隐藏：患者出现II度骨髓抑制，考虑化疗引起的副反应，予升白等对症处理，密切观察患者病情变化。遵嘱。\n- [全程D19] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。检查结果回报：白细胞 11.8×109/L。胡医生信息已隐藏：患者血象已恢复正常，密切观察患者病情变化。遵嘱。\n- [全程D22] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。胡医生信息已隐藏：患者予对症处理，密切观察患者病情变化。遵嘱。\n- [全程D25] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。胡医生信息已隐藏：患者予对症处理，密切观察患者病情变化。遵嘱。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 预防性给予重组人粒细胞集落刺激因子（G-CSF）皮下注射，并推迟后续抗肿瘤治疗。\nB. 立即输注红细胞悬液2U，并皮下注射促红细胞生成素（EPO）纠正贫血。\nC. 启动异甘草酸镁及多烯磷脂酰胆碱静脉滴注，进行双靶点强化保肝治疗。\nD. 建立中心静脉通道，给予10%氯化钾注射液微量泵持续静脉泵入补钾。\nE. 留取血培养后，经验性静脉滴注头孢哌酮舒巴坦等广谱抗菌药物抗感染。\nF. 每日静脉输注人血白蛋白10g，并配合静脉推注呋塞米进行利尿消肿。\nG. 给予碳酸氢钠静脉滴注碱化尿液，并进行每日3000ml以上大剂量水化。\nH. 启动胰岛素泵持续皮下泵入强化降糖治疗，并严格限制碳水化合物摄入。\nI. 暂不需集落刺激因子支持，予以复方氨基酸及转化糖电解质静脉营养支持，并进行动静脉置管护理。\nJ. 持续静脉泵入质子泵抑制剂及5-HT3受体拮抗剂，进行强化抑酸止吐。\nK. 预防性输注单采血小板1个治疗量，并皮下注射重组人血小板生成素。\nL. 给予拉布立酶静脉滴注，并配合大剂量静脉水化预防肿瘤溶解综合征。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、颈动脉鞘、斜坡、海绵窦、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D9] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；白细胞计数(WBC#)-静脉血: 9.210E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.812；单核细胞百分比(Mono%)-静脉血: 0.005；平均血小板体积(MPV)-静脉血: 11.2fL；平均红细胞体积(MCV)-静脉血: 95.5fL；血小板比容-静脉血: 21%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.1；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339g/L；大血小板百分比(P-LCR%)-静脉血: 36.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.178；平均红细胞血红蛋白含量(MCH)-静脉血: 32.4pg；单核细胞计数(Mono#)-静脉血: 0.110E9/L；红细胞计数(RBC#)-静脉血: 3.5210E12/L；血小板分布宽度(PDW)-静脉血: 13.8%；血小板计数(PLT#)-静脉血: 19010E9/L；红细胞比容(Hct)-静脉血: 33.6%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 114g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.4；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；中性粒细胞计数(Neut#)-静脉血: 7.410E9/L\n- [全程D13] 检验组合: 嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；大血小板百分比(P-LCR%)-静脉血: 33.8%；淋巴细胞百分比(Lymph%)-静脉血: 0.645；平均红细胞血红蛋白含量(MCH)-静脉血: 32.1pg；血红蛋白(Hb)-静脉血: 130g/L；白细胞计数(WBC#)-静脉血: 1.710E9/L；平均红细胞体积(MCV)-静脉血: 92.6fL；红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；单核细胞百分比(Mono%)-静脉血: 0.114；血小板分布宽度(PDW)-静脉血: 13%；中性粒细胞百分比(Neut%)-静脉血: 0.229；红细胞比容(Hct)-静脉血: 37.5%；单核细胞计数(Mono#)-静脉血: 0.210E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 35.6；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；血小板比容-静脉血: 27%；中性粒细胞计数(Neut#)-静脉血: 0.410E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.006；血小板计数(PLT#)-静脉血: 24210E9/L；平均血小板体积(MPV)-静脉血: 11fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 10.6；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L\n- [全程D14] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；淋巴细胞百分比(Lymph%)-静脉血: 0.51；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板比容-静脉血: 23%；红细胞计数(RBC#)-静脉血: 3.8110E12/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.8pg；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.8；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；白细胞计数(WBC#)-静脉血: 2.510E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.151；大血小板百分比(P-LCR%)-静脉血: 28.8%；红细胞比容(Hct)-静脉血: 34.9%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 121g/L；平均红细胞体积(MCV)-静脉血: 91.6fL；血小板分布宽度(PDW)-静脉血: 12.4%；单核细胞百分比(Mono%)-静脉血: 0.291；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；中性粒细胞计数(Neut#)-静脉血: 0.410E9/L；平均血小板体积(MPV)-静脉血: 10.4fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.3；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；血小板计数(PLT#)-静脉血: 22010E9/L\n- [全程D15] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；红细胞计数(RBC#)-静脉血: 3.8910E12/L；血小板分布宽度(PDW)-静脉血: 12.8%；平均红细胞体积(MCV)-静脉血: 94.6fL；中性粒细胞计数(Neut#)-静脉血: 2.610E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 35.8；平均血小板体积(MPV)-静脉血: 10.4fL；中性粒细胞百分比(Neut%)-静脉血: 0.496；淋巴细胞百分比(Lymph%)-静脉血: 0.292；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 334g/L；血红蛋白(Hb)-静脉血: 123g/L；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.202；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 10.8；白细胞计数(WBC#)-静脉血: 5.210E9/L；血小板计数(PLT#)-静脉血: 25410E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.6pg；血小板比容-静脉血: 26%；大血小板百分比(P-LCR%)-静脉血: 29%；红细胞比容(Hct)-静脉血: 36.8%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；单核细胞计数(Mono#)-静脉血: 1.110E9/L\n- [全程D16] 检验组合: 红细胞体积分布宽度SD(RDW-SD)-静脉血: 37；大血小板百分比(P-LCR%)-静脉血: 29.9%；红细胞比容(Hct)-静脉血: 34.2%；血小板计数(PLT#)-静脉血: 26510E9/L；单核细胞计数(Mono#)-静脉血: 1.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.128；血小板比容-静脉血: 28%；白细胞计数(WBC#)-静脉血: 11.810E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；血红蛋白(Hb)-静脉血: 113g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.8pg；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11；中性粒细胞计数(Neut#)-静脉血: 7.910E9/L；血小板分布宽度(PDW)-静脉血: 12.3%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；红细胞计数(RBC#)-静脉血: 3.5510E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.667；平均血小板体积(MPV)-静脉血: 10.5fL；淋巴细胞计数(Lymph#)-静脉血: 2.310E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.197；平均红细胞体积(MCV)-静脉血: 96.3fL\n- [全程D26] 检验组合: 直接胆红素(DBIL)-静脉血: 1.5umol/L；C-反应蛋白(CRP)-静脉血: 6.47mg/L；红细胞比容(Hct)-静脉血: 35.4%；阴离子间隙(AG)-静脉血: 8；血小板分布宽度(PDW)-静脉血: 10.3%；总钙(Ca)-静脉血: 2.27mmol/L；甘油三酯(TG)-静脉血: 0.74mmol/L；尿素氮(BUN)-静脉血: 4.68mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 32.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 32.4U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；葡萄糖(Glu)-静脉血: 5.39mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；白细胞计数(WBC#)-静脉血: 410E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 34U/L；磷(P)-静脉血: 1.35mmol/L；乳酸脱氢酶(LDH)-静脉血: 198.6U/L；血小板计数(PLT#)-静脉血: 25510E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.4；碱性磷酸酶(ALP)-静脉血: 92.4U/L；钾离子(K+)-静脉血: 3.9mmol/L；总蛋白(TP)-静脉血: 64.1g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.435；钠离子(Na+)-静脉血: 140.2mmol/L；胱抑素(Cys-C)-静脉血: 0.82mg/L；大血小板百分比(P-LCR%)-静脉血: 19.1%；间接胆红素(IBIL)-静脉血: 3.9umolL；红细胞计数(RBC#)-静脉血: 3.710E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.6pg；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；平均血小板体积(MPV)-静脉血: 9.3fL；氯离子(Cl-)-静脉血: 100.2mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.23g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.9；淋巴细胞百分比(Lymph%)-静脉血: 0.481；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.9；中性粒细胞计数(Neut#)-静脉……\n\n【既往治疗与反应】\n- [全程D13] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。胡医生信息已隐藏：患者予复查血象变化，密切观察患者病情变化。遵嘱。\n- [全程D16] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。检查回报：白细胞 2.5×109/L 。胡医生信息已隐藏：患者出现II度骨髓抑制，考虑化疗引起的副反应，予升白等对症处理，密切观察患者病情变化。遵嘱。\n- [全程D19] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。检查结果回报：白细胞 11.8×109/L。胡医生信息已隐藏：患者血象已恢复正常，密切观察患者病情变化。遵嘱。\n- [全程D22] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。胡医生信息已隐藏：患者予对症处理，密切观察患者病情变化。遵嘱。\n- [全程D25] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。胡医生信息已隐藏：患者予对症处理，密切观察患者病情变化。遵嘱。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 预防性给予重组人粒细胞集落刺激因子（G-CSF）皮下注射，并推迟后续抗肿瘤治疗。\nB. 立即输注红细胞悬液2U，并皮下注射促红细胞生成素（EPO）纠正贫血。\nC. 启动异甘草酸镁及多烯磷脂酰胆碱静脉滴注，进行双靶点强化保肝治疗。\nD. 建立中心静脉通道，给予10%氯化钾注射液微量泵持续静脉泵入补钾。\nE. 留取血培养后，经验性静脉滴注头孢哌酮舒巴坦等广谱抗菌药物抗感染。\nF. 每日静脉输注人血白蛋白10g，并配合静脉推注呋塞米进行利尿消肿。\nG. 给予碳酸氢钠静脉滴注碱化尿液，并进行每日3000ml以上大剂量水化。\nH. 启动胰岛素泵持续皮下泵入强化降糖治疗，并严格限制碳水化合物摄入。\nI. 暂不需集落刺激因子支持，予以复方氨基酸及转化糖电解质静脉营养支持，并进行动静脉置管护理。\nJ. 持续静脉泵入质子泵抑制剂及5-HT3受体拮抗剂，进行强化抑酸止吐。\nK. 预防性输注单采血小板1个治疗量，并皮下注射重组人血小板生成素。\nL. 给予拉布立酶静脉滴注，并配合大剂量静脉水化预防肿瘤溶解综合征。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-00fdb85efc65b944f8959fc3","patient_id":"patient-e90c2443e271b2e927262653","turn_id":"turn07","turn_position":6,"turn_type":"response_assessment_decision","gold_letter":"J","gold_action":"评估为部分缓解（PR），结束诱导化疗，出院休养并定期监测血象，择期行根治性放疗及同期化疗。","options":[{"letter":"A","text":"评估为完全缓解（CR），结束诱导化疗，直接进入随访观察阶段，定期复查鼻咽及颈部MRI。","is_gold":false},{"letter":"B","text":"评估为疾病稳定（SD），更换为吉西他滨联合顺铂方案继续化疗2周期。","is_gold":false},{"letter":"C","text":"评估为疾病进展（PD），转为姑息性放疗及靶向治疗。","is_gold":false},{"letter":"D","text":"评估为部分缓解（PR），继续原方案（多西他赛联合顺铂）诱导化疗第4-6周期。","is_gold":false},{"letter":"E","text":"评估为部分缓解（PR），先行双侧颈部淋巴结清扫术，术后行根治性放疗。","is_gold":false},{"letter":"F","text":"评估为部分缓解（PR），结束诱导化疗，择期行单纯根治性放疗。","is_gold":false},{"letter":"G","text":"评估为部分缓解（PR），行鼻咽内镜下颅底肿瘤切除术联合术后放疗。","is_gold":false},{"letter":"H","text":"评估为部分缓解（PR），结束诱导化疗，择期行根治性放疗及同期靶向治疗。","is_gold":false},{"letter":"I","text":"评估为疾病稳定（SD），提前终止化疗，立即开始根治性放疗及同期化疗。","is_gold":false},{"letter":"J","text":"评估为部分缓解（PR），结束诱导化疗，出院休养并定期监测血象，择期行根治性放疗及同期化疗。","is_gold":true},{"letter":"K","text":"评估为部分缓解（PR），结束诱导化疗，行全身PET-CT检查排除远处转移后再决定后续治疗。","is_gold":false},{"letter":"L","text":"评估为完全缓解（CR），结束诱导化疗，择期行预防性低剂量放疗。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、颈动脉鞘、斜坡、海绵窦、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D36] 检验组合: 总胆固醇(TC)-静脉血: 4.01mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.55；γ-谷氨酰基转移酶(GGT)-静脉血: 22.5U/L；平均血小板体积(MPV)-静脉血: 10.1fL；淋巴细胞计数(Lymph#)-静脉血: 0.910E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.04；丙氨酸氨基转移酶(ALT)-静脉血: 42.3U/L；尿素氮(BUN)-静脉血: 6.2mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 26.3U/L；总胆红素(TBIL)-静脉血: 14.1umol/L；钠离子(Na+)-静脉血: 136mmol/L；碱性磷酸酶(ALP)-静脉血: 68U/L；白细胞计数(WBC#)-静脉血: 4.310E9/L；直接胆红素(DBIL)-静脉血: 4.6umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；单核细胞计数(Mono#)-静脉血: 0.110E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；磷(P)-静脉血: 0.99mmol/L；血红蛋白(Hb)-静脉血: 122g/L；氯离子(Cl-)-静脉血: 95mmol/L；血小板分布宽度(PDW)-静脉血: 12.3%；平均红细胞体积(MCV)-静脉血: 93.9fL；α-L-岩藻糖苷酶(AFU)-静脉血: 48.7U/L；阴离子间隙(AG)-静脉血: 14.1；钾离子(K+)-静脉血: 4.06mmol/L；红细胞比容(Hct)-静脉血: 35.7%；血小板比容-静脉血: 23%；白蛋白(ALB)-静脉血: 40.7g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；C-反应蛋白(CRP)-静脉血: 3.19mg/L；球蛋白(GLO)-静脉血: 26.19g/L；胱抑素(Cys-C)-静脉血: 0.64mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.04mmol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；载脂蛋白B(apoB)-静脉血: 0.72g/L；间接胆红素(IBIL)-静脉血: 9.5umolL；中性粒细胞百分比(Neut%)-静脉血: 0.729；尿酸(UA)-静脉血: 258.1umol/L；单核细胞百分比(Mono%)-静脉血: 0……\n- [全程D49] 检验组合: 单核细胞百分比(Mono%)-静脉血: 0.066；C-反应蛋白(CRP)-静脉血: 0.26mg/L；乳酸脱氢酶(LDH)-静脉血: 257.7U/L；氯离子(Cl-)-静脉血: 105.6mmol/L；总蛋白(TP)-静脉血: 65.51g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.002；甘油三酯(TG)-静脉血: 0.97mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.25mmolL；红细胞比容(Hct)-静脉血: 34.7%；间接胆红素(IBIL)-静脉血: 5.5umolL；单核细胞计数(Mono#)-静脉血: 0.310E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.5U/L；红细胞计数(RBC#)-静脉血: 3.5110E12/L；总钙(Ca)-静脉血: 2.08mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.94；葡萄糖(Glu)-静脉血: 4.89mmol/L；直接胆红素(DBIL)-静脉血: 2.4umol/L；镁离子(Mg2+)-静脉血: 1.09mmol/L；胱抑素(Cys-C)-静脉血: 0.69mg/L；总胆汁酸(TBA)-静脉血: 1.9umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 35.4U/L；肌酐(Crea)-静脉血: 52.4umol/L；载脂蛋白B(apoB)-静脉血: 0.81g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 48.8；平均红细胞血红蛋白含量(MCH)-静脉血: 32.5pg；钠离子(Na+)-静脉血: 141.4mmol/L；白蛋白(ALB)-静脉血: 40.9g/L；血小板分布宽度(PDW)-静脉血: 11%；血小板计数(PLT#)-静脉血: 19910E9/L；磷(P)-静脉血: 1.21mmol/L；钾离子(K+)-静脉血: 3.94mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.66；总胆固醇(TC)-静脉血: 4.19mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.55mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.465……\n- [全程D57] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后复查，对比某次就诊时间片： 鼻咽腔稍狭窄，鼻咽肿物较前明显缩小，鼻咽顶壁及双侧壁粘膜欠光滑，双侧咽隐窝变浅，鼻咽未见明显肿物，左侧腭帆提肌张肌及头长肌轮廓不清，其内及左侧咽后区见异常信号灶，增强扫描轻度强化，病灶范围较前明显缩小，强化程度较前降低。 左侧咽旁脂肪间隙变窄，左侧颈动脉鞘区见肿物占据，范围较前缩小，强化程度较前降低。左侧腭帆张提肌及左侧头长肌受侵。 口咽双侧壁未见增厚。鼻腔未见肿物。 左侧翼腭窝见少许软组织影，大致同前。右侧翼腭窝、双侧颞下窝未见异常。 斜坡、左侧岩尖、左侧破裂孔，左侧蝶骨大翼、左侧翼突、左侧翼管、左侧圆孔、蝶骨基底部骨质破坏，大致同前。 蝶窦见软组织肿物，较前明显缩小。 双侧上颌窦、蝶窦、筛窦粘膜增厚，左侧乳突少量分泌物。 双侧眼眶未见异常。左侧海绵窦未见明显右侧。 左侧咽后淋巴结肿大，短径约10mm，较前稍缩小。右侧咽后见小淋巴结，短径约4mm，较前明显缩小。双侧II区见多个淋巴结，相互融合，边界不清，较前明显缩小。右侧腮腺见小淋巴结，短径约为4mm。明显强化 左侧腮腺及双侧颌下腺未见异常。所示甲状腺未见异常。 所示脑实质常规MR及DTI未见明显异常信号灶。；检查结论: 鼻咽癌化疗后，鼻咽未见明显肿物，左侧咽旁、蝶窦肿物较前明显缩小。 颅底骨质破坏，大致同前。 双侧咽后及双颈II区淋巴结，较前缩小。 右侧腮腺小淋巴结。 鼻窦炎，左侧乳突炎症。\n- [全程D57] MRI；脑功能成像、DTI: 检查类型: MRI；检查名称: 脑功能成像、DTI；检查部位:；检查所见: 鼻咽癌化疗后复查，对比某次就诊时间片： 鼻咽腔稍狭窄，鼻咽肿物较前明显缩小，鼻咽顶壁及双侧壁粘膜欠光滑，双侧咽隐窝变浅，鼻咽未见明显肿物，左侧腭帆提肌张肌及头长肌轮廓不清，其内及左侧咽后区见异常信号灶，增强扫描轻度强化，病灶范围较前明显缩小，强化程度较前降低。 左侧咽旁脂肪间隙变窄，左侧颈动脉鞘区见肿物占据，范围较前缩小，强化程度较前降低。左侧腭帆张提肌及左侧头长肌受侵。 口咽双侧壁未见增厚。鼻腔未见肿物。 左侧翼腭窝见少许软组织影，大致同前。右侧翼腭窝、双侧颞下窝未见异常。 斜坡、左侧岩尖、左侧破裂孔，左侧蝶骨大翼、左侧翼突、左侧翼管、左侧圆孔、蝶骨基底部骨质破坏，大致同前。 蝶窦见软组织肿物，较前明显缩小。 双侧上颌窦、蝶窦、筛窦粘膜增厚，左侧乳突少量分泌物。 双侧眼眶未见异常。左侧海绵窦未见明显右侧。 左侧咽后淋巴结肿大，短径约10mm，较前稍缩小。右侧咽后见小淋巴结，短径约4mm，较前明显缩小。双侧II区见多个淋巴结，相互融合，边界不清，较前明显缩小。右侧腮腺见小淋巴结，短径约为4mm。明显强化 左侧腮腺及双侧颌下腺未见异常。所示甲状腺未见异常。 所示脑实质常规MR及DTI未见明显异常信号灶。；检查结论: 鼻咽癌化疗后，鼻咽未见明显肿物，左侧咽旁、蝶窦肿物较前明显缩小。 颅底骨质破坏，大致同前。 双侧咽后及双颈II区淋巴结，较前缩小。 右侧腮腺小淋巴结。 鼻窦炎，左侧乳突炎症。\n\n【既往治疗与反应】\n- [全程D51] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者入院第2天，一般情况可，血常规、生化检查无明显异常。[姓名已隐去]医生信息已隐藏示：目前患者诊断明确，今日水化，明日开始第三程诱导化疗。\n- [全程D52] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，血常规、生化检查无明显异常。今日开始予多西他赛90mg/d1+PDD35mg/d1-3方案化疗。[姓名已隐去]医生信息已隐藏示：目前患者诊断明确，今日开始化疗，密切观察病情变化。\n- [全程D55] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，未诉特殊不适。[姓名已隐去]医生信息已隐藏示：目前患者今日化疗结束，密切观病情变化，如有不适，及时对症处理。\n- [全程D57] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，未诉特殊不适。[姓名已隐去]医生信息已隐藏示：目前患者化疗结束，病情稳定，可予出院。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估为完全缓解（CR），结束诱导化疗，直接进入随访观察阶段，定期复查鼻咽及颈部MRI。\nB. 评估为疾病稳定（SD），更换为吉西他滨联合顺铂方案继续化疗2周期。\nC. 评估为疾病进展（PD），转为姑息性放疗及靶向治疗。\nD. 评估为部分缓解（PR），继续原方案（多西他赛联合顺铂）诱导化疗第4-6周期。\nE. 评估为部分缓解（PR），先行双侧颈部淋巴结清扫术，术后行根治性放疗。\nF. 评估为部分缓解（PR），结束诱导化疗，择期行单纯根治性放疗。\nG. 评估为部分缓解（PR），行鼻咽内镜下颅底肿瘤切除术联合术后放疗。\nH. 评估为部分缓解（PR），结束诱导化疗，择期行根治性放疗及同期靶向治疗。\nI. 评估为疾病稳定（SD），提前终止化疗，立即开始根治性放疗及同期化疗。\nJ. 评估为部分缓解（PR），结束诱导化疗，出院休养并定期监测血象，择期行根治性放疗及同期化疗。\nK. 评估为部分缓解（PR），结束诱导化疗，行全身PET-CT检查排除远处转移后再决定后续治疗。\nL. 评估为完全缓解（CR），结束诱导化疗，择期行预防性低剂量放疗。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、颈动脉鞘、斜坡、海绵窦、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D36] 检验组合: 总胆固醇(TC)-静脉血: 4.01mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.55；γ-谷氨酰基转移酶(GGT)-静脉血: 22.5U/L；平均血小板体积(MPV)-静脉血: 10.1fL；淋巴细胞计数(Lymph#)-静脉血: 0.910E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.04；丙氨酸氨基转移酶(ALT)-静脉血: 42.3U/L；尿素氮(BUN)-静脉血: 6.2mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 26.3U/L；总胆红素(TBIL)-静脉血: 14.1umol/L；钠离子(Na+)-静脉血: 136mmol/L；碱性磷酸酶(ALP)-静脉血: 68U/L；白细胞计数(WBC#)-静脉血: 4.310E9/L；直接胆红素(DBIL)-静脉血: 4.6umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；单核细胞计数(Mono#)-静脉血: 0.110E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；磷(P)-静脉血: 0.99mmol/L；血红蛋白(Hb)-静脉血: 122g/L；氯离子(Cl-)-静脉血: 95mmol/L；血小板分布宽度(PDW)-静脉血: 12.3%；平均红细胞体积(MCV)-静脉血: 93.9fL；α-L-岩藻糖苷酶(AFU)-静脉血: 48.7U/L；阴离子间隙(AG)-静脉血: 14.1；钾离子(K+)-静脉血: 4.06mmol/L；红细胞比容(Hct)-静脉血: 35.7%；血小板比容-静脉血: 23%；白蛋白(ALB)-静脉血: 40.7g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；C-反应蛋白(CRP)-静脉血: 3.19mg/L；球蛋白(GLO)-静脉血: 26.19g/L；胱抑素(Cys-C)-静脉血: 0.64mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.04mmol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；载脂蛋白B(apoB)-静脉血: 0.72g/L；间接胆红素(IBIL)-静脉血: 9.5umolL；中性粒细胞百分比(Neut%)-静脉血: 0.729；尿酸(UA)-静脉血: 258.1umol/L；单核细胞百分比(Mono%)-静脉血: 0……\n- [全程D49] 检验组合: 单核细胞百分比(Mono%)-静脉血: 0.066；C-反应蛋白(CRP)-静脉血: 0.26mg/L；乳酸脱氢酶(LDH)-静脉血: 257.7U/L；氯离子(Cl-)-静脉血: 105.6mmol/L；总蛋白(TP)-静脉血: 65.51g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.002；甘油三酯(TG)-静脉血: 0.97mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.25mmolL；红细胞比容(Hct)-静脉血: 34.7%；间接胆红素(IBIL)-静脉血: 5.5umolL；单核细胞计数(Mono#)-静脉血: 0.310E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.5U/L；红细胞计数(RBC#)-静脉血: 3.5110E12/L；总钙(Ca)-静脉血: 2.08mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.94；葡萄糖(Glu)-静脉血: 4.89mmol/L；直接胆红素(DBIL)-静脉血: 2.4umol/L；镁离子(Mg2+)-静脉血: 1.09mmol/L；胱抑素(Cys-C)-静脉血: 0.69mg/L；总胆汁酸(TBA)-静脉血: 1.9umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 35.4U/L；肌酐(Crea)-静脉血: 52.4umol/L；载脂蛋白B(apoB)-静脉血: 0.81g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 48.8；平均红细胞血红蛋白含量(MCH)-静脉血: 32.5pg；钠离子(Na+)-静脉血: 141.4mmol/L；白蛋白(ALB)-静脉血: 40.9g/L；血小板分布宽度(PDW)-静脉血: 11%；血小板计数(PLT#)-静脉血: 19910E9/L；磷(P)-静脉血: 1.21mmol/L；钾离子(K+)-静脉血: 3.94mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.66；总胆固醇(TC)-静脉血: 4.19mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.55mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.465……\n- [全程D57] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后复查，对比某次就诊时间片： 鼻咽腔稍狭窄，鼻咽肿物较前明显缩小，鼻咽顶壁及双侧壁粘膜欠光滑，双侧咽隐窝变浅，鼻咽未见明显肿物，左侧腭帆提肌张肌及头长肌轮廓不清，其内及左侧咽后区见异常信号灶，增强扫描轻度强化，病灶范围较前明显缩小，强化程度较前降低。 左侧咽旁脂肪间隙变窄，左侧颈动脉鞘区见肿物占据，范围较前缩小，强化程度较前降低。左侧腭帆张提肌及左侧头长肌受侵。 口咽双侧壁未见增厚。鼻腔未见肿物。 左侧翼腭窝见少许软组织影，大致同前。右侧翼腭窝、双侧颞下窝未见异常。 斜坡、左侧岩尖、左侧破裂孔，左侧蝶骨大翼、左侧翼突、左侧翼管、左侧圆孔、蝶骨基底部骨质破坏，大致同前。 蝶窦见软组织肿物，较前明显缩小。 双侧上颌窦、蝶窦、筛窦粘膜增厚，左侧乳突少量分泌物。 双侧眼眶未见异常。左侧海绵窦未见明显右侧。 左侧咽后淋巴结肿大，短径约10mm，较前稍缩小。右侧咽后见小淋巴结，短径约4mm，较前明显缩小。双侧II区见多个淋巴结，相互融合，边界不清，较前明显缩小。右侧腮腺见小淋巴结，短径约为4mm。明显强化 左侧腮腺及双侧颌下腺未见异常。所示甲状腺未见异常。 所示脑实质常规MR及DTI未见明显异常信号灶。；检查结论: 鼻咽癌化疗后，鼻咽未见明显肿物，左侧咽旁、蝶窦肿物较前明显缩小。 颅底骨质破坏，大致同前。 双侧咽后及双颈II区淋巴结，较前缩小。 右侧腮腺小淋巴结。 鼻窦炎，左侧乳突炎症。\n- [全程D57] MRI；脑功能成像、DTI: 检查类型: MRI；检查名称: 脑功能成像、DTI；检查部位:；检查所见: 鼻咽癌化疗后复查，对比某次就诊时间片： 鼻咽腔稍狭窄，鼻咽肿物较前明显缩小，鼻咽顶壁及双侧壁粘膜欠光滑，双侧咽隐窝变浅，鼻咽未见明显肿物，左侧腭帆提肌张肌及头长肌轮廓不清，其内及左侧咽后区见异常信号灶，增强扫描轻度强化，病灶范围较前明显缩小，强化程度较前降低。 左侧咽旁脂肪间隙变窄，左侧颈动脉鞘区见肿物占据，范围较前缩小，强化程度较前降低。左侧腭帆张提肌及左侧头长肌受侵。 口咽双侧壁未见增厚。鼻腔未见肿物。 左侧翼腭窝见少许软组织影，大致同前。右侧翼腭窝、双侧颞下窝未见异常。 斜坡、左侧岩尖、左侧破裂孔，左侧蝶骨大翼、左侧翼突、左侧翼管、左侧圆孔、蝶骨基底部骨质破坏，大致同前。 蝶窦见软组织肿物，较前明显缩小。 双侧上颌窦、蝶窦、筛窦粘膜增厚，左侧乳突少量分泌物。 双侧眼眶未见异常。左侧海绵窦未见明显右侧。 左侧咽后淋巴结肿大，短径约10mm，较前稍缩小。右侧咽后见小淋巴结，短径约4mm，较前明显缩小。双侧II区见多个淋巴结，相互融合，边界不清，较前明显缩小。右侧腮腺见小淋巴结，短径约为4mm。明显强化 左侧腮腺及双侧颌下腺未见异常。所示甲状腺未见异常。 所示脑实质常规MR及DTI未见明显异常信号灶。；检查结论: 鼻咽癌化疗后，鼻咽未见明显肿物，左侧咽旁、蝶窦肿物较前明显缩小。 颅底骨质破坏，大致同前。 双侧咽后及双颈II区淋巴结，较前缩小。 右侧腮腺小淋巴结。 鼻窦炎，左侧乳突炎症。\n\n【既往治疗与反应】\n- [全程D51] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者入院第2天，一般情况可，血常规、生化检查无明显异常。[姓名已隐去]医生信息已隐藏示：目前患者诊断明确，今日水化，明日开始第三程诱导化疗。\n- [全程D52] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，血常规、生化检查无明显异常。今日开始予多西他赛90mg/d1+PDD35mg/d1-3方案化疗。[姓名已隐去]医生信息已隐藏示：目前患者诊断明确，今日开始化疗，密切观察病情变化。\n- [全程D55] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，未诉特殊不适。[姓名已隐去]医生信息已隐藏示：目前患者今日化疗结束，密切观病情变化，如有不适，及时对症处理。\n- [全程D57] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，未诉特殊不适。[姓名已隐去]医生信息已隐藏示：目前患者化疗结束，病情稳定，可予出院。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估为完全缓解（CR），结束诱导化疗，直接进入随访观察阶段，定期复查鼻咽及颈部MRI。\nB. 评估为疾病稳定（SD），更换为吉西他滨联合顺铂方案继续化疗2周期。\nC. 评估为疾病进展（PD），转为姑息性放疗及靶向治疗。\nD. 评估为部分缓解（PR），继续原方案（多西他赛联合顺铂）诱导化疗第4-6周期。\nE. 评估为部分缓解（PR），先行双侧颈部淋巴结清扫术，术后行根治性放疗。\nF. 评估为部分缓解（PR），结束诱导化疗，择期行单纯根治性放疗。\nG. 评估为部分缓解（PR），行鼻咽内镜下颅底肿瘤切除术联合术后放疗。\nH. 评估为部分缓解（PR），结束诱导化疗，择期行根治性放疗及同期靶向治疗。\nI. 评估为疾病稳定（SD），提前终止化疗，立即开始根治性放疗及同期化疗。\nJ. 评估为部分缓解（PR），结束诱导化疗，出院休养并定期监测血象，择期行根治性放疗及同期化疗。\nK. 评估为部分缓解（PR），结束诱导化疗，行全身PET-CT检查排除远处转移后再决定后续治疗。\nL. 评估为完全缓解（CR），结束诱导化疗，择期行预防性低剂量放疗。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-c754017abe0842c4e67e064f","patient_id":"patient-e90c2443e271b2e927262653","turn_id":"turn08","turn_position":7,"turn_type":"response_assessment_decision","gold_letter":"K","gold_action":"评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排根治性放疗及同期化疗。","options":[{"letter":"A","text":"评估为诱导化疗后完全缓解（CR），予以出院并定期随访观察，暂缓后续放化疗。","is_gold":false},{"letter":"B","text":"评估为诱导化疗后部分缓解（PR），继续原方案（多西他赛+顺铂）行第4周期诱导化疗。","is_gold":false},{"letter":"C","text":"评估为诱导化疗后疾病稳定（SD），更改化疗方案为吉西他滨+顺铂继续诱导化疗。","is_gold":false},{"letter":"D","text":"评估为诱导化疗后疾病进展（PD），建议行姑息性放疗及靶向治疗。","is_gold":false},{"letter":"E","text":"评估为诱导化疗后部分缓解（PR），立即行双侧颈部淋巴结清扫术及鼻咽原发灶切除术。","is_gold":false},{"letter":"F","text":"评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排单纯根治性放疗。","is_gold":false},{"letter":"G","text":"评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排根治性放疗及靶向治疗。","is_gold":false},{"letter":"H","text":"评估为诱导化疗后完全缓解（CR），予以出院及对症支持治疗，并择期安排根治性放疗及同期化疗。","is_gold":false},{"letter":"I","text":"评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排根治性放疗及免疫治疗。","is_gold":false},{"letter":"J","text":"评估为诱导化疗后部分缓解（PR），继续住院观察，待血象恢复后立即行第4周期诱导化疗。","is_gold":false},{"letter":"K","text":"评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排根治性放疗及同期化疗。","is_gold":true},{"letter":"L","text":"评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排姑息性放疗。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、颈动脉鞘、斜坡、海绵窦、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- 无可展示记录。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估为诱导化疗后完全缓解（CR），予以出院并定期随访观察，暂缓后续放化疗。\nB. 评估为诱导化疗后部分缓解（PR），继续原方案（多西他赛+顺铂）行第4周期诱导化疗。\nC. 评估为诱导化疗后疾病稳定（SD），更改化疗方案为吉西他滨+顺铂继续诱导化疗。\nD. 评估为诱导化疗后疾病进展（PD），建议行姑息性放疗及靶向治疗。\nE. 评估为诱导化疗后部分缓解（PR），立即行双侧颈部淋巴结清扫术及鼻咽原发灶切除术。\nF. 评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排单纯根治性放疗。\nG. 评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排根治性放疗及靶向治疗。\nH. 评估为诱导化疗后完全缓解（CR），予以出院及对症支持治疗，并择期安排根治性放疗及同期化疗。\nI. 评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排根治性放疗及免疫治疗。\nJ. 评估为诱导化疗后部分缓解（PR），继续住院观察，待血象恢复后立即行第4周期诱导化疗。\nK. 评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排根治性放疗及同期化疗。\nL. 评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排姑息性放疗。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、颈动脉鞘、斜坡、海绵窦、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- 无可展示记录。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估为诱导化疗后完全缓解（CR），予以出院并定期随访观察，暂缓后续放化疗。\nB. 评估为诱导化疗后部分缓解（PR），继续原方案（多西他赛+顺铂）行第4周期诱导化疗。\nC. 评估为诱导化疗后疾病稳定（SD），更改化疗方案为吉西他滨+顺铂继续诱导化疗。\nD. 评估为诱导化疗后疾病进展（PD），建议行姑息性放疗及靶向治疗。\nE. 评估为诱导化疗后部分缓解（PR），立即行双侧颈部淋巴结清扫术及鼻咽原发灶切除术。\nF. 评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排单纯根治性放疗。\nG. 评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排根治性放疗及靶向治疗。\nH. 评估为诱导化疗后完全缓解（CR），予以出院及对症支持治疗，并择期安排根治性放疗及同期化疗。\nI. 评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排根治性放疗及免疫治疗。\nJ. 评估为诱导化疗后部分缓解（PR），继续住院观察，待血象恢复后立即行第4周期诱导化疗。\nK. 评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排根治性放疗及同期化疗。\nL. 评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排姑息性放疗。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-c81d5e1363b1f79117650da1","patient_id":"patient-7c0941dbdd4694260fd4de38","turn_id":"turn01","turn_position":1,"turn_type":"initial_workup_choice","gold_letter":"L","gold_action":"颈部MRI平扫+增强、电子鼻咽镜检查、腹部超声检查。","options":[{"letter":"A","text":"颈部CT平扫+增强、电子鼻咽镜检查、全身PET-CT检查","is_gold":false},{"letter":"B","text":"颈部MRI平扫、间接鼻咽镜检查、腹部超声检查","is_gold":false},{"letter":"C","text":"颈部MRI平扫+增强、电子鼻咽镜下活检、腹部超声检查","is_gold":false},{"letter":"D","text":"颈部超声、电子鼻咽镜检查、胸腹部CT平扫","is_gold":false},{"letter":"E","text":"颈部CT平扫、电子鼻咽镜检查、腹部超声检查","is_gold":false},{"letter":"F","text":"颈部MRI平扫+增强、间接鼻咽镜检查、胸部X线片","is_gold":false},{"letter":"G","text":"鼻咽及颈部CT平扫+增强、电子鼻咽镜检查、全身骨扫描","is_gold":false},{"letter":"H","text":"颈部MRI平扫、电子鼻咽镜检查、腹部超声检查","is_gold":false},{"letter":"I","text":"颈部MRI平扫+增强、鼻咽活检、全身骨扫描","is_gold":false},{"letter":"J","text":"鼻咽部CT平扫、电子鼻咽镜检查、全身PET-CT检查","is_gold":false},{"letter":"K","text":"颈部MRI平扫+增强、电子鼻咽镜检查、全身骨扫描","is_gold":false},{"letter":"L","text":"颈部MRI平扫+增强、电子鼻咽镜检查、腹部超声检查","is_gold":true}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、口咽。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 反复右中耳积液半年余。；现病史: 简要入院病史:患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；阳性症状体征:；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史: 吸烟2包/日×20年，否认疫区接触史，否认冶游史，否认嗜酒。；家族史: 无特殊。；体格检查:；专科检查:；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 颈部CT平扫+增强、电子鼻咽镜检查、全身PET-CT检查\nB. 颈部MRI平扫、间接鼻咽镜检查、腹部超声检查\nC. 颈部MRI平扫+增强、电子鼻咽镜下活检、腹部超声检查\nD. 颈部超声、电子鼻咽镜检查、胸腹部CT平扫\nE. 颈部CT平扫、电子鼻咽镜检查、腹部超声检查\nF. 颈部MRI平扫+增强、间接鼻咽镜检查、胸部X线片\nG. 鼻咽及颈部CT平扫+增强、电子鼻咽镜检查、全身骨扫描\nH. 颈部MRI平扫、电子鼻咽镜检查、腹部超声检查\nI. 颈部MRI平扫+增强、鼻咽活检、全身骨扫描\nJ. 鼻咽部CT平扫、电子鼻咽镜检查、全身PET-CT检查\nK. 颈部MRI平扫+增强、电子鼻咽镜检查、全身骨扫描\nL. 颈部MRI平扫+增强、电子鼻咽镜检查、腹部超声检查\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、口咽。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 反复右中耳积液半年余。；现病史: 简要入院病史:患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；阳性症状体征:；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史: 吸烟2包/日×20年，否认疫区接触史，否认冶游史，否认嗜酒。；家族史: 无特殊。；体格检查:；专科检查:；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 颈部CT平扫+增强、电子鼻咽镜检查、全身PET-CT检查\nB. 颈部MRI平扫、间接鼻咽镜检查、腹部超声检查\nC. 颈部MRI平扫+增强、电子鼻咽镜下活检、腹部超声检查\nD. 颈部超声、电子鼻咽镜检查、胸腹部CT平扫\nE. 颈部CT平扫、电子鼻咽镜检查、腹部超声检查\nF. 颈部MRI平扫+增强、间接鼻咽镜检查、胸部X线片\nG. 鼻咽及颈部CT平扫+增强、电子鼻咽镜检查、全身骨扫描\nH. 颈部MRI平扫、电子鼻咽镜检查、腹部超声检查\nI. 颈部MRI平扫+增强、鼻咽活检、全身骨扫描\nJ. 鼻咽部CT平扫、电子鼻咽镜检查、全身PET-CT检查\nK. 颈部MRI平扫+增强、电子鼻咽镜检查、全身骨扫描\nL. 颈部MRI平扫+增强、电子鼻咽镜检查、腹部超声检查\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-72b57dbdb0633da918062d61","patient_id":"patient-7c0941dbdd4694260fd4de38","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"A","gold_action":"行电子鼻咽镜检查及鼻咽肿物活检，并辅以颈部淋巴结彩超及穿刺活检，以明确病理诊断及淋巴结分期。","options":[{"letter":"A","text":"行电子鼻咽镜检查及鼻咽肿物活检，并辅以颈部淋巴结彩超及穿刺活检","is_gold":true},{"letter":"B","text":"行电子鼻咽镜检查及鼻咽肿物活检，颈部淋巴结仅作临床触诊及随访","is_gold":false},{"letter":"C","text":"行颈部淋巴结切除活检明确病理，暂缓鼻咽部有创检查及活检","is_gold":false},{"letter":"D","text":"行鼻内镜下鼻咽肿物扩大切除术，同步完成病理诊断与局部治疗","is_gold":false},{"letter":"E","text":"行颈部淋巴结彩超及穿刺活检，若确诊转移则免于鼻咽部活检","is_gold":false},{"letter":"F","text":"行鼻咽部脱落细胞学涂片及血浆EBV-DNA检测，替代组织学活检","is_gold":false},{"letter":"G","text":"启动根治性放化疗，免于组织学活检及颈部淋巴结穿刺评估","is_gold":false},{"letter":"H","text":"行电子鼻咽镜检查及活检，并预防性行双侧颈部淋巴结清扫术","is_gold":false},{"letter":"I","text":"补充全身骨扫描及头颅增强MRI，暂缓鼻咽及颈部组织学活检","is_gold":false},{"letter":"J","text":"行电子鼻咽镜评估局部侵犯范围，免于鼻咽肿物组织学活检","is_gold":false},{"letter":"K","text":"优先行鼓膜穿刺置管术缓解中耳积液，暂缓鼻咽部及颈部检查","is_gold":false},{"letter":"L","text":"予以诊断性抗炎治疗2周，随后复查PET/CT评估局部代谢变化","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、口咽。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [时间未明] 门急诊记录: 主诉: 反复右中耳积液半年余。；现病史: 患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史:；家族史: 无特殊。；体格检查: KPS90分，DG4.0cm，鼻咽右侧隆突肿物，接近右侧后鼻孔，双颈未触及肿大淋巴结，颅神经检查阴性，心肺腹未及异常，全身骨无压痛。\n\n【已完成检查与客观结果】\n- [全程D8] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽右侧咽隐窝区软组织影放射性浓聚，SUV41.8，病灶侵犯右腭帆肌群、右头长肌，病灶与蝶骨基底部右份及右翼突内板分界不清。右咽旁间隙变浅，右咽隐窝消失，左侧咽隐窝未见明显异常。口咽及喉咽结构及放射性分布未见明显异常。双侧上颌窦低密度影放射性分布未见异常；额窦、蝶窦、筛窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双颈多个小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 右中肺小片状影放射性分布未见异常；余双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏弥漫性密度减低，CT值约46Hu（脾脏CT值约58Hu），形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 盆腔放射性分布均匀，膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 右乳突气房内低密度影放射性分布未见异常；余颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽右咽隐窝病灶代谢活跃，符合鼻咽癌，病灶疑累及蝶骨基底部右份及右翼突内板。 双上颌窦炎症；右乳突炎症。 右中肺小片状影代谢未见异常，考虑增殖灶。 轻度脂肪肝。\n- [全程D8] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 早期复极改变 其余未见异常\n- [全程D8] 检验组合: 红细胞计数(RBC#)-静脉血: 5.2310E12/L；血液二氧化碳含量ctCO2(B)-静脉血: 25mmol/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.766COI；血小板分布宽度(PDW)-静脉血: 16.4%；单核细胞百分比(Mono%)-静脉血: 0.077；红细胞比容(Hct)-静脉血: 48.4%；凝血酶时间(TT)-静脉血: 19.8sec.；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 32.8U/L；凝血酶原时间(PT)-静脉血: 9.9sec.；淋巴细胞计数(Lymph#)-静脉血: 2.310E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.025；白蛋白(ALB)-静脉血: 46g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.61；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.08；胱抑素(Cys-C)-静脉血: 0.98mg/L；尿素氮(BUN)-静脉血: 5.5mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.597；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 6.1umolL；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；碱性磷酸酶(ALP)-静脉血: 60.9U/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 0.006COI；C-反应蛋白(CRP)-静脉血: 1.86mg/L；Rh血型-静脉血: 阳性；总钙(Ca)-静脉血: 2.14mmol/L；总胆汁酸(TBA)-静脉血: 8.3umol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.1ug/ml；丙氨酸氨基转移酶(ALT)-静脉血: 46.9U/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；氯离子(Cl-)-静脉血: 104.3mmol/L；低密度脂蛋白胆固醇……\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行电子鼻咽镜检查及鼻咽肿物活检，并辅以颈部淋巴结彩超及穿刺活检\nB. 行电子鼻咽镜检查及鼻咽肿物活检，颈部淋巴结仅作临床触诊及随访\nC. 行颈部淋巴结切除活检明确病理，暂缓鼻咽部有创检查及活检\nD. 行鼻内镜下鼻咽肿物扩大切除术，同步完成病理诊断与局部治疗\nE. 行颈部淋巴结彩超及穿刺活检，若确诊转移则免于鼻咽部活检\nF. 行鼻咽部脱落细胞学涂片及血浆EBV-DNA检测，替代组织学活检\nG. 启动根治性放化疗，免于组织学活检及颈部淋巴结穿刺评估\nH. 行电子鼻咽镜检查及活检，并预防性行双侧颈部淋巴结清扫术\nI. 补充全身骨扫描及头颅增强MRI，暂缓鼻咽及颈部组织学活检\nJ. 行电子鼻咽镜评估局部侵犯范围，免于鼻咽肿物组织学活检\nK. 优先行鼓膜穿刺置管术缓解中耳积液，暂缓鼻咽部及颈部检查\nL. 予以诊断性抗炎治疗2周，随后复查PET/CT评估局部代谢变化\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、口咽。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [时间未明] 门急诊记录: 主诉: 反复右中耳积液半年余。；现病史: 患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史:；家族史: 无特殊。；体格检查: KPS90分，DG4.0cm，鼻咽右侧隆突肿物，接近右侧后鼻孔，双颈未触及肿大淋巴结，颅神经检查阴性，心肺腹未及异常，全身骨无压痛。\n\n【已完成检查与客观结果】\n- [全程D8] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽右侧咽隐窝区软组织影放射性浓聚，SUV41.8，病灶侵犯右腭帆肌群、右头长肌，病灶与蝶骨基底部右份及右翼突内板分界不清。右咽旁间隙变浅，右咽隐窝消失，左侧咽隐窝未见明显异常。口咽及喉咽结构及放射性分布未见明显异常。双侧上颌窦低密度影放射性分布未见异常；额窦、蝶窦、筛窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双颈多个小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 右中肺小片状影放射性分布未见异常；余双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏弥漫性密度减低，CT值约46Hu（脾脏CT值约58Hu），形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 盆腔放射性分布均匀，膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 右乳突气房内低密度影放射性分布未见异常；余颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽右咽隐窝病灶代谢活跃，符合鼻咽癌，病灶疑累及蝶骨基底部右份及右翼突内板。 双上颌窦炎症；右乳突炎症。 右中肺小片状影代谢未见异常，考虑增殖灶。 轻度脂肪肝。\n- [全程D8] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 早期复极改变 其余未见异常\n- [全程D8] 检验组合: 红细胞计数(RBC#)-静脉血: 5.2310E12/L；血液二氧化碳含量ctCO2(B)-静脉血: 25mmol/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.766COI；血小板分布宽度(PDW)-静脉血: 16.4%；单核细胞百分比(Mono%)-静脉血: 0.077；红细胞比容(Hct)-静脉血: 48.4%；凝血酶时间(TT)-静脉血: 19.8sec.；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 32.8U/L；凝血酶原时间(PT)-静脉血: 9.9sec.；淋巴细胞计数(Lymph#)-静脉血: 2.310E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.025；白蛋白(ALB)-静脉血: 46g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.61；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.08；胱抑素(Cys-C)-静脉血: 0.98mg/L；尿素氮(BUN)-静脉血: 5.5mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.597；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 6.1umolL；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；碱性磷酸酶(ALP)-静脉血: 60.9U/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 0.006COI；C-反应蛋白(CRP)-静脉血: 1.86mg/L；Rh血型-静脉血: 阳性；总钙(Ca)-静脉血: 2.14mmol/L；总胆汁酸(TBA)-静脉血: 8.3umol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.1ug/ml；丙氨酸氨基转移酶(ALT)-静脉血: 46.9U/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；氯离子(Cl-)-静脉血: 104.3mmol/L；低密度脂蛋白胆固醇……\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行电子鼻咽镜检查及鼻咽肿物活检，并辅以颈部淋巴结彩超及穿刺活检\nB. 行电子鼻咽镜检查及鼻咽肿物活检，颈部淋巴结仅作临床触诊及随访\nC. 行颈部淋巴结切除活检明确病理，暂缓鼻咽部有创检查及活检\nD. 行鼻内镜下鼻咽肿物扩大切除术，同步完成病理诊断与局部治疗\nE. 行颈部淋巴结彩超及穿刺活检，若确诊转移则免于鼻咽部活检\nF. 行鼻咽部脱落细胞学涂片及血浆EBV-DNA检测，替代组织学活检\nG. 启动根治性放化疗，免于组织学活检及颈部淋巴结穿刺评估\nH. 行电子鼻咽镜检查及活检，并预防性行双侧颈部淋巴结清扫术\nI. 补充全身骨扫描及头颅增强MRI，暂缓鼻咽及颈部组织学活检\nJ. 行电子鼻咽镜评估局部侵犯范围，免于鼻咽肿物组织学活检\nK. 优先行鼓膜穿刺置管术缓解中耳积液，暂缓鼻咽部及颈部检查\nL. 予以诊断性抗炎治疗2周，随后复查PET/CT评估局部代谢变化\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-3ed269e9b5e894b444089bf3","patient_id":"patient-7c0941dbdd4694260fd4de38","turn_id":"turn04","turn_position":3,"turn_type":"initial_treatment_selection","gold_letter":"C","gold_action":"单纯根治性放疗（鼻咽及双侧颈部）","options":[{"letter":"A","text":"诱导化疗序贯单纯根治性放疗（鼻咽及双侧颈部）","is_gold":false},{"letter":"B","text":"同期放化疗（鼻咽及双侧颈部）","is_gold":false},{"letter":"C","text":"单纯根治性放疗（鼻咽及双侧颈部）","is_gold":true},{"letter":"D","text":"诱导化疗序贯同期放化疗（鼻咽及双侧颈部）","is_gold":false},{"letter":"E","text":"鼻咽原发灶切除术联合术后辅助放疗","is_gold":false},{"letter":"F","text":"靶向治疗联合单纯根治性放疗（鼻咽及双侧颈部）","is_gold":false},{"letter":"G","text":"免疫治疗联合单纯根治性放疗（鼻咽及双侧颈部）","is_gold":false},{"letter":"H","text":"诱导化疗联合免疫治疗序贯同期放化疗","is_gold":false},{"letter":"I","text":"单纯根治性放疗（仅照射鼻咽及右侧颈部）","is_gold":false},{"letter":"J","text":"姑息性全身化疗联合鼻咽局部减症放疗","is_gold":false},{"letter":"K","text":"诱导化疗后肿瘤退缩情况决定是否行根治性放疗","is_gold":false},{"letter":"L","text":"同期放化疗序贯全身辅助化疗","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、口咽。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 反复右中耳积液半年余。；现病史: 简要入院病史:患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。后来我院，我院病理示未分化非角化性癌。我院鼻咽+颈部MR：鼻咽部肿物，考虑鼻咽癌。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；阳性症状体征:；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史: 吸烟2包/日×20年，否认疫区接触史，否认冶游史，否认嗜酒。；家族史: 无特殊。；体格检查:；专科检查:；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D9] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁明显增厚，右侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描强化较明显。左侧咽隐窝存在。肿块累及右侧口咽壁。 右侧咽旁脂肪间隙变窄；左侧咽旁间隙未见明显狭窄。右侧腭帆张提肌受侵，左侧腭帆张提肌、双侧头长肌、双侧翼内外肌未见受侵。 鼻腔内未见肿物。 双侧翼腭窝、双侧上颌后脂肪间隙及咀嚼肌间隙未见异常。 颅底骨质信号均匀，增强扫描未见异常强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧上颌窦内见囊性灶，最大长径约27mm，边界清，无强化。右侧乳突见分泌物。左乳突充气良好，骨壁完整。 右侧咽后见一肿大淋巴结，大小约6mm×9mm，增强扫描明显强化。左侧咽后未见肿大淋巴结。颈部双侧见多个小淋巴结，最大者约8mm×11mm，未见坏死及包膜外侵。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。 扫描范围脑实质信号未见异常。；检查结论: 鼻咽肿物，考虑鼻咽癌。 颅底骨质未见破坏。 右侧咽后肿大淋巴结，考虑转移。 颈部小淋巴结。 双侧上颌窦囊肿，右侧乳突炎。\n- [全程D13] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见: 双颈II区可见几个小淋巴结，最大约11mm×4mm（右），12mm×5mm（左），边界清，椭圆形，皮髓质分界清，淋巴门可见。 CDFI:上述淋巴结内可见点状血流信号。 双侧颈部淋巴结穿刺活检： （1）右侧颈部淋巴结穿刺活检：常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以16G穿刺针穿刺入右颈淋巴结内，进针2次，取出长约0.5-1cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。 （2）左侧颈部淋巴结穿刺活检：常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以18G穿刺针穿刺入左颈淋巴结内，进针2次，取出长约0.8-1cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。；检查结论: 双侧颈部淋巴结穿刺活检。 不适随诊。 4个工作日后凭发票到2号楼6楼病理科取结果。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 诱导化疗序贯单纯根治性放疗（鼻咽及双侧颈部）\nB. 同期放化疗（鼻咽及双侧颈部）\nC. 单纯根治性放疗（鼻咽及双侧颈部）\nD. 诱导化疗序贯同期放化疗（鼻咽及双侧颈部）\nE. 鼻咽原发灶切除术联合术后辅助放疗\nF. 靶向治疗联合单纯根治性放疗（鼻咽及双侧颈部）\nG. 免疫治疗联合单纯根治性放疗（鼻咽及双侧颈部）\nH. 诱导化疗联合免疫治疗序贯同期放化疗\nI. 单纯根治性放疗（仅照射鼻咽及右侧颈部）\nJ. 姑息性全身化疗联合鼻咽局部减症放疗\nK. 诱导化疗后肿瘤退缩情况决定是否行根治性放疗\nL. 同期放化疗序贯全身辅助化疗\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、口咽。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 反复右中耳积液半年余。；现病史: 简要入院病史:患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。后来我院，我院病理示未分化非角化性癌。我院鼻咽+颈部MR：鼻咽部肿物，考虑鼻咽癌。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；阳性症状体征:；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史: 吸烟2包/日×20年，否认疫区接触史，否认冶游史，否认嗜酒。；家族史: 无特殊。；体格检查:；专科检查:；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D9] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁明显增厚，右侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描强化较明显。左侧咽隐窝存在。肿块累及右侧口咽壁。 右侧咽旁脂肪间隙变窄；左侧咽旁间隙未见明显狭窄。右侧腭帆张提肌受侵，左侧腭帆张提肌、双侧头长肌、双侧翼内外肌未见受侵。 鼻腔内未见肿物。 双侧翼腭窝、双侧上颌后脂肪间隙及咀嚼肌间隙未见异常。 颅底骨质信号均匀，增强扫描未见异常强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧上颌窦内见囊性灶，最大长径约27mm，边界清，无强化。右侧乳突见分泌物。左乳突充气良好，骨壁完整。 右侧咽后见一肿大淋巴结，大小约6mm×9mm，增强扫描明显强化。左侧咽后未见肿大淋巴结。颈部双侧见多个小淋巴结，最大者约8mm×11mm，未见坏死及包膜外侵。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。 扫描范围脑实质信号未见异常。；检查结论: 鼻咽肿物，考虑鼻咽癌。 颅底骨质未见破坏。 右侧咽后肿大淋巴结，考虑转移。 颈部小淋巴结。 双侧上颌窦囊肿，右侧乳突炎。\n- [全程D13] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见: 双颈II区可见几个小淋巴结，最大约11mm×4mm（右），12mm×5mm（左），边界清，椭圆形，皮髓质分界清，淋巴门可见。 CDFI:上述淋巴结内可见点状血流信号。 双侧颈部淋巴结穿刺活检： （1）右侧颈部淋巴结穿刺活检：常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以16G穿刺针穿刺入右颈淋巴结内，进针2次，取出长约0.5-1cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。 （2）左侧颈部淋巴结穿刺活检：常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以18G穿刺针穿刺入左颈淋巴结内，进针2次，取出长约0.8-1cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。；检查结论: 双侧颈部淋巴结穿刺活检。 不适随诊。 4个工作日后凭发票到2号楼6楼病理科取结果。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 诱导化疗序贯单纯根治性放疗（鼻咽及双侧颈部）\nB. 同期放化疗（鼻咽及双侧颈部）\nC. 单纯根治性放疗（鼻咽及双侧颈部）\nD. 诱导化疗序贯同期放化疗（鼻咽及双侧颈部）\nE. 鼻咽原发灶切除术联合术后辅助放疗\nF. 靶向治疗联合单纯根治性放疗（鼻咽及双侧颈部）\nG. 免疫治疗联合单纯根治性放疗（鼻咽及双侧颈部）\nH. 诱导化疗联合免疫治疗序贯同期放化疗\nI. 单纯根治性放疗（仅照射鼻咽及右侧颈部）\nJ. 姑息性全身化疗联合鼻咽局部减症放疗\nK. 诱导化疗后肿瘤退缩情况决定是否行根治性放疗\nL. 同期放化疗序贯全身辅助化疗\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-f6df1555c3bac7ae4b972cd4","patient_id":"patient-7c0941dbdd4694260fd4de38","turn_id":"turn05","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"D","gold_action":"继续当前根治性放疗计划，定期常规监测血象及生化。","options":[{"letter":"A","text":"继续放疗，加用多烯磷脂酰胆碱等保肝药物。","is_gold":false},{"letter":"B","text":"继续放疗，皮下注射重组人粒细胞刺激因子。","is_gold":false},{"letter":"C","text":"暂停放疗，完善超声心动图及动态心电图检查。","is_gold":false},{"letter":"D","text":"继续根治性放疗计划，定期常规监测血象及生化。","is_gold":true},{"letter":"E","text":"继续放疗，加用阿托伐他汀等降脂药物。","is_gold":false},{"letter":"F","text":"继续放疗，给予静脉补液及利尿治疗。","is_gold":false},{"letter":"G","text":"暂停放疗，静脉滴注广谱抗生素抗感染治疗。","is_gold":false},{"letter":"H","text":"继续放疗，口服头孢类抗生素及促排痰药物。","is_gold":false},{"letter":"I","text":"继续放疗，静脉滴注地塞米松及甘露醇。","is_gold":false},{"letter":"J","text":"调整放疗计划，降低右侧中耳及乳突区的照射剂量。","is_gold":false},{"letter":"K","text":"继续放疗，皮下注射促红细胞生成素。","is_gold":false},{"letter":"L","text":"暂停放疗，行鼻内镜下鼓膜穿刺置管引流术。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、口咽。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D28] 检验组合: 总蛋白(TP)-静脉血: 67.97g/L；总胆红素(TBIL)-静脉血: 13.8umol/L；载脂蛋白B(apoB)-静脉血: 1.32g/L；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.99mmolL；大血小板百分比(P-LCR%)-静脉血: 25.7%；球蛋白(GLO)-静脉血: 23.97g/L；总钙(Ca)-静脉血: 2.26mmol/L；红细胞比容(Hct)-静脉血: 46.8%；血小板计数(PLT#)-静脉血: 20110E9/L；磷(P)-静脉血: 1.5mmol/L；血小板比容-静脉血: 20%；肌酐(Crea)-静脉血: 84.5umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.3；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；总胆汁酸(TBA)-静脉血: 3.5umol/L；钾离子(K+)-静脉血: 4mmol/L；C-反应蛋白(CRP)-静脉血: 2.01mg/L；间接胆红素(IBIL)-静脉血: 9.7umolL；胱抑素(Cys-C)-静脉血: 1.04mg/L；尿素氮(BUN)-静脉血: 6.93mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.6；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.11mmol/L；碱性磷酸酶(ALP)-静脉血: 50.9U/L；平均红细胞体积(MCV)-静脉血: 91.4fL；单核细胞计数(Mono#)-静脉血: 0.710E9/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；单核细胞百分比(Mono%)-静脉血: 0.081；红细胞计数(RBC#)-静脉血: 5.1210E12/L；白细胞计数(WBC#)-静脉血: 8.4210E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；平均血小板体积(MPV)-静脉血: 10.2fL；总胆固醇(TC)-静脉血: 5.98mmol/L；血红蛋白(Hb)-静脉血: 159g/L；直接胆红素(DBIL)-静脉血: 4.1umol/L；氯离子(Cl-)-静脉血: 105.9mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 340g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D27] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗1次，无特殊主诉。Rx：1.继续放疗。2.定期复查血常规等。3.对症支持。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 继续放疗，加用多烯磷脂酰胆碱等保肝药物。\nB. 继续放疗，皮下注射重组人粒细胞刺激因子。\nC. 暂停放疗，完善超声心动图及动态心电图检查。\nD. 继续根治性放疗计划，定期常规监测血象及生化。\nE. 继续放疗，加用阿托伐他汀等降脂药物。\nF. 继续放疗，给予静脉补液及利尿治疗。\nG. 暂停放疗，静脉滴注广谱抗生素抗感染治疗。\nH. 继续放疗，口服头孢类抗生素及促排痰药物。\nI. 继续放疗，静脉滴注地塞米松及甘露醇。\nJ. 调整放疗计划，降低右侧中耳及乳突区的照射剂量。\nK. 继续放疗，皮下注射促红细胞生成素。\nL. 暂停放疗，行鼻内镜下鼓膜穿刺置管引流术。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、口咽。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D28] 检验组合: 总蛋白(TP)-静脉血: 67.97g/L；总胆红素(TBIL)-静脉血: 13.8umol/L；载脂蛋白B(apoB)-静脉血: 1.32g/L；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.99mmolL；大血小板百分比(P-LCR%)-静脉血: 25.7%；球蛋白(GLO)-静脉血: 23.97g/L；总钙(Ca)-静脉血: 2.26mmol/L；红细胞比容(Hct)-静脉血: 46.8%；血小板计数(PLT#)-静脉血: 20110E9/L；磷(P)-静脉血: 1.5mmol/L；血小板比容-静脉血: 20%；肌酐(Crea)-静脉血: 84.5umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.3；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；总胆汁酸(TBA)-静脉血: 3.5umol/L；钾离子(K+)-静脉血: 4mmol/L；C-反应蛋白(CRP)-静脉血: 2.01mg/L；间接胆红素(IBIL)-静脉血: 9.7umolL；胱抑素(Cys-C)-静脉血: 1.04mg/L；尿素氮(BUN)-静脉血: 6.93mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.6；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.11mmol/L；碱性磷酸酶(ALP)-静脉血: 50.9U/L；平均红细胞体积(MCV)-静脉血: 91.4fL；单核细胞计数(Mono#)-静脉血: 0.710E9/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；单核细胞百分比(Mono%)-静脉血: 0.081；红细胞计数(RBC#)-静脉血: 5.1210E12/L；白细胞计数(WBC#)-静脉血: 8.4210E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；平均血小板体积(MPV)-静脉血: 10.2fL；总胆固醇(TC)-静脉血: 5.98mmol/L；血红蛋白(Hb)-静脉血: 159g/L；直接胆红素(DBIL)-静脉血: 4.1umol/L；氯离子(Cl-)-静脉血: 105.9mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 340g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D27] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗1次，无特殊主诉。Rx：1.继续放疗。2.定期复查血常规等。3.对症支持。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 继续放疗，加用多烯磷脂酰胆碱等保肝药物。\nB. 继续放疗，皮下注射重组人粒细胞刺激因子。\nC. 暂停放疗，完善超声心动图及动态心电图检查。\nD. 继续根治性放疗计划，定期常规监测血象及生化。\nE. 继续放疗，加用阿托伐他汀等降脂药物。\nF. 继续放疗，给予静脉补液及利尿治疗。\nG. 暂停放疗，静脉滴注广谱抗生素抗感染治疗。\nH. 继续放疗，口服头孢类抗生素及促排痰药物。\nI. 继续放疗，静脉滴注地塞米松及甘露醇。\nJ. 调整放疗计划，降低右侧中耳及乳突区的照射剂量。\nK. 继续放疗，皮下注射促红细胞生成素。\nL. 暂停放疗，行鼻内镜下鼓膜穿刺置管引流术。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-f1eec05ca151dc9bde0f1f55","patient_id":"patient-7c0941dbdd4694260fd4de38","turn_id":"turn06","turn_position":5,"turn_type":"toxicity_or_support_decision","gold_letter":"E","gold_action":"继续调强放疗，给予局部含漱等对症处理，定期复查血常规及生化。","options":[{"letter":"A","text":"暂停调强放疗，待口腔黏膜炎恢复至Ⅰ度后恢复放疗，期间加强静脉营养支持。","is_gold":false},{"letter":"B","text":"继续调强放疗，加用全身静脉广谱抗生素，定期复查血常规及生化。","is_gold":false},{"letter":"C","text":"继续调强放疗，降低单次靶区照射剂量，给予局部含漱等对症处理。","is_gold":false},{"letter":"D","text":"继续调强放疗，加用静脉糖皮质激素，定期复查血常规及生化。","is_gold":false},{"letter":"E","text":"继续调强放疗，给予局部含漱等对症处理，定期复查血常规及生化。","is_gold":true},{"letter":"F","text":"暂停调强放疗，加用全身抗真菌药物，待黏膜白膜消退后恢复放疗。","is_gold":false},{"letter":"G","text":"继续调强放疗，加用顺铂单药同步化疗，给予局部含漱等对症处理。","is_gold":false},{"letter":"H","text":"继续调强放疗，给予重组人粒细胞刺激因子皮下注射，定期复查血常规。","is_gold":false},{"letter":"I","text":"暂停调强放疗，行鼻咽黏膜活检明确白膜性质，给予局部含漱等对症处理。","is_gold":false},{"letter":"J","text":"继续调强放疗，加用尼妥珠单抗靶向治疗，给予局部含漱等对症处理。","is_gold":false},{"letter":"K","text":"终止根治性放疗，转为姑息性放疗，加强镇痛及口腔局部护理。","is_gold":false},{"letter":"L","text":"继续调强放疗，预防性留置胃管，给予局部含漱等对症处理。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、口咽。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D36] 检验组合: 血小板比容-静脉血: 21%；红细胞计数(RBC#)-静脉血: 5.3510E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 327g/L；血小板计数(PLT#)-静脉血: 20710E9/L；大血小板百分比(P-LCR%)-静脉血: 25.9%；单核细胞计数(Mono#)-静脉血: 0.410E9/L；白细胞计数(WBC#)-静脉血: 5.9110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.654；血小板分布宽度(PDW)-静脉血: 11.9%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4；红细胞比容(Hct)-静脉血: 49.8%；单核细胞百分比(Mono%)-静脉血: 0.059；平均血小板体积(MPV)-静脉血: 10.1fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.9；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.262；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.022；平均红细胞体积(MCV)-静脉血: 93.1fL；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；血红蛋白(Hb)-静脉血: 163g/L\n- [全程D41] 检验组合: 红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.3%；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；血小板比容-静脉血: 15.7%；γ-谷氨酰基转移酶(GGT)-静脉血: 29.2U/L；红细胞计数(RBC#)-静脉血: 4.9510E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.024；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 338.3g/L；钠离子(Na+)-静脉血: 141.9mmol/L；单核细胞百分比(Mono%)-静脉血: 0.068；尿酸(UA)-静脉血: 478.3umol/L；钾离子(K+)-静脉血: 4.3mmol/L；间接胆红素(IBIL)-静脉血: 16.8umolL；乳酸脱氢酶(LDH)-静脉血: 152.4U/L；平均红细胞体积(MCV)-静脉血: 91.7fL；碱性磷酸酶(ALP)-静脉血: 56.1U/L；白蛋白(ALB)-静脉血: 45.9g/L；白细胞计数(WBC#)-静脉血: 8.1810E9/L；葡萄糖(Glu)-静脉血: 4.49mmol/L；阴离子间隙(AG)-静脉血: 17；血小板计数(PLT#)-静脉血: 193.210E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；总蛋白(TP)-静脉血: 70.66g/L；总钙(Ca)-静脉血: 2.29mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.9；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；中性粒细胞计数(Neut#)-静脉血: 610E9/L；胱抑素(Cys-C)-静脉血: 0.96mg/L；C-反应蛋白(CRP)-静脉血: 5.9mg/L；载脂蛋白B(apoB)-静脉血: 1.37g/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.5mmol/L；红细胞比容(Hct)-静脉血: 45.4%；丙氨酸氨基转移酶(ALT)-静脉血: 37.9U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.77mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 25.2U/……\n\n【既往治疗与反应】\n- [全程D34] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗6次，无特殊主诉。复查血常规、生化未见明显异常。Rx：1.继续放疗。2.定期复查血常规等。3.对症支持。\n- [全程D41] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗11次，无特殊主诉。查体见鼻咽顶壁、右顶侧壁可见多个小结节，较前有所缩小，粘膜可见小片状白膜，双颈淋巴结未触及肿大，颅神经检查阴性，全身骨无压痛。和11-10复查血常规、血生化均未见明显异常。皮肤反应：0 Rx：1.继续放疗。粘膜反应：Ⅱ° 2.定期复查血常规等。3.对症支持。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停调强放疗，待口腔黏膜炎恢复至Ⅰ度后恢复放疗，期间加强静脉营养支持。\nB. 继续调强放疗，加用全身静脉广谱抗生素，定期复查血常规及生化。\nC. 继续调强放疗，降低单次靶区照射剂量，给予局部含漱等对症处理。\nD. 继续调强放疗，加用静脉糖皮质激素，定期复查血常规及生化。\nE. 继续调强放疗，给予局部含漱等对症处理，定期复查血常规及生化。\nF. 暂停调强放疗，加用全身抗真菌药物，待黏膜白膜消退后恢复放疗。\nG. 继续调强放疗，加用顺铂单药同步化疗，给予局部含漱等对症处理。\nH. 继续调强放疗，给予重组人粒细胞刺激因子皮下注射，定期复查血常规。\nI. 暂停调强放疗，行鼻咽黏膜活检明确白膜性质，给予局部含漱等对症处理。\nJ. 继续调强放疗，加用尼妥珠单抗靶向治疗，给予局部含漱等对症处理。\nK. 终止根治性放疗，转为姑息性放疗，加强镇痛及口腔局部护理。\nL. 继续调强放疗，预防性留置胃管，给予局部含漱等对症处理。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、口咽。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D36] 检验组合: 血小板比容-静脉血: 21%；红细胞计数(RBC#)-静脉血: 5.3510E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 327g/L；血小板计数(PLT#)-静脉血: 20710E9/L；大血小板百分比(P-LCR%)-静脉血: 25.9%；单核细胞计数(Mono#)-静脉血: 0.410E9/L；白细胞计数(WBC#)-静脉血: 5.9110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.654；血小板分布宽度(PDW)-静脉血: 11.9%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4；红细胞比容(Hct)-静脉血: 49.8%；单核细胞百分比(Mono%)-静脉血: 0.059；平均血小板体积(MPV)-静脉血: 10.1fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.9；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.262；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.022；平均红细胞体积(MCV)-静脉血: 93.1fL；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；血红蛋白(Hb)-静脉血: 163g/L\n- [全程D41] 检验组合: 红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.3%；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；血小板比容-静脉血: 15.7%；γ-谷氨酰基转移酶(GGT)-静脉血: 29.2U/L；红细胞计数(RBC#)-静脉血: 4.9510E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.024；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 338.3g/L；钠离子(Na+)-静脉血: 141.9mmol/L；单核细胞百分比(Mono%)-静脉血: 0.068；尿酸(UA)-静脉血: 478.3umol/L；钾离子(K+)-静脉血: 4.3mmol/L；间接胆红素(IBIL)-静脉血: 16.8umolL；乳酸脱氢酶(LDH)-静脉血: 152.4U/L；平均红细胞体积(MCV)-静脉血: 91.7fL；碱性磷酸酶(ALP)-静脉血: 56.1U/L；白蛋白(ALB)-静脉血: 45.9g/L；白细胞计数(WBC#)-静脉血: 8.1810E9/L；葡萄糖(Glu)-静脉血: 4.49mmol/L；阴离子间隙(AG)-静脉血: 17；血小板计数(PLT#)-静脉血: 193.210E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；总蛋白(TP)-静脉血: 70.66g/L；总钙(Ca)-静脉血: 2.29mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.9；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；中性粒细胞计数(Neut#)-静脉血: 610E9/L；胱抑素(Cys-C)-静脉血: 0.96mg/L；C-反应蛋白(CRP)-静脉血: 5.9mg/L；载脂蛋白B(apoB)-静脉血: 1.37g/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.5mmol/L；红细胞比容(Hct)-静脉血: 45.4%；丙氨酸氨基转移酶(ALT)-静脉血: 37.9U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.77mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 25.2U/……\n\n【既往治疗与反应】\n- [全程D34] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗6次，无特殊主诉。复查血常规、生化未见明显异常。Rx：1.继续放疗。2.定期复查血常规等。3.对症支持。\n- [全程D41] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗11次，无特殊主诉。查体见鼻咽顶壁、右顶侧壁可见多个小结节，较前有所缩小，粘膜可见小片状白膜，双颈淋巴结未触及肿大，颅神经检查阴性，全身骨无压痛。和11-10复查血常规、血生化均未见明显异常。皮肤反应：0 Rx：1.继续放疗。粘膜反应：Ⅱ° 2.定期复查血常规等。3.对症支持。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停调强放疗，待口腔黏膜炎恢复至Ⅰ度后恢复放疗，期间加强静脉营养支持。\nB. 继续调强放疗，加用全身静脉广谱抗生素，定期复查血常规及生化。\nC. 继续调强放疗，降低单次靶区照射剂量，给予局部含漱等对症处理。\nD. 继续调强放疗，加用静脉糖皮质激素，定期复查血常规及生化。\nE. 继续调强放疗，给予局部含漱等对症处理，定期复查血常规及生化。\nF. 暂停调强放疗，加用全身抗真菌药物，待黏膜白膜消退后恢复放疗。\nG. 继续调强放疗，加用顺铂单药同步化疗，给予局部含漱等对症处理。\nH. 继续调强放疗，给予重组人粒细胞刺激因子皮下注射，定期复查血常规。\nI. 暂停调强放疗，行鼻咽黏膜活检明确白膜性质，给予局部含漱等对症处理。\nJ. 继续调强放疗，加用尼妥珠单抗靶向治疗，给予局部含漱等对症处理。\nK. 终止根治性放疗，转为姑息性放疗，加强镇痛及口腔局部护理。\nL. 继续调强放疗，预防性留置胃管，给予局部含漱等对症处理。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-be3624e29a98e9da91fced75","patient_id":"patient-7c0941dbdd4694260fd4de38","turn_id":"turn07","turn_position":6,"turn_type":"recurrence_or_salvage_decision","gold_letter":"F","gold_action":"维持规范随访观察，可根据症状给予一般对症及支持治疗，不启动挽救性局部治疗或全身抗肿瘤治疗。","options":[{"letter":"A","text":"安排鼻咽及颈部活检，准备行挽救性内镜下鼻咽切除术。","is_gold":false},{"letter":"B","text":"启动含铂双药方案全身化疗4-6个周期。","is_gold":false},{"letter":"C","text":"行全身PET/CT评估，若有局部高代谢灶则行挽救性放疗。","is_gold":false},{"letter":"D","text":"予以原发灶及颈部引流区局部推量补照4-6Gy。","is_gold":false},{"letter":"E","text":"给予卡培他滨单药口服维持治疗半年至一年。","is_gold":false},{"letter":"F","text":"维持规范随访观察，可症状给予一般对症及支持治疗。","is_gold":true},{"letter":"G","text":"行鼻咽及颈部MRI增强扫描，若有可疑残留则行诱导化疗。","is_gold":false},{"letter":"H","text":"启动PD-1抑制剂联合含铂双药全身化疗。","is_gold":false},{"letter":"I","text":"安排鼻咽内镜活检，若病理阳性则行双侧颈部淋巴结清扫术。","is_gold":false},{"letter":"J","text":"补充顺铂单药全身化疗2个周期以强化局部控制。","is_gold":false},{"letter":"K","text":"行全身骨扫描及头颅MRI，排除远处转移后行局部挽救性放疗。","is_gold":false},{"letter":"L","text":"予以吉西他滨联合顺铂全身化疗4-6个周期。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、口咽。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D50] 检验组合: 平均红细胞体积(MCV)-静脉血: 92.2fL；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.727；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.033；血小板计数(PLT#)-静脉血: 15910E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.165；单核细胞百分比(Mono%)-静脉血: 0.073；血红蛋白(Hb)-静脉血: 162g/L；平均血小板体积(MPV)-静脉血: 10.6fL；白细胞计数(WBC#)-静脉血: 4.210E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.9；红细胞计数(RBC#)-静脉血: 5.2310E12/L；中性粒细胞计数(Neut#)-静脉血: 3.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；大血小板百分比(P-LCR%)-静脉血: 28.7%；血小板分布宽度(PDW)-静脉血: 11.3%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.4；血小板比容-静脉血: 17%；单核细胞计数(Mono#)-静脉血: 0.310E9/L；红细胞比容(Hct)-静脉血: 48.2%\n- [全程D56] 检验组合: 血小板分布宽度(PDW)-静脉血: 12.4%；中性粒细胞百分比(Neut%)-静脉血: 0.84；单核细胞计数(Mono#)-静脉血: 0.410E9/L；血小板比容-静脉血: 19%；血红蛋白(Hb)-静脉血: 158g/L；红细胞计数(RBC#)-静脉血: 5.2110E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.7；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均血小板体积(MPV)-静脉血: 10.5fL；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；红细胞比容(Hct)-静脉血: 47.9%；血小板计数(PLT#)-静脉血: 17710E9/L；平均红细胞体积(MCV)-静脉血: 91.9fL；淋巴细胞百分比(Lymph%)-静脉血: 0.077；平均红细胞血红蛋白含量(MCH)-静脉血: 30.3pg；中性粒细胞计数(Neut#)-静脉血: 5.310E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；单核细胞百分比(Mono%)-静脉血: 0.061；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.9；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；大血小板百分比(P-LCR%)-静脉血: 28.7%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.016；白细胞计数(WBC#)-静脉血: 6.3510E9/L\n- [全程D62] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；血小板分布宽度(PDW)-静脉血: 13.6%；单核细胞计数(Mono#)-静脉血: 0.310E9/L；白细胞计数(WBC#)-静脉血: 5.1610E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.798；红细胞比容(Hct)-静脉血: 47.9%；单核细胞百分比(Mono%)-静脉血: 0.066；大血小板百分比(P-LCR%)-静脉血: 30.3%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.7；血小板计数(PLT#)-静脉血: 21110E9/L；血小板比容-静脉血: 22%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.7；平均红细胞体积(MCV)-静脉血: 91.6fL；平均红细胞血红蛋白含量(MCH)-静脉血: 30.4pg；红细胞计数(RBC#)-静脉血: 5.2310E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞计数(Neut#)-静脉血: 4.110E9/L；血红蛋白(Hb)-静脉血: 159g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；淋巴细胞百分比(Lymph%)-静脉血: 0.109；平均红细胞血红蛋白浓度(MCHC)-静脉血: 332g/L；平均血小板体积(MPV)-静脉血: 10.5fL；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L\n- [全程D63] 检验组合: 低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.79mmol/L；总蛋白(TP)-静脉血: 66.06g/L；乳酸脱氢酶(LDH)-静脉血: 190U/L；葡萄糖(Glu)-静脉血: 4.43mmol/L；C-反应蛋白(CRP)-静脉血: 8.61mg/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.48；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.01mmolL；γ-谷氨酰基转移酶(GGT)-静脉血: 16.1U/L；镁离子(Mg2+)-静脉血: 0.98mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21U/L；总胆固醇(TC)-静脉血: 5.22mmol/L；阴离子间隙(AG)-静脉血: 15.7；氯离子(Cl-)-静脉血: 99.4mmol/L；碱性磷酸酶(ALP)-静脉血: 59.5U/L；磷(P)-静脉血: 1.2mmol/L；钾离子(K+)-静脉血: 3.7mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.11；甘油三酯(TG)-静脉血: 1.21mmol/L；肌酐(Crea)-静脉血: 80.4umol/L；总胆红素(TBIL)-静脉血: 23.7umol/L；载脂蛋白B(apoB)-静脉血: 1.27g/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.4mmol/L；总钙(Ca)-静脉血: 2.2mmol/L；尿素氮(BUN)-静脉血: 6.6mmol/L；钠离子(Na+)-静脉血: 142.5mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 14.2U/L；载脂蛋白AI(apoAI)-静脉血: 0.95g/L；间接胆红素(IBIL)-静脉血: 17.2umolL；直接胆红素(DBIL)-静脉血: 6.5umol/L；尿酸(UA)-静脉血: 490.3umol/L；总胆汁酸(TBA)-静脉血: 3.4umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 15.5U/L；球蛋白(GLO)-静脉血: 21.26g/L；白蛋白(ALB)-静脉血: 44.8g/L；胱抑素(Cys-C)-静脉血: 0.81mg/L\n- [全程D65] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:80（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:20（参考: 阴性）\n- [全程D160] 超声；腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约12cm/s。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、脾脏未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D160] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺野纹理清晰，双肺野未见明显实质性病变。双侧肺门无增大，纵隔未见增宽，心影形态、大小、位置未见异常。双膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n- [全程D160] 检验组合: EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）\n\n【既往治疗与反应】\n- [全程D55] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗21次，诉口干、咽痛较前明显，乏力，余无特殊主诉。查体见鼻咽右顶侧壁稍增厚，炎性分泌物较多，粘膜充血水肿，双颈淋巴结未触及肿大，颅神经检查阴性，全身骨无压痛。复查血常规未见明显异常。皮肤反应：I°Rx：1.继续放疗。粘膜反应：Ⅱ° 2.定期复查血常规等。3.抗炎、止痛、营养对症支持。\n- [全程D62] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗26次，诉口干、咽痛较前缓解，仍觉乏力，无特殊主诉。和12-01复查血常规、生化均未见明显异常。皮肤反应：Ⅰ°Rx：1.继续放疗。粘膜反应：Ⅱ° 2.定期复查血常规等。3.营养对症支持。\n- [全程D65] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗28次，诉口干、咽痛好转，自觉体力虚弱，并拒绝最后2次放疗。皮肤反应：Ⅰ° Rx：1.定期复查。粘膜反应：Ⅰ° 2.不适随诊。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 安排鼻咽及颈部活检，准备行挽救性内镜下鼻咽切除术。\nB. 启动含铂双药方案全身化疗4-6个周期。\nC. 行全身PET/CT评估，若有局部高代谢灶则行挽救性放疗。\nD. 予以原发灶及颈部引流区局部推量补照4-6Gy。\nE. 给予卡培他滨单药口服维持治疗半年至一年。\nF. 维持规范随访观察，可症状给予一般对症及支持治疗。\nG. 行鼻咽及颈部MRI增强扫描，若有可疑残留则行诱导化疗。\nH. 启动PD-1抑制剂联合含铂双药全身化疗。\nI. 安排鼻咽内镜活检，若病理阳性则行双侧颈部淋巴结清扫术。\nJ. 补充顺铂单药全身化疗2个周期以强化局部控制。\nK. 行全身骨扫描及头颅MRI，排除远处转移后行局部挽救性放疗。\nL. 予以吉西他滨联合顺铂全身化疗4-6个周期。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、口咽。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D50] 检验组合: 平均红细胞体积(MCV)-静脉血: 92.2fL；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.727；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.033；血小板计数(PLT#)-静脉血: 15910E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.165；单核细胞百分比(Mono%)-静脉血: 0.073；血红蛋白(Hb)-静脉血: 162g/L；平均血小板体积(MPV)-静脉血: 10.6fL；白细胞计数(WBC#)-静脉血: 4.210E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.9；红细胞计数(RBC#)-静脉血: 5.2310E12/L；中性粒细胞计数(Neut#)-静脉血: 3.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；大血小板百分比(P-LCR%)-静脉血: 28.7%；血小板分布宽度(PDW)-静脉血: 11.3%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.4；血小板比容-静脉血: 17%；单核细胞计数(Mono#)-静脉血: 0.310E9/L；红细胞比容(Hct)-静脉血: 48.2%\n- [全程D56] 检验组合: 血小板分布宽度(PDW)-静脉血: 12.4%；中性粒细胞百分比(Neut%)-静脉血: 0.84；单核细胞计数(Mono#)-静脉血: 0.410E9/L；血小板比容-静脉血: 19%；血红蛋白(Hb)-静脉血: 158g/L；红细胞计数(RBC#)-静脉血: 5.2110E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.7；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均血小板体积(MPV)-静脉血: 10.5fL；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；红细胞比容(Hct)-静脉血: 47.9%；血小板计数(PLT#)-静脉血: 17710E9/L；平均红细胞体积(MCV)-静脉血: 91.9fL；淋巴细胞百分比(Lymph%)-静脉血: 0.077；平均红细胞血红蛋白含量(MCH)-静脉血: 30.3pg；中性粒细胞计数(Neut#)-静脉血: 5.310E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；单核细胞百分比(Mono%)-静脉血: 0.061；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.9；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；大血小板百分比(P-LCR%)-静脉血: 28.7%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.016；白细胞计数(WBC#)-静脉血: 6.3510E9/L\n- [全程D62] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；血小板分布宽度(PDW)-静脉血: 13.6%；单核细胞计数(Mono#)-静脉血: 0.310E9/L；白细胞计数(WBC#)-静脉血: 5.1610E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.798；红细胞比容(Hct)-静脉血: 47.9%；单核细胞百分比(Mono%)-静脉血: 0.066；大血小板百分比(P-LCR%)-静脉血: 30.3%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.7；血小板计数(PLT#)-静脉血: 21110E9/L；血小板比容-静脉血: 22%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.7；平均红细胞体积(MCV)-静脉血: 91.6fL；平均红细胞血红蛋白含量(MCH)-静脉血: 30.4pg；红细胞计数(RBC#)-静脉血: 5.2310E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞计数(Neut#)-静脉血: 4.110E9/L；血红蛋白(Hb)-静脉血: 159g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；淋巴细胞百分比(Lymph%)-静脉血: 0.109；平均红细胞血红蛋白浓度(MCHC)-静脉血: 332g/L；平均血小板体积(MPV)-静脉血: 10.5fL；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L\n- [全程D63] 检验组合: 低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.79mmol/L；总蛋白(TP)-静脉血: 66.06g/L；乳酸脱氢酶(LDH)-静脉血: 190U/L；葡萄糖(Glu)-静脉血: 4.43mmol/L；C-反应蛋白(CRP)-静脉血: 8.61mg/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.48；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.01mmolL；γ-谷氨酰基转移酶(GGT)-静脉血: 16.1U/L；镁离子(Mg2+)-静脉血: 0.98mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21U/L；总胆固醇(TC)-静脉血: 5.22mmol/L；阴离子间隙(AG)-静脉血: 15.7；氯离子(Cl-)-静脉血: 99.4mmol/L；碱性磷酸酶(ALP)-静脉血: 59.5U/L；磷(P)-静脉血: 1.2mmol/L；钾离子(K+)-静脉血: 3.7mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.11；甘油三酯(TG)-静脉血: 1.21mmol/L；肌酐(Crea)-静脉血: 80.4umol/L；总胆红素(TBIL)-静脉血: 23.7umol/L；载脂蛋白B(apoB)-静脉血: 1.27g/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.4mmol/L；总钙(Ca)-静脉血: 2.2mmol/L；尿素氮(BUN)-静脉血: 6.6mmol/L；钠离子(Na+)-静脉血: 142.5mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 14.2U/L；载脂蛋白AI(apoAI)-静脉血: 0.95g/L；间接胆红素(IBIL)-静脉血: 17.2umolL；直接胆红素(DBIL)-静脉血: 6.5umol/L；尿酸(UA)-静脉血: 490.3umol/L；总胆汁酸(TBA)-静脉血: 3.4umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 15.5U/L；球蛋白(GLO)-静脉血: 21.26g/L；白蛋白(ALB)-静脉血: 44.8g/L；胱抑素(Cys-C)-静脉血: 0.81mg/L\n- [全程D65] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:80（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:20（参考: 阴性）\n- [全程D160] 超声；腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约12cm/s。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、脾脏未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D160] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺野纹理清晰，双肺野未见明显实质性病变。双侧肺门无增大，纵隔未见增宽，心影形态、大小、位置未见异常。双膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n- [全程D160] 检验组合: EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）\n\n【既往治疗与反应】\n- [全程D55] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗21次，诉口干、咽痛较前明显，乏力，余无特殊主诉。查体见鼻咽右顶侧壁稍增厚，炎性分泌物较多，粘膜充血水肿，双颈淋巴结未触及肿大，颅神经检查阴性，全身骨无压痛。复查血常规未见明显异常。皮肤反应：I°Rx：1.继续放疗。粘膜反应：Ⅱ° 2.定期复查血常规等。3.抗炎、止痛、营养对症支持。\n- [全程D62] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗26次，诉口干、咽痛较前缓解，仍觉乏力，无特殊主诉。和12-01复查血常规、生化均未见明显异常。皮肤反应：Ⅰ°Rx：1.继续放疗。粘膜反应：Ⅱ° 2.定期复查血常规等。3.营养对症支持。\n- [全程D65] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗28次，诉口干、咽痛好转，自觉体力虚弱，并拒绝最后2次放疗。皮肤反应：Ⅰ° Rx：1.定期复查。粘膜反应：Ⅰ° 2.不适随诊。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 安排鼻咽及颈部活检，准备行挽救性内镜下鼻咽切除术。\nB. 启动含铂双药方案全身化疗4-6个周期。\nC. 行全身PET/CT评估，若有局部高代谢灶则行挽救性放疗。\nD. 予以原发灶及颈部引流区局部推量补照4-6Gy。\nE. 给予卡培他滨单药口服维持治疗半年至一年。\nF. 维持规范随访观察，可症状给予一般对症及支持治疗。\nG. 行鼻咽及颈部MRI增强扫描，若有可疑残留则行诱导化疗。\nH. 启动PD-1抑制剂联合含铂双药全身化疗。\nI. 安排鼻咽内镜活检，若病理阳性则行双侧颈部淋巴结清扫术。\nJ. 补充顺铂单药全身化疗2个周期以强化局部控制。\nK. 行全身骨扫描及头颅MRI，排除远处转移后行局部挽救性放疗。\nL. 予以吉西他滨联合顺铂全身化疗4-6个周期。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-5737526b7d92f1b3d5423663","patient_id":"patient-02ca51eed4fedbb13e4db76d","turn_id":"turn01","turn_position":1,"turn_type":"initial_workup_choice","gold_letter":"H","gold_action":"完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。","options":[{"letter":"A","text":"完善电子鼻咽镜检查及活检，行鼻咽及颈部CT平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。","is_gold":false},{"letter":"B","text":"完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，并直接行全身PET-CT评估远处转移。","is_gold":false},{"letter":"C","text":"完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，暂不进行胸腹部影像学检查待病理确诊。","is_gold":false},{"letter":"D","text":"完善间接鼻咽镜检查，行鼻咽及颈部MRI平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。","is_gold":false},{"letter":"E","text":"完善颈部淋巴结细针穿刺活检，行鼻咽及颈部MRI平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。","is_gold":false},{"letter":"F","text":"完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。","is_gold":false},{"letter":"G","text":"完善电子鼻咽镜检查及活检，行鼻咽及颈部CT平扫，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。","is_gold":false},{"letter":"H","text":"完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。","is_gold":true},{"letter":"I","text":"完善颈部淋巴结切除活检，行鼻咽及颈部MRI平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。","is_gold":false},{"letter":"J","text":"完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，并完善骨扫描及头颅MRI检查。","is_gold":false},{"letter":"K","text":"完善电子鼻咽镜检查及活检，仅行鼻咽MRI平扫+增强，颈部行彩超评估，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。","is_gold":false},{"letter":"L","text":"完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，并完善全身骨髓穿刺活检。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、鼻腔。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左颈肿物20天；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物；既往史: 20余年前患“血吸虫”病行脾脏切除术，当地医院检查示“早期肝硬化”，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：37.3℃，P：62次/分，R：20次/分，BP：121/75mmHg,Ht：165cm，Wt：58kg，BSA：1.63m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽左侧顶后壁粘膜稍隆起；左侧颈部II区可扪及1个淋巴结，最大径1×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善电子鼻咽镜检查及活检，行鼻咽及颈部CT平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。\nB. 完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，并直接行全身PET-CT评估远处转移。\nC. 完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，暂不进行胸腹部影像学检查待病理确诊。\nD. 完善间接鼻咽镜检查，行鼻咽及颈部MRI平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。\nE. 完善颈部淋巴结细针穿刺活检，行鼻咽及颈部MRI平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。\nF. 完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。\nG. 完善电子鼻咽镜检查及活检，行鼻咽及颈部CT平扫，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。\nH. 完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。\nI. 完善颈部淋巴结切除活检，行鼻咽及颈部MRI平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。\nJ. 完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，并完善骨扫描及头颅MRI检查。\nK. 完善电子鼻咽镜检查及活检，仅行鼻咽MRI平扫+增强，颈部行彩超评估，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。\nL. 完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，并完善全身骨髓穿刺活检。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、鼻腔。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左颈肿物20天；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物；既往史: 20余年前患“血吸虫”病行脾脏切除术，当地医院检查示“早期肝硬化”，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：37.3℃，P：62次/分，R：20次/分，BP：121/75mmHg,Ht：165cm，Wt：58kg，BSA：1.63m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 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+{"sample_id":"sample-84b4eab1f1613c7517fd613a","patient_id":"patient-02ca51eed4fedbb13e4db76d","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"I","gold_action":"行鼻咽镜下鼻咽原发灶活检以明确病理诊断","options":[{"letter":"A","text":"行PET-CT检查以重新评估全身分期","is_gold":false},{"letter":"B","text":"行左侧颈部淋巴结切除活检以明确病理诊断","is_gold":false},{"letter":"C","text":"行左侧颈部淋巴结细针穿刺活检(FNAC)以明确病理诊断","is_gold":false},{"letter":"D","text":"行鼻咽脱落细胞涂片检查以替代组织活检","is_gold":false},{"letter":"E","text":"行肝脏增强MRI检查以进一步排查肝脏转移灶","is_gold":false},{"letter":"F","text":"行右侧颈部II区小淋巴结切除活检以明确对侧转移情况","is_gold":false},{"letter":"G","text":"行外周血EB病毒DNA定量检测作为确诊依据","is_gold":false},{"letter":"H","text":"行左上颌骨病灶穿刺活检以明确骨扫描异常灶性质","is_gold":false},{"letter":"I","text":"行鼻咽镜下鼻咽原发灶活检以明确病理诊断","is_gold":true},{"letter":"J","text":"行鼻咽肿物广泛切除术以达到诊断与治疗目的","is_gold":false},{"letter":"K","text":"行颈部超声造影检查以进一步评估右颈淋巴结性质","is_gold":false},{"letter":"L","text":"行鼻咽及颈部CT平扫加增强以补充评估颅底骨质破坏","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、鼻腔。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 逆钟向转位 正常范围心电图\n- [全程D1] 检验组合: 肌酐(Crea)-静脉血: 56.1umol/L；阴离子间隙(AG)-静脉血: 11.1；α-L-岩藻糖苷酶(AFU)-静脉血: 35.5U/L；凝血酶原时间(PT)-静脉血: 11.7sec.；胱抑素(Cys-C)-静脉血: 0.85mg/L；淋巴细胞百分比(Lymph%)-静脉血: 0.428；骨钙素N端中分子片段(N-MID)-静脉血: 19.3ng/ml；纤维蛋白原(Fbg)-静脉血: 2.07g/L；钠离子(Na+)-静脉血: 140.5mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；总钙(Ca)-静脉血: 2.29mmol/L；乳酸脱氢酶(LDH)-静脉血: 164U/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.44；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.35mmol/L；血小板分布宽度(PDW)-静脉血: 15.9%；平均红细胞血红蛋白含量(MCH)-静脉血: 31.5pg；总胆固醇(TC)-静脉血: 4.12mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；Rh血型-静脉血: 阳性；红细胞比容(Hct)-静脉血: 41.2%；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 9.9umolL；D-二聚体(D-Dimer)-静脉血: 5.09ug/ml；钾离子(K+)-静脉血: 4.24mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.424；直接胆红素(DBIL)-静脉血: 5.8umol/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；天门冬氨酸氨基转移酶(AST)-静脉血: 18.6U/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；透明质酸(HA)-静脉血: 71.337ng/ml；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.5；纤维蛋白原降解产物(FDP)-静脉血:……\n- [全程D2] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双下肺纹理稍粗，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n- [全程D4] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏形态失常，表面凸凹不平，边缘钝，肝实质回声不均匀，明显增强、粗糙，肝内未见明确肿块回声。门静脉主干内径约15mm。肝静脉、门静脉内未见异常回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约14cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏术后缺如。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约35×24×23mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝硬化声像。 脾脏术后缺如。 胆囊、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D7] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 左上颌骨可见片状放射性浓集灶。胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 左上颌骨炎症。 余全身骨骼未见明显异常。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行PET-CT检查以重新评估全身分期\nB. 行左侧颈部淋巴结切除活检以明确病理诊断\nC. 行左侧颈部淋巴结细针穿刺活检(FNAC)以明确病理诊断\nD. 行鼻咽脱落细胞涂片检查以替代组织活检\nE. 行肝脏增强MRI检查以进一步排查肝脏转移灶\nF. 行右侧颈部II区小淋巴结切除活检以明确对侧转移情况\nG. 行外周血EB病毒DNA定量检测作为确诊依据\nH. 行左上颌骨病灶穿刺活检以明确骨扫描异常灶性质\nI. 行鼻咽镜下鼻咽原发灶活检以明确病理诊断\nJ. 行鼻咽肿物广泛切除术以达到诊断与治疗目的\nK. 行颈部超声造影检查以进一步评估右颈淋巴结性质\nL. 行鼻咽及颈部CT平扫加增强以补充评估颅底骨质破坏\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、鼻腔。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 逆钟向转位 正常范围心电图\n- [全程D1] 检验组合: 肌酐(Crea)-静脉血: 56.1umol/L；阴离子间隙(AG)-静脉血: 11.1；α-L-岩藻糖苷酶(AFU)-静脉血: 35.5U/L；凝血酶原时间(PT)-静脉血: 11.7sec.；胱抑素(Cys-C)-静脉血: 0.85mg/L；淋巴细胞百分比(Lymph%)-静脉血: 0.428；骨钙素N端中分子片段(N-MID)-静脉血: 19.3ng/ml；纤维蛋白原(Fbg)-静脉血: 2.07g/L；钠离子(Na+)-静脉血: 140.5mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；总钙(Ca)-静脉血: 2.29mmol/L；乳酸脱氢酶(LDH)-静脉血: 164U/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.44；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.35mmol/L；血小板分布宽度(PDW)-静脉血: 15.9%；平均红细胞血红蛋白含量(MCH)-静脉血: 31.5pg；总胆固醇(TC)-静脉血: 4.12mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；Rh血型-静脉血: 阳性；红细胞比容(Hct)-静脉血: 41.2%；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 9.9umolL；D-二聚体(D-Dimer)-静脉血: 5.09ug/ml；钾离子(K+)-静脉血: 4.24mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.424；直接胆红素(DBIL)-静脉血: 5.8umol/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；天门冬氨酸氨基转移酶(AST)-静脉血: 18.6U/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；透明质酸(HA)-静脉血: 71.337ng/ml；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.5；纤维蛋白原降解产物(FDP)-静脉血:……\n- [全程D2] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双下肺纹理稍粗，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n- [全程D4] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏形态失常，表面凸凹不平，边缘钝，肝实质回声不均匀，明显增强、粗糙，肝内未见明确肿块回声。门静脉主干内径约15mm。肝静脉、门静脉内未见异常回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约14cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏术后缺如。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约35×24×23mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝硬化声像。 脾脏术后缺如。 胆囊、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D7] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 左上颌骨可见片状放射性浓集灶。胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 左上颌骨炎症。 余全身骨骼未见明显异常。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行PET-CT检查以重新评估全身分期\nB. 行左侧颈部淋巴结切除活检以明确病理诊断\nC. 行左侧颈部淋巴结细针穿刺活检(FNAC)以明确病理诊断\nD. 行鼻咽脱落细胞涂片检查以替代组织活检\nE. 行肝脏增强MRI检查以进一步排查肝脏转移灶\nF. 行右侧颈部II区小淋巴结切除活检以明确对侧转移情况\nG. 行外周血EB病毒DNA定量检测作为确诊依据\nH. 行左上颌骨病灶穿刺活检以明确骨扫描异常灶性质\nI. 行鼻咽镜下鼻咽原发灶活检以明确病理诊断\nJ. 行鼻咽肿物广泛切除术以达到诊断与治疗目的\nK. 行颈部超声造影检查以进一步评估右颈淋巴结性质\nL. 行鼻咽及颈部CT平扫加增强以补充评估颅底骨质破坏\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-9895c4d0f7c600fd0c046a50","patient_id":"patient-02ca51eed4fedbb13e4db76d","turn_id":"turn05","turn_position":3,"turn_type":"toxicity_or_support_decision","gold_letter":"L","gold_action":"继续行第2程同期化疗，化疗后复查血象视情况予以升白细胞治疗，并给予静脉营养、补液及通便等对症支持。","options":[{"letter":"A","text":"暂停同期化疗，单纯行根治性放疗，立即予以重组人粒细胞集落刺激因子升白细胞治疗。","is_gold":false},{"letter":"B","text":"暂停放化疗，立即予以重组人粒细胞集落刺激因子，待白细胞恢复正常后再恢复放化综合治疗。","is_gold":false},{"letter":"C","text":"延迟第2程同期化疗，继续放疗，观察3天后复查血常规，若中性粒细胞达标再行化疗。","is_gold":false},{"letter":"D","text":"继续行第2程同期化疗，化疗前予以长效聚乙二醇化重组人粒细胞集落刺激因子预防性升白细胞。","is_gold":false},{"letter":"E","text":"继续行第2程同期化疗，化疗期间同步予以口服抗生素预防感染及静脉营养支持。","is_gold":false},{"letter":"F","text":"继续行第2程同期化疗，将顺铂剂量下调20%，并给予静脉营养、补液及通便等对症支持。","is_gold":false},{"letter":"G","text":"终止同期化疗，改为单纯放疗联合西妥昔单抗靶向治疗，并予以静脉营养支持。","is_gold":false},{"letter":"H","text":"继续行第2程同期化疗，化疗后立即常规予以重组人粒细胞集落刺激因子连续升白细胞治疗3天。","is_gold":false},{"letter":"I","text":"暂停放疗，按计划行第2程同期化疗，化疗后复查血象视情况予以升白细胞治疗。","is_gold":false},{"letter":"J","text":"继续行第2程同期化疗，将顺铂更换为卡铂，并给予静脉营养、补液及通便等对症支持。","is_gold":false},{"letter":"K","text":"延迟第2程同期化疗，予以静脉营养、补液及通便等对症支持，待1周后复查血象再决定是否化疗。","is_gold":false},{"letter":"L","text":"继续行第2程同期化疗，化疗后复查血象视情况予以升白细胞治疗，并给予静脉营养、补液及通便等对症支持。","is_gold":true}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、鼻腔。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左颈肿物20天；现病史: 缘于20天前患者无意中出现左颈肿物，未伴涕血、耳鸣、听力下降、头痛、面麻等不适，某次就诊时间在当地医院行左颈淋巴结穿刺，病理示未见癌，某次就诊时间行鼻咽活检病理示鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物；既往史: 20余年前患“血吸虫”病行脾脏切除术，当地医院检查示“早期肝硬化”，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：37.3℃，P：62次/分，R：20次/分，BP：121/75mmHg,Ht：165cm，Wt：58kg，BSA：1.63m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率62次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽左侧顶后壁粘膜稍隆起；左侧颈部II区可扪及1个淋巴结，最大径1×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D27] 入院记录: 主诉: 确诊鼻咽癌1月余；现病史: 缘于某次就诊时间9月下旬患者无意中出现左颈肿物，未伴涕血、耳鸣、听力下降、头痛、面麻等不适，某次就诊时间在当地医院行左颈淋巴结穿刺，病理示未见癌，某次就诊时间行鼻咽活检病理示分化非角化癌。某次就诊时间日入院予以治疗前相关检查，明确诊断为鼻咽分化非角化癌，[分期信息见历史辅助诊断节点],III期，予以行放疗计划设计，现放疗计划设计完成，入院行放化综合治疗。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物；既往史: 20余年前患“血吸虫”病行脾脏切除术，当地医院检查示“早期肝硬化”，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：37.3℃，P：62次/分，R：20次/分，BP：121/75mmHg,Ht：165cm，Wt：58kg，BSA：1.63m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率62次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽左侧顶后壁粘膜稍隆起；左侧颈部II区可扪及1个淋巴结，最大径1×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D35] 检验组合: 碱性磷酸酶(ALP)-静脉血: 93.6U/L；丙氨酸氨基转移酶(ALT)-静脉血: 26.3U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.2U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 34.4U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.73；α-L-岩藻糖苷酶(AFU)-静脉血: 38.5U/L；乳酸脱氢酶(LDH)-静脉血: 195.7U/L；总胆汁酸(TBA)-静脉血: 2.9umol/L\n- [全程D39] 检验组合: 胱抑素(Cys-C)-静脉血: 0.84mg/L；肌酐(Crea)-静脉血: 62.7umol/L；阴离子间隙(AG)-静脉血: 11；单核细胞计数(Mono#)-静脉血: 0.510E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.8mmol/L；载脂蛋白B(apoB)-静脉血: 0.81g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.8U/L；平均红细胞体积(MCV)-静脉血: 93.8fL；单核细胞百分比(Mono%)-静脉血: 0.149；C-反应蛋白(CRP)-静脉血: 0.37mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；淋巴细胞百分比(Lymph%)-静脉血: 0.352；有核红细胞百分比(NRBC%)-静脉血: 0；尿素氮(BUN)-静脉血: 7.54mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.17g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 40U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；直接胆红素(DBIL)-静脉血: 6.9umol/L；平均血小板体积(MPV)-静脉血: 9.04fL；红细胞计数(RBC#)-静脉血: 4.2310E12/L；总胆固醇(TC)-静脉血: 4.39mmol/L；总钙(Ca)-静脉血: 2.39mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.21mmolL；丙氨酸氨基转移酶(ALT)-静脉血: 28.6U/L；间接胆红素(IBIL)-静脉血: 11.6umolL；甘油三酯(TG)-静脉血: 0.5mmol/L；尿酸(UA)-静脉血: 332.9umol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32.2pg；中性粒细胞计数(Neut#)-静脉血: 1.510E9/L；总胆红素(TBIL)-静脉血: 18.5umol/L；乳酸脱氢酶(LDH)-静脉血: 145.6U/L；磷(P)-静脉血: 1.34mmol/L；碱性磷酸酶(ALP)-静脉血: 93.2U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D28] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者今日返院，一般情况可，无明显不适主诉，体查情况基本同前，患者现放疗计划已设计完成并通过全科会诊，NPDT70Gy/30F,CTV1:60Gy/30F,CTV2：54Gy/30F，靶区剂量分布均匀，正常组织剂量在可接受范围内。[姓名已隐去]副医生信息已隐藏，患者放疗计划设计完成，可行放疗前复位及验证等准备，开始放疗，患者既往血吸虫肝硬化病史，患者化疗后可能出现肝功能损伤，肝衰竭，严重者可危及生命，与患者及家属沟通后，患者及家属表示愿意承担化疗风险，予以择期行DDP单药每周同时期化疗。\n- [全程D29] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 今日查房，患者一般情况可，无明显不适主诉，体查同入院。[姓名已隐去]副医生信息已隐藏示：依约开始放疗，嘱患者注意营养与休息。\n- [全程D34] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者已开始行根治性放疗，现放疗2F，昨日完成一程同期化疗，诉额、双侧颞部头痛，一般情况尚可，体查情况基本同前。[姓名已隐去]副医生信息已隐藏：现患者已开始放疗，一程化疗结束，针对患者主诉，考虑放疗引起不良反应，予以止痛等对症处理，病情继观。\n- [全程D39] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现处于放化综合治疗中，放疗3F，无诉，体查情况基本同前，血常规、生化常规结果示：WBC3.33*10E9/L、中性粒1.5*10E9/L；[姓名已隐去]副医生信息已隐藏：现患者血象稍低，明日予以行同期化疗二程，化疗后予以复查血象后再予以升白等对症处理，密观病情。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停同期化疗，单纯行根治性放疗，立即予以重组人粒细胞集落刺激因子升白细胞治疗。\nB. 暂停放化疗，立即予以重组人粒细胞集落刺激因子，待白细胞恢复正常后再恢复放化综合治疗。\nC. 延迟第2程同期化疗，继续放疗，观察3天后复查血常规，若中性粒细胞达标再行化疗。\nD. 继续行第2程同期化疗，化疗前予以长效聚乙二醇化重组人粒细胞集落刺激因子预防性升白细胞。\nE. 继续行第2程同期化疗，化疗期间同步予以口服抗生素预防感染及静脉营养支持。\nF. 继续行第2程同期化疗，将顺铂剂量下调20%，并给予静脉营养、补液及通便等对症支持。\nG. 终止同期化疗，改为单纯放疗联合西妥昔单抗靶向治疗，并予以静脉营养支持。\nH. 继续行第2程同期化疗，化疗后立即常规予以重组人粒细胞集落刺激因子连续升白细胞治疗3天。\nI. 暂停放疗，按计划行第2程同期化疗，化疗后复查血象视情况予以升白细胞治疗。\nJ. 继续行第2程同期化疗，将顺铂更换为卡铂，并给予静脉营养、补液及通便等对症支持。\nK. 延迟第2程同期化疗，予以静脉营养、补液及通便等对症支持，待1周后复查血象再决定是否化疗。\nL. 继续行第2程同期化疗，化疗后复查血象视情况予以升白细胞治疗，并给予静脉营养、补液及通便等对症支持。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、鼻腔。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左颈肿物20天；现病史: 缘于20天前患者无意中出现左颈肿物，未伴涕血、耳鸣、听力下降、头痛、面麻等不适，某次就诊时间在当地医院行左颈淋巴结穿刺，病理示未见癌，某次就诊时间行鼻咽活检病理示鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物；既往史: 20余年前患“血吸虫”病行脾脏切除术，当地医院检查示“早期肝硬化”，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：37.3℃，P：62次/分，R：20次/分，BP：121/75mmHg,Ht：165cm，Wt：58kg，BSA：1.63m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率62次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽左侧顶后壁粘膜稍隆起；左侧颈部II区可扪及1个淋巴结，最大径1×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D27] 入院记录: 主诉: 确诊鼻咽癌1月余；现病史: 缘于某次就诊时间9月下旬患者无意中出现左颈肿物，未伴涕血、耳鸣、听力下降、头痛、面麻等不适，某次就诊时间在当地医院行左颈淋巴结穿刺，病理示未见癌，某次就诊时间行鼻咽活检病理示分化非角化癌。某次就诊时间日入院予以治疗前相关检查，明确诊断为鼻咽分化非角化癌，[分期信息见历史辅助诊断节点],III期，予以行放疗计划设计，现放疗计划设计完成，入院行放化综合治疗。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物；既往史: 20余年前患“血吸虫”病行脾脏切除术，当地医院检查示“早期肝硬化”，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：37.3℃，P：62次/分，R：20次/分，BP：121/75mmHg,Ht：165cm，Wt：58kg，BSA：1.63m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率62次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽左侧顶后壁粘膜稍隆起；左侧颈部II区可扪及1个淋巴结，最大径1×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D35] 检验组合: 碱性磷酸酶(ALP)-静脉血: 93.6U/L；丙氨酸氨基转移酶(ALT)-静脉血: 26.3U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.2U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 34.4U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.73；α-L-岩藻糖苷酶(AFU)-静脉血: 38.5U/L；乳酸脱氢酶(LDH)-静脉血: 195.7U/L；总胆汁酸(TBA)-静脉血: 2.9umol/L\n- [全程D39] 检验组合: 胱抑素(Cys-C)-静脉血: 0.84mg/L；肌酐(Crea)-静脉血: 62.7umol/L；阴离子间隙(AG)-静脉血: 11；单核细胞计数(Mono#)-静脉血: 0.510E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.8mmol/L；载脂蛋白B(apoB)-静脉血: 0.81g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.8U/L；平均红细胞体积(MCV)-静脉血: 93.8fL；单核细胞百分比(Mono%)-静脉血: 0.149；C-反应蛋白(CRP)-静脉血: 0.37mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；淋巴细胞百分比(Lymph%)-静脉血: 0.352；有核红细胞百分比(NRBC%)-静脉血: 0；尿素氮(BUN)-静脉血: 7.54mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.17g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 40U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；直接胆红素(DBIL)-静脉血: 6.9umol/L；平均血小板体积(MPV)-静脉血: 9.04fL；红细胞计数(RBC#)-静脉血: 4.2310E12/L；总胆固醇(TC)-静脉血: 4.39mmol/L；总钙(Ca)-静脉血: 2.39mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.21mmolL；丙氨酸氨基转移酶(ALT)-静脉血: 28.6U/L；间接胆红素(IBIL)-静脉血: 11.6umolL；甘油三酯(TG)-静脉血: 0.5mmol/L；尿酸(UA)-静脉血: 332.9umol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32.2pg；中性粒细胞计数(Neut#)-静脉血: 1.510E9/L；总胆红素(TBIL)-静脉血: 18.5umol/L；乳酸脱氢酶(LDH)-静脉血: 145.6U/L；磷(P)-静脉血: 1.34mmol/L；碱性磷酸酶(ALP)-静脉血: 93.2U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D28] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者今日返院，一般情况可，无明显不适主诉，体查情况基本同前，患者现放疗计划已设计完成并通过全科会诊，NPDT70Gy/30F,CTV1:60Gy/30F,CTV2：54Gy/30F，靶区剂量分布均匀，正常组织剂量在可接受范围内。[姓名已隐去]副医生信息已隐藏，患者放疗计划设计完成，可行放疗前复位及验证等准备，开始放疗，患者既往血吸虫肝硬化病史，患者化疗后可能出现肝功能损伤，肝衰竭，严重者可危及生命，与患者及家属沟通后，患者及家属表示愿意承担化疗风险，予以择期行DDP单药每周同时期化疗。\n- [全程D29] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 今日查房，患者一般情况可，无明显不适主诉，体查同入院。[姓名已隐去]副医生信息已隐藏示：依约开始放疗，嘱患者注意营养与休息。\n- [全程D34] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者已开始行根治性放疗，现放疗2F，昨日完成一程同期化疗，诉额、双侧颞部头痛，一般情况尚可，体查情况基本同前。[姓名已隐去]副医生信息已隐藏：现患者已开始放疗，一程化疗结束，针对患者主诉，考虑放疗引起不良反应，予以止痛等对症处理，病情继观。\n- [全程D39] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现处于放化综合治疗中，放疗3F，无诉，体查情况基本同前，血常规、生化常规结果示：WBC3.33*10E9/L、中性粒1.5*10E9/L；[姓名已隐去]副医生信息已隐藏：现患者血象稍低，明日予以行同期化疗二程，化疗后予以复查血象后再予以升白等对症处理，密观病情。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停同期化疗，单纯行根治性放疗，立即予以重组人粒细胞集落刺激因子升白细胞治疗。\nB. 暂停放化疗，立即予以重组人粒细胞集落刺激因子，待白细胞恢复正常后再恢复放化综合治疗。\nC. 延迟第2程同期化疗，继续放疗，观察3天后复查血常规，若中性粒细胞达标再行化疗。\nD. 继续行第2程同期化疗，化疗前予以长效聚乙二醇化重组人粒细胞集落刺激因子预防性升白细胞。\nE. 继续行第2程同期化疗，化疗期间同步予以口服抗生素预防感染及静脉营养支持。\nF. 继续行第2程同期化疗，将顺铂剂量下调20%，并给予静脉营养、补液及通便等对症支持。\nG. 终止同期化疗，改为单纯放疗联合西妥昔单抗靶向治疗，并予以静脉营养支持。\nH. 继续行第2程同期化疗，化疗后立即常规予以重组人粒细胞集落刺激因子连续升白细胞治疗3天。\nI. 暂停放疗，按计划行第2程同期化疗，化疗后复查血象视情况予以升白细胞治疗。\nJ. 继续行第2程同期化疗，将顺铂更换为卡铂，并给予静脉营养、补液及通便等对症支持。\nK. 延迟第2程同期化疗，予以静脉营养、补液及通便等对症支持，待1周后复查血象再决定是否化疗。\nL. 继续行第2程同期化疗，化疗后复查血象视情况予以升白细胞治疗，并给予静脉营养、补液及通便等对症支持。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-5f99c90d4e8627eaecab64fc","patient_id":"patient-02ca51eed4fedbb13e4db76d","turn_id":"turn06","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"A","gold_action":"继续按计划行放化综合治疗，并进行静脉导管常规维护。","options":[{"letter":"A","text":"继续按计划行放化综合治疗，并进行静脉导管常规维护。","is_gold":true},{"letter":"B","text":"暂停放化疗，再次给予粒细胞集落刺激因子（G-CSF）升白治疗。","is_gold":false},{"letter":"C","text":"暂停同期化疗，仅继续单纯放射治疗，并进行静脉导管常规维护。","is_gold":false},{"letter":"D","text":"继续按计划行放化综合治疗，并预防性输注单采血小板。","is_gold":false},{"letter":"E","text":"暂停放化疗，经验性给予广谱静脉抗生素抗感染治疗。","is_gold":false},{"letter":"F","text":"继续按计划行放化综合治疗，并预防性给予重组人促红素（EPO）治疗。","is_gold":false},{"letter":"G","text":"继续按计划行放化综合治疗，并拔除静脉留置导管改为口服给药。","is_gold":false},{"letter":"H","text":"继续按计划行放化综合治疗，但将后续同期化疗剂量减量20%。","is_gold":false},{"letter":"I","text":"提前结束同期化疗，仅继续完成剩余放射治疗。","is_gold":false},{"letter":"J","text":"暂停放化疗，给予保肝降酶药物静脉滴注。","is_gold":false},{"letter":"K","text":"继续按计划行放化综合治疗，并预防性给予白介素-11（IL-11）治疗。","is_gold":false},{"letter":"L","text":"继续按计划行放化综合治疗，并加用大剂量静脉糖皮质激素治疗。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、鼻腔。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D42] 检验组合: 红细胞比容(Hct)-静脉血: 38.5%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 335g/L；红细胞计数(RBC#)-静脉血: 4.1110E12/L；平均红细胞体积(MCV)-静脉血: 93.7fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；血小板计数(PLT#)-静脉血: 26910E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；碱性磷酸酶(ALP)-静脉血: 88U/L；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18U/L；中性粒细胞百分比(Neut%)-静脉血: 0.659；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.019；乳酸脱氢酶(LDH)-静脉血: 139.5U/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6；α-L-岩藻糖苷酶(AFU)-静脉血: 41U/L；血小板分布宽度(PDW)-静脉血: 11.5%；中性粒细胞计数(Neut#)-静脉血: 2.110E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 24.4U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；平均红细胞血红蛋白含量(MCH)-静脉血: 31.4pg；总胆汁酸(TBA)-静脉血: 1umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 33.2U/L；平均血小板体积(MPV)-静脉血: 10.3fL；白细胞计数(WBC#)-静脉血: 3.1410E9/L；大血小板百分比(P-LCR%)-静脉血: 26.3%；单核细胞计数(Mono#)-静脉血: 0.410E9/L；血红蛋白(Hb)-静脉血: 129g/L；单核细胞百分比(Mono%)-静脉血: 0.134；血小板比容-静脉血: 28%；淋巴细胞百分比(Lymph%)-静脉血: 0.185；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43\n- [全程D46] 检验组合: 平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；C-反应蛋白(CRP)-静脉血: 0.38mg/L；γ-谷氨酰基转移酶(GGT)-静脉血: 34.2U/L；尿酸(UA)-静脉血: 292.5umol/L；红细胞计数(RBC#)-静脉血: 4.0510E12/L；总蛋白(TP)-静脉血: 70.3g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞计数(Neut#)-静脉血: 1.410E9/L；磷(P)-静脉血: 1.21mmol/L；总胆固醇(TC)-静脉血: 3.73mmol/L；单核细胞百分比(Mono%)-静脉血: 0.167；总钙(Ca)-静脉血: 2.2mmol/L；胱抑素(Cys-C)-静脉血: 0.68mg/L；葡萄糖(Glu)-静脉血: 4.54mmol/L；白细胞计数(WBC#)-静脉血: 2.3910E9/L；载脂蛋白B(apoB)-静脉血: 0.82g/L；直接胆红素(DBIL)-静脉血: 4.6umol/L；镁离子(Mg2+)-静脉血: 0.76mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.89；氯离子(Cl-)-静脉血: 100.1mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.197；肌酐(Crea)-静脉血: 56.4umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；血小板比容-静脉血: 22%；碱性磷酸酶(ALP)-静脉血: 81.9U/L；钾离子(K+)-静脉血: 4.1mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.1；球蛋白(GLO)-静脉血: 29.4g/L；总胆汁酸(TBA)-静脉血: 1.4umol/L；尿素氮(BUN)-静脉血: 6.3mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.4pg；天门冬氨酸氨基转移酶(AST)-静脉血: 17.1U/L；血小板计数(PLT#)-静脉血: 21610E9/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.09g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；钠离子(Na+)-静脉血: 138.5mmol/L；淋巴细胞计数(Lymph#)……\n- [全程D49] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；白细胞计数(WBC#)-静脉血: 28.910E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0；平均红细胞体积(MCV)-静脉血: 96.4fL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.77；α-L-岩藻糖苷酶(AFU)-静脉血: 37.1U/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.003；平均血小板体积(MPV)-静脉血: 8.48fL；血小板计数(PLT#)-静脉血: 16710E9/L；红细胞计数(RBC#)-静脉血: 3.9610E12/L；碱性磷酸酶(ALP)-静脉血: 119.8U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32.2pg；中性粒细胞百分比(Neut%)-静脉血: 0.933；血小板分布宽度(PDW)-静脉血: 15.7%；血小板比容-静脉血: 14.1%；中性粒细胞计数(Neut#)-静脉血: 2710E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 13.5U/L；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；红细胞比容(Hct)-静脉血: 38.2%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 334.1g/L；总胆汁酸(TBA)-静脉血: 1.5umol/L；单核细胞百分比(Mono%)-静脉血: 0.035；单核细胞计数(Mono#)-静脉血: 110E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 17.5U/L；血红蛋白(Hb)-静脉血: 127.7g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.028；乳酸脱氢酶(LDH)-静脉血: 177U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 34.4U/L\n- [全程D53] 检验组合: 总胆固醇(TC)-静脉血: 4.04mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 17.7U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.8；血小板计数(PLT#)-静脉血: 199.710E9/L；镁离子(Mg2+)-静脉血: 0.73mmol/L；红细胞比容(Hct)-静脉血: 38.2%；总蛋白(TP)-静脉血: 70.35g/L；载脂蛋白B(apoB)-静脉血: 0.83g/L；尿酸(UA)-静脉血: 359.2umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.133；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.6；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；血小板分布宽度(PDW)-静脉血: 15.6%；中性粒细胞百分比(Neut%)-静脉血: 0.671；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；球蛋白(GLO)-静脉血: 26.85g/L；氯离子(Cl-)-静脉血: 102.6mmol/L；肌酐(Crea)-静脉血: 59umol/L；平均红细胞体积(MCV)-静脉血: 95.9fL；血小板比容-静脉血: 16.6%；红细胞计数(RBC#)-静脉血: 3.9810E12/L；C-反应蛋白(CRP)-静脉血: 0.91mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.69mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 337.3g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.11mmolL；白蛋白(ALB)-静脉血: 43.5g/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32.3pg；白细胞计数(WBC#)-静脉血: 3.9610E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 38U/L；甘油三酯(TG)-静脉血: 0.67mmol/L；平均血小板体积(MPV)-静脉血: 8.31fL；葡萄糖(Glu)-静脉血: 4.61mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.6%；单核细胞百分比(Mono%)-静脉血: 0.143；总钙(Ca)-静脉血: 2.28mmol/L；血……\n\n【既往治疗与反应】\n- [全程D44] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现处于放化综合治疗中，放疗8F，诉口苦，体查情况基本同前，21号复查血常规、生化常规结果基本正常；[姓名已隐去]副医生信息已隐藏：现患者已完成同期化疗二程，继续放疗，余治疗不变，密观病情。\n- [全程D49] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现处于放化综合治疗中，放疗10F，诉喉咙疼痛，体查情况基本同前，25号血常规、生化常规结果示：WBC2.39*10E9/L、中性粒1.4*10E9/L，今日复查血常规、肝肾功能结果基本正常；[姓名已隐去]副医生信息已隐藏：患者25号血象示2度骨髓抑制，予以升白等对症处理，并于26号予以三程同期化疗，今日复查血象已恢复，继续予以放化综合治疗，密观病情。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 继续按计划行放化综合治疗，并进行静脉导管常规维护。\nB. 暂停放化疗，再次给予粒细胞集落刺激因子（G-CSF）升白治疗。\nC. 暂停同期化疗，仅继续单纯放射治疗，并进行静脉导管常规维护。\nD. 继续按计划行放化综合治疗，并预防性输注单采血小板。\nE. 暂停放化疗，经验性给予广谱静脉抗生素抗感染治疗。\nF. 继续按计划行放化综合治疗，并预防性给予重组人促红素（EPO）治疗。\nG. 继续按计划行放化综合治疗，并拔除静脉留置导管改为口服给药。\nH. 继续按计划行放化综合治疗，但将后续同期化疗剂量减量20%。\nI. 提前结束同期化疗，仅继续完成剩余放射治疗。\nJ. 暂停放化疗，给予保肝降酶药物静脉滴注。\nK. 继续按计划行放化综合治疗，并预防性给予白介素-11（IL-11）治疗。\nL. 继续按计划行放化综合治疗，并加用大剂量静脉糖皮质激素治疗。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、鼻腔。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D42] 检验组合: 红细胞比容(Hct)-静脉血: 38.5%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 335g/L；红细胞计数(RBC#)-静脉血: 4.1110E12/L；平均红细胞体积(MCV)-静脉血: 93.7fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；血小板计数(PLT#)-静脉血: 26910E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；碱性磷酸酶(ALP)-静脉血: 88U/L；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18U/L；中性粒细胞百分比(Neut%)-静脉血: 0.659；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.019；乳酸脱氢酶(LDH)-静脉血: 139.5U/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6；α-L-岩藻糖苷酶(AFU)-静脉血: 41U/L；血小板分布宽度(PDW)-静脉血: 11.5%；中性粒细胞计数(Neut#)-静脉血: 2.110E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 24.4U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；平均红细胞血红蛋白含量(MCH)-静脉血: 31.4pg；总胆汁酸(TBA)-静脉血: 1umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 33.2U/L；平均血小板体积(MPV)-静脉血: 10.3fL；白细胞计数(WBC#)-静脉血: 3.1410E9/L；大血小板百分比(P-LCR%)-静脉血: 26.3%；单核细胞计数(Mono#)-静脉血: 0.410E9/L；血红蛋白(Hb)-静脉血: 129g/L；单核细胞百分比(Mono%)-静脉血: 0.134；血小板比容-静脉血: 28%；淋巴细胞百分比(Lymph%)-静脉血: 0.185；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43\n- [全程D46] 检验组合: 平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；C-反应蛋白(CRP)-静脉血: 0.38mg/L；γ-谷氨酰基转移酶(GGT)-静脉血: 34.2U/L；尿酸(UA)-静脉血: 292.5umol/L；红细胞计数(RBC#)-静脉血: 4.0510E12/L；总蛋白(TP)-静脉血: 70.3g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞计数(Neut#)-静脉血: 1.410E9/L；磷(P)-静脉血: 1.21mmol/L；总胆固醇(TC)-静脉血: 3.73mmol/L；单核细胞百分比(Mono%)-静脉血: 0.167；总钙(Ca)-静脉血: 2.2mmol/L；胱抑素(Cys-C)-静脉血: 0.68mg/L；葡萄糖(Glu)-静脉血: 4.54mmol/L；白细胞计数(WBC#)-静脉血: 2.3910E9/L；载脂蛋白B(apoB)-静脉血: 0.82g/L；直接胆红素(DBIL)-静脉血: 4.6umol/L；镁离子(Mg2+)-静脉血: 0.76mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.89；氯离子(Cl-)-静脉血: 100.1mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.197；肌酐(Crea)-静脉血: 56.4umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；血小板比容-静脉血: 22%；碱性磷酸酶(ALP)-静脉血: 81.9U/L；钾离子(K+)-静脉血: 4.1mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.1；球蛋白(GLO)-静脉血: 29.4g/L；总胆汁酸(TBA)-静脉血: 1.4umol/L；尿素氮(BUN)-静脉血: 6.3mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.4pg；天门冬氨酸氨基转移酶(AST)-静脉血: 17.1U/L；血小板计数(PLT#)-静脉血: 21610E9/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.09g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；钠离子(Na+)-静脉血: 138.5mmol/L；淋巴细胞计数(Lymph#)……\n- [全程D49] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；白细胞计数(WBC#)-静脉血: 28.910E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0；平均红细胞体积(MCV)-静脉血: 96.4fL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.77；α-L-岩藻糖苷酶(AFU)-静脉血: 37.1U/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.003；平均血小板体积(MPV)-静脉血: 8.48fL；血小板计数(PLT#)-静脉血: 16710E9/L；红细胞计数(RBC#)-静脉血: 3.9610E12/L；碱性磷酸酶(ALP)-静脉血: 119.8U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32.2pg；中性粒细胞百分比(Neut%)-静脉血: 0.933；血小板分布宽度(PDW)-静脉血: 15.7%；血小板比容-静脉血: 14.1%；中性粒细胞计数(Neut#)-静脉血: 2710E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 13.5U/L；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；红细胞比容(Hct)-静脉血: 38.2%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 334.1g/L；总胆汁酸(TBA)-静脉血: 1.5umol/L；单核细胞百分比(Mono%)-静脉血: 0.035；单核细胞计数(Mono#)-静脉血: 110E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 17.5U/L；血红蛋白(Hb)-静脉血: 127.7g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.028；乳酸脱氢酶(LDH)-静脉血: 177U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 34.4U/L\n- [全程D53] 检验组合: 总胆固醇(TC)-静脉血: 4.04mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 17.7U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.8；血小板计数(PLT#)-静脉血: 199.710E9/L；镁离子(Mg2+)-静脉血: 0.73mmol/L；红细胞比容(Hct)-静脉血: 38.2%；总蛋白(TP)-静脉血: 70.35g/L；载脂蛋白B(apoB)-静脉血: 0.83g/L；尿酸(UA)-静脉血: 359.2umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.133；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.6；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；血小板分布宽度(PDW)-静脉血: 15.6%；中性粒细胞百分比(Neut%)-静脉血: 0.671；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；球蛋白(GLO)-静脉血: 26.85g/L；氯离子(Cl-)-静脉血: 102.6mmol/L；肌酐(Crea)-静脉血: 59umol/L；平均红细胞体积(MCV)-静脉血: 95.9fL；血小板比容-静脉血: 16.6%；红细胞计数(RBC#)-静脉血: 3.9810E12/L；C-反应蛋白(CRP)-静脉血: 0.91mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.69mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 337.3g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.11mmolL；白蛋白(ALB)-静脉血: 43.5g/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32.3pg；白细胞计数(WBC#)-静脉血: 3.9610E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 38U/L；甘油三酯(TG)-静脉血: 0.67mmol/L；平均血小板体积(MPV)-静脉血: 8.31fL；葡萄糖(Glu)-静脉血: 4.61mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.6%；单核细胞百分比(Mono%)-静脉血: 0.143；总钙(Ca)-静脉血: 2.28mmol/L；血……\n\n【既往治疗与反应】\n- [全程D44] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现处于放化综合治疗中，放疗8F，诉口苦，体查情况基本同前，21号复查血常规、生化常规结果基本正常；[姓名已隐去]副医生信息已隐藏：现患者已完成同期化疗二程，继续放疗，余治疗不变，密观病情。\n- [全程D49] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现处于放化综合治疗中，放疗10F，诉喉咙疼痛，体查情况基本同前，25号血常规、生化常规结果示：WBC2.39*10E9/L、中性粒1.4*10E9/L，今日复查血常规、肝肾功能结果基本正常；[姓名已隐去]副医生信息已隐藏：患者25号血象示2度骨髓抑制，予以升白等对症处理，并于26号予以三程同期化疗，今日复查血象已恢复，继续予以放化综合治疗，密观病情。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 继续按计划行放化综合治疗，并进行静脉导管常规维护。\nB. 暂停放化疗，再次给予粒细胞集落刺激因子（G-CSF）升白治疗。\nC. 暂停同期化疗，仅继续单纯放射治疗，并进行静脉导管常规维护。\nD. 继续按计划行放化综合治疗，并预防性输注单采血小板。\nE. 暂停放化疗，经验性给予广谱静脉抗生素抗感染治疗。\nF. 继续按计划行放化综合治疗，并预防性给予重组人促红素（EPO）治疗。\nG. 继续按计划行放化综合治疗，并拔除静脉留置导管改为口服给药。\nH. 继续按计划行放化综合治疗，但将后续同期化疗剂量减量20%。\nI. 提前结束同期化疗，仅继续完成剩余放射治疗。\nJ. 暂停放化疗，给予保肝降酶药物静脉滴注。\nK. 继续按计划行放化综合治疗，并预防性给予白介素-11（IL-11）治疗。\nL. 继续按计划行放化综合治疗，并加用大剂量静脉糖皮质激素治疗。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-46fc2f7bd9dd0872ef1b356e","patient_id":"patient-36d433557e63f939b878347d","turn_id":"turn02","turn_position":1,"turn_type":"imaging_release_workup","gold_letter":"E","gold_action":"行鼻咽镜下肿物活检以明确病理诊断；当前影像学评估为 cT4N2M0","options":[{"letter":"A","text":"行鼻咽镜下肿物活检；影像学评估为 cT3N2M0","is_gold":false},{"letter":"B","text":"行鼻咽镜下肿物活检；影像学评估为 cT4N1M0","is_gold":false},{"letter":"C","text":"行颈部淋巴结穿刺活检；影像学评估为 cT4N2M0","is_gold":false},{"letter":"D","text":"完善血浆EBV-DNA检测；影像学评估为 cT4N2M0","is_gold":false},{"letter":"E","text":"行鼻咽镜下肿物活检；影像学评估为 cT4N2M0","is_gold":true},{"letter":"F","text":"安排诱导化疗联合根治性放疗；影像学评估为 cT4N2M0","is_gold":false},{"letter":"G","text":"行鼻咽镜下肿物活检；影像学评估为 cT4N3M0","is_gold":false},{"letter":"H","text":"行鼻咽镜下肿物活检；影像学评估为 cT3N1M0","is_gold":false},{"letter":"I","text":"行全身PET-CT检查；影像学评估为 cT4N2M0","is_gold":false},{"letter":"J","text":"行鼻咽镜下肿物活检；影像学评估为 cT2N2M0","is_gold":false},{"letter":"K","text":"行鼻咽镜下肿物活检；影像学评估为 cT4N0M0","is_gold":false},{"letter":"L","text":"行鼻咽镜下肿物活检；影像学评估为 cT1N2M0","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、海绵窦、翼突基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1078] 入院记录: 主诉: 外院可疑鼻咽癌；现病史: 简要入院病史:患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n- [全程D1081] 入院记录: 主诉: 回吸性涕血3月余；现病史: 患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：70次/分，R：14次/分，BP：126/71mmHg,Ht：155cm，Wt：48kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左颈Ⅱ区触及肿大淋巴结，约2×1.5cm，无融合，质地硬，边界尚清，活动度中等，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- [全程D1078] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 Ⅱ、Ⅲ、aVF、V4～V6导联ST段下移\n- [全程D1078] 检验组合: 镁离子(Mg2+)-静脉血: 0.96mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.6；Rh血型-静脉血: 阳性；直接胆红素(DBIL)-静脉血: 2umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.61COI；白蛋白(ALB)-静脉血: 45.5g/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 0.085COI；γ-谷氨酰基转移酶(GGT)-静脉血: 13.6U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.2fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；葡萄糖(Glu)-静脉血: 4.67mmol/L；总胆红素(TBIL)-静脉血: 8.3umol/L；单核细胞百分比(Mono%)-静脉血: 0.074；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.5U/L；红细胞比容(Hct)-静脉血: 41%；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 1.56COI；单核细胞计数(Mono#)-静脉血: 0.310E9/L；中性粒细胞计数(Neut#)-静脉血: 2.510E9/L；胱抑素(Cys-C)-静脉血: 0.84mg/L；碱性磷酸酶(ALP)-静脉血: 80.5U/L；钠离子(Na+)-静脉血: 143.8mmol/L；乳酸脱氢酶(LDH)-静脉血: 194.4U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；平均红细胞血红蛋白浓度(MCHC)-静脉血: 324g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21.7U/L；氯离子(Cl-)-静脉血: 105.2mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.74；平均红细胞体积(MCV)-静脉血: 92.8fL；C-反应蛋白(CRP)-静脉血: 1.78mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.4；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: >1000IU/L；总胆固醇(TC)-静脉血: 5.98mmol/L；血红蛋白(Hb)-静脉血: 133g/L；大血小板百分比(P-LCR%)-静脉血: 26.1%；间接胆红素(I……\n- [全程D1079] 检验组合: 梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）\n- [全程D1081] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 多个颈腰椎、双侧膝关节可见片状放射性浓集灶。余颅骨、胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 考虑多个颈腰椎、双侧膝关节骨质退行性变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行鼻咽镜下肿物活检；影像学评估为 cT3N2M0\nB. 行鼻咽镜下肿物活检；影像学评估为 cT4N1M0\nC. 行颈部淋巴结穿刺活检；影像学评估为 cT4N2M0\nD. 完善血浆EBV-DNA检测；影像学评估为 cT4N2M0\nE. 行鼻咽镜下肿物活检；影像学评估为 cT4N2M0\nF. 安排诱导化疗联合根治性放疗；影像学评估为 cT4N2M0\nG. 行鼻咽镜下肿物活检；影像学评估为 cT4N3M0\nH. 行鼻咽镜下肿物活检；影像学评估为 cT3N1M0\nI. 行全身PET-CT检查；影像学评估为 cT4N2M0\nJ. 行鼻咽镜下肿物活检；影像学评估为 cT2N2M0\nK. 行鼻咽镜下肿物活检；影像学评估为 cT4N0M0\nL. 行鼻咽镜下肿物活检；影像学评估为 cT1N2M0\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、海绵窦、翼突基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1078] 入院记录: 主诉: 外院可疑鼻咽癌；现病史: 简要入院病史:患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n- [全程D1081] 入院记录: 主诉: 回吸性涕血3月余；现病史: 患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：70次/分，R：14次/分，BP：126/71mmHg,Ht：155cm，Wt：48kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左颈Ⅱ区触及肿大淋巴结，约2×1.5cm，无融合，质地硬，边界尚清，活动度中等，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- [全程D1078] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 Ⅱ、Ⅲ、aVF、V4～V6导联ST段下移\n- [全程D1078] 检验组合: 镁离子(Mg2+)-静脉血: 0.96mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.6；Rh血型-静脉血: 阳性；直接胆红素(DBIL)-静脉血: 2umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.61COI；白蛋白(ALB)-静脉血: 45.5g/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 0.085COI；γ-谷氨酰基转移酶(GGT)-静脉血: 13.6U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.2fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；葡萄糖(Glu)-静脉血: 4.67mmol/L；总胆红素(TBIL)-静脉血: 8.3umol/L；单核细胞百分比(Mono%)-静脉血: 0.074；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.5U/L；红细胞比容(Hct)-静脉血: 41%；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 1.56COI；单核细胞计数(Mono#)-静脉血: 0.310E9/L；中性粒细胞计数(Neut#)-静脉血: 2.510E9/L；胱抑素(Cys-C)-静脉血: 0.84mg/L；碱性磷酸酶(ALP)-静脉血: 80.5U/L；钠离子(Na+)-静脉血: 143.8mmol/L；乳酸脱氢酶(LDH)-静脉血: 194.4U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；平均红细胞血红蛋白浓度(MCHC)-静脉血: 324g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21.7U/L；氯离子(Cl-)-静脉血: 105.2mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.74；平均红细胞体积(MCV)-静脉血: 92.8fL；C-反应蛋白(CRP)-静脉血: 1.78mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.4；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: >1000IU/L；总胆固醇(TC)-静脉血: 5.98mmol/L；血红蛋白(Hb)-静脉血: 133g/L；大血小板百分比(P-LCR%)-静脉血: 26.1%；间接胆红素(I……\n- [全程D1079] 检验组合: 梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）\n- [全程D1081] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 多个颈腰椎、双侧膝关节可见片状放射性浓集灶。余颅骨、胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 考虑多个颈腰椎、双侧膝关节骨质退行性变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行鼻咽镜下肿物活检；影像学评估为 cT3N2M0\nB. 行鼻咽镜下肿物活检；影像学评估为 cT4N1M0\nC. 行颈部淋巴结穿刺活检；影像学评估为 cT4N2M0\nD. 完善血浆EBV-DNA检测；影像学评估为 cT4N2M0\nE. 行鼻咽镜下肿物活检；影像学评估为 cT4N2M0\nF. 安排诱导化疗联合根治性放疗；影像学评估为 cT4N2M0\nG. 行鼻咽镜下肿物活检；影像学评估为 cT4N3M0\nH. 行鼻咽镜下肿物活检；影像学评估为 cT3N1M0\nI. 行全身PET-CT检查；影像学评估为 cT4N2M0\nJ. 行鼻咽镜下肿物活检；影像学评估为 cT2N2M0\nK. 行鼻咽镜下肿物活检；影像学评估为 cT4N0M0\nL. 行鼻咽镜下肿物活检；影像学评估为 cT1N2M0\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-7c52866e0776802e0c94516f","patient_id":"patient-36d433557e63f939b878347d","turn_id":"turn04","turn_position":2,"turn_type":"initial_treatment_selection","gold_letter":"G","gold_action":"完善头颈部MRI及全身分期检查，若评估为局部晚期，行诱导化疗序贯同步放化疗","options":[{"letter":"A","text":"暂缓影像学分期检查，直接启动根治性同步放化疗","is_gold":false},{"letter":"B","text":"完善头颈部MRI及全身分期检查，若评估为局部晚期，行单纯根治性放疗","is_gold":false},{"letter":"C","text":"完善头颈部MRI及全身分期检查，若评估为局部晚期，行诱导化疗序贯单纯根治性放疗","is_gold":false},{"letter":"D","text":"完善头颈部MRI及全身分期检查，若评估为局部晚期，行根治性手术切除序贯术后放疗","is_gold":false},{"letter":"E","text":"完善头颈部增强CT及全身分期检查，若评估为局部晚期，行诱导化疗序贯同步放化疗","is_gold":false},{"letter":"F","text":"完善头颈部MRI及全身分期检查，若评估为早期（I期），行诱导化疗序贯同步放化疗","is_gold":false},{"letter":"G","text":"完善头颈部MRI及全身分期检查，若评估为局部晚期，行诱导化疗序贯同步放化疗","is_gold":true},{"letter":"H","text":"完善头颈部MRI及全身分期检查，无论分期结果，均行诱导化疗序贯同步放化疗","is_gold":false},{"letter":"I","text":"仅行全身PET-CT替代所有常规分期检查，若评估为局部晚期，行诱导化疗序贯同步放化疗","is_gold":false},{"letter":"J","text":"完善头颈部MRI及全身分期检查，若评估为局部晚期，行抗EGFR单抗靶向治疗替代放疗","is_gold":false},{"letter":"K","text":"完善头颈部MRI及全身分期检查，若评估为局部晚期，行PD-1抑制剂单药根治性治疗","is_gold":false},{"letter":"L","text":"完善头颈部MRI及全身分期检查，若评估为局部晚期，行姑息性化疗联合最佳支持治疗","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、海绵窦、翼突基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1078] 入院记录: 主诉: 外院可疑鼻咽癌；现病史: 简要入院病史:患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。某次就诊时间再次出现回吸性涕血，遂行鼻咽镜检查，活检示：鼻咽炎性渗出。行鼻咽部CT示：鼻咽左侧可见软组织占位。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- 无可展示记录。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂缓影像学分期检查，直接启动根治性同步放化疗\nB. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行单纯根治性放疗\nC. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行诱导化疗序贯单纯根治性放疗\nD. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行根治性手术切除序贯术后放疗\nE. 完善头颈部增强CT及全身分期检查，若评估为局部晚期，行诱导化疗序贯同步放化疗\nF. 完善头颈部MRI及全身分期检查，若评估为早期（I期），行诱导化疗序贯同步放化疗\nG. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行诱导化疗序贯同步放化疗\nH. 完善头颈部MRI及全身分期检查，无论分期结果，均行诱导化疗序贯同步放化疗\nI. 仅行全身PET-CT替代所有常规分期检查，若评估为局部晚期，行诱导化疗序贯同步放化疗\nJ. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行抗EGFR单抗靶向治疗替代放疗\nK. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行PD-1抑制剂单药根治性治疗\nL. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行姑息性化疗联合最佳支持治疗\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、海绵窦、翼突基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1078] 入院记录: 主诉: 外院可疑鼻咽癌；现病史: 简要入院病史:患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。某次就诊时间再次出现回吸性涕血，遂行鼻咽镜检查，活检示：鼻咽炎性渗出。行鼻咽部CT示：鼻咽左侧可见软组织占位。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- 无可展示记录。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂缓影像学分期检查，直接启动根治性同步放化疗\nB. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行单纯根治性放疗\nC. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行诱导化疗序贯单纯根治性放疗\nD. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行根治性手术切除序贯术后放疗\nE. 完善头颈部增强CT及全身分期检查，若评估为局部晚期，行诱导化疗序贯同步放化疗\nF. 完善头颈部MRI及全身分期检查，若评估为早期（I期），行诱导化疗序贯同步放化疗\nG. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行诱导化疗序贯同步放化疗\nH. 完善头颈部MRI及全身分期检查，无论分期结果，均行诱导化疗序贯同步放化疗\nI. 仅行全身PET-CT替代所有常规分期检查，若评估为局部晚期，行诱导化疗序贯同步放化疗\nJ. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行抗EGFR单抗靶向治疗替代放疗\nK. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行PD-1抑制剂单药根治性治疗\nL. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行姑息性化疗联合最佳支持治疗\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-ce21ad4c82d0349356f5fbb9","patient_id":"patient-36d433557e63f939b878347d","turn_id":"turn05","turn_position":3,"turn_type":"toxicity_or_support_decision","gold_letter":"H","gold_action":"给予口服保肝药物（如复方甘草酸苷、葡醛内酯），按原计划执行顺铂同期化疗，并动态复查肝功能。","options":[{"letter":"A","text":"暂停同期化疗，给予静脉保肝药物治疗，待转氨酶降至正常后再启动顺铂化疗","is_gold":false},{"letter":"B","text":"按原计划执行顺铂同期化疗，暂不予特殊保肝处理，常规监测肝功能","is_gold":false},{"letter":"C","text":"给予口服保肝药物，将顺铂剂量下调20%后执行同期化疗","is_gold":false},{"letter":"D","text":"给予静脉双重保肝药物，按原计划执行顺铂同期化疗，并动态复查肝功能","is_gold":false},{"letter":"E","text":"停用顺铂，更改为卡铂方案执行同期化疗，并给予口服保肝药物","is_gold":false},{"letter":"F","text":"给予口服保肝药物，推迟顺铂化疗1周，期间正常进行放疗","is_gold":false},{"letter":"G","text":"停用顺铂，更改为西妥昔单抗靶向治疗联合放疗，并给予口服保肝药物","is_gold":false},{"letter":"H","text":"给予口服保肝药物（如复方甘草酸苷、葡醛内酯），按原计划执行顺铂同期化疗，并动态复查肝功能","is_gold":true},{"letter":"I","text":"暂停放化疗，行腹部增强CT排查肝脏转移，并给予静脉保肝治疗","is_gold":false},{"letter":"J","text":"给予口服保肝药物，按原计划执行顺铂同期化疗，并预防性使用重组人粒细胞刺激因子","is_gold":false},{"letter":"K","text":"给予口服保肝药物，按原计划执行顺铂同期化疗，并预防性使用广谱抗生素","is_gold":false},{"letter":"L","text":"给予口服保肝药物，将顺铂方案更改为奈达铂方案执行同期化疗","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、海绵窦、翼突基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1081] 入院记录: 主诉: 回吸性涕血3月余；现病史: 患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。某次就诊时间再次出现回吸性涕血，遂行鼻咽镜检查，活检示：鼻咽炎性渗出。行鼻咽部CT示：鼻咽左侧可见软组织占位。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：70次/分，R：14次/分，BP：126/71mmHg,Ht：155cm，Wt：48kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率70次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左颈Ⅱ区触及肿大淋巴结，约2×1.5cm，无融合，质地硬，边界尚清，活动度中等，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- [全程D1092] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.006；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；颜色-尿液: 无色；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮\n- [全程D1094] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 28/μL；比重(SG)-尿液: 1.025；葡萄糖(Glu)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 36/μL；白细胞计数(WBC#)-尿液: 5/μL；酸碱度(pH)-尿液: 6.5；颜色-尿液: Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D1095] 检验组合: 白蛋白(ALB)-静脉血: 40.5g/L；镁离子(Mg2+)-静脉血: 0.84mmol/L；碱性磷酸酶(ALP)-静脉血: 63.2U/L；载脂蛋白B(apoB)-静脉血: 0.8g/L；葡萄糖(Glu)-静脉血: 5.31mmol/L；血小板比容-静脉血: 19%；直接胆红素(DBIL)-静脉血: 2.3umol/L；载脂蛋白AI(apoAI)-静脉血: 1.4g/L；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；总胆固醇(TC)-静脉血: 5.3mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.69mmolL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 325g/L；红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.9pg；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；γ-谷氨酰基转移酶(GGT)-静脉血: 16.8U/L；间接胆红素(IBIL)-静脉血: 5.6umolL；红细胞比容(Hct)-静脉血: 37.2%；钠离子(Na+)-静脉血: 141.6mmol/L；尿酸(UA)-静脉血: 219.2umol/L；总钙(Ca)-静脉血: 2.16mmol/L；尿素氮(BUN)-静脉血: 4.72mmol/L；平均红细胞体积(MCV)-静脉血: 91.9fL；球蛋白(GLO)-静脉血: 22.71g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.1；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14；乳酸脱氢酶(LDH)-静脉血: 179.4U/L；总胆红素(TBIL)-静脉血: 7.9umol/L；阴离子间隙(AG)-静脉血: 12；中性粒细胞百分比(Neut%)-静脉血: 0.814；血红蛋白(Hb)-静脉血: 121g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.1；丙氨酸氨基转移酶(ALT)-静脉血: 55.1U/L；白细胞计数(WBC#)-静脉血: 6.1210E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 36.2U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.58mmol/L；胱抑素(Cys-C)-静脉血: 0.95mg/L；大血小板……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1082] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者目前诊断明确，[计划性表述已隐藏]根治性放疗及同期化疗。向患者及其家属交代病情，治疗方案及治疗风险，做好治疗前准备工作。\n- [全程D1083] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者入院第三天，无明显不适主诉，查体情况：一般情况可，余同入院。预约放疗。\n- [全程D1088] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 今日查房，患者无明显不适主诉，生命体征平稳。已予预约放疗。候治疗。\n- [全程D1093] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 今日查房，患者无明显不适主诉，生命体征平稳。查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常。患者现放疗计划已设计完成并通过全科会诊，靶区剂量分布均匀，正常组织剂量在可接受范围内。[姓名已隐去]医生信息已隐藏示：患者无明显放化疗禁忌症，拟于今日开始行根治性放疗+同时期化疗。向患者及其家属交代病情及化疗风险，表示理解并已签署知情同意书，可于今日执行第1程顺铂方案同时期化疗，注意化疗不良反应。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停同期化疗，给予静脉保肝药物治疗，待转氨酶降至正常后再启动顺铂化疗\nB. 按原计划执行顺铂同期化疗，暂不予特殊保肝处理，常规监测肝功能\nC. 给予口服保肝药物，将顺铂剂量下调20%后执行同期化疗\nD. 给予静脉双重保肝药物，按原计划执行顺铂同期化疗，并动态复查肝功能\nE. 停用顺铂，更改为卡铂方案执行同期化疗，并给予口服保肝药物\nF. 给予口服保肝药物，推迟顺铂化疗1周，期间正常进行放疗\nG. 停用顺铂，更改为西妥昔单抗靶向治疗联合放疗，并给予口服保肝药物\nH. 给予口服保肝药物（如复方甘草酸苷、葡醛内酯），按原计划执行顺铂同期化疗，并动态复查肝功能\nI. 暂停放化疗，行腹部增强CT排查肝脏转移，并给予静脉保肝治疗\nJ. 给予口服保肝药物，按原计划执行顺铂同期化疗，并预防性使用重组人粒细胞刺激因子\nK. 给予口服保肝药物，按原计划执行顺铂同期化疗，并预防性使用广谱抗生素\nL. 给予口服保肝药物，将顺铂方案更改为奈达铂方案执行同期化疗\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、海绵窦、翼突基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1081] 入院记录: 主诉: 回吸性涕血3月余；现病史: 患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。某次就诊时间再次出现回吸性涕血，遂行鼻咽镜检查，活检示：鼻咽炎性渗出。行鼻咽部CT示：鼻咽左侧可见软组织占位。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：70次/分，R：14次/分，BP：126/71mmHg,Ht：155cm，Wt：48kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率70次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左颈Ⅱ区触及肿大淋巴结，约2×1.5cm，无融合，质地硬，边界尚清，活动度中等，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- [全程D1092] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.006；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；颜色-尿液: 无色；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮\n- [全程D1094] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 28/μL；比重(SG)-尿液: 1.025；葡萄糖(Glu)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 36/μL；白细胞计数(WBC#)-尿液: 5/μL；酸碱度(pH)-尿液: 6.5；颜色-尿液: Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D1095] 检验组合: 白蛋白(ALB)-静脉血: 40.5g/L；镁离子(Mg2+)-静脉血: 0.84mmol/L；碱性磷酸酶(ALP)-静脉血: 63.2U/L；载脂蛋白B(apoB)-静脉血: 0.8g/L；葡萄糖(Glu)-静脉血: 5.31mmol/L；血小板比容-静脉血: 19%；直接胆红素(DBIL)-静脉血: 2.3umol/L；载脂蛋白AI(apoAI)-静脉血: 1.4g/L；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；总胆固醇(TC)-静脉血: 5.3mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.69mmolL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 325g/L；红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.9pg；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；γ-谷氨酰基转移酶(GGT)-静脉血: 16.8U/L；间接胆红素(IBIL)-静脉血: 5.6umolL；红细胞比容(Hct)-静脉血: 37.2%；钠离子(Na+)-静脉血: 141.6mmol/L；尿酸(UA)-静脉血: 219.2umol/L；总钙(Ca)-静脉血: 2.16mmol/L；尿素氮(BUN)-静脉血: 4.72mmol/L；平均红细胞体积(MCV)-静脉血: 91.9fL；球蛋白(GLO)-静脉血: 22.71g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.1；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14；乳酸脱氢酶(LDH)-静脉血: 179.4U/L；总胆红素(TBIL)-静脉血: 7.9umol/L；阴离子间隙(AG)-静脉血: 12；中性粒细胞百分比(Neut%)-静脉血: 0.814；血红蛋白(Hb)-静脉血: 121g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.1；丙氨酸氨基转移酶(ALT)-静脉血: 55.1U/L；白细胞计数(WBC#)-静脉血: 6.1210E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 36.2U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.58mmol/L；胱抑素(Cys-C)-静脉血: 0.95mg/L；大血小板……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1082] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者目前诊断明确，[计划性表述已隐藏]根治性放疗及同期化疗。向患者及其家属交代病情，治疗方案及治疗风险，做好治疗前准备工作。\n- [全程D1083] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者入院第三天，无明显不适主诉，查体情况：一般情况可，余同入院。预约放疗。\n- [全程D1088] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 今日查房，患者无明显不适主诉，生命体征平稳。已予预约放疗。候治疗。\n- [全程D1093] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 今日查房，患者无明显不适主诉，生命体征平稳。查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常。患者现放疗计划已设计完成并通过全科会诊，靶区剂量分布均匀，正常组织剂量在可接受范围内。[姓名已隐去]医生信息已隐藏示：患者无明显放化疗禁忌症，拟于今日开始行根治性放疗+同时期化疗。向患者及其家属交代病情及化疗风险，表示理解并已签署知情同意书，可于今日执行第1程顺铂方案同时期化疗，注意化疗不良反应。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停同期化疗，给予静脉保肝药物治疗，待转氨酶降至正常后再启动顺铂化疗\nB. 按原计划执行顺铂同期化疗，暂不予特殊保肝处理，常规监测肝功能\nC. 给予口服保肝药物，将顺铂剂量下调20%后执行同期化疗\nD. 给予静脉双重保肝药物，按原计划执行顺铂同期化疗，并动态复查肝功能\nE. 停用顺铂，更改为卡铂方案执行同期化疗，并给予口服保肝药物\nF. 给予口服保肝药物，推迟顺铂化疗1周，期间正常进行放疗\nG. 停用顺铂，更改为西妥昔单抗靶向治疗联合放疗，并给予口服保肝药物\nH. 给予口服保肝药物（如复方甘草酸苷、葡醛内酯），按原计划执行顺铂同期化疗，并动态复查肝功能\nI. 暂停放化疗，行腹部增强CT排查肝脏转移，并给予静脉保肝治疗\nJ. 给予口服保肝药物，按原计划执行顺铂同期化疗，并预防性使用重组人粒细胞刺激因子\nK. 给予口服保肝药物，按原计划执行顺铂同期化疗，并预防性使用广谱抗生素\nL. 给予口服保肝药物，将顺铂方案更改为奈达铂方案执行同期化疗\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-c47048c6a3961cfb24a6bb12","patient_id":"patient-36d433557e63f939b878347d","turn_id":"turn06","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"I","gold_action":"继续根治性放疗及同期化疗，暂不予集落刺激因子支持，密切监测血常规","options":[{"letter":"A","text":"暂停放化疗，给予重组人粒细胞集落刺激因子治疗，待白细胞恢复后继续","is_gold":false},{"letter":"B","text":"暂停同期化疗，仅继续根治性放疗，并给予重组人粒细胞集落刺激因子","is_gold":false},{"letter":"C","text":"继续根治性放疗及同期化疗，下一疗程顺铂剂量减量20%","is_gold":false},{"letter":"D","text":"继续根治性放疗及同期化疗，加用重组人粒细胞集落刺激因子","is_gold":false},{"letter":"E","text":"暂停放化疗，给予静脉高营养及强效止吐、补液支持，暂缓抗肿瘤治疗","is_gold":false},{"letter":"F","text":"继续根治性放疗及同期化疗，加用重组人血小板生成素","is_gold":false},{"letter":"G","text":"暂停同期化疗，将后续全身治疗更换为尼妥珠单抗靶向治疗","is_gold":false},{"letter":"H","text":"继续根治性放疗及同期化疗，加用促红细胞生成素及铁剂","is_gold":false},{"letter":"I","text":"继续根治性放疗及同期化疗，暂不予集落刺激因子支持，密切监测血常规","is_gold":true},{"letter":"J","text":"暂停放化疗，行骨髓穿刺评估造血功能后再决定后续治疗","is_gold":false},{"letter":"K","text":"继续根治性放疗，终止同期化疗，放疗结束后改为辅助化疗","is_gold":false},{"letter":"L","text":"继续根治性放疗及同期化疗，降低放疗靶区处方剂量","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、海绵窦、翼突基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D1102] 检验组合: 尿酸(UA)-静脉血: 238.2umol/L；总胆红素(TBIL)-静脉血: 6.2umol/L；白细胞计数(WBC#)-静脉血: 3.5310E9/L；间接胆红素(IBIL)-静脉血: 4.8umolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.3；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.02；阴离子间隙(AG)-静脉血: 15.1；磷(P)-静脉血: 1.08mmol/L；钠离子(Na+)-静脉血: 137.5mmol/L；总钙(Ca)-静脉血: 2.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 26.7U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.8；直接胆红素(DBIL)-静脉血: 1.4umol/L；球蛋白(GLO)-静脉血: 27.56g/L；载脂蛋白AI(apoAI)-静脉血: 1.46g/L；红细胞计数(RBC#)-静脉血: 4.6610E12/L；载脂蛋白B(apoB)-静脉血: 1.09g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；血红蛋白(Hb)-静脉血: 142g/L；葡萄糖(Glu)-静脉血: 5.62mmol/L；甘油三酯(TG)-静脉血: 0.98mmol/L；镁离子(Mg2+)-静脉血: 0.97mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；血小板分布宽度(PDW)-静脉血: 9.2%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；总胆固醇(TC)-静脉血: 5.85mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336g/L；平均血小板体积(MPV)-静脉血: 9fL；血小板计数(PLT#)-静脉血: 19010E9/L；血小板比容-静脉血: 17%；红细胞比容(Hct)-静脉血: 42.3%；总胆汁酸(TBA)-静脉血: 1.8umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.76mmolL；胱抑素(Cys-C)-静脉血: 0.89mg/L；肌酐(Crea)-静脉血: 54.9umol/L；白蛋白(ALB)-静脉血: 46.6g/L；氯离子(Cl-)-静脉血: 97.8mmol/L；钾离子(K+)-静脉血: 3.78mmol/……\n\n【既往治疗与反应】\n- [全程D1098] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中，第1程顺铂方案同时期化疗结束。今日查房，患者诉呕吐2次，咽痛、恶心、食欲下降，伴头晕，无腹痛、腹泻等不适。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放化疗，给予重组人粒细胞集落刺激因子治疗，待白细胞恢复后继续\nB. 暂停同期化疗，仅继续根治性放疗，并给予重组人粒细胞集落刺激因子\nC. 继续根治性放疗及同期化疗，下一疗程顺铂剂量减量20%\nD. 继续根治性放疗及同期化疗，加用重组人粒细胞集落刺激因子\nE. 暂停放化疗，给予静脉高营养及强效止吐、补液支持，暂缓抗肿瘤治疗\nF. 继续根治性放疗及同期化疗，加用重组人血小板生成素\nG. 暂停同期化疗，将后续全身治疗更换为尼妥珠单抗靶向治疗\nH. 继续根治性放疗及同期化疗，加用促红细胞生成素及铁剂\nI. 继续根治性放疗及同期化疗，暂不予集落刺激因子支持，密切监测血常规\nJ. 暂停放化疗，行骨髓穿刺评估造血功能后再决定后续治疗\nK. 继续根治性放疗，终止同期化疗，放疗结束后改为辅助化疗\nL. 继续根治性放疗及同期化疗，降低放疗靶区处方剂量\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、海绵窦、翼突基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D1102] 检验组合: 尿酸(UA)-静脉血: 238.2umol/L；总胆红素(TBIL)-静脉血: 6.2umol/L；白细胞计数(WBC#)-静脉血: 3.5310E9/L；间接胆红素(IBIL)-静脉血: 4.8umolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.3；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.02；阴离子间隙(AG)-静脉血: 15.1；磷(P)-静脉血: 1.08mmol/L；钠离子(Na+)-静脉血: 137.5mmol/L；总钙(Ca)-静脉血: 2.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 26.7U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.8；直接胆红素(DBIL)-静脉血: 1.4umol/L；球蛋白(GLO)-静脉血: 27.56g/L；载脂蛋白AI(apoAI)-静脉血: 1.46g/L；红细胞计数(RBC#)-静脉血: 4.6610E12/L；载脂蛋白B(apoB)-静脉血: 1.09g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；血红蛋白(Hb)-静脉血: 142g/L；葡萄糖(Glu)-静脉血: 5.62mmol/L；甘油三酯(TG)-静脉血: 0.98mmol/L；镁离子(Mg2+)-静脉血: 0.97mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；血小板分布宽度(PDW)-静脉血: 9.2%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；总胆固醇(TC)-静脉血: 5.85mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336g/L；平均血小板体积(MPV)-静脉血: 9fL；血小板计数(PLT#)-静脉血: 19010E9/L；血小板比容-静脉血: 17%；红细胞比容(Hct)-静脉血: 42.3%；总胆汁酸(TBA)-静脉血: 1.8umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.76mmolL；胱抑素(Cys-C)-静脉血: 0.89mg/L；肌酐(Crea)-静脉血: 54.9umol/L；白蛋白(ALB)-静脉血: 46.6g/L；氯离子(Cl-)-静脉血: 97.8mmol/L；钾离子(K+)-静脉血: 3.78mmol/……\n\n【既往治疗与反应】\n- [全程D1098] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中，第1程顺铂方案同时期化疗结束。今日查房，患者诉呕吐2次，咽痛、恶心、食欲下降，伴头晕，无腹痛、腹泻等不适。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放化疗，给予重组人粒细胞集落刺激因子治疗，待白细胞恢复后继续\nB. 暂停同期化疗，仅继续根治性放疗，并给予重组人粒细胞集落刺激因子\nC. 继续根治性放疗及同期化疗，下一疗程顺铂剂量减量20%\nD. 继续根治性放疗及同期化疗，加用重组人粒细胞集落刺激因子\nE. 暂停放化疗，给予静脉高营养及强效止吐、补液支持，暂缓抗肿瘤治疗\nF. 继续根治性放疗及同期化疗，加用重组人血小板生成素\nG. 暂停同期化疗，将后续全身治疗更换为尼妥珠单抗靶向治疗\nH. 继续根治性放疗及同期化疗，加用促红细胞生成素及铁剂\nI. 继续根治性放疗及同期化疗，暂不予集落刺激因子支持，密切监测血常规\nJ. 暂停放化疗，行骨髓穿刺评估造血功能后再决定后续治疗\nK. 继续根治性放疗，终止同期化疗，放疗结束后改为辅助化疗\nL. 继续根治性放疗及同期化疗，降低放疗靶区处方剂量\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-28a13cf2b32abdc303bbad45","patient_id":"patient-36d433557e63f939b878347d","turn_id":"turn07","turn_position":5,"turn_type":"response_assessment_decision","gold_letter":"I","gold_action":"评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，每周复查血常规及生化，指导功能锻炼。","options":[{"letter":"A","text":"评估临床症状完全缓解，提前终止放疗，办理出院并进入定期随访阶段，1个月后复查头颈部MRI。","is_gold":false},{"letter":"B","text":"评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，并口服替吉奥单药维持化疗。","is_gold":false},{"letter":"C","text":"评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，期间无需定期复查血液学指标。","is_gold":false},{"letter":"D","text":"评估肿瘤退缩缓慢，继续住院，将放疗方案调整为超分割放疗，并加用西妥昔单抗靶向治疗。","is_gold":false},{"letter":"E","text":"评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，期间暂停放疗2周以促进粘膜修复。","is_gold":false},{"letter":"F","text":"评估肿瘤部分缓解，继续住院完成根治性放疗，并每周行鼻咽部MRI以动态监测肿瘤退缩情况。","is_gold":false},{"letter":"G","text":"评估临床症状缓解且毒副反应可耐受，转外科行鼻咽及颈部残留病灶切除术，术后在门诊继续完成剩余放疗。","is_gold":false},{"letter":"H","text":"评估疑似疾病进展，停止放疗，改为吉西他滨联合顺铂方案全身姑息化疗并办理出院。","is_gold":false},{"letter":"I","text":"评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，每周复查血常规及生化，指导功能锻炼。","is_gold":true},{"letter":"J","text":"评估临床症状缓解且毒副反应可耐受，继续住院完成剩余根治性放疗，期间常规给予静脉高营养支持及预防性抗感染。","is_gold":false},{"letter":"K","text":"评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，并立即安排全身PET-CT确认疗效。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、海绵窦、翼突基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D1109] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 28.2mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；钾离子(K+)-静脉血: 3.77mmol/L；甘油三酯(TG)-静脉血: 0.8mmol/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；红细胞计数(RBC#)-静脉血: 4.2410E12/L；总胆固醇(TC)-静脉血: 5.21mmol/L；镁离子(Mg2+)-静脉血: 0.97mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.6；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；总胆汁酸(TBA)-静脉血: 0.6umol/L；总胆红素(TBIL)-静脉血: 8.6umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.119；红细胞比容(Hct)-静脉血: 38.7%；尿素氮(BUN)-静脉血: 4.1mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；间接胆红素(IBIL)-静脉血: 6.5umolL；C-反应蛋白(CRP)-静脉血: 2.85mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.53mmolL；血小板分布宽度(PDW)-静脉血: 17.4%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.29mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；阴离子间隙(AG)-静脉血: 15；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；血小板计数(PLT#)-静脉血: 204.310E9/L；平均红细胞体积(MCV)-静脉血: 91.1fL；丙氨酸氨基转移酶(ALT)-静脉血: 12.3U/L；总蛋白(TP)-静脉血: 69.21g/L；直接胆红素(DBIL)-静脉血: 2.1umol/L；氯离子(Cl-)-静脉血: 95.7mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.784；中性粒细胞计数(Neut#)-静脉血: 2.310E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22.8U/L；平均血小板体积(MPV)-静脉血: 6.38fL；γ-谷氨酰基转移酶(GGT)-静脉血: 23.6U/L；总钙(Ca)-静脉血: 2.22mmol/L；单核……\n- [全程D1113] 检验组合: 血小板比容-静脉血: 15%；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 6.5；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.734；平均红细胞体积(MCV)-静脉血: 91.5fL；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；隐血(OB)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；中性粒细胞计数(Neut#)-静脉血: 2.310E9/L；总蛋白(TP)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 1/μL；红细胞计数(RBC#)-静脉血: 4.1310E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；血小板计数(PLT#)-静脉血: 16810E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；比重(SG)-尿液: 1.009；浊度(TRUB)-尿液: 清亮；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.05；大血小板百分比(P-LCR%)-静脉血: 18%；单核细胞计数(Mono#)-静脉血: 0.410E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.5；酮体(KET)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 13/μL；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-静脉血: 3.210E9/L；白细胞(LEU)-尿液: -（参考: 阴性）；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；红细胞比容(Hct)-静脉血: 37.8%；血红蛋白(Hb)-静脉血: 126g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.5；血小板分布宽度(PDW)-静脉血: 9.3%；淋巴细胞百分比(Lymph%)-静脉血: 0.103；平均红细胞血红蛋白浓度(MCHC)-静脉血: 333g/L；平均血小板体积(MPV)-静脉血: 8.9fL；单核细胞百分比(Mono%)-静脉血: 0.11\n- [全程D1114] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 16/μL；颜色-尿液: Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: +- 0.1g（参考: 阴性）；酮体(KET)-尿液: 1+ 1mmol（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 6.5；比重(SG)-尿液: 1.022；白细胞计数(WBC#)-尿液: 10/μL；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）\n- [全程D1116] 检验组合: 亚硝酸盐(NIT)-尿液: -（参考: 阴性）；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336.3g/L；阴离子间隙(AG)-静脉血: 12；总蛋白(TP)-尿液: -（参考: 阴性）；磷(P)-静脉血: 0.93mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20U/L；尿酸(UA)-静脉血: 199.4umol/L；平均红细胞体积(MCV)-静脉血: 92.9fL；碱性磷酸酶(ALP)-静脉血: 61.6U/L；酸碱度(pH)-尿液: 6.5；血小板分布宽度(PDW)-静脉血: 17%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.032；隐血(OB)-尿液: -（参考: 阴性）；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.44mmolL；肌酐(Crea)-静脉血: 67.5umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.2；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；氯离子(Cl-)-静脉血: 102.9mmol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；总胆红素(TBIL)-静脉血: 6.7umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14%；血小板计数(PLT#)-静脉血: 176.710E9/L；总蛋白(TP)-静脉血: 65.51g/L；尿素氮(BUN)-静脉血: 3.95mmol/L；红细胞计数(RBC#)-静脉血: 3.8510E12/L；甘油三酯(TG)-静脉血: 1.05mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；α-L-岩藻糖苷酶(AFU)-静脉血: 30U/L；间接胆红素(IBIL)-静脉血: 4.4umolL；总胆固醇(TC)-静脉血: 5.25mmol/L；浊度(TRUB)-尿液: 清亮；平均血小板体积(MPV)-静脉血: 6.6fL；胆红素(BIL)-尿液: -（参考: 阴性）；总胆汁酸(TBA)-静脉血: 0.2umol/L；载脂蛋白B(apoB)-静脉血: 0.98g/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；中性粒细胞计数(Neut#)-静脉血: 2.81……\n- [全程D1123] 检验组合: 红细胞计数(RBC#)-静脉血: 4.3710E12/L；中性粒细胞计数(Neut#)-静脉血: 310E9/L；平均红细胞体积(MCV)-静脉血: 90fL；甘油三酯(TG)-静脉血: 1.06mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.55；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.072；白蛋白(ALB)-静脉血: 44.8g/L；单核细胞百分比(Mono%)-静脉血: 0.081；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；红细胞比容(Hct)-静脉血: 39.4%；总钙(Ca)-静脉血: 2.44mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.8pg；血小板比容-静脉血: 10%；氯离子(Cl-)-静脉血: 92.5mmol/L；血小板计数(PLT#)-静脉血: 143.810E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.98mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4%；中性粒细胞百分比(Neut%)-静脉血: 0.841；总胆固醇(TC)-静脉血: 6.12mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 343.2g/L；间接胆红素(IBIL)-静脉血: 6.2umolL；尿素氮(BUN)-静脉血: 7.4mmol/L；平均血小板体积(MPV)-静脉血: 6.98fL；总胆红素(TBIL)-静脉血: 8.2umol/L；胱抑素(Cys-C)-静脉血: 0.86mg/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；载脂蛋白B(apoB)-静脉血: 1.37g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.9U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；C-反应蛋白(CRP)-静脉血: 10.49mg/L；球蛋白(GLO)-静脉血: 30.65g/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.46；葡萄糖(Glu)-静脉血: 5.64mmol/L；磷(P)-静脉血: 1.16mmol/L……\n- [全程D1125] 检验组合: 总钙(Ca)-静脉血: 2.38mmol/L；阴离子间隙(AG)-静脉血: 12.7；磷(P)-静脉血: 0.81mmol/L；氯离子(Cl-)-静脉血: 92.5mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 28.7mmol/L；钾离子(K+)-静脉血: 3.68mmol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；钠离子(Na+)-静脉血: 133.9mmol/L\n- [全程D1130] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对侧，双肺野纹理清晰，未见明显实质性病变。双侧肺门不大，纵隔不宽，心影形态、大小、位置未见异常。双膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见异常。\n- [全程D1130] 超声；肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。\n- [全程D1130] 检验组合: 有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞血红蛋白含量(MCH)-静脉血: 31.3pg；淋巴细胞百分比(Lymph%)-静脉血: 0.09；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4%；单核细胞计数(Mono#)-静脉血: 0.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.184；白蛋白(ALB)-静脉血: 43.5g/L；球蛋白(GLO)-静脉血: 29.66g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.32mmolL；总胆固醇(TC)-静脉血: 5.82mmol/L；葡萄糖(Glu)-静脉血: 5.74mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21U/L；中性粒细胞计数(Neut#)-静脉血: 1.510E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.9U/L；中性粒细胞百分比(Neut%)-静脉血: 0.715；尿酸(UA)-静脉血: 242.7umol/L；总胆汁酸(TBA)-静脉血: 0.2umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.005；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；血红蛋白(Hb)-静脉血: 125g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血小板分布宽度(PDW)-静脉血: 17.2%；总胆红素(TBIL)-静脉血: 6.6umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 28.4mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 344.5g/L；钾离子(K+)-静脉血: 3.7mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.8U/L；载脂蛋白B(apoB)-静脉血: 1.31g/L；红细胞计数(RBC#)-静脉血: 3.9910E12/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.4；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 90.9fL；总蛋白(TP)-静脉血: 73.16g/L；平均血小板体积(MPV)-静脉血: 6.84fL；血小板计数(PLT#)-静脉血: 181.410E9/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；低密度脂蛋白胆固醇(LDL-C)……\n\n【既往治疗与反应】\n- [全程D1108] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中。今日查房，患者无明显不适主诉，生命体征平稳。[姓名已隐去]医生信息已隐藏：继续治疗。\n- [全程D1113] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中。今日查房，患者无明显不适主诉，生命体征平稳。查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：可于今日水化，明日执行第2程DDP方案同时期化疗，注意化疗不良反应。\n- [全程D1118] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中，第2程顺铂方案同时期化疗结束。诉咽痛、恶心、食欲下降，呕吐1次，伴头晕，无腹痛、腹泻等不适。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D1123] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中。今日查房，患者无明显不适主诉，生命体征平稳。[姓名已隐去]医生信息已隐藏：患者治疗疗程过半，予预约治疗结束后影像学复查。继续治疗。\n- [全程D1129] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中。今日查房，患者无明显不适主诉，生命体征平稳。[姓名已隐去]医生信息已隐藏：嘱患者冲洗鼻咽，保持鼻咽清洁。继续治疗。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 评估临床症状完全缓解，提前终止放疗，办理出院并进入定期随访阶段，1个月后复查头颈部MRI。\nB. 评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，并口服替吉奥单药维持化疗。\nC. 评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，期间无需定期复查血液学指标。\nD. 评估肿瘤退缩缓慢，继续住院，将放疗方案调整为超分割放疗，并加用西妥昔单抗靶向治疗。\nE. 评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，期间暂停放疗2周以促进粘膜修复。\nF. 评估肿瘤部分缓解，继续住院完成根治性放疗，并每周行鼻咽部MRI以动态监测肿瘤退缩情况。\nG. 评估临床症状缓解且毒副反应可耐受，转外科行鼻咽及颈部残留病灶切除术，术后在门诊继续完成剩余放疗。\nH. 评估疑似疾病进展，停止放疗，改为吉西他滨联合顺铂方案全身姑息化疗并办理出院。\nI. 评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，每周复查血常规及生化，指导功能锻炼。\nJ. 评估临床症状缓解且毒副反应可耐受，继续住院完成剩余根治性放疗，期间常规给予静脉高营养支持及预防性抗感染。\nK. 评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，并立即安排全身PET-CT确认疗效。\n\n请仅输出一个选项字母（A-K）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、海绵窦、翼突基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D1109] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 28.2mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；钾离子(K+)-静脉血: 3.77mmol/L；甘油三酯(TG)-静脉血: 0.8mmol/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；红细胞计数(RBC#)-静脉血: 4.2410E12/L；总胆固醇(TC)-静脉血: 5.21mmol/L；镁离子(Mg2+)-静脉血: 0.97mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.6；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；总胆汁酸(TBA)-静脉血: 0.6umol/L；总胆红素(TBIL)-静脉血: 8.6umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.119；红细胞比容(Hct)-静脉血: 38.7%；尿素氮(BUN)-静脉血: 4.1mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；间接胆红素(IBIL)-静脉血: 6.5umolL；C-反应蛋白(CRP)-静脉血: 2.85mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.53mmolL；血小板分布宽度(PDW)-静脉血: 17.4%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.29mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；阴离子间隙(AG)-静脉血: 15；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；血小板计数(PLT#)-静脉血: 204.310E9/L；平均红细胞体积(MCV)-静脉血: 91.1fL；丙氨酸氨基转移酶(ALT)-静脉血: 12.3U/L；总蛋白(TP)-静脉血: 69.21g/L；直接胆红素(DBIL)-静脉血: 2.1umol/L；氯离子(Cl-)-静脉血: 95.7mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.784；中性粒细胞计数(Neut#)-静脉血: 2.310E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22.8U/L；平均血小板体积(MPV)-静脉血: 6.38fL；γ-谷氨酰基转移酶(GGT)-静脉血: 23.6U/L；总钙(Ca)-静脉血: 2.22mmol/L；单核……\n- [全程D1113] 检验组合: 血小板比容-静脉血: 15%；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 6.5；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.734；平均红细胞体积(MCV)-静脉血: 91.5fL；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；隐血(OB)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；中性粒细胞计数(Neut#)-静脉血: 2.310E9/L；总蛋白(TP)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 1/μL；红细胞计数(RBC#)-静脉血: 4.1310E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；血小板计数(PLT#)-静脉血: 16810E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；比重(SG)-尿液: 1.009；浊度(TRUB)-尿液: 清亮；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.05；大血小板百分比(P-LCR%)-静脉血: 18%；单核细胞计数(Mono#)-静脉血: 0.410E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.5；酮体(KET)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 13/μL；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-静脉血: 3.210E9/L；白细胞(LEU)-尿液: -（参考: 阴性）；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；红细胞比容(Hct)-静脉血: 37.8%；血红蛋白(Hb)-静脉血: 126g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.5；血小板分布宽度(PDW)-静脉血: 9.3%；淋巴细胞百分比(Lymph%)-静脉血: 0.103；平均红细胞血红蛋白浓度(MCHC)-静脉血: 333g/L；平均血小板体积(MPV)-静脉血: 8.9fL；单核细胞百分比(Mono%)-静脉血: 0.11\n- [全程D1114] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 16/μL；颜色-尿液: Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: +- 0.1g（参考: 阴性）；酮体(KET)-尿液: 1+ 1mmol（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 6.5；比重(SG)-尿液: 1.022；白细胞计数(WBC#)-尿液: 10/μL；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）\n- [全程D1116] 检验组合: 亚硝酸盐(NIT)-尿液: -（参考: 阴性）；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336.3g/L；阴离子间隙(AG)-静脉血: 12；总蛋白(TP)-尿液: -（参考: 阴性）；磷(P)-静脉血: 0.93mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20U/L；尿酸(UA)-静脉血: 199.4umol/L；平均红细胞体积(MCV)-静脉血: 92.9fL；碱性磷酸酶(ALP)-静脉血: 61.6U/L；酸碱度(pH)-尿液: 6.5；血小板分布宽度(PDW)-静脉血: 17%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.032；隐血(OB)-尿液: -（参考: 阴性）；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.44mmolL；肌酐(Crea)-静脉血: 67.5umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.2；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；氯离子(Cl-)-静脉血: 102.9mmol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；总胆红素(TBIL)-静脉血: 6.7umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14%；血小板计数(PLT#)-静脉血: 176.710E9/L；总蛋白(TP)-静脉血: 65.51g/L；尿素氮(BUN)-静脉血: 3.95mmol/L；红细胞计数(RBC#)-静脉血: 3.8510E12/L；甘油三酯(TG)-静脉血: 1.05mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；α-L-岩藻糖苷酶(AFU)-静脉血: 30U/L；间接胆红素(IBIL)-静脉血: 4.4umolL；总胆固醇(TC)-静脉血: 5.25mmol/L；浊度(TRUB)-尿液: 清亮；平均血小板体积(MPV)-静脉血: 6.6fL；胆红素(BIL)-尿液: -（参考: 阴性）；总胆汁酸(TBA)-静脉血: 0.2umol/L；载脂蛋白B(apoB)-静脉血: 0.98g/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；中性粒细胞计数(Neut#)-静脉血: 2.81……\n- [全程D1123] 检验组合: 红细胞计数(RBC#)-静脉血: 4.3710E12/L；中性粒细胞计数(Neut#)-静脉血: 310E9/L；平均红细胞体积(MCV)-静脉血: 90fL；甘油三酯(TG)-静脉血: 1.06mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.55；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.072；白蛋白(ALB)-静脉血: 44.8g/L；单核细胞百分比(Mono%)-静脉血: 0.081；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；红细胞比容(Hct)-静脉血: 39.4%；总钙(Ca)-静脉血: 2.44mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.8pg；血小板比容-静脉血: 10%；氯离子(Cl-)-静脉血: 92.5mmol/L；血小板计数(PLT#)-静脉血: 143.810E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.98mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4%；中性粒细胞百分比(Neut%)-静脉血: 0.841；总胆固醇(TC)-静脉血: 6.12mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 343.2g/L；间接胆红素(IBIL)-静脉血: 6.2umolL；尿素氮(BUN)-静脉血: 7.4mmol/L；平均血小板体积(MPV)-静脉血: 6.98fL；总胆红素(TBIL)-静脉血: 8.2umol/L；胱抑素(Cys-C)-静脉血: 0.86mg/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；载脂蛋白B(apoB)-静脉血: 1.37g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.9U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；C-反应蛋白(CRP)-静脉血: 10.49mg/L；球蛋白(GLO)-静脉血: 30.65g/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.46；葡萄糖(Glu)-静脉血: 5.64mmol/L；磷(P)-静脉血: 1.16mmol/L……\n- [全程D1125] 检验组合: 总钙(Ca)-静脉血: 2.38mmol/L；阴离子间隙(AG)-静脉血: 12.7；磷(P)-静脉血: 0.81mmol/L；氯离子(Cl-)-静脉血: 92.5mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 28.7mmol/L；钾离子(K+)-静脉血: 3.68mmol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；钠离子(Na+)-静脉血: 133.9mmol/L\n- [全程D1130] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对侧，双肺野纹理清晰，未见明显实质性病变。双侧肺门不大，纵隔不宽，心影形态、大小、位置未见异常。双膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见异常。\n- [全程D1130] 超声；肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。\n- [全程D1130] 检验组合: 有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞血红蛋白含量(MCH)-静脉血: 31.3pg；淋巴细胞百分比(Lymph%)-静脉血: 0.09；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4%；单核细胞计数(Mono#)-静脉血: 0.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.184；白蛋白(ALB)-静脉血: 43.5g/L；球蛋白(GLO)-静脉血: 29.66g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.32mmolL；总胆固醇(TC)-静脉血: 5.82mmol/L；葡萄糖(Glu)-静脉血: 5.74mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21U/L；中性粒细胞计数(Neut#)-静脉血: 1.510E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.9U/L；中性粒细胞百分比(Neut%)-静脉血: 0.715；尿酸(UA)-静脉血: 242.7umol/L；总胆汁酸(TBA)-静脉血: 0.2umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.005；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；血红蛋白(Hb)-静脉血: 125g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血小板分布宽度(PDW)-静脉血: 17.2%；总胆红素(TBIL)-静脉血: 6.6umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 28.4mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 344.5g/L；钾离子(K+)-静脉血: 3.7mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.8U/L；载脂蛋白B(apoB)-静脉血: 1.31g/L；红细胞计数(RBC#)-静脉血: 3.9910E12/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.4；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 90.9fL；总蛋白(TP)-静脉血: 73.16g/L；平均血小板体积(MPV)-静脉血: 6.84fL；血小板计数(PLT#)-静脉血: 181.410E9/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；低密度脂蛋白胆固醇(LDL-C)……\n\n【既往治疗与反应】\n- [全程D1108] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中。今日查房，患者无明显不适主诉，生命体征平稳。[姓名已隐去]医生信息已隐藏：继续治疗。\n- [全程D1113] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中。今日查房，患者无明显不适主诉，生命体征平稳。查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：可于今日水化，明日执行第2程DDP方案同时期化疗，注意化疗不良反应。\n- [全程D1118] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中，第2程顺铂方案同时期化疗结束。诉咽痛、恶心、食欲下降，呕吐1次，伴头晕，无腹痛、腹泻等不适。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D1123] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中。今日查房，患者无明显不适主诉，生命体征平稳。[姓名已隐去]医生信息已隐藏：患者治疗疗程过半，予预约治疗结束后影像学复查。继续治疗。\n- [全程D1129] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中。今日查房，患者无明显不适主诉，生命体征平稳。[姓名已隐去]医生信息已隐藏：嘱患者冲洗鼻咽，保持鼻咽清洁。继续治疗。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 评估临床症状完全缓解，提前终止放疗，办理出院并进入定期随访阶段，1个月后复查头颈部MRI。\nB. 评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，并口服替吉奥单药维持化疗。\nC. 评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，期间无需定期复查血液学指标。\nD. 评估肿瘤退缩缓慢，继续住院，将放疗方案调整为超分割放疗，并加用西妥昔单抗靶向治疗。\nE. 评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，期间暂停放疗2周以促进粘膜修复。\nF. 评估肿瘤部分缓解，继续住院完成根治性放疗，并每周行鼻咽部MRI以动态监测肿瘤退缩情况。\nG. 评估临床症状缓解且毒副反应可耐受，转外科行鼻咽及颈部残留病灶切除术，术后在门诊继续完成剩余放疗。\nH. 评估疑似疾病进展，停止放疗，改为吉西他滨联合顺铂方案全身姑息化疗并办理出院。\nI. 评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，每周复查血常规及生化，指导功能锻炼。\nJ. 评估临床症状缓解且毒副反应可耐受，继续住院完成剩余根治性放疗，期间常规给予静脉高营养支持及预防性抗感染。\nK. 评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，并立即安排全身PET-CT确认疗效。\n\n请仅输出一个选项字母（A-K）。"}]}
+{"sample_id":"sample-40b7a6f655350cf46e9ce33c","patient_id":"patient-36d433557e63f939b878347d","turn_id":"turn08","turn_position":6,"turn_type":"response_assessment_decision","gold_letter":"K","gold_action":"办理出院，转门诊继续完成根治性放疗，每周复查血常规及生化，指导鼻腔冲洗与功能锻炼。","options":[{"letter":"A","text":"立即行鼻咽及颈部MRI复查，视近期疗效评估结果调整放疗靶区及剂量。","is_gold":false},{"letter":"B","text":"安排第3程顺铂同期化疗，并继续住院完成剩余根治性放疗疗程。","is_gold":false},{"letter":"C","text":"暂停放疗，行全身PET-CT检查以排除远处转移，待结果回报后决定后续方案。","is_gold":false},{"letter":"D","text":"办理出院，结束所有抗肿瘤治疗，进入定期随访阶段，1个月后复查MRI。","is_gold":false},{"letter":"E","text":"调整化疗方案为紫杉醇+顺铂，继续住院行第3程同期化疗及放疗。","is_gold":false},{"letter":"F","text":"立即行鼻咽镜检查及活检，视病理退缩情况调整后续放疗方案。","is_gold":false},{"letter":"G","text":"办理出院，转门诊继续放疗，并加用西妥昔单抗靶向治疗。","is_gold":false},{"letter":"H","text":"继续住院完成剩余放疗，期间每周复查血常规及生化，待放疗结束后出院。","is_gold":false},{"letter":"I","text":"办理出院，转门诊继续放疗，并立即启动顺铂+氟尿嘧啶方案辅助化疗。","is_gold":false},{"letter":"J","text":"立即行胸部CT及腹部增强CT，视全面评估结果决定是否继续门诊放疗。","is_gold":false},{"letter":"K","text":"办理出院，转门诊继续完成根治性放疗，每周复查血常规及生化，指导鼻腔冲洗与功能锻炼。","is_gold":true},{"letter":"L","text":"暂停放疗，给予重组人粒细胞刺激因子及升血小板治疗，待血象完全恢复正常后继续放疗。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、海绵窦、翼突基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- 无可展示记录。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即行鼻咽及颈部MRI复查，视近期疗效评估结果调整放疗靶区及剂量。\nB. 安排第3程顺铂同期化疗，并继续住院完成剩余根治性放疗疗程。\nC. 暂停放疗，行全身PET-CT检查以排除远处转移，待结果回报后决定后续方案。\nD. 办理出院，结束所有抗肿瘤治疗，进入定期随访阶段，1个月后复查MRI。\nE. 调整化疗方案为紫杉醇+顺铂，继续住院行第3程同期化疗及放疗。\nF. 立即行鼻咽镜检查及活检，视病理退缩情况调整后续放疗方案。\nG. 办理出院，转门诊继续放疗，并加用西妥昔单抗靶向治疗。\nH. 继续住院完成剩余放疗，期间每周复查血常规及生化，待放疗结束后出院。\nI. 办理出院，转门诊继续放疗，并立即启动顺铂+氟尿嘧啶方案辅助化疗。\nJ. 立即行胸部CT及腹部增强CT，视全面评估结果决定是否继续门诊放疗。\nK. 办理出院，转门诊继续完成根治性放疗，每周复查血常规及生化，指导鼻腔冲洗与功能锻炼。\nL. 暂停放疗，给予重组人粒细胞刺激因子及升血小板治疗，待血象完全恢复正常后继续放疗。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、海绵窦、翼突基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- 无可展示记录。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即行鼻咽及颈部MRI复查，视近期疗效评估结果调整放疗靶区及剂量。\nB. 安排第3程顺铂同期化疗，并继续住院完成剩余根治性放疗疗程。\nC. 暂停放疗，行全身PET-CT检查以排除远处转移，待结果回报后决定后续方案。\nD. 办理出院，结束所有抗肿瘤治疗，进入定期随访阶段，1个月后复查MRI。\nE. 调整化疗方案为紫杉醇+顺铂，继续住院行第3程同期化疗及放疗。\nF. 立即行鼻咽镜检查及活检，视病理退缩情况调整后续放疗方案。\nG. 办理出院，转门诊继续放疗，并加用西妥昔单抗靶向治疗。\nH. 继续住院完成剩余放疗，期间每周复查血常规及生化，待放疗结束后出院。\nI. 办理出院，转门诊继续放疗，并立即启动顺铂+氟尿嘧啶方案辅助化疗。\nJ. 立即行胸部CT及腹部增强CT，视全面评估结果决定是否继续门诊放疗。\nK. 办理出院，转门诊继续完成根治性放疗，每周复查血常规及生化，指导鼻腔冲洗与功能锻炼。\nL. 暂停放疗，给予重组人粒细胞刺激因子及升血小板治疗，待血象完全恢复正常后继续放疗。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-295d4b99725721eb1811c149","patient_id":"patient-79fa00752e4405e2980f6292","turn_id":"turn01","turn_position":1,"turn_type":"initial_workup_choice","gold_letter":"L","gold_action":"鼻咽镜检查及活检，鼻咽及颈部增强MRI，胸部CT、腹部超声及全身骨扫描，以及包含EBV-DNA的基线血液学检查","options":[{"letter":"A","text":"鼻咽及颈部增强CT，胸部CT、腹部超声及全身骨扫描，以及包含EBV-DNA的基线血液学检查","is_gold":false},{"letter":"B","text":"鼻咽镜检查及活检，鼻咽及颈部增强CT，胸部CT、腹部超声及全身骨扫描，以及常规血液学检查","is_gold":false},{"letter":"C","text":"鼻咽镜检查及活检，鼻咽及颈部增强MRI，常规血液学检查，暂缓全身远处转移筛查","is_gold":false},{"letter":"D","text":"鼻咽及颈部增强MRI，全身PET-CT，包含EBV-DNA的基线血液学检查，直接安排诱导化疗","is_gold":false},{"letter":"E","text":"鼻咽镜检查及活检，鼻咽及颈部增强MRI，胸部X线、腹部超声，以及常规血液学检查","is_gold":false},{"letter":"F","text":"鼻咽及颈部增强MRI，颈部淋巴结穿刺活检，胸部CT、腹部超声及全身骨扫描，以及包含EBV-DNA的基线血液学检查","is_gold":false},{"letter":"G","text":"鼻咽镜检查及活检，鼻咽及颈部增强MRI，全身PET-CT，随后行鼻咽肿物切除术","is_gold":false},{"letter":"H","text":"鼻咽镜检查及活检，鼻咽及颈部平扫MRI，胸部CT、腹部超声及全身骨扫描，以及包含EBV-DNA的基线血液学检查","is_gold":false},{"letter":"I","text":"鼻咽镜检查及活检，鼻咽及颈部增强MRI，胸部CT、腹部超声及全身骨扫描，暂缓基线血液学及EBV-DNA检测","is_gold":false},{"letter":"J","text":"鼻咽镜检查及活检，鼻咽及颈部增强CT，全身PET-CT，以及包含EBV-DNA的基线血液学检查","is_gold":false},{"letter":"K","text":"鼻咽及颈部增强MRI，胸部CT、腹部超声及全身骨扫描，包含EBV-DNA的基线血液学检查，随后行根治性放疗","is_gold":false},{"letter":"L","text":"鼻咽镜检查及活检，鼻咽及颈部增强MRI，胸部CT、腹部超声及全身骨扫描，以及包含EBV-DNA的基线血液学检查","is_gold":true}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 涕血1年余，头痛3月；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 额部疼痛,涕血；既往史: 高血压10年余服药治疗中，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.9℃，P：72次/分，R：20次/分，BP：127/91mmHg,Ht：160cm，Wt：62.5kg，BSA：1.65m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽右侧顶后壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 鼻咽及颈部增强CT，胸部CT、腹部超声及全身骨扫描，以及包含EBV-DNA的基线血液学检查\nB. 鼻咽镜检查及活检，鼻咽及颈部增强CT，胸部CT、腹部超声及全身骨扫描，以及常规血液学检查\nC. 鼻咽镜检查及活检，鼻咽及颈部增强MRI，常规血液学检查，暂缓全身远处转移筛查\nD. 鼻咽及颈部增强MRI，全身PET-CT，包含EBV-DNA的基线血液学检查，直接安排诱导化疗\nE. 鼻咽镜检查及活检，鼻咽及颈部增强MRI，胸部X线、腹部超声，以及常规血液学检查\nF. 鼻咽及颈部增强MRI，颈部淋巴结穿刺活检，胸部CT、腹部超声及全身骨扫描，以及包含EBV-DNA的基线血液学检查\nG. 鼻咽镜检查及活检，鼻咽及颈部增强MRI，全身PET-CT，随后行鼻咽肿物切除术\nH. 鼻咽镜检查及活检，鼻咽及颈部平扫MRI，胸部CT、腹部超声及全身骨扫描，以及包含EBV-DNA的基线血液学检查\nI. 鼻咽镜检查及活检，鼻咽及颈部增强MRI，胸部CT、腹部超声及全身骨扫描，暂缓基线血液学及EBV-DNA检测\nJ. 鼻咽镜检查及活检，鼻咽及颈部增强CT，全身PET-CT，以及包含EBV-DNA的基线血液学检查\nK. 鼻咽及颈部增强MRI，胸部CT、腹部超声及全身骨扫描，包含EBV-DNA的基线血液学检查，随后行根治性放疗\nL. 鼻咽镜检查及活检，鼻咽及颈部增强MRI，胸部CT、腹部超声及全身骨扫描，以及包含EBV-DNA的基线血液学检查\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 涕血1年余，头痛3月；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 额部疼痛,涕血；既往史: 高血压10年余服药治疗中，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.9℃，P：72次/分，R：20次/分，BP：127/91mmHg,Ht：160cm，Wt：62.5kg，BSA：1.65m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽右侧顶后壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 鼻咽及颈部增强CT，胸部CT、腹部超声及全身骨扫描，以及包含EBV-DNA的基线血液学检查\nB. 鼻咽镜检查及活检，鼻咽及颈部增强CT，胸部CT、腹部超声及全身骨扫描，以及常规血液学检查\nC. 鼻咽镜检查及活检，鼻咽及颈部增强MRI，常规血液学检查，暂缓全身远处转移筛查\nD. 鼻咽及颈部增强MRI，全身PET-CT，包含EBV-DNA的基线血液学检查，直接安排诱导化疗\nE. 鼻咽镜检查及活检，鼻咽及颈部增强MRI，胸部X线、腹部超声，以及常规血液学检查\nF. 鼻咽及颈部增强MRI，颈部淋巴结穿刺活检，胸部CT、腹部超声及全身骨扫描，以及包含EBV-DNA的基线血液学检查\nG. 鼻咽镜检查及活检，鼻咽及颈部增强MRI，全身PET-CT，随后行鼻咽肿物切除术\nH. 鼻咽镜检查及活检，鼻咽及颈部平扫MRI，胸部CT、腹部超声及全身骨扫描，以及包含EBV-DNA的基线血液学检查\nI. 鼻咽镜检查及活检，鼻咽及颈部增强MRI，胸部CT、腹部超声及全身骨扫描，暂缓基线血液学及EBV-DNA检测\nJ. 鼻咽镜检查及活检，鼻咽及颈部增强CT，全身PET-CT，以及包含EBV-DNA的基线血液学检查\nK. 鼻咽及颈部增强MRI，胸部CT、腹部超声及全身骨扫描，包含EBV-DNA的基线血液学检查，随后行根治性放疗\nL. 鼻咽镜检查及活检，鼻咽及颈部增强MRI，胸部CT、腹部超声及全身骨扫描，以及包含EBV-DNA的基线血液学检查\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-58cbc880ddd38089d56cda8c","patient_id":"patient-79fa00752e4405e2980f6292","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"A","gold_action":"行鼻咽镜检查及局部活检，并完善鼻咽及颈部增强MRI","options":[{"letter":"A","text":"行鼻咽镜检查及局部活检，并完善鼻咽及颈部增强MRI","is_gold":true},{"letter":"B","text":"行鼻咽镜检查及局部活检，并完善鼻咽及颈部平扫CT","is_gold":false},{"letter":"C","text":"行鼻咽镜检查及局部活检，无需补充其他局部影像学检查","is_gold":false},{"letter":"D","text":"完善鼻咽及颈部增强MRI，并直接开始根治性放疗","is_gold":false},{"letter":"E","text":"行鼻咽镜检查及局部活检，并完善全身骨扫描及胸部平扫CT","is_gold":false},{"letter":"F","text":"行鼻咽镜检查及局部活检，并完善头颅增强MRI及颈部超声","is_gold":false},{"letter":"G","text":"完善鼻咽及颈部增强MRI，并择期行鼻咽部肿物切除术","is_gold":false},{"letter":"H","text":"行鼻咽镜检查及局部活检，并完善颈部淋巴结穿刺活检","is_gold":false},{"letter":"I","text":"行鼻咽镜检查及局部活检，并完善鼻咽及颈部增强CT","is_gold":false},{"letter":"J","text":"完善鼻咽及颈部增强MRI，并完善外周血EBV-DNA定量检测","is_gold":false},{"letter":"K","text":"行鼻咽镜检查及局部活检，并完善盆腔增强MRI及妇科超声","is_gold":false},{"letter":"L","text":"行鼻咽镜检查及局部活检，并完善脑脊液脱落细胞学检查","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 Ⅰ、Ⅱ、Ⅲ、aVF、V4～V6导联ST段下移\n- [全程D1] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；球蛋白(GLO)-静脉血: 30.03g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.9mmol/L；D-二聚体(D-Dimer)-静脉血: 0.13ug/ml；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；氯离子(Cl-)-静脉血: 98.1mmol/L；平均红细胞体积(MCV)-静脉血: 87.2fL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.91；大血小板百分比(P-LCR%)-静脉血: 33.4%；甘油三酯(TG)-静脉血: 1.01mmol/L；总钙(Ca)-静脉血: 2.28mmol/L；总胆固醇(TC)-静脉血: 5.44mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 25.2U/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 40.9umol/L；纤维蛋白原(Fbg)-静脉血: 2.51g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 20U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.34mmolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.58mmol/L；白细胞计数(WBC#)-静脉血: 6.9810E9/L；凝血酶时间(TT)-静脉血: 17.5sec.；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.013；红细胞计数(RBC#)-静脉血: 4.6710E12/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.98；直接胆红素(DBIL)-静脉血: 3.4umol/L；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 26.3mmol/L；磷(P)-静脉血: 1.03mmol/L；尿酸(UA)-静脉血: 391.1umol/L；碱性磷酸酶(ALP)-静脉血……\n- [全程D5] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁及右侧壁粘膜增厚放射性浓聚，SUV约7.3，病灶疑累及蝶骨基底部；右侧咽隐窝变浅；双侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见明显异常。口咽及喉咽结构及放射性分布未见明显异常。额窦、蝶窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双上颈小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。双乳腺结构及放射性分布未见明显异常。 肝S7点状高密度影放射性缺损，CT值约124Hu；其余肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 子宫边缘弧形改变，见结节状稍高密度影放射性分布未见明显异常，大小约3.8×4.3cm；左附件囊性低密度影放射性稀疏，大小约2.2×2.3cm，CT值约22Hu。膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 所见颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽顶壁及右侧壁粘膜增厚代谢活跃，考虑鼻咽癌，疑累及蝶骨基底部。 肝S7肝内胆管结石。 子宫肌瘤。 左附件囊肿。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行鼻咽镜检查及局部活检，并完善鼻咽及颈部增强MRI\nB. 行鼻咽镜检查及局部活检，并完善鼻咽及颈部平扫CT\nC. 行鼻咽镜检查及局部活检，无需补充其他局部影像学检查\nD. 完善鼻咽及颈部增强MRI，并直接开始根治性放疗\nE. 行鼻咽镜检查及局部活检，并完善全身骨扫描及胸部平扫CT\nF. 行鼻咽镜检查及局部活检，并完善头颅增强MRI及颈部超声\nG. 完善鼻咽及颈部增强MRI，并择期行鼻咽部肿物切除术\nH. 行鼻咽镜检查及局部活检，并完善颈部淋巴结穿刺活检\nI. 行鼻咽镜检查及局部活检，并完善鼻咽及颈部增强CT\nJ. 完善鼻咽及颈部增强MRI，并完善外周血EBV-DNA定量检测\nK. 行鼻咽镜检查及局部活检，并完善盆腔增强MRI及妇科超声\nL. 行鼻咽镜检查及局部活检，并完善脑脊液脱落细胞学检查\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 Ⅰ、Ⅱ、Ⅲ、aVF、V4～V6导联ST段下移\n- [全程D1] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；球蛋白(GLO)-静脉血: 30.03g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.9mmol/L；D-二聚体(D-Dimer)-静脉血: 0.13ug/ml；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；氯离子(Cl-)-静脉血: 98.1mmol/L；平均红细胞体积(MCV)-静脉血: 87.2fL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.91；大血小板百分比(P-LCR%)-静脉血: 33.4%；甘油三酯(TG)-静脉血: 1.01mmol/L；总钙(Ca)-静脉血: 2.28mmol/L；总胆固醇(TC)-静脉血: 5.44mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 25.2U/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 40.9umol/L；纤维蛋白原(Fbg)-静脉血: 2.51g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 20U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.34mmolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.58mmol/L；白细胞计数(WBC#)-静脉血: 6.9810E9/L；凝血酶时间(TT)-静脉血: 17.5sec.；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.013；红细胞计数(RBC#)-静脉血: 4.6710E12/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.98；直接胆红素(DBIL)-静脉血: 3.4umol/L；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 26.3mmol/L；磷(P)-静脉血: 1.03mmol/L；尿酸(UA)-静脉血: 391.1umol/L；碱性磷酸酶(ALP)-静脉血……\n- [全程D5] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁及右侧壁粘膜增厚放射性浓聚，SUV约7.3，病灶疑累及蝶骨基底部；右侧咽隐窝变浅；双侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见明显异常。口咽及喉咽结构及放射性分布未见明显异常。额窦、蝶窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双上颈小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。双乳腺结构及放射性分布未见明显异常。 肝S7点状高密度影放射性缺损，CT值约124Hu；其余肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 子宫边缘弧形改变，见结节状稍高密度影放射性分布未见明显异常，大小约3.8×4.3cm；左附件囊性低密度影放射性稀疏，大小约2.2×2.3cm，CT值约22Hu。膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 所见颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽顶壁及右侧壁粘膜增厚代谢活跃，考虑鼻咽癌，疑累及蝶骨基底部。 肝S7肝内胆管结石。 子宫肌瘤。 左附件囊肿。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行鼻咽镜检查及局部活检，并完善鼻咽及颈部增强MRI\nB. 行鼻咽镜检查及局部活检，并完善鼻咽及颈部平扫CT\nC. 行鼻咽镜检查及局部活检，无需补充其他局部影像学检查\nD. 完善鼻咽及颈部增强MRI，并直接开始根治性放疗\nE. 行鼻咽镜检查及局部活检，并完善全身骨扫描及胸部平扫CT\nF. 行鼻咽镜检查及局部活检，并完善头颅增强MRI及颈部超声\nG. 完善鼻咽及颈部增强MRI，并择期行鼻咽部肿物切除术\nH. 行鼻咽镜检查及局部活检，并完善颈部淋巴结穿刺活检\nI. 行鼻咽镜检查及局部活检，并完善鼻咽及颈部增强CT\nJ. 完善鼻咽及颈部增强MRI，并完善外周血EBV-DNA定量检测\nK. 行鼻咽镜检查及局部活检，并完善盆腔增强MRI及妇科超声\nL. 行鼻咽镜检查及局部活检，并完善脑脊液脱落细胞学检查\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-75c75fa1e197461f4b0d7395","patient_id":"patient-79fa00752e4405e2980f6292","turn_id":"turn06","turn_position":3,"turn_type":"toxicity_or_support_decision","gold_letter":"E","gold_action":"继续根治性放疗与顺铂同期化疗，予以止呕、护胃、补液及补钾等支持治疗，并安排放疗中段MRI评估。","options":[{"letter":"A","text":"暂停顺铂同期化疗，继续根治性放疗，予以止呕、补液、补钾等支持治疗，并安排放疗中段MRI评估。","is_gold":false},{"letter":"B","text":"顺铂减量20%继续同期化疗，继续根治性放疗，予以止呕、补液等支持治疗，暂不复查MRI。","is_gold":false},{"letter":"C","text":"继续根治性放疗与顺铂同期化疗，予以止呕、护胃治疗，暂不予补液及补钾，并安排放疗中段MRI评估。","is_gold":false},{"letter":"D","text":"暂停根治性放疗与顺铂同期化疗，予以积极补液、补钾治疗，暂不安排影像学评估。","is_gold":false},{"letter":"E","text":"继续根治性放疗与顺铂同期化疗，予以止呕、护胃、补液及补钾等支持治疗，并安排放疗中段MRI评估。","is_gold":true},{"letter":"F","text":"继续根治性放疗与顺铂同期化疗，予以止呕、护胃、补液及补钾等支持治疗，并安排PET-CT评估全身疗效。","is_gold":false},{"letter":"G","text":"暂停顺铂同期化疗，改为替加氟口服化疗，继续根治性放疗，予以止呕、补钾等支持治疗。","is_gold":false},{"letter":"H","text":"继续根治性放疗与顺铂同期化疗，予以止呕、护胃、补液及补钾等支持治疗，并安排鼻咽镜活检评估疗效。","is_gold":false},{"letter":"I","text":"顺铂减量50%继续同期化疗，继续根治性放疗，予以止呕、补液及补钾等支持治疗，并安排放疗中段MRI评估。","is_gold":false},{"letter":"J","text":"继续根治性放疗，取消后续化疗，予以止呕、补液及补钾等支持治疗，并安排放疗中段MRI评估。","is_gold":false},{"letter":"K","text":"继续根治性放疗与顺铂同期化疗，予以止呕、护胃、补液治疗，暂不予补钾，并安排放疗中段MRI评估。","is_gold":false},{"letter":"L","text":"暂停根治性放疗，继续顺铂同期化疗，予以止呕、补液及补钾等支持治疗，并安排放疗中段MRI评估。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D52] 入院记录: 主诉: 鼻咽癌一程化疗后两周余；现病史: 缘于1年前患者无明显诱因出现回吸性涕血，无头痛、鼻塞、耳鸣、复视、面麻等不适，未予重视，3个月前出现前额部疼痛，伴鼻衅，并于当地医院行鼻咽活检病理考虑鼻咽低分化型癌可能性大。于某次就诊时间10月底来我科就诊，并行根治性放疗计划设计，于某次就诊时间开始行根治性放疗，同时期予以DDP化疗1程，治疗过程顺利。今同期化疗到期来我科继续治疗，患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 额部疼痛,涕血；既往史: 高血压10年余服药治疗中，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.9℃，P：72次/分，R：20次/分，BP：127/91mmHg,Ht：160cm，Wt：62.5kg，BSA：1.65m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率72次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽右侧顶后壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D26] 检验组合: 比重(SG)-尿液: 1.019；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；酮体(KET)-尿液: +-（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: Turbid；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 82/μL；总蛋白(TP)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；白细胞计数(WBC#)-尿液: 17/μL\n- [全程D27] 检验组合: 血小板分布宽度(PDW)-静脉血: 12.2%；平均血小板体积(MPV)-静脉血: 11.2fL；红细胞比容(Hct)-静脉血: 37.5%；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；红细胞比容(Hct)-静脉血: 35.5%；碱性磷酸酶(ALP)-静脉血: 91.7U/L；白蛋白(ALB)-静脉血: 45.5g/L；C-反应蛋白(CRP)-静脉血: 1.15mg/L；血红蛋白(Hb)-静脉血: 121g/L；直接胆红素(DBIL)-静脉血: 3.7umol/L；血红蛋白(Hb)-静脉血: 111g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.4；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；葡萄糖(Glu)-静脉血: 5.1mmol/L；白细胞计数(WBC#)-静脉血: 13.710E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.51mmolL；红细胞计数(RBC#)-静脉血: 3.8810E12/L；颜色-尿液: Light-Orange；尿素氮(BUN)-静脉血: 5.77mmol/L；胱抑素(Cys-C)-静脉血: 0.99mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.59；钾离子(K+)-静脉血: 4.2mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 19U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 266.5U/L；磷(P)-静脉血: 1.03mmol/L；中性粒细胞计数(Neut#)-静脉血: 4.110E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.241；平均红细胞体积(MCV)-静脉血: 82.9fL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.81mmol/L；大血小板百分比(P-LCR%)-静脉血: 27.5%；红细胞计数(RBC#)-静脉血: 4.1410E12/L；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；甘油三酯(TG)-静脉血: 1.02mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.9；尿酸(UA)-静脉血: 295.4umol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.……\n- [全程D31] 检验组合: 丙氨酸氨基转移酶(ALT)-静脉血: 91.9U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 30.5U/L；碱性磷酸酶(ALP)-静脉血: 104.1U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 114U/L；乳酸脱氢酶(LDH)-静脉血: 159.5U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 23.5U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.33；总胆汁酸(TBA)-静脉血: 2umol/L\n- [全程D42] 检验组合: 磷(P)-静脉血: 1.12mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.66；钠离子(Na+)-静脉血: 139.9mmol/L；白蛋白(ALB)-静脉血: 43.7g/L；镁离子(Mg2+)-静脉血: 0.74mmol/L；钾离子(K+)-静脉血: 4.14mmol/L；氯离子(Cl-)-静脉血: 98mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 91.5U/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.5U/L；总胆红素(TBIL)-静脉血: 10.2umol/L；尿素氮(BUN)-静脉血: 5.7mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.7mmol/L；阴离子间隙(AG)-静脉血: 16.2；直接胆红素(DBIL)-静脉血: 3.2umol/L；尿酸(UA)-静脉血: 335.2umol/L；碱性磷酸酶(ALP)-静脉血: 75.1U/L；间接胆红素(IBIL)-静脉血: 7umolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.28；α-L-岩藻糖苷酶(AFU)-静脉血: 18.2U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.3U/L；球蛋白(GLO)-静脉血: 26.28g/L；总钙(Ca)-静脉血: 2.33mmol/L；肌酐(Crea)-静脉血: 77.8umol/L；总蛋白(TP)-静脉血: 69.98g/L；乳酸脱氢酶(LDH)-静脉血: 203.7U/L；总胆汁酸(TBA)-静脉血: 1.9umol/L\n- [全程D52] 检验组合: 白细胞计数(WBC#)-尿液: 2/μL；非鳞状上皮细胞计数-尿液: 3/μL；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；酸碱度(pH)-尿液: 6.5；红细胞计数(RBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；隐血(OB)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.014；尿胆原(URO)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 28/μL；总蛋白(TP)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 26/μL；白细胞(LEU)-尿液: -（参考: 阴性）\n- [全程D54] 检验组合: 红细胞计数(RBC#)-静脉血: 3.9510E12/L；血小板分布宽度(PDW)-静脉血: 12.5%；载脂蛋白B(apoB)-静脉血: 1.08g/L；酸碱度(pH)-尿液: 6.5；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.002；丙氨酸氨基转移酶(ALT)-静脉血: 12.3U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.092；尿素氮(BUN)-静脉血: 4.3mmol/L；酮体(KET)-尿液: 1+ 2mmol（参考: 阴性）；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.6；阴离子间隙(AG)-静脉血: 13.6；浊度(TRUB)-尿液: Turbid；颜色-尿液: Yellow；隐血(OB)-尿液: -（参考: 阴性）；镁离子(Mg2+)-静脉血: 0.61mmol/L；透明管型计数(HYAL#)-尿液: 1/μL；总胆红素(TBIL)-静脉血: 12umol/L；磷(P)-静脉血: 1.12mmol/L；浊度(TRUB)-尿液: Turbid；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿酸(UA)-静脉血: 317.3umol/L；总蛋白(TP)-尿液: 1+ 0.3g（参考: 阴性）；白蛋白(ALB)-静脉血: 42.2g/L；平均血小板体积(MPV)-静脉血: 10.8fL；中性粒细胞计数(Neut#)-静脉血: 3.410E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.1U/L；透明管型计数(HYAL#)-尿液: 2/μL；直接胆红素(DBIL)-静脉血: 3.8umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.67；白细胞计数(WBC#)-尿液: 25/μL；钾离子(K+)-静脉血: 3.33mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.6；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.08mmolL；比重(SG)-尿液: 1.024；未分类管型计数(UNCC#)-尿液: 2/μL；载脂蛋白AI(apoAI)-静脉血: 1.1g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.6pg；未分类管型计数(UNCC#)-尿液: 4/μL；隐血(OB)-尿液: -（参考: 阴性）；球蛋白(GLO)-静脉血: 25.25g/L；红细胞比容(H……\n\n【既往治疗与反应】\n- [全程D26] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者入院第三天，无特殊不适主诉，体查情况基本同前，患者现一般情况尚可，今日开始行根治性放疗，同时期予以DDP方案化疗，并予以护胃、止呕等对症支持处理，密观患者病情。\n- [全程D31] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现处于放化综合治疗中，放疗4F，现已基本完成一程同期化疗，诉口干、腹胀、纳差，体查：张口门齿距4.5cm；鼻咽右侧顶后壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。复查生化常规结果示：ALT87.0U/L，[姓名已隐去]副医生信息已隐藏：患者在院行一程同期化疗期间，出现肝功轻度损伤，期间予以护肝等对症处理，现患者复查生化示肝功指标仍有轻度升高，继续予以护肝等对症处理，今日可出院，每周定期复查血常规、生化常规，定期门诊复诊，门诊继续放疗，按期[计划性表述已隐藏]下程治疗，不适随诊。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D53] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者入院第二天，现处于放化综合治疗中，放疗21F，诉口苦，体查情况：张口门齿距4.5cm；鼻咽右侧顶后壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。复查血常规、生化常规结果基本正常。[姓名已隐去]副医生信息已隐藏：现患者入院[计划性表述已隐藏]第二程顺铂同期方案化疗，昨日开始予以水化，目前患者情况尚可，今日可行化疗，并予以止呕、护胃、加强营养等对症支持治疗，针对患者口苦症状，为放疗引起常见急性不良反应，予以对症处理，病情继观。\n- [全程D54] 上级查房记录；[姓名已隐去]医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医师查房记录；病程内容: 患者入院第三天，现处于放化综合治疗中，放疗22F，诉恶心、呕吐，体查情况基本同前。[姓名已隐去]医师查房后示：现患者处于DDP方案同期化疗中，目前患者情况尚可，继续予以止呕、护胃、加强营养等对症支持治疗，病情继观。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停顺铂同期化疗，继续根治性放疗，予以止呕、补液、补钾等支持治疗，并安排放疗中段MRI评估。\nB. 顺铂减量20%继续同期化疗，继续根治性放疗，予以止呕、补液等支持治疗，暂不复查MRI。\nC. 继续根治性放疗与顺铂同期化疗，予以止呕、护胃治疗，暂不予补液及补钾，并安排放疗中段MRI评估。\nD. 暂停根治性放疗与顺铂同期化疗，予以积极补液、补钾治疗，暂不安排影像学评估。\nE. 继续根治性放疗与顺铂同期化疗，予以止呕、护胃、补液及补钾等支持治疗，并安排放疗中段MRI评估。\nF. 继续根治性放疗与顺铂同期化疗，予以止呕、护胃、补液及补钾等支持治疗，并安排PET-CT评估全身疗效。\nG. 暂停顺铂同期化疗，改为替加氟口服化疗，继续根治性放疗，予以止呕、补钾等支持治疗。\nH. 继续根治性放疗与顺铂同期化疗，予以止呕、护胃、补液及补钾等支持治疗，并安排鼻咽镜活检评估疗效。\nI. 顺铂减量50%继续同期化疗，继续根治性放疗，予以止呕、补液及补钾等支持治疗，并安排放疗中段MRI评估。\nJ. 继续根治性放疗，取消后续化疗，予以止呕、补液及补钾等支持治疗，并安排放疗中段MRI评估。\nK. 继续根治性放疗与顺铂同期化疗，予以止呕、护胃、补液治疗，暂不予补钾，并安排放疗中段MRI评估。\nL. 暂停根治性放疗，继续顺铂同期化疗，予以止呕、补液及补钾等支持治疗，并安排放疗中段MRI评估。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D52] 入院记录: 主诉: 鼻咽癌一程化疗后两周余；现病史: 缘于1年前患者无明显诱因出现回吸性涕血，无头痛、鼻塞、耳鸣、复视、面麻等不适，未予重视，3个月前出现前额部疼痛，伴鼻衅，并于当地医院行鼻咽活检病理考虑鼻咽低分化型癌可能性大。于某次就诊时间10月底来我科就诊，并行根治性放疗计划设计，于某次就诊时间开始行根治性放疗，同时期予以DDP化疗1程，治疗过程顺利。今同期化疗到期来我科继续治疗，患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 额部疼痛,涕血；既往史: 高血压10年余服药治疗中，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.9℃，P：72次/分，R：20次/分，BP：127/91mmHg,Ht：160cm，Wt：62.5kg，BSA：1.65m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率72次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽右侧顶后壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D26] 检验组合: 比重(SG)-尿液: 1.019；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；酮体(KET)-尿液: +-（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: Turbid；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 82/μL；总蛋白(TP)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；白细胞计数(WBC#)-尿液: 17/μL\n- [全程D27] 检验组合: 血小板分布宽度(PDW)-静脉血: 12.2%；平均血小板体积(MPV)-静脉血: 11.2fL；红细胞比容(Hct)-静脉血: 37.5%；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；红细胞比容(Hct)-静脉血: 35.5%；碱性磷酸酶(ALP)-静脉血: 91.7U/L；白蛋白(ALB)-静脉血: 45.5g/L；C-反应蛋白(CRP)-静脉血: 1.15mg/L；血红蛋白(Hb)-静脉血: 121g/L；直接胆红素(DBIL)-静脉血: 3.7umol/L；血红蛋白(Hb)-静脉血: 111g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.4；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；葡萄糖(Glu)-静脉血: 5.1mmol/L；白细胞计数(WBC#)-静脉血: 13.710E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.51mmolL；红细胞计数(RBC#)-静脉血: 3.8810E12/L；颜色-尿液: Light-Orange；尿素氮(BUN)-静脉血: 5.77mmol/L；胱抑素(Cys-C)-静脉血: 0.99mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.59；钾离子(K+)-静脉血: 4.2mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 19U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 266.5U/L；磷(P)-静脉血: 1.03mmol/L；中性粒细胞计数(Neut#)-静脉血: 4.110E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.241；平均红细胞体积(MCV)-静脉血: 82.9fL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.81mmol/L；大血小板百分比(P-LCR%)-静脉血: 27.5%；红细胞计数(RBC#)-静脉血: 4.1410E12/L；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；甘油三酯(TG)-静脉血: 1.02mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.9；尿酸(UA)-静脉血: 295.4umol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.……\n- [全程D31] 检验组合: 丙氨酸氨基转移酶(ALT)-静脉血: 91.9U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 30.5U/L；碱性磷酸酶(ALP)-静脉血: 104.1U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 114U/L；乳酸脱氢酶(LDH)-静脉血: 159.5U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 23.5U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.33；总胆汁酸(TBA)-静脉血: 2umol/L\n- [全程D42] 检验组合: 磷(P)-静脉血: 1.12mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.66；钠离子(Na+)-静脉血: 139.9mmol/L；白蛋白(ALB)-静脉血: 43.7g/L；镁离子(Mg2+)-静脉血: 0.74mmol/L；钾离子(K+)-静脉血: 4.14mmol/L；氯离子(Cl-)-静脉血: 98mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 91.5U/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.5U/L；总胆红素(TBIL)-静脉血: 10.2umol/L；尿素氮(BUN)-静脉血: 5.7mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.7mmol/L；阴离子间隙(AG)-静脉血: 16.2；直接胆红素(DBIL)-静脉血: 3.2umol/L；尿酸(UA)-静脉血: 335.2umol/L；碱性磷酸酶(ALP)-静脉血: 75.1U/L；间接胆红素(IBIL)-静脉血: 7umolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.28；α-L-岩藻糖苷酶(AFU)-静脉血: 18.2U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.3U/L；球蛋白(GLO)-静脉血: 26.28g/L；总钙(Ca)-静脉血: 2.33mmol/L；肌酐(Crea)-静脉血: 77.8umol/L；总蛋白(TP)-静脉血: 69.98g/L；乳酸脱氢酶(LDH)-静脉血: 203.7U/L；总胆汁酸(TBA)-静脉血: 1.9umol/L\n- [全程D52] 检验组合: 白细胞计数(WBC#)-尿液: 2/μL；非鳞状上皮细胞计数-尿液: 3/μL；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；酸碱度(pH)-尿液: 6.5；红细胞计数(RBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；隐血(OB)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.014；尿胆原(URO)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 28/μL；总蛋白(TP)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 26/μL；白细胞(LEU)-尿液: -（参考: 阴性）\n- [全程D54] 检验组合: 红细胞计数(RBC#)-静脉血: 3.9510E12/L；血小板分布宽度(PDW)-静脉血: 12.5%；载脂蛋白B(apoB)-静脉血: 1.08g/L；酸碱度(pH)-尿液: 6.5；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.002；丙氨酸氨基转移酶(ALT)-静脉血: 12.3U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.092；尿素氮(BUN)-静脉血: 4.3mmol/L；酮体(KET)-尿液: 1+ 2mmol（参考: 阴性）；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.6；阴离子间隙(AG)-静脉血: 13.6；浊度(TRUB)-尿液: Turbid；颜色-尿液: Yellow；隐血(OB)-尿液: -（参考: 阴性）；镁离子(Mg2+)-静脉血: 0.61mmol/L；透明管型计数(HYAL#)-尿液: 1/μL；总胆红素(TBIL)-静脉血: 12umol/L；磷(P)-静脉血: 1.12mmol/L；浊度(TRUB)-尿液: Turbid；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿酸(UA)-静脉血: 317.3umol/L；总蛋白(TP)-尿液: 1+ 0.3g（参考: 阴性）；白蛋白(ALB)-静脉血: 42.2g/L；平均血小板体积(MPV)-静脉血: 10.8fL；中性粒细胞计数(Neut#)-静脉血: 3.410E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.1U/L；透明管型计数(HYAL#)-尿液: 2/μL；直接胆红素(DBIL)-静脉血: 3.8umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.67；白细胞计数(WBC#)-尿液: 25/μL；钾离子(K+)-静脉血: 3.33mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.6；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.08mmolL；比重(SG)-尿液: 1.024；未分类管型计数(UNCC#)-尿液: 2/μL；载脂蛋白AI(apoAI)-静脉血: 1.1g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.6pg；未分类管型计数(UNCC#)-尿液: 4/μL；隐血(OB)-尿液: -（参考: 阴性）；球蛋白(GLO)-静脉血: 25.25g/L；红细胞比容(H……\n\n【既往治疗与反应】\n- [全程D26] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者入院第三天，无特殊不适主诉，体查情况基本同前，患者现一般情况尚可，今日开始行根治性放疗，同时期予以DDP方案化疗，并予以护胃、止呕等对症支持处理，密观患者病情。\n- [全程D31] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现处于放化综合治疗中，放疗4F，现已基本完成一程同期化疗，诉口干、腹胀、纳差，体查：张口门齿距4.5cm；鼻咽右侧顶后壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。复查生化常规结果示：ALT87.0U/L，[姓名已隐去]副医生信息已隐藏：患者在院行一程同期化疗期间，出现肝功轻度损伤，期间予以护肝等对症处理，现患者复查生化示肝功指标仍有轻度升高，继续予以护肝等对症处理，今日可出院，每周定期复查血常规、生化常规，定期门诊复诊，门诊继续放疗，按期[计划性表述已隐藏]下程治疗，不适随诊。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D53] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者入院第二天，现处于放化综合治疗中，放疗21F，诉口苦，体查情况：张口门齿距4.5cm；鼻咽右侧顶后壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。复查血常规、生化常规结果基本正常。[姓名已隐去]副医生信息已隐藏：现患者入院[计划性表述已隐藏]第二程顺铂同期方案化疗，昨日开始予以水化，目前患者情况尚可，今日可行化疗，并予以止呕、护胃、加强营养等对症支持治疗，针对患者口苦症状，为放疗引起常见急性不良反应，予以对症处理，病情继观。\n- [全程D54] 上级查房记录；[姓名已隐去]医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医师查房记录；病程内容: 患者入院第三天，现处于放化综合治疗中，放疗22F，诉恶心、呕吐，体查情况基本同前。[姓名已隐去]医师查房后示：现患者处于DDP方案同期化疗中，目前患者情况尚可，继续予以止呕、护胃、加强营养等对症支持治疗，病情继观。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停顺铂同期化疗，继续根治性放疗，予以止呕、补液、补钾等支持治疗，并安排放疗中段MRI评估。\nB. 顺铂减量20%继续同期化疗，继续根治性放疗，予以止呕、补液等支持治疗，暂不复查MRI。\nC. 继续根治性放疗与顺铂同期化疗，予以止呕、护胃治疗，暂不予补液及补钾，并安排放疗中段MRI评估。\nD. 暂停根治性放疗与顺铂同期化疗，予以积极补液、补钾治疗，暂不安排影像学评估。\nE. 继续根治性放疗与顺铂同期化疗，予以止呕、护胃、补液及补钾等支持治疗，并安排放疗中段MRI评估。\nF. 继续根治性放疗与顺铂同期化疗，予以止呕、护胃、补液及补钾等支持治疗，并安排PET-CT评估全身疗效。\nG. 暂停顺铂同期化疗，改为替加氟口服化疗，继续根治性放疗，予以止呕、补钾等支持治疗。\nH. 继续根治性放疗与顺铂同期化疗，予以止呕、护胃、补液及补钾等支持治疗，并安排鼻咽镜活检评估疗效。\nI. 顺铂减量50%继续同期化疗，继续根治性放疗，予以止呕、补液及补钾等支持治疗，并安排放疗中段MRI评估。\nJ. 继续根治性放疗，取消后续化疗，予以止呕、补液及补钾等支持治疗，并安排放疗中段MRI评估。\nK. 继续根治性放疗与顺铂同期化疗，予以止呕、护胃、补液治疗，暂不予补钾，并安排放疗中段MRI评估。\nL. 暂停根治性放疗，继续顺铂同期化疗，予以止呕、补液及补钾等支持治疗，并安排放疗中段MRI评估。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-cc72c6bbde9abe2a112ce0fc","patient_id":"patient-79fa00752e4405e2980f6292","turn_id":"turn07","turn_position":4,"turn_type":"response_assessment_decision","gold_letter":"B","gold_action":"评估腹部无转移征象，继续根治性放疗，予以重组人促红素皮下注射改善贫血，并动态复查血常规。","options":[{"letter":"A","text":"评估腹部无转移征象，继续根治性放疗，予以重组人粒细胞刺激因子皮下注射，待血常规恢复后重启化疗。","is_gold":false},{"letter":"B","text":"评估腹部无转移征象，继续根治性放疗，予以重组人促红素皮下注射改善贫血，并动态复查血常规。","is_gold":true},{"letter":"C","text":"腹部彩超见可疑占位，暂停放疗，行肝脏MRI平扫+增强以明确病变性质。","is_gold":false},{"letter":"D","text":"评估腹部无转移征象，继续根治性放疗，并即刻启动第三程顺铂同期化疗。","is_gold":false},{"letter":"E","text":"评估腹部无转移征象，提前结束放疗，转为顺铂联合氟尿嘧啶方案辅助化疗。","is_gold":false},{"letter":"F","text":"评估腹部无转移征象，继续根治性放疗，予以利可君口服改善骨髓抑制，并动态复查血常规。","is_gold":false},{"letter":"G","text":"评估腹部无转移征象，继续根治性放疗，予以异甘草酸镁静脉滴注强化保肝治疗。","is_gold":false},{"letter":"H","text":"评估腹部无转移征象，继续根治性放疗，予以输注单采血小板预防出血，并动态复查血常规。","is_gold":false},{"letter":"I","text":"评估腹部无转移征象，暂停放疗，行全身PET/CT检查以全面评估近期疗效。","is_gold":false},{"letter":"J","text":"评估腹部无转移征象，继续根治性放疗，予以昂丹司琼强化止吐，并预防性放置胃管。","is_gold":false},{"letter":"K","text":"评估腹部无转移征象，继续根治性放疗，加用尼妥珠单抗靶向治疗以提高局部控制率。","is_gold":false},{"letter":"L","text":"评估腹部无转移征象，继续根治性放疗，予以地塞米松口服改善骨髓抑制，并动态复查血常规。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D55] 检验组合: 中性粒细胞计数(Neut#)-静脉血: 8.410E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；直接胆红素(DBIL)-静脉血: 7umol/L；血小板计数(PLT#)-静脉血: 16910E9/L；红细胞计数(RBC#)-静脉血: 3.2710E12/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0；血小板比容-静脉血: 17%；碱性磷酸酶(ALP)-静脉血: 79.8U/L；阴离子间隙(AG)-静脉血: 13；天门冬氨酸氨基转移酶(AST)-静脉血: 19.5U/L；碱性磷酸酶(ALP)-静脉血: 58.6U/L；载脂蛋白AI(apoAI)-静脉血: 0.97g/L；丙氨酸氨基转移酶(ALT)-静脉血: 31.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；钾离子(K+)-静脉血: 3.14mmol/L；胱抑素(Cys-C)-静脉血: 1.36mg/L；血红蛋白(Hb)-静脉血: 96g/L；平均血小板体积(MPV)-静脉血: 9.9fL；血小板分布宽度(PDW)-静脉血: 16.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 30.3pg；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.66；载脂蛋白B(apoB)-静脉血: 1.48g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.5U/L；白细胞计数(WBC#)-静脉血: 9.3910E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.48mmolL；淋巴细胞百分比(Lymph%)-静脉血: 0.064；总钙(Ca)-静脉血: 2.53mmol/L；甘油三酯(TG)-静脉血: 1.31mmol/L；尿酸(UA)-静脉血: 560.6umol/L；阴离子间隙(AG)-静脉血: 17；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.81mmol/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；尿素氮(BUN)-静脉血: 4.58mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.04mmolL；尿酸(UA)-静脉血: 415.9umol/L；白蛋白(ALB)-静脉血: 47.6g/L；红细胞比容(Hct)-静脉血: 28.4%；球蛋白(GLO)-静脉血: 28.72g/L；肌酐(Crea)-静脉血: 10……\n- [全程D64] 超声；腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径9mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约22cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确肿物回声。 膀胱未充盈。；检查结论: 肝脏、胆囊、脾脏、胰腺、双肾未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n\n【既往治疗与反应】\n- [全程D56] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现处于放化综合治疗中，放疗24F，诉恶心、呕吐较前好转，体查情况：KPS 90分；鼻咽部右侧壁肿物，双颈部淋巴结未触及；颅神经检查：阴性。[姓名已隐去]副医生信息已隐藏：现患者基本完成二程DDP方案同期化疗，目前患者情况尚可，继续予以对症支持，今日可予以出院，并嘱按时[计划性表述已隐藏]治疗后复查，不适随诊。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估腹部无转移征象，继续根治性放疗，予以重组人粒细胞刺激因子皮下注射，待血常规恢复后重启化疗。\nB. 评估腹部无转移征象，继续根治性放疗，予以重组人促红素皮下注射改善贫血，并动态复查血常规。\nC. 腹部彩超见可疑占位，暂停放疗，行肝脏MRI平扫+增强以明确病变性质。\nD. 评估腹部无转移征象，继续根治性放疗，并即刻启动第三程顺铂同期化疗。\nE. 评估腹部无转移征象，提前结束放疗，转为顺铂联合氟尿嘧啶方案辅助化疗。\nF. 评估腹部无转移征象，继续根治性放疗，予以利可君口服改善骨髓抑制，并动态复查血常规。\nG. 评估腹部无转移征象，继续根治性放疗，予以异甘草酸镁静脉滴注强化保肝治疗。\nH. 评估腹部无转移征象，继续根治性放疗，予以输注单采血小板预防出血，并动态复查血常规。\nI. 评估腹部无转移征象，暂停放疗，行全身PET/CT检查以全面评估近期疗效。\nJ. 评估腹部无转移征象，继续根治性放疗，予以昂丹司琼强化止吐，并预防性放置胃管。\nK. 评估腹部无转移征象，继续根治性放疗，加用尼妥珠单抗靶向治疗以提高局部控制率。\nL. 评估腹部无转移征象，继续根治性放疗，予以地塞米松口服改善骨髓抑制，并动态复查血常规。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D55] 检验组合: 中性粒细胞计数(Neut#)-静脉血: 8.410E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；直接胆红素(DBIL)-静脉血: 7umol/L；血小板计数(PLT#)-静脉血: 16910E9/L；红细胞计数(RBC#)-静脉血: 3.2710E12/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0；血小板比容-静脉血: 17%；碱性磷酸酶(ALP)-静脉血: 79.8U/L；阴离子间隙(AG)-静脉血: 13；天门冬氨酸氨基转移酶(AST)-静脉血: 19.5U/L；碱性磷酸酶(ALP)-静脉血: 58.6U/L；载脂蛋白AI(apoAI)-静脉血: 0.97g/L；丙氨酸氨基转移酶(ALT)-静脉血: 31.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；钾离子(K+)-静脉血: 3.14mmol/L；胱抑素(Cys-C)-静脉血: 1.36mg/L；血红蛋白(Hb)-静脉血: 96g/L；平均血小板体积(MPV)-静脉血: 9.9fL；血小板分布宽度(PDW)-静脉血: 16.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 30.3pg；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.66；载脂蛋白B(apoB)-静脉血: 1.48g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.5U/L；白细胞计数(WBC#)-静脉血: 9.3910E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.48mmolL；淋巴细胞百分比(Lymph%)-静脉血: 0.064；总钙(Ca)-静脉血: 2.53mmol/L；甘油三酯(TG)-静脉血: 1.31mmol/L；尿酸(UA)-静脉血: 560.6umol/L；阴离子间隙(AG)-静脉血: 17；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.81mmol/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；尿素氮(BUN)-静脉血: 4.58mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.04mmolL；尿酸(UA)-静脉血: 415.9umol/L；白蛋白(ALB)-静脉血: 47.6g/L；红细胞比容(Hct)-静脉血: 28.4%；球蛋白(GLO)-静脉血: 28.72g/L；肌酐(Crea)-静脉血: 10……\n- [全程D64] 超声；腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径9mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约22cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确肿物回声。 膀胱未充盈。；检查结论: 肝脏、胆囊、脾脏、胰腺、双肾未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n\n【既往治疗与反应】\n- [全程D56] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现处于放化综合治疗中，放疗24F，诉恶心、呕吐较前好转，体查情况：KPS 90分；鼻咽部右侧壁肿物，双颈部淋巴结未触及；颅神经检查：阴性。[姓名已隐去]副医生信息已隐藏：现患者基本完成二程DDP方案同期化疗，目前患者情况尚可，继续予以对症支持，今日可予以出院，并嘱按时[计划性表述已隐藏]治疗后复查，不适随诊。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估腹部无转移征象，继续根治性放疗，予以重组人粒细胞刺激因子皮下注射，待血常规恢复后重启化疗。\nB. 评估腹部无转移征象，继续根治性放疗，予以重组人促红素皮下注射改善贫血，并动态复查血常规。\nC. 腹部彩超见可疑占位，暂停放疗，行肝脏MRI平扫+增强以明确病变性质。\nD. 评估腹部无转移征象，继续根治性放疗，并即刻启动第三程顺铂同期化疗。\nE. 评估腹部无转移征象，提前结束放疗，转为顺铂联合氟尿嘧啶方案辅助化疗。\nF. 评估腹部无转移征象，继续根治性放疗，予以利可君口服改善骨髓抑制，并动态复查血常规。\nG. 评估腹部无转移征象，继续根治性放疗，予以异甘草酸镁静脉滴注强化保肝治疗。\nH. 评估腹部无转移征象，继续根治性放疗，予以输注单采血小板预防出血，并动态复查血常规。\nI. 评估腹部无转移征象，暂停放疗，行全身PET/CT检查以全面评估近期疗效。\nJ. 评估腹部无转移征象，继续根治性放疗，予以昂丹司琼强化止吐，并预防性放置胃管。\nK. 评估腹部无转移征象，继续根治性放疗，加用尼妥珠单抗靶向治疗以提高局部控制率。\nL. 评估腹部无转移征象，继续根治性放疗，予以地塞米松口服改善骨髓抑制，并动态复查血常规。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-38fe8a3260ea673c5c5ddb90","patient_id":"patient-e7eec542502a097814d58d8a","turn_id":"turn01","turn_position":1,"turn_type":"initial_workup_choice","gold_letter":"H","gold_action":"完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部及腹部彩超，全身骨显像，常规血液学与心电图检查。","options":[{"letter":"A","text":"完善鼻咽镜检查及活检，行头颈部CT平扫+增强，颈部及腹部彩超，常规血液学与心电图检查。","is_gold":false},{"letter":"B","text":"行右颈部肿物切除活检，待病理确诊后再行头颈部MRI平扫+增强，颈部及腹部彩超，全身骨显像。","is_gold":false},{"letter":"C","text":"完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，全身PET-CT显像，常规血液学与心电图检查。","is_gold":false},{"letter":"D","text":"完善鼻咽镜检查及活检，行头颈部MRI平扫，颈部及腹部彩超，全身骨显像，常规血液学与心电图检查。","is_gold":false},{"letter":"E","text":"行右颈部肿物细针穿刺活检，待病理确诊后再行鼻咽镜检查，头颈部MRI平扫+增强，全身骨显像。","is_gold":false},{"letter":"F","text":"完善鼻咽镜检查及活检，行头颈部CT平扫，颈部及腹部彩超，全身骨显像，常规血液学与心电图检查。","is_gold":false},{"letter":"G","text":"完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部彩超，常规血液学与心电图检查，暂缓全身骨显像。","is_gold":false},{"letter":"H","text":"完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部及腹部彩超，全身骨显像，常规血液学与心电图检查。","is_gold":true},{"letter":"I","text":"完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部彩超，全身骨显像，常规血液学与心电图检查。","is_gold":false},{"letter":"J","text":"完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部及腹部彩超，头颅MRI平扫+增强，常规血液学检查。","is_gold":false},{"letter":"K","text":"完善鼻咽镜检查及活检，行头颈部CT平扫+增强，颈部及腹部彩超，全身骨显像，常规血液学与心电图检查。","is_gold":false},{"letter":"L","text":"完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部及腹部彩超，全身骨显像，骨髓穿刺活检。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 双侧耳鸣2年，发现右颈肿物3天；现病史: 患者2年前无明显诱因间断出现双侧耳鸣，近2周自觉右侧耳鸣症状加重，无鼻塞、涕血等不适。今为进一步诊治收入我院。起病以来，患者无发热、咳嗽，无胸闷、胸痛，无恶心、呕吐，胃纳、睡眠、精神可，大小便正常，体重无明显变化。；阳性症状体征: 双耳鸣,右颈部肿物,右耳鸣；既往史: 10+年前因“腰椎间盘突出”行手术治疗，并予输血，无“输血反应”。否认\"肝炎\"、\"结核\"、\"高血压\"、\"糖尿病\"等疾病史；无外伤病史。过敏史:否认药物、食物过敏史。；个人史: 原籍出生、长大，无疫水、疫区暴露史；无吸烟、酗酒等不良嗜好。；家族史: 否认家族其他成员有肿瘤病史及遗传病史。；体格检查: T：36.0℃ P：81bpm R：18bpm BP：111/76mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。牙龈无肿胀、出血，咽无充血，双扁桃体无肿大。颈部检查详见肿瘤专科 检查。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率81bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善鼻咽镜检查及活检，行头颈部CT平扫+增强，颈部及腹部彩超，常规血液学与心电图检查。\nB. 行右颈部肿物切除活检，待病理确诊后再行头颈部MRI平扫+增强，颈部及腹部彩超，全身骨显像。\nC. 完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，全身PET-CT显像，常规血液学与心电图检查。\nD. 完善鼻咽镜检查及活检，行头颈部MRI平扫，颈部及腹部彩超，全身骨显像，常规血液学与心电图检查。\nE. 行右颈部肿物细针穿刺活检，待病理确诊后再行鼻咽镜检查，头颈部MRI平扫+增强，全身骨显像。\nF. 完善鼻咽镜检查及活检，行头颈部CT平扫，颈部及腹部彩超，全身骨显像，常规血液学与心电图检查。\nG. 完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部彩超，常规血液学与心电图检查，暂缓全身骨显像。\nH. 完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部及腹部彩超，全身骨显像，常规血液学与心电图检查。\nI. 完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部彩超，全身骨显像，常规血液学与心电图检查。\nJ. 完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部及腹部彩超，头颅MRI平扫+增强，常规血液学检查。\nK. 完善鼻咽镜检查及活检，行头颈部CT平扫+增强，颈部及腹部彩超，全身骨显像，常规血液学与心电图检查。\nL. 完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部及腹部彩超，全身骨显像，骨髓穿刺活检。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 双侧耳鸣2年，发现右颈肿物3天；现病史: 患者2年前无明显诱因间断出现双侧耳鸣，近2周自觉右侧耳鸣症状加重，无鼻塞、涕血等不适。今为进一步诊治收入我院。起病以来，患者无发热、咳嗽，无胸闷、胸痛，无恶心、呕吐，胃纳、睡眠、精神可，大小便正常，体重无明显变化。；阳性症状体征: 双耳鸣,右颈部肿物,右耳鸣；既往史: 10+年前因“腰椎间盘突出”行手术治疗，并予输血，无“输血反应”。否认\"肝炎\"、\"结核\"、\"高血压\"、\"糖尿病\"等疾病史；无外伤病史。过敏史:否认药物、食物过敏史。；个人史: 原籍出生、长大，无疫水、疫区暴露史；无吸烟、酗酒等不良嗜好。；家族史: 否认家族其他成员有肿瘤病史及遗传病史。；体格检查: T：36.0℃ P：81bpm R：18bpm BP：111/76mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。牙龈无肿胀、出血，咽无充血，双扁桃体无肿大。颈部检查详见肿瘤专科 检查。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率81bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善鼻咽镜检查及活检，行头颈部CT平扫+增强，颈部及腹部彩超，常规血液学与心电图检查。\nB. 行右颈部肿物切除活检，待病理确诊后再行头颈部MRI平扫+增强，颈部及腹部彩超，全身骨显像。\nC. 完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，全身PET-CT显像，常规血液学与心电图检查。\nD. 完善鼻咽镜检查及活检，行头颈部MRI平扫，颈部及腹部彩超，全身骨显像，常规血液学与心电图检查。\nE. 行右颈部肿物细针穿刺活检，待病理确诊后再行鼻咽镜检查，头颈部MRI平扫+增强，全身骨显像。\nF. 完善鼻咽镜检查及活检，行头颈部CT平扫，颈部及腹部彩超，全身骨显像，常规血液学与心电图检查。\nG. 完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部彩超，常规血液学与心电图检查，暂缓全身骨显像。\nH. 完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部及腹部彩超，全身骨显像，常规血液学与心电图检查。\nI. 完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部彩超，全身骨显像，常规血液学与心电图检查。\nJ. 完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部及腹部彩超，头颅MRI平扫+增强，常规血液学检查。\nK. 完善鼻咽镜检查及活检，行头颈部CT平扫+增强，颈部及腹部彩超，全身骨显像，常规血液学与心电图检查。\nL. 完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部及腹部彩超，全身骨显像，骨髓穿刺活检。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-06aacdbb23f806198bd0b70c","patient_id":"patient-e7eec542502a097814d58d8a","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"I","gold_action":"行鼻咽镜检查并取鼻咽部肿物活检。","options":[{"letter":"A","text":"行右侧颈部淋巴结切除活检术","is_gold":false},{"letter":"B","text":"行右侧颈部淋巴结细针穿刺抽吸活检","is_gold":false},{"letter":"C","text":"安排诱导化疗联合同期放化疗","is_gold":false},{"letter":"D","text":"行全身PET-CT检查","is_gold":false},{"letter":"E","text":"行全身骨显像检查","is_gold":false},{"letter":"F","text":"行鼻内镜下鼻咽部肿物切除术","is_gold":false},{"letter":"G","text":"行鼻咽部高分辨率CT检查","is_gold":false},{"letter":"H","text":"行右侧颈部淋巴结微创旋切活检术","is_gold":false},{"letter":"I","text":"行鼻咽镜检查并取鼻咽部肿物活检","is_gold":true},{"letter":"J","text":"行胸部增强CT及腹部增强CT检查","is_gold":false},{"letter":"K","text":"抽取外周血行血浆EBV-DNA定量检测","is_gold":false},{"letter":"L","text":"密切观察随访，1个月后复查鼻咽部MRI","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显斑片或结节影。双侧肺门影未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见明显病变。\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 间接胆红素(IBIL)-静脉血: 9.6umolL；尿胆原(URO)-尿液: -（参考: 阴性）；钾离子(K+)-静脉血: 4mmol/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；总胆固醇(TC)-静脉血: 6.89mmol/L；肿瘤特异性生长因子(TSGF)-静脉血: 32U/mL；红细胞计数(RBC#)-静脉血: 4.9610E12/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.5U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.3pg；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 13.4umol/L；总蛋白(TP)-尿液: -（参考: 阴性）；血小板计数(PLT#)-静脉血: 319.310E9/L；比重(SG)-尿液: LAMPL.；凝血酶原时间活动度(PTA)-静脉血: 113.8%；直接胆红素(DBIL)-静脉血: 3.8umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-静脉血: 10.310E9/L；平均血小板体积(MPV)-静脉血: 7.46fL；镁离子(Mg2+)-静脉血: 0.98mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.310E9/L；鳞状细胞癌相关抗原(SCC)-静脉血: 0.4ng/ml；低密度脂蛋白胆固醇(LDL-C)-静脉血: 5.13mmol/L；血小板比容-静脉血: 23.8%；Rh血型-静脉血: 阳性；总前列腺特异性抗原(TPSA)-静脉血: 1ng/ml；神经元特异性烯醇化酶(NSE)-静脉血: 12.85ng/ml；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；游……\n- [全程D2] 检验组合: CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 0.8%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 3%；CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 24.9%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 9.8%；CD3+T淋巴细胞百分比-静脉血: 60.3%；CD4+/CD8+辅助/抑制T淋巴细胞比值(Th/Ts比值)-静脉血: 1.7；CD3-CD16+CD56+自然杀伤细胞百分比(NK%)-静脉血: 15.5%；CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 3.1%；CD3+CD4+辅助/诱导T淋巴细胞百分比(Th/Ti%)-静脉血: 29%；CD19+B淋巴细胞百分比-静脉血: 23%；CD3+CD8+抑制/细胞毒T淋巴细胞百分比(Ts/Tc%)-静脉血: 18.4%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 27.7%\n- [全程D7] 超声；双侧颈部、锁骨上区淋巴结彩超(套): 检查类型: 超声；检查名称: 双侧颈部、锁骨上区淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉内径约14mm，门静脉最大血流速度约17cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约44×36×33mm，包膜光滑，实质回声不均匀，可见强回声斑。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 前列腺钙化。 胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D7] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 右侧颈部II区可见数个淋巴结回声，最大约23×12mm，椭圆形，边界清，皮髓质分界不清，未见淋巴门。余右侧颈部未见明确异常淋巴结。 CDFI：上述最大淋巴结内可见周边型血流信号。 左侧颈部及锁骨上区未见明确异常淋巴结回声。；检查结论: 右侧颈部II区淋巴结，恶性待排，建议穿刺活检。 左侧颈部及锁骨上区未见明确异常淋巴结声像。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行右侧颈部淋巴结切除活检术\nB. 行右侧颈部淋巴结细针穿刺抽吸活检\nC. 安排诱导化疗联合同期放化疗\nD. 行全身PET-CT检查\nE. 行全身骨显像检查\nF. 行鼻内镜下鼻咽部肿物切除术\nG. 行鼻咽部高分辨率CT检查\nH. 行右侧颈部淋巴结微创旋切活检术\nI. 行鼻咽镜检查并取鼻咽部肿物活检\nJ. 行胸部增强CT及腹部增强CT检查\nK. 抽取外周血行血浆EBV-DNA定量检测\nL. 密切观察随访，1个月后复查鼻咽部MRI\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显斑片或结节影。双侧肺门影未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见明显病变。\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 间接胆红素(IBIL)-静脉血: 9.6umolL；尿胆原(URO)-尿液: -（参考: 阴性）；钾离子(K+)-静脉血: 4mmol/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；总胆固醇(TC)-静脉血: 6.89mmol/L；肿瘤特异性生长因子(TSGF)-静脉血: 32U/mL；红细胞计数(RBC#)-静脉血: 4.9610E12/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.5U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.3pg；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 13.4umol/L；总蛋白(TP)-尿液: -（参考: 阴性）；血小板计数(PLT#)-静脉血: 319.310E9/L；比重(SG)-尿液: LAMPL.；凝血酶原时间活动度(PTA)-静脉血: 113.8%；直接胆红素(DBIL)-静脉血: 3.8umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-静脉血: 10.310E9/L；平均血小板体积(MPV)-静脉血: 7.46fL；镁离子(Mg2+)-静脉血: 0.98mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.310E9/L；鳞状细胞癌相关抗原(SCC)-静脉血: 0.4ng/ml；低密度脂蛋白胆固醇(LDL-C)-静脉血: 5.13mmol/L；血小板比容-静脉血: 23.8%；Rh血型-静脉血: 阳性；总前列腺特异性抗原(TPSA)-静脉血: 1ng/ml；神经元特异性烯醇化酶(NSE)-静脉血: 12.85ng/ml；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；游……\n- [全程D2] 检验组合: CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 0.8%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 3%；CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 24.9%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 9.8%；CD3+T淋巴细胞百分比-静脉血: 60.3%；CD4+/CD8+辅助/抑制T淋巴细胞比值(Th/Ts比值)-静脉血: 1.7；CD3-CD16+CD56+自然杀伤细胞百分比(NK%)-静脉血: 15.5%；CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 3.1%；CD3+CD4+辅助/诱导T淋巴细胞百分比(Th/Ti%)-静脉血: 29%；CD19+B淋巴细胞百分比-静脉血: 23%；CD3+CD8+抑制/细胞毒T淋巴细胞百分比(Ts/Tc%)-静脉血: 18.4%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 27.7%\n- [全程D7] 超声；双侧颈部、锁骨上区淋巴结彩超(套): 检查类型: 超声；检查名称: 双侧颈部、锁骨上区淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉内径约14mm，门静脉最大血流速度约17cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约44×36×33mm，包膜光滑，实质回声不均匀，可见强回声斑。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 前列腺钙化。 胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D7] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 右侧颈部II区可见数个淋巴结回声，最大约23×12mm，椭圆形，边界清，皮髓质分界不清，未见淋巴门。余右侧颈部未见明确异常淋巴结。 CDFI：上述最大淋巴结内可见周边型血流信号。 左侧颈部及锁骨上区未见明确异常淋巴结回声。；检查结论: 右侧颈部II区淋巴结，恶性待排，建议穿刺活检。 左侧颈部及锁骨上区未见明确异常淋巴结声像。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行右侧颈部淋巴结切除活检术\nB. 行右侧颈部淋巴结细针穿刺抽吸活检\nC. 安排诱导化疗联合同期放化疗\nD. 行全身PET-CT检查\nE. 行全身骨显像检查\nF. 行鼻内镜下鼻咽部肿物切除术\nG. 行鼻咽部高分辨率CT检查\nH. 行右侧颈部淋巴结微创旋切活检术\nI. 行鼻咽镜检查并取鼻咽部肿物活检\nJ. 行胸部增强CT及腹部增强CT检查\nK. 抽取外周血行血浆EBV-DNA定量检测\nL. 密切观察随访，1个月后复查鼻咽部MRI\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-9713cef7ba61651ea6a5f02e","patient_id":"patient-e7eec542502a097814d58d8a","turn_id":"turn05","turn_position":3,"turn_type":"toxicity_or_support_decision","gold_letter":"L","gold_action":"予以静脉水化及电解质（含钾）补充，嘱计24小时尿量，并常规行PICC导管护理。","options":[{"letter":"A","text":"暂不予静脉水化及电解质补充，待明日行顺铂化疗时同步予以补液支持。","is_gold":false},{"letter":"B","text":"予以静脉水化，暂不补充钾离子，嘱计24小时尿量，并常规行PICC导管护理。","is_gold":false},{"letter":"C","text":"予以静脉水化及电解质补充，常规静脉推注呋塞米强效利尿，并计24小时尿量。","is_gold":false},{"letter":"D","text":"予以静脉水化及电解质补充，皮下注射重组人粒细胞集落刺激因子预防骨髓抑制。","is_gold":false},{"letter":"E","text":"予以静脉水化及电解质补充，静脉滴注右丙亚胺预防大剂量顺铂相关心脏毒性。","is_gold":false},{"letter":"F","text":"予以静脉水化及电解质补充，静脉滴注阿米福汀预防大剂量顺铂相关肾毒性。","is_gold":false},{"letter":"G","text":"予以静脉水化及电解质补充，嘱计24小时尿量，并静脉滴注头孢菌素预防感染。","is_gold":false},{"letter":"H","text":"予以静脉水化及电解质补充，静脉滴注地塞米松及帕洛诺司琼进行止吐预处理。","is_gold":false},{"letter":"I","text":"予以静脉水化及电解质补充，静脉输注人血白蛋白以预防大剂量化疗后低蛋白血症。","is_gold":false},{"letter":"J","text":"予以静脉水化及电解质补充，静脉滴注异甘草酸镁预防大剂量顺铂相关肝损伤。","is_gold":false},{"letter":"K","text":"予以静脉水化及电解质补充，嘱计24小时尿量，并皮下注射促红细胞生成素。","is_gold":false},{"letter":"L","text":"予以静脉水化及电解质（含钾）补充，嘱计24小时尿量，并常规行PICC导管护理。","is_gold":true}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 双侧耳鸣2年，发现右颈肿物3天；现病史: 患者2年前无明显诱因间断出现双侧耳鸣，近2周自觉右侧耳鸣症状加重，无鼻塞、涕血等不适。3天前无明显诱因发现右颈部肿物，遂就诊外院行CT检查示：鼻咽右侧壁增厚，考虑鼻咽癌可能，伴右侧乳突阻塞性炎症。今为进一步诊治收入我院。起病以来，患者无发热、咳嗽，无胸闷、胸痛，无恶心、呕吐，胃纳、睡眠、精神可，大小便正常，体重无明显变化。；阳性症状体征: 双耳鸣,右颈部肿物,右耳鸣；既往史: 10+年前因“腰椎间盘突出”行手术治疗，并予输血，无“输血反应”。否认\"肝炎\"、\"结核\"、\"高血压\"、\"糖尿病\"等疾病史；无外伤病史。过敏史:否认药物、食物过敏史。；个人史: 原籍出生、长大，无疫水、疫区暴露史；无吸烟、酗酒等不良嗜好。；家族史: 否认家族其他成员有肿瘤病史及遗传病史。；体格检查: T：36.0℃ P：81bpm R：18bpm BP：111/76mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。牙龈无肿胀、出血，咽无充血，双扁桃体无肿大。颈部检查详见肿瘤专科 检查。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率81bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。肛门外生殖器未见异常，生理反射存在，病理反射未引出。；专科检查: 间接鼻咽镜检查见双侧鼻腔通畅，内未窥及明显肿物；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D24] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽右顶壁及右侧壁粘膜增厚放射性浓聚，SUV约16.7，病灶累及右翼突基底部及内侧板、右侧腭帆张提肌。右侧咽隐窝消失，左侧咽隐窝存在。双侧咽后未见肿大淋巴结及异常放射性分布。口咽、喉咽未见异常。筛窦、左上颌窦及右乳突内低密度影放射性稀疏；额窦、蝶窦、右上颌窦及左乳突结构及放射性分布未见明显异常。双侧海绵窦放射性分布未见明显异常。甲状腺结构及放射性分布未见明显异常。右颈II区数个淋巴结放射性浓聚，SUV约18.0，大者约1.5×2.2cm；余双颈小淋巴结放射性分布未见异常。 所见脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔主肺动脉窗小淋巴结放射性分布未见明显异常，大小约0.9×1.0cm。双肺门未见肿大淋巴结及异常放射性分布。双侧腋窝小淋巴结放射性未见明显异常。 肝脏密度减低，CT值约36Hu（脾脏CT值约56Hu），结构及放射性分布未见异常；肝门区未见占位及异常放射性分布。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。左肾上腺体部小结节影放射性略浓密，大小约1.0×1.1cm。脾脏、双肾、右肾上腺及胰腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺大小正常，内见数个点状钙化灶。膀胱及肠管形态、结构及放射性分布未见明显异常。双髂血管旁及双侧腹股沟未见肿大淋巴结及异常放射性分布。 颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，病灶累及右翼突基底部及内侧板、右侧腭帆张提肌；右颈II区数个淋巴结代谢活跃，考虑转移。 左肾上腺体部小结节代谢稍活跃，疑良性增生病变。 前列腺多发钙化灶。 脂肪肝。 副鼻窦炎症；右乳突炎症。\n- [全程D28] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T6上缘水平，估计导管末端位于上腔静脉上段内。；检查结论: PICC管末端位置如上述。\n- [全程D28] 检验组合: 红细胞计数(RBC#)-静脉血: 4.710E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7；钾离子(K+)-静脉血: 4.2mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 32.3U/L；尿素氮(BUN)-静脉血: 8.2mmol/L；间接胆红素(IBIL)-静脉血: 6.2umolL；氯离子(Cl-)-静脉血: 100.2mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 326g/L；红细胞比容(Hct)-静脉血: 43.5%；总胆固醇(TC)-静脉血: 5.88mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 22.9U/L；载脂蛋白AI(apoAI)-静脉血: 1.32g/L；血小板比容-静脉血: 32%；葡萄糖(Glu)-静脉血: 5.95mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.8mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.2pg；乳酸脱氢酶(LDH)-静脉血: 159.8U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.279；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.67；白细胞计数(WBC#)-静脉血: 10.7710E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 16.9U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.99mmol/L；中性粒细胞计数(Neut#)-静脉血: 6.410E9/L；平均红细胞体积(MCV)-静脉血: 92.6fL；平均血小板体积(MPV)-静脉血: 9.2fL；总胆红素(TBIL)-静脉血: 8.6umol/L；血小板分布宽度(PDW)-静脉血: 10%；磷(P)-静脉血: 1.6mmol/L；肌酐(Crea)-静脉血: 64.4umol/L；血小板计数(PLT#)-静脉血: 34410E9/L；C-反应蛋白(CRP)-静脉血: 3.29mg/L；碱性磷酸酶(ALP)-静脉血: 102.6U/L；白蛋白(ALB)-静脉血: 46.3g/L；淋巴细胞计数(Lymph#)-静脉血: 310E9/L；单核细胞计数(Mono#)-静脉血: 0.810E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 54U/L；大血小板百分比(P-LCR%)-静脉血: 18.4%；单核细胞百分比(Mono%)-静……\n\n【既往治疗与反应】\n- [全程D9] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，无发热、涕血等不适症状。查体：生命体征平稳。电子喉镜检查示：鼻咽右隆突肿物，符合鼻咽癌。并取肿物活检，等待病理结果。[姓名已隐去]副教授示，结合患者病情及相关检查，诊断考虑鼻咽癌可能性大，明确诊断，予鼻咽科进一步诊治。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D15] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：KPS 90分；鼻咽右侧壁、顶后壁结节状肿物，右颈Ⅱ区可扪及已肿大淋巴结，大小约2*1cm，颅神经检查（-）。今日[姓名已隐去]医生信息已隐藏后示：患者已完善相关检查，并预约放疗，今日可结账出院，嘱出院后按时[计划性表述已隐藏]放化综合治疗，不适随诊。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂不予静脉水化及电解质补充，待明日行顺铂化疗时同步予以补液支持。\nB. 予以静脉水化，暂不补充钾离子，嘱计24小时尿量，并常规行PICC导管护理。\nC. 予以静脉水化及电解质补充，常规静脉推注呋塞米强效利尿，并计24小时尿量。\nD. 予以静脉水化及电解质补充，皮下注射重组人粒细胞集落刺激因子预防骨髓抑制。\nE. 予以静脉水化及电解质补充，静脉滴注右丙亚胺预防大剂量顺铂相关心脏毒性。\nF. 予以静脉水化及电解质补充，静脉滴注阿米福汀预防大剂量顺铂相关肾毒性。\nG. 予以静脉水化及电解质补充，嘱计24小时尿量，并静脉滴注头孢菌素预防感染。\nH. 予以静脉水化及电解质补充，静脉滴注地塞米松及帕洛诺司琼进行止吐预处理。\nI. 予以静脉水化及电解质补充，静脉输注人血白蛋白以预防大剂量化疗后低蛋白血症。\nJ. 予以静脉水化及电解质补充，静脉滴注异甘草酸镁预防大剂量顺铂相关肝损伤。\nK. 予以静脉水化及电解质补充，嘱计24小时尿量，并皮下注射促红细胞生成素。\nL. 予以静脉水化及电解质（含钾）补充，嘱计24小时尿量，并常规行PICC导管护理。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 双侧耳鸣2年，发现右颈肿物3天；现病史: 患者2年前无明显诱因间断出现双侧耳鸣，近2周自觉右侧耳鸣症状加重，无鼻塞、涕血等不适。3天前无明显诱因发现右颈部肿物，遂就诊外院行CT检查示：鼻咽右侧壁增厚，考虑鼻咽癌可能，伴右侧乳突阻塞性炎症。今为进一步诊治收入我院。起病以来，患者无发热、咳嗽，无胸闷、胸痛，无恶心、呕吐，胃纳、睡眠、精神可，大小便正常，体重无明显变化。；阳性症状体征: 双耳鸣,右颈部肿物,右耳鸣；既往史: 10+年前因“腰椎间盘突出”行手术治疗，并予输血，无“输血反应”。否认\"肝炎\"、\"结核\"、\"高血压\"、\"糖尿病\"等疾病史；无外伤病史。过敏史:否认药物、食物过敏史。；个人史: 原籍出生、长大，无疫水、疫区暴露史；无吸烟、酗酒等不良嗜好。；家族史: 否认家族其他成员有肿瘤病史及遗传病史。；体格检查: T：36.0℃ P：81bpm R：18bpm BP：111/76mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。牙龈无肿胀、出血，咽无充血，双扁桃体无肿大。颈部检查详见肿瘤专科 检查。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率81bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。肛门外生殖器未见异常，生理反射存在，病理反射未引出。；专科检查: 间接鼻咽镜检查见双侧鼻腔通畅，内未窥及明显肿物；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D24] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽右顶壁及右侧壁粘膜增厚放射性浓聚，SUV约16.7，病灶累及右翼突基底部及内侧板、右侧腭帆张提肌。右侧咽隐窝消失，左侧咽隐窝存在。双侧咽后未见肿大淋巴结及异常放射性分布。口咽、喉咽未见异常。筛窦、左上颌窦及右乳突内低密度影放射性稀疏；额窦、蝶窦、右上颌窦及左乳突结构及放射性分布未见明显异常。双侧海绵窦放射性分布未见明显异常。甲状腺结构及放射性分布未见明显异常。右颈II区数个淋巴结放射性浓聚，SUV约18.0，大者约1.5×2.2cm；余双颈小淋巴结放射性分布未见异常。 所见脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔主肺动脉窗小淋巴结放射性分布未见明显异常，大小约0.9×1.0cm。双肺门未见肿大淋巴结及异常放射性分布。双侧腋窝小淋巴结放射性未见明显异常。 肝脏密度减低，CT值约36Hu（脾脏CT值约56Hu），结构及放射性分布未见异常；肝门区未见占位及异常放射性分布。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。左肾上腺体部小结节影放射性略浓密，大小约1.0×1.1cm。脾脏、双肾、右肾上腺及胰腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺大小正常，内见数个点状钙化灶。膀胱及肠管形态、结构及放射性分布未见明显异常。双髂血管旁及双侧腹股沟未见肿大淋巴结及异常放射性分布。 颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，病灶累及右翼突基底部及内侧板、右侧腭帆张提肌；右颈II区数个淋巴结代谢活跃，考虑转移。 左肾上腺体部小结节代谢稍活跃，疑良性增生病变。 前列腺多发钙化灶。 脂肪肝。 副鼻窦炎症；右乳突炎症。\n- [全程D28] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T6上缘水平，估计导管末端位于上腔静脉上段内。；检查结论: PICC管末端位置如上述。\n- [全程D28] 检验组合: 红细胞计数(RBC#)-静脉血: 4.710E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7；钾离子(K+)-静脉血: 4.2mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 32.3U/L；尿素氮(BUN)-静脉血: 8.2mmol/L；间接胆红素(IBIL)-静脉血: 6.2umolL；氯离子(Cl-)-静脉血: 100.2mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 326g/L；红细胞比容(Hct)-静脉血: 43.5%；总胆固醇(TC)-静脉血: 5.88mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 22.9U/L；载脂蛋白AI(apoAI)-静脉血: 1.32g/L；血小板比容-静脉血: 32%；葡萄糖(Glu)-静脉血: 5.95mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.8mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.2pg；乳酸脱氢酶(LDH)-静脉血: 159.8U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.279；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.67；白细胞计数(WBC#)-静脉血: 10.7710E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 16.9U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.99mmol/L；中性粒细胞计数(Neut#)-静脉血: 6.410E9/L；平均红细胞体积(MCV)-静脉血: 92.6fL；平均血小板体积(MPV)-静脉血: 9.2fL；总胆红素(TBIL)-静脉血: 8.6umol/L；血小板分布宽度(PDW)-静脉血: 10%；磷(P)-静脉血: 1.6mmol/L；肌酐(Crea)-静脉血: 64.4umol/L；血小板计数(PLT#)-静脉血: 34410E9/L；C-反应蛋白(CRP)-静脉血: 3.29mg/L；碱性磷酸酶(ALP)-静脉血: 102.6U/L；白蛋白(ALB)-静脉血: 46.3g/L；淋巴细胞计数(Lymph#)-静脉血: 310E9/L；单核细胞计数(Mono#)-静脉血: 0.810E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 54U/L；大血小板百分比(P-LCR%)-静脉血: 18.4%；单核细胞百分比(Mono%)-静……\n\n【既往治疗与反应】\n- [全程D9] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，无发热、涕血等不适症状。查体：生命体征平稳。电子喉镜检查示：鼻咽右隆突肿物，符合鼻咽癌。并取肿物活检，等待病理结果。[姓名已隐去]副教授示，结合患者病情及相关检查，诊断考虑鼻咽癌可能性大，明确诊断，予鼻咽科进一步诊治。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D15] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：KPS 90分；鼻咽右侧壁、顶后壁结节状肿物，右颈Ⅱ区可扪及已肿大淋巴结，大小约2*1cm，颅神经检查（-）。今日[姓名已隐去]医生信息已隐藏后示：患者已完善相关检查，并预约放疗，今日可结账出院，嘱出院后按时[计划性表述已隐藏]放化综合治疗，不适随诊。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂不予静脉水化及电解质补充，待明日行顺铂化疗时同步予以补液支持。\nB. 予以静脉水化，暂不补充钾离子，嘱计24小时尿量，并常规行PICC导管护理。\nC. 予以静脉水化及电解质补充，常规静脉推注呋塞米强效利尿，并计24小时尿量。\nD. 予以静脉水化及电解质补充，皮下注射重组人粒细胞集落刺激因子预防骨髓抑制。\nE. 予以静脉水化及电解质补充，静脉滴注右丙亚胺预防大剂量顺铂相关心脏毒性。\nF. 予以静脉水化及电解质补充，静脉滴注阿米福汀预防大剂量顺铂相关肾毒性。\nG. 予以静脉水化及电解质补充，嘱计24小时尿量，并静脉滴注头孢菌素预防感染。\nH. 予以静脉水化及电解质补充，静脉滴注地塞米松及帕洛诺司琼进行止吐预处理。\nI. 予以静脉水化及电解质补充，静脉输注人血白蛋白以预防大剂量化疗后低蛋白血症。\nJ. 予以静脉水化及电解质补充，静脉滴注异甘草酸镁预防大剂量顺铂相关肝损伤。\nK. 予以静脉水化及电解质补充，嘱计24小时尿量，并皮下注射促红细胞生成素。\nL. 予以静脉水化及电解质（含钾）补充，嘱计24小时尿量，并常规行PICC导管护理。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-e0f912ad55b7b1f092a1b468","patient_id":"patient-e7eec542502a097814d58d8a","turn_id":"turn06","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"L","gold_action":"仅常规复查血常规、生化常规及EBV-DNA定量，暂不予特殊药物干预","options":[{"letter":"A","text":"在无明显感染或疼痛症状的情况下经验性给予阿莫西林口服抗感染及酚咖片止痛，并复查血常规、生化常规及EBV-DNA定量","is_gold":false},{"letter":"B","text":"在无明显感染或疼痛症状的情况下静脉滴注头孢类抗生素并酚咖片止痛，同时复查血常规、生化常规及EBV-DNA定量","is_gold":false},{"letter":"C","text":"经验性给予阿莫西林口服抗感染及酚咖片止痛，并暂停放疗直至症状完全缓解","is_gold":false},{"letter":"D","text":"经验性给予酚咖片对症止痛，暂不予抗感染治疗，并复查血常规、生化常规及EBV-DNA定量","is_gold":false},{"letter":"E","text":"经验性给予阿莫西林口服抗感染，暂不予止痛治疗，并复查血常规、生化常规及EBV-DNA定量","is_gold":false},{"letter":"F","text":"经验性给予阿莫西林口服抗感染及酚咖片止痛，并提前安排第二程顺铂化疗","is_gold":false},{"letter":"G","text":"经验性给予阿莫西林口服抗感染及酚咖片止痛，并加用静脉地塞米松减轻局部水肿","is_gold":false},{"letter":"H","text":"经验性给予静脉滴注广谱抗生素及曲马多止痛，并复查血常规、生化常规及EBV-DNA定量","is_gold":false},{"letter":"I","text":"经验性给予阿莫西林口服抗感染及酚咖片止痛，并取消后续顺铂化疗计划","is_gold":false},{"letter":"J","text":"经验性给予阿莫西林口服抗感染及酚咖片止痛，并复查鼻咽颈部MRI评估近期疗效","is_gold":false},{"letter":"K","text":"经验性给予口服抗真菌药物及酚咖片止痛，并复查血常规、生化常规及EBV-DNA定量","is_gold":false},{"letter":"L","text":"仅常规复查血常规、生化常规及EBV-DNA定量，暂不予特殊药物干预","is_gold":true}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D29] 检验组合: 隐血(OB)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；淀粉样蛋白A(SAA)-静脉血: 3.65mg/L；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；白细胞计数(WBC#)-尿液: 7/μL；比重(SG)-尿液: 1.027；总蛋白(TP)-尿液: +- 0.2g（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；葡萄糖(Glu)-尿液: 3+ 17mmol（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 80/μL\n- [全程D30] 检验组合: 颜色-尿液: Yellow；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 13/μL；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 6；总蛋白(TP)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.023\n- [全程D35] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.7；单核细胞计数(Mono#)-静脉血: 0.810E9/L；甘油三酯(TG)-静脉血: 2.15mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；载脂蛋白AI(apoAI)-静脉血: 1.26g/L；中性粒细胞百分比(Neut%)-静脉血: 0.702；葡萄糖(Glu)-静脉血: 6.03mmol/L；尿素氮(BUN)-静脉血: 7.02mmol/L；直接胆红素(DBIL)-静脉血: 4.8umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20U/L；C-反应蛋白(CRP)-静脉血: 2.65mg/L；乳酸脱氢酶(LDH)-静脉血: 166.9U/L；红细胞计数(RBC#)-静脉血: 4.7510E12/L；总胆汁酸(TBA)-静脉血: 1.5umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；总蛋白(TP)-静脉血: 71.69g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；肌酐(Crea)-静脉血: 69.7umol/L；总钙(Ca)-静脉血: 2.31mmol/L；白细胞计数(WBC#)-静脉血: 7.4610E9/L；镁离子(Mg2+)-静脉血: 1mmol/L；平均红细胞体积(MCV)-静脉血: 88.8fL；总胆固醇(TC)-静脉血: 5.15mmol/L；磷(P)-静脉血: 1.3mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；总胆红素(TBIL)-静脉血: 15umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；阴离子间隙(AG)-静脉血: 17；间接胆红素(IBIL)-静脉血: 10.2umolL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.18mmolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4；球蛋白(GLO)-静脉血: 26.39g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.168；血小板分布宽度(PDW)-静脉血: 9.8%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.015；血红蛋白(Hb)-静脉血: 141g/L；淋巴细胞计数(L……\n\n【既往治疗与反应】\n- [全程D29] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者放疗1次。患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：基本同前。今日[姓名已隐去]副医生信息已隐藏后示：患于今日行第一程DDP方案化疗（100mg/m2）。继续放疗，续观。\n- [全程D34] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：KPS 90分； 间接鼻咽镜检查见双侧鼻腔通畅，内未窥及明显肿物；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。复查血常规、生化常规未见明显异常。今日[姓名已隐去]医生信息已隐藏后示：患者已结束第一程同时期DDP方案化疗（100mg/m2），治疗过程顺利，今日可结账出院，嘱出院后继续在门诊放疗，每周复查血常规、肝肾功能，并按时[计划性表述已隐藏]下一程治疗，不适随诊。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 在无明显感染或疼痛症状的情况下经验性给予阿莫西林口服抗感染及酚咖片止痛，并复查血常规、生化常规及EBV-DNA定量\nB. 在无明显感染或疼痛症状的情况下静脉滴注头孢类抗生素并酚咖片止痛，同时复查血常规、生化常规及EBV-DNA定量\nC. 经验性给予阿莫西林口服抗感染及酚咖片止痛，并暂停放疗直至症状完全缓解\nD. 经验性给予酚咖片对症止痛，暂不予抗感染治疗，并复查血常规、生化常规及EBV-DNA定量\nE. 经验性给予阿莫西林口服抗感染，暂不予止痛治疗，并复查血常规、生化常规及EBV-DNA定量\nF. 经验性给予阿莫西林口服抗感染及酚咖片止痛，并提前安排第二程顺铂化疗\nG. 经验性给予阿莫西林口服抗感染及酚咖片止痛，并加用静脉地塞米松减轻局部水肿\nH. 经验性给予静脉滴注广谱抗生素及曲马多止痛，并复查血常规、生化常规及EBV-DNA定量\nI. 经验性给予阿莫西林口服抗感染及酚咖片止痛，并取消后续顺铂化疗计划\nJ. 经验性给予阿莫西林口服抗感染及酚咖片止痛，并复查鼻咽颈部MRI评估近期疗效\nK. 经验性给予口服抗真菌药物及酚咖片止痛，并复查血常规、生化常规及EBV-DNA定量\nL. 仅常规复查血常规、生化常规及EBV-DNA定量，暂不予特殊药物干预\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D29] 检验组合: 隐血(OB)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；淀粉样蛋白A(SAA)-静脉血: 3.65mg/L；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；白细胞计数(WBC#)-尿液: 7/μL；比重(SG)-尿液: 1.027；总蛋白(TP)-尿液: +- 0.2g（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；葡萄糖(Glu)-尿液: 3+ 17mmol（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 80/μL\n- [全程D30] 检验组合: 颜色-尿液: Yellow；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 13/μL；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 6；总蛋白(TP)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.023\n- [全程D35] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.7；单核细胞计数(Mono#)-静脉血: 0.810E9/L；甘油三酯(TG)-静脉血: 2.15mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；载脂蛋白AI(apoAI)-静脉血: 1.26g/L；中性粒细胞百分比(Neut%)-静脉血: 0.702；葡萄糖(Glu)-静脉血: 6.03mmol/L；尿素氮(BUN)-静脉血: 7.02mmol/L；直接胆红素(DBIL)-静脉血: 4.8umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20U/L；C-反应蛋白(CRP)-静脉血: 2.65mg/L；乳酸脱氢酶(LDH)-静脉血: 166.9U/L；红细胞计数(RBC#)-静脉血: 4.7510E12/L；总胆汁酸(TBA)-静脉血: 1.5umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；总蛋白(TP)-静脉血: 71.69g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；肌酐(Crea)-静脉血: 69.7umol/L；总钙(Ca)-静脉血: 2.31mmol/L；白细胞计数(WBC#)-静脉血: 7.4610E9/L；镁离子(Mg2+)-静脉血: 1mmol/L；平均红细胞体积(MCV)-静脉血: 88.8fL；总胆固醇(TC)-静脉血: 5.15mmol/L；磷(P)-静脉血: 1.3mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；总胆红素(TBIL)-静脉血: 15umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；阴离子间隙(AG)-静脉血: 17；间接胆红素(IBIL)-静脉血: 10.2umolL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.18mmolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4；球蛋白(GLO)-静脉血: 26.39g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.168；血小板分布宽度(PDW)-静脉血: 9.8%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.015；血红蛋白(Hb)-静脉血: 141g/L；淋巴细胞计数(L……\n\n【既往治疗与反应】\n- [全程D29] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者放疗1次。患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：基本同前。今日[姓名已隐去]副医生信息已隐藏后示：患于今日行第一程DDP方案化疗（100mg/m2）。继续放疗，续观。\n- [全程D34] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：KPS 90分； 间接鼻咽镜检查见双侧鼻腔通畅，内未窥及明显肿物；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。复查血常规、生化常规未见明显异常。今日[姓名已隐去]医生信息已隐藏后示：患者已结束第一程同时期DDP方案化疗（100mg/m2），治疗过程顺利，今日可结账出院，嘱出院后继续在门诊放疗，每周复查血常规、肝肾功能，并按时[计划性表述已隐藏]下一程治疗，不适随诊。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 在无明显感染或疼痛症状的情况下经验性给予阿莫西林口服抗感染及酚咖片止痛，并复查血常规、生化常规及EBV-DNA定量\nB. 在无明显感染或疼痛症状的情况下静脉滴注头孢类抗生素并酚咖片止痛，同时复查血常规、生化常规及EBV-DNA定量\nC. 经验性给予阿莫西林口服抗感染及酚咖片止痛，并暂停放疗直至症状完全缓解\nD. 经验性给予酚咖片对症止痛，暂不予抗感染治疗，并复查血常规、生化常规及EBV-DNA定量\nE. 经验性给予阿莫西林口服抗感染，暂不予止痛治疗，并复查血常规、生化常规及EBV-DNA定量\nF. 经验性给予阿莫西林口服抗感染及酚咖片止痛，并提前安排第二程顺铂化疗\nG. 经验性给予阿莫西林口服抗感染及酚咖片止痛，并加用静脉地塞米松减轻局部水肿\nH. 经验性给予静脉滴注广谱抗生素及曲马多止痛，并复查血常规、生化常规及EBV-DNA定量\nI. 经验性给予阿莫西林口服抗感染及酚咖片止痛，并取消后续顺铂化疗计划\nJ. 经验性给予阿莫西林口服抗感染及酚咖片止痛，并复查鼻咽颈部MRI评估近期疗效\nK. 经验性给予口服抗真菌药物及酚咖片止痛，并复查血常规、生化常规及EBV-DNA定量\nL. 仅常规复查血常规、生化常规及EBV-DNA定量，暂不予特殊药物干预\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-67a2318574aada2f5af690c0","patient_id":"patient-e7eec542502a097814d58d8a","turn_id":"turn07","turn_position":5,"turn_type":"recurrence_or_salvage_decision","gold_letter":"B","gold_action":"继续完成原计划的根治性放疗，给予阿片类药物镇痛及静脉补液与营养支持治疗。","options":[{"letter":"A","text":"提前终止放疗，转为单纯全身化疗或靶向治疗，并给予静脉营养支持。","is_gold":false},{"letter":"B","text":"继续完成原计划的根治性放疗，给予阿片类药物镇痛及静脉补液与营养支持治疗。","is_gold":true},{"letter":"C","text":"暂停放疗直至口腔黏膜反应降至1度，期间给予广谱抗生素及静脉糖皮质激素治疗。","is_gold":false},{"letter":"D","text":"继续放疗，重新定位并缩减放疗靶区及处方剂量，同时给予非甾体类抗炎药镇痛。","is_gold":false},{"letter":"E","text":"暂停放疗，更改全身治疗方案为TPF方案化疗，待局部症状好转后择期恢复放疗。","is_gold":false},{"letter":"F","text":"继续完成根治性放疗，给予局部利多卡因含漱液及非甾体类抗炎药镇痛，并仅口服营养支持，无需静脉补液。","is_gold":false},{"letter":"G","text":"终止放疗，行右侧颈部淋巴结清扫术及鼻咽原发灶挽救性切除术。","is_gold":false},{"letter":"H","text":"继续放疗并同步行第3程大剂量顺铂化疗，给予阿片类药物镇痛，暂不予静脉补液。","is_gold":false},{"letter":"I","text":"暂停放疗，行鼻咽部内镜下微创手术切除残留病灶，术后继续静脉补液支持。","is_gold":false},{"letter":"J","text":"继续完成根治性放疗，行经皮内镜下胃造瘘术（PEG）以建立长期肠内营养途径。","is_gold":false},{"letter":"K","text":"提前终止放疗，改为PD-1抑制剂联合化疗的全身系统性维持治疗。","is_gold":false},{"letter":"L","text":"继续放疗，给予大剂量静脉糖皮质激素冲击治疗缓解黏膜反应，并继续口服营养液。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D49] 检验组合: 丙氨酸氨基转移酶(ALT)-静脉血: 18.4U/L；球蛋白(GLO)-静脉血: 27.24g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；γ-谷氨酰基转移酶(GGT)-静脉血: 42U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 16.9U/L；平均红细胞体积(MCV)-静脉血: 90.3fL；血小板比容-静脉血: 11.8%；血小板分布宽度(PDW)-静脉血: 16.8%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；钠离子(Na+)-静脉血: 138mmol/L；平均血小板体积(MPV)-静脉血: 6.76fL；总胆汁酸(TBA)-静脉血: 2.9umol/L；载脂蛋白B(apoB)-静脉血: 1.36g/L；总钙(Ca)-静脉血: 2.22mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.16g/L；红细胞计数(RBC#)-静脉血: 4.3410E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.019；血红蛋白(Hb)-静脉血: 133.6g/L；阴离子间隙(AG)-静脉血: 15.6；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；C-反应蛋白(CRP)-静脉血: 10.3mg/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.6mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.17；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.87mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9%；淀粉样蛋白A(SAA)-静脉血: 24.6mg/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.7pg；甘油三酯(TG)-静脉血: 2.36mmol/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；总蛋白(TP)-静脉血: 71.04g/L；碱性磷酸酶(ALP)-静脉血: 108.1U/L；总胆固醇(TC)-静脉血: 5.6mmol/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.104；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.92；平均红细胞血红蛋白浓度(MCHC)-静脉血: 340.7g/……\n- [全程D55] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位置位于第3胸椎体右下缘，估计位于右侧头臂静脉内。；检查结论: PICC管末端位置如上所述。\n- [全程D55] 检验组合: 葡萄糖(Glu)-尿液: +- 2.8mmol（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: 1+ 0.3g（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 3/μL；白细胞计数(WBC#)-尿液: 20/μL；酸碱度(pH)-尿液: 5.5；颜色-尿液: Yellow；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: +- 0.1g（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；比重(SG)-尿液: 1.021；红细胞计数(RBC#)-尿液: 2/μL；红细胞计数(RBC#)-尿液: 2/μL；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.025；浊度(TRUB)-尿液: 清亮；粘液丝计数(MUCS#)-尿液: 80/μL；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；葡萄糖(Glu)-尿液: 3+ 17mmol（参考: 阴性）；白细胞计数(WBC#)-尿液: 4/μL\n- [全程D63] 检验组合: 红细胞计数(RBC#)-静脉血: 3.910E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞计数(Neut#)-静脉血: 5.210E9/L；阴离子间隙(AG)-静脉血: 16.2；尿酸(UA)-静脉血: 364.7umol/L；钠离子(Na+)-静脉血: 132.6mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；球蛋白(GLO)-静脉血: 26.68g/L；单核细胞计数(Mono#)-静脉血: 1.110E9/L；葡萄糖(Glu)-静脉血: 4.06mmol/L；单核细胞百分比(Mono%)-静脉血: 0.166；平均血小板体积(MPV)-静脉血: 8.1fL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；尿素氮(BUN)-静脉血: 7.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 20.7U/L；白细胞计数(WBC#)-静脉血: 6.6710E9/L；甘油三酯(TG)-静脉血: 1.04mmol/L；氯离子(Cl-)-静脉血: 93.2mmol/L；磷(P)-静脉血: 1.24mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.2mmol/L；平均红细胞体积(MCV)-静脉血: 89.2fL；总胆汁酸(TBA)-静脉血: 0.9umol/L；载脂蛋白B(apoB)-静脉血: 1.28g/L；总钙(Ca)-静脉血: 2.2mmol/L；镁离子(Mg2+)-静脉血: 1.01mmol/L；红细胞比容(Hct)-静脉血: 34.8%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；乳酸脱氢酶(LDH)-静脉血: 151.8U/L；间接胆红素(IBIL)-静脉血: 9umolL；载脂蛋白AI(apoAI)-静脉血: 0.91g/L；总胆红素(TBIL)-静脉血: 12.8umol/L；大血小板百分比(P-LCR%)-静脉血: 9.3%；中性粒细胞百分比(Neut%)-静脉血: 0.782；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；血小板分布宽度(PDW)-静脉血: 8%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.1；碱性磷酸酶(ALP)-静脉血: 113.9U/L；平均红……\n- [全程D69] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌治疗后，与某次就诊时间0日片对比: 鼻咽腔未见明显狭窄，鼻咽顶后壁、右侧壁轻度增厚，见少许软组织影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，右侧咽隐窝消失。鼻咽左侧壁未见明显增厚，左侧咽隐窝稍浅。右侧咽旁脂肪间隙稍变窄，左侧咽旁脂肪间隙未见异常。 右侧腭帆提张肌信号不均匀，左侧腭帆提张肌、双侧头长肌未见受侵征象。 双侧翼腭窝、上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 口咽双侧壁未见受累增厚，病变未累及双侧后鼻孔。 右侧翼突内份及内板、蝶骨基底部右份骨质信号减低，增强扫描轻度强化，范围较前缩小。余颅底未见明确骨质破坏征象。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦、右侧乳突粘膜增厚，双侧上颌窦见少量分泌物，蝶窦、左侧乳突充气良好，骨壁完整。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 右侧咽后淋巴结短径约6mm，较前缩小。左侧咽后未见肿大淋巴结。 右颈IIb区见稍大淋巴结，较大者短径约7mm，增强扫描明显强化，较前缩小。双颈IIa区见数个小淋巴结，较大者短径约5mm，增强扫描轻度强化，大致同前。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 扫描所见脑实质未见明显异常。；检查结论: 鼻咽癌治疗后，与某次就诊时间0日片对比: 鼻咽病变较前缩小。 颅底骨质破坏，较前有修复。 右侧咽后肿大淋巴结，考虑转移，较前缩小。 右颈IIb区淋巴结肿大，考虑转移，较前缩小。 双颈IIa区小淋巴结。 副鼻窦炎，右侧乳突炎。\n- [全程D69] 检验组合: 直接胆红素(DBIL)-静脉血: 3.2umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.033；阴离子间隙(AG)-静脉血: 16.9；白细胞计数(WBC#)-静脉血: 3.510E9/L；总胆红素(TBIL)-静脉血: 11.7umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 24.1U/L；尿酸(UA)-静脉血: 468.3umol/L；白蛋白(ALB)-静脉血: 39.4g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.016；红细胞比容(Hct)-静脉血: 33.6%；磷(P)-静脉血: 1.09mmol/L；C-反应蛋白(CRP)-静脉血: 20.73mg/L；载脂蛋白B(apoB)-静脉血: 1.37g/L；葡萄糖(Glu)-静脉血: 4.3mmol/L；单核细胞百分比(Mono%)-静脉血: 0.112；血小板比容-静脉血: 15.3%；肌酐(Crea)-静脉血: 62.2umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4%；碱性磷酸酶(ALP)-静脉血: 92.8U/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.9mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.57；总蛋白(TP)-静脉血: 64.43g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.86；淋巴细胞计数(Lymph#)-静脉血: 0.110E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；球蛋白(GLO)-静脉血: 25.03g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 36.2U/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.839；甘油三酯(TG)-静脉血: 1.02mmol/L；间接胆红素(IBIL)-静脉血: 8.5umolL；丙氨酸氨基转移酶(ALT)-静脉血: 16.3U/L；血小板计数(PLT#)-静脉血: 266.210E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.27mmol/L；平均血小板体积(MPV)-静脉血: 5.77fL；胱抑素(Cys-C)-静脉血: 0.73mg/L；尿素氮(BUN)-静脉血: 5mmol/L；血小板分布宽度(PDW)-静脉……\n\n【既往治疗与反应】\n- [全程D54] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者放疗16次，口腔黏膜反应2度，放射性皮炎1度，患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：KPS 90分；张口门齿距4.5cm，鼻咽顶后壁、右侧壁肿物，较前缩小；右颈II区扪及一肿大淋巴结，大小约1X1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。颅神经检查：阴性。今日[姓名已隐去]副医生信息已隐藏后示：今日开始行第2程同时期DDP方案（DDP100mg/m2）化疗，继续放疗，续观。\n- [全程D64] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者放疗22次，口腔黏膜反应2度，放射性皮炎1度，患者诉喉痛，余未诉特殊不适。生命体征平稳。查体：KPS 90分；张口门齿距4.5cm，鼻咽顶后壁、右侧壁肿物，较前缩小；双颈未触及肿大淋巴结；颅神经检查：阴性。今日[姓名已隐去]副医生信息已隐藏后示：患者诉喉痛，予患者奥施康定止痛，继续放疗，续观。\n- [全程D69] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者放疗26次，口腔黏膜反应3度，放射性皮炎2度，患者诉喉痛，余未诉特殊不适。生命体征平稳。查体：KPS 90分；张口门齿距4.5cm，鼻咽肿物已不明显；双颈未触及肿大淋巴结；颅神经检查：阴性。今日[姓名已隐去]医生信息已隐藏后示：患者诉喉痛，继续予患者奥施康定止痛，继续放疗，续观。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 提前终止放疗，转为单纯全身化疗或靶向治疗，并给予静脉营养支持。\nB. 继续完成原计划的根治性放疗，给予阿片类药物镇痛及静脉补液与营养支持治疗。\nC. 暂停放疗直至口腔黏膜反应降至1度，期间给予广谱抗生素及静脉糖皮质激素治疗。\nD. 继续放疗，重新定位并缩减放疗靶区及处方剂量，同时给予非甾体类抗炎药镇痛。\nE. 暂停放疗，更改全身治疗方案为TPF方案化疗，待局部症状好转后择期恢复放疗。\nF. 继续完成根治性放疗，给予局部利多卡因含漱液及非甾体类抗炎药镇痛，并仅口服营养支持，无需静脉补液。\nG. 终止放疗，行右侧颈部淋巴结清扫术及鼻咽原发灶挽救性切除术。\nH. 继续放疗并同步行第3程大剂量顺铂化疗，给予阿片类药物镇痛，暂不予静脉补液。\nI. 暂停放疗，行鼻咽部内镜下微创手术切除残留病灶，术后继续静脉补液支持。\nJ. 继续完成根治性放疗，行经皮内镜下胃造瘘术（PEG）以建立长期肠内营养途径。\nK. 提前终止放疗，改为PD-1抑制剂联合化疗的全身系统性维持治疗。\nL. 继续放疗，给予大剂量静脉糖皮质激素冲击治疗缓解黏膜反应，并继续口服营养液。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D49] 检验组合: 丙氨酸氨基转移酶(ALT)-静脉血: 18.4U/L；球蛋白(GLO)-静脉血: 27.24g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；γ-谷氨酰基转移酶(GGT)-静脉血: 42U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 16.9U/L；平均红细胞体积(MCV)-静脉血: 90.3fL；血小板比容-静脉血: 11.8%；血小板分布宽度(PDW)-静脉血: 16.8%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；钠离子(Na+)-静脉血: 138mmol/L；平均血小板体积(MPV)-静脉血: 6.76fL；总胆汁酸(TBA)-静脉血: 2.9umol/L；载脂蛋白B(apoB)-静脉血: 1.36g/L；总钙(Ca)-静脉血: 2.22mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.16g/L；红细胞计数(RBC#)-静脉血: 4.3410E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.019；血红蛋白(Hb)-静脉血: 133.6g/L；阴离子间隙(AG)-静脉血: 15.6；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；C-反应蛋白(CRP)-静脉血: 10.3mg/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.6mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.17；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.87mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9%；淀粉样蛋白A(SAA)-静脉血: 24.6mg/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.7pg；甘油三酯(TG)-静脉血: 2.36mmol/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；总蛋白(TP)-静脉血: 71.04g/L；碱性磷酸酶(ALP)-静脉血: 108.1U/L；总胆固醇(TC)-静脉血: 5.6mmol/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.104；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.92；平均红细胞血红蛋白浓度(MCHC)-静脉血: 340.7g/……\n- [全程D55] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位置位于第3胸椎体右下缘，估计位于右侧头臂静脉内。；检查结论: PICC管末端位置如上所述。\n- [全程D55] 检验组合: 葡萄糖(Glu)-尿液: +- 2.8mmol（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: 1+ 0.3g（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 3/μL；白细胞计数(WBC#)-尿液: 20/μL；酸碱度(pH)-尿液: 5.5；颜色-尿液: Yellow；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: +- 0.1g（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；比重(SG)-尿液: 1.021；红细胞计数(RBC#)-尿液: 2/μL；红细胞计数(RBC#)-尿液: 2/μL；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.025；浊度(TRUB)-尿液: 清亮；粘液丝计数(MUCS#)-尿液: 80/μL；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；葡萄糖(Glu)-尿液: 3+ 17mmol（参考: 阴性）；白细胞计数(WBC#)-尿液: 4/μL\n- [全程D63] 检验组合: 红细胞计数(RBC#)-静脉血: 3.910E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞计数(Neut#)-静脉血: 5.210E9/L；阴离子间隙(AG)-静脉血: 16.2；尿酸(UA)-静脉血: 364.7umol/L；钠离子(Na+)-静脉血: 132.6mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；球蛋白(GLO)-静脉血: 26.68g/L；单核细胞计数(Mono#)-静脉血: 1.110E9/L；葡萄糖(Glu)-静脉血: 4.06mmol/L；单核细胞百分比(Mono%)-静脉血: 0.166；平均血小板体积(MPV)-静脉血: 8.1fL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；尿素氮(BUN)-静脉血: 7.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 20.7U/L；白细胞计数(WBC#)-静脉血: 6.6710E9/L；甘油三酯(TG)-静脉血: 1.04mmol/L；氯离子(Cl-)-静脉血: 93.2mmol/L；磷(P)-静脉血: 1.24mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.2mmol/L；平均红细胞体积(MCV)-静脉血: 89.2fL；总胆汁酸(TBA)-静脉血: 0.9umol/L；载脂蛋白B(apoB)-静脉血: 1.28g/L；总钙(Ca)-静脉血: 2.2mmol/L；镁离子(Mg2+)-静脉血: 1.01mmol/L；红细胞比容(Hct)-静脉血: 34.8%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；乳酸脱氢酶(LDH)-静脉血: 151.8U/L；间接胆红素(IBIL)-静脉血: 9umolL；载脂蛋白AI(apoAI)-静脉血: 0.91g/L；总胆红素(TBIL)-静脉血: 12.8umol/L；大血小板百分比(P-LCR%)-静脉血: 9.3%；中性粒细胞百分比(Neut%)-静脉血: 0.782；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；血小板分布宽度(PDW)-静脉血: 8%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.1；碱性磷酸酶(ALP)-静脉血: 113.9U/L；平均红……\n- [全程D69] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌治疗后，与某次就诊时间0日片对比: 鼻咽腔未见明显狭窄，鼻咽顶后壁、右侧壁轻度增厚，见少许软组织影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，右侧咽隐窝消失。鼻咽左侧壁未见明显增厚，左侧咽隐窝稍浅。右侧咽旁脂肪间隙稍变窄，左侧咽旁脂肪间隙未见异常。 右侧腭帆提张肌信号不均匀，左侧腭帆提张肌、双侧头长肌未见受侵征象。 双侧翼腭窝、上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 口咽双侧壁未见受累增厚，病变未累及双侧后鼻孔。 右侧翼突内份及内板、蝶骨基底部右份骨质信号减低，增强扫描轻度强化，范围较前缩小。余颅底未见明确骨质破坏征象。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦、右侧乳突粘膜增厚，双侧上颌窦见少量分泌物，蝶窦、左侧乳突充气良好，骨壁完整。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 右侧咽后淋巴结短径约6mm，较前缩小。左侧咽后未见肿大淋巴结。 右颈IIb区见稍大淋巴结，较大者短径约7mm，增强扫描明显强化，较前缩小。双颈IIa区见数个小淋巴结，较大者短径约5mm，增强扫描轻度强化，大致同前。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 扫描所见脑实质未见明显异常。；检查结论: 鼻咽癌治疗后，与某次就诊时间0日片对比: 鼻咽病变较前缩小。 颅底骨质破坏，较前有修复。 右侧咽后肿大淋巴结，考虑转移，较前缩小。 右颈IIb区淋巴结肿大，考虑转移，较前缩小。 双颈IIa区小淋巴结。 副鼻窦炎，右侧乳突炎。\n- [全程D69] 检验组合: 直接胆红素(DBIL)-静脉血: 3.2umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.033；阴离子间隙(AG)-静脉血: 16.9；白细胞计数(WBC#)-静脉血: 3.510E9/L；总胆红素(TBIL)-静脉血: 11.7umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 24.1U/L；尿酸(UA)-静脉血: 468.3umol/L；白蛋白(ALB)-静脉血: 39.4g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.016；红细胞比容(Hct)-静脉血: 33.6%；磷(P)-静脉血: 1.09mmol/L；C-反应蛋白(CRP)-静脉血: 20.73mg/L；载脂蛋白B(apoB)-静脉血: 1.37g/L；葡萄糖(Glu)-静脉血: 4.3mmol/L；单核细胞百分比(Mono%)-静脉血: 0.112；血小板比容-静脉血: 15.3%；肌酐(Crea)-静脉血: 62.2umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4%；碱性磷酸酶(ALP)-静脉血: 92.8U/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.9mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.57；总蛋白(TP)-静脉血: 64.43g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.86；淋巴细胞计数(Lymph#)-静脉血: 0.110E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；球蛋白(GLO)-静脉血: 25.03g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 36.2U/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.839；甘油三酯(TG)-静脉血: 1.02mmol/L；间接胆红素(IBIL)-静脉血: 8.5umolL；丙氨酸氨基转移酶(ALT)-静脉血: 16.3U/L；血小板计数(PLT#)-静脉血: 266.210E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.27mmol/L；平均血小板体积(MPV)-静脉血: 5.77fL；胱抑素(Cys-C)-静脉血: 0.73mg/L；尿素氮(BUN)-静脉血: 5mmol/L；血小板分布宽度(PDW)-静脉……\n\n【既往治疗与反应】\n- [全程D54] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者放疗16次，口腔黏膜反应2度，放射性皮炎1度，患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：KPS 90分；张口门齿距4.5cm，鼻咽顶后壁、右侧壁肿物，较前缩小；右颈II区扪及一肿大淋巴结，大小约1X1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。颅神经检查：阴性。今日[姓名已隐去]副医生信息已隐藏后示：今日开始行第2程同时期DDP方案（DDP100mg/m2）化疗，继续放疗，续观。\n- [全程D64] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者放疗22次，口腔黏膜反应2度，放射性皮炎1度，患者诉喉痛，余未诉特殊不适。生命体征平稳。查体：KPS 90分；张口门齿距4.5cm，鼻咽顶后壁、右侧壁肿物，较前缩小；双颈未触及肿大淋巴结；颅神经检查：阴性。今日[姓名已隐去]副医生信息已隐藏后示：患者诉喉痛，予患者奥施康定止痛，继续放疗，续观。\n- [全程D69] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者放疗26次，口腔黏膜反应3度，放射性皮炎2度，患者诉喉痛，余未诉特殊不适。生命体征平稳。查体：KPS 90分；张口门齿距4.5cm，鼻咽肿物已不明显；双颈未触及肿大淋巴结；颅神经检查：阴性。今日[姓名已隐去]医生信息已隐藏后示：患者诉喉痛，继续予患者奥施康定止痛，继续放疗，续观。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 提前终止放疗，转为单纯全身化疗或靶向治疗，并给予静脉营养支持。\nB. 继续完成原计划的根治性放疗，给予阿片类药物镇痛及静脉补液与营养支持治疗。\nC. 暂停放疗直至口腔黏膜反应降至1度，期间给予广谱抗生素及静脉糖皮质激素治疗。\nD. 继续放疗，重新定位并缩减放疗靶区及处方剂量，同时给予非甾体类抗炎药镇痛。\nE. 暂停放疗，更改全身治疗方案为TPF方案化疗，待局部症状好转后择期恢复放疗。\nF. 继续完成根治性放疗，给予局部利多卡因含漱液及非甾体类抗炎药镇痛，并仅口服营养支持，无需静脉补液。\nG. 终止放疗，行右侧颈部淋巴结清扫术及鼻咽原发灶挽救性切除术。\nH. 继续放疗并同步行第3程大剂量顺铂化疗，给予阿片类药物镇痛，暂不予静脉补液。\nI. 暂停放疗，行鼻咽部内镜下微创手术切除残留病灶，术后继续静脉补液支持。\nJ. 继续完成根治性放疗，行经皮内镜下胃造瘘术（PEG）以建立长期肠内营养途径。\nK. 提前终止放疗，改为PD-1抑制剂联合化疗的全身系统性维持治疗。\nL. 继续放疗，给予大剂量静脉糖皮质激素冲击治疗缓解黏膜反应，并继续口服营养液。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-5549469386bb20d944ce932b","patient_id":"patient-e7eec542502a097814d58d8a","turn_id":"turn08","turn_position":6,"turn_type":"response_assessment_decision","gold_letter":"C","gold_action":"影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；针对3度放射性口腔黏膜炎伴咽痛，继续予羟考酮镇痛及静脉营养支持，并常规行PICC导管护理。","options":[{"letter":"A","text":"影像学评估病灶较前缩小，疗效肯定，需暂停放疗，待3度放射性口腔黏膜炎恢复至1度后再恢复放疗，期间予静脉营养支持。","is_gold":false},{"letter":"B","text":"影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，局部使用含漱液及非甾体类抗炎药镇痛，停用阿片类药物。","is_gold":false},{"letter":"C","text":"影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎伴咽痛，继续予羟考酮镇痛及静脉营养支持，并常规行PICC导管护理。","is_gold":true},{"letter":"D","text":"影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，行预防性气管切开以防气道水肿梗阻，并予静脉营养支持。","is_gold":false},{"letter":"E","text":"影像学评估病灶较前缩小，疗效肯定，已完成26次放疗且出现3度黏膜炎，提前结束放疗并转为辅助化疗，同时予羟考酮镇痛。","is_gold":false},{"letter":"F","text":"影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，拔除PICC导管以预防导管相关性血流感染，改用外周静脉营养。","is_gold":false},{"letter":"G","text":"影像学评估病灶未见明显缩小，疗效评价为疾病稳定（SD），重新定位更改放疗靶区并提高局部照射剂量，同时予羟考酮镇痛及静脉营养支持。","is_gold":false},{"letter":"H","text":"影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，立即行经皮内镜下胃造瘘术（PEG）以保证肠内营养。","is_gold":false},{"letter":"I","text":"影像学评估病灶完全消失，疗效评价为完全缓解（CR），提前终止放疗，进入随访观察期，对咽痛继续予羟考酮镇痛。","is_gold":false},{"letter":"J","text":"影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；放疗已达26次且肿瘤退缩，同步加用西妥昔单抗以增强局部控制，并予静脉营养支持。","is_gold":false},{"letter":"K","text":"影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，静脉大剂量使用糖皮质激素以快速减轻炎症反应。","is_gold":false},{"letter":"L","text":"影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；出现3度放射性口腔黏膜炎，将后续放疗改为姑息性低剂量放疗，并予羟考酮镇痛。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D70] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质回声均匀，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉内径约11mm，门静脉最大血流速度约23cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约40×35×31mm，包膜光滑，实质回声不均匀，可见强回声斑。 腹主动脉旁未见明确肿物回声。；检查结论: 前列腺钙化。 肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 影像学评估病灶较前缩小，疗效肯定，需暂停放疗，待3度放射性口腔黏膜炎恢复至1度后再恢复放疗，期间予静脉营养支持。\nB. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，局部使用含漱液及非甾体类抗炎药镇痛，停用阿片类药物。\nC. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎伴咽痛，继续予羟考酮镇痛及静脉营养支持，并常规行PICC导管护理。\nD. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，行预防性气管切开以防气道水肿梗阻，并予静脉营养支持。\nE. 影像学评估病灶较前缩小，疗效肯定，已完成26次放疗且出现3度黏膜炎，提前结束放疗并转为辅助化疗，同时予羟考酮镇痛。\nF. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，拔除PICC导管以预防导管相关性血流感染，改用外周静脉营养。\nG. 影像学评估病灶未见明显缩小，疗效评价为疾病稳定（SD），重新定位更改放疗靶区并提高局部照射剂量，同时予羟考酮镇痛及静脉营养支持。\nH. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，立即行经皮内镜下胃造瘘术（PEG）以保证肠内营养。\nI. 影像学评估病灶完全消失，疗效评价为完全缓解（CR），提前终止放疗，进入随访观察期，对咽痛继续予羟考酮镇痛。\nJ. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；放疗已达26次且肿瘤退缩，同步加用西妥昔单抗以增强局部控制，并予静脉营养支持。\nK. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，静脉大剂量使用糖皮质激素以快速减轻炎症反应。\nL. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；出现3度放射性口腔黏膜炎，将后续放疗改为姑息性低剂量放疗，并予羟考酮镇痛。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D70] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质回声均匀，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉内径约11mm，门静脉最大血流速度约23cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约40×35×31mm，包膜光滑，实质回声不均匀，可见强回声斑。 腹主动脉旁未见明确肿物回声。；检查结论: 前列腺钙化。 肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 影像学评估病灶较前缩小，疗效肯定，需暂停放疗，待3度放射性口腔黏膜炎恢复至1度后再恢复放疗，期间予静脉营养支持。\nB. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，局部使用含漱液及非甾体类抗炎药镇痛，停用阿片类药物。\nC. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎伴咽痛，继续予羟考酮镇痛及静脉营养支持，并常规行PICC导管护理。\nD. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，行预防性气管切开以防气道水肿梗阻，并予静脉营养支持。\nE. 影像学评估病灶较前缩小，疗效肯定，已完成26次放疗且出现3度黏膜炎，提前结束放疗并转为辅助化疗，同时予羟考酮镇痛。\nF. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，拔除PICC导管以预防导管相关性血流感染，改用外周静脉营养。\nG. 影像学评估病灶未见明显缩小，疗效评价为疾病稳定（SD），重新定位更改放疗靶区并提高局部照射剂量，同时予羟考酮镇痛及静脉营养支持。\nH. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，立即行经皮内镜下胃造瘘术（PEG）以保证肠内营养。\nI. 影像学评估病灶完全消失，疗效评价为完全缓解（CR），提前终止放疗，进入随访观察期，对咽痛继续予羟考酮镇痛。\nJ. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；放疗已达26次且肿瘤退缩，同步加用西妥昔单抗以增强局部控制，并予静脉营养支持。\nK. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，静脉大剂量使用糖皮质激素以快速减轻炎症反应。\nL. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；出现3度放射性口腔黏膜炎，将后续放疗改为姑息性低剂量放疗，并予羟考酮镇痛。\n\n请仅输出一个选项字母（A-L）。"}]}
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full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、鼻腔、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现右颈部肿块伴耳鸣、听力下降4个月。；现病史: 缘于4个月前患者无意中发现右颈部包块，如拇指大小，无压痛，伴耳鸣、听力下降，颈部包块后逐渐增大，近1周偶发头痛，白天明显，视物如常，无鼻塞、鼻血、面麻、等不适。为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,鼻咽肿物,右颈部包块,头痛；既往史: 4年前患痔疮，已治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:青霉素皮试阳性。；个人史: 长期居于原籍，无疫区居住史。吸烟3-4支/天*10年，饮酒1-2次/月。否认不洁性生活史。；家族史: 舅舅患鼻咽癌，舅妈患肺癌。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：103/73mmHg,Ht：174cm，Wt：79kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；右颈IIa区可扪及1个淋巴结，最大径2.5×2.5cm，左颈IIa区扪及1个淋巴结，最大径约3*3cm，无融合，质地韧，边界模糊，活动度好，无压痛，无皮肤浸润，无溃疡，右颈III区可见一长约4cm手术疤痕；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 电子鼻咽镜及鼻咽活检，鼻咽及颈部CT平扫+增强，胸部X线片，腹部彩超，基线血液学检查。\nB. 颈部淋巴结细针穿刺活检，鼻咽及颈部MRI平扫+增强，胸腹部CT平扫+增强，全身骨扫描。\nC. 全身PET-CT检查，电子鼻咽镜及鼻咽活检，头颅MRI平扫+增强，常规心电图及血液学检查。\nD. 电子鼻咽镜及鼻咽活检，鼻咽及颈部MRI平扫+增强，腹部及浅表淋巴结彩超，心电图，包含EBV抗体的基线血液学检查。\nE. 电子鼻咽镜检查，鼻咽及颈部MRI平扫+增强，胸腹部CT平扫+增强，待影像学评估后再决定是否活检。\nF. 鼻咽及颈部MRI平扫+增强，胸腹部CT平扫+增强，全身骨扫描，基线血液学检查。\nG. 电子鼻咽镜及鼻咽活检，鼻咽及颈部MRI平扫，腹部彩超，胸部CT平扫，基线血液学检查。\nH. 颈部淋巴结切除活检，鼻咽及颈部CT平扫+增强，腹部彩超，心电图，包含EBV抗体的基线血液学检查。\nI. 电子鼻咽镜及鼻咽活检，头颈部PET-CT，腹部及盆腔MRI平扫+增强，心电图，基线血液学检查。\nJ. 电子鼻咽镜及鼻咽活检，鼻咽及颈部MRI平扫+增强，常规心电图及血液学检查，并直接安排诱导化疗。\nK. 鼻咽刷片细胞学检查，鼻咽及颈部MRI平扫+增强，胸腹部彩超，全身骨扫描，基线血液学检查。\nL. 电子鼻咽镜及鼻咽活检，鼻咽及颈部CT平扫，全身骨扫描，腹部彩超，心电图，基线血液学检查。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、鼻腔、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现右颈部肿块伴耳鸣、听力下降4个月。；现病史: 缘于4个月前患者无意中发现右颈部包块，如拇指大小，无压痛，伴耳鸣、听力下降，颈部包块后逐渐增大，近1周偶发头痛，白天明显，视物如常，无鼻塞、鼻血、面麻、等不适。为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,鼻咽肿物,右颈部包块,头痛；既往史: 4年前患痔疮，已治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:青霉素皮试阳性。；个人史: 长期居于原籍，无疫区居住史。吸烟3-4支/天*10年，饮酒1-2次/月。否认不洁性生活史。；家族史: 舅舅患鼻咽癌，舅妈患肺癌。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：103/73mmHg,Ht：174cm，Wt：79kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；右颈IIa区可扪及1个淋巴结，最大径2.5×2.5cm，左颈IIa区扪及1个淋巴结，最大径约3*3cm，无融合，质地韧，边界模糊，活动度好，无压痛，无皮肤浸润，无溃疡，右颈III区可见一长约4cm手术疤痕；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 电子鼻咽镜及鼻咽活检，鼻咽及颈部CT平扫+增强，胸部X线片，腹部彩超，基线血液学检查。\nB. 颈部淋巴结细针穿刺活检，鼻咽及颈部MRI平扫+增强，胸腹部CT平扫+增强，全身骨扫描。\nC. 全身PET-CT检查，电子鼻咽镜及鼻咽活检，头颅MRI平扫+增强，常规心电图及血液学检查。\nD. 电子鼻咽镜及鼻咽活检，鼻咽及颈部MRI平扫+增强，腹部及浅表淋巴结彩超，心电图，包含EBV抗体的基线血液学检查。\nE. 电子鼻咽镜检查，鼻咽及颈部MRI平扫+增强，胸腹部CT平扫+增强，待影像学评估后再决定是否活检。\nF. 鼻咽及颈部MRI平扫+增强，胸腹部CT平扫+增强，全身骨扫描，基线血液学检查。\nG. 电子鼻咽镜及鼻咽活检，鼻咽及颈部MRI平扫，腹部彩超，胸部CT平扫，基线血液学检查。\nH. 颈部淋巴结切除活检，鼻咽及颈部CT平扫+增强，腹部彩超，心电图，包含EBV抗体的基线血液学检查。\nI. 电子鼻咽镜及鼻咽活检，头颈部PET-CT，腹部及盆腔MRI平扫+增强，心电图，基线血液学检查。\nJ. 电子鼻咽镜及鼻咽活检，鼻咽及颈部MRI平扫+增强，常规心电图及血液学检查，并直接安排诱导化疗。\nK. 鼻咽刷片细胞学检查，鼻咽及颈部MRI平扫+增强，胸腹部彩超，全身骨扫描，基线血液学检查。\nL. 电子鼻咽镜及鼻咽活检，鼻咽及颈部CT平扫，全身骨扫描，腹部彩超，心电图，基线血液学检查。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-cef4654d5f291c72b760bfcf","patient_id":"patient-f25e20b1e5c6eea840d4cc21","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"E","gold_action":"行鼻咽镜下活检明确病理，并补充胸部CT、全身骨扫描及血清EBV DNA检测。","options":[{"letter":"A","text":"安排适形调强放射治疗（IMRT）及同步化疗","is_gold":false},{"letter":"B","text":"行鼻咽镜下活检，并补充头颅PET-MR评估颅底受侵范围","is_gold":false},{"letter":"C","text":"行右颈部淋巴结细针穿刺活检，并补充胸部CT及全身骨扫描","is_gold":false},{"letter":"D","text":"行鼻咽镜下活检，并补充腹部增强CT排查肝脏转移","is_gold":false},{"letter":"E","text":"行鼻咽镜下活检，并补充胸部CT、全身骨扫描及血清EBV DNA检测","is_gold":true},{"letter":"F","text":"行鼻咽镜下活检，直接进行放疗定位及靶区勾画","is_gold":false},{"letter":"G","text":"行全身PET-CT进行分期，随后开始诱导化疗","is_gold":false},{"letter":"H","text":"行鼻咽镜下活检，并补充颈部超声评估淋巴结包膜外侵犯","is_gold":false},{"letter":"I","text":"行鼻咽镜下活检，并补充胸部X线及头颅CT平扫","is_gold":false},{"letter":"J","text":"行鼻咽镜下活检，并补充骨髓穿刺排除骨髓转移","is_gold":false},{"letter":"K","text":"行鼻咽镜下活检，并补充全身骨扫描，暂缓胸部影像学检查","is_gold":false},{"letter":"L","text":"行右颈部淋巴结切除活检，并补充胸部CT及血清EBV DNA检测","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、鼻腔、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 电轴左偏(轻度) 正常范围心电图\n- [全程D1] 检验组合: 血小板比容-静脉血: 19%；载脂蛋白B(apoB)-静脉血: 1.03g/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；肌酐(Crea)-静脉血: 66.2umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.1；球蛋白(GLO)-静脉血: 31.61g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.011；尿胆原(URO)-尿液: -（参考: 阴性）；红细胞比容(Hct)-静脉血: 48.9%；凝血酶原时间活动度(PTA)-静脉血: 111.2%；隐血(OB)-粪便: 阴性（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.91mg/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；碱性磷酸酶(ALP)-静脉血: 76.3U/L；载脂蛋白AI(apoAI)-静脉血: 1.04g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；葡萄糖(Glu)-静脉血: 4.96mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.5；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；血小板分布宽度(PDW)-静脉血: 13.9%；淋巴细胞百分比(Lymph%)-静脉血: 0.315；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；总胆红素(TBIL)-静脉血: 7umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.910E9/L；Rh血型-静脉血: 阳性；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.2sec.；酮体(KET)-尿液: -（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 21.9mmol/L；浊度(TRUB)-尿液: 清亮；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 4.88mmol/L；C-反应蛋白(C……\n- [全程D3] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D7] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及双侧壁增厚，以右侧为著，T1WI呈等信号，T2WI呈稍高信号，增强扫描强化明显，右侧咽隐窝消失，见增厚组织占据，左侧咽隐窝变浅。病变与右侧中鼻甲分界不清，口咽双侧壁未见增厚。 右侧咽旁间隙及右侧咽后间隙见不规则肿物突入。双侧腭帆提肌、右侧腭帆张肌、右侧头长肌受侵。左侧腭帆张肌、双侧翼内肌及双侧翼外肌未见受侵。 右侧翼腭窝内见少许软组织信号，增强扫描明显强化。 左侧翼腭窝、双侧上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 斜坡、蝶骨基底部、右侧翼突基底部及内外板、右侧蝶骨大翼及右侧岩尖骨质信号减低，增强扫描见不均匀强化。 右侧破裂扩大，右侧海绵窦增宽，内见不规则软组织信号灶，右侧蝶窦内见软组织信号灶突入，增强扫描上述病变强化明显。 左侧海绵窦未见增宽。蝶鞍形态正常，其内未见占位性病变。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧上颌窦、筛窦及蝶窦粘膜增厚。右侧乳突内见大量分泌物。 右侧咽后见肿大淋巴结，大者约12mm×17mm，增强扫描强化明显。双颈II、III、V区见多个肿大淋巴结，最大者约23mm×29mm，部分边界欠清晰，包膜不完整，信号欠均匀，增强扫描明显不均匀强化。双侧腮腺内及腮腺旁见数个淋巴结，大者短径约6mm，增强扫描强化明显。双颈I区见数个淋巴结，大者短径约7mm，信号尚均匀。 甲状腺双叶及峡部、喉咽、双侧颌下腺信号均匀，未见占位性病变。；检查结论: 鼻咽病变，考虑鼻咽癌，侵犯范围如上述。 颅底骨质破坏。 右侧咽后、双颈II、III、V区多发肿大淋巴结，考虑转移。 双侧腮腺内及腮腺旁数个淋巴结，性质待定。 鼻窦炎、右侧乳突炎。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 安排适形调强放射治疗（IMRT）及同步化疗\nB. 行鼻咽镜下活检，并补充头颅PET-MR评估颅底受侵范围\nC. 行右颈部淋巴结细针穿刺活检，并补充胸部CT及全身骨扫描\nD. 行鼻咽镜下活检，并补充腹部增强CT排查肝脏转移\nE. 行鼻咽镜下活检，并补充胸部CT、全身骨扫描及血清EBV DNA检测\nF. 行鼻咽镜下活检，直接进行放疗定位及靶区勾画\nG. 行全身PET-CT进行分期，随后开始诱导化疗\nH. 行鼻咽镜下活检，并补充颈部超声评估淋巴结包膜外侵犯\nI. 行鼻咽镜下活检，并补充胸部X线及头颅CT平扫\nJ. 行鼻咽镜下活检，并补充骨髓穿刺排除骨髓转移\nK. 行鼻咽镜下活检，并补充全身骨扫描，暂缓胸部影像学检查\nL. 行右颈部淋巴结切除活检，并补充胸部CT及血清EBV DNA检测\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、鼻腔、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 电轴左偏(轻度) 正常范围心电图\n- [全程D1] 检验组合: 血小板比容-静脉血: 19%；载脂蛋白B(apoB)-静脉血: 1.03g/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；肌酐(Crea)-静脉血: 66.2umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.1；球蛋白(GLO)-静脉血: 31.61g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.011；尿胆原(URO)-尿液: -（参考: 阴性）；红细胞比容(Hct)-静脉血: 48.9%；凝血酶原时间活动度(PTA)-静脉血: 111.2%；隐血(OB)-粪便: 阴性（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.91mg/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；碱性磷酸酶(ALP)-静脉血: 76.3U/L；载脂蛋白AI(apoAI)-静脉血: 1.04g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；葡萄糖(Glu)-静脉血: 4.96mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.5；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；血小板分布宽度(PDW)-静脉血: 13.9%；淋巴细胞百分比(Lymph%)-静脉血: 0.315；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；总胆红素(TBIL)-静脉血: 7umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.910E9/L；Rh血型-静脉血: 阳性；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.2sec.；酮体(KET)-尿液: -（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 21.9mmol/L；浊度(TRUB)-尿液: 清亮；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 4.88mmol/L；C-反应蛋白(C……\n- [全程D3] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D7] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及双侧壁增厚，以右侧为著，T1WI呈等信号，T2WI呈稍高信号，增强扫描强化明显，右侧咽隐窝消失，见增厚组织占据，左侧咽隐窝变浅。病变与右侧中鼻甲分界不清，口咽双侧壁未见增厚。 右侧咽旁间隙及右侧咽后间隙见不规则肿物突入。双侧腭帆提肌、右侧腭帆张肌、右侧头长肌受侵。左侧腭帆张肌、双侧翼内肌及双侧翼外肌未见受侵。 右侧翼腭窝内见少许软组织信号，增强扫描明显强化。 左侧翼腭窝、双侧上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 斜坡、蝶骨基底部、右侧翼突基底部及内外板、右侧蝶骨大翼及右侧岩尖骨质信号减低，增强扫描见不均匀强化。 右侧破裂扩大，右侧海绵窦增宽，内见不规则软组织信号灶，右侧蝶窦内见软组织信号灶突入，增强扫描上述病变强化明显。 左侧海绵窦未见增宽。蝶鞍形态正常，其内未见占位性病变。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧上颌窦、筛窦及蝶窦粘膜增厚。右侧乳突内见大量分泌物。 右侧咽后见肿大淋巴结，大者约12mm×17mm，增强扫描强化明显。双颈II、III、V区见多个肿大淋巴结，最大者约23mm×29mm，部分边界欠清晰，包膜不完整，信号欠均匀，增强扫描明显不均匀强化。双侧腮腺内及腮腺旁见数个淋巴结，大者短径约6mm，增强扫描强化明显。双颈I区见数个淋巴结，大者短径约7mm，信号尚均匀。 甲状腺双叶及峡部、喉咽、双侧颌下腺信号均匀，未见占位性病变。；检查结论: 鼻咽病变，考虑鼻咽癌，侵犯范围如上述。 颅底骨质破坏。 右侧咽后、双颈II、III、V区多发肿大淋巴结，考虑转移。 双侧腮腺内及腮腺旁数个淋巴结，性质待定。 鼻窦炎、右侧乳突炎。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 安排适形调强放射治疗（IMRT）及同步化疗\nB. 行鼻咽镜下活检，并补充头颅PET-MR评估颅底受侵范围\nC. 行右颈部淋巴结细针穿刺活检，并补充胸部CT及全身骨扫描\nD. 行鼻咽镜下活检，并补充腹部增强CT排查肝脏转移\nE. 行鼻咽镜下活检，并补充胸部CT、全身骨扫描及血清EBV DNA检测\nF. 行鼻咽镜下活检，直接进行放疗定位及靶区勾画\nG. 行全身PET-CT进行分期，随后开始诱导化疗\nH. 行鼻咽镜下活检，并补充颈部超声评估淋巴结包膜外侵犯\nI. 行鼻咽镜下活检，并补充胸部X线及头颅CT平扫\nJ. 行鼻咽镜下活检，并补充骨髓穿刺排除骨髓转移\nK. 行鼻咽镜下活检，并补充全身骨扫描，暂缓胸部影像学检查\nL. 行右颈部淋巴结切除活检，并补充胸部CT及血清EBV DNA检测\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-5ae78b6dca4ce8a61a44d0ca","patient_id":"patient-f25e20b1e5c6eea840d4cc21","turn_id":"turn04","turn_position":3,"turn_type":"initial_treatment_selection","gold_letter":"G","gold_action":"诱导化疗序贯同步放化疗","options":[{"letter":"A","text":"单纯根治性放疗","is_gold":false},{"letter":"B","text":"诱导化疗序贯单纯根治性放疗","is_gold":false},{"letter":"C","text":"同步放化疗序贯辅助化疗","is_gold":false},{"letter":"D","text":"根治性颈淋巴结清扫术序贯辅助放化疗","is_gold":false},{"letter":"E","text":"姑息性全身化疗联合靶向治疗","is_gold":false},{"letter":"F","text":"诱导化疗序贯根治性手术","is_gold":false},{"letter":"G","text":"诱导化疗序贯同步放化疗","is_gold":true},{"letter":"H","text":"免疫治疗联合同步放化疗","is_gold":false},{"letter":"I","text":"靶向治疗联合同步放化疗","is_gold":false},{"letter":"J","text":"诱导化疗序贯同步放化疗联合辅助化疗","is_gold":false},{"letter":"K","text":"根治性放疗序贯辅助化疗","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、鼻腔、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现右颈部肿块伴耳鸣、听力下降4个月。；现病史: 缘于4个月前患者无意中发现右颈部包块，如拇指大小，无压痛，伴耳鸣、听力下降，颈部包块后逐渐增大，近1周偶发头痛，白天明显，视物如常，无鼻塞、鼻血、面麻、等不适。就诊[机构已隐去]，行右颈部淋巴结活检术，病理示转移性低分化鳞癌，行电子鼻咽镜检查见鼻咽肿物，取活检病理示可疑癌。为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,鼻咽肿物,右颈部包块,头痛；既往史: 4年前患痔疮，已治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:青霉素皮试阳性。；个人史: 长期居于原籍，无疫区居住史。吸烟3-4支/天*10年，饮酒1-2次/月。否认不洁性生活史。；家族史: 舅舅患鼻咽癌，舅妈患肺癌。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：103/73mmHg,Ht：174cm，Wt：79kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；右颈IIa区可扪及1个淋巴结，最大径2.5×2.5cm，左颈IIa区扪及1个淋巴结，最大径约3*3cm，无融合，质地韧，边界模糊，活动度好，无压痛，无皮肤浸润，无溃疡，右颈III区可见一长约4cm手术疤痕；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 单纯根治性放疗\nB. 诱导化疗序贯单纯根治性放疗\nC. 同步放化疗序贯辅助化疗\nD. 根治性颈淋巴结清扫术序贯辅助放化疗\nE. 姑息性全身化疗联合靶向治疗\nF. 诱导化疗序贯根治性手术\nG. 诱导化疗序贯同步放化疗\nH. 免疫治疗联合同步放化疗\nI. 靶向治疗联合同步放化疗\nJ. 诱导化疗序贯同步放化疗联合辅助化疗\nK. 根治性放疗序贯辅助化疗\n\n请仅输出一个选项字母（A-K）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、鼻腔、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现右颈部肿块伴耳鸣、听力下降4个月。；现病史: 缘于4个月前患者无意中发现右颈部包块，如拇指大小，无压痛，伴耳鸣、听力下降，颈部包块后逐渐增大，近1周偶发头痛，白天明显，视物如常，无鼻塞、鼻血、面麻、等不适。就诊[机构已隐去]，行右颈部淋巴结活检术，病理示转移性低分化鳞癌，行电子鼻咽镜检查见鼻咽肿物，取活检病理示可疑癌。为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,鼻咽肿物,右颈部包块,头痛；既往史: 4年前患痔疮，已治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:青霉素皮试阳性。；个人史: 长期居于原籍，无疫区居住史。吸烟3-4支/天*10年，饮酒1-2次/月。否认不洁性生活史。；家族史: 舅舅患鼻咽癌，舅妈患肺癌。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：103/73mmHg,Ht：174cm，Wt：79kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；右颈IIa区可扪及1个淋巴结，最大径2.5×2.5cm，左颈IIa区扪及1个淋巴结，最大径约3*3cm，无融合，质地韧，边界模糊，活动度好，无压痛，无皮肤浸润，无溃疡，右颈III区可见一长约4cm手术疤痕；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 单纯根治性放疗\nB. 诱导化疗序贯单纯根治性放疗\nC. 同步放化疗序贯辅助化疗\nD. 根治性颈淋巴结清扫术序贯辅助放化疗\nE. 姑息性全身化疗联合靶向治疗\nF. 诱导化疗序贯根治性手术\nG. 诱导化疗序贯同步放化疗\nH. 免疫治疗联合同步放化疗\nI. 靶向治疗联合同步放化疗\nJ. 诱导化疗序贯同步放化疗联合辅助化疗\nK. 根治性放疗序贯辅助化疗\n\n请仅输出一个选项字母（A-K）。"}]}
+{"sample_id":"sample-a4cf25bef13a63de3e012971","patient_id":"patient-f25e20b1e5c6eea840d4cc21","turn_id":"turn05","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"H","gold_action":"完善放化疗前基线检验（血常规、生化、凝血、传染病、EBV等），全面评估器官功能。","options":[{"letter":"A","text":"完善放化疗前基线检验，若肌酐清除率>30ml/min即可启动大剂量顺铂同步化疗。","is_gold":false},{"letter":"B","text":"完善放化疗前基线检验，并预防性给予质子泵抑制剂和双环醇保肝治疗。","is_gold":false},{"letter":"C","text":"完善放化疗前基线检验，若中性粒细胞绝对值>1.0×10^9/L即可启动全身化疗。","is_gold":false},{"letter":"D","text":"完善放化疗前基线检验，并预防性给予长效重组人粒细胞集落刺激因子。","is_gold":false},{"letter":"E","text":"完善放化疗前基线检验，仅需心电图和血常规正常即可启动诱导化疗。","is_gold":false},{"letter":"F","text":"完善放化疗前基线检验，并常规预防性使用头孢类抗生素以防中耳炎加重。","is_gold":false},{"letter":"G","text":"完善放化疗前基线检验，若转氨酶升高超过正常上限1倍则直接放弃化疗。","is_gold":false},{"letter":"H","text":"完善放化疗前基线检验（血常规、生化、凝血、传染病、EBV等），全面评估器官功能。","is_gold":true},{"letter":"I","text":"完善放化疗前基线检验，并预防性给予地塞米松以减轻放疗引起的脑水肿。","is_gold":false},{"letter":"J","text":"完善放化疗前基线检验，若伴有右侧中耳乳突炎则需先完成乳突根治术再行放疗。","is_gold":false},{"letter":"K","text":"完善放化疗前基线检验，并常规行深静脉置管及低分子肝素预防性抗凝治疗。","is_gold":false},{"letter":"L","text":"完善放化疗前基线检验，若存在感音神经性听力下降则绝对禁忌使用任何含铂方案。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、鼻腔、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- 无可展示记录。\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。仍有听力下降，请[姓名已隐去]医生信息已隐藏出：根据患者外院鼻咽部检查提示鼻咽部病灶侵犯右侧海绵窦，颅底骨质等，分为分期信息见历史辅助诊断节点，双侧颈部淋巴结肿大，最大径＜6cm，分为分期信息见历史辅助诊断节点，未见远处转移，分为[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点，[计划性表述已隐藏]放疗及同步增敏化疗控制病情，目前行放疗前准备。.\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善放化疗前基线检验，若肌酐清除率>30ml/min即可启动大剂量顺铂同步化疗。\nB. 完善放化疗前基线检验，并预防性给予质子泵抑制剂和双环醇保肝治疗。\nC. 完善放化疗前基线检验，若中性粒细胞绝对值>1.0×10^9/L即可启动全身化疗。\nD. 完善放化疗前基线检验，并预防性给予长效重组人粒细胞集落刺激因子。\nE. 完善放化疗前基线检验，仅需心电图和血常规正常即可启动诱导化疗。\nF. 完善放化疗前基线检验，并常规预防性使用头孢类抗生素以防中耳炎加重。\nG. 完善放化疗前基线检验，若转氨酶升高超过正常上限1倍则直接放弃化疗。\nH. 完善放化疗前基线检验（血常规、生化、凝血、传染病、EBV等），全面评估器官功能。\nI. 完善放化疗前基线检验，并预防性给予地塞米松以减轻放疗引起的脑水肿。\nJ. 完善放化疗前基线检验，若伴有右侧中耳乳突炎则需先完成乳突根治术再行放疗。\nK. 完善放化疗前基线检验，并常规行深静脉置管及低分子肝素预防性抗凝治疗。\nL. 完善放化疗前基线检验，若存在感音神经性听力下降则绝对禁忌使用任何含铂方案。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、鼻腔、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- 无可展示记录。\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。仍有听力下降，请[姓名已隐去]医生信息已隐藏出：根据患者外院鼻咽部检查提示鼻咽部病灶侵犯右侧海绵窦，颅底骨质等，分为分期信息见历史辅助诊断节点，双侧颈部淋巴结肿大，最大径＜6cm，分为分期信息见历史辅助诊断节点，未见远处转移，分为[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点，[计划性表述已隐藏]放疗及同步增敏化疗控制病情，目前行放疗前准备。.\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善放化疗前基线检验，若肌酐清除率>30ml/min即可启动大剂量顺铂同步化疗。\nB. 完善放化疗前基线检验，并预防性给予质子泵抑制剂和双环醇保肝治疗。\nC. 完善放化疗前基线检验，若中性粒细胞绝对值>1.0×10^9/L即可启动全身化疗。\nD. 完善放化疗前基线检验，并预防性给予长效重组人粒细胞集落刺激因子。\nE. 完善放化疗前基线检验，仅需心电图和血常规正常即可启动诱导化疗。\nF. 完善放化疗前基线检验，并常规预防性使用头孢类抗生素以防中耳炎加重。\nG. 完善放化疗前基线检验，若转氨酶升高超过正常上限1倍则直接放弃化疗。\nH. 完善放化疗前基线检验（血常规、生化、凝血、传染病、EBV等），全面评估器官功能。\nI. 完善放化疗前基线检验，并预防性给予地塞米松以减轻放疗引起的脑水肿。\nJ. 完善放化疗前基线检验，若伴有右侧中耳乳突炎则需先完成乳突根治术再行放疗。\nK. 完善放化疗前基线检验，并常规行深静脉置管及低分子肝素预防性抗凝治疗。\nL. 完善放化疗前基线检验，若存在感音神经性听力下降则绝对禁忌使用任何含铂方案。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-44b84e88a5f0beade51ae0ca","patient_id":"patient-f25e20b1e5c6eea840d4cc21","turn_id":"turn06","turn_position":5,"turn_type":"toxicity_or_support_decision","gold_letter":"I","gold_action":"按计划启动放疗，并为顺铂（100mg/㎡）同期化疗行充分的静脉水化、甘露醇利尿及电解质补充，同时给予放疗局部保护用药。","options":[{"letter":"A","text":"按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗当天给予常规静脉补液，无需特殊水化与利尿处理。","is_gold":false},{"letter":"B","text":"暂缓放化疗，先静脉补充硫酸镁及氯化钾纠正电解质异常，待复查正常后再启动顺铂同期化疗。","is_gold":false},{"letter":"C","text":"按计划启动放疗，将顺铂剂量调整为40mg/㎡周疗，化疗期间仅需常规止吐，无需使用甘露醇利尿。","is_gold":false},{"letter":"D","text":"按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗前给予呋塞米静脉推注利尿，并预防性注射G-CSF。","is_gold":false},{"letter":"E","text":"按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗期间采用口服补液替代静脉水化，并外用三乙醇胺乳膏。","is_gold":false},{"letter":"F","text":"暂缓顺铂化疗，先行单纯根治性放疗，待放疗剂量达到40Gy后再评估并启动顺铂同期化疗。","is_gold":false},{"letter":"G","text":"按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗前给予大剂量糖皮质激素及NK-1受体拮抗剂，免除静脉水化。","is_gold":false},{"letter":"H","text":"按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗当天给予等渗盐水静脉滴注，避免使用甘露醇。","is_gold":false},{"letter":"I","text":"按计划启动放疗，并为顺铂（100mg/㎡）同期化疗行充分的静脉水化、甘露醇利尿及电解质补充，同时给予放疗局部保护用药。","is_gold":true},{"letter":"J","text":"按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗后连续3天静脉输注人血白蛋白以预防低蛋白血症。","is_gold":false},{"letter":"K","text":"暂缓放疗，先给予顺铂联合氟尿嘧啶方案诱导化疗2个周期，期间常规给予静脉水化及止吐处理。","is_gold":false},{"letter":"L","text":"按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗期间常规预防性静脉滴注广谱抗菌药物。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、鼻腔、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D26] 检验组合: 镁离子(Mg2+)-静脉血: 0.88mmol/L；阴离子间隙(AG)-静脉血: 13.2；血小板比容-静脉血: 18%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；乳酸脱氢酶(LDH)-静脉血: 177.9U/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.7U/L；血小板分布宽度(PDW)-静脉血: 13.2%；钾离子(K+)-静脉血: 4.02mmol/L；白蛋白(ALB)-静脉血: 44.5g/L；直接胆红素(DBIL)-静脉血: 3.8umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.58mmol/L；大血小板百分比(P-LCR%)-静脉血: 28.9%；单核细胞计数(Mono#)-静脉血: 0.610E9/L；钠离子(Na+)-静脉血: 143.5mmol/L；总胆固醇(TC)-静脉血: 5.13mmol/L；总胆红素(TBIL)-静脉血: 11.7umol/L；甘油三酯(TG)-静脉血: 1.44mmol/L；红细胞比容(Hct)-静脉血: 48.1%；中性粒细胞计数(Neut#)-静脉血: 3.310E9/L；白细胞计数(WBC#)-静脉血: 6.2110E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.86；中性粒细胞百分比(Neut%)-静脉血: 0.528；总钙(Ca)-静脉血: 2.18mmol/L；总蛋白(TP)-静脉血: 76.63g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.38；α-L-岩藻糖苷酶(AFU)-静脉血: 35.5U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.97mmolL；淋巴细胞计数(Lymph#)-静脉血: 2.110E9/L；间接胆红素(IBIL)-静脉血: 7.9umolL；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；尿素氮(BUN)-静脉血: 4.1mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 333g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.9；单核细胞百分比(Mono%)-静脉血: 0.103；血液二氧化碳含量ctCO2(B)-静脉血: 26.……\n\n【既往治疗与反应】\n- [全程D14] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，继续行放化疗前准备，余无特殊。.\n- [全程D17] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，请[姓名已隐去]医生信息已隐藏出：患者目前无特殊，继续行放化疗前准备，继续观察病情。.\n- [全程D20] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，患者放疗计划准备完成，[计划性表述已隐藏]GTV70Gy/32f，GTVnd68Gy/32f，CTV1 60Gy/32f，CTV2 56Gy/32f。拟本周开始放疗，因患者分期晚，病变范围大，视神经、眼球、颞叶剂量较高，已与患者沟通不良反应，患者及时家属表示理解并同意治疗，继续观察病情。.\n- [全程D23] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，患者目前继续行放疗前准备，[姓名已隐去]医生信息已隐藏出：患者继续行放疗前准备，[计划性表述已隐藏]顺铂同期化疗，继续观察病情。.\n- [全程D26] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，患者目前无特殊，拟周一开始行放疗，周二行顺铂100mg/㎡同期化疗，继续行放化疗前准备，继续观察病情。.\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗当天给予常规静脉补液，无需特殊水化与利尿处理。\nB. 暂缓放化疗，先静脉补充硫酸镁及氯化钾纠正电解质异常，待复查正常后再启动顺铂同期化疗。\nC. 按计划启动放疗，将顺铂剂量调整为40mg/㎡周疗，化疗期间仅需常规止吐，无需使用甘露醇利尿。\nD. 按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗前给予呋塞米静脉推注利尿，并预防性注射G-CSF。\nE. 按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗期间采用口服补液替代静脉水化，并外用三乙醇胺乳膏。\nF. 暂缓顺铂化疗，先行单纯根治性放疗，待放疗剂量达到40Gy后再评估并启动顺铂同期化疗。\nG. 按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗前给予大剂量糖皮质激素及NK-1受体拮抗剂，免除静脉水化。\nH. 按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗当天给予等渗盐水静脉滴注，避免使用甘露醇。\nI. 按计划启动放疗，并为顺铂（100mg/㎡）同期化疗行充分的静脉水化、甘露醇利尿及电解质补充，同时给予放疗局部保护用药。\nJ. 按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗后连续3天静脉输注人血白蛋白以预防低蛋白血症。\nK. 暂缓放疗，先给予顺铂联合氟尿嘧啶方案诱导化疗2个周期，期间常规给予静脉水化及止吐处理。\nL. 按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗期间常规预防性静脉滴注广谱抗菌药物。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、鼻腔、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D26] 检验组合: 镁离子(Mg2+)-静脉血: 0.88mmol/L；阴离子间隙(AG)-静脉血: 13.2；血小板比容-静脉血: 18%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；乳酸脱氢酶(LDH)-静脉血: 177.9U/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.7U/L；血小板分布宽度(PDW)-静脉血: 13.2%；钾离子(K+)-静脉血: 4.02mmol/L；白蛋白(ALB)-静脉血: 44.5g/L；直接胆红素(DBIL)-静脉血: 3.8umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.58mmol/L；大血小板百分比(P-LCR%)-静脉血: 28.9%；单核细胞计数(Mono#)-静脉血: 0.610E9/L；钠离子(Na+)-静脉血: 143.5mmol/L；总胆固醇(TC)-静脉血: 5.13mmol/L；总胆红素(TBIL)-静脉血: 11.7umol/L；甘油三酯(TG)-静脉血: 1.44mmol/L；红细胞比容(Hct)-静脉血: 48.1%；中性粒细胞计数(Neut#)-静脉血: 3.310E9/L；白细胞计数(WBC#)-静脉血: 6.2110E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.86；中性粒细胞百分比(Neut%)-静脉血: 0.528；总钙(Ca)-静脉血: 2.18mmol/L；总蛋白(TP)-静脉血: 76.63g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.38；α-L-岩藻糖苷酶(AFU)-静脉血: 35.5U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.97mmolL；淋巴细胞计数(Lymph#)-静脉血: 2.110E9/L；间接胆红素(IBIL)-静脉血: 7.9umolL；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；尿素氮(BUN)-静脉血: 4.1mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 333g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.9；单核细胞百分比(Mono%)-静脉血: 0.103；血液二氧化碳含量ctCO2(B)-静脉血: 26.……\n\n【既往治疗与反应】\n- [全程D14] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，继续行放化疗前准备，余无特殊。.\n- [全程D17] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，请[姓名已隐去]医生信息已隐藏出：患者目前无特殊，继续行放化疗前准备，继续观察病情。.\n- [全程D20] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，患者放疗计划准备完成，[计划性表述已隐藏]GTV70Gy/32f，GTVnd68Gy/32f，CTV1 60Gy/32f，CTV2 56Gy/32f。拟本周开始放疗，因患者分期晚，病变范围大，视神经、眼球、颞叶剂量较高，已与患者沟通不良反应，患者及时家属表示理解并同意治疗，继续观察病情。.\n- [全程D23] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，患者目前继续行放疗前准备，[姓名已隐去]医生信息已隐藏出：患者继续行放疗前准备，[计划性表述已隐藏]顺铂同期化疗，继续观察病情。.\n- [全程D26] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，患者目前无特殊，拟周一开始行放疗，周二行顺铂100mg/㎡同期化疗，继续行放化疗前准备，继续观察病情。.\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗当天给予常规静脉补液，无需特殊水化与利尿处理。\nB. 暂缓放化疗，先静脉补充硫酸镁及氯化钾纠正电解质异常，待复查正常后再启动顺铂同期化疗。\nC. 按计划启动放疗，将顺铂剂量调整为40mg/㎡周疗，化疗期间仅需常规止吐，无需使用甘露醇利尿。\nD. 按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗前给予呋塞米静脉推注利尿，并预防性注射G-CSF。\nE. 按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗期间采用口服补液替代静脉水化，并外用三乙醇胺乳膏。\nF. 暂缓顺铂化疗，先行单纯根治性放疗，待放疗剂量达到40Gy后再评估并启动顺铂同期化疗。\nG. 按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗前给予大剂量糖皮质激素及NK-1受体拮抗剂，免除静脉水化。\nH. 按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗当天给予等渗盐水静脉滴注，避免使用甘露醇。\nI. 按计划启动放疗，并为顺铂（100mg/㎡）同期化疗行充分的静脉水化、甘露醇利尿及电解质补充，同时给予放疗局部保护用药。\nJ. 按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗后连续3天静脉输注人血白蛋白以预防低蛋白血症。\nK. 暂缓放疗，先给予顺铂联合氟尿嘧啶方案诱导化疗2个周期，期间常规给予静脉水化及止吐处理。\nL. 按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗期间常规预防性静脉滴注广谱抗菌药物。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-0534c4bc264d81d07f7ff87c","patient_id":"patient-f25e20b1e5c6eea840d4cc21","turn_id":"turn07","turn_position":6,"turn_type":"response_assessment_decision","gold_letter":"J","gold_action":"结束住院诊疗办理出院，嘱定期返院复查以评估近期疗效。","options":[{"letter":"A","text":"立即行颈部淋巴结清扫术处理未完全消退的残存淋巴结。","is_gold":false},{"letter":"B","text":"立即安排鼻咽及颈部MRI与全身PET-CT检查全面评估近期疗效。","is_gold":false},{"letter":"C","text":"立即启动PF方案（顺铂+氟尿嘧啶）辅助化疗以巩固局部及全身控制。","is_gold":false},{"letter":"D","text":"继续住院给予静脉高营养及广谱抗生素治疗直至口腔黏膜反应完全消失。","is_gold":false},{"letter":"E","text":"立即行电子鼻咽镜下原发灶活检以明确是否达到病理完全缓解。","is_gold":false},{"letter":"F","text":"预防性给予长效G-CSF并口服抗生素后办理出院。","is_gold":false},{"letter":"G","text":"立即启动西妥昔单抗靶向维持治疗以降低局部复发风险。","is_gold":false},{"letter":"H","text":"对颈部残存淋巴结局部追加外照射放疗推量至75-80Gy。","is_gold":false},{"letter":"I","text":"立即复查血浆EBV-DNA，若阳性则继续给予单药顺铂化疗。","is_gold":false},{"letter":"J","text":"结束住院诊疗办理出院，嘱定期返院复查以评估近期疗效。","is_gold":true},{"letter":"K","text":"立即行胸腹部增强CT及骨ECT检查排除放化疗期间的远处转移。","is_gold":false},{"letter":"L","text":"立即请耳鼻喉科会诊行鼓膜穿刺抽液或置管术处理听力下降。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、鼻腔、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D44] 检验组合: 白细胞计数(WBC#)-静脉血: 4.4610E9/L；镁离子(Mg2+)-静脉血: 0.96mmol/L；葡萄糖(Glu)-静脉血: 4.12mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；丙氨酸氨基转移酶(ALT)-静脉血: 16U/L；总蛋白(TP)-静脉血: 72.33g/L；胱抑素(Cys-C)-静脉血: 0.78mg/L；血小板分布宽度(PDW)-静脉血: 11.6%；中性粒细胞计数(Neut#)-静脉血: 3.110E9/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.910E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 35.8U/L；C-反应蛋白(CRP)-静脉血: 3.43mg/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.1；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.32mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.9；氯离子(Cl-)-静脉血: 103mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 29mmol/L；乳酸脱氢酶(LDH)-静脉血: 172.3U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.195；直接胆红素(DBIL)-静脉血: 4.2umol/L；球蛋白(GLO)-静脉血: 29.23g/L；甘油三酯(TG)-静脉血: 1.13mmol/L；血小板计数(PLT#)-静脉血: 16510E9/L；钾离子(K+)-静脉血: 4.12mmol/L；肌酐(Crea)-静脉血: 67.7umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.3U/L；白蛋白(ALB)-静脉血: 43.1g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均血小板体积(MPV)-静脉血: 9.8fL；载脂蛋白AI(apoAI)-静脉血: 1.11g/L；总胆红素(TBIL)-静脉血: 12.6umol/L；单核细胞百分比(Mono%)-静脉血: 0.09；间接胆红素(IBIL)-静脉血: 8.4umolL；血红蛋白(Hb)-静脉血: 148g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 32.8U/L；红细胞……\n- [全程D51] 检验组合: 磷(P)-静脉血: 1.15mmol/L；氯离子(Cl-)-静脉血: 103.1mmol/L；球蛋白(GLO)-静脉血: 31.65g/L；中性粒细胞计数(Neut#)-静脉血: 1.110E9/L；钠离子(Na+)-静脉血: 141.8mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；中性粒细胞百分比(Neut%)-静脉血: 0.466；单核细胞百分比(Mono%)-静脉血: 0.221；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.03；血小板比容-静脉血: 15%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；乳酸脱氢酶(LDH)-静脉血: 170.6U/L；总胆红素(TBIL)-静脉血: 9.8umol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.2pg；肌酐(Crea)-静脉血: 72.4umol/L；尿素氮(BUN)-静脉血: 4.2mmol/L；尿酸(UA)-静脉血: 346.6umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.04；红细胞计数(RBC#)-静脉血: 5.1710E12/L；总蛋白(TP)-静脉血: 75.85g/L；平均血小板体积(MPV)-静脉血: 10fL；平均红细胞体积(MCV)-静脉血: 85.7fL；红细胞比容(Hct)-静脉血: 44.3%；白蛋白(ALB)-静脉血: 44.2g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.09mmolL；总胆固醇(TC)-静脉血: 5.11mmol/L；间接胆红素(IBIL)-静脉血: 6.3umolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.51mmol/L；胱抑素(Cys-C)-静脉血: 0.82mg/L；葡萄糖(Glu)-静脉血: 4.91mmol/L；C-反应蛋白(CRP)-静脉血: 2.13mg/L；碱性磷酸酶(ALP)-静脉血: 77.4U/L；总胆汁酸(TBA)-静脉血: 4.3umol/L；载脂蛋白AI(apoAI)-静脉血: 1.23g/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；直接胆红素(DBIL)-静脉血: 3.5umol/L；血小板分布宽度(PDW)-静脉血: 10.8%；血液二氧化碳含量ctCO2(B)-静脉血: 24.1m……\n- [全程D56] 检验组合: 血红蛋白(Hb)-静脉血: 154g/L；白细胞计数(WBC#)-静脉血: 510E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.28；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 48.1；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.6；中性粒细胞计数(Neut#)-静脉血: 3.110E9/L；大血小板百分比(P-LCR%)-静脉血: 28.9%；红细胞比容(Hct)-静脉血: 49.1%；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.612；单核细胞百分比(Mono%)-静脉血: 0.09；平均红细胞血红蛋白含量(MCH)-静脉血: 29.4pg；平均血小板体积(MPV)-静脉血: 10.4fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 11910E9/L；平均红细胞体积(MCV)-静脉血: 93.7fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0；血小板比容-静脉血: 12%；单核细胞计数(Mono#)-静脉血: 0.510E9/L；血小板分布宽度(PDW)-静脉血: 12.6%；红细胞计数(RBC#)-静脉血: 5.2410E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；平均红细胞血红蛋白浓度(MCHC)-静脉血: 314g/L\n- [全程D58] 检验组合: 白蛋白(ALB)-静脉血: 44.1g/L；血液二氧化碳含量ctCO2(B)-静脉血: 29.5mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 342.3g/L；尿酸(UA)-静脉血: 336.4umol/L；平均红细胞体积(MCV)-静脉血: 87.6fL；氯离子(Cl-)-静脉血: 101.4mmol/L；血小板计数(PLT#)-静脉血: 119.610E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.51；球蛋白(GLO)-静脉血: 30.98g/L；碱性磷酸酶(ALP)-静脉血: 84.6U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；天门冬氨酸氨基转移酶(AST)-静脉血: 16.5U/L；有核红细胞百分比(NRBC%)-静脉血: 0；间接胆红素(IBIL)-静脉血: 6umolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.02；载脂蛋白AI(apoAI)-静脉血: 1.07g/L；钠离子(Na+)-静脉血: 140.4mmol/L；葡萄糖(Glu)-静脉血: 4.22mmol/L；直接胆红素(DBIL)-静脉血: 2.9umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.71mmol/L；尿素氮(BUN)-静脉血: 5.4mmol/L；总胆固醇(TC)-静脉血: 5.2mmol/L；单核细胞百分比(Mono%)-静脉血: 0.141；胱抑素(Cys-C)-静脉血: 0.86mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.89mmolL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总胆汁酸(TBA)-静脉血: 7.2umol/L；总胆红素(TBIL)-静脉血: 8.9umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 27U/L；红细胞比容(Hct)-静脉血: 44.8%；淋巴细胞百分比(Lymph%)-静脉血: 0.143；乳酸脱氢酶(LDH)-静脉血: 185U/L；钾离子(K+)-静脉血: 3.96mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 34.8U/L；白细胞计数(WBC#)-静脉血: 4.5310E9/L；平均血小板体积(MPV)-静脉血: 8.57fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.……\n- [全程D64] 超声；腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约19cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D64] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对侧，双肺野纹理清晰，双肺野未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影形态、大小、位置未见异常。双膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n\n【既往治疗与反应】\n- [全程D52] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。诉吞咽稍有疼痛，体查:I度口腔粘膜反应。昨日查血常规示白细胞计数2.26*10E9/L ↓,中性粒细胞1.1*10E9/L↓，予以升白针对症治疗。下周复查血常规。继续当前放疗。\n- [全程D55] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。诉口干，吞咽稍有疼痛，体查:I度口腔粘膜反应。已予以升白针治疗三天，明日复查血常规，[计划性表述已隐藏]同期DDP第二程化疗。继续放疗治疗。\n- [全程D58] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。诉口干，吞咽稍有疼痛，体查:I度口腔粘膜反应。今日行同期DDP第二程化疗，予以护肝、护胃、制酸、止吐对症治疗。继续放疗治疗。\n- [全程D61] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。诉口干，吞咽稍有疼痛，体查:I度口腔粘膜反应。继续放疗治疗。\n- [全程D64] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者一般情况可，诉耳鸣、听力下降有所缓解，口干及轻微咽痛，无发热、咳嗽、咳痰等不适。查体：I度口腔粘膜反应，张口门齿距4.5cm；颈部淋巴结较前明显缩小，右颈III区可见一长约4cm手术疤痕，颈部皮肤呈放疗后改变。[姓名已隐去]医生信息已隐藏：患者一般情况良好，予以明天出院，嘱患者出院后定期返院复查。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即行颈部淋巴结清扫术处理未完全消退的残存淋巴结。\nB. 立即安排鼻咽及颈部MRI与全身PET-CT检查全面评估近期疗效。\nC. 立即启动PF方案（顺铂+氟尿嘧啶）辅助化疗以巩固局部及全身控制。\nD. 继续住院给予静脉高营养及广谱抗生素治疗直至口腔黏膜反应完全消失。\nE. 立即行电子鼻咽镜下原发灶活检以明确是否达到病理完全缓解。\nF. 预防性给予长效G-CSF并口服抗生素后办理出院。\nG. 立即启动西妥昔单抗靶向维持治疗以降低局部复发风险。\nH. 对颈部残存淋巴结局部追加外照射放疗推量至75-80Gy。\nI. 立即复查血浆EBV-DNA，若阳性则继续给予单药顺铂化疗。\nJ. 结束住院诊疗办理出院，嘱定期返院复查以评估近期疗效。\nK. 立即行胸腹部增强CT及骨ECT检查排除放化疗期间的远处转移。\nL. 立即请耳鼻喉科会诊行鼓膜穿刺抽液或置管术处理听力下降。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、鼻腔、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D44] 检验组合: 白细胞计数(WBC#)-静脉血: 4.4610E9/L；镁离子(Mg2+)-静脉血: 0.96mmol/L；葡萄糖(Glu)-静脉血: 4.12mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；丙氨酸氨基转移酶(ALT)-静脉血: 16U/L；总蛋白(TP)-静脉血: 72.33g/L；胱抑素(Cys-C)-静脉血: 0.78mg/L；血小板分布宽度(PDW)-静脉血: 11.6%；中性粒细胞计数(Neut#)-静脉血: 3.110E9/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.910E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 35.8U/L；C-反应蛋白(CRP)-静脉血: 3.43mg/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.1；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.32mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.9；氯离子(Cl-)-静脉血: 103mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 29mmol/L；乳酸脱氢酶(LDH)-静脉血: 172.3U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.195；直接胆红素(DBIL)-静脉血: 4.2umol/L；球蛋白(GLO)-静脉血: 29.23g/L；甘油三酯(TG)-静脉血: 1.13mmol/L；血小板计数(PLT#)-静脉血: 16510E9/L；钾离子(K+)-静脉血: 4.12mmol/L；肌酐(Crea)-静脉血: 67.7umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.3U/L；白蛋白(ALB)-静脉血: 43.1g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均血小板体积(MPV)-静脉血: 9.8fL；载脂蛋白AI(apoAI)-静脉血: 1.11g/L；总胆红素(TBIL)-静脉血: 12.6umol/L；单核细胞百分比(Mono%)-静脉血: 0.09；间接胆红素(IBIL)-静脉血: 8.4umolL；血红蛋白(Hb)-静脉血: 148g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 32.8U/L；红细胞……\n- [全程D51] 检验组合: 磷(P)-静脉血: 1.15mmol/L；氯离子(Cl-)-静脉血: 103.1mmol/L；球蛋白(GLO)-静脉血: 31.65g/L；中性粒细胞计数(Neut#)-静脉血: 1.110E9/L；钠离子(Na+)-静脉血: 141.8mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；中性粒细胞百分比(Neut%)-静脉血: 0.466；单核细胞百分比(Mono%)-静脉血: 0.221；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.03；血小板比容-静脉血: 15%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；乳酸脱氢酶(LDH)-静脉血: 170.6U/L；总胆红素(TBIL)-静脉血: 9.8umol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.2pg；肌酐(Crea)-静脉血: 72.4umol/L；尿素氮(BUN)-静脉血: 4.2mmol/L；尿酸(UA)-静脉血: 346.6umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.04；红细胞计数(RBC#)-静脉血: 5.1710E12/L；总蛋白(TP)-静脉血: 75.85g/L；平均血小板体积(MPV)-静脉血: 10fL；平均红细胞体积(MCV)-静脉血: 85.7fL；红细胞比容(Hct)-静脉血: 44.3%；白蛋白(ALB)-静脉血: 44.2g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.09mmolL；总胆固醇(TC)-静脉血: 5.11mmol/L；间接胆红素(IBIL)-静脉血: 6.3umolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.51mmol/L；胱抑素(Cys-C)-静脉血: 0.82mg/L；葡萄糖(Glu)-静脉血: 4.91mmol/L；C-反应蛋白(CRP)-静脉血: 2.13mg/L；碱性磷酸酶(ALP)-静脉血: 77.4U/L；总胆汁酸(TBA)-静脉血: 4.3umol/L；载脂蛋白AI(apoAI)-静脉血: 1.23g/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；直接胆红素(DBIL)-静脉血: 3.5umol/L；血小板分布宽度(PDW)-静脉血: 10.8%；血液二氧化碳含量ctCO2(B)-静脉血: 24.1m……\n- [全程D56] 检验组合: 血红蛋白(Hb)-静脉血: 154g/L；白细胞计数(WBC#)-静脉血: 510E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.28；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 48.1；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.6；中性粒细胞计数(Neut#)-静脉血: 3.110E9/L；大血小板百分比(P-LCR%)-静脉血: 28.9%；红细胞比容(Hct)-静脉血: 49.1%；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.612；单核细胞百分比(Mono%)-静脉血: 0.09；平均红细胞血红蛋白含量(MCH)-静脉血: 29.4pg；平均血小板体积(MPV)-静脉血: 10.4fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 11910E9/L；平均红细胞体积(MCV)-静脉血: 93.7fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0；血小板比容-静脉血: 12%；单核细胞计数(Mono#)-静脉血: 0.510E9/L；血小板分布宽度(PDW)-静脉血: 12.6%；红细胞计数(RBC#)-静脉血: 5.2410E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；平均红细胞血红蛋白浓度(MCHC)-静脉血: 314g/L\n- [全程D58] 检验组合: 白蛋白(ALB)-静脉血: 44.1g/L；血液二氧化碳含量ctCO2(B)-静脉血: 29.5mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 342.3g/L；尿酸(UA)-静脉血: 336.4umol/L；平均红细胞体积(MCV)-静脉血: 87.6fL；氯离子(Cl-)-静脉血: 101.4mmol/L；血小板计数(PLT#)-静脉血: 119.610E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.51；球蛋白(GLO)-静脉血: 30.98g/L；碱性磷酸酶(ALP)-静脉血: 84.6U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；天门冬氨酸氨基转移酶(AST)-静脉血: 16.5U/L；有核红细胞百分比(NRBC%)-静脉血: 0；间接胆红素(IBIL)-静脉血: 6umolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.02；载脂蛋白AI(apoAI)-静脉血: 1.07g/L；钠离子(Na+)-静脉血: 140.4mmol/L；葡萄糖(Glu)-静脉血: 4.22mmol/L；直接胆红素(DBIL)-静脉血: 2.9umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.71mmol/L；尿素氮(BUN)-静脉血: 5.4mmol/L；总胆固醇(TC)-静脉血: 5.2mmol/L；单核细胞百分比(Mono%)-静脉血: 0.141；胱抑素(Cys-C)-静脉血: 0.86mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.89mmolL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总胆汁酸(TBA)-静脉血: 7.2umol/L；总胆红素(TBIL)-静脉血: 8.9umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 27U/L；红细胞比容(Hct)-静脉血: 44.8%；淋巴细胞百分比(Lymph%)-静脉血: 0.143；乳酸脱氢酶(LDH)-静脉血: 185U/L；钾离子(K+)-静脉血: 3.96mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 34.8U/L；白细胞计数(WBC#)-静脉血: 4.5310E9/L；平均血小板体积(MPV)-静脉血: 8.57fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.……\n- [全程D64] 超声；腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约19cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D64] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对侧，双肺野纹理清晰，双肺野未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影形态、大小、位置未见异常。双膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n\n【既往治疗与反应】\n- [全程D52] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。诉吞咽稍有疼痛，体查:I度口腔粘膜反应。昨日查血常规示白细胞计数2.26*10E9/L ↓,中性粒细胞1.1*10E9/L↓，予以升白针对症治疗。下周复查血常规。继续当前放疗。\n- [全程D55] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。诉口干，吞咽稍有疼痛，体查:I度口腔粘膜反应。已予以升白针治疗三天，明日复查血常规，[计划性表述已隐藏]同期DDP第二程化疗。继续放疗治疗。\n- [全程D58] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。诉口干，吞咽稍有疼痛，体查:I度口腔粘膜反应。今日行同期DDP第二程化疗，予以护肝、护胃、制酸、止吐对症治疗。继续放疗治疗。\n- [全程D61] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。诉口干，吞咽稍有疼痛，体查:I度口腔粘膜反应。继续放疗治疗。\n- [全程D64] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者一般情况可，诉耳鸣、听力下降有所缓解，口干及轻微咽痛，无发热、咳嗽、咳痰等不适。查体：I度口腔粘膜反应，张口门齿距4.5cm；颈部淋巴结较前明显缩小，右颈III区可见一长约4cm手术疤痕，颈部皮肤呈放疗后改变。[姓名已隐去]医生信息已隐藏：患者一般情况良好，予以明天出院，嘱患者出院后定期返院复查。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即行颈部淋巴结清扫术处理未完全消退的残存淋巴结。\nB. 立即安排鼻咽及颈部MRI与全身PET-CT检查全面评估近期疗效。\nC. 立即启动PF方案（顺铂+氟尿嘧啶）辅助化疗以巩固局部及全身控制。\nD. 继续住院给予静脉高营养及广谱抗生素治疗直至口腔黏膜反应完全消失。\nE. 立即行电子鼻咽镜下原发灶活检以明确是否达到病理完全缓解。\nF. 预防性给予长效G-CSF并口服抗生素后办理出院。\nG. 立即启动西妥昔单抗靶向维持治疗以降低局部复发风险。\nH. 对颈部残存淋巴结局部追加外照射放疗推量至75-80Gy。\nI. 立即复查血浆EBV-DNA，若阳性则继续给予单药顺铂化疗。\nJ. 结束住院诊疗办理出院，嘱定期返院复查以评估近期疗效。\nK. 立即行胸腹部增强CT及骨ECT检查排除放化疗期间的远处转移。\nL. 立即请耳鼻喉科会诊行鼓膜穿刺抽液或置管术处理听力下降。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-03e671c4e9fab822b9938832","patient_id":"patient-f25e20b1e5c6eea840d4cc21","turn_id":"turn08","turn_position":7,"turn_type":"response_assessment_decision","gold_letter":"K","gold_action":"评估为有效，结束根治性放化疗，予以办理出院并嘱定期门诊随访复查。","options":[{"letter":"A","text":"评估为疾病进展，停用放疗，改行吉西他滨联合顺铂姑息性化疗。","is_gold":false},{"letter":"B","text":"评估为部分缓解，继续住院行第3周期顺铂单药同期化疗。","is_gold":false},{"letter":"C","text":"评估为部分缓解，序贯启动顺铂联合氟尿嘧啶方案辅助化疗3个周期。","is_gold":false},{"letter":"D","text":"评估为完全缓解，转入头颈外科行右侧颈部淋巴结清扫术。","is_gold":false},{"letter":"E","text":"评估为部分缓解，对右颈部残留淋巴结追加局部外照射放疗至74Gy。","is_gold":false},{"letter":"F","text":"评估为疾病稳定，加用西妥昔单抗靶向治疗并延长原发灶放疗疗程。","is_gold":false},{"letter":"G","text":"评估为部分缓解，转入头颈外科行内镜下鼻咽原发灶切除术。","is_gold":false},{"letter":"H","text":"评估为有效，继续住院静脉使用抗生素及营养支持以治疗口腔黏膜反应。","is_gold":false},{"letter":"I","text":"评估为有效，立即安排鼻咽及颈部增强MRI复查以确认靶区消退情况。","is_gold":false},{"letter":"J","text":"评估为有效，办理出院，并序贯启动PD-1抑制剂维持治疗1年。","is_gold":false},{"letter":"K","text":"评估为有效，结束根治性放化疗，予以办理出院并嘱定期门诊随访复查。","is_gold":true},{"letter":"L","text":"评估为有效，办理出院，并嘱出院后1个月常规行全身PET-CT检查。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、鼻腔、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- 无可展示记录。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估为疾病进展，停用放疗，改行吉西他滨联合顺铂姑息性化疗。\nB. 评估为部分缓解，继续住院行第3周期顺铂单药同期化疗。\nC. 评估为部分缓解，序贯启动顺铂联合氟尿嘧啶方案辅助化疗3个周期。\nD. 评估为完全缓解，转入头颈外科行右侧颈部淋巴结清扫术。\nE. 评估为部分缓解，对右颈部残留淋巴结追加局部外照射放疗至74Gy。\nF. 评估为疾病稳定，加用西妥昔单抗靶向治疗并延长原发灶放疗疗程。\nG. 评估为部分缓解，转入头颈外科行内镜下鼻咽原发灶切除术。\nH. 评估为有效，继续住院静脉使用抗生素及营养支持以治疗口腔黏膜反应。\nI. 评估为有效，立即安排鼻咽及颈部增强MRI复查以确认靶区消退情况。\nJ. 评估为有效，办理出院，并序贯启动PD-1抑制剂维持治疗1年。\nK. 评估为有效，结束根治性放化疗，予以办理出院并嘱定期门诊随访复查。\nL. 评估为有效，办理出院，并嘱出院后1个月常规行全身PET-CT检查。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、鼻腔、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- 无可展示记录。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估为疾病进展，停用放疗，改行吉西他滨联合顺铂姑息性化疗。\nB. 评估为部分缓解，继续住院行第3周期顺铂单药同期化疗。\nC. 评估为部分缓解，序贯启动顺铂联合氟尿嘧啶方案辅助化疗3个周期。\nD. 评估为完全缓解，转入头颈外科行右侧颈部淋巴结清扫术。\nE. 评估为部分缓解，对右颈部残留淋巴结追加局部外照射放疗至74Gy。\nF. 评估为疾病稳定，加用西妥昔单抗靶向治疗并延长原发灶放疗疗程。\nG. 评估为部分缓解，转入头颈外科行内镜下鼻咽原发灶切除术。\nH. 评估为有效，继续住院静脉使用抗生素及营养支持以治疗口腔黏膜反应。\nI. 评估为有效，立即安排鼻咽及颈部增强MRI复查以确认靶区消退情况。\nJ. 评估为有效，办理出院，并序贯启动PD-1抑制剂维持治疗1年。\nK. 评估为有效，结束根治性放化疗，予以办理出院并嘱定期门诊随访复查。\nL. 评估为有效，办理出院，并嘱出院后1个月常规行全身PET-CT检查。\n\n请仅输出一个选项字母（A-L）。"}]}
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+{"sample_id":"sample-057bee25fe3533856610d5c8","patient_id":"patient-9fcde7a95f4d57501ecbf7b2","turn_id":"turn02","turn_position":2,"turn_type":"imaging_release_workup","gold_letter":"A","gold_action":"行电子鼻咽镜检查及鼻咽肿物活检以明确病理诊断。","options":[{"letter":"A","text":"电子鼻咽镜检查及鼻咽肿物活检","is_gold":true},{"letter":"B","text":"颈部淋巴结切开活检术","is_gold":false},{"letter":"C","text":"超声引导下颈部淋巴结细针穿刺活检","is_gold":false},{"letter":"D","text":"全身PET-CT检查","is_gold":false},{"letter":"E","text":"胸部CT、腹部超声及全身骨扫描","is_gold":false},{"letter":"F","text":"鼻内镜下鼻咽肿物切除术","is_gold":false},{"letter":"G","text":"诊断性抗炎治疗2周后复查MRI","is_gold":false},{"letter":"H","text":"外周血EBV-DNA定量检测","is_gold":false},{"letter":"I","text":"鼻咽脱落细胞学检查","is_gold":false},{"letter":"J","text":"鼻咽及颈部CT平扫+增强","is_gold":false},{"letter":"K","text":"鼻咽颅底三维CT重建","is_gold":false},{"letter":"L","text":"颈部淋巴结清扫术","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：咽旁间隙、斜坡、蝶骨基底部、岩尖。\n文本分期信息：N3，M0。\n综合TNM状态：T3N3M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D4] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 V5～V6导联低电压 V1～V3导联r波递增不良\n- [全程D4] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 25.6U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.341；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；平均红细胞体积(MCV)-静脉血: 94.7fL；白细胞计数(WBC#)-静脉血: 4.5110E9/L；平均血小板体积(MPV)-静脉血: 12fL；D-二聚体(D-Dimer)-静脉血: 0.1ug/ml；单核细胞计数(Mono#)-静脉血: 0.510E9/L；磷(P)-静脉血: 1.36mmol/L；甘油三酯(TG)-静脉血: 2.22mmol/L；间接胆红素(IBIL)-静脉血: 5.2umolL；白蛋白(ALB)-静脉血: 44.8g/L；碱性磷酸酶(ALP)-静脉血: 81.9U/L；凝血酶时间(TT)-静脉血: 18.5sec.；载脂蛋白B(apoB)-静脉血: 0.57g/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.1U/L；阴离子间隙(AG)-静脉血: 11；血小板比容-静脉血: 15%；凝血酶原时间(PT)-静脉血: 11.7sec.；肌酐(Crea)-静脉血: 82.7umol/L；总胆红素(TBIL)-静脉血: 8.2umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.503；球蛋白(GLO)-静脉血: 25.56g/L；红细胞计数(RBC#)-静脉血: 4.5210E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；大血小板百分比(P-LCR%)-静脉血: 40%；血小板分布宽度(PDW)-静脉血: 14.2%；凝血酶原时间活动度(PTA)-静脉血: 90.4%；乳酸脱氢酶(LDH)-静脉血: 359.7U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32.3pg；ABO血型-静脉血: B；总钙(Ca)-静脉血: 2.3mmol/L；镁离子(Mg2+)-静脉血: 0.99mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 146g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；γ-谷氨酰基转移酶(GGT)-静脉血: 14.6U/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.1mmol/L……\n- [全程D5] 检验组合: 乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阳性(+)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D6] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、双侧壁明显不均匀增厚，平扫T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，双侧咽隐窝变浅，双侧咽旁脂肪间隙稍狭窄；双侧腭帆提肌、腭帆张肌、头长肌受压。双侧咽后见肿大淋巴结，左侧较大者短径11mm，右侧较大者短径12mm。 双侧后鼻孔堵塞，口咽双侧壁未见受累增厚。 双侧翼腭窝、颞下窝未见异常。 蝶骨基底部、斜坡、双侧岩尖、双侧枕骨基底部骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽；双侧筛窦、蝶窦，右乳突内见积液；上颌窦、左乳突充气良好，骨壁完整；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双颈II区、右颈III、IV区见淋巴结肿大，部分融合，较大者短径28mm，信号欠均匀，增强较明显不均匀强化。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。；检查结论: 鼻咽顶壁、顶后壁、双侧壁明显不均匀增厚，考虑鼻咽癌。 颅底骨质破坏。 双侧咽后、双颈部多发淋巴结肿大，考虑转移瘤。 副鼻窦炎；右乳突炎。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 电子鼻咽镜检查及鼻咽肿物活检\nB. 颈部淋巴结切开活检术\nC. 超声引导下颈部淋巴结细针穿刺活检\nD. 全身PET-CT检查\nE. 胸部CT、腹部超声及全身骨扫描\nF. 鼻内镜下鼻咽肿物切除术\nG. 诊断性抗炎治疗2周后复查MRI\nH. 外周血EBV-DNA定量检测\nI. 鼻咽脱落细胞学检查\nJ. 鼻咽及颈部CT平扫+增强\nK. 鼻咽颅底三维CT重建\nL. 颈部淋巴结清扫术\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：咽旁间隙、斜坡、蝶骨基底部、岩尖。\n文本分期信息：N3，M0。\n综合TNM状态：T3N3M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D4] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 V5～V6导联低电压 V1～V3导联r波递增不良\n- [全程D4] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 25.6U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.341；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；平均红细胞体积(MCV)-静脉血: 94.7fL；白细胞计数(WBC#)-静脉血: 4.5110E9/L；平均血小板体积(MPV)-静脉血: 12fL；D-二聚体(D-Dimer)-静脉血: 0.1ug/ml；单核细胞计数(Mono#)-静脉血: 0.510E9/L；磷(P)-静脉血: 1.36mmol/L；甘油三酯(TG)-静脉血: 2.22mmol/L；间接胆红素(IBIL)-静脉血: 5.2umolL；白蛋白(ALB)-静脉血: 44.8g/L；碱性磷酸酶(ALP)-静脉血: 81.9U/L；凝血酶时间(TT)-静脉血: 18.5sec.；载脂蛋白B(apoB)-静脉血: 0.57g/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.1U/L；阴离子间隙(AG)-静脉血: 11；血小板比容-静脉血: 15%；凝血酶原时间(PT)-静脉血: 11.7sec.；肌酐(Crea)-静脉血: 82.7umol/L；总胆红素(TBIL)-静脉血: 8.2umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.503；球蛋白(GLO)-静脉血: 25.56g/L；红细胞计数(RBC#)-静脉血: 4.5210E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；大血小板百分比(P-LCR%)-静脉血: 40%；血小板分布宽度(PDW)-静脉血: 14.2%；凝血酶原时间活动度(PTA)-静脉血: 90.4%；乳酸脱氢酶(LDH)-静脉血: 359.7U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32.3pg；ABO血型-静脉血: B；总钙(Ca)-静脉血: 2.3mmol/L；镁离子(Mg2+)-静脉血: 0.99mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 146g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；γ-谷氨酰基转移酶(GGT)-静脉血: 14.6U/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.1mmol/L……\n- [全程D5] 检验组合: 乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阳性(+)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D6] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、双侧壁明显不均匀增厚，平扫T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，双侧咽隐窝变浅，双侧咽旁脂肪间隙稍狭窄；双侧腭帆提肌、腭帆张肌、头长肌受压。双侧咽后见肿大淋巴结，左侧较大者短径11mm，右侧较大者短径12mm。 双侧后鼻孔堵塞，口咽双侧壁未见受累增厚。 双侧翼腭窝、颞下窝未见异常。 蝶骨基底部、斜坡、双侧岩尖、双侧枕骨基底部骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽；双侧筛窦、蝶窦，右乳突内见积液；上颌窦、左乳突充气良好，骨壁完整；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双颈II区、右颈III、IV区见淋巴结肿大，部分融合，较大者短径28mm，信号欠均匀，增强较明显不均匀强化。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。；检查结论: 鼻咽顶壁、顶后壁、双侧壁明显不均匀增厚，考虑鼻咽癌。 颅底骨质破坏。 双侧咽后、双颈部多发淋巴结肿大，考虑转移瘤。 副鼻窦炎；右乳突炎。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 电子鼻咽镜检查及鼻咽肿物活检\nB. 颈部淋巴结切开活检术\nC. 超声引导下颈部淋巴结细针穿刺活检\nD. 全身PET-CT检查\nE. 胸部CT、腹部超声及全身骨扫描\nF. 鼻内镜下鼻咽肿物切除术\nG. 诊断性抗炎治疗2周后复查MRI\nH. 外周血EBV-DNA定量检测\nI. 鼻咽脱落细胞学检查\nJ. 鼻咽及颈部CT平扫+增强\nK. 鼻咽颅底三维CT重建\nL. 颈部淋巴结清扫术\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-ea63b7a358722be15870f84c","patient_id":"patient-9fcde7a95f4d57501ecbf7b2","turn_id":"turn04","turn_position":3,"turn_type":"initial_treatment_selection","gold_letter":"C","gold_action":"完善中心静脉置管，行诱导化疗序贯根治性同期放化疗。","options":[{"letter":"A","text":"完善中心静脉置管，直接行根治性同期放化疗","is_gold":false},{"letter":"B","text":"完善中心静脉置管，行诱导化疗序贯单纯根治性放疗","is_gold":false},{"letter":"C","text":"完善中心静脉置管，行诱导化疗序贯根治性同期放化疗","is_gold":true},{"letter":"D","text":"完善中心静脉置管，行诱导化疗序贯根治性同期放化疗及辅助化疗","is_gold":false},{"letter":"E","text":"完善中心静脉置管，行诱导化疗联合PD-1单抗序贯根治性同期放化疗","is_gold":false},{"letter":"F","text":"完善中心静脉置管，直接行根治性同期放化疗及辅助化疗","is_gold":false},{"letter":"G","text":"完善中心静脉置管，行诱导化疗序贯根治性放疗联合EGFR单抗","is_gold":false},{"letter":"H","text":"完善中心静脉置管，行诱导化疗，放疗前行右颈部淋巴结清扫术","is_gold":false},{"letter":"I","text":"完善中心静脉置管，行姑息性化疗，视颈部淋巴结退缩情况决定放疗时机","is_gold":false},{"letter":"J","text":"完善中心静脉置管，直接行根治性放疗联合EGFR单抗","is_gold":false},{"letter":"K","text":"完善中心静脉置管，行诱导化疗序贯根治性放疗及辅助化疗","is_gold":false},{"letter":"L","text":"完善中心静脉置管，行诱导化疗联合EGFR单抗序贯单纯根治性放疗","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：咽旁间隙、斜坡、蝶骨基底部、岩尖。\n文本分期信息：N3，M0。\n综合TNM状态：T3N3M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1] 入院记录: 主诉: 右颈肿物半年，右耳听力下降半月；现病史: 缘于6月前患者无意中出现右颈肿物，未予重视，进行性增大，半月前出现右耳听力下降，无头痛、复视，无涕血、面麻等，就诊于当地医院，发现鼻咽肿物。今为求进一步诊治来我院。患者发病以来,精神、饮食、睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟20支/日*5年，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.3℃，P：79次/分，R：20次/分，BP：105/65mmHg,Ht：168cm，Wt：56kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率79次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见: 左颈II区可见多个大小不一肿大淋巴结，最大约22mm×12mm，边界清，椭圆形，内部回声均匀，后方回声稍增强，淋巴门未探及。 CDFI:上述淋巴结内可见周边型血流信号。 左颈淋巴结穿刺活检： 常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以16G穿刺针穿刺入左颈肿物内，进针2次，取出长约2cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。；检查结论: 左侧颈部肿大淋巴结穿刺活检。 不适随诊。 4个工作日后凭发票到2号楼6楼病理科取结果。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善中心静脉置管，直接行根治性同期放化疗\nB. 完善中心静脉置管，行诱导化疗序贯单纯根治性放疗\nC. 完善中心静脉置管，行诱导化疗序贯根治性同期放化疗\nD. 完善中心静脉置管，行诱导化疗序贯根治性同期放化疗及辅助化疗\nE. 完善中心静脉置管，行诱导化疗联合PD-1单抗序贯根治性同期放化疗\nF. 完善中心静脉置管，直接行根治性同期放化疗及辅助化疗\nG. 完善中心静脉置管，行诱导化疗序贯根治性放疗联合EGFR单抗\nH. 完善中心静脉置管，行诱导化疗，放疗前行右颈部淋巴结清扫术\nI. 完善中心静脉置管，行姑息性化疗，视颈部淋巴结退缩情况决定放疗时机\nJ. 完善中心静脉置管，直接行根治性放疗联合EGFR单抗\nK. 完善中心静脉置管，行诱导化疗序贯根治性放疗及辅助化疗\nL. 完善中心静脉置管，行诱导化疗联合EGFR单抗序贯单纯根治性放疗\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：咽旁间隙、斜坡、蝶骨基底部、岩尖。\n文本分期信息：N3，M0。\n综合TNM状态：T3N3M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1] 入院记录: 主诉: 右颈肿物半年，右耳听力下降半月；现病史: 缘于6月前患者无意中出现右颈肿物，未予重视，进行性增大，半月前出现右耳听力下降，无头痛、复视，无涕血、面麻等，就诊于当地医院，发现鼻咽肿物。今为求进一步诊治来我院。患者发病以来,精神、饮食、睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟20支/日*5年，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.3℃，P：79次/分，R：20次/分，BP：105/65mmHg,Ht：168cm，Wt：56kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率79次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见: 左颈II区可见多个大小不一肿大淋巴结，最大约22mm×12mm，边界清，椭圆形，内部回声均匀，后方回声稍增强，淋巴门未探及。 CDFI:上述淋巴结内可见周边型血流信号。 左颈淋巴结穿刺活检： 常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以16G穿刺针穿刺入左颈肿物内，进针2次，取出长约2cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。；检查结论: 左侧颈部肿大淋巴结穿刺活检。 不适随诊。 4个工作日后凭发票到2号楼6楼病理科取结果。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善中心静脉置管，直接行根治性同期放化疗\nB. 完善中心静脉置管，行诱导化疗序贯单纯根治性放疗\nC. 完善中心静脉置管，行诱导化疗序贯根治性同期放化疗\nD. 完善中心静脉置管，行诱导化疗序贯根治性同期放化疗及辅助化疗\nE. 完善中心静脉置管，行诱导化疗联合PD-1单抗序贯根治性同期放化疗\nF. 完善中心静脉置管，直接行根治性同期放化疗及辅助化疗\nG. 完善中心静脉置管，行诱导化疗序贯根治性放疗联合EGFR单抗\nH. 完善中心静脉置管，行诱导化疗，放疗前行右颈部淋巴结清扫术\nI. 完善中心静脉置管，行姑息性化疗，视颈部淋巴结退缩情况决定放疗时机\nJ. 完善中心静脉置管，直接行根治性放疗联合EGFR单抗\nK. 完善中心静脉置管，行诱导化疗序贯根治性放疗及辅助化疗\nL. 完善中心静脉置管，行诱导化疗联合EGFR单抗序贯单纯根治性放疗\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-077ecf4aba208fcc4f66c309","patient_id":"patient-9fcde7a95f4d57501ecbf7b2","turn_id":"turn05","turn_position":4,"turn_type":"toxicity_or_support_decision","gold_letter":"D","gold_action":"继续放疗，针对轻度恶心给予常规止吐对症处理，按规范进行PICC导管维护，并定期复查血常规与生化。","options":[{"letter":"A","text":"暂停放疗，给予重组人粒细胞集落刺激因子皮下注射，处理淋巴细胞减少，待血象恢复后恢复放疗。","is_gold":false},{"letter":"B","text":"暂停放疗，给予静脉营养支持及补液，处理恶心症状，待胃肠道反应缓解后重新评估放疗计划。","is_gold":false},{"letter":"C","text":"继续放疗，对淋巴细胞减少预防性静脉滴注广谱抗生素，并常规进行PICC导管维护。","is_gold":false},{"letter":"D","text":"继续放疗，给予常规止吐对症处理，处理轻度恶心，按规范进行PICC导管维护，并定期复查血常规与生化。","is_gold":true},{"letter":"E","text":"继续放疗，对出现的骨髓抑制，将下一周期顺铂化疗剂量减量20%，并常规进行PICC导管维护。","is_gold":false},{"letter":"F","text":"暂停放疗，拔除PICC导管改用外周静脉留置针，继续常规止吐对症支持与定期复查。","is_gold":false},{"letter":"G","text":"继续放疗，给予重组人白介素-2免疫支持治疗，处理淋巴细胞减少，并定期复查血常规与生化。","is_gold":false},{"letter":"H","text":"暂停放疗，立即行鼻咽及颈部MRI复查以评估放化疗疗效，并决定后续放疗剂量。","is_gold":false},{"letter":"I","text":"继续放疗，终止同期化疗计划，后续仅行单纯放射治疗，并常规进行PICC导管维护。","is_gold":false},{"letter":"J","text":"继续放疗，加用大剂量糖皮质激素冲击止吐，处理恶心症状，并预防性使用抗真菌药物。","is_gold":false},{"letter":"K","text":"暂停放疗，转入重症监护室进行严密生命体征监测与器官功能支持，暂缓抗肿瘤治疗。","is_gold":false},{"letter":"L","text":"继续放疗，立即启动第二周期顺铂同期化疗，并给予5-HT3受体拮抗剂联合NK-1受体拮抗剂。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：咽旁间隙、斜坡、蝶骨基底部、岩尖。\n文本分期信息：N3，M0。\n综合TNM状态：T3N3M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D20] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右旁T7椎体横突水平，估计位于上腔静脉内。；检查结论: PICC管位置如上所述。\n- [全程D20] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 24mm AO 28mm MV E 0.53m/s EF 63% LV 37mm IVS 8mm A 0.41m/s FS 34% RA 35mm LVPW 6mm RV 16mm PA 14mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 心脏结构及运动未见异常 各房室腔及大血管未探及异常血流信号 心功能正常\n- [全程D21] 检验组合: 隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；酮体(KET)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；比重(SG)-尿液: 1.021；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D22] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 5.5；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.012；颜色-尿液: Light-Yellow；隐血(OB)-尿液: -（参考: 阴性）\n- [全程D28] 检验组合: 钠离子(Na+)-静脉血: 138.4mmol/L；胱抑素(Cys-C)-静脉血: 0.85mg/L；葡萄糖(Glu)-静脉血: 4.19mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；碱性磷酸酶(ALP)-静脉血: 77.2U/L；尿素氮(BUN)-静脉血: 4.1mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 32.5pg；淋巴细胞百分比(Lymph%)-静脉血: 0.13；C-反应蛋白(CRP)-静脉血: 2.54mg/L；氯离子(Cl-)-静脉血: 98.1mmol/L；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.64；阴离子间隙(AG)-静脉血: 16；红细胞比容(Hct)-静脉血: 43.3%；磷(P)-静脉血: 1.38mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.695；血液二氧化碳含量ctCO2(B)-静脉血: 24.3mmol/L；总胆汁酸(TBA)-静脉血: 2.1umol/L；总钙(Ca)-静脉血: 2.12mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 32.1U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.86；γ-谷氨酰基转移酶(GGT)-静脉血: 21.1U/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；甘油三酯(TG)-静脉血: 0.75mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；载脂蛋白B(apoB)-静脉血: 0.58g/L；直接胆红素(DBIL)-静脉血: 4.7umol/L；乳酸脱氢酶(LDH)-静脉血: 269.3U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 36.1U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；平均红细胞体积(MCV)-静脉血: 95.9fL；单核细胞百分比(Mono%)-静脉血: 0.13；总胆固醇(TC)-静脉血: 2.75mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339g/L；球蛋白(GLO)-静脉血: 21.89g/……\n\n【既往治疗与反应】\n- [全程D2] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉右耳听力下降，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，结合患者检查，认为患者鼻咽癌可能性大，指示完善相关检查后在决定下一步治疗方案，遵嘱执行。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D14] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉右耳听力下降，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，指示尽快完成放疗计划，遵嘱执行。\n- [全程D19] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉右耳听力下降，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，考虑患者放疗计划即将完成，指示可提前2天先予以化疗，指示今日予以DDP方案化疗第1程，做好水化、护胃、止呕等对症支持处理，密切观察化疗中副反应，遵嘱执行。\n- [全程D24] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉恶心，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，较前缩小，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，认为患者化疗顺利完成，指示继续放疗，密切观察放疗中副反应，遵嘱执行。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，给予重组人粒细胞集落刺激因子皮下注射，处理淋巴细胞减少，待血象恢复后恢复放疗。\nB. 暂停放疗，给予静脉营养支持及补液，处理恶心症状，待胃肠道反应缓解后重新评估放疗计划。\nC. 继续放疗，对淋巴细胞减少预防性静脉滴注广谱抗生素，并常规进行PICC导管维护。\nD. 继续放疗，给予常规止吐对症处理，处理轻度恶心，按规范进行PICC导管维护，并定期复查血常规与生化。\nE. 继续放疗，对出现的骨髓抑制，将下一周期顺铂化疗剂量减量20%，并常规进行PICC导管维护。\nF. 暂停放疗，拔除PICC导管改用外周静脉留置针，继续常规止吐对症支持与定期复查。\nG. 继续放疗，给予重组人白介素-2免疫支持治疗，处理淋巴细胞减少，并定期复查血常规与生化。\nH. 暂停放疗，立即行鼻咽及颈部MRI复查以评估放化疗疗效，并决定后续放疗剂量。\nI. 继续放疗，终止同期化疗计划，后续仅行单纯放射治疗，并常规进行PICC导管维护。\nJ. 继续放疗，加用大剂量糖皮质激素冲击止吐，处理恶心症状，并预防性使用抗真菌药物。\nK. 暂停放疗，转入重症监护室进行严密生命体征监测与器官功能支持，暂缓抗肿瘤治疗。\nL. 继续放疗，立即启动第二周期顺铂同期化疗，并给予5-HT3受体拮抗剂联合NK-1受体拮抗剂。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：咽旁间隙、斜坡、蝶骨基底部、岩尖。\n文本分期信息：N3，M0。\n综合TNM状态：T3N3M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D20] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右旁T7椎体横突水平，估计位于上腔静脉内。；检查结论: PICC管位置如上所述。\n- [全程D20] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 24mm AO 28mm MV E 0.53m/s EF 63% LV 37mm IVS 8mm A 0.41m/s FS 34% RA 35mm LVPW 6mm RV 16mm PA 14mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 心脏结构及运动未见异常 各房室腔及大血管未探及异常血流信号 心功能正常\n- [全程D21] 检验组合: 隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；酮体(KET)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；比重(SG)-尿液: 1.021；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D22] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 5.5；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.012；颜色-尿液: Light-Yellow；隐血(OB)-尿液: -（参考: 阴性）\n- [全程D28] 检验组合: 钠离子(Na+)-静脉血: 138.4mmol/L；胱抑素(Cys-C)-静脉血: 0.85mg/L；葡萄糖(Glu)-静脉血: 4.19mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；碱性磷酸酶(ALP)-静脉血: 77.2U/L；尿素氮(BUN)-静脉血: 4.1mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 32.5pg；淋巴细胞百分比(Lymph%)-静脉血: 0.13；C-反应蛋白(CRP)-静脉血: 2.54mg/L；氯离子(Cl-)-静脉血: 98.1mmol/L；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.64；阴离子间隙(AG)-静脉血: 16；红细胞比容(Hct)-静脉血: 43.3%；磷(P)-静脉血: 1.38mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.695；血液二氧化碳含量ctCO2(B)-静脉血: 24.3mmol/L；总胆汁酸(TBA)-静脉血: 2.1umol/L；总钙(Ca)-静脉血: 2.12mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 32.1U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.86；γ-谷氨酰基转移酶(GGT)-静脉血: 21.1U/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；甘油三酯(TG)-静脉血: 0.75mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；载脂蛋白B(apoB)-静脉血: 0.58g/L；直接胆红素(DBIL)-静脉血: 4.7umol/L；乳酸脱氢酶(LDH)-静脉血: 269.3U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 36.1U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；平均红细胞体积(MCV)-静脉血: 95.9fL；单核细胞百分比(Mono%)-静脉血: 0.13；总胆固醇(TC)-静脉血: 2.75mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339g/L；球蛋白(GLO)-静脉血: 21.89g/……\n\n【既往治疗与反应】\n- [全程D2] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉右耳听力下降，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，结合患者检查，认为患者鼻咽癌可能性大，指示完善相关检查后在决定下一步治疗方案，遵嘱执行。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D14] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉右耳听力下降，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，指示尽快完成放疗计划，遵嘱执行。\n- [全程D19] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉右耳听力下降，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，考虑患者放疗计划即将完成，指示可提前2天先予以化疗，指示今日予以DDP方案化疗第1程，做好水化、护胃、止呕等对症支持处理，密切观察化疗中副反应，遵嘱执行。\n- [全程D24] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉恶心，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，较前缩小，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，认为患者化疗顺利完成，指示继续放疗，密切观察放疗中副反应，遵嘱执行。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，给予重组人粒细胞集落刺激因子皮下注射，处理淋巴细胞减少，待血象恢复后恢复放疗。\nB. 暂停放疗，给予静脉营养支持及补液，处理恶心症状，待胃肠道反应缓解后重新评估放疗计划。\nC. 继续放疗，对淋巴细胞减少预防性静脉滴注广谱抗生素，并常规进行PICC导管维护。\nD. 继续放疗，给予常规止吐对症处理，处理轻度恶心，按规范进行PICC导管维护，并定期复查血常规与生化。\nE. 继续放疗，对出现的骨髓抑制，将下一周期顺铂化疗剂量减量20%，并常规进行PICC导管维护。\nF. 暂停放疗，拔除PICC导管改用外周静脉留置针，继续常规止吐对症支持与定期复查。\nG. 继续放疗，给予重组人白介素-2免疫支持治疗，处理淋巴细胞减少，并定期复查血常规与生化。\nH. 暂停放疗，立即行鼻咽及颈部MRI复查以评估放化疗疗效，并决定后续放疗剂量。\nI. 继续放疗，终止同期化疗计划，后续仅行单纯放射治疗，并常规进行PICC导管维护。\nJ. 继续放疗，加用大剂量糖皮质激素冲击止吐，处理恶心症状，并预防性使用抗真菌药物。\nK. 暂停放疗，转入重症监护室进行严密生命体征监测与器官功能支持，暂缓抗肿瘤治疗。\nL. 继续放疗，立即启动第二周期顺铂同期化疗，并给予5-HT3受体拮抗剂联合NK-1受体拮抗剂。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-6fc96ea65282f416f15f852e","patient_id":"patient-9fcde7a95f4d57501ecbf7b2","turn_id":"turn06","turn_position":5,"turn_type":"toxicity_or_support_decision","gold_letter":"E","gold_action":"继续放疗，予以洗鼻、免疫调节/辅助支持（如香菇多糖）及动静脉置管护理，复查血常规与生化常规。","options":[{"letter":"A","text":"暂停放疗，予以重组人血小板生成素（rhTPO）皮下注射，待血小板恢复后继续放疗。","is_gold":false},{"letter":"B","text":"继续放疗，予以重组人白介素-11（rhIL-11）皮下注射，复查血常规与生化常规。","is_gold":false},{"letter":"C","text":"暂停放疗，输注单采血小板1个治疗量，复查血常规与生化常规。","is_gold":false},{"letter":"D","text":"继续放疗，予以重组人粒细胞集落刺激因子（rhG-CSF）皮下注射，复查血常规。","is_gold":false},{"letter":"E","text":"继续放疗，予以洗鼻、免疫调节/辅助支持（如香菇多糖）及动静脉置管护理，复查血常规与生化常规。","is_gold":true},{"letter":"F","text":"暂停放疗，予以促红细胞生成素（EPO）皮下注射，待血红蛋白恢复后继续放疗。","is_gold":false},{"letter":"G","text":"继续放疗，予以低分子肝素皮下注射预防血栓，复查凝血功能与血常规。","is_gold":false},{"letter":"H","text":"暂停放疗，予以甲泼尼龙静脉滴注提升血小板，复查血常规与生化常规。","is_gold":false},{"letter":"I","text":"继续放疗，予以静脉输注人免疫球蛋白（IVIG），复查血常规与生化常规。","is_gold":false},{"letter":"J","text":"终止放疗，予以单药化疗维持，配合洗鼻及动静脉置管护理。","is_gold":false},{"letter":"K","text":"继续放疗，予以重组人血小板生成素与重组人粒细胞集落刺激因子联合皮下注射。","is_gold":false},{"letter":"L","text":"暂停放疗，予以洗鼻及动静脉置管护理，暂不予升血小板药物干预。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：咽旁间隙、斜坡、蝶骨基底部、岩尖。\n文本分期信息：N3，M0。\n综合TNM状态：T3N3M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D35] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；镁离子(Mg2+)-静脉血: 0.88mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44；载脂蛋白B(apoB)-静脉血: 0.56g/L；钠离子(Na+)-静脉血: 143.1mmol/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞比容(Hct)-静脉血: 37.1%；甘油三酯(TG)-静脉血: 0.68mmol/L；葡萄糖(Glu)-静脉血: 4.35mmol/L；C-反应蛋白(CRP)-静脉血: 16.07mg/L；平均血小板体积(MPV)-静脉血: 11.3fL；血红蛋白(Hb)-静脉血: 125g/L；载脂蛋白AI(apoAI)-静脉血: 0.89g/L；红细胞计数(RBC#)-静脉血: 3.9410E12/L；血小板比容-静脉血: 10%；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；血小板计数(PLT#)-静脉血: 8910E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.14；天门冬氨酸氨基转移酶(AST)-静脉血: 16U/L；丙氨酸氨基转移酶(ALT)-静脉血: 16.4U/L；总钙(Ca)-静脉血: 2.03mmol/L；钾离子(K+)-静脉血: 3.4mmol/L；磷(P)-静脉血: 1.05mmol/L；白蛋白(ALB)-静脉血: 36.3g/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 337g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；直接胆红素(DBIL)-静脉血: 5.4umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 94.2fL；氯离子(Cl-)-静脉血: 105.6mmol/L；肌酐(Crea)-静脉血: 70umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；胱抑素(Cys-C)-静脉血: 0.85mg/L；球蛋白(GLO)-静脉血: 21.19g/L；间接胆红素(IBIL)-静脉血: 5.9umolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.……\n\n【既往治疗与反应】\n- [全程D29] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，未诉特殊不适，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，较前缩小，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，指示继续放疗，密切观察放疗中副反应，遵嘱执行。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，予以重组人血小板生成素（rhTPO）皮下注射，待血小板恢复后继续放疗。\nB. 继续放疗，予以重组人白介素-11（rhIL-11）皮下注射，复查血常规与生化常规。\nC. 暂停放疗，输注单采血小板1个治疗量，复查血常规与生化常规。\nD. 继续放疗，予以重组人粒细胞集落刺激因子（rhG-CSF）皮下注射，复查血常规。\nE. 继续放疗，予以洗鼻、免疫调节/辅助支持（如香菇多糖）及动静脉置管护理，复查血常规与生化常规。\nF. 暂停放疗，予以促红细胞生成素（EPO）皮下注射，待血红蛋白恢复后继续放疗。\nG. 继续放疗，予以低分子肝素皮下注射预防血栓，复查凝血功能与血常规。\nH. 暂停放疗，予以甲泼尼龙静脉滴注提升血小板，复查血常规与生化常规。\nI. 继续放疗，予以静脉输注人免疫球蛋白（IVIG），复查血常规与生化常规。\nJ. 终止放疗，予以单药化疗维持，配合洗鼻及动静脉置管护理。\nK. 继续放疗，予以重组人血小板生成素与重组人粒细胞集落刺激因子联合皮下注射。\nL. 暂停放疗，予以洗鼻及动静脉置管护理，暂不予升血小板药物干预。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：咽旁间隙、斜坡、蝶骨基底部、岩尖。\n文本分期信息：N3，M0。\n综合TNM状态：T3N3M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D35] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；镁离子(Mg2+)-静脉血: 0.88mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44；载脂蛋白B(apoB)-静脉血: 0.56g/L；钠离子(Na+)-静脉血: 143.1mmol/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞比容(Hct)-静脉血: 37.1%；甘油三酯(TG)-静脉血: 0.68mmol/L；葡萄糖(Glu)-静脉血: 4.35mmol/L；C-反应蛋白(CRP)-静脉血: 16.07mg/L；平均血小板体积(MPV)-静脉血: 11.3fL；血红蛋白(Hb)-静脉血: 125g/L；载脂蛋白AI(apoAI)-静脉血: 0.89g/L；红细胞计数(RBC#)-静脉血: 3.9410E12/L；血小板比容-静脉血: 10%；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；血小板计数(PLT#)-静脉血: 8910E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.14；天门冬氨酸氨基转移酶(AST)-静脉血: 16U/L；丙氨酸氨基转移酶(ALT)-静脉血: 16.4U/L；总钙(Ca)-静脉血: 2.03mmol/L；钾离子(K+)-静脉血: 3.4mmol/L；磷(P)-静脉血: 1.05mmol/L；白蛋白(ALB)-静脉血: 36.3g/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 337g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；直接胆红素(DBIL)-静脉血: 5.4umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 94.2fL；氯离子(Cl-)-静脉血: 105.6mmol/L；肌酐(Crea)-静脉血: 70umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；胱抑素(Cys-C)-静脉血: 0.85mg/L；球蛋白(GLO)-静脉血: 21.19g/L；间接胆红素(IBIL)-静脉血: 5.9umolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.……\n\n【既往治疗与反应】\n- [全程D29] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，未诉特殊不适，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，较前缩小，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，指示继续放疗，密切观察放疗中副反应，遵嘱执行。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，予以重组人血小板生成素（rhTPO）皮下注射，待血小板恢复后继续放疗。\nB. 继续放疗，予以重组人白介素-11（rhIL-11）皮下注射，复查血常规与生化常规。\nC. 暂停放疗，输注单采血小板1个治疗量，复查血常规与生化常规。\nD. 继续放疗，予以重组人粒细胞集落刺激因子（rhG-CSF）皮下注射，复查血常规。\nE. 继续放疗，予以洗鼻、免疫调节/辅助支持（如香菇多糖）及动静脉置管护理，复查血常规与生化常规。\nF. 暂停放疗，予以促红细胞生成素（EPO）皮下注射，待血红蛋白恢复后继续放疗。\nG. 继续放疗，予以低分子肝素皮下注射预防血栓，复查凝血功能与血常规。\nH. 暂停放疗，予以甲泼尼龙静脉滴注提升血小板，复查血常规与生化常规。\nI. 继续放疗，予以静脉输注人免疫球蛋白（IVIG），复查血常规与生化常规。\nJ. 终止放疗，予以单药化疗维持，配合洗鼻及动静脉置管护理。\nK. 继续放疗，予以重组人血小板生成素与重组人粒细胞集落刺激因子联合皮下注射。\nL. 暂停放疗，予以洗鼻及动静脉置管护理，暂不予升血小板药物干预。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-08d32abcf26a92c62d1dc762","patient_id":"patient-9fcde7a95f4d57501ecbf7b2","turn_id":"turn07","turn_position":6,"turn_type":"response_assessment_decision","gold_letter":"F","gold_action":"取消第三程同期化疗，按原计划完成根治性放疗，胆囊结石暂予观察，放疗结束后择期行全面疗效评估。","options":[{"letter":"A","text":"强制收治入院完成第三程同期化疗，期间暂停放疗，待化疗结束后恢复放疗。","is_gold":false},{"letter":"B","text":"取消第三程同期化疗，加用西妥昔单抗靶向治疗联合放疗，放疗结束后行疗效评估。","is_gold":false},{"letter":"C","text":"提前终止放疗，行全身PET-CT及头颈部MRI评估，视肿瘤退缩情况决定后续辅助化疗方案。","is_gold":false},{"letter":"D","text":"取消第三程同期化疗，下调原定放疗处方剂量以减轻黏膜反应，放疗结束后即刻行鼻咽镜活检。","is_gold":false},{"letter":"E","text":"安排入院行TPF方案补充化疗，同时继续放疗，放疗结束后行全面疗效评估。","is_gold":false},{"letter":"F","text":"取消第三程同期化疗，按原计划完成根治性放疗，胆囊结石暂予观察，放疗结束后择期行全面疗效评估。","is_gold":true},{"letter":"G","text":"请普外科急会诊行腹腔镜胆囊切除术，术后择期恢复放疗，并取消后续化疗。","is_gold":false},{"letter":"H","text":"改用口服卡培他滨单药替代静脉化疗，继续门诊放疗，放疗结束后行辅助化疗。","is_gold":false},{"letter":"I","text":"立即行鼻咽及颈部MRI复查，若肿瘤已完全消退则提前结束放疗，进入随访阶段。","is_gold":false},{"letter":"J","text":"取消第三程同期化疗，增加放疗靶区外扩范围及处方剂量，放疗结束后择期行全面疗效评估。","is_gold":false},{"letter":"K","text":"暂停放疗，待咽痛及口腔黏膜反应完全缓解后再恢复放疗，并补充第三程化疗。","is_gold":false},{"letter":"L","text":"采用中药及针灸治疗替代第三程化疗，继续门诊放疗，放疗结束后常规行全身骨扫描。","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：咽旁间隙、斜坡、蝶骨基底部、岩尖。\n文本分期信息：N3，M0。\n综合TNM状态：T3N3M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D40] 检验组合: 钾离子(K+)-静脉血: 3.64mmol/L；血小板比容-静脉血: 12%；平均红细胞体积(MCV)-静脉血: 94.1fL；乳酸脱氢酶(LDH)-静脉血: 181.7U/L；碱性磷酸酶(ALP)-静脉血: 62.2U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.2；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.83mmolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.7；中性粒细胞计数(Neut#)-静脉血: 1.710E9/L；尿酸(UA)-静脉血: 230.6umol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.9pg；直接胆红素(DBIL)-静脉血: 3.3umol/L；磷(P)-静脉血: 1.27mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 13.3U/L；总胆固醇(TC)-静脉血: 2.44mmol/L；血小板分布宽度(PDW)-静脉血: 12%；平均血小板体积(MPV)-静脉血: 10.9fL；间接胆红素(IBIL)-静脉血: 3.9umolL；阴离子间隙(AG)-静脉血: 10.4；大血小板百分比(P-LCR%)-静脉血: 31.2%；镁离子(Mg2+)-静脉血: 0.87mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.028；低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.25mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 29.7mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.118；白细胞计数(WBC#)-静脉血: 2.4610E9/L；单核细胞百分比(Mono%)-静脉血: 0.179；单核细胞计数(Mono#)-静脉血: 0.410E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.16；丙氨酸氨基转移酶(ALT)-静脉血: 11.5U/L；C-反应蛋白(CRP)-静脉血: 17.05mg/L；白蛋白(ALB)-静脉血: 36.9g/L；总钙(Ca)-静脉血: 2.05mmol/L；总胆汁酸(TBA)-静脉血: 6.7umol/L；红细胞比容(Hct)-静脉血: 36.9%；葡萄糖(Glu)-静脉血: 5.02mmol/L；氯离子(Cl-)-静脉血: 102.1mmol/L；血小板计数(PLT#)……\n- [全程D42] 检验组合: 比重(SG)-尿液: 1.015；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 5；颜色-尿液: Light-Yellow；总蛋白(TP)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）\n- [全程D43] 检验组合: 颜色-尿液: Yellow；总蛋白(TP)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酮体(KET)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 10/μL；酸碱度(pH)-尿液: 5.5；胆红素(BIL)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 2/μL；比重(SG)-尿液: 1.02；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D46] 检验组合: 红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8%；间接胆红素(IBIL)-静脉血: 5.4umolL；尿酸(UA)-静脉血: 292.3umol/L；血小板分布宽度(PDW)-静脉血: 16.6%；磷(P)-静脉血: 1.39mmol/L；白细胞计数(WBC#)-静脉血: 3.2610E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 29.4U/L；中性粒细胞计数(Neut#)-静脉血: 2.510E9/L；总钙(Ca)-静脉血: 2.23mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 33pg；低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.63mmol/L；阴离子间隙(AG)-静脉血: 12；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.7；钠离子(Na+)-静脉血: 142mmol/L；钾离子(K+)-静脉血: 3.3mmol/L；氯离子(Cl-)-静脉血: 97.5mmol/L；白蛋白(ALB)-静脉血: 42.8g/L；总胆汁酸(TBA)-静脉血: 2.9umol/L；单核细胞百分比(Mono%)-静脉血: 0.143；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞比容(Hct)-静脉血: 40.8%；肌酐(Crea)-静脉血: 84.7umol/L；碱性磷酸酶(ALP)-静脉血: 64.7U/L；尿素氮(BUN)-静脉血: 5.06mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；总胆红素(TBIL)-静脉血: 9.3umol/L；载脂蛋白B(apoB)-静脉血: 0.65g/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；葡萄糖(Glu)-静脉血: 5.63mmol/L；球蛋白(GLO)-静脉血: 24.97g/L；C-反应蛋白(CRP)-静脉血: 6.22mg/L；镁离子(Mg2+)-静脉血: 0.97mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；α-L-岩藻糖苷酶(AFU)-静脉血: 40U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.009；平均红细胞血红蛋白浓度(MCHC)-静脉血: 342.2g/L；载脂蛋白AI(apoAI)-静脉血: 0.96g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 28.……\n- [全程D56] 检验组合: 碱性磷酸酶(ALP)-静脉血: 64.1U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；钾离子(K+)-静脉血: 3.65mmol/L；总蛋白(TP)-静脉血: 62.2g/L；血液二氧化碳含量ctCO2(B)-静脉血: 32mmol/L；胱抑素(Cys-C)-静脉血: 0.81mg/L；钠离子(Na+)-静脉血: 139.1mmol/L；红细胞比容(Hct)-静脉血: 38.2%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.5；载脂蛋白B(apoB)-静脉血: 0.72g/L；阴离子间隙(AG)-静脉血: 7.6；平均血小板体积(MPV)-静脉血: 10.7fL；丙氨酸氨基转移酶(ALT)-静脉血: 8.1U/L；中性粒细胞百分比(Neut%)-静脉血: 0.707；低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.56mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 13.8U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.69mmolL；总胆固醇(TC)-静脉血: 2.82mmol/L；总胆红素(TBIL)-静脉血: 9.5umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 14U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；乳酸脱氢酶(LDH)-静脉血: 146.4U/L；单核细胞百分比(Mono%)-静脉血: 0.202；血小板分布宽度(PDW)-静脉血: 12.5%；α-L-岩藻糖苷酶(AFU)-静脉血: 22.8U/L；肌酐(Crea)-静脉血: 73.2umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；磷(P)-静脉血: 1.17mmol/L；氯离子(Cl-)-静脉血: 99.5mmol/L；尿素氮(BUN)-静脉血: 4.3mmol/L；血小板比容-静脉血: 11%；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；总胆汁酸(TBA)-静脉血: 3.7umol/L；甘油三酯(TG)-静脉血: 0.85mmol/L；间接胆红素(IBIL)-静脉血: 5.5umolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.7；直接胆红素(DBIL)-静脉血: 4u……\n- [全程D62] 检验组合: 细菌涂片3-咽拭子: 未发现念珠状菌\n- [全程D63] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径10mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约27cm/s。 胆囊餐后改变，胆囊内可见一强回声团，直径约9mm，后方伴声影。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约33×27×24mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 胆囊结石。 肝脏、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n\n【既往治疗与反应】\n- [全程D42] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉咽痛，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。BR、生化常规大致正常。[姓名已隐去]主诊医生信息已隐藏，考虑患者上次化疗已达3周，指示今日按[计划性表述已隐藏]以DDP方案化疗第二程，做好水化、护肝等对症支持处理，继续放疗，密切观察放化疗副反应，遵嘱执行。\n- [全程D47] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉咽痛，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，认为患者化疗顺利完成，指示继续放疗，密切观察放疗副反应，遵嘱执行。\n- [全程D52] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉咽痛，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，指示予以止痛、口腔粘膜保护对症处理，加强营养支持，继续放疗。\n- [全程D57] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，未诉明显特殊不适，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，指示继续放疗，遵嘱执行。\n- [全程D61] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，未诉明显特殊不适，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]医生信息已隐藏，考虑患者化疗即将到期，建议患者行第三程化疗，但患者拒绝，遂指示今日予以出院，于门诊继续放疗，遵嘱执行。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 强制收治入院完成第三程同期化疗，期间暂停放疗，待化疗结束后恢复放疗。\nB. 取消第三程同期化疗，加用西妥昔单抗靶向治疗联合放疗，放疗结束后行疗效评估。\nC. 提前终止放疗，行全身PET-CT及头颈部MRI评估，视肿瘤退缩情况决定后续辅助化疗方案。\nD. 取消第三程同期化疗，下调原定放疗处方剂量以减轻黏膜反应，放疗结束后即刻行鼻咽镜活检。\nE. 安排入院行TPF方案补充化疗，同时继续放疗，放疗结束后行全面疗效评估。\nF. 取消第三程同期化疗，按原计划完成根治性放疗，胆囊结石暂予观察，放疗结束后择期行全面疗效评估。\nG. 请普外科急会诊行腹腔镜胆囊切除术，术后择期恢复放疗，并取消后续化疗。\nH. 改用口服卡培他滨单药替代静脉化疗，继续门诊放疗，放疗结束后行辅助化疗。\nI. 立即行鼻咽及颈部MRI复查，若肿瘤已完全消退则提前结束放疗，进入随访阶段。\nJ. 取消第三程同期化疗，增加放疗靶区外扩范围及处方剂量，放疗结束后择期行全面疗效评估。\nK. 暂停放疗，待咽痛及口腔黏膜反应完全缓解后再恢复放疗，并补充第三程化疗。\nL. 采用中药及针灸治疗替代第三程化疗，继续门诊放疗，放疗结束后常规行全身骨扫描。\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：咽旁间隙、斜坡、蝶骨基底部、岩尖。\n文本分期信息：N3，M0。\n综合TNM状态：T3N3M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D40] 检验组合: 钾离子(K+)-静脉血: 3.64mmol/L；血小板比容-静脉血: 12%；平均红细胞体积(MCV)-静脉血: 94.1fL；乳酸脱氢酶(LDH)-静脉血: 181.7U/L；碱性磷酸酶(ALP)-静脉血: 62.2U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.2；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.83mmolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.7；中性粒细胞计数(Neut#)-静脉血: 1.710E9/L；尿酸(UA)-静脉血: 230.6umol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.9pg；直接胆红素(DBIL)-静脉血: 3.3umol/L；磷(P)-静脉血: 1.27mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 13.3U/L；总胆固醇(TC)-静脉血: 2.44mmol/L；血小板分布宽度(PDW)-静脉血: 12%；平均血小板体积(MPV)-静脉血: 10.9fL；间接胆红素(IBIL)-静脉血: 3.9umolL；阴离子间隙(AG)-静脉血: 10.4；大血小板百分比(P-LCR%)-静脉血: 31.2%；镁离子(Mg2+)-静脉血: 0.87mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.028；低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.25mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 29.7mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.118；白细胞计数(WBC#)-静脉血: 2.4610E9/L；单核细胞百分比(Mono%)-静脉血: 0.179；单核细胞计数(Mono#)-静脉血: 0.410E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.16；丙氨酸氨基转移酶(ALT)-静脉血: 11.5U/L；C-反应蛋白(CRP)-静脉血: 17.05mg/L；白蛋白(ALB)-静脉血: 36.9g/L；总钙(Ca)-静脉血: 2.05mmol/L；总胆汁酸(TBA)-静脉血: 6.7umol/L；红细胞比容(Hct)-静脉血: 36.9%；葡萄糖(Glu)-静脉血: 5.02mmol/L；氯离子(Cl-)-静脉血: 102.1mmol/L；血小板计数(PLT#)……\n- [全程D42] 检验组合: 比重(SG)-尿液: 1.015；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 5；颜色-尿液: Light-Yellow；总蛋白(TP)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）\n- [全程D43] 检验组合: 颜色-尿液: Yellow；总蛋白(TP)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酮体(KET)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 10/μL；酸碱度(pH)-尿液: 5.5；胆红素(BIL)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 2/μL；比重(SG)-尿液: 1.02；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D46] 检验组合: 红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8%；间接胆红素(IBIL)-静脉血: 5.4umolL；尿酸(UA)-静脉血: 292.3umol/L；血小板分布宽度(PDW)-静脉血: 16.6%；磷(P)-静脉血: 1.39mmol/L；白细胞计数(WBC#)-静脉血: 3.2610E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 29.4U/L；中性粒细胞计数(Neut#)-静脉血: 2.510E9/L；总钙(Ca)-静脉血: 2.23mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 33pg；低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.63mmol/L；阴离子间隙(AG)-静脉血: 12；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.7；钠离子(Na+)-静脉血: 142mmol/L；钾离子(K+)-静脉血: 3.3mmol/L；氯离子(Cl-)-静脉血: 97.5mmol/L；白蛋白(ALB)-静脉血: 42.8g/L；总胆汁酸(TBA)-静脉血: 2.9umol/L；单核细胞百分比(Mono%)-静脉血: 0.143；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞比容(Hct)-静脉血: 40.8%；肌酐(Crea)-静脉血: 84.7umol/L；碱性磷酸酶(ALP)-静脉血: 64.7U/L；尿素氮(BUN)-静脉血: 5.06mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；总胆红素(TBIL)-静脉血: 9.3umol/L；载脂蛋白B(apoB)-静脉血: 0.65g/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；葡萄糖(Glu)-静脉血: 5.63mmol/L；球蛋白(GLO)-静脉血: 24.97g/L；C-反应蛋白(CRP)-静脉血: 6.22mg/L；镁离子(Mg2+)-静脉血: 0.97mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；α-L-岩藻糖苷酶(AFU)-静脉血: 40U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.009；平均红细胞血红蛋白浓度(MCHC)-静脉血: 342.2g/L；载脂蛋白AI(apoAI)-静脉血: 0.96g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 28.……\n- [全程D56] 检验组合: 碱性磷酸酶(ALP)-静脉血: 64.1U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；钾离子(K+)-静脉血: 3.65mmol/L；总蛋白(TP)-静脉血: 62.2g/L；血液二氧化碳含量ctCO2(B)-静脉血: 32mmol/L；胱抑素(Cys-C)-静脉血: 0.81mg/L；钠离子(Na+)-静脉血: 139.1mmol/L；红细胞比容(Hct)-静脉血: 38.2%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.5；载脂蛋白B(apoB)-静脉血: 0.72g/L；阴离子间隙(AG)-静脉血: 7.6；平均血小板体积(MPV)-静脉血: 10.7fL；丙氨酸氨基转移酶(ALT)-静脉血: 8.1U/L；中性粒细胞百分比(Neut%)-静脉血: 0.707；低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.56mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 13.8U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.69mmolL；总胆固醇(TC)-静脉血: 2.82mmol/L；总胆红素(TBIL)-静脉血: 9.5umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 14U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；乳酸脱氢酶(LDH)-静脉血: 146.4U/L；单核细胞百分比(Mono%)-静脉血: 0.202；血小板分布宽度(PDW)-静脉血: 12.5%；α-L-岩藻糖苷酶(AFU)-静脉血: 22.8U/L；肌酐(Crea)-静脉血: 73.2umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；磷(P)-静脉血: 1.17mmol/L；氯离子(Cl-)-静脉血: 99.5mmol/L；尿素氮(BUN)-静脉血: 4.3mmol/L；血小板比容-静脉血: 11%；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；总胆汁酸(TBA)-静脉血: 3.7umol/L；甘油三酯(TG)-静脉血: 0.85mmol/L；间接胆红素(IBIL)-静脉血: 5.5umolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.7；直接胆红素(DBIL)-静脉血: 4u……\n- [全程D62] 检验组合: 细菌涂片3-咽拭子: 未发现念珠状菌\n- [全程D63] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径10mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约27cm/s。 胆囊餐后改变，胆囊内可见一强回声团，直径约9mm，后方伴声影。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约33×27×24mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 胆囊结石。 肝脏、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n\n【既往治疗与反应】\n- [全程D42] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉咽痛，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。BR、生化常规大致正常。[姓名已隐去]主诊医生信息已隐藏，考虑患者上次化疗已达3周，指示今日按[计划性表述已隐藏]以DDP方案化疗第二程，做好水化、护肝等对症支持处理，继续放疗，密切观察放化疗副反应，遵嘱执行。\n- [全程D47] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉咽痛，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，认为患者化疗顺利完成，指示继续放疗，密切观察放疗副反应，遵嘱执行。\n- [全程D52] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉咽痛，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，指示予以止痛、口腔粘膜保护对症处理，加强营养支持，继续放疗。\n- [全程D57] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，未诉明显特殊不适，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，指示继续放疗，遵嘱执行。\n- [全程D61] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，未诉明显特殊不适，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]医生信息已隐藏，考虑患者化疗即将到期，建议患者行第三程化疗，但患者拒绝，遂指示今日予以出院，于门诊继续放疗，遵嘱执行。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 强制收治入院完成第三程同期化疗，期间暂停放疗，待化疗结束后恢复放疗。\nB. 取消第三程同期化疗，加用西妥昔单抗靶向治疗联合放疗，放疗结束后行疗效评估。\nC. 提前终止放疗，行全身PET-CT及头颈部MRI评估，视肿瘤退缩情况决定后续辅助化疗方案。\nD. 取消第三程同期化疗，下调原定放疗处方剂量以减轻黏膜反应，放疗结束后即刻行鼻咽镜活检。\nE. 安排入院行TPF方案补充化疗，同时继续放疗，放疗结束后行全面疗效评估。\nF. 取消第三程同期化疗，按原计划完成根治性放疗，胆囊结石暂予观察，放疗结束后择期行全面疗效评估。\nG. 请普外科急会诊行腹腔镜胆囊切除术，术后择期恢复放疗，并取消后续化疗。\nH. 改用口服卡培他滨单药替代静脉化疗，继续门诊放疗，放疗结束后行辅助化疗。\nI. 立即行鼻咽及颈部MRI复查，若肿瘤已完全消退则提前结束放疗，进入随访阶段。\nJ. 取消第三程同期化疗，增加放疗靶区外扩范围及处方剂量，放疗结束后择期行全面疗效评估。\nK. 暂停放疗，待咽痛及口腔黏膜反应完全缓解后再恢复放疗，并补充第三程化疗。\nL. 采用中药及针灸治疗替代第三程化疗，继续门诊放疗，放疗结束后常规行全身骨扫描。\n\n请仅输出一个选项字母（A-L）。"}]}
+{"sample_id":"sample-bc1decc91eb488b9888718b5","patient_id":"patient-9fcde7a95f4d57501ecbf7b2","turn_id":"turn08","turn_position":7,"turn_type":"recurrence_or_salvage_decision","gold_letter":"G","gold_action":"结束根治性治疗进入随访，放疗后3个月复查影像学评估疗效","options":[{"letter":"A","text":"立即行双侧颈部淋巴结清扫术以彻底清除颈部残留病灶","is_gold":false},{"letter":"B","text":"立即行鼻咽及颈部局部追加外照射放疗10-15Gy推量","is_gold":false},{"letter":"C","text":"立即行全身PET-CT检查评估颈部淋巴结活性及远处转移","is_gold":false},{"letter":"D","text":"立即行鼻咽内镜下活检评估原发灶病理完全缓解情况","is_gold":false},{"letter":"E","text":"立即启动含铂双药方案辅助化疗2-3个周期强化全身控制","is_gold":false},{"letter":"F","text":"予以表皮生长因子受体靶向药物单药维持治疗半年至一年","is_gold":false},{"letter":"G","text":"结束根治性治疗进入随访，放疗后3个月复查影像学评估疗效","is_gold":true},{"letter":"H","text":"立即行颈部残留淋巴结细针穿刺活检以指导后续局部治疗","is_gold":false},{"letter":"I","text":"立即启动PD-1单抗等免疫检查点抑制剂维持治疗1年","is_gold":false},{"letter":"J","text":"予以抗炎及对症支持治疗，放疗后1个月复查鼻咽颈部MRI","is_gold":false},{"letter":"K","text":"立即采用原诱导化疗方案进行2至3个周期全身巩固化疗","is_gold":false},{"letter":"L","text":"立即行颈部残留淋巴结局部微波消融或放射性粒子植入术","is_gold":false}],"condition":"stateless_current_delta","prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：咽旁间隙、斜坡、蝶骨基底部、岩尖。\n文本分期信息：N3，M0。\n综合TNM状态：T3N3M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D64] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双上肺纹理增粗，走行尚自然，双上肺野可见小斑点、条索影，双上胸膜稍增厚，余双肺野内未见明确实质性病变。双侧肺门未见增大，纵隔未见增宽，心影大小形态未见明显异常。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 双上肺少许纤维增殖灶并双上胸膜稍增厚。\n- [全程D64] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌放疗结束，对比某次就诊时间片： 鼻咽腔未见明显狭窄，鼻咽各壁未见明显增厚，粘膜表面尚光滑，增强扫描明显强化。双侧咽隐窝变浅，双侧咽旁脂肪间隙稍狭窄。 双侧腭帆提肌、腭帆张肌、头长肌结构清晰。双侧咽后见小淋巴结，较大者短径约7mm。 双侧后鼻孔未见堵塞，口咽双侧壁未见受累增厚。 双侧翼腭窝、颞下窝未见异常。 蝶骨基底部、斜坡、双侧岩尖、双侧枕骨基底部骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽。双侧筛窦、蝶窦、上颌窦粘膜增厚，双侧乳突内见积液。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。蝶鞍形态未见异常，其内未见占位性病变。 双侧颈II区、右侧颈III、IV区见多发淋巴结，部分融合，较大者短径11mm，信号欠均匀，增强较明显不均匀强化。 双侧颌下腺、腮腺大小、形态未见异常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态未见异常，信号均匀，未见占位性病变。喉咽腔形态未见异常，未见占位性病变。；检查结论: 鼻咽癌放疗后改变，较前明显好转。 颅底骨质破坏。 双侧咽后、双侧颈部多发淋巴结，较前缩小。 鼻窦炎，乳突炎。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即行双侧颈部淋巴结清扫术以彻底清除颈部残留病灶\nB. 立即行鼻咽及颈部局部追加外照射放疗10-15Gy推量\nC. 立即行全身PET-CT检查评估颈部淋巴结活性及远处转移\nD. 立即行鼻咽内镜下活检评估原发灶病理完全缓解情况\nE. 立即启动含铂双药方案辅助化疗2-3个周期强化全身控制\nF. 予以表皮生长因子受体靶向药物单药维持治疗半年至一年\nG. 结束根治性治疗进入随访，放疗后3个月复查影像学评估疗效\nH. 立即行颈部残留淋巴结细针穿刺活检以指导后续局部治疗\nI. 立即启动PD-1单抗等免疫检查点抑制剂维持治疗1年\nJ. 予以抗炎及对症支持治疗，放疗后1个月复查鼻咽颈部MRI\nK. 立即采用原诱导化疗方案进行2至3个周期全身巩固化疗\nL. 立即行颈部残留淋巴结局部微波消融或放射性粒子植入术\n\n请仅输出一个选项字母（A-L）。","messages":[{"role":"user","content":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：咽旁间隙、斜坡、蝶骨基底部、岩尖。\n文本分期信息：N3，M0。\n综合TNM状态：T3N3M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 无可展示记录。\n\n【已完成检查与客观结果】\n- [全程D64] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双上肺纹理增粗，走行尚自然，双上肺野可见小斑点、条索影，双上胸膜稍增厚，余双肺野内未见明确实质性病变。双侧肺门未见增大，纵隔未见增宽，心影大小形态未见明显异常。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 双上肺少许纤维增殖灶并双上胸膜稍增厚。\n- [全程D64] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌放疗结束，对比某次就诊时间片： 鼻咽腔未见明显狭窄，鼻咽各壁未见明显增厚，粘膜表面尚光滑，增强扫描明显强化。双侧咽隐窝变浅，双侧咽旁脂肪间隙稍狭窄。 双侧腭帆提肌、腭帆张肌、头长肌结构清晰。双侧咽后见小淋巴结，较大者短径约7mm。 双侧后鼻孔未见堵塞，口咽双侧壁未见受累增厚。 双侧翼腭窝、颞下窝未见异常。 蝶骨基底部、斜坡、双侧岩尖、双侧枕骨基底部骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽。双侧筛窦、蝶窦、上颌窦粘膜增厚，双侧乳突内见积液。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。蝶鞍形态未见异常，其内未见占位性病变。 双侧颈II区、右侧颈III、IV区见多发淋巴结，部分融合，较大者短径11mm，信号欠均匀，增强较明显不均匀强化。 双侧颌下腺、腮腺大小、形态未见异常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态未见异常，信号均匀，未见占位性病变。喉咽腔形态未见异常，未见占位性病变。；检查结论: 鼻咽癌放疗后改变，较前明显好转。 颅底骨质破坏。 双侧咽后、双侧颈部多发淋巴结，较前缩小。 鼻窦炎，乳突炎。\n\n【既往治疗与反应】\n- 无可展示记录。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即行双侧颈部淋巴结清扫术以彻底清除颈部残留病灶\nB. 立即行鼻咽及颈部局部追加外照射放疗10-15Gy推量\nC. 立即行全身PET-CT检查评估颈部淋巴结活性及远处转移\nD. 立即行鼻咽内镜下活检评估原发灶病理完全缓解情况\nE. 立即启动含铂双药方案辅助化疗2-3个周期强化全身控制\nF. 予以表皮生长因子受体靶向药物单药维持治疗半年至一年\nG. 结束根治性治疗进入随访，放疗后3个月复查影像学评估疗效\nH. 立即行颈部残留淋巴结细针穿刺活检以指导后续局部治疗\nI. 立即启动PD-1单抗等免疫检查点抑制剂维持治疗1年\nJ. 予以抗炎及对症支持治疗，放疗后1个月复查鼻咽颈部MRI\nK. 立即采用原诱导化疗方案进行2至3个周期全身巩固化疗\nL. 立即行颈部残留淋巴结局部微波消融或放射性粒子植入术\n\n请仅输出一个选项字母（A-L）。"}]}
diff --git a/supplementary/carepath_history/episodes.jsonl b/supplementary/carepath_history/episodes.jsonl
new file mode 100644
index 0000000000000000000000000000000000000000..81ee3ce93210ef47abfc0ce34b2f00c5505a8d11
--- /dev/null
+++ b/supplementary/carepath_history/episodes.jsonl
@@ -0,0 +1,25 @@
+{"patient_id":"patient-5fa48522b2703f35ead0224b","bootstrap_cluster_id":"cluster-008","turns":[{"sample_id":"sample-c56105087904f0da386b7001","patient_id":"patient-5fa48522b2703f35ead0224b","turn_id":"turn02","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、斜坡、口咽、蝶骨基底部、岩尖。\n文本分期信息：N2，Mx 左侧腋窝淋巴结可疑转移。\n综合TNM状态：T3N2Mx 左侧腋窝淋巴结可疑转移。\n综合分期：未明。\n\n【已知病史与当前主诉】\n- 暂无可展示的初诊主诉/入院资料。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 正常范围心电图\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽左顶壁、左顶后壁、左侧壁增厚，并见团块状软组织信号影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，鼻咽右侧壁粘膜未见增厚，左侧咽隐窝闭塞，右侧咽隐窝存在，左侧咽旁脂肪间隙狭窄。左侧腭帆提肌、腭帆张肌、头长肌、翼内肌受侵犯，余咽旁诸肌未见异常； 左侧咽后见肿大的淋巴结，短径22mm，右侧咽后见小淋巴结，短径5mm。 病灶向前堵塞左侧后鼻孔，口咽左侧壁受侵增厚。 左侧翼腭窝软组织影稍增多，右侧翼腭窝、双侧颞下窝未见异常。 蝶骨基底部、斜坡左侧份、左侧岩尖骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、上颌窦粘膜增厚；蝶窦、双侧乳突气化良好，未见异常信号影；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。 双颈II区、左颈III区见多个淋巴结，较大者短径24mm，信号欠均匀，增强扫描不均匀强化。；检查结论: 鼻咽左顶后壁、左侧壁病灶，考虑鼻咽癌，侵犯左侧咽旁、口咽左侧壁。 颅底骨质破坏。 双侧咽后、双颈II区、左颈III区淋巴结，考虑转移瘤。 副鼻窦炎。\n- [全程D5] 检验组合: 红细胞比容(Hct)-静脉血: 38.9%；血红蛋白(Hb)-静脉血: 131.6g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.5mmolL；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；总蛋白(TP)-静脉血: 69.64g/L；总钙(Ca)-静脉血: 2.26mmol/L；白蛋白(ALB)-静脉血: 43.1g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.42mmol/L；磷(P)-静脉血: 1.22mmol/L；凝血酶时间(TT)-静脉血: 17.3sec.；淋巴细胞百分比(Lymph%)-静脉血: 0.325；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；钠离子(Na+)-静脉血: 140.5mmol/L；单核细胞百分比(Mono%)-静脉血: 0.0954；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；载脂蛋白AI(apoAI)-静脉血: 1.38g/L；丙氨酸氨基转移酶(ALT)-静脉血: 21.7U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；氯离子(Cl-)-静脉血: 103.9mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；血小板计数(PLT#)-静脉血: 270.910E9/L；总胆固醇(TC)-静脉血: 5.3mmol/L；C-反应蛋白(CRP)-静脉血: 0.37mg/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.69mmol/L；甘油三酯(TG)-静脉血: 0.78mmol/L；淋巴细胞计数(Lymph#)-静脉血: 210E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.568；凝血酶原时间活动度(PTA)-静脉血: 94%；活化部分凝血活酶时间(APTT)-静脉血: 25.3sec.；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；平均红细胞血红蛋白含量(MCH)-静脉血: 30.2pg；凝血酶原时间(PT)-静脉血: 11.4sec.；纤维蛋白原(Fbg)-静脉血: 2.62g/L；天门冬氨酸氨基转移酶/丙氨酸氨……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善血浆EBV-DNA检测，若结果阳性则临床确诊鼻咽癌并启动根治性放疗\nB. 行鼻咽肿物开放性切除活检以明确病理诊断，并完善胸腹部CT及骨扫描\nC. 行颈部淋巴结切除活检以明确病理诊断，暂缓全身远处转移排查\nD. 行颈部淋巴结细针穿刺细胞学检查（FNAC）作为最终确诊依据，并完善全身分期检查\nE. 行鼻咽镜下活检以明确病理诊断，无需常规进行胸腹部影像学分期\nF. 优先行全身PET-CT检查，若无远处转移则直接开始诱导化疗\nG. 行双侧颈部淋巴结清扫术并送常规病理，确诊后安排术后放疗\nH. 行鼻咽镜下活检以明确病理诊断，并仅行头颈部增强CT以补充评估颅底骨质破坏\nI. 行鼻咽镜下活检以明确病理诊断，并直接安排诱导化疗，化疗后补充全身分期检查\nJ. 行颈部淋巴结穿刺活检或鼻咽镜活检以明确病理诊断，并完善全身分期检查\nK. 密切观察鼻咽部病灶及颈部淋巴结变化，1个月后复查头颈部MRI决定是否活检\nL. 行颈部淋巴结穿刺活检，确诊后直接启动根治性放疗，无需全身分期检查\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"完善血浆EBV-DNA检测，若结果阳性则临床确诊鼻咽癌并启动根治性放疗","is_gold":false},{"letter":"B","text":"行鼻咽肿物开放性切除活检以明确病理诊断，并完善胸腹部CT及骨扫描","is_gold":false},{"letter":"C","text":"行颈部淋巴结切除活检以明确病理诊断，暂缓全身远处转移排查","is_gold":false},{"letter":"D","text":"行颈部淋巴结细针穿刺细胞学检查（FNAC）作为最终确诊依据，并完善全身分期检查","is_gold":false},{"letter":"E","text":"行鼻咽镜下活检以明确病理诊断，无需常规进行胸腹部影像学分期","is_gold":false},{"letter":"F","text":"优先行全身PET-CT检查，若无远处转移则直接开始诱导化疗","is_gold":false},{"letter":"G","text":"行双侧颈部淋巴结清扫术并送常规病理，确诊后安排术后放疗","is_gold":false},{"letter":"H","text":"行鼻咽镜下活检以明确病理诊断，并仅行头颈部增强CT以补充评估颅底骨质破坏","is_gold":false},{"letter":"I","text":"行鼻咽镜下活检以明确病理诊断，并直接安排诱导化疗，化疗后补充全身分期检查","is_gold":false},{"letter":"J","text":"行颈部淋巴结穿刺活检或鼻咽镜活检以明确病理诊断，并完善全身分期检查","is_gold":true},{"letter":"K","text":"密切观察鼻咽部病灶及颈部淋巴结变化，1个月后复查头颈部MRI决定是否活检","is_gold":false},{"letter":"L","text":"行颈部淋巴结穿刺活检，确诊后直接启动根治性放疗，无需全身分期检查","is_gold":false}],"gold_letter":"J"},{"sample_id":"sample-9b76347b9a2749777a06cd80","patient_id":"patient-5fa48522b2703f35ead0224b","turn_id":"turn04","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、斜坡、口咽、蝶骨基底部、岩尖。\n文本分期信息：N2，Mx 左侧腋窝淋巴结可疑转移。\n综合TNM状态：T3N2Mx 左侧腋窝淋巴结可疑转移。\n综合分期：未明。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 正常范围心电图\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽左顶壁、左顶后壁、左侧壁增厚，并见团块状软组织信号影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，鼻咽右侧壁粘膜未见增厚，左侧咽隐窝闭塞，右侧咽隐窝存在，左侧咽旁脂肪间隙狭窄。左侧腭帆提肌、腭帆张肌、头长肌、翼内肌受侵犯，余咽旁诸肌未见异常； 左侧咽后见肿大的淋巴结，短径22mm，右侧咽后见小淋巴结，短径5mm。 病灶向前堵塞左侧后鼻孔，口咽左侧壁受侵增厚。 左侧翼腭窝软组织影稍增多，右侧翼腭窝、双侧颞下窝未见异常。 蝶骨基底部、斜坡左侧份、左侧岩尖骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、上颌窦粘膜增厚；蝶窦、双侧乳突气化良好，未见异常信号影；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。 双颈II区、左颈III区见多个淋巴结，较大者短径24mm，信号欠均匀，增强扫描不均匀强化。；检查结论: 鼻咽左顶后壁、左侧壁病灶，考虑鼻咽癌，侵犯左侧咽旁、口咽左侧壁。 颅底骨质破坏。 双侧咽后、双颈II区、左颈III区淋巴结，考虑转移瘤。 副鼻窦炎。\n- [全程D5] 检验组合: 红细胞比容(Hct)-静脉血: 38.9%；血红蛋白(Hb)-静脉血: 131.6g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.5mmolL；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；总蛋白(TP)-静脉血: 69.64g/L；总钙(Ca)-静脉血: 2.26mmol/L；白蛋白(ALB)-静脉血: 43.1g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.42mmol/L；磷(P)-静脉血: 1.22mmol/L；凝血酶时间(TT)-静脉血: 17.3sec.；淋巴细胞百分比(Lymph%)-静脉血: 0.325；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；钠离子(Na+)-静脉血: 140.5mmol/L；单核细胞百分比(Mono%)-静脉血: 0.0954；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；载脂蛋白AI(apoAI)-静脉血: 1.38g/L；丙氨酸氨基转移酶(ALT)-静脉血: 21.7U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；氯离子(Cl-)-静脉血: 103.9mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；血小板计数(PLT#)-静脉血: 270.910E9/L；总胆固醇(TC)-静脉血: 5.3mmol/L；C-反应蛋白(CRP)-静脉血: 0.37mg/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.69mmol/L；甘油三酯(TG)-静脉血: 0.78mmol/L；淋巴细胞计数(Lymph#)-静脉血: 210E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.568；凝血酶原时间活动度(PTA)-静脉血: 94%；活化部分凝血活酶时间(APTT)-静脉血: 25.3sec.；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；平均红细胞血红蛋白含量(MCH)-静脉血: 30.2pg；凝血酶原时间(PT)-静脉血: 11.4sec.；纤维蛋白原(Fbg)-静脉血: 2.62g/L；天门冬氨酸氨基转移酶/丙氨酸氨……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D8] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见:；检查结论:\n- [全程D14] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；透明质酸(HA)-静脉血: 76.89ng/ml；III型前胶原氨基端肽(PIIINP)-静脉血: 28.08ng/ml；葡萄糖(Glu)-尿液: -（参考: 阴性）；降钙素(CT)-静脉血: 22.05pg/ml；总蛋白(TP)-尿液: -（参考: 阴性）；IV型胶原(C-IV)-静脉血: 28.93ng/ml；比重(SG)-尿液: 1.008；颜色-尿液: 无色；酸碱度(pH)-尿液: 6.5；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；层粘连蛋白(LN)-静脉血: 35.29ng/ml；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D15] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T6水平，估计导管末端位于上腔静脉内。；检查结论: PICC管末端位置如上述。\n- [全程D15] 检验组合: 骨钙素N端中分子片段(N-MID)-静脉血: 11.9ng/ml；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.318ng/ml\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 同步放化疗（顺铂单药方案）\nB. 诱导化疗（吉西他滨+顺铂方案）联合PD-1抑制剂\nC. 根治性放疗联合辅助化疗（顺铂+氟尿嘧啶方案）\nD. 诱导化疗（紫杉醇+卡铂方案）\nE. 诱导化疗（多西他赛+顺铂+氟尿嘧啶方案）联合西妥昔单抗\nF. 根治性放疗（单纯放疗）\nG. 诱导化疗（卡培他滨单药方案）\nH. 靶向治疗（尼妥珠单抗）联合同步放化疗\nI. 诱导化疗（依托泊苷+顺铂方案）\nJ. 姑息性化疗（顺铂+氟尿嘧啶方案）\nK. 诱导化疗（顺铂单药方案）\nL. 诱导化疗（顺铂+氟尿嘧啶方案）\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"同步放化疗（顺铂单药方案）","is_gold":false},{"letter":"B","text":"诱导化疗（吉西他滨+顺铂方案）联合PD-1抑制剂","is_gold":false},{"letter":"C","text":"根治性放疗联合辅助化疗（顺铂+氟尿嘧啶方案）","is_gold":false},{"letter":"D","text":"诱导化疗（紫杉醇+卡铂方案）","is_gold":false},{"letter":"E","text":"诱导化疗（多西他赛+顺铂+氟尿嘧啶方案）联合西妥昔单抗","is_gold":false},{"letter":"F","text":"根治性放疗（单纯放疗）","is_gold":false},{"letter":"G","text":"诱导化疗（卡培他滨单药方案）","is_gold":false},{"letter":"H","text":"靶向治疗（尼妥珠单抗）联合同步放化疗","is_gold":false},{"letter":"I","text":"诱导化疗（依托泊苷+顺铂方案）","is_gold":false},{"letter":"J","text":"姑息性化疗（顺铂+氟尿嘧啶方案）","is_gold":false},{"letter":"K","text":"诱导化疗（顺铂单药方案）","is_gold":false},{"letter":"L","text":"诱导化疗（顺铂+氟尿嘧啶方案）","is_gold":true}],"gold_letter":"L"},{"sample_id":"sample-ad9c851cda35b0e3c9061982","patient_id":"patient-5fa48522b2703f35ead0224b","turn_id":"turn05","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、斜坡、口咽、蝶骨基底部、岩尖。\n文本分期信息：N2，Mx 左侧腋窝淋巴结可疑转移。\n综合TNM状态：T3N2Mx 左侧腋窝淋巴结可疑转移。\n综合分期：未明。\n\n【已知病史与当前主诉】\n- 暂无可展示的初诊主诉/入院资料。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 正常范围心电图\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽左顶壁、左顶后壁、左侧壁增厚，并见团块状软组织信号影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，鼻咽右侧壁粘膜未见增厚，左侧咽隐窝闭塞，右侧咽隐窝存在，左侧咽旁脂肪间隙狭窄。左侧腭帆提肌、腭帆张肌、头长肌、翼内肌受侵犯，余咽旁诸肌未见异常； 左侧咽后见肿大的淋巴结，短径22mm，右侧咽后见小淋巴结，短径5mm。 病灶向前堵塞左侧后鼻孔，口咽左侧壁受侵增厚。 左侧翼腭窝软组织影稍增多，右侧翼腭窝、双侧颞下窝未见异常。 蝶骨基底部、斜坡左侧份、左侧岩尖骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、上颌窦粘膜增厚；蝶窦、双侧乳突气化良好，未见异常信号影；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。 双颈II区、左颈III区见多个淋巴结，较大者短径24mm，信号欠均匀，增强扫描不均匀强化。；检查结论: 鼻咽左顶后壁、左侧壁病灶，考虑鼻咽癌，侵犯左侧咽旁、口咽左侧壁。 颅底骨质破坏。 双侧咽后、双颈II区、左颈III区淋巴结，考虑转移瘤。 副鼻窦炎。\n- [全程D5] 检验组合: 红细胞比容(Hct)-静脉血: 38.9%；血红蛋白(Hb)-静脉血: 131.6g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.5mmolL；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；总蛋白(TP)-静脉血: 69.64g/L；总钙(Ca)-静脉血: 2.26mmol/L；白蛋白(ALB)-静脉血: 43.1g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.42mmol/L；磷(P)-静脉血: 1.22mmol/L；凝血酶时间(TT)-静脉血: 17.3sec.；淋巴细胞百分比(Lymph%)-静脉血: 0.325；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；钠离子(Na+)-静脉血: 140.5mmol/L；单核细胞百分比(Mono%)-静脉血: 0.0954；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；载脂蛋白AI(apoAI)-静脉血: 1.38g/L；丙氨酸氨基转移酶(ALT)-静脉血: 21.7U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；氯离子(Cl-)-静脉血: 103.9mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；血小板计数(PLT#)-静脉血: 270.910E9/L；总胆固醇(TC)-静脉血: 5.3mmol/L；C-反应蛋白(CRP)-静脉血: 0.37mg/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.69mmol/L；甘油三酯(TG)-静脉血: 0.78mmol/L；淋巴细胞计数(Lymph#)-静脉血: 210E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.568；凝血酶原时间活动度(PTA)-静脉血: 94%；活化部分凝血活酶时间(APTT)-静脉血: 25.3sec.；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；平均红细胞血红蛋白含量(MCH)-静脉血: 30.2pg；凝血酶原时间(PT)-静脉血: 11.4sec.；纤维蛋白原(Fbg)-静脉血: 2.62g/L；天门冬氨酸氨基转移酶/丙氨酸氨……\n- [全程D14] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；透明质酸(HA)-静脉血: 76.89ng/ml；III型前胶原氨基端肽(PIIINP)-静脉血: 28.08ng/ml；葡萄糖(Glu)-尿液: -（参考: 阴性）；降钙素(CT)-静脉血: 22.05pg/ml；总蛋白(TP)-尿液: -（参考: 阴性）；IV型胶原(C-IV)-静脉血: 28.93ng/ml；比重(SG)-尿液: 1.008；颜色-尿液: 无色；酸碱度(pH)-尿液: 6.5；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；层粘连蛋白(LN)-静脉血: 35.29ng/ml；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D15] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T6水平，估计导管末端位于上腔静脉内。；检查结论: PICC管末端位置如上述。\n- [全程D15] 检验组合: 骨钙素N端中分子片段(N-MID)-静脉血: 11.9ng/ml；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.318ng/ml\n- [全程D16] 检验组合: 浊度(TRUB)-尿液: 清亮；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: +-（参考: 阴性）；酸碱度(pH)-尿液: 7；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.016；葡萄糖(Glu)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 3/μL\n- [全程D17] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 31/μL；颜色-尿液: Yellow；鳞状上皮细胞计数(SQEP#)-尿液: 7/μL；白细胞计数(WBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.021；浊度(TRUB)-尿液: 清亮；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D19] 检验组合: 总钙(Ca)-静脉血: 2.15mmol/L；钠离子(Na+)-静脉血: 138.8mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.2mmol/L；钾离子(K+)-静脉血: 3.08mmol/L；氯离子(Cl-)-静脉血: 102.2mmol/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；磷(P)-静脉血: 1.19mmol/L；阴离子间隙(AG)-静脉血: 15.4\n- [全程D20] 超声；双侧腋窝淋巴结彩超(套): 检查类型: 超声；检查名称: 双侧腋窝淋巴结彩超(套)；检查部位:；检查所见: 左侧腋窝腋下组可见1个淋巴结回声，大小约16x4mm，椭圆形，边界清，皮髓质分界清，淋巴门结构可探及。腋上组及腋中组未见明显异常淋巴结回声。 CDFI：上述淋巴结内可见门型血流信号。；检查结论: 左侧腋窝腋下组淋巴结，符合良性淋巴结声像。\n- [全程D20] 检验组合: 血小板计数(PLT#)-静脉血: 250.210E9/L；肌酐(Crea)-静脉血: 54umol/L；总胆红素(TBIL)-静脉血: 13.7umol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；阴离子间隙(AG)-静脉血: 12.4；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；碱性磷酸酶(ALP)-静脉血: 59.5U/L；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；球蛋白(GLO)-静脉血: 25.26g/L；葡萄糖(Glu)-静脉血: 4.81mmol/L；白蛋白(ALB)-静脉血: 40.9g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；尿素氮(BUN)-静脉血: 3.9mmol/L；血小板分布宽度(PDW)-静脉血: 15.8%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.38mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.05mmolL；乳酸脱氢酶(LDH)-静脉血: 275.2U/L；单核细胞百分比(Mono%)-静脉血: 0.0621；中性粒细胞计数(Neut#)-静脉血: 4.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.711；γ-谷氨酰基转移酶(GGT)-静脉血: 19.5U/L；甘油三酯(TG)-静脉血: 1.23mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.5pg；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.0032；磷(P)-静脉血: 1.37mmol/L；总钙(Ca)-静脉血: 2.23mmol/L；间接胆红素(IBIL)-静脉血: 9umolL；血小板比容-静脉血: 20.8%；C-反应蛋白(CRP)-静脉血: 0.65mg/L；载脂蛋白AI(apoAI)-静脉血: 1.12g/L；总蛋白(TP)-静脉血: 66.16g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.62；单核细胞计数(Mono#)-静脉血: 0.410E9/L；钠离子(Na+)-静脉血: 137.8mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 27.7U/L；丙氨酸氨基转移酶(ALT)-静脉……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D15] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D20] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗结束，诉呕吐 次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程5-FU+顺铂方案诱导化疗结束，无诉特殊不适，可予出院，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 办理出院，予以胸腺五肽皮下注射支持治疗，嘱每周复查血常规及生化，按期返院行第2程诱导化疗。\nB. 暂缓出院，继续静脉给予5-HT3受体拮抗剂及补液支持，待恶心呕吐完全缓解后出院。\nC. 办理出院，嘱每周复查血常规及生化，第2程诱导化疗将顺铂剂量下调20%。\nD. 办理出院，嘱每周复查血常规及生化，第2程诱导化疗更改为吉西他滨+顺铂（GP）方案。\nE. 办理出院，予以重组人粒细胞集落刺激因子（G-CSF）皮下注射，按期返院行第2程诱导化疗。\nF. 办理出院，予以重组人促红素（EPO）皮下注射，按期返院行第2程诱导化疗。\nG. 办理出院，予以胸腺五肽皮下注射支持治疗，并安排左侧腋窝淋巴结穿刺活检。\nH. 办理出院，予以胸腺五肽皮下注射支持治疗，嘱返院直接开始根治性放疗及同步化疗。\nI. 办理出院，予以口服阿瑞匹坦带药，嘱第2程诱导化疗推迟1周进行。\nJ. 办理出院，予以重组人血小板生成素（rhTPO）皮下注射，按期返院行第2程诱导化疗。\nK. 暂缓出院，复查鼻咽及颈部MRI评估近期疗效，结果决定第2程化疗方案。\nL. 办理出院，予以胸腺五肽皮下注射支持治疗，嘱第2程诱导化疗加用尼妥珠单抗。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"办理出院，予以胸腺五肽皮下注射支持治疗，嘱每周复查血常规及生化，按期返院行第2程诱导化疗。","is_gold":true},{"letter":"B","text":"暂缓出院，继续静脉给予5-HT3受体拮抗剂及补液支持，待恶心呕吐完全缓解后出院。","is_gold":false},{"letter":"C","text":"办理出院，嘱每周复查血常规及生化，第2程诱导化疗将顺铂剂量下调20%。","is_gold":false},{"letter":"D","text":"办理出院，嘱每周复查血常规及生化，第2程诱导化疗更改为吉西他滨+顺铂（GP）方案。","is_gold":false},{"letter":"E","text":"办理出院，予以重组人粒细胞集落刺激因子（G-CSF）皮下注射，按期返院行第2程诱导化疗。","is_gold":false},{"letter":"F","text":"办理出院，予以重组人促红素（EPO）皮下注射，按期返院行第2程诱导化疗。","is_gold":false},{"letter":"G","text":"办理出院，予以胸腺五肽皮下注射支持治疗，并安排左侧腋窝淋巴结穿刺活检。","is_gold":false},{"letter":"H","text":"办理出院，予以胸腺五肽皮下注射支持治疗，嘱返院直接开始根治性放疗及同步化疗。","is_gold":false},{"letter":"I","text":"办理出院，予以口服阿瑞匹坦带药，嘱第2程诱导化疗推迟1周进行。","is_gold":false},{"letter":"J","text":"办理出院，予以重组人血小板生成素（rhTPO）皮下注射，按期返院行第2程诱导化疗。","is_gold":false},{"letter":"K","text":"暂缓出院，复查鼻咽及颈部MRI评估近期疗效，结果决定第2程化疗方案。","is_gold":false},{"letter":"L","text":"办理出院，予以胸腺五肽皮下注射支持治疗，嘱第2程诱导化疗加用尼妥珠单抗。","is_gold":false}],"gold_letter":"A"},{"sample_id":"sample-9acca1b0c829ebdd4e952950","patient_id":"patient-5fa48522b2703f35ead0224b","turn_id":"turn06","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、斜坡、口咽、蝶骨基底部、岩尖。\n文本分期信息：N2，Mx 左侧腋窝淋巴结可疑转移。\n综合TNM状态：T3N2Mx 左侧腋窝淋巴结可疑转移。\n综合分期：未明。\n\n【已知病史与当前主诉】\n- 暂无可展示的初诊主诉/入院资料。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 正常范围心电图\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽左顶壁、左顶后壁、左侧壁增厚，并见团块状软组织信号影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，鼻咽右侧壁粘膜未见增厚，左侧咽隐窝闭塞，右侧咽隐窝存在，左侧咽旁脂肪间隙狭窄。左侧腭帆提肌、腭帆张肌、头长肌、翼内肌受侵犯，余咽旁诸肌未见异常； 左侧咽后见肿大的淋巴结，短径22mm，右侧咽后见小淋巴结，短径5mm。 病灶向前堵塞左侧后鼻孔，口咽左侧壁受侵增厚。 左侧翼腭窝软组织影稍增多，右侧翼腭窝、双侧颞下窝未见异常。 蝶骨基底部、斜坡左侧份、左侧岩尖骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、上颌窦粘膜增厚；蝶窦、双侧乳突气化良好，未见异常信号影；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。 双颈II区、左颈III区见多个淋巴结，较大者短径24mm，信号欠均匀，增强扫描不均匀强化。；检查结论: 鼻咽左顶后壁、左侧壁病灶，考虑鼻咽癌，侵犯左侧咽旁、口咽左侧壁。 颅底骨质破坏。 双侧咽后、双颈II区、左颈III区淋巴结，考虑转移瘤。 副鼻窦炎。\n- [全程D5] 检验组合: 红细胞比容(Hct)-静脉血: 38.9%；血红蛋白(Hb)-静脉血: 131.6g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.5mmolL；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；总蛋白(TP)-静脉血: 69.64g/L；总钙(Ca)-静脉血: 2.26mmol/L；白蛋白(ALB)-静脉血: 43.1g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.42mmol/L；磷(P)-静脉血: 1.22mmol/L；凝血酶时间(TT)-静脉血: 17.3sec.；淋巴细胞百分比(Lymph%)-静脉血: 0.325；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；钠离子(Na+)-静脉血: 140.5mmol/L；单核细胞百分比(Mono%)-静脉血: 0.0954；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；载脂蛋白AI(apoAI)-静脉血: 1.38g/L；丙氨酸氨基转移酶(ALT)-静脉血: 21.7U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；氯离子(Cl-)-静脉血: 103.9mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；血小板计数(PLT#)-静脉血: 270.910E9/L；总胆固醇(TC)-静脉血: 5.3mmol/L；C-反应蛋白(CRP)-静脉血: 0.37mg/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.69mmol/L；甘油三酯(TG)-静脉血: 0.78mmol/L；淋巴细胞计数(Lymph#)-静脉血: 210E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.568；凝血酶原时间活动度(PTA)-静脉血: 94%；活化部分凝血活酶时间(APTT)-静脉血: 25.3sec.；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；平均红细胞血红蛋白含量(MCH)-静脉血: 30.2pg；凝血酶原时间(PT)-静脉血: 11.4sec.；纤维蛋白原(Fbg)-静脉血: 2.62g/L；天门冬氨酸氨基转移酶/丙氨酸氨……\n- [全程D37] 检验组合: 嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.4；红细胞比容(Hct)-静脉血: 35.6%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞体积(MCV)-静脉血: 89.9fL；单核细胞百分比(Mono%)-静脉血: 0.046；血小板计数(PLT#)-静脉血: 21310E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.8pg；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.9；平均血小板体积(MPV)-静脉血: 9.2fL；单核细胞计数(Mono#)-静脉血: 0.410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；中性粒细胞百分比(Neut%)-静脉血: 0.79；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；血小板比容-静脉血: 20%；血红蛋白(Hb)-静脉血: 118g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.009；淋巴细胞百分比(Lymph%)-静脉血: 0.147；红细胞计数(RBC#)-静脉血: 3.9610E12/L；血小板分布宽度(PDW)-静脉血: 9.9%；大血小板百分比(P-LCR%)-静脉血: 18.7%；中性粒细胞计数(Neut#)-静脉血: 7.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；白细胞计数(WBC#)-静脉血: 910E9/L\n- [全程D40] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.018；草酸钙结晶计数(CAOX#)-尿液: 10/μL；红细胞计数(RBC#)-尿液: 4/μL；总蛋白(TP)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: 无色；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D41] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；红细胞计数(RBC#)-尿液: 4/μL；白细胞(LEU)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；酮体(KET)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 1/μL；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.024；颜色-尿液: Light-Yellow\n- [全程D42] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 6/μL；隐血(OB)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 4/μL；总蛋白(TP)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7；颜色-尿液: Light-Yellow；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.023；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）；细菌计数(BACT#)-尿液: 8/μL\n- [全程D47] 超声；双侧腋窝淋巴结彩超(套): 检查类型: 超声；检查名称: 双侧腋窝淋巴结彩超(套)；检查部位:；检查所见: 双侧侧腋窝腋下组可见多个淋巴结回声，最大约12x6mm，椭圆形，边界清，皮髓质分界清，淋巴门结构可探及。腋上组及腋中组未见明显异常淋巴结回声。 CDFI：上述淋巴结内可见门型血流信号。；检查结论: 左侧腋窝腋下组淋巴结，符合良性淋巴结声像。\n- [全程D47] 检验组合: 有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 89.5fL；钠离子(Na+)-静脉血: 135.9mmol/L；尿酸(UA)-静脉血: 277.5umol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.0062；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；血红蛋白(Hb)-静脉血: 115.6g/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 332.5g/L；碱性磷酸酶(ALP)-静脉血: 63.1U/L；白蛋白(ALB)-静脉血: 39.9g/L；单核细胞百分比(Mono%)-静脉血: 0.056；α-L-岩藻糖苷酶(AFU)-静脉血: 42.7U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.315；尿素氮(BUN)-静脉血: 5.4mmol/L；白细胞计数(WBC#)-静脉血: 4.0510E9/L；总胆固醇(TC)-静脉血: 4.12mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24U/L；氯离子(Cl-)-静脉血: 99.2mmol/L；载脂蛋白B(apoB)-静脉血: 0.78g/L；丙氨酸氨基转移酶(ALT)-静脉血: 41.3U/L；总胆汁酸(TBA)-静脉血: 0.5umol/L；血小板计数(PLT#)-静脉血: 196.310E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.5%；葡萄糖(Glu)-静脉血: 4.67mmol/L；球蛋白(GLO)-静脉血: 23.82g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.3mmol/L；间接胆红素(IBIL)-静脉血: 7umolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.0051；镁离子(Mg2+)-静脉血: 0.69mmol/L；磷(P)-静脉血: 1.4mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 3.7umol/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；总钙(Ca)-静脉血: 2.27mmol/L；胱抑素(Cys-C)-静脉血: 0.95mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.68；中性粒细胞百分比(……\n- [全程D49] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后： 鼻咽腔轻度狭窄，鼻咽左顶壁、左顶后壁、左侧壁增厚，并见团块状软组织信号影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。鼻咽右侧壁粘膜未见增厚，左侧咽隐窝闭塞，右侧咽隐窝存在，左侧咽旁脂肪间隙狭窄。左侧腭帆提肌、腭帆张肌、头长肌受侵犯，余咽旁诸肌未见异常。 鼻腔未见肿物，口咽左侧壁受侵稍增厚。 双侧翼腭窝、双侧颞下窝未见异常。 蝶骨基底部、斜坡左侧份、左侧岩尖、左侧翼突基底部、左侧翼突内侧板骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、上颌窦、蝶窦、双侧乳突气化良好，未见异常信号影。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。蝶鞍形态正常，其内未见占位性病变。 左侧咽后见肿大的淋巴结，短径17mm，右侧咽后见小淋巴结，短径5mm。左颈II、III区见多个肿大淋巴结，较大者短径13mm，信号欠均匀，增强扫描不均匀强化。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。 扫描所见脑组织未见明确异常。；检查结论: 鼻咽癌化疗后，对比某次就诊时间日片： 鼻咽肿物，较前明显缩小。 颅底骨质破坏，基本同前。 左侧咽后淋巴结、左颈II、III区淋巴结，考虑转移瘤，较前明显缩小。右侧咽后小淋巴结，较前变化不大。\n- [全程D50] 检验组合: 总胆红素(TBIL)-静脉血: 8.1umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 20710E9/L；磷(P)-静脉血: 1.19mmol/L；中性粒细胞计数(Neut#)-静脉血: 2.810E9/L；葡萄糖(Glu)-静脉血: 5.75mmol/L；血红蛋白(Hb)-静脉血: 118g/L；尿酸(UA)-静脉血: 347.3umol/L；平均红细胞体积(MCV)-静脉血: 85.6fL；胱抑素(Cys-C)-静脉血: 1.01mg/L；红细胞比容(Hct)-静脉血: 34%；C-反应蛋白(CRP)-静脉血: 0.45mg/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；白蛋白(ALB)-静脉血: 44.1g/L；肌酐(Crea)-静脉血: 93.9umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 44.6U/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；总钙(Ca)-静脉血: 2.32mmol/L；红细胞计数(RBC#)-静脉血: 3.9710E12/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.1；球蛋白(GLO)-静脉血: 26.11g/L；尿素氮(BUN)-静脉血: 7.9mmol/L；钾离子(K+)-静脉血: 3.55mmol/L；载脂蛋白B(apoB)-静脉血: 0.88g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.72mmol/L；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.592；载脂蛋白AI(apoAI)-静脉血: 1.31g/L；乳酸脱氢酶(LDH)-静脉血: 232.4U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；总胆汁酸(TBA)-静脉血: 2.1umol/L；氯离子(Cl-)-静脉血: 102mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 23.5U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.33mmolL；总蛋白(TP)-静脉血: 70.21g/L；阴离子间隙(AG)-静脉血: 12.8；α-L-岩藻糖苷酶(AFU)-静脉血: 40.7U/L；总胆固醇(TC)-静脉血: 4.57mmol/L；白细胞计数(W……\n\n【既往治疗与反应】\n- [全程D36] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者复查血常规：中性粒细胞1.2×109/L。郭医生信息已隐藏：暂停化疗，予以患者升中西粒细胞处理。\n- [全程D37] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 患者入院第三天，继续升白细胞处理，今日复查血常规，白细胞已经恢复正常，郭医生信息已隐藏：下周一予以患者第二程化疗。\n- [全程D40] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，可于今日执行第2程5-FU+顺铂方案诱导化疗，注意化疗不良反应。\n- [全程D43] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D47] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+顺铂方案诱导化疗结束，诉恶心、食欲下降，无发热、呕吐、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第2程5-FU+顺铂方案诱导化疗结束，无诉特殊不适，嘱其完成鼻咽、颈MRI复查，以及放疗定位扫描，定期返院治疗。遵嘱。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 予以第3程5-FU+顺铂方案诱导化疗，并继续予以护胃、止呕、补液等常规对症支持治疗。\nB. 开始适形调强放射治疗（IMRT），并予以雾化吸入、鼻腔冲洗、皮肤及黏膜保护剂等放疗支持处理。\nC. 开始适形调强放射治疗（IMRT），待出现III度以上放射性皮炎或黏膜炎时再启动局部保护剂及雾化治疗。\nD. 予以第3程5-FU+顺铂方案诱导化疗，并预防性使用长效重组人粒细胞集落刺激因子。\nE. 开始适形调强放射治疗（IMRT），并常规预防性静脉滴注头孢类广谱抗生素及抗真菌药物。\nF. 暂缓抗肿瘤治疗，继续予以升白细胞及营养支持治疗，观察1-2周后再复查各项生化指标。\nG. 开始适形调强放射治疗（IMRT），并常规预防性静脉滴注大剂量糖皮质激素及甘露醇脱水。\nH. 开始适形调强放射治疗（IMRT），并预防性给予全胃肠外营养（TPN）及静脉高营养支持。\nI. 予以单药顺铂同期化疗，并常规予以水化、利尿及止吐等支持治疗，暂缓启动放射治疗。\nJ. 开始适形调强放射治疗（IMRT），并常规预防性口服非甾体抗炎药及阿片类镇痛药物。\nK. 开始适形调强放射治疗（IMRT），并予以预防性低分子肝素抗凝及深静脉置管常规护理。\nL. 予以靶向治疗联合适形调强放射治疗（IMRT），并常规予以抗过敏及皮疹预防对症处理。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"予以第3程5-FU+顺铂方案诱导化疗，并继续予以护胃、止呕、补液等常规对症支持治疗。","is_gold":false},{"letter":"B","text":"开始适形调强放射治疗（IMRT），并予以雾化吸入、鼻腔冲洗、皮肤及黏膜保护剂等放疗支持处理。","is_gold":true},{"letter":"C","text":"开始适形调强放射治疗（IMRT），待出现III度以上放射性皮炎或黏膜炎时再启动局部保护剂及雾化治疗。","is_gold":false},{"letter":"D","text":"予以第3程5-FU+顺铂方案诱导化疗，并预防性使用长效重组人粒细胞集落刺激因子。","is_gold":false},{"letter":"E","text":"开始适形调强放射治疗（IMRT），并常规预防性静脉滴注头孢类广谱抗生素及抗真菌药物。","is_gold":false},{"letter":"F","text":"暂缓抗肿瘤治疗，继续予以升白细胞及营养支持治疗，观察1-2周后再复查各项生化指标。","is_gold":false},{"letter":"G","text":"开始适形调强放射治疗（IMRT），并常规预防性静脉滴注大剂量糖皮质激素及甘露醇脱水。","is_gold":false},{"letter":"H","text":"开始适形调强放射治疗（IMRT），并预防性给予全胃肠外营养（TPN）及静脉高营养支持。","is_gold":false},{"letter":"I","text":"予以单药顺铂同期化疗，并常规予以水化、利尿及止吐等支持治疗，暂缓启动放射治疗。","is_gold":false},{"letter":"J","text":"开始适形调强放射治疗（IMRT），并常规预防性口服非甾体抗炎药及阿片类镇痛药物。","is_gold":false},{"letter":"K","text":"开始适形调强放射治疗（IMRT），并予以预防性低分子肝素抗凝及深静脉置管常规护理。","is_gold":false},{"letter":"L","text":"予以靶向治疗联合适形调强放射治疗（IMRT），并常规予以抗过敏及皮疹预防对症处理。","is_gold":false}],"gold_letter":"B"},{"sample_id":"sample-ba3079ee7b3ef01162117027","patient_id":"patient-5fa48522b2703f35ead0224b","turn_id":"turn07","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、斜坡、口咽、蝶骨基底部、岩尖。\n文本分期信息：N2，Mx 左侧腋窝淋巴结可疑转移。\n综合TNM状态：T3N2Mx 左侧腋窝淋巴结可疑转移。\n综合分期：未明。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 正常范围心电图\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽左顶壁、左顶后壁、左侧壁增厚，并见团块状软组织信号影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，鼻咽右侧壁粘膜未见增厚，左侧咽隐窝闭塞，右侧咽隐窝存在，左侧咽旁脂肪间隙狭窄。左侧腭帆提肌、腭帆张肌、头长肌、翼内肌受侵犯，余咽旁诸肌未见异常； 左侧咽后见肿大的淋巴结，短径22mm，右侧咽后见小淋巴结，短径5mm。 病灶向前堵塞左侧后鼻孔，口咽左侧壁受侵增厚。 左侧翼腭窝软组织影稍增多，右侧翼腭窝、双侧颞下窝未见异常。 蝶骨基底部、斜坡左侧份、左侧岩尖骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、上颌窦粘膜增厚；蝶窦、双侧乳突气化良好，未见异常信号影；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。 双颈II区、左颈III区见多个淋巴结，较大者短径24mm，信号欠均匀，增强扫描不均匀强化。；检查结论: 鼻咽左顶后壁、左侧壁病灶，考虑鼻咽癌，侵犯左侧咽旁、口咽左侧壁。 颅底骨质破坏。 双侧咽后、双颈II区、左颈III区淋巴结，考虑转移瘤。 副鼻窦炎。\n- [全程D5] 检验组合: 红细胞比容(Hct)-静脉血: 38.9%；血红蛋白(Hb)-静脉血: 131.6g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.5mmolL；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；总蛋白(TP)-静脉血: 69.64g/L；总钙(Ca)-静脉血: 2.26mmol/L；白蛋白(ALB)-静脉血: 43.1g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.42mmol/L；磷(P)-静脉血: 1.22mmol/L；凝血酶时间(TT)-静脉血: 17.3sec.；淋巴细胞百分比(Lymph%)-静脉血: 0.325；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；钠离子(Na+)-静脉血: 140.5mmol/L；单核细胞百分比(Mono%)-静脉血: 0.0954；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；载脂蛋白AI(apoAI)-静脉血: 1.38g/L；丙氨酸氨基转移酶(ALT)-静脉血: 21.7U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；氯离子(Cl-)-静脉血: 103.9mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；血小板计数(PLT#)-静脉血: 270.910E9/L；总胆固醇(TC)-静脉血: 5.3mmol/L；C-反应蛋白(CRP)-静脉血: 0.37mg/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.69mmol/L；甘油三酯(TG)-静脉血: 0.78mmol/L；淋巴细胞计数(Lymph#)-静脉血: 210E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.568；凝血酶原时间活动度(PTA)-静脉血: 94%；活化部分凝血活酶时间(APTT)-静脉血: 25.3sec.；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；平均红细胞血红蛋白含量(MCH)-静脉血: 30.2pg；凝血酶原时间(PT)-静脉血: 11.4sec.；纤维蛋白原(Fbg)-静脉血: 2.62g/L；天门冬氨酸氨基转移酶/丙氨酸氨……\n- [全程D15] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T6水平，估计导管末端位于上腔静脉内。；检查结论: PICC管末端位置如上述。\n- [全程D15] 检验组合: 骨钙素N端中分子片段(N-MID)-静脉血: 11.9ng/ml；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.318ng/ml\n- [全程D16] 检验组合: 浊度(TRUB)-尿液: 清亮；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: +-（参考: 阴性）；酸碱度(pH)-尿液: 7；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.016；葡萄糖(Glu)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 3/μL\n- [全程D17] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 31/μL；颜色-尿液: Yellow；鳞状上皮细胞计数(SQEP#)-尿液: 7/μL；白细胞计数(WBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.021；浊度(TRUB)-尿液: 清亮；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D19] 检验组合: 总钙(Ca)-静脉血: 2.15mmol/L；钠离子(Na+)-静脉血: 138.8mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.2mmol/L；钾离子(K+)-静脉血: 3.08mmol/L；氯离子(Cl-)-静脉血: 102.2mmol/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；磷(P)-静脉血: 1.19mmol/L；阴离子间隙(AG)-静脉血: 15.4\n- [全程D20] 超声；双侧腋窝淋巴结彩超(套): 检查类型: 超声；检查名称: 双侧腋窝淋巴结彩超(套)；检查部位:；检查所见: 左侧腋窝腋下组可见1个淋巴结回声，大小约16x4mm，椭圆形，边界清，皮髓质分界清，淋巴门结构可探及。腋上组及腋中组未见明显异常淋巴结回声。 CDFI：上述淋巴结内可见门型血流信号。；检查结论: 左侧腋窝腋下组淋巴结，符合良性淋巴结声像。\n- [全程D20] 检验组合: 血小板计数(PLT#)-静脉血: 250.210E9/L；肌酐(Crea)-静脉血: 54umol/L；总胆红素(TBIL)-静脉血: 13.7umol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；阴离子间隙(AG)-静脉血: 12.4；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；碱性磷酸酶(ALP)-静脉血: 59.5U/L；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；球蛋白(GLO)-静脉血: 25.26g/L；葡萄糖(Glu)-静脉血: 4.81mmol/L；白蛋白(ALB)-静脉血: 40.9g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；尿素氮(BUN)-静脉血: 3.9mmol/L；血小板分布宽度(PDW)-静脉血: 15.8%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.38mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.05mmolL；乳酸脱氢酶(LDH)-静脉血: 275.2U/L；单核细胞百分比(Mono%)-静脉血: 0.0621；中性粒细胞计数(Neut#)-静脉血: 4.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.711；γ-谷氨酰基转移酶(GGT)-静脉血: 19.5U/L；甘油三酯(TG)-静脉血: 1.23mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.5pg；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.0032；磷(P)-静脉血: 1.37mmol/L；总钙(Ca)-静脉血: 2.23mmol/L；间接胆红素(IBIL)-静脉血: 9umolL；血小板比容-静脉血: 20.8%；C-反应蛋白(CRP)-静脉血: 0.65mg/L；载脂蛋白AI(apoAI)-静脉血: 1.12g/L；总蛋白(TP)-静脉血: 66.16g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.62；单核细胞计数(Mono#)-静脉血: 0.410E9/L；钠离子(Na+)-静脉血: 137.8mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 27.7U/L；丙氨酸氨基转移酶(ALT)-静脉……\n- [全程D34] 检验组合: 中性粒细胞百分比(Neut%)-静脉血: 0.356；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329.8g/L；中性粒细胞计数(Neut#)-静脉血: 1.210E9/L；载脂蛋白AI(apoAI)-静脉血: 1.23g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 1.9umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.3；平均红细胞体积(MCV)-静脉血: 89.7fL；钾离子(K+)-静脉血: 3.9mmol/L；总蛋白(TP)-静脉血: 68.46g/L；球蛋白(GLO)-静脉血: 29.66g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.5%；血小板分布宽度(PDW)-静脉血: 16%；白细胞计数(WBC#)-静脉血: 3.2410E9/L；磷(P)-静脉血: 1.24mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.0079；间接胆红素(IBIL)-静脉血: 2.8umolL；镁离子(Mg2+)-静脉血: 0.89mmol/L；碱性磷酸酶(ALP)-静脉血: 66.5U/L；红细胞比容(Hct)-静脉血: 36.1%；丙氨酸氨基转移酶(ALT)-静脉血: 18.5U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.51；单核细胞百分比(Mono%)-静脉血: 0.1112；尿素氮(BUN)-静脉血: 5.39mmol/L；红细胞计数(RBC#)-静脉血: 4.0210E12/L；血小板计数(PLT#)-静脉血: 240.610E9/L；胱抑素(Cys-C)-静脉血: 0.87mg/L；天门冬氨酸氨基转移酶(AST)-静脉血: 22.2U/L；C-反应蛋白(CRP)-静脉血: 0.37mg/L；阴离子间隙(AG)-静脉血: 13；总胆汁酸(TBA)-静脉血: 0.8umol/L；葡萄糖(Glu)-静脉血: 4.81mmol/L；总钙(Ca)-静脉血: 2.31mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；总胆红素(TBIL)-静脉血: 4.7umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.2；平均血小板体积(MPV)-静脉血……\n- [全程D35] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁、后壁及左侧壁增厚放射性浓聚，SUV约22.8，病灶向下侵犯软腭及口咽左侧壁；病灶侵犯左头长肌、左侧腭帆提张肌及左咽旁间隙，左侧咽隐窝消失，左侧咽旁间隙消失。左咽后肿大淋巴结放射性浓聚，SUV约19.2，与鼻咽病灶分界不清。喉咽结构及放射性分布未见明显异常。额窦、蝶窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。左颈II、III区数个淋巴结放射性浓聚，SUV约20.2，最大约1.8×3.3cm；右颈II、Va区数个小淋巴结部分放射性分布略浓密，SUV约3.3，最大约0.6×1.1cm；余双颈小淋巴结放射性分布未见异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。心脏及纵隔大血管未见明显异常。左腋窝淋巴结放射性分布浓密，SUV约9.0，大小约0.9×1.5cm；纵隔、双肺门及右侧腋窝未见肿大淋巴结及异常放射性分布。双侧乳腺放射性分布未见明显异常。 肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 子宫体积增大，外形呈波浪状，放射性分布未见异常；子宫旁见高密度节育器影；膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，病灶侵犯软腭、口咽左侧壁及左咽旁间隙；左咽后及左颈II、III区淋巴结代谢活跃，考虑转移；左腋窝淋巴结代谢活跃，不排除转移。 右颈II、Va区小淋巴结部分代谢略活跃，疑炎性病变，请结合临床。 疑子宫肌瘤。\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D15] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D20] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗结束，诉呕吐 次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程5-FU+顺铂方案诱导化疗结束，无诉特殊不适，可予出院，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即按原剂量启动第二程5-FU+顺铂方案化疗，并预防性给予长效重组人粒细胞刺激因子皮下注射\nB. 立即按原剂量启动第二程5-FU+顺铂方案化疗，化疗期间同步给予短效重组人粒细胞刺激因子皮下注射\nC. 暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，动态监测血常规，待中性粒细胞计数恢复后再行下一程化疗\nD. 暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射及广谱抗菌药物静脉滴注，待中性粒细胞计数恢复后再行化疗\nE. 终止诱导化疗，直接进入根治性放疗阶段，并给予重组人粒细胞刺激因子皮下注射\nF. 暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，待中性粒细胞恢复后调整下一程化疗方案为单药顺铂\nG. 暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，待中性粒细胞恢复后将5-FU与顺铂剂量均减低20%行下一程化疗\nH. 暂缓本周期化疗，仅予密切观察和口服升白药物，待中性粒细胞计数自然恢复后再行化疗\nI. 暂缓本周期化疗，行左侧腋窝淋巴结穿刺活检，同时给予重组人粒细胞刺激因子皮下注射\nJ. 立即按原剂量启动第二程5-FU+顺铂方案化疗，化疗结束后48小时给予重组人粒细胞刺激因子皮下注射\nK. 暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，并安排全身PET-CT重新评估肿瘤范围\nL. 终止诱导化疗，改为靶向治疗联合重组人粒细胞刺激因子皮下注射，动态监测血常规\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"立即按原剂量启动第二程5-FU+顺铂方案化疗，并预防性给予长效重组人粒细胞刺激因子皮下注射","is_gold":false},{"letter":"B","text":"立即按原剂量启动第二程5-FU+顺铂方案化疗，化疗期间同步给予短效重组人粒细胞刺激因子皮下注射","is_gold":false},{"letter":"C","text":"暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，动态监测血常规，待中性粒细胞计数恢复后再行下一程化疗","is_gold":true},{"letter":"D","text":"暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射及广谱抗菌药物静脉滴注，待中性粒细胞计数恢复后再行化疗","is_gold":false},{"letter":"E","text":"终止诱导化疗，直接进入根治性放疗阶段，并给予重组人粒细胞刺激因子皮下注射","is_gold":false},{"letter":"F","text":"暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，待中性粒细胞恢复后调整下一程化疗方案为单药顺铂","is_gold":false},{"letter":"G","text":"暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，待中性粒细胞恢复后将5-FU与顺铂剂量均减低20%行下一程化疗","is_gold":false},{"letter":"H","text":"暂缓本周期化疗，仅予密切观察和口服升白药物，待中性粒细胞计数自然恢复后再行化疗","is_gold":false},{"letter":"I","text":"暂缓本周期化疗，行左侧腋窝淋巴结穿刺活检，同时给予重组人粒细胞刺激因子皮下注射","is_gold":false},{"letter":"J","text":"立即按原剂量启动第二程5-FU+顺铂方案化疗，化疗结束后48小时给予重组人粒细胞刺激因子皮下注射","is_gold":false},{"letter":"K","text":"暂缓本周期化疗，给予重组人粒细胞刺激因子皮下注射，并安排全身PET-CT重新评估肿瘤范围","is_gold":false},{"letter":"L","text":"终止诱导化疗，改为靶向治疗联合重组人粒细胞刺激因子皮下注射，动态监测血常规","is_gold":false}],"gold_letter":"C"},{"sample_id":"sample-800192dfaf82bbe4edb2533a","patient_id":"patient-5fa48522b2703f35ead0224b","turn_id":"turn08","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、斜坡、口咽、蝶骨基底部、岩尖。\n文本分期信息：N2，Mx 左侧腋窝淋巴结可疑转移。\n综合TNM状态：T3N2Mx 左侧腋窝淋巴结可疑转移。\n综合分期：未明。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 正常范围心电图\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽左顶壁、左顶后壁、左侧壁增厚，并见团块状软组织信号影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，鼻咽右侧壁粘膜未见增厚，左侧咽隐窝闭塞，右侧咽隐窝存在，左侧咽旁脂肪间隙狭窄。左侧腭帆提肌、腭帆张肌、头长肌、翼内肌受侵犯，余咽旁诸肌未见异常； 左侧咽后见肿大的淋巴结，短径22mm，右侧咽后见小淋巴结，短径5mm。 病灶向前堵塞左侧后鼻孔，口咽左侧壁受侵增厚。 左侧翼腭窝软组织影稍增多，右侧翼腭窝、双侧颞下窝未见异常。 蝶骨基底部、斜坡左侧份、左侧岩尖骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、上颌窦粘膜增厚；蝶窦、双侧乳突气化良好，未见异常信号影；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。 双颈II区、左颈III区见多个淋巴结，较大者短径24mm，信号欠均匀，增强扫描不均匀强化。；检查结论: 鼻咽左顶后壁、左侧壁病灶，考虑鼻咽癌，侵犯左侧咽旁、口咽左侧壁。 颅底骨质破坏。 双侧咽后、双颈II区、左颈III区淋巴结，考虑转移瘤。 副鼻窦炎。\n- [全程D5] 检验组合: 红细胞比容(Hct)-静脉血: 38.9%；血红蛋白(Hb)-静脉血: 131.6g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.5mmolL；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；总蛋白(TP)-静脉血: 69.64g/L；总钙(Ca)-静脉血: 2.26mmol/L；白蛋白(ALB)-静脉血: 43.1g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.42mmol/L；磷(P)-静脉血: 1.22mmol/L；凝血酶时间(TT)-静脉血: 17.3sec.；淋巴细胞百分比(Lymph%)-静脉血: 0.325；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；钠离子(Na+)-静脉血: 140.5mmol/L；单核细胞百分比(Mono%)-静脉血: 0.0954；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；载脂蛋白AI(apoAI)-静脉血: 1.38g/L；丙氨酸氨基转移酶(ALT)-静脉血: 21.7U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；氯离子(Cl-)-静脉血: 103.9mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；血小板计数(PLT#)-静脉血: 270.910E9/L；总胆固醇(TC)-静脉血: 5.3mmol/L；C-反应蛋白(CRP)-静脉血: 0.37mg/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.69mmol/L；甘油三酯(TG)-静脉血: 0.78mmol/L；淋巴细胞计数(Lymph#)-静脉血: 210E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.568；凝血酶原时间活动度(PTA)-静脉血: 94%；活化部分凝血活酶时间(APTT)-静脉血: 25.3sec.；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；平均红细胞血红蛋白含量(MCH)-静脉血: 30.2pg；凝血酶原时间(PT)-静脉血: 11.4sec.；纤维蛋白原(Fbg)-静脉血: 2.62g/L；天门冬氨酸氨基转移酶/丙氨酸氨……\n- [全程D34] 检验组合: 中性粒细胞百分比(Neut%)-静脉血: 0.356；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329.8g/L；中性粒细胞计数(Neut#)-静脉血: 1.210E9/L；载脂蛋白AI(apoAI)-静脉血: 1.23g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 1.9umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.3；平均红细胞体积(MCV)-静脉血: 89.7fL；钾离子(K+)-静脉血: 3.9mmol/L；总蛋白(TP)-静脉血: 68.46g/L；球蛋白(GLO)-静脉血: 29.66g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.5%；血小板分布宽度(PDW)-静脉血: 16%；白细胞计数(WBC#)-静脉血: 3.2410E9/L；磷(P)-静脉血: 1.24mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.0079；间接胆红素(IBIL)-静脉血: 2.8umolL；镁离子(Mg2+)-静脉血: 0.89mmol/L；碱性磷酸酶(ALP)-静脉血: 66.5U/L；红细胞比容(Hct)-静脉血: 36.1%；丙氨酸氨基转移酶(ALT)-静脉血: 18.5U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.51；单核细胞百分比(Mono%)-静脉血: 0.1112；尿素氮(BUN)-静脉血: 5.39mmol/L；红细胞计数(RBC#)-静脉血: 4.0210E12/L；血小板计数(PLT#)-静脉血: 240.610E9/L；胱抑素(Cys-C)-静脉血: 0.87mg/L；天门冬氨酸氨基转移酶(AST)-静脉血: 22.2U/L；C-反应蛋白(CRP)-静脉血: 0.37mg/L；阴离子间隙(AG)-静脉血: 13；总胆汁酸(TBA)-静脉血: 0.8umol/L；葡萄糖(Glu)-静脉血: 4.81mmol/L；总钙(Ca)-静脉血: 2.31mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；总胆红素(TBIL)-静脉血: 4.7umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.2；平均血小板体积(MPV)-静脉血……\n- [全程D35] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁、后壁及左侧壁增厚放射性浓聚，SUV约22.8，病灶向下侵犯软腭及口咽左侧壁；病灶侵犯左头长肌、左侧腭帆提张肌及左咽旁间隙，左侧咽隐窝消失，左侧咽旁间隙消失。左咽后肿大淋巴结放射性浓聚，SUV约19.2，与鼻咽病灶分界不清。喉咽结构及放射性分布未见明显异常。额窦、蝶窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。左颈II、III区数个淋巴结放射性浓聚，SUV约20.2，最大约1.8×3.3cm；右颈II、Va区数个小淋巴结部分放射性分布略浓密，SUV约3.3，最大约0.6×1.1cm；余双颈小淋巴结放射性分布未见异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。心脏及纵隔大血管未见明显异常。左腋窝淋巴结放射性分布浓密，SUV约9.0，大小约0.9×1.5cm；纵隔、双肺门及右侧腋窝未见肿大淋巴结及异常放射性分布。双侧乳腺放射性分布未见明显异常。 肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 子宫体积增大，外形呈波浪状，放射性分布未见异常；子宫旁见高密度节育器影；膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，病灶侵犯软腭、口咽左侧壁及左咽旁间隙；左咽后及左颈II、III区淋巴结代谢活跃，考虑转移；左腋窝淋巴结代谢活跃，不排除转移。 右颈II、Va区小淋巴结部分代谢略活跃，疑炎性病变，请结合临床。 疑子宫肌瘤。\n- [全程D37] 检验组合: 嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.4；红细胞比容(Hct)-静脉血: 35.6%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞体积(MCV)-静脉血: 89.9fL；单核细胞百分比(Mono%)-静脉血: 0.046；血小板计数(PLT#)-静脉血: 21310E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.8pg；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.9；平均血小板体积(MPV)-静脉血: 9.2fL；单核细胞计数(Mono#)-静脉血: 0.410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；中性粒细胞百分比(Neut%)-静脉血: 0.79；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；血小板比容-静脉血: 20%；血红蛋白(Hb)-静脉血: 118g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.009；淋巴细胞百分比(Lymph%)-静脉血: 0.147；红细胞计数(RBC#)-静脉血: 3.9610E12/L；血小板分布宽度(PDW)-静脉血: 9.9%；大血小板百分比(P-LCR%)-静脉血: 18.7%；中性粒细胞计数(Neut#)-静脉血: 7.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；白细胞计数(WBC#)-静脉血: 910E9/L\n- [全程D40] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.018；草酸钙结晶计数(CAOX#)-尿液: 10/μL；红细胞计数(RBC#)-尿液: 4/μL；总蛋白(TP)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: 无色；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D41] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；红细胞计数(RBC#)-尿液: 4/μL；白细胞(LEU)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；酮体(KET)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 1/μL；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.024；颜色-尿液: Light-Yellow\n- [全程D42] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 6/μL；隐血(OB)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 4/μL；总蛋白(TP)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7；颜色-尿液: Light-Yellow；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.023；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）；细菌计数(BACT#)-尿液: 8/μL\n- [全程D47] 超声；双侧腋窝淋巴结彩超(套): 检查类型: 超声；检查名称: 双侧腋窝淋巴结彩超(套)；检查部位:；检查所见: 双侧侧腋窝腋下组可见多个淋巴结回声，最大约12x6mm，椭圆形，边界清，皮髓质分界清，淋巴门结构可探及。腋上组及腋中组未见明显异常淋巴结回声。 CDFI：上述淋巴结内可见门型血流信号。；检查结论: 左侧腋窝腋下组淋巴结，符合良性淋巴结声像。\n- [全程D47] 检验组合: 有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 89.5fL；钠离子(Na+)-静脉血: 135.9mmol/L；尿酸(UA)-静脉血: 277.5umol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.0062；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；血红蛋白(Hb)-静脉血: 115.6g/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 332.5g/L；碱性磷酸酶(ALP)-静脉血: 63.1U/L；白蛋白(ALB)-静脉血: 39.9g/L；单核细胞百分比(Mono%)-静脉血: 0.056；α-L-岩藻糖苷酶(AFU)-静脉血: 42.7U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.315；尿素氮(BUN)-静脉血: 5.4mmol/L；白细胞计数(WBC#)-静脉血: 4.0510E9/L；总胆固醇(TC)-静脉血: 4.12mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24U/L；氯离子(Cl-)-静脉血: 99.2mmol/L；载脂蛋白B(apoB)-静脉血: 0.78g/L；丙氨酸氨基转移酶(ALT)-静脉血: 41.3U/L；总胆汁酸(TBA)-静脉血: 0.5umol/L；血小板计数(PLT#)-静脉血: 196.310E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.5%；葡萄糖(Glu)-静脉血: 4.67mmol/L；球蛋白(GLO)-静脉血: 23.82g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.3mmol/L；间接胆红素(IBIL)-静脉血: 7umolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.0051；镁离子(Mg2+)-静脉血: 0.69mmol/L；磷(P)-静脉血: 1.4mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 3.7umol/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；总钙(Ca)-静脉血: 2.27mmol/L；胱抑素(Cys-C)-静脉血: 0.95mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.68；中性粒细胞百分比(……\n\n【既往治疗与反应】\n- [全程D36] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者复查血常规：中性粒细胞1.2×109/L。郭医生信息已隐藏：暂停化疗，予以患者升中西粒细胞处理。\n- [全程D37] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 患者入院第三天，继续升白细胞处理，今日复查血常规，白细胞已经恢复正常，郭医生信息已隐藏：下周一予以患者第二程化疗。\n- [全程D40] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，可于今日执行第2程5-FU+顺铂方案诱导化疗，注意化疗不良反应。\n- [全程D43] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D47] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+顺铂方案诱导化疗结束，诉恶心、食欲下降，无发热、呕吐、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第2程5-FU+顺铂方案诱导化疗结束，无诉特殊不适，嘱其完成鼻咽、颈MRI复查，以及放疗定位扫描，定期返院治疗。遵嘱。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动顺铂同期化放疗\nB. 完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动第3程5-FU+顺铂诱导化疗\nC. 完善左侧腋窝淋巴结穿刺活检，行放疗定位扫描，并启动顺铂同期化放疗\nD. 完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动尼妥珠单抗联合根治性放疗\nE. 完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动单纯根治性放疗\nF. 完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动信迪利单抗联合根治性放疗\nG. 完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动尼妥珠单抗联合顺铂同期化放疗\nH. 完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动卡培他滨同期化放疗\nI. 完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动西妥昔单抗联合根治性放疗\nJ. 完善全身PET-CT复查，行放疗定位扫描，并启动尼妥珠单抗联合根治性放疗\nK. 完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动吉西他滨联合顺铂同期化放疗\nL. 完善鼻咽及颈部MRI复查，暂缓放疗定位，启动第3程5-FU+顺铂诱导化疗\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动顺铂同期化放疗","is_gold":true},{"letter":"B","text":"完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动第3程5-FU+顺铂诱导化疗","is_gold":false},{"letter":"C","text":"完善左侧腋窝淋巴结穿刺活检，行放疗定位扫描，并启动顺铂同期化放疗","is_gold":false},{"letter":"D","text":"完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动尼妥珠单抗联合根治性放疗","is_gold":false},{"letter":"E","text":"完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动单纯根治性放疗","is_gold":false},{"letter":"F","text":"完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动信迪利单抗联合根治性放疗","is_gold":false},{"letter":"G","text":"完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动尼妥珠单抗联合顺铂同期化放疗","is_gold":false},{"letter":"H","text":"完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动卡培他滨同期化放疗","is_gold":false},{"letter":"I","text":"完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动西妥昔单抗联合根治性放疗","is_gold":false},{"letter":"J","text":"完善全身PET-CT复查，行放疗定位扫描，并启动尼妥珠单抗联合根治性放疗","is_gold":false},{"letter":"K","text":"完善鼻咽及颈部MRI复查，行放疗定位扫描，并启动吉西他滨联合顺铂同期化放疗","is_gold":false},{"letter":"L","text":"完善鼻咽及颈部MRI复查，暂缓放疗定位，启动第3程5-FU+顺铂诱导化疗","is_gold":false}],"gold_letter":"A"}]}
+{"patient_id":"patient-84fa3d6098d10a1d14b6b19e","bootstrap_cluster_id":"cluster-006","turns":[{"sample_id":"sample-1a7cec18df1c66d68f69d55f","patient_id":"patient-84fa3d6098d10a1d14b6b19e","turn_id":"turn01","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、斜坡、海绵窦、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左耳听力下降1年余；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右耳鸣；既往史: 某次就诊时间患“结核性胸膜炎”已治愈，某次就诊时间患“急性胰腺炎”已治愈。否认\"肝炎、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟史30年，1包每天，常饮酒，两天/次，每次500ml。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：120/80mmHg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧壁、顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸腹部CT平扫，常规血液学检查。\nB. 鼻咽及颈部MRI平扫+增强，全身PET/CT，常规血液学检查，直接安排诱导化疗。\nC. 鼻咽镜检查及活检，鼻咽MRI平扫+增强，胸部X线片，腹部超声，全身骨扫描。\nD. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫，全身PET/CT，常规血液学及心电图检查。\nE. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT，常规血液学、心电图与超声检查。\nF. 颈部淋巴结穿刺活检，鼻咽及颈部MRI平扫+增强，全身PET/CT，常规血液学检查。\nG. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，暂缓全身影像学检查待病理结果回报。\nH. 鼻咽镜检查及活检，头颅CT平扫，颈部超声，胸腹部CT平扫+增强，常规血液学检查。\nI. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部CT平扫，腹部超声，暂不进行骨骼检查。\nJ. 鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，全身PET/CT，常规血液学及心电图检查。\nK. 鼻咽镜检查，鼻咽及颈部MRI平扫+增强，全身PET/CT，待影像学评估后再行内镜活检。\nL. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT，同步进行根治性放疗定位。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸腹部CT平扫，常规血液学检查。","is_gold":false},{"letter":"B","text":"鼻咽及颈部MRI平扫+增强，全身PET/CT，常规血液学检查，直接安排诱导化疗。","is_gold":false},{"letter":"C","text":"鼻咽镜检查及活检，鼻咽MRI平扫+增强，胸部X线片，腹部超声，全身骨扫描。","is_gold":false},{"letter":"D","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫，全身PET/CT，常规血液学及心电图检查。","is_gold":false},{"letter":"E","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT，常规血液学、心电图与超声检查。","is_gold":true},{"letter":"F","text":"颈部淋巴结穿刺活检，鼻咽及颈部MRI平扫+增强，全身PET/CT，常规血液学检查。","is_gold":false},{"letter":"G","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，暂缓全身影像学检查待病理结果回报。","is_gold":false},{"letter":"H","text":"鼻咽镜检查及活检，头颅CT平扫，颈部超声，胸腹部CT平扫+增强，常规血液学检查。","is_gold":false},{"letter":"I","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部CT平扫，腹部超声，暂不进行骨骼检查。","is_gold":false},{"letter":"J","text":"鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，全身PET/CT，常规血液学及心电图检查。","is_gold":false},{"letter":"K","text":"鼻咽镜检查，鼻咽及颈部MRI平扫+增强，全身PET/CT，待影像学评估后再行内镜活检。","is_gold":false},{"letter":"L","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT，同步进行根治性放疗定位。","is_gold":false}],"gold_letter":"E"},{"sample_id":"sample-13d0893c195434e9115bcbbc","patient_id":"patient-84fa3d6098d10a1d14b6b19e","turn_id":"turn02","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、斜坡、海绵窦、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左耳听力下降1年余；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右耳鸣；既往史: 某次就诊时间患“结核性胸膜炎”已治愈，某次就诊时间患“急性胰腺炎”已治愈。否认\"肝炎、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟史30年，1包每天，常饮酒，两天/次，每次500ml。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：120/80mmHg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧壁、顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善基线血液学检查，包含血常规、生化常规及凝血功能，暂缓检测EB病毒DNA及骨代谢标志物。\nB. 完善基线血液学检查，包含生化常规、凝血功能及传染病筛查，并安排全身PET-CT替代常规影像学分期。\nC. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能及传染病筛查，暂缓检测骨代谢标志物。\nD. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查，并安排颈部淋巴结穿刺活检明确病理。\nE. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查，并安排头颅增强MRI评估颅内侵犯。\nF. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测。\nG. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并安排全身PET-CT替代所有常规分期检查。\nH. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并安排鼻咽部平扫MRI。\nI. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并安排颈部超声指导淋巴结清扫。\nJ. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并安排鼻咽镜评估治疗疗效。\nK. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并首选胸部X线片排除肺转移。\nL. 完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并常规安排骨髓穿刺排除骨髓转移。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"完善基线血液学检查，包含血常规、生化常规及凝血功能，暂缓检测EB病毒DNA及骨代谢标志物。","is_gold":false},{"letter":"B","text":"完善基线血液学检查，包含生化常规、凝血功能及传染病筛查，并安排全身PET-CT替代常规影像学分期。","is_gold":false},{"letter":"C","text":"完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能及传染病筛查，暂缓检测骨代谢标志物。","is_gold":false},{"letter":"D","text":"完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查，并安排颈部淋巴结穿刺活检明确病理。","is_gold":false},{"letter":"E","text":"完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查，并安排头颅增强MRI评估颅内侵犯。","is_gold":false},{"letter":"F","text":"完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测。","is_gold":true},{"letter":"G","text":"完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并安排全身PET-CT替代所有常规分期检查。","is_gold":false},{"letter":"H","text":"完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并安排鼻咽部平扫MRI。","is_gold":false},{"letter":"I","text":"完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并安排颈部超声指导淋巴结清扫。","is_gold":false},{"letter":"J","text":"完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并安排鼻咽镜评估治疗疗效。","is_gold":false},{"letter":"K","text":"完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并首选胸部X线片排除肺转移。","is_gold":false},{"letter":"L","text":"完善基线血液学检查，包含EB病毒DNA定量、生化常规、凝血功能、传染病筛查及骨代谢标志物检测，并常规安排骨髓穿刺排除骨髓转移。","is_gold":false}],"gold_letter":"F"},{"sample_id":"sample-474b60646fc04122e2c1c7ce","patient_id":"patient-84fa3d6098d10a1d14b6b19e","turn_id":"turn04","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、斜坡、海绵窦、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D3] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D3] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 38mm AO 26mm MV E 0.79m/s EF 75% LV 50mm IVS 11mm A 0.67m/s FS 45% RA 33mm LVPW 8mm RV 20mm PA 19mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 左房稍大，余各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 左房稍大 各房室腔及大血管未探及异常血流信号 心功能正常\n- [全程D3] 检验组合: 丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D4] CT；胸部CT平扫＋增强: 检查类型: CT；检查名称: 胸部CT平扫＋增强；检查部位:；检查所见: 右中肺及双下肺见数个类结节影，最大者直径约 5 mm，病灶边界清楚而不规则，密度较高而不均匀；气管及支气管分枝通畅，未见明显软组织肿物或受压变窄；双侧肺门及纵隔未见明确肿大淋巴结；双侧胸腔未见积液；胸膜未见增厚；扫描范围内胸椎、胸壁骨未见骨质破坏征象。；检查结论: 双肺类结节影，转移瘤可能性大。\n- [全程D4] 检验组合: 酮体(KET)-尿液: +-（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；尿胆原(URO)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 4/μL；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；白细胞计数(WBC#)-尿液: 26/μL；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；酸碱度(pH)-尿液: 6；总蛋白(TP)-尿液: -（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性（参考: 阴性）；颜色-尿液: Light-Yellow；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；非鳞状上皮细胞计数-尿液: 2/μL；比重(SG)-尿液: 1.032；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.05；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 顺铂单药同期放化疗\nB. 多西他赛+顺铂（TP方案）姑息化疗\nC. 鼻咽及颈部根治性放射治疗\nD. 顺铂+多西他赛（TP方案）同期放化疗\nE. 依托泊苷+顺铂（EP方案）诱导化疗\nF. 顺铂+氟尿嘧啶（PF方案）姑息化疗\nG. 西妥昔单抗联合根治性放疗\nH. 顺铂+氟尿嘧啶（PF方案）诱导化疗\nI. 氟尿嘧啶单药诱导化疗\nJ. 吉西他滨+顺铂（GP方案）姑息化疗\nK. 顺铂单药诱导化疗\nL. 卡瑞利珠单抗联合PF方案姑息化疗\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"顺铂单药同期放化疗","is_gold":false},{"letter":"B","text":"多西他赛+顺铂（TP方案）姑息化疗","is_gold":false},{"letter":"C","text":"鼻咽及颈部根治性放射治疗","is_gold":false},{"letter":"D","text":"顺铂+多西他赛（TP方案）同期放化疗","is_gold":false},{"letter":"E","text":"依托泊苷+顺铂（EP方案）诱导化疗","is_gold":false},{"letter":"F","text":"顺铂+氟尿嘧啶（PF方案）姑息化疗","is_gold":false},{"letter":"G","text":"西妥昔单抗联合根治性放疗","is_gold":false},{"letter":"H","text":"顺铂+氟尿嘧啶（PF方案）诱导化疗","is_gold":true},{"letter":"I","text":"氟尿嘧啶单药诱导化疗","is_gold":false},{"letter":"J","text":"吉西他滨+顺铂（GP方案）姑息化疗","is_gold":false},{"letter":"K","text":"顺铂单药诱导化疗","is_gold":false},{"letter":"L","text":"卡瑞利珠单抗联合PF方案姑息化疗","is_gold":false}],"gold_letter":"H"},{"sample_id":"sample-654cb1177e5cb9c5732eccb0","patient_id":"patient-84fa3d6098d10a1d14b6b19e","turn_id":"turn05","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、斜坡、海绵窦、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: 右臂静脉插管,导管末端位于T 6右旁，估计位于上腔静脉中段。；检查结论: 导管末端位置如上述。\n- [全程D2] 检验组合: 血小板分布宽度(PDW)-静脉血: 13.8%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；淋巴细胞百分比(Lymph%)-静脉血: 0.262；单核细胞计数(Mono#)-静脉血: 0.510E9/L；胱抑素(Cys-C)-静脉血: 1.01mg/L；总蛋白(TP)-静脉血: 68.46g/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.16COI；透明质酸(HA)-静脉血: 61.97ng/ml；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；大血小板百分比(P-LCR%)-静脉血: 32.4%；白蛋白(ALB)-静脉血: 43.7g/L；总胆固醇(TC)-静脉血: 5.59mmol/L；总胆红素(TBIL)-静脉血: 14.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.84；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.009；丙氨酸氨基转移酶(ALT)-静脉血: 27U/L；氯离子(Cl-)-静脉血: 103.1mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；淋巴细胞计数(Lymph#)-静脉血: 2.510E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.63mmol/L；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.06S/CO；血小板比容-静脉血: 21%；载脂蛋白B(apoB)-静脉血: 1.22g/L；C-反应蛋白(CRP)-静脉血: 4.05mg/L；ABO血型-静脉血: A；载脂蛋白AI(apoAI)-静脉血: 1.2g/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；单核细胞百分比(Mono%)-静脉血: 0.049；钠离子(Na+)-静脉血: 139.6mmol/L；凝血酶原时间(PT)-静脉血: 10.3sec.；球蛋白(GLO)-静脉血: 24.76g/L；纤维蛋白原(Fbg)-静脉血: 2.49g/L；凝血酶时间(TT)-静脉血: 20sec.；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44.6；Rh血型-静脉血: 阳性；平均红细胞体积(MCV)-静脉血: 85.8fL；直接胆红素(DBIL)-静脉血: 3.3umol/L；凝血酶原时间活动度(PTA)-静脉血: 113.8……\n- [全程D3] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D3] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 38mm AO 26mm MV E 0.79m/s EF 75% LV 50mm IVS 11mm A 0.67m/s FS 45% RA 33mm LVPW 8mm RV 20mm PA 19mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 左房稍大，余各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 左房稍大 各房室腔及大血管未探及异常血流信号 心功能正常\n- [全程D3] 检验组合: 丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D4] CT；胸部CT平扫＋增强: 检查类型: CT；检查名称: 胸部CT平扫＋增强；检查部位:；检查所见: 右中肺及双下肺见数个类结节影，最大者直径约 5 mm，病灶边界清楚而不规则，密度较高而不均匀；气管及支气管分枝通畅，未见明显软组织肿物或受压变窄；双侧肺门及纵隔未见明确肿大淋巴结；双侧胸腔未见积液；胸膜未见增厚；扫描范围内胸椎、胸壁骨未见骨质破坏征象。；检查结论: 双肺类结节影，转移瘤可能性大。\n- [全程D4] 检验组合: 酮体(KET)-尿液: +-（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；尿胆原(URO)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 4/μL；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；白细胞计数(WBC#)-尿液: 26/μL；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；酸碱度(pH)-尿液: 6；总蛋白(TP)-尿液: -（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性（参考: 阴性）；颜色-尿液: Light-Yellow；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；非鳞状上皮细胞计数-尿液: 2/μL；比重(SG)-尿液: 1.032；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.05；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D5] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: 3+500Leu（参考: 阴性）；白细胞计数(WBC#)-尿液: 18/μL；鳞状上皮细胞计数(SQEP#)-尿液: 5/μL；比重(SG)-尿液: 1.02；总蛋白(TP)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: Turbid；隐血(OB)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；未分类结晶计数(UNCX#)-尿液: 25/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；非鳞状上皮细胞计数-尿液: 5/μL\n- [全程D9] 检验组合: 钾离子(K+)-静脉血: 3.73mmol/L；红细胞比容(Hct)-静脉血: 48.1%；血小板比容-静脉血: 19%；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.94mmolL；尿素氮(BUN)-静脉血: 9.5mmol/L；钠离子(Na+)-静脉血: 137.8mmol/L；血红蛋白(Hb)-静脉血: 159g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.095；总钙(Ca)-静脉血: 1.93mmol/L；血小板分布宽度(PDW)-静脉血: 13.3%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；丙氨酸氨基转移酶(ALT)-静脉血: 94.9U/L；载脂蛋白B(apoB)-静脉血: 1.06g/L；白蛋白(ALB)-静脉血: 40.3g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.46；白细胞计数(WBC#)-静脉血: 14.910E9/L；胱抑素(Cys-C)-静脉血: 1.26mg/L；平均血小板体积(MPV)-静脉血: 10.4fL；中性粒细胞百分比(Neut%)-静脉血: 0.837；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.45mmol/L；血小板计数(PLT#)-静脉血: 17910E9/L；总胆固醇(TC)-静脉血: 5.1mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.4；球蛋白(GLO)-静脉血: 23.17g/L；磷(P)-静脉血: 1.26mmol/L；间接胆红素(IBIL)-静脉血: 13.1umolL；红细胞计数(RBC#)-静脉血: 5.5910E12/L；直接胆红素(DBIL)-静脉血: 5.4umol/L；总胆汁酸(TBA)-静脉血: 0.1umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；单核细胞百分比(Mono%)-静脉血: 0.06；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 42.8U/L；肌酐(Crea)-静脉血: 101.5umol/L；载脂蛋白AI(apoAI)-静脉血: 0.99g/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.4mmol/L；单核细胞计……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者无诉特殊不适，完善各项检查中，体查同入院时，[姓名已隐去]主任查房指示，待各项检查完成明确分期后，再决定下一步治疗。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D8] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停化疗，静脉滴注还原型谷胱甘肽进行保肝治疗，待肝功能恢复正常后重启化疗。\nB. 暂停化疗，静脉滴注头孢类抗生素进行经验性抗感染治疗，待白细胞计数恢复正常后重启化疗。\nC. 继续化疗，皮下注射重组人粒细胞集落刺激因子预防中性粒细胞缺乏。\nD. 终止诱导化疗，提前进入根治性放疗阶段，并静脉滴注保肝药物。\nE. 继续化疗，静脉滴注异甘草酸镁注射液进行保肝治疗，并每日复查肝功能。\nF. 暂停化疗，行腹部CT增强扫描以排除肝脏转移或化疗引起的急性肝损伤。\nG. 继续化疗，停用所有止吐及护胃药物以减轻肝脏代谢负担。\nH. 暂停化疗，静脉推注地塞米松及异丙嗪进行抗过敏治疗。\nI. 继续化疗及对症支持治疗，执行动静脉置管常规护理，并常规监测血常规与生化指标。\nJ. 继续化疗，拔除动静脉置管以预防导管相关性血流感染，改用外周静脉穿刺。\nK. 暂停化疗，静脉滴注氯化钾进行补钾治疗，待血钾明显上升后继续化疗。\nL. 继续化疗，静脉推注呋塞米促进顺铂排泄，预防急性肾功能损伤。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"暂停化疗，静脉滴注还原型谷胱甘肽进行保肝治疗，待肝功能恢复正常后重启化疗。","is_gold":false},{"letter":"B","text":"暂停化疗，静脉滴注头孢类抗生素进行经验性抗感染治疗，待白细胞计数恢复正常后重启化疗。","is_gold":false},{"letter":"C","text":"继续化疗，皮下注射重组人粒细胞集落刺激因子预防中性粒细胞缺乏。","is_gold":false},{"letter":"D","text":"终止诱导化疗，提前进入根治性放疗阶段，并静脉滴注保肝药物。","is_gold":false},{"letter":"E","text":"继续化疗，静脉滴注异甘草酸镁注射液进行保肝治疗，并每日复查肝功能。","is_gold":false},{"letter":"F","text":"暂停化疗，行腹部CT增强扫描以排除肝脏转移或化疗引起的急性肝损伤。","is_gold":false},{"letter":"G","text":"继续化疗，停用所有止吐及护胃药物以减轻肝脏代谢负担。","is_gold":false},{"letter":"H","text":"暂停化疗，静脉推注地塞米松及异丙嗪进行抗过敏治疗。","is_gold":false},{"letter":"I","text":"继续化疗及对症支持治疗，执行动静脉置管常规护理，并常规监测血常规与生化指标。","is_gold":true},{"letter":"J","text":"继续化疗，拔除动静脉置管以预防导管相关性血流感染，改用外周静脉穿刺。","is_gold":false},{"letter":"K","text":"暂停化疗，静脉滴注氯化钾进行补钾治疗，待血钾明显上升后继续化疗。","is_gold":false},{"letter":"L","text":"继续化疗，静脉推注呋塞米促进顺铂排泄，预防急性肾功能损伤。","is_gold":false}],"gold_letter":"I"},{"sample_id":"sample-b094635ac349a10618a48030","patient_id":"patient-84fa3d6098d10a1d14b6b19e","turn_id":"turn06","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、斜坡、海绵窦、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D3] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 38mm AO 26mm MV E 0.79m/s EF 75% LV 50mm IVS 11mm A 0.67m/s FS 45% RA 33mm LVPW 8mm RV 20mm PA 19mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 左房稍大，余各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 左房稍大 各房室腔及大血管未探及异常血流信号 心功能正常\n- [全程D3] 检验组合: 丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D4] CT；胸部CT平扫＋增强: 检查类型: CT；检查名称: 胸部CT平扫＋增强；检查部位:；检查所见: 右中肺及双下肺见数个类结节影，最大者直径约 5 mm，病灶边界清楚而不规则，密度较高而不均匀；气管及支气管分枝通畅，未见明显软组织肿物或受压变窄；双侧肺门及纵隔未见明确肿大淋巴结；双侧胸腔未见积液；胸膜未见增厚；扫描范围内胸椎、胸壁骨未见骨质破坏征象。；检查结论: 双肺类结节影，转移瘤可能性大。\n- [全程D4] 检验组合: 酮体(KET)-尿液: +-（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；尿胆原(URO)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 4/μL；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；白细胞计数(WBC#)-尿液: 26/μL；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；酸碱度(pH)-尿液: 6；总蛋白(TP)-尿液: -（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性（参考: 阴性）；颜色-尿液: Light-Yellow；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；非鳞状上皮细胞计数-尿液: 2/μL；比重(SG)-尿液: 1.032；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.05；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D5] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: 3+500Leu（参考: 阴性）；白细胞计数(WBC#)-尿液: 18/μL；鳞状上皮细胞计数(SQEP#)-尿液: 5/μL；比重(SG)-尿液: 1.02；总蛋白(TP)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: Turbid；隐血(OB)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；未分类结晶计数(UNCX#)-尿液: 25/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；非鳞状上皮细胞计数-尿液: 5/μL\n- [全程D9] 检验组合: 钾离子(K+)-静脉血: 3.73mmol/L；红细胞比容(Hct)-静脉血: 48.1%；血小板比容-静脉血: 19%；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.94mmolL；尿素氮(BUN)-静脉血: 9.5mmol/L；钠离子(Na+)-静脉血: 137.8mmol/L；血红蛋白(Hb)-静脉血: 159g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.095；总钙(Ca)-静脉血: 1.93mmol/L；血小板分布宽度(PDW)-静脉血: 13.3%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；丙氨酸氨基转移酶(ALT)-静脉血: 94.9U/L；载脂蛋白B(apoB)-静脉血: 1.06g/L；白蛋白(ALB)-静脉血: 40.3g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.46；白细胞计数(WBC#)-静脉血: 14.910E9/L；胱抑素(Cys-C)-静脉血: 1.26mg/L；平均血小板体积(MPV)-静脉血: 10.4fL；中性粒细胞百分比(Neut%)-静脉血: 0.837；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.45mmol/L；血小板计数(PLT#)-静脉血: 17910E9/L；总胆固醇(TC)-静脉血: 5.1mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.4；球蛋白(GLO)-静脉血: 23.17g/L；磷(P)-静脉血: 1.26mmol/L；间接胆红素(IBIL)-静脉血: 13.1umolL；红细胞计数(RBC#)-静脉血: 5.5910E12/L；直接胆红素(DBIL)-静脉血: 5.4umol/L；总胆汁酸(TBA)-静脉血: 0.1umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；单核细胞百分比(Mono%)-静脉血: 0.06；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 42.8U/L；肌酐(Crea)-静脉血: 101.5umol/L；载脂蛋白AI(apoAI)-静脉血: 0.99g/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.4mmol/L；单核细胞计……\n- [全程D16] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及双侧壁增厚放射性浓聚，SUV约11.9，双侧咽隐窝消失；病灶侵犯双侧腭帆提肌、左侧腭帆张肌、左翼内肌，左咽旁间隙及左咽后间隙消失；病灶向上侵犯蝶骨基底部、左翼突区、左蝶骨大翼、左卵圆孔及左海绵窦；向前侵犯左翼腭窝、左上颌后脂肪间隙、左眶尖及左眶内后份，左框内病灶与视神经分界不清。右咽后小淋巴结放射性分布未见明显异常。双侧扁桃体放射性浓聚，SUV约9.4；喉咽结构及放射性分布未见明显异常。双侧上颌窦低密度影放射性分布未见异常；额窦、蝶窦、筛窦结构及放射性分布未见明显异常。甲状腺双叶密度减低，放射性分布未见异常。双颈多个小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺散在多发结节影放射性分布未见明显异常，最大约0.6×0.8cm；左上肺舌段条索影放射性分布未见异常；气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。心脏及纵隔大血管未见明显异常。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏弥漫性密度减低，CT值约36Hu（脾脏CT值约51Hu），放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾门区结节影放射性分布未见异常，大小约1.1×1.4cm（副脾）；脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 双侧乳突气房内低密度影放射性分布未见异常；余颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌病灶，侵犯左咽后及左咽旁间隙、颅底骨骼、左卵圆孔、左海绵窦、左翼腭窝、左上颌后脂肪间隙、左眶尖及左眶内后份，累及左视神经。 双肺多发小结节影代谢未见异常，疑增殖灶。 双侧上颌窦炎症；双侧乳突炎症。 双侧扁桃体代谢活跃，考虑炎性病变。 脂肪肝。\n- [全程D24] 检验组合: 红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.4%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.71mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.0123；平均血小板体积(MPV)-静脉血: 8.22fL；载脂蛋白B(apoB)-静脉血: 1.13g/L；总胆固醇(TC)-静脉血: 5.18mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.281；有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞血红蛋白浓度(MCHC)-静脉血: 325.6g/L；磷(P)-静脉血: 1.14mmol/L；胱抑素(Cys-C)-静脉血: 1.19mg/L；尿素氮(BUN)-静脉血: 7.71mmol/L；血小板分布宽度(PDW)-静脉血: 16.4%；丙氨酸氨基转移酶(ALT)-静脉血: 28.8U/L；直接胆红素(DBIL)-静脉血: 2.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.8；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.14mmolL；氯离子(Cl-)-静脉血: 105.9mmol/L；血小板计数(PLT#)-静脉血: 18310E9/L；中性粒细胞计数(Neut#)-静脉血: 510E9/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；乳酸脱氢酶(LDH)-静脉血: 159U/L；平均红细胞体积(MCV)-静脉血: 84.3fL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；红细胞计数(RBC#)-静脉血: 5.2310E12/L；球蛋白(GLO)-静脉血: 27.58g/L；葡萄糖(Glu)-静脉血: 4.55mmol/L；肌酐(Crea)-静脉血: 91.9umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；血小板比容-静脉血: 15%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 50.8U/L；白细胞计数(WBC#)-静脉血: 7.810E9/L；单核细胞百分比(Mono%)-静脉血: 0.0665；淋巴细胞计数(Lymph#)-静脉血: 2.210E9/L；C-反应蛋白(CRP)-静脉血: 4.59mg/L；红细胞比容(Hct)-静脉血:……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D8] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D10] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗结束，诉呕吐2次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程5-FU+顺铂方案诱导化疗结束，无诉特殊不适，可予请假至6月13日，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n- [全程D15] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者请假至.吕星\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 予以口服升白细胞药物，静脉水化及补充电解质，皮下注射胸腺法新，并监测24小时尿量，准备行下一程化疗。\nB. 予以静脉滴注保肝药物，静脉水化及补充电解质，皮下注射胸腺法新，暂缓化疗待复查指标正常后继续。\nC. 予以静脉输注碳酸氢钠碱化尿液及利尿处理，静脉水化及补充电解质，将下一程化疗方案中的顺铂替换为卡铂。\nD. 予以静脉营养支持，静脉水化及补充电解质，皮下注射胸腺法新，下一程化疗顺铂剂量下调20%。\nE. 予以静脉水化、补充电解质及维生素，预防性皮下注射重组人粒细胞刺激因子，口服止咳药物，准备行下一程化疗。\nF. 予以静脉水化、补充电解质及维生素，预防性皮下注射重组人血小板生成素，口服止咳药物，准备行下一程化疗。\nG. 予以静脉水化、补充电解质及维生素，口服止咳药物，加用异烟肼预防性抗结核治疗，准备行下一程化疗。\nH. 予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，无需监测尿量，准备行下一程化疗。\nI. 予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，并监测24小时尿量，准备行单纯放射治疗。\nJ. 予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，并监测24小时尿量，准备行下一程化疗。\nK. 予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，并监测24小时尿量，将下一程化疗方案更改为吉西他滨加顺铂。\nL. 予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，并监测24小时尿量，将下一程化疗方案更改为紫杉醇加顺铂。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"予以口服升白细胞药物，静脉水化及补充电解质，皮下注射胸腺法新，并监测24小时尿量，准备行下一程化疗。","is_gold":false},{"letter":"B","text":"予以静脉滴注保肝药物，静脉水化及补充电解质，皮下注射胸腺法新，暂缓化疗待复查指标正常后继续。","is_gold":false},{"letter":"C","text":"予以静脉输注碳酸氢钠碱化尿液及利尿处理，静脉水化及补充电解质，将下一程化疗方案中的顺铂替换为卡铂。","is_gold":false},{"letter":"D","text":"予以静脉营养支持，静脉水化及补充电解质，皮下注射胸腺法新，下一程化疗顺铂剂量下调20%。","is_gold":false},{"letter":"E","text":"予以静脉水化、补充电解质及维生素，预防性皮下注射重组人粒细胞刺激因子，口服止咳药物，准备行下一程化疗。","is_gold":false},{"letter":"F","text":"予以静脉水化、补充电解质及维生素，预防性皮下注射重组人血小板生成素，口服止咳药物，准备行下一程化疗。","is_gold":false},{"letter":"G","text":"予以静脉水化、补充电解质及维生素，口服止咳药物，加用异烟肼预防性抗结核治疗，准备行下一程化疗。","is_gold":false},{"letter":"H","text":"予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，无需监测尿量，准备行下一程化疗。","is_gold":false},{"letter":"I","text":"予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，并监测24小时尿量，准备行单纯放射治疗。","is_gold":false},{"letter":"J","text":"予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，并监测24小时尿量，准备行下一程化疗。","is_gold":true},{"letter":"K","text":"予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，并监测24小时尿量，将下一程化疗方案更改为吉西他滨加顺铂。","is_gold":false},{"letter":"L","text":"予以静脉水化、补充电解质及维生素，皮下注射胸腺法新，口服止咳药物对症处理，并监测24小时尿量，将下一程化疗方案更改为紫杉醇加顺铂。","is_gold":false}],"gold_letter":"J"},{"sample_id":"sample-237ee315803b648b5eb4c67f","patient_id":"patient-84fa3d6098d10a1d14b6b19e","turn_id":"turn07","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、斜坡、海绵窦、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 检验组合: 血小板分布宽度(PDW)-静脉血: 13.8%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；淋巴细胞百分比(Lymph%)-静脉血: 0.262；单核细胞计数(Mono#)-静脉血: 0.510E9/L；胱抑素(Cys-C)-静脉血: 1.01mg/L；总蛋白(TP)-静脉血: 68.46g/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.16COI；透明质酸(HA)-静脉血: 61.97ng/ml；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；大血小板百分比(P-LCR%)-静脉血: 32.4%；白蛋白(ALB)-静脉血: 43.7g/L；总胆固醇(TC)-静脉血: 5.59mmol/L；总胆红素(TBIL)-静脉血: 14.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.84；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.009；丙氨酸氨基转移酶(ALT)-静脉血: 27U/L；氯离子(Cl-)-静脉血: 103.1mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；淋巴细胞计数(Lymph#)-静脉血: 2.510E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.63mmol/L；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.06S/CO；血小板比容-静脉血: 21%；载脂蛋白B(apoB)-静脉血: 1.22g/L；C-反应蛋白(CRP)-静脉血: 4.05mg/L；ABO血型-静脉血: A；载脂蛋白AI(apoAI)-静脉血: 1.2g/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；单核细胞百分比(Mono%)-静脉血: 0.049；钠离子(Na+)-静脉血: 139.6mmol/L；凝血酶原时间(PT)-静脉血: 10.3sec.；球蛋白(GLO)-静脉血: 24.76g/L；纤维蛋白原(Fbg)-静脉血: 2.49g/L；凝血酶时间(TT)-静脉血: 20sec.；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44.6；Rh血型-静脉血: 阳性；平均红细胞体积(MCV)-静脉血: 85.8fL；直接胆红素(DBIL)-静脉血: 3.3umol/L；凝血酶原时间活动度(PTA)-静脉血: 113.8……\n- [全程D3] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D3] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 38mm AO 26mm MV E 0.79m/s EF 75% LV 50mm IVS 11mm A 0.67m/s FS 45% RA 33mm LVPW 8mm RV 20mm PA 19mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 左房稍大，余各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 左房稍大 各房室腔及大血管未探及异常血流信号 心功能正常\n- [全程D3] 检验组合: 丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D4] CT；胸部CT平扫＋增强: 检查类型: CT；检查名称: 胸部CT平扫＋增强；检查部位:；检查所见: 右中肺及双下肺见数个类结节影，最大者直径约 5 mm，病灶边界清楚而不规则，密度较高而不均匀；气管及支气管分枝通畅，未见明显软组织肿物或受压变窄；双侧肺门及纵隔未见明确肿大淋巴结；双侧胸腔未见积液；胸膜未见增厚；扫描范围内胸椎、胸壁骨未见骨质破坏征象。；检查结论: 双肺类结节影，转移瘤可能性大。\n- [全程D4] 检验组合: 酮体(KET)-尿液: +-（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；尿胆原(URO)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 4/μL；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；白细胞计数(WBC#)-尿液: 26/μL；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；酸碱度(pH)-尿液: 6；总蛋白(TP)-尿液: -（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性（参考: 阴性）；颜色-尿液: Light-Yellow；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；非鳞状上皮细胞计数-尿液: 2/μL；比重(SG)-尿液: 1.032；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.05；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D5] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: 3+500Leu（参考: 阴性）；白细胞计数(WBC#)-尿液: 18/μL；鳞状上皮细胞计数(SQEP#)-尿液: 5/μL；比重(SG)-尿液: 1.02；总蛋白(TP)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: Turbid；隐血(OB)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；未分类结晶计数(UNCX#)-尿液: 25/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；非鳞状上皮细胞计数-尿液: 5/μL\n- [全程D9] 检验组合: 钾离子(K+)-静脉血: 3.73mmol/L；红细胞比容(Hct)-静脉血: 48.1%；血小板比容-静脉血: 19%；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.94mmolL；尿素氮(BUN)-静脉血: 9.5mmol/L；钠离子(Na+)-静脉血: 137.8mmol/L；血红蛋白(Hb)-静脉血: 159g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.095；总钙(Ca)-静脉血: 1.93mmol/L；血小板分布宽度(PDW)-静脉血: 13.3%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；丙氨酸氨基转移酶(ALT)-静脉血: 94.9U/L；载脂蛋白B(apoB)-静脉血: 1.06g/L；白蛋白(ALB)-静脉血: 40.3g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.46；白细胞计数(WBC#)-静脉血: 14.910E9/L；胱抑素(Cys-C)-静脉血: 1.26mg/L；平均血小板体积(MPV)-静脉血: 10.4fL；中性粒细胞百分比(Neut%)-静脉血: 0.837；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.45mmol/L；血小板计数(PLT#)-静脉血: 17910E9/L；总胆固醇(TC)-静脉血: 5.1mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.4；球蛋白(GLO)-静脉血: 23.17g/L；磷(P)-静脉血: 1.26mmol/L；间接胆红素(IBIL)-静脉血: 13.1umolL；红细胞计数(RBC#)-静脉血: 5.5910E12/L；直接胆红素(DBIL)-静脉血: 5.4umol/L；总胆汁酸(TBA)-静脉血: 0.1umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；单核细胞百分比(Mono%)-静脉血: 0.06；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 42.8U/L；肌酐(Crea)-静脉血: 101.5umol/L；载脂蛋白AI(apoAI)-静脉血: 0.99g/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.4mmol/L；单核细胞计……\n- [全程D16] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及双侧壁增厚放射性浓聚，SUV约11.9，双侧咽隐窝消失；病灶侵犯双侧腭帆提肌、左侧腭帆张肌、左翼内肌，左咽旁间隙及左咽后间隙消失；病灶向上侵犯蝶骨基底部、左翼突区、左蝶骨大翼、左卵圆孔及左海绵窦；向前侵犯左翼腭窝、左上颌后脂肪间隙、左眶尖及左眶内后份，左框内病灶与视神经分界不清。右咽后小淋巴结放射性分布未见明显异常。双侧扁桃体放射性浓聚，SUV约9.4；喉咽结构及放射性分布未见明显异常。双侧上颌窦低密度影放射性分布未见异常；额窦、蝶窦、筛窦结构及放射性分布未见明显异常。甲状腺双叶密度减低，放射性分布未见异常。双颈多个小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺散在多发结节影放射性分布未见明显异常，最大约0.6×0.8cm；左上肺舌段条索影放射性分布未见异常；气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。心脏及纵隔大血管未见明显异常。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏弥漫性密度减低，CT值约36Hu（脾脏CT值约51Hu），放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾门区结节影放射性分布未见异常，大小约1.1×1.4cm（副脾）；脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 双侧乳突气房内低密度影放射性分布未见异常；余颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌病灶，侵犯左咽后及左咽旁间隙、颅底骨骼、左卵圆孔、左海绵窦、左翼腭窝、左上颌后脂肪间隙、左眶尖及左眶内后份，累及左视神经。 双肺多发小结节影代谢未见异常，疑增殖灶。 双侧上颌窦炎症；双侧乳突炎症。 双侧扁桃体代谢活跃，考虑炎性病变。 脂肪肝。\n\n【既往治疗与反应】\n- [全程D2] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者无诉特殊不适，完善各项检查中，体查同入院时，[姓名已隐去]主任查房指示，待各项检查完成明确分期后，再决定下一步治疗。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D8] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D10] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+顺铂方案诱导化疗结束，诉呕吐2次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程5-FU+顺铂方案诱导化疗结束，无诉特殊不适，可予请假至6月13日，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n- [全程D15] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者请假至.吕星\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估PET/CT双侧扁桃体代谢活跃为淋巴结转移，双肺结节无代谢活性；调整为GP方案（吉西他滨+顺铂）行第2程诱导化疗，并加强静脉导管护理。\nB. 评估PET/CT证实双肺结节无代谢活性（排除M1）；已完成1程诱导化疗，直接进入根治性放疗阶段，并辅以同期顺铂化疗，定期复查生化常规。\nC. 评估PET/CT见双肺多发结节伴鼻咽病灶广泛侵犯，考虑为IVB期（M1）；调整为姑息性化疗，采用TP方案联合PD-1抑制剂，并维持静脉通路。\nD. 评估PET/CT证实双肺结节无代谢活性；病灶侵犯视神经及海绵窦，第2程诱导化疗需升级为TPF方案（多西他赛+顺铂+5-FU），并复查生化。\nE. 评估PET/CT证实双肺结节无代谢活性；拔除原有静脉置管以防血栓，复查生化常规后，继续行第2程PF方案（5-FU+顺铂）诱导化疗。\nF. 评估PET/CT证实双肺结节无代谢活性；局部病灶侵犯广泛，暂停化疗，优先行局部病灶减瘤术以解除视神经压迫，术后继续PF方案化疗。\nG. 评估PET/CT证实双肺结节无代谢活性；为加强局部控制，第2程诱导化疗在PF方案基础上加用西妥昔单抗靶向治疗，并常规维护静脉导管。\nH. 评估PET/CT证实双肺结节无代谢活性；第1程化疗后出现胃肠道反应，第2程化疗将顺铂替换为卡铂，行5-FU+卡铂方案，复查生化常规。\nI. 评估PET/CT证实双肺结节无代谢活性；行静脉置管护理，复查生化常规后，提前终止诱导化疗，开始单纯根治性放疗，密切监测不良反应。\nJ. 评估PET/CT证实双肺结节无代谢活性，鼻咽病灶SUV值偏高说明原方案疗效欠佳；换用吉西他滨+顺铂方案行第2程诱导化疗，并复查生化。\nK. 评估PET/CT证实双肺结节无代谢活性（排除M1），维持局部晚期诊断；行静脉置管护理与通畅性维护，复查生化常规后，继续行第2程PF方案诱导化疗。\nL. 评估PET/CT证实双肺结节无代谢活性；病灶累及颅底及海绵窦，行第2程PF方案诱导化疗的同时，加用局部姑息性放疗，并维护静脉导管。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"评估PET/CT双侧扁桃体代谢活跃为淋巴结转移，双肺结节无代谢活性；调整为GP方案（吉西他滨+顺铂）行第2程诱导化疗，并加强静脉导管护理。","is_gold":false},{"letter":"B","text":"评估PET/CT证实双肺结节无代谢活性（排除M1）；已完成1程诱导化疗，直接进入根治性放疗阶段，并辅以同期顺铂化疗，定期复查生化常规。","is_gold":false},{"letter":"C","text":"评估PET/CT见双肺多发结节伴鼻咽病灶广泛侵犯，考虑为IVB期（M1）；调整为姑息性化疗，采用TP方案联合PD-1抑制剂，并维持静脉通路。","is_gold":false},{"letter":"D","text":"评估PET/CT证实双肺结节无代谢活性；病灶侵犯视神经及海绵窦，第2程诱导化疗需升级为TPF方案（多西他赛+顺铂+5-FU），并复查生化。","is_gold":false},{"letter":"E","text":"评估PET/CT证实双肺结节无代谢活性；拔除原有静脉置管以防血栓，复查生化常规后，继续行第2程PF方案（5-FU+顺铂）诱导化疗。","is_gold":false},{"letter":"F","text":"评估PET/CT证实双肺结节无代谢活性；局部病灶侵犯广泛，暂停化疗，优先行局部病灶减瘤术以解除视神经压迫，术后继续PF方案化疗。","is_gold":false},{"letter":"G","text":"评估PET/CT证实双肺结节无代谢活性；为加强局部控制，第2程诱导化疗在PF方案基础上加用西妥昔单抗靶向治疗，并常规维护静脉导管。","is_gold":false},{"letter":"H","text":"评估PET/CT证实双肺结节无代谢活性；第1程化疗后出现胃肠道反应，第2程化疗将顺铂替换为卡铂，行5-FU+卡铂方案，复查生化常规。","is_gold":false},{"letter":"I","text":"评估PET/CT证实双肺结节无代谢活性；行静脉置管护理，复查生化常规后，提前终止诱导化疗，开始单纯根治性放疗，密切监测不良反应。","is_gold":false},{"letter":"J","text":"评估PET/CT证实双肺结节无代谢活性，鼻咽病灶SUV值偏高说明原方案疗效欠佳；换用吉西他滨+顺铂方案行第2程诱导化疗，并复查生化。","is_gold":false},{"letter":"K","text":"评估PET/CT证实双肺结节无代谢活性（排除M1），维持局部晚期诊断；行静脉置管护理与通畅性维护，复查生化常规后，继续行第2程PF方案诱导化疗。","is_gold":true},{"letter":"L","text":"评估PET/CT证实双肺结节无代谢活性；病灶累及颅底及海绵窦，行第2程PF方案诱导化疗的同时，加用局部姑息性放疗，并维护静脉导管。","is_gold":false}],"gold_letter":"K"},{"sample_id":"sample-c9510f9db8861176764ecc37","patient_id":"patient-84fa3d6098d10a1d14b6b19e","turn_id":"turn08","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、斜坡、海绵窦、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D16] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及双侧壁增厚放射性浓聚，SUV约11.9，双侧咽隐窝消失；病灶侵犯双侧腭帆提肌、左侧腭帆张肌、左翼内肌，左咽旁间隙及左咽后间隙消失；病灶向上侵犯蝶骨基底部、左翼突区、左蝶骨大翼、左卵圆孔及左海绵窦；向前侵犯左翼腭窝、左上颌后脂肪间隙、左眶尖及左眶内后份，左框内病灶与视神经分界不清。右咽后小淋巴结放射性分布未见明显异常。双侧扁桃体放射性浓聚，SUV约9.4；喉咽结构及放射性分布未见明显异常。双侧上颌窦低密度影放射性分布未见异常；额窦、蝶窦、筛窦结构及放射性分布未见明显异常。甲状腺双叶密度减低，放射性分布未见异常。双颈多个小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺散在多发结节影放射性分布未见明显异常，最大约0.6×0.8cm；左上肺舌段条索影放射性分布未见异常；气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。心脏及纵隔大血管未见明显异常。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏弥漫性密度减低，CT值约36Hu（脾脏CT值约51Hu），放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾门区结节影放射性分布未见异常，大小约1.1×1.4cm（副脾）；脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 双侧乳突气房内低密度影放射性分布未见异常；余颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌病灶，侵犯左咽后及左咽旁间隙、颅底骨骼、左卵圆孔、左海绵窦、左翼腭窝、左上颌后脂肪间隙、左眶尖及左眶内后份，累及左视神经。 双肺多发小结节影代谢未见异常，疑增殖灶。 双侧上颌窦炎症；双侧乳突炎症。 双侧扁桃体代谢活跃，考虑炎性病变。 脂肪肝。\n- [全程D24] 检验组合: 红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.4%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.71mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.0123；平均血小板体积(MPV)-静脉血: 8.22fL；载脂蛋白B(apoB)-静脉血: 1.13g/L；总胆固醇(TC)-静脉血: 5.18mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.281；有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞血红蛋白浓度(MCHC)-静脉血: 325.6g/L；磷(P)-静脉血: 1.14mmol/L；胱抑素(Cys-C)-静脉血: 1.19mg/L；尿素氮(BUN)-静脉血: 7.71mmol/L；血小板分布宽度(PDW)-静脉血: 16.4%；丙氨酸氨基转移酶(ALT)-静脉血: 28.8U/L；直接胆红素(DBIL)-静脉血: 2.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.8；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.14mmolL；氯离子(Cl-)-静脉血: 105.9mmol/L；血小板计数(PLT#)-静脉血: 18310E9/L；中性粒细胞计数(Neut#)-静脉血: 510E9/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；乳酸脱氢酶(LDH)-静脉血: 159U/L；平均红细胞体积(MCV)-静脉血: 84.3fL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；红细胞计数(RBC#)-静脉血: 5.2310E12/L；球蛋白(GLO)-静脉血: 27.58g/L；葡萄糖(Glu)-静脉血: 4.55mmol/L；肌酐(Crea)-静脉血: 91.9umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；血小板比容-静脉血: 15%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 50.8U/L；白细胞计数(WBC#)-静脉血: 7.810E9/L；单核细胞百分比(Mono%)-静脉血: 0.0665；淋巴细胞计数(Lymph#)-静脉血: 2.210E9/L；C-反应蛋白(CRP)-静脉血: 4.59mg/L；红细胞比容(Hct)-静脉血:……\n- [全程D25] 检验组合: 浊度(TRUB)-尿液: 清亮；白细胞计数(WBC#)-尿液: 100/μL；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；红细胞计数(RBC#)-尿液: 4/μL；比重(SG)-尿液: 1.028；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -+25Leu（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow\n- [全程D26] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.027；颜色-尿液: Light-Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；葡萄糖(Glu)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）\n- [全程D27] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 9/μL；酮体(KET)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.026；酸碱度(pH)-尿液: 6.5；颜色-尿液: Light-Yellow；浊度(TRUB)-尿液: 清亮；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）\n- [全程D31] 检验组合: 钠离子(Na+)-静脉血: 137.1mmol/L；直接胆红素(DBIL)-静脉血: 5.1umol/L；磷(P)-静脉血: 1.46mmol/L；红细胞计数(RBC#)-静脉血: 5.0710E12/L；镁离子(Mg2+)-静脉血: 0.64mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.7mmol/L；血小板计数(PLT#)-静脉血: 11810E9/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；胱抑素(Cys-C)-静脉血: 1.51mg/L；间接胆红素(IBIL)-静脉血: 9umolL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.9；中性粒细胞百分比(Neut%)-静脉血: 0.581；甘油三酯(TG)-静脉血: 1.92mmol/L；血小板分布宽度(PDW)-静脉血: 11.5%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.006；氯离子(Cl-)-静脉血: 98.9mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.94mmolL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；总蛋白(TP)-静脉血: 63.22g/L；尿素氮(BUN)-静脉血: 10.16mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 27.6pg；总胆汁酸(TBA)-静脉血: 0.3umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.710E9/L；葡萄糖(Glu)-静脉血: 5.19mmol/L；血红蛋白(Hb)-静脉血: 140g/L；载脂蛋白AI(apoAI)-静脉血: 1.13g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 41.9U/L；总胆固醇(TC)-静脉血: 5.12mmol/L；肌酐(Crea)-静脉血: 132.7umol/L；总钙(Ca)-静脉血: 1.91mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 44U/L；球蛋白(GLO)-静脉血: 24.42g/L；白蛋白(ALB)-静脉血: 38.8g/L；平均红细胞体积(MCV)-静脉血: 83.8fL；乳酸脱氢酶(LDH)-静脉血: 199.2U/L；总胆红素(TBIL)-静脉血: 14.1umol/L；钾离子(K+)……\n- [全程D32] 检验组合: 肌酐(Crea)-静脉血: 122.2umol/L；磷(P)-静脉血: 1.38mmol/L；尿素氮(BUN)-静脉血: 9.9mmol/L；总胆红素(TBIL)-静脉血: 14.5umol/L；尿酸(UA)-静脉血: 496.4umol/L；镁离子(Mg2+)-静脉血: 0.57mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.76；总钙(Ca)-静脉血: 1.79mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.5mmol/L；球蛋白(GLO)-静脉血: 23.74g/L；氯离子(Cl-)-静脉血: 97.6mmol/L；钠离子(Na+)-静脉血: 136.5mmol/L；阴离子间隙(AG)-静脉血: 16.4；间接胆红素(IBIL)-静脉血: 10.3umolL；直接胆红素(DBIL)-静脉血: 4.2umol/L；白蛋白(ALB)-静脉血: 41.9g/L；总蛋白(TP)-静脉血: 65.64g/L；钾离子(K+)-静脉血: 3.56mmol/L\n- [全程D35] 检验组合: 磷(P)-静脉血: 1.32mmol/L；镁离子(Mg2+)-静脉血: 0.53mmol/L；阴离子间隙(AG)-静脉血: 14.8；球蛋白(GLO)-静脉血: 21.96g/L；总钙(Ca)-静脉血: 1.51mmol/L；总胆红素(TBIL)-静脉血: 7.6umol/L；总蛋白(TP)-静脉血: 60.56g/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.2mmol/L；间接胆红素(IBIL)-静脉血: 5umolL；尿素氮(BUN)-静脉血: 11.2mmol/L；钾离子(K+)-静脉血: 3.94mmol/L；白蛋白(ALB)-静脉血: 38.6g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.76；尿酸(UA)-静脉血: 490.1umol/L；肌酐(Crea)-静脉血: 116.6umol/L；直接胆红素(DBIL)-静脉血: 2.6umol/L；氯离子(Cl-)-静脉血: 104.1mmol/L；钠离子(Na+)-静脉血: 140.1mmol/L\n- [全程D36] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌两程诱导化疗后复查：对比某次就诊时间MRI， 鼻咽顶壁、顶后壁、后壁及双侧壁稍增厚，形成软组织肿物向腔内突出，T1WI呈等信号，T2WI呈高信号，增强后明显强化。肿物占据双侧咽隐窝，侵犯双侧腭帆张、提肌及左侧翼内肌。右侧翼外肌未见明显异常。双侧咽旁间隙清晰。 口咽未见明确病变。 蝶骨基底部、左侧岩尖骨质信号减低 ，增强后明显强化。 双侧海绵窦形态正常，未见增宽。 双侧蝶窦、筛窦、额窦粘膜增厚，呈长分期信息见历史辅助诊断节点长分期信息见历史辅助诊断节点信号，增强后边缘轻度强化，双侧乳突内见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点信号分泌物，骨壁完好。 双侧眼球大小、形态、位置均属正常，信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变。 双侧咽后各见一淋巴结，大小分别约为6mm×6mm（左）、7mm×4mm（右），边界清，信号均，增强后可见强化。 双颈II区见数个稍大淋巴结，边缘清，信号欠均，增强后明显强化，孤立散在，未见明显坏死，最大者位于右颈II区，大小约13mm×9mm。 双颈II~IV区可见小淋巴结，边缘清，信号尚均，增强后可见强化。 喉咽腔形态正常，未见占位性病变。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽占位，对比某次就诊时间MRI所见病变明显缩小好转。 颅底骨质破坏。 双颈II区稍大淋巴结，不除外转移。 鼻窦炎、乳突炎。\n\n【既往治疗与反应】\n- [全程D15] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者请假至.吕星\n- [全程D25] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者安返病房，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，可于今日执行第2程5-FU+顺铂方案诱导化疗，注意化疗不良反应。\n- [全程D27] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+顺铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D36] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者请假至.\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即启动根治性调强放射治疗及同步化疗，暂不安排其他局部影像或内镜检查。\nB. 行电子鼻咽镜检查并对残留病灶取活检以明确病理状态，复查血常规与生化常规。\nC. 继续予以第3程5-FU+顺铂方案诱导化疗，待化疗结束后再行鼻咽镜评估。\nD. 安排全身PET/CT复查以评估全身肿瘤代谢活性变化，随后制定放疗计划。\nE. 更改为紫杉醇+顺铂方案行第3程诱导化疗，并予动静脉置管常规护理。\nF. 安排鼻咽及颈部CT平扫+增强进一步评估颅底骨质破坏情况，复查血常规。\nG. 择期行双侧颈部淋巴结清扫术，术后启动鼻咽局部及颈部放射治疗。\nH. 行电子鼻咽镜检查（不活检）评估局部疗效，并拔除动静脉置管准备单纯放疗。\nI. 更改为吉西他滨+顺铂方案行第3程诱导化疗，复查血常规与生化常规。\nJ. 行电子鼻咽镜检查（不活检），若无明显外生型肿物则暂缓放疗并定期随访。\nK. 立即启动单纯根治性放射治疗，并予动静脉置管常规护理。\nL. 行电子鼻咽镜检查（不活检）进一步评估鼻咽局部疗效，复查血常规与生化常规，并予动静脉置管护理。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"立即启动根治性调强放射治疗及同步化疗，暂不安排其他局部影像或内镜检查。","is_gold":false},{"letter":"B","text":"行电子鼻咽镜检查并对残留病灶取活检以明确病理状态，复查血常规与生化常规。","is_gold":false},{"letter":"C","text":"继续予以第3程5-FU+顺铂方案诱导化疗，待化疗结束后再行鼻咽镜评估。","is_gold":false},{"letter":"D","text":"安排全身PET/CT复查以评估全身肿瘤代谢活性变化，随后制定放疗计划。","is_gold":false},{"letter":"E","text":"更改为紫杉醇+顺铂方案行第3程诱导化疗，并予动静脉置管常规护理。","is_gold":false},{"letter":"F","text":"安排鼻咽及颈部CT平扫+增强进一步评估颅底骨质破坏情况，复查血常规。","is_gold":false},{"letter":"G","text":"择期行双侧颈部淋巴结清扫术，术后启动鼻咽局部及颈部放射治疗。","is_gold":false},{"letter":"H","text":"行电子鼻咽镜检查（不活检）评估局部疗效，并拔除动静脉置管准备单纯放疗。","is_gold":false},{"letter":"I","text":"更改为吉西他滨+顺铂方案行第3程诱导化疗，复查血常规与生化常规。","is_gold":false},{"letter":"J","text":"行电子鼻咽镜检查（不活检），若无明显外生型肿物则暂缓放疗并定期随访。","is_gold":false},{"letter":"K","text":"立即启动单纯根治性放射治疗，并予动静脉置管常规护理。","is_gold":false},{"letter":"L","text":"行电子鼻咽镜检查（不活检）进一步评估鼻咽局部疗效，复查血常规与生化常规，并予动静脉置管护理。","is_gold":true}],"gold_letter":"L"}]}
+{"patient_id":"patient-34616c327ce5d69194ca7f4d","bootstrap_cluster_id":"cluster-025","turns":[{"sample_id":"sample-eb32294d1506d6b48368496f","patient_id":"patient-34616c327ce5d69194ca7f4d","turn_id":"turn01","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D3189] 门急诊记录: 主诉: 鼻咽癌治疗后8年；患者家属自述行放疗（具体方案不详）。患者家属来诊，诉近来头后部疼痛，持续二月余，逐渐加重，无其他明显，来诊咨询诊疗意见。；既往史: 是否有过敏史无过敏史。是否有吸烟史吸烟史详情；个人史:；家族史:；体格检查:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善鼻咽镜检查及活检，检测EBV DNA定量、常规血液学指标，并进行胸部DR与腹盆腔彩超检查\nB. 完善鼻咽镜检查及活检，检测EBV DNA定量，并进行全身PET-CT检查，暂缓常规血液学指标检测\nC. 完善鼻咽镜检查及活检，检测EBV DNA定量，并进行胸腹部增强CT检查，暂缓常规血液学指标检测\nD. 行头颈部MRI及颅底薄层CT检查，待影像学显示异常后再行鼻咽镜活检及EBV DNA检测\nE. 检测EBV DNA定量及常规血液学指标，待EBV DNA结果阳性后再行鼻咽镜活检及影像学检查\nF. 完善鼻咽镜检查及活检，检测常规血液学指标，并进行胸部DR与腹盆腔彩超检查，暂不检测EBV DNA\nG. 完善鼻咽镜检查（暂不活检），检测EBV DNA定量、常规血液学指标，并进行胸部DR与腹盆腔彩超检查\nH. 行全身骨扫描及头颅增强MRI检查，暂缓鼻咽镜活检及EBV DNA定量检测\nI. 完善鼻咽镜检查及活检，检测EBV DNA定量，并进行全身骨扫描，暂缓胸部及腹盆腔影像学检查\nJ. 完善鼻咽镜检查及活检，检测EBV DNA定量、常规血液学指标，仅行胸部CT检查，暂不进行腹盆腔影像学评估\nK. 行常规血液学指标检测及基础影像学检查（胸部DR、腹盆腔彩超），暂缓鼻咽镜活检及EBV DNA检测\nL. 完善鼻咽镜检查及活检，检测常规血液学指标，行头颈部PET-CT检查，暂不检测EBV DNA定量\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"完善鼻咽镜检查及活检，检测EBV DNA定量、常规血液学指标，并进行胸部DR与腹盆腔彩超检查","is_gold":true},{"letter":"B","text":"完善鼻咽镜检查及活检，检测EBV DNA定量，并进行全身PET-CT检查，暂缓常规血液学指标检测","is_gold":false},{"letter":"C","text":"完善鼻咽镜检查及活检，检测EBV DNA定量，并进行胸腹部增强CT检查，暂缓常规血液学指标检测","is_gold":false},{"letter":"D","text":"行头颈部MRI及颅底薄层CT检查，待影像学显示异常后再行鼻咽镜活检及EBV DNA检测","is_gold":false},{"letter":"E","text":"检测EBV DNA定量及常规血液学指标，待EBV DNA结果阳性后再行鼻咽镜活检及影像学检查","is_gold":false},{"letter":"F","text":"完善鼻咽镜检查及活检，检测常规血液学指标，并进行胸部DR与腹盆腔彩超检查，暂不检测EBV DNA","is_gold":false},{"letter":"G","text":"完善鼻咽镜检查（暂不活检），检测EBV DNA定量、常规血液学指标，并进行胸部DR与腹盆腔彩超检查","is_gold":false},{"letter":"H","text":"行全身骨扫描及头颅增强MRI检查，暂缓鼻咽镜活检及EBV DNA定量检测","is_gold":false},{"letter":"I","text":"完善鼻咽镜检查及活检，检测EBV DNA定量，并进行全身骨扫描，暂缓胸部及腹盆腔影像学检查","is_gold":false},{"letter":"J","text":"完善鼻咽镜检查及活检，检测EBV DNA定量、常规血液学指标，仅行胸部CT检查，暂不进行腹盆腔影像学评估","is_gold":false},{"letter":"K","text":"行常规血液学指标检测及基础影像学检查（胸部DR、腹盆腔彩超），暂缓鼻咽镜活检及EBV DNA检测","is_gold":false},{"letter":"L","text":"完善鼻咽镜检查及活检，检测常规血液学指标，行头颈部PET-CT检查，暂不检测EBV DNA定量","is_gold":false}],"gold_letter":"A"},{"sample_id":"sample-f19200235c8a99467249ed0c","patient_id":"patient-34616c327ce5d69194ca7f4d","turn_id":"turn02","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 暂无可展示的初诊主诉/入院资料。\n\n【已完成检查与客观结果】\n- [全程D0] 检验组合: 嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；凝血酶原时间活动度(PTA)-静脉血: 89%；平均血小板体积(MPV)-静脉血: 9.4fL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 334g/L；D-二聚体(D-Dimer)-静脉血: 0.29ug/ml；凝血酶原国际标准化比值(PT-INR)-静脉血: 1.02；纤维蛋白原(Fbg)-静脉血: 3.21g/L；红细胞比容(Hct)-静脉血: 48.2%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；平均红细胞血红蛋白含量(MCH)-静脉血: 32pg；红细胞计数(RBC#)-静脉血: 5.0310E12/L；淋巴细胞百分比(Lymph%)-静脉血: 0.271；中性粒细胞计数(Neut#)-静脉血: 5.910E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.65；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.8；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；大血小板百分比(P-LCR%)-静脉血: 20.8%；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；血小板比容-静脉血: 27%；平均红细胞体积(MCV)-静脉血: 95.8fL；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.06S/CO；血小板分布宽度(PDW)-静脉血: 10.8%；单核细胞计数(Mono#)-静脉血: 0.510E9/L；活化部分凝血活酶时间(APTT)-静脉血: 29.2sec.；凝血酶原时间(PT)-静脉血: 11.4sec.；纤维蛋白原降解产物(FDP)-静脉血: 2.8ug/ml；淋巴细胞计数(Lymph#)-静脉血: 2.510E9/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.01IU/mL；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.13COI；凝血酶时间(TT)-静脉血: 20sec.；血小板计数(PLT#)-静脉血: 28910E9/L；Rh血型-静脉血: 阳性；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.06S/CO；血红蛋白(Hb)-静脉血: 161g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；白细胞计数(WBC……\n- [全程D14] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 左前分支阻滞\n- [全程D14] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理稍增粗，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见重要病变。\n- [全程D15] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 右侧乳突可见片状放射性浓集灶。胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 右侧乳突炎症。 余全身骨骼未见明显异常。\n- [全程D16] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，肝S7可见一强回声斑，直径约5mm，后方伴声影。血管走行清晰、自然，肝内胆管不扩张，门静脉内径14mm。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约21cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约36×26×23mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝S7强回声斑，考虑肝内胆管结石。 胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估影像分期为 cT3N1M0（AJCC 第9版 II期），直接安排诱导化疗联合同期放化疗，并补充生化常规检查\nB. 评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nC. 评估影像分期为 cT4N1M0（AJCC 第9版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nD. 评估影像分期为 cT3N2M0（AJCC 第9版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nE. 评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽镜及活检以获取病理确诊，并补充全身PET-CT检查\nF. 评估影像分期为 cT2N1M0（AJCC 第9版 I期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nG. 评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽镜及活检以获取病理确诊，并补充头颅增强MRI检查\nH. 评估影像分期为 cT3N1M1（AJCC 第9版 IVB期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nI. 评估影像分期为 cT3N1M0（AJCC 第8版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nJ. 评估影像分期为 cT4N2M0（AJCC 第9版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查\nK. 评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽肿物切除活检以获取病理确诊，并补充生化常规检查\nL. 评估影像分期为 cT3N1M0（AJCC 第9版 II期），行右颈部淋巴结穿刺活检以获取病理确诊，并补充生化常规检查\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"评估影像分期为 cT3N1M0（AJCC 第9版 II期），直接安排诱导化疗联合同期放化疗，并补充生化常规检查","is_gold":false},{"letter":"B","text":"评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查","is_gold":true},{"letter":"C","text":"评估影像分期为 cT4N1M0（AJCC 第9版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查","is_gold":false},{"letter":"D","text":"评估影像分期为 cT3N2M0（AJCC 第9版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查","is_gold":false},{"letter":"E","text":"评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽镜及活检以获取病理确诊，并补充全身PET-CT检查","is_gold":false},{"letter":"F","text":"评估影像分期为 cT2N1M0（AJCC 第9版 I期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查","is_gold":false},{"letter":"G","text":"评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽镜及活检以获取病理确诊，并补充头颅增强MRI检查","is_gold":false},{"letter":"H","text":"评估影像分期为 cT3N1M1（AJCC 第9版 IVB期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查","is_gold":false},{"letter":"I","text":"评估影像分期为 cT3N1M0（AJCC 第8版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查","is_gold":false},{"letter":"J","text":"评估影像分期为 cT4N2M0（AJCC 第9版 III期），行鼻咽镜及活检以获取病理确诊，并补充生化常规检查","is_gold":false},{"letter":"K","text":"评估影像分期为 cT3N1M0（AJCC 第9版 II期），行鼻咽肿物切除活检以获取病理确诊，并补充生化常规检查","is_gold":false},{"letter":"L","text":"评估影像分期为 cT3N1M0（AJCC 第9版 II期），行右颈部淋巴结穿刺活检以获取病理确诊，并补充生化常规检查","is_gold":false}],"gold_letter":"B"},{"sample_id":"sample-2288420a623ad83bf0b0a558","patient_id":"patient-34616c327ce5d69194ca7f4d","turn_id":"turn04","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 暂无可展示的初诊主诉/入院资料。\n\n【已完成检查与客观结果】\n- [全程D0] 检验组合: 嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；凝血酶原时间活动度(PTA)-静脉血: 89%；平均血小板体积(MPV)-静脉血: 9.4fL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 334g/L；D-二聚体(D-Dimer)-静脉血: 0.29ug/ml；凝血酶原国际标准化比值(PT-INR)-静脉血: 1.02；纤维蛋白原(Fbg)-静脉血: 3.21g/L；红细胞比容(Hct)-静脉血: 48.2%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；平均红细胞血红蛋白含量(MCH)-静脉血: 32pg；红细胞计数(RBC#)-静脉血: 5.0310E12/L；淋巴细胞百分比(Lymph%)-静脉血: 0.271；中性粒细胞计数(Neut#)-静脉血: 5.910E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.65；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.8；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；大血小板百分比(P-LCR%)-静脉血: 20.8%；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；血小板比容-静脉血: 27%；平均红细胞体积(MCV)-静脉血: 95.8fL；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.06S/CO；血小板分布宽度(PDW)-静脉血: 10.8%；单核细胞计数(Mono#)-静脉血: 0.510E9/L；活化部分凝血活酶时间(APTT)-静脉血: 29.2sec.；凝血酶原时间(PT)-静脉血: 11.4sec.；纤维蛋白原降解产物(FDP)-静脉血: 2.8ug/ml；淋巴细胞计数(Lymph#)-静脉血: 2.510E9/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.01IU/mL；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.13COI；凝血酶时间(TT)-静脉血: 20sec.；血小板计数(PLT#)-静脉血: 28910E9/L；Rh血型-静脉血: 阳性；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.06S/CO；血红蛋白(Hb)-静脉血: 161g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；白细胞计数(WBC……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D14] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 左前分支阻滞\n- [全程D14] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理稍增粗，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见重要病变。\n- [全程D15] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 右侧乳突可见片状放射性浓集灶。胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 右侧乳突炎症。 余全身骨骼未见明显异常。\n- [全程D16] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，肝S7可见一强回声斑，直径约5mm，后方伴声影。血管走行清晰、自然，肝内胆管不扩张，门静脉内径14mm。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约21cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约36×26×23mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝S7强回声斑，考虑肝内胆管结石。 胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D22] 检验组合: 钾离子(K+)-静脉血: 4.18mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 46.8U/L；氯离子(Cl-)-静脉血: 101.7mmol/L；直接胆红素(DBIL)-静脉血: 2.5umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；乳酸脱氢酶(LDH)-静脉血: 172.2U/L；尿酸(UA)-静脉血: 299umol/L；碱性磷酸酶(ALP)-静脉血: 35.4U/L；载脂蛋白B(apoB)-静脉血: 0.71g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.09mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.82；γ-谷氨酰基转移酶(GGT)-静脉血: 23.1U/L；总钙(Ca)-静脉血: 2.31mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.1U/L；间接胆红素(IBIL)-静脉血: 4.8umolL；血液二氧化碳含量ctCO2(B)-静脉血: 22.5mmol/L；总蛋白(TP)-静脉血: 76.15g/L；阴离子间隙(AG)-静脉血: 16.8；总胆固醇(TC)-静脉血: 4.05mmol/L；总胆汁酸(TBA)-静脉血: 3.1umol/L；总胆红素(TBIL)-静脉血: 7.3umol/L；肌酐(Crea)-静脉血: 58.1umol/L；载脂蛋白AI(apoAI)-静脉血: 1.48g/L；球蛋白(GLO)-静脉血: 30.25g/L；C-反应蛋白(CRP)-静脉血: 3.66mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.33mmolL；镁离子(Mg2+)-静脉血: 0.86mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.3U/L；胱抑素(Cys-C)-静脉血: 0.88mg/L；尿素氮(BUN)-静脉血: 3.4mmol/L；葡萄糖(Glu)-静脉血: 5.59mmol/L；甘油三酯(TG)-静脉血: 2.5mmol/L；磷(P)-静脉血: 1.15mmol/L；白蛋白(ALB)-静脉血: 45.9g/L；钠离子(Na+)-静脉血: 141mmol/L\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 单纯根治性调强放射治疗\nB. 含铂双药方案诱导化疗序贯单纯根治性放疗\nC. 根治性放疗联合含铂方案同步化疗，序贯含铂双药辅助化疗\nD. 含铂方案诱导化疗序贯根治性放化疗，或根治性放疗联合含铂方案同步化疗\nE. 根治性放疗联合西妥昔单抗等EGFR靶向治疗\nF. 根治性放疗联合PD-1抑制剂同步免疫治疗\nG. 姑息性全身化疗联合局部病灶姑息性放疗\nH. 含铂双药方案诱导化疗序贯鼻咽原发灶切除及颈部淋巴结清扫术\nI. 根治性放疗联合大分子抗血管生成靶向治疗\nJ. 单纯含铂双药方案全身化疗4-6个周期\nK. 鼻咽原发灶切除及颈部淋巴结清扫术序贯术后辅助放化疗\nL. 含铂双药方案诱导化疗序贯根治性放疗及PD-1抑制剂维持治疗\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"单纯根治性调强放射治疗","is_gold":false},{"letter":"B","text":"含铂双药方案诱导化疗序贯单纯根治性放疗","is_gold":false},{"letter":"C","text":"根治性放疗联合含铂方案同步化疗，序贯含铂双药辅助化疗","is_gold":false},{"letter":"D","text":"含铂方案诱导化疗序贯根治性放化疗，或根治性放疗联合含铂方案同步化疗","is_gold":true},{"letter":"E","text":"根治性放疗联合西妥昔单抗等EGFR靶向治疗","is_gold":false},{"letter":"F","text":"根治性放疗联合PD-1抑制剂同步免疫治疗","is_gold":false},{"letter":"G","text":"姑息性全身化疗联合局部病灶姑息性放疗","is_gold":false},{"letter":"H","text":"含铂双药方案诱导化疗序贯鼻咽原发灶切除及颈部淋巴结清扫术","is_gold":false},{"letter":"I","text":"根治性放疗联合大分子抗血管生成靶向治疗","is_gold":false},{"letter":"J","text":"单纯含铂双药方案全身化疗4-6个周期","is_gold":false},{"letter":"K","text":"鼻咽原发灶切除及颈部淋巴结清扫术序贯术后辅助放化疗","is_gold":false},{"letter":"L","text":"含铂双药方案诱导化疗序贯根治性放疗及PD-1抑制剂维持治疗","is_gold":false}],"gold_letter":"D"},{"sample_id":"sample-258f93513eac99791d84464c","patient_id":"patient-34616c327ce5d69194ca7f4d","turn_id":"turn05","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 暂无可展示的初诊主诉/入院资料。\n\n【已完成检查与客观结果】\n- [全程D0] 检验组合: 嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；凝血酶原时间活动度(PTA)-静脉血: 89%；平均血小板体积(MPV)-静脉血: 9.4fL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 334g/L；D-二聚体(D-Dimer)-静脉血: 0.29ug/ml；凝血酶原国际标准化比值(PT-INR)-静脉血: 1.02；纤维蛋白原(Fbg)-静脉血: 3.21g/L；红细胞比容(Hct)-静脉血: 48.2%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；平均红细胞血红蛋白含量(MCH)-静脉血: 32pg；红细胞计数(RBC#)-静脉血: 5.0310E12/L；淋巴细胞百分比(Lymph%)-静脉血: 0.271；中性粒细胞计数(Neut#)-静脉血: 5.910E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.65；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.8；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；大血小板百分比(P-LCR%)-静脉血: 20.8%；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；血小板比容-静脉血: 27%；平均红细胞体积(MCV)-静脉血: 95.8fL；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.06S/CO；血小板分布宽度(PDW)-静脉血: 10.8%；单核细胞计数(Mono#)-静脉血: 0.510E9/L；活化部分凝血活酶时间(APTT)-静脉血: 29.2sec.；凝血酶原时间(PT)-静脉血: 11.4sec.；纤维蛋白原降解产物(FDP)-静脉血: 2.8ug/ml；淋巴细胞计数(Lymph#)-静脉血: 2.510E9/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.01IU/mL；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.13COI；凝血酶时间(TT)-静脉血: 20sec.；血小板计数(PLT#)-静脉血: 28910E9/L；Rh血型-静脉血: 阳性；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.06S/CO；血红蛋白(Hb)-静脉血: 161g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；白细胞计数(WBC……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D14] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 左前分支阻滞\n- [全程D14] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理稍增粗，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见重要病变。\n- [全程D15] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 右侧乳突可见片状放射性浓集灶。胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 右侧乳突炎症。 余全身骨骼未见明显异常。\n- [全程D16] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，肝S7可见一强回声斑，直径约5mm，后方伴声影。血管走行清晰、自然，肝内胆管不扩张，门静脉内径14mm。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约21cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约36×26×23mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝S7强回声斑，考虑肝内胆管结石。 胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D22] 检验组合: 钾离子(K+)-静脉血: 4.18mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 46.8U/L；氯离子(Cl-)-静脉血: 101.7mmol/L；直接胆红素(DBIL)-静脉血: 2.5umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；乳酸脱氢酶(LDH)-静脉血: 172.2U/L；尿酸(UA)-静脉血: 299umol/L；碱性磷酸酶(ALP)-静脉血: 35.4U/L；载脂蛋白B(apoB)-静脉血: 0.71g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.09mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.82；γ-谷氨酰基转移酶(GGT)-静脉血: 23.1U/L；总钙(Ca)-静脉血: 2.31mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.1U/L；间接胆红素(IBIL)-静脉血: 4.8umolL；血液二氧化碳含量ctCO2(B)-静脉血: 22.5mmol/L；总蛋白(TP)-静脉血: 76.15g/L；阴离子间隙(AG)-静脉血: 16.8；总胆固醇(TC)-静脉血: 4.05mmol/L；总胆汁酸(TBA)-静脉血: 3.1umol/L；总胆红素(TBIL)-静脉血: 7.3umol/L；肌酐(Crea)-静脉血: 58.1umol/L；载脂蛋白AI(apoAI)-静脉血: 1.48g/L；球蛋白(GLO)-静脉血: 30.25g/L；C-反应蛋白(CRP)-静脉血: 3.66mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.33mmolL；镁离子(Mg2+)-静脉血: 0.86mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.3U/L；胱抑素(Cys-C)-静脉血: 0.88mg/L；尿素氮(BUN)-静脉血: 3.4mmol/L；葡萄糖(Glu)-静脉血: 5.59mmol/L；甘油三酯(TG)-静脉血: 2.5mmol/L；磷(P)-静脉血: 1.15mmol/L；白蛋白(ALB)-静脉血: 45.9g/L；钠离子(Na+)-静脉血: 141mmol/L\n- [全程D70] 检验组合: 低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.66mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.6；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32pg；白细胞计数(WBC#)-静脉血: 7.7410E9/L；血红蛋白(Hb)-静脉血: 164g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 27.3U/L；磷(P)-静脉血: 1.31mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 20.8mmol/L；尿酸(UA)-静脉血: 323.7umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 44.8U/L；C-反应蛋白(CRP)-静脉血: 1.33mg/L；血小板比容-静脉血: 22%；血小板计数(PLT#)-静脉血: 23710E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.35mmolL；总胆红素(TBIL)-静脉血: 10.7umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 36.6U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.75；平均红细胞血红蛋白浓度(MCHC)-静脉血: 342g/L；肌酐(Crea)-静脉血: 62.3umol/L；总蛋白(TP)-静脉血: 75.99g/L；单核细胞百分比(Mono%)-静脉血: 0.056；平均红细胞血红蛋白浓度(MCHC)-静脉血: 337g/L；平均血小板体积(MPV)-静脉血: 9.5fL；血小板计数(PLT#)-静脉血: 24810E9/L；甘油三酯(TG)-静脉血: 1.02mmol/L；单核细胞百分比(Mono%)-静脉血: 0.081；球蛋白(GLO)-静脉血: 29.79g/L；平均红细胞体积(MCV)-静脉血: 95.1fL；总钙(Ca)-静脉血: 2.3mmol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；直接胆红素(DBIL)-静脉血: 3.9umol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；载脂蛋白AI(apoAI)-静脉血: 1.36g/L；大血小板百分比(P-LCR%)-静脉血: 17.2%；血红蛋白(Hb)-静脉血: 158g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32pg……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D64] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者近日精神好，胃纳尚可，暂无特殊不适。体查大致同入院。患者目前无放疗禁忌症，开始予以行鼻咽癌放疗。靶区剂量为：GTV70Gy/31F。放疗期间予同期化疗，并予加强对症、支持治疗。注意观察放疗不良反应表现。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停同期化疗，继续单纯放疗，并加用保肝药物\nB. 暂停放化疗，给予重组人粒细胞刺激因子支持治疗\nC. 继续放疗，将同期化疗剂量减低20%\nD. 继续放化疗方案，给予重组人血小板生成素\nE. 继续放化疗方案，定期复查血常规及生化指标\nF. 暂停放化疗，给予还原型谷胱甘肽保肝治疗\nG. 继续放化疗方案，加用双环醇保肝治疗\nH. 继续放化疗方案，给予重组人粒细胞刺激因子\nI. 暂停同期化疗，给予静脉补液及利尿处理\nJ. 继续放疗，取消同期化疗，改为西妥昔单抗治疗\nK. 暂停放疗，继续同期化疗，给予促红细胞生成素治疗\nL. 继续放化疗方案，输注单采血小板\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"暂停同期化疗，继续单纯放疗，并加用保肝药物","is_gold":false},{"letter":"B","text":"暂停放化疗，给予重组人粒细胞刺激因子支持治疗","is_gold":false},{"letter":"C","text":"继续放疗，将同期化疗剂量减低20%","is_gold":false},{"letter":"D","text":"继续放化疗方案，给予重组人血小板生成素","is_gold":false},{"letter":"E","text":"继续放化疗方案，定期复查血常规及生化指标","is_gold":true},{"letter":"F","text":"暂停放化疗，给予还原型谷胱甘肽保肝治疗","is_gold":false},{"letter":"G","text":"继续放化疗方案，加用双环醇保肝治疗","is_gold":false},{"letter":"H","text":"继续放化疗方案，给予重组人粒细胞刺激因子","is_gold":false},{"letter":"I","text":"暂停同期化疗，给予静脉补液及利尿处理","is_gold":false},{"letter":"J","text":"继续放疗，取消同期化疗，改为西妥昔单抗治疗","is_gold":false},{"letter":"K","text":"暂停放疗，继续同期化疗，给予促红细胞生成素治疗","is_gold":false},{"letter":"L","text":"继续放化疗方案，输注单采血小板","is_gold":false}],"gold_letter":"E"},{"sample_id":"sample-5a0d01adf33246131a9f67e1","patient_id":"patient-34616c327ce5d69194ca7f4d","turn_id":"turn06","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 暂无可展示的初诊主诉/入院资料。\n\n【已完成检查与客观结果】\n- [全程D0] 检验组合: 嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；凝血酶原时间活动度(PTA)-静脉血: 89%；平均血小板体积(MPV)-静脉血: 9.4fL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 334g/L；D-二聚体(D-Dimer)-静脉血: 0.29ug/ml；凝血酶原国际标准化比值(PT-INR)-静脉血: 1.02；纤维蛋白原(Fbg)-静脉血: 3.21g/L；红细胞比容(Hct)-静脉血: 48.2%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；平均红细胞血红蛋白含量(MCH)-静脉血: 32pg；红细胞计数(RBC#)-静脉血: 5.0310E12/L；淋巴细胞百分比(Lymph%)-静脉血: 0.271；中性粒细胞计数(Neut#)-静脉血: 5.910E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.65；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.8；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；大血小板百分比(P-LCR%)-静脉血: 20.8%；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；血小板比容-静脉血: 27%；平均红细胞体积(MCV)-静脉血: 95.8fL；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.06S/CO；血小板分布宽度(PDW)-静脉血: 10.8%；单核细胞计数(Mono#)-静脉血: 0.510E9/L；活化部分凝血活酶时间(APTT)-静脉血: 29.2sec.；凝血酶原时间(PT)-静脉血: 11.4sec.；纤维蛋白原降解产物(FDP)-静脉血: 2.8ug/ml；淋巴细胞计数(Lymph#)-静脉血: 2.510E9/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.01IU/mL；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.13COI；凝血酶时间(TT)-静脉血: 20sec.；血小板计数(PLT#)-静脉血: 28910E9/L；Rh血型-静脉血: 阳性；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.06S/CO；血红蛋白(Hb)-静脉血: 161g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；白细胞计数(WBC……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D16] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，肝S7可见一强回声斑，直径约5mm，后方伴声影。血管走行清晰、自然，肝内胆管不扩张，门静脉内径14mm。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约21cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约36×26×23mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝S7强回声斑，考虑肝内胆管结石。 胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D22] 检验组合: 钾离子(K+)-静脉血: 4.18mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 46.8U/L；氯离子(Cl-)-静脉血: 101.7mmol/L；直接胆红素(DBIL)-静脉血: 2.5umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；乳酸脱氢酶(LDH)-静脉血: 172.2U/L；尿酸(UA)-静脉血: 299umol/L；碱性磷酸酶(ALP)-静脉血: 35.4U/L；载脂蛋白B(apoB)-静脉血: 0.71g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.09mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.82；γ-谷氨酰基转移酶(GGT)-静脉血: 23.1U/L；总钙(Ca)-静脉血: 2.31mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.1U/L；间接胆红素(IBIL)-静脉血: 4.8umolL；血液二氧化碳含量ctCO2(B)-静脉血: 22.5mmol/L；总蛋白(TP)-静脉血: 76.15g/L；阴离子间隙(AG)-静脉血: 16.8；总胆固醇(TC)-静脉血: 4.05mmol/L；总胆汁酸(TBA)-静脉血: 3.1umol/L；总胆红素(TBIL)-静脉血: 7.3umol/L；肌酐(Crea)-静脉血: 58.1umol/L；载脂蛋白AI(apoAI)-静脉血: 1.48g/L；球蛋白(GLO)-静脉血: 30.25g/L；C-反应蛋白(CRP)-静脉血: 3.66mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.33mmolL；镁离子(Mg2+)-静脉血: 0.86mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.3U/L；胱抑素(Cys-C)-静脉血: 0.88mg/L；尿素氮(BUN)-静脉血: 3.4mmol/L；葡萄糖(Glu)-静脉血: 5.59mmol/L；甘油三酯(TG)-静脉血: 2.5mmol/L；磷(P)-静脉血: 1.15mmol/L；白蛋白(ALB)-静脉血: 45.9g/L；钠离子(Na+)-静脉血: 141mmol/L\n- [全程D70] 检验组合: 低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.66mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.6；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32pg；白细胞计数(WBC#)-静脉血: 7.7410E9/L；血红蛋白(Hb)-静脉血: 164g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 27.3U/L；磷(P)-静脉血: 1.31mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 20.8mmol/L；尿酸(UA)-静脉血: 323.7umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 44.8U/L；C-反应蛋白(CRP)-静脉血: 1.33mg/L；血小板比容-静脉血: 22%；血小板计数(PLT#)-静脉血: 23710E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.35mmolL；总胆红素(TBIL)-静脉血: 10.7umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 36.6U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.75；平均红细胞血红蛋白浓度(MCHC)-静脉血: 342g/L；肌酐(Crea)-静脉血: 62.3umol/L；总蛋白(TP)-静脉血: 75.99g/L；单核细胞百分比(Mono%)-静脉血: 0.056；平均红细胞血红蛋白浓度(MCHC)-静脉血: 337g/L；平均血小板体积(MPV)-静脉血: 9.5fL；血小板计数(PLT#)-静脉血: 24810E9/L；甘油三酯(TG)-静脉血: 1.02mmol/L；单核细胞百分比(Mono%)-静脉血: 0.081；球蛋白(GLO)-静脉血: 29.79g/L；平均红细胞体积(MCV)-静脉血: 95.1fL；总钙(Ca)-静脉血: 2.3mmol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；直接胆红素(DBIL)-静脉血: 3.9umol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；载脂蛋白AI(apoAI)-静脉血: 1.36g/L；大血小板百分比(P-LCR%)-静脉血: 17.2%；血红蛋白(Hb)-静脉血: 158g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32pg……\n- [全程D83] 检验组合: 平均红细胞血红蛋白含量(MCH)-静脉血: 32.2pg；乳酸脱氢酶(LDH)-静脉血: 190.8U/L；直接胆红素(DBIL)-静脉血: 5.3umol/L；血小板计数(PLT#)-静脉血: 22010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.8；中性粒细胞计数(Neut#)-静脉血: 6.310E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.5；白蛋白(ALB)-静脉血: 45.7g/L；大血小板百分比(P-LCR%)-静脉血: 18.3%；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.81；球蛋白(GLO)-静脉血: 30.11g/L；血小板比容-静脉血: 20%；间接胆红素(IBIL)-静脉血: 8.8umolL；淋巴细胞百分比(Lymph%)-静脉血: 0.068；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 27.5U/L；总胆红素(TBIL)-静脉血: 14.1umol/L；单核细胞百分比(Mono%)-静脉血: 0.075；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；碱性磷酸酶(ALP)-静脉血: 31.2U/L；肌酐(Crea)-静脉血: 68.3umol/L；白细胞计数(WBC#)-静脉血: 7.610E9/L；总蛋白(TP)-静脉血: 75.81g/L；尿素氮(BUN)-静脉血: 4.4mmol/L；总胆汁酸(TBA)-静脉血: 1.8umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 343g/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；红细胞计数(RBC#)-静脉血: 4.910E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；红细胞比容(Hct)-静脉血: 46.1%；平均血小板体积(MPV)-静脉血: 9.3fL；平均红细胞体积(MCV)-静脉血: 94.1fL；尿酸(UA)-静脉血: 343.1umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 39U/L；中……\n- [全程D97] 检验组合: 磷(P)-静脉血: 1.26mmol/L；阴离子间隙(AG)-静脉血: 17.4；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；间接胆红素(IBIL)-静脉血: 5.9umolL；白蛋白(ALB)-静脉血: 45.2g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14；镁离子(Mg2+)-静脉血: 0.87mmol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；葡萄糖(Glu)-静脉血: 4.31mmol/L；尿酸(UA)-静脉血: 265.3umol/L；尿素氮(BUN)-静脉血: 3.1mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.6mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；单核细胞百分比(Mono%)-静脉血: 0.093；总胆汁酸(TBA)-静脉血: 0.9umol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；胱抑素(Cys-C)-静脉血: 0.73mg/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20.7U/L；钾离子(K+)-静脉血: 3.7mmol/L；总胆红素(TBIL)-静脉血: 11.1umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.98；载脂蛋白AI(apoAI)-静脉血: 1.29g/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；红细胞计数(RBC#)-静脉血: 4.5510E12/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336g/L；红细胞比容(Hct)-静脉血: 43.4%；球蛋白(GLO)-静脉血: 29.28g/L；肌酐(Crea)-静脉血: 63.8umol/L；中性粒细胞计数(Neut#)-静脉血: 4.910E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.8；大血小板百分比(P-LCR%)-静脉血: 16.8%；血红蛋白(Hb)-静脉血: 146g/L；直接胆红素(DBIL)-静脉血: 5.2umol/L；总胆固醇(TC)-静脉血: 3.12mmol/L；血小板分布宽度(PDW)-静脉血: 9.8%；总钙(Ca)-静脉血: 2.2mmol/L；血小板比容-静脉血: 13%；丙氨酸氨基转移酶(ALT)-静脉血: 21.2U/L……\n\n【既往治疗与反应】\n- [全程D71] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者近1周放疗期间一般情况好，精神好，胃纳佳，无耳鸣、无涕血、无鼻塞，无头痛、面麻，无视物模糊、复视，无声嘶、饮水呛咳、无发热，二便正常。体查大致同前。至今天，患者共完成放疗11F，暂无特殊不良反应表现。继续予以目前放疗及对症治疗。\n- [全程D78] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者至今天已行放疗16F，过程顺利。今患者精神好，胃纳尚可，诉口干、味觉改变，无咽痛，无耳鸣、无涕血、无鼻塞，无头痛、面麻，无视物模糊、复视，无声嘶、饮水呛咳、无发热，二便正常。体查：鼻咽顶后壁及右侧壁结节状肿物，肿物较放疗前稍有缩小，双颈未及明显肿大淋巴结，颅神经（－）。患者放疗期间出现口干、味觉改变，考虑为放疗副作用所致，嘱患者勤含漱，余继续予以放疗对症治疗。\n- [全程D85] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 今患者精神好，胃纳尚可，诉口干、味觉改变，轻微咽痛，无耳鸣、无涕血、无鼻塞，无头痛、面麻，无视物模糊、复视，无声嘶、饮水呛咳、无发热，二便正常。患者至今天已行放疗18F。体查：口咽黏膜充血，无明显破溃，鼻咽顶后壁及右侧壁结节状肿物，肿物较放疗前继续有缩小，双颈未及明显肿大淋巴结，颅神经（－）。患者放疗期间出现轻微咽痛，考虑为放疗所致口咽黏膜反应，予以继续加强含漱对症治疗，余继续予以放疗对症治疗。\n- [全程D92] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者近1周放疗期间一般情况好，精神好，胃纳佳，诉咽痛症状较前好转，仍有口干、味觉改变，无头痛，无发热，二便正常。体查大致同前。至今天，患者共完成放疗22F，继续予以目前放疗及对症治疗。\n- [全程D97] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者近1周放疗期间一般情况好，精神好，胃纳佳，诉咽痛症状较前好转，仍有口干、味觉改变，无头痛，无发热，二便正常。体查大致同前。至今天，患者共完成放疗27F，继续予以目前放疗及对症治疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，给予静脉营养支持及广谱抗生素，待黏膜反应恢复后恢复放疗。\nB. 暂停放疗，复查鼻咽颈部MRI评估疗效，若肿瘤完全消退则提前终止放疗。\nC. 继续放疗，给予重组人粒细胞集落刺激因子皮下注射以纠正淋巴细胞减少。\nD. 继续放疗，加用大剂量糖皮质激素静脉滴注以减轻放射性口腔黏膜炎。\nE. 暂停放疗，行经皮内镜下胃造瘘术以保障后续营养摄入及防止体重下降。\nF. 继续按计划完成根治性放疗，并维持口腔含漱等常规对症支持治疗。\nG. 继续放疗，加用氟康唑口服以预防放疗后期可能出现的真菌性口腔炎。\nH. 暂停放疗，给予局部放射性保护剂及高压氧治疗，待口干症状缓解后继续。\nI. 继续放疗，降低单次放疗剂量以减少对双侧腮腺及颌下腺的进一步损伤。\nJ. 提前结束放疗，转为单药辅助化学治疗以控制微小转移灶并减轻局部毒性。\nK. 继续放疗，预防性留置鼻胃管以应对放疗末期可能加重的吞咽困难。\nL. 暂停放疗，行全身PET-CT排除远处转移后再决定是否完成剩余放疗。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"暂停放疗，给予静脉营养支持及广谱抗生素，待黏膜反应恢复后恢复放疗。","is_gold":false},{"letter":"B","text":"暂停放疗，复查鼻咽颈部MRI评估疗效，若肿瘤完全消退则提前终止放疗。","is_gold":false},{"letter":"C","text":"继续放疗，给予重组人粒细胞集落刺激因子皮下注射以纠正淋巴细胞减少。","is_gold":false},{"letter":"D","text":"继续放疗，加用大剂量糖皮质激素静脉滴注以减轻放射性口腔黏膜炎。","is_gold":false},{"letter":"E","text":"暂停放疗，行经皮内镜下胃造瘘术以保障后续营养摄入及防止体重下降。","is_gold":false},{"letter":"F","text":"继续按计划完成根治性放疗，并维持口腔含漱等常规对症支持治疗。","is_gold":true},{"letter":"G","text":"继续放疗，加用氟康唑口服以预防放疗后期可能出现的真菌性口腔炎。","is_gold":false},{"letter":"H","text":"暂停放疗，给予局部放射性保护剂及高压氧治疗，待口干症状缓解后继续。","is_gold":false},{"letter":"I","text":"继续放疗，降低单次放疗剂量以减少对双侧腮腺及颌下腺的进一步损伤。","is_gold":false},{"letter":"J","text":"提前结束放疗，转为单药辅助化学治疗以控制微小转移灶并减轻局部毒性。","is_gold":false},{"letter":"K","text":"继续放疗，预防性留置鼻胃管以应对放疗末期可能加重的吞咽困难。","is_gold":false},{"letter":"L","text":"暂停放疗，行全身PET-CT排除远处转移后再决定是否完成剩余放疗。","is_gold":false}],"gold_letter":"F"}]}
+{"patient_id":"patient-9bf5c8c03860cdf61108611d","bootstrap_cluster_id":"cluster-014","turns":[{"sample_id":"sample-a4894f941ebb70f32d9155cc","patient_id":"patient-9bf5c8c03860cdf61108611d","turn_id":"turn01","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：腭帆提肌。\n文本分期信息：N2，M0。\n综合TNM状态：T1N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 听力下降8月，发现左颈部包块1月余；现病史: 患者于某次就诊时间初开始无明显诱因出现听力下降，以右侧为著，未予重视。某次就诊时间7月初患者无意中发现左颈部包块，大小约4×4cm，无疼痛，无表面皮肤发红，未就诊，肿物进行性增大。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,左颈部包块,颈部肿物；既往史: 发现血糖升高一年余，未行药物治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟：30－40支/天×30余。否认饮酒史。否认不洁性生活史。；家族史: 两个舅舅分别患有肝癌及骨肿瘤。；体格检查: T：36.4℃，P：83次/分，R：20次/分，BP：100/65mmHg,Ht：164cm，Wt：87kg，BSA：1.93m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左侧颈部IIa区可扪及1个淋巴结，最大径7×3cm，无融合，质地硬，边界清，活动度差，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 电子鼻咽镜检查及活检，鼻咽及颈部平扫CT，胸部X线、腹部彩超，暂缓全身骨显像及EBV检测\nB. 左颈部淋巴结切除活检，鼻咽及颈部增强MRI，胸部X线、腹部彩超、全身骨显像及EBV检测\nC. 电子鼻咽镜检查及活检，鼻咽及颈部增强CT，胸部X线、腹部彩超、全身骨显像，暂缓EBV检测\nD. 电子鼻咽镜检查（暂不活检），鼻咽及颈部增强MRI，全身PET-CT，以及EBV抗体检测\nE. 左颈部淋巴结细针穿刺活检，鼻咽及颈部平扫MRI，胸部X线、腹部彩超、全身骨显像\nF. 电子鼻咽镜检查及活检，鼻咽及颈部增强MRI，仅行胸部X线及腹部彩超，无需全身骨显像\nG. 电子鼻咽镜检查及活检，鼻咽及颈部增强MRI，胸部X线、腹部彩超、全身骨显像，以及EBV抗体检测\nH. 电子鼻咽镜检查及活检，鼻咽及颈部增强MRI，头颅增强MRI，全身骨髓穿刺活检及EBV检测\nI. 电子鼻咽镜检查及活检，鼻咽及颈部增强MRI，胸部X线、腹部彩超、全身骨显像，并预防性气管切开\nJ. 电子鼻咽镜检查及活检，鼻咽及颈部平扫MRI，胸部X线、腹部彩超、全身骨显像，以及EBV抗体检测\nK. 鼻咽及颈部增强MRI，胸部X线、腹部彩超、全身骨显像，待影像学出具恶性报告后再行鼻咽镜活检\nL. 电子鼻咽镜检查及活检，鼻咽及颈部增强MRI，直接行全身骨显像及头颅CT，免除胸腹部影像学检查\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"电子鼻咽镜检查及活检，鼻咽及颈部平扫CT，胸部X线、腹部彩超，暂缓全身骨显像及EBV检测","is_gold":false},{"letter":"B","text":"左颈部淋巴结切除活检，鼻咽及颈部增强MRI，胸部X线、腹部彩超、全身骨显像及EBV检测","is_gold":false},{"letter":"C","text":"电子鼻咽镜检查及活检，鼻咽及颈部增强CT，胸部X线、腹部彩超、全身骨显像，暂缓EBV检测","is_gold":false},{"letter":"D","text":"电子鼻咽镜检查（暂不活检），鼻咽及颈部增强MRI，全身PET-CT，以及EBV抗体检测","is_gold":false},{"letter":"E","text":"左颈部淋巴结细针穿刺活检，鼻咽及颈部平扫MRI，胸部X线、腹部彩超、全身骨显像","is_gold":false},{"letter":"F","text":"电子鼻咽镜检查及活检，鼻咽及颈部增强MRI，仅行胸部X线及腹部彩超，无需全身骨显像","is_gold":false},{"letter":"G","text":"电子鼻咽镜检查及活检，鼻咽及颈部增强MRI，胸部X线、腹部彩超、全身骨显像，以及EBV抗体检测","is_gold":true},{"letter":"H","text":"电子鼻咽镜检查及活检，鼻咽及颈部增强MRI，头颅增强MRI，全身骨髓穿刺活检及EBV检测","is_gold":false},{"letter":"I","text":"电子鼻咽镜检查及活检，鼻咽及颈部增强MRI，胸部X线、腹部彩超、全身骨显像，并预防性气管切开","is_gold":false},{"letter":"J","text":"电子鼻咽镜检查及活检，鼻咽及颈部平扫MRI，胸部X线、腹部彩超、全身骨显像，以及EBV抗体检测","is_gold":false},{"letter":"K","text":"鼻咽及颈部增强MRI，胸部X线、腹部彩超、全身骨显像，待影像学出具恶性报告后再行鼻咽镜活检","is_gold":false},{"letter":"L","text":"电子鼻咽镜检查及活检，鼻咽及颈部增强MRI，直接行全身骨显像及头颅CT，免除胸腹部影像学检查","is_gold":false}],"gold_letter":"G"},{"sample_id":"sample-487e8333de7d37de56947d09","patient_id":"patient-9bf5c8c03860cdf61108611d","turn_id":"turn02","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：腭帆提肌。\n文本分期信息：N2，M0。\n综合TNM状态：T1N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 听力下降8月，发现左颈部包块1月余；现病史: 患者于某次就诊时间初开始无明显诱因出现听力下降，以右侧为著，未予重视。某次就诊时间7月初患者无意中发现左颈部包块，大小约4×4cm，无疼痛，无表面皮肤发红，未就诊，肿物进行性增大。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,左颈部包块,颈部肿物；既往史: 发现血糖升高一年余，未行药物治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟：30－40支/天×30余。否认饮酒史。否认不洁性生活史。；家族史: 两个舅舅分别患有肝癌及骨肿瘤。；体格检查: T：36.4℃，P：83次/分，R：20次/分，BP：100/65mmHg,Ht：164cm，Wt：87kg，BSA：1.93m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左侧颈部IIa区可扪及1个淋巴结，最大径7×3cm，无融合，质地硬，边界清，活动度差，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D0] 检验组合: 隐血(OB)-粪便: 阴性（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-粪便: 棕色；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；比重(SG)-尿液: 1.021；浊度(TRUB)-尿液: 清亮；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 5.5；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；白细胞计数(WBC#)-尿液: 3/μL；虫卵-粪便: 未见虫卵（参考: 未见虫卵）\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理增多增粗，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，右肋膈角锐利，左肋膈角模糊。；检查结论: 考虑双肺慢性支气管炎X线改变。 左侧胸膜稍增厚。\n- [全程D1] 检验组合: 人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；载脂蛋白B(apoB)-静脉血: 1.08g/L；间接胆红素(IBIL)-静脉血: 5.9umolL；钾离子(K+)-静脉血: 4.1mmol/L；阴离子间隙(AG)-静脉血: 17.5；血红蛋白(Hb)-静脉血: 151g/L；凝血酶原时间活动度(PTA)-静脉血: 113.8%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；单核细胞计数(Mono#)-静脉血: 0.610E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.99mmol/L；ABO血型-静脉血: O；中性粒细胞百分比(Neut%)-静脉血: 0.578；血小板比容-静脉血: 24%；Rh血型-静脉血: 阳性；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 5.12mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；梅毒非特异性抗体甲苯胺红不加热血清试验(TRUST)-静脉血: 阴性(-)（参考: 阴性）；淋巴细胞百分比(Lymph%)-静脉血: 0.307；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.9；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 7.9umol/L；白细胞计数(WBC#)-静脉血: 7.610E9/L；直接胆红素(DBIL)-静脉血: 2umol/L；红细胞计数(RBC#)-静脉血: 5.2510E12/L；白蛋白(ALB)-静脉血: 42.2g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；红细胞比容(Hct)-静脉血: 44.7%；糖化血红蛋白A1c(HbA1c)-静脉血: 7.2%；总蛋白(TP)-静脉血: 76.24g/L；凝血酶时间(TT)-静脉血: 18.9sec.；纤维蛋白原(Fbg)-静脉血: 2.44g/L；钠离子(Na+)-静脉血……\n- [全程D4] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔变窄，鼻咽各壁粘膜明显增厚，见结节状肿物向鼻咽腔内突出，T1WI呈等信号，T2WI呈稍高信号，增强扫描轻度不均匀强化，双侧咽隐窝见肿物填塞。口咽双侧壁未见受累增厚，病变未累及双侧后鼻孔。 双侧腭帆提肌受侵，双侧腭帆张肌及头长肌、双侧翼内外肌未见受侵征象。 双侧翼腭窝、双侧上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 颅底骨质未见破坏。 双侧海绵窦形态未见异常。 双侧筛窦、双侧上颌窦粘膜增厚，增强扫描呈轻度强化。双侧乳突未见分泌物。 双眼未见异常，球后未见占位性病变。蝶鞍形态未见异常，其内未见占位性病变。 双侧咽后见淋巴结，大小约7mm×9mm，增强扫描明显强化。 双颈II区、左颈III区见多个肿大淋巴结，最大约33mm×27mm，边界欠清，增强扫描呈明显强化。 右颈III区、双颈I区见数个小淋巴结，最大约5mm×11mm，边界清楚，孤立散在。 甲状腺双叶及峡部形态未见异常，信号均匀，未见占位性病变。喉咽腔形态未见异常，未见占位性病变。双侧颌下腺、腮腺大小、形态未见异常，信号均匀，未见占位性病变。 扫描所见脑组织未见明确异常。；检查结论: 鼻咽肿物，考虑鼻咽癌。 颅底骨质未见破坏。 双侧咽后、双颈II区、左颈III区肿大淋巴结，考虑转移。 鼻窦炎。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善颈部淋巴结细针穿刺活检作为首选病理确诊手段。\nB. 完善全身PET-CT检查，若无远处转移则直接开始根治性放疗。\nC. 完善电子鼻咽镜检查评估局部侵犯范围，暂不取活检以防大出血。\nD. 完善鼻咽镜检查并取活检，同时行颈部淋巴结切除活检以明确分期。\nE. 完善鼻咽部刷片细胞学检查明确病理诊断。\nF. 完善鼻内镜下鼻咽肿物切除术，术后送常规病理。\nG. 完善电子鼻咽镜检查并取活检，若首次活检阴性则按临床诊断开始化疗。\nH. 完善电子鼻咽镜检查并取活检明确病理诊断。\nI. 完善颈部淋巴结切除活检作为首选病理确诊手段。\nJ. 完善电子鼻咽镜检查并取活检，同时行预防性气管切开。\nK. 完善鼻咽镜检查并取活检，同时行扁桃体切除活检排除隐匿原发灶。\nL. 完善全身骨扫描及腹部超声，待全身分期明确后再行鼻咽活检。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"完善颈部淋巴结细针穿刺活检作为首选病理确诊手段。","is_gold":false},{"letter":"B","text":"完善全身PET-CT检查，若无远处转移则直接开始根治性放疗。","is_gold":false},{"letter":"C","text":"完善电子鼻咽镜检查评估局部侵犯范围，暂不取活检以防大出血。","is_gold":false},{"letter":"D","text":"完善鼻咽镜检查并取活检，同时行颈部淋巴结切除活检以明确分期。","is_gold":false},{"letter":"E","text":"完善鼻咽部刷片细胞学检查明确病理诊断。","is_gold":false},{"letter":"F","text":"完善鼻内镜下鼻咽肿物切除术，术后送常规病理。","is_gold":false},{"letter":"G","text":"完善电子鼻咽镜检查并取活检，若首次活检阴性则按临床诊断开始化疗。","is_gold":false},{"letter":"H","text":"完善电子鼻咽镜检查并取活检明确病理诊断。","is_gold":true},{"letter":"I","text":"完善颈部淋巴结切除活检作为首选病理确诊手段。","is_gold":false},{"letter":"J","text":"完善电子鼻咽镜检查并取活检，同时行预防性气管切开。","is_gold":false},{"letter":"K","text":"完善鼻咽镜检查并取活检，同时行扁桃体切除活检排除隐匿原发灶。","is_gold":false},{"letter":"L","text":"完善全身骨扫描及腹部超声，待全身分期明确后再行鼻咽活检。","is_gold":false}],"gold_letter":"H"},{"sample_id":"sample-7ff1cd1ea3ebf1a9891b521d","patient_id":"patient-9bf5c8c03860cdf61108611d","turn_id":"turn05","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：腭帆提肌。\n文本分期信息：N2，M0。\n综合TNM状态：T1N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D8] 入院记录: 主诉: 听力下降8月，发现左颈部包块1月余；现病史: 简要入院病史:患者于某次就诊时间初开始无明显诱因出现听力下降，以右侧为著，未予重视。某次就诊时间7月初患者无意中发现左颈部包块，大小约4×4cm，无疼痛，无表面皮肤发红，未就诊，肿物进行性增大。8月初肿物增大至鸡蛋大小，就诊地域信息已隐藏，行颈部肿块穿刺，病理回报：转移癌可能性大。8－11行鼻咽＋颈部MRI提示：鼻咽双侧壁及顶后壁软组织增厚，考虑鼻咽癌并双侧咽后、双颈部多发淋巴结肿大。胸部MRI检查未见异常。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,左颈部包块,颈部肿物；既往史: 发现血糖升高一年余，未行药物治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、肾病”病史；否认手术、外伤、输血史及献血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D0] 检验组合: 隐血(OB)-粪便: 阴性（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-粪便: 棕色；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；比重(SG)-尿液: 1.021；浊度(TRUB)-尿液: 清亮；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 5.5；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；白细胞计数(WBC#)-尿液: 3/μL；虫卵-粪便: 未见虫卵（参考: 未见虫卵）\n- [全程D4] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔变窄，鼻咽各壁粘膜明显增厚，见结节状肿物向鼻咽腔内突出，T1WI呈等信号，T2WI呈稍高信号，增强扫描轻度不均匀强化，双侧咽隐窝见肿物填塞。口咽双侧壁未见受累增厚，病变未累及双侧后鼻孔。 双侧腭帆提肌受侵，双侧腭帆张肌及头长肌、双侧翼内外肌未见受侵征象。 双侧翼腭窝、双侧上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 颅底骨质未见破坏。 双侧海绵窦形态未见异常。 双侧筛窦、双侧上颌窦粘膜增厚，增强扫描呈轻度强化。双侧乳突未见分泌物。 双眼未见异常，球后未见占位性病变。蝶鞍形态未见异常，其内未见占位性病变。 双侧咽后见淋巴结，大小约7mm×9mm，增强扫描明显强化。 双颈II区、左颈III区见多个肿大淋巴结，最大约33mm×27mm，边界欠清，增强扫描呈明显强化。 右颈III区、双颈I区见数个小淋巴结，最大约5mm×11mm，边界清楚，孤立散在。 甲状腺双叶及峡部形态未见异常，信号均匀，未见占位性病变。喉咽腔形态未见异常，未见占位性病变。双侧颌下腺、腮腺大小、形态未见异常，信号均匀，未见占位性病变。 扫描所见脑组织未见明确异常。；检查结论: 鼻咽肿物，考虑鼻咽癌。 颅底骨质未见破坏。 双侧咽后、双颈II区、左颈III区肿大淋巴结，考虑转移。 鼻窦炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D5] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约15cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D7] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 双上颌骨可见片状放射性浓集灶。胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 双上颌骨炎症。 余全身骨骼未见明显异常。\n- [全程D12] 检验组合: 平均红细胞血红蛋白浓度(MCHC)-静脉血: 340g/L；血小板比容-静脉血: 24%；单核细胞计数(Mono#)-静脉血: 0.110E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；红细胞比容(Hct)-静脉血: 41.8%；平均红细胞血红蛋白含量(MCH)-静脉血: 29pg；单核细胞百分比(Mono%)-静脉血: 0.016；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.1；平均血小板体积(MPV)-静脉血: 10.3fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.007；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；红细胞计数(RBC#)-静脉血: 4.8910E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；大血小板百分比(P-LCR%)-静脉血: 27%；淋巴细胞百分比(Lymph%)-静脉血: 0.422；血小板计数(PLT#)-静脉血: 23710E9/L；平均红细胞体积(MCV)-静脉血: 85.5fL；淋巴细胞计数(Lymph#)-静脉血: 310E9/L；白细胞计数(WBC#)-静脉血: 710E9/L；血小板分布宽度(PDW)-静脉血: 11.6%；血红蛋白(Hb)-静脉血: 142g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；中性粒细胞百分比(Neut%)-静脉血: 0.552\n- [全程D15] 检验组合: 单核细胞计数(Mono#)-静脉血: 0.310E9/L；血小板计数(PLT#)-静脉血: 19810E9/L；红细胞比容(Hct)-静脉血: 44.3%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13；大血小板百分比(P-LCR%)-静脉血: 22.1%；红细胞计数(RBC#)-静脉血: 5.2510E12/L；淋巴细胞百分比(Lymph%)-静脉血: 0.443；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；血小板比容-静脉血: 19%；血红蛋白(Hb)-静脉血: 151g/L；血小板分布宽度(PDW)-静脉血: 11.5%；平均红细胞体积(MCV)-静脉血: 84.4fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.033；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；单核细胞百分比(Mono%)-静脉血: 0.059；平均血小板体积(MPV)-静脉血: 9.5fL；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.46；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；白细胞计数(WBC#)-静脉血: 5.7610E9/L；淋巴细胞计数(Lymph#)-静脉血: 2.610E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.8\n- [全程D19] 检验组合: 中性粒细胞计数(Neut#)-静脉血: 5.210E9/L；单核细胞计数(Mono#)-静脉血: 0.110E9/L；血红蛋白(Hb)-静脉血: 131g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.231；红细胞计数(RBC#)-静脉血: 4.510E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.742；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；大血小板百分比(P-LCR%)-静脉血: 21.7%；血小板计数(PLT#)-静脉血: 14310E9/L；血小板分布宽度(PDW)-静脉血: 10.7%；平均红细胞体积(MCV)-静脉血: 88.9fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.6；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；血小板比容-静脉血: 14%；白细胞计数(WBC#)-静脉血: 710E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.3；单核细胞百分比(Mono%)-静脉血: 0.01；平均血小板体积(MPV)-静脉血: 9.5fL；红细胞比容(Hct)-静脉血: 40%；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L\n- [全程D27] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 拟不完全性右束支传导阻滞\n- [全程D27] 检验组合: 镁离子(Mg2+)-静脉血: 0.82mmol/L；氯离子(Cl-)-静脉血: 103.6mmol/L；总胆固醇(TC)-静脉血: 5.1mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.25mmol/L；总胆汁酸(TBA)-静脉血: 4.1umol/L；肌酐(Crea)-静脉血: 76.9umol/L；直接胆红素(DBIL)-静脉血: 1.6umol/L；总钙(Ca)-静脉血: 2.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 19.8U/L；总蛋白(TP)-静脉血: 75.08g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.29；尿酸(UA)-静脉血: 440.4umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 19.1mmol/L；磷(P)-静脉血: 1.09mmol/L；胱抑素(Cys-C)-静脉血: 1.21mg/L；C-反应蛋白(CRP)-静脉血: 4.53mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.06mmolL；碱性磷酸酶(ALP)-静脉血: 84.7U/L；白蛋白(ALB)-静脉血: 42.3g/L；载脂蛋白B(apoB)-静脉血: 1.13g/L；球蛋白(GLO)-静脉血: 32.78g/L；尿素氮(BUN)-静脉血: 7.3mmol/L；钠离子(Na+)-静脉血: 138.8mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 47.8U/L；甘油三酯(TG)-静脉血: 2.38mmol/L；乳酸脱氢酶(LDH)-静脉血: 183.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 54U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.2U/L；葡萄糖(Glu)-静脉血: 7.26mmol/L；总胆红素(TBIL)-静脉血: 5.3umol/L；载脂蛋白AI(apoAI)-静脉血: 1.29g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.92；钾离子(K+)-静脉血: 4.48mmol/L；间接胆红素(IBIL)-静脉血: 3.7umolL；阴离子间隙(AG)-静脉血: 16.1\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂缓化疗，给予重组人血小板生成素升血小板治疗，待血小板恢复至正常范围后原剂量行第二程GP诱导化疗。\nB. 行第二程GP诱导化疗，吉西他滨剂量下调25%，顺铂维持原剂量，辅以常规止吐及水化利尿等支持治疗。\nC. 停用GP诱导化疗方案，直接转入根治性单纯放疗阶段，并安排心血管专科随访与干预。\nD. 更改诱导化疗方案，将第二程方案由GP（吉西他滨+顺铂）调整为TP（多西他赛+顺铂）方案并按原剂量给药。\nE. 按原剂量行第二程GP诱导化疗，并于化疗结束后预防性给予聚乙二醇化重组人粒细胞刺激因子支持。\nF. 暂缓化疗，请心血管内科会诊并完善超声心动图等检查，待心血管专科评估通过后再行第二程GP化疗。\nG. 按原剂量行第二程GP诱导化疗，并同步皮下注射重组人促红细胞生成素以提升血红蛋白水平。\nH. 行第二程GP诱导化疗，顺铂剂量下调25%，吉西他滨维持原剂量，辅以常规止吐及水化利尿等支持治疗。\nI. 终止诱导化疗，直接进入根治性同步放化疗阶段，同步化疗采用单药顺铂标准剂量方案。\nJ. 按原剂量行第二程GP诱导化疗，化疗前预防性输注单采血小板1个治疗量以降低出血风险。\nK. 按原剂量行第二程GP诱导化疗，并辅以常规止吐、护胃及水化利尿等支持治疗。\nL. 按原剂量行第二程GP诱导化疗，并预防性加用异甘草酸镁等保肝药物以防止化疗相关肝损伤。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"暂缓化疗，给予重组人血小板生成素升血小板治疗，待血小板恢复至正常范围后原剂量行第二程GP诱导化疗。","is_gold":false},{"letter":"B","text":"行第二程GP诱导化疗，吉西他滨剂量下调25%，顺铂维持原剂量，辅以常规止吐及水化利尿等支持治疗。","is_gold":false},{"letter":"C","text":"停用GP诱导化疗方案，直接转入根治性单纯放疗阶段，并安排心血管专科随访与干预。","is_gold":false},{"letter":"D","text":"更改诱导化疗方案，将第二程方案由GP（吉西他滨+顺铂）调整为TP（多西他赛+顺铂）方案并按原剂量给药。","is_gold":false},{"letter":"E","text":"按原剂量行第二程GP诱导化疗，并于化疗结束后预防性给予聚乙二醇化重组人粒细胞刺激因子支持。","is_gold":false},{"letter":"F","text":"暂缓化疗，请心血管内科会诊并完善超声心动图等检查，待心血管专科评估通过后再行第二程GP化疗。","is_gold":false},{"letter":"G","text":"按原剂量行第二程GP诱导化疗，并同步皮下注射重组人促红细胞生成素以提升血红蛋白水平。","is_gold":false},{"letter":"H","text":"行第二程GP诱导化疗，顺铂剂量下调25%，吉西他滨维持原剂量，辅以常规止吐及水化利尿等支持治疗。","is_gold":false},{"letter":"I","text":"终止诱导化疗，直接进入根治性同步放化疗阶段，同步化疗采用单药顺铂标准剂量方案。","is_gold":false},{"letter":"J","text":"按原剂量行第二程GP诱导化疗，化疗前预防性输注单采血小板1个治疗量以降低出血风险。","is_gold":false},{"letter":"K","text":"按原剂量行第二程GP诱导化疗，并辅以常规止吐、护胃及水化利尿等支持治疗。","is_gold":true},{"letter":"L","text":"按原剂量行第二程GP诱导化疗，并预防性加用异甘草酸镁等保肝药物以防止化疗相关肝损伤。","is_gold":false}],"gold_letter":"K"},{"sample_id":"sample-9fc5959f48286f0a038d3acb","patient_id":"patient-9bf5c8c03860cdf61108611d","turn_id":"turn07","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：腭帆提肌。\n文本分期信息：N2，M0。\n综合TNM状态：T1N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D69] 入院记录: 主诉: 鼻咽癌3程诱导化疗后2周；现病史: 患者于某次就诊时间初开始无明显诱因出现听力下降，以右侧为著，未予重视。某次就诊时间7月初患者无意中发现左颈部包块，大小约4×4cm，无疼痛，无表面皮肤发红，未就诊，肿物进行性增大。8月初肿物增大至鸡蛋大小，就诊地域信息已隐藏，行颈部肿块穿刺，病理回报：转移癌可能性大。8－11行鼻咽＋颈部MRI提示：鼻咽双侧壁及顶后壁软组织增厚，考虑鼻咽癌并双侧咽后、双颈部多发淋巴结肿大。胸部MRI检查未见异常。于某次就诊时间、某次就诊时间、某次就诊时间我院各行一程GP诱导化疗，（剂量：吉西他滨：1g/m^2,d1,d8;顺铂：80mg/m^2,d1），现为同期放化疗入院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 听力下降,左颈部包块,颈部肿物；既往史: 发现血糖升高一年余，未行药物治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、肾病”病史；否认手术、外伤、输血史及献血史。；个人史: 长期居于原籍，无疫区居住史。吸烟：30－40支/天×30余。否认饮酒史。否认不洁性生活史。；家族史: 两个舅舅分别患有肝癌及骨肿瘤。；体格检查:；专科检查:；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D0] 检验组合: 隐血(OB)-粪便: 阴性（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-粪便: 棕色；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；比重(SG)-尿液: 1.021；浊度(TRUB)-尿液: 清亮；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 5.5；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；白细胞计数(WBC#)-尿液: 3/μL；虫卵-粪便: 未见虫卵（参考: 未见虫卵）\n- [全程D64] 检验组合: 肌酐(Crea)-静脉血: 160.7umol/L；葡萄糖(Glu)-静脉血: 8.34mmol/L；碱性磷酸酶(ALP)-静脉血: 72.1U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 55U/L；C-反应蛋白(CRP)-静脉血: 2.43mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.94mmol/L；总胆固醇(TC)-静脉血: 4.9mmol/L；镁离子(Mg2+)-静脉血: 0.61mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；总钙(Ca)-静脉血: 2.32mmol/L；氯离子(Cl-)-静脉血: 96.3mmol/L；甘油三酯(TG)-静脉血: 2.49mmol/L；尿素氮(BUN)-静脉血: 9.9mmol/L；直接胆红素(DBIL)-静脉血: 2.6umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.2mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 23.9U/L；载脂蛋白B(apoB)-静脉血: 1.05g/L；乳酸脱氢酶(LDH)-静脉血: 221.5U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.43；间接胆红素(IBIL)-静脉血: 5.8umolL；尿酸(UA)-静脉血: 602.1umol/L；球蛋白(GLO)-静脉血: 30.83g/L；胱抑素(Cys-C)-静脉血: 1.84mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.13mmolL；γ-谷氨酰基转移酶(GGT)-静脉血: 54.4U/L；总胆红素(TBIL)-静脉血: 8.4umol/L；钾离子(K+)-静脉血: 3.86mmol/L；白蛋白(ALB)-静脉血: 44g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.97；丙氨酸氨基转移酶(ALT)-静脉血: 24.7U/L；磷(P)-静脉血: 1.33mmol/L；总胆汁酸(TBA)-静脉血: 2.2umol/L；钠离子(Na+)-静脉血: 136.5mmol/L；阴离子间隙(AG)-静脉血: 15；总蛋白(TP)-静脉血: 74.83g/L\n- [全程D71] 检验组合: 平均红细胞体积(MCV)-静脉血: 86.5fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.015；中性粒细胞计数(Neut#)-静脉血: 2.210E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.8；血红蛋白(Hb)-静脉血: 111g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.011；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.36；平均红细胞血红蛋白浓度(MCHC)-静脉血: 352g/L；红细胞计数(RBC#)-静脉血: 3.6410E12/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.482；大血小板百分比(P-LCR%)-静脉血: 19.1%；血小板比容-静脉血: 10%；平均血小板体积(MPV)-静脉血: 9.3fL；红细胞比容(Hct)-静脉血: 31.5%；单核细胞百分比(Mono%)-静脉血: 0.132；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；血小板分布宽度(PDW)-静脉血: 9.1%；血小板计数(PLT#)-静脉血: 10910E9/L；白细胞计数(WBC#)-静脉血: 4.610E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.1\n- [全程D78] 检验组合: 嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；红细胞比容(Hct)-静脉血: 31.2%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；血小板计数(PLT#)-静脉血: 22110E9/L；血小板比容-静脉血: 20%；大血小板百分比(P-LCR%)-静脉血: 19.1%；单核细胞百分比(Mono%)-静脉血: 0.108；血红蛋白(Hb)-静脉血: 108g/L；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；血小板分布宽度(PDW)-静脉血: 10%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.02；白细胞计数(WBC#)-静脉血: 4.510E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.653；平均红细胞体积(MCV)-静脉血: 86.9fL；平均血小板体积(MPV)-静脉血: 9.2fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.9；中性粒细胞计数(Neut#)-静脉血: 310E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.215；平均红细胞血红蛋白浓度(MCHC)-静脉血: 346g/L；红细胞计数(RBC#)-静脉血: 3.5910E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；单核细胞计数(Mono#)-静脉血: 0.510E9/L\n- [全程D85] 检验组合: 平均血小板体积(MPV)-静脉血: 9fL；血小板计数(PLT#)-静脉血: 26310E9/L；血小板分布宽度(PDW)-静脉血: 9.9%；淋巴细胞计数(Lymph#)-静脉血: 1.210E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.9；血红蛋白(Hb)-静脉血: 103g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；平均红细胞体积(MCV)-静脉血: 88.5fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.7；白细胞计数(WBC#)-静脉血: 4.2910E9/L；大血小板百分比(P-LCR%)-静脉血: 17.7%；单核细胞百分比(Mono%)-静脉血: 0.191；平均红细胞血红蛋白含量(MCH)-静脉血: 30.3pg；血小板比容-静脉血: 24%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 342g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞计数(RBC#)-静脉血: 3.410E12/L；红细胞比容(Hct)-静脉血: 30.1%；淋巴细胞百分比(Lymph%)-静脉血: 0.27；中性粒细胞百分比(Neut%)-静脉血: 0.513；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.021；单核细胞计数(Mono#)-静脉血: 0.810E9/L；中性粒细胞计数(Neut#)-静脉血: 2.210E9/L\n- [全程D85] 检验组合: 总胆固醇(TC)-静脉血: 5mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 41U/L；球蛋白(GLO)-静脉血: 29.79g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.3；血液二氧化碳含量ctCO2(B)-静脉血: 20.9mmol/L；钠离子(Na+)-静脉血: 137.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.12g/L；载脂蛋白B(apoB)-静脉血: 1.02g/L；丙氨酸氨基转移酶(ALT)-静脉血: 15.3U/L；阴离子间隙(AG)-静脉血: 16；氯离子(Cl-)-静脉血: 100.4mmol/L；磷(P)-静脉血: 1.27mmol/L；总钙(Ca)-静脉血: 2.29mmol/L；总胆红素(TBIL)-静脉血: 10.7umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 32.1U/L；尿酸(UA)-静脉血: 642.2umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.2mmol/L；钾离子(K+)-静脉血: 4.6mmol/L；镁离子(Mg2+)-静脉血: 0.56mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20.5U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；间接胆红素(IBIL)-静脉血: 6.8umolL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；胱抑素(Cys-C)-静脉血: 1.89mg/L；肌酐(Crea)-静脉血: 171.5umol/L；碱性磷酸酶(ALP)-静脉血: 55.8U/L；乳酸脱氢酶(LDH)-静脉血: 182U/L；总胆汁酸(TBA)-静脉血: 1.2umol/L；总蛋白(TP)-静脉血: 72.99g/L；直接胆红素(DBIL)-静脉血: 3.9umol/L；C-反应蛋白(CRP)-静脉血: 2.96mg/L；甘油三酯(TG)-静脉血: 2.22mmol/L；葡萄糖(Glu)-静脉血: 6.63mmol/L；尿素氮(BUN)-静脉血: 10.78mmol/L；白蛋白(ALB)-静脉血: 43.2g/L\n- [全程D92] 检验组合: 嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；单核细胞百分比(Mono%)-静脉血: 0.13；中性粒细胞计数(Neut#)-静脉血: 5.310E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.7pg；血小板比容-静脉血: 24%；红细胞计数(RBC#)-静脉血: 3.3610E12/L；平均红细胞体积(MCV)-静脉血: 89.9fL；血红蛋白(Hb)-静脉血: 103g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.9；单核细胞计数(Mono#)-静脉血: 0.910E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；血小板计数(PLT#)-静脉血: 26210E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；大血小板百分比(P-LCR%)-静脉血: 17.3%；白细胞计数(WBC#)-静脉血: 710E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.103；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.8；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；中性粒细胞百分比(Neut%)-静脉血: 0.757；红细胞比容(Hct)-静脉血: 30.2%；血小板分布宽度(PDW)-静脉血: 9.9%；平均血小板体积(MPV)-静脉血: 9.1fL\n- [全程D99] 检验组合: 球蛋白(GLO)-静脉血: 25.82g/L；血小板比容-静脉血: 12%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 4.5umol/L；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 14.7mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.104；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；总胆红素(TBIL)-静脉血: 11.3umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 33.1U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.1；总钙(Ca)-静脉血: 1.94mmol/L；间接胆红素(IBIL)-静脉血: 6.8umolL；血红蛋白(Hb)-静脉血: 92g/L；肌酐(Crea)-静脉血: 230.6umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.53；单核细胞计数(Mono#)-静脉血: 0.710E9/L；磷(P)-静脉血: 1.43mmol/L；尿素氮(BUN)-静脉血: 14.3mmol/L；尿酸(UA)-静脉血: 664.3umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.5；氯离子(Cl-)-静脉血: 101.4mmol/L；镁离子(Mg2+)-静脉血: 0.39mmol/L；载脂蛋白AI(apoAI)-静脉血: 0.93g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；红细胞比容(Hct)-静脉血: 27.4%；γ-谷氨酰基转移酶(GGT)-静脉血: 32.2U/L；阴离子间隙(AG)-静脉血: 22；血小板分布宽度(PDW)-静脉血: 10.5%；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.41；总蛋白(TP)-静脉血: 65.22g/L；单核细胞百分比(Mono%)-静脉血: 0.138；白蛋白(ALB)-静脉血: 39.4g/L；乳酸脱氢酶(LDH)-静脉血: 174.3U/L；C-反应蛋白(CRP)-静脉血: 5.63mg/L；血小板计数(PLT#)-静脉血: 13410E9/L；总胆汁酸(TBA)-静脉血: 1.9um……\n- [全程D103] 检验组合: 白蛋白(ALB)-静脉血: 38.8g/L；肌酐(Crea)-静脉血: 213.9umol/L；球蛋白(GLO)-静脉血: 26.15g/L；间接胆红素(IBIL)-静脉血: 6.6umolL；总胆红素(TBIL)-静脉血: 10.9umol/L；总蛋白(TP)-静脉血: 64.95g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.48；直接胆红素(DBIL)-静脉血: 4.3umol/L；尿素氮(BUN)-静脉血: 14.5mmol/L；尿酸(UA)-静脉血: 660.5umol/L\n- [全程D106] 检验组合: 平均血小板体积(MPV)-静脉血: 9.5fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44.6；血小板计数(PLT#)-静脉血: 7110E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；血红蛋白(Hb)-静脉血: 75g/L；红细胞比容(Hct)-静脉血: 21.6%；白细胞计数(WBC#)-静脉血: 3.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.089；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；单核细胞计数(Mono#)-静脉血: 0.310E9/L；血小板分布宽度(PDW)-静脉血: 9.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 31.9pg；中性粒细胞百分比(Neut%)-静脉血: 0.784；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；大血小板百分比(P-LCR%)-静脉血: 20.6%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.098；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板比容-静脉血: 6%；红细胞计数(RBC#)-静脉血: 2.3510E12/L；平均红细胞体积(MCV)-静脉血: 91.9fL\n- [全程D109] 检验组合: 红细胞比容(Hct)-静脉血: 21.5%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.7；白细胞计数(WBC#)-静脉血: 4.210E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.4pg；单核细胞百分比(Mono%)-静脉血: 0.057；平均红细胞血红蛋白浓度(MCHC)-静脉血: 335g/L；血红蛋白(Hb)-静脉血: 72g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；红细胞计数(RBC#)-静脉血: 2.2910E12/L；血小板计数(PLT#)-静脉血: 6210E9/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.041；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；大血小板百分比(P-LCR%)-静脉血: 21.1%；平均血小板体积(MPV)-静脉血: 9.4fL；平均红细胞体积(MCV)-静脉血: 93.9fL；血小板比容-静脉血: 6%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；血小板分布宽度(PDW)-静脉血: 10.3%；中性粒细胞百分比(Neut%)-静脉血: 0.847；淋巴细胞百分比(Lymph%)-静脉血: 0.05；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L\n- [全程D113] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.082；血小板分布宽度(PDW)-静脉血: 10.8%；淋巴细胞百分比(Lymph%)-静脉血: 0.114；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；红细胞比容(Hct)-静脉血: 22.8%；平均血小板体积(MPV)-静脉血: 9.8fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 48.1；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；中性粒细胞计数(Neut#)-静脉血: 1.610E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1；白细胞计数(WBC#)-静脉血: 2.210E9/L；血小板计数(PLT#)-静脉血: 11810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.722；大血小板百分比(P-LCR%)-静脉血: 24.7%；单核细胞计数(Mono#)-静脉血: 0.210E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 320g/L；红细胞计数(RBC#)-静脉血: 2.2910E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.9pg；血小板比容-静脉血: 12%；血红蛋白(Hb)-静脉血: 73g/L；平均红细胞体积(MCV)-静脉血: 99.6fL；单核细胞百分比(Mono%)-静脉血: 0.077；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L\n- [全程D117] 检验组合: 天门冬氨酸氨基转移酶(AST)-静脉血: 14.1U/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；镁离子(Mg2+)-静脉血: 0.67mmol/L；血小板计数(PLT#)-静脉血: 23410E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.72mmolL；中性粒细胞计数(Neut#)-静脉血: 2.410E9/L；胱抑素(Cys-C)-静脉血: 2.73mg/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；血小板分布宽度(PDW)-静脉血: 10.4%；总蛋白(TP)-静脉血: 69.47g/L；大血小板百分比(P-LCR%)-静脉血: 22%；球蛋白(GLO)-静脉血: 32.07g/L；氯离子(Cl-)-静脉血: 102.3mmol/L；尿素氮(BUN)-静脉血: 14.7mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.136；丙氨酸氨基转移酶(ALT)-静脉血: 11.2U/L；葡萄糖(Glu)-静脉血: 7.22mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 19.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 0.81g/L；总胆固醇(TC)-静脉血: 4.12mmol/L；血小板比容-静脉血: 22%；C-反应蛋白(CRP)-静脉血: 15.19mg/L；总胆汁酸(TBA)-静脉血: 2.1umol/L；直接胆红素(DBIL)-静脉血: 2.3umol/L；尿酸(UA)-静脉血: 692umol/L；白细胞计数(WBC#)-静脉血: 3.710E9/L；乳酸脱氢酶(LDH)-静脉血: 178.2U/L；中性粒细胞百分比(Neut%)-静脉血: 0.651；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；肌酐(Crea)-静脉血: 220.1umol/L；红细胞计数(RBC#)-静脉血: 2.3510E12/L；钠离子(Na+)-静脉血: 138.8mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.26；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.6mmol/L；红细胞比容(Hct)-静脉血: 23.1%；钾离子(K+)-静脉血: 4.79mmol/L……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 完善鼻咽及颈部MRI评估疗效；取消同期顺铂化疗，予以纠正贫血并单纯根治性调强放疗（或联合靶向治疗）。\nB. 完善鼻咽及颈部MRI评估疗效；按原计划行同期顺铂化疗联合根治性调强放疗。\nC. 完善鼻咽及颈部MRI评估疗效；将同期顺铂减量至40mg/m2周疗，联合根治性调强放疗。\nD. 完善鼻咽及颈部MRI评估疗效；将同期化疗方案更换为卡铂，联合根治性调强放疗。\nE. 完善鼻咽及颈部MRI评估疗效；暂停抗肿瘤治疗，待血红蛋白恢复至100g/L以上后再行同期放化疗。\nF. 完善鼻咽及颈部MRI评估疗效；予以输血支持，待贫血纠正后按原计划行同期顺铂化疗联合调强放疗。\nG. 完善鼻咽及颈部MRI评估疗效；取消同期顺铂化疗，直接行根治性调强放疗，暂不予纠正贫血。\nH. 完善鼻咽及颈部MRI评估疗效；将同期化疗方案更换为氟尿嘧啶单药，联合根治性调强放疗。\nI. 完善鼻咽及颈部MRI评估疗效；取消同期顺铂化疗，予以纠正贫血并联合PD-1抑制剂及调强放疗。\nJ. 完善鼻咽及颈部MRI评估疗效；将同期化疗方案更换为吉西他滨单药，联合根治性调强放疗。\nK. 完善鼻咽及颈部MRI评估疗效；取消放疗，继续行非铂类方案（如紫杉醇单药）化疗。\n\n请仅输出一个选项字母（A-K）。","options":[{"letter":"A","text":"完善鼻咽及颈部MRI评估疗效；取消同期顺铂化疗，予以纠正贫血并单纯根治性调强放疗（或联合靶向治疗）。","is_gold":true},{"letter":"B","text":"完善鼻咽及颈部MRI评估疗效；按原计划行同期顺铂化疗联合根治性调强放疗。","is_gold":false},{"letter":"C","text":"完善鼻咽及颈部MRI评估疗效；将同期顺铂减量至40mg/m2周疗，联合根治性调强放疗。","is_gold":false},{"letter":"D","text":"完善鼻咽及颈部MRI评估疗效；将同期化疗方案更换为卡铂，联合根治性调强放疗。","is_gold":false},{"letter":"E","text":"完善鼻咽及颈部MRI评估疗效；暂停抗肿瘤治疗，待血红蛋白恢复至100g/L以上后再行同期放化疗。","is_gold":false},{"letter":"F","text":"完善鼻咽及颈部MRI评估疗效；予以输血支持，待贫血纠正后按原计划行同期顺铂化疗联合调强放疗。","is_gold":false},{"letter":"G","text":"完善鼻咽及颈部MRI评估疗效；取消同期顺铂化疗，直接行根治性调强放疗，暂不予纠正贫血。","is_gold":false},{"letter":"H","text":"完善鼻咽及颈部MRI评估疗效；将同期化疗方案更换为氟尿嘧啶单药，联合根治性调强放疗。","is_gold":false},{"letter":"I","text":"完善鼻咽及颈部MRI评估疗效；取消同期顺铂化疗，予以纠正贫血并联合PD-1抑制剂及调强放疗。","is_gold":false},{"letter":"J","text":"完善鼻咽及颈部MRI评估疗效；将同期化疗方案更换为吉西他滨单药，联合根治性调强放疗。","is_gold":false},{"letter":"K","text":"完善鼻咽及颈部MRI评估疗效；取消放疗，继续行非铂类方案（如紫杉醇单药）化疗。","is_gold":false}],"gold_letter":"A"},{"sample_id":"sample-340a8b44018e54c31bcf1d9c","patient_id":"patient-9bf5c8c03860cdf61108611d","turn_id":"turn08","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：腭帆提肌。\n文本分期信息：N2，M0。\n综合TNM状态：T1N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D0] 检验组合: 隐血(OB)-粪便: 阴性（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-粪便: 棕色；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；比重(SG)-尿液: 1.021；浊度(TRUB)-尿液: 清亮；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 5.5；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；白细胞计数(WBC#)-尿液: 3/μL；虫卵-粪便: 未见虫卵（参考: 未见虫卵）\n- [全程D78] 检验组合: 嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；红细胞比容(Hct)-静脉血: 31.2%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；血小板计数(PLT#)-静脉血: 22110E9/L；血小板比容-静脉血: 20%；大血小板百分比(P-LCR%)-静脉血: 19.1%；单核细胞百分比(Mono%)-静脉血: 0.108；血红蛋白(Hb)-静脉血: 108g/L；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；血小板分布宽度(PDW)-静脉血: 10%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.02；白细胞计数(WBC#)-静脉血: 4.510E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.653；平均红细胞体积(MCV)-静脉血: 86.9fL；平均血小板体积(MPV)-静脉血: 9.2fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.9；中性粒细胞计数(Neut#)-静脉血: 310E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.215；平均红细胞血红蛋白浓度(MCHC)-静脉血: 346g/L；红细胞计数(RBC#)-静脉血: 3.5910E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；单核细胞计数(Mono#)-静脉血: 0.510E9/L\n- [全程D85] 检验组合: 平均血小板体积(MPV)-静脉血: 9fL；血小板计数(PLT#)-静脉血: 26310E9/L；血小板分布宽度(PDW)-静脉血: 9.9%；淋巴细胞计数(Lymph#)-静脉血: 1.210E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.9；血红蛋白(Hb)-静脉血: 103g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；平均红细胞体积(MCV)-静脉血: 88.5fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.7；白细胞计数(WBC#)-静脉血: 4.2910E9/L；大血小板百分比(P-LCR%)-静脉血: 17.7%；单核细胞百分比(Mono%)-静脉血: 0.191；平均红细胞血红蛋白含量(MCH)-静脉血: 30.3pg；血小板比容-静脉血: 24%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 342g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞计数(RBC#)-静脉血: 3.410E12/L；红细胞比容(Hct)-静脉血: 30.1%；淋巴细胞百分比(Lymph%)-静脉血: 0.27；中性粒细胞百分比(Neut%)-静脉血: 0.513；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.021；单核细胞计数(Mono#)-静脉血: 0.810E9/L；中性粒细胞计数(Neut#)-静脉血: 2.210E9/L\n- [全程D85] 检验组合: 总胆固醇(TC)-静脉血: 5mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 41U/L；球蛋白(GLO)-静脉血: 29.79g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.3；血液二氧化碳含量ctCO2(B)-静脉血: 20.9mmol/L；钠离子(Na+)-静脉血: 137.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.12g/L；载脂蛋白B(apoB)-静脉血: 1.02g/L；丙氨酸氨基转移酶(ALT)-静脉血: 15.3U/L；阴离子间隙(AG)-静脉血: 16；氯离子(Cl-)-静脉血: 100.4mmol/L；磷(P)-静脉血: 1.27mmol/L；总钙(Ca)-静脉血: 2.29mmol/L；总胆红素(TBIL)-静脉血: 10.7umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 32.1U/L；尿酸(UA)-静脉血: 642.2umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.2mmol/L；钾离子(K+)-静脉血: 4.6mmol/L；镁离子(Mg2+)-静脉血: 0.56mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20.5U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；间接胆红素(IBIL)-静脉血: 6.8umolL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；胱抑素(Cys-C)-静脉血: 1.89mg/L；肌酐(Crea)-静脉血: 171.5umol/L；碱性磷酸酶(ALP)-静脉血: 55.8U/L；乳酸脱氢酶(LDH)-静脉血: 182U/L；总胆汁酸(TBA)-静脉血: 1.2umol/L；总蛋白(TP)-静脉血: 72.99g/L；直接胆红素(DBIL)-静脉血: 3.9umol/L；C-反应蛋白(CRP)-静脉血: 2.96mg/L；甘油三酯(TG)-静脉血: 2.22mmol/L；葡萄糖(Glu)-静脉血: 6.63mmol/L；尿素氮(BUN)-静脉血: 10.78mmol/L；白蛋白(ALB)-静脉血: 43.2g/L\n- [全程D92] 检验组合: 嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；单核细胞百分比(Mono%)-静脉血: 0.13；中性粒细胞计数(Neut#)-静脉血: 5.310E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.7pg；血小板比容-静脉血: 24%；红细胞计数(RBC#)-静脉血: 3.3610E12/L；平均红细胞体积(MCV)-静脉血: 89.9fL；血红蛋白(Hb)-静脉血: 103g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.9；单核细胞计数(Mono#)-静脉血: 0.910E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；血小板计数(PLT#)-静脉血: 26210E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；大血小板百分比(P-LCR%)-静脉血: 17.3%；白细胞计数(WBC#)-静脉血: 710E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.103；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.8；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；中性粒细胞百分比(Neut%)-静脉血: 0.757；红细胞比容(Hct)-静脉血: 30.2%；血小板分布宽度(PDW)-静脉血: 9.9%；平均血小板体积(MPV)-静脉血: 9.1fL\n- [全程D99] 检验组合: 球蛋白(GLO)-静脉血: 25.82g/L；血小板比容-静脉血: 12%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 4.5umol/L；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 14.7mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.104；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；总胆红素(TBIL)-静脉血: 11.3umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 33.1U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.1；总钙(Ca)-静脉血: 1.94mmol/L；间接胆红素(IBIL)-静脉血: 6.8umolL；血红蛋白(Hb)-静脉血: 92g/L；肌酐(Crea)-静脉血: 230.6umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.53；单核细胞计数(Mono#)-静脉血: 0.710E9/L；磷(P)-静脉血: 1.43mmol/L；尿素氮(BUN)-静脉血: 14.3mmol/L；尿酸(UA)-静脉血: 664.3umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.5；氯离子(Cl-)-静脉血: 101.4mmol/L；镁离子(Mg2+)-静脉血: 0.39mmol/L；载脂蛋白AI(apoAI)-静脉血: 0.93g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；红细胞比容(Hct)-静脉血: 27.4%；γ-谷氨酰基转移酶(GGT)-静脉血: 32.2U/L；阴离子间隙(AG)-静脉血: 22；血小板分布宽度(PDW)-静脉血: 10.5%；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.41；总蛋白(TP)-静脉血: 65.22g/L；单核细胞百分比(Mono%)-静脉血: 0.138；白蛋白(ALB)-静脉血: 39.4g/L；乳酸脱氢酶(LDH)-静脉血: 174.3U/L；C-反应蛋白(CRP)-静脉血: 5.63mg/L；血小板计数(PLT#)-静脉血: 13410E9/L；总胆汁酸(TBA)-静脉血: 1.9um……\n- [全程D103] 检验组合: 白蛋白(ALB)-静脉血: 38.8g/L；肌酐(Crea)-静脉血: 213.9umol/L；球蛋白(GLO)-静脉血: 26.15g/L；间接胆红素(IBIL)-静脉血: 6.6umolL；总胆红素(TBIL)-静脉血: 10.9umol/L；总蛋白(TP)-静脉血: 64.95g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.48；直接胆红素(DBIL)-静脉血: 4.3umol/L；尿素氮(BUN)-静脉血: 14.5mmol/L；尿酸(UA)-静脉血: 660.5umol/L\n- [全程D106] 检验组合: 平均血小板体积(MPV)-静脉血: 9.5fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44.6；血小板计数(PLT#)-静脉血: 7110E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；血红蛋白(Hb)-静脉血: 75g/L；红细胞比容(Hct)-静脉血: 21.6%；白细胞计数(WBC#)-静脉血: 3.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.089；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；单核细胞计数(Mono#)-静脉血: 0.310E9/L；血小板分布宽度(PDW)-静脉血: 9.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 31.9pg；中性粒细胞百分比(Neut%)-静脉血: 0.784；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；大血小板百分比(P-LCR%)-静脉血: 20.6%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.098；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板比容-静脉血: 6%；红细胞计数(RBC#)-静脉血: 2.3510E12/L；平均红细胞体积(MCV)-静脉血: 91.9fL\n- [全程D109] 检验组合: 红细胞比容(Hct)-静脉血: 21.5%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.7；白细胞计数(WBC#)-静脉血: 4.210E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.4pg；单核细胞百分比(Mono%)-静脉血: 0.057；平均红细胞血红蛋白浓度(MCHC)-静脉血: 335g/L；血红蛋白(Hb)-静脉血: 72g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；红细胞计数(RBC#)-静脉血: 2.2910E12/L；血小板计数(PLT#)-静脉血: 6210E9/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.041；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；大血小板百分比(P-LCR%)-静脉血: 21.1%；平均血小板体积(MPV)-静脉血: 9.4fL；平均红细胞体积(MCV)-静脉血: 93.9fL；血小板比容-静脉血: 6%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；血小板分布宽度(PDW)-静脉血: 10.3%；中性粒细胞百分比(Neut%)-静脉血: 0.847；淋巴细胞百分比(Lymph%)-静脉血: 0.05；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L\n- [全程D113] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.082；血小板分布宽度(PDW)-静脉血: 10.8%；淋巴细胞百分比(Lymph%)-静脉血: 0.114；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；红细胞比容(Hct)-静脉血: 22.8%；平均血小板体积(MPV)-静脉血: 9.8fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 48.1；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；中性粒细胞计数(Neut#)-静脉血: 1.610E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1；白细胞计数(WBC#)-静脉血: 2.210E9/L；血小板计数(PLT#)-静脉血: 11810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.722；大血小板百分比(P-LCR%)-静脉血: 24.7%；单核细胞计数(Mono#)-静脉血: 0.210E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 320g/L；红细胞计数(RBC#)-静脉血: 2.2910E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.9pg；血小板比容-静脉血: 12%；血红蛋白(Hb)-静脉血: 73g/L；平均红细胞体积(MCV)-静脉血: 99.6fL；单核细胞百分比(Mono%)-静脉血: 0.077；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L\n- [全程D117] 检验组合: 天门冬氨酸氨基转移酶(AST)-静脉血: 14.1U/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；镁离子(Mg2+)-静脉血: 0.67mmol/L；血小板计数(PLT#)-静脉血: 23410E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.72mmolL；中性粒细胞计数(Neut#)-静脉血: 2.410E9/L；胱抑素(Cys-C)-静脉血: 2.73mg/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；血小板分布宽度(PDW)-静脉血: 10.4%；总蛋白(TP)-静脉血: 69.47g/L；大血小板百分比(P-LCR%)-静脉血: 22%；球蛋白(GLO)-静脉血: 32.07g/L；氯离子(Cl-)-静脉血: 102.3mmol/L；尿素氮(BUN)-静脉血: 14.7mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.136；丙氨酸氨基转移酶(ALT)-静脉血: 11.2U/L；葡萄糖(Glu)-静脉血: 7.22mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 19.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 0.81g/L；总胆固醇(TC)-静脉血: 4.12mmol/L；血小板比容-静脉血: 22%；C-反应蛋白(CRP)-静脉血: 15.19mg/L；总胆汁酸(TBA)-静脉血: 2.1umol/L；直接胆红素(DBIL)-静脉血: 2.3umol/L；尿酸(UA)-静脉血: 692umol/L；白细胞计数(WBC#)-静脉血: 3.710E9/L；乳酸脱氢酶(LDH)-静脉血: 178.2U/L；中性粒细胞百分比(Neut%)-静脉血: 0.651；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；肌酐(Crea)-静脉血: 220.1umol/L；红细胞计数(RBC#)-静脉血: 2.3510E12/L；钠离子(Na+)-静脉血: 138.8mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.26；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.6mmol/L；红细胞比容(Hct)-静脉血: 23.1%；钾离子(K+)-静脉血: 4.79mmol/L……\n- [全程D209] CT；胸、上腹CT平扫+增强: 检查类型: CT；检查名称: 胸、上腹CT平扫+增强；检查部位:；检查所见: 双肺纹理清晰，未见结节影；气管及支气管分枝通畅，未见明显软组织肿物或受压变窄；双锁上、双腋窝、双肺门及纵隔未见明显肿大淋巴结；双侧胸腔未见积液；胸膜未见增厚。 肝脏形态正常，比例正常，外形轮廓光整，密度均匀，快速注射造影剂后，动脉期未见明确异常强化灶，门脉期及平衡期未见明确低密度区，肝内见数个（约3个）囊肿影，大小约为 4 × 3 mm至 12 × 10 mm，边界清楚，密度均匀，未见强化；肝内胆管未见扩张，胆囊大小正常，内未见结石影，胆总管未见扩张；肝门区未见肿大淋巴结；门静脉未见充盈缺损；脾大小正常，密度均匀；胰腺大小、形态正常，密度均匀；双肾大小、形态正常，排泌功能正常，双肾见多个囊肿影，大小约为 3 × 3 mm 至 60 × 40 mm；双侧肾上腺大小、形态、密度正常；膈脚后、腹主动脉旁未见肿大淋巴结。 扫描范围内胸椎、腰椎、肋骨未见明确骨质破坏征象。；检查结论: 胸部、腹部未见明显占位性病变， 肝、肾囊肿。\n- [全程D210] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌放疗后复查： 鼻咽腔变窄，鼻咽各壁粘膜增厚，T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化，双侧咽隐窝变浅。口咽双侧壁未见受累增厚，病变未累及双侧后鼻孔。 双侧腭帆提肌结构欠清晰，双侧腭帆张肌及头长肌、双侧翼内外肌未见受侵征象。 双侧翼腭窝、双侧上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 双侧翼突基底部及内板骨质信号减低，增强扫描可见轻度强化。 双侧海绵窦形态未见异常。 双侧筛窦、双侧上颌窦粘膜增厚，增强扫描呈轻度强化。双侧乳突内见分泌物。 双眼未见异常，球后未见占位性病变。蝶鞍形态未见异常，其内未见占位性病变。 双侧咽后未见肿大淋巴结。 双颈II区、III区见多个小淋巴结，最大约6mm×13mm，部分边界欠，呈明显强化。 甲状腺双叶及峡部形态未见异常，信号均匀，未见占位性病变。 喉咽腔形态未见异常，未见占位性病变。 双侧颌下腺、腮腺大小、形态未见异常，信号均匀，未见占位性病变。 扫描所见脑组织未见明确异常。；检查结论: 鼻咽癌放疗后复查，与某次就诊时间片比较： 鼻咽肿物已不明显，现鼻咽粘膜增厚，考虑放疗后改变可能，建议随诊。 颅底骨质异常信号，放疗后改变？建议随诊。 双侧咽后未见肿大淋巴结。 双颈II、III区小淋巴结，较前明显缩小。 鼻窦炎；双侧乳突炎。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 判定为局部残留，行鼻咽及颈部挽救性手术\nB. 判定为放疗后改变或临床完全缓解，进入定期随访观察\nC. 判定为局部残留，行鼻咽及颈部局部追加放疗\nD. 判定为疾病稳定，启动卡培他滨维持化疗\nE. 判定为疾病进展，启动含铂双药联合免疫全身治疗\nF. 判定为放疗后改变，启动尼妥珠单抗靶向维持治疗\nG. 判定为颈部淋巴结残留，行双侧颈淋巴结清扫术\nH. 判定为颅底骨质受侵进展，行颅底病灶切除术\nI. 判定为疗效不确定，行全身PET-CT检查明确病灶活性\nJ. 判定为放疗后改变，行鼻咽黏膜活检排除微小残留\nK. 判定为临床完全缓解，启动PD-1抑制剂维持治疗\nL. 判定为局部残留，行原全身化疗方案追加2个周期\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"判定为局部残留，行鼻咽及颈部挽救性手术","is_gold":false},{"letter":"B","text":"判定为放疗后改变或临床完全缓解，进入定期随访观察","is_gold":true},{"letter":"C","text":"判定为局部残留，行鼻咽及颈部局部追加放疗","is_gold":false},{"letter":"D","text":"判定为疾病稳定，启动卡培他滨维持化疗","is_gold":false},{"letter":"E","text":"判定为疾病进展，启动含铂双药联合免疫全身治疗","is_gold":false},{"letter":"F","text":"判定为放疗后改变，启动尼妥珠单抗靶向维持治疗","is_gold":false},{"letter":"G","text":"判定为颈部淋巴结残留，行双侧颈淋巴结清扫术","is_gold":false},{"letter":"H","text":"判定为颅底骨质受侵进展，行颅底病灶切除术","is_gold":false},{"letter":"I","text":"判定为疗效不确定，行全身PET-CT检查明确病灶活性","is_gold":false},{"letter":"J","text":"判定为放疗后改变，行鼻咽黏膜活检排除微小残留","is_gold":false},{"letter":"K","text":"判定为临床完全缓解，启动PD-1抑制剂维持治疗","is_gold":false},{"letter":"L","text":"判定为局部残留，行原全身化疗方案追加2个周期","is_gold":false}],"gold_letter":"B"}]}
+{"patient_id":"patient-5ee5dba6116030961a7a97b5","bootstrap_cluster_id":"cluster-010","turns":[{"sample_id":"sample-de1b18b9f870f76853282d28","patient_id":"patient-5ee5dba6116030961a7a97b5","turn_id":"turn01","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 涕血半年伴右颈肿物2周；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 鼻咽及颈部CT平扫+增强、间接鼻咽镜检查及活检、PET/CT全身显像、EB病毒DNA定量及常规血液生化检查\nB. 鼻咽及颈部MRI平扫、间接鼻咽镜检查及活检、PET/CT全身显像、EB病毒DNA定量及常规血液生化检查\nC. 鼻咽MRI平扫+增强、间接鼻咽镜检查及活检、PET/CT全身显像、EB病毒DNA定量及常规血液生化检查\nD. 鼻咽及颈部MRI平扫+增强、右颈部肿物穿刺活检、PET/CT全身显像、EB病毒DNA定量及常规血液生化检查\nE. 鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查及活检、胸部X线及腹部B超、EB病毒DNA定量及常规血液生化检查\nF. 鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查及活检、PET/CT全身显像、常规血液生化检查\nG. 鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查及活检、头颅MRI平扫+增强、EB病毒DNA定量及常规血液生化检查\nH. 鼻咽及颈部CT平扫、间接鼻咽镜检查及活检、PET/CT全身显像、EB病毒DNA定量及常规血液生化检查\nI. 鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查及活检、PET/CT全身显像、EB病毒VCA-IgA检测及常规血液生化检查\nJ. 鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查及活检、全身骨扫描、EB病毒DNA定量及常规血液生化检查\nK. 鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查及活检、PET/CT全身显像、EB病毒DNA定量及常规血液生化检查\nL. 鼻咽及颈部MRI平扫+增强、PET/CT全身显像、EB病毒DNA定量及常规血液生化检查、直接行诱导化疗\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"鼻咽及颈部CT平扫+增强、间接鼻咽镜检查及活检、PET/CT全身显像、EB病毒DNA定量及常规血液生化检查","is_gold":false},{"letter":"B","text":"鼻咽及颈部MRI平扫、间接鼻咽镜检查及活检、PET/CT全身显像、EB病毒DNA定量及常规血液生化检查","is_gold":false},{"letter":"C","text":"鼻咽MRI平扫+增强、间接鼻咽镜检查及活检、PET/CT全身显像、EB病毒DNA定量及常规血液生化检查","is_gold":false},{"letter":"D","text":"鼻咽及颈部MRI平扫+增强、右颈部肿物穿刺活检、PET/CT全身显像、EB病毒DNA定量及常规血液生化检查","is_gold":false},{"letter":"E","text":"鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查及活检、胸部X线及腹部B超、EB病毒DNA定量及常规血液生化检查","is_gold":false},{"letter":"F","text":"鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查及活检、PET/CT全身显像、常规血液生化检查","is_gold":false},{"letter":"G","text":"鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查及活检、头颅MRI平扫+增强、EB病毒DNA定量及常规血液生化检查","is_gold":false},{"letter":"H","text":"鼻咽及颈部CT平扫、间接鼻咽镜检查及活检、PET/CT全身显像、EB病毒DNA定量及常规血液生化检查","is_gold":false},{"letter":"I","text":"鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查及活检、PET/CT全身显像、EB病毒VCA-IgA检测及常规血液生化检查","is_gold":false},{"letter":"J","text":"鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查及活检、全身骨扫描、EB病毒DNA定量及常规血液生化检查","is_gold":false},{"letter":"K","text":"鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查及活检、PET/CT全身显像、EB病毒DNA定量及常规血液生化检查","is_gold":true},{"letter":"L","text":"鼻咽及颈部MRI平扫+增强、PET/CT全身显像、EB病毒DNA定量及常规血液生化检查、直接行诱导化疗","is_gold":false}],"gold_letter":"K"},{"sample_id":"sample-2c772b6972f0c7fdbd562b73","patient_id":"patient-5ee5dba6116030961a7a97b5","turn_id":"turn02","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 涕血半年伴右颈肿物2周；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D3] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁增厚，可见软组织肿块形成，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。双侧咽隐窝见软组织占据，双侧咽旁脂肪间隙受压变窄，病灶侵犯双侧腭帆提肌。双侧腭帆张肌、头长肌未见受侵。 双侧翼腭窝、颞下窝未见异常；口咽双侧壁未见受累增厚，病变未累及后鼻孔。 双侧翼突基底内份、蝶骨基底部右份骨髓信号减低，增强可见轻度强化。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 双侧咽后间隙见肿大淋巴结，右侧大小约为7mm ×8 mm，左侧大小约3mm×4mm。双颈II区、III区见数个淋巴结，最大位于右颈II区，大小约为15mm×27mm。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽肿块，考虑鼻咽癌。 颅底骨质破坏。 右侧咽后及右颈淋巴结肿大，考虑转移瘤。 左侧咽后及左颈小淋巴结。 鼻窦炎、右乳突炎。\n- [全程D3] 检验组合: 平均红细胞体积(MCV)-静脉血: 93.7fL；凝血酶原时间活动度(PTA)-静脉血: 97%；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；中性粒细胞计数(Neut#)-静脉血: 3.610E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.7sec.；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；尿酸(UA)-静脉血: 413.6umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；血小板分布宽度(PDW)-静脉血: 14.7%；间接胆红素(IBIL)-静脉血: 9.7umolL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；丙氨酸氨基转移酶(ALT)-静脉血: 24U/L；碱性磷酸酶(ALP)-静脉血: 84.3U/L；总胆汁酸(TBA)-静脉血: 2.2umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.3mmol/L；葡萄糖(Glu)-静脉血: 4.51mmol/L；磷(P)-静脉血: 1.39mmol/L；C-反应蛋白(CRP)-静脉血: 4.68mg/L；血小板比容-静脉血: 25%；大血小板百分比(P-LCR%)-静脉血: 35.8%；血小板计数(PLT#)-静脉血: 21810E9/L；红细胞计数(RBC#)-静脉血: 4.5910E12/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；阴离子间隙(AG)-静脉血: 18；凝血酶时间(TT)-静脉血: 21.4sec.；红细胞比容(Hct)-静脉血: 43%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 344g/L；纤维蛋白原(Fbg)-静脉血: 3.09g/L；乳酸脱氢酶(LDH)-静脉血: 116.6U/L；总蛋白(TP)-静脉血: 69.58g/L；总钙(Ca)-静脉血: 2.31mmol/L；总胆固醇(TC)-静脉血: 5.94mmol/L；甘油三酯(TG)-静脉血: 1.79mmol/L；总胆红素(TBIL)-静脉血: 13.9umol/L；尿素氮(BUN……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 安排颈部淋巴结细针穿刺活检明确病理，并补充全身PET-CT检查\nB. 安排右侧颈部肿大淋巴结切除活检，并补充EB病毒DNA荧光定量PCR检测\nC. 直接基于MRI及EBV抗体阳性结果启动根治性放化疗\nD. 行电子鼻咽镜检查观察肿瘤范围，并补充全身骨扫描及胸腹部CT\nE. 行电子鼻咽镜检查及活检明确病理诊断，但不安排任何与EB病毒相关的检查\nF. 安排鼻内镜下鼻咽肿物切除术，并补充EB病毒DNA荧光定量PCR检测\nG. 安排颈部淋巴结细针穿刺活检，并补充EB病毒DNA荧光定量PCR检测\nH. 行电子鼻咽镜检查及活检明确病理诊断，并立即行右颈部淋巴结切除活检\nI. 补充EB病毒DNA荧光定量PCR检测，待结果回报后再决定是否行鼻咽活检\nJ. 行电子鼻咽镜检查及活检明确病理诊断，并预防性行右颈淋巴结清扫术\nK. 安排颈部淋巴结穿刺活检及鼻咽镜下活检，并直接启动诱导化疗\nL. 行电子鼻咽镜检查及活检明确病理诊断，并补充EB病毒DNA荧光定量PCR检测\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"安排颈部淋巴结细针穿刺活检明确病理，并补充全身PET-CT检查","is_gold":false},{"letter":"B","text":"安排右侧颈部肿大淋巴结切除活检，并补充EB病毒DNA荧光定量PCR检测","is_gold":false},{"letter":"C","text":"直接基于MRI及EBV抗体阳性结果启动根治性放化疗","is_gold":false},{"letter":"D","text":"行电子鼻咽镜检查观察肿瘤范围，并补充全身骨扫描及胸腹部CT","is_gold":false},{"letter":"E","text":"行电子鼻咽镜检查及活检明确病理诊断，但不安排任何与EB病毒相关的检查","is_gold":false},{"letter":"F","text":"安排鼻内镜下鼻咽肿物切除术，并补充EB病毒DNA荧光定量PCR检测","is_gold":false},{"letter":"G","text":"安排颈部淋巴结细针穿刺活检，并补充EB病毒DNA荧光定量PCR检测","is_gold":false},{"letter":"H","text":"行电子鼻咽镜检查及活检明确病理诊断，并立即行右颈部淋巴结切除活检","is_gold":false},{"letter":"I","text":"补充EB病毒DNA荧光定量PCR检测，待结果回报后再决定是否行鼻咽活检","is_gold":false},{"letter":"J","text":"行电子鼻咽镜检查及活检明确病理诊断，并预防性行右颈淋巴结清扫术","is_gold":false},{"letter":"K","text":"安排颈部淋巴结穿刺活检及鼻咽镜下活检，并直接启动诱导化疗","is_gold":false},{"letter":"L","text":"行电子鼻咽镜检查及活检明确病理诊断，并补充EB病毒DNA荧光定量PCR检测","is_gold":true}],"gold_letter":"L"},{"sample_id":"sample-8976031a638416cb5f037a59","patient_id":"patient-5ee5dba6116030961a7a97b5","turn_id":"turn04","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 涕血半年伴右颈肿物2周；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D10] 入院记录: 主诉: 涕血半年伴右颈肿物2周.；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D3] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁增厚，可见软组织肿块形成，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。双侧咽隐窝见软组织占据，双侧咽旁脂肪间隙受压变窄，病灶侵犯双侧腭帆提肌。双侧腭帆张肌、头长肌未见受侵。 双侧翼腭窝、颞下窝未见异常；口咽双侧壁未见受累增厚，病变未累及后鼻孔。 双侧翼突基底内份、蝶骨基底部右份骨髓信号减低，增强可见轻度强化。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 双侧咽后间隙见肿大淋巴结，右侧大小约为7mm ×8 mm，左侧大小约3mm×4mm。双颈II区、III区见数个淋巴结，最大位于右颈II区，大小约为15mm×27mm。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽肿块，考虑鼻咽癌。 颅底骨质破坏。 右侧咽后及右颈淋巴结肿大，考虑转移瘤。 左侧咽后及左颈小淋巴结。 鼻窦炎、右乳突炎。\n- [全程D3] 检验组合: 平均红细胞体积(MCV)-静脉血: 93.7fL；凝血酶原时间活动度(PTA)-静脉血: 97%；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；中性粒细胞计数(Neut#)-静脉血: 3.610E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.7sec.；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；尿酸(UA)-静脉血: 413.6umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；血小板分布宽度(PDW)-静脉血: 14.7%；间接胆红素(IBIL)-静脉血: 9.7umolL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；丙氨酸氨基转移酶(ALT)-静脉血: 24U/L；碱性磷酸酶(ALP)-静脉血: 84.3U/L；总胆汁酸(TBA)-静脉血: 2.2umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.3mmol/L；葡萄糖(Glu)-静脉血: 4.51mmol/L；磷(P)-静脉血: 1.39mmol/L；C-反应蛋白(CRP)-静脉血: 4.68mg/L；血小板比容-静脉血: 25%；大血小板百分比(P-LCR%)-静脉血: 35.8%；血小板计数(PLT#)-静脉血: 21810E9/L；红细胞计数(RBC#)-静脉血: 4.5910E12/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；阴离子间隙(AG)-静脉血: 18；凝血酶时间(TT)-静脉血: 21.4sec.；红细胞比容(Hct)-静脉血: 43%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 344g/L；纤维蛋白原(Fbg)-静脉血: 3.09g/L；乳酸脱氢酶(LDH)-静脉血: 116.6U/L；总蛋白(TP)-静脉血: 69.58g/L；总钙(Ca)-静脉血: 2.31mmol/L；总胆固醇(TC)-静脉血: 5.94mmol/L；甘油三酯(TG)-静脉血: 1.79mmol/L；总胆红素(TBIL)-静脉血: 13.9umol/L；尿素氮(BUN……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D4] 检验组合: 乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D5] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶后壁及双侧壁粘膜增厚放射性浓聚，SUV约23.1；病灶填塞双侧鼻后孔，向上侵犯蝶骨基底部、双翼突基底部、犁骨及枕骨斜坡，局部骨质稍模糊放射性分布浓密。双侧破裂孔未见明显异常。双侧咽隐窝变浅。双侧咽旁间隙结构尚清。右侧咽后淋巴结放射性浓聚，SUV约11.4，大小约0.7×1.0cm；左侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见异常。筛窦、右上颌窦及右乳突稍低密度影放射性分布未见异常；额窦、蝶窦、左侧上颌窦及左乳突结构及放射性分布未见明显异常。口咽、喉咽未见明显异常。甲状腺放射性分布未见异常。双颈Ⅱ区肿大淋巴结放射性浓聚，SUV约10.2，最大约1.6×2.6cm；余双侧颈部未见肿大淋巴结及异常放射性分布。 双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺纹理清晰，双侧肺野未见确切病灶和异常放射性分布。气管、支气管通畅。心脏及大血管放射性分布未见异常。胸壁未见确切病灶和异常放射性分布。双肺门、纵隔及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏密度不均匀降低，放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管及胆总管未见扩张。胆囊、胃及十二指肠放射性分布未见异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、肠管等形态、结构及放射性分布未见明显异常。前列腺点状高密度影放射性分布未见异常。双侧髂血管旁及腹股沟未见明显肿大淋巴结及异常放射性分布。 余所见颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，病灶侵犯颅底骨；右咽后及双颈Ⅱ区淋巴结代谢较活跃，考虑转移。 鼻窦炎；右乳突炎。 脂肪肝。 前列腺钙化灶。\n- [全程D10] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: 右臂静脉插管, 导管末端位于胸椎右旁T 7上缘水平，估计位于上腔静脉下段。；检查结论: 导管末端位置如上述。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-J 选项中选择唯一最合适的答案。\nA. 行吉西他滨+顺铂方案诱导化疗联合PD-1抑制剂\nB. 行单纯根治性放射治疗\nC. 行紫杉醇+顺铂+氟尿嘧啶方案诱导化疗联合西妥昔单抗\nD. 行鼻咽原发灶及颈部淋巴结根治性切除术\nE. 行洛铂+氟尿嘧啶方案姑息性化疗\nF. 行卡培他滨单药节拍化疗\nG. 行洛铂+氟尿嘧啶方案诱导化疗后序贯颈部淋巴结清扫术\nH. 行多西他赛+顺铂方案同期放化疗\nI. 行吉西他滨单药诱导化疗\nJ. 行依托泊苷+顺铂方案诱导化疗\n\n请仅输出一个选项字母（A-J）。","options":[{"letter":"A","text":"行吉西他滨+顺铂方案诱导化疗联合PD-1抑制剂","is_gold":true},{"letter":"B","text":"行单纯根治性放射治疗","is_gold":false},{"letter":"C","text":"行紫杉醇+顺铂+氟尿嘧啶方案诱导化疗联合西妥昔单抗","is_gold":false},{"letter":"D","text":"行鼻咽原发灶及颈部淋巴结根治性切除术","is_gold":false},{"letter":"E","text":"行洛铂+氟尿嘧啶方案姑息性化疗","is_gold":false},{"letter":"F","text":"行卡培他滨单药节拍化疗","is_gold":false},{"letter":"G","text":"行洛铂+氟尿嘧啶方案诱导化疗后序贯颈部淋巴结清扫术","is_gold":false},{"letter":"H","text":"行多西他赛+顺铂方案同期放化疗","is_gold":false},{"letter":"I","text":"行吉西他滨单药诱导化疗","is_gold":false},{"letter":"J","text":"行依托泊苷+顺铂方案诱导化疗","is_gold":false}],"gold_letter":"A"},{"sample_id":"sample-5d943566dde88ca9f3640bc0","patient_id":"patient-5ee5dba6116030961a7a97b5","turn_id":"turn05","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 涕血半年伴右颈肿物2周；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D10] 入院记录: 主诉: 涕血半年伴右颈肿物2周.；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D10] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: 右臂静脉插管, 导管末端位于胸椎右旁T 7上缘水平，估计位于上腔静脉下段。；检查结论: 导管末端位置如上述。\n- [全程D39] 检验组合: 胱抑素(Cys-C)-静脉血: 0.78mg/L；血小板比容-静脉血: 14.8%；中性粒细胞百分比(Neut%)-静脉血: 0.61；γ-谷氨酰基转移酶(GGT)-静脉血: 57.8U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；总蛋白(TP)-静脉血: 67.84g/L；平均红细胞体积(MCV)-静脉血: 96.4fL；镁离子(Mg2+)-静脉血: 0.92mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.05mmolL；钠离子(Na+)-静脉血: 139.4mmol/L；磷(P)-静脉血: 1.36mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.302；氯离子(Cl-)-静脉血: 103.4mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.54；平均红细胞血红蛋白含量(MCH)-静脉血: 32.7pg；平均血小板体积(MPV)-静脉血: 8.84fL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.59；钾离子(K+)-静脉血: 3.79mmol/L；单核细胞百分比(Mono%)-静脉血: 0.06；白细胞计数(WBC#)-静脉血: 5.4510E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；α-L-岩藻糖苷酶(AFU)-静脉血: 35.8U/L；血小板分布宽度(PDW)-静脉血: 16.9%；红细胞比容(Hct)-静脉血: 40.3%；乳酸脱氢酶(LDH)-静脉血: 149.5U/L；红细胞计数(RBC#)-静脉血: 4.1810E12/L；C-反应蛋白(CRP)-静脉血: 2.31mg/L；总钙(Ca)-静脉血: 2.19mmol/L；尿素氮(BUN)-静脉血: 3.8mmol/L；尿酸(UA)-静脉血: 285umol/L；阴离子间隙(AG)-静脉血: 11.3；葡萄糖(Glu)-静脉血: 4.38mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339.2g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 32.4U/L；甘油三酯(TG)-静脉血: 2.32mmol/L；白蛋白(ALB)-静脉血: 41.6g/L；血小板计数(PLT#)-静脉血: 167.……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D34] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者今日洛铂+5-FU化疗第2天，诉食欲较差，无恶心、呕吐等不适，精神、睡眠尚可，大小便正常。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者化疗第2日，一般情况可，嘱患者注意饮食，加强营养，续行化疗。密切观察化疗反应，必要时加强处理。现已按查房指示执行。\n- [全程D35] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者今日洛铂+5-FU化疗第3天，诉食欲较差，无恶心、呕吐等不适，精神、睡眠尚可，大小便正常。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者化疗第3日，一般情况可，密切观察化疗反应，必要时加强处理。现已按查房指示执行。\n- [全程D39] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者计划于今日完成第2程洛铂+5-FU方案诱导化疗，未诉特殊不适。[姓名已隐去]主诊医生信息已隐藏：患者现完成第2程洛铂+5-FU方案诱导化疗，一般情况可，予今日出院。嘱患者出院后定期每周复查血常规、肝肾功能，2周后返院续治。现已按查房指示执行。\n- [时间未明] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 现已按查房指示执行。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 办理出院，嘱每3天复查血常规及肝肾功能，1周后返院继续下一阶段治疗\nB. 予以重组人粒细胞刺激因子皮下注射后办理出院，嘱每周复查血常规，2周后返院\nC. 办理出院，嘱每周复查血常规及肝肾功能，2周后返院继续下一阶段治疗\nD. 办理出院，嘱每2周复查血常规及肝肾功能，3周后返院继续下一阶段治疗\nE. 暂缓出院，继续住院观察并每日复查血常规，待血液学指标进一步稳定后出院\nF. 办理出院，嘱每月复查血常规及肝肾功能，4周后返院评估疗效并决定后续治疗\nG. 予以静脉滴注保肝药物治疗，待复查肝功能指标完全正常后办理出院\nH. 办理出院，处方口服升血小板药物，嘱每周复查血常规，2周后返院\nI. 办理出院，处方口服卡培他滨单药维持，嘱每周复查血常规，3周后返院\nJ. 办理出院，嘱每周复查血常规及肝肾功能，4周后返院行MRI复查评估疗效\nK. 予以口服氯化钾缓释片补钾治疗，每日监测电解质，待血钾水平上升后办理出院\nL. 办理出院，无需定期复查化验指标，嘱出现发热或出血症状时急诊就诊，3周后返院\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"办理出院，嘱每3天复查血常规及肝肾功能，1周后返院继续下一阶段治疗","is_gold":false},{"letter":"B","text":"予以重组人粒细胞刺激因子皮下注射后办理出院，嘱每周复查血常规，2周后返院","is_gold":false},{"letter":"C","text":"办理出院，嘱每周复查血常规及肝肾功能，2周后返院继续下一阶段治疗","is_gold":true},{"letter":"D","text":"办理出院，嘱每2周复查血常规及肝肾功能，3周后返院继续下一阶段治疗","is_gold":false},{"letter":"E","text":"暂缓出院，继续住院观察并每日复查血常规，待血液学指标进一步稳定后出院","is_gold":false},{"letter":"F","text":"办理出院，嘱每月复查血常规及肝肾功能，4周后返院评估疗效并决定后续治疗","is_gold":false},{"letter":"G","text":"予以静脉滴注保肝药物治疗，待复查肝功能指标完全正常后办理出院","is_gold":false},{"letter":"H","text":"办理出院，处方口服升血小板药物，嘱每周复查血常规，2周后返院","is_gold":false},{"letter":"I","text":"办理出院，处方口服卡培他滨单药维持，嘱每周复查血常规，3周后返院","is_gold":false},{"letter":"J","text":"办理出院，嘱每周复查血常规及肝肾功能，4周后返院行MRI复查评估疗效","is_gold":false},{"letter":"K","text":"予以口服氯化钾缓释片补钾治疗，每日监测电解质，待血钾水平上升后办理出院","is_gold":false},{"letter":"L","text":"办理出院，无需定期复查化验指标，嘱出现发热或出血症状时急诊就诊，3周后返院","is_gold":false}],"gold_letter":"C"},{"sample_id":"sample-90c3b83f1d4c9db69ef01572","patient_id":"patient-5ee5dba6116030961a7a97b5","turn_id":"turn06","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 涕血半年伴右颈肿物2周；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D39] 检验组合: 胱抑素(Cys-C)-静脉血: 0.78mg/L；血小板比容-静脉血: 14.8%；中性粒细胞百分比(Neut%)-静脉血: 0.61；γ-谷氨酰基转移酶(GGT)-静脉血: 57.8U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；总蛋白(TP)-静脉血: 67.84g/L；平均红细胞体积(MCV)-静脉血: 96.4fL；镁离子(Mg2+)-静脉血: 0.92mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.05mmolL；钠离子(Na+)-静脉血: 139.4mmol/L；磷(P)-静脉血: 1.36mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.302；氯离子(Cl-)-静脉血: 103.4mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.54；平均红细胞血红蛋白含量(MCH)-静脉血: 32.7pg；平均血小板体积(MPV)-静脉血: 8.84fL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.59；钾离子(K+)-静脉血: 3.79mmol/L；单核细胞百分比(Mono%)-静脉血: 0.06；白细胞计数(WBC#)-静脉血: 5.4510E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；α-L-岩藻糖苷酶(AFU)-静脉血: 35.8U/L；血小板分布宽度(PDW)-静脉血: 16.9%；红细胞比容(Hct)-静脉血: 40.3%；乳酸脱氢酶(LDH)-静脉血: 149.5U/L；红细胞计数(RBC#)-静脉血: 4.1810E12/L；C-反应蛋白(CRP)-静脉血: 2.31mg/L；总钙(Ca)-静脉血: 2.19mmol/L；尿素氮(BUN)-静脉血: 3.8mmol/L；尿酸(UA)-静脉血: 285umol/L；阴离子间隙(AG)-静脉血: 11.3；葡萄糖(Glu)-静脉血: 4.38mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339.2g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 32.4U/L；甘油三酯(TG)-静脉血: 2.32mmol/L；白蛋白(ALB)-静脉血: 41.6g/L；血小板计数(PLT#)-静脉血: 167.……\n- [全程D45] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌2程化疗后，与某次就诊时间片对比： 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁增厚，可见软组织肿块形成，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，对比前片，较前明显缩小。双侧咽隐窝见软组织占据，双侧咽旁脂肪间隙受压变窄，病灶侵犯双侧腭帆提肌，范围较前稍缩小。双侧腭帆张肌、头长肌未见受侵。 双侧翼腭窝、颞下窝未见异常；口咽双侧壁未见受累增厚，病变未累及后鼻孔。 双侧翼突基底内份、蝶骨基底部右份骨髓信号减低，增强可见轻度强化。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 双侧咽后间隙见肿大淋巴结，右侧大小约为6mm ×7 mm，左侧大小约4mm×6mm。双颈II区、III区见数个淋巴结，最大位于右颈II区，大小约为11mm×24mm，较前明显缩小。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌2程化疗后： 鼻咽病灶较前明显缩小。 颅底骨质破坏。 双侧咽后及颈部淋巴结，较前明显缩小。 鼻窦炎、右乳突炎。\n- [全程D60] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 28.3U/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.1g/L；平均红细胞体积(MCV)-静脉血: 97.9fL；血液二氧化碳含量ctCO2(B)-静脉血: 22.6mmol/L；血小板计数(PLT#)-静脉血: 152.910E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；钾离子(K+)-静脉血: 4.2mmol/L；碱性磷酸酶(ALP)-静脉血: 76.4U/L；单核细胞百分比(Mono%)-静脉血: 0.073；γ-谷氨酰基转移酶(GGT)-静脉血: 46.4U/L；血红蛋白(Hb)-静脉血: 145.2g/L；胱抑素(Cys-C)-静脉血: 0.82mg/L；阴离子间隙(AG)-静脉血: 18；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；甘油三酯(TG)-静脉血: 1.57mmol/L；直接胆红素(DBIL)-静脉血: 6.7umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 345.2g/L；间接胆红素(IBIL)-静脉血: 17.9umolL；中性粒细胞百分比(Neut%)-静脉血: 0.676；乳酸脱氢酶(LDH)-静脉血: 132.5U/L；总蛋白(TP)-静脉血: 71.34g/L；总胆固醇(TC)-静脉血: 6.52mmol/L；总钙(Ca)-静脉血: 2.33mmol/L；血小板分布宽度(PDW)-静脉血: 16.9%；血小板比容-静脉血: 13%；尿酸(UA)-静脉血: 305.5umol/L；平均血小板体积(MPV)-静脉血: 8.53fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1%；淋巴细胞百分比(Lymph%)-静脉血: 0.221；钠离子(Na+)-静脉血: 139.5mmol/L；载脂蛋白B(apoB)-静脉血: 1.31g/L；有核红细胞百分比(NRBC%)-静脉血: 0；总胆汁酸(TBA)-静脉血: 3.6umol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总胆红素(TBIL)-静脉血: 24.6umol/L……\n\n【既往治疗与反应】\n- [全程D39] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者计划于今日完成第2程洛铂+5-FU方案诱导化疗，未诉特殊不适。[姓名已隐去]主诊医生信息已隐藏：患者现完成第2程洛铂+5-FU方案诱导化疗，一般情况可，予今日出院。嘱患者出院后定期每周复查血常规、肝肾功能，2周后返院续治。现已按查房指示执行。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D55] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者未诉特殊不适，饮食、睡眠、精神尚可，大小便正常。查体：基本同前。[姓名已隐去]主诊医生信息已隐藏：患者诊断明确，已完成患者靶区设计，并通过全科会诊，剂量分布均匀，予GTVnx:70Gy/30F,GTVnd(L):66Gy/30F,GTVnd(R):66Gy/30F。考虑联合洛铂同期放化疗，告知患者放疗及化疗的可能获益及相关风险，患者表示已知情并同意。续观。现已按查房指示执行。\n- [全程D56] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现放疗1F，未诉特殊不适。生命体征平稳。查体情况大致同前。[姓名已隐去]主诊医生信息已隐藏：考虑患者一般情况可，继续放疗，密切关注放疗副反应，必要时加强处理。现已按查房指示执行。\n- [时间未明] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 现已按查房指示执行。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 继续同期放化疗，予以重组人粒细胞刺激因子皮下注射及甲氧氯普胺口服止吐。\nB. 继续同期放化疗，予以重组人血小板生成素皮下注射及脂肪乳氨基酸葡萄糖静脉营养。\nC. 继续同期放化疗，予以多烯磷脂酰胆碱静脉滴注保肝及甲氧氯普胺口服止吐。\nD. 继续同期放化疗，予以甲氧氯普胺口服止吐，加用脂肪乳氨基酸葡萄糖静脉营养及胸腺五肽支持治疗。\nE. 暂停同期化疗，仅行单纯放疗，予以甲氧氯普胺口服止吐及脂肪乳氨基酸葡萄糖静脉营养。\nF. 继续同期放化疗，予以促红细胞生成素皮下注射及胸腺五肽支持治疗。\nG. 暂停放化疗，予以静脉输注红细胞悬液及脂肪乳氨基酸葡萄糖静脉营养。\nH. 继续同期放化疗，予以5-HT3受体拮抗剂静脉推注强化止吐，暂不予静脉营养支持。\nI. 继续同期放化疗，予以水化碱化尿液及甲氧氯普胺口服止吐。\nJ. 暂停放化疗，予以广谱抗生素静脉滴注抗感染及胸腺五肽支持治疗。\nK. 继续同期放化疗，予以甲氧氯普胺口服止吐，暂不予静脉营养及免疫调节支持。\nL. 继续同期放化疗，予以重组人粒细胞刺激因子及促红细胞生成素双重支持。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"继续同期放化疗，予以重组人粒细胞刺激因子皮下注射及甲氧氯普胺口服止吐。","is_gold":false},{"letter":"B","text":"继续同期放化疗，予以重组人血小板生成素皮下注射及脂肪乳氨基酸葡萄糖静脉营养。","is_gold":false},{"letter":"C","text":"继续同期放化疗，予以多烯磷脂酰胆碱静脉滴注保肝及甲氧氯普胺口服止吐。","is_gold":false},{"letter":"D","text":"继续同期放化疗，予以甲氧氯普胺口服止吐，加用脂肪乳氨基酸葡萄糖静脉营养及胸腺五肽支持治疗。","is_gold":false},{"letter":"E","text":"暂停同期化疗，仅行单纯放疗，予以甲氧氯普胺口服止吐及脂肪乳氨基酸葡萄糖静脉营养。","is_gold":false},{"letter":"F","text":"继续同期放化疗，予以促红细胞生成素皮下注射及胸腺五肽支持治疗。","is_gold":false},{"letter":"G","text":"暂停放化疗，予以静脉输注红细胞悬液及脂肪乳氨基酸葡萄糖静脉营养。","is_gold":false},{"letter":"H","text":"继续同期放化疗，予以5-HT3受体拮抗剂静脉推注强化止吐，暂不予静脉营养支持。","is_gold":false},{"letter":"I","text":"继续同期放化疗，予以水化碱化尿液及甲氧氯普胺口服止吐。","is_gold":false},{"letter":"J","text":"暂停放化疗，予以广谱抗生素静脉滴注抗感染及胸腺五肽支持治疗。","is_gold":false},{"letter":"K","text":"继续同期放化疗，予以甲氧氯普胺口服止吐，暂不予静脉营养及免疫调节支持。","is_gold":true},{"letter":"L","text":"继续同期放化疗，予以重组人粒细胞刺激因子及促红细胞生成素双重支持。","is_gold":false}],"gold_letter":"K"},{"sample_id":"sample-d1b602a57ed6c599e7f441cc","patient_id":"patient-5ee5dba6116030961a7a97b5","turn_id":"turn07","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 涕血半年伴右颈肿物2周；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D10] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: 右臂静脉插管, 导管末端位于胸椎右旁T 7上缘水平，估计位于上腔静脉下段。；检查结论: 导管末端位置如上述。\n- [全程D39] 检验组合: 胱抑素(Cys-C)-静脉血: 0.78mg/L；血小板比容-静脉血: 14.8%；中性粒细胞百分比(Neut%)-静脉血: 0.61；γ-谷氨酰基转移酶(GGT)-静脉血: 57.8U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；总蛋白(TP)-静脉血: 67.84g/L；平均红细胞体积(MCV)-静脉血: 96.4fL；镁离子(Mg2+)-静脉血: 0.92mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.05mmolL；钠离子(Na+)-静脉血: 139.4mmol/L；磷(P)-静脉血: 1.36mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.302；氯离子(Cl-)-静脉血: 103.4mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.54；平均红细胞血红蛋白含量(MCH)-静脉血: 32.7pg；平均血小板体积(MPV)-静脉血: 8.84fL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.59；钾离子(K+)-静脉血: 3.79mmol/L；单核细胞百分比(Mono%)-静脉血: 0.06；白细胞计数(WBC#)-静脉血: 5.4510E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；α-L-岩藻糖苷酶(AFU)-静脉血: 35.8U/L；血小板分布宽度(PDW)-静脉血: 16.9%；红细胞比容(Hct)-静脉血: 40.3%；乳酸脱氢酶(LDH)-静脉血: 149.5U/L；红细胞计数(RBC#)-静脉血: 4.1810E12/L；C-反应蛋白(CRP)-静脉血: 2.31mg/L；总钙(Ca)-静脉血: 2.19mmol/L；尿素氮(BUN)-静脉血: 3.8mmol/L；尿酸(UA)-静脉血: 285umol/L；阴离子间隙(AG)-静脉血: 11.3；葡萄糖(Glu)-静脉血: 4.38mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339.2g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 32.4U/L；甘油三酯(TG)-静脉血: 2.32mmol/L；白蛋白(ALB)-静脉血: 41.6g/L；血小板计数(PLT#)-静脉血: 167.……\n- [全程D45] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌2程化疗后，与某次就诊时间片对比： 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁增厚，可见软组织肿块形成，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，对比前片，较前明显缩小。双侧咽隐窝见软组织占据，双侧咽旁脂肪间隙受压变窄，病灶侵犯双侧腭帆提肌，范围较前稍缩小。双侧腭帆张肌、头长肌未见受侵。 双侧翼腭窝、颞下窝未见异常；口咽双侧壁未见受累增厚，病变未累及后鼻孔。 双侧翼突基底内份、蝶骨基底部右份骨髓信号减低，增强可见轻度强化。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 双侧咽后间隙见肿大淋巴结，右侧大小约为6mm ×7 mm，左侧大小约4mm×6mm。双颈II区、III区见数个淋巴结，最大位于右颈II区，大小约为11mm×24mm，较前明显缩小。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌2程化疗后： 鼻咽病灶较前明显缩小。 颅底骨质破坏。 双侧咽后及颈部淋巴结，较前明显缩小。 鼻窦炎、右乳突炎。\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D34] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者今日洛铂+5-FU化疗第2天，诉食欲较差，无恶心、呕吐等不适，精神、睡眠尚可，大小便正常。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者化疗第2日，一般情况可，嘱患者注意饮食，加强营养，续行化疗。密切观察化疗反应，必要时加强处理。现已按查房指示执行。\n- [全程D35] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者今日洛铂+5-FU化疗第3天，诉食欲较差，无恶心、呕吐等不适，精神、睡眠尚可，大小便正常。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者化疗第3日，一般情况可，密切观察化疗反应，必要时加强处理。现已按查房指示执行。\n- [全程D39] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者计划于今日完成第2程洛铂+5-FU方案诱导化疗，未诉特殊不适。[姓名已隐去]主诊医生信息已隐藏：患者现完成第2程洛铂+5-FU方案诱导化疗，一般情况可，予今日出院。嘱患者出院后定期每周复查血常规、肝肾功能，2周后返院续治。现已按查房指示执行。\n- [时间未明] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 现已按查房指示执行。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估为诱导化疗疾病稳定（SD），原方案（洛铂+5-FU）继续第3程诱导化疗，随后再评估放疗指征。\nB. 评估为诱导化疗部分缓解（PR），原方案（洛铂+5-FU）继续第3程诱导化疗，以期达到完全缓解后放疗。\nC. 评估为诱导化疗部分缓解（PR），行鼻咽及颈部病灶根治性手术切除，术后辅助调强放射治疗。\nD. 评估为诱导化疗完全缓解（CR），暂缓放射治疗，进入定期随访观察阶段。\nE. 评估为诱导化疗部分缓解（PR），完善放疗前常规血液学检查，启动根治性调强放射治疗（IMRT）及放疗相关支持治疗。\nF. 评估为诱导化疗部分缓解（PR），启动根治性三维适形放射治疗（3D-CRT）及放疗相关支持治疗。\nG. 评估为诱导化疗疾病进展（PD），更改诱导化疗方案为吉西他滨+顺铂（GP），2程后再次评估。\nH. 评估为诱导化疗部分缓解（PR），行颈部淋巴结清扫术，术后行鼻咽局部调强放射治疗。\nI. 评估为诱导化疗部分缓解（PR），启动姑息性减症放射治疗，剂量控制在40Gy左右。\nJ. 评估为诱导化疗疾病稳定（SD），加用免疫检查点抑制剂联合原方案化疗。\nK. 评估为诱导化疗部分缓解（PR），等待4周后复查PET-CT，视代谢活性决定是否启动放射治疗。\nL. 评估为诱导化疗部分缓解（PR），停用化疗，单用靶向药物维持治疗。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"评估为诱导化疗疾病稳定（SD），原方案（洛铂+5-FU）继续第3程诱导化疗，随后再评估放疗指征。","is_gold":false},{"letter":"B","text":"评估为诱导化疗部分缓解（PR），原方案（洛铂+5-FU）继续第3程诱导化疗，以期达到完全缓解后放疗。","is_gold":false},{"letter":"C","text":"评估为诱导化疗部分缓解（PR），行鼻咽及颈部病灶根治性手术切除，术后辅助调强放射治疗。","is_gold":false},{"letter":"D","text":"评估为诱导化疗完全缓解（CR），暂缓放射治疗，进入定期随访观察阶段。","is_gold":false},{"letter":"E","text":"评估为诱导化疗部分缓解（PR），完善放疗前常规血液学检查，启动根治性调强放射治疗（IMRT）及放疗相关支持治疗。","is_gold":true},{"letter":"F","text":"评估为诱导化疗部分缓解（PR），启动根治性三维适形放射治疗（3D-CRT）及放疗相关支持治疗。","is_gold":false},{"letter":"G","text":"评估为诱导化疗疾病进展（PD），更改诱导化疗方案为吉西他滨+顺铂（GP），2程后再次评估。","is_gold":false},{"letter":"H","text":"评估为诱导化疗部分缓解（PR），行颈部淋巴结清扫术，术后行鼻咽局部调强放射治疗。","is_gold":false},{"letter":"I","text":"评估为诱导化疗部分缓解（PR），启动姑息性减症放射治疗，剂量控制在40Gy左右。","is_gold":false},{"letter":"J","text":"评估为诱导化疗疾病稳定（SD），加用免疫检查点抑制剂联合原方案化疗。","is_gold":false},{"letter":"K","text":"评估为诱导化疗部分缓解（PR），等待4周后复查PET-CT，视代谢活性决定是否启动放射治疗。","is_gold":false},{"letter":"L","text":"评估为诱导化疗部分缓解（PR），停用化疗，单用靶向药物维持治疗。","is_gold":false}],"gold_letter":"E"},{"sample_id":"sample-c2aa48d510cb846f4ee51384","patient_id":"patient-5ee5dba6116030961a7a97b5","turn_id":"turn08","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 涕血半年伴右颈肿物2周；现病史: 缘于半年前患者无意中出现间断性涕血，未予重视，于2周前出现右颈肿物，无痛、面麻等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：111/52mmHg,Ht：170cm，Wt：77kg，BSA：1.8845m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距3.5cm；鼻咽顶后壁结节状肿物；右侧颈部IIa区可扪及1个淋巴结，最大径3×3cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D60] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 28.3U/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.1g/L；平均红细胞体积(MCV)-静脉血: 97.9fL；血液二氧化碳含量ctCO2(B)-静脉血: 22.6mmol/L；血小板计数(PLT#)-静脉血: 152.910E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；钾离子(K+)-静脉血: 4.2mmol/L；碱性磷酸酶(ALP)-静脉血: 76.4U/L；单核细胞百分比(Mono%)-静脉血: 0.073；γ-谷氨酰基转移酶(GGT)-静脉血: 46.4U/L；血红蛋白(Hb)-静脉血: 145.2g/L；胱抑素(Cys-C)-静脉血: 0.82mg/L；阴离子间隙(AG)-静脉血: 18；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；甘油三酯(TG)-静脉血: 1.57mmol/L；直接胆红素(DBIL)-静脉血: 6.7umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 345.2g/L；间接胆红素(IBIL)-静脉血: 17.9umolL；中性粒细胞百分比(Neut%)-静脉血: 0.676；乳酸脱氢酶(LDH)-静脉血: 132.5U/L；总蛋白(TP)-静脉血: 71.34g/L；总胆固醇(TC)-静脉血: 6.52mmol/L；总钙(Ca)-静脉血: 2.33mmol/L；血小板分布宽度(PDW)-静脉血: 16.9%；血小板比容-静脉血: 13%；尿酸(UA)-静脉血: 305.5umol/L；平均血小板体积(MPV)-静脉血: 8.53fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1%；淋巴细胞百分比(Lymph%)-静脉血: 0.221；钠离子(Na+)-静脉血: 139.5mmol/L；载脂蛋白B(apoB)-静脉血: 1.31g/L；有核红细胞百分比(NRBC%)-静脉血: 0；总胆汁酸(TBA)-静脉血: 3.6umol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总胆红素(TBIL)-静脉血: 24.6umol/L……\n- [全程D67] 检验组合: 平均红细胞血红蛋白浓度(MCHC)-静脉血: 349g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.5；血小板比容-静脉血: 12%；总蛋白(TP)-静脉血: 64.55g/L；镁离子(Mg2+)-静脉血: 0.9mmol/L；乳酸脱氢酶(LDH)-静脉血: 113.1U/L；总胆固醇(TC)-静脉血: 5.45mmol/L；葡萄糖(Glu)-静脉血: 4.72mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.5；钠离子(Na+)-静脉血: 142.5mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 33.4pg；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.022；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；总胆汁酸(TBA)-静脉血: 2.5umol/L；阴离子间隙(AG)-静脉血: 10；胱抑素(Cys-C)-静脉血: 0.75mg/L；间接胆红素(IBIL)-静脉血: 8.9umolL；钾离子(K+)-静脉血: 3.8mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 36.7U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；红细胞比容(Hct)-静脉血: 39%；血小板分布宽度(PDW)-静脉血: 12.4%；中性粒细胞百分比(Neut%)-静脉血: 0.753；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；球蛋白(GLO)-静脉血: 26.65g/L；甘油三酯(TG)-静脉血: 1.38mmol/L；碱性磷酸酶(ALP)-静脉血: 67.5U/L；白细胞计数(WBC#)-静脉血: 5.0810E9/L；总胆红素(TBIL)-静脉血: 13.1umol/L；单核细胞百分比(Mono%)-静脉血: 0.089；α-L-岩藻糖苷酶(AFU)-静脉血: 26U/L；尿酸(UA)-静脉血: 318.1umol/L；尿素氮(BUN)-静脉血: 3.21mmol/L；平均血小板体积(MPV)-静脉血: 10.4fL；载脂蛋白B(apoB)-静脉血: 1.08g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；血红蛋白(Hb)-静脉血: 136g/L；氯离子(Cl-)-静……\n- [全程D74] 检验组合: 有核红细胞计数(NRBC#)-静脉血: 010E9/L；乳酸脱氢酶(LDH)-静脉血: 120.6U/L；磷(P)-静脉血: 1.42mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.111；天门冬氨酸氨基转移酶(AST)-静脉血: 20.1U/L；直接胆红素(DBIL)-静脉血: 5.8umol/L；胱抑素(Cys-C)-静脉血: 0.73mg/L；血小板比容-静脉血: 12.1%；载脂蛋白AI(apoAI)-静脉血: 1.03g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；C-反应蛋白(CRP)-静脉血: 12.33mg/L；血红蛋白(Hb)-静脉血: 131.8g/L；尿素氮(BUN)-静脉血: 4.01mmol/L；载脂蛋白B(apoB)-静脉血: 1.28g/L；甘油三酯(TG)-静脉血: 1.16mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 34pg；单核细胞百分比(Mono%)-静脉血: 0.103；总钙(Ca)-静脉血: 2.21mmol/L；红细胞计数(RBC#)-静脉血: 3.8710E12/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；尿酸(UA)-静脉血: 319.8umol/L；总胆红素(TBIL)-静脉血: 18.5umol/L；钠离子(Na+)-静脉血: 140.1mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.11mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347.8g/L；中性粒细胞百分比(Neut%)-静脉血: 0.746；红细胞比容(Hct)-静脉血: 37.8%；血小板分布宽度(PDW)-静脉血: 16.7%；球蛋白(GLO)-静脉血: 21.96g/L；肌酐(Crea)-静脉血: 61.6umol/L；总胆汁酸(TBA)-静脉血: 3.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 34.1U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.01mmolL；碱性磷酸酶(ALP)-静脉血: 65.6U/L；葡萄糖(Glu)-静脉血: 5.14mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.036；嗜碱性粒细胞计数(B……\n- [全程D81] 检验组合: 红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.6；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.77；平均红细胞体积(MCV)-静脉血: 95.3fL；直接胆红素(DBIL)-静脉血: 6.5umol/L；平均血小板体积(MPV)-静脉血: 10fL；大血小板百分比(P-LCR%)-静脉血: 25.7%；白蛋白(ALB)-静脉血: 41.6g/L；肌酐(Crea)-静脉血: 53.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.75；钠离子(Na+)-静脉血: 137.9mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.7U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7；间接胆红素(IBIL)-静脉血: 17.4umolL；球蛋白(GLO)-静脉血: 23.48g/L；总胆固醇(TC)-静脉血: 5.17mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.833；胱抑素(Cys-C)-静脉血: 0.67mg/L；乳酸脱氢酶(LDH)-静脉血: 137.4U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.51mmol/L；血小板分布宽度(PDW)-静脉血: 11.9%；白细胞计数(WBC#)-静脉血: 3.7810E9/L；载脂蛋白B(apoB)-静脉血: 1.17g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 38.7U/L；中性粒细胞计数(Neut#)-静脉血: 3.210E9/L；总胆红素(TBIL)-静脉血: 23.9umol/L；阴离子间隙(AG)-静脉血: 11.3；α-L-岩藻糖苷酶(AFU)-静脉血: 30.5U/L；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；血小板比容-静脉血: 15%；C-反应蛋白(CRP)-静脉血: 15.45mg/L；氯离子(Cl-)-静脉血: 100.4mmol/L；总胆汁酸(TBA)-静脉血: 1.2umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.024；尿素氮(BUN)-静脉血: 4.4mmol/L；血红蛋白(Hb)-静脉血: 134g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.8U/L；单核细胞计数(……\n- [全程D88] 检验组合: C-反应蛋白(CRP)-静脉血: 7.88mg/L；甘油三酯(TG)-静脉血: 1.18mmol/L；平均红细胞体积(MCV)-静脉血: 96.4fL；载脂蛋白B(apoB)-静脉血: 1.03g/L；血小板计数(PLT#)-静脉血: 92.910E9/L；总胆红素(TBIL)-静脉血: 29umol/L；中性粒细胞计数(Neut#)-静脉血: 2.810E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 30.3U/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；葡萄糖(Glu)-静脉血: 4.55mmol/L；总胆汁酸(TBA)-静脉血: 2.3umol/L；血小板比容-静脉血: 7.5%；红细胞比容(Hct)-静脉血: 32.9%；中性粒细胞百分比(Neut%)-静脉血: 0.784；载脂蛋白AI(apoAI)-静脉血: 0.93g/L；血红蛋白(Hb)-静脉血: 117.2g/L；间接胆红素(IBIL)-静脉血: 20.4umolL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；白细胞计数(WBC#)-静脉血: 3.5310E9/L；总胆固醇(TC)-静脉血: 4.84mmol/L；总钙(Ca)-静脉血: 2.27mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；平均红细胞血红蛋白含量(MCH)-静脉血: 34.2pg；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总蛋白(TP)-静脉血: 62g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.86mmolL；单核细胞计数(Mono#)-静脉血: 0.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.108；直接胆红素(DBIL)-静脉血: 8.6umol/L；钠离子(Na+)-静脉血: 141mmol/L；镁离子(Mg2+)-静脉血: 0.94mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.088；钾离子(K+)-静脉血: 4.2mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 48.3U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；尿酸(UA)-静脉血: 281.5umol/L；白蛋白(ALB)-静……\n- [全程D94] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理清晰，走行自然，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影形态、大小未见异常。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见异常。\n\n【既往治疗与反应】\n- [全程D71] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现放疗13F，诉口干，轻微咽痛，偶有咳嗽，食欲欠佳，无恶心、呕吐等不适，精神、睡眠欠佳，大小便正常。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者放疗初期出现口腔粘膜反应，予止咳、止痛等对症处理，继续放疗，密切关注放疗副反应，定期复查血常规，必要时加强处理。现已按查房指示执行。\n- [全程D76] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现放疗16F，DDP同期化疗第1日，诉咽痛较前加重，偶有咳嗽，食欲欠佳，无恶心、呕吐等不适，精神、睡眠欠佳，大小便正常。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者咽痛较前加重，予加强止痛。患者今日洛铂同期化疗第1日，密切观察化疗反应，加强止呕处理，注意放化疗叠加副反应，继续喷喉、洗鼻等对症处理，续行放疗。现已按查房指示执行。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D91] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现放疗26F，诉口干，咽痛较前明显，食欲较前变差，余无不适，精神、睡眠一般。查体基本同前。[姓名已隐去]主诊医生信息已隐藏：患者现于同时期放化疗中，放射性口腔粘膜反应1度，予止痛、静脉营养支持等加强处理，继续予喷喉、洗鼻等对症处理，定期复查血常规，续行放疗。现已按查房指示执行。\n- [时间未明] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 现已按查房指示执行。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行鼻咽部MRI及全身PET-CT全面评估疗效，若疑有残留即刻行局部挽救性手术。\nB. 行电子鼻咽镜检查并对原发灶区域行多点活检，明确病理缓解情况后决定是否追加化疗。\nC. 暂缓局部内镜检查，继续原方案洛铂单药辅助化疗2个周期后再行全面评估。\nD. 行电子鼻咽镜检查评估局部疗效，并继续住院行第3周期洛铂同期化疗。\nE. 直接安排出院，嘱3个月后返院行鼻咽镜及MRI检查，期间停用所有处方药物。\nF. 行电子鼻咽镜检查（不活检）评估局部情况，安排出院并予以镇痛、黏膜保护及雾化等对症药物。\nG. 行鼻咽部及颈部增强CT评估病灶退缩情况，若有残留予以局部追加放疗推量。\nH. 行电子鼻咽镜检查评估局部疗效，安排出院并立即开始PD-1抑制剂维持治疗半年。\nI. 行全身骨扫描及腹部超声评估远处转移情况，若阴性则安排出院并定期随访。\nJ. 行电子鼻咽镜检查（不活检）评估局部情况，并转入头颈外科行右颈淋巴结清扫术。\nK. 安排出院并予以镇痛药物，1个月后返院行鼻咽镜下活检以明确是否达到病理完全缓解。\nL. 行鼻咽部MRI评估局部疗效，若达到完全缓解则安排出院并逐步停用所有镇痛药物。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"行鼻咽部MRI及全身PET-CT全面评估疗效，若疑有残留即刻行局部挽救性手术。","is_gold":false},{"letter":"B","text":"行电子鼻咽镜检查并对原发灶区域行多点活检，明确病理缓解情况后决定是否追加化疗。","is_gold":false},{"letter":"C","text":"暂缓局部内镜检查，继续原方案洛铂单药辅助化疗2个周期后再行全面评估。","is_gold":false},{"letter":"D","text":"行电子鼻咽镜检查评估局部疗效，并继续住院行第3周期洛铂同期化疗。","is_gold":false},{"letter":"E","text":"直接安排出院，嘱3个月后返院行鼻咽镜及MRI检查，期间停用所有处方药物。","is_gold":false},{"letter":"F","text":"行电子鼻咽镜检查（不活检）评估局部情况，安排出院并予以镇痛、黏膜保护及雾化等对症药物。","is_gold":true},{"letter":"G","text":"行鼻咽部及颈部增强CT评估病灶退缩情况，若有残留予以局部追加放疗推量。","is_gold":false},{"letter":"H","text":"行电子鼻咽镜检查评估局部疗效，安排出院并立即开始PD-1抑制剂维持治疗半年。","is_gold":false},{"letter":"I","text":"行全身骨扫描及腹部超声评估远处转移情况，若阴性则安排出院并定期随访。","is_gold":false},{"letter":"J","text":"行电子鼻咽镜检查（不活检）评估局部情况，并转入头颈外科行右颈淋巴结清扫术。","is_gold":false},{"letter":"K","text":"安排出院并予以镇痛药物，1个月后返院行鼻咽镜下活检以明确是否达到病理完全缓解。","is_gold":false},{"letter":"L","text":"行鼻咽部MRI评估局部疗效，若达到完全缓解则安排出院并逐步停用所有镇痛药物。","is_gold":false}],"gold_letter":"F"}]}
+{"patient_id":"patient-f402aced5926698da3194c37","bootstrap_cluster_id":"cluster-019","turns":[{"sample_id":"sample-6a54e1ca8d841063a11b801b","patient_id":"patient-f402aced5926698da3194c37","turn_id":"turn01","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左颈肿物20余天；现病史: 20余天前患者无明显诱因自觉左颈肿物，无发热、疼痛，伴涕血、左耳堵塞感。无头痛、面麻、鼻塞、复视、张口困难等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左耳闷胀感,涕血,左颈肿物；既往史: 高血压10余年，规律服药，血压控制在130/80mmHg左右。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:穿山甲壳、蜂蛹、伟哥过敏。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 大儿子患“脑胶质瘤”，已病逝。；体格检查: T：36.4℃，P：66次/分，R：20次/分，BP：134/81mmHg,Ht：175cm，Wt：84kg，BSA：2.0m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽顶后壁、左侧壁结节状肿物；双侧颈部II区可扪及1个淋巴结，最大径6×5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 电子鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸部及腹部CT平扫，常规血液学检查。\nB. 颈部淋巴结切除活检，鼻咽及颈部MRI平扫+增强，全身PET/CT显像，常规血液学检查。\nC. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，颈部超声，暂缓全身影像学分期。\nD. 鼻咽及颈部MRI平扫+增强，全身PET/CT显像，先行诱导化疗待肿瘤缩小后行鼻咽活检。\nE. 电子鼻咽镜检查及活检，鼻咽MRI平扫+增强，胸部X线，腹部超声，全身骨显像。\nF. 颈部淋巴结细针穿刺活检，鼻咽及颈部CT平扫+增强，全身PET/CT显像，常规血液学检查。\nG. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT显像，常规血液学、心电图与心脏彩超检查。\nH. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸腹部CT平扫+增强，免除全身骨显像。\nI. 电子鼻咽镜检查及活检，头颅MRI平扫+增强，颈部超声，全身PET/CT显像，常规血液学检查。\nJ. 鼻咽刷片细胞学检查，鼻咽及颈部MRI平扫+增强，全身PET/CT显像，常规血液学检查。\nK. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫，全身PET/CT显像，常规血液学检查。\nL. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT显像，同步安排根治性放疗定位。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"电子鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸部及腹部CT平扫，常规血液学检查。","is_gold":false},{"letter":"B","text":"颈部淋巴结切除活检，鼻咽及颈部MRI平扫+增强，全身PET/CT显像，常规血液学检查。","is_gold":false},{"letter":"C","text":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，颈部超声，暂缓全身影像学分期。","is_gold":false},{"letter":"D","text":"鼻咽及颈部MRI平扫+增强，全身PET/CT显像，先行诱导化疗待肿瘤缩小后行鼻咽活检。","is_gold":false},{"letter":"E","text":"电子鼻咽镜检查及活检，鼻咽MRI平扫+增强，胸部X线，腹部超声，全身骨显像。","is_gold":false},{"letter":"F","text":"颈部淋巴结细针穿刺活检，鼻咽及颈部CT平扫+增强，全身PET/CT显像，常规血液学检查。","is_gold":false},{"letter":"G","text":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT显像，常规血液学、心电图与心脏彩超检查。","is_gold":true},{"letter":"H","text":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸腹部CT平扫+增强，免除全身骨显像。","is_gold":false},{"letter":"I","text":"电子鼻咽镜检查及活检，头颅MRI平扫+增强，颈部超声，全身PET/CT显像，常规血液学检查。","is_gold":false},{"letter":"J","text":"鼻咽刷片细胞学检查，鼻咽及颈部MRI平扫+增强，全身PET/CT显像，常规血液学检查。","is_gold":false},{"letter":"K","text":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫，全身PET/CT显像，常规血液学检查。","is_gold":false},{"letter":"L","text":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT显像，同步安排根治性放疗定位。","is_gold":false}],"gold_letter":"G"},{"sample_id":"sample-1d99d3a2f71afa9bcb3f941a","patient_id":"patient-f402aced5926698da3194c37","turn_id":"turn02","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左颈肿物20余天；现病史: 20余天前患者无明显诱因自觉左颈肿物，无发热、疼痛，伴涕血、左耳堵塞感。无头痛、面麻、鼻塞、复视、张口困难等不适。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左耳闷胀感,涕血,左颈肿物；既往史: 高血压10余年，规律服药，血压控制在130/80mmHg左右。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:穿山甲壳、蜂蛹、伟哥过敏。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 大儿子患“脑胶质瘤”，已病逝。；体格检查: T：36.4℃，P：66次/分，R：20次/分，BP：134/81mmHg,Ht：175cm，Wt：84kg，BSA：2.0m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽顶后壁、左侧壁结节状肿物；双侧颈部II区可扪及1个淋巴结，最大径6×5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 ST-T轻度改变\n- [全程D1] 检验组合: 梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；有核红细胞计数(NRBC#)-静脉血: 010E9/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；单核细胞计数(Mono#)-静脉血: 0.510E9/L；胱抑素(Cys-C)-静脉血: 0.76mg/L；磷(P)-静脉血: 1.12mmol/L；纤维蛋白原(Fbg)-静脉血: 3.32g/L；Rh血型-静脉血: 阳性；血红蛋白(Hb)-静脉血: 136.2g/L；ABO血型-静脉血: O；骨钙素N端中分子片段(N-MID)-静脉血: 14.08ng/ml；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；直接胆红素(DBIL)-静脉血: 3.1umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 28.5U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；中性粒细胞百分比(Neut%)-静脉血: 0.617；镁离子(Mg2+)-静脉血: 0.88mmol/L；白细胞计数(WBC#)-静脉血: 7.0810E9/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 26.4U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.295ng/ml（参考: <0.704）；凝血酶原时间活动度(PTA)-静脉血: 120%；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.9mmol/L；血小板比容-静脉血: 18.3%；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.05S/CO；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.23mmolL；平均红细胞血红蛋白含量(MCH)-静脉血: 30pg；单核细胞百分比(Mono%)-静脉血: 0.072；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；总蛋白(TP)-静脉血: 71.09g/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40……\n- [全程D3] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及左侧壁粘膜增厚放射性浓聚，SUV约14.5，病灶累及蝶骨基底部、枕骨斜坡、左侧翼突、左岩尖、左侧破裂孔及左侧鼻后孔。双侧咽隐窝消失。双侧咽后未见明显肿大淋巴结及异常放射性分布。口咽及喉咽结构及放射性分布未见明显异常。左侧上颌窦及蝶窦内见低密度影放射性分布未见明显异常，额窦、筛窦及右侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双颈Ⅱ区多发肿大淋巴结放射性浓聚，SUV约14.2，最大约2.2×2.6cm。 双侧苍白球钙化放射性分布缺损，余所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。左肾盂小结石放射性分布缺损。脾脏、胰腺、右肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺小点状钙化灶。余盆腔放射性分布均匀，膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 所见颅盖骨、余躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽顶壁、顶后壁及左侧壁粘膜增厚代谢活跃，考虑鼻咽癌，病灶累及颅底骨、左侧破裂孔及左侧鼻后孔；双颈Ⅱ区多发肿大淋巴结代谢活跃，考虑转移。 左侧上颌窦及蝶窦炎症。 左肾盂小结石。 前列腺钙化。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行颈部淋巴结细针穿刺活检，完善鼻咽及颈部CT平扫+增强，查乙肝病毒DNA定量\nB. 行鼻咽内镜组织活检，完善鼻咽及颈部CT平扫+增强，查乙肝病毒DNA定量\nC. 行鼻咽内镜组织活检，完善鼻咽及颈部MRI平扫+增强，暂不查乙肝病毒DNA定量\nD. 行颈部淋巴结切除活检，完善鼻咽及颈部MRI平扫+增强，查乙肝病毒DNA定量\nE. 行鼻咽内镜组织活检，完善鼻咽及颈部CT平扫+增强，查丙肝病毒RNA定量\nF. 行鼻咽内镜组织活检，完善头颅MRI平扫+增强，查乙肝病毒DNA定量\nG. 行颈部淋巴结细针穿刺活检，完善鼻咽及颈部MRI平扫+增强，暂不查乙肝病毒DNA定量\nH. 行鼻咽内镜组织活检，完善鼻咽及颈部MRI平扫+增强，查乙肝病毒DNA定量\nI. 行鼻咽内镜组织活检及颈部淋巴结穿刺活检，完善鼻咽及颈部MRI平扫+增强\nJ. 行鼻咽内镜组织活检，完善鼻咽及颈部MRI平扫+增强，查丙肝病毒RNA定量\nK. 行鼻咽内镜组织活检，完善颈部超声造影，查乙肝病毒DNA定量\nL. 行鼻咽内镜组织活检，完善全身骨扫描，查乙肝病毒DNA定量\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"行颈部淋巴结细针穿刺活检，完善鼻咽及颈部CT平扫+增强，查乙肝病毒DNA定量","is_gold":false},{"letter":"B","text":"行鼻咽内镜组织活检，完善鼻咽及颈部CT平扫+增强，查乙肝病毒DNA定量","is_gold":false},{"letter":"C","text":"行鼻咽内镜组织活检，完善鼻咽及颈部MRI平扫+增强，暂不查乙肝病毒DNA定量","is_gold":false},{"letter":"D","text":"行颈部淋巴结切除活检，完善鼻咽及颈部MRI平扫+增强，查乙肝病毒DNA定量","is_gold":false},{"letter":"E","text":"行鼻咽内镜组织活检，完善鼻咽及颈部CT平扫+增强，查丙肝病毒RNA定量","is_gold":false},{"letter":"F","text":"行鼻咽内镜组织活检，完善头颅MRI平扫+增强，查乙肝病毒DNA定量","is_gold":false},{"letter":"G","text":"行颈部淋巴结细针穿刺活检，完善鼻咽及颈部MRI平扫+增强，暂不查乙肝病毒DNA定量","is_gold":false},{"letter":"H","text":"行鼻咽内镜组织活检，完善鼻咽及颈部MRI平扫+增强，查乙肝病毒DNA定量","is_gold":true},{"letter":"I","text":"行鼻咽内镜组织活检及颈部淋巴结穿刺活检，完善鼻咽及颈部MRI平扫+增强","is_gold":false},{"letter":"J","text":"行鼻咽内镜组织活检，完善鼻咽及颈部MRI平扫+增强，查丙肝病毒RNA定量","is_gold":false},{"letter":"K","text":"行鼻咽内镜组织活检，完善颈部超声造影，查乙肝病毒DNA定量","is_gold":false},{"letter":"L","text":"行鼻咽内镜组织活检，完善全身骨扫描，查乙肝病毒DNA定量","is_gold":false}],"gold_letter":"H"},{"sample_id":"sample-9fa3bde2f5d0ac4e910cb3cb","patient_id":"patient-f402aced5926698da3194c37","turn_id":"turn05","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 ST-T轻度改变\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D3] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及左侧壁粘膜增厚放射性浓聚，SUV约14.5，病灶累及蝶骨基底部、枕骨斜坡、左侧翼突、左岩尖、左侧破裂孔及左侧鼻后孔。双侧咽隐窝消失。双侧咽后未见明显肿大淋巴结及异常放射性分布。口咽及喉咽结构及放射性分布未见明显异常。左侧上颌窦及蝶窦内见低密度影放射性分布未见明显异常，额窦、筛窦及右侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双颈Ⅱ区多发肿大淋巴结放射性浓聚，SUV约14.2，最大约2.2×2.6cm。 双侧苍白球钙化放射性分布缺损，余所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。左肾盂小结石放射性分布缺损。脾脏、胰腺、右肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺小点状钙化灶。余盆腔放射性分布均匀，膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 所见颅盖骨、余躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽顶壁、顶后壁及左侧壁粘膜增厚代谢活跃，考虑鼻咽癌，病灶累及颅底骨、左侧破裂孔及左侧鼻后孔；双颈Ⅱ区多发肿大淋巴结代谢活跃，考虑转移。 左侧上颌窦及蝶窦炎症。 左肾盂小结石。 前列腺钙化。\n- [全程D6] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽左侧壁、顶壁及后壁增厚，见软组织灶形成，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，病灶占据左侧咽隐窝，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，右侧咽隐窝稍变浅，右侧咽旁脂肪间隙及颈动脉鞘区未见异常； 左侧腭帆提肌、双侧头长肌直接受侵；病灶累及左侧破裂孔、左侧后鼻孔； 双侧侧翼腭窝、颞下窝未见异常；口咽各壁无受累增厚。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部骨质破坏。 双侧海绵窦形态正常，未见增宽。 左侧上颌窦、蝶窦、左侧乳突粘膜稍增厚，双侧筛窦、右侧乳突气化好，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 左侧咽后间隙见小淋巴结，短径约4mm；双颈II区见肿大淋巴结，较大者短径约25mm；左颈III、V区见多发淋巴结，边界清，信号均匀，较大者短径约7mm。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 考虑鼻咽癌可能性大。 颅底骨质破坏。 左侧咽后小淋巴结。 双颈II区淋巴结肿大。\n- [全程D6] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T7上缘水平，估计导管末端位于上腔静脉下段内。；检查结论: PICC管末端位置如上述。\n- [全程D6] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 28mm AO 29mm MV E 0.51m/s EF 73% LV 49mm IVS 9mm A 0.73m/s FS 42% RA 28mm LVPW 10mm RV 18mm PA 20mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 心脏结构及运动未见异常 各房室腔及大血管未探及异常血流信号 左室舒张功能减低，收缩功能正常\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] 检验组合: 镁离子(Mg2+)-静脉血: 0.89mmol/L；总胆红素(TBIL)-静脉血: 13.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 23.7U/L；丙氨酸氨基转移酶(ALT)-静脉血: 21.4U/L；总钙(Ca)-静脉血: 2.2mmol/L；氯离子(Cl-)-静脉血: 104mmol/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；直接胆红素(DBIL)-静脉血: 5umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6；红细胞比容(Hct)-静脉血: 38.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.358；间接胆红素(IBIL)-静脉血: 8.3umolL；平均红细胞体积(MCV)-静脉血: 87.1fL；载脂蛋白AI(apoAI)-静脉血: 1.11g/L；球蛋白(GLO)-静脉血: 29.01g/L；C-反应蛋白(CRP)-静脉血: 13.69mg/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；白细胞计数(WBC#)-静脉血: 4.8310E9/L；碱性磷酸酶(ALP)-静脉血: 70.4U/L；血小板比容-静脉血: 18%；载脂蛋白B(apoB)-静脉血: 0.67g/L；中性粒细胞百分比(Neut%)-静脉血: 0.566；淋巴细胞计数(Lymph#)-静脉血: 1.710E9/L；钾离子(K+)-静脉血: 4.1mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；乳酸脱氢酶(LDH)-静脉血: 203.5U/L；阴离子间隙(AG)-静脉血: 14；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；甘油三酯(TG)-静脉血: 1.28mmol/L；红细胞计数(RBC#)-静脉血: 4.4310E12/L；血小板分布宽度(PDW)-静脉血: 8.5%；单核细胞百分比(Mono%)-静脉血: 0.058；大血小板百分比(P-LCR%)-静脉血: 11.6%；血液二氧化碳含量ctCO2(B)-静脉血: 25.1mmol/L；白蛋白(ALB)-静脉血: 40.2g/L；尿素氮(BUN)-静脉血: 5.8mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.3U/L；尿酸(UA)-静脉血: 378.8umol/L；总胆固醇(TC)-……\n- [全程D21] 检验组合: 单核细胞百分比(Mono%)-静脉血: 0.062；中性粒细胞百分比(Neut%)-静脉血: 0.67；白细胞计数(WBC#)-静脉血: 5.9710E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.9；平均红细胞血红蛋白含量(MCH)-静脉血: 29.3pg；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 134g/L；红细胞比容(Hct)-静脉血: 41.3%；血小板比容-静脉血: 13%；平均红细胞体积(MCV)-静脉血: 90.4fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；平均血小板体积(MPV)-静脉血: 9.4fL；血小板计数(PLT#)-静脉血: 13810E9/L；中性粒细胞计数(Neut#)-静脉血: 410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 324g/L；血小板分布宽度(PDW)-静脉血: 9.9%；大血小板百分比(P-LCR%)-静脉血: 21.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.255；单核细胞计数(Mono#)-静脉血: 0.410E9/L；红细胞计数(RBC#)-静脉血: 4.5710E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.2\n- [全程D27] 检验组合: 红细胞计数(RBC#)-静脉血: 4.3410E12/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.85mmol/L；血小板计数(PLT#)-静脉血: 255.510E9/L；白细胞计数(WBC#)-静脉血: 6.210E9/L；氯离子(Cl-)-静脉血: 104.9mmol/L；总胆汁酸(TBA)-静脉血: 1umol/L；肌酐(Crea)-静脉血: 96.8umol/L；钾离子(K+)-静脉血: 4.5mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.386；乳酸脱氢酶(LDH)-静脉血: 212.1U/L；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.33mmolL；淋巴细胞计数(Lymph#)-静脉血: 2.410E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21U/L；平均红细胞体积(MCV)-静脉血: 90.1fL；总蛋白(TP)-静脉血: 70.21g/L；丙氨酸氨基转移酶(ALT)-静脉血: 19.6U/L；间接胆红素(IBIL)-静脉血: 4.6umolL；尿酸(UA)-静脉血: 469.1umol/L；血小板比容-静脉血: 15.3%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；甘油三酯(TG)-静脉血: 1.12mmol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白B(apoB)-静脉血: 0.9g/L；平均血小板体积(MPV)-静脉血: 6.02fL；总钙(Ca)-静脉血: 2.25mmol/L；单核细胞百分比(Mono%)-静脉血: 0.066；红细胞比容(Hct)-静脉血: 39.1%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；γ-谷氨酰基转移酶(GGT)-静脉血: 25.5U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.7pg；尿素氮(BUN)-静脉血: 4.22mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341.2g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；中性粒细胞计数(Neut#)-静脉血: 3.310E9/L；有核红细胞计数(NRBC#)-静脉血: 010E……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+洛铂方案诱导化疗结束，诉呕吐1次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程5-FU+洛铂方案诱导化疗结束，无诉特殊不适，可予出院，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 将第2程洛铂+5-FU诱导化疗减量20%，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nB. 暂停第2程诱导化疗，仅给予肠内营养及护胃支持，待胃肠道症状完全缓解后再评估化疗指征\nC. 按原剂量执行第2程洛铂+5-FU诱导化疗，并预防性给予重组人粒细胞集落刺激因子及止吐护胃支持治疗\nD. 按原剂量执行第2程洛铂+5-FU诱导化疗，并预防性给予重组人血小板生成素及止吐护胃支持治疗\nE. 将第2程诱导化疗方案更改为吉西他滨+顺铂，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nF. 将第2程诱导化疗方案更改为多西他赛+顺铂，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nG. 终止诱导化疗直接进入根治性放疗及同期化疗，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nH. 延迟第2程诱导化疗1周，期间给予护胃及止吐支持，待胃肠道症状完全缓解后再按原剂量化疗\nI. 按原剂量执行第2程洛铂+5-FU诱导化疗，取消常规止吐及护胃支持，仅在出现严重呕吐时给予解救治疗\nJ. 将第2程洛铂+5-FU诱导化疗减量25%，并预防性给予重组人粒细胞集落刺激因子及止吐护胃支持治疗\nK. 按原剂量执行第2程洛铂+5-FU诱导化疗，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nL. 停用静脉化疗，改为口服卡培他滨单药化疗，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"将第2程洛铂+5-FU诱导化疗减量20%，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗","is_gold":false},{"letter":"B","text":"暂停第2程诱导化疗，仅给予肠内营养及护胃支持，待胃肠道症状完全缓解后再评估化疗指征","is_gold":false},{"letter":"C","text":"按原剂量执行第2程洛铂+5-FU诱导化疗，并预防性给予重组人粒细胞集落刺激因子及止吐护胃支持治疗","is_gold":false},{"letter":"D","text":"按原剂量执行第2程洛铂+5-FU诱导化疗，并预防性给予重组人血小板生成素及止吐护胃支持治疗","is_gold":false},{"letter":"E","text":"将第2程诱导化疗方案更改为吉西他滨+顺铂，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗","is_gold":false},{"letter":"F","text":"将第2程诱导化疗方案更改为多西他赛+顺铂，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗","is_gold":false},{"letter":"G","text":"终止诱导化疗直接进入根治性放疗及同期化疗，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗","is_gold":false},{"letter":"H","text":"延迟第2程诱导化疗1周，期间给予护胃及止吐支持，待胃肠道症状完全缓解后再按原剂量化疗","is_gold":false},{"letter":"I","text":"按原剂量执行第2程洛铂+5-FU诱导化疗，取消常规止吐及护胃支持，仅在出现严重呕吐时给予解救治疗","is_gold":false},{"letter":"J","text":"将第2程洛铂+5-FU诱导化疗减量25%，并预防性给予重组人粒细胞集落刺激因子及止吐护胃支持治疗","is_gold":false},{"letter":"K","text":"按原剂量执行第2程洛铂+5-FU诱导化疗，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗","is_gold":true},{"letter":"L","text":"停用静脉化疗，改为口服卡培他滨单药化疗，并给予5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗","is_gold":false}],"gold_letter":"K"},{"sample_id":"sample-cc3b58d3bf4229805e8c7b84","patient_id":"patient-f402aced5926698da3194c37","turn_id":"turn06","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 ST-T轻度改变\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D6] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 28mm AO 29mm MV E 0.51m/s EF 73% LV 49mm IVS 9mm A 0.73m/s FS 42% RA 28mm LVPW 10mm RV 18mm PA 20mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 心脏结构及运动未见异常 各房室腔及大血管未探及异常血流信号 左室舒张功能减低，收缩功能正常\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] 检验组合: 镁离子(Mg2+)-静脉血: 0.89mmol/L；总胆红素(TBIL)-静脉血: 13.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 23.7U/L；丙氨酸氨基转移酶(ALT)-静脉血: 21.4U/L；总钙(Ca)-静脉血: 2.2mmol/L；氯离子(Cl-)-静脉血: 104mmol/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；直接胆红素(DBIL)-静脉血: 5umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6；红细胞比容(Hct)-静脉血: 38.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.358；间接胆红素(IBIL)-静脉血: 8.3umolL；平均红细胞体积(MCV)-静脉血: 87.1fL；载脂蛋白AI(apoAI)-静脉血: 1.11g/L；球蛋白(GLO)-静脉血: 29.01g/L；C-反应蛋白(CRP)-静脉血: 13.69mg/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；白细胞计数(WBC#)-静脉血: 4.8310E9/L；碱性磷酸酶(ALP)-静脉血: 70.4U/L；血小板比容-静脉血: 18%；载脂蛋白B(apoB)-静脉血: 0.67g/L；中性粒细胞百分比(Neut%)-静脉血: 0.566；淋巴细胞计数(Lymph#)-静脉血: 1.710E9/L；钾离子(K+)-静脉血: 4.1mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；乳酸脱氢酶(LDH)-静脉血: 203.5U/L；阴离子间隙(AG)-静脉血: 14；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；甘油三酯(TG)-静脉血: 1.28mmol/L；红细胞计数(RBC#)-静脉血: 4.4310E12/L；血小板分布宽度(PDW)-静脉血: 8.5%；单核细胞百分比(Mono%)-静脉血: 0.058；大血小板百分比(P-LCR%)-静脉血: 11.6%；血液二氧化碳含量ctCO2(B)-静脉血: 25.1mmol/L；白蛋白(ALB)-静脉血: 40.2g/L；尿素氮(BUN)-静脉血: 5.8mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.3U/L；尿酸(UA)-静脉血: 378.8umol/L；总胆固醇(TC)-……\n- [全程D21] 检验组合: 单核细胞百分比(Mono%)-静脉血: 0.062；中性粒细胞百分比(Neut%)-静脉血: 0.67；白细胞计数(WBC#)-静脉血: 5.9710E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.9；平均红细胞血红蛋白含量(MCH)-静脉血: 29.3pg；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 134g/L；红细胞比容(Hct)-静脉血: 41.3%；血小板比容-静脉血: 13%；平均红细胞体积(MCV)-静脉血: 90.4fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；平均血小板体积(MPV)-静脉血: 9.4fL；血小板计数(PLT#)-静脉血: 13810E9/L；中性粒细胞计数(Neut#)-静脉血: 410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 324g/L；血小板分布宽度(PDW)-静脉血: 9.9%；大血小板百分比(P-LCR%)-静脉血: 21.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.255；单核细胞计数(Mono#)-静脉血: 0.410E9/L；红细胞计数(RBC#)-静脉血: 4.5710E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.2\n- [全程D27] 检验组合: 红细胞计数(RBC#)-静脉血: 4.3410E12/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.85mmol/L；血小板计数(PLT#)-静脉血: 255.510E9/L；白细胞计数(WBC#)-静脉血: 6.210E9/L；氯离子(Cl-)-静脉血: 104.9mmol/L；总胆汁酸(TBA)-静脉血: 1umol/L；肌酐(Crea)-静脉血: 96.8umol/L；钾离子(K+)-静脉血: 4.5mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.386；乳酸脱氢酶(LDH)-静脉血: 212.1U/L；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.33mmolL；淋巴细胞计数(Lymph#)-静脉血: 2.410E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21U/L；平均红细胞体积(MCV)-静脉血: 90.1fL；总蛋白(TP)-静脉血: 70.21g/L；丙氨酸氨基转移酶(ALT)-静脉血: 19.6U/L；间接胆红素(IBIL)-静脉血: 4.6umolL；尿酸(UA)-静脉血: 469.1umol/L；血小板比容-静脉血: 15.3%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；甘油三酯(TG)-静脉血: 1.12mmol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白B(apoB)-静脉血: 0.9g/L；平均血小板体积(MPV)-静脉血: 6.02fL；总钙(Ca)-静脉血: 2.25mmol/L；单核细胞百分比(Mono%)-静脉血: 0.066；红细胞比容(Hct)-静脉血: 39.1%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；γ-谷氨酰基转移酶(GGT)-静脉血: 25.5U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.7pg；尿素氮(BUN)-静脉血: 4.22mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341.2g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；中性粒细胞计数(Neut#)-静脉血: 3.310E9/L；有核红细胞计数(NRBC#)-静脉血: 010E……\n- [全程D33] 检验组合: 尿素氮(BUN)-静脉血: 3.5mmol/L；直接胆红素(DBIL)-静脉血: 9umol/L；红细胞计数(RBC#)-静脉血: 3.8710E12/L；球蛋白(GLO)-静脉血: 27.06g/L；总胆红素(TBIL)-静脉血: 28.4umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.08mmolL；钾离子(K+)-静脉血: 3.68mmol/L；钠离子(Na+)-静脉血: 140.7mmol/L；肌酐(Crea)-静脉血: 71.4umol/L；红细胞比容(Hct)-静脉血: 34.5%；血小板比容-静脉血: 13.9%；总胆固醇(TC)-静脉血: 3.79mmol/L；磷(P)-静脉血: 1.21mmol/L；阴离子间隙(AG)-静脉血: 14.8；C-反应蛋白(CRP)-静脉血: 15.32mg/L；有核红细胞百分比(NRBC%)-静脉血: 0；乳酸脱氢酶(LDH)-静脉血: 214.8U/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15.3U/L；间接胆红素(IBIL)-静脉血: 19.4umolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.21mmol/L；白蛋白(ALB)-静脉血: 36.4g/L；总钙(Ca)-静脉血: 2.01mmol/L；载脂蛋白B(apoB)-静脉血: 0.79g/L；中性粒细胞计数(Neut#)-静脉血: 3.210E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.308；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.02；平均红细胞血红蛋白含量(MCH)-静脉血: 30.6pg；载脂蛋白AI(apoAI)-静脉血: 1.04g/L；尿酸(UA)-静脉血: 290.1umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.35；平均红细胞体积(MCV)-静脉血: 89.1fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；碱性磷酸酶(ALP)-静脉血: 60.5U/L；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；血小板计数(PLT#)-静脉血: 230.610E9/L；γ-谷氨酰基转移酶(GGT)-静……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+洛铂方案诱导化疗结束，诉呕吐1次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程5-FU+洛铂方案诱导化疗结束，无诉特殊不适，可予出院，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D28] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，可于今日执行第2程5-FU+洛铂方案诱导化疗，注意化疗不良反应。\n- [全程D29] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+洛铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 予以静脉输注红细胞悬液，并常规监测血常规、生化常规\nB. 予以重组人促红素（EPO）皮下注射，并常规监测血常规、生化常规\nC. 予以静脉滴注蔗糖铁注射液，并常规监测血常规、生化常规\nD. 暂不予特殊药物支持治疗，仅常规监测血常规、生化常规\nE. 予以粒细胞集落刺激因子（G-CSF）皮下注射，并常规监测血常规、生化常规\nF. 予以重组人血小板生成素（rhTPO）皮下注射，并常规监测血常规、生化常规\nG. 予以静脉滴注人血白蛋白，并常规监测血常规、生化常规\nH. 予以口服叶酸及维生素B12片，并常规监测血常规、生化常规\nI. 予以口服利血生及鲨肝醇片，并常规监测血常规、生化常规\nJ. 予以静脉滴注右旋糖酐铁注射液，并常规监测血常规、生化常规\nK. 予以静脉滴注地塞米松及托烷司琼，并常规监测血常规、生化常规\nL. 予以口服多糖铁复合物胶囊，并常规监测血常规、生化常规\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"予以静脉输注红细胞悬液，并常规监测血常规、生化常规","is_gold":false},{"letter":"B","text":"予以重组人促红素（EPO）皮下注射，并常规监测血常规、生化常规","is_gold":false},{"letter":"C","text":"予以静脉滴注蔗糖铁注射液，并常规监测血常规、生化常规","is_gold":false},{"letter":"D","text":"暂不予特殊药物支持治疗，仅常规监测血常规、生化常规","is_gold":true},{"letter":"E","text":"予以粒细胞集落刺激因子（G-CSF）皮下注射，并常规监测血常规、生化常规","is_gold":false},{"letter":"F","text":"予以重组人血小板生成素（rhTPO）皮下注射，并常规监测血常规、生化常规","is_gold":false},{"letter":"G","text":"予以静脉滴注人血白蛋白，并常规监测血常规、生化常规","is_gold":false},{"letter":"H","text":"予以口服叶酸及维生素B12片，并常规监测血常规、生化常规","is_gold":false},{"letter":"I","text":"予以口服利血生及鲨肝醇片，并常规监测血常规、生化常规","is_gold":false},{"letter":"J","text":"予以静脉滴注右旋糖酐铁注射液，并常规监测血常规、生化常规","is_gold":false},{"letter":"K","text":"予以静脉滴注地塞米松及托烷司琼，并常规监测血常规、生化常规","is_gold":false},{"letter":"L","text":"予以口服多糖铁复合物胶囊，并常规监测血常规、生化常规","is_gold":false}],"gold_letter":"D"},{"sample_id":"sample-80438584d0b66a199c599a7d","patient_id":"patient-f402aced5926698da3194c37","turn_id":"turn07","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 ST-T轻度改变\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] 检验组合: 镁离子(Mg2+)-静脉血: 0.89mmol/L；总胆红素(TBIL)-静脉血: 13.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 23.7U/L；丙氨酸氨基转移酶(ALT)-静脉血: 21.4U/L；总钙(Ca)-静脉血: 2.2mmol/L；氯离子(Cl-)-静脉血: 104mmol/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；直接胆红素(DBIL)-静脉血: 5umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6；红细胞比容(Hct)-静脉血: 38.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.358；间接胆红素(IBIL)-静脉血: 8.3umolL；平均红细胞体积(MCV)-静脉血: 87.1fL；载脂蛋白AI(apoAI)-静脉血: 1.11g/L；球蛋白(GLO)-静脉血: 29.01g/L；C-反应蛋白(CRP)-静脉血: 13.69mg/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；白细胞计数(WBC#)-静脉血: 4.8310E9/L；碱性磷酸酶(ALP)-静脉血: 70.4U/L；血小板比容-静脉血: 18%；载脂蛋白B(apoB)-静脉血: 0.67g/L；中性粒细胞百分比(Neut%)-静脉血: 0.566；淋巴细胞计数(Lymph#)-静脉血: 1.710E9/L；钾离子(K+)-静脉血: 4.1mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；乳酸脱氢酶(LDH)-静脉血: 203.5U/L；阴离子间隙(AG)-静脉血: 14；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；甘油三酯(TG)-静脉血: 1.28mmol/L；红细胞计数(RBC#)-静脉血: 4.4310E12/L；血小板分布宽度(PDW)-静脉血: 8.5%；单核细胞百分比(Mono%)-静脉血: 0.058；大血小板百分比(P-LCR%)-静脉血: 11.6%；血液二氧化碳含量ctCO2(B)-静脉血: 25.1mmol/L；白蛋白(ALB)-静脉血: 40.2g/L；尿素氮(BUN)-静脉血: 5.8mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.3U/L；尿酸(UA)-静脉血: 378.8umol/L；总胆固醇(TC)-……\n- [全程D21] 检验组合: 单核细胞百分比(Mono%)-静脉血: 0.062；中性粒细胞百分比(Neut%)-静脉血: 0.67；白细胞计数(WBC#)-静脉血: 5.9710E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.9；平均红细胞血红蛋白含量(MCH)-静脉血: 29.3pg；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 134g/L；红细胞比容(Hct)-静脉血: 41.3%；血小板比容-静脉血: 13%；平均红细胞体积(MCV)-静脉血: 90.4fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；平均血小板体积(MPV)-静脉血: 9.4fL；血小板计数(PLT#)-静脉血: 13810E9/L；中性粒细胞计数(Neut#)-静脉血: 410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 324g/L；血小板分布宽度(PDW)-静脉血: 9.9%；大血小板百分比(P-LCR%)-静脉血: 21.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.255；单核细胞计数(Mono#)-静脉血: 0.410E9/L；红细胞计数(RBC#)-静脉血: 4.5710E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.2\n- [全程D27] 检验组合: 红细胞计数(RBC#)-静脉血: 4.3410E12/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.85mmol/L；血小板计数(PLT#)-静脉血: 255.510E9/L；白细胞计数(WBC#)-静脉血: 6.210E9/L；氯离子(Cl-)-静脉血: 104.9mmol/L；总胆汁酸(TBA)-静脉血: 1umol/L；肌酐(Crea)-静脉血: 96.8umol/L；钾离子(K+)-静脉血: 4.5mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.386；乳酸脱氢酶(LDH)-静脉血: 212.1U/L；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.33mmolL；淋巴细胞计数(Lymph#)-静脉血: 2.410E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21U/L；平均红细胞体积(MCV)-静脉血: 90.1fL；总蛋白(TP)-静脉血: 70.21g/L；丙氨酸氨基转移酶(ALT)-静脉血: 19.6U/L；间接胆红素(IBIL)-静脉血: 4.6umolL；尿酸(UA)-静脉血: 469.1umol/L；血小板比容-静脉血: 15.3%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；甘油三酯(TG)-静脉血: 1.12mmol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白B(apoB)-静脉血: 0.9g/L；平均血小板体积(MPV)-静脉血: 6.02fL；总钙(Ca)-静脉血: 2.25mmol/L；单核细胞百分比(Mono%)-静脉血: 0.066；红细胞比容(Hct)-静脉血: 39.1%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；γ-谷氨酰基转移酶(GGT)-静脉血: 25.5U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.7pg；尿素氮(BUN)-静脉血: 4.22mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341.2g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；中性粒细胞计数(Neut#)-静脉血: 3.310E9/L；有核红细胞计数(NRBC#)-静脉血: 010E……\n- [全程D33] 检验组合: 尿素氮(BUN)-静脉血: 3.5mmol/L；直接胆红素(DBIL)-静脉血: 9umol/L；红细胞计数(RBC#)-静脉血: 3.8710E12/L；球蛋白(GLO)-静脉血: 27.06g/L；总胆红素(TBIL)-静脉血: 28.4umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.08mmolL；钾离子(K+)-静脉血: 3.68mmol/L；钠离子(Na+)-静脉血: 140.7mmol/L；肌酐(Crea)-静脉血: 71.4umol/L；红细胞比容(Hct)-静脉血: 34.5%；血小板比容-静脉血: 13.9%；总胆固醇(TC)-静脉血: 3.79mmol/L；磷(P)-静脉血: 1.21mmol/L；阴离子间隙(AG)-静脉血: 14.8；C-反应蛋白(CRP)-静脉血: 15.32mg/L；有核红细胞百分比(NRBC%)-静脉血: 0；乳酸脱氢酶(LDH)-静脉血: 214.8U/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15.3U/L；间接胆红素(IBIL)-静脉血: 19.4umolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.21mmol/L；白蛋白(ALB)-静脉血: 36.4g/L；总钙(Ca)-静脉血: 2.01mmol/L；载脂蛋白B(apoB)-静脉血: 0.79g/L；中性粒细胞计数(Neut#)-静脉血: 3.210E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.308；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.02；平均红细胞血红蛋白含量(MCH)-静脉血: 30.6pg；载脂蛋白AI(apoAI)-静脉血: 1.04g/L；尿酸(UA)-静脉血: 290.1umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.35；平均红细胞体积(MCV)-静脉血: 89.1fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；碱性磷酸酶(ALP)-静脉血: 60.5U/L；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；血小板计数(PLT#)-静脉血: 230.610E9/L；γ-谷氨酰基转移酶(GGT)-静……\n- [全程D36] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后，与某次就诊时间片对比， 鼻咽腔狭窄，鼻咽左侧壁、顶壁及后壁增厚，见软组织灶形成，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，病灶占据左侧咽隐窝，向前堵塞左侧后鼻孔，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，右侧咽隐窝稍变浅，范围较前缩小，右侧咽旁脂肪间隙及颈动脉鞘区未见异常。 左侧腭帆提肌、双侧头长肌受侵。 双侧翼腭窝、咀嚼肌间隙未见明显异常；口咽各壁无受累增厚。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部骨质破坏。双侧海绵窦形态正常，未见增宽。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。蝶鞍形态正常，其内未见占位性病变。 双侧上颌窦、蝶窦、筛窦、左侧乳突粘膜增厚，见不等量分泌物，右侧乳突气化好，骨壁完整。 左侧咽后间隙见小淋巴结，短径约4mm，较前未见明显变化。 双颈II区见肿大淋巴结，较大者短径约22mm，较前稍缩小。 左颈III、V区见多发小淋巴结，边界清，信号均匀，较大者短径约7mm，较前未见明显变化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。 喉咽腔形态正常，未见占位性病变。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗后，鼻咽肿物较前缩小。 颅底骨质破坏。 左侧咽后小淋巴结，较前未见明显变化。 双颈II区淋巴结肿大，较前稍缩小。 左颈III、V区多发小淋巴结，较前未见明显变化。 副鼻窦炎、左侧乳突炎。\n\n【既往治疗与反应】\n- [全程D13] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程5-FU+洛铂方案诱导化疗结束，诉呕吐1次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程5-FU+洛铂方案诱导化疗结束，无诉特殊不适，可予出院，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D28] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，可于今日执行第2程5-FU+洛铂方案诱导化疗，注意化疗不良反应。\n- [全程D29] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+洛铂方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D34] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程5-FU+洛铂方案诱导化疗结束，诉恶心、食欲下降，无发热、呕吐、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规示轻度贫血，肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第2程5-FU+洛铂方案诱导化疗结束，无诉特殊不适，血象提示轻度贫血，予铁剂口服等纠正贫血治疗，下周及时监测血常规、肝肾功能，备行同时期放化疗+靶向治疗。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 疗效评估为部分缓解（PR），启动靶向治疗（西妥昔单抗）联合同期放化疗\nB. 疗效评估为部分缓解（PR），启动靶向治疗（尼妥珠单抗）联合同期放化疗\nC. 疗效评估为部分缓解（PR），继续原方案（洛铂+5-FU）第3程诱导化疗\nD. 疗效评估为部分缓解（PR），启动同期放化疗，暂不联合靶向治疗\nE. 疗效评估为疾病稳定（SD），启动免疫治疗（卡瑞利珠单抗）联合同期放化疗\nF. 疗效评估为疾病进展（PD），更改化疗方案为吉西他滨+顺铂诱导化疗\nG. 疗效评估为部分缓解（PR），行鼻咽及颈部根治性放疗，不联合全身治疗\nH. 疗效评估为部分缓解（PR），暂停抗肿瘤治疗，单纯行纠正贫血支持治疗\nI. 疗效评估为部分缓解（PR），行双侧颈部淋巴结清扫术，术后辅助放疗\nJ. 疗效评估为完全缓解（CR），启动靶向治疗（西妥昔单抗）联合同期放化疗\nK. 疗效评估为部分缓解（PR），启动靶向治疗（贝伐珠单抗）联合同期放化疗\nL. 疗效评估为部分缓解（PR），启动免疫治疗（帕博利珠单抗）联合同期放化疗\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"疗效评估为部分缓解（PR），启动靶向治疗（西妥昔单抗）联合同期放化疗","is_gold":true},{"letter":"B","text":"疗效评估为部分缓解（PR），启动靶向治疗（尼妥珠单抗）联合同期放化疗","is_gold":false},{"letter":"C","text":"疗效评估为部分缓解（PR），继续原方案（洛铂+5-FU）第3程诱导化疗","is_gold":false},{"letter":"D","text":"疗效评估为部分缓解（PR），启动同期放化疗，暂不联合靶向治疗","is_gold":false},{"letter":"E","text":"疗效评估为疾病稳定（SD），启动免疫治疗（卡瑞利珠单抗）联合同期放化疗","is_gold":false},{"letter":"F","text":"疗效评估为疾病进展（PD），更改化疗方案为吉西他滨+顺铂诱导化疗","is_gold":false},{"letter":"G","text":"疗效评估为部分缓解（PR），行鼻咽及颈部根治性放疗，不联合全身治疗","is_gold":false},{"letter":"H","text":"疗效评估为部分缓解（PR），暂停抗肿瘤治疗，单纯行纠正贫血支持治疗","is_gold":false},{"letter":"I","text":"疗效评估为部分缓解（PR），行双侧颈部淋巴结清扫术，术后辅助放疗","is_gold":false},{"letter":"J","text":"疗效评估为完全缓解（CR），启动靶向治疗（西妥昔单抗）联合同期放化疗","is_gold":false},{"letter":"K","text":"疗效评估为部分缓解（PR），启动靶向治疗（贝伐珠单抗）联合同期放化疗","is_gold":false},{"letter":"L","text":"疗效评估为部分缓解（PR），启动免疫治疗（帕博利珠单抗）联合同期放化疗","is_gold":false}],"gold_letter":"A"},{"sample_id":"sample-8b39359cc6c7b630fd005591","patient_id":"patient-f402aced5926698da3194c37","turn_id":"turn08","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 ST-T轻度改变\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D58] 检验组合: 红细胞比容(Hct)-静脉血: 34.3%；载脂蛋白B(apoB)-静脉血: 0.73g/L；碱性磷酸酶(ALP)-静脉血: 76U/L；肌酐(Crea)-静脉血: 67.8umol/L；胱抑素(Cys-C)-静脉血: 0.64mg/L；中性粒细胞百分比(Neut%)-静脉血: 0.768；血红蛋白(Hb)-静脉血: 116g/L；平均血小板体积(MPV)-静脉血: 8.4fL；总胆红素(TBIL)-静脉血: 15.8umol/L；尿素氮(BUN)-静脉血: 3.79mmol/L；镁离子(Mg2+)-静脉血: 0.9mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 22.5U/L；钾离子(K+)-静脉血: 3.6mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 16U/L；直接胆红素(DBIL)-静脉血: 6.5umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.5mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.5；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.7；白蛋白(ALB)-静脉血: 35.4g/L；钠离子(Na+)-静脉血: 138.1mmol/L；总钙(Ca)-静脉血: 2.12mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.08mmolL；磷(P)-静脉血: 1.18mmol/L；C-反应蛋白(CRP)-静脉血: 30.45mg/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.005；总胆汁酸(TBA)-静脉血: 1.6umol/L；乳酸脱氢酶(LDH)-静脉血: 175.3U/L；甘油三酯(TG)-静脉血: 0.98mmol/L；红细胞计数(RBC#)-静脉血: 3.8810E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血小板比容-静脉血: 13%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.28mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.04g/L；间接胆红素(IBIL)-静脉血: 9.3umolL；平均红细胞血红蛋白含量(MCH)-静脉血: 29.9pg；氯离子(Cl-)-静脉血: 102.7mmol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L……\n- [全程D65] 检验组合: 钾离子(K+)-静脉血: 3.65mmol/L；总胆固醇(TC)-静脉血: 3.47mmol/L；阴离子间隙(AG)-静脉血: 9.1；磷(P)-静脉血: 1.16mmol/L；间接胆红素(IBIL)-静脉血: 7.2umolL；总蛋白(TP)-静脉血: 66.88g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 14.2U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.07mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；红细胞比容(Hct)-静脉血: 35.8%；淋巴细胞百分比(Lymph%)-静脉血: 0.077；红细胞体积分布宽度CV(RDW-CV)-静脉血: 15.7%；丙氨酸氨基转移酶(ALT)-静脉血: 15.7U/L；钠离子(Na+)-静脉血: 141.1mmol/L；乳酸脱氢酶(LDH)-静脉血: 147.8U/L；C-反应蛋白(CRP)-静脉血: 23.42mg/L；甘油三酯(TG)-静脉血: 1.16mmol/L；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；血小板分布宽度(PDW)-静脉血: 17.3%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；肌酐(Crea)-静脉血: 62.8umol/L；镁离子(Mg2+)-静脉血: 0.8mmol/L；总胆红素(TBIL)-静脉血: 12.5umol/L；淋巴细胞计数(Lymph#)-静脉血: 0.410E9/L；直接胆红素(DBIL)-静脉血: 5.3umol/L；球蛋白(GLO)-静脉血: 30.38g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；尿素氮(BUN)-静脉血: 3.1mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 35.9U/L；载脂蛋白AI(apoAI)-静脉血: 0.9g/L；白蛋白(ALB)-静脉血: 36.5g/L；血红蛋白(Hb)-静脉血: 118.5g/L；载脂蛋白B(apoB)-静脉血: 0.74g/L；白细胞计数(WBC#)-静脉血: 4.5110E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 18.3U/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血……\n- [全程D72] 检验组合: 磷(P)-静脉血: 1.31mmol/L；总钙(Ca)-静脉血: 2.11mmol/L；总胆红素(TBIL)-静脉血: 12umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.745；镁离子(Mg2+)-静脉血: 0.8mmol/L；总蛋白(TP)-静脉血: 65.97g/L；单核细胞百分比(Mono%)-静脉血: 0.132；血小板计数(PLT#)-静脉血: 17910E9/L；球蛋白(GLO)-静脉血: 33.37g/L；尿素氮(BUN)-静脉血: 3.82mmol/L；尿酸(UA)-静脉血: 232.9umol/L；间接胆红素(IBIL)-静脉血: 6.9umolL；中性粒细胞计数(Neut#)-静脉血: 2.510E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.9；氯离子(Cl-)-静脉血: 105mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.6；血小板比容-静脉血: 15%；平均红细胞血红蛋白含量(MCH)-静脉血: 29.2pg；总胆固醇(TC)-静脉血: 3.73mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；载脂蛋白AI(apoAI)-静脉血: 0.88g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 36.1U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.026；胱抑素(Cys-C)-静脉血: 0.62mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.91mmolL；乳酸脱氢酶(LDH)-静脉血: 137U/L；肌酐(Crea)-静脉血: 68.5umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 87.7fL；血小板分布宽度(PDW)-静脉血: 7.4%；白蛋白(ALB)-静脉血: 32.6g/L；甘油三酯(TG)-静脉血: 0.96mmol/L；大血小板百分比(P-LCR%)-静脉血: 11.2%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15.9U/L；丙氨酸氨基转移酶(ALT)-静脉血: 17.3U/L；钠离子(Na+)-静脉血: 141.2mmol……\n- [全程D75] 检验组合: 白细胞计数(WBC#)-静脉血: 3.3210E9/L；血小板分布宽度(PDW)-静脉血: 7.9%；钾离子(K+)-静脉血: 3.4mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 18.6U/L；C-反应蛋白(CRP)-静脉血: 56.54mg/L；红细胞比容(Hct)-静脉血: 33.5%；单核细胞百分比(Mono%)-静脉血: 0.117；肌酐(Crea)-静脉血: 63.4umol/L；尿酸(UA)-静脉血: 304umol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；血小板比容-静脉血: 18%；α-L-岩藻糖苷酶(AFU)-静脉血: 22U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.72mmol/L；血小板计数(PLT#)-静脉血: 21110E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.9；中性粒细胞百分比(Neut%)-静脉血: 0.772；淋巴细胞百分比(Lymph%)-静脉血: 0.072；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；总钙(Ca)-静脉血: 2.12mmol/L；药物曲线下面积(AUC)-静脉血: 1；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；总胆固醇(TC)-静脉血: 4.15mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.88mmolL；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 16.7U/L；白蛋白(ALB)-静脉血: 33g/L；平均血小板体积(MPV)-静脉血: 8.3fL；总胆红素(TBIL)-静脉血: 13.6umol/L；磷(P)-静脉血: 1.15mmol/L；球蛋白(GLO)-静脉血: 33.66g/L；阴离子间隙(AG)-静脉血: 14；葡萄糖(Glu)-静脉血: 5.63mmol/L；载脂蛋白AI(apoAI)-静脉血: 0.81g/L；总胆汁酸(TBA)-静脉血: 1.4umol/L；间接胆红素(IBIL)-静脉血: 7.9umolL；尿素氮(BUN)-静脉血: 5.04mmol/L；胱抑素(Cys-C)-静脉血: 0.65mg/L；红细胞计数(RBC#)-静脉血: 3.8110E12/L；红细胞体积分布宽度……\n- [全程D86] 检验组合: 总胆汁酸(TBA)-静脉血: 1.6umol/L；直接胆红素(DBIL)-静脉血: 2.4umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 16U/L；C-反应蛋白(CRP)-静脉血: 15.4mg/L；淋巴细胞百分比(Lymph%)-静脉血: 0.142；总钙(Ca)-静脉血: 2.08mmol/L；阴离子间隙(AG)-静脉血: 10；丙氨酸氨基转移酶(ALT)-静脉血: 27.7U/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；白蛋白(ALB)-静脉血: 30.3g/L；钾离子(K+)-静脉血: 3.2mmol/L；葡萄糖(Glu)-静脉血: 5.56mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.27mmol/L；总胆固醇(TC)-静脉血: 3.75mmol/L；平均红细胞体积(MCV)-静脉血: 89.4fL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.83mmolL；肌酐(Crea)-静脉血: 72.9umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 53U/L；尿酸(UA)-静脉血: 338.6umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.9mmol/L；白细胞计数(WBC#)-静脉血: 2.610E9/L；钠离子(Na+)-静脉血: 140.5mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.4pg；单核细胞百分比(Mono%)-静脉血: 0.281；大血小板百分比(P-LCR%)-静脉血: 12.6%；载脂蛋白B(apoB)-静脉血: 0.76g/L；载脂蛋白AI(apoAI)-静脉血: 0.84g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.6U/L；间接胆红素(IBIL)-静脉血: 3umolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.7；甘油三酯(TG)-静脉血: 1.42mmol/L；磷(P)-静脉血: 1.4mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.8；碱性磷酸酶(ALP)-静脉血: 70.5U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；尿素氮……\n- [全程D88] 检验组合: 血红蛋白(Hb)-静脉血: 118g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.26；平均血小板体积(MPV)-静脉血: 8.5fL；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；红细胞比容(Hct)-静脉血: 35.8%；血小板比容-静脉血: 14%；血小板分布宽度(PDW)-静脉血: 7.6%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.7；平均红细胞体积(MCV)-静脉血: 90.4fL；血小板计数(PLT#)-静脉血: 16910E9/L；红细胞计数(RBC#)-静脉血: 3.9610E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.028；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；单核细胞百分比(Mono%)-静脉血: 0.097；大血小板百分比(P-LCR%)-静脉血: 14.3%；白细胞计数(WBC#)-静脉血: 2.8810E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.8pg；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.5；中性粒细胞计数(Neut#)-静脉血: 1.810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.612\n- [全程D93] 检验组合: 低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.82mmol/L；白蛋白(ALB)-静脉血: 37.8g/L；总胆红素(TBIL)-静脉血: 9.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 39.6U/L；胱抑素(Cys-C)-静脉血: 0.78mg/L；淋巴细胞百分比(Lymph%)-静脉血: 0.15；天门冬氨酸氨基转移酶(AST)-静脉血: 21.3U/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；尿酸(UA)-静脉血: 295.9umol/L；血小板比容-静脉血: 12.1%；中性粒细胞计数(Neut#)-静脉血: 2.410E9/L；氯离子(Cl-)-静脉血: 102mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.7mmol/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；阴离子间隙(AG)-静脉血: 13.1；钠离子(Na+)-静脉血: 142.8mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 16.1%；血小板分布宽度(PDW)-静脉血: 15.9%；红细胞比容(Hct)-静脉血: 36.4%；磷(P)-静脉血: 1.26mmol/L；直接胆红素(DBIL)-静脉血: 3.4umol/L；总蛋白(TP)-静脉血: 70.94g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；葡萄糖(Glu)-静脉血: 6.22mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.019；间接胆红素(IBIL)-静脉血: 5.9umolL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；载脂蛋白B(apoB)-静脉血: 0.94g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.11mmolL；总胆固醇(TC)-静脉血: 4.28mmol/L；碱性磷酸酶(ALP)-静脉血: 88.1U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.5pg；血小板计数(PLT#)-静脉血: 215.910E9/L；钾离子(K+)-静脉血: 3.96mmol/L；单核细胞百分比(Mono%)-静脉血: 0.146；平均血小板体积(MPV)-静脉血: 5.62fL；有核红细胞百分比(NRBC%)-静脉血:……\n- [全程D94] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约28cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，右肾实质回声均匀，未见明显异常回声。左肾下盏可见一强回声团，直径约6mm，边界清。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约28×25×25mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 左肾结石。 肝脏、胆囊、脾脏、胰腺、右肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n\n【既往治疗与反应】\n- [全程D64] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者放疗中，第4程爱必妥靶向治疗后3天，诉口感、咽痛、纳差。查体同前。[姓名已隐去]医生信息已隐藏：予喷喉、洗鼻、保护皮肤处理，加强营养，继续放疗。\n- [全程D69] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者放疗中，今日第5程爱必妥靶向治疗，诉头面部皮疹，口感、咽痛，余无明显不适。查体：头面部散在红疹，无脱皮、水泡，余同前。[姓名已隐去]医生信息已隐藏：予红外线治疗，喷喉、洗鼻、保护皮肤处理，加强营养，继续放疗。\n- [全程D74] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者放疗中，第2程洛铂方案同时期化疗结束，诉恶心、食欲下降，呕吐1次，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。复查血常规示轻度贫血，肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第2程洛铂方案同时期化疗结束，诉恶心、呕吐，予止呕护胃处理，继续放疗。\n- [全程D78] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者2月18日至2月26日春节请假中。\n- [全程D88] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者放疗中，第6程爱必妥靶向治疗结束，诉头面部皮疹，口感、咽痛，余无明显不适。查体：头面部散在红疹，无脱皮、水泡，余同前。复查血常规、生化插管基本正常。[姓名已隐去]医生信息已隐藏：予喷喉、洗鼻、保护皮肤处理，加强营养，今日可办理出院，继续门诊放疗，按时间行复查。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 确认腹部彩超无转移，暂停放疗，请泌尿外科会诊行左肾结石碎石治疗，并予乳果糖口服液。\nB. 确认腹部彩超无转移，继续门诊放疗，左肾结石暂予观察，并予乳果糖口服液。\nC. 确认腹部彩超无转移，继续门诊放疗，左肾结石暂予观察，并加用洛铂行第3程同期化疗。\nD. 确认腹部彩超无转移，暂停门诊放疗，复查鼻咽及颈部MRI评估局部疗效，并予乳果糖口服液。\nE. 确认腹部彩超无转移，继续门诊放疗，对左肾结石予排石颗粒，并加用西妥昔单抗靶向治疗。\nF. 确认腹部彩超无转移，终止放疗，左肾结石暂予观察，转入康复科行便秘治疗。\nG. 确认腹部彩超无转移，继续门诊放疗，对左肾结石予留置双J管，并予乳果糖口服液。\nH. 确认腹部彩超无转移，暂停门诊放疗，予温肥皂水灌肠处理便秘，左肾结石暂予观察。\nI. 确认腹部彩超无转移，继续门诊放疗，左肾结石暂予观察，并予洛哌丁胺口服。\nJ. 确认腹部彩超无转移，继续门诊放疗，左肾结石暂予观察，并予开塞露联合新斯的明肌注。\nK. 确认腹部彩超无转移，暂停门诊放疗，行全身PET-CT评估疗效，左肾结石暂予观察。\nL. 确认腹部彩超无转移，继续门诊放疗，行体外冲击波碎石，处理左肾结石，并予乳果糖口服液。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"确认腹部彩超无转移，暂停放疗，请泌尿外科会诊行左肾结石碎石治疗，并予乳果糖口服液。","is_gold":false},{"letter":"B","text":"确认腹部彩超无转移，继续门诊放疗，左肾结石暂予观察，并予乳果糖口服液。","is_gold":true},{"letter":"C","text":"确认腹部彩超无转移，继续门诊放疗，左肾结石暂予观察，并加用洛铂行第3程同期化疗。","is_gold":false},{"letter":"D","text":"确认腹部彩超无转移，暂停门诊放疗，复查鼻咽及颈部MRI评估局部疗效，并予乳果糖口服液。","is_gold":false},{"letter":"E","text":"确认腹部彩超无转移，继续门诊放疗，对左肾结石予排石颗粒，并加用西妥昔单抗靶向治疗。","is_gold":false},{"letter":"F","text":"确认腹部彩超无转移，终止放疗，左肾结石暂予观察，转入康复科行便秘治疗。","is_gold":false},{"letter":"G","text":"确认腹部彩超无转移，继续门诊放疗，对左肾结石予留置双J管，并予乳果糖口服液。","is_gold":false},{"letter":"H","text":"确认腹部彩超无转移，暂停门诊放疗，予温肥皂水灌肠处理便秘，左肾结石暂予观察。","is_gold":false},{"letter":"I","text":"确认腹部彩超无转移，继续门诊放疗，左肾结石暂予观察，并予洛哌丁胺口服。","is_gold":false},{"letter":"J","text":"确认腹部彩超无转移，继续门诊放疗，左肾结石暂予观察，并予开塞露联合新斯的明肌注。","is_gold":false},{"letter":"K","text":"确认腹部彩超无转移，暂停门诊放疗，行全身PET-CT评估疗效，左肾结石暂予观察。","is_gold":false},{"letter":"L","text":"确认腹部彩超无转移，继续门诊放疗，行体外冲击波碎石，处理左肾结石，并予乳果糖口服液。","is_gold":false}],"gold_letter":"B"}]}
+{"patient_id":"patient-51e6f99c527367bbd97aebd8","bootstrap_cluster_id":"cluster-003","turns":[{"sample_id":"sample-9e8ddeeab49a15f0eb3930d7","patient_id":"patient-51e6f99c527367bbd97aebd8","turn_id":"turn01","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：鼻腔。\n文本分期信息：N0，M0。\n综合TNM状态：T1N0M0。\n综合分期：IA。\n\n【已知病史与当前主诉】\n- [全程D6] 入院记录: 主诉: 涕血2月；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血；既往史: “胃溃疡”病史22年，于某次就诊时间、某次就诊时间发生2次“胃出血”，经“输血”、“药物”治疗后好转，具体不详。某次就诊时间发现“胃底息肉”，行“内镜下胃底息肉切除术”。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：114/69mmHg,Ht：157cm，Wt：53kg，BSA：1.52m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽左侧壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 完善鼻咽及颈部CT平扫+增强、胸腹部CT平扫+增强、全身骨扫描，并进行病理会诊或鼻咽活检。\nB. 完善鼻咽MRI平扫+增强、胸腹部CT平扫+增强、全身骨扫描，暂缓病理检查。\nC. 完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像，并进行病理会诊或鼻咽活检及心电图等基线检查。\nD. 完善鼻咽及颈部MRI平扫、PET/CT全身显像，并进行病理会诊或鼻咽活检。\nE. 完善鼻咽及颈部MRI平扫+增强、头颅MRI平扫+增强，直接安排放疗定位。\nF. 完善鼻咽及颈部CT平扫、PET/CT全身显像，并进行鼻咽肿物切除活检。\nG. 完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像，并进行颈部淋巴结穿刺活检。\nH. 完善鼻咽及颈部MRI平扫+增强、胸部X线、腹部超声，并进行病理会诊或鼻咽活检。\nI. 完善鼻咽及颈部MRI平扫+增强、全身骨扫描，并进行病理会诊或鼻咽活检。\nJ. 完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像，直接开始诱导化疗。\nK. 完善鼻咽及颈部MRI平扫+增强、胸腹部CT平扫+增强、全身骨扫描，并进行鼻内镜下鼻咽肿物扩大切除术。\n\n请仅输出一个选项字母（A-K）。","options":[{"letter":"A","text":"完善鼻咽及颈部CT平扫+增强、胸腹部CT平扫+增强、全身骨扫描，并进行病理会诊或鼻咽活检。","is_gold":false},{"letter":"B","text":"完善鼻咽MRI平扫+增强、胸腹部CT平扫+增强、全身骨扫描，暂缓病理检查。","is_gold":false},{"letter":"C","text":"完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像，并进行病理会诊或鼻咽活检及心电图等基线检查。","is_gold":true},{"letter":"D","text":"完善鼻咽及颈部MRI平扫、PET/CT全身显像，并进行病理会诊或鼻咽活检。","is_gold":false},{"letter":"E","text":"完善鼻咽及颈部MRI平扫+增强、头颅MRI平扫+增强，直接安排放疗定位。","is_gold":false},{"letter":"F","text":"完善鼻咽及颈部CT平扫、PET/CT全身显像，并进行鼻咽肿物切除活检。","is_gold":false},{"letter":"G","text":"完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像，并进行颈部淋巴结穿刺活检。","is_gold":false},{"letter":"H","text":"完善鼻咽及颈部MRI平扫+增强、胸部X线、腹部超声，并进行病理会诊或鼻咽活检。","is_gold":false},{"letter":"I","text":"完善鼻咽及颈部MRI平扫+增强、全身骨扫描，并进行病理会诊或鼻咽活检。","is_gold":false},{"letter":"J","text":"完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像，直接开始诱导化疗。","is_gold":false},{"letter":"K","text":"完善鼻咽及颈部MRI平扫+增强、胸腹部CT平扫+增强、全身骨扫描，并进行鼻内镜下鼻咽肿物扩大切除术。","is_gold":false}],"gold_letter":"C"},{"sample_id":"sample-78b27b455a910a93bd013384","patient_id":"patient-51e6f99c527367bbd97aebd8","turn_id":"turn02","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：鼻腔。\n文本分期信息：N0，M0。\n综合TNM状态：T1N0M0。\n综合分期：IA。\n\n【已知病史与当前主诉】\n- [全程D6] 入院记录: 主诉: 涕血2月；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血；既往史: “胃溃疡”病史22年，于某次就诊时间、某次就诊时间发生2次“胃出血”，经“输血”、“药物”治疗后好转，具体不详。某次就诊时间发现“胃底息肉”，行“内镜下胃底息肉切除术”。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：114/69mmHg,Ht：157cm，Wt：53kg，BSA：1.52m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽左侧壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D7] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- [全程D7] 检验组合: 平均红细胞体积(MCV)-静脉血: 91.1fL；总钙(Ca)-静脉血: 2.21mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24.2U/L；碱性磷酸酶(ALP)-静脉血: 74.3U/L；IV型胶原(C-IV)-静脉血: 12.97ng/ml；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 35.9U/L；钾离子(K+)-静脉血: 3.76mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；D-二聚体(D-Dimer)-静脉血: 0.07ug/ml；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；淀粉样蛋白A(SAA)-静脉血: 2.44mg/L；C-反应蛋白(CRP)-静脉血: 1.92mg/L；凝血酶原时间活动度(PTA)-静脉血: 120%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.67；载脂蛋白B(apoB)-静脉血: 1.07g/L；球蛋白(GLO)-静脉血: 26.18g/L；磷(P)-静脉血: 1.03mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；胱抑素(Cys-C)-静脉血: 0.79mg/L；红细胞计数(RBC#)-静脉血: 5.2710E12/L；单核细胞计数(Mono#)-静脉血: 110E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.6sec.；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.87；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 0.411ng/ml（参考: <0.584）；尿素氮(BUN)-静脉血: 4.7mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；血小板计数(PLT#)-静脉血: 21810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.578；凝血酶原时间(PT)-静脉血: 10.1sec.；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.05mmol/L；尿酸(UA)-静脉血: 331.5umol/L；阴离子间隙(AG)-静脉血: 15.7；层粘……\n- [全程D10] 内镜；胃镜: 检查类型: 内镜；检查名称: 胃镜；检查部位:；检查所见: 插镜情况：顺利 送达部位：十二指肠降部。 食 管：粘膜光滑, 舒缩好。 贲 门：开闭好, E-G线清楚。 胃 底：粘液湖清亮，粘膜光滑，无静脉曲张。 胃 体：花斑样充血，未见溃疡肿物。 胃 角：弧形， 光滑。 胃 窦：蠕动好，粘膜呈花斑样充血，未见溃疡肿物。 幽 门：圆， 开闭好。 球 部：球腔变形，后壁可见霜斑样溃疡，表面附着白苔。 降 部：十二指肠乳头及降部粘膜未见异常。 请4个工作日后到病理科（5楼）取活检结果。；检查结论: 十二指肠球部霜斑样溃疡 慢性浅表性胃炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 明确鼻咽癌临床分期为 cT2N0M0，II期（肿瘤累及左侧后鼻孔，无颈部淋巴结转移）\nB. 明确鼻咽癌临床分期为 cT1N1M0，II期（肿瘤局限于鼻咽，伴单侧咽后淋巴结转移）\nC. 明确鼻咽癌临床分期为 cT2N1M0，II期（肿瘤累及左侧后鼻孔及咽旁间隙，伴单侧颈部淋巴结转移）\nD. 明确鼻咽癌临床分期为 cT1N0M0，IA期（肿瘤累及鼻咽及左侧后鼻孔，无颈部淋巴结转移）\nE. 明确鼻咽癌临床分期为 cT3N0M0，III期（肿瘤累及颅底骨质，无颈部淋巴结转移）\nF. 明确鼻咽癌临床分期为 cT1N0M0，IA期（肿瘤局限于鼻咽，未累及鼻腔及口咽等邻近结构）\nG. 明确鼻咽癌临床分期为 cT2N0M0，II期（肿瘤累及鼻咽及口咽，无颈部淋巴结转移）\nH. 明确鼻咽癌临床分期为 cT1N2M0，III期（肿瘤累及左侧后鼻孔，伴双侧颈部淋巴结转移）\nI. 明确鼻咽癌临床分期为 cT3N1M0，III期（肿瘤累及翼内肌，伴单侧颈部淋巴结转移）\nJ. 明确鼻咽癌临床分期为 cT4N0M0，IVA期（肿瘤累及海绵窦，无颈部淋巴结转移）\nK. 明确鼻咽癌临床分期为 cT1N0M1，IVB期（肿瘤累及左侧后鼻孔，伴远处器官转移）\nL. 明确鼻咽癌临床分期为 cT2N2M0，III期（肿瘤累及咽旁间隙，伴双侧颈部淋巴结转移）\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"明确鼻咽癌临床分期为 cT2N0M0，II期（肿瘤累及左侧后鼻孔，无颈部淋巴结转移）","is_gold":false},{"letter":"B","text":"明确鼻咽癌临床分期为 cT1N1M0，II期（肿瘤局限于鼻咽，伴单侧咽后淋巴结转移）","is_gold":false},{"letter":"C","text":"明确鼻咽癌临床分期为 cT2N1M0，II期（肿瘤累及左侧后鼻孔及咽旁间隙，伴单侧颈部淋巴结转移）","is_gold":false},{"letter":"D","text":"明确鼻咽癌临床分期为 cT1N0M0，IA期（肿瘤累及鼻咽及左侧后鼻孔，无颈部淋巴结转移）","is_gold":true},{"letter":"E","text":"明确鼻咽癌临床分期为 cT3N0M0，III期（肿瘤累及颅底骨质，无颈部淋巴结转移）","is_gold":false},{"letter":"F","text":"明确鼻咽癌临床分期为 cT1N0M0，IA期（肿瘤局限于鼻咽，未累及鼻腔及口咽等邻近结构）","is_gold":false},{"letter":"G","text":"明确鼻咽癌临床分期为 cT2N0M0，II期（肿瘤累及鼻咽及口咽，无颈部淋巴结转移）","is_gold":false},{"letter":"H","text":"明确鼻咽癌临床分期为 cT1N2M0，III期（肿瘤累及左侧后鼻孔，伴双侧颈部淋巴结转移）","is_gold":false},{"letter":"I","text":"明确鼻咽癌临床分期为 cT3N1M0，III期（肿瘤累及翼内肌，伴单侧颈部淋巴结转移）","is_gold":false},{"letter":"J","text":"明确鼻咽癌临床分期为 cT4N0M0，IVA期（肿瘤累及海绵窦，无颈部淋巴结转移）","is_gold":false},{"letter":"K","text":"明确鼻咽癌临床分期为 cT1N0M1，IVB期（肿瘤累及左侧后鼻孔，伴远处器官转移）","is_gold":false},{"letter":"L","text":"明确鼻咽癌临床分期为 cT2N2M0，III期（肿瘤累及咽旁间隙，伴双侧颈部淋巴结转移）","is_gold":false}],"gold_letter":"D"},{"sample_id":"sample-db8d6d3eabcfcb123b0c3cb1","patient_id":"patient-51e6f99c527367bbd97aebd8","turn_id":"turn05","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：鼻腔。\n文本分期信息：N0，M0。\n综合TNM状态：T1N0M0。\n综合分期：IA。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D7] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D10] 内镜；胃镜: 检查类型: 内镜；检查名称: 胃镜；检查部位:；检查所见: 插镜情况：顺利 送达部位：十二指肠降部。 食 管：粘膜光滑, 舒缩好。 贲 门：开闭好, E-G线清楚。 胃 底：粘液湖清亮，粘膜光滑，无静脉曲张。 胃 体：花斑样充血，未见溃疡肿物。 胃 角：弧形， 光滑。 胃 窦：蠕动好，粘膜呈花斑样充血，未见溃疡肿物。 幽 门：圆， 开闭好。 球 部：球腔变形，后壁可见霜斑样溃疡，表面附着白苔。 降 部：十二指肠乳头及降部粘膜未见异常。 请4个工作日后到病理科（5楼）取活检结果。；检查结论: 十二指肠球部霜斑样溃疡 慢性浅表性胃炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D24] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽左侧顶后壁及左侧壁局部粘膜增厚形成软组织影放射性浓聚，SUV约21.0，堵塞左侧鼻后孔，鼻咽腔变窄，累及左侧翼突基底部及犁骨。左侧咽隐窝变，右侧咽隐窝未见明显异常，双侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。口咽及喉咽结构及放射性分布未见明显异常。额窦、蝶窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双上颈小淋巴结放射性分布未见明显异常。 双上肺尖、右中肺内侧段及左下肺后基底段少许条索影放射性分布未见明显异常；其余双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏S4低密度影放射性分布未见明显异常，大小约0.6×0.6cm，边界尚清，密度欠均匀，CT值约26Hu；其余肝脏密度减低，CT值约50Hu，结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。盆腔盆底静脉内多发点状/小结节状高密度影放射性缺损。 所见颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，侵犯左侧鼻后孔，累及颅底骨。 肝S4低密度影代谢未见明显异常，建议随诊。 脂肪肝。\n- [全程D29] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.013；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 6.5\n- [全程D30] 检验组合: 浊度(TRUB)-尿液: 清亮；白细胞计数(WBC#)-尿液: 3/μL；白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.023；酮体(KET)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 13/μL；颜色-尿液: Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；隐血(OB)-尿液: 1+ 0.6mg（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D31] 检验组合: 红细胞计数(RBC#)-静脉血: 4.6210E12/L；血小板计数(PLT#)-静脉血: 22810E9/L；大血小板百分比(P-LCR%)-静脉血: 21.2%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.61mmol/L；白蛋白(ALB)-静脉血: 38.5g/L；间接胆红素(IBIL)-静脉血: 8.4umolL；球蛋白(GLO)-静脉血: 25.82g/L；单核细胞百分比(Mono%)-静脉血: 0.093；血小板分布宽度(PDW)-静脉血: 10.8%；红细胞比容(Hct)-静脉血: 41.4%；总蛋白(TP)-静脉血: 64.32g/L；单核细胞计数(Mono#)-静脉血: 1.510E9/L；葡萄糖(Glu)-静脉血: 5.98mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.6；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；总胆红素(TBIL)-静脉血: 12.9umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 176.9U/L；甘油三酯(TG)-静脉血: 1.4mmol/L；乳酸脱氢酶(LDH)-静脉血: 239U/L；总胆汁酸(TBA)-静脉血: 3umol/L；直接胆红素(DBIL)-静脉血: 4.5umol/L；肌酐(Crea)-静脉血: 70umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.7；尿素氮(BUN)-静脉血: 6.02mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 136.5U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；天门冬氨酸氨基转移酶(AST)-静脉血: 104.5U/L；磷(P)-静脉血: 1.34mmol/L；钠离子(Na+)-静脉血: 138.8mmol/L；平均红细胞体积(MCV)-静脉血: 89.6fL；白细胞计数(WBC#)-静脉血: 15.9910E9/L；载脂蛋白AI(apoAI)-静脉血: 1.29g/L；阴离子间隙(AG)-静脉血: 14；C-反应蛋白(CRP)-静脉血: 1.98mg/L；钾离子(K+)-静脉血: 3.5mmol/L；碱性磷酸酶(ALP)-静脉血:……\n\n【既往治疗与反应】\n- [全程D8] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者相关检查完善中，请假未回病房。\n- [全程D13] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者相关检查完善中，请假未回病房。\n- [全程D19] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者元旦假期请假中。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D29] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者无明显不适主诉，查体情况：一般情况可，余同入院。放疗计划已完善。[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，向患者及其家属交代病情及化疗风险，表示理解并已签署知情同意书，同意入组三周/单周DDP同时期化疗临床试验，抽签入三周组，可于今日执行第1程顺铂方案同时期化疗，注意化疗不良反应，开始放疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放化疗，给予多烯磷脂酰胆碱、还原型谷胱甘肽等静脉保肝治疗，待肝功能恢复正常后恢复放化疗。\nB. 继续放化疗，仅密切监测肝功能变化，暂不给予静脉保肝药物干预。\nC. 继续放化疗，给予广谱抗生素静脉滴注预防感染，并辅以雾化吸入及止吐等对症支持处理。\nD. 将顺铂方案调整为卡铂方案同时期化疗，并给予静脉保肝治疗及止吐等对症支持处理。\nE. 顺铂剂量减低25%继续同时期化疗，给予静脉保肝治疗，辅以雾化吸入及止吐等对症支持处理。\nF. 暂停顺铂化疗，继续单纯放疗，给予静脉保肝治疗，待肝功能恢复后补足化疗周期。\nG. 给予多烯磷脂酰胆碱、还原型谷胱甘肽、复方甘草酸苷等静脉保肝治疗，辅以雾化吸入及止吐等对症支持处理。\nH. 给予大剂量质子泵抑制剂静脉滴注预防消化道出血，暂缓保肝治疗，继续放化疗。\nI. 暂停放疗，继续顺铂化疗，给予静脉保肝治疗及止吐等对症支持处理。\nJ. 给予静脉保肝治疗，行骨髓穿刺检查排除血液系统异常，继续放化疗。\nK. 终止临床试验，转为常规单药顺铂同时期放化疗，并给予静脉保肝治疗。\nL. 给予口服保肝药物治疗，辅以雾化吸入及止吐等对症支持处理，继续放化疗。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"暂停放化疗，给予多烯磷脂酰胆碱、还原型谷胱甘肽等静脉保肝治疗，待肝功能恢复正常后恢复放化疗。","is_gold":false},{"letter":"B","text":"继续放化疗，仅密切监测肝功能变化，暂不给予静脉保肝药物干预。","is_gold":false},{"letter":"C","text":"继续放化疗，给予广谱抗生素静脉滴注预防感染，并辅以雾化吸入及止吐等对症支持处理。","is_gold":false},{"letter":"D","text":"将顺铂方案调整为卡铂方案同时期化疗，并给予静脉保肝治疗及止吐等对症支持处理。","is_gold":false},{"letter":"E","text":"顺铂剂量减低25%继续同时期化疗，给予静脉保肝治疗，辅以雾化吸入及止吐等对症支持处理。","is_gold":false},{"letter":"F","text":"暂停顺铂化疗，继续单纯放疗，给予静脉保肝治疗，待肝功能恢复后补足化疗周期。","is_gold":true},{"letter":"G","text":"给予多烯磷脂酰胆碱、还原型谷胱甘肽、复方甘草酸苷等静脉保肝治疗，辅以雾化吸入及止吐等对症支持处理。","is_gold":false},{"letter":"H","text":"给予大剂量质子泵抑制剂静脉滴注预防消化道出血，暂缓保肝治疗，继续放化疗。","is_gold":false},{"letter":"I","text":"暂停放疗，继续顺铂化疗，给予静脉保肝治疗及止吐等对症支持处理。","is_gold":false},{"letter":"J","text":"给予静脉保肝治疗，行骨髓穿刺检查排除血液系统异常，继续放化疗。","is_gold":false},{"letter":"K","text":"终止临床试验，转为常规单药顺铂同时期放化疗，并给予静脉保肝治疗。","is_gold":false},{"letter":"L","text":"给予口服保肝药物治疗，辅以雾化吸入及止吐等对症支持处理，继续放化疗。","is_gold":false}],"gold_letter":"F"},{"sample_id":"sample-1d71f20ed555c71c5a4de4ee","patient_id":"patient-51e6f99c527367bbd97aebd8","turn_id":"turn06","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：鼻腔。\n文本分期信息：N0，M0。\n综合TNM状态：T1N0M0。\n综合分期：IA。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D7] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D10] 内镜；胃镜: 检查类型: 内镜；检查名称: 胃镜；检查部位:；检查所见: 插镜情况：顺利 送达部位：十二指肠降部。 食 管：粘膜光滑, 舒缩好。 贲 门：开闭好, E-G线清楚。 胃 底：粘液湖清亮，粘膜光滑，无静脉曲张。 胃 体：花斑样充血，未见溃疡肿物。 胃 角：弧形， 光滑。 胃 窦：蠕动好，粘膜呈花斑样充血，未见溃疡肿物。 幽 门：圆， 开闭好。 球 部：球腔变形，后壁可见霜斑样溃疡，表面附着白苔。 降 部：十二指肠乳头及降部粘膜未见异常。 请4个工作日后到病理科（5楼）取活检结果。；检查结论: 十二指肠球部霜斑样溃疡 慢性浅表性胃炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D24] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽左侧顶后壁及左侧壁局部粘膜增厚形成软组织影放射性浓聚，SUV约21.0，堵塞左侧鼻后孔，鼻咽腔变窄，累及左侧翼突基底部及犁骨。左侧咽隐窝变，右侧咽隐窝未见明显异常，双侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。口咽及喉咽结构及放射性分布未见明显异常。额窦、蝶窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双上颈小淋巴结放射性分布未见明显异常。 双上肺尖、右中肺内侧段及左下肺后基底段少许条索影放射性分布未见明显异常；其余双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏S4低密度影放射性分布未见明显异常，大小约0.6×0.6cm，边界尚清，密度欠均匀，CT值约26Hu；其余肝脏密度减低，CT值约50Hu，结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。盆腔盆底静脉内多发点状/小结节状高密度影放射性缺损。 所见颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，侵犯左侧鼻后孔，累及颅底骨。 肝S4低密度影代谢未见明显异常，建议随诊。 脂肪肝。\n- [全程D29] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.013；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 6.5\n- [全程D30] 检验组合: 浊度(TRUB)-尿液: 清亮；白细胞计数(WBC#)-尿液: 3/μL；白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.023；酮体(KET)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 13/μL；颜色-尿液: Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；隐血(OB)-尿液: 1+ 0.6mg（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D31] 检验组合: 红细胞计数(RBC#)-静脉血: 4.6210E12/L；血小板计数(PLT#)-静脉血: 22810E9/L；大血小板百分比(P-LCR%)-静脉血: 21.2%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.61mmol/L；白蛋白(ALB)-静脉血: 38.5g/L；间接胆红素(IBIL)-静脉血: 8.4umolL；球蛋白(GLO)-静脉血: 25.82g/L；单核细胞百分比(Mono%)-静脉血: 0.093；血小板分布宽度(PDW)-静脉血: 10.8%；红细胞比容(Hct)-静脉血: 41.4%；总蛋白(TP)-静脉血: 64.32g/L；单核细胞计数(Mono#)-静脉血: 1.510E9/L；葡萄糖(Glu)-静脉血: 5.98mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.6；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；总胆红素(TBIL)-静脉血: 12.9umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 176.9U/L；甘油三酯(TG)-静脉血: 1.4mmol/L；乳酸脱氢酶(LDH)-静脉血: 239U/L；总胆汁酸(TBA)-静脉血: 3umol/L；直接胆红素(DBIL)-静脉血: 4.5umol/L；肌酐(Crea)-静脉血: 70umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.7；尿素氮(BUN)-静脉血: 6.02mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 136.5U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；天门冬氨酸氨基转移酶(AST)-静脉血: 104.5U/L；磷(P)-静脉血: 1.34mmol/L；钠离子(Na+)-静脉血: 138.8mmol/L；平均红细胞体积(MCV)-静脉血: 89.6fL；白细胞计数(WBC#)-静脉血: 15.9910E9/L；载脂蛋白AI(apoAI)-静脉血: 1.29g/L；阴离子间隙(AG)-静脉血: 14；C-反应蛋白(CRP)-静脉血: 1.98mg/L；钾离子(K+)-静脉血: 3.5mmol/L；碱性磷酸酶(ALP)-静脉血:……\n- [全程D32] 检验组合: 胱抑素(Cys-C)-静脉血: 0.73mg/L；乳酸脱氢酶(LDH)-静脉血: 162.4U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.51mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；淋巴细胞百分比(Lymph%)-静脉血: 0.05；平均红细胞血红蛋白含量(MCH)-静脉血: 29.9pg；血红蛋白(Hb)-静脉血: 137.4g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 5.43mmol/L；白蛋白(ALB)-静脉血: 43.2g/L；肌酐(Crea)-静脉血: 86.7umol/L；氯离子(Cl-)-静脉血: 97.6mmol/L；C-反应蛋白(CRP)-静脉血: 6.52mg/L；钾离子(K+)-静脉血: 4.2mmol/L；尿酸(UA)-静脉血: 298.5umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.15mmolL；载脂蛋白B(apoB)-静脉血: 1.3g/L；血小板比容-静脉血: 14.7%；血小板分布宽度(PDW)-静脉血: 8.7%；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.41mmolL；有核红细胞百分比(NRBC%)-静脉血: 0；血小板比容-静脉血: 14%；总胆固醇(TC)-静脉血: 7.5mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；甘油三酯(TG)-静脉血: 1.38mmol/L；平均血小板体积(MPV)-静脉血: 8.9fL；平均红细胞体积(MCV)-静脉血: 90.2fL；γ-谷氨酰基转移酶(GGT)-静脉血: 97.8U/L；阴离子间隙(AG)-静脉血: 17；胱抑素(Cys-C)-静脉血: 1.03mg/L；氯离子(Cl-)-静脉血: 96.7mmol/L；血小板分布宽度(PDW)-静脉血: 16.1%；平均血小板体积(MPV)-静脉血: 6.78fL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；球蛋白(GLO)-静脉血: 35.61g/L；镁离子(Mg2+)-静脉血: 0.66mmol/L；间接胆红素(IBIL)-静脉血: 6.3umolL；γ-谷氨酰基转移酶(GGT)-静脉血: 151U/L；阴离子间隙(AG)-静脉血: 17；单核细胞计数(Mono#)-……\n\n【既往治疗与反应】\n- [全程D8] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者相关检查完善中，请假未回病房。\n- [全程D13] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者相关检查完善中，请假未回病房。\n- [全程D19] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者元旦假期请假中。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D29] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者无明显不适主诉，查体情况：一般情况可，余同入院。放疗计划已完善。[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，向患者及其家属交代病情及化疗风险，表示理解并已签署知情同意书，同意入组三周/单周DDP同时期化疗临床试验，抽签入三周组，可于今日执行第1程顺铂方案同时期化疗，注意化疗不良反应，开始放疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗与化疗，给予异甘草酸镁静脉滴注，待转氨酶降至正常水平后重启治疗。\nB. 终止顺铂化疗，后续疗程替换为卡铂，并加用甲泼尼龙静脉滴注。\nC. 暂停放疗，继续按计划执行化疗，给予联苯双酯口服及静脉营养支持。\nD. 维持治疗节奏，暂不加用保肝药物，1周后常规复查肝肾功能。\nE. 加用恩替卡韦口服抗病毒治疗，并维持放化疗方案不变。\nF. 安排肝脏病灶穿刺活检，明确病理性质前暂停所有抗肿瘤治疗。\nG. 给予重组人粒细胞集落刺激因子皮下注射，辅以静脉营养支持。\nH. 给予联苯双酯等保肝降酶药物，辅以静脉营养支持，并密切复查肝功能。\nI. 给予重组人血小板生成素皮下注射，并推迟下一疗程化疗。\nJ. 给予头孢哌酮舒巴坦静脉滴注抗感染，并密切复查肝功能。\nK. 给予保肝降酶药物治疗，并按比例降低后续颈部放疗靶区处方剂量。\nL. 立即行血浆置换治疗，暂停放疗及化疗。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"暂停放疗与化疗，给予异甘草酸镁静脉滴注，待转氨酶降至正常水平后重启治疗。","is_gold":false},{"letter":"B","text":"终止顺铂化疗，后续疗程替换为卡铂，并加用甲泼尼龙静脉滴注。","is_gold":false},{"letter":"C","text":"暂停放疗，继续按计划执行化疗，给予联苯双酯口服及静脉营养支持。","is_gold":false},{"letter":"D","text":"维持治疗节奏，暂不加用保肝药物，1周后常规复查肝肾功能。","is_gold":false},{"letter":"E","text":"加用恩替卡韦口服抗病毒治疗，并维持放化疗方案不变。","is_gold":false},{"letter":"F","text":"安排肝脏病灶穿刺活检，明确病理性质前暂停所有抗肿瘤治疗。","is_gold":false},{"letter":"G","text":"给予重组人粒细胞集落刺激因子皮下注射，辅以静脉营养支持。","is_gold":false},{"letter":"H","text":"给予联苯双酯等保肝降酶药物，辅以静脉营养支持，并密切复查肝功能。","is_gold":true},{"letter":"I","text":"给予重组人血小板生成素皮下注射，并推迟下一疗程化疗。","is_gold":false},{"letter":"J","text":"给予头孢哌酮舒巴坦静脉滴注抗感染，并密切复查肝功能。","is_gold":false},{"letter":"K","text":"给予保肝降酶药物治疗，并按比例降低后续颈部放疗靶区处方剂量。","is_gold":false},{"letter":"L","text":"立即行血浆置换治疗，暂停放疗及化疗。","is_gold":false}],"gold_letter":"H"},{"sample_id":"sample-5eba0030ab5d024288a0d69d","patient_id":"patient-51e6f99c527367bbd97aebd8","turn_id":"turn07","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：鼻腔。\n文本分期信息：N0，M0。\n综合TNM状态：T1N0M0。\n综合分期：IA。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D7] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- [全程D41] 检验组合: 中性粒细胞计数(Neut#)-静脉血: 6.110E9/L；钠离子(Na+)-静脉血: 139.4mmol/L；尿素氮(BUN)-静脉血: 7.2mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.53；淋巴细胞计数(Lymph#)-静脉血: 0.910E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 42.7U/L；丙氨酸氨基转移酶(ALT)-静脉血: 35.4U/L；甘油三酯(TG)-静脉血: 1.71mmol/L；白细胞计数(WBC#)-静脉血: 7.7810E9/L；总蛋白(TP)-静脉血: 62.51g/L；血红蛋白(Hb)-静脉血: 131g/L；总钙(Ca)-静脉血: 2.05mmol/L；肌酐(Crea)-静脉血: 81.5umol/L；载脂蛋白B(apoB)-静脉血: 1.23g/L；白蛋白(ALB)-静脉血: 36.6g/L；中性粒细胞百分比(Neut%)-静脉血: 0.79；红细胞比容(Hct)-静脉血: 38.9%；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.6；淋巴细胞百分比(Lymph%)-静脉血: 0.113；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.006；大血小板百分比(P-LCR%)-静脉血: 15.3%；乳酸脱氢酶(LDH)-静脉血: 185.9U/L；间接胆红素(IBIL)-静脉血: 6.7umolL；氯离子(Cl-)-静脉血: 100.4mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.8U/L；血小板计数(PLT#)-静脉血: 15410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.3g/L；平均血小板体积(MPV)-静脉血: 8.9fL；胱抑素(Cys-C)-静脉血: 0.86mg/L；γ-谷氨酰基转移酶(GGT)-静脉血: 268.3U/L；总胆红素(TBIL)-静脉血: 8umol/L；葡萄糖(Glu)-静脉血: 5.28mmol/L；红细胞计数(RBC#)-静脉血: 4.3510E12/L；总胆汁酸(TBA)-静脉血: 2.7umol/L；血小板分……\n- [全程D49] 检验组合: 红细胞计数(RBC#)-尿液: 6/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；白细胞计数(WBC#)-尿液: 1/μL；比重(SG)-尿液: 1.009；胆红素(BIL)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: 无色；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮\n- [全程D50] 检验组合: 浊度(TRUB)-尿液: clear；酮体(KET)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 13/μL；比重(SG)-尿液: 1.017；白细胞计数(WBC#)-尿液: 10/μL；隐血(OB)-尿液: 1+0.6mg（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；总蛋白(TP)-尿液: -（参考: 阴性）；非鳞状上皮细胞计数-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 3/μL；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow\n- [全程D51] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；比重(SG)-尿液: 1.013；白细胞计数(WBC#)-尿液: 13/μL；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 8/μL；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；白细胞(LEU)-尿液: -（参考: 阴性）\n- [全程D52] 检验组合: 淋巴细胞百分比(Lymph%)-静脉血: 0.1；镁离子(Mg2+)-静脉血: 0.52mmol/L；尿素氮(BUN)-静脉血: 6.1mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.14mmolL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；总蛋白(TP)-静脉血: 64.42g/L；磷(P)-静脉血: 1.33mmol/L；总胆红素(TBIL)-静脉血: 6umol/L；氯离子(Cl-)-静脉血: 99.5mmol/L；红细胞比容(Hct)-静脉血: 36.9%；平均红细胞体积(MCV)-静脉血: 89.1fL；红细胞计数(RBC#)-静脉血: 4.1410E12/L；C-反应蛋白(CRP)-静脉血: 4.91mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；白细胞计数(WBC#)-静脉血: 3.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.253；血小板比容-静脉血: 20%；丙氨酸氨基转移酶(ALT)-静脉血: 42.9U/L；血液二氧化碳含量ctCO2(B)-静脉血: 26.2mmol/L；胱抑素(Cys-C)-静脉血: 1.28mg/L；球蛋白(GLO)-静脉血: 29.62g/L；甘油三酯(TG)-静脉血: 1.61mmol/L；尿酸(UA)-静脉血: 292.8umol/L；血小板分布宽度(PDW)-静脉血: 8.6%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.8；单核细胞计数(Mono#)-静脉血: 0.910E9/L；肌酐(Crea)-静脉血: 109.5umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.015；总胆固醇(TC)-静脉血: 5.96mmol/L；阴离子间隙(AG)-静脉血: 12；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 47U/L；平均血小板体积(MPV)-静脉血: 8.8fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.4；中性粒细胞百分比(Neut%)-静脉血: 0.626；总钙(Ca)-静脉血: 1.94mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.……\n- [全程D61] 超声；肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声不均匀，肝S5可见2个无回声灶，直径约3-4mm，边界清,内透声可，后方回声增强。血管走行清晰、自然，肝内胆管不扩张，门静脉内径约7mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约28cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约43×27×32mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝S5囊性灶，考虑肝囊肿可能性大。 胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D61] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，走行自然，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n\n【既往治疗与反应】\n- [全程D41] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者放疗中，诉口感、咽痛，余无不适。查体同前。复查血常规：基本正常，生化常规：正常。[姓名已隐去]医生信息已隐藏：患者DDP化疗后出现肝酶升高，考虑为药物性肝损害，经多种滑竿药物治疗后肝功能恢复正常，今日可办理出院，继续门诊放疗。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D50] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，向患者及其家属交代病情及化疗风险，表示理解并已签署知情同意书，可于今日水化，明日执行第2程DDP方案同时期化疗，注意化疗不良反应。\n- [全程D51] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程DDP方案同时期化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D52] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第二程DDP单药同期化疗结束，诉咽痛、恶心、食欲下降，呕吐1次，伴头晕，无腹痛、腹泻等不适。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者同时期化疗结束，一般情况可，可以今日结账出院，门诊继续放疗。嘱定期复查血常规及肝肾功能，行放疗结束前常规检查。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，给予静脉滴注广谱抗菌药物及大剂量糖皮质激素。\nB. 暂停放疗，行肝脏穿刺活检明确肝脏病灶性质后调整全身系统性化疗方案。\nC. 继续根治性放疗，给予重组人粒细胞集落刺激因子（G-CSF）皮下注射。\nD. 继续根治性放疗，加用第3程顺铂同期化疗，并给予静脉保肝药物。\nE. 终止放疗，转为TPF方案全身系统性化疗。\nF. 继续根治性放疗，局部外用强效糖皮质激素软膏，并口服非甾体抗炎药。\nG. 暂停放疗，复查鼻咽及颈部MRI以决定是否降低后续放疗靶区剂量。\nH. 继续根治性放疗，给予静脉异甘草酸镁及还原型谷胱甘肽保肝治疗。\nI. 继续根治性放疗，给予雾化吸入氨溴索与地塞米松，并局部外用三乙醇胺乳膏。\nJ. 继续根治性放疗，联合靶向药物尼妥珠单抗及PD-1抑制剂治疗。\nK. 继续根治性放疗，给予静脉滴注地塞米松，并局部外用莫匹罗星软膏。\nL. 结束放化疗综合治疗，进入随访观察期，定期复查鼻咽MRI及颈部超声。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"暂停放疗，给予静脉滴注广谱抗菌药物及大剂量糖皮质激素。","is_gold":false},{"letter":"B","text":"暂停放疗，行肝脏穿刺活检明确肝脏病灶性质后调整全身系统性化疗方案。","is_gold":false},{"letter":"C","text":"继续根治性放疗，给予重组人粒细胞集落刺激因子（G-CSF）皮下注射。","is_gold":false},{"letter":"D","text":"继续根治性放疗，加用第3程顺铂同期化疗，并给予静脉保肝药物。","is_gold":false},{"letter":"E","text":"终止放疗，转为TPF方案全身系统性化疗。","is_gold":false},{"letter":"F","text":"继续根治性放疗，局部外用强效糖皮质激素软膏，并口服非甾体抗炎药。","is_gold":false},{"letter":"G","text":"暂停放疗，复查鼻咽及颈部MRI以决定是否降低后续放疗靶区剂量。","is_gold":false},{"letter":"H","text":"继续根治性放疗，给予静脉异甘草酸镁及还原型谷胱甘肽保肝治疗。","is_gold":false},{"letter":"I","text":"继续根治性放疗，给予雾化吸入氨溴索与地塞米松，并局部外用三乙醇胺乳膏。","is_gold":true},{"letter":"J","text":"继续根治性放疗，联合靶向药物尼妥珠单抗及PD-1抑制剂治疗。","is_gold":false},{"letter":"K","text":"继续根治性放疗，给予静脉滴注地塞米松，并局部外用莫匹罗星软膏。","is_gold":false},{"letter":"L","text":"结束放化疗综合治疗，进入随访观察期，定期复查鼻咽MRI及颈部超声。","is_gold":false}],"gold_letter":"I"},{"sample_id":"sample-24c04c80074ea3aab5465600","patient_id":"patient-51e6f99c527367bbd97aebd8","turn_id":"turn08","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T1；受侵结构包括：鼻腔。\n文本分期信息：N0，M0。\n综合TNM状态：T1N0M0。\n综合分期：IA。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D7] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- [全程D41] 检验组合: 中性粒细胞计数(Neut#)-静脉血: 6.110E9/L；钠离子(Na+)-静脉血: 139.4mmol/L；尿素氮(BUN)-静脉血: 7.2mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.53；淋巴细胞计数(Lymph#)-静脉血: 0.910E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 42.7U/L；丙氨酸氨基转移酶(ALT)-静脉血: 35.4U/L；甘油三酯(TG)-静脉血: 1.71mmol/L；白细胞计数(WBC#)-静脉血: 7.7810E9/L；总蛋白(TP)-静脉血: 62.51g/L；血红蛋白(Hb)-静脉血: 131g/L；总钙(Ca)-静脉血: 2.05mmol/L；肌酐(Crea)-静脉血: 81.5umol/L；载脂蛋白B(apoB)-静脉血: 1.23g/L；白蛋白(ALB)-静脉血: 36.6g/L；中性粒细胞百分比(Neut%)-静脉血: 0.79；红细胞比容(Hct)-静脉血: 38.9%；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.6；淋巴细胞百分比(Lymph%)-静脉血: 0.113；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.006；大血小板百分比(P-LCR%)-静脉血: 15.3%；乳酸脱氢酶(LDH)-静脉血: 185.9U/L；间接胆红素(IBIL)-静脉血: 6.7umolL；氯离子(Cl-)-静脉血: 100.4mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.8U/L；血小板计数(PLT#)-静脉血: 15410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.3g/L；平均血小板体积(MPV)-静脉血: 8.9fL；胱抑素(Cys-C)-静脉血: 0.86mg/L；γ-谷氨酰基转移酶(GGT)-静脉血: 268.3U/L；总胆红素(TBIL)-静脉血: 8umol/L；葡萄糖(Glu)-静脉血: 5.28mmol/L；红细胞计数(RBC#)-静脉血: 4.3510E12/L；总胆汁酸(TBA)-静脉血: 2.7umol/L；血小板分……\n- [全程D49] 检验组合: 红细胞计数(RBC#)-尿液: 6/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；白细胞计数(WBC#)-尿液: 1/μL；比重(SG)-尿液: 1.009；胆红素(BIL)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: 无色；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮\n- [全程D50] 检验组合: 浊度(TRUB)-尿液: clear；酮体(KET)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 13/μL；比重(SG)-尿液: 1.017；白细胞计数(WBC#)-尿液: 10/μL；隐血(OB)-尿液: 1+0.6mg（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；总蛋白(TP)-尿液: -（参考: 阴性）；非鳞状上皮细胞计数-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 3/μL；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow\n- [全程D51] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；比重(SG)-尿液: 1.013；白细胞计数(WBC#)-尿液: 13/μL；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 8/μL；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；白细胞(LEU)-尿液: -（参考: 阴性）\n- [全程D52] 检验组合: 淋巴细胞百分比(Lymph%)-静脉血: 0.1；镁离子(Mg2+)-静脉血: 0.52mmol/L；尿素氮(BUN)-静脉血: 6.1mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.14mmolL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；总蛋白(TP)-静脉血: 64.42g/L；磷(P)-静脉血: 1.33mmol/L；总胆红素(TBIL)-静脉血: 6umol/L；氯离子(Cl-)-静脉血: 99.5mmol/L；红细胞比容(Hct)-静脉血: 36.9%；平均红细胞体积(MCV)-静脉血: 89.1fL；红细胞计数(RBC#)-静脉血: 4.1410E12/L；C-反应蛋白(CRP)-静脉血: 4.91mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；白细胞计数(WBC#)-静脉血: 3.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.253；血小板比容-静脉血: 20%；丙氨酸氨基转移酶(ALT)-静脉血: 42.9U/L；血液二氧化碳含量ctCO2(B)-静脉血: 26.2mmol/L；胱抑素(Cys-C)-静脉血: 1.28mg/L；球蛋白(GLO)-静脉血: 29.62g/L；甘油三酯(TG)-静脉血: 1.61mmol/L；尿酸(UA)-静脉血: 292.8umol/L；血小板分布宽度(PDW)-静脉血: 8.6%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 39.8；单核细胞计数(Mono#)-静脉血: 0.910E9/L；肌酐(Crea)-静脉血: 109.5umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.015；总胆固醇(TC)-静脉血: 5.96mmol/L；阴离子间隙(AG)-静脉血: 12；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 47U/L；平均血小板体积(MPV)-静脉血: 8.8fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.4；中性粒细胞百分比(Neut%)-静脉血: 0.626；总钙(Ca)-静脉血: 1.94mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.……\n- [全程D61] 超声；肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声不均匀，肝S5可见2个无回声灶，直径约3-4mm，边界清,内透声可，后方回声增强。血管走行清晰、自然，肝内胆管不扩张，门静脉内径约7mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约28cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约43×27×32mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝S5囊性灶，考虑肝囊肿可能性大。 胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D61] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，走行自然，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n\n【既往治疗与反应】\n- [全程D41] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者放疗中，诉口感、咽痛，余无不适。查体同前。复查血常规：基本正常，生化常规：正常。[姓名已隐去]医生信息已隐藏：患者DDP化疗后出现肝酶升高，考虑为药物性肝损害，经多种滑竿药物治疗后肝功能恢复正常，今日可办理出院，继续门诊放疗。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D50] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，向患者及其家属交代病情及化疗风险，表示理解并已签署知情同意书，可于今日水化，明日执行第2程DDP方案同时期化疗，注意化疗不良反应。\n- [全程D51] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程DDP方案同时期化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D52] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第二程DDP单药同期化疗结束，诉咽痛、恶心、食欲下降，呕吐1次，伴头晕，无腹痛、腹泻等不适。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者同时期化疗结束，一般情况可，可以今日结账出院，门诊继续放疗。嘱定期复查血常规及肝肾功能，行放疗结束前常规检查。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，行腹部增强MRI或穿刺活检明确肝脏囊性病灶性质，待明确性质后再决定后续治疗方案。\nB. 继续根治性放疗，启动第三程顺铂单药同期化疗，并给予保肝、止吐及水化等预防性对症支持治疗。\nC. 继续根治性放疗，加用卡培他滨口服节拍化疗，并给予雾化吸入及局部外用药处理放疗反应。\nD. 提前结束放疗，给予静脉滴注大剂量糖皮质激素及广谱抗生素处理放射性黏膜炎和皮炎。\nE. 继续根治性放疗，给予静脉高营养支持处理急性放射性黏膜炎，并预防性使用重组人粒细胞刺激因子。\nF. 暂停放疗，复查鼻咽及颈部MRI，重新定位并缩减原发灶及颈部放疗靶区。\nG. 继续根治性放疗，行肝脏囊性灶局部射频消融治疗，并给予雾化吸入及局部外用药处理放疗反应。\nH. 继续根治性放疗，继续给予静脉双环醇等保肝药物强化治疗，并给予局部外用药处理放疗反应。\nI. 暂停放疗，给予局部清创换药，待皮肤及黏膜反应恢复至1级以下再恢复根治性放疗。\nJ. 继续根治性放疗，给予雾化吸入（氨溴索、地塞米松）及局部外用药（三乙醇胺乳膏）处理急性放射性黏膜炎和皮炎。\nK. 继续根治性放疗，给予口服非甾体抗炎药缓解黏膜疼痛，并在局部皮炎处预防性涂抹抗生素软膏。\nL. 结束根治性放疗，进入定期随访阶段，给予雾化吸入及局部外用药处理急性放射性黏膜炎和皮炎。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"暂停放疗，行腹部增强MRI或穿刺活检明确肝脏囊性病灶性质，待明确性质后再决定后续治疗方案。","is_gold":false},{"letter":"B","text":"继续根治性放疗，启动第三程顺铂单药同期化疗，并给予保肝、止吐及水化等预防性对症支持治疗。","is_gold":false},{"letter":"C","text":"继续根治性放疗，加用卡培他滨口服节拍化疗，并给予雾化吸入及局部外用药处理放疗反应。","is_gold":false},{"letter":"D","text":"提前结束放疗，给予静脉滴注大剂量糖皮质激素及广谱抗生素处理放射性黏膜炎和皮炎。","is_gold":false},{"letter":"E","text":"继续根治性放疗，给予静脉高营养支持处理急性放射性黏膜炎，并预防性使用重组人粒细胞刺激因子。","is_gold":false},{"letter":"F","text":"暂停放疗，复查鼻咽及颈部MRI，重新定位并缩减原发灶及颈部放疗靶区。","is_gold":false},{"letter":"G","text":"继续根治性放疗，行肝脏囊性灶局部射频消融治疗，并给予雾化吸入及局部外用药处理放疗反应。","is_gold":false},{"letter":"H","text":"继续根治性放疗，继续给予静脉双环醇等保肝药物强化治疗，并给予局部外用药处理放疗反应。","is_gold":false},{"letter":"I","text":"暂停放疗，给予局部清创换药，待皮肤及黏膜反应恢复至1级以下再恢复根治性放疗。","is_gold":false},{"letter":"J","text":"继续根治性放疗，给予雾化吸入（氨溴索、地塞米松）及局部外用药（三乙醇胺乳膏）处理急性放射性黏膜炎和皮炎。","is_gold":true},{"letter":"K","text":"继续根治性放疗，给予口服非甾体抗炎药缓解黏膜疼痛，并在局部皮炎处预防性涂抹抗生素软膏。","is_gold":false},{"letter":"L","text":"结束根治性放疗，进入定期随访阶段，给予雾化吸入及局部外用药处理急性放射性黏膜炎和皮炎。","is_gold":false}],"gold_letter":"J"}]}
+{"patient_id":"patient-867f2373fc1b04e0b8b80452","bootstrap_cluster_id":"cluster-023","turns":[{"sample_id":"sample-6bc929b6a549b509a4ffbecf","patient_id":"patient-867f2373fc1b04e0b8b80452","turn_id":"turn01","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、鼻腔、翼外肌、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1750] 入院记录: 主诉: 间断性涕血3月，面麻、复视1月，耳鸣20天；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 复视,涕血,双面麻；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟1包，30年，不嗜酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：88次/分，R：20次/分，BP：114/69mmHg,Ht：170cm，Wt：62kg，BSA：1.71m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 电子鼻咽镜下活检，鼻咽及颈部CT平扫加增强，常规血液学检查\nB. 鼻咽及颈部MRI平扫加增强，全身PET-CT检查，常规血液学检查\nC. 电子鼻咽镜下活检，鼻咽MRI平扫加增强，常规血液学检查\nD. 电子鼻咽镜下活检，鼻咽及颈部MRI平扫，常规血液学检查\nE. 鼻咽及颈部CT平扫加增强，全身骨扫描，常规血液学检查\nF. 电子鼻咽镜下活检，鼻咽及颈部MRI平扫加增强，腰椎穿刺脑脊液检查\nG. 电子鼻咽镜下活检，全身PET-CT检查，常规血液学检查\nH. 鼻咽刷片细胞学检查，鼻咽及颈部MRI平扫加增强，常规血液学检查\nI. 电子鼻咽镜下活检，鼻咽及颈部MRI平扫加增强，颈部淋巴结穿刺活检\nJ. 电子鼻咽镜下活检，鼻咽及颈部超声检查，常规血液学检查\nK. 电子鼻咽镜下活检，鼻咽及颈部MRI平扫加增强，常规血液学检查\nL. 鼻咽及颈部MRI平扫加增强，常规血液学检查，择期行鼻咽肿物切除术\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"电子鼻咽镜下活检，鼻咽及颈部CT平扫加增强，常规血液学检查","is_gold":false},{"letter":"B","text":"鼻咽及颈部MRI平扫加增强，全身PET-CT检查，常规血液学检查","is_gold":false},{"letter":"C","text":"电子鼻咽镜下活检，鼻咽MRI平扫加增强，常规血液学检查","is_gold":false},{"letter":"D","text":"电子鼻咽镜下活检，鼻咽及颈部MRI平扫，常规血液学检查","is_gold":false},{"letter":"E","text":"鼻咽及颈部CT平扫加增强，全身骨扫描，常规血液学检查","is_gold":false},{"letter":"F","text":"电子鼻咽镜下活检，鼻咽及颈部MRI平扫加增强，腰椎穿刺脑脊液检查","is_gold":false},{"letter":"G","text":"电子鼻咽镜下活检，全身PET-CT检查，常规血液学检查","is_gold":false},{"letter":"H","text":"鼻咽刷片细胞学检查，鼻咽及颈部MRI平扫加增强，常规血液学检查","is_gold":false},{"letter":"I","text":"电子鼻咽镜下活检，鼻咽及颈部MRI平扫加增强，颈部淋巴结穿刺活检","is_gold":false},{"letter":"J","text":"电子鼻咽镜下活检，鼻咽及颈部超声检查，常规血液学检查","is_gold":false},{"letter":"K","text":"电子鼻咽镜下活检，鼻咽及颈部MRI平扫加增强，常规血液学检查","is_gold":true},{"letter":"L","text":"鼻咽及颈部MRI平扫加增强，常规血液学检查，择期行鼻咽肿物切除术","is_gold":false}],"gold_letter":"K"},{"sample_id":"sample-31a839b9f99ab6bf0a218575","patient_id":"patient-867f2373fc1b04e0b8b80452","turn_id":"turn02","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、鼻腔、翼外肌、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1750] 入院记录: 主诉: 间断性涕血3月，面麻、复视1月，耳鸣20天；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 复视,涕血,双面麻；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟1包，30年，不嗜酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：88次/分，R：20次/分，BP：114/69mmHg,Ht：170cm，Wt：62kg，BSA：1.71m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D1751] 检验组合: 阴离子间隙(AG)-静脉血: 18.2；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；平均血小板体积(MPV)-静脉血: 9.8fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.8；白细胞计数(WBC#)-静脉血: 6.2310E9/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 64.8umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阳性(+)（参考: 阴性）；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.92mmol/L；透明质酸(HA)-静脉血: 91.434ng/ml；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.4U/L；氯离子(Cl-)-静脉血: 101.8mmol/L；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 1.43ng/ml（参考: <0.704）；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；血小板比容-静脉血: 20%；活化部分凝血活酶时间(APTT)-静脉血: 27.5sec.；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.62；梅毒非特异性抗体甲苯胺红不加热血清试验(TRUST)-静脉血: 阴性(-)（参考: 阴性）；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；总钙(Ca)-静脉血: 2.27mmol/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.43；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；凝血酶时间(TT)-静脉血: 17.6sec.；间接胆红素(IBIL)-静脉血: 6.6umolL；凝血酶原时间活动度(PTA)-静脉血: 97.9%；降钙素(CT)-静脉血: 25.774pg/ml；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 44.9U/L……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善全身远处转移排查及血浆EBV-DNA检测，并直接安排单纯根治性放射治疗定位。\nB. 完善全身远处转移排查及血浆EBV-DNA检测，并请头颈外科会诊评估鼻咽及颈部病灶根治性切除可能。\nC. 完善胸部X线、腹部超声及血浆EBV-DNA检测进行分期，并行超声引导下中心静脉穿刺置管及X线定位，为全身化疗做准备。\nD. 完善全身远处转移排查及血浆EBV-DNA检测，并预防性行经皮内镜下胃造瘘术（PEG）以保障放化疗期间营养。\nE. 安排鼻咽镜下再次活检以明确组织学亚型，暂缓全身远处转移排查及静脉置管，待病理亚型确诊后再行后续安排。\nF. 完善全身远处转移排查及血浆EBV-DNA检测，并直接通过外周静脉留置针（PIV）启动全身化疗。\nG. 完善全身骨扫描及血浆EBV-DNA检测，并行超声引导下中心静脉穿刺置管及X线定位，为全身化疗做准备。\nH. 完善全身远处转移排查及血浆EBV-DNA检测，并先行双侧颈部淋巴结清扫术，术后行全身化疗。\nI. 完善全身远处转移排查及血浆EBV-DNA检测，并安排单药免疫治疗作为诱导治疗，无需中心静脉置管。\nJ. 完善全身远处转移排查及血浆EBV-DNA检测，并安排超声引导下颈部淋巴结穿刺活检以病理确诊N分期。\nK. 完善全身远处转移排查及血浆EBV-DNA检测，并常规安排腰椎穿刺脑脊液检查以排除脑膜转移。\nL. 完善全身远处转移排查（如PET-CT或胸腹部CT联合骨扫描）及血浆EBV-DNA检测，并行超声引导下中心静脉穿刺置管及X线定位，为全身化疗做准备。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"完善全身远处转移排查及血浆EBV-DNA检测，并直接安排单纯根治性放射治疗定位。","is_gold":false},{"letter":"B","text":"完善全身远处转移排查及血浆EBV-DNA检测，并请头颈外科会诊评估鼻咽及颈部病灶根治性切除可能。","is_gold":false},{"letter":"C","text":"完善胸部X线、腹部超声及血浆EBV-DNA检测进行分期，并行超声引导下中心静脉穿刺置管及X线定位，为全身化疗做准备。","is_gold":false},{"letter":"D","text":"完善全身远处转移排查及血浆EBV-DNA检测，并预防性行经皮内镜下胃造瘘术（PEG）以保障放化疗期间营养。","is_gold":false},{"letter":"E","text":"安排鼻咽镜下再次活检以明确组织学亚型，暂缓全身远处转移排查及静脉置管，待病理亚型确诊后再行后续安排。","is_gold":false},{"letter":"F","text":"完善全身远处转移排查及血浆EBV-DNA检测，并直接通过外周静脉留置针（PIV）启动全身化疗。","is_gold":false},{"letter":"G","text":"完善全身骨扫描及血浆EBV-DNA检测，并行超声引导下中心静脉穿刺置管及X线定位，为全身化疗做准备。","is_gold":false},{"letter":"H","text":"完善全身远处转移排查及血浆EBV-DNA检测，并先行双侧颈部淋巴结清扫术，术后行全身化疗。","is_gold":false},{"letter":"I","text":"完善全身远处转移排查及血浆EBV-DNA检测，并安排单药免疫治疗作为诱导治疗，无需中心静脉置管。","is_gold":false},{"letter":"J","text":"完善全身远处转移排查及血浆EBV-DNA检测，并安排超声引导下颈部淋巴结穿刺活检以病理确诊N分期。","is_gold":false},{"letter":"K","text":"完善全身远处转移排查及血浆EBV-DNA检测，并常规安排腰椎穿刺脑脊液检查以排除脑膜转移。","is_gold":false},{"letter":"L","text":"完善全身远处转移排查（如PET-CT或胸腹部CT联合骨扫描）及血浆EBV-DNA检测，并行超声引导下中心静脉穿刺置管及X线定位，为全身化疗做准备。","is_gold":true}],"gold_letter":"L"},{"sample_id":"sample-9833293530ca96a9a65dbbb8","patient_id":"patient-867f2373fc1b04e0b8b80452","turn_id":"turn04","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、鼻腔、翼外肌、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1750] 入院记录: 主诉: 间断性涕血3月，面麻、复视1月，耳鸣20天；现病史: 缘于3月余前患者无明显诱因出现间断性回吸性涕血，未予重视，一月前患者出现双侧面麻、复视，无鼻塞、头痛、视力下降等不适，遂就诊当地医院行鼻咽活检病理确诊鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 复视,涕血,双面麻；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟1包，30年，不嗜酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：88次/分，R：20次/分，BP：114/69mmHg,Ht：170cm，Wt：62kg，BSA：1.71m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率88次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1751] 检验组合: 阴离子间隙(AG)-静脉血: 18.2；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；平均血小板体积(MPV)-静脉血: 9.8fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.8；白细胞计数(WBC#)-静脉血: 6.2310E9/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 64.8umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阳性(+)（参考: 阴性）；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.92mmol/L；透明质酸(HA)-静脉血: 91.434ng/ml；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.4U/L；氯离子(Cl-)-静脉血: 101.8mmol/L；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 1.43ng/ml（参考: <0.704）；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；血小板比容-静脉血: 20%；活化部分凝血活酶时间(APTT)-静脉血: 27.5sec.；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.62；梅毒非特异性抗体甲苯胺红不加热血清试验(TRUST)-静脉血: 阴性(-)（参考: 阴性）；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；总钙(Ca)-静脉血: 2.27mmol/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.43；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；凝血酶时间(TT)-静脉血: 17.6sec.；间接胆红素(IBIL)-静脉血: 6.6umolL；凝血酶原时间活动度(PTA)-静脉血: 97.9%；降钙素(CT)-静脉血: 25.774pg/ml；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 44.9U/L……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 诱导化疗（吉西他滨+顺铂）序贯单纯根治性放疗\nB. 诱导化疗（洛铂+氟尿嘧啶）序贯同期放化疗\nC. 同期放化疗（顺铂单药）序贯辅助化疗\nD. 诱导化疗（多西他赛+顺铂+氟尿嘧啶）序贯单纯根治性放疗\nE. 诱导化疗（紫杉醇+卡铂）序贯同期放化疗\nF. 靶向治疗（西妥昔单抗）联合根治性放疗\nG. 诱导化疗（洛铂+氟尿嘧啶）联合特瑞普利单抗序贯同期放化疗\nH. 诱导化疗（依托泊苷+顺铂）序贯同期放化疗\nI. 单纯根治性放疗序贯辅助化疗\nJ. 诱导化疗（顺铂+氟尿嘧啶）序贯单纯根治性放疗\nK. 诱导化疗（吉西他滨+卡培他滨）序贯同期放化疗\nL. 姑息性化疗（洛铂+氟尿嘧啶）序贯姑息性放疗\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"诱导化疗（吉西他滨+顺铂）序贯单纯根治性放疗","is_gold":false},{"letter":"B","text":"诱导化疗（洛铂+氟尿嘧啶）序贯同期放化疗","is_gold":true},{"letter":"C","text":"同期放化疗（顺铂单药）序贯辅助化疗","is_gold":false},{"letter":"D","text":"诱导化疗（多西他赛+顺铂+氟尿嘧啶）序贯单纯根治性放疗","is_gold":false},{"letter":"E","text":"诱导化疗（紫杉醇+卡铂）序贯同期放化疗","is_gold":false},{"letter":"F","text":"靶向治疗（西妥昔单抗）联合根治性放疗","is_gold":false},{"letter":"G","text":"诱导化疗（洛铂+氟尿嘧啶）联合特瑞普利单抗序贯同期放化疗","is_gold":false},{"letter":"H","text":"诱导化疗（依托泊苷+顺铂）序贯同期放化疗","is_gold":false},{"letter":"I","text":"单纯根治性放疗序贯辅助化疗","is_gold":false},{"letter":"J","text":"诱导化疗（顺铂+氟尿嘧啶）序贯单纯根治性放疗","is_gold":false},{"letter":"K","text":"诱导化疗（吉西他滨+卡培他滨）序贯同期放化疗","is_gold":false},{"letter":"L","text":"姑息性化疗（洛铂+氟尿嘧啶）序贯姑息性放疗","is_gold":false}],"gold_letter":"B"},{"sample_id":"sample-5d0eff95cd33597017422fc5","patient_id":"patient-867f2373fc1b04e0b8b80452","turn_id":"turn05","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、鼻腔、翼外肌、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1750] 入院记录: 主诉: 间断性涕血3月，面麻、复视1月，耳鸣20天；现病史: 缘于3月余前患者无明显诱因出现间断性回吸性涕血，未予重视，一月前患者出现双侧面麻、复视，无鼻塞、头痛、视力下降等不适，遂就诊当地医院行鼻咽活检病理确诊鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 复视,涕血,双面麻；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟1包，30年，不嗜酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：88次/分，R：20次/分，BP：114/69mmHg,Ht：170cm，Wt：62kg，BSA：1.71m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率88次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1751] 检验组合: 阴离子间隙(AG)-静脉血: 18.2；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；平均血小板体积(MPV)-静脉血: 9.8fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.8；白细胞计数(WBC#)-静脉血: 6.2310E9/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 64.8umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阳性(+)（参考: 阴性）；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.92mmol/L；透明质酸(HA)-静脉血: 91.434ng/ml；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.4U/L；氯离子(Cl-)-静脉血: 101.8mmol/L；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 1.43ng/ml（参考: <0.704）；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；血小板比容-静脉血: 20%；活化部分凝血活酶时间(APTT)-静脉血: 27.5sec.；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.62；梅毒非特异性抗体甲苯胺红不加热血清试验(TRUST)-静脉血: 阴性(-)（参考: 阴性）；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；总钙(Ca)-静脉血: 2.27mmol/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.43；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；凝血酶时间(TT)-静脉血: 17.6sec.；间接胆红素(IBIL)-静脉血: 6.6umolL；凝血酶原时间活动度(PTA)-静脉血: 97.9%；降钙素(CT)-静脉血: 25.774pg/ml；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 44.9U/L……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1754] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右旁T7椎体上缘水平，估计位于上腔静脉内。；检查结论: PICC管位置如上所述。\n- [全程D1758] 检验组合: 红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.410E9/L；总胆红素(TBIL)-静脉血: 15.3umol/L；葡萄糖(Glu)-静脉血: 4.9mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.6pg；间接胆红素(IBIL)-静脉血: 10.2umolL；肌酐(Crea)-静脉血: 67.1umol/L；血小板计数(PLT#)-静脉血: 159.110E9/L；中性粒细胞计数(Neut#)-静脉血: 5.210E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；血小板比容-静脉血: 13.7%；氯离子(Cl-)-静脉血: 100.4mmol/L；尿素氮(BUN)-静脉血: 5.1mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；平均血小板体积(MPV)-静脉血: 8.66fL；白蛋白(ALB)-静脉血: 36.6g/L；载脂蛋白B(apoB)-静脉血: 0.97g/L；C-反应蛋白(CRP)-静脉血: 17.22mg/L；乳酸脱氢酶(LDH)-静脉血: 196.7U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.69mmol/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；尿酸(UA)-静脉血: 195.2umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.759；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.37；总胆固醇(TC)-静脉血: 4.18mmol/L；钾离子(K+)-静脉血: 4.29mmol/L；单核细胞百分比(Mono%)-静脉血: 0.062；α-L-岩藻糖苷酶(AFU)-静脉血: 34.2U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.97；直接胆红素(DBIL)-静脉血: 5.1umol/L；碱性磷酸酶(ALP)-静脉血: 54.4U/L；有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞体积(MCV)-静脉血: 90.4fL；白细胞计数(WBC#)-静脉血: 6.810E9/L；总蛋白(TP)-静脉血: 63.4g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15U/L；甘油三酯(TG)-静脉血: 0.61mmol/L；球蛋白(……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1751] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者入院第二天，无特殊不适主诉，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。复查血常规、生化常规结果无异常。[姓名已隐去]副医生信息已隐藏：现等待患者鼻咽颈部影像学检查结果，明确分期后再行进一步诊治，病情继观。\n- [全程D1752] 上级查房记录；[姓名已隐去]医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医师查房记录；病程内容: 患者入院第三天，无诉，体查情况基本同前，[姓名已隐去]医师查房后示：等待患者影像学检查结果，明确分期后再行进一步诊治，余治疗同前，继观。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1758] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者处于一程洛铂+5FU方案诱导化疗中，诉恶心、呕吐，一般情况可，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。复查血常规、生化常规结果基本正常，[姓名已隐去]副医生信息已隐藏：现患者已完成一程诱导化疗，情况尚可，予以止呕、护胃等对症支持，嘱今日可予以出院，按期返院，不适随诊。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 予以止呕、护胃等对症支持，继续住院观察至消化道反应完全缓解后再予出院，出院后按期返院行下一程治疗。\nB. 予以止呕、护胃等对症支持，办理出院；下一程化疗将洛铂及5-FU剂量下调20%，嘱院外每周复查血常规及肝肾功能。\nC. 予以止呕、护胃等对症支持，办理出院；嘱院外每周复查血常规及肝肾功能，定期进行PICC导管维护，按期返院行下一程治疗。\nD. 予以止呕、护胃等对症支持，办理出院；嘱院外预防性皮下注射重组人粒细胞刺激因子（G-CSF），每周复查血常规。\nE. 予以止呕、护胃等对症支持，办理出院；下一程化疗方案更改为吉西他滨+顺铂（GP方案），嘱院外每周复查血常规。\nF. 予以止呕、护胃等对症支持，办理出院；嘱院外每周复查血常规及肝肾功能，并拔除PICC导管以防感染。\nG. 予以止呕、护胃等对症支持，办理出院；嘱院外每月复查一次血常规及肝肾功能，按期返院行下一程治疗。\nH. 予以止呕、护胃等对症支持，办理出院；上报严重不良事件（SAE）并暂停临床试验入组治疗，转为常规放化疗。\nI. 予以止呕、护胃等对症支持，办理出院；嘱院外口服卡培他滨维持治疗，按期返院行下一程静脉化疗。\nJ. 予以止呕、护胃等对症支持，办理出院；嘱院外每周复查血常规及肝肾功能，并于院外立即开始同步放射治疗。\nK. 予以止呕、护胃等对症支持，常规留取大便隐血及行腹部CT检查排除消化道并发症后，再办理出院。\nL. 予以止呕、护胃等对症支持，办理出院；嘱院外每周复查血常规及肝肾功能，若出现发热则自行口服抗生素观察。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"予以止呕、护胃等对症支持，继续住院观察至消化道反应完全缓解后再予出院，出院后按期返院行下一程治疗。","is_gold":false},{"letter":"B","text":"予以止呕、护胃等对症支持，办理出院；下一程化疗将洛铂及5-FU剂量下调20%，嘱院外每周复查血常规及肝肾功能。","is_gold":false},{"letter":"C","text":"予以止呕、护胃等对症支持，办理出院；嘱院外每周复查血常规及肝肾功能，定期进行PICC导管维护，按期返院行下一程治疗。","is_gold":true},{"letter":"D","text":"予以止呕、护胃等对症支持，办理出院；嘱院外预防性皮下注射重组人粒细胞刺激因子（G-CSF），每周复查血常规。","is_gold":false},{"letter":"E","text":"予以止呕、护胃等对症支持，办理出院；下一程化疗方案更改为吉西他滨+顺铂（GP方案），嘱院外每周复查血常规。","is_gold":false},{"letter":"F","text":"予以止呕、护胃等对症支持，办理出院；嘱院外每周复查血常规及肝肾功能，并拔除PICC导管以防感染。","is_gold":false},{"letter":"G","text":"予以止呕、护胃等对症支持，办理出院；嘱院外每月复查一次血常规及肝肾功能，按期返院行下一程治疗。","is_gold":false},{"letter":"H","text":"予以止呕、护胃等对症支持，办理出院；上报严重不良事件（SAE）并暂停临床试验入组治疗，转为常规放化疗。","is_gold":false},{"letter":"I","text":"予以止呕、护胃等对症支持，办理出院；嘱院外口服卡培他滨维持治疗，按期返院行下一程静脉化疗。","is_gold":false},{"letter":"J","text":"予以止呕、护胃等对症支持，办理出院；嘱院外每周复查血常规及肝肾功能，并于院外立即开始同步放射治疗。","is_gold":false},{"letter":"K","text":"予以止呕、护胃等对症支持，常规留取大便隐血及行腹部CT检查排除消化道并发症后，再办理出院。","is_gold":false},{"letter":"L","text":"予以止呕、护胃等对症支持，办理出院；嘱院外每周复查血常规及肝肾功能，若出现发热则自行口服抗生素观察。","is_gold":false}],"gold_letter":"C"},{"sample_id":"sample-be610c2d167fae3585440ece","patient_id":"patient-867f2373fc1b04e0b8b80452","turn_id":"turn06","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、鼻腔、翼外肌、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1750] 入院记录: 主诉: 间断性涕血3月，面麻、复视1月，耳鸣20天；现病史: 缘于3月余前患者无明显诱因出现间断性回吸性涕血，未予重视，一月前患者出现双侧面麻、复视，无鼻塞、头痛、视力下降等不适，遂就诊当地医院行鼻咽活检病理确诊鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 复视,涕血,双面麻；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟1包，30年，不嗜酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：88次/分，R：20次/分，BP：114/69mmHg,Ht：170cm，Wt：62kg，BSA：1.71m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率88次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1751] 检验组合: 阴离子间隙(AG)-静脉血: 18.2；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；平均血小板体积(MPV)-静脉血: 9.8fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.8；白细胞计数(WBC#)-静脉血: 6.2310E9/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 64.8umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阳性(+)（参考: 阴性）；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.92mmol/L；透明质酸(HA)-静脉血: 91.434ng/ml；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.4U/L；氯离子(Cl-)-静脉血: 101.8mmol/L；I型胶原羧基端肽β-特殊系列(β-Crosslaps)-静脉血: 1.43ng/ml（参考: <0.704）；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；血小板比容-静脉血: 20%；活化部分凝血活酶时间(APTT)-静脉血: 27.5sec.；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.62；梅毒非特异性抗体甲苯胺红不加热血清试验(TRUST)-静脉血: 阴性(-)（参考: 阴性）；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；总钙(Ca)-静脉血: 2.27mmol/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.43；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；凝血酶时间(TT)-静脉血: 17.6sec.；间接胆红素(IBIL)-静脉血: 6.6umolL；凝血酶原时间活动度(PTA)-静脉血: 97.9%；降钙素(CT)-静脉血: 25.774pg/ml；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 44.9U/L……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1754] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右旁T7椎体上缘水平，估计位于上腔静脉内。；检查结论: PICC管位置如上所述。\n- [全程D1758] 检验组合: 红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.410E9/L；总胆红素(TBIL)-静脉血: 15.3umol/L；葡萄糖(Glu)-静脉血: 4.9mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.6pg；间接胆红素(IBIL)-静脉血: 10.2umolL；肌酐(Crea)-静脉血: 67.1umol/L；血小板计数(PLT#)-静脉血: 159.110E9/L；中性粒细胞计数(Neut#)-静脉血: 5.210E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；血小板比容-静脉血: 13.7%；氯离子(Cl-)-静脉血: 100.4mmol/L；尿素氮(BUN)-静脉血: 5.1mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；平均血小板体积(MPV)-静脉血: 8.66fL；白蛋白(ALB)-静脉血: 36.6g/L；载脂蛋白B(apoB)-静脉血: 0.97g/L；C-反应蛋白(CRP)-静脉血: 17.22mg/L；乳酸脱氢酶(LDH)-静脉血: 196.7U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.69mmol/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；尿酸(UA)-静脉血: 195.2umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.759；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.37；总胆固醇(TC)-静脉血: 4.18mmol/L；钾离子(K+)-静脉血: 4.29mmol/L；单核细胞百分比(Mono%)-静脉血: 0.062；α-L-岩藻糖苷酶(AFU)-静脉血: 34.2U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.97；直接胆红素(DBIL)-静脉血: 5.1umol/L；碱性磷酸酶(ALP)-静脉血: 54.4U/L；有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞体积(MCV)-静脉血: 90.4fL；白细胞计数(WBC#)-静脉血: 6.810E9/L；总蛋白(TP)-静脉血: 63.4g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15U/L；甘油三酯(TG)-静脉血: 0.61mmol/L；球蛋白(……\n- [全程D1772] 检验组合: 总胆红素(TBIL)-静脉血: 7.6umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.472；红细胞计数(RBC#)-静脉血: 4.2810E12/L；直接胆红素(DBIL)-静脉血: 1.4umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.281；中性粒细胞计数(Neut#)-静脉血: 1.810E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.07；载脂蛋白B(apoB)-静脉血: 1.11g/L；血小板比容-静脉血: 18%；磷(P)-静脉血: 1.23mmol/L；总蛋白(TP)-静脉血: 70.84g/L；平均红细胞体积(MCV)-静脉血: 93.5fL；间接胆红素(IBIL)-静脉血: 6.2umolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.78；丙氨酸氨基转移酶(ALT)-静脉血: 20.8U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.6pg；乳酸脱氢酶(LDH)-静脉血: 173.8U/L；白蛋白(ALB)-静脉血: 41.6g/L；钾离子(K+)-静脉血: 4.12mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 20.8mmol/L；钠离子(Na+)-静脉血: 140.8mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.55mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.33g/L；尿素氮(BUN)-静脉血: 5.1mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.42；甘油三酯(TG)-静脉血: 0.99mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.2；碱性磷酸酶(ALP)-静脉血: 67.2U/L；肌酐(Crea)-静脉血: 68.4umol/L；C-反应蛋白(CRP)-静脉血: 1.24mg/L；血小板计数(PLT#)-静脉血: 18110E9/L；红细胞比容(Hct)-静脉血: 40%；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 30.4U/L；血红蛋白(Hb)-静脉血: 131g/L；镁离子(Mg2+)-静脉血: 0.92mmol/L；平均红细胞血红蛋白……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1751] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者入院第二天，无特殊不适主诉，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。复查血常规、生化常规结果无异常。[姓名已隐去]副医生信息已隐藏：现等待患者鼻咽颈部影像学检查结果，明确分期后再行进一步诊治，病情继观。\n- [全程D1752] 上级查房记录；[姓名已隐去]医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医师查房记录；病程内容: 患者入院第三天，无诉，体查情况基本同前，[姓名已隐去]医师查房后示：等待患者影像学检查结果，明确分期后再行进一步诊治，余治疗同前，继观。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1758] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者处于一程洛铂+5FU方案诱导化疗中，诉恶心、呕吐，一般情况可，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。复查血常规、生化常规结果基本正常，[姓名已隐去]副医生信息已隐藏：现患者已完成一程诱导化疗，情况尚可，予以止呕、护胃等对症支持，嘱今日可予以出院，按期返院，不适随诊。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂缓化疗，予以重组人粒细胞集落刺激因子升白治疗，待中性粒细胞绝对值恢复至2.0×10^9/L以上再行第二周期化疗\nB. 开展第二周期洛铂+5-FU诱导化疗，将洛铂剂量下调20%，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃\nC. 终止诱导化疗，直接进入同期放化疗阶段，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nD. 按计划开展第二周期洛铂+5-FU诱导化疗，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗\nE. 开展第二周期洛铂+5-FU诱导化疗，暂不予以预防性止吐，待出现恶心呕吐症状时再予以甲氧氯普胺解痉止吐\nF. 更改化疗方案为紫杉醇+顺铂方案进行第二周期诱导化疗，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃\nG. 开展第二周期洛铂+5-FU诱导化疗，并预防性予以阿瑞匹坦、地塞米松联合5-HT3受体拮抗剂三联强效止吐\nH. 暂缓化疗，复查鼻咽颈部MRI评估一程化疗疗效，若肿瘤缩小则继续原方案，否则更改为紫杉醇+顺铂方案\nI. 开展第二周期洛铂+5-FU诱导化疗，将5-FU剂量下调25%，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃\nJ. 暂缓化疗，予以静脉高营养支持及补液治疗，待消化道症状完全缓解、体重增加后再行第二周期诱导化疗\nK. 退出临床试验，更改为顺铂+5-FU方案进行第二周期诱导化疗，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃\nL. 开展第二周期洛铂+5-FU诱导化疗，并预防性予以奥氮平联合地塞米松双联止吐及质子泵抑制剂护胃支持治疗\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"暂缓化疗，予以重组人粒细胞集落刺激因子升白治疗，待中性粒细胞绝对值恢复至2.0×10^9/L以上再行第二周期化疗","is_gold":false},{"letter":"B","text":"开展第二周期洛铂+5-FU诱导化疗，将洛铂剂量下调20%，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃","is_gold":false},{"letter":"C","text":"终止诱导化疗，直接进入同期放化疗阶段，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗","is_gold":false},{"letter":"D","text":"按计划开展第二周期洛铂+5-FU诱导化疗，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃等支持治疗","is_gold":true},{"letter":"E","text":"开展第二周期洛铂+5-FU诱导化疗，暂不予以预防性止吐，待出现恶心呕吐症状时再予以甲氧氯普胺解痉止吐","is_gold":false},{"letter":"F","text":"更改化疗方案为紫杉醇+顺铂方案进行第二周期诱导化疗，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃","is_gold":false},{"letter":"G","text":"开展第二周期洛铂+5-FU诱导化疗，并预防性予以阿瑞匹坦、地塞米松联合5-HT3受体拮抗剂三联强效止吐","is_gold":false},{"letter":"H","text":"暂缓化疗，复查鼻咽颈部MRI评估一程化疗疗效，若肿瘤缩小则继续原方案，否则更改为紫杉醇+顺铂方案","is_gold":false},{"letter":"I","text":"开展第二周期洛铂+5-FU诱导化疗，将5-FU剂量下调25%，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃","is_gold":false},{"letter":"J","text":"暂缓化疗，予以静脉高营养支持及补液治疗，待消化道症状完全缓解、体重增加后再行第二周期诱导化疗","is_gold":false},{"letter":"K","text":"退出临床试验，更改为顺铂+5-FU方案进行第二周期诱导化疗，并予以5-HT3受体拮抗剂止吐及质子泵抑制剂护胃","is_gold":false},{"letter":"L","text":"开展第二周期洛铂+5-FU诱导化疗，并预防性予以奥氮平联合地塞米松双联止吐及质子泵抑制剂护胃支持治疗","is_gold":false}],"gold_letter":"D"},{"sample_id":"sample-08c11518d363599b5511b9c9","patient_id":"patient-867f2373fc1b04e0b8b80452","turn_id":"turn07","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、鼻腔、翼外肌、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1750] 入院记录: 主诉: 间断性涕血3月，面麻、复视1月，耳鸣20天；现病史: 缘于3月余前患者无明显诱因出现间断性回吸性涕血，未予重视，一月前患者出现双侧面麻、复视，无鼻塞、头痛、视力下降等不适，遂就诊当地医院行鼻咽活检病理确诊鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 复视,涕血,双面麻；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟1包，30年，不嗜酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：88次/分，R：20次/分，BP：114/69mmHg,Ht：170cm，Wt：62kg，BSA：1.71m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率88次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1754] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右旁T7椎体上缘水平，估计位于上腔静脉内。；检查结论: PICC管位置如上所述。\n- [全程D1758] 检验组合: 红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.410E9/L；总胆红素(TBIL)-静脉血: 15.3umol/L；葡萄糖(Glu)-静脉血: 4.9mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.6pg；间接胆红素(IBIL)-静脉血: 10.2umolL；肌酐(Crea)-静脉血: 67.1umol/L；血小板计数(PLT#)-静脉血: 159.110E9/L；中性粒细胞计数(Neut#)-静脉血: 5.210E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；血小板比容-静脉血: 13.7%；氯离子(Cl-)-静脉血: 100.4mmol/L；尿素氮(BUN)-静脉血: 5.1mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；平均血小板体积(MPV)-静脉血: 8.66fL；白蛋白(ALB)-静脉血: 36.6g/L；载脂蛋白B(apoB)-静脉血: 0.97g/L；C-反应蛋白(CRP)-静脉血: 17.22mg/L；乳酸脱氢酶(LDH)-静脉血: 196.7U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.69mmol/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；尿酸(UA)-静脉血: 195.2umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.759；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.37；总胆固醇(TC)-静脉血: 4.18mmol/L；钾离子(K+)-静脉血: 4.29mmol/L；单核细胞百分比(Mono%)-静脉血: 0.062；α-L-岩藻糖苷酶(AFU)-静脉血: 34.2U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.97；直接胆红素(DBIL)-静脉血: 5.1umol/L；碱性磷酸酶(ALP)-静脉血: 54.4U/L；有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞体积(MCV)-静脉血: 90.4fL；白细胞计数(WBC#)-静脉血: 6.810E9/L；总蛋白(TP)-静脉血: 63.4g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15U/L；甘油三酯(TG)-静脉血: 0.61mmol/L；球蛋白(……\n- [全程D1772] 检验组合: 总胆红素(TBIL)-静脉血: 7.6umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.472；红细胞计数(RBC#)-静脉血: 4.2810E12/L；直接胆红素(DBIL)-静脉血: 1.4umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.281；中性粒细胞计数(Neut#)-静脉血: 1.810E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.07；载脂蛋白B(apoB)-静脉血: 1.11g/L；血小板比容-静脉血: 18%；磷(P)-静脉血: 1.23mmol/L；总蛋白(TP)-静脉血: 70.84g/L；平均红细胞体积(MCV)-静脉血: 93.5fL；间接胆红素(IBIL)-静脉血: 6.2umolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.78；丙氨酸氨基转移酶(ALT)-静脉血: 20.8U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.6pg；乳酸脱氢酶(LDH)-静脉血: 173.8U/L；白蛋白(ALB)-静脉血: 41.6g/L；钾离子(K+)-静脉血: 4.12mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 20.8mmol/L；钠离子(Na+)-静脉血: 140.8mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.55mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.33g/L；尿素氮(BUN)-静脉血: 5.1mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.42；甘油三酯(TG)-静脉血: 0.99mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.2；碱性磷酸酶(ALP)-静脉血: 67.2U/L；肌酐(Crea)-静脉血: 68.4umol/L；C-反应蛋白(CRP)-静脉血: 1.24mg/L；血小板计数(PLT#)-静脉血: 18110E9/L；红细胞比容(Hct)-静脉血: 40%；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 30.4U/L；血红蛋白(Hb)-静脉血: 131g/L；镁离子(Mg2+)-静脉血: 0.92mmol/L；平均红细胞血红蛋白……\n- [全程D1777] 检验组合: 低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.92mmol/L；尿素氮(BUN)-静脉血: 5.65mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；载脂蛋白B(apoB)-静脉血: 1.12g/L；平均红细胞体积(MCV)-静脉血: 91.7fL；中性粒细胞计数(Neut#)-静脉血: 3.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.108；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336.6g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.8；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.23mmolL；血小板比容-静脉血: 11.1%；血红蛋白(Hb)-静脉血: 131.2g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.6mmol/L；甘油三酯(TG)-静脉血: 0.96mmol/L；镁离子(Mg2+)-静脉血: 1.02mmol/L；总胆固醇(TC)-静脉血: 5.75mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.510E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；直接胆红素(DBIL)-静脉血: 5.7umol/L；总蛋白(TP)-静脉血: 68.83g/L；白蛋白(ALB)-静脉血: 37.6g/L；钾离子(K+)-静脉血: 4.1mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；尿酸(UA)-静脉血: 299.7umol/L；碱性磷酸酶(ALP)-静脉血: 64.4U/L；阴离子间隙(AG)-静脉血: 13；氯离子(Cl-)-静脉血: 101.5mmol/L；球蛋白(GLO)-静脉血: 31.23g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1%；血小板分布宽度(PDW)-静脉血: 17.9%；间接胆红素(IBIL)-静脉血: 12.7umolL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；丙氨酸氨基转移酶(ALT)-静脉血: 23.7U/L；C-反……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- [全程D1758] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者处于一程洛铂+5FU方案诱导化疗中，诉恶心、呕吐，一般情况可，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。复查血常规、生化常规结果基本正常，[姓名已隐去]副医生信息已隐藏：现患者已完成一程诱导化疗，情况尚可，予以止呕、护胃等对症支持，嘱今日可予以出院，按期返院，不适随诊。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1774] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者入院第二天，诉复视、面麻未见好转，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经（-）。复查血常规、生化常规结果无异常。[姓名已隐去]副医生信息已隐藏：现患者入院行第一程洛铂+5FU方案诱导化疗中，目前患者情况尚可，继续予以止呕、护胃、加强营养等对症支持治疗，病情继观。\n- [全程D1775] 上级查房记录；[姓名已隐去]医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医师查房记录；病程内容: 患者入院第三天，无诉，体查情况基本同前，[姓名已隐去]医师查房后示：现患者第一程洛铂+5FU方案诱导化疗中，目前患者情况尚可，继续予以对症支持治疗，病情继观。\n- [全程D1779] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现基本完成一程诱导化疗，诉恶心，一般情况尚可，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经（-）。复查血常规、生化常规结果基本正常，[姓名已隐去]副医生信息已隐藏：现患者情况尚可，嘱今日可予以出院，按期返院，不适随诊。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 继续行洛铂联合5-FU方案第3程诱导化疗，予以重组人粒细胞刺激因子支持治疗，暂缓放疗。\nB. 启动根治性放疗及同步化疗，每周复查血常规，暂不予以重组人白介素-11及粒细胞刺激因子。\nC. 准备行根治性放疗及同步化疗，予以重组人促红素及重组人粒细胞刺激因子支持治疗，动态复查血常规。\nD. 更改化疗方案为吉西他滨联合顺铂诱导化疗，予以重组人白介素-11支持治疗，暂缓放疗。\nE. 准备行根治性放疗及同步化疗，予以输注单采血小板及红细胞悬液支持治疗，动态复查血常规。\nF. 准备行根治性放疗及同步化疗，因骨髓抑制降低同步化疗药物剂量，予以重组人粒细胞刺激因子支持治疗。\nG. 继续行洛铂联合5-FU方案第3程诱导化疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗。\nH. 准备行单纯根治性放疗，取消同步化疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗。\nI. 转为姑息性放疗及最佳支持治疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗。\nJ. 准备行根治性放疗及同步化疗，予以重组人血小板生成素支持治疗，暂不使用粒细胞刺激因子。\nK. 暂停抗肿瘤治疗，待血象自然恢复后，再行第3程洛铂联合5-FU方案诱导化疗，暂缓放疗。\n\n请仅输出一个选项字母（A-K）。","options":[{"letter":"A","text":"继续行洛铂联合5-FU方案第3程诱导化疗，予以重组人粒细胞刺激因子支持治疗，暂缓放疗。","is_gold":false},{"letter":"B","text":"启动根治性放疗及同步化疗，每周复查血常规，暂不予以重组人白介素-11及粒细胞刺激因子。","is_gold":true},{"letter":"C","text":"准备行根治性放疗及同步化疗，予以重组人促红素及重组人粒细胞刺激因子支持治疗，动态复查血常规。","is_gold":false},{"letter":"D","text":"更改化疗方案为吉西他滨联合顺铂诱导化疗，予以重组人白介素-11支持治疗，暂缓放疗。","is_gold":false},{"letter":"E","text":"准备行根治性放疗及同步化疗，予以输注单采血小板及红细胞悬液支持治疗，动态复查血常规。","is_gold":false},{"letter":"F","text":"准备行根治性放疗及同步化疗，因骨髓抑制降低同步化疗药物剂量，予以重组人粒细胞刺激因子支持治疗。","is_gold":false},{"letter":"G","text":"继续行洛铂联合5-FU方案第3程诱导化疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗。","is_gold":false},{"letter":"H","text":"准备行单纯根治性放疗，取消同步化疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗。","is_gold":false},{"letter":"I","text":"转为姑息性放疗及最佳支持治疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗。","is_gold":false},{"letter":"J","text":"准备行根治性放疗及同步化疗，予以重组人血小板生成素支持治疗，暂不使用粒细胞刺激因子。","is_gold":false},{"letter":"K","text":"暂停抗肿瘤治疗，待血象自然恢复后，再行第3程洛铂联合5-FU方案诱导化疗，暂缓放疗。","is_gold":false}],"gold_letter":"B"},{"sample_id":"sample-070df43e0c39a4c5f77b459e","patient_id":"patient-867f2373fc1b04e0b8b80452","turn_id":"turn08","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、鼻腔、翼外肌、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1750] 入院记录: 主诉: 间断性涕血3月，面麻、复视1月，耳鸣20天；现病史: 缘于3月余前患者无明显诱因出现间断性回吸性涕血，未予重视，一月前患者出现双侧面麻、复视，无鼻塞、头痛、视力下降等不适，遂就诊当地医院行鼻咽活检病理确诊鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 复视,涕血,双面麻；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟1包，30年，不嗜酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：88次/分，R：20次/分，BP：114/69mmHg,Ht：170cm，Wt：62kg，BSA：1.71m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率88次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1754] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右旁T7椎体上缘水平，估计位于上腔静脉内。；检查结论: PICC管位置如上所述。\n- [全程D1758] 检验组合: 红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.410E9/L；总胆红素(TBIL)-静脉血: 15.3umol/L；葡萄糖(Glu)-静脉血: 4.9mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.6pg；间接胆红素(IBIL)-静脉血: 10.2umolL；肌酐(Crea)-静脉血: 67.1umol/L；血小板计数(PLT#)-静脉血: 159.110E9/L；中性粒细胞计数(Neut#)-静脉血: 5.210E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；血小板比容-静脉血: 13.7%；氯离子(Cl-)-静脉血: 100.4mmol/L；尿素氮(BUN)-静脉血: 5.1mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；平均血小板体积(MPV)-静脉血: 8.66fL；白蛋白(ALB)-静脉血: 36.6g/L；载脂蛋白B(apoB)-静脉血: 0.97g/L；C-反应蛋白(CRP)-静脉血: 17.22mg/L；乳酸脱氢酶(LDH)-静脉血: 196.7U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.69mmol/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；尿酸(UA)-静脉血: 195.2umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.759；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.37；总胆固醇(TC)-静脉血: 4.18mmol/L；钾离子(K+)-静脉血: 4.29mmol/L；单核细胞百分比(Mono%)-静脉血: 0.062；α-L-岩藻糖苷酶(AFU)-静脉血: 34.2U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.97；直接胆红素(DBIL)-静脉血: 5.1umol/L；碱性磷酸酶(ALP)-静脉血: 54.4U/L；有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞体积(MCV)-静脉血: 90.4fL；白细胞计数(WBC#)-静脉血: 6.810E9/L；总蛋白(TP)-静脉血: 63.4g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15U/L；甘油三酯(TG)-静脉血: 0.61mmol/L；球蛋白(……\n- [全程D1772] 检验组合: 总胆红素(TBIL)-静脉血: 7.6umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.472；红细胞计数(RBC#)-静脉血: 4.2810E12/L；直接胆红素(DBIL)-静脉血: 1.4umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.281；中性粒细胞计数(Neut#)-静脉血: 1.810E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.07；载脂蛋白B(apoB)-静脉血: 1.11g/L；血小板比容-静脉血: 18%；磷(P)-静脉血: 1.23mmol/L；总蛋白(TP)-静脉血: 70.84g/L；平均红细胞体积(MCV)-静脉血: 93.5fL；间接胆红素(IBIL)-静脉血: 6.2umolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.78；丙氨酸氨基转移酶(ALT)-静脉血: 20.8U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.6pg；乳酸脱氢酶(LDH)-静脉血: 173.8U/L；白蛋白(ALB)-静脉血: 41.6g/L；钾离子(K+)-静脉血: 4.12mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 20.8mmol/L；钠离子(Na+)-静脉血: 140.8mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.55mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.33g/L；尿素氮(BUN)-静脉血: 5.1mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.42；甘油三酯(TG)-静脉血: 0.99mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.2；碱性磷酸酶(ALP)-静脉血: 67.2U/L；肌酐(Crea)-静脉血: 68.4umol/L；C-反应蛋白(CRP)-静脉血: 1.24mg/L；血小板计数(PLT#)-静脉血: 18110E9/L；红细胞比容(Hct)-静脉血: 40%；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 30.4U/L；血红蛋白(Hb)-静脉血: 131g/L；镁离子(Mg2+)-静脉血: 0.92mmol/L；平均红细胞血红蛋白……\n- [全程D1777] 检验组合: 低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.92mmol/L；尿素氮(BUN)-静脉血: 5.65mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；载脂蛋白B(apoB)-静脉血: 1.12g/L；平均红细胞体积(MCV)-静脉血: 91.7fL；中性粒细胞计数(Neut#)-静脉血: 3.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.108；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336.6g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.8；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.23mmolL；血小板比容-静脉血: 11.1%；血红蛋白(Hb)-静脉血: 131.2g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.6mmol/L；甘油三酯(TG)-静脉血: 0.96mmol/L；镁离子(Mg2+)-静脉血: 1.02mmol/L；总胆固醇(TC)-静脉血: 5.75mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.510E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；直接胆红素(DBIL)-静脉血: 5.7umol/L；总蛋白(TP)-静脉血: 68.83g/L；白蛋白(ALB)-静脉血: 37.6g/L；钾离子(K+)-静脉血: 4.1mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；尿酸(UA)-静脉血: 299.7umol/L；碱性磷酸酶(ALP)-静脉血: 64.4U/L；阴离子间隙(AG)-静脉血: 13；氯离子(Cl-)-静脉血: 101.5mmol/L；球蛋白(GLO)-静脉血: 31.23g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1%；血小板分布宽度(PDW)-静脉血: 17.9%；间接胆红素(IBIL)-静脉血: 12.7umolL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；丙氨酸氨基转移酶(ALT)-静脉血: 23.7U/L；C-反……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1782] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁、顶后壁及双侧壁粘膜增厚形成软组织影放射性浓聚，SUV约15.6，病灶侵犯蝶窦、蝶骨体、右侧蝶骨翼、蝶骨基底部、枕骨基底部、枕骨斜坡、右侧颈动脉孔、右侧破裂孔、右侧岩枕裂、右侧桥小脑角、右侧颞骨岩尖、双侧翼突基底部、右翼突内/外板、双侧鼻后孔、右翼腭窝、鼻中隔后份、双侧中鼻甲后份、左侧下鼻甲后份、右侧咽旁/咽后间隙、右侧头长肌、右侧腭帆张/提肌及右翼内肌，累及左侧翼腭窝，堵塞鼻咽腔。双侧咽隐窝消失。双侧咽后小淋巴结放射性较浓密，SUV约4.1，大者约0.8×0.9cm。口咽、喉咽未见异常。蝶窦、筛窦、双侧上颌窦及双侧乳突内低密度影放射性分布未见明显异常。双侧海绵窦放射性分布未见明显异常。甲状腺放射性分布未见明显异常。左颈II区数个淋巴结放射性浓聚，SUV约21.9，大者约1.1×1.5cm；右颈II区数个小淋巴结放射性较浓密，SUV约2.7，大者约0.6×0.7cm；余双颈未见肿大淋巴结及异常放射性分布。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺多发条片影放射性分布未见明显异常；余双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔右下气管旁及右肺门数个小淋巴结放射性略浓密。左肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏形态、结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺、膀胱、肠管等形态、结构及放射性分布未见明显异常。双侧髂血管旁及双侧腹股沟未见肿大淋巴结及异常放射性分布。 L5棘突局部放射性略浓密（良性病变）。左髂骨小片状低密度影放射性稀疏（良性病变）。所见颅盖骨、余躯干骨及四肢骨结构及放射性分布未见明显异常。 鼻咽局部代谢较活跃，双侧扁桃体代谢较活跃，双颈II区小淋巴结代谢稍活跃，考虑炎性病变。；检查结论: 鼻咽病灶代谢活跃，符合鼻咽癌，侵犯范围如上述；双侧咽后小淋巴结代谢较活跃，左颈II区数个淋巴结……\n\n【既往治疗与反应】\n- [全程D1758] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者处于一程洛铂+5FU方案诱导化疗中，诉恶心、呕吐，一般情况可，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：右VI（+）、双侧V2（+）。复查血常规、生化常规结果基本正常，[姓名已隐去]副医生信息已隐藏：现患者已完成一程诱导化疗，情况尚可，予以止呕、护胃等对症支持，嘱今日可予以出院，按期返院，不适随诊。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1774] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者入院第二天，诉复视、面麻未见好转，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经（-）。复查血常规、生化常规结果无异常。[姓名已隐去]副医生信息已隐藏：现患者入院行第一程洛铂+5FU方案诱导化疗中，目前患者情况尚可，继续予以止呕、护胃、加强营养等对症支持治疗，病情继观。\n- [全程D1775] 上级查房记录；[姓名已隐去]医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医师查房记录；病程内容: 患者入院第三天，无诉，体查情况基本同前，[姓名已隐去]医师查房后示：现患者第一程洛铂+5FU方案诱导化疗中，目前患者情况尚可，继续予以对症支持治疗，病情继观。\n- [全程D1779] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现基本完成一程诱导化疗，诉恶心，一般情况尚可，体查情况：张口门齿距4.5cm；鼻咽右侧壁肿物；双侧颈部未扪及肿大淋巴结；颅神经（-）。复查血常规、生化常规结果基本正常，[姓名已隐去]副医生信息已隐藏：现患者情况尚可，嘱今日可予以出院，按期返院，不适随诊。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即开展根治性放疗及顺铂同步化疗，期间定期监测血常规，暂不予造血生长因子干预。\nB. 予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及顺铂同步化疗。\nC. 仅予以重组人白介素-11升血小板治疗，动态复查血常规，并序贯开展根治性放疗及顺铂同步化疗。\nD. 立即开展根治性放疗及洛铂同步化疗，期间定期监测血常规，暂不予造血生长因子干预。\nE. 仅予以重组人粒细胞刺激因子升白细胞治疗，动态复查血常规，并序贯开展根治性放疗及洛铂同步化疗。\nF. 予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及洛铂同步化疗。\nG. 予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并转为洛铂单药姑息性化疗。\nH. 予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展开放性手术切除原发灶及颈部淋巴结。\nI. 予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及西妥昔单抗靶向治疗。\nJ. 予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及PD-1抑制剂免疫治疗。\nK. 暂暂停抗肿瘤治疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，待血象恢复后继续行第三程洛铂+5FU诱导化疗。\nL. 予以输注单采血小板及洗涤红细胞支持治疗，动态复查血常规，并序贯开展根治性放疗及洛铂同步化疗。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"立即开展根治性放疗及顺铂同步化疗，期间定期监测血常规，暂不予造血生长因子干预。","is_gold":false},{"letter":"B","text":"予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及顺铂同步化疗。","is_gold":false},{"letter":"C","text":"仅予以重组人白介素-11升血小板治疗，动态复查血常规，并序贯开展根治性放疗及顺铂同步化疗。","is_gold":false},{"letter":"D","text":"立即开展根治性放疗及洛铂同步化疗，期间定期监测血常规，暂不予造血生长因子干预。","is_gold":true},{"letter":"E","text":"仅予以重组人粒细胞刺激因子升白细胞治疗，动态复查血常规，并序贯开展根治性放疗及洛铂同步化疗。","is_gold":false},{"letter":"F","text":"予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及洛铂同步化疗。","is_gold":false},{"letter":"G","text":"予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并转为洛铂单药姑息性化疗。","is_gold":false},{"letter":"H","text":"予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展开放性手术切除原发灶及颈部淋巴结。","is_gold":false},{"letter":"I","text":"予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及西妥昔单抗靶向治疗。","is_gold":false},{"letter":"J","text":"予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，动态复查血常规，并序贯开展根治性放疗及PD-1抑制剂免疫治疗。","is_gold":false},{"letter":"K","text":"暂暂停抗肿瘤治疗，予以重组人白介素-11及重组人粒细胞刺激因子支持治疗，待血象恢复后继续行第三程洛铂+5FU诱导化疗。","is_gold":false},{"letter":"L","text":"予以输注单采血小板及洗涤红细胞支持治疗，动态复查血常规，并序贯开展根治性放疗及洛铂同步化疗。","is_gold":false}],"gold_letter":"D"}]}
+{"patient_id":"patient-5731cc38ced94b2ee39c442a","bootstrap_cluster_id":"cluster-024","turns":[{"sample_id":"sample-ce0b8b89ec8b1d9a2405353d","patient_id":"patient-5731cc38ced94b2ee39c442a","turn_id":"turn01","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、蝶窦、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 左耳闷涉不适1年，涕血2月。；某次就诊时间特来我院门诊进一步诊治，完善相关检查，诊断明确后，今日入院系统治疗。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,左耳闷胀感,涕血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。有吸烟史1年，日7支；少量饮酒。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：90次/分，R：20次/分，BP：131/86mmHg,Ht：171cm，Wt：76.5kg，BSA1.89m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶壁、顶后壁、双侧壁结节状肿物；左侧颈部II区可扪及1个淋巴结，最大径2cm×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善鼻咽+颈部增强CT，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查，择期行颈部淋巴结穿刺活检。\nB. 完善鼻咽镜及活检，鼻咽+颈部增强CT，胸腹部超声及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。\nC. 完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，常规血液学检查，暂缓EBV相关检测。\nD. 完善鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查，若影像典型直接开始放化疗。\nE. 完善鼻咽镜及活检，头颅增强MRI，颈部超声，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。\nF. 完善鼻咽镜及活检，鼻咽+颈部平扫MRI，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。\nG. 完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描（或PET-CT），EBV-DNA及抗体检测，常规血液学检查。\nH. 完善鼻咽镜及活检，鼻咽+颈部增强MRI，EBV-DNA及抗体检测，常规血液学检查，待局部放疗结束后再行全身转移排查。\nI. 完善颈部淋巴结切除活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。\nJ. 完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，常规血液学检查，并立即行诱导化疗。\nK. 完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸部X线，腹部超声，全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。\nL. 完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查，并预防性行气管切开。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"完善鼻咽+颈部增强CT，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查，择期行颈部淋巴结穿刺活检。","is_gold":false},{"letter":"B","text":"完善鼻咽镜及活检，鼻咽+颈部增强CT，胸腹部超声及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。","is_gold":false},{"letter":"C","text":"完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，常规血液学检查，暂缓EBV相关检测。","is_gold":false},{"letter":"D","text":"完善鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查，若影像典型直接开始放化疗。","is_gold":false},{"letter":"E","text":"完善鼻咽镜及活检，头颅增强MRI，颈部超声，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。","is_gold":false},{"letter":"F","text":"完善鼻咽镜及活检，鼻咽+颈部平扫MRI，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。","is_gold":false},{"letter":"G","text":"完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描（或PET-CT），EBV-DNA及抗体检测，常规血液学检查。","is_gold":true},{"letter":"H","text":"完善鼻咽镜及活检，鼻咽+颈部增强MRI，EBV-DNA及抗体检测，常规血液学检查，待局部放疗结束后再行全身转移排查。","is_gold":false},{"letter":"I","text":"完善颈部淋巴结切除活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。","is_gold":false},{"letter":"J","text":"完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，常规血液学检查，并立即行诱导化疗。","is_gold":false},{"letter":"K","text":"完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸部X线，腹部超声，全身骨扫描，EBV-DNA及抗体检测，常规血液学检查。","is_gold":false},{"letter":"L","text":"完善鼻咽镜及活检，鼻咽+颈部增强MRI，胸腹部CT及全身骨扫描，EBV-DNA及抗体检测，常规血液学检查，并预防性行气管切开。","is_gold":false}],"gold_letter":"G"},{"sample_id":"sample-e3ed1270448c84eefbda9f61","patient_id":"patient-5731cc38ced94b2ee39c442a","turn_id":"turn02","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、蝶窦、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 暂无可展示的初诊主诉/入院资料。\n\n【已完成检查与客观结果】\n- [全程D0] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.51；平均红细胞血红蛋白含量(MCH)-静脉血: 27.4pg；磷(P)-静脉血: 0.9mmol/L；直接胆红素(DBIL)-静脉血: 4.7umol/L；凝血酶时间(TT)-静脉血: 22.7sec.；D-二聚体(D-Dimer)-静脉血: 0.29ug/ml；活化部分凝血活酶时间(APTT)-静脉血: 38.5sec.；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.04S/CO；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.82mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.6；单核细胞百分比(Mono%)-静脉血: 0.047；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；间接胆红素(IBIL)-静脉血: 10.5umolL；白蛋白(ALB)-静脉血: 48g/L；氯离子(Cl-)-静脉血: 101.7mmol/L；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.718；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.1COI；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；白细胞计数(WBC#)-静脉血: 6.9510E9/L；红细胞比容(Hct)-静脉血: 46.8%；尿酸(UA)-静脉血: 431.8umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 81.8umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 26mmol/L；血小板分布宽度(PDW)-静脉血: 11.2%；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.04S/CO；平均血小板体积(MPV)-静脉血: 9.7fL；中性粒细胞计数(Neut#)-静脉血: 510E9/L；载脂蛋白B(apoB)-静脉血: 0.96g/L；凝血酶原时间(PT)-静脉血: 11.8sec.；钠离子(Na+)-静脉血: 138.7mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；甘油三酯(TG)-静脉血: 2.2mmol/L；总胆红素(TBIL)-……\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 Ⅱ、Ⅲ、aVF、V5、V6导联T波低平\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、后壁及双侧壁增厚，见软组织肿物向鼻咽腔内突出，在T1WI上呈等信号，在T2WI上呈稍高信号，增强扫描明显强化。双侧咽隐窝变浅，见软组织肿物填充。病灶侵犯左侧后鼻孔，侵犯左侧腭帆张提肌、左侧翼内肌头部、左侧咽旁脂肪间隙，侵犯蝶窦左侧份及左侧翼腭窝，侵犯左侧破裂孔、左侧海绵窦。 右侧咽旁间隙及双侧颈动脉鞘区血管未见明显异常。右侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常。口咽双侧壁未见增厚。 斜坡、左侧岩尖、蝶骨基底部、左侧翼突区骨质信号减低，增强扫描明显强化。 右侧海绵窦形态正常，未见增宽。 双侧筛窦、左侧上颌窦、蝶窦及右侧乳突粘膜增厚，左侧乳突内见大量长分期信息见历史辅助诊断节点长分期信息见历史辅助诊断节点信号分泌物。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变。 左侧咽后可见数个小淋巴结，较大短径约4mm；右侧咽后可见小淋巴结，短径约2mm。左颈II、III区可见数个淋巴结，最大约21mm×15mm，部分呈相互融合改变，边界欠清，增强扫描可见明显强化。右颈II、III区可见数个淋巴结，最大约12mm×7mm，边界清。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质破坏。 左颈II、III区淋巴结肿大，考虑转移。 左侧咽后、右颈II、III区淋巴结，不排除转移。 右侧咽后小淋巴结。 鼻窦炎。双侧乳突炎。\n- [全程D5] 检验组合: EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；Rh血型-静脉血: 阳性；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；ABO血型-静脉血: O\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善胸部CT、腹部CT及全身骨扫描，并补充颈部淋巴结切除活检\nB. 完善全身PET-CT检查，并补充颈部淋巴结穿刺活检\nC. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充头颈部CTA检查\nD. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充颈部淋巴结穿刺活检\nE. 完善胸部CT、腹部CT，并补充脑部MRI平扫及增强\nF. 完善全身骨扫描及脑部MRI增强，并补充血浆EBV DNA定量检测\nG. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充鼻咽脱落细胞学检查\nH. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充血浆EBV DNA定量检测\nI. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充骨髓穿刺活检\nJ. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充EBV抗体滴度复查\nK. 完善胸部CT、腹部CT及全身骨扫描，并补充头颅PET-MR检查\nL. 完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并立即开始诱导化疗\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"完善胸部CT、腹部CT及全身骨扫描，并补充颈部淋巴结切除活检","is_gold":false},{"letter":"B","text":"完善全身PET-CT检查，并补充颈部淋巴结穿刺活检","is_gold":false},{"letter":"C","text":"完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充头颈部CTA检查","is_gold":false},{"letter":"D","text":"完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充颈部淋巴结穿刺活检","is_gold":false},{"letter":"E","text":"完善胸部CT、腹部CT，并补充脑部MRI平扫及增强","is_gold":false},{"letter":"F","text":"完善全身骨扫描及脑部MRI增强，并补充血浆EBV DNA定量检测","is_gold":false},{"letter":"G","text":"完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充鼻咽脱落细胞学检查","is_gold":false},{"letter":"H","text":"完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充血浆EBV DNA定量检测","is_gold":true},{"letter":"I","text":"完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充骨髓穿刺活检","is_gold":false},{"letter":"J","text":"完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并补充EBV抗体滴度复查","is_gold":false},{"letter":"K","text":"完善胸部CT、腹部CT及全身骨扫描，并补充头颅PET-MR检查","is_gold":false},{"letter":"L","text":"完善胸部X线片、腹部及腹主动脉旁淋巴结彩超，并立即开始诱导化疗","is_gold":false}],"gold_letter":"H"},{"sample_id":"sample-cd1385d4e13dda199ba81658","patient_id":"patient-5731cc38ced94b2ee39c442a","turn_id":"turn05","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、蝶窦、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D0] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.51；平均红细胞血红蛋白含量(MCH)-静脉血: 27.4pg；磷(P)-静脉血: 0.9mmol/L；直接胆红素(DBIL)-静脉血: 4.7umol/L；凝血酶时间(TT)-静脉血: 22.7sec.；D-二聚体(D-Dimer)-静脉血: 0.29ug/ml；活化部分凝血活酶时间(APTT)-静脉血: 38.5sec.；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.04S/CO；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.82mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.6；单核细胞百分比(Mono%)-静脉血: 0.047；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；间接胆红素(IBIL)-静脉血: 10.5umolL；白蛋白(ALB)-静脉血: 48g/L；氯离子(Cl-)-静脉血: 101.7mmol/L；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.718；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.1COI；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；白细胞计数(WBC#)-静脉血: 6.9510E9/L；红细胞比容(Hct)-静脉血: 46.8%；尿酸(UA)-静脉血: 431.8umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 81.8umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 26mmol/L；血小板分布宽度(PDW)-静脉血: 11.2%；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.04S/CO；平均血小板体积(MPV)-静脉血: 9.7fL；中性粒细胞计数(Neut#)-静脉血: 510E9/L；载脂蛋白B(apoB)-静脉血: 0.96g/L；凝血酶原时间(PT)-静脉血: 11.8sec.；钠离子(Na+)-静脉血: 138.7mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；甘油三酯(TG)-静脉血: 2.2mmol/L；总胆红素(TBIL)-……\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 Ⅱ、Ⅲ、aVF、V5、V6导联T波低平\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D24] 检验组合: 天门冬氨酸氨基转移酶(AST)-静脉血: 20.1U/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；血小板分布宽度(PDW)-静脉血: 11.9%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.1；尿素氮(BUN)-静脉血: 3.6mmol/L；磷(P)-静脉血: 0.97mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21.8U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.55；丙氨酸氨基转移酶(ALT)-静脉血: 41U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.19mmol/L；葡萄糖(Glu)-静脉血: 5.41mmol/L；白蛋白(ALB)-静脉血: 46.9g/L；白细胞计数(WBC#)-静脉血: 5.2810E9/L；红细胞计数(RBC#)-静脉血: 5.3910E12/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.6；尿酸(UA)-静脉血: 386.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 27U/L；C-反应蛋白(CRP)-静脉血: 4.25mg/L；钾离子(K+)-静脉血: 4.08mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.051；载脂蛋白B(apoB)-静脉血: 1.1g/L；球蛋白(GLO)-静脉血: 30.3g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；平均血小板体积(MPV)-静脉血: 10.3fL；总胆汁酸(TBA)-静脉血: 1.8umol/L；总蛋白(TP)-静脉血: 77.2g/L；间接胆红素(IBIL)-静脉血: 11.1umolL；甘油三酯(TG)-静脉血: 1.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.08g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.310E9/L；氯离子(Cl-)-静脉血: 102.2mmol/L；单核细胞百分比(Mono%)-静脉血: 0.072；碱性磷酸酶(ALP)-静脉血: 82.4U/L；总胆红素(TBIL)-静脉血: 15.1umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.49；总胆固醇(TC)-静脉血: 4.74mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.237；血小板比容……\n- [全程D25] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右侧约平T6椎体下缘水平，估计导管末端位于上腔静脉下段内。；检查结论: PICC管位置如上所述。\n- [全程D25] 检验组合: 浊度(TRUB)-尿液: clear；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 5.5；葡萄糖(Glu)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；虫卵-粪便: 未见虫卵（参考: 未见虫卵）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 30/μL；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；隐血(OB)-粪便: 阴性（参考: 阴性）；比重(SG)-尿液: 1.021；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-粪便: 棕色；酮体(KET)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D29] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；磷(P)-静脉血: 1.54mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.4U/L；总胆固醇(TC)-静脉血: 6.28mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.3pg；镁离子(Mg2+)-静脉血: 1.06mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=2.00)（参考: 阴性）；肌酐(Crea)-静脉血: 76.5umol/L；球蛋白(GLO)-静脉血: 31.62g/L；白蛋白(ALB)-静脉血: 48.1g/L；白细胞计数(WBC#)-静脉血: 5.310E9/L；血小板分布宽度(PDW)-静脉血: 14.3%；单核细胞百分比(Mono%)-静脉血: 0.011；淋巴细胞百分比(Lymph%)-静脉血: 0.128；血小板计数(PLT#)-静脉血: 18310E9/L；甘油三酯(TG)-静脉血: 1.83mmol/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；碱性磷酸酶(ALP)-静脉血: 76.4U/L；总胆汁酸(TBA)-静脉血: 14.5umol/L；总蛋白(TP)-静脉血: 79.72g/L；有核红细胞百分比(NRBC%)-静脉血: 0；红细胞比容(Hct)-静脉血: 44.3%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.7；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.42mmolL；胱抑素(Cys-C)-静脉血: 1.15mg/L；尿酸(UA)-静脉血: 254.8umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；间接胆红素(IBIL)-静脉血: 27.2umolL；钾离子(K+)-静脉血: 4.43mmol/L；乳酸脱氢酶(LDH)-静脉血: 200.6U/L；C-反应蛋白(CRP)-静脉血: 1.97mg/L；浊度(TRUB)-尿液: clear；酸碱度(pH)-尿液: 5.5；平均红细胞体积(MCV……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D26] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 化疗第2天，患者一般情况可，未诉特殊不适。查体：左侧颈部II区可扪及1个淋巴结，最大径2cm×2.5cm2，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]医生信息已隐藏示：目前暂未出现明显副反应，继续行化疗，密切观察病情。\n- [全程D29] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 化疗第5天，患者一般情况可。体查：KPS90分，张口门齿距4.5cm。鼻咽顶壁、顶后壁、双侧壁结节状肿物；左侧颈部II区可扪及1个淋巴结，最大径2cm×2cm2，无融合，质中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。复查血常规无明显异常。生化示：ALT 77.8U/L↑、IBIL27.20 umolL↑、TBIL35.1umol/L↑。[姓名已隐去]医生信息已隐藏示:第1程化疗结束，病情稳定，今日予办理出院。嘱其注意休息及营养支持，保持口腔清洁；出院后每周复查血常规2次，生化1次常规；按时[计划性表述已隐藏]下一程诱导化疗；若有不适，及时就诊。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 办理出院，暂不予保肝药物干预，嘱每周复查血常规和生化，按期返院行下一程诱导化疗。\nB. 暂缓出院，予静脉滴注保肝降酶药物，待转氨酶及胆红素完全恢复正常后出院，按期行下一程诱导化疗。\nC. 办理出院，开具口服保肝药物，终止后续诱导化疗计划，择期直接开始根治性同期放化疗。\nD. 办理出院，开具口服保肝药物，下一程诱导化疗直接将多西他赛及顺铂剂量下调20%。\nE. 办理出院，开具口服保肝药物，下一程诱导化疗方案更改为吉西他滨联合顺铂（GP方案）。\nF. 暂缓出院，请感染内科会诊排除乙肝病毒再激活，待专科意见明确后再决定后续抗肿瘤治疗计划。\nG. 办理出院，开具口服保肝药物，嘱每周复查血常规和生化，将下一程诱导化疗推迟1至2周进行。\nH. 办理出院，开具口服保肝药物，并预防性给予长效G-CSF支持，按期返院行下一程诱导化疗。\nI. 暂缓出院，按重度药物性肝损伤启动多学科联合诊疗，待肝功能好转后，按期行下一程诱导化疗。\nJ. 办理出院，开具口服保肝药物，下一程治疗停用尼妥珠单抗，仅行TPF方案诱导化疗。\nK. 办理出院，开具口服保肝药物（如多烯磷脂酰胆碱等），嘱每周复查血常规和生化，按期返院行下一程诱导化疗。\nL. 办理出院，开具口服保肝药物，下一程诱导化疗剔除氟尿嘧啶，改为多西他赛联合顺铂双药方案。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"办理出院，暂不予保肝药物干预，嘱每周复查血常规和生化，按期返院行下一程诱导化疗。","is_gold":false},{"letter":"B","text":"暂缓出院，予静脉滴注保肝降酶药物，待转氨酶及胆红素完全恢复正常后出院，按期行下一程诱导化疗。","is_gold":false},{"letter":"C","text":"办理出院，开具口服保肝药物，终止后续诱导化疗计划，择期直接开始根治性同期放化疗。","is_gold":false},{"letter":"D","text":"办理出院，开具口服保肝药物，下一程诱导化疗直接将多西他赛及顺铂剂量下调20%。","is_gold":false},{"letter":"E","text":"办理出院，开具口服保肝药物，下一程诱导化疗方案更改为吉西他滨联合顺铂（GP方案）。","is_gold":false},{"letter":"F","text":"暂缓出院，请感染内科会诊排除乙肝病毒再激活，待专科意见明确后再决定后续抗肿瘤治疗计划。","is_gold":false},{"letter":"G","text":"办理出院，开具口服保肝药物，嘱每周复查血常规和生化，将下一程诱导化疗推迟1至2周进行。","is_gold":false},{"letter":"H","text":"办理出院，开具口服保肝药物，并预防性给予长效G-CSF支持，按期返院行下一程诱导化疗。","is_gold":false},{"letter":"I","text":"暂缓出院，按重度药物性肝损伤启动多学科联合诊疗，待肝功能好转后，按期行下一程诱导化疗。","is_gold":false},{"letter":"J","text":"办理出院，开具口服保肝药物，下一程治疗停用尼妥珠单抗，仅行TPF方案诱导化疗。","is_gold":false},{"letter":"K","text":"办理出院，开具口服保肝药物（如多烯磷脂酰胆碱等），嘱每周复查血常规和生化，按期返院行下一程诱导化疗。","is_gold":true},{"letter":"L","text":"办理出院，开具口服保肝药物，下一程诱导化疗剔除氟尿嘧啶，改为多西他赛联合顺铂双药方案。","is_gold":false}],"gold_letter":"K"},{"sample_id":"sample-ad5a1060b6801c87debff9d0","patient_id":"patient-5731cc38ced94b2ee39c442a","turn_id":"turn06","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、蝶窦、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D0] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.51；平均红细胞血红蛋白含量(MCH)-静脉血: 27.4pg；磷(P)-静脉血: 0.9mmol/L；直接胆红素(DBIL)-静脉血: 4.7umol/L；凝血酶时间(TT)-静脉血: 22.7sec.；D-二聚体(D-Dimer)-静脉血: 0.29ug/ml；活化部分凝血活酶时间(APTT)-静脉血: 38.5sec.；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.04S/CO；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.82mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.6；单核细胞百分比(Mono%)-静脉血: 0.047；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；间接胆红素(IBIL)-静脉血: 10.5umolL；白蛋白(ALB)-静脉血: 48g/L；氯离子(Cl-)-静脉血: 101.7mmol/L；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.718；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.1COI；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；白细胞计数(WBC#)-静脉血: 6.9510E9/L；红细胞比容(Hct)-静脉血: 46.8%；尿酸(UA)-静脉血: 431.8umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 81.8umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 26mmol/L；血小板分布宽度(PDW)-静脉血: 11.2%；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.04S/CO；平均血小板体积(MPV)-静脉血: 9.7fL；中性粒细胞计数(Neut#)-静脉血: 510E9/L；载脂蛋白B(apoB)-静脉血: 0.96g/L；凝血酶原时间(PT)-静脉血: 11.8sec.；钠离子(Na+)-静脉血: 138.7mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；甘油三酯(TG)-静脉血: 2.2mmol/L；总胆红素(TBIL)-……\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 Ⅱ、Ⅲ、aVF、V5、V6导联T波低平\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D24] 检验组合: 天门冬氨酸氨基转移酶(AST)-静脉血: 20.1U/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；血小板分布宽度(PDW)-静脉血: 11.9%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.1；尿素氮(BUN)-静脉血: 3.6mmol/L；磷(P)-静脉血: 0.97mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21.8U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.55；丙氨酸氨基转移酶(ALT)-静脉血: 41U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.19mmol/L；葡萄糖(Glu)-静脉血: 5.41mmol/L；白蛋白(ALB)-静脉血: 46.9g/L；白细胞计数(WBC#)-静脉血: 5.2810E9/L；红细胞计数(RBC#)-静脉血: 5.3910E12/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.6；尿酸(UA)-静脉血: 386.3umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 27U/L；C-反应蛋白(CRP)-静脉血: 4.25mg/L；钾离子(K+)-静脉血: 4.08mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.051；载脂蛋白B(apoB)-静脉血: 1.1g/L；球蛋白(GLO)-静脉血: 30.3g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；平均血小板体积(MPV)-静脉血: 10.3fL；总胆汁酸(TBA)-静脉血: 1.8umol/L；总蛋白(TP)-静脉血: 77.2g/L；间接胆红素(IBIL)-静脉血: 11.1umolL；甘油三酯(TG)-静脉血: 1.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.08g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.310E9/L；氯离子(Cl-)-静脉血: 102.2mmol/L；单核细胞百分比(Mono%)-静脉血: 0.072；碱性磷酸酶(ALP)-静脉血: 82.4U/L；总胆红素(TBIL)-静脉血: 15.1umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.49；总胆固醇(TC)-静脉血: 4.74mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.237；血小板比容……\n- [全程D25] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右侧约平T6椎体下缘水平，估计导管末端位于上腔静脉下段内。；检查结论: PICC管位置如上所述。\n- [全程D25] 检验组合: 浊度(TRUB)-尿液: clear；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 5.5；葡萄糖(Glu)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；虫卵-粪便: 未见虫卵（参考: 未见虫卵）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 30/μL；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；隐血(OB)-粪便: 阴性（参考: 阴性）；比重(SG)-尿液: 1.021；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-粪便: 棕色；酮体(KET)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D29] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；磷(P)-静脉血: 1.54mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.4U/L；总胆固醇(TC)-静脉血: 6.28mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.3pg；镁离子(Mg2+)-静脉血: 1.06mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=2.00)（参考: 阴性）；肌酐(Crea)-静脉血: 76.5umol/L；球蛋白(GLO)-静脉血: 31.62g/L；白蛋白(ALB)-静脉血: 48.1g/L；白细胞计数(WBC#)-静脉血: 5.310E9/L；血小板分布宽度(PDW)-静脉血: 14.3%；单核细胞百分比(Mono%)-静脉血: 0.011；淋巴细胞百分比(Lymph%)-静脉血: 0.128；血小板计数(PLT#)-静脉血: 18310E9/L；甘油三酯(TG)-静脉血: 1.83mmol/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；碱性磷酸酶(ALP)-静脉血: 76.4U/L；总胆汁酸(TBA)-静脉血: 14.5umol/L；总蛋白(TP)-静脉血: 79.72g/L；有核红细胞百分比(NRBC%)-静脉血: 0；红细胞比容(Hct)-静脉血: 44.3%；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.7；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.42mmolL；胱抑素(Cys-C)-静脉血: 1.15mg/L；尿酸(UA)-静脉血: 254.8umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；间接胆红素(IBIL)-静脉血: 27.2umolL；钾离子(K+)-静脉血: 4.43mmol/L；乳酸脱氢酶(LDH)-静脉血: 200.6U/L；C-反应蛋白(CRP)-静脉血: 1.97mg/L；浊度(TRUB)-尿液: clear；酸碱度(pH)-尿液: 5.5；平均红细胞体积(MCV……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D32] 检验组合: 间接胆红素(IBIL)-静脉血: 13.9umolL；肌酐(Crea)-静脉血: 83.3umol/L；碱性磷酸酶(ALP)-静脉血: 80.7U/L；镁离子(Mg2+)-静脉血: 1.02mmol/L；总胆红素(TBIL)-静脉血: 19.3umol/L；胱抑素(Cys-C)-静脉血: 0.87mg/L；尿素氮(BUN)-静脉血: 4.5mmol/L；载脂蛋白B(apoB)-静脉血: 1.13g/L；白细胞计数(WBC#)-静脉血: 3.0510E9/L；总胆汁酸(TBA)-静脉血: 1.7umol/L；血小板分布宽度(PDW)-静脉血: 12.5%；血小板比容-静脉血: 17%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.01；单核细胞百分比(Mono%)-静脉血: 0.013；平均血小板体积(MPV)-静脉血: 10.9fL；乳酸脱氢酶(LDH)-静脉血: 186U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.36；平均红细胞血红蛋白含量(MCH)-静脉血: 27.7pg；平均红细胞体积(MCV)-静脉血: 81.7fL；单核细胞计数(Mono#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 15410E9/L；氯离子(Cl-)-静脉血: 96.9mmol/L；钾离子(K+)-静脉血: 3.58mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.4mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 28U/L；甘油三酯(TG)-静脉血: 1.46mmol/L；红细胞比容(Hct)-静脉血: 44.3%；中性粒细胞百分比(Neut%)-静脉血: 0.748；总钙(Ca)-静脉血: 2.27mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 34.1；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 25.5U/L；葡萄糖(Glu)-静脉血: 5.55mmol/L；尿酸(UA)-静脉血: 325.7umol/L；直接胆红素(DBIL)-静脉血: 5.4umol/L；钠离子(Na+)-静脉血: 133.9mmol/L；大血小板百分比(P-LCR%)-静脉血: 31.7%；红细胞体积分布宽度CV(RDW-CV)-静……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D26] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 化疗第2天，患者一般情况可，未诉特殊不适。查体：左侧颈部II区可扪及1个淋巴结，最大径2cm×2.5cm2，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]医生信息已隐藏示：目前暂未出现明显副反应，继续行化疗，密切观察病情。\n- [全程D29] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 化疗第5天，患者一般情况可。体查：KPS90分，张口门齿距4.5cm。鼻咽顶壁、顶后壁、双侧壁结节状肿物；左侧颈部II区可扪及1个淋巴结，最大径2cm×2cm2，无融合，质中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。复查血常规无明显异常。生化示：ALT 77.8U/L↑、IBIL27.20 umolL↑、TBIL35.1umol/L↑。[姓名已隐去]医生信息已隐藏示:第1程化疗结束，病情稳定，今日予办理出院。嘱其注意休息及营养支持，保持口腔清洁；出院后每周复查血常规2次，生化1次常规；按时[计划性表述已隐藏]下一程诱导化疗；若有不适，及时就诊。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 予以皮下注射重组人粒细胞集落刺激因子（G-CSF），并静脉滴注异甘草酸镁进行保肝治疗。\nB. 嘱多饮水及注意休息，暂不予药物干预，定期门诊复查血常规及肝肾功能以评估毒性。\nC. 开具口服升白细胞药物（如咖啡酸片）及保肝药物（如复方甘草酸苷），暂不使用护胃止吐药物。\nD. 立即收治入院，予以静脉滴注质子泵抑制剂、止吐药及保肝药物，并密切监测血常规变化。\nE. 开具口服抑酸护胃及促胃动力药物（如艾司奥美拉唑、多潘立酮），暂不处理白细胞及肝功能异常。\nF. 提前开始第二周期TPF诱导化疗，并预防性给予长效G-CSF及静脉保肝药物支持治疗。\nG. 开具口服保肝药物（如复方甘草酸苷）及护胃止吐药物，暂不予口服升白细胞药物进行干预。\nH. 予以皮下注射重组人促红素（EPO），并开具口服保肝、护胃及促动力药物进行对症支持。\nI. 开具口服升白细胞药物（如咖啡酸片）、抑酸护胃及促胃动力药物，暂不予保肝药物治疗。\nJ. 安排骨髓穿刺检查以明确白细胞减少原因，同时开具口服保肝及护胃药物进行对症支持。\nK. 门诊静脉推注地塞米松及昂丹司琼强化止吐，并开具口服保肝及升白药物进行对症支持。\nL. 开具口服升白细胞药物（如咖啡酸片）、保肝药物（如复方甘草酸苷）及抑酸护胃、促动力药物进行对症支持。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"予以皮下注射重组人粒细胞集落刺激因子（G-CSF），并静脉滴注异甘草酸镁进行保肝治疗。","is_gold":false},{"letter":"B","text":"嘱多饮水及注意休息，暂不予药物干预，定期门诊复查血常规及肝肾功能以评估毒性。","is_gold":false},{"letter":"C","text":"开具口服升白细胞药物（如咖啡酸片）及保肝药物（如复方甘草酸苷），暂不使用护胃止吐药物。","is_gold":false},{"letter":"D","text":"立即收治入院，予以静脉滴注质子泵抑制剂、止吐药及保肝药物，并密切监测血常规变化。","is_gold":false},{"letter":"E","text":"开具口服抑酸护胃及促胃动力药物（如艾司奥美拉唑、多潘立酮），暂不处理白细胞及肝功能异常。","is_gold":false},{"letter":"F","text":"提前开始第二周期TPF诱导化疗，并预防性给予长效G-CSF及静脉保肝药物支持治疗。","is_gold":false},{"letter":"G","text":"开具口服保肝药物（如复方甘草酸苷）及护胃止吐药物，暂不予口服升白细胞药物进行干预。","is_gold":false},{"letter":"H","text":"予以皮下注射重组人促红素（EPO），并开具口服保肝、护胃及促动力药物进行对症支持。","is_gold":false},{"letter":"I","text":"开具口服升白细胞药物（如咖啡酸片）、抑酸护胃及促胃动力药物，暂不予保肝药物治疗。","is_gold":false},{"letter":"J","text":"安排骨髓穿刺检查以明确白细胞减少原因，同时开具口服保肝及护胃药物进行对症支持。","is_gold":false},{"letter":"K","text":"门诊静脉推注地塞米松及昂丹司琼强化止吐，并开具口服保肝及升白药物进行对症支持。","is_gold":false},{"letter":"L","text":"开具口服升白细胞药物（如咖啡酸片）、保肝药物（如复方甘草酸苷）及抑酸护胃、促动力药物进行对症支持。","is_gold":true}],"gold_letter":"L"},{"sample_id":"sample-b10ed2b10a17f1626353b252","patient_id":"patient-5731cc38ced94b2ee39c442a","turn_id":"turn07","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、蝶窦、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D0] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.51；平均红细胞血红蛋白含量(MCH)-静脉血: 27.4pg；磷(P)-静脉血: 0.9mmol/L；直接胆红素(DBIL)-静脉血: 4.7umol/L；凝血酶时间(TT)-静脉血: 22.7sec.；D-二聚体(D-Dimer)-静脉血: 0.29ug/ml；活化部分凝血活酶时间(APTT)-静脉血: 38.5sec.；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.04S/CO；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.82mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.6；单核细胞百分比(Mono%)-静脉血: 0.047；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；间接胆红素(IBIL)-静脉血: 10.5umolL；白蛋白(ALB)-静脉血: 48g/L；氯离子(Cl-)-静脉血: 101.7mmol/L；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.718；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.1COI；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；白细胞计数(WBC#)-静脉血: 6.9510E9/L；红细胞比容(Hct)-静脉血: 46.8%；尿酸(UA)-静脉血: 431.8umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 81.8umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 26mmol/L；血小板分布宽度(PDW)-静脉血: 11.2%；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.04S/CO；平均血小板体积(MPV)-静脉血: 9.7fL；中性粒细胞计数(Neut#)-静脉血: 510E9/L；载脂蛋白B(apoB)-静脉血: 0.96g/L；凝血酶原时间(PT)-静脉血: 11.8sec.；钠离子(Na+)-静脉血: 138.7mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；甘油三酯(TG)-静脉血: 2.2mmol/L；总胆红素(TBIL)-……\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 Ⅱ、Ⅲ、aVF、V5、V6导联T波低平\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D50] 检验组合: 碱性磷酸酶(ALP)-静脉血: 79.1U/L；总胆红素(TBIL)-静脉血: 18.4umol/L；血小板比容-静脉血: 24%；磷(P)-静脉血: 1.77mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=4.50)（参考: 阴性）；白蛋白(ALB)-静脉血: 44g/L；C-反应蛋白(CRP)-静脉血: 2.48mg/L；球蛋白(GLO)-静脉血: 30.07g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 5.18mmol/L；总胆汁酸(TBA)-静脉血: 3umol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.9；平均红细胞血红蛋白浓度(MCHC)-静脉血: 332g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0；淋巴细胞百分比(Lymph%)-静脉血: 0.212；胱抑素(Cys-C)-静脉血: 1.1mg/L；乳酸脱氢酶(LDH)-静脉血: 209.6U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 51.1U/L；氯离子(Cl-)-静脉血: 99.5mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 45.8U/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.7mmol/L；载脂蛋白B(apoB)-静脉血: 1.54g/L；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.726；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.18mmolL；镁离子(Mg2+)-静脉血: 0.94mmol/L；钾离子(K+)-静脉血: 4.21mmol/L；阴离子间隙(AG)-静脉血: 15；单核细胞百分比(Mono%)-静脉血: 0.06；直接胆红素(DBIL)-静脉血: 3.3umol/L；总蛋白(TP)-静脉血: 74.07g/L；红细胞比容(Hct)-静脉血: 41.9%；血小板计数(PLT#)-静脉血: 24410E9/L；EB病毒Zta蛋白抗体IgA(EBV-Zta-IgA)-静脉血: 阳性(SCO=5.00)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 32.5U/L；载脂蛋白AI(ap……\n- [全程D53] 检验组合: 单核细胞计数(Mono#)-静脉血: 0.210E9/L；平均血小板体积(MPV)-静脉血: 10.1fL；平均红细胞血红蛋白含量(MCH)-静脉血: 27.5pg；氯离子(Cl-)-静脉血: 102.2mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；血小板分布宽度(PDW)-静脉血: 11.6%；钾离子(K+)-静脉血: 4.44mmol/L；血红蛋白(Hb)-静脉血: 146g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.4U/L；血小板比容-静脉血: 24%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 23610E9/L；肌酐(Crea)-静脉血: 78umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.97mmolL；直接胆红素(DBIL)-静脉血: 2.9umol/L；镁离子(Mg2+)-静脉血: 0.89mmol/L；白细胞计数(WBC#)-静脉血: 4.8410E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.9；有核红细胞计数(NRBC#)-静脉血: 010E9/L；尿酸(UA)-静脉血: 396.5umol/L；白蛋白(ALB)-静脉血: 43.6g/L；有核红细胞百分比(NRBC%)-静脉血: 0；单核细胞百分比(Mono%)-静脉血: 0.041；甘油三酯(TG)-静脉血: 1.5mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.5；总胆汁酸(TBA)-静脉血: 3.2umol/L；总钙(Ca)-静脉血: 2.29mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 29.4U/L；碱性磷酸酶(ALP)-静脉血: 88.9U/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.5mmol/L；平均红细胞体积(MCV)-静脉血: 84fL；丙氨酸氨基转移酶(ALT)-静脉血: 34.7U/L；红细胞比容(Hct)-静脉血: 44.5%；尿素氮(BUN)-静脉血: 6.4mmol/L；胱抑素(Cys-C)-……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D64] 检验组合: 磷(P)-静脉血: 1.1mmol/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；平均红细胞血红蛋白含量(MCH)-静脉血: 27.3pg；平均血小板体积(MPV)-静脉血: 9.4fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.4；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；总钙(Ca)-静脉血: 2.24mmol/L；总蛋白(TP)-静脉血: 73.3g/L；氯离子(Cl-)-静脉血: 104.7mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 46.1U/L；单核细胞百分比(Mono%)-静脉血: 0.094；α-L-岩藻糖苷酶(AFU)-静脉血: 31.3U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.93mmol/L；尿素氮(BUN)-静脉血: 6.4mmol/L；总胆固醇(TC)-静脉血: 5.7mmol/L；血小板计数(PLT#)-静脉血: 15510E9/L；球蛋白(GLO)-静脉血: 28g/L；直接胆红素(DBIL)-静脉血: 2.3umol/L；总胆汁酸(TBA)-静脉血: 1.8umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.09mmolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.74；载脂蛋白B(apoB)-静脉血: 1.34g/L；钠离子(Na+)-静脉血: 141.6mmol/L；C-反应蛋白(CRP)-静脉血: 4.1mg/L；血小板比容-静脉血: 15%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；葡萄糖(Glu)-静脉血: 5.4mmol/L；白蛋白(ALB)-静脉血: 45.3g/L；有核红细胞计数(NRBC#)-静脉血: 0.0110E9/L；尿酸(UA)-静脉血: 511.6umol/L；甘油三酯(TG)-静脉血: 1.82mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.5mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 26.8U/L；大血小板百分比(P-LCR%)-静脉血: 19.5%；中性粒细胞计数(Neut#)-静脉血: 3.110E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 319g/L；乳酸脱氢酶(……\n- [全程D71] 检验组合: γ-谷氨酰基转移酶(GGT)-静脉血: 47U/L；尿酸(UA)-静脉血: 339.1umol/L；阴离子间隙(AG)-静脉血: 16.7；白细胞计数(WBC#)-静脉血: 5.8510E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 27.4pg；有核红细胞计数(NRBC#)-静脉血: 010E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.156；EB病毒Zta蛋白抗体IgA(EBV-Zta-IgA)-静脉血: 阳性(SCO=4.00)（参考: 阴性）；磷(P)-静脉血: 1.25mmol/L；肌酐(Crea)-静脉血: 80.9umol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:20（参考: 阴性）；单核细胞百分比(Mono%)-静脉血: 0.029；中性粒细胞计数(Neut#)-静脉血: 4.810E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.7mmol/L；红细胞比容(Hct)-静脉血: 43.3%；总胆红素(TBIL)-静脉血: 18.3umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 6.04mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；平均血小板体积(MPV)-静脉血: 10.9fL；碱性磷酸酶(ALP)-静脉血: 81.8U/L；葡萄糖(Glu)-静脉血: 5.79mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.6；间接胆红素(IBIL)-静脉血: 15umolL；α-L-岩藻糖苷酶(AFU)-静脉血: 41.6U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.48mmolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.3；载脂蛋白AI(apoAI)-静脉血: 1.28g/L；甘油三酯(TG)-静脉血: 2.29mmol/L；平均红细胞体积(MCV)-静脉血: 83.1fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板比容-静脉血: 17%；球蛋白(GLO)-静脉血: 29.1g/L；载脂蛋白B(apoB)-静脉血: 1.64g/L；乳酸脱氢酶(LDH)-静脉血: 229.2U/L；镁离子(Mg2+)-静脉血: 0.76mmol……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D75] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后，对比某次就诊时间片： 鼻咽腔稍狭窄，鼻咽左顶壁及左侧壁增厚，在T1WI上呈等信号，在T2WI上呈稍高信号，增强扫描明显强化，较前明显缩小，左侧破裂孔、海绵窦、翼腭窝及蝶窦左份仍可见软组织灶，边界欠清，明显强化。右侧咽隐窝存在，左侧咽隐窝变浅 左侧腭帆张提肌、左侧翼内肌上缘信号不均匀，可见强化。 左侧咽旁间隙变窄，右侧咽旁间隙及双侧颈动脉鞘区血管未见明显异常。 右侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常。口咽双侧壁未见增厚。 斜坡、左侧岩尖、蝶骨基底部、左侧翼突区骨质信号减低，增强扫描明显强化。 右侧海绵窦形态正常，未见增宽。 双侧筛窦、左侧上颌窦、蝶窦粘膜增厚，左侧乳突内见少量信号分泌物。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变。 双侧咽后未见明确肿大淋巴结。 双颈II区及左颈III区可见数个淋巴结，最大约14mm×5mm，边界欠清，增强扫描可见明显强化。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。 所示脑实质未见明确异常。；检查结论: 鼻咽癌化疗后，范围较前明显缩小。 颅底骨质破坏。 双颈淋巴结，考虑转移，较前缩小、减少。 双侧咽后未见肿大淋巴结。 鼻窦炎。 左侧乳突炎。\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D65] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日患者症状体征基本同前，无诉其余特殊不适。[姓名已隐去]医生信息已隐藏示：患者诊断明确，复查血常规、生化常规无明显化疗禁忌症，拟按期于某次就诊时间开始行TPF诱导化疗， 具体用药：DOC60mg/㎡d1+DDP60mg/㎡ d2+5-FU2.5g/㎡civ48hQ3w，并指示化疗期间给予护肝、护胃、止吐及营养支持治疗，昨日已行泰欣生靶向治疗，密切观察患者病情变化。\n- [全程D66] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，未诉恶心、呕吐、腹痛、腹泻等不适，大小便正常。[姓名已隐去]医生信息已隐藏出，患者目前一般情况可，予明日按TPF方案行第3周期化疗，注意化疗结束后复查血、生化常规，及时对症处理。\n- [全程D69] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日为化疗第3天，诉间有恶心，无呕吐，无咳嗽、咳痰，无头痛、头晕，大小便正常。[姓名已隐去]医生信息已隐藏出，患者化疗后出现胃肠道反应I度，予继续对症处理，减轻化疗后反应。\n- [全程D71] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日患者症状体征基本同前，无诉其余特殊不适。今日复查血常规及生化常规未见明显异常。[姓名已隐去]医生信息已隐藏示：患者病情平稳，一般情况良好，目前予完善相关放疗前准备，今日予办理出院。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 结束诱导化疗，序贯开展根治性放射治疗\nB. 继续原方案（TPF联合尼妥珠单抗）诱导化疗至第6周期后再行放射治疗\nC. 更换为GP方案（吉西他滨联合顺铂）继续诱导化疗2个周期\nD. 行鼻咽原发灶及双侧颈部淋巴结根治性切除术\nE. 行双侧颈部淋巴结清扫术，术后序贯鼻咽局部放射治疗\nF. 加用PD-1抑制剂联合原方案继续诱导化疗2个周期\nG. 暂停抗肿瘤治疗，进入定期随访观察阶段\nH. 完善全身PET-CT重新分期后再决定后续局部治疗方案\nI. 仅行根治性放射治疗，处理鼻咽原发灶，颈部病灶继续随访观察\nJ. 结束诱导化疗，序贯开展尼妥珠单抗单药靶向维持治疗\nK. 行放射性粒子植入术，处理鼻咽及颈部残留病灶直接\nL. 采用卡培他滨单药维持化疗，推迟局部放射治疗\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"结束诱导化疗，序贯开展根治性放射治疗","is_gold":true},{"letter":"B","text":"继续原方案（TPF联合尼妥珠单抗）诱导化疗至第6周期后再行放射治疗","is_gold":false},{"letter":"C","text":"更换为GP方案（吉西他滨联合顺铂）继续诱导化疗2个周期","is_gold":false},{"letter":"D","text":"行鼻咽原发灶及双侧颈部淋巴结根治性切除术","is_gold":false},{"letter":"E","text":"行双侧颈部淋巴结清扫术，术后序贯鼻咽局部放射治疗","is_gold":false},{"letter":"F","text":"加用PD-1抑制剂联合原方案继续诱导化疗2个周期","is_gold":false},{"letter":"G","text":"暂停抗肿瘤治疗，进入定期随访观察阶段","is_gold":false},{"letter":"H","text":"完善全身PET-CT重新分期后再决定后续局部治疗方案","is_gold":false},{"letter":"I","text":"仅行根治性放射治疗，处理鼻咽原发灶，颈部病灶继续随访观察","is_gold":false},{"letter":"J","text":"结束诱导化疗，序贯开展尼妥珠单抗单药靶向维持治疗","is_gold":false},{"letter":"K","text":"行放射性粒子植入术，处理鼻咽及颈部残留病灶直接","is_gold":false},{"letter":"L","text":"采用卡培他滨单药维持化疗，推迟局部放射治疗","is_gold":false}],"gold_letter":"A"},{"sample_id":"sample-95ccde5ff1e164e8d7edc6f5","patient_id":"patient-5731cc38ced94b2ee39c442a","turn_id":"turn08","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、翼内肌、蝶窦、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 暂无可展示的初诊主诉/入院资料。\n\n【已完成检查与客观结果】\n- [全程D0] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.51；平均红细胞血红蛋白含量(MCH)-静脉血: 27.4pg；磷(P)-静脉血: 0.9mmol/L；直接胆红素(DBIL)-静脉血: 4.7umol/L；凝血酶时间(TT)-静脉血: 22.7sec.；D-二聚体(D-Dimer)-静脉血: 0.29ug/ml；活化部分凝血活酶时间(APTT)-静脉血: 38.5sec.；丙型肝炎病毒抗体(HCV-Ab)-静脉血: 0.04S/CO；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.82mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.6；单核细胞百分比(Mono%)-静脉血: 0.047；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；间接胆红素(IBIL)-静脉血: 10.5umolL；白蛋白(ALB)-静脉血: 48g/L；氯离子(Cl-)-静脉血: 101.7mmol/L；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.718；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.1COI；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；白细胞计数(WBC#)-静脉血: 6.9510E9/L；红细胞比容(Hct)-静脉血: 46.8%；尿酸(UA)-静脉血: 431.8umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；肌酐(Crea)-静脉血: 81.8umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 26mmol/L；血小板分布宽度(PDW)-静脉血: 11.2%；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.04S/CO；平均血小板体积(MPV)-静脉血: 9.7fL；中性粒细胞计数(Neut#)-静脉血: 510E9/L；载脂蛋白B(apoB)-静脉血: 0.96g/L；凝血酶原时间(PT)-静脉血: 11.8sec.；钠离子(Na+)-静脉血: 138.7mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；甘油三酯(TG)-静脉血: 2.2mmol/L；总胆红素(TBIL)-……\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 Ⅱ、Ⅲ、aVF、V5、V6导联T波低平\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D120] 检验组合: 尿酸(UA)-静脉血: 409.8umol/L；球蛋白(GLO)-静脉血: 27.4g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.63；总钙(Ca)-静脉血: 2.24mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 25U/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；γ-谷氨酰基转移酶(GGT)-静脉血: 55.3U/L；中性粒细胞百分比(Neut%)-静脉血: 0.859；白细胞计数(WBC#)-静脉血: 5.710E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.058；间接胆红素(IBIL)-静脉血: 6.28umolL；C-反应蛋白(CRP)-静脉血: 88.14mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 48；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；碱性磷酸酶(ALP)-静脉血: 82.1U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15.7U/L；磷(P)-静脉血: 1.36mmol/L；白蛋白(ALB)-静脉血: 41.7g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.78mmolL；镁离子(Mg2+)-静脉血: 0.9mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.79mmol/L；钠离子(Na+)-静脉血: 139.5mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 15.1；中性粒细胞计数(Neut#)-静脉血: 4.910E9/L；血红蛋白(Hb)-静脉血: 113g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.3fL；氯离子(Cl-)-静脉血: 101.6mmol/L；红细胞比容(Hct)-静脉血: 34.4%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；乳酸脱氢酶(LDH)-静脉血: 163.4U/L；总胆汁酸(TBA)-静脉血: 5.6umol/L；尿素氮(BUN)-静脉血: 6mmol/L；血小板比容-静脉血: 10%；大血小板百分比(P-LCR%)-静脉血: 25%；葡萄糖(Glu)-静脉……\n- [全程D127] 检验组合: 红细胞比容(Hct)-静脉血: 27.7%；血红蛋白(Hb)-静脉血: 88g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.005；尿酸(UA)-静脉血: 268.3umol/L；直接胆红素(DBIL)-静脉血: 2.1umol/L；乳酸脱氢酶(LDH)-静脉血: 105.9U/L；碱性磷酸酶(ALP)-静脉血: 82.3U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.72；中性粒细胞百分比(Neut%)-静脉血: 0.798；尿素氮(BUN)-静脉血: 4.9mmol/L；载脂蛋白B(apoB)-静脉血: 1.41g/L；C-反应蛋白(CRP)-静脉血: 198.52mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.26；总胆汁酸(TBA)-静脉血: 1.1umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 9.6U/L；球蛋白(GLO)-静脉血: 27.52g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.03；总钙(Ca)-静脉血: 2.35mmol/L；甘油三酯(TG)-静脉血: 2.27mmol/L；氯离子(Cl-)-静脉血: 102.6mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28pg；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.74mmolL；白蛋白(ALB)-静脉血: 34.8g/L；载脂蛋白AI(apoAI)-静脉血: 0.71g/L；单核细胞百分比(Mono%)-静脉血: 0.167；淋巴细胞计数(Lymph#)-静脉血: 0.110E9/L；血小板比容-静脉血: 11%；肌酐(Crea)-静脉血: 68.7umol/L；总胆固醇(TC)-静脉血: 5.14mmol/L；胱抑素(Cys-C)-静脉血: 0.91mg/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 60.6U/L；镁离子(Mg2+)-静脉血: 0.81mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 12610E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.2mmol/L；大血小板百分比(P-LCR%)-静脉血: 16.5%；丙氨酸氨基转移酶(ALT)-静脉血:……\n- [全程D132] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D167] 检验组合: EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:80（参考: 阴性）\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D222] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:80（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）\n- [全程D222] 检验组合: 氯离子(Cl-)-静脉血: 103.6mmol/L；血小板分布宽度(PDW)-静脉血: 10.7%；C-反应蛋白(CRP)-静脉血: 1.07mg/L；甘油三酯(TG)-静脉血: 1.41mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.89；白蛋白(ALB)-静脉血: 46.7g/L；葡萄糖(Glu)-静脉血: 5.1mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.68；血小板比容-静脉血: 17%；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L；直接胆红素(DBIL)-静脉血: 2.1umol/L；磷(P)-静脉血: 1.27mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 317g/L；大血小板百分比(P-LCR%)-静脉血: 24.8%；丙氨酸氨基转移酶(ALT)-静脉血: 19.3U/L；总蛋白(TP)-静脉血: 74.5g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 18.4U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.2U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.63mmol/L；总胆固醇(TC)-静脉血: 5.21mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 15.7U/L；乳酸脱氢酶(LDH)-静脉血: 168.2U/L；间接胆红素(IBIL)-静脉血: 6.8umolL；平均红细胞体积(MCV)-静脉血: 87.3fL；红细胞比容(Hct)-静脉血: 39.7%；中性粒细胞百分比(Neut%)-静脉血: 0.657；钠离子(Na+)-静脉血: 139.4mmol/L；碱性磷酸酶(ALP)-静脉血: 72U/L；单核细胞百分比(Mono%)-静脉血: 0.101；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.05；阴离子间隙(AG)-静脉血: 13.3；总胆汁酸(TBA)-静脉血: 2.7umol/L；镁离子(Mg2+)-静脉血: 0.92mmol/L；总胆红素(TBIL)-静脉血: 8.9umol/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 42.4；肌酐(Crea)-静脉血: 74.3um……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D223] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理清晰，未见明确实质性病变。双侧肺门未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n\n【既往治疗与反应】\n- [全程D121] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今天完成放疗24次，仍有轻度口干，口咽疼痛NRS1分，无恶心、呕吐，无头晕、头痛。查体：口咽部放射性粘膜炎Ⅱ°，颈部放射性皮炎Ⅰ°。某次就诊时间血常规HGB113g/L，生化大致正常。[姓名已隐去]医生信息已隐藏：继续予加强止痛、营养、改善贫血等对症支持治疗，密切观察病情变化。\n- [全程D124] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者昨天行第6次泰欣生分子靶向治疗，今天完成放疗26次，仍有轻度口干，口咽疼痛NRS1分，无恶心、呕吐，无发热、畏寒，查体：口咽部放射性粘膜炎Ⅱ°，颈部放射性皮炎Ⅰ°。[姓名已隐去]医生信息已隐藏示：患者放射性口咽炎仍明显，需加强局部冲洗、止痛等支持治疗，继续予按计划放疗。\n- [全程D127] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今天完成放疗29次，仍有轻度口干，口咽疼痛NRS1分，无发热、畏寒，无恶心、呕吐，查体：口咽部放射性粘膜炎Ⅰ°，颈部放射性皮炎Ⅰ°。某次就诊时间血常规示WBC3.6510E9/L， NE#2.9*10E9/L， HGB88.0g/L，PLT126.0*10E9/L，[姓名已隐去]医生信息已隐藏：患者白细胞稍低，但血红蛋白较前下降，考虑营养摄入不足和放化疗后骨髓抑制所致，予口服升白、改善贫血药治疗，加强口腔局部冲洗，密切观察病情变化。\n- [全程D130] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今天完成放疗30次，仍有轻度口干，口咽疼痛NRS2分，无发热、畏寒，无恶心、呕吐，查体：口咽部放射性粘膜炎Ⅱ°，颈部放射性皮炎Ⅰ°。[姓名已隐去]医生信息已隐藏：患者今天予第7次泰欣生分子靶向治疗。患者口咽痛反复，继续加强止痛治疗，辅以局部冲洗等护理，观察病情变化。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行全身PET-CT扫描评估全身肿瘤负荷及近期疗效\nB. 行鼻咽及颈部MRI增强扫描评估近期疗效，继续定期随访\nC. 行鼻咽镜检查并对原发灶区域进行常规多点活检排除残留\nD. 启动卡培他滨节拍性维持化疗降低远处转移风险\nE. 启动PD-1抑制剂维持治疗巩固靶向联合放疗的近期疗效\nF. 仅定期复查血常规、生化及EBV-DNA，暂不复查局部影像学\nG. 直接安排鼻咽原发灶内镜下挽救性切除手术\nH. 直接安排鼻咽原发灶挽救性立体定向放疗\nI. 行胸部及全腹部增强CT扫描，暂缓头颈部局部影像学复查\nJ. 行全身骨扫描及头颅MRI排除无症状的远处器官转移风险\nK. 启动吉西他滨联合顺铂方案全身化疗清除潜在微小转移灶\nL. 继续使用尼妥珠单抗单药维持治疗至满一年巩固局部疗效\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"行全身PET-CT扫描评估全身肿瘤负荷及近期疗效","is_gold":false},{"letter":"B","text":"行鼻咽及颈部MRI增强扫描评估近期疗效，继续定期随访","is_gold":true},{"letter":"C","text":"行鼻咽镜检查并对原发灶区域进行常规多点活检排除残留","is_gold":false},{"letter":"D","text":"启动卡培他滨节拍性维持化疗降低远处转移风险","is_gold":false},{"letter":"E","text":"启动PD-1抑制剂维持治疗巩固靶向联合放疗的近期疗效","is_gold":false},{"letter":"F","text":"仅定期复查血常规、生化及EBV-DNA，暂不复查局部影像学","is_gold":false},{"letter":"G","text":"直接安排鼻咽原发灶内镜下挽救性切除手术","is_gold":false},{"letter":"H","text":"直接安排鼻咽原发灶挽救性立体定向放疗","is_gold":false},{"letter":"I","text":"行胸部及全腹部增强CT扫描，暂缓头颈部局部影像学复查","is_gold":false},{"letter":"J","text":"行全身骨扫描及头颅MRI排除无症状的远处器官转移风险","is_gold":false},{"letter":"K","text":"启动吉西他滨联合顺铂方案全身化疗清除潜在微小转移灶","is_gold":false},{"letter":"L","text":"继续使用尼妥珠单抗单药维持治疗至满一年巩固局部疗效","is_gold":false}],"gold_letter":"B"}]}
+{"patient_id":"patient-9149023ec8599161ec3e5cfd","bootstrap_cluster_id":"cluster-011","turns":[{"sample_id":"sample-9d5015177e675883e0c4ec7b","patient_id":"patient-9149023ec8599161ec3e5cfd","turn_id":"turn01","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现双颈肿物半年余；现病史: 者半年余前无明显诱因出现左侧颈部肿物，无疼痛，逐渐增大，伴有鼻塞、流涕，至当地医院予抗炎对症治疗后，肿物能减小；2月前患者始出现右侧颈部肿物，逐渐增大，伴有鼻塞、流涕，间中有涕血，无发热、畏寒，无头晕、头痛，无周身骨痛等，于当地医院检查ＣＴ示：鼻咽肿物，遂转至我院进一步诊治。门诊拟诊“鼻咽肿物”收入我科进一步治疗。患者起病以来精神、睡眠欠佳，胃纳尚可，二便正常，体重无明显下降。；阳性症状体征: 鼻塞,睡眠欠佳,鼻咽肿物,涕血,右颈部肿物,左颈部肿物,流涕；既往史: 体健，无高血压、心脏病等慢性病，无糖尿病、肾病等全身性疾病，无乙肝、结核等传染病，无外伤史。；个人史: 生于原籍，有吸烟史30年,无饮酒，无其他嗜好，否认冶游史。；家族史: 家族中无类似患者，无家族性遗传病患者，无重大精神病患者。；体格检查:；专科检查:；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 电子鼻咽镜检查及活检，颈部超声，胸部X线片，腹部超声\nB. 电子鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，全身PET-CT\nC. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部及上腹部CT平扫+增强，全身骨显像\nD. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，暂不安排胸腹部及骨骼影像学检查\nE. 鼻咽及颈部MRI平扫+增强，胸部及上腹部CT平扫+增强，全身骨显像，暂不安排内镜活检\nF. 颈部淋巴结切除活检，鼻咽及颈部MRI平扫+增强，胸部及上腹部CT平扫+增强，全身骨显像\nG. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫，胸部及上腹部CT平扫，全身骨显像\nH. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部CT平扫+增强，腹部超声\nI. 电子鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸部及上腹部CT平扫+增强，全身骨显像\nJ. 颈部淋巴结细针穿刺活检，鼻咽及颈部MRI平扫+增强，胸部及上腹部CT平扫+增强，全身骨显像\nK. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身骨显像，头颅MRI平扫+增强\nL. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部及上腹部CT平扫+增强，骨髓穿刺活检\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"电子鼻咽镜检查及活检，颈部超声，胸部X线片，腹部超声","is_gold":false},{"letter":"B","text":"电子鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，全身PET-CT","is_gold":false},{"letter":"C","text":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部及上腹部CT平扫+增强，全身骨显像","is_gold":true},{"letter":"D","text":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，暂不安排胸腹部及骨骼影像学检查","is_gold":false},{"letter":"E","text":"鼻咽及颈部MRI平扫+增强，胸部及上腹部CT平扫+增强，全身骨显像，暂不安排内镜活检","is_gold":false},{"letter":"F","text":"颈部淋巴结切除活检，鼻咽及颈部MRI平扫+增强，胸部及上腹部CT平扫+增强，全身骨显像","is_gold":false},{"letter":"G","text":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫，胸部及上腹部CT平扫，全身骨显像","is_gold":false},{"letter":"H","text":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部CT平扫+增强，腹部超声","is_gold":false},{"letter":"I","text":"电子鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸部及上腹部CT平扫+增强，全身骨显像","is_gold":false},{"letter":"J","text":"颈部淋巴结细针穿刺活检，鼻咽及颈部MRI平扫+增强，胸部及上腹部CT平扫+增强，全身骨显像","is_gold":false},{"letter":"K","text":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身骨显像，头颅MRI平扫+增强","is_gold":false},{"letter":"L","text":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部及上腹部CT平扫+增强，骨髓穿刺活检","is_gold":false}],"gold_letter":"C"},{"sample_id":"sample-ebeecf0887be3e478e385ec0","patient_id":"patient-9149023ec8599161ec3e5cfd","turn_id":"turn02","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现双颈肿物半年余；现病史: 者半年余前无明显诱因出现左侧颈部肿物，无疼痛，逐渐增大，伴有鼻塞、流涕，至当地医院予抗炎对症治疗后，肿物能减小；2月前患者始出现右侧颈部肿物，逐渐增大，伴有鼻塞、流涕，间中有涕血，无发热、畏寒，无头晕、头痛，无周身骨痛等，于当地医院检查ＣＴ示：鼻咽肿物，遂转至我院进一步诊治。门诊拟诊“鼻咽肿物”收入我科进一步治疗。患者起病以来精神、睡眠欠佳，胃纳尚可，二便正常，体重无明显下降。；阳性症状体征: 鼻塞,睡眠欠佳,鼻咽肿物,涕血,右颈部肿物,左颈部肿物,流涕；既往史: 体健，无高血压、心脏病等慢性病，无糖尿病、肾病等全身性疾病，无乙肝、结核等传染病，无外伤史。；个人史: 生于原籍，有吸烟史30年,无饮酒，无其他嗜好，否认冶游史。；家族史: 家族中无类似患者，无家族性遗传病患者，无重大精神病患者。；体格检查:；专科检查:；KPS:；ECOG:\n- [时间未明] 门急诊记录: 主诉:；现病史: 者半年余前无明显诱因出现左侧颈部肿物，无疼痛，逐渐增大，伴有鼻塞、流涕，至当地医院予抗炎对症治疗后，肿物能减小；2月前患者始出现右侧颈部肿物，逐渐增大，伴有鼻塞、流涕，间中有涕血，无发热、畏寒，无头晕、头痛，无周身骨痛等，于当地医院检查ＣＴ示：鼻咽肿物，遂转至我院进一步诊治。门诊拟诊“鼻咽肿物”收入我科进一步治疗。患者起病以来精神、睡眠欠佳，胃纳尚可，二便正常，体重无明显下降。；既往史: 否认高血压、糖尿病及心脏病史，否认结核等传染病史、否认手术、外伤及输血史。；个人史:；家族史: 家族中无类似患者，无家族性遗传病患者，无重大精神病患者。；体格检查: KPS90，一般状况可，鼻咽左侧壁、顶后壁肿物，双颈扪及肿大淋巴结，右颈多枚肿大淋巴结，较大者约6*4及2*2cm,质硬，活动差，左上颈可及一淋巴结，约3*3cm，质中，活动度可，无融合，无皮肤浸润等，左中颈可及一大小约1*1cm质硬淋巴结；张口门齿距约4cm，颅神经征阴性。。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D0] 检验组合: 磷(P)-静脉血: 1.15mmol/L；平均红细胞体积(MCV)-静脉血: 87fL；肌酐(Crea)-静脉血: 58.2umol/L；C-反应蛋白(CRP)-静脉血: 1.11mg/L；尿酸(UA)-静脉血: 148.1umol/L；葡萄糖(Glu)-静脉血: 5.38mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.29；总胆红素(TBIL)-静脉血: 7.6umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.39mmolL；凝血酶时间(TT)-静脉血: 19.1sec.；钾离子(K+)-静脉血: 4.25mmol/L；阴离子间隙(AG)-静脉血: 10.3；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；白细胞计数(WBC#)-静脉血: 710E9/L；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阳性(169.39U/mL)（参考: 阴性）；载脂蛋白AI(apoAI)-静脉血: 1.57g/L；纤维蛋白原(Fbg)-静脉血: 3.35g/L；中性粒细胞计数(Neut#)-静脉血: 4.210E9/L；平均血小板体积(MPV)-静脉血: 9.6fL；有核红细胞百分比(NRBC%)-静脉血: 0；血小板比容-静脉血: 29%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 27mmol/L；凝血酶原时间活动度(PTA)-静脉血: 85.4%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；ABO血型-静脉血: O；甘油三酯(TG)-静脉血: 1.43mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.04S/CO；球蛋白(GLO)-静脉血: 33.45g/L；总钙(Ca)-静脉血: 2.26mmol/L；血小板分布宽度(PDW)-静脉血: 9.7%；间接胆红素(IBIL)-静脉血: 5.8umolL；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0IU/mL；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 安排根治性放化疗并完善胸腹部及骨骼等远处转移排查\nB. 行颈部淋巴结切除活检明确病理并完善胸腹部及骨骼等远处转移排查\nC. 行鼻咽镜下活检明确病理并暂缓远处转移排查直至病理确诊\nD. 行鼻咽镜下活检明确病理并完善胸腹部及骨骼等远处转移排查\nE. 行鼻咽镜下活检明确病理并安排诱导化疗联合同步放化疗\nF. 完善全身PET-CT检查排查远处转移并安排根治性放疗\nG. 行鼻咽镜下活检明确病理并完善头颅CT进一步评估颅底骨质破坏\nH. 行鼻咽镜下活检明确病理并完善EBV-DNA定量检测暂缓影像学排查\nI. 行颈部淋巴结穿刺活检明确病理并完善胸腹部及骨骼等远处转移排查\nJ. 完善胸部CT和腹部超声排查远处转移并暂缓鼻咽原发灶活检\nK. 行鼻咽镜下活检明确病理并完善全身骨扫描暂缓胸腹部影像学检查\nL. 安排鼻咽部肿物切除术明确病理并完善胸腹部及骨骼等远处转移排查\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"安排根治性放化疗并完善胸腹部及骨骼等远处转移排查","is_gold":false},{"letter":"B","text":"行颈部淋巴结切除活检明确病理并完善胸腹部及骨骼等远处转移排查","is_gold":false},{"letter":"C","text":"行鼻咽镜下活检明确病理并暂缓远处转移排查直至病理确诊","is_gold":false},{"letter":"D","text":"行鼻咽镜下活检明确病理并完善胸腹部及骨骼等远处转移排查","is_gold":true},{"letter":"E","text":"行鼻咽镜下活检明确病理并安排诱导化疗联合同步放化疗","is_gold":false},{"letter":"F","text":"完善全身PET-CT检查排查远处转移并安排根治性放疗","is_gold":false},{"letter":"G","text":"行鼻咽镜下活检明确病理并完善头颅CT进一步评估颅底骨质破坏","is_gold":false},{"letter":"H","text":"行鼻咽镜下活检明确病理并完善EBV-DNA定量检测暂缓影像学排查","is_gold":false},{"letter":"I","text":"行颈部淋巴结穿刺活检明确病理并完善胸腹部及骨骼等远处转移排查","is_gold":false},{"letter":"J","text":"完善胸部CT和腹部超声排查远处转移并暂缓鼻咽原发灶活检","is_gold":false},{"letter":"K","text":"行鼻咽镜下活检明确病理并完善全身骨扫描暂缓胸腹部影像学检查","is_gold":false},{"letter":"L","text":"安排鼻咽部肿物切除术明确病理并完善胸腹部及骨骼等远处转移排查","is_gold":false}],"gold_letter":"D"},{"sample_id":"sample-220f428c46f369e75a66e1ab","patient_id":"patient-9149023ec8599161ec3e5cfd","turn_id":"turn04","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现双颈肿物半年余；现病史: 者半年余前无明显诱因出现左侧颈部肿物，无疼痛，逐渐增大，伴有鼻塞、流涕，至当地医院予抗炎对症治疗后，肿物能减小；2月前患者始出现右侧颈部肿物，逐渐增大，伴有鼻塞、流涕，间中有涕血，无发热、畏寒，无头晕、头痛，无周身骨痛等，于当地医院检查ＣＴ示：鼻咽肿物，遂转至我院进一步诊治。门诊拟诊“鼻咽肿物”收入我科进一步治疗。患者起病以来精神、睡眠欠佳，胃纳尚可，二便正常，体重无明显下降。；阳性症状体征: 鼻塞,睡眠欠佳,鼻咽肿物,涕血,右颈部肿物,左颈部肿物,流涕；既往史: 体健，无高血压、心脏病等慢性病，无糖尿病、肾病等全身性疾病，无乙肝、结核等传染病，无外伤史。；个人史: 生于原籍，有吸烟史30年,无饮酒，无其他嗜好，否认冶游史。；家族史: 家族中无类似患者，无家族性遗传病患者，无重大精神病患者。；体格检查:；专科检查:；KPS:；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D0] 检验组合: 磷(P)-静脉血: 1.15mmol/L；平均红细胞体积(MCV)-静脉血: 87fL；肌酐(Crea)-静脉血: 58.2umol/L；C-反应蛋白(CRP)-静脉血: 1.11mg/L；尿酸(UA)-静脉血: 148.1umol/L；葡萄糖(Glu)-静脉血: 5.38mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.29；总胆红素(TBIL)-静脉血: 7.6umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.39mmolL；凝血酶时间(TT)-静脉血: 19.1sec.；钾离子(K+)-静脉血: 4.25mmol/L；阴离子间隙(AG)-静脉血: 10.3；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；白细胞计数(WBC#)-静脉血: 710E9/L；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阳性(169.39U/mL)（参考: 阴性）；载脂蛋白AI(apoAI)-静脉血: 1.57g/L；纤维蛋白原(Fbg)-静脉血: 3.35g/L；中性粒细胞计数(Neut#)-静脉血: 4.210E9/L；平均血小板体积(MPV)-静脉血: 9.6fL；有核红细胞百分比(NRBC%)-静脉血: 0；血小板比容-静脉血: 29%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 27mmol/L；凝血酶原时间活动度(PTA)-静脉血: 85.4%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；ABO血型-静脉血: O；甘油三酯(TG)-静脉血: 1.43mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.04S/CO；球蛋白(GLO)-静脉血: 33.45g/L；总钙(Ca)-静脉血: 2.26mmol/L；血小板分布宽度(PDW)-静脉血: 9.7%；间接胆红素(IBIL)-静脉血: 5.8umolL；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0IU/mL；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1] CT；胸、上腹CT平扫+增强: 检查类型: CT；检查名称: 胸、上腹CT平扫+增强；检查部位:；检查所见: 双肺纹理清晰，左肺下叶外基底段见条索状高密度影，边界清；余双肺内未见明显实质性病变。 气管及支气管分支通畅。 双肺门及纵隔未见明显肿大淋巴结。 双侧胸腔未见积液。双侧胸膜未见增厚、粘连。 肝脏形态未见异常，轮廓光整，各叶比例在正常范围以内，密度均匀。 肝内胆管未见明显异常。胆囊不大、壁不厚，其内未见结石。胆总管未见扩张，其内未见结石。 肝门区结构清晰。门静脉未见明显异常。 脾脏大小、形态未见明显异常，密度均匀。 胰腺大小、形态未见明显异常，密度均匀。 所示双肾及双侧肾上腺大小、形态未见明显异常，密度均匀。 膈脚后、肝门区、腹主动脉旁、腹腔干周围未见明显肿大淋巴结。 扫描层面内未见明显骨质破坏。；检查结论: 左肺下叶外基底段条索影，考虑纤维灶。 上腹部未见明显异常。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 鼻咽部见片状放射性浓密影。胸骨、锁骨、肩胛骨、肋骨、颈椎、胸椎、腰椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 鼻咽部代谢活跃，考虑鼻咽癌所致。 余全身骨骼未见明显异常。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 单纯根治性放疗\nB. 同步放化疗\nC. 诱导化疗序贯单纯根治性放疗\nD. 同步放化疗序贯辅助化疗\nE. 诱导化疗联合靶向治疗序贯放疗\nF. 诱导化疗序贯同步放化疗\nG. 根治性放疗序贯辅助化疗\nH. 诱导化疗序贯免疫联合同步放化疗\nI. 姑息性化疗联合免疫治疗\nJ. 鼻咽放疗联合颈部淋巴结清扫术\nK. 靶向治疗联合同步放化疗\nL. 诱导化疗序贯颈部淋巴结清扫术\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"单纯根治性放疗","is_gold":false},{"letter":"B","text":"同步放化疗","is_gold":false},{"letter":"C","text":"诱导化疗序贯单纯根治性放疗","is_gold":false},{"letter":"D","text":"同步放化疗序贯辅助化疗","is_gold":false},{"letter":"E","text":"诱导化疗联合靶向治疗序贯放疗","is_gold":false},{"letter":"F","text":"诱导化疗序贯同步放化疗","is_gold":true},{"letter":"G","text":"根治性放疗序贯辅助化疗","is_gold":false},{"letter":"H","text":"诱导化疗序贯免疫联合同步放化疗","is_gold":false},{"letter":"I","text":"姑息性化疗联合免疫治疗","is_gold":false},{"letter":"J","text":"鼻咽放疗联合颈部淋巴结清扫术","is_gold":false},{"letter":"K","text":"靶向治疗联合同步放化疗","is_gold":false},{"letter":"L","text":"诱导化疗序贯颈部淋巴结清扫术","is_gold":false}],"gold_letter":"F"},{"sample_id":"sample-ed1b449691d94cea18e7b28b","patient_id":"patient-9149023ec8599161ec3e5cfd","turn_id":"turn05","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现双颈肿物半年余；现病史: 者半年余前无明显诱因出现左侧颈部肿物，无疼痛，逐渐增大，伴有鼻塞、流涕，至当地医院予抗炎对症治疗后，肿物能减小；2月前患者始出现右侧颈部肿物，逐渐增大，伴有鼻塞、流涕，间中有涕血，无发热、畏寒，无头晕、头痛，无周身骨痛等，于当地医院检查ＣＴ示：鼻咽肿物，遂转至我院进一步诊治。门诊拟诊“鼻咽肿物”收入我科进一步治疗。患者起病以来精神、睡眠欠佳，胃纳尚可，二便正常，体重无明显下降。；阳性症状体征: 鼻塞,睡眠欠佳,鼻咽肿物,涕血,右颈部肿物,左颈部肿物,流涕；既往史: 体健，无高血压、心脏病等慢性病，无糖尿病、肾病等全身性疾病，无乙肝、结核等传染病，无外伤史。；个人史: 生于原籍，有吸烟史30年,无饮酒，无其他嗜好，否认冶游史。；家族史: 家族中无类似患者，无家族性遗传病患者，无重大精神病患者。；体格检查:；专科检查:；KPS:；ECOG:\n- [全程D986] 门急诊记录: 主诉: 鼻咽癌放化疗结束2年，诉轻度口干，听力视力正常，无头晕、头痛。体查：鼻咽未见明确肿物，双颈未扪及明显肿大淋巴结，颅神经（-）甲功五项示正常。鼻咽MRI未见明确复发，腹部B超、胸片未见明确转移。EBV-DNA:0；现病史:；既往史:；个人史:；家族史:；体格检查:\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D985] MRI；鼻咽部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部MR平扫+增强；检查部位:；检查所见: 鼻咽癌放疗后复查，对比某次就诊时间片： 鼻咽腔未见狭窄，鼻咽顶壁、顶后壁、右侧壁轻度增厚，均匀强化，右侧咽隐窝变浅，考虑放疗后改变，较前相仿。 蝶骨基底部、左侧枕骨基底部、左侧岩尖、左侧翼突基底部骨质信号下降，增强扫描轻度不均匀强化，较前相仿。 左侧破裂孔见少许软组织影，增强扫描轻度强化，较前相仿。 双侧咽后间隙见小淋巴结，大者短径约3mm，较前相仿。 右颈II区见多个淋巴结，最大短径约为5mm，部分边界欠清，增强扫描不均匀强化，较前稍缩小。 双侧上颌窦、筛窦、额窦粘膜增厚，考虑副鼻窦炎，较前相仿。 扫描所见颅脑未见明确异常。；检查结论:\n- [全程D985] MRI；颈部MR平扫+增强: 检查类型: MRI；检查名称: 颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌放疗后复查，对比某次就诊时间片： 鼻咽腔未见狭窄，鼻咽顶壁、顶后壁、右侧壁轻度增厚，均匀强化，右侧咽隐窝变浅，考虑放疗后改变，较前相仿。 蝶骨基底部、左侧枕骨基底部、左侧岩尖、左侧翼突基底部骨质信号下降，增强扫描轻度不均匀强化，较前相仿。 左侧破裂孔见少许软组织影，增强扫描轻度强化，较前相仿。 双侧咽后间隙见小淋巴结，大者短径约3mm，较前相仿。 右颈II区见多个淋巴结，最大短径约为5mm，部分边界欠清，增强扫描不均匀强化，较前稍缩小。 双侧上颌窦、筛窦、额窦粘膜增厚，考虑副鼻窦炎，较前相仿。 扫描所见颅脑未见明确异常。；检查结论:\n- [全程D1168] 检验组合: 游离甲状腺素(FT4)-静脉血: 14.91pmol/L；甲状腺过氧化物酶抗体(TPO-Ab)-静脉血: 12.55U/ml；游离三碘甲状腺原氨酸(FT3)-静脉血: 4.97pmol/L；甲状腺球蛋白(TG)-静脉血: 1.12ng/ml；促甲状腺激素(TSH)-静脉血: 1.59uIU/ml\n- [全程D1169] 超声；肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径不宽，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1170] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，走行自然，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n- [全程D1380] 检验组合: 游离三碘甲状腺原氨酸(FT3)-静脉血: 5.27pmol/L；游离甲状腺素(FT4)-静脉血: 13.84pmol/L；胆碱酯酶(ChE)-静脉血: 10374U/L；总钙(Ca)-静脉血: 2.33mmol/L；中性粒细胞百分比(Neut%)-静脉血: 56.6%；γ-谷氨酰基转移酶(GGT)-静脉血: 25.6U/L；肌酸激酶(CK)-静脉血: 80U/L；肌酐(Crea)-静脉血: 59.7umol/L；总蛋白(TP)-静脉血: 72.07g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 27.9pg；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.29mmol/L；淋巴细胞计数(Lymph#)-静脉血: 2.110E9/L；镁离子(Mg2+)-静脉血: 1.02mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.3mmol/L；碱性磷酸酶(ALP)-静脉血: 75.5U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.2510E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.2%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.1fL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；大血小板百分比(P-LCR%)-静脉血: 21.4%；白蛋白(ALB)-静脉血: 43.8g/L；载脂蛋白AI(apoAI)-静脉血: 1.52g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.55；总胆固醇(TC)-静脉血: 6.32mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.7U/L；阴离子间隙(AG)-静脉血: 18.4；血红蛋白(Hb)-静脉血: 131g/L；甲状腺球蛋白(TG)-静脉血: 1.4ng/ml；平均红细胞血红蛋白浓度(MCHC)-静脉血: 300g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.34mmolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 2.4；钾离子(K+)-静脉血: 3.9mmol/L；红细胞比容(Hct)-静脉血: 43.7%；未成熟粒细胞百分比(IG%)-静脉血: 0.5%；磷(P)-静脉血: 1.39mmol/L；钠离子(Na+)-静脉血: 141.4mmol/L；间接胆红素(IBIL)-静脉血:……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- [全程D986] 门急诊记录: 主诉: 鼻咽癌放化疗结束2年，诉轻度口干，听力视力正常，无头晕、头痛。体查：鼻咽未见明确肿物，双颈未扪及明显肿大淋巴结，颅神经（-）甲功五项示正常。鼻咽MRI未见明确复发，腹部B超、胸片未见明确转移。EBV-DNA:0；现病史:；既往史:；个人史:；家族史:；体格检查:\n- [全程D1174] 门急诊记录: 主诉: 鼻咽癌放化疗结束2年，诉轻度口干，听力视力正常，无头晕、头痛。体查：鼻咽未见明确肿物，双颈未扪及明显肿大淋巴结，颅神经（-）甲功五项示正常。鼻咽MRI未见明确复发，腹部B超、胸片未见明确转移。EBV-DNA:0；现病史:；既往史:；个人史:；家族史:；体格检查:\n- [时间未明] 门急诊记录: 主诉:；现病史: 者半年余前无明显诱因出现左侧颈部肿物，无疼痛，逐渐增大，伴有鼻塞、流涕，至当地医院予抗炎对症治疗后，肿物能减小；2月前患者始出现右侧颈部肿物，逐渐增大，伴有鼻塞、流涕，间中有涕血，无发热、畏寒，无头晕、头痛，无周身骨痛等，于当地医院检查ＣＴ示：鼻咽肿物，遂转至我院进一步诊治。门诊拟诊“鼻咽肿物”收入我科进一步治疗。患者起病以来精神、睡眠欠佳，胃纳尚可，二便正常，体重无明显下降。；既往史: 否认高血压、糖尿病及心脏病史，否认结核等传染病史、否认手术、外伤及输血史。；个人史:；家族史: 家族中无类似患者，无家族性遗传病患者，无重大精神病患者。；体格检查: KPS90，一般状况可，鼻咽左侧壁、顶后壁肿物，双颈扪及肿大淋巴结，右颈多枚肿大淋巴结，较大者约6*4及2*2cm,质硬，活动差，左上颈可及一淋巴结，约3*3cm，质中，活动度可，无融合，无皮肤浸润等，左中颈可及一大小约1*1cm质硬淋巴结；张口门齿距约4cm，颅神经征阴性。。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 给予大剂量糖皮质激素冲击治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超\nB. 给予贝伐珠单抗靶向治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项\nC. 安排头颅PET-CT检查鉴别左侧颞叶病变性质，并安排胸部X线、腹部彩超、甲功五项\nD. 安排立体定向脑活检明确左侧颞叶病变性质，并安排胸部X线、腹部彩超、甲功五项\nE. 给予高压氧治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项\nF. 给予甘露醇静脉滴注脱水降颅压，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超\nG. 安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项及EBV-DNA定量检测\nH. 给予神经营养药物治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项\nI. 安排鼻咽及颈部CT平扫+增强、胸部CT平扫、腹部CT平扫、甲功五项及EBV-DNA定量检测\nJ. 安排立体定向放射外科治疗左侧颞叶病变，并安排胸部X线、腹部彩超、甲功五项\nK. 安排鼻咽及颈部MRI平扫+增强、头颅MRI平扫+增强，暂缓胸部X线及腹部彩超检查\nL. 给予抗癫痫药物预防性治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"给予大剂量糖皮质激素冲击治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超","is_gold":false},{"letter":"B","text":"给予贝伐珠单抗靶向治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项","is_gold":false},{"letter":"C","text":"安排头颅PET-CT检查鉴别左侧颞叶病变性质，并安排胸部X线、腹部彩超、甲功五项","is_gold":false},{"letter":"D","text":"安排立体定向脑活检明确左侧颞叶病变性质，并安排胸部X线、腹部彩超、甲功五项","is_gold":false},{"letter":"E","text":"给予高压氧治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项","is_gold":false},{"letter":"F","text":"给予甘露醇静脉滴注脱水降颅压，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超","is_gold":false},{"letter":"G","text":"安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项及EBV-DNA定量检测","is_gold":false},{"letter":"H","text":"给予神经营养药物治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超、甲功五项","is_gold":false},{"letter":"I","text":"安排鼻咽及颈部CT平扫+增强、胸部CT平扫、腹部CT平扫、甲功五项及EBV-DNA定量检测","is_gold":false},{"letter":"J","text":"安排立体定向放射外科治疗左侧颞叶病变，并安排胸部X线、腹部彩超、甲功五项","is_gold":false},{"letter":"K","text":"安排鼻咽及颈部MRI平扫+增强、头颅MRI平扫+增强，暂缓胸部X线及腹部彩超检查","is_gold":true},{"letter":"L","text":"给予抗癫痫药物预防性治疗，并安排鼻咽及颈部MRI平扫+增强、胸部X线、腹部彩超","is_gold":false}],"gold_letter":"K"},{"sample_id":"sample-2fc2bca32acf3eb67f65396b","patient_id":"patient-9149023ec8599161ec3e5cfd","turn_id":"turn07","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现双颈肿物半年余；现病史: 者半年余前无明显诱因出现左侧颈部肿物，无疼痛，逐渐增大，伴有鼻塞、流涕，至当地医院予抗炎对症治疗后，肿物能减小；2月前患者始出现右侧颈部肿物，逐渐增大，伴有鼻塞、流涕，间中有涕血，无发热、畏寒，无头晕、头痛，无周身骨痛等，于当地医院检查ＣＴ示：鼻咽肿物，遂转至我院进一步诊治。门诊拟诊“鼻咽肿物”收入我科进一步治疗。患者起病以来精神、睡眠欠佳，胃纳尚可，二便正常，体重无明显下降。；阳性症状体征: 鼻塞,睡眠欠佳,鼻咽肿物,涕血,右颈部肿物,左颈部肿物,流涕；既往史: 体健，无高血压、心脏病等慢性病，无糖尿病、肾病等全身性疾病，无乙肝、结核等传染病，无外伤史。；个人史: 生于原籍，有吸烟史30年,无饮酒，无其他嗜好，否认冶游史。；家族史: 家族中无类似患者，无家族性遗传病患者，无重大精神病患者。；体格检查:；专科检查:；KPS:；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D46] 检验组合: 中性粒细胞百分比(Neut%)-静脉血: 0.568；血液二氧化碳含量ctCO2(B)-静脉血: 23mmol/L；钾离子(K+)-静脉血: 3.97mmol/L；镁离子(Mg2+)-静脉血: 0.79mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.383；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.55；钠离子(Na+)-静脉血: 130mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；平均红细胞体积(MCV)-静脉血: 82.6fL；单核细胞百分比(Mono%)-静脉血: 0.042；肌酐(Crea)-静脉血: 46.6umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 44U/L；血红蛋白(Hb)-静脉血: 118g/L；磷(P)-静脉血: 1.18mmol/L；总胆红素(TBIL)-静脉血: 7.2umol/L；平均血小板体积(MPV)-静脉血: 9fL；总蛋白(TP)-静脉血: 67.1g/L；乳酸脱氢酶(LDH)-静脉血: 137.5U/L；间接胆红素(IBIL)-静脉血: 5.3umolL；球蛋白(GLO)-静脉血: 28.1g/L；尿酸(UA)-静脉血: 102.4umol/L；白蛋白(ALB)-静脉血: 39g/L；有核红细胞百分比(NRBC%)-静脉血: 0；单核细胞计数(Mono#)-静脉血: 0.210E9/L；红细胞比容(Hct)-静脉血: 36%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血小板分布宽度(PDW)-静脉血: 9%；阴离子间隙(AG)-静脉血: 14.1；直接胆红素(DBIL)-静脉血: 1.9umol/L；总胆汁酸(TBA)-静脉血: 1.5umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.4；有核红细胞计数(NRBC#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.710E9/L；大血小板百分比(P-LCR%)-静脉血: 16.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 27.1pg；γ-谷氨酰基转移酶(GGT)-静脉血: 62.8U/L；尿素氮(BUN)-静脉血: 3.4mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.39；红细胞计数(RBC#……\n- [全程D55] 检验组合: 平均红细胞血红蛋白含量(MCH)-静脉血: 27.3pg；天门冬氨酸氨基转移酶(AST)-静脉血: 14.5U/L；碱性磷酸酶(ALP)-静脉血: 103.1U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；淋巴细胞计数(Lymph#)-静脉血: 2.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.145；红细胞计数(RBC#)-静脉血: 3.7410E12/L；有核红细胞百分比(NRBC%)-静脉血: 0；大血小板百分比(P-LCR%)-静脉血: 18.5%；红细胞比容(Hct)-静脉血: 32.5%；淋巴细胞百分比(Lymph%)-静脉血: 0.531；丙氨酸氨基转移酶(ALT)-静脉血: 7.8U/L；氯离子(Cl-)-静脉血: 102mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；间接胆红素(IBIL)-静脉血: 1.7umolL；平均血小板体积(MPV)-静脉血: 9.3fL；总钙(Ca)-静脉血: 2.22mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；总蛋白(TP)-静脉血: 64.51g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.6mmol/L；血红蛋白(Hb)-静脉血: 102g/L；血小板比容-静脉血: 15%；中性粒细胞计数(Neut#)-静脉血: 1.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.318；白细胞计数(WBC#)-静脉血: 4.4810E9/L；镁离子(Mg2+)-静脉血: 0.78mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 35.3U/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 314g/L；乳酸脱氢酶(LDH)-静脉血: 139.5U/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；钠离子(Na+)-静脉血: 137.5mmol/L；总胆红素(TBIL)-静脉血: 2.4umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.86；尿素氮(BUN)-静脉血: 3.4mmol/L；肌酐(Crea)-静脉血: 64.6umol/L；总胆汁酸(TBA)-静脉血: 3.8umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 55.2U/L；单核细……\n- [全程D61] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- [全程D61] 检验组合: 碱性磷酸酶(ALP)-静脉血: 108.3U/L；丙氨酸氨基转移酶(ALT)-静脉血: 14.3U/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；直接胆红素(DBIL)-静脉血: 0.6umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24U/L；中性粒细胞百分比(Neut%)-静脉血: 0.512；α-L-岩藻糖苷酶(AFU)-静脉血: 44.3U/L；钾离子(K+)-静脉血: 4.3mmol/L；平均红细胞体积(MCV)-静脉血: 87.2fL；白细胞计数(WBC#)-静脉血: 7.6610E9/L；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；血小板比容-静脉血: 24%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；平均红细胞血红蛋白含量(MCH)-静脉血: 27.2pg；乳酸脱氢酶(LDH)-静脉血: 151.5U/L；阴离子间隙(AG)-静脉血: 16.2；肌酐(Crea)-静脉血: 58.2umol/L；总胆汁酸(TBA)-静脉血: 12.2umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.9mmol/L；球蛋白(GLO)-静脉血: 28.8g/L；淋巴细胞计数(Lymph#)-静脉血: 2.710E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 312g/L；氯离子(Cl-)-静脉血: 100.7mmol/L；尿酸(UA)-静脉血: 217.3umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.47；总钙(Ca)-静脉血: 2.18mmol/L；白蛋白(ALB)-静脉血: 42.2g/L；大血小板百分比(P-LCR%)-静脉血: 17.6%；γ-谷氨酰基转移酶(GGT)-静脉血: 62.4U/L；平均血小板体积(MPV)-静脉血: 9.1fL；磷(P)-静脉血: 1.45mmol/L；间接胆红素(IBIL)-静脉血: 2.4umolL；血小板计数(PLT#)-静脉血: 26810E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；血小板分布宽度(PDW)-静脉血: 9.4%；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.68；总胆红素(TBIL)-静脉血: 3umol/L；单核细胞百分比(Mono%)-静脉血:……\n- [全程D68] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后，对比某次就诊时间片： 鼻咽腔狭窄，鼻咽顶壁、顶后壁、左侧壁见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强后明显强化，肿物占据左侧咽隐窝，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，向前累及双侧后鼻孔，范围较前缩小，右侧咽隐窝变浅，右侧咽旁脂肪间隙及颈动脉鞘区未见异常。 左侧腭帆张提肌、左侧翼内肌上缘及双侧头长肌受侵，右侧腭帆提肌、腭帆张肌未见受侵征象。左侧翼腭窝可见软组织稍增厚，大致同前，右侧翼腭窝、右侧颞下窝未见异常；口咽双侧壁未见增厚。 斜坡、蝶骨基底部、左侧枕骨基底部、左侧岩尖、左侧翼突基底部、左侧翼突内外板、左侧蝶骨大翼骨质破坏，增强扫描后明显强化，大致同前。 左侧破裂孔及左侧海绵窦下份见少许软组织影，增强扫描后明显强化，较前变化不大，右侧海绵窦形态正常。 左侧上颌窦、筛窦、蝶窦、双侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 双侧咽后间隙见小淋巴结，最大短径约3mm，较前稍缩小；双颈II区见肿大淋巴结，最大约为20mm×30mm，边界清楚，信号不均匀，部分见囊变坏死，增强后不均匀强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗后，对比某次就诊时间片： 鼻咽病灶较前范围稍缩小。 颅底骨质破坏，大致同前。 双侧咽后淋巴结小淋巴结，较前稍缩小；双颈II区淋巴结肿大，考虑转移，部分较前缩小。 鼻窦炎、双侧乳突炎。\n- [全程D68] 检验组合: 阴离子间隙(AG)-静脉血: 14.8；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.75；白蛋白(ALB)-静脉血: 42.2g/L；间接胆红素(IBIL)-静脉血: 6.1umolL；总胆红素(TBIL)-静脉血: 8umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.6；血小板分布宽度(PDW)-静脉血: 8.4%；平均红细胞血红蛋白含量(MCH)-静脉血: 27.1pg；钠离子(Na+)-静脉血: 132.5mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 323g/L；直接胆红素(DBIL)-静脉血: 1.9umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 65.5U/L；钾离子(K+)-静脉血: 4.64mmol/L；碱性磷酸酶(ALP)-静脉血: 83.1U/L；白细胞计数(WBC#)-静脉血: 3.3810E9/L；血红蛋白(Hb)-静脉血: 107g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞比容(Hct)-静脉血: 33.1%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44.7；α-L-岩藻糖苷酶(AFU)-静脉血: 49.8U/L；中性粒细胞百分比(Neut%)-静脉血: 0.558；乳酸脱氢酶(LDH)-静脉血: 136.8U/L；尿素氮(BUN)-静脉血: 2.6mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.3mmol/L；单核细胞计数(Mono#)-静脉血: 0.110E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.033；氯离子(Cl-)-静脉血: 94.4mmol/L；肌酐(Crea)-静脉血: 53.8umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.9U/L；球蛋白(GLO)-静脉血: 28.48g/L；平均血小板体积(MPV)-静脉血: 8.3fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；中性粒细胞计数(Neut#)-静脉血: 1.910E9/L；总胆汁酸(TBA)-静脉血: 2.7umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.373；血小板比容-静脉血: 31%；总蛋白(TP)-静脉……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D62] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日查房时自述精神食欲可，睡眠休息好。查体：KPS 90，一般状况可，鼻咽左侧壁、顶后壁肿物，双颈扪及肿大淋巴结，右颈多枚肿大淋巴结，较大者约6*4及2*2cm,质硬，活动差，左上颈可及一淋巴结，约3*3cm，质中，活动度可，无融合，无皮肤浸润等，左中颈可及一大小约1*1cm质硬淋巴结；张口门齿距约4cm，颅神经征阴性。[姓名已隐去]医生信息已隐藏：该病人为鼻咽癌，已接受GP方案诱导化疗2周期。目前排除化疗禁忌症，今日水化，明日再予GP方案行第三周期化疗，遵执。\n- [全程D63] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日查房时无特殊不适主诉，精神食欲可，昨日水化顺利。查体大致同前。[姓名已隐去]医生信息已隐藏：该病人继续按原方案（吉西他滨 1g/m2d1、d8+顺铂 80mg/m2d1）化疗，注意护胃、止吐等对症支持处理，遵执。\n- [全程D66] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 患者化疗输液顺利完成。今日查房时自诉精神食欲可，二便通畅。今继续对症支持治疗，择期复查血常规及血生化。\n- [时间未明] 门急诊记录: 主诉:；现病史: 者半年余前无明显诱因出现左侧颈部肿物，无疼痛，逐渐增大，伴有鼻塞、流涕，至当地医院予抗炎对症治疗后，肿物能减小；2月前患者始出现右侧颈部肿物，逐渐增大，伴有鼻塞、流涕，间中有涕血，无发热、畏寒，无头晕、头痛，无周身骨痛等，于当地医院检查ＣＴ示：鼻咽肿物，遂转至我院进一步诊治。门诊拟诊“鼻咽肿物”收入我科进一步治疗。患者起病以来精神、睡眠欠佳，胃纳尚可，二便正常，体重无明显下降。；既往史: 否认高血压、糖尿病及心脏病史，否认结核等传染病史、否认手术、外伤及输血史。；个人史:；家族史: 家族中无类似患者，无家族性遗传病患者，无重大精神病患者。；体格检查: KPS90，一般状况可，鼻咽左侧壁、顶后壁肿物，双颈扪及肿大淋巴结，右颈多枚肿大淋巴结，较大者约6*4及2*2cm,质硬，活动差，左上颈可及一淋巴结，约3*3cm，质中，活动度可，无融合，无皮肤浸润等，左中颈可及一大小约1*1cm质硬淋巴结；张口门齿距约4cm，颅神经征阴性。。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 提前终止第3周期诱导化疗，直接进入根治性同步放化疗阶段。\nB. 暂停第8天化疗，予重组人粒细胞集落刺激因子升白治疗后复查血常规。\nC. 更改诱导化疗方案为TP（多西他赛+顺铂）进行第4周期治疗。\nD. 继续行第3周期GP方案第8天化疗（吉西他滨联合顺铂），并安排出院。\nE. 计划在第3周期结束后，继续行第4周期GP方案诱导化疗。\nF. 暂停化疗，行双侧颈部淋巴结清扫术及鼻咽原发灶切除术。\nG. 终止后续放疗计划，按完全缓解（CR）状态进入定期随访观察。\nH. 将第8天吉西他滨剂量下调25%后给药，并密切监测血常规。\nI. 继续行第3周期GP方案第8天化疗（吉西他滨），辅以肠内营养支持，并安排出院。\nJ. 暂停治疗，行全身PET-CT检查以重新评估全身肿瘤负荷。\nK. 在第8天化疗基础上加用PD-1抑制剂（如特瑞普利单抗）进行联合治疗。\nL. 立即启动根治性调强放疗，并同步给予吉西他滨单药化疗。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"提前终止第3周期诱导化疗，直接进入根治性同步放化疗阶段。","is_gold":false},{"letter":"B","text":"暂停第8天化疗，予重组人粒细胞集落刺激因子升白治疗后复查血常规。","is_gold":false},{"letter":"C","text":"更改诱导化疗方案为TP（多西他赛+顺铂）进行第4周期治疗。","is_gold":false},{"letter":"D","text":"继续行第3周期GP方案第8天化疗（吉西他滨联合顺铂），并安排出院。","is_gold":false},{"letter":"E","text":"计划在第3周期结束后，继续行第4周期GP方案诱导化疗。","is_gold":false},{"letter":"F","text":"暂停化疗，行双侧颈部淋巴结清扫术及鼻咽原发灶切除术。","is_gold":false},{"letter":"G","text":"终止后续放疗计划，按完全缓解（CR）状态进入定期随访观察。","is_gold":false},{"letter":"H","text":"将第8天吉西他滨剂量下调25%后给药，并密切监测血常规。","is_gold":false},{"letter":"I","text":"继续行第3周期GP方案第8天化疗（吉西他滨），辅以肠内营养支持，并安排出院。","is_gold":true},{"letter":"J","text":"暂停治疗，行全身PET-CT检查以重新评估全身肿瘤负荷。","is_gold":false},{"letter":"K","text":"在第8天化疗基础上加用PD-1抑制剂（如特瑞普利单抗）进行联合治疗。","is_gold":false},{"letter":"L","text":"立即启动根治性调强放疗，并同步给予吉西他滨单药化疗。","is_gold":false}],"gold_letter":"I"}]}
+{"patient_id":"patient-4e3ac84b9e1451cea981f98e","bootstrap_cluster_id":"cluster-017","turns":[{"sample_id":"sample-655ad2033595c09c6c4ce571","patient_id":"patient-4e3ac84b9e1451cea981f98e","turn_id":"turn01","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、头长肌。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D37] 入院记录: 主诉: 回吸性涕血3月；现病史: 患者于某次就诊时间无明显诱因出现涕中带血，量少，色鲜红，呈间歇性，未引起重视。近2个月间歇性出现耳鸣，伴左颈肿物，遂就诊我院。患者无头痛、面麻、复视、听力下降等症状。左侧腭帆提肌、头长肌受侵，右侧腭帆提肌、双侧腭帆张肌及右侧头长肌未见受侵征象。颅底骨质未见破坏征象。右侧咽后淋巴结、左颈II区淋巴肿大。第3、7胸椎局部代谢活跃，建议随诊。胸部平片、腹部彩超未见明显异常。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,涕中带血,左颈肿物,淋巴肿大；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.8℃，P：18次/分，R: 76次/分，BP：116/68mmHg,Ht：165cm，Wt：56.5kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；双侧顶后壁，左侧隐窝可见结节状肿物，左颈II区可扪及肿大淋巴结，大小约10*15mm,质韧，无压痛，活动度可，与周围组织分界清楚。颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善血常规、肝肾功能、EBV-DNA检测，并安排全身PET-CT。\nB. 完善血常规、肝肾功能、凝血功能，并安排鼻咽部活检。\nC. 完善血常规、肝功能、EBV-DNA检测，并直接开始诱导化疗。\nD. 完善血常规、肝功能、甲状腺功能检测，并安排胸部CT和腹部增强CT。\nE. 完善血常规、肝功能、肾功能及心电图检查，暂不检测内分泌功能。\nF. 完善血常规、肝功能、脑垂体激素五项检测，暂不检测甲状腺功能。\nG. 完善血常规、肝功能、甲状腺功能及性激素六项检测。\nH. 完善血常规、肝功能检测，并安排骨扫描。\nI. 完善血常规、肝功能、甲状腺功能及肾上腺皮质激素检测。\nJ. 完善血常规、肝功能、甲状腺功能及脑垂体激素五项检测。\nK. 完善血常规、肝功能、甲状腺功能及脑垂体激素五项检测，并立即行胸椎穿刺活检。\nL. 完善血常规、肝功能检测，并安排全身骨髓穿刺。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"完善血常规、肝肾功能、EBV-DNA检测，并安排全身PET-CT。","is_gold":false},{"letter":"B","text":"完善血常规、肝肾功能、凝血功能，并安排鼻咽部活检。","is_gold":true},{"letter":"C","text":"完善血常规、肝功能、EBV-DNA检测，并直接开始诱导化疗。","is_gold":false},{"letter":"D","text":"完善血常规、肝功能、甲状腺功能检测，并安排胸部CT和腹部增强CT。","is_gold":false},{"letter":"E","text":"完善血常规、肝功能、肾功能及心电图检查，暂不检测内分泌功能。","is_gold":false},{"letter":"F","text":"完善血常规、肝功能、脑垂体激素五项检测，暂不检测甲状腺功能。","is_gold":false},{"letter":"G","text":"完善血常规、肝功能、甲状腺功能及性激素六项检测。","is_gold":false},{"letter":"H","text":"完善血常规、肝功能检测，并安排骨扫描。","is_gold":false},{"letter":"I","text":"完善血常规、肝功能、甲状腺功能及肾上腺皮质激素检测。","is_gold":false},{"letter":"J","text":"完善血常规、肝功能、甲状腺功能及脑垂体激素五项检测。","is_gold":false},{"letter":"K","text":"完善血常规、肝功能、甲状腺功能及脑垂体激素五项检测，并立即行胸椎穿刺活检。","is_gold":false},{"letter":"L","text":"完善血常规、肝功能检测，并安排全身骨髓穿刺。","is_gold":false}],"gold_letter":"B"},{"sample_id":"sample-49bfe4582a9d9a75f21d4be4","patient_id":"patient-4e3ac84b9e1451cea981f98e","turn_id":"turn02","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、头长肌。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- 暂无可展示的初诊主诉/入院资料。\n\n【已完成检查与客观结果】\n- [全程D1] 检验组合: 尿酸(UA)-静脉血: 316.2umol/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 5.28mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 7.2umol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；球蛋白(GLO)-静脉血: 32.53g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.54mmol/L；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；磷(P)-静脉血: 1.06mmol/L；总胆汁酸(TBA)-静脉血: 2.6umol/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；Rh血型-静脉血: 阳性；血红蛋白(Hb)-静脉血: 153g/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.94；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.93mg/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；血小板分布宽度(PDW)-静脉血: 11.2%；血小板计数(PLT#)-静脉血: 29810E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；白蛋白(ALB)-静脉血: 48g/L；直接胆红素(DBIL)-静脉血: 1.8umol/L；活化部分凝血活酶时间(APTT)-静脉血: 24.9sec.；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；钠离子(Na+)-静脉血: 139.1mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.39；尿素氮(BUN)-静脉血: 5.9mmol/L；钾离子(K+)-静脉血: 4.04mmol/L；C-反应蛋白(CRP)-静脉血: 9.58mg/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22.5U/L；纤维蛋白原(Fbg)-静脉血: 4.77g/L；凝血酶原时间活动度(PTA)-静脉血: 125.5%；淋巴细胞……\n- [全程D18] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- [全程D18] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约25cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约45×26×26mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D19] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显斑片或结节影。双侧肺门影未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见病变。\n- [全程D20] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 第3、7胸椎及右股骨上段见片状放射性浓聚影。颅骨、胸骨、锁骨、肩胛骨、肋骨、颈椎、腰椎、骶尾骨、髋骨及上肢骨骼放射性分布未见明显异常。；检查结论: 右股骨上段局部代谢活跃，疑良性病变，缺血性坏死待排。 第3、7胸椎局部代谢活跃，建议随诊。\n- [全程D20] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁及左侧壁明显增厚，见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。左侧咽隐窝见肿物占据，右侧咽隐窝存在。左侧腭帆提肌、头长肌受侵，右侧腭帆提肌、双侧腭帆张肌及右侧头长肌未见受侵征象。病灶堵塞左侧后鼻孔。 双侧翼腭窝、双侧颞下窝未见异常；口咽未见异常。 颅底骨质未见破坏征象。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦粘膜未见增厚，双侧乳突充气良好，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 左侧咽后间隙见肿大淋巴结，大小约11mm×14mm；右侧咽后间隙见淋巴结，边界欠清，较大者短径约5mm。 左颈II区见数个淋巴结，部分信号不均匀，较大者大小约10mm×13mm，不均匀强化。颈部双侧Ⅰ、ⅡI区见小淋巴结，边界清，较大者短径约5mm，孤立散在。 甲状腺未见异常信号灶。喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 扫描范围颈椎未见明确骨质破坏。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质未见破坏征象。 左侧咽后淋巴结，考虑转移。右侧咽后淋巴结，考虑转移可能性大。 左颈II区淋巴结，考虑转移可能性大。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 临床分期为 cT1N1M0（AJCC v9 IB期），病变局限于鼻咽腔及咽隐窝，未见明确周围软组织受侵，骨显像异常考虑良性。\nB. 临床分期为 cT2N2M0（AJCC v9 II期），双侧咽后淋巴结受累按分期规则应评为N2，骨显像异常考虑良性。\nC. 临床分期为 cT2N1M1（AJCC v9 IVB期），骨显像胸椎及股骨代谢活跃表现已达到多发骨转移诊断标准。\nD. 临床分期为 cT3N1M0（AJCC v9 II期），病灶堵塞后鼻孔已构成鼻腔侵犯，按分期规则应评为T3。\nE. 临床分期为 cT2N1M0（AJCC v9 II期），头长肌受侵定为T2，单侧颈部淋巴结转移定为N1，综合评为II期。\nF. 临床分期暂定 cT2N1Mx，骨显像异常代谢灶性质未明，需常规补充全身PET-CT或骨活检明确M分期。\nG. 临床分期为 cT1N2M0（AJCC v9 II期），左侧咽后及左颈II区淋巴结转移评为N2，未见明确T2结构受侵。\nH. 临床分期为 cT3N1M0（AJCC v9 II期），腭帆提肌受侵代表侵犯咽旁间隙以外结构，按分期规则应评为T3。\nI. 临床分期为 cT2N0M0（AJCC v9 IB期），咽后及颈部淋巴结短径均小于15mm，未达转移诊断标准，应评为N0。\nJ. 临床分期为 cT4N1M0（AJCC v9 III期），病变侵犯头长肌属于广泛软组织受侵，按分期规则应评为T4。\nK. 临床分期为 cT2N1M0（AJCC v9 IB期），头长肌受侵定为T2，双侧咽后及单侧颈部淋巴结转移定为N1，骨显像异常考虑良性暂定M0。\nL. 临床分期为 cT2N1M0（AJCC v9 IB期），腭帆提肌受侵定为T2，建议加做全身PET-CT以排除隐匿性转移。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"临床分期为 cT1N1M0（AJCC v9 IB期），病变局限于鼻咽腔及咽隐窝，未见明确周围软组织受侵，骨显像异常考虑良性。","is_gold":false},{"letter":"B","text":"临床分期为 cT2N2M0（AJCC v9 II期），双侧咽后淋巴结受累按分期规则应评为N2，骨显像异常考虑良性。","is_gold":false},{"letter":"C","text":"临床分期为 cT2N1M1（AJCC v9 IVB期），骨显像胸椎及股骨代谢活跃表现已达到多发骨转移诊断标准。","is_gold":false},{"letter":"D","text":"临床分期为 cT3N1M0（AJCC v9 II期），病灶堵塞后鼻孔已构成鼻腔侵犯，按分期规则应评为T3。","is_gold":false},{"letter":"E","text":"临床分期为 cT2N1M0（AJCC v9 II期），头长肌受侵定为T2，单侧颈部淋巴结转移定为N1，综合评为II期。","is_gold":false},{"letter":"F","text":"临床分期暂定 cT2N1Mx，骨显像异常代谢灶性质未明，需常规补充全身PET-CT或骨活检明确M分期。","is_gold":false},{"letter":"G","text":"临床分期为 cT1N2M0（AJCC v9 II期），左侧咽后及左颈II区淋巴结转移评为N2，未见明确T2结构受侵。","is_gold":false},{"letter":"H","text":"临床分期为 cT3N1M0（AJCC v9 II期），腭帆提肌受侵代表侵犯咽旁间隙以外结构，按分期规则应评为T3。","is_gold":false},{"letter":"I","text":"临床分期为 cT2N0M0（AJCC v9 IB期），咽后及颈部淋巴结短径均小于15mm，未达转移诊断标准，应评为N0。","is_gold":false},{"letter":"J","text":"临床分期为 cT4N1M0（AJCC v9 III期），病变侵犯头长肌属于广泛软组织受侵，按分期规则应评为T4。","is_gold":false},{"letter":"K","text":"临床分期为 cT2N1M0（AJCC v9 IB期），头长肌受侵定为T2，双侧咽后及单侧颈部淋巴结转移定为N1，骨显像异常考虑良性暂定M0。","is_gold":true},{"letter":"L","text":"临床分期为 cT2N1M0（AJCC v9 IB期），腭帆提肌受侵定为T2，建议加做全身PET-CT以排除隐匿性转移。","is_gold":false}],"gold_letter":"K"},{"sample_id":"sample-04c8674f03cec4de991fcf32","patient_id":"patient-4e3ac84b9e1451cea981f98e","turn_id":"turn04","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、头长肌。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D1] 检验组合: 尿酸(UA)-静脉血: 316.2umol/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 5.28mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 7.2umol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；球蛋白(GLO)-静脉血: 32.53g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.54mmol/L；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；磷(P)-静脉血: 1.06mmol/L；总胆汁酸(TBA)-静脉血: 2.6umol/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；Rh血型-静脉血: 阳性；血红蛋白(Hb)-静脉血: 153g/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.94；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.93mg/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；血小板分布宽度(PDW)-静脉血: 11.2%；血小板计数(PLT#)-静脉血: 29810E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；白蛋白(ALB)-静脉血: 48g/L；直接胆红素(DBIL)-静脉血: 1.8umol/L；活化部分凝血活酶时间(APTT)-静脉血: 24.9sec.；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；钠离子(Na+)-静脉血: 139.1mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.39；尿素氮(BUN)-静脉血: 5.9mmol/L；钾离子(K+)-静脉血: 4.04mmol/L；C-反应蛋白(CRP)-静脉血: 9.58mg/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22.5U/L；纤维蛋白原(Fbg)-静脉血: 4.77g/L；凝血酶原时间活动度(PTA)-静脉血: 125.5%；淋巴细胞……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D18] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- [全程D18] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约25cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约45×26×26mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D19] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显斑片或结节影。双侧肺门影未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见病变。\n- [全程D20] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 第3、7胸椎及右股骨上段见片状放射性浓聚影。颅骨、胸骨、锁骨、肩胛骨、肋骨、颈椎、腰椎、骶尾骨、髋骨及上肢骨骼放射性分布未见明显异常。；检查结论: 右股骨上段局部代谢活跃，疑良性病变，缺血性坏死待排。 第3、7胸椎局部代谢活跃，建议随诊。\n- [全程D20] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁及左侧壁明显增厚，见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。左侧咽隐窝见肿物占据，右侧咽隐窝存在。左侧腭帆提肌、头长肌受侵，右侧腭帆提肌、双侧腭帆张肌及右侧头长肌未见受侵征象。病灶堵塞左侧后鼻孔。 双侧翼腭窝、双侧颞下窝未见异常；口咽未见异常。 颅底骨质未见破坏征象。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦粘膜未见增厚，双侧乳突充气良好，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 左侧咽后间隙见肿大淋巴结，大小约11mm×14mm；右侧咽后间隙见淋巴结，边界欠清，较大者短径约5mm。 左颈II区见数个淋巴结，部分信号不均匀，较大者大小约10mm×13mm，不均匀强化。颈部双侧Ⅰ、ⅡI区见小淋巴结，边界清，较大者短径约5mm，孤立散在。 甲状腺未见异常信号灶。喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 扫描范围颈椎未见明确骨质破坏。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质未见破坏征象。 左侧咽后淋巴结，考虑转移。右侧咽后淋巴结，考虑转移可能性大。 左颈II区淋巴结，考虑转移可能性大。\n- [全程D23] 检验组合: 天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.75；乳酸脱氢酶(LDH)-静脉血: 285.9U/L；总胆汁酸(TBA)-静脉血: 12.7umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 220U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 20.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 249.9U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 165.4U/L；碱性磷酸酶(ALP)-静脉血: 161.1U/L\n- [全程D37] 检验组合: 甲状腺球蛋白(TG)-静脉血: 13.08ng/ml；平均血小板体积(MPV)-静脉血: 9.9fL；α-L-岩藻糖苷酶(AFU)-静脉血: 21.1U/L；促卵泡刺激素(FSH)-静脉血: 6.26mIU/ml；血小板比容-静脉血: 29%；血小板分布宽度(PDW)-静脉血: 11.3%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.2；催乳素(PRL)-静脉血: 277.6uIU/ml；大血小板百分比(P-LCR%)-静脉血: 23.9%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；促黄体生成素(LH)-静脉血: 9.22mIU/ml；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；血小板计数(PLT#)-静脉血: 29710E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.262；γ-谷氨酰基转移酶(GGT)-静脉血: 227.5U/L；生长激素(GH)-静脉血: 0.54ng/ml；碱性磷酸酶(ALP)-静脉血: 164.9U/L；乳酸脱氢酶(LDH)-静脉血: 170.2U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 38.5；平均红细胞体积(MCV)-静脉血: 94fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；血红蛋白(Hb)-静脉血: 140g/L；中性粒细胞计数(Neut#)-静脉血: 4.410E9/L；促甲状腺激素(TSH)-静脉血: 4.45uIU/ml；有核红细胞计数(NRBC#)-静脉血: 010E9/L；单核细胞百分比(Mono%)-静脉血: 0.105；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.619；红细胞计数(RBC#)-静脉血: 4.5110E12/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；红细胞比容(Hct)-静脉血: 42.4%；总胆汁酸(TBA)-静脉血: 2umol/L；甲状腺过氧化物酶抗体(TPO-Ab)-静脉血: 14.45U/ml；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.58；丙氨酸氨基转移酶(ALT)-静脉血:……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 单纯根治性放射治疗或根治性放化疗\nB. 诱导化疗后序贯单纯根治性放射治疗\nC. 诱导化疗后序贯根治性放化疗\nD. 单纯根治性放射治疗后序贯辅助化疗\nE. 根治性放化疗后序贯辅助化疗\nF. 诱导化疗后序贯根治性放化疗及辅助化疗\nG. 姑息性放射治疗联合全身系统性化疗\nH. 单纯根治性放射治疗联合EGFR靶向治疗\nI. 诱导化疗联合EGFR靶向治疗后序贯放疗\nJ. 根治性放化疗联合PD-1抑制剂治疗\nK. 诱导化疗联合PD-1抑制剂后序贯放化疗\nL. 单纯全身系统性化疗\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"单纯根治性放射治疗或根治性放化疗","is_gold":true},{"letter":"B","text":"诱导化疗后序贯单纯根治性放射治疗","is_gold":false},{"letter":"C","text":"诱导化疗后序贯根治性放化疗","is_gold":false},{"letter":"D","text":"单纯根治性放射治疗后序贯辅助化疗","is_gold":false},{"letter":"E","text":"根治性放化疗后序贯辅助化疗","is_gold":false},{"letter":"F","text":"诱导化疗后序贯根治性放化疗及辅助化疗","is_gold":false},{"letter":"G","text":"姑息性放射治疗联合全身系统性化疗","is_gold":false},{"letter":"H","text":"单纯根治性放射治疗联合EGFR靶向治疗","is_gold":false},{"letter":"I","text":"诱导化疗联合EGFR靶向治疗后序贯放疗","is_gold":false},{"letter":"J","text":"根治性放化疗联合PD-1抑制剂治疗","is_gold":false},{"letter":"K","text":"诱导化疗联合PD-1抑制剂后序贯放化疗","is_gold":false},{"letter":"L","text":"单纯全身系统性化疗","is_gold":false}],"gold_letter":"A"},{"sample_id":"sample-453547f6b6c780c6834cd926","patient_id":"patient-4e3ac84b9e1451cea981f98e","turn_id":"turn05","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、头长肌。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D1] 检验组合: 尿酸(UA)-静脉血: 316.2umol/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 5.28mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 7.2umol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；球蛋白(GLO)-静脉血: 32.53g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.54mmol/L；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；磷(P)-静脉血: 1.06mmol/L；总胆汁酸(TBA)-静脉血: 2.6umol/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；Rh血型-静脉血: 阳性；血红蛋白(Hb)-静脉血: 153g/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.94；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.93mg/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；血小板分布宽度(PDW)-静脉血: 11.2%；血小板计数(PLT#)-静脉血: 29810E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；白蛋白(ALB)-静脉血: 48g/L；直接胆红素(DBIL)-静脉血: 1.8umol/L；活化部分凝血活酶时间(APTT)-静脉血: 24.9sec.；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；钠离子(Na+)-静脉血: 139.1mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.39；尿素氮(BUN)-静脉血: 5.9mmol/L；钾离子(K+)-静脉血: 4.04mmol/L；C-反应蛋白(CRP)-静脉血: 9.58mg/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22.5U/L；纤维蛋白原(Fbg)-静脉血: 4.77g/L；凝血酶原时间活动度(PTA)-静脉血: 125.5%；淋巴细胞……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D18] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 心电图大致正常\n- [全程D18] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约25cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约45×26×26mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D19] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显斑片或结节影。双侧肺门影未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见病变。\n- [全程D20] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 第3、7胸椎及右股骨上段见片状放射性浓聚影。颅骨、胸骨、锁骨、肩胛骨、肋骨、颈椎、腰椎、骶尾骨、髋骨及上肢骨骼放射性分布未见明显异常。；检查结论: 右股骨上段局部代谢活跃，疑良性病变，缺血性坏死待排。 第3、7胸椎局部代谢活跃，建议随诊。\n- [全程D20] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁及左侧壁明显增厚，见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。左侧咽隐窝见肿物占据，右侧咽隐窝存在。左侧腭帆提肌、头长肌受侵，右侧腭帆提肌、双侧腭帆张肌及右侧头长肌未见受侵征象。病灶堵塞左侧后鼻孔。 双侧翼腭窝、双侧颞下窝未见异常；口咽未见异常。 颅底骨质未见破坏征象。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦粘膜未见增厚，双侧乳突充气良好，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 左侧咽后间隙见肿大淋巴结，大小约11mm×14mm；右侧咽后间隙见淋巴结，边界欠清，较大者短径约5mm。 左颈II区见数个淋巴结，部分信号不均匀，较大者大小约10mm×13mm，不均匀强化。颈部双侧Ⅰ、ⅡI区见小淋巴结，边界清，较大者短径约5mm，孤立散在。 甲状腺未见异常信号灶。喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 扫描范围颈椎未见明确骨质破坏。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质未见破坏征象。 左侧咽后淋巴结，考虑转移。右侧咽后淋巴结，考虑转移可能性大。 左颈II区淋巴结，考虑转移可能性大。\n- [全程D23] 检验组合: 天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.75；乳酸脱氢酶(LDH)-静脉血: 285.9U/L；总胆汁酸(TBA)-静脉血: 12.7umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 220U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 20.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 249.9U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 165.4U/L；碱性磷酸酶(ALP)-静脉血: 161.1U/L\n- [全程D37] 检验组合: 甲状腺球蛋白(TG)-静脉血: 13.08ng/ml；平均血小板体积(MPV)-静脉血: 9.9fL；α-L-岩藻糖苷酶(AFU)-静脉血: 21.1U/L；促卵泡刺激素(FSH)-静脉血: 6.26mIU/ml；血小板比容-静脉血: 29%；血小板分布宽度(PDW)-静脉血: 11.3%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.2；催乳素(PRL)-静脉血: 277.6uIU/ml；大血小板百分比(P-LCR%)-静脉血: 23.9%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；促黄体生成素(LH)-静脉血: 9.22mIU/ml；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；血小板计数(PLT#)-静脉血: 29710E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.262；γ-谷氨酰基转移酶(GGT)-静脉血: 227.5U/L；生长激素(GH)-静脉血: 0.54ng/ml；碱性磷酸酶(ALP)-静脉血: 164.9U/L；乳酸脱氢酶(LDH)-静脉血: 170.2U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 38.5；平均红细胞体积(MCV)-静脉血: 94fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；血红蛋白(Hb)-静脉血: 140g/L；中性粒细胞计数(Neut#)-静脉血: 4.410E9/L；促甲状腺激素(TSH)-静脉血: 4.45uIU/ml；有核红细胞计数(NRBC#)-静脉血: 010E9/L；单核细胞百分比(Mono%)-静脉血: 0.105；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.619；红细胞计数(RBC#)-静脉血: 4.5110E12/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；红细胞比容(Hct)-静脉血: 42.4%；总胆汁酸(TBA)-静脉血: 2umol/L；甲状腺过氧化物酶抗体(TPO-Ab)-静脉血: 14.45U/ml；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.58；丙氨酸氨基转移酶(ALT)-静脉血:……\n- [全程D44] 检验组合: 平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；单核细胞百分比(Mono%)-静脉血: 0.084；载脂蛋白B(apoB)-静脉血: 1.02g/L；磷(P)-静脉血: 1.54mmol/L；钠离子(Na+)-静脉血: 137mmol/L；白蛋白(ALB)-静脉血: 41.2g/L；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 38.1U/L；总胆固醇(TC)-静脉血: 5.9mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；中性粒细胞百分比(Neut%)-静脉血: 0.789；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.65mmol/L；间接胆红素(IBIL)-静脉血: 5.6umolL；尿素氮(BUN)-静脉血: 7.73mmol/L；总胆红素(TBIL)-静脉血: 7.4umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.4mmol/L；C-反应蛋白(CRP)-静脉血: 9.62mg/L；血小板比容-静脉血: 27%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；大血小板百分比(P-LCR%)-静脉血: 26.8%；α-L-岩藻糖苷酶(AFU)-静脉血: 35U/L；钾离子(K+)-静脉血: 4.2mmol/L；直接胆红素(DBIL)-静脉血: 1.8umol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.6；尿酸(UA)-静脉血: 288.4umol/L；碱性磷酸酶(ALP)-静脉血: 138.4U/L；中性粒细胞计数(Neut#)-静脉血: 11.910E9/L；总钙(Ca)-静脉血: 2.25mmol/L；肌酐(Crea)-静脉血: 84umol/L；总胆汁酸(TBA)-静脉血: 4.1umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.24；球蛋白(GLO)-静脉血: 33.12g/L；氯离子(Cl-)-静脉血: 97.5mmol/L；甘油三酯(TG)-静脉血: 2.9mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；丙氨酸氨基转移酶(ALT)-静脉血:……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D39] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者一般情况可，未诉特殊不适。按[计划性表述已隐藏]同期放化疗，放疗技术采用调强放疗9野，处方剂量：PTVp 7029cGy/33F， PTVn_L 6600cGy/33F,PTVn_R 6000cGy/33F,PTV1 6000cGy/33F,PTV2 5400cGy/33F。目前放疗计划已完善，予以今日复位验证后执行放疗。\n- [全程D40] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者精神食欲可，放疗2次，无特殊不适，查体无特殊。今日按[计划性表述已隐藏]第一程DDP同期化疗（顺铂 80mg/m2），若无特殊不适，今日化疗结束后予以出院。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，给予静脉保肝降酶药物，待转氨酶正常后重启放疗\nB. 继续调强放疗，定期监测血常规及肝肾功能，暂不予特殊药物干预\nC. 暂停放疗，经验性静脉滴注广谱抗生素，待中性粒细胞正常后重启放疗\nD. 继续调强放疗，皮下注射重组人粒细胞集落刺激因子\nE. 暂停放疗，给予大剂量静脉水化及利尿治疗\nF. 继续调强放疗，计划在下一周期将顺铂剂量下调20%\nG. 暂停放疗，完善血培养及降钙素原检查\nH. 继续调强放疗，静脉滴注大剂量糖皮质激素\nI. 暂停放疗，给予静脉输注人血白蛋白及肠外营养支持\nJ. 继续调强放疗，计划将下一周期同期化疗药物替换为卡铂\nK. 暂停放疗，复查鼻咽及颈部增强MRI\nL. 继续调强放疗，取消后续同期化疗周期\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"暂停放疗，给予静脉保肝降酶药物，待转氨酶正常后重启放疗","is_gold":false},{"letter":"B","text":"继续调强放疗，定期监测血常规及肝肾功能，暂不予特殊药物干预","is_gold":true},{"letter":"C","text":"暂停放疗，经验性静脉滴注广谱抗生素，待中性粒细胞正常后重启放疗","is_gold":false},{"letter":"D","text":"继续调强放疗，皮下注射重组人粒细胞集落刺激因子","is_gold":false},{"letter":"E","text":"暂停放疗，给予大剂量静脉水化及利尿治疗","is_gold":false},{"letter":"F","text":"继续调强放疗，计划在下一周期将顺铂剂量下调20%","is_gold":false},{"letter":"G","text":"暂停放疗，完善血培养及降钙素原检查","is_gold":false},{"letter":"H","text":"继续调强放疗，静脉滴注大剂量糖皮质激素","is_gold":false},{"letter":"I","text":"暂停放疗，给予静脉输注人血白蛋白及肠外营养支持","is_gold":false},{"letter":"J","text":"继续调强放疗，计划将下一周期同期化疗药物替换为卡铂","is_gold":false},{"letter":"K","text":"暂停放疗，复查鼻咽及颈部增强MRI","is_gold":false},{"letter":"L","text":"继续调强放疗，取消后续同期化疗周期","is_gold":false}],"gold_letter":"B"},{"sample_id":"sample-192932039e740110f5fb9ae6","patient_id":"patient-4e3ac84b9e1451cea981f98e","turn_id":"turn06","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、头长肌。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D1] 检验组合: 尿酸(UA)-静脉血: 316.2umol/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 5.28mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 7.2umol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；球蛋白(GLO)-静脉血: 32.53g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.54mmol/L；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；磷(P)-静脉血: 1.06mmol/L；总胆汁酸(TBA)-静脉血: 2.6umol/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；Rh血型-静脉血: 阳性；血红蛋白(Hb)-静脉血: 153g/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.94；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.93mg/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；血小板分布宽度(PDW)-静脉血: 11.2%；血小板计数(PLT#)-静脉血: 29810E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；白蛋白(ALB)-静脉血: 48g/L；直接胆红素(DBIL)-静脉血: 1.8umol/L；活化部分凝血活酶时间(APTT)-静脉血: 24.9sec.；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；钠离子(Na+)-静脉血: 139.1mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.39；尿素氮(BUN)-静脉血: 5.9mmol/L；钾离子(K+)-静脉血: 4.04mmol/L；C-反应蛋白(CRP)-静脉血: 9.58mg/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22.5U/L；纤维蛋白原(Fbg)-静脉血: 4.77g/L；凝血酶原时间活动度(PTA)-静脉血: 125.5%；淋巴细胞……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D20] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 第3、7胸椎及右股骨上段见片状放射性浓聚影。颅骨、胸骨、锁骨、肩胛骨、肋骨、颈椎、腰椎、骶尾骨、髋骨及上肢骨骼放射性分布未见明显异常。；检查结论: 右股骨上段局部代谢活跃，疑良性病变，缺血性坏死待排。 第3、7胸椎局部代谢活跃，建议随诊。\n- [全程D20] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁及左侧壁明显增厚，见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化。左侧咽隐窝见肿物占据，右侧咽隐窝存在。左侧腭帆提肌、头长肌受侵，右侧腭帆提肌、双侧腭帆张肌及右侧头长肌未见受侵征象。病灶堵塞左侧后鼻孔。 双侧翼腭窝、双侧颞下窝未见异常；口咽未见异常。 颅底骨质未见破坏征象。 双侧海绵窦形态正常，未见增宽。 双侧上颌窦、筛窦、蝶窦粘膜未见增厚，双侧乳突充气良好，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶鞍形态正常，其内未见占位性病变； 左侧咽后间隙见肿大淋巴结，大小约11mm×14mm；右侧咽后间隙见淋巴结，边界欠清，较大者短径约5mm。 左颈II区见数个淋巴结，部分信号不均匀，较大者大小约10mm×13mm，不均匀强化。颈部双侧Ⅰ、ⅡI区见小淋巴结，边界清，较大者短径约5mm，孤立散在。 甲状腺未见异常信号灶。喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 扫描范围颈椎未见明确骨质破坏。；检查结论: 鼻咽病变，考虑鼻咽癌。 颅底骨质未见破坏征象。 左侧咽后淋巴结，考虑转移。右侧咽后淋巴结，考虑转移可能性大。 左颈II区淋巴结，考虑转移可能性大。\n- [全程D23] 检验组合: 天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.75；乳酸脱氢酶(LDH)-静脉血: 285.9U/L；总胆汁酸(TBA)-静脉血: 12.7umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 220U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 20.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 249.9U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 165.4U/L；碱性磷酸酶(ALP)-静脉血: 161.1U/L\n- [全程D37] 检验组合: 甲状腺球蛋白(TG)-静脉血: 13.08ng/ml；平均血小板体积(MPV)-静脉血: 9.9fL；α-L-岩藻糖苷酶(AFU)-静脉血: 21.1U/L；促卵泡刺激素(FSH)-静脉血: 6.26mIU/ml；血小板比容-静脉血: 29%；血小板分布宽度(PDW)-静脉血: 11.3%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.2；催乳素(PRL)-静脉血: 277.6uIU/ml；大血小板百分比(P-LCR%)-静脉血: 23.9%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；促黄体生成素(LH)-静脉血: 9.22mIU/ml；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；血小板计数(PLT#)-静脉血: 29710E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.262；γ-谷氨酰基转移酶(GGT)-静脉血: 227.5U/L；生长激素(GH)-静脉血: 0.54ng/ml；碱性磷酸酶(ALP)-静脉血: 164.9U/L；乳酸脱氢酶(LDH)-静脉血: 170.2U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 38.5；平均红细胞体积(MCV)-静脉血: 94fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；血红蛋白(Hb)-静脉血: 140g/L；中性粒细胞计数(Neut#)-静脉血: 4.410E9/L；促甲状腺激素(TSH)-静脉血: 4.45uIU/ml；有核红细胞计数(NRBC#)-静脉血: 010E9/L；单核细胞百分比(Mono%)-静脉血: 0.105；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.619；红细胞计数(RBC#)-静脉血: 4.5110E12/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；红细胞比容(Hct)-静脉血: 42.4%；总胆汁酸(TBA)-静脉血: 2umol/L；甲状腺过氧化物酶抗体(TPO-Ab)-静脉血: 14.45U/ml；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.58；丙氨酸氨基转移酶(ALT)-静脉血:……\n- [全程D44] 检验组合: 平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；单核细胞百分比(Mono%)-静脉血: 0.084；载脂蛋白B(apoB)-静脉血: 1.02g/L；磷(P)-静脉血: 1.54mmol/L；钠离子(Na+)-静脉血: 137mmol/L；白蛋白(ALB)-静脉血: 41.2g/L；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 38.1U/L；总胆固醇(TC)-静脉血: 5.9mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞血红蛋白浓度(MCHC)-静脉血: 328g/L；中性粒细胞百分比(Neut%)-静脉血: 0.789；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.65mmol/L；间接胆红素(IBIL)-静脉血: 5.6umolL；尿素氮(BUN)-静脉血: 7.73mmol/L；总胆红素(TBIL)-静脉血: 7.4umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.4mmol/L；C-反应蛋白(CRP)-静脉血: 9.62mg/L；血小板比容-静脉血: 27%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；大血小板百分比(P-LCR%)-静脉血: 26.8%；α-L-岩藻糖苷酶(AFU)-静脉血: 35U/L；钾离子(K+)-静脉血: 4.2mmol/L；直接胆红素(DBIL)-静脉血: 1.8umol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.6；尿酸(UA)-静脉血: 288.4umol/L；碱性磷酸酶(ALP)-静脉血: 138.4U/L；中性粒细胞计数(Neut#)-静脉血: 11.910E9/L；总钙(Ca)-静脉血: 2.25mmol/L；肌酐(Crea)-静脉血: 84umol/L；总胆汁酸(TBA)-静脉血: 4.1umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.24；球蛋白(GLO)-静脉血: 33.12g/L；氯离子(Cl-)-静脉血: 97.5mmol/L；甘油三酯(TG)-静脉血: 2.9mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；丙氨酸氨基转移酶(ALT)-静脉血:……\n- [全程D47] 检验组合: 血小板分布宽度(PDW)-静脉血: 13.9%；白细胞计数(WBC#)-静脉血: 6.3810E9/L；单核细胞计数(Mono#)-静脉血: 1.410E9/L；红细胞比容(Hct)-静脉血: 43.9%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 38.1；平均红细胞血红蛋白浓度(MCHC)-静脉血: 333g/L；血小板计数(PLT#)-静脉血: 26510E9/L；平均红细胞体积(MCV)-静脉血: 93.6fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；大血小板百分比(P-LCR%)-静脉血: 34.5%；血小板比容-静脉血: 30%；平均血小板体积(MPV)-静脉血: 11.2fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 146g/L；中性粒细胞百分比(Neut%)-静脉血: 0.569；单核细胞百分比(Mono%)-静脉血: 0.216；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.008；红细胞计数(RBC#)-静脉血: 4.6910E12/L；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；中性粒细胞计数(Neut#)-静脉血: 3.610E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.205；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.5；平均红细胞血红蛋白含量(MCH)-静脉血: 31.1pg\n- [全程D54] 检验组合: 直接胆红素(DBIL)-静脉血: 1.3umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 337g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.173；血小板计数(PLT#)-静脉血: 14810E9/L；碱性磷酸酶(ALP)-静脉血: 120.1U/L；氯离子(Cl-)-静脉血: 101.8mmol/L；总胆固醇(TC)-静脉血: 5.93mmol/L；钾离子(K+)-静脉血: 3.93mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 127.6U/L；有核红细胞百分比(NRBC%)-静脉血: 0；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.51；甘油三酯(TG)-静脉血: 2.02mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 38.4；单核细胞计数(Mono#)-静脉血: 0.710E9/L；平均血小板体积(MPV)-静脉血: 10.1fL；白细胞计数(WBC#)-静脉血: 5.910E9/L；钠离子(Na+)-静脉血: 140.2mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；中性粒细胞计数(Neut#)-静脉血: 4.110E9/L；红细胞比容(Hct)-静脉血: 40.7%；尿素氮(BUN)-静脉血: 3.9mmol/L；平均红细胞体积(MCV)-静脉血: 91.3fL；总胆红素(TBIL)-静脉血: 9.5umol/L；总胆汁酸(TBA)-静脉血: 6.5umol/L；C-反应蛋白(CRP)-静脉血: 5.08mg/L；淋巴细胞计数(Lymph#)-静脉血: 110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.7pg；总蛋白(TP)-静脉血: 72.34g/L；总钙(Ca)-静脉血: 2.35mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.6mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.2mmolL；载脂蛋白AI(apoAI)-静脉血: 1.36g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 36.9U/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.9；红细胞计数(RBC#)-静脉血: 4.4610E12/L；嗜碱性粒细胞百分比(Baso%)-静脉血……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D39] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者一般情况可，未诉特殊不适。按[计划性表述已隐藏]同期放化疗，放疗技术采用调强放疗9野，处方剂量：PTVp 7029cGy/33F， PTVn_L 6600cGy/33F,PTVn_R 6000cGy/33F,PTV1 6000cGy/33F,PTV2 5400cGy/33F。目前放疗计划已完善，予以今日复位验证后执行放疗。\n- [全程D40] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者精神食欲可，放疗2次，无特殊不适，查体无特殊。今日按[计划性表述已隐藏]第一程DDP同期化疗（顺铂 80mg/m2），若无特殊不适，今日化疗结束后予以出院。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，给予重组人粒细胞刺激因子皮下注射\nB. 继续放疗，给予重组人血小板生成素皮下注射\nC. 继续按计划执行调强放疗，定期复查血常规及肝肾功能\nD. 暂停放疗，给予静脉保肝降酶治疗并密切监测\nE. 继续放疗，立即启动第二周期顺铂同期化疗\nF. 继续放疗，将第二周期顺铂同期化疗剂量下调20%\nG. 继续放疗，将第二周期同期化疗药物更换为卡铂\nH. 暂停放疗，完善鼻咽及颈部MRI评估近期疗效\nI. 继续放疗，给予大剂量静脉水化及利尿促排治疗\nJ. 继续放疗，联合尼妥珠单抗靶向治疗以增强疗效\nK. 继续放疗，给予促红细胞生成素皮下注射纠正贫血\nL. 终止放疗，转为全身静脉化疗并评估后续方案\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"暂停放疗，给予重组人粒细胞刺激因子皮下注射","is_gold":false},{"letter":"B","text":"继续放疗，给予重组人血小板生成素皮下注射","is_gold":false},{"letter":"C","text":"继续按计划执行调强放疗，定期复查血常规及肝肾功能","is_gold":true},{"letter":"D","text":"暂停放疗，给予静脉保肝降酶治疗并密切监测","is_gold":false},{"letter":"E","text":"继续放疗，立即启动第二周期顺铂同期化疗","is_gold":false},{"letter":"F","text":"继续放疗，将第二周期顺铂同期化疗剂量下调20%","is_gold":false},{"letter":"G","text":"继续放疗，将第二周期同期化疗药物更换为卡铂","is_gold":false},{"letter":"H","text":"暂停放疗，完善鼻咽及颈部MRI评估近期疗效","is_gold":false},{"letter":"I","text":"继续放疗，给予大剂量静脉水化及利尿促排治疗","is_gold":false},{"letter":"J","text":"继续放疗，联合尼妥珠单抗靶向治疗以增强疗效","is_gold":false},{"letter":"K","text":"继续放疗，给予促红细胞生成素皮下注射纠正贫血","is_gold":false},{"letter":"L","text":"终止放疗，转为全身静脉化疗并评估后续方案","is_gold":false}],"gold_letter":"C"}]}
+{"patient_id":"patient-e5fcd31b4b8b85194b146991","bootstrap_cluster_id":"cluster-013","turns":[{"sample_id":"sample-7fddfe1b2a584f133c3b89f7","patient_id":"patient-e5fcd31b4b8b85194b146991","turn_id":"turn01","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 回吸性涕血1月余。；现病史: 缘于1月前患者无意中出现抽吸性血涕，痰中带血；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻咽角化,涕血,痰中带血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：78次/分，R：20次/分，BP：125/80mmHg,Ht：162cm，Wt：61kg，BSA：1.6483m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善鼻咽及颈部CT平扫+增强、胸腹部CT、全身骨扫描、电子鼻咽镜检查及活检。\nB. 完善鼻咽及颈部MRI平扫+增强、胸腹部CT、全身骨扫描、电子鼻咽镜检查及活检。\nC. 完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像、电子鼻咽镜检查及活检。\nD. 完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像、电子鼻咽镜检查及病理会诊。\nE. 完善鼻咽及颈部MRI平扫+增强、胸腹部CT、全身骨扫描、电子鼻咽镜检查及病理会诊。\nF. 完善鼻咽及颈部CT平扫+增强、PET/CT全身显像、电子鼻咽镜检查及病理会诊。\nG. 完善鼻咽MRI平扫+增强、颈部超声、PET/CT全身显像、电子鼻咽镜检查及病理会诊。\nH. 完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像、直接安排诱导化疗。\nI. 完善鼻咽及颈部MRI平扫+增强、胸腹部CT、全身骨扫描、直接安排根治性放疗。\nJ. 完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像、鼻内镜下鼻咽肿物切除术。\nK. 完善鼻咽及颈部CT平扫+增强、胸腹部CT、全身骨扫描、电子鼻咽镜检查及病理会诊。\nL. 完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像、EBV-DNA检测、暂缓病理确诊。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"完善鼻咽及颈部CT平扫+增强、胸腹部CT、全身骨扫描、电子鼻咽镜检查及活检。","is_gold":false},{"letter":"B","text":"完善鼻咽及颈部MRI平扫+增强、胸腹部CT、全身骨扫描、电子鼻咽镜检查及活检。","is_gold":true},{"letter":"C","text":"完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像、电子鼻咽镜检查及活检。","is_gold":false},{"letter":"D","text":"完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像、电子鼻咽镜检查及病理会诊。","is_gold":false},{"letter":"E","text":"完善鼻咽及颈部MRI平扫+增强、胸腹部CT、全身骨扫描、电子鼻咽镜检查及病理会诊。","is_gold":false},{"letter":"F","text":"完善鼻咽及颈部CT平扫+增强、PET/CT全身显像、电子鼻咽镜检查及病理会诊。","is_gold":false},{"letter":"G","text":"完善鼻咽MRI平扫+增强、颈部超声、PET/CT全身显像、电子鼻咽镜检查及病理会诊。","is_gold":false},{"letter":"H","text":"完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像、直接安排诱导化疗。","is_gold":false},{"letter":"I","text":"完善鼻咽及颈部MRI平扫+增强、胸腹部CT、全身骨扫描、直接安排根治性放疗。","is_gold":false},{"letter":"J","text":"完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像、鼻内镜下鼻咽肿物切除术。","is_gold":false},{"letter":"K","text":"完善鼻咽及颈部CT平扫+增强、胸腹部CT、全身骨扫描、电子鼻咽镜检查及病理会诊。","is_gold":false},{"letter":"L","text":"完善鼻咽及颈部MRI平扫+增强、PET/CT全身显像、EBV-DNA检测、暂缓病理确诊。","is_gold":false}],"gold_letter":"B"},{"sample_id":"sample-bc7a956bb6d6b0bc48992292","patient_id":"patient-e5fcd31b4b8b85194b146991","turn_id":"turn02","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 回吸性涕血1月余。；现病史: 缘于1月前患者无意中出现抽吸性血涕，痰中带血；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻咽角化,涕血,痰中带血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：78次/分，R：20次/分，BP：125/80mmHg,Ht：162cm，Wt：61kg，BSA：1.6483m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 胱抑素(Cys-C)-静脉血: 0.77mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.69mmol/L；阴离子间隙(AG)-静脉血: 13；磷(P)-静脉血: 0.92mmol/L；总胆红素(TBIL)-静脉血: 12.4umol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；肌酐(Crea)-静脉血: 80.5umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.58；Rh血型-静脉血: 阳性；总钙(Ca)-静脉血: 2.44mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；血小板计数(PLT#)-静脉血: 21910E9/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 4.81mmol/L；直接胆红素(DBIL)-静脉血: 4.2umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.64mmolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.013；载脂蛋白B(apoB)-静脉血: 0.73g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.3pg；α-L-岩藻糖苷酶(AFU)-静脉血: 24U/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 8.2umolL；白蛋白(ALB)-静脉血: 45.8g/L；血小板比容-静脉血: 21%；ABO血型-静脉血: O；尿素氮(BUN)-静脉血: 3.6mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；凝血酶时间(TT)-静脉血: 20.2sec.；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；载脂蛋白AI(apoAI)-静脉血: 1.33g/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；C-反应蛋白(CRP)-静脉血: 0.36mg/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血:……\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔稍狭窄，鼻咽左侧壁明显增厚，左侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。肿物侵犯左侧腭帆张提肌，左侧咽旁脂肪间隙变窄。鼻咽顶后壁稍增厚，右侧壁未见明显增厚，右侧咽隐窝清晰。 右侧腭帆张提肌、双侧头长肌、翼内外肌未见明显异常。 双侧翼腭窝、上颌后脂肪间隙、咀嚼肌间隙未见异常。 口咽各壁未见增厚。鼻腔内未见肿物。 蝶骨基底部、左侧翼突基底部及内侧板骨质信号降低，增强扫描可见强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦粘膜稍增厚，双侧乳突未见明显异常。 左侧咽后见几个淋巴结，最大者约8mm×5mm，边界欠清，明显强化。双颈II区见多个淋巴结，最大者约16mm×8mm，边界尚清，较均匀明显强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽左侧壁增厚，左侧咽隐窝肿物，考虑鼻咽癌。 颅底骨质破坏。 左侧咽后、双颈II区淋巴结，可疑转移。 轻度鼻窦炎。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 安排颈部淋巴结切除活检，并完善全身PET-CT检查\nB. 安排鼻咽镜下活检，并完善头颅CT检查\nC. 安排颈部淋巴结细针穿刺活检，并完善胸腹部CT及骨扫描\nD. 安排鼻咽镜下活检，并完善EBV-DNA定量检测，暂缓全身影像学检查\nE. 安排电子鼻咽镜及鼻咽肿物活检，并完善胸腹部CT及骨扫描（或PET-CT）\nF. 安排鼻咽肿物及颈部淋巴结双重活检，并完善胸腹部MRI检查\nG. 安排鼻咽镜下活检，并完善颈部超声检查\nH. 安排全身PET-CT检查，并直接开始根治性放化疗\nI. 安排电子鼻咽镜检查，并直接进入放疗定位阶段\nJ. 安排鼻咽镜下活检，并直接开始根治性放疗\nK. 安排鼻咽肿物活检，并直接进入诱导化疗阶段\nL. 安排鼻咽镜下活检，并完善全身骨髓穿刺检查\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"安排颈部淋巴结切除活检，并完善全身PET-CT检查","is_gold":false},{"letter":"B","text":"安排鼻咽镜下活检，并完善头颅CT检查","is_gold":false},{"letter":"C","text":"安排颈部淋巴结细针穿刺活检，并完善胸腹部CT及骨扫描","is_gold":false},{"letter":"D","text":"安排鼻咽镜下活检，并完善EBV-DNA定量检测，暂缓全身影像学检查","is_gold":false},{"letter":"E","text":"安排电子鼻咽镜及鼻咽肿物活检，并完善胸腹部CT及骨扫描（或PET-CT）","is_gold":true},{"letter":"F","text":"安排鼻咽肿物及颈部淋巴结双重活检，并完善胸腹部MRI检查","is_gold":false},{"letter":"G","text":"安排鼻咽镜下活检，并完善颈部超声检查","is_gold":false},{"letter":"H","text":"安排全身PET-CT检查，并直接开始根治性放化疗","is_gold":false},{"letter":"I","text":"安排电子鼻咽镜检查，并直接进入放疗定位阶段","is_gold":false},{"letter":"J","text":"安排鼻咽镜下活检，并直接开始根治性放疗","is_gold":false},{"letter":"K","text":"安排鼻咽肿物活检，并直接进入诱导化疗阶段","is_gold":false},{"letter":"L","text":"安排鼻咽镜下活检，并完善全身骨髓穿刺检查","is_gold":false}],"gold_letter":"E"},{"sample_id":"sample-49519c2b08d621c382f2a093","patient_id":"patient-e5fcd31b4b8b85194b146991","turn_id":"turn04","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 回吸性涕血1月余。；现病史: 缘于1月前患者无意中出现抽吸性血涕，痰中带血；无头痛、面麻，无视力下降、复视，无听力下降、耳鸣等不适，于当地乡镇医院予滴鼻治疗，具体药物不详，未见好转，遂于某次就诊时间往[地点已隐去]人民医院检查，某次就诊时间病理活检示：鼻咽未分化型角化性癌。某次就诊时间鼻咽MRI示：左侧鼻咽部占位病变，考虑鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻咽角化,涕血,痰中带血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：78次/分，R：20次/分，BP：125/80mmHg,Ht：162cm，Wt：61kg，BSA：1.6483m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率100次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1] 检验组合: 胱抑素(Cys-C)-静脉血: 0.77mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.69mmol/L；阴离子间隙(AG)-静脉血: 13；磷(P)-静脉血: 0.92mmol/L；总胆红素(TBIL)-静脉血: 12.4umol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；肌酐(Crea)-静脉血: 80.5umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.58；Rh血型-静脉血: 阳性；总钙(Ca)-静脉血: 2.44mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；血小板计数(PLT#)-静脉血: 21910E9/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 4.81mmol/L；直接胆红素(DBIL)-静脉血: 4.2umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.64mmolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.013；载脂蛋白B(apoB)-静脉血: 0.73g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.3pg；α-L-岩藻糖苷酶(AFU)-静脉血: 24U/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 8.2umolL；白蛋白(ALB)-静脉血: 45.8g/L；血小板比容-静脉血: 21%；ABO血型-静脉血: O；尿素氮(BUN)-静脉血: 3.6mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；凝血酶时间(TT)-静脉血: 20.2sec.；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；载脂蛋白AI(apoAI)-静脉血: 1.33g/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；C-反应蛋白(CRP)-静脉血: 0.36mg/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血:……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔稍狭窄，鼻咽左侧壁明显增厚，左侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。肿物侵犯左侧腭帆张提肌，左侧咽旁脂肪间隙变窄。鼻咽顶后壁稍增厚，右侧壁未见明显增厚，右侧咽隐窝清晰。 右侧腭帆张提肌、双侧头长肌、翼内外肌未见明显异常。 双侧翼腭窝、上颌后脂肪间隙、咀嚼肌间隙未见异常。 口咽各壁未见增厚。鼻腔内未见肿物。 蝶骨基底部、左侧翼突基底部及内侧板骨质信号降低，增强扫描可见强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦粘膜稍增厚，双侧乳突未见明显异常。 左侧咽后见几个淋巴结，最大者约8mm×5mm，边界欠清，明显强化。双颈II区见多个淋巴结，最大者约16mm×8mm，边界尚清，较均匀明显强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽左侧壁增厚，左侧咽隐窝肿物，考虑鼻咽癌。 颅底骨质破坏。 左侧咽后、双颈II区淋巴结，可疑转移。 轻度鼻窦炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右侧约平T6椎体水平，估计导管末端位于上腔静脉上段内。；检查结论: PICC管位置如上所述。\n- [全程D13] 检验组合: 酸碱度(pH)-尿液: 5.5；粘液丝计数(MUCS#)-尿液: 11/μL；酮体(KET)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 1/μL；红细胞计数(RBC#)-尿液: 3/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: colorless；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；比重(SG)-尿液: 1.008\n- [全程D14] 检验组合: 总蛋白(TP)-尿液: +- 0.2g（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；红细胞计数(RBC#)-尿液: 1/μL；葡萄糖(Glu)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.02；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；粘液丝计数(MUCS#)-尿液: 4/μL；白细胞(LEU)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；胆红素(BIL)-尿液: -（参考: 阴性）\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 根治性单纯放疗\nB. 诱导化疗（紫杉醇+卡铂）\nC. 诱导化疗（吉西他滨+奥沙利铂）\nD. 同期放化疗（顺铂）\nE. 诱导化疗（依托泊苷+顺铂）\nF. 诱导化疗（长春瑞滨+顺铂）\nG. 诱导化疗（顺铂+氟尿嘧啶）\nH. 靶向单药治疗（西妥昔单抗）\nI. 诱导化疗（多柔比星+环磷酰胺）\nJ. 姑息性单药化疗（卡培他滨）\nK. 免疫单药治疗（帕博利珠单抗）\nL. 鼻咽及颈部淋巴结根治性切除术\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"根治性单纯放疗","is_gold":false},{"letter":"B","text":"诱导化疗（紫杉醇+卡铂）","is_gold":false},{"letter":"C","text":"诱导化疗（吉西他滨+奥沙利铂）","is_gold":false},{"letter":"D","text":"同期放化疗（顺铂）","is_gold":false},{"letter":"E","text":"诱导化疗（依托泊苷+顺铂）","is_gold":false},{"letter":"F","text":"诱导化疗（长春瑞滨+顺铂）","is_gold":false},{"letter":"G","text":"诱导化疗（顺铂+氟尿嘧啶）","is_gold":true},{"letter":"H","text":"靶向单药治疗（西妥昔单抗）","is_gold":false},{"letter":"I","text":"诱导化疗（多柔比星+环磷酰胺）","is_gold":false},{"letter":"J","text":"姑息性单药化疗（卡培他滨）","is_gold":false},{"letter":"K","text":"免疫单药治疗（帕博利珠单抗）","is_gold":false},{"letter":"L","text":"鼻咽及颈部淋巴结根治性切除术","is_gold":false}],"gold_letter":"G"},{"sample_id":"sample-ba0bc8aff143756f9ee645b5","patient_id":"patient-e5fcd31b4b8b85194b146991","turn_id":"turn05","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 回吸性涕血1月余。；现病史: 缘于1月前患者无意中出现抽吸性血涕，痰中带血；无头痛、面麻，无视力下降、复视，无听力下降、耳鸣等不适，于当地乡镇医院予滴鼻治疗，具体药物不详，未见好转，遂于某次就诊时间往[地点已隐去]人民医院检查，某次就诊时间病理活检示：鼻咽未分化型角化性癌。某次就诊时间鼻咽MRI示：左侧鼻咽部占位病变，考虑鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻咽角化,涕血,痰中带血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：78次/分，R：20次/分，BP：125/80mmHg,Ht：162cm，Wt：61kg，BSA：1.6483m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率100次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔稍狭窄，鼻咽左侧壁明显增厚，左侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。肿物侵犯左侧腭帆张提肌，左侧咽旁脂肪间隙变窄。鼻咽顶后壁稍增厚，右侧壁未见明显增厚，右侧咽隐窝清晰。 右侧腭帆张提肌、双侧头长肌、翼内外肌未见明显异常。 双侧翼腭窝、上颌后脂肪间隙、咀嚼肌间隙未见异常。 口咽各壁未见增厚。鼻腔内未见肿物。 蝶骨基底部、左侧翼突基底部及内侧板骨质信号降低，增强扫描可见强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦粘膜稍增厚，双侧乳突未见明显异常。 左侧咽后见几个淋巴结，最大者约8mm×5mm，边界欠清，明显强化。双颈II区见多个淋巴结，最大者约16mm×8mm，边界尚清，较均匀明显强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽左侧壁增厚，左侧咽隐窝肿物，考虑鼻咽癌。 颅底骨质破坏。 左侧咽后、双颈II区淋巴结，可疑转移。 轻度鼻窦炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右侧约平T6椎体水平，估计导管末端位于上腔静脉上段内。；检查结论: PICC管位置如上所述。\n- [全程D13] 检验组合: 酸碱度(pH)-尿液: 5.5；粘液丝计数(MUCS#)-尿液: 11/μL；酮体(KET)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 1/μL；红细胞计数(RBC#)-尿液: 3/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: colorless；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；比重(SG)-尿液: 1.008\n- [全程D14] 检验组合: 总蛋白(TP)-尿液: +- 0.2g（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；红细胞计数(RBC#)-尿液: 1/μL；葡萄糖(Glu)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.02；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；粘液丝计数(MUCS#)-尿液: 4/μL；白细胞(LEU)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D15] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 11/μL；酮体(KET)-尿液: -（参考: 阴性）；酵母菌(YEAST)-尿液: 1/μL；白细胞(LEU)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 1/μL；比重(SG)-尿液: 1.019；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 7/μL；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；酸碱度(pH)-尿液: 6.5；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D19] 检验组合: 氯离子(Cl-)-静脉血: 96.7mmol/L；总蛋白(TP)-静脉血: 73.8g/L；甘油三酯(TG)-静脉血: 1mmol/L；血小板计数(PLT#)-静脉血: 18410E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.2；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.27；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.44mmolL；球蛋白(GLO)-静脉血: 27.4g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；丙氨酸氨基转移酶(ALT)-静脉血: 16.1U/L；总钙(Ca)-静脉血: 2.31mmol/L；血小板比容-静脉血: 18%；血红蛋白(Hb)-静脉血: 144g/L；血液二氧化碳含量ctCO2(B)-静脉血: 26.5mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 356g/L；胱抑素(Cys-C)-静脉血: 0.75mg/L；γ-谷氨酰基转移酶(GGT)-静脉血: 18.1U/L；红细胞计数(RBC#)-静脉血: 4.5310E12/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.1；淋巴细胞百分比(Lymph%)-静脉血: 0.277；平均红细胞血红蛋白含量(MCH)-静脉血: 31.8pg；尿酸(UA)-静脉血: 231.9umol/L；乳酸脱氢酶(LDH)-静脉血: 158.8U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；载脂蛋白B(apoB)-静脉血: 0.78g/L；中性粒细胞百分比(Neut%)-静脉血: 0.597；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；血小板分布宽度(PDW)-静脉血: 10.5%；间接胆红素(IBIL)-静脉血: 11.1umolL；单核细胞百分比(Mono%)-静脉血: 0.101；天门冬氨酸氨基转移酶(AST)-静脉血: 20.5U/L；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L；白细胞计数(WBC#)-静脉血: 4.8310E9/L；镁离子(Mg2+)-静脉血: 0.93mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.36g/L；总胆红素(TBIL)-静脉血: 16.1umol/……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D17] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者第一程诱导化疗后，诉轻度恶心呕吐，精神睡眠尚可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。钱医生信息已隐藏：患者03-02开始予5-Fu6.6g,DDP130mg化疗，患者未诉特殊不适，注意观察不良反应。\n- [全程D19] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者化疗后，诉轻度恶心，精神睡眠尚可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。医生信息已隐藏：患者第一程诱导化疗顺利，一般情况可，予出院。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 办理出院，无需特殊用药，嘱出院后每2周复查血常规及肝肾功能，按计划返院行下一程诱导化疗。\nB. 暂缓出院，予以静脉营养支持及强效止吐治疗，待恶心症状完全缓解后出院，按计划返院行下一程化疗。\nC. 办理出院，予以止吐处理并预防性给予长效G-CSF支持，嘱出院后每周复查血常规，按计划返院行下一程化疗。\nD. 办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，下一程化疗方案需减量20%并延迟1周进行。\nE. 暂缓出院，予以保肝降酶及护胃治疗，待复查肝功能及消化道症状好转后出院，按计划返院行下一程化疗。\nF. 办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，下一阶段直接转入同期放化疗。\nG. 办理出院，予以止吐处理，嘱出院后每3天复查肾功能及电解质，按计划返院行下一程诱导化疗。\nH. 办理出院，予以帕洛诺司琼等止吐处理，嘱出院后每周复查血常规及肝肾功能，按计划返院行下一程化疗。\nI. 暂缓出院，予以静脉补液及纠正电解质紊乱治疗，复查生化指标正常后出院，按计划返院行下一程化疗。\nJ. 办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，下一程化疗更改为单药方案以减轻反应。\nK. 办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，按计划返院行靶向治疗联合放疗。\nL. 暂缓出院，予以质子泵抑制剂静脉滴注预防应激性溃疡，观察3天后出院，按计划返院行下一程化疗。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"办理出院，无需特殊用药，嘱出院后每2周复查血常规及肝肾功能，按计划返院行下一程诱导化疗。","is_gold":false},{"letter":"B","text":"暂缓出院，予以静脉营养支持及强效止吐治疗，待恶心症状完全缓解后出院，按计划返院行下一程化疗。","is_gold":false},{"letter":"C","text":"办理出院，予以止吐处理并预防性给予长效G-CSF支持，嘱出院后每周复查血常规，按计划返院行下一程化疗。","is_gold":false},{"letter":"D","text":"办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，下一程化疗方案需减量20%并延迟1周进行。","is_gold":false},{"letter":"E","text":"暂缓出院，予以保肝降酶及护胃治疗，待复查肝功能及消化道症状好转后出院，按计划返院行下一程化疗。","is_gold":false},{"letter":"F","text":"办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，下一阶段直接转入同期放化疗。","is_gold":false},{"letter":"G","text":"办理出院，予以止吐处理，嘱出院后每3天复查肾功能及电解质，按计划返院行下一程诱导化疗。","is_gold":false},{"letter":"H","text":"办理出院，予以帕洛诺司琼等止吐处理，嘱出院后每周复查血常规及肝肾功能，按计划返院行下一程化疗。","is_gold":true},{"letter":"I","text":"暂缓出院，予以静脉补液及纠正电解质紊乱治疗，复查生化指标正常后出院，按计划返院行下一程化疗。","is_gold":false},{"letter":"J","text":"办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，下一程化疗更改为单药方案以减轻反应。","is_gold":false},{"letter":"K","text":"办理出院，予以止吐处理，嘱出院后每周复查血常规及肝肾功能，按计划返院行靶向治疗联合放疗。","is_gold":false},{"letter":"L","text":"暂缓出院，予以质子泵抑制剂静脉滴注预防应激性溃疡，观察3天后出院，按计划返院行下一程化疗。","is_gold":false}],"gold_letter":"H"},{"sample_id":"sample-f5ab8fe6b2ae40df32eed56b","patient_id":"patient-e5fcd31b4b8b85194b146991","turn_id":"turn06","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 回吸性涕血1月余。；现病史: 缘于1月前患者无意中出现抽吸性血涕，痰中带血；无头痛、面麻，无视力下降、复视，无听力下降、耳鸣等不适，于当地乡镇医院予滴鼻治疗，具体药物不详，未见好转，遂于某次就诊时间往[地点已隐去]人民医院检查，某次就诊时间病理活检示：鼻咽未分化型角化性癌。某次就诊时间鼻咽MRI示：左侧鼻咽部占位病变，考虑鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻咽角化,涕血,痰中带血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：78次/分，R：20次/分，BP：125/80mmHg,Ht：162cm，Wt：61kg，BSA：1.6483m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率100次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右侧约平T6椎体水平，估计导管末端位于上腔静脉上段内。；检查结论: PICC管位置如上所述。\n- [全程D13] 检验组合: 酸碱度(pH)-尿液: 5.5；粘液丝计数(MUCS#)-尿液: 11/μL；酮体(KET)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 1/μL；红细胞计数(RBC#)-尿液: 3/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: colorless；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；比重(SG)-尿液: 1.008\n- [全程D14] 检验组合: 总蛋白(TP)-尿液: +- 0.2g（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；红细胞计数(RBC#)-尿液: 1/μL；葡萄糖(Glu)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.02；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；粘液丝计数(MUCS#)-尿液: 4/μL；白细胞(LEU)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D15] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 11/μL；酮体(KET)-尿液: -（参考: 阴性）；酵母菌(YEAST)-尿液: 1/μL；白细胞(LEU)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 1/μL；比重(SG)-尿液: 1.019；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 7/μL；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；酸碱度(pH)-尿液: 6.5；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D19] 检验组合: 氯离子(Cl-)-静脉血: 96.7mmol/L；总蛋白(TP)-静脉血: 73.8g/L；甘油三酯(TG)-静脉血: 1mmol/L；血小板计数(PLT#)-静脉血: 18410E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.2；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.27；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.44mmolL；球蛋白(GLO)-静脉血: 27.4g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；丙氨酸氨基转移酶(ALT)-静脉血: 16.1U/L；总钙(Ca)-静脉血: 2.31mmol/L；血小板比容-静脉血: 18%；血红蛋白(Hb)-静脉血: 144g/L；血液二氧化碳含量ctCO2(B)-静脉血: 26.5mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 356g/L；胱抑素(Cys-C)-静脉血: 0.75mg/L；γ-谷氨酰基转移酶(GGT)-静脉血: 18.1U/L；红细胞计数(RBC#)-静脉血: 4.5310E12/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.1；淋巴细胞百分比(Lymph%)-静脉血: 0.277；平均红细胞血红蛋白含量(MCH)-静脉血: 31.8pg；尿酸(UA)-静脉血: 231.9umol/L；乳酸脱氢酶(LDH)-静脉血: 158.8U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；载脂蛋白B(apoB)-静脉血: 0.78g/L；中性粒细胞百分比(Neut%)-静脉血: 0.597；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；血小板分布宽度(PDW)-静脉血: 10.5%；间接胆红素(IBIL)-静脉血: 11.1umolL；单核细胞百分比(Mono%)-静脉血: 0.101；天门冬氨酸氨基转移酶(AST)-静脉血: 20.5U/L；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L；白细胞计数(WBC#)-静脉血: 4.8310E9/L；镁离子(Mg2+)-静脉血: 0.93mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.36g/L；总胆红素(TBIL)-静脉血: 16.1umol/……\n- [全程D34] 检验组合: 阴离子间隙(AG)-静脉血: 10.5；乳酸脱氢酶(LDH)-静脉血: 175.1U/L；肌酐(Crea)-静脉血: 86umol/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；钾离子(K+)-静脉血: 3.9mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.43；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.18；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；甘油三酯(TG)-静脉血: 0.79mmol/L；总蛋白(TP)-静脉血: 76.5g/L；大血小板百分比(P-LCR%)-静脉血: 15.9%；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.537；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；总钙(Ca)-静脉血: 2.39mmol/L；尿酸(UA)-静脉血: 334.3umol/L；钠离子(Na+)-静脉血: 142.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.53g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；单核细胞百分比(Mono%)-静脉血: 0.102；有核红细胞百分比(NRBC%)-静脉血: 0；单核细胞计数(Mono#)-静脉血: 0.510E9/L；碱性磷酸酶(ALP)-静脉血: 63.6U/L；间接胆红素(IBIL)-静脉血: 6.8umolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.028；平均红细胞体积(MCV)-静脉血: 90.7fL；淋巴细胞百分比(Lymph%)-静脉血: 0.325；血液二氧化碳含量ctCO2(B)-静脉血: 29.6mmol/L；血小板分布宽度(PDW)-静脉血: 8.8%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.3；平均血小板体积(MPV)-静脉血: 8.9fL；球蛋白(GLO)-静脉血: 31.5g/L；血红蛋白(Hb)-静脉血: 130g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 29U/L；白蛋白(ALB)-静脉血: 45g/L；总胆汁酸(TBA)-静脉血: 5.6umol/L；总胆固醇(TC)-静脉血: 5.01mmol/L……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D17] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者第一程诱导化疗后，诉轻度恶心呕吐，精神睡眠尚可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。钱医生信息已隐藏：患者03-02开始予5-Fu6.6g,DDP130mg化疗，患者未诉特殊不适，注意观察不良反应。\n- [全程D19] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者化疗后，诉轻度恶心，精神睡眠尚可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。医生信息已隐藏：患者第一程诱导化疗顺利，一般情况可，予出院。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 拔除PICC导管改行外周静脉穿刺，并完善间接鼻咽镜检查准备下一周期治疗。\nB. 予重组人粒细胞刺激因子皮下注射，并行动静脉置管常规护理准备下一周期治疗。\nC. 予静脉补钾、补镁及水化利尿治疗，并行动静脉置管常规护理准备下一周期治疗。\nD. 予静脉输注红细胞悬液，并行动静脉置管常规护理准备下一周期治疗。\nE. 予静脉滴注广谱抗菌药物，并完善间接鼻咽镜检查准备下一周期治疗。\nF. 拔除PICC导管更换为锁骨下静脉置管，并完善间接鼻咽镜检查准备下一周期治疗。\nG. 予静脉滴注5-HT3受体拮抗剂，并行动静脉置管常规护理准备下一周期治疗。\nH. 予静脉输注肠外营养液，并完善间接鼻咽镜检查准备下一周期治疗。\nI. 行PICC导管常规维护（更换敷料与正压接头），并完善间接鼻咽镜检查准备下一周期治疗。\nJ. 行鼻咽内镜下组织活检，并行动静脉置管常规护理准备下一周期治疗。\nK. 予静脉输注人血白蛋白，并行动静脉置管常规护理准备下一周期治疗。\nL. 予口服保肝药物，并完善间接鼻咽镜检查准备下一周期治疗。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"拔除PICC导管改行外周静脉穿刺，并完善间接鼻咽镜检查准备下一周期治疗。","is_gold":false},{"letter":"B","text":"予重组人粒细胞刺激因子皮下注射，并行动静脉置管常规护理准备下一周期治疗。","is_gold":false},{"letter":"C","text":"予静脉补钾、补镁及水化利尿治疗，并行动静脉置管常规护理准备下一周期治疗。","is_gold":false},{"letter":"D","text":"予静脉输注红细胞悬液，并行动静脉置管常规护理准备下一周期治疗。","is_gold":false},{"letter":"E","text":"予静脉滴注广谱抗菌药物，并完善间接鼻咽镜检查准备下一周期治疗。","is_gold":false},{"letter":"F","text":"拔除PICC导管更换为锁骨下静脉置管，并完善间接鼻咽镜检查准备下一周期治疗。","is_gold":false},{"letter":"G","text":"予静脉滴注5-HT3受体拮抗剂，并行动静脉置管常规护理准备下一周期治疗。","is_gold":false},{"letter":"H","text":"予静脉输注肠外营养液，并完善间接鼻咽镜检查准备下一周期治疗。","is_gold":false},{"letter":"I","text":"行PICC导管常规维护（更换敷料与正压接头），并完善间接鼻咽镜检查准备下一周期治疗。","is_gold":true},{"letter":"J","text":"行鼻咽内镜下组织活检，并行动静脉置管常规护理准备下一周期治疗。","is_gold":false},{"letter":"K","text":"予静脉输注人血白蛋白，并行动静脉置管常规护理准备下一周期治疗。","is_gold":false},{"letter":"L","text":"予口服保肝药物，并完善间接鼻咽镜检查准备下一周期治疗。","is_gold":false}],"gold_letter":"I"},{"sample_id":"sample-dd7067359645093ab08b6c16","patient_id":"patient-e5fcd31b4b8b85194b146991","turn_id":"turn07","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 回吸性涕血1月余。；现病史: 缘于1月前患者无意中出现抽吸性血涕，痰中带血；无头痛、面麻，无视力下降、复视，无听力下降、耳鸣等不适，于当地乡镇医院予滴鼻治疗，具体药物不详，未见好转，遂于某次就诊时间往[地点已隐去]人民医院检查，某次就诊时间病理活检示：鼻咽未分化型角化性癌。某次就诊时间鼻咽MRI示：左侧鼻咽部占位病变，考虑鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻咽角化,涕血,痰中带血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：78次/分，R：20次/分，BP：125/80mmHg,Ht：162cm，Wt：61kg，BSA：1.6483m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率100次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D19] 检验组合: 氯离子(Cl-)-静脉血: 96.7mmol/L；总蛋白(TP)-静脉血: 73.8g/L；甘油三酯(TG)-静脉血: 1mmol/L；血小板计数(PLT#)-静脉血: 18410E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.2；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.27；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.44mmolL；球蛋白(GLO)-静脉血: 27.4g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；丙氨酸氨基转移酶(ALT)-静脉血: 16.1U/L；总钙(Ca)-静脉血: 2.31mmol/L；血小板比容-静脉血: 18%；血红蛋白(Hb)-静脉血: 144g/L；血液二氧化碳含量ctCO2(B)-静脉血: 26.5mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 356g/L；胱抑素(Cys-C)-静脉血: 0.75mg/L；γ-谷氨酰基转移酶(GGT)-静脉血: 18.1U/L；红细胞计数(RBC#)-静脉血: 4.5310E12/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.1；淋巴细胞百分比(Lymph%)-静脉血: 0.277；平均红细胞血红蛋白含量(MCH)-静脉血: 31.8pg；尿酸(UA)-静脉血: 231.9umol/L；乳酸脱氢酶(LDH)-静脉血: 158.8U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；载脂蛋白B(apoB)-静脉血: 0.78g/L；中性粒细胞百分比(Neut%)-静脉血: 0.597；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；血小板分布宽度(PDW)-静脉血: 10.5%；间接胆红素(IBIL)-静脉血: 11.1umolL；单核细胞百分比(Mono%)-静脉血: 0.101；天门冬氨酸氨基转移酶(AST)-静脉血: 20.5U/L；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L；白细胞计数(WBC#)-静脉血: 4.8310E9/L；镁离子(Mg2+)-静脉血: 0.93mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.36g/L；总胆红素(TBIL)-静脉血: 16.1umol/……\n- [全程D34] 检验组合: 阴离子间隙(AG)-静脉血: 10.5；乳酸脱氢酶(LDH)-静脉血: 175.1U/L；肌酐(Crea)-静脉血: 86umol/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；钾离子(K+)-静脉血: 3.9mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.43；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.18；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；甘油三酯(TG)-静脉血: 0.79mmol/L；总蛋白(TP)-静脉血: 76.5g/L；大血小板百分比(P-LCR%)-静脉血: 15.9%；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.537；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；总钙(Ca)-静脉血: 2.39mmol/L；尿酸(UA)-静脉血: 334.3umol/L；钠离子(Na+)-静脉血: 142.4mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.53g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.4；单核细胞百分比(Mono%)-静脉血: 0.102；有核红细胞百分比(NRBC%)-静脉血: 0；单核细胞计数(Mono#)-静脉血: 0.510E9/L；碱性磷酸酶(ALP)-静脉血: 63.6U/L；间接胆红素(IBIL)-静脉血: 6.8umolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.028；平均红细胞体积(MCV)-静脉血: 90.7fL；淋巴细胞百分比(Lymph%)-静脉血: 0.325；血液二氧化碳含量ctCO2(B)-静脉血: 29.6mmol/L；血小板分布宽度(PDW)-静脉血: 8.8%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.3；平均血小板体积(MPV)-静脉血: 8.9fL；球蛋白(GLO)-静脉血: 31.5g/L；血红蛋白(Hb)-静脉血: 130g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 29U/L；白蛋白(ALB)-静脉血: 45g/L；总胆汁酸(TBA)-静脉血: 5.6umol/L；总胆固醇(TC)-静脉血: 5.01mmol/L……\n- [全程D35] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；比重(SG)-尿液: 1.015；白细胞计数(WBC#)-尿液: 2/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 6.5；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）\n- [全程D36] 检验组合: 浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 7.5；隐血(OB)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；胆红素(BIL)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.022；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）\n- [全程D37] 检验组合: 颜色-尿液: Yellow；葡萄糖(Glu)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.018；隐血(OB)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 3/μL；酸碱度(pH)-尿液: 7；酮体(KET)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D41] 检验组合: 总胆固醇(TC)-静脉血: 4.84mmol/L；红细胞计数(RBC#)-静脉血: 4.2110E12/L；红细胞比容(Hct)-静脉血: 36.6%；血小板分布宽度(PDW)-静脉血: 7.9%；白蛋白(ALB)-静脉血: 42.1g/L；尿素氮(BUN)-静脉血: 4.8mmol/L；总钙(Ca)-静脉血: 2.25mmol/L；乳酸脱氢酶(LDH)-静脉血: 148.6U/L；钾离子(K+)-静脉血: 3.3mmol/L；阴离子间隙(AG)-静脉血: 14.2；血液二氧化碳含量ctCO2(B)-静脉血: 25mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；胱抑素(Cys-C)-静脉血: 0.8mg/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 350g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.4pg；平均红细胞体积(MCV)-静脉血: 86.9fL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；氯离子(Cl-)-静脉血: 97.5mmol/L；葡萄糖(Glu)-静脉血: 5.35mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.89；镁离子(Mg2+)-静脉血: 0.78mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.34mmolL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.5；中性粒细胞计数(Neut#)-静脉血: 1.710E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.13mmol/L；直接胆红素(DBIL)-静脉血: 2.5umol/L；磷(P)-静脉血: 1.18mmol/L；球蛋白(GLO)-静脉血: 28.13g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.01；白细胞计数(WBC#)-静脉血: 3.0210E9/L；平均血小板体积(MPV)-静脉血: 8.8fL；总胆红素(TBIL)-静脉血: 9.3umol/L；碱性磷酸酶(ALP)-静脉血: 57.9U/L；中性粒细胞百分比(Neut%)-静脉血: 0.55；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；血小板计数(PLT#)-静脉血: 13810E9/L；肌酐(Crea)-静脉血: 90.1umol/L；血红蛋白(Hb)-静……\n- [全程D42] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后复查： 鼻咽腔稍狭窄，鼻咽双侧壁、顶后壁增厚，左侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。右侧咽隐窝变窄。肿物侵犯左侧腭帆张提肌，右侧腭帆提肌结构稍模糊，右侧腭帆张提肌间隙稍模糊。 双侧头长肌、翼内外肌未见明显异常。 双侧翼腭窝、上颌后脂肪间隙、咀嚼肌间隙未见异常。 口咽各壁未见增厚。鼻腔内未见肿物。 蝶骨基底部、左侧翼突基底部及内侧板骨质信号降低，增强扫描可见强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦粘膜稍增厚，双侧乳突未见明显异常。 左侧咽后见几个淋巴结，最大者约8mm×5mm，边界欠清，明显强化。双颈II区见多个淋巴结，最大者约15mm×12mm，边界尚清，较均匀明显强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗后复查，对比某次就诊时间片： 鼻咽部肿物，较前明显缩小。 颅底骨质破坏，较前未见明显变化。 左侧咽后、双颈II区淋巴结，可疑转移，其中右颈IIa区淋巴结较前增大，余较前未见明显变化。 轻度鼻窦炎。\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D35] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者未诉特殊不适，精神睡眠可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。03-22血生化常规未见异常。[姓名已隐去]医生信息已隐藏：患者1程PF方案诱导化疗后，一般情况可，已排除化疗禁忌症，今日水化，明日开始化疗（DDP 130mg d1 ; 5-Fu6.5g civ）。并予对症支持治疗。\n- [全程D36] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉稍恶心呕吐，无头痛、头晕，精神睡眠可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]副医生信息已隐藏：加强对症治疗，患者一般情况可，继续完成化疗，注意休息，加强营养。\n- [全程D37] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉稍恶心，无明显呕吐，无头痛、头晕，精神睡眠可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]副医生信息已隐藏：患者一般情况可继续完成化疗，\n- [全程D41] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者诉恶心呕吐，盗汗，头晕鼻塞，精神睡眠可。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。03-29血常规示：WBC3.0*109/L NE1.7*109/L 生化示：血钾 3.3mmol/L[姓名已隐去]医生信息已隐藏：患者第二程诱导化疗，出现I度骨髓抑制，予香伏益血。胃肠道反应相比上次稍重，嘱少食多餐，加强营养。今日化疗结束，嘱明日出院。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即启动第三程PF方案诱导化疗，随后再行根治性放射治疗。\nB. 更改化疗方案为TP或GP方案继续诱导化疗，随后再行根治性放射治疗。\nC. 立即行鼻咽及颈部根治性手术切除，术后辅以根治性放射治疗。\nD. 出院休养，待化疗副反应恢复后，行右颈部淋巴结清扫术，再行根治性放疗。\nE. 立即予以全量根治性放射治疗，并联合靶向药物如西妥昔单抗。\nF. 出院休养，行颈部淋巴结穿刺活检明确病理，再决定后续放疗方案。\nG. 立即启动根治性放射治疗，暂缓处理骨髓抑制及胃肠道反应。\nH. 出院休养，待化疗副反应恢复后，行姑息性放射治疗联合免疫治疗。\nI. 行全身PET-CT重新评估远处转移情况，再决定是否启动根治性放疗。\nJ. 出院休养并对症处理化疗副反应，定期复查血常规及肝肾功能，按计划返院行根治性放射治疗。\nK. 出院休养，定期复查血常规及肝肾功能，待恢复后返院行第三程PF方案诱导化疗。\nL. 立即予以同期放化疗，并对右颈淋巴结局部推量加量放疗。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"立即启动第三程PF方案诱导化疗，随后再行根治性放射治疗。","is_gold":false},{"letter":"B","text":"更改化疗方案为TP或GP方案继续诱导化疗，随后再行根治性放射治疗。","is_gold":false},{"letter":"C","text":"立即行鼻咽及颈部根治性手术切除，术后辅以根治性放射治疗。","is_gold":false},{"letter":"D","text":"出院休养，待化疗副反应恢复后，行右颈部淋巴结清扫术，再行根治性放疗。","is_gold":false},{"letter":"E","text":"立即予以全量根治性放射治疗，并联合靶向药物如西妥昔单抗。","is_gold":false},{"letter":"F","text":"出院休养，行颈部淋巴结穿刺活检明确病理，再决定后续放疗方案。","is_gold":false},{"letter":"G","text":"立即启动根治性放射治疗，暂缓处理骨髓抑制及胃肠道反应。","is_gold":false},{"letter":"H","text":"出院休养，待化疗副反应恢复后，行姑息性放射治疗联合免疫治疗。","is_gold":false},{"letter":"I","text":"行全身PET-CT重新评估远处转移情况，再决定是否启动根治性放疗。","is_gold":false},{"letter":"J","text":"出院休养并对症处理化疗副反应，定期复查血常规及肝肾功能，按计划返院行根治性放射治疗。","is_gold":true},{"letter":"K","text":"出院休养，定期复查血常规及肝肾功能，待恢复后返院行第三程PF方案诱导化疗。","is_gold":false},{"letter":"L","text":"立即予以同期放化疗，并对右颈淋巴结局部推量加量放疗。","is_gold":false}],"gold_letter":"J"},{"sample_id":"sample-9cd68a6b9c75f1d90e6a9dbe","patient_id":"patient-e5fcd31b4b8b85194b146991","turn_id":"turn08","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 回吸性涕血1月余。；现病史: 缘于1月前患者无意中出现抽吸性血涕，痰中带血；无头痛、面麻，无视力下降、复视，无听力下降、耳鸣等不适，于当地乡镇医院予滴鼻治疗，具体药物不详，未见好转，遂于某次就诊时间往[地点已隐去]人民医院检查，某次就诊时间病理活检示：鼻咽未分化型角化性癌。某次就诊时间鼻咽MRI示：左侧鼻咽部占位病变，考虑鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻咽角化,涕血,痰中带血；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.7℃，P：78次/分，R：20次/分，BP：125/80mmHg,Ht：162cm，Wt：61kg，BSA：1.6483m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率100次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D76] 检验组合: 钠离子(Na+)-静脉血: 138.3mmol/L；球蛋白(GLO)-静脉血: 27.6g/L；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 14.1U/L；碱性磷酸酶(ALP)-静脉血: 64.9U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 26.4U/L；平均血小板体积(MPV)-静脉血: 9fL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；红细胞比容(Hct)-静脉血: 29.5%；白蛋白(ALB)-静脉血: 44.6g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.62；α-L-岩藻糖苷酶(AFU)-静脉血: 24U/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；尿酸(UA)-静脉血: 284.2umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 8.7U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.73mmol/L；平均红细胞体积(MCV)-静脉血: 87.5fL；血小板比容-静脉血: 14%；单核细胞百分比(Mono%)-静脉血: 0.136；间接胆红素(IBIL)-静脉血: 7.16umolL；血液二氧化碳含量ctCO2(B)-静脉血: 23.6mmol/L；尿素氮(BUN)-静脉血: 5.4mmol/L；乳酸脱氢酶(LDH)-静脉血: 140.2U/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 104g/L；直接胆红素(DBIL)-静脉血: 3.72umol/L；载脂蛋白B(apoB)-静脉血: 0.86g/L；钾离子(K+)-静脉血: 4.1mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.129；中性粒细胞百分比(Neut%)-静脉血: 0.713；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.2；平均红细胞血红蛋白浓度(MCHC)-静脉血: 353g/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L；红细胞计数(RBC#)-静脉血: 3.3710E12/L；C-反应蛋白(CRP)-静脉……\n- [全程D83] 检验组合: 碱性磷酸酶(ALP)-静脉血: 52.7U/L；血红蛋白(Hb)-静脉血: 96g/L；总胆汁酸(TBA)-静脉血: 2.4umol/L；磷(P)-静脉血: 1.26mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.41mmol/L；尿酸(UA)-静脉血: 329.6umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.76；血小板比容-静脉血: 11%；淋巴细胞计数(Lymph#)-静脉血: 0.410E9/L；红细胞计数(RBC#)-静脉血: 3.0610E12/L；间接胆红素(IBIL)-静脉血: 6.3umolL；血液二氧化碳含量ctCO2(B)-静脉血: 24.5mmol/L；钾离子(K+)-静脉血: 3.83mmol/L；葡萄糖(Glu)-静脉血: 4.88mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 356g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.56；氯离子(Cl-)-静脉血: 102.9mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总胆固醇(TC)-静脉血: 3.96mmol/L；平均红细胞体积(MCV)-静脉血: 88.2fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.9；中性粒细胞计数(Neut#)-静脉血: 1.310E9/L；阴离子间隙(AG)-静脉血: 12.6；尿素氮(BUN)-静脉血: 5.9mmol/L；肌酐(Crea)-静脉血: 89.8umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 20.3U/L；球蛋白(GLO)-静脉血: 25.51g/L；镁离子(Mg2+)-静脉血: 0.77mmol/L；乳酸脱氢酶(LDH)-静脉血: 128.5U/L；C-反应蛋白(CRP)-静脉血: 0.49mg/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.4pg；总蛋白(TP)-静脉血: 65.31g/L；红细胞比容(Hct)-静脉血: 27%；单核细胞计数(Mono#)-静脉血: 0.310E9/L；血小板分布宽度(PDW)-静脉血: 8.1%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.009；单核细胞百分比(Mono%)-静脉血: 0.156；嗜碱性粒细胞计数(Baso#)-静脉血:……\n- [全程D90] 检验组合: 尿素氮(BUN)-静脉血: 5.1mmol/L；总胆汁酸(TBA)-静脉血: 3.6umol/L；总钙(Ca)-静脉血: 2.27mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 21.5U/L；总胆红素(TBIL)-静脉血: 11.71umol/L；载脂蛋白AI(apoAI)-静脉血: 1.59g/L；载脂蛋白B(apoB)-静脉血: 0.85g/L；氯离子(Cl-)-静脉血: 99.7mmol/L；白蛋白(ALB)-静脉血: 46.3g/L；有核红细胞百分比(NRBC%)-静脉血: 0；血小板计数(PLT#)-静脉血: 14210E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；血小板比容-静脉血: 13%；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.58；嗜酸性粒细胞计数(Eos#)-静脉血: 0.410E9/L；血小板分布宽度(PDW)-静脉血: 9%；磷(P)-静脉血: 1.33mmol/L；尿酸(UA)-静脉血: 467.8umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.78；甘油三酯(TG)-静脉血: 0.58mmol/L；C-反应蛋白(CRP)-静脉血: 0.4mg/L；平均红细胞体积(MCV)-静脉血: 91.4fL；α-L-岩藻糖苷酶(AFU)-静脉血: 22.5U/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1；中性粒细胞计数(Neut#)-静脉血: 2.210E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 346g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；白细胞计数(WBC#)-静脉血: 3.4910E9/L；钾离子(K+)-静脉血: 3.89mmol/L；血红蛋白(Hb)-静脉血: 118g/L；平均血小板体积(MPV)-静脉血: 9fL；中性粒细胞百分比(Neut%)-静脉血: 0.636；红细胞计数(RBC#)-静脉血: 3.7310E12/L；肌酐(Crea)-静脉血: 91.5umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.132；总胆固醇(TC)-静脉血: 4.55mmol/L；阴离子间隙(AG)-静脉血: 14.7……\n- [全程D91] 检验组合: 比重(SG)-尿液: 1.011；酮体(KET)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5；隐血(OB)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；总蛋白(TP)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；白细胞计数(WBC#)-尿液: 3/μL\n- [全程D92] 检验组合: 亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；隐血(OB)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 2/μL；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；比重(SG)-尿液: 1.018；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）\n- [全程D94] 检验组合: 亚硝酸盐(NIT)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 11/μL；颜色-尿液: Yellow；白细胞计数(WBC#)-尿液: 5/μL；酮体(KET)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 28/μL；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.014；酸碱度(pH)-尿液: 6\n- [全程D97] 检验组合: 低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.8mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；平均红细胞体积(MCV)-静脉血: 86.8fL；载脂蛋白AI(apoAI)-静脉血: 1.3g/L；甘油三酯(TG)-静脉血: 0.75mmol/L；钠离子(Na+)-静脉血: 139mmol/L；总钙(Ca)-静脉血: 2.24mmol/L；氯离子(Cl-)-静脉血: 98.2mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 13.3U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.65；α-L-岩藻糖苷酶(AFU)-静脉血: 24.8U/L；碱性磷酸酶(ALP)-静脉血: 57U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 21.5U/L；血小板比容-静脉血: 12%；直接胆红素(DBIL)-静脉血: 4.61umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.642；白细胞计数(WBC#)-静脉血: 2.0410E9/L；大血小板百分比(P-LCR%)-静脉血: 11.5%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.127；血液二氧化碳含量ctCO2(B)-静脉血: 27.4mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 357g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.5；总蛋白(TP)-静脉血: 67.8g/L；血红蛋白(Hb)-静脉血: 96g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.310E9/L；尿酸(UA)-静脉血: 356.9umol/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；血小板计数(PLT#)-静脉血: 14210E9/L；钾离子(K+)-静脉血: 3.77mmol/L；载脂蛋白B(apoB)-静脉血: 0.86g/L；单核细胞百分比(Mono%)-静脉血: 0.083；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.37；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.02；胱抑素(Cys-C)-静脉血: 0.71mg/L；白蛋白(ALB)-静脉血: 42.2g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞计数(Neut#)-静脉血: 1.310E9/L……\n- [全程D98] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗放疗后复查： 鼻咽腔无狭窄，鼻咽壁无增厚，粘膜规整无增厚，双侧咽隐窝、咽旁脂肪间隙未见异常。双侧腭帆张、提肌、双侧头长肌、翼内外肌未见明显异常。 双侧翼腭窝、上颌后脂肪间隙、咀嚼肌间隙未见异常。 口咽各壁未见增厚。鼻腔内未见肿物。 蝶骨基底部左份、左侧翼突基底部及内侧骨质信号降低，增强扫描可见强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦粘膜稍增厚，骨壁完整。左乳头见少许渗出影。 双侧咽后未见肿大淋巴结。双颈II区见多个淋巴结，最大者约8mm×5mm，边界尚清，较均匀明显强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗放疗后复查，对比某次就诊时间片： 鼻咽未见明显病灶。 颅底骨质破坏，较前未见明显变化。 左侧咽后淋巴结消失，双颈II区淋巴结缩小。 鼻窦炎，左乳突炎。\n- [全程D98] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称。双肺纹理清晰；双肺野未见明显实质性病变；双侧肺门无增大。纵隔未见增宽。心影大小、形态正常。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n\n【既往治疗与反应】\n- [全程D77] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 今行放疗第15次，患者口干咽痛，稍恶心、呕吐，食纳、睡眠欠佳。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。某次就诊时间日查血常规、肝肾功能电解质无明显异常。[姓名已隐去]副医生信息已隐藏：予口腔粘膜保护等对症治疗，加强营养支持治疗，继续完成放疗。\n- [全程D82] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今行放疗第18次，患者口干咽痛，稍恶心、呕吐，食纳、睡眠欠佳。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物，较前缩小；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]医生信息已隐藏：予口腔粘膜保护等对症治疗，加强营养支持治疗，明日复查血常规、肝肾功能，继续完成放疗。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D91] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今行放疗第25次，患者口干咽痛，稍恶心、呕吐，食纳、睡眠欠佳。查体：张口门齿距4.5cm；鼻咽肿物不明显；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。昨日查血常规、肝肾功能未见明显异常。[姓名已隐去]医生信息已隐藏：予口腔粘膜保护等对症治疗，加强营养支持治疗，明日予同期DDP化疗，密切观察放化疗反应，继续完成放疗。\n- [全程D96] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 今行放疗第28次，患者口干咽痛，稍恶心、呕吐，食纳、睡眠欠佳。查体：张口门齿距4.5cm；鼻咽肿物不明显；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]医生信息已隐藏：予口腔粘膜保护等对症治疗，加强营养支持治疗，明日复查血常规、肝肾功能，继续完成放疗。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估为原发灶缓解但颈部淋巴结残留，行双侧颈部淋巴结清扫术，术后定期随访复查。\nB. 评估为颅底骨质破坏未缓解，局部追加立体定向放射治疗推量，并定期随访复查。\nC. 评估为放化疗后部分缓解，继续原方案辅助化疗2个周期以巩固疗效。\nD. 评估为放化疗后临床缓解，按计划结疗出院，序贯PD-1抑制剂维持治疗1年。\nE. 评估为原发灶残留，行鼻咽内镜下挽救性切除术，术后配合张口及颈部功能锻炼。\nF. 评估为放化疗后临床缓解，按计划结疗出院，3个月后行PET-CT评估，期间无需特殊干预。\nG. 评估为放化疗后病情稳定，更改化疗方案为吉西他滨联合顺铂进行二线化疗。\nH. 评估为放化疗后临床缓解，按计划结疗出院，预防性给予全脑放射治疗。\nI. 评估为颈部淋巴结残留，局部追加电子线放射治疗推量，并加强营养支持。\nJ. 评估为放化疗后临床缓解，按计划结疗出院，序贯口服卡培他滨节拍维持治疗1年。\nK. 评估为放化疗后临床缓解，按计划结疗出院，嘱鼻腔冲洗、张口及颈部功能锻炼，定期随访复查。\nL. 评估为颅底病灶残留，转诊行质子重离子放射治疗以提高局部控制率。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"评估为原发灶缓解但颈部淋巴结残留，行双侧颈部淋巴结清扫术，术后定期随访复查。","is_gold":false},{"letter":"B","text":"评估为颅底骨质破坏未缓解，局部追加立体定向放射治疗推量，并定期随访复查。","is_gold":false},{"letter":"C","text":"评估为放化疗后部分缓解，继续原方案辅助化疗2个周期以巩固疗效。","is_gold":false},{"letter":"D","text":"评估为放化疗后临床缓解，按计划结疗出院，序贯PD-1抑制剂维持治疗1年。","is_gold":false},{"letter":"E","text":"评估为原发灶残留，行鼻咽内镜下挽救性切除术，术后配合张口及颈部功能锻炼。","is_gold":false},{"letter":"F","text":"评估为放化疗后临床缓解，按计划结疗出院，3个月后行PET-CT评估，期间无需特殊干预。","is_gold":false},{"letter":"G","text":"评估为放化疗后病情稳定，更改化疗方案为吉西他滨联合顺铂进行二线化疗。","is_gold":false},{"letter":"H","text":"评估为放化疗后临床缓解，按计划结疗出院，预防性给予全脑放射治疗。","is_gold":false},{"letter":"I","text":"评估为颈部淋巴结残留，局部追加电子线放射治疗推量，并加强营养支持。","is_gold":false},{"letter":"J","text":"评估为放化疗后临床缓解，按计划结疗出院，序贯口服卡培他滨节拍维持治疗1年。","is_gold":false},{"letter":"K","text":"评估为放化疗后临床缓解，按计划结疗出院，嘱鼻腔冲洗、张口及颈部功能锻炼，定期随访复查。","is_gold":true},{"letter":"L","text":"评估为颅底病灶残留，转诊行质子重离子放射治疗以提高局部控制率。","is_gold":false}],"gold_letter":"K"}]}
+{"patient_id":"patient-d6812a1c46ed21fda9ebb9f8","bootstrap_cluster_id":"cluster-001","turns":[{"sample_id":"sample-deb84ffb5f7c209f58040b0d","patient_id":"patient-d6812a1c46ed21fda9ebb9f8","turn_id":"turn01","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 右侧耳鸣、鼻塞3月余，加重1周。；现病史: 缘于某次就诊时间11月下旬患者无意中出现右侧耳鸣、鼻塞，伴有右耳听力下降、头痛症状，无鼻出血，无面麻，无视物模糊、复视，无呛咳等症状；未予重视，逐渐加重，于某次就诊时间在[机构已隐去]就诊；建议患者住院治疗，患者及家属不同意。近1周来，耳鸣、鼻塞及头痛症状加重，今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,听力下降,右耳鸣,头痛；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：75次/分，R：20次/分，BP：110/65mmHg,Ht：150cm，Wt：41kg，BSA：1.316m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶壁、顶后壁、右侧壁明显增厚，左侧壁稍增厚，并见结节状肿物突出；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸部X线，腹部彩超\nB. 鼻咽及颈部MRI平扫+增强，全身PET-CT检查，暂缓鼻咽活检\nC. 鼻咽镜检查及活检，仅行鼻咽MRI平扫+增强，胸部CT，腹部彩超\nD. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部X线，腹部彩超及心电图\nE. 鼻咽镜检查及活检，全身PET-CT检查，头颅MRI平扫+增强\nF. 鼻咽及颈部根治性放疗，同步行胸部及腹部影像学检查\nG. 鼻咽肿物切除活检，鼻咽及颈部MRI平扫+增强，胸部X线，腹部彩超\nH. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，暂不进行胸腹部影像学检查\nI. 鼻咽镜检查及活检，鼻咽CT平扫+增强，颈部超声，胸部X线，腹部彩超\nJ. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身骨扫描，头颅CT\nK. 鼻咽脱落细胞学检查，鼻咽及颈部MRI平扫+增强，胸部CT，腹部彩超\nL. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，预防性颈部淋巴结清扫术\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸部X线，腹部彩超","is_gold":false},{"letter":"B","text":"鼻咽及颈部MRI平扫+增强，全身PET-CT检查，暂缓鼻咽活检","is_gold":false},{"letter":"C","text":"鼻咽镜检查及活检，仅行鼻咽MRI平扫+增强，胸部CT，腹部彩超","is_gold":false},{"letter":"D","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部X线，腹部彩超及心电图","is_gold":true},{"letter":"E","text":"鼻咽镜检查及活检，全身PET-CT检查，头颅MRI平扫+增强","is_gold":false},{"letter":"F","text":"鼻咽及颈部根治性放疗，同步行胸部及腹部影像学检查","is_gold":false},{"letter":"G","text":"鼻咽肿物切除活检，鼻咽及颈部MRI平扫+增强，胸部X线，腹部彩超","is_gold":false},{"letter":"H","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，暂不进行胸腹部影像学检查","is_gold":false},{"letter":"I","text":"鼻咽镜检查及活检，鼻咽CT平扫+增强，颈部超声，胸部X线，腹部彩超","is_gold":false},{"letter":"J","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身骨扫描，头颅CT","is_gold":false},{"letter":"K","text":"鼻咽脱落细胞学检查，鼻咽及颈部MRI平扫+增强，胸部CT，腹部彩超","is_gold":false},{"letter":"L","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，预防性颈部淋巴结清扫术","is_gold":false}],"gold_letter":"D"},{"sample_id":"sample-76e183c8ae4202bcecbc9d87","patient_id":"patient-d6812a1c46ed21fda9ebb9f8","turn_id":"turn02","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 右侧耳鸣、鼻塞3月余，加重1周。；现病史: 缘于某次就诊时间11月下旬患者无意中出现右侧耳鸣、鼻塞，伴有右耳听力下降、头痛症状，无鼻出血，无面麻，无视物模糊、复视，无呛咳等症状；未予重视，逐渐加重，于某次就诊时间在[机构已隐去]就诊；建议患者住院治疗，患者及家属不同意。近1周来，耳鸣、鼻塞及头痛症状加重，今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,听力下降,右耳鸣,头痛；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.6℃，P：75次/分，R：20次/分，BP：110/65mmHg,Ht：150cm，Wt：41kg，BSA：1.316m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶壁、顶后壁、右侧壁明显增厚，左侧壁稍增厚，并见结节状肿物突出；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见: 轻度ST段下移；检查结论: 窦性心律 轻度ST段下移\n- [全程D1] 检验组合: 淋巴细胞百分比(Lymph%)-静脉血: 0.35；平均红细胞血红蛋白含量(MCH)-静脉血: 28.7pg；总钙(Ca)-静脉血: 2.32mmol/L；凝血酶时间(TT)-静脉血: 19.8sec.；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阳性(+)（参考: 阴性）；总胆汁酸(TBA)-静脉血: 4.1umol/L；钾离子(K+)-静脉血: 3.82mmol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；红细胞计数(RBC#)-静脉血: 5.0210E12/L；钠离子(Na+)-静脉血: 142.9mmol/L；尿素氮(BUN)-静脉血: 4.2mmol/L；葡萄糖(Glu)-静脉血: 5.36mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.66mmolL；球蛋白(GLO)-静脉血: 25.7g/L；尿酸(UA)-静脉血: 214.3umol/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；ABO血型-静脉血: O；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.98mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.76；中性粒细胞百分比(Neut%)-静脉血: 0.579；阴离子间隙(AG)-静脉血: 11.5；γ-谷氨酰基转移酶(GGT)-静脉血: 12.3U/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 23.4U/L；载脂蛋白B(apoB)-静脉血: 0.98g/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 6.4umolL；中性粒细胞计数(Neut#)-静脉血: 3.710E9/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；载脂蛋白AI(apoAI)-静脉血: 1.79g/L；肌酐(Crea)-静脉血: 50.2umol/L；总蛋白(TP)-静脉血: 70.9g/L；总胆固醇(TC)-静脉血: 5.02mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)……\n- [全程D2] 超声；双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声欠均匀，肝内可见多个无回声灶，较大者约43×29mm，椭圆形，边界清，内透声好，部分可见高回声分隔，后方回声增强。血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：上述病灶内未见明确血流信号。肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声欠均匀，右肾多个无回声灶，较大者约15×13mm，类圆形，边界清，内透声好，后方回声增强。左肾未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确肿物回声。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。；检查结论: 肝多发囊肿。 右肾多发囊肿。 胆囊、脾脏、胰腺、左肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D2] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对侧，双肺野纹理稍增多、增粗，未见明显实质性病变。双侧肺门不大，纵隔不宽，心影形态、大小、位置未见异常。双膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明确病变。\n- [全程D7] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、右侧壁明显增厚，左侧壁稍增厚，并见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号增强扫描明显强化，肿物占据右侧咽隐窝。双侧鼻腔及口咽各壁未见异常。 右侧腭帆张提肌、右侧头长肌及右侧翼内肌受侵，病变包绕右侧颈内动静脉。 右侧腭帆提肌、腭帆张肌、双侧头长肌受侵；左侧腭帆提肌、腭帆张肌未见受侵征象。 双侧翼腭窝、颞下窝未见异常；口咽侧壁未见受累增厚。 蝶骨基底部右份及右侧翼突基底部内侧、右侧翼突内板骨质信号减低，增强扫描不均匀强化。余颅底骨质未见明确异常。 双侧海绵窦形态正常，未见增宽。 双侧筛窦、右侧乳突粘膜增厚，双侧上颌窦、蝶窦、左侧乳突充气良好，骨壁完整；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 右侧咽后见多个肿大淋巴结，最大者短径13mm，增强后明显强化，融合。左侧咽后及双颈II区见多发小淋巴结，最大者短径约7mm，未见坏死及包膜外侵。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺左叶见一结节，大小约11mm×11mm，边界尚清， T1WI及T2WI均呈混杂高信号，增强扫描部分区域强化较明显。甲状腺右叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。；检查结论: 鼻咽病变侵犯右侧咽旁间隙、椎前间隙右份及右侧翼内肌，考虑鼻咽癌可能性大。 蝶骨基底部右份、右侧翼突基底部内侧及右侧翼突内板骨质信号异常，考虑肿瘤浸润可能性大。 右侧咽后肿大淋巴结，考虑转移瘤。 左侧咽后及双颈II区小淋巴结，未排除转移可能。 鼻窦炎；右侧乳突炎。 甲状腺左叶结节灶，建议超声检查。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行鼻咽肿物活检明确病理诊断，并安排全身PET-CT检查\nB. 行鼻咽肿物活检明确病理诊断，并安排全身骨扫描检查\nC. 行颈部淋巴结细针穿刺活检明确病理诊断，并安排甲状腺超声检查\nD. 行鼻咽肿物活检明确病理诊断，并直接安排甲状腺结节细针穿刺活检\nE. 行鼻咽肿物活检明确病理诊断，并安排甲状腺超声检查\nF. 行鼻咽肿物活检明确病理诊断，并安排胸部增强CT检查\nG. 行鼻咽肿物活检明确病理诊断，并安排头颅增强MRI检查\nH. 行鼻咽肿物活检明确病理诊断，并安排甲状腺功能生化检查\nI. 行鼻咽肿物活检明确病理诊断，并安排颈部超声检查\nJ. 行鼻咽肿物活检明确病理诊断，并安排肝脏增强MRI检查\nK. 行鼻咽肿物活检明确病理诊断，并安排甲状腺核素扫描检查\nL. 暂缓活检操作，先行诊断性抗炎治疗两周后复查鼻咽部MRI\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"行鼻咽肿物活检明确病理诊断，并安排全身PET-CT检查","is_gold":false},{"letter":"B","text":"行鼻咽肿物活检明确病理诊断，并安排全身骨扫描检查","is_gold":false},{"letter":"C","text":"行颈部淋巴结细针穿刺活检明确病理诊断，并安排甲状腺超声检查","is_gold":false},{"letter":"D","text":"行鼻咽肿物活检明确病理诊断，并直接安排甲状腺结节细针穿刺活检","is_gold":false},{"letter":"E","text":"行鼻咽肿物活检明确病理诊断，并安排甲状腺超声检查","is_gold":true},{"letter":"F","text":"行鼻咽肿物活检明确病理诊断，并安排胸部增强CT检查","is_gold":false},{"letter":"G","text":"行鼻咽肿物活检明确病理诊断，并安排头颅增强MRI检查","is_gold":false},{"letter":"H","text":"行鼻咽肿物活检明确病理诊断，并安排甲状腺功能生化检查","is_gold":false},{"letter":"I","text":"行鼻咽肿物活检明确病理诊断，并安排颈部超声检查","is_gold":false},{"letter":"J","text":"行鼻咽肿物活检明确病理诊断，并安排肝脏增强MRI检查","is_gold":false},{"letter":"K","text":"行鼻咽肿物活检明确病理诊断，并安排甲状腺核素扫描检查","is_gold":false},{"letter":"L","text":"暂缓活检操作，先行诊断性抗炎治疗两周后复查鼻咽部MRI","is_gold":false}],"gold_letter":"E"},{"sample_id":"sample-bf94c856279752df44d2b5a5","patient_id":"patient-d6812a1c46ed21fda9ebb9f8","turn_id":"turn05","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见: 轻度ST段下移；检查结论: 窦性心律 轻度ST段下移\n- [全程D42] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位置位于第5胸椎体下缘，估计位于上腔静脉上段。；检查结论: PICC管末端位置如上所述。\n- [全程D42] 检验组合: 阴离子间隙(AG)-静脉血: 11；丙氨酸氨基转移酶(ALT)-静脉血: 12.8U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；钠离子(Na+)-静脉血: 143.3mmol/L；总钙(Ca)-静脉血: 2.2mmol/L；总胆红素(TBIL)-静脉血: 8.4umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.3U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.86；C-反应蛋白(CRP)-静脉血: 0.85mg/L；胱抑素(Cys-C)-静脉血: 0.61mg/L；磷(P)-静脉血: 1.14mmol/L；总胆固醇(TC)-静脉血: 4.61mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.292；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；载脂蛋白B(apoB)-静脉血: 0.93g/L；间接胆红素(IBIL)-静脉血: 6.4umolL；甘油三酯(TG)-静脉血: 0.64mmol/L；碱性磷酸酶(ALP)-静脉血: 87.2U/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 2umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；尿酸(UA)-静脉血: 194.8umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.02mmol/L；总胆汁酸(TBA)-静脉血: 2.1umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.96；钾离子(K+)-静脉血: 3.83mmol/L；红细胞比容(Hct)-静脉血: 40.7%；氯离子(Cl-)-静脉血: 107.6mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；肌酐(Crea)-静脉血: 46.2umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.810E9/L；血小板分布宽度(PDW)-静脉血: 10.6%；平均血小板体积(MPV)-静脉血: 9.5fL；白蛋白(ALB)-静脉血: 43.5g/L；尿素氮(BUN)-静脉血: 3.6mmol/L；白细胞计数(WBC#)-静脉血: 6.3110……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D43] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.016；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: 1+ 0.6mg（参考: 阴性）；浊度(TRUB)-尿液: 清亮；葡萄糖(Glu)-尿液: +- 1.7mmol（参考: 阴性）；酸碱度(pH)-尿液: 6.5；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；红细胞计数(RBC#)-尿液: 8/μL；酮体(KET)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 7/μL；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D44] 检验组合: 白蛋白(ALB)-静脉血: 37.7g/L；总胆红素(TBIL)-静脉血: 9umol/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；钠离子(Na+)-静脉血: 133.7mmol/L；直接胆红素(DBIL)-静脉血: 2.1umol/L；总胆汁酸(TBA)-静脉血: 1.4umol/L；尿酸(UA)-静脉血: 164.1umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.6U/L；总蛋白(TP)-静脉血: 58.49g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 23.7U/L；碱性磷酸酶(ALP)-静脉血: 72.8U/L；肌酐(Crea)-静脉血: 44.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.95；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.81；尿素氮(BUN)-静脉血: 4.4mmol/L；磷(P)-静脉血: 0.93mmol/L；总钙(Ca)-静脉血: 2.02mmol/L；乳酸脱氢酶(LDH)-静脉血: 210.9U/L；氯离子(Cl-)-静脉血: 100.2mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 12.3U/L；间接胆红素(IBIL)-静脉血: 6.9umolL；钾离子(K+)-静脉血: 2.94mmol/L；阴离子间隙(AG)-静脉血: 12.1；血液二氧化碳含量ctCO2(B)-静脉血: 21.4mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.3U/L；球蛋白(GLO)-静脉血: 20.79g/L\n- [全程D45] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 1/μL；钠离子(Na+)-静脉血: 131.1mmol/L；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；阴离子间隙(AG)-静脉血: 14.5；浊度(TRUB)-尿液: clear；胆红素(BIL)-尿液: -（参考: 阴性）；镁离子(Mg2+)-静脉血: 0.79mmol/L；钾离子(K+)-静脉血: 3.17mmol/L；红细胞计数(RBC#)-尿液: 17/μL；磷(P)-静脉血: 0.95mmol/L；氯离子(Cl-)-静脉血: 96.2mmol/L；白细胞计数(WBC#)-尿液: 5/μL；总钙(Ca)-静脉血: 1.92mmol/L；颜色-尿液: Light-Yellow；比重(SG)-尿液: 1.011；葡萄糖(Glu)-尿液: 1+ 5.6mmol（参考: 阴性）；隐血(OB)-尿液: +-0.3mg（参考: 阴性）；未分类结晶计数(UNCX#)-尿液: 5/μL；血液二氧化碳含量ctCO2(B)-静脉血: 20.4mmol/L；酸碱度(pH)-尿液: 6.5；尿胆原(URO)-尿液: -（参考: 阴性）\n- [全程D46] 检验组合: 阴离子间隙(AG)-静脉血: 17.7；血液二氧化碳含量ctCO2(B)-静脉血: 19.3mmol/L；氯离子(Cl-)-静脉血: 85.6mmol/L；总钙(Ca)-静脉血: 2.04mmol/L；钠离子(Na+)-静脉血: 122.6mmol/L；钾离子(K+)-静脉血: 3.26mmol/L；镁离子(Mg2+)-静脉血: 0.77mmol/L；磷(P)-静脉血: 0.51mmol/L\n- [全程D47] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 20.9mmol/L；总钙(Ca)-静脉血: 2.12mmol/L；阴离子间隙(AG)-静脉血: 14.5；磷(P)-静脉血: 0.67mmol/L；钾离子(K+)-静脉血: 4.06mmol/L；氯离子(Cl-)-静脉血: 89.8mmol/L；钠离子(Na+)-静脉血: 125.2mmol/L；镁离子(Mg2+)-静脉血: 0.93mmol/L\n- [全程D49] 检验组合: 镁离子(Mg2+)-静脉血: 0.89mmol/L；血小板分布宽度(PDW)-静脉血: 11.2%；有核红细胞百分比(NRBC%)-静脉血: 0；白蛋白(ALB)-静脉血: 44.2g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 33.1U/L；丙氨酸氨基转移酶(ALT)-静脉血: 22.6U/L；葡萄糖(Glu)-静脉血: 5.17mmol/L；间接胆红素(IBIL)-静脉血: 8.9umolL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.09mmolL；载脂蛋白B(apoB)-静脉血: 0.78g/L；总胆汁酸(TBA)-静脉血: 7.4umol/L；磷(P)-静脉血: 0.8mmol/L；肌酐(Crea)-静脉血: 38.9umol/L；甘油三酯(TG)-静脉血: 1.35mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29pg；平均红细胞体积(MCV)-静脉血: 83.3fL；单核细胞计数(Mono#)-静脉血: 0.710E9/L；总胆固醇(TC)-静脉血: 3.61mmol/L；总蛋白(TP)-静脉血: 67.8g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.003；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；总胆红素(TBIL)-静脉血: 12.8umol/L；血小板计数(PLT#)-静脉血: 19410E9/L；血小板比容-静脉血: 20%；天门冬氨酸氨基转移酶(AST)-静脉血: 12.9U/L；阴离子间隙(AG)-静脉血: 14.6；直接胆红素(DBIL)-静脉血: 3.9umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.05mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.2mmol/L；大血小板百分比(P-LCR%)-静脉血: 25.6%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 35.8；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.87；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；C-反应蛋白(CRP)-静脉血: 0.28mg/L；尿酸(UA)-静脉血: 110.7umol/L；单核细胞百分比(Mono%)-静脉血: 0……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D11] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者检查完善，已完成放疗预约，嘱今日出院，按期行放疗前准备及放疗前口腔检查。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 继续静脉滴注氯化钾及氯化钠注射液，暂缓出院继续住院观察。\nB. 停止静脉输液，停用所有补钾药物，拔除PICC导管，安排出院休养。\nC. 停止静脉输液，予以口服氯化钾缓释片，拔除PICC导管，安排出院休养。\nD. 继续静脉滴注氯化钾，行PICC导管常规护理，暂缓出院继续住院观察。\nE. 停止静脉输液，停用所有补钾药物，行PICC导管常规护理，安排出院休养。\nF. 予以静脉推注氯化钾注射液，行PICC导管常规护理，暂缓出院继续住院观察。\nG. 停止静脉输液，予以口服氯化钾缓释片及螺内酯，行PICC导管常规护理，安排出院休养。\nH. 停止静脉输液，予以口服氯化钾缓释片，行PICC导管常规护理，安排出院休养。\nI. 继续静脉滴注氯化钠注射液，予以口服氯化钾缓释片，行PICC导管常规护理，暂缓出院。\nJ. 停止静脉输液，予以口服聚苯乙烯磺酸钙散，行PICC导管常规护理，安排出院休养。\nK. 停止静脉输液，予以静脉泵入氯化钾注射液，行PICC导管常规护理，暂缓出院。\nL. 继续静脉滴注氯化钾及氯化钠注射液，行PICC导管常规护理，带静脉输液装置出院。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"继续静脉滴注氯化钾及氯化钠注射液，暂缓出院继续住院观察。","is_gold":false},{"letter":"B","text":"停止静脉输液，停用所有补钾药物，拔除PICC导管，安排出院休养。","is_gold":false},{"letter":"C","text":"停止静脉输液，予以口服氯化钾缓释片，拔除PICC导管，安排出院休养。","is_gold":false},{"letter":"D","text":"继续静脉滴注氯化钾，行PICC导管常规护理，暂缓出院继续住院观察。","is_gold":false},{"letter":"E","text":"停止静脉输液，停用所有补钾药物，行PICC导管常规护理，安排出院休养。","is_gold":false},{"letter":"F","text":"予以静脉推注氯化钾注射液，行PICC导管常规护理，暂缓出院继续住院观察。","is_gold":false},{"letter":"G","text":"停止静脉输液，予以口服氯化钾缓释片及螺内酯，行PICC导管常规护理，安排出院休养。","is_gold":false},{"letter":"H","text":"停止静脉输液，予以口服氯化钾缓释片，行PICC导管常规护理，安排出院休养。","is_gold":true},{"letter":"I","text":"继续静脉滴注氯化钠注射液，予以口服氯化钾缓释片，行PICC导管常规护理，暂缓出院。","is_gold":false},{"letter":"J","text":"停止静脉输液，予以口服聚苯乙烯磺酸钙散，行PICC导管常规护理，安排出院休养。","is_gold":false},{"letter":"K","text":"停止静脉输液，予以静脉泵入氯化钾注射液，行PICC导管常规护理，暂缓出院。","is_gold":false},{"letter":"L","text":"继续静脉滴注氯化钾及氯化钠注射液，行PICC导管常规护理，带静脉输液装置出院。","is_gold":false}],"gold_letter":"H"},{"sample_id":"sample-9549c3c98f10ace802cbb08b","patient_id":"patient-d6812a1c46ed21fda9ebb9f8","turn_id":"turn06","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见: 轻度ST段下移；检查结论: 窦性心律 轻度ST段下移\n- [全程D42] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位置位于第5胸椎体下缘，估计位于上腔静脉上段。；检查结论: PICC管末端位置如上所述。\n- [全程D42] 检验组合: 阴离子间隙(AG)-静脉血: 11；丙氨酸氨基转移酶(ALT)-静脉血: 12.8U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；钠离子(Na+)-静脉血: 143.3mmol/L；总钙(Ca)-静脉血: 2.2mmol/L；总胆红素(TBIL)-静脉血: 8.4umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.3U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.86；C-反应蛋白(CRP)-静脉血: 0.85mg/L；胱抑素(Cys-C)-静脉血: 0.61mg/L；磷(P)-静脉血: 1.14mmol/L；总胆固醇(TC)-静脉血: 4.61mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.292；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；载脂蛋白B(apoB)-静脉血: 0.93g/L；间接胆红素(IBIL)-静脉血: 6.4umolL；甘油三酯(TG)-静脉血: 0.64mmol/L；碱性磷酸酶(ALP)-静脉血: 87.2U/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；直接胆红素(DBIL)-静脉血: 2umol/L；有核红细胞百分比(NRBC%)-静脉血: 0；尿酸(UA)-静脉血: 194.8umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.02mmol/L；总胆汁酸(TBA)-静脉血: 2.1umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.96；钾离子(K+)-静脉血: 3.83mmol/L；红细胞比容(Hct)-静脉血: 40.7%；氯离子(Cl-)-静脉血: 107.6mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；肌酐(Crea)-静脉血: 46.2umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.810E9/L；血小板分布宽度(PDW)-静脉血: 10.6%；平均血小板体积(MPV)-静脉血: 9.5fL；白蛋白(ALB)-静脉血: 43.5g/L；尿素氮(BUN)-静脉血: 3.6mmol/L；白细胞计数(WBC#)-静脉血: 6.3110……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D43] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.016；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: 1+ 0.6mg（参考: 阴性）；浊度(TRUB)-尿液: 清亮；葡萄糖(Glu)-尿液: +- 1.7mmol（参考: 阴性）；酸碱度(pH)-尿液: 6.5；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；红细胞计数(RBC#)-尿液: 8/μL；酮体(KET)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 7/μL；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D44] 检验组合: 白蛋白(ALB)-静脉血: 37.7g/L；总胆红素(TBIL)-静脉血: 9umol/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；钠离子(Na+)-静脉血: 133.7mmol/L；直接胆红素(DBIL)-静脉血: 2.1umol/L；总胆汁酸(TBA)-静脉血: 1.4umol/L；尿酸(UA)-静脉血: 164.1umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.6U/L；总蛋白(TP)-静脉血: 58.49g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 23.7U/L；碱性磷酸酶(ALP)-静脉血: 72.8U/L；肌酐(Crea)-静脉血: 44.7umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.95；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.81；尿素氮(BUN)-静脉血: 4.4mmol/L；磷(P)-静脉血: 0.93mmol/L；总钙(Ca)-静脉血: 2.02mmol/L；乳酸脱氢酶(LDH)-静脉血: 210.9U/L；氯离子(Cl-)-静脉血: 100.2mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 12.3U/L；间接胆红素(IBIL)-静脉血: 6.9umolL；钾离子(K+)-静脉血: 2.94mmol/L；阴离子间隙(AG)-静脉血: 12.1；血液二氧化碳含量ctCO2(B)-静脉血: 21.4mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.3U/L；球蛋白(GLO)-静脉血: 20.79g/L\n- [全程D45] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 1/μL；钠离子(Na+)-静脉血: 131.1mmol/L；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；阴离子间隙(AG)-静脉血: 14.5；浊度(TRUB)-尿液: clear；胆红素(BIL)-尿液: -（参考: 阴性）；镁离子(Mg2+)-静脉血: 0.79mmol/L；钾离子(K+)-静脉血: 3.17mmol/L；红细胞计数(RBC#)-尿液: 17/μL；磷(P)-静脉血: 0.95mmol/L；氯离子(Cl-)-静脉血: 96.2mmol/L；白细胞计数(WBC#)-尿液: 5/μL；总钙(Ca)-静脉血: 1.92mmol/L；颜色-尿液: Light-Yellow；比重(SG)-尿液: 1.011；葡萄糖(Glu)-尿液: 1+ 5.6mmol（参考: 阴性）；隐血(OB)-尿液: +-0.3mg（参考: 阴性）；未分类结晶计数(UNCX#)-尿液: 5/μL；血液二氧化碳含量ctCO2(B)-静脉血: 20.4mmol/L；酸碱度(pH)-尿液: 6.5；尿胆原(URO)-尿液: -（参考: 阴性）\n- [全程D46] 检验组合: 阴离子间隙(AG)-静脉血: 17.7；血液二氧化碳含量ctCO2(B)-静脉血: 19.3mmol/L；氯离子(Cl-)-静脉血: 85.6mmol/L；总钙(Ca)-静脉血: 2.04mmol/L；钠离子(Na+)-静脉血: 122.6mmol/L；钾离子(K+)-静脉血: 3.26mmol/L；镁离子(Mg2+)-静脉血: 0.77mmol/L；磷(P)-静脉血: 0.51mmol/L\n- [全程D47] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 20.9mmol/L；总钙(Ca)-静脉血: 2.12mmol/L；阴离子间隙(AG)-静脉血: 14.5；磷(P)-静脉血: 0.67mmol/L；钾离子(K+)-静脉血: 4.06mmol/L；氯离子(Cl-)-静脉血: 89.8mmol/L；钠离子(Na+)-静脉血: 125.2mmol/L；镁离子(Mg2+)-静脉血: 0.93mmol/L\n- [全程D49] 检验组合: 镁离子(Mg2+)-静脉血: 0.89mmol/L；血小板分布宽度(PDW)-静脉血: 11.2%；有核红细胞百分比(NRBC%)-静脉血: 0；白蛋白(ALB)-静脉血: 44.2g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 33.1U/L；丙氨酸氨基转移酶(ALT)-静脉血: 22.6U/L；葡萄糖(Glu)-静脉血: 5.17mmol/L；间接胆红素(IBIL)-静脉血: 8.9umolL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.09mmolL；载脂蛋白B(apoB)-静脉血: 0.78g/L；总胆汁酸(TBA)-静脉血: 7.4umol/L；磷(P)-静脉血: 0.8mmol/L；肌酐(Crea)-静脉血: 38.9umol/L；甘油三酯(TG)-静脉血: 1.35mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29pg；平均红细胞体积(MCV)-静脉血: 83.3fL；单核细胞计数(Mono#)-静脉血: 0.710E9/L；总胆固醇(TC)-静脉血: 3.61mmol/L；总蛋白(TP)-静脉血: 67.8g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.003；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；总胆红素(TBIL)-静脉血: 12.8umol/L；血小板计数(PLT#)-静脉血: 19410E9/L；血小板比容-静脉血: 20%；天门冬氨酸氨基转移酶(AST)-静脉血: 12.9U/L；阴离子间隙(AG)-静脉血: 14.6；直接胆红素(DBIL)-静脉血: 3.9umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.05mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.2mmol/L；大血小板百分比(P-LCR%)-静脉血: 25.6%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 35.8；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.87；载脂蛋白AI(apoAI)-静脉血: 1.25g/L；C-反应蛋白(CRP)-静脉血: 0.28mg/L；尿酸(UA)-静脉血: 110.7umol/L；单核细胞百分比(Mono%)-静脉血: 0……\n- [全程D60] 检验组合: α-L-岩藻糖苷酶(AFU)-静脉血: 20.3U/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；总胆固醇(TC)-静脉血: 3.99mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.68；天门冬氨酸氨基转移酶(AST)-静脉血: 11.8U/L；总钙(Ca)-静脉血: 2.22mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.05；有核红细胞计数(NRBC#)-静脉血: 010E9/L；白细胞计数(WBC#)-静脉血: 3.5710E9/L；钾离子(K+)-静脉血: 3.88mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.14；碱性磷酸酶(ALP)-静脉血: 52.6U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.62mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.89mmolL；氯离子(Cl-)-静脉血: 103mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；阴离子间隙(AG)-静脉血: 11；球蛋白(GLO)-静脉血: 22.9g/L；总胆汁酸(TBA)-静脉血: 0.9umol/L；镁离子(Mg2+)-静脉血: 0.9mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336g/L；血红蛋白(Hb)-静脉血: 115g/L；红细胞计数(RBC#)-静脉血: 3.910E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；甘油三酯(TG)-静脉血: 0.63mmol/L；磷(P)-静脉血: 1.02mmol/L；直接胆红素(DBIL)-静脉血: 2.86umol/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；单核细胞百分比(Mono%)-静脉血: 0.101；红细胞比容(Hct)-静脉血: 34.2%；血小板比容-静脉血: 17%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.5pg；平均血小板体积(MPV)-静脉血: 9.5fL；尿酸(UA)-静脉血: 152.4umol/L；肌酐(Crea)-静脉血: 43umol/L；丙氨酸氨基转移酶(ALT……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D11] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者检查完善，已完成放疗预约，嘱今日出院，按期行放疗前准备及放疗前口腔检查。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停化疗，给予重组人粒细胞集落刺激因子升白细胞治疗，待白细胞恢复后继续顺铂化疗。\nB. 暂停化疗，给予3%氯化钠注射液强化纠正低钠血症，待血钠持续稳定正常后再考虑恢复顺铂化疗。\nC. 将化疗方案调整为卡铂单药，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化支持治疗。\nD. 继续顺铂化疗，并给予地塞米松、甲氧氯普胺、奥美拉唑止吐，无需常规静脉水化及补钾。\nE. 继续顺铂化疗，并给予昂丹司琼单药止吐，辅以静脉水化及补钾支持治疗。\nF. 继续顺铂联合5-氟尿嘧啶化疗，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化支持治疗。\nG. 继续顺铂化疗，并给予地塞米松、甲氧氯普胺、奥美拉唑止吐，同时预防性使用重组人粒细胞集落刺激因子。\nH. 终止化疗，仅行单纯放射治疗，并给予静脉水化及营养支持。\nI. 继续顺铂化疗，并给予地塞米松、甲氧氯普胺、奥美拉唑止吐，辅以静脉水化及补钾支持治疗。\nJ. 继续顺铂化疗，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化，同时加用呋塞米强迫利尿且不补钾。\nK. 暂停化疗，给予保肝降酶治疗，待肝功能恢复后继续顺铂化疗。\nL. 将化疗方案调整为紫杉醇单药，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化支持治疗。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"暂停化疗，给予重组人粒细胞集落刺激因子升白细胞治疗，待白细胞恢复后继续顺铂化疗。","is_gold":false},{"letter":"B","text":"暂停化疗，给予3%氯化钠注射液强化纠正低钠血症，待血钠持续稳定正常后再考虑恢复顺铂化疗。","is_gold":false},{"letter":"C","text":"将化疗方案调整为卡铂单药，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化支持治疗。","is_gold":false},{"letter":"D","text":"继续顺铂化疗，并给予地塞米松、甲氧氯普胺、奥美拉唑止吐，无需常规静脉水化及补钾。","is_gold":false},{"letter":"E","text":"继续顺铂化疗，并给予昂丹司琼单药止吐，辅以静脉水化及补钾支持治疗。","is_gold":false},{"letter":"F","text":"继续顺铂联合5-氟尿嘧啶化疗，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化支持治疗。","is_gold":false},{"letter":"G","text":"继续顺铂化疗，并给予地塞米松、甲氧氯普胺、奥美拉唑止吐，同时预防性使用重组人粒细胞集落刺激因子。","is_gold":false},{"letter":"H","text":"终止化疗，仅行单纯放射治疗，并给予静脉水化及营养支持。","is_gold":false},{"letter":"I","text":"继续顺铂化疗，并给予地塞米松、甲氧氯普胺、奥美拉唑止吐，辅以静脉水化及补钾支持治疗。","is_gold":true},{"letter":"J","text":"继续顺铂化疗，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化，同时加用呋塞米强迫利尿且不补钾。","is_gold":false},{"letter":"K","text":"暂停化疗，给予保肝降酶治疗，待肝功能恢复后继续顺铂化疗。","is_gold":false},{"letter":"L","text":"将化疗方案调整为紫杉醇单药，并给予地塞米松、甲氧氯普胺止吐，辅以静脉水化支持治疗。","is_gold":false}],"gold_letter":"I"},{"sample_id":"sample-5acaafa7f13a3c4be08160aa","patient_id":"patient-d6812a1c46ed21fda9ebb9f8","turn_id":"turn07","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见: 轻度ST段下移；检查结论: 窦性心律 轻度ST段下移\n- [全程D60] 检验组合: α-L-岩藻糖苷酶(AFU)-静脉血: 20.3U/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；总胆固醇(TC)-静脉血: 3.99mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.68；天门冬氨酸氨基转移酶(AST)-静脉血: 11.8U/L；总钙(Ca)-静脉血: 2.22mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.05；有核红细胞计数(NRBC#)-静脉血: 010E9/L；白细胞计数(WBC#)-静脉血: 3.5710E9/L；钾离子(K+)-静脉血: 3.88mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.14；碱性磷酸酶(ALP)-静脉血: 52.6U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.62mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.89mmolL；氯离子(Cl-)-静脉血: 103mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；阴离子间隙(AG)-静脉血: 11；球蛋白(GLO)-静脉血: 22.9g/L；总胆汁酸(TBA)-静脉血: 0.9umol/L；镁离子(Mg2+)-静脉血: 0.9mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336g/L；血红蛋白(Hb)-静脉血: 115g/L；红细胞计数(RBC#)-静脉血: 3.910E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；甘油三酯(TG)-静脉血: 0.63mmol/L；磷(P)-静脉血: 1.02mmol/L；直接胆红素(DBIL)-静脉血: 2.86umol/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；单核细胞百分比(Mono%)-静脉血: 0.101；红细胞比容(Hct)-静脉血: 34.2%；血小板比容-静脉血: 17%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.5pg；平均血小板体积(MPV)-静脉血: 9.5fL；尿酸(UA)-静脉血: 152.4umol/L；肌酐(Crea)-静脉血: 43umol/L；丙氨酸氨基转移酶(ALT……\n- [全程D68] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0；有核红细胞计数(NRBC#)-静脉血: 010E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0；大血小板百分比(P-LCR%)-静脉血: 20.1%；尿酸(UA)-静脉血: 120.2umol/L；总胆固醇(TC)-静脉血: 4.11mmol/L；总钙(Ca)-静脉血: 2.22mmol/L；平均红细胞体积(MCV)-静脉血: 84.4fL；单核细胞百分比(Mono%)-静脉血: 0.155；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；淋巴细胞百分比(Lymph%)-静脉血: 0.088；总胆汁酸(TBA)-静脉血: 2.6umol/L；白蛋白(ALB)-静脉血: 40.1g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.22mmolL；总蛋白(TP)-静脉血: 62.7g/L；载脂蛋白AI(apoAI)-静脉血: 1.32g/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.5U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.77；中性粒细胞百分比(Neut%)-静脉血: 0.757；α-L-岩藻糖苷酶(AFU)-静脉血: 42.2U/L；C-反应蛋白(CRP)-静脉血: 0.25mg/L；阴离子间隙(AG)-静脉血: 13.4；肌酐(Crea)-静脉血: 43.4umol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.7；中性粒细胞计数(Neut#)-静脉血: 4.210E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.9U/L；钠离子(Na+)-静脉血: 134mmol/L；单核细胞计数(Mono#)-静脉血: 0.910E9/L；血小板分布宽度(PDW)-静脉血: 10.6%；镁离子(Mg2+)-静脉血: 0.72mmol/L；血小板比容-静脉血: 19%；白细胞计数(WBC#)-静脉血: 5.4810E9/L；胱抑素(Cys-C)-静脉血: 0.92mg/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.3；葡萄糖(Glu)-静脉血: 4.71mmol/L；直接胆红素(DBIL)-静脉血: 2.12umol/L；血红蛋白(Hb)-静脉血: 123g/L；碱性磷酸酶(……\n- [全程D70] 检验组合: 淋巴细胞百分比(Lymph%)-静脉血: 0.097；血小板分布宽度(PDW)-静脉血: 10.4%；白细胞计数(WBC#)-静脉血: 5.3710E9/L；平均血小板体积(MPV)-静脉血: 9.5fL；乳酸脱氢酶(LDH)-静脉血: 191.8U/L；直接胆红素(DBIL)-静脉血: 2.52umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20.6U/L；氯离子(Cl-)-静脉血: 92.5mmol/L；尿素氮(BUN)-静脉血: 5mmol/L；血小板比容-静脉血: 21%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总钙(Ca)-静脉血: 2.25mmol/L；尿酸(UA)-静脉血: 198umol/L；总胆红素(TBIL)-静脉血: 9.15umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 37.3U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.006；中性粒细胞计数(Neut#)-静脉血: 4.110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.77；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；间接胆红素(IBIL)-静脉血: 6.63umolL；碱性磷酸酶(ALP)-静脉血: 58U/L；单核细胞百分比(Mono%)-静脉血: 0.125；载脂蛋白B(apoB)-静脉血: 1.02g/L；C-反应蛋白(CRP)-静脉血: 1.01mg/L；γ-谷氨酰基转移酶(GGT)-静脉血: 27.6U/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.3mmol/L；甘油三酯(TG)-静脉血: 1.4mmol/L；总胆汁酸(TBA)-静脉血: 3.6umol/L；球蛋白(GLO)-静脉血: 24.2g/L；白蛋白(ALB)-静脉血: 41.8g/L；葡萄糖(Glu)-静脉血: 5.35mmol/L；平均红细胞体积(MCV)-静脉血: 83.5fL；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 348g/L；胱抑素(Cys-C)-静脉血: 0.79mg/L；丙氨酸氨基转移酶(ALT)-静脉血: 24U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.88mmol/L；红细……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D77] 检验组合: 总胆红素(TBIL)-静脉血: 9.1umol/L；血小板分布宽度(PDW)-静脉血: 10.7%；乳酸脱氢酶(LDH)-静脉血: 184.4U/L；直接胆红素(DBIL)-静脉血: 2.92umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.9mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 24U/L；总胆固醇(TC)-静脉血: 4.36mmol/L；平均血小板体积(MPV)-静脉血: 9.7fL；白细胞计数(WBC#)-静脉血: 6.0610E9/L；氯离子(Cl-)-静脉血: 97.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 9.2U/L；阴离子间隙(AG)-静脉血: 15.2；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞计数(RBC#)-静脉血: 4.0510E12/L；总胆汁酸(TBA)-静脉血: 1.1umol/L；C-反应蛋白(CRP)-静脉血: 6.66mg/L；磷(P)-静脉血: 1.11mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.012；中性粒细胞百分比(Neut%)-静脉血: 0.799；淋巴细胞计数(Lymph#)-静脉血: 0.410E9/L；总钙(Ca)-静脉血: 2.14mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.03mmol/L；球蛋白(GLO)-静脉血: 22g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.99mmolL；淋巴细胞百分比(Lymph%)-静脉血: 0.064；血小板计数(PLT#)-静脉血: 12010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.2；钾离子(K+)-静脉血: 3.15mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.09；碱性磷酸酶(ALP)-静脉血: 49.9U/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 44.5umol/L；中性粒细胞计数(Neut#)-静脉血: 4.810E9/L；间接胆红素(IBIL)-静脉血: 6.18umolL；尿素氮(BUN)-静脉血: 5.3mmol/L；红细胞体积分布宽度CV(RDW-CV)-……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D79] 超声；双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 双肾大小形态正常，右肾探及几个无回声灶，大者约16×13mm，边界清，内透声可，后方回声增强。左肾实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确肿物回声。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。；检查结论: 右肾多发囊性灶，考虑肾囊肿。 左肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位性病变。\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D66] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者诉恶心，食欲差，于未诉特殊不适，查体基本同前。患者第二程DDP同时期化疗。予加强止呕及营养支持治疗，防治放化毒副反应。续观。\n- [全程D70] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者诉恶心，进食差，余未诉特殊不适，查体基本同前。今日[姓名已隐去]医生信息已隐藏后示：患者已完成第二程DDP同时期化疗，予加强营养支持治疗。一般情况平稳，嘱今日补液结束后出院，于门诊继续放疗。按期返院继续治疗。遵嘱。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 疗效评估为疾病进展，存在低钾血症，暂停放疗，改为单药靶向治疗并静脉补钾。\nB. 疗效评估为放化疗有效，存在低钾血症及进食差，终止同期化疗，仅继续单纯放疗及口服补钾。\nC. 疗效评估为放化疗有效，存在低钾血症，暂停放疗及化疗，待血钾恢复正常后再恢复原方案。\nD. 疗效评估为疾病稳定，存在骨髓抑制，给予重组人血小板生成素并推迟后续化疗。\nE. 疗效评估为放化疗有效，右肾多发囊肿，请泌尿外科急会诊行囊肿穿刺引流，暂缓化疗。\nF. 疗效评估为疾病进展，复查鼻咽 MRI 及全身 PET-CT，更改化疗方案为吉西他滨联合顺铂。\nG. 疗效评估为放化疗有效，进食差，行经皮胃造瘘术进行肠内营养，继续放化疗。\nH. 疗效评估为放化疗有效，存在低钾血症，门诊口服氯化钾缓释片，继续放疗，取消第三程化疗。\nI. 疗效评估为放化疗有效，存在肝功能损害，停用顺铂，改为西妥昔单抗靶向治疗并保肝处理。\nJ. 疗效评估为放化疗有效，予以静脉营养支持及补钾，处理进食差及低钾血症，继续根治性放疗并按期行第三程同期化疗。\nK. 疗效评估为放化疗有效，予以静脉补钾，处理低钾血症，结束同期化疗阶段，后续仅需完成单纯放疗。\nL. 疗效评估为疾病稳定，存在恶心呕吐，预防性给予三联止吐方案，提前结束放疗并转为辅助化疗。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"疗效评估为疾病进展，存在低钾血症，暂停放疗，改为单药靶向治疗并静脉补钾。","is_gold":false},{"letter":"B","text":"疗效评估为放化疗有效，存在低钾血症及进食差，终止同期化疗，仅继续单纯放疗及口服补钾。","is_gold":false},{"letter":"C","text":"疗效评估为放化疗有效，存在低钾血症，暂停放疗及化疗，待血钾恢复正常后再恢复原方案。","is_gold":false},{"letter":"D","text":"疗效评估为疾病稳定，存在骨髓抑制，给予重组人血小板生成素并推迟后续化疗。","is_gold":false},{"letter":"E","text":"疗效评估为放化疗有效，右肾多发囊肿，请泌尿外科急会诊行囊肿穿刺引流，暂缓化疗。","is_gold":false},{"letter":"F","text":"疗效评估为疾病进展，复查鼻咽 MRI 及全身 PET-CT，更改化疗方案为吉西他滨联合顺铂。","is_gold":false},{"letter":"G","text":"疗效评估为放化疗有效，进食差，行经皮胃造瘘术进行肠内营养，继续放化疗。","is_gold":false},{"letter":"H","text":"疗效评估为放化疗有效，存在低钾血症，门诊口服氯化钾缓释片，继续放疗，取消第三程化疗。","is_gold":false},{"letter":"I","text":"疗效评估为放化疗有效，存在肝功能损害，停用顺铂，改为西妥昔单抗靶向治疗并保肝处理。","is_gold":false},{"letter":"J","text":"疗效评估为放化疗有效，予以静脉营养支持及补钾，处理进食差及低钾血症，继续根治性放疗并按期行第三程同期化疗。","is_gold":true},{"letter":"K","text":"疗效评估为放化疗有效，予以静脉补钾，处理低钾血症，结束同期化疗阶段，后续仅需完成单纯放疗。","is_gold":false},{"letter":"L","text":"疗效评估为疾病稳定，存在恶心呕吐，预防性给予三联止吐方案，提前结束放疗并转为辅助化疗。","is_gold":false}],"gold_letter":"J"},{"sample_id":"sample-47e9b2e315a805773d669325","patient_id":"patient-d6812a1c46ed21fda9ebb9f8","turn_id":"turn08","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见: 轻度ST段下移；检查结论: 窦性心律 轻度ST段下移\n- [全程D68] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0；有核红细胞计数(NRBC#)-静脉血: 010E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0；大血小板百分比(P-LCR%)-静脉血: 20.1%；尿酸(UA)-静脉血: 120.2umol/L；总胆固醇(TC)-静脉血: 4.11mmol/L；总钙(Ca)-静脉血: 2.22mmol/L；平均红细胞体积(MCV)-静脉血: 84.4fL；单核细胞百分比(Mono%)-静脉血: 0.155；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；淋巴细胞百分比(Lymph%)-静脉血: 0.088；总胆汁酸(TBA)-静脉血: 2.6umol/L；白蛋白(ALB)-静脉血: 40.1g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.22mmolL；总蛋白(TP)-静脉血: 62.7g/L；载脂蛋白AI(apoAI)-静脉血: 1.32g/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.5U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.77；中性粒细胞百分比(Neut%)-静脉血: 0.757；α-L-岩藻糖苷酶(AFU)-静脉血: 42.2U/L；C-反应蛋白(CRP)-静脉血: 0.25mg/L；阴离子间隙(AG)-静脉血: 13.4；肌酐(Crea)-静脉血: 43.4umol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.7；中性粒细胞计数(Neut#)-静脉血: 4.210E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.9U/L；钠离子(Na+)-静脉血: 134mmol/L；单核细胞计数(Mono#)-静脉血: 0.910E9/L；血小板分布宽度(PDW)-静脉血: 10.6%；镁离子(Mg2+)-静脉血: 0.72mmol/L；血小板比容-静脉血: 19%；白细胞计数(WBC#)-静脉血: 5.4810E9/L；胱抑素(Cys-C)-静脉血: 0.92mg/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.3；葡萄糖(Glu)-静脉血: 4.71mmol/L；直接胆红素(DBIL)-静脉血: 2.12umol/L；血红蛋白(Hb)-静脉血: 123g/L；碱性磷酸酶(……\n- [全程D70] 检验组合: 淋巴细胞百分比(Lymph%)-静脉血: 0.097；血小板分布宽度(PDW)-静脉血: 10.4%；白细胞计数(WBC#)-静脉血: 5.3710E9/L；平均血小板体积(MPV)-静脉血: 9.5fL；乳酸脱氢酶(LDH)-静脉血: 191.8U/L；直接胆红素(DBIL)-静脉血: 2.52umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20.6U/L；氯离子(Cl-)-静脉血: 92.5mmol/L；尿素氮(BUN)-静脉血: 5mmol/L；血小板比容-静脉血: 21%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总钙(Ca)-静脉血: 2.25mmol/L；尿酸(UA)-静脉血: 198umol/L；总胆红素(TBIL)-静脉血: 9.15umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 37.3U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.006；中性粒细胞计数(Neut#)-静脉血: 4.110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.77；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；间接胆红素(IBIL)-静脉血: 6.63umolL；碱性磷酸酶(ALP)-静脉血: 58U/L；单核细胞百分比(Mono%)-静脉血: 0.125；载脂蛋白B(apoB)-静脉血: 1.02g/L；C-反应蛋白(CRP)-静脉血: 1.01mg/L；γ-谷氨酰基转移酶(GGT)-静脉血: 27.6U/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.3mmol/L；甘油三酯(TG)-静脉血: 1.4mmol/L；总胆汁酸(TBA)-静脉血: 3.6umol/L；球蛋白(GLO)-静脉血: 24.2g/L；白蛋白(ALB)-静脉血: 41.8g/L；葡萄糖(Glu)-静脉血: 5.35mmol/L；平均红细胞体积(MCV)-静脉血: 83.5fL；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 348g/L；胱抑素(Cys-C)-静脉血: 0.79mg/L；丙氨酸氨基转移酶(ALT)-静脉血: 24U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.88mmol/L；红细……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D77] 检验组合: 总胆红素(TBIL)-静脉血: 9.1umol/L；血小板分布宽度(PDW)-静脉血: 10.7%；乳酸脱氢酶(LDH)-静脉血: 184.4U/L；直接胆红素(DBIL)-静脉血: 2.92umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 24.9mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 24U/L；总胆固醇(TC)-静脉血: 4.36mmol/L；平均血小板体积(MPV)-静脉血: 9.7fL；白细胞计数(WBC#)-静脉血: 6.0610E9/L；氯离子(Cl-)-静脉血: 97.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 9.2U/L；阴离子间隙(AG)-静脉血: 15.2；平均红细胞血红蛋白含量(MCH)-静脉血: 29.1pg；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞计数(RBC#)-静脉血: 4.0510E12/L；总胆汁酸(TBA)-静脉血: 1.1umol/L；C-反应蛋白(CRP)-静脉血: 6.66mg/L；磷(P)-静脉血: 1.11mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.012；中性粒细胞百分比(Neut%)-静脉血: 0.799；淋巴细胞计数(Lymph#)-静脉血: 0.410E9/L；总钙(Ca)-静脉血: 2.14mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.03mmol/L；球蛋白(GLO)-静脉血: 22g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.99mmolL；淋巴细胞百分比(Lymph%)-静脉血: 0.064；血小板计数(PLT#)-静脉血: 12010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.2；钾离子(K+)-静脉血: 3.15mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.09；碱性磷酸酶(ALP)-静脉血: 49.9U/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 44.5umol/L；中性粒细胞计数(Neut#)-静脉血: 4.810E9/L；间接胆红素(IBIL)-静脉血: 6.18umolL；尿素氮(BUN)-静脉血: 5.3mmol/L；红细胞体积分布宽度CV(RDW-CV)-……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D79] 超声；双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 双肾大小形态正常，右肾探及几个无回声灶，大者约16×13mm，边界清，内透声可，后方回声增强。左肾实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确肿物回声。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。；检查结论: 右肾多发囊性灶，考虑肾囊肿。 左肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位性病变。\n- [全程D80] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌放疗后，对比某次就诊时间日MR： 鼻咽腔狭窄，鼻咽顶壁、顶后壁、右侧壁明显增厚，并见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化，肿物占据右侧咽隐窝。鼻咽左侧壁未见增厚，左侧咽隐窝正常，左侧咽旁及颈动脉鞘区未见异常。双侧鼻腔及口咽各壁未见异常。 右侧腭帆张提肌、右侧头长肌及右侧翼内肌受侵，病变包绕右侧颈内动静脉。 左侧腭帆提肌、腭帆张肌、头长肌未见受侵征象。 双侧翼腭窝、颞下窝未见异常；口咽侧壁未见增厚。 蝶骨基底部右份及右侧翼突基底部内侧、右侧翼突内板骨质信号减低，增强扫描不均匀强化。余颅底骨质未见明确异常。双侧海绵窦形态正常，未见增宽。 双侧筛窦、上颌窦、蝶窦及双侧乳突粘膜增厚，可见大量分泌物，骨壁完整；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 右侧咽后见多个肿大淋巴结，最大者短径9mm，增强后明显强化，融合。左侧咽后及双颈II区见多发小淋巴结，最大者短径约7mm，未见坏死及包膜外侵。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺左叶见一结节，大小约11mm×11mm，边界尚清， T1WI及T2WI均呈混杂高信号，增强扫描部分区域强化较明显。甲状腺右叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。；检查结论: 鼻咽癌放疗后，右侧咽旁见肿瘤残留，病变范围较前缩小。 颅底骨质破坏，范围大致同前。 右侧咽后肿大淋巴结，考虑转移，较前缩小。 左侧咽后及双颈II区小淋巴结，较前未见明显变化。 鼻窦炎；乳突炎，较前明显。 甲状腺左叶结节灶，大致同前。\n- [全程D80] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理稍粗，走行自然，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显病变。\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D66] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者诉恶心，食欲差，于未诉特殊不适，查体基本同前。患者第二程DDP同时期化疗。予加强止呕及营养支持治疗，防治放化毒副反应。续观。\n- [全程D70] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者诉恶心，进食差，余未诉特殊不适，查体基本同前。今日[姓名已隐去]医生信息已隐藏后示：患者已完成第二程DDP同时期化疗，予加强营养支持治疗。一般情况平稳，嘱今日补液结束后出院，于门诊继续放疗。按期返院继续治疗。遵嘱。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 疗效评估为疾病进展（PD），终止放化疗计划，改行鼻咽及颈部挽救性手术切除。\nB. 疗效评估为疾病进展（PD），停用顺铂，更改化疗方案为吉西他滨联合氟尿嘧啶并继续放疗。\nC. 疗效评估为部分缓解（PR），继续完成根治性放疗，对鼻咽及颈部残留病灶局部加量至76Gy。\nD. 疗效评估为部分缓解（PR），继续完成根治性放疗，取消后续化疗计划，仅予口服补钾与营养支持。\nE. 疗效评估为部分缓解（PR），继续完成根治性放疗及既定化疗计划，并加用尼妥珠单抗靶向治疗。\nF. 疗效评估为完全缓解（CR），提前终止放疗与化疗，拔除静脉通道，转入定期门诊随访观察阶段。\nG. 疗效评估为部分缓解（PR），继续完成根治性放疗，并行局部清扫术，处理右侧咽旁及咽后残留病灶。\nH. 疗效评估为疾病稳定（SD），继续放疗，并联合PD-1抑制剂以增强局部控制与全身抗肿瘤反应。\nI. 疗效评估为部分缓解（PR），暂停放疗优先纠正低钾血症与营养不良，待电解质完全恢复后重启放疗。\nJ. 疗效评估为部分缓解（PR），继续完成根治性放疗及既定化疗计划，无需特殊支持治疗，定期复查即可。\nK. 疗效评估为部分缓解（PR），继续完成根治性放疗及既定化疗计划，并加强静脉营养支持与补钾等对症处理。\nL. 疗效评估为疾病稳定（SD），继续完成根治性放疗，将后续化疗方案调整为紫杉醇联合卡铂以克服耐药。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"疗效评估为疾病进展（PD），终止放化疗计划，改行鼻咽及颈部挽救性手术切除。","is_gold":false},{"letter":"B","text":"疗效评估为疾病进展（PD），停用顺铂，更改化疗方案为吉西他滨联合氟尿嘧啶并继续放疗。","is_gold":false},{"letter":"C","text":"疗效评估为部分缓解（PR），继续完成根治性放疗，对鼻咽及颈部残留病灶局部加量至76Gy。","is_gold":false},{"letter":"D","text":"疗效评估为部分缓解（PR），继续完成根治性放疗，取消后续化疗计划，仅予口服补钾与营养支持。","is_gold":false},{"letter":"E","text":"疗效评估为部分缓解（PR），继续完成根治性放疗及既定化疗计划，并加用尼妥珠单抗靶向治疗。","is_gold":false},{"letter":"F","text":"疗效评估为完全缓解（CR），提前终止放疗与化疗，拔除静脉通道，转入定期门诊随访观察阶段。","is_gold":false},{"letter":"G","text":"疗效评估为部分缓解（PR），继续完成根治性放疗，并行局部清扫术，处理右侧咽旁及咽后残留病灶。","is_gold":false},{"letter":"H","text":"疗效评估为疾病稳定（SD），继续放疗，并联合PD-1抑制剂以增强局部控制与全身抗肿瘤反应。","is_gold":false},{"letter":"I","text":"疗效评估为部分缓解（PR），暂停放疗优先纠正低钾血症与营养不良，待电解质完全恢复后重启放疗。","is_gold":false},{"letter":"J","text":"疗效评估为部分缓解（PR），继续完成根治性放疗及既定化疗计划，无需特殊支持治疗，定期复查即可。","is_gold":false},{"letter":"K","text":"疗效评估为部分缓解（PR），继续完成根治性放疗及既定化疗计划，并加强静脉营养支持与补钾等对症处理。","is_gold":true},{"letter":"L","text":"疗效评估为疾病稳定（SD），继续完成根治性放疗，将后续化疗方案调整为紫杉醇联合卡铂以克服耐药。","is_gold":false}],"gold_letter":"K"}]}
+{"patient_id":"patient-eecadcdf172a1efe8947b052","bootstrap_cluster_id":"cluster-012","turns":[{"sample_id":"sample-7a40e0f2bd95183560f7b041","patient_id":"patient-eecadcdf172a1efe8947b052","turn_id":"turn01","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N1，M0。\n综合TNM状态：T4N1M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D7] 入院记录: 主诉: 头痛伴耳鸣、听力下降3月余。；颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。今患者为进一步诊治，予收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,双咽后淋巴结肿大,头痛；既往史: 否认\"乙肝、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认饮酒史。否认不洁性生活史。；家族史: 患者叔叔因肺癌死亡。；体格检查: T：36.2℃，P：82次/分，R：20次/分，BP：128/74mmHg,Ht：172cm，Wt：80kg，BSA：1.92m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无叩痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约1cm*0.8cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 直接安排根治性同步放化疗，暂缓病理活检及血液学检查\nB. 行鼻咽及颈部增强CT评估局部病变，暂缓病理活检及血液学检查\nC. 行颈部淋巴结切除活检明确病理，并完善全身PET-CT及基线血液学检查\nD. 行鼻咽镜下活检明确病理，并直接开始诱导化疗，暂缓基线血液学检查\nE. 抽血查EBV-DNA及肿瘤标志物，若阳性则直接开始根治性放疗\nF. 行全身骨扫描及头颅增强MRI，待排除远处转移后再行鼻咽局部活检\nG. 行鼻咽镜下活检明确病理，并预防性行双侧颈部淋巴结清扫术\nH. 行鼻咽镜下活检明确病理，并抽血查血常规、生化、EBV-DNA等基线指标\nI. 行鼻咽脱落细胞学检查明确病理，并抽血查血常规、生化、EBV-DNA等基线指标\nJ. 行胸腹部增强CT及全身骨扫描，待排除远处转移后再行鼻咽活检及血液学检查\nK. 行鼻咽镜下活检明确病理，并立即给予大剂量甲氨蝶呤静脉化疗\nL. 行颈部淋巴结细针穿刺活检明确病理，并抽血查血常规、生化、EBV-DNA等基线指标\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"直接安排根治性同步放化疗，暂缓病理活检及血液学检查","is_gold":false},{"letter":"B","text":"行鼻咽及颈部增强CT评估局部病变，暂缓病理活检及血液学检查","is_gold":false},{"letter":"C","text":"行颈部淋巴结切除活检明确病理，并完善全身PET-CT及基线血液学检查","is_gold":false},{"letter":"D","text":"行鼻咽镜下活检明确病理，并直接开始诱导化疗，暂缓基线血液学检查","is_gold":false},{"letter":"E","text":"抽血查EBV-DNA及肿瘤标志物，若阳性则直接开始根治性放疗","is_gold":false},{"letter":"F","text":"行全身骨扫描及头颅增强MRI，待排除远处转移后再行鼻咽局部活检","is_gold":false},{"letter":"G","text":"行鼻咽镜下活检明确病理，并预防性行双侧颈部淋巴结清扫术","is_gold":false},{"letter":"H","text":"行鼻咽镜下活检明确病理，并抽血查血常规、生化、EBV-DNA等基线指标","is_gold":true},{"letter":"I","text":"行鼻咽脱落细胞学检查明确病理，并抽血查血常规、生化、EBV-DNA等基线指标","is_gold":false},{"letter":"J","text":"行胸腹部增强CT及全身骨扫描，待排除远处转移后再行鼻咽活检及血液学检查","is_gold":false},{"letter":"K","text":"行鼻咽镜下活检明确病理，并立即给予大剂量甲氨蝶呤静脉化疗","is_gold":false},{"letter":"L","text":"行颈部淋巴结细针穿刺活检明确病理，并抽血查血常规、生化、EBV-DNA等基线指标","is_gold":false}],"gold_letter":"H"},{"sample_id":"sample-fd63f0707132f4eb9174ab3e","patient_id":"patient-eecadcdf172a1efe8947b052","turn_id":"turn02","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N1，M0。\n综合TNM状态：T4N1M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 暂无可展示的初诊主诉/入院资料。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 早期复极改变\n- [全程D0] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.6；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:20（参考: 阴性）；活化部分凝血活酶时间(APTT)-静脉血: 23.1sec.；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；血红蛋白(Hb)-静脉血: 158g/L；血小板比容-静脉血: 26%；氯离子(Cl-)-静脉血: 105.3mmol/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 1.04；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；尿酸(UA)-静脉血: 341umol/L；甘油三酯(TG)-静脉血: 1.27mmol/L；总蛋白(TP)-静脉血: 73.53g/L；尿素氮(BUN)-静脉血: 6.35mmol/L；C-反应蛋白(CRP)-静脉血: 1.45mg/L；载脂蛋白B(apoB)-静脉血: 0.8g/L；总胆汁酸(TBA)-静脉血: 4.7umol/L；葡萄糖(Glu)-静脉血: 4.78mmol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；乳酸脱氢酶(LDH)-静脉血: 160.3U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；大血小板百分比(P-LCR%)-静脉血: 30.4%；中性粒细胞计数(Neut#)-静脉血: 6.410E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；丙氨酸氨基转移酶(ALT)-静脉血: 12.1U/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；ABO血型-静脉血: B；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.7fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；球蛋白(GLO)-静脉血: 28.23g/L；凝血酶时间(TT)-静脉血: 17.5sec.；红细胞计数(RBC#)-静脉血: 5.3710E12/L；平均红细胞体积(MCV)-静脉血: 87fL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.17mmolL；磷(P)-静脉血: 1.03mmol/L；总钙(Ca)-……\n- [全程D3] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理稍粗，未见明确实质性病变。双侧肺门不大，纵隔居中、无增宽。双膈形态正常。双侧肋膈角锐利。心影形态、大小、位置未见异常。；检查结论: 心肺未见明显异常。\n- [全程D3] 超声；双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约11cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约37×31×26mm，包膜光滑，实质回声不均匀，可见强回声斑。 腹主动脉旁未见明确肿物回声。；检查结论: 前列腺钙化。 肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、左侧壁见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强后明显强化，肿物占据鼻咽顶壁、左侧咽隐窝、左侧咽后间隙，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，右侧咽隐窝变浅，右侧咽旁脂肪间隙及颈动脉鞘区未见异常。 左侧腭帆张提肌及左侧头长肌受侵，右侧腭帆提肌、腭帆张肌、头长肌未见受侵征象。 双侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽双侧壁未见增厚。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部、翼突内外板、左侧枕骨基底部及左侧枕骨髁骨质信号减低，增强扫描后明显强化，斜坡局部见不规则软组织肿物影累及斜坡后份脑膜及蝶鞍后份，部分层面与垂体后叶分界欠清。双侧海绵窦形态正常，未见增宽。筛窦、蝶窦、左侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 左侧咽后间隙见肿大淋巴结，大小约为11mm ×9 mm，右侧咽后见肿大淋巴结，短径约6mm，均匀强化。 双颈I、II区见多个淋巴结，边界清，信号均匀，最大短径约8mm，均匀强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。 颅底骨质破坏。 双侧咽后淋巴结肿大，考虑转移。 双颈Ib、II区小淋巴结，性质待定。 副鼻窦炎、左侧乳突炎。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 明确临床分期为T3N1M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。\nB. 明确临床分期为T4N2M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。\nC. 明确临床分期为T4N1M0，并直接安排鼻咽及颈部根治性放疗，暂不留置静脉导管。\nD. 明确临床分期为T4N1M0，并安排全身PET-CT以进一步明确双颈部淋巴结性质。\nE. 明确临床分期为T4N0M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。\nF. 明确临床分期为T3N2M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。\nG. 明确临床分期为T4N1M0，并安排垂体MRI动态增强扫描以明确垂体受累情况。\nH. 明确临床分期为T4N1M0，并安排颈部淋巴结穿刺活检以明确N分期。\nI. 明确临床分期为T4N1M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。\nJ. 明确临床分期为T4N1M0，并安排骨扫描及头颅CT以排除远处转移。\nK. 明确临床分期为T4N1M0，并安排鼻咽肿物再次活检以进行EBV相关基因检测。\nL. 明确临床分期为T4N1M0，并留置CVC导管及行胸部CT确认管端位置，为后续静脉给药做准备。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"明确临床分期为T3N1M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。","is_gold":false},{"letter":"B","text":"明确临床分期为T4N2M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。","is_gold":false},{"letter":"C","text":"明确临床分期为T4N1M0，并直接安排鼻咽及颈部根治性放疗，暂不留置静脉导管。","is_gold":false},{"letter":"D","text":"明确临床分期为T4N1M0，并安排全身PET-CT以进一步明确双颈部淋巴结性质。","is_gold":false},{"letter":"E","text":"明确临床分期为T4N0M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。","is_gold":false},{"letter":"F","text":"明确临床分期为T3N2M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。","is_gold":false},{"letter":"G","text":"明确临床分期为T4N1M0，并安排垂体MRI动态增强扫描以明确垂体受累情况。","is_gold":false},{"letter":"H","text":"明确临床分期为T4N1M0，并安排颈部淋巴结穿刺活检以明确N分期。","is_gold":false},{"letter":"I","text":"明确临床分期为T4N1M0，并留置PICC管及行静脉插管DR照片，为后续静脉给药做准备。","is_gold":true},{"letter":"J","text":"明确临床分期为T4N1M0，并安排骨扫描及头颅CT以排除远处转移。","is_gold":false},{"letter":"K","text":"明确临床分期为T4N1M0，并安排鼻咽肿物再次活检以进行EBV相关基因检测。","is_gold":false},{"letter":"L","text":"明确临床分期为T4N1M0，并留置CVC导管及行胸部CT确认管端位置，为后续静脉给药做准备。","is_gold":false}],"gold_letter":"I"},{"sample_id":"sample-1a0c7a960fe6a9b60533da3d","patient_id":"patient-eecadcdf172a1efe8947b052","turn_id":"turn05","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N1，M0。\n综合TNM状态：T4N1M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D7] 入院记录: 主诉: 头痛伴耳鸣、听力下降3月余。；现病史: 患者于某次就诊时间1月无明显诱因下出现头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，患者于至[机构已隐去]就诊，行鼻咽活检病理，并送我院病理会诊示鼻咽分化型非角化性癌。某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。今患者为进一步诊治，予收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,双咽后淋巴结肿大,头痛；既往史: 否认\"乙肝、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认饮酒史。否认不洁性生活史。；家族史: 患者叔叔因肺癌死亡。；体格检查: T：36.2℃，P：82次/分，R：20次/分，BP：128/74mmHg,Ht：172cm，Wt：80kg，BSA：1.92m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率82次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无叩痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约1cm*0.8cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 早期复极改变\n- [全程D0] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.6；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:20（参考: 阴性）；活化部分凝血活酶时间(APTT)-静脉血: 23.1sec.；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；血红蛋白(Hb)-静脉血: 158g/L；血小板比容-静脉血: 26%；氯离子(Cl-)-静脉血: 105.3mmol/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 1.04；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；尿酸(UA)-静脉血: 341umol/L；甘油三酯(TG)-静脉血: 1.27mmol/L；总蛋白(TP)-静脉血: 73.53g/L；尿素氮(BUN)-静脉血: 6.35mmol/L；C-反应蛋白(CRP)-静脉血: 1.45mg/L；载脂蛋白B(apoB)-静脉血: 0.8g/L；总胆汁酸(TBA)-静脉血: 4.7umol/L；葡萄糖(Glu)-静脉血: 4.78mmol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；乳酸脱氢酶(LDH)-静脉血: 160.3U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；大血小板百分比(P-LCR%)-静脉血: 30.4%；中性粒细胞计数(Neut#)-静脉血: 6.410E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；丙氨酸氨基转移酶(ALT)-静脉血: 12.1U/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；ABO血型-静脉血: B；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.7fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；球蛋白(GLO)-静脉血: 28.23g/L；凝血酶时间(TT)-静脉血: 17.5sec.；红细胞计数(RBC#)-静脉血: 5.3710E12/L；平均红细胞体积(MCV)-静脉血: 87fL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.17mmolL；磷(P)-静脉血: 1.03mmol/L；总钙(Ca)-……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D3] 超声；双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 双肾、输尿管、膀胱（前列腺）彩超(套);腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约11cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约37×31×26mm，包膜光滑，实质回声不均匀，可见强回声斑。 腹主动脉旁未见明确肿物回声。；检查结论: 前列腺钙化。 肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D5] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、左侧壁见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强后明显强化，肿物占据鼻咽顶壁、左侧咽隐窝、左侧咽后间隙，推移左侧咽旁脂肪间隙及颈动脉鞘区血管，右侧咽隐窝变浅，右侧咽旁脂肪间隙及颈动脉鞘区未见异常。 左侧腭帆张提肌及左侧头长肌受侵，右侧腭帆提肌、腭帆张肌、头长肌未见受侵征象。 双侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽双侧壁未见增厚。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部、翼突内外板、左侧枕骨基底部及左侧枕骨髁骨质信号减低，增强扫描后明显强化，斜坡局部见不规则软组织肿物影累及斜坡后份脑膜及蝶鞍后份，部分层面与垂体后叶分界欠清。双侧海绵窦形态正常，未见增宽。筛窦、蝶窦、左侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 左侧咽后间隙见肿大淋巴结，大小约为11mm ×9 mm，右侧咽后见肿大淋巴结，短径约6mm，均匀强化。 双颈I、II区见多个淋巴结，边界清，信号均匀，最大短径约8mm，均匀强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。 颅底骨质破坏。 双侧咽后淋巴结肿大，考虑转移。 双颈Ib、II区小淋巴结，性质待定。 副鼻窦炎、左侧乳突炎。\n- [全程D7] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；载脂蛋白AI(apoAI)-静脉血: 1.41g/L；总蛋白(TP)-静脉血: 72.8g/L；肌酐(Crea)-静脉血: 96.4umol/L；总胆红素(TBIL)-静脉血: 10.3umol/L；血小板比容-静脉血: 26%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；尿素氮(BUN)-静脉血: 5.6mmol/L；白细胞计数(WBC#)-尿液: 1/μL；钠离子(Na+)-静脉血: 140.2mmol/L；颜色-尿液: Light-Yellow；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.2mmolL；C-反应蛋白(CRP)-静脉血: 1.6mg/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；乳酸脱氢酶(LDH)-静脉血: 148.2U/L；总胆固醇(TC)-静脉血: 4.78mmol/L；总蛋白(TP)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 5/μL；平均血小板体积(MPV)-静脉血: 10.8fL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 345g/L；总钙(Ca)-静脉血: 2.34mmol/L；甘油三酯(TG)-静脉血: 1.84mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.34；胱抑素(Cys-C)-静脉血: 0.97mg/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.8U/L；红细胞计数(RBC#)-静脉血: 5.3810E12/L；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；单核细胞百分比(Mono%)-静脉血: 0.065；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.76；血液二氧化碳含量ctCO2(B)-静脉血: 24.3mmol/L；红细胞计数(RBC#)-尿液: 4/μL；间接胆红素(IBIL)-静脉血: 7umolL；浊度(TRUB)-尿液: clear；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.026；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；血小板计数(PLT#)-静脉血: 24610E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；颜色-粪便: 棕色；载脂蛋白……\n- [全程D11] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于第7胸椎椎体右侧水平，估计导管末端位于上腔静脉中-下段交界处。；检查结论: 导管末端位置如上述。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D14] 检验组合: α-L-岩藻糖苷酶(AFU)-静脉血: 38.9U/L；载脂蛋白AI(apoAI)-静脉血: 1.64g/L；血红蛋白(Hb)-静脉血: 158g/L；有核红细胞百分比(NRBC%)-静脉血: 0；促黄体生成素(LH)-静脉血: 6.12mIU/ml；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.87mmol/L；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 弱阳性(±)（参考: 阴性）；天门冬氨酸氨基转移酶(AST)-静脉血: 17.6U/L；总胆汁酸(TBA)-静脉血: 1umol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.4pg；大血小板百分比(P-LCR%)-静脉血: 35.7%；胱抑素(Cys-C)-静脉血: 1.56mg/L；白蛋白(ALB)-静脉血: 45.2g/L；甘油三酯(TG)-静脉血: 1.3mmol/L；白细胞计数(WBC#)-静脉血: 9.310E9/L；红细胞计数(RBC#)-静脉血: 5.3710E12/L；单核细胞百分比(Mono%)-静脉血: 0.008；中性粒细胞计数(Neut#)-静脉血: 8.710E9/L；乳酸脱氢酶(LDH)-静脉血: 181.6U/L；总蛋白(TP)-静脉血: 70.8g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.9mmolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.02；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；催乳素(PRL)-静脉血: 308.5uIU/ml；中性粒细胞百分比(Neut%)-静脉血: 0.939；有核红细胞计数(NRBC#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 33.6；促卵泡刺激素(FSH)-静脉血: 9.93mIU/ml；钾离子(K+)-静脉血: 4.53mmol/L；镁离子(Mg2+)-静脉血: 0.89mmol/L；平均血小板体积(MPV)-静脉血: 11.3fL；碱性磷酸酶(ALP)-静脉血: 87.4U/L；总胆红素(TBIL)-静脉血: 22.5umol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=1.50)（参考: 阴性）；尿酸(UA)-静脉血: 385.9umol/L；EB……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- [全程D7] 首次病程记录；首次病程记录: 病程类型: 首次病程记录；病程主题: 首次病程记录；病程内容: 病历特点：1、患者中年男性。2、患者于某次就诊时间1月无明显诱因下出现头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，患者于至[机构已隐去]就诊，行鼻咽活检病理，并送我院病理会诊示鼻咽分化型非角化性癌。某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。现患者为进一步诊治，予收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。3、体查：张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约1cm*0.8cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）示图：4、辅助检查：（1） 某次就诊时间在我医院（病理号：[记录编号已隐去]）鼻咽活检病理示：（鼻咽肿物）镜检为分化型非角化性癌（2） 某次就诊时间在我院胸片检查：心肺未见异常。（3） 某次就诊时间在我院腹部B超检查：肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。（4） 某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。副鼻窦炎、左侧乳突炎。（6）某次就诊时间我院：VCA-IgA 1:160 EA-IgA 1:20EBV-DNA定性检测：2.14E102copy/ml。 诊断依据： 初步诊断： 鉴别诊断：患者诊断明确，无需鉴别诊断。 诊疗计划：1、完善相关检查如全身骨扫描、血常规、生化等。2、诱导化疗及同期化放疗。\n- [全程D8] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者诉间有头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，无面麻、声嘶。[姓名已隐去]医生信息已隐藏示：嘱患者今日完善全身骨扫描检查，排除骨转移征象，治疗上暂给予对症处理，继续观察病情。\n- [全程D9] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日患者症状体征基本同前，无诉其余特殊不适。[姓名已隐去]医生信息已隐藏后指示：某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，最大短径约8mm，均匀强化。骨ECT示鼻咽部、颅底骨代谢较活跃，考虑NPC所致。胸片、腹部B超排除远处转移。故目前临床诊断明确为“鼻咽分化型非角化性癌[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)，治疗方案定为TPF（多西紫杉醇 60mg/m2 + 顺铂 60mg/m2 + 5-FU 2.5g/m2， q21d）诱导化疗3程后再行同期放化疗，放疗采用IMRT技术，同期化疗采用顺铂 60mg/m2（q21d）2程。并指示化疗期间给予护肝、护胃、止吐及营养支持治疗。已向患者及家属交代病情及治疗相关不良反应后，其表示理解，并同意上述治疗方案。拟明日开始行多西紫杉醇化疗，密切观察患者病情变化。\n- [全程D12] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 患者今日TPF方案化疗第3天，现一般情况可，未诉恶心、呕吐、腹痛、腹泻等不适，大小便正常。[姓名已隐去]医生信息已隐藏出，患者目前一般情况可，可继续化疗。注意化疗结束后复查血、生化常规，及时对症处理。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 停止本周期化疗，给予粒细胞集落刺激因子及抗感染支持治疗，并完善脑垂体激素五项检查。\nB. 继续本周期化疗，给予止吐、护肝及静脉营养等支持治疗，并完善甲状腺功能及皮质醇检查。\nC. 停止本周期化疗，给予大剂量水化、碱化尿液及利尿处理，并完善脑垂体激素五项检查。\nD. 继续本周期化疗，给予止吐、护胃及静脉营养支持治疗，暂不进行内分泌功能相关检查。\nE. 提前结束本周期化疗，给予全静脉营养支持及强效止吐治疗，并完善脑垂体激素五项检查。\nF. 继续本周期化疗，给予止吐、护肝及静脉营养支持治疗，同时行腰椎穿刺脑脊液常规及生化检查。\nG. 结束本周期化疗，给予预防性抗感染及护肝支持治疗，并完善脑垂体激素五项检查。\nH. 继续本周期化疗，给予止吐及肠内营养支持治疗，避免静脉营养，并复查鼻咽及垂体增强MRI。\nI. 暂停氟尿嘧啶持续静脉滴注，给予口腔局部镇痛及促进黏膜愈合处理，并完善脑垂体激素五项检查。\nJ. 继续本周期化疗，给予止吐、护肝支持治疗，暂不予静脉营养，并请内分泌科急会诊。\nK. 结束本周期化疗，给予止吐、护肝及静脉营养支持治疗，并于次日开始局部区域调强放疗。\nL. 继续本周期化疗，给予止吐、护肝及静脉营养等支持治疗，并完善脑垂体激素五项检查。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"停止本周期化疗，给予粒细胞集落刺激因子及抗感染支持治疗，并完善脑垂体激素五项检查。","is_gold":false},{"letter":"B","text":"继续本周期化疗，给予止吐、护肝及静脉营养等支持治疗，并完善甲状腺功能及皮质醇检查。","is_gold":false},{"letter":"C","text":"停止本周期化疗，给予大剂量水化、碱化尿液及利尿处理，并完善脑垂体激素五项检查。","is_gold":false},{"letter":"D","text":"继续本周期化疗，给予止吐、护胃及静脉营养支持治疗，暂不进行内分泌功能相关检查。","is_gold":false},{"letter":"E","text":"提前结束本周期化疗，给予全静脉营养支持及强效止吐治疗，并完善脑垂体激素五项检查。","is_gold":false},{"letter":"F","text":"继续本周期化疗，给予止吐、护肝及静脉营养支持治疗，同时行腰椎穿刺脑脊液常规及生化检查。","is_gold":false},{"letter":"G","text":"结束本周期化疗，给予预防性抗感染及护肝支持治疗，并完善脑垂体激素五项检查。","is_gold":false},{"letter":"H","text":"继续本周期化疗，给予止吐及肠内营养支持治疗，避免静脉营养，并复查鼻咽及垂体增强MRI。","is_gold":false},{"letter":"I","text":"暂停氟尿嘧啶持续静脉滴注，给予口腔局部镇痛及促进黏膜愈合处理，并完善脑垂体激素五项检查。","is_gold":false},{"letter":"J","text":"继续本周期化疗，给予止吐、护肝支持治疗，暂不予静脉营养，并请内分泌科急会诊。","is_gold":false},{"letter":"K","text":"结束本周期化疗，给予止吐、护肝及静脉营养支持治疗，并于次日开始局部区域调强放疗。","is_gold":false},{"letter":"L","text":"继续本周期化疗，给予止吐、护肝及静脉营养等支持治疗，并完善脑垂体激素五项检查。","is_gold":true}],"gold_letter":"L"},{"sample_id":"sample-efbe1e2a6ec0abf3be38883f","patient_id":"patient-eecadcdf172a1efe8947b052","turn_id":"turn07","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N1，M0。\n综合TNM状态：T4N1M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D53] 入院记录: 主诉: 鼻咽癌2程诱导化疗后20天。；现病史: 患者于某次就诊时间1月无明显诱因下出现头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，患者于至[机构已隐去]就诊，行鼻咽活检，并送我院病理会诊示鼻咽分化型非角化性癌。某次就诊时间在我院行鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶；颅底骨质破坏；双侧咽后淋巴结肿大，考虑转移；双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。明确诊断为鼻咽分化型非角化性癌，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)。于某次就诊时间、某次就诊时间行TPF化疗（DOC 60mg/m2+DDP 60mg/m2+5-FU 2.5g/m2civ48h）2程诱导化疗，化疗过程顺利。今患者为行第3程诱导化疗收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,双咽后淋巴结肿大,头痛；既往史: 否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认饮酒史。否认不洁性生活史。；家族史: 患者叔叔因肺癌死亡。；体格检查: T：36.5℃，P：88次/分，R：20次/分，BP：134/63mmHg,Ht：172cm，Wt：76kg，BSA：1.88m2，KPS：90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率88次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无叩痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射……\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 早期复极改变\n- [全程D0] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.6；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:20（参考: 阴性）；活化部分凝血活酶时间(APTT)-静脉血: 23.1sec.；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；血红蛋白(Hb)-静脉血: 158g/L；血小板比容-静脉血: 26%；氯离子(Cl-)-静脉血: 105.3mmol/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 1.04；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；尿酸(UA)-静脉血: 341umol/L；甘油三酯(TG)-静脉血: 1.27mmol/L；总蛋白(TP)-静脉血: 73.53g/L；尿素氮(BUN)-静脉血: 6.35mmol/L；C-反应蛋白(CRP)-静脉血: 1.45mg/L；载脂蛋白B(apoB)-静脉血: 0.8g/L；总胆汁酸(TBA)-静脉血: 4.7umol/L；葡萄糖(Glu)-静脉血: 4.78mmol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；乳酸脱氢酶(LDH)-静脉血: 160.3U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；大血小板百分比(P-LCR%)-静脉血: 30.4%；中性粒细胞计数(Neut#)-静脉血: 6.410E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；丙氨酸氨基转移酶(ALT)-静脉血: 12.1U/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；ABO血型-静脉血: B；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.7fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；球蛋白(GLO)-静脉血: 28.23g/L；凝血酶时间(TT)-静脉血: 17.5sec.；红细胞计数(RBC#)-静脉血: 5.3710E12/L；平均红细胞体积(MCV)-静脉血: 87fL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.17mmolL；磷(P)-静脉血: 1.03mmol/L；总钙(Ca)-……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D38] 检验组合: α-L-岩藻糖苷酶(AFU)-静脉血: 31.3U/L；氯离子(Cl-)-静脉血: 90.1mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.85mmol/L；胱抑素(Cys-C)-静脉血: 1.22mg/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.8mmol/L；钾离子(K+)-静脉血: 3.66mmol/L；总胆汁酸(TBA)-静脉血: 2.2umol/L；甘油三酯(TG)-静脉血: 2.25mmol/L；肌酐(Crea)-静脉血: 108.2umol/L；总钙(Ca)-静脉血: 2.23mmol/L；C-反应蛋白(CRP)-静脉血: 0.28mg/L；钠离子(Na+)-静脉血: 129.2mmol/L；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阴性(-)（参考: 阴性）；球蛋白(GLO)-静脉血: 21.3g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.69mmolL；间接胆红素(IBIL)-静脉血: 16umolL；总胆固醇(TC)-静脉血: 6.95mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 27.8U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.73；白蛋白(ALB)-静脉血: 40.8g/L；总蛋白(TP)-静脉血: 62.1g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.92；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；尿素氮(BUN)-静脉血: 11.7mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=1.25)（参考: 阴性）；尿酸(UA)-静脉血: 368.1umol/L；总胆红素(TBIL)-静脉血: 20.1umol/L；乳酸脱氢酶(LDH)-静脉血: 167U/L；阴离子间隙(AG)-静脉血: 16.3；载脂蛋白B(apoB)-静脉血: 1.3g/L；EB病毒Zta蛋白抗体IgA(EBV-Zta-IgA)-静脉血: 阴性(-)（参考: 阴性）；葡萄糖(Glu)-静脉血: 4.91mmol/L；磷(P)-静脉血: 1.13mmol/L；直接胆……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D53] 检验组合: 钠离子(Na+)-静脉血: 142.5mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 29.9U/L；乳酸脱氢酶(LDH)-静脉血: 207.9U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.6；血小板分布宽度(PDW)-静脉血: 10.8%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.035；间接胆红素(IBIL)-静脉血: 5.54umolL；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；天门冬氨酸氨基转移酶(AST)-静脉血: 18.5U/L；磷(P)-静脉血: 0.96mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.04；肌酐(Crea)-静脉血: 102umol/L；甘油三酯(TG)-静脉血: 1.26mmol/L；单核细胞百分比(Mono%)-静脉血: 0.09；大血小板百分比(P-LCR%)-静脉血: 22.6%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；C-反应蛋白(CRP)-静脉血: 0.69mg/L；血红蛋白(Hb)-静脉血: 134g/L；平均红细胞体积(MCV)-静脉血: 86.7fL；平均血小板体积(MPV)-静脉血: 9.7fL；单核细胞计数(Mono#)-静脉血: 0.610E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.009；有核红细胞计数(NRBC#)-静脉血: 010E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.13mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.22；葡萄糖(Glu)-静脉血: 4.43mmol/L；载脂蛋白B(apoB)-静脉血: 1.26g/L；载脂蛋白AI(apoAI)-静脉血: 1.74g/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 332g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.3mmol/L；氯离子(Cl-)-静脉血: 99.6mmol/L；尿酸(UA)-静脉血: 362.4umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.53mmolL；直接胆红素(DBIL)-静脉血: 1.88umol/L；红细胞比容(Hct)-静脉血: 40.4%；总胆固醇(TC)-静脉血: 6.07mmol/L；总钙(Ca)-静脉血:……\n- [全程D59] 检验组合: 平均红细胞体积(MCV)-静脉血: 82fL；大血小板百分比(P-LCR%)-静脉血: 36.3%；有核红细胞百分比(NRBC%)-静脉血: 0；血小板分布宽度(PDW)-静脉血: 15.9%；血小板比容-静脉血: 15%；白细胞计数(WBC#)-静脉血: 4.2710E9/L；血小板计数(PLT#)-静脉血: 13510E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.351；红细胞比容(Hct)-静脉血: 37.9%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.002；有核红细胞计数(NRBC#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 133g/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.631；单核细胞计数(Mono#)-静脉血: 0.110E9/L；红细胞计数(RBC#)-静脉血: 4.6210E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；平均红细胞血红蛋白浓度(MCHC)-静脉血: 351g/L；平均血小板体积(MPV)-静脉血: 11.4fL；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 36.7；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；单核细胞百分比(Mono%)-静脉血: 0.014；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L\n- [全程D60] 检验组合: 阴离子间隙(AG)-静脉血: 17.3；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阳性(SCO=1.25)（参考: 阴性）；胱抑素(Cys-C)-静脉血: 1.21mg/L；氯离子(Cl-)-静脉血: 90.7mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 35.4U/L；载脂蛋白AI(apoAI)-静脉血: 1.83g/L；钠离子(Na+)-静脉血: 130.8mmol/L；总胆红素(TBIL)-静脉血: 20.2umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.8mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；球蛋白(GLO)-静脉血: 22.01g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.03；丙氨酸氨基转移酶(ALT)-静脉血: 24.3U/L；白蛋白(ALB)-静脉血: 44.6g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.5U/L；载脂蛋白B(apoB)-静脉血: 1.33g/L；碱性磷酸酶(ALP)-静脉血: 78.3U/L；葡萄糖(Glu)-静脉血: 5.06mmol/L；磷(P)-静脉血: 1mmol/L；总钙(Ca)-静脉血: 2.29mmol/L；尿酸(UA)-静脉血: 326.1umol/L；总胆汁酸(TBA)-静脉血: 2.7umol/L；总胆固醇(TC)-静脉血: 7.06mmol/L；C-反应蛋白(CRP)-静脉血: 0.2mg/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.72；直接胆红素(DBIL)-静脉血: 4.4umol/L；镁离子(Mg2+)-静脉血: 0.72mmol/L；EB病毒Zta蛋白抗体IgA(EBV-Zta-IgA)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.71mmolL；总蛋白(TP)-静脉血: 66.61g/L；甘油三酯(TG)-静脉血: 2.92mmol/L；肌酐(Crea)-静脉血: 112.8umol/L；尿素氮(BUN)-静脉血: 10.2mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.……\n- [全程D61] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后复查，较某次就诊时间片对比： 鼻咽腔未见明显狭窄，鼻咽左侧壁粘膜稍增厚，T1WI呈等信号，T2WI呈稍高信号，增强后明显强化，左侧咽隐窝变浅，右侧咽隐窝清晰，双侧咽旁脂肪间隙及颈动脉鞘区未见异常。鼻咽肿物较前明显缩小好转。 左侧腭帆张提肌及左侧头长肌稍肿胀，右侧腭帆提肌、腭帆张肌、头长肌未见受侵征象。 双侧翼腭窝、上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽双侧壁未见增厚，双侧后鼻孔未见肿物。 斜坡、蝶骨基底部、左侧岩尖、左侧翼突基底部、翼突内外板、左侧枕骨基底部及左侧枕骨髁骨质信号减低，增强扫描后明显强化。双侧海绵窦形态正常，未见增宽。左侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，骨壁完整。双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧咽后见小淋巴结，最大短径约5 mm。 双颈I、II区见多个淋巴结，边界清，信号均匀，最大短径约7mm，均匀强化。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变；双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗后复查，较某次就诊时间片对比： 鼻咽肿物较前明显缩小好转，累及范围较前缩小。 颅底骨质破坏同前。 双侧咽后淋巴结较前缩小。 双颈I、II区小淋巴结，较前稍缩小。 左侧乳突炎。\n\n【既往治疗与反应】\n- [全程D53] 首次病程记录；首次病程记录: 病程类型: 首次病程记录；病程主题: 首次病程记录；病程内容: 病历特点：1、患者中年男性。2、患者于某次就诊时间1月无明显诱因下出现头痛，伴耳鸣，双耳听力下降和闭塞感，无鼻塞、涕血，无面麻，无复视、视力下降，患者于至[机构已隐去]就诊，行鼻咽活检，并送我院病理会诊示鼻咽分化型非角化性癌。某次就诊时间在我院行鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶；颅底骨质破坏；双侧咽后淋巴结肿大，考虑转移；双颈Ib、II区小淋巴结，性质待定。胸片、腹部B超排除远处转移。明确诊断为鼻咽分化型非角化性癌，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)。于某次就诊时间、某次就诊时间行TPF化疗（DOC 60mg/m2+DDP 60mg/m2+5-FU 2.5g/m2civ48h）2程诱导化疗，化疗过程顺利。今患者为行第3程诱导化疗收入我科。患者入院以后,精神、饮食、睡眠尚可,大小便正常，体重无减轻。3、体查：张口门齿距5cm；鼻咽肿物较前明显消退；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约0.8cm*0.5cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）。4、辅助检查：（1） 某次就诊时间在我医院（病理号：[记录编号已隐去]）鼻咽活检病理示：（鼻咽肿物）镜检为分化型非角化性癌（2） 某次就诊时间在我院胸片检查：心肺未见异常。（3） 某次就诊时间在我院腹部B超检查：肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。（4） 某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。副鼻窦炎、左侧乳突炎。（6） 某次就诊时间我院：VCA-IgA 1:160 EA-IgA 1:20 EBV-DNA定性检测：2.14E102copy/ml 诊断依据： 初步诊断： 鉴别诊断：诊断明确，暂无需鉴别。 诊疗计划：1、完善相关检查如三大常规、电子鼻咽镜等。2、综合治疗。\n- [全程D54] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日随[姓名已隐去]医生信息已隐藏，详细询问病史并查体后，分析病情如下：1、患者中年男性，因“鼻咽癌2程诱导化疗后20天”入院。2、查体：张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约0.8cm*0.5cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）。3、辅助检查：某次就诊时间在我医院（病理号：[记录编号已隐去]）鼻咽活检病理示：（鼻咽肿物）镜检为分化型非角化性癌。某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。副鼻窦炎、左侧乳突炎。综上述，患者诊断鼻咽分化型非角化性癌，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)。[姓名已隐去]医生信息已隐藏，患者现一般情况可。昨日复查血常规及生化常规未见明显异常，拟今日开始行第3程诱导化疗，注意防治化疗相关毒副反应。\n- [全程D55] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日随[姓名已隐去]医生信息已隐藏，详细询问病史并查体后，分析病情如下：1、患者中年男性，因“鼻咽癌2程诱导化疗后20天”入院。2、查体：张口门齿距5cm；鼻咽顶后壁及左侧壁见肿物隆起；左颈Ⅱ区可扪及1枚肿大淋巴结，大小约0.8cm*0.5cm，质地中等，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；右颈淋巴结（-），颅神经检查：（-）。3、辅助检查：某次就诊时间在我医院（病理号：[记录编号已隐去]）鼻咽活检病理示：（鼻咽肿物）镜检为分化型非角化性癌。某次就诊时间在我院鼻咽＋颈部MRI检查：鼻咽部肿物，考虑鼻咽癌，可疑累及垂体后叶。颅底骨质破坏。双侧咽后淋巴结肿大，考虑转移。双颈Ib、II区小淋巴结，性质待定。副鼻窦炎、左侧乳突炎。综上述，患者诊断鼻咽分化型非角化性癌，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(AJCC/UICC 2009分期)，[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点(2008中国分期)。[姓名已隐去]医生信息已隐藏，患者现一般情况可。化疗前复查血常规及生化常规未见明显异常，于昨日开始行第3程诱导化疗，注意水化、护胃止呕、营养补液等对症支持治疗。\n- [全程D58] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日TPF方案化疗第5天，现一般情况可，未诉恶心、呕吐、腹痛、腹泻等不适，大小便正常。[姓名已隐去]主治医师，患者目前一般情况可，可继续化疗。注意化疗结束后复查血、生化常规，及时对症处理。\n- [全程D60] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日已完成第3程TPF方案（多西紫杉醇 60mg/m2 + DDP 60mg/m2 + 5-Fu 2.5g/m2）诱导化疗，未诉特殊不适。2/5复查血常规结果基本正常，今日复查血生化结果示：K+ 3.13↓ mmol/L，Na+ 130.8↓ mmol/L，IBIL 15.80 ↑ umolL，CRE 112.8↑ umol/L。[姓名已隐去]医生信息已隐藏示：患者现已完成化疗，今日可带口服补钾、护肝及护肾药物出院。嘱患者注意休息，加强营养，口服补钠，每周复查血常规、肝肾功能。按期返院开始同期放化疗，不适时随诊。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估诱导化疗疗效为疾病稳定，继续原方案第4程诱导化疗，并予以静脉补钾、补钠及护肾治疗后出院。\nB. 评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行根治性同期放化疗。\nC. 评估诱导化疗疗效为完全缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行单纯根治性放疗。\nD. 评估诱导化疗疗效为部分缓解，予以静脉补钾、补钠及护肾治疗，待电解质及肾功能恢复正常后立即开始第4程诱导化疗。\nE. 评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行单纯根治性放疗。\nF. 评估诱导化疗疗效为疾病进展，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院更改为GP方案化疗。\nG. 评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行根治性放疗联合靶向治疗。\nH. 评估诱导化疗疗效为部分缓解，因出现肾功能损害，予以护肾治疗后出院，并安排按期返院行单纯根治性放疗，取消同期化疗。\nI. 评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行姑息性放化疗。\nJ. 评估诱导化疗疗效为部分缓解，予以静脉补钾、补钠及护肾治疗，住院期间直接开始根治性同期放化疗。\nK. 评估诱导化疗疗效为疾病稳定，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行根治性同期放化疗。\nL. 评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行鼻咽及颈部淋巴结清扫术。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"评估诱导化疗疗效为疾病稳定，继续原方案第4程诱导化疗，并予以静脉补钾、补钠及护肾治疗后出院。","is_gold":false},{"letter":"B","text":"评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行根治性同期放化疗。","is_gold":true},{"letter":"C","text":"评估诱导化疗疗效为完全缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行单纯根治性放疗。","is_gold":false},{"letter":"D","text":"评估诱导化疗疗效为部分缓解，予以静脉补钾、补钠及护肾治疗，待电解质及肾功能恢复正常后立即开始第4程诱导化疗。","is_gold":false},{"letter":"E","text":"评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行单纯根治性放疗。","is_gold":false},{"letter":"F","text":"评估诱导化疗疗效为疾病进展，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院更改为GP方案化疗。","is_gold":false},{"letter":"G","text":"评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行根治性放疗联合靶向治疗。","is_gold":false},{"letter":"H","text":"评估诱导化疗疗效为部分缓解，因出现肾功能损害，予以护肾治疗后出院，并安排按期返院行单纯根治性放疗，取消同期化疗。","is_gold":false},{"letter":"I","text":"评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行姑息性放化疗。","is_gold":false},{"letter":"J","text":"评估诱导化疗疗效为部分缓解，予以静脉补钾、补钠及护肾治疗，住院期间直接开始根治性同期放化疗。","is_gold":false},{"letter":"K","text":"评估诱导化疗疗效为疾病稳定，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行根治性同期放化疗。","is_gold":false},{"letter":"L","text":"评估诱导化疗疗效为部分缓解，予以口服补钾、补钠及护肾等对症支持治疗后出院，并安排按期返院行鼻咽及颈部淋巴结清扫术。","is_gold":false}],"gold_letter":"B"},{"sample_id":"sample-a1bcb1dd845b682149871b63","patient_id":"patient-eecadcdf172a1efe8947b052","turn_id":"turn08","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N1，M0。\n综合TNM状态：T4N1M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- 暂无可展示的初诊主诉/入院资料。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 早期复极改变\n- [全程D0] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.6；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:20（参考: 阴性）；活化部分凝血活酶时间(APTT)-静脉血: 23.1sec.；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；血红蛋白(Hb)-静脉血: 158g/L；血小板比容-静脉血: 26%；氯离子(Cl-)-静脉血: 105.3mmol/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 1.04；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；尿酸(UA)-静脉血: 341umol/L；甘油三酯(TG)-静脉血: 1.27mmol/L；总蛋白(TP)-静脉血: 73.53g/L；尿素氮(BUN)-静脉血: 6.35mmol/L；C-反应蛋白(CRP)-静脉血: 1.45mg/L；载脂蛋白B(apoB)-静脉血: 0.8g/L；总胆汁酸(TBA)-静脉血: 4.7umol/L；葡萄糖(Glu)-静脉血: 4.78mmol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；乳酸脱氢酶(LDH)-静脉血: 160.3U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；大血小板百分比(P-LCR%)-静脉血: 30.4%；中性粒细胞计数(Neut#)-静脉血: 6.410E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；丙氨酸氨基转移酶(ALT)-静脉血: 12.1U/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；ABO血型-静脉血: B；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.7fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；球蛋白(GLO)-静脉血: 28.23g/L；凝血酶时间(TT)-静脉血: 17.5sec.；红细胞计数(RBC#)-静脉血: 5.3710E12/L；平均红细胞体积(MCV)-静脉血: 87fL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.17mmolL；磷(P)-静脉血: 1.03mmol/L；总钙(Ca)-……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D99] 检验组合: 单核细胞计数(Mono#)-静脉血: 1.710E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；血小板分布宽度(PDW)-静脉血: 11.4%；大血小板百分比(P-LCR%)-静脉血: 29.1%；单核细胞百分比(Mono%)-静脉血: 0.093；平均红细胞体积(MCV)-静脉血: 88.1fL；红细胞比容(Hct)-静脉血: 29%；有核红细胞百分比(NRBC%)-静脉血: 0.1；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.9；嗜酸性粒细胞计数(Eos#)-静脉血: 0.410E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.022；白细胞计数(WBC#)-静脉血: 18.7210E9/L；红细胞计数(RBC#)-静脉血: 3.2910E12/L；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；血小板比容-静脉血: 12%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 48；血小板计数(PLT#)-静脉血: 11710E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 345g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.034；平均红细胞血红蛋白含量(MCH)-静脉血: 30.4pg；中性粒细胞计数(Neut#)-静脉血: 15.910E9/L；血红蛋白(Hb)-静脉血: 100g/L；中性粒细胞百分比(Neut%)-静脉血: 0.848；平均血小板体积(MPV)-静脉血: 10.7fL；有核红细胞计数(NRBC#)-静脉血: 0.0210E9/L\n- [全程D104] 检验组合: 钠离子(Na+)-静脉血: 136.2mmol/L；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；血小板分布宽度(PDW)-静脉血: 11.8%；葡萄糖(Glu)-静脉血: 6mmol/L；碱性磷酸酶(ALP)-静脉血: 59.8U/L；尿酸(UA)-静脉血: 486.4umol/L；尿素氮(BUN)-静脉血: 15mmol/L；直接胆红素(DBIL)-静脉血: 2.5umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；间接胆红素(IBIL)-静脉血: 7.3umolL；镁离子(Mg2+)-静脉血: 0.75mmol/L；血小板计数(PLT#)-静脉血: 15910E9/L；单核细胞百分比(Mono%)-静脉血: 0.081；平均血小板体积(MPV)-静脉血: 10.5fL；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.08mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.6；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；总胆固醇(TC)-静脉血: 6.02mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.899；血红蛋白(Hb)-静脉血: 107g/L；红细胞计数(RBC#)-静脉血: 3.5110E12/L；球蛋白(GLO)-静脉血: 20.38g/L；甘油三酯(TG)-静脉血: 1.26mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；大血小板百分比(P-LCR%)-静脉血: 29.3%；总钙(Ca)-静脉血: 2.37mmol/L；总胆汁酸(TBA)-静脉血: 0.8umol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 45.1；胱抑素(Cys-C)-静脉血: 1.67mg/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 358g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.01；α-L-岩藻糖苷酶(AFU)-静脉血: 31.2U/L；钾离子(K+)-静脉血: 3.53mmol/L；总蛋白(TP)-静脉血: 61.28g/L；天门冬氨酸氨基转移酶(AST)-静……\n- [全程D108] 检验组合: 总胆红素(TBIL)-静脉血: 13.8umol/L；总蛋白(TP)-静脉血: 57.11g/L；单核细胞百分比(Mono%)-静脉血: 0.048；球蛋白(GLO)-静脉血: 18.41g/L；尿素氮(BUN)-静脉血: 9.7mmol/L；间接胆红素(IBIL)-静脉血: 10.2umolL；碱性磷酸酶(ALP)-静脉血: 52.2U/L；胱抑素(Cys-C)-静脉血: 1.26mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.2mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1；肌酐(Crea)-静脉血: 85umol/L；尿酸(UA)-静脉血: 283umol/L；乳酸脱氢酶(LDH)-静脉血: 131.8U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 9.3U/L；红细胞计数(RBC#)-静脉血: 3.4610E12/L；C-反应蛋白(CRP)-静脉血: 1.53mg/L；阴离子间隙(AG)-静脉血: 15.1；平均血小板体积(MPV)-静脉血: 9.8fL；淋巴细胞百分比(Lymph%)-静脉血: 0.039；γ-谷氨酰基转移酶(GGT)-静脉血: 27.7U/L；镁离子(Mg2+)-静脉血: 0.65mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 367g/L；大血小板百分比(P-LCR%)-静脉血: 24.8%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 42.5；载脂蛋白AI(apoAI)-静脉血: 1.09g/L；白蛋白(ALB)-静脉血: 38.7g/L；总胆汁酸(TBA)-静脉血: 1.5umol/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；白细胞计数(WBC#)-静脉血: 8.2710E9/L；总胆固醇(TC)-静脉血: 6.03mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.21；氯离子(Cl-)-静脉血: 90.9mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 7.7U/L；血小板分布宽度(PDW)-静脉血: 11.2%；血液二氧化碳含量ctCO2(B)-静脉血: 21.1mmol/L；红细胞比容(Hct)-静脉血: 28.3%；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；中性粒细胞百……\n- [全程D116] 检验组合: 大血小板百分比(P-LCR%)-静脉血: 28.7%；载脂蛋白B(apoB)-静脉血: 1.55g/L；钠离子(Na+)-静脉血: 133.3mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 32.4U/L；胱抑素(Cys-C)-静脉血: 0.84mg/L；直接胆红素(DBIL)-静脉血: 3.2umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 348g/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；血小板比容-静脉血: 13%；平均红细胞体积(MCV)-静脉血: 86.3fL；尿素氮(BUN)-静脉血: 6.6mmol/L；磷(P)-静脉血: 1.15mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.4mmolL；有核红细胞百分比(NRBC%)-静脉血: 0；有核红细胞计数(NRBC#)-静脉血: 010E9/L；载脂蛋白AI(apoAI)-静脉血: 1.2g/L；总胆固醇(TC)-静脉血: 7.16mmol/L；甘油三酯(TG)-静脉血: 1.74mmol/L；总钙(Ca)-静脉血: 2.28mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 76.6umol/L；钾离子(K+)-静脉血: 3.01mmol/L；间接胆红素(IBIL)-静脉血: 10.4umolL；尿酸(UA)-静脉血: 216umol/L；镁离子(Mg2+)-静脉血: 0.56mmol/L；单核细胞百分比(Mono%)-静脉血: 0.065；红细胞计数(RBC#)-静脉血: 3.3610E12/L；天门冬氨酸氨基转移酶(AST)-静脉血: 9.4U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.053；血小板计数(PLT#)-静脉血: 12210E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.6；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；乳酸脱氢酶(LDH)-静脉血: 130.3U/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；中性粒细胞计数(Neut#)-静脉血: 4.410E9/L；C-反应蛋白(CRP)-静脉血: 6.72mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 5.32mmol/L；丙氨酸氨基转移酶(ALT)……\n- [全程D152] 检验组合: EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D222] 超声；腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约21cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D222] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:80（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）\n\n【既往治疗与反应】\n- [全程D104] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者放疗22次，诉中度咽痛，有干咳，感恶心，无呕吐，无畏寒、发热。查体大致同前。今日查血常规生化未见异常。[姓名已隐去]医生信息已隐藏，患者放化疗顺利，现继续予以加强护胃、护肝等营养支持对症治疗，定期复查血生化常规，严密观察病情变化。\n- [全程D108] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者诉乏力，无恶心、呕吐，仍有便秘。查体大致同前。今日查血生化提示：血钾3.06mmol/L，血钠127.1mmol/L。血常规提示血红蛋白稍低。[姓名已隐去]医生信息已隐藏后指示：患者放疗过程中，现血钾、血钠低，可予以加强补钾、补钠治疗，现继续放疗，加强支持对症治疗，严密观察病情变化。\n- [全程D111] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者放疗27次，诉有咳嗽、咳痰，大便未解。查体大致同前。[姓名已隐去]医生信息已隐藏，患者放疗进行中，现有咳嗽，予以加强祛痰处理，大便未解加强通便治疗。继续加强支持对症治疗，严密观察病情变化。\n- [全程D116] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者放疗30次，患者诉感乏力，咳嗽、咳痰症状较前改善，无畏寒、发热。查体大致同前。今日查血常规大致正常。生化提示血钠低、血钾低、血镁低。[姓名已隐去]医生信息已隐藏，患者生化提示血钾、血钠、血镁低，加强支持对症治疗，严密观察病情变化。\n- [全程D118] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日完成放疗。今日[姓名已隐去]医生信息已隐藏者诉轻度咽痛，胃纳一般，无恶心、呕吐，无发热、咳嗽、咳痰等，精神、睡眠一般，大小便正常。体查：张口门齿距4.5cm；鼻咽顶壁见肿物，较前明显消退；浅表淋巴结未及肿大，颅神经检查：（-）。口腔黏膜反应Ⅱ度，皮肤反应Ⅰ度。[姓名已隐去]医生信息已隐藏示：患者已结束放疗及同期化疗，过程顺利，现病情平稳，可予以出院，嘱患者注意休息，加强营养，出院后一个月内每周复查血常规、肝肾功能，出院后一个月返院复查，不适时随诊。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善鼻咽及颈部MRI检查，暂缓EB病毒DNA及抗体检测。\nB. 安排全身PET-CT检查，替代常规影像学及EB病毒相关指标随访。\nC. 完善EB病毒DNA定量及EBV抗体（VCA-IgA、EA-IgA）检测，继续定期随访观察。\nD. 完善胸部增强CT及全身骨扫描，暂缓EB病毒DNA定量检测。\nE. 延长随访间隔至每半年一次，仅复查腹部彩超及血常规。\nF. 安排鼻内镜检查并常规行鼻咽部组织活检，复查EB病毒DNA。\nG. 给予抗病毒药物治疗以降低EBV-VCA-IgA滴度，继续随访观察。\nH. 启动卡培他滨节拍维持治疗，并每半年复查EB病毒DNA定量。\nI. 完善鼻咽及颈部CT平扫，替代MRI及EB病毒DNA定量检测。\nJ. 安排双侧颈部淋巴结彩超检查，暂缓EB病毒相关指标检测。\nK. 启动PD-1抑制剂免疫维持治疗，并定期复查EB病毒DNA定量。\nL. 完善头颅增强MRI检查，暂缓鼻咽部及颈部影像学评估。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"完善鼻咽及颈部MRI检查，暂缓EB病毒DNA及抗体检测。","is_gold":false},{"letter":"B","text":"安排全身PET-CT检查，替代常规影像学及EB病毒相关指标随访。","is_gold":false},{"letter":"C","text":"完善EB病毒DNA定量及EBV抗体（VCA-IgA、EA-IgA）检测，继续定期随访观察。","is_gold":true},{"letter":"D","text":"完善胸部增强CT及全身骨扫描，暂缓EB病毒DNA定量检测。","is_gold":false},{"letter":"E","text":"延长随访间隔至每半年一次，仅复查腹部彩超及血常规。","is_gold":false},{"letter":"F","text":"安排鼻内镜检查并常规行鼻咽部组织活检，复查EB病毒DNA。","is_gold":false},{"letter":"G","text":"给予抗病毒药物治疗以降低EBV-VCA-IgA滴度，继续随访观察。","is_gold":false},{"letter":"H","text":"启动卡培他滨节拍维持治疗，并每半年复查EB病毒DNA定量。","is_gold":false},{"letter":"I","text":"完善鼻咽及颈部CT平扫，替代MRI及EB病毒DNA定量检测。","is_gold":false},{"letter":"J","text":"安排双侧颈部淋巴结彩超检查，暂缓EB病毒相关指标检测。","is_gold":false},{"letter":"K","text":"启动PD-1抑制剂免疫维持治疗，并定期复查EB病毒DNA定量。","is_gold":false},{"letter":"L","text":"完善头颅增强MRI检查，暂缓鼻咽部及颈部影像学评估。","is_gold":false}],"gold_letter":"C"}]}
+{"patient_id":"patient-290a042206ccfe67e72f9a19","bootstrap_cluster_id":"cluster-018","turns":[{"sample_id":"sample-32fca5d8e1da4de5e54c5c0b","patient_id":"patient-290a042206ccfe67e72f9a19","turn_id":"turn01","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现颈部肿物1月余；当地诊断：鼻咽癌。于某次就诊时间在[机构已隐去]行力扑素270mgd1+奈达铂120mgd1+泰欣生200mgd1化疗一程，化疗后出现四度中性粒细胞减少，无发热、腹泻、寒战等，予升白处理后中性粒细胞恢复。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物,中性粒细胞减少,颈部肿物；既往史: 颈椎病史10年，既往有慢性肠炎病史。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：362.℃，P：100次/分，R：20次/分，BP：126/74mmHg,Ht：168cm，Wt：63kg，BSA：1.72m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；双侧颈部IIa区各可扪及1个淋巴结，左颈2×3cm，右颈2×2cm,无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行电子鼻咽镜检查（不活检），并完善鼻咽及颈部CT平扫+增强，常规心电图检查\nB. 行颈部淋巴结切除活检，并完善鼻咽及颈部MRI平扫+增强，常规心电图检查\nC. 行电子鼻咽镜检查及活检，并完善鼻咽及颈部MRI平扫（不增强），常规心电图检查\nD. 行电子鼻咽镜检查及活检，并完善鼻咽及颈部MRI平扫+增强，常规心电图检查\nE. 行电子鼻咽镜检查及活检，并完善鼻咽MRI平扫+增强，暂缓颈部影像学检查\nF. 直接行全身PET-CT检查，暂缓电子鼻咽镜及活检与局部MRI\nG. 行电子鼻咽镜检查及活检，并完善胸部及腹部CT平扫+增强，暂缓头颈部MRI\nH. 行鼻咽及颈部MRI平扫+增强，常规心电图检查，暂缓鼻咽镜检查及活检\nI. 行电子鼻咽镜检查及活检，并完善鼻咽及颈部CT平扫，常规心电图检查\nJ. 行颈部淋巴结穿刺活检，并完善鼻咽及颈部MRI平扫+增强，常规心电图检查\nK. 行电子鼻咽镜检查（不活检），并完善全身PET-CT检查，常规心电图检查\nL. 行电子鼻咽镜检查及活检，并完善鼻咽及颈部超声检查，常规心电图检查\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"行电子鼻咽镜检查（不活检），并完善鼻咽及颈部CT平扫+增强，常规心电图检查","is_gold":false},{"letter":"B","text":"行颈部淋巴结切除活检，并完善鼻咽及颈部MRI平扫+增强，常规心电图检查","is_gold":false},{"letter":"C","text":"行电子鼻咽镜检查及活检，并完善鼻咽及颈部MRI平扫（不增强），常规心电图检查","is_gold":false},{"letter":"D","text":"行电子鼻咽镜检查及活检，并完善鼻咽及颈部MRI平扫+增强，常规心电图检查","is_gold":true},{"letter":"E","text":"行电子鼻咽镜检查及活检，并完善鼻咽MRI平扫+增强，暂缓颈部影像学检查","is_gold":false},{"letter":"F","text":"直接行全身PET-CT检查，暂缓电子鼻咽镜及活检与局部MRI","is_gold":false},{"letter":"G","text":"行电子鼻咽镜检查及活检，并完善胸部及腹部CT平扫+增强，暂缓头颈部MRI","is_gold":false},{"letter":"H","text":"行鼻咽及颈部MRI平扫+增强，常规心电图检查，暂缓鼻咽镜检查及活检","is_gold":false},{"letter":"I","text":"行电子鼻咽镜检查及活检，并完善鼻咽及颈部CT平扫，常规心电图检查","is_gold":false},{"letter":"J","text":"行颈部淋巴结穿刺活检，并完善鼻咽及颈部MRI平扫+增强，常规心电图检查","is_gold":false},{"letter":"K","text":"行电子鼻咽镜检查（不活检），并完善全身PET-CT检查，常规心电图检查","is_gold":false},{"letter":"L","text":"行电子鼻咽镜检查及活检，并完善鼻咽及颈部超声检查，常规心电图检查","is_gold":false}],"gold_letter":"D"},{"sample_id":"sample-95b51d663e429afb86c572e7","patient_id":"patient-290a042206ccfe67e72f9a19","turn_id":"turn02","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现颈部肿物1月余；当地诊断：鼻咽癌。于某次就诊时间在[机构已隐去]行力扑素270mgd1+奈达铂120mgd1+泰欣生200mgd1化疗一程，化疗后出现四度中性粒细胞减少，无发热、腹泻、寒战等，予升白处理后中性粒细胞恢复。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物,中性粒细胞减少,颈部肿物；既往史: 颈椎病史10年，既往有慢性肠炎病史。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：362.℃，P：100次/分，R：20次/分，BP：126/74mmHg,Ht：168cm，Wt：63kg，BSA：1.72m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；双侧颈部IIa区各可扪及1个淋巴结，左颈2×3cm，右颈2×2cm,无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 电轴左偏(轻度) 心电图大致正常\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1] 检验组合: 纤维蛋白原降解产物(FDP)-静脉血: 2ug/ml；平均红细胞体积(MCV)-静脉血: 93.5fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6；甘油三酯(TG)-静脉血: 2.17mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 51.4U/L；胱抑素(Cys-C)-静脉血: 0.91mg/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.08COI；总钙(Ca)-静脉血: 2.24mmol/L；淋巴细胞计数(Lymph#)-静脉血: 2.610E9/L；葡萄糖(Glu)-静脉血: 5.18mmol/L；球蛋白(GLO)-静脉血: 26.59g/L；有核红细胞计数(NRBC#)-静脉血: 0.0410E9/L；平均血小板体积(MPV)-静脉血: 9.5fL；大血小板百分比(P-LCR%)-静脉血: 20.5%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.003；红细胞计数(RBC#)-静脉血: 4.1410E12/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.07S/CO；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.55mmol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0IU/mL；血小板分布宽度(PDW)-静脉血: 9.8%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.014；载脂蛋白B(apoB)-静脉血: 0.91g/L；C-反应蛋白(CRP)-静脉血: 2.8mg/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；镁离子(Mg2+)-静脉血: 0.83mmol/L；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；肌酐(Crea)-静脉血: 77umol/L；钾离子(K+)-静脉血: 4mmol/L；白蛋白(ALB)-静脉血: 40.9g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；凝血酶原时间活动度(PTA)-静脉血: 90.4%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.54；阴离子间隙(AG)-静脉血: 12……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 行鼻咽镜下重新活检，完善胸部CT、腹部超声及全身骨扫描，检测血浆EBV DNA\nB. 行外院疑难病理会诊，完善胸部CT、腹部超声，暂缓全身骨扫描，检测血浆EBV DNA\nC. 沿用外院病理诊断，完善PET/CT全身显像及血浆EBV DNA检测\nD. 行外院疑难病理会诊，完善胸部增强CT及腹部增强CT，暂缓全身骨扫描\nE. 行外院疑难病理会诊，完善PET/CT全身显像及血浆EBV DNA检测\nF. 行鼻咽镜下重新活检，完善PET/CT全身显像及血浆EBV DNA检测\nG. 行外院疑难病理会诊，完善PET/CT全身显像，暂缓血浆EBV DNA检测\nH. 行外院疑难病理会诊，完善胸部CT及腹部CT，暂缓全身骨扫描及血浆EBV DNA检测\nI. 沿用外院病理诊断，完善PET/CT全身显像，暂缓血浆EBV DNA检测\nJ. 行外院疑难病理会诊，完善头颈部局部PET/CT及血浆EBV DNA检测\nK. 行鼻咽镜下重新活检，完善胸部CT及腹部CT，暂缓血浆EBV DNA检测\n\n请仅输出一个选项字母（A-K）。","options":[{"letter":"A","text":"行鼻咽镜下重新活检，完善胸部CT、腹部超声及全身骨扫描，检测血浆EBV DNA","is_gold":false},{"letter":"B","text":"行外院疑难病理会诊，完善胸部CT、腹部超声，暂缓全身骨扫描，检测血浆EBV DNA","is_gold":false},{"letter":"C","text":"沿用外院病理诊断，完善PET/CT全身显像及血浆EBV DNA检测","is_gold":false},{"letter":"D","text":"行外院疑难病理会诊，完善胸部增强CT及腹部增强CT，暂缓全身骨扫描","is_gold":false},{"letter":"E","text":"行外院疑难病理会诊，完善PET/CT全身显像及血浆EBV DNA检测","is_gold":true},{"letter":"F","text":"行鼻咽镜下重新活检，完善PET/CT全身显像及血浆EBV DNA检测","is_gold":false},{"letter":"G","text":"行外院疑难病理会诊，完善PET/CT全身显像，暂缓血浆EBV DNA检测","is_gold":false},{"letter":"H","text":"行外院疑难病理会诊，完善胸部CT及腹部CT，暂缓全身骨扫描及血浆EBV DNA检测","is_gold":false},{"letter":"I","text":"沿用外院病理诊断，完善PET/CT全身显像，暂缓血浆EBV DNA检测","is_gold":false},{"letter":"J","text":"行外院疑难病理会诊，完善头颈部局部PET/CT及血浆EBV DNA检测","is_gold":false},{"letter":"K","text":"行鼻咽镜下重新活检，完善胸部CT及腹部CT，暂缓血浆EBV DNA检测","is_gold":false}],"gold_letter":"E"},{"sample_id":"sample-ac55ce5273aeb2587f3051e7","patient_id":"patient-290a042206ccfe67e72f9a19","turn_id":"turn05","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 电轴左偏(轻度) 心电图大致正常\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1] 检验组合: 纤维蛋白原降解产物(FDP)-静脉血: 2ug/ml；平均红细胞体积(MCV)-静脉血: 93.5fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6；甘油三酯(TG)-静脉血: 2.17mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 51.4U/L；胱抑素(Cys-C)-静脉血: 0.91mg/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 0.08COI；总钙(Ca)-静脉血: 2.24mmol/L；淋巴细胞计数(Lymph#)-静脉血: 2.610E9/L；葡萄糖(Glu)-静脉血: 5.18mmol/L；球蛋白(GLO)-静脉血: 26.59g/L；有核红细胞计数(NRBC#)-静脉血: 0.0410E9/L；平均血小板体积(MPV)-静脉血: 9.5fL；大血小板百分比(P-LCR%)-静脉血: 20.5%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.003；红细胞计数(RBC#)-静脉血: 4.1410E12/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 0.07S/CO；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.55mmol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0IU/mL；血小板分布宽度(PDW)-静脉血: 9.8%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.014；载脂蛋白B(apoB)-静脉血: 0.91g/L；C-反应蛋白(CRP)-静脉血: 2.8mg/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；镁离子(Mg2+)-静脉血: 0.83mmol/L；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；肌酐(Crea)-静脉血: 77umol/L；钾离子(K+)-静脉血: 4mmol/L；白蛋白(ALB)-静脉血: 40.9g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；凝血酶原时间活动度(PTA)-静脉血: 90.4%；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.54；阴离子间隙(AG)-静脉血: 12……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D8] 检验组合: 单核细胞百分比(Mono%)-静脉血: 0.065；血红蛋白(Hb)-静脉血: 129g/L；淋巴细胞计数(Lymph#)-静脉血: 2.110E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；大血小板百分比(P-LCR%)-静脉血: 22%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.013；平均红细胞体积(MCV)-静脉血: 93.8fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.2；红细胞比容(Hct)-静脉血: 39.2%；中性粒细胞百分比(Neut%)-静脉血: 0.53；单核细胞计数(Mono#)-静脉血: 0.410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；白细胞计数(WBC#)-静脉血: 5.3910E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血小板分布宽度(PDW)-静脉血: 10.3%；平均红细胞血红蛋白含量(MCH)-静脉血: 30.9pg；血小板计数(PLT#)-静脉血: 14810E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.8；淋巴细胞百分比(Lymph%)-静脉血: 0.39；有核红细胞计数(NRBC#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.002；血小板比容-静脉血: 14%；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；红细胞计数(RBC#)-静脉血: 4.1810E12/L；平均血小板体积(MPV)-静脉血: 9.7fL；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L\n- [全程D9] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: 输液港走行于右锁骨下静脉，导管末端位于脊柱右旁T6椎体下缘水平，估计位于上腔静脉上段。；检查结论: 导管末端位置如上述。\n- [全程D9] 检验组合: 葡萄糖(Glu)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；非鳞状上皮细胞计数-尿液: 1/μL；颜色-尿液: Light-Yellow；粘液丝计数(MUCS#)-尿液: 5/μL；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-尿液: colorless；比重(SG)-尿液: 1.013；白细胞(LEU)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；白细胞(LEU)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 1/μL；酸碱度(pH)-尿液: 6.5；浊度(TRUB)-尿液: clear；比重(SG)-尿液: 1.016；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D10] 检验组合: 红细胞计数(RBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 6；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 7/μL；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.017；总蛋白(TP)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 1/μL；隐血(OB)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow\n- [全程D14] 检验组合: 总胆固醇(TC)-静脉血: 5.88mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜碱性粒细胞百分比(Baso%)-静脉血: 0；单核细胞百分比(Mono%)-静脉血: 0.008；丙氨酸氨基转移酶(ALT)-静脉血: 65.5U/L；血小板分布宽度(PDW)-静脉血: 13.8%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.9；白蛋白(ALB)-静脉血: 42.5g/L；球蛋白(GLO)-静脉血: 26g/L；胱抑素(Cys-C)-静脉血: 1.11mg/L；总蛋白(TP)-静脉血: 68.5g/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.7mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞计数(RBC#)-静脉血: 4.4510E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；总胆红素(TBIL)-静脉血: 15.4umol/L；钾离子(K+)-静脉血: 4.03mmol/L；葡萄糖(Glu)-静脉血: 5.74mmol/L；乳酸脱氢酶(LDH)-静脉血: 175U/L；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；肌酐(Crea)-静脉血: 80umol/L；总钙(Ca)-静脉血: 2.18mmol/L；钠离子(Na+)-静脉血: 132.2mmol/L；大血小板百分比(P-LCR%)-静脉血: 34.4%；红细胞比容(Hct)-静脉血: 39.3%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；阴离子间隙(AG)-静脉血: 17.8；γ-谷氨酰基转移酶(GGT)-静脉血: 26.8U/L；白细胞计数(WBC#)-静脉血: 5.2310E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.83mmol/L；平均血小板体积(MPV)-静脉血: 11.2fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.01；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.51mmolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.35；碱性磷酸酶(ALP)-静脉血: 57.4U/L；直接胆红素(DBIL)-静脉血: 4.1umol/L；镁离子(Mg2+)-静脉血: 0.93mmol/L；血红蛋白(Hb)-静脉血: 1……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者各项检查继续完善中。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D10] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程多西紫杉醇＋DDP+5-FU方案诱导化疗中，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 予以短效重组人粒细胞刺激因子（rhG-CSF）皮下注射，暂不予口服保肝药物治疗，并复查血常规及生化后继续住院观察。\nB. 暂不予粒细胞集落刺激因子预防，仅口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。\nC. 予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，静脉滴注头孢菌素预防感染，并复查血常规及生化后安排出院。\nD. 予以短效重组人粒细胞刺激因子（rhG-CSF）皮下注射，静脉滴注异甘草酸镁强效保肝，并复查血常规及生化后继续住院观察。\nE. 暂不予粒细胞集落刺激因子预防，暂不予口服保肝药物治疗，直接安排出院并嘱院外定期复查血常规及生化。\nF. 予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，口服恩替卡韦抗病毒治疗，并复查血常规及生化后安排出院。\nG. 予以短效重组人粒细胞刺激因子（rhG-CSF）皮下注射，口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。\nH. 予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。\nI. 予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，暂不予口服保肝药物治疗，并复查血常规及生化后安排出院。\nJ. 予以重组人促血小板生成素（rhTPO）皮下注射，口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。\nK. 予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，静脉滴注还原型谷胱甘肽保肝，并复查血常规及生化后继续住院观察。\nL. 暂不予任何药物处理，直接安排出院，嘱院外定期复查血常规及生化，若出现发热再返院使用粒细胞集落刺激因子。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"予以短效重组人粒细胞刺激因子（rhG-CSF）皮下注射，暂不予口服保肝药物治疗，并复查血常规及生化后继续住院观察。","is_gold":false},{"letter":"B","text":"暂不予粒细胞集落刺激因子预防，仅口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。","is_gold":false},{"letter":"C","text":"予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，静脉滴注头孢菌素预防感染，并复查血常规及生化后安排出院。","is_gold":false},{"letter":"D","text":"予以短效重组人粒细胞刺激因子（rhG-CSF）皮下注射，静脉滴注异甘草酸镁强效保肝，并复查血常规及生化后继续住院观察。","is_gold":false},{"letter":"E","text":"暂不予粒细胞集落刺激因子预防，暂不予口服保肝药物治疗，直接安排出院并嘱院外定期复查血常规及生化。","is_gold":false},{"letter":"F","text":"予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，口服恩替卡韦抗病毒治疗，并复查血常规及生化后安排出院。","is_gold":false},{"letter":"G","text":"予以短效重组人粒细胞刺激因子（rhG-CSF）皮下注射，口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。","is_gold":false},{"letter":"H","text":"予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。","is_gold":false},{"letter":"I","text":"予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，暂不予口服保肝药物治疗，并复查血常规及生化后安排出院。","is_gold":true},{"letter":"J","text":"予以重组人促血小板生成素（rhTPO）皮下注射，口服葡醛内酯片保肝治疗，并复查血常规及生化后安排出院。","is_gold":false},{"letter":"K","text":"予以聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）皮下注射，静脉滴注还原型谷胱甘肽保肝，并复查血常规及生化后继续住院观察。","is_gold":false},{"letter":"L","text":"暂不予任何药物处理，直接安排出院，嘱院外定期复查血常规及生化，若出现发热再返院使用粒细胞集落刺激因子。","is_gold":false}],"gold_letter":"I"},{"sample_id":"sample-6d1ca43d48e1d74031505487","patient_id":"patient-290a042206ccfe67e72f9a19","turn_id":"turn07","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、头长肌、斜坡、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 电轴左偏(轻度) 心电图大致正常\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D14] 检验组合: 总胆固醇(TC)-静脉血: 5.88mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜碱性粒细胞百分比(Baso%)-静脉血: 0；单核细胞百分比(Mono%)-静脉血: 0.008；丙氨酸氨基转移酶(ALT)-静脉血: 65.5U/L；血小板分布宽度(PDW)-静脉血: 13.8%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.9；白蛋白(ALB)-静脉血: 42.5g/L；球蛋白(GLO)-静脉血: 26g/L；胱抑素(Cys-C)-静脉血: 1.11mg/L；总蛋白(TP)-静脉血: 68.5g/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.7mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞计数(RBC#)-静脉血: 4.4510E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；总胆红素(TBIL)-静脉血: 15.4umol/L；钾离子(K+)-静脉血: 4.03mmol/L；葡萄糖(Glu)-静脉血: 5.74mmol/L；乳酸脱氢酶(LDH)-静脉血: 175U/L；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；肌酐(Crea)-静脉血: 80umol/L；总钙(Ca)-静脉血: 2.18mmol/L；钠离子(Na+)-静脉血: 132.2mmol/L；大血小板百分比(P-LCR%)-静脉血: 34.4%；红细胞比容(Hct)-静脉血: 39.3%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；阴离子间隙(AG)-静脉血: 17.8；γ-谷氨酰基转移酶(GGT)-静脉血: 26.8U/L；白细胞计数(WBC#)-静脉血: 5.2310E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.83mmol/L；平均血小板体积(MPV)-静脉血: 11.2fL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.01；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.51mmolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.35；碱性磷酸酶(ALP)-静脉血: 57.4U/L；直接胆红素(DBIL)-静脉血: 4.1umol/L；镁离子(Mg2+)-静脉血: 0.93mmol/L；血红蛋白(Hb)-静脉血: 1……\n- [全程D29] 检验组合: γ-谷氨酰基转移酶(GGT)-静脉血: 24.3U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.69；中性粒细胞计数(Neut#)-静脉血: 5.710E9/L；载脂蛋白AI(apoAI)-静脉血: 1.44g/L；血红蛋白(Hb)-静脉血: 117g/L；总胆固醇(TC)-静脉血: 5.21mmol/L；血小板分布宽度(PDW)-静脉血: 9.2%；乳酸脱氢酶(LDH)-静脉血: 181.3U/L；总胆汁酸(TBA)-静脉血: 3.1umol/L；直接胆红素(DBIL)-静脉血: 2umol/L；白蛋白(ALB)-静脉血: 39.2g/L；总胆红素(TBIL)-静脉血: 7.9umol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；平均红细胞体积(MCV)-静脉血: 92.9fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.647；C-反应蛋白(CRP)-静脉血: 1.01mg/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.3；红细胞计数(RBC#)-静脉血: 3.9410E12/L；白细胞计数(WBC#)-静脉血: 8.7310E9/L；肌酐(Crea)-静脉血: 102.7umol/L；钠离子(Na+)-静脉血: 141.8mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.56；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.32mmolL；总钙(Ca)-静脉血: 2.29mmol/L；胱抑素(Cys-C)-静脉血: 1.08mg/L；血液二氧化碳含量ctCO2(B)-静脉血: 26.3mmol/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；碱性磷酸酶(ALP)-静脉血: 61.9U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.5U/L；甘油三酯(TG)-静脉血: 1.82mmol/L；氯离子(Cl-)-静脉血: 103.6mmol/L；间接胆红素(IBIL)-静脉血: 5.9umolL；大血小板百分比(P-LCR%)-静脉血: 13.5%；淋巴细胞百分比(Lymph%)-静脉血: 0.282；葡萄糖(Glu)-静脉血: 5.18mmol/L；尿素氮(BUN)-静脉血: 6.……\n- [全程D31] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 2/μL；胆红素(BIL)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.011；比重(SG)-尿液: 1.017；隐血(OB)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 1/μL；胆红素(BIL)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 10/μL；白细胞(LEU)-尿液: -（参考: 阴性）；颜色-尿液: 无色；浊度(TRUB)-尿液: clear；总蛋白(TP)-尿液: -（参考: 阴性）\n- [全程D33] 检验组合: 胆红素(BIL)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.016；浊度(TRUB)-尿液: 清亮；总蛋白(TP)-尿液: -（参考: 阴性）；颜色-尿液: Light-Yellow；隐血(OB)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7；白细胞计数(WBC#)-尿液: 1/μL；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）\n- [全程D34] 检验组合: 隐血(OB)-粪便: 阴性（参考: 阴性）；阴离子间隙(AG)-静脉血: 10.6；颜色-粪便: 棕色；钠离子(Na+)-静脉血: 136.7mmol/L；虫卵-粪便: 未见虫卵（参考: 未见虫卵）；血液二氧化碳含量ctCO2(B)-静脉血: 26.2mmol/L；氯离子(Cl-)-静脉血: 99.9mmol/L；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；磷(P)-静脉血: 1.16mmol/L；总钙(Ca)-静脉血: 1.98mmol/L；镁离子(Mg2+)-静脉血: 0.59mmol/L；钾离子(K+)-静脉血: 3.49mmol/L；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）\n- [全程D36] 检验组合: 钾离子(K+)-静脉血: 4.1mmol/L；碱性磷酸酶(ALP)-静脉血: 51.9U/L；球蛋白(GLO)-静脉血: 20.23g/L；钠离子(Na+)-静脉血: 136.6mmol/L；阴离子间隙(AG)-静脉血: 13；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.82mmol/L；总胆红素(TBIL)-静脉血: 15.3umol/L；镁离子(Mg2+)-静脉血: 0.51mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.14g/L；氯离子(Cl-)-静脉血: 99mmol/L；单核细胞计数(Mono#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 46.3；乳酸脱氢酶(LDH)-静脉血: 169.8U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15.6U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.78；磷(P)-静脉血: 1.11mmol/L；葡萄糖(Glu)-静脉血: 5.25mmol/L；总钙(Ca)-静脉血: 2.08mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 27.3U/L；血小板计数(PLT#)-静脉血: 10410E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 327g/L；单核细胞百分比(Mono%)-静脉血: 0.005；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；总胆固醇(TC)-静脉血: 5.03mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 28U/L；平均红细胞体积(MCV)-静脉血: 90.6fL；血红蛋白(Hb)-静脉血: 110g/L；血小板分布宽度(PDW)-静脉血: 11.8%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.6pg；白蛋白(ALB)-静脉血: 36g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.1；血液二氧化碳含量ctCO2(B)-静脉血: 24.8mmol/L；总蛋白(TP)-静脉血: 56.23g/L；间接胆红素(IBIL)-静脉血: 10umolL；总胆汁酸(TBA)-静脉血: 4.4umol/L；载脂蛋白B(apoB)-静脉血: 0.9g/L；C-反应蛋白(CRP)-静脉血: 1.75mg/L；嗜酸性粒细胞百分……\n- [全程D37] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后复查，与某次就诊时间对比： 鼻咽腔稍狭窄，鼻咽顶壁、顶后壁、后壁及双侧壁稍增厚，T1WI呈等信号，T2WI呈稍高信号，增强扫描强化明显，粘膜表面不光整。双侧咽隐窝变浅。双侧咽旁间隙未见明显狭窄。双侧腭帆张提肌、头长肌信号不均匀，增强后不均匀强化。双侧翼内外肌未见受侵。 口咽双侧壁未见增厚，左侧鼻甲明显肿大，气道狭窄。双侧鼻腔未见肿物。 双侧翼腭窝、上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 斜坡、枕骨基底部、蝶骨基底部、双侧翼突基底、翼内板、右侧岩尖骨质信号降低，增强扫描强化明显。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 蝶窦、筛窦及右侧乳突气房内见积液，双侧上颌窦及左侧乳突充气良好，骨壁完整。 左侧咽后见淋巴结，大小约4mm×7mm，较前缩小；右侧咽后见小淋巴结，大小约3mm×4mm，较前缩小。双颈II、III区见数个淋巴结，大者大小约8mm×14mm，边界欠清，信号不均匀，增强扫描不均匀明显强化，较前缩小。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌化疗后复查，与某次就诊时间对比： 鼻咽病变，较前明显好转。 颅底骨质破坏，较前好转。 双侧咽后淋巴结，较前缩小。 双颈II、III区淋巴结，考虑转移，较前缩小。 鼻窦炎，右侧乳突炎。\n\n【既往治疗与反应】\n- [全程D15] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第1程TPF方案诱导化疗结束，诉呕吐1次，恶心、食欲下降，无发热、腹痛、腹泻，无手足麻木、脱屑、关节酸痛等。查体：张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；双侧颈部IIa区各可扪及1个淋巴结，左颈2×2cm，右颈1.5×1.5cm,无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第1程TPF方案诱导化疗结束，无诉特殊不适，可予出院，嘱其门诊监测血常规、肝肾功能，定期返院治疗。遵嘱。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D30] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者无明显化疗禁忌症，可于今日水化，明日执行第2程多西紫杉醇＋DDP+5-FU方案诱导化疗，注意化疗不良反应。\n- [全程D31] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程多西紫杉醇＋DDP+5-FU方案诱导化疗第一天，诉恶心、上腹不适，无发热、腹痛、腹泻等不适。查体：基本同前。[姓名已隐去]医生信息已隐藏示：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D35] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者第2程多西紫杉醇＋DDP+5-FU方案诱导化疗结束，诉反酸、恶心，无发热、腹痛、腹泻，无关节酸痛等。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者第2程多西紫杉醇＋DDP+5-FU方案诱导化疗结束后出现反酸、恶心现象，予抑酸护胃、补液等对症处理，继观。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即启动根治性调强放疗联合同步顺铂化疗，停止静脉高营养以避免导管相关感染。\nB. 更换为吉西他滨联合顺铂方案进行第四周期诱导化疗，并继续抑酸护胃治疗。\nC. 安排鼻咽原发灶及双侧颈部淋巴结根治性切除术，术后辅以静脉营养支持。\nD. 维持静脉营养支持，并立即启动根治性放疗联合PD-1抑制剂及靶向治疗。\nE. 继续原方案（多西紫杉醇+顺铂+5-FU）进行第四周期诱导化疗，并辅以抑酸护胃治疗。\nF. 暂停所有抗肿瘤治疗，仅维持静脉营养支持及抑酸治疗，1个月后复查MRI决定后续方案。\nG. 安排全身PET-CT检查评估全身情况，若无远处转移则继续原方案诱导化疗两周期。\nH. 行局部清扫术，处理颈部残留淋巴结，术后序贯鼻咽部根治性放疗及静脉营养支持。\nI. 调整为卡培他滨节拍化疗联合静脉营养支持，待消化道反应完全缓解后启动放疗。\nJ. 继续予以抑酸护胃及静脉高营养等对症支持治疗，待体能恢复后序贯开展根治性放疗或同步放化疗。\nK. 启动姑息性放疗控制局部及颈部病灶，并联合阿帕替尼等抗血管生成药物治疗。\nL. 维持静脉营养支持，并安排鼻咽镜下局部病灶再次活检以病理确认肿瘤退缩程度。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"立即启动根治性调强放疗联合同步顺铂化疗，停止静脉高营养以避免导管相关感染。","is_gold":false},{"letter":"B","text":"更换为吉西他滨联合顺铂方案进行第四周期诱导化疗，并继续抑酸护胃治疗。","is_gold":false},{"letter":"C","text":"安排鼻咽原发灶及双侧颈部淋巴结根治性切除术，术后辅以静脉营养支持。","is_gold":false},{"letter":"D","text":"维持静脉营养支持，并立即启动根治性放疗联合PD-1抑制剂及靶向治疗。","is_gold":false},{"letter":"E","text":"继续原方案（多西紫杉醇+顺铂+5-FU）进行第四周期诱导化疗，并辅以抑酸护胃治疗。","is_gold":false},{"letter":"F","text":"暂停所有抗肿瘤治疗，仅维持静脉营养支持及抑酸治疗，1个月后复查MRI决定后续方案。","is_gold":false},{"letter":"G","text":"安排全身PET-CT检查评估全身情况，若无远处转移则继续原方案诱导化疗两周期。","is_gold":false},{"letter":"H","text":"行局部清扫术，处理颈部残留淋巴结，术后序贯鼻咽部根治性放疗及静脉营养支持。","is_gold":false},{"letter":"I","text":"调整为卡培他滨节拍化疗联合静脉营养支持，待消化道反应完全缓解后启动放疗。","is_gold":false},{"letter":"J","text":"继续予以抑酸护胃及静脉高营养等对症支持治疗，待体能恢复后序贯开展根治性放疗或同步放化疗。","is_gold":true},{"letter":"K","text":"启动姑息性放疗控制局部及颈部病灶，并联合阿帕替尼等抗血管生成药物治疗。","is_gold":false},{"letter":"L","text":"维持静脉营养支持，并安排鼻咽镜下局部病灶再次活检以病理确认肿瘤退缩程度。","is_gold":false}],"gold_letter":"J"}]}
+{"patient_id":"patient-e45c55cc63c050892e6b2467","bootstrap_cluster_id":"cluster-015","turns":[{"sample_id":"sample-23bcdf34802b996618f9500b","patient_id":"patient-e45c55cc63c050892e6b2467","turn_id":"turn01","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、颈动脉鞘、斜坡、翼突基底部、蝶骨基底部、岩尖、寰椎。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D2] 入院记录: 主诉: 发现右颈部肿物5月余；现病史: 患者于入院前5月前（某次就诊时间10月）高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；阳性症状体征: 体重下降,疼痛,高热,右颈部肿物,颈部酸痛；既往史: 既往有“肾病综合征”病史，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。；家族史: 否认肿瘤家族史。；体格检查: T：36℃，P：68次/分，R：20次/分，BP：91/58mmHg,Ht：144cm，Wt：31kg，BSA：1.135m2，KPS：KPS 90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，暂缓全身影像学分期检查。\nB. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，PET-CT全身显像。\nC. 右颈部肿物切除活检，鼻咽及颈部MRI平扫+增强，全身骨显像，腹部彩超。\nD. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫，全身骨显像，腹部彩超，心电图。\nE. 鼻咽镜检查及活检，头颅MRI平扫+增强，颈部彩超，全身骨显像，腹部彩超。\nF. 鼻咽刷片细胞学检查，鼻咽及颈部MRI平扫+增强，全身骨显像，腹部彩超。\nG. 鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，全身骨显像，腹部彩超，心电图。\nH. 右颈部肿物细针穿刺活检，鼻咽及颈部MRI平扫+增强，全身骨显像，腹部彩超。\nI. 鼻咽镜检查及活检，鼻咽MRI平扫+增强，全身骨显像，腹部彩超，心电图。\nJ. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，骨髓穿刺活检，腹部彩超。\nK. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部及腹部MRI平扫+增强。\nL. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身骨显像、腹部彩超及心电图等基线检查。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，暂缓全身影像学分期检查。","is_gold":false},{"letter":"B","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，PET-CT全身显像。","is_gold":false},{"letter":"C","text":"右颈部肿物切除活检，鼻咽及颈部MRI平扫+增强，全身骨显像，腹部彩超。","is_gold":false},{"letter":"D","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫，全身骨显像，腹部彩超，心电图。","is_gold":false},{"letter":"E","text":"鼻咽镜检查及活检，头颅MRI平扫+增强，颈部彩超，全身骨显像，腹部彩超。","is_gold":false},{"letter":"F","text":"鼻咽刷片细胞学检查，鼻咽及颈部MRI平扫+增强，全身骨显像，腹部彩超。","is_gold":false},{"letter":"G","text":"鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，全身骨显像，腹部彩超，心电图。","is_gold":false},{"letter":"H","text":"右颈部肿物细针穿刺活检，鼻咽及颈部MRI平扫+增强，全身骨显像，腹部彩超。","is_gold":false},{"letter":"I","text":"鼻咽镜检查及活检，鼻咽MRI平扫+增强，全身骨显像，腹部彩超，心电图。","is_gold":false},{"letter":"J","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，骨髓穿刺活检，腹部彩超。","is_gold":false},{"letter":"K","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部及腹部MRI平扫+增强。","is_gold":false},{"letter":"L","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身骨显像、腹部彩超及心电图等基线检查。","is_gold":true}],"gold_letter":"L"},{"sample_id":"sample-6cb68b4fe11abd5f5e27ea88","patient_id":"patient-e45c55cc63c050892e6b2467","turn_id":"turn02","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、颈动脉鞘、斜坡、翼突基底部、蝶骨基底部、岩尖、寰椎。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D1] 门急诊记录: 主诉: 右颈部肿物6月余；现病史: 患者某次就诊时间10月份高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；既往史: 肾病综合征。否认高血压、糖尿病、冠心病、肾病等慢性病史，否认乙肝、结核等传染病史，否认重大外伤史，否认献血输血及使用血制品史，否认食物药物过敏史。；个人史: 原籍出生长大，否认疫区疫水接触史，否认化学毒性及放射性物质接触史。；家族史: 否认家族类似病史及肿瘤病史。；体格检查: KPS90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。\n- [全程D2] 入院记录: 主诉: 发现右颈部肿物5月余；现病史: 患者于入院前5月前（某次就诊时间10月）高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；阳性症状体征: 体重下降,疼痛,高热,右颈部肿物,颈部酸痛；既往史: 既往有“肾病综合征”病史，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。；家族史: 否认肿瘤家族史。；体格检查: T：36℃，P：68次/分，R：20次/分，BP：91/58mmHg,Ht：144cm，Wt：31kg，BSA：1.135m2，KPS：KPS 90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D3] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见: 心电图大致正常；检查结论: 窦性心律不齐 心电图大致正常\n- [全程D3] 检验组合: 乳酸脱氢酶(LDH)-静脉血: 198.2U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 10.4U/L；总胆红素(TBIL)-静脉血: 4.2umol/L；葡萄糖(Glu)-静脉血: 4.55mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.495COI；α-L-岩藻糖苷酶(AFU)-静脉血: 35U/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；铁蛋白(Ferr)-静脉血: 91.44ng/ml；磷(P)-静脉血: 1.76mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阴性(-)（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.21ug/ml；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阳性(129.78U/mL)（参考: 阴性）；淋巴细胞百分比(Lymph%)-静脉血: 0.426；碱性磷酸酶(ALP)-静脉血: 130.2U/L；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；纤维蛋白原(Fbg)-静脉血: 2.78g/L；钾离子(K+)-静脉血: 3.5mmol/L；免疫球蛋白游离λ轻链(F-Lambda)-静脉血: 阴性(-)（参考: 阴性(-)）；平均血小板体积(MPV)-静脉血: 8.8fL；尿酸(UA)-静脉血: 200umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.24mmolL；天门冬氨酸氨基转移酶(AST)-静脉血: 18.5U/L；尿素氮(BUN)-静脉血: 3.59mmol/L；总胆固醇(TC)-静脉血: 3.29mmol/L；直接胆红素(DBIL)-静脉血: 1.6umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 11.9U/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.98；中性粒细胞百分比(Neut%)-静脉血: 0.516；肌酐(Crea)-静脉血: 35.7umol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞体积(MCV)-静脉血……\n- [全程D4] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约24cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行鼻咽镜检查及活检，并完善胸片或胸部CT检查。\nB. 行右颈部肿大淋巴结切除活检，并完善胸片或胸部CT检查。\nC. 行鼻咽镜检查及活检，并完善头颅增强MRI检查。\nD. 行右颈部肿大淋巴结细针穿刺活检，并完善全身骨扫描。\nE. 行全身PET-CT检查，暂缓鼻咽及颈部活检。\nF. 行鼻咽镜检查及活检，暂不安排其他部位影像学检查。\nG. 完善胸部及全腹部增强CT检查，待结果回报后再行活检。\nH. 行鼻咽镜检查及活检，并复查颈部彩超评估淋巴结。\nI. 安排鼻咽及颈部根治性放疗，同步完善胸片或胸部CT检查。\nJ. 行鼻咽镜检查及活检，并完善全身骨扫描检查。\nK. 给予抗炎治疗2周后复查鼻咽MRI，再决定是否行鼻咽活检。\nL. 行鼻咽镜检查及活检，并完善血浆EBV-DNA检测，暂缓胸部影像学检查。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"行鼻咽镜检查及活检，并完善胸片或胸部CT检查。","is_gold":true},{"letter":"B","text":"行右颈部肿大淋巴结切除活检，并完善胸片或胸部CT检查。","is_gold":false},{"letter":"C","text":"行鼻咽镜检查及活检，并完善头颅增强MRI检查。","is_gold":false},{"letter":"D","text":"行右颈部肿大淋巴结细针穿刺活检，并完善全身骨扫描。","is_gold":false},{"letter":"E","text":"行全身PET-CT检查，暂缓鼻咽及颈部活检。","is_gold":false},{"letter":"F","text":"行鼻咽镜检查及活检，暂不安排其他部位影像学检查。","is_gold":false},{"letter":"G","text":"完善胸部及全腹部增强CT检查，待结果回报后再行活检。","is_gold":false},{"letter":"H","text":"行鼻咽镜检查及活检，并复查颈部彩超评估淋巴结。","is_gold":false},{"letter":"I","text":"安排鼻咽及颈部根治性放疗，同步完善胸片或胸部CT检查。","is_gold":false},{"letter":"J","text":"行鼻咽镜检查及活检，并完善全身骨扫描检查。","is_gold":false},{"letter":"K","text":"给予抗炎治疗2周后复查鼻咽MRI，再决定是否行鼻咽活检。","is_gold":false},{"letter":"L","text":"行鼻咽镜检查及活检，并完善血浆EBV-DNA检测，暂缓胸部影像学检查。","is_gold":false}],"gold_letter":"A"},{"sample_id":"sample-51ced222567a8eb77bc8161d","patient_id":"patient-e45c55cc63c050892e6b2467","turn_id":"turn04","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、颈动脉鞘、斜坡、翼突基底部、蝶骨基底部、岩尖、寰椎。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 入院记录: 主诉: 发现右颈部肿物5月余；现病史: 患者于入院前5月前（某次就诊时间10月）高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。行右颈部肿物活检病理回报：提示鼻咽部鳞癌转移。鼻咽部MR示：鼻咽顶后壁及两侧壁粘膜增厚，右侧翼内肌、咽鼓管、头长肌受侵，右侧斜坡，颞骨岩部，寰椎前弓骨质破坏。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；阳性症状体征: 体重下降,疼痛,高热,右颈部肿物,颈部酸痛；既往史: 既往有“肾病综合征”病史，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。；家族史: 否认肿瘤家族史。；体格检查: T：36℃，P：68次/分，R：20次/分，BP：91/58mmHg,Ht：144cm，Wt：31kg，BSA：1.135m2，KPS：KPS 90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率{数值}次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。右颈扪及肿物，约4*3cm,无压痛，质硬，活动差，边界尚清，未扪及明显融合，活检伤口愈合良好。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D3] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见: 心电图大致正常；检查结论: 窦性心律不齐 心电图大致正常\n- [全程D3] 检验组合: 乳酸脱氢酶(LDH)-静脉血: 198.2U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 10.4U/L；总胆红素(TBIL)-静脉血: 4.2umol/L；葡萄糖(Glu)-静脉血: 4.55mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.495COI；α-L-岩藻糖苷酶(AFU)-静脉血: 35U/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；铁蛋白(Ferr)-静脉血: 91.44ng/ml；磷(P)-静脉血: 1.76mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阴性(-)（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.21ug/ml；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阳性(129.78U/mL)（参考: 阴性）；淋巴细胞百分比(Lymph%)-静脉血: 0.426；碱性磷酸酶(ALP)-静脉血: 130.2U/L；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；纤维蛋白原(Fbg)-静脉血: 2.78g/L；钾离子(K+)-静脉血: 3.5mmol/L；免疫球蛋白游离λ轻链(F-Lambda)-静脉血: 阴性(-)（参考: 阴性(-)）；平均血小板体积(MPV)-静脉血: 8.8fL；尿酸(UA)-静脉血: 200umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.24mmolL；天门冬氨酸氨基转移酶(AST)-静脉血: 18.5U/L；尿素氮(BUN)-静脉血: 3.59mmol/L；总胆固醇(TC)-静脉血: 3.29mmol/L；直接胆红素(DBIL)-静脉血: 1.6umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 11.9U/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.98；中性粒细胞百分比(Neut%)-静脉血: 0.516；肌酐(Crea)-静脉血: 35.7umol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞体积(MCV)-静脉血……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 予以根治性单纯放疗\nB. 予以诱导化疗序贯同期放化疗\nC. 予以诱导化疗序贯单纯放疗\nD. 予以同期放化疗序贯辅助化疗\nE. 予以靶向治疗联合同期放化疗\nF. 予以免疫治疗联合同期放化疗\nG. 予以诱导化疗序贯靶向治疗联合放疗\nH. 行颈部淋巴结清扫术序贯根治性放疗\nI. 行鼻咽原发灶切除联合颈部淋巴结清扫术\nJ. 予以姑息性化疗联合局部姑息性放疗\nK. 予以诱导化疗序贯根治性手术切除\n\n请仅输出一个选项字母（A-K）。","options":[{"letter":"A","text":"予以根治性单纯放疗","is_gold":false},{"letter":"B","text":"予以诱导化疗序贯同期放化疗","is_gold":true},{"letter":"C","text":"予以诱导化疗序贯单纯放疗","is_gold":false},{"letter":"D","text":"予以同期放化疗序贯辅助化疗","is_gold":false},{"letter":"E","text":"予以靶向治疗联合同期放化疗","is_gold":false},{"letter":"F","text":"予以免疫治疗联合同期放化疗","is_gold":false},{"letter":"G","text":"予以诱导化疗序贯靶向治疗联合放疗","is_gold":false},{"letter":"H","text":"行颈部淋巴结清扫术序贯根治性放疗","is_gold":false},{"letter":"I","text":"行鼻咽原发灶切除联合颈部淋巴结清扫术","is_gold":false},{"letter":"J","text":"予以姑息性化疗联合局部姑息性放疗","is_gold":false},{"letter":"K","text":"予以诱导化疗序贯根治性手术切除","is_gold":false}],"gold_letter":"B"},{"sample_id":"sample-31164fa636b978a86d54f0c9","patient_id":"patient-e45c55cc63c050892e6b2467","turn_id":"turn05","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、颈动脉鞘、斜坡、翼突基底部、蝶骨基底部、岩尖、寰椎。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 入院记录: 主诉: 发现右颈部肿物5月余；现病史: 患者于入院前5月前（某次就诊时间10月）高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。行右颈部肿物活检病理回报：提示鼻咽部鳞癌转移。鼻咽部MR示：鼻咽顶后壁及两侧壁粘膜增厚，右侧翼内肌、咽鼓管、头长肌受侵，右侧斜坡，颞骨岩部，寰椎前弓骨质破坏。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；阳性症状体征: 体重下降,疼痛,高热,右颈部肿物,颈部酸痛；既往史: 既往有“肾病综合征”病史，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。；家族史: 否认肿瘤家族史。；体格检查: T：36℃，P：68次/分，R：20次/分，BP：91/58mmHg,Ht：144cm，Wt：31kg，BSA：1.135m2，KPS：KPS 90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率{数值}次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。右颈扪及肿物，约4*3cm,无压痛，质硬，活动差，边界尚清，未扪及明显融合，活检伤口愈合良好。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D3] 检验组合: 乳酸脱氢酶(LDH)-静脉血: 198.2U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 10.4U/L；总胆红素(TBIL)-静脉血: 4.2umol/L；葡萄糖(Glu)-静脉血: 4.55mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.495COI；α-L-岩藻糖苷酶(AFU)-静脉血: 35U/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；铁蛋白(Ferr)-静脉血: 91.44ng/ml；磷(P)-静脉血: 1.76mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阴性(-)（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.21ug/ml；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阳性(129.78U/mL)（参考: 阴性）；淋巴细胞百分比(Lymph%)-静脉血: 0.426；碱性磷酸酶(ALP)-静脉血: 130.2U/L；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；纤维蛋白原(Fbg)-静脉血: 2.78g/L；钾离子(K+)-静脉血: 3.5mmol/L；免疫球蛋白游离λ轻链(F-Lambda)-静脉血: 阴性(-)（参考: 阴性(-)）；平均血小板体积(MPV)-静脉血: 8.8fL；尿酸(UA)-静脉血: 200umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.24mmolL；天门冬氨酸氨基转移酶(AST)-静脉血: 18.5U/L；尿素氮(BUN)-静脉血: 3.59mmol/L；总胆固醇(TC)-静脉血: 3.29mmol/L；直接胆红素(DBIL)-静脉血: 1.6umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 11.9U/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.98；中性粒细胞百分比(Neut%)-静脉血: 0.516；肌酐(Crea)-静脉血: 35.7umol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞体积(MCV)-静脉血……\n- [全程D4] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约24cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D21] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显占位病变，肺门纵隔未见明显增宽，心影无增大，双侧肋膈角锐利。；检查结论: 心肺未见病变。\n- [全程D21] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 23mmol/L；总胆红素(TBIL)-静脉血: 7.6umol/L；C-反应蛋白(CRP)-静脉血: 4.9mg/L；总胆固醇(TC)-静脉血: 4.18mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.5mmolL；总胆汁酸(TBA)-静脉血: 2.5umol/L；血型抗体筛查-静脉血: 阴性；ABO血型-静脉血: B；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；大血小板百分比(P-LCR%)-静脉血: 24.7%；血小板比容-静脉血: 32%；血小板分布宽度(PDW)-静脉血: 11.1%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；总蛋白(TP)-静脉血: 74.14g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.011；平均红细胞血红蛋白含量(MCH)-静脉血: 28.1pg；白蛋白(ALB)-静脉血: 38.9g/L；甘油三酯(TG)-静脉血: 0.81mmol/L；磷(P)-静脉血: 1.55mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.1；直接胆红素(DBIL)-静脉血: 2.5umol/L；平均红细胞体积(MCV)-静脉血: 84.5fL；平均血小板体积(MPV)-静脉血: 10.1fL；钠离子(Na+)-静脉血: 136.6mmol/L；氯离子(Cl-)-静脉血: 101.1mmol/L；镁离子(Mg2+)-静脉血: 0.72mmol/L；肌酐(Crea)-静脉血: 33.8umol/L；Rh血型-静脉血: 阳性；载脂蛋白AI(apoAI)-静脉血: 1.34g/L；尿素氮(BUN)-静脉血: 5.75mmol/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；淋巴细胞计数(Lymph#)-静脉血: 2.810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.591；白细胞计数(WBC#)-静脉血: 8.5610E9/L；钾离子(K+)-静脉血: 4.3mmol/L；总钙(Ca)-静脉血: 2.26mmol/L；尿酸(UA)-静脉血: 204.9umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24.5U/L；有核红细胞计数(NRBC……\n\n【既往治疗与反应】\n- [全程D3] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日随夏医生信息已隐藏，患者颈背部酸痛较前有好转，无发热畏寒，无恶心呕吐，无胸闷心悸，胃纳睡眠尚可，二便未见明显异常，体查：KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。右颈扪及肿物，约4*3cm,无压痛，质硬，活动差，边界尚清，未扪及明显融合，活检伤口愈合良好。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。右颈部肿物活检病理回报：提示鼻咽部鳞癌转移。鼻咽部MR示：鼻咽顶后壁及两侧壁粘膜增厚，右侧翼内肌、咽鼓管、头长肌受侵，右侧斜坡，颞骨岩部，寰椎前弓骨质破坏。目前患者诊断：鼻咽癌，患者病理活检部位为右颈部肿物，提示转移性鳞癌，建议其行鼻咽部肿物病理活检，患者家属不同意，有放疗适应症，无相对放疗禁忌症，告知患者放疗风险及副反应，患者家属表示理解病情，现治疗后患者要求出院，予以办理，嘱注意休息合理饮食，定期复诊，不适随诊。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D19] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。凝血、乙肝两对半、肝炎四项、HIV/梅毒等检验结果无明显异常。[姓名已隐去]主任查房后，患者因年龄较小，完成活检等操作不配合，家属要求全麻下行活检明确病理，完善相关检查后择期手术，遵嘱执行。\n- [全程D20] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。[姓名已隐去]主任查房后示，完善术前相关检验检查，做好术前准备，遵嘱执行。\n- [全程D21] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。血常规、生化常规回报无明显异常。输血三项回报：B型、RH阳性、抗体筛选阴性。[姓名已隐去]主任查房后示，结合患者各项检查，未见明显手术禁忌，拟明日在气管内吸入全麻下经鼻内镜行鼻咽肿物活检+颈部肿物活检术，做好术前准备，遵嘱执行。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善局麻下鼻咽及颈部肿物活检术前准备，予以口服地西泮镇静及配血备用。\nB. 完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注头孢类抗生素预防感染。\nC. 完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注氨甲环酸预防术中出血。\nD. 完善全麻下鼻咽及颈部肿物活检术前准备，予以配血备用及口服地西泮镇静。\nE. 完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注人血白蛋白及复方氨基酸。\nF. 完善全麻下鼻咽及颈部肿物活检术前准备，予以皮下注射低分子肝素及下肢气压治疗。\nG. 完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉滴注地塞米松及雾化吸入。\nH. 完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉补充氯化钾及晶体液扩容。\nI. 暂缓活检手术，予以静脉输注广谱抗生素及补液支持治疗。\nJ. 暂缓活检手术，予以口服非甾体类抗炎药及局部热敷理疗。\nK. 完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注单采血小板及冷沉淀。\nL. 完善全麻下鼻咽及颈部肿物活检术前准备，予以口服氯雷他定及局部涂抹糖皮质激素。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"完善局麻下鼻咽及颈部肿物活检术前准备，予以口服地西泮镇静及配血备用。","is_gold":false},{"letter":"B","text":"完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注头孢类抗生素预防感染。","is_gold":false},{"letter":"C","text":"完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注氨甲环酸预防术中出血。","is_gold":false},{"letter":"D","text":"完善全麻下鼻咽及颈部肿物活检术前准备，予以配血备用及口服地西泮镇静。","is_gold":true},{"letter":"E","text":"完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注人血白蛋白及复方氨基酸。","is_gold":false},{"letter":"F","text":"完善全麻下鼻咽及颈部肿物活检术前准备，予以皮下注射低分子肝素及下肢气压治疗。","is_gold":false},{"letter":"G","text":"完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉滴注地塞米松及雾化吸入。","is_gold":false},{"letter":"H","text":"完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉补充氯化钾及晶体液扩容。","is_gold":false},{"letter":"I","text":"暂缓活检手术，予以静脉输注广谱抗生素及补液支持治疗。","is_gold":false},{"letter":"J","text":"暂缓活检手术，予以口服非甾体类抗炎药及局部热敷理疗。","is_gold":false},{"letter":"K","text":"完善全麻下鼻咽及颈部肿物活检术前准备，予以静脉输注单采血小板及冷沉淀。","is_gold":false},{"letter":"L","text":"完善全麻下鼻咽及颈部肿物活检术前准备，予以口服氯雷他定及局部涂抹糖皮质激素。","is_gold":false}],"gold_letter":"D"},{"sample_id":"sample-e79a5ee2227343d5e15dc4d1","patient_id":"patient-e45c55cc63c050892e6b2467","turn_id":"turn06","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、颈动脉鞘、斜坡、翼突基底部、蝶骨基底部、岩尖、寰椎。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 入院记录: 主诉: 发现右颈部肿物5月余；现病史: 患者于入院前5月前（某次就诊时间10月）高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。行右颈部肿物活检病理回报：提示鼻咽部鳞癌转移。鼻咽部MR示：鼻咽顶后壁及两侧壁粘膜增厚，右侧翼内肌、咽鼓管、头长肌受侵，右侧斜坡，颞骨岩部，寰椎前弓骨质破坏。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；阳性症状体征: 体重下降,疼痛,高热,右颈部肿物,颈部酸痛；既往史: 既往有“肾病综合征”病史，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。；家族史: 否认肿瘤家族史。；体格检查: T：36℃，P：68次/分，R：20次/分，BP：91/58mmHg,Ht：144cm，Wt：31kg，BSA：1.135m2，KPS：KPS 90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率{数值}次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。右颈扪及肿物，约4*3cm,无压痛，质硬，活动差，边界尚清，未扪及明显融合，活检伤口愈合良好。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D21] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显占位病变，肺门纵隔未见明显增宽，心影无增大，双侧肋膈角锐利。；检查结论: 心肺未见病变。\n- [全程D21] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 23mmol/L；总胆红素(TBIL)-静脉血: 7.6umol/L；C-反应蛋白(CRP)-静脉血: 4.9mg/L；总胆固醇(TC)-静脉血: 4.18mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.5mmolL；总胆汁酸(TBA)-静脉血: 2.5umol/L；血型抗体筛查-静脉血: 阴性；ABO血型-静脉血: B；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；大血小板百分比(P-LCR%)-静脉血: 24.7%；血小板比容-静脉血: 32%；血小板分布宽度(PDW)-静脉血: 11.1%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；总蛋白(TP)-静脉血: 74.14g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.011；平均红细胞血红蛋白含量(MCH)-静脉血: 28.1pg；白蛋白(ALB)-静脉血: 38.9g/L；甘油三酯(TG)-静脉血: 0.81mmol/L；磷(P)-静脉血: 1.55mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.1；直接胆红素(DBIL)-静脉血: 2.5umol/L；平均红细胞体积(MCV)-静脉血: 84.5fL；平均血小板体积(MPV)-静脉血: 10.1fL；钠离子(Na+)-静脉血: 136.6mmol/L；氯离子(Cl-)-静脉血: 101.1mmol/L；镁离子(Mg2+)-静脉血: 0.72mmol/L；肌酐(Crea)-静脉血: 33.8umol/L；Rh血型-静脉血: 阳性；载脂蛋白AI(apoAI)-静脉血: 1.34g/L；尿素氮(BUN)-静脉血: 5.75mmol/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；淋巴细胞计数(Lymph#)-静脉血: 2.810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.591；白细胞计数(WBC#)-静脉血: 8.5610E9/L；钾离子(K+)-静脉血: 4.3mmol/L；总钙(Ca)-静脉血: 2.26mmol/L；尿酸(UA)-静脉血: 204.9umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24.5U/L；有核红细胞计数(NRBC……\n- [全程D22] 检验组合: 乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D25] 检验组合: 血小板分布宽度(PDW)-静脉血: 10.3%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；比重(SG)-尿液: 1.028；甘油三酯(TG)-静脉血: 1.05mmol/L；红细胞计数(RBC#)-静脉血: 3.4910E12/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.86mmolL；平均红细胞体积(MCV)-静脉血: 84.8fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 42.4；丙氨酸氨基转移酶(ALT)-静脉血: 14.8U/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.001；尿酸(UA)-静脉血: 132.3umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.910E9/L；大血小板百分比(P-LCR%)-静脉血: 21.8%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；粘液丝计数(MUCS#)-尿液: 28/μL；红细胞计数(RBC#)-尿液: 1/μL；浊度(TRUB)-尿液: 清亮；血小板计数(PLT#)-静脉血: 31810E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.218；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7；天门冬氨酸氨基转移酶(AST)-静脉血: 11.2U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.1；载脂蛋白AI(apoAI)-静脉血: 1.14g/L；单核细胞百分比(Mono%)-静脉血: 0.084；总钙(Ca)-静脉血: 2.2mmol/L；总胆汁酸(TBA)-静脉血: 4.4umol/L；白蛋白(ALB)-静脉血: 35.7g/L；红细胞比容(Hct)-静脉血: 29.6%；单核细胞计数(Mono#)-静脉血: 0.710E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 10.9U/L；平均血小板体积(MPV)-静脉血: 9.7fL；中性粒细胞计数(Neut#)-静脉血: 6.110E9/L；胆红素(BIL)-尿液: -（参考: 阴性）；血红蛋白(Hb)-静脉血: 100g/L；C-反应蛋白(CRP)-静脉血: 66.11mg/L；葡萄糖(Glu)-静脉血: 4.89mmol/L；磷(P)-静脉血: 1.26mmol/L；直接胆红素(DBIL……\n\n【既往治疗与反应】\n- [全程D21] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。血常规、生化常规回报无明显异常。输血三项回报：B型、RH阳性、抗体筛选阴性。[姓名已隐去]主任查房后示，结合患者各项检查，未见明显手术禁忌，拟明日在气管内吸入全麻下经鼻内镜行鼻咽肿物活检+颈部肿物活检术，做好术前准备，遵嘱执行。\n- [全程D22] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者今日在气管内全麻下行左颈淋巴结切除活检+经鼻内镜鼻咽肿物切开活检术。术程顺利，术后麻醉复苏顺利，安返病房，生命体征平稳，未见口鼻活动性出血。[姓名已隐去]主任查房后，指示予抗炎、止血和支持对症治疗，并注意：1、呼吸情况；2、出血情况，遵嘱执行。\n- [全程D23] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者昨日在气管内全麻下行左颈淋巴结切除活检+经鼻内镜鼻咽肿物切开活检术，目前生命体征平稳，未见口鼻活动性出血，颈部伤口少许渗出，引流条固定在位，诉头痛、颈部肿物痛、鼻部不适。[姓名已隐去]主任查房后，指示继续抗炎、支持治疗，遵嘱执行。\n- [全程D24] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者前日在气管内全麻下行左颈淋巴结切除活检+经鼻内镜鼻咽肿物切开活检术，目前生命体征平稳，未见口鼻活动性出血，颈部伤口已无明显渗出，诉头痛、颈部肿物痛。[姓名已隐去]主任查房后，拔出引流条，指示继续抗炎、止痛、支持治疗，遵嘱执行。\n- [全程D25] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者前3日在气管内全麻下行左颈淋巴结切除活检+经鼻内镜鼻咽肿物切开活检术，目前生命体征平稳，未见口鼻活动性出血，诉头痛、颈部肿物痛。[姓名已隐去]主任查房后，指示继续抗炎、支持治疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即启动含铂双药诱导化疗，并完善心电图及超声心动图检查。\nB. 予以静脉输注氨甲环酸，并完善凝血常规及D-二聚体检查。\nC. 安排右颈部淋巴结清扫术，并静脉使用广谱抗生素抗感染。\nD. 予以阿片类药物滴定止痛，并完善全身骨扫描检查。\nE. 继续抗炎及支持治疗，完善血常规、尿常规及生化常规检查。\nF. 启动根治性调强放射治疗，并复查鼻咽及颈部增强MRI。\nG. 予以静脉高营养支持治疗，并复查血浆EBV-DNA定量。\nH. 预防性皮下注射低分子肝素，并完善双下肢深静脉彩超。\nI. 予以静脉滴注地塞米松，并复查头颈部增强CT。\nJ. 拔除静脉留置针，仅予以口服非甾体抗炎药，并继续留院观察。\nK. 停止静脉用药，改为口服头孢类抗生素，并立即办理出院。\nL. 予以颈部局部姑息性放疗，并完善甲状腺功能检查。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"立即启动含铂双药诱导化疗，并完善心电图及超声心动图检查。","is_gold":false},{"letter":"B","text":"予以静脉输注氨甲环酸，并完善凝血常规及D-二聚体检查。","is_gold":false},{"letter":"C","text":"安排右颈部淋巴结清扫术，并静脉使用广谱抗生素抗感染。","is_gold":false},{"letter":"D","text":"予以阿片类药物滴定止痛，并完善全身骨扫描检查。","is_gold":false},{"letter":"E","text":"继续抗炎及支持治疗，完善血常规、尿常规及生化常规检查。","is_gold":true},{"letter":"F","text":"启动根治性调强放射治疗，并复查鼻咽及颈部增强MRI。","is_gold":false},{"letter":"G","text":"予以静脉高营养支持治疗，并复查血浆EBV-DNA定量。","is_gold":false},{"letter":"H","text":"预防性皮下注射低分子肝素，并完善双下肢深静脉彩超。","is_gold":false},{"letter":"I","text":"予以静脉滴注地塞米松，并复查头颈部增强CT。","is_gold":false},{"letter":"J","text":"拔除静脉留置针，仅予以口服非甾体抗炎药，并继续留院观察。","is_gold":false},{"letter":"K","text":"停止静脉用药，改为口服头孢类抗生素，并立即办理出院。","is_gold":false},{"letter":"L","text":"予以颈部局部姑息性放疗，并完善甲状腺功能检查。","is_gold":false}],"gold_letter":"E"},{"sample_id":"sample-3246297632d882a392dfe20a","patient_id":"patient-e45c55cc63c050892e6b2467","turn_id":"turn07","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、颈动脉鞘、斜坡、翼突基底部、蝶骨基底部、岩尖、寰椎。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 入院记录: 主诉: 发现右颈部肿物5月余；现病史: 患者于入院前5月前（某次就诊时间10月）高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。行右颈部肿物活检病理回报：提示鼻咽部鳞癌转移。鼻咽部MR示：鼻咽顶后壁及两侧壁粘膜增厚，右侧翼内肌、咽鼓管、头长肌受侵，右侧斜坡，颞骨岩部，寰椎前弓骨质破坏。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；阳性症状体征: 体重下降,疼痛,高热,右颈部肿物,颈部酸痛；既往史: 既往有“肾病综合征”病史，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。；家族史: 否认肿瘤家族史。；体格检查: T：36℃，P：68次/分，R：20次/分，BP：91/58mmHg,Ht：144cm，Wt：31kg，BSA：1.135m2，KPS：KPS 90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率{数值}次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。右颈扪及肿物，约4*3cm,无压痛，质硬，活动差，边界尚清，未扪及明显融合，活检伤口愈合良好。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D3] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见: 心电图大致正常；检查结论: 窦性心律不齐 心电图大致正常\n- [全程D3] 检验组合: 乳酸脱氢酶(LDH)-静脉血: 198.2U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 10.4U/L；总胆红素(TBIL)-静脉血: 4.2umol/L；葡萄糖(Glu)-静脉血: 4.55mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.495COI；α-L-岩藻糖苷酶(AFU)-静脉血: 35U/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；铁蛋白(Ferr)-静脉血: 91.44ng/ml；磷(P)-静脉血: 1.76mmol/L；EB病毒核抗原1抗体IgA(EBV-NA1-IGA)-静脉血: 阴性(-)（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.21ug/ml；EB病毒Rta蛋白抗体IgG(EBV-Rta-IgG)-静脉血: 阳性(129.78U/mL)（参考: 阴性）；淋巴细胞百分比(Lymph%)-静脉血: 0.426；碱性磷酸酶(ALP)-静脉血: 130.2U/L；载脂蛋白AI(apoAI)-静脉血: 1.24g/L；纤维蛋白原(Fbg)-静脉血: 2.78g/L；钾离子(K+)-静脉血: 3.5mmol/L；免疫球蛋白游离λ轻链(F-Lambda)-静脉血: 阴性(-)（参考: 阴性(-)）；平均血小板体积(MPV)-静脉血: 8.8fL；尿酸(UA)-静脉血: 200umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.24mmolL；天门冬氨酸氨基转移酶(AST)-静脉血: 18.5U/L；尿素氮(BUN)-静脉血: 3.59mmol/L；总胆固醇(TC)-静脉血: 3.29mmol/L；直接胆红素(DBIL)-静脉血: 1.6umol/L；丙氨酸氨基转移酶(ALT)-静脉血: 11.9U/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.98；中性粒细胞百分比(Neut%)-静脉血: 0.516；肌酐(Crea)-静脉血: 35.7umol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞体积(MCV)-静脉血……\n- [全程D4] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约24cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D21] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显占位病变，肺门纵隔未见明显增宽，心影无增大，双侧肋膈角锐利。；检查结论: 心肺未见病变。\n- [全程D21] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 23mmol/L；总胆红素(TBIL)-静脉血: 7.6umol/L；C-反应蛋白(CRP)-静脉血: 4.9mg/L；总胆固醇(TC)-静脉血: 4.18mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.5mmolL；总胆汁酸(TBA)-静脉血: 2.5umol/L；血型抗体筛查-静脉血: 阴性；ABO血型-静脉血: B；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；大血小板百分比(P-LCR%)-静脉血: 24.7%；血小板比容-静脉血: 32%；血小板分布宽度(PDW)-静脉血: 11.1%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；总蛋白(TP)-静脉血: 74.14g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.011；平均红细胞血红蛋白含量(MCH)-静脉血: 28.1pg；白蛋白(ALB)-静脉血: 38.9g/L；甘油三酯(TG)-静脉血: 0.81mmol/L；磷(P)-静脉血: 1.55mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.1；直接胆红素(DBIL)-静脉血: 2.5umol/L；平均红细胞体积(MCV)-静脉血: 84.5fL；平均血小板体积(MPV)-静脉血: 10.1fL；钠离子(Na+)-静脉血: 136.6mmol/L；氯离子(Cl-)-静脉血: 101.1mmol/L；镁离子(Mg2+)-静脉血: 0.72mmol/L；肌酐(Crea)-静脉血: 33.8umol/L；Rh血型-静脉血: 阳性；载脂蛋白AI(apoAI)-静脉血: 1.34g/L；尿素氮(BUN)-静脉血: 5.75mmol/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；淋巴细胞计数(Lymph#)-静脉血: 2.810E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.591；白细胞计数(WBC#)-静脉血: 8.5610E9/L；钾离子(K+)-静脉血: 4.3mmol/L；总钙(Ca)-静脉血: 2.26mmol/L；尿酸(UA)-静脉血: 204.9umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 24.5U/L；有核红细胞计数(NRBC……\n\n【既往治疗与反应】\n- [全程D3] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日随夏医生信息已隐藏，患者颈背部酸痛较前有好转，无发热畏寒，无恶心呕吐，无胸闷心悸，胃纳睡眠尚可，二便未见明显异常，体查：KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。右颈扪及肿物，约4*3cm,无压痛，质硬，活动差，边界尚清，未扪及明显融合，活检伤口愈合良好。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。右颈部肿物活检病理回报：提示鼻咽部鳞癌转移。鼻咽部MR示：鼻咽顶后壁及两侧壁粘膜增厚，右侧翼内肌、咽鼓管、头长肌受侵，右侧斜坡，颞骨岩部，寰椎前弓骨质破坏。目前患者诊断：鼻咽癌，患者病理活检部位为右颈部肿物，提示转移性鳞癌，建议其行鼻咽部肿物病理活检，患者家属不同意，有放疗适应症，无相对放疗禁忌症，告知患者放疗风险及副反应，患者家属表示理解病情，现治疗后患者要求出院，予以办理，嘱注意休息合理饮食，定期复诊，不适随诊。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D19] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。凝血、乙肝两对半、肝炎四项、HIV/梅毒等检验结果无明显异常。[姓名已隐去]主任查房后，患者因年龄较小，完成活检等操作不配合，家属要求全麻下行活检明确病理，完善相关检查后择期手术，遵嘱执行。\n- [全程D20] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。[姓名已隐去]主任查房后示，完善术前相关检验检查，做好术前准备，遵嘱执行。\n- [全程D21] 上级查房记录；主任医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者颈部肿物疼痛，精神、饮食、睡眠尚可,大小便正常。体查同前。血常规、生化常规回报无明显异常。输血三项回报：B型、RH阳性、抗体筛选阴性。[姓名已隐去]主任查房后示，结合患者各项检查，未见明显手术禁忌，拟明日在气管内吸入全麻下经鼻内镜行鼻咽肿物活检+颈部肿物活检术，做好术前准备，遵嘱执行。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善术前准备，在局麻下行经鼻内镜鼻咽肿物活检及颈部肿物活检术。\nB. 直接以颈部淋巴结转移性鳞癌及影像学表现为依据，开始诱导化疗。\nC. 完善术前准备，在全麻下仅行经鼻内镜鼻咽肿物活检术。\nD. 完善术前准备，在全麻下仅行颈部肿物切除活检术。\nE. 完善术前准备，在全麻下行鼻咽肿物活检术，并预防性切除双侧扁桃体。\nF. 完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检及颈部肿物活检术。\nG. 完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检，若为阴性则行颈部淋巴结清扫术。\nH. 暂缓活检，先行EBV-DNA及鼻咽部PET-CT检查，结果决定是否再次活检。\nI. 完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检及颈部肿物细针穿刺活检术。\nJ. 完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检，并同期行鼻咽部及颈部放疗定位。\nK. 完善术前准备，在局麻下行颈部肿物切除活检，待病理确诊后再行鼻咽活检。\nL. 完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检及右侧颈部淋巴结清扫术。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"完善术前准备，在局麻下行经鼻内镜鼻咽肿物活检及颈部肿物活检术。","is_gold":false},{"letter":"B","text":"直接以颈部淋巴结转移性鳞癌及影像学表现为依据，开始诱导化疗。","is_gold":false},{"letter":"C","text":"完善术前准备，在全麻下仅行经鼻内镜鼻咽肿物活检术。","is_gold":false},{"letter":"D","text":"完善术前准备，在全麻下仅行颈部肿物切除活检术。","is_gold":false},{"letter":"E","text":"完善术前准备，在全麻下行鼻咽肿物活检术，并预防性切除双侧扁桃体。","is_gold":false},{"letter":"F","text":"完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检及颈部肿物活检术。","is_gold":true},{"letter":"G","text":"完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检，若为阴性则行颈部淋巴结清扫术。","is_gold":false},{"letter":"H","text":"暂缓活检，先行EBV-DNA及鼻咽部PET-CT检查，结果决定是否再次活检。","is_gold":false},{"letter":"I","text":"完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检及颈部肿物细针穿刺活检术。","is_gold":false},{"letter":"J","text":"完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检，并同期行鼻咽部及颈部放疗定位。","is_gold":false},{"letter":"K","text":"完善术前准备，在局麻下行颈部肿物切除活检，待病理确诊后再行鼻咽活检。","is_gold":false},{"letter":"L","text":"完善术前准备，在全麻下行经鼻内镜鼻咽肿物活检及右侧颈部淋巴结清扫术。","is_gold":false}],"gold_letter":"F"},{"sample_id":"sample-da812d38ab5771a5dbc8fc87","patient_id":"patient-e45c55cc63c050892e6b2467","turn_id":"turn08","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、翼内肌、蝶窦、颈动脉鞘、斜坡、翼突基底部、蝶骨基底部、岩尖、寰椎。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D2] 入院记录: 主诉: 发现右颈部肿物5月余；现病史: 患者于入院前5月前（某次就诊时间10月）高烧后扪及右颈部肿物，于当地医院予以消炎对症处理。某次就诊时间1月份开始出现疼痛，继续在当地医院住院消炎治疗。行右颈部肿物活检病理回报：提示鼻咽部鳞癌转移。鼻咽部MR示：鼻咽顶后壁及两侧壁粘膜增厚，右侧翼内肌、咽鼓管、头长肌受侵，右侧斜坡，颞骨岩部，寰椎前弓骨质破坏。现患者感颈部酸痛，无鼻塞涕血，无耳鸣耳、听力下降，无面麻骨痛发热，口服布洛芬止痛处理。现为进一步诊治来我院就诊。自起病以来，患者精神、胃纳、睡眠一般，二便如常，体重下降约1Kg。；阳性症状体征: 体重下降,疼痛,高热,右颈部肿物,颈部酸痛；既往史: 既往有“肾病综合征”病史，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:否认药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。；家族史: 否认肿瘤家族史。；体格检查: T：36℃，P：68次/分，R：20次/分，BP：91/58mmHg,Ht：144cm，Wt：31kg，BSA：1.135m2，KPS：KPS 90分神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率{数值}次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: KPS 90分，鼻咽顶后壁双侧壁粘膜增厚，右侧为甚。右颈扪及肿物，约4*3cm,无压痛，质硬，活动差，边界尚清，未扪及明显融合，活检伤口愈合良好。左颈未扪及明显肿大淋巴结。颅神经检查阴性。DG=4cm。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D45] 检验组合: 红细胞计数(RBC#)-静脉血: 4.0510E12/L；淋巴细胞百分比(Lymph%)-静脉血: 0.347；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.42mmolL；磷(P)-静脉血: 1.77mmol/L；肌酐(Crea)-静脉血: 30.1umol/L；总胆红素(TBIL)-静脉血: 3.5umol/L；白蛋白(ALB)-静脉血: 41.3g/L；钾离子(K+)-静脉血: 4.49mmol/L；总胆固醇(TC)-静脉血: 4.9mmol/L；直接胆红素(DBIL)-静脉血: 1.1umol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；碱性磷酸酶(ALP)-静脉血: 147.1U/L；镁离子(Mg2+)-静脉血: 0.84mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 16.5U/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.1mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 15；淋巴细胞计数(Lymph#)-静脉血: 2.210E9/L；球蛋白(GLO)-静脉血: 35g/L；血红蛋白(Hb)-静脉血: 115g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.4pg；总蛋白(TP)-静脉血: 76.3g/L；H2U:U-静脉血: 2.1；尿酸(UA)-静脉血: 236.8umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.18；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.36；白细胞计数(WBC#)-静脉血: 6.4610E9/L；血小板分布宽度(PDW)-静脉血: 8.7%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；乳酸脱氢酶(LDH)-静脉血: 195.6U/L；间接胆红素(IBIL)-静脉血: 2.4umolL；葡萄糖(Glu)-静脉血: 4.66mmol/L；总胆汁酸(TBA)-静脉血: 6.1umol/L；阴离子间隙(AG)-静脉血: 14.5；总钙(Ca)-静脉血: 2.36mmol/L；平均红细胞体积(MCV)-静脉血: 85.9fL；α-L-岩藻糖苷酶(AFU)-静脉血: 35.1U/L；甘油三酯(TG)-静脉血: 1.29mmol/L；大血小板百分比(P-LCR%)-静脉血: 14.3%；嗜碱性……\n- [全程D52] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 25mmol/L；总胆红素(TBIL)-静脉血: 7.6umol/L；磷(P)-静脉血: 1.66mmol/L；阴离子间隙(AG)-静脉血: 13.5；肌酐(Crea)-静脉血: 31.2umol/L；载脂蛋白B(apoB)-静脉血: 0.98g/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞计数(Neut#)-静脉血: 210E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 16.5U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.048；单核细胞百分比(Mono%)-静脉血: 0.082；总蛋白(TP)-静脉血: 76.7g/L；甘油三酯(TG)-静脉血: 0.86mmol/L；直接胆红素(DBIL)-静脉血: 2.21umol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；钾离子(K+)-静脉血: 4.11mmol/L；红细胞比容(Hct)-静脉血: 35.1%；葡萄糖(Glu)-静脉血: 4.64mmol/L；血红蛋白(Hb)-静脉血: 117g/L；乳酸脱氢酶(LDH)-静脉血: 217.1U/L；总胆固醇(TC)-静脉血: 5.39mmol/L；白蛋白(ALB)-静脉血: 42.7g/L；胱抑素(Cys-C)-静脉血: 0.74mg/L；钠离子(Na+)-静脉血: 138.9mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 43.6U/L；淋巴细胞计数(Lymph#)-静脉血: 1.210E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.7pg；血小板计数(PLT#)-静脉血: 19610E9/L；白细胞计数(WBC#)-静脉血: 3.7710E9/L；平均血小板体积(MPV)-静脉血: 9.2fL；中性粒细胞百分比(Neut%)-静脉血: 0.536；H2U:U-静脉血: 1.99；间接胆红素(IBIL)-静脉血: 5.39umolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 15.7；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.6mmolL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 49.1；平均……\n- [全程D58] 检验组合: 总钙(Ca)-静脉血: 2.42mmol/L；乳酸脱氢酶(LDH)-静脉血: 177.8U/L；总蛋白(TP)-静脉血: 73.37g/L；C-反应蛋白(CRP)-静脉血: 0.68mg/L；血红蛋白(Hb)-静脉血: 111g/L；尿素氮(BUN)-静脉血: 3.6mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.38mmol/L；总胆固醇(TC)-静脉血: 5.13mmol/L；总胆汁酸(TBA)-静脉血: 5.2umol/L；直接胆红素(DBIL)-静脉血: 0.2umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.323；大血小板百分比(P-LCR%)-静脉血: 15.4%；载脂蛋白AI(apoAI)-静脉血: 1.42g/L；白蛋白(ALB)-静脉血: 42.1g/L；磷(P)-静脉血: 1.65mmol/L；淋巴细胞计数(Lymph#)-静脉血: 0.910E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.16；钠离子(Na+)-静脉血: 140.4mmol/L；血小板分布宽度(PDW)-静脉血: 9.2%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；中性粒细胞百分比(Neut%)-静脉血: 0.516；单核细胞计数(Mono#)-静脉血: 0.310E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 22.6U/L；丙氨酸氨基转移酶(ALT)-静脉血: 19.4U/L；红细胞计数(RBC#)-静脉血: 3.7910E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 15.6；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.069；血小板比容-静脉血: 16%；钾离子(K+)-静脉血: 4.5mmol/L；阴离子间隙(AG)-静脉血: 13.5；肌酐(Crea)-静脉血: 35.9umol/L；球蛋白(GLO)-静脉血: 31.27g/L；氯离子(Cl-)-静脉血: 103.5mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；间接胆红素(IBIL)-静脉血: 5umolL；白细胞计数(WBC#)-静脉血: 2.9110E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.35mmolL；α-L-岩藻糖苷酶(AFU)-静脉血: 30……\n- [全程D60] 检验组合: H2U:U-静脉血: 2.1；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.011；淋巴细胞百分比(Lymph%)-静脉血: 0.214；单核细胞计数(Mono#)-静脉血: 0.510E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 50；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 333g/L；红细胞计数(RBC#)-静脉血: 3.4910E12/L；血小板比容-静脉血: 17%；白细胞计数(WBC#)-静脉血: 3.610E9/L；血小板分布宽度(PDW)-静脉血: 9.6%；单核细胞百分比(Mono%)-静脉血: 0.136；血小板计数(PLT#)-静脉血: 18110E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；红细胞比容(Hct)-静脉血: 30.9%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 15.8；平均红细胞血红蛋白含量(MCH)-静脉血: 29.5pg；平均血小板体积(MPV)-静脉血: 9.3fL；大血小板百分比(P-LCR%)-静脉血: 18.6%；中性粒细胞计数(Neut#)-静脉血: 2.310E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；血红蛋白(Hb)-静脉血: 103g/L；平均红细胞体积(MCV)-静脉血: 88.5fL；中性粒细胞百分比(Neut%)-静脉血: 0.636\n- [全程D62] 检验组合: 血红蛋白(Hb)-静脉血: 113g/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；白细胞计数(WBC#)-静脉血: 1.910E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.032；中性粒细胞百分比(Neut%)-静脉血: 0.532；血小板计数(PLT#)-静脉血: 21510E9/L；红细胞计数(RBC#)-静脉血: 3.7810E12/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 49.3；平均红细胞血红蛋白含量(MCH)-静脉血: 29.9pg；淋巴细胞百分比(Lymph%)-静脉血: 0.284；有核红细胞计数(NRBC#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 15.4；中性粒细胞计数(Neut#)-静脉血: 110E9/L；血小板比容-静脉血: 20%；大血小板百分比(P-LCR%)-静脉血: 17.6%；单核细胞百分比(Mono%)-静脉血: 0.147；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；红细胞比容(Hct)-静脉血: 33.1%；血小板分布宽度(PDW)-静脉血: 9.4%；平均红细胞体积(MCV)-静脉血: 87.6fL；平均血小板体积(MPV)-静脉血: 9.1fL\n- [全程D65] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔稍狭窄，原鼻咽肿物现明显缩小，病变累及右侧咽隐窝，侵犯右侧咽旁脂肪间隙、右颈动脉鞘区、右侧咽后脂肪间隙及椎前间隙。右侧腭帆提肌、头长肌、颈长肌、右侧腭帆张肌及右侧翼内肌。 双侧翼腭窝、咀嚼肌间隙未见异常。口咽双侧壁未见受累增厚，双侧后鼻孔未见受累。双侧扁桃体未见明显异常。 右侧破裂孔、卵圆孔、舌下神经管内见少许软组织影，增强扫描明显强化。斜坡后缘脑膜增厚，增强扫描明显强化。双侧海绵窦未见增宽。 斜坡、蝶骨基底部、枕骨基底部、蝶骨基底部、右侧蝶骨大翼、寰椎右侧侧块、右侧枕骨髁、右侧翼突、右侧岩尖骨髓信号减低，增强扫描明显强化。 双侧筛窦、蝶窦及双侧乳突粘膜增厚。双侧乳突可见分泌物。双侧上颌窦充气良好。 双眼大小、形态、位置及信号未见异常，球后未见占位性病变。蝶鞍形态未见异常，其内未见占位性病变。 左侧咽后可见小淋巴结，短径约4mm，边界较清，增强扫描明显强化。右侧咽后可见肿大淋巴结，与鼻咽病变分界不清，增强扫描明显强化。颈右侧II、III区可见多个淋巴结，部分融合，较大范围约14mm×17mm，增强扫描明显强化。颈左侧II区、双侧Ⅲ、Ⅳ区可见多发小淋巴结，增强扫描轻度强化。 甲状腺双叶及峡部形态未见异常，信号均匀，未见占位性病变。喉咽腔形态未见异常，未见占位性病变。双侧颌下腺、腮腺大小、形态未见异常，信号均匀，未见占位性病变。 所见脑内未见明显异常。；检查结论: 鼻咽癌放疗后，与某次就诊时间MR相比： 鼻咽肿物较前明显缩小。 颅底骨质破坏，大致同前。 右侧咽后、颈右侧II、III区多个肿大淋巴结，考虑转移，较前缩小。 左侧咽后、颈左侧II区、双侧III、IV区小淋巴结，较前缩小。 双侧筛窦、蝶窦及双侧乳突炎。\n- [全程D65] 检验组合: 平均红细胞血红蛋白浓度(MCHC)-静脉血: 337g/L；大血小板百分比(P-LCR%)-静脉血: 18.8%；单核细胞计数(Mono#)-静脉血: 1.410E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；平均红细胞血红蛋白含量(MCH)-静脉血: 29.8pg；血小板计数(PLT#)-静脉血: 19110E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 16.2；红细胞比容(Hct)-静脉血: 33.8%；中性粒细胞计数(Neut#)-静脉血: 10.510E9/L；白细胞计数(WBC#)-静脉血: 13.2210E9/L；血红蛋白(Hb)-静脉血: 114g/L；红细胞计数(RBC#)-静脉血: 3.8210E12/L；血小板分布宽度(PDW)-静脉血: 10.3%；淋巴细胞百分比(Lymph%)-静脉血: 0.091；中性粒细胞百分比(Neut%)-静脉血: 0.796；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.007；红细胞体积分布宽度SD(RDW-SD)-静脉血: 49.5；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.210E9/L；平均红细胞体积(MCV)-静脉血: 88.5fL；血小板比容-静脉血: 18%；单核细胞百分比(Mono%)-静脉血: 0.104；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均血小板体积(MPV)-静脉血: 9.2fL\n\n【既往治疗与反应】\n- [全程D52] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 现患者局部放疗3次，同期PF30d 化疗第19日，无特殊不适主诉。查体大致同前。复查生化常规未见异常，血常规示白细胞I度降低。[姓名已隐去]医生信息已隐藏示，患者一般状况好，继续放化疗。\n- [全程D55] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 现患者局部放疗4次，同期PF30d 化疗第22日，无特殊不适主诉。查体见颈部淋巴结较前缩小。血常规、生化未见异常。继续放化疗。\n- [全程D58] 上级查房记录；主治医师查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 现患者局部放疗6次，同期PF30d 化疗第25日，无特殊不适主诉。查体见颈部淋巴结较前缩小。血常规示：白细胞计数(白细胞计数(WBC)) 2.91 10E9/L；[姓名已隐去]医生信息已隐藏示：予纠正白细胞治疗，继续放化疗。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D64] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 现患者局部放疗10次，无特殊不适主诉。查体见颈部淋巴结较前缩小。血常规示：白细胞计数(白细胞计数(WBC)) 1.90 10E9/L；予升白细胞治疗，继续放疗。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 终止放化疗，转为手术切除鼻咽原发灶及颈部残留淋巴结。\nB. 暂停放疗，予以静脉抗感染治疗，2周后恢复放疗。\nC. 重新定位并修改放疗计划，缩减原发灶及颈部淋巴结的照射靶区，继续放疗。\nD. 提前结束放疗，改为单药靶向治疗或PD-1抑制剂维持治疗。\nE. 继续根治性放疗，停用原化疗方案，改用吉西他滨联合顺铂方案化疗。\nF. 暂停治疗，完善全身PET-CT检查评估远处转移情况，再决定后续方案。\nG. 继续根治性放疗，完善电子鼻咽镜检查，并予以肠内营养支持及定期复查血常规。\nH. 终止放化疗，转为定期随访观察，3个月后复查鼻咽及颈部MRI。\nI. 继续根治性放疗，常规加用大剂量地塞米松以减轻局部黏膜炎症反应。\nJ. 暂停放疗，行右颈部残留淋巴结穿刺活检明确病理，再制定后续治疗计划。\nK. 继续根治性放疗，并择期行右侧颈部淋巴结清扫术。\n\n请仅输出一个选项字母（A-K）。","options":[{"letter":"A","text":"终止放化疗，转为手术切除鼻咽原发灶及颈部残留淋巴结。","is_gold":false},{"letter":"B","text":"暂停放疗，予以静脉抗感染治疗，2周后恢复放疗。","is_gold":false},{"letter":"C","text":"重新定位并修改放疗计划，缩减原发灶及颈部淋巴结的照射靶区，继续放疗。","is_gold":false},{"letter":"D","text":"提前结束放疗，改为单药靶向治疗或PD-1抑制剂维持治疗。","is_gold":false},{"letter":"E","text":"继续根治性放疗，停用原化疗方案，改用吉西他滨联合顺铂方案化疗。","is_gold":false},{"letter":"F","text":"暂停治疗，完善全身PET-CT检查评估远处转移情况，再决定后续方案。","is_gold":false},{"letter":"G","text":"继续根治性放疗，完善电子鼻咽镜检查，并予以肠内营养支持及定期复查血常规。","is_gold":true},{"letter":"H","text":"终止放化疗，转为定期随访观察，3个月后复查鼻咽及颈部MRI。","is_gold":false},{"letter":"I","text":"继续根治性放疗，常规加用大剂量地塞米松以减轻局部黏膜炎症反应。","is_gold":false},{"letter":"J","text":"暂停放疗，行右颈部残留淋巴结穿刺活检明确病理，再制定后续治疗计划。","is_gold":false},{"letter":"K","text":"继续根治性放疗，并择期行右侧颈部淋巴结清扫术。","is_gold":false}],"gold_letter":"G"}]}
+{"patient_id":"patient-a48d1d72efa6c4217cf5b79c","bootstrap_cluster_id":"cluster-021","turns":[{"sample_id":"sample-6d0ec36f585feac9ee8c0aa5","patient_id":"patient-a48d1d72efa6c4217cf5b79c","turn_id":"turn01","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、筛窦、斜坡、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现颈部肿物伴涕血、鼻塞2月；患者未予相关诊治，转至我院就诊。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,涕血,颈部肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。偶伴吸烟、饮酒15年，3两/天，。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：90次/分，R：20次/分，BP：120/70mmHg,Ht：172cm，Wt：73kg，BSA：1.85m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.0cm；鼻咽双侧顶后壁结节状肿物；双侧颈部IIa区可扪及1个淋巴结，最大径2×2cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸腹部CT平扫\nB. 颈部淋巴结切除活检，鼻咽及颈部MRI平扫+增强，全身PET/CT检查\nC. 鼻咽镜检查及活检，鼻咽部MRI平扫+增强，胸部X线，腹部B超\nD. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，暂不进行全身分期检查\nE. 颈部淋巴结细针穿刺活检，鼻咽及颈部CT平扫+增强，全身骨扫描\nF. 鼻咽镜检查及活检，鼻咽部MRI平扫+增强，全身PET/CT检查\nG. 鼻咽及颈部MRI平扫+增强，全身PET/CT检查，直接安排根治性放疗\nH. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT检查\nI. 鼻咽镜检查及活检，鼻咽及颈部MRI平扫，胸腹部CT平扫+增强，全身骨扫描\nJ. 鼻咽脱落细胞学涂片，鼻咽及颈部MRI平扫+增强，全身PET/CT检查\nK. 鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，全身PET/CT检查\nL. 鼻咽及颈部MRI平扫+增强，EBV-DNA检测，胸腹部CT平扫+增强\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸腹部CT平扫","is_gold":false},{"letter":"B","text":"颈部淋巴结切除活检，鼻咽及颈部MRI平扫+增强，全身PET/CT检查","is_gold":false},{"letter":"C","text":"鼻咽镜检查及活检，鼻咽部MRI平扫+增强，胸部X线，腹部B超","is_gold":false},{"letter":"D","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，暂不进行全身分期检查","is_gold":false},{"letter":"E","text":"颈部淋巴结细针穿刺活检，鼻咽及颈部CT平扫+增强，全身骨扫描","is_gold":false},{"letter":"F","text":"鼻咽镜检查及活检，鼻咽部MRI平扫+增强，全身PET/CT检查","is_gold":false},{"letter":"G","text":"鼻咽及颈部MRI平扫+增强，全身PET/CT检查，直接安排根治性放疗","is_gold":false},{"letter":"H","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，全身PET/CT检查","is_gold":true},{"letter":"I","text":"鼻咽镜检查及活检，鼻咽及颈部MRI平扫，胸腹部CT平扫+增强，全身骨扫描","is_gold":false},{"letter":"J","text":"鼻咽脱落细胞学涂片，鼻咽及颈部MRI平扫+增强，全身PET/CT检查","is_gold":false},{"letter":"K","text":"鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，全身PET/CT检查","is_gold":false},{"letter":"L","text":"鼻咽及颈部MRI平扫+增强，EBV-DNA检测，胸腹部CT平扫+增强","is_gold":false}],"gold_letter":"H"},{"sample_id":"sample-11ca3bd9dd2a5877fa6a6b49","patient_id":"patient-a48d1d72efa6c4217cf5b79c","turn_id":"turn02","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、筛窦、斜坡、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现颈部肿物伴涕血、鼻塞2月；患者未予相关诊治，转至我院就诊。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,涕血,颈部肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。偶伴吸烟、饮酒15年，3两/天，。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：90次/分，R：20次/分，BP：120/70mmHg,Ht：172cm，Wt：73kg，BSA：1.85m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.0cm；鼻咽双侧顶后壁结节状肿物；双侧颈部IIa区可扪及1个淋巴结，最大径2×2cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 甘油三酯(TG)-静脉血: 1.1mmol/L；透明质酸(HA)-静脉血: 34.26ng/ml；中性粒细胞计数(Neut#)-静脉血: 3.710E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；层粘连蛋白(LN)-静脉血: 11.97ng/ml；凝血酶原时间活动度(PTA)-静脉血: 125.5%；总胆固醇(TC)-静脉血: 4.12mmol/L；凝血酶原时间(PT)-静脉血: 10.8sec.；碱性磷酸酶(ALP)-静脉血: 83.4U/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；ABO血型-静脉血: O；镁离子(Mg2+)-静脉血: 0.88mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.005；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 65.2umol/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；尿素氮(BUN)-静脉血: 5.1mmol/L；总蛋白(TP)-静脉血: 75.4g/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 22.8U/L；钾离子(K+)-静脉血: 3.71mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 17.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 18.1U/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；乳酸脱氢酶(LDH)-静脉血: 142.3U/L；III型前胶原氨基端肽(PIIINP)-静脉血: 17.25ng/ml；尿酸(UA)-静脉血: 293.9umol/L；血小板计数(PLT#)-静脉血: 18910E9/L；Rh血型-静脉血: 阳性；总胆汁酸(TBA)-静脉血: 2.8umol/L；IV型胶原(C-IV)-静脉血: 21.48ng/ml；天门冬氨酸氨基转移酶(AST)-静脉血: 15.4U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；氯离子(Cl-)-静脉血: 103.6mmol/L；磷(P)-静脉血: 0.78m……\n- [全程D2] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D8] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、右侧壁见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。肿物占据双侧咽隐窝，向后外推移右侧咽旁脂肪间隙，前方浸润右侧筛窦及上鼻道，左侧咽旁脂肪间隙及左侧颈动脉鞘区未见异常。 右侧腭帆提肌、腭帆张肌受侵；左侧腭帆提肌、腭帆张肌、头长肌未见受累征象。 右侧翼腭窝及右侧上颌后脂肪间隙稍变窄；左侧翼腭窝、左上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽未见明显异常。 斜坡、蝶骨基底部、右侧翼突基底部及右侧蝶骨大翼信号降低，增强后强化。 双侧海绵窦未见明显异常。 双侧上颌窦、筛窦、右侧蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，无强化，骨壁完整。双眼大小、形态、位置均属正常、信号均匀。蝶鞍形态正常，其内未见占位性病变。 右侧咽后间隙见淋巴结，较大者约11mm×10mm；左侧咽后间隙未见肿大淋巴结。双颈Ⅱ区、右颈Ⅲ区见多个淋巴结，部分融合，边界清，不均匀明显强化，较大者约大小约24mm×13mm。 所见甲状腺双叶形态正常、喉咽腔、双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 符合鼻咽癌。 颅底骨质破坏。 左侧咽后、双颈Ⅱ区及右颈Ⅲ区肿大淋巴结，考虑转移。 副鼻窦炎、乳突炎。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 影像评估为 cT4N2，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nB. 影像评估为 cT3N1，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nC. 影像评估为 cT3N2，需完善鼻咽镜及活检明确病理，无需常规进行胸腹部及骨骼的远处转移筛查\nD. 影像评估为 cT4N3，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nE. 影像评估为 cT2N2，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nF. 影像评估为 cT3N2，需完善颈部淋巴结穿刺活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nG. 影像评估为 cT3N2，已具备影像学确诊条件，直接安排诱导化疗及后续根治性放疗\nH. 影像评估为 cT4N2，需完善颈部淋巴结穿刺活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nI. 影像评估为 cT3N2，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nJ. 影像评估为 cT3N3，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nK. 影像评估为 cT2N1，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期\nL. 影像评估为 cT3N2，需完善鼻咽镜及活检明确病理，并完善头颅MRI及脑脊液检查以排除中枢神经系统转移\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"影像评估为 cT4N2，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期","is_gold":false},{"letter":"B","text":"影像评估为 cT3N1，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期","is_gold":false},{"letter":"C","text":"影像评估为 cT3N2，需完善鼻咽镜及活检明确病理，无需常规进行胸腹部及骨骼的远处转移筛查","is_gold":false},{"letter":"D","text":"影像评估为 cT4N3，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期","is_gold":false},{"letter":"E","text":"影像评估为 cT2N2，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期","is_gold":false},{"letter":"F","text":"影像评估为 cT3N2，需完善颈部淋巴结穿刺活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期","is_gold":false},{"letter":"G","text":"影像评估为 cT3N2，已具备影像学确诊条件，直接安排诱导化疗及后续根治性放疗","is_gold":false},{"letter":"H","text":"影像评估为 cT4N2，需完善颈部淋巴结穿刺活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期","is_gold":false},{"letter":"I","text":"影像评估为 cT3N2，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期","is_gold":true},{"letter":"J","text":"影像评估为 cT3N3，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期","is_gold":false},{"letter":"K","text":"影像评估为 cT2N1，需完善鼻咽镜及活检明确病理，并完善胸部CT、腹部彩超及骨扫描（或PET-CT）完成全身分期","is_gold":false},{"letter":"L","text":"影像评估为 cT3N2，需完善鼻咽镜及活检明确病理，并完善头颅MRI及脑脊液检查以排除中枢神经系统转移","is_gold":false}],"gold_letter":"I"},{"sample_id":"sample-b061f796c98789c2958f0baf","patient_id":"patient-a48d1d72efa6c4217cf5b79c","turn_id":"turn04","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、筛窦、斜坡、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现颈部肿物伴涕血、鼻塞2月；现病史: 患者2月前无明显诱因出现颈部肿物，拇指大小，偶伴涕血、鼻塞，右侧明显，无面麻、复视等其他不适，未予重视，逐渐加重，患者遂于某次就诊时间行颈部彩超示：右侧颈部低回声，行鼻咽镜示：鼻咽肿物，建议活检。患者未予相关诊治，转至我院就诊。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,涕血,颈部肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。偶伴吸烟、饮酒15年，3两/天，。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：90次/分，R：20次/分，BP：120/70mmHg,Ht：172cm，Wt：73kg，BSA：1.85m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率90次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.0cm；鼻咽双侧顶后壁结节状肿物；双侧颈部IIa区可扪及1个淋巴结，最大径2×2cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1] 检验组合: 甘油三酯(TG)-静脉血: 1.1mmol/L；透明质酸(HA)-静脉血: 34.26ng/ml；中性粒细胞计数(Neut#)-静脉血: 3.710E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；层粘连蛋白(LN)-静脉血: 11.97ng/ml；凝血酶原时间活动度(PTA)-静脉血: 125.5%；总胆固醇(TC)-静脉血: 4.12mmol/L；凝血酶原时间(PT)-静脉血: 10.8sec.；碱性磷酸酶(ALP)-静脉血: 83.4U/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；ABO血型-静脉血: O；镁离子(Mg2+)-静脉血: 0.88mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.005；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 65.2umol/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；尿素氮(BUN)-静脉血: 5.1mmol/L；总蛋白(TP)-静脉血: 75.4g/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；α-L-岩藻糖苷酶(AFU)-静脉血: 22.8U/L；钾离子(K+)-静脉血: 3.71mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 17.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 18.1U/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；乳酸脱氢酶(LDH)-静脉血: 142.3U/L；III型前胶原氨基端肽(PIIINP)-静脉血: 17.25ng/ml；尿酸(UA)-静脉血: 293.9umol/L；血小板计数(PLT#)-静脉血: 18910E9/L；Rh血型-静脉血: 阳性；总胆汁酸(TBA)-静脉血: 2.8umol/L；IV型胶原(C-IV)-静脉血: 21.48ng/ml；天门冬氨酸氨基转移酶(AST)-静脉血: 15.4U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；氯离子(Cl-)-静脉血: 103.6mmol/L；磷(P)-静脉血: 0.78m……\n- [全程D2] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D8] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、右侧壁见结节状肿物突出，肿物T1WI呈等信号，T2WI呈稍高信号，增强扫描明显强化。肿物占据双侧咽隐窝，向后外推移右侧咽旁脂肪间隙，前方浸润右侧筛窦及上鼻道，左侧咽旁脂肪间隙及左侧颈动脉鞘区未见异常。 右侧腭帆提肌、腭帆张肌受侵；左侧腭帆提肌、腭帆张肌、头长肌未见受累征象。 右侧翼腭窝及右侧上颌后脂肪间隙稍变窄；左侧翼腭窝、左上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽未见明显异常。 斜坡、蝶骨基底部、右侧翼突基底部及右侧蝶骨大翼信号降低，增强后强化。 双侧海绵窦未见明显异常。 双侧上颌窦、筛窦、右侧蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，无强化，骨壁完整。双眼大小、形态、位置均属正常、信号均匀。蝶鞍形态正常，其内未见占位性病变。 右侧咽后间隙见淋巴结，较大者约11mm×10mm；左侧咽后间隙未见肿大淋巴结。双颈Ⅱ区、右颈Ⅲ区见多个淋巴结，部分融合，边界清，不均匀明显强化，较大者约大小约24mm×13mm。 所见甲状腺双叶形态正常、喉咽腔、双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 符合鼻咽癌。 颅底骨质破坏。 左侧咽后、双颈Ⅱ区及右颈Ⅲ区肿大淋巴结，考虑转移。 副鼻窦炎、乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 启动首周期同步放化疗（辅以水化、止吐预处理），不考虑诱导化疗\nB. 启动首周期诱导化疗，计划序贯根治性单纯放疗\nC. 启动首周期诱导化疗联合PD-1抑制剂，计划序贯根治性同步放化疗\nD. 启动首周期诱导化疗，计划序贯手术切除原发灶及颈部淋巴结\nE. 启动根治性单纯放疗，计划放疗结束后行多周期辅助化疗\nF. 启动根治性放疗联合EGFR靶向治疗，免除全身静脉化疗\nG. 优先行双侧颈部淋巴结清扫术，术后行根治性同步放化疗\nH. 优先行鼻咽原发灶内镜下切除术，术后行根治性同步放化疗\nI. 启动首周期姑息性化疗，计划化疗后行局部姑息性放疗\nJ. 启动首周期诱导化疗，若疗效达完全缓解（CR）则免除后续放疗\nK. 启动首周期诱导化疗（辅以水化、止吐预处理），计划序贯根治性同步放化疗\nL. 启动首周期同步放化疗，计划放疗结束后行多周期辅助化疗\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"启动首周期同步放化疗（辅以水化、止吐预处理），不考虑诱导化疗","is_gold":false},{"letter":"B","text":"启动首周期诱导化疗，计划序贯根治性单纯放疗","is_gold":false},{"letter":"C","text":"启动首周期诱导化疗联合PD-1抑制剂，计划序贯根治性同步放化疗","is_gold":false},{"letter":"D","text":"启动首周期诱导化疗，计划序贯手术切除原发灶及颈部淋巴结","is_gold":false},{"letter":"E","text":"启动根治性单纯放疗，计划放疗结束后行多周期辅助化疗","is_gold":false},{"letter":"F","text":"启动根治性放疗联合EGFR靶向治疗，免除全身静脉化疗","is_gold":false},{"letter":"G","text":"优先行双侧颈部淋巴结清扫术，术后行根治性同步放化疗","is_gold":false},{"letter":"H","text":"优先行鼻咽原发灶内镜下切除术，术后行根治性同步放化疗","is_gold":false},{"letter":"I","text":"启动首周期姑息性化疗，计划化疗后行局部姑息性放疗","is_gold":false},{"letter":"J","text":"启动首周期诱导化疗，若疗效达完全缓解（CR）则免除后续放疗","is_gold":false},{"letter":"K","text":"启动首周期诱导化疗（辅以水化、止吐预处理），计划序贯根治性同步放化疗","is_gold":true},{"letter":"L","text":"启动首周期同步放化疗，计划放疗结束后行多周期辅助化疗","is_gold":false}],"gold_letter":"K"},{"sample_id":"sample-b024e6abb04a58aab366631a","patient_id":"patient-a48d1d72efa6c4217cf5b79c","turn_id":"turn07","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、筛窦、斜坡、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现颈部肿物伴涕血、鼻塞2月；现病史: 患者2月前无明显诱因出现颈部肿物，拇指大小，偶伴涕血、鼻塞，右侧明显，无面麻、复视等其他不适，未予重视，逐渐加重，患者遂于某次就诊时间行颈部彩超示：右侧颈部低回声，行鼻咽镜示：鼻咽肿物，建议活检。患者未予相关诊治，转至我院就诊。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,涕血,颈部肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。偶伴吸烟、饮酒15年，3两/天，。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：90次/分，R：20次/分，BP：120/70mmHg,Ht：172cm，Wt：73kg，BSA：1.85m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率90次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.0cm；鼻咽双侧顶后壁结节状肿物；双侧颈部IIa区可扪及1个淋巴结，最大径2×2cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D25] 检验组合: 间接胆红素(IBIL)-静脉血: 4.41umolL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.41；肌酐(Crea)-静脉血: 102.2umol/L；尿酸(UA)-静脉血: 315.6umol/L；总蛋白(TP)-静脉血: 63.4g/L；直接胆红素(DBIL)-静脉血: 2.3umol/L；白蛋白(ALB)-静脉血: 37.1g/L；总胆红素(TBIL)-静脉血: 6.71umol/L；尿素氮(BUN)-静脉血: 7.1mmol/L；球蛋白(GLO)-静脉血: 26.3g/L\n- [全程D29] 检验组合: 碱性磷酸酶(ALP)-静脉血: 72.7U/L；钠离子(Na+)-静脉血: 140.9mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0.3；大血小板百分比(P-LCR%)-静脉血: 28.3%；葡萄糖(Glu)-静脉血: 4.98mmol/L；载脂蛋白B(apoB)-静脉血: 0.9g/L；磷(P)-静脉血: 0.95mmol/L；球蛋白(GLO)-静脉血: 26.2g/L；氯离子(Cl-)-静脉血: 102.9mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.9U/L；镁离子(Mg2+)-静脉血: 0.81mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.67mmol/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；红细胞计数(RBC#)-静脉血: 4.2510E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.9；总蛋白(TP)-静脉血: 63.5g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 88.7fL；红细胞比容(Hct)-静脉血: 37.7%；总胆固醇(TC)-静脉血: 3.9mmol/L；乳酸脱氢酶(LDH)-静脉血: 144.8U/L；载脂蛋白AI(apoAI)-静脉血: 1.05g/L；丙氨酸氨基转移酶(ALT)-静脉血: 18.8U/L；甘油三酯(TG)-静脉血: 1mmol/L；尿酸(UA)-静脉血: 351.4umol/L；尿素氮(BUN)-静脉血: 6mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；单核细胞百分比(Mono%)-静脉血: 0.077；胱抑素(Cys-C)-静脉血: 0.99mg/L；血小板分布宽度(PDW)-静脉血: 11.5%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；有核红细胞计数(NRBC#)-静脉血: 0.0110E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 38；白细胞计数(WBC#)-静脉血: 3.6610E9/L；平均血小板体积(MPV)-静脉血: 10.5fL；血小板比容-静脉血: 20%；单核细胞计数(Mono#)-静脉血: 0.310E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；总胆汁酸……\n- [全程D36] 检验组合: 酸碱度(pH)-尿液: 6.5；丙氨酸氨基转移酶(ALT)-静脉血: 18.7U/L；阴离子间隙(AG)-静脉血: 12.9；钾离子(K+)-静脉血: 3.75mmol/L；磷(P)-静脉血: 0.98mmol/L；球蛋白(GLO)-静脉血: 29.5g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；酮体(KET)-尿液: -（参考: 阴性）；总胆固醇(TC)-静脉血: 4.56mmol/L；尿素氮(BUN)-静脉血: 4.6mmol/L；红细胞计数(RBC#)-静脉血: 4.4810E12/L；比重(SG)-尿液: 1.008；γ-谷氨酰基转移酶(GGT)-静脉血: 28U/L；红细胞比容(Hct)-静脉血: 39.4%；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.755；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.4；总胆红素(TBIL)-静脉血: 9.28umol/L；葡萄糖(Glu)-静脉血: 5.08mmol/L；钠离子(Na+)-静脉血: 141.1mmol/L；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 25.4mmol/L；颜色-尿液: colorless；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.046；乳酸脱氢酶(LDH)-静脉血: 144U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22.6U/L；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.37；C-反应蛋白(CRP)-静脉血: 7.02mg/L；间接胆红素(IBIL)-静脉血: 6.27umolL；血红蛋白(Hb)-静脉血: 135g/L；单核细胞百分比(Mono%)-静脉血: 0.08；淋巴细胞百分比(Lymph%)-静脉血: 0.113；总钙(Ca)-静脉血: 2.18mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.68；平均血小板体积(MPV)-静脉血: 10fL；淋巴细胞计数(Lymph#……\n- [全程D37] 检验组合: 亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 1/μL；酸碱度(pH)-尿液: 6.5；白细胞计数(WBC#)-尿液: 8/μL；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 1/μL；颜色-尿液: colorless；尿胆原(URO)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；胆红素(BIL)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.006；酮体(KET)-尿液: -（参考: 阴性）\n- [全程D38] 检验组合: 白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.006；尿胆原(URO)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；细菌计数(BACT#)-尿液: 2/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 1/μL；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；颜色-尿液: colorless；浊度(TRUB)-尿液: clear；隐血(OB)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 6.5\n- [全程D43] 检验组合: 尿素氮(BUN)-静脉血: 7.4mmol/L；直接胆红素(DBIL)-静脉血: 3.4umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.3mmol/L；白蛋白(ALB)-静脉血: 41.2g/L；磷(P)-静脉血: 1.12mmol/L；氯离子(Cl-)-静脉血: 97.6mmol/L；总蛋白(TP)-静脉血: 72.16g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 45.7U/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；血小板分布宽度(PDW)-静脉血: 11.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；碱性磷酸酶(ALP)-静脉血: 88.2U/L；C-反应蛋白(CRP)-静脉血: 1.75mg/L；红细胞计数(RBC#)-静脉血: 4.4910E12/L；白细胞计数(WBC#)-静脉血: 3.910E9/L；血小板比容-静脉血: 15%；淋巴细胞百分比(Lymph%)-静脉血: 0.062；总胆固醇(TC)-静脉血: 4.41mmol/L；球蛋白(GLO)-静脉血: 30.96g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.55；α-L-岩藻糖苷酶(AFU)-静脉血: 38.6U/L；钠离子(Na+)-静脉血: 138mmol/L；总胆红素(TBIL)-静脉血: 10.5umol/L；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；血小板计数(PLT#)-静脉血: 15010E9/L；平均血小板体积(MPV)-静脉血: 10.3fL；葡萄糖(Glu)-静脉血: 5.12mmol/L；载脂蛋白B(apoB)-静脉血: 0.95g/L；甘油三酯(TG)-静脉血: 1.59mmol/L；血红蛋白(Hb)-静脉血: 139g/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；胱抑素(Cys-C)-静脉血: 1.23mg/L；载脂蛋白AI(apoAI)-静脉血: 1.33g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.07mmolL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.33；乳酸脱氢酶(LDH)-静脉血: 158.1U/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜酸性粒细胞计数(Eos#)-静脉血: 0.1……\n- [全程D50] 检验组合: 乳酸脱氢酶(LDH)-静脉血: 164U/L；葡萄糖(Glu)-静脉血: 5.3mmol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；肌酐(Crea)-静脉血: 108.9umol/L；平均红细胞体积(MCV)-静脉血: 85.7fL；间接胆红素(IBIL)-静脉血: 7.8umolL；磷(P)-静脉血: 1.01mmol/L；球蛋白(GLO)-静脉血: 29.5g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；总胆固醇(TC)-静脉血: 4.57mmol/L；总蛋白(TP)-静脉血: 69g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15.2U/L；大血小板百分比(P-LCR%)-静脉血: 20.1%；钾离子(K+)-静脉血: 3.73mmol/L；碱性磷酸酶(ALP)-静脉血: 81.5U/L；阴离子间隙(AG)-静脉血: 16.9；胱抑素(Cys-C)-静脉血: 1.07mg/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；直接胆红素(DBIL)-静脉血: 3.9umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；血小板计数(PLT#)-静脉血: 18610E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 25.2U/L；细菌名称-咽拭子: 细菌涂片3；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.03；平均红细胞血红蛋白含量(MCH)-静脉血: 29.8pg；白细胞计数(WBC#)-静脉血: 3.6610E9/L；尿素氮(BUN)-静脉血: 4.8mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 24U/L；氯离子(Cl-)-静脉血: 97.1mmol/L；血小板分布宽度(PDW)-静脉血: 10.4%；淋巴细胞百分比(Lymph%)-静脉血: 0.085；血液二氧化碳含量ctCO2(B)-静脉血: 23.3mmol/L；钠离子(Na+)-静脉血: 137.3mmol/L；总胆红素(TBIL)-静脉血: 11.7umol/L；C-反应蛋白(CRP)-静脉血: 11.52mg/L；总胆汁酸(TBA)-静脉血: 1.4umol/L；中性粒细胞计……\n- [全程D55] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约12mm，肝S5可见一无回声灶，大小约11×9mm,椭圆形，边界清，内透声可，后方回声增强。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约19cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱不充盈。 前列腺大小形态正常，大小约38×30×37mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝囊肿。 胆囊、脾脏、胰腺、双肾、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n\n【既往治疗与反应】\n- [全程D32] 阶段小结；阶段小结: 病程类型: 阶段小结；病程主题: 阶段小结；病程内容: 患者[姓名已隐去]，男，51岁，因“颈部肿物，偶伴涕血、鼻塞2月”于某次就诊时间入院。征求患者同意并签字入住顺铂三周/单周方案联合IMRT治疗局部中晚期鼻咽癌三期临床试验，抽签入三周顺铂100mg/m2组。目前放疗14次，同时期化疗1次。3次靶向治疗，继续原方案治疗，并予患者营养支持治疗。\n- [全程D37] 上级查房记录；[姓名已隐去]主任医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者诉咽喉疼痛，目前放疗17次，今日行第2次顺铂同时期化疗，查体：患者鼻咽壁肿物明显缩小，双颈未扪及淋巴结，面部、双颈部皮肤色素沉着。[姓名已隐去]医生信息已隐藏：密切关注患者放化疗副反应，遵嘱执行。\n- [全程D42] 上级查房记录；[姓名已隐去]主任医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者诉咽喉疼痛，目前放疗20次，已行2次顺铂同时期化疗，4次靶向治疗，诉食欲不佳，查体：患者鼻咽顶后壁肿物明显缩小，双颈未扪及淋巴结，面部、双颈部皮肤色素沉着。[姓名已隐去]医生信息已隐藏：嘱患者加强营养及日常休息。密切关注患者放化疗副反应。 遵嘱。\n- [全程D47] 上级查房记录；[姓名已隐去]主任医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者目前放疗24次，已行2次顺铂同时期化疗，5次靶向治疗，诉咽喉疼痛，纳差，乏力。查体：患者鼻咽顶后壁稍增厚，双颈未扪及淋巴结，面部、双颈部皮肤色素沉着。[姓名已隐去]医生信息已隐藏：予以抗炎对症处理，并予患者行营养支持治疗，并密切关注患者血象变化。\n- [全程D52] 上级查房记录；[姓名已隐去]主任医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者目前放疗27次，已行2次顺铂同时期化疗，6次靶向治疗，诉咽喉疼痛，纳差，乏力。查体：患者鼻咽右侧壁肿物已基本消退，双颈未扪及淋巴结，面部、双颈部皮肤色素沉着。[姓名已隐去]医生信息已隐藏：予患者行营养支持治疗，并密切关注患者血象变化。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 提前终止放疗；给予重组人表皮生长因子、GM-CSF含漱液局部促修复及静脉营养支持治疗。\nB. 继续完成既定根治性放疗计划；加用重组人表皮生长因子、GM-CSF含漱液局部治疗，并予以静脉营养支持及抗感染治疗。\nC. 暂停放疗及靶向治疗直至黏膜炎好转；给予重组人表皮生长因子、GM-CSF含漱液局部治疗及静脉营养支持。\nD. 继续完成既定根治性放疗计划；仅给予氯化钠含漱液及常规饮食指导，避免使用生长因子类药物及静脉营养。\nE. 继续完成既定根治性放疗计划；加用氟康唑等广谱抗真菌药物静脉滴注，并予以静脉营养支持治疗。\nF. 继续完成既定根治性放疗计划并立即安排鼻咽部局部加量放疗；给予重组人表皮生长因子含漱液及静脉营养支持。\nG. 继续完成既定根治性放疗计划；行预防性经皮内镜下胃造瘘术（PEG）替代静脉营养支持。\nH. 暂停放疗计划；复查鼻咽及颈部MRI以明确肿瘤退缩情况，再决定后续放疗靶区及剂量。\nI. 继续完成既定根治性放疗计划；给予大剂量静脉糖皮质激素冲击治疗，暂缓静脉营养支持。\nJ. 继续完成既定根治性放疗计划；立即给予聚乙二醇化重组人粒细胞刺激因子皮下注射及静脉营养支持。\nK. 提前结束放疗，转为维持性靶向治疗及免疫治疗；给予重组人表皮生长因子及静脉营养支持。\nL. 继续完成既定根治性放疗计划；行预防性气管切开术，并予以静脉营养支持及抗感染治疗。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"提前终止放疗；给予重组人表皮生长因子、GM-CSF含漱液局部促修复及静脉营养支持治疗。","is_gold":false},{"letter":"B","text":"继续完成既定根治性放疗计划；加用重组人表皮生长因子、GM-CSF含漱液局部治疗，并予以静脉营养支持及抗感染治疗。","is_gold":true},{"letter":"C","text":"暂停放疗及靶向治疗直至黏膜炎好转；给予重组人表皮生长因子、GM-CSF含漱液局部治疗及静脉营养支持。","is_gold":false},{"letter":"D","text":"继续完成既定根治性放疗计划；仅给予氯化钠含漱液及常规饮食指导，避免使用生长因子类药物及静脉营养。","is_gold":false},{"letter":"E","text":"继续完成既定根治性放疗计划；加用氟康唑等广谱抗真菌药物静脉滴注，并予以静脉营养支持治疗。","is_gold":false},{"letter":"F","text":"继续完成既定根治性放疗计划并立即安排鼻咽部局部加量放疗；给予重组人表皮生长因子含漱液及静脉营养支持。","is_gold":false},{"letter":"G","text":"继续完成既定根治性放疗计划；行预防性经皮内镜下胃造瘘术（PEG）替代静脉营养支持。","is_gold":false},{"letter":"H","text":"暂停放疗计划；复查鼻咽及颈部MRI以明确肿瘤退缩情况，再决定后续放疗靶区及剂量。","is_gold":false},{"letter":"I","text":"继续完成既定根治性放疗计划；给予大剂量静脉糖皮质激素冲击治疗，暂缓静脉营养支持。","is_gold":false},{"letter":"J","text":"继续完成既定根治性放疗计划；立即给予聚乙二醇化重组人粒细胞刺激因子皮下注射及静脉营养支持。","is_gold":false},{"letter":"K","text":"提前结束放疗，转为维持性靶向治疗及免疫治疗；给予重组人表皮生长因子及静脉营养支持。","is_gold":false},{"letter":"L","text":"继续完成既定根治性放疗计划；行预防性气管切开术，并予以静脉营养支持及抗感染治疗。","is_gold":false}],"gold_letter":"B"},{"sample_id":"sample-c54efc446616b72b81ae7555","patient_id":"patient-a48d1d72efa6c4217cf5b79c","turn_id":"turn08","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、咽旁间隙、筛窦、斜坡、翼突基底部、蝶骨基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T3N2M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现颈部肿物伴涕血、鼻塞2月；现病史: 患者2月前无明显诱因出现颈部肿物，拇指大小，偶伴涕血、鼻塞，右侧明显，无面麻、复视等其他不适，未予重视，逐渐加重，患者遂于某次就诊时间行颈部彩超示：右侧颈部低回声，行鼻咽镜示：鼻咽肿物，建议活检。患者未予相关诊治，转至我院就诊。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 鼻塞,涕血,颈部肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。偶伴吸烟、饮酒15年，3两/天，。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：90次/分，R：20次/分，BP：120/70mmHg,Ht：172cm，Wt：73kg，BSA：1.85m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率90次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.0cm；鼻咽双侧顶后壁结节状肿物；双侧颈部IIa区可扪及1个淋巴结，最大径2×2cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D29] 检验组合: 碱性磷酸酶(ALP)-静脉血: 72.7U/L；钠离子(Na+)-静脉血: 140.9mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0.3；大血小板百分比(P-LCR%)-静脉血: 28.3%；葡萄糖(Glu)-静脉血: 4.98mmol/L；载脂蛋白B(apoB)-静脉血: 0.9g/L；磷(P)-静脉血: 0.95mmol/L；球蛋白(GLO)-静脉血: 26.2g/L；氯离子(Cl-)-静脉血: 102.9mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 12.9U/L；镁离子(Mg2+)-静脉血: 0.81mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.67mmol/L；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；红细胞计数(RBC#)-静脉血: 4.2510E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.9；总蛋白(TP)-静脉血: 63.5g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 88.7fL；红细胞比容(Hct)-静脉血: 37.7%；总胆固醇(TC)-静脉血: 3.9mmol/L；乳酸脱氢酶(LDH)-静脉血: 144.8U/L；载脂蛋白AI(apoAI)-静脉血: 1.05g/L；丙氨酸氨基转移酶(ALT)-静脉血: 18.8U/L；甘油三酯(TG)-静脉血: 1mmol/L；尿酸(UA)-静脉血: 351.4umol/L；尿素氮(BUN)-静脉血: 6mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；单核细胞百分比(Mono%)-静脉血: 0.077；胱抑素(Cys-C)-静脉血: 0.99mg/L；血小板分布宽度(PDW)-静脉血: 11.5%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；有核红细胞计数(NRBC#)-静脉血: 0.0110E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 38；白细胞计数(WBC#)-静脉血: 3.6610E9/L；平均血小板体积(MPV)-静脉血: 10.5fL；血小板比容-静脉血: 20%；单核细胞计数(Mono#)-静脉血: 0.310E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；总胆汁酸……\n- [全程D36] 检验组合: 酸碱度(pH)-尿液: 6.5；丙氨酸氨基转移酶(ALT)-静脉血: 18.7U/L；阴离子间隙(AG)-静脉血: 12.9；钾离子(K+)-静脉血: 3.75mmol/L；磷(P)-静脉血: 0.98mmol/L；球蛋白(GLO)-静脉血: 29.5g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.1pg；酮体(KET)-尿液: -（参考: 阴性）；总胆固醇(TC)-静脉血: 4.56mmol/L；尿素氮(BUN)-静脉血: 4.6mmol/L；红细胞计数(RBC#)-静脉血: 4.4810E12/L；比重(SG)-尿液: 1.008；γ-谷氨酰基转移酶(GGT)-静脉血: 28U/L；红细胞比容(Hct)-静脉血: 39.4%；中性粒细胞计数(Neut#)-静脉血: 2.910E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.755；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.4；总胆红素(TBIL)-静脉血: 9.28umol/L；葡萄糖(Glu)-静脉血: 5.08mmol/L；钠离子(Na+)-静脉血: 141.1mmol/L；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 25.4mmol/L；颜色-尿液: colorless；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.046；乳酸脱氢酶(LDH)-静脉血: 144U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22.6U/L；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.37；C-反应蛋白(CRP)-静脉血: 7.02mg/L；间接胆红素(IBIL)-静脉血: 6.27umolL；血红蛋白(Hb)-静脉血: 135g/L；单核细胞百分比(Mono%)-静脉血: 0.08；淋巴细胞百分比(Lymph%)-静脉血: 0.113；总钙(Ca)-静脉血: 2.18mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.68；平均血小板体积(MPV)-静脉血: 10fL；淋巴细胞计数(Lymph#……\n- [全程D37] 检验组合: 亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 1/μL；酸碱度(pH)-尿液: 6.5；白细胞计数(WBC#)-尿液: 8/μL；总蛋白(TP)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 1/μL；颜色-尿液: colorless；尿胆原(URO)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: clear；胆红素(BIL)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.006；酮体(KET)-尿液: -（参考: 阴性）\n- [全程D38] 检验组合: 白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.006；尿胆原(URO)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；细菌计数(BACT#)-尿液: 2/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 1/μL；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；颜色-尿液: colorless；浊度(TRUB)-尿液: clear；隐血(OB)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 6.5\n- [全程D43] 检验组合: 尿素氮(BUN)-静脉血: 7.4mmol/L；直接胆红素(DBIL)-静脉血: 3.4umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.3mmol/L；白蛋白(ALB)-静脉血: 41.2g/L；磷(P)-静脉血: 1.12mmol/L；氯离子(Cl-)-静脉血: 97.6mmol/L；总蛋白(TP)-静脉血: 72.16g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 45.7U/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；血小板分布宽度(PDW)-静脉血: 11.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；碱性磷酸酶(ALP)-静脉血: 88.2U/L；C-反应蛋白(CRP)-静脉血: 1.75mg/L；红细胞计数(RBC#)-静脉血: 4.4910E12/L；白细胞计数(WBC#)-静脉血: 3.910E9/L；血小板比容-静脉血: 15%；淋巴细胞百分比(Lymph%)-静脉血: 0.062；总胆固醇(TC)-静脉血: 4.41mmol/L；球蛋白(GLO)-静脉血: 30.96g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.55；α-L-岩藻糖苷酶(AFU)-静脉血: 38.6U/L；钠离子(Na+)-静脉血: 138mmol/L；总胆红素(TBIL)-静脉血: 10.5umol/L；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；血小板计数(PLT#)-静脉血: 15010E9/L；平均血小板体积(MPV)-静脉血: 10.3fL；葡萄糖(Glu)-静脉血: 5.12mmol/L；载脂蛋白B(apoB)-静脉血: 0.95g/L；甘油三酯(TG)-静脉血: 1.59mmol/L；血红蛋白(Hb)-静脉血: 139g/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；胱抑素(Cys-C)-静脉血: 1.23mg/L；载脂蛋白AI(apoAI)-静脉血: 1.33g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.07mmolL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.33；乳酸脱氢酶(LDH)-静脉血: 158.1U/L；有核红细胞百分比(NRBC%)-静脉血: 0；嗜酸性粒细胞计数(Eos#)-静脉血: 0.1……\n- [全程D50] 检验组合: 乳酸脱氢酶(LDH)-静脉血: 164U/L；葡萄糖(Glu)-静脉血: 5.3mmol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；肌酐(Crea)-静脉血: 108.9umol/L；平均红细胞体积(MCV)-静脉血: 85.7fL；间接胆红素(IBIL)-静脉血: 7.8umolL；磷(P)-静脉血: 1.01mmol/L；球蛋白(GLO)-静脉血: 29.5g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；总胆固醇(TC)-静脉血: 4.57mmol/L；总蛋白(TP)-静脉血: 69g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 15.2U/L；大血小板百分比(P-LCR%)-静脉血: 20.1%；钾离子(K+)-静脉血: 3.73mmol/L；碱性磷酸酶(ALP)-静脉血: 81.5U/L；阴离子间隙(AG)-静脉血: 16.9；胱抑素(Cys-C)-静脉血: 1.07mg/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；直接胆红素(DBIL)-静脉血: 3.9umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；血小板计数(PLT#)-静脉血: 18610E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 25.2U/L；细菌名称-咽拭子: 细菌涂片3；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.03；平均红细胞血红蛋白含量(MCH)-静脉血: 29.8pg；白细胞计数(WBC#)-静脉血: 3.6610E9/L；尿素氮(BUN)-静脉血: 4.8mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 24U/L；氯离子(Cl-)-静脉血: 97.1mmol/L；血小板分布宽度(PDW)-静脉血: 10.4%；淋巴细胞百分比(Lymph%)-静脉血: 0.085；血液二氧化碳含量ctCO2(B)-静脉血: 23.3mmol/L；钠离子(Na+)-静脉血: 137.3mmol/L；总胆红素(TBIL)-静脉血: 11.7umol/L；C-反应蛋白(CRP)-静脉血: 11.52mg/L；总胆汁酸(TBA)-静脉血: 1.4umol/L；中性粒细胞计……\n- [全程D55] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约12mm，肝S5可见一无回声灶，大小约11×9mm,椭圆形，边界清，内透声可，后方回声增强。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约19cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱不充盈。 前列腺大小形态正常，大小约38×30×37mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝囊肿。 胆囊、脾脏、胰腺、双肾、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D56] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理清晰，双肺野内未见明显实质性病变。双侧肺门未见增大，纵隔未见增宽，心影形态、大小未见异常。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见异常。\n- [全程D56] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌治疗后，对比某次就诊时间片： 鼻咽腔狭窄，鼻咽顶壁、顶后壁、右侧壁稍增厚，粘膜表面欠光滑，增强后较明显强化，较前明显缩小，双侧咽隐窝稍变浅，鼻中隔后缘见少许软组织，增强后较明显强化，右侧咽旁间隙稍变窄，左侧咽旁脂肪间隙及左侧颈动脉鞘区未见异常。 右侧腭帆提肌稍模糊；左侧腭帆提肌、腭帆张肌、头长肌未见受累征象。 左侧中下鼻甲明显肥厚。 双侧翼腭窝、双上颌后脂肪间隙及咀嚼肌间隙未见异常；口咽未见明显异常。 斜坡、蝶骨基底部、右侧翼突基底部信号降低，增强后强化，较前范围稍缩小。 双侧海绵窦未见明显异常。 双侧上颌窦、筛窦、右侧蝶窦、右侧乳突粘膜增厚，可见长分期信息见历史辅助诊断节点、分期信息见历史辅助诊断节点异常信号影，无强化，骨壁完整。双眼大小、形态、位置均属正常、信号均匀。蝶鞍形态正常，其内未见占位性病变。 右侧咽后间隙见淋巴结，较大者约7mm×6mm，信号欠均匀，增强后明显强化，较前缩小；左侧咽后间隙未见肿大淋巴结。双颈Ⅱ区、右颈Ⅲ区见多个淋巴结，边界欠清，最大约10mm×7mm，增强后不均匀强化，较前缩小、数目减少。 所见甲状腺双叶形态正常、喉咽腔、双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。；检查结论: 鼻咽癌治疗后，对比某次就诊时间片： 鼻咽病灶较前明显缩小。 颅底骨质破坏，较前修复。 右侧咽后淋巴结肿大，较前明显缩小。 双颈II区、右颈III区小淋巴结，较前明显缩小、数目减少。 鼻窦炎及右侧乳突炎。 左侧中下鼻甲肥厚。\n\n【既往治疗与反应】\n- [全程D32] 阶段小结；阶段小结: 病程类型: 阶段小结；病程主题: 阶段小结；病程内容: 患者[姓名已隐去]，男，51岁，因“颈部肿物，偶伴涕血、鼻塞2月”于某次就诊时间入院。征求患者同意并签字入住顺铂三周/单周方案联合IMRT治疗局部中晚期鼻咽癌三期临床试验，抽签入三周顺铂100mg/m2组。目前放疗14次，同时期化疗1次。3次靶向治疗，继续原方案治疗，并予患者营养支持治疗。\n- [全程D37] 上级查房记录；[姓名已隐去]主任医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者诉咽喉疼痛，目前放疗17次，今日行第2次顺铂同时期化疗，查体：患者鼻咽壁肿物明显缩小，双颈未扪及淋巴结，面部、双颈部皮肤色素沉着。[姓名已隐去]医生信息已隐藏：密切关注患者放化疗副反应，遵嘱执行。\n- [全程D42] 上级查房记录；[姓名已隐去]主任医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者诉咽喉疼痛，目前放疗20次，已行2次顺铂同时期化疗，4次靶向治疗，诉食欲不佳，查体：患者鼻咽顶后壁肿物明显缩小，双颈未扪及淋巴结，面部、双颈部皮肤色素沉着。[姓名已隐去]医生信息已隐藏：嘱患者加强营养及日常休息。密切关注患者放化疗副反应。 遵嘱。\n- [全程D47] 上级查房记录；[姓名已隐去]主任医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者目前放疗24次，已行2次顺铂同时期化疗，5次靶向治疗，诉咽喉疼痛，纳差，乏力。查体：患者鼻咽顶后壁稍增厚，双颈未扪及淋巴结，面部、双颈部皮肤色素沉着。[姓名已隐去]医生信息已隐藏：予以抗炎对症处理，并予患者行营养支持治疗，并密切关注患者血象变化。\n- [全程D52] 上级查房记录；[姓名已隐去]主任医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者目前放疗27次，已行2次顺铂同时期化疗，6次靶向治疗，诉咽喉疼痛，纳差，乏力。查体：患者鼻咽右侧壁肿物已基本消退，双颈未扪及淋巴结，面部、双颈部皮肤色素沉着。[姓名已隐去]医生信息已隐藏：予患者行营养支持治疗，并密切关注患者血象变化。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行电子鼻咽镜检查并在可疑残留区域取活检，继续静脉滴注莫西沙星及地塞米松预防感染与水肿，暂不予抗肿瘤治疗。\nB. 安排全身PET-CT检查评估放化疗后全身代谢缓解情况，并继续静脉滴注脂肪乳及氨基酸等营养支持治疗。\nC. 行电子鼻咽镜检查评估局部肿瘤退缩情况，并继续使用重组人表皮生长因子、重组人粒细胞巨噬细胞刺激因子等含漱药物促进粘膜修复。\nD. 对右侧咽后及颈部残留淋巴结行局部追加放疗推量，并继续使用重组人表皮生长因子等含漱药物促进粘膜修复。\nE. 行电子鼻咽镜检查评估局部疗效，并启动吉西他滨联合顺铂方案进行2至3个周期的辅助化疗以巩固全身疗效。\nF. 行右侧颈部淋巴结清扫术处理残留淋巴结，术后继续使用重组人表皮生长因子外用溶液促进局部创面愈合。\nG. 行鼻咽及颈部超声检查评估淋巴结结构，并加用卡培他滨口服进行为期1年的节拍化疗作为维持治疗。\nH. 暂不进行鼻咽镜检查，直接出院，嘱1个月后返院行鼻咽部活检及MRI复查，期间继续静脉营养支持。\nI. 行电子鼻咽镜检查评估局部疗效，并继续静脉滴注脂肪乳、氨基酸及复方氯化钠注射液加强全身营养支持。\nJ. 安排头颅增强MRI及全身骨扫描排除远处转移，并继续原方案靶向治疗至满1年，辅以局部含漱药物治疗。\nK. 行电子鼻咽镜检查评估局部疗效，若发现粘膜坏死则立即行内镜下清创术，并静脉滴注大剂量抗生素抗感染。\nL. 继续静脉滴注莫西沙星及地塞米松抗炎治疗2周以控制鼻窦炎及乳突炎，并定期复查鼻窦CT评估炎症吸收情况。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"行电子鼻咽镜检查并在可疑残留区域取活检，继续静脉滴注莫西沙星及地塞米松预防感染与水肿，暂不予抗肿瘤治疗。","is_gold":false},{"letter":"B","text":"安排全身PET-CT检查评估放化疗后全身代谢缓解情况，并继续静脉滴注脂肪乳及氨基酸等营养支持治疗。","is_gold":false},{"letter":"C","text":"行电子鼻咽镜检查评估局部肿瘤退缩情况，并继续使用重组人表皮生长因子、重组人粒细胞巨噬细胞刺激因子等含漱药物促进粘膜修复。","is_gold":true},{"letter":"D","text":"对右侧咽后及颈部残留淋巴结行局部追加放疗推量，并继续使用重组人表皮生长因子等含漱药物促进粘膜修复。","is_gold":false},{"letter":"E","text":"行电子鼻咽镜检查评估局部疗效，并启动吉西他滨联合顺铂方案进行2至3个周期的辅助化疗以巩固全身疗效。","is_gold":false},{"letter":"F","text":"行右侧颈部淋巴结清扫术处理残留淋巴结，术后继续使用重组人表皮生长因子外用溶液促进局部创面愈合。","is_gold":false},{"letter":"G","text":"行鼻咽及颈部超声检查评估淋巴结结构，并加用卡培他滨口服进行为期1年的节拍化疗作为维持治疗。","is_gold":false},{"letter":"H","text":"暂不进行鼻咽镜检查，直接出院，嘱1个月后返院行鼻咽部活检及MRI复查，期间继续静脉营养支持。","is_gold":false},{"letter":"I","text":"行电子鼻咽镜检查评估局部疗效，并继续静脉滴注脂肪乳、氨基酸及复方氯化钠注射液加强全身营养支持。","is_gold":false},{"letter":"J","text":"安排头颅增强MRI及全身骨扫描排除远处转移，并继续原方案靶向治疗至满1年，辅以局部含漱药物治疗。","is_gold":false},{"letter":"K","text":"行电子鼻咽镜检查评估局部疗效，若发现粘膜坏死则立即行内镜下清创术，并静脉滴注大剂量抗生素抗感染。","is_gold":false},{"letter":"L","text":"继续静脉滴注莫西沙星及地塞米松抗炎治疗2周以控制鼻窦炎及乳突炎，并定期复查鼻窦CT评估炎症吸收情况。","is_gold":false}],"gold_letter":"C"}]}
+{"patient_id":"patient-e90c2443e271b2e927262653","bootstrap_cluster_id":"cluster-020","turns":[{"sample_id":"sample-37f31044df5e45295b88793a","patient_id":"patient-e90c2443e271b2e927262653","turn_id":"turn01","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、颈动脉鞘、斜坡、海绵窦、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 间断性回吸性涕血1年余。；现病史: 患者近一年以来无明显原因出现回吸性涕血、近一个月左侧鼻塞明显，间断鼻衄。双侧耳鸣伴左耳听力下降，左侧头痛，双颈肿块。无面麻、张口困难、软腭麻痹，无咳嗽咳痰、呼吸困难。伴双侧咽后、颈部淋巴结转移。现为进一步诊治入院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重下降1Kg。；阳性症状体征: 体重下降,听力下降,双颈肿物,双耳鸣,涕血,鼻衄,左鼻塞,左侧头痛；既往史: 既往体健。4年前妊娠期间高血糖。3年前剖宫产。否认肝炎、结核等传染病史。否认心脏病、高血压史。预防接种史不详。过敏史:无药物及食物过敏史。；个人史: 出生于原籍，无烟酒药物等嗜好，无疫水接触史，否认不洁性生活史。无工业毒物，粉尘，放射性物质接触史。；家族史: 否认家族其他成员中有类似病患者或肿瘤患者。；体格检查: T36.5℃P78次/分R19次/分BP115/70mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。无鼻翼扇动、鼻衄。牙龈无肿胀、出血。气管居中，甲状腺不大。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率70bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。；专科检查: KPS 90。双颈II区触及多枚肿大淋巴结，直径约1.0cm，质韧、固定、相互融合。颅神经（-）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 电子鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸部DR、腹部彩超、全身骨显像\nB. 鼻咽及颈部MRI平扫+增强，胸部DR、腹部彩超、全身骨显像，暂缓鼻咽镜及活检\nC. 颈部淋巴结切除活检，鼻咽及颈部MRI平扫+增强，胸部DR、腹部彩超、全身骨显像\nD. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部DR、腹部彩超、全身骨显像\nE. 电子鼻咽镜检查及活检，鼻咽MRI平扫+增强，胸部DR、腹部彩超、全身骨显像\nF. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，暂缓胸腹部及骨骼影像学筛查\nG. 全身PET-CT检查，颈部淋巴结细针穿刺活检，暂缓电子鼻咽镜检查及活检\nH. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫，胸部DR、腹部彩超、全身骨显像\nI. 电子鼻咽镜检查，鼻咽及颈部MRI平扫+增强，胸部CT、腹部CT，暂缓组织活检\nJ. 颈部淋巴结穿刺活检，鼻咽及颈部CT平扫+增强，胸部DR、腹部彩超、全身骨显像\nK. 电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，头颅CT平扫，暂缓远处转移筛查\nL. 电子鼻咽镜检查及活检，鼻咽及颈部超声检查，胸部DR、腹部彩超、全身骨显像\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"电子鼻咽镜检查及活检，鼻咽及颈部CT平扫+增强，胸部DR、腹部彩超、全身骨显像","is_gold":false},{"letter":"B","text":"鼻咽及颈部MRI平扫+增强，胸部DR、腹部彩超、全身骨显像，暂缓鼻咽镜及活检","is_gold":false},{"letter":"C","text":"颈部淋巴结切除活检，鼻咽及颈部MRI平扫+增强，胸部DR、腹部彩超、全身骨显像","is_gold":false},{"letter":"D","text":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，胸部DR、腹部彩超、全身骨显像","is_gold":true},{"letter":"E","text":"电子鼻咽镜检查及活检，鼻咽MRI平扫+增强，胸部DR、腹部彩超、全身骨显像","is_gold":false},{"letter":"F","text":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，暂缓胸腹部及骨骼影像学筛查","is_gold":false},{"letter":"G","text":"全身PET-CT检查，颈部淋巴结细针穿刺活检，暂缓电子鼻咽镜检查及活检","is_gold":false},{"letter":"H","text":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫，胸部DR、腹部彩超、全身骨显像","is_gold":false},{"letter":"I","text":"电子鼻咽镜检查，鼻咽及颈部MRI平扫+增强，胸部CT、腹部CT，暂缓组织活检","is_gold":false},{"letter":"J","text":"颈部淋巴结穿刺活检，鼻咽及颈部CT平扫+增强，胸部DR、腹部彩超、全身骨显像","is_gold":false},{"letter":"K","text":"电子鼻咽镜检查及活检，鼻咽及颈部MRI平扫+增强，头颅CT平扫，暂缓远处转移筛查","is_gold":false},{"letter":"L","text":"电子鼻咽镜检查及活检，鼻咽及颈部超声检查，胸部DR、腹部彩超、全身骨显像","is_gold":false}],"gold_letter":"D"},{"sample_id":"sample-6fba8e9f22d1b7d086664e36","patient_id":"patient-e90c2443e271b2e927262653","turn_id":"turn02","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、颈动脉鞘、斜坡、海绵窦、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 间断性回吸性涕血1年余。；现病史: 患者近一年以来无明显原因出现回吸性涕血、近一个月左侧鼻塞明显，间断鼻衄。双侧耳鸣伴左耳听力下降，左侧头痛，双颈肿块。无面麻、张口困难、软腭麻痹，无咳嗽咳痰、呼吸困难。伴双侧咽后、颈部淋巴结转移。现为进一步诊治入院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重下降1Kg。；阳性症状体征: 体重下降,听力下降,双颈肿物,双耳鸣,涕血,鼻衄,左鼻塞,左侧头痛；既往史: 既往体健。4年前妊娠期间高血糖。3年前剖宫产。否认肝炎、结核等传染病史。否认心脏病、高血压史。预防接种史不详。过敏史:无药物及食物过敏史。；个人史: 出生于原籍，无烟酒药物等嗜好，无疫水接触史，否认不洁性生活史。无工业毒物，粉尘，放射性物质接触史。；家族史: 否认家族其他成员中有类似病患者或肿瘤患者。；体格检查: T36.5℃P78次/分R19次/分BP115/70mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。无鼻翼扇动、鼻衄。牙龈无肿胀、出血。气管居中，甲状腺不大。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率70bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。；专科检查: KPS 90。双颈II区触及多枚肿大淋巴结，直径约1.0cm，质韧、固定、相互融合。颅神经（-）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 正常范围心电图\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理清晰，走行自然，双肺野内未见明确实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。双上胸膜略厚。；检查结论: 心肺未见明显病变。\n- [全程D1] 检验组合: 胱抑素(Cys-C)-静脉血: 0.8mg/L；钾离子(K+)-静脉血: 4.14mmol/L；肌酐(Crea)-静脉血: 65umol/L；葡萄糖(Glu)-静脉血: 5.25mmol/L；载脂蛋白B(apoB)-静脉血: 0.81g/L；碱性磷酸酶(ALP)-静脉血: 47U/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:20（参考: 阴性）；乳酸脱氢酶(LDH)-静脉血: 210.4U/L；纤维蛋白原(Fbg)-静脉血: 2.89g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.62；天门冬氨酸氨基转移酶(AST)-静脉血: 19.6U/L；阴离子间隙(AG)-静脉血: 14.7；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.376COI；总胆固醇(TC)-静脉血: 4.58mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.7mmolL；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.56g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.5mmol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 1.79COI；总胆汁酸(TBA)-静脉血: 2umol/L；平均血小板体积(MPV)-静脉血: 10.5fL；磷(P)-静脉血: 1.23mmol/L；单核细胞百分比(Mono%)-静脉血: 0.042；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 0.009COI；甘油三酯(TG)-静脉血: 0.86mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.1mmol/L；平均红细胞体积(MCV)-静脉血: 96.1fL；丙氨酸氨基转移酶(ALT)-静脉血: 15U/L；血小板分布宽度(PDW)-静脉血: 12.1%；C-反应蛋白(CRP)-静脉血: 0.28mg/L；α-L-岩藻糖苷酶(AFU)-静脉血: 33.2U/L；尿素氮(BUN)-静脉血: 4.7mmol/L；球蛋白(GLO)-静脉血: 28.21g/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 0.109……\n- [全程D2] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁 、顶后壁、左侧壁增厚，见软组织肿物影。左侧咽隐窝消失，右侧咽隐窝变浅；病灶呈稍长分期信息见历史辅助诊断节点稍长分期信息见历史辅助诊断节点信号，增强扫描强化明显。 口咽双侧壁未见增厚。鼻腔未见肿物影。 左侧咽旁脂肪间隙变窄，左侧颈动脉鞘区见肿物占据。左侧腭帆张提肌及左侧头长肌受侵。 左侧翼腭窝见软组织影；右侧翼腭窝、双侧颞下窝未见异常。 斜坡、左侧岩尖、左侧破裂孔，左侧蝶骨大翼、左侧翼突、左侧翼管、左侧圆孔、蝶骨基底部骨质破坏。 蝶窦见软组织肿物；右侧乳突、双侧上颌窦充气良好；蝶窦、筛窦及左侧乳突见分泌物。 双眼未见异常。 左侧海绵窦见可疑肿物侵犯。 双侧咽后淋巴结肿大，左侧短径大小约为15mm，见包膜外侵；右侧短径大小约为11mm。双侧II区见多个肿大淋巴结，相互融合，最大短径大小约为18mm。 右侧腮腺见小淋巴结，短径约为7mm。 双侧腮腺。颌下腺、甲状腺未见异常。；检查结论: 考虑鼻咽癌，左侧咽旁间隙、颅底骨质； 可疑左侧海绵窦受侵。 双侧咽后淋巴结，双侧II区淋巴结肿大，考虑转移。 右侧腮腺小淋巴结，性质待定。 副鼻窦炎症。 左侧乳突炎症。\n- [全程D2] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，肝内血管走行自然，门静脉内径约10mm，未见明确肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约26cm/s。 胆囊大小正常，壁不厚，光滑，其内未见异常回声。 脾脏大小正常，包膜光滑，实质回声均匀。 胰腺大小正常，包膜光滑，实质回声均匀，胰管无扩张。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位性病变。 腹主动脉旁未见明确占位病变。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善颈部淋巴结细针穿刺活检及全身骨扫描\nB. 完善颈部淋巴结切除活检及全身PET-CT\nC. 完善电子鼻咽镜检查及鼻咽脱落细胞学检查\nD. 完善鼻咽肿物切除活检及全身骨扫描检查\nE. 完善电子鼻咽镜检查及鼻咽肿物活检\nF. 完善全身骨扫描检查并直接启动根治性放疗\nG. 完善鼻内镜下鼻咽肿物扩大切除及组织活检\nH. 完善颈部淋巴结切除活检及EB病毒DNA检测\nI. 完善电子鼻咽镜检查及鼻咽部多点盲取活检\nJ. 完善电子鼻咽镜检查及鼻咽肿物细针穿刺活检\nK. 完善脑部增强MRI检查及颈部淋巴结穿刺活检\nL. 完善电子鼻咽镜检查及活检并立即启动化疗\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"完善颈部淋巴结细针穿刺活检及全身骨扫描","is_gold":false},{"letter":"B","text":"完善颈部淋巴结切除活检及全身PET-CT","is_gold":false},{"letter":"C","text":"完善电子鼻咽镜检查及鼻咽脱落细胞学检查","is_gold":false},{"letter":"D","text":"完善鼻咽肿物切除活检及全身骨扫描检查","is_gold":false},{"letter":"E","text":"完善电子鼻咽镜检查及鼻咽肿物活检","is_gold":true},{"letter":"F","text":"完善全身骨扫描检查并直接启动根治性放疗","is_gold":false},{"letter":"G","text":"完善鼻内镜下鼻咽肿物扩大切除及组织活检","is_gold":false},{"letter":"H","text":"完善颈部淋巴结切除活检及EB病毒DNA检测","is_gold":false},{"letter":"I","text":"完善电子鼻咽镜检查及鼻咽部多点盲取活检","is_gold":false},{"letter":"J","text":"完善电子鼻咽镜检查及鼻咽肿物细针穿刺活检","is_gold":false},{"letter":"K","text":"完善脑部增强MRI检查及颈部淋巴结穿刺活检","is_gold":false},{"letter":"L","text":"完善电子鼻咽镜检查及活检并立即启动化疗","is_gold":false}],"gold_letter":"E"},{"sample_id":"sample-4caf9a9989bff46283725cce","patient_id":"patient-e90c2443e271b2e927262653","turn_id":"turn04","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、颈动脉鞘、斜坡、海绵窦、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 间断性回吸性涕血1年余。；现病史: 患者近一年以来无明显原因出现回吸性涕血、近一个月左侧鼻塞明显，间断鼻衄。双侧耳鸣伴左耳听力下降，左侧头痛，双颈肿块。无面麻、张口困难、软腭麻痹，无咳嗽咳痰、呼吸困难。当地医院CT提示：鼻咽癌侵犯枕斜坡双侧蝶窦。伴双侧咽后、颈部淋巴结转移。现为进一步诊治入院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重下降1Kg。；阳性症状体征: 体重下降,听力下降,双颈肿物,双耳鸣,涕血,鼻衄,左鼻塞,左侧头痛；既往史: 既往体健。4年前妊娠期间高血糖。3年前剖宫产。否认肝炎、结核等传染病史。否认心脏病、高血压史。预防接种史不详。过敏史:无药物及食物过敏史。；个人史: 出生于原籍，无烟酒药物等嗜好，无疫水接触史，否认不洁性生活史。无工业毒物，粉尘，放射性物质接触史。；家族史: 否认家族其他成员中有类似病患者或肿瘤患者。；体格检查: T36.5℃P78次/分R19次/分BP115/70mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。无鼻翼扇动、鼻衄。牙龈无肿胀、出血。气管居中，甲状腺不大。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率70bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。肛门外生殖器未见异常，生理反射存在，病理反射未引出。；专科检查: KPS 90。张口门齿距4.5cm，间接鼻咽镜：见鼻咽左侧壁肿物肿物；双颈II区触及多枚肿大淋巴结，直径约1.0cm，质韧、固定、相互融合。颅神经（-）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 正常范围心电图\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 单纯根治性放疗\nB. 同步放化疗序贯辅助化疗\nC. 诱导化疗序贯单纯根治性放疗\nD. 根治性手术切除序贯术后放化疗\nE. 诱导化疗序贯靶向治疗联合放疗\nF. 姑息性化疗联合免疫治疗\nG. 诱导化疗序贯同步放化疗\nH. 同步放化疗联合靶向治疗\nI. 诱导化疗序贯根治性颈清扫术\nJ. 单纯同步放化疗\nK. 靶向治疗联合同步放化疗\nL. 诱导化疗联合免疫治疗序贯单纯放疗\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"单纯根治性放疗","is_gold":false},{"letter":"B","text":"同步放化疗序贯辅助化疗","is_gold":false},{"letter":"C","text":"诱导化疗序贯单纯根治性放疗","is_gold":false},{"letter":"D","text":"根治性手术切除序贯术后放化疗","is_gold":false},{"letter":"E","text":"诱导化疗序贯靶向治疗联合放疗","is_gold":false},{"letter":"F","text":"姑息性化疗联合免疫治疗","is_gold":false},{"letter":"G","text":"诱导化疗序贯同步放化疗","is_gold":true},{"letter":"H","text":"同步放化疗联合靶向治疗","is_gold":false},{"letter":"I","text":"诱导化疗序贯根治性颈清扫术","is_gold":false},{"letter":"J","text":"单纯同步放化疗","is_gold":false},{"letter":"K","text":"靶向治疗联合同步放化疗","is_gold":false},{"letter":"L","text":"诱导化疗联合免疫治疗序贯单纯放疗","is_gold":false}],"gold_letter":"G"},{"sample_id":"sample-9253a0b82814c8e2231522e6","patient_id":"patient-e90c2443e271b2e927262653","turn_id":"turn05","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、颈动脉鞘、斜坡、海绵窦、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 间断性回吸性涕血1年余。；现病史: 患者近一年以来无明显原因出现回吸性涕血、近一个月左侧鼻塞明显，间断鼻衄。双侧耳鸣伴左耳听力下降，左侧头痛，双颈肿块。无面麻、张口困难、软腭麻痹，无咳嗽咳痰、呼吸困难。当地医院CT提示：鼻咽癌侵犯枕斜坡双侧蝶窦。伴双侧咽后、颈部淋巴结转移。现为进一步诊治入院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重下降1Kg。；阳性症状体征: 体重下降,听力下降,双颈肿物,双耳鸣,涕血,鼻衄,左鼻塞,左侧头痛；既往史: 既往体健。4年前妊娠期间高血糖。3年前剖宫产。否认肝炎、结核等传染病史。否认心脏病、高血压史。预防接种史不详。过敏史:无药物及食物过敏史。；个人史: 出生于原籍，无烟酒药物等嗜好，无疫水接触史，否认不洁性生活史。无工业毒物，粉尘，放射性物质接触史。；家族史: 否认家族其他成员中有类似病患者或肿瘤患者。；体格检查: T36.5℃P78次/分R19次/分BP115/70mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。无鼻翼扇动、鼻衄。牙龈无肿胀、出血。气管居中，甲状腺不大。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率70bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。肛门外生殖器未见异常，生理反射存在，病理反射未引出。；专科检查: KPS 90。张口门齿距4.5cm，间接鼻咽镜：见鼻咽左侧壁肿物肿物；双颈II区触及多枚肿大淋巴结，直径约1.0cm，质韧、固定、相互融合。颅神经（-）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 正常范围心电图\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺纹理清晰，走行自然，双肺野内未见明确实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。双上胸膜略厚。；检查结论: 心肺未见明显病变。\n- [全程D1] 检验组合: 胱抑素(Cys-C)-静脉血: 0.8mg/L；钾离子(K+)-静脉血: 4.14mmol/L；肌酐(Crea)-静脉血: 65umol/L；葡萄糖(Glu)-静脉血: 5.25mmol/L；载脂蛋白B(apoB)-静脉血: 0.81g/L；碱性磷酸酶(ALP)-静脉血: 47U/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:20（参考: 阴性）；乳酸脱氢酶(LDH)-静脉血: 210.4U/L；纤维蛋白原(Fbg)-静脉血: 2.89g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.62；天门冬氨酸氨基转移酶(AST)-静脉血: 19.6U/L；阴离子间隙(AG)-静脉血: 14.7；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.376COI；总胆固醇(TC)-静脉血: 4.58mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.7mmolL；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.56g/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.5mmol/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 1.79COI；总胆汁酸(TBA)-静脉血: 2umol/L；平均血小板体积(MPV)-静脉血: 10.5fL；磷(P)-静脉血: 1.23mmol/L；单核细胞百分比(Mono%)-静脉血: 0.042；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 0.009COI；甘油三酯(TG)-静脉血: 0.86mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 331g/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.1mmol/L；平均红细胞体积(MCV)-静脉血: 96.1fL；丙氨酸氨基转移酶(ALT)-静脉血: 15U/L；血小板分布宽度(PDW)-静脉血: 12.1%；C-反应蛋白(CRP)-静脉血: 0.28mg/L；α-L-岩藻糖苷酶(AFU)-静脉血: 33.2U/L；尿素氮(BUN)-静脉血: 4.7mmol/L；球蛋白(GLO)-静脉血: 28.21g/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 0.109……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者入院第2天，一般情况可，今日[姓名已隐去]医生信息已隐藏，详细听取病情汇报、检查患者后指示：尽快完善各项治疗前检查，明确诊断及分期，并了解有无合并其他基础疾病，待分期明确后再定治疗方案。遵嘱执行。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 给予重组人粒细胞集落刺激因子（rhG-CSF）皮下注射，并完善基线心电图及超声心动图检查。\nB. 给予地塞米松及20%甘露醇注射液静脉滴注，并紧急行头颅CT平扫。\nC. 给予异甘草酸镁注射液静脉滴注进行预防性保肝治疗。\nD. 给予唑来膦酸静脉滴注，并完善全身骨骼核素扫描（ECT）。\nE. 给予肠内营养粉剂口服进行营养支持，并留置鼻胃管。\nF. 给予静脉铁剂及重组人促红素（rhEPO）皮下注射，并复查血常规及网织红细胞。\nG. 给予头孢曲松钠静脉滴注进行预防性抗感染治疗，并完善血培养及药敏试验。\nH. 不额外给予预防性升白、保肝或抗凝等支持治疗，继续完善乙肝定量、凝血功能及其他治疗前基线血液学和感染学筛查。\nI. 给予塞来昔布胶囊常规口服进行镇痛治疗，并局部外用氟比洛芬凝胶贴膏。\nJ. 给予低分子量肝素钙皮下注射进行抗凝治疗，并完善双下肢深静脉彩超。\nK. 给予奥美拉唑肠溶胶囊口服进行抑酸护胃治疗，并完善胃镜检查。\nL. 给予安替可及硒酵母口服进行辅助治疗，并暂缓乙肝及梅毒等传染病筛查。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"给予重组人粒细胞集落刺激因子（rhG-CSF）皮下注射，并完善基线心电图及超声心动图检查。","is_gold":false},{"letter":"B","text":"给予地塞米松及20%甘露醇注射液静脉滴注，并紧急行头颅CT平扫。","is_gold":false},{"letter":"C","text":"给予异甘草酸镁注射液静脉滴注进行预防性保肝治疗。","is_gold":false},{"letter":"D","text":"给予唑来膦酸静脉滴注，并完善全身骨骼核素扫描（ECT）。","is_gold":false},{"letter":"E","text":"给予肠内营养粉剂口服进行营养支持，并留置鼻胃管。","is_gold":false},{"letter":"F","text":"给予静脉铁剂及重组人促红素（rhEPO）皮下注射，并复查血常规及网织红细胞。","is_gold":false},{"letter":"G","text":"给予头孢曲松钠静脉滴注进行预防性抗感染治疗，并完善血培养及药敏试验。","is_gold":false},{"letter":"H","text":"不额外给予预防性升白、保肝或抗凝等支持治疗，继续完善乙肝定量、凝血功能及其他治疗前基线血液学和感染学筛查。","is_gold":true},{"letter":"I","text":"给予塞来昔布胶囊常规口服进行镇痛治疗，并局部外用氟比洛芬凝胶贴膏。","is_gold":false},{"letter":"J","text":"给予低分子量肝素钙皮下注射进行抗凝治疗，并完善双下肢深静脉彩超。","is_gold":false},{"letter":"K","text":"给予奥美拉唑肠溶胶囊口服进行抑酸护胃治疗，并完善胃镜检查。","is_gold":false},{"letter":"L","text":"给予安替可及硒酵母口服进行辅助治疗，并暂缓乙肝及梅毒等传染病筛查。","is_gold":false}],"gold_letter":"H"},{"sample_id":"sample-3b37bb5b3505f87a241c1a6f","patient_id":"patient-e90c2443e271b2e927262653","turn_id":"turn06","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、颈动脉鞘、斜坡、海绵窦、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 间断性回吸性涕血1年余。；现病史: 患者近一年以来无明显原因出现回吸性涕血、近一个月左侧鼻塞明显，间断鼻衄。双侧耳鸣伴左耳听力下降，左侧头痛，双颈肿块。无面麻、张口困难、软腭麻痹，无咳嗽咳痰、呼吸困难。当地医院CT提示：鼻咽癌侵犯枕斜坡双侧蝶窦。伴双侧咽后、颈部淋巴结转移。现为进一步诊治入院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重下降1Kg。；阳性症状体征: 体重下降,听力下降,双颈肿物,双耳鸣,涕血,鼻衄,左鼻塞,左侧头痛；既往史: 既往体健。4年前妊娠期间高血糖。3年前剖宫产。否认肝炎、结核等传染病史。否认心脏病、高血压史。预防接种史不详。过敏史:无药物及食物过敏史。；个人史: 出生于原籍，无烟酒药物等嗜好，无疫水接触史，否认不洁性生活史。无工业毒物，粉尘，放射性物质接触史。；家族史: 否认家族其他成员中有类似病患者或肿瘤患者。；体格检查: T36.5℃P78次/分R19次/分BP115/70mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。无鼻翼扇动、鼻衄。牙龈无肿胀、出血。气管居中，甲状腺不大。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率70bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。肛门外生殖器未见异常，生理反射存在，病理反射未引出。；专科检查: KPS 90。张口门齿距4.5cm，间接鼻咽镜：见鼻咽左侧壁肿物肿物；双颈II区触及多枚肿大淋巴结，直径约1.0cm，质韧、固定、相互融合。颅神经（-）。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 正常范围心电图\n- [全程D9] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；白细胞计数(WBC#)-静脉血: 9.210E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.812；单核细胞百分比(Mono%)-静脉血: 0.005；平均血小板体积(MPV)-静脉血: 11.2fL；平均红细胞体积(MCV)-静脉血: 95.5fL；血小板比容-静脉血: 21%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.1；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339g/L；大血小板百分比(P-LCR%)-静脉血: 36.6%；淋巴细胞百分比(Lymph%)-静脉血: 0.178；平均红细胞血红蛋白含量(MCH)-静脉血: 32.4pg；单核细胞计数(Mono#)-静脉血: 0.110E9/L；红细胞计数(RBC#)-静脉血: 3.5210E12/L；血小板分布宽度(PDW)-静脉血: 13.8%；血小板计数(PLT#)-静脉血: 19010E9/L；红细胞比容(Hct)-静脉血: 33.6%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 114g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.001；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.4；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；中性粒细胞计数(Neut#)-静脉血: 7.410E9/L\n- [全程D13] 检验组合: 嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；大血小板百分比(P-LCR%)-静脉血: 33.8%；淋巴细胞百分比(Lymph%)-静脉血: 0.645；平均红细胞血红蛋白含量(MCH)-静脉血: 32.1pg；血红蛋白(Hb)-静脉血: 130g/L；白细胞计数(WBC#)-静脉血: 1.710E9/L；平均红细胞体积(MCV)-静脉血: 92.6fL；红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；单核细胞百分比(Mono%)-静脉血: 0.114；血小板分布宽度(PDW)-静脉血: 13%；中性粒细胞百分比(Neut%)-静脉血: 0.229；红细胞比容(Hct)-静脉血: 37.5%；单核细胞计数(Mono#)-静脉血: 0.210E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 35.6；淋巴细胞计数(Lymph#)-静脉血: 1.110E9/L；血小板比容-静脉血: 27%；中性粒细胞计数(Neut#)-静脉血: 0.410E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.006；血小板计数(PLT#)-静脉血: 24210E9/L；平均血小板体积(MPV)-静脉血: 11fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 10.6；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L\n- [全程D14] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；淋巴细胞百分比(Lymph%)-静脉血: 0.51；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板比容-静脉血: 23%；红细胞计数(RBC#)-静脉血: 3.8110E12/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.8pg；红细胞体积分布宽度SD(RDW-SD)-静脉血: 37.8；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；白细胞计数(WBC#)-静脉血: 2.510E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.151；大血小板百分比(P-LCR%)-静脉血: 28.8%；红细胞比容(Hct)-静脉血: 34.9%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 121g/L；平均红细胞体积(MCV)-静脉血: 91.6fL；血小板分布宽度(PDW)-静脉血: 12.4%；单核细胞百分比(Mono%)-静脉血: 0.291；平均红细胞血红蛋白浓度(MCHC)-静脉血: 347g/L；中性粒细胞计数(Neut#)-静脉血: 0.410E9/L；平均血小板体积(MPV)-静脉血: 10.4fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.3；淋巴细胞计数(Lymph#)-静脉血: 1.310E9/L；血小板计数(PLT#)-静脉血: 22010E9/L\n- [全程D15] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；红细胞计数(RBC#)-静脉血: 3.8910E12/L；血小板分布宽度(PDW)-静脉血: 12.8%；平均红细胞体积(MCV)-静脉血: 94.6fL；中性粒细胞计数(Neut#)-静脉血: 2.610E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 35.8；平均血小板体积(MPV)-静脉血: 10.4fL；中性粒细胞百分比(Neut%)-静脉血: 0.496；淋巴细胞百分比(Lymph%)-静脉血: 0.292；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 334g/L；血红蛋白(Hb)-静脉血: 123g/L；淋巴细胞计数(Lymph#)-静脉血: 1.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.202；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 10.8；白细胞计数(WBC#)-静脉血: 5.210E9/L；血小板计数(PLT#)-静脉血: 25410E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.6pg；血小板比容-静脉血: 26%；大血小板百分比(P-LCR%)-静脉血: 29%；红细胞比容(Hct)-静脉血: 36.8%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；单核细胞计数(Mono#)-静脉血: 1.110E9/L\n- [全程D16] 检验组合: 红细胞体积分布宽度SD(RDW-SD)-静脉血: 37；大血小板百分比(P-LCR%)-静脉血: 29.9%；红细胞比容(Hct)-静脉血: 34.2%；血小板计数(PLT#)-静脉血: 26510E9/L；单核细胞计数(Mono#)-静脉血: 1.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.128；血小板比容-静脉血: 28%；白细胞计数(WBC#)-静脉血: 11.810E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；血红蛋白(Hb)-静脉血: 113g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.8pg；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11；中性粒细胞计数(Neut#)-静脉血: 7.910E9/L；血小板分布宽度(PDW)-静脉血: 12.3%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；红细胞计数(RBC#)-静脉血: 3.5510E12/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.667；平均血小板体积(MPV)-静脉血: 10.5fL；淋巴细胞计数(Lymph#)-静脉血: 2.310E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.197；平均红细胞体积(MCV)-静脉血: 96.3fL\n- [全程D26] 检验组合: 直接胆红素(DBIL)-静脉血: 1.5umol/L；C-反应蛋白(CRP)-静脉血: 6.47mg/L；红细胞比容(Hct)-静脉血: 35.4%；阴离子间隙(AG)-静脉血: 8；血小板分布宽度(PDW)-静脉血: 10.3%；总钙(Ca)-静脉血: 2.27mmol/L；甘油三酯(TG)-静脉血: 0.74mmol/L；尿素氮(BUN)-静脉血: 4.68mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 32.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 32.4U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；葡萄糖(Glu)-静脉血: 5.39mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；白细胞计数(WBC#)-静脉血: 410E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 34U/L；磷(P)-静脉血: 1.35mmol/L；乳酸脱氢酶(LDH)-静脉血: 198.6U/L；血小板计数(PLT#)-静脉血: 25510E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.4；碱性磷酸酶(ALP)-静脉血: 92.4U/L；钾离子(K+)-静脉血: 3.9mmol/L；总蛋白(TP)-静脉血: 64.1g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.435；钠离子(Na+)-静脉血: 140.2mmol/L；胱抑素(Cys-C)-静脉血: 0.82mg/L；大血小板百分比(P-LCR%)-静脉血: 19.1%；间接胆红素(IBIL)-静脉血: 3.9umolL；红细胞计数(RBC#)-静脉血: 3.710E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.6pg；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；平均血小板体积(MPV)-静脉血: 9.3fL；氯离子(Cl-)-静脉血: 100.2mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.23g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.9；淋巴细胞百分比(Lymph%)-静脉血: 0.481；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.9；中性粒细胞计数(Neut#)-静脉……\n\n【既往治疗与反应】\n- [全程D13] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。胡医生信息已隐藏：患者予复查血象变化，密切观察患者病情变化。遵嘱。\n- [全程D16] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。检查回报：白细胞 2.5×109/L 。胡医生信息已隐藏：患者出现II度骨髓抑制，考虑化疗引起的副反应，予升白等对症处理，密切观察患者病情变化。遵嘱。\n- [全程D19] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。检查结果回报：白细胞 11.8×109/L。胡医生信息已隐藏：患者血象已恢复正常，密切观察患者病情变化。遵嘱。\n- [全程D22] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。胡医生信息已隐藏：患者予对症处理，密切观察患者病情变化。遵嘱。\n- [全程D25] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般状态良好，生命体征平稳。胡医生信息已隐藏：患者予对症处理，密切观察患者病情变化。遵嘱。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 预防性给予重组人粒细胞集落刺激因子（G-CSF）皮下注射，并推迟后续抗肿瘤治疗。\nB. 立即输注红细胞悬液2U，并皮下注射促红细胞生成素（EPO）纠正贫血。\nC. 启动异甘草酸镁及多烯磷脂酰胆碱静脉滴注，进行双靶点强化保肝治疗。\nD. 建立中心静脉通道，给予10%氯化钾注射液微量泵持续静脉泵入补钾。\nE. 留取血培养后，经验性静脉滴注头孢哌酮舒巴坦等广谱抗菌药物抗感染。\nF. 每日静脉输注人血白蛋白10g，并配合静脉推注呋塞米进行利尿消肿。\nG. 给予碳酸氢钠静脉滴注碱化尿液，并进行每日3000ml以上大剂量水化。\nH. 启动胰岛素泵持续皮下泵入强化降糖治疗，并严格限制碳水化合物摄入。\nI. 暂不需集落刺激因子支持，予以复方氨基酸及转化糖电解质静脉营养支持，并进行动静脉置管护理。\nJ. 持续静脉泵入质子泵抑制剂及5-HT3受体拮抗剂，进行强化抑酸止吐。\nK. 预防性输注单采血小板1个治疗量，并皮下注射重组人血小板生成素。\nL. 给予拉布立酶静脉滴注，并配合大剂量静脉水化预防肿瘤溶解综合征。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"预防性给予重组人粒细胞集落刺激因子（G-CSF）皮下注射，并推迟后续抗肿瘤治疗。","is_gold":false},{"letter":"B","text":"立即输注红细胞悬液2U，并皮下注射促红细胞生成素（EPO）纠正贫血。","is_gold":false},{"letter":"C","text":"启动异甘草酸镁及多烯磷脂酰胆碱静脉滴注，进行双靶点强化保肝治疗。","is_gold":false},{"letter":"D","text":"建立中心静脉通道，给予10%氯化钾注射液微量泵持续静脉泵入补钾。","is_gold":false},{"letter":"E","text":"留取血培养后，经验性静脉滴注头孢哌酮舒巴坦等广谱抗菌药物抗感染。","is_gold":false},{"letter":"F","text":"每日静脉输注人血白蛋白10g，并配合静脉推注呋塞米进行利尿消肿。","is_gold":false},{"letter":"G","text":"给予碳酸氢钠静脉滴注碱化尿液，并进行每日3000ml以上大剂量水化。","is_gold":false},{"letter":"H","text":"启动胰岛素泵持续皮下泵入强化降糖治疗，并严格限制碳水化合物摄入。","is_gold":false},{"letter":"I","text":"暂不需集落刺激因子支持，予以复方氨基酸及转化糖电解质静脉营养支持，并进行动静脉置管护理。","is_gold":true},{"letter":"J","text":"持续静脉泵入质子泵抑制剂及5-HT3受体拮抗剂，进行强化抑酸止吐。","is_gold":false},{"letter":"K","text":"预防性输注单采血小板1个治疗量，并皮下注射重组人血小板生成素。","is_gold":false},{"letter":"L","text":"给予拉布立酶静脉滴注，并配合大剂量静脉水化预防肿瘤溶解综合征。","is_gold":false}],"gold_letter":"I"},{"sample_id":"sample-00fdb85efc65b944f8959fc3","patient_id":"patient-e90c2443e271b2e927262653","turn_id":"turn07","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、颈动脉鞘、斜坡、海绵窦、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 间断性回吸性涕血1年余。；现病史: 患者近一年以来无明显原因出现回吸性涕血、近一个月左侧鼻塞明显，间断鼻衄。双侧耳鸣伴左耳听力下降，左侧头痛，双颈肿块。无面麻、张口困难、软腭麻痹，无咳嗽咳痰、呼吸困难。当地医院CT提示：鼻咽癌侵犯枕斜坡双侧蝶窦。伴双侧咽后、颈部淋巴结转移。现为进一步诊治入院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重下降1Kg。；阳性症状体征: 体重下降,听力下降,双颈肿物,双耳鸣,涕血,鼻衄,左鼻塞,左侧头痛；既往史: 既往体健。4年前妊娠期间高血糖。3年前剖宫产。否认肝炎、结核等传染病史。否认心脏病、高血压史。预防接种史不详。过敏史:无药物及食物过敏史。；个人史: 出生于原籍，无烟酒药物等嗜好，无疫水接触史，否认不洁性生活史。无工业毒物，粉尘，放射性物质接触史。；家族史: 否认家族其他成员中有类似病患者或肿瘤患者。；体格检查: T36.5℃P78次/分R19次/分BP115/70mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。无鼻翼扇动、鼻衄。牙龈无肿胀、出血。气管居中，甲状腺不大。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率70bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。肛门外生殖器未见异常，生理反射存在，病理反射未引出。；专科检查: KPS 90。张口门齿距4.5cm，间接鼻咽镜：见鼻咽左侧壁肿物肿物；双颈II区触及多枚肿大淋巴结，直径约1.0cm，质韧、固定、相互融合。颅神经（-）。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 正常范围心电图\n- [全程D26] 检验组合: 直接胆红素(DBIL)-静脉血: 1.5umol/L；C-反应蛋白(CRP)-静脉血: 6.47mg/L；红细胞比容(Hct)-静脉血: 35.4%；阴离子间隙(AG)-静脉血: 8；血小板分布宽度(PDW)-静脉血: 10.3%；总钙(Ca)-静脉血: 2.27mmol/L；甘油三酯(TG)-静脉血: 0.74mmol/L；尿素氮(BUN)-静脉血: 4.68mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 32.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 32.4U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；葡萄糖(Glu)-静脉血: 5.39mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；白细胞计数(WBC#)-静脉血: 410E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 34U/L；磷(P)-静脉血: 1.35mmol/L；乳酸脱氢酶(LDH)-静脉血: 198.6U/L；血小板计数(PLT#)-静脉血: 25510E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.4；碱性磷酸酶(ALP)-静脉血: 92.4U/L；钾离子(K+)-静脉血: 3.9mmol/L；总蛋白(TP)-静脉血: 64.1g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.435；钠离子(Na+)-静脉血: 140.2mmol/L；胱抑素(Cys-C)-静脉血: 0.82mg/L；大血小板百分比(P-LCR%)-静脉血: 19.1%；间接胆红素(IBIL)-静脉血: 3.9umolL；红细胞计数(RBC#)-静脉血: 3.710E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.6pg；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；平均血小板体积(MPV)-静脉血: 9.3fL；氯离子(Cl-)-静脉血: 100.2mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.23g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.9；淋巴细胞百分比(Lymph%)-静脉血: 0.481；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.9；中性粒细胞计数(Neut#)-静脉……\n- [全程D36] 检验组合: 总胆固醇(TC)-静脉血: 4.01mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.55；γ-谷氨酰基转移酶(GGT)-静脉血: 22.5U/L；平均血小板体积(MPV)-静脉血: 10.1fL；淋巴细胞计数(Lymph#)-静脉血: 0.910E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.04；丙氨酸氨基转移酶(ALT)-静脉血: 42.3U/L；尿素氮(BUN)-静脉血: 6.2mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 26.3U/L；总胆红素(TBIL)-静脉血: 14.1umol/L；钠离子(Na+)-静脉血: 136mmol/L；碱性磷酸酶(ALP)-静脉血: 68U/L；白细胞计数(WBC#)-静脉血: 4.310E9/L；直接胆红素(DBIL)-静脉血: 4.6umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；单核细胞计数(Mono#)-静脉血: 0.110E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；磷(P)-静脉血: 0.99mmol/L；血红蛋白(Hb)-静脉血: 122g/L；氯离子(Cl-)-静脉血: 95mmol/L；血小板分布宽度(PDW)-静脉血: 12.3%；平均红细胞体积(MCV)-静脉血: 93.9fL；α-L-岩藻糖苷酶(AFU)-静脉血: 48.7U/L；阴离子间隙(AG)-静脉血: 14.1；钾离子(K+)-静脉血: 4.06mmol/L；红细胞比容(Hct)-静脉血: 35.7%；血小板比容-静脉血: 23%；白蛋白(ALB)-静脉血: 40.7g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；C-反应蛋白(CRP)-静脉血: 3.19mg/L；球蛋白(GLO)-静脉血: 26.19g/L；胱抑素(Cys-C)-静脉血: 0.64mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.04mmol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；载脂蛋白B(apoB)-静脉血: 0.72g/L；间接胆红素(IBIL)-静脉血: 9.5umolL；中性粒细胞百分比(Neut%)-静脉血: 0.729；尿酸(UA)-静脉血: 258.1umol/L；单核细胞百分比(Mono%)-静脉血: 0……\n- [全程D49] 检验组合: 单核细胞百分比(Mono%)-静脉血: 0.066；C-反应蛋白(CRP)-静脉血: 0.26mg/L；乳酸脱氢酶(LDH)-静脉血: 257.7U/L；氯离子(Cl-)-静脉血: 105.6mmol/L；总蛋白(TP)-静脉血: 65.51g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.002；甘油三酯(TG)-静脉血: 0.97mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.25mmolL；红细胞比容(Hct)-静脉血: 34.7%；间接胆红素(IBIL)-静脉血: 5.5umolL；单核细胞计数(Mono#)-静脉血: 0.310E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.5U/L；红细胞计数(RBC#)-静脉血: 3.5110E12/L；总钙(Ca)-静脉血: 2.08mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.94；葡萄糖(Glu)-静脉血: 4.89mmol/L；直接胆红素(DBIL)-静脉血: 2.4umol/L；镁离子(Mg2+)-静脉血: 1.09mmol/L；胱抑素(Cys-C)-静脉血: 0.69mg/L；总胆汁酸(TBA)-静脉血: 1.9umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 35.4U/L；肌酐(Crea)-静脉血: 52.4umol/L；载脂蛋白B(apoB)-静脉血: 0.81g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 48.8；平均红细胞血红蛋白含量(MCH)-静脉血: 32.5pg；钠离子(Na+)-静脉血: 141.4mmol/L；白蛋白(ALB)-静脉血: 40.9g/L；血小板分布宽度(PDW)-静脉血: 11%；血小板计数(PLT#)-静脉血: 19910E9/L；磷(P)-静脉血: 1.21mmol/L；钾离子(K+)-静脉血: 3.94mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.66；总胆固醇(TC)-静脉血: 4.19mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.55mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.465……\n- [全程D57] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后复查，对比某次就诊时间片： 鼻咽腔稍狭窄，鼻咽肿物较前明显缩小，鼻咽顶壁及双侧壁粘膜欠光滑，双侧咽隐窝变浅，鼻咽未见明显肿物，左侧腭帆提肌张肌及头长肌轮廓不清，其内及左侧咽后区见异常信号灶，增强扫描轻度强化，病灶范围较前明显缩小，强化程度较前降低。 左侧咽旁脂肪间隙变窄，左侧颈动脉鞘区见肿物占据，范围较前缩小，强化程度较前降低。左侧腭帆张提肌及左侧头长肌受侵。 口咽双侧壁未见增厚。鼻腔未见肿物。 左侧翼腭窝见少许软组织影，大致同前。右侧翼腭窝、双侧颞下窝未见异常。 斜坡、左侧岩尖、左侧破裂孔，左侧蝶骨大翼、左侧翼突、左侧翼管、左侧圆孔、蝶骨基底部骨质破坏，大致同前。 蝶窦见软组织肿物，较前明显缩小。 双侧上颌窦、蝶窦、筛窦粘膜增厚，左侧乳突少量分泌物。 双侧眼眶未见异常。左侧海绵窦未见明显右侧。 左侧咽后淋巴结肿大，短径约10mm，较前稍缩小。右侧咽后见小淋巴结，短径约4mm，较前明显缩小。双侧II区见多个淋巴结，相互融合，边界不清，较前明显缩小。右侧腮腺见小淋巴结，短径约为4mm。明显强化 左侧腮腺及双侧颌下腺未见异常。所示甲状腺未见异常。 所示脑实质常规MR及DTI未见明显异常信号灶。；检查结论: 鼻咽癌化疗后，鼻咽未见明显肿物，左侧咽旁、蝶窦肿物较前明显缩小。 颅底骨质破坏，大致同前。 双侧咽后及双颈II区淋巴结，较前缩小。 右侧腮腺小淋巴结。 鼻窦炎，左侧乳突炎症。\n- [全程D57] MRI；脑功能成像、DTI: 检查类型: MRI；检查名称: 脑功能成像、DTI；检查部位:；检查所见: 鼻咽癌化疗后复查，对比某次就诊时间片： 鼻咽腔稍狭窄，鼻咽肿物较前明显缩小，鼻咽顶壁及双侧壁粘膜欠光滑，双侧咽隐窝变浅，鼻咽未见明显肿物，左侧腭帆提肌张肌及头长肌轮廓不清，其内及左侧咽后区见异常信号灶，增强扫描轻度强化，病灶范围较前明显缩小，强化程度较前降低。 左侧咽旁脂肪间隙变窄，左侧颈动脉鞘区见肿物占据，范围较前缩小，强化程度较前降低。左侧腭帆张提肌及左侧头长肌受侵。 口咽双侧壁未见增厚。鼻腔未见肿物。 左侧翼腭窝见少许软组织影，大致同前。右侧翼腭窝、双侧颞下窝未见异常。 斜坡、左侧岩尖、左侧破裂孔，左侧蝶骨大翼、左侧翼突、左侧翼管、左侧圆孔、蝶骨基底部骨质破坏，大致同前。 蝶窦见软组织肿物，较前明显缩小。 双侧上颌窦、蝶窦、筛窦粘膜增厚，左侧乳突少量分泌物。 双侧眼眶未见异常。左侧海绵窦未见明显右侧。 左侧咽后淋巴结肿大，短径约10mm，较前稍缩小。右侧咽后见小淋巴结，短径约4mm，较前明显缩小。双侧II区见多个淋巴结，相互融合，边界不清，较前明显缩小。右侧腮腺见小淋巴结，短径约为4mm。明显强化 左侧腮腺及双侧颌下腺未见异常。所示甲状腺未见异常。 所示脑实质常规MR及DTI未见明显异常信号灶。；检查结论: 鼻咽癌化疗后，鼻咽未见明显肿物，左侧咽旁、蝶窦肿物较前明显缩小。 颅底骨质破坏，大致同前。 双侧咽后及双颈II区淋巴结，较前缩小。 右侧腮腺小淋巴结。 鼻窦炎，左侧乳突炎症。\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D51] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者入院第2天，一般情况可，血常规、生化检查无明显异常。[姓名已隐去]医生信息已隐藏示：目前患者诊断明确，今日水化，明日开始第三程诱导化疗。\n- [全程D52] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，血常规、生化检查无明显异常。今日开始予多西他赛90mg/d1+PDD35mg/d1-3方案化疗。[姓名已隐去]医生信息已隐藏示：目前患者诊断明确，今日开始化疗，密切观察病情变化。\n- [全程D55] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，未诉特殊不适。[姓名已隐去]医生信息已隐藏示：目前患者今日化疗结束，密切观病情变化，如有不适，及时对症处理。\n- [全程D57] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，未诉特殊不适。[姓名已隐去]医生信息已隐藏示：目前患者化疗结束，病情稳定，可予出院。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估为完全缓解（CR），结束诱导化疗，直接进入随访观察阶段，定期复查鼻咽及颈部MRI。\nB. 评估为疾病稳定（SD），更换为吉西他滨联合顺铂方案继续化疗2周期。\nC. 评估为疾病进展（PD），转为姑息性放疗及靶向治疗。\nD. 评估为部分缓解（PR），继续原方案（多西他赛联合顺铂）诱导化疗第4-6周期。\nE. 评估为部分缓解（PR），先行双侧颈部淋巴结清扫术，术后行根治性放疗。\nF. 评估为部分缓解（PR），结束诱导化疗，择期行单纯根治性放疗。\nG. 评估为部分缓解（PR），行鼻咽内镜下颅底肿瘤切除术联合术后放疗。\nH. 评估为部分缓解（PR），结束诱导化疗，择期行根治性放疗及同期靶向治疗。\nI. 评估为疾病稳定（SD），提前终止化疗，立即开始根治性放疗及同期化疗。\nJ. 评估为部分缓解（PR），结束诱导化疗，出院休养并定期监测血象，择期行根治性放疗及同期化疗。\nK. 评估为部分缓解（PR），结束诱导化疗，行全身PET-CT检查排除远处转移后再决定后续治疗。\nL. 评估为完全缓解（CR），结束诱导化疗，择期行预防性低剂量放疗。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"评估为完全缓解（CR），结束诱导化疗，直接进入随访观察阶段，定期复查鼻咽及颈部MRI。","is_gold":false},{"letter":"B","text":"评估为疾病稳定（SD），更换为吉西他滨联合顺铂方案继续化疗2周期。","is_gold":false},{"letter":"C","text":"评估为疾病进展（PD），转为姑息性放疗及靶向治疗。","is_gold":false},{"letter":"D","text":"评估为部分缓解（PR），继续原方案（多西他赛联合顺铂）诱导化疗第4-6周期。","is_gold":false},{"letter":"E","text":"评估为部分缓解（PR），先行双侧颈部淋巴结清扫术，术后行根治性放疗。","is_gold":false},{"letter":"F","text":"评估为部分缓解（PR），结束诱导化疗，择期行单纯根治性放疗。","is_gold":false},{"letter":"G","text":"评估为部分缓解（PR），行鼻咽内镜下颅底肿瘤切除术联合术后放疗。","is_gold":false},{"letter":"H","text":"评估为部分缓解（PR），结束诱导化疗，择期行根治性放疗及同期靶向治疗。","is_gold":false},{"letter":"I","text":"评估为疾病稳定（SD），提前终止化疗，立即开始根治性放疗及同期化疗。","is_gold":false},{"letter":"J","text":"评估为部分缓解（PR），结束诱导化疗，出院休养并定期监测血象，择期行根治性放疗及同期化疗。","is_gold":true},{"letter":"K","text":"评估为部分缓解（PR），结束诱导化疗，行全身PET-CT检查排除远处转移后再决定后续治疗。","is_gold":false},{"letter":"L","text":"评估为完全缓解（CR），结束诱导化疗，择期行预防性低剂量放疗。","is_gold":false}],"gold_letter":"J"},{"sample_id":"sample-c754017abe0842c4e67e064f","patient_id":"patient-e90c2443e271b2e927262653","turn_id":"turn08","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、颈动脉鞘、斜坡、海绵窦、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 间断性回吸性涕血1年余。；现病史: 患者近一年以来无明显原因出现回吸性涕血、近一个月左侧鼻塞明显，间断鼻衄。双侧耳鸣伴左耳听力下降，左侧头痛，双颈肿块。无面麻、张口困难、软腭麻痹，无咳嗽咳痰、呼吸困难。当地医院CT提示：鼻咽癌侵犯枕斜坡双侧蝶窦。伴双侧咽后、颈部淋巴结转移。现为进一步诊治入院。自起病以来，患者精神、睡眠可，食欲如常，大小便正常，体重下降1Kg。；阳性症状体征: 体重下降,听力下降,双颈肿物,双耳鸣,涕血,鼻衄,左鼻塞,左侧头痛；既往史: 既往体健。4年前妊娠期间高血糖。3年前剖宫产。否认肝炎、结核等传染病史。否认心脏病、高血压史。预防接种史不详。过敏史:无药物及食物过敏史。；个人史: 出生于原籍，无烟酒药物等嗜好，无疫水接触史，否认不洁性生活史。无工业毒物，粉尘，放射性物质接触史。；家族史: 否认家族其他成员中有类似病患者或肿瘤患者。；体格检查: T36.5℃P78次/分R19次/分BP115/70mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。无鼻翼扇动、鼻衄。牙龈无肿胀、出血。气管居中，甲状腺不大。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率70bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。肛门外生殖器未见异常，生理反射存在，病理反射未引出。；专科检查: KPS 90。张口门齿距4.5cm，间接鼻咽镜：见鼻咽左侧壁肿物肿物；双颈II区触及多枚肿大淋巴结，直径约1.0cm，质韧、固定、相互融合。颅神经（-）。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 正常范围心电图\n- [全程D26] 检验组合: 直接胆红素(DBIL)-静脉血: 1.5umol/L；C-反应蛋白(CRP)-静脉血: 6.47mg/L；红细胞比容(Hct)-静脉血: 35.4%；阴离子间隙(AG)-静脉血: 8；血小板分布宽度(PDW)-静脉血: 10.3%；总钙(Ca)-静脉血: 2.27mmol/L；甘油三酯(TG)-静脉血: 0.74mmol/L；尿素氮(BUN)-静脉血: 4.68mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 32.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 32.4U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；葡萄糖(Glu)-静脉血: 5.39mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；白细胞计数(WBC#)-静脉血: 410E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 34U/L；磷(P)-静脉血: 1.35mmol/L；乳酸脱氢酶(LDH)-静脉血: 198.6U/L；血小板计数(PLT#)-静脉血: 25510E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.4；碱性磷酸酶(ALP)-静脉血: 92.4U/L；钾离子(K+)-静脉血: 3.9mmol/L；总蛋白(TP)-静脉血: 64.1g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.435；钠离子(Na+)-静脉血: 140.2mmol/L；胱抑素(Cys-C)-静脉血: 0.82mg/L；大血小板百分比(P-LCR%)-静脉血: 19.1%；间接胆红素(IBIL)-静脉血: 3.9umolL；红细胞计数(RBC#)-静脉血: 3.710E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.6pg；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；平均血小板体积(MPV)-静脉血: 9.3fL；氯离子(Cl-)-静脉血: 100.2mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.23g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.9；淋巴细胞百分比(Lymph%)-静脉血: 0.481；红细胞体积分布宽度CV(RDW-CV)-静脉血: 11.9；中性粒细胞计数(Neut#)-静脉……\n- [全程D36] 检验组合: 总胆固醇(TC)-静脉血: 4.01mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.55；γ-谷氨酰基转移酶(GGT)-静脉血: 22.5U/L；平均血小板体积(MPV)-静脉血: 10.1fL；淋巴细胞计数(Lymph#)-静脉血: 0.910E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.04；丙氨酸氨基转移酶(ALT)-静脉血: 42.3U/L；尿素氮(BUN)-静脉血: 6.2mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 26.3U/L；总胆红素(TBIL)-静脉血: 14.1umol/L；钠离子(Na+)-静脉血: 136mmol/L；碱性磷酸酶(ALP)-静脉血: 68U/L；白细胞计数(WBC#)-静脉血: 4.310E9/L；直接胆红素(DBIL)-静脉血: 4.6umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；单核细胞计数(Mono#)-静脉血: 0.110E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；磷(P)-静脉血: 0.99mmol/L；血红蛋白(Hb)-静脉血: 122g/L；氯离子(Cl-)-静脉血: 95mmol/L；血小板分布宽度(PDW)-静脉血: 12.3%；平均红细胞体积(MCV)-静脉血: 93.9fL；α-L-岩藻糖苷酶(AFU)-静脉血: 48.7U/L；阴离子间隙(AG)-静脉血: 14.1；钾离子(K+)-静脉血: 4.06mmol/L；红细胞比容(Hct)-静脉血: 35.7%；血小板比容-静脉血: 23%；白蛋白(ALB)-静脉血: 40.7g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；C-反应蛋白(CRP)-静脉血: 3.19mg/L；球蛋白(GLO)-静脉血: 26.19g/L；胱抑素(Cys-C)-静脉血: 0.64mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.04mmol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；载脂蛋白B(apoB)-静脉血: 0.72g/L；间接胆红素(IBIL)-静脉血: 9.5umolL；中性粒细胞百分比(Neut%)-静脉血: 0.729；尿酸(UA)-静脉血: 258.1umol/L；单核细胞百分比(Mono%)-静脉血: 0……\n- [全程D49] 检验组合: 单核细胞百分比(Mono%)-静脉血: 0.066；C-反应蛋白(CRP)-静脉血: 0.26mg/L；乳酸脱氢酶(LDH)-静脉血: 257.7U/L；氯离子(Cl-)-静脉血: 105.6mmol/L；总蛋白(TP)-静脉血: 65.51g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.002；甘油三酯(TG)-静脉血: 0.97mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.25mmolL；红细胞比容(Hct)-静脉血: 34.7%；间接胆红素(IBIL)-静脉血: 5.5umolL；单核细胞计数(Mono#)-静脉血: 0.310E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.5U/L；红细胞计数(RBC#)-静脉血: 3.5110E12/L；总钙(Ca)-静脉血: 2.08mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.94；葡萄糖(Glu)-静脉血: 4.89mmol/L；直接胆红素(DBIL)-静脉血: 2.4umol/L；镁离子(Mg2+)-静脉血: 1.09mmol/L；胱抑素(Cys-C)-静脉血: 0.69mg/L；总胆汁酸(TBA)-静脉血: 1.9umol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 329g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 35.4U/L；肌酐(Crea)-静脉血: 52.4umol/L；载脂蛋白B(apoB)-静脉血: 0.81g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 48.8；平均红细胞血红蛋白含量(MCH)-静脉血: 32.5pg；钠离子(Na+)-静脉血: 141.4mmol/L；白蛋白(ALB)-静脉血: 40.9g/L；血小板分布宽度(PDW)-静脉血: 11%；血小板计数(PLT#)-静脉血: 19910E9/L；磷(P)-静脉血: 1.21mmol/L；钾离子(K+)-静脉血: 3.94mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.66；总胆固醇(TC)-静脉血: 4.19mmol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.55mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.465……\n- [全程D57] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌化疗后复查，对比某次就诊时间片： 鼻咽腔稍狭窄，鼻咽肿物较前明显缩小，鼻咽顶壁及双侧壁粘膜欠光滑，双侧咽隐窝变浅，鼻咽未见明显肿物，左侧腭帆提肌张肌及头长肌轮廓不清，其内及左侧咽后区见异常信号灶，增强扫描轻度强化，病灶范围较前明显缩小，强化程度较前降低。 左侧咽旁脂肪间隙变窄，左侧颈动脉鞘区见肿物占据，范围较前缩小，强化程度较前降低。左侧腭帆张提肌及左侧头长肌受侵。 口咽双侧壁未见增厚。鼻腔未见肿物。 左侧翼腭窝见少许软组织影，大致同前。右侧翼腭窝、双侧颞下窝未见异常。 斜坡、左侧岩尖、左侧破裂孔，左侧蝶骨大翼、左侧翼突、左侧翼管、左侧圆孔、蝶骨基底部骨质破坏，大致同前。 蝶窦见软组织肿物，较前明显缩小。 双侧上颌窦、蝶窦、筛窦粘膜增厚，左侧乳突少量分泌物。 双侧眼眶未见异常。左侧海绵窦未见明显右侧。 左侧咽后淋巴结肿大，短径约10mm，较前稍缩小。右侧咽后见小淋巴结，短径约4mm，较前明显缩小。双侧II区见多个淋巴结，相互融合，边界不清，较前明显缩小。右侧腮腺见小淋巴结，短径约为4mm。明显强化 左侧腮腺及双侧颌下腺未见异常。所示甲状腺未见异常。 所示脑实质常规MR及DTI未见明显异常信号灶。；检查结论: 鼻咽癌化疗后，鼻咽未见明显肿物，左侧咽旁、蝶窦肿物较前明显缩小。 颅底骨质破坏，大致同前。 双侧咽后及双颈II区淋巴结，较前缩小。 右侧腮腺小淋巴结。 鼻窦炎，左侧乳突炎症。\n- [全程D57] MRI；脑功能成像、DTI: 检查类型: MRI；检查名称: 脑功能成像、DTI；检查部位:；检查所见: 鼻咽癌化疗后复查，对比某次就诊时间片： 鼻咽腔稍狭窄，鼻咽肿物较前明显缩小，鼻咽顶壁及双侧壁粘膜欠光滑，双侧咽隐窝变浅，鼻咽未见明显肿物，左侧腭帆提肌张肌及头长肌轮廓不清，其内及左侧咽后区见异常信号灶，增强扫描轻度强化，病灶范围较前明显缩小，强化程度较前降低。 左侧咽旁脂肪间隙变窄，左侧颈动脉鞘区见肿物占据，范围较前缩小，强化程度较前降低。左侧腭帆张提肌及左侧头长肌受侵。 口咽双侧壁未见增厚。鼻腔未见肿物。 左侧翼腭窝见少许软组织影，大致同前。右侧翼腭窝、双侧颞下窝未见异常。 斜坡、左侧岩尖、左侧破裂孔，左侧蝶骨大翼、左侧翼突、左侧翼管、左侧圆孔、蝶骨基底部骨质破坏，大致同前。 蝶窦见软组织肿物，较前明显缩小。 双侧上颌窦、蝶窦、筛窦粘膜增厚，左侧乳突少量分泌物。 双侧眼眶未见异常。左侧海绵窦未见明显右侧。 左侧咽后淋巴结肿大，短径约10mm，较前稍缩小。右侧咽后见小淋巴结，短径约4mm，较前明显缩小。双侧II区见多个淋巴结，相互融合，边界不清，较前明显缩小。右侧腮腺见小淋巴结，短径约为4mm。明显强化 左侧腮腺及双侧颌下腺未见异常。所示甲状腺未见异常。 所示脑实质常规MR及DTI未见明显异常信号灶。；检查结论: 鼻咽癌化疗后，鼻咽未见明显肿物，左侧咽旁、蝶窦肿物较前明显缩小。 颅底骨质破坏，大致同前。 双侧咽后及双颈II区淋巴结，较前缩小。 右侧腮腺小淋巴结。 鼻窦炎，左侧乳突炎症。\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D51] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者入院第2天，一般情况可，血常规、生化检查无明显异常。[姓名已隐去]医生信息已隐藏示：目前患者诊断明确，今日水化，明日开始第三程诱导化疗。\n- [全程D52] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，血常规、生化检查无明显异常。今日开始予多西他赛90mg/d1+PDD35mg/d1-3方案化疗。[姓名已隐去]医生信息已隐藏示：目前患者诊断明确，今日开始化疗，密切观察病情变化。\n- [全程D55] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，未诉特殊不适。[姓名已隐去]医生信息已隐藏示：目前患者今日化疗结束，密切观病情变化，如有不适，及时对症处理。\n- [全程D57] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，未诉特殊不适。[姓名已隐去]医生信息已隐藏示：目前患者化疗结束，病情稳定，可予出院。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估为诱导化疗后完全缓解（CR），予以出院并定期随访观察，暂缓后续放化疗。\nB. 评估为诱导化疗后部分缓解（PR），继续原方案（多西他赛+顺铂）行第4周期诱导化疗。\nC. 评估为诱导化疗后疾病稳定（SD），更改化疗方案为吉西他滨+顺铂继续诱导化疗。\nD. 评估为诱导化疗后疾病进展（PD），建议行姑息性放疗及靶向治疗。\nE. 评估为诱导化疗后部分缓解（PR），立即行双侧颈部淋巴结清扫术及鼻咽原发灶切除术。\nF. 评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排单纯根治性放疗。\nG. 评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排根治性放疗及靶向治疗。\nH. 评估为诱导化疗后完全缓解（CR），予以出院及对症支持治疗，并择期安排根治性放疗及同期化疗。\nI. 评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排根治性放疗及免疫治疗。\nJ. 评估为诱导化疗后部分缓解（PR），继续住院观察，待血象恢复后立即行第4周期诱导化疗。\nK. 评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排根治性放疗及同期化疗。\nL. 评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排姑息性放疗。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"评估为诱导化疗后完全缓解（CR），予以出院并定期随访观察，暂缓后续放化疗。","is_gold":false},{"letter":"B","text":"评估为诱导化疗后部分缓解（PR），继续原方案（多西他赛+顺铂）行第4周期诱导化疗。","is_gold":false},{"letter":"C","text":"评估为诱导化疗后疾病稳定（SD），更改化疗方案为吉西他滨+顺铂继续诱导化疗。","is_gold":false},{"letter":"D","text":"评估为诱导化疗后疾病进展（PD），建议行姑息性放疗及靶向治疗。","is_gold":false},{"letter":"E","text":"评估为诱导化疗后部分缓解（PR），立即行双侧颈部淋巴结清扫术及鼻咽原发灶切除术。","is_gold":false},{"letter":"F","text":"评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排单纯根治性放疗。","is_gold":false},{"letter":"G","text":"评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排根治性放疗及靶向治疗。","is_gold":false},{"letter":"H","text":"评估为诱导化疗后完全缓解（CR），予以出院及对症支持治疗，并择期安排根治性放疗及同期化疗。","is_gold":false},{"letter":"I","text":"评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排根治性放疗及免疫治疗。","is_gold":false},{"letter":"J","text":"评估为诱导化疗后部分缓解（PR），继续住院观察，待血象恢复后立即行第4周期诱导化疗。","is_gold":false},{"letter":"K","text":"评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排根治性放疗及同期化疗。","is_gold":true},{"letter":"L","text":"评估为诱导化疗后部分缓解（PR），予以出院及对症支持治疗，并择期安排姑息性放疗。","is_gold":false}],"gold_letter":"K"}]}
+{"patient_id":"patient-7c0941dbdd4694260fd4de38","bootstrap_cluster_id":"cluster-005","turns":[{"sample_id":"sample-c81d5e1363b1f79117650da1","patient_id":"patient-7c0941dbdd4694260fd4de38","turn_id":"turn01","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、口咽。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 反复右中耳积液半年余。；现病史: 简要入院病史:患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；阳性症状体征:；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史: 吸烟2包/日×20年，否认疫区接触史，否认冶游史，否认嗜酒。；家族史: 无特殊。；体格检查:；专科检查:；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 颈部CT平扫+增强、电子鼻咽镜检查、全身PET-CT检查\nB. 颈部MRI平扫、间接鼻咽镜检查、腹部超声检查\nC. 颈部MRI平扫+增强、电子鼻咽镜下活检、腹部超声检查\nD. 颈部超声、电子鼻咽镜检查、胸腹部CT平扫\nE. 颈部CT平扫、电子鼻咽镜检查、腹部超声检查\nF. 颈部MRI平扫+增强、间接鼻咽镜检查、胸部X线片\nG. 鼻咽及颈部CT平扫+增强、电子鼻咽镜检查、全身骨扫描\nH. 颈部MRI平扫、电子鼻咽镜检查、腹部超声检查\nI. 颈部MRI平扫+增强、鼻咽活检、全身骨扫描\nJ. 鼻咽部CT平扫、电子鼻咽镜检查、全身PET-CT检查\nK. 颈部MRI平扫+增强、电子鼻咽镜检查、全身骨扫描\nL. 颈部MRI平扫+增强、电子鼻咽镜检查、腹部超声检查\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"颈部CT平扫+增强、电子鼻咽镜检查、全身PET-CT检查","is_gold":false},{"letter":"B","text":"颈部MRI平扫、间接鼻咽镜检查、腹部超声检查","is_gold":false},{"letter":"C","text":"颈部MRI平扫+增强、电子鼻咽镜下活检、腹部超声检查","is_gold":false},{"letter":"D","text":"颈部超声、电子鼻咽镜检查、胸腹部CT平扫","is_gold":false},{"letter":"E","text":"颈部CT平扫、电子鼻咽镜检查、腹部超声检查","is_gold":false},{"letter":"F","text":"颈部MRI平扫+增强、间接鼻咽镜检查、胸部X线片","is_gold":false},{"letter":"G","text":"鼻咽及颈部CT平扫+增强、电子鼻咽镜检查、全身骨扫描","is_gold":false},{"letter":"H","text":"颈部MRI平扫、电子鼻咽镜检查、腹部超声检查","is_gold":false},{"letter":"I","text":"颈部MRI平扫+增强、鼻咽活检、全身骨扫描","is_gold":false},{"letter":"J","text":"鼻咽部CT平扫、电子鼻咽镜检查、全身PET-CT检查","is_gold":false},{"letter":"K","text":"颈部MRI平扫+增强、电子鼻咽镜检查、全身骨扫描","is_gold":false},{"letter":"L","text":"颈部MRI平扫+增强、电子鼻咽镜检查、腹部超声检查","is_gold":true}],"gold_letter":"L"},{"sample_id":"sample-72b57dbdb0633da918062d61","patient_id":"patient-7c0941dbdd4694260fd4de38","turn_id":"turn02","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、口咽。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [时间未明] 门急诊记录: 主诉: 反复右中耳积液半年余。；现病史: 患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史:；家族史: 无特殊。；体格检查: KPS90分，DG4.0cm，鼻咽右侧隆突肿物，接近右侧后鼻孔，双颈未触及肿大淋巴结，颅神经检查阴性，心肺腹未及异常，全身骨无压痛。\n\n【已完成检查与客观结果】\n- [全程D8] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽右侧咽隐窝区软组织影放射性浓聚，SUV41.8，病灶侵犯右腭帆肌群、右头长肌，病灶与蝶骨基底部右份及右翼突内板分界不清。右咽旁间隙变浅，右咽隐窝消失，左侧咽隐窝未见明显异常。口咽及喉咽结构及放射性分布未见明显异常。双侧上颌窦低密度影放射性分布未见异常；额窦、蝶窦、筛窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双颈多个小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 右中肺小片状影放射性分布未见异常；余双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏弥漫性密度减低，CT值约46Hu（脾脏CT值约58Hu），形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 盆腔放射性分布均匀，膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 右乳突气房内低密度影放射性分布未见异常；余颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽右咽隐窝病灶代谢活跃，符合鼻咽癌，病灶疑累及蝶骨基底部右份及右翼突内板。 双上颌窦炎症；右乳突炎症。 右中肺小片状影代谢未见异常，考虑增殖灶。 轻度脂肪肝。\n- [全程D8] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 早期复极改变 其余未见异常\n- [全程D8] 检验组合: 红细胞计数(RBC#)-静脉血: 5.2310E12/L；血液二氧化碳含量ctCO2(B)-静脉血: 25mmol/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.766COI；血小板分布宽度(PDW)-静脉血: 16.4%；单核细胞百分比(Mono%)-静脉血: 0.077；红细胞比容(Hct)-静脉血: 48.4%；凝血酶时间(TT)-静脉血: 19.8sec.；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 32.8U/L；凝血酶原时间(PT)-静脉血: 9.9sec.；淋巴细胞计数(Lymph#)-静脉血: 2.310E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.025；白蛋白(ALB)-静脉血: 46g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.61；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.08；胱抑素(Cys-C)-静脉血: 0.98mg/L；尿素氮(BUN)-静脉血: 5.5mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.597；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 6.1umolL；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；碱性磷酸酶(ALP)-静脉血: 60.9U/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 0.006COI；C-反应蛋白(CRP)-静脉血: 1.86mg/L；Rh血型-静脉血: 阳性；总钙(Ca)-静脉血: 2.14mmol/L；总胆汁酸(TBA)-静脉血: 8.3umol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.1ug/ml；丙氨酸氨基转移酶(ALT)-静脉血: 46.9U/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；氯离子(Cl-)-静脉血: 104.3mmol/L；低密度脂蛋白胆固醇……\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行电子鼻咽镜检查及鼻咽肿物活检，并辅以颈部淋巴结彩超及穿刺活检\nB. 行电子鼻咽镜检查及鼻咽肿物活检，颈部淋巴结仅作临床触诊及随访\nC. 行颈部淋巴结切除活检明确病理，暂缓鼻咽部有创检查及活检\nD. 行鼻内镜下鼻咽肿物扩大切除术，同步完成病理诊断与局部治疗\nE. 行颈部淋巴结彩超及穿刺活检，若确诊转移则免于鼻咽部活检\nF. 行鼻咽部脱落细胞学涂片及血浆EBV-DNA检测，替代组织学活检\nG. 启动根治性放化疗，免于组织学活检及颈部淋巴结穿刺评估\nH. 行电子鼻咽镜检查及活检，并预防性行双侧颈部淋巴结清扫术\nI. 补充全身骨扫描及头颅增强MRI，暂缓鼻咽及颈部组织学活检\nJ. 行电子鼻咽镜评估局部侵犯范围，免于鼻咽肿物组织学活检\nK. 优先行鼓膜穿刺置管术缓解中耳积液，暂缓鼻咽部及颈部检查\nL. 予以诊断性抗炎治疗2周，随后复查PET/CT评估局部代谢变化\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"行电子鼻咽镜检查及鼻咽肿物活检，并辅以颈部淋巴结彩超及穿刺活检","is_gold":true},{"letter":"B","text":"行电子鼻咽镜检查及鼻咽肿物活检，颈部淋巴结仅作临床触诊及随访","is_gold":false},{"letter":"C","text":"行颈部淋巴结切除活检明确病理，暂缓鼻咽部有创检查及活检","is_gold":false},{"letter":"D","text":"行鼻内镜下鼻咽肿物扩大切除术，同步完成病理诊断与局部治疗","is_gold":false},{"letter":"E","text":"行颈部淋巴结彩超及穿刺活检，若确诊转移则免于鼻咽部活检","is_gold":false},{"letter":"F","text":"行鼻咽部脱落细胞学涂片及血浆EBV-DNA检测，替代组织学活检","is_gold":false},{"letter":"G","text":"启动根治性放化疗，免于组织学活检及颈部淋巴结穿刺评估","is_gold":false},{"letter":"H","text":"行电子鼻咽镜检查及活检，并预防性行双侧颈部淋巴结清扫术","is_gold":false},{"letter":"I","text":"补充全身骨扫描及头颅增强MRI，暂缓鼻咽及颈部组织学活检","is_gold":false},{"letter":"J","text":"行电子鼻咽镜评估局部侵犯范围，免于鼻咽肿物组织学活检","is_gold":false},{"letter":"K","text":"优先行鼓膜穿刺置管术缓解中耳积液，暂缓鼻咽部及颈部检查","is_gold":false},{"letter":"L","text":"予以诊断性抗炎治疗2周，随后复查PET/CT评估局部代谢变化","is_gold":false}],"gold_letter":"A"},{"sample_id":"sample-3ed269e9b5e894b444089bf3","patient_id":"patient-7c0941dbdd4694260fd4de38","turn_id":"turn04","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、口咽。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 反复右中耳积液半年余。；现病史: 简要入院病史:患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。后来我院，我院病理示未分化非角化性癌。我院鼻咽+颈部MR：鼻咽部肿物，考虑鼻咽癌。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；阳性症状体征:；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史: 吸烟2包/日×20年，否认疫区接触史，否认冶游史，否认嗜酒。；家族史: 无特殊。；体格检查:；专科检查:；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D8] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽右侧咽隐窝区软组织影放射性浓聚，SUV41.8，病灶侵犯右腭帆肌群、右头长肌，病灶与蝶骨基底部右份及右翼突内板分界不清。右咽旁间隙变浅，右咽隐窝消失，左侧咽隐窝未见明显异常。口咽及喉咽结构及放射性分布未见明显异常。双侧上颌窦低密度影放射性分布未见异常；额窦、蝶窦、筛窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双颈多个小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 右中肺小片状影放射性分布未见异常；余双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏弥漫性密度减低，CT值约46Hu（脾脏CT值约58Hu），形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 盆腔放射性分布均匀，膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 右乳突气房内低密度影放射性分布未见异常；余颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽右咽隐窝病灶代谢活跃，符合鼻咽癌，病灶疑累及蝶骨基底部右份及右翼突内板。 双上颌窦炎症；右乳突炎症。 右中肺小片状影代谢未见异常，考虑增殖灶。 轻度脂肪肝。\n- [全程D8] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 早期复极改变 其余未见异常\n- [全程D8] 检验组合: 红细胞计数(RBC#)-静脉血: 5.2310E12/L；血液二氧化碳含量ctCO2(B)-静脉血: 25mmol/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.766COI；血小板分布宽度(PDW)-静脉血: 16.4%；单核细胞百分比(Mono%)-静脉血: 0.077；红细胞比容(Hct)-静脉血: 48.4%；凝血酶时间(TT)-静脉血: 19.8sec.；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 32.8U/L；凝血酶原时间(PT)-静脉血: 9.9sec.；淋巴细胞计数(Lymph#)-静脉血: 2.310E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.025；白蛋白(ALB)-静脉血: 46g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.61；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.08；胱抑素(Cys-C)-静脉血: 0.98mg/L；尿素氮(BUN)-静脉血: 5.5mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.597；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 6.1umolL；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；碱性磷酸酶(ALP)-静脉血: 60.9U/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 0.006COI；C-反应蛋白(CRP)-静脉血: 1.86mg/L；Rh血型-静脉血: 阳性；总钙(Ca)-静脉血: 2.14mmol/L；总胆汁酸(TBA)-静脉血: 8.3umol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.1ug/ml；丙氨酸氨基转移酶(ALT)-静脉血: 46.9U/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；氯离子(Cl-)-静脉血: 104.3mmol/L；低密度脂蛋白胆固醇……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D9] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁明显增厚，右侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描强化较明显。左侧咽隐窝存在。肿块累及右侧口咽壁。 右侧咽旁脂肪间隙变窄；左侧咽旁间隙未见明显狭窄。右侧腭帆张提肌受侵，左侧腭帆张提肌、双侧头长肌、双侧翼内外肌未见受侵。 鼻腔内未见肿物。 双侧翼腭窝、双侧上颌后脂肪间隙及咀嚼肌间隙未见异常。 颅底骨质信号均匀，增强扫描未见异常强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧上颌窦内见囊性灶，最大长径约27mm，边界清，无强化。右侧乳突见分泌物。左乳突充气良好，骨壁完整。 右侧咽后见一肿大淋巴结，大小约6mm×9mm，增强扫描明显强化。左侧咽后未见肿大淋巴结。颈部双侧见多个小淋巴结，最大者约8mm×11mm，未见坏死及包膜外侵。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。 扫描范围脑实质信号未见异常。；检查结论: 鼻咽肿物，考虑鼻咽癌。 颅底骨质未见破坏。 右侧咽后肿大淋巴结，考虑转移。 颈部小淋巴结。 双侧上颌窦囊肿，右侧乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见: 双颈II区可见几个小淋巴结，最大约11mm×4mm（右），12mm×5mm（左），边界清，椭圆形，皮髓质分界清，淋巴门可见。 CDFI:上述淋巴结内可见点状血流信号。 双侧颈部淋巴结穿刺活检： （1）右侧颈部淋巴结穿刺活检：常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以16G穿刺针穿刺入右颈淋巴结内，进针2次，取出长约0.5-1cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。 （2）左侧颈部淋巴结穿刺活检：常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以18G穿刺针穿刺入左颈淋巴结内，进针2次，取出长约0.8-1cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。；检查结论: 双侧颈部淋巴结穿刺活检。 不适随诊。 4个工作日后凭发票到2号楼6楼病理科取结果。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 诱导化疗序贯单纯根治性放疗（鼻咽及双侧颈部）\nB. 同期放化疗（鼻咽及双侧颈部）\nC. 单纯根治性放疗（鼻咽及双侧颈部）\nD. 诱导化疗序贯同期放化疗（鼻咽及双侧颈部）\nE. 鼻咽原发灶切除术联合术后辅助放疗\nF. 靶向治疗联合单纯根治性放疗（鼻咽及双侧颈部）\nG. 免疫治疗联合单纯根治性放疗（鼻咽及双侧颈部）\nH. 诱导化疗联合免疫治疗序贯同期放化疗\nI. 单纯根治性放疗（仅照射鼻咽及右侧颈部）\nJ. 姑息性全身化疗联合鼻咽局部减症放疗\nK. 诱导化疗后肿瘤退缩情况决定是否行根治性放疗\nL. 同期放化疗序贯全身辅助化疗\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"诱导化疗序贯单纯根治性放疗（鼻咽及双侧颈部）","is_gold":false},{"letter":"B","text":"同期放化疗（鼻咽及双侧颈部）","is_gold":false},{"letter":"C","text":"单纯根治性放疗（鼻咽及双侧颈部）","is_gold":true},{"letter":"D","text":"诱导化疗序贯同期放化疗（鼻咽及双侧颈部）","is_gold":false},{"letter":"E","text":"鼻咽原发灶切除术联合术后辅助放疗","is_gold":false},{"letter":"F","text":"靶向治疗联合单纯根治性放疗（鼻咽及双侧颈部）","is_gold":false},{"letter":"G","text":"免疫治疗联合单纯根治性放疗（鼻咽及双侧颈部）","is_gold":false},{"letter":"H","text":"诱导化疗联合免疫治疗序贯同期放化疗","is_gold":false},{"letter":"I","text":"单纯根治性放疗（仅照射鼻咽及右侧颈部）","is_gold":false},{"letter":"J","text":"姑息性全身化疗联合鼻咽局部减症放疗","is_gold":false},{"letter":"K","text":"诱导化疗后肿瘤退缩情况决定是否行根治性放疗","is_gold":false},{"letter":"L","text":"同期放化疗序贯全身辅助化疗","is_gold":false}],"gold_letter":"C"},{"sample_id":"sample-f6df1555c3bac7ae4b972cd4","patient_id":"patient-7c0941dbdd4694260fd4de38","turn_id":"turn05","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、口咽。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 反复右中耳积液半年余。；现病史: 简要入院病史:患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。后来我院，我院病理示未分化非角化性癌。我院鼻咽+颈部MR：鼻咽部肿物，考虑鼻咽癌。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；阳性症状体征:；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史: 吸烟2包/日×20年，否认疫区接触史，否认冶游史，否认嗜酒。；家族史: 无特殊。；体格检查:；专科检查:；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D8] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽右侧咽隐窝区软组织影放射性浓聚，SUV41.8，病灶侵犯右腭帆肌群、右头长肌，病灶与蝶骨基底部右份及右翼突内板分界不清。右咽旁间隙变浅，右咽隐窝消失，左侧咽隐窝未见明显异常。口咽及喉咽结构及放射性分布未见明显异常。双侧上颌窦低密度影放射性分布未见异常；额窦、蝶窦、筛窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双颈多个小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 右中肺小片状影放射性分布未见异常；余双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏弥漫性密度减低，CT值约46Hu（脾脏CT值约58Hu），形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 盆腔放射性分布均匀，膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 右乳突气房内低密度影放射性分布未见异常；余颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽右咽隐窝病灶代谢活跃，符合鼻咽癌，病灶疑累及蝶骨基底部右份及右翼突内板。 双上颌窦炎症；右乳突炎症。 右中肺小片状影代谢未见异常，考虑增殖灶。 轻度脂肪肝。\n- [全程D8] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 早期复极改变 其余未见异常\n- [全程D8] 检验组合: 红细胞计数(RBC#)-静脉血: 5.2310E12/L；血液二氧化碳含量ctCO2(B)-静脉血: 25mmol/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.766COI；血小板分布宽度(PDW)-静脉血: 16.4%；单核细胞百分比(Mono%)-静脉血: 0.077；红细胞比容(Hct)-静脉血: 48.4%；凝血酶时间(TT)-静脉血: 19.8sec.；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 32.8U/L；凝血酶原时间(PT)-静脉血: 9.9sec.；淋巴细胞计数(Lymph#)-静脉血: 2.310E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.025；白蛋白(ALB)-静脉血: 46g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.61；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.08；胱抑素(Cys-C)-静脉血: 0.98mg/L；尿素氮(BUN)-静脉血: 5.5mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.597；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 6.1umolL；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；碱性磷酸酶(ALP)-静脉血: 60.9U/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 0.006COI；C-反应蛋白(CRP)-静脉血: 1.86mg/L；Rh血型-静脉血: 阳性；总钙(Ca)-静脉血: 2.14mmol/L；总胆汁酸(TBA)-静脉血: 8.3umol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.1ug/ml；丙氨酸氨基转移酶(ALT)-静脉血: 46.9U/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；氯离子(Cl-)-静脉血: 104.3mmol/L；低密度脂蛋白胆固醇……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D9] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁明显增厚，右侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描强化较明显。左侧咽隐窝存在。肿块累及右侧口咽壁。 右侧咽旁脂肪间隙变窄；左侧咽旁间隙未见明显狭窄。右侧腭帆张提肌受侵，左侧腭帆张提肌、双侧头长肌、双侧翼内外肌未见受侵。 鼻腔内未见肿物。 双侧翼腭窝、双侧上颌后脂肪间隙及咀嚼肌间隙未见异常。 颅底骨质信号均匀，增强扫描未见异常强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧上颌窦内见囊性灶，最大长径约27mm，边界清，无强化。右侧乳突见分泌物。左乳突充气良好，骨壁完整。 右侧咽后见一肿大淋巴结，大小约6mm×9mm，增强扫描明显强化。左侧咽后未见肿大淋巴结。颈部双侧见多个小淋巴结，最大者约8mm×11mm，未见坏死及包膜外侵。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。 扫描范围脑实质信号未见异常。；检查结论: 鼻咽肿物，考虑鼻咽癌。 颅底骨质未见破坏。 右侧咽后肿大淋巴结，考虑转移。 颈部小淋巴结。 双侧上颌窦囊肿，右侧乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见: 双颈II区可见几个小淋巴结，最大约11mm×4mm（右），12mm×5mm（左），边界清，椭圆形，皮髓质分界清，淋巴门可见。 CDFI:上述淋巴结内可见点状血流信号。 双侧颈部淋巴结穿刺活检： （1）右侧颈部淋巴结穿刺活检：常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以16G穿刺针穿刺入右颈淋巴结内，进针2次，取出长约0.5-1cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。 （2）左侧颈部淋巴结穿刺活检：常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以18G穿刺针穿刺入左颈淋巴结内，进针2次，取出长约0.8-1cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。；检查结论: 双侧颈部淋巴结穿刺活检。 不适随诊。 4个工作日后凭发票到2号楼6楼病理科取结果。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D28] 检验组合: 总蛋白(TP)-静脉血: 67.97g/L；总胆红素(TBIL)-静脉血: 13.8umol/L；载脂蛋白B(apoB)-静脉血: 1.32g/L；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.99mmolL；大血小板百分比(P-LCR%)-静脉血: 25.7%；球蛋白(GLO)-静脉血: 23.97g/L；总钙(Ca)-静脉血: 2.26mmol/L；红细胞比容(Hct)-静脉血: 46.8%；血小板计数(PLT#)-静脉血: 20110E9/L；磷(P)-静脉血: 1.5mmol/L；血小板比容-静脉血: 20%；肌酐(Crea)-静脉血: 84.5umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.3；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；总胆汁酸(TBA)-静脉血: 3.5umol/L；钾离子(K+)-静脉血: 4mmol/L；C-反应蛋白(CRP)-静脉血: 2.01mg/L；间接胆红素(IBIL)-静脉血: 9.7umolL；胱抑素(Cys-C)-静脉血: 1.04mg/L；尿素氮(BUN)-静脉血: 6.93mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.6；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.11mmol/L；碱性磷酸酶(ALP)-静脉血: 50.9U/L；平均红细胞体积(MCV)-静脉血: 91.4fL；单核细胞计数(Mono#)-静脉血: 0.710E9/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；单核细胞百分比(Mono%)-静脉血: 0.081；红细胞计数(RBC#)-静脉血: 5.1210E12/L；白细胞计数(WBC#)-静脉血: 8.4210E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；平均血小板体积(MPV)-静脉血: 10.2fL；总胆固醇(TC)-静脉血: 5.98mmol/L；血红蛋白(Hb)-静脉血: 159g/L；直接胆红素(DBIL)-静脉血: 4.1umol/L；氯离子(Cl-)-静脉血: 105.9mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 340g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D27] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗1次，无特殊主诉。Rx：1.继续放疗。2.定期复查血常规等。3.对症支持。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 继续放疗，加用多烯磷脂酰胆碱等保肝药物。\nB. 继续放疗，皮下注射重组人粒细胞刺激因子。\nC. 暂停放疗，完善超声心动图及动态心电图检查。\nD. 继续根治性放疗计划，定期常规监测血象及生化。\nE. 继续放疗，加用阿托伐他汀等降脂药物。\nF. 继续放疗，给予静脉补液及利尿治疗。\nG. 暂停放疗，静脉滴注广谱抗生素抗感染治疗。\nH. 继续放疗，口服头孢类抗生素及促排痰药物。\nI. 继续放疗，静脉滴注地塞米松及甘露醇。\nJ. 调整放疗计划，降低右侧中耳及乳突区的照射剂量。\nK. 继续放疗，皮下注射促红细胞生成素。\nL. 暂停放疗，行鼻内镜下鼓膜穿刺置管引流术。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"继续放疗，加用多烯磷脂酰胆碱等保肝药物。","is_gold":false},{"letter":"B","text":"继续放疗，皮下注射重组人粒细胞刺激因子。","is_gold":false},{"letter":"C","text":"暂停放疗，完善超声心动图及动态心电图检查。","is_gold":false},{"letter":"D","text":"继续根治性放疗计划，定期常规监测血象及生化。","is_gold":true},{"letter":"E","text":"继续放疗，加用阿托伐他汀等降脂药物。","is_gold":false},{"letter":"F","text":"继续放疗，给予静脉补液及利尿治疗。","is_gold":false},{"letter":"G","text":"暂停放疗，静脉滴注广谱抗生素抗感染治疗。","is_gold":false},{"letter":"H","text":"继续放疗，口服头孢类抗生素及促排痰药物。","is_gold":false},{"letter":"I","text":"继续放疗，静脉滴注地塞米松及甘露醇。","is_gold":false},{"letter":"J","text":"调整放疗计划，降低右侧中耳及乳突区的照射剂量。","is_gold":false},{"letter":"K","text":"继续放疗，皮下注射促红细胞生成素。","is_gold":false},{"letter":"L","text":"暂停放疗，行鼻内镜下鼓膜穿刺置管引流术。","is_gold":false}],"gold_letter":"D"},{"sample_id":"sample-f1eec05ca151dc9bde0f1f55","patient_id":"patient-7c0941dbdd4694260fd4de38","turn_id":"turn06","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、口咽。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 反复右中耳积液半年余。；现病史: 简要入院病史:患者于半年多前出现右中耳反复积液，当地医院多次抽液治疗，未见明显好转。无耳鸣，无回吸性血涕、头痛，无明显面麻、复视。后来我院，我院病理示未分化非角化性癌。我院鼻咽+颈部MR：鼻咽部肿物，考虑鼻咽癌。今日遵嘱[计划性表述已隐藏]放疗，遂入我院。患者自起病以来，精神、睡眠偏差，饮食可，二便正常，无明显体重下降。；阳性症状体征:；既往史: 既往体健。否认高血压病、糖尿病，否认肝炎、结核、伤寒等病史。5年前因“右侧手外伤”在当地医院行手术治疗（具体不详）。否输血史。；个人史: 吸烟2包/日×20年，否认疫区接触史，否认冶游史，否认嗜酒。；家族史: 无特殊。；体格检查:；专科检查:；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D8] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽右侧咽隐窝区软组织影放射性浓聚，SUV41.8，病灶侵犯右腭帆肌群、右头长肌，病灶与蝶骨基底部右份及右翼突内板分界不清。右咽旁间隙变浅，右咽隐窝消失，左侧咽隐窝未见明显异常。口咽及喉咽结构及放射性分布未见明显异常。双侧上颌窦低密度影放射性分布未见异常；额窦、蝶窦、筛窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双颈多个小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 右中肺小片状影放射性分布未见异常；余双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏弥漫性密度减低，CT值约46Hu（脾脏CT值约58Hu），形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 盆腔放射性分布均匀，膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 右乳突气房内低密度影放射性分布未见异常；余颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽右咽隐窝病灶代谢活跃，符合鼻咽癌，病灶疑累及蝶骨基底部右份及右翼突内板。 双上颌窦炎症；右乳突炎症。 右中肺小片状影代谢未见异常，考虑增殖灶。 轻度脂肪肝。\n- [全程D8] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 早期复极改变 其余未见异常\n- [全程D8] 检验组合: 红细胞计数(RBC#)-静脉血: 5.2310E12/L；血液二氧化碳含量ctCO2(B)-静脉血: 25mmol/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.766COI；血小板分布宽度(PDW)-静脉血: 16.4%；单核细胞百分比(Mono%)-静脉血: 0.077；红细胞比容(Hct)-静脉血: 48.4%；凝血酶时间(TT)-静脉血: 19.8sec.；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 32.8U/L；凝血酶原时间(PT)-静脉血: 9.9sec.；淋巴细胞计数(Lymph#)-静脉血: 2.310E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.025；白蛋白(ALB)-静脉血: 46g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.61；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.08；胱抑素(Cys-C)-静脉血: 0.98mg/L；尿素氮(BUN)-静脉血: 5.5mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.597；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 6.1umolL；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；碱性磷酸酶(ALP)-静脉血: 60.9U/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 0.006COI；C-反应蛋白(CRP)-静脉血: 1.86mg/L；Rh血型-静脉血: 阳性；总钙(Ca)-静脉血: 2.14mmol/L；总胆汁酸(TBA)-静脉血: 8.3umol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.1ug/ml；丙氨酸氨基转移酶(ALT)-静脉血: 46.9U/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；氯离子(Cl-)-静脉血: 104.3mmol/L；低密度脂蛋白胆固醇……\n- [全程D9] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、后壁及右侧壁明显增厚，右侧咽隐窝见软组织肿块，T1WI呈等信号，T2WI呈稍高信号，增强扫描强化较明显。左侧咽隐窝存在。肿块累及右侧口咽壁。 右侧咽旁脂肪间隙变窄；左侧咽旁间隙未见明显狭窄。右侧腭帆张提肌受侵，左侧腭帆张提肌、双侧头长肌、双侧翼内外肌未见受侵。 鼻腔内未见肿物。 双侧翼腭窝、双侧上颌后脂肪间隙及咀嚼肌间隙未见异常。 颅底骨质信号均匀，增强扫描未见异常强化。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧上颌窦内见囊性灶，最大长径约27mm，边界清，无强化。右侧乳突见分泌物。左乳突充气良好，骨壁完整。 右侧咽后见一肿大淋巴结，大小约6mm×9mm，增强扫描明显强化。左侧咽后未见肿大淋巴结。颈部双侧见多个小淋巴结，最大者约8mm×11mm，未见坏死及包膜外侵。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。 扫描范围脑实质信号未见异常。；检查结论: 鼻咽肿物，考虑鼻咽癌。 颅底骨质未见破坏。 右侧咽后肿大淋巴结，考虑转移。 颈部小淋巴结。 双侧上颌窦囊肿，右侧乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见: 双颈II区可见几个小淋巴结，最大约11mm×4mm（右），12mm×5mm（左），边界清，椭圆形，皮髓质分界清，淋巴门可见。 CDFI:上述淋巴结内可见点状血流信号。 双侧颈部淋巴结穿刺活检： （1）右侧颈部淋巴结穿刺活检：常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以16G穿刺针穿刺入右颈淋巴结内，进针2次，取出长约0.5-1cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。 （2）左侧颈部淋巴结穿刺活检：常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以18G穿刺针穿刺入左颈淋巴结内，进针2次，取出长约0.8-1cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。；检查结论: 双侧颈部淋巴结穿刺活检。 不适随诊。 4个工作日后凭发票到2号楼6楼病理科取结果。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D28] 检验组合: 总蛋白(TP)-静脉血: 67.97g/L；总胆红素(TBIL)-静脉血: 13.8umol/L；载脂蛋白B(apoB)-静脉血: 1.32g/L；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.99mmolL；大血小板百分比(P-LCR%)-静脉血: 25.7%；球蛋白(GLO)-静脉血: 23.97g/L；总钙(Ca)-静脉血: 2.26mmol/L；红细胞比容(Hct)-静脉血: 46.8%；血小板计数(PLT#)-静脉血: 20110E9/L；磷(P)-静脉血: 1.5mmol/L；血小板比容-静脉血: 20%；肌酐(Crea)-静脉血: 84.5umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.3；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；总胆汁酸(TBA)-静脉血: 3.5umol/L；钾离子(K+)-静脉血: 4mmol/L；C-反应蛋白(CRP)-静脉血: 2.01mg/L；间接胆红素(IBIL)-静脉血: 9.7umolL；胱抑素(Cys-C)-静脉血: 1.04mg/L；尿素氮(BUN)-静脉血: 6.93mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.6；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.11mmol/L；碱性磷酸酶(ALP)-静脉血: 50.9U/L；平均红细胞体积(MCV)-静脉血: 91.4fL；单核细胞计数(Mono#)-静脉血: 0.710E9/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；单核细胞百分比(Mono%)-静脉血: 0.081；红细胞计数(RBC#)-静脉血: 5.1210E12/L；白细胞计数(WBC#)-静脉血: 8.4210E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；平均血小板体积(MPV)-静脉血: 10.2fL；总胆固醇(TC)-静脉血: 5.98mmol/L；血红蛋白(Hb)-静脉血: 159g/L；直接胆红素(DBIL)-静脉血: 4.1umol/L；氯离子(Cl-)-静脉血: 105.9mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 340g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0……\n- [全程D36] 检验组合: 血小板比容-静脉血: 21%；红细胞计数(RBC#)-静脉血: 5.3510E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 1.610E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 327g/L；血小板计数(PLT#)-静脉血: 20710E9/L；大血小板百分比(P-LCR%)-静脉血: 25.9%；单核细胞计数(Mono#)-静脉血: 0.410E9/L；白细胞计数(WBC#)-静脉血: 5.9110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.654；血小板分布宽度(PDW)-静脉血: 11.9%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4；红细胞比容(Hct)-静脉血: 49.8%；单核细胞百分比(Mono%)-静脉血: 0.059；平均血小板体积(MPV)-静脉血: 10.1fL；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.9；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.262；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.022；平均红细胞体积(MCV)-静脉血: 93.1fL；中性粒细胞计数(Neut#)-静脉血: 3.910E9/L；血红蛋白(Hb)-静脉血: 163g/L\n- [全程D41] 检验组合: 红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.3%；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；血小板比容-静脉血: 15.7%；γ-谷氨酰基转移酶(GGT)-静脉血: 29.2U/L；红细胞计数(RBC#)-静脉血: 4.9510E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.024；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 338.3g/L；钠离子(Na+)-静脉血: 141.9mmol/L；单核细胞百分比(Mono%)-静脉血: 0.068；尿酸(UA)-静脉血: 478.3umol/L；钾离子(K+)-静脉血: 4.3mmol/L；间接胆红素(IBIL)-静脉血: 16.8umolL；乳酸脱氢酶(LDH)-静脉血: 152.4U/L；平均红细胞体积(MCV)-静脉血: 91.7fL；碱性磷酸酶(ALP)-静脉血: 56.1U/L；白蛋白(ALB)-静脉血: 45.9g/L；白细胞计数(WBC#)-静脉血: 8.1810E9/L；葡萄糖(Glu)-静脉血: 4.49mmol/L；阴离子间隙(AG)-静脉血: 17；血小板计数(PLT#)-静脉血: 193.210E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；总蛋白(TP)-静脉血: 70.66g/L；总钙(Ca)-静脉血: 2.29mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.9；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；中性粒细胞计数(Neut#)-静脉血: 610E9/L；胱抑素(Cys-C)-静脉血: 0.96mg/L；C-反应蛋白(CRP)-静脉血: 5.9mg/L；载脂蛋白B(apoB)-静脉血: 1.37g/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.5mmol/L；红细胞比容(Hct)-静脉血: 45.4%；丙氨酸氨基转移酶(ALT)-静脉血: 37.9U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 4.77mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 25.2U/……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D27] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗1次，无特殊主诉。Rx：1.继续放疗。2.定期复查血常规等。3.对症支持。\n- [全程D34] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗6次，无特殊主诉。复查血常规、生化未见明显异常。Rx：1.继续放疗。2.定期复查血常规等。3.对症支持。\n- [全程D41] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗11次，无特殊主诉。查体见鼻咽顶壁、右顶侧壁可见多个小结节，较前有所缩小，粘膜可见小片状白膜，双颈淋巴结未触及肿大，颅神经检查阴性，全身骨无压痛。和11-10复查血常规、血生化均未见明显异常。皮肤反应：0 Rx：1.继续放疗。粘膜反应：Ⅱ° 2.定期复查血常规等。3.对症支持。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停调强放疗，待口腔黏膜炎恢复至Ⅰ度后恢复放疗，期间加强静脉营养支持。\nB. 继续调强放疗，加用全身静脉广谱抗生素，定期复查血常规及生化。\nC. 继续调强放疗，降低单次靶区照射剂量，给予局部含漱等对症处理。\nD. 继续调强放疗，加用静脉糖皮质激素，定期复查血常规及生化。\nE. 继续调强放疗，给予局部含漱等对症处理，定期复查血常规及生化。\nF. 暂停调强放疗，加用全身抗真菌药物，待黏膜白膜消退后恢复放疗。\nG. 继续调强放疗，加用顺铂单药同步化疗，给予局部含漱等对症处理。\nH. 继续调强放疗，给予重组人粒细胞刺激因子皮下注射，定期复查血常规。\nI. 暂停调强放疗，行鼻咽黏膜活检明确白膜性质，给予局部含漱等对症处理。\nJ. 继续调强放疗，加用尼妥珠单抗靶向治疗，给予局部含漱等对症处理。\nK. 终止根治性放疗，转为姑息性放疗，加强镇痛及口腔局部护理。\nL. 继续调强放疗，预防性留置胃管，给予局部含漱等对症处理。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"暂停调强放疗，待口腔黏膜炎恢复至Ⅰ度后恢复放疗，期间加强静脉营养支持。","is_gold":false},{"letter":"B","text":"继续调强放疗，加用全身静脉广谱抗生素，定期复查血常规及生化。","is_gold":false},{"letter":"C","text":"继续调强放疗，降低单次靶区照射剂量，给予局部含漱等对症处理。","is_gold":false},{"letter":"D","text":"继续调强放疗，加用静脉糖皮质激素，定期复查血常规及生化。","is_gold":false},{"letter":"E","text":"继续调强放疗，给予局部含漱等对症处理，定期复查血常规及生化。","is_gold":true},{"letter":"F","text":"暂停调强放疗，加用全身抗真菌药物，待黏膜白膜消退后恢复放疗。","is_gold":false},{"letter":"G","text":"继续调强放疗，加用顺铂单药同步化疗，给予局部含漱等对症处理。","is_gold":false},{"letter":"H","text":"继续调强放疗，给予重组人粒细胞刺激因子皮下注射，定期复查血常规。","is_gold":false},{"letter":"I","text":"暂停调强放疗，行鼻咽黏膜活检明确白膜性质，给予局部含漱等对症处理。","is_gold":false},{"letter":"J","text":"继续调强放疗，加用尼妥珠单抗靶向治疗，给予局部含漱等对症处理。","is_gold":false},{"letter":"K","text":"终止根治性放疗，转为姑息性放疗，加强镇痛及口腔局部护理。","is_gold":false},{"letter":"L","text":"继续调强放疗，预防性留置胃管，给予局部含漱等对症处理。","is_gold":false}],"gold_letter":"E"},{"sample_id":"sample-be3624e29a98e9da91fced75","patient_id":"patient-7c0941dbdd4694260fd4de38","turn_id":"turn07","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、口咽。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D8] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽右侧咽隐窝区软组织影放射性浓聚，SUV41.8，病灶侵犯右腭帆肌群、右头长肌，病灶与蝶骨基底部右份及右翼突内板分界不清。右咽旁间隙变浅，右咽隐窝消失，左侧咽隐窝未见明显异常。口咽及喉咽结构及放射性分布未见明显异常。双侧上颌窦低密度影放射性分布未见异常；额窦、蝶窦、筛窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双颈多个小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 右中肺小片状影放射性分布未见异常；余双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。 肝脏弥漫性密度减低，CT值约46Hu（脾脏CT值约58Hu），形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 盆腔放射性分布均匀，膀胱、前列腺及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 右乳突气房内低密度影放射性分布未见异常；余颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽右咽隐窝病灶代谢活跃，符合鼻咽癌，病灶疑累及蝶骨基底部右份及右翼突内板。 双上颌窦炎症；右乳突炎症。 右中肺小片状影代谢未见异常，考虑增殖灶。 轻度脂肪肝。\n- [全程D8] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 早期复极改变 其余未见异常\n- [全程D8] 检验组合: 红细胞计数(RBC#)-静脉血: 5.2310E12/L；血液二氧化碳含量ctCO2(B)-静脉血: 25mmol/L；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.766COI；血小板分布宽度(PDW)-静脉血: 16.4%；单核细胞百分比(Mono%)-静脉血: 0.077；红细胞比容(Hct)-静脉血: 48.4%；凝血酶时间(TT)-静脉血: 19.8sec.；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；γ-谷氨酰基转移酶(GGT)-静脉血: 32.8U/L；凝血酶原时间(PT)-静脉血: 9.9sec.；淋巴细胞计数(Lymph#)-静脉血: 2.310E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.025；白蛋白(ALB)-静脉血: 46g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.61；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.08；胱抑素(Cys-C)-静脉血: 0.98mg/L；尿素氮(BUN)-静脉血: 5.5mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.597；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 6.1umolL；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；碱性磷酸酶(ALP)-静脉血: 60.9U/L；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 0.006COI；C-反应蛋白(CRP)-静脉血: 1.86mg/L；Rh血型-静脉血: 阳性；总钙(Ca)-静脉血: 2.14mmol/L；总胆汁酸(TBA)-静脉血: 8.3umol/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；D-二聚体(D-Dimer)-静脉血: 0.1ug/ml；丙氨酸氨基转移酶(ALT)-静脉血: 46.9U/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；氯离子(Cl-)-静脉血: 104.3mmol/L；低密度脂蛋白胆固醇……\n- [全程D50] 检验组合: 平均红细胞体积(MCV)-静脉血: 92.2fL；平均红细胞血红蛋白含量(MCH)-静脉血: 31pg；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.727；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.033；血小板计数(PLT#)-静脉血: 15910E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.165；单核细胞百分比(Mono%)-静脉血: 0.073；血红蛋白(Hb)-静脉血: 162g/L；平均血小板体积(MPV)-静脉血: 10.6fL；白细胞计数(WBC#)-静脉血: 4.210E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.9；红细胞计数(RBC#)-静脉血: 5.2310E12/L；中性粒细胞计数(Neut#)-静脉血: 3.110E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；大血小板百分比(P-LCR%)-静脉血: 28.7%；血小板分布宽度(PDW)-静脉血: 11.3%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.4；血小板比容-静脉血: 17%；单核细胞计数(Mono#)-静脉血: 0.310E9/L；红细胞比容(Hct)-静脉血: 48.2%\n- [全程D56] 检验组合: 血小板分布宽度(PDW)-静脉血: 12.4%；中性粒细胞百分比(Neut%)-静脉血: 0.84；单核细胞计数(Mono#)-静脉血: 0.410E9/L；血小板比容-静脉血: 19%；血红蛋白(Hb)-静脉血: 158g/L；红细胞计数(RBC#)-静脉血: 5.2110E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.7；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均血小板体积(MPV)-静脉血: 10.5fL；淋巴细胞计数(Lymph#)-静脉血: 0.510E9/L；红细胞比容(Hct)-静脉血: 47.9%；血小板计数(PLT#)-静脉血: 17710E9/L；平均红细胞体积(MCV)-静脉血: 91.9fL；淋巴细胞百分比(Lymph%)-静脉血: 0.077；平均红细胞血红蛋白含量(MCH)-静脉血: 30.3pg；中性粒细胞计数(Neut#)-静脉血: 5.310E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 330g/L；单核细胞百分比(Mono%)-静脉血: 0.061；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.9；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；大血小板百分比(P-LCR%)-静脉血: 28.7%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.016；白细胞计数(WBC#)-静脉血: 6.3510E9/L\n- [全程D62] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；血小板分布宽度(PDW)-静脉血: 13.6%；单核细胞计数(Mono#)-静脉血: 0.310E9/L；白细胞计数(WBC#)-静脉血: 5.1610E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.798；红细胞比容(Hct)-静脉血: 47.9%；单核细胞百分比(Mono%)-静脉血: 0.066；大血小板百分比(P-LCR%)-静脉血: 30.3%；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.7；血小板计数(PLT#)-静脉血: 21110E9/L；血小板比容-静脉血: 22%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.023；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.7；平均红细胞体积(MCV)-静脉血: 91.6fL；平均红细胞血红蛋白含量(MCH)-静脉血: 30.4pg；红细胞计数(RBC#)-静脉血: 5.2310E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞计数(Neut#)-静脉血: 4.110E9/L；血红蛋白(Hb)-静脉血: 159g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；淋巴细胞百分比(Lymph%)-静脉血: 0.109；平均红细胞血红蛋白浓度(MCHC)-静脉血: 332g/L；平均血小板体积(MPV)-静脉血: 10.5fL；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L\n- [全程D63] 检验组合: 低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.79mmol/L；总蛋白(TP)-静脉血: 66.06g/L；乳酸脱氢酶(LDH)-静脉血: 190U/L；葡萄糖(Glu)-静脉血: 4.43mmol/L；C-反应蛋白(CRP)-静脉血: 8.61mg/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.48；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.01mmolL；γ-谷氨酰基转移酶(GGT)-静脉血: 16.1U/L；镁离子(Mg2+)-静脉血: 0.98mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21U/L；总胆固醇(TC)-静脉血: 5.22mmol/L；阴离子间隙(AG)-静脉血: 15.7；氯离子(Cl-)-静脉血: 99.4mmol/L；碱性磷酸酶(ALP)-静脉血: 59.5U/L；磷(P)-静脉血: 1.2mmol/L；钾离子(K+)-静脉血: 3.7mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 2.11；甘油三酯(TG)-静脉血: 1.21mmol/L；肌酐(Crea)-静脉血: 80.4umol/L；总胆红素(TBIL)-静脉血: 23.7umol/L；载脂蛋白B(apoB)-静脉血: 1.27g/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.4mmol/L；总钙(Ca)-静脉血: 2.2mmol/L；尿素氮(BUN)-静脉血: 6.6mmol/L；钠离子(Na+)-静脉血: 142.5mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 14.2U/L；载脂蛋白AI(apoAI)-静脉血: 0.95g/L；间接胆红素(IBIL)-静脉血: 17.2umolL；直接胆红素(DBIL)-静脉血: 6.5umol/L；尿酸(UA)-静脉血: 490.3umol/L；总胆汁酸(TBA)-静脉血: 3.4umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 15.5U/L；球蛋白(GLO)-静脉血: 21.26g/L；白蛋白(ALB)-静脉血: 44.8g/L；胱抑素(Cys-C)-静脉血: 0.81mg/L\n- [全程D65] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:80（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:20（参考: 阴性）\n- [全程D160] 超声；腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径约11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约12cm/s。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、脾脏未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D160] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对称，双肺野纹理清晰，双肺野未见明显实质性病变。双侧肺门无增大，纵隔未见增宽，心影形态、大小、位置未见异常。双膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n- [全程D160] 检验组合: EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:40（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- [全程D55] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗21次，诉口干、咽痛较前明显，乏力，余无特殊主诉。查体见鼻咽右顶侧壁稍增厚，炎性分泌物较多，粘膜充血水肿，双颈淋巴结未触及肿大，颅神经检查阴性，全身骨无压痛。复查血常规未见明显异常。皮肤反应：I°Rx：1.继续放疗。粘膜反应：Ⅱ° 2.定期复查血常规等。3.抗炎、止痛、营养对症支持。\n- [全程D62] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗26次，诉口干、咽痛较前缓解，仍觉乏力，无特殊主诉。和12-01复查血常规、生化均未见明显异常。皮肤反应：Ⅰ°Rx：1.继续放疗。粘膜反应：Ⅱ° 2.定期复查血常规等。3.营养对症支持。\n- [全程D65] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者放疗28次，诉口干、咽痛好转，自觉体力虚弱，并拒绝最后2次放疗。皮肤反应：Ⅰ° Rx：1.定期复查。粘膜反应：Ⅰ° 2.不适随诊。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 安排鼻咽及颈部活检，准备行挽救性内镜下鼻咽切除术。\nB. 启动含铂双药方案全身化疗4-6个周期。\nC. 行全身PET/CT评估，若有局部高代谢灶则行挽救性放疗。\nD. 予以原发灶及颈部引流区局部推量补照4-6Gy。\nE. 给予卡培他滨单药口服维持治疗半年至一年。\nF. 维持规范随访观察，可症状给予一般对症及支持治疗。\nG. 行鼻咽及颈部MRI增强扫描，若有可疑残留则行诱导化疗。\nH. 启动PD-1抑制剂联合含铂双药全身化疗。\nI. 安排鼻咽内镜活检，若病理阳性则行双侧颈部淋巴结清扫术。\nJ. 补充顺铂单药全身化疗2个周期以强化局部控制。\nK. 行全身骨扫描及头颅MRI，排除远处转移后行局部挽救性放疗。\nL. 予以吉西他滨联合顺铂全身化疗4-6个周期。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"安排鼻咽及颈部活检，准备行挽救性内镜下鼻咽切除术。","is_gold":false},{"letter":"B","text":"启动含铂双药方案全身化疗4-6个周期。","is_gold":false},{"letter":"C","text":"行全身PET/CT评估，若有局部高代谢灶则行挽救性放疗。","is_gold":false},{"letter":"D","text":"予以原发灶及颈部引流区局部推量补照4-6Gy。","is_gold":false},{"letter":"E","text":"给予卡培他滨单药口服维持治疗半年至一年。","is_gold":false},{"letter":"F","text":"维持规范随访观察，可症状给予一般对症及支持治疗。","is_gold":true},{"letter":"G","text":"行鼻咽及颈部MRI增强扫描，若有可疑残留则行诱导化疗。","is_gold":false},{"letter":"H","text":"启动PD-1抑制剂联合含铂双药全身化疗。","is_gold":false},{"letter":"I","text":"安排鼻咽内镜活检，若病理阳性则行双侧颈部淋巴结清扫术。","is_gold":false},{"letter":"J","text":"补充顺铂单药全身化疗2个周期以强化局部控制。","is_gold":false},{"letter":"K","text":"行全身骨扫描及头颅MRI，排除远处转移后行局部挽救性放疗。","is_gold":false},{"letter":"L","text":"予以吉西他滨联合顺铂全身化疗4-6个周期。","is_gold":false}],"gold_letter":"F"}]}
+{"patient_id":"patient-02ca51eed4fedbb13e4db76d","bootstrap_cluster_id":"cluster-009","turns":[{"sample_id":"sample-5737526b7d92f1b3d5423663","patient_id":"patient-02ca51eed4fedbb13e4db76d","turn_id":"turn01","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、鼻腔。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左颈肿物20天；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物；既往史: 20余年前患“血吸虫”病行脾脏切除术，当地医院检查示“早期肝硬化”，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：37.3℃，P：62次/分，R：20次/分，BP：121/75mmHg,Ht：165cm，Wt：58kg，BSA：1.63m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽左侧顶后壁粘膜稍隆起；左侧颈部II区可扪及1个淋巴结，最大径1×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善电子鼻咽镜检查及活检，行鼻咽及颈部CT平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。\nB. 完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，并直接行全身PET-CT评估远处转移。\nC. 完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，暂不进行胸腹部影像学检查待病理确诊。\nD. 完善间接鼻咽镜检查，行鼻咽及颈部MRI平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。\nE. 完善颈部淋巴结细针穿刺活检，行鼻咽及颈部MRI平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。\nF. 完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。\nG. 完善电子鼻咽镜检查及活检，行鼻咽及颈部CT平扫，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。\nH. 完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。\nI. 完善颈部淋巴结切除活检，行鼻咽及颈部MRI平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。\nJ. 完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，并完善骨扫描及头颅MRI检查。\nK. 完善电子鼻咽镜检查及活检，仅行鼻咽MRI平扫+增强，颈部行彩超评估，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。\nL. 完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，并完善全身骨髓穿刺活检。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"完善电子鼻咽镜检查及活检，行鼻咽及颈部CT平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。","is_gold":false},{"letter":"B","text":"完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，并直接行全身PET-CT评估远处转移。","is_gold":false},{"letter":"C","text":"完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，暂不进行胸腹部影像学检查待病理确诊。","is_gold":false},{"letter":"D","text":"完善间接鼻咽镜检查，行鼻咽及颈部MRI平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。","is_gold":false},{"letter":"E","text":"完善颈部淋巴结细针穿刺活检，行鼻咽及颈部MRI平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。","is_gold":false},{"letter":"F","text":"完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。","is_gold":false},{"letter":"G","text":"完善电子鼻咽镜检查及活检，行鼻咽及颈部CT平扫，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。","is_gold":false},{"letter":"H","text":"完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。","is_gold":true},{"letter":"I","text":"完善颈部淋巴结切除活检，行鼻咽及颈部MRI平扫+增强，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。","is_gold":false},{"letter":"J","text":"完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，并完善骨扫描及头颅MRI检查。","is_gold":false},{"letter":"K","text":"完善电子鼻咽镜检查及活检，仅行鼻咽MRI平扫+增强，颈部行彩超评估，并完善胸部DR、腹部及泌尿系彩超、心电图等基线检查。","is_gold":false},{"letter":"L","text":"完善电子鼻咽镜检查及活检，行鼻咽及颈部MRI平扫+增强，并完善全身骨髓穿刺活检。","is_gold":false}],"gold_letter":"H"},{"sample_id":"sample-84b4eab1f1613c7517fd613a","patient_id":"patient-02ca51eed4fedbb13e4db76d","turn_id":"turn02","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、鼻腔。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左颈肿物20天；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物；既往史: 20余年前患“血吸虫”病行脾脏切除术，当地医院检查示“早期肝硬化”，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：37.3℃，P：62次/分，R：20次/分，BP：121/75mmHg,Ht：165cm，Wt：58kg，BSA：1.63m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽左侧顶后壁粘膜稍隆起；左侧颈部II区可扪及1个淋巴结，最大径1×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 逆钟向转位 正常范围心电图\n- [全程D1] 检验组合: 肌酐(Crea)-静脉血: 56.1umol/L；阴离子间隙(AG)-静脉血: 11.1；α-L-岩藻糖苷酶(AFU)-静脉血: 35.5U/L；凝血酶原时间(PT)-静脉血: 11.7sec.；胱抑素(Cys-C)-静脉血: 0.85mg/L；淋巴细胞百分比(Lymph%)-静脉血: 0.428；骨钙素N端中分子片段(N-MID)-静脉血: 19.3ng/ml；纤维蛋白原(Fbg)-静脉血: 2.07g/L；钠离子(Na+)-静脉血: 140.5mmol/L；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；总钙(Ca)-静脉血: 2.29mmol/L；乳酸脱氢酶(LDH)-静脉血: 164U/L；镁离子(Mg2+)-静脉血: 0.87mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.44；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.35mmol/L；血小板分布宽度(PDW)-静脉血: 15.9%；平均红细胞血红蛋白含量(MCH)-静脉血: 31.5pg；总胆固醇(TC)-静脉血: 4.12mmol/L；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；Rh血型-静脉血: 阳性；红细胞比容(Hct)-静脉血: 41.2%；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；间接胆红素(IBIL)-静脉血: 9.9umolL；D-二聚体(D-Dimer)-静脉血: 5.09ug/ml；钾离子(K+)-静脉血: 4.24mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.424；直接胆红素(DBIL)-静脉血: 5.8umol/L；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；天门冬氨酸氨基转移酶(AST)-静脉血: 18.6U/L；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阳性(+)（参考: 阴性）；透明质酸(HA)-静脉血: 71.337ng/ml；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.5；纤维蛋白原降解产物(FDP)-静脉血:……\n- [全程D2] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双下肺纹理稍粗，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n- [全程D4] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏形态失常，表面凸凹不平，边缘钝，肝实质回声不均匀，明显增强、粗糙，肝内未见明确肿块回声。门静脉主干内径约15mm。肝静脉、门静脉内未见异常回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约14cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏术后缺如。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约35×24×23mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝硬化声像。 脾脏术后缺如。 胆囊、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D7] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 左上颌骨可见片状放射性浓集灶。胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 左上颌骨炎症。 余全身骨骼未见明显异常。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行PET-CT检查以重新评估全身分期\nB. 行左侧颈部淋巴结切除活检以明确病理诊断\nC. 行左侧颈部淋巴结细针穿刺活检(FNAC)以明确病理诊断\nD. 行鼻咽脱落细胞涂片检查以替代组织活检\nE. 行肝脏增强MRI检查以进一步排查肝脏转移灶\nF. 行右侧颈部II区小淋巴结切除活检以明确对侧转移情况\nG. 行外周血EB病毒DNA定量检测作为确诊依据\nH. 行左上颌骨病灶穿刺活检以明确骨扫描异常灶性质\nI. 行鼻咽镜下鼻咽原发灶活检以明确病理诊断\nJ. 行鼻咽肿物广泛切除术以达到诊断与治疗目的\nK. 行颈部超声造影检查以进一步评估右颈淋巴结性质\nL. 行鼻咽及颈部CT平扫加增强以补充评估颅底骨质破坏\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"行PET-CT检查以重新评估全身分期","is_gold":false},{"letter":"B","text":"行左侧颈部淋巴结切除活检以明确病理诊断","is_gold":false},{"letter":"C","text":"行左侧颈部淋巴结细针穿刺活检(FNAC)以明确病理诊断","is_gold":false},{"letter":"D","text":"行鼻咽脱落细胞涂片检查以替代组织活检","is_gold":false},{"letter":"E","text":"行肝脏增强MRI检查以进一步排查肝脏转移灶","is_gold":false},{"letter":"F","text":"行右侧颈部II区小淋巴结切除活检以明确对侧转移情况","is_gold":false},{"letter":"G","text":"行外周血EB病毒DNA定量检测作为确诊依据","is_gold":false},{"letter":"H","text":"行左上颌骨病灶穿刺活检以明确骨扫描异常灶性质","is_gold":false},{"letter":"I","text":"行鼻咽镜下鼻咽原发灶活检以明确病理诊断","is_gold":true},{"letter":"J","text":"行鼻咽肿物广泛切除术以达到诊断与治疗目的","is_gold":false},{"letter":"K","text":"行颈部超声造影检查以进一步评估右颈淋巴结性质","is_gold":false},{"letter":"L","text":"行鼻咽及颈部CT平扫加增强以补充评估颅底骨质破坏","is_gold":false}],"gold_letter":"I"},{"sample_id":"sample-9895c4d0f7c600fd0c046a50","patient_id":"patient-02ca51eed4fedbb13e4db76d","turn_id":"turn05","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、鼻腔。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左颈肿物20天；现病史: 缘于20天前患者无意中出现左颈肿物，未伴涕血、耳鸣、听力下降、头痛、面麻等不适，某次就诊时间在当地医院行左颈淋巴结穿刺，病理示未见癌，某次就诊时间行鼻咽活检病理示鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物；既往史: 20余年前患“血吸虫”病行脾脏切除术，当地医院检查示“早期肝硬化”，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：37.3℃，P：62次/分，R：20次/分，BP：121/75mmHg,Ht：165cm，Wt：58kg，BSA：1.63m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率62次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽左侧顶后壁粘膜稍隆起；左侧颈部II区可扪及1个淋巴结，最大径1×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n- [全程D27] 入院记录: 主诉: 确诊鼻咽癌1月余；现病史: 缘于某次就诊时间9月下旬患者无意中出现左颈肿物，未伴涕血、耳鸣、听力下降、头痛、面麻等不适，某次就诊时间在当地医院行左颈淋巴结穿刺，病理示未见癌，某次就诊时间行鼻咽活检病理示分化非角化癌。某次就诊时间日入院予以治疗前相关检查，明确诊断为鼻咽分化非角化癌，[分期信息见历史辅助诊断节点],III期，予以行放疗计划设计，现放疗计划设计完成，入院行放化综合治疗。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物；既往史: 20余年前患“血吸虫”病行脾脏切除术，当地医院检查示“早期肝硬化”，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：37.3℃，P：62次/分，R：20次/分，BP：121/75mmHg,Ht：165cm，Wt：58kg，BSA：1.63m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率62次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽左侧顶后壁粘膜稍隆起；左侧颈部II区可扪及1个淋巴结，最大径1×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 逆钟向转位 正常范围心电图\n- [全程D2] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双下肺纹理稍粗，双肺野内未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影不大。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n- [全程D4] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏形态失常，表面凸凹不平，边缘钝，肝实质回声不均匀，明显增强、粗糙，肝内未见明确肿块回声。门静脉主干内径约15mm。肝静脉、门静脉内未见异常回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约14cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏术后缺如。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约35×24×23mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝硬化声像。 脾脏术后缺如。 胆囊、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D7] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 左上颌骨可见片状放射性浓集灶。胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 左上颌骨炎症。 余全身骨骼未见明显异常。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D35] 检验组合: 碱性磷酸酶(ALP)-静脉血: 93.6U/L；丙氨酸氨基转移酶(ALT)-静脉血: 26.3U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.2U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 34.4U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.73；α-L-岩藻糖苷酶(AFU)-静脉血: 38.5U/L；乳酸脱氢酶(LDH)-静脉血: 195.7U/L；总胆汁酸(TBA)-静脉血: 2.9umol/L\n- [全程D39] 检验组合: 胱抑素(Cys-C)-静脉血: 0.84mg/L；肌酐(Crea)-静脉血: 62.7umol/L；阴离子间隙(AG)-静脉血: 11；单核细胞计数(Mono#)-静脉血: 0.510E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.8mmol/L；载脂蛋白B(apoB)-静脉血: 0.81g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.8U/L；平均红细胞体积(MCV)-静脉血: 93.8fL；单核细胞百分比(Mono%)-静脉血: 0.149；C-反应蛋白(CRP)-静脉血: 0.37mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；淋巴细胞百分比(Lymph%)-静脉血: 0.352；有核红细胞百分比(NRBC%)-静脉血: 0；尿素氮(BUN)-静脉血: 7.54mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.17g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 40U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；直接胆红素(DBIL)-静脉血: 6.9umol/L；平均血小板体积(MPV)-静脉血: 9.04fL；红细胞计数(RBC#)-静脉血: 4.2310E12/L；总胆固醇(TC)-静脉血: 4.39mmol/L；总钙(Ca)-静脉血: 2.39mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.21mmolL；丙氨酸氨基转移酶(ALT)-静脉血: 28.6U/L；间接胆红素(IBIL)-静脉血: 11.6umolL；甘油三酯(TG)-静脉血: 0.5mmol/L；尿酸(UA)-静脉血: 332.9umol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32.2pg；中性粒细胞计数(Neut#)-静脉血: 1.510E9/L；总胆红素(TBIL)-静脉血: 18.5umol/L；乳酸脱氢酶(LDH)-静脉血: 145.6U/L；磷(P)-静脉血: 1.34mmol/L；碱性磷酸酶(ALP)-静脉血: 93.2U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D28] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者今日返院，一般情况可，无明显不适主诉，体查情况基本同前，患者现放疗计划已设计完成并通过全科会诊，NPDT70Gy/30F,CTV1:60Gy/30F,CTV2：54Gy/30F，靶区剂量分布均匀，正常组织剂量在可接受范围内。[姓名已隐去]副医生信息已隐藏，患者放疗计划设计完成，可行放疗前复位及验证等准备，开始放疗，患者既往血吸虫肝硬化病史，患者化疗后可能出现肝功能损伤，肝衰竭，严重者可危及生命，与患者及家属沟通后，患者及家属表示愿意承担化疗风险，予以择期行DDP单药每周同时期化疗。\n- [全程D29] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 今日查房，患者一般情况可，无明显不适主诉，体查同入院。[姓名已隐去]副医生信息已隐藏示：依约开始放疗，嘱患者注意营养与休息。\n- [全程D34] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者已开始行根治性放疗，现放疗2F，昨日完成一程同期化疗，诉额、双侧颞部头痛，一般情况尚可，体查情况基本同前。[姓名已隐去]副医生信息已隐藏：现患者已开始放疗，一程化疗结束，针对患者主诉，考虑放疗引起不良反应，予以止痛等对症处理，病情继观。\n- [全程D39] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现处于放化综合治疗中，放疗3F，无诉，体查情况基本同前，血常规、生化常规结果示：WBC3.33*10E9/L、中性粒1.5*10E9/L；[姓名已隐去]副医生信息已隐藏：现患者血象稍低，明日予以行同期化疗二程，化疗后予以复查血象后再予以升白等对症处理，密观病情。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停同期化疗，单纯行根治性放疗，立即予以重组人粒细胞集落刺激因子升白细胞治疗。\nB. 暂停放化疗，立即予以重组人粒细胞集落刺激因子，待白细胞恢复正常后再恢复放化综合治疗。\nC. 延迟第2程同期化疗，继续放疗，观察3天后复查血常规，若中性粒细胞达标再行化疗。\nD. 继续行第2程同期化疗，化疗前予以长效聚乙二醇化重组人粒细胞集落刺激因子预防性升白细胞。\nE. 继续行第2程同期化疗，化疗期间同步予以口服抗生素预防感染及静脉营养支持。\nF. 继续行第2程同期化疗，将顺铂剂量下调20%，并给予静脉营养、补液及通便等对症支持。\nG. 终止同期化疗，改为单纯放疗联合西妥昔单抗靶向治疗，并予以静脉营养支持。\nH. 继续行第2程同期化疗，化疗后立即常规予以重组人粒细胞集落刺激因子连续升白细胞治疗3天。\nI. 暂停放疗，按计划行第2程同期化疗，化疗后复查血象视情况予以升白细胞治疗。\nJ. 继续行第2程同期化疗，将顺铂更换为卡铂，并给予静脉营养、补液及通便等对症支持。\nK. 延迟第2程同期化疗，予以静脉营养、补液及通便等对症支持，待1周后复查血象再决定是否化疗。\nL. 继续行第2程同期化疗，化疗后复查血象视情况予以升白细胞治疗，并给予静脉营养、补液及通便等对症支持。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"暂停同期化疗，单纯行根治性放疗，立即予以重组人粒细胞集落刺激因子升白细胞治疗。","is_gold":false},{"letter":"B","text":"暂停放化疗，立即予以重组人粒细胞集落刺激因子，待白细胞恢复正常后再恢复放化综合治疗。","is_gold":false},{"letter":"C","text":"延迟第2程同期化疗，继续放疗，观察3天后复查血常规，若中性粒细胞达标再行化疗。","is_gold":false},{"letter":"D","text":"继续行第2程同期化疗，化疗前予以长效聚乙二醇化重组人粒细胞集落刺激因子预防性升白细胞。","is_gold":false},{"letter":"E","text":"继续行第2程同期化疗，化疗期间同步予以口服抗生素预防感染及静脉营养支持。","is_gold":false},{"letter":"F","text":"继续行第2程同期化疗，将顺铂剂量下调20%，并给予静脉营养、补液及通便等对症支持。","is_gold":false},{"letter":"G","text":"终止同期化疗，改为单纯放疗联合西妥昔单抗靶向治疗，并予以静脉营养支持。","is_gold":false},{"letter":"H","text":"继续行第2程同期化疗，化疗后立即常规予以重组人粒细胞集落刺激因子连续升白细胞治疗3天。","is_gold":false},{"letter":"I","text":"暂停放疗，按计划行第2程同期化疗，化疗后复查血象视情况予以升白细胞治疗。","is_gold":false},{"letter":"J","text":"继续行第2程同期化疗，将顺铂更换为卡铂，并给予静脉营养、补液及通便等对症支持。","is_gold":false},{"letter":"K","text":"延迟第2程同期化疗，予以静脉营养、补液及通便等对症支持，待1周后复查血象再决定是否化疗。","is_gold":false},{"letter":"L","text":"继续行第2程同期化疗，化疗后复查血象视情况予以升白细胞治疗，并给予静脉营养、补液及通便等对症支持。","is_gold":true}],"gold_letter":"L"},{"sample_id":"sample-5f99c90d4e8627eaecab64fc","patient_id":"patient-02ca51eed4fedbb13e4db76d","turn_id":"turn06","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T2；受侵结构包括：腭帆提肌、咽旁间隙、鼻腔。\n文本分期信息：N1，M0。\n综合TNM状态：T2N1M0。\n综合分期：IB。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 左颈肿物20天；现病史: 缘于20天前患者无意中出现左颈肿物，未伴涕血、耳鸣、听力下降、头痛、面麻等不适，某次就诊时间在当地医院行左颈淋巴结穿刺，病理示未见癌，某次就诊时间行鼻咽活检病理示鼻咽癌。今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 左颈肿物；既往史: 20余年前患“血吸虫”病行脾脏切除术，当地医院检查示“早期肝硬化”，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：37.3℃，P：62次/分，R：20次/分，BP：121/75mmHg,Ht：165cm，Wt：58kg，BSA：1.63m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率62次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽左侧顶后壁粘膜稍隆起；左侧颈部II区可扪及1个淋巴结，最大径1×2.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律不齐 逆钟向转位 正常范围心电图\n- [全程D35] 检验组合: 碱性磷酸酶(ALP)-静脉血: 93.6U/L；丙氨酸氨基转移酶(ALT)-静脉血: 26.3U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.2U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 34.4U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.73；α-L-岩藻糖苷酶(AFU)-静脉血: 38.5U/L；乳酸脱氢酶(LDH)-静脉血: 195.7U/L；总胆汁酸(TBA)-静脉血: 2.9umol/L\n- [全程D39] 检验组合: 胱抑素(Cys-C)-静脉血: 0.84mg/L；肌酐(Crea)-静脉血: 62.7umol/L；阴离子间隙(AG)-静脉血: 11；单核细胞计数(Mono#)-静脉血: 0.510E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.8mmol/L；载脂蛋白B(apoB)-静脉血: 0.81g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.8U/L；平均红细胞体积(MCV)-静脉血: 93.8fL；单核细胞百分比(Mono%)-静脉血: 0.149；C-反应蛋白(CRP)-静脉血: 0.37mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.2；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；淋巴细胞百分比(Lymph%)-静脉血: 0.352；有核红细胞百分比(NRBC%)-静脉血: 0；尿素氮(BUN)-静脉血: 7.54mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.17g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 40U/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；直接胆红素(DBIL)-静脉血: 6.9umol/L；平均血小板体积(MPV)-静脉血: 9.04fL；红细胞计数(RBC#)-静脉血: 4.2310E12/L；总胆固醇(TC)-静脉血: 4.39mmol/L；总钙(Ca)-静脉血: 2.39mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.21mmolL；丙氨酸氨基转移酶(ALT)-静脉血: 28.6U/L；间接胆红素(IBIL)-静脉血: 11.6umolL；甘油三酯(TG)-静脉血: 0.5mmol/L；尿酸(UA)-静脉血: 332.9umol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32.2pg；中性粒细胞计数(Neut#)-静脉血: 1.510E9/L；总胆红素(TBIL)-静脉血: 18.5umol/L；乳酸脱氢酶(LDH)-静脉血: 145.6U/L；磷(P)-静脉血: 1.34mmol/L；碱性磷酸酶(ALP)-静脉血: 93.2U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0……\n- [全程D42] 检验组合: 红细胞比容(Hct)-静脉血: 38.5%；平均红细胞血红蛋白浓度(MCHC)-静脉血: 335g/L；红细胞计数(RBC#)-静脉血: 4.1110E12/L；平均红细胞体积(MCV)-静脉血: 93.7fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；血小板计数(PLT#)-静脉血: 26910E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；碱性磷酸酶(ALP)-静脉血: 88U/L；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18U/L；中性粒细胞百分比(Neut%)-静脉血: 0.659；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.019；乳酸脱氢酶(LDH)-静脉血: 139.5U/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6；α-L-岩藻糖苷酶(AFU)-静脉血: 41U/L；血小板分布宽度(PDW)-静脉血: 11.5%；中性粒细胞计数(Neut#)-静脉血: 2.110E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 24.4U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；平均红细胞血红蛋白含量(MCH)-静脉血: 31.4pg；总胆汁酸(TBA)-静脉血: 1umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 33.2U/L；平均血小板体积(MPV)-静脉血: 10.3fL；白细胞计数(WBC#)-静脉血: 3.1410E9/L；大血小板百分比(P-LCR%)-静脉血: 26.3%；单核细胞计数(Mono#)-静脉血: 0.410E9/L；血红蛋白(Hb)-静脉血: 129g/L；单核细胞百分比(Mono%)-静脉血: 0.134；血小板比容-静脉血: 28%；淋巴细胞百分比(Lymph%)-静脉血: 0.185；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43\n- [全程D46] 检验组合: 平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；C-反应蛋白(CRP)-静脉血: 0.38mg/L；γ-谷氨酰基转移酶(GGT)-静脉血: 34.2U/L；尿酸(UA)-静脉血: 292.5umol/L；红细胞计数(RBC#)-静脉血: 4.0510E12/L；总蛋白(TP)-静脉血: 70.3g/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞计数(Neut#)-静脉血: 1.410E9/L；磷(P)-静脉血: 1.21mmol/L；总胆固醇(TC)-静脉血: 3.73mmol/L；单核细胞百分比(Mono%)-静脉血: 0.167；总钙(Ca)-静脉血: 2.2mmol/L；胱抑素(Cys-C)-静脉血: 0.68mg/L；葡萄糖(Glu)-静脉血: 4.54mmol/L；白细胞计数(WBC#)-静脉血: 2.3910E9/L；载脂蛋白B(apoB)-静脉血: 0.82g/L；直接胆红素(DBIL)-静脉血: 4.6umol/L；镁离子(Mg2+)-静脉血: 0.76mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.89；氯离子(Cl-)-静脉血: 100.1mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.197；肌酐(Crea)-静脉血: 56.4umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；血小板比容-静脉血: 22%；碱性磷酸酶(ALP)-静脉血: 81.9U/L；钾离子(K+)-静脉血: 4.1mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.1；球蛋白(GLO)-静脉血: 29.4g/L；总胆汁酸(TBA)-静脉血: 1.4umol/L；尿素氮(BUN)-静脉血: 6.3mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.4pg；天门冬氨酸氨基转移酶(AST)-静脉血: 17.1U/L；血小板计数(PLT#)-静脉血: 21610E9/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；载脂蛋白AI(apoAI)-静脉血: 1.09g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.008；钠离子(Na+)-静脉血: 138.5mmol/L；淋巴细胞计数(Lymph#)……\n- [全程D49] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；有核红细胞百分比(NRBC%)-静脉血: 0；白细胞计数(WBC#)-静脉血: 28.910E9/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0；平均红细胞体积(MCV)-静脉血: 96.4fL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.77；α-L-岩藻糖苷酶(AFU)-静脉血: 37.1U/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.003；平均血小板体积(MPV)-静脉血: 8.48fL；血小板计数(PLT#)-静脉血: 16710E9/L；红细胞计数(RBC#)-静脉血: 3.9610E12/L；碱性磷酸酶(ALP)-静脉血: 119.8U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32.2pg；中性粒细胞百分比(Neut%)-静脉血: 0.933；血小板分布宽度(PDW)-静脉血: 15.7%；血小板比容-静脉血: 14.1%；中性粒细胞计数(Neut#)-静脉血: 2710E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 13.5U/L；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；红细胞比容(Hct)-静脉血: 38.2%；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 334.1g/L；总胆汁酸(TBA)-静脉血: 1.5umol/L；单核细胞百分比(Mono%)-静脉血: 0.035；单核细胞计数(Mono#)-静脉血: 110E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 17.5U/L；血红蛋白(Hb)-静脉血: 127.7g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.028；乳酸脱氢酶(LDH)-静脉血: 177U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 34.4U/L\n- [全程D53] 检验组合: 总胆固醇(TC)-静脉血: 4.04mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 17.7U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.8；血小板计数(PLT#)-静脉血: 199.710E9/L；镁离子(Mg2+)-静脉血: 0.73mmol/L；红细胞比容(Hct)-静脉血: 38.2%；总蛋白(TP)-静脉血: 70.35g/L；载脂蛋白B(apoB)-静脉血: 0.83g/L；尿酸(UA)-静脉血: 359.2umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.133；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.6；中性粒细胞计数(Neut#)-静脉血: 2.710E9/L；血小板分布宽度(PDW)-静脉血: 15.6%；中性粒细胞百分比(Neut%)-静脉血: 0.671；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；球蛋白(GLO)-静脉血: 26.85g/L；氯离子(Cl-)-静脉血: 102.6mmol/L；肌酐(Crea)-静脉血: 59umol/L；平均红细胞体积(MCV)-静脉血: 95.9fL；血小板比容-静脉血: 16.6%；红细胞计数(RBC#)-静脉血: 3.9810E12/L；C-反应蛋白(CRP)-静脉血: 0.91mg/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.69mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 337.3g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.11mmolL；白蛋白(ALB)-静脉血: 43.5g/L；单核细胞计数(Mono#)-静脉血: 0.610E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32.3pg；白细胞计数(WBC#)-静脉血: 3.9610E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 38U/L；甘油三酯(TG)-静脉血: 0.67mmol/L；平均血小板体积(MPV)-静脉血: 8.31fL；葡萄糖(Glu)-静脉血: 4.61mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.6%；单核细胞百分比(Mono%)-静脉血: 0.143；总钙(Ca)-静脉血: 2.28mmol/L；血……\n\n【既往治疗与反应】\n- [全程D29] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 今日查房，患者一般情况可，无明显不适主诉，体查同入院。[姓名已隐去]副医生信息已隐藏示：依约开始放疗，嘱患者注意营养与休息。\n- [全程D34] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者已开始行根治性放疗，现放疗2F，昨日完成一程同期化疗，诉额、双侧颞部头痛，一般情况尚可，体查情况基本同前。[姓名已隐去]副医生信息已隐藏：现患者已开始放疗，一程化疗结束，针对患者主诉，考虑放疗引起不良反应，予以止痛等对症处理，病情继观。\n- [全程D39] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现处于放化综合治疗中，放疗3F，无诉，体查情况基本同前，血常规、生化常规结果示：WBC3.33*10E9/L、中性粒1.5*10E9/L；[姓名已隐去]副医生信息已隐藏：现患者血象稍低，明日予以行同期化疗二程，化疗后予以复查血象后再予以升白等对症处理，密观病情。\n- [全程D44] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现处于放化综合治疗中，放疗8F，诉口苦，体查情况基本同前，21号复查血常规、生化常规结果基本正常；[姓名已隐去]副医生信息已隐藏：现患者已完成同期化疗二程，继续放疗，余治疗不变，密观病情。\n- [全程D49] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现处于放化综合治疗中，放疗10F，诉喉咙疼痛，体查情况基本同前，25号血常规、生化常规结果示：WBC2.39*10E9/L、中性粒1.4*10E9/L，今日复查血常规、肝肾功能结果基本正常；[姓名已隐去]副医生信息已隐藏：患者25号血象示2度骨髓抑制，予以升白等对症处理，并于26号予以三程同期化疗，今日复查血象已恢复，继续予以放化综合治疗，密观病情。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 继续按计划行放化综合治疗，并进行静脉导管常规维护。\nB. 暂停放化疗，再次给予粒细胞集落刺激因子（G-CSF）升白治疗。\nC. 暂停同期化疗，仅继续单纯放射治疗，并进行静脉导管常规维护。\nD. 继续按计划行放化综合治疗，并预防性输注单采血小板。\nE. 暂停放化疗，经验性给予广谱静脉抗生素抗感染治疗。\nF. 继续按计划行放化综合治疗，并预防性给予重组人促红素（EPO）治疗。\nG. 继续按计划行放化综合治疗，并拔除静脉留置导管改为口服给药。\nH. 继续按计划行放化综合治疗，但将后续同期化疗剂量减量20%。\nI. 提前结束同期化疗，仅继续完成剩余放射治疗。\nJ. 暂停放化疗，给予保肝降酶药物静脉滴注。\nK. 继续按计划行放化综合治疗，并预防性给予白介素-11（IL-11）治疗。\nL. 继续按计划行放化综合治疗，并加用大剂量静脉糖皮质激素治疗。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"继续按计划行放化综合治疗，并进行静脉导管常规维护。","is_gold":true},{"letter":"B","text":"暂停放化疗，再次给予粒细胞集落刺激因子（G-CSF）升白治疗。","is_gold":false},{"letter":"C","text":"暂停同期化疗，仅继续单纯放射治疗，并进行静脉导管常规维护。","is_gold":false},{"letter":"D","text":"继续按计划行放化综合治疗，并预防性输注单采血小板。","is_gold":false},{"letter":"E","text":"暂停放化疗，经验性给予广谱静脉抗生素抗感染治疗。","is_gold":false},{"letter":"F","text":"继续按计划行放化综合治疗，并预防性给予重组人促红素（EPO）治疗。","is_gold":false},{"letter":"G","text":"继续按计划行放化综合治疗，并拔除静脉留置导管改为口服给药。","is_gold":false},{"letter":"H","text":"继续按计划行放化综合治疗，但将后续同期化疗剂量减量20%。","is_gold":false},{"letter":"I","text":"提前结束同期化疗，仅继续完成剩余放射治疗。","is_gold":false},{"letter":"J","text":"暂停放化疗，给予保肝降酶药物静脉滴注。","is_gold":false},{"letter":"K","text":"继续按计划行放化综合治疗，并预防性给予白介素-11（IL-11）治疗。","is_gold":false},{"letter":"L","text":"继续按计划行放化综合治疗，并加用大剂量静脉糖皮质激素治疗。","is_gold":false}],"gold_letter":"A"}]}
+{"patient_id":"patient-36d433557e63f939b878347d","bootstrap_cluster_id":"cluster-007","turns":[{"sample_id":"sample-46fc2f7bd9dd0872ef1b356e","patient_id":"patient-36d433557e63f939b878347d","turn_id":"turn02","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、海绵窦、翼突基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1078] 入院记录: 主诉: 外院可疑鼻咽癌；现病史: 简要入院病史:患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n- [全程D1081] 入院记录: 主诉: 回吸性涕血3月余；现病史: 患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：70次/分，R：14次/分，BP：126/71mmHg,Ht：155cm，Wt：48kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左颈Ⅱ区触及肿大淋巴结，约2×1.5cm，无融合，质地硬，边界尚清，活动度中等，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- [全程D1078] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 Ⅱ、Ⅲ、aVF、V4～V6导联ST段下移\n- [全程D1078] 检验组合: 镁离子(Mg2+)-静脉血: 0.96mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.6；Rh血型-静脉血: 阳性；直接胆红素(DBIL)-静脉血: 2umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.61COI；白蛋白(ALB)-静脉血: 45.5g/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 0.085COI；γ-谷氨酰基转移酶(GGT)-静脉血: 13.6U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.2fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；葡萄糖(Glu)-静脉血: 4.67mmol/L；总胆红素(TBIL)-静脉血: 8.3umol/L；单核细胞百分比(Mono%)-静脉血: 0.074；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.5U/L；红细胞比容(Hct)-静脉血: 41%；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 1.56COI；单核细胞计数(Mono#)-静脉血: 0.310E9/L；中性粒细胞计数(Neut#)-静脉血: 2.510E9/L；胱抑素(Cys-C)-静脉血: 0.84mg/L；碱性磷酸酶(ALP)-静脉血: 80.5U/L；钠离子(Na+)-静脉血: 143.8mmol/L；乳酸脱氢酶(LDH)-静脉血: 194.4U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；平均红细胞血红蛋白浓度(MCHC)-静脉血: 324g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21.7U/L；氯离子(Cl-)-静脉血: 105.2mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.74；平均红细胞体积(MCV)-静脉血: 92.8fL；C-反应蛋白(CRP)-静脉血: 1.78mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.4；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: >1000IU/L；总胆固醇(TC)-静脉血: 5.98mmol/L；血红蛋白(Hb)-静脉血: 133g/L；大血小板百分比(P-LCR%)-静脉血: 26.1%；间接胆红素(I……\n- [全程D1079] 检验组合: 梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:160（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）\n- [全程D1081] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 多个颈腰椎、双侧膝关节可见片状放射性浓集灶。余颅骨、胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 考虑多个颈腰椎、双侧膝关节骨质退行性变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行鼻咽镜下肿物活检；影像学评估为 cT3N2M0\nB. 行鼻咽镜下肿物活检；影像学评估为 cT4N1M0\nC. 行颈部淋巴结穿刺活检；影像学评估为 cT4N2M0\nD. 完善血浆EBV-DNA检测；影像学评估为 cT4N2M0\nE. 行鼻咽镜下肿物活检；影像学评估为 cT4N2M0\nF. 安排诱导化疗联合根治性放疗；影像学评估为 cT4N2M0\nG. 行鼻咽镜下肿物活检；影像学评估为 cT4N3M0\nH. 行鼻咽镜下肿物活检；影像学评估为 cT3N1M0\nI. 行全身PET-CT检查；影像学评估为 cT4N2M0\nJ. 行鼻咽镜下肿物活检；影像学评估为 cT2N2M0\nK. 行鼻咽镜下肿物活检；影像学评估为 cT4N0M0\nL. 行鼻咽镜下肿物活检；影像学评估为 cT1N2M0\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"行鼻咽镜下肿物活检；影像学评估为 cT3N2M0","is_gold":false},{"letter":"B","text":"行鼻咽镜下肿物活检；影像学评估为 cT4N1M0","is_gold":false},{"letter":"C","text":"行颈部淋巴结穿刺活检；影像学评估为 cT4N2M0","is_gold":false},{"letter":"D","text":"完善血浆EBV-DNA检测；影像学评估为 cT4N2M0","is_gold":false},{"letter":"E","text":"行鼻咽镜下肿物活检；影像学评估为 cT4N2M0","is_gold":true},{"letter":"F","text":"安排诱导化疗联合根治性放疗；影像学评估为 cT4N2M0","is_gold":false},{"letter":"G","text":"行鼻咽镜下肿物活检；影像学评估为 cT4N3M0","is_gold":false},{"letter":"H","text":"行鼻咽镜下肿物活检；影像学评估为 cT3N1M0","is_gold":false},{"letter":"I","text":"行全身PET-CT检查；影像学评估为 cT4N2M0","is_gold":false},{"letter":"J","text":"行鼻咽镜下肿物活检；影像学评估为 cT2N2M0","is_gold":false},{"letter":"K","text":"行鼻咽镜下肿物活检；影像学评估为 cT4N0M0","is_gold":false},{"letter":"L","text":"行鼻咽镜下肿物活检；影像学评估为 cT1N2M0","is_gold":false}],"gold_letter":"E"},{"sample_id":"sample-7c52866e0776802e0c94516f","patient_id":"patient-36d433557e63f939b878347d","turn_id":"turn04","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、海绵窦、翼突基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1078] 入院记录: 主诉: 外院可疑鼻咽癌；现病史: 简要入院病史:患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。某次就诊时间再次出现回吸性涕血，遂行鼻咽镜检查，活检示：鼻咽炎性渗出。行鼻咽部CT示：鼻咽左侧可见软组织占位。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- [全程D1078] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 Ⅱ、Ⅲ、aVF、V4～V6导联ST段下移\n- [全程D1078] 检验组合: 镁离子(Mg2+)-静脉血: 0.96mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.6；Rh血型-静脉血: 阳性；直接胆红素(DBIL)-静脉血: 2umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.61COI；白蛋白(ALB)-静脉血: 45.5g/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 0.085COI；γ-谷氨酰基转移酶(GGT)-静脉血: 13.6U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.2fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；葡萄糖(Glu)-静脉血: 4.67mmol/L；总胆红素(TBIL)-静脉血: 8.3umol/L；单核细胞百分比(Mono%)-静脉血: 0.074；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.5U/L；红细胞比容(Hct)-静脉血: 41%；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 1.56COI；单核细胞计数(Mono#)-静脉血: 0.310E9/L；中性粒细胞计数(Neut#)-静脉血: 2.510E9/L；胱抑素(Cys-C)-静脉血: 0.84mg/L；碱性磷酸酶(ALP)-静脉血: 80.5U/L；钠离子(Na+)-静脉血: 143.8mmol/L；乳酸脱氢酶(LDH)-静脉血: 194.4U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；平均红细胞血红蛋白浓度(MCHC)-静脉血: 324g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21.7U/L；氯离子(Cl-)-静脉血: 105.2mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.74；平均红细胞体积(MCV)-静脉血: 92.8fL；C-反应蛋白(CRP)-静脉血: 1.78mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.4；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: >1000IU/L；总胆固醇(TC)-静脉血: 5.98mmol/L；血红蛋白(Hb)-静脉血: 133g/L；大血小板百分比(P-LCR%)-静脉血: 26.1%；间接胆红素(I……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂缓影像学分期检查，直接启动根治性同步放化疗\nB. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行单纯根治性放疗\nC. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行诱导化疗序贯单纯根治性放疗\nD. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行根治性手术切除序贯术后放疗\nE. 完善头颈部增强CT及全身分期检查，若评估为局部晚期，行诱导化疗序贯同步放化疗\nF. 完善头颈部MRI及全身分期检查，若评估为早期（I期），行诱导化疗序贯同步放化疗\nG. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行诱导化疗序贯同步放化疗\nH. 完善头颈部MRI及全身分期检查，无论分期结果，均行诱导化疗序贯同步放化疗\nI. 仅行全身PET-CT替代所有常规分期检查，若评估为局部晚期，行诱导化疗序贯同步放化疗\nJ. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行抗EGFR单抗靶向治疗替代放疗\nK. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行PD-1抑制剂单药根治性治疗\nL. 完善头颈部MRI及全身分期检查，若评估为局部晚期，行姑息性化疗联合最佳支持治疗\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"暂缓影像学分期检查，直接启动根治性同步放化疗","is_gold":false},{"letter":"B","text":"完善头颈部MRI及全身分期检查，若评估为局部晚期，行单纯根治性放疗","is_gold":false},{"letter":"C","text":"完善头颈部MRI及全身分期检查，若评估为局部晚期，行诱导化疗序贯单纯根治性放疗","is_gold":false},{"letter":"D","text":"完善头颈部MRI及全身分期检查，若评估为局部晚期，行根治性手术切除序贯术后放疗","is_gold":false},{"letter":"E","text":"完善头颈部增强CT及全身分期检查，若评估为局部晚期，行诱导化疗序贯同步放化疗","is_gold":false},{"letter":"F","text":"完善头颈部MRI及全身分期检查，若评估为早期（I期），行诱导化疗序贯同步放化疗","is_gold":false},{"letter":"G","text":"完善头颈部MRI及全身分期检查，若评估为局部晚期，行诱导化疗序贯同步放化疗","is_gold":true},{"letter":"H","text":"完善头颈部MRI及全身分期检查，无论分期结果，均行诱导化疗序贯同步放化疗","is_gold":false},{"letter":"I","text":"仅行全身PET-CT替代所有常规分期检查，若评估为局部晚期，行诱导化疗序贯同步放化疗","is_gold":false},{"letter":"J","text":"完善头颈部MRI及全身分期检查，若评估为局部晚期，行抗EGFR单抗靶向治疗替代放疗","is_gold":false},{"letter":"K","text":"完善头颈部MRI及全身分期检查，若评估为局部晚期，行PD-1抑制剂单药根治性治疗","is_gold":false},{"letter":"L","text":"完善头颈部MRI及全身分期检查，若评估为局部晚期，行姑息性化疗联合最佳支持治疗","is_gold":false}],"gold_letter":"G"},{"sample_id":"sample-ce21ad4c82d0349356f5fbb9","patient_id":"patient-36d433557e63f939b878347d","turn_id":"turn05","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、海绵窦、翼突基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1078] 入院记录: 主诉: 外院可疑鼻咽癌；现病史: 简要入院病史:患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。某次就诊时间再次出现回吸性涕血，遂行鼻咽镜检查，活检示：鼻咽炎性渗出。行鼻咽部CT示：鼻咽左侧可见软组织占位。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n- [全程D1081] 入院记录: 主诉: 回吸性涕血3月余；现病史: 患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。某次就诊时间再次出现回吸性涕血，遂行鼻咽镜检查，活检示：鼻咽炎性渗出。行鼻咽部CT示：鼻咽左侧可见软组织占位。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.5℃，P：70次/分，R：14次/分，BP：126/71mmHg,Ht：155cm，Wt：48kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率70次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽双侧顶后壁结节状肿物；左颈Ⅱ区触及肿大淋巴结，约2×1.5cm，无融合，质地硬，边界尚清，活动度中等，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- [全程D1078] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 Ⅱ、Ⅲ、aVF、V4～V6导联ST段下移\n- [全程D1078] 检验组合: 镁离子(Mg2+)-静脉血: 0.96mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.6；Rh血型-静脉血: 阳性；直接胆红素(DBIL)-静脉血: 2umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.61COI；白蛋白(ALB)-静脉血: 45.5g/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 0.085COI；γ-谷氨酰基转移酶(GGT)-静脉血: 13.6U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.2fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；葡萄糖(Glu)-静脉血: 4.67mmol/L；总胆红素(TBIL)-静脉血: 8.3umol/L；单核细胞百分比(Mono%)-静脉血: 0.074；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.5U/L；红细胞比容(Hct)-静脉血: 41%；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 1.56COI；单核细胞计数(Mono#)-静脉血: 0.310E9/L；中性粒细胞计数(Neut#)-静脉血: 2.510E9/L；胱抑素(Cys-C)-静脉血: 0.84mg/L；碱性磷酸酶(ALP)-静脉血: 80.5U/L；钠离子(Na+)-静脉血: 143.8mmol/L；乳酸脱氢酶(LDH)-静脉血: 194.4U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；平均红细胞血红蛋白浓度(MCHC)-静脉血: 324g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21.7U/L；氯离子(Cl-)-静脉血: 105.2mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.74；平均红细胞体积(MCV)-静脉血: 92.8fL；C-反应蛋白(CRP)-静脉血: 1.78mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.4；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: >1000IU/L；总胆固醇(TC)-静脉血: 5.98mmol/L；血红蛋白(Hb)-静脉血: 133g/L；大血小板百分比(P-LCR%)-静脉血: 26.1%；间接胆红素(I……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1081] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 多个颈腰椎、双侧膝关节可见片状放射性浓集灶。余颅骨、胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 考虑多个颈腰椎、双侧膝关节骨质退行性变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1092] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.006；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；颜色-尿液: 无色；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮\n- [全程D1094] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 28/μL；比重(SG)-尿液: 1.025；葡萄糖(Glu)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 36/μL；白细胞计数(WBC#)-尿液: 5/μL；酸碱度(pH)-尿液: 6.5；颜色-尿液: Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D1095] 检验组合: 白蛋白(ALB)-静脉血: 40.5g/L；镁离子(Mg2+)-静脉血: 0.84mmol/L；碱性磷酸酶(ALP)-静脉血: 63.2U/L；载脂蛋白B(apoB)-静脉血: 0.8g/L；葡萄糖(Glu)-静脉血: 5.31mmol/L；血小板比容-静脉血: 19%；直接胆红素(DBIL)-静脉血: 2.3umol/L；载脂蛋白AI(apoAI)-静脉血: 1.4g/L；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；总胆固醇(TC)-静脉血: 5.3mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.69mmolL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 325g/L；红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.9pg；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；γ-谷氨酰基转移酶(GGT)-静脉血: 16.8U/L；间接胆红素(IBIL)-静脉血: 5.6umolL；红细胞比容(Hct)-静脉血: 37.2%；钠离子(Na+)-静脉血: 141.6mmol/L；尿酸(UA)-静脉血: 219.2umol/L；总钙(Ca)-静脉血: 2.16mmol/L；尿素氮(BUN)-静脉血: 4.72mmol/L；平均红细胞体积(MCV)-静脉血: 91.9fL；球蛋白(GLO)-静脉血: 22.71g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.1；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14；乳酸脱氢酶(LDH)-静脉血: 179.4U/L；总胆红素(TBIL)-静脉血: 7.9umol/L；阴离子间隙(AG)-静脉血: 12；中性粒细胞百分比(Neut%)-静脉血: 0.814；血红蛋白(Hb)-静脉血: 121g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.1；丙氨酸氨基转移酶(ALT)-静脉血: 55.1U/L；白细胞计数(WBC#)-静脉血: 6.1210E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 36.2U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.58mmol/L；胱抑素(Cys-C)-静脉血: 0.95mg/L；大血小板……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1082] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者目前诊断明确，[计划性表述已隐藏]根治性放疗及同期化疗。向患者及其家属交代病情，治疗方案及治疗风险，做好治疗前准备工作。\n- [全程D1083] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者入院第三天，无明显不适主诉，查体情况：一般情况可，余同入院。预约放疗。\n- [全程D1088] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 今日查房，患者无明显不适主诉，生命体征平稳。已予预约放疗。候治疗。\n- [全程D1093] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 今日查房，患者无明显不适主诉，生命体征平稳。查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常。患者现放疗计划已设计完成并通过全科会诊，靶区剂量分布均匀，正常组织剂量在可接受范围内。[姓名已隐去]医生信息已隐藏示：患者无明显放化疗禁忌症，拟于今日开始行根治性放疗+同时期化疗。向患者及其家属交代病情及化疗风险，表示理解并已签署知情同意书，可于今日执行第1程顺铂方案同时期化疗，注意化疗不良反应。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停同期化疗，给予静脉保肝药物治疗，待转氨酶降至正常后再启动顺铂化疗\nB. 按原计划执行顺铂同期化疗，暂不予特殊保肝处理，常规监测肝功能\nC. 给予口服保肝药物，将顺铂剂量下调20%后执行同期化疗\nD. 给予静脉双重保肝药物，按原计划执行顺铂同期化疗，并动态复查肝功能\nE. 停用顺铂，更改为卡铂方案执行同期化疗，并给予口服保肝药物\nF. 给予口服保肝药物，推迟顺铂化疗1周，期间正常进行放疗\nG. 停用顺铂，更改为西妥昔单抗靶向治疗联合放疗，并给予口服保肝药物\nH. 给予口服保肝药物（如复方甘草酸苷、葡醛内酯），按原计划执行顺铂同期化疗，并动态复查肝功能\nI. 暂停放化疗，行腹部增强CT排查肝脏转移，并给予静脉保肝治疗\nJ. 给予口服保肝药物，按原计划执行顺铂同期化疗，并预防性使用重组人粒细胞刺激因子\nK. 给予口服保肝药物，按原计划执行顺铂同期化疗，并预防性使用广谱抗生素\nL. 给予口服保肝药物，将顺铂方案更改为奈达铂方案执行同期化疗\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"暂停同期化疗，给予静脉保肝药物治疗，待转氨酶降至正常后再启动顺铂化疗","is_gold":false},{"letter":"B","text":"按原计划执行顺铂同期化疗，暂不予特殊保肝处理，常规监测肝功能","is_gold":false},{"letter":"C","text":"给予口服保肝药物，将顺铂剂量下调20%后执行同期化疗","is_gold":false},{"letter":"D","text":"给予静脉双重保肝药物，按原计划执行顺铂同期化疗，并动态复查肝功能","is_gold":false},{"letter":"E","text":"停用顺铂，更改为卡铂方案执行同期化疗，并给予口服保肝药物","is_gold":false},{"letter":"F","text":"给予口服保肝药物，推迟顺铂化疗1周，期间正常进行放疗","is_gold":false},{"letter":"G","text":"停用顺铂，更改为西妥昔单抗靶向治疗联合放疗，并给予口服保肝药物","is_gold":false},{"letter":"H","text":"给予口服保肝药物（如复方甘草酸苷、葡醛内酯），按原计划执行顺铂同期化疗，并动态复查肝功能","is_gold":true},{"letter":"I","text":"暂停放化疗，行腹部增强CT排查肝脏转移，并给予静脉保肝治疗","is_gold":false},{"letter":"J","text":"给予口服保肝药物，按原计划执行顺铂同期化疗，并预防性使用重组人粒细胞刺激因子","is_gold":false},{"letter":"K","text":"给予口服保肝药物，按原计划执行顺铂同期化疗，并预防性使用广谱抗生素","is_gold":false},{"letter":"L","text":"给予口服保肝药物，将顺铂方案更改为奈达铂方案执行同期化疗","is_gold":false}],"gold_letter":"H"},{"sample_id":"sample-c47048c6a3961cfb24a6bb12","patient_id":"patient-36d433557e63f939b878347d","turn_id":"turn06","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、海绵窦、翼突基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1078] 入院记录: 主诉: 外院可疑鼻咽癌；现病史: 简要入院病史:患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。某次就诊时间再次出现回吸性涕血，遂行鼻咽镜检查，活检示：鼻咽炎性渗出。行鼻咽部CT示：鼻咽左侧可见软组织占位。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- [全程D1078] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 Ⅱ、Ⅲ、aVF、V4～V6导联ST段下移\n- [全程D1078] 检验组合: 镁离子(Mg2+)-静脉血: 0.96mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.6；Rh血型-静脉血: 阳性；直接胆红素(DBIL)-静脉血: 2umol/L；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 0.61COI；白蛋白(ALB)-静脉血: 45.5g/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 0.085COI；γ-谷氨酰基转移酶(GGT)-静脉血: 13.6U/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均血小板体积(MPV)-静脉血: 10.2fL；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；葡萄糖(Glu)-静脉血: 4.67mmol/L；总胆红素(TBIL)-静脉血: 8.3umol/L；单核细胞百分比(Mono%)-静脉血: 0.074；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 19.5U/L；红细胞比容(Hct)-静脉血: 41%；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 1.56COI；单核细胞计数(Mono#)-静脉血: 0.310E9/L；中性粒细胞计数(Neut#)-静脉血: 2.510E9/L；胱抑素(Cys-C)-静脉血: 0.84mg/L；碱性磷酸酶(ALP)-静脉血: 80.5U/L；钠离子(Na+)-静脉血: 143.8mmol/L；乳酸脱氢酶(LDH)-静脉血: 194.4U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；平均红细胞血红蛋白浓度(MCHC)-静脉血: 324g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21.7U/L；氯离子(Cl-)-静脉血: 105.2mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.74；平均红细胞体积(MCV)-静脉血: 92.8fL；C-反应蛋白(CRP)-静脉血: 1.78mg/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.4；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: >1000IU/L；总胆固醇(TC)-静脉血: 5.98mmol/L；血红蛋白(Hb)-静脉血: 133g/L；大血小板百分比(P-LCR%)-静脉血: 26.1%；间接胆红素(I……\n- [全程D1081] 核医学；全身骨显像: 检查类型: 核医学；检查名称: 全身骨显像；检查部位:；检查所见: 如片所示：图像清晰，对比度佳。 多个颈腰椎、双侧膝关节可见片状放射性浓集灶。余颅骨、胸骨、锁骨、肩胛骨、肋骨、胸椎、骶尾骨、髋骨及上下肢骨骼放射性分布未见明显异常。；检查结论: 考虑多个颈腰椎、双侧膝关节骨质退行性变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1092] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.006；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；颜色-尿液: 无色；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮\n- [全程D1094] 检验组合: 总蛋白(TP)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 28/μL；比重(SG)-尿液: 1.025；葡萄糖(Glu)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 36/μL；白细胞计数(WBC#)-尿液: 5/μL；酸碱度(pH)-尿液: 6.5；颜色-尿液: Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）\n- [全程D1095] 检验组合: 白蛋白(ALB)-静脉血: 40.5g/L；镁离子(Mg2+)-静脉血: 0.84mmol/L；碱性磷酸酶(ALP)-静脉血: 63.2U/L；载脂蛋白B(apoB)-静脉血: 0.8g/L；葡萄糖(Glu)-静脉血: 5.31mmol/L；血小板比容-静脉血: 19%；直接胆红素(DBIL)-静脉血: 2.3umol/L；载脂蛋白AI(apoAI)-静脉血: 1.4g/L；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；总胆固醇(TC)-静脉血: 5.3mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.69mmolL；平均红细胞血红蛋白浓度(MCHC)-静脉血: 325g/L；红细胞计数(RBC#)-静脉血: 4.0510E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.9pg；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；γ-谷氨酰基转移酶(GGT)-静脉血: 16.8U/L；间接胆红素(IBIL)-静脉血: 5.6umolL；红细胞比容(Hct)-静脉血: 37.2%；钠离子(Na+)-静脉血: 141.6mmol/L；尿酸(UA)-静脉血: 219.2umol/L；总钙(Ca)-静脉血: 2.16mmol/L；尿素氮(BUN)-静脉血: 4.72mmol/L；平均红细胞体积(MCV)-静脉血: 91.9fL；球蛋白(GLO)-静脉血: 22.71g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 47.1；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14；乳酸脱氢酶(LDH)-静脉血: 179.4U/L；总胆红素(TBIL)-静脉血: 7.9umol/L；阴离子间隙(AG)-静脉血: 12；中性粒细胞百分比(Neut%)-静脉血: 0.814；血红蛋白(Hb)-静脉血: 121g/L；淋巴细胞百分比(Lymph%)-静脉血: 0.1；丙氨酸氨基转移酶(ALT)-静脉血: 55.1U/L；白细胞计数(WBC#)-静脉血: 6.1210E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 36.2U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 2.58mmol/L；胱抑素(Cys-C)-静脉血: 0.95mg/L；大血小板……\n- [全程D1102] 检验组合: 尿酸(UA)-静脉血: 238.2umol/L；总胆红素(TBIL)-静脉血: 6.2umol/L；白细胞计数(WBC#)-静脉血: 3.5310E9/L；间接胆红素(IBIL)-静脉血: 4.8umolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.3；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.02；阴离子间隙(AG)-静脉血: 15.1；磷(P)-静脉血: 1.08mmol/L；钠离子(Na+)-静脉血: 137.5mmol/L；总钙(Ca)-静脉血: 2.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 26.7U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.8；直接胆红素(DBIL)-静脉血: 1.4umol/L；球蛋白(GLO)-静脉血: 27.56g/L；载脂蛋白AI(apoAI)-静脉血: 1.46g/L；红细胞计数(RBC#)-静脉血: 4.6610E12/L；载脂蛋白B(apoB)-静脉血: 1.09g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；血红蛋白(Hb)-静脉血: 142g/L；葡萄糖(Glu)-静脉血: 5.62mmol/L；甘油三酯(TG)-静脉血: 0.98mmol/L；镁离子(Mg2+)-静脉血: 0.97mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；血小板分布宽度(PDW)-静脉血: 9.2%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；总胆固醇(TC)-静脉血: 5.85mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.006；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336g/L；平均血小板体积(MPV)-静脉血: 9fL；血小板计数(PLT#)-静脉血: 19010E9/L；血小板比容-静脉血: 17%；红细胞比容(Hct)-静脉血: 42.3%；总胆汁酸(TBA)-静脉血: 1.8umol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.76mmolL；胱抑素(Cys-C)-静脉血: 0.89mg/L；肌酐(Crea)-静脉血: 54.9umol/L；白蛋白(ALB)-静脉血: 46.6g/L；氯离子(Cl-)-静脉血: 97.8mmol/L；钾离子(K+)-静脉血: 3.78mmol/……\n\n【既往治疗与反应】\n- [全程D1082] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者入院第二天，无明显不适主诉，查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：患者目前诊断明确，[计划性表述已隐藏]根治性放疗及同期化疗。向患者及其家属交代病情，治疗方案及治疗风险，做好治疗前准备工作。\n- [全程D1083] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者入院第三天，无明显不适主诉，查体情况：一般情况可，余同入院。预约放疗。\n- [全程D1088] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 今日查房，患者无明显不适主诉，生命体征平稳。已予预约放疗。候治疗。\n- [全程D1093] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 今日查房，患者无明显不适主诉，生命体征平稳。查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常。患者现放疗计划已设计完成并通过全科会诊，靶区剂量分布均匀，正常组织剂量在可接受范围内。[姓名已隐去]医生信息已隐藏示：患者无明显放化疗禁忌症，拟于今日开始行根治性放疗+同时期化疗。向患者及其家属交代病情及化疗风险，表示理解并已签署知情同意书，可于今日执行第1程顺铂方案同时期化疗，注意化疗不良反应。\n- [全程D1098] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中，第1程顺铂方案同时期化疗结束。今日查房，患者诉呕吐2次，咽痛、恶心、食欲下降，伴头晕，无腹痛、腹泻等不适。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放化疗，给予重组人粒细胞集落刺激因子治疗，待白细胞恢复后继续\nB. 暂停同期化疗，仅继续根治性放疗，并给予重组人粒细胞集落刺激因子\nC. 继续根治性放疗及同期化疗，下一疗程顺铂剂量减量20%\nD. 继续根治性放疗及同期化疗，加用重组人粒细胞集落刺激因子\nE. 暂停放化疗，给予静脉高营养及强效止吐、补液支持，暂缓抗肿瘤治疗\nF. 继续根治性放疗及同期化疗，加用重组人血小板生成素\nG. 暂停同期化疗，将后续全身治疗更换为尼妥珠单抗靶向治疗\nH. 继续根治性放疗及同期化疗，加用促红细胞生成素及铁剂\nI. 继续根治性放疗及同期化疗，暂不予集落刺激因子支持，密切监测血常规\nJ. 暂停放化疗，行骨髓穿刺评估造血功能后再决定后续治疗\nK. 继续根治性放疗，终止同期化疗，放疗结束后改为辅助化疗\nL. 继续根治性放疗及同期化疗，降低放疗靶区处方剂量\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"暂停放化疗，给予重组人粒细胞集落刺激因子治疗，待白细胞恢复后继续","is_gold":false},{"letter":"B","text":"暂停同期化疗，仅继续根治性放疗，并给予重组人粒细胞集落刺激因子","is_gold":false},{"letter":"C","text":"继续根治性放疗及同期化疗，下一疗程顺铂剂量减量20%","is_gold":false},{"letter":"D","text":"继续根治性放疗及同期化疗，加用重组人粒细胞集落刺激因子","is_gold":false},{"letter":"E","text":"暂停放化疗，给予静脉高营养及强效止吐、补液支持，暂缓抗肿瘤治疗","is_gold":false},{"letter":"F","text":"继续根治性放疗及同期化疗，加用重组人血小板生成素","is_gold":false},{"letter":"G","text":"暂停同期化疗，将后续全身治疗更换为尼妥珠单抗靶向治疗","is_gold":false},{"letter":"H","text":"继续根治性放疗及同期化疗，加用促红细胞生成素及铁剂","is_gold":false},{"letter":"I","text":"继续根治性放疗及同期化疗，暂不予集落刺激因子支持，密切监测血常规","is_gold":true},{"letter":"J","text":"暂停放化疗，行骨髓穿刺评估造血功能后再决定后续治疗","is_gold":false},{"letter":"K","text":"继续根治性放疗，终止同期化疗，放疗结束后改为辅助化疗","is_gold":false},{"letter":"L","text":"继续根治性放疗及同期化疗，降低放疗靶区处方剂量","is_gold":false}],"gold_letter":"I"},{"sample_id":"sample-28a13cf2b32abdc303bbad45","patient_id":"patient-36d433557e63f939b878347d","turn_id":"turn07","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、海绵窦、翼突基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1078] 入院记录: 主诉: 外院可疑鼻咽癌；现病史: 简要入院病史:患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。某次就诊时间再次出现回吸性涕血，遂行鼻咽镜检查，活检示：鼻咽炎性渗出。行鼻咽部CT示：鼻咽左侧可见软组织占位。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- [全程D1078] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 Ⅱ、Ⅲ、aVF、V4～V6导联ST段下移\n- [全程D1109] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 28.2mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；钾离子(K+)-静脉血: 3.77mmol/L；甘油三酯(TG)-静脉血: 0.8mmol/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；红细胞计数(RBC#)-静脉血: 4.2410E12/L；总胆固醇(TC)-静脉血: 5.21mmol/L；镁离子(Mg2+)-静脉血: 0.97mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.6；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；总胆汁酸(TBA)-静脉血: 0.6umol/L；总胆红素(TBIL)-静脉血: 8.6umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.119；红细胞比容(Hct)-静脉血: 38.7%；尿素氮(BUN)-静脉血: 4.1mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；间接胆红素(IBIL)-静脉血: 6.5umolL；C-反应蛋白(CRP)-静脉血: 2.85mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.53mmolL；血小板分布宽度(PDW)-静脉血: 17.4%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.29mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；阴离子间隙(AG)-静脉血: 15；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；血小板计数(PLT#)-静脉血: 204.310E9/L；平均红细胞体积(MCV)-静脉血: 91.1fL；丙氨酸氨基转移酶(ALT)-静脉血: 12.3U/L；总蛋白(TP)-静脉血: 69.21g/L；直接胆红素(DBIL)-静脉血: 2.1umol/L；氯离子(Cl-)-静脉血: 95.7mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.784；中性粒细胞计数(Neut#)-静脉血: 2.310E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22.8U/L；平均血小板体积(MPV)-静脉血: 6.38fL；γ-谷氨酰基转移酶(GGT)-静脉血: 23.6U/L；总钙(Ca)-静脉血: 2.22mmol/L；单核……\n- [全程D1113] 检验组合: 血小板比容-静脉血: 15%；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 6.5；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.734；平均红细胞体积(MCV)-静脉血: 91.5fL；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；隐血(OB)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；中性粒细胞计数(Neut#)-静脉血: 2.310E9/L；总蛋白(TP)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 1/μL；红细胞计数(RBC#)-静脉血: 4.1310E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；血小板计数(PLT#)-静脉血: 16810E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；比重(SG)-尿液: 1.009；浊度(TRUB)-尿液: 清亮；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.05；大血小板百分比(P-LCR%)-静脉血: 18%；单核细胞计数(Mono#)-静脉血: 0.410E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.5；酮体(KET)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 13/μL；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-静脉血: 3.210E9/L；白细胞(LEU)-尿液: -（参考: 阴性）；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；红细胞比容(Hct)-静脉血: 37.8%；血红蛋白(Hb)-静脉血: 126g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.5；血小板分布宽度(PDW)-静脉血: 9.3%；淋巴细胞百分比(Lymph%)-静脉血: 0.103；平均红细胞血红蛋白浓度(MCHC)-静脉血: 333g/L；平均血小板体积(MPV)-静脉血: 8.9fL；单核细胞百分比(Mono%)-静脉血: 0.11\n- [全程D1114] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 16/μL；颜色-尿液: Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: +- 0.1g（参考: 阴性）；酮体(KET)-尿液: 1+ 1mmol（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 6.5；比重(SG)-尿液: 1.022；白细胞计数(WBC#)-尿液: 10/μL；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）\n- [全程D1116] 检验组合: 亚硝酸盐(NIT)-尿液: -（参考: 阴性）；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336.3g/L；阴离子间隙(AG)-静脉血: 12；总蛋白(TP)-尿液: -（参考: 阴性）；磷(P)-静脉血: 0.93mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20U/L；尿酸(UA)-静脉血: 199.4umol/L；平均红细胞体积(MCV)-静脉血: 92.9fL；碱性磷酸酶(ALP)-静脉血: 61.6U/L；酸碱度(pH)-尿液: 6.5；血小板分布宽度(PDW)-静脉血: 17%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.032；隐血(OB)-尿液: -（参考: 阴性）；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.44mmolL；肌酐(Crea)-静脉血: 67.5umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.2；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；氯离子(Cl-)-静脉血: 102.9mmol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；总胆红素(TBIL)-静脉血: 6.7umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14%；血小板计数(PLT#)-静脉血: 176.710E9/L；总蛋白(TP)-静脉血: 65.51g/L；尿素氮(BUN)-静脉血: 3.95mmol/L；红细胞计数(RBC#)-静脉血: 3.8510E12/L；甘油三酯(TG)-静脉血: 1.05mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；α-L-岩藻糖苷酶(AFU)-静脉血: 30U/L；间接胆红素(IBIL)-静脉血: 4.4umolL；总胆固醇(TC)-静脉血: 5.25mmol/L；浊度(TRUB)-尿液: 清亮；平均血小板体积(MPV)-静脉血: 6.6fL；胆红素(BIL)-尿液: -（参考: 阴性）；总胆汁酸(TBA)-静脉血: 0.2umol/L；载脂蛋白B(apoB)-静脉血: 0.98g/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；中性粒细胞计数(Neut#)-静脉血: 2.81……\n- [全程D1123] 检验组合: 红细胞计数(RBC#)-静脉血: 4.3710E12/L；中性粒细胞计数(Neut#)-静脉血: 310E9/L；平均红细胞体积(MCV)-静脉血: 90fL；甘油三酯(TG)-静脉血: 1.06mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.55；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.072；白蛋白(ALB)-静脉血: 44.8g/L；单核细胞百分比(Mono%)-静脉血: 0.081；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；红细胞比容(Hct)-静脉血: 39.4%；总钙(Ca)-静脉血: 2.44mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.8pg；血小板比容-静脉血: 10%；氯离子(Cl-)-静脉血: 92.5mmol/L；血小板计数(PLT#)-静脉血: 143.810E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.98mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4%；中性粒细胞百分比(Neut%)-静脉血: 0.841；总胆固醇(TC)-静脉血: 6.12mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 343.2g/L；间接胆红素(IBIL)-静脉血: 6.2umolL；尿素氮(BUN)-静脉血: 7.4mmol/L；平均血小板体积(MPV)-静脉血: 6.98fL；总胆红素(TBIL)-静脉血: 8.2umol/L；胱抑素(Cys-C)-静脉血: 0.86mg/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；载脂蛋白B(apoB)-静脉血: 1.37g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.9U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；C-反应蛋白(CRP)-静脉血: 10.49mg/L；球蛋白(GLO)-静脉血: 30.65g/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.46；葡萄糖(Glu)-静脉血: 5.64mmol/L；磷(P)-静脉血: 1.16mmol/L……\n- [全程D1125] 检验组合: 总钙(Ca)-静脉血: 2.38mmol/L；阴离子间隙(AG)-静脉血: 12.7；磷(P)-静脉血: 0.81mmol/L；氯离子(Cl-)-静脉血: 92.5mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 28.7mmol/L；钾离子(K+)-静脉血: 3.68mmol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；钠离子(Na+)-静脉血: 133.9mmol/L\n- [全程D1130] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对侧，双肺野纹理清晰，未见明显实质性病变。双侧肺门不大，纵隔不宽，心影形态、大小、位置未见异常。双膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见异常。\n- [全程D1130] 超声；肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。\n- [全程D1130] 检验组合: 有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞血红蛋白含量(MCH)-静脉血: 31.3pg；淋巴细胞百分比(Lymph%)-静脉血: 0.09；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4%；单核细胞计数(Mono#)-静脉血: 0.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.184；白蛋白(ALB)-静脉血: 43.5g/L；球蛋白(GLO)-静脉血: 29.66g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.32mmolL；总胆固醇(TC)-静脉血: 5.82mmol/L；葡萄糖(Glu)-静脉血: 5.74mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21U/L；中性粒细胞计数(Neut#)-静脉血: 1.510E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.9U/L；中性粒细胞百分比(Neut%)-静脉血: 0.715；尿酸(UA)-静脉血: 242.7umol/L；总胆汁酸(TBA)-静脉血: 0.2umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.005；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；血红蛋白(Hb)-静脉血: 125g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血小板分布宽度(PDW)-静脉血: 17.2%；总胆红素(TBIL)-静脉血: 6.6umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 28.4mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 344.5g/L；钾离子(K+)-静脉血: 3.7mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.8U/L；载脂蛋白B(apoB)-静脉血: 1.31g/L；红细胞计数(RBC#)-静脉血: 3.9910E12/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.4；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 90.9fL；总蛋白(TP)-静脉血: 73.16g/L；平均血小板体积(MPV)-静脉血: 6.84fL；血小板计数(PLT#)-静脉血: 181.410E9/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；低密度脂蛋白胆固醇(LDL-C)……\n\n【既往治疗与反应】\n- [全程D1108] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中。今日查房，患者无明显不适主诉，生命体征平稳。[姓名已隐去]医生信息已隐藏：继续治疗。\n- [全程D1113] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中。今日查房，患者无明显不适主诉，生命体征平稳。查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：可于今日水化，明日执行第2程DDP方案同时期化疗，注意化疗不良反应。\n- [全程D1118] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中，第2程顺铂方案同时期化疗结束。诉咽痛、恶心、食欲下降，呕吐1次，伴头晕，无腹痛、腹泻等不适。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D1123] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中。今日查房，患者无明显不适主诉，生命体征平稳。[姓名已隐去]医生信息已隐藏：患者治疗疗程过半，予预约治疗结束后影像学复查。继续治疗。\n- [全程D1129] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中。今日查房，患者无明显不适主诉，生命体征平稳。[姓名已隐去]医生信息已隐藏：嘱患者冲洗鼻咽，保持鼻咽清洁。继续治疗。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 评估临床症状完全缓解，提前终止放疗，办理出院并进入定期随访阶段，1个月后复查头颈部MRI。\nB. 评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，并口服替吉奥单药维持化疗。\nC. 评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，期间无需定期复查血液学指标。\nD. 评估肿瘤退缩缓慢，继续住院，将放疗方案调整为超分割放疗，并加用西妥昔单抗靶向治疗。\nE. 评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，期间暂停放疗2周以促进粘膜修复。\nF. 评估肿瘤部分缓解，继续住院完成根治性放疗，并每周行鼻咽部MRI以动态监测肿瘤退缩情况。\nG. 评估临床症状缓解且毒副反应可耐受，转外科行鼻咽及颈部残留病灶切除术，术后在门诊继续完成剩余放疗。\nH. 评估疑似疾病进展，停止放疗，改为吉西他滨联合顺铂方案全身姑息化疗并办理出院。\nI. 评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，每周复查血常规及生化，指导功能锻炼。\nJ. 评估临床症状缓解且毒副反应可耐受，继续住院完成剩余根治性放疗，期间常规给予静脉高营养支持及预防性抗感染。\nK. 评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，并立即安排全身PET-CT确认疗效。\n\n请仅输出一个选项字母（A-K）。","options":[{"letter":"A","text":"评估临床症状完全缓解，提前终止放疗，办理出院并进入定期随访阶段，1个月后复查头颈部MRI。","is_gold":false},{"letter":"B","text":"评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，并口服替吉奥单药维持化疗。","is_gold":false},{"letter":"C","text":"评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，期间无需定期复查血液学指标。","is_gold":false},{"letter":"D","text":"评估肿瘤退缩缓慢，继续住院，将放疗方案调整为超分割放疗，并加用西妥昔单抗靶向治疗。","is_gold":false},{"letter":"E","text":"评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，期间暂停放疗2周以促进粘膜修复。","is_gold":false},{"letter":"F","text":"评估肿瘤部分缓解，继续住院完成根治性放疗，并每周行鼻咽部MRI以动态监测肿瘤退缩情况。","is_gold":false},{"letter":"G","text":"评估临床症状缓解且毒副反应可耐受，转外科行鼻咽及颈部残留病灶切除术，术后在门诊继续完成剩余放疗。","is_gold":false},{"letter":"H","text":"评估疑似疾病进展，停止放疗，改为吉西他滨联合顺铂方案全身姑息化疗并办理出院。","is_gold":false},{"letter":"I","text":"评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，每周复查血常规及生化，指导功能锻炼。","is_gold":true},{"letter":"J","text":"评估临床症状缓解且毒副反应可耐受，继续住院完成剩余根治性放疗，期间常规给予静脉高营养支持及预防性抗感染。","is_gold":false},{"letter":"K","text":"评估临床症状缓解且毒副反应可耐受，办理出院，转门诊继续完成根治性放疗，并立即安排全身PET-CT确认疗效。","is_gold":false}],"gold_letter":"I"},{"sample_id":"sample-40b7a6f655350cf46e9ce33c","patient_id":"patient-36d433557e63f939b878347d","turn_id":"turn08","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、海绵窦、翼突基底部。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1078] 入院记录: 主诉: 外院可疑鼻咽癌；现病史: 简要入院病史:患者于某次就诊时间无明显诱因出现回吸性涕血，鲜红色，不伴头痛、头晕等不适。患者未行特殊处理。某次就诊时间再次出现回吸性涕血，量较前明显增多。遂至当地医院行喉镜检查，未发现明显异常。某次就诊时间再次出现回吸性涕血，遂行鼻咽镜检查，活检示：鼻咽炎性渗出。行鼻咽部CT示：鼻咽左侧可见软组织占位。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 涕血,鼻咽渗出；既往史: 患者于某次就诊时间行甲状腺肿物切除术。某次就诊时间行耳部手术。否认乙肝、结核等传染病史。否认心脏病、糖尿病、高血压等病史。否认外伤、输血史。；个人史:；家族史:；体格检查:；专科检查:；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- [全程D1078] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 Ⅱ、Ⅲ、aVF、V4～V6导联ST段下移\n- [全程D1109] 检验组合: 血液二氧化碳含量ctCO2(B)-静脉血: 28.2mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；钾离子(K+)-静脉血: 3.77mmol/L；甘油三酯(TG)-静脉血: 0.8mmol/L；单核细胞计数(Mono#)-静脉血: 0.210E9/L；红细胞计数(RBC#)-静脉血: 4.2410E12/L；总胆固醇(TC)-静脉血: 5.21mmol/L；镁离子(Mg2+)-静脉血: 0.97mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.6；载脂蛋白AI(apoAI)-静脉血: 1.35g/L；总胆汁酸(TBA)-静脉血: 0.6umol/L；总胆红素(TBIL)-静脉血: 8.6umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.119；红细胞比容(Hct)-静脉血: 38.7%；尿素氮(BUN)-静脉血: 4.1mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.002；间接胆红素(IBIL)-静脉血: 6.5umolL；C-反应蛋白(CRP)-静脉血: 2.85mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.53mmolL；血小板分布宽度(PDW)-静脉血: 17.4%；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.29mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.014；阴离子间隙(AG)-静脉血: 15；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；血小板计数(PLT#)-静脉血: 204.310E9/L；平均红细胞体积(MCV)-静脉血: 91.1fL；丙氨酸氨基转移酶(ALT)-静脉血: 12.3U/L；总蛋白(TP)-静脉血: 69.21g/L；直接胆红素(DBIL)-静脉血: 2.1umol/L；氯离子(Cl-)-静脉血: 95.7mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.784；中性粒细胞计数(Neut#)-静脉血: 2.310E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 22.8U/L；平均血小板体积(MPV)-静脉血: 6.38fL；γ-谷氨酰基转移酶(GGT)-静脉血: 23.6U/L；总钙(Ca)-静脉血: 2.22mmol/L；单核……\n- [全程D1113] 检验组合: 血小板比容-静脉血: 15%；颜色-尿液: Light-Yellow；酸碱度(pH)-尿液: 6.5；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.734；平均红细胞体积(MCV)-静脉血: 91.5fL；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；隐血(OB)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；中性粒细胞计数(Neut#)-静脉血: 2.310E9/L；总蛋白(TP)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 1/μL；红细胞计数(RBC#)-静脉血: 4.1310E12/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；血小板计数(PLT#)-静脉血: 16810E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；比重(SG)-尿液: 1.009；浊度(TRUB)-尿液: 清亮；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.05；大血小板百分比(P-LCR%)-静脉血: 18%；单核细胞计数(Mono#)-静脉血: 0.410E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.5；酮体(KET)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 13/μL；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-静脉血: 3.210E9/L；白细胞(LEU)-尿液: -（参考: 阴性）；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；红细胞比容(Hct)-静脉血: 37.8%；血红蛋白(Hb)-静脉血: 126g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.5；血小板分布宽度(PDW)-静脉血: 9.3%；淋巴细胞百分比(Lymph%)-静脉血: 0.103；平均红细胞血红蛋白浓度(MCHC)-静脉血: 333g/L；平均血小板体积(MPV)-静脉血: 8.9fL；单核细胞百分比(Mono%)-静脉血: 0.11\n- [全程D1114] 检验组合: 尿胆原(URO)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 16/μL；颜色-尿液: Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: +- 0.1g（参考: 阴性）；酮体(KET)-尿液: 1+ 1mmol（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 6.5；比重(SG)-尿液: 1.022；白细胞计数(WBC#)-尿液: 10/μL；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）\n- [全程D1116] 检验组合: 亚硝酸盐(NIT)-尿液: -（参考: 阴性）；平均红细胞血红蛋白浓度(MCHC)-静脉血: 336.3g/L；阴离子间隙(AG)-静脉血: 12；总蛋白(TP)-尿液: -（参考: 阴性）；磷(P)-静脉血: 0.93mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20U/L；尿酸(UA)-静脉血: 199.4umol/L；平均红细胞体积(MCV)-静脉血: 92.9fL；碱性磷酸酶(ALP)-静脉血: 61.6U/L；酸碱度(pH)-尿液: 6.5；血小板分布宽度(PDW)-静脉血: 17%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.032；隐血(OB)-尿液: -（参考: 阴性）；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.44mmolL；肌酐(Crea)-静脉血: 67.5umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.2；载脂蛋白AI(apoAI)-静脉血: 1.15g/L；氯离子(Cl-)-静脉血: 102.9mmol/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；总胆红素(TBIL)-静脉血: 6.7umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14%；血小板计数(PLT#)-静脉血: 176.710E9/L；总蛋白(TP)-静脉血: 65.51g/L；尿素氮(BUN)-静脉血: 3.95mmol/L；红细胞计数(RBC#)-静脉血: 3.8510E12/L；甘油三酯(TG)-静脉血: 1.05mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；α-L-岩藻糖苷酶(AFU)-静脉血: 30U/L；间接胆红素(IBIL)-静脉血: 4.4umolL；总胆固醇(TC)-静脉血: 5.25mmol/L；浊度(TRUB)-尿液: 清亮；平均血小板体积(MPV)-静脉血: 6.6fL；胆红素(BIL)-尿液: -（参考: 阴性）；总胆汁酸(TBA)-静脉血: 0.2umol/L；载脂蛋白B(apoB)-静脉血: 0.98g/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；中性粒细胞计数(Neut#)-静脉血: 2.81……\n- [全程D1123] 检验组合: 红细胞计数(RBC#)-静脉血: 4.3710E12/L；中性粒细胞计数(Neut#)-静脉血: 310E9/L；平均红细胞体积(MCV)-静脉血: 90fL；甘油三酯(TG)-静脉血: 1.06mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.55；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.072；白蛋白(ALB)-静脉血: 44.8g/L；单核细胞百分比(Mono%)-静脉血: 0.081；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；红细胞比容(Hct)-静脉血: 39.4%；总钙(Ca)-静脉血: 2.44mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.8pg；血小板比容-静脉血: 10%；氯离子(Cl-)-静脉血: 92.5mmol/L；血小板计数(PLT#)-静脉血: 143.810E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.98mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4%；中性粒细胞百分比(Neut%)-静脉血: 0.841；总胆固醇(TC)-静脉血: 6.12mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 343.2g/L；间接胆红素(IBIL)-静脉血: 6.2umolL；尿素氮(BUN)-静脉血: 7.4mmol/L；平均血小板体积(MPV)-静脉血: 6.98fL；总胆红素(TBIL)-静脉血: 8.2umol/L；胱抑素(Cys-C)-静脉血: 0.86mg/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；载脂蛋白B(apoB)-静脉血: 1.37g/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.9U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；C-反应蛋白(CRP)-静脉血: 10.49mg/L；球蛋白(GLO)-静脉血: 30.65g/L；单核细胞计数(Mono#)-静脉血: 0.310E9/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.46；葡萄糖(Glu)-静脉血: 5.64mmol/L；磷(P)-静脉血: 1.16mmol/L……\n- [全程D1125] 检验组合: 总钙(Ca)-静脉血: 2.38mmol/L；阴离子间隙(AG)-静脉血: 12.7；磷(P)-静脉血: 0.81mmol/L；氯离子(Cl-)-静脉血: 92.5mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 28.7mmol/L；钾离子(K+)-静脉血: 3.68mmol/L；镁离子(Mg2+)-静脉血: 0.88mmol/L；钠离子(Na+)-静脉血: 133.9mmol/L\n- [全程D1130] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对侧，双肺野纹理清晰，未见明显实质性病变。双侧肺门不大，纵隔不宽，心影形态、大小、位置未见异常。双膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见异常。\n- [全程D1130] 超声；肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。\n- [全程D1130] 检验组合: 有核红细胞百分比(NRBC%)-静脉血: 0；平均红细胞血红蛋白含量(MCH)-静脉血: 31.3pg；淋巴细胞百分比(Lymph%)-静脉血: 0.09；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4%；单核细胞计数(Mono#)-静脉血: 0.410E9/L；单核细胞百分比(Mono%)-静脉血: 0.184；白蛋白(ALB)-静脉血: 43.5g/L；球蛋白(GLO)-静脉血: 29.66g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.32mmolL；总胆固醇(TC)-静脉血: 5.82mmol/L；葡萄糖(Glu)-静脉血: 5.74mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 21U/L；中性粒细胞计数(Neut#)-静脉血: 1.510E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.9U/L；中性粒细胞百分比(Neut%)-静脉血: 0.715；尿酸(UA)-静脉血: 242.7umol/L；总胆汁酸(TBA)-静脉血: 0.2umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.005；淋巴细胞计数(Lymph#)-静脉血: 0.210E9/L；血红蛋白(Hb)-静脉血: 125g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；血小板分布宽度(PDW)-静脉血: 17.2%；总胆红素(TBIL)-静脉血: 6.6umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 28.4mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 344.5g/L；钾离子(K+)-静脉血: 3.7mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.8U/L；载脂蛋白B(apoB)-静脉血: 1.31g/L；红细胞计数(RBC#)-静脉血: 3.9910E12/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.4；有核红细胞计数(NRBC#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 90.9fL；总蛋白(TP)-静脉血: 73.16g/L；平均血小板体积(MPV)-静脉血: 6.84fL；血小板计数(PLT#)-静脉血: 181.410E9/L；镁离子(Mg2+)-静脉血: 0.86mmol/L；低密度脂蛋白胆固醇(LDL-C)……\n\n【既往治疗与反应】\n- [全程D1108] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中。今日查房，患者无明显不适主诉，生命体征平稳。[姓名已隐去]医生信息已隐藏：继续治疗。\n- [全程D1113] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中。今日查房，患者无明显不适主诉，生命体征平稳。查体情况：一般情况可，余同入院。血常规、生化常规复查基本正常，[姓名已隐去]医生信息已隐藏示：可于今日水化，明日执行第2程DDP方案同时期化疗，注意化疗不良反应。\n- [全程D1118] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中，第2程顺铂方案同时期化疗结束。诉咽痛、恶心、食欲下降，呕吐1次，伴头晕，无腹痛、腹泻等不适。复查血常规、肝肾功能大致正常。[姓名已隐去]医生信息已隐藏：患者化疗中，予以护胃、止呕、补液等对症支持治疗，嘱其加强营养及注意休息，注意维持水电解质酸碱平衡，继续治疗。\n- [全程D1123] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中。今日查房，患者无明显不适主诉，生命体征平稳。[姓名已隐去]医生信息已隐藏：患者治疗疗程过半，予预约治疗结束后影像学复查。继续治疗。\n- [全程D1129] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者根治性放疗中。今日查房，患者无明显不适主诉，生命体征平稳。[姓名已隐去]医生信息已隐藏：嘱患者冲洗鼻咽，保持鼻咽清洁。继续治疗。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即行鼻咽及颈部MRI复查，视近期疗效评估结果调整放疗靶区及剂量。\nB. 安排第3程顺铂同期化疗，并继续住院完成剩余根治性放疗疗程。\nC. 暂停放疗，行全身PET-CT检查以排除远处转移，待结果回报后决定后续方案。\nD. 办理出院，结束所有抗肿瘤治疗，进入定期随访阶段，1个月后复查MRI。\nE. 调整化疗方案为紫杉醇+顺铂，继续住院行第3程同期化疗及放疗。\nF. 立即行鼻咽镜检查及活检，视病理退缩情况调整后续放疗方案。\nG. 办理出院，转门诊继续放疗，并加用西妥昔单抗靶向治疗。\nH. 继续住院完成剩余放疗，期间每周复查血常规及生化，待放疗结束后出院。\nI. 办理出院，转门诊继续放疗，并立即启动顺铂+氟尿嘧啶方案辅助化疗。\nJ. 立即行胸部CT及腹部增强CT，视全面评估结果决定是否继续门诊放疗。\nK. 办理出院，转门诊继续完成根治性放疗，每周复查血常规及生化，指导鼻腔冲洗与功能锻炼。\nL. 暂停放疗，给予重组人粒细胞刺激因子及升血小板治疗，待血象完全恢复正常后继续放疗。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"立即行鼻咽及颈部MRI复查，视近期疗效评估结果调整放疗靶区及剂量。","is_gold":false},{"letter":"B","text":"安排第3程顺铂同期化疗，并继续住院完成剩余根治性放疗疗程。","is_gold":false},{"letter":"C","text":"暂停放疗，行全身PET-CT检查以排除远处转移，待结果回报后决定后续方案。","is_gold":false},{"letter":"D","text":"办理出院，结束所有抗肿瘤治疗，进入定期随访阶段，1个月后复查MRI。","is_gold":false},{"letter":"E","text":"调整化疗方案为紫杉醇+顺铂，继续住院行第3程同期化疗及放疗。","is_gold":false},{"letter":"F","text":"立即行鼻咽镜检查及活检，视病理退缩情况调整后续放疗方案。","is_gold":false},{"letter":"G","text":"办理出院，转门诊继续放疗，并加用西妥昔单抗靶向治疗。","is_gold":false},{"letter":"H","text":"继续住院完成剩余放疗，期间每周复查血常规及生化，待放疗结束后出院。","is_gold":false},{"letter":"I","text":"办理出院，转门诊继续放疗，并立即启动顺铂+氟尿嘧啶方案辅助化疗。","is_gold":false},{"letter":"J","text":"立即行胸部CT及腹部增强CT，视全面评估结果决定是否继续门诊放疗。","is_gold":false},{"letter":"K","text":"办理出院，转门诊继续完成根治性放疗，每周复查血常规及生化，指导鼻腔冲洗与功能锻炼。","is_gold":true},{"letter":"L","text":"暂停放疗，给予重组人粒细胞刺激因子及升血小板治疗，待血象完全恢复正常后继续放疗。","is_gold":false}],"gold_letter":"K"}]}
+{"patient_id":"patient-79fa00752e4405e2980f6292","bootstrap_cluster_id":"cluster-016","turns":[{"sample_id":"sample-295d4b99725721eb1811c149","patient_id":"patient-79fa00752e4405e2980f6292","turn_id":"turn01","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D24] 入院记录: 主诉: 涕血1年余，头痛3月；今为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 额部疼痛,涕血；既往史: 高血压10年余服药治疗中，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.9℃，P：72次/分，R：20次/分，BP：127/91mmHg,Ht：160cm，Wt：62.5kg，BSA：1.65m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽右侧顶后壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 鼻咽及颈部增强CT，胸部CT、腹部超声及全身骨扫描，以及包含EBV-DNA的基线血液学检查\nB. 鼻咽镜检查及活检，鼻咽及颈部增强CT，胸部CT、腹部超声及全身骨扫描，以及常规血液学检查\nC. 鼻咽镜检查及活检，鼻咽及颈部增强MRI，常规血液学检查，暂缓全身远处转移筛查\nD. 鼻咽及颈部增强MRI，全身PET-CT，包含EBV-DNA的基线血液学检查，直接安排诱导化疗\nE. 鼻咽镜检查及活检，鼻咽及颈部增强MRI，胸部X线、腹部超声，以及常规血液学检查\nF. 鼻咽及颈部增强MRI，颈部淋巴结穿刺活检，胸部CT、腹部超声及全身骨扫描，以及包含EBV-DNA的基线血液学检查\nG. 鼻咽镜检查及活检，鼻咽及颈部增强MRI，全身PET-CT，随后行鼻咽肿物切除术\nH. 鼻咽镜检查及活检，鼻咽及颈部平扫MRI，胸部CT、腹部超声及全身骨扫描，以及包含EBV-DNA的基线血液学检查\nI. 鼻咽镜检查及活检，鼻咽及颈部增强MRI，胸部CT、腹部超声及全身骨扫描，暂缓基线血液学及EBV-DNA检测\nJ. 鼻咽镜检查及活检，鼻咽及颈部增强CT，全身PET-CT，以及包含EBV-DNA的基线血液学检查\nK. 鼻咽及颈部增强MRI，胸部CT、腹部超声及全身骨扫描，包含EBV-DNA的基线血液学检查，随后行根治性放疗\nL. 鼻咽镜检查及活检，鼻咽及颈部增强MRI，胸部CT、腹部超声及全身骨扫描，以及包含EBV-DNA的基线血液学检查\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"鼻咽及颈部增强CT，胸部CT、腹部超声及全身骨扫描，以及包含EBV-DNA的基线血液学检查","is_gold":false},{"letter":"B","text":"鼻咽镜检查及活检，鼻咽及颈部增强CT，胸部CT、腹部超声及全身骨扫描，以及常规血液学检查","is_gold":false},{"letter":"C","text":"鼻咽镜检查及活检，鼻咽及颈部增强MRI，常规血液学检查，暂缓全身远处转移筛查","is_gold":false},{"letter":"D","text":"鼻咽及颈部增强MRI，全身PET-CT，包含EBV-DNA的基线血液学检查，直接安排诱导化疗","is_gold":false},{"letter":"E","text":"鼻咽镜检查及活检，鼻咽及颈部增强MRI，胸部X线、腹部超声，以及常规血液学检查","is_gold":false},{"letter":"F","text":"鼻咽及颈部增强MRI，颈部淋巴结穿刺活检，胸部CT、腹部超声及全身骨扫描，以及包含EBV-DNA的基线血液学检查","is_gold":false},{"letter":"G","text":"鼻咽镜检查及活检，鼻咽及颈部增强MRI，全身PET-CT，随后行鼻咽肿物切除术","is_gold":false},{"letter":"H","text":"鼻咽镜检查及活检，鼻咽及颈部平扫MRI，胸部CT、腹部超声及全身骨扫描，以及包含EBV-DNA的基线血液学检查","is_gold":false},{"letter":"I","text":"鼻咽镜检查及活检，鼻咽及颈部增强MRI，胸部CT、腹部超声及全身骨扫描，暂缓基线血液学及EBV-DNA检测","is_gold":false},{"letter":"J","text":"鼻咽镜检查及活检，鼻咽及颈部增强CT，全身PET-CT，以及包含EBV-DNA的基线血液学检查","is_gold":false},{"letter":"K","text":"鼻咽及颈部增强MRI，胸部CT、腹部超声及全身骨扫描，包含EBV-DNA的基线血液学检查，随后行根治性放疗","is_gold":false},{"letter":"L","text":"鼻咽镜检查及活检，鼻咽及颈部增强MRI，胸部CT、腹部超声及全身骨扫描，以及包含EBV-DNA的基线血液学检查","is_gold":true}],"gold_letter":"L"},{"sample_id":"sample-58cbc880ddd38089d56cda8c","patient_id":"patient-79fa00752e4405e2980f6292","turn_id":"turn02","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- 暂无可展示的初诊主诉/入院资料。\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 Ⅰ、Ⅱ、Ⅲ、aVF、V4～V6导联ST段下移\n- [全程D1] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；球蛋白(GLO)-静脉血: 30.03g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.9mmol/L；D-二聚体(D-Dimer)-静脉血: 0.13ug/ml；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；氯离子(Cl-)-静脉血: 98.1mmol/L；平均红细胞体积(MCV)-静脉血: 87.2fL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.91；大血小板百分比(P-LCR%)-静脉血: 33.4%；甘油三酯(TG)-静脉血: 1.01mmol/L；总钙(Ca)-静脉血: 2.28mmol/L；总胆固醇(TC)-静脉血: 5.44mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 25.2U/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 40.9umol/L；纤维蛋白原(Fbg)-静脉血: 2.51g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 20U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.34mmolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.58mmol/L；白细胞计数(WBC#)-静脉血: 6.9810E9/L；凝血酶时间(TT)-静脉血: 17.5sec.；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.013；红细胞计数(RBC#)-静脉血: 4.6710E12/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.98；直接胆红素(DBIL)-静脉血: 3.4umol/L；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 26.3mmol/L；磷(P)-静脉血: 1.03mmol/L；尿酸(UA)-静脉血: 391.1umol/L；碱性磷酸酶(ALP)-静脉血……\n- [全程D5] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽顶壁及右侧壁粘膜增厚放射性浓聚，SUV约7.3，病灶疑累及蝶骨基底部；右侧咽隐窝变浅；双侧咽后未见肿大淋巴结及异常放射性分布。双侧海绵窦结构及放射性分布未见明显异常。口咽及喉咽结构及放射性分布未见明显异常。额窦、蝶窦、筛窦及双侧上颌窦结构及放射性分布未见明显异常。甲状腺放射性分布未见异常。双上颈小淋巴结放射性分布未见明显异常。 所见双侧脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双侧肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔、双肺门及双侧腋窝未见肿大淋巴结及异常放射性分布。双乳腺结构及放射性分布未见明显异常。 肝S7点状高密度影放射性缺损，CT值约124Hu；其余肝脏形态、结构及放射性分布未见明显异常。肝门结构及放射性分布未见明显异常。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。脾脏、胰腺、双肾及肾上腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 子宫边缘弧形改变，见结节状稍高密度影放射性分布未见明显异常，大小约3.8×4.3cm；左附件囊性低密度影放射性稀疏，大小约2.2×2.3cm，CT值约22Hu。膀胱及肠管等形态、结构及放射性分布未见明显异常。双髂血管旁及双腹股沟未见肿大淋巴结及异常放射性分布。 所见颅骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽顶壁及右侧壁粘膜增厚代谢活跃，考虑鼻咽癌，疑累及蝶骨基底部。 肝S7肝内胆管结石。 子宫肌瘤。 左附件囊肿。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行鼻咽镜检查及局部活检，并完善鼻咽及颈部增强MRI\nB. 行鼻咽镜检查及局部活检，并完善鼻咽及颈部平扫CT\nC. 行鼻咽镜检查及局部活检，无需补充其他局部影像学检查\nD. 完善鼻咽及颈部增强MRI，并直接开始根治性放疗\nE. 行鼻咽镜检查及局部活检，并完善全身骨扫描及胸部平扫CT\nF. 行鼻咽镜检查及局部活检，并完善头颅增强MRI及颈部超声\nG. 完善鼻咽及颈部增强MRI，并择期行鼻咽部肿物切除术\nH. 行鼻咽镜检查及局部活检，并完善颈部淋巴结穿刺活检\nI. 行鼻咽镜检查及局部活检，并完善鼻咽及颈部增强CT\nJ. 完善鼻咽及颈部增强MRI，并完善外周血EBV-DNA定量检测\nK. 行鼻咽镜检查及局部活检，并完善盆腔增强MRI及妇科超声\nL. 行鼻咽镜检查及局部活检，并完善脑脊液脱落细胞学检查\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"行鼻咽镜检查及局部活检，并完善鼻咽及颈部增强MRI","is_gold":true},{"letter":"B","text":"行鼻咽镜检查及局部活检，并完善鼻咽及颈部平扫CT","is_gold":false},{"letter":"C","text":"行鼻咽镜检查及局部活检，无需补充其他局部影像学检查","is_gold":false},{"letter":"D","text":"完善鼻咽及颈部增强MRI，并直接开始根治性放疗","is_gold":false},{"letter":"E","text":"行鼻咽镜检查及局部活检，并完善全身骨扫描及胸部平扫CT","is_gold":false},{"letter":"F","text":"行鼻咽镜检查及局部活检，并完善头颅增强MRI及颈部超声","is_gold":false},{"letter":"G","text":"完善鼻咽及颈部增强MRI，并择期行鼻咽部肿物切除术","is_gold":false},{"letter":"H","text":"行鼻咽镜检查及局部活检，并完善颈部淋巴结穿刺活检","is_gold":false},{"letter":"I","text":"行鼻咽镜检查及局部活检，并完善鼻咽及颈部增强CT","is_gold":false},{"letter":"J","text":"完善鼻咽及颈部增强MRI，并完善外周血EBV-DNA定量检测","is_gold":false},{"letter":"K","text":"行鼻咽镜检查及局部活检，并完善盆腔增强MRI及妇科超声","is_gold":false},{"letter":"L","text":"行鼻咽镜检查及局部活检，并完善脑脊液脱落细胞学检查","is_gold":false}],"gold_letter":"A"},{"sample_id":"sample-75c75fa1e197461f4b0d7395","patient_id":"patient-79fa00752e4405e2980f6292","turn_id":"turn06","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D52] 入院记录: 主诉: 鼻咽癌一程化疗后两周余；现病史: 缘于1年前患者无明显诱因出现回吸性涕血，无头痛、鼻塞、耳鸣、复视、面麻等不适，未予重视，3个月前出现前额部疼痛，伴鼻衅，并于当地医院行鼻咽活检病理考虑鼻咽低分化型癌可能性大。于某次就诊时间10月底来我科就诊，并行根治性放疗计划设计，于某次就诊时间开始行根治性放疗，同时期予以DDP化疗1程，治疗过程顺利。今同期化疗到期来我科继续治疗，患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 额部疼痛,涕血；既往史: 高血压10年余服药治疗中，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.9℃，P：72次/分，R：20次/分，BP：127/91mmHg,Ht：160cm，Wt：62.5kg，BSA：1.65m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率72次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽右侧顶后壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 Ⅰ、Ⅱ、Ⅲ、aVF、V4～V6导联ST段下移\n- [全程D1] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；球蛋白(GLO)-静脉血: 30.03g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.9mmol/L；D-二聚体(D-Dimer)-静脉血: 0.13ug/ml；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；氯离子(Cl-)-静脉血: 98.1mmol/L；平均红细胞体积(MCV)-静脉血: 87.2fL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.91；大血小板百分比(P-LCR%)-静脉血: 33.4%；甘油三酯(TG)-静脉血: 1.01mmol/L；总钙(Ca)-静脉血: 2.28mmol/L；总胆固醇(TC)-静脉血: 5.44mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 25.2U/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 40.9umol/L；纤维蛋白原(Fbg)-静脉血: 2.51g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 20U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.34mmolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.58mmol/L；白细胞计数(WBC#)-静脉血: 6.9810E9/L；凝血酶时间(TT)-静脉血: 17.5sec.；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.013；红细胞计数(RBC#)-静脉血: 4.6710E12/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.98；直接胆红素(DBIL)-静脉血: 3.4umol/L；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 26.3mmol/L；磷(P)-静脉血: 1.03mmol/L；尿酸(UA)-静脉血: 391.1umol/L；碱性磷酸酶(ALP)-静脉血……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D26] 检验组合: 比重(SG)-尿液: 1.019；胆红素(BIL)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；酮体(KET)-尿液: +-（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；尿胆原(URO)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: Turbid；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 82/μL；总蛋白(TP)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6.5；白细胞计数(WBC#)-尿液: 17/μL\n- [全程D27] 检验组合: 血小板分布宽度(PDW)-静脉血: 12.2%；平均血小板体积(MPV)-静脉血: 11.2fL；红细胞比容(Hct)-静脉血: 37.5%；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；红细胞比容(Hct)-静脉血: 35.5%；碱性磷酸酶(ALP)-静脉血: 91.7U/L；白蛋白(ALB)-静脉血: 45.5g/L；C-反应蛋白(CRP)-静脉血: 1.15mg/L；血红蛋白(Hb)-静脉血: 121g/L；直接胆红素(DBIL)-静脉血: 3.7umol/L；血红蛋白(Hb)-静脉血: 111g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.4；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；葡萄糖(Glu)-静脉血: 5.1mmol/L；白细胞计数(WBC#)-静脉血: 13.710E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.51mmolL；红细胞计数(RBC#)-静脉血: 3.8810E12/L；颜色-尿液: Light-Orange；尿素氮(BUN)-静脉血: 5.77mmol/L；胱抑素(Cys-C)-静脉血: 0.99mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.59；钾离子(K+)-静脉血: 4.2mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 19U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 266.5U/L；磷(P)-静脉血: 1.03mmol/L；中性粒细胞计数(Neut#)-静脉血: 4.110E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.241；平均红细胞体积(MCV)-静脉血: 82.9fL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.81mmol/L；大血小板百分比(P-LCR%)-静脉血: 27.5%；红细胞计数(RBC#)-静脉血: 4.1410E12/L；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；甘油三酯(TG)-静脉血: 1.02mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.9；尿酸(UA)-静脉血: 295.4umol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.……\n- [全程D31] 检验组合: 丙氨酸氨基转移酶(ALT)-静脉血: 91.9U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 30.5U/L；碱性磷酸酶(ALP)-静脉血: 104.1U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 114U/L；乳酸脱氢酶(LDH)-静脉血: 159.5U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 23.5U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.33；总胆汁酸(TBA)-静脉血: 2umol/L\n- [全程D42] 检验组合: 磷(P)-静脉血: 1.12mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.66；钠离子(Na+)-静脉血: 139.9mmol/L；白蛋白(ALB)-静脉血: 43.7g/L；镁离子(Mg2+)-静脉血: 0.74mmol/L；钾离子(K+)-静脉血: 4.14mmol/L；氯离子(Cl-)-静脉血: 98mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 91.5U/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.5U/L；总胆红素(TBIL)-静脉血: 10.2umol/L；尿素氮(BUN)-静脉血: 5.7mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.7mmol/L；阴离子间隙(AG)-静脉血: 16.2；直接胆红素(DBIL)-静脉血: 3.2umol/L；尿酸(UA)-静脉血: 335.2umol/L；碱性磷酸酶(ALP)-静脉血: 75.1U/L；间接胆红素(IBIL)-静脉血: 7umolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.28；α-L-岩藻糖苷酶(AFU)-静脉血: 18.2U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.3U/L；球蛋白(GLO)-静脉血: 26.28g/L；总钙(Ca)-静脉血: 2.33mmol/L；肌酐(Crea)-静脉血: 77.8umol/L；总蛋白(TP)-静脉血: 69.98g/L；乳酸脱氢酶(LDH)-静脉血: 203.7U/L；总胆汁酸(TBA)-静脉血: 1.9umol/L\n- [全程D52] 检验组合: 白细胞计数(WBC#)-尿液: 2/μL；非鳞状上皮细胞计数-尿液: 3/μL；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；酸碱度(pH)-尿液: 6.5；红细胞计数(RBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；隐血(OB)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.014；尿胆原(URO)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 28/μL；总蛋白(TP)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 26/μL；白细胞(LEU)-尿液: -（参考: 阴性）\n- [全程D54] 检验组合: 红细胞计数(RBC#)-静脉血: 3.9510E12/L；血小板分布宽度(PDW)-静脉血: 12.5%；载脂蛋白B(apoB)-静脉血: 1.08g/L；酸碱度(pH)-尿液: 6.5；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.002；丙氨酸氨基转移酶(ALT)-静脉血: 12.3U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.092；尿素氮(BUN)-静脉血: 4.3mmol/L；酮体(KET)-尿液: 1+ 2mmol（参考: 阴性）；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.6；阴离子间隙(AG)-静脉血: 13.6；浊度(TRUB)-尿液: Turbid；颜色-尿液: Yellow；隐血(OB)-尿液: -（参考: 阴性）；镁离子(Mg2+)-静脉血: 0.61mmol/L；透明管型计数(HYAL#)-尿液: 1/μL；总胆红素(TBIL)-静脉血: 12umol/L；磷(P)-静脉血: 1.12mmol/L；浊度(TRUB)-尿液: Turbid；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿酸(UA)-静脉血: 317.3umol/L；总蛋白(TP)-尿液: 1+ 0.3g（参考: 阴性）；白蛋白(ALB)-静脉血: 42.2g/L；平均血小板体积(MPV)-静脉血: 10.8fL；中性粒细胞计数(Neut#)-静脉血: 3.410E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.1U/L；透明管型计数(HYAL#)-尿液: 2/μL；直接胆红素(DBIL)-静脉血: 3.8umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.67；白细胞计数(WBC#)-尿液: 25/μL；钾离子(K+)-静脉血: 3.33mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.6；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.08mmolL；比重(SG)-尿液: 1.024；未分类管型计数(UNCC#)-尿液: 2/μL；载脂蛋白AI(apoAI)-静脉血: 1.1g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.6pg；未分类管型计数(UNCC#)-尿液: 4/μL；隐血(OB)-尿液: -（参考: 阴性）；球蛋白(GLO)-静脉血: 25.25g/L；红细胞比容(H……\n\n【既往治疗与反应】\n- [全程D26] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者入院第三天，无特殊不适主诉，体查情况基本同前，患者现一般情况尚可，今日开始行根治性放疗，同时期予以DDP方案化疗，并予以护胃、止呕等对症支持处理，密观患者病情。\n- [全程D31] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现处于放化综合治疗中，放疗4F，现已基本完成一程同期化疗，诉口干、腹胀、纳差，体查：张口门齿距4.5cm；鼻咽右侧顶后壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。复查生化常规结果示：ALT87.0U/L，[姓名已隐去]副医生信息已隐藏：患者在院行一程同期化疗期间，出现肝功轻度损伤，期间予以护肝等对症处理，现患者复查生化示肝功指标仍有轻度升高，继续予以护肝等对症处理，今日可出院，每周定期复查血常规、生化常规，定期门诊复诊，门诊继续放疗，按期[计划性表述已隐藏]下程治疗，不适随诊。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D53] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者入院第二天，现处于放化综合治疗中，放疗21F，诉口苦，体查情况：张口门齿距4.5cm；鼻咽右侧顶后壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。复查血常规、生化常规结果基本正常。[姓名已隐去]副医生信息已隐藏：现患者入院[计划性表述已隐藏]第二程顺铂同期方案化疗，昨日开始予以水化，目前患者情况尚可，今日可行化疗，并予以止呕、护胃、加强营养等对症支持治疗，针对患者口苦症状，为放疗引起常见急性不良反应，予以对症处理，病情继观。\n- [全程D54] 上级查房记录；[姓名已隐去]医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医师查房记录；病程内容: 患者入院第三天，现处于放化综合治疗中，放疗22F，诉恶心、呕吐，体查情况基本同前。[姓名已隐去]医师查房后示：现患者处于DDP方案同期化疗中，目前患者情况尚可，继续予以止呕、护胃、加强营养等对症支持治疗，病情继观。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停顺铂同期化疗，继续根治性放疗，予以止呕、补液、补钾等支持治疗，并安排放疗中段MRI评估。\nB. 顺铂减量20%继续同期化疗，继续根治性放疗，予以止呕、补液等支持治疗，暂不复查MRI。\nC. 继续根治性放疗与顺铂同期化疗，予以止呕、护胃治疗，暂不予补液及补钾，并安排放疗中段MRI评估。\nD. 暂停根治性放疗与顺铂同期化疗，予以积极补液、补钾治疗，暂不安排影像学评估。\nE. 继续根治性放疗与顺铂同期化疗，予以止呕、护胃、补液及补钾等支持治疗，并安排放疗中段MRI评估。\nF. 继续根治性放疗与顺铂同期化疗，予以止呕、护胃、补液及补钾等支持治疗，并安排PET-CT评估全身疗效。\nG. 暂停顺铂同期化疗，改为替加氟口服化疗，继续根治性放疗，予以止呕、补钾等支持治疗。\nH. 继续根治性放疗与顺铂同期化疗，予以止呕、护胃、补液及补钾等支持治疗，并安排鼻咽镜活检评估疗效。\nI. 顺铂减量50%继续同期化疗，继续根治性放疗，予以止呕、补液及补钾等支持治疗，并安排放疗中段MRI评估。\nJ. 继续根治性放疗，取消后续化疗，予以止呕、补液及补钾等支持治疗，并安排放疗中段MRI评估。\nK. 继续根治性放疗与顺铂同期化疗，予以止呕、护胃、补液治疗，暂不予补钾，并安排放疗中段MRI评估。\nL. 暂停根治性放疗，继续顺铂同期化疗，予以止呕、补液及补钾等支持治疗，并安排放疗中段MRI评估。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"暂停顺铂同期化疗，继续根治性放疗，予以止呕、补液、补钾等支持治疗，并安排放疗中段MRI评估。","is_gold":false},{"letter":"B","text":"顺铂减量20%继续同期化疗，继续根治性放疗，予以止呕、补液等支持治疗，暂不复查MRI。","is_gold":false},{"letter":"C","text":"继续根治性放疗与顺铂同期化疗，予以止呕、护胃治疗，暂不予补液及补钾，并安排放疗中段MRI评估。","is_gold":false},{"letter":"D","text":"暂停根治性放疗与顺铂同期化疗，予以积极补液、补钾治疗，暂不安排影像学评估。","is_gold":false},{"letter":"E","text":"继续根治性放疗与顺铂同期化疗，予以止呕、护胃、补液及补钾等支持治疗，并安排放疗中段MRI评估。","is_gold":true},{"letter":"F","text":"继续根治性放疗与顺铂同期化疗，予以止呕、护胃、补液及补钾等支持治疗，并安排PET-CT评估全身疗效。","is_gold":false},{"letter":"G","text":"暂停顺铂同期化疗，改为替加氟口服化疗，继续根治性放疗，予以止呕、补钾等支持治疗。","is_gold":false},{"letter":"H","text":"继续根治性放疗与顺铂同期化疗，予以止呕、护胃、补液及补钾等支持治疗，并安排鼻咽镜活检评估疗效。","is_gold":false},{"letter":"I","text":"顺铂减量50%继续同期化疗，继续根治性放疗，予以止呕、补液及补钾等支持治疗，并安排放疗中段MRI评估。","is_gold":false},{"letter":"J","text":"继续根治性放疗，取消后续化疗，予以止呕、补液及补钾等支持治疗，并安排放疗中段MRI评估。","is_gold":false},{"letter":"K","text":"继续根治性放疗与顺铂同期化疗，予以止呕、护胃、补液治疗，暂不予补钾，并安排放疗中段MRI评估。","is_gold":false},{"letter":"L","text":"暂停根治性放疗，继续顺铂同期化疗，予以止呕、补液及补钾等支持治疗，并安排放疗中段MRI评估。","is_gold":false}],"gold_letter":"E"},{"sample_id":"sample-cc72c6bbde9abe2a112ce0fc","patient_id":"patient-79fa00752e4405e2980f6292","turn_id":"turn07","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D52] 入院记录: 主诉: 鼻咽癌一程化疗后两周余；现病史: 缘于1年前患者无明显诱因出现回吸性涕血，无头痛、鼻塞、耳鸣、复视、面麻等不适，未予重视，3个月前出现前额部疼痛，伴鼻衅，并于当地医院行鼻咽活检病理考虑鼻咽低分化型癌可能性大。于某次就诊时间10月底来我科就诊，并行根治性放疗计划设计，于某次就诊时间开始行根治性放疗，同时期予以DDP化疗1程，治疗过程顺利。今同期化疗到期来我科继续治疗，患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 额部疼痛,涕血；既往史: 高血压10年余服药治疗中，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。否认吸烟史，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.9℃，P：72次/分，R：20次/分，BP：127/91mmHg,Ht：160cm，Wt：62.5kg，BSA：1.65m2，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率72次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽右侧顶后壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D0] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 Ⅰ、Ⅱ、Ⅲ、aVF、V4～V6导联ST段下移\n- [全程D1] 检验组合: EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 1:10（参考: 阴性）；球蛋白(GLO)-静脉血: 30.03g/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；钾离子(K+)-静脉血: 3.9mmol/L；D-二聚体(D-Dimer)-静脉血: 0.13ug/ml；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；氯离子(Cl-)-静脉血: 98.1mmol/L；平均红细胞体积(MCV)-静脉血: 87.2fL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.91；大血小板百分比(P-LCR%)-静脉血: 33.4%；甘油三酯(TG)-静脉血: 1.01mmol/L；总钙(Ca)-静脉血: 2.28mmol/L；总胆固醇(TC)-静脉血: 5.44mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 25.2U/L；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；肌酐(Crea)-静脉血: 40.9umol/L；纤维蛋白原(Fbg)-静脉血: 2.51g/L；α-L-岩藻糖苷酶(AFU)-静脉血: 20U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.34mmolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.58mmol/L；白细胞计数(WBC#)-静脉血: 6.9810E9/L；凝血酶时间(TT)-静脉血: 17.5sec.；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.013；红细胞计数(RBC#)-静脉血: 4.6710E12/L；凝血酶原国际标准化比值(PT-INR)-静脉血: 0.98；直接胆红素(DBIL)-静脉血: 3.4umol/L；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 26.3mmol/L；磷(P)-静脉血: 1.03mmol/L；尿酸(UA)-静脉血: 391.1umol/L；碱性磷酸酶(ALP)-静脉血……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D27] 检验组合: 血小板分布宽度(PDW)-静脉血: 12.2%；平均血小板体积(MPV)-静脉血: 11.2fL；红细胞比容(Hct)-静脉血: 37.5%；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；红细胞比容(Hct)-静脉血: 35.5%；碱性磷酸酶(ALP)-静脉血: 91.7U/L；白蛋白(ALB)-静脉血: 45.5g/L；C-反应蛋白(CRP)-静脉血: 1.15mg/L；血红蛋白(Hb)-静脉血: 121g/L；直接胆红素(DBIL)-静脉血: 3.7umol/L；血红蛋白(Hb)-静脉血: 111g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.4；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.2；葡萄糖(Glu)-静脉血: 5.1mmol/L；白细胞计数(WBC#)-静脉血: 13.710E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.51mmolL；红细胞计数(RBC#)-静脉血: 3.8810E12/L；颜色-尿液: Light-Orange；尿素氮(BUN)-静脉血: 5.77mmol/L；胱抑素(Cys-C)-静脉血: 0.99mg/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.59；钾离子(K+)-静脉血: 4.2mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 19U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 266.5U/L；磷(P)-静脉血: 1.03mmol/L；中性粒细胞计数(Neut#)-静脉血: 4.110E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.241；平均红细胞体积(MCV)-静脉血: 82.9fL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.81mmol/L；大血小板百分比(P-LCR%)-静脉血: 27.5%；红细胞计数(RBC#)-静脉血: 4.1410E12/L；淋巴细胞计数(Lymph#)-静脉血: 0.610E9/L；甘油三酯(TG)-静脉血: 1.02mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.9；尿酸(UA)-静脉血: 295.4umol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.……\n- [全程D31] 检验组合: 丙氨酸氨基转移酶(ALT)-静脉血: 91.9U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 30.5U/L；碱性磷酸酶(ALP)-静脉血: 104.1U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 114U/L；乳酸脱氢酶(LDH)-静脉血: 159.5U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 23.5U/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.33；总胆汁酸(TBA)-静脉血: 2umol/L\n- [全程D42] 检验组合: 磷(P)-静脉血: 1.12mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.66；钠离子(Na+)-静脉血: 139.9mmol/L；白蛋白(ALB)-静脉血: 43.7g/L；镁离子(Mg2+)-静脉血: 0.74mmol/L；钾离子(K+)-静脉血: 4.14mmol/L；氯离子(Cl-)-静脉血: 98mmol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 91.5U/L；丙氨酸氨基转移酶(ALT)-静脉血: 13.5U/L；总胆红素(TBIL)-静脉血: 10.2umol/L；尿素氮(BUN)-静脉血: 5.7mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 25.7mmol/L；阴离子间隙(AG)-静脉血: 16.2；直接胆红素(DBIL)-静脉血: 3.2umol/L；尿酸(UA)-静脉血: 335.2umol/L；碱性磷酸酶(ALP)-静脉血: 75.1U/L；间接胆红素(IBIL)-静脉血: 7umolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.28；α-L-岩藻糖苷酶(AFU)-静脉血: 18.2U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.3U/L；球蛋白(GLO)-静脉血: 26.28g/L；总钙(Ca)-静脉血: 2.33mmol/L；肌酐(Crea)-静脉血: 77.8umol/L；总蛋白(TP)-静脉血: 69.98g/L；乳酸脱氢酶(LDH)-静脉血: 203.7U/L；总胆汁酸(TBA)-静脉血: 1.9umol/L\n- [全程D52] 检验组合: 白细胞计数(WBC#)-尿液: 2/μL；非鳞状上皮细胞计数-尿液: 3/μL；酮体(KET)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；酸碱度(pH)-尿液: 6.5；红细胞计数(RBC#)-尿液: 1/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；隐血(OB)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.014；尿胆原(URO)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 28/μL；总蛋白(TP)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 26/μL；白细胞(LEU)-尿液: -（参考: 阴性）\n- [全程D54] 检验组合: 红细胞计数(RBC#)-静脉血: 3.9510E12/L；血小板分布宽度(PDW)-静脉血: 12.5%；载脂蛋白B(apoB)-静脉血: 1.08g/L；酸碱度(pH)-尿液: 6.5；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.002；丙氨酸氨基转移酶(ALT)-静脉血: 12.3U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.092；尿素氮(BUN)-静脉血: 4.3mmol/L；酮体(KET)-尿液: 1+ 2mmol（参考: 阴性）；红细胞体积分布宽度SD(RDW-SD)-静脉血: 41.6；阴离子间隙(AG)-静脉血: 13.6；浊度(TRUB)-尿液: Turbid；颜色-尿液: Yellow；隐血(OB)-尿液: -（参考: 阴性）；镁离子(Mg2+)-静脉血: 0.61mmol/L；透明管型计数(HYAL#)-尿液: 1/μL；总胆红素(TBIL)-静脉血: 12umol/L；磷(P)-静脉血: 1.12mmol/L；浊度(TRUB)-尿液: Turbid；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；尿酸(UA)-静脉血: 317.3umol/L；总蛋白(TP)-尿液: 1+ 0.3g（参考: 阴性）；白蛋白(ALB)-静脉血: 42.2g/L；平均血小板体积(MPV)-静脉血: 10.8fL；中性粒细胞计数(Neut#)-静脉血: 3.410E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.1U/L；透明管型计数(HYAL#)-尿液: 2/μL；直接胆红素(DBIL)-静脉血: 3.8umol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.67；白细胞计数(WBC#)-尿液: 25/μL；钾离子(K+)-静脉血: 3.33mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.6；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.08mmolL；比重(SG)-尿液: 1.024；未分类管型计数(UNCC#)-尿液: 2/μL；载脂蛋白AI(apoAI)-静脉血: 1.1g/L；平均红细胞血红蛋白含量(MCH)-静脉血: 28.6pg；未分类管型计数(UNCC#)-尿液: 4/μL；隐血(OB)-尿液: -（参考: 阴性）；球蛋白(GLO)-静脉血: 25.25g/L；红细胞比容(H……\n- [全程D55] 检验组合: 中性粒细胞计数(Neut#)-静脉血: 8.410E9/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；直接胆红素(DBIL)-静脉血: 7umol/L；血小板计数(PLT#)-静脉血: 16910E9/L；红细胞计数(RBC#)-静脉血: 3.2710E12/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0；血小板比容-静脉血: 17%；碱性磷酸酶(ALP)-静脉血: 79.8U/L；阴离子间隙(AG)-静脉血: 13；天门冬氨酸氨基转移酶(AST)-静脉血: 19.5U/L；碱性磷酸酶(ALP)-静脉血: 58.6U/L；载脂蛋白AI(apoAI)-静脉血: 0.97g/L；丙氨酸氨基转移酶(ALT)-静脉血: 31.4U/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；钾离子(K+)-静脉血: 3.14mmol/L；胱抑素(Cys-C)-静脉血: 1.36mg/L；血红蛋白(Hb)-静脉血: 96g/L；平均血小板体积(MPV)-静脉血: 9.9fL；血小板分布宽度(PDW)-静脉血: 16.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 30.3pg；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.66；载脂蛋白B(apoB)-静脉血: 1.48g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 17.5U/L；白细胞计数(WBC#)-静脉血: 9.3910E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.48mmolL；淋巴细胞百分比(Lymph%)-静脉血: 0.064；总钙(Ca)-静脉血: 2.53mmol/L；甘油三酯(TG)-静脉血: 1.31mmol/L；尿酸(UA)-静脉血: 560.6umol/L；阴离子间隙(AG)-静脉血: 17；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.81mmol/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；尿素氮(BUN)-静脉血: 4.58mmol/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.04mmolL；尿酸(UA)-静脉血: 415.9umol/L；白蛋白(ALB)-静脉血: 47.6g/L；红细胞比容(Hct)-静脉血: 28.4%；球蛋白(GLO)-静脉血: 28.72g/L；肌酐(Crea)-静脉血: 10……\n- [全程D64] 超声；腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径9mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约22cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确肿物回声。 膀胱未充盈。；检查结论: 肝脏、胆囊、脾脏、胰腺、双肾未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n\n【既往治疗与反应】\n- [全程D31] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现处于放化综合治疗中，放疗4F，现已基本完成一程同期化疗，诉口干、腹胀、纳差，体查：张口门齿距4.5cm；鼻咽右侧顶后壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。复查生化常规结果示：ALT87.0U/L，[姓名已隐去]副医生信息已隐藏：患者在院行一程同期化疗期间，出现肝功轻度损伤，期间予以护肝等对症处理，现患者复查生化示肝功指标仍有轻度升高，继续予以护肝等对症处理，今日可出院，每周定期复查血常规、生化常规，定期门诊复诊，门诊继续放疗，按期[计划性表述已隐藏]下程治疗，不适随诊。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D53] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者入院第二天，现处于放化综合治疗中，放疗21F，诉口苦，体查情况：张口门齿距4.5cm；鼻咽右侧顶后壁肿物；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。复查血常规、生化常规结果基本正常。[姓名已隐去]副医生信息已隐藏：现患者入院[计划性表述已隐藏]第二程顺铂同期方案化疗，昨日开始予以水化，目前患者情况尚可，今日可行化疗，并予以止呕、护胃、加强营养等对症支持治疗，针对患者口苦症状，为放疗引起常见急性不良反应，予以对症处理，病情继观。\n- [全程D54] 上级查房记录；[姓名已隐去]医师查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医师查房记录；病程内容: 患者入院第三天，现处于放化综合治疗中，放疗22F，诉恶心、呕吐，体查情况基本同前。[姓名已隐去]医师查房后示：现患者处于DDP方案同期化疗中，目前患者情况尚可，继续予以止呕、护胃、加强营养等对症支持治疗，病情继观。\n- [全程D56] 上级查房记录；[姓名已隐去]副教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]副医生信息已隐藏；病程内容: 患者现处于放化综合治疗中，放疗24F，诉恶心、呕吐较前好转，体查情况：KPS 90分；鼻咽部右侧壁肿物，双颈部淋巴结未触及；颅神经检查：阴性。[姓名已隐去]副医生信息已隐藏：现患者基本完成二程DDP方案同期化疗，目前患者情况尚可，继续予以对症支持，今日可予以出院，并嘱按时[计划性表述已隐藏]治疗后复查，不适随诊。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估腹部无转移征象，继续根治性放疗，予以重组人粒细胞刺激因子皮下注射，待血常规恢复后重启化疗。\nB. 评估腹部无转移征象，继续根治性放疗，予以重组人促红素皮下注射改善贫血，并动态复查血常规。\nC. 腹部彩超见可疑占位，暂停放疗，行肝脏MRI平扫+增强以明确病变性质。\nD. 评估腹部无转移征象，继续根治性放疗，并即刻启动第三程顺铂同期化疗。\nE. 评估腹部无转移征象，提前结束放疗，转为顺铂联合氟尿嘧啶方案辅助化疗。\nF. 评估腹部无转移征象，继续根治性放疗，予以利可君口服改善骨髓抑制，并动态复查血常规。\nG. 评估腹部无转移征象，继续根治性放疗，予以异甘草酸镁静脉滴注强化保肝治疗。\nH. 评估腹部无转移征象，继续根治性放疗，予以输注单采血小板预防出血，并动态复查血常规。\nI. 评估腹部无转移征象，暂停放疗，行全身PET/CT检查以全面评估近期疗效。\nJ. 评估腹部无转移征象，继续根治性放疗，予以昂丹司琼强化止吐，并预防性放置胃管。\nK. 评估腹部无转移征象，继续根治性放疗，加用尼妥珠单抗靶向治疗以提高局部控制率。\nL. 评估腹部无转移征象，继续根治性放疗，予以地塞米松口服改善骨髓抑制，并动态复查血常规。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"评估腹部无转移征象，继续根治性放疗，予以重组人粒细胞刺激因子皮下注射，待血常规恢复后重启化疗。","is_gold":false},{"letter":"B","text":"评估腹部无转移征象，继续根治性放疗，予以重组人促红素皮下注射改善贫血，并动态复查血常规。","is_gold":true},{"letter":"C","text":"腹部彩超见可疑占位，暂停放疗，行肝脏MRI平扫+增强以明确病变性质。","is_gold":false},{"letter":"D","text":"评估腹部无转移征象，继续根治性放疗，并即刻启动第三程顺铂同期化疗。","is_gold":false},{"letter":"E","text":"评估腹部无转移征象，提前结束放疗，转为顺铂联合氟尿嘧啶方案辅助化疗。","is_gold":false},{"letter":"F","text":"评估腹部无转移征象，继续根治性放疗，予以利可君口服改善骨髓抑制，并动态复查血常规。","is_gold":false},{"letter":"G","text":"评估腹部无转移征象，继续根治性放疗，予以异甘草酸镁静脉滴注强化保肝治疗。","is_gold":false},{"letter":"H","text":"评估腹部无转移征象，继续根治性放疗，予以输注单采血小板预防出血，并动态复查血常规。","is_gold":false},{"letter":"I","text":"评估腹部无转移征象，暂停放疗，行全身PET/CT检查以全面评估近期疗效。","is_gold":false},{"letter":"J","text":"评估腹部无转移征象，继续根治性放疗，予以昂丹司琼强化止吐，并预防性放置胃管。","is_gold":false},{"letter":"K","text":"评估腹部无转移征象，继续根治性放疗，加用尼妥珠单抗靶向治疗以提高局部控制率。","is_gold":false},{"letter":"L","text":"评估腹部无转移征象，继续根治性放疗，予以地塞米松口服改善骨髓抑制，并动态复查血常规。","is_gold":false}],"gold_letter":"B"}]}
+{"patient_id":"patient-e7eec542502a097814d58d8a","bootstrap_cluster_id":"cluster-022","turns":[{"sample_id":"sample-38fe8a3260ea673c5c5ddb90","patient_id":"patient-e7eec542502a097814d58d8a","turn_id":"turn01","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 双侧耳鸣2年，发现右颈肿物3天；现病史: 患者2年前无明显诱因间断出现双侧耳鸣，近2周自觉右侧耳鸣症状加重，无鼻塞、涕血等不适。今为进一步诊治收入我院。起病以来，患者无发热、咳嗽，无胸闷、胸痛，无恶心、呕吐，胃纳、睡眠、精神可，大小便正常，体重无明显变化。；阳性症状体征: 双耳鸣,右颈部肿物,右耳鸣；既往史: 10+年前因“腰椎间盘突出”行手术治疗，并予输血，无“输血反应”。否认\"肝炎\"、\"结核\"、\"高血压\"、\"糖尿病\"等疾病史；无外伤病史。过敏史:否认药物、食物过敏史。；个人史: 原籍出生、长大，无疫水、疫区暴露史；无吸烟、酗酒等不良嗜好。；家族史: 否认家族其他成员有肿瘤病史及遗传病史。；体格检查: T：36.0℃ P：81bpm R：18bpm BP：111/76mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。牙龈无肿胀、出血，咽无充血，双扁桃体无肿大。颈部检查详见肿瘤专科 检查。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率81bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善鼻咽镜检查及活检，行头颈部CT平扫+增强，颈部及腹部彩超，常规血液学与心电图检查。\nB. 行右颈部肿物切除活检，待病理确诊后再行头颈部MRI平扫+增强，颈部及腹部彩超，全身骨显像。\nC. 完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，全身PET-CT显像，常规血液学与心电图检查。\nD. 完善鼻咽镜检查及活检，行头颈部MRI平扫，颈部及腹部彩超，全身骨显像，常规血液学与心电图检查。\nE. 行右颈部肿物细针穿刺活检，待病理确诊后再行鼻咽镜检查，头颈部MRI平扫+增强，全身骨显像。\nF. 完善鼻咽镜检查及活检，行头颈部CT平扫，颈部及腹部彩超，全身骨显像，常规血液学与心电图检查。\nG. 完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部彩超，常规血液学与心电图检查，暂缓全身骨显像。\nH. 完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部及腹部彩超，全身骨显像，常规血液学与心电图检查。\nI. 完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部彩超，全身骨显像，常规血液学与心电图检查。\nJ. 完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部及腹部彩超，头颅MRI平扫+增强，常规血液学检查。\nK. 完善鼻咽镜检查及活检，行头颈部CT平扫+增强，颈部及腹部彩超，全身骨显像，常规血液学与心电图检查。\nL. 完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部及腹部彩超，全身骨显像，骨髓穿刺活检。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"完善鼻咽镜检查及活检，行头颈部CT平扫+增强，颈部及腹部彩超，常规血液学与心电图检查。","is_gold":false},{"letter":"B","text":"行右颈部肿物切除活检，待病理确诊后再行头颈部MRI平扫+增强，颈部及腹部彩超，全身骨显像。","is_gold":false},{"letter":"C","text":"完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，全身PET-CT显像，常规血液学与心电图检查。","is_gold":false},{"letter":"D","text":"完善鼻咽镜检查及活检，行头颈部MRI平扫，颈部及腹部彩超，全身骨显像，常规血液学与心电图检查。","is_gold":false},{"letter":"E","text":"行右颈部肿物细针穿刺活检，待病理确诊后再行鼻咽镜检查，头颈部MRI平扫+增强，全身骨显像。","is_gold":false},{"letter":"F","text":"完善鼻咽镜检查及活检，行头颈部CT平扫，颈部及腹部彩超，全身骨显像，常规血液学与心电图检查。","is_gold":false},{"letter":"G","text":"完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部彩超，常规血液学与心电图检查，暂缓全身骨显像。","is_gold":false},{"letter":"H","text":"完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部及腹部彩超，全身骨显像，常规血液学与心电图检查。","is_gold":true},{"letter":"I","text":"完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部彩超，全身骨显像，常规血液学与心电图检查。","is_gold":false},{"letter":"J","text":"完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部及腹部彩超，头颅MRI平扫+增强，常规血液学检查。","is_gold":false},{"letter":"K","text":"完善鼻咽镜检查及活检，行头颈部CT平扫+增强，颈部及腹部彩超，全身骨显像，常规血液学与心电图检查。","is_gold":false},{"letter":"L","text":"完善鼻咽镜检查及活检，行头颈部MRI平扫+增强，颈部及腹部彩超，全身骨显像，骨髓穿刺活检。","is_gold":false}],"gold_letter":"H"},{"sample_id":"sample-06aacdbb23f806198bd0b70c","patient_id":"patient-e7eec542502a097814d58d8a","turn_id":"turn02","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 双侧耳鸣2年，发现右颈肿物3天；现病史: 患者2年前无明显诱因间断出现双侧耳鸣，近2周自觉右侧耳鸣症状加重，无鼻塞、涕血等不适。今为进一步诊治收入我院。起病以来，患者无发热、咳嗽，无胸闷、胸痛，无恶心、呕吐，胃纳、睡眠、精神可，大小便正常，体重无明显变化。；阳性症状体征: 双耳鸣,右颈部肿物,右耳鸣；既往史: 10+年前因“腰椎间盘突出”行手术治疗，并予输血，无“输血反应”。否认\"肝炎\"、\"结核\"、\"高血压\"、\"糖尿病\"等疾病史；无外伤病史。过敏史:否认药物、食物过敏史。；个人史: 原籍出生、长大，无疫水、疫区暴露史；无吸烟、酗酒等不良嗜好。；家族史: 否认家族其他成员有肿瘤病史及遗传病史。；体格检查: T：36.0℃ P：81bpm R：18bpm BP：111/76mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。牙龈无肿胀、出血，咽无充血，双扁桃体无肿大。颈部检查详见肿瘤专科 检查。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率81bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显斑片或结节影。双侧肺门影未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见明显病变。\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 正常心电图\n- [全程D1] 检验组合: 间接胆红素(IBIL)-静脉血: 9.6umolL；尿胆原(URO)-尿液: -（参考: 阴性）；钾离子(K+)-静脉血: 4mmol/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:40（参考: 阴性）；总胆固醇(TC)-静脉血: 6.89mmol/L；肿瘤特异性生长因子(TSGF)-静脉血: 32U/mL；红细胞计数(RBC#)-静脉血: 4.9610E12/L；天门冬氨酸氨基转移酶(AST)-静脉血: 21.5U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.3pg；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阴性(-)（参考: 阴性）；总胆红素(TBIL)-静脉血: 13.4umol/L；总蛋白(TP)-尿液: -（参考: 阴性）；血小板计数(PLT#)-静脉血: 319.310E9/L；比重(SG)-尿液: LAMPL.；凝血酶原时间活动度(PTA)-静脉血: 113.8%；直接胆红素(DBIL)-静脉血: 3.8umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-静脉血: 10.310E9/L；平均血小板体积(MPV)-静脉血: 7.46fL；镁离子(Mg2+)-静脉血: 0.98mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.310E9/L；鳞状细胞癌相关抗原(SCC)-静脉血: 0.4ng/ml；低密度脂蛋白胆固醇(LDL-C)-静脉血: 5.13mmol/L；血小板比容-静脉血: 23.8%；Rh血型-静脉血: 阳性；总前列腺特异性抗原(TPSA)-静脉血: 1ng/ml；神经元特异性烯醇化酶(NSE)-静脉血: 12.85ng/ml；白细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；隐血(OB)-尿液: +- 0.3mg（参考: 阴性）；游……\n- [全程D2] 检验组合: CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 0.8%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 3%；CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 24.9%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 9.8%；CD3+T淋巴细胞百分比-静脉血: 60.3%；CD4+/CD8+辅助/抑制T淋巴细胞比值(Th/Ts比值)-静脉血: 1.7；CD3-CD16+CD56+自然杀伤细胞百分比(NK%)-静脉血: 15.5%；CD8+CD25+调节T淋巴细胞百分比(T8reg%)-静脉血: 3.1%；CD3+CD4+辅助/诱导T淋巴细胞百分比(Th/Ti%)-静脉血: 29%；CD19+B淋巴细胞百分比-静脉血: 23%；CD3+CD8+抑制/细胞毒T淋巴细胞百分比(Ts/Tc%)-静脉血: 18.4%；CD4+CD25+调节T淋巴细胞百分比(T4reg%)-静脉血: 27.7%\n- [全程D7] 超声；双侧颈部、锁骨上区淋巴结彩超(套): 检查类型: 超声；检查名称: 双侧颈部、锁骨上区淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉内径约14mm，门静脉最大血流速度约17cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约44×36×33mm，包膜光滑，实质回声不均匀，可见强回声斑。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 前列腺钙化。 胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D7] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 右侧颈部II区可见数个淋巴结回声，最大约23×12mm，椭圆形，边界清，皮髓质分界不清，未见淋巴门。余右侧颈部未见明确异常淋巴结。 CDFI：上述最大淋巴结内可见周边型血流信号。 左侧颈部及锁骨上区未见明确异常淋巴结回声。；检查结论: 右侧颈部II区淋巴结，恶性待排，建议穿刺活检。 左侧颈部及锁骨上区未见明确异常淋巴结声像。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 行右侧颈部淋巴结切除活检术\nB. 行右侧颈部淋巴结细针穿刺抽吸活检\nC. 安排诱导化疗联合同期放化疗\nD. 行全身PET-CT检查\nE. 行全身骨显像检查\nF. 行鼻内镜下鼻咽部肿物切除术\nG. 行鼻咽部高分辨率CT检查\nH. 行右侧颈部淋巴结微创旋切活检术\nI. 行鼻咽镜检查并取鼻咽部肿物活检\nJ. 行胸部增强CT及腹部增强CT检查\nK. 抽取外周血行血浆EBV-DNA定量检测\nL. 密切观察随访，1个月后复查鼻咽部MRI\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"行右侧颈部淋巴结切除活检术","is_gold":false},{"letter":"B","text":"行右侧颈部淋巴结细针穿刺抽吸活检","is_gold":false},{"letter":"C","text":"安排诱导化疗联合同期放化疗","is_gold":false},{"letter":"D","text":"行全身PET-CT检查","is_gold":false},{"letter":"E","text":"行全身骨显像检查","is_gold":false},{"letter":"F","text":"行鼻内镜下鼻咽部肿物切除术","is_gold":false},{"letter":"G","text":"行鼻咽部高分辨率CT检查","is_gold":false},{"letter":"H","text":"行右侧颈部淋巴结微创旋切活检术","is_gold":false},{"letter":"I","text":"行鼻咽镜检查并取鼻咽部肿物活检","is_gold":true},{"letter":"J","text":"行胸部增强CT及腹部增强CT检查","is_gold":false},{"letter":"K","text":"抽取外周血行血浆EBV-DNA定量检测","is_gold":false},{"letter":"L","text":"密切观察随访，1个月后复查鼻咽部MRI","is_gold":false}],"gold_letter":"I"},{"sample_id":"sample-9713cef7ba61651ea6a5f02e","patient_id":"patient-e7eec542502a097814d58d8a","turn_id":"turn05","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 双侧耳鸣2年，发现右颈肿物3天；现病史: 患者2年前无明显诱因间断出现双侧耳鸣，近2周自觉右侧耳鸣症状加重，无鼻塞、涕血等不适。3天前无明显诱因发现右颈部肿物，遂就诊外院行CT检查示：鼻咽右侧壁增厚，考虑鼻咽癌可能，伴右侧乳突阻塞性炎症。今为进一步诊治收入我院。起病以来，患者无发热、咳嗽，无胸闷、胸痛，无恶心、呕吐，胃纳、睡眠、精神可，大小便正常，体重无明显变化。；阳性症状体征: 双耳鸣,右颈部肿物,右耳鸣；既往史: 10+年前因“腰椎间盘突出”行手术治疗，并予输血，无“输血反应”。否认\"肝炎\"、\"结核\"、\"高血压\"、\"糖尿病\"等疾病史；无外伤病史。过敏史:否认药物、食物过敏史。；个人史: 原籍出生、长大，无疫水、疫区暴露史；无吸烟、酗酒等不良嗜好。；家族史: 否认家族其他成员有肿瘤病史及遗传病史。；体格检查: T：36.0℃ P：81bpm R：18bpm BP：111/76mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。牙龈无肿胀、出血，咽无充血，双扁桃体无肿大。颈部检查详见肿瘤专科 检查。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率81bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。肛门外生殖器未见异常，生理反射存在，病理反射未引出。；专科检查: 间接鼻咽镜检查见双侧鼻腔通畅，内未窥及明显肿物；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显斑片或结节影。双侧肺门影未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见明显病变。\n- [全程D7] 超声；腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 右侧颈部II区可见数个淋巴结回声，最大约23×12mm，椭圆形，边界清，皮髓质分界不清，未见淋巴门。余右侧颈部未见明确异常淋巴结。 CDFI：上述最大淋巴结内可见周边型血流信号。 左侧颈部及锁骨上区未见明确异常淋巴结回声。；检查结论: 右侧颈部II区淋巴结，恶性待排，建议穿刺活检。 左侧颈部及锁骨上区未见明确异常淋巴结声像。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D24] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽右顶壁及右侧壁粘膜增厚放射性浓聚，SUV约16.7，病灶累及右翼突基底部及内侧板、右侧腭帆张提肌。右侧咽隐窝消失，左侧咽隐窝存在。双侧咽后未见肿大淋巴结及异常放射性分布。口咽、喉咽未见异常。筛窦、左上颌窦及右乳突内低密度影放射性稀疏；额窦、蝶窦、右上颌窦及左乳突结构及放射性分布未见明显异常。双侧海绵窦放射性分布未见明显异常。甲状腺结构及放射性分布未见明显异常。右颈II区数个淋巴结放射性浓聚，SUV约18.0，大者约1.5×2.2cm；余双颈小淋巴结放射性分布未见异常。 所见脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔主肺动脉窗小淋巴结放射性分布未见明显异常，大小约0.9×1.0cm。双肺门未见肿大淋巴结及异常放射性分布。双侧腋窝小淋巴结放射性未见明显异常。 肝脏密度减低，CT值约36Hu（脾脏CT值约56Hu），结构及放射性分布未见异常；肝门区未见占位及异常放射性分布。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。左肾上腺体部小结节影放射性略浓密，大小约1.0×1.1cm。脾脏、双肾、右肾上腺及胰腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺大小正常，内见数个点状钙化灶。膀胱及肠管形态、结构及放射性分布未见明显异常。双髂血管旁及双侧腹股沟未见肿大淋巴结及异常放射性分布。 颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，病灶累及右翼突基底部及内侧板、右侧腭帆张提肌；右颈II区数个淋巴结代谢活跃，考虑转移。 左肾上腺体部小结节代谢稍活跃，疑良性增生病变。 前列腺多发钙化灶。 脂肪肝。 副鼻窦炎症；右乳突炎症。\n- [全程D28] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T6上缘水平，估计导管末端位于上腔静脉上段内。；检查结论: PICC管末端位置如上述。\n- [全程D28] 检验组合: 红细胞计数(RBC#)-静脉血: 4.710E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7；钾离子(K+)-静脉血: 4.2mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 32.3U/L；尿素氮(BUN)-静脉血: 8.2mmol/L；间接胆红素(IBIL)-静脉血: 6.2umolL；氯离子(Cl-)-静脉血: 100.2mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 326g/L；红细胞比容(Hct)-静脉血: 43.5%；总胆固醇(TC)-静脉血: 5.88mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 22.9U/L；载脂蛋白AI(apoAI)-静脉血: 1.32g/L；血小板比容-静脉血: 32%；葡萄糖(Glu)-静脉血: 5.95mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.8mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.2pg；乳酸脱氢酶(LDH)-静脉血: 159.8U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.279；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.67；白细胞计数(WBC#)-静脉血: 10.7710E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 16.9U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.99mmol/L；中性粒细胞计数(Neut#)-静脉血: 6.410E9/L；平均红细胞体积(MCV)-静脉血: 92.6fL；平均血小板体积(MPV)-静脉血: 9.2fL；总胆红素(TBIL)-静脉血: 8.6umol/L；血小板分布宽度(PDW)-静脉血: 10%；磷(P)-静脉血: 1.6mmol/L；肌酐(Crea)-静脉血: 64.4umol/L；血小板计数(PLT#)-静脉血: 34410E9/L；C-反应蛋白(CRP)-静脉血: 3.29mg/L；碱性磷酸酶(ALP)-静脉血: 102.6U/L；白蛋白(ALB)-静脉血: 46.3g/L；淋巴细胞计数(Lymph#)-静脉血: 310E9/L；单核细胞计数(Mono#)-静脉血: 0.810E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 54U/L；大血小板百分比(P-LCR%)-静脉血: 18.4%；单核细胞百分比(Mono%)-静……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- [全程D9] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者一般情况可，无发热、涕血等不适症状。查体：生命体征平稳。电子喉镜检查示：鼻咽右隆突肿物，符合鼻咽癌。并取肿物活检，等待病理结果。[姓名已隐去]副教授示，结合患者病情及相关检查，诊断考虑鼻咽癌可能性大，明确诊断，予鼻咽科进一步诊治。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D15] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：KPS 90分；鼻咽右侧壁、顶后壁结节状肿物，右颈Ⅱ区可扪及已肿大淋巴结，大小约2*1cm，颅神经检查（-）。今日[姓名已隐去]医生信息已隐藏后示：患者已完善相关检查，并预约放疗，今日可结账出院，嘱出院后按时[计划性表述已隐藏]放化综合治疗，不适随诊。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂不予静脉水化及电解质补充，待明日行顺铂化疗时同步予以补液支持。\nB. 予以静脉水化，暂不补充钾离子，嘱计24小时尿量，并常规行PICC导管护理。\nC. 予以静脉水化及电解质补充，常规静脉推注呋塞米强效利尿，并计24小时尿量。\nD. 予以静脉水化及电解质补充，皮下注射重组人粒细胞集落刺激因子预防骨髓抑制。\nE. 予以静脉水化及电解质补充，静脉滴注右丙亚胺预防大剂量顺铂相关心脏毒性。\nF. 予以静脉水化及电解质补充，静脉滴注阿米福汀预防大剂量顺铂相关肾毒性。\nG. 予以静脉水化及电解质补充，嘱计24小时尿量，并静脉滴注头孢菌素预防感染。\nH. 予以静脉水化及电解质补充，静脉滴注地塞米松及帕洛诺司琼进行止吐预处理。\nI. 予以静脉水化及电解质补充，静脉输注人血白蛋白以预防大剂量化疗后低蛋白血症。\nJ. 予以静脉水化及电解质补充，静脉滴注异甘草酸镁预防大剂量顺铂相关肝损伤。\nK. 予以静脉水化及电解质补充，嘱计24小时尿量，并皮下注射促红细胞生成素。\nL. 予以静脉水化及电解质（含钾）补充，嘱计24小时尿量，并常规行PICC导管护理。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"暂不予静脉水化及电解质补充，待明日行顺铂化疗时同步予以补液支持。","is_gold":false},{"letter":"B","text":"予以静脉水化，暂不补充钾离子，嘱计24小时尿量，并常规行PICC导管护理。","is_gold":false},{"letter":"C","text":"予以静脉水化及电解质补充，常规静脉推注呋塞米强效利尿，并计24小时尿量。","is_gold":false},{"letter":"D","text":"予以静脉水化及电解质补充，皮下注射重组人粒细胞集落刺激因子预防骨髓抑制。","is_gold":false},{"letter":"E","text":"予以静脉水化及电解质补充，静脉滴注右丙亚胺预防大剂量顺铂相关心脏毒性。","is_gold":false},{"letter":"F","text":"予以静脉水化及电解质补充，静脉滴注阿米福汀预防大剂量顺铂相关肾毒性。","is_gold":false},{"letter":"G","text":"予以静脉水化及电解质补充，嘱计24小时尿量，并静脉滴注头孢菌素预防感染。","is_gold":false},{"letter":"H","text":"予以静脉水化及电解质补充，静脉滴注地塞米松及帕洛诺司琼进行止吐预处理。","is_gold":false},{"letter":"I","text":"予以静脉水化及电解质补充，静脉输注人血白蛋白以预防大剂量化疗后低蛋白血症。","is_gold":false},{"letter":"J","text":"予以静脉水化及电解质补充，静脉滴注异甘草酸镁预防大剂量顺铂相关肝损伤。","is_gold":false},{"letter":"K","text":"予以静脉水化及电解质补充，嘱计24小时尿量，并皮下注射促红细胞生成素。","is_gold":false},{"letter":"L","text":"予以静脉水化及电解质（含钾）补充，嘱计24小时尿量，并常规行PICC导管护理。","is_gold":true}],"gold_letter":"L"},{"sample_id":"sample-e0f912ad55b7b1f092a1b468","patient_id":"patient-e7eec542502a097814d58d8a","turn_id":"turn06","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 双侧耳鸣2年，发现右颈肿物3天；现病史: 患者2年前无明显诱因间断出现双侧耳鸣，近2周自觉右侧耳鸣症状加重，无鼻塞、涕血等不适。3天前无明显诱因发现右颈部肿物，遂就诊外院行CT检查示：鼻咽右侧壁增厚，考虑鼻咽癌可能，伴右侧乳突阻塞性炎症。今为进一步诊治收入我院。起病以来，患者无发热、咳嗽，无胸闷、胸痛，无恶心、呕吐，胃纳、睡眠、精神可，大小便正常，体重无明显变化。；阳性症状体征: 双耳鸣,右颈部肿物,右耳鸣；既往史: 10+年前因“腰椎间盘突出”行手术治疗，并予输血，无“输血反应”。否认\"肝炎\"、\"结核\"、\"高血压\"、\"糖尿病\"等疾病史；无外伤病史。过敏史:否认药物、食物过敏史。；个人史: 原籍出生、长大，无疫水、疫区暴露史；无吸烟、酗酒等不良嗜好。；家族史: 否认家族其他成员有肿瘤病史及遗传病史。；体格检查: T：36.0℃ P：81bpm R：18bpm BP：111/76mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。牙龈无肿胀、出血，咽无充血，双扁桃体无肿大。颈部检查详见肿瘤专科 检查。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率81bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。肛门外生殖器未见异常，生理反射存在，病理反射未引出。；专科检查: 间接鼻咽镜检查见双侧鼻腔通畅，内未窥及明显肿物；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显斑片或结节影。双侧肺门影未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见明显病变。\n- [全程D24] 核医学；PET/CT全身显像: 检查类型: 核医学；检查名称: PET/CT全身显像；检查部位:；检查所见: 空腹6h以上，静脉注射18F-FDG，静息约60min后行全身PET/CT断层显像，影像清晰。 鼻咽右顶壁及右侧壁粘膜增厚放射性浓聚，SUV约16.7，病灶累及右翼突基底部及内侧板、右侧腭帆张提肌。右侧咽隐窝消失，左侧咽隐窝存在。双侧咽后未见肿大淋巴结及异常放射性分布。口咽、喉咽未见异常。筛窦、左上颌窦及右乳突内低密度影放射性稀疏；额窦、蝶窦、右上颌窦及左乳突结构及放射性分布未见明显异常。双侧海绵窦放射性分布未见明显异常。甲状腺结构及放射性分布未见明显异常。右颈II区数个淋巴结放射性浓聚，SUV约18.0，大者约1.5×2.2cm；余双颈小淋巴结放射性分布未见异常。 所见脑实质密度、形态正常，放射性分布均匀、对称，诸脑室、脑池、脑沟、脑裂未见异常，中线结构居中。 双肺纹理未见明显异常，气管、支气管通畅。双侧胸壁未见确切病灶和异常放射性分布。纵隔主肺动脉窗小淋巴结放射性分布未见明显异常，大小约0.9×1.0cm。双肺门未见肿大淋巴结及异常放射性分布。双侧腋窝小淋巴结放射性未见明显异常。 肝脏密度减低，CT值约36Hu（脾脏CT值约56Hu），结构及放射性分布未见异常；肝门区未见占位及异常放射性分布。肝内、外胆管未见扩张。胆囊、胃及十二指肠放射性分布未见明显异常。左肾上腺体部小结节影放射性略浓密，大小约1.0×1.1cm。脾脏、双肾、右肾上腺及胰腺形态、结构及放射性分布未见异常。腹腔及腹膜后未见肿大淋巴结及异常放射性分布。 前列腺大小正常，内见数个点状钙化灶。膀胱及肠管形态、结构及放射性分布未见明显异常。双髂血管旁及双侧腹股沟未见肿大淋巴结及异常放射性分布。 颅盖骨、各躯干骨、四肢骨放射性分布未见明显异常。；检查结论: 鼻咽病灶代谢活跃，考虑鼻咽癌，病灶累及右翼突基底部及内侧板、右侧腭帆张提肌；右颈II区数个淋巴结代谢活跃，考虑转移。 左肾上腺体部小结节代谢稍活跃，疑良性增生病变。 前列腺多发钙化灶。 脂肪肝。 副鼻窦炎症；右乳突炎症。\n- [全程D28] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC导管末端位于脊柱右旁T6上缘水平，估计导管末端位于上腔静脉上段内。；检查结论: PICC管末端位置如上述。\n- [全程D28] 检验组合: 红细胞计数(RBC#)-静脉血: 4.710E12/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.7；钾离子(K+)-静脉血: 4.2mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 32.3U/L；尿素氮(BUN)-静脉血: 8.2mmol/L；间接胆红素(IBIL)-静脉血: 6.2umolL；氯离子(Cl-)-静脉血: 100.2mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 326g/L；红细胞比容(Hct)-静脉血: 43.5%；总胆固醇(TC)-静脉血: 5.88mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 22.9U/L；载脂蛋白AI(apoAI)-静脉血: 1.32g/L；血小板比容-静脉血: 32%；葡萄糖(Glu)-静脉血: 5.95mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 21.8mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.2pg；乳酸脱氢酶(LDH)-静脉血: 159.8U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.279；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.67；白细胞计数(WBC#)-静脉血: 10.7710E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 16.9U/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.99mmol/L；中性粒细胞计数(Neut#)-静脉血: 6.410E9/L；平均红细胞体积(MCV)-静脉血: 92.6fL；平均血小板体积(MPV)-静脉血: 9.2fL；总胆红素(TBIL)-静脉血: 8.6umol/L；血小板分布宽度(PDW)-静脉血: 10%；磷(P)-静脉血: 1.6mmol/L；肌酐(Crea)-静脉血: 64.4umol/L；血小板计数(PLT#)-静脉血: 34410E9/L；C-反应蛋白(CRP)-静脉血: 3.29mg/L；碱性磷酸酶(ALP)-静脉血: 102.6U/L；白蛋白(ALB)-静脉血: 46.3g/L；淋巴细胞计数(Lymph#)-静脉血: 310E9/L；单核细胞计数(Mono#)-静脉血: 0.810E9/L；γ-谷氨酰基转移酶(GGT)-静脉血: 54U/L；大血小板百分比(P-LCR%)-静脉血: 18.4%；单核细胞百分比(Mono%)-静……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D29] 检验组合: 隐血(OB)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 3/μL；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；淀粉样蛋白A(SAA)-静脉血: 3.65mg/L；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；白细胞计数(WBC#)-尿液: 7/μL；比重(SG)-尿液: 1.027；总蛋白(TP)-尿液: +- 0.2g（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；胆红素(BIL)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 6；葡萄糖(Glu)-尿液: 3+ 17mmol（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；粘液丝计数(MUCS#)-尿液: 80/μL\n- [全程D30] 检验组合: 颜色-尿液: Yellow；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 13/μL；白细胞(LEU)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 6；总蛋白(TP)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.023\n- [全程D35] 检验组合: 白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.7；单核细胞计数(Mono#)-静脉血: 0.810E9/L；甘油三酯(TG)-静脉血: 2.15mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 0.110E9/L；载脂蛋白AI(apoAI)-静脉血: 1.26g/L；中性粒细胞百分比(Neut%)-静脉血: 0.702；葡萄糖(Glu)-静脉血: 6.03mmol/L；尿素氮(BUN)-静脉血: 7.02mmol/L；直接胆红素(DBIL)-静脉血: 4.8umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 20U/L；C-反应蛋白(CRP)-静脉血: 2.65mg/L；乳酸脱氢酶(LDH)-静脉血: 166.9U/L；红细胞计数(RBC#)-静脉血: 4.7510E12/L；总胆汁酸(TBA)-静脉血: 1.5umol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.7；总蛋白(TP)-静脉血: 71.69g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.007；肌酐(Crea)-静脉血: 69.7umol/L；总钙(Ca)-静脉血: 2.31mmol/L；白细胞计数(WBC#)-静脉血: 7.4610E9/L；镁离子(Mg2+)-静脉血: 1mmol/L；平均红细胞体积(MCV)-静脉血: 88.8fL；总胆固醇(TC)-静脉血: 5.15mmol/L；磷(P)-静脉血: 1.3mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.7pg；总胆红素(TBIL)-静脉血: 15umol/L；血液二氧化碳含量ctCO2(B)-静脉血: 22.2mmol/L；阴离子间隙(AG)-静脉血: 17；间接胆红素(IBIL)-静脉血: 10.2umolL；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.18mmolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4；球蛋白(GLO)-静脉血: 26.39g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.168；血小板分布宽度(PDW)-静脉血: 9.8%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.015；血红蛋白(Hb)-静脉血: 141g/L；淋巴细胞计数(L……\n\n【既往治疗与反应】\n- [全程D15] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：KPS 90分；鼻咽右侧壁、顶后壁结节状肿物，右颈Ⅱ区可扪及已肿大淋巴结，大小约2*1cm，颅神经检查（-）。今日[姓名已隐去]医生信息已隐藏后示：患者已完善相关检查，并预约放疗，今日可结账出院，嘱出院后按时[计划性表述已隐藏]放化综合治疗，不适随诊。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D29] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者放疗1次。患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：基本同前。今日[姓名已隐去]副医生信息已隐藏后示：患于今日行第一程DDP方案化疗（100mg/m2）。继续放疗，续观。\n- [全程D34] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：KPS 90分； 间接鼻咽镜检查见双侧鼻腔通畅，内未窥及明显肿物；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。复查血常规、生化常规未见明显异常。今日[姓名已隐去]医生信息已隐藏后示：患者已结束第一程同时期DDP方案化疗（100mg/m2），治疗过程顺利，今日可结账出院，嘱出院后继续在门诊放疗，每周复查血常规、肝肾功能，并按时[计划性表述已隐藏]下一程治疗，不适随诊。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 在无明显感染或疼痛症状的情况下经验性给予阿莫西林口服抗感染及酚咖片止痛，并复查血常规、生化常规及EBV-DNA定量\nB. 在无明显感染或疼痛症状的情况下静脉滴注头孢类抗生素并酚咖片止痛，同时复查血常规、生化常规及EBV-DNA定量\nC. 经验性给予阿莫西林口服抗感染及酚咖片止痛，并暂停放疗直至症状完全缓解\nD. 经验性给予酚咖片对症止痛，暂不予抗感染治疗，并复查血常规、生化常规及EBV-DNA定量\nE. 经验性给予阿莫西林口服抗感染，暂不予止痛治疗，并复查血常规、生化常规及EBV-DNA定量\nF. 经验性给予阿莫西林口服抗感染及酚咖片止痛，并提前安排第二程顺铂化疗\nG. 经验性给予阿莫西林口服抗感染及酚咖片止痛，并加用静脉地塞米松减轻局部水肿\nH. 经验性给予静脉滴注广谱抗生素及曲马多止痛，并复查血常规、生化常规及EBV-DNA定量\nI. 经验性给予阿莫西林口服抗感染及酚咖片止痛，并取消后续顺铂化疗计划\nJ. 经验性给予阿莫西林口服抗感染及酚咖片止痛，并复查鼻咽颈部MRI评估近期疗效\nK. 经验性给予口服抗真菌药物及酚咖片止痛，并复查血常规、生化常规及EBV-DNA定量\nL. 仅常规复查血常规、生化常规及EBV-DNA定量，暂不予特殊药物干预\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"在无明显感染或疼痛症状的情况下经验性给予阿莫西林口服抗感染及酚咖片止痛，并复查血常规、生化常规及EBV-DNA定量","is_gold":false},{"letter":"B","text":"在无明显感染或疼痛症状的情况下静脉滴注头孢类抗生素并酚咖片止痛，同时复查血常规、生化常规及EBV-DNA定量","is_gold":false},{"letter":"C","text":"经验性给予阿莫西林口服抗感染及酚咖片止痛，并暂停放疗直至症状完全缓解","is_gold":false},{"letter":"D","text":"经验性给予酚咖片对症止痛，暂不予抗感染治疗，并复查血常规、生化常规及EBV-DNA定量","is_gold":false},{"letter":"E","text":"经验性给予阿莫西林口服抗感染，暂不予止痛治疗，并复查血常规、生化常规及EBV-DNA定量","is_gold":false},{"letter":"F","text":"经验性给予阿莫西林口服抗感染及酚咖片止痛，并提前安排第二程顺铂化疗","is_gold":false},{"letter":"G","text":"经验性给予阿莫西林口服抗感染及酚咖片止痛，并加用静脉地塞米松减轻局部水肿","is_gold":false},{"letter":"H","text":"经验性给予静脉滴注广谱抗生素及曲马多止痛，并复查血常规、生化常规及EBV-DNA定量","is_gold":false},{"letter":"I","text":"经验性给予阿莫西林口服抗感染及酚咖片止痛，并取消后续顺铂化疗计划","is_gold":false},{"letter":"J","text":"经验性给予阿莫西林口服抗感染及酚咖片止痛，并复查鼻咽颈部MRI评估近期疗效","is_gold":false},{"letter":"K","text":"经验性给予口服抗真菌药物及酚咖片止痛，并复查血常规、生化常规及EBV-DNA定量","is_gold":false},{"letter":"L","text":"仅常规复查血常规、生化常规及EBV-DNA定量，暂不予特殊药物干预","is_gold":true}],"gold_letter":"L"},{"sample_id":"sample-67a2318574aada2f5af690c0","patient_id":"patient-e7eec542502a097814d58d8a","turn_id":"turn07","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 双侧耳鸣2年，发现右颈肿物3天；现病史: 患者2年前无明显诱因间断出现双侧耳鸣，近2周自觉右侧耳鸣症状加重，无鼻塞、涕血等不适。3天前无明显诱因发现右颈部肿物，遂就诊外院行CT检查示：鼻咽右侧壁增厚，考虑鼻咽癌可能，伴右侧乳突阻塞性炎症。今为进一步诊治收入我院。起病以来，患者无发热、咳嗽，无胸闷、胸痛，无恶心、呕吐，胃纳、睡眠、精神可，大小便正常，体重无明显变化。；阳性症状体征: 双耳鸣,右颈部肿物,右耳鸣；既往史: 10+年前因“腰椎间盘突出”行手术治疗，并予输血，无“输血反应”。否认\"肝炎\"、\"结核\"、\"高血压\"、\"糖尿病\"等疾病史；无外伤病史。过敏史:否认药物、食物过敏史。；个人史: 原籍出生、长大，无疫水、疫区暴露史；无吸烟、酗酒等不良嗜好。；家族史: 否认家族其他成员有肿瘤病史及遗传病史。；体格检查: T：36.0℃ P：81bpm R：18bpm BP：111/76mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。牙龈无肿胀、出血，咽无充血，双扁桃体无肿大。颈部检查详见肿瘤专科 检查。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率81bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。肛门外生殖器未见异常，生理反射存在，病理反射未引出。；专科检查: 间接鼻咽镜检查见双侧鼻腔通畅，内未窥及明显肿物；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显斑片或结节影。双侧肺门影未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见明显病变。\n- [全程D49] 检验组合: 丙氨酸氨基转移酶(ALT)-静脉血: 18.4U/L；球蛋白(GLO)-静脉血: 27.24g/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；γ-谷氨酰基转移酶(GGT)-静脉血: 42U/L；天门冬氨酸氨基转移酶(AST)-静脉血: 16.9U/L；平均红细胞体积(MCV)-静脉血: 90.3fL；血小板比容-静脉血: 11.8%；血小板分布宽度(PDW)-静脉血: 16.8%；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；钠离子(Na+)-静脉血: 138mmol/L；平均血小板体积(MPV)-静脉血: 6.76fL；总胆汁酸(TBA)-静脉血: 2.9umol/L；载脂蛋白B(apoB)-静脉血: 1.36g/L；总钙(Ca)-静脉血: 2.22mmol/L；载脂蛋白AI(apoAI)-静脉血: 1.16g/L；红细胞计数(RBC#)-静脉血: 4.3410E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.019；血红蛋白(Hb)-静脉血: 133.6g/L；阴离子间隙(AG)-静脉血: 15.6；中性粒细胞计数(Neut#)-静脉血: 3.510E9/L；C-反应蛋白(CRP)-静脉血: 10.3mg/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.6mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.17；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.87mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.9%；淀粉样蛋白A(SAA)-静脉血: 24.6mg/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.7pg；甘油三酯(TG)-静脉血: 2.36mmol/L；直接胆红素(DBIL)-静脉血: 3.3umol/L；总蛋白(TP)-静脉血: 71.04g/L；碱性磷酸酶(ALP)-静脉血: 108.1U/L；总胆固醇(TC)-静脉血: 5.6mmol/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；单核细胞百分比(Mono%)-静脉血: 0.104；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.92；平均红细胞血红蛋白浓度(MCHC)-静脉血: 340.7g/……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D55] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位置位于第3胸椎体右下缘，估计位于右侧头臂静脉内。；检查结论: PICC管末端位置如上所述。\n- [全程D55] 检验组合: 葡萄糖(Glu)-尿液: +- 2.8mmol（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: 1+ 0.3g（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 3/μL；白细胞计数(WBC#)-尿液: 20/μL；酸碱度(pH)-尿液: 5.5；颜色-尿液: Yellow；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: +- 0.1g（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；比重(SG)-尿液: 1.021；红细胞计数(RBC#)-尿液: 2/μL；红细胞计数(RBC#)-尿液: 2/μL；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.025；浊度(TRUB)-尿液: 清亮；粘液丝计数(MUCS#)-尿液: 80/μL；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；葡萄糖(Glu)-尿液: 3+ 17mmol（参考: 阴性）；白细胞计数(WBC#)-尿液: 4/μL\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D63] 检验组合: 红细胞计数(RBC#)-静脉血: 3.910E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞计数(Neut#)-静脉血: 5.210E9/L；阴离子间隙(AG)-静脉血: 16.2；尿酸(UA)-静脉血: 364.7umol/L；钠离子(Na+)-静脉血: 132.6mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；球蛋白(GLO)-静脉血: 26.68g/L；单核细胞计数(Mono#)-静脉血: 1.110E9/L；葡萄糖(Glu)-静脉血: 4.06mmol/L；单核细胞百分比(Mono%)-静脉血: 0.166；平均血小板体积(MPV)-静脉血: 8.1fL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；尿素氮(BUN)-静脉血: 7.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 20.7U/L；白细胞计数(WBC#)-静脉血: 6.6710E9/L；甘油三酯(TG)-静脉血: 1.04mmol/L；氯离子(Cl-)-静脉血: 93.2mmol/L；磷(P)-静脉血: 1.24mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.2mmol/L；平均红细胞体积(MCV)-静脉血: 89.2fL；总胆汁酸(TBA)-静脉血: 0.9umol/L；载脂蛋白B(apoB)-静脉血: 1.28g/L；总钙(Ca)-静脉血: 2.2mmol/L；镁离子(Mg2+)-静脉血: 1.01mmol/L；红细胞比容(Hct)-静脉血: 34.8%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；乳酸脱氢酶(LDH)-静脉血: 151.8U/L；间接胆红素(IBIL)-静脉血: 9umolL；载脂蛋白AI(apoAI)-静脉血: 0.91g/L；总胆红素(TBIL)-静脉血: 12.8umol/L；大血小板百分比(P-LCR%)-静脉血: 9.3%；中性粒细胞百分比(Neut%)-静脉血: 0.782；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；血小板分布宽度(PDW)-静脉血: 8%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.1；碱性磷酸酶(ALP)-静脉血: 113.9U/L；平均红……\n- [全程D69] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌治疗后，与某次就诊时间0日片对比: 鼻咽腔未见明显狭窄，鼻咽顶后壁、右侧壁轻度增厚，见少许软组织影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，右侧咽隐窝消失。鼻咽左侧壁未见明显增厚，左侧咽隐窝稍浅。右侧咽旁脂肪间隙稍变窄，左侧咽旁脂肪间隙未见异常。 右侧腭帆提张肌信号不均匀，左侧腭帆提张肌、双侧头长肌未见受侵征象。 双侧翼腭窝、上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 口咽双侧壁未见受累增厚，病变未累及双侧后鼻孔。 右侧翼突内份及内板、蝶骨基底部右份骨质信号减低，增强扫描轻度强化，范围较前缩小。余颅底未见明确骨质破坏征象。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦、右侧乳突粘膜增厚，双侧上颌窦见少量分泌物，蝶窦、左侧乳突充气良好，骨壁完整。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 右侧咽后淋巴结短径约6mm，较前缩小。左侧咽后未见肿大淋巴结。 右颈IIb区见稍大淋巴结，较大者短径约7mm，增强扫描明显强化，较前缩小。双颈IIa区见数个小淋巴结，较大者短径约5mm，增强扫描轻度强化，大致同前。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 扫描所见脑实质未见明显异常。；检查结论: 鼻咽癌治疗后，与某次就诊时间0日片对比: 鼻咽病变较前缩小。 颅底骨质破坏，较前有修复。 右侧咽后肿大淋巴结，考虑转移，较前缩小。 右颈IIb区淋巴结肿大，考虑转移，较前缩小。 双颈IIa区小淋巴结。 副鼻窦炎，右侧乳突炎。\n- [全程D69] 检验组合: 直接胆红素(DBIL)-静脉血: 3.2umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.033；阴离子间隙(AG)-静脉血: 16.9；白细胞计数(WBC#)-静脉血: 3.510E9/L；总胆红素(TBIL)-静脉血: 11.7umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 24.1U/L；尿酸(UA)-静脉血: 468.3umol/L；白蛋白(ALB)-静脉血: 39.4g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.016；红细胞比容(Hct)-静脉血: 33.6%；磷(P)-静脉血: 1.09mmol/L；C-反应蛋白(CRP)-静脉血: 20.73mg/L；载脂蛋白B(apoB)-静脉血: 1.37g/L；葡萄糖(Glu)-静脉血: 4.3mmol/L；单核细胞百分比(Mono%)-静脉血: 0.112；血小板比容-静脉血: 15.3%；肌酐(Crea)-静脉血: 62.2umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4%；碱性磷酸酶(ALP)-静脉血: 92.8U/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.9mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.57；总蛋白(TP)-静脉血: 64.43g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.86；淋巴细胞计数(Lymph#)-静脉血: 0.110E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；球蛋白(GLO)-静脉血: 25.03g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 36.2U/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.839；甘油三酯(TG)-静脉血: 1.02mmol/L；间接胆红素(IBIL)-静脉血: 8.5umolL；丙氨酸氨基转移酶(ALT)-静脉血: 16.3U/L；血小板计数(PLT#)-静脉血: 266.210E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.27mmol/L；平均血小板体积(MPV)-静脉血: 5.77fL；胱抑素(Cys-C)-静脉血: 0.73mg/L；尿素氮(BUN)-静脉血: 5mmol/L；血小板分布宽度(PDW)-静脉……\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D54] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者放疗16次，口腔黏膜反应2度，放射性皮炎1度，患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：KPS 90分；张口门齿距4.5cm，鼻咽顶后壁、右侧壁肿物，较前缩小；右颈II区扪及一肿大淋巴结，大小约1X1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。颅神经检查：阴性。今日[姓名已隐去]副医生信息已隐藏后示：今日开始行第2程同时期DDP方案（DDP100mg/m2）化疗，继续放疗，续观。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D64] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者放疗22次，口腔黏膜反应2度，放射性皮炎1度，患者诉喉痛，余未诉特殊不适。生命体征平稳。查体：KPS 90分；张口门齿距4.5cm，鼻咽顶后壁、右侧壁肿物，较前缩小；双颈未触及肿大淋巴结；颅神经检查：阴性。今日[姓名已隐去]副医生信息已隐藏后示：患者诉喉痛，予患者奥施康定止痛，继续放疗，续观。\n- [全程D69] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者放疗26次，口腔黏膜反应3度，放射性皮炎2度，患者诉喉痛，余未诉特殊不适。生命体征平稳。查体：KPS 90分；张口门齿距4.5cm，鼻咽肿物已不明显；双颈未触及肿大淋巴结；颅神经检查：阴性。今日[姓名已隐去]医生信息已隐藏后示：患者诉喉痛，继续予患者奥施康定止痛，继续放疗，续观。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 提前终止放疗，转为单纯全身化疗或靶向治疗，并给予静脉营养支持。\nB. 继续完成原计划的根治性放疗，给予阿片类药物镇痛及静脉补液与营养支持治疗。\nC. 暂停放疗直至口腔黏膜反应降至1度，期间给予广谱抗生素及静脉糖皮质激素治疗。\nD. 继续放疗，重新定位并缩减放疗靶区及处方剂量，同时给予非甾体类抗炎药镇痛。\nE. 暂停放疗，更改全身治疗方案为TPF方案化疗，待局部症状好转后择期恢复放疗。\nF. 继续完成根治性放疗，给予局部利多卡因含漱液及非甾体类抗炎药镇痛，并仅口服营养支持，无需静脉补液。\nG. 终止放疗，行右侧颈部淋巴结清扫术及鼻咽原发灶挽救性切除术。\nH. 继续放疗并同步行第3程大剂量顺铂化疗，给予阿片类药物镇痛，暂不予静脉补液。\nI. 暂停放疗，行鼻咽部内镜下微创手术切除残留病灶，术后继续静脉补液支持。\nJ. 继续完成根治性放疗，行经皮内镜下胃造瘘术（PEG）以建立长期肠内营养途径。\nK. 提前终止放疗，改为PD-1抑制剂联合化疗的全身系统性维持治疗。\nL. 继续放疗，给予大剂量静脉糖皮质激素冲击治疗缓解黏膜反应，并继续口服营养液。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"提前终止放疗，转为单纯全身化疗或靶向治疗，并给予静脉营养支持。","is_gold":false},{"letter":"B","text":"继续完成原计划的根治性放疗，给予阿片类药物镇痛及静脉补液与营养支持治疗。","is_gold":true},{"letter":"C","text":"暂停放疗直至口腔黏膜反应降至1度，期间给予广谱抗生素及静脉糖皮质激素治疗。","is_gold":false},{"letter":"D","text":"继续放疗，重新定位并缩减放疗靶区及处方剂量，同时给予非甾体类抗炎药镇痛。","is_gold":false},{"letter":"E","text":"暂停放疗，更改全身治疗方案为TPF方案化疗，待局部症状好转后择期恢复放疗。","is_gold":false},{"letter":"F","text":"继续完成根治性放疗，给予局部利多卡因含漱液及非甾体类抗炎药镇痛，并仅口服营养支持，无需静脉补液。","is_gold":false},{"letter":"G","text":"终止放疗，行右侧颈部淋巴结清扫术及鼻咽原发灶挽救性切除术。","is_gold":false},{"letter":"H","text":"继续放疗并同步行第3程大剂量顺铂化疗，给予阿片类药物镇痛，暂不予静脉补液。","is_gold":false},{"letter":"I","text":"暂停放疗，行鼻咽部内镜下微创手术切除残留病灶，术后继续静脉补液支持。","is_gold":false},{"letter":"J","text":"继续完成根治性放疗，行经皮内镜下胃造瘘术（PEG）以建立长期肠内营养途径。","is_gold":false},{"letter":"K","text":"提前终止放疗，改为PD-1抑制剂联合化疗的全身系统性维持治疗。","is_gold":false},{"letter":"L","text":"继续放疗，给予大剂量静脉糖皮质激素冲击治疗缓解黏膜反应，并继续口服营养液。","is_gold":false}],"gold_letter":"B"},{"sample_id":"sample-5549469386bb20d944ce932b","patient_id":"patient-e7eec542502a097814d58d8a","turn_id":"turn08","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：腭帆提肌、翼突基底部、蝶骨基底部。\n文本分期信息：N1，M0。\n综合TNM状态：T3N1M0。\n综合分期：II。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 双侧耳鸣2年，发现右颈肿物3天；现病史: 患者2年前无明显诱因间断出现双侧耳鸣，近2周自觉右侧耳鸣症状加重，无鼻塞、涕血等不适。3天前无明显诱因发现右颈部肿物，遂就诊外院行CT检查示：鼻咽右侧壁增厚，考虑鼻咽癌可能，伴右侧乳突阻塞性炎症。今为进一步诊治收入我院。起病以来，患者无发热、咳嗽，无胸闷、胸痛，无恶心、呕吐，胃纳、睡眠、精神可，大小便正常，体重无明显变化。；阳性症状体征: 双耳鸣,右颈部肿物,右耳鸣；既往史: 10+年前因“腰椎间盘突出”行手术治疗，并予输血，无“输血反应”。否认\"肝炎\"、\"结核\"、\"高血压\"、\"糖尿病\"等疾病史；无外伤病史。过敏史:否认药物、食物过敏史。；个人史: 原籍出生、长大，无疫水、疫区暴露史；无吸烟、酗酒等不良嗜好。；家族史: 否认家族其他成员有肿瘤病史及遗传病史。；体格检查: T：36.0℃ P：81bpm R：18bpm BP：111/76mmHg发育正常，营养一般，神志清楚，自主体位，查体合作。全身皮肤粘膜无苍白、黄染、水肿、出血。巩膜无苍白、黄染，双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏。牙龈无肿胀、出血，咽无充血，双扁桃体无肿大。颈部检查详见肿瘤专科 检查。胸骨无压痛。双肺呼吸音清，未闻及干湿啰音。心率81bpm，心律齐，心脏各瓣膜听诊区未闻及杂音。腹平软，肝脾肋下未及，肝区及双肾区无叩击痛，肠鸣音正常，约4次/分。肛门外生殖器未见异常，生理反射存在，病理反射未引出。；专科检查: 间接鼻咽镜检查见双侧鼻腔通畅，内未窥及明显肿物；右颈II区扪及一肿大淋巴结，大小约2*1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。；KPS: 90；ECOG:\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【已完成检查与客观结果】\n- [全程D1] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双肺纹理清晰，未见明显斑片或结节影。双侧肺门影未见增大，气管居中，纵隔未见增宽，心影大小形态未见异常。双侧膈面光整，双侧肋膈角锐利。；检查结论: 心肺未见明显病变。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D55] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位置位于第3胸椎体右下缘，估计位于右侧头臂静脉内。；检查结论: PICC管末端位置如上所述。\n- [全程D55] 检验组合: 葡萄糖(Glu)-尿液: +- 2.8mmol（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: 1+ 0.3g（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 3/μL；白细胞计数(WBC#)-尿液: 20/μL；酸碱度(pH)-尿液: 5.5；颜色-尿液: Yellow；酮体(KET)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 5.5；白细胞(LEU)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: +- 0.1g（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；比重(SG)-尿液: 1.021；红细胞计数(RBC#)-尿液: 2/μL；红细胞计数(RBC#)-尿液: 2/μL；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.025；浊度(TRUB)-尿液: 清亮；粘液丝计数(MUCS#)-尿液: 80/μL；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；葡萄糖(Glu)-尿液: 3+ 17mmol（参考: 阴性）；白细胞计数(WBC#)-尿液: 4/μL\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D63] 检验组合: 红细胞计数(RBC#)-静脉血: 3.910E12/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；中性粒细胞计数(Neut#)-静脉血: 5.210E9/L；阴离子间隙(AG)-静脉血: 16.2；尿酸(UA)-静脉血: 364.7umol/L；钠离子(Na+)-静脉血: 132.6mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 30.5pg；球蛋白(GLO)-静脉血: 26.68g/L；单核细胞计数(Mono#)-静脉血: 1.110E9/L；葡萄糖(Glu)-静脉血: 4.06mmol/L；单核细胞百分比(Mono%)-静脉血: 0.166；平均血小板体积(MPV)-静脉血: 8.1fL；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.52；尿素氮(BUN)-静脉血: 7.3mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 20.7U/L；白细胞计数(WBC#)-静脉血: 6.6710E9/L；甘油三酯(TG)-静脉血: 1.04mmol/L；氯离子(Cl-)-静脉血: 93.2mmol/L；磷(P)-静脉血: 1.24mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.2mmol/L；平均红细胞体积(MCV)-静脉血: 89.2fL；总胆汁酸(TBA)-静脉血: 0.9umol/L；载脂蛋白B(apoB)-静脉血: 1.28g/L；总钙(Ca)-静脉血: 2.2mmol/L；镁离子(Mg2+)-静脉血: 1.01mmol/L；红细胞比容(Hct)-静脉血: 34.8%；嗜酸性粒细胞计数(Eos#)-静脉血: 010E9/L；乳酸脱氢酶(LDH)-静脉血: 151.8U/L；间接胆红素(IBIL)-静脉血: 9umolL；载脂蛋白AI(apoAI)-静脉血: 0.91g/L；总胆红素(TBIL)-静脉血: 12.8umol/L；大血小板百分比(P-LCR%)-静脉血: 9.3%；中性粒细胞百分比(Neut%)-静脉血: 0.782；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；血小板分布宽度(PDW)-静脉血: 8%；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.004；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.1；碱性磷酸酶(ALP)-静脉血: 113.9U/L；平均红……\n- [全程D69] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌治疗后，与某次就诊时间0日片对比: 鼻咽腔未见明显狭窄，鼻咽顶后壁、右侧壁轻度增厚，见少许软组织影，T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，右侧咽隐窝消失。鼻咽左侧壁未见明显增厚，左侧咽隐窝稍浅。右侧咽旁脂肪间隙稍变窄，左侧咽旁脂肪间隙未见异常。 右侧腭帆提张肌信号不均匀，左侧腭帆提张肌、双侧头长肌未见受侵征象。 双侧翼腭窝、上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 口咽双侧壁未见受累增厚，病变未累及双侧后鼻孔。 右侧翼突内份及内板、蝶骨基底部右份骨质信号减低，增强扫描轻度强化，范围较前缩小。余颅底未见明确骨质破坏征象。 双侧海绵窦形态正常，未见增宽。蝶鞍形态正常，其内未见占位性病变。 双侧筛窦、右侧乳突粘膜增厚，双侧上颌窦见少量分泌物，蝶窦、左侧乳突充气良好，骨壁完整。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 右侧咽后淋巴结短径约6mm，较前缩小。左侧咽后未见肿大淋巴结。 右颈IIb区见稍大淋巴结，较大者短径约7mm，增强扫描明显强化，较前缩小。双颈IIa区见数个小淋巴结，较大者短径约5mm，增强扫描轻度强化，大致同前。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变。喉咽腔形态正常，未见占位性病变。双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 扫描所见脑实质未见明显异常。；检查结论: 鼻咽癌治疗后，与某次就诊时间0日片对比: 鼻咽病变较前缩小。 颅底骨质破坏，较前有修复。 右侧咽后肿大淋巴结，考虑转移，较前缩小。 右颈IIb区淋巴结肿大，考虑转移，较前缩小。 双颈IIa区小淋巴结。 副鼻窦炎，右侧乳突炎。\n- [全程D69] 检验组合: 直接胆红素(DBIL)-静脉血: 3.2umol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.033；阴离子间隙(AG)-静脉血: 16.9；白细胞计数(WBC#)-静脉血: 3.510E9/L；总胆红素(TBIL)-静脉血: 11.7umol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 24.1U/L；尿酸(UA)-静脉血: 468.3umol/L；白蛋白(ALB)-静脉血: 39.4g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.016；红细胞比容(Hct)-静脉血: 33.6%；磷(P)-静脉血: 1.09mmol/L；C-反应蛋白(CRP)-静脉血: 20.73mg/L；载脂蛋白B(apoB)-静脉血: 1.37g/L；葡萄糖(Glu)-静脉血: 4.3mmol/L；单核细胞百分比(Mono%)-静脉血: 0.112；血小板比容-静脉血: 15.3%；肌酐(Crea)-静脉血: 62.2umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.4%；碱性磷酸酶(ALP)-静脉血: 92.8U/L；血液二氧化碳含量ctCO2(B)-静脉血: 23.9mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.57；总蛋白(TP)-静脉血: 64.43g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.86；淋巴细胞计数(Lymph#)-静脉血: 0.110E9/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；球蛋白(GLO)-静脉血: 25.03g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 36.2U/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.839；甘油三酯(TG)-静脉血: 1.02mmol/L；间接胆红素(IBIL)-静脉血: 8.5umolL；丙氨酸氨基转移酶(ALT)-静脉血: 16.3U/L；血小板计数(PLT#)-静脉血: 266.210E9/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.27mmol/L；平均血小板体积(MPV)-静脉血: 5.77fL；胱抑素(Cys-C)-静脉血: 0.73mg/L；尿素氮(BUN)-静脉血: 5mmol/L；血小板分布宽度(PDW)-静脉……\n- [全程D70] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质回声均匀，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉内径约11mm，门静脉最大血流速度约23cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约40×35×31mm，包膜光滑，实质回声不均匀，可见强回声斑。 腹主动脉旁未见明确肿物回声。；检查结论: 前列腺钙化。 肝脏、胆囊、脾脏、胰腺、双肾、膀胱未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D54] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者放疗16次，口腔黏膜反应2度，放射性皮炎1度，患者未诉特殊不适，饮食、睡眠、精神可，大小便如常。生命体征平稳。查体：KPS 90分；张口门齿距4.5cm，鼻咽顶后壁、右侧壁肿物，较前缩小；右颈II区扪及一肿大淋巴结，大小约1X1cm,质韧，活动尚可。颈部余区未扪及异常肿大淋巴结；头颈其他部位未见明显异常。颅神经检查：阴性。今日[姓名已隐去]副医生信息已隐藏后示：今日开始行第2程同时期DDP方案（DDP100mg/m2）化疗，继续放疗，续观。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D64] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者放疗22次，口腔黏膜反应2度，放射性皮炎1度，患者诉喉痛，余未诉特殊不适。生命体征平稳。查体：KPS 90分；张口门齿距4.5cm，鼻咽顶后壁、右侧壁肿物，较前缩小；双颈未触及肿大淋巴结；颅神经检查：阴性。今日[姓名已隐去]副医生信息已隐藏后示：患者诉喉痛，予患者奥施康定止痛，继续放疗，续观。\n- [全程D69] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者放疗26次，口腔黏膜反应3度，放射性皮炎2度，患者诉喉痛，余未诉特殊不适。生命体征平稳。查体：KPS 90分；张口门齿距4.5cm，鼻咽肿物已不明显；双颈未触及肿大淋巴结；颅神经检查：阴性。今日[姓名已隐去]医生信息已隐藏后示：患者诉喉痛，继续予患者奥施康定止痛，继续放疗，续观。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 影像学评估病灶较前缩小，疗效肯定，需暂停放疗，待3度放射性口腔黏膜炎恢复至1度后再恢复放疗，期间予静脉营养支持。\nB. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，局部使用含漱液及非甾体类抗炎药镇痛，停用阿片类药物。\nC. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎伴咽痛，继续予羟考酮镇痛及静脉营养支持，并常规行PICC导管护理。\nD. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，行预防性气管切开以防气道水肿梗阻，并予静脉营养支持。\nE. 影像学评估病灶较前缩小，疗效肯定，已完成26次放疗且出现3度黏膜炎，提前结束放疗并转为辅助化疗，同时予羟考酮镇痛。\nF. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，拔除PICC导管以预防导管相关性血流感染，改用外周静脉营养。\nG. 影像学评估病灶未见明显缩小，疗效评价为疾病稳定（SD），重新定位更改放疗靶区并提高局部照射剂量，同时予羟考酮镇痛及静脉营养支持。\nH. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，立即行经皮内镜下胃造瘘术（PEG）以保证肠内营养。\nI. 影像学评估病灶完全消失，疗效评价为完全缓解（CR），提前终止放疗，进入随访观察期，对咽痛继续予羟考酮镇痛。\nJ. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；放疗已达26次且肿瘤退缩，同步加用西妥昔单抗以增强局部控制，并予静脉营养支持。\nK. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，静脉大剂量使用糖皮质激素以快速减轻炎症反应。\nL. 影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；出现3度放射性口腔黏膜炎，将后续放疗改为姑息性低剂量放疗，并予羟考酮镇痛。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"影像学评估病灶较前缩小，疗效肯定，需暂停放疗，待3度放射性口腔黏膜炎恢复至1度后再恢复放疗，期间予静脉营养支持。","is_gold":false},{"letter":"B","text":"影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，局部使用含漱液及非甾体类抗炎药镇痛，停用阿片类药物。","is_gold":false},{"letter":"C","text":"影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎伴咽痛，继续予羟考酮镇痛及静脉营养支持，并常规行PICC导管护理。","is_gold":true},{"letter":"D","text":"影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，行预防性气管切开以防气道水肿梗阻，并予静脉营养支持。","is_gold":false},{"letter":"E","text":"影像学评估病灶较前缩小，疗效肯定，已完成26次放疗且出现3度黏膜炎，提前结束放疗并转为辅助化疗，同时予羟考酮镇痛。","is_gold":false},{"letter":"F","text":"影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，拔除PICC导管以预防导管相关性血流感染，改用外周静脉营养。","is_gold":false},{"letter":"G","text":"影像学评估病灶未见明显缩小，疗效评价为疾病稳定（SD），重新定位更改放疗靶区并提高局部照射剂量，同时予羟考酮镇痛及静脉营养支持。","is_gold":false},{"letter":"H","text":"影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，立即行经皮内镜下胃造瘘术（PEG）以保证肠内营养。","is_gold":false},{"letter":"I","text":"影像学评估病灶完全消失，疗效评价为完全缓解（CR），提前终止放疗，进入随访观察期，对咽痛继续予羟考酮镇痛。","is_gold":false},{"letter":"J","text":"影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；放疗已达26次且肿瘤退缩，同步加用西妥昔单抗以增强局部控制，并予静脉营养支持。","is_gold":false},{"letter":"K","text":"影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；对3度放射性口腔黏膜炎，静脉大剂量使用糖皮质激素以快速减轻炎症反应。","is_gold":false},{"letter":"L","text":"影像学评估病灶较前缩小，疗效肯定，继续原计划根治性放疗；出现3度放射性口腔黏膜炎，将后续放疗改为姑息性低剂量放疗，并予羟考酮镇痛。","is_gold":false}],"gold_letter":"C"}]}
+{"patient_id":"patient-f25e20b1e5c6eea840d4cc21","bootstrap_cluster_id":"cluster-002","turns":[{"sample_id":"sample-4da20c3d27d6501be61a2584","patient_id":"patient-f25e20b1e5c6eea840d4cc21","turn_id":"turn01","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、鼻腔、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现右颈部肿块伴耳鸣、听力下降4个月。；现病史: 缘于4个月前患者无意中发现右颈部包块，如拇指大小，无压痛，伴耳鸣、听力下降，颈部包块后逐渐增大，近1周偶发头痛，白天明显，视物如常，无鼻塞、鼻血、面麻、等不适。为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,鼻咽肿物,右颈部包块,头痛；既往史: 4年前患痔疮，已治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:青霉素皮试阳性。；个人史: 长期居于原籍，无疫区居住史。吸烟3-4支/天*10年，饮酒1-2次/月。否认不洁性生活史。；家族史: 舅舅患鼻咽癌，舅妈患肺癌。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：103/73mmHg,Ht：174cm，Wt：79kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；右颈IIa区可扪及1个淋巴结，最大径2.5×2.5cm，左颈IIa区扪及1个淋巴结，最大径约3*3cm，无融合，质地韧，边界模糊，活动度好，无压痛，无皮肤浸润，无溃疡，右颈III区可见一长约4cm手术疤痕；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 电子鼻咽镜及鼻咽活检，鼻咽及颈部CT平扫+增强，胸部X线片，腹部彩超，基线血液学检查。\nB. 颈部淋巴结细针穿刺活检，鼻咽及颈部MRI平扫+增强，胸腹部CT平扫+增强，全身骨扫描。\nC. 全身PET-CT检查，电子鼻咽镜及鼻咽活检，头颅MRI平扫+增强，常规心电图及血液学检查。\nD. 电子鼻咽镜及鼻咽活检，鼻咽及颈部MRI平扫+增强，腹部及浅表淋巴结彩超，心电图，包含EBV抗体的基线血液学检查。\nE. 电子鼻咽镜检查，鼻咽及颈部MRI平扫+增强，胸腹部CT平扫+增强，待影像学评估后再决定是否活检。\nF. 鼻咽及颈部MRI平扫+增强，胸腹部CT平扫+增强，全身骨扫描，基线血液学检查。\nG. 电子鼻咽镜及鼻咽活检，鼻咽及颈部MRI平扫，腹部彩超，胸部CT平扫，基线血液学检查。\nH. 颈部淋巴结切除活检，鼻咽及颈部CT平扫+增强，腹部彩超，心电图，包含EBV抗体的基线血液学检查。\nI. 电子鼻咽镜及鼻咽活检，头颈部PET-CT，腹部及盆腔MRI平扫+增强，心电图，基线血液学检查。\nJ. 电子鼻咽镜及鼻咽活检，鼻咽及颈部MRI平扫+增强，常规心电图及血液学检查，并直接安排诱导化疗。\nK. 鼻咽刷片细胞学检查，鼻咽及颈部MRI平扫+增强，胸腹部彩超，全身骨扫描，基线血液学检查。\nL. 电子鼻咽镜及鼻咽活检，鼻咽及颈部CT平扫，全身骨扫描，腹部彩超，心电图，基线血液学检查。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"电子鼻咽镜及鼻咽活检，鼻咽及颈部CT平扫+增强，胸部X线片，腹部彩超，基线血液学检查。","is_gold":false},{"letter":"B","text":"颈部淋巴结细针穿刺活检，鼻咽及颈部MRI平扫+增强，胸腹部CT平扫+增强，全身骨扫描。","is_gold":false},{"letter":"C","text":"全身PET-CT检查，电子鼻咽镜及鼻咽活检，头颅MRI平扫+增强，常规心电图及血液学检查。","is_gold":false},{"letter":"D","text":"电子鼻咽镜及鼻咽活检，鼻咽及颈部MRI平扫+增强，腹部及浅表淋巴结彩超，心电图，包含EBV抗体的基线血液学检查。","is_gold":true},{"letter":"E","text":"电子鼻咽镜检查，鼻咽及颈部MRI平扫+增强，胸腹部CT平扫+增强，待影像学评估后再决定是否活检。","is_gold":false},{"letter":"F","text":"鼻咽及颈部MRI平扫+增强，胸腹部CT平扫+增强，全身骨扫描，基线血液学检查。","is_gold":false},{"letter":"G","text":"电子鼻咽镜及鼻咽活检，鼻咽及颈部MRI平扫，腹部彩超，胸部CT平扫，基线血液学检查。","is_gold":false},{"letter":"H","text":"颈部淋巴结切除活检，鼻咽及颈部CT平扫+增强，腹部彩超，心电图，包含EBV抗体的基线血液学检查。","is_gold":false},{"letter":"I","text":"电子鼻咽镜及鼻咽活检，头颈部PET-CT，腹部及盆腔MRI平扫+增强，心电图，基线血液学检查。","is_gold":false},{"letter":"J","text":"电子鼻咽镜及鼻咽活检，鼻咽及颈部MRI平扫+增强，常规心电图及血液学检查，并直接安排诱导化疗。","is_gold":false},{"letter":"K","text":"鼻咽刷片细胞学检查，鼻咽及颈部MRI平扫+增强，胸腹部彩超，全身骨扫描，基线血液学检查。","is_gold":false},{"letter":"L","text":"电子鼻咽镜及鼻咽活检，鼻咽及颈部CT平扫，全身骨扫描，腹部彩超，心电图，基线血液学检查。","is_gold":false}],"gold_letter":"D"},{"sample_id":"sample-cef4654d5f291c72b760bfcf","patient_id":"patient-f25e20b1e5c6eea840d4cc21","turn_id":"turn02","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、鼻腔、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现右颈部肿块伴耳鸣、听力下降4个月。；现病史: 缘于4个月前患者无意中发现右颈部包块，如拇指大小，无压痛，伴耳鸣、听力下降，颈部包块后逐渐增大，近1周偶发头痛，白天明显，视物如常，无鼻塞、鼻血、面麻、等不适。为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,鼻咽肿物,右颈部包块,头痛；既往史: 4年前患痔疮，已治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:青霉素皮试阳性。；个人史: 长期居于原籍，无疫区居住史。吸烟3-4支/天*10年，饮酒1-2次/月。否认不洁性生活史。；家族史: 舅舅患鼻咽癌，舅妈患肺癌。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：103/73mmHg,Ht：174cm，Wt：79kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；右颈IIa区可扪及1个淋巴结，最大径2.5×2.5cm，左颈IIa区扪及1个淋巴结，最大径约3*3cm，无融合，质地韧，边界模糊，活动度好，无压痛，无皮肤浸润，无溃疡，右颈III区可见一长约4cm手术疤痕；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 电轴左偏(轻度) 正常范围心电图\n- [全程D1] 检验组合: 血小板比容-静脉血: 19%；载脂蛋白B(apoB)-静脉血: 1.03g/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；肌酐(Crea)-静脉血: 66.2umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.1；球蛋白(GLO)-静脉血: 31.61g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.011；尿胆原(URO)-尿液: -（参考: 阴性）；红细胞比容(Hct)-静脉血: 48.9%；凝血酶原时间活动度(PTA)-静脉血: 111.2%；隐血(OB)-粪便: 阴性（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.91mg/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；碱性磷酸酶(ALP)-静脉血: 76.3U/L；载脂蛋白AI(apoAI)-静脉血: 1.04g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；葡萄糖(Glu)-静脉血: 4.96mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.5；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；血小板分布宽度(PDW)-静脉血: 13.9%；淋巴细胞百分比(Lymph%)-静脉血: 0.315；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；总胆红素(TBIL)-静脉血: 7umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.910E9/L；Rh血型-静脉血: 阳性；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.2sec.；酮体(KET)-尿液: -（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 21.9mmol/L；浊度(TRUB)-尿液: 清亮；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 4.88mmol/L；C-反应蛋白(C……\n- [全程D3] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D7] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及双侧壁增厚，以右侧为著，T1WI呈等信号，T2WI呈稍高信号，增强扫描强化明显，右侧咽隐窝消失，见增厚组织占据，左侧咽隐窝变浅。病变与右侧中鼻甲分界不清，口咽双侧壁未见增厚。 右侧咽旁间隙及右侧咽后间隙见不规则肿物突入。双侧腭帆提肌、右侧腭帆张肌、右侧头长肌受侵。左侧腭帆张肌、双侧翼内肌及双侧翼外肌未见受侵。 右侧翼腭窝内见少许软组织信号，增强扫描明显强化。 左侧翼腭窝、双侧上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 斜坡、蝶骨基底部、右侧翼突基底部及内外板、右侧蝶骨大翼及右侧岩尖骨质信号减低，增强扫描见不均匀强化。 右侧破裂扩大，右侧海绵窦增宽，内见不规则软组织信号灶，右侧蝶窦内见软组织信号灶突入，增强扫描上述病变强化明显。 左侧海绵窦未见增宽。蝶鞍形态正常，其内未见占位性病变。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧上颌窦、筛窦及蝶窦粘膜增厚。右侧乳突内见大量分泌物。 右侧咽后见肿大淋巴结，大者约12mm×17mm，增强扫描强化明显。双颈II、III、V区见多个肿大淋巴结，最大者约23mm×29mm，部分边界欠清晰，包膜不完整，信号欠均匀，增强扫描明显不均匀强化。双侧腮腺内及腮腺旁见数个淋巴结，大者短径约6mm，增强扫描强化明显。双颈I区见数个淋巴结，大者短径约7mm，信号尚均匀。 甲状腺双叶及峡部、喉咽、双侧颌下腺信号均匀，未见占位性病变。；检查结论: 鼻咽病变，考虑鼻咽癌，侵犯范围如上述。 颅底骨质破坏。 右侧咽后、双颈II、III、V区多发肿大淋巴结，考虑转移。 双侧腮腺内及腮腺旁数个淋巴结，性质待定。 鼻窦炎、右侧乳突炎。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 安排适形调强放射治疗（IMRT）及同步化疗\nB. 行鼻咽镜下活检，并补充头颅PET-MR评估颅底受侵范围\nC. 行右颈部淋巴结细针穿刺活检，并补充胸部CT及全身骨扫描\nD. 行鼻咽镜下活检，并补充腹部增强CT排查肝脏转移\nE. 行鼻咽镜下活检，并补充胸部CT、全身骨扫描及血清EBV DNA检测\nF. 行鼻咽镜下活检，直接进行放疗定位及靶区勾画\nG. 行全身PET-CT进行分期，随后开始诱导化疗\nH. 行鼻咽镜下活检，并补充颈部超声评估淋巴结包膜外侵犯\nI. 行鼻咽镜下活检，并补充胸部X线及头颅CT平扫\nJ. 行鼻咽镜下活检，并补充骨髓穿刺排除骨髓转移\nK. 行鼻咽镜下活检，并补充全身骨扫描，暂缓胸部影像学检查\nL. 行右颈部淋巴结切除活检，并补充胸部CT及血清EBV DNA检测\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"安排适形调强放射治疗（IMRT）及同步化疗","is_gold":false},{"letter":"B","text":"行鼻咽镜下活检，并补充头颅PET-MR评估颅底受侵范围","is_gold":false},{"letter":"C","text":"行右颈部淋巴结细针穿刺活检，并补充胸部CT及全身骨扫描","is_gold":false},{"letter":"D","text":"行鼻咽镜下活检，并补充腹部增强CT排查肝脏转移","is_gold":false},{"letter":"E","text":"行鼻咽镜下活检，并补充胸部CT、全身骨扫描及血清EBV DNA检测","is_gold":true},{"letter":"F","text":"行鼻咽镜下活检，直接进行放疗定位及靶区勾画","is_gold":false},{"letter":"G","text":"行全身PET-CT进行分期，随后开始诱导化疗","is_gold":false},{"letter":"H","text":"行鼻咽镜下活检，并补充颈部超声评估淋巴结包膜外侵犯","is_gold":false},{"letter":"I","text":"行鼻咽镜下活检，并补充胸部X线及头颅CT平扫","is_gold":false},{"letter":"J","text":"行鼻咽镜下活检，并补充骨髓穿刺排除骨髓转移","is_gold":false},{"letter":"K","text":"行鼻咽镜下活检，并补充全身骨扫描，暂缓胸部影像学检查","is_gold":false},{"letter":"L","text":"行右颈部淋巴结切除活检，并补充胸部CT及血清EBV DNA检测","is_gold":false}],"gold_letter":"E"},{"sample_id":"sample-5ae78b6dca4ce8a61a44d0ca","patient_id":"patient-f25e20b1e5c6eea840d4cc21","turn_id":"turn04","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、鼻腔、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现右颈部肿块伴耳鸣、听力下降4个月。；现病史: 缘于4个月前患者无意中发现右颈部包块，如拇指大小，无压痛，伴耳鸣、听力下降，颈部包块后逐渐增大，近1周偶发头痛，白天明显，视物如常，无鼻塞、鼻血、面麻、等不适。就诊[机构已隐去]，行右颈部淋巴结活检术，病理示转移性低分化鳞癌，行电子鼻咽镜检查见鼻咽肿物，取活检病理示可疑癌。为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,鼻咽肿物,右颈部包块,头痛；既往史: 4年前患痔疮，已治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:青霉素皮试阳性。；个人史: 长期居于原籍，无疫区居住史。吸烟3-4支/天*10年，饮酒1-2次/月。否认不洁性生活史。；家族史: 舅舅患鼻咽癌，舅妈患肺癌。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：103/73mmHg,Ht：174cm，Wt：79kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；右颈IIa区可扪及1个淋巴结，最大径2.5×2.5cm，左颈IIa区扪及1个淋巴结，最大径约3*3cm，无融合，质地韧，边界模糊，活动度好，无压痛，无皮肤浸润，无溃疡，右颈III区可见一长约4cm手术疤痕；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 单纯根治性放疗\nB. 诱导化疗序贯单纯根治性放疗\nC. 同步放化疗序贯辅助化疗\nD. 根治性颈淋巴结清扫术序贯辅助放化疗\nE. 姑息性全身化疗联合靶向治疗\nF. 诱导化疗序贯根治性手术\nG. 诱导化疗序贯同步放化疗\nH. 免疫治疗联合同步放化疗\nI. 靶向治疗联合同步放化疗\nJ. 诱导化疗序贯同步放化疗联合辅助化疗\nK. 根治性放疗序贯辅助化疗\n\n请仅输出一个选项字母（A-K）。","options":[{"letter":"A","text":"单纯根治性放疗","is_gold":false},{"letter":"B","text":"诱导化疗序贯单纯根治性放疗","is_gold":false},{"letter":"C","text":"同步放化疗序贯辅助化疗","is_gold":false},{"letter":"D","text":"根治性颈淋巴结清扫术序贯辅助放化疗","is_gold":false},{"letter":"E","text":"姑息性全身化疗联合靶向治疗","is_gold":false},{"letter":"F","text":"诱导化疗序贯根治性手术","is_gold":false},{"letter":"G","text":"诱导化疗序贯同步放化疗","is_gold":true},{"letter":"H","text":"免疫治疗联合同步放化疗","is_gold":false},{"letter":"I","text":"靶向治疗联合同步放化疗","is_gold":false},{"letter":"J","text":"诱导化疗序贯同步放化疗联合辅助化疗","is_gold":false},{"letter":"K","text":"根治性放疗序贯辅助化疗","is_gold":false}],"gold_letter":"G"},{"sample_id":"sample-a4cf25bef13a63de3e012971","patient_id":"patient-f25e20b1e5c6eea840d4cc21","turn_id":"turn05","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、鼻腔、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现右颈部肿块伴耳鸣、听力下降4个月。；现病史: 缘于4个月前患者无意中发现右颈部包块，如拇指大小，无压痛，伴耳鸣、听力下降，颈部包块后逐渐增大，近1周偶发头痛，白天明显，视物如常，无鼻塞、鼻血、面麻、等不适。就诊[机构已隐去]，行右颈部淋巴结活检术，病理示转移性低分化鳞癌，行电子鼻咽镜检查见鼻咽肿物，取活检病理示可疑癌。为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,鼻咽肿物,右颈部包块,头痛；既往史: 4年前患痔疮，已治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:青霉素皮试阳性。；个人史: 长期居于原籍，无疫区居住史。吸烟3-4支/天*10年，饮酒1-2次/月。否认不洁性生活史。；家族史: 舅舅患鼻咽癌，舅妈患肺癌。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：103/73mmHg,Ht：174cm，Wt：79kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；右颈IIa区可扪及1个淋巴结，最大径2.5×2.5cm，左颈IIa区扪及1个淋巴结，最大径约3*3cm，无融合，质地韧，边界模糊，活动度好，无压痛，无皮肤浸润，无溃疡，右颈III区可见一长约4cm手术疤痕；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 电轴左偏(轻度) 正常范围心电图\n- [全程D1] 检验组合: 血小板比容-静脉血: 19%；载脂蛋白B(apoB)-静脉血: 1.03g/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞(镜检)-粪便: 阴性/HP（参考: 阴性）；肌酐(Crea)-静脉血: 66.2umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 13.1；球蛋白(GLO)-静脉血: 31.61g/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.011；尿胆原(URO)-尿液: -（参考: 阴性）；红细胞比容(Hct)-静脉血: 48.9%；凝血酶原时间活动度(PTA)-静脉血: 111.2%；隐血(OB)-粪便: 阴性（参考: 阴性）；胱抑素(Cys-C)-静脉血: 0.91mg/L；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.003；碱性磷酸酶(ALP)-静脉血: 76.3U/L；载脂蛋白AI(apoAI)-静脉血: 1.04g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；葡萄糖(Glu)-静脉血: 4.96mmol/L；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.5；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阴性(-)（参考: 阴性）；血小板分布宽度(PDW)-静脉血: 13.9%；淋巴细胞百分比(Lymph%)-静脉血: 0.315；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；总胆红素(TBIL)-静脉血: 7umol/L；淋巴细胞计数(Lymph#)-静脉血: 1.910E9/L；Rh血型-静脉血: 阳性；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；活化部分凝血活酶时间(APTT)-静脉血: 27.2sec.；酮体(KET)-尿液: -（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）；血液二氧化碳含量ctCO2(B)-静脉血: 21.9mmol/L；浊度(TRUB)-尿液: 清亮；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；总胆固醇(TC)-静脉血: 4.88mmol/L；C-反应蛋白(C……\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D1] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。仍有听力下降，请[姓名已隐去]医生信息已隐藏出：根据患者外院鼻咽部检查提示鼻咽部病灶侵犯右侧海绵窦，颅底骨质等，分为分期信息见历史辅助诊断节点，双侧颈部淋巴结肿大，最大径＜6cm，分为分期信息见历史辅助诊断节点，未见远处转移，分为[分期信息见历史辅助诊断节点]分期信息见历史辅助诊断节点，[计划性表述已隐藏]放疗及同步增敏化疗控制病情，目前行放疗前准备。.\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善放化疗前基线检验，若肌酐清除率>30ml/min即可启动大剂量顺铂同步化疗。\nB. 完善放化疗前基线检验，并预防性给予质子泵抑制剂和双环醇保肝治疗。\nC. 完善放化疗前基线检验，若中性粒细胞绝对值>1.0×10^9/L即可启动全身化疗。\nD. 完善放化疗前基线检验，并预防性给予长效重组人粒细胞集落刺激因子。\nE. 完善放化疗前基线检验，仅需心电图和血常规正常即可启动诱导化疗。\nF. 完善放化疗前基线检验，并常规预防性使用头孢类抗生素以防中耳炎加重。\nG. 完善放化疗前基线检验，若转氨酶升高超过正常上限1倍则直接放弃化疗。\nH. 完善放化疗前基线检验（血常规、生化、凝血、传染病、EBV等），全面评估器官功能。\nI. 完善放化疗前基线检验，并预防性给予地塞米松以减轻放疗引起的脑水肿。\nJ. 完善放化疗前基线检验，若伴有右侧中耳乳突炎则需先完成乳突根治术再行放疗。\nK. 完善放化疗前基线检验，并常规行深静脉置管及低分子肝素预防性抗凝治疗。\nL. 完善放化疗前基线检验，若存在感音神经性听力下降则绝对禁忌使用任何含铂方案。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"完善放化疗前基线检验，若肌酐清除率>30ml/min即可启动大剂量顺铂同步化疗。","is_gold":false},{"letter":"B","text":"完善放化疗前基线检验，并预防性给予质子泵抑制剂和双环醇保肝治疗。","is_gold":false},{"letter":"C","text":"完善放化疗前基线检验，若中性粒细胞绝对值>1.0×10^9/L即可启动全身化疗。","is_gold":false},{"letter":"D","text":"完善放化疗前基线检验，并预防性给予长效重组人粒细胞集落刺激因子。","is_gold":false},{"letter":"E","text":"完善放化疗前基线检验，仅需心电图和血常规正常即可启动诱导化疗。","is_gold":false},{"letter":"F","text":"完善放化疗前基线检验，并常规预防性使用头孢类抗生素以防中耳炎加重。","is_gold":false},{"letter":"G","text":"完善放化疗前基线检验，若转氨酶升高超过正常上限1倍则直接放弃化疗。","is_gold":false},{"letter":"H","text":"完善放化疗前基线检验（血常规、生化、凝血、传染病、EBV等），全面评估器官功能。","is_gold":true},{"letter":"I","text":"完善放化疗前基线检验，并预防性给予地塞米松以减轻放疗引起的脑水肿。","is_gold":false},{"letter":"J","text":"完善放化疗前基线检验，若伴有右侧中耳乳突炎则需先完成乳突根治术再行放疗。","is_gold":false},{"letter":"K","text":"完善放化疗前基线检验，并常规行深静脉置管及低分子肝素预防性抗凝治疗。","is_gold":false},{"letter":"L","text":"完善放化疗前基线检验，若存在感音神经性听力下降则绝对禁忌使用任何含铂方案。","is_gold":false}],"gold_letter":"H"},{"sample_id":"sample-44b84e88a5f0beade51ae0ca","patient_id":"patient-f25e20b1e5c6eea840d4cc21","turn_id":"turn06","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、鼻腔、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现右颈部肿块伴耳鸣、听力下降4个月。；现病史: 缘于4个月前患者无意中发现右颈部包块，如拇指大小，无压痛，伴耳鸣、听力下降，颈部包块后逐渐增大，近1周偶发头痛，白天明显，视物如常，无鼻塞、鼻血、面麻、等不适。就诊[机构已隐去]，行右颈部淋巴结活检术，病理示转移性低分化鳞癌，行电子鼻咽镜检查见鼻咽肿物，取活检病理示可疑癌。为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,鼻咽肿物,右颈部包块,头痛；既往史: 4年前患痔疮，已治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:青霉素皮试阳性。；个人史: 长期居于原籍，无疫区居住史。吸烟3-4支/天*10年，饮酒1-2次/月。否认不洁性生活史。；家族史: 舅舅患鼻咽癌，舅妈患肺癌。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：103/73mmHg,Ht：174cm，Wt：79kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；右颈IIa区可扪及1个淋巴结，最大径2.5×2.5cm，左颈IIa区扪及1个淋巴结，最大径约3*3cm，无融合，质地韧，边界模糊，活动度好，无压痛，无皮肤浸润，无溃疡，右颈III区可见一长约4cm手术疤痕；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 电轴左偏(轻度) 正常范围心电图\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D3] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套)；检查部位:；检查所见: 肝脏体积不大，边缘变钝，实质光点回声前场细密，后场衰减，肝静脉走行尚自然，管腔稍变细，显示欠清晰，肝内胆管不扩张。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约16cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 脂肪肝。 胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D7] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔明显狭窄，鼻咽顶壁、顶后壁、后壁及双侧壁增厚，以右侧为著，T1WI呈等信号，T2WI呈稍高信号，增强扫描强化明显，右侧咽隐窝消失，见增厚组织占据，左侧咽隐窝变浅。病变与右侧中鼻甲分界不清，口咽双侧壁未见增厚。 右侧咽旁间隙及右侧咽后间隙见不规则肿物突入。双侧腭帆提肌、右侧腭帆张肌、右侧头长肌受侵。左侧腭帆张肌、双侧翼内肌及双侧翼外肌未见受侵。 右侧翼腭窝内见少许软组织信号，增强扫描明显强化。 左侧翼腭窝、双侧上颌后脂肪间隙及双侧咀嚼肌间隙未见异常。 斜坡、蝶骨基底部、右侧翼突基底部及内外板、右侧蝶骨大翼及右侧岩尖骨质信号减低，增强扫描见不均匀强化。 右侧破裂扩大，右侧海绵窦增宽，内见不规则软组织信号灶，右侧蝶窦内见软组织信号灶突入，增强扫描上述病变强化明显。 左侧海绵窦未见增宽。蝶鞍形态正常，其内未见占位性病变。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。 双侧上颌窦、筛窦及蝶窦粘膜增厚。右侧乳突内见大量分泌物。 右侧咽后见肿大淋巴结，大者约12mm×17mm，增强扫描强化明显。双颈II、III、V区见多个肿大淋巴结，最大者约23mm×29mm，部分边界欠清晰，包膜不完整，信号欠均匀，增强扫描明显不均匀强化。双侧腮腺内及腮腺旁见数个淋巴结，大者短径约6mm，增强扫描强化明显。双颈I区见数个淋巴结，大者短径约7mm，信号尚均匀。 甲状腺双叶及峡部、喉咽、双侧颌下腺信号均匀，未见占位性病变。；检查结论: 鼻咽病变，考虑鼻咽癌，侵犯范围如上述。 颅底骨质破坏。 右侧咽后、双颈II、III、V区多发肿大淋巴结，考虑转移。 双侧腮腺内及腮腺旁数个淋巴结，性质待定。 鼻窦炎、右侧乳突炎。\n- [全程D26] 检验组合: 镁离子(Mg2+)-静脉血: 0.88mmol/L；阴离子间隙(AG)-静脉血: 13.2；血小板比容-静脉血: 18%；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；乳酸脱氢酶(LDH)-静脉血: 177.9U/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.7U/L；血小板分布宽度(PDW)-静脉血: 13.2%；钾离子(K+)-静脉血: 4.02mmol/L；白蛋白(ALB)-静脉血: 44.5g/L；直接胆红素(DBIL)-静脉血: 3.8umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.58mmol/L；大血小板百分比(P-LCR%)-静脉血: 28.9%；单核细胞计数(Mono#)-静脉血: 0.610E9/L；钠离子(Na+)-静脉血: 143.5mmol/L；总胆固醇(TC)-静脉血: 5.13mmol/L；总胆红素(TBIL)-静脉血: 11.7umol/L；甘油三酯(TG)-静脉血: 1.44mmol/L；红细胞比容(Hct)-静脉血: 48.1%；中性粒细胞计数(Neut#)-静脉血: 3.310E9/L；白细胞计数(WBC#)-静脉血: 6.2110E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.86；中性粒细胞百分比(Neut%)-静脉血: 0.528；总钙(Ca)-静脉血: 2.18mmol/L；总蛋白(TP)-静脉血: 76.63g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.38；α-L-岩藻糖苷酶(AFU)-静脉血: 35.5U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.97mmolL；淋巴细胞计数(Lymph#)-静脉血: 2.110E9/L；间接胆红素(IBIL)-静脉血: 7.9umolL；平均红细胞血红蛋白含量(MCH)-静脉血: 28.8pg；γ-谷氨酰基转移酶(GGT)-静脉血: 31.3U/L；尿素氮(BUN)-静脉血: 4.1mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 333g/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.9；单核细胞百分比(Mono%)-静脉血: 0.103；血液二氧化碳含量ctCO2(B)-静脉血: 26.……\n\n【既往治疗与反应】\n- [全程D14] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，继续行放化疗前准备，余无特殊。.\n- [全程D17] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，请[姓名已隐去]医生信息已隐藏出：患者目前无特殊，继续行放化疗前准备，继续观察病情。.\n- [全程D20] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，患者放疗计划准备完成，[计划性表述已隐藏]GTV70Gy/32f，GTVnd68Gy/32f，CTV1 60Gy/32f，CTV2 56Gy/32f。拟本周开始放疗，因患者分期晚，病变范围大，视神经、眼球、颞叶剂量较高，已与患者沟通不良反应，患者及时家属表示理解并同意治疗，继续观察病情。.\n- [全程D23] 上级查房记录；[姓名已隐去]教授查房记录: 病程类型: 上级查房记录；病程主题: [姓名已隐去]医生信息已隐藏；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，患者目前继续行放疗前准备，[姓名已隐去]医生信息已隐藏出：患者继续行放疗前准备，[计划性表述已隐藏]顺铂同期化疗，继续观察病情。.\n- [全程D26] 日常病程记录；日常病程记录: 病程类型: 日常病程记录；病程主题: 日常病程记录；病程内容: 患者精神、饮食、睡眠一般，大小便正常。仍有听力下降等不适，患者目前无特殊，拟周一开始行放疗，周二行顺铂100mg/㎡同期化疗，继续行放化疗前准备，继续观察病情。.\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗当天给予常规静脉补液，无需特殊水化与利尿处理。\nB. 暂缓放化疗，先静脉补充硫酸镁及氯化钾纠正电解质异常，待复查正常后再启动顺铂同期化疗。\nC. 按计划启动放疗，将顺铂剂量调整为40mg/㎡周疗，化疗期间仅需常规止吐，无需使用甘露醇利尿。\nD. 按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗前给予呋塞米静脉推注利尿，并预防性注射G-CSF。\nE. 按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗期间采用口服补液替代静脉水化，并外用三乙醇胺乳膏。\nF. 暂缓顺铂化疗，先行单纯根治性放疗，待放疗剂量达到40Gy后再评估并启动顺铂同期化疗。\nG. 按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗前给予大剂量糖皮质激素及NK-1受体拮抗剂，免除静脉水化。\nH. 按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗当天给予等渗盐水静脉滴注，避免使用甘露醇。\nI. 按计划启动放疗，并为顺铂（100mg/㎡）同期化疗行充分的静脉水化、甘露醇利尿及电解质补充，同时给予放疗局部保护用药。\nJ. 按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗后连续3天静脉输注人血白蛋白以预防低蛋白血症。\nK. 暂缓放疗，先给予顺铂联合氟尿嘧啶方案诱导化疗2个周期，期间常规给予静脉水化及止吐处理。\nL. 按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗期间常规预防性静脉滴注广谱抗菌药物。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗当天给予常规静脉补液，无需特殊水化与利尿处理。","is_gold":false},{"letter":"B","text":"暂缓放化疗，先静脉补充硫酸镁及氯化钾纠正电解质异常，待复查正常后再启动顺铂同期化疗。","is_gold":false},{"letter":"C","text":"按计划启动放疗，将顺铂剂量调整为40mg/㎡周疗，化疗期间仅需常规止吐，无需使用甘露醇利尿。","is_gold":false},{"letter":"D","text":"按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗前给予呋塞米静脉推注利尿，并预防性注射G-CSF。","is_gold":false},{"letter":"E","text":"按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗期间采用口服补液替代静脉水化，并外用三乙醇胺乳膏。","is_gold":false},{"letter":"F","text":"暂缓顺铂化疗，先行单纯根治性放疗，待放疗剂量达到40Gy后再评估并启动顺铂同期化疗。","is_gold":false},{"letter":"G","text":"按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗前给予大剂量糖皮质激素及NK-1受体拮抗剂，免除静脉水化。","is_gold":false},{"letter":"H","text":"按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗当天给予等渗盐水静脉滴注，避免使用甘露醇。","is_gold":false},{"letter":"I","text":"按计划启动放疗，并为顺铂（100mg/㎡）同期化疗行充分的静脉水化、甘露醇利尿及电解质补充，同时给予放疗局部保护用药。","is_gold":true},{"letter":"J","text":"按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗后连续3天静脉输注人血白蛋白以预防低蛋白血症。","is_gold":false},{"letter":"K","text":"暂缓放疗，先给予顺铂联合氟尿嘧啶方案诱导化疗2个周期，期间常规给予静脉水化及止吐处理。","is_gold":false},{"letter":"L","text":"按计划启动放疗与顺铂（100mg/㎡）同期化疗，化疗期间常规预防性静脉滴注广谱抗菌药物。","is_gold":false}],"gold_letter":"I"},{"sample_id":"sample-0534c4bc264d81d07f7ff87c","patient_id":"patient-f25e20b1e5c6eea840d4cc21","turn_id":"turn07","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、鼻腔、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现右颈部肿块伴耳鸣、听力下降4个月。；现病史: 缘于4个月前患者无意中发现右颈部包块，如拇指大小，无压痛，伴耳鸣、听力下降，颈部包块后逐渐增大，近1周偶发头痛，白天明显，视物如常，无鼻塞、鼻血、面麻、等不适。就诊[机构已隐去]，行右颈部淋巴结活检术，病理示转移性低分化鳞癌，行电子鼻咽镜检查见鼻咽肿物，取活检病理示可疑癌。为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,鼻咽肿物,右颈部包块,头痛；既往史: 4年前患痔疮，已治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:青霉素皮试阳性。；个人史: 长期居于原籍，无疫区居住史。吸烟3-4支/天*10年，饮酒1-2次/月。否认不洁性生活史。；家族史: 舅舅患鼻咽癌，舅妈患肺癌。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：103/73mmHg,Ht：174cm，Wt：79kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；右颈IIa区可扪及1个淋巴结，最大径2.5×2.5cm，左颈IIa区扪及1个淋巴结，最大径约3*3cm，无融合，质地韧，边界模糊，活动度好，无压痛，无皮肤浸润，无溃疡，右颈III区可见一长约4cm手术疤痕；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 电轴左偏(轻度) 正常范围心电图\n- [全程D44] 检验组合: 白细胞计数(WBC#)-静脉血: 4.4610E9/L；镁离子(Mg2+)-静脉血: 0.96mmol/L；葡萄糖(Glu)-静脉血: 4.12mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；丙氨酸氨基转移酶(ALT)-静脉血: 16U/L；总蛋白(TP)-静脉血: 72.33g/L；胱抑素(Cys-C)-静脉血: 0.78mg/L；血小板分布宽度(PDW)-静脉血: 11.6%；中性粒细胞计数(Neut#)-静脉血: 3.110E9/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.910E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 35.8U/L；C-反应蛋白(CRP)-静脉血: 3.43mg/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.1；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.32mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.9；氯离子(Cl-)-静脉血: 103mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 29mmol/L；乳酸脱氢酶(LDH)-静脉血: 172.3U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.195；直接胆红素(DBIL)-静脉血: 4.2umol/L；球蛋白(GLO)-静脉血: 29.23g/L；甘油三酯(TG)-静脉血: 1.13mmol/L；血小板计数(PLT#)-静脉血: 16510E9/L；钾离子(K+)-静脉血: 4.12mmol/L；肌酐(Crea)-静脉血: 67.7umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.3U/L；白蛋白(ALB)-静脉血: 43.1g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均血小板体积(MPV)-静脉血: 9.8fL；载脂蛋白AI(apoAI)-静脉血: 1.11g/L；总胆红素(TBIL)-静脉血: 12.6umol/L；单核细胞百分比(Mono%)-静脉血: 0.09；间接胆红素(IBIL)-静脉血: 8.4umolL；血红蛋白(Hb)-静脉血: 148g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 32.8U/L；红细胞……\n- [全程D51] 检验组合: 磷(P)-静脉血: 1.15mmol/L；氯离子(Cl-)-静脉血: 103.1mmol/L；球蛋白(GLO)-静脉血: 31.65g/L；中性粒细胞计数(Neut#)-静脉血: 1.110E9/L；钠离子(Na+)-静脉血: 141.8mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；中性粒细胞百分比(Neut%)-静脉血: 0.466；单核细胞百分比(Mono%)-静脉血: 0.221；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.03；血小板比容-静脉血: 15%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；乳酸脱氢酶(LDH)-静脉血: 170.6U/L；总胆红素(TBIL)-静脉血: 9.8umol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.2pg；肌酐(Crea)-静脉血: 72.4umol/L；尿素氮(BUN)-静脉血: 4.2mmol/L；尿酸(UA)-静脉血: 346.6umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.04；红细胞计数(RBC#)-静脉血: 5.1710E12/L；总蛋白(TP)-静脉血: 75.85g/L；平均血小板体积(MPV)-静脉血: 10fL；平均红细胞体积(MCV)-静脉血: 85.7fL；红细胞比容(Hct)-静脉血: 44.3%；白蛋白(ALB)-静脉血: 44.2g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.09mmolL；总胆固醇(TC)-静脉血: 5.11mmol/L；间接胆红素(IBIL)-静脉血: 6.3umolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.51mmol/L；胱抑素(Cys-C)-静脉血: 0.82mg/L；葡萄糖(Glu)-静脉血: 4.91mmol/L；C-反应蛋白(CRP)-静脉血: 2.13mg/L；碱性磷酸酶(ALP)-静脉血: 77.4U/L；总胆汁酸(TBA)-静脉血: 4.3umol/L；载脂蛋白AI(apoAI)-静脉血: 1.23g/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；直接胆红素(DBIL)-静脉血: 3.5umol/L；血小板分布宽度(PDW)-静脉血: 10.8%；血液二氧化碳含量ctCO2(B)-静脉血: 24.1m……\n- [全程D56] 检验组合: 血红蛋白(Hb)-静脉血: 154g/L；白细胞计数(WBC#)-静脉血: 510E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.28；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 48.1；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.6；中性粒细胞计数(Neut#)-静脉血: 3.110E9/L；大血小板百分比(P-LCR%)-静脉血: 28.9%；红细胞比容(Hct)-静脉血: 49.1%；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.612；单核细胞百分比(Mono%)-静脉血: 0.09；平均红细胞血红蛋白含量(MCH)-静脉血: 29.4pg；平均血小板体积(MPV)-静脉血: 10.4fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 11910E9/L；平均红细胞体积(MCV)-静脉血: 93.7fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0；血小板比容-静脉血: 12%；单核细胞计数(Mono#)-静脉血: 0.510E9/L；血小板分布宽度(PDW)-静脉血: 12.6%；红细胞计数(RBC#)-静脉血: 5.2410E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；平均红细胞血红蛋白浓度(MCHC)-静脉血: 314g/L\n- [全程D58] 检验组合: 白蛋白(ALB)-静脉血: 44.1g/L；血液二氧化碳含量ctCO2(B)-静脉血: 29.5mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 342.3g/L；尿酸(UA)-静脉血: 336.4umol/L；平均红细胞体积(MCV)-静脉血: 87.6fL；氯离子(Cl-)-静脉血: 101.4mmol/L；血小板计数(PLT#)-静脉血: 119.610E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.51；球蛋白(GLO)-静脉血: 30.98g/L；碱性磷酸酶(ALP)-静脉血: 84.6U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；天门冬氨酸氨基转移酶(AST)-静脉血: 16.5U/L；有核红细胞百分比(NRBC%)-静脉血: 0；间接胆红素(IBIL)-静脉血: 6umolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.02；载脂蛋白AI(apoAI)-静脉血: 1.07g/L；钠离子(Na+)-静脉血: 140.4mmol/L；葡萄糖(Glu)-静脉血: 4.22mmol/L；直接胆红素(DBIL)-静脉血: 2.9umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.71mmol/L；尿素氮(BUN)-静脉血: 5.4mmol/L；总胆固醇(TC)-静脉血: 5.2mmol/L；单核细胞百分比(Mono%)-静脉血: 0.141；胱抑素(Cys-C)-静脉血: 0.86mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.89mmolL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总胆汁酸(TBA)-静脉血: 7.2umol/L；总胆红素(TBIL)-静脉血: 8.9umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 27U/L；红细胞比容(Hct)-静脉血: 44.8%；淋巴细胞百分比(Lymph%)-静脉血: 0.143；乳酸脱氢酶(LDH)-静脉血: 185U/L；钾离子(K+)-静脉血: 3.96mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 34.8U/L；白细胞计数(WBC#)-静脉血: 4.5310E9/L；平均血小板体积(MPV)-静脉血: 8.57fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.……\n- [全程D64] 超声；腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约19cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D64] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对侧，双肺野纹理清晰，双肺野未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影形态、大小、位置未见异常。双膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n\n【既往治疗与反应】\n- [全程D52] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。诉吞咽稍有疼痛，体查:I度口腔粘膜反应。昨日查血常规示白细胞计数2.26*10E9/L ↓,中性粒细胞1.1*10E9/L↓，予以升白针对症治疗。下周复查血常规。继续当前放疗。\n- [全程D55] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。诉口干，吞咽稍有疼痛，体查:I度口腔粘膜反应。已予以升白针治疗三天，明日复查血常规，[计划性表述已隐藏]同期DDP第二程化疗。继续放疗治疗。\n- [全程D58] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。诉口干，吞咽稍有疼痛，体查:I度口腔粘膜反应。今日行同期DDP第二程化疗，予以护肝、护胃、制酸、止吐对症治疗。继续放疗治疗。\n- [全程D61] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。诉口干，吞咽稍有疼痛，体查:I度口腔粘膜反应。继续放疗治疗。\n- [全程D64] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者一般情况可，诉耳鸣、听力下降有所缓解，口干及轻微咽痛，无发热、咳嗽、咳痰等不适。查体：I度口腔粘膜反应，张口门齿距4.5cm；颈部淋巴结较前明显缩小，右颈III区可见一长约4cm手术疤痕，颈部皮肤呈放疗后改变。[姓名已隐去]医生信息已隐藏：患者一般情况良好，予以明天出院，嘱患者出院后定期返院复查。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即行颈部淋巴结清扫术处理未完全消退的残存淋巴结。\nB. 立即安排鼻咽及颈部MRI与全身PET-CT检查全面评估近期疗效。\nC. 立即启动PF方案（顺铂+氟尿嘧啶）辅助化疗以巩固局部及全身控制。\nD. 继续住院给予静脉高营养及广谱抗生素治疗直至口腔黏膜反应完全消失。\nE. 立即行电子鼻咽镜下原发灶活检以明确是否达到病理完全缓解。\nF. 预防性给予长效G-CSF并口服抗生素后办理出院。\nG. 立即启动西妥昔单抗靶向维持治疗以降低局部复发风险。\nH. 对颈部残存淋巴结局部追加外照射放疗推量至75-80Gy。\nI. 立即复查血浆EBV-DNA，若阳性则继续给予单药顺铂化疗。\nJ. 结束住院诊疗办理出院，嘱定期返院复查以评估近期疗效。\nK. 立即行胸腹部增强CT及骨ECT检查排除放化疗期间的远处转移。\nL. 立即请耳鼻喉科会诊行鼓膜穿刺抽液或置管术处理听力下降。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"立即行颈部淋巴结清扫术处理未完全消退的残存淋巴结。","is_gold":false},{"letter":"B","text":"立即安排鼻咽及颈部MRI与全身PET-CT检查全面评估近期疗效。","is_gold":false},{"letter":"C","text":"立即启动PF方案（顺铂+氟尿嘧啶）辅助化疗以巩固局部及全身控制。","is_gold":false},{"letter":"D","text":"继续住院给予静脉高营养及广谱抗生素治疗直至口腔黏膜反应完全消失。","is_gold":false},{"letter":"E","text":"立即行电子鼻咽镜下原发灶活检以明确是否达到病理完全缓解。","is_gold":false},{"letter":"F","text":"预防性给予长效G-CSF并口服抗生素后办理出院。","is_gold":false},{"letter":"G","text":"立即启动西妥昔单抗靶向维持治疗以降低局部复发风险。","is_gold":false},{"letter":"H","text":"对颈部残存淋巴结局部追加外照射放疗推量至75-80Gy。","is_gold":false},{"letter":"I","text":"立即复查血浆EBV-DNA，若阳性则继续给予单药顺铂化疗。","is_gold":false},{"letter":"J","text":"结束住院诊疗办理出院，嘱定期返院复查以评估近期疗效。","is_gold":true},{"letter":"K","text":"立即行胸腹部增强CT及骨ECT检查排除放化疗期间的远处转移。","is_gold":false},{"letter":"L","text":"立即请耳鼻喉科会诊行鼓膜穿刺抽液或置管术处理听力下降。","is_gold":false}],"gold_letter":"J"},{"sample_id":"sample-03e671c4e9fab822b9938832","patient_id":"patient-f25e20b1e5c6eea840d4cc21","turn_id":"turn08","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T4；受侵结构包括：腭帆提肌、咽旁间隙、头长肌、蝶窦、鼻腔、斜坡、海绵窦、翼突基底部、蝶骨基底部、岩尖。\n文本分期信息：N2，M0。\n综合TNM状态：T4N2M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D0] 入院记录: 主诉: 发现右颈部肿块伴耳鸣、听力下降4个月。；现病史: 缘于4个月前患者无意中发现右颈部包块，如拇指大小，无压痛，伴耳鸣、听力下降，颈部包块后逐渐增大，近1周偶发头痛，白天明显，视物如常，无鼻塞、鼻血、面麻、等不适。就诊[机构已隐去]，行右颈部淋巴结活检术，病理示转移性低分化鳞癌，行电子鼻咽镜检查见鼻咽肿物，取活检病理示可疑癌。为求进一步诊治来我院。患者发病以来,精神佳,饮食睡眠佳,大小便正常，体重无减轻。；阳性症状体征: 耳鸣,听力下降,鼻咽肿物,右颈部包块,头痛；既往史: 4年前患痔疮，已治疗。否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:青霉素皮试阳性。；个人史: 长期居于原籍，无疫区居住史。吸烟3-4支/天*10年，饮酒1-2次/月。否认不洁性生活史。；家族史: 舅舅患鼻咽癌，舅妈患肺癌。；体格检查: T：36.5℃，P：80次/分，R：20次/分，BP：103/73mmHg,Ht：174cm，Wt：79kg神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率80次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4.5cm；鼻咽顶后壁结节状肿物；右颈IIa区可扪及1个淋巴结，最大径2.5×2.5cm，左颈IIa区扪及1个淋巴结，最大径约3*3cm，无融合，质地韧，边界模糊，活动度好，无压痛，无皮肤浸润，无溃疡，右颈III区可见一长约4cm手术疤痕；颅神经检查：阴性。；KPS:；ECOG:\n\n【已完成检查与客观结果】\n- [全程D1] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 逆钟向转位 电轴左偏(轻度) 正常范围心电图\n- [全程D44] 检验组合: 白细胞计数(WBC#)-静脉血: 4.4610E9/L；镁离子(Mg2+)-静脉血: 0.96mmol/L；葡萄糖(Glu)-静脉血: 4.12mmol/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；丙氨酸氨基转移酶(ALT)-静脉血: 16U/L；总蛋白(TP)-静脉血: 72.33g/L；胱抑素(Cys-C)-静脉血: 0.78mg/L；血小板分布宽度(PDW)-静脉血: 11.6%；中性粒细胞计数(Neut#)-静脉血: 3.110E9/L；单核细胞计数(Mono#)-静脉血: 0.410E9/L；淋巴细胞计数(Lymph#)-静脉血: 0.910E9/L；α-L-岩藻糖苷酶(AFU)-静脉血: 35.8U/L；C-反应蛋白(CRP)-静脉血: 3.43mg/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 40.1；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.32mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.9；氯离子(Cl-)-静脉血: 103mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 29mmol/L；乳酸脱氢酶(LDH)-静脉血: 172.3U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.195；直接胆红素(DBIL)-静脉血: 4.2umol/L；球蛋白(GLO)-静脉血: 29.23g/L；甘油三酯(TG)-静脉血: 1.13mmol/L；血小板计数(PLT#)-静脉血: 16510E9/L；钾离子(K+)-静脉血: 4.12mmol/L；肌酐(Crea)-静脉血: 67.7umol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 18.3U/L；白蛋白(ALB)-静脉血: 43.1g/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；平均血小板体积(MPV)-静脉血: 9.8fL；载脂蛋白AI(apoAI)-静脉血: 1.11g/L；总胆红素(TBIL)-静脉血: 12.6umol/L；单核细胞百分比(Mono%)-静脉血: 0.09；间接胆红素(IBIL)-静脉血: 8.4umolL；血红蛋白(Hb)-静脉血: 148g/L；γ-谷氨酰基转移酶(GGT)-静脉血: 32.8U/L；红细胞……\n- [全程D51] 检验组合: 磷(P)-静脉血: 1.15mmol/L；氯离子(Cl-)-静脉血: 103.1mmol/L；球蛋白(GLO)-静脉血: 31.65g/L；中性粒细胞计数(Neut#)-静脉血: 1.110E9/L；钠离子(Na+)-静脉血: 141.8mmol/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.4；中性粒细胞百分比(Neut%)-静脉血: 0.466；单核细胞百分比(Mono%)-静脉血: 0.221；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.03；血小板比容-静脉血: 15%；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；乳酸脱氢酶(LDH)-静脉血: 170.6U/L；总胆红素(TBIL)-静脉血: 9.8umol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 29.2pg；肌酐(Crea)-静脉血: 72.4umol/L；尿素氮(BUN)-静脉血: 4.2mmol/L；尿酸(UA)-静脉血: 346.6umol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.04；红细胞计数(RBC#)-静脉血: 5.1710E12/L；总蛋白(TP)-静脉血: 75.85g/L；平均血小板体积(MPV)-静脉血: 10fL；平均红细胞体积(MCV)-静脉血: 85.7fL；红细胞比容(Hct)-静脉血: 44.3%；白蛋白(ALB)-静脉血: 44.2g/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.09mmolL；总胆固醇(TC)-静脉血: 5.11mmol/L；间接胆红素(IBIL)-静脉血: 6.3umolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.51mmol/L；胱抑素(Cys-C)-静脉血: 0.82mg/L；葡萄糖(Glu)-静脉血: 4.91mmol/L；C-反应蛋白(CRP)-静脉血: 2.13mg/L；碱性磷酸酶(ALP)-静脉血: 77.4U/L；总胆汁酸(TBA)-静脉血: 4.3umol/L；载脂蛋白AI(apoAI)-静脉血: 1.23g/L；单核细胞计数(Mono#)-静脉血: 0.510E9/L；直接胆红素(DBIL)-静脉血: 3.5umol/L；血小板分布宽度(PDW)-静脉血: 10.8%；血液二氧化碳含量ctCO2(B)-静脉血: 24.1m……\n- [全程D56] 检验组合: 血红蛋白(Hb)-静脉血: 154g/L；白细胞计数(WBC#)-静脉血: 510E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.28；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 48.1；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.6；中性粒细胞计数(Neut#)-静脉血: 3.110E9/L；大血小板百分比(P-LCR%)-静脉血: 28.9%；红细胞比容(Hct)-静脉血: 49.1%；淋巴细胞计数(Lymph#)-静脉血: 1.410E9/L；中性粒细胞百分比(Neut%)-静脉血: 0.612；单核细胞百分比(Mono%)-静脉血: 0.09；平均红细胞血红蛋白含量(MCH)-静脉血: 29.4pg；平均血小板体积(MPV)-静脉血: 10.4fL；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血小板计数(PLT#)-静脉血: 11910E9/L；平均红细胞体积(MCV)-静脉血: 93.7fL；嗜碱性粒细胞百分比(Baso%)-静脉血: 0；血小板比容-静脉血: 12%；单核细胞计数(Mono#)-静脉血: 0.510E9/L；血小板分布宽度(PDW)-静脉血: 12.6%；红细胞计数(RBC#)-静脉血: 5.2410E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；平均红细胞血红蛋白浓度(MCHC)-静脉血: 314g/L\n- [全程D58] 检验组合: 白蛋白(ALB)-静脉血: 44.1g/L；血液二氧化碳含量ctCO2(B)-静脉血: 29.5mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 342.3g/L；尿酸(UA)-静脉血: 336.4umol/L；平均红细胞体积(MCV)-静脉血: 87.6fL；氯离子(Cl-)-静脉血: 101.4mmol/L；血小板计数(PLT#)-静脉血: 119.610E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.51；球蛋白(GLO)-静脉血: 30.98g/L；碱性磷酸酶(ALP)-静脉血: 84.6U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；天门冬氨酸氨基转移酶(AST)-静脉血: 16.5U/L；有核红细胞百分比(NRBC%)-静脉血: 0；间接胆红素(IBIL)-静脉血: 6umolL；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.02；载脂蛋白AI(apoAI)-静脉血: 1.07g/L；钠离子(Na+)-静脉血: 140.4mmol/L；葡萄糖(Glu)-静脉血: 4.22mmol/L；直接胆红素(DBIL)-静脉血: 2.9umol/L；低密度脂蛋白胆固醇(LDL-C)-静脉血: 3.71mmol/L；尿素氮(BUN)-静脉血: 5.4mmol/L；总胆固醇(TC)-静脉血: 5.2mmol/L；单核细胞百分比(Mono%)-静脉血: 0.141；胱抑素(Cys-C)-静脉血: 0.86mg/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.89mmolL；有核红细胞计数(NRBC#)-静脉血: 010E9/L；总胆汁酸(TBA)-静脉血: 7.2umol/L；总胆红素(TBIL)-静脉血: 8.9umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 27U/L；红细胞比容(Hct)-静脉血: 44.8%；淋巴细胞百分比(Lymph%)-静脉血: 0.143；乳酸脱氢酶(LDH)-静脉血: 185U/L；钾离子(K+)-静脉血: 3.96mmol/L；α-L-岩藻糖苷酶(AFU)-静脉血: 34.8U/L；白细胞计数(WBC#)-静脉血: 4.5310E9/L；平均血小板体积(MPV)-静脉血: 8.57fL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 14.……\n- [全程D64] 超声；腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套): 检查类型: 超声；检查名称: 腹主动脉旁淋巴结彩超(套);肝、胆、胰、脾彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径11mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约19cm/s。 胆囊大小形态正常，囊壁不厚，胆囊内未见明显异常回声。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 腹主动脉旁未见明确肿物回声。；检查结论: 肝脏、胆囊、脾脏、胰腺未见明显占位病变声像。 腹主动脉旁未见明确占位病变。\n- [全程D64] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双侧胸廓对侧，双肺野纹理清晰，双肺野未见明显实质性病变。双侧肺门不大，纵隔未见增宽，心影形态、大小、位置未见异常。双膈面光滑，双侧肋膈角锐利。；检查结论: 心肺未见明显异常。\n\n【既往治疗与反应】\n- [全程D52] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。诉吞咽稍有疼痛，体查:I度口腔粘膜反应。昨日查血常规示白细胞计数2.26*10E9/L ↓,中性粒细胞1.1*10E9/L↓，予以升白针对症治疗。下周复查血常规。继续当前放疗。\n- [全程D55] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。诉口干，吞咽稍有疼痛，体查:I度口腔粘膜反应。已予以升白针治疗三天，明日复查血常规，[计划性表述已隐藏]同期DDP第二程化疗。继续放疗治疗。\n- [全程D58] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。诉口干，吞咽稍有疼痛，体查:I度口腔粘膜反应。今日行同期DDP第二程化疗，予以护肝、护胃、制酸、止吐对症治疗。继续放疗治疗。\n- [全程D61] 上级查房记录；上级查房记录: 病程类型: 上级查房记录；病程主题: 上级查房记录；病程内容: 今日查房，患者精神、饮食、睡眠一般，大小便正常。诉口干，吞咽稍有疼痛，体查:I度口腔粘膜反应。继续放疗治疗。\n- [全程D64] 上级查房记录；教授查房记录: 病程类型: 上级查房记录；病程主题: 医生信息已隐藏；病程内容: 今日查房，患者一般情况可，诉耳鸣、听力下降有所缓解，口干及轻微咽痛，无发热、咳嗽、咳痰等不适。查体：I度口腔粘膜反应，张口门齿距4.5cm；颈部淋巴结较前明显缩小，右颈III区可见一长约4cm手术疤痕，颈部皮肤呈放疗后改变。[姓名已隐去]医生信息已隐藏：患者一般情况良好，予以明天出院，嘱患者出院后定期返院复查。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 评估为疾病进展，停用放疗，改行吉西他滨联合顺铂姑息性化疗。\nB. 评估为部分缓解，继续住院行第3周期顺铂单药同期化疗。\nC. 评估为部分缓解，序贯启动顺铂联合氟尿嘧啶方案辅助化疗3个周期。\nD. 评估为完全缓解，转入头颈外科行右侧颈部淋巴结清扫术。\nE. 评估为部分缓解，对右颈部残留淋巴结追加局部外照射放疗至74Gy。\nF. 评估为疾病稳定，加用西妥昔单抗靶向治疗并延长原发灶放疗疗程。\nG. 评估为部分缓解，转入头颈外科行内镜下鼻咽原发灶切除术。\nH. 评估为有效，继续住院静脉使用抗生素及营养支持以治疗口腔黏膜反应。\nI. 评估为有效，立即安排鼻咽及颈部增强MRI复查以确认靶区消退情况。\nJ. 评估为有效，办理出院，并序贯启动PD-1抑制剂维持治疗1年。\nK. 评估为有效，结束根治性放化疗，予以办理出院并嘱定期门诊随访复查。\nL. 评估为有效，办理出院，并嘱出院后1个月常规行全身PET-CT检查。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"评估为疾病进展，停用放疗，改行吉西他滨联合顺铂姑息性化疗。","is_gold":false},{"letter":"B","text":"评估为部分缓解，继续住院行第3周期顺铂单药同期化疗。","is_gold":false},{"letter":"C","text":"评估为部分缓解，序贯启动顺铂联合氟尿嘧啶方案辅助化疗3个周期。","is_gold":false},{"letter":"D","text":"评估为完全缓解，转入头颈外科行右侧颈部淋巴结清扫术。","is_gold":false},{"letter":"E","text":"评估为部分缓解，对右颈部残留淋巴结追加局部外照射放疗至74Gy。","is_gold":false},{"letter":"F","text":"评估为疾病稳定，加用西妥昔单抗靶向治疗并延长原发灶放疗疗程。","is_gold":false},{"letter":"G","text":"评估为部分缓解，转入头颈外科行内镜下鼻咽原发灶切除术。","is_gold":false},{"letter":"H","text":"评估为有效，继续住院静脉使用抗生素及营养支持以治疗口腔黏膜反应。","is_gold":false},{"letter":"I","text":"评估为有效，立即安排鼻咽及颈部增强MRI复查以确认靶区消退情况。","is_gold":false},{"letter":"J","text":"评估为有效，办理出院，并序贯启动PD-1抑制剂维持治疗1年。","is_gold":false},{"letter":"K","text":"评估为有效，结束根治性放化疗，予以办理出院并嘱定期门诊随访复查。","is_gold":true},{"letter":"L","text":"评估为有效，办理出院，并嘱出院后1个月常规行全身PET-CT检查。","is_gold":false}],"gold_letter":"K"}]}
+{"patient_id":"patient-9fcde7a95f4d57501ecbf7b2","bootstrap_cluster_id":"cluster-004","turns":[{"sample_id":"sample-b03a0a9310651ef3f13754f1","patient_id":"patient-9fcde7a95f4d57501ecbf7b2","turn_id":"turn01","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：咽旁间隙、斜坡、蝶骨基底部、岩尖。\n文本分期信息：N3，M0。\n综合TNM状态：T3N3M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1] 入院记录: 主诉: 右颈肿物半年，右耳听力下降半月；现病史: 缘于6月前患者无意中出现右颈肿物，未予重视，进行性增大，半月前出现右耳听力下降，无头痛、复视，无涕血、面麻等，就诊于当地医院，发现鼻咽肿物。今为求进一步诊治来我院。患者发病以来,精神、饮食、睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟20支/日*5年，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.3℃，P：79次/分，R：20次/分，BP：105/65mmHg,Ht：168cm，Wt：56kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 暂无可展示的客观检查检验结果。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于初诊信息，下一步最合理的检查与诊断路径是什么？请给出推荐检查组合，并说明关键依据。\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-K 选项中选择唯一最合适的答案。\nA. 行鼻咽及颈部CT平扫+增强、间接鼻咽镜检查，并完善心电图及基线抽血化验。\nB. 行鼻咽及颈部MRI平扫（不加增强）、间接鼻咽镜检查，并完善心电图及基线抽血化验。\nC. 行鼻咽及颈部MRI平扫+增强，暂缓鼻咽镜检查，先行颈部淋巴结细针穿刺活检。\nD. 行鼻咽及颈部CT平扫+增强，暂缓鼻咽镜检查，先行颈部淋巴结切除活检。\nE. 行鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查，并直接安排全身骨扫描及肝脏超声。\nF. 行鼻咽及颈部MRI平扫+增强、鼻内镜下鼻腔扩宽术，并完善心电图及基线抽血化验。\nG. 行鼻咽及颈部超声检查、间接鼻咽镜检查，并完善心电图及基线抽血化验。\nH. 行鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查，并完善心电图，暂缓抽血化验。\nI. 行鼻咽及颈部MRI平扫+增强、直接喉镜检查，并完善心电图及基线抽血化验。\nJ. 行鼻咽及颈部CT平扫+增强、间接鼻咽镜检查，并直接安排胸腹部CT平扫+增强。\nK. 行鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查，并完善心电图及基线抽血化验。\n\n请仅输出一个选项字母（A-K）。","options":[{"letter":"A","text":"行鼻咽及颈部CT平扫+增强、间接鼻咽镜检查，并完善心电图及基线抽血化验。","is_gold":false},{"letter":"B","text":"行鼻咽及颈部MRI平扫（不加增强）、间接鼻咽镜检查，并完善心电图及基线抽血化验。","is_gold":false},{"letter":"C","text":"行鼻咽及颈部MRI平扫+增强，暂缓鼻咽镜检查，先行颈部淋巴结细针穿刺活检。","is_gold":false},{"letter":"D","text":"行鼻咽及颈部CT平扫+增强，暂缓鼻咽镜检查，先行颈部淋巴结切除活检。","is_gold":false},{"letter":"E","text":"行鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查，并直接安排全身骨扫描及肝脏超声。","is_gold":false},{"letter":"F","text":"行鼻咽及颈部MRI平扫+增强、鼻内镜下鼻腔扩宽术，并完善心电图及基线抽血化验。","is_gold":false},{"letter":"G","text":"行鼻咽及颈部超声检查、间接鼻咽镜检查，并完善心电图及基线抽血化验。","is_gold":false},{"letter":"H","text":"行鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查，并完善心电图，暂缓抽血化验。","is_gold":false},{"letter":"I","text":"行鼻咽及颈部MRI平扫+增强、直接喉镜检查，并完善心电图及基线抽血化验。","is_gold":false},{"letter":"J","text":"行鼻咽及颈部CT平扫+增强、间接鼻咽镜检查，并直接安排胸腹部CT平扫+增强。","is_gold":false},{"letter":"K","text":"行鼻咽及颈部MRI平扫+增强、间接鼻咽镜检查，并完善心电图及基线抽血化验。","is_gold":true}],"gold_letter":"K"},{"sample_id":"sample-057bee25fe3533856610d5c8","patient_id":"patient-9fcde7a95f4d57501ecbf7b2","turn_id":"turn02","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：咽旁间隙、斜坡、蝶骨基底部、岩尖。\n文本分期信息：N3，M0。\n综合TNM状态：T3N3M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1] 入院记录: 主诉: 右颈肿物半年，右耳听力下降半月；现病史: 缘于6月前患者无意中出现右颈肿物，未予重视，进行性增大，半月前出现右耳听力下降，无头痛、复视，无涕血、面麻等，就诊于当地医院，发现鼻咽肿物。今为求进一步诊治来我院。患者发病以来,精神、饮食、睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟20支/日*5年，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.3℃，P：79次/分，R：20次/分，BP：105/65mmHg,Ht：168cm，Wt：56kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。；专科检查: 张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D4] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 V5～V6导联低电压 V1～V3导联r波递增不良\n- [全程D4] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 25.6U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.341；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；平均红细胞体积(MCV)-静脉血: 94.7fL；白细胞计数(WBC#)-静脉血: 4.5110E9/L；平均血小板体积(MPV)-静脉血: 12fL；D-二聚体(D-Dimer)-静脉血: 0.1ug/ml；单核细胞计数(Mono#)-静脉血: 0.510E9/L；磷(P)-静脉血: 1.36mmol/L；甘油三酯(TG)-静脉血: 2.22mmol/L；间接胆红素(IBIL)-静脉血: 5.2umolL；白蛋白(ALB)-静脉血: 44.8g/L；碱性磷酸酶(ALP)-静脉血: 81.9U/L；凝血酶时间(TT)-静脉血: 18.5sec.；载脂蛋白B(apoB)-静脉血: 0.57g/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.1U/L；阴离子间隙(AG)-静脉血: 11；血小板比容-静脉血: 15%；凝血酶原时间(PT)-静脉血: 11.7sec.；肌酐(Crea)-静脉血: 82.7umol/L；总胆红素(TBIL)-静脉血: 8.2umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.503；球蛋白(GLO)-静脉血: 25.56g/L；红细胞计数(RBC#)-静脉血: 4.5210E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；大血小板百分比(P-LCR%)-静脉血: 40%；血小板分布宽度(PDW)-静脉血: 14.2%；凝血酶原时间活动度(PTA)-静脉血: 90.4%；乳酸脱氢酶(LDH)-静脉血: 359.7U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32.3pg；ABO血型-静脉血: B；总钙(Ca)-静脉血: 2.3mmol/L；镁离子(Mg2+)-静脉血: 0.99mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 146g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；γ-谷氨酰基转移酶(GGT)-静脉血: 14.6U/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.1mmol/L……\n- [全程D5] 检验组合: 乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阳性(+)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）\n- [全程D6] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、双侧壁明显不均匀增厚，平扫T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，双侧咽隐窝变浅，双侧咽旁脂肪间隙稍狭窄；双侧腭帆提肌、腭帆张肌、头长肌受压。双侧咽后见肿大淋巴结，左侧较大者短径11mm，右侧较大者短径12mm。 双侧后鼻孔堵塞，口咽双侧壁未见受累增厚。 双侧翼腭窝、颞下窝未见异常。 蝶骨基底部、斜坡、双侧岩尖、双侧枕骨基底部骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽；双侧筛窦、蝶窦，右乳突内见积液；上颌窦、左乳突充气良好，骨壁完整；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双颈II区、右颈III、IV区见淋巴结肿大，部分融合，较大者短径28mm，信号欠均匀，增强较明显不均匀强化。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。；检查结论: 鼻咽顶壁、顶后壁、双侧壁明显不均匀增厚，考虑鼻咽癌。 颅底骨质破坏。 双侧咽后、双颈部多发淋巴结肿大，考虑转移瘤。 副鼻窦炎；右乳突炎。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n基于已经返回的影像/内镜等客观资料，下一步最合理的诊断或分期补充是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 电子鼻咽镜检查及鼻咽肿物活检\nB. 颈部淋巴结切开活检术\nC. 超声引导下颈部淋巴结细针穿刺活检\nD. 全身PET-CT检查\nE. 胸部CT、腹部超声及全身骨扫描\nF. 鼻内镜下鼻咽肿物切除术\nG. 诊断性抗炎治疗2周后复查MRI\nH. 外周血EBV-DNA定量检测\nI. 鼻咽脱落细胞学检查\nJ. 鼻咽及颈部CT平扫+增强\nK. 鼻咽颅底三维CT重建\nL. 颈部淋巴结清扫术\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"电子鼻咽镜检查及鼻咽肿物活检","is_gold":true},{"letter":"B","text":"颈部淋巴结切开活检术","is_gold":false},{"letter":"C","text":"超声引导下颈部淋巴结细针穿刺活检","is_gold":false},{"letter":"D","text":"全身PET-CT检查","is_gold":false},{"letter":"E","text":"胸部CT、腹部超声及全身骨扫描","is_gold":false},{"letter":"F","text":"鼻内镜下鼻咽肿物切除术","is_gold":false},{"letter":"G","text":"诊断性抗炎治疗2周后复查MRI","is_gold":false},{"letter":"H","text":"外周血EBV-DNA定量检测","is_gold":false},{"letter":"I","text":"鼻咽脱落细胞学检查","is_gold":false},{"letter":"J","text":"鼻咽及颈部CT平扫+增强","is_gold":false},{"letter":"K","text":"鼻咽颅底三维CT重建","is_gold":false},{"letter":"L","text":"颈部淋巴结清扫术","is_gold":false}],"gold_letter":"A"},{"sample_id":"sample-ea63b7a358722be15870f84c","patient_id":"patient-9fcde7a95f4d57501ecbf7b2","turn_id":"turn04","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：咽旁间隙、斜坡、蝶骨基底部、岩尖。\n文本分期信息：N3，M0。\n综合TNM状态：T3N3M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1] 入院记录: 主诉: 右颈肿物半年，右耳听力下降半月；现病史: 缘于6月前患者无意中出现右颈肿物，未予重视，进行性增大，半月前出现右耳听力下降，无头痛、复视，无涕血、面麻等，就诊于当地医院，发现鼻咽肿物。今为求进一步诊治来我院。患者发病以来,精神、饮食、睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟20支/日*5年，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.3℃，P：79次/分，R：20次/分，BP：105/65mmHg,Ht：168cm，Wt：56kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率79次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D4] 心电图；ECG: 检查类型: 心电图；检查名称: ECG；检查部位:；检查所见:；检查结论: 窦性心律 V5～V6导联低电压 V1～V3导联r波递增不良\n- [全程D4] 检验组合: 嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；天门冬氨酸氨基转移酶(AST)-静脉血: 25.6U/L；淋巴细胞百分比(Lymph%)-静脉血: 0.341；平均红细胞血红蛋白浓度(MCHC)-静脉血: 341g/L；平均红细胞体积(MCV)-静脉血: 94.7fL；白细胞计数(WBC#)-静脉血: 4.5110E9/L；平均血小板体积(MPV)-静脉血: 12fL；D-二聚体(D-Dimer)-静脉血: 0.1ug/ml；单核细胞计数(Mono#)-静脉血: 0.510E9/L；磷(P)-静脉血: 1.36mmol/L；甘油三酯(TG)-静脉血: 2.22mmol/L；间接胆红素(IBIL)-静脉血: 5.2umolL；白蛋白(ALB)-静脉血: 44.8g/L；碱性磷酸酶(ALP)-静脉血: 81.9U/L；凝血酶时间(TT)-静脉血: 18.5sec.；载脂蛋白B(apoB)-静脉血: 0.57g/L；丙氨酸氨基转移酶(ALT)-静脉血: 23.1U/L；阴离子间隙(AG)-静脉血: 11；血小板比容-静脉血: 15%；凝血酶原时间(PT)-静脉血: 11.7sec.；肌酐(Crea)-静脉血: 82.7umol/L；总胆红素(TBIL)-静脉血: 8.2umol/L；中性粒细胞百分比(Neut%)-静脉血: 0.503；球蛋白(GLO)-静脉血: 25.56g/L；红细胞计数(RBC#)-静脉血: 4.5210E12/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.027；大血小板百分比(P-LCR%)-静脉血: 40%；血小板分布宽度(PDW)-静脉血: 14.2%；凝血酶原时间活动度(PTA)-静脉血: 90.4%；乳酸脱氢酶(LDH)-静脉血: 359.7U/L；平均红细胞血红蛋白含量(MCH)-静脉血: 32.3pg；ABO血型-静脉血: B；总钙(Ca)-静脉血: 2.3mmol/L；镁离子(Mg2+)-静脉血: 0.99mmol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；血红蛋白(Hb)-静脉血: 146g/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.8；γ-谷氨酰基转移酶(GGT)-静脉血: 14.6U/L；血液二氧化碳含量ctCO2(B)-静脉血: 27.1mmol/L……\n- [全程D5] 检验组合: 乙型肝炎病毒核心抗体(HBV-cAb)-静脉血: 阳性(+)（参考: 阴性）；EB病毒早期抗体IgA(EBV-EA-IgA)-静脉血: 阴性(-)（参考: 阴性）；戊型肝炎病毒抗体IgM(HEV-IgM)-静脉血: 阴性(-)（参考: 阴性）；人类免疫缺陷病毒抗原抗体联合(HIV-comb)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗原(HBV-sAg)-静脉血: 阳性(+)（参考: 阴性）；甲型肝炎病毒抗体IgM(HAV-IgM)-静脉血: 阴性(-)（参考: 阴性）；丙型肝炎病毒抗体IgG(HCV-IgG)-静脉血: 阴性(-)（参考: 阴性）；梅毒螺旋体特异性抗体(TP-Ab)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒表面抗体(HBV-sAb)-静脉血: 阴性(-)（参考: 阴性）；EB病毒衣壳抗体IgA(EBV-VCA-IgA)-静脉血: 1:10（参考: 阴性）；乙型肝炎病毒e抗原(HBV-eAg)-静脉血: 阴性(-)（参考: 阴性）；乙型肝炎病毒e抗体(HBV-eAb)-静脉血: 阳性(+)（参考: 阴性）；丙型肝炎病毒核心抗原(HCV-cAg)-静脉血: 阴性(-)（参考: 阴性）\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D6] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽腔狭窄，鼻咽顶壁、顶后壁、双侧壁明显不均匀增厚，平扫T1WI呈等信号，T2WI呈稍高信号，注射造影剂后明显强化，双侧咽隐窝变浅，双侧咽旁脂肪间隙稍狭窄；双侧腭帆提肌、腭帆张肌、头长肌受压。双侧咽后见肿大淋巴结，左侧较大者短径11mm，右侧较大者短径12mm。 双侧后鼻孔堵塞，口咽双侧壁未见受累增厚。 双侧翼腭窝、颞下窝未见异常。 蝶骨基底部、斜坡、双侧岩尖、双侧枕骨基底部骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽；双侧筛窦、蝶窦，右乳突内见积液；上颌窦、左乳突充气良好，骨壁完整；双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变；蝶鞍形态正常，其内未见占位性病变。 双颈II区、右颈III、IV区见淋巴结肿大，部分融合，较大者短径28mm，信号欠均匀，增强较明显不均匀强化。 双侧颌下腺、腮腺大小、形态正常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态正常，信号均匀，未见占位性病变；喉咽腔形态正常，未见占位性病变。；检查结论: 鼻咽顶壁、顶后壁、双侧壁明显不均匀增厚，考虑鼻咽癌。 颅底骨质破坏。 双侧咽后、双颈部多发淋巴结肿大，考虑转移瘤。 副鼻窦炎；右乳突炎。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见: 左颈II区可见多个大小不一肿大淋巴结，最大约22mm×12mm，边界清，椭圆形，内部回声均匀，后方回声稍增强，淋巴门未探及。 CDFI:上述淋巴结内可见周边型血流信号。 左颈淋巴结穿刺活检： 常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以16G穿刺针穿刺入左颈肿物内，进针2次，取出长约2cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。；检查结论: 左侧颈部肿大淋巴结穿刺活检。 不适随诊。 4个工作日后凭发票到2号楼6楼病理科取结果。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【既往治疗与反应】\n- 当前轮次前暂无可展示的已执行治疗与反应记录。\n\n【当前需要决策的问题】\n结合已知诊断证据、影像范围、基线检查和患者状态，初始治疗路径最合理如何选择？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 完善中心静脉置管，直接行根治性同期放化疗\nB. 完善中心静脉置管，行诱导化疗序贯单纯根治性放疗\nC. 完善中心静脉置管，行诱导化疗序贯根治性同期放化疗\nD. 完善中心静脉置管，行诱导化疗序贯根治性同期放化疗及辅助化疗\nE. 完善中心静脉置管，行诱导化疗联合PD-1单抗序贯根治性同期放化疗\nF. 完善中心静脉置管，直接行根治性同期放化疗及辅助化疗\nG. 完善中心静脉置管，行诱导化疗序贯根治性放疗联合EGFR单抗\nH. 完善中心静脉置管，行诱导化疗，放疗前行右颈部淋巴结清扫术\nI. 完善中心静脉置管，行姑息性化疗，视颈部淋巴结退缩情况决定放疗时机\nJ. 完善中心静脉置管，直接行根治性放疗联合EGFR单抗\nK. 完善中心静脉置管，行诱导化疗序贯根治性放疗及辅助化疗\nL. 完善中心静脉置管，行诱导化疗联合EGFR单抗序贯单纯根治性放疗\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"完善中心静脉置管，直接行根治性同期放化疗","is_gold":false},{"letter":"B","text":"完善中心静脉置管，行诱导化疗序贯单纯根治性放疗","is_gold":false},{"letter":"C","text":"完善中心静脉置管，行诱导化疗序贯根治性同期放化疗","is_gold":true},{"letter":"D","text":"完善中心静脉置管，行诱导化疗序贯根治性同期放化疗及辅助化疗","is_gold":false},{"letter":"E","text":"完善中心静脉置管，行诱导化疗联合PD-1单抗序贯根治性同期放化疗","is_gold":false},{"letter":"F","text":"完善中心静脉置管，直接行根治性同期放化疗及辅助化疗","is_gold":false},{"letter":"G","text":"完善中心静脉置管，行诱导化疗序贯根治性放疗联合EGFR单抗","is_gold":false},{"letter":"H","text":"完善中心静脉置管，行诱导化疗，放疗前行右颈部淋巴结清扫术","is_gold":false},{"letter":"I","text":"完善中心静脉置管，行姑息性化疗，视颈部淋巴结退缩情况决定放疗时机","is_gold":false},{"letter":"J","text":"完善中心静脉置管，直接行根治性放疗联合EGFR单抗","is_gold":false},{"letter":"K","text":"完善中心静脉置管，行诱导化疗序贯根治性放疗及辅助化疗","is_gold":false},{"letter":"L","text":"完善中心静脉置管，行诱导化疗联合EGFR单抗序贯单纯根治性放疗","is_gold":false}],"gold_letter":"C"},{"sample_id":"sample-077ecf4aba208fcc4f66c309","patient_id":"patient-9fcde7a95f4d57501ecbf7b2","turn_id":"turn05","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：咽旁间隙、斜坡、蝶骨基底部、岩尖。\n文本分期信息：N3，M0。\n综合TNM状态：T3N3M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1] 入院记录: 主诉: 右颈肿物半年，右耳听力下降半月；现病史: 缘于6月前患者无意中出现右颈肿物，未予重视，进行性增大，半月前出现右耳听力下降，无头痛、复视，无涕血、面麻等，就诊于当地医院，发现鼻咽肿物。今为求进一步诊治来我院。患者发病以来,精神、饮食、睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟20支/日*5年，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.3℃，P：79次/分，R：20次/分，BP：105/65mmHg,Ht：168cm，Wt：56kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率79次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D13] 超声；彩超引导下体表肿物、淋巴结穿刺术(套): 检查类型: 超声；检查名称: 彩超引导下体表肿物、淋巴结穿刺术(套)；检查部位:；检查所见: 左颈II区可见多个大小不一肿大淋巴结，最大约22mm×12mm，边界清，椭圆形，内部回声均匀，后方回声稍增强，淋巴门未探及。 CDFI:上述淋巴结内可见周边型血流信号。 左颈淋巴结穿刺活检： 常规消毒、铺巾，2%利多卡因3ml局部麻醉，于超声引导下以16G穿刺针穿刺入左颈肿物内，进针2次，取出长约2cm的灰白色组织2条，并送病理检查。术程顺利，术中病人无不适反应。；检查结论: 左侧颈部肿大淋巴结穿刺活检。 不适随诊。 4个工作日后凭发票到2号楼6楼病理科取结果。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D20] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右旁T7椎体横突水平，估计位于上腔静脉内。；检查结论: PICC管位置如上所述。\n- [全程D20] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 24mm AO 28mm MV E 0.53m/s EF 63% LV 37mm IVS 8mm A 0.41m/s FS 34% RA 35mm LVPW 6mm RV 16mm PA 14mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 心脏结构及运动未见异常 各房室腔及大血管未探及异常血流信号 心功能正常\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D21] 检验组合: 隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；酮体(KET)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；比重(SG)-尿液: 1.021；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D22] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 5.5；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.012；颜色-尿液: Light-Yellow；隐血(OB)-尿液: -（参考: 阴性）\n- [全程D28] 检验组合: 钠离子(Na+)-静脉血: 138.4mmol/L；胱抑素(Cys-C)-静脉血: 0.85mg/L；葡萄糖(Glu)-静脉血: 4.19mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；碱性磷酸酶(ALP)-静脉血: 77.2U/L；尿素氮(BUN)-静脉血: 4.1mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 32.5pg；淋巴细胞百分比(Lymph%)-静脉血: 0.13；C-反应蛋白(CRP)-静脉血: 2.54mg/L；氯离子(Cl-)-静脉血: 98.1mmol/L；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.64；阴离子间隙(AG)-静脉血: 16；红细胞比容(Hct)-静脉血: 43.3%；磷(P)-静脉血: 1.38mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.695；血液二氧化碳含量ctCO2(B)-静脉血: 24.3mmol/L；总胆汁酸(TBA)-静脉血: 2.1umol/L；总钙(Ca)-静脉血: 2.12mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 32.1U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.86；γ-谷氨酰基转移酶(GGT)-静脉血: 21.1U/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；甘油三酯(TG)-静脉血: 0.75mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；载脂蛋白B(apoB)-静脉血: 0.58g/L；直接胆红素(DBIL)-静脉血: 4.7umol/L；乳酸脱氢酶(LDH)-静脉血: 269.3U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 36.1U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；平均红细胞体积(MCV)-静脉血: 95.9fL；单核细胞百分比(Mono%)-静脉血: 0.13；总胆固醇(TC)-静脉血: 2.75mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339g/L；球蛋白(GLO)-静脉血: 21.89g/……\n\n【既往治疗与反应】\n- [全程D2] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉右耳听力下降，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，结合患者检查，认为患者鼻咽癌可能性大，指示完善相关检查后在决定下一步治疗方案，遵嘱执行。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D14] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉右耳听力下降，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，指示尽快完成放疗计划，遵嘱执行。\n- [全程D19] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉右耳听力下降，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，考虑患者放疗计划即将完成，指示可提前2天先予以化疗，指示今日予以DDP方案化疗第1程，做好水化、护胃、止呕等对症支持处理，密切观察化疗中副反应，遵嘱执行。\n- [全程D24] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉恶心，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，较前缩小，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，认为患者化疗顺利完成，指示继续放疗，密切观察放疗中副反应，遵嘱执行。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，给予重组人粒细胞集落刺激因子皮下注射，处理淋巴细胞减少，待血象恢复后恢复放疗。\nB. 暂停放疗，给予静脉营养支持及补液，处理恶心症状，待胃肠道反应缓解后重新评估放疗计划。\nC. 继续放疗，对淋巴细胞减少预防性静脉滴注广谱抗生素，并常规进行PICC导管维护。\nD. 继续放疗，给予常规止吐对症处理，处理轻度恶心，按规范进行PICC导管维护，并定期复查血常规与生化。\nE. 继续放疗，对出现的骨髓抑制，将下一周期顺铂化疗剂量减量20%，并常规进行PICC导管维护。\nF. 暂停放疗，拔除PICC导管改用外周静脉留置针，继续常规止吐对症支持与定期复查。\nG. 继续放疗，给予重组人白介素-2免疫支持治疗，处理淋巴细胞减少，并定期复查血常规与生化。\nH. 暂停放疗，立即行鼻咽及颈部MRI复查以评估放化疗疗效，并决定后续放疗剂量。\nI. 继续放疗，终止同期化疗计划，后续仅行单纯放射治疗，并常规进行PICC导管维护。\nJ. 继续放疗，加用大剂量糖皮质激素冲击止吐，处理恶心症状，并预防性使用抗真菌药物。\nK. 暂停放疗，转入重症监护室进行严密生命体征监测与器官功能支持，暂缓抗肿瘤治疗。\nL. 继续放疗，立即启动第二周期顺铂同期化疗，并给予5-HT3受体拮抗剂联合NK-1受体拮抗剂。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"暂停放疗，给予重组人粒细胞集落刺激因子皮下注射，处理淋巴细胞减少，待血象恢复后恢复放疗。","is_gold":false},{"letter":"B","text":"暂停放疗，给予静脉营养支持及补液，处理恶心症状，待胃肠道反应缓解后重新评估放疗计划。","is_gold":false},{"letter":"C","text":"继续放疗，对淋巴细胞减少预防性静脉滴注广谱抗生素，并常规进行PICC导管维护。","is_gold":false},{"letter":"D","text":"继续放疗，给予常规止吐对症处理，处理轻度恶心，按规范进行PICC导管维护，并定期复查血常规与生化。","is_gold":true},{"letter":"E","text":"继续放疗，对出现的骨髓抑制，将下一周期顺铂化疗剂量减量20%，并常规进行PICC导管维护。","is_gold":false},{"letter":"F","text":"暂停放疗，拔除PICC导管改用外周静脉留置针，继续常规止吐对症支持与定期复查。","is_gold":false},{"letter":"G","text":"继续放疗，给予重组人白介素-2免疫支持治疗，处理淋巴细胞减少，并定期复查血常规与生化。","is_gold":false},{"letter":"H","text":"暂停放疗，立即行鼻咽及颈部MRI复查以评估放化疗疗效，并决定后续放疗剂量。","is_gold":false},{"letter":"I","text":"继续放疗，终止同期化疗计划，后续仅行单纯放射治疗，并常规进行PICC导管维护。","is_gold":false},{"letter":"J","text":"继续放疗，加用大剂量糖皮质激素冲击止吐，处理恶心症状，并预防性使用抗真菌药物。","is_gold":false},{"letter":"K","text":"暂停放疗，转入重症监护室进行严密生命体征监测与器官功能支持，暂缓抗肿瘤治疗。","is_gold":false},{"letter":"L","text":"继续放疗，立即启动第二周期顺铂同期化疗，并给予5-HT3受体拮抗剂联合NK-1受体拮抗剂。","is_gold":false}],"gold_letter":"D"},{"sample_id":"sample-6fc96ea65282f416f15f852e","patient_id":"patient-9fcde7a95f4d57501ecbf7b2","turn_id":"turn06","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：咽旁间隙、斜坡、蝶骨基底部、岩尖。\n文本分期信息：N3，M0。\n综合TNM状态：T3N3M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1] 入院记录: 主诉: 右颈肿物半年，右耳听力下降半月；现病史: 缘于6月前患者无意中出现右颈肿物，未予重视，进行性增大，半月前出现右耳听力下降，无头痛、复视，无涕血、面麻等，就诊于当地医院，发现鼻咽肿物。今为求进一步诊治来我院。患者发病以来,精神、饮食、睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟20支/日*5年，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.3℃，P：79次/分，R：20次/分，BP：105/65mmHg,Ht：168cm，Wt：56kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率79次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D20] X线检查；静脉插管照片: 检查类型: X线检查；检查名称: 静脉插管照片；检查部位:；检查所见: PICC管末端位于脊柱右旁T7椎体横突水平，估计位于上腔静脉内。；检查结论: PICC管位置如上所述。\n- [全程D20] 超声；心脏彩超(套): 检查类型: 超声；检查名称: 心脏彩超(套)；检查部位:；检查所见: 心脏超声测值： LA 24mm AO 28mm MV E 0.53m/s EF 63% LV 37mm IVS 8mm A 0.41m/s FS 34% RA 35mm LVPW 6mm RV 16mm PA 14mm 二维及Ｍ型超声心动图特征： 升主动脉内径正常，管壁光滑，主波幅度正常，重搏波存在；肺动脉内径正常； 各房室腔径正常。 室壁厚度及运动正常。房、室间隔连续性完好。 各组瓣膜形态、结构及运动正常。 心包及心包腔未见异常。 彩色及频谱多普勒超声心动图未见异常。；检查结论: 心脏结构及运动未见异常 各房室腔及大血管未探及异常血流信号 心功能正常\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n- [全程D21] 检验组合: 隐血(OB)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；酸碱度(pH)-尿液: 7.5；酮体(KET)-尿液: -（参考: 阴性）；鳞状上皮细胞计数(SQEP#)-尿液: 2/μL；尿胆原(URO)-尿液: -（参考: 阴性）；颜色-尿液: Yellow；白细胞(LEU)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；比重(SG)-尿液: 1.021；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D22] 检验组合: 酮体(KET)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；总蛋白(TP)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酸碱度(pH)-尿液: 5.5；胆红素(BIL)-尿液: -（参考: 阴性）；比重(SG)-尿液: 1.012；颜色-尿液: Light-Yellow；隐血(OB)-尿液: -（参考: 阴性）\n- [全程D28] 检验组合: 钠离子(Na+)-静脉血: 138.4mmol/L；胱抑素(Cys-C)-静脉血: 0.85mg/L；葡萄糖(Glu)-静脉血: 4.19mmol/L；有核红细胞计数(NRBC#)-静脉血: 010E9/L；碱性磷酸酶(ALP)-静脉血: 77.2U/L；尿素氮(BUN)-静脉血: 4.1mmol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.6%；平均红细胞血红蛋白含量(MCH)-静脉血: 32.5pg；淋巴细胞百分比(Lymph%)-静脉血: 0.13；C-反应蛋白(CRP)-静脉血: 2.54mg/L；氯离子(Cl-)-静脉血: 98.1mmol/L；淋巴细胞计数(Lymph#)-静脉血: 0.710E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 0.64；阴离子间隙(AG)-静脉血: 16；红细胞比容(Hct)-静脉血: 43.3%；磷(P)-静脉血: 1.38mmol/L；中性粒细胞百分比(Neut%)-静脉血: 0.695；血液二氧化碳含量ctCO2(B)-静脉血: 24.3mmol/L；总胆汁酸(TBA)-静脉血: 2.1umol/L；总钙(Ca)-静脉血: 2.12mmol/L；丙氨酸氨基转移酶(ALT)-静脉血: 32.1U/L；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.86；γ-谷氨酰基转移酶(GGT)-静脉血: 21.1U/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；甘油三酯(TG)-静脉血: 0.75mmol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.210E9/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；载脂蛋白B(apoB)-静脉血: 0.58g/L；直接胆红素(DBIL)-静脉血: 4.7umol/L；乳酸脱氢酶(LDH)-静脉血: 269.3U/L；α-L-岩藻糖苷酶(AFU)-静脉血: 36.1U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 1.02mmolL；平均红细胞体积(MCV)-静脉血: 95.9fL；单核细胞百分比(Mono%)-静脉血: 0.13；总胆固醇(TC)-静脉血: 2.75mmol/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 339g/L；球蛋白(GLO)-静脉血: 21.89g/……\n- [全程D35] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；镁离子(Mg2+)-静脉血: 0.88mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44；载脂蛋白B(apoB)-静脉血: 0.56g/L；钠离子(Na+)-静脉血: 143.1mmol/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞比容(Hct)-静脉血: 37.1%；甘油三酯(TG)-静脉血: 0.68mmol/L；葡萄糖(Glu)-静脉血: 4.35mmol/L；C-反应蛋白(CRP)-静脉血: 16.07mg/L；平均血小板体积(MPV)-静脉血: 11.3fL；血红蛋白(Hb)-静脉血: 125g/L；载脂蛋白AI(apoAI)-静脉血: 0.89g/L；红细胞计数(RBC#)-静脉血: 3.9410E12/L；血小板比容-静脉血: 10%；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；血小板计数(PLT#)-静脉血: 8910E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.14；天门冬氨酸氨基转移酶(AST)-静脉血: 16U/L；丙氨酸氨基转移酶(ALT)-静脉血: 16.4U/L；总钙(Ca)-静脉血: 2.03mmol/L；钾离子(K+)-静脉血: 3.4mmol/L；磷(P)-静脉血: 1.05mmol/L；白蛋白(ALB)-静脉血: 36.3g/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 337g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；直接胆红素(DBIL)-静脉血: 5.4umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 94.2fL；氯离子(Cl-)-静脉血: 105.6mmol/L；肌酐(Crea)-静脉血: 70umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；胱抑素(Cys-C)-静脉血: 0.85mg/L；球蛋白(GLO)-静脉血: 21.19g/L；间接胆红素(IBIL)-静脉血: 5.9umolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.……\n\n【既往治疗与反应】\n- [全程D14] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉右耳听力下降，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，指示尽快完成放疗计划，遵嘱执行。\n- [全程D19] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者诉右耳听力下降，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，考虑患者放疗计划即将完成，指示可提前2天先予以化疗，指示今日予以DDP方案化疗第1程，做好水化、护胃、止呕等对症支持处理，密切观察化疗中副反应，遵嘱执行。\n- [全程D24] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉恶心，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，较前缩小，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，认为患者化疗顺利完成，指示继续放疗，密切观察放疗中副反应，遵嘱执行。\n- [全程D29] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，未诉特殊不适，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，较前缩小，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，指示继续放疗，密切观察放疗中副反应，遵嘱执行。\n- 基线病理/MRI诊断信息见历史辅助诊断节点。\n\n【当前需要决策的问题】\n结合既往治疗和当前客观检查检验资料，下一步最合理的治疗节奏或支持处理是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 暂停放疗，予以重组人血小板生成素（rhTPO）皮下注射，待血小板恢复后继续放疗。\nB. 继续放疗，予以重组人白介素-11（rhIL-11）皮下注射，复查血常规与生化常规。\nC. 暂停放疗，输注单采血小板1个治疗量，复查血常规与生化常规。\nD. 继续放疗，予以重组人粒细胞集落刺激因子（rhG-CSF）皮下注射，复查血常规。\nE. 继续放疗，予以洗鼻、免疫调节/辅助支持（如香菇多糖）及动静脉置管护理，复查血常规与生化常规。\nF. 暂停放疗，予以促红细胞生成素（EPO）皮下注射，待血红蛋白恢复后继续放疗。\nG. 继续放疗，予以低分子肝素皮下注射预防血栓，复查凝血功能与血常规。\nH. 暂停放疗，予以甲泼尼龙静脉滴注提升血小板，复查血常规与生化常规。\nI. 继续放疗，予以静脉输注人免疫球蛋白（IVIG），复查血常规与生化常规。\nJ. 终止放疗，予以单药化疗维持，配合洗鼻及动静脉置管护理。\nK. 继续放疗，予以重组人血小板生成素与重组人粒细胞集落刺激因子联合皮下注射。\nL. 暂停放疗，予以洗鼻及动静脉置管护理，暂不予升血小板药物干预。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"暂停放疗，予以重组人血小板生成素（rhTPO）皮下注射，待血小板恢复后继续放疗。","is_gold":false},{"letter":"B","text":"继续放疗，予以重组人白介素-11（rhIL-11）皮下注射，复查血常规与生化常规。","is_gold":false},{"letter":"C","text":"暂停放疗，输注单采血小板1个治疗量，复查血常规与生化常规。","is_gold":false},{"letter":"D","text":"继续放疗，予以重组人粒细胞集落刺激因子（rhG-CSF）皮下注射，复查血常规。","is_gold":false},{"letter":"E","text":"继续放疗，予以洗鼻、免疫调节/辅助支持（如香菇多糖）及动静脉置管护理，复查血常规与生化常规。","is_gold":true},{"letter":"F","text":"暂停放疗，予以促红细胞生成素（EPO）皮下注射，待血红蛋白恢复后继续放疗。","is_gold":false},{"letter":"G","text":"继续放疗，予以低分子肝素皮下注射预防血栓，复查凝血功能与血常规。","is_gold":false},{"letter":"H","text":"暂停放疗，予以甲泼尼龙静脉滴注提升血小板，复查血常规与生化常规。","is_gold":false},{"letter":"I","text":"继续放疗，予以静脉输注人免疫球蛋白（IVIG），复查血常规与生化常规。","is_gold":false},{"letter":"J","text":"终止放疗，予以单药化疗维持，配合洗鼻及动静脉置管护理。","is_gold":false},{"letter":"K","text":"继续放疗，予以重组人血小板生成素与重组人粒细胞集落刺激因子联合皮下注射。","is_gold":false},{"letter":"L","text":"暂停放疗，予以洗鼻及动静脉置管护理，暂不予升血小板药物干预。","is_gold":false}],"gold_letter":"E"},{"sample_id":"sample-08d32abcf26a92c62d1dc762","patient_id":"patient-9fcde7a95f4d57501ecbf7b2","turn_id":"turn07","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：咽旁间隙、斜坡、蝶骨基底部、岩尖。\n文本分期信息：N3，M0。\n综合TNM状态：T3N3M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1] 入院记录: 主诉: 右颈肿物半年，右耳听力下降半月；现病史: 缘于6月前患者无意中出现右颈肿物，未予重视，进行性增大，半月前出现右耳听力下降，无头痛、复视，无涕血、面麻等，就诊于当地医院，发现鼻咽肿物。今为求进一步诊治来我院。患者发病以来,精神、饮食、睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟20支/日*5年，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.3℃，P：79次/分，R：20次/分，BP：105/65mmHg,Ht：168cm，Wt：56kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率79次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D35] 检验组合: 嗜酸性粒细胞百分比(Eos%)-静脉血: 0.018；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.004；镁离子(Mg2+)-静脉血: 0.88mmol/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 44；载脂蛋白B(apoB)-静脉血: 0.56g/L；钠离子(Na+)-静脉血: 143.1mmol/L；单核细胞计数(Mono#)-静脉血: 0.710E9/L；红细胞比容(Hct)-静脉血: 37.1%；甘油三酯(TG)-静脉血: 0.68mmol/L；葡萄糖(Glu)-静脉血: 4.35mmol/L；C-反应蛋白(CRP)-静脉血: 16.07mg/L；平均血小板体积(MPV)-静脉血: 11.3fL；血红蛋白(Hb)-静脉血: 125g/L；载脂蛋白AI(apoAI)-静脉血: 0.89g/L；红细胞计数(RBC#)-静脉血: 3.9410E12/L；血小板比容-静脉血: 10%；淋巴细胞计数(Lymph#)-静脉血: 0.810E9/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.81mmolL；血小板计数(PLT#)-静脉血: 8910E9/L；淋巴细胞百分比(Lymph%)-静脉血: 0.14；天门冬氨酸氨基转移酶(AST)-静脉血: 16U/L；丙氨酸氨基转移酶(ALT)-静脉血: 16.4U/L；总钙(Ca)-静脉血: 2.03mmol/L；钾离子(K+)-静脉血: 3.4mmol/L；磷(P)-静脉血: 1.05mmol/L；白蛋白(ALB)-静脉血: 36.3g/L；平均红细胞血红蛋白浓度(MCHC)-静脉血: 337g/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；直接胆红素(DBIL)-静脉血: 5.4umol/L；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；平均红细胞体积(MCV)-静脉血: 94.2fL；氯离子(Cl-)-静脉血: 105.6mmol/L；肌酐(Crea)-静脉血: 70umol/L；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8；胱抑素(Cys-C)-静脉血: 0.85mg/L；球蛋白(GLO)-静脉血: 21.19g/L；间接胆红素(IBIL)-静脉血: 5.9umolL；低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.……\n- [全程D40] 检验组合: 钾离子(K+)-静脉血: 3.64mmol/L；血小板比容-静脉血: 12%；平均红细胞体积(MCV)-静脉血: 94.1fL；乳酸脱氢酶(LDH)-静脉血: 181.7U/L；碱性磷酸酶(ALP)-静脉血: 62.2U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.2；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.83mmolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.7；中性粒细胞计数(Neut#)-静脉血: 1.710E9/L；尿酸(UA)-静脉血: 230.6umol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.9pg；直接胆红素(DBIL)-静脉血: 3.3umol/L；磷(P)-静脉血: 1.27mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 13.3U/L；总胆固醇(TC)-静脉血: 2.44mmol/L；血小板分布宽度(PDW)-静脉血: 12%；平均血小板体积(MPV)-静脉血: 10.9fL；间接胆红素(IBIL)-静脉血: 3.9umolL；阴离子间隙(AG)-静脉血: 10.4；大血小板百分比(P-LCR%)-静脉血: 31.2%；镁离子(Mg2+)-静脉血: 0.87mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.028；低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.25mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 29.7mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.118；白细胞计数(WBC#)-静脉血: 2.4610E9/L；单核细胞百分比(Mono%)-静脉血: 0.179；单核细胞计数(Mono#)-静脉血: 0.410E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.16；丙氨酸氨基转移酶(ALT)-静脉血: 11.5U/L；C-反应蛋白(CRP)-静脉血: 17.05mg/L；白蛋白(ALB)-静脉血: 36.9g/L；总钙(Ca)-静脉血: 2.05mmol/L；总胆汁酸(TBA)-静脉血: 6.7umol/L；红细胞比容(Hct)-静脉血: 36.9%；葡萄糖(Glu)-静脉血: 5.02mmol/L；氯离子(Cl-)-静脉血: 102.1mmol/L；血小板计数(PLT#)……\n- [全程D42] 检验组合: 比重(SG)-尿液: 1.015；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 5；颜色-尿液: Light-Yellow；总蛋白(TP)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）\n- [全程D43] 检验组合: 颜色-尿液: Yellow；总蛋白(TP)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酮体(KET)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 10/μL；酸碱度(pH)-尿液: 5.5；胆红素(BIL)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 2/μL；比重(SG)-尿液: 1.02；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D46] 检验组合: 红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8%；间接胆红素(IBIL)-静脉血: 5.4umolL；尿酸(UA)-静脉血: 292.3umol/L；血小板分布宽度(PDW)-静脉血: 16.6%；磷(P)-静脉血: 1.39mmol/L；白细胞计数(WBC#)-静脉血: 3.2610E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 29.4U/L；中性粒细胞计数(Neut#)-静脉血: 2.510E9/L；总钙(Ca)-静脉血: 2.23mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 33pg；低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.63mmol/L；阴离子间隙(AG)-静脉血: 12；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.7；钠离子(Na+)-静脉血: 142mmol/L；钾离子(K+)-静脉血: 3.3mmol/L；氯离子(Cl-)-静脉血: 97.5mmol/L；白蛋白(ALB)-静脉血: 42.8g/L；总胆汁酸(TBA)-静脉血: 2.9umol/L；单核细胞百分比(Mono%)-静脉血: 0.143；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞比容(Hct)-静脉血: 40.8%；肌酐(Crea)-静脉血: 84.7umol/L；碱性磷酸酶(ALP)-静脉血: 64.7U/L；尿素氮(BUN)-静脉血: 5.06mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；总胆红素(TBIL)-静脉血: 9.3umol/L；载脂蛋白B(apoB)-静脉血: 0.65g/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；葡萄糖(Glu)-静脉血: 5.63mmol/L；球蛋白(GLO)-静脉血: 24.97g/L；C-反应蛋白(CRP)-静脉血: 6.22mg/L；镁离子(Mg2+)-静脉血: 0.97mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；α-L-岩藻糖苷酶(AFU)-静脉血: 40U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.009；平均红细胞血红蛋白浓度(MCHC)-静脉血: 342.2g/L；载脂蛋白AI(apoAI)-静脉血: 0.96g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 28.……\n- [全程D56] 检验组合: 碱性磷酸酶(ALP)-静脉血: 64.1U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；钾离子(K+)-静脉血: 3.65mmol/L；总蛋白(TP)-静脉血: 62.2g/L；血液二氧化碳含量ctCO2(B)-静脉血: 32mmol/L；胱抑素(Cys-C)-静脉血: 0.81mg/L；钠离子(Na+)-静脉血: 139.1mmol/L；红细胞比容(Hct)-静脉血: 38.2%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.5；载脂蛋白B(apoB)-静脉血: 0.72g/L；阴离子间隙(AG)-静脉血: 7.6；平均血小板体积(MPV)-静脉血: 10.7fL；丙氨酸氨基转移酶(ALT)-静脉血: 8.1U/L；中性粒细胞百分比(Neut%)-静脉血: 0.707；低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.56mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 13.8U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.69mmolL；总胆固醇(TC)-静脉血: 2.82mmol/L；总胆红素(TBIL)-静脉血: 9.5umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 14U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；乳酸脱氢酶(LDH)-静脉血: 146.4U/L；单核细胞百分比(Mono%)-静脉血: 0.202；血小板分布宽度(PDW)-静脉血: 12.5%；α-L-岩藻糖苷酶(AFU)-静脉血: 22.8U/L；肌酐(Crea)-静脉血: 73.2umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；磷(P)-静脉血: 1.17mmol/L；氯离子(Cl-)-静脉血: 99.5mmol/L；尿素氮(BUN)-静脉血: 4.3mmol/L；血小板比容-静脉血: 11%；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；总胆汁酸(TBA)-静脉血: 3.7umol/L；甘油三酯(TG)-静脉血: 0.85mmol/L；间接胆红素(IBIL)-静脉血: 5.5umolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.7；直接胆红素(DBIL)-静脉血: 4u……\n- [全程D62] 检验组合: 细菌涂片3-咽拭子: 未发现念珠状菌\n- [全程D63] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径10mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约27cm/s。 胆囊餐后改变，胆囊内可见一强回声团，直径约9mm，后方伴声影。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约33×27×24mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 胆囊结石。 肝脏、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n\n【既往治疗与反应】\n- [全程D42] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉咽痛，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。BR、生化常规大致正常。[姓名已隐去]主诊医生信息已隐藏，考虑患者上次化疗已达3周，指示今日按[计划性表述已隐藏]以DDP方案化疗第二程，做好水化、护肝等对症支持处理，继续放疗，密切观察放化疗副反应，遵嘱执行。\n- [全程D47] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉咽痛，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，认为患者化疗顺利完成，指示继续放疗，密切观察放疗副反应，遵嘱执行。\n- [全程D52] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉咽痛，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，指示予以止痛、口腔粘膜保护对症处理，加强营养支持，继续放疗。\n- [全程D57] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，未诉明显特殊不适，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，指示继续放疗，遵嘱执行。\n- [全程D61] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，未诉明显特殊不适，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]医生信息已隐藏，考虑患者化疗即将到期，建议患者行第三程化疗，但患者拒绝，遂指示今日予以出院，于门诊继续放疗，遵嘱执行。\n\n【当前需要决策的问题】\n结合既往治疗过程和当前复查结果，下一步最合理的疗效评估与处理策略是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 强制收治入院完成第三程同期化疗，期间暂停放疗，待化疗结束后恢复放疗。\nB. 取消第三程同期化疗，加用西妥昔单抗靶向治疗联合放疗，放疗结束后行疗效评估。\nC. 提前终止放疗，行全身PET-CT及头颈部MRI评估，视肿瘤退缩情况决定后续辅助化疗方案。\nD. 取消第三程同期化疗，下调原定放疗处方剂量以减轻黏膜反应，放疗结束后即刻行鼻咽镜活检。\nE. 安排入院行TPF方案补充化疗，同时继续放疗，放疗结束后行全面疗效评估。\nF. 取消第三程同期化疗，按原计划完成根治性放疗，胆囊结石暂予观察，放疗结束后择期行全面疗效评估。\nG. 请普外科急会诊行腹腔镜胆囊切除术，术后择期恢复放疗，并取消后续化疗。\nH. 改用口服卡培他滨单药替代静脉化疗，继续门诊放疗，放疗结束后行辅助化疗。\nI. 立即行鼻咽及颈部MRI复查，若肿瘤已完全消退则提前结束放疗，进入随访阶段。\nJ. 取消第三程同期化疗，增加放疗靶区外扩范围及处方剂量，放疗结束后择期行全面疗效评估。\nK. 暂停放疗，待咽痛及口腔黏膜反应完全缓解后再恢复放疗，并补充第三程化疗。\nL. 采用中药及针灸治疗替代第三程化疗，继续门诊放疗，放疗结束后常规行全身骨扫描。\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"强制收治入院完成第三程同期化疗，期间暂停放疗，待化疗结束后恢复放疗。","is_gold":false},{"letter":"B","text":"取消第三程同期化疗，加用西妥昔单抗靶向治疗联合放疗，放疗结束后行疗效评估。","is_gold":false},{"letter":"C","text":"提前终止放疗，行全身PET-CT及头颈部MRI评估，视肿瘤退缩情况决定后续辅助化疗方案。","is_gold":false},{"letter":"D","text":"取消第三程同期化疗，下调原定放疗处方剂量以减轻黏膜反应，放疗结束后即刻行鼻咽镜活检。","is_gold":false},{"letter":"E","text":"安排入院行TPF方案补充化疗，同时继续放疗，放疗结束后行全面疗效评估。","is_gold":false},{"letter":"F","text":"取消第三程同期化疗，按原计划完成根治性放疗，胆囊结石暂予观察，放疗结束后择期行全面疗效评估。","is_gold":true},{"letter":"G","text":"请普外科急会诊行腹腔镜胆囊切除术，术后择期恢复放疗，并取消后续化疗。","is_gold":false},{"letter":"H","text":"改用口服卡培他滨单药替代静脉化疗，继续门诊放疗，放疗结束后行辅助化疗。","is_gold":false},{"letter":"I","text":"立即行鼻咽及颈部MRI复查，若肿瘤已完全消退则提前结束放疗，进入随访阶段。","is_gold":false},{"letter":"J","text":"取消第三程同期化疗，增加放疗靶区外扩范围及处方剂量，放疗结束后择期行全面疗效评估。","is_gold":false},{"letter":"K","text":"暂停放疗，待咽痛及口腔黏膜反应完全缓解后再恢复放疗，并补充第三程化疗。","is_gold":false},{"letter":"L","text":"采用中药及针灸治疗替代第三程化疗，继续门诊放疗，放疗结束后常规行全身骨扫描。","is_gold":false}],"gold_letter":"F"},{"sample_id":"sample-bc1decc91eb488b9888718b5","patient_id":"patient-9fcde7a95f4d57501ecbf7b2","turn_id":"turn08","base_prompt":"你正在参与一名鼻咽癌相关患者的 full-care 多轮诊疗模拟。\n说明：以下资料按诊疗进程逐步释放；真实日期、地域、医生姓名、原始表名、结构化分期字段和未来医嘱已隐藏。\n请仅根据当前轮次及此前已经释放的资料作答，不额外假设题面未提供的信息。\n\n【历史辅助诊断节点】\n病理图像判断：支持鼻咽癌诊断。\nMRI影像判断：T3；受侵结构包括：咽旁间隙、斜坡、蝶骨基底部、岩尖。\n文本分期信息：N3，M0。\n综合TNM状态：T3N3M0。\n综合分期：III。\n\n【已知病史与当前主诉】\n- [全程D1] 入院记录: 主诉: 右颈肿物半年，右耳听力下降半月；现病史: 缘于6月前患者无意中出现右颈肿物，未予重视，进行性增大，半月前出现右耳听力下降，无头痛、复视，无涕血、面麻等，就诊于当地医院，发现鼻咽肿物。今为求进一步诊治来我院。患者发病以来,精神、饮食、睡眠一般,大小便正常，体重无减轻。；阳性症状体征: 听力下降,鼻咽肿物,右颈肿物；既往史: 既往体健，否认\"肝炎、结核、伤寒\"等传染性疾病史；否认“高血压、冠心病、糖尿病、肾病”病史；否认手术、外伤、输血史及献血史。过敏史:无药物食物过敏史。；个人史: 长期居于原籍，无疫区居住史。吸烟20支/日*5年，否认饮酒史。否认不洁性生活史。；家族史: 否认肿瘤家族史。；体格检查: T：36.3℃，P：79次/分，R：20次/分，BP：105/65mmHg,Ht：168cm，Wt：56kg，KPS：90神智清楚，表情自然，发育正常，营养中等。自主体位，检查合作。皮肤粘膜无水肿，无出血，无溃疡，无皮疹、肝掌、蜘蛛痣。浅表淋巴结见专科 情况。头颅五官无畸形，眼睑无浮肿，无下垂；巩膜无黄染，结膜无充血、无苍白；眼球活动正常，角膜透明，双侧瞳孔等大等圆，直径3mm，直接、间接对光反射正常。耳廓无畸形，外耳道无溢脓溢液，乳突区无压痛。听力正常，鼓膜无穿孔。鼻无畸形，鼻中隔居中，副鼻窦区无压痛、叩击痛。口腔粘膜正常。齿龈无红肿，扁桃体无肿大。颈静脉无怒张，甲状腺未扪及肿大，颈无抵抗。胸廓对称，胸壁静脉无曲张，双肺触觉语颤对称，扣诊呈清音，双肺呼吸音清，未闻及干湿啰音。心前区无隆起，未触及震颤。心率79次/分，心律整齐，各瓣膜听诊区未闻及病理性杂音。腹部平软，未见胃型、肠型、蠕动波，全腹无压痛、反跳痛，未扪及包块。肝脾未扪及，Murphy's sign 阴性，肝肾区无扣痛；移动性浊音阴性，肠鸣音正常。肛门、外生殖器未查。脊柱四肢无畸形，肌力、肌张力正常。生理反射存在，病理神经反射未引出。；专科检查: 张口门齿距4cm；鼻咽顶后壁粘膜增厚；双颈II区、右颈III、IV区可扪及肿大淋巴结，最大径2.5×1.5cm，无融合，质地硬，边界清，活动度好，无压痛，无皮肤浸润，无溃疡；颅神经检查：阴性。；KPS: 90；ECOG:\n\n【已完成检查与客观结果】\n- [全程D40] 检验组合: 钾离子(K+)-静脉血: 3.64mmol/L；血小板比容-静脉血: 12%；平均红细胞体积(MCV)-静脉血: 94.1fL；乳酸脱氢酶(LDH)-静脉血: 181.7U/L；碱性磷酸酶(ALP)-静脉血: 62.2U/L；红细胞体积分布宽度SD(RDW-SD)-静脉血: 43.2；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.83mmolL；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.7；中性粒细胞计数(Neut#)-静脉血: 1.710E9/L；尿酸(UA)-静脉血: 230.6umol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 31.9pg；直接胆红素(DBIL)-静脉血: 3.3umol/L；磷(P)-静脉血: 1.27mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 13.3U/L；总胆固醇(TC)-静脉血: 2.44mmol/L；血小板分布宽度(PDW)-静脉血: 12%；平均血小板体积(MPV)-静脉血: 10.9fL；间接胆红素(IBIL)-静脉血: 3.9umolL；阴离子间隙(AG)-静脉血: 10.4；大血小板百分比(P-LCR%)-静脉血: 31.2%；镁离子(Mg2+)-静脉血: 0.87mmol/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.028；低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.25mmol/L；血液二氧化碳含量ctCO2(B)-静脉血: 29.7mmol/L；淋巴细胞百分比(Lymph%)-静脉血: 0.118；白细胞计数(WBC#)-静脉血: 2.4610E9/L；单核细胞百分比(Mono%)-静脉血: 0.179；单核细胞计数(Mono#)-静脉血: 0.410E9/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.16；丙氨酸氨基转移酶(ALT)-静脉血: 11.5U/L；C-反应蛋白(CRP)-静脉血: 17.05mg/L；白蛋白(ALB)-静脉血: 36.9g/L；总钙(Ca)-静脉血: 2.05mmol/L；总胆汁酸(TBA)-静脉血: 6.7umol/L；红细胞比容(Hct)-静脉血: 36.9%；葡萄糖(Glu)-静脉血: 5.02mmol/L；氯离子(Cl-)-静脉血: 102.1mmol/L；血小板计数(PLT#)……\n- [全程D42] 检验组合: 比重(SG)-尿液: 1.015；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；胆红素(BIL)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 2/μL；酸碱度(pH)-尿液: 5；颜色-尿液: Light-Yellow；总蛋白(TP)-尿液: -（参考: 阴性）；白细胞(LEU)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；隐血(OB)-尿液: -（参考: 阴性）；酮体(KET)-尿液: -（参考: 阴性）\n- [全程D43] 检验组合: 颜色-尿液: Yellow；总蛋白(TP)-尿液: -（参考: 阴性）；尿胆原(URO)-尿液: -（参考: 阴性）；隐血(OB)-尿液: -（参考: 阴性）；浊度(TRUB)-尿液: 清亮；酮体(KET)-尿液: -（参考: 阴性）；亚硝酸盐(NIT)-尿液: -（参考: 阴性）；白细胞计数(WBC#)-尿液: 10/μL；酸碱度(pH)-尿液: 5.5；胆红素(BIL)-尿液: -（参考: 阴性）；红细胞计数(RBC#)-尿液: 2/μL；比重(SG)-尿液: 1.02；白细胞(LEU)-尿液: -（参考: 阴性）；葡萄糖(Glu)-尿液: -（参考: 阴性）\n- [全程D46] 检验组合: 红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.8%；间接胆红素(IBIL)-静脉血: 5.4umolL；尿酸(UA)-静脉血: 292.3umol/L；血小板分布宽度(PDW)-静脉血: 16.6%；磷(P)-静脉血: 1.39mmol/L；白细胞计数(WBC#)-静脉血: 3.2610E9/L；丙氨酸氨基转移酶(ALT)-静脉血: 29.4U/L；中性粒细胞计数(Neut#)-静脉血: 2.510E9/L；总钙(Ca)-静脉血: 2.23mmol/L；平均红细胞血红蛋白含量(MCH)-静脉血: 33pg；低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.63mmol/L；阴离子间隙(AG)-静脉血: 12；白蛋白/球蛋白比值(ALB/GLO)-静脉血: 1.7；钠离子(Na+)-静脉血: 142mmol/L；钾离子(K+)-静脉血: 3.3mmol/L；氯离子(Cl-)-静脉血: 97.5mmol/L；白蛋白(ALB)-静脉血: 42.8g/L；总胆汁酸(TBA)-静脉血: 2.9umol/L；单核细胞百分比(Mono%)-静脉血: 0.143；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；红细胞比容(Hct)-静脉血: 40.8%；肌酐(Crea)-静脉血: 84.7umol/L；碱性磷酸酶(ALP)-静脉血: 64.7U/L；尿素氮(BUN)-静脉血: 5.06mmol/L；有核红细胞百分比(NRBC%)-静脉血: 0；总胆红素(TBIL)-静脉血: 9.3umol/L；载脂蛋白B(apoB)-静脉血: 0.65g/L；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；葡萄糖(Glu)-静脉血: 5.63mmol/L；球蛋白(GLO)-静脉血: 24.97g/L；C-反应蛋白(CRP)-静脉血: 6.22mg/L；镁离子(Mg2+)-静脉血: 0.97mmol/L；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1；α-L-岩藻糖苷酶(AFU)-静脉血: 40U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.009；平均红细胞血红蛋白浓度(MCHC)-静脉血: 342.2g/L；载脂蛋白AI(apoAI)-静脉血: 0.96g/L；天门冬氨酸氨基转移酶(AST)-静脉血: 28.……\n- [全程D56] 检验组合: 碱性磷酸酶(ALP)-静脉血: 64.1U/L；嗜酸性粒细胞百分比(Eos%)-静脉血: 0.017；嗜碱性粒细胞计数(Baso#)-静脉血: 010E9/L；钾离子(K+)-静脉血: 3.65mmol/L；总蛋白(TP)-静脉血: 62.2g/L；血液二氧化碳含量ctCO2(B)-静脉血: 32mmol/L；胱抑素(Cys-C)-静脉血: 0.81mg/L；钠离子(Na+)-静脉血: 139.1mmol/L；红细胞比容(Hct)-静脉血: 38.2%；红细胞体积分布宽度CV(RDW-CV)-静脉血: 12.5；载脂蛋白B(apoB)-静脉血: 0.72g/L；阴离子间隙(AG)-静脉血: 7.6；平均血小板体积(MPV)-静脉血: 10.7fL；丙氨酸氨基转移酶(ALT)-静脉血: 8.1U/L；中性粒细胞百分比(Neut%)-静脉血: 0.707；低密度脂蛋白胆固醇(LDL-C)-静脉血: 1.56mmol/L；天门冬氨酸氨基转移酶(AST)-静脉血: 13.8U/L；高密度脂蛋白胆固醇(HDL-C)-静脉血: 0.69mmolL；总胆固醇(TC)-静脉血: 2.82mmol/L；总胆红素(TBIL)-静脉血: 9.5umol/L；γ-谷氨酰基转移酶(GGT)-静脉血: 14U/L；嗜碱性粒细胞百分比(Baso%)-静脉血: 0.005；乳酸脱氢酶(LDH)-静脉血: 146.4U/L；单核细胞百分比(Mono%)-静脉血: 0.202；血小板分布宽度(PDW)-静脉血: 12.5%；α-L-岩藻糖苷酶(AFU)-静脉血: 22.8U/L；肌酐(Crea)-静脉血: 73.2umol/L；嗜酸性粒细胞计数(Eos#)-静脉血: 0.110E9/L；磷(P)-静脉血: 1.17mmol/L；氯离子(Cl-)-静脉血: 99.5mmol/L；尿素氮(BUN)-静脉血: 4.3mmol/L；血小板比容-静脉血: 11%；淋巴细胞计数(Lymph#)-静脉血: 0.310E9/L；总胆汁酸(TBA)-静脉血: 3.7umol/L；甘油三酯(TG)-静脉血: 0.85mmol/L；间接胆红素(IBIL)-静脉血: 5.5umolL；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST/ALT)-静脉血: 1.7；直接胆红素(DBIL)-静脉血: 4u……\n- [全程D62] 检验组合: 细菌涂片3-咽拭子: 未发现念珠状菌\n- [全程D63] 超声；肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套): 检查类型: 超声；检查名称: 肝、胆、胰、脾彩超(套);腹主动脉旁淋巴结彩超(套);双肾、输尿管、膀胱（前列腺）彩超(套)；检查部位:；检查所见: 肝脏大小、形态正常，包膜光滑，实质回声均匀，血管走行清晰、自然，肝内胆管不扩张，门静脉内径10mm，肝内未见明显肿物回声。 CDFI：肝动脉、门静脉血流通畅，为向肝血流信号，充盈良好，肝内未见明确异常血流信号。门静脉最大血流速度约27cm/s。 胆囊餐后改变，胆囊内可见一强回声团，直径约9mm，后方伴声影。 脾脏大小形态正常，包膜光滑，实质回声均匀，未见明显异常回声。 胰腺大小形态正常，实质回声均匀，未见明显异常回声。 双肾大小形态正常，实质回声均匀，未见明显异常回声。 CDFI：双肾血流呈珊瑚状，未见明确异常血流信号。 双侧输尿管未见明确扩张。 膀胱充盈良好，膀胱壁光滑，不厚，膀胱腔内未见明确肿物回声。 前列腺大小形态正常，大小约33×27×24mm，包膜光滑，实质回声均匀，未见明确肿物回声。 腹主动脉旁未见明确肿物回声。；检查结论: 胆囊结石。 肝脏、脾脏、胰腺、双肾、膀胱、前列腺未见明显占位病变声像。 双侧输尿管未见明确扩张。 腹主动脉旁未见明确占位病变。\n- [全程D64] X线检查；胸部正侧位照片: 检查类型: X线检查；检查名称: 胸部正侧位照片；检查部位:；检查所见: 双上肺纹理增粗，走行尚自然，双上肺野可见小斑点、条索影，双上胸膜稍增厚，余双肺野内未见明确实质性病变。双侧肺门未见增大，纵隔未见增宽，心影大小形态未见明显异常。双侧膈面光滑，双侧肋膈角锐利。；检查结论: 双上肺少许纤维增殖灶并双上胸膜稍增厚。\n- [全程D64] MRI；鼻咽部、颈部MR平扫+增强: 检查类型: MRI；检查名称: 鼻咽部、颈部MR平扫+增强；检查部位:；检查所见: 鼻咽癌放疗结束，对比某次就诊时间片： 鼻咽腔未见明显狭窄，鼻咽各壁未见明显增厚，粘膜表面尚光滑，增强扫描明显强化。双侧咽隐窝变浅，双侧咽旁脂肪间隙稍狭窄。 双侧腭帆提肌、腭帆张肌、头长肌结构清晰。双侧咽后见小淋巴结，较大者短径约7mm。 双侧后鼻孔未见堵塞，口咽双侧壁未见受累增厚。 双侧翼腭窝、颞下窝未见异常。 蝶骨基底部、斜坡、双侧岩尖、双侧枕骨基底部骨质信号减低，增强扫描见强化。 双侧海绵窦形态正常，未见增宽。双侧筛窦、蝶窦、上颌窦粘膜增厚，双侧乳突内见积液。 双眼大小、形态、位置均属正常、信号均匀，球后未见占位性病变。蝶鞍形态未见异常，其内未见占位性病变。 双侧颈II区、右侧颈III、IV区见多发淋巴结，部分融合，较大者短径11mm，信号欠均匀，增强较明显不均匀强化。 双侧颌下腺、腮腺大小、形态未见异常，信号均匀，未见占位性病变。 甲状腺双叶及峡部形态未见异常，信号均匀，未见占位性病变。喉咽腔形态未见异常，未见占位性病变。；检查结论: 鼻咽癌放疗后改变，较前明显好转。 颅底骨质破坏。 双侧咽后、双侧颈部多发淋巴结，较前缩小。 鼻窦炎，乳突炎。\n\n【既往治疗与反应】\n- [全程D42] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉咽痛，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。BR、生化常规大致正常。[姓名已隐去]主诊医生信息已隐藏，考虑患者上次化疗已达3周，指示今日按[计划性表述已隐藏]以DDP方案化疗第二程，做好水化、护肝等对症支持处理，继续放疗，密切观察放化疗副反应，遵嘱执行。\n- [全程D47] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉咽痛，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，认为患者化疗顺利完成，指示继续放疗，密切观察放疗副反应，遵嘱执行。\n- [全程D52] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，诉咽痛，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，指示予以止痛、口腔粘膜保护对症处理，加强营养支持，继续放疗。\n- [全程D57] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，未诉明显特殊不适，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]主诊医生信息已隐藏，指示继续放疗，遵嘱执行。\n- [全程D61] 上级查房记录；副教授查房记录: 病程类型: 上级查房记录；病程主题: 副医生信息已隐藏；病程内容: 患者继续放疗中，未诉明显特殊不适，精神、饮食、睡眠一般,大小便正常。体查：张口门齿距4cm；鼻咽顶后壁粘膜增厚；双侧颈部未扪及肿大淋巴结；颅神经检查：阴性。[姓名已隐去]医生信息已隐藏，考虑患者化疗即将到期，建议患者行第三程化疗，但患者拒绝，遂指示今日予以出院，于门诊继续放疗，遵嘱执行。\n\n【当前需要决策的问题】\n结合长期随访、当前客观证据和既往治疗史，下一步最合理的复发/转移评估或后续治疗路径是什么？\n\n\n【历史辅助决策节点】\n- 暂无可展示的历史辅助决策节点。\n\n请在以下 A-L 选项中选择唯一最合适的答案。\nA. 立即行双侧颈部淋巴结清扫术以彻底清除颈部残留病灶\nB. 立即行鼻咽及颈部局部追加外照射放疗10-15Gy推量\nC. 立即行全身PET-CT检查评估颈部淋巴结活性及远处转移\nD. 立即行鼻咽内镜下活检评估原发灶病理完全缓解情况\nE. 立即启动含铂双药方案辅助化疗2-3个周期强化全身控制\nF. 予以表皮生长因子受体靶向药物单药维持治疗半年至一年\nG. 结束根治性治疗进入随访，放疗后3个月复查影像学评估疗效\nH. 立即行颈部残留淋巴结细针穿刺活检以指导后续局部治疗\nI. 立即启动PD-1单抗等免疫检查点抑制剂维持治疗1年\nJ. 予以抗炎及对症支持治疗，放疗后1个月复查鼻咽颈部MRI\nK. 立即采用原诱导化疗方案进行2至3个周期全身巩固化疗\nL. 立即行颈部残留淋巴结局部微波消融或放射性粒子植入术\n\n请仅输出一个选项字母（A-L）。","options":[{"letter":"A","text":"立即行双侧颈部淋巴结清扫术以彻底清除颈部残留病灶","is_gold":false},{"letter":"B","text":"立即行鼻咽及颈部局部追加外照射放疗10-15Gy推量","is_gold":false},{"letter":"C","text":"立即行全身PET-CT检查评估颈部淋巴结活性及远处转移","is_gold":false},{"letter":"D","text":"立即行鼻咽内镜下活检评估原发灶病理完全缓解情况","is_gold":false},{"letter":"E","text":"立即启动含铂双药方案辅助化疗2-3个周期强化全身控制","is_gold":false},{"letter":"F","text":"予以表皮生长因子受体靶向药物单药维持治疗半年至一年","is_gold":false},{"letter":"G","text":"结束根治性治疗进入随访，放疗后3个月复查影像学评估疗效","is_gold":true},{"letter":"H","text":"立即行颈部残留淋巴结细针穿刺活检以指导后续局部治疗","is_gold":false},{"letter":"I","text":"立即启动PD-1单抗等免疫检查点抑制剂维持治疗1年","is_gold":false},{"letter":"J","text":"予以抗炎及对症支持治疗，放疗后1个月复查鼻咽颈部MRI","is_gold":false},{"letter":"K","text":"立即采用原诱导化疗方案进行2至3个周期全身巩固化疗","is_gold":false},{"letter":"L","text":"立即行颈部残留淋巴结局部微波消融或放射性粒子植入术","is_gold":false}],"gold_letter":"G"}]}
diff --git a/supplementary/external_mri/README.md b/supplementary/external_mri/README.md
new file mode 100644
index 0000000000000000000000000000000000000000..1615ecd6d9f9ea76ddff598e598f2576726f1d38
--- /dev/null
+++ b/supplementary/external_mri/README.md
@@ -0,0 +1,16 @@
+# External-centre MRI T staging
+
+This panel contains 53 patients from Nanfang Hospital, with T1/T2/T3/T4 counts
+of 4/8/31/10. Labels follow AJCC/UICC edition 8 and the clinical assessment
+associated with the examination. Two examinations without a unique reference
+category are excluded from this scored panel.
+
+Each patient has ten four-row JPEG panels. Each row presents three spatially
+ordered slices from one source sequence; 30 positions are sampled per sequence.
+Sequence labels reflect the acquired sequences, including STIR and mDIXON where
+applicable. The images contain no report text. All ten panels are supplied jointly
+with the T-only prompt in `requests.jsonl`. This presentation differs from the
+five-sequence groups in T400/N400.
+
+Extract `images.tar` in this directory. `labels.jsonl` contains the reference
+categories, and the request image paths are relative to this directory.
diff --git a/supplementary/external_mri/images.tar b/supplementary/external_mri/images.tar
new file mode 100644
index 0000000000000000000000000000000000000000..03db39b3b4c08a002c1527166dd4ad1a0fa555bc
--- /dev/null
+++ b/supplementary/external_mri/images.tar
@@ -0,0 +1,3 @@
+version https://git-lfs.github.com/spec/v1
+oid sha256:b2bb8c4f2670eb9bb380436c92a6af7e04639dee3e5ab9a45396c35183cae69f
+size 316180480
diff --git a/supplementary/external_mri/labels.jsonl b/supplementary/external_mri/labels.jsonl
new file mode 100644
index 0000000000000000000000000000000000000000..6f7acec6b7ab957a6290c0693e294d9aa8d7981f
--- /dev/null
+++ b/supplementary/external_mri/labels.jsonl
@@ -0,0 +1,53 @@
+{"id": "nf-t-001", "t_stage": "T4"}
+{"id": "nf-t-002", "t_stage": "T4"}
+{"id": "nf-t-003", "t_stage": "T2"}
+{"id": "nf-t-004", "t_stage": "T4"}
+{"id": "nf-t-005", "t_stage": "T3"}
+{"id": "nf-t-006", "t_stage": "T3"}
+{"id": "nf-t-007", "t_stage": "T3"}
+{"id": "nf-t-008", "t_stage": "T3"}
+{"id": "nf-t-009", "t_stage": "T1"}
+{"id": "nf-t-010", "t_stage": "T3"}
+{"id": "nf-t-011", "t_stage": "T3"}
+{"id": "nf-t-012", "t_stage": "T3"}
+{"id": "nf-t-013", "t_stage": "T4"}
+{"id": "nf-t-014", "t_stage": "T3"}
+{"id": "nf-t-015", "t_stage": "T3"}
+{"id": "nf-t-016", "t_stage": "T3"}
+{"id": "nf-t-018", "t_stage": "T2"}
+{"id": "nf-t-019", "t_stage": "T4"}
+{"id": "nf-t-020", "t_stage": "T2"}
+{"id": "nf-t-021", "t_stage": "T2"}
+{"id": "nf-t-022", "t_stage": "T4"}
+{"id": "nf-t-023", "t_stage": "T1"}
+{"id": "nf-t-024", "t_stage": "T4"}
+{"id": "nf-t-025", "t_stage": "T3"}
+{"id": "nf-t-027", "t_stage": "T3"}
+{"id": "nf-t-028", "t_stage": "T3"}
+{"id": "nf-t-029", "t_stage": "T3"}
+{"id": "nf-t-030", "t_stage": "T4"}
+{"id": "nf-t-031", "t_stage": "T3"}
+{"id": "nf-t-032", "t_stage": "T3"}
+{"id": "nf-t-033", "t_stage": "T4"}
+{"id": "nf-t-034", "t_stage": "T3"}
+{"id": "nf-t-035", "t_stage": "T2"}
+{"id": "nf-t-036", "t_stage": "T3"}
+{"id": "nf-t-037", "t_stage": "T3"}
+{"id": "nf-t-038", "t_stage": "T1"}
+{"id": "nf-t-039", "t_stage": "T3"}
+{"id": "nf-t-040", "t_stage": "T3"}
+{"id": "nf-t-041", "t_stage": "T2"}
+{"id": "nf-t-042", "t_stage": "T3"}
+{"id": "nf-t-043", "t_stage": "T3"}
+{"id": "nf-t-044", "t_stage": "T3"}
+{"id": "nf-t-045", "t_stage": "T3"}
+{"id": "nf-t-046", "t_stage": "T1"}
+{"id": "nf-t-047", "t_stage": "T2"}
+{"id": "nf-t-048", "t_stage": "T3"}
+{"id": "nf-t-049", "t_stage": "T3"}
+{"id": "nf-t-050", "t_stage": "T3"}
+{"id": "nf-t-051", "t_stage": "T3"}
+{"id": "nf-t-052", "t_stage": "T4"}
+{"id": "nf-t-053", "t_stage": "T3"}
+{"id": "nf-t-054", "t_stage": "T2"}
+{"id": "nf-t-055", "t_stage": "T3"}
diff --git a/supplementary/external_mri/requests.jsonl b/supplementary/external_mri/requests.jsonl
new file mode 100644
index 0000000000000000000000000000000000000000..4cf59a9d4fe247ed3d40724619b00a422718cf3c
--- /dev/null
+++ b/supplementary/external_mri/requests.jsonl
@@ -0,0 +1,53 @@
+{"id": "nf-t-001", "sample_id": "nf-t-001", "task": "external_T_stage", "stage_edition": 8, "prompt": "你将看到同一患者的10张鼻咽 MRI 多序列图像面板。请仅依据这些图像，按 AJCC/UICC 第8版鼻咽癌 T 分类判断原发肿瘤的 T 类别。不要判断 N、M 或总体分期。\n仅输出一个 JSON 对象，键为 t_stage，值为 T1、T2、T3 或 T4 之一。不要输出解释、Markdown 或占位符。", "images": ["assets/nf-t-001/panel_01.jpg", "assets/nf-t-001/panel_02.jpg", "assets/nf-t-001/panel_03.jpg", "assets/nf-t-001/panel_04.jpg", "assets/nf-t-001/panel_05.jpg", "assets/nf-t-001/panel_06.jpg", "assets/nf-t-001/panel_07.jpg", "assets/nf-t-001/panel_08.jpg", "assets/nf-t-001/panel_09.jpg", "assets/nf-t-001/panel_10.jpg"]}
+{"id": "nf-t-002", "sample_id": "nf-t-002", "task": "external_T_stage", "stage_edition": 8, "prompt": "你将看到同一患者的10张鼻咽 MRI 多序列图像面板。请仅依据这些图像，按 AJCC/UICC 第8版鼻咽癌 T 分类判断原发肿瘤的 T 类别。不要判断 N、M 或总体分期。\n仅输出一个 JSON 对象，键为 t_stage，值为 T1、T2、T3 或 T4 之一。不要输出解释、Markdown 或占位符。", "images": ["assets/nf-t-002/panel_01.jpg", "assets/nf-t-002/panel_02.jpg", "assets/nf-t-002/panel_03.jpg", "assets/nf-t-002/panel_04.jpg", "assets/nf-t-002/panel_05.jpg", "assets/nf-t-002/panel_06.jpg", "assets/nf-t-002/panel_07.jpg", "assets/nf-t-002/panel_08.jpg", "assets/nf-t-002/panel_09.jpg", "assets/nf-t-002/panel_10.jpg"]}
+{"id": "nf-t-003", "sample_id": "nf-t-003", "task": "external_T_stage", "stage_edition": 8, "prompt": "你将看到同一患者的10张鼻咽 MRI 多序列图像面板。请仅依据这些图像，按 AJCC/UICC 第8版鼻咽癌 T 分类判断原发肿瘤的 T 类别。不要判断 N、M 或总体分期。\n仅输出一个 JSON 对象，键为 t_stage，值为 T1、T2、T3 或 T4 之一。不要输出解释、Markdown 或占位符。", "images": ["assets/nf-t-003/panel_01.jpg", "assets/nf-t-003/panel_02.jpg", "assets/nf-t-003/panel_03.jpg", "assets/nf-t-003/panel_04.jpg", "assets/nf-t-003/panel_05.jpg", "assets/nf-t-003/panel_06.jpg", "assets/nf-t-003/panel_07.jpg", "assets/nf-t-003/panel_08.jpg", "assets/nf-t-003/panel_09.jpg", "assets/nf-t-003/panel_10.jpg"]}
+{"id": "nf-t-004", "sample_id": "nf-t-004", "task": "external_T_stage", "stage_edition": 8, "prompt": "你将看到同一患者的10张鼻咽 MRI 多序列图像面板。请仅依据这些图像，按 AJCC/UICC 第8版鼻咽癌 T 分类判断原发肿瘤的 T 类别。不要判断 N、M 或总体分期。\n仅输出一个 JSON 对象，键为 t_stage，值为 T1、T2、T3 或 T4 之一。不要输出解释、Markdown 或占位符。", "images": ["assets/nf-t-004/panel_01.jpg", "assets/nf-t-004/panel_02.jpg", "assets/nf-t-004/panel_03.jpg", "assets/nf-t-004/panel_04.jpg", "assets/nf-t-004/panel_05.jpg", "assets/nf-t-004/panel_06.jpg", "assets/nf-t-004/panel_07.jpg", "assets/nf-t-004/panel_08.jpg", "assets/nf-t-004/panel_09.jpg", "assets/nf-t-004/panel_10.jpg"]}
+{"id": "nf-t-005", "sample_id": "nf-t-005", "task": "external_T_stage", "stage_edition": 8, "prompt": "你将看到同一患者的10张鼻咽 MRI 多序列图像面板。请仅依据这些图像，按 AJCC/UICC 第8版鼻咽癌 T 分类判断原发肿瘤的 T 类别。不要判断 N、M 或总体分期。\n仅输出一个 JSON 对象，键为 t_stage，值为 T1、T2、T3 或 T4 之一。不要输出解释、Markdown 或占位符。", "images": ["assets/nf-t-005/panel_01.jpg", "assets/nf-t-005/panel_02.jpg", "assets/nf-t-005/panel_03.jpg", "assets/nf-t-005/panel_04.jpg", "assets/nf-t-005/panel_05.jpg", "assets/nf-t-005/panel_06.jpg", "assets/nf-t-005/panel_07.jpg", "assets/nf-t-005/panel_08.jpg", "assets/nf-t-005/panel_09.jpg", "assets/nf-t-005/panel_10.jpg"]}
+{"id": "nf-t-006", "sample_id": "nf-t-006", "task": "external_T_stage", "stage_edition": 8, "prompt": "你将看到同一患者的10张鼻咽 MRI 多序列图像面板。请仅依据这些图像，按 AJCC/UICC 第8版鼻咽癌 T 分类判断原发肿瘤的 T 类别。不要判断 N、M 或总体分期。\n仅输出一个 JSON 对象，键为 t_stage，值为 T1、T2、T3 或 T4 之一。不要输出解释、Markdown 或占位符。", "images": ["assets/nf-t-006/panel_01.jpg", "assets/nf-t-006/panel_02.jpg", "assets/nf-t-006/panel_03.jpg", "assets/nf-t-006/panel_04.jpg", "assets/nf-t-006/panel_05.jpg", "assets/nf-t-006/panel_06.jpg", "assets/nf-t-006/panel_07.jpg", "assets/nf-t-006/panel_08.jpg", "assets/nf-t-006/panel_09.jpg", "assets/nf-t-006/panel_10.jpg"]}
+{"id": "nf-t-007", "sample_id": "nf-t-007", "task": "external_T_stage", "stage_edition": 8, "prompt": "你将看到同一患者的10张鼻咽 MRI 多序列图像面板。请仅依据这些图像，按 AJCC/UICC 第8版鼻咽癌 T 分类判断原发肿瘤的 T 类别。不要判断 N、M 或总体分期。\n仅输出一个 JSON 对象，键为 t_stage，值为 T1、T2、T3 或 T4 之一。不要输出解释、Markdown 或占位符。", "images": ["assets/nf-t-007/panel_01.jpg", "assets/nf-t-007/panel_02.jpg", "assets/nf-t-007/panel_03.jpg", "assets/nf-t-007/panel_04.jpg", "assets/nf-t-007/panel_05.jpg", "assets/nf-t-007/panel_06.jpg", "assets/nf-t-007/panel_07.jpg", "assets/nf-t-007/panel_08.jpg", "assets/nf-t-007/panel_09.jpg", "assets/nf-t-007/panel_10.jpg"]}
+{"id": "nf-t-008", "sample_id": "nf-t-008", "task": "external_T_stage", "stage_edition": 8, "prompt": "你将看到同一患者的10张鼻咽 MRI 多序列图像面板。请仅依据这些图像，按 AJCC/UICC 第8版鼻咽癌 T 分类判断原发肿瘤的 T 类别。不要判断 N、M 或总体分期。\n仅输出一个 JSON 对象，键为 t_stage，值为 T1、T2、T3 或 T4 之一。不要输出解释、Markdown 或占位符。", "images": ["assets/nf-t-008/panel_01.jpg", "assets/nf-t-008/panel_02.jpg", "assets/nf-t-008/panel_03.jpg", "assets/nf-t-008/panel_04.jpg", "assets/nf-t-008/panel_05.jpg", "assets/nf-t-008/panel_06.jpg", "assets/nf-t-008/panel_07.jpg", "assets/nf-t-008/panel_08.jpg", "assets/nf-t-008/panel_09.jpg", "assets/nf-t-008/panel_10.jpg"]}
+{"id": "nf-t-009", "sample_id": "nf-t-009", "task": "external_T_stage", "stage_edition": 8, "prompt": "你将看到同一患者的10张鼻咽 MRI 多序列图像面板。请仅依据这些图像，按 AJCC/UICC 第8版鼻咽癌 T 分类判断原发肿瘤的 T 类别。不要判断 N、M 或总体分期。\n仅输出一个 JSON 对象，键为 t_stage，值为 T1、T2、T3 或 T4 之一。不要输出解释、Markdown 或占位符。", "images": ["assets/nf-t-009/panel_01.jpg", "assets/nf-t-009/panel_02.jpg", "assets/nf-t-009/panel_03.jpg", "assets/nf-t-009/panel_04.jpg", "assets/nf-t-009/panel_05.jpg", "assets/nf-t-009/panel_06.jpg", "assets/nf-t-009/panel_07.jpg", "assets/nf-t-009/panel_08.jpg", "assets/nf-t-009/panel_09.jpg", "assets/nf-t-009/panel_10.jpg"]}
+{"id": "nf-t-010", "sample_id": "nf-t-010", "task": "external_T_stage", "stage_edition": 8, "prompt": "你将看到同一患者的10张鼻咽 MRI 多序列图像面板。请仅依据这些图像，按 AJCC/UICC 第8版鼻咽癌 T 分类判断原发肿瘤的 T 类别。不要判断 N、M 或总体分期。\n仅输出一个 JSON 对象，键为 t_stage，值为 T1、T2、T3 或 T4 之一。不要输出解释、Markdown 或占位符。", "images": ["assets/nf-t-010/panel_01.jpg", "assets/nf-t-010/panel_02.jpg", "assets/nf-t-010/panel_03.jpg", "assets/nf-t-010/panel_04.jpg", "assets/nf-t-010/panel_05.jpg", "assets/nf-t-010/panel_06.jpg", "assets/nf-t-010/panel_07.jpg", "assets/nf-t-010/panel_08.jpg", "assets/nf-t-010/panel_09.jpg", "assets/nf-t-010/panel_10.jpg"]}
+{"id": "nf-t-011", "sample_id": "nf-t-011", "task": "external_T_stage", "stage_edition": 8, "prompt": "你将看到同一患者的10张鼻咽 MRI 多序列图像面板。请仅依据这些图像，按 AJCC/UICC 第8版鼻咽癌 T 分类判断原发肿瘤的 T 类别。不要判断 N、M 或总体分期。\n仅输出一个 JSON 对象，键为 t_stage，值为 T1、T2、T3 或 T4 之一。不要输出解释、Markdown 或占位符。", "images": ["assets/nf-t-011/panel_01.jpg", "assets/nf-t-011/panel_02.jpg", "assets/nf-t-011/panel_03.jpg", "assets/nf-t-011/panel_04.jpg", "assets/nf-t-011/panel_05.jpg", "assets/nf-t-011/panel_06.jpg", "assets/nf-t-011/panel_07.jpg", "assets/nf-t-011/panel_08.jpg", "assets/nf-t-011/panel_09.jpg", "assets/nf-t-011/panel_10.jpg"]}
+{"id": "nf-t-012", "sample_id": "nf-t-012", "task": "external_T_stage", "stage_edition": 8, "prompt": "你将看到同一患者的10张鼻咽 MRI 多序列图像面板。请仅依据这些图像，按 AJCC/UICC 第8版鼻咽癌 T 分类判断原发肿瘤的 T 类别。不要判断 N、M 或总体分期。\n仅输出一个 JSON 对象，键为 t_stage，值为 T1、T2、T3 或 T4 之一。不要输出解释、Markdown 或占位符。", "images": ["assets/nf-t-012/panel_01.jpg", "assets/nf-t-012/panel_02.jpg", "assets/nf-t-012/panel_03.jpg", "assets/nf-t-012/panel_04.jpg", "assets/nf-t-012/panel_05.jpg", "assets/nf-t-012/panel_06.jpg", "assets/nf-t-012/panel_07.jpg", "assets/nf-t-012/panel_08.jpg", "assets/nf-t-012/panel_09.jpg", "assets/nf-t-012/panel_10.jpg"]}
+{"id": "nf-t-013", "sample_id": "nf-t-013", "task": "external_T_stage", "stage_edition": 8, "prompt": "你将看到同一患者的10张鼻咽 MRI 多序列图像面板。请仅依据这些图像，按 AJCC/UICC 第8版鼻咽癌 T 分类判断原发肿瘤的 T 类别。不要判断 N、M 或总体分期。\n仅输出一个 JSON 对象，键为 t_stage，值为 T1、T2、T3 或 T4 之一。不要输出解释、Markdown 或占位符。", "images": ["assets/nf-t-013/panel_01.jpg", "assets/nf-t-013/panel_02.jpg", "assets/nf-t-013/panel_03.jpg", "assets/nf-t-013/panel_04.jpg", "assets/nf-t-013/panel_05.jpg", "assets/nf-t-013/panel_06.jpg", "assets/nf-t-013/panel_07.jpg", "assets/nf-t-013/panel_08.jpg", "assets/nf-t-013/panel_09.jpg", "assets/nf-t-013/panel_10.jpg"]}
+{"id": "nf-t-014", "sample_id": "nf-t-014", "task": "external_T_stage", "stage_edition": 8, "prompt": "你将看到同一患者的10张鼻咽 MRI 多序列图像面板。请仅依据这些图像，按 AJCC/UICC 第8版鼻咽癌 T 分类判断原发肿瘤的 T 类别。不要判断 N、M 或总体分期。\n仅输出一个 JSON 对象，键为 t_stage，值为 T1、T2、T3 或 T4 之一。不要输出解释、Markdown 或占位符。", "images": ["assets/nf-t-014/panel_01.jpg", "assets/nf-t-014/panel_02.jpg", "assets/nf-t-014/panel_03.jpg", "assets/nf-t-014/panel_04.jpg", "assets/nf-t-014/panel_05.jpg", "assets/nf-t-014/panel_06.jpg", "assets/nf-t-014/panel_07.jpg", "assets/nf-t-014/panel_08.jpg", "assets/nf-t-014/panel_09.jpg", "assets/nf-t-014/panel_10.jpg"]}
+{"id": "nf-t-015", "sample_id": "nf-t-015", "task": "external_T_stage", "stage_edition": 8, "prompt": "你将看到同一患者的10张鼻咽 MRI 多序列图像面板。请仅依据这些图像，按 AJCC/UICC 第8版鼻咽癌 T 分类判断原发肿瘤的 T 类别。不要判断 N、M 或总体分期。\n仅输出一个 JSON 对象，键为 t_stage，值为 T1、T2、T3 或 T4 之一。不要输出解释、Markdown 或占位符。", "images": ["assets/nf-t-015/panel_01.jpg", "assets/nf-t-015/panel_02.jpg", "assets/nf-t-015/panel_03.jpg", "assets/nf-t-015/panel_04.jpg", "assets/nf-t-015/panel_05.jpg", "assets/nf-t-015/panel_06.jpg", "assets/nf-t-015/panel_07.jpg", "assets/nf-t-015/panel_08.jpg", "assets/nf-t-015/panel_09.jpg", "assets/nf-t-015/panel_10.jpg"]}
+{"id": "nf-t-016", "sample_id": "nf-t-016", "task": "external_T_stage", "stage_edition": 8, "prompt": "你将看到同一患者的10张鼻咽 MRI 多序列图像面板。请仅依据这些图像，按 AJCC/UICC 第8版鼻咽癌 T 分类判断原发肿瘤的 T 类别。不要判断 N、M 或总体分期。\n仅输出一个 JSON 对象，键为 t_stage，值为 T1、T2、T3 或 T4 之一。不要输出解释、Markdown 或占位符。", "images": ["assets/nf-t-016/panel_01.jpg", "assets/nf-t-016/panel_02.jpg", "assets/nf-t-016/panel_03.jpg", "assets/nf-t-016/panel_04.jpg", "assets/nf-t-016/panel_05.jpg", "assets/nf-t-016/panel_06.jpg", "assets/nf-t-016/panel_07.jpg", "assets/nf-t-016/panel_08.jpg", "assets/nf-t-016/panel_09.jpg", "assets/nf-t-016/panel_10.jpg"]}
+{"id": "nf-t-018", "sample_id": "nf-t-018", "task": "external_T_stage", "stage_edition": 8, "prompt": "你将看到同一患者的10张鼻咽 MRI 多序列图像面板。请仅依据这些图像，按 AJCC/UICC 第8版鼻咽癌 T 分类判断原发肿瘤的 T 类别。不要判断 N、M 或总体分期。\n仅输出一个 JSON 对象，键为 t_stage，值为 T1、T2、T3 或 T4 之一。不要输出解释、Markdown 或占位符。", "images": ["assets/nf-t-018/panel_01.jpg", "assets/nf-t-018/panel_02.jpg", "assets/nf-t-018/panel_03.jpg", "assets/nf-t-018/panel_04.jpg", "assets/nf-t-018/panel_05.jpg", "assets/nf-t-018/panel_06.jpg", "assets/nf-t-018/panel_07.jpg", "assets/nf-t-018/panel_08.jpg", "assets/nf-t-018/panel_09.jpg", "assets/nf-t-018/panel_10.jpg"]}
+{"id": "nf-t-019", "sample_id": "nf-t-019", "task": "external_T_stage", "stage_edition": 8, "prompt": "你将看到同一患者的10张鼻咽 MRI 多序列图像面板。请仅依据这些图像，按 AJCC/UICC 第8版鼻咽癌 T 分类判断原发肿瘤的 T 类别。不要判断 N、M 或总体分期。\n仅输出一个 JSON 对象，键为 t_stage，值为 T1、T2、T3 或 T4 之一。不要输出解释、Markdown 或占位符。", "images": ["assets/nf-t-019/panel_01.jpg", "assets/nf-t-019/panel_02.jpg", "assets/nf-t-019/panel_03.jpg", "assets/nf-t-019/panel_04.jpg", "assets/nf-t-019/panel_05.jpg", "assets/nf-t-019/panel_06.jpg", "assets/nf-t-019/panel_07.jpg", "assets/nf-t-019/panel_08.jpg", "assets/nf-t-019/panel_09.jpg", "assets/nf-t-019/panel_10.jpg"]}
+{"id": "nf-t-020", "sample_id": "nf-t-020", "task": "external_T_stage", "stage_edition": 8, "prompt": "你将看到同一患者的10张鼻咽 MRI 多序列图像面板。请仅依据这些图像，按 AJCC/UICC 第8版鼻咽癌 T 分类判断原发肿瘤的 T 类别。不要判断 N、M 或总体分期。\n仅输出一个 JSON 对象，键为 t_stage，值为 T1、T2、T3 或 T4 之一。不要输出解释、Markdown 或占位符。", "images": ["assets/nf-t-020/panel_01.jpg", "assets/nf-t-020/panel_02.jpg", "assets/nf-t-020/panel_03.jpg", "assets/nf-t-020/panel_04.jpg", "assets/nf-t-020/panel_05.jpg", "assets/nf-t-020/panel_06.jpg", "assets/nf-t-020/panel_07.jpg", "assets/nf-t-020/panel_08.jpg", "assets/nf-t-020/panel_09.jpg", "assets/nf-t-020/panel_10.jpg"]}
+{"id": "nf-t-021", "sample_id": "nf-t-021", "task": "external_T_stage", "stage_edition": 8, "prompt": "你将看到同一患者的10张鼻咽 MRI 多序列图像面板。请仅依据这些图像，按 AJCC/UICC 第8版鼻咽癌 T 分类判断原发肿瘤的 T 类别。不要判断 N、M 或总体分期。\n仅输出一个 JSON 对象，键为 t_stage，值为 T1、T2、T3 或 T4 之一。不要输出解释、Markdown 或占位符。", "images": ["assets/nf-t-021/panel_01.jpg", "assets/nf-t-021/panel_02.jpg", "assets/nf-t-021/panel_03.jpg", "assets/nf-t-021/panel_04.jpg", "assets/nf-t-021/panel_05.jpg", "assets/nf-t-021/panel_06.jpg", "assets/nf-t-021/panel_07.jpg", "assets/nf-t-021/panel_08.jpg", "assets/nf-t-021/panel_09.jpg", "assets/nf-t-021/panel_10.jpg"]}
+{"id": "nf-t-022", "sample_id": "nf-t-022", "task": "external_T_stage", "stage_edition": 8, "prompt": "你将看到同一患者的10张鼻咽 MRI 多序列图像面板。请仅依据这些图像，按 AJCC/UICC 第8版鼻咽癌 T 分类判断原发肿瘤的 T 类别。不要判断 N、M 或总体分期。\n仅输出一个 JSON 对象，键为 t_stage，值为 T1、T2、T3 或 T4 之一。不要输出解释、Markdown 或占位符。", "images": ["assets/nf-t-022/panel_01.jpg", "assets/nf-t-022/panel_02.jpg", "assets/nf-t-022/panel_03.jpg", "assets/nf-t-022/panel_04.jpg", "assets/nf-t-022/panel_05.jpg", "assets/nf-t-022/panel_06.jpg", "assets/nf-t-022/panel_07.jpg", "assets/nf-t-022/panel_08.jpg", "assets/nf-t-022/panel_09.jpg", "assets/nf-t-022/panel_10.jpg"]}
+{"id": "nf-t-023", "sample_id": "nf-t-023", "task": "external_T_stage", "stage_edition": 8, "prompt": "你将看到同一患者的10张鼻咽 MRI 多序列图像面板。请仅依据这些图像，按 AJCC/UICC 第8版鼻咽癌 T 分类判断原发肿瘤的 T 类别。不要判断 N、M 或总体分期。\n仅输出一个 JSON 对象，键为 t_stage，值为 T1、T2、T3 或 T4 之一。不要输出解释、Markdown 或占位符。", "images": ["assets/nf-t-023/panel_01.jpg", "assets/nf-t-023/panel_02.jpg", "assets/nf-t-023/panel_03.jpg", "assets/nf-t-023/panel_04.jpg", "assets/nf-t-023/panel_05.jpg", "assets/nf-t-023/panel_06.jpg", "assets/nf-t-023/panel_07.jpg", "assets/nf-t-023/panel_08.jpg", "assets/nf-t-023/panel_09.jpg", "assets/nf-t-023/panel_10.jpg"]}
+{"id": "nf-t-024", "sample_id": "nf-t-024", "task": "external_T_stage", "stage_edition": 8, "prompt": "你将看到同一患者的10张鼻咽 MRI 多序列图像面板。请仅依据这些图像，按 AJCC/UICC 第8版鼻咽癌 T 分类判断原发肿瘤的 T 类别。不要判断 N、M 或总体分期。\n仅输出一个 JSON 对象，键为 t_stage，值为 T1、T2、T3 或 T4 之一。不要输出解释、Markdown 或占位符。", "images": ["assets/nf-t-024/panel_01.jpg", "assets/nf-t-024/panel_02.jpg", "assets/nf-t-024/panel_03.jpg", "assets/nf-t-024/panel_04.jpg", "assets/nf-t-024/panel_05.jpg", "assets/nf-t-024/panel_06.jpg", "assets/nf-t-024/panel_07.jpg", "assets/nf-t-024/panel_08.jpg", "assets/nf-t-024/panel_09.jpg", "assets/nf-t-024/panel_10.jpg"]}
+{"id": "nf-t-025", "sample_id": "nf-t-025", "task": "external_T_stage", "stage_edition": 8, "prompt": "你将看到同一患者的10张鼻咽 MRI 多序列图像面板。请仅依据这些图像，按 AJCC/UICC 第8版鼻咽癌 T 分类判断原发肿瘤的 T 类别。不要判断 N、M 或总体分期。\n仅输出一个 JSON 对象，键为 t_stage，值为 T1、T2、T3 或 T4 之一。不要输出解释、Markdown 或占位符。", "images": ["assets/nf-t-025/panel_01.jpg", "assets/nf-t-025/panel_02.jpg", "assets/nf-t-025/panel_03.jpg", "assets/nf-t-025/panel_04.jpg", "assets/nf-t-025/panel_05.jpg", "assets/nf-t-025/panel_06.jpg", "assets/nf-t-025/panel_07.jpg", "assets/nf-t-025/panel_08.jpg", "assets/nf-t-025/panel_09.jpg", "assets/nf-t-025/panel_10.jpg"]}
+{"id": "nf-t-027", "sample_id": "nf-t-027", "task": "external_T_stage", "stage_edition": 8, "prompt": "你将看到同一患者的10张鼻咽 MRI 多序列图像面板。请仅依据这些图像，按 AJCC/UICC 第8版鼻咽癌 T 分类判断原发肿瘤的 T 类别。不要判断 N、M 或总体分期。\n仅输出一个 JSON 对象，键为 t_stage，值为 T1、T2、T3 或 T4 之一。不要输出解释、Markdown 或占位符。", "images": ["assets/nf-t-027/panel_01.jpg", "assets/nf-t-027/panel_02.jpg", "assets/nf-t-027/panel_03.jpg", "assets/nf-t-027/panel_04.jpg", "assets/nf-t-027/panel_05.jpg", "assets/nf-t-027/panel_06.jpg", "assets/nf-t-027/panel_07.jpg", "assets/nf-t-027/panel_08.jpg", "assets/nf-t-027/panel_09.jpg", "assets/nf-t-027/panel_10.jpg"]}
+{"id": "nf-t-028", "sample_id": "nf-t-028", "task": "external_T_stage", "stage_edition": 8, "prompt": "你将看到同一患者的10张鼻咽 MRI 多序列图像面板。请仅依据这些图像，按 AJCC/UICC 第8版鼻咽癌 T 分类判断原发肿瘤的 T 类别。不要判断 N、M 或总体分期。\n仅输出一个 JSON 对象，键为 t_stage，值为 T1、T2、T3 或 T4 之一。不要输出解释、Markdown 或占位符。", "images": ["assets/nf-t-028/panel_01.jpg", "assets/nf-t-028/panel_02.jpg", "assets/nf-t-028/panel_03.jpg", "assets/nf-t-028/panel_04.jpg", "assets/nf-t-028/panel_05.jpg", "assets/nf-t-028/panel_06.jpg", "assets/nf-t-028/panel_07.jpg", "assets/nf-t-028/panel_08.jpg", "assets/nf-t-028/panel_09.jpg", "assets/nf-t-028/panel_10.jpg"]}
+{"id": "nf-t-029", "sample_id": "nf-t-029", "task": "external_T_stage", "stage_edition": 8, "prompt": "你将看到同一患者的10张鼻咽 MRI 多序列图像面板。请仅依据这些图像，按 AJCC/UICC 第8版鼻咽癌 T 分类判断原发肿瘤的 T 类别。不要判断 N、M 或总体分期。\n仅输出一个 JSON 对象，键为 t_stage，值为 T1、T2、T3 或 T4 之一。不要输出解释、Markdown 或占位符。", "images": ["assets/nf-t-029/panel_01.jpg", "assets/nf-t-029/panel_02.jpg", "assets/nf-t-029/panel_03.jpg", "assets/nf-t-029/panel_04.jpg", "assets/nf-t-029/panel_05.jpg", "assets/nf-t-029/panel_06.jpg", "assets/nf-t-029/panel_07.jpg", "assets/nf-t-029/panel_08.jpg", "assets/nf-t-029/panel_09.jpg", "assets/nf-t-029/panel_10.jpg"]}
+{"id": "nf-t-030", "sample_id": "nf-t-030", "task": "external_T_stage", "stage_edition": 8, "prompt": "你将看到同一患者的10张鼻咽 MRI 多序列图像面板。请仅依据这些图像，按 AJCC/UICC 第8版鼻咽癌 T 分类判断原发肿瘤的 T 类别。不要判断 N、M 或总体分期。\n仅输出一个 JSON 对象，键为 t_stage，值为 T1、T2、T3 或 T4 之一。不要输出解释、Markdown 或占位符。", "images": ["assets/nf-t-030/panel_01.jpg", "assets/nf-t-030/panel_02.jpg", "assets/nf-t-030/panel_03.jpg", "assets/nf-t-030/panel_04.jpg", "assets/nf-t-030/panel_05.jpg", "assets/nf-t-030/panel_06.jpg", "assets/nf-t-030/panel_07.jpg", "assets/nf-t-030/panel_08.jpg", "assets/nf-t-030/panel_09.jpg", "assets/nf-t-030/panel_10.jpg"]}
+{"id": "nf-t-031", "sample_id": "nf-t-031", "task": "external_T_stage", "stage_edition": 8, "prompt": "你将看到同一患者的10张鼻咽 MRI 多序列图像面板。请仅依据这些图像，按 AJCC/UICC 第8版鼻咽癌 T 分类判断原发肿瘤的 T 类别。不要判断 N、M 或总体分期。\n仅输出一个 JSON 对象，键为 t_stage，值为 T1、T2、T3 或 T4 之一。不要输出解释、Markdown 或占位符。", "images": ["assets/nf-t-031/panel_01.jpg", "assets/nf-t-031/panel_02.jpg", "assets/nf-t-031/panel_03.jpg", "assets/nf-t-031/panel_04.jpg", "assets/nf-t-031/panel_05.jpg", "assets/nf-t-031/panel_06.jpg", "assets/nf-t-031/panel_07.jpg", "assets/nf-t-031/panel_08.jpg", "assets/nf-t-031/panel_09.jpg", "assets/nf-t-031/panel_10.jpg"]}
+{"id": "nf-t-032", "sample_id": "nf-t-032", "task": "external_T_stage", "stage_edition": 8, "prompt": "你将看到同一患者的10张鼻咽 MRI 多序列图像面板。请仅依据这些图像，按 AJCC/UICC 第8版鼻咽癌 T 分类判断原发肿瘤的 T 类别。不要判断 N、M 或总体分期。\n仅输出一个 JSON 对象，键为 t_stage，值为 T1、T2、T3 或 T4 之一。不要输出解释、Markdown 或占位符。", "images": ["assets/nf-t-032/panel_01.jpg", "assets/nf-t-032/panel_02.jpg", "assets/nf-t-032/panel_03.jpg", "assets/nf-t-032/panel_04.jpg", "assets/nf-t-032/panel_05.jpg", "assets/nf-t-032/panel_06.jpg", "assets/nf-t-032/panel_07.jpg", "assets/nf-t-032/panel_08.jpg", "assets/nf-t-032/panel_09.jpg", "assets/nf-t-032/panel_10.jpg"]}
+{"id": "nf-t-033", "sample_id": "nf-t-033", "task": "external_T_stage", "stage_edition": 8, "prompt": "你将看到同一患者的10张鼻咽 MRI 多序列图像面板。请仅依据这些图像，按 AJCC/UICC 第8版鼻咽癌 T 分类判断原发肿瘤的 T 类别。不要判断 N、M 或总体分期。\n仅输出一个 JSON 对象，键为 t_stage，值为 T1、T2、T3 或 T4 之一。不要输出解释、Markdown 或占位符。", "images": ["assets/nf-t-033/panel_01.jpg", "assets/nf-t-033/panel_02.jpg", "assets/nf-t-033/panel_03.jpg", "assets/nf-t-033/panel_04.jpg", "assets/nf-t-033/panel_05.jpg", "assets/nf-t-033/panel_06.jpg", "assets/nf-t-033/panel_07.jpg", "assets/nf-t-033/panel_08.jpg", "assets/nf-t-033/panel_09.jpg", "assets/nf-t-033/panel_10.jpg"]}
+{"id": "nf-t-034", "sample_id": "nf-t-034", "task": "external_T_stage", "stage_edition": 8, "prompt": "你将看到同一患者的10张鼻咽 MRI 多序列图像面板。请仅依据这些图像，按 AJCC/UICC 第8版鼻咽癌 T 分类判断原发肿瘤的 T 类别。不要判断 N、M 或总体分期。\n仅输出一个 JSON 对象，键为 t_stage，值为 T1、T2、T3 或 T4 之一。不要输出解释、Markdown 或占位符。", "images": ["assets/nf-t-034/panel_01.jpg", "assets/nf-t-034/panel_02.jpg", "assets/nf-t-034/panel_03.jpg", "assets/nf-t-034/panel_04.jpg", "assets/nf-t-034/panel_05.jpg", "assets/nf-t-034/panel_06.jpg", "assets/nf-t-034/panel_07.jpg", "assets/nf-t-034/panel_08.jpg", "assets/nf-t-034/panel_09.jpg", "assets/nf-t-034/panel_10.jpg"]}
+{"id": "nf-t-035", "sample_id": "nf-t-035", "task": "external_T_stage", "stage_edition": 8, "prompt": "你将看到同一患者的10张鼻咽 MRI 多序列图像面板。请仅依据这些图像，按 AJCC/UICC 第8版鼻咽癌 T 分类判断原发肿瘤的 T 类别。不要判断 N、M 或总体分期。\n仅输出一个 JSON 对象，键为 t_stage，值为 T1、T2、T3 或 T4 之一。不要输出解释、Markdown 或占位符。", "images": ["assets/nf-t-035/panel_01.jpg", "assets/nf-t-035/panel_02.jpg", "assets/nf-t-035/panel_03.jpg", "assets/nf-t-035/panel_04.jpg", "assets/nf-t-035/panel_05.jpg", "assets/nf-t-035/panel_06.jpg", "assets/nf-t-035/panel_07.jpg", "assets/nf-t-035/panel_08.jpg", "assets/nf-t-035/panel_09.jpg", "assets/nf-t-035/panel_10.jpg"]}
+{"id": "nf-t-036", "sample_id": "nf-t-036", "task": "external_T_stage", "stage_edition": 8, "prompt": "你将看到同一患者的10张鼻咽 MRI 多序列图像面板。请仅依据这些图像，按 AJCC/UICC 第8版鼻咽癌 T 分类判断原发肿瘤的 T 类别。不要判断 N、M 或总体分期。\n仅输出一个 JSON 对象，键为 t_stage，值为 T1、T2、T3 或 T4 之一。不要输出解释、Markdown 或占位符。", "images": ["assets/nf-t-036/panel_01.jpg", "assets/nf-t-036/panel_02.jpg", "assets/nf-t-036/panel_03.jpg", "assets/nf-t-036/panel_04.jpg", "assets/nf-t-036/panel_05.jpg", "assets/nf-t-036/panel_06.jpg", "assets/nf-t-036/panel_07.jpg", "assets/nf-t-036/panel_08.jpg", "assets/nf-t-036/panel_09.jpg", "assets/nf-t-036/panel_10.jpg"]}
+{"id": "nf-t-037", "sample_id": "nf-t-037", "task": "external_T_stage", "stage_edition": 8, "prompt": "你将看到同一患者的10张鼻咽 MRI 多序列图像面板。请仅依据这些图像，按 AJCC/UICC 第8版鼻咽癌 T 分类判断原发肿瘤的 T 类别。不要判断 N、M 或总体分期。\n仅输出一个 JSON 对象，键为 t_stage，值为 T1、T2、T3 或 T4 之一。不要输出解释、Markdown 或占位符。", "images": ["assets/nf-t-037/panel_01.jpg", "assets/nf-t-037/panel_02.jpg", "assets/nf-t-037/panel_03.jpg", "assets/nf-t-037/panel_04.jpg", "assets/nf-t-037/panel_05.jpg", "assets/nf-t-037/panel_06.jpg", "assets/nf-t-037/panel_07.jpg", "assets/nf-t-037/panel_08.jpg", "assets/nf-t-037/panel_09.jpg", "assets/nf-t-037/panel_10.jpg"]}
+{"id": "nf-t-038", "sample_id": "nf-t-038", "task": "external_T_stage", "stage_edition": 8, "prompt": "你将看到同一患者的10张鼻咽 MRI 多序列图像面板。请仅依据这些图像，按 AJCC/UICC 第8版鼻咽癌 T 分类判断原发肿瘤的 T 类别。不要判断 N、M 或总体分期。\n仅输出一个 JSON 对象，键为 t_stage，值为 T1、T2、T3 或 T4 之一。不要输出解释、Markdown 或占位符。", "images": ["assets/nf-t-038/panel_01.jpg", "assets/nf-t-038/panel_02.jpg", "assets/nf-t-038/panel_03.jpg", "assets/nf-t-038/panel_04.jpg", "assets/nf-t-038/panel_05.jpg", "assets/nf-t-038/panel_06.jpg", "assets/nf-t-038/panel_07.jpg", "assets/nf-t-038/panel_08.jpg", "assets/nf-t-038/panel_09.jpg", "assets/nf-t-038/panel_10.jpg"]}
+{"id": "nf-t-039", "sample_id": "nf-t-039", "task": "external_T_stage", "stage_edition": 8, "prompt": "你将看到同一患者的10张鼻咽 MRI 多序列图像面板。请仅依据这些图像，按 AJCC/UICC 第8版鼻咽癌 T 分类判断原发肿瘤的 T 类别。不要判断 N、M 或总体分期。\n仅输出一个 JSON 对象，键为 t_stage，值为 T1、T2、T3 或 T4 之一。不要输出解释、Markdown 或占位符。", "images": ["assets/nf-t-039/panel_01.jpg", "assets/nf-t-039/panel_02.jpg", "assets/nf-t-039/panel_03.jpg", "assets/nf-t-039/panel_04.jpg", "assets/nf-t-039/panel_05.jpg", "assets/nf-t-039/panel_06.jpg", "assets/nf-t-039/panel_07.jpg", "assets/nf-t-039/panel_08.jpg", "assets/nf-t-039/panel_09.jpg", "assets/nf-t-039/panel_10.jpg"]}
+{"id": "nf-t-040", "sample_id": "nf-t-040", "task": "external_T_stage", "stage_edition": 8, "prompt": "你将看到同一患者的10张鼻咽 MRI 多序列图像面板。请仅依据这些图像，按 AJCC/UICC 第8版鼻咽癌 T 分类判断原发肿瘤的 T 类别。不要判断 N、M 或总体分期。\n仅输出一个 JSON 对象，键为 t_stage，值为 T1、T2、T3 或 T4 之一。不要输出解释、Markdown 或占位符。", "images": ["assets/nf-t-040/panel_01.jpg", "assets/nf-t-040/panel_02.jpg", "assets/nf-t-040/panel_03.jpg", "assets/nf-t-040/panel_04.jpg", "assets/nf-t-040/panel_05.jpg", "assets/nf-t-040/panel_06.jpg", "assets/nf-t-040/panel_07.jpg", "assets/nf-t-040/panel_08.jpg", "assets/nf-t-040/panel_09.jpg", "assets/nf-t-040/panel_10.jpg"]}
+{"id": "nf-t-041", "sample_id": "nf-t-041", "task": "external_T_stage", "stage_edition": 8, "prompt": "你将看到同一患者的10张鼻咽 MRI 多序列图像面板。请仅依据这些图像，按 AJCC/UICC 第8版鼻咽癌 T 分类判断原发肿瘤的 T 类别。不要判断 N、M 或总体分期。\n仅输出一个 JSON 对象，键为 t_stage，值为 T1、T2、T3 或 T4 之一。不要输出解释、Markdown 或占位符。", "images": ["assets/nf-t-041/panel_01.jpg", "assets/nf-t-041/panel_02.jpg", "assets/nf-t-041/panel_03.jpg", "assets/nf-t-041/panel_04.jpg", "assets/nf-t-041/panel_05.jpg", "assets/nf-t-041/panel_06.jpg", "assets/nf-t-041/panel_07.jpg", "assets/nf-t-041/panel_08.jpg", "assets/nf-t-041/panel_09.jpg", "assets/nf-t-041/panel_10.jpg"]}
+{"id": "nf-t-042", "sample_id": "nf-t-042", "task": "external_T_stage", "stage_edition": 8, "prompt": "你将看到同一患者的10张鼻咽 MRI 多序列图像面板。请仅依据这些图像，按 AJCC/UICC 第8版鼻咽癌 T 分类判断原发肿瘤的 T 类别。不要判断 N、M 或总体分期。\n仅输出一个 JSON 对象，键为 t_stage，值为 T1、T2、T3 或 T4 之一。不要输出解释、Markdown 或占位符。", "images": ["assets/nf-t-042/panel_01.jpg", "assets/nf-t-042/panel_02.jpg", "assets/nf-t-042/panel_03.jpg", "assets/nf-t-042/panel_04.jpg", "assets/nf-t-042/panel_05.jpg", "assets/nf-t-042/panel_06.jpg", "assets/nf-t-042/panel_07.jpg", "assets/nf-t-042/panel_08.jpg", "assets/nf-t-042/panel_09.jpg", "assets/nf-t-042/panel_10.jpg"]}
+{"id": "nf-t-043", "sample_id": "nf-t-043", "task": "external_T_stage", "stage_edition": 8, "prompt": "你将看到同一患者的10张鼻咽 MRI 多序列图像面板。请仅依据这些图像，按 AJCC/UICC 第8版鼻咽癌 T 分类判断原发肿瘤的 T 类别。不要判断 N、M 或总体分期。\n仅输出一个 JSON 对象，键为 t_stage，值为 T1、T2、T3 或 T4 之一。不要输出解释、Markdown 或占位符。", "images": ["assets/nf-t-043/panel_01.jpg", "assets/nf-t-043/panel_02.jpg", "assets/nf-t-043/panel_03.jpg", "assets/nf-t-043/panel_04.jpg", "assets/nf-t-043/panel_05.jpg", "assets/nf-t-043/panel_06.jpg", "assets/nf-t-043/panel_07.jpg", "assets/nf-t-043/panel_08.jpg", "assets/nf-t-043/panel_09.jpg", "assets/nf-t-043/panel_10.jpg"]}
+{"id": "nf-t-044", "sample_id": "nf-t-044", "task": "external_T_stage", "stage_edition": 8, "prompt": "你将看到同一患者的10张鼻咽 MRI 多序列图像面板。请仅依据这些图像，按 AJCC/UICC 第8版鼻咽癌 T 分类判断原发肿瘤的 T 类别。不要判断 N、M 或总体分期。\n仅输出一个 JSON 对象，键为 t_stage，值为 T1、T2、T3 或 T4 之一。不要输出解释、Markdown 或占位符。", "images": ["assets/nf-t-044/panel_01.jpg", "assets/nf-t-044/panel_02.jpg", "assets/nf-t-044/panel_03.jpg", "assets/nf-t-044/panel_04.jpg", "assets/nf-t-044/panel_05.jpg", "assets/nf-t-044/panel_06.jpg", "assets/nf-t-044/panel_07.jpg", "assets/nf-t-044/panel_08.jpg", "assets/nf-t-044/panel_09.jpg", "assets/nf-t-044/panel_10.jpg"]}
+{"id": "nf-t-045", "sample_id": "nf-t-045", "task": "external_T_stage", "stage_edition": 8, "prompt": "你将看到同一患者的10张鼻咽 MRI 多序列图像面板。请仅依据这些图像，按 AJCC/UICC 第8版鼻咽癌 T 分类判断原发肿瘤的 T 类别。不要判断 N、M 或总体分期。\n仅输出一个 JSON 对象，键为 t_stage，值为 T1、T2、T3 或 T4 之一。不要输出解释、Markdown 或占位符。", "images": ["assets/nf-t-045/panel_01.jpg", "assets/nf-t-045/panel_02.jpg", "assets/nf-t-045/panel_03.jpg", "assets/nf-t-045/panel_04.jpg", "assets/nf-t-045/panel_05.jpg", "assets/nf-t-045/panel_06.jpg", "assets/nf-t-045/panel_07.jpg", "assets/nf-t-045/panel_08.jpg", "assets/nf-t-045/panel_09.jpg", "assets/nf-t-045/panel_10.jpg"]}
+{"id": "nf-t-046", "sample_id": "nf-t-046", "task": "external_T_stage", "stage_edition": 8, "prompt": "你将看到同一患者的10张鼻咽 MRI 多序列图像面板。请仅依据这些图像，按 AJCC/UICC 第8版鼻咽癌 T 分类判断原发肿瘤的 T 类别。不要判断 N、M 或总体分期。\n仅输出一个 JSON 对象，键为 t_stage，值为 T1、T2、T3 或 T4 之一。不要输出解释、Markdown 或占位符。", "images": ["assets/nf-t-046/panel_01.jpg", "assets/nf-t-046/panel_02.jpg", "assets/nf-t-046/panel_03.jpg", "assets/nf-t-046/panel_04.jpg", "assets/nf-t-046/panel_05.jpg", "assets/nf-t-046/panel_06.jpg", "assets/nf-t-046/panel_07.jpg", "assets/nf-t-046/panel_08.jpg", "assets/nf-t-046/panel_09.jpg", "assets/nf-t-046/panel_10.jpg"]}
+{"id": "nf-t-047", "sample_id": "nf-t-047", "task": "external_T_stage", "stage_edition": 8, "prompt": "你将看到同一患者的10张鼻咽 MRI 多序列图像面板。请仅依据这些图像，按 AJCC/UICC 第8版鼻咽癌 T 分类判断原发肿瘤的 T 类别。不要判断 N、M 或总体分期。\n仅输出一个 JSON 对象，键为 t_stage，值为 T1、T2、T3 或 T4 之一。不要输出解释、Markdown 或占位符。", "images": ["assets/nf-t-047/panel_01.jpg", "assets/nf-t-047/panel_02.jpg", "assets/nf-t-047/panel_03.jpg", "assets/nf-t-047/panel_04.jpg", "assets/nf-t-047/panel_05.jpg", "assets/nf-t-047/panel_06.jpg", "assets/nf-t-047/panel_07.jpg", "assets/nf-t-047/panel_08.jpg", "assets/nf-t-047/panel_09.jpg", "assets/nf-t-047/panel_10.jpg"]}
+{"id": "nf-t-048", "sample_id": "nf-t-048", "task": "external_T_stage", "stage_edition": 8, "prompt": "你将看到同一患者的10张鼻咽 MRI 多序列图像面板。请仅依据这些图像，按 AJCC/UICC 第8版鼻咽癌 T 分类判断原发肿瘤的 T 类别。不要判断 N、M 或总体分期。\n仅输出一个 JSON 对象，键为 t_stage，值为 T1、T2、T3 或 T4 之一。不要输出解释、Markdown 或占位符。", "images": ["assets/nf-t-048/panel_01.jpg", "assets/nf-t-048/panel_02.jpg", "assets/nf-t-048/panel_03.jpg", "assets/nf-t-048/panel_04.jpg", "assets/nf-t-048/panel_05.jpg", "assets/nf-t-048/panel_06.jpg", "assets/nf-t-048/panel_07.jpg", "assets/nf-t-048/panel_08.jpg", "assets/nf-t-048/panel_09.jpg", "assets/nf-t-048/panel_10.jpg"]}
+{"id": "nf-t-049", "sample_id": "nf-t-049", "task": "external_T_stage", "stage_edition": 8, "prompt": "你将看到同一患者的10张鼻咽 MRI 多序列图像面板。请仅依据这些图像，按 AJCC/UICC 第8版鼻咽癌 T 分类判断原发肿瘤的 T 类别。不要判断 N、M 或总体分期。\n仅输出一个 JSON 对象，键为 t_stage，值为 T1、T2、T3 或 T4 之一。不要输出解释、Markdown 或占位符。", "images": ["assets/nf-t-049/panel_01.jpg", "assets/nf-t-049/panel_02.jpg", "assets/nf-t-049/panel_03.jpg", "assets/nf-t-049/panel_04.jpg", "assets/nf-t-049/panel_05.jpg", "assets/nf-t-049/panel_06.jpg", "assets/nf-t-049/panel_07.jpg", "assets/nf-t-049/panel_08.jpg", "assets/nf-t-049/panel_09.jpg", "assets/nf-t-049/panel_10.jpg"]}
+{"id": "nf-t-050", "sample_id": "nf-t-050", "task": "external_T_stage", "stage_edition": 8, "prompt": "你将看到同一患者的10张鼻咽 MRI 多序列图像面板。请仅依据这些图像，按 AJCC/UICC 第8版鼻咽癌 T 分类判断原发肿瘤的 T 类别。不要判断 N、M 或总体分期。\n仅输出一个 JSON 对象，键为 t_stage，值为 T1、T2、T3 或 T4 之一。不要输出解释、Markdown 或占位符。", "images": ["assets/nf-t-050/panel_01.jpg", "assets/nf-t-050/panel_02.jpg", "assets/nf-t-050/panel_03.jpg", "assets/nf-t-050/panel_04.jpg", "assets/nf-t-050/panel_05.jpg", "assets/nf-t-050/panel_06.jpg", "assets/nf-t-050/panel_07.jpg", "assets/nf-t-050/panel_08.jpg", "assets/nf-t-050/panel_09.jpg", "assets/nf-t-050/panel_10.jpg"]}
+{"id": "nf-t-051", "sample_id": "nf-t-051", "task": "external_T_stage", "stage_edition": 8, "prompt": "你将看到同一患者的10张鼻咽 MRI 多序列图像面板。请仅依据这些图像，按 AJCC/UICC 第8版鼻咽癌 T 分类判断原发肿瘤的 T 类别。不要判断 N、M 或总体分期。\n仅输出一个 JSON 对象，键为 t_stage，值为 T1、T2、T3 或 T4 之一。不要输出解释、Markdown 或占位符。", "images": ["assets/nf-t-051/panel_01.jpg", "assets/nf-t-051/panel_02.jpg", "assets/nf-t-051/panel_03.jpg", "assets/nf-t-051/panel_04.jpg", "assets/nf-t-051/panel_05.jpg", "assets/nf-t-051/panel_06.jpg", "assets/nf-t-051/panel_07.jpg", "assets/nf-t-051/panel_08.jpg", "assets/nf-t-051/panel_09.jpg", "assets/nf-t-051/panel_10.jpg"]}
+{"id": "nf-t-052", "sample_id": "nf-t-052", "task": "external_T_stage", "stage_edition": 8, "prompt": "你将看到同一患者的10张鼻咽 MRI 多序列图像面板。请仅依据这些图像，按 AJCC/UICC 第8版鼻咽癌 T 分类判断原发肿瘤的 T 类别。不要判断 N、M 或总体分期。\n仅输出一个 JSON 对象，键为 t_stage，值为 T1、T2、T3 或 T4 之一。不要输出解释、Markdown 或占位符。", "images": ["assets/nf-t-052/panel_01.jpg", "assets/nf-t-052/panel_02.jpg", "assets/nf-t-052/panel_03.jpg", "assets/nf-t-052/panel_04.jpg", "assets/nf-t-052/panel_05.jpg", "assets/nf-t-052/panel_06.jpg", "assets/nf-t-052/panel_07.jpg", "assets/nf-t-052/panel_08.jpg", "assets/nf-t-052/panel_09.jpg", "assets/nf-t-052/panel_10.jpg"]}
+{"id": "nf-t-053", "sample_id": "nf-t-053", "task": "external_T_stage", "stage_edition": 8, "prompt": "你将看到同一患者的10张鼻咽 MRI 多序列图像面板。请仅依据这些图像，按 AJCC/UICC 第8版鼻咽癌 T 分类判断原发肿瘤的 T 类别。不要判断 N、M 或总体分期。\n仅输出一个 JSON 对象，键为 t_stage，值为 T1、T2、T3 或 T4 之一。不要输出解释、Markdown 或占位符。", "images": ["assets/nf-t-053/panel_01.jpg", "assets/nf-t-053/panel_02.jpg", "assets/nf-t-053/panel_03.jpg", "assets/nf-t-053/panel_04.jpg", "assets/nf-t-053/panel_05.jpg", "assets/nf-t-053/panel_06.jpg", "assets/nf-t-053/panel_07.jpg", "assets/nf-t-053/panel_08.jpg", "assets/nf-t-053/panel_09.jpg", "assets/nf-t-053/panel_10.jpg"]}
+{"id": "nf-t-054", "sample_id": "nf-t-054", "task": "external_T_stage", "stage_edition": 8, "prompt": "你将看到同一患者的10张鼻咽 MRI 多序列图像面板。请仅依据这些图像，按 AJCC/UICC 第8版鼻咽癌 T 分类判断原发肿瘤的 T 类别。不要判断 N、M 或总体分期。\n仅输出一个 JSON 对象，键为 t_stage，值为 T1、T2、T3 或 T4 之一。不要输出解释、Markdown 或占位符。", "images": ["assets/nf-t-054/panel_01.jpg", "assets/nf-t-054/panel_02.jpg", "assets/nf-t-054/panel_03.jpg", "assets/nf-t-054/panel_04.jpg", "assets/nf-t-054/panel_05.jpg", "assets/nf-t-054/panel_06.jpg", "assets/nf-t-054/panel_07.jpg", "assets/nf-t-054/panel_08.jpg", "assets/nf-t-054/panel_09.jpg", "assets/nf-t-054/panel_10.jpg"]}
+{"id": "nf-t-055", "sample_id": "nf-t-055", "task": "external_T_stage", "stage_edition": 8, "prompt": "你将看到同一患者的10张鼻咽 MRI 多序列图像面板。请仅依据这些图像，按 AJCC/UICC 第8版鼻咽癌 T 分类判断原发肿瘤的 T 类别。不要判断 N、M 或总体分期。\n仅输出一个 JSON 对象，键为 t_stage，值为 T1、T2、T3 或 T4 之一。不要输出解释、Markdown 或占位符。", "images": ["assets/nf-t-055/panel_01.jpg", "assets/nf-t-055/panel_02.jpg", "assets/nf-t-055/panel_03.jpg", "assets/nf-t-055/panel_04.jpg", "assets/nf-t-055/panel_05.jpg", "assets/nf-t-055/panel_06.jpg", "assets/nf-t-055/panel_07.jpg", "assets/nf-t-055/panel_08.jpg", "assets/nf-t-055/panel_09.jpg", "assets/nf-t-055/panel_10.jpg"]}
diff --git a/supplementary/full100_schema/README.md b/supplementary/full100_schema/README.md
new file mode 100644
index 0000000000000000000000000000000000000000..fd9d70974b868d104e4cd16d62eea7bac995ec2a
--- /dev/null
+++ b/supplementary/full100_schema/README.md
@@ -0,0 +1,5 @@
+# CarePath MRI response-format control
+
+This 100-patient prompt set explicitly lists the JSON response fields for structure invasion, involved structures, T stage and imaging evidence. It uses the CarePath MRI images and AJCC ninth-edition reference labels.
+
+The control changes response-format instructions for 75 patients. The remaining 25 prompts already contain the full schema. Compare care answers only when the actual image-derived input fields differ.
diff --git a/supplementary/full100_schema/mri_samples.jsonl b/supplementary/full100_schema/mri_samples.jsonl
new file mode 100644
index 0000000000000000000000000000000000000000..e6d845ff649e4498f520c67ef9a1558a176a90d4
--- /dev/null
+++ b/supplementary/full100_schema/mri_samples.jsonl
@@ -0,0 +1,100 @@
+{"sample_id": "sample-696d19bff6d991b4bc744712", "patient_id": "patient-5fa48522b2703f35ead0224b", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/f74aad52f7c880d6693aa7f28c7c568a68b81d043b6a644ab68b7040eb4c6de0.jpg", "assets/653cedfc9b826e600bbab4d09df1e5c3cd4b2dc3cb39dba9c0867067890ecc03.jpg", "assets/156671243ea7fa909883330ebb191aca8e3caff23ece30b6220c04e2d2b118d2.jpg", "assets/9c8ef004b21233f2da97d2c00c3320093eea300592f08d2bde4eaec89f794df0.jpg", "assets/4eb0fdeb9de7c9609bdccb37ecf83d83ad152b787e1003a37eddfac8a34d3406.jpg", "assets/31f639a022e9ecef7ac2e7561e4970387cdf687be4646924d75c112108e0e129.jpg", "assets/03161fedc30f7c61c1f66868a2c2a925c49bc5728ed0b8024180bbbacf3cb111.jpg", "assets/3fe92181cbd30011cccf46a421dece3ea770131993459a14c28750bf0e6ce37c.jpg", "assets/faffd63b765d633efb6e9ccd6bd7c7b1abf75513f5d0399d456eae3570e6328e.jpg", "assets/ec2e42177e09aa60f10e1874d0057a7e127fc9beed66ee6cd49123012c6d97f3.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 1, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 0, "口咽": 1, "翼突基底部": 0, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "翼内肌", "斜坡", "口咽", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-8c7b00b765d9c70ed98b27dd", "patient_id": "patient-84fa3d6098d10a1d14b6b19e", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/03527a5bed44e0e813f429fc03246f3478220398cdac19e015cc5ca7c03a5fc5.jpg", "assets/f92758edb46cb68cb5869dd4068f32ba916ea5d24631cb910ffb6b27b3145a75.jpg", "assets/53474d52fb1672365f1a97f1df842f9af0cf7595f62ba0c9fa2dded33ae34b83.jpg", "assets/466def3bdf7a9a6eafcf78bae89e2baed8b2905998bd0a6878ac7a736f572f85.jpg", "assets/9959ff3450ff0e72f9451d0c0589d83244974523753a036ee26166b48999f9c0.jpg", "assets/c0b85f0e1ce01c5566a38e9cae342e90cf4a72e635227e26bf16e182969ae43a.jpg", "assets/fb5f25085781906497101c41bfdb80020a511c7e5e1ec13bd37435728cc75667.jpg", "assets/4107cd8e14297e6ef2bbe62035e8d66b3f90f309254ff874454cac035d786174.jpg", "assets/755ca10e36c4fe8f9223b49700462edf0da2285390566aafc5ac1d23ad0b9cef.jpg", "assets/3ff5c8cbf31b19d1429ff0addf334ac94b923f689eb54f8fa7178f28b88a22cd.jpg"], "answer": {"T_stage": "T4", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 0, "翼内肌": 1, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 1, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "翼内肌", "斜坡", "海绵窦", "翼突基底部", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-1124bea189a1759a23ce2ef2", "patient_id": "patient-34616c327ce5d69194ca7f4d", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/a334349be060a5eb4b4cc599f8e5d76e6c41bace54c403be6522cce1fd2499f2.jpg", "assets/adb8f018c43422a8bb481885296b83967f4d8c008b37d4af327e752f69c165d0.jpg", "assets/5629bac1a5debdab5f6ff0b657ad0290e67137429880b4ec336fc51961b83ec7.jpg", "assets/c86748053957657533937b5bf0233f7a63e7e64204c17b98b57d9f6cfea9f6b1.jpg", "assets/770aad1f11451111fd78e4da112bdf7f661e02b397a90030627bf1fc06b29c80.jpg", "assets/b32b6bade8844559fea69316a4a244428fc07fd7f089f8fc5ebe33339d5092cb.jpg", "assets/8bb1cd79966ec19e1bd5e3c03a1158299e405f712cf9cbeb2ef52f196d2cb540.jpg", "assets/090347e8a606e38ad1c7090e385e6d8c1a08681f65925f96b328a636392f57fb.jpg", "assets/34d929647d903d5700395c4e204cbeb5106ec4f390d2cc1baed6fe973046920e.jpg", "assets/4630f3b63ba5aadcf370c782d067fe5d6c720af0411ea84d2381d6e56a4b87d1.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 0, "咽旁间隙": 0, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "翼突基底部", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-58b6ed030d470b20fbd59d48", "patient_id": "patient-9bf5c8c03860cdf61108611d", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/87445c02c46d81d8e06fd808b95207242100de96e83f2af978444aa40b32c038.jpg", "assets/a15b218012f18b485d338a4737e3ca368067eab08318df58e57dbe2aaf26386f.jpg", "assets/ead349981525fedd40e53974e4ae54e9671bacc587b21b32d626cbdc9913a39d.jpg", "assets/be163e777e9e2864d84aa68d88df4609afd8a6f44b2a86a7b7a31781dfd6ccbb.jpg", "assets/d2c21989e2dff1b1aae599fc683693d1f664bef5fb3b36cad6b1a8aa0bd849ed.jpg", "assets/76962bc4f60666b8d3eac1f6fb2332aae96c8f1582671cbe9482a11fad414c8e.jpg", "assets/dc3c4d57ec0c0473c23d84932a920dd2600c84694f25f5ff65a15cc62f87c670.jpg", "assets/99bcae65ac53c317d518e9bc9d84a64865834c005fffc331123c13728108ed14.jpg", "assets/fd6515165fe616be788211939cc33a6d50d6bfe86d4d017a80e1d52e081ede13.jpg", "assets/3cd823e500cd22530244a8f43efe3094ab245db07608b584034a425a2b84e617.jpg"], "answer": {"T_stage": "T1", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 0, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 0, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-1207ed9082e2263a1d3782e0", "patient_id": "patient-5ee5dba6116030961a7a97b5", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/164f3f7c842001b08bae3d96ffe3b7b79e2cecbfe98d3d6238679573bc9842bb.jpg", "assets/ae60f499e03c677fc7d38a889c9c865e23650ece5ee78f01e0d9522b2a6bff7a.jpg", "assets/01744ed4df0ea2f908dc9cbacd8b5b79d817b3f0ce491451da3db52e316037b0.jpg", "assets/d55a420adfc518fa5cfdc904c1e6315d23179533faa381a168df4984e5c57071.jpg", "assets/20ed1443f0337b574a4947759510633dc6230e1cf05efe2b12c2feb6cbc8cdf6.jpg", "assets/e4eae3fd6ecae3dbe26ba1ddd55f09e21b75a600b7dab4af36dc7ca91ae204c9.jpg", "assets/476f9175ca20bfcf7abbeb390291f2005fa02cb1e5457062170cf8e95476c6fa.jpg", "assets/be8c6e7fe15239fae1b9032f3420bb07e7b6576878a87bc02f2a14692c017b9f.jpg", "assets/cc94dca7acdd17c17b2212e76c4678a122ff749f8c3603db12bb0b44c6b90249.jpg", "assets/66194724f4a1b0eb146f2596ce1c28f412b7eb73cb12429043b33f5721300772.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "翼突基底部", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-f8a46b6b13ef0358c5d560f0", "patient_id": "patient-f402aced5926698da3194c37", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/9b4304bccdf8e43b9288ed7dcdb69037403629b86849e28bee9b36de6bfb2035.jpg", "assets/57f01c565b54d9db9bca6f065f096449560dc22f58dffad857fcebf6c9b7aa35.jpg", "assets/b9bf199748c93ff3c65404357417aaaf4fbd678f75bfcfac8db9d6268fd002a0.jpg", "assets/6e2d1bacca9028eacfe22d6b331a9a85bf7f962697b36c4346ca247ce49ac73b.jpg", "assets/2085740b3b8f42d59c67084fba622becb6480bd75911a14385575b65686c2950.jpg", "assets/160fa24472f983af04820793dfd07fad3336173a89c5ae15109160dc986d2d2e.jpg", "assets/a54bb604c744d4739ef0ba7d699b8f0a7c617aa41e15acfa4078f2e6ebe1b671.jpg", "assets/375ddcaabdf16508b0041c4e2eee31648b65e80a7753477c5381f7acf026b8be.jpg", "assets/68ba2d02eb2294dd9e75abf54d8837787818294434f035eebaa0c3f6b13b0734.jpg", "assets/d927b9f00198291f4fe1fa005a0aaded44b60b7e4587a377e682718b7053c32a.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 0, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "头长肌", "斜坡", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-c02b01cecfcf0b5cbf78aa88", "patient_id": "patient-51e6f99c527367bbd97aebd8", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/066179a6162737f04650100744d22f2e75f17ab4e6ff605a821fb1dca4a7f884.jpg", "assets/ca0f9a62284f9813525f3b411d18277e45c68e3fb58fca739f1d901c00e5b115.jpg", "assets/3ace759c05f46311968bbc1cd3115f9166a778c753a69de6430ccb5f0477b3c7.jpg", "assets/5243f27b5da026dac8c3d1ac16c7a6ff8e8841fae83dc870a34c10e5497cae38.jpg", "assets/4bba41db4155403f69539b4a037a1d585af5f391d8733d75c7bfd09aa68b2ea1.jpg", "assets/d436e88b80581384ddb21b6281592de5c2356f993a4145aa7b44b654c4b5c8c2.jpg", "assets/a812a9419c7f1cfc99058bdbf84695291badb8cc394b3611b109a58de61b122c.jpg", "assets/bb29226a694005381f49ba671ae10431ecbfafa1a82eebfe27c4e88ce7b8f05c.jpg", "assets/ba6185d6d25b024bce1960d50be8c14f1ea7e6036b4aff0ad67fa841b6953f8a.jpg", "assets/b7c24415c4c6fad4a37e694d30f441b6a7477faaab1a9fd67d8f7e28ec81c9fe.jpg"], "answer": {"T_stage": "T1", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 0, "咽旁间隙": 0, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 1, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 0, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "鼻腔"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-60fd3a65c7b9461b49e2ad79", "patient_id": "patient-867f2373fc1b04e0b8b80452", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/20616619537b796ee5b5ec7c15c2b3577697a37b8d453565345903a5bae3b627.jpg", "assets/a6e7bb6c6783df8b6b719960f47b10d8c57b786cd031743205ac4f136ea89293.jpg", "assets/bbfc8b6a24e0c464d90bbeb2f96ae4d2118967e1e359ee6a4398080d360368ea.jpg", "assets/22c91d767c942fdd758cea5b06ca77869a5fd38a5af76e63d1200810e767fbe5.jpg", "assets/07c4955e121bcd7f8774ca858bdbaccc81b9d11c275bec1595e09605ec0f567e.jpg", "assets/a39be4fe534cb6dc942c8deae89b4057b97a99c1db32f8ecda26f04146c823d4.jpg", "assets/87b251ac1d05e4f708c02f46aca0d84fdaf219438c46e607d92d2cd84fe95864.jpg", "assets/a96da581eb561ce3535a77f225ead45437fe2c8acb17518ad70ff60a4b6af167.jpg", "assets/08023e85914a3a57f5188fd82066b7fe0631523ae38d69326f93990735f62bfa.jpg", "assets/19e71b6abab24c39befc187b61e4cceed899696510f4a47f63d299820ed89a1f.jpg"], "answer": {"T_stage": "T4", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 1, "蝶窦": 1, "鼻腔": 1, "颈动脉鞘": 0, "翼外肌": 1, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 1, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "翼内肌", "蝶窦", "鼻腔", "翼外肌", "斜坡", "海绵窦", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-deb29a86d49bb3474ef49a4f", "patient_id": "patient-5731cc38ced94b2ee39c442a", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/ceadf8c8550b3db82ad5886e8311adabfc9a2c9dba0fa2a4bfe5aafe5c45d2b8.jpg", "assets/9f3a6e3f43db97517bcb67f718581ae97ad397482d2eebe0e2da6b1ce15cbad2.jpg", "assets/2234a2f763a07349891af6c7736bbb46975e8b66f9edbfbbf4b8b36b8ecf81ed.jpg", "assets/9013a6af30d7a641ee9d45601eb224fcac2437f00593c0bbd0b75d7ad77e6f83.jpg", "assets/ac9021ae6830c3867ffe4b2ffec3efab0fea2336bb21031278a38bc3ae18f497.jpg", "assets/125cc40946390943d64a76b0408c536e5b0766714ee4835d2bfd229f5d550482.jpg", "assets/b333b9a5ebf36dfd058047021acdc56de3ede47112b0ac0e65bc15f886857e8c.jpg", "assets/a29efb26b7b05f497c8e172f749b0f3705ba71004caffdd45043573e18436b2d.jpg", "assets/73dd11f6afd9a669ad18160dc4b3807d01cd98572180c7058cb23f07d4c72d9b.jpg", "assets/3f4352fef08e43d2b6a202b9edd522720787b3dbeeca502995efaec032f531b4.jpg"], "answer": {"T_stage": "T4", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 0, "翼内肌": 1, "蝶窦": 1, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 1, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "翼内肌", "蝶窦", "斜坡", "海绵窦", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-d181677097153837949be4d8", "patient_id": "patient-9149023ec8599161ec3e5cfd", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/6d04014a7b954c01d5980508f22f29a0170209e2ec3e53b3ef8b28f984426383.jpg", "assets/ccc81d01433e2b019071ef8464a69d8ad7b3b191ce5a0e352a6d9540cb30e029.jpg", "assets/2437a725aaf259345ae8d5e05642c553bbedff6efc1f02a5efd92a1e143c243a.jpg", "assets/296f9591995b04ed071632b0cc24ab9c989f58ab2f84e4af0de30759f2504be3.jpg", "assets/55f9b4efd80610956ed01e46e1deb0f4da2118c77bbf9533b6da41554edbd7bb.jpg", "assets/c2248ca61df301dd9ee38c6a051e4f8e61f6156d4d1b8bce93f1f614abe62e21.jpg", "assets/56f547b9240932ce1c93c8ca3f4d303a1f9c0f0ddc45962ca9afce9cc358906f.jpg", "assets/8e8c943a5eed7ac04c6c23977c15f7a8655352a55df42acefcd5d80ded7e798b.jpg", "assets/cbbf314a19e94f2ff74124b6b1e5c8c7b3501071739087775055c1e802871fa9.jpg", "assets/5c0b89f58f1dd9c2ff8e48867445ed47fa529da83765159cf9b4c5dab4e64d79.jpg"], "answer": {"T_stage": "T4", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 0, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 1, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "头长肌", "斜坡", "海绵窦", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-2e9a500ab730a8b812a30781", "patient_id": "patient-4e3ac84b9e1451cea981f98e", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/2b7b5c9f2fdbf60c39044c6fed93d5d84e55a3e20f792e66c1fa556e373a1040.jpg", "assets/6436ea318464da871651a25a0809fe419070839a3b689cbe0ef96fcaffad967c.jpg", "assets/659ef0a013eb2fbeca8e8518d0baea208dd0ba801889f9687a4f343147d78f8b.jpg", "assets/241c89b1d3115271704173c49bdd0470922ed8a6fd8a83eb33254c9e9e87fb89.jpg", "assets/ec22ecf38da03c8239cb5c54c90d0817c9a5f813fa859e0f534a2cd65ecef7ec.jpg", "assets/2db5a902c0aec8b5904dcabd87b47444e3397790bf23febe6bd7c3754654d4df.jpg", "assets/05bc772aab23b5b85e69946437ea3c17289d9f947568f00bba3094bb1a704364.jpg", "assets/890ed4dc0afadc32cd020f95451bc2a82ce23e2d0c20883eeb8f6fca8d60d69e.jpg", "assets/995eff980d45f20066a942a659eb6e9b1bee341871ba80a3b819da4f6fe109fe.jpg", "assets/b43c57705e8574c8d9f3f75708711ba4726e6fe00f300990f099711413bee93d.jpg"], "answer": {"T_stage": "T2", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 0, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 0, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "头长肌"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-205f6b3043c596a4d6434ed6", "patient_id": "patient-e5fcd31b4b8b85194b146991", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/2f42f41b3f2dcfb71120f1db8d7dde0784565546f53c5453f8cf45b22b7b7152.jpg", "assets/301ce31335434038f308c60d14e4429b6a3c28726fad0ba96e1dfa2cf59985d8.jpg", "assets/ee40be93563e13f5f8d16f4fe6c78b692ffe237fbd9e41f41d933c80f3e66bcb.jpg", "assets/4240a32eeb26815de8b509c46180d789bc2687775637e828664b998e5633e6aa.jpg", "assets/5a6387eb70054aac1e610a5dfa8dbf677472e747fd40c07dcad8588e6285208b.jpg", "assets/4c7c436e3c49008533a909df94195255dbf8cbfb89ddbf09fd2ca4ae2bdb1449.jpg", "assets/158d403d110856575aedd50572c9e97a8eb22d63a57f6c552e2abc7494152f67.jpg", "assets/966a04db00a9f3a4b946d1d3e346622edafe6109c09cae3de7d4f067b14cd993.jpg", "assets/2038e88691281b095c3394c367d101856467d2138b83f9c773890103eadf2d01.jpg", "assets/78942c0ef564ba599893c3cd2a70fb41ea2a871a446836f1a9d004a61a416a1e.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "翼突基底部", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-c413de747f5d59b2cbc2317c", "patient_id": "patient-d6812a1c46ed21fda9ebb9f8", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/3bec4c512284a8ae6c519a893bcfb11b711112f6f9610df10ed40948dfa54338.jpg", "assets/6d826b98a58558e86e7571a89c80aae28e59d1107e0e144fe177fbbd07b5795b.jpg", "assets/6708c9e9f4330b1f1ec2463a73978ad481d942397b7c6decfa0ea50d3ad44160.jpg", "assets/70ff605c330cfd7955bade09984ad131166e54160435ff63fa12708f10f91a88.jpg", "assets/e901a84c7c2d576369fb21efa6df28bc9c6495510f6e5b8cc70df954b1244de1.jpg", "assets/71a164940ab9086ae599bb1e8454581fa6a800f55660f8cfc32aa3b19da64351.jpg", "assets/ef89adf8de0217d5e215a5111e39585d7b658833e1c808d3bb210a29f526fb16.jpg", "assets/f5a694e59f09056133306c3a7fd4d87da7b63bbcf781a5c7db1fdd84aa8da42b.jpg", "assets/4de88f3bc374d3743843cb47f3599b85e57cc2c07fe5a66b93282ea0d795b48f.jpg", "assets/2caf2cf7f9015ba6ec68cf5c0078dd7469ad4474a61679e92f1a1e730bc2923c.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 1, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "翼内肌", "翼突基底部", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-873d91c7abbe2fa373339449", "patient_id": "patient-eecadcdf172a1efe8947b052", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/3ddc9cfef371cd3260630931c1270ccee6aa0ef3eebf88b45079843c39156619.jpg", "assets/f8642fdeebfe5ff8b42985a47eb4d1609ef93b9688d171437c0898368f371afe.jpg", "assets/17ed7b40716b8d75a001c1db9cbb24b3369de06bd19e8ae2ebcd0d94133a32df.jpg", "assets/e03955e28337613a75abc78552d91fadcbdd148f5855426b56c83570877427dc.jpg", "assets/7fe0e96fa3c0a00a7fb155304ab070116f3d5c06536c27b73c25c8e0af27835d.jpg", "assets/d739c95079238cfc7f94602376234eb4345b1d5327e478679cc83ebc41bfd753.jpg", "assets/9c66c409e0854a6c87dea376e336df7e770bdfb01965b3d483a69fe4217d8450.jpg", "assets/7c7afa4f7de3f5fac06eb49bd1a27b4baa18bb5fa299b10e74cb0ee4516682fb.jpg", "assets/b259810ac9315ad3e754dc40aa119794d691249f380c4bd110982448f6a8385b.jpg", "assets/7cb924511719873570cb5d8bd87a7501c49f03f51893e3b8ef1e0c9337d2a0e4.jpg"], "answer": {"T_stage": "T4", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 0, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "头长肌", "斜坡", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-512e0976e07cf5bdef790b77", "patient_id": "patient-290a042206ccfe67e72f9a19", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/0e21b69a2a9a058277513c236a04841bc50dd5d69c20df58bfa356f0d25dc8b5.jpg", "assets/06f520afefd08392b0133b0e5507006a364a1175cab55a3c3985f1e224cdc2b8.jpg", "assets/c0ec4c05f9a6d7dbcd8f5a3659986616c3e8996c66d421153956b6c270b091f7.jpg", "assets/d2f4a6543f672625da8afc5034016d6f576888a5d6c76ed90599c82993744b97.jpg", "assets/6806b3940dac8e3a2c8b95a1a41e84531509ada8045e0cd0be1ac3b62973ea7e.jpg", "assets/6c80839a90f82b1dcd1de4488e8075e901fdb515c72392dd9c1338a8801cafe8.jpg", "assets/1da9e8d3587226b3f9ee28b9888bb90c6fa9198fec7322ae6d2a9cd0d9d2d6d4.jpg", "assets/0760dcc3a750f95e176d3c4df4adf9f01a1c86fef9f8e721f3ddaf8de0c7afc2.jpg", "assets/9a665d2981aba7b4757106f913c78ed6f0c411823bb65ba7fb34f43ea2c2a6af.jpg", "assets/451094b595c0b6c37b8195b87545b6b7a2f76904ac612d4a79ae2a9d0a14c061.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 0, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "头长肌", "斜坡", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-ec87b3b629d494caa3b0c2f1", "patient_id": "patient-e45c55cc63c050892e6b2467", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/f9960bae334cdceb3eb93f3d8252ecfcd18afe7cb11a71dbe39e97a2ed358352.jpg", "assets/fbaf3c23d2b6a6eeb541f7dcb4055f58c861094bbdb54a54367c839276b353d4.jpg", "assets/2e4103e10e43bf317323d4b567a0795839da3d0f41cc34b16423612982e97188.jpg", "assets/a87f8194bd40c5d6d0ee9cedc7c13eb9072aeea7af26dcbb4f741c02c4c6e361.jpg", "assets/664d2867df97e0c4503ca4d0a78aeb8e514b45a792ad6c968a785c5abb1747be.jpg", "assets/598219df480a3e53c649a5fa9f087114ec4e0994335a9368d03fd7185a1f3da8.jpg", "assets/c6b6f28cc3a7989b241eb2ab566921d7b9e048eebe4ab120492bf0a8eda21079.jpg", "assets/b9169abe479ad98c9aca6cc132edab45ff9fdc2d73c5952d9c718009da2118e2.jpg", "assets/b93bcf634112dc938e9aa9d1ba076a3dc99911e2e6f50b3dbb18800dcbd8bfeb.jpg", "assets/b42628e6de1aee61c640333f5876f91eb10f239255a5d9fed67f46f303ce7ef6.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 1, "蝶窦": 1, "鼻腔": 0, "颈动脉鞘": 1, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 1, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "翼内肌", "蝶窦", "颈动脉鞘", "斜坡", "翼突基底部", "蝶骨基底部", "岩尖", "寰椎"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-69daf2c670fd11615e125384", "patient_id": "patient-a48d1d72efa6c4217cf5b79c", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/8b47be8c61a58da83628e3562a391abfa0ddb181f6cd4d4320aea39028c90654.jpg", "assets/2c31594924a13e7169573a23522df348757bcb57f989cfa2c45dbf76ee309110.jpg", "assets/cdd5e77a6b2b64e78957d5f66411b1a18b9f387db17fd385870074d1e0d6af98.jpg", "assets/8b999dd5d961821db0a5cd4cccca6dab1e561f37f8367006d4fcfe75ed2e57c5.jpg", "assets/ce29a9ee1cff9740a73d4ca0a153f6c4434f6f6a9e08a9887b7df08f117e78dd.jpg", "assets/a248d3aa8bf92698685b24b600bc7eb68d4bf8390e0670b0742a549d4c3ee13a.jpg", "assets/f8e8fbc7409ac6cd751eddc58e938f150f1e730f3dd8fecbd41d84ebe691ed71.jpg", "assets/014a7169d0c026167af61fc8d7ce16db70d1d1aa98be44af7351fdfd847cac85.jpg", "assets/e4e2b27b3ff4650ca833dca88a61570dea0e5128e485dee52b6e853d2bab4b11.jpg", "assets/9483dfc90a95ed0dd7b6c8ae40a3faf46bd321379184377b5a702e7a7ec77e12.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 1, "上颌窦": 0, "斜坡": 1, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "筛窦", "斜坡", "翼突基底部", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-4e7313af07e4b05947cdb8b4", "patient_id": "patient-e90c2443e271b2e927262653", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/2982920e907972b3d0b09ee3a704c6bc0a7c6436e503e1d05d479e1ca7711e6a.jpg", "assets/943b715c4b976a4b2b04a3e63245c73445560944502a934d10c82a4885645e7e.jpg", "assets/c18ef8d010419f57185674a60bc5d58c554ca73ec04af1849ba4316bc9d52422.jpg", "assets/31fb48125ab9af5cde20f0f089a7aadced53c87b282196813b323e532a14fc99.jpg", "assets/fde929825c6d7dd1fd399e3386b8824a28709e9927e60b865875a3a53373decb.jpg", "assets/458e414a66ca8a356f0a7a87e5b77aafcedfe72f792588256d9a9fe7dbc41c5b.jpg", "assets/4426b2403495c0919942ed0f29240e999d016458a99c34a998145698fc560097.jpg", "assets/d4428f427ebccd59ab89778226771cac989f46e03064d690f2041995c71cc463.jpg", "assets/08ed05d1ea329ab1c50bd27307c3bea4dafff802e1f7d5bb852d51b2d034b61e.jpg", "assets/f53b0ef7208fa1e17ddede451c5121e7e6970922b403da170ae32ac88a5e8983.jpg"], "answer": {"T_stage": "T4", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 0, "蝶窦": 1, "鼻腔": 0, "颈动脉鞘": 1, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 1, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "蝶窦", "颈动脉鞘", "斜坡", "海绵窦", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-a3d53ddfb29c79a21cedc3e9", "patient_id": "patient-7c0941dbdd4694260fd4de38", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/931f2174e6ca64ac79c2a0fc0144cd13abf3548840d1ea95952ff64865522557.jpg", "assets/0910a70d0fb942ab23f5d0ee8c4a5b31325f85312fa44e0058aeae7e53d1c407.jpg", "assets/3be0880a106fdc3eede19dd87f389e4d9a6312e440138eb10693ee0692c2d1ad.jpg", "assets/2552b3c58797d82a7476c2e94fb6094d967150c510041984a9fc7122f3efea32.jpg", "assets/38955c3191af348f64be6cbf2c0657bc0ca3ca3e0e5192e127521d6b044b3bb5.jpg", "assets/5b6218515b688ea959d0eaf063c73218ca99c54403eb788aad43a23d197cf339.jpg", "assets/24bc4766aacbfbfa0f8c780f07309d54f39849cd2b868708341cade82e3ebc20.jpg", "assets/e0c7db93ad86a91c9cec402ffbb5e6f0a699a850b78aaac2fef2aa9fd4112f83.jpg", "assets/506d72043ac0a4a5dbf312bd927644a7263a187a5825c896cf0d0701d9d7f81c.jpg", "assets/5dc5f040baec78775c0e3241d2b6bfb59f403bb3d8eff82675c218a51e419af6.jpg"], "answer": {"T_stage": "T2", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 1, "翼突基底部": 0, "蝶骨基底部": 0, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "口咽"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-82bbc2aaedb84d88ceaa56ac", "patient_id": "patient-02ca51eed4fedbb13e4db76d", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/4b74e80d3e4788b71a63813b284d303d4cd5a395d3ba24ad57fbd5ca5d8284f3.jpg", "assets/62914741cc4210d1e755c2fd2812014bf717784198071d35080d91215f5209f4.jpg", "assets/16921840b70322ae2419217bfc8bf5c7540958b1f8c890032119b85f8888307e.jpg", "assets/cdc12071e5370b848569e2caedc898376cb19b38b0f50aefdae670b65735bc68.jpg", "assets/0e11822edda898a2695c0a6a82e27a029ccbbd2958f02005952cab84d525b180.jpg", "assets/9eb99125ad04c86c1d8f38da7754e967650941b8b9b6923e8c00c68858bcfc0e.jpg", "assets/fe12c5ac189ed7d511d59b28614dafa3fed7cb902a79a9af1e44fdf3a63cd06e.jpg", "assets/673888a2c3d63040c95bdc8e33112a46bad9ac5a41aa3f68fbca62035baa3749.jpg", "assets/3ad56f8a21191c2288bbfab588a0413ed2cb63b816dc9d8c9dd122a4c1b03d6a.jpg", "assets/c14379fddcf07d1ba43d1c762b5609172f68a362a51bdcb1a8b600bfb8af2f44.jpg"], "answer": {"T_stage": "T2", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 1, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 0, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "鼻腔"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-c8f353e4bb6411158a854549", "patient_id": "patient-36d433557e63f939b878347d", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/55451eca025e5d9eb23c35363f229c2dee1e05d506e4501a9adf5aad57fa725a.jpg", "assets/412f51042f52fbc504f5118295f77c0b793426d51322a15c89bb6ea829d61722.jpg", "assets/72a209ae8d5d8595f0506ea4522fdd028444dcc07e0d7bb4c94d0104ca038de3.jpg", "assets/0a6c33db3cfdd65dcb83e3727c55760c6218bf342862bf5558e9d22b46ba3d2a.jpg", "assets/aec426628a9f91c415de4fced8da8de923900eaf753eaed43cceab5edfd100e5.jpg", "assets/da957fd6fe57014f397e0b0e7fbc0d3eaf133f4d6129a8416e49cd0abcc47ced.jpg", "assets/fef5f6d114b8fafc4707b1b5033d179b4b046fe4012d02af09d56f8918728d85.jpg", "assets/221b4cf259af4e880f58a938d3dd150fc41c8548d3c4470bc64860ae65de0b0b.jpg", "assets/d89f437727cc22522b11f051c351c539277a9260153f13296256dcddc2ac7396.jpg", "assets/34ec0a135c5b26cad43281720175f6f4105fe93068de89325fbe249e36f2ab4a.jpg"], "answer": {"T_stage": "T4", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 0, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 1, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 0, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "海绵窦", "翼突基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-ff52fcd72975621572f86d0a", "patient_id": "patient-79fa00752e4405e2980f6292", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/a2c85240f07c1a1d7ee8a01d87dfda44c4270154f71225099746ba6da2cb46f0.jpg", "assets/f285efd666cd3b7b118b4bbe28e56776abb51af814557bdc8e51d235ae3aea7a.jpg", "assets/e9c499df7d4ecd6d3b1c8780c4837f5b6976e168c02e06eaa5a40ae6bacc101c.jpg", "assets/a1e7dc2da8a8a5426b60f7863e1151ab1b7edeb9ef9083922efec17537460f75.jpg", "assets/3ffa6aeea91a4147bfe002f000e2c33026daa9f00505b3e91c7e4e8dbf00e929.jpg", "assets/afc06c6962e03b132b4254774ded3858f69b57efa7cc1cdab8c84b0e1bdbead8.jpg", "assets/20f13bfe738d1d7bef17415209095509a8e5a2f5bc27632183643b181b1c0527.jpg", "assets/5f29989419b5ebf7cbd94834571f1d781aeb23cd001f18fecf70d1de0d8785f5.jpg", "assets/6055eb946f9f9ef3cac1995c1dd6dd70b018e20b806572f01c1346b4601c4928.jpg", "assets/fc1fdc5d1228c2fdd0d9264fd3d759b79f3d89cd2a54da62d527613da50026c3.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 0, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-6936a30a34ceed215a43ffaf", "patient_id": "patient-e7eec542502a097814d58d8a", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/d22640b76c9e20b7d7f3787d4e8e804f95bef5e8db5736456a7458c54f300563.jpg", "assets/d1e766f0067e16b03e8abdef6addd6ab53fe1d30034526b89d773885c8b979aa.jpg", "assets/5bce19b9cdbbd93668261a6aec825fffd2b1a5a0dd58e147d5c26e063b53a3c5.jpg", "assets/f126c421018fd107c0cf6b1e87a2ccd1e3361af7ef6fd48cd586a2307f515e1f.jpg", "assets/2971e6ed997b08d51c0c4f24c1cd5a13e625217d3c171d55c6cc903e983fa03f.jpg", "assets/c5e646b4c2d702060446cce24360bd7d53b254f550ce908e21d687c492567f85.jpg", "assets/109a4473ca486f6cc4df06b2d5f12df7ac299c82b77a26d700122a51b8fae473.jpg", "assets/dfcf9593f5c1b9833b242e3c97dddf5ea1180ff9a77b417c2ac524c57eff4e14.jpg", "assets/6f7d1657f7d9a86df53a378f216f95a0fe45bbfc5083ba67f85bcc361345c747.jpg", "assets/8b4faa8d45be9e86a538a0a60ade4609622f3e7066ada518bd99a312dab2d4e3.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 0, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "翼突基底部", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-6eac8e0c62b2116853b28000", "patient_id": "patient-f25e20b1e5c6eea840d4cc21", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/9c1d219377b4ab42380522e93ae4a91670aa9c38fdacd9122e3371760e540df1.jpg", "assets/a783167276f29535306b574348d4ae11a88109c4057ca7f4fdb491426bcbc728.jpg", "assets/f63461721d78a357d02d932494b92d9f9514112d524c61aeaeb14affa969785d.jpg", "assets/e20355be1998cd599139591ab876641a292fe754e46e8b5d5bc6a0a8f686f463.jpg", "assets/bc765f61afe13994d6a6b0507f5e05d840e310eef0b0db3ac2fe74a7d2525102.jpg", "assets/730ec25c0f0b2831ad6e3837884e0e18ca506d51fd02c3eb36ccb0b5dbef658d.jpg", "assets/2179e5014c1cff46d8e194e084f3df2eb9880680f2b2476771e4a2f4afaae1f2.jpg", "assets/3f04b53dab6d8703944c059f389ededfa2eba4ca89bf061fbb84a0335e822c88.jpg", "assets/e34c75dedee71f6c9cd088403376ceaa0c83b30dec537dfea0fbbf7e78573a41.jpg", "assets/f7754768c14704ff4cba252a0ad912a94bdeecacf4adda74ec2af132c347c586.jpg"], "answer": {"T_stage": "T4", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 0, "蝶窦": 1, "鼻腔": 1, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 1, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "蝶窦", "鼻腔", "斜坡", "海绵窦", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-e4cfe8969392b8172de4cc15", "patient_id": "patient-9fcde7a95f4d57501ecbf7b2", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/b17260547813674ff18eaa0b120d450b6b6435d073659b4ca531cae33ba6c363.jpg", "assets/a37ff78889b125a7f0bb14e82e3820df030d5a01aa550b437fd87337d8062851.jpg", "assets/7902c9c9cb5eb084be027c5d243a828108885da64794a65b580a8fc8169a1c3e.jpg", "assets/e36922e8831743e23b5857348c58ee70b409e2ce701fe07e253fee953f9b9f06.jpg", "assets/7900099d8ef66e6d8a77246cf7cd241d5d122909e4cb64d5767add44ea6a05a4.jpg", "assets/b924d485b77b3599bd79d0c6d6f85f546e64275a6027abe79aebae079a8fdca9.jpg", "assets/5481de537be57cdc0c877860b435f4ca7daa5b88eb2dd237d2e00917945b0549.jpg", "assets/7e4715a85f00c55d527b411721e5e0e70b977e01951497fdcc5e99c51c8f168c.jpg", "assets/234c84b6270ead9de01943a207373d75cd2ac9b782728b759a2ba59667b30c0a.jpg", "assets/f877165022b87a7e6b5140c8904f19191967f45eb8f9fa7080a19ac9e504b534.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 0, "咽旁间隙": 1, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "咽旁间隙", "斜坡", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-bf2ce212a9088377084a5aad", "patient_id": "patient-4912d2bc95150726fba7d603", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/5422f6ac38239cc1392d762becd3a3a6d1978abcc404ac26142f5584da077dd6.jpg", "assets/02d6d258208664bf2ad7224fb8d771bdaf65637cde9c2341379d48532890767e.jpg", "assets/1a5884f87e41712abdb99d2c63baa15fde3576edf1600db484c2069019c1fcb7.jpg", "assets/15f39eef3adb9fc477bf8f9433e15083cac743ffffecfc6ee9f9bb8a50acc98f.jpg", "assets/eea782568a1e60f1ecfbd2c029188900e47af800c730edddaea8247b07724550.jpg", "assets/963ac186efa2b8994a802e822afda280f72a34c49f2e92f337c2dc9c0570fc6a.jpg", "assets/c530352b76f2f63059b3bec2a3f61e7b4a9a61b304b90d737f995690d636d066.jpg", "assets/20dffecd3b0626592a9c86d43fca509c80f9e782ae819572f42d4e6a67e5127e.jpg", "assets/c9bf7603cd38583584b86f71a6689011cb6b398a4f4ea39f6ad8f1e10c24cd4f.jpg", "assets/5b980ebcc4c557fb27e6f7b6e2e916be01125bb9ec470ad716e79b30defd642c.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 0, "咽旁间隙": 0, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-6d82c1a95d7e735b5b682f87", "patient_id": "patient-658c901d241197123d75230c", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/bea9b06e69b9afb619aee57b7bb28e49c620b96fef59a4e1b5ddb5fa3718ed40.jpg", "assets/5ccdda8d98b00403e6f5a800951c28903981ddbdbe1c6d29037da5889f5ff20c.jpg", "assets/76cda12eb082ae15f1d5bb250e46d58d35cd024450b669a4163a874c4d09eaf9.jpg", "assets/2c7b5b44c93d9c4280f7bbc9741cc9cca3c083cb95cc233097b9e3f19f1abc02.jpg", "assets/5567263c1b423b5c0575e2f4c9809f9425f1b27bd54858641bacf902b2df65b5.jpg", "assets/b15f60152de1495c1acd3d2af9cb0d55abc7086f0c994c17b9af49178a99e542.jpg", "assets/6e8f21c8356c4e658f3fe7c72c1e30bd6ebb59c7dbef93d36316203a246c0a26.jpg", "assets/1275a3b06bbaeb90c99585d26ac2059a3574072a0ce770eeb957daf0103ddc36.jpg", "assets/fce1d8914eb7757ee6f797eac992ca3d974264b7c6f846bcadc7978c105887e1.jpg", "assets/9715366246e6acb5723b9785c7958dd1964af2cdcf9d34949899db0f7c3d2d13.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-60768a3b6b3b6d861cf4aec3", "patient_id": "patient-817588890ea7d1df0cf353ab", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/8248be14c977a4a1400b7f64a6ff3b652c629c03fb8fbda4ef38938e6b5fed5e.jpg", "assets/de8253a2538b0c0be3eca41b5ded0466279728417b1363013c235265a9275f02.jpg", "assets/b05575da5bda4866d86c2d16102adfa9cf14cecf703818cd20517229944ff264.jpg", "assets/a1ce9342c868a273f3c720939263e406afcff59f1f4cb0fe42f3ec4ca855fd06.jpg", "assets/cf6e26946c777b9a0e78e70d0a24a3d8adcc9fe2c1c04e8bab68976defeff098.jpg", "assets/751b519efaa3f3a6dbc9f2600f8b4cc70c647eb9b9e73f78caa990ffe97a2441.jpg", "assets/75a1d2e992d10fe89dd15c9ff46731aa381560779927ec86495d61af8c8781f4.jpg", "assets/19f0033a3aee44c0fd31dd5697543d6d2bebbf334691d24cd8af1901c8b69d9d.jpg", "assets/155e9bec31259f6efd9e6c841f732f136d8134daf9fde498b25ff68808154730.jpg", "assets/2b76828b8515487ddddf4475ee0f211c1e12a66d1193ec163e8b5a2a3cbb2fb1.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "翼突基底部", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-251d516cf3ed760cd63a5f74", "patient_id": "patient-1189badad5e7374b82a3cc86", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/186234c35a9f84dfb63ae2b8e83ec554bd10fa5b80788627852cc846831dc77d.jpg", "assets/a5c3e966721d1e4990b6f32b1bdcb09b4edd73a01ee61883a6de3022c87f4ea1.jpg", "assets/02b956af80df858600e49687e25408858ae06e86a71288277751078284e58d40.jpg", "assets/863b6e8a3389a5b9217a3a1d305d42dea20cb05670ae0d88ddf745484cf2b215.jpg", "assets/2b97fa780f832007db1ef84f2b640f6dd58a49e90de7f2145b67133abf60b171.jpg", "assets/9da2bc1ef5a02768d9519f61c6a91c6ff5513d3701cf693b46847786bfd17049.jpg", "assets/72f0a440d608e4c9909c320614fa3662bdcbb1cd0859319c30f0a59d3fc24669.jpg", "assets/a906e325345e9a268bea4472bac2aa647f4f161e1d01c2a83232358b266e7d9e.jpg", "assets/cea6d12f08339f8095a1f4943171e3490896b7dc3ba235fca82ee85bbb675a6d.jpg", "assets/6a097867db953ae7d5ecac4261a6e02ecdbdd6e7484ded529d74abff736ff496.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 0, "翼内肌": 0, "蝶窦": 1, "鼻腔": 1, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 1, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "蝶窦", "鼻腔", "筛窦", "翼突基底部", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-6be5f76a822e2d0df7fab100", "patient_id": "patient-283ba4356f86fb9f68ac5c06", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/a37302f4f3f1ac83e95923978b54bae44d884eb88a613ba69490bfaf1fb99444.jpg", "assets/041b4cf3c492927c30462c6d22b003abb33b9f092da4a4fae95b8f4849c6d1e5.jpg", "assets/7fd1de6194fd8b3237645f8ff8479e641f983ca358525d14e0125c3b6db03e92.jpg", "assets/14094ebcef443abe6ff0275d4ab51710e001a967c0c8847004bfec192db3424c.jpg", "assets/6dd56531fe5bd3cfdd6b4645e7ad6b832f4b290f0707e80c4e7dda04a4ca6b69.jpg", "assets/a5e4a0aeda7b686feada18cb4753fee37158e0816d4a6443a0ff22c6f0ab5de2.jpg", "assets/7d2041dda7eb047b2d68f143514c3fb999337b00125c0967f5588ed2c960e64b.jpg", "assets/b1301f7119132d34070c28c018d160b76d0376d882bb153701d2eb62e912e7e8.jpg", "assets/bdda7af5651f2d8aad4e5a4769de9b770c30eae76dd77b4d6b4f7f3710209952.jpg", "assets/a31cade90cb275e25f8f97a57be36f2f62c7148680fb347f84e5bdfa6a11a3fd.jpg"], "answer": {"T_stage": "T4", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 0, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 1, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "斜坡", "海绵窦", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-3e8681d614cfeaa63a137c16", "patient_id": "patient-f89d81ee7716a74d2854d920", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/b441cb3a853b977f8058c77ef09b7a1de1ea37465c71a927b035629c1ae45043.jpg", "assets/fb49b4e5e623e42bbf487f915a46524957a915ed1490507479a275b4158a943d.jpg", "assets/7513ac108096c64ae64134f2f265be9ad4d5bc169e3c85429914b90bcff96c8d.jpg", "assets/840379d3c69ad4d19a9753705b025a193e310055af90007c556fc59f9388104c.jpg", "assets/fc77516d4213fed438eefa1811e18e720ec015f36b39ea3630c774aa5076304d.jpg", "assets/180dab461352290ef846184e78481041c5f358666af1f1880e37186273311312.jpg", "assets/065cc3f581cb44ad27600fa56e317e8b74388eaf0b6ba3268e02190f939d5087.jpg", "assets/5c8f97b99f220a2c0604a1f9caa396833ea78d787b74438840127474cb43b00c.jpg", "assets/5eaac33afcf3baee20d34fd8b6d5423fd6f89faef87c128202ab2b673660a8ed.jpg", "assets/1ba76ec2971aca5d0460b02b1faaf84a8da574bc426b846e656a809417e68a5d.jpg"], "answer": {"T_stage": "T4", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 1, "蝶窦": 1, "鼻腔": 1, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 1, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "翼内肌", "蝶窦", "鼻腔", "斜坡", "海绵窦", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-bae59bd979ddbf3acf974725", "patient_id": "patient-eefab65cf080ff1d932d6946", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/8b7380dc2125ea1d60a4e60fb4e97a8bd3df72390263300d048dd684346cf934.jpg", "assets/692dc7fb2154298a6cc1a46d4979c53dc3fe7f8667d8bcb0dfdeb80db1096755.jpg", "assets/a0afcc76f35256f2fa6618610246d59e608109e5827c121726ae6e16d89652a3.jpg", "assets/14e08b156e636b213a576febf5bd7541bbaaa5558892cdb361c34a7452772160.jpg", "assets/a5befc86072376dbe967672715ac5d71fe5efe855a82f941e6da10187504595a.jpg", "assets/f4cdf1d04a6ac08f6d5bd8f10b344aa9a7c19fbe98b83bb4afea63f7d3bea6e5.jpg", "assets/4e5026092097c677786988253ae7fd24c8e6d6e752f0814f3de411be73329555.jpg", "assets/dad26cfa4698c8b2aa3ce74b9edac40e8032ac2c5df7df61ab832e3a88e5f5df.jpg", "assets/1483f6ca50fa297aea4a22a95b6199ef7bf7061754ab87def4e24f67276e9621.jpg", "assets/99b0b1de1625650f727f52fab2780b8889f75a7cd4302deddd6f559548bd9cf5.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "斜坡", "翼突基底部", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-329ccf16e682fc0694b2fadc", "patient_id": "patient-f229dd9bf4b869b8294dd81a", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/b006929f58b9b5b60897bd92e20554b86de81f14234e1718bb2a19692ef7dce3.jpg", "assets/1a986109f16297075e7ad3da3d85a53c42a7d0eeaf8806feeb6eb9d0e2254835.jpg", "assets/f95d5c3a829fc53bfc7aed048785568c2f03652ba7aab75ef399cd739db950ee.jpg", "assets/148a19a05b3e68b7c442ac8b46a3a562fe65772f68e57b4b816054cabea78fe7.jpg", "assets/743c1dd90043638babe97729c134af90d71836f7f95c39ddb924c7b9cc99784d.jpg", "assets/27f093396c33e5dae9134aab13a84a4f80b30ea7e7d87d2f472f6c7d27ad3871.jpg", "assets/7c001e896eab09b34f1a3a3fe7c5ebc731d3ab0a5a41db1a90aeb50f4eba1b7e.jpg", "assets/50cbda6fe38c78a818ef079c651a95321c2ebac2641f3ecdba9445f7ae74f571.jpg", "assets/2592a7909ac24ef3c90547f18de2cd23d62fc82007c45bb670e7d47510537bdc.jpg", "assets/92241844ef456126a6abffe5361c52d1219737185f72fbd0b27f7b2ab8f379f1.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 1, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "鼻腔", "斜坡", "翼突基底部", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-6c1680d16f1a18f09aa7be4e", "patient_id": "patient-01cb4effba96aca19ec352ef", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/4fea9d8f965dd22146969bb495a7c247ccd69b1bae86b6b339f0a85536435de3.jpg", "assets/ab1839bafe602f85dc9bd157f5313e7d476ee9d0a028e3198c60824492d3c0b4.jpg", "assets/428b98d79ce4d2c170034c49cb76d5f3ebc0adc63dc6286e9c6c18cf73ae6244.jpg", "assets/30cf6bd6a1f8368d62da81b37ffe6c0e02ef6873a14d4f5921c9c9119da9848f.jpg", "assets/863ad006bd59d96d2f4ca3cd913ee4bb78d2936ad9528cb22f56a4b6959dc328.jpg", "assets/2c00ecc25be76d93b11d06c9b3c55838415b3bd99957944451310e54a2abd2d0.jpg", "assets/128ac20fa7d3a4367f91a12c6634a10ab4c665d0ea2a70b25ed48dec842a8590.jpg", "assets/4a716d8387e81f27dee27fc79428fad419442bca72c506aa8a8fd1a966a2720f.jpg", "assets/df9d9704bc99fd2828c19d1297f582fc066389fa8fde718495de4f5094625b7f.jpg", "assets/b944a465ddbb577448a3d94404830fadca2d83f51e82a1e7d055d0bcfd1da422.jpg"], "answer": {"T_stage": "T2", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 0, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-9e78fd52f56647fbf59437b7", "patient_id": "patient-2904f892de88d1d694b3a4f3", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/a5958399db98bc15a90f9d13a82402e34fa37f168c1045fa84e6e77d920b2dff.jpg", "assets/0bc6fae94f86267fb83e02607059abd968880c59d74730187d37c8cc3ac77089.jpg", "assets/90013b8f0617c0b991e4ebf763a4327935af72c7628b25718a0696fa3d4cf1a6.jpg", "assets/72f8e5c3f21d8b77e4a0e8a43a999be062f9e1f84bd5190be9642bb833c3195c.jpg", "assets/f5290df91dbe24a22b4866d47e691efe0f775fdceb01629cc2aa6c73f94e00ea.jpg", "assets/0e44989538f68c1a168f8a92aceb5b0650e5d971d5cea058a4e68df2c5bdd4d5.jpg", "assets/6b3b0f0e3e256a1ec8ec7bb25d21af167b1704b760c02f9289bee249ddb6e203.jpg", "assets/400c7120f18f330f4413b0edd54b33a266a75b4868e3d4025e9cd96023f42a89.jpg", "assets/919093032f4a431e153bb3d2f0d4b2de4317c3950a6beb7cb210fed814ff501d.jpg", "assets/04ac66e877b72a2323d4780363d8deb009dff2b535ade0b54595f751485e6e68.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "斜坡", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-f5cfb00949f641c11df92567", "patient_id": "patient-8e2d677e2677ad4a75d70dcb", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/5eef599a7c7a00d588688558c07f124ed5c3a0b082a6a4c100a455fc451af76b.jpg", "assets/f49695e008aba4b10704819b228ad61e9ee043e354021ff4f5e782c0b02460ae.jpg", "assets/498a6ce14be85c23b90527892dd8dc412115afe141b2725730f9cd6ef534b2e5.jpg", "assets/e8715bb6eece9401f93bc989fc5b7dcb04d2e1270cca65a68d4b237b2cc38821.jpg", "assets/37fc19f45dd34e31948856d9b0015d006727a2e939a2a62be9a4d3bc2da6de74.jpg", "assets/d79a08a54bc95095199344365e941dc52a087e702e8af65994eba9000633856b.jpg", "assets/17a0c2a60aea5861d6dfe97228b57e6b23545fb7ebcb0ff074969ebcd80e9a6c.jpg", "assets/f685cbccb6d3a3a374ef6c1fa9ade25329362f747023d78423aa35e24e5794ba.jpg", "assets/ed2d290bf14a1afe2a5ab1d79757eb162875d770cf9b81b217b40b0c8d593556.jpg", "assets/9020bcb8b29a36b73d7360e2e123aaef376fc19d077184730db95e8a8819e39e.jpg"], "answer": {"T_stage": "T4", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 0, "头长肌": 1, "翼内肌": 0, "蝶窦": 1, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 1, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 1, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "头长肌", "蝶窦", "斜坡", "海绵窦", "翼突基底部", "蝶骨基底部", "岩尖", "寰椎"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-2d307d567fa41a0d57e9c8e1", "patient_id": "patient-9eaf0b40aec7a0f326916f11", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/6e60e497e214ff813287d465c1d7f3fcd932fdb7d7293595913f0927dd05dd71.jpg", "assets/240beeb2b2800621bc4aa1493fd20c2176bc7e5d389a547540adb866e0a397ad.jpg", "assets/c61f6846f228642fc7c9a321eb8c5107483c04d2a6622d97b49107572820c1d2.jpg", "assets/9272da51a1d34e93295ddf1250fc9f6a70787ddaa7d81594b27643170a9a0056.jpg", "assets/039ca6a100162a601681de31ddafcd6aa6960840f21499ddbaf45d81c4e0fd52.jpg", "assets/b4753fb646a2eeea06e0860ee4a08d2b6efb50ffbb27cf8142a73bfe9d2d8c53.jpg", "assets/cf4400f72081b9d0fa82b309abd184f788a9150ef27e9e45361bd0f393172e9a.jpg", "assets/7d674867cd3b58483109ca1275b29d11ad62e5988f3bb493c9835a55ad09e0eb.jpg", "assets/9a6e41aa7217caa92662f9ac48919f0bf8b0ea0665b4d03af004ccf53758608c.jpg", "assets/c65bc2a2a060265c7102a45c10c7e0b628dd9bde4a8af42417959f122f481c22.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 1, "蝶窦": 0, "鼻腔": 1, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 0, "口咽": 1, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "翼内肌", "鼻腔", "斜坡", "口咽", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-b4d5db8447be6a3dc920cf36", "patient_id": "patient-c37f6b32f02ac91bd1ae7799", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/7a33b11520f2d272640be6d7a56c0aeabe401d3273e5e52ffc7ac3534311c7dd.jpg", "assets/681840e6cb1fb7d18a6af21dc1333ebdb19b4c14c0bdae734d064542390e9e9e.jpg", "assets/a09137260760b8abecc51b56093a11daa8667416303b69ddff4c9096c4366a84.jpg", "assets/c917e872795104694a9a6057925e9db9c351483c47d9ce3b92288a5f1736afaf.jpg", "assets/9d7ed35c8b6fbc2ddee0d80cd21ed97b12b408a4c5ead49342dd4b3d7560edce.jpg", "assets/96ccc05e8d48d81894e954ecec06f4999209255e98c4ba68b84c7afedf8e176a.jpg", "assets/29436805d56d28295408cc76c0156364a51ca4f4c4a985df46914790b7a8a453.jpg", "assets/78b718cccfb1e5249405e9bc5e224f79c707cb0ce462ebf7369d3e41c46b7f77.jpg", "assets/96243cddb34c98cb8c70e40bd173ab5e05370de42d85c714974e335097a56175.jpg", "assets/f149c609232f1942707ee3962f6a443316335fee3411e0c34adce4ae6e2c80a9.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-42d3f7b229983d8d1b8f26b3", "patient_id": "patient-9eee365a9ef54e00d4f99666", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/3f7a4fe64a40eba10705d5d8f5f84221ed1c7312def26f2948bd38d64b6eea52.jpg", "assets/372c83dfd31814fd7763afd07cdab48029241070ed6fb326f19eb9a083e3726a.jpg", "assets/a6922030333e8af49d31d1e1f24f179b6f31900b9e25f2a82134517777ac43e5.jpg", "assets/efa54cd12af26fe74fd4b2a96941577896ad44c464688386403c221273467def.jpg", "assets/89a13aa28d120d3511c5e1b6cbe0da26bfc56121d063c9dcb462cb99998cdf74.jpg", "assets/3b706792a9a04653ffa6eb7902e27e90bde211b47f249f049d1ce0e982d68016.jpg", "assets/709ccb09c359db72c044f98f2f22fce1ba3991c4896c799fc2c613f103d990c2.jpg", "assets/575953bbbe3e9934cdcc9307d6e6b552085d714618071d9ea4a0f6eb33deddfc.jpg", "assets/1fe6a6fcdaed9421234b5713997fc70a3bc07cf2934bc3024db44aba92bee0b6.jpg", "assets/c261a164368d9178fea3d58d8bfe72d3b6db83c8acfb82b636560246a5f35a15.jpg"], "answer": {"T_stage": "T1", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 0, "咽旁间隙": 0, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 0, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-9d78c7f06b9d18847a6c6042", "patient_id": "patient-2636abbed83572883f5aa8f0", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/0bfd6eb46dcac92c6f9b4f208f65365fe2b3b96f957272711e89ef0d8864fe7a.jpg", "assets/41b8eae28d4bbe9fa3405ef10276f757028834faca3253792ea5801e6e971b84.jpg", "assets/827532133b050036db68ce150c4e8fa91be0a0e2c16536f81739ed8f2e399405.jpg", "assets/10c3672067774eccaa0aac2657d2337e63bfd3f976ec0ab94dd38c3b6e333eaf.jpg", "assets/986f470f7a09e2e99b7322312a0b85de676a9e2e5aa8f2212bfc9532f2ea7f04.jpg", "assets/a6a3d27db4f55cf8d85f8dcac54429289760fdcdb07a454e8f9ce4e2754df4dd.jpg", "assets/44c1bc936745821d2917047b70a947a3a98f6831033ecac149cea48dae357275.jpg", "assets/19839c5aaeab9f8f50d587664a2df20b599906232cea1afcb0aba106de89b8bc.jpg", "assets/575f5952aaf79b38100898eff05e48d72ec89d39b069842c2f130f91ab4b2d63.jpg", "assets/ce5f521652924a7e80c4054b0c3dab6b9b52761f6d9f39cf6ec15343f1006464.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "斜坡", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-ab3b575732e80d8aef4ab9f6", "patient_id": "patient-a1f42fd798b22a2ae5c5a7bc", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/615105f751667ec87a9d921b2ee9254c2faa81644cf41e6646d117fe4475e776.jpg", "assets/4f1f66ee0419fd3191215005aaeb42e3667ae5207f46d262ed76fe946a29f9f9.jpg", "assets/fe1e3081b7f26003fefee0f3acc5fddd2e2c33850e4e5825228854c0823f35d7.jpg", "assets/7045ad26b6c59934e00691fcbe2cca5acec0b4ff57215394d803d582cae423ef.jpg", "assets/727ca332bb34ed19bea724a2fbd8dafcd203e8942e88be80d9242fc7aaaaa452.jpg", "assets/0875f635a6e4b1765adba5f2a50d7b4674513127940484c96d8202d9dd502c00.jpg", "assets/4b2de92ca914ebf10331878c86dbb126621ab7f78ae402173fbc666a73342262.jpg", "assets/4f6e028081ef31f344b2e36a69f79b6735cc037d699f904cbd3bba93731a43f7.jpg", "assets/563adf18bde55e30aa3d1740988627e0b53a34669fc17044e4eac4c5189471ee.jpg", "assets/767af46da25c2788f235c7e3f4475f39ec948d2a7889e7c988ab125863a465bd.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 1, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 0, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "鼻腔", "斜坡", "翼突基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-cfcdffa3528332d59b5b50d2", "patient_id": "patient-4aef168669533556a36bc39e", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/94ce13e05831ff01f3bf8be4ef3b454f06b193f8c0e38ea595e7c4714e56dfa2.jpg", "assets/9598283eae9436a51306cfb14081455046c784defdcb5797402aac4386c5aff1.jpg", "assets/0e5fdcf8b3867c8ef34b26aa1a17392b8990e60db21c9f1e106f904b0eaff625.jpg", "assets/9aa29a3a5f950717331759126c49c3ddbddc7aa10790ee719e233432325107f9.jpg", "assets/c775b826647bdca3e8c305618cc0251b015846185ba9f3ac3285be3a5a0cb0af.jpg", "assets/01136139dd8a9d5be421869ace92516343c947f30be3f2936d0f1501c44f9aaf.jpg", "assets/11985251cd651171a3e032d7a2addc6f357358e2f2281335f67c313e58e34a4c.jpg", "assets/09071f50a4c4afd3ad97625c10b3587e11b281a4409b0ca602f5917a3d34adce.jpg", "assets/5a3c5c7969dd10f1cb47ca979020d2ae2f890c1622f26055b8e8066b4a6e9446.jpg", "assets/dc8a4af88661bcae764d0036616cbe9b39bbcab7dfc9231791e193b17bf8972b.jpg"], "answer": {"T_stage": "T2", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 0, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 1, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 0, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "鼻腔"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-12c1267ec05c2c2e1941c2b8", "patient_id": "patient-722916e6f49e457dd9fb890f", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/a377d84f0000d91bd77968eb15e55b7a39f68cecacf336700eb31b31006a7545.jpg", "assets/99fbe32952d50fe8f4971fba04c2434aa88c74b56ccf05cd4ef6907a1815ca32.jpg", "assets/1cdc959ec630db654aa0222dd134b112218930f69255acf1654281895fb667df.jpg", "assets/df32c5eff4db9ae7ebc7032122e20f0a74eba522a386ff7d6f9ba9f8895fa4fc.jpg", "assets/e4a15c5b460a311df7e89c49ac65cc5be1523dad55f636d18f6a8ead1441e5f4.jpg", "assets/c0a17235f9fb8fab3d4eab4438dcd01863d4511c737f430273ab53c5472e7406.jpg", "assets/b08def03bf0c92561f5ae65ce9301b391cd1332d28f39816df777975bb0f981a.jpg", "assets/266de664963c3b4fa6568011b65eb03713fb9d802b6f910c9d518e38b78f735b.jpg", "assets/518335b5f06e17ec4638beaadd12d2e46622124f4227f263bd35892653590af9.jpg", "assets/5f2a8d22e6cb1f4a9f88b4ef8f2a5904633741f4203aff00dbaa52bf4a41c32d.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 1, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 0, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "翼内肌", "翼突基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-53d2c4abfaf8a1ec764ba5ef", "patient_id": "patient-e675eddb370b74337da96684", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/712d5816eba2ce556fda08b200212b702d924331e080f98cb228743d36ba77fa.jpg", "assets/65ba13156e48f6ba8b8944f4388ec6e31005efa166b476b9c3d2c836d2519453.jpg", "assets/3838f2b34a798e557b5ce358060b13d1eb42bf7b36ca75ceaee26baceef8cf10.jpg", "assets/8578766cb78dad2db48f8fd46eb3d99a86595844d68e2ae099ce70872ca0b8e1.jpg", "assets/62e2ed8c9799ec5a8d77fecbd4451890a2df7974e04d23f9c0a126451ad0a340.jpg", "assets/142184bbbf7e77a94793d47d9b6cb2faca977d2616b2b61dd1279445fb5c3652.jpg", "assets/c3da209cf69c5881643d7705d778cedb03b5d79c22c21c6884dd2d40e730c396.jpg", "assets/9d213be602942564e9e52004a18fd4e7ba9e7c3900b57fe4761ddcbfcb88f651.jpg", "assets/0419900b6a5e837f5800f75cae9e3fcf6bbe865fff46a7b00886df20b231d8f8.jpg", "assets/01aaf2b5185dcbc97d32425822c09b4ec9ca513c0bd4735772c9cbd4334492f6.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 1, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 1, "翼外肌": 1, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 0, "口咽": 1, "翼突基底部": 1, "蝶骨基底部": 0, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "翼内肌", "颈动脉鞘", "翼外肌", "斜坡", "口咽", "翼突基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-215f010636d995bed6596f5a", "patient_id": "patient-174236bff64528c2f91d7aa7", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/95e42ea829f5d438a879e517e7c20dea11825c48bc3103c53cffe6cfb0b920cb.jpg", "assets/1537d67fccabf3118ed8633303bc088914018c002f201ab35c8bf20780ecc8fd.jpg", "assets/c301a131cb21314ef2ca420a24c0a32424707f90d1dfdd47f9ca6645bd17f794.jpg", "assets/77578b0306d02b572fa3cf2f2f5a9da5c8b2abc0d6ea39f3a481afe393c505e3.jpg", "assets/a9a84e7ed2908053f7e5b9d1dacb3f3a4085258b73373ac7fe501b37acc7a328.jpg", "assets/5c87b6f676d661c7c5db5bd67d219d8762078a328ae6780e8b850ffab9a05100.jpg", "assets/9e20524dca3dabd9b39f4e9ccdc57ed6096fe8bbd1ff0b896e516e12b880c311.jpg", "assets/d8b1aa4e3f887b1bb8f8a6c84bd88bd4edcb7ba178db83dd56be122894af9f48.jpg", "assets/4ded6a282c63aa4bd720d9b47707bdcea02ba3520cb7a496df4a2ca7e799816a.jpg", "assets/0a76c3372c2aac7d413d2cd9829e7933218235d2c0053004a46ebbbb4db4be20.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 1, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "翼内肌", "翼突基底部", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-65d7d5bb220f36def131b282", "patient_id": "patient-b933c2f377b80fd439ace547", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/5701eb38e392795bee28b7710f42dbf20f1f35acdbc5492538ee4a29a4d90b60.jpg", "assets/9b6913bfbd7e4ec7850451059446357a0b816b43756f27a0ed9c30468e0b0709.jpg", "assets/5a4e9bb6b5306c9dc5b1db91f7c11df59bba96baac95e4365e61397318787b6a.jpg", "assets/5bec347a9d6026dc04f61d44365043ccc9ae4f5c4932b1cfc22b2fe97db66204.jpg", "assets/0054044ea73e46379af146adeaa3ba34fb1730c25da28a209db6abbd2128897b.jpg", "assets/4c16a8b2fdb34736ccc03a12d196e5d62bfccec401abfa6bbce89526b0928d9b.jpg", "assets/703e33356a1f48e9ab991208f13af43e5d80f5dc06e7128e95c5e665b9fda10c.jpg", "assets/2a11b605dfabaffedee278f8f4fcc12e2929e2e2500d3fcb4d9bc542e2543db0.jpg", "assets/ea9d04b779c3517ca73b34beb55c2c1533abb3d7aa767b2fa6a1da7fcaf1d7a7.jpg", "assets/4fdfac961855faf1f5df7cfa28450abed8f7031928bb740c096867dedf1c44e3.jpg"], "answer": {"T_stage": "T4", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 1, "蝶窦": 0, "鼻腔": 1, "颈动脉鞘": 1, "翼外肌": 1, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 1, "口咽": 1, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "翼内肌", "鼻腔", "颈动脉鞘", "翼外肌", "海绵窦", "口咽", "翼突基底部", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-66571f9c2a886a2916965d62", "patient_id": "patient-28f7f3a688fe8d84fcbc1ce9", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/d1e7c7ec8975b0306e78710ea354a3917427b7b0bb29f20c55a7fb5c73e709fc.jpg", "assets/e6d492b0f2d4ffd59b5fb4ad2b8e4a5ca32701420a43e853fb47fb6fe96b7518.jpg", "assets/ebf525e05ab432cb280414346cdd2bc3890b96e6830525ce36d32f1d1dc44112.jpg", "assets/1f67278e85f62343b51bebf04e87db001b84c4fb4a3f4ec174fad8a15c55d06a.jpg", "assets/da02f95a2cd8abc63530962c121ff53f226e1dd4293f743332da01a2695b795a.jpg", "assets/3478a086c9e6c44afa41d334d5b2200b642f57cd7bc47c7af12a9c04e0e1d64f.jpg", "assets/ac42cc854a28cfb417c90183b15bfd4b2cc1fa9881de55678f3e083f542146f8.jpg", "assets/80cff6e8b77a057e0845bd0953661b1a26209baf02642fac3dea541a81af2186.jpg", "assets/2c5f3389e180c78e47dfdfaf7597c999ad13cec69ff7c52e058699fe4ddb8752.jpg", "assets/c4e51aca1193559aa7df2d9a2358d9166bb8ac24d6f76bf69a4ca834fce887c9.jpg"], "answer": {"T_stage": "T2", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 0, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-6e82ffe1226119ce74609eee", "patient_id": "patient-640515b141269ff2b238a29f", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/c8ba40da18073d9dd022f5f825cfff36ce85e024ef29c1303d14fcb824aa8dbc.jpg", "assets/ddf2e3419679711c3c658d0261aa82dbf542b210def42b17713a4de592544e31.jpg", "assets/b70e0a37956aa58a5c0602250d9604df972874898395f87e3ff3187015504b44.jpg", "assets/1882053e2af3631d336686c611133cfe8dc3c5a0c82bf366bf6eb02ca4899486.jpg", "assets/d9f5c6484ac9db09f265ef3371c149a5fa03643d599ba2ed62b1ec71f5e7bedd.jpg", "assets/fcb38346888664e4f57aee5c2b6473497fa390601e4bf84db157f8e96e0d96b2.jpg", "assets/9d975a4806f9e5ab2faa67b33bc3fced6d065b35fdcb861c2b9165cc1a9f66d3.jpg", "assets/ef4955fd064307ba65788cf8a04d437c84cac8f4c6f2885d43be948615eaa8b5.jpg", "assets/b45b0a3b12d8861a0c4fb90e9ecc139f2b84c16e0fd8b1f373b50ebdb11dcbec.jpg", "assets/b469309c3ab5c9cc15d09658f238e7d431766a7489db48c0811e929ddbe4fae6.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 0, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "翼突基底部", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-95eeb5e1223bd086a1fd0199", "patient_id": "patient-09adf80599b6978210d6c9c8", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/c0bf4d77d1b6610a727f341447d195ce7127ac920c7fa3eea83a22fde3b80049.jpg", "assets/ffd8cfa9d1e3680d6ef8f54e9a9393182caae7a56c0eec72b8243bd8303b6049.jpg", "assets/a08fc8bf479af50a0465d71e58a4e5297d46d173dcd917b9844b43202654a315.jpg", "assets/ede6b0ee92c06c6fb675e4d657761fadebcc17962c2d058a962bd026b338b917.jpg", "assets/395d9fc1e8f4635e0d01c25519d52cf48f809f780af1deb06992cd6582a906a4.jpg", "assets/56f740999b74db1804bb636ed813052d31b9d10488d3b7fd1970224867b1b0d8.jpg", "assets/8d55ac347470218c4e25774a89eafe852be54152fb2a35999bda684585fb1821.jpg", "assets/bf67b41ab75f16b675452852611c02bff4c3bafa7347159b9127d043187d7760.jpg", "assets/d571fd15898e25d45c6c4dc48740b74c8a6cb8f978176df0b568737a362da3fc.jpg", "assets/775d460b6468e632d77da27395486f8e7dae965b676bd5413f0a35452f85ae85.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 1, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 0, "口咽": 1, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "颈动脉鞘", "斜坡", "口咽", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-a4400216bd2efe27e647860f", "patient_id": "patient-11503878835da201ca5804cc", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/e5e0c54481f0dd89a68f535011b138ac3c467521d6c6ae62850824f9a5bc135e.jpg", "assets/f54145ab5d52f21bc1d072b3089c5dd36510a88bfa5bc29ad70a25023c37d63f.jpg", "assets/08b606297e56e3b4bbe66fe3263c6415965016b8a517d3f75bc97030375c41d9.jpg", "assets/0d6f253406a5f0fbcd08c1b68e963470fae119e6e4c1df4c57c888c14aa7d0e1.jpg", "assets/9ab348715bf3000ad1f29e42bf8031a2cb8413c9c90759d26c7c186a972b52a6.jpg", "assets/aea3762de274a74767daf47ad22c3fe86bf874baaf3da705b21aa30ad7ac7245.jpg", "assets/fe97474a556adc542b209cda8cf70a80f13379b8df1c97b8d40ef1f7325668cc.jpg", "assets/00421f6daeddb4fc7350f55664c673aaf87f9efd7311af41d9eba2bccc6b2557.jpg", "assets/0c51131c14f311d8db12090e1f1f1fd31319ddde32f805234aaaf1f4610e0e7d.jpg", "assets/c74959613c48fd191a2dd24d3979df6710982d4ac5fa89d6a2046659ee315936.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 1, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "鼻腔", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-fc337d4b1970e2f158281e11", "patient_id": "patient-fe3907002c96678650d6585c", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/74ce58ad9f644a99e8a12111cad9ec3975a5cc9fbfcdff715312b0cbac61497d.jpg", "assets/90cc2e4cc30b4d0081cdc764e21a4873e87c6ba4772b48db64e8049ef86d7697.jpg", "assets/f6e990b296cf9ab4ad9205fea1d3a220025e8aa27d3de23ba222b08e012d1a15.jpg", "assets/35e1c5c54c5509e025f52bfac444871fb116c9cd6bc650dc356d4447356742be.jpg", "assets/314600116c91d1339479678fe2fe65ce57887159c1e2e2652233958af8107ba1.jpg", "assets/8a49cce3b60e3ec1c06b8694d62becd466d8666f26758bac46b17bb273d430f8.jpg", "assets/d7323c503090d670d50c59fa3a6c2d0bd72bedf1200f700960dfbb3b586b54bc.jpg", "assets/3a053523f2f8ad22cabbcb2a95bb41eb35b704afaeabc355c3a04925615b6d1d.jpg", "assets/358d66c6bc358bd5b45703df8ba2f3d712a91e1dc6b724a74bd74e1962836613.jpg", "assets/916463cd5ff891b62a4b178732f16af1f714a6d4916d30e8bca399311d11f863.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "翼突基底部", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-6ce30c8ff1fa167a057151f1", "patient_id": "patient-14905446c8bcef1504c57491", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/495525ea28294393d1ed55d4cbff2056f7070307ea4e3cabea8b32ad959fd1f7.jpg", "assets/c5f122449e74637bd633a7d5ccb0bd61e45b75e7303f481edc7035ec095d9b17.jpg", "assets/401adec7425c6147d7225dfb4e4c1af61fe21cf2883e058212a3b8113cf57cd5.jpg", "assets/b71f57f9c9850c8fd913f60fe54b05abcee31de08e83b3167d01a49abfffa19f.jpg", "assets/31a64931656d992538b492520ec6b82131f48543f65a76b9d14e0cdc80c86548.jpg", "assets/310ddd70db2232ce662249aadfa12e74ceb1a400422180664997abf3ee21951a.jpg", "assets/9caa913f941daed6863171690001ea69d37985c0f6ebf2fa1c2279ddfe6b4711.jpg", "assets/a9ff8bffbc683d0d71c82ae5902e13d8e3c9003714dfe6291f7238e45f279754.jpg", "assets/732c0499f37f1c88d1954a070a1a15332e747bc7d07bebd6e4a866b32f3c8d88.jpg", "assets/71053c72d991908894b560c0b9b4786b2600fa5feef68f96e3a7b43d2acbdabb.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 0, "蝶窦": 1, "鼻腔": 1, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "蝶窦", "鼻腔", "斜坡", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-bc35f6a40967decc094b6116", "patient_id": "patient-37545afdde23568d4e27a6d4", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/207db438d6cd1f785e68f2c3a58c71a36dd4e459d34aea8ec66589c32d3564c3.jpg", "assets/c0ff5cb52d386bffd6f1ed8a3280f576138e0a999c73d734ab7b13b37981997c.jpg", "assets/57d4fc7e31ad11de7b4c88c1487b50fad2bca977439bb0981aee7bbab1f91e42.jpg", "assets/89f4e438fd56e9d421f0ad5373de40c82bffdecc7feaa7c6817d651918381baf.jpg", "assets/44a6bef155ac69077cea12bd0550823a1753a4786e7dcdfcbd1957e6ce3cedfb.jpg", "assets/e9d330ba6465749f89421d3bdddf4add53e83e6d116e08bd067b0000865a2627.jpg", "assets/3523a197cb55481f0665dcfe28349edc8564b79fe64454619946fd10de68185a.jpg", "assets/511662489c1160679c342c10cfcd33f3f2e1c57e4294cc6022655390e9444793.jpg", "assets/c2465e08137884ae3457b7c9b2e534c3fb18ada244f0560128c7447bdd494700.jpg", "assets/49c4b539e66d3ca14ab11d1f0795ae844201b3e17478b9e50175e917a84cfdb5.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "翼突基底部", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-648573dc187092af06f70a5e", "patient_id": "patient-08132992947b1cf09e7de6ed", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/e7590ba4f01c39f3280bbb8dee86c123cb94e2f02fd92c3e914f4cb80d75efcf.jpg", "assets/05671a44fefd215ec8645b795959c89525b26c86b3018b3c90d8be8cfad8207d.jpg", "assets/0162f3035277a7a174b404bfe3c2225d0da1ea972a4f9cc162a30ef4898da2b8.jpg", "assets/3bb728b380168e3ebc6708321f8a4a9b898e9dc3c276f5786fd0fc894413d645.jpg", "assets/38af55947edd00ef9bafe01a830347c5ac6d17750c67925671db374b55bbbb85.jpg", "assets/b3bfd0097e0179be2cbf9d2ab7d23261b42b3ec9689e16cc6bbb0026430ca510.jpg", "assets/98136cbd61fe37e3dafdde4e5683573ca7e4af0738004cb1f5eef7f4e2523465.jpg", "assets/b63c5a99f3c493f6b9a50b636f48100cf0a7c45802f7cfb80678ecba1cf34dc0.jpg", "assets/799628670344f6589b2c02c7275365c58c13e73ed2a9e5e00e13d828f824c739.jpg", "assets/e240c2ce2d86e639f3dbbce86183dd167f06435508b72e050b1af521cbd58e77.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 1, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 1, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "翼内肌", "颈动脉鞘", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-d0363582f657458f4630f74b", "patient_id": "patient-b574ac1f42cd6a06d5a529d9", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/938b04dc77c936ddf5d3e960dbbbe82d775506ba428485d83fccb21b8d23e65f.jpg", "assets/785914fd7fe3755ffad176e8f797ce7f2f32b3f04fffff136785bf3496405420.jpg", "assets/1e7089dff7256d7ad9fec0b669ca2965860d96505a6432062742eafce85f5d18.jpg", "assets/a4f564e31050a616abcccb71e9c9b51d99cb9c632c335bfa2ee5506c12d192e7.jpg", "assets/bca6cdc895d07bd78fa7e64bef20271135e947d8bf531833f9ffa377422a725d.jpg", "assets/5b877ed39eda175e5bc0b386363138ed40387a49c427dbaacb54046fea19b087.jpg", "assets/0af570e06c4abbbd3b2d831f14eb4756f9ca130b77d2319119ce4e45b2ebd028.jpg", "assets/e04d734a939552fc1fdb14ff86dce0da33bf6f4fe429e68dd1b4d41d2bc720b5.jpg", "assets/335f36eccbf3d4afd99e3926206a81b4082d81d6545b3ddbc6e54cdf2d263406.jpg", "assets/04583b19b18f845868254cf01b9dcf42afeb04929b434c3f3f5c609bed0f33c0.jpg"], "answer": {"T_stage": "T4", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 1, "蝶窦": 0, "鼻腔": 1, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 1, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "翼内肌", "鼻腔", "斜坡", "海绵窦", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-049893635ccfde4dea3770e1", "patient_id": "patient-cdb749e199be2356a7040391", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/f5e0d2e4f043d27657ed1101377ecceb908d4a398a54049f7196a5545a20b0c5.jpg", "assets/516517c4770332e929d627789f72f3c78a4dc4417e435202fb217d95efa39cbd.jpg", "assets/3d0cb4c65383e4faf1159eb94d6a6c32b140ebafe8120ed8fbfc095e46eda2d6.jpg", "assets/8d032680f6af0c0eb2bf17831b7df0e7d62b3eb7de16b572d60202965b6df969.jpg", "assets/11f71fdc9870aa6d1964ec4eeec8896fed226ffe30c0ed258e797438987355fb.jpg", "assets/0f04168cd3290eccd03157dbb9b065ca19e1349139450009268ac76f381c4721.jpg", "assets/e509cec2ae5089f05d352f8c0e3f7e737954a993a152f2f42edd55e2911f287a.jpg", "assets/534a01063e6cb79913c7ff973f74d887f17f5753bdc417c5e5078efaafc5cd07.jpg", "assets/eeb7bc52cb86fb60ceeefcac384e6a1fa468dfc042e3eb828b5a8be4d327557e.jpg", "assets/4d16e7fe2fb69f7d04da58023700582b00368ea0300f1cb06623adca110fb484.jpg"], "answer": {"T_stage": "T4", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 1, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "斜坡", "海绵窦", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-b154372f8a76cfae8c0c3000", "patient_id": "patient-e03e0bb9f04b511dce152fc5", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/f1094929aa66f5bca88d1b26e0fc740fe8edf7a678e531439a0904ee83111025.jpg", "assets/76475c8157e50ce226c9cd7ce5df6d56424fb0cf7fc3883b62c93459d514c34a.jpg", "assets/f028287e40832efdc51e5e2fede9c36e8d48dc8f68ff858d3609d0cf083496ce.jpg", "assets/f0a081fffd73e0a453dad8df04586253305cf69c209678e333970889ef698525.jpg", "assets/4cb0f07b0fe8b732f84fcbcb36f099386d3d52d78dcb3a748b087d2f27d14bde.jpg", "assets/b06e7cc64a9432e4ab9210ddf1a6723000ff04a322b8fc38865e93b1d86b42e5.jpg", "assets/37f37080ab36f8561141e472d729cce2f8b988733c9296002a5061461e4ce108.jpg", "assets/afaf04c3c1370d84966e50a8b9eb7e30075c39f1dc1e96c4875d4d0639f9e30e.jpg", "assets/ab75b1fdc5da285f4ad548e03d4a479adf2b2884cfa321bb99fa695f8ac43093.jpg", "assets/4fe75b6fc435cab3d0cde6159ad0857f3cc09592a4373cd6e50e8e54250775fe.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 0, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 1, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "鼻腔", "翼突基底部", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-bc9dcabd5ab7726fb3c83d63", "patient_id": "patient-5f7d232ab1dbb3e235a22839", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/65d5ec7db2f6aca8b7f614fcdfeb011aa6588b5bbc1e9b4e0c2d227ad151d99f.jpg", "assets/eb76e6f6b535f9263fc086c448bb77a2646b830c92aca7601c971fed334e3afb.jpg", "assets/fc6300c5428373084945adeb1c320648c3ad79ace2f579d91e69dd18eba2eab6.jpg", "assets/fedbd0e7af6854ebfe61fb5b0e00c7a9da40d4622573976c05db104bf691edfc.jpg", "assets/02e7485b9ebefbee9508232af4917310c78218639b32276216d4a6634e302e3e.jpg", "assets/9fe53552e9974631b4719b822df8e79b258fab6a64d91ada04744425feaf5c27.jpg", "assets/c9adb5686b78841a424a3c702883daa3f849836dcc9521d31599afd8fdf6ccd1.jpg", "assets/d27b6e2c3bd1a74d1668c92ead685cd9fcabcfeedf868e816aea7b541c9fc8a6.jpg", "assets/c6e8baad10209e57391ae573414b226cadbbe5871aa73c7a4e1f6c46e033ad6a.jpg", "assets/d9a6ac7fe225b803f339a41ee7f0034ce001a9c9d09796214577d53c7843f9b0.jpg"], "answer": {"T_stage": "T4", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 1, "蝶窦": 0, "鼻腔": 1, "颈动脉鞘": 1, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 1, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 0, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "翼内肌", "鼻腔", "颈动脉鞘", "海绵窦", "翼突基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-610ff0ce550ac525781689c2", "patient_id": "patient-8fc9073eeef1f579602c53c2", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/b28e3cd62ae9c85799144e2c5e475d18b94ee363b7d7b1852009e111a40f77c6.jpg", "assets/3a0676e596c3b0d60e4ef258b9444f05238dbdab1c130334c4ad6df6694b8193.jpg", "assets/0ea5259dbcf0cfe2c1943209184f7bbbe6135127564a053d81522194149435e6.jpg", "assets/1d7f1d4f3bce64c696c02a597c33f662a697222fe6cbb4da70890d6763def709.jpg", "assets/74a85e431550556b869084f63ee6b9d483f61b966ae87471c7173f6dbc6d6446.jpg", "assets/d93f971fd94688ce2feb56c2e3af30fb6d79a0d06b55c513fbbb2b5bf84d9452.jpg", "assets/81f1db501a4d7511c8acaa1d20cac46eed04110f54b1abf47c8f8604bb36d19a.jpg", "assets/1e9c29d75fdd4d1f7f09f46b5b1adbc9383d9d565011f6e1982a71ed3811887e.jpg", "assets/ce4c3c87c17508135bcad350d4837c4ed832992a7eeefb5656822e38c722dd12.jpg", "assets/2addfe5a2dca1e7f17e9c8e995fed82ac0aead0a09c43ae6cb1a9f446e940b25.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 0, "头长肌": 1, "翼内肌": 0, "蝶窦": 1, "鼻腔": 1, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "头长肌", "蝶窦", "鼻腔", "斜坡", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-1c664e71a8219910c8bd81b1", "patient_id": "patient-8711d6dac046e543146e43a2", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/eaad2abaa7576a5aed8a5ff183fdf542b839317ecdcb2bf431aa7fc698669f0f.jpg", "assets/d878cf4174311b337c1bdeec8adb605177806bb581038b3ce9bafd0163b11dea.jpg", "assets/95875d69aa6ce4e45fcdaf9bc01a73dce658b7ab6e88466c5ef0c3fb9e2200ef.jpg", "assets/586644a436088ae9f536b552777088fa69d360243c43fe33ee99927f6267690b.jpg", "assets/627723ba1d930e3249512f64917c8135aad82a10839da94a2166de1dc953349b.jpg", "assets/cd0df9777b511739edbb82de2d1780072f5dc1641c91e88567b5c5280f5e6880.jpg", "assets/3c2618bce6b2c51322d7f4b59e2fff929446ecda89f7acec52015afe5d5336ab.jpg", "assets/97f1706ce5459e53d53cd741d34e006caca355110e95ce1140494d78ce176e81.jpg", "assets/780833a092e5d609627c1325f9b83c241704a42d3581e754eea20029e6262ade.jpg", "assets/aa74c0096e7bd1a1554ae98e4509a2af44cd36306b8e84dd4eae19ddeeb65463.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 0, "口咽": 1, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 1, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "斜坡", "口咽", "翼突基底部", "蝶骨基底部", "岩尖", "寰椎"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-aaf1c899fc2e4e167ca41bfa", "patient_id": "patient-f5101794bd0a287128017a19", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/05e589246b76c61313e1c19e9199735d695fcff6a878149e9ef75367db959c7e.jpg", "assets/3f2896768e3de784acbb849684bf8a48fdc9db731591f4f785ac86f716f655b0.jpg", "assets/f29fbf3ee35b75590c1bea39e6865d29b58aa2a9edea8218cd360e4c1be4c009.jpg", "assets/ca14c69a62f668c1aa03036a50ee358ebe1bbef8f20c982c03a1a962bb0877c7.jpg", "assets/936ad69ba97815edc80faeb0204fcc607f6a65826be8c7c53d3af91284e2320f.jpg", "assets/3439a385c39a28105e9fcada843367cfe9308cdb92d63696061be993d23a07c2.jpg", "assets/97d69561fcf85fe83a7fa41482a81639d6b1a86ae744dcbe2c7a142d6e5af1ea.jpg", "assets/c13d667c931995056158655b31b88d738d8054a264c97368b419870d0b931489.jpg", "assets/557970c05449e98034579da87a452fbd1b05985bb79d96a62f8b3fecbb3df0c6.jpg", "assets/6e4a2ef0cca9bc253d09144c9174e13067c499e42c4d33f8df78fcc8e49698da.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 0, "咽旁间隙": 0, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 1, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "鼻腔", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-d2ce7e932e0f462d098cd5b1", "patient_id": "patient-a8747d2f636013b6aaea5e0e", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/a98fce92ea00018ccb38357cbb128be145857164eed3e1081df905c6711084fb.jpg", "assets/09f13e45a2bcff607747cc68a6d1c763acf57763a88fd4db62ae5b35a09069dc.jpg", "assets/731648be3c0a32f3ff8d77fbc9777aaf74bc61ddb8e1b3b2e146da3cd7a39ae1.jpg", "assets/7dca60fd94b0bf784e0c29aad9e32d819203c3fa128f0f8e475f9fcad811a2f6.jpg", "assets/12b7c8b7755f5c18584a66e67d216e203f71ea848132c5fff29b377bb4d2369f.jpg", "assets/f2512d839cd36eff53034b1a94d690d793e96c9926c0c6c32ff84d254fc8620c.jpg", "assets/463860d01ec86c0ff9ad5c4bed014fc4dfc6fb7d63b131dbcec3bf0c056d493b.jpg", "assets/851ea6cc2d9f17e44b0cc6ed8cf1cadab05a3750e69ef321c13467323a36b9eb.jpg", "assets/998970ac46e705b7d4f9a2bd9664afd5a865f2f016ad9393f555a72c97d7f7ea.jpg", "assets/99b8813faa8bc4700362a7f278efac66242898ab94b4eefcb9ff3db934bb6ca3.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 1, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "翼内肌", "斜坡", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-051805e1ed2dad752bb5f780", "patient_id": "patient-8f9d5f890b71f169b48cfb7a", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/93987cfa291acdd3c9832752693c6839901a3e0d559266e3ea9917ed83869c9d.jpg", "assets/d1f985c3f33cb17e9b82477424c13f417317deb5c1fda343ab8320a1876d6e00.jpg", "assets/52723e10709f4e22d75f7eeca9c32fe6b1750cb80a2511c653b48c999787a127.jpg", "assets/d69f210df0dbf67f4629b035a00ab03f89be6277c5881078d34c19c94bf4c12f.jpg", "assets/6caea1b5e99b09fefde332a93db7ff26d17409190a6005ccbe2feb2f303f56b0.jpg", "assets/be5d7207997508996fd47788143d6860a8c98af5d3e00c2df1391db9192048a2.jpg", "assets/3ff485323114e0a8e00a8e76d4bb8a78cdc816ffd2c8382e8a7c117bb1459eca.jpg", "assets/1f8d2f9e06d04ff6a83a728f4123ff67cdeade7dc951c66cbb2957e8a78138e5.jpg", "assets/0754c7fe829246eaae2fb6ec4c62b4a0fc71b8914ee5bee6bed1232acd442338.jpg", "assets/fc755d2139a001594342313d34cfdc12ab4f9bc0510e05bc442f8d00888f3304.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 0, "蝶窦": 1, "鼻腔": 1, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "蝶窦", "鼻腔", "斜坡", "翼突基底部", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-d5883b4a5d5f7fb1d90b2f1c", "patient_id": "patient-26124904f2562282e2449ddc", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/31b684bd9c31f81b716a4eab95cf160bb6caca8aa6ee2fc2ae8fd378f9edf954.jpg", "assets/54c3ad8d166ada1c7f0ad3a4eae7fd3cb2b6053dbce2b6044e9f18f06661d7d0.jpg", "assets/60176d0fd89a79db75408a733da9d912522b69fcc96b7f530a537b3b68f97555.jpg", "assets/2de43503dfd0a24b7dde21dd9d722c9639188f654e12ee0b3289baab636c528f.jpg", "assets/f2bd174961877c99e8f2882955f3c0062cb7ededde6860761e959267affb06b2.jpg", "assets/671b39848835d16c185662e0c67be6d097d12319980afb9bad18c5be81619dba.jpg", "assets/2c6ff48c6c62e845d02e2b2bf288924a74044324550472215c08e0af83b995c7.jpg", "assets/9f01ecb3b14e992c3a380c7dda7fa693b77f5a55ffce704efd4e336de1f720b9.jpg", "assets/1d5ac166db2e0721349beea48d1db5fc0786a0834ff0af5a6a7730a60a8cd0a6.jpg", "assets/00b4ed935fc32dcd9096ffa209883b1b24b6a3a7af2faf5906b44f58db262796.jpg"], "answer": {"T_stage": "T1", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 0, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 0, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-0a8e5d72381b30faf4203a6b", "patient_id": "patient-45e4c46d921f3565452c0d71", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/e9181b05c0cd2f49ca86012e2403b4c0986ff25516724271c433393f024c718c.jpg", "assets/38daa15d7f62f12b93d5b8194a5f2c24fff367df34af989bf12488da8ed14121.jpg", "assets/68e71cbc83af1f82c5915878eb364e2d55084abadad1d7dcaa0a40fd3ad4e07f.jpg", "assets/6b8d95b93face05f3e8710b092a40fab600340c0875449aeb13d4a9b8fa90b9c.jpg", "assets/c5bf332ca0d95ac8de2b13e940ba4aa34ba0c16bf5c4fd6b9bab292756e60899.jpg", "assets/95cc0c0a749b51892885231274b99fdb98a44737145ed1ce35d6da507a451ddc.jpg", "assets/03eed1e3fe2f081cfcafa18f4da21e59176f925586ff694917f7b8a7ac93045f.jpg", "assets/7783bd12c823da2404da6cda1d56d9d154986cd393066ad00580572653fc9c7a.jpg", "assets/38060cd96b111bc3084268c6df32de957021125a1778b08adb9adb91d97d1329.jpg", "assets/58d2600a0ae961d75e2506f1773efec994051c080450b4c72889c28500499f30.jpg"], "answer": {"T_stage": "T1", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 0, "咽旁间隙": 0, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 0, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-065e53b438bda3cb3c7406cf", "patient_id": "patient-5d0c932da06a8cecf1430be4", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/28d75c39745f840e5e4a95b9572559c811013711ec74e243eac0821ac56457aa.jpg", "assets/bf12c6b5628302271b9f798cd0c56df23b281a1abf452b11b8d2fe2e99531a6e.jpg", "assets/362f511b8d624af73a3fd6cd2f852068db05447c8216f52374aa4b8fc00662ae.jpg", "assets/1384dc6623795f9924b1c7d2aeaeff04d996d3c1d003bc7acf733a5ef5362905.jpg", "assets/80ce96945f3f690d775b5eb98452fafd1183b71e82ae00d8cb1eb32f885327fc.jpg", "assets/9dd33757d50e22a2ff81d0fd7bd8621ff603229d555760874512b67bd29ee73f.jpg", "assets/00dcbbe5aa8f89c9bdfa4891fae76f198eb00ea90b37629569a9daaebe301000.jpg", "assets/a8c7e3d56d4efb012faf02694e54a8b30ddfd82dbecebf1e955cda5a91b897ef.jpg", "assets/7707c2da14b412b5d6b308f9091f52e52327e5ba413a493afafc5532a8cb09c2.jpg", "assets/64b89f7dff3a10c984f8f1fec4ffdaa1dc28ab44c91c9a8d7e2bec88dda895ab.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 0, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 1, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "头长肌", "鼻腔", "翼突基底部", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-c70dc87fb87d24a717adc608", "patient_id": "patient-684941835dbbdf1c83ea8f14", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/70d4256efcf01576c010a81c1463a3fc6886d9cdb8231f39566b2f39fbec3679.jpg", "assets/5cb641d5678e53d509261a6f1df749d48713b586333946f31b3a0bcd62336e8a.jpg", "assets/5f0fe2042358ec1ecc02fd7342a07c8063ad9c722a1e9b280b261fd197e9dc45.jpg", "assets/a1d82801cff8a48e2670a852aae094e817797b04016392e887827ada4ab94bad.jpg", "assets/763d4bd41653fdf8a335d8904a264490388a0e32f67ee8bfd7d331d301cab768.jpg", "assets/1ba2e6a32cccb345f8dc29ae69fcd80627cbc58da6410b1213ccf4a1f3f3b0b3.jpg", "assets/17efd2775bf893f48fb85ed020d2efd0cb3242992d436052d55005fee3e797b3.jpg", "assets/df2d529007153d7ac8b5d041f801ae98e50413f87e1fe8b787c6b1f124f372ba.jpg", "assets/c11d9091e9a3135c87571aa7958e8201dbb08f817ed1e161de4a393b90293b34.jpg", "assets/17328a2fc93bc5065e5b1f299ec5ec57a8c504f87693779a45d7367b533a2a3e.jpg"], "answer": {"T_stage": "T2", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 1, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 0, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "鼻腔"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-a3480884898de1dc46893ae2", "patient_id": "patient-cd8d5017ed5c739576ddc3c8", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/1398c277867afdce82bc4e4bed8c70b3c1b34ad512cb94ae33c8a7ae49c9f60d.jpg", "assets/9137417b104359440470a06c9e90cb12be56677f8ba6c7c92bd74d63420e9bca.jpg", "assets/77fc80ff36d9f97bb14a559cb7498350d9455bac30018403c5c51cb921b367b0.jpg", "assets/ec173dad43b20e24d9b1b4fbbd4cfc25f95f655cba2b929cc04492e741d0941d.jpg", "assets/933f1a91e797e2ee90fd165c77e9256196c75c60462a8a0410dc48111392b94f.jpg", "assets/3211ad7c8ed9077667fc8d66a780ac71bc0694294d6198411b4f0c8c2a2c8b7f.jpg", "assets/e073e07263ac4fc70b2210d5ca433b5f3984c4ba187abaaa2aa5d4511bf5c199.jpg", "assets/87eff71f11373f0c4df04a53c8179a6bdf535778f7949a6821c1a275b5b3abcd.jpg", "assets/b1def53179990adf636cf4c8e7a91b2725144919301d25865d0f145b97667a63.jpg", "assets/d1a23cbdce0f753409d04a970dd5a6eebc29038b43bbdb391b32cfcd3522e123.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "翼突基底部", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-8726f9123d46d7dcce0a997e", "patient_id": "patient-a6aa1737ddf626a453650fc7", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/332bcd74dcf0adc2061ae90bcf702d50cf503e9f4669cbf14560d82191a9cebf.jpg", "assets/2b018c7deb7ed73941c4189db6f4cc04382425c2b2dd1e8226e6f61157608a39.jpg", "assets/a02236c533fc79f0a38677dc361cf7b78a0c5b60baf0f387d1fc8698aed795c1.jpg", "assets/f825683e859810603da81206eba71345eb5d4c1d58851c30a447b560c5933f8e.jpg", "assets/1c324628505adaa9706e37860f523a1e163b426a0f53ef7f70d0b14620789263.jpg", "assets/e40c2ea3817594260ec5fda3c98f6803d925a3ec24f024bfc42fd375c1b946ba.jpg", "assets/3421b8657aa73086e8f4c91a0b2a6668feb2d3471770664b0e1305151f2384ad.jpg", "assets/b51ce70d06729fbc7c757724f1299e3fc70d5d75df4356e55b0897d3b1827ca7.jpg", "assets/b177dc0dc8a3f9fcbe7b76b2b1c3bdb9e31cdf30ad1c0c5b6bd824ed6fd82df7.jpg", "assets/67daf76d2f7caa28f3a869ff9c46123d93651ffb66840ea91177b88ecd235183.jpg"], "answer": {"T_stage": "T4", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 1, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 1, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "翼内肌", "斜坡", "海绵窦", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-d9da0492d89e27ad54874707", "patient_id": "patient-e84ab9973716353b1e20d968", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/b185b0f60c592d0578ae5d8d16c46a1c0a0d525494cb0f086da7602289a9f99a.jpg", "assets/db1d6e22a3348f073945acf4e01e44212d61dcac2ef3101c9f3966967b9f803c.jpg", "assets/9d0c7c27e60392004d53991f0ac206bfa28ca9924ad6f777d1a329e2e2341269.jpg", "assets/258f8488e4373f50854f79e08e744b69e564e7ef7bed450223c3e6bff9bc949a.jpg", "assets/5964ddded220062f02c284ab6d1f34e79dc50590dfd500d3d484915855c1b9fb.jpg", "assets/b648c676f00337ca61acee4aa1444d2ab34d6cc5e47c96d2b30de23e0c434c05.jpg", "assets/f49dc5ac5b1f33064fe205650f02ca3c4812b2a1f3ed6305a2f52e885a13cd3b.jpg", "assets/ac349eea30cecb8acec919169a943df2d3c7c06abbf8e9e352bcc017031f4c5e.jpg", "assets/57c6ba8cfd32250c8960347b4445015966cf85d821c4f60f303971277b7413f1.jpg", "assets/04284297233e4e89d7206b004250a65973ac5942b427846bd1dc299d3ece621d.jpg"], "answer": {"T_stage": "T4", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 1, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 1, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "颈动脉鞘", "斜坡", "海绵窦", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-0d5abcc135f03b66de811bc1", "patient_id": "patient-ea6494e889c7facfd6a5b961", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/f7b2ecd6d9c1d82fca13c099ae7122417c93f4813ae870af22b8f91d9fc35b2d.jpg", "assets/8accf751f7ed981a4225c01fe9a8e7bef517874718b8137f4e1cb290d6939d82.jpg", "assets/50f14adf1198d222bff329084f662d2ddbe7562e6573bff689c040f76f500853.jpg", "assets/730c653c469de722355555c8d773cc166719890bf20a22a092ee619b3eb980d0.jpg", "assets/9a866af7c62d77719443ed72f1e28722b2866fcbcac97365e63595b54176e0c2.jpg", "assets/d64784d906da55d4645fb965c8ac5b2a93e016b3ad86540a2ca0ce67634f2314.jpg", "assets/c85ed5f21d7c7031282b83a675b3c54a30629437fa280431cbfc4949742aaff5.jpg", "assets/27b7f556893d5f2ccc8a0b866b2ca074f949673eba7164767924f6fd78aa73e8.jpg", "assets/44b90541ec094d613ffadfc05fbde4b60e5f60daf051c3819558b763e9433739.jpg", "assets/8063536a4ebea7030a8cd4e004533bc8075122a56aa3cafc634abbba4259ee3f.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 0, "翼内肌": 1, "蝶窦": 0, "鼻腔": 1, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "翼内肌", "鼻腔", "斜坡", "翼突基底部", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-d789c317af83e47be88922e4", "patient_id": "patient-393a69d1a905e05600212d51", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/881624b13def3bc2fd4d22f186caf15c7a3f0e93f939eb7ae0b029743954ba03.jpg", "assets/5305c3b4a50966d9e2355e95a96a9f76bb8d513aa0295ebe2b44a81022bd8bf9.jpg", "assets/739247e7c38747d2c45978aa07021d05bd4febd42445cd02109a01a7fdd644ad.jpg", "assets/7ba994848caeaec105359c4196ec2b66950f05fc7aa6c9929ad1c760bd6f91e1.jpg", "assets/43313578c68615db9d8e0f8f89923066cc2427346857dcc2c63fab2d2c9ecaba.jpg", "assets/b5458390c53300e8a85f24ec2db98e5051f2f1f3f1be42bc3778a8027d916899.jpg", "assets/e9e6aaefd5cbb5b827a20cb6b9a4343861e2ed44d6c8db821f276968d867084a.jpg", "assets/858e5ecfd0f30d7d3293a5906ef3b2bc67feb1ad000d7f668f932c2385f67b0d.jpg", "assets/7d76932bdec7b15820fe4a9e5a194aac7ff2ea2ffedbddef607b8dc5da7fd957.jpg", "assets/3d74f2b21912b19f13e780fe70b297c375bddc1677078cb3dd0c136abae5cbfd.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 1, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "翼内肌", "斜坡", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-1f5909676fa1955e44933180", "patient_id": "patient-b65cb84467c638c61d55d3fd", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/124634c80c04e32301b3860cab85ba9b4348b827bc18388b83af1577641dd886.jpg", "assets/820c3162a8a286a593ab232b23b8f446dcbbc8d8549f8b85f999ae366a79db43.jpg", "assets/bae6189cb104140afe840897bcccf1382531b684137458cdd7dc68f84409970b.jpg", "assets/9be2fbdef733651002e479525a60759d71afd553dbdf263cda42d655a94d983a.jpg", "assets/83ba2a0fbce058e49176b5a781211b3f940aa6cfcc5820d2168b1d7e483ce656.jpg", "assets/690fbf1ad1ac10deb68c61d4dfe70c0cb4f615651b84f5b5ea5b16fc5ae43bb4.jpg", "assets/9c3cac71b671df354957612906923017fa1fe4b4d17e67526caca99ee67037ef.jpg", "assets/fe9b9e57e7429c6139ce81e98ab95c848dd2d29b4c2e192680d5556a5ffa722e.jpg", "assets/3eb17c08f92d92ab9125d17ff3068f85b663db76ea3579bd889e0fc99a6ad5ba.jpg", "assets/5d1aace9fb389a2fbbaf8e6e58ce57d6f5f103b1d2b4badb10bc0c0f016f4fa4.jpg"], "answer": {"T_stage": "T2", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 0, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-8aa660dc04d081deb2f963e3", "patient_id": "patient-2cf7bbf9c878504492560fe8", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/e524c22851d71425ecfe2fc6cf89eb4e643abd29fc50c78c85dd132e7cd4d73a.jpg", "assets/47fa8c6f6b5c8b8e766bbde665b62be0fa6e58ba4697ccc395137527826d9d6e.jpg", "assets/7a7b35118b1fde431f0b7eff887827f52ee7dd04d86120a901fb2924bcad07de.jpg", "assets/7355afa29ea6dd5ac265fab376b74c1ee16e1dfe8050d7d03e4b366e6a30fc98.jpg", "assets/b6580b15dbd841094119a21ea618b9989ea8799b85071c2a385c750b22e93032.jpg", "assets/a7e96924a09c0b47c9c79569ba6bb2bf67b9ea6c84940296a8ec566de6cb82eb.jpg", "assets/52e722748940ec2863d54ea8e367b7db4ea5ecf7d47168ade595491e4895c300.jpg", "assets/328c0943f12855bfe4993d0220bf48b6bff3eadc922b906f61b82854da503b9f.jpg", "assets/70c1ddbbc5d03624945729ca9e96380d0230f9287a67720f9a517aa91148fd8a.jpg", "assets/108628e146d0c00859c257dde44b751364616f5fc1cef3524f9ca448cae5530c.jpg"], "answer": {"T_stage": "T2", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 0, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 0, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-95449aad7df78e1b50df2585", "patient_id": "patient-960f6ab1e16dbdd23090f492", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/fe3581d077a8a466dff736da957194c8a095e4eb02a8b46aec0e54650b96a2e2.jpg", "assets/fef661669464824f5ba5f6e890ab301fdd43c1e12f572f2f6d68cf304de44a6f.jpg", "assets/72d2467c2b4bc6642da6b9dd67aaab53e70a3daef4932d9a6b5e6f9cb7a64586.jpg", "assets/ce10838ac3e63d696bf654551ce11265bb8ae7e1c3342edaa023867c44c42a32.jpg", "assets/f91e3aa5932e288f97b78507e7c2a42b64658bda461b454b5a0285a72f633e74.jpg", "assets/bf13a008ad62cf7d74814659034b099124add93406f5e2d6c6b075aea1f3f3fa.jpg", "assets/08e45c5ac824049917189c3e9440200be85ce0799c632033aac67a03cfcab18b.jpg", "assets/4141d61828f38997aaa4bc03e633ac2dd1b87e0a6717a3c3e9f98c32fe4645e8.jpg", "assets/1315a0b9e9befc8d09559ade715f69da62e42c69278ec5a1e8c2e0420b3c7db9.jpg", "assets/1b3eed208ad967e0dd4c55701a4d45026b59eebb7f20d2ba83f845fc0db2e348.jpg"], "answer": {"T_stage": "T4", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 1, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 1, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "颈动脉鞘", "斜坡", "海绵窦", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-1c27ad47144e22f4bd4e8c51", "patient_id": "patient-f509f093a998dace3479c00a", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/a5e7969751d253062f5590c32d11f7f89de8d81481475b9502bf6d8697e00c4a.jpg", "assets/e91cadb77c210dc9eb61e038ef682f3e5ba016e0427838667b2cfe50561edfdd.jpg", "assets/251163e89f8cc93ff8a0137123710ddf1a379ac99ed90d780b5e397085ff8550.jpg", "assets/d26251226136da0c0fcb6d6c713c9d685143f3faa425d7876997c4dcf54d0f33.jpg", "assets/5abefb19851bdd501c8bf67d8e7eab5ef2baef84276cf534126b641b47a94e04.jpg", "assets/3dca21a64eef49730fb3947bd6998f74a66118f0575c684439360d3df1d2e1a0.jpg", "assets/74b760903e72d2842c3c245e5175e7f8bd4e9d114678918c06b9bc94c709fe32.jpg", "assets/e0ca9b39d793eaed34c7435c57a67c866f245ca77ed88813263d21b13d4d9ce6.jpg", "assets/fa7f66e990537c23c1f68f2908d0d41e7b87a58858883187eb2a38e16fabee14.jpg", "assets/0dc6a1af2402f01204056b232fc6486b2d1491c46a796d245eddc376913513ed.jpg"], "answer": {"T_stage": "T4", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 1, "蝶窦": 0, "鼻腔": 1, "颈动脉鞘": 1, "翼外肌": 1, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 1, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "翼内肌", "鼻腔", "颈动脉鞘", "翼外肌", "斜坡", "海绵窦", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-54df38ad62851e78b1834559", "patient_id": "patient-16c0f88f348c8b36a4e0ba3d", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/bd1f2a64a1482de4b5cd0d7119223f609ff3b6073e01086bc1dd13cc7196eb91.jpg", "assets/150faa2f828bcb42a888c024097f8e9898ce7bf7d8b257181f0959f751220e01.jpg", "assets/efb0b3663f3b82b042eb9e5725f40597ad1deb2091e5eb9947e24539fe60dbf6.jpg", "assets/8cc8858e2df7950ecbde8df5dfb298c6398528a7acdd1dd955a50bb33212827b.jpg", "assets/0aeea4bebc6a11323d423d2bebaff3e3865ba6fb1549596f73f136d69e0f030e.jpg", "assets/adf9fb344dbf9dc9fb3c6db14c3b777085b8cb21949609e673b4d878cd0745ed.jpg", "assets/8a610d988c932910f525639becc1adfa189987c0cb5a67f57ac856dfa8b11d76.jpg", "assets/494b239829c0e5b1db92d17a1744b3b75977c4b0425bfd744c454f83479aa4b3.jpg", "assets/a97d81391a88d2b8d4548a2ce019f72aced983a80aac441d7f4b4c9987ea9f99.jpg", "assets/03198d827dbd9ba70ade26991d6498a70503af3ab66ff6b513fc11998d24cd7c.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 1, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 0, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "鼻腔", "翼突基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-3af98f4c6c1957eee2f4e977", "patient_id": "patient-48b354132fb0421b229210e0", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/96788bb10d181a7a071d432e23c5b65ed4404c81be8462a8b2fe9db24c8f9351.jpg", "assets/ea01bf32a9afba59b47866d9b99c72b69da7d957861f0d983d7b74a0de7ffb00.jpg", "assets/447432a13fb9d257cd19f592a648b35bf961107c4636a82a05af3a17bd5400a9.jpg", "assets/46abf3adc0af64b0c22c3fa56b35e4c519f656a69bce2a9a68ec756197f24ffa.jpg", "assets/c3e7dfd5b9b314359afc336f9b086c21bb202b5befdc8580720cc16659925707.jpg", "assets/05943eacc6e3f46ab6a3991a4d043c5ac4646e19af125abcf9f794ae3d2571c0.jpg", "assets/6a41b57386c2cb35c868b6fe94b7f330031bcfdaab197327058c26ec8a01b146.jpg", "assets/29d216d65df2011cd96a496d8aeae3d0e4bace98efd4756c812c56e7c83f9eab.jpg", "assets/4f9fdf916be867747149b6b132aceab76feec7e1bc2018a73d173abec025da1c.jpg", "assets/c14d49e85b2b46bfc1af2210e283ce28587b7536d3164906c307012248a60cfe.jpg"], "answer": {"T_stage": "T4", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 1, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 1, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "翼内肌", "斜坡", "海绵窦", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-a837b0a76ac7658c3922164d", "patient_id": "patient-641b087096be76a631a78061", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/e079e18314844f7a848c43246c4fea003be58f290942d307eeacff89afa090c8.jpg", "assets/ac46054f2c95ee6daddcd386b575e98a472bb5ca917a6701f7021744cb7670d0.jpg", "assets/19288f5db6bafa5a46badae2c202d542825eba398703481f2f73ad9d38962084.jpg", "assets/392f0f0d98e64668b6d0e6dc9ff01391b98b09f97f9c04b49cebacf3561c3b4a.jpg", "assets/55aa0733fed415bb57dfe92e76079014fd657590a52fc4dce61c55afa9e9fdb6.jpg", "assets/e54fefd0e28590ed4d6a33ce831520b52a8720afca8907dce2f336ee56874cd2.jpg", "assets/8eb579ac05fd9f7c38531db0c2d9ea5af6a92ddef08dcbb04fbd159c3578ef2d.jpg", "assets/f387c47125614bc64cc810a09111ade1ca4d66930fb705cc11854fe8fe02d2f3.jpg", "assets/4628100b8daae28893e3f03cd52122fb15307a475f2b5099a1bed440ca80c2e0.jpg", "assets/3779656b84594d02ca13bbc03f7ebafdb3230266b1b06c1781bebaf08a670496.jpg"], "answer": {"T_stage": "T1", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 0, "咽旁间隙": 0, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 0, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-8e93d0e278cd4e21cca56728", "patient_id": "patient-30c44ba207e66a3175f648ed", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/766621a97be76942fb546d18554031a96f08fa32d0d975219683e452eebdb505.jpg", "assets/1f957f4bd507c226506770594f962ea619c84d3531e0fd569033fec04b9113ce.jpg", "assets/9e725ad3b311c341cc652a8fe11203de8b7b987e448e5c440f54371e2d311d2f.jpg", "assets/7184bbd42f963d8426ce4c4e37556bd1f28766c5302681263800cfb64e412073.jpg", "assets/c8a61988edfdc592c351a6f6be807ef32b58b7273a253116e79fa18b25fb4b4f.jpg", "assets/dbae873c4afb76851c3a8f8a45942dca701eb7a629791818056b0c5db7cb61c0.jpg", "assets/4aaa21b077b37de77797a100b35fe22db3d048b43f8c8248284d0a98dc27ae37.jpg", "assets/f6006f2951e26088d5813e9c3b9d58cd92956a20b45139a3e671705ba2468c2d.jpg", "assets/b8143875ee9d903573498ce932ccd1f0badc4c289532ce11524e9aa0749a6e9f.jpg", "assets/203b04c3b76ce114de6b82daee3b6b9f03f3ef1469f5cf8aa8dcf5eea15ebe43.jpg"], "answer": {"T_stage": "T2", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 0, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-e2b177ab139df3cd74d86247", "patient_id": "patient-23d7450690ac27c41cf2d08a", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/ea50a00d9dab8724e8b437981f197927aa4a4767491e88619cf8c66c4a263a0c.jpg", "assets/55945a905e620e5b831d1364a2843cb47e27de266a378d0ea778059e61628b7d.jpg", "assets/c8ed0fd0a67417d74a95486142bf8db967b95094ceb6a10f6c5dd08852f900eb.jpg", "assets/634f1371a364e9cbf65b3b13dbbc33df7d32279b6e690d2ee835ef3496dd3625.jpg", "assets/7459a4fd9378aea8c366dd5fa264b21e9d5d9d797b5bb55fb2adc62f96d30188.jpg", "assets/6c71a6db3d6962ce59f8fbbf4b70e967db7ae16cb8e311f2df537800b030e019.jpg", "assets/41e3c631dad5341a71811e6490ca8358130d707678c826ecd182d5062d3cb237.jpg", "assets/d1a582a6d147a483f73805689ce12ec60a83ab50cf0881e22e563394a465d5b8.jpg", "assets/e3bf5169c93879e243c0d88281e007bd9b81153fae676da06ca49c900eae0a5b.jpg", "assets/c0f3631734c9dcc9fe4ffa0b74be0663476e1a47de842d5ef78c65a9dfeaf4b8.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "翼突基底部", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-41c691d472544b2e773d4be9", "patient_id": "patient-d35b8662b9cf177265f9f63d", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/abc8fc729f0620a96d6efee1a0d6df345fda2de5930ffe346560c3f8d5b3a52e.jpg", "assets/8637dc1e6bbd61d8c0deeb95f7b2d85996b7798e76632b609cf95fc6a72e6caf.jpg", "assets/70a088e71d77ce93b80cec7b5c4511729134cd9da149103d855d8bac0c6276f6.jpg", "assets/82a90fd339de1413f52b67071055b810db340f3fa3c06e9ffa3e94759678d603.jpg", "assets/ae157c7347a48abef44b57cef617e275645fcf29c78f7d003cb9e05aa52b6991.jpg", "assets/1dfa15fa0eaee5069a315a7beeb6a58e955b27df4b60b27b3094c4abd7daf091.jpg", "assets/1906c6b19b47fbff17b50b82f87add79f1d540fa8b1635a445116c151ded8266.jpg", "assets/c1d297d5858cec142ee55aaa2441902b15f7998c1644fa9e9b5af7842db0f7e0.jpg", "assets/b394d6f8a881678e31d346e7b40aab7a460d7af567bcedfa54367775125897c8.jpg", "assets/5b0415d4854975ca918073636511031bfc05fc3df3c4d30375686de24a7dd97e.jpg"], "answer": {"T_stage": "T4", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 0, "翼内肌": 1, "蝶窦": 1, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 1, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 1, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "翼内肌", "蝶窦", "翼外肌", "斜坡", "海绵窦", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-507325988f182761f38e73c5", "patient_id": "patient-8b32cb25120a42a552884380", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/6db3fe7c907d80dbe7720ecbcf7f80e28f45afaf3482d8e92884fae975d80df9.jpg", "assets/4c3036201332d0371895a96bfb1ebb4b219404d33897b588c318fa0841f84077.jpg", "assets/c186518fb57e362a9b89ebb20bbf67900b4cb368691e6aa6141554cb5f4052ae.jpg", "assets/d0f3f3256b29552c3cd2f6a2537e22b7b47e3c5f2a81c9435aa519215c74bceb.jpg", "assets/8e06885a7188ffe9daf51ed2002f7fcc3907dcf17c05b03543da31925e63d731.jpg", "assets/f06b645ea509420e36365921548d27480ff76d5223620f2907e3225e53777981.jpg", "assets/c33646758dd0adb67fb5829de45f22c3d5974f7b54a3ded83632b3333c9e1918.jpg", "assets/fc6ba5ed7e6b655a87d73633bd911acf1236d10a530ca3e6672c8cb49714f26d.jpg", "assets/ee73af99e8e6d76371fd5017caca3a4fe9d6c988ce8ce26768f4cd72346300de.jpg", "assets/1ce9e8a95a8a5270ed942ae3bc1f5638d4899191f9c0a63249119e0181692c91.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 1, "颈动脉鞘": 1, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "鼻腔", "颈动脉鞘", "斜坡", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-d45a38b94d9bec9b6901506b", "patient_id": "patient-5990e6fe34e7e300b080c17a", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/f2dfaa6eefd6a9ceda7d2f247ac1535d5370fc1edd70b9a7f055602f7a0fbb69.jpg", "assets/302698229311fa128527555244dd9c556ac7d92e4c8c949c71049e76a1aaab30.jpg", "assets/2e892631ea4f29280b7013bd5fa8a4687de905f7326ae571a38159b5b5146c04.jpg", "assets/8fd937899a031743f3cfa3f8a281a9ed3d9747b0fb80416dd932fd8811b37120.jpg", "assets/e6009487615d06de1352a4b34dfe48c505ffcecf923023919f9c8a4ed85d9d57.jpg", "assets/a12d3ed30f072d82432a9eb9fcd65a874aef9fde01da5afbde8203c303b27b18.jpg", "assets/c1b560daafb5f8c8aea691db6317e569e982aa421e3382b2a0444a63489da414.jpg", "assets/6a79a1c055e2847f25943ad1526dc304530b6949a3c72bb1b159ee24c2249d23.jpg", "assets/c85ad72b75a72071ad59b5d837a896847caba350e0e97e00e61c1a6dc82b20b3.jpg", "assets/38ecf349881f2366bc17c89a1cdb0767a0ba70f6fc0cb444d19eb1fbc9b75972.jpg"], "answer": {"T_stage": "T2", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 0, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-67d4cc1852435095d3eadd06", "patient_id": "patient-d0d7ee4ee410114ceb96522e", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/687e2dc87957d41d1c096b2819fa49dfdd02665ead4353ab766ba7721c2ee9dd.jpg", "assets/f0584a98e1b3c837c30f493287577ac34612bab644e43e43b1bef0653127d683.jpg", "assets/064e4b5b9f80028cd5979f526471ce19361f2c711b96fb456fa31da93a845ef0.jpg", "assets/7f0466cbaad56cf4c4cabac3651bff34d6f924de3a6f19e885bb381792efb922.jpg", "assets/179c3d5a87231dac82bfd344ccb95dbdf75dfdcad41dd049b0c0018f88e30352.jpg", "assets/14775990f205b7f8922080caeb7fb102c3235f760fa4806d6126b31d180156f1.jpg", "assets/41abd63dbaa530ff5508ebeec91f69ec5f17a35d85c53b4ff1ccb68327f9eda7.jpg", "assets/4cb2c5826921875d35f84de2d6fff2c3ee6b92783163d6bee236cab503bf8315.jpg", "assets/e42c97271ef9a2050fbd5a7918c25de9b5d69d1c10aa1c325da6806c45972839.jpg", "assets/eeb2f9bc57cbc021b93271fe826db54e23cf96e3e6cb72adefbb833425d81488.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 1, "蝶窦": 1, "鼻腔": 1, "颈动脉鞘": 1, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 1, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "翼内肌", "蝶窦", "鼻腔", "颈动脉鞘", "口咽", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-fa3fd1418d9dd5360b918557", "patient_id": "patient-1f701280917a20dc32022e52", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/9e557d210e51c95d2fefd8e5ac0af43bd6469b8e07be7a250885b08b0b0c11fe.jpg", "assets/e4de7bd8247aa5a3e5dd79cb043bb55bfab3224200ed170390bf29905c4cc64c.jpg", "assets/1bf8b5e11f09afa0b0d1c818966c94ca24d5a93ada46948d4cf90e8fca17db40.jpg", "assets/0dd665901aa7f9232818cb1b6d5e7cbaf6e1bb0e853a2672b3a3a1d5bf7cf2e6.jpg", "assets/da0d5666d5b637d1e84fe0e18d9dc06f19704d0512e7c3f68d3707830665ce32.jpg", "assets/5ed8bc7513dc607d53ad979c1d0ddec2c01c5d7caae03e6d6c0f70a98ca5a56b.jpg", "assets/ef7e3c85b2de5443742aa7aa17fb87df5bb61bf03ff094ac50d40e84bd6d51cd.jpg", "assets/4f4e8064af04942f49d6ef3c732bae31e38e5dd5d9fd7d51c41a54f60b7bc0c5.jpg", "assets/d1e3015aa5b9357a70a40c900e15357ebbaf19682f7a539eb01538ee1beaeed1.jpg", "assets/0b86cf644e5763a530515e39ab15a295eab346a8e9355fd7e9a6d4576381dfcb.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-45b839d74e5b4504ce2d2598", "patient_id": "patient-49de37b11211aa728bd7cf39", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/8ad4a097aae1f19297798f97b72d5b952d2df5c0fde70e9fd25ccfa7b9a038b4.jpg", "assets/9b2766b55a7cc7bad8de27844508bb3435b02189dddedd72966c5b7cd72ea6e8.jpg", "assets/cfe4c3dbcba2f8ba5d809d8d115789fd5222423d3d901cab30f3ada56f693d7a.jpg", "assets/e21f70c789fb7c3daa09cb862fac1ff7bef2e3158a235d47bef20e7fa0082e54.jpg", "assets/adcfd5b440f250b80d73b6cd33fd905542a1f651e5ea702bf099937c6c586e55.jpg", "assets/7d57919f989ce111b677208516c1471e5274c00ef16ac712bfa44660f8081899.jpg", "assets/a7f4ccf23b3f5109f8d338485e73643e90b6cbeaf1e0bce03b75ea3dc5338173.jpg", "assets/9b95b980ce75aaa4415448e00ee6c60337a71dfa730b84bab1bfd7d01f0010cb.jpg", "assets/a9275621de3fb0b7f3eb0dfbeac85b6f1dc8af71713fa8c9c24267c18c1f9326.jpg", "assets/1780f34ffe7c08356c23908800b2a88f8bf074f5b5bf6f8834bcd2264b608aa2.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 1, "蝶窦": 1, "鼻腔": 1, "颈动脉鞘": 1, "翼外肌": 1, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "翼内肌", "蝶窦", "鼻腔", "颈动脉鞘", "翼外肌", "斜坡", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-9b283d58da6f08039e89e0e9", "patient_id": "patient-aa7bbd78f73aee5acf2a27c4", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/c2062c84e787a9ecc96f09f873738b91ba7104c74773e4456a859d656cc45370.jpg", "assets/9f4c3377f1795fc7f9bd4b6c018329fe239de2c7947a3e901b5f0d8654e9d4ec.jpg", "assets/dae4f4e79bda70e14e9da91db720b9a2e132b2b4085e1c60ae5d710d298d074f.jpg", "assets/2215cdfbc0931f82d4e1a90cb18225cf939d7e74711a53492be501cc1bdfc3ff.jpg", "assets/3b074144bb7c05087aeca14fedabc39def024de02a3c5a61325402db0f5db60f.jpg", "assets/30babe2bd7277823199759ed938c0c0767546e7e63c3348b52a575c7e829c4ca.jpg", "assets/a3cfe3e145075b7bda73a7d1def0caaf104cf44b8d1267ccb1cbe0bbedd68998.jpg", "assets/8660fe79083a2fda3fb212222a2c67dd31bdbe9bf4028753f384dfa1ea1d22cf.jpg", "assets/a486e7fab99bd338e8a267f83b15146ef641aa588721857267f5cc26aa645530.jpg", "assets/6f02f498466ebc8cde56d427af51ba7546afcff35643166b4d67310c27502355.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 0, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "斜坡", "翼突基底部", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-8159e1790fb1d175debe12c5", "patient_id": "patient-9aa3715525d6a6720ad66982", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/ad5665a714341ece513b4b960135819ae69cdeaf911a2c3f36f16da345c2e0c7.jpg", "assets/35bcba87e1086706da384452e2cb458e6de252c2d8859aab189674111aa0860c.jpg", "assets/54d4f3854bd161b51450cd918bf3f894a8e12dd7064720c7313a5e3a17986890.jpg", "assets/f068c0a1e071ea994744f559106601a04577222cbfe690a244b8f75b61e148ff.jpg", "assets/4d12dc6295ee59e9b79afd778fa7cc43867b59742cdbddb975a3c9f69e7de433.jpg", "assets/9deece9306d8fb1b4e13c43467a1bae4febe3f737d8940a542887645e50a7ad9.jpg", "assets/79d36890a3fe770c0948824125a1475fdd8ba5bfcdd7fb6be95b3e461ba6ff02.jpg", "assets/595ced86793752e368099aef036aa2d1b442a8fc53adde7eab5f09dc19aed369.jpg", "assets/7ef5562cc746c8c39b4ed1ab32b9eb16babef21b8b121516eaa5fcddad85810f.jpg", "assets/0c08b25aa8f7e308062097eb4adc70bcc73c7f012c0a4ecad6de1cb400bc47e9.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "斜坡", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-23debcf6d1f4006c0b1d7976", "patient_id": "patient-5c77cf118819bdf31fcf8f42", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/c4528376e08511970742b73ba79c3c23cf2099975796367d4c6c02fa3c2f46eb.jpg", "assets/ce2fcd5ed26122f615f07603138f05e3259a1500d018366b9a0de3cdbdeff40d.jpg", "assets/8bcef54d3dec6eaadf3a1ea5508e3b8232dee8833971ae292a79077b2eec948a.jpg", "assets/8a9c7961992a9667868d5575213959d89756e928288d3119eb97e17f9a8c42ba.jpg", "assets/72895ac86c181e1c8843e4fa67937b4aa54cfeaef158bab30bc1ee04377e7a89.jpg", "assets/70f446eaada735e363dd266a2fedd259fff600e58addab9196be6bc045f992bb.jpg", "assets/57f82f6e38d22f59112140030541641ee13153f1a8811c54635203725e290fd9.jpg", "assets/d5998196886502b25b913828578d83b6b863bab3ef846d94c7062a1d682f9982.jpg", "assets/dcfd9589f14659c58d38fd62b7e9b8cf4d09f1dc823da92e09923f656c9b0d26.jpg", "assets/5076ce5ea6cb74f762793707ac0ed3a478cdd20ebfee3e8f0d29a7a6596f8354.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 1, "蝶窦": 0, "鼻腔": 1, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "翼内肌", "鼻腔", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-2adea75e88323de160c23708", "patient_id": "patient-91e3c16145c17bad01196479", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/a77e1feb1c130e60d2f473d4bdfe1fbf0ffd432d2df309024fd5606105a0538c.jpg", "assets/ed7e91b8b0745f8fbfe84dc1194b9a7ce535db346283198794022494a05830e3.jpg", "assets/ce5880626d2811f58e8455061832e88b877e1a655b74a713ec6d21892282142b.jpg", "assets/131cd8e3b20cd1501eec992a56959e6280ebdd52495c0cbb9222a5103b66bdbb.jpg", "assets/b1e6c377fa441b75afe68f7f6706833d4a3522ca25efa09ccb2ed76a25889ea9.jpg", "assets/43076114ee25be760f0502be7d582e13b22f732c53e0c2a3fc8a6a93937c1632.jpg", "assets/49af777fbbd71d589a3b492e6d365e8c043bff06c3bff5d43d72f73877aba853.jpg", "assets/f8f0748d70b109314e6b0b8ddebe0de18d1af9bd505f1ba591d0a7af02bdafac.jpg", "assets/e82ea724939b70a65d6e110717c3bc2f3c4e73f5361061961af61e6154a9d82d.jpg", "assets/f5aa0fa8a657335afad20a0bb46fc4a9d8621aed27206e6f5b2f7aec21497a27.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 0, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "斜坡", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-5edca731b395888f1c974eba", "patient_id": "patient-412a1cb9536aabf4688e2144", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/843abaf9d3e4871c36c489a3ad0d91ca4dc60fb869dea27d86460322f49d7f0a.jpg", "assets/17f2d977d32592e0dcc21a30d2afe0e98f59c3ab1215ba9e4d282641ab0ddb1d.jpg", "assets/2e20643f5209bce3ef331c4562ef9bead3796f5148b624900a803803c178ff2d.jpg", "assets/37fd6df3096419abade00f3e5e5fcc1a7b986a959aa5af566febe6c9492a75fa.jpg", "assets/941b5bf15e171162814b441ec30c44d04963c695356b4d56b1ff0adecfa31542.jpg", "assets/a4baef93419d01f0a1c10c87d2c4aefbc51105bdcf7431ac5802597837565a42.jpg", "assets/48089110eb538f6e7f1458875134f2a188cc3279f06270e03d879aaf039e9c9d.jpg", "assets/f80f1875cb6f5d47b328a9afa17dc3e6d34bc0438853f8da022fd72a0015a010.jpg", "assets/512ee5abcaf7bf234418c59de0c9ec8da4b06b7b09da49113f8199af6e6a1466.jpg", "assets/3f439ba38bb452cda6728b77b05f64baed6410f00301d3dfe210345c866e0129.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "斜坡", "翼突基底部", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-a926bcb19fede743a3ff33a8", "patient_id": "patient-003420d0da40426e1c7e0974", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/2dcc41101dfac600671f207085a860b20f4ae5e70c53df3c9b93f1dd0257794b.jpg", "assets/c63267d5b626cd1e44e7b44d06a8a2ee7e06d67c3e97d6adff5850fe318e4503.jpg", "assets/490ca46253a7b7ebaf040ae0d312214cdfcfe616671ce79a579a944fbe3a43b9.jpg", "assets/768b073785202e264f1f473fa7c82f0ed26417b47619a9549ba31b4084849e51.jpg", "assets/d22f0078deb161057026fbdefbf171764e53ebd9f2914fd9a23e886f5b0a9a3c.jpg", "assets/f27591c8c5db11a05fc576c97c27e4ae8a98c38770717f86b46f16efd327c9fe.jpg", "assets/bf62ec3afd3b31674685d7847cdd24d71746d6d4a0a6d52caac073bcd981a158.jpg", "assets/71fd7738c72f4be061ed33890597f44b14103decf5fcc405498f0f51851d63f5.jpg", "assets/43f26e754d29b3e83e92281d5545b59a68f02b678327f41b84540e353bb8de46.jpg", "assets/e081f87b33178fa62f2ccb9b9757bf20dcc097ed2c4069f6c49602b903f4e2e5.jpg"], "answer": {"T_stage": "T1", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 0, "咽旁间隙": 0, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 0, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-ace7412fef28656aaa765b1a", "patient_id": "patient-772412c07d2776f303790dfa", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/57f7650be5899387e3787dcaacca3044a8b8014a0cc15be4b44af693f1039eea.jpg", "assets/051e26ad3dc1aa4d5ad7e04d055493749c5511a71ab58456294afd86d2fdbbac.jpg", "assets/55de8a207d951578b1dae4ba3cf12870e6cb50e140d5fc13b1c8258e41efbe2b.jpg", "assets/033a4541e73a024f8f247660238b98b0c6623cb938b5c2acb0687f6d9b1c064d.jpg", "assets/3d4b7a3387b90803003e39b368753dfd6eecd105c023cc92778c0ec9bfd852a8.jpg", "assets/ffd4427348a8917dffa11d48761c4d9bec0c3c323bd794d6eb2261b3f175374e.jpg", "assets/31a02aaeeb6d01e20f94f2723fe053900c2406e54522746fb32bc120c9204795.jpg", "assets/1f9ba6e07b113845e59395d68fcde9779c13bee331edb0a11cc433b7c9ce53f6.jpg", "assets/859966eeecfa8cb4530a2f38ff58daf557d96915a920cec505d7a8f222aa088c.jpg", "assets/be228d624be8eff4f5fb748701cc474bd581d6b63fb6cb04fad7eab5f4afadcb.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 1, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "鼻腔", "翼突基底部", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-350958be7e80c5aa6926a3bf", "patient_id": "patient-8977b4b1d24f1a473b242981", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/2d4e66a18e11bf50cc4674e18804efac417cdf243749118a3288f6ab07c1ffc6.jpg", "assets/81823cd7ba0a887573fd98afb5916021a3dea3544dd0a9021ab205ad9c26978d.jpg", "assets/98272bfedd5d27dbc34aad250fc1ca0733eeaca5a57a468a09aa6f0c3bf632fa.jpg", "assets/b996904ec12d3da6cfdd6b2eeb9abb6de7e500325b5336a3e5e710389e819a0a.jpg", "assets/c492e25e57c8cda1c2b592ba3f37766905577afd57e1b6db611bac247b3b5456.jpg", "assets/afd00e53aa646e11283929cc26019d56914c2f30f5e47551bcc6f8b75072d2ee.jpg", "assets/a6b0403aca5a057b4b3bbe99f35d8afb23b14065096d54814db0ac315b9ebdf5.jpg", "assets/856ae070235de8113d7ceae5c3a4668f85e2ae0d22228b7d7dbd01f483a6461a.jpg", "assets/cad84585e51084a97d33bcd302b9f68000531af0ec635213f769545812913df9.jpg", "assets/ffa38f7aa829ba61bcfa6c02454a879cf5649e0557918d8df74959cdfc7a6ac3.jpg"], "answer": {"T_stage": "T2", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 0, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-db1667d194c1789864c0cd1e", "patient_id": "patient-5800309a4e814fbcbd295754", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/61a08bb59579bfd1bc2095d01f0447fdd5e150acdb94a11208e8281ea4cf49ab.jpg", "assets/b728157bce82aa374bd1546bc3e2575be5ab682303fda9eeb3270afca8dc70ad.jpg", "assets/5299e83e7159300a4c375791cc9b656a0d0ffb881c456acca5d6707abc4a1c98.jpg", "assets/f7a3356b90e35b720b1def9e033471145c3eb87e701e736cbd3876b040474338.jpg", "assets/acaf19292fdbd6b9660100ead235395abe7c71b06c2da2ade713cfc446298744.jpg", "assets/5203fcc6f452e3466d16ad33fd298b5a903a102712a63c3f2a67ae4cbcc61489.jpg", "assets/6367dabf94a105f07e3bf051d052c19270934c2832c41788102c455a52b58247.jpg", "assets/d9e5c561726604779d41f409c5db9d9403f7a17f23493ab217a7f8bde49d0906.jpg", "assets/d241660d61ba3e5f6fba340cbd4ebcba3553bcf433f6cb82fd3cac9cbfd9352d.jpg", "assets/22a0c164a140c7d9a36eab4215d3e2d58731eaaf610ac15d11521990c25e56e7.jpg"], "answer": {"T_stage": "T4", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 1, "蝶窦": 1, "鼻腔": 0, "颈动脉鞘": 1, "翼外肌": 1, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 1, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "翼内肌", "蝶窦", "颈动脉鞘", "翼外肌", "斜坡", "海绵窦", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-16d89bda37dd37ed8ccc860d", "patient_id": "patient-476cb2a0d6afea80b42088a3", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/027c42acaa6d85131e55bd83f51566ccf016cc3e98796a916594b93989e7ba50.jpg", "assets/a1b259974fefad0e5f71ddb46df69350fa2b64ab87daa66240934b099f87a3f8.jpg", "assets/d284d743bedabbae5b5fcb15f2cb7db7b549b6db505f040f4c90ccd64b9e37e4.jpg", "assets/fbd7adc9df7b0bf654f143e8753a7e36028ec3c44add195c064020f083e6f48e.jpg", "assets/702b5ab6c1497e08b0d928413f398db12533036a3627da06bc712cffe1588f08.jpg", "assets/b1b1be671e40c451738d371b025722408eed5f894a0daccdc4c804bee60ea53e.jpg", "assets/a04e7766f8d75031a002435a1c17df8c094c91e1e20ff566ff7df7774d4e1b11.jpg", "assets/7062c15dbe19f4fa9021ec5c62c85a986ec8b64e3ebafedaca6ee20126476aa6.jpg", "assets/acebd351050ec880b40770c8e0d8dcab26d06052ca288747bb32179640d00667.jpg", "assets/f18ec16d8432fdc0d94832c7346ca3af9a04155efcfa397ff1b28ca8d1ea345d.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 0, "翼内肌": 0, "蝶窦": 0, "鼻腔": 1, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 0, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "鼻腔", "翼突基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-21d034b231e0efc33d90aa62", "patient_id": "patient-a578b52d91765d2dc023e7ca", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/afa6f22d468a2d902634b335dd35752392cf1b00e457ba59c1ed3f32d59dc8bf.jpg", "assets/211df3ebc6bbf899035d35e0a7cdae88d733f0a04aae465aee71c4321ed4cc4c.jpg", "assets/c57da21ff8d328fa4a144fddfc72662c0287fc27483cc88becf566235c6ae52d.jpg", "assets/bf5011db9b28a5575c0461b14b04a5ff04f59214b7dbb0d0e977436d4e95a049.jpg", "assets/771335075f352765b2fe505ba80b5fe2cb88c5753caa6e6914dc0c17dc7a575b.jpg", "assets/6f01d85a192aa2d2a1325c52ecc95faec8cd9daf4a5dc78a964672ecc3c47a85.jpg", "assets/068b8d1b9f84e65e77ca2f9c202b122e981b362a0868146ac33042ebf2db76c9.jpg", "assets/4c1b24791b8ef997981e19aab6c037e59f68328d988e860e9977931fa546fc47.jpg", "assets/f75b4819fa3508dd6615608ea3b919aa8774dbd9cbe1c3721120e3af20806c63.jpg", "assets/1c744c304451c74ecf73ec8e6da79a16875fbe518326111e228db2dc65127b53.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 0, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "蝶骨基底部"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-035ed2337a42b297993aa905", "patient_id": "patient-0adb245ab94b19ab3ec93940", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/0b6e6d1ae6ad301b27e848a42bb89b482fa58f5221bdbc75c91875ac62aa6e41.jpg", "assets/6d12fb571bb0a9bed28934108adbeee32cbb04fc573642a592a575c71cd269a0.jpg", "assets/69fff995c8c7e2acf6db926c8be79ab948b1a6597f3b901ca718212bf8fe4691.jpg", "assets/c701d235c8a42e59f031f98a6e4548b6e1a49e860858a663539187e45dd7b242.jpg", "assets/16a0378934b7ef7c7547700226b3c22d30c5f59793fba0c2da3a7703a3cb969b.jpg", "assets/de66a544f931ef9f03548335ca5d63acbb7a553fae924e55db4527fef27e4d9e.jpg", "assets/9eb4e37acbfa83d69f821050097a4069e877cccc39a615a7526c204858072254.jpg", "assets/bb414c74f5614963d542de8a24f33b9c7be2ef33b2ad52e8dc20361753664d1c.jpg", "assets/b05e097af3eb06c51b90a87a8e9aeba6f2b713b58d5af69541a8fcd63af837d5.jpg", "assets/a9cbae7c908a3e1f5f1183f6575f336a117dc81f72a5f9e27133b76eb3726cad.jpg"], "answer": {"T_stage": "T4", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 1, "蝶窦": 0, "鼻腔": 1, "颈动脉鞘": 0, "翼外肌": 1, "筛窦": 0, "上颌窦": 0, "斜坡": 1, "海绵窦": 1, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 1, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "翼内肌", "鼻腔", "翼外肌", "斜坡", "海绵窦", "翼突基底部", "蝶骨基底部", "岩尖"]}, "modality_source": "patient_matched"}
+{"sample_id": "sample-f4abe5c77434b64b05c33be5", "patient_id": "patient-f81cca3c5327e5165d731767", "task": "mri_structure_invasion_and_t_stage", "prompt": "你将看到同一位鼻咽癌患者的一组 MRI panel 图像。每张 panel 为同一次检查的多序列、多层面组合图。\n\n任务：\n1. 判断下列候选结构是否受侵犯，并逐项输出 0 或 1。\n2. 基于结构侵犯情况，判断 AJCC 第9版 T 分期。\n3. 给出简要影像依据。\n\n说明：鼻咽为鼻咽癌原发部位，默认作为背景阳性部位记录，不纳入下列结构侵犯评分；请重点判断鼻咽以外结构。\n\n候选结构：\n- 腭帆提肌\n- 咽旁间隙\n- 头长肌\n- 翼内肌\n- 蝶窦\n- 鼻腔\n- 颈动脉鞘\n- 翼外肌\n- 筛窦\n- 上颌窦\n- 斜坡\n- 海绵窦\n- 口咽\n- 翼突基底部\n- 蝶骨基底部\n- 岩尖\n- 寰椎\n- 枢椎\n\n请只输出 JSON，格式如下：\n{\n  \"structure_invasion\": {\"腭帆提肌\": 0, \"咽旁间隙\": 0},\n  \"involved_structures\": [\"...\"],\n  \"T_stage\": \"T1/T2/T3/T4\",\n  \"evidence\": \"简要影像依据\"\n}\n\nT_stage 只能为 T1、T2、T3 或 T4。", "images": ["assets/1a93dd0f63ef2428bee5aa72159859f4d0fd209e01706f2825a2c0a60d046925.jpg", "assets/8b87ba28905119d36cbd926458bca4e1beef51e770ead374ee045d464adba13b.jpg", "assets/e0bad654cd8818466b82a426c39ad9a8354c529160a53f537bd82ae7dc257daa.jpg", "assets/ed3fa455c8a246111d3904189bfc9e3dc0b6270fd3f9e13a42312faf419b8ab3.jpg", "assets/8c572d17d1507750a25998e6ccce8b2665ef0f4c742dac0e9f9233198244dbde.jpg", "assets/3a352015c3260e0a23320d92caf5dd7e878f6ae875299f861c355ae5c86642c2.jpg", "assets/80521cd69bd5f1122ef669cc5e3ff8c8637c10a4fcc40588c725818a4337ea46.jpg", "assets/a3a277560830caaeb45a50a3f54507247a741c4c19f142197ea0e56023005148.jpg", "assets/605e8c75bfeee24ba5dc5e9d1285f7e33d6575216738cb2cd625d2e9158d85a1.jpg", "assets/821ab0093c5097d44d6d93819b457618a12b563706f7c518dd95d257851accf3.jpg"], "answer": {"T_stage": "T3", "structure_invasion": {"鼻咽": 1, "腭帆提肌": 1, "咽旁间隙": 1, "头长肌": 1, "翼内肌": 0, "蝶窦": 0, "鼻腔": 0, "颈动脉鞘": 0, "翼外肌": 0, "筛窦": 0, "上颌窦": 0, "斜坡": 0, "海绵窦": 0, "口咽": 0, "翼突基底部": 1, "蝶骨基底部": 1, "岩尖": 0, "寰椎": 0, "枢椎": 0}, "involved_structures": ["鼻咽", "腭帆提肌", "咽旁间隙", "头长肌", "翼突基底部", "蝶骨基底部"]}, "modality_source": "patient_matched"}
diff --git a/supplementary/l5_history/README.md b/supplementary/l5_history/README.md
new file mode 100644
index 0000000000000000000000000000000000000000..2154eac51bdf379ff4012194f8a113a4f0835392
--- /dev/null
+++ b/supplementary/l5_history/README.md
@@ -0,0 +1,7 @@
+# L5 history controls
+
+`state_equivalent.jsonl` contains the same 305 questions under full history, a time-stripped and regrouped snapshot, and an order-only shuffle. Each row identifies its condition and paired question. The snapshot changes temporal information; the shuffle retains time markers and changes line order.
+
+`strict_history.jsonl` contains full-history and current-only inputs with the prespecified review mask `in_hr_core`. Report the broader and core subsets separately.
+
+`serial.jsonl` contains the three interaction conditions on 292 questions from 87 patients. The `serial/` directory additionally provides episode replay messages; persistent interaction inserts that model's preceding answers in chronological order.
diff --git a/supplementary/l5_history/serial.jsonl b/supplementary/l5_history/serial.jsonl
new file mode 100644
index 0000000000000000000000000000000000000000..12f2d3fbcaebf085580f20d472cfdd2964c3ffaa
--- /dev/null
+++ b/supplementary/l5_history/serial.jsonl
@@ -0,0 +1,3 @@
+version https://git-lfs.github.com/spec/v1
+oid sha256:7960dc29ac84228235857e68cef8025fe7f9ca3a7c86aa1400aabfde96a951c2
+size 58379713
diff --git a/supplementary/l5_history/serial/canonical_packed.jsonl b/supplementary/l5_history/serial/canonical_packed.jsonl
new file mode 100644
index 0000000000000000000000000000000000000000..1b344043adffc628d28f48c242e691120b320b74
--- /dev/null
+++ b/supplementary/l5_history/serial/canonical_packed.jsonl
@@ -0,0 +1,3 @@
+version https://git-lfs.github.com/spec/v1
+oid sha256:41355c8692eb561c200ce96dc6130f62d179a47aa6679f822dcc9e08a15a0f84
+size 24248587
diff --git a/supplementary/l5_history/serial/episode_replay.jsonl b/supplementary/l5_history/serial/episode_replay.jsonl
new file mode 100644
index 0000000000000000000000000000000000000000..314bea0fff2af44ac3b4b9ece3b39406b7557fc4
--- /dev/null
+++ b/supplementary/l5_history/serial/episode_replay.jsonl
@@ -0,0 +1,3 @@
+version https://git-lfs.github.com/spec/v1
+oid sha256:99c39f02968c3b8c09ea987b9244454c2071c1f2d8f68c60324bcd88a222f1ee
+size 22946382
diff --git a/supplementary/l5_history/serial/stateless_current_delta.jsonl b/supplementary/l5_history/serial/stateless_current_delta.jsonl
new file mode 100644
index 0000000000000000000000000000000000000000..72b3c3aeaac3474027ac4776de5704e0f2f2784d
--- /dev/null
+++ b/supplementary/l5_history/serial/stateless_current_delta.jsonl
@@ -0,0 +1,3 @@
+version https://git-lfs.github.com/spec/v1
+oid sha256:7982980bee8a02808766f48a99e04079e1a6af71793f5a0bce400e5e1df3a845
+size 11133591
diff --git a/supplementary/l5_history/state_equivalent.jsonl b/supplementary/l5_history/state_equivalent.jsonl
new file mode 100644
index 0000000000000000000000000000000000000000..6f616f1113ba7417b95257d4adf8a520c579ab05
--- /dev/null
+++ b/supplementary/l5_history/state_equivalent.jsonl
@@ -0,0 +1,3 @@
+version https://git-lfs.github.com/spec/v1
+oid sha256:e725cb189ffe1d236f0d0048f232e06543050cb4792806c0884bd83ea5582787
+size 32228445
diff --git a/supplementary/l5_history/strict_history.jsonl b/supplementary/l5_history/strict_history.jsonl
new file mode 100644
index 0000000000000000000000000000000000000000..0c91e461a8a946441ff47674b960725e58016298
--- /dev/null
+++ b/supplementary/l5_history/strict_history.jsonl
@@ -0,0 +1,3 @@
+version https://git-lfs.github.com/spec/v1
+oid sha256:3659c7b83a11ce3900a8c31257d6fc58677c1500fd85fa800dccb9126729fcd0
+size 15178172
diff --git a/supplementary/mri_cine/README.md b/supplementary/mri_cine/README.md
new file mode 100644
index 0000000000000000000000000000000000000000..a7c9dffc2124051550bf640088e27823140be04f
--- /dev/null
+++ b/supplementary/mri_cine/README.md
@@ -0,0 +1,13 @@
+# MRI cine data
+
+`inputs.tar.gz` contains the original cine inputs, video assets, sampled images
+and frame-to-image mappings. Extract it into this directory:
+
+```sh
+tar -xzf inputs.tar.gz
+```
+
+The three input files under `inputs/` describe sequence-matched, card-matched
+and full-patient cine conditions. Keep these conditions distinct from the static
+L3 image tasks. The evaluation code provides the native-video runner and cine
+answer parser.
diff --git a/supplementary/mri_cine/inputs.tar.gz b/supplementary/mri_cine/inputs.tar.gz
new file mode 100644
index 0000000000000000000000000000000000000000..3b9dd600687c000e103e6bf061e77dcea655b87b
--- /dev/null
+++ b/supplementary/mri_cine/inputs.tar.gz
@@ -0,0 +1,3 @@
+version https://git-lfs.github.com/spec/v1
+oid sha256:4051ad90b19897b67f5aa08ec3530a1731f6eab574e7f110de34c37b9c7c36b4
+size 1585913239
diff --git a/supplementary/option_free/answers.jsonl b/supplementary/option_free/answers.jsonl
new file mode 100644
index 0000000000000000000000000000000000000000..4983609dc5d7a3139b513c300072cce87cff3f3f
--- /dev/null
+++ b/supplementary/option_free/answers.jsonl
@@ -0,0 +1,238 @@
+{"item_id":"1","interface_type":"vsaq_single_slot","response_count":1,"max_points":1,"stem":"根据 CSCO 2025 指南，评估鼻咽癌原发灶侵犯范围的首选影像学检查是什么？（1 分；请用简短医学术语作答，无需解释。）","reference_answer":"鼻咽平扫+增强MRI","answer_slots":[{"slot_id":"S1","slot_focus":"首选影像学检查","minimum_sufficient_answer":"鼻咽平扫+增强MRI","accepted_aliases":["平扫及增强MRI","鼻咽MRI平扫+增强","磁共振平扫加增强","增强MRI"],"numeric_tolerance":null,"required_concepts":["MRI或磁共振","增强"],"explicitly_incorrect_or_insufficient":["CT","PET/CT","超声","仅平扫MRI"],"points":1}]}
+{"item_id":"2","interface_type":"saq_component","response_count":1,"max_points":1,"stem":"根据 CSCO 2025，对 MRI 尚未达到转移标准的小颈部淋巴结，若 PET/CT 出现明确异常摄取，请写出指南建议的处理方式（答 1 项）。（共1分，每项1分。）","reference_answer":"按转移淋巴结处理","answer_slots":[{"slot_id":"S1","slot_focus":"淋巴结处理方式","minimum_sufficient_answer":"按转移淋巴结处理","accepted_aliases":["按转移处理","作为转移淋巴结处理","按转移淋巴结纳入分期与靶区评估"],"numeric_tolerance":null,"required_concepts":[],"explicitly_incorrect_or_insufficient":[],"points":1}]}
+{"item_id":"3","interface_type":"saq_component","response_count":3,"max_points":3,"stem":"根据 CSCO 2025，建议治疗前常规加做 PET/CT 的“高远处转移风险”人群具体包括哪3项情况？（请列出3项）（共3分，每项1分。）","reference_answer":"N0-1且EBV DNA>4000 copies/mL；N2-3；T3-4","answer_slots":[{"slot_id":"S1","slot_focus":"N0-1期伴高EBV DNA","minimum_sufficient_answer":"N0-1且EBV DNA>4000 copies/mL","accepted_aliases":["N0-1伴EBV DNA>4000","N0-1期且EBV DNA>4000"],"numeric_tolerance":null,"required_concepts":["N0-1","EBV DNA>4000"],"explicitly_incorrect_or_insufficient":["仅写N0-1","仅写EBV DNA>4000"],"points":1},{"slot_id":"S2","slot_focus":"N分期高危","minimum_sufficient_answer":"N2-3","accepted_aliases":["N2-3期","N2-N3"],"numeric_tolerance":null,"required_concepts":["N2-3"],"explicitly_incorrect_or_insufficient":["N1","N0"],"points":1},{"slot_id":"S3","slot_focus":"T分期高危","minimum_sufficient_answer":"T3-4","accepted_aliases":["T3-4期","T3-T4"],"numeric_tolerance":null,"required_concepts":["T3-4"],"explicitly_incorrect_or_insufficient":["T1","T2"],"points":1}]}
+{"item_id":"4","interface_type":"saq_component","response_count":2,"max_points":2,"stem":"根据 CSCO 2025，对极低远处转移风险的确诊鼻咽癌患者进行腹部远处转移评估时，请分别写出：1. 首选检查；2. 首选检查结果可疑时的补充检查。（共2分，每项1分。）","reference_answer":"1. 腹部超声；2. 上腹部增强CT或MRI","answer_slots":[{"slot_id":"S1","slot_focus":"首选检查","minimum_sufficient_answer":"腹部超声","accepted_aliases":["腹部B超","超声"],"numeric_tolerance":null,"required_concepts":["超声"],"explicitly_incorrect_or_insufficient":["CT","MRI","PET/CT"],"points":1},{"slot_id":"S2","slot_focus":"结果可疑时的补充检查","minimum_sufficient_answer":"上腹部增强CT或MRI","accepted_aliases":["增强CT或MRI","上腹部增强CT","上腹部增强MRI","腹部增强CT或MRI"],"numeric_tolerance":null,"required_concepts":["增强"],"explicitly_incorrect_or_insufficient":["平扫CT","PET/CT","骨扫描","超声"],"points":1}]}
+{"item_id":"5","interface_type":"vsaq_single_slot","response_count":1,"max_points":1,"stem":"根据 CSCO 2025，当鼻咽原发灶尚未明确、但出现颈部淋巴结肿大或非常规区域淋巴结可疑转移时，指南推荐的下一步首选诊断操作是什么？（1 分；请用简短医学术语作答，无需解释。）","reference_answer":"影像引导下穿刺/活检","answer_slots":[{"slot_id":"S1","slot_focus":"首选诊断操作","minimum_sufficient_answer":"影像引导下穿刺/活检","accepted_aliases":["影像引导下穿刺","影像引导下活检","超声引导下穿刺","影像引导下FNA","影像引导下穿刺活检","影像引导下细针穿刺","超声引导下穿刺活检","图像引导下粗针穿刺活检"],"numeric_tolerance":null,"required_concepts":["影像引导","穿刺或活检"],"explicitly_incorrect_or_insufficient":["直接放化疗","开放性淋巴结切除","仅查EBV DNA","盲穿","单纯穿刺（未提及影像引导）"],"points":1}]}
+{"item_id":"6","interface_type":"saq_component","response_count":2,"max_points":2,"stem":"根据 CSCO 2025，在鼻咽癌影像学评估中，请分别写出 MRI 和 PET/CT 各自最主要的评估对象。（共2分，每项1分。）","reference_answer":"1. 原发灶与邻近软组织侵犯；2. 小淋巴结和远处转移","answer_slots":[{"slot_id":"S1","slot_focus":"MRI 作为首选的评估范围","minimum_sufficient_answer":"原发灶与邻近软组织侵犯","accepted_aliases":["原发灶及邻近软组织","原发灶与局部软组织侵犯","局部T分期及原发灶侵犯范围"],"numeric_tolerance":null,"required_concepts":["原发灶","软组织"],"explicitly_incorrect_or_insufficient":["远处转移","仅写原发灶","仅写软组织"],"points":1},{"slot_id":"S2","slot_focus":"PET/CT 更有助于评估的范围","minimum_sufficient_answer":"小淋巴结和远处转移","accepted_aliases":["远处转移和小淋巴结","远处转移筛查及小淋巴结识别","全身远处转移及小淋巴结"],"numeric_tolerance":null,"required_concepts":["淋巴结","远处转移"],"explicitly_incorrect_or_insufficient":["原发灶","局部侵犯","仅写远处转移","仅写淋巴结"],"points":1}]}
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+{"item_id":"9","interface_type":"vsaq_single_slot","response_count":1,"max_points":1,"stem":"根据 CSCO 2025，在鼻咽镜可达且可见可疑原发灶的前提下，获取组织学诊断的首选方式是什么？（1 分；请用简短医学术语作答，无需解释。）","reference_answer":"鼻咽镜下肿块活检","answer_slots":[{"slot_id":"S1","slot_focus":"获取组织学诊断的首选方式","minimum_sufficient_answer":"鼻咽镜下活检","accepted_aliases":["鼻咽镜下肿块活检","内镜下活检","鼻咽镜活检","鼻咽活检"],"numeric_tolerance":null,"required_concepts":["鼻咽镜/内镜/鼻咽","活检"],"explicitly_incorrect_or_insufficient":["颈部淋巴结活检","细针穿刺","外周血ctDNA检测","PET/CT","手术切除"],"points":1}]}
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+{"item_id":"63","interface_type":"saq_component","response_count":3,"max_points":3,"stem":"根据 NCCN 2025，对于无局部手术或放疗机会的复发、不可切除、寡转移或转移性鼻咽癌，首选一线全身治疗方案（preferred first-line regimen）包含哪3种药物？请列出3项。（共3分，每项1分。）","reference_answer":"顺铂、吉西他滨、特瑞普利单抗","answer_slots":[{"slot_id":"S1","slot_focus":"化疗药物1","minimum_sufficient_answer":"顺铂","accepted_aliases":["cisplatin","DDP","顺铂"],"numeric_tolerance":null,"required_concepts":["顺铂"],"explicitly_incorrect_or_insufficient":["卡铂","奥沙利铂","GP"],"points":1},{"slot_id":"S2","slot_focus":"化疗药物2","minimum_sufficient_answer":"吉西他滨","accepted_aliases":["gemcitabine","GEM","吉西他滨"],"numeric_tolerance":null,"required_concepts":["吉西他滨"],"explicitly_incorrect_or_insufficient":["紫杉醇","氟尿嘧啶","GP"],"points":1},{"slot_id":"S3","slot_focus":"免疫药物","minimum_sufficient_answer":"特瑞普利单抗","accepted_aliases":["toripalimab","toripalimab-tpzi","特瑞普利单抗","拓益"],"numeric_tolerance":null,"required_concepts":["特瑞普利单抗"],"explicitly_incorrect_or_insufficient":["帕博利珠单抗","纳武利尤单抗","卡瑞利珠单抗","替雷利珠单抗","PD-1"],"points":1}]}
+{"item_id":"64","interface_type":"vsaq_single_slot","response_count":1,"max_points":1,"stem":"根据 NCCN 2025 指南，对于含铂治疗后进展的鼻咽癌（NPC），首选的后线治疗方案（preferred subsequent-line regimen）是哪种药物？（1 分；请用简短医学术语作答，无需解释。）","reference_answer":"toripalimab-tpzi","answer_slots":[{"slot_id":"S1","slot_focus":"首选后线治疗药物","minimum_sufficient_answer":"toripalimab-tpzi","accepted_aliases":["toripalimab","特瑞普利单抗","特瑞普利单抗-tpzi"],"numeric_tolerance":null,"required_concepts":["toripalimab"],"explicitly_incorrect_or_insufficient":["PD-1抑制剂","免疫治疗","capecitabine","methotrexate","cetuximab","卡培他滨","甲氨蝶呤","西妥昔单抗"],"points":1}]}
+{"item_id":"65","interface_type":"saq_component","response_count":4,"max_points":4,"stem":"根据 CSCO 2025，复发/转移性鼻咽癌一线 GP 方案中，获 1A类推荐的 PD-1 抑制剂有哪些？请列出4种。（共4分，每项1分。）","reference_answer":"卡瑞利珠单抗；特瑞普利单抗；替雷利珠单抗；派安普利单抗","answer_slots":[{"slot_id":"S1","slot_focus":"与GP联合获1A类推荐的PD-1抑制剂","minimum_sufficient_answer":"卡瑞利珠单抗","accepted_aliases":["camrelizumab"],"numeric_tolerance":null,"required_concepts":[],"explicitly_incorrect_or_insufficient":[],"points":1},{"slot_id":"S2","slot_focus":"与GP联合获1A类推荐的PD-1抑制剂","minimum_sufficient_answer":"特瑞普利单抗","accepted_aliases":["toripalimab"],"numeric_tolerance":null,"required_concepts":[],"explicitly_incorrect_or_insufficient":[],"points":1},{"slot_id":"S3","slot_focus":"与GP联合获1A类推荐的PD-1抑制剂","minimum_sufficient_answer":"替雷利珠单抗","accepted_aliases":["tislelizumab"],"numeric_tolerance":null,"required_concepts":[],"explicitly_incorrect_or_insufficient":[],"points":1},{"slot_id":"S4","slot_focus":"与GP联合获1A类推荐的PD-1抑制剂","minimum_sufficient_answer":"派安普利单抗","accepted_aliases":["tagitanlimab","penpulimab"],"numeric_tolerance":null,"required_concepts":[],"explicitly_incorrect_or_insufficient":[],"points":1}]}
+{"item_id":"66","interface_type":"saq_component","response_count":2,"max_points":2,"stem":"根据 CSCO 2025，一线 GP 方案中，请分别写出吉西他滨和顺铂的常用剂量及给药天数（共2项）。（共2分，每项1分。）","reference_answer":"吉西他滨 1000 mg/m² d1,8；顺铂 80 mg/m² d1","answer_slots":[{"slot_id":"S1","slot_focus":"吉西他滨的剂量及给药天数","minimum_sufficient_answer":"1000 mg/m² d1,8","accepted_aliases":["1000mg/m2 d1,8","1g/m² d1,8","1000 mg/m² 第1,8天"],"numeric_tolerance":null,"required_concepts":["1000","1","8"],"explicitly_incorrect_or_insufficient":["1250 mg/m²","d1,15","800 mg/m²"],"points":1},{"slot_id":"S2","slot_focus":"顺铂的剂量及给药天数","minimum_sufficient_answer":"80 mg/m² d1","accepted_aliases":["80mg/m2 d1","80 mg/m² 第1天"],"numeric_tolerance":null,"required_concepts":["80","1"],"explicitly_incorrect_or_insufficient":["100 mg/m²","75 mg/m²"],"points":1}]}
+{"item_id":"67","interface_type":"vsaq_single_slot","response_count":1,"max_points":1,"stem":"根据 CSCO 2025，在鼻咽癌一线 GP 联合特瑞普利单抗（toripalimab）治疗中，特瑞普利单抗的常用给药方案是什么？（1 分；请用简短医学术语作答，无需解释。）","reference_answer":"240 mg q3w","answer_slots":[{"slot_id":"S1","slot_focus":"最终单槽答案","minimum_sufficient_answer":"240 mg q3w","accepted_aliases":["240mg q3w","240 mg 每3周1次","240mg 每3周一次","240 mg 静脉注射，每三周一次","240 mg 静脉滴注，每 3 周一次"],"numeric_tolerance":null,"required_concepts":[],"explicitly_incorrect_or_insufficient":[],"points":1}]}
+{"item_id":"68","interface_type":"vsaq_single_slot","response_count":1,"max_points":1,"stem":"根据 CSCO 2025，在鼻咽癌一线 GP 联合卡瑞利珠单抗（camrelizumab）治疗中，卡瑞利珠单抗的常用给药方案是什么？（1 分；请用简短医学术语作答，无需解释。）","reference_answer":"200 mg q3w","answer_slots":[{"slot_id":"S1","slot_focus":"最终单槽答案","minimum_sufficient_answer":"200 mg q3w","accepted_aliases":["200mg q3w","200 mg 每3周1次","200mg 每3周一次","200 mg 静脉注射，每三周一次","200 mg 静脉滴注q3w"],"numeric_tolerance":null,"required_concepts":[],"explicitly_incorrect_or_insufficient":[],"points":1}]}
+{"item_id":"69","interface_type":"vsaq_single_slot","response_count":1,"max_points":1,"stem":"根据 CSCO 2025，在鼻咽癌一线 GP 联合替雷利珠单抗（tislelizumab）治疗中，替雷利珠单抗的常用给药方案是什么？（1 分；请用简短医学术语作答，无需解释。）","reference_answer":"200 mg q3w","answer_slots":[{"slot_id":"S1","slot_focus":"最终单槽答案","minimum_sufficient_answer":"200 mg q3w","accepted_aliases":["200mg q3w","200 mg 每3周1次","200mg 每3周一次","200 mg 静脉注射，每 3 周一次","200 mg 静脉滴注，每 3 周一次"],"numeric_tolerance":null,"required_concepts":[],"explicitly_incorrect_or_insufficient":[],"points":1}]}
+{"item_id":"70","interface_type":"saq_component","response_count":2,"max_points":2,"stem":"根据 CSCO 2025，复发/转移性鼻咽癌一线治疗中，含氟尿嘧啶的铂类双药方案由哪 2 类药物组成？（共2分，每项1分。）","reference_answer":"顺铂或卡铂；5-FU","answer_slots":[{"slot_id":"S1","slot_focus":"铂类药物","minimum_sufficient_answer":"顺铂或卡铂","accepted_aliases":["顺铂","卡铂","cisplatin","carboplatin"],"numeric_tolerance":null,"required_concepts":["顺铂或卡铂（二者任一）"],"explicitly_incorrect_or_insufficient":["吉西他滨","多西他赛","5-FU"],"points":1},{"slot_id":"S2","slot_focus":"氟尿嘧啶类药物","minimum_sufficient_answer":"5-FU","accepted_aliases":["5-氟尿嘧啶","氟尿嘧啶","5-fluorouracil"],"numeric_tolerance":null,"required_concepts":["5-FU"],"explicitly_incorrect_or_insufficient":["吉西他滨","卡培他滨","多西他赛"],"points":1}]}
+{"item_id":"71","interface_type":"vsaq_single_slot","response_count":1,"max_points":1,"stem":"根据 CSCO 2025，在复发/转移性鼻咽癌（RM-NPC）一线治疗中，GP（吉西他滨+顺铂）联合哪种药物被列为 2B 类推荐方案？（1 分；请用简短医学术语作答，无需解释。）","reference_answer":"恩度","answer_slots":[{"slot_id":"S1","slot_focus":"与GP联合的药物名称","minimum_sufficient_answer":"恩度","accepted_aliases":["Endostar","重组人血管内皮抑制素","GP + Endostar","GP + 恩度"],"numeric_tolerance":null,"required_concepts":["恩度或Endostar或重组人血管内皮抑制素"],"explicitly_incorrect_or_insufficient":["特瑞普利单抗","卡瑞利珠单抗","替雷利珠单抗","信迪利单抗","派安普利单抗","西妥昔单抗","尼妥珠单抗"],"points":1}]}
+{"item_id":"72","interface_type":"saq_component","response_count":3,"max_points":3,"stem":"根据 NCCN 2025，复发/转移性鼻咽癌的首选一线系统治疗方案（preferred first-line regimen）包含哪3种药物？请列出3项。（共3分，每项1分。）","reference_answer":"顺铂、吉西他滨、特瑞普利单抗","answer_slots":[{"slot_id":"S1","slot_focus":"铂类化疗药","minimum_sufficient_answer":"顺铂","accepted_aliases":["cisplatin","DDP"],"numeric_tolerance":null,"required_concepts":["顺铂"],"explicitly_incorrect_or_insufficient":["卡铂","carboplatin","奥沙利铂"],"points":1},{"slot_id":"S2","slot_focus":"抗代谢化疗药","minimum_sufficient_answer":"吉西他滨","accepted_aliases":["gemcitabine","GEM"],"numeric_tolerance":null,"required_concepts":["吉西他滨"],"explicitly_incorrect_or_insufficient":["5-FU","氟尿嘧啶","紫杉醇"],"points":1},{"slot_id":"S3","slot_focus":"PD-1抑制剂","minimum_sufficient_answer":"特瑞普利单抗","accepted_aliases":["toripalimab","toripalimab-tpzi"],"numeric_tolerance":null,"required_concepts":["特瑞普利单抗"],"explicitly_incorrect_or_insufficient":["帕博利珠单抗","卡瑞利珠单抗","信迪利单抗","替雷利珠单抗"],"points":1}]}
+{"item_id":"73","interface_type":"saq_component","response_count":2,"max_points":2,"stem":"根据 CSCO 2025，对可切除的局部复发鼻咽癌，写出以下2项内容：1）首选的局部根治性治疗手段；2）优先考虑的手术路径。（共2分，每项1分。）","reference_answer":"1）挽救性手术；2）经鼻内镜微创","answer_slots":[{"slot_id":"S1","slot_focus":"首选的局部根治性治疗手段","minimum_sufficient_answer":"挽救性手术","accepted_aliases":["手术","手术切除","挽救手术"],"numeric_tolerance":null,"required_concepts":["手术"],"explicitly_incorrect_or_insufficient":["放疗","再程放疗","化疗","免疫治疗","支持治疗"],"points":1},{"slot_id":"S2","slot_focus":"优先考虑的手术路径","minimum_sufficient_answer":"经鼻内镜微创","accepted_aliases":["经鼻内镜","内镜微创","鼻内镜手术","内窥镜手术"],"numeric_tolerance":null,"required_concepts":["内镜"],"explicitly_incorrect_or_insufficient":["开放手术","传统手术","放疗"],"points":1}]}
+{"item_id":"74","interface_type":"vsaq_single_slot","response_count":1,"max_points":1,"stem":"根据 CSCO 2025，对于单纯颈部淋巴结复发的鼻咽癌患者，首选的局部治疗方式是什么？（1 分；请用简短医学术语作答，无需解释。）","reference_answer":"颈部淋巴结清扫术","answer_slots":[{"slot_id":"S1","slot_focus":"首选局部治疗方式","minimum_sufficient_answer":"颈部淋巴结清扫术","accepted_aliases":["颈淋巴结清扫术","颈清扫术","颈部淋巴结清扫","颈清扫","手术切除","手术","手术治疗"],"numeric_tolerance":null,"required_concepts":["清扫"],"explicitly_incorrect_or_insufficient":["化疗","放疗","再程放疗","观察","单纯化疗"],"points":1}]}
+{"item_id":"75","interface_type":"vsaq_single_slot","response_count":1,"max_points":1,"stem":"根据 NCCN 2025，pembrolizumab 被列为复发/转移性鼻咽癌“useful in certain circumstances”的治疗选项时，要求患者具备哪种特定的生物标志物状态？（1 分；请用简短医学术语作答，无需解释。）","reference_answer":"TMB-H（≥10 mut/Mb）","answer_slots":[{"slot_id":"S1","slot_focus":"pembrolizumab特定适用情境的生物标志物状态","minimum_sufficient_answer":"TMB-H（≥10 mut/Mb）","accepted_aliases":["TMB-H","高肿瘤突变负荷（≥10 mut/Mb）","TMB ≥10 mut/Mb","TMB-H ≥10 mut/Mb"],"numeric_tolerance":null,"required_concepts":["TMB-H或高肿瘤突变负荷或TMB"],"explicitly_incorrect_or_insufficient":["PD-L1阳性","EBV阳性","dMMR","MSI-H"],"points":1}]}
+{"item_id":"76","interface_type":"vsaq_single_slot","response_count":1,"max_points":1,"stem":"根据 CSCO 2025，对于至少二线系统治疗失败的鼻咽癌患者，单药卡瑞利珠单抗（camrelizumab）的常用给药方案（需写明单次剂量和给药周期）是？（1 分；请用简短医学术语作答，无需解释。）","reference_answer":"200 mg q2w","answer_slots":[{"slot_id":"S1","slot_focus":"卡瑞利珠单抗单药后线治疗的剂量和周期","minimum_sufficient_answer":"200 mg q2w","accepted_aliases":["200mg q2w","200mg 每2周1次","200 mg 每2周1次","200mg 每两周一次"],"numeric_tolerance":null,"required_concepts":["200mg","q2w或每2周"],"explicitly_incorrect_or_insufficient":["200 mg q3w","240 mg q3w","3 mg/kg q2w","200 mg","q2w"],"points":1}]}
+{"item_id":"77","interface_type":"vsaq_single_slot","response_count":1,"max_points":1,"stem":"根据 CSCO 2025，后线单药特瑞普利单抗（toripalimab）的常用给药方案是什么？（1 分；请用简短医学术语作答，无需解释。）","reference_answer":"3 mg/kg q2w","answer_slots":[{"slot_id":"S1","slot_focus":"最终单槽答案","minimum_sufficient_answer":"3 mg/kg q2w","accepted_aliases":["3mg/kg q2w","3 mg/kg 每2周1次","3mg/kg 每2周一次"],"numeric_tolerance":null,"required_concepts":[],"explicitly_incorrect_or_insufficient":[],"points":1}]}
+{"item_id":"78","interface_type":"vsaq_single_slot","response_count":1,"max_points":1,"stem":"根据 CSCO 2025，后线单药 penpulimab 的常用单次剂量及给药频率是？（1 分；请用简短医学术语作答，无需解释。）","reference_answer":"200 mg q2w","answer_slots":[{"slot_id":"S1","slot_focus":"单次剂量及给药频率","minimum_sufficient_answer":"200 mg q2w","accepted_aliases":["200mg q2w","200 mg 每2周","200mg 每两周","200 mg 每两周1次"],"numeric_tolerance":null,"required_concepts":["200"],"explicitly_incorrect_or_insufficient":["240 mg q3w","3 mg/kg q2w","1200 mg q3w","200 mg","q2w"],"points":1}]}
+{"item_id":"79","interface_type":"saq_component","response_count":2,"max_points":2,"stem":"根据 CSCO 2025 鼻咽癌指南，卡瑞利珠单抗（camrelizumab）联合阿帕替尼（apatinib）作为常见后线治疗方案时，请分别写出这2种药物的推荐单次剂量与给药频率（共2项）。（共2分，每项1分。）","reference_answer":"卡瑞利珠单抗 200 mg q3w；阿帕替尼 250 mg qd","answer_slots":[{"slot_id":"S1","slot_focus":"卡瑞利珠单抗（camrelizumab）的单次剂量与给药频率","minimum_sufficient_answer":"200 mg q3w","accepted_aliases":["200mg q3w","200mg 每3周1次","200 mg 每三周一次"],"numeric_tolerance":null,"required_concepts":["200","q3w"],"explicitly_incorrect_or_insufficient":["240 mg","q2w"],"points":1},{"slot_id":"S2","slot_focus":"阿帕替尼（apatinib）的单次剂量与给药频率","minimum_sufficient_answer":"250 mg qd","accepted_aliases":["250mg qd","250mg 每天1次","250 mg 每日一次"],"numeric_tolerance":null,"required_concepts":["250","qd"],"explicitly_incorrect_or_insufficient":["500 mg","125 mg"],"points":1}]}
+{"item_id":"80","interface_type":"saq_component","response_count":3,"max_points":3,"stem":"根据 NCCN 2025，对 M1 寡转移、PS 0–1 的鼻咽癌患者，诱导治疗后若考虑整合局部治疗，其放疗靶区范围应包括哪3个部位？请列出3项。（共3分，每项1分。）","reference_answer":"原发灶、区域淋巴结、寡转移灶","answer_slots":[{"slot_id":"S1","slot_focus":"原发灶","minimum_sufficient_answer":"原发灶","accepted_aliases":["原发肿瘤","primary site","primary tumor"],"numeric_tolerance":null,"required_concepts":["原发"],"explicitly_incorrect_or_insufficient":["全身"],"points":1},{"slot_id":"S2","slot_focus":"区域淋巴结","minimum_sufficient_answer":"区域淋巴结","accepted_aliases":["颈部淋巴结","regional lymph nodes","淋巴结"],"numeric_tolerance":null,"required_concepts":["淋巴结"],"explicitly_incorrect_or_insufficient":["远处淋巴结"],"points":1},{"slot_id":"S3","slot_focus":"寡转移灶","minimum_sufficient_answer":"寡转移灶","accepted_aliases":["转移灶","oligometastatic sites","转移部位","寡转移部位"],"numeric_tolerance":null,"required_concepts":["转移"],"explicitly_incorrect_or_insufficient":["广泛转移灶"],"points":1}]}
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+{"item_id":"184","interface_type":"saq_component","response_count":2,"max_points":2,"stem":"根据 CSCO 2025，卡瑞利珠单抗联合阿帕替尼用于复发/转移性鼻咽癌需满足哪2项条件？（共2分，每项1分。）","reference_answer":"1. 至少一线系统治疗失败，或诱导/同期/辅助放化疗结束后6个月内进展；2. 不适合放疗及手术","answer_slots":[{"slot_id":"S1","slot_focus":"既往系统治疗或放化疗的失败/进展条件","minimum_sufficient_answer":"至少一线系统治疗失败，或放化疗结束后6个月内进展","accepted_aliases":["至少一线系统治疗失败，或诱导/同期/辅助放化疗结束后6个月内进展","一线治疗失败或放化疗后半年内进展"],"numeric_tolerance":null,"required_concepts":["一线","失败","6个月","进展"],"explicitly_incorrect_or_insufficient":["仅一线失败","放化疗后12个月内进展","二线治疗失败"],"points":1},{"slot_id":"S2","slot_focus":"对放疗及手术的适用性要求","minimum_sufficient_answer":"不适合放疗及手术","accepted_aliases":["不适合手术和放疗","无法行局部治疗（放疗及手术）","不适合局部治疗"],"numeric_tolerance":null,"required_concepts":["不适合","放疗","手术"],"explicitly_incorrect_or_insufficient":["适合放疗","适合手术","仅不适合手术"],"points":1}]}
+{"item_id":"185","interface_type":"saq_component","response_count":3,"max_points":3,"stem":"根据 CSCO 2025，复发/转移性鼻咽癌三线及以上治疗中，既往未接受和已接受 PD-1/PD-L1 抑制剂的患者分别优先采用何种治疗？后者还应鼓励参与什么？（共3分，每项1分。）","reference_answer":"1）PD-1/PD-L1抑制剂；2）前线尚未使用的单药化疗；3）临床试验","answer_slots":[{"slot_id":"S1","slot_focus":"既往未接受过 PD-1/PD-L1 抑制剂时优先考虑的药物类型","minimum_sufficient_answer":"PD-1/PD-L1抑制剂","accepted_aliases":["PD-1/PD-L1","PD-1单抗或PD-L1单抗","免疫检查点抑制剂"],"numeric_tolerance":null,"required_concepts":["PD"],"explicitly_incorrect_or_insufficient":["双药化疗","靶向治疗"],"points":1},{"slot_id":"S2","slot_focus":"既往已接受过 PD-1/PD-L1 抑制剂时优先考虑的化疗策略","minimum_sufficient_answer":"前线尚未使用的单药化疗","accepted_aliases":["前线未使用的单药化疗","既往未用过的单药化疗"],"numeric_tolerance":null,"required_concepts":["单药","化疗","未"],"explicitly_incorrect_or_insufficient":["含铂双药化疗","联合化疗","重复一线方案"],"points":1},{"slot_id":"S3","slot_focus":"既往已接受过 PD-1/PD-L1 抑制剂时鼓励患者参与的项目","minimum_sufficient_answer":"临床试验","accepted_aliases":["临床研究","参加临床试验"],"numeric_tolerance":null,"required_concepts":["临床"],"explicitly_incorrect_or_insufficient":["姑息治疗","最佳支持治疗"],"points":1}]}
+{"item_id":"186","interface_type":"saq_component","response_count":2,"max_points":2,"stem":"根据 CSCO 2025，关于帕博利珠单抗在复发转移性鼻咽癌二线及以上治疗中的应用，请写出以下2项内容：1. 推荐级别；2. 应用的前提条件。（共2分，每项1分。）","reference_answer":"1. 2A类；2. 既往一线未接受PD-1/PD-L1抑制剂","answer_slots":[{"slot_id":"S1","slot_focus":"推荐级别","minimum_sufficient_answer":"2A类","accepted_aliases":["2A","2A级"],"numeric_tolerance":null,"required_concepts":["2A"],"explicitly_incorrect_or_insufficient":["1A类","2B类","3类","1类"],"points":1},{"slot_id":"S2","slot_focus":"应用的前提条件","minimum_sufficient_answer":"既往一线未接受PD-1/PD-L1抑制剂","accepted_aliases":["一线未接受PD-1/PD-L1抑制剂","既往未使用PD-1/PD-L1抑制剂","既往未接受过免疫治疗"],"numeric_tolerance":null,"required_concepts":["未接受","PD-1/PD-L1"],"explicitly_incorrect_or_insufficient":["PD-L1高表达","既往接受过免疫治疗","无前提条件"],"points":1}]}
+{"item_id":"187","interface_type":"saq_component","response_count":3,"max_points":3,"stem":"根据 CSCO 2025，进入二线治疗的2个主要触发条件是什么？若一线免疫联合治疗后未进展，应转入哪一治疗阶段？（共3分，每项1分。）","reference_answer":"疾病进展；无法耐受毒性；维持治疗","answer_slots":[{"slot_id":"S1","slot_focus":"转线触发条件1","minimum_sufficient_answer":"疾病进展","accepted_aliases":["PD","进展","肿瘤进展"],"numeric_tolerance":null,"required_concepts":[],"explicitly_incorrect_or_insufficient":["部分缓解","完全缓解","EBV DNA不下降"],"points":1},{"slot_id":"S2","slot_focus":"转线触发条件2","minimum_sufficient_answer":"无法耐受毒性","accepted_aliases":["不可耐受毒性","毒性不耐受","无法耐受的不良反应","不可耐受的毒副作用","毒性无法耐受"],"numeric_tolerance":null,"required_concepts":["耐受"],"explicitly_incorrect_or_insufficient":["完成4个周期","疗程结束"],"points":1},{"slot_id":"S3","slot_focus":"免疫联合未进展的后续治疗阶段","minimum_sufficient_answer":"维持治疗","accepted_aliases":["维持","单药维持","免疫维持","维持阶段"],"numeric_tolerance":null,"required_concepts":["维持"],"explicitly_incorrect_or_insufficient":["二线治疗","观察","停药"],"points":1}]}
+{"item_id":"188","interface_type":"saq_component","response_count":2,"max_points":2,"stem":"根据 CSCO 2025，写出鼻咽癌 MRI 定位（MR-sim）推荐的2项扫描参数数值：1. 层厚；2. 层间距。（共2分，每项1分。）","reference_answer":"1. 3 mm；2. 0 mm","answer_slots":[{"slot_id":"S1","slot_focus":"层厚","minimum_sufficient_answer":"3 mm","accepted_aliases":["3","3毫米"],"numeric_tolerance":"exact","required_concepts":["3"],"explicitly_incorrect_or_insufficient":["1 mm","5 mm"],"points":1},{"slot_id":"S2","slot_focus":"层间距","minimum_sufficient_answer":"0 mm","accepted_aliases":["0","0毫米","无间距"],"numeric_tolerance":"exact","required_concepts":["0"],"explicitly_incorrect_or_insufficient":["1 mm","2 mm"],"points":1}]}
+{"item_id":"189","interface_type":"saq_component","response_count":3,"max_points":3,"stem":"根据 CSCO 2025，鼻咽癌调强放疗（IMRT）的计划验证应包括哪2项常规验证，并鼓励开展哪1项验证？（写出3项）（共3分，每项1分。）","reference_answer":"点剂量验证；剂量分布验证；基于患者解剖结构的三维剂量验证","answer_slots":[{"slot_id":"S1","slot_focus":"常规验证1","minimum_sufficient_answer":"点剂量验证","accepted_aliases":["点剂量","绝对剂量验证"],"numeric_tolerance":null,"required_concepts":["点剂量"],"explicitly_incorrect_or_insufficient":["三维剂量验证"],"points":1},{"slot_id":"S2","slot_focus":"常规验证2","minimum_sufficient_answer":"剂量分布验证","accepted_aliases":["剂量分布","面剂量验证","相对剂量验证"],"numeric_tolerance":null,"required_concepts":["剂量分布"],"explicitly_incorrect_or_insufficient":["三维剂量验证"],"points":1},{"slot_id":"S3","slot_focus":"鼓励开展的验证","minimum_sufficient_answer":"基于患者解剖结构的三维剂量验证","accepted_aliases":["三维剂量验证","基于解剖结构的三维剂量验证","3D剂量验证"],"numeric_tolerance":null,"required_concepts":["三维剂量"],"explicitly_incorrect_or_insufficient":["点剂量验证","剂量分布验证"],"points":1}]}
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+{"item_id":"191","interface_type":"saq_component","response_count":2,"max_points":2,"stem":"根据 NCCN 2025，对需要同步全身治疗/放疗的鼻咽癌患者，请分别写出以下2项靶区的常规放疗剂量：1. 高危区；2. 低至中危亚临床扩散区。（共2分，每项1分。）","reference_answer":"1. 70 Gy；2. 44-50 Gy或54-63 Gy","answer_slots":[{"slot_id":"S1","slot_focus":"高危区常规放疗剂量","minimum_sufficient_answer":"70 Gy","accepted_aliases":["约70 Gy","70Gy","70"],"numeric_tolerance":null,"required_concepts":["70"],"explicitly_incorrect_or_insufficient":["60 Gy","50 Gy"],"points":1},{"slot_id":"S2","slot_focus":"低至中危亚临床扩散区常规放疗剂量","minimum_sufficient_answer":"44-50 Gy或54-63 Gy","accepted_aliases":["44-50Gy或54-63Gy","44-50或54-63","44-50 Gy, 54-63 Gy","44-50 Gy / 54-63 Gy"],"numeric_tolerance":null,"required_concepts":["44-50","54-63"],"explicitly_incorrect_or_insufficient":["44-50 Gy","54-63 Gy","70 Gy"],"points":1}]}
+{"item_id":"192","interface_type":"saq_component","response_count":3,"max_points":3,"stem":"根据 CSCO 2025，营养不良可对鼻咽癌放疗造成哪3项明确不良影响？（共3分，每项1分。）","reference_answer":"放疗中断、摆位误差增大、放疗敏感性降低","answer_slots":[{"slot_id":"S1","slot_focus":"治疗连续性","minimum_sufficient_answer":"放疗中断","accepted_aliases":["导致放疗中断","治疗中断","中断放疗"],"numeric_tolerance":null,"required_concepts":["中断"],"explicitly_incorrect_or_insufficient":["影响预后","体重下降"],"points":1},{"slot_id":"S2","slot_focus":"物理精度","minimum_sufficient_answer":"摆位误差增大","accepted_aliases":["摆位误差增加","增加摆位误差","摆位误差大"],"numeric_tolerance":null,"required_concepts":["摆位误差"],"explicitly_incorrect_or_insufficient":["影响预后","体重下降"],"points":1},{"slot_id":"S3","slot_focus":"生物学效应","minimum_sufficient_answer":"放疗敏感性降低","accepted_aliases":["敏感性降低","放疗敏感度下降","降低放疗敏感性","放射敏感性下降"],"numeric_tolerance":null,"required_concepts":["敏感"],"explicitly_incorrect_or_insufficient":["影响预后","体重下降"],"points":1}]}
+{"item_id":"193","interface_type":"saq_component","response_count":2,"max_points":2,"stem":"根据 CSCO 2025，关于鼻咽癌围放疗期营养管理原则，请分别写出以下2项核心要求：1. 适用的患者群体；2. 管理的时间跨度。（共2分，每项1分。）","reference_answer":"1. 所有放疗患者；2. 全程","answer_slots":[{"slot_id":"S1","slot_focus":"适用的患者群体","minimum_sufficient_answer":"所有放疗患者","accepted_aliases":["所有患者","全部放疗患者","所有鼻咽癌放疗患者"],"numeric_tolerance":null,"required_concepts":["所有"],"explicitly_incorrect_or_insufficient":["仅高龄患者","体重下降>10%的患者","出现营养不良的患者","放疗患者"],"points":1},{"slot_id":"S2","slot_focus":"管理的时间跨度","minimum_sufficient_answer":"全程","accepted_aliases":["全程规范化","放疗全程","整个围放疗期"],"numeric_tolerance":null,"required_concepts":["全程"],"explicitly_incorrect_or_insufficient":["放疗完成后","体重下降后","仅放疗前"],"points":1}]}
+{"item_id":"194","interface_type":"vsaq_single_slot","response_count":1,"max_points":1,"stem":"根据 CSCO 2025，哪种严重的鼻咽癌放疗晚期并发症可依据放疗疗程数和颈内动脉暴露情况进行临床风险分层？（1 分；请用简短医学术语作答，无需解释。）","reference_answer":"鼻咽坏死","answer_slots":[{"slot_id":"S1","slot_focus":"严重晚期并发症名称","minimum_sufficient_answer":"鼻咽坏死","accepted_aliases":["放射性鼻咽坏死"],"numeric_tolerance":null,"required_concepts":["鼻咽","坏死"],"explicitly_incorrect_or_insufficient":["放射性脑病","听力下降","口干","恶心","味觉减退","口腔黏膜充血"],"points":1}]}
+{"item_id":"195","interface_type":"saq_component","response_count":5,"max_points":5,"stem":"根据 NCCN 2025，长期随访中，除监测 TSH 外，还应持续关注哪5项支持照护领域？（共5分，每项1分。）","reference_answer":"抑郁、淋巴水肿、吞咽/言语、听力、营养与功能康复","answer_slots":[{"slot_id":"S1","slot_focus":"心理状态","minimum_sufficient_answer":"抑郁","accepted_aliases":["抑郁症","depression"],"numeric_tolerance":null,"required_concepts":["抑郁"],"explicitly_incorrect_or_insufficient":[],"points":1},{"slot_id":"S2","slot_focus":"局部并发症","minimum_sufficient_answer":"淋巴水肿","accepted_aliases":["lymphedema","颈部淋巴水肿"],"numeric_tolerance":null,"required_concepts":["淋巴水肿"],"explicitly_incorrect_or_insufficient":[],"points":1},{"slot_id":"S3","slot_focus":"头颈部功能","minimum_sufficient_answer":"吞咽/言语","accepted_aliases":["吞咽","言语","吞咽和言语","speech/swallowing"],"numeric_tolerance":null,"required_concepts":[],"explicitly_incorrect_or_insufficient":[],"points":1},{"slot_id":"S4","slot_focus":"感觉功能","minimum_sufficient_answer":"听力","accepted_aliases":["听觉","hearing","听力下降"],"numeric_tolerance":null,"required_concepts":["听力"],"explicitly_incorrect_or_insufficient":[],"points":1},{"slot_id":"S5","slot_focus":"全身状态","minimum_sufficient_answer":"营养与功能康复","accepted_aliases":["营养","功能康复","营养支持","nutrition"],"numeric_tolerance":null,"required_concepts":["营养"],"explicitly_incorrect_or_insufficient":[],"points":1}]}
+{"item_id":"196","interface_type":"vsaq_single_slot","response_count":1,"max_points":1,"stem":"根据 CSCO 2025，对于不可手术的局部复发鼻咽癌，若评估为再程放疗低危组，针对局部复发灶通常如何处理？（1 分；请用简短医学术语作答，无需解释。）","reference_answer":"可考虑挽救性再程放疗","answer_slots":[{"slot_id":"S1","slot_focus":"再程放疗低危组的局部治疗决策","minimum_sufficient_answer":"可考虑挽救性再程放疗","accepted_aliases":["可考虑再程放疗","可行再程放疗","适合挽救性再程放疗","可接受挽救性再照射","可行挽救性放疗"],"numeric_tolerance":null,"required_concepts":["低危组","可考虑或可行再程放疗"],"explicitly_incorrect_or_insufficient":["绝对禁止再程放疗","完全不适合再程放疗","只能系统治疗"],"points":1}]}
+{"item_id":"197","interface_type":"vsaq_single_slot","response_count":1,"max_points":1,"stem":"根据 CSCO 2025，对于鼻咽坏死患者，临床风险分层模型可结合放疗疗程数和哪一解剖结构的暴露情况，用于预后判断和外科决策？（1 分；请用简短医学术语作答，无需解释。）","reference_answer":"颈内动脉","answer_slots":[{"slot_id":"S1","slot_focus":"解剖结构","minimum_sufficient_answer":"颈内动脉","accepted_aliases":["颈内动脉暴露情况","ICA","颈内动脉暴露"],"numeric_tolerance":null,"required_concepts":["颈内动脉"],"explicitly_incorrect_or_insufficient":["颈动脉","颈外动脉","血管","动脉"],"points":1}]}
+{"item_id":"198","interface_type":"vsaq_single_slot","response_count":1,"max_points":1,"stem":"根据 CSCO 2025，对初治转移后获得控制、但局部复发合并远处转移的鼻咽癌患者，主要以哪种治疗手段为主？（1 分；请用简短医学术语作答，无需解释。）","reference_answer":"全身系统性药物治疗","answer_slots":[{"slot_id":"S1","slot_focus":"主要治疗手段","minimum_sufficient_answer":"全身系统性药物治疗","accepted_aliases":["全身治疗","系统性治疗","全身系统治疗","系统性药物治疗","全身药物治疗"],"numeric_tolerance":null,"required_concepts":["全身或系统性"],"explicitly_incorrect_or_insufficient":["局部手术","颈清扫","再程放疗","放疗","手术"],"points":1}]}
+{"item_id":"200","interface_type":"vsaq_single_slot","response_count":1,"max_points":1,"stem":"根据 CSCO 2025，在鼻咽癌中，治疗前血浆 EBV DNA 联合 TNM 分期可进一步提高哪方面的效能？（1 分；请用简短医学术语作答，无需解释。）","reference_answer":"风险分层与预后分层","answer_slots":[{"slot_id":"S1","slot_focus":"EBV DNA联合TNM的临床价值","minimum_sufficient_answer":"风险分层与预后分层","accepted_aliases":["风险分层","预后分层","风险预测","预后评估","预后预测"],"numeric_tolerance":null,"required_concepts":[],"explicitly_incorrect_or_insufficient":["早期诊断","人群筛查","无额外价值"],"points":1}]}
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+{"item_id":"203","interface_type":"saq_component","response_count":5,"max_points":5,"stem":"根据 CSCO 2025，EBV DNA 标准化检测应使用哪种样本、哪种抗凝剂？实验室应划分哪3个工作区？（共5分，每项1分。）","reference_answer":"外周血；EDTA；试剂准备区；标本制备区；扩增区","answer_slots":[{"slot_id":"S1","slot_focus":"样本类型","minimum_sufficient_answer":"外周血","accepted_aliases":["静脉血","外周静脉血"],"numeric_tolerance":null,"required_concepts":["外周血"],"explicitly_incorrect_or_insufficient":["唾液","组织","血清"],"points":1},{"slot_id":"S2","slot_focus":"抗凝剂","minimum_sufficient_answer":"EDTA","accepted_aliases":["乙二胺四乙酸","EDTA抗凝剂"],"numeric_tolerance":null,"required_concepts":["EDTA"],"explicitly_incorrect_or_insufficient":["肝素","枸橼酸钠"],"points":1},{"slot_id":"S3","slot_focus":"实验室分区1","minimum_sufficient_answer":"试剂准备区","accepted_aliases":["试剂配制区"],"numeric_tolerance":null,"required_concepts":["试剂准备"],"explicitly_incorrect_or_insufficient":["办公区","休息区"],"points":1},{"slot_id":"S4","slot_focus":"实验室分区2","minimum_sufficient_answer":"标本制备区","accepted_aliases":["样本制备区","标本处理区","样本处理区"],"numeric_tolerance":null,"required_concepts":["标本制备"],"explicitly_incorrect_or_insufficient":["采样区"],"points":1},{"slot_id":"S5","slot_focus":"实验室分区3","minimum_sufficient_answer":"扩增区","accepted_aliases":["核酸扩增区","PCR扩增区","扩增分析区"],"numeric_tolerance":null,"required_concepts":["扩增"],"explicitly_incorrect_or_insufficient":["测序区"],"points":1}]}
+{"item_id":"204","interface_type":"saq_component","response_count":4,"max_points":4,"stem":"根据 CSCO 2025，复发/转移性鼻咽癌一线 GP 联合卡瑞利珠单抗治疗中，卡瑞利珠单抗的剂量和频次、联合化疗疗程数及后续维持策略分别是什么？（共4分，每项1分。）","reference_answer":"1. 200 mg；2. q3w；3. 4-6疗程；4. 单药维持","answer_slots":[{"slot_id":"S1","slot_focus":"卡瑞利珠单抗的单次给药剂量","minimum_sufficient_answer":"200 mg","accepted_aliases":["200mg"],"numeric_tolerance":null,"required_concepts":["200"],"explicitly_incorrect_or_insufficient":["240 mg","3 mg/kg"],"points":1},{"slot_id":"S2","slot_focus":"卡瑞利珠单抗的给药频率","minimum_sufficient_answer":"q3w","accepted_aliases":["每3周1次","每3周","3周一次","每三周"],"numeric_tolerance":null,"required_concepts":[],"explicitly_incorrect_or_insufficient":["q2w","每2周"],"points":1},{"slot_id":"S3","slot_focus":"联合化疗的疗程数","minimum_sufficient_answer":"4-6疗程","accepted_aliases":["4-6周期","4~6疗程","4至6个疗程","4-6"],"numeric_tolerance":null,"required_concepts":["4","6"],"explicitly_incorrect_or_insufficient":["2疗程","最多6疗程"],"points":1},{"slot_id":"S4","slot_focus":"联合化疗结束后的维持治疗策略","minimum_sufficient_answer":"单药维持","accepted_aliases":["卡瑞利珠单抗单药维持","免疫单药维持","单药维持治疗"],"numeric_tolerance":null,"required_concepts":["单药","维持"],"explicitly_incorrect_or_insufficient":["不需要维持","停药","双药维持"],"points":1}]}
+{"item_id":"205","interface_type":"saq_component","response_count":4,"max_points":4,"stem":"根据 CSCO 2025，复发/转移性鼻咽癌一线特瑞普利单抗联合 GP 治疗中，特瑞普利单抗的剂量和频次、联合化疗最大疗程数及后续治疗策略分别是什么？（共4分，每项1分。）","reference_answer":"1. 240 mg；2. q3w；3. 6；4. 单药维持","answer_slots":[{"slot_id":"S1","slot_focus":"特瑞普利单抗的单次给药剂量","minimum_sufficient_answer":"240 mg","accepted_aliases":["240mg","240"],"numeric_tolerance":null,"required_concepts":["240"],"explicitly_incorrect_or_insufficient":["200 mg","3 mg/kg","200"],"points":1},{"slot_id":"S2","slot_focus":"特瑞普利单抗的给药频率","minimum_sufficient_answer":"q3w","accepted_aliases":["每3周1次","每3周一次","3周1次","q21d"],"numeric_tolerance":null,"required_concepts":["3"],"explicitly_incorrect_or_insufficient":["q2w","q6w","2周","6周"],"points":1},{"slot_id":"S3","slot_focus":"联合GP化疗的最大疗程数","minimum_sufficient_answer":"6","accepted_aliases":["6疗程","6个周期","最多6疗程","6次"],"numeric_tolerance":null,"required_concepts":["6"],"explicitly_incorrect_or_insufficient":["4","4-6","8"],"points":1},{"slot_id":"S4","slot_focus":"联合化疗结束后的后续治疗策略","minimum_sufficient_answer":"单药维持","accepted_aliases":["特瑞普利单抗单药维持","免疫单药维持","维持治疗","单药维持治疗"],"numeric_tolerance":null,"required_concepts":["维持"],"explicitly_incorrect_or_insufficient":["停药","观察"],"points":1}]}
+{"item_id":"206","interface_type":"saq_component","response_count":3,"max_points":3,"stem":"根据 CSCO 2025，复发/转移性鼻咽癌一线 GP 联合替雷利珠单抗治疗中，替雷利珠单抗的剂量/频次、联合化疗疗程数及后续治疗策略分别是什么？（共3分，每项1分。）","reference_answer":"1. 200 mg q3w；2. 4-6疗程；3. 单药维持","answer_slots":[{"slot_id":"S1","slot_focus":"替雷利珠单抗的推荐剂量与给药频率","minimum_sufficient_answer":"200 mg q3w","accepted_aliases":["200mg 每3周1次","200mg 每3周一次"],"numeric_tolerance":null,"required_concepts":["200","q3w|3周"],"explicitly_incorrect_or_insufficient":["240 mg","q2w","3 mg/kg"],"points":1},{"slot_id":"S2","slot_focus":"联合化疗的推荐疗程数","minimum_sufficient_answer":"4-6疗程","accepted_aliases":["4-6","4至6个疗程","4~6疗程"],"numeric_tolerance":null,"required_concepts":["4-6"],"explicitly_incorrect_or_insufficient":["2疗程","6疗程","4疗程"],"points":1},{"slot_id":"S3","slot_focus":"联合化疗结束后的后续治疗策略","minimum_sufficient_answer":"单药维持","accepted_aliases":["替雷利珠单抗单药维持","免疫单药维持"],"numeric_tolerance":null,"required_concepts":["单药","维持"],"explicitly_incorrect_or_insufficient":["停药","继续联合化疗"],"points":1}]}
+{"item_id":"207","interface_type":"saq_component","response_count":2,"max_points":2,"stem":"根据 CSCO 2025，顺铂或卡铂联合5-FU作为复发/转移性鼻咽癌（RM-NPC）一线2A类方案时，写出其推荐的2项疗程参数（单疗程天数、总疗程数）。（共2分，每项1分。）","reference_answer":"21天；4-6疗程","answer_slots":[{"slot_id":"S1","slot_focus":"单疗程天数","minimum_sufficient_answer":"21天","accepted_aliases":["3周","21"],"numeric_tolerance":null,"required_concepts":["21"],"explicitly_incorrect_or_insufficient":["14天","28天"],"points":1},{"slot_id":"S2","slot_focus":"总疗程数","minimum_sufficient_answer":"4-6疗程","accepted_aliases":["4-6","4至6","4~6周期"],"numeric_tolerance":null,"required_concepts":["4-6"],"explicitly_incorrect_or_insufficient":["直至进展","2疗程","8疗程"],"points":1}]}
+{"item_id":"208","interface_type":"saq_component","response_count":3,"max_points":3,"stem":"根据 CSCO 2025，紫杉醇（或紫杉醇白蛋白）+ 顺铂 + 卡培他滨作为鼻咽癌一线治疗方案，请写出该方案的3项具体特征：1. 一个疗程的周期天数；2. 化疗阶段后用于维持治疗的药物名称；3. 维持治疗的终止条件。（共3分，每项1分。）","reference_answer":"1. 21天；2. 卡培他滨；3. 疾病进展或不良反应不可耐受","answer_slots":[{"slot_id":"S1","slot_focus":"疗程周期天数","minimum_sufficient_answer":"21天","accepted_aliases":["21","21d","3周"],"numeric_tolerance":null,"required_concepts":["21"],"explicitly_incorrect_or_insufficient":["14天","28天"],"points":1},{"slot_id":"S2","slot_focus":"维持治疗药物","minimum_sufficient_answer":"卡培他滨","accepted_aliases":["Capecitabine","希罗达"],"numeric_tolerance":null,"required_concepts":["卡培他滨"],"explicitly_incorrect_or_insufficient":["紫杉醇","顺铂","紫杉醇白蛋白"],"points":1},{"slot_id":"S3","slot_focus":"维持治疗终止条件","minimum_sufficient_answer":"疾病进展或不可耐受","accepted_aliases":["疾病进展或不良反应不可耐受","PD或不可耐受","疾病进展或毒性不可耐受"],"numeric_tolerance":null,"required_concepts":["进展","不可耐受"],"explicitly_incorrect_or_insufficient":["固定疗程结束","治愈","仅写疾病进展"],"points":1}]}
+{"item_id":"209","interface_type":"saq_component","response_count":5,"max_points":5,"stem":"根据 CSCO 2025，卡铂联合紫杉醇作为复发/转移性鼻咽癌一线 2A类方案时，两药剂量、给药日、疗程周期及总疗程数分别是什么？（共5分，每项1分。）","reference_answer":"1. 5；2. 175；3. 1；4. 21；5. 4-6","answer_slots":[{"slot_id":"S1","slot_focus":"卡铂的剂量（AUC）","minimum_sufficient_answer":"5","accepted_aliases":["AUC 5","5"],"numeric_tolerance":null,"required_concepts":["5"],"explicitly_incorrect_or_insufficient":["2","6"],"points":1},{"slot_id":"S2","slot_focus":"紫杉醇的剂量（mg/m²）","minimum_sufficient_answer":"175","accepted_aliases":["175 mg/m²","175"],"numeric_tolerance":null,"required_concepts":["175"],"explicitly_incorrect_or_insufficient":["80","135"],"points":1},{"slot_id":"S3","slot_focus":"两药的给药时间（第几天）","minimum_sufficient_answer":"1","accepted_aliases":["第1天","d1","Day 1"],"numeric_tolerance":null,"required_concepts":["1"],"explicitly_incorrect_or_insufficient":["8","每周"],"points":1},{"slot_id":"S4","slot_focus":"单疗程周期天数","minimum_sufficient_answer":"21","accepted_aliases":["21天","21d"],"numeric_tolerance":null,"required_concepts":["21"],"explicitly_incorrect_or_insufficient":["28","14","7"],"points":1},{"slot_id":"S5","slot_focus":"推荐的总疗程数","minimum_sufficient_answer":"4-6","accepted_aliases":["4~6","4到6","4-6疗程","4-6周期"],"numeric_tolerance":null,"required_concepts":["4","6"],"explicitly_incorrect_or_insufficient":["8","单药维持"],"points":1}]}
+{"item_id":"210","interface_type":"saq_component","response_count":2,"max_points":2,"stem":"根据 CSCO 2025，顺铂联合多西他赛作为复发/转移性鼻咽癌（RM-NPC）一线2A类方案时，请写出关于治疗周期的2项具体参数：1）单疗程的天数；2）推荐的总疗程数。（共2分，每项1分。）","reference_answer":"1）21天；2）4-6疗程","answer_slots":[{"slot_id":"S1","slot_focus":"单疗程天数","minimum_sufficient_answer":"21天","accepted_aliases":["21","21d","21天一疗程"],"numeric_tolerance":null,"required_concepts":["21"],"explicitly_incorrect_or_insufficient":["14天","28天"],"points":1},{"slot_id":"S2","slot_focus":"推荐总疗程数","minimum_sufficient_answer":"4-6","accepted_aliases":["4至6","4~6","4到6","4-6个疗程","4-6疗程"],"numeric_tolerance":null,"required_concepts":["4","6"],"explicitly_incorrect_or_insufficient":["最多8疗程","固定2疗程","直到进展"],"points":1}]}
+{"item_id":"211","interface_type":"saq_component","response_count":2,"max_points":2,"stem":"根据 CSCO 2025，对于顺铂 + 吉西他滨 + 恩度这一 2B 类方案，请写出其周期特征的 2 项参数：1. 每疗程的天数；2. 最多进行的疗程数。（共2分，每项1分。）","reference_answer":"21天一疗程，最多4疗程","answer_slots":[{"slot_id":"S1","slot_focus":"每疗程的天数","minimum_sufficient_answer":"21天","accepted_aliases":["21","21d"],"numeric_tolerance":null,"required_concepts":["21"],"explicitly_incorrect_or_insufficient":["14天","28天"],"points":1},{"slot_id":"S2","slot_focus":"最多进行的疗程数","minimum_sufficient_answer":"4个","accepted_aliases":["4","4疗程","最多4疗程"],"numeric_tolerance":null,"required_concepts":["4"],"explicitly_incorrect_or_insufficient":["6","8","直到进展"],"points":1}]}
+{"item_id":"212","interface_type":"saq_component","response_count":2,"max_points":2,"stem":"根据 CSCO 2025，关于帕博利珠单抗在鼻咽癌二线及以上治疗中的应用，请写出以下2项内容：1. 推荐类别；2. 附带的前提条件。（共2分，每项1分。）","reference_answer":"1. 2A类；2. 一线未接受PD-1/PD-L1抑制剂","answer_slots":[{"slot_id":"S1","slot_focus":"推荐类别","minimum_sufficient_answer":"2A类","accepted_aliases":["2A"],"numeric_tolerance":null,"required_concepts":["2A"],"explicitly_incorrect_or_insufficient":["1A类","2B类","3类","1A","2B","3"],"points":1},{"slot_id":"S2","slot_focus":"前提条件","minimum_sufficient_answer":"一线未接受PD-1/PD-L1抑制剂","accepted_aliases":["一线未使用PD-1/PD-L1抑制剂","既往未接受PD-1/PD-L1抑制剂","未接受过PD-1/PD-L1抑制剂"],"numeric_tolerance":null,"required_concepts":["未","PD-1/PD-L1"],"explicitly_incorrect_or_insufficient":["一线已接受PD-1/PD-L1抑制剂","儿童患者","无前提条件"],"points":1}]}
+{"item_id":"213","interface_type":"saq_component","response_count":2,"max_points":2,"stem":"根据 CSCO 2025，局部晚期鼻咽癌诱导化疗中，GP 与 TPF 方案的典型给药频率和总疗程数分别是多少？请写出这2项指标。（共2分，每项1分。）","reference_answer":"每3周一次；3疗程","answer_slots":[{"slot_id":"S1","slot_focus":"给药频率","minimum_sufficient_answer":"每3周一次","accepted_aliases":["3周","每3周","q3w","Q3W","3周一次"],"numeric_tolerance":null,"required_concepts":["3"],"explicitly_incorrect_or_insufficient":["1周","2周","4周","每周"],"points":1},{"slot_id":"S2","slot_focus":"总疗程数","minimum_sufficient_answer":"3疗程","accepted_aliases":["3","3个疗程","共3疗程","3周期"],"numeric_tolerance":null,"required_concepts":["3"],"explicitly_incorrect_or_insufficient":["1","2","4","6"],"points":1}]}
+{"item_id":"214","interface_type":"saq_component","response_count":2,"max_points":2,"stem":"根据 CSCO 2025 表10，对 T3N0 且无高危不良预后因素的鼻咽癌患者，分别写出其对应的1A类推荐方案和2A类推荐方案（共2项）。（共2分，每项1分。）","reference_answer":"1A类：单纯放疗；2A类：同期放化疗","answer_slots":[{"slot_id":"S1","slot_focus":"1A类推荐方案","minimum_sufficient_answer":"单纯放疗","accepted_aliases":["单纯放射治疗","放疗","RT"],"numeric_tolerance":null,"required_concepts":["单纯放疗"],"explicitly_incorrect_or_insufficient":["化疗","同期放化疗","诱导化疗"],"points":1},{"slot_id":"S2","slot_focus":"2A类推荐方案","minimum_sufficient_answer":"同期放化疗","accepted_aliases":["同步放化疗","CCRT"],"numeric_tolerance":null,"required_concepts":["同期放化疗"],"explicitly_incorrect_or_insufficient":["单纯放疗","诱导化疗","辅助化疗"],"points":1}]}
+{"item_id":"215","interface_type":"saq_component","response_count":2,"max_points":2,"stem":"根据 CSCO 2025 表10，对于 T1–2N1 且不具备淋巴结≥3 cm、Ⅳ/ⅤB区淋巴结转移、包膜外侵或 EBV DNA≥4,000 等任一高危因素的鼻咽癌患者，单纯放疗和同期放化疗分别属于哪一推荐类别？（共2分，每项1分。）","reference_answer":"1. 1A类；2. 2A类","answer_slots":[{"slot_id":"S1","slot_focus":"单纯放疗的推荐类别","minimum_sufficient_answer":"1A类","accepted_aliases":["1A","1A级","1A类推荐"],"numeric_tolerance":null,"required_concepts":["1A"],"explicitly_incorrect_or_insufficient":["2A","1B","2B","3类"],"points":1},{"slot_id":"S2","slot_focus":"同期放化疗的推荐类别","minimum_sufficient_answer":"2A类","accepted_aliases":["2A","2A级","2A类推荐"],"numeric_tolerance":null,"required_concepts":["2A"],"explicitly_incorrect_or_insufficient":["1A","1B","2B","3类"],"points":1}]}
+{"item_id":"216","interface_type":"saq_component","response_count":3,"max_points":3,"stem":"根据 CSCO 2025 表10，对于 T1-4N2-3 和 T4N1 鼻咽癌，列出 3 项 1A类推荐的治疗方案。（共3分，每项1分。）","reference_answer":"1. 诱导化疗+同期放化疗；2. 诱导化疗+同期放化疗+节拍辅助化疗；3. 诱导化疗+同期放化疗+信迪利单抗/卡瑞利珠单抗","answer_slots":[{"slot_id":"S1","slot_focus":"基础方案","minimum_sufficient_answer":"诱导化疗+同期放化疗","accepted_aliases":["IC+CCRT","诱导化疗联合同期放化疗"],"numeric_tolerance":null,"required_concepts":["诱导化疗","同期放化疗"],"explicitly_incorrect_or_insufficient":["单纯放疗","仅同期放化疗","仅诱导化疗"],"points":1},{"slot_id":"S2","slot_focus":"联合节拍辅助化疗方案","minimum_sufficient_answer":"诱导化疗+同期放化疗+节拍辅助化疗","accepted_aliases":["IC+CCRT+节拍辅助化疗","诱导化疗联合同期放化疗及节拍辅助化疗"],"numeric_tolerance":null,"required_concepts":["诱导化疗","同期放化疗","节拍辅助化疗"],"explicitly_incorrect_or_insufficient":["常规辅助化疗","未指明节拍"],"points":1},{"slot_id":"S3","slot_focus":"联合免疫方案","minimum_sufficient_answer":"诱导化疗+同期放化疗+信迪利单抗/卡瑞利珠单抗","accepted_aliases":["IC+CCRT+信迪利单抗/卡瑞利珠单抗","诱导化疗+同期放化疗+信迪利单抗","诱导化疗+同期放化疗+卡瑞利珠单抗","IC+CCRT+信迪利单抗","IC+CCRT+卡瑞利珠单抗"],"numeric_tolerance":null,"required_concepts":["诱导化疗","同期放化疗"],"explicitly_incorrect_or_insufficient":["未指明信迪利单抗或卡瑞利珠单抗","单纯免疫治疗"],"points":1}]}
+{"item_id":"217","interface_type":"saq_component","response_count":2,"max_points":2,"stem":"根据 CSCO 2025 表11，局部晚期鼻咽癌的诱导化疗方案中，被列为 1B 类推荐的双药联合方案包含哪两种具体药物？列出 2 项。（共2分，每项1分。）","reference_answer":"顺铂；5-FU","answer_slots":[{"slot_id":"S1","slot_focus":"铂类药物","minimum_sufficient_answer":"顺铂","accepted_aliases":["Cisplatin","DDP"],"numeric_tolerance":null,"required_concepts":["顺铂"],"explicitly_incorrect_or_insufficient":["卡铂","奈达铂","奥沙利铂"],"points":1},{"slot_id":"S2","slot_focus":"抗代谢药物","minimum_sufficient_answer":"5-FU","accepted_aliases":["5-氟尿嘧啶","氟尿嘧啶","Fluorouracil"],"numeric_tolerance":null,"required_concepts":["氟尿嘧啶"],"explicitly_incorrect_or_insufficient":["卡培他滨","替吉奥","紫杉醇","吉西他滨"],"points":1}]}
+{"item_id":"218","interface_type":"saq_component","response_count":2,"max_points":2,"stem":"根据 CSCO 2025 表11，列出局部晚期鼻咽癌辅助化疗中推荐层级为1A类的2项方案。（共2分，每项1分。）","reference_answer":"节拍卡培他滨；顺铂+5-FU","answer_slots":[{"slot_id":"S1","slot_focus":"方案1","minimum_sufficient_answer":"节拍卡培他滨","accepted_aliases":["卡培他滨节拍化疗","metronomic capecitabine"],"numeric_tolerance":null,"required_concepts":["节拍","卡培他滨"],"explicitly_incorrect_or_insufficient":["卡培他滨","顺铂+卡培他滨"],"points":1},{"slot_id":"S2","slot_focus":"方案2","minimum_sufficient_answer":"顺铂+5-FU","accepted_aliases":["PF方案","顺铂联合氟尿嘧啶","顺铂+氟尿嘧啶","Cisplatin + 5-FU"],"numeric_tolerance":null,"required_concepts":["顺铂","5-FU"],"explicitly_incorrect_or_insufficient":["顺铂单药","5-FU单药"],"points":1}]}
+{"item_id":"219","interface_type":"saq_component","response_count":2,"max_points":2,"stem":"根据 CSCO 2025 表17，非转移儿童鼻咽癌分层中，ⅣB期的推荐治疗方案及证据类别分别是什么？请写出这2项内容。（共2分，每项1分。）","reference_answer":"1. 全身化疗±局部放疗；2. 3类","answer_slots":[{"slot_id":"S1","slot_focus":"ⅣB期的推荐治疗方案","minimum_sufficient_answer":"全身化疗±局部放疗","accepted_aliases":["全身化疗+/-局部放疗","全身化疗加或不加局部放疗","全身化疗联合或不联合局部放疗"],"numeric_tolerance":null,"required_concepts":["全身化疗","局部放疗"],"explicitly_incorrect_or_insufficient":["单纯放疗","诱导化疗+同期放化疗","免疫联合放疗"],"points":1},{"slot_id":"S2","slot_focus":"证据类别","minimum_sufficient_answer":"3类","accepted_aliases":["3类证据","3"],"numeric_tolerance":null,"required_concepts":["3"],"explicitly_incorrect_or_insufficient":["1A类","2A类","2B类","1类"],"points":1}]}
+{"item_id":"220","interface_type":"vsaq_single_slot","response_count":1,"max_points":1,"stem":"根据 CSCO 2025，儿童鼻咽癌诱导化疗推荐中，GP 方案的推荐等级是哪一类？（1 分；请用简短医学术语作答，无需解释。）","reference_answer":"3类","answer_slots":[{"slot_id":"S1","slot_focus":"GP方案的推荐等级","minimum_sufficient_answer":"3类","accepted_aliases":["3","Category 3","3级"],"numeric_tolerance":null,"required_concepts":["3"],"explicitly_incorrect_or_insufficient":["1A类","1B类","2A类","2B类","1类","2类"],"points":1}]}
+{"item_id":"221","interface_type":"saq_component","response_count":2,"max_points":2,"stem":"根据 CSCO 2025 指南，写出儿童鼻咽癌 TPF 方案的 2 项给药参数：1. 给药周期；2. 总疗程数。（共2分，每项1分。）","reference_answer":"1. 每3周一次；2. 3-4疗程","answer_slots":[{"slot_id":"S1","slot_focus":"给药周期","minimum_sufficient_answer":"3周","accepted_aliases":["每3周一次","3周一次","q3w","21天"],"numeric_tolerance":null,"required_concepts":["3周"],"explicitly_incorrect_or_insufficient":["2周","4周","每周"],"points":1},{"slot_id":"S2","slot_focus":"总疗程数","minimum_sufficient_answer":"3-4","accepted_aliases":["3-4疗程","3至4个疗程","3~4"],"numeric_tolerance":null,"required_concepts":["3-4"],"explicitly_incorrect_or_insufficient":["2","6","7","3"],"points":1}]}
+{"item_id":"222","interface_type":"saq_component","response_count":2,"max_points":2,"stem":"根据 CSCO 2025 表19，儿童鼻咽癌 GP 诱导方案中，吉西他滨与顺铂的给药时间分别是什么？请分别写出这2项药物的给药时间（以dX格式表示）。（共2分，每项1分。）","reference_answer":"吉西他滨 d1、8；顺铂 d1","answer_slots":[{"slot_id":"S1","slot_focus":"吉西他滨的给药时间","minimum_sufficient_answer":"d1、8","accepted_aliases":["d1,8","d1和8","d1, d8","第1、8天"],"numeric_tolerance":null,"required_concepts":["1","8"],"explicitly_incorrect_or_insufficient":["d1","d8","d1-4"],"points":1},{"slot_id":"S2","slot_focus":"顺铂的给药时间","minimum_sufficient_answer":"d1","accepted_aliases":["第1天"],"numeric_tolerance":null,"required_concepts":["1"],"explicitly_incorrect_or_insufficient":["d8","d1-4"],"points":1}]}
+{"item_id":"223","interface_type":"saq_component","response_count":4,"max_points":4,"stem":"根据 CSCO 2025，儿童鼻咽癌同期 DDP 化疗的单周方案和三周方案中，推荐剂量及总疗程数分别是什么？（共4分，每项1分。）","reference_answer":"1. 30-40；2. 7；3. 100；4. 3","answer_slots":[{"slot_id":"S1","slot_focus":"单周方案的推荐剂量","minimum_sufficient_answer":"30-40","accepted_aliases":["30~40","30至40","30-40 mg/m²"],"numeric_tolerance":"exact","required_concepts":["30-40"],"explicitly_incorrect_or_insufficient":["20","100"],"points":1},{"slot_id":"S2","slot_focus":"单周方案的总疗程数","minimum_sufficient_answer":"7","accepted_aliases":["7个","7疗程","共7疗程"],"numeric_tolerance":"exact","required_concepts":["7"],"explicitly_incorrect_or_insufficient":["3","4","6"],"points":1},{"slot_id":"S3","slot_focus":"三周方案的推荐剂量","minimum_sufficient_answer":"100","accepted_aliases":["100 mg/m²"],"numeric_tolerance":"exact","required_concepts":["100"],"explicitly_incorrect_or_insufficient":["80","30-40"],"points":1},{"slot_id":"S4","slot_focus":"三周方案的总疗程数","minimum_sufficient_answer":"3","accepted_aliases":["3个","3疗程","共3疗程"],"numeric_tolerance":"exact","required_concepts":["3"],"explicitly_incorrect_or_insufficient":["7","6"],"points":1}]}
+{"item_id":"224","interface_type":"vsaq_single_slot","response_count":1,"max_points":1,"stem":"根据 CSCO 2025 指南，儿童鼻咽癌诱导化疗后达到完全缓解（CR）时，PTVp/PTVn 的推荐放疗剂量是多少？（1 分；请用简短医学术语作答，无需解释。）","reference_answer":"60-61.2 Gy","answer_slots":[{"slot_id":"S1","slot_focus":"诱导化疗后CR的PTVp/PTVn放疗剂量","minimum_sufficient_answer":"60-61.2 Gy","accepted_aliases":["60~61.2 Gy","60至61.2 Gy","60-61.2Gy"],"numeric_tolerance":null,"required_concepts":["60","61.2"],"explicitly_incorrect_or_insufficient":["68-70 Gy","60-66 Gy","54 Gy","60 Gy","61.2 Gy"],"points":1}]}
+{"item_id":"225","interface_type":"saq_component","response_count":2,"max_points":2,"stem":"根据 CSCO 2025，鼻咽癌随访中 PET/CT 主要适用于哪2种情况或人群？请列出2项。（共2分，每项1分。）","reference_answer":"1. 临床怀疑远处转移；2. EBV DNA升高的T4/N3患者","answer_slots":[{"slot_id":"S1","slot_focus":"基于临床怀疑的触发条件","minimum_sufficient_answer":"临床怀疑远处转移","accepted_aliases":["怀疑远处转移","临床怀疑转移"],"numeric_tolerance":null,"required_concepts":["怀疑","远处转移"],"explicitly_incorrect_or_insufficient":["常规复查","怀疑局部复发"],"points":1},{"slot_id":"S2","slot_focus":"基于分期和生物标志物的触发条件","minimum_sufficient_answer":"EBV DNA升高的T4/N3患者","accepted_aliases":["EBV DNA拷贝数升高的T4/N3患者","T4/N3且EBV DNA升高"],"numeric_tolerance":null,"required_concepts":["EBV DNA升高","T4/N3"],"explicitly_incorrect_or_insufficient":["所有EBV DNA升高的患者","所有T4/N3患者","T1N0患者"],"points":1}]}
+{"item_id":"226","interface_type":"saq_component","response_count":3,"max_points":3,"stem":"根据 CSCO 2025 §3.3及表8，写出鼻咽原发灶 GTVp 外扩形成 PTVp 的3项参数：1. 边界外扩距离（mm）；2. 典型处方总剂量（cGy）；3. 分次数量（F）。（共3分，每项1分。）","reference_answer":"3 mm；6996 cGy；33 F","answer_slots":[{"slot_id":"S1","slot_focus":"边界外扩距离（mm）","minimum_sufficient_answer":"3","accepted_aliases":["3mm","3 mm"],"numeric_tolerance":null,"required_concepts":["3"],"explicitly_incorrect_or_insufficient":["1","5","10"],"points":1},{"slot_id":"S2","slot_focus":"典型处方总剂量（cGy）","minimum_sufficient_answer":"6996","accepted_aliases":["6996cGy","6996 cGy","69.96Gy","69.96 Gy"],"numeric_tolerance":null,"required_concepts":["6996"],"explicitly_incorrect_or_insufficient":["7000","70","6006","5412"],"points":1},{"slot_id":"S3","slot_focus":"分次数量（F）","minimum_sufficient_answer":"33","accepted_aliases":["33F","33 F","33次"],"numeric_tolerance":null,"required_concepts":["33"],"explicitly_incorrect_or_insufficient":["35"],"points":1}]}
+{"item_id":"227","interface_type":"saq_component","response_count":2,"max_points":2,"stem":"根据 CSCO 2025 第3.3节/表8，针对颈部淋巴结 GTVn，请写出以下2项放疗参数：1. GTVn 外扩形成 PTVn 的边界（mm）；2. 典型处方剂量范围及分次（格式：XXXX-XXXX cGy/XX F）。（共2分，每项1分。）","reference_answer":"1. 5 mm；2. 6600-6996 cGy/33 F","answer_slots":[{"slot_id":"S1","slot_focus":"PTVn边界","minimum_sufficient_answer":"5 mm","accepted_aliases":["5","5mm"],"numeric_tolerance":null,"required_concepts":["5"],"explicitly_incorrect_or_insufficient":["3 mm","1 mm","10 mm"],"points":1},{"slot_id":"S2","slot_focus":"处方剂量及分次","minimum_sufficient_answer":"6600-6996 cGy/33 F","accepted_aliases":["6600~6996 cGy/33 F","66-69.96 Gy/33 F","6600-6996cGy/33F"],"numeric_tolerance":null,"required_concepts":["6600","6996","33"],"explicitly_incorrect_or_insufficient":["6006 cGy/33 F","5412-5610 cGy/33 F"],"points":1}]}
+{"item_id":"228","interface_type":"saq_component","response_count":3,"max_points":3,"stem":"根据 CSCO 2025，CTVp1 的常规外扩距离、通常应包括的解剖结构及邻近重要危及器官时的最小外扩距离分别是什么？（共3分，每项1分。）","reference_answer":"1. 5-10mm；2. 全部鼻咽黏膜；3. 1mm","answer_slots":[{"slot_id":"S1","slot_focus":"常规外扩距离范围","minimum_sufficient_answer":"5-10mm","accepted_aliases":["5~10mm","5至10mm","5-10毫米"],"numeric_tolerance":null,"required_concepts":["5-10"],"explicitly_incorrect_or_insufficient":["15mm","5mm","10mm"],"points":1},{"slot_id":"S2","slot_focus":"通常包括的解剖结构","minimum_sufficient_answer":"全部鼻咽黏膜","accepted_aliases":["整个鼻咽黏膜","鼻咽黏膜"],"numeric_tolerance":null,"required_concepts":["鼻咽黏膜"],"explicitly_incorrect_or_insufficient":["淋巴结","原发灶"],"points":1},{"slot_id":"S3","slot_focus":"邻近重要OAR时的最小外扩距离","minimum_sufficient_answer":"1mm","accepted_aliases":["1毫米","1"],"numeric_tolerance":null,"required_concepts":["1"],"explicitly_incorrect_or_insufficient":["0mm","2mm","不外扩"],"points":1}]}
+{"item_id":"229","interface_type":"saq_component","response_count":2,"max_points":2,"stem":"根据 CSCO 2025，鼻腔受侵时，CTV2 应包括哪2个解剖区域？（共2分，每项1分。）","reference_answer":"翼腭窝；后组筛窦","answer_slots":[{"slot_id":"S1","slot_focus":"解剖区域1","minimum_sufficient_answer":"翼腭窝","accepted_aliases":[],"numeric_tolerance":null,"required_concepts":["翼腭窝"],"explicitly_incorrect_or_insufficient":[],"points":1},{"slot_id":"S2","slot_focus":"解剖区域2","minimum_sufficient_answer":"后组筛窦","accepted_aliases":["后筛窦"],"numeric_tolerance":null,"required_concepts":["后组筛窦"],"explicitly_incorrect_or_insufficient":["前组筛窦","筛窦"],"points":1}]}
+{"item_id":"230","interface_type":"saq_component","response_count":3,"max_points":3,"stem":"根据 CSCO 2025，写出 CTVn1 的外扩距离、诱导化疗后的勾画范围及 PTVn1 处方剂量。（共3分，每项1分。）","reference_answer":"1. 3-5 mm；2. 化疗前侵犯范围；3. 6006 cGy/33 F","answer_slots":[{"slot_id":"S1","slot_focus":"CTVn1外扩毫米数","minimum_sufficient_answer":"3-5 mm","accepted_aliases":["3~5 mm","3至5 mm","3-5毫米"],"numeric_tolerance":"必须准确回答3-5","required_concepts":["3-5"],"explicitly_incorrect_or_insufficient":["10 mm","5 mm"],"points":1},{"slot_id":"S2","slot_focus":"诱导化疗后的勾画范围","minimum_sufficient_answer":"化疗前侵犯范围","accepted_aliases":["化疗前边界","诱导化疗前范围","化疗前范围/边界"],"numeric_tolerance":null,"required_concepts":["化疗前","范围"],"explicitly_incorrect_or_insufficient":["化疗后范围","原发灶范围"],"points":1},{"slot_id":"S3","slot_focus":"PTVn1典型剂量与分次","minimum_sufficient_answer":"6006 cGy/33 F","accepted_aliases":["60.06 Gy/33 F","6006cGy/33F","60.06Gy/33F"],"numeric_tolerance":"剂量允许6006 cGy或60.06 Gy，分次必须为33 F","required_concepts":["6006","33"],"explicitly_incorrect_or_insufficient":["5412 cGy/33 F","6000 cGy/30 F"],"points":1}]}
+{"item_id":"231","interface_type":"saq_component","response_count":2,"max_points":2,"stem":"根据 CSCO 2025 表12，复发/转移性鼻咽癌一线治疗中，2A类口服氟尿嘧啶类药物联合铂类方案由哪2种药物组成？（共2分，每项1分。）","reference_answer":"卡培他滨，顺铂","answer_slots":[{"slot_id":"S1","slot_focus":"口服氟尿嘧啶类药物","minimum_sufficient_answer":"卡培他滨","accepted_aliases":["Capecitabine","Xeloda","希罗达"],"numeric_tolerance":null,"required_concepts":["卡培他滨"],"explicitly_incorrect_or_insufficient":["氟尿嘧啶","5-FU","替吉奥","S-1"],"points":1},{"slot_id":"S2","slot_focus":"铂类药物","minimum_sufficient_answer":"顺铂","accepted_aliases":["Cisplatin","DDP"],"numeric_tolerance":null,"required_concepts":["顺铂"],"explicitly_incorrect_or_insufficient":["卡铂","奈达铂","奥沙利铂","铂类"],"points":1}]}
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+{"item_id":"234","interface_type":"saq_component","response_count":3,"max_points":3,"stem":"根据 CSCO 2025，复发/转移性鼻咽癌二线及以上免疫治疗中，卡瑞利珠单抗、特瑞普利单抗和纳武利尤单抗的推荐类别，帕博利珠单抗的推荐类别及其使用前提分别是什么？（共3分，每项1分。）","reference_answer":"1. 2B类；2. 2A类；3. 一线未接受PD-1/PD-L1抑制剂","answer_slots":[{"slot_id":"S1","slot_focus":"卡瑞利珠单抗、特瑞普利单抗、纳武利尤单抗的推荐类别","minimum_sufficient_answer":"2B类","accepted_aliases":["2B","IIB","IIB类"],"numeric_tolerance":null,"required_concepts":["2B"],"explicitly_incorrect_or_insufficient":["2A","1A","3类"],"points":1},{"slot_id":"S2","slot_focus":"帕博利珠单抗的推荐类别","minimum_sufficient_answer":"2A类","accepted_aliases":["2A","IIA","IIA类"],"numeric_tolerance":null,"required_concepts":["2A"],"explicitly_incorrect_or_insufficient":["2B","1A","3类"],"points":1},{"slot_id":"S3","slot_focus":"帕博利珠单抗的前提条件","minimum_sufficient_answer":"一线未接受PD-1/PD-L1抑制剂","accepted_aliases":["一线未使用PD-1/PD-L1","既往未接受PD-1/PD-L1","一线未用免疫治疗"],"numeric_tolerance":null,"required_concepts":["未","PD-1"],"explicitly_incorrect_or_insufficient":["一线已接受PD-1/PD-L1","无条件"],"points":1}]}
+{"item_id":"235","interface_type":"saq_component","response_count":6,"max_points":6,"stem":"根据 CSCO 2025 表22及注释，鼻咽癌患者在治疗后4–5年及5年以上的长期随访中，仍建议关注哪6个方面？（共6分，每项1分。）","reference_answer":"口腔、听力、视力、吞咽、营养、功能康复","answer_slots":[{"slot_id":"S1","slot_focus":"口腔评估","minimum_sufficient_answer":"口腔","accepted_aliases":["口腔评估","口腔健康"],"numeric_tolerance":null,"required_concepts":["口腔"],"explicitly_incorrect_or_insufficient":[],"points":1},{"slot_id":"S2","slot_focus":"听力评估","minimum_sufficient_answer":"听力","accepted_aliases":["听力评估","听觉"],"numeric_tolerance":null,"required_concepts":["听力"],"explicitly_incorrect_or_insufficient":[],"points":1},{"slot_id":"S3","slot_focus":"视力评估","minimum_sufficient_answer":"视力","accepted_aliases":["视力评估","视觉"],"numeric_tolerance":null,"required_concepts":["视力"],"explicitly_incorrect_or_insufficient":[],"points":1},{"slot_id":"S4","slot_focus":"吞咽评估","minimum_sufficient_answer":"吞咽","accepted_aliases":["吞咽评估","吞咽功能"],"numeric_tolerance":null,"required_concepts":["吞咽"],"explicitly_incorrect_or_insufficient":[],"points":1},{"slot_id":"S5","slot_focus":"营养评估","minimum_sufficient_answer":"营养","accepted_aliases":["营养评估","营养状况"],"numeric_tolerance":null,"required_concepts":["营养"],"explicitly_incorrect_or_insufficient":[],"points":1},{"slot_id":"S6","slot_focus":"功能康复评估","minimum_sufficient_answer":"功能康复","accepted_aliases":["功能/康复","功能评估","康复评估"],"numeric_tolerance":null,"required_concepts":["康复"],"explicitly_incorrect_or_insufficient":[],"points":1}]}
+{"item_id":"236","interface_type":"vsaq_single_slot","response_count":1,"max_points":1,"stem":"根据 NCCN 2025，当总剂量超过 70 Gy 时，为降低毒性，至少部分疗程的单次剂量应低于多少？（1 分；请用简短医学术语作答，无需解释。）","reference_answer":"<2.0 Gy/次","answer_slots":[{"slot_id":"S1","slot_focus":"高总剂量时部分疗程的单次剂量上限","minimum_sufficient_answer":"<2.0 Gy/次","accepted_aliases":["<2 Gy/次","<2 Gy/fraction","小于2 Gy/次"],"numeric_tolerance":null,"required_concepts":[],"explicitly_incorrect_or_insufficient":["2 Gy/次","2.0 Gy/次","≤2 Gy/次"],"points":1}]}
+{"item_id":"237","interface_type":"vsaq_single_slot","response_count":1,"max_points":1,"stem":"根据 NCCN 2025 ADV-A/NASO-A 脚注，当鼻咽癌放疗剂量 >70 Gy 时，在某些临床情况下可额外增加多少次照射（boost）？（1 分；请用简短医学术语作答，无需解释。）","reference_answer":"2-3次","answer_slots":[{"slot_id":"S1","slot_focus":"额外增加的照射次数","minimum_sufficient_answer":"2-3次","accepted_aliases":["2-3","2至3次","2~3次","2到3次","2-3 fractions"],"numeric_tolerance":null,"required_concepts":["2","3"],"explicitly_incorrect_or_insufficient":["1次","4次","10次"],"points":1}]}
+{"item_id":"238","interface_type":"saq_component","response_count":2,"max_points":2,"stem":"根据 NCCN 2025 ADV-A/NASO-A，在常规光子放疗无法满足正常组织限量或会影响标准肿瘤/术后靶体积剂量时，可考虑使用质子治疗。请列出这2种情况。（共2分，每项1分。）","reference_answer":"1. 无法满足正常组织限量；2. 影响标准肿瘤/术后体积剂量","answer_slots":[{"slot_id":"S1","slot_focus":"正常组织限量","minimum_sufficient_answer":"无法满足正常组织限量","accepted_aliases":["不能满足正常组织约束","正常组织受量超标","无法达到正常组织剂量限制","cannot meet normal tissue constraints"],"numeric_tolerance":null,"required_concepts":["正常组织","无法满足限量/超标"],"explicitly_incorrect_or_insufficient":["化疗失败","T1N0"],"points":1},{"slot_id":"S2","slot_focus":"靶区剂量妥协","minimum_sufficient_answer":"影响标准肿瘤或术后体积剂量","accepted_aliases":["妥协靶区剂量","影响靶区剂量","降低肿瘤体积剂量","compromise标准肿瘤剂量","compromise standard tumor/postoperative volume doses"],"numeric_tolerance":null,"required_concepts":["影响/妥协","肿瘤/术后体积/靶区剂量"],"explicitly_incorrect_or_insufficient":["姑息放疗"],"points":1}]}
+{"item_id":"239","interface_type":"saq_component","response_count":4,"max_points":4,"stem":"根据 NCCN 2025 ADV-A，既往放疗后拟行再放疗时，评估危及器官（OAR）可接受剂量需综合哪些4项主要依据？（共4分，每项1分。）","reference_answer":"原始放疗距今的时间间隔、拟纳入体积、患者预期寿命、DVH分析","answer_slots":[{"slot_id":"S1","slot_focus":"时间维度","minimum_sufficient_answer":"原始放疗距今的时间间隔","accepted_aliases":["时间间隔","距前次放疗时间","原放疗时间间隔"],"numeric_tolerance":null,"required_concepts":["时间间隔"],"explicitly_incorrect_or_insufficient":["年龄","治疗时间"],"points":1},{"slot_id":"S2","slot_focus":"体积维度","minimum_sufficient_answer":"拟纳入体积","accepted_aliases":["照射体积","纳入体积","靶区体积"],"numeric_tolerance":null,"required_concepts":["体积"],"explicitly_incorrect_or_insufficient":["肿瘤大小","分期"],"points":1},{"slot_id":"S3","slot_focus":"患者生存期维度","minimum_sufficient_answer":"患者预期寿命","accepted_aliases":["预期寿命","生存期"],"numeric_tolerance":null,"required_concepts":["预期寿命"],"explicitly_incorrect_or_insufficient":["生活质量","体能评分"],"points":1},{"slot_id":"S4","slot_focus":"剂量学分析维度","minimum_sufficient_answer":"DVH分析","accepted_aliases":["剂量体积直方图分析","DVH"],"numeric_tolerance":null,"required_concepts":["DVH"],"explicitly_incorrect_or_insufficient":["CT图像","MRI"],"points":1}]}
+{"item_id":"241","interface_type":"saq_component","response_count":2,"max_points":2,"stem":"根据 CSCO 2025 §3.3 正常组织限量，腮腺的2项可替代剂量限制标准是什么？（共2分，每项1分。）","reference_answer":"Dmean ≤26 Gy；至少一侧腮腺 V30 Gy ≤50%","answer_slots":[{"slot_id":"S1","slot_focus":"腮腺平均剂量限制","minimum_sufficient_answer":"Dmean ≤26 Gy","accepted_aliases":["平均剂量≤26 Gy","Dmean≤26Gy"],"numeric_tolerance":null,"required_concepts":[],"explicitly_incorrect_or_insufficient":[],"points":1},{"slot_id":"S2","slot_focus":"腮腺体积剂量限制","minimum_sufficient_answer":"至少一侧腮腺 V30 Gy ≤50%","accepted_aliases":["至少一侧 V30 Gy≤50%","一侧 V30≤50%"],"numeric_tolerance":null,"required_concepts":[],"explicitly_incorrect_or_insufficient":[],"points":1}]}
+{"item_id":"242","interface_type":"saq_component","response_count":2,"max_points":2,"stem":"根据 CSCO 2025 正常组织限量标准，分别写出甲状腺和臂丛的剂量限制；甲状腺的两个可替代限量中任写其一即可。（共2分，每项1分。）","reference_answer":"V50 Gy ≤60%；PRV D0.03cc ≤66 Gy，MAC ≤70 Gy","answer_slots":[{"slot_id":"S1","slot_focus":"甲状腺剂量限制（任一可替代标准）","minimum_sufficient_answer":"V50 Gy ≤60%","accepted_aliases":["V50≤60%","V60 Gy MAC ≤10 cm²","V60 MAC≤10cm²"],"numeric_tolerance":null,"required_concepts":[],"explicitly_incorrect_or_insufficient":[],"points":1},{"slot_id":"S2","slot_focus":"臂丛剂量限制","minimum_sufficient_answer":"PRV D0.03cc ≤66 Gy，MAC ≤70 Gy","accepted_aliases":["PRV D0.03cc≤66Gy，MAC≤70Gy","D0.03cc≤66 Gy，MAC≤70 Gy"],"numeric_tolerance":null,"required_concepts":[],"explicitly_incorrect_or_insufficient":[],"points":1}]}
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+{"item_id":"248","interface_type":"saq_component","response_count":2,"max_points":2,"stem":"根据 NCCN 2025，对于广泛转移且体能状态差的鼻咽癌患者，PS 3 和 PS 4 的推荐治疗策略分别是什么？（共2分，每项1分。）","reference_answer":"1. single-agent systemic therapy 或 BSC ± palliative RT/surgery；2. BSC ± palliative RT","answer_slots":[{"slot_id":"S1","slot_focus":"PS 3的治疗策略","minimum_sufficient_answer":"single-agent systemic therapy 或 BSC ± palliative RT/surgery","accepted_aliases":["单药系统治疗或最佳支持治疗±姑息放疗/手术","单药系统治疗或BSC±姑息放疗/手术","single-agent systemic therapy or BSC ± palliative RT/surgery"],"numeric_tolerance":null,"required_concepts":["单药系统治疗/single-agent systemic therapy","最佳支持治疗/BSC"],"explicitly_incorrect_or_insufficient":["联合系统治疗/combination systemic therapy","根治性放疗"],"points":1},{"slot_id":"S2","slot_focus":"PS 4的治疗策略","minimum_sufficient_answer":"BSC ± palliative RT","accepted_aliases":["最佳支持治疗±姑息放疗","以BSC±palliative RT为主","BSC ± palliative RT为主"],"numeric_tolerance":null,"required_concepts":["最佳支持治疗/BSC"],"explicitly_incorrect_or_insufficient":["系统治疗/systemic therapy","单药系统治疗","根治性放疗"],"points":1}]}
+{"item_id":"249","interface_type":"saq_component","response_count":2,"max_points":2,"stem":"根据 NCCN 2025 ADV-3/ADV-4，对“既往已放疗、局部区域复发/持续存在、且不可切除”的患者，写出指南推荐的2项干预原则：1. 首选（preferred）的干预路径；2. 再放疗±全身治疗仅适用的病例类型。（共2分，每项1分。）","reference_answer":"1. 临床试验；2. 高度筛选病例","answer_slots":[{"slot_id":"S1","slot_focus":"首选干预路径","minimum_sufficient_answer":"临床试验","accepted_aliases":["clinical trial","参加临床试验"],"numeric_tolerance":null,"required_concepts":["临床试验"],"explicitly_incorrect_or_insufficient":["观察","直接再放疗","全身治疗"],"points":1},{"slot_id":"S2","slot_focus":"再放疗±全身治疗的适用病例类型","minimum_sufficient_answer":"高度筛选病例","accepted_aliases":["highly selected cases","高度筛选的患者","高度筛选"],"numeric_tolerance":null,"required_concepts":["高度筛选"],"explicitly_incorrect_or_insufficient":["所有病例","年轻患者","无转移患者"],"points":1}]}
+{"item_id":"250","interface_type":"vsaq_single_slot","response_count":1,"max_points":1,"stem":"根据 CSCO 2025 儿童注释，甲氨蝶呤和博来霉素目前较少用于儿童鼻咽癌诱导化疗的主要原因是什么？（1 分；请用简短医学术语作答，无需解释。）","reference_answer":"不良反应较大","answer_slots":[{"slot_id":"S1","slot_focus":"最终单槽答案","minimum_sufficient_answer":"不良反应较大","accepted_aliases":["毒性较大","不良反应大","毒性大","远期毒性","毒性反应","毒性和耐受性问题"],"numeric_tolerance":null,"required_concepts":[],"explicitly_incorrect_or_insufficient":[],"points":1}]}
diff --git a/supplementary/option_free/questions.jsonl b/supplementary/option_free/questions.jsonl
new file mode 100644
index 0000000000000000000000000000000000000000..42c71c35456373025e6438fd971d4db9441d077f
--- /dev/null
+++ b/supplementary/option_free/questions.jsonl
@@ -0,0 +1,238 @@
+{"request_id": "formal_vsaq_saq::1", "item_id": "1", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025 指南，评估鼻咽癌原发灶侵犯范围的首选影像学检查是什么？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::2", "item_id": "2", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出1项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，对 MRI 尚未达到转移标准的小颈部淋巴结，若 PET/CT 出现明确异常摄取，请写出指南建议的处理方式（答 1 项）。（共1分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::3", "item_id": "3", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 3, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出3项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，建议治疗前常规加做 PET/CT 的“高远处转移风险”人群具体包括哪3项情况？（请列出3项）（共3分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::4", "item_id": "4", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，对极低远处转移风险的确诊鼻咽癌患者进行腹部远处转移评估时，请分别写出：1. 首选检查；2. 首选检查结果可疑时的补充检查。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::5", "item_id": "5", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，当鼻咽原发灶尚未明确、但出现颈部淋巴结肿大或非常规区域淋巴结可疑转移时，指南推荐的下一步首选诊断操作是什么？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::6", "item_id": "6", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，在鼻咽癌影像学评估中，请分别写出 MRI 和 PET/CT 各自最主要的评估对象。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::7", "item_id": "7", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，当鼻咽原发灶复发/残留与放疗后纤维化难以鉴别时，建议联合采用哪 2 种影像学检查进行评估？（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::9", "item_id": "9", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，在鼻咽镜可达且可见可疑原发灶的前提下，获取组织学诊断的首选方式是什么？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::10", "item_id": "10", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，若鼻咽原发灶难以取得诊断性组织，指南建议通过其他途径获取病理。请分别写出推荐的取材部位和取材方式。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::11", "item_id": "11", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，当常规形态学尚不能明确诊断鼻咽癌时，为辅助诊断可补做哪些检测？请分别写出 1 项免疫组化标志物和 1 项原位杂交检测。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::12", "item_id": "12", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 3, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出3项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，我国流行区鼻咽癌最常见的病理类型是什么？该类型主要可分为哪2个亚型？（共3分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::13", "item_id": "13", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，外周血EBV抗体/EBV DNA在鼻咽癌中阳性结果的2项主要临床作用是什么？（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::14", "item_id": "14", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，与局部或区域复发相比，鼻咽癌治疗后血浆 EBV DNA 更适合识别哪种失败类型？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::15", "item_id": "15", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 NCCN 2025，对于以囊性颈部淋巴结肿大为首发表现的患者，进行细针穿刺或粗针活检取材时，推荐采用哪两种影像学技术进行引导？（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::16", "item_id": "16", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 3, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出3项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 NCCN 2025，对不可切除或转移性疾病、且计划接受系统治疗的患者，若需追加组织取材，请写出指南建议尽量获取的1种活检样本类型，以及该样本主要用于后续的2类辅助检测。（共需写出3项）（共3分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::17", "item_id": "17", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 AJCC/UICC 第9版及 CSCO 2025，T1期鼻咽癌定义中，肿瘤不得侵犯哪个间隙？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::18", "item_id": "18", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 AJCC/UICC 第9版及 CSCO 2025，T2期鼻咽癌的定义涉及哪2个主要解剖范围？请按题干顺序分别写出。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::19", "item_id": "19", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 4, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出4项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 AJCC/UICC 第9版及 CSCO 2025，T3期鼻咽癌的定义中，肿瘤可侵犯哪4个骨性部位？请分别写出。（共4分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::20", "item_id": "20", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 3, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出3项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 AJCC/UICC 第9版及 CSCO 2025，T4期鼻咽癌的定义涉及哪3类解剖结构或区域受侵？请分别写出。（共3分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::21", "item_id": "21", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，评估鼻咽癌早期颅底骨受侵时，影像学判定需满足哪2项要求？（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::22", "item_id": "22", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 4, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出4项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 AJCC/UICC 第9版及 CSCO 2025，鼻咽癌 N1期的定义需满足哪4项条件？请列出4项。（共4分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::23", "item_id": "23", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 4, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出4项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 AJCC/UICC 第9版及 CSCO 2025，鼻咽癌 N2期的定义需满足哪4项条件？请列出4项。（共4分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::24", "item_id": "24", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 3, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出3项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 AJCC/UICC 第9版及 CSCO 2025，鼻咽癌可判定为 N3期的独立条件有哪些？请列出3项。（共3分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::25", "item_id": "25", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 AJCC/UICC 第9版与 CSCO 2025 鼻咽癌指南，严重颈部淋巴结包膜外侵（ENE）可将原本N1-N2级别的颈部淋巴结病变升级至哪个N分期级别？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::26", "item_id": "26", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 AJCC/UICC 第9版及 CSCO 2025，咽后淋巴结存在严重包膜外侵时，是否可仅据此判定为 N3期？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::27", "item_id": "27", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 AJCC/UICC 第9版及 CSCO 2025，T0期鼻咽癌的定义需同时满足哪2项条件？（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::28", "item_id": "28", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 AJCC/UICC 第9版及 CSCO 2025，M1a期鼻咽癌的转移病灶总数为多少？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::29", "item_id": "29", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 AJCC/UICC 第9版及 CSCO 2025，M1b期鼻咽癌的转移病灶总数为多少？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::30", "item_id": "30", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 AJCC/UICC 第9版与 CSCO 2025，鼻咽癌 IA 期包括哪 2 项 TNM 分期组合？请按 T 分期由低到高分别写出。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::31", "item_id": "31", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 AJCC/UICC 第9版与 CSCO 2025，鼻咽癌ⅠB期包括哪 2 项 TNM 分期组合？请按 T 分期由低到高分别写出。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::32", "item_id": "32", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 AJCC/UICC 第9版及 CSCO 2025，鼻咽癌 II期包括哪2类 TNM 分期组合？请列出2项。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::33", "item_id": "33", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 AJCC/UICC 第9版及 CSCO 2025，鼻咽癌 Ⅲ期包括哪2类 TNM 分期组合？请列出2项。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::34", "item_id": "34", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 3, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出3项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 AJCC/UICC 第9版及 CSCO 2025，鼻咽癌 Stage IV 在总体分期中适用于哪类疾病？又分为哪2个亚期？（共3分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::35", "item_id": "35", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025 指南，鼻咽癌 T1N0 期患者的标准初治方案是什么？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::36", "item_id": "36", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 NCCN 2025 指南，鼻咽癌 T1N0M0 期的标准局部治疗方式是什么？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::37", "item_id": "37", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，对于 T2N0 且无 EBV DNA ≥4000 copies/mL、无 bulky 等不良因素的鼻咽癌患者，优先推荐的治疗模式是什么？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::38", "item_id": "38", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出1项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 NCCN 2025，对于存在高危因素（high-risk features）的 T2N0M0 鼻咽癌，请写出最推荐的根治性治疗模式。（共1分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::39", "item_id": "39", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 NCCN 2025，T2N0/T0(EBV+)–2N1/T3N0 路径中的高危特征（high-risk features）包括哪2项？请列出2项。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::40", "item_id": "40", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，对于 T1–2N1 且无 ≥3 cm 淋巴结、无 Ⅳ/ⅤB 区转移、无包膜外侵、无高 EBV DNA 的鼻咽癌患者，可考虑哪种治疗方案？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::41", "item_id": "41", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，鼻咽癌 T1-2N1 期患者一旦合并明显不良因素，推荐的标准治疗路径是什么？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::42", "item_id": "42", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，对于 T3N0 鼻咽癌患者，在无 EBV DNA ≥4000 copies/mL、无 bulky 淋巴结等不良因素时，可考虑的治疗方案是什么？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::43", "item_id": "43", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025 指南，鼻咽癌 T4N0 或 T3N1 患者的 I 级推荐治疗方案包含哪2个连续的治疗阶段？请列出这2项。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::44", "item_id": "44", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，对于 T1–4N2–3 和 T4N1期鼻咽癌，Ⅰ级推荐包括哪2种综合治疗方案？请列出2项。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::45", "item_id": "45", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 3, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出3项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，对于 T1–4N2–3 或 T4N1 期鼻咽癌，以同期放化疗为基础的高等级免疫整合治疗路径包含哪 3 个治疗组成部分？请按治疗顺序写出。（共3分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::46", "item_id": "46", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 NCCN 2025，对于 T0(EBV+)–2N1M0 或 T3N0M0 鼻咽癌患者，写出以下 2 项治疗原则：1. 推荐的核心治疗模式；2. 考虑增加诱导或辅助治疗的前提条件。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::47", "item_id": "47", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 3, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出3项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 NCCN 2025，对于 T3N1–3M0、T4N0–3M0 或 T0(EBV+)–2N2–3M0 的鼻咽癌患者，推荐的主要治疗路径有哪些？请列出3项。（共3分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::48", "item_id": "48", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 NCCN 2025，局部晚期鼻咽癌诱导/序贯全身治疗的首选方案（preferred regimens）有哪些？请列出2项。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::49", "item_id": "49", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 NCCN 2025，鼻咽癌诱导治疗的其他推荐方案（other recommended regimens）有哪些？请列出2项。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::50", "item_id": "50", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 3, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出3项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，局部晚期鼻咽癌诱导化疗中，GP/TPF、TP 和单药吉西他滨的推荐层级或定位分别是什么？（共3分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::51", "item_id": "51", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，局部晚期鼻咽癌诱导化疗的 2A 类 TP 方案由哪 2 种药物组成？（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::52", "item_id": "52", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025 鼻咽癌指南，局部晚期鼻咽癌同期化疗的 1A 类推荐化疗药物是哪种？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::53", "item_id": "53", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 3, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出3项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，对顺铂绝对禁忌但仍需完成同期治疗的鼻咽癌患者，指南明确列出的替代同步化疗方案有哪些？请列出3项，每项需包含药物名称、剂量及给药频率。（共3分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::54", "item_id": "54", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 NCCN 2025，诱导化疗后与放疗同期的周疗方案通常包括哪2种药物？请列出2项。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::55", "item_id": "55", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，在比较同期化疗的周疗与三周疗顺铂时，请写出以下2项关键信息：1. 决定疗效的更关键的剂量指标名称；2. 该指标通常不应低于的剂量阈值（数值，单位为 mg/m²）。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::56", "item_id": "56", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025 指南，鼻咽癌同期周疗顺铂的常用剂量范围是多少（单位：mg/m²）？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::57", "item_id": "57", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025 与 NCCN 2025 指南，鼻咽癌同期放化疗中，三周方案顺铂的常用推荐剂量是多少（单位：mg/m²）？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::58", "item_id": "58", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 NCCN 2025，在经典同步放化疗（classic concurrent systemic therapy/RT）中，采用每3周一次（q3w）的顺铂方案时，请分别写出以下2项参数：1. 单次给药剂量（mg/m²）；2. 推荐的总周期数。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::59", "item_id": "59", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 NCCN 2025，接受同期放化疗后辅助治疗的首选方案包括哪2个治疗阶段？（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::60", "item_id": "60", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 NCCN 2025，对于不适合或不耐受顺铂的鼻咽癌患者，可考虑的替代放化疗方案包括哪2个治疗阶段？（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::61", "item_id": "61", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025 指南，局部晚期鼻咽癌辅助治疗的 1A 类推荐方案除了顺铂+5-FU外，还包括哪种方案？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::62", "item_id": "62", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 3, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出3项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 NCCN 2025，对于 EBV 相关且分期为 T4N1–3 或任何 T、N2–3 的鼻咽癌患者，可在特定情况下采用的治疗序列包括哪3个阶段？请按治疗顺序作答。（共3分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::63", "item_id": "63", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 3, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出3项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 NCCN 2025，对于无局部手术或放疗机会的复发、不可切除、寡转移或转移性鼻咽癌，首选一线全身治疗方案（preferred first-line regimen）包含哪3种药物？请列出3项。（共3分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::64", "item_id": "64", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 NCCN 2025 指南，对于含铂治疗后进展的鼻咽癌（NPC），首选的后线治疗方案（preferred subsequent-line regimen）是哪种药物？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::65", "item_id": "65", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 4, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出4项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，复发/转移性鼻咽癌一线 GP 方案中，获 1A类推荐的 PD-1 抑制剂有哪些？请列出4种。（共4分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::66", "item_id": "66", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，一线 GP 方案中，请分别写出吉西他滨和顺铂的常用剂量及给药天数（共2项）。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::67", "item_id": "67", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，在鼻咽癌一线 GP 联合特瑞普利单抗（toripalimab）治疗中，特瑞普利单抗的常用给药方案是什么？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::68", "item_id": "68", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，在鼻咽癌一线 GP 联合卡瑞利珠单抗（camrelizumab）治疗中，卡瑞利珠单抗的常用给药方案是什么？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::69", "item_id": "69", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，在鼻咽癌一线 GP 联合替雷利珠单抗（tislelizumab）治疗中，替雷利珠单抗的常用给药方案是什么？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::70", "item_id": "70", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，复发/转移性鼻咽癌一线治疗中，含氟尿嘧啶的铂类双药方案由哪 2 类药物组成？（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::71", "item_id": "71", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，在复发/转移性鼻咽癌（RM-NPC）一线治疗中，GP（吉西他滨+顺铂）联合哪种药物被列为 2B 类推荐方案？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::72", "item_id": "72", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 3, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出3项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 NCCN 2025，复发/转移性鼻咽癌的首选一线系统治疗方案（preferred first-line regimen）包含哪3种药物？请列出3项。（共3分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::73", "item_id": "73", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，对可切除的局部复发鼻咽癌，写出以下2项内容：1）首选的局部根治性治疗手段；2）优先考虑的手术路径。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::74", "item_id": "74", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，对于单纯颈部淋巴结复发的鼻咽癌患者，首选的局部治疗方式是什么？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::75", "item_id": "75", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 NCCN 2025，pembrolizumab 被列为复发/转移性鼻咽癌“useful in certain circumstances”的治疗选项时，要求患者具备哪种特定的生物标志物状态？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::76", "item_id": "76", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，对于至少二线系统治疗失败的鼻咽癌患者，单药卡瑞利珠单抗（camrelizumab）的常用给药方案（需写明单次剂量和给药周期）是？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::77", "item_id": "77", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，后线单药特瑞普利单抗（toripalimab）的常用给药方案是什么？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::78", "item_id": "78", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，后线单药 penpulimab 的常用单次剂量及给药频率是？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::79", "item_id": "79", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025 鼻咽癌指南，卡瑞利珠单抗（camrelizumab）联合阿帕替尼（apatinib）作为常见后线治疗方案时，请分别写出这2种药物的推荐单次剂量与给药频率（共2项）。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::80", "item_id": "80", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 3, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出3项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 NCCN 2025，对 M1 寡转移、PS 0–1 的鼻咽癌患者，诱导治疗后若考虑整合局部治疗，其放疗靶区范围应包括哪3个部位？请列出3项。（共3分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::81", "item_id": "81", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 3, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出3项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 NCCN 2025，对系统治疗后达到 CR 或 near CR 的 M1 寡转移鼻咽癌病例，首选的局部放疗策略包括哪3项要素？请列出3项。（共3分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::82", "item_id": "82", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 3, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出3项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 NCCN 2025，列出鼻咽癌再放疗候选者通常需要满足的3项条件（请分别写出：1. 距初次放疗的时间要求；2. 能再给予的最低剂量要求；3. 治疗耐受性要求）。（共3分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::83", "item_id": "83", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 3, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出3项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，非转移性儿童鼻咽癌诱导化疗中，被列为 2A类推荐的方案有哪些？请列出3项。（共3分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::84", "item_id": "84", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025 指南儿童章节，在非转移性儿童鼻咽癌的治疗中，哪种诱导化疗方案被列为 3类推荐？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::85", "item_id": "85", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025 指南，儿童鼻咽癌同期化疗推荐的核心药物是哪种？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::86", "item_id": "86", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025 指南儿童章节，儿童鼻咽癌同步“周疗”顺铂的常用剂量范围是多少（单位：mg/m²）？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::87", "item_id": "87", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025 指南儿童章节，儿童鼻咽癌同步放化疗“三周方案”中，顺铂的常用单次剂量是多少（需包含单位）？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::88", "item_id": "88", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 3, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出3项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025 儿童章节，写出儿童鼻咽癌辅助 IFN-β 常用方案的 3 项具体参数：剂量、给药频率和总疗程。（共3分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::89", "item_id": "89", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 3, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出3项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025 儿童章节，儿童鼻咽癌的治疗策略通常参照哪个人群的治疗框架？此外，在制定策略时需特别强调哪两方面的影响？（请写出这3项内容）（共3分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::90", "item_id": "90", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025 指南，为减少后遗症，儿童鼻咽癌放疗的每天分割剂量可降至多少 Gy？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::91", "item_id": "91", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，鼻咽癌放化疗结束后，首次系统随访评估通常安排在哪个时间窗？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::92", "item_id": "92", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，鼻咽癌治疗后第1–3年的常规随访间隔通常为多少？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::93", "item_id": "93", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025 鼻咽癌指南，患者在治疗后第 4–5 年的常规随访频率通常为每多久一次？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::94", "item_id": "94", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，鼻咽癌放疗体位固定中，指南优先推荐的组合包含哪2种固定装置？请列出2项。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::95", "item_id": "95", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，鼻咽癌放疗定位中，CT-sim 和 MR-sim 建议的扫描层厚约为多少？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::96", "item_id": "96", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 3, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出3项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，鼻咽癌 IMRT 计划的推荐方式、固定野照射野数量和 VMAT 弧数分别是什么？（共3分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::97", "item_id": "97", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 3, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出3项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，调强计划剂量验证常用的 Gamma 分析标准需满足哪3项具体指标要求（请分别写出：1. 剂量差/吻合距离；2. 阈值；3. Gamma通过率）？（共3分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::98", "item_id": "98", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，对 IMRT 结束时 MRI 仍可检出残留病灶者，可考虑追加局部加量（boost）。请分别写出该加量方案的2项具体参数：1. 追加的次数范围；2. 单次剂量范围（Gy）。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::99", "item_id": "99", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 NCCN 2025，治疗后首次 FDG-PET/CT 疗效评估最早应安排在何时？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::101", "item_id": "101", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 NCCN 2025，对于 T2N0M0 且原发灶体积大、EBV DNA 升高的鼻咽癌患者，初始治疗的基础方案及可加用治疗分别是什么？（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::102", "item_id": "102", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：45岁男性鼻咽癌患者，cT1N1M0，单侧II区淋巴结 1.8 cm，无IV/VB区转移，无包膜外侵，EBV DNA 1800 copies/mL。按CSCO指南，该患者推荐的治疗方案是什么？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::103", "item_id": "103", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：48岁男性，鼻咽癌cT2N1M0，单侧VB区淋巴结转移，最大短径2.4 cm，EBV DNA 6200 copies/mL。按CSCO指南，该患者推荐的治疗模式是什么？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::104", "item_id": "104", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：50岁患者，T0(EBV+)N1M0，EBV DNA显著升高。按NCCN指南，针对该分期人群，写出以下2项内容：1. 标准的主路径治疗方案；2. 考虑增加诱导或辅助治疗的前提条件。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::105", "item_id": "105", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 3, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出3项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：58岁鼻咽癌患者，cT3N2M0，ECOG 0。根据 NCCN 2025，推荐的治疗策略有哪些？请列出3项。（共3分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::106", "item_id": "106", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：在鼻咽癌 TNM 分期评估中，若 MRI 提示蝶骨基底部轻度骨硬化，但病灶与原发灶不连续，且各序列信号不与原发灶一致，是否可仅凭此表现判定为 T3期？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::107", "item_id": "107", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 AJCC/UICC 第9版与 CSCO 2025，鼻咽癌颈Ⅱ区淋巴结最大径4.5 cm并侵犯胸锁乳突肌，应归为哪一 N 分期？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::108", "item_id": "108", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据CSCO 2025指南（基于AJCC/UICC第9版），鼻咽癌患者TNM分期为T2N1M0时，其总体临床分期应为哪一期？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::109", "item_id": "109", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：在鼻咽癌的治疗中，写出特瑞普利单抗（toripalimab）在以下2种场景的推荐给药方案（需包含具体剂量及给药频率）：1. 一线联合GP方案；2. 后线单药治疗。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::110", "item_id": "110", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，复发/转移性鼻咽癌中，卡瑞利珠单抗一线联合 GP 和后线单药的剂量及给药频次分别是什么？（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::111", "item_id": "111", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据CSCO指南儿童章节，儿童非转移性鼻咽癌患者在诱导治疗后达到完全缓解（CR），推荐的放疗剂量（PTVp/PTVn）是多少？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::112", "item_id": "112", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，儿童鼻咽癌患者在哪2种情况下可考虑 IFN-β 辅助治疗？请列出2项。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::113", "item_id": "113", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 NCCN 2025，对于诱导治疗后达到近完全缓解的 M1 寡转移、PS 0–1 鼻咽癌患者，原发灶/区域淋巴结和寡转移灶的后续治疗原则分别是什么？（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::114", "item_id": "114", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据NCCN指南，对于广泛转移且体能状态评分（PS）为3-4分的鼻咽癌患者，首选的治疗策略是什么？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::115", "item_id": "115", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据CSCO指南，对于病灶局限且可完整切除的局部鼻咽复发患者，写出以下2项内容：1. 首选的治疗手段；2. 优先推荐的手术路径。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::116", "item_id": "116", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据CSCO指南，对于仅颈部淋巴结复发且无明显原发局部复发的鼻咽癌患者，当前首选的局部治疗方式是什么？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::117", "item_id": "117", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 3, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出3项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据NCCN指南，评估鼻咽癌再放疗候选者时，请分别写出需满足的3项条件：1. 距初次放疗的最短时间间隔；2. 以治愈为目标的最低再放疗剂量；3. 需耐受的治疗类型。（共3分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::118", "item_id": "118", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 NCCN 2025，治疗后 FDG-PET/CT 用于疗效评估的首选时点至少为治疗结束后多少周？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::119", "item_id": "119", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 NCCN 2025，鼻咽癌患者治疗后≥12周复查 PET/CT 结果为 equivocal（模棱两可），且无明确进行性症状时，可选择哪些后续处理策略？请列出2项。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::120", "item_id": "120", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：当囊性颈部淋巴结作为初始诊断线索时，指南推荐采用何种取材策略以提高诊断收益？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::121", "item_id": "121", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：对不可切除或转移性鼻咽癌且已计划接受全身系统治疗的患者，额外获取粗针穿刺活检（core biopsy）主要是为了满足后续哪两类辅助检测的需要？请列出2项。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::122", "item_id": "122", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，PET/MRI 在鼻咽癌治疗前评估中的定位有哪些结论？请列出2项。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::123", "item_id": "123", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据CSCO指南，鼻咽癌患者治疗后常规影像未见明确病灶，但血浆EBV DNA持续进行性升高时，建议进一步结合哪项影像学检查？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::124", "item_id": "124", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 4, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出4项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，哪些患者情况最需要纳入鼻咽癌 MDT 常规讨论？请列出4项。（共4分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::125", "item_id": "125", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 3, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出3项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，鼻咽癌 IMRT 计划剂量验证的 Gamma 标准、剂量阈值和通过率分别是什么？（共3分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::126", "item_id": "126", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：按CSCO指南，IMRT结束时MRI仍见明确残留病灶，且病灶位置允许继续补量，推荐的追加放疗方案是什么？请分别写出以下2项内容：1. 追加的次数；2. 单次剂量（Gy）。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::127", "item_id": "127", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：64岁复发或转移性鼻咽癌（RM-NPC）患者，现含铂化疗后进展，PD-L1阳性，且既往未接受过免疫治疗。根据NCCN指南，被列为“首选后线治疗（preferred subsequent-line）”的药物是哪种？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::128", "item_id": "128", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 3, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出3项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 NCCN 2025，纳武利尤单抗可考虑用于哪类鼻咽癌？请写出其3项适用条件。（共3分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::130", "item_id": "130", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：患者cT4N2M1，PET/CT示肝和骨共4个远处病灶。按最新版（AJCC/UICC 第9版）鼻咽癌总体分期，该患者属于哪一期？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::131", "item_id": "131", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，鼻咽癌固定野调强放射治疗（fixed-beam IMRT）常用的照射野数是多少？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::132", "item_id": "132", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，写出鼻咽癌放疗期间摆位验证最低要求的2项核心要素（分别写出验证频率和最低技术标准）。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::133", "item_id": "133", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，影像学诊断鼻咽癌颅底骨侵犯需满足哪2项条件？请列出2项。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::134", "item_id": "134", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，明确眶下裂受侵的鼻咽癌应归入哪一T分期？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::135", "item_id": "135", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 4, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出4项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 NCCN 2025，对 T1N0M0鼻咽癌行颈部预防照射时，推荐纳入哪些淋巴结引流区（层面）？请列出4项。（共4分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::137", "item_id": "137", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，鼻咽癌最常用、应用最广泛的营养风险筛查工具是什么？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::138", "item_id": "138", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，鼻咽癌患者放疗期间出现高营养风险时，NRS 2002 评分阈值为多少？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::139", "item_id": "139", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，为预防放疗相关黏膜炎和营养恶化，应在何时启动营养干预？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::140", "item_id": "140", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 4, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出4项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 NCCN 2025，鼻咽癌长期支持性评估中，按临床需要应考虑哪些主要功能或专科评估方面？请列出4项。（共4分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::141", "item_id": "141", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，对于不可手术的局部复发鼻咽癌，若评估为再程放疗高危组，针对再程放疗通常如何处理？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::142", "item_id": "142", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 NCCN 2025，复发/持续性鼻咽癌术后若存在高危病理特征（如包膜外侵犯[ENE]或阳性切缘），推荐的辅助治疗方案是什么？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::143", "item_id": "143", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，已被前瞻性筛查研究用于提高鼻咽癌早诊率的血清学指标组合包括哪2项？请列出2项。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::144", "item_id": "144", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，关于血浆 EBV DNA 用于鼻咽癌筛查，有哪2项主要结论？请列出2项。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::145", "item_id": "145", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 NCCN 2025，在检测血浆/血清EBV DNA时，最常用的PCR扩增靶点序列是什么？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::146", "item_id": "146", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，若患者的鼻咽癌相关EBV检测（如EBV抗体和EBV DNA）结果均为阴性，能否据此排除鼻咽癌？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::147", "item_id": "147", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，目前血浆EBV DNA的检测是否已存在国际公认的统一标准化流程？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::148", "item_id": "148", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 NCCN 2025 随访原则，对于EBER阳性的鼻咽癌患者，随访中可考虑进行哪项特定的分子标志物监测？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::149", "item_id": "149", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025 儿童章节，由于复发/转移儿童鼻咽癌的治疗证据较少，其治疗原则可参考哪类人群已证实有效的治疗原则？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::150", "item_id": "150", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025 儿童章节，对初治即存在转移的儿童鼻咽癌，在转移灶获得控制后，是否可考虑对原发灶行放疗？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::151", "item_id": "151", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，对于寡转移儿童鼻咽癌的综合治疗，更强调哪2种治疗手段的结合？请列出2项。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::152", "item_id": "152", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，鼻咽癌的随访策略应采用哪种管理模式，并在时间跨度上强调什么？（请写出2项内容：管理模式和时间跨度）（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::153", "item_id": "153", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，哪一临床分期（需指出具体的T分期或N分期范围）的鼻咽癌患者在治疗后5年内更需要密切随访？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::155", "item_id": "155", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 NCCN 2025，对颅底接受高剂量放疗的鼻咽癌长期生存者，可考虑的长期内分泌评估主要针对哪个腺体的功能？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::156", "item_id": "156", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025 指南，与2024版相比，复发/转移性鼻咽癌（RM-NPC）一线治疗的 1A 类推荐方案中，新增了哪种免疫联合化疗方案？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::157", "item_id": "157", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 3, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出3项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，鼻咽癌总体分期新框架中，Stage IV 适用于哪类疾病？又分为哪2个亚期？（共3分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::158", "item_id": "158", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025 鼻咽癌指南，严重颈部淋巴结包膜外侵（如侵犯皮肤、肌肉、神经血管束等）被升级至哪个 N 分期？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::159", "item_id": "159", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，在对早期颅底骨质受侵进行影像诊断时，请分别写出以下2项内容：1. 仅有 MRI/CT 骨质硬化是否足以诊断为 T3？ 2. 若要诊断 T3，病变在所有 MRI 序列上需满足什么信号特征？（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::160", "item_id": "160", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，鼻咽癌 MDT 讨论对象中，除局部晚期及复发/转移患者外，还应特别纳入出现哪类治疗相关严重并发症的患者？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::163", "item_id": "163", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，在局部晚期鼻咽癌同期顺铂化疗中，相较于给药频次，决定疗效更关键的给药参数是什么？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::164", "item_id": "164", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，局部晚期鼻咽癌药物治疗中，同期顺铂累积剂量不应低于多少（单位：mg/m²）？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::165", "item_id": "165", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，复发/转移性鼻咽癌（RM-NPC）的一线标准系统治疗方案是什么？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::166", "item_id": "166", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，RM-NPC 一线含铂治疗失败后，后线单药化疗可选用的药物中，请写出 1 种药物名称。（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::167", "item_id": "167", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，派安普利单抗用于复发/转移性鼻咽癌后线治疗需满足哪2项条件？（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::168", "item_id": "168", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，对于既往接受过再放疗或存在鼻咽局部复发的鼻咽癌患者，使用阿帕替尼相关方案时最需要特别警惕的严重临床风险是什么？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::169", "item_id": "169", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据CSCO 2025，在鼻咽癌筛查中，目前缺乏哪种类型的临床研究来明确血浆EBV DNA与血清IgA抗体孰优孰劣？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::170", "item_id": "170", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，治疗前血浆 EBV DNA 与鼻咽癌的肿瘤负荷、分期和进展风险呈何种相关性？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::171", "item_id": "171", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，鼻咽拭子/唾液甲基化或 miRNA-BARTs 等新型 EBV 相关检测在鼻咽癌筛查中具有潜力，但指南指出其目前仍缺乏哪种规模的人群研究验证？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::172", "item_id": "172", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，关于儿童鼻咽癌同期化疗的最佳策略，目前的共识状态是已统一还是存在争议？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::173", "item_id": "173", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，对诱导化疗后达到完全缓解（CR）或非常好部分缓解（VGPR）的儿童鼻咽癌患者，部分学者提出可考虑采取哪种强度的放疗策略？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::174", "item_id": "174", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，对于鼻咽原发灶复发或残留诊断困难的病例，推荐如何应用 PET/CT 与 MRI？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::175", "item_id": "175", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，对局部晚期（T3–4 或 N2–3）患者的随访，写出以下2项内容：1. 建议采用的管理策略名称；2. 对于高风险患者，强调在治疗后需更密切随访的年数。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::176", "item_id": "176", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，复发/转移性鼻咽癌（RM-NPC）的一线标准系统治疗方案是什么？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::177", "item_id": "177", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 4, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出4项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，一线 GP+PD-1/PD-L1 治疗后未进展的复发/转移性鼻咽癌患者，维持治疗的方案及3项停止条件是什么？请列出4项。（共4分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::178", "item_id": "178", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，对一线仅接受化疗且未进展的复发/转移性鼻咽癌（RM-NPC）患者，指南允许考虑采用哪类口服药物进行维持治疗？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::179", "item_id": "179", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，对于一线含铂治疗失败的复发/转移性鼻咽癌（RM-NPC）患者，除鼓励参加临床试验外，二线治疗仍可保留哪类全身治疗？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::180", "item_id": "180", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 4, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出4项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，复发/转移性鼻咽癌二线及以上单药化疗的 2A类推荐包括哪3种药物？其应用前提条件是什么？（共4分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::181", "item_id": "181", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 3, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出3项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，复发/转移性鼻咽癌二线及以上联合化疗的 2A类推荐包括哪2项方案或药物？其应用前提条件是什么？（共3分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::182", "item_id": "182", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，特瑞普利单抗及卡瑞利珠单抗/派安普利单抗用于后线免疫治疗的进入条件分别是什么？（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::183", "item_id": "183", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，对于“不超过一线治疗失败”且 EBV 相关的复发/转移性鼻咽癌，可考虑的双免疫联合方案是什么？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::184", "item_id": "184", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，卡瑞利珠单抗联合阿帕替尼用于复发/转移性鼻咽癌需满足哪2项条件？（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::185", "item_id": "185", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 3, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出3项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，复发/转移性鼻咽癌三线及以上治疗中，既往未接受和已接受 PD-1/PD-L1 抑制剂的患者分别优先采用何种治疗？后者还应鼓励参与什么？（共3分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::186", "item_id": "186", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，关于帕博利珠单抗在复发转移性鼻咽癌二线及以上治疗中的应用，请写出以下2项内容：1. 推荐级别；2. 应用的前提条件。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::187", "item_id": "187", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 3, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出3项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，进入二线治疗的2个主要触发条件是什么？若一线免疫联合治疗后未进展，应转入哪一治疗阶段？（共3分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::188", "item_id": "188", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，写出鼻咽癌 MRI 定位（MR-sim）推荐的2项扫描参数数值：1. 层厚；2. 层间距。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::189", "item_id": "189", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 3, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出3项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，鼻咽癌调强放疗（IMRT）的计划验证应包括哪2项常规验证，并鼓励开展哪1项验证？（写出3项）（共3分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::190", "item_id": "190", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，对于鼻咽癌患者的咽后淋巴结高级别包膜外侵犯，一般不建议仅凭此特征将分期直接升级至哪个 N 分期级别？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::191", "item_id": "191", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 NCCN 2025，对需要同步全身治疗/放疗的鼻咽癌患者，请分别写出以下2项靶区的常规放疗剂量：1. 高危区；2. 低至中危亚临床扩散区。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::192", "item_id": "192", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 3, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出3项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，营养不良可对鼻咽癌放疗造成哪3项明确不良影响？（共3分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::193", "item_id": "193", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，关于鼻咽癌围放疗期营养管理原则，请分别写出以下2项核心要求：1. 适用的患者群体；2. 管理的时间跨度。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::194", "item_id": "194", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，哪种严重的鼻咽癌放疗晚期并发症可依据放疗疗程数和颈内动脉暴露情况进行临床风险分层？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::195", "item_id": "195", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 5, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出5项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 NCCN 2025，长期随访中，除监测 TSH 外，还应持续关注哪5项支持照护领域？（共5分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::196", "item_id": "196", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，对于不可手术的局部复发鼻咽癌，若评估为再程放疗低危组，针对局部复发灶通常如何处理？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::197", "item_id": "197", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，对于鼻咽坏死患者，临床风险分层模型可结合放疗疗程数和哪一解剖结构的暴露情况，用于预后判断和外科决策？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::198", "item_id": "198", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，对初治转移后获得控制、但局部复发合并远处转移的鼻咽癌患者，主要以哪种治疗手段为主？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::200", "item_id": "200", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，在鼻咽癌中，治疗前血浆 EBV DNA 联合 TNM 分期可进一步提高哪方面的效能？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::201", "item_id": "201", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025 指南注释，哪种新型血清学分子标志物（抗体）在鼻咽癌筛查中被提及表现优异？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::203", "item_id": "203", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 5, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出5项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，EBV DNA 标准化检测应使用哪种样本、哪种抗凝剂？实验室应划分哪3个工作区？（共5分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::204", "item_id": "204", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 4, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出4项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，复发/转移性鼻咽癌一线 GP 联合卡瑞利珠单抗治疗中，卡瑞利珠单抗的剂量和频次、联合化疗疗程数及后续维持策略分别是什么？（共4分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::205", "item_id": "205", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 4, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出4项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，复发/转移性鼻咽癌一线特瑞普利单抗联合 GP 治疗中，特瑞普利单抗的剂量和频次、联合化疗最大疗程数及后续治疗策略分别是什么？（共4分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::206", "item_id": "206", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 3, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出3项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，复发/转移性鼻咽癌一线 GP 联合替雷利珠单抗治疗中，替雷利珠单抗的剂量/频次、联合化疗疗程数及后续治疗策略分别是什么？（共3分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::207", "item_id": "207", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，顺铂或卡铂联合5-FU作为复发/转移性鼻咽癌（RM-NPC）一线2A类方案时，写出其推荐的2项疗程参数（单疗程天数、总疗程数）。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::208", "item_id": "208", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 3, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出3项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，紫杉醇（或紫杉醇白蛋白）+ 顺铂 + 卡培他滨作为鼻咽癌一线治疗方案，请写出该方案的3项具体特征：1. 一个疗程的周期天数；2. 化疗阶段后用于维持治疗的药物名称；3. 维持治疗的终止条件。（共3分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::209", "item_id": "209", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 5, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出5项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，卡铂联合紫杉醇作为复发/转移性鼻咽癌一线 2A类方案时，两药剂量、给药日、疗程周期及总疗程数分别是什么？（共5分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::210", "item_id": "210", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，顺铂联合多西他赛作为复发/转移性鼻咽癌（RM-NPC）一线2A类方案时，请写出关于治疗周期的2项具体参数：1）单疗程的天数；2）推荐的总疗程数。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::211", "item_id": "211", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，对于顺铂 + 吉西他滨 + 恩度这一 2B 类方案，请写出其周期特征的 2 项参数：1. 每疗程的天数；2. 最多进行的疗程数。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::212", "item_id": "212", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，关于帕博利珠单抗在鼻咽癌二线及以上治疗中的应用，请写出以下2项内容：1. 推荐类别；2. 附带的前提条件。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::213", "item_id": "213", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，局部晚期鼻咽癌诱导化疗中，GP 与 TPF 方案的典型给药频率和总疗程数分别是多少？请写出这2项指标。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::214", "item_id": "214", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025 表10，对 T3N0 且无高危不良预后因素的鼻咽癌患者，分别写出其对应的1A类推荐方案和2A类推荐方案（共2项）。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::215", "item_id": "215", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025 表10，对于 T1–2N1 且不具备淋巴结≥3 cm、Ⅳ/ⅤB区淋巴结转移、包膜外侵或 EBV DNA≥4,000 等任一高危因素的鼻咽癌患者，单纯放疗和同期放化疗分别属于哪一推荐类别？（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::216", "item_id": "216", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 3, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出3项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025 表10，对于 T1-4N2-3 和 T4N1 鼻咽癌，列出 3 项 1A类推荐的治疗方案。（共3分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::217", "item_id": "217", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025 表11，局部晚期鼻咽癌的诱导化疗方案中，被列为 1B 类推荐的双药联合方案包含哪两种具体药物？列出 2 项。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::218", "item_id": "218", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025 表11，列出局部晚期鼻咽癌辅助化疗中推荐层级为1A类的2项方案。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::219", "item_id": "219", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025 表17，非转移儿童鼻咽癌分层中，ⅣB期的推荐治疗方案及证据类别分别是什么？请写出这2项内容。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::220", "item_id": "220", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，儿童鼻咽癌诱导化疗推荐中，GP 方案的推荐等级是哪一类？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::221", "item_id": "221", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025 指南，写出儿童鼻咽癌 TPF 方案的 2 项给药参数：1. 给药周期；2. 总疗程数。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::222", "item_id": "222", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025 表19，儿童鼻咽癌 GP 诱导方案中，吉西他滨与顺铂的给药时间分别是什么？请分别写出这2项药物的给药时间（以dX格式表示）。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::223", "item_id": "223", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 4, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出4项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，儿童鼻咽癌同期 DDP 化疗的单周方案和三周方案中，推荐剂量及总疗程数分别是什么？（共4分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::224", "item_id": "224", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025 指南，儿童鼻咽癌诱导化疗后达到完全缓解（CR）时，PTVp/PTVn 的推荐放疗剂量是多少？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::225", "item_id": "225", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，鼻咽癌随访中 PET/CT 主要适用于哪2种情况或人群？请列出2项。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::226", "item_id": "226", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 3, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出3项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025 §3.3及表8，写出鼻咽原发灶 GTVp 外扩形成 PTVp 的3项参数：1. 边界外扩距离（mm）；2. 典型处方总剂量（cGy）；3. 分次数量（F）。（共3分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::227", "item_id": "227", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025 第3.3节/表8，针对颈部淋巴结 GTVn，请写出以下2项放疗参数：1. GTVn 外扩形成 PTVn 的边界（mm）；2. 典型处方剂量范围及分次（格式：XXXX-XXXX cGy/XX F）。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::228", "item_id": "228", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 3, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出3项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，CTVp1 的常规外扩距离、通常应包括的解剖结构及邻近重要危及器官时的最小外扩距离分别是什么？（共3分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::229", "item_id": "229", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，鼻腔受侵时，CTV2 应包括哪2个解剖区域？（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::230", "item_id": "230", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 3, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出3项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，写出 CTVn1 的外扩距离、诱导化疗后的勾画范围及 PTVn1 处方剂量。（共3分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::231", "item_id": "231", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025 表12，复发/转移性鼻咽癌一线治疗中，2A类口服氟尿嘧啶类药物联合铂类方案由哪2种药物组成？（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::233", "item_id": "233", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 3, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出3项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025 表12，复发/转移性鼻咽癌一线治疗中，2B类推荐方案包含哪3种药物？（共3分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::234", "item_id": "234", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 3, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出3项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025，复发/转移性鼻咽癌二线及以上免疫治疗中，卡瑞利珠单抗、特瑞普利单抗和纳武利尤单抗的推荐类别，帕博利珠单抗的推荐类别及其使用前提分别是什么？（共3分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::235", "item_id": "235", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 6, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出6项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025 表22及注释，鼻咽癌患者在治疗后4–5年及5年以上的长期随访中，仍建议关注哪6个方面？（共6分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::236", "item_id": "236", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 NCCN 2025，当总剂量超过 70 Gy 时，为降低毒性，至少部分疗程的单次剂量应低于多少？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::237", "item_id": "237", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 NCCN 2025 ADV-A/NASO-A 脚注，当鼻咽癌放疗剂量 >70 Gy 时，在某些临床情况下可额外增加多少次照射（boost）？（1 分；请用简短医学术语作答，无需解释。）"}
+{"request_id": "formal_vsaq_saq::238", "item_id": "238", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 NCCN 2025 ADV-A/NASO-A，在常规光子放疗无法满足正常组织限量或会影响标准肿瘤/术后靶体积剂量时，可考虑使用质子治疗。请列出这2种情况。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::239", "item_id": "239", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 4, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出4项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 NCCN 2025 ADV-A，既往放疗后拟行再放疗时，评估危及器官（OAR）可接受剂量需综合哪些4项主要依据？（共4分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::241", "item_id": "241", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025 §3.3 正常组织限量，腮腺的2项可替代剂量限制标准是什么？（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::242", "item_id": "242", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025 正常组织限量标准，分别写出甲状腺和臂丛的剂量限制；甲状腺的两个可替代限量中任写其一即可。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::243", "item_id": "243", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 NCCN 2025 NASO-B，鼻咽癌系统治疗开始前，指南脚注建议至少检测哪2项生物标志物？（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::244", "item_id": "244", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 NCCN 2025，对于诱导化疗后 M1 寡转移且 PS 0–1 的鼻咽癌患者，可在特定情况下使用的维持方案是什么？请写出维持药物及是否联合放疗。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::245", "item_id": "245", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 4, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出4项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 NCCN 2025 NASO-B 脚注，关于“顺铂 + 放疗（不接辅助化疗）”方案，请写出证据等级为 2B 类的 3 组具体 TNM 分期组合，以及其他适应分期的证据等级类别（共4项）。（共4分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::246", "item_id": "246", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 NCCN 2025，nivolumab and hyaluronidase-nvhy 可替代哪种纳武利尤单抗制剂？其剂量和给药方式是否相同？（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::248", "item_id": "248", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 NCCN 2025，对于广泛转移且体能状态差的鼻咽癌患者，PS 3 和 PS 4 的推荐治疗策略分别是什么？（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::249", "item_id": "249", "condition": "formal_vsaq_saq", "interface_type": "saq_component", "response_count": 2, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请严格给出2项答案；按题干要求的顺序编号，每项仅写必要结论，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 NCCN 2025 ADV-3/ADV-4，对“既往已放疗、局部区域复发/持续存在、且不可切除”的患者，写出指南推荐的2项干预原则：1. 首选（preferred）的干预路径；2. 再放疗±全身治疗仅适用的病例类型。（共2分，每项1分。）"}
+{"request_id": "formal_vsaq_saq::250", "item_id": "250", "condition": "formal_vsaq_saq", "interface_type": "vsaq_single_slot", "response_count": 1, "prompt": "请独立回答下列鼻咽癌指南知识题，不使用任何候选选项。\n请直接给出一个最短、规范的医学术语或短语，不要解释。\n只输出一个 JSON 对象，格式为 {\"answer\":\"...\"}，不得输出其他字段或正文。\n\n问题：根据 CSCO 2025 儿童注释，甲氨蝶呤和博来霉素目前较少用于儿童鼻咽癌诱导化疗的主要原因是什么？（1 分；请用简短医学术语作答，无需解释。）"}
diff --git a/supplementary/physician_calibration/README.md b/supplementary/physician_calibration/README.md
new file mode 100644
index 0000000000000000000000000000000000000000..87c354302c03b65066fcb672e43e871618505010
--- /dev/null
+++ b/supplementary/physician_calibration/README.md
@@ -0,0 +1,7 @@
+# Physician calibration
+
+Physicians annotated 1,017 criteria from 54 consultation responses generated by nine models on six cases. The released files contain physician and model-judge labels for reproducing the agreement analysis.
+
+`comparison_included` selects the 1,013 criteria with native judgments from all four compared judges. Four criteria lack a native Qwen3.6-27B judgment and are excluded from every judge comparison. The physician labels themselves remain available.
+
+`judge_labels.jsonl` provides the four sets of criterion judgments on this common panel. A true label means that the criterion holds, including the presence of an error for a negative criterion. Compute sensitivity and specificity with physician labels as the reference, and resample complete responses or cases for clustered intervals.
diff --git a/supplementary/physician_calibration/judge_labels.jsonl b/supplementary/physician_calibration/judge_labels.jsonl
new file mode 100644
index 0000000000000000000000000000000000000000..e5969031431b6e34a59f926ba53edd46c54b075b
--- /dev/null
+++ b/supplementary/physician_calibration/judge_labels.jsonl
@@ -0,0 +1,4052 @@
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-8b1c4e89668793d9bf3e3eb8::major_errors::0", "judge": "GPT-4.1", "criteria_met": false}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-8b1c4e89668793d9bf3e3eb8::major_errors::1", "judge": "GPT-4.1", "criteria_met": false}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-8b1c4e89668793d9bf3e3eb8::conditional_modifiers::2", "judge": "GPT-4.1", "criteria_met": true}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-8652d9f7bafcc85e75768212::core_answer::0", "judge": "GPT-4.1", "criteria_met": true}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-8b1c4e89668793d9bf3e3eb8::conditional_modifiers::3", "judge": "GPT-4.1", "criteria_met": false}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-8b1c4e89668793d9bf3e3eb8::conditional_modifiers::1", "judge": "GPT-4.1", "criteria_met": false}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-8652d9f7bafcc85e75768212::core_answer::1", "judge": "GPT-4.1", "criteria_met": true}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-8652d9f7bafcc85e75768212::minor_errors::2", "judge": "GPT-4.1", "criteria_met": false}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-8652d9f7bafcc85e75768212::major_errors::0", "judge": "GPT-4.1", "criteria_met": false}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-8b1c4e89668793d9bf3e3eb8::core_answer::3", "judge": "GPT-4.1", "criteria_met": true}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-8652d9f7bafcc85e75768212::minor_errors::0", "judge": "GPT-4.1", "criteria_met": false}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-8652d9f7bafcc85e75768212::major_errors::1", "judge": "GPT-4.1", "criteria_met": false}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-8652d9f7bafcc85e75768212::major_errors::2", "judge": "GPT-4.1", "criteria_met": false}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-8b1c4e89668793d9bf3e3eb8::core_answer::0", "judge": "GPT-4.1", "criteria_met": true}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-8652d9f7bafcc85e75768212::minor_errors::1", "judge": "GPT-4.1", "criteria_met": false}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-8b1c4e89668793d9bf3e3eb8::conditional_modifiers::0", "judge": "GPT-4.1", "criteria_met": true}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-8b1c4e89668793d9bf3e3eb8::major_errors::3", "judge": "GPT-4.1", "criteria_met": false}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-8652d9f7bafcc85e75768212::key_evidence::0", "judge": "GPT-4.1", "criteria_met": true}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-8b1c4e89668793d9bf3e3eb8::major_errors::2", "judge": "GPT-4.1", "criteria_met": false}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-8b1c4e89668793d9bf3e3eb8::key_evidence::1", "judge": "GPT-4.1", "criteria_met": true}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-8b1c4e89668793d9bf3e3eb8::key_evidence::0", "judge": "GPT-4.1", "criteria_met": true}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-8b1c4e89668793d9bf3e3eb8::key_evidence::3", "judge": "GPT-4.1", "criteria_met": true}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-8b1c4e89668793d9bf3e3eb8::minor_errors::0", "judge": "GPT-4.1", "criteria_met": false}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-8b1c4e89668793d9bf3e3eb8::minor_errors::2", "judge": "GPT-4.1", "criteria_met": false}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-8b1c4e89668793d9bf3e3eb8::minor_errors::1", "judge": "GPT-4.1", "criteria_met": false}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-8b1c4e89668793d9bf3e3eb8::core_answer::1", "judge": "GPT-4.1", "criteria_met": true}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-8b1c4e89668793d9bf3e3eb8::conditional_modifiers::4", "judge": "GPT-4.1", "criteria_met": true}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-8652d9f7bafcc85e75768212::key_evidence::1", "judge": "GPT-4.1", "criteria_met": true}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-8b1c4e89668793d9bf3e3eb8::core_answer::2", "judge": "GPT-4.1", "criteria_met": true}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-54ff793adae23ed110a85fb4::major_errors::3", "judge": "GPT-4.1", "criteria_met": false}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-54ff793adae23ed110a85fb4::core_answer::0", "judge": "GPT-4.1", "criteria_met": false}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-54ff793adae23ed110a85fb4::key_evidence::1", "judge": "GPT-4.1", "criteria_met": true}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-54ff793adae23ed110a85fb4::core_answer::1", "judge": "GPT-4.1", "criteria_met": false}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-54ff793adae23ed110a85fb4::conditional_modifiers::1", "judge": "GPT-4.1", "criteria_met": true}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-54ff793adae23ed110a85fb4::key_evidence::0", "judge": "GPT-4.1", "criteria_met": true}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-54ff793adae23ed110a85fb4::core_answer::2", "judge": "GPT-4.1", "criteria_met": true}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-54ff793adae23ed110a85fb4::key_evidence::2", "judge": "GPT-4.1", "criteria_met": true}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-54ff793adae23ed110a85fb4::conditional_modifiers::0", "judge": "GPT-4.1", "criteria_met": true}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-54ff793adae23ed110a85fb4::major_errors::1", "judge": "GPT-4.1", "criteria_met": false}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-54ff793adae23ed110a85fb4::major_errors::0", "judge": "GPT-4.1", "criteria_met": false}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-0d7517d83c6e589783859366::core_answer::2", "judge": "GPT-4.1", "criteria_met": true}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-54ff793adae23ed110a85fb4::major_errors::2", "judge": "GPT-4.1", "criteria_met": false}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-54ff793adae23ed110a85fb4::minor_errors::1", "judge": "GPT-4.1", "criteria_met": false}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-0d7517d83c6e589783859366::conditional_modifiers::0", "judge": "GPT-4.1", "criteria_met": true}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-0d7517d83c6e589783859366::key_evidence::2", "judge": "GPT-4.1", "criteria_met": true}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-0d7517d83c6e589783859366::key_evidence::3", "judge": "GPT-4.1", "criteria_met": true}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-0d7517d83c6e589783859366::core_answer::3", "judge": "GPT-4.1", "criteria_met": true}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-0d7517d83c6e589783859366::core_answer::0", "judge": "GPT-4.1", "criteria_met": true}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-0d7517d83c6e589783859366::key_evidence::4", "judge": "GPT-4.1", "criteria_met": true}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-54ff793adae23ed110a85fb4::minor_errors::3", "judge": "GPT-4.1", "criteria_met": false}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-0d7517d83c6e589783859366::core_answer::1", "judge": "GPT-4.1", "criteria_met": false}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-0d7517d83c6e589783859366::key_evidence::1", "judge": "GPT-4.1", "criteria_met": true}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-0d7517d83c6e589783859366::conditional_modifiers::1", "judge": "GPT-4.1", "criteria_met": true}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-0d7517d83c6e589783859366::conditional_modifiers::2", "judge": "GPT-4.1", "criteria_met": false}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-0d7517d83c6e589783859366::core_answer::4", "judge": "GPT-4.1", "criteria_met": true}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-54ff793adae23ed110a85fb4::minor_errors::0", "judge": "GPT-4.1", "criteria_met": false}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-0d7517d83c6e589783859366::conditional_modifiers::3", "judge": "GPT-4.1", "criteria_met": false}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-54ff793adae23ed110a85fb4::minor_errors::2", "judge": "GPT-4.1", "criteria_met": false}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-0d7517d83c6e589783859366::major_errors::0", "judge": "GPT-4.1", "criteria_met": false}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-0d7517d83c6e589783859366::major_errors::1", "judge": "GPT-4.1", "criteria_met": false}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-96abe3b20ccd214aeda1f3ac::core_answer::1", "judge": "GPT-4.1", "criteria_met": true}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-96abe3b20ccd214aeda1f3ac::core_answer::0", "judge": "GPT-4.1", "criteria_met": true}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-0d7517d83c6e589783859366::minor_errors::0", "judge": "GPT-4.1", "criteria_met": false}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-0d7517d83c6e589783859366::minor_errors::1", "judge": "GPT-4.1", "criteria_met": false}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-0d7517d83c6e589783859366::minor_errors::2", "judge": "GPT-4.1", "criteria_met": false}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-0d7517d83c6e589783859366::major_errors::2", "judge": "GPT-4.1", "criteria_met": false}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-96abe3b20ccd214aeda1f3ac::core_answer::2", "judge": "GPT-4.1", "criteria_met": true}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-96abe3b20ccd214aeda1f3ac::core_answer::3", "judge": "GPT-4.1", "criteria_met": true}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-96abe3b20ccd214aeda1f3ac::key_evidence::3", "judge": "GPT-4.1", "criteria_met": true}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-96abe3b20ccd214aeda1f3ac::key_evidence::0", "judge": "GPT-4.1", "criteria_met": true}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-96abe3b20ccd214aeda1f3ac::key_evidence::1", "judge": "GPT-4.1", "criteria_met": true}
+{"rubric_id": "Claude-Sonnet-4.6::o1-item-96abe3b20ccd214aeda1f3ac::key_evidence::4", "judge": "GPT-4.1", "criteria_met": true}
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diff --git a/supplementary/physician_calibration/labels.jsonl b/supplementary/physician_calibration/labels.jsonl
new file mode 100644
index 0000000000000000000000000000000000000000..9b3121b30a3e4f05f5e80386df386ecf81653a37
--- /dev/null
+++ b/supplementary/physician_calibration/labels.jsonl
@@ -0,0 +1,1017 @@
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